What Would It Take for All Americans to Have Access to Healthy Foods?
The American diet can be deadly—but there are ways to dramatically improve it.
Unhealthy diets are a scourge on American health, .
The source of the problem is well-known: overconsumption of salt, sugar, fats, and ultra-processed foods, that drive deadly diet-related illnesses like heart disease, cancer, and type 2 diabetes.
Healthy diets—high in fruits, vegetables, and fiber, and low in trans and saturated fat, red meats, and ultra-processed foods— of death and disease .
While getting healthy foods to all Americans is one of the countryʼs greatest public health challenges, experts say that community-driven solutions that can dramatically improve Americansʼ diets and, in turn, their health, already exist.
They can take the form of urban corner stores stocked with affordable produce from regional farms. Or families swiping an EBT card at a farmerʼs market—and getting money back to buy more healthy produce. Children could be given multiple chances to eat nutritious meals at school. Doctors could be empowered to prescribe healthy foods for health conditions.
Deploying the Purchasing Power of Cities
Increasingly, cities are using their massive purchasing power to get healthier foods to the public and reduce reliance on larger food corporations that control production, processing, distribution, marketing, and where food products are placed in stores.
Around 80% of the U.S. population lives in urban areas, and cities are some of the biggest food purchasers in the country, supplying food for schools, senior centers, day cares, sports programs, and more. “More and more cities are developing comprehensive plans that are specifically focused on food” and designed around core values, not profits, says Yeeli Mui, PhD ’17, MPH, a Bloomberg Assistant Professor of American Health in International Health.
Consider the , which has been adopted in over a dozen U.S. cities including Los Angeles, Buffalo, Chicago, and New York. Communities that sign on to the program redirect their buying power to prioritize five core values: health, local economies, environmental sustainability, a valued workforce, and animal welfare.
These programs boost local economies by sourcing from local and regional farmers, suppliers that use environmentally sustainable practices, or greenhouse gas emissions, practice fair and safe labor policies, and support animal welfare, says Mui.
“Itʼs creating a blueprint for how a city, county, or even region, is going to invest in its local food system infrastructure to be able to provide nutritious foods for all of its people.”
Another way communities are advocating for healthier diets is . These groups bring together local food leaders—such as government officials, farmers, industry groups, schools, restaurants, faith groups, and more—to influence or advocate for local food policy. For example, in the early months of the COVID pandemic, they were instrumental in connecting food resources to people in need, says Mui. “Twenty years ago there were about 100 of these across the U.S., but they've really gained a lot of attention and popularity. And now there are over 300.”
Making Healthy Choices Accessible
Federal nutrition benefits can be used to help Americans shop for healthier foods. Several jurisdictions have adopted incentive programs through the Supplemental Nutrition Assistance Program (SNAP), the federal program that supplements grocery budgets for low-income families. They “make SNAP dollars go further by matching every dollar spent on fruit and vegetables with another extra dollar for fruits and vegetables,” says Sonia Angell, MD, DTMH, MPH, distinguished professor of the practice in Epidemiology.
One went further by incorporating this incentive into EBT, the debit card-like system that beneficiaries can use to pay for food. Participants could earn up to $60 per month in fruit and vegetable supplemental benefits directly onto their EBT cards. From February 2023 through April 2024, the program provided $10.5 million in supplemental benefits to 93,000 households across the state.
Embracing Food as Medicine
Prescribing healthy foods is gaining momentum as part of care plans for specific medical conditions, says Angell. “A care delivery system could decide that it makes sense because it decreases readmission.”
This could mean prescribing fruits and vegetables to be sent to patientsʼ homes, or giving whole families specific foods that they should be eating for their specific medical conditions. For example, “a person with heart failure could be receiving pre-prepared, lower-sodium meals every night for dinner for three weeks after they get discharged from the hospital to decrease the likelihood that they'll hold water and then end up with heart failure again,” says Angell. “On the other end of the spectrum, you'll see programs that send people coupon vouchers for fruits and vegetables and foods, to be able to go to the grocery store and spend it any way they like.”
One gave families of pediatric patients experiencing food insecurity a prescription for fruits and vegetables in the form of a Produce Rx card that can be used at any participating farmers market to purchase locally grown fresh produce.
Making Schools Hubs of Nutrition
Schools can play an instrumental role in helping kids and their families access healthy meals.
In California, improving nutrition access was integral to a $4.1 billion investment in expanding full-service community schools, which offer wraparound services beyond academics to help students thrive. , MPH ’24, MA, director at Bay Area Community Resources, and Erin Hager, PhD ’08, associate professor in Population, Family and Reproductive Health, developed recommendations for implementing policies including “second chance” breakfast programs that offer mid-morning meals, backpack programs that discreetly provide nutritious food for students to take home, and onsite enrollment for federal food benefits.
Combating Food Deserts
Some Americans—about 6% of the population—live in areas where residents have limited access to affordable, healthy food options. Zoning policy can play a key role in filling these nutrition gaps, says Mui.
Washington, D.C. and other cities have expanded . In Arkansas, where all 75 counties have at least one food desert, helped fund mobile market pop-up shops in underserved areas, seed swap programs, and community gardens.
In communities across the country, aims to foster food policies that promote access to nutrition and support local agriculture—including in rural areas, where distance from food resources is a key barrier to access and requires a different approach than cities battling a glut of unhealthy food options. “It means creating places where people can come and pick up a diversity of fruits and vegetables, and programs that are also designed to help deliver to people who don't have the means to get there,” says Angell. “It's a lot more about community networking and creating mutual reliance on networks of people than there is in urban areas.”
Scaling Up What Works
When it comes to prioritizing local foods and economies, making these solutions work may require a shift in expectations of what foods are available, and when. Currently, fresh foods travel 1,500 miles, on average, to reach our plates.
“Often we're not fully aware of what the true cost of that is to our health and future generations. It's about making that more visible to generate a cultural shift,” says Mui. “Maybe we don't need to have everything [available] 365 days of the year.”
During an East Coast winter, eating more seasonally could mean foregoing strawberries and opting for locally grown, in-season pears instead. On the West Coast, it could mean nixing out-of-season root vegetables and enjoying peak-season citrus. These cultural shifts require both individual choices, and policies that make them accessible and affordable.
While efforts to tackle the barriers to good nutrition often start local, effective interventions can be scaled and adapted to different communities—and possibly grow into national policy, says Angell.
One example: calorie labels on chain restaurant menus. “That happened in New York City. Other cities started to look at it. They thought it was cool, and started to do it. The federal government saw it, , and now it's available all over the U.S., because it was put into law.”
Annalies Winny is a senior writer in the Office of External Affairs at the Johns ѻý.
