The Farm Bill impacts public health through the nutrition assistance programs it authorizes,

as well as through programs that impact the cost and availability of foods we eat and the

environments in which we live. The “Farm Bill” is a term used to describe a major piece of

federal legislation that governs national food and agriculture policies. Congress reauthorizes

a new version of the Farm Bill roughly every five to seven years. The Farm Bill was last authorized in 2008

and the national debate over priorities for the 2012 Farm Bill has already begun. The Farm Bill reauthoriza-

tion is an opportunity to support a healthier, more sustainable food system for the U.S.; increase demand for

healthy foods; and improve the nation’s public health and communities in the process. Given the importance

of the Farm Bill for public health, this primer is intended to provide a summary of the major components

of the Farm Bill and their connections to public health.

American Public Health Association

JUNE 2012

The Farm Bill and Public Health: A Primer for Public Health Professionals

800 I Street, NW • Washington, DC 20001-3710 • 202-777-APHA • fax: 202-777-2534 • www.apha.org

Patricia Elliott, JD, MPH; and Amanda Raziano, MPH

2

There are four principal ways in which the collection of programs authorized by the Farm Bill impact public health:

� PROVIDING FOOD AND NUTRITION ASSISTANCE—The Farm Bill is foremost a nutrition bill; nutrition assistance programs comprise 65% of the Bill’s funding. The Bill authorizes and funds a number of key food assistance and nutrition support programs, including the Supplemental Nutrition As-sistance Program (SNAP—formerly the food stamp program), for the most vulner-able Americans: people with low-incomes, children, and elderly. These programs, com-bined with programs governed by other laws (e.g., school lunch programs, child nutrition programs), comprise the nation’s safety net for vulnerable individuals—a safety net that has been vital during the recent economic downturn.

� PRODUCING HEALTHY, AFFORDABLE FOODS—Farm Bill policies including crop subsidies, crop insurance, conservation, gov-ernment distribution of foods, and support for market promotion, play a crucial role in shaping domestic agricultural produc-tion, thereby influencing the kinds and costs of foods available in our communities. The Farm Bill offers an opportunity to further improve nutrition and reduce obesity through increased production of healthy and afford-able foods.

� INCREASING ACCESS TO HEALTHY FOODS—Federal farm policies reflected in the Farm Bill directly and indirectly influence how we access our food in urban, suburban, and rural communities alike. The 2008 Farm Bill contained several critical measures that have begun to remake the food system to improve regional food systems, support local economies and increase access to healthy food choices in all communities.

� FOSTERING SUSTAINABLE FOOD SYSTEMS—The Farm Bill includes provi-sions that affect the environmental sustain-ability and environmental health impacts of agricultural practices, through conservation programs that help minimize negative envi-ronmental health impacts.

This primer is divided into six sections:

� Farm Bill History and Overview—This sec-tion provides a brief history of the Farm Bill and its original intent and an introduction to the structure and funding of the most recent law (2008 Farm Bill).

� Providing Food and Nutrition Assistance—This section describes food insecurity and the central role that Farm Bill nutrition programs and initiatives play in addressing hunger and nutrition in the U.S.

� Producing Healthy, Affordable Foods—This section discusses key issues related to the food we produce: federal policies governing com-modity crops and specialty crops, the role of federal crop insurance, and changing trends in the foods available for consumers.

� Increasing Access to Healthy Foods—This section reviews the challenges that some communities face in accessing healthy, afford-able foods and highlights Farm Bill initia-tives designed to increase the demand for and availability of these foods and improve consumers’ understanding of the importance of healthy eating.

� Fostering Sustainable Food Systems—This section highlights changes in the U.S. food system and their human health and environ-mental impacts.

� Creating a Public Health Farm Bill—This section summarizes the four key ways in which the Farm Bill can improve the public’s health and how Farm Bill programs can be further improved.

Farm Bill History and Overview

History of the Farm Bill

Today’s Farm Bill has its origins in the Great Depression and the Dust Bowl of the 1930s, a period that saw overproduction of crops, col-lapsing agriculture prices, and high levels of unemployment across the country. Gross farm income declined 52% between 1929 and 1932, and by 1933 the unemployment rate in urban areas had reached 30%.2

In response to these pressures, the government enacted a series of laws and programs begin-ning in the 1930s to pay farmers to reduce crop production levels and create a vehicle to feed the poor with surplus commodities.2,3 The intent of these early federal initiatives was twofold: to sup-port failing rural economies and to address the needs of thousands of unemployed individuals in both rural and urban areas. To support farmers, the government limited planting of specified crops, supported soil conservation practices and limited the supply of crops to ensure that prices did not fall below a set level.2 The government

CONTENTS

Farm Bill History and Overview ............................................. 2

Providing Food and Nutrition Assistance ............................................ 4

Producing Healthy, Affordable Foods ...................................................... 8

Increasing Access to Healthy Foods ....................................................11

Fostering Sustainable Food Systems ...............................................15

Creating a Farm Bill for Public Health ..................................................17

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also established a grain reserve system, purchas-ing surplus wheat and other commodities to remove the excess supply and stabilize prices in the market; these surplus items were then pro-cessed and provided to the hungry.4 Commodity purchases of surplus farm products and distri-bution of these products to pregnant women, children, and the elderly, as well as to food banks, schools, and other institutions, continue to be authorized through the Farm Bill today.

In addition to these farming support and food distribution programs, the Department of Ag-riculture also initiated food assistance programs, known as food stamps. Program participants received two kinds of food stamps: those al-lowing them to buy any foods they wished and supplemental food stamps that allowed them to buy discounted surplus food items offered by the government.5 The early food stamp program began in 1939 and ended in 1943, but it became the precedent for current federal food programs, which were first congressionally authorized by the Food Stamp Act of 1964.3,5,6

The first legislation designated as the “Farm Bill” passed as the “Food and Agriculture Act of 1965.”96 Since then, many policies and laws have been consolidated or modified through the Farm Bill. It has evolved and continues to ex-pand on the policy approaches used to support rural economies, farmers, and consumers in all types of communities, including making direct government payments to farmers and consum-ers. In addition to food and nutrition assistance programs, commodity programs, and crop insur-ance, the Farm Bill now addresses issues such as food safety, trade and foreign aid, conservation, organic agriculture, horticulture, energy, and research.

Farm Bill Overview

Congress debates and reauthorizes the na-tion’s major agricultural policies in the Farm Bill approximately every five to seven years.7 The most recent version of the bill was passed in 2008, as the Food, Conservation, and Energy Act.1 The 2008 legislation creates an umbrella structure that encompasses 15 sections (called titles) addressing a wide and disparate array of agriculture, nutrition, and other programs. Table 1 provides a brief description of each of the 2008 Farm Bill titles. Collectively, the programs represented in the Farm Bill directly and indi-rectly impact the types of crops grown, nutri-tion research, control of animal diseases, waste generated, labor needed, and chemicals used to produce our food—all of which ultimately affect the public’s health. A number of the titles

are discussed in depth throughout this primer. In addition to food assistance and nutrition programs that ensure a safer food supply and decrease food insecurity, the Farm Bill also ad-dresses organic farming, food safety inspections, and control and eradication of animal diseases.

Farm Bill Funding

When the 2008 Farm Bill was enacted, the Congressional Budget Office (CBO) estimated the bill’s total cost at $284 billion over five years (FY2008–FY2012) and $604 billion over 10

Table 1

The 2008 Farm Bill: Titles and Respective Programs and Policies

Title I, Commodities: Income support to growers of selected commodities, including wheat, feed grains, cotton, rice, oilseeds, peanuts, sugar, and dairy. Support is largely through direct payments, countercyclical payments, and marketing loans. Other support mechanisms include government purchases for dairy and marketing quotas and import barriers for sugar.

Title II, Conservation: Environmental stewardship of farmlands and improved management practices through land retirement and working lands programs, among other programs geared to farmland conservation, preservation, and resource protection.

Title III, Agricultural Trade and Food Aid: U.S. agriculture export and international food assistance programs and various World Trade Organization (WTO) obligations.

Title IV, Nutrition: Domestic food and nutrition and commodity distribution programs, such as food stamps and supplemental nutrition assistance.

Title V, Farm Credit: Federal direct and guaranteed farm loan programs. Also specifies loan eligibility rules and other policies.

Title VI, Rural Development: Business and community programs for planning, feasibility assessments, and coordination activities with other local, state, and federal programs, including rural broadband access.

Title VII, Research: Agricultural research and extension programs, including biosecurity and response, biotechnology, and organic production.

Title VIII, Forestry: USDA Forest Service programs, including forestry management, enhancement, and agroforestry programs.

Title IX, Energy: Bioenergy programs and grants for procurement of biobased products to support development of biorefineries and assist eligible farmers, ranchers, and rural small businesses in purchasing renewable energy systems, as well as user education programs.

Title X, Horticulture and Organic Agriculture: A new Farm Bill title covering fruits, vegetables, and specialty crops and organic agriculture.

Title XI, Livestock: A new Farm Bill title covering livestock and poultry production, including provisions that amend existing laws governing livestock and poultry marketing and competition, country-of-origin labeling requirements for retailers, and meat and poultry state inspections.

Title XII, Crop Insurance and Disaster Assistance: A new Farm Bill title covering crop insurance and assistance previously included in the Miscellaneous title (not including the supplemental disaster assistance provisions in the Trade and Tax Provisions title).

Title XIII, Commodity Futures: A new Farm Bill title covering reauthorization of the Commodity Futures Trading Commission (CFTC) and other changes to current law.

Title XIV, Miscellaneous: Other types of farm programs and assistance not covered in other bill titles, including provisions to assist limited-resource and socially disadvantaged farmers, agricultural security, and other provisions.

Title XV, Trade and Tax Provisions: A new title covering tax-related provisions intended to offset spending initiatives for some programs, including those in the Nutrition, Conservation, and Energy titles. The title also contains other provisions, including the new supplemental disaster assistance and disaster relief trust fund.

Source: Johnson et al.8

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years (FY2008–FY2017).8 More than 95% of the funding supports four titles: nutrition (65%), commodity crop support payments (15%), con-servation (8%), and crop insurance (8%). Figure 1 shows the distribution of the Farm Bill 2008 funding.8 Disaster assistance and other programs, including trade, horticulture and livestock pro-duction, rural development, research, forestry, and energy, make up the remaining 5%.8

While the bulk of Farm Bill spending goes to support Nutrition title programs, this reflects the great need for food assistance in the U.S. Federal nutrition programs funded by the Farm Bill have seen historic increases in the number of partici-pants due to the prolonged economic downturn in the U.S. and expanded eligibility. The federal nutrition programs are a vital part of the safety net for America’s most vulnerable populations and reduce the food insecurity of low-income households, especially those with children.10

Recent CBO estimates for FY2010–FY2012 and actual expenditures for FY2008–FY2009 indicate that five-year spending on most major Farm Bill programs will likely be above that estimated by CBO in 2008.9 CBO further esti-mated that spending for domestic food assistance programs and crop insurance will be significantly

greater than previously anticipated due to the economic recession beginning in 2009, the expansion of eligibility criteria and additional funding in the American Recovery and Rein-vestment Act, and increased crop prices (for crop insurance).9

Providing Food and Nutrition Assistance

Despite its name, which focuses attention on agricultural issues, the Farm Bill is the nation’s largest source of food assistance funding for needy families. The Farm Bill’s food and nutri-tion assistance programs are therefore a crucial contributor to public health, especially among the nation’s low-income populations.

Public health professionals are keenly aware of the chronic health problems associated with poor nutrition and unhealthy diets. Chronically mal-nourished children do more poorly in school, are at risk for learning problems and developmental delays, and exhibit more behavioral problems in school.12 Food-insecure adults may need more time off from work for health reasons and are at increased risk of diabetes, hypertension and other chronic diseases; food insecurity is associ-ated with increased mental health problems as well.13,14 Food assistance programs, such as those authorized in the Farm Bill, help reduce these impacts and improve the public’s health.

This section describes the ongoing problem of food insecurity in the U.S. and the vital role that the Farm Bill’s Supplemental Nutrition Assis-tance Program (SNAP) and other food assis-tance programs play in providing basic food and nutrition assistance to large segments of the U.S. population. It also describes how the size and scope of the Nutrition title offers an opportunity to drive agriculture policies that promote healthy food choices and better health for all Americans.

Food Insecurity in the U.S.

The U.S. Department of Agriculture (USDA) defines food security as “access by all people at all times to enough nutritious food for an active, healthy life.”15 Food insecurity occurs when a

While the bulk of Farm Bill spending goes to support Nutrition title programs, this reflects the great need

for food assistance in the U.S. Federal nutrition programs funded by the Farm Bill have seen historic

increases in the number of participants due to the prolonged economic downturn in the U.S. and expanded

eligibility. The federal nutrition programs are a vital part of the safety net for America’s most vulnerable

populations and reduce the food insecurity of low-income households, especially those with children.10

NOTE: Figures total to $289B, but 2008 Farm Bill budget includes offsets for a total outlay of $284B.

Source: Congressional Research Service (2008)8

5

person is unable to access food sufficient in qual-ity or quantity, and it can result in disrupted eat-ing patterns and reduced intake of food.15 More than 14% of U.S. households—over 50 million people—were food insecure in 2010, the most recent year for which data are available.15 This percentage was unchanged from 2009, when the level of food insecurity was the highest since the federal government began recording food insecu-rity data in 1995.16

Food insecurity is particularly prevalent in low-income households. In 2010, more than 40% of households with incomes below the federal poverty line of $22,113 for a family of four were food insecure.16 Low-income households can face budget constraints due to low wages, inad-equate public income support, high housing and energy costs, unemployment, underemployment, or health problems, which can result in hunger and food insecurity.17 Paradoxically, food-insecure households may also be at high risk for obesity (see Box 1).

Federal Nutrition Programs

The federal government addresses food insecurity through a suite of food and nutri-tion assistance programs, authorized through the Farm Bill and various other laws. To date there are more than two dozen USDA programs that provide food assistance or meals to low-income individuals and families. Among the programs authorized in Title IV of the 2008 Farm Bill are SNAP (formerly the Food Stamp program), commodity distribution programs, fruit and vegetable promotion programs, and nutrition education programs. Other important nutrition programs, such as Special Supplemental Nutri-tion Program for Women, Infants, and Children (WIC) and the National School Lunch Program (NSLP), are authorized through the Child Nutri-tion Act or other laws. All of these programs are designed to protect nutritionally vulnerable individuals20 and also to increase the demand for healthy foods. Only recently, however, have these programs focused on providing foods that meet the Dietary Guidelines for Americans. For example, in 2012 the USDA, for the first time, established a rule that aligns school lunch and breakfast programs offerings with the Dietary Guidelines for Americans, as recommended by the Institute of Medicine.97,98

These food assistance programs are a vital component of the nation’s safety net for nutri-tionally vulnerable individuals. More than 59% of all food-insecure households participate in one or more of the three largest federal food as-sistance programs: SNAP, NSLP, and WIC.18 The

current economic downturn greatly increased the demand for food assistance programs. Federal food assistance programs served one in four persons in 2010.19 The USDA reports that federal expenditures for food and nutrition assistance programs totaled nearly $95 billion in FY2010, a 20% increase over the prior fiscal year.22,23 2010 was the 10th consecutive year in which food and nutrition program expenditures exceeded the previous historical record.22 While some of the cost increase is attributed to increased benefits in the American Recovery and Reinvestment Act, the overall number of participants has continued to grow as well.9,19,22

The following sections describe in more detail the federal nutrition assistance programs autho-rized through the Farm Bill.

Supplemental Nutrition Assistance Program Overview

SNAP is the largest and oldest of the nation’s food programs.5,24 With an estimated 2012 budget of $85 billion, SNAP provides eligible low-in-come households with monthly benefits that can be used to purchase food from approved retail-ers.99 Written into law as the Food Stamp Act of 1964, it was first reauthorized as part of the Farm Bill in 2002. In an effort to fight the perceived stigma of using food stamps, the 2008 Farm Bill changed the name of the federal food stamp pro-gram to SNAP and renamed the Food Stamp Act of 1977 the Food and Nutrition Act of 2008.5, 100 In 2011, SNAP served nearly 45 million Ameri-cans.25 SNAP enrollment levels are at historic highs—more than one in seven Americans rely on SNAP for their food needs.19

SNAP Eligibility and Benefits

SNAP/food stamp eligibility requirements and benefit amounts have changed frequently throughout the history of the program.5 Benefits eligibility is based on factors such as household size, income, and assets. The eligibility require-ments have been modified over time through changes in the income thresholds, deductions for expenses such as housing and childcare, and calculation of assets (e.g. stocks, bonds, or vehicle value). For example, based on 2008 Farm Bill eligibility requirements, a family of three could make no more than $22,330, report less than $17,172 in taxable income, and no more than $2,000 in personal assets.100 In the 2008 Farm Bill, benefits were augmented for most house-holds due to an increase in the minimum benefit and standard deduction and elimination of the cap on the deduction for child care expenses.100

On average, households received $272 in monthly

BOX 1: HUNGER- OBESITY PARADOX

While food insecu-

rity can lead to

health problems

due to underweight, it can also

lead to obesity. Obesity and

overweight affect all ages and

segments of the U.S. popula-

tion; however, members of

low-income and food-insecure

households are at increased

risk for obesity and overweight

due to limited financial re-

sources to buy healthy foods

and lack of access to healthy

foods and safe places to

exercise within their immediate

neighborhood or community.17

Cycles of food deprivation and

overeating can lead to meta-

bolic changes over time that

promote fat storage and weight

gain.17 When healthy foods are

available in low income areas,

they often tend to be more ex-

pensive and of poorer quality.

Foods high in refined grains,

added sugars, and fats, which

contribute to obesity, tend to

be generally less expensive

and more readily available in

low-income communities.17

6

SNAP benefits in 2009; the maximum benefit for a family of four was $588 during the first half of that year.27

Administration of SNAP

Although SNAP is a federal program, state and local programs are responsible for determining eligibility and benefits and monitoring delivery of benefits. USDA Food Nutrition Service field offices license and monitor retailers, including farmers’ markets, which accept SNAP benefits. All SNAP benefits are provided via electronic benefit transfer (EBT) cards, which can be used at approved retail food stores and farm-ers’ markets. Initiatives to expand the number of farmers’ markets and other fresh produce retailers that accept EBT cards are an important means of increasing access to fresh fruits and vegetables among SNAP participants.

Eligible Foods

The types of foods eligible for purchase with SNAP benefits have changed over time. Cur-rently, SNAP benefits can be used to purchase all foods and food products other than alcohol or tobacco products, items that are not intended for human consumption (e.g., paper products, pet foods), foods sold hot at the point of sale, and vitamins and supplements.28 Seeds and plants that produce food for the household to eat may also be purchased with SNAP benefits. Of note, as described by the USDA, “Soft drinks, candy, cookies, snack crackers, and ice cream are food items and are therefore eligible items.”28 Most SNAP benefits—86% in FY2009—are redeemed at supermarkets across the U.S.29 In some areas, however, qualified homeless, elderly, or disabled people who are not able to prepare food on their own, may use their SNAP benefits for low-cost meals at authorized restaurants.28

The fact that SNAP benefits can be used for soft drinks, candy, cookies and other foods that have limited nutritional benefits is a point of controversy. Many public health advocates concerned with rising obesity rates have argued that foods with little nutritional value should not be eligible for purchase with SNAP benefits.101,102 The USDA reports that because the list of eli-gible foods is defined in federal law, any changes to the eligible foods would require congressio-nal action.28 Bills to restrict certain foods from SNAP benefit redemption have been introduced in state legislatures as well, including recent bills in Florida and Texas30,31 and a Vermont resolution, urging USDA to give states authority to define eligible foods.32

In addition, there are concerns about the logis-tics of implementing limits on the foods that can be purchased with SNAP benefits. The USDA notes that when Congress has considered placing limits on eligible foods, it has concluded that designating foods as “luxury or non-nutritious would be administratively costly and burden-some.”28 In March 2007, the USDA issued a report, “Implications of Restricting the Use of Food Stamp Benefits,” that reached a similar con-clusion.33 Some states and localities have applied for permission to conduct pilot SNAP programs in their jurisdictions that would disallow the use of SNAP benefits to purchase sugar-sweetened beverages or other “junk foods.”34 In 2011, the USDA denied New York City’s request to con-duct a pilot project that would limit the ability of SNAP participants to purchase high-sugar-content beverages, including non-diet soda.35 The denial was based on the logistical complexity involved in determining which beverages could or could not be purchased using SNAP benefits and the difficulty in gauging the program’s ef-fectiveness with respect to reducing obesity.35 An alternative strategy to increase SNAP purchases of healthy foods is to require SNAP vendors to comply with specific guidelines regarding the availability of healthy foods.

Other Food and Nutrition Assistance Programs in the Farm Bill

In addition to SNAP, the 2008 Farm Bill included a number of other food and nutrition assistance programs that contribute to the nation’s food safety net.

� The Emergency Food Assistance Program (TEFAP)—TEFAP helps supplement the diets of low-income individuals, including the elderly, by providing them with emergency food and nutrition assistance.36 The USDA buys, processes, and packages commodity foods and makes them available to the states to distribute via local food agencies, including food banks, soup kitchens, and food pantries that directly serve the public.37 Mandatory funding for TEFAP is $250 million, plus any adjustments for inflation.

� Fresh Fruit and Vegetable Program (FFVP)—FFVP operates in selected low-income ele-mentary schools in all 50 states, the District of Columbia, Guam, Puerto Rico, and the Virgin Islands and is primarily administered through state departments of education.38,39 The pro-gram helps schools provide children with free fresh fruits and vegetables for mealtimes and as snacks.39 Funding in 2012 is estimated at

The fact that SNAP

benefits can be used

for soft drinks, candy,

cookies and other foods that

have limited nutritional benefits

is a point of controversy. Many

public health advocates con-

cerned with rising obesity rates

have argued that foods with

little nutritional value should

not be eligible for purchase

with SNAP benefits.101,102 The

USDA reports that because the

list of eligible foods is defined

in federal law, any changes to

the eligible foods would require

congressional action.28

7

$163.5 million dollars (this amount increased each year beginning in 2009, from $40M - $150M). Beginning in 2012, the amount is adjusted by inflation.

� Healthy Incentives Pilot Project (HIP)—The 2008 Farm Bill authorized $20 million for pilot projects to determine whether finan-cial incentives provided to SNAP participants increase the purchase of fruits, vegetables, and other healthful foods.40 For every dollar proj-ect participants spend on fruits and vegetables using their SNAP electronic benefit transfer cards, 30 cents will be added to their benefit balance to subsidize the cost by almost one third.40 HIP is an effort to explore a new and innovative approach to empower low-income Americans to consume diets that include more fruits and vegetables, whole grains, and other healthful foods.40 A pilot, in Hampden County, Massachusetts, began in November 2011 and will be evaluated in 2013.40

� Hunger-Free Communities Initiative—The 2008 Farm Bill authorized $5 million for new Hunger-Free Communities grants to food-in-secure communities in the U.S. Large numbers of households in these communities have dif-ficulty providing enough food for all mem-bers due to a lack of resources.42 In February 2011, the USDA awarded research, planning, and implementation grants to 14 communities in eight states to promote coordination and partnerships among public, private, and non-profit partners to maximize enrollment, help eligible households make full use of benefits and better understand the reasons for food insecurity.42

� Whole Grain Pilot Project—The 2008 Food Bill instructed the USDA to establish a pilot project to purchase whole grains and whole-grain products for use in school meal pro-grams. It authorized $4 million to fund the project.

� Nutrition Monitoring—The 2008 Food Bill required the USDA and the Department of Health and Human Services to jointly moni-tor, conduct research on, and disseminate to the public information on diet, nutrition, physical activity, and related issues.

The programs and initiatives described above are designed to increase access to and demand for nutritious foods among those with low incomes. USDA expenditures on food assistance and nutri-tion programs increasingly work to support the Dietary Guidelines for Americans and, through initiatives such as SNAP education programs

and other efforts, enhance the ability of program recipients to purchase, prepare, and consume healthy foods. The Farm Bill includes mea-sures that ensure individuals, schools, and other institutions have access to nutritious, affordable foods and that bolster local producers’ ability to produce, promote, and market nutritious foods. The historical safety net of federal food assis-tance programs, such as SNAP, TEFAP, and fruit and vegetable programs, has worked to reduce food insecurity even during times of economic hardship and provided an economic stimulus to local communities and agriculture producers.43,44 USDA’s continuous efforts to monitor the nutri-tion and dietary habits of Americans through the Agriculture Research Service and the National Institute of Food and Agriculture, is essential to informing Dietary Guidelines and food and nutrition programs.

Nutrition programs are at the heart of the Farm Bill, addressing recipients’ food insecu-rity and improving their nutritional status and overall health.

Producing Healthy, Affordable Foods

Today’s food system is very different than it was even 30 years ago. Our food production systems have become increasingly consolidated among food growers, processors, manufacturers, and retailers. With this consolidation has come concerns about decreased diversity in the types

The Farm Bill includes measures that ensure individuals, schools, and other

institutions have access to nutritious, affordable foods and that bolster

local producers’ ability to produce, promote, and market nutritious foods.

8

of crops grown in the U.S. and the safety of our food system overall. The evolution of federal farm policies over time has led to a food supply system in which a relatively few types of crops are grown on large-scale farming operations and fresh fruits and vegetables and organic crops are riskier to produce. This type of food production system may fail to meet the recommendations for a healthy diet outlined by the USDA and the Institute of Medicine.45

This section describes the different federal policies governing commodity crops such as corn and wheat and specialty crops such as fruits and vegetables. It also reviews the federal crop insur-ance program and the important role it plays, especially for growers of specialty crops. Finally, the section discusses how our food choices have changed over time, due in part to convenience foods made from low-cost commodities, and provides recent examples showing that our food system is capable of producing healthier foods.

Commodity Crops and Subsidies

Title I of the 2008 Farm Bill addressed com-modity crops and subsidies paid to growers of these types of crops. Subsidies provide growers with a risk management tool, serving as a safety net against seasonal fluctuations and disasters, controlling market prices, and maintaining a reli-able food supply.46 Subsidies can be in the form of direct payments, countercyclical payments, or marketing loans.47

Eligible commodities include dairy items in addition to items such as grains and cotton that can be stored for long periods and can be bought or sold in bulk in the U.S. and abroad. The types of crops included in the commodity programs have expanded over time and currently encompass about two dozen crops. Corn, sugar beets, soybeans, wheat, rice, chickpeas, lentils, dry peas, oats, barley canola and other oilseeds, dairy products, and peanuts are all designated in federal laws and regulations as commodities eligible for subsidies.48 Fruits and vegetables are not eligible for commodity subsidies.

In the 1970s and 1980s, federal agricultural policies moved away from ensuring price stabil-ity by managing production. Instead it shifted to a system of direct subsidies for growers that maintains low prices and high outputs for certain

crops (e.g. corn, wheat, and rice) that could be sold as commodities both in the U.S. and inter-nationally.45,49 Direct payments to growers were instituted to encourage competition and increase production, and led to lower prices for commod-ity crops.

Commodity crops are also used in U.S. in-ternational food aid efforts. Bulk processed and unprocessed commodity crops and foods made with these crops are part of international food relief packages (see Box 2 for more information about international aid activities in the 2008 Farm Bill). Surplus commodities continue to feed the poor—both in the U.S. and abroad—through direct commodity assistance, as well as, in the form of low-cost, processed food products that are easily transported and have long shelf lives.

While commodity crops are important to the U.S. economy and international food aid efforts, some argue that the current system of commod-ity subsidies has distorted the types and produc-tion methods of crops grown, benefits only a relatively few large growers, and may ultimately have a negative impact on the diets and health of Americans.49 However, research has shown that farmers growing commodity crops receive only pennies on the dollar for their crops, due to overproduction, with the majority of the profit made by processors, manufacturers, and retailers.49 Between 1984 and 2000, the proportion of each food dollar that went to farmers decreased from 35% to 19%.49 In 2008, 88 cents of every dollar spent on food went to nonfarm activities such as packaging, transportation, and marketing.49,50 Processors of low-cost commodity crops have increasingly profited from the conversion of these crops into processed foods.45,49 This results in a system that reinforces production and marketing of processed foods over fresh fruits and vegetables.

Importantly, commodity programs are only one piece of a complex system of food policies, and there is little evidence that supports a direct connection between commodity programs and poor health outcomes.49 As discussed later, the introduction of a number of Farm Bill provisions in 2008 encouraging use of local foods and other community food system efforts has begun to increase the demand for locally grown foods and reverse the trend toward consolidation among growers and retailers.

In 2008, 88 cents of every dollar spent on food went to nonfarm activities such as packaging,

transportation, and marketing.49,50 Processors of low-cost commodity crops have increasingly profited from

the conversion of these crops into processed foods.45,49 This results in a system that reinforces production

and marketing of processed foods over fresh fruits and vegetables.

9

Specialty Crops: Fruits and Vegetables

Certain types of crops, including fruits, veg-etables, tree nuts, herbs, and nursery plants, are classified as “specialty crops” under the Farm Bill. Specialty crops were covered in Title X of the 2008 Farm Bill, the first time there was a separate title for horticulture and organic agricultural programs.47 The creation of a separate title for these programs demonstrates their importance and the growing awareness that providing access to fruits and vegetables and food produced with-out synthetic pesticides or other chemicals is an important function of Farm Bill policies. Title X addressed a number of key programs and policies important to the public health community:

� Specialty Crops—The 2008 Farm Bill re-authorized the specialty crop block grant program, which provides states with grants to support marketing research and promotion to enhance the competitiveness of their specialty crops.47

� Organic Agriculture—Title X also included provisions to support organic agriculture. The National Organic Cost Share Program was designed to help farmers defray the cost of obtaining certification under the National Or-ganic Program. The 2008 law also requires the USDA to collect data about organically grown crops and distribute current price data for the organic market.

Production of Fruits and Vegetables in the U.S.

Approximately 2.5% of total cropland in the U.S. was planted with fruits and vegetables in 2007.51 The food system’s current output falls short of providing the amount of fruits and vegetables needed to meet the recommendations outlined in the Dietary Guidelines for Ameri-cans.45 The guidelines recommend more than four times the amount of fruits and vegetables as grains. Other factors such as limitations on the ability to store and safely transport fresh produce (especially when compared to commodity crops) also contribute to insufficient supplies of do-mestically produced produce relative to recom-mended consumption levels.

Federal Crop Insurance Program

The federal crop insurance program is another risk-management tool designed to compensate and protect crop producers from unavoidable risks associated with adverse weather, weather-related plant diseases, and insect infestations.47 Crop insurance policies are sold through private

insurance companies, but all or a portion of a producer’s premium is paid for by the federal government. Although permanently authorized through the Federal Crop Insurance Act of 1980,52 the federal crop insurance program was modified in the 2008 Farm Bill and is likely to be further modified in the 2012 reauthorization process.

Role of Crop Insurance

The Federal Crop Insurance Corporation underwrites policies offered through private insurance companies to producers of more than 100 different types of commodity and non-commodity crops. It is the primary mechanism through which producers of fruit and vegetables manage risk because they are not eligible for fed-eral direct commodity subsidy programs. In fact, farmers can be penalized for growing specialty crops on lands enrolled in federal commodity programs, even if commodity crops are not cur-rently being grown on that land. 45 Because crop insurance is the only federally subsidized risk

Box 2: Farm Bill Title III: International Aid Activities

The U.S. is the largest provider of food aid in the world, accounting for about

60% of total global food aid over the past decade.47 International food aid

ensures that individuals around the world receive the necessary nutrition to

maintain their health. Title III of the Farm Bill covers funding for USDA’s inter-

national food aid and also addresses barriers to U.S. agriculture exports. The

Farm Bill authorizes food aid purchase and distribution programs, although

most international food aid activities are administered by the U.S. Agency for

International Development (USAID).47

The 2008 Farm Bill extended international food aid programs through FY2012

and authorized the use of U.S. commodities for emergency relief and non-

emergency (development) projects overseas.47 It also provided funds for a

pilot project to purchase food aid locally, thereby saving substantially in ship-

ping costs and time and simultaneously addressing the potential damaging

effects of free or below-market-cost food on local producers and economies.

The 2008 law increased funding for administrative operations, stockpiling and

prepositioning costs, evaluating food aid quality, and segregating emergency

and non-emergency aid funding.47 The law’s food aid components are vital to

addressing emergency and ongoing food insecurity internationally.

10

management tool available to fruit and vegetable producers, it is an important policy mechanism for protecting the viability of these operations and, ultimately, maintaining and expanding the number of suppliers of fruits and vegetables.

While many specialty crop farmers prefer to maintain crop insurance rather than receive crop subsidies, it has not historically been sufficient to fully support farmers’ needs.51 Additionally, farms planting diverse crops or using organic methods have a difficult time obtaining crop insurance due to a lack of historic actuarial data.53,54 Hav-ing access to crop insurance at affordable rates is important for small, mid-sized, and specialty crop growers. In Farm Bill 2012 discussions, expan-sion of crop insurance is being considered as an alternative to some of the existing farm safety net policies, including direct subsidies. However, reducing or replacing direct subsidies with crop insurance could result in higher federal costs if claims are made during periods of relatively high prices for growers. Improved insurance coverage to better support small and mid-sized farm-ers, producers of organic foods, and farms that grow diverse crops in managing their risks will also increase fruit and vegetable production to

help meet dietary needs. As discussed later, these types of producers are key to rebuilding local and regional food systems that have declined or disappeared in recent decades.

Our Changing Diet and Food Options

Food manufacturers have successfully created an array of new foods with low-cost commodity crops as their foundation.45 In addition to their lower cost relative to healthier choices, many of these foods are convenient to prepare and eat, are calorie dense, and appeal to people’s tastes; how-ever, they are often produced by using added fats, sugars, and salt and artificial colors and flavor-ings.45,46 While these changes have extended the amounts and shelf life of foods, processed foods dominate grocery sales and have contributed to increased consumption of fats and sugars in the U.S. diet, thereby contributing to the nation’s obesity epidemic.45,57

Producing Healthier Foods

Sensitivity to obesity and other health issues and the public’s desire for healthier products have caused many food companies to respond to mar-ket demand by reformulating products to reduce calories, fats, sodium, and sugars. Some producers have begun to use more organically produced ingredients in their products. Others have simply decreased portion sizes without reformulating their products to achieve calorie reductions.

Food retailers are also beginning to respond to consumer demands for healthier food options. Large-scale buyers such as Wal-Mart are using their buying power to influence food companies’ products, developing their own healthier in-house brands, and increasing purchases from local and regional producers around their stores.58,59 These responses to consumer demands are en-couraging, and combined with USDA nutrition programs, will help to effect healthier food and agriculture practices as well as meaningful long-term change.

Current Farm Bill policies could have a pro-found impact on what the general population purchases and consumes. Foods high in refined grains, added sugars, and fats tend to be generally inexpensive relative to healthier foods and more readily available in low-income communities.17 Households with limited resources try to stretch their available money by buying cheap, high-calorie, filling foods. Schools, hospitals, and other large institutions are also faced with purchasing choices that pit more costly nutritious items against less expensive, low-nutrient foods.17 There is a need for a combined strategy of increased demand—to drive production of healthy foods—

FOSTERING PRODUCTION THROUGH DEMAND

The 2008 Farm Bill included the new Farm to School Initiative, which

encourages and supports schools purchasing local, unprocessed

foods.60 The new guidelines, which apply to food purchased through

Child Nutrition Act programs (school lunches, etc.), have the potential to greatly

impact the choices available to American schoolchildren. This program links

local producers to institutions, creating stable demand for products from small

and mid-sized farmers. The 2008 Farm Bill also increased mandatory spending

on fruits, vegetables, and nuts for school lunches; encouraged nutrition educa-

tion; and authorized a pilot program for school gardens in high-poverty schools.

These changes help set healthy eating habits that will positively impact children

throughout their lives.

11

and pricing approaches that make the healthier choice the affordable choice. As the demand from food assistance programs for healthier foods grows, food manufacturers will produce healthier products for institutions as well as for retail markets. Farm Bill efforts to assist organic farmers with market data, crop insurance, and other support have also led to growth in this market segment of healthier foods.

Increasing Access to Healthy Foods

Equally important to fostering public policies that encourage the production of healthy foods is the need to promote policies that increase de-mand for and access to healthy foods. Increasing demand for healthy food choices and provid-ing sufficient access to nutritious foods are key public health policies supported through several programs and initiatives in the 2008 Farm Bill.

This section reviews the challenges that some communities face in accessing healthy, affordable food and the public health implications of this lack of access. The section also highlights 2008 Farm Bill initiatives designed to increase the demand for healthy foods, improve consumers’ understanding of the importance of healthy eat-ing, and foster better access to healthy, affordable foods. Finally, the section identifies programs aimed at diversifying and rebuilding local and regional food systems.

The Challenge of Accessing Healthy, Affordable Foods

A significant factor in nutritional status is the extent to which people have regular access to healthy food options within their community. Studies have shown that those who have better access to full-service supermarkets tend to have healthier diets and a reduced risk of obesity.17

A variety of factors—consolidation among retail food outlets, inaccessibility of full-service grocery stores, and the relatively higher cost of healthy foods—have made it difficult for people in some communities to access healthy foods and resulted in “food deserts”: areas with limited access to affordable and nutritious food.61 Food deserts disproportionately impact urban low-income communities and communities of color. In a review of 21 studies, it was consistently found that food stores in these communities offer lower quality items, are less likely to stock healthy foods, and are more likely to charge higher prices than stores in higher income or predominantly white communities.62 In low-

income communities where residents are reliant on SNAP and other food assistance programs and many residents do not have their own vehicles, accessing healthy, affordable foods can be difficult.

Lack of access to healthy foods is not limited to urban communities; food deserts can also impact rural communities, although some of the causes are different than in urban areas. Low population densities and longer distances be-tween grocery stores, as well as the rapid growth of “supercenters” and their impact on smaller, local food retailers, have resulted in the creation of rural food deserts.62 A USDA report on food deserts noted that consumer behavior, prefer-ences, and other factors may also account for differences in the types of foods offered across different areas and that public health educa-tion efforts are needed, in addition to increased access, to help change consumer preferences in favor of healthier foods.61

Impact of Food Deserts

Residents in food desert communities may not have many options for buying healthy foods. This can be especially difficult for low-income residents who do not have transportation, have to travel farther to get to a full-service grocery store, or shop predominantly at local conve-nience stores that do not have many healthy food options. Further complicating the “food environment” is the reality that in many food desert communities—and even in neighbor-hoods with supermarkets—residents are inun-dated with fast-food restaurants and convenience stores that provide ample opportunity to buy low-cost, high-calorie, nutrient-poor foods.62,63 When lack of access to healthy foods is coupled with other community factors such as a lack of playgrounds, recreation areas, and safe sidewalks

FOOD DESERTS

• Low-incomezipcodeshave

25% fewer chain supermar-

kets and 1.3 times more con-

venience stores than middle-

income zip codes.62

• Adultswithnosupermarkets

within a mile of their homes are

25% to 46% less likely to have

a healthy diet than those with

the highest number of super-

markets near their homes.62

USDA FOOD DESERT LOCATOR WEBSITE

The 2008 Farm Bill directed the USDA to study areas with limited access

to affordable, healthy food. Following up on those studies, USDA created

aFoodDesertLocator.TheFoodDesertLocatormapsandprovides

selected population characteristics of census tracts defined as food deserts: low-in-

come neighborhoods without easy access to a supermarket or large grocery store.

The locator can be accessed at www.ers.usda.gov/data/fooddesert/index.htm.

12

and paths on which to walk, residents of urban and rural communities alike can be at increased risk for overweight or obesity.63,64

Retailer Consolidation

Concentration within the retail grocery sector is increasing; the market share of groceries sold by the four largest food retailers has more than doubled since 1997.80 As of 2009, the top four food retailers controlled more than half of all grocery sales.80 A study of the largest 100 met-ropolitan areas showed that the four largest food retailers control 72% of sales.80

Paradoxically, although more grocery stores nationwide have opened than closed in recent decades, urban areas have continued to lose supermarkets as retailers follow their more af-fluent customers to the suburbs.62,77 And while alternative sources of fresh foods such as farm-ers’ markets, produce stands, and community-supported agriculture programs have likewise increased in recent years, they tend to be found in middle-class or wealthy communities.62 Other factors such as high crime rates, inadequate building space, and the relatively high cost of doing business in urban communities have also contributed to the overall and continuing decline in the number of chain or large grocery stores in these communities.61

While consolidation in the various segments of the food system is not necessarily bad per se, it can ultimately affect the price, quality, choice, and availability of foods; eliminate small- and mid-sized stores; and create highly centralized opera-tions.76 For example, grocery store concentration can lead to higher consumer prices and drive out smaller, less competitive stores.80

Initiatives to Promote Demand for and Access to Healthy Foods

The 2008 Farm Bill authorized a number of programs to encourage the purchase and consumption of healthy foods as well as increase their accessibility. Initiatives designed to increase the availability of and access to healthy foods can result in better eating habits: studies have shown that there is a positive link between access to healthy food and healthy eating behaviors.62 A USDA study on food deserts notes that easy access to all foods may be more important than a lack of access to specific healthy foods in explain-ing increases in obesity.61 Furthermore, while easy availability of healthy foods is important, individuals must choose to purchase these foods; they need the motivation to buy healthy foods, the skills to prepare them, and budgeting tools to maximize their healthy food dollars.

BUILDING ON A SUCCESSFUL FOOD BUSINESS MODEL: The Fresh Food Financing Initiative

In 2011, the USDA together with the Department of Health and Human

Services and the Department of Treasury, jointly implemented a Healthy

Food Financing budget initiative to reduce food deserts and increase ac-

cess to healthy, affordable foods. The initiative was modeled on The Pennsyl-

vania Fresh Food Financing Initiative, a successful public-private partnership

designed to bring options for healthier foods to underserved rural and urban

communities throughout the state. In the five years between 2004 and 2009,

the PA Fresh Food Financing Initiative developed 83 supermarkets and fresh

food outlets, which created or retained 5,000 jobs.93 The $30 million invest-

ment in state seed funds has resulted in projects totaling $190 million.93Local

tax revenues from one store in Philadelphia increased by $540,000.93 State-

wide, 400,000 residents now have increased access to healthier foods.93

The 2012 Senate Farm Bill includes authorization language to further establish

a federal Healthy Food Financing Initiative (HFFI).107 The federal program aims

to attract investments to underserved communities by providing crucial loan

and grant financing to fresh food retailers. The program is designed to help

these retailers overcome significant start-up costs of beginning operations in

underserved, low-income rural, suburban, and urban communities.94 The pro-

gram can also support renovation and expansion of existing stores.

Programs such as the Pennsylvania model or the proposed federal HFFI and

similar programs in other states are sound approaches to addressing problems

associated with obesity and lack of access to healthy foods while taking into

account the current fiscal constraints and the need to leverage investment to

stimulate economic development and job growth.

13

A variety of new and continuing Farm Bill programs and initiatives are designed to increase demand for and access to healthy foods:

� SNAP Nutrition Education—This is a specific component of the 2008 law that gives states discretion to implement nutrition education programs directed at individuals who receive or are eligible for program benefits.

� Procurement Preferences for Locally Grown Products for In-School Meals—The 2008 Farm Bill amended the Richard B. Russell National School Lunch Act to reduce existing barriers faced by child nutrition programs in purchasing unprocessed locally grown and lo-cally raised agricultural products.65 Institutions receiving funds through the federal child nu-trition programs, which include the National School Lunch Program, School Breakfast Program, Fresh Fruit and Vegetable Program, Special Milk Program for Children, Child and Adult Care Food Program, and Summer Food Service Program, may apply an optional geographic preference in food procurement for these programs.65 Due to the geographic diversity of the United States, neither the 2008 Farm Bill nor USDA’s rules define “local”; each school food authority is permitted to define the term for itself.65 The locally grown procurement preference is part of USDA’s Farm to School Initiative in kindergarten through grade 12. The initiative seeks to effi-ciently meet the diverse needs of school nutri-tion programs, provide support for health and nutrition education, and support regional and local farmers, thereby strengthening local food systems and regional economies.66

� Expansion of Community Food Projects—The USDA Community Food Projects Competi-tive Grant Program has existed since 1996 to fight food insecurity through community food projects that promote self-sufficiency in low-income areas.67 It was incorporated into the Farm Bill in 2008. Grants help eligible entities carry out community food projects that make communities more self-reliant in maintaining their food systems while addressing food, nu-trition, and farm issues.68 Examples of funded community food projects include nutrition education, food policy councils, community gardening, youth gardening, community-sup-ported agriculture, farm-to-school programs, farmers’ markets, micro-enterprise develop-ment, consumer education and marketing campaigns, business training, and community kitchens.69,70 As of 2007, 243 grants and more than $36 million, which was matched by local

resources, had been distributed through this program.71

� Healthy Urban Food Enterprise Development (HUFED) Center—The 2008 Farm Bill pro-vided $5 million to the USDA to establish the Healthy Urban Food Enterprise Development Center, designed to help make affordable, nu-tritious fresh foods, including locally produced foods, more readily available in low-income communities and neighborhoods.47,72 In Janu-ary 2009, the USDA announced a $900,000 award to the Wallace Center at Winrock International (Little Rock, Arkansas) to run the HUFED Center.73 The center provides training, technical assistance, and subgrants to eligible entities for healthy food enter-prise development.72 In July 2011, the center awarded $630,000 to 17 groups to resolve bar-riers and strengthen or build access to healthy and regionally produced food in underserved communities, where rates of diet-related pre-ventable conditions such as obesity are high-est.74 The strategies used to achieve these goals include improved processing and distribution options, improved aggregation and marketing with food hubs, mobile markets in rural and urban areas, and large-scale community-sup-ported agriculture.74

� Access to Fresh Foods—Title X included sev-eral provisions to encourage the consumption of fresh fruits and vegetables. The bill expand-ed the Farmers’ Market Promotion Program to enable food assistance program participants to use their electronic benefit cards at more farmers’ markets. Another provision established the Healthy Urban Food Enterprise Develop-ment Center, which makes fresh foods more readily available to low-income communities while simultaneously creating jobs.47

� Senior Farmers’ Market Nutrition Program (SFMNP)—SFMNP offers grants to states, territories, and tribal governments to provide low-income seniors with coupons that can be exchanged for eligible foods (fruits, vegetables, honey, and fresh-cut herbs) at venues includ-ing farmers’ markets, roadside stands, and com-munity-supported agriculture programs.75 The program supports and expands the number of such venues in addition to making healthy foods available to low-income seniors.75

Developing and Enhancing Our Food Systems

While the U.S. food system remains signifi-cantly consolidated and centralized, the situa-

Initiatives designed to

increase the availability

of and access to healthy

foods can result in better eat-

ing habits: studies have shown

that there is a positive link

between access to healthy

food and healthy eating

behaviors.62

14

tion has begun to change recently. Consumers’ interest in knowing more about how their food is produced and where it comes from has steadily increased over the past decade.79,92 Demand for organically and locally grown products continues to grow.92 The number of farmers’ markets na-tionally and annual receipts at those markets have increased.92 These are positive indications that all players in the food system, as well as consumers and communities, are envisioning and creating a more diverse system. Increases in direct-to-con-sumer sales by farming operations are a sign of the demand for products produced locally. Gov-ernment agencies and institutions such as schools and hospitals have likewise increased their pur-chases of locally sourced products. Regional food systems must be reinvigorated to better meet the rising demand for organic and/or locally grown foods and to provide markets large enough for farming operations to be economically viable.

2008 Farm Bill Programs Affecting Food Systems

The 2008 Farm Bill incorporated programs designed to help address gaps in community healthy food access and provide needed eco-nomic opportunities in urban as well as rural communities.

� Rural Development Programs—The Farm Bill’s rural development programs help im-

prove the economic well-being of rural com-munities. Title VI of the 2008 law included support for locally produced agricultural food products and grants to enhance employment opportunities for disabled individuals in rural areas.47 In addition, the title contained several provisions that promote rural public health, such as telemedicine and water/waste disposal programs. It also reauthorized programs to assist the development of broadband Internet access and telecommunication in rural areas. Taken together, these provisions are designed to help strengthen the infrastructure in rural communities and support the creation and ex-pansion of local and regional food systems.

� Research Programs—Title VII of the 2008 Farm Bill contained important agricultural research provisions that reorganized the man-agement and conduct of agricultural research. While individually these provisions support programs and initiatives across many titles of the Farm Bill, collectively they support the advancement of our understanding about ag-riculture and food and how they affect people and the communities where they live. Specifi-cally, the legislation created the National In-stitute of Food and Agriculture (NIFA), a new USDA entity replacing the Cooperative State Research, Education, and Extension Service (CSREES), which was responsible for manag-ing extramural research. NIFA was envisioned as an independent, scientific, research-based agency for the food and agricultural sciences based on the competitive research model of the National Institutes of Health. Title VII also funded a specialty crop research and extension initiative and grants to research the safety of fresh produce.47 Moreover, the legislation sup-ports human nutrition research centers, which were established through the 1977 Farm Bill to provide the primary evidence base used to form and revise the USDA Dietary Guidelines.

A food system that includes the necessary infrastructure for small- and mid-sized farmers to process and market their products economi-cally will provide the missing link between our current system of large agribusiness operations and small direct-to-consumer farms.95 Rebuild-ing regional food system infrastructures will also create jobs, improve local tax bases, and create further economic opportunities. Supporting small- and mid-sized farmers and encourag-ing and supporting the development of regional food systems is important in making long-term impacts on health.95

A food system that includes the necessary infrastructure for small- and

mid-sized farmers to process and market their products economi-

cally will provide the missing link between our current system of large

agribusiness operations and small direct-to-consumer farms.95 Rebuilding re-

gional food system infrastructures will also create jobs, improve local tax bases,

and create further economic opportunities.

15

Fostering Sustainable Food Systems

The food system in the U.S.—defined broadly as growers, processors, manufactures, distributors, and retailers—remains, despite recent improvements, significantly central-ized and consolidated. The methods used in each of these sectors carry with them human health and environmental impacts. And while there are increased efforts to reduce the envi-ronmental impacts of food production, more work remains to be done to create a more sustainable food system that limits negative environmental health impacts. This section identifies some of the health and environmen-tal impacts associated with our current food system and highlights 2008 Farm Bill pro-grams and initiatives to address these impacts.

Health and Environmental Impacts of Our Food System

The consolidation of the food system has led to the participation of increasingly smaller numbers of food producers and processors in all segments of the system. For example, the market share of the four largest fluid milk manufacturers doubled between 1997 and 2002, from 21% to 43%.76 One company controls about 40% of the nation’s fluid milk supply.77 Similarly, the market share for beef and pork processing operations has become more consoli-dated, with fewer processors controlling a higher share of the market.78,79 Although the U.S. food system is viewed as the most productive in the world, the methods used in producing, process-ing, and manufacturing our foods can result in significant adverse human health and environ-mental impacts. A number of these impacts are summarized below.

� Food Safety—The highly centralized and industrialized nature of our food system has contributed to the occurrence of large-scale foodborne illness outbreaks. Centralization of processes may make it easier to detect where there is contamination; however, if hazard control practices are not implemented and rigorous inspections are not conducted regu-larly, when contamination does occur, it can rapidly spread throughout the food system within a matter of days. National outbreaks of foodborne diseases in recent years have repeatedly demonstrated how vulnerable the system is to spreading foodborne disease. Each year foodborne contaminants cause an average of 3,000 deaths, 127,000 hospitaliza-

tions, and 48 million illnesses and cost billions of dollars.81 Reliance on a highly centralized food system likewise puts the U.S. food sup-ply at greater risk of intentional acts of con-tamination. Importantly, while smaller, more localized regional food systems offer com-munity and health benefits, they pose unique challenges with respect to balancing safety and business viability.

� Monoculture Agriculture—A significant im-pact of federal commodity subsidies has been their encouragement of large-scale planting of a single or limited number of species of a crop over wide areas. Large corporate food buyers have the ability to alter the types and amounts of food grown through their procurement practices.49,82 Monoculture agriculture is also seen as an efficient way to reap large harvests with minimal labor. While efficient from a la-bor standpoint, reliance on a single or limited number of species grown year after year can be costly in terms of pesticide and fertilizer usage, which can contaminate drinking water and air quality and impact the health of local communities.103 For example, Rivers in the Northeastern U.S. have nitrogren levels 10-15 time higher than they were at the beginning of the 20th Century.104 Reliance on growing a limited scope of species of plants and ani-mals also leads to increased disease suscepti-

Keeping large numbers of animals together results in amounts

of waste that exceed the land’s capacity to absorb and process

effectively.83 Waste lagoons and other practices to retain the waste

on site vary in their effectiveness, sometimes subjecting fields, groundwater,

and surface water to contamination.84

16

bility and a loss of biodiversity over time.105 In addition to reducing the variety of crops grown, commodity programs can increase and concentrate the environmental impacts of farming.103 However, some commodity pro-grams require compliance with conservation measures to reduce environmental and health impacts. These programs provide an impor-tant balance in our food production system to protect the public’s health and are important to maintain. Shifting to more diversified crop production will further support human and environmental health and may create addi-tional jobs.

� Confined Animal Feedlot Operations—Con-fined animal feedlot operations (CAFOs) are a significant example of the health and environ-mental impacts of highly centralized agricul-tural practices. CAFOs are used by livestock producers to raise or finish growing livestock prior to slaughter. Keeping such large num-bers of animals together results in amounts of waste that exceed the land’s capacity to absorb and process effectively.83 Waste lagoons and other practices to retain the waste on site vary in their effectiveness, sometimes subjecting fields, groundwater, and surface water to con-tamination.84 Such contamination has been linked in some instances to nationwide disease outbreaks. For example, dairy feedlots were implicated as a source of one of the largest waterborne disease outbreaks in the United States. Over 400,000 residents of Milwaukee, Wisconsin became ill and more than 50 died as a result of cryptosporidium contamination of their drinking water in 1993.104 CAFOs are also sources of air pollution, releasing am-monia, hydrogen sulfide, carbon dioxide, and particulates. Recent studies have tied CAFOs to increased rates of respiratory disease and asthma among workers and neighbors, includ-ing young children.78

� Overuse of Antibiotics—Another common practice among CAFOs and other large ani-mal feeding operations is the use of antibiot-ics to both reduce diseases and promote rapid growth. Recent reports indicate that most an-tibiotics used in the U.S. are fed to animals in feedstock.85 Overuse and subtherapeutic use of antibiotics can lead to antibiotic resistance in animals and humans. The World Health Orga-nization (WHO) and the U.S. Food and Drug Administration (FDA) have both called for phasing out the use of antimicrobial growth stimulants for livestock and fish production in order to preserve therapeutic uses for human and veterinary care.45,86–88 In January 2012, the FDA announced its intent to prohibit the use of one family of antibiotics, cephalosporins, in animals.89

� Air Quality, Climate Change, and Energy—Highly centralized agricultural practices allow crops to be harvested long distances from where they are stored, processed, and retailed. Transporting food from farm to table under a highly centralized, industrialized system involves using fossil fuels to manufacture and transport fertilizer and pesticides and move crops from farms to processors to retailers.45 This not only consumes nonrenewable energy but contributes to air pollution and climate change. Small and mid-sized farming opera-tions, when linked with local and regional markets, can make important contributions to promoting clean energy and mitigating climate change.90 Farms that use sustainable agriculture practices can contribute by using renewable energy sources such as on-farm windmills and bioenergy from crop wastes to fuel their operations and by growing food without the use of fossil fuel–based pesticides and fertilizers.90

Recent reports indicate that most antibiotics used in the U.S. are fed to animals in feedstock.85 Overuse

and subtherapeutic use of antibiotics can lead to antibiotic resistance in animals and humans. The World

Health Organization (WHO) and the U.S. Food and Drug Administration (FDA) have both called for phasing

out the use of antimicrobial growth stimulants for livestock and fish production in order to preserve

therapeutic uses for human and veterinary care.45,86–88

17

2008 Farm Bill Programs Addressing Health and Environmental Impacts of Food Production

Title II of the 2008 Farm Bill addresses con-servation programs. The USDA administers two types of conservation programs that seek to im-prove and manage the environmental impacts of farming operations: land retirement and easement programs and working lands programs. Land retirement and easement programs take land out of crop production and provide rent payments and cost-sharing assistance to land owners to convert the land back into forests, grasslands, or wetlands and achieve longer term conservation.47 Working lands programs provide technical and financial assistance to farmers to improve land management practices.47 These programs prevent land from being overused and depleted, which can result in an overreliance on fertilizers and pesticides to maintain production. The use of fertilizers and pesticides directly affects the health of farm workers during application and can lead to contamination of community watersheds and drinking water sources.91 Conservation programs are important for the long-term sustainability of agricultural lands and the health of their sur-rounding communities.

Creating a Farm Bill for Public Health

The Farm Bill affects important agriculture, health, economic, environment, and social poli-cies both domestically and globally. Public health professionals, cannot ignore or underestimate the important role that Farm Bill policies can play in combating growing chronic disease burdens; increasing demand for and access to nutritious, affordable foods; and reducing the environmental health harms associated with the conventional food system.

Policies and programs governed by the Farm Bill have evolved and expanded over time, with a variety of approaches now being used to support rural economies, farmers, and consumers in all types of communities and to ensure a safe, af-fordable, and plentiful food supply. These policies and programs encompass a range of issues related to the public’s health, including food assistance and distribution, nutrition education, commod-ity programs, food safety inspections, trade and foreign aid, conservation, organic agriculture, horticulture, energy, and research. Collectively, the Farm Bill programs impact the types of crops grown, energy consumed, waste generated, labor

needed, and chemicals used to produce our food, all factors that ultimately affect the public’s health. More recently, the focus of the Farm Bill has been to ensure consumers have access to nu-tritious, affordable foods, grown locally in a safe and sustainable manner.

Challenges for 2012

This document examined four key ways in which the Farm Bill can improve the public’s health and how the programs represented in the bill can be further improved. While many public health gains were incorporated into the 2008 Farm Bill, many new and ongoing challenges remain as the nation develops the 2012 Farm Bill. Key among these is the tight budgetary constraints in which the 2012 bill will be crafted that limits the government’s ability to expand funding for promising programs. Nonetheless, the 2012 Farm Bill is an opportunity to support a healthier, more sustainable food system for the U.S. and improve the nation’s public health and communities in the process:

� Providing Food and Nutrition Assis-tance—The Farm Bill is foremost a nutrition bill; nutrition assistance programs comprise 65% of the Bill’s funding. It authorizes and funds a number of key food assistance and nutrition support programs, including SNAP (formerly the food stamp program), for the

APHA POLICIES RELATED TO FARM BILL ISSUES

APHA’s member-developed policy statement and positions on

the important health, environmental, and community justice issues

affected by U.S. agricultural policies are the foundation for the

association’s work on food policy and Farm Bill issues. Key policies include:

• Toward a Healthy, Sustainable Food System (2007)

• Reducing Nutrition-Related Disparities in America Through Food Stamp

Nutrition Education and the Reauthorization of the Farm Bill (2006)

• Addressing Obesity and Health Disparities Through Federal Nutrition and

Agriculture Policy (2007)

• Child Health Policy for the United States (2010)

These and other policies can be accessed through APHA’s website at

www.APHA.org.

18

most vulnerable Americans. These programs are a vital component of the nation’s safety net for vulnerable individuals, and with the U.S. economic downturn, the need for food assis-tance programs is clear and continuing. SNAP and other federal food programs represent the most significant policy mechanisms to main-tain and enhance public health. The scope of the Nutrition title also represents an oppor-tunity to drive agriculture policy. The Farm Bill plays an important role in ensuring that individuals, schools, and other institutions have access to nutritious, affordable foods, as well as enhancing local producers’ ability to produce, promote, and market nutritious food. Fed-eral food assistance programs such as SNAP, TEFAP, and the Senior Farmers’ Market Nu-trition Program have reduced food insecurity even during economic hardships and have provided economic incentives to local com-munities and agriculture producers.

� Producing Healthy, Affordable Foods—Federal farm policies reflected in the Farm Bill directly and indirectly influence the availabil-ity and affordability of crops grown and food produced in this country. Historic agricul-tural policy preferences for certain commod-ity crops have shifted the nation’s agriculture output, affected the types of foods being produced, and ultimately altered the Ameri-can diet. Federal farm subsidies have evolved over time to create a safety net for producers that includes income support through direct payments, price supports, crop insurance, conservation and acreage limitations, govern-ment purchases and distribution of foods, and support for market promotion, both domesti-cally and internationally. These risk-reduction programs play a crucial role, particularly for small and mid-sized farms that supply local communities and regional markets. Congress may consider reducing or eliminating direct payments to commodity farmers and replac-ing them with crop insurance programs in the 2012 Farm Bill. With a shift to crop insurance as the primary tool for commodity farmers, it will be especially important to ensure that fruit and vegetable producers also have ad-equate coverage, since crop insurance is their primary federally subsidized risk management tool. The Farm Bill offers an opportunity to further improve nutrition and reduce obesity through increased production of healthy and affordable foods for all communities.

� Increasing Access to Healthy Foods—Agriculture and food policies developed over the years through successive Farm Bills have not only affected what we eat and how we produce our food but also directly and in-directly influenced how we access our food in urban, suburban, and rural communities alike. The 2008 Farm Bill increased access to healthy foods for children through govern-ment purchases of fruits, vegetables, and other healthy foods for use in school meal and snack programs and commodity distribution programs. The 2008 Farm Bill also contained several critical measures to begin remaking the food system by supporting local and regional farmers through farmers’ markets, and pro-curements for schools and other institutions year round. These programs are in their early stages and their value to local economies and on the public’s health will become clear over time. Adequate technical assistance for small and mid-sized farmers is essential to ensur-ing that product safety is not compromised in production or processing and that addition of fat, sugar, and sodium to processed foods is minimal. Attention to food deserts through support of the Healthy Food Financing Initia-tive or other strategies to encourage new and improved grocery stores in urban and rural areas is a promising avenue for improving the access to healthy food in underserved com-munities. Programs focusing on rural devel-opment and research help to address gaps in community health food access and provide needed economic opportunities.

� Fostering Sustainable Food Systems—While there are growing efforts to make healthier foods more readily available and to reduce environmental impacts related to their production, there remains a need to make a more diverse variety of healthy foods avail-able in all communities and to create a more sustainable food system. The 2008 Farm Bill contained important conservation programs that help minimize negative environmental health impacts from farming, and improve the long-term sustainability of agricultural lands and the health of their surrounding commu-nities. Continued support of organic agricul-ture approaches that use fewer pesticides and chemicals will advance public health.

Adequate techni-

cal assistance for

small and mid-sized

farmers is essential to ensur-

ing that product safety is not

compromised in production or

processing and that addition of

fat, sugar, and sodium to pro-

cessed foods is minimal. Atten-

tion to food deserts through

support of the Healthy Food

Financing Initiative or other

strategies to encourage new

and improved grocery stores

in urban and rural areas is a

promising avenue for improving

the access to healthy food in

underserved communities.

19

Notes and References

1. Pub L No. 110-234.

2. Cain Z, Lovejoy S. History and outlook for Farm Bill conservation programs. Choices. 2004;19(4):37–42.

3. Yowell E, Estrow FG. Farm Bill 1.01. Available at: http://foodsystemsnyc.org/node/1854. Accessed April 20, 2012.

4. Roth D. Food stamps, 1932–1977: from provisional and pilot programs to permanent policy. Available at: http://www.nal.usda.gov/ric/ricpubs/foodstamps.htm. Accessed April 20, 2012.

5. U.S. Department of Agriculture. A short history of SNAP. Available at: http://www.fns.usda.gov/snap/rules/Legislation/about.htm. Accessed April 20, 2012.

6. Food Stamp Act of 1964, Pub L No. 88-525, 78 Stat 703–709 (1964).

7. In Agriculture: A Glossary of Terms, Programs, and Laws (http://cnie.org/NLE/CRSreports/05jun/97-905.pdf), the Congressional Research Service noted that “[b]eginning in 1973, farm bills have included titles on commodity programs, trade, rural development, farm credit, conservation, agricultural research, food and nutrition programs, marketing, etc. These are referred to as omnibus farm bills. The following is a generally agreed chronological list of farm bills: (1) Food and CRS-96 Agriculture Act of 1965, P.L. 89-321; (2) Agricultural Act of 1970, P.L. 91-524; (3) Agriculture and Consumer Protection Act of 1973, P.L. 93-86; (4) Food and Agriculture Act of 1977, P.L. 95-113; (5) Agriculture and Food Act of 1981, P.L. 97-98; (6) Food Security Act of 1985, P.L. 99-198; (7) Food, Agriculture, Conservation, and Trade Act of 1990, P.L. 101-624; (8) Federal Agriculture Improvement and Reform Act of 1996, P.L. 104-127; (9) Farm Security and Rural Investment Act of 2002, P.L. 107-171.” The most recent version of the Farm Bill adopted was the Food, Conservation, and Energy Act of 2008 (Pub L No. 110-234).

8. Johnson R, Becker GS, Capehart T, et al. The 2008 Farm Bill: Major Provisions and Legislative Action. CRS report for Congress. Washington, DC: Congressional Research Service; 2008.

9. Monke J, Johnson R. Actual Farm Bill spending and cost estimates. Available at: http://www.nationa-laglawcenter.org/assets/crs/R41195.pdf. Accessed April 20, 2012.

10. U.S. Department of Agriculture, Economic Research Service. Does SNAP decrease food insecurity? Available at: http://www.ers.usda.gov/publications/err85/. Accessed April 20, 2012.

11. Monke J. Previewing the next Farm Bill: unfunded and early-expiring provisions. Available at: http://www.nationalaglawcenter.org/assets/crs/R41433.pdf. Accessed April 20, 2012.

12. Feeding America. Child food insecurity: the eco-nomic impact on our nation. Available at: http://feedingamerica.org/SiteFiles/child-economy-study.pdf. Accessed April 20, 2012.

13. Seligman HK, Bindman AB, Vittinghoff AM, et al. Food insecurity is associated with diabetes mellitus: results from the National Health Examination and Nutrition Examination Survey (NHANES) 1999-2002. Journal of General Internal Medicine. 2007;22(7):1018-23.

14. Feeding America. The potential consequences of food insecurity regarding physical and mental health. Available at: http://feedingamerica.org/hunger-in-america/impact-of-hunger/physical-and-mental-health.aspx. Accessed April 20, 2012.

15. U.S. Department of Agriculture. Food security. Avail-able at: http://www.fns.usda.gov/fsec/. Accessed April 20, 2012.

16. U.S. Department of Agriculture, Economic Research Service. Food security in the United States: key statistics and graphics. Available at: http://www.ers.usda.gov/Briefing/FoodSecurity/stats_graphs.htm. Accessed April 20, 2012.

17. Hunger and Obesity? Making the Connection. Working document. Washington, DC: Food Research and Ac-tion Center; 2010.

18. U.S. Department of Agriculture, Economic Research Service. Household food security in the United States in 2010. Available at: http://www.ers.usda.gov/Publications/ERR125/ERR125.pdf. Accessed April 20, 2012.

19. U.S. Department of Agriculture, Food and Nutri-tion Service. USDA announces efforts to increase nutrition assistance to low-income families. Avail-able at: http://www.fns.usda.gov/cga/pressreleas-es/2011/0154.htm. Accessed April 20, 2012.

20. Richardson J. Domestic Food Assistance: The Farm Bill and Other Legislation in the 110th Congress. CRS report for Congress. Washington, DC: Congressional Research Service; 2008.

21. U.S. Department of Agriculture, Food and Nutrition Service. WIC food packages. Available at: http://www.fns.usda.gov/wic/benefitsandservices/foodpkg.htm. Accessed April 20, 2012.

22. The Food Assistance Landscape: FY 2010 Annual Re-port. Economic information bulletin 6-8. Washing-ton, DC: U.S. Department of Agriculture; 2011.

23. Note that the $95 billion figure represents total USDA funding on food and nutrition assistance programs, not just on those programs contained in the Farm Bill. See Note 22.

24. For the legislative history of SNAP/food stamps, see http://www.fns.usda.gov/snap/rules/Legislation/about.htm. Accessed April 20, 2012

25. U.S. Department of Agriculture, Food and Nutrition Service. Supplemental Nutrition Assistance Program participation and costs. (data as of April 2, 2012). Available at: http://www.fns.usda.gov/pd/SNAP-summary.htm. Accessed April 20, 2012.

26. U.S. Department of Agriculture, Food and Nutrition Service. Trends in Supplemental Nutrition Assistance Program participation rates: fiscal years 2002–2009. Available at: http://www.fns.usda.gov/ora/menu/Published/snap/FILES/Participation/Trends2002-09Sum.pdf. Accessed April 20, 2012.

27. U.S. Department of Agriculture, Food and Nutrition Service. Characteristics of Supplemental Nutrition Assistance Program households: fiscal year 2009 summary. Available at: http://www.fns.usda.gov/ora/menu/published/snap/FILES/Participation/2009CharacteristicsSummary.pdf. Accessed April 20, 2012.

28. U.S. Department of Agriculture. Supplemental Nutrition Assistance Program: eligible food items. Available at: http://www.fns.usda.gov/snap/retailers/eligible.htm. Accessed April 20, 2012.

29. U.S. Department of Agriculture, Food and Nutrition Service. Supplemental Nutrition Assistance Program community partner outreach toolkit. Available at: http://www.fns.usda.gov/snap/outreach/tool-kits/2011/basics.html. Accessed April 20, 2012.

30. Yale Rudd Center for Food Policy & Obesity. Restrictions on use of SNAP benefits. Available at: http://www.yaleruddcenter.org/legislation/bill.aspx?i=34&s=11. Accessed April 20, 2012.

31. Yale Rudd Center for Food Policy & Obesity. Purchase of certain foods prohibited under SNAP. Available at: http://www.yaleruddcenter.org/resources/upload/docs/what/policy/legislation/

The Farm Bill plays an important role in ensuring that individuals, schools, and other institutions have

access to nutritious, affordable foods, as well as enhancing local producers’ ability to produce, promote,

and market nutritious food. Federal food assistance programs such as SNAP, TEFAP, and the Senior

Farmers’ Market Nutrition Program have reduced food insecurity even during economic hardships and have

provided economic incentives to local communities and agriculture producers.

20

TX_HB_1151_Relating_to_purchase_of_certain_food_under_SNAP_Feb_8_2011.pdf. Accessed April 20, 2012.

32. Yale Rudd Center for Food Policy & Obesity. Allowing states to create lists of eligible foods. Avail-able at: http://www.yaleruddcenter.org/resources/upload/docs/what/policy/legislation/VT_JRH_13_Allow_states_to_create_list_of_eligible_foods_for_SNAP_Olsen_Feb_2011.pdf. Accessed April 20, 2012.

33. U.S. Department of Agriculture, Food and Nutrition Service. Implications of restricting the use of food stamp benefits: summary. Available at: http://www.fns.usda.gov/ora/menu/Published/snap/FILES/Pro-gramOperations/FSPFoodRestrictions.pdf. Accessed April 20, 2012.

34. Hartocollis A. New York asks to bar use of food stamps to buy sodas. New York Times. Avail-able at: http://www.nytimes.com/2010/10/07/nyregion/07stamps.html. Accessed April 20, 2012.

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40. U.S. Department of Agriculture, Food and Nutri-tion Service. “USDA selects Massachusetts to test ground-breaking nutrition pilot program: SNAP recipients to receive incentives for healthy eating. Available at: http://www.fns.usda.gov/cga/PressRe-leases/2010/0413.htm. Accessed April 20, 2012.

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48. Federal regulations (7 CFR 1412.3) define the commodity crops covered under federal subsidy pro-grams administered by the U.S. Commodity Credit Corporation: “Covered commodity means wheat, corn, grain sorghum, barley, oats, upland cotton, long grain rice, medium grain rice, soybeans, sunflower seed, rapeseed, canola, safflower, flaxseed, mustard seed, crambe, sesame seed, pulse crops, and other oilseeds as determined by the Secretary.”

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21

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APHA would like to thank the following reviewers for their time and insights: Caroline Fichtenberg, PhD; Don Hoppert; Rebecca Klein, MS, Ronnie Neff, PhD, MS; Geri Henchy, MPH, RD; Anne Haddix, PhD; Nancy Chapman, MPH, RD; and Noel Chavez, PhD, RD, LDN