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Keeping America Fed: Food Security and Nutrition Post-COVID

October 20, 2020

Food security is a daily challenge for millions of Americans, but the COVID-19 pandemic has exacerbated a myriad of issues for those same people and the stakeholders who work with them. Keeping America Fed is a podcast miniseries through which we’ll look at those issues, and how they’re being addressed locally and at the state and federal level.

In the third and final episode of Keeping America Fed, Abt’s Maria Boyle talks to Lorrene Ritchie, director of the Nutrition Policy Institute, about the long-term impacts of COVID-19 on consumer practices, food security, and nutrition in the United States. Learn how we can seize this moment to expand school lunch programs, bolster food security for families, and use data and analysis to determine a better way forward beyond the coronavirus.

Don’t forget to check out the first two episodes:

  • COVID-19 and Local Food Security (episode 1)
  • COVID-19 and National Food Security (episode 2)

Read the Transcript:

Eric Tischler: Food security is a daily challenge for millions of Americans but the COVID-19 pandemic has exacerbated a myriad of issues for those same people and the stakeholders who work with them. Keeping America Fed has been looking at those issues and how they're being addressed locally at the state and federal levels. Today we’re talking with Lorrene Ritchie and Maria Boyle.

Lorrene is director of the Nutrition Policy Institute and is a cooperative extension nutrition specialist in the Division of Agriculture and Natural Resources at the University of California. She has devoted her 30 year career to synthesizing and conducting research to inform nutrition policy and programs.

Maria is a senior associate here at Abt. She has over 20 years of experience working on programs, policies, research studies, and evaluations related to nutrition, food security, and food assistance programs. Thank you both for joining me.

Lorrene Ritchie: Thank you for having me.

Maria Boyle: Thanks Eric. We're so excited to have Lorrene with us today.

Eric: Yes! And Lorrene do you want to tell us a little bit about NPI?

Lorrene: Sure. So the Nutrition Policy Institute is dedicated to understanding how to make food insecurity not a problem, to improve nutrition among populations, and to address the systemic and environmental impacts of our food system on what and how we eat. So if you think of health, it is really a form of wealth and, not unlike other forms of wealth, there's huge disparities. And what we see is epidemics of obesity, diabetes, heart disease, all of which are preventable, all of which are largely caused by what we eat. Those things are not equally distributed. Low income, populations of color face those challenges more than other populations. So the research we do at NPI is to try to figure out how we can improve the federal nutrition programs because they reach the most children and low-income populations. How  can nudge the food system and environment to influence what we eat and drink, and how we can better understand what impacts those different programs and interventions have on populations.

Eric: So, Lorrene, we've seen during COVID—and Maria and I have talked to our previous guests about this—how different programs have made adjustments to help continue serving people. What do you think about the viability of continuing those adjustments into the future, even beyond COVID? Is this an opportunity for us to maybe make some gains in the issues you were just describing?

Lorrene: I think we're going to have to evaluate that. So we're going to lean on folks like you at Abt to help us figure out how to collect that data and interpret the findings. But what we're seeing, for example, and I'll just focus on children because that's the area that we target in on at NPI because, by the time you're two or three, these things aren’t immutable but your dietary patterns are pretty much set. So if you aren't focusing on the youngest kids then you're changing bad habits instead of establishing good ones. But in terms of children and what we're seeing, I'm going to talk about WIC, the supplemental nutrition program for women, infants and children and the school meals program.

So you probably know that nearly every school in the nation has a school lunch program that is federally subsidized, about half of schools also have a school breakfast program. These meals in pre-COVID, anybody could purchase them, but they were free or reduced price to low-income kids. And those were the kids that mostly consumed those meals. During COVID, what we've seen is that schools have been granted waivers so that they can allow anyone to have the school meals, whether they were free, reduced price, or paid students. And in other studies that we've done looking at what we call universal meals, we see that has a huge benefit to all children. So it would be one thing if most American children ate a healthy diet, but they don't. And every single study that's been shown to compare school meals versus what kids tend to bring from home have shown the school meals to be far superior.

So I think we have a huge opportunity to learn from the provision of school meals, the central role that school meals play in children's lives to understand how perhaps universal free school meals could be a way to increase the nutritional quality for children and reduce food insecurity across the board. When children go to school, they don't pay for their books, they don't pay for their pencils, or their equipment. We don't make some kids pay and others get it free.

Maria: So Lorrene, what do you think are some of the lessons learned that we could sort of pull out from these changes that are happening during COVID with the school meals? What are things that we, as researchers and as evaluators, would want to take into consideration? Because I think we know, you've probably seen these statistics too, that the school meal participation in the spring, when people went to completely remote actually decreased quite a bit. The number of school meals that were being served went down quite a bit compared to the same time as in previous years. So what lessons learned can we sort of glean from what's happening now that we could put into place once we're past the pandemic?

Lorrene: The likely explanation for the decrease in participation is because, as people weren't coming to the schools, then they would have to actually go out of their way when they weren't bringing their kids to the school to pick up those meals. So some lessons learned: convenience.

You guys probably know that the percentage of families that have dual parents working or single parents working has increased dramatically since when we started these school meal programs. There's no longer typically an adult at home who can pack a lunch or be there for kids just to come and eat lunch. Those days are gone and they're probably not coming back. So convenience is huge. So I think there's opportunities for us to understand how to meet families where they are, how to make those school meals convenient, how to promote them as nutritious. So I think there's opportunities to understand how to promote them to parents, how to demonstrate their convenience, how to demonstrate the cost effectiveness of it. And then also how to demonstrate the impacts on child nutrition when everyone has access to them.

Maria: Yeah, that's great. And we've done a lot of studies at Abt where we've looked at kind of the costs associated with providing school lunches, school breakfast, the food costs, the labor costs. And I'm wondering ... that is one thing that I've been thinking about quite a bit is where all these meals are now being offered to free for everybody, what is the cost structure—look at that—and how can we begin to document that and say, "Here is what the cost picture looks like when all the meals are being offered to the children for free." Because I think what often does make a good argument for making any kind of policy changes to programs is that cost piece.

Lorrene: Absolutely, cost is essential. More Americans are sick right now than they are healthy. Half of adults have diabetes or pre-diabetes, more than half of adults have cardiovascular disease. Over 2000 deaths each day are from these preventable illnesses now. So the numbers are staggering.

Maria: And I think that makes people also at higher risk for complications from COVID, as well. Sort of all those chronic disease, obesity pieces, as well as the food insecurity that's tied into what's happening. It all kind of comes together and makes for even greater problems if someone does get the coronavirus.

Lorrene: Everything we're trying to accomplish depends on a healthy workforce and, right now, we don't have it. So yes, I think the school meals are going to, if we provided them free to everybody, it's going to be at a cost, but the cost savings are huge. The cost to businesses for all these preventable diseases has been estimated to be around $100 billion a that year. So it's a little bit hard to make those connections between investing in those school meals and the savings we get at the other end. But I think doing more of those modeling studies such as Harvard is doing with choices to be able to demonstrate to decision-makers that yep, you can make an investment now and it's going to pay off in the end. I think that would also be a really great thing if Abt could do that.

Eric: Well, Maria, you've talked about the cost of food going up. If kids are getting free meals, what does that do for a local economy if parents aren't having to buy that food, for example?

Maria: Right. And I think that's something we've been thinking about, too, and I know that, in the beginning of the pandemic, in the spring, we did see that a lot of the food prices initially went up. And I think having ways that families can continue to get food and get free meals, that'll really help with what they're able to spend their money on. And I don't know if you've seen this Lorrene in any of your work, but I do feel like those prices initially went up in the pandemic and may have stabilized now at this point for parents. But I think that's something that we all still need to be looking at given all the other issues that many families are facing during the pandemic, including food insecurity, if the prices of foods have now increased as well, that makes the access to the free foods, to free meals through schools, through childcare, just so much more important.

Lorrene: Absolutely. And it's interesting what we, hear for example, from WIC participants. This is a program that's designed to help women during pregnancy, postpartum and then young children, and we often ask WIC participants in different surveys. We've asked them questions like “What are barriers for you for eating more fruits and vegetables?” So they get $9 to $11 per month for fruits and vegetables. And $9 for a kid is maybe a quarter of what the recommended amount is.

So it is a supplemental program, but we've asked parents about this and resoundingly they say, "No, it's not the taste of fruits and vegetables that's the barrier. It's not that I that they're perishable or that I have to cook them or prepare them. Those, I can deal with all that. What it is, is the cost." And the cost is high in the grocery store, but it's also a cost in terms of the perishability. It's not like I buy preserved, processed food that can sit in my shelf for many, many months. What we clearly hear from the WIC participants is that they want more of their WIC benefit for fruits and vegetables. So that tells me that we have a lot of things to investigate. What if we switched some of the WIC food package to fruits and vegetables, augmented that, would that result in more satisfaction with the program, more people coming to WIC and dietary impacts in terms of kids and mothers eating healthier fruits and vegetables?

So I think those are also things Abt could help with evaluating, I would call them nudges or tweaks to programs. The programs are clear, they haven't established impact, we know they work, but what can we do to make them just a little bit better to make the dietary impacts a little bit stronger and to make the program work a little bit better for participants?

Maria: No, I think that's great. And we have done a lot of that work in the past so it would make a lot of sense for us to continue to do that work. And I know that right now you're kind of asking questions of WIC participants around what's happening for them in the pandemic. We'd be curious to hear how have things changed for WIC families during the pandemic in terms of foods and food availability and what have been some of the challenges that they've faced.

Lorrene: So their number one concern is employment, but they also face some additional barriers that we haven't quite figured out. So some of them, for example, have complained that, yes, they had a really hard time finding WIC foods at the beginning of the pandemic. So the WIC food package includes staples like milk, and eggs, and peanut butter, and grains, in addition to fruits and vegetables. They weren't having so much trouble finding the fruits and vegetables, but you'll remember at the beginning of the pandemic, some of those staples were off the shelves.

Maria: Like the milk and the eggs were really tough.

Lorrene: And even some of the other brands that they were looking for, which tend to be the cheaper brands, people were buying those in bulk. And then the WIC participants who have to buy specific types of brands weren't able to find them.

But even after that initial emergency happened, transportation is an issue for a lot of WIC participants. They may be relying on friends or family to drive them to the grocery store. They may be taking public transportation. A lot of those options went away during COVID and there's still a lot of concerns about using public transportation or getting in the car with other people that aren't in their bubble or in their family.

Maria: I did also want to ask, Lorrene I know you've done a lot of work and a lot of research in the childcare arena and the child and adult care food program. We at Abt are just finishing our study on nutrition and activity in childcare where we've looked at family daycare homes, childcare centers, headstart programs, and the foods and beverages that are being offered in those programs as well as opportunities for wellness and physical activity. And I think one thing that is, when we think about sort of parents as consumers and how they've relied so much on foods and beverages and childcare, too, as they've been working and to help address food security, what does this pandemic mean for those parents that can't get childcare or who have relied on those meals so much?

Lorrene: Yep. It's just another stab in the back isn't it Maria?

Maria: Yes.

Lorrene: Because they're losing their jobs or their wages are cut because they're furloughed. It's harder to get school food, it's harder to get childcare meals because your kid's not going to childcare. It's no wonder that we're seeing food insecurity rates rapidly increase. One of the things about the child and adult care food program that I think would be wonderful if Abt could help us understand better is how to get more childcare centers and homes on the program. It's kind of one of those it's a fabulous program and it's kind of a secret. It's not a well-known program.

Maria: Exactly.

Lorrene: I'm sure if parents knew that if a center home participates in CCFP, their kids will get better nutrition, then they would ask for that and look for it when they were looking for childcare. We've looked at nutrition standards across different states, they're not consistent. So that's a huge area for more research, I think. And like you said, as more and more children are in childcare, it's going to be more and more important to, like we have done with schools and we have nutrition standards for the meals and snacks served there, we need consistent standards for the meals and snacks served in childcare.

Maria: I'm also thinking about during the pandemic that these family daycare homes, not only are the families who get childcare from those homes impacted, but those family daycare homes then have lost all this income from not being able to provide childcare anymore because parents aren't sending their children to childcare. And I just think there's kind of some food and nutrition, food and security nutrition issues as well for those family daycare home owners or the folks that run the family daycare homes as well.

Lorrene: Yep. Family daycare home providers, it's a wonderful business. We are thankful and indebted, they're really heroes, but it's not a very lucrative business.

Maria: That's right. The pandemic has impacted that group too, in terms of their nutrition and food insecurity.

Eric: We just did a study, the Early Learning Study at Harvard, where we measured some of those impacts more broadly, [but] not on a nutrition level.

Maria: Right, yeah.

Lorrene: Family childcare especially, it's a tough, tough job. It's hard to find time for training. In California, you have to become a childcare provider. You now have to have one hour of nutrition training, but before, a couple of years ago, you didn't have to have any nutrition training. So we are kind of putting providers in a tough position of saying, "You need to do all this feeding healthy foods and figuring this out," but we don't provide very much support for them to figure out how to do that. So I think that's another area for research. How can we create programs where it makes it easier for the family childcare providers to do the right thing?

Eric: This is the last episode of our miniseries. And I think it's great that we're leaving with so much to do. So much on our plates, so much we could look at.

Maria: I like the so much on our plates metaphor, that's good.

Eric: I'm a writer by trade so, you know ... Lorrene, thank you so much for joining us.

Lorrene: Thank you for having me. It's been a pleasure. I know you just said it's the last one, which I hadn't known, but I think it's important that we do more of these things. COVID has given us an opportunity to really see in a short time span, how important health is. Like you said, the folks that are most often succumbing to COVID are the same folks that have all these preexisting conditions that are preventable.

Maria: That's right, yeah.

Lorrene: So it really shines a light on how much work there needs to be done and how much research needs to be done to figure out how to make healthy eating easier for people.

Maria: Maybe we can do this more often Eric huh?

Eric: This is the end of season one! I think that's a good note to go out on. So thank you again, and thank you to everyone out there listening.

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