Across the country, many populations suffer malnutrition and its associated health complications that result from poor access to nutritious foods. According to the USDA, food deserts, or “low-access communities,” are defined as places where at least 500 people or 33% of the population lives more than one mile (urban areas) or more than ten miles (rural areas) from the nearest food market.

“Our goal is ambitious. It’s to eliminate food deserts in America completely in seven years,” First Lady Michelle Obama proclaimed in 2011 as a part of her Let’s Move campaign.

There have been innovative and interdepartamental approaches from the national level, down to the local level, to tackle this issue of access. The Baltimore Food Policy Initiative (BFPI) was founded in 2010 to “improve health outcomes by increasing access to healthy affordable food in Baltimore City’s food deserts.” Hippocrates Medical Review spoke with Baltimore’s first Food Policy Director Holly Freishtat to further understand the development of BFPI, amidst the backdrop of a nationwide issue.

The Baltimore Food Policy Initiative tries to tackle a very large problem and approach a very large goal from many perspectives. So what have been the biggest challenges in reforms and implementations?

HOLLY FREISHTAT: The Baltimore Food Policy Initiative, in collaboration with the Center for a Livable Future, has been doing extensive food environment mapping, so that we have a much clearer understanding of the concentration of poverty and where the food access barriers are. That also leads us to what to look at for opportunities for improvement. So one of the strengths we have is that we have food environment mapping.

We have a city-specific food environment–food desert–definition and a city-specific map. However, of the 4 points of the food desert definition, many of them, we cannot control. The Baltimore Food Policy Initiative cannot control the economy. It cannot control many of the factors that causes food deserts in the city. So that is the greatest challenge. We can show great success, but we can’t control many of the factors with the food environment map. And so if the economy drops out or tanks, grocery stores are probably not opening around the country. So even though we have some great strategies, it depends on many factors that we have no control over.

Since the economic challenge is so great, how does the organization try to, not combat it, but at least work around it?

FREISHTAT: So the way that we address it is that there is no single solution–there is a multi-pronged approach. The Baltimore Food Policy Initiative is interdepartmental cooperation. The Baltimore Development Corporation has a food and retailer economics development officer who is responsible for all attraction and retention of grocery stores in the city. So the way we address this is that we have multiple agencies working on the same issues, at different angles. And then we have the Baltimore City Health Department spot the market for our plan, tracing other cities from community-based food access programming. And then we have an Office of Sustainability looking at it from a food resiliency and planning angle, incorporating, food into the planning process, and with the Department of Planning, we’re looking at the policy and research perspective in how to address it. We are also working with over 12 other agencies in the city.  We’re going to asset map where they address food issues, and then we’re working with them to support their goals.

With the BFPI’s work with SNAP benefits, tax incentives, etc–What are the biggest successes, in terms of legislations and changes in communities, that you have seen?

FREISHTAT: So there are a couple. One, I would say, is the very extensive Food Environment Map and Report. So, understanding the needs. Two, is on food access–the personal property tax credits. What’s really innovative in there is that it’s setting the framework for food desert incentive areas. It allows us to provide the framework so now we can do other policy in the future, whether it’s with corner stores or other things that is using the food desert incentive. So we were able to translate the research from the food environment map and incorporate it into policy. I would say another big one has to do with SNAP, working with the state to change [the issuance period for] SNAP from 10 days to 20 days was a huge deal. That has a huge impact for retailers, and also for residents. So the third big one, which I think is huge, is online SNAP benefits that was incorporated with Baltimarket. Baltimore City was a prototype of how to implement the online SNAP benefit. We had to work around the federal policy barrier. So we were integral in incorporating it into the 2014 Farm Bill, and now Maryland is one of the few pilot states to pilot online SNAP benefits, and the key retailers are Amazon, Safeway, and ShopRite.

Where does BFPI hope to go from here? What are some long-term approaches and reforms you’re hoping for?

FREISHTAT: So here are some things that are on the horizon. So remember, we’re building on what we have, continuing to do what we do and add more. Another area we’re working on is good food procurement. You can go to the website “Center for Good Food Purchasing” and see their prototype. So we’re working on all cities’ procurement contracts, to look at nutrition, quality of the contract, local food production, and equity issues related to food supply. That’s one. We’re moving into another thing that’s coming into the horizon; it’s related to food resilience plans for the city and also city food plans, so that’ll be within the next year.

How is the initiative in Baltimore unique from other food access initiatives across the country?

FREISHTAT: I want to answer that question, but speaking to the work that we do, it’s specifically on how the city government addresses and leverages food access issues to address the economics of environmental disparities. So we’re coming from the city municipality perspective, where there’s growing movement from the grassroots nonprofit sector, The Food Policy Council, and we are working with all organizations and entities in Baltimore collaboratively. There is around 20 other cities in the country that have a food policy advisor or a similar position to myself. So that is one of the movements that we’re seeing, it’s the role cities can play. Food access is just one component of the work we do.

There have been a lot of studies that supermarket interventions don’t solve everything and bridge those gaps in access.  

FREISHTAT: That’s really why we need a multipronged plan. We have our food desert retail strategy and our food resiliency strategy. One of the things that supermarkets do is provide stabilit–economic stability. It also increases job employment. So there’s multiple assets of what supermarkets provide in a community that goes beyond just food. But it can’t be the centerfold and the only approach on what it takes, because there are so many factors that impact whether a store will locate or not locate in one area.

As I further research this issue of food access and malnutrition, what are some nuances I should pay attention to, such as the differences in urban/suburban/rural areas. Are there other determinants that I should pay special attention to?

FREISHTAT: Well, I can just speak to urban areas, because that’s where my expertise lies. And I would say the main difference between food access in cities and rural areas is that in cities such as Baltimore, it’s about where poverty is concentrated. A food environment, a food desert map, is very effective to show priority areas. In rural areas, I would say that food insecurity and hunger is hidden, and it takes course over a wider area. It’s going to be very different to identify the issues when it takes course over a large geographical area.

So how do you take cities like New York, where there’s also this issue of insecurity? Yet, overall, the city is considered wealthy and densely populated, with accessible transportation?

FREISHTAT: New York has great innovations happening in New York City. ____ is the food policy director, and they have a very comprehensive approach for food access. So what I would say is the biggest difference lies between cities. City approach is going to be relatively similar, but very different from rural approach. And I think, also, when you’re just concentrated on food insecurity, there may be the ability to have positions like myself, where in areas where food insecurity is hidden, it may be harder to have a position specifically focusing on rural policy.

Has Baltimore taken or shared ideas with cities across the countries? Are there some ideas that you think would work very well at other cities?

FREISHTAT: So one of the things that we’ve done is the Conference of the Mayors establish a food policy task force, with mayors and food policy advisors convening regularly to share best practices and innovations among cities. And so we address issues from urban agriculture to healthy corner stores, from fresh food financing initiative to food employment–to a multitude of issues. In addition to that, Baltimore was one of the ____ food policy chapter from last year, and we’re convening on the food policy advisor, who wants to share best practices based on subject area.

Thank you so much for your insight.

FREISHTAT: Thanks, I’m glad we had a chance to talk.

Posted by Olivia Chan

Olivia is a freshman pursuing a major in Public Health and minors in Social Policy and History. As a member of the Domestic Health team, her work focuses on policy and inequity, and explores the various ways political decisions affect disparities in care. Outside of HMR, Olivia is currently doing research on refugee care and health systems in politically unstable nations. She is also a brother in Alphi Phi Omega, volunteers with JHU LEAD, and works at the Alan Chesney Medical Archives at Johns Hopkins. In the future, she hopes to continue her work with community organizing and service by promoting health equity for underserved and international populations.

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