Transcripts For CSPAN2 Key Capitol Hill Hearings 20160603

Nutrients and this is example is cholesterol. When i graduated law school in early 70s and early 80s, cholesterol was a demon we were told you have eat foods low in colest cholesterol and egg took a big hit and egg are a cheap source of income in protein for lowincome people. And now in the new dietary guidelines for american that is will go 2015 to 2020 cholesterol is not a concern. This is covered in the news media. And it took about 2030 years but the Nutrition Community has changed its mind on cholesterol. The u. S. Dietary guidelines say cholesterol in foods is no longer a consume and we can go ahead and eat eggs again. This time it seems to be added sugar poses the same questions, is that the best approach to changing culture, changing consumer demand for healthier foods . Now, i want to turn off the slides. Okay. Next point is that the u. S. Dietary guidelines when it talks about added sugars, it says that a dietary pattern that is low in added sugars and has various levels of nine other ingredients, fat, different types of fats, saturated fat, fiber, sodium, so forth, its not added sugar by itself, added sugar thats part of dietary pattern will help reduce the risk of disease. But the message that comes out from the fda is added sugars is a demon. So i see a disconnect between those two things and, again, by emphasizing added sugars we run the risk that we did with cholesterol. So if nutrition labeling and the other things that have been suggested have risks of backfiring, what can we do . Well, other countries have taken somewhat different approaches and i think some of you may have heard of what brazil has done. And this was covered recently in the Atlanta Magazine in january, favorably covered by food politics blog. In brazils approach to improving diet they suffer from obesity and same problems we do involves efforts to convince consumers to eat meals at regular intervals. Three meals a and not snacks and to eat with other people. To prepare meals from fresh foods, to practice food preparation not just learn how to cook and enjoy those kills skills as a social activity with other people and plan meals and eat at the proper time and place. So that if the government encouraged americans to do those things, i think we would see changes in consumer demand and food culture and what Consumers Want and just like some major corporations have represented with gmo labeling and agreed to do it, the corporations would respond with the foods Consumers Want. And its funny, dr. Jacobson is a scientist and im the lawyer, you recommended legal approaches and im recommending what brazil has done which is is something else, its a form of social change which is among some of the suggestions. But the factors i named dominate the theme of brazils approach to the obesity problem. So lets be innovative and im happy to answer questions. [applause] thank you. Thank you very much, bruce and we will hold our questions until after our third speaker. So let me now introduce debra atwood, debra joins the Meridian Institute, one of our partners here at the conference today. Debra has over 35 years of experience in policy and legislative Matters Regarding food, agriculture, the environment, research and Risk Management including extensive experience working with executives in the private sector as well as federal government and nonprofit organizations. Thank you, debra. Yeah, thank you all. Shes poking the buttons here to advance my slide. First, i think you need to add to your chart, michael, what wine in sugar equates to. [laughter] when i looked at your chart, forget the candy, i want to know what wine looks like in terms of teaspoon in sugar. Just saying, a full ipa as well. [laughter] so with that said, i know we are running late in the afternoon and i thank you all for being here and agree to go participate but before i launch into everything in all the jobs i had in washington, d. C. And outside of washington, d. C. Ive always had to have good Legal Counsel with me. So while im innovativing innovating and getting crazy about my ideas and i always sought legal advice, if they do, lets map them out and lets look at how we can actually go to where i want to go. And its usually not just me by myself, its always been a Team Approach with good Legal Counsel walking right with us. And im always pushing the lawyers that ive worked with over the years to find the, yes answer, yes we can do this unless its just totally crazy and we will put something in jail, which i never want to go there. So i have three slides, one of them is just the big slide here that says agree, agree is an initiative that is house Meridian Institute, the Meridian Institute thank god has this effort. Fund an eightyear initiative to have a dialogue with food and chain agriculture to identify by 2030 and 2050 how u. S. Policies are going to look in order to see not only the United States, which is expected to grow by 100 Million People, but how do we fit in to the Global Dialogue of 2 billion plus more mouths to feed. That according to my chief of staff lets go boil the ocean and i can appreciate that. It was a big, big task and the Meridian Institute undertook very complex facilitation efforts to connect people to solve problems which is their tag line. I had the good fortune of having the backbone of meridian to help us navigate forward. 45 advisers, actually at one time we counted 150 people would be groovy to have in the room. But we were able to identify 45 advisers, one of them was here claire wang. Dan is one of our cochairs and he spoke this morning. But the bread and depth of people that we have have been really incredibly innovative and creative in terms of identifying not only the problems. We have done a very good job at the Meridian Institute, we admire the problem long enough. The first two years was, okay, lets admire the problem, lets define the problem, lets see if we can get along with one another in the supply change. Very tricky, the supply chain is not a monolithic group. Its very diverse. People in production agriculture, fruits and vegetables, organic are not really sure what walmart is up to, you know. Its their customer, ultimate customer but its a scary organization when they tell the supply chain that will shall be sustainable or that will shall do things to improve nutrition or how do you deal with your workforce, those are all value statement that is are coming down the supply chain or up the supply chain to production and having individuals in the room grappling with positions and ideas of how we are going to see 2 billion people nutritionally and sustain being was a biggal order but we got there through lots of drinking wine and excess sugar im sure tossed but and trans fat. We engaged over 2,000 people in the last five and a half years asking people and identifying what we believe are the categories of issues that are not actually categories, they are linked together and so the first two years we were socializing the ideas, we were getting to know one another, we established that, the following two years were about truly identifying the big astroid as dan talked about in the panel. What are the issues that we need as a nation to think about as a country, as individuals in our own lives when we go home or the Grocery Store or engage with families and friends and we came up with about initiatives and publicly out there on our website. My third and last slide gives all the beta of where to go to follow us. It captures four or five articles of interest around the eight initiatives that weve identified. Interestingly enough, we didnt know, i didnt know as being with 45 advisers and nine foundations and eight academics and four cochairs whether we could agree on anything and it started, i start with this because its really important. I start with small holder organic hog farmer who said what keeps him up at night is he doesnt have a regular legal supply chain. He doesnt have a legal set of workers on his operation. And the whole room erupted and said, we have a common interest in Immigration Reform and so who knew, none of the foundations that were funding this, none of us in the room realizeled that immigration was such a powerful policy initiative that needs to be undertaken. That was our first consensus document that came out with the series of recommendations. And, yeah, so its out there. Now the question is can it be implemented and we, of course, were one voice among many voices with that and teamed up and the idea of identifying the top initiatives, why mia spending time here . Im going to get to food and nutrition. Through collective impact or whatever you want to call it, we identify eight initiatives and identified what people cared about and how people operate in the community to come up with ideas on how to solve the problem. So after Immigration Reform we roll right into food and nutrition, working landscape, research and development, International Development when it comes to food and agriculture. Next generation of farmers and ranchers, very, very rich discussion that took a long time and once the dam broke open about Diverse Group could agree to it became very much easier, we built the trust and engaged a lot of different people not just ourselves but we really relied on the different communities we went into and convened and around these subject matters, which takes me to the topic. Congress, sugar, obesity. Okay, we went through many exercises just with our 45 advisers. On taxes, on the issue of should we make the snap program like wic, all the types of things as dan was saying, all the bullets, theyre not bullets theyre silver buckshots. What we did is exercises, okay, lets stand up in a line, those of you that want to regulate the snap program in terms of what people can purchase with the snapp dollars, you go here, those who are dead set against it and the rest figure out where your position is. I will tell you, theres a reason why congress cant do anything. Theres a reason why new york city cant do anything around some of the more sticky issues, if you will, because people were very, very spread along the spectrum of what they believed in. This is not science. Theres enough political science, the people that stood up among the spectrum whether it was taxes was very telling. We thought to ourselves, okay, theres a lot of people around soda, sugar, regulating, maybe we ought to examine things that are working in communities that are not so regulatory or legal or topped down heavy, and that is when we convene health care hunger, medical insurance, the Food Industry, consumer in a room and most of these individuals had never been in a room together. Theyre in rooms where nutritionist talk, rooms where Health Officials talk, rooms where safety net people talk, but we mix it all up. I work with feeding america on it and it was telling and what emerged out of it was the model that sonia is doing on the ground in new york. Now, this info graphic was actually drafted by a millennial who just graduated from stanford and she listened and said, you have to have an info graph so i can tweet it and basically what this graphic says we have to figure out how to empower families to eat healthier. How do we do that . We have to increase access to Healthy Foods, medicine, medical care and we give an example here. What you see here are the component pieces of people in organizations in community that is need to come together. But what this model shows, this info graphic show that is there has to be connectivity. How do we take what new york is doing or what portland, oregon is doing or what nashville is doing and share those stories and connect it with whats going on in the new york Healthcare System because youre all having the same conversation and utilizing different groups of people to help deliver and and address these issues. In the case of lake forest baptist health, we are in conversation with them, but the idea of using churches and faithbased organizations, very powerful in that community and ymcas and the School System, the ymcas are building kitchens because theres a legal issue, the school due to liability issues wont let them go to the schools and use the School Kitchens to help show kids how to prepare meals. Anyway, im talking on and on and on. But the point is we dont have this info graphic on our website, i think we probably should. Its confusing, not for me but i lived through all of the circles and connections but articulates the pieces that have been part of the methodology that the groups, people that have to connect not only at the local level but federal level but a task for all of you as you are studying law, if you get into a class where you are looking across the federal government at the federal level, what are the laws that would allow this kind of model to happen that it could not happen but help help incentivize . What is the incentive of obamacare, child nutrition act, pick the laws that deal with feeding program . What are the incentive programs that are built in and how do we encourage this crossjurisdictional conversation. Thats something that would be incredibly helpful to see all the departmental rules and law that is are implementing in programs that actually if we if they came together could help support what dr. angel is doing in new york and help lake first baptist. I have spoken up in my very nonlinear way. By the way im a marine ecologist so there you have it. Thank you very much. [applause] thank you so much to all of our panelists today. I think we have a little bit of time so if there are any audience members with questions, i would invite you to come to the microphones. We probably have time for two or three questions, depending if there are any, thanks. Hi, there, i am mia kat and i am bruces success or in a way, this is somewhat of a question and also a comment. As i sat and listened to a few references about that nanny state, i knew i would leave here a little disturbed if i didnt throw out some of our experiences in litigation. Innovation is a terrific thing and i too believe that the private sector can be enormous force in innovation. The Environmental Movement is one example of that. Theyve had to be that in california and these sorts of people lead the way, but i think it is i brought cautionary note with respect to food that consumers are clambering for help. All the Research Shows that they are pressing for healthier and healthier foods, but if you walk down the grocery aisle, even at whole foods, which is one of my favorite past times, you will see some of us litigate which are claimed to be whole grain and not whole grain, claim vitamins and water and, in fact, are sugar or they claim to be protein 45 when they have no more protein but 17 times the sugar cheerios as oppose to cheerios protein. I dont think we want to blame the consumer here and i just i need to throw that out and and to make as we talk about congress and obesity to just reiterate what was said this morning that the fda needs funding for Consumer Fraud and enhancing those activities. Thank you. Go ahead. And actually i could add to that, tom sherman at georgetown. We cant pretend like we dont respond to marketing. You cant pretend that marketing isnt creating a demand thats being countered by other people that are demanding good food and one solution to that is to learn how to cook. You know, dr. angel had it on her last item in the long list of things in new york and i would love to hear what she is doing with that, but if you learn how to cook, you dont have to worry about added sugar and you dont have to worry about added salt or trans fats or gmo or whether or not its whole grain or not because you put whole grain in your cooking vessel and its not on your food health chart is learning how to cook. Can i respond . Yeah. And feeding as families is actually fundamental to the changes that need to occur. I was running through because i thought it was 3 30 p. M. And i appreciated that. Further is a solution. Families have real challenges and the real impediments to cooking. And so everything from subsidizing asic ingredients for cooking to making them widely available to strategies for efficient all of those are real impediments to every family coming home and cooking together and eating together. But it is something that i if yu set as ago is as a family for a communities or as the city, that its a notable coal. The first point of empower and families to eat healthier foods, it involves everything you described. Thats what its a set of silver buckshot, not a silver bullet. Its a combination of what we are saying, behavior, education, opportunities, access. Its complicated and the social determinants are also a very important factor come is what weve learned. This is just us talking to lots of different individuals with their points of view. This actually is our first attempt at capturing the moving participants to achieve the goal. At the are no more questions perhaps i will just end with a question for our panelists. As i mentioned in the introduction, you are from some racial and ethnic minorities and individuals of our socioeconomic status akin to consumer greater amounts of added sugars and that are more likely to be overweight or obese. I was interested in your ideas on how we can short out laws and policies encourage reduction of added sugars among all our population groups . Are there some policies and rules that are more equitable in that sense or are there some actions that we can take to make sure that we are achieving these reductions across the board . Can i take a crack at that . I think new york city has pointed the way, getting rid of trans fat from restaurant foods affected everybody. And probably gave preferential benefit to low income people. Lowering sodium in packaged foods come in restaurant food as the fda is proposing is voluntary guidelines. I think we will preferentially benefit low income people, less educated people who rely on packaged food. Some of this regulatory work is especially beneficial, even taxing soft drinks, its a progressive kind of tax but the benefits are progressive, special is the money, the tax revenues are invested in promoting health among low income people. But regulation side, i think School Food Programs or schools can be a great leveler of helping the income less educated people in particular, such as healthier school meals which has been talked about, but thats especially helpful to low income people. And they dont have to pay for them. Free lunches and breakfasts. Just follow up on the discussion on cooking, hopefully schools will bring back home back and teach kids how to cook and how do garden. Some schools are doing that already. And alice waters and berkeley have gotten huge attention for doing that in that one community. The number of schools around the country of gardening programs and then kids cook with a garden and hopefully they like what they have cooked. Doing things to the school is especially helpful to low income people who dont get the rental assistance that middle and upperclass kids get. Spent advance the slide to the last one in case anyones to get i just wanted, i dont purport to be an expert on these issues, but its nicer some overlap between what is being said about cooking thats in both of our list of recommended policy options. So nice to see some coalescence of there. Thank you very much to our panel. These join in thanking our panel on congress and sugar. [applause] and in the interest of ending our day on time well take a 10 minute break and gather again at 3 45. Thank you spent if you want a copy, please come up. [inaudible conversations] [inaudible conversations] we are in a break from the daylong forum on food policy and Public Health posted by Georgetown University law center. And expo gets underway at 3 45 eastern or discussion on the availability and access to produce as a form of nutrition in our food system. We will have that live when it begins. Until then remarks from new york citys Health Deputy commissioner who gave the Keynote Luncheon address at todays conference talking about how state and local government can take a legal in managing Health Problems like diabetes. [inaudible conversations] thank you for sticking with us. Im really very pleased to be here. Hugely pleased that such an honor and a fascinating panel this morning. And it will help to rebuild from that but perhaps in a different direction. The outline for my presentation today is i want to talk a little bit about changing the context and importance of that as we consider policies and will be impactful, sustainable and create changes in behaviors that result in health when it comes to food. I will provide examples of the new york city context that approaching food policy with Health Equity lens i think was alluded to but i think its something we need to central in the way we think about food and its meaning to health and advancement of our society at large. Im going to talk about the value of the state of local innovation. I think in the introduction of the recent examples were i feel like the contribution tha this y of local governments make the federal policy is sharing and testing mechanisms that may or sometimes may not be best to the evaluation component of the to his credit important adult talk about examples of innovation in new york city. I go to talk about the power of integration because we often talk about food and food policy as if it is just about food. But the opportunity to change the file but goes much farther just what we would perhaps consider to be specifically food. Im going to talk of opportunities to leverage large movements that are currently underway. First of all let me start at the health and of this. Why do we care about food is because its so important to health but we all know. Heart disease is the leading cause of death in the United States. I have put up a slide of heart disease, stroke and cancer illustrating that they are responsible for about 50 of all premature deaths. I talk about premature death because nobody should die from these diseases which are largely preventable before age 65 when. When we have high rates of preventable death we also are reflecting a society in equities were structural things that are preventing people from being able to live as long as we all should. Not only is dying the leading cause of death important but also the leading cause of the premature death, some things that should give us pause. And thats where fruitcakes into all of this because when it comes to prevention and prevention of chronic diseases in particular, food is a central part. Its one of the leading contributors to health and one of the leading contributors to the list as well. This slide shows so that a comparison of deaths attributed to individual risks in the thousands, in both sectors combined. Smoking is at the top i of this slide and our many iterations of this analysis. Sometimes smoking comes ahead of time, sometimes i pressure comes out ahead but in the end what you see is of all the major computers to death, the vast majority come vast majority are related to food which means if we really, really care about health we have to care about food. So this is the slight i think simplifies this idea of how we address chronic diseases. What i call the making and breaking of chronic disease. On the right inside you see the major cause of death, cardiovascular disease and cancer as mentioned adequate diabetes out there which is a top leading cause. It to contribute to cardiovascular disease as well as death itself so its got a special color. Theres a couple of different pathways you can get to those diseases of the metabolic risk factors which are a product and a result of the common risk factors, including tobacco, for diet, harmful use of alcohol and physical inactivity is one of the pathways through which we must consider the impacts we can have. Theres sort of two different ways we can think about where to intervene. We can think about these sort of two arrows where i think most of us and its not entirely but most of us consider those the places where our clinical vibe is one of the most important places to intervene and to save lives. I think thats true, thats for clinical intervention can make a huge difference. Its just pipeline over here that is a decrease concerted this is where we start to talk about Health Policy and legal and regular framework that could stem the tide into this whole process. I want to go back to the theme of Health Inequities and disparities because i dont think they can be ignored when we think about food and the distribution of food. This slide shows in new york city the concentration of raised by neighborhoods, operate by neighborhoods have a premature mortality by neighborhood. I dont how many of you are familiar with new york city, but this represents our boroughs. Two things going. You will see these two concentrated areas throughout the city sort of track. That doesnt everywhere else is healthy. Thats not what im point and it doesnt mean we should just target these areas but we need to be sensitive and aware there are areas that are experiencing unacceptable higher levels of disease, and those are clearly marked by high rates of poverty and higher concentration of minority populations. In new york city they are socalled minority that they arent the majority of our population. So how do we intervene . I like this slide because it is dr. Thomas friedman who is a former commissioner that heads up the cdc, sort of speaks to the different places in which we can make defense the with the greatest impacts would be. At the very top would be counseling people that eating healthy, so as you can see can make a difference but its very laborintensive and impact to have because it is so intense with the middle. As you work your way down you go for clinical intervention. The next long act includes things like vaccination, colonoscopy and then we spend a lot of time in the conversation when changing the context. That means creating an environment with healthy choice is the easy choice for the individual. Thats what we spend most of our time in newark city and thats what the policies i will talk to you about our. When i used to show this likely to get very uncomfortable and acknowledged that discovered and acknowledged that discover when i get to socioeconomic factors because we are acknowledging they are one of the leading sort of cause. They would have the greatest impact if we would address them but we spent little time in that space in Public Health. That was an area we didnt feel like we necessarily had authority over or the means to make a difference. We spent time in this area around changing the context where it was safe and we could be very effective. I say i mean it was an area where we had authority and we were also have the tools and the history and the track record and sort of the Comfort Level of working in. Now im very proud to say that we are much more aggressive in think about changing socioeconomic factors enter that was before us on the about some of the opportunities when we think about food policy both regulatory and legal. So things that we can do. I love this slide. This was shared with me from a colleague when i was at the cdc and it helps to illustrate the two edges and where we were. We can talk about individual assets. And individual can be empowered to make healthy decisions. They can have the resources to purchase foods that are good. They might know what they need. They might have time to be able to afford it but if the environment doesnt allow them to do that, so healthy food for not being sold in their neighborhood or they dont have access or perhaps they dont have the resources because they are too expensive, if they are being bombarded by media event in fast food is not do so if the foods they should decide, its at the point of the decisions they dont know the information they need. For example, that isnt calorie label available so that the one part or another product would be better, or demand education of the vibe around doesnt help promote or educate, then that is the disadvantage. No matter how many asset she built into the individual they are not going to give to be healthy and we should think about the environment system and adjust them so they can roll the ball up with easy. So thats where we are working. Let me talk a little bit about the ballot of state and local interventions. Im going to keep some examples of new york city and talk about how as mentioned earlier they became relevant to the National Landscape quite quickly. It to testing them at the local level to make that difference. Thank you. Or to contribute to making a difference can let me say. Many people working in many different environments around these areas. These just happen to the areas im getting as examples here at this moment. The Food Environment the nukes he specifically as we thought about what we could do, this lays out nicely a different sort of actors or domains in which we really could think about whether or not we had authority and if we had authority, would want to exercise that through encouraging voluntary change we did put out cookies during the break. Those cookies were made by the opposition mdc altogether we bake, and its a group that takes women who are coming out of being incarcerated who dont have job skills and help strengthen and not against them skills but confidence and other necessary tools for getting your life back on track. So they are focus sugar and butter. They are delicious. Achieving feel good about that. I wanted to add that. So we are ending the conference with a panel about access to produce and nutrition. You may save what i would end of the conversation . Produce, or access to healthy food is among the most fundamental of the social determines to help and you would think we should talk about this first. Without access to healthy food, all the of the conversations are not quite as important. But when we start think about what does it mean to ask it to produce you realize one of the most holistic all encompassing topics youd would talk about today because access to healthy food and produce in particular is really about all of the other issues that are important right now in this election cycle. We are talking about the economy. You dont have enough money you cant afford healthy food. By that same token Food Production both the production peace in the restaurant peace our huge part of the American Economy and huge part of our labor force. Access to healthy food is about immigration. If foreignborn workers make up about 90 of our seasonal workforce can we get told by an accident to healthy food if we dont talk about who is going to pick the food and get it to market. Access to healthy food is about the vibe and heard a lot about concerns about water usage in Food Production. Its estimated as much as 80 of this nations consumptive water usage is for agriculture. We have to think about those kinds of issues if we want to access to healthy food. I could go on and on about this topic but it wont because her speakers are about to do that. Also going to confer reading their bios. The each have really interesting jobs and jessica to each of them, i thought i would like to do what you do it i suggest, i encourage you to read their bios. And with that i would introduce our first speaker will go down the line and lets start with manel kappagoda. [applause] let me get myself sorted out. All right. Good afternoon, everyone. Thank you for sticking with us. We are a small but mighty crowd at this point. So i appreciate that you are all still here. I from Changelab Solutions i we are a National Nonprofit based in oakland, california. We focus on helping communities address the drug of chronic disease using law and policy. Today im going to talk specifically about how we can use law and policy to increase consumption of fruits and vegetables. And im going to talk about this topic in the context of a new collaborative project that im part of. Its the Healthy People 2020 law and Health Policy project. This is my technology test. Let me see if i can change the slide. Okay, excellent. So these are the partners in this project. Cdc, hhs and the cdc foundation. And the law and Health Policy project is under the umbrella of hhs Healthy People initiative. Im sure many of you are familiar with this, but it is a sciencebased tenure national, an initiative that provides tenure National Objectives from improving the health of all americans. The purpose of the law and policy project is to provide in depth analyses of evidencebased legal intervention sincerity to improve the health in a series of reports. The project is a big issue about 1015 report on a wide range of topics from dental health to hospital acquired infections. One of those reports is going to be specifically on using law policy to increase fruit and vegetable consumption. Lets begin to the fruit and vegetable report i will try to use as many times as possible throughout his 15 minutes. The Healthy People 2020 identified increase consumption of fruits and vegetables by individuals two years and older as a leading indicator for overall population health. The report we are developing advisory summary of laws and policies to influence the availability and offering of fruits and vegetables, particularly in settings wide access by the general public and highlights examples from a wide range of sectors and institutional policies, federal, state, local, tribal policies, all of which are likely to increase fruit and vegetable consumption. And what we are really trying to do although its not possible in every case is tied the policy to evidence that the policy works. That one of the things weve learned from the process of developing this report is that the Evidence Base related to how law and policy influences Public Health generally fruit and vegetable consumption specifically needs to be strengthened. Doctor angell did a good job of talking about the Health Disparities and so im not going to dig into what the problem is that were trying to address here but i do want to highlight a couple of things that are very specific to fruit and vegetable consumption. So currently fewer than one in four American Adults consume the recommended daily servings of fruits and vegetables. And one in 1 10 children eat no fruits and vegetables at all in a day, which is kind of amazing. The rates of consumption across the board for americans is poor, but its lower in communities of color and underserved communities. And this is as has been discussed earlier today, due to the fact that these communities do not have access to Healthy Foods, generally, and fruits and vegetables specifically. The Research Evidence does show us that there is a Clear Association between access to healthy food, particularly fruits and vegetables, and Better Health outcomes such as lower rates of all of the things that doctor engel laid out earlier today. So i could not come to Georgetown Law Center and the site the professor. So he is cited here. When we were looking at the universe of policies that can address fruits and vegetables consumption, it is a vast the many of the things weve talked about today can be influenced by public policy. So the organized i think, we used this framework which has been developed by the professor to think about the different strategies to try to put them into some context. We also looked at the different settings where its possible to government policy with it to increasing consumption of fruits and vegetables, and those settings, very broadly, our government settings, school settings, which are just mention as an important kind of access point, Early Childhood setting, retail setting, worksite and generally community settings. So im going to give you an of a whirlwind tour of the policies that we looked at in each one of these settings. And go to drill down onto examples that i think are particularly interesting. So in the community and government settings, obviously that covers just a wide range of things. The kind of things we look at in terms of different policies and also in terms of what the Evidence Base is, where zoning regulations, local policies for Farmers Markets and community gardens, local ordinances, regulations of restaurants. Doctor jacobson talked about childrens meals at fast food restaurants, making the default choice to healthy choice. You can do that through local policy, nutrition pulsipher food banks to be more of an Institutional Policy and food procurement policies for Government Agencies and properties. This is one of want to take a minute to highlight. In 2011, hhs and the General Services administration, with a lot of support from the centers for disease control, issued a health and sustainability guidelines for federal confessions and thinning operations. And i know i could just everybodys faces. I know this sounds incredibly boring but this is a really interesting policy. The guidelines came about because president obama met with ceos, with major corporations about their worksite Wellness Programs, and he wanted to put something in place that was similar for federal employees. So we passed the office of Personnel Management to develop similar plan for the federal workforce. And as a part of the effort the General Services administration worked with other agencies to develop foodservice procurement guidelines for federal facilities. So these are guidelines that vendors are either encouraged or required to follow if they want to contract with the federal government to serve food on government property. So these are the types of things that are covered by the guidelines. You are nutrition standards but theres also recommendations which could be interpreted as a requirement for pricing, healthier food more cheaply than unhealthy food, for promoting and marketing healthy food in a way that we dont typically see. And guidelines related to sustainability, environmentally responsible practices using organic products, forcing food locally. I would just note that the cdc is in the process of updating these guidelines and theyre going to become the revised version will be issued probably later this year. I think this is a really elegant intervention because it has brought him back. It sets an example for states and municipalities to follow, its not a regulatory intervention. So with the boys the nanny state brand that Public Health so often receives. Pashtun it avoids. As it says on the website this increase in choice, the guidelines are designed to make healthy choices more accessible, more appealing and more affordable. This is what we need you vendors to do. I will run through all these statistics but i will just highlight the National Parks statistics. You can think about the concessions thatthe National Parks in 2014 , 219 Million People visited the National Parks, so all those concessions are selling Healthy Foods. That as a huge impact on the social norms we have set in terms of the food that is going to be offered and served. There are some important Health Equity considerations. I think thatmay not be immediately apparent from this type of policy. One is that these policies, the guidelines are relevant for institutionalized populations that are being served food under the auspices of the federal government and it also is important to note that shift workers who are working on off hours or the weekends may not have access to say, a cafeteria during their shift and have to rely on vending machines so for them, having vending machines that are serving healthy food may be particularly important. I do think that this policy of which i am a great champion does need to be evaluated. There isnt much evaluation data, it was implemented in 2011 so acrosstheboard i think there should be more funding for evaluation of how policies work once theyre implemented and this one in particular i think should be evaluated. So moving on to the retail setting, these are the policies that we looked at in the retailsetting. Many of them have already been discussed today. Federal level with and snap at the federal level but also i think more prominently at the state level, Healthy Food Financing Initiative and local zoning ordinances and corners for initiatives and i want to flag one very interesting Tribal Initiative which is closely related to the panel that we just had. So this is the healthy been a act of 2014 and it didnt come up at all in the panel that we just had so im curious how folks go at this piece of legislation. Good. Im glad im going to get to talk about it. The healthy did a act of 2014 is also known as the knothole donation junkfood tax. According to the Indian Health service, one in three navajos suffer from diabetes. The entire Navajo Nation has been labeled a food desert by the fda and an estimated 10 Grocery Stores serve the entire 27,000 mile read his reservation so in about 2010, community activists, Public Health experts who were living on the reservation decided they really wanted to take a bold step to change the Food Environment and after three years of controversy in 2014, president , Navajo Nation president ben shelley who was president at the time passed this healthy dine act of 2014. The law levied a two percent sales tax on food and beverages of minimal to no nutritional value so its estate tax but its broader than that and also covers junk food. The definitions within the tax, within the legislation are very broad, its very ambitious. It also at the same time the Tribal Council passed a resolution which is a tribal law that removed the five percent sales tax on fruits and vegetables as a complementary measure. Proceeds of the healthy dine act are earmarked for Community Wellness projects including farming, Farmers Markets andconvenience stores, stocking helpful products. So in terms of impact, whats great about this piece of legislation is that its a Community Driven solution, the readers of this with the advocacy alliance, it changed the conversation certainly for those of us that are really interested in looking at food policy and regulatory approaches. It was really the precursor to what has happened in berkeley and it created a source of revenue for health and Wellness Programs but that said, its very complicated. There are concerns about the aggressive nature of the tax, over 60 percent of people who live on the Navajo Nation with on under 35,000 a year and retailers reported they found it really difficult to implement the tax so more Technical Assistance is needed to make folks feel like its been a success. Continuing the whirlwind tour, the last two settings that we looked at were the early childcare and education setting and the school setting. In the ece setting we looked at the child and Adult Food Care Program which i will just flag because it reimburses childcare providers for 3. 3, four daily meals for 3. 3 million infants and children nationwide so the nutrition standards for cfc p which have been updated are incredibly important in terms of the nutrition, particularly for low income, young children. And im going to, im going to end by spending a minute talking about the healthy hunger free kids act. That has come up a number of times. The healthyhunger free kids act is a piece of legislation that covers school meals, School Breakfasts , school competitive foods which are the snack foods on school grounds. Its very important for folks to know that the healthy hunger free kids act was up for reauthorization in 2015 and is currently being debated right now. The house is considering a bill that would weaken the current nutrition standards and make eligibility requirements for the program significantly more onerous. There has been a remarkable progress in terms of what the School Nutrition environment looks like from the passage of the 2010 healthy hunger free kids act to now and it would be very, it would be a huge setback for Public Health and for the health of the nation if we were to cut back on the standards that we put in place for child nutrition in schools and that is currently the case with the house, the proposed legislation. If this is something you are interested in, the Pew Charitable trust has a lot of information about that, about this on their website. I would encourage folks to get involved and Pay Attention to whats happening right now with the healthy hunger free kids act. So in terms of, ill get off my soapbox and go back to the report. In terms of the report, we looked at this very expensive landscape of laws and policies, federal, state, local, tribal, institutional and a number of things rose to the surface. It is amazing how many policy levers there are to promote food and vegetable consumption. Theres been remarkable progress across a number of major federal programs, with, School Nutrition, snacks, cfc p over the last decade and its really important that those standards do not compromise or rollback. Theres also a need for policy mapping of state and local policies. Theres no one place that people can go to figure out all these different policy levers and finally, when we started this and ill just put up here who the wii is, when we started this project, we thought it would be really easy to find policies that have a clear Evidence Base that shows the policy has led to increased consumption of fruit and vegetables and that was not the case so its not because there are Great Researchers doing Great Research but there needs to be more funding of this type of research so as one of the panelists this morning said, we really know what works. I will end there. Im hoping some of you guys will ask us questions and i really again thank you for staying with us for the whole day. [applause] we now turn to mike lavender whose joining us to meet on concerned sciences. Everyone. Good afternoon. Excuse me. Thank you to the Oneill Institute for having me here and having such a great conference throughout the day. Im thrilled to have so many people here this afternoon to talk with and i think its been a great panel so far. I am a washington representative at the union of concerned scientists. On the food and Environment Program, ucs is a National Nonprofit Advocacy Organization based in cambridge massachusetts. We also have an office here which is almost as big as that in cambridge we were founded in the late 60s and about 20 years ago, the food and Environment Program at ucs was established. Today, the food and Environment Program is deeply involved in advocacy around debates such as public nutrition and Health Issues and also on the farm side of things and farming practices and other issues in that sphere. What im going to talk about today is how the union of concerned scientists along with a couple of the groups is taking these issues that many of which have been talked about today into the president ial election and trying to raise them up. I think weve heard from last panel and kind of throughout the day, where do consumers and question mark we where do voters stand quest mark where do people in general stand on these issues so im going to talk about that and how it relates to policy. You can call this president ial election a lot of Different Things but one of the things that i dont think you can call it is outwardly focused on the food and agriculture issues. Its not something you hear a lot in the debate sphere as you are watching tv at night or listening to the radio. Given what we all know and what weve heard today, the farreaching impacts of agriculture and food particularly on public and individual health, jobs and the economy, and on the environment, its striking to me that talk of food and agriculture and the issues related to them are confined to a few niche issues and to very select states and districts throughout the president ial campaign trail. So partially in response to this, in 2015 the union of concerned scientists along with the heel Food Alliance and food policy action wants to campaign called the plate of the Union Campaign. The plate of the Union Campaign as a simple goal. The goal is to spur all president ial candidates to talk about food and agriculture issues throughout the president ial election process. But its also to encourage the next president to take bold steps to reform our food system once they take office. We want the next president to, whoever it is to ultimately take office with a clear understanding of all the complex issues that have been discussed here today and where the opportunities for success are that we also want to highlight the great amount of support that comes from the American Public and where they stand on these issues so i think its obvious for us here in this room the importance of everything weve covered here today. Its almost 2nd nature to us. You see the positives and negatives. We also hear a lot about how food is trendy and how agriculture is trendy and its a hot issue now and thats absolutely true but where does the American Public stand . Todays conference is focusing on legal opportunities that facilitate better food and Better Health. The American Public is a tremendously important role. Their opinions, in the policymaking process and ultimately influencing how policy is made, how quickly it is made and whether or not it is made so the American Public places significant role in this process. So last years late of the union lost in october 2015, we released Research Done by bipartisan Research Done by Late Research partners and bellwether research consulting. And what the Research Found was that American Voters have a surprising amount of familiarity with food and agriculture issues that we in this room with think of them. They agreed that our food system isnt meeting everyones needs and that stronger food policies are needed to ensure that all americans have access to healthy, affordable food so i want to highlight a couple more rings we found throughout this research. Voters are very concerned about the availability of healthy food but even more so, they are concerned about the affordability of healthy food. In fact, the number one priority of what we saw throughout this particularly for millennials and for individuals of color was that healthy food needs to be more affordable. Voters also indicated they are very concerned about the overuseof antibiotics. Something that voters volunteered actually, this wasnt something that was an option but something that they willingly volunteered was that in their view, our food system is based entirely on profits and on money. That it has no incorporation of Health Outcomes for the individual. That was something that was interesting, particularly because it was volunteer. Another thing we found was that they are very concerned that five of the worst eight paying jobs in the United States are in the food system. Jobs such as farmworkers, meatpackers and fast food workers. I think finally just to finish out the highlights, perhaps most applicable ethos and for the rest of my talk is that they inherently recognize the overlap between and the basic connection between environmental policy, food policy and the foreign policy. This seemed intuitive to them that the preshould Work Together and be integrated to create Better Solutions for everyone so that is something the American Public seem to get pretty well but at least in my opinion doesnt necessarily reflect in the policies that make up our food system in washington. So many of the issues discussed here today, voters are aware of them. They find them very persuasive. And they recognize they are interconnected. So from these findings, the plate of the Union Campaign took these and work with several other groups and developed a fivepoint call to action for president ial candidates, loosely based in different policy buckets so the first is the plate of the Union Campaign calling on president ial, all president ial candidates and ultimately the next president to keep, staying with working families to committing to ensuring that all americans have access to healthy, affordable food. To keep children healthy by preventing companies from marketing junk food to children and ending subsidies that support processed junk food. Making foreignpolicy work for our farmers so performing agricultural policies, subsidies and support to ensure fair markets and pricing were diverse farmers of all sizes promote healthy diet and support stable diversified and organic farming in all communities to protect food and farmworkers and fair labor standards exemptions for farmworkers, raise the minimum wage for all workers and eliminates of minimum wage for restaurant workers and finally, the antibiotics working im getting the process of feeding antibiotics the farm animals that are not. So we are communicating all those principles and some of the topline findings from our research to all president ial candidates but today i wanted to pull out the couple that relate to our panel here and these were two of the most resonant messages in the research we did. Which are the availability of healthy, affordable food and also the impact of the food system on food and farmworkers, those individuals or on the front lines throughout the country. As weve heard earlier today, just the speaker before me, there are literally hundreds, probably thousands of ways to increase the availability of healthy food across all different spectrums. There are no shortage of policy numbers that can be pulled to increase those opportunities for individuals. Congress right now is in the midst of child nutrition reauthorization. The farm bill is another opportunity thats out there. Earlier, listening to doug obrien speak , his comments about interagency collaboration examples such as the Healthy Food Financing Initiative that will promise through better food, i was thrilled to hear him say that to a degree, to one degree or another that way of thinking, of interagency collaboration is kind of baking to the administration now and that that can be something that carries over so i wanted to conclude with a brief example about the necessity for that connectivity and the integration that we need to see more broadly across the government in terms of policies and food and agriculture. So we clearly know how closely food and individual health are linked. A specific example, diabetes rates in this country have quadrupled over the past three decades. Of 30 million americans suffer from diabetes and about 95 percent of those are type ii diabetes. Type ii diabetes is the diet related form of the disease though diets high in sugar, salt and fat and low in fiber, vitamins, minerals such as fruits and vegetables and whole grains increase the risk for type ii diabetes. But what people largely eat is dependent on their access to various different foods area so recently, a colleague at the union of concerned scientists released a first of its kind study that study diabetes rates across the country and compare them to local access to Healthy Foods and what she found was that there was a direct correlation in all us counties between physical proximity to healthy Food Retailers and diabetes rates so if there was greater physical proximity to healthy Food Retailers, there were lower rates of diabetes in that county. It seems fairly intuitive but this was the first time a study like this had been conducted. If you put a healthy food retail store in a community that didnt have one already or particularly in communities of color, those impact the resulting decrease and rates of diabetes were compounded in certain areas. So if you are looking just at that, that would lead one to believe that you increase the amount of healthy food on Grocery Store, corner store shelves then thats the solution to ultimately making a healthier public. But if our goal is for better food and Better Health, that solution misses half of the point. So there seems to be a tendency when talking about equity and access in terms of nutrition to focus primarily on the delivery side or the sales side of the equation. This is of course valid but theres seemingly less attentiongetting to the other side of the equation which is access and equity for food and farmworkers. So broadly, jobs in the Food Industry can be divided into three different buckets. Restaurants jobs, assessing jobs and jobs thatare based on farms. The restaurant sector is by far the largest followed by the processing sector and then followed by the farm sector and the restaurant industry, one of the Major Industries weve seen is the sub minimum wage has been stagnant for over 20 years at 2. 13 an hour which has a huge impact on the economy. In processing jobs, one of the biggest issues for workers can be lines the and resulting issues with repetitive motion illness. For jobs on the farm itself, some of the most pressing issues center around labor law exemptions, primarily exemptions for child farmworkers. Children as young as eight have been found working in farm fields and some groups estimate that about seven percent of all the children working in the United States work in agriculture. A particularly sobering reality is that often, those who harvest food from the fields themselves can in turn afford the food they are harvesting at the Grocery Store. So when were thinking about productivity and thinking about making sure that theres better food and Better Health for all individuals, we need to look at the larger picture and think about whos coming to the store, whos trying to buy these items. It cant simply be about providing more access, there are base reasons that need to be considered before that so the american system is obviously endlessly interconnected but also the policies and agencies that govern the food system are not as connected as they should be. So whether those policies are inthe financial sector, environmental or food or farm. Each issue is of course individually important but its also important for leaders whether they be in government , nonprofit organizations and the private sector to identify opportunities across the board for connectivity so thinking outside the box and looking at ways, a great example brought up was the Healthy Food Financing Initiative. How can we bring voices together that are traditionally connected and provide Better Outcomes for people and those are the kind of things we aretrying to promote so the plate of the union, we are communicating all those five points. Particularly the message for connectivity and greater productivitypresident ial candidates because we see that as a way , as one of the ways to ultimately move forward the conversation to a place where True Solutions can be found to provide better access and equity to healthy affordable food. Thank you. [applause] last but certainly not least we will welcome Marlon Butler to come, ever be farms and has his hands in a number of other food policy related projects. Thank you so much. Lets begin, what an extraordinary day. Lets begin by thanking lisa, the conference organizers and the Global Social enterprise initiative. This is really good, thank you all. This is fantastic. [applause] im the only one standing between you and cocktail hour so buckle up, were going to do this fast. It occurred to me since im going last and thinking, i have to follow atwood and sony angel and peggy and dan and donna and theres no beer. Fine. All right. I want to pick up where you left off a little bit, talking about this complex of issues strategically and yes, i know we are supposed to be talking fairly specifically about equity and access as it relates to produce and i will. But i want to step back a little as my employees will roll their eyes when i say take this up to 60,000 feet and i see them rolling their eyes back there. And try to take this all the way back to where we were this morning during the conversation that peggy, dan and donna were having because i think that their political experience, policy depth of the political experience is very important so this particular conversation. Its my understanding that back in 2008, Something Like this led to a document that informed the president ial transition, is that correct . And healthcare. Shorthand, who here has worked on a president ial transition in any form at all , shorthand class market on hand back there, too. You all know what im talking about a little bit. What i want to do is i want to take a lot of what we talked and i want to put into first a business and then a political and ultimately a strategic frame but before i do that im going to go through a section that i kindly call files and biases which means i will tell you a little bit about who i am, what ive done and what i allegedly care about. So i begin by saying i am an unreconstructed, unrepentant, unrelenting capitalist area and my wife will tell you im taxcutting this democratic you will ever see and she would say that with concern. Morgan seriously, i believe in the power of capitalism to eliminate market failures and there is no place in america where you see the market failing as badly as in certain parts of our food policy and food policy environment and indeed, sometimes i look back and i look across the landscapeand i think to myself , we would immediately declare war on our food system, unfortunately weve done this to ourselves. We spent a good part of the day talking about the problems, we understand a lot of the data, im not going to go over huge amount of. I want to talk first about sort of the business piece of all this because i do think its particularly relevant as it relates to the access and equity challenge and in doing so i want to tell you a bit of a story. As you may have heard earlier, we are involved in sustainable and regenerative livestock production at forever you farms. We run goats in Central Virginia and in northern alabama. But a funny thing happened to me on the way to regenerative livestock production and that was that we found ourselves in the produce business. Another quick show of hands, who here has ever worked on a farm . Grew up on a farm work on a farm for any period of time . One or two. All right. You know this is the hardest work that youre ever going to do. It is a very, very difficult business and we learn that very quickly. We purchased a commercial apple orchard, it had been conventionally farmed, chemically farmed. And i quickly found myself in the middle of, we will figure it out and its all sort of romantic and blah blah blah. Horrible business area absolutely awful. By awful, i mean we were getting if i we made our way . 40 a bushel for the apples that we harvested. A bushel is about this. . 40. It does not take mcdonough nba to figure out thats a bad business. So i took one look at our pml after the first year and i said this is going to work. We are getting out. But it was interesting what we learned over the course of just the two years we were in that business. First, that the labor market as it relates to farming and mike talked about this, a train wreck. It is an absolute disaster. It is very difficult as important as the program is, it is very difficult to manage the labor issues associated with the production of produce in this country and unfortunately, its not Getting Better, its getting worse but we will get to that. In a minute. So back to the apple orchard, as it turned out the Michigan Apple crop kind of failed that year so our aggregator processor cameto us and said , the michigan guys are going to come in a vial or apples, thats fine. I end upselling all these apples , . 40 a bushel apples to mcdonalds for the slices, the apple slices in the happy meals so kids in detroit are eating my . 40 a bushel apples and guess what they were paying for them . Okay. All that is to say that ive learned the very most important business lesson there is to learn in agriculture which is the way to make a small fortune in agriculture is to start out with a large amount. We didnt. So thats sort of the business half that i wear. I wanted to say a word or two in terms of backlog about the policy work weve done over the course of the last 10 or 15 years or so. Worked on principally in, exclusively in dc really, work on child nutrition authorization, food safety organization, a couple of farm bills and in the farm bills we worked very hard on reform and particular snap incentives. Spent years working on immigration and all of these interrelated questions go to the equity and access challenge. So to take this back into kind of a political frame and thats why i was asking if anybody had ever done a transition, when you do the Agency Review and come back and you get the, the team gets the metals from the Agency Looking at the situation and every agency and how do things fixed, where do things stand relative to what it is the president elect is seeking to accomplish, youve got to, you take those memos in and read them through a particular analytic and political frame so the Due Diligence has been done but that comes back and now youve got to make decisions so what i want to offer here is an analytic framework by which any one of you who happens to work on the president ial transition, whoever that president , she may be, that you have a way, and im going to make an argument, that you have a way of looking at the challenge of equity and access and i would begin by saying that point of fact we dont have an access problem at all. We dont. What is the problem that we have . Somebody. Whats the real problem that we have . We have a poverty problem. The end only thing you need to get good food in this country are the three things that pretty much everybody in this room has. A cell phone, a credit card thats not max out in the fixed address. You got those three things, you are fine. Theres no access problem. So i really want us to focus on the poverty problem that we have because so much of what we have talked about today and so much of the challenge that we face is the magic of the fundamental poverty challenge that we face in america and that, to is getting worse, its not Getting Better as we all know. The second problem or the second feature of the analysis here can i think my be roughly summarized in what i call the unfortunate crisis of a brain dead incentive system. And by that i mean we, as we talked about today, we know that bad food equals bad health but too much of a wellintentioned antihunger policy exacerbates existing problems and we talked a little bit about what those are so policy perspective right, what we have are a set of robust s skills but to some degree swaying bandages. We are not actually solving the underlyingproblem. You think about the food waste challenge, especially in produce and we seen this. A neighbor down the road last summer, he left probably 15 or 20 grand of food in the field so think about that. 15 to 20 grant of food in the field. Thats a huge, huge amount of food. It just went to waste. I suppose you could make the argument he was regenerating the soil but of all the poor people in Nelson County that could have been fed by that 15 20,000 that sat rotting in the field. The food waste problem is a great example of the fact that we have a brain dead incentive system in our food system generally. We see the rise of socalled ugly produce campaigns in europe and trends in the us around socalled number two zen number crease for Food Bank Donations or canned or processing and those are efforts that we have tried to deal with this very basic challenge but we still, i think, if we are in the Agency Review transition process have to ask ourselves, okay. How do we organize from the usda, treasury and hhs and elsewhere to deal with this very fundamental incentive problem that we have. Our incentive systems are upside down. We reward the wrong things. All right. So what do we do Going Forward . We keep the antipoverty challenge at the center of the conversation and ask ourselves as we get these memos back in transition process, we have two strategic questions. Lets ask those of every food policy proposal. Heres the first question i submit we should ask. Is this policy designed to combat the poverty that is in fact the source of the challenge that we are addressing . And second, will this policy catalyze longterm private sector marketbased solutions that promote health and increase wealth creation. Why am i explaining Health Creation question mark any intelligent model of sustainable capitalism has got to to those and when you look at produce in particular, if you are not having a Health Conversation and a wealth conversation, remember our antipoverty problem, youre just going to end up with bandaids and bandages. Youre not going to fix the actual problem. So if the answer to the second question is yes but the answer to the first question is no, then weve got this potentially fatal disconnect to an otherwise useful policy prescription and its ability to drive structural, societal change. I would say at this point we are still talking about politics, right . At the end of the day, good enough is all we are going to have to be good enough but we are understand what success really looks like. I want to pivot a little bit to some of the comments that were made earlier. Because it goes to the environment moving forward. I think doug about interagency collaboration is great. Its actually i think a feature of the fact that the Obama Administration has in my view done more to move the culture of our public policymaking in a progressive way in food issues than certainly any of the second half of the 20th century and any in the 21st. Michelle obama as i think similarly begun to change our society in ways that very, very few people have been able to do and i think that we are in the very important position of starting to move the needle on winning the argument. First, you win the argument, then you win the vote. We are starting to win the argument. We got a long way to go but some of this stuff that douglas was talking about, a lot of the initiatives that my colleagues on this panel have been discussing have been funded as a result of the culture change thats happening. Were talking at the beginning about our wj in beginning. There antiobesity efforts. All those signals tell us that the culture is moving. So what we have to think about is, what we have to think about in the next presidency are ways in which we can build on the successes thathave been established and address those two critical challenges , the two critical questions that i highlighted and the way we do that is by creating an enabling environment that allows us to answer yes to both of the two critical strategic questions that i raise a moment ago. The way to do that is to promote as we talked about a little bit, to promote what works. At a time when Government Resources are limited, its absolutely critical that programs we fund our effective and achieve results so we have to rely on evidence when we make decisions on how to use government funds, we need datadriven decisions, datadriven decisionmaking and evidence. Its absolutely critical. We have to ensure that what we do, the activities we undertake that are datadriven and evidencebased help to ensure that we are not creating a situation where we are program rich but system poor. We have to think systemically. Thats why i raise the point i was making about interagency collaboration. Thats the kind of systemic change inside the federal government that can move a lot of policy. Thats about getting our thinking in a way that, moving our thinking to away place that will allow us to be system rich so that the system can then begin to drive the change based on the two questions that i outlined earlier. I think the enabling environment should focus on using three keywords and thats to build, invest and redirect. You hear how three quick examples of ways in which we can think about the current policy environment , good examples. Lets think about snap incentives. Double up some food but programs and allowing for increased purchasing power for fruits and vegetables at Farmers Markets area by low income snap beneficiaries. That has a net economic benefit because we know that for every, i think theres a nine Dollar Benefit for every dollar snap purchase, i believe thats the figure. Folks can google that and correct me if im wrong but theres a net economic benefit to snap so we use double up food box which is a publicprivate collaboration, all of a sudden youre drawing an awful lot more of that produce that my neighbor left rotting in the field, youre drawing that into the market because theres an opportunity through the Farmers Market program to bring that to customers that otherwise didnt exist so hes making more money and they are getting healthier, theyre getting access to lowercost produce. There are a whole host of tax opportunities that we have, im not going to spend a lot of time there. I do think that in terms of investments, i think one of the areas we could really benefit from is increased investment in organic crop land. I think one percent of us cropland is currently in organic production and we could make investments that would accelerate the conversion to organic which would have a net economic benefit. Weseen organic go from 0 to 30 billion from 1970 to 2000. Thats just the market, only one policy driver and that is the usda organic label so think about the impact that has had on just on some of this environment alone let alone the access to healthcare produce. We should redirect, build, invest, redirect and be redirect here i need some city. Speaking of braindead incentive structures, we all know the drill there. But theres i think a way that now the next administration can think about using policy to be creative about how to deal with some of the challenges that we face both environmentally and from a Health Access perspective. If you think about us lettuce production, today i think its Something Like 300,000 acres art use to produce lettuce in this country. 300,000 acres of land. Why . It makes no sense to me. One of the other things we did our farm is we set up in agrippina the menstruation program. 300 squarefoot greenhouse and we produced all kinds of fantastic green. Kale and spinach and a bunch of different kind of lettuce. Think about what we would be able to do it we could take a portion of the terrestrial production, transfer it to greenhouse base production using recirculating technology, we could take the land that is currently in use and by the way represents a bio security risk. We could take that rent land out of production and we could use it say, for carbon sequestration. That might be a good idea. All of a sudden the farmer that owns the land as to sources of income instead of one. The health of the environment, wealth of the farmer. The problem is, we dont have a price on carbon. So sequestering it doesnt do you any good. It cant get me any money so why would i do it . Thats a great example of a brain dead incentive system. Now, you walk over the hill and people will be talking about, we cant rest carbon for all kinds of different reasons. At the end of the day, its really, really impractical for us to not do that. We could make so much money if we did. And so many people would be so much better off. Sugar. Im not saying we should treat sugar like tobacco. However, ill leave it at that. So look, let me wrap it up and simply say that the two strategic questions that i asked, how do we address the fundamental, the underlying problem of access and affordability to create a situation that improves health and drives wealth creation. We need to realign our incentive systems in many ways we discussed. We need to use data and evidence to do it you we need to build on what works, we need to invest on a scale that works. We need to redirect away from wasteful spending into things that do work and we will then begin to have a structure in place that will allow us to move forward, to have the kind of food system that we are all hoping to achieve and with that, its cocktail hour. [applause] im going to keep you for 15 more minutes because we had this great group withus, we can ask some questions. I have a couplequestions but im also happy to defer to the group. If people want to start , ill go first. My first question is for minella. This morning we heard from the panel in particular from doctor slagle about the gap in response of registration for science and that our legislators will follow necessarily because of recommendations and i think that struck me because i as a personal anecdote but i have a fouryearold in dc Public Schools and i was excited at the beginning of school this year because they serve breakfast, lunch and juice snacks and its a title i school and its free for all students and its a wonderful way for kids who might not have had breakfast or lunch. So i got the menu. And breakfast every day is wholegrain something but its usually wholegrain cinnamon crunch. Nasty whole grains and sugar is not particularly healthy and theyre required to have a serving of fruit and vegetables at every meal but often they get the juice instead and its typically either grape juice or fruit punch, its not even fibrous so i sent an email to the head of catering, the catering units for the most part in the email me back and said we are following the dietary guidelines of healthy food. We get a certain grains and we dont have the cash. Its not something we look for. With all that Michelle Obama has done to make food accessible and make food there in school,something is missing with the science and im wondering for the next administration to hopefully continue whats being done. How do we get the legislature to hear the finance line . I followed some people around tomato paste and i understand theres a lot of projects on the menu but these problems, how do we as lawyers and as cadets, how do we make this science really matter . Great question and i have five girls in Public Schools and sometimes she does lunch and she very gleefully tells me she gets chocolate milk which its like nails on a chalkboard but so, i think that theres still a lot more than can be done but a lot has been done in terms of the child nutrition act. We definitely need to celebrate what has been done. I think that there are sort of two answers your question. The fishing act and healthy kids act and all the areas we looked at in terms of an evidencebased, it probably has one of the strongest evidence basis so you can, because a lot of folks, a lot of researchers have been looking at how the rollout of the nutrition regulations have gone, its actually one of the places where we can show that kids health has improved with these regulations even though they are not perfect. And thats why i and experts looking on this issue feel its important that we do not rollback those standards which is what is being debated at the moment. I think Public Health and the School System folks who can get better at explaining the benefits and explaining and encouraging local School Districts to go beyond whats required in the federal regulations if they want to do that so you send an email to your School Services director is fantastic. We need to get more parents, pdas, wellness policy parents involved in really looking at what their kids are eating and encouraging local School Districts to strengthen whats being offered going back to doctor engels panel, the federal government can do an awful lot but really, i think the best thing for the federal government is setting a baseline to make nutrition standards and encouraging that for the city in places all across the country to go further and then the baseline and i think this is a case where that could definitely happen. Im going to throw out one more and then we will go to the audience. This is a double part question for mike and marlon. When you look at some of the ways that workers are treated , compensated, in healthcare is very sobering and as a consumer, its almost impossible. [audio lost]. And really to strengthen our food system. Can you what the goal could be in the first hundred days of office of the next president in terms of how you start the conversation and marlon, as an employer who as he talked about , you have very low Profit Margins and betting on what youre producing, what you do . When you are really in a hard position to treat workers equitably . What do you do . So i think thats a great question and thinking of in terms of the next administration and what are those actionable things specifically in this area and the next hundred days that they can pull a lever on or at least start a conversation on question mark i wont pretend to know the specific regulations that should be expanded or drawn back but one of the most important things is talking to the Transition Team of an administration or the next administration once they take office in showing the breadth of support and strength and legal case of course but also the numbers behind whatever policy or whatever certain standards you are trying to promote to get these things whether its some sort of label on a supermarket shelf, i think it gives people a good indication but really making sure youre communicating with the administration in showing the numbers and what are the distinct benefits and points on the Board Administration could get from taking action in the first 100 days in office . New administrations are clearly slammed with 1 billion different requests from all different sorts of sectors on things to do within the first 100 days so demonstrating that these are actionable items that can be done simply and theres a lot of support behind them is really critical. The short answer to question is you cant them out of business. Its not going to happen. Why question mark because,and this is the simple, cold, brutal, factual deal. The American People are utterly unwilling to pay the cost of food that it would take to pay the people that produce it. Theyre just not going to pay it. They wont. Theyll say they will but theyre lying. In order for me to stay in business, you saw . 40 deal , thats why i put that out there. If im getting . 40 for that ball, what do you suppose the guy who is hanging off a ladder is getting . Okay . So let me know what drupal your shopping bill. Guess what happens. So i would love to tell you that there is like a magical policy solution and when people tell you that, its crap. Its just not true. The American People are unwilling to pay the freight. And until they are, nothing will change. Can i ask, this is kind of a nacve question but ive been thinking about my favorite pet policy, the hhs procurement guidelines and it occurred to me that there are standards and their related to organic produce and Animal Welfare and local sourcing but theres not actually anything in there about the conditions, working conditions of the folks that are working on the farms that are providing the food. So would it be possible hypothetically to include Something Like that in those procurement guidelines and what kind of impact mikethat half. Yes and little or none because the, what it would take to drive compliance would be very, very expensive. And i doubt the appropriators would pony up for it. I think its a good and important valuable idea. I think we do need to look and understand the Workforce Development opportunities that actually exist in our food system and this is i think the principal area, theres a great opportunity for innovation. Theres actually a Workforce Development bonanza if we really think about this and as i said earlier, get our incentives structured properly but under the current regime, i dont see a path forward. Okay. We had a couple of questions. Just to add to that discussion, the truth is we have an economy that is dependent upon the us Consumer Spending the smallest percent of their income on food ever in history and we are used to a disposable income that buys all these products that drives the rest of the economy so even if we were willing to spend more on food, the economy has to be willing to accept less money for other goods but i love the discussion. About farm labor. And i think thats a complicated issue that i think is even more, located looking at the politics between liberals and conservatives and for example, this morning they were right in saying that the science that eating gm owes is safe is pretty clear but the science on whether or not gm owes are safe to grow and the safer the exposure to farmworkers or the environment or the risks associated with monocultures, i think is far less clear. So it is more complex and just to ask a question, there was a recent study that showed that conservatives groups donations toward most sectors of the Food Production system certainly animals, poultry, beef with few exceptions is largely conservative. Its almost 8205 percent conservative and these are the same groups that seem to resist Immigration Reform for the workers that we need for this kind of labor and im just not sure i understand this. And im sure you can explain it. Way, so youre asking me . To fill the distance between ted cruz and donald trump . [laughter] i thought it was to you. I dont expect an answer but its bizarre. I think that again, how can we take, how can we take some of the bleeding edge innovation in our food system and theres a lot of it, we see the rush of Venture Capital into some degree at tech but what sits behind that is an Innovation Ecosystem that is very immature relative to other elements of our technology, other elements of the Technology Sector but i do think the nexus of technology and agricultural practice give us a path forward to deal with the labor market to the conundrum we face right now. Imagine a situation where lettuce is produced in greenhouses harvested by robots delivered by drones. Thats not crazy. Thats amazon. Right . But what are the Workforce Development consequences of that question mark youre taking lettuce pickers out of the field and their wearing lab coats in abio secure environment. All the the on food, nutrition and other successful example said of Community Side effects. And then the other question has to do with the Transition Team and i think we focus a lot on that but not so much the moment right now where we can kind of, you know, get the candidates on the record on specific issues. Is there one or two issues that it is important to get the president ial candidates and or congression congression congressional candidates on . That is a lot. I will talk about things really quickly because i am aware we are out of time. I would say a policy vehicle to look at in terms of getting Community Involvement in the system is sponsor projects. If you are interested in food systems, getting involved in a local food council policy, or starting one, is a great way to do that. The second example both of us were going to talk about but we didnt, i will flag it as a local example, but i think it is an example like the ones that dr. Angle talked about that could be elevated to state, federal or some form of the other is minneapolis staple food ordinance. The city of minneapolis passed an ordinance that requires gas stations, food stores, or anything with food to stock a certain amount of staple foods and they track the wic basket. They have not done this in isolation but are playing the groundwork for this and the first version of the ordinance was passed in 2011 and got updat updated. They provide Technical Assistance through the Health Department particularly in communities and it is important to know how to store and sell produce. Building off that, a report called fixing food was reported last year and looked at five major cities, one being minneapolis, and highlighted that. There are small and large cities across the country doing incredibly unique things in food spaces to bring healthier food to people across the range of spectrum. There is a lot of activity in the state but it is about how you translate that in the federal level, would that work, how do you bring the voices together with other communities around them. I think the appetite in different communities is there. It is really more about bringing them together. The question is is there one or two issues, on behalf of the union i would love to see every food and agricultural issue be on the record. At the beginning of the election season, there has been a mention of corn ethanol and sugar cain and a little immigration but nothing directed at agricultural. Anything is better than nothing in terms of food and agricultural space. The union is going to do work throughout the remainder of the year to make sure candidates do get on the record the issues. Since there is agreement on the issue we face trouble. I think that is recognize. To answer the second question, i will put my chief of staff hat on and say anything you get the candidates on the record saying, the way to be effective like right now, the way to think about being effective is think down the ballot and demonstrate where the interests are that matter to them. I am a member or city council person, i can the Food Policy Council at the local and state, but mostly more local is a very powerful organizing tool to bring people into the process at literally the retail level. That has a way of trickling up quickly in the political process. When you have super delegates on the democrat side going to the conventi convention, talking about the fact they are mayors; right . When super delegate chose up it is like i have a thousand people coming and yelling about blah blah and dealing with food and i dont know anything about it. Same thing here. That is how you move the process now. All right