[House Hearing, 114 Congress]
[From the U.S. Government Publishing Office]
HEARING TO REVIEW INCENTIVE PROGRAMS AIMED AT INCREASING LOW-INCOME
FAMILIES' PURCHASING POWER FOR FRUITS AND VEGETABLES
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON NUTRITION
OF THE
COMMITTEE ON AGRICULTURE
HOUSE OF REPRESENTATIVES
ONE HUNDRED FOURTEENTH CONGRESS
SECOND SESSION
__________
FEBRUARY 3, 2016
__________
Serial No. 114-39
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Printed for the use of the Committee on Agriculture
agriculture.house.gov
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COMMITTEE ON AGRICULTURE
K. MICHAEL CONAWAY, Texas, Chairman
RANDY NEUGEBAUER, Texas, COLLIN C. PETERSON, Minnesota,
Vice Chairman Ranking Minority Member
BOB GOODLATTE, Virginia DAVID SCOTT, Georgia
FRANK D. LUCAS, Oklahoma JIM COSTA, California
STEVE KING, Iowa TIMOTHY J. WALZ, Minnesota
MIKE ROGERS, Alabama MARCIA L. FUDGE, Ohio
GLENN THOMPSON, Pennsylvania JAMES P. McGOVERN, Massachusetts
BOB GIBBS, Ohio SUZAN K. DelBENE, Washington
AUSTIN SCOTT, Georgia FILEMON VELA, Texas
ERIC A. ``RICK'' CRAWFORD, Arkansas MICHELLE LUJAN GRISHAM, New Mexico
SCOTT DesJARLAIS, Tennessee ANN M. KUSTER, New Hampshire
CHRISTOPHER P. GIBSON, New York RICHARD M. NOLAN, Minnesota
VICKY HARTZLER, Missouri CHERI BUSTOS, Illinois
DAN BENISHEK, Michigan SEAN PATRICK MALONEY, New York
JEFF DENHAM, California ANN KIRKPATRICK, Arizona
DOUG LaMALFA, California PETE AGUILAR, California
RODNEY DAVIS, Illinois STACEY E. PLASKETT, Virgin Islands
TED S. YOHO, Florida ALMA S. ADAMS, North Carolina
JACKIE WALORSKI, Indiana GWEN GRAHAM, Florida
RICK W. ALLEN, Georgia BRAD ASHFORD, Nebraska
MIKE BOST, Illinois
DAVID ROUZER, North Carolina
RALPH LEE ABRAHAM, Louisiana
JOHN R. MOOLENAAR, Michigan
DAN NEWHOUSE, Washington
TRENT KELLY, Mississippi
______
Scott C. Graves, Staff Director
Robert L. Larew, Minority Staff Director
______
Subcommittee on Nutrition
JACKIE WALORSKI, Indiana, Chairwoman
RANDY NEUGEBAUER, Texas JAMES P. McGOVERN, Massachusetts,
GLENN THOMPSON, Pennsylvania Ranking Minority Member
BOB GIBBS, Ohio MARCIA L. FUDGE, Ohio
ERIC A. ``RICK'' CRAWFORD, Arkansas ALMA S. ADAMS, North Carolina
VICKY HARTZLER, Missouri MICHELLE LUJAN GRISHAM, New Mexico
DAN BENISHEK, Michigan PETE AGUILAR, California
RODNEY DAVIS, Illinois STACEY E. PLASKETT, Virgin Islands
TED S. YOHO, Florida BRAD ASHFORD, Nebraska
DAVID ROUZER, North Carolina SUZAN K. DelBENE, Washington
RALPH LEE ABRAHAM, Louisiana
JOHN R. MOOLENAAR, Michigan
(ii)
C O N T E N T S
----------
Page
McGovern, Hon. James P., a Representative in Congress from
Massachusetts, opening statement............................... 3
Walorski, Hon. Jackie, a Representative in Congress from Indiana,
opening statement.............................................. 1
Prepared statement........................................... 2
Witnesses
Hesterman, Ph.D., Oran B., President and Chief Executive Officer,
Fair Food Network, Ann Arbor, MI............................... 5
Prepared statement........................................... 6
Wright, Ph.D., Ashton Potter, Local Food Coordinator, Bluegrass
Farm to Table, Office of the Mayor, City of Lexington,
Lexington, KY.................................................. 24
Prepared statement........................................... 25
Kiley, Kathleen L., Crossroads Farmers' Market shopper and
current SNAP and WIC recipient, Washington, D.C................ 28
Prepared statement........................................... 30
Cooper, Eric S., President and Chief Executive Officer, San
Antonio Food Bank, San Antonio, TX............................. 31
Prepared statement........................................... 32
Submitted questions.......................................... 109
Petee, Barbara J., Executive Director, The Root Cause Coalition;
Chief Advocacy and Government Relations Officer, ProMedica,
Washington, D.C................................................ 39
Prepared statement........................................... 41
Submitted Material
Hatcher, Jennifer, Senior Vice President, Government and Public
Affairs, Food Marketing Institute, submitted letter............ 63
Hunt, Ph.D., Alan R., Director of Policy and Research, Wholesome
Wave, submitted letter......................................... 74
Hurd, Hon. Will, a Representative in Congress from Texas,
submitted statement............................................ 63
HEARING TO REVIEW INCENTIVE PROGRAMS AIMED AT INCREASING LOW-INCOME
FAMILIES' PURCHASING POWER FOR FRUITS AND VEGETABLES
----------
WEDNESDAY, FEBRUARY 3, 2016
House of Representatives,
Subcommittee on Nutrition,
Committee on Agriculture,
Washington, D.C.
The Subcommittee met, pursuant to call, at 10:01 a.m., in
Room 1300 of the Longworth House Office Building, Hon. Jackie
Walorski [Chairwoman of the Subcommittee] presiding.
Members present: Representatives Walorski, Thompson,
Crawford, Hartzler, Benishek, Davis, Abraham, Moolenaar,
McGovern, Adams, Lujan Grisham, Aguilar, Plaskett, Ashford, and
DelBene.
Staff present: Caleb Crosswhite, Mollie Wilken, Stephanie
Addison, Faisal Siddiqui, John Konya, Lisa Shelton, Liz
Friedlander, Nicole Scott, and Carly Reedholm.
OPENING STATEMENT OF HON. JACKIE WALORSKI, A REPRESENTATIVE IN
CONGRESS FROM INDIANA
The Chairwoman. Welcome to today's Subcommittee on
Nutrition hearing to review incentive programs aimed at
increasing low-income families' purchasing power of fruits and
vegetables. And I want to just say to our Members that are
here, if you have any trouble with these new iPads, there are
IT people around. They are going to be watching. If you have
some trouble, just catch their eyes.
Good morning. Welcome to today's Nutrition Subcommittee
hearing. Thank you to everyone for taking the time to be here,
and I want to thank in particular our witnesses for their
participation and valuable insight. It is easy to think of
malnutrition only in terms of a quantity of food intake, is
someone eating enough? But there is another crucial element
that we can't overlook when discussing malnutrition, and that
is the nutrition itself. What is the quality of what they are
eating? This is an especially important question as America is
in the midst of an obesity epidemic. According to the Centers
for Disease Control, 69 percent of adults, and almost 32
percent of children and adolescents, are overweight or obese.
This puts them at an increased risk of a range of major
diseases, including diabetes, heart disease, and certain types
of cancer. These diseases, in turn, cut people's quality of
life and life expectancy, and increase health care costs at an
alarming rate. Government programs like SNAP, or the Women,
Infants, and Children, or WIC Program, aren't going to end the
obesity epidemic alone, nor will getting rid of junk food. It
requires proper nutrition and exercise, which, at the end of
the day, is a much larger discussion. What we are here to do
today is to ask, how can we incentivize and encourage people,
particularly low-income families, who are at a higher risk of
malnutrition, to eat healthier. Are current efforts working,
and what are the characteristics of successful programs?
The effort to incentivize more nutritious purchases by low-
income families began organically, typically involving private-
sector donations or local funding. It also has required a
collaboration within the community itself, including local
nonprofits and local governments. The 2008 Farm Bill authorized
a $20 million pilot project called the Healthy Initiatives
Pilot, or HIP. The goal of HIP was to determine if incentives
given to SNAP recipients at the point of sale would boost the
purchase of fruits and vegetables and other nutritious foods.
Hampden County, Massachusetts was selected for the pilot. The
pilot ran for 14 months, from November 2011 until December
2012, and credited back 30 for every SNAP dollar spent on
targeted fruits and vegetables to a randomly selected pool of
recipients. The incentive was able to be spent on any food. The
results were encouraging: \2/3\ of HIP households said they
bought a larger amount, and greater variety, of fruits and
vegetables, and \3/4\ said they felt that fruits and vegetables
had become more affordable because of HIP. Building on this,
the 2014 Farm Bill established the Food Insecurity Nutrition
Incentive, or FINI, a $100 million grant program to fund
projects across the country to further test incentive
strategies to encourage healthier eating among SNAP recipients.
Several of our witnesses here today have received the FINI
grants.
Before I close, I once again want to reiterate a theme I
alluded to earlier. No one program can end hunger, poverty, or
obesity. It takes collaboration within communities, and a 360
approach, to address these issues. As policymakers, we must
ensure that Federal programs we oversee compliment, instead of
conflict with, other Federal, state, and private-sector
programs and initiatives to best serve Americans. Today we will
hear from witnesses who can speak firsthand of successes,
challenges, and different strategies in encouraging healthier
food choices. I thank each of you again for being here, and
lending your expertise, and I look forward to hearing from you.
[The prepared statement of Mrs. Walorski follows:]
Prepared Statement of Hon. Jackie Walorski, a Representative in
Congress from Indiana
Good morning, and welcome to today's Nutrition Subcommittee
hearing. Thank you to everyone for taking the time to be here and I
want to thank, in particular, our witnesses for their participation and
valuable insights.
It's easy to think of malnutrition only in terms of the quantity of
food intake: Is someone eating enough? But there's another crucial
element that we can't overlook when discussing malnutrition, and that's
the nutrition itself: What is the quality of what they're eating?
This is an especially important question as America is in the midst
of an obesity epidemic. According to the Centers for Disease Control,
69% of adults and almost 32% of children and adolescents are overweight
or obese. This puts them at an increased risk of a range of major
diseases, including diabetes, heart disease, and certain types of
cancer. These diseases in turn cut peoples' quality of life and life
expectancy and increase healthcare costs at an alarming rate.
Government programs like SNAP, or the Woman, Infants, and Children,
or WIC, aren't going to end the obesity epidemic alone. Nor will
getting rid of junk food. It requires proper nutrition and exercise,
which at the end of the day is a much larger discussion. What we are
here to do today is to ask, how can we incentivize and encourage
people, particularly low-income families who are at a higher risk of
malnutrition, to eat healthier? Are current efforts working? And what
are the characteristics of successful programs?
The effort to incentivize more nutritious purchases by low-income
families began organically, typically involving private-sector
donations or local funding. It has also required collaboration within
the community, including local nonprofits and local governments.
The 2008 Farm Bill authorized a $20 million pilot project called
the Healthy Incentives Pilot, or HIP. The goal of HIP was to determine
if incentives given to SNAP recipients at the point of sale would boost
the purchase of fruits, vegetables, and other nutritious foods. Hampden
County, Massachusetts was selected for the pilot. The pilot ran for 14
months, from November 2011 until December 2012, and credited back 30
for every SNAP dollar spent on targeted fruits and vegetables to a
randomly-selected pool of recipients. The incentive was able to be
spent on any food. The results were encouraging: \2/3\ of HIP
households said they bought a larger amount and greater variety of
fruits and vegetables and \3/4\ said they felt that fruits and
vegetables had become more affordable because of HIP.
Building on this, the 2014 Farm Bill established the Food
Insecurity Nutrition Incentive, or FINI, a $100 million grant program
to fund projects across the country to further test incentive
strategies to encourage healthier eating among SNAP recipients. Several
of our witnesses today have received FINI grants.
Before I close, I once again want to reiterate a theme I alluded to
earlier: no one program can end hunger, poverty, or obesity. It takes
collaboration within communities and a 360 approach to address these
issues. As policy makers we must ensure that Federal programs we
oversee complement, instead of conflict with, other Federal, state, and
private-sector programs and initiatives to best serve Americans.
Today we'll hear from witnesses who can speak first-hand of
successes, challenges, and different strategies in encouraging
healthier food choices. I thank each of you again for being here and
lending your expertise and I look forward to hearing from you.
The Chairwoman. I would now like to recognize Ranking
Member McGovern for his opening statement.
OPENING STATEMENT OF HON. JAMES P. McGOVERN, A REPRESENTATIVE
IN CONGRESS FROM MASSACHUSETTS
Mr. McGovern. Well, thank you, Chairwoman Walorski, for
holding today's hearing, and I want to thank all the witnesses
for being here. I am happy to see a familiar face in Barb Petee
from The Root Cause Coalition. I look forward to hearing
everybody's testimony.
Incentives for maximizing Federal nutrition programs is a
relatively new area of policy, and one that I think holds a lot
of promise. Through programs like SNAP EBT at farmers' markets,
the Seniors' Farmers' Market Nutrition Program, and the WIC
Farmers' Market Nutrition Program, we can get more bang for our
buck with our Federal nutrition dollars. And there are a number
of creative initiatives happening all over this country that
are worth focusing on.
I am impressed with the growing body of research that is
looking at hunger as a health issue, and food as medicine. When
I was growing up, my grandmother always used to say an apple a
day keeps the doctor away. I wish she was still alive to tell
her she was right. But we know that hunger can exacerbate
underlying medical conditions like diabetes, heart disease, and
cancer, and can result in life threatening complications. Not
only that, hunger can result in more trips to the emergency
room, and more hospitalizations, which only increase health
care costs all across the board. But hunger can also be one of
the most treatable health conditions. We have the resources,
and we know the solution. We just need to connect the dots,
which is where these incentive programs come in.
I have had the pleasure of working with Gus Schumacher, who
served, first in the Clinton Administration, and then in a
variety of capacities, and currently at Wholesome Wave. I have
seen firsthand the way his organization has been able to
leverage Federal dollars to double, and even triple, fresh
fruit and vegetable purchases at farmers' markets for seniors
and low-income families. It is really impressive. And we ought
to be thinking about how we can expand these incentive programs
even more.
During our Subcommittee hearing a few weeks ago, we heard
about the growing problem of hunger among veterans and military
families. Why not create a Veterans' Farmers' Market Nutrition
Program? Veterans could get vouchers at their local VA clinics
to purchase fresh fruits and vegetables. And, in addition, why
not encourage VA clinics to hold farmers' markets at their
facilities? These kinds of incentives programs are not only
good for consumers, but they are good for the farmers who grow
the food. They are economic drivers in the local economy, and
have a positive multiplier effect. We heard that firsthand from
farmers in yesterday's Biotechnology, Horticulture, and
Research Subcommittee hearing. And there is also good data
emerging showing that incentive programs can lead to real
savings in the long run, in terms of improved health outcomes,
higher educational attainment, and increased productivity in
the workforce. Nutrition incentive programs are a sound
investment, and I look forward to today's conversation, and
again thank you all for being here.
The Chairwoman. Thank you, Mr. McGovern. The chair would
request that other Members submit their opening statements for
the record so the witnesses may begin testimony, and to ensure
there is ample time for questions. The chair would also like to
notify Members that they will be recognized for questioning in
order of seniority for Members who were here at the start of
the hearing. After that, Members will be recognized in order of
arrival. I appreciate Members' understanding.
Witnesses are reminded to limit their oral statements to 5
minutes, and there is a countdown clock in front of you. All of
the written statements will be included in the record. So I
would now like to welcome our witnesses to the table. Dr. Oran
Hesterman, CEO, Fair Food Network, Ann Arbor, Michigan. Dr.
Ashton Potter Wright, Bluegrass Farm to Table, Office of the
Mayor, Lexington, Kentucky. Kathleen Kiley, Crossroads Farmers'
Market shopper, and current SNAP recipient, Washington, D.C.
Eric Cooper, President and CEO, San Antonio Food Bank, San
Antonio, Texas. And Barbara Petee, Executive Director, The Root
Cause Coalition, Washington, D.C.
Dr. Hesterman, please begin with your testimony when you
are ready.
STATEMENT OF ORAN B. HESTERMAN, Ph.D., PRESIDENT AND CHIEF
EXECUTIVE OFFICER, FAIR FOOD NETWORK, ANN ARBOR, MI
Dr. Hesterman. Thank you, Chairwoman Walorski, Ranking
Member McGovern, and distinguished Members of the Subcommittee,
including my Michigan representatives, Mr. Benishek and Mr.
Moolenaar. Good morning. Thank you for holding today's hearing.
Fair Food Network's signature program is Double Up Food
Bucks. Our experience shows that matching SNAP benefits with
incentives for locally grown produce is a cost-effective way to
reduce hunger, improve dietary health, and stimulate local
economies that create jobs. There are three main points that I
would like to leave you with today. First, health food
incentives work. Second, the Food Insecurity Nutrition
Incentives grant program, or FINI, that Congress created in the
2014 Farm Bill is supporting excellent work nationwide. And
third, such results warrant supporting and expanding this
public-private partnership.
I founded Fair Food Network in 2009, at a time when 17
percent of Michiganders were receiving SNAP. Knowing that I was
in a state with a strong agriculture sector, it made sense to
try a SNAP incentive program modeled after one that I had seen
in Maryland a few years before, and you are going to hear a
little bit more about that program in a minute. The design is
simple. For every dollar of SNAP a customer spends on locally
grown produce, they get an additional dollar to spend on more
fruits and vegetables. We piloted Double Up Food Bucks at five
farmers' markets that first year. Last year, Double Up operated
in more than 140 farmers' markets and 22 groceries stores
throughout the state.
So how do we know it works? In 2007, prior to the start of
Double Up Food Bucks, total annual SNAP sales at farmers'
markets throughout the State of Michigan was $15,000. In 2015,
shoppers spent more than $1.5 million in SNAP and Double Up at
participating farmers' markets, an additional $200,000 at
grocery stores. These are dollars dedicated to helping families
bring home more fruits and vegetables. Our evaluation shows
that 85 percent of customers say they are eating more produce
because of the program, and 60 percent are eating less junk
food. Partnerships are crucial to the program's success. We
work closely with Michigan SNAP education efforts and
organizations. You can learn more about our experience in
Michigan in documents that we included in the appendix of our
testimony.
But this is not just a Michigan success story. We conducted
an evaluation with three other organizations, analyzing 500
farmers' markets in 24 states, and found that, regardless of
the setting, urban or rural, large or small, incentives work.
Congress responded, and created the Food Insecurity Nutrition
Incentive Program. USDA's National Institute of Food and
Agriculture is implementing this $100 million competitive
grants program. We were honored to receive a grant in the first
round of funding, which we matched with over $5 million of
additional private funding. This multi-year investment has been
a game changer for us, and a huge opportunity for the field. It
is allowing us to expand Double Up to many more sites, to
extend the program to year-round, and develop new payment
transaction technologies that ensure SNAP program integrity,
and reduce administrative costs. New partners in many states
are working with Fair Food Network to bring Double Up to their
communities. As we look ahead toward the next farm bill, there
are two opportunities we should be considering. First, we need
to develop additional payment technologies for different retail
settings, and second, communications is absolutely vital to the
success of incentive programs. When people use Double Up, they
are hooked. But if they don't know about it, they are not able
to benefit from the incentives.
In conclusion, we know there is no single silver bullet,
but our experience, and that of our colleagues nationwide,
demonstrates the power of healthy food incentives. They work.
By partnering across disciplines, we can integrate healthy
local produce into an existing Federal nutrition program, and
create benefits on multiple fronts simultaneously. Every
Federal dollar spent has an immediate return on investment, in
terms of reducing hunger, increasing produce consumption, and
boosting farm income. FINI is making a difference. It is
supporting workable models that are enhancing the value of SNAP
and creating connections between rural and urban communities.
We have an opportunity now to prepare for and support further
development and expansion of this public-private partnership.
Many of you have SNAP incentive programs in your districts, and
I encourage you to visit them and learn more. Thank you again
for this opportunity to share our experience.
[The prepared statement of Dr. Hesterman follows:]
Prepared Statement of Oran B. Hesterman, Ph.D., President and Chief
Executive Officer, Fair Food Network, Ann Arbor, MI
Introduction
Chairwoman Walorski, Ranking Member McGovern, and distinguished
Members of the Subcommittee--good morning. Thank you for holding
today's hearing regarding incentive programs aimed at increasing the
purchase of fruits and vegetables by low-income families and for
inviting Fair Food Network to speak.
My name is Oran Hesterman. I am the President and CEO of Fair Food
Network, a national nonprofit founded on the belief that vibrant local
food systems can create health and economic opportunity for all. It is
an honor to address you today and share information about our 7 years
of experience implementing the Double Up Food Bucks healthy food
incentive program.
I know the Committee has been engaged over the past year in a
review of the various nutrition programs that fall under your
jurisdiction. I understand your goal is to find ways to ensure that no
American goes hungry while also helping families who are facing hard
financial times to move out of poverty. You have heard from many
experts and understand the cost of hunger and the toll that diet-
related health conditions take on individuals and the lost economic
productivity it represents.
The Multiple Wins of Healthy Food Incentives
Our experience implementing healthy food incentives has shown that
matching SNAP benefits with incentives for locally and regionally grown
fruits and vegetables is a cost-effective way to simultaneously reduce
hunger, improve dietary health, and stimulate local food economies in a
way that can create new job opportunities. Through this one
intervention, we can meet immediate caloric needs and build a healthy
population.
There are three main points that I would like to leave you with
today:
Adding healthy food incentives to SNAP benefits works and is
generating wins for families, farmers, and local economies.
The Food Insecurity Nutrition Incentive (FINI) grants
program Congress created in the 2014 Farm Bill is supporting
excellent projects nationwide, scaling up programs that work,
testing and evaluating new approaches and technologies, and
extending the benefits to more hard-to-reach communities.
Finally, the positive results across the country warrant
serious consideration to develop and continue expanding this
proven public-private partnership.
From Pilot to Statewide Success Story
I first saw the potential of healthy food incentives at a farmers'
market in Maryland in 2006 when I was a program officer for the
Integrated Farming Systems and Food & Society programs at the W.K.
Kellogg Foundation. As a philanthropist and trained agronomist, the
systems approach and practicality of linking producers and consumers
through nutrition benefits appealed to me.
I founded Fair Food Network in 2009 with the mission to design and
field-test such multi-win efforts to create on-the-ground impact and
serve as a models for others.
Michigan was in the depths of the Great Recession: the number of
people living in poverty was approaching 17 percent, and more than 1.7
million people were receiving SNAP benefits. Then as now Michiganders
suffered higher rates of obesity and other diet-related illnesses than
the national average. Michigan is also a high-ranking agricultural
state with a strong and diverse produce sector. Given this context,
Michigan seemed a ripe proving ground to demonstrate the impact
incentives could have if brought to a statewide scale.
The design of Double Up is simple: For every dollar a SNAP customer
spends on fresh Michigan-grown produce he or she receives an additional
Double Up dollar to spend on more nutritious fruits and vegetables.
We piloted Double Up in five farmers' markets in that first year.
Expanding the program with foundation funding, the ensuing six seasons
have resulted in remarkable growth. Last year Double Up operated in
more than 140 farmers' markets, mobile markets, and farm stands, and in
22 grocery stores throughout Michigan.
So how do we know it works?
In 2007, prior to the start of Double Up, annual SNAP sales at
farmers' markets were a mere $15,000. Preliminary 2015 data show that
last season shoppers spent more than $1.5 million in combined SNAP and
Double Up at participating farmers' markets and an additional $200,000+
at participating grocery stores. These are dollars dedicated to helping
families bring home more nutritious fruits and vegetables. In this way,
Double Up is helping fill SNAP families' ``hunger gap'' while
simultaneously increasing the consumption of nutritious produce.
Indeed, our most recent evaluation shows that 85 percent of Double
Up customers surveyed say they increased the amount of produce they
consume because of the program, and more than 60 percent have tried new
fruits and vegetables and reduced the amount of junk food they eat.
Today, 90 percent of Michigan shoppers live in a county where the
program operates. More than 1,000 Michigan farmers participate
annually. At farmers' markets, we find that SNAP customers are
maximizing the full potential of the program--redemption rates top 90
percent. Many SNAP shoppers report that the Michigan produce in the
markets is less expensive and of higher quality than where they usually
shop and that the selection is better. Farmers and market managers also
tell us that customers that come to the markets for the first time to
take advantage of the Double Up program continue to shop at the markets
when they are no longer using the SNAP program.
Focus groups conducted by University of Michigan researchers found
that SNAP shoppers using Double Up in Detroit were very low-income,
with 90 percent living below the Federal Poverty Line (FPL). These
participants also suffered from higher rates of diet-related health
conditions than state and county averages.
This is all important feedback. It tells us that Double Up
participants are motivated shoppers who take nutrition and health
seriously and work hard to get the best nutritional value for their
very limited food dollars. It also indicates that new shopping habits
begun as a result of the incentives continue when families leave the
program.
We all know that changing dietary patterns takes time and that new
healthy food cultures are forged through a combination of approaches.
That's why we have built strong partnerships with our state's nutrition
education programs, which have been crucial to our ability to pilot,
adapt, improve, and expand Double Up. We work closely with the Michigan
Department of Health and Human Services to connect directly with SNAP
consumers. We partner with the Michigan Fitness Foundation's SNAP-Ed
efforts to integrate information about Double Up into its statewide
social marketing campaign. And we have a close collaboration with
Michigan State University Extension, which assists with outreach by
equipping its statewide network of nutrition educators with information
about the program, spotlighting the program on market and grocery store
tours, and providing additional boots on the ground at participating
grocery stores to explain the program and educate consumers about how
to eat healthier and prepare meals with fresh fruits and vegetables. We
also have strong partnerships with food banks and school systems across
the state, the YMCA, and other nonprofits. We know our efforts are
amplified and enhanced when working together.
You can learn more about Double Up in Michigan in additional
documents included in the appendix. This includes a brief overview of
the program and a break down by Congressional district, as well as
three reports including analyses on the consumer experience at farmers'
markets, the program's growth in rural communities, and how Double Up
can successfully enhance the benefit of the SNAP program by reducing
hunger while also improving nutrition.
But this is not just a Michigan success story.
Such positive findings were echoed in a national cluster evaluation
conducted with Wholesome Wave, Roots of Change/Ecology Center, and
Market Umbrella. Evaluators analyzed data from more than 500 farmers'
markets in 24 states and the District of Columbia. The study showed
that regardless of the setting--urban or rural, small or large--healthy
food incentives work with significant health and economic benefits. I
would be glad to provide this report.
Food Insecurity Nutrition Incentive Program, Michigan Impact
Congress responded to the success of incentive pilots such as
Double Up Food Bucks by creating the Food Insecurity Nutrition
Incentive (FINI) grants program in the last farm bill. This program has
already had a substantial positive effect on the field. USDA's National
Institute of Food and Agriculture is implementing the $100 million
competitive grants program well and made the first round of $31.5
million in grants last spring. Fair Food Network was honored to receive
a grant, which we matched with $5 million in additional private
funding.
This multi-year investment has been a game-changer for us and a
huge opportunity for the field at large. It is allowing us to expand
Double Up to at least 100 more sites than when we applied, including
many more grocery and small food stores. The program is also evolving
from a seasonal to a year-round approach, which will strengthen its
long-term impact on diet by giving families dedicated funds to buy
produce 12 months a year.
The range of food retail venues in which Double Up operates is
broad and growing. We have standardized the program as much as possible
so it is easily recognizable to SNAP shoppers across the state. Federal
funding is allowing us to invest in developing transaction technologies
for farmers' markets and grocery stores that ensure SNAP program
integrity, reduce the program's administrative cost, are easy to use
for shoppers, and respond to the back-end needs of various vendors. I
am confident that in the next several years, we will have generated
promising practices and models that others can implement as the program
expands to other retail venues.
Finally, our FINI grant has given us the resources we need for a
comprehensive external evaluation of the program. We are committed to
ongoing rigorous research to continue refining the Double Up model and
generating insights for the field, including a deeper understanding of
who uses incentive programs and its effect on their diets.
Local partners interested in launching healthy food incentive
efforts in their communities are looking to the Double Up model to get
them started. There are currently 239 Double Up markets and 24
groceries in 13 states with an additional six states coming online in
2016. Support from Fair Food Network is helping partners hit the ground
running and avoid making the same mistakes we did. We are facilitating
an informal network to share information and collaborate on common
challenges. This cooperation is an unanticipated benefit of the Federal
grants and will help us move forward faster than would have been
possible if we had worked in isolation.
Future Opportunities
A year's experience with our FINI grant has illuminated policy
opportunities as we look toward the next farm bill.
Appropriate technology for different kinds of retail
settings is necessary but expensive to develop. Farm direct
marketing is a new and currently small market segment, which
means that there are not a lot of products that have the
capacity to add incentives to SNAP purchases that meet FNS
requirements and are affordable for the nonprofit organizations
that conduct these programs.
Fair Food Network and our colleagues are working with software
designers to develop new systems that are user-friendly for
retailers and SNAP families and can capture data for
evaluation. There are now different electronic systems and
approaches being piloted at farmers' markets and grocery
stores. There are interesting new options to pursue, but
designing and implementing these systems is expensive.
Communications is absolutely vital to the success of
incentive programs. When people use Double Up they are hooked,
but if SNAP shoppers do not know about the program, they will
not be able to benefit from the incentives offered. Even though
we have been operating Double Up statewide for many years the
feedback we get most often from participants is that they had
not heard of the program before they got to the farmers' market
or grocery store. Since most families do not stay on SNAP for
extended periods of time there is a constant need to reach out
to new participants, explain the incentive concept, and connect
them with the participating retailers.
Our experience has taught us that we need to use a variety of
communications tools to build awareness and support this new
behavior. This includes working closely with partner
organizations on multiple outreach efforts in a coordinated
social marketing campaign. Doing this effectively requires
resources and is crucial to the ongoing success of the program.
Finally, we need to ensure that SNAP program rules do not
undermine the good work FINI is doing and that they support
farm direct marketers serving these shoppers.
Conclusion
We know that there is no silver bullet that will solve our hunger
and health challenges.
Our experience with Double Up Food Bucks and that of our colleagues
nationwide demonstrates the power of healthy food incentives. They
work. By collaborating across disciplines, we can integrate healthy
local produce into an existing Federal nutrition program and create
benefits on multiple fronts simultaneously. The return on investment
for every Federal dollar spent is an immediate reduction in hunger,
increase in produce consumption, and greater farm income.
FINI is making a difference. The long-term returns on investment
supported by FINI are workable models that will enhance the value of
the SNAP program and create dynamic connections between rural and urban
communities, which will build healthier food environments and a more
viable and responsive food system.
Finally, the positive results such programs are generating signals
an opportunity for us all. The time is now to thoughtfully prepare to
support the development and expansion of such programs so that we can
scale this proven public-private partnership.
Thank you again for holding this hearing and for recognizing the
potential of healthy food incentives to help low-income families
purchase more fruits and vegetables. I am happy to answer any
questions.
Appendix
double up food bucks
A win/win/win for SNAP participants, farmers & local economies.
Fair Food Network's Double Up Food Bucks (Double Up) healthy food
incentive program helps low-income Americans eat more fruits and
vegetables while supporting family farmers and growing local economies.
``I just want to say thank you. My health is improved, (I)
learned better cooking and preserving for winter, and enjoy new
food.''
Michigan Double Up participant.
``We appreciate the fact that it's putting honest, healthy
foods in people's hands. We are glad to have more business, but
even aside from the sales factor, we're happy knowing the
people have the good food.''
Matt & Carissa Visser, Isadore Farm D Cedar, Michigan.
Here's how it works: Double Up provides SNAP program participants
with matching dollars to buy additional produce when they spend their
Federal nutrition benefits on locally grown fruits and vegetables.
The wins are three-fold: Low-income families eat more healthy food,
area farmers gain new customers and make more money, and more food
dollars stay in the local economy. Each has a ripple effect of
benefits.
Growth & Impact: Since 2009, Double Up has grown from five farmers'
markets to more than 150 sites across the state. Today, nearly 90
percent of Michigan shoppers live in a county where the program
operates, either at a farmers' market or grocery store. Preliminary
2015 data show that shoppers spent more than $1.5 million in combined
SNAP and Double Up at farmers' markets, and an additional $200,000+ at
participating grocery stores, helping families bring home more fruits
and vegetables.
------------------------------------------------------------------------
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Helps Low-Income Consumers:
SNAP shoppers bought 4+ million pounds of healthy food with
SNAP & Double Up since 2009.
87% said they eat more fruits and vegetables because of
Double Up.
69% tried new fruits and vegetables; 66% say they eat less
junk food.
Helps Michigan Farmers:
Michigan farmers increased their income with $7+ million in
new SNAP & Double Up sales.
63% reported making more money; 50% report gaining new
customers.
More than 1,000 farmers participate annually.
------------------------------------------------------------------------
``I am all for anything that is going to help our customers.
It's excellent for your customers to stretch their food dollar.
I would do it again.''
Michigan Double Up Participating Grocer.
double up in farmers' market: the consumer experience
Double Up: Reports from the Field No. 1 *
---------------------------------------------------------------------------
* http://www.fairfoodnetwork.org/resources/double-up-farmers-
markets-consumer-experience.
---------------------------------------------------------------------------
Fair Food Network (http://www.fairfoodnetwork.org/) works at
the intersection of food systems, sustainability, and social
equity to develop solutions that support farmers, strengthen
local economies, and increase access to healthy food--
especially in under-served communities. Double Up Food Bucks
(Double Up), a project of Fair Food Network, matches SNAP
(formerly food stamps) benefits spent at participating retail
locations with additional funds for the purchase of fresh
Michigan grown fruits and vegetables. The Double Up program
began in five Detroit farmers' markets in 2009 and has expanded
to more than 150 farmers' markets, mobile markets, food share
programs, and grocery stores around the state. This is the
first of a series of papers that will look at 3 years of
program data through a variety of lenses and discuss their
implications for policy. The second report analyzes Double Up's
multiple impacts in rural Michigan--on low-income SNAP
consumers, on the farmers selling in the markets, and on the
communities in which they live. Future reports will include a
discussion of how the Double Up program works in grocery
stores, the results of a pilot integrating several nutrition
programs in one county's farmers' markets, and technology
options that markets and grocery stores can use to implement
SNAP incentive programs.
Kate Fitzgerald for Fair Food Network, May 2015.
Too many Americans suffer from debilitating chronic health
conditions, and Michiganders are no exception: over 31 percent of the
state's adults are obese, one in ten has diabetes, and the state's
heart disease rate is one of the highest in the country.\1\ All of
these conditions are related to unhealthy diets, a hallmark of which is
an inadequate consumption of produce. The burden is most acute in low-
income communities where there is not easy access to high quality
affordable food, and where the local built and social environments
often do not foster healthy food cultures.
---------------------------------------------------------------------------
\1\ Trust for America's Health and Robert Wood Johnson Foundation,
Investing in America's Health: A State-by-State Look at Public Health
Funding and Key Health Facts (May 2014): 30-31, accessed July 14, 2014
and April 10, 2015. http://healthyamericans.org/assets/files/TFAH2014-
InvestInAmericaRpt08.pdf.
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In farmers' markets, Double Up provides an additional dollar to
spend on Michigan grown produce for every $1 in SNAP benefits families
spend. Several years of evaluations indicate that Double Up's
deceptively simple design influences shoppers positively in several
ways: it increases their spending power while creating concentrated
demand for fresh fruits and vegetables--a demand that encourages
farmers to locate markets in or near low-income communities. The
farmers' markets in turn foster healthy social networks, and the many
personal interactions provide effective environments for experiential
nutrition education.\2\ Thus, the program impacts both the individual
and the community.
---------------------------------------------------------------------------
\2\ Farmers Market Coalition, 2013 National Farmers Market Week.
http://farmersmarketcoalition.org/wp-content/uploads/gravity_forms/1-
66fc51da018bd946fb1dfb
74f4bea1e7/2015/03/NFMW_TalkingPoints_2013_Cover.pdf.
---------------------------------------------------------------------------
This report looks at the SNAP consumer's experience using Double Up
in farmers' markets to help policymakers and practitioners understand
what guides participants' food shopping decisions--how they perceive
their choices, their awareness of nutrition, and what they think about
the utility of the Double Up program to their diets and their lives.
The information is designed to encourage conversation and stimulate new
research that considers the powerful social and psychological forces,
as well as the economic and geographic realities, that support or
constrain healthy food choices for the poor. The goal is to help inform
wise public policy that will put Michigan--and the nation--back on the
road to dietary health.
Double Up Customer Produce Consumption 2014
Low-income families most often cite higher costs as the reason they
do not eat more produce. The Double Up program addresses this challenge
head on by doubling SNAP consumers' purchasing power when they use
their benefits in farmers' markets, giving families the resources they
need to invest in their long-term health by buying nutritious foods.
The program maximizes the health impact of these food dollars by
targeting them specifically for the purchase of fresh fruits and
vegetables, the foods most often absent in American diets. The approach
works. Since 2009, consumer demand has allowed the program to expand
from five pilot markets in Detroit to more than 150 rural and urban
communities around the state. Michigan SNAP participants have spent
more than $7 million in combined SNAP and Double Up Food Bucks in
participating markets and farm-direct retail since 2010 and have bought
more than 4 million pounds of healthy fresh produce.\3\
---------------------------------------------------------------------------
\3\ Calculated using Feeding America's conversion factor of $1.62
per pound of food.
``Double Up helps to stretch my budget and helps to improve
my diet. I can afford more fruits and vegetables with Double
Up. I can buy local, and I really like being able to do that''
Michigan Double Up Participant.
Double Up is having a powerful effect on participants' diets. In
2014, 559 shoppers using Double Up Food Bucks at 61 participating
markets filled out a survey on their experience with the program.
Eighty-seven percent reported they were eating more fruits and
vegetables because of the incentives, 96 percent planned to increase
their produce consumption, and 69 percent reported trying new kinds of
healthy foods. Equally important, 66 percent reported that they were
buying fewer chips, cookies and candy as a result of the program. These
responses are consistent with the results of 3 years of independent
evaluations. Double Up may be sparking new interest among SNAP
consumers in buying fruits and vegetables. It may also be providing
health conscious low-income shoppers the opportunity to purchase the
kinds of foods they want but cannot afford.\4\
---------------------------------------------------------------------------
\4\ Dr. Corinna Hawkes, et al., ``Smart Food Policy for Obesity
Prevention,'' The Lancet (February 18, 2015), http://www.thelancet.com/
journals/lancet/article/PIIS0140-6736(14)61745-1/abstract.
---------------------------------------------------------------------------
Lack of easy access exacerbates the challenge to healthy eating for
the 1.8 million Michiganders who live in communities without adequate
food retail.\5\ Farmers' markets, mobile markets and food share
programs are filling this retail gap in many communities. There are
more than 300 farmers' markets in Michigan now, almost triple what
there were 10 years ago. Almost 200 markets and farmers now accept SNAP
benefits, and 86 percent of Michiganders live in a county with a
participating Double Up Food Bucks site. By initially promoting their
use at farmers' markets, Double Up stimulated demand for local produce
in low-income communities. This demand provides the farmers the
economic safety net they need to locate markets in or near these
neighborhoods. In this way, Double Up's design simultaneously creates
both a demand for and supply of healthy produce. The program reduces
the financial and physical access challenges to buying health food,
providing a benefit to individual SNAP participants and also their
neighbors by improving the food environments in which they live.
---------------------------------------------------------------------------
\5\ Manon M., Church D., Treering D., Food for Every Child: The
Need for Healthy Food Financing in Michigan. (2015). http://
thefoodtrust.org/uploads/media_items/michigan-mapping-
final.original.pdf.
---------------------------------------------------------------------------
SNAP Authorization and Spending in Michigan Farmers' Markets
Double Up Food Buck's incentives address the financial and
geographic barriers to healthy eating for low-income families, but the
program's benefits run deeper. The Centers for Disease Control and
Prevention (CDC) includes access to farmers' markets among its key
indicators of food environments that support the consumption of fruits
and vegetables, and respondents in a national study of incentive
programs reported that incentives in local farmers' markets improve the
health of their communities.\6\ While consumers may believe that
markets are assets to their neighborhoods, they will only spend their
limited food dollars there if they believe that they are getting the
best food value--and Double Up shoppers do. Program participants
overwhelmingly report that the quality and selection at the farmers'
markets are much better, and the prices are either the same or lower
than where they usually shop. Too often higher prices and inferior
quality confound low-income shoppers' desire for healthy food and
create reasonable disincentives for the purchase of fruits and
vegetables.\7\
---------------------------------------------------------------------------
\6\ Richard McCarthy, ``Evaluating the Social, Financial, and Human
Capital Impacts of Farmers Markets.'' (2010) http://
www.marketumbrella.org/uploads/Evaluating_farmers_markets.pdf.
\7\ Lancet, ibid.
---------------------------------------------------------------------------
Double Up Food Bucks Farmers' Market Locations 2014
A farmers' market is very different from a grocery store and offers
an environment with significant advantages for both facilitating
healthy eating and nurturing good dietary habits. Many offer regular
health, nutrition, and cooking activities, engaging shoppers in ways
that reinforce healthy eating messages and make them easy to act on.
Shoppers have many more personal interactions in farmers' markets than
in supermarkets, and these connections create strong social networks
and can build civic culture.\8\ Perhaps equally powerful is the value
to SNAP participants of the reciprocity in the economic relationship
Double Up creates. Knowing that their purchases help to support the
farmers is a welcome change from the feeling of dependency that relying
on public nutrition benefits can bring. It is hard to measure the
impact these factors have on personal shopping patterns or community
culture, but every year Double Up shoppers talk about the importance of
the relational aspects of the program and teaching their children about
food and health as much as they credit the immediate financial
assistance it provides.
---------------------------------------------------------------------------
\8\ Dr. Neal Kaufman and Steve Davies, ``Public Markets Promote
Economic, Social, and Health Benefits--And Should Be Encouraged,'' The
Planning Report (March 20, 2006). http://www.planningreport.com/2006/
03/20/public-markets-promote-economic-social-and-health-benefits-and-
should-be-encouraged.
``I have had so much fun taking my girls to the market with
me this summer to let them pick out fruits and veggies. . . . I
taught them how to freeze fruits and veggies so that we can
enjoy them in the winter. . . . I have also been able to
develop relationships with some of the local growers. I love
that they recognize me!''
Michigan Double Up Participant.
The most common criticism of incentive programs in farmers' markets
is that their efficacy is limited because a small percentage of
American shoppers use markets. While it is true that most Americans do
not shop in farmers' markets, the number of low-income shoppers using
them continues to increase.\9\ It is worth considering that the portion
of the population that uses these markets can have a considerable
positive influence on local food cultures and on the habits of their
families and neighbors. Over time, markets may exert an outsized
influence on the creation of healthier food environments. They are
credited with changing the tastes of ``mainstream culture''--why
shouldn't they have at least an equal impact on low-income consumers
and communities?
---------------------------------------------------------------------------
\9\ USDA Food and Nutrition Service.
---------------------------------------------------------------------------
Double Up Customer Perception of Produce in Participating Farmers'
Markets 2014
The Double Up program design overcomes the two most common barriers
to produce consumption by SNAP participants: it increases the amount
families have to spend on produce and uses the new buying power to
bring farm-fresh fruits and vegetables into under-served low-income
communities. Each year, the demand for the program grows, participants
consistently report that they eat more fruit and vegetables as a result
of the incentives, and the value of SNAP dollars spent with farmers
across the state increases. The Michigan experience demonstrates that
well-designed programs can exert positive influences on individual
dietary behavior as well as on culture and community food environments.
``You mean I get that much food and the farmer gets all of
that money? I like this. It feels like we're helping each
other.''
Grand Rapids Market Shopper.
Fair Food Network believes that we need coordinated approaches that
recognize the powerful interplay between economic, cultural, and
environmental forces to improve our food choices and dietary behavior.
There is no one easy answer, but there are promising patterns emerging
as the Double Up program expands. Fair Food Network is committed to
extending the benefits to more low-income consumers, finding ways to
integrate it successfully into other kinds of retail, and identifying
technologies to make implementation easier.
``We are glad to have more business, but even aside from the
sales factor, we're happy knowing the people have the good
food.''
Western Michigan Farmer.
``I've lost 45 lbs so far. . . . I know Double Up has helped
me, because I am able to walk 2 miles now, and I know that if I
wasn't eating better, I would not be able to do that.''
Michigan Double Up Participant.
the double up experience in rural michigan
Double Up: Reports from the Field No. 2 *
---------------------------------------------------------------------------
* http://www.fairfoodnetwork.org/resources/double-up-experience-
rural-michigan.
---------------------------------------------------------------------------
Fair Food Network (http://www.fairfoodnetwork.org/) works at
the intersection of food systems, sustainability, and social
equity to develop solutions that support farmers, strengthen
local economies, and increase access to healthy food--
especially in under-served communities. Double Up Food Bucks
(Double Up), a project of Fair Food Network, matches SNAP
(formerly food stamps) benefits spent at participating retail
locations with additional funds for the purchase of fresh
Michigan grown fruits and vegetables. The Double Up program
began in five Detroit farmers' markets in 2009 and has expanded
to more than 150 farmers' markets, mobile markets, food share
programs, and grocery stores around the state. This is the
second of a series of papers that will look at 3 years of
program data through a variety of lenses and discuss their
implications for policy. The first in the series analyzed the
SNAP consumer's experience using Double Up Food Bucks and the
impact the program can have on diet, food environment, and
behavior. Future reports will include a discussion of how the
Double Up program works in grocery stores, the results of a
pilot integrating several nutrition programs in one county's
farmers' markets, and technology options that markets and
grocery stores can use to implement SNAP incentive programs.
Kate Fitzgerald for Fair Food Network, June 2015.
One of the most exciting trends of the past 3 years has been the
Double Up Food Bucks program's growth in rural Michigan.** In 2014,
more than \1/3\ of the farmers' markets that participated in the
program were in communities of fewer than 50,000 people, and 50 of
these markets were in rural communities with populations of less than
20,000. Almost 20 percent of the SNAP and Double Up dollars were spent
in these markets last year, and 34 new rural markets and farmstands
joined the program in 2015. Rural residents also used Double Up
incentives at higher rates than urban shoppers, which may dispel myths
that farmers' markets are an affluent urban phenomenon. While much has
been written about food deserts and the connection between poverty, low
food access and high rates of chronic disease, most of the studies and
projects have been conducted in big cities. Poverty, poor health, and
limited access to healthy food are often more acute in rural
communities where isolation and limited public and private sector
resources make these challenges harder to fight.\1\ Several years of
independent evaluations and more than 500 customer and farmer surveys,
as well as data on SNAP and Double Up transactions in rural Michigan
markets, indicate that the program is having multiple, tangible
positive effects. Doubling Federal nutrition benefits when they are
spent on produce from local farmers keeps more food dollars in the
local economy and helps low-income rural consumers overcome barriers to
healthy eating. The program's approach is holistic and it is in rural
Michigan where the power of an integrated design that meets families'
food needs while also getting at the lack of economic activity that
leads to poverty can be seen most clearly.
---------------------------------------------------------------------------
** USDA defines ``rural'' as a community of fewer than 50,000
people. This means there are some larger communities that are
classified as urban for our purposes even though they are in counties
considered rural using Metropolitan Statistical Area (MSA) definitions.
\1\ Opportunity for All: Fighting Rural Child Poverty, The White
House, May 2015. https://www.whitehouse.gov/sites/default/files/docs/
rural_child_poverty_report_final_non-embargoed.pdf.
---------------------------------------------------------------------------
Rural Consumers
Rural Michigan was hit hard by the Great Recession. Fifty-three
rural counties in the state have fewer jobs now than they had in 2007,
and poverty rates are greater than 22 percent in nine of these
counties.\2\ The problem is most acute among children, with as many as
one in three rural kids experiencing hunger in 2014.\3\ Poverty takes a
long-term toll on health, and increasingly the chronic conditions from
which Americans suffer--particularly low-income Americans--are diet
related. Thirty-five percent of rural Michiganders are obese and rural
counties are near the bottom of state rankings for health and well-
being.4-5 While surveys reflect that shoppers know that
eating produce is important, 37 percent of Michiganders do not eat one
portion of fruit per day and almost one in four does not eat a
vegetable daily.\6\
---------------------------------------------------------------------------
\2\ Bishop, B., ``Rural Jobs Remain Below 2007 Levels,'' May 21,
2015, The Daily Yonder. Dailyyonder.com/rural-counties-missing-half-
million-jobs/2015/01/20/7686.
\3\ Feeding America's Map the Meal Gap 2015.
\4-5\ http://www.americashealthrankings.org/ALL/Obesity/
disparities; http://www.countyhealthrankings.org/rankings/data/MI;
http://www.well-beingindex.com/2014-state-rankings.
\6\ http://www.cdc.gov/nutrition/downloads/State-Indicator-Report-
Fruits-Vegetables-2013.pdf.
---------------------------------------------------------------------------
The Double Up program is designed to make it as easy as possible
for low-income families to buy and eat local fresh produce. For every
dollar in SNAP benefits a family spends at a participating farmers'
market, they receive an additional dollar to buy fresh fruits and
vegetables. Since low-income families spend as much as 36 percent of
their total income on food, these additional dollars are crucial to
provide families the extra margin they need to buy food that will
support long-term health rather than maximizing calories as
inexpensively as possible.\7\
---------------------------------------------------------------------------
\7\ United States Bureau of Labor Statistics, 2013 Consumer
Expenditure Survey (U.S. Government Printing Office).
---------------------------------------------------------------------------
By linking the new Double Up dollars to purchases of local produce,
the incentives also redirect Federal SNAP benefits to regional farmers,
helping to stimulate the establishment of new markets and to encourage
existing markets to become authorized to accept SNAP. Sixty-six percent
of Double Up's rural markets started accepting SNAP in just the last 3
years, and 35 of these markets are in the smallest rural communities.
Double Up simultaneously increases low-income families' buying power
and helps create access to healthy food retail in rural communities,
which is critical in towns that have lost their local grocery stores.
Even with money and access, shoppers can choose not to buy fresh
produce if they feel stores are not clean, if the produce for sale is
not high quality, or if they do not feel that personnel value their
business.\8\ Studies have shown that obesity rates are significantly
lower in rural areas with farmers' markets and that mortality rates are
inversely associated with higher per capita direct farm
sales.9-10 There are multiple reasons for this, but the
outsized role a farmers' market can play in fostering a healthy eating
culture is worth exploring more fully.
---------------------------------------------------------------------------
\8\ Blitstein, J.L., Snider, J., and Evans, W.D., ``Perceptions of
the food shopping environment are associated with greater consumption
of fruits and vegetables.'' Himmelfarb Health Sciences Library, The
George Washington University Health Sciences Research Commons
Prevention and Community Health Faculty Publications. June 2012.
\9\ Jillcot, S.B., et al. ``Examining Association Among Obesity and
Per Capita Farmers' Markets, Grocery Stores/Supermarkets, and
Supercenters in U.S. Counties.'' Journal of the American Dietetic
Association, (2011) 111: 567-572.
\10\ Ahern, M., Brown, C. and Dukas, S., ``A National Study of the
Association Between Food Environments and County-Level Health
Outcomes.'' Journal of Rural Health, (2011) 27: 367-379.
``You mean I get that much food and the farmer gets all that
money? I like this. It feels like we are helping each other.''
Double Up participant.
Double Up consumer data indicate that shoppers like the program and
feel that it improves their diets.\11\ In 2014, 302 Double Up shoppers
at rural markets responded to written customer surveys. Of the 224
shoppers who answered a question asking how the program had affected
their diets, 90 percent said that they were eating more fruits and
vegetables because of the incentives, and 68 percent of respondents
said that because of the program they were eating fewer potato chips,
candy and cookies. Farmers' markets are also meeting Double Up shoppers
demands for high-quality food: 97 percent of shoppers said that the
quality of produce at the market was better than where they usually
shop, 93 percent said that the selection was better, and 83 percent
said that prices were either cheaper or the same as where they usually
shop.
---------------------------------------------------------------------------
\11\ http://www.fairfoodnetwork.org/resources/double-up-farmers-
markets-consumer-experience.
---------------------------------------------------------------------------
Double Up Rural Customer Consumption, 2014
Rural shoppers use the Double Up program intensively. Redemption
rates have never been lower than 90 percent in the rural farmers'
markets and have been as high as 99 percent in some communities. Only
15 percent of shoppers used the Double Up program just once, 28 percent
used it two or three times and 58 percent four or more times. This high
use rate and multiple visits to participating markets have been
consistent for 5 years and exceeds that in urban areas.
Double Up appears to be effectively addressing the practical
reasons rural consumers most often cite for not buying produce--its
cost, accessibility, quality, and comfort in the retail setting.\12\
Customers state that they enjoy their interactions with farmers and
feel good that their purchases are helping to support them. Many
markets offer cooking and nutrition activities, and in some Extension
Service nutritionists provide tours that explain how to use different
Federal nutrition benefits in the markets.
---------------------------------------------------------------------------
\12\ Webber, C.B., Sobal, J. and Dollahite, J.S., ``Shopping for
fruits and vegetables. Food and retail qualities of importance to low-
income households at the grocery store.'' Appetite, Vol. 54 (2010) 297-
303.
---------------------------------------------------------------------------
Double Up Rural Customer Perception of Produce in Rural Farmers'
Markets, 2014
It appears that Double Up can successfully connect low-income
shoppers with local farmers by helping overcome some financial and
geographic hurdles that they both face. Markets also foster supportive
social networks that can build a civic culture necessary for stronger
and more resilient communities.\13\ Future research could look at why
rural SNAP participants use the Double Up program more than their urban
counterparts, whether seasonal incentives lead to long-term dietary
change, and whether increased fruit and vegetable purchases in farmers'
markets carry over to grocery store shopping.
---------------------------------------------------------------------------
\13\ Alia, K., et al., ``Identifying emergent social networks at a
federally qualified health center-based farmers' market.'' Selected
submission for special issue on social network theory in the American
Journal of Community Psychology, (2014) 53, 335-345. DOI 10.1007/
s10464-013-9616-0 PMID: 24352510.
---------------------------------------------------------------------------
Rural Producers and Economies
The Double Up program results look as promising for participating
farmers as they do for rural SNAP shoppers. The SNAP and Double Up
dollars that flow through Michigan farmers' markets benefit not only
farmers, but the entire local economy. Responses on self-administered
surveys from 356 farmers selling at 68 Michigan farmers' markets in
2014 confirm the data from 3 years of independent evaluations, as well
as sales data since 2009: Double Up supports the proliferation of
markets, expands their customer base, and increases direct spending by
producers. This indicates that the program can support local economic
development and job creation that can grow into a self-sustaining cycle
of community self-help.
The number of farmers' markets in Michigan has increased from only
three in 2006 to more than 300 today, \1/2\ of which are authorized to
accept SNAP. The development of strong farmers' markets allows farmers
to capture a larger share of the consumers' food dollars, while the
Double Up program introduces a new community of consumers to these
markets. The incentive helps markets diversify their customer base,
increase their long-term financial stability and establish their place
as important components of the local food retail economy.
Growth in Rural Farmers' Markets with Double Up, 2010-2014
Last year the state's farmers received more than $1.6 million in
SNAP dollars, the third highest level of SNAP use in farmers' markets
in the country even though eight states distributed more in SNAP
benefits. Double Up has been directly responsible for at least $7
million in SNAP and incentive sales in farmers' markets in the last 5
years--representing $7 million in new income and spending power for the
1,000 Michigan farmers that participated in the program each year.
Studies by Michigan State University in 2006 and 2008 assessed the
economic development potential of a theoretical increased localization
of the state's fruit and vegetable sector. They found that there was
the potential to create between 1,800 and 1,900 new jobs and generate
between $187 million and $211 million in new income in Michigan.\14\
Fair Food Network ties Double Up to the purchase of Michigan fresh
fruits and vegetables in a bid to help the state realize this
potential. As the program expands to operate in grocery stores, the
goal is to extend the economic impact to the state's mid-sized farmers
that sell into wholesale rather than direct markets.
---------------------------------------------------------------------------
\14\ http://foodsystems.msu.edu/uploads/files/EatFresh.pdf & http:/
/foodsystems.msu.edu/uploads/files/FSasEconomic_Driver.pdf.
``Many customers have said that they had never been to a
farmers' market, and they love it. Also, many have appreciated
our educational component of teaching cooking, canning and
preserving.''
Market Manager.
In 2014, 63 percent of 356 surveyed farmers reported that they were
making more money because of Double Up. The economic development value
of new income is greatest when farmers spend earnings in their local
rural communities. Studies looking at where producers buy their inputs
find that 50 to 95 percent are purchased locally.15-16 In-
depth evaluator interviews with six farmers participating in Double Up
in 2013 found that all purchased almost all of their farm inputs either
in their home county or in an adjacent rural county. This indicates a
high potential local economic impact.
---------------------------------------------------------------------------
\15\ USDA, Economic Research Service using data from USDA's
Agricultural Resource Management Survey, 2004 Phase III, Version 1.
\16\ Chism, J.W., Levins, R.A., ``Farm Spending and Local Selling:
How Do They Match Up?'' Minnesota Agricultural Economist, No. 676,
Spring 1994.
---------------------------------------------------------------------------
In 2013, 46 percent of Double Up producers selling in rural markets
said that they had purchased new equipment because of the program.
Thirty-three percent said they would put more land into production to
meet new demand, and 60 percent said that they had started using season
extenders because of the program. In 2014, an additional seven percent
had or would purchase new equipment, 16 percent will use season
extenders, and 14.5 percent have or will increase their acreage. This
new production and longer season means farmers are investing their new
income in inputs most of which they are buying from local rural
businesses. Local business expansion is crucial in a state with a rural
unemployment rate of almost ten percent.\17\
---------------------------------------------------------------------------
\17\ https://www.raconline.org/states/michigan.
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Impact of Double Up on Producers Participating in Rural Markets, 2013-
2014
All the SNAP and Double Up income earned in farmers' markets around
the state is important to rural economies; but the potential power of
the direct producer-consumer relationship Double Up creates is easiest
to see at markets in farmers' home communities where the SNAP shoppers
buying food are the producers' neighbors. In 2010, $1,000 in SNAP and
Double Up dollars were spent at the single farmers' market
participating in rural Michigan. By 2014, SNAP and Double Up shoppers
spent more than $300,000 at 56 participating rural markets.
SNAP & Double Up Spending in Participating Michigan Farmers' Markets
Each successful farmers' market creates an average of four new
jobs, and every dollar spent at a market creates an estimated $2.80 in
local economic activity.18-19 Rural businesses near markets
also get a boost, as market shoppers stroll and spend money.\20\ In
addition to jobs created at or near rural farmers' markets, ten percent
of Double Up farmers reported in 2014 that the increased market volume
the program created had required them to hire extra workers.
---------------------------------------------------------------------------
\18\ Jeffery O'Hara, Market Forces: Creating Jobs Through Public
Investment in Local and Regional Food Systems, Union of Concerned
Scientists, 2011. http://www.ucsusa.org/sites/default/files/legacy/
assets/documents/food_and_agriculture/market-forces-report.pdf.
\19\ Sonntag, V., ``Why Local Linkages Matter: Findings from the
Local Food Economy Study.'' Sustainable Seattle. Seattle, Washington,
April 2008.
\20\ McCarthy, R. and Moon, J.R., ``The Economic Impact of Farmers
Markets: A Study of 9 Markets in 3 Major U.S. Cities,'' 5 July 2012.
More information at: http://marketumbrella.org/
index.php?mact=News,cntnt01,detail,0&cntnt01articleid=163&cntnt01returni
d=83.
``We are glad to have more business, but even aside from the
sales factor, we're happy knowing the people have the good
food.''
Western Michigan Farmer.
Just as farmers' markets can introduce consumers to healthier
foods, farmers' markets are often the first retail outlet for beginning
farmers. To the extent that the Double Up program helps keep these
markets viable, it also supports the success of beginning farmers in
Michigan. The Double Up program appears to maintain demand during the
summer, support the extension of the market season, boost farmer
income, and stimulate sales at rural businesses. The program's economic
impact looks promising and offers tantalizing avenues for future
research. How many of the participating producers are beginning farmers
or come from historically disadvantaged groups? Do rural shoppers
continue to come to market when they no longer receive incentives,
keeping those food dollars from leaking out of the local economy? Has
the growth of rural farmers' markets stimulated increased local
purchasing by institutions, restaurants or stores? How much are
participating farmers spending on new farm inputs, and how many of the
purchases are made locally? How does the program's economic impact on
rural communities change over time, and what specific effects have
local businesses seen as a result of the incentives? With support from
USDA's Food Insecurity Nutrition Incentive Program, Fair Food Network
will continue to collect data on the Double Up program that should help
answer these questions.
double up food bucks and hunger
Double Up: Reports from the Field *
---------------------------------------------------------------------------
* http://www.fairfoodnetwork.org/resources/double-up-and-hunger.
---------------------------------------------------------------------------
Fair Food Network works at the intersection of food systems,
sustainability, and social equity to develop solutions that
support farmers, strengthen local economies, and increase
access to healthy food--especially in our most under-served
communities. Fair Food Network's Double Up Food Bucks program
provides SNAP program participants with matching dollars to buy
additional produce when they spend their Federal nutrition
benefits on locally grown fruits and vegetables. The Double Up
program began in five farmers' markets in 2009 and has since
expanded to more than 150 sites across the state including
farmers' markets, mobile markets, food share programs, and
grocery stores. These field reports look at program evaluation
data through a variety of lenses and discuss their policy
implications.
Kate Fitzgerald for Fair Food Network.
Reports from the Council of Economic Advisors (CEA) and the
National Commission on Hunger confirm that the Supplemental Nutrition
Assistance Program (SNAP, formerly known as food stamps) does an
excellent job of averting deep and widespread hunger but also that it
cannot ensure participants' optimal nutrition.1-2
---------------------------------------------------------------------------
\1\ Council of Economic Advisers report: https://
www.whitehouse.gov/sites/whitehouse.gov/files/documents/
SNAP_report_final_nonembargo.pdf.
\2\ National Commission on Hunger report: http://
cybercemetery.unt.edu/archive/hungercommission/20151216222324/https://
hungercommission.rti.org/Portals/0/SiteHtml/Activities/FinalReport/
Hunger_Commission_Final_Report.pdf.
---------------------------------------------------------------------------
Fair Food Network's Double Up Food Bucks healthy food incentive
program provides low-income shoppers an additional $20 per day
incentive to buy produce when they use their SNAP benefits on locally
grown fruits and vegetables at participating farmers' markets and
grocery stores. At the most basic level such healthy food incentive
efforts are anti-hunger programs because they increase the food buying
power of low-income individuals who might otherwise be hungry.
Preliminary results from a study analyzing transaction data of
Double Up participants in Detroit in 2012 and 2013 found that the
program reached the poorest SNAP shoppers.\3\ We believe that this is a
crucial finding as we understand more about the connection between
hunger and diet-related illness and the destructive cycles of hunger
and poor health that can trap people in poverty.
---------------------------------------------------------------------------
\3\ Cohen, A.J., Lachance L., Hesterman O.B., Bair R.C., Noonan G.,
Zick S.M. ``Utilization of a SNAP Incentive Program for the Purchase of
Fruits and Vegetables at Detroit Farmers Markets.'' Conference
presentation at the American Public Health Association Annual Meeting,
New Orleans, Louisiana, November 2014.
---------------------------------------------------------------------------
Many factors influence food consumption decisions, but Fair Food
Network's experience with the Double Up Food Bucks healthy food
incentive program and similar efforts around the country indicate that
produce incentives can successfully enhance the benefit of the SNAP
program by reducing hunger while also improving nutrition.\4\
---------------------------------------------------------------------------
\4\ Block, J.P., Subramianian S.V. (2015) Moving Beyond ``Food
Deserts'': Reorienting United States Policies to Reduce Disparities in
Diet Quality. PLos Med. 12(12): e10001914. Doi:10.1371/journal.
Pmed.1001914.
---------------------------------------------------------------------------
The Economics of Why Hunger Matters
The challenges of hunger and food insecurity are complicated in the
United States with the seeming paradox of millions of families that are
overfed but undernourished. Even as the country pulls out of the Great
Recession, more than 45 million people depended on monthly SNAP
benefits in 2015. To provide some context, that is more than the entire
population of California and about equal to the number of people who
live in Georgia, Illinois, Michigan, and Pennsylvania combined. Less
visible are the almost seven million Americans who do not have enough
of any kind of food to eat. There are as many hungry people in the
United States as the total population of Washington State.\5\
---------------------------------------------------------------------------
\5\ http://www.ers.usda.gov/data-products/ag-and-food-statistics-
charting-the-essentials/food-security-and-nutrition-assistance.aspx.
In 2006 USDA started using new definitions to describe the range of
levels of food insecurity in the U.S. Food insecurity is defined as
lacking dependable and consistent access to food. Very low food
security means that at least one member of a household missed meals as
a result of insufficient resources for food. See more detailed
descriptions here: http://www.ers.usda.gov/topics/food-nutrition-
assistance/food-security-in-the-us/definitions-of-food-security.aspx.
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Poverty forces individuals to make tough choices that can have
long-term effects on their individual futures and on our collective
economic potential. Rates of chronic diseases associated with diet are
exploding in the United States and the incidence of these are highest
among poor Americans. According to Bread for the World, the immediate
health-related cost of hunger and food insecurity in the United States
exceeded $160 billion in 2014.\6\
---------------------------------------------------------------------------
\6\ Bread for the World Institute 2015 Hunger Report. Estimating
the Health-Related Costs of Food Insecurity and Hunger by John T. Cook
and Ana Paula Poblacion. Available here: http://www.bread.org/about-
bread-world-institute.
---------------------------------------------------------------------------
A key problem for low-income families is that even with SNAP
benefits they do not always have enough money to buy food for the whole
month. The average American spends about $50 a week on food while the
average SNAP benefit for an individual is $29 a week.\7\ This leaves a
$20 per week food spending gap, which helps explain why roughly 80
percent of SNAP benefits are redeemed within 2 weeks of receiving them.
Research shows that SNAP recipients consume between 10 to 25 percent
fewer calories as the month progresses.\8\ In one California study,
insufficient money to buy food was associated with a 27 percent
increase in hospital admissions for low blood sugar among low-income
adults.\9\
---------------------------------------------------------------------------
\7\ http://hungerreport.org/2016/wp-content/uploads/2015/11/HR2016-
Executive-Summary.pdf.
\8\ Seligman H.K., Bolger A.F., Guzman D., Lopez A., Bibbins-
Domingo K. (2015). Exhaustion of Food Budgets at Months End and
Hospital Admissions for Hypoglycemia. Health Affairs doi: 10.1377/
hlthaff.2013.0096, Health Aff. January 2014, vol. 33 no. 1116-123.
\9\ Ibid.
``(Double Up Food Bucks) just stretches my food budget so
much more. I find myself eating a lot more fruits and
vegetables than I might
have . . .''
Double Up Focus Group Participant, Detroit.
When families run out of food they turn to food pantries. According
to a 2013 Feeding America survey, 84 percent of the low-income
households with children that they served reported that they purchased
junk food even though they knew it was not nutritious but because they
had to provide enough calories to make their children feel full.\10\
Hungry and undernourished children do not learn, are more likely to get
in trouble in school, and to develop diet-related diseases.\11\ This is
a cause for deep concern at a time when almost \1/2\ of SNAP
participants are children under the age of 18.\12\
---------------------------------------------------------------------------
\10\ http://www.feedingamerica.org/about-us/about-feeding-america/
annual-report/2015-feeding-america-annual.pdf.
\11\ Hickson M., deCuba S.E., Weiss I., Donofrio G., Cook J. Too
Hungry to Learn: Food Insecurity and School Readiness, Part I of II MA:
Children's HealthWatch, Boston Medical Center; 2013.
\12\ Cohen, A.J., Lachance L., Hesterman O.B., Bair R.C., Zick S.M.
``Barriers and Facilitators to Use of a SNAP Incentive Program at
Detroit Farmers Market: A Qualitative Evaluation.'' Conference
presentation at the American Public Health Association Annual Meeting,
New Orleans, Louisiana, November 2014.
---------------------------------------------------------------------------
Double Up produce incentives can help by filling SNAP families'
``hunger gap'' while simultaneously increasing the consumption of
nutritious produce and stimulating local economies by sparking demand
for fruits and vegetables.
``I didn't know what bok choy was . . . but once I started I
got hooked.''
Double Up Focus Group Participant, Detroit.
The Double Up Story in Detroit
University of Michigan researchers have been analyzing transaction
data for almost 12,000 SNAP shoppers--almost five percent of all SNAP
households in the region--who used Double Up Food Bucks at eight
Detroit farmers' markets in 2012 and 2013. The researchers led by Dr.
Alicia Cohen also conducted seven focus groups with SNAP shoppers who
had used the program with the goal to understand the challenges
participants faced accessing food, the strategies they adopted to
achieve the best nutrition with limited means, how they felt about the
Double Up program, and what they thought could be done to improve
it.\13\
---------------------------------------------------------------------------
\13\ Ibid.
---------------------------------------------------------------------------
Preliminary data show that 90 percent of Double Up participants in
Detroit had annual household income of less than 100 percent of the
Federal Poverty Level (FPL) and were poorer than the area's SNAP
population as a whole. Among focus group participants, almost 40
percent usually or always worried about having enough money to buy
food. Thirty percent reported that they were in fair or poor health, 41
percent were overweight, 27 percent had diabetes, and 27 percent had
hypertension.\14\ These SNAP shoppers reported regularly having to make
trade-offs between more expensive healthier foods and having enough to
eat at all. They stretched their limited food dollars by shopping at
sales, using coupons, buying in bulk, and preserving food.
---------------------------------------------------------------------------
\14\ [Ibid.]
---------------------------------------------------------------------------
These consumers were worried about their health and worked hard to
ensure that their diets were as nutritious as possible. More than \1/2\
had shopped at a participating farmers' market six or more times during
the season, which was impressive considering the transportation
barriers some faced.
``Where I work, it's 15 miles away and it takes about 2\1/2\
hours to get there on the bus and 2\1/2\ hours to get back on
the bus . . . So I'm not only working my 5 or 6 hour shift but
it literally takes 5 or 6 hours and by that time I'm ready to
go to bed.''
Double Up Focus Group Participant, Detroit.
Studies consistently show that shoppers of all income levels are
motivated by the same things: price, taste, quality, selection,
environment, and convenience with low-income shoppers much more
sensitive to price. Double Up program participants in Detroit talked
about the importance of having additional food dollars to spend and
also emphasized the benefits the farmers' markets provided including
high-quality fruits and vegetables, wide product selection that allowed
them to try new foods, and a positive environment and shopping
experience. They liked participating in market activities, sometimes
with their children, and the opportunities to forge relationships with
the vendors. They also talked about feeling good that the money they
spent helped support the farmers and stayed in the local economy.
The Food Insecurity Nutrition Incentive Grants Program
Based on the positive results of pilot SNAP produce incentive
programs around the country, the 2014 Farm Bill established the Food
Insecurity Nutrition Incentive (FINI) program at the USDA.\15\ This
competitive grants program provides supports projects that incentivize
SNAP shoppers to purchase fruits and vegetables. The goal is to allow
existing projects to reach scale and to seed new work. The program
allows practitioners to test different approaches to incentive
delivery, to experiment with new technologies, to replicate proven
models, and to study the impact incentives have on SNAP participants'
consumption of healthy produce.
---------------------------------------------------------------------------
\15\ http://nifa.usda.gov/program/food-insecurity-nutrition-
incentive-fini-grant-program.
---------------------------------------------------------------------------
In April 2015, Fair Food Network received a $5 million grant, which
was matched with private funding. Fair Food Network used the feedback
from the Detroit focus groups and years of participant surveys to guide
the organization's plans for the $10 million investment in Double Up in
Michigan.
The funds will be used to better serve SNAP participants by
expanding the program to more farmers' markets and grocery store
locations across Michigan so it's easier to use, and supporting new
technology and other innovations.
In participating grocery stores, shoppers earn Double Up dollars
when they use their SNAP benefits to purchase Michigan-grown fresh
fruits and vegetables. The incentive dollars can be used for any kind
of fresh produce. Requiring the initial SNAP purchase be used on
Michigan produce maintains Double Up's strong connection to local
agriculture and extending the program benefits year round as shoppers
use their incentive dollars to purchase any fresh produce in the store.
Fair Food Network is testing various transaction technologies to
ensure program integrity and minimize any stigma customers might feel
using Double Up. The goal is to find approaches that are cost
effective, secure, user-friendly for vendors and customers, and that
can capture the information necessary to assess the program's impact on
shopping behavior.
Conclusion
Reports from the Council of Economic Advisors and the National
Hunger Commission reaffirm that the SNAP program is a strong and
crucially important food safety net. They highlight the connections
between poverty, hunger, and good nutrition, and encourage careful
experimentation with new ideas to enhance its efficacy.
Fair Food Network's experience and careful external research
indicates that the Double Up Food Bucks' approach incentivizing
nutritious produce purchases among SNAP participants is an effective
way to both reduce hunger and support healthy diets.
Low-income American families should not have to choose between
being hungry and being healthy. Implemented well, SNAP local produce
incentive programs are an effective way to ensure families do not have
to make that choice. Creating a market connection between farmers to
consumers deepens the impact by injecting food dollars into the local
farm economy and fostering a strong and resilient local civic culture.
The Chairwoman. Thank you, Dr. Hesterman. Dr. Wright,
please proceed with your testimony.
STATEMENT OF ASHTON POTTER WRIGHT, Ph.D., LOCAL FOOD
COORDINATOR, BLUEGRASS FARM TO TABLE, OFFICE OF THE MAYOR, CITY
OF LEXINGTON, LEXINGTON, KY
Dr. Wright. Chairwoman Walorski, Ranking Member McGovern,
and Members of the Subcommittee, thank you for the honor to
testify on the Bluegrass Double Dollars Pilot Program, a
project supported by the USDA Food Insecurity Nutrition
Incentive Program, or FINI. And a special thank you to my
fellow witnesses for sharing their important work. My name is
Ashton Wright, and I have the unique responsibility of serving
as the City of Lexington, Kentucky's first local food
coordinator. I manage Bluegrass Farm to Table, a program that
supports food related agricultural development, and the
improvement of nutritional health in the region. In today's
testimony, I will highlight the work happening in Lexington
around nutrition incentive programs, work that was established
by pilot funding from FINI.
I work in partnership with Bluegrass Community Foundation
to implement our Double Dollars Program, which aims to improve
access to healthy, affordable, locally grown produce for low-
income individuals participating in the Supplemental Nutrition
Assistance Program, or SNAP. Simultaneously, the program
strives to strengthen Kentucky's farm economy by increasing the
demand for locally grown produce. Based on our pilot project
experience, we have identified three ways to strengthen the
FINI program. One, encourage strong multi-sector partnerships.
Two, increase coordination and collaboration with state SNAP
offices. And three, develop a community of practice for FINI
grantees.
To provide context, one in five Kentucky residents
participates in SNAP. Additionally, our region faces the
dichotomy of food insecurity and high rates of obesity.
Increasing produce consumption is a documented strategy to help
reduce many of the health outcomes associated with obesity. Two
of the critical barriers to the purchase and consumption of
fresh produce among low-income Lexington residents is lack of
access and affordability. Bluegrass Double Dollars aims to
reduce these barriers.
Specifically, our program allow SNAP participants to double
their purchasing power to buy locally grown produce at three
pilot locations, a farmers' market, a cooperatively owned
grocery store, and a corner market. The program provides
incentives for Kentucky grown produce, coupled with targeted
community outreach and education to help SNAP participants
become more familiar with, and more willing to purchase,
locally grown produce. According to our evaluation data, 90
percent of respondents said that the program encouraged them to
purchase more locally grown produce. In the first 6 months of
our pilot, the average redemption rate of our incentive
vouchers was nearly 80 percent, and the total value of double
dollars redeemed for Kentucky grown produce was over $15,000, a
win-win for SNAP recipients and Kentucky farmers. This last
year we have learned that there is tremendous value in
partnering with the Federal Government on nutrition incentive
programs. It demonstrates commitment to promoting healthy
eating and reducing food insecurity. Because our pilot
demonstrates the benefits of healthy eating and supporting
local farmers, it allows us to partner and leverage support
with stakeholders and funders in both the health and
agriculture sectors.
From our experience, we recommend the Committee consider
providing USDA with an increase of resources to implement the
following three recommendations. First, we recommend that
strong multi-sector partnerships be encouraged in an effort to
develop sustainable incentive programs that encourage healthy
eating among SNAP participants. FINI provides a unique
opportunity for building stronger partnerships between the food
security and local agriculture sectors by prioritizing projects
that incentivize locally sourced produce. Future Federal
initiatives should build on this momentum to improve access to
healthy, affordable produce, while also strengthening local
food economies.
Second, we recommend a more comprehensive approach to
educating SNAP recipients about where they can use their SNAP
benefits. Specifically, we recommend incentivizing state and
local SNAP offices to work collaboratively with grantees to
help educate SNAP participants about where they can purchase
produce with their benefits, and encourage them to take
advantage of these incentive programs, like Bluegrass Double
Dollars. Cultivating this buy-in from state and local SNAP
offices is critical to the future success of programs like
FINI.
Third, in the spirit of maximizing the impact of Federal
dollars, we recommend that USDA develop a community of practice
for organizations implementing incentive programs through FINI
to share best practices and lessons learned. This peer-to-peer
technical assistance network would streamline the development
of resources on which all FINI grantees are working, including
technology development, logistics, and education. Fostering
this multi-sector collaboration will maximize the impact of the
Federal investment in this program.
I look forward to working with the Subcommittee, and my
colleagues, to build on the momentum FINI has established to
bridge the gap between the important work of reducing food
insecurity and strengthening local food economies. And again, I
sincerely thank the Chairwoman, Ranking Member McGovern, and
members of the staff and Subcommittee for the opportunity to
share our lessons learned from the field today.
[The prepared statement of Dr. Wright:]
Prepared Statement of Ashton Potter Wright, Ph.D., Local Food
Coordinator, Bluegrass Farm to Table, Office of the Mayor, City of
Lexington, Lexington, KY
Improving Access to Healthy Food and Supporting Local Food Systems
through the Food Insecurity Nutrition Incentive (FINI) Program
Introduction
Subcommittee Chairwoman Walorski, Ranking Member McGovern, and
Members of the Subcommittee on Nutrition, it is an honor to be here to
testify on the Bluegrass Double Dollars Pilot Program--a project
supported by the USDA Food Insecurity Nutrition Incentive (FINI)
program. Thank you for the opportunity to share what we have learned
from our pilot project relating to food insecurity, nutrition, economic
development, and public-private partnerships. And a special thank you
to my fellow witnesses for sharing their strategies to reduce food
insecurity through the implementation of nutrition incentive programs.
I manage Bluegrass Farm to Table, an initiative of the City of
Lexington's Office of Economic Development. Bluegrass Farm to Table
serves as a mechanism to increase coordination and collaboration among
stakeholders at all levels of the local food system--from production to
consumption--and to improve the nutritional health in the region. FINI
presents an incredible opportunity to tackle both of these priorities.
In partnership with Blue Grass Community Foundation, Bluegrass Farm to
Table manages the Bluegrass Double Dollars Pilot Program funded by
FINI. Bluegrass Double Dollars aims to improve access to affordable,
locally grown produce for low-income individuals participating in the
Supplemental Nutrition Assistance Program (SNAP). Simultaneously,
Bluegrass Double Dollars strives to stimulate Kentucky's farm economy
by increasing the demand for locally grown fruits and vegetables.
Based on our experience as a FINI pilot project recipient, we
recommend that the Committee provide USDA with an increase of resources
to:
encourage stronger multi-sector partnerships;
increase coordination and collaboration with state SNAP
offices; and
develop a community of practice for FINI grantees.
Background
One in five Kentucky residents (828,000) participates in SNAP--the
majority of whom are children, elderly, or the disabled. 16.4% of all
households are considered food-insecure.\1\ Additionally, Kentucky has
the 5th highest prevalence of obesity in the nation (prevalence =
33.2%).\2\ High rates of obesity correlate with high rates of chronic
health conditions such as diabetes, hypertension, heart disease, and
certain cancers. Therefore, it is imperative to continue to find
solutions to address these problems, particularly among low-income and
food-insecure individuals.
---------------------------------------------------------------------------
\1\ Center on Budget and Policy Priorities analysis of data from
USDA Food and Nutrition Service, FY 2013.
\2\ ``The State of Obesity: Better Policies for a Healthier
America'' from Trust for America's Health and the Robert Wood Johnson
Foundation, 2014.
---------------------------------------------------------------------------
A documented strategy to help reduce many of the aforementioned
chronic health conditions is to increase the consumption of fruits and
vegetables. However, low-income individuals are often unable to locate,
purchase, and prepare healthier food items. Two of the critical
barriers to the purchase and consumption of fresh fruits and vegetables
among low-income Lexington residents are the lack of access and
affordability. Specifically, access is particularly problematic for
low-income individuals who live in the pockets of food deserts where
fresh fruit and vegetables are not available. The fresh fruits and
vegetables that are available, particularly those that are locally
grown, are often too expensive for low-income individuals to purchase.
The Bluegrass Double Dollars program aims to reduce these barriers.
Kentucky enjoys a rich agricultural history, largely steeped in
tobacco production. Over time, farmers have begun to transition to
vegetable production. Most farms in Kentucky are small (under 50 acres)
and depend on direct-to-consumer markets to sustain their farm
enterprises. With a ready and growing supply of local produce and other
farm products, many of these small to medium-sized producers are eager
to grow their customer base and welcome the opportunity to partner with
programs, such as Bluegrass Double Dollars.
Bluegrass Double Dollars Pilot Program
The Bluegrass Double Dollars program is a collaborative public-
private partnership between Bluegrass Farm to Table and Blue Grass
Community Foundation. The program is designed to make local produce
more accessible to SNAP participants in the Lexington area while
expanding the market for local food producers. Specifically, the
program allows SNAP beneficiaries to double their purchasing power to
buy locally grown fruits and vegetables at three pilot sites--a
farmers' market, a cooperatively owned grocery store, and a corner
store. The program provides incentives for Kentucky-grown produce
coupled with targeted community outreach and education to help SNAP
participants become more familiar with and more willing to purchase
locally-grown produce. According to our pilot project evaluation data,
90% of respondents said the Bluegrass Double Dollars program encouraged
them to purchase more locally grown fruits and vegetables and that they
would be more likely to shop at venues where they know the program will
be offered.
This collaborative economic initiative is focused on supporting
both Kentucky SNAP participants and Kentucky farmers. In the first 6
months of our pilot, the average redemption rate of our incentive
vouchers was nearly 80%, and the total value of Double Dollars redeemed
for Kentucky grown produce was just over $15,000--a win-win for SNAP
recipients and Kentucky farmers. The pilot program has gained momentum
as participation and redemption have increased nearly each month the
program has been in place.
Value of FINI
The Food Insecurity Nutrition Assistance Program represents a
unique opportunity to meet the two primary goals of Bluegrass Farm to
Table-supporting food-related agricultural development and the
improvement of nutritional health in the region. The architects of FINI
should be commended for providing multiple levels of funding (pilots,
projects, and large-scale projects) to develop programs with varying
scales and scopes as opposed to taking a one-size-fits-all approach.
The pilot funding parameters afforded our planning team in Lexington a
great deal of flexibility when designing and implementing our incentive
program.
There is tremendous value in nonprofits partnering with the Federal
Government on incentive programs such as FINI. It demonstrates that the
Federal Government is committed to promoting healthy eating and
reducing food insecurity. Having the FINI pilot project grant also
allows us to leverage support and buy-in from partner organizations to
help sustain the Bluegrass Double Dollars program. Because our pilot
demonstrates the benefits of healthy eating and supporting local
farmers, it allows us to partner with stakeholders and funders in both
the health and agriculture sectors.
Lessons Learned and Recommendations from the Field
FINI provides a strong foundation for developing sustainable
incentive programs to improve healthy eating among food-insecure
individuals. It also provides a unique opportunity to support local
food producers. To build on this momentum and to improve future
iterations of the program, we recommend that the Committee provide USDA
with an increase in resources to:
Encourage strong multi-sector partnerships;
Increase coordination and collaboration with state SNAP
offices; and
Develop a community of practice for FINI grantees.
Encourage Strong Multi-Sector Partnerships
Strong multi-sector partnerships should be encouraged in an effort
to develop holistic and sustainable incentive programs that encourage
healthy eating among SNAP recipients. The FINI program provides a
unique opportunity for building stronger partnerships between the food
security and local agriculture sectors because it gives preference to
projects that incentivize locally or regionally sourced produce. Future
Federal opportunities should build on this momentum. Practitioners
working on food security and local food systems should be challenged to
work with one another to develop creative and sustainable solutions
that improve access to healthy, affordable, local food while
stimulating the local and regional food economies. Increased synergy
between these two sectors has the potential to maximize funding,
leverage existing resources, and foster multi-sector collaboration.
Bluegrass Farm to Table and its partner organizations were thrilled
to see FINI as a provision in the Agriculture Act of 2014 (Farm Bill)
because it allows for increased collaboration between organizations
working to address food insecurity and those working to build strong
local food economies. The key multi-sector partners involved in
Bluegrass Double Dollars include: a community foundation, a
cooperatively owned grocery store, a farmers' market, a corner store
located in a food desert, Cooperative Extension/SNAP Education Staff,
and the University of Kentucky's College of Agriculture, Food, and
Environment.
Increased Coordination and Collaboration with State/Local SNAP Offices
A more comprehensive approach to educating SNAP recipients about
where they can use their SNAP benefits, particularly places that
routinely offer healthy, locally produced food is needed. Specifically,
we recommend that future FINI requests for proposals incentivize state
and local SNAP offices to work collaboratively with FINI grantees to
help educate SNAP beneficiaries about where they can use their SNAP
benefits for the purchase of produce and encourage them to take
advantage of incentive programs such as Bluegrass Double Dollars. We
heard stories from program participants that it was not until they
heard about the Bluegrass Double Dollars Program that they realized
they could even use their SNAP benefits at the farmers' market and the
cooperatively owned grocery store. We recognize that educating SNAP
users about locations where they can take advantage of the incentive
program is an integral component of the program; therefore, we will
continue to invest in education and outreach aimed at a wider audience
of SNAP users in the Lexington.
Because state and local SNAP offices are tasked with the
responsibility of issuing and managing benefits, beneficiaries view
them as a trusted source of information. If state and local SNAP
offices are incentivized to make healthy eating, especially from local
and regional markets, an internal priority, SNAP recipients will be
encouraged to use their benefits for locally grown produce, which
directly benefits local farm economies. Because all SNAP beneficiaries
come into contact with their state and/or local office while
participating in the program, partnering with these offices is a much
more efficient way to ensure that all possible beneficiaries are
receiving pertinent information related to available incentive programs
than grantee organizations operating alone. Cultivating this buy-in
from state and local SNAP offices is critical to the future success of
programs like FINI.
Develop a Community of Practice for FINI Grantees
In the spirit of maximizing Federal dollars and minimizing
redundancy, we recommend that the USDA develop a community of practice
for organizations implementing incentive programs through FINI to share
best practices and lessons learned on a regular and recurring basis.
This peer-to-peer technical assistance network would streamline the
development of resources on which all FINI grantees are working,
including technology development, logistics, and education.
Developing the appropriate technology to issue and redeem
incentives is time and resource intensive. Our pilot, and likely
others, would benefit tremendously from utilizing a standardized
technology platform that could be easily tailored to different types of
venues (farmers' markets, retail establishments, etc.) while allowing
for streamlined incentive issuance, redemption, and reporting/data
collection. It is our understanding that several of the programs that
have been implementing incentive programs have experimented with
various types of technological applications, yet none have found a tool
that works well for both farmers' market and retail settings. Working
collaboratively in a community of practice to develop such a tool would
be tremendously valuable.
Currently, there is no incentive for grant recipients to work
together. Establishing a community of practice would ensure that
Federal resources are being maximized in the most efficient manner.
Additionally, because many of the pilot projects involve unique
partnerships, it would benefit the entire group to learn from and
collaborate with organizations from different sectors. Increased
coordination and collaboration among government entities, nonprofits,
and the private sector could have tremendous positive implications for
the success of SNAP incentive programs.
Conclusion
In conclusion, while the FINI program provides us with the
opportunity to bridge the gap between the important work of reducing
food insecurity and stimulating local food systems, more work remains
to ensure that future funding opportunities encourage strong multi-
sector partnerships; coordination and collaboration with state/local
SNAP Offices, and the development of a community of practice for FINI
grantees. Again, I sincerely thank Chairwoman Walorski, Ranking Member
McGovern, and Members of the Subcommittee for providing me with the
opportunity to share our lessons learned from the field.
The Chairwoman. Thank you, Dr. Wright. Ms. Kiley, we are
thrilled to have you today, and you can proceed with your
testimony.
STATEMENT OF KATHLEEN L. KILEY, CROSSROADS FARMERS' MARKET
SHOPPER AND CURRENT SNAP AND WIC
RECIPIENT, WASHINGTON, D.C.
Ms. Kiley. Chairwoman, Ranking Member, and Members of the
Subcommittee, thank you for having me. I am already really awed
by what I am hearing, and excited about it as a member that is
actually using these benefits, and helping my family become
healthier, building a stronger community, and it is really
wonderful, so thank you.
I want to thank you guys for opportunities. There are so
many opportunities I am thankful for, for a part of a
community, and a nation, that lets voices be heard, and really
working with that to change. I have a lot to say about SNAP. I
have a lot to say about WIC. I know I am not here to talk to
WIC, but these are things that have taken my family and held us
up in a time when we really needed it. And that is really
important for our communities to see. So many of these
opportunities--I know that we talk about--don't come easily.
Just the fact that there is a current Subcommittee hearing on
this lets me know that there is work to be done, right? And
those programs are always changing, and are always needing more
eyes and more ears to see them, and to help them, and guide
them, so I thank you for that. I have been a participant in the
SNAP program and the WIC program, the WIC program for 4 years--
it is coming to an end as my son turns 5 next month--and the
SNAP program for at least 3 years. I foresee my time in both
programs really coming to an end soon. But as I do that, I
really feel the need to be a conduit for change, a voice for
really continuing, and letting these things grow.
Hands down my favorite part about the SNAP program are the
incentives that I get at the farmers' market. Not only because
I have really grown a personal relationship with this market,
but because it is such--hands down, ``I am getting something
for free,'' right? But to know that I can go to a market, and
the Crossroads Market allows me to get $15 shared every week
that I go. They will match that, and it is really important. I
have used this particular market to feed my family in a healthy
way through the winter. Literally, there is a beef stick from
the market in my bag. What I do is I go and I buy items that I
know are going to last, because I don't have this market in the
winter. So I go, and I spend all, and I buy things that will
last, onions, potatoes, meat that I can freeze, and it is going
to see me through.
So one of the things that is frustrating is that these
markets are out there, and, as you said, these can't be used if
people don't know about them, right? We do find that the
momentum and the--just hearing that you have this extra money
to buy fruits and vegetables is really important. But, if you
don't know about it, finding where these markets are, I find
that the advertising, or the listing of it on their websites is
very difficult to decipher. I know what I am looking for, so I
know what to ask, but there are a lot of people that don't,
right? I have a food education. I have a relationship with food
that gives me the knowledge to actually begin to already know
how to plan meals that are healthy. There are a lot of
community people that don't know that, right? They haven't been
brought up that way. My son will be brought up that way, so it
is different.
So for me it hasn't affected the health of the way I cook,
because we were already so healthy, but it absolutely affects
the ease at how I do it, the quantity of what I do, what I
cook, and what I purchase for my son, and it has been really
important. But getting this information out there and
streamlined--for one example, how many different names do we
have to have for this program? I mean, Double Dollars, $5,
Triple Your Money Here, is that something that we want to
streamline? Is that something that makes more sense? I know WIC
in Ohio, right? I know WIC in Kentucky. But Double Dollars, do
I know that is what are we calling it? And that is important
for people to see, for them to see, the branding. I mean, that
is how we work, right? I mean, we all know what Pepsi is,
right? So what is the branding for this?
You will notice that I am not really reading off of the
statement, because I don't work as well reading, so one of the
things I would be really excited to think about using this at a
grocery store, but one of the things that this actually does
for me that is important is it takes us out of that large chain
grocery store, and it takes us into this community with
farmers, right, with other families that I would never meet. I
would never meet these families, probably, and their children.
And it gives you a community with--where things are coming
from. Now, the farmer might come from 2 hours away in
Pennsylvania, right, but I see them every single week for 3, 4
months on a row, right? And they know. ``Hey, Kiley, where were
you? I haven't seen you for 2 weeks, what is going on? Here,
give your son an apple.'' Like, that is the kind of thing that
we need to see, to really get to know people, right? To
strengthen our communities, and talk about food. So thank you.
[The prepared statement of Ms. Kiley follows:]
Prepared Statement of Kathleen L. Kiley, Crossroads Farmers' Market
Shopper and Current SNAP and WIC Recipient, Washington, D.C.
Subcommittee on Nutrition,
Committee on Agriculture,
U.S. House of Representatives,
Washington, D.C.
Dear Subcommittee on Nutrition:
Let me begin by giving real thanks for so many things, but first
and foremost for opportunities. Thank you for the opportunity to let
voices be heard, the opportunity to be part of a system that aids those
in need, the opportunity to stress less when it comes to feeding my
family, the opportunity to take part in local community markets that in
turn create awareness and knowledge.
Many of these opportunities have not come easily. Just the fact
that there is a current Congressional hearing in regards to these
programs lets me know that things are always evolving. My hope is that
the continued conversation aids in bettering the system for all
involved.
I have been a participant in the SNAP and WIC programs for over 3
years. As I foresee my time in both programs coming to an end I feel
compelled to stay connected and be a conduit for change where needed.
I must say that my favorite part about using SNAP and WIC are the
farmers' market incentives. These incentives give me the option to show
my son an alternative way of shopping; a way that takes us out of the
traditional stale settings of our large chain grocery stores and lets
us create relationships with vendors and neighbors. I do not always
find the pricing at farmers' markets to be less than our local large
chain supermarket but I do find the quality to be just as good and the
lessons in regards to eating more locally, cutting down on shipping
emissions, and putting growers' faces to products are lessons that will
help mold a generation of growing children armed with social awareness.
As mentioned above, sometimes the pricing at a large chain grocery
store for produce or meat will be less than at a market . . . this is
where the incentives make an huge difference. Knowing that a certain
allotment of my monthly benefits can be used at the market and will be
matched definitely affects my shopping habits, especially during the
summer months when markets are readily accessible and produce is
abundant. I am able to use the extra money to buy products that I can
freeze and use through the winter months.
I am adamant about making as much as our own food as possible and
teaching children how things are made. It is wonderful to buy
ingredients for such foods as applesauce, ice cream, and tomato sauce
from the market and transform the list into a finished product. This
empowers children and adults alike to learn how to adapt food to fit
their likes and dislikes and also leaves little worry as to what
additives have gone into a finished product. Crossroads Market in
Takoma Park, MD does a superb job of creating a food demonstration each
week that is made of items (many times) entirely from the market. This
has given me the opportunity to learn about and taste new herbs,
greens, fruits, and vegetables that I would otherwise have to purchase
first to taste. This is wonderful for children and adults alike.
As is the case with any program a constant eye on how it is
evolving and bettering the community must always be there. I have so
many positive feelings from the market incentive program that is a part
of SNAP and WIC. In regards to the SNAP program, I do wish that the
markets were more transparent about the matching benefits that they
offered. Many times a market site will advertise that they offer these
incentives but it is difficult to decipher from the site, especially if
you are not already familiar with the program. Also the site does not
typically list the matching dollar amount on their website. I was also
pondering if it would help to have all of the markets offering the same
amount of matching dollars or if these amounts should be based per SNAP
recipient and the amount they may receive monthly. I am assuming that
each of these ideas would be based on a number of factors and one
important factor is the means by which a market receives its funding:
private donations or government grants. As it currently stands, the
ease of this program for participants may be one of its largest draws
and too much bureaucracy may diminish the participation . . . and we
would not like that to happen.
I thank you once again for letting voices be heard, for letting
families feed their children in a healthy manner, and for helping
create small communities within this grand United States of America.
These are the opportunities we dream of providing for our children!
Sincerely,
Kathleen L. Kiley.
The Chairwoman. Thank you, Ms. Kiley. Mr. Cooper, please
proceed.
STATEMENT OF ERIC S. COOPER, PRESIDENT AND CHIEF
EXECUTIVE OFFICER, SAN ANTONIO FOOD BANK, SAN
ANTONIO, TX
Mr. Cooper. Chairwoman Walorski, Ranking Member McGovern,
and Members of the Subcommittee, thank you so much for this
opportunity to bring you warm greetings from the great State of
Texas, our Congressional delegation here, and our county
government, and also our mayor, Ivy Taylor. I am pleased to
represent the San Antonio Food Bank, which has a great staff
who work diligently, and a wonderful board, with executives
from companies like Valero Energy, and USAA, and even our World
Champion San Antonio Spurs Greg Popovich. So just feel that
love and support. We are, as a food bank, a member of a state
association, Feeding Texas, where there are a little over 20
food banks that work within the boundaries of the State of
Texas, and we are a part of a national network, Feeding
America, where there are 200 food banks that work together to
feed and serve more than 46 million people in need, which
includes 12 million children and about seven million seniors.
The San Antonio Food Bank actually serves 16 counties of
the great State of Texas, and within those 16 counties, we have
about 530 different partner organizations. They provide food to
about 58,000 people each week. And we basically frame our work
into three different areas, food for today, food for tomorrow,
and food for a lifetime. As clients are in need, that stress of
being food-insecure, and being without food, they might call or
come to the food bank. We want to meet that immediate need of
hunger through a referral to one of our 530 different nonprofit
organizations. We then want to have a conversation around food
for tomorrow. And what we do there is help those families with
application assistance in many Federal programs, to include
SNAP, WIC, the Children's Health Insurance Program, Medicaid,
TANF, and long-term care. In that process we are able to work
with our state to determine eligibility, and we are then able
to have a conversation around employment.
In our core belief, we believe that people should work
according to their ability, and receive according to their
need, and that opportunity for those individuals receiving
assistance to take advantage of our workforce training
opportunities there at the food bank, whether in culinary arts,
or warehouse training, or just direct job placement, moves them
to a place of self-sufficiency, and gives them the dollars that
then they can make decisions on. And we have a very robust
nutrition education program in that last tier of Food For A
Lifetime, which is really about educating families on how to
get the best nutrition for their dollar, and how to leverage
their dollar to get the best nutrition. We were so privileged
to be chosen as a FINI grant recipient, and we have launched a
strategy working with our local Children's Hospital of San
Antonio, and several clinics, and a major grocery retailer, H-
E-B. And we have identified expecting mothers that are SNAP
eligible that enter the program, and receive an incentive based
on participating in a nutrition education curriculum that is
orchestrated at the store level. Those individuals are taught
how to shop a grocery store, and leverage the dollars that they
have.
Time and time again we see the direct correlation between
the poverty line and the waste line. San Antonio has high rates
of diabetes, obesity, heart disease, and we believe in what
Ranking Member McGovern's mother believed, that the apple a day
does keep the doctor away, and that families struggle to get
access to good, healthy food. And there are lots of barriers,
whether that is income, or knowledge, or geography. The food
bank is working to try to bring together the partners in public
and private partnerships to try to remedy that.
It is humbling when we can provide the right food in the
right amounts at the right time to someone that is hungry. When
someone is in need--and we believe that hunger is a symptom of
poverty, and people that are in poverty have lots of issues,
but someone that is hungry just has one issue. And until we
solve that one issue, it is tough to move folks forward to that
place of self-sufficiency. So thank you so much for the
opportunity to share just a few thoughts.
[The prepared statement of Mr. Cooper follows:]
Prepared Statement of Eric S. Cooper, President and Chief Executive
Officer, San Antonio Food Bank, San Antonio, TX
Dear Chairwoman Walorski, Ranking Member McGovern, and Members of
the Subcommittee:
Thank you for inviting me here today. My name is Eric Cooper and I
am the President and CEO of the San Antonio Food Bank in San Antonio,
Texas. I am honored to represent Feeding America's network of food
banks and agencies that, like colleagues here today, work to address
the nutrition and health needs of those in our country facing hunger.
The San Antonio Food Bank is one of nearly 200 food banks in
Feeding America's network, and one of 21 served by Feeding Texas, our
state food bank association, that helps combat hunger and food
insecurity across the United States. Together, we distribute more than
3.7 billion meals each year to more than 46 million people in need,
including 12 million children and seven million seniors, through 58,000
food programs including food pantries, soup kitchens, shelters, after
school and summer feeding sites for children, and other programs.\1\
Last year, the San Antonio Food Bank provided around 60 million pounds
of food and grocery items to needy Texans through more than 530
nonprofit agencies and a myriad of distribution programs across 16
counties in southwest Texas. Our service area spans more than 17,500\2\
miles and includes urban, suburban and rural areas.
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\1\ Feeding America, Hunger in America 2014: National Report.
August 2014. Available at http://help.feedingamerica.org/
HungerInAmerica/hunger-in-america-2014-full-report.pdf (Accessed Feb.
1, 2016).
---------------------------------------------------------------------------
My remarks today will address the important work taking place at
the San Antonio Food Bank and across the Feeding America network to
ensure our low-income neighbors receive the nutritious food they need
to live active, healthy, productive lives. I will discuss our
commitment to providing nutritious food through all of our distribution
channels, as well as providing nutrition education to our clients. From
our experience working directly with clients to help improve their
healthy eating habits, I will discuss the important role of the Food
Insecurity and Nutrition Incentive (FINI) program grants to test new
models in Southwest Texas to incentivize healthy eating among
Supplemental Nutrition Assistance Program (SNAP) recipients.
It is important to note that making real progress toward ending
food insecurity, improving individuals' health, and ensuring
opportunity for all of our nation's adults and children will require
sustaining and strengthening the nutrition safety net. Investments in
SNAP and other nutrition programs are an investment in our country's
health and education and a productive competitive workforce that will
pay dividends in years to come.
Background
The Supplemental Nutrition Assistance Program (SNAP), formerly
known as Food Stamps, is the cornerstone of our country's efforts to
alleviate hunger by supplementing the food budgets of low-income
households. Yet recent studies have shown that the current level of
SNAP benefits are often insufficient to sustain families through the
end of the month and have linked the gap in food access to serious
high-cost consequences, including higher hospitalization rates and
poorer performance in school. The research suggests that modestly
higher benefit levels would lead to improvements in food security and,
in turn, to a wide range of short-run and long-run health, educational,
and economic benefits.\2\
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\2\ White House Council of Economic Advisers. Long-Term Benefits of
the Supplemental Nutrition Assistance Program. December 2015. Available
at http://go.wh.gov/SnapReport (Accessed Feb. 1, 2016).
---------------------------------------------------------------------------
To help meet their nutritional needs, many SNAP recipients still
turn to the Feeding America network of food banks and emergency food
programs for assistance in order to cover all household expenses. In
fact, more than \1/2\ (55 percent) of client households served by the
food bank network receive monthly benefits from SNAP. Of those
households not receiving SNAP benefits, almost \1/2\ have never
applied, most commonly because they did not think they were eligible
though they may be income eligible.\3\
---------------------------------------------------------------------------
\3\ Ibid. Seventy-two percent of client households served by the
Feeding America network not receiving SNAP benefits may in fact be
income eligible for SNAP based on data provided they provided in the
survey.
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The food bank network has evolved from serving clients in short-
term crisis to providing long-term assistance to those in chronic need
of food assistance, many of whom are working, but in low wage jobs.\4\
Clients now turn to food bank programs on a regular basis. Nearly \2/3\
(63 percent) of client households served by food banks report that they
plan to get food from an emergency feeding program on a regular basis
to help with their monthly food budget.\5\ Many clients are working,
though underemployment and stagnant wages persist. More than \1/2\ of
households (53.9 percent) report at least one person working in the
past year, with more than \1/2\ of those indicating they are working
only part-time.\6\ Wages also remain very low. The median monthly
income of households served by food banks is only $927, and 72 percent
of households have incomes below the poverty level.\7\ This requires
critical budget management to cover all expenses, including but not
limited to housing-related costs, food, clothing, transportation, and
medical expenses, for all household members.
---------------------------------------------------------------------------
\4\ Campbell, E., K. Webb, M. Ross, P. Crawford, H. Hudson, and K.
Hecht. 2015. Nutrition-focused food banking. Discussion Paper,
Institute of Medicine, Washington, D.C. http://nam.edu/perspectives-
2015-nutrition-focused-food-banking/ (Accessed Feb. 1, 2016).
\5\ Feeding America, Hunger in America 2014: National Report.
August 2014. Available at http://help.feedingamerica.org/
HungerInAmerica/hunger-in-america-2014-full-report.pdf (Accessed Feb.
1, 2016)
\6\ Ibid.
\7\ Ibid.
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The San Antonio Food Bank, like food banks across the country, is
an active service provider, partner, and thought leader in our local
community. Food banks have become central to the economic well-being of
clients, who often struggle to find regular access to food and are
considered food-insecure, by providing food, resources and other
services. Our food bank is committed to addressing the food and
nutrition needs of our clients. This year, the San Antonio Food Bank
plans to distribute 65 million pounds of food to more than 319,300
hungry adults and children as part of a multi-faceted effort to address
food insecurity in the region. Our efforts rely on the following key
initiatives:
Food Bank Client Service staff assists approximately 3,000
families each month in determining eligibility and completing
applications for a variety of Federal aid programs, including
the Supplemental Nutrition Assistance Program (SNAP), Temporary
Assistance to Needy Families (TANF), Medicaid and the
Supplemental Nutrition Assistance Program for Women, Infants
and Children (WIC);
The Food Bank's Workforce Development staff conducts client-
level needs assessments for referrals from Client Service staff
for those identified as need job placement or continuing
education assistance. The Workforce Program helps unemployed or
under-employed individuals, through case management and job
readiness trainings (e.g., resume writing, job search,
interview preparation and soft skills training), to obtain
employment that earns them a living wage;
The Community Kitchen Culinary Training Program provides
culinary education and job training to economically
disadvantaged community members, helping them gain valuable
certifications and job skills needed to secure jobs in the
restaurant, hotel or catering industries. The Community Kitchen
also provide more than \1/2\ million meals to homeless adults
and children every year;
Through a partnership with the Texas Department of Criminal
Justice, non-violent offenders at the end of their sentences
are offered culinary and warehouse skill training. Individuals
are inserted into our Community Kitchen to learn culinary
skills and help prepare meals, and in our warehouse to learn
relevant trade skills such as using a pallet jack and forklift;
The Food Bank's Nutrition Department educates individuals
about how to eat well and be physically active to prevent
disease. The team is teaching children at schools how to
establish gardens to put them in contact with real food.
The Food Bank's 29 acre Community Garden/Farm is an example
of a successful Urban Agriculture, increasing the access to
fresh produce to low-income communities affected with food
insecurity through the San Antonio Food Bank network. The
Garden/Farm produced around 200,000 pounds of fresh produce in
2015;
The Kid's Cafe Program provides meals directly to hungry
children participating in this community's after school
programs;
The Mobile Pantry Program and the Healthy Options Program
for the Elderly distribute more than 11.9 million pounds of
food a year; and
The Kitchen Table is a client choice food pantry serving
approximately 1200 households with monthly access to food
assistance providing an average of about 100 pounds of food;
the Kitchen Table distributes more than 1 million pounds of
food each year which is 50% of the total for Comal County. The
Kitchen Table will be moving to a new stand-alone facility that
will provide more room for program expansion for the region and
will be known as the New Braunfels Food Bank.
Health Challenges of Clients
In addition to limited household financial resources, we also know
that many clients touching our food bank network have significant
health concerns and a high prevalence of diet-related disease.
According to the most recent national survey of food bank clients,
nearly \1/2\ (47 percent) reported ``fair'' or ``poor'' health. Across
the country, 33 percent of client households include at least one
member with diabetes. For hypertension, the number increases to 58
percent. The costs of care are also concerning for food bank clients
and their households. Nationwide, 29 percent of client households
report having no health insurance coverage, including Medicaid or
Medicare (Note: The Affordable Care Act went into effect after the
fielding period of this survey). Recent data show that more than \1/2\
(55 percent) of food bank clients have unpaid medical bills. Further,
\2/3\ (66 percent) of clients have had to choose between buying food
and paying for medicine or medical care in the past year, with 31
percent reporting facing this tradeoff every month.\8\
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\8\ Feeding America, Hunger in America 2014: National Report.
August 2014. Available at http://help.feedingamerica.org/
HungerInAmerica/hunger-in-america-2014-full-report.pdf (Accessed Feb.
1, 2016)
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Many of the nation's most prevalent chronic illnesses are diet-
related, including obesity, cardiovascular disease, hypertension, and
type 2 diabetes. These diseases can be prevented or mitigated by access
to and consumption of healthful food.\9\ Food bank clients who are low-
income and struggle with food insecurity often struggle with several
factors that increase their risk of developing chronic diet-related
health issues and exacerbate these conditions for those who already
live with them. These factors include limited financial resources; lack
of regular access to healthy, affordable foods; and limited access to
basic health care.\10\
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\9\ Harvard Law School's Center for Health Law Policy and
Innovation, Feeding America. Food Banks as Partners in Health
Promotion: Creating Connections for Clients & Community Health (White
paper). Available at http://healthyfoodbankhub.feedingamerica.org/
resource/food-banks-as-partners-in-health-promotion/ (Accessed Feb. 1.
2016).
\10\ Food Research and Action Center. Why Low-Income and Food
Insecure People are Vulnerable to Obesity. Available at http://
frac.org/initiatives/hunger-and-obesity/why-are-low-income-and-food-
insecure-people-vulnerable-to-obesity/ (Accessed Feb. 1. 2016).
---------------------------------------------------------------------------
Our network's collective understanding of how food insecurity and
nutrition connect and contribute to health outcomes has increased and
continues to grow. That knowledge helps inform our programs and
initiatives to help address the full health needs of our clients.
Providing Nutritious Food
The San Antonio Food Bank and the broader Feeding America network
is dedicated to helping improve client access to fruits, vegetables,
lean protein and dairy foods. Food banking began as a ``salvage and
rescue model'' more than 40 years ago, redirecting food from landfills
and delivering it to individuals and families in need. Today, the
Feeding America network has evolved into a much more complex system. A
diverse mix of food moves through the food bank network, secured from
many different places including farms, manufacturers, retailers, the
Federal, state, or local government, food drives and even some food
purchases. Through all of these sources of food, the Feeding America
network strives to balance the need of providing enough food while also
working to ensure that the foods secured are as healthful as possible
to nourish the millions of people served.
To secure healthful foods, the network has increased national
efforts to provide Foods to Encourage, or foods that closely align with
the 2015 USDA Dietary Guidelines for Americans, at member food banks.
Foods to Encourage is Feeding America's approach to estimate the
nutritional contributions of food categories in food banks'
inventories.\11\ The goal is to have 75 percent of food distributed
through the Feeding America network classified as Foods to Encourage by
2025. Of the nearly 4.1 billion pounds of groceries Feeding America
distributed in 2014, 67.8 percent, or 2.8 billion pounds, were
categorized as Foods to Encourage. Over the last few years, Feeding
America has made great strides in increasing the capacity of the
network to handle fresh foods. This has included a comprehensive array
of services built around securing and distributing produce, dairy and
lean protein. As a result, produce is now the number one food category
of Foods to Encourage distributed--with over 1.1 billion pounds
distributed, or 38.9 percent of Foods to Encourage.
---------------------------------------------------------------------------
\11\ Download a list of Foods to Encourage at Healthy Food Bank
Hub: Tools & Resources. Available at http://
healthyfoodbankhub.feedingamerica.org/resource/foods-to-encourage/
(Accessed Feb. 1, 2016)
---------------------------------------------------------------------------
At the San Antonio Food Bank, \2/3\ of the roughly 60 million
pounds of food and grocery items in 2014 were classified as Foods to
Encourage. Overall, \1/3\ of the food, or 20 million pounds, we
distribute to our partner agencies and clients was produce.
Securing and storing food is just the beginning, and ensuring that
it is delivered in a manner that ensures client dignity, choice, health
and safety is critical. Like the diverse channels of food sources, the
San Antonio Food Bank and our sister food banks distribute food through
a multifaceted system, which ultimately gets food to people in need
through traditional emergency food distributions such as local food
pantries, soup kitchens, shelters and increasingly through other core
programs such as mobile pantry programs, senior programs, and child
nutrition programs.
Helping Clients Improve Healthy Eating
In addition to procuring and distributing healthy food, efforts to
pair healthy food access with nutrition education have increasingly
spread across the network and been central to our work at the San
Antonio Food Bank. These efforts help individuals and families choose,
prepare and consume healthful foods.
Nutrition Education and Food IQ
There is no ``one-size-fits-all'' model for delivering nutrition
education. Nonetheless, there are some widely accepted nutrition
education and public health best practices, including, but not limited
to focusing on specific behaviors rather than knowledge alone;
involving active participation on the part of the learners through a
variety of teaching methods; and addressing the motivations, needs and
interests of the target audience. Food banks and other emergency food
providers use a wide range of nutrition education strategies--from
establishing school gardens, teaching healthy cooking and partnering
with healthcare organizations--to promote healthy food choices in the
communities they serve. With a new brand--FoodIQ--the SAFB continues to
direct all efforts to modify the environment and promote health.
The San Antonio Food Bank has 35 years of experience partnering
with public, private, for-profit and nonprofit entities to develop and
sustain regional nutrition and health and wellness initiatives. The
Food Bank has developed a highly successful, unique approach to the
provision of nutritional education to thousands of Food Bank clients
and community participants each year, benefiting age groups ranging
from infants to schoolchildren and pregnant women to seniors. Examples
of programs implemented by the Food Bank include:
Raising Healthy Eaters emphasizes proper nutrition and the
inculcation of lifelong healthy eating habits at the most
critical stages of development, from conception to the age of
3.
Diabetes Education Classes (Viva Bien/Live Well with
Diabetes) teach participants how to use healthy dietary
practices to prevent and manage their diabetes.
Healthy Cooking/Gardening Curriculum is offered at several
school districts and charter schools to connect students to
real foods while teaching them cooking and gardening skills.
Project HOPE food distribution promotes a healthy lifestyle
and improved nutrition for participants over the age of 60.
The San Antonio Food Bank Farmers' Market Association hosts
farmers' markets throughout the year in the community and at
the Food Bank, increasing access to fresh fruits and vegetables
for the community and target families receiving SNAP and other
Federal assistance.
Mobile Farmers' Markets procure, package, transport and
distribute fresh fruits and vegetables in areas of the
community where there is little or no access to healthful
produce. Each distribution provides as much as 10,000 pounds of
produce to as many as 200 families. On-site nutrition education
is also provided.
Promoting Urban Gardening teaches agencies and schools how
to establish community gardens and teaches gardening classes.
Healthcare Partnerships
The San Antonio Food Bank is also partnering with hospitals and
other healthcare providers with the purpose of stabilizing the lives of
people affected with food insecurity to help them prevent or better
manage chronic diseases. Recent developments in the health care
landscape aim to improve both access to health care and the quality of
care received. Food banks like ours are well-positioned to help clients
benefit from these new developments by becoming partners in health
promotion. As experts in addressing food insecurity, our food bank can
expand on existing community relationships to craft new collaborative
endeavors to address food and nutrition needs with both public and
private insurers as well as providers, including hospitals, community
health centers, clinics, and private medical practices.
We are working with the local chapter of the Bexar County
University Health System to establish a food pantry for discharged
patients experiencing food insecurity. The hospital will screen
patients for food insecurity and for those deemed food-insecure, their
doctor will give them a prescription for produce.\12\ The patient will
then redeem the prescription at a food pantry on-site in a space being
renovated by the hospital. The San Antonio Food Bank will staff the
pantry with a nutritionist who will run the pantry and educate patients
to help them better manage or prevent a chronic condition. In addition,
the patient will be referred to the San Antonio Food Bank's client
services department for assistance signing up for Federal nutrition
benefits, health insurance benefits and workforce development
assistance.
---------------------------------------------------------------------------
\12\ Patients will be deemed food-insecure when they respond
``often true'' or ``sometimes true'' to these two statements: (1)
Within the past 12 months we worried whether our food would run out
before we got money to buy more; and (2) Within the past 12 months the
food we bought just didn't last and we didn't have money to get more.
---------------------------------------------------------------------------
However, not all healthcare entities have space for a food pantry.
So, in the near future the San Antonio Food Bank will be launching its
``Mobile Mercado'' produce truck. The Mobile Mercado is an affordable
farmers' market on wheels that can travel to food deserts and other
locations throughout the city. In an effort to offer fresh produce to
more patients in need, the San Antonio Food Bank Mobile Mercado will
partner with different hospitals that do not have room for a pantry.
Doctors will write a prescription for produce to patients experiencing
food insecurity. The patient will redeem the prescription at the Mobile
Mercado while receiving nutrition, health and wellness education, along
with a referral to our Client Services Department for assistance
applying for Federal benefits.
This program is designed to not only help patients currently in
need to receive healthy food today, but to teach them how to live a
healthier lifestyle for a more fulfilling future.
Innovations to Improve Client Health
Below are other innovative programs taking place at food banks
across the country to help improve client health.
Nudges: Building on findings from behavioral economics, some food
banks have made simple changes to food distribution environments that
``nudge'' clients to select healthier options. Feeding America has been
working with Cornell University on evidence-based nutrition education
strategies to help increase the consumption of healthy foods. When it
comes to food, ``nudges'' or environmental cues such as signage,
colors, packaging and product placement, have been identified as
factors that an influence consumer choice and, ultimately, health. An
example of a nudge intervention for increasing the selection of more
healthy foods is the front and center placement of a Foods to Encourage
product, along with signage, that brings that product to the attention
of shoppers.\13\
---------------------------------------------------------------------------
\13\ For more information on the use of nudges in the food bank
network setting, see http://healthyfoodbankhub.feedingamerica.org/
nudges/.
---------------------------------------------------------------------------
Diabetes Intervention: To determine whether healthy food can help
low-income people better control their diabetes, a pilot study by UC
San Francisco and Feeding America tracked nearly 700 people at food
banks in California, Texas and Ohio over 2 years. The result: better
diabetes control and medication adherence and an overall improvement in
the consumption of healthy food.\14\ This research, funded by the
Bristol-Myers Squibb Foundation, is the first formal evaluation of a
diabetes intervention for food-insecure people involving the actual
provision of food. The observational pilot study is now being followed
by randomized control trials at food banks in Oakland, Detroit and
Houston by UCSF and Feeding America.\15\
---------------------------------------------------------------------------
\14\ Seligman, Hilary K., et al. ``A Pilot Food Bank Intervention
Featuring Diabetes-Appropriate Food Improved Glycemic Control Among
Clients In Three States.'' Health Affairs 34.11 (2015): 1956-1963.
\15\ For more information about the diabetes interventions, see
http://healthyfoodbankhub.feedingamerica.org/resource/health-affairs-
article-a-pilot-food-bank-intervention-featuring-diabetes-appropriate-
food/.
---------------------------------------------------------------------------
Food Insecurity and Nutrition Incentive Grant
Building on the San Antonio Food Bank's extensive work directly
with clients to improve their health, the Food Bank applied for and was
awarded a grant in 2015 through the Food Insecurity Nutrition Incentive
(FINI) program. The FINI Grant Program supports projects to increase
the purchase of fruits and vegetables among low-income consumers
participating in SNAP by providing incentives to use at the point of
purchase.
The goal of the San Antonio Food Bank's proposed FINI Pilot Project
is to determine if a combination of targeted, culturally appropriate
health education and point of sale incentives can increase the purchase
and consumption of fruits and vegetables among 200 pregnant and post-
partum SNAP recipients. The San Antonio Food Bank along with local
grocer H-E-B, Children's Hospital of San Antonio, CentroMed, and
Goldsbury Foundation are partners in the local FINI grant.
The proposed FINI Pilot Project is a 1 year pilot project to
determine the efficacy, scalability and sustainability of an integrated
model that seeks to make permanent changes in eating behaviors
(increasing consumption of fruits and vegetables) by providing
targeted, easily accessed support (shopping assistance, cooking
classes, purchase incentives) to high risk, highly vulnerable SNAP
recipients (women and children will be the main beneficiaries).
The FINI study was designed to be presented to patients of the
CentroMed Clinic who are being seen for prenatal care. A table tent is
displayed in the lobby of the CentroMed Clinics to advertise the study.
Additionally, flyers are displayed at the San Antonio Food Bank and at
the Food Bank's Mobile Pantry distributions (four scheduled) to
advertise the research study. New pregnant mothers inquiring about the
study without an established obstetric physician must establish care
with a CentroMed Clinic before being included in the study. Eligible
patients will be 0-20 weeks in pregnancy gestational age.
The FINI project has several components that will be provided to
participants over a 9 month period:
Nutritional literacy administered three times during the
study participation.
Cooking classes sponsored and conducted by dietitians from
H-E-B, our local grocery partner.
Shopping tours sponsored by and conducted by H-E-B
dietitians.
Access to a mobile farmers' market sponsored by the San
Antonio Food Bank.
Nutrition education will be provided on topics including: education
on MyPlate regarding balance and variety, nutritional label reading,
nutrients list, breastfeeding, post-pregnancy nutrition, and cooking at
home. This education will be provided by the CentroMed nurse following
a standard of care appointment. The educational session will last
anywhere from 5-15 minutes. This may be longer depending on the
questions and feedback and interest in the topic that the subject has.
This is a research only educational session. It is not standard of care
that prenatal patients receive in-depth nutritional information.
Subjects must attend the monthly educational session to continue their
participation in the study.
Participants in the FINI project who complete the required
activities are given a $40 food card redeemable for fresh produce,
frozen or canned fruits and vegetables. The incentive food cards are
provided monthly during study participation. The food card can be
redeemed at a local grocery store, H-E-B, who has partnered on the FINI
project.
The planned study to enroll 200 low-income pregnant and postpartum
mothers faced a challenge of slower recruitment rate of SNAP
participants under the proposed criteria than expected. The Food Bank
has worked with USDA to modify the scope by broadening the target
population. Initial feedback from study participants show promising
indications pointing to improved fruit and vegetable purchases and
improved eating habits. We look forward to continuing this FINI
project, learning from the results and applying them to strengthen
similar interventions, going forward.
Second Round FINI Grant Proposal
The San Antonio Food Bank submitted a subsequent proposal for the
second round of FINI grants, this time to address the ``grocery gap''
problem in two communities of Texas--the Eastside Promise Neighborhood
of Bexar County in San Antonio, and rural La Salle County. The Food
Bank will leverage the knowledge and understanding gained operating
SNAP outreach and education programs during the last 12 years and
working with food-insecure, low-income communities. For example, since
2010 we have partnered with multiple community agencies to operate
Farmers' Markets to ensure those neighborhoods in food deserts--areas
with little or no access to fresh fruits and vegetables--have access to
fresh, healthy foods. Five markets operated in 2015 to provide produce
and products from a diverse collection of local farmers and vendors,
nutrition education, and on-site demos. The markets are also SNAP and
WIC certified retailers.
The FINI project will be implemented in Bexar and La Salle Counties
using the San Antonio Food Bank ``Mobile Mercado'' to travel to the
targeted areas to outreach and implement the food, nutrition, healthy
cooking and health education intervention. The Mobile Mercado is an
affordable farmers' market on wheels that can travel to food deserts
and other locations throughout the city. In an effort to offer fresh
produce to more SNAP participants benefiting from the FINI
intervention, the San Antonio Food Bank Mobile Mercado will partner
with different community organizations located in food desert areas
without access to grocery stores selling healthy foods. SNAP
participants coming to the Mobile Mercado will receive health
screenings, nutrition education services and will have access to
healthy food on site. SNAP participants will receive their monthly
produce incentive after attending the classes. They will also receive
information on how to access other Federal benefits in addition to SNAP
as well as information on the Food Bank's Workforce Program to help
them find gainful employment. Through a partnership with Baptist Health
Solutions, we will screen the SNAP population participating in the
project for health risk factors associated with food insecurity, such
as obesity, high blood pressure and pre-diabetes.
Conclusion
The San Antonio Food Bank, like food banks across the country, is
proactive. We identify challenges facing our clients and our
communities and we address them head-on. The work we have done over the
years to improve the health and nutrition of members of our community
continues to grow. The FINI grant has allowed us to address even more
community nutrition challenges by working with new partners in a new
context to improve the health of targeted or selected SNAP recipients
through the use of nutrition incentives. We do not do this work alone.
We have long-standing and effective partnerships with local, state and
national public and private organizations, are increasing partnerships
with the healthcare sector, and have fostered targeted partnerships
around the FINI grants.
While the FINI grants are important for developing learning to help
encourage nutrition, ensuring benefit adequacy is critical. The SNAP
program has successfully improved the nutritional needs of millions of
low-income individuals. Congress should protect and strengthen the SNAP
program and improve SNAP benefit adequacy for all recipients. This will
further help households build on the knowledge gained through nutrition
education and programs like the FINI grants, and ensure they have the
resources they need for an adequate, nutritious diet. Working together
with Federal, state, and local partners and the clients we serve, we
can ensure all of our neighbors have the nutrition they need.
On behalf of the San Antonio Food Bank, Feeding Texas, Feeding
America, our partner agencies and the people we serve, I thank you for
your time and attention. I encourage you to strengthen SNAP and other
nutrition assistance programs to help ensure low-income individuals
have the resources they need for adequate, nutritious food. And if you
have not already, I encourage you to visit your local food bank to see
first-hand the great work they do. Thank you.
Sincerely,
Eric S. Cooper,
President and CEO,
San Antonio Food Bank.
The Chairwoman. Thank you, Mr. Cooper. Ms. Petee, please
proceed. Can you turn your microphone on?
STATEMENT OF BARBARA J. PETEE, EXECUTIVE DIRECTOR, THE ROOT
CAUSE COALITION; CHIEF ADVOCACY AND
GOVERNMENT RELATIONS OFFICER, ProMedica,
WASHINGTON, D.C.
Ms. Petee. Good morning, Chairwoman Walorski, Ranking
Member McGovern, and Members of the Nutrition Subcommittee. It
is my pleasure to be here today as the Executive Director of
The Root Cause Coalition, as well as the Chief Advocacy Officer
for ProMedica, a Toledo, Ohio based nonprofit health system
that serves 27 counties of northwest Ohio and southeast
Michigan. I have spent the better part of my career working
with clinicians, administrators, policymakers, health care
leaders, and community partners to address health disparities
in ProMedica's service area. As we battled epidemics of low
birth weight, childhood obesity, diabetes, heart disease,
cancer, and other chronic diseases, we, like many health care
providers across the country, began to ask, why? Why are we
seeing such high rates of these issues in our community?
From this simple question, ProMedica began a journey that,
in partnership with the AARP Foundation, founded The Root Cause
Coalition, to bring the full power of the health care community
to bear in addressing the social determinants of health, with
specific focus on hunger as a health issue. If I have learned
anything from this work, and this is the most important thing
that I hope the Committee will take away from my short time
with you today, is that hunger is a health issue, and food is
the best medicine.
It is because of this indisputable fact that the work of
the Subcommittee to strengthen our nation's nutrition policy is
so vitally important. Your work on these basic building blocks,
especially the SNAP Program, have far-reaching impacts on many
issues at the foundation of a strong future for our country.
Proper nutrition, especially during an individual's
developmental years, has a direct impact on the long-term
productivity, economic status, and health of that individual,
and ultimately entire communities. The programs overseen by
this Committee are about more than the immediate needs of
hungry children, adults, and seniors. These programs are core
investments in the health and well-being of your constituents,
and our nation's ability to adapt to an ever-changing global
economy.
As a nation, the health care community in particular are
coming to terms with the realization that the social
determinants of health, especially access to proper nutrition,
have a direct impact on an individual's health. Lack of access
to proper nutrition not only leads to and exacerbates a plague
of chronic physical and mental health conditions, but it also
impedes brains development, educational outcomes, and economic
viability. It limits access to safe, affordable housing and
transportation, and leads to disciplinary and public safety
concerns. Proper nutrition is the cornerstone of our ability to
ensure the lifetime health of individuals, communities, and our
nation. Without it we cannot hope to have a lasting impact on a
litany of other social determinants affecting community health.
But this is more than just an altruistic discussion, it is
about dollars and cents. The cost of hunger to the health care
community alone totals nearly $130.5 billion every year, and
the cost to every U.S. citizen over a lifetime is on pace to
reach roughly $42,400. We know that ensuring pregnant women
have access to nourishing food throughout pregnancy increases
the chance for a full term, healthy weight baby. To put that in
perspective, in 2008 approximately ten percent of births
nationwide included a diagnosis of pre-term or low birth
weight, but those births accounted for nearly 45 percent of all
infant hospitalization costs, or over $10 billion. These low
birth weight and pre-term babies are also at a greater risk of
delayed development, chronic disease, and a lifetime of poor
health.
We know that hunger is a health issue, we know that food is
the best medicine, and we know that the SNAP Program is helping
to address the immediate needs of the most vulnerable in our
communities. We also know that Congress, and programs such as
SNAP, are not, and should not, be the only solution. SNAP is an
essential safety net that must remain strong to ensure the most
vulnerable in our communities do not fall through the cracks.
But the health care industry must be part of a more permanent
solution to addressing basic needs as well. That is why we at
ProMedica have begun to screen patients for food insecurity in
our acute care and physician office settings. We have food
pharmacies that replace the cycle of medicine being used to
treat conditions that nutritious food can treat more
effectively. ProMedica has even eliminated a food desert in
Toledo's inner city by opening a 5,000 square foot grocery
store that is now being used as a model not only for food
access and affordability, but for job training and economic
growth. And through The Root Cause Coalition, we are working
with organizations across our community, and across the
country, that showcase creative, effective partnerships in
addressing food insecurity, nutrition education, and even
economic development so that every citizen can reach his or her
highest potential. Thank you for your time this morning.
[The prepared statement of Ms. Petee follows:]
Prepared Statement of Barbara J. Petee, Executive Director, The Root
Cause Coalition; Chief Advocacy and Government Relations Officer,
ProMedica, Washington, D.C.
With more than 17.5 million U.S. households facing hunger--or one
in every seven households nationwide--healthcare systems and leaders
must recognize that lacking nutritious food to eat is a dire public
health concern. Food insecurity and its results, including true hunger,
is a health issue causing distress in communities nationwide by taking
a toll across the age spectrum.
Hunger is a problem healthcare providers see every day among
patients of all ages in emergency rooms, clinics, offices, and hospital
beds. Babies born to malnourished mothers may be underweight, have
developmental delays and continue to have health problems throughout
life. Children experiencing food insecurity, meaning they live in
households that at times are unable to acquire adequate food, are more
likely to have behavioral health issues such as anxiety and depression.
These children may also be at higher risk for developing chronic health
conditions, including anemia and asthma.
Among the elderly, another particularly vulnerable group,
malnutrition increases disability and decreases resistance to
infection. Both not only harm quality of life, but they extend hospital
stays. People who are food-insecure often have irregular eating
patterns, which can lead to being overweight and obese. Additionally,
people facing food insecurity typically consume food with fewer
nutrients, so they have dietary shortfalls linked to the development of
hypertension, diabetes and other chronic diseases.\1\
---------------------------------------------------------------------------
\1\ Addressing Hunger to Essential to Improving Health, Partnership
to Fight Chronic Disease and ProMedica, March 2013.
---------------------------------------------------------------------------
``For critically and chronically ill people, food is medicine,''
opens a Harvard Law School Center for Health Law & Policy Innovation
paper presenting the case for nutritional counseling and medically-
tailored, home-delivered meals. ``With adequate amounts of nutritious
food, people who are sick have a better response to medication,
maintain and gain strength, and have improved chances of recovery.
Ultimately, access to healthy food leads to improved health outcomes
and lower healthcare costs.''
With the Affordable Care Act (ACA) changing the way the healthcare
industry does business, hospital administrators and physicians must
look beyond our four walls more than ever before in modern medicine.
Preventing illness, improving population health and eliminating health
disparities are critical for the shift both for clinical and social
reasons. In many ways, the healthcare industry, while accelerating as
necessary in technology to deliver state-of-the-art care that helps
ensure safe and affordable care, must concurrently return to its
charitable roots of more than a century ago, when hospitals were
community pillars concerned with basic public health needs and overall
health and welfare. The industry needs a unified system of common goals
that builds from the fundamentals of health and wellness that value
one's overall health.
Incentive models that make the healthy choice the easy choice are
critical to improving the health status of our citizens. By increasing
access to nutritious and affordable food, we can have a significant
positive impact on health while at the same time decreasing healthcare
costs.
Hunger Is a Health Issue 2
Breaking Out the Health Care Costs of Hunger
(Costs of hunger-induced illnesses, 2007 and 2010, in billions of 2010 dollars)
----------------------------------------------------------------------------------------------------------------
Increased cost over
Adverse health condition 2007 2010 3 years
----------------------------------------------------------------------------------------------------------------
Poor health (excluding items below) $28.7 $38.9 $10.2
2 Shepard, D., Setren, E., and Cooper, D.
Hunger In America: Suffering We All Pay For,
Center for American Progress, October 2011.
Depression $2.2 $29.2 $7.1
Suicide $15.8 $19.7 $3.9
Anxiety $12.9 $17.4 $4.5
Hospitalizations $12.1 $16.1 $4.0
Upper gastrointestinal disorders $4.2 $5.7 $1.4
Colds, migraines, and iron deficiency $2.5 $3.5 $1.0
------------------------------------------------------------------
Total illness costs caused by hunger....... $98.4 $130.5 $32.1
----------------------------------------------------------------------------------------------------------------
The healthcare industry must not only deliver clinical excellence
and efficiency, we must hone in on how we can act as catalysts,
innovators and leaders to improve the health of our entire communities.
ProMedica has taken steps to improve nutrition and access to healthy
foods that are a great complement to the nutrition incentive programs
offered by the USDA.
As our industry battles epidemics of low birth weight, childhood
obesity, diabetes, heart disease, cancer, and other chronic diseases--
we, like many healthcare providers across the country, began to ask
why. Why are we seeing such high rates of these issues in our
community? From this simple question--ProMedica began a journey that,
in partnership with the AARP Foundation, founded The Root Cause
Coalition to bring the full power of the healthcare community to bear
in addressing the social determinants of health.
That is why the work of this Subcommittee to strengthen our
nation's nutrition policy is so vitally important. Your work on these
basic building blocks, especially the SNAP program, have far reaching
impacts on a plethora of issues at the foundation of a strong future
for our country. The programs overseen by this Committee are about more
than the immediate needs of hungry children, adults, and seniors. These
programs are core investments in the health and well-being of your
constituents and our nation's ability to adapt to an ever changing
global economy.
We know that hunger is a health issue, we know that food is the
best medicine, and we know that the SNAP program is helping to address
the immediate needs of the most vulnerable in our communities. We also
know that Congress, and programs such as SNAP are not--and should not--
be the only solution. SNAP is an essential safety net that MUST remain
strong to ensure the most vulnerable in our communities do not fall
through the cracks. But the healthcare industry must also be part of a
more permanent solution to addressing basic needs, as well.
That is why we--at ProMedica--have begun to screen patients for
food insecurity in our acute care and physician office settings. We
have food pharmacies that replace the cycle of medicine being used to
treat conditions that nutritious food can treat more effectively.
ProMedica has even eliminated a food desert in Toledo's inner city, by
opening a 5,000\2\ grocery that is now being used as a model not only
for food access and affordability, but for job training and economic
growth. And, through The Root Cause Coalition, we are working with
organizations across our community, and across the country, that
showcase creative, effective partnerships in addressing food
insecurity, nutrition education and even economic development, so that
every citizen has the opportunity to reach his or her highest
potential.
In partnership with all sectors, the healthcare industry must make
fundamental changes. As key economic drivers in most communities, we
should use our might to improve population health through an array of
collaborations and innovations targeted to meet each community's needs.
Health care must be integrated and focus on the most common social
determinants, starting with nutrition and hunger, to ensure Americans
have what they need to live productive lives. Strategic, purposeful and
intentional changes can create an improved model to deliver better
public health care.
The Chairwoman. Thank you, Ms. Petee. Ms. Kiley, I am so
thrilled that you are here to tell us real life, real time,
exactly how this works, and how it has impacted you. So my one
question is: I am just thinking about it, because in northern
Indiana, where I live, I shop at a farmers' market too, and I
think about: knowing the growers, knowing the farmers
personally when you go through, picking seasonal stuff. But I
am also thinking about it from the standpoint that you already
are so far advanced in the issue of cooking, preparing this
stuff, raising your son, eating healthy, do you come across
people, when you are in the market, that have no idea what to
do with this food, how to cook it, how to prepare it, asking
themselves is it worth the hassle of coming home, and then
trying to figure out how to prepare this food? Do you come
across people that really are puzzled? And my follow up to that
is, are there resources available for people that don't know
how to prepare this food? Like, I can't imagine a lot of people
walking in for the first time, buying a bunch of raw fruit and
vegetables, thinking, what am I doing with these when I get
home, other than boil them?
Ms. Kiley. Well, thank you for letting me be here. I think
there are two things there. One, an apple a day keeps the
doctor away. Let us really think about that. Does an apple a
day keep a doctor away because all of a sudden we eat an apple
a day, and it is a miracle? No. An apple a day keeps the doctor
away because we are setting habits, right? Because we are
setting a habit of not grabbing a bag of potato chips, or even
pretzels, right? I opt for a pretzel because it is a little
better, right? So setting these habits are what is keeping the
doctor away, right? Really, this foundation, having that
available. I can't tell you how many mothers say to me, my
child won't eat that. I bet he will. I bet he will. I bet you
can go through a stage of a lot of pissing and moaning, but I
bet he will, right?
So how do we set these habits? One of the things that
Crossroads does, and a lot of other markets do, is they have a
food demonstration, and the food that they are preparing is
minimally processed, meaning even cooked, right? There are a
lot of raw salads that are quick and easy, and you add
something like honey, or maple syrup. Almost everything, if not
everything, is from that market. So those food demonstrations
are really great. They are fun for the children. I see so many
children try things such as jicama that they would never, ever
try.
The Chairwoman. But is that education available there at
the market?
Ms. Kiley. That education is something they do at every
market.
The Chairwoman. Okay.
Ms. Kiley. And so they do it once a week. I don't think I
have ever been there and not seen a little food demonstration.
And it is there the whole 4 hours of the market, which is
really great. Is it enough? Probably not, no. Are there free
cooking classes around? Probably not a lot. But that is part of
conversation, right? And part of the other thing, as a mother,
that has more of this ability, is knowing how to talk to other
people. And it doesn't mean I accost people at the market and
say, what are you buying? What are you making? Do you even know
how to cook that? You know, no, but part of it is--I have
learned how to cook herbs that I would never buy, right? It is
a largely--there is a large Hispanic community that attends
this market, and there are foods that I would never have seen,
right? And every Wednesday my son eats a pupusa. It is amazing.
So part of it is, yes, it is a difficult hurdle, a really
difficult hurdle.
The Chairwoman. I appreciate it. And let me ask Dr.
Hesterman really quickly----
Ms. Kiley. Please.
The Chairwoman.--I live in northern Indiana with strong
winters, January, February freezes that we are in now. So what
do you do about the seasonality issue in Ann Arbor, Michigan?
You are a fellow Midwesterner, not like our friends from Texas,
when you have sun in the wintertime. What do you do, then, in
the middle of winter, when the farmers' markets--and even the
one I attend in northern Indiana, has crafts and things moving
in for the winter because there is no fresh food? How do you
handle that with your program?
Dr. Hesterman. So for most of the markets so far the
program starts around beginning of June, and ends either end of
October or end of December. We are just now starting to
experiment with some year-round programs. So there are ten
farmers' markets now throughout the state, including in
Detroit, including in Flint, Michigan now that are running
year-round. And it is a combination of products coming from
hoop houses from the farmers, some products that have been
stored, but certainly the amount of locally grown is much
reduced.
In the grocery store setting, we are going to start next
year with some experiments with year-round, and seeing if we
can get a combination of locally grown and produce that are
grown in other places by other growers, because we know
families need fruits and vegetables year-round, not just during
the northern growing season.
The Chairwoman. I appreciate it. And just quickly, Dr.
Wright, in the Bluegrass Farm To Table, the public-private
partnership, was it easier to get private dollars for the FINI
grant because you actually had an established program that you
could say to the community, we just need partnership with this?
Was it a relatively easy partnership?
Dr. Wright. Absolutely. I would say our pilot is unique
because it is the Municipality of Lexington partnering with our
very successful community foundation in Lexington. So we both
kind of bring really a unique partnership together, so melding
those partnerships was critical. And it allowed us, with the
FINI money, to leverage just over $10,000 in public and private
money through the community foundation's networks, and through
local ag and health sectors as well.
The Chairwoman. I appreciate it. Thank you so much. Mr.
McGovern.
Mr. McGovern. Well, thank you very much. Let me thank you
all for your testimony, and also thank you for all of the work
that you do, and all the advocacy. This is all very, very
inspiring, and we all appreciate all that you do. We know that
hunger and health are inextricably linked. We know that hunger
and food insecurity is associated with higher rates of
depression, cardiovascular disease, high blood pressure,
diabetes, and other physical and mental health conditions. And
we also should know that food assistance programs, such as
SNAP, save money in the long run by improving educational and
health outcomes. Quite frankly, I am one of the people who
believes that the benefit we provide is inadequate, and we need
to do better on the Federal level in terms of that.
But the private monies and the innovation that you have all
brought to this are very, very encouraging. Incentive programs
like the ones that you are involved with rely heavily on a
strong Federal partner. You have a commitment to SNAP funding
to ensure that low-income individuals who are eligible for SNAP
get the benefit that can then be used in your programs. But, I
remain--I say this at every one of these hearings--I am deeply
concerned about where we are going as a Congress on all this
stuff. I am worried that we may be headed down a pathway that
could do significant harm to SNAP, that we might consider
proposals that would fundamentally change the basic structure
of SNAP, and/or cut the benefit dramatically. Can any of you
comment on the impact that a cut to SNAP would have on your
programs? Would your programs be able to survive if Congress
would fundamentally change SNAP, or cut it? I am open to
anybody.
Ms. Petee. Thank you, Congressman. I think it would have a
devastating impact, obviously, and, to your point, the fact
that those programs exist are what help us complement, and make
sure that the SNAP Program, and WIC, and other programs do
work. If those programs were cut, and people did not know where
to go, or how to access those critical nutritious foods, our
programs wouldn't have a reason to exist, and it would be
really going out almost on a door to door basis, which,
obviously, is not tenable.
There is an adage that you can teach a man to fish or give
him a fish, and it is much better to teach him how to fish. I
like to add that we have to find the pond in the communities,
and we have to make sure that we identify that there is a pond
in which people can go and do their fishing. And education for
so many of these people who have been born into poverty, and
can't break that cycle until they get the proper education and
access, is critical. So reducing SNAP would have a devastating
impact.
Dr. Hesterman. I would just say that what these incentive
programs are doing is demonstrating that we can take a program
that has been designed primarily as an anti-hunger program and
turning it into an anti-hunger and pro-health program at the
same time. I like to say you can pay the farmer now or the
doctor later. And so the integration of the incentive programs
with a strong SNAP Program is absolutely critical to the
success of both.
Mr. McGovern. Mr. Cooper?
Mr. Cooper. Yes, Ranking Member McGovern. Yes, we would not
be able to make up any ground when it comes to a SNAP cut, from
a food bank perspective. All that we do to provide food to
people, 40 percent of that is produce, but just a minor
adjustment in a cut to SNAP would set us back, and we would not
be able to recover.
I would like to add on to that that parable of give a man a
fish, teach him how to fish, that if he doesn't know that you
pack tuna fish sandwiches, he won't meet you at the dock,
right? He can't. He would love to learn, but we all know a
child can't learn when they are hungry, nor can an adult. And
SNAP provides such nourishment that we can complement that. I
share your views that it is not enough, and we need to be doing
more to strengthen SNAP to adequately nourish those families in
need.
Mr. McGovern. I appreciate that. I raised the point just to
put everybody on notice that moving down a pathway to reduce
the benefit, or somehow re-imagine this whole program is not a
good idea. We need charities, and we need private monies, and
we need these partnerships, but they can't make up the
difference. We need a strong Federal partner in this if we are
going to do this right, and I appreciate all your testimony.
Thank you.
The Chairwoman. Mr. Crawford, you are recognized for 5
minutes.
Mr. Crawford. Thank you, Madam Chair. We hear this term
food desert quite a bit, and it characterizes an area with
limited access to healthy foods, but there is a difference
between urban and rural food deserts that probably we don't
talk about very often, and I represent a very rural district.
According to USDA, an urban food desert is an area that is 1
mile or more from healthy food providers, but if you live in an
area like I do, in rural America, you may live 10 miles or
more, and in remote areas, it is even worse than that, from
your nearest grocery store or farmers' market.
So apart from the obvious geographic differences between
urban and rural food deserts, can you discuss the distinct
challenges that urban and rural food deserts present, and how
that might merit a different response from both policymakers
and those on the ground like yourselves? And anybody is welcome
to weigh in on that, whoever wants to go first.
Dr. Wright. So I will just make a couple of quick points. I
do think Lexington is a population center surrounded by a
really interesting mix of rural communities. And so often in
Lexington, SNAP shoppers and just Lexington residents, there is
a big disconnect between the food they purchase at the farmers'
market, or the grocery store, and where that food is produced.
I think the FINI program, for us, allows us to bridge that gap,
and helps educate SNAP users by using farmers as that tool to
educate them. My farm is 15 miles away, I picked it this
morning, here is how you can prepare it. Farmers' markets
represent a really unique opportunity to get at that issue.
I will say another challenge that we have identified that
you spoke to about in our urban center, transportation to the
venues where these incentive programs are being offered is a
huge barrier. Getting folks to the farmers' market, and to the
cooperatively owned grocery store. So we are partnering with
our Health Department on a funding mechanism they received to
provide vouchers for transportation to get folks to these
markets.
Dr. Hesterman. In Michigan we have actually looked
specifically at the comparison of the Double Up Food Bucks
Program in urban and rural settings, and, in fact, in the
packet that we gave you, one of the appendices is a paper that
we put together, specifically, on the rural experience with
Double Up Food Bucks. What we are finding is, while the program
operation works whether you are in an urban or rural setting,
right now we are finding, in Michigan, faster growth of the
program in our rural communities and rural markets than we are
in our urban settings. And that is not what we had expected,
but we are just finding the uptake on the program in rural
markets and rural communities actually is going much faster
now.
Mr. Crawford. That is encouraging, and I will just say that
I represent a big part of the Mississippi River Delta in east
Arkansas, and the irony of food production there, I guess, is
that it is one of the most productive regions in the world,
rice, cotton, corn, wheat, soybeans, milo, and so on, but very
little production of anything else. And so farmers' markets
have been a little bit slow in response to the need there,
based on healthy food choices.
Now, I am a big advocate of rice, but the reality is, year-
round you need healthy food choices. And, unfortunately, what
we are relying on heavily are convenience stores in small
towns. Please talk about the need for incentives for healthy
food choices, which has been addressed to some degree on the
preventative measures, making good healthy food choices versus
the challenge of accessing that on a year-round basis. And
particularly in the, ironically, under-served rural areas,
where they can't get those kinds of food choices on a year-
round basis.
Mr. Cooper. I was just going to comment, we suffer from
that same irony, representing Crystal City, which is in Zavala
County. It is known as the spinach capital of the world. Del
Monte has a canning facility there, and Zavala County has one
of the highest rates of childhood hunger in the U.S. So where
food is grown, they lack access, so it is variety. That
opportunity to provide that variety when transportation limits
are in place is a challenge. And I totally agree with your
comments around trying to create opportunities where people can
get greater access.
Mr. Crawford. Thank you. I yield back Madam----
Ms. Petee. I will just----
Mr. Crawford. Go ahead.
Ms. Petee. I will just underscore what the others have
stated, that we see the same challenges in our rural
communities. Again, in southeast Michigan, we have received a
USDA grant for a veggie mobile that actually goes from spot to
spot in the rural communities because of transportation, and,
to your point, the irony of living in a farmland, and not
having access to the fresh fruit that is being grown around
you. So it is a challenge. The incentives are critically
important, and the education that goes with these programs is
really essential. People do learn how to prepare foods that
they have been unfamiliar with because they didn't have access
to them. They learn how to stretch the dollar, stretch the
food, make different meals, and make it last. So it is very
important.
Mr. Crawford. Thank you.
The Chairwoman. Mr. Aguilar, you are recognized for 5
minutes.
Mr. Aguilar. Thank you, Madam Chair. Mr. Cooper, in my
district, farmers' markets that participate in SNAP have, at
times, encountered challenges. And I wanted to ask about your
experience with this. And despite efforts, I read in your
testimony, your knowledge of these issues, and I wanted to see
what do you think might be the cause? Despite our best efforts,
and some of our recruitment for these farmers' markets, and
offering that access to folks, what can we do to improve that
access? And I have some questions for Dr. Hesterman and Dr.
Wright as well.
Mr. Cooper. Well, thank you so much for the question. We
are so privileged to actually facilitate six farmers' markets
throughout our community and participate in the WIC Farmers'
Market Program, and the Senior Farmers' Market Program. The
challenge for some of our clients is that the markets might not
be geographically close, and the affluence, the shoppers, and
the price points. And so we really try to bring back that
concept of a fruit stand. Making it more about agriculture,
making it more about value, so that the clients are able to get
the most produce for that investment. They don't feel like the
dollars they spend are equal to retail, and that the quality is
equivalent, and the local aspects, and organic, and those kind
of things, they wouldn't utilize the benefits. And so we have
really worked to kind of streamline bringing those markets to
those communities.
And I am reminded of a woman that received a watermelon in
our agricultural belt, the Winter Garden, a lot of watermelons
are produced, and one of the farmers brought up a watermelon.
And the mom broke open the watermelon and gave it to her kids.
And the kids didn't really look like they liked it. And I was
like, they don't like watermelon? And she said, well, they have
never had it. And I am like, are you serious? They have never
had watermelon? She said, well, I don't have a car, I have to
take the bus. And a gallon of milk weighs 8 pounds, so it just
seemed impossible to carry one of those home. And so that is
where diet is impacted. That is where the variety of access is
impacted, by these barriers that you wouldn't think of.
Mr. Aguilar. True. Thank you. Dr. Hesterman and Dr. Wright,
your matching programs are incredibly interesting to read
about. In southern California, my district is different than
Mr. Crawford's, but to follow up what the Chairwoman had
mentioned as well, the philanthropic efforts are huge, and a
huge component to what you have described where they matched.
Dr. Wright, you mentioned that they have been matched with
public dollars, as well as private. Who was the first money in?
Who were the first folks? Was it $5,000, or $10,000, or was it
bigger denominations? Please talk to me about the mix of the
public and private from the matching perspective.
Dr. Wright. Sure. So, really, our fundraising efforts,
aside from FINI, really started at the grassroots level, so it
really started on a smaller scale, targeting interested bodies
of individuals who may be supportive of programs like this. So
we partnered with local restaurants to do some interesting
fundraising with them, donating a percentage of their purchases
to the Double Dollars Program. We did some community outreach
activities at some of the venues, like the farmers' market. We
did an unlimited doubling event, and actually did a watermelon
sampling that day, and asked for donations. So patrons at the
farmers' market who were regular shoppers could have the
opportunity to donate there.
So it really started with that grassroots level. That,
coupled with the FINI money allowed us to approach larger
organizations, like our Farm Credit agency, and health care
organizations. So we kind of started at the grass roots, and
are slowly building to approach larger funders.
Dr. Hesterman. So in my case I had an advantage that not
all of my colleagues in the field have, and that is that I
spent about 17 years as a Program Director at the W.K. Kellogg
Foundation, actually funding programs in food systems and rural
development. And, in fact, the very first funding that ever
went to the Crossroads Market, where Ms. Kiley now shops, came
from our program at Kellogg Foundation. And I thought it was
such a cool idea that I followed it throughout the years, and
when we founded Fair Food Network, I decided, let us try this
in a state that really needs it, that doesn't have any kind of
incentive program.
But at that time, raising money from foundations, for me,
was talking with my friends and colleagues, because I had been
in the field so much. So we actually went after some pretty
significant dollars from some of the larger foundations, and
that is how we got it started in Michigan, was with
philanthropic dollars, and ran it for about 5 years, solely
based on funding from about 50 different foundations. Some of
the large private foundations, like Kellogg and Kresge
Foundations, but some of the smaller foundations, Battle Creek
Community Foundation, Jackson County Community Foundation--what
I have found is that this incentive work is some of the easiest
work to raise money for in the philanthropic community because
the people get it. It is a win-win-win. This investment of $1
is leveraging so much impact. And it is important to say that
now that we have the match from the Federal Government, that--
it has brought on board many, many more philanthropic resources
because they can see their funding being leveraged as well.
Mr. Aguilar. Thank you so much. Thank you, Madam Chair.
The Chairwoman. Mr. Benishek, you are recognized for 5
minutes.
Mr. Benishek. Thank you, Madam Chair. Dr. Hesterman, thanks
for being here today.
Dr. Hesterman. You are welcome.
Mr. Benishek. We have 21 markets in my district in northern
Michigan, and thank you for your great work there. I have been
to the one in Traverse City many times, and I see the booth
that has the Bucks there at the end. And it is great work. I am
just going to question you about one of the problems that had
been reported to me, and that apparently they try to run the
market even in the winter, because they have to move, of
course, because they can't do it in that parking lot in the
winter. They have to do it inside. And then the USDA is
requiring the market to buy all kinds of new equipment to----
Dr. Hesterman. Yes.
Mr. Benishek.--process the SNAP cards. Can we help these
small farmers' markets out, where this purchase of equipment
costs money? What is going on there? Have you run into this
problem at your level?
Dr. Hesterman. Actually, we are hearing more about this. It
is sort of part of a larger set of issues that we are hearing
about, where farmers' markets, in order to do the EBT and the
incentive work, are needing to invest in equipment, and
wireless technologies, to do this. And we believe that, if USDA
were able to make it easier for farmers' markets to equip
themselves with what they need to transact EBT and Double Up
incentive business, we would be way ahead. And right now that
is something that I believe needs to be worked out, probably
USDA, and with the state SNAP----
Mr. Benishek. Well, if there is anything I can do to help
you with that, I would appreciate you letting me know, and I
will have my staff follow up with you. But----
Dr. Hesterman. Great.
Mr. Benishek.--I think that is an undue burden on many of
the markets, which don't have a lot of money to be throwing
around with equipment.
Dr. Hesterman. Yes, I agree with you, and definitely will
follow up.
Mr. Benishek. The other thing about winter is that the
access to the fresh foods is difficult in Michigan.
Dr. Hesterman. Yes.
Mr. Benishek. Are you familiar with this Farm to Freezer
Program in Traverse City? There is a guy named Mark Coe that
took me around there, where they take fresh local produce, and
they flash freeze it. And it is part of Goodwill Industries.
You know about those guys?
Dr. Hesterman. Yes, sure. Met them. In fact, we are in a
conversation with them up in Traverse, and with folks in
Detroit, at the Eastern Market, to look into, as we go to a
year-round program with our Double Up Food Bucks, to have some
of those locally grown and frozen products available during the
winter that can be purchased with the incentives.
Mr. Benishek. Yes. Is that possible, to allow those--I
mean, I don't know exactly where we want to go with that,
because we don't want to--I don't know if you can use Double Up
food products for frozen food, so I am not exactly sure. Can
you kind of explain that a little bit to me? What is the policy
there?
Dr. Hesterman. The FINI program allows for fresh, and
frozen, and canned, as long as there are no added sugars and so
forth to the product. So we don't have any restrictions about
whether we want to take that from fresh, and also look at
frozen. And it is something for a couple of markets, where you
have the specific programs that freeze, and the locally grown,
we are looking at.
Mr. Benishek. The other question that you touched on, about
the USDA is this wireless technology. So they have to have a
wireless hookup? I mean, some of my areas in my district we
don't have wireless.
Dr. Hesterman. Well, you either need WiFi, or you need to
hook into the cellular data system, or you need a land line,
but to conduct the EBT business, you need some kind of----
Mr. Benishek. Internet.
Dr. Hesterman.--like that.
Mr. Benishek. Okay. I guess that is a different committee
making sure that we have Internet across my district, which
doesn't always happen. Well, I yield back the remainder of my
time, but thank you, Dr. Hesterman, and I would really like to
look forward to maybe working with you to help solve your
problems with the USDA in regard to some of the problems that
have come to my attention, and whatever problems you may have.
Because this incentive thing is a really the way to go. I mean,
I am really happy that we are doing this. I think that, as a
pilot, and as a model for other areas of the country, you have
done a great job, and happy to have it happen to Michigan.
Thank you. I yield back.
The Chairwoman. Thank you. Congresswoman Lujan Grisham, you
are recognized for 5 minutes.
Ms. Lujan Grisham. Thank you, Madam Chair, and thanks to
the panel. Given that my state is still one of the hungriest
states in the country, New Mexico, it is great to hear about
the kinds of ideas and incentives that allow you to do more
with what you have, and making it as healthy as possible. I did
the SNAP Challenge, and without a dollar to dollar match,
notwithstanding the incentive, there isn't enough to buy fresh
fruits and produce. I think when I did the challenge, in order
to have enough protein, the only fruit I could buy was a couple
of bananas. And so it just isn't enough to sustain yourself or
your family.
And so I am very excited to hear about the organization's
work in Michigan, and the Double Up Food Bucks. And I have a
public health background, so all of this is exactly the way in
which these programs were intended to work. But we find that
they need an additional boost to do that. I think these kinds
of incentives are especially important for poor states like New
Mexico, and any other areas in the country that have high rates
of food insecurity, poverty, obesity, and other diet related
illnesses.
I want to tell you that, in fact, the Double Up Program is
very successful in New Mexico. We are seeing more low-income
families being able to purchase fruits and vegetables. And, in
fact, according to a report, the New Mexico Farmers' Marketing
Association put out this month 88 percent of their customers
increased the amount of fresh fruit and vegetables they
purchased because of the program. In 2015 alone the Double Up
Program benefited more than 4,000 low-income New Mexicans. So
not only are we improving nutrition and health outcomes in
communities, but we are seeing Double Up do the other thing,
which is create more economic development opportunities,
particularly for farmers. And we are seeing a resurgence of
young people interested in farming in both rural and urban
communities. We saw 195 percent increase in total EBT sales
through the Farmers' Market Association, and that impacted 60
percent of New Mexico counties, and 60 percent of the direct
market farmers statewide. We are also expecting the program to
generate more than $4 million over the next 4 years.
I am sure you already have all these stats, about all the
different impacts. And I have been listening in earnest, of
course, but really interested in the points we are making about
really connecting and coalescing our nonprofit and charitable
community in this effort in providing these kinds of
incentives. But notwithstanding the wonderful results in New
Mexico, the reality is we still have one of the hardest hit
economies in the country, with some of the highest poverty
rates in the country. We are, in fact, the only state in the
nation that is losing population because there are no job
opportunities in the state. We are in an interesting battle
about what we do about work requirements when we can't find
work anywhere in the state. And when we had our Human Services
Secretary talk about work incentives a year ago--she is no
longer with that department--she talked about the great jobs in
oil and gas, and there are no jobs in oil and gas in our state,
and we are really struggling.
So I am really excited to tell you that, in spite of that
situation, I believe that New Mexico is the only state that has
state funding over the long-term to secure this program so that
the Double Up Program is available. And the reason I think that
that is really important, and want to get your ideas about how
we encourage other states with the time we have left, is that
our charitable organizations in this environment are also
stretched too thin. So, to take advantage, I do think that you
want to have local governments, state governments, engaged.
What are you doing to get more states to think about long-term
funding for these kinds of ideas?
Ms. Petee. Congresswoman, if I could comment on that, and I
would like to acknowledge too that last June we partnered with
Presbyterian Health Services in Albuquerque to do a hunger
summit, and you know the great work they are doing. And I would
encourage us to look to the health care industry, hospitals,
health systems in communities are often the largest employer.
It is not a position that we have wanted to get to, but, to
your point, when other industries and businesses are losing
jobs, we find ourselves in a very precarious predicament, where
we are the employer, but it is also incumbent on us, especially
as a nonprofit organization, and by and large the hospital
systems are, to make sure that we are out in the community, we
have a mission beyond our four walls.
So it is a matter of getting the local government and the
state government together. That is what we started to do in
Ohio with ProMedica. That is our aim, really, through The Root
Cause Coalition. Because it is going to take the work with
Congress, the work with local and state governments, and then
the work with the health care industry, and other related
organizations. Not one organization can do this alone, but we
really do need everyone at the table.
Ms. Lujan Grisham. Thank you. Thank you, Madam Chair. I
yield back.
The Chairwoman. Mr. Davis, you are recognized for 5
minutes.
Mr. Davis. Thank you, Madam Chair, and this is a great
opportunity for those of us who sat around these tables and
crafted the farm bill to kind of see and hear what our policy
changes that we put into effect, and new and innovative
approaches, how they are being implemented in the marketplace.
I want to follow up a little bit on what my colleague Mr.
Benishek asked you, Dr. Hesterman, about the ability to put
point of sale equipment into farmers' markets. I know that part
of our policies that we put forth allows the states to get from
the USDA upwards of $4 million to help with these point of sale
equipment purchases. Can you tell me, has that program been
effective, or are you taking advantage of it at any of the ones
that you see in your community?
Dr. Hesterman. So there are farmers' markets in Michigan,
and the Michigan Farmers' Market Association is very active
with helping markets get set up, with the----
Mr. Davis. But is the State of Michigan giving any of these
USDA dollars to those markets for the point of sale equipment?
Dr. Hesterman. I believe through the Farmers' Market
Coalition, that is happening. One of the issues that Mr.
Benishek raised is the issue of when a farmers' market moves
location they have to get a different FNS authorization number
to be a vendor. You have situations where markets may have to
shift location different times of the year. So that is one way
that it is not just about the equipment, but it is about having
to get a new authorization number, which could require
additional equipment.
Mr. Davis. Okay. Dr. Wright, are you taking advantage of
that in Kentucky? Does your state?
Dr. Wright. Yes, they certainly are. So that program is
coordinated through our Department of Agriculture. The current
farmers' market that we are partnering with as a part of our
pilot is a little unique in that there is one EBT terminal for
the entire market. There are other markets in----
Mr. Davis. So they just come to a specific area if they use
EBT?
Dr. Wright. That is correct. They will contact the market--
there is a booth with the market manager. They come and swipe
their EBT for all purchases, regardless of the incentive or
not. So the EBT dollars are transferred into tokens, and then
the incentive tokens are also given at that same time, so the
SNAP participants can use those tokens at any vendor at the
market.
Mr. Davis. So the SNAP participant goes to the manager's
tent, swipes the EBT card, gets the Double Bucks, and they hand
them to the recipient so the recipient can go to the different
booths, and then spend them how they wish?
Dr. Wright. How they wish, yes.
On SNAP eligible items, yes, certainly.
Mr. Davis. On SNAP eligible items?
Dr. Wright. Yes. Our doubling is a little bit unique too,
is that our incentives are only for Kentucky grown produce. So
at our farmers' market there is----
Mr. Davis. Why do you not like Illinois?
Dr. Wright. We do love Illinois, but part of my job,
obviously, is supporting Kentucky farmers, so----
Mr. Davis. Part of my job is supporting Illinois farmers.
No, thank you. Mr. Cooper, I am an Oakland Raider fan. I am
very disappointed that they may move to San Antonio rather than
St. Louis, but I won't hold that against you today. Can you
tell us what is your process for the EBT point of sale
equipment?
Mr. Cooper. Well, we have absolutely taken advantage of
that opportunity, and applied for the grants, and have that
technology available in our market.
Mr. Davis. Did you take all $4 million?
Mr. Cooper. Anything to get those Raiders, right? There are
a lot of barriers. It is complicated. I mean, you have to see
if the market has enough customers that would demand the
technology, and then try to run it efficiently. It doesn't make
sense to have each farmer have a terminal. They usually have
the ability to take cash very easily, or credit cards, using
Square, their iPhone, or whatever. But it is the SNAP EBT
benefit that you can have one terminal, and then have a token
system, or a way to do the accounting.
Mr. Davis. And that is what you do?
Mr. Cooper. That is what we do. And we will provide that to
any market. Some of our markets, there just isn't enough
participation at the market to warrant it.
Mr. Davis. So when a recipient like Ms. Kiley would come
in, you would give her vouchers, tokens, or dollars?
Mr. Cooper. She would go to the vendor, choose the produce,
they would write up a ticket. They bring the ticket, we run the
card, charge it for that amount, and then the customer would
take that voucher back, showing that that has been paid. Then
we reimburse the farmer at the end of the market for all of
those SNAP sales that they incurred.
Mr. Davis. All right. I hope we have a chance to ask a
second round of questions, because I want to ask Ms. Kiley what
your process has been, and see if it is as seamless as what you
have talked about. She already answered it?
Ms. Kiley. It is the same as Bluegrass, where I go in, and
swipe my card, and say, I want to spend $15, and they give me
$15 in tokens plus----
Mr. Davis. Okay.
Ms. Kiley.--whatever they double. And then I take it
directly to the farmers. My only concern about that is what
does it do for some of these families that might have--they are
out there. Some of these families that might be a little
conscious about being on SNAP, where you are at markets where
you don't see as many SNAP participants. Tacoma Park Market is
a perfect example of a market that is a little more--say upper
echelon. And going to that booth, it does have a little bit of
a stigma to it, maybe it is not used as much? But it has worked
out very easily for me.
Mr. Davis. Well, thank you. Madam Chair, I apologize for
going over.
The Chairwoman. Thank you. Congresswoman Adams, you are
recognized for 5 minutes.
Ms. Adams. Thank you, Madam Chair, and Ranking Member
McGovern. Thank you all for your testimony. It has been very
interesting to hear the stories. Farmers' markets have become a
very popular way to improve fresh food options in food deserts
throughout the 12th District, and we have a lot of them in the
12th District of North Carolina that I represent. Guilford
County is currently using USDA funding to support farmers'
markets in food deserts, including the Mobile Oasis Farmers'
Market in Greensboro and High Point. Food Insecurity Nutrition
Incentive Grants, and the Farmers' Market Promotion Program are
vital programs for supporting one of the few grocery store
alternatives available to residents living in food deserts.
As mobile and seasonal retailers in farmers' markets
usually use wireless equipment for processing SNAP benefits,
this requires a farmers' market to contract out equipment, and
to pay a transaction fee for every purchase that uses SNAP
benefits. For smaller business owners or farmers, this is a
significant barrier to allowing a SNAP recipient to use their
benefits to purchase fresh produce.
Dr. Hesterman, what long-term solutions would you recommend
for USDA in order to meet Congress's intent that healthy food
retailers not face cost barriers to serving participants in the
SNAP Program?
Dr. Hesterman. Thank you for that question. So I actually
look at this a little bit differently than what I have heard
from some of my colleagues here. I actually think we need to
start figuring out how to take advantage of the current and
future of transaction processing technology. We are doing an
experiment now, ten farmers' markets in the Grand Rapids area
of Michigan, where this becomes the transaction processing
device for farmers for EBT and for incentives.
So we worked with a software company to get an app
developed that farmers can download. It is like Square, where
customers can come and bring their EBT card directly to the
farmer, and earn their Double Up Food Bucks, spend their Double
Up Food Bucks. You get rid of the stigma of a person having to
go and collect tokens. You get rid of the administrative cost
of counting out tokens and writing reimbursement checks to
farmers. And we need to be encouraging, USDA and all of us,
working together, need to be encouraging the development of
more types of transaction processing technology like this.
We don't need just one app. We need a bunch of different
experiments, and how we are going to use modern processing
technology, it keeps the program more secure, and helps us keep
track of what is going on, and makes it easier transaction
processing for the vendor and for the customer.
Ms. Adams. Yes, a great strategy. Ms. Petee, there is much
interest in my district in encouraging convenience stores to
sell more fresh fruits and vegetables. Can you tell me a little
bit about how the Live Well Toledo initiative worked with
convenience stores to sell more produce, and what incentives or
processes were put in place to help convenience stores who were
concerned that they would take a loss from selling produce?
Ms. Petee. Yes, thank you for the question, Congresswoman.
It is going quite well, and, as you can imagine, making a shift
from typical carryout items that you would see in a corner
store to implementing fresh fruits, vegetables, milk, as
opposed to just juices and soda pop, is quite well received.
And, in fact, the grocery store that we opened in the inner-
city of Toledo is part of the broader effort, because we
realize how essential it is to make sure that access to
affordable, nutritious fruits, vegetables, dairy, protein, is
essential.
It really takes the whole community. I can attest that
Toledo is working as a community. I have often said there is no
market share in hunger, so we have a couple different health
systems in Toledo, but it takes everybody working at that same
table to make sure that we are level setting the playing field
for everyone involved. And that is one of the reasons, again,
going back to The Root Cause Coalition, that we felt it was
critical to establish such a national coalition. We have
commissioned the CDC to do a research study, through The Root
Cause Coalition, that will be identifying what different
hospitals and health systems across the country are doing to
combat food insecurity, nutrition, obesity education throughout
the country. And what we intend to do with that data is
identify what is working, what is not working. Of what is
working, how do we replicate that for different geographies and
regions of the country? Because, obviously, there are many
different ways in which we come to this problem.
So it goes back to the comment I made earlier, that it
really takes everyone at the table. To get the most benefit out
of the assistance and incentive programs that the government
offers, it really takes the local communities, the local
government, and the state communities working together.
Ms. Adams. Thank you very much, and, Madam Chair, I am out
of time. I will yield back.
The Chairwoman. Thank you. The chair recognizes Congressman
Thompson, for 5 minutes.
Mr. Thompson. Madam Chair, thank you so much for this
hearing. Thanks to all the panelists for not just being here,
but for the work you do in your communities each and every day.
This last month I really had the privilege and honor, I hosted
a couple of events. The first was at our 100th annual Farm Show
in Harrisburg, Pennsylvania, and we did a listening session. I
was joined by several of my colleagues, including the full
Agriculture Committee Chairman, Mr. Conaway from Texas, and we
really heard from a lot of different aspects of agriculture,
but there was a heavy emphasis on food insecurity.
And I heard from just a great champion, Karen Wooding from
the Central Pennsylvania Food Bank, and then most recently--
just a couple weeks ago I did a visit to a food bank in my home
county. We spent some time there talking with the people that
were there, looking for nutrition for themselves and their
family members. And the wonderful people that run, dedicate
themselves, a lot of volunteers, including a pediatrician who
was there volunteering. As a former health care professional, I
mean, good nutrition is a fundamental building block to good
health, there is no doubt about it. And the fact that we are
starting to explore that more consciously, and build upon that,
and build collaborations, that is part of the fruit we are
hoping to yield from the work that is done here. I am not a--I
am not going to hear--I don't think there is--we have no
preconceived outcome here. I think we want to make this better.
We want to make sure we are serving people, and we want to make
things operate efficiently, and I am proud of the work that we
are doing.
So let me follow up a little bit. Dr. Hesterman, we know
there are Americans who are not consuming enough fruits and
vegetables, which is why the incentive dollars used
specifically for fruits and vegetables make sense. However,
some would argue that also allowing incentive dollars to be
used for lean meats, dairy, eggs--I saw all that, and I heard
about that, and I actually saw that in my food bank visit, the
whole use of freeze flash technology, or flash freeze, whatever
order that is, it is just amazing what people are able to get
access to. It gives it a much longer shelf life, it is
nutritious, it is tasty. Should we consider allowing these
incentive dollars to be used for those other commodities, lean
meats, dairy, eggs, you can fill in the blank, to provide
additional nutritional benefits to the consumer, and do you
envision most incentive programs will remain focused on fruits
and vegetables, or will expand to healthy foods throughout the
store and the market?
Dr. Hesterman. Thank you for the question. We know that the
number one dietary challenge across the board, but especially
for low-income families, is increasing fruit and vegetable
consumption. And we also know it is one of the most difficult
to afford aspects of creating a healthier diet. So, for those
reasons, my belief is that we should keep this program
pinpointed in the area of greatest need, which is for fruits
and vegetables incentives.
Mr. Thompson. Okay. Thank you. Now, Dr. Wright, the
Supplemental Nutritional Assistance Program, or SNAP,
acceptance at farmers' markets has been a priority of this
Committee to ensure that low-income families have access to
fresh fruit and vegetables. We also acknowledge the benefit to
both the consumers and the farmer. Additionally, USDA provides
up to $4 million per year for states to distribute point of
sales equipment. I know that was a topic of discussion earlier.
I wanted to just throw a few details on what is happening
now. That is for states to distribute point of sales equipment
for individual vendors at farmers' markets to utilize when
accepting these transactions. Can you discuss your process for
accepting SNAP benefits, and are SNAP customers able to use
their EBT cards at the individual vendors, or do they visit a
management tent to receive their Bluegrass Dollars? I would
love to hear a little bit about what your future visions are.
Like Dr. Hesterman--thank you for your vision--in terms of how
do we take the stigma off by thinking creatively in the future,
and are there other thoughts and ideas you may have on how we
reduce that stigma?
Dr. Wright. Sure. So, at the Lexington Farmers' Market, one
of our pilot sites, the way it works, a SNAP user would come up
to the market tent, swipe their EBT card for however much they
wanted to swipe for, and then they would double up to $10,
explicitly, for Kentucky grown produce. The stigma issue is a
really interesting one, and our farmers' market also provides
tokens for non-EBT transactions. So if you want to use your
debit card at the farmers' market, you could go and swipe your
debit card. You would also get tokens. They look a little bit
differently, but to the casual observer, they look like tokens.
So the stigma issue hasn't really been a challenge for us, but
certainly appreciate that that is a challenge in other areas.
I do think having the one point of sale at the market
manager booth, as opposed to each individual farmer having
their own equipment right now, given our parameters, is the way
to go. However, I am very excited about the development of this
app, and I think that that could definitely streamline our
process in Lexington.
Mr. Thompson. And I appreciate you being sensitive to that
issue. When we were first starting out in life, my wife and I,
she was pregnant with our first son, we were WIC recipients,
and that is going back a couple decades----
Dr. Wright. Yes.
Mr. Thompson.--several decades. But even then, we still
remember how uncomfortable it was to walk into the local IGA.
And so I appreciate those types of innovations. Thank you.
The Chairwoman. The chair recognizes Congressman Ashford,
for 5 minutes.
Mr. Ashford. Thank you, Madam Chair. This is really
exciting stuff. And I know we are similar to Kentucky in some
ways, we are a rural state, Nebraska, and we have an urban area
in Omaha. Last fall we had a conference sponsored by former
Lieutenant Governor Maxine Moul from Nebraska, who is the USDA
Rural Development ag person in the state. It was very, very,
very well attended by both rural and urban people. These grants
that have been handed out are really creative, and, looking
through them, what a great program for the country.
I have a question--and thank you, Dr. Hesterman, for your
leadership in getting this started. Someone has to get it
started, I guess, and you did, so it is really great work. I
had spent a number of years running a housing authority in
Omaha, and it is a public housing authority, with residents
living throughout the community, and in public housing as well,
but in scatter site housing. Obviously many of the residents
qualified for SNAP. And I have asked this before when we have
discussed these programs generally, I would ask Dr. Wright. In
Lexington, which is a beautiful city, by the way. In Lexington,
how about the housing authorities there? Was that part of your
partnership initiative?
Dr. Wright. It wasn't in our ground level pilot
application, but we certainly have been exploring. We did some
outreach to those communities to make sure that they were
hearing about the incentive program. But, again, that goes back
to the challenge of transportation, and some of these other
issues. So we are looking forward to partnering with our local
Health Department in this upcoming cycle to really get at that
transportation issue, and educate folks about where they can
use their benefits.
Mr. Ashford. That is, obviously, an area with so many
opportunities with this in Nebraska, and apparently we don't
have a grant up to this point, but I sure am going to encourage
our people in Nebraska to look at this. I know transportation
is an issue with housing authorities, but, at least where we
are, we have attempted to create at least urban gardens around
housing authority facilities. That doesn't, in and of itself,
create the SNAP option, but it does heighten the awareness of
the need for nutrition. And, obviously, our school nutrition
programs and all those go together. But the point that was made
as well about everybody must be at the table is clearly the
case.
So I don't really have any other questions, other than just
to really applaud this, applaud the Committee. This is the kind
of stuff that really makes a difference. And I know working
with that population at Omaha Housing Authority, we were always
looking for self-sufficiency programs, always looking for ways
to address, certainly, nutrition, and job self-sufficiency, and
so forth and so on.
And the last point I would make is that what I also found
was that the more we could break down the barriers between the
agencies, like HUD, for example, and USDA, and that sort of
thing, the better we are. And the way to break those barriers
down is to have an actual concrete program that works. You can
then sort of work through those barriers and nutrition.
Obviously, we don't want to cut SNAP benefits, but we get into
that discussion, and then back and forth. But, these kinds of
discussions, where we are thinking of ways to break those
barriers down between housing and nutrition and education, are
significant. I am just amazed at how successful this is. Thank
you, Madam Chair.
Ms. Petee. May I add a comment to that about the stigma?
Mr. Ashford. Sure.
Ms. Petee. I think that is one of the reasons we are
finding the food insecurity screening in our hospitals being so
effective, is because we do a two question screen that, if the
patient answers yes to either of those questions, it prompts
further evaluation by either a social worker or a clinician who
is trained to have that conversation. Then we are working to
enroll those patients right there at the bedside into the SNAP
programs, or whatever assistance programs.
Also, we just opened a food pharmacy last April, so coming
up on a year, and we have 19 physicians in one of our clinics
that will actually write a prescription for food versus
medicine. That conversation with the individual to go get this
prescription filled, which is nutritious food, takes away so
much of the stigma for that individual, who then utilizes the
other food banks and pantries in the intervening weeks before
that prescription can be rewritten. So they are understanding
better, this is for my health, this is something that my doctor
has given me the green light to do. I am not a failure, these
services are out there for me to use. We have seen just
tremendous use of the food pharmacy, so much so that we opened
a second one just last month. And many hospitals across the
country are doing the same. Thank you.
The Chairwoman. Thank you.
Mr. Ashford. Yes, it is brilliant. Thank you.
The Chairwoman. Ms. Plaskett, you are recognized for 5
minutes.
Ms. Plaskett. Thank you. Thank you, Madam Chair, and thank
you also for all being here. Ms. Kylie, I was really moved by
your written testimony, and, as a mother, I am very keenly
aware, and thank you for the importance of having your children
be at the food markets as well, the farmers' markets, to have
them grab healthy habits with regard to--and I loved how you
are putting the face of the farmers who are creating their
food. I think that that is really important in the kind of
world that we live now. So many of our children are in urban
areas, or in areas where they don't meet farmers, to know that
these are the people that are growing your food. And it also
really does something great for the farmers as well, to see
young people who are going to be eating the foods that they are
working to create for them.
I wanted to ask you, Dr. Wright, about one of the things
that you were talking about. You talked about the best place to
inform SNAP recipients of the Double Dollars Program is the
state SNAP offices. And it is interesting, and unfortunate,
because we know that that outreach is no longer funded by
Congress, which at one time funded it. Do you think that that
is a good investment of our funding source, to be able to use
those offices? I know that our local government does not have
the capacity to have someone specifically for that. Have you
seen any demonstrable evidence of that being able to assist in
the utilization of the program?
Dr. Wright. Thank you for that question. Our Bluegrass
Community Foundation and Bluegrass Farm to Table have been
reaching out to our state SNAP office to start this dialogue
about how they, and our local SNAP offices, can be more
involved in the education process about these incentive
programs. We really feel like it is critical to build that
capacity at the state and local level, because really they are
the front line, and they have the potential to touch every SNAP
recipient in the communities that we are working in. And so if
they are on the front lines, in the trenches with us, helping
to educate folks about where they can use their benefits, where
they can access these incentive programs, that is a really,
really important tool to have. And so we hope, in Lexington, to
engage with both our state and local office to improve that
communication and that dialogue
Ms. Plaskett. Thank you.
And, Dr. Hesterman, one of the things that we found in our
location, I represent the Virgin Islands, it would appear to
most people that we would have an abundance of produce. But
because our farmers are not on very large scale farming, it
becomes an issue of cost for them to be able to be participants
in programs like this. But, because of the availability of
their produce we are very interested. Our governor, our local
Department of Agriculture is really interested in our farmers
being able to be participants in the SNAP Program, like school
lunch programs, and some of the others.
But availability, and also cost, and the cost of the EBT
system, when we don't have access to Square, necessarily, or
some of those others, is something that is a barrier to entry
for the farmers, and therefore for the recipients of SNAP to be
able to receive those kind of programs. What are some creative
ways that you think, or have you been looking at--I heard you
talk about the app as one. Are there other programs that you
are looking at to drive down that cost for the farmers
themselves to be able to be participants?
Dr. Hesterman. Yes. Actually, one of the most exciting
ideas that we are thinking about is creating a transaction
processing system that can operate across the farmers' market
and the grocery store setting for EBT and for incentives so
that we are not looking at solely, well, there is a different
way to use the program at a farmers' market, and a different
way to use the program at a grocery store, but let us think
about how we can use technology and transaction processing
systems to actually engage grocers and farmers' markets
managers, and try to get something uniform so that it is lower
cost, it can be used by customers, in my view across the
country. I mean, the idea, Ms. Kiley, of creating a common
brand across the country, so we can actually create a common
brand for incentives, a common way to actually conduct this
business, a common way to collect information, that is sort of
what I hold in my head for the future, and hope we are taking
some steps to get there.
Ms. Plaskett. Thank you.
The Chairwoman. I appreciate the panel's help in
understanding the importance of nutritional education and
incentive programs. When discussing the overall health of low-
income people, incentivizing healthy eating habits, while
working within communities, is an important part of looking at
how we can continue to best serve our fellow Americans. You
have certainly given us plenty to think about as we continue to
look for ways to improve the nutrition programs to better serve
their recipients. No program is perfect, and we can always do
better.
Under the rules of the Committee, the record of today's
hearing will remain open for 10 calendar days to receive
additional material and supplementary written responses from
the witnesses to any question posed by a Member. This hearing
of the Committee on Agriculture, Nutrition Subcommittee, is
adjourned.
[Whereupon, at 11:35 a.m., the Subcommittee was adjourned.]
[Material submitted for inclusion in the record follows:]
Submitted Statement by Hon. Will Hurd, a Representative in Congress
from Texas
The 23rd Congressional District of Texas spans from San Antonio to
the outskirts of El Paso, covering countless smaller towns and cities
in between. Food security is one pressing issue that Americans face
every day, whether they live in a small town in West Texas or in a big
city like San Antonio. The San Antonio Food Bank (SAFB) provides
countless pounds of food to organizations and individuals in Texas,
hosts a number of nutrition education programs, and finds innovative
methods of developing the local economy and workforce. It is because of
organizations like the San Antonio Food Bank that individuals can focus
on issues important to their family instead of worrying about putting
food on the table.
The lack of healthy habits and fresh food consumption pose a direct
threat to the state of wellness in the United States. One of the most
harmful and prevalent diseases Americans face today is diabetes, which
causes needless suffering and contributes to millions in healthcare
costs. While it is essential to treat the symptoms of diabetes and
other chronic diseases like obesity and heart disease, it is of
paramount importance to focus on their root causes like poor lifestyle
choices and lack of proper nutrition. Increasing access to fresh fruits
and vegetables, increasing families' ability to purchase them, and
educating the community about the importance of nutrition are among the
most important proactive measures that support good health.
While healthcare professionals care for those who are already
battling disease, organizations like the SAFB play a crucial role in
providing services that aid in disease prevention. It is my hope that
the SAFB and similar organizations share their stories and continue to
expand their impact on the well-being of communities across Texas and
across the nation.
______
Submitted Letter by Jennifer Hatcher, Senior Vice President, Government
and Public Affairs, Food Marketing Institute
February 3, 2016
Hon. Jackie Walorski, Hon. James P. McGovern,
Chairwoman Ranking Minority Member,
Subcommittee on Nutrition, House Subcommittee on Nutrition, House
Committee on Agriculture, Committee on Agriculture,
Washington, D.C.; Washington, D.C.
Dear Chairman Walorski and Ranking Member McGovern,
The Food Marketing Institute (FMI) commends the House Agriculture
Subcommittee on Nutrition for holding a hearing ``To review incentive
programs aimed at increasing low-income families' purchasing power for
fruits and vegetables.'' As the point of redemption for both the
Supplemental Nutrition Assistance Program (SNAP) and the Special
Supplemental Nutrition Program for Women, Infants and Children (WIC),
the grocery industry has a unique perspective on how the programs are
administered and on ways to create opportunities to improve the health
not just of program participants but the entire population.
FMI's members have participated in various initiatives and pilot
projects to encourage SNAP and WIC participants to purchase more fruits
and vegetables with varying degrees of success and many lessons
learned. For instance, the WIC program now includes cash value vouchers
for families to purchase fruits and vegetables in addition to their WIC
package foods. These vouchers have proven to be incredibly popular and
have increased families' buying power of those foods.
FMI retail members have also participated in state and locally run
initiatives that ``double up'' SNAP customers' buying power of fruits
and vegetables. For example, in one initiative a SNAP customer would
receive a $5 voucher to purchase fruits and vegetables for every $5
SNAP dollars they spent on fruits and vegetables. FMIs members have
reported that they learned very important lessons from these
initiatives, most importantly, customer education from the beginning is
essential; not just that these foods are healthy, but how to prepare
them. The education must start from the beginning of the SNAP process
with states' using their SNAP-Ed resources to educate the participant
before they ever go to the store. Many of our retail members conduct
educational programs in their stores demonstrating ways to prepare
fruits and vegetables in addition to ideas for stretching their
shopping dollars.
The grocery industry is fully committed to the health of all of our
customers. Today 95% of grocery stores employ dietitians at the
corporate, regional and store levels. FMI members proudly employ
nutritionists and dietitians to aid all of their shoppers in making
healthy balanced choices. Additionally, these professionals often teach
customers with various health conditions, including food allergies,
diabetes and nutritional deficiencies, on how to shop and prepare foods
that address their dietary needs and restrictions. Many of our members
host school groups to teach children about healthy eating and making
thoughtful selections and maintaining a balanced diet.
Chefs in the grocery store have become more prevalent over the past
several years. FMI members hire professional chefs to further aid all
of our shoppers in eating a more balanced diet. The chefs supply
recipes for shopping and preparing healthy and often low cost meals.
Additionally, grocery chefs participate in cooking demonstrations, food
sampling occasions and other in-store events to help educate the
customer.
These are only a few of the initiatives and programs our retail
members have and are participating in. All grocery customers benefit
from the grocery industry's commitment to customers' health and
wellness, whether they are shopping on a budget, are participants in
SNAP or WIC or have unique dietary restrictions or needs. I have
attached FMI's recent report entitled, ``Retailer Contributions to
Health & Wellness'' that shows the industry's strong commitment and
investment into this area.
Thank you again for your interest in the initiatives to encourage
greater consumption of fruits and vegetables in an economical way. We
look forward to working with the Subcommittee as we continue to learn
from some of the initiatives we are considering or have in place . . .
to make a difference in the health of all of our customers.
Sincerely,
Jennifer Hatcher,
Senior Vice President,
Government and Public Affairs.
attachment
2014 Report on Retailer Contributions to Health & Wellness
The growing arena of health and wellness represents a complex
combination of corporate social responsibility and vast business
opportunities for food retailers. For the past 2 years, the Food
Marketing Institute (FMI) has conducted surveys and published reports
to track how members are meeting the needs of shoppers who are seeking
healthier lifestyles.
Now in its third year, this 2014 Report on Retailer Contributions
to Health & Wellness represents an evolution of the previous survey
reports. At its core, the information gathered for this report will
help to demonstrate how food retailers are contributing to the health
of their customers. One goal is to share this information with media,
legislators and the public to highlight the positive impact of our
industry.
More importantly, FMI's vision is to use this information as more
than a simple status report of what the industry is doing in the sphere
of health and wellness. We hope that this expanded report will serve as
a useful planning tool that will help members strategically grow and
shape their companies' health and wellness offerings in a meaningful
way.
Contents
Recognizing the Business Power of Health & Wellness
Constructing In-Store Health & Wellness
Current Health & Wellness Offerings
Getting on Consumers' Radar
In-Store Health Professionals
Health Professional Community Partners
It's All About the Content, Content, Content
Leveraging Store Websites
The Growing Value of In-Store Clinics and Pharmacies
What's Working?
Methodology
The majority of data for this report was generated by a survey
conducted among FMI members in November and December 2014. Twenty-nine
store chains responded. It is estimated that these retailers represent
at total of more than 6,800 stores across the country. Forty percent of
the respondents operate between 101 and 500 stores. Twenty-five percent
operate more than 500 stores. Fifteen percent operate between 31 and
100 stores. The remaining 20% operate between one and 30 stores. The
location of the stores operated by the surveyed companies spans every
region of the United States.
While not all operators participated in the survey, FMI believes it
represents a strong sampling of food retailers' health and wellness
initiatives nationwide. Information used to supplement this report was
taken from two other studies conducted in 2014 by the management
consulting firm, Oliver Wyman, ``Are Consumers Ready for Retail
Healthcare?'' and ``Opportunities for Grocers in Health Services.'' The
later study was commissioned by FMI.
Data analysis was conducted by The Ginger Network, LLC, a marketing
communications firm based in the Washington, DC, metropolitan area,
dedicated to providing seasoned counsel on food & nutrition brand and
marketing issues for food companies, associations and commodity groups.
Almost all retailers surveyed (96%) report that their
companies are committed to expanding health and wellness
programs in their stores.
Recognizing the Business Power of Health & Wellness
Participants were asked to view health and wellness from both an
industry and an individual store-chain perspective. From a holistic
retail-industry perspective, the majority of food retailers in this
survey (70%) currently view supermarket health and wellness programs as
a significant business growth opportunity for the entire industry in
the year(s) ahead.
In fact, the preponderance of respondents (63%) sees health and
wellness as one of many selling points for food retailers to compete
for customer loyalty. Approximately \1/2\ see these programs as a
momentous shift in how Americans will access healthcare in the years
ahead.
From an individual store-chain perspective, an impressive 78% of
respondents view in-store health and wellness programs as a
responsibility to their communities and family of customers and a
significant business growth opportunity for their individual brand in
the year(s) ahead. At the same time, approximately \1/2\ see these
programs as a core business requirement for reducing sick time and
insurance costs as well as a necessity to keep up with the competition
of other retailers' health and wellness efforts.
There is a significant opportunity to apply actions to these
beliefs. About \1/2\ (54%) of food retailers in this survey have an
established health and wellness program for both customers and
employees. Currently, 34% have existing programs for employees only.
The reasons for this disconnect between belief and action is not clear.
However, almost all retailers surveyed (96%) report that, going
forward, their companies are committed to expanding health and wellness
programs in their stores.
Among those who do have established programs, their efforts are
growing. Sixty-one percent of retailers in this survey report that
their companies' overall health and wellness programs and activities in
2014 have moderately or significantly increased in comparison to 2013.
Most importantly, these companies are not just giving lip service to
health and wellness by talking about it. Rather, 83% of them report
having genuine activities in which consumers and employees can
participate.
Companies that report being more focused on talking about
health and wellness or actively implementing them.
Constructing In-Store Health & Wellness
When it comes to evaluating health and wellness opportunities and
deciding how and if they will be operationalized, pharmacy team
leadership (59%) and nutrition team leadership (50%) are the two groups
who make the most decisions. However, more than 36% of stores report
that their President/CEO is making these decisions.
These findings are significant on multiple levels. They demonstrate
that the majority of these efforts are not being driven by sales.
Rather they are entrusting this level of strategic planning to the
health professionals on staff and/or that these decisions are happening
at the absolute highest level of the organization.
Similarly, once operationalized, the pharmacy teams (43%) and the
nutrition teams (38%) are the clear primary leaders of the in-store
health and wellness programs across the country. A very small number of
programs are operationalized by the consumer affairs or marketing
teams.
At this time, the jury is still out among retailers on the best
organizational structure. When asked if this structure is set in place
for the foreseeable future, or if it is still under review, a little
more than \1/2\ responded that it is set in place.
For the most part, the majority of respondents have organized their
health and wellness activities to balance engagement with customers who
are ill (with some existing condition) as well as with customers who
are well and seeking to maximize their health--as opposed to focusing
more on one than the other.
Leaders of In-Store Health and Balance of Health and Wellness
Wellness Programs Activities
Current Health & Wellness Offerings
The following types of health & wellness programs and/or features
are being provided by survey respondents over this past year:
Of these, the following programs and/or features are offered free
to participants in the majority of stores.
Getting on Consumers' Radar
Consumers have become increasingly interested in information on
nutrition labeling. Whether they are looking for health information
like ``fat free'' or ``low sodium'' or lifestyle choices like
``organic'' or ``Kosher,'' over the past year, retailers significantly
have increased efforts to meet this demand for information.
The following chart demonstrates how many retailers in this survey
identified specific products on shelves in 2014 versus 2013.
Over the past year, there has been a shift in the strategies
retailers use to help consumers identify healthy products.
Specifically, there has been a significant increase in identifying
wellness products by lifestyle (i.e., vegan, Kosher, etc.). At the same
time, there has been a significant decrease in identifying products
according to the health conditions they benefit (i.e., gluten
intolerance, diabetes, etc. . . .). However, directly placing
alternative healthful products next to original versions (i.e., low-
sodium, fat-free, etc.) continues to be a growing strategy.
Retailers are implementing various means to promote their
companies' health and wellness activities to consumers. The following
chart [Retail Promotion Efforts] demonstrates the primary efforts being
used. Ninety percent of all stores are investing in advertising, in-
store signage, website and social media outreach to connect with
consumers in this arena. However, when asked to rate the effectiveness
of their promotion efforts, retailers surveyed report that in-store
pharmacists and dietitians are the most successful at engaging
consumers in health and wellness activities.
Identification Strategy
Retail Promotion Efforts
In-Store Health Professionals
It is reasonable to envision that supermarkets are indeed becoming
a health care destination. In addition to the fact that almost all
stores have pharmacists on staff, a healthy 95% of stores employ
dietitians at the corporate, regional and store levels.
Importantly, these dietitians and pharmacists are making noteworthy
gains in working as a team to advance health and wellness. For example,
67% of them are working together to develop programs and almost \1/2\
(48%) are working together to make customer-specific recommendations.
These are significant increases from 2013. In addition, 52% of them say
they are referring customers/patients to each other for counsel.
Moreover, 70% of respondents have in-store clinics in some or all
stores. That is a sizable increase from 40% only 1 year ago.
Interestingly, there has been a shift between 2014 and 2013 in how
in-store health professionals are following up with customers after
they participate in a store nutrition program. Specifically,
recommendations have doubled for encouragement to get a health
screening at the pharmacy or in-store clinic. However, there has been a
precipitous drop in the amount of coupons offered for healthy foods in
the store or information offered on other nutrition and wellness
programs.
Activity After In-Store Nutrition Program
Health Professional Community Partners
Consumers are looking for more than just convenience and easy
access to healthcare. Trust and perceived quality are key concerns.\1\
Doctors and nurses traditionally are the most trusted health
information sources. Pharmacists are usually ranked third.
---------------------------------------------------------------------------
\1\ Are Consumers Ready for Retail Healthcare?--Copyright 2014
Oliver Wyman.
---------------------------------------------------------------------------
This is great news for retailers since almost all employ
pharmacists. However, a new study \2\ of more than 2,019 consumers
suggests that for health-related matters, they are significantly more
likely to trust retailers who have partnerships with local healthcare
providers.
---------------------------------------------------------------------------
\[2]\ [Ibid.]
---------------------------------------------------------------------------
Therefore, FMI specifically asked retailers if their companies work
with partners in the community to underscore their professional health
and wellness credibility and/or to enhance their programs. The results
are overwhelmingly positive and ones that should be communicated
clearly to customers.
It's All About the Content, Content, Content
Virtually all retailers surveyed offered store tours in 2014. The
vast majority of these tours (85%) are conducted by the registered
dietitians on staff, and the balance is conducted by the pharmacy
staff.
The two most popular tour topics are diabetes and healthy eating,
which underscores the finding above that stores are trying to offer a
balance of education programs that appeal to both ends of the customer
spectrum--to those who are ill (with some existing condition) as well
as to those who are well and seeking to maximize their health.
In 2014, more than \1/2\ of food retailers in this survey employed
chefs at the corporate level. And 76% employed a chef at all or some
stores. A very similar percentage of respondents (74%) offered cooking
classes to customers. The majority of these classes were geared for
customers with restricted diets.
Types of Cooking Classes
In addition to cooking classes, 63% of stores also provide weight
management classes for adults. Outside the classroom setting, healthy
recipes are made available on 80% of store websites and in 59% of
stores on printed cards or in kiosks.
Beyond classes and recipes, food retailers must be keenly aware of
the numerous studies that cite the benefits of families eating
together. In 2014, they clearly embraced this concept. In fact, 84% say
they are actively promoting communal eating such as family meals. (This
is a jump from last year's reported 75%.) However, very few of these
programs have been formalized.
------------------------------------------------------------------------
-------------------------------------------------------------------------
Retailers should be aware that the FMI Foundation has established a
national family meals initiative to provide stores with turnkey tools
and building blocks to advance their role as community promoters of
family meals.
Learn more at www.fmifamilymeals.com
------------------------------------------------------------------------
Leveraging Store Websites
Eighty-one percent of retailers in this study have a dedicated
space on their website to engage with customers on the topic of health
and wellness. Sixty-seven percent have a similarly dedicated webpage
for employees. These sites are being used most to share health
articles, healthy recipes and Q&A documents about nutrition.
The most popular topics on these websites focus on common health
concerns and food allergies.
The Growing Value of In-Store Clinics and Pharmacies
As noted earlier, there has been significant growth in the number
of retailers who established in-store clinics in 2014. Combined with
in-store pharmacies, these locations are perhaps the most tangible
demonstration to customers that supermarkets not only offer health and
wellness education and support, but are convenient and affordable
alternative healthcare providers.
The following graphic demonstrates the high percentage of survey
respondents offering a broad array of immunizations and screenings that
define the foundations of ``retail healthcare.''
The momentous opportunity for retailers is that these pharmacy and
clinic visits engage the customer with health professionals who not
only offer information about medical adherence, but whom also:
Refer consumers to other nutrition and wellness information
in the store;
Offer them coupons for the appropriate healthy foods in the
same store;
Encourage them to participate in in-store nutrition
programming; and/or
Refer them to the company dietitian.
What's Working?
Unquestionably, one of the most important planning tools for retail
health and wellness programs moving forward is careful measurement of
existing efforts to determine what works, what can be improved and what
elements should be left behind. Many retailers are far along this path
already. In 2014, more than 63% of retailers in this survey have set
quantitative business goals for their health and wellness programs and
are tracking results. In addition more than 42% have set qualitative
goals and are tracking those results too.
The following graph shows ten different tracking mechanisms that
respondents have been using to assess the effectiveness of health and
wellness efforts. By far, the most popular measure employed (by almost
90% of companies) is a quantitative one--actual customer participation
and attendance numbers in program activities. This is followed by a
qualitative measure employed by almost 80% of respondents--the
collection of consumer comments. The next most prevalent tracking
mechanism is the ultimate consumer-behavior--change gauge, sales.
Plotted on the same graph, is an assessment of usefulness for each
of the tracking mechanisms. Retailers were asked to provide a score on
a scale from 1 to 7 (with 1 being the least useful and 7 being the most
useful). The three most useful forms of tracking are aligned with the
most popular methods of tracking--consumer comments, participation and
attendance, and sales.
While tracking sales is certainly a reasonable and common form to
track all new initiatives, retailers are cautioned to remember that
consumers need to have awareness of health and wellness programs, and
have a positive attitude about them, before they will change their
behavior as a result of participation. So it is important not to let
the sales measurement dominate the decision process for health and
wellness initiatives, moving forward.
Tracking Mechanisms
Moving Forward
In the 3 years since this survey report was started, there clearly
has been tremendous exploration and growth of health and wellness
programs in the food retail setting. It is even more clear that the
cross section of retail and healthcare is fertile ground for both
community service and business growth. Insurers are actively looking
for alternatives to reduce costs and satisfy consumer preferences. At
the same time, the majority of consumers are interested in receiving
minor care beyond the doctor's office. They are willing to receive
advice on diet, nutrition, fitness, well-being, and even on managing a
chronic condition.
In other words, we are seeing an unusual and ideal confluence of
circumstances--healthcare environment, consumer interest, and
supermarket-solution-provider capabilities--for food retailers to
define the business models that will build the future of retail
healthcare.
Food Marketing Institute proudly advocates on behalf of the
food retail industry. FMI's U.S. members operate nearly 40,000
retail food stores and 25,000 pharmacies, representing a
combined annual sales volume of almost $770 billion. Through
programs in public affairs, food safety, research, education
and industry relations, FMI offers resources and provides
valuable benefits to more than 1,225 food retail and wholesale
member companies in the United States and around the world. FMI
membership covers the spectrum of diverse venues where food is
sold, including single owner grocery stores, large multi-store
supermarket chains and mixed retail stores.
For more information, visit www.fmi.org and for information
regarding the FMI foundation, visit www.fmifoundation.org.
Catherine M. Polley, Vice President, Health & Wellness and
Executive Director, FMI Foundation;
Megan J. Tinklepaugh, Manager, Health & Wellness.
______
Submitted Letter by Alan R. Hunt, Ph.D., Director of Policy and
Research, Wholesome Wave
February 17, 2016
RE: Additional Written Testimony for the Hearing to review incentive
programs aimed at increasing low-income families'
purchasing power for fruits and vegetables
Dear Members of the House Agriculture Committee,
Since its founding in 2007, Wholesome Wave has strived to fulfill
its vision of increasing affordable access to fresh, local, and
regional food for under-served consumers. In the 8 years from our
launch of the Double Value Coupon Program in California, Massachusetts,
and New York, Wholesome Wave now supports nutrition incentives programs
in 38 states, the District of Columbia, and the Navajo Nation. Recast
as the National Nutrition Incentive Network, to highlight the shared
leadership and community of practice amongst our partners, the Network
reached about 50,000 consumers and more than 6,600 farmers in 2015.
Partnerships are an effective strategy for expanding the adoption
of nutrition incentives, as shown through our work with the AARP
Foundation and BlueCross BlueShield of Minnesota. Our National
Nutrition Incentive Network facilitates a national healthy food
incentive community of practice around innovative incentive models,
including Fruit and Vegetable Prescriptions and farm to grocery
projects. Our growing evidence base shows nutrition incentives are a
successful strategy for improving the health of Americans with low
incomes.
We sincerely appreciate the House Agriculture Committee's
leadership and continuing interest in nutrition incentives for families
and individuals with low incomes. The Agriculture Committee's
leadership on the Food Insecurity Nutrition Incentive program (of which
we are recipient), SNAP EBT provision at direct to consumer markets,
Community Supported Agriculture (CSA) access to SNAP EBT, the Farmers'
Market and Local Food Promotion Program, and Community Food Projects is
making real improvements to under-served Americans and small and mid-
sized farm operators.
The February 3rd Nutrition Subcommittee hearing to review incentive
programs aimed at increasing low-income families' purchasing power for
fruits and vegetables helped examine the multi-faceted issues of
nutrition incentive programming and outcomes. We look forward to
continuing to work with the Committee Members on its unique policy
charge, which includes both nutrition and agriculture. We are providing
written testimony for the record as a supplement to the witness
testimonies at the hearing. Please contact us with any questions.
Sincerely,
Alan R. Hunt, Ph.D.,
Director of Policy and Research.
attached statement
Introduction
Wholesome Wave supports and facilitates a National Nutrition
Incentive Network that builds the capacity and provides technical
assistance to more than 100 organizations in 38 states, D.C., and the
Navajo Nation. In 2015, the National Nutrition Incentive Network
reached about 50,000 consumers and 6,600 farmers. Wholesome Wave
received a $3.77 million USDA Food Insecurity Nutrition Incentive
(FINI) grant in 2015, matched with $3.77 million from private sector
sources. We are a FINI sub-grantee for AARP Foundation, Florida
Organics Growers, Maine Farmland Trust, and Green Mountain Farm to
School. FINI was critical to expand the National Nutrition Incentive
Network's community of practice.
The following testimony includes policy relevant to nutrition
incentives, background on Wholesome Wave and the National Nutrition
Incentive Network, consumer and producer impacts, and an appendix.
Goals of Nutrition Incentives
Nutrition incentive programs encourage consumers to spend their
Federal nutrition benefits (SNAP, WIC, etc.) on healthy foods, such as
fresh fruits and vegetables, at farmers' markets, mobile markets, CSAs
and grocery stores by offering a financial match (``the nutrition
incentive'') based on how much the customer spends. Nutrition
Incentives, also called Healthy Food Incentives, have three primary
aims:
Increase the affordability and access for fruits and
vegetables for food-insecure Americans,
Improve the health status of low-income Americans, and
Benefit local and regional farmers, often small and medium
sized farms.
Upcoming Issues for Congressional and Federal Policymakers
Completing USDA implementation of Section 4002 of the
Agriculture Act of 2014 to provide free wireless EBT POS
devices for use at direct markets.
A common sense policy on use of EBT terminals at farmers'
markets with more than one site, which promotes SNAP integrity
and minimizes SNAP EBT cost for farmers' markets. In contrast,
authorized SNAP producers can use a single EBT POS device at
multiple markets.
The development of eWIC pilots that include wireless POS
technologies appropriate for direct marketing farmers and
farmers' markets by the 2020 eWIC transition. Ideally all
states would allow multiple wireless technologies for eWIC,
SNAP, FMNP, and incentives.
Ensuring the continued allowance of WIC-based nutrition
incentives (based on the Cash Value Voucher) at direct to
consumer markets, of which there has been unclear guidance from
USDA.
Continuing the appropriation for the Farmers Market SNAP
Services Support Grant.
Continuing and expanding the USDA FINI program in the 2018
Farm Bill.
Most all nutrition incentive programs utilize a combination of
private sector, municipal, state, and other Federal funds to sustain
the overall nutrition incentive program, including: USDA Community Food
Projects, USDA Farmers Markets and Local Food Promotion Program, USDA
Specialty Crop Block Grants, and SNAP-Ed (other Federal sources cannot
be used to match activities within a FINI grant).
Federal Policy on Nutrition Incentives
Nutrition incentives require several steps for successful
operation, nearly all of which policy influences.
Retailers must become authorized for an existing Federal
nutrition assistance program (SNAP, WIC, WIC Cash Value
Vouchers, WIC FMNP, SFMNP).
Retailers must be authorized for exemption from the SNAP
equal treatment provision to provide the nutrition incentive,
receiving either a blanket waiver (as direct markets have
received) or individual authorization (as grocery retailers
need) from USDA FNS.
Retailers must have technology to redeem electronic benefits
for SNAP, and eWIC by 2020.
Retailer Point of Sale (POS) technology needs to
differentiate between food product types--fruits and
vegetables.
Retailers need a means to issue an incentive at the Point of
Sale, either for that transaction (e.g., discount applied
instantaneously and electronically, or an incentive token to be
redeemed at a farmers' market vendor), or at a future
transaction (e.g., a coupon).
A system to track the issuance and redemption of the
incentives (for some farmers' markets this includes a token or
scrip management system).
Recent Congressional actions have supported the expansion of
nutrition incentives. This includes the continued provision of free
SNAP EBT POS devices to direct marketing producers and farmers' markets
that centrally operate EBT for the market's vendors as authorized in
Section 4002 in the Agriculture Act of 2014. Also, the authorization of
FINI significantly expanded public funding for nutrition incentives,
and catalyzed private sector and other non-Federal public sector
support for nutrition incentives by requiring a $1 for $1 non-Federal
match.
Recent Federal actions by USDA have also supported the expansion of
nutrition incentives. For example, from funds appropriated by Congress
in FY 2012, the USDA helped develop a wireless SNAP EBT technology, in
partnership with the National Association of Farmers Market Nutrition
Programs, called MarketLink.\1\ MarketLink has a built-in function that
allows local markets to apply a nutrition incentive to the SNAP
purchase. In 2015, USDA FNS released $3.3 million for SNAP Farmers
Market Support Grants which aim to increase ``the participation of
farmers' markets in SNAP by providing equipment and support grants to
new markets and those currently participating in the program'' from
approximately $4 million that Congress Appropriated in FY 2014.\2\
Unlike other grants, these grants provided dedicated assistance to
direct markets for: SNAP EBT equipment (including WiFi hotspots to
operate wireless EBT POS devices, scrip, tracking systems), SNAP
outreach and educational materials customized for direct markets, and
SNAP EBT device training and operation.
---------------------------------------------------------------------------
\1\ http://www.fns.usda.gov/sites/default/files/FM_051112.pdf.
\2\ http://www.fns.usda.gov/sites/default/files/snap/FMSSG-RFA-
FINAL-05.05.15.docx.pdf.
---------------------------------------------------------------------------
Background on Wholesome Wave
Wholesome Wave employs a solution-driven and a market-based
approach to achieving its mission of healthy, affordable, local food
for all. Wholesome Wave's Founding Board Chair, Gus Schumacher, began
to lay the groundwork for the advent of nutrition incentive programs in
the 1980s, first as the Commissioner of Food and Agriculture for
Massachusetts, leading to the creation of the WIC Farmers Market
Nutrition Program (FMNP), and later as Undersecretary at USDA and
creating the Senior FMNP. Since then, the field of incentive programs
has grown exponentially. The following is a short history of the field
in the last 10 years.
2005--1st Nutrition Incentive Program. The New York City
Department of Health and Mental Hygiene began the Health Bucks
Program.
2007--Wholesome Wave Formed. USDA Waiver Obtained.
Crossroads Farmers Market in Takoma Park, MD obtained a formal
USDA pilot waiver to operate a nutrition incentive program.
2008--Double Value Coupon Nutrition Incentive Program
launched by Wholesome Wave in California, Massachusetts, and
New York.
2010--Obstacles for Incentives Minimized. Wholesome Wave and
its partners work with the USDA to ease the waiver policy on
nutrition incentives at farmers' markets.
2013--Evidence of Impact shown through Healthy Food
Incentives Cluster Evaluation demonstrating economic impacts of
nutrition incentive programs.\3\
---------------------------------------------------------------------------
\3\ Available from Wholesome Wave at: http://www.wholesomewave.org/
wpcontent/uploads/2014/07/
2013_healthy_food_incentives_cluster_evaluation.pdf.
2014--Agriculture Act Provides $100 Million over the 5 years
through the USDA Food Insecurity Nutrition Incentive (FINI)
---------------------------------------------------------------------------
program.
2015--$31.5 Million Allocated through FINI Grant Program and
Wholesome Wave receives a $3.77 million grant, with $3.77
million raised in matching funds to support expansion of the
National Nutrition Incentive Network.
The Wholesome Wave Approach
Wholesome Wave utilizes a capacity-building approach to launch,
support, grow, and sustain our partners' nutrition incentive
programming. Wholesome Wave begins its partnership work with an
invitation from community organizations. We then use a four-step
approach to work with community-based partners to identify needs,
develop and test programs, spread their impact, and institutionalize
change that will yield healthier people, stronger local communities,
and enhance farm income.
National Nutrition Incentive Network
Wholesome Wave is transforming individual, community, economic, and
environmental health by facilitating a national network of nutrition
incentive practitioners dedicated to leveraging simple solutions at the
local level into long-term policy change. Wholesome Wave builds the
capacity of network members to deliver nutrition incentive program
benefits to their customers, farmers, and communities. As network
members, they participate in a community of innovation and learning,
have their impact aggregated as part of a national data set, and serve
as policy advocates.
Network Highlights
38 states, D.C., and Navajo Nation.
Over 730 direct to consumer sites (farmers' markets, CSAs,
farm stands, & mobile markets).
Over $3.3 million in Federal food assistance and incentives
redeemed cross-Network in 2014.
Fruit and Vegetable Prescriptions offered in ten states and
the Navajo Nation reaching 6,134 people from 2011-2015.
Partnerships with AARP Foundation, BlueCross BlueShield
Minnesota, & Fair Food Network.
Co-developed the FM TracksTM app & website to
measure network performance with Case Western Reserve
University.
Conducting the first Randomized Controlled Trial on
nutrition incentive impacts on fruit and vegetable consumption
and health outcomes with University of Delaware.
National Nutrition Incentive Network & FVRxTM Partners
Current as of 1/25/16.
Network Services:
Community of Practice--a peer to peer community where
members interact, share ideas, resources, identify solutions
and build the body of knowledge for nutrition incentive
programs.
Online listserv--380 subscribers by January, 2016.
Newsletter--226 subscribers by end of 2015.
Annual Summit--Held in January 2016, 290 attendees,
including USDA and CDC staff.
Tools and Technical Assistance:
In-person training and field visits--At least one
visit per year for 32 FINI partners.
Trained staff on-call--All 92 network members received
access via phone and e-mail.
Training and educational webinars--9 webinars with
over 340 attendees in 2015.
Online resource library--62 resources to launch &
sustain nutrition incentive programs.
Data Collection and Evaluation:
Data collection and reporting via FM
TracksTM--Daily data for over 230 sites in 2015.
Randomized Controlled Trial on nutrition incentive
impacts (supported by USDA FINI).
Annual program report completed by all National
Nutrition Incentive Network members with outcomes
disseminated back to the field via a community of practice.
Education and Advocacy:
State-wide nutrition incentive program development.
Collaborations with state agencies of Agriculture,
Public Health, and Social Services.
State and Federal advocacy toolkits & trainings.
State fact sheets on program performance for all
network members.
Network Growth
Consumers Network Members
Farmers Direct-to-Consumer Sites **
* Projected; ** Includes farmers' markets, mobile markets,
and CSAs.
Wholesome Wave's Food Insecurity Nutrition Incentive Large-Scale
Project
Ladder for Growth: A National Network To Build Capacity and Test
Innovative Strategies for Healthy Food Incentives
In the first round of the newly authorized FINI grant program,
Wholesome Wave was awarded a 3 year, Large Scale Project to deploy
nutrition incentive programs at 364 farmers' markets, 23 CSAs, and 38
mobile market sites, thereby increasing affordability and access for
110,000 SNAP consumers to purchase local fruits and vegetables in 17
states and D.C. Small and mid-sized farms participate as retailers in
these programs, and directly engage with both SNAP consumers and
community-based incentive program operators.
To build the capacity of program operators, Wholesome Wave provides
both standardized and customized assistance through trainings,
toolkits, and workshops. By taking primary responsibility for capacity
building, data collection, and evaluation, Wholesome Wave allows
program partners to focus on activities best accomplished at the
community level: engagement with SNAP consumers and local fruit and
vegetable vendors, outreach, nutrition education, and on-site
programming. The project also builds statewide nutrition incentive
programs in Maine, New Hampshire, New Jersey, Ohio, and Virginia.
Statewide incentive programs create opportunities for efficient
expansion and lay the foundation for program sustainability.
Food Insecurity Nutrition Incentive (FINI)--USDA Grant: 2015-2018
Total Funding $7.5 million Over 3 Years
Building Evidence for Health Impacts--FINI Evaluation
Generating an evidence base for nutrition incentive programming has
always been integral to Wholesome Wave's initiatives, and is a shared
interest among the members of our national network.
Monitoring and Evaluation: For collecting and reporting incentive
program data, Wholesome Wave is piloting the use of FM
TracksTM, an iOS-based mobile application (App) and linked
website developed by Darcy Freedman, Ph.D., at Case Western Reserve
University's Prevention Research Center for Health Research. It
replaces paper and pencil data collection systems used by most
incentive operators with one-step digitized data entry, saving time and
reducing error. FM Tracks provides a common system with consistent
metrics, creating opportunities for assessing program innovations by
comparing market-level data across sites.
Process Evaluation: Process-related data collection through FM
Tracks allows us to evaluate the challenges and successes of project
implementation and operation among programs participating in Wholesome
Wave's FINI project. The process evaluation, conducted by Case Western
Reserve University, also addresses the extent to which natural
variation in site characteristics and management explain differences in
incentive redemption rates.
Outcomes Evaluation: Wholesome Wave, in partnership with the
University of Delaware Center for Research on Education and Social
Policy, is conducting a field-based, coordinated, multi-site randomized
experiment at 40-50 farmers' markets, and collecting non-randomized
consumption data at 16 CSAs to test the effectiveness of several
monetary and non-monetary incentive program innovations. This outcomes
evaluation will provide crucial evidence on how best to increase SNAP
shoppers' purchase and consumption of fruits and vegetables (F&V). The
outcomes evaluation has three main research questions:
1. How different incentive levels result in different F&V purchase
and consumption levels.
2. Comparative outcomes of monetary and non-monetary incentives.
3. Identifying how SNAP shoppers at direct to consumer markets are
similar and different to SNAP participants by comparing
project data with national datasets (e.g., USDA Food APS).
We are testing five incentive levels or ratios, including the
common $1 for $1 or ``Double Up'' level:
$1 EBT: $0.40 Incentive
$1 EBT: $0.80 Incentive
$1 EBT: $1.00 Incentive
$1 EBT: $1.50 Incentive
$1 EBT: $2.00 Incentive
About \2/3\ of survey participants randomly receive one of the
above levels, above the market's preexisting incentive level. No
participants receive less than the market level. Through repeated
entries into this monthly survey and lottery, we are building a dataset
that can be evaluated for statistically significant changes in fruit
and vegetable consumption and self-reported health measures, such as
BMI, within the evaluation period. This should yield a supply and
demand curve for fruits and vegetables providing insight on a dose-
response effect on produce consumption from varying levels of
incentive. We anticipate the first peer-reviewed publication of this
data should be available prior to the 2018 Farm Bill. This is the first
Randomized Controlled Trial on nutrition incentives and will provide
cause and effect data.
Consumer Impacts
``The fact that they double the dollars helps a lot . . . It
helps food stamps go farther, which helps eaters and helps the
farmers--it helps everyone. I can buy fresh produce here and
double my money, and I know it's wholesomely grown, healthier--
it's just an amazing, amazing thing.''
Pearl Market Customer, Columbus, OH.
* * * * *
``I love the double your food stamps program because it
allows me to buy fruits and vegetables for my family which is
what we need in order to maintain health. . . . And I think
it's a great program the government has something to do with,
because it's so much better to help people proactively maintain
health rather than use Medicaid to pay for all their sicknesses
after the fact. It just makes so much more sense and it's one
of the best programs I've ever seen the government do for
people of low-income. We haven't always been people of low-
income. Before I was divorced we had as much money as we wanted
to spend on food and healthcare and everything, but that's just
not the way it is right now and sometimes people are in this
situation and if the government is going to help it's helpful
that it's actually helping and not hurting.''
Webb City Farmers Market Customer, MO.
* * * * *
``It's definitely . . . coming here . . . I eat a lot more
vegetables because they taste a lot better. And doubling my
money has made it a lot easier to eat more vegetables. It's
challenging when I can't make it on a Sunday because it's just
such better food.''
Heirloom Farmers Market Customer, Tucson AZ.
Producer Impacts
``Thank you. Seriously. Your program really benefits us. We
sell at six markets and we see many more tokens come through at
markets where they have the FF incentive program. If it weren't
for the coins/WIC/FMNP we would only sell about \1/3\ of what
we do
now . . . It is also really exciting to see folks that wouldn't
normally eat fruits and vegetables buying and consuming these
foods.''
Laura Mello, Vegetable and Fruit Vendor at Thundermist Market, Warwick,
RI.
* * * * *
``I want you to know how much I value the work that you all
do. It is very personal for me and for Nate. He grew up in a
family of undocumented immigrants. My father left when I was
quite young and my mother really relied on food stamps for my
family. I remember how people at the store would shame us for
being on food stamps. But now, because of this program, I watch
mothers bring their children here and they are so proud. This
program is so important. It is so valued. Because it gives
people dignity. It's political to me. It's meaningful. It
equalizes people. People think this is a rich town, but there
is so much hidden poverty. We see it here when people come to
us with crop cash. A lot of us are farmers because we
understand hunger and we want to make a difference.''
Ama and Nate of Nama farm, Jericho, VT.
Wholesome Wave Impacts
``All of the farmers in the Skowhegan Farmers Market would
like to commend Wholesome Wave for all the support of both our
programs and of the food system in this country overall. You
help to give a voice for farmers and consumers in places that
we are not always able to be present. We are incredibly
thankful for your support over the past few years and look
forward to continuing our work together in the future.''
Skowhegan Farmers Market, ME.
* * * * *
``Heirloom Farmers Market has been an island unto itself, but
with FINI we've been able to bridge gaps with other community
organizations.''
Deb Tenino, Heirloom Farmers Market Development Director, Tucson, AZ.
* * * * *
``With the people who have won the [Randomized Controlled
Trial] lottery, it was like Christmas morning. There was a
couple who came very week; she got a stack of money and she was
going to be good for like weeks. Her and her family were eating
really well and buying everything for the week from the
market.''
Nick, Heirloom Farmers Market Manager, Tucson, AZ.
* * * * *
``So for me, affordable access to healthy food is pretty tied
to healthcare in general . . . Pennies on every SNAP dollar are
actually going to growers . . . That we can be involved in a
great way is a great privilege and it's my hope that we help
share that this model is successful so that it can be adopted
elsewhere.''
Benjamin, Food Access Director, Arcadia Mobile Market--Parkside, D.C.
* * * * *
``To me I think it's a really good program. It helps the
families. And young parents especially. Young moms. Some of
them basically don't do home cooking anymore and a lot of them
get state assistance like food stamps and a lot of them need to
buy food. So with these vouchers that they receive every month
. . . they purchase vegetable and fruit on a weekly basis, I
really like that because the kids are really being introduced
into eating a variety of vegetables whether it's raw or whether
it's steamed or cooked. And fruits too . . . They really enjoy
it because I'm seeing in the little kids eyes when they see the
food demos and I put out all the stuff for them and they look
at it and they say what's this, what's this. They're curious .
. . I sense that the kids are learning. The kids are
understanding and the kids know that vegetable is much more
healthy. . . . One family is doing really good, making
progress. She says her kids are really into eating fruits and
vegetables that they never used to have that. That they always
ask for salad, she said. If I don't make salad, they'll say we
don't want to eat. So she always has to have a salad. . . . So
I know that we're making progress and it's happening and I just
can't wait to see how much weight that this little girl's gonna
lose because she's down by 3 already. And she's really active.
I've seen her. She's really active, energized, more outgoing .
. . I hope we expand to other communities, too.''
Bernice, Health Education Technician with Navajo FVRx, Counselor
Chapter, Navajo Nation.
Resources Included in the Appendix
1. Wholesome Wave Overview & Initiatives (with current Network Map)
2. Fruit & Vegetable Prescription Program
3. National Nutrition Incentive Network & Growth of Incentive
Programs
4. National Nutrition Incentive Network Current Projects (FINI)
5. FM Tracks App & Website
6. Community of Practice
7. ``How to Run a Nutrition Incentive Program'' excerpts, Diagrams
of SNAP & FMNP Incentives
8. Partnering with Your SNAP Agency
9. Developing a Statewide Network
10. Fostering a Culture of Inclusivity at Your Market
11. Funding Your Nutrition Incentive Program
Additional Resources Available in the National Nutrition Incentive
Network Online Resource Library
Fact Sheets
NNIN How To's/Success Stories
Partnering with Your Local/State SNAP Agency
Developing a Statewide Network for Nutrition Incentive Programs
Fostering an Inclusive Market Environment
Funding Your Nutrition Incentive Program
Success Stories: Corporate Sponsorship Case Study: Farm Fresh Rhode
Island
Success Stories: Corporate Sponsorship Case Study: GrowNYC
Success Stories: Corporate Sponsorship Case Study: Wholesome Wave
Toolkits
Stage 1 FM (How to Run)
Stage 2 FM (How to Grow)
How to Start a CSA Incentive Program
Outreach Idea Book
FM Tracks* (also listed under FM Tracks)
Story-gathering About Nutrition Incentive Programs
Wholesome Wave Data Portal Training Manual 2015
Street Team/Canvassing Toolkit
SNAP-Ed in Maine
Advocacy Toolkit
FVRx Toolkit
FM Tracks
FM Tracks Toolkit
FM Tracks App--1 pager (Entering Market Day Data)
FM Tracks Website--1 pager (Recording Transactions)
FM Tracks Promo Piece (3-pager)
Slide Decks
Incentive Programs at Farmers Markets 101
Incentive Programs at Farmers Markets 101--AARP
Outreach Strategies for Nutrition Incentive Programs
Outreach: On-Site Promotion & Community Partnerships
Maximizing the Impact of Fruit and Vegetable Incentive Programs
Data Portal Training
FINI financial/admin review
Training Exercises
Communications Exercise: Explaining a Nutrition Incentive Program
to Different Audiences
Outreach: Building Community Partnerships
Outreach: Developing an Outreach Plan
Role Play for Market Staff: Centralized/De-Centralized EBT &
Incentive/Purchase-First Systems
Visioning Exercise: Network Development
Traffic Light Exercise: Reflecting on the Season
Tools: Plug & Play Templates
Photo (Media) Release Form
Consumer Impact Survey: Sample
Vendor Survey: Sample
Market Manager Survey: Sample
Media Alert: Sample
Press Release: Sample
Legislator Invitation Template (Farmers Market Week)
Resources for Consumers
Common SNAP Myths
SNAP Cookbook: Good and Cheap
Guides/Handbooks/Informational
SNAP/EBT at Your Farmers Market: 7 Steps to Success
Innovations in DVCP (Double Value Coupon Program)
How to Create an Internship Program in 7 Easy Steps
Successful DVCP Fundraising Tips and Selected Resources
Guide to Grant Funding for Your DVCP
DVCP & Hospital Community Benefit Programs: Understanding the
Opportunity
Utilization of Community Benefits to Improve Healthy Food Access in
MA
Ten Ways to Fund Your SNAP Program
Reports
2009-2012 Outcomes and Trends (Full Report and Exec Summary)
Diet & Shopping Behavior Study (2012)
2013 SNAP Healthy Food Incentives Cluster Evaluation
appendix
Wholesome Wave Overview
Vision
Affordable, Healthy, Local Food for All
Wholesome Wave strives to create a vibrant, just and sustainable
food system. By increasing affordable access to fresh, local and
regional food, Wholesome Wave inspires under-served consumers to make
healthier food choices. Through advocacy at the local, state, and
regional level, Wholesome Wave and its partners are institutionalizing
public and business policy to make affordable access a reality for all.
Focus Areas
Approach to Transforming the Food System
Initiatives
Wholesome Wave takes a holistic, community-based approach to its
initiatives, working collaboratively with community-based
organizations, farmers, healthcare providers, corporations,
policymakers and government entities.
National Nutrition Incentive Network
A national network of nutrition incentive practitioners dedicated
to leveraging simple solutions at the local level into long-term policy
change. Wholesome Wave builds the capacity of network members to
deliver nutrition incentive program benefits to their customers,
farmers, and communities, while also collecting and sharing data and
stories from network members in its efforts to institutionalize policy
change.
Fruit and Vegetable Prescription Program
An innovative solution to preventing and treating chronic diet-
related disease. Through partnerships with healthcare providers,
community organizations and fresh produce retailers, the FVRx program
provides low-income patients and their families affected by diet-
related diseases with nutritional education and a prescription for
fruits and vegetables to be spent at participating retailers for a 6
month period. Wholesome Wave gathers and evaluates a variety of
metrics, including health outcomes.
Healthy Food Commerce Initiative
An approach to improving the supply chain for local food in under-
served communities by connecting food retailers with food hub
businesses to increase the supply and competitiveness of local and
regional agricultural products. Wholesome Wave provides technical
assistance and develops tools and resources in partnership with
emerging food businesses, the USDA, and other corporations to provide
the latest in best practices in the growing food hub sector.
Impact
* Community-based Organizations, Healthcare Centers, and
Hospitals.
Wholesome Wave's
Fruit and Vegetable Prescription Program'
The Fruit and Vegetable Prescription' (FVRx')
Program is an innovative solution to preventing and treating chronic
diet-related disease. FVRx promotes affordable access to fruits and
vegetables and healthy eating in under-served communities through
partnerships with healthcare providers, community organizations and
fresh produce retailers. FVRx is a proven evidence-based model of
preventative health care with a demonstrated impact, resulting in
healthier communities, food systems, and local economies.
``FVRx allows the families not only to get nutrition
education but to put it into action . . . They can take what we
talk about in the clinic, out to the market, purchase healthy
foods and then take them home and engage the family in a
healthy cooking and dining experience.''
Jennifer Cook, Nutritionist, Thundermist Health Center, RI.
FVRx's Reach 2011-2015
------------------------------------------------------------------------
------------------------------------------------------------------------
6,134 15% 61% 82% 2.9%
Individuals Receive WIC Receive SNAP are covered Uninsured
and family by Medicaid/
members Public
------------------------------------------------------------------------
10 States (CA, CT, GA, MA, ME, MN, NM, NY, RI, TX, Washington, D.C. and
Navajo Nation)
------------------------------------------------------------------------
FVRx Program Impact 2014
``Since joining the program I have seen a difference in the
way I eat. I take healthy snacks to school like grapes, apples
and oranges. Not only has my eating changed but I have also
become very active.''
FVRx Patient, New Mexico.
FVRx Program Innovators
New York City 2013-Present
The New York City Health and Hospitals Corporation (HHC)
Refining the FVRx model to be scaled at hospitals city-wide,
then replicated throughout the country.
Hospital sites to date include: Elmhurst, Harlem, Lincoln,
and Bellevue.
Minneapolis, MN 2014
The Center for Prevention at Blue Cross and Blue Shield of
Minnesota.
Testing FVRx Program Impact on adult diabetics and
prescription redemption at Coborn's grocery store in Melrose,
MN.
FVRx families spent $15,284 from their prescriptions on
fruits and vegetables at Coborn's.
Navajo Nation 2015
Community Outreach and Patient Empowerment (COPE) Project.
Bringing healthy food access to Navajo Nation by offering
chronic disease prevention outreach through community, clinic,
and retail partnerships.
FVRx Navajo Nation will launch at ten Navajo health centers
and retail sites, with an anticipated reach to over 3,00 Navajo
family members.
Wholesome Wave's
National Nutrition Incentive Network
Wholesome Wave is transforming individual, community, economic, and
environmental health by facilitating a national network of nutrition
incentive practitioners dedicated to leveraging simple solutions at the
local level into long term policy change. Wholesome Wave builds the
capacity of network members to deliver nutrition incentive program
benefits to their customers, farmers, and communities. As network
members, they participate in a community of innovation and learning,
have their impact aggregated as part of a national data set, and serve
as policy advocates.
------------------------------------------------------------------------
-------------------------------------------------------------------------
What is a Nutrition Incentive Program?
Nutrition incentive programs encourage consumers to spend their
federal nutrition benefits (SNAP, WIC, etc.) on healthy foods, such as
fresh fruits and vegetables, at farmers markets, mobile markets, CSAs
and other retail stores, by offering a financial match based on how
much the customer spends. For information on the impact of nutrition
incentive programs, visit www.wholesomewave.org/publications.
------------------------------------------------------------------------
2014 Network Impact
------------------------------------------------------------------------
------------------------------------------------------------------------
50,119 5,641 $3.3 million
Consumers and their Participating Farmers Total Nutrition
households Incentives and
Federal Benefits *
Redeemed
------------------------------------------------------------------------
* SNAP, WIC CVV/FMNP, Senior FMNP.
Network Member Sites
(Including 2015 FINI Members)
The Growth of Nutrition Incentive Programs
Wholesome Wave's Founding Board Chair, Gus Schumacher, began to lay
the groundwork for the advent of nutrition incentive programs in the
1980s, first as the Commissioner of Food and Agriculture for MA, and
then as Under Secretary for the USDA, leading to the creation of the
WIC Farmers Market Nutrition Program (FMNP) and Senior FMNP. Since
then, the field of incentive programs has grown exponentially. The
following is a short history of the field in the last ten years.
2005 2010
1st Nutrition Incentive Program Obstacle for Incentives Minimized
The New York City Department of Wholesome Wave and its partners
Health and Mental Hygiene begins work with the USDA to ease the
the Health Bucks Program. waiver policy on nutrition
incentives at farmers markets.
2007 2014
USDA Waiver Obtained $100 Million in Funding
Crossroads Farmers Market (MD) The 2014 Farm Bill introduces the
obtains a formal USDA pilot waiver Food Insecurity Nutrition
to operate a nutrition incentive Incentive (FINI) Program, which
program. provides $100 million in grants
for nutrition incentive programs
over the next five years.
2008 2015
DVCP Launches $31.5 Million Allocated Through
FINI Grant Program
Wholesome Wave launches the Double Wholesome Wave receives a $3.77
Value Coupon Nutrition Incentive million grant to support expansion
Program in CA, MA, and NY. of its national network of
nutrition incentive programs.
Network Growth
Network Services
Tools and Technical Assistance Data Collection and Evaluation
Members have access to tools,
toolkits and direct assistance to
build their capacity from a Stage
1 to a Stage 4 member. Subjects
include:
Program Operations.
Wholesome Wave has a national
Communications, Outreach incentive program data set based
and on reporting from members.
Marketing. Wholesome Wave provides common
metrics and data reporting
platforms for members to submit
their data and for evaluators to
conduct research.
Fundraising.
Advocacy and Education Community of Practice
Members are engaged as policy Members interact, share ideas,
advocates and educators to inform resources, solutions and build the
public policy. body of knowledge for nutrition
incentive programs through five
platforms:
Listserv.
Newsletter.
Topical webinars.
Resource library.
Annual conference.
Network Member Capacity Building
Through our network, we build the capacity of nutrition incentive
practitioners, advancing them from a Stage 1 to Stage 4 member.
Wholesome Wave's National Nutrition Incentive Network
Current Projects
Food Insecurity Nutrition Incentive (FINI)
USDA Grant: 2015-2018
Wholesome Wave Is a Sub-Grantee on Four Additional FINI Awards
AARP: Wholesome Florida Certified Maine Farmland Trust
Wave will serve as a Organic Growers (FOG): (ME) and Green
technical assistance 12 of FOG's farmers Mountain Farm to
partner to provide markets will join School (VT):
capacity building Wholesome Wave's RCT Wholesome Wave will
expertise, as well as evaluation to measure provide technical
branding, marketing the impact of assistance as both
and outreach incentive program groups work to deploy
assistance for SNAP innovations on SNAP SNAP incentives at
incentive programs in consumers' purchase retail grocery
Mississippi and and consumption of outlets and
Tennessee. fruits and vegetables. aggregated CSA's.
Double Up Collaboration with Fair Food Network
Fair Food Network and Wholesome Wave are partnering to develop a
model for healthy food incentives at farmer markets. Leveraging more
than a decade of demonstrated success, they are pairing best practices
in program design with the insights of a national network to support
the growth of incentive programs that increase access to healthy,
locally grown food, support farmers, and stimulate economic activity.
The Double Up collaboration is working with local partners in Oklahoma
and Georgia to launch this effort.
FM Tracks
In an innovative partnership that brings together researchers and
nutrition incentive practitioners, Wholesome Wave and Case Western
Reserve will use technology, data, research, and education as tools to:
Build the capacity of incentive program practitioners to
increase affordable access to healthy foods;
Develop industry standard system for uniform incentive
program data collection and reporting;
Build an evidence base to educate on the importance of
healthy food incentive policy change.
Through this partnership, they will launch FM Tracks, an IOS-based
app and website for gathering and organizing farmers market sales and
incentive usage while evaluating trends and impact.
Know Your Market, Know Your Customers
FM Tracks is an iOS based application to collect, manage, and
evaluate information about your farmers market.
Save time. FM Tracks eliminates the need for pen-and-paper tracking
and keeps all your market and vendor information in one place.
Save Money. Reduce staff time spent on recording and processing
information.
Improve your market. Use customer information to increase vendor
sales, introduce new products, and make changes to your market.
Show your impact. Export your data in comprehensive and detailed
reports for grant reporting, financial tracking, communications, and
outreach.
FM Tracks includes an iOS application and website that work
together to improve your market.
Users: Intended for use by direct-to-consumer market managers
operating one or more markets, and for healthy food incentive network
managers organizing programming locally, regionally, or across states.
Central System for Recording Information: Provides a central portal
for sales transactions and recording information about customers, the
market, and healthy food incentives.
Transaction Accounting: Designed to track transaction data,
specifically for SNAP/EBT and other federal nutrition benefit programs,
as well as credit/debit and cash.
Customer-Level Data Collection: With the ability to assign unique
customer IDs, market managers can now better understand who is shopping
at their market, and tailor activities to attract more customers.
State-of-the-Art Methods for Evaluation: Includes metrics used and
approved by the USDA, Farmers Market Coalition, and the U.S. Census to
support comparisons to other data sources.
Real-Time Access to Reporting: Data dashboard provides quick look
at market trends and reporting features allow for more careful
examination of impact.
FM Tracks is not a system for transacting and transferring
money.
FM Tracks Mobile App
Running on an iOS device (iPad, iPad mini), the mobile app is used
by market managers to collect information on-site. This includes: sales
data, customer data, market day information, and health, economic, and
community impacts of the market.
The mobile app replaces the traditional pen-and-paper method of on-
site data collection, reducing error and saving time for managers. Data
can be entered into the mobile app without an Internet connection.
FM Tracks Website
The website provides the capabilities to manage and view all data
entered via the mobile app, reporting and exporting functions, the
ability to add new markets or networks, and the selection of questions
to be asked at market. You can also develop your own questions to be
added to the system. Finally, the website also has a manual entry
function to allow data collected via pen-and-paper at market to be
input off-site. With this function, even if your market does not have
an iOS device, FM Tracks can be still be used.
A limited number of markets are beta testing FM Tracks in
2015. The full, optimized version will be made publicly
available in 2016. If you are interested in staying connected
and getting updates on the public release of FM Tracks in 2016,
e-mail us at [email protected].
FM Tracks development is led by Dr. Darcy Freedman through a
partnership between Case Western Reserve University, the
Prevention Research Center for Healthy Neighborhoods, and
Wholesome Wave. It is supported through funding from the Ohio
Department of Health and the Prevention Research Center for
Healthy Neighborhoods.
Wholesome Wave: National Nutrition Incentive Network
Community of Practice
The Community of Practice is a core benefit of membership in the
National Nutrition Incentive Network (NNIN). It provides five platforms
for engagement through which members interact; share ideas, resources,
and solutions; and build the body of knowledge about nutrition
incentive programs:
Resource Library Listserv Webinars
Summit Newsletter
Online Resource Library
Contains tools, templates, case studies, and other information in 5
key areas: program implementation, data collection and evaluation,
communications, fundraising, and policy and advocacy.
Log in at www.wholesomewave.org with your e-mail address as your
user name and your password.
Listserv
A forum for open communication among members to ask questions,
share experiences and best practices, and contribute to a searchable
database of knowledge. Submit a post by e-mailing
[email protected].
Webinars
Live and recorded presentations on the nuts and bolts of running an
incentive program and topics including marketing and outreach, policy
and advocacy, cutting-edge research, fundraising, and more.
Annual Summit
Annual summits offer trainings, cutting-edge innovations, and a
place to network with other NNIN members, funders, policymakers, and
researchers.
Monthly E-Newsletter
Provides program, policy, funding, and research updates. To share
photos, innovations and best practices, or other exciting updates with
the network, email your Program Manager.
How to Run a Nutrition Incentive Program
A Toolkit for Wholesome Wave's National Nutrition Incentive Network
[Excerpt]
Table of Contents
Executive Summary
Introduction
How to Use This Toolkit
About Wholesome Wave
Acknowledgements
Glossary
Chapter 1: Set Up Your Program for Success
Define Community Needs and Resources
Set Goals
Build a Budget
Chapter 2: Design Your Program
Federal Benefits Overview
Decide Which Federal Benefits to Incentivize
Understand the Components of an Incentive Program
Select Your Alternative Currency
Chapter 3: Operate Your Program On-site
Choose How to Operate Your Program
Track Data at the Market
Get the Right Equipment
Make Your Vendors Champions of Your Program
Chapter 4: Maintain Financial Controls and Collect Data
Maintain Financial Controls
Collect Accurate Data for Grant Reporting
Chapter 5: Conduct Outreach and Attract Attention to Your Program
Find Your Customers
Name and Brand Your Program
Develop Outreach Materials
Alert the Press
Nutrition Incentive Program Talking Points
Appendices
* * * * *
Chapter 3: Operate Your Program On-site
How to Run a Nutrition Incentive Program
Step-by-Step: Incentive First--SNAP-only Incentive Program
The incentive first system for SNAP incentives can easily be
integrated into your existing SNAP program if you use a central market
booth to process transactions.
How to Run a Nutrition Incentive Program
Step-by-Step: Incentive First--WIC CVV and WIC/Senior FMNP Incentive
Program
The incentive first system can be slightly more complicated when
applied to programs that incentivize WIC CVV or WIC and Senior FMNP
because those benefits are redeemed directly with vendors rather than
at a central market booth. In most cases, customers are asked to show
their CVV or FMNP checks they are going to spend to the market manager,
who then gives the customers incentives for the amount they are
eligible. To keep track of which CVV or FMNP checks have already been
incentivized, many markets mark the checks with their initials or the
date of the transaction so that they cannot be reused. However, not all
states allow writing or marking on checks, so please check with the
state agency responsible for administering the CVV or FMNP program
before applying this method.
National Nutrition Incentive Network: Partnering With Your Local/State
SNAP Agency
Local and state agencies that administer SNAP can be important
allies in promoting your nutrition incentive program directly to people
receiving federal benefits. Caseworkers typically meet with individuals
and families receiving SNAP at least twice a year and many offices
regularly send mail to SNAP households.
How can you partner with your local and state agencies to promote
your program?
Getting Started
Find Your Local & State Snap Agencies
The state agency that administers SNAP differs depending on the
state (e.g., Departments of Health and Human Services, Social Services,
or Children and Families), and there are typically many local SNAP
offices throughout the state. Use the USDA Food and Nutrition Service's
website to find your state and local SNAP offices:
www.fns.usda.gov/snap/snap-application-andlocal-office-locators
Search for public assistance.
Collaborating:
Establish a Relationship
Schedule an appointment with your local SNAP office to introduce
yourself and share the story of your program. At your initial meeting,
present the agency with details on the history and impacts of your
program. Share your accomplishments and vision, and highlight any
stories of how your program has affected families in your area. Invite
the SNAP office to visit a market to see the program in action.
Prepare for the meeting by thinking of a specific ask for how to
collaborate with the agency. Whether partnering to conduct a direct
mailing campaign, asking SNAP caseworkers to distribute your program's
fliers, or requesting that the agency provide a letter of support for a
grant, there are a number of creative ways the agency can help your
program thrive.
Moving Forward:
Build a Partnership
After your initial meeting it is important that you maintain and
build upon your relationship with the local SNAP offices. Add them to
any newsletters about your market and program. Meet them at the end of
the season to share information on the impacts and reach of your
program. Invite them to attend events and fundraisers. Keeping them
engaged and demonstrating how your program grows over time is crucial
for maintaining a fruitful partnership.
Once you have established a relationship with your local SNAP
offices, reach out to your state SNAP agency and follow a similar
process to build a relationship. It is important to form relationships
with both levels of government; state and local SNAP agencies can
support your program in complimentary ways.
------------------------------------------------------------------------
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Network Member Highlight: Old Town Farmers' Market
6 Ways To Collaborate With Your Local SNAP Agency
The City of Alexandria, Virginia, which operates the Old Town
Farmers' Market, has developed diverse strategies for partnering with
the local SNAP agency, the Alexandria Department of Community and Human
Services (DCHS), to promote their Double Dollars nutrition incentive
program at the market. These include:
Direct Mailing: The market provides DCHS with approximately
900 bilingual postcards promoting the incentive program. DCHS
includes the postcards as part of the information packet mailed out
each month to new SNAP recipients living in the ZIP Code around the
farmers market.
Fliers: The market provides bilingual fliers to DCHS, whose
case workers distribute them to people who are signing up for SNAP.
Tabling: The manager of the incentive program for the
market sets up a booth on the first and last Monday of each month
at DCHS to conduct outreach for Double Dollars. During these
visits, she is helped by a volunteer who is fluent in Spanish.
Cooking Demos with Market Produce: The program manager
holds cooking demos at DCHS once per month during the summer using
produce donated from the market, handing out recipes along with
SNAP fliers.
Field Trips: The program manager coordinates four field
trips to the market every Spring and Summer with SNAP recipients in
the market's ZIP Code. The manager provides a flier promoting the
field trip to DCHS, who then mails them out in four installments
every month. Field trip attendees receive $5 in incentive tokens.
The outings have proven a successful outreach method; according to
the program manager, ``we've gotten a lot of new customers that
way.''
SNAP Working Group: The market partners with Healthy
Alexandria and the Alexandria Department of Health, meeting monthly
to brainstorm ways to promote SNAP at the market.
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Network Member Highlight: The Farmers Market.co.
Conducting a Direct Mailing Campaign
In spring of 2015, The Farmers Market.co--which operates markets in
Fredericksburg, Spotsylvania, King George, and Dale City, VA--piloted a
targeted direct mail campaign to bring new SNAP customers to its
farmers markets. The goal was to reach SNAP households not currently
using the farmers market nutrition incentive programs by providing
information and issuing a call to action.
Working with the directors of Social Services from the local SNAP
offices in Fredericksburg, Spotsylvania, and King George, they designed
a bilingual (English and Spanish), black-and-white, 6 x 9 postcard,
which was mailed to every SNAP household in the three counties--a total
of 6,800 postcards--using a local secure mailhouse. See top of page 3
for an image of the postcard.
For privacy protection and to avoid legal issues regarding
confidential mailing lists, Social Services removed all client names,
replacing them with ``Resident,'' before releasing the list to the
mailhouse.
The pilot postcard project included a response mechanism (i.e.,
bring the postcard to the market for a free market bag) for tracking
and evaluation. The response has been encouraging and the markets
continue to see new customers as a result of the campaign.
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Conducting a Direct Mail Campaign
Background Information
Direct mail refers to sending marketing materials directly to a
filtered set of households based on certain demographic factors. When
planned and conducted properly, mailings are an effective means of
directly reaching people receiving federal nutrition benefits. By
sending a postcard or flier to your target audience, you can promote
your program to those who will benefit from it most, propel new
customers to market, and remind existing customers to return.
Credit: The Farmers Market.co.
Design Considerations
Your mailer should include all of the basic information on the
details of your market and incentive program. Be sure to highlight the
dates and hours of operation, location of the market, name of your
incentive program, and the amount of match provided.
While stand-alone postcard mailings are common for SNAP and
incentive outreach, also consider developing brochures that fit into
regular-sized business envelopes so that your local hunger coalition or
SNAP agency can easily include them in mailings they are already
sending to your target population.
Credit: DC Greens.
Example: SNAP Outreach Postcard
Credit: Boston Farmers Market.
This postcard-sized mailer from Boston Farmers Markets in
Massachusetts highlights the household's closest market while also
providing a full list of farmers markets (on the back side) where SNAP/
EBT and Boston Bounty Bucks are accepted.
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Key Takeaways
Explore creative partnerships with your local and state SNAP
agencies. Many will hang posters about your program at their offices,
and are often willing to have their caseworkers distribute fliers
directly to people applying for SNAP.
Strong relationships with your SNAP agencies can be leveraged
to support your program in many ways, from increasing program
participation to being a valuable supporter in a grant application or
policy effort.
Once you have established a relationship with your SNAP agency,
follow up throughout the year by inviting them to attend market or
organizational events, including them on relevant listservs or
newsletters, and meeting with them at the end of the season to share
updates on your program's impact and reach.
Due to privacy concerns, most agencies will not allow you to
access their mailing list of SNAP households. As a workaround, provide
the agency with your promotional materials for them to address and
mail, or request a list of addresses with the names listed only as
`Resident.'
Limiting a direct mailing to ZIP Codes in or around the radius
of your farmers markets can help you target the customers you are most
trying to reach.
As part of your direct mailing campaign, offer an additional
incentive (such as a coupon for market tokens or a market bag that the
recipient can redeem when visiting the market) to further motivate
people to attend.
Provide your SNAP agency with fliers or postcards (or, simply,
the language you use to promote your program) that can be included in
mailings they are already sending to new SNAP recipients. This can
reduce the cost of outreach campaigns.
Develop multilingual resources to a reach wide audience.
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Interested in learning more?
See the Outreach Idea Book on the NNIN Online Resource Library:
www.wholesomewave.org/our-initiatives/
nationalnutritionincentivenetwork/resourcelibrary.
National Nutrition Incentive Network: Developing a Statewide Network of
Nutrition Incentive Programs
As part of the FINI project, Wholesome Wave (WW) is investing
significant resources in and working closely with stakeholders on the
ground in five states--Maine, New Hampshire, New Jersey, Ohio and
Virginia--to develop statewide nutrition incentive programs. WW engages
local stakeholders as leaders in their communities to work together
using a collective impact approach to scale affordable food access,
largely through nutrition incentive programs at farmers markets and
other direct-to-consumer markets. To facilitate the development and
operation of each statewide program, WW partners and stakeholders work
collaboratively within the structure of a network.
Why a Network?
Types of Networks
Informational Equals
Turnkey Hub & Spoke
A network is an effective mechanism for scaling and sustaining a
statewide nutrition incentive program by:
E Creating a structure that facilitates efficient and effective
decisionmaking and coordination of a program implemented by
multiple, distinct organizations;
E Providing a systematic way to define program standards and build
capacity across organizations, resulting in higher quality
programs; and
E Leveraging expertise, knowledge and collaboration across sectors.
Our Approach
A collective impact approach is a structured method for
collaboration among organizations, with the goal of creating
meaningful, long-term change. Key elements are:
E A common agenda,
E Consistent data collection and measurement,
E A backbone organization,
E Open and continuous communication, and
E Mutually reinforcing activities.
New Hampshire Network Development
Working with WW, the NH statewide network scaled up nutrition
incentive programs rapidly, from 11 to 30 farmers markets.
Our Role
Wholesome Wave explores, engages, convenes and works together with
leading individuals and organizations already implementing nutrition
incentive programs in their communities. WW tailors its approach to
each state's unique culture and distinct regional characteristics,
while providing technical assistance from a national perspective to
develop a sustainable network structure.
Wholesome Wave builds capacity within the state, positioning
networks to develop strong infrastructure and operating procedures that
expand their programmatic reach, achieve efficiencies from economies of
scale, track effectiveness and share best practices through a localized
community of practice.
Building the Network: A 4-Step Process
The network-building process consists of 4 stages that represent
key components of network formation. State network members determine
their priorities and set the pace of network building.
To begin, Wholesome Wave conducts a landscape assessment,
aggregating relevant data to understand the status of agriculture,
local food access, federal nutrition assistance and food security in
the state.
From there, WW staff and local leaders conduct interviews with key
organizations and stakeholders in the field to gather their insights
into strengths, challenges and opportunities related to affordable
local food access and incentive programs in the state, as well as
potential network structures and organizational roles.
After the discovery phase, Wholesome Wave and local stakeholders
begin to expedite network development and build consensus among
members. This starts with a stakeholder meeting, where WW staff present
findings from the landscape assessment and facilitate discussion to
assess options and identify a viable networked approach, including
basic structure and roles and responsibilities for members.
Based on this discussion and a final round of formal stakeholder
input, Wholesome Wave develops an implementation plan to guide network
formation and works with key organizations to determine next steps,
leading to a first network meeting.
Network development begins at this phase, meaning network members
convene to work through key questions and establish operating
procedures to strengthen and expand programming. Networks differ in
their convening styles (e.g., in-person or virtually and as a whole or
in subcommittees) and intervals (e.g., every month, quarter, or year);
these styles can be adjusted as the network and its needs evolve.
Wholesome Wave facilitates discussion and decision-making on key
network elements, including: incentive program design, statewide
branding, marketing and outreach strategies, network growth, data
collection and program evaluation, fundraising and policy advocacy. WW
staff work with the network to develop a written set of standard
operating practices based on these decisions that serve as both a tool
and a reference as membership and reach grow.
The network now has the tools to support and scale effective
nutrition incentive program operations in the state. As the network
further formalizes and streamlines operations and systems, members have
the ability to engage more deeply on program evaluation, test
innovations in the field, fundraise on a large scale and share findings
at the national level, strengthening the national voice to build
support for affordable, local food access.
National Nutrition Incentive Network: Foster a Culture of Inclusivity
at Your Market
Farmers markets are celebrated not only for the fresh, healthy,
local food they provide to a neighborhood but also for the intangible
benefits: increasing social ties, serving as a hub for the community,
and providing a real connection between producer and consumer. As a
nutrition incentive program operator, you are invested in ensuring your
market is a place where everyone feels welcome. Network members from
across the country have used the following strategies to help foster an
inclusive market environment.
Getting Started: Set Your Intentions
Take a moment to visualize the ideal market environment where
everyone is welcome to shop--no matter their payment mechanism,
socioeconomic status, race, or ethnicity--and interactions are friendly
among customers, vendors, and staff. Brainstorm the following
questions:
Why is inclusivity important to the market?
What does this look like at the market?
How does this differ from the current reality at the market?
Identify a few key areas where your market may benefit from a shift
toward inclusivity. Even if you think everything is running smoothly,
seek others' opinions--including those of customers and other community
members.
Know Thy Customer
2014 Glenn Charles.
Find out what ``welcoming'' means from the customer's perspective.
Survey existing customers to find out:
How comfortable they feel about shopping and using benefits
at the market;
Whether their interactions with market staff and vendors are
friendly and positive and, if not, why;
What types of products they want to buy at the market
(including culturally relevant produce); and
What suggestions they may have for making the market feel
more welcome to them, their friends, and their family.
You'll also want to find out what potential customers think about
the market. Reach out to community partners who are in touch with
neighborhood residents to help you to communicate with people who may
not yet have shopped at the market and to find out why.
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Quick Tip: Use FM Tracks to Learn about Your Customers
Use the FM Tracks app at your market as an easy way to survey
customers. FM Tracks comes preprogrammed with questions that your
market administrator may select to ask customers, such as: ``How much
do you agree with this statement: I feel welcome at this market.''
(with a scale of strongly agree to strongly disagree to capture
responses). You can also add your own, customized questions. Market
staff can either read these questions to customers or turn the iPad
around so they may answer privately. To learn more about customer
questions, download the FM Tracks Toolkit from the NNIN online Resource
Library: wholesomewave.org/our-initiatives/
nationalnutritionincentivenetwork/resourcelibrary.
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Articulate Your Intentions in Writing
Demonstrate your commitment to inclusivity as an essential
component of your market's culture by putting it in writing. Consider
incorporating this language in your market's or organization's:
mission statement,
website and social media platforms,
training manuals, and/or
vendor agreements.
Also consider creating a stand-alone market ``policy'' that
outlines your market's commitment and intentions.
Build Partnerships with the Community
2014 Glenn Charles.
Form partnerships with community-based organizations to build ties
to the neighborhoods your market serves. In addition to the large
groups that serve the community (who may be easiest to reach), seek out
the smaller organizations who may have deeper ties to residents. Some
suggestions for helping to develop a relationship include:
Elicit feedback from partners about how to create a market
that feels welcoming to the specific population they serve.
Invite partners to table at your market, and ask if you can
table or distribute your program's promotional materials at
their site or events.
Conduct targeted outreach in communities who may not be
aware of your market.
Organize tours to the farmers market with partners' groups.
Conduct Events and Activities
Demonstrate that your market is for everyone through your events
and activities. Some suggestions include:
Conduct healthy cooking demos for individuals and families
on a budget; seek out local chefs from the neighborhood.
Distribute low-cost and culturally diverse recipe handouts
featuring that week's harvest bounty with prices priced out per
meal.
Host events that celebrate the diversity of the community
and honor the traditions of the various cultures represented;
ask musicians and entertainers from the neighborhood to perform
at the market.
Collaborate with the local SNAP office; for example, invite
them to the market to provide information on applying for
federal benefits (see NNIN Online Resource below).
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NNIN Online Resource
For ideas and guidance on reaching out to and collaborating with
your SNAP office, download Partnering with Your Local/State SNAP Agency
from the NNIN online Resource Library: wholesomewave.org/our-
initiatives/nationalnutritionincentivenetwork/resourcelibrary.
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Network Member Highlight: Fondy Food Center
Credit: Fondy Food Center.
Fondy Food Center's (Fondy) mission is to connect neighborhoods to
fresh, local food--from farm to market to table--so that children learn
better, adults live healthier, and communities embrace cultural food
traditions. The nonprofit organization was created in 2000 on
Milwaukee's Northside as a response to a Food Security Assessment that
identified a high concentration of hunger, poverty, and dependence on
emergency food pantries in the area. Fondy Farmers Market has been the
cornerstone of Fondy's healthy food access efforts since its
inception--it was the first market in the state to accept SNAP EBT and
is a national leader in attracting low-income consumers to the market
to purchase fresh, healthy food.
The Fondy Farmers Market is a pioneer on the federal nutrition
benefits front: It has been accepting WIC vouchers since the program's
founding in 1992, and was the first market in the state to offer a WIC
incentive program, providing a $1-for-$1 match for WIC FMNP. The market
began accepting SNAP benefits in 2003 and now runs a wildly successful
SNAP + WIC Market Match incentive program--which redeemed more than
$30,000 in just a few weeks this past summer. On a typical Saturday
morning during the height of the season, you can expect to see a line
of customers at the market manager booth by 7 a.m.
Credit: Fondy Food Center.
To create a culture of inclusivity, Fondy uses a number of
strategies:
Forms Relationships: Maintains strong relationships with a
large number of community organizations.
Develops Relevant Marketing Materials: Print and online
communications reflect the diversity of shoppers and vendors.
Celebrates Diversity: Celebrates the many and varied
cultures represented across Milwaukee through:
Special Events--BBQ Cook-off, Greens Throwdown, and
Pho Cook-off are community cooking contests that celebrate
the Northside's Soulfood & Southeast Asian cuisines;
Seasonal Soul--a weekly cooking demo features
neighborhood residents and professional chefs sharing
healthy, seasonal recipes; and
Entertainment--a variety of musical, artistic,
theater, spoken word, dance, and childrens' community
groups and professional entertainers are invited to perform
at the market each week.
For more information, visit fondymarket.org.
Use Language that Welcomes
The language you use can have a profound affect on how people feel,
even if subconsciously. Take a fresh eye to your promotional materials
from a customer's perspective; even better, run your pieces by
community members to assess comprehension and to obtain feedback.
In your program's promotional materials:
Use simple, clear language to explain how the program works;
consider also showing it pictorially to accommodate various
literacy levels.
Shift the language at the market booth--even just slightly--
to proclaim that the market serves all shoppers; the insertion
of a single modifier may do the trick: ``We Gladly Accept
EBT.''
Encourage all vendors who participate in the program to
advertise using friendly, plain signage, such as ``ABC
Farmstand Welcomes Bonus Bucks Tokens.''
Translate all materials into other languages as necessary.
Hire and Train Market Staff
Develop the culture at your market by training vendors, staff, and
volunteers. Incorporate the following elements into existing trainings
or orientations to help institutionalize a welcoming environment at
your market:
Offer cultural competency and sensitivity training to help
staff communicate with and interact with diverse audiences (see
Online Resources below).
Provide a primer on federal benefits programs, including a
discussion of ``SNAP Myths and Facts'' (see Online Resources
below) to dispel misinformation.
Encourage vendors to engage with customers about their
products; this benefits not only farmers in terms of potential
to increase sales but also customers who learn from and feel
more connected to the vendor.
Encourage vendors to use price signs for all products to
make their stand more inviting to price-conscious consumers.
Using the results from your customer surveys, share
information with vendors on what culturally appropriate
products customers want to buy at the market.
Finally, when hiring new staff, looking for volunteers, nominating
board members, or seeking information about the community, look to
neighborhood residents to fill these roles.
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Online Resources
Cultural Competency: Read more from the USDA's Food and Nutrition
Service: Engaging Special Populations: Cultural Competency at
fns.usda.gov/sites/default/files/cultural_competency.pdf.
SNAP Myths and Facts: Wholesome Wave Georgia created this fact sheet
to help people better understand the facts and overcome misconceptions
about SNAP: wholesomewavegeorgia.org/tjffcjyb625qtp9ekzotw4riyo8sdu/
2015/6/17/snap-myths-facts.
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We want to hear from you! What strategies have you incorporated at
your market to create a more inclusive environment? What has or has not
worked? Contact us and share your experiences with the Network.
National Nutrition Incentive Network: Funding Your Nutrition Incentive
Program
Ensuring your nutrition incentive program is fully funded year to
year is essential to maintaining consistency for customers and vendors
while providing you the opportunity to expand and innovate on your
program. Across the country, NNIN members have used the following
diverse strategies to fund their programs.
Business Sponsorships
Many farmers markets benefit from local, regional, and even
national business sponsors interested in allying themselves with
programs that promote affordable, healthy food access and in
demonstrating corporate responsibility. To facilitate the sponsorship
seeking process for your market, create a short, visually appealing
Sponsorship Package to distribute to potential sponsors that outlines
what your market offers in exchange for funding. Typically this
resource outlines multiple sponsorship levels to accommodate the
financial capacity of a diverse array of potential partners. Great
sponsorship packages also include a demographic profile of your
customers, information on your social media reach, any recent media
attention garnered by your program, as well as a sponsorship commitment
form that captures the basic information you need from the sponsor.
When beginning a business sponsorship strategy, keep the following
in mind:
Brainstorm a list of potential sponsors; consider businesses
that share a mission or focus area that is similar to that of
your market or organization.