I'm Alice Ammerman, I'm a Professor in the Department of Nutrition in the Gillings School of Global Public Health here at UNC. I also direct a Center for Health Promotion and Disease Prevention, which is a CDC Prevention Research Center. And today I'm going to talk about the area that I spend a lot of time thinking about and researching, which is how to get enough healthy food to the people who need it most. So, this involves both the agricultural production distribution side, as well as the food consumer side of things. Okay. So the problem that I'm going to talk about today is how do we get enough good, healthy food to people who need it to maintain good health? And this involves both understanding how the production system works, and then how the consumer side does. So, if you think about it globally and we worry a lot about hunger and that kind of thing, it actually boils down to more of an issue of poverty and access than it does food scarcity. There's really enough food available even more than enough, but it doesn't get to the right people. And those who suffer the most from chronic disease and other things tend to be the ones who get the least access, especially to the healthier options. So, our current food system has become very industrialized. So that we, it makes really easy access to poor quality food that's very cheap to produce but then it makes it harder to get the good quality sort of food. So that's the conundrum that we have. And then we have this unusual paradox of the blending of hunger and obesity. So, hunger is no longer just a gnawing kind of feeling in your stomach but it's, it's tied in with what we'll talk about in a minute with food secure, insecurity. Which is where you don't know when your next, where your next food is coming from so you might eat, you know, whatever you can get your hands on which often is not that healthy. So that can lead to problems with obesity. So with the food production system over the years it's become more industrialized. More focused on production as the main goal rather than protecting the environment or that sort of thing. So very heavily dependent on pesticides and fertilizers which are fossil fuel dependent. So, so that's caused a lot of environmental concerns at the same time. And then it's kind of disrupted our local food systems. Everything is kind of built on a national scale, rather than growing food near where we eat it. So we ship it across the country and package it and ship it back. So, again that's very inefficient, it's not good for the local food system. So, I thought I'd spend a minute on definitions. Since there are a few things that are maybe people are not accustomed to. One is this notion of food insecurity. kind of sounds like a national security issue and in some ways it actually is and that we do need to be able to produce enough food to, to feed our population. But in this case it's really, more this notion, to some extent of hunger. But then it goes beyond that to kind of this notion of where is your food coming from? Can you depend on it to be able to feed your family? That sort of thing. So it, it tends to, to create a situation where people are choosing poor quality food just to be able to kind of fill up. And then food, the notion of a food system. That really involves all the different pieces of the what it takes to keep a population fed. So that includes growing, harvesting, processing, packaging, distributing. Marketing consumption and, and even to disposal of waste, which is often forgotten about when it comes to this. And then, you hear lot about local sustainable food movements. And that idea is really to build more locally viable communities where they're self-reliant on food. And sustainable has kind of taken the place of organic in a lot of ways, because it's more the notion of using sensible practices. Low use of pesticides and fertilizer, but not necessarily everything having to be organic, it's just making it more environmentally sustainable. And then, people have probably heard of the notion of a food desert. We have to be careful not to call it a food dessert, with the extra s in there. And that's the notion of communities that have very limited access to food, often like no grocery stores and just corner stores that have soda, cigarettes and alcohol. And then kind of the opposite of that which is less commonly used is, food swamp. And that's the notion of having excess, low, low value food. So that tends to be a high concentration of fast foods or, liquor stores, or convenience stores. And unfortunately in the lower income communities, that tends to be the, the most accessible kind of food. So, thinking again globally obesity is really starting to replace hunger as a, as an international problem. And it's surprising in many parts of the world that we would not have thought obesity would be an issue, especially in urban areas, and that's even spreading to more rural areas. So, and it's growing over time. We're seeing the dramatic increase in many countries that are less developed as well as, of course, the United States which have very high rates of obesity. All right. So now, we're going to focus on more discrete specific aspects of all of this. And try to break it down so that you can have a sense of where you can focus your ideas and your energy. So we'll break it down to more bite-size pieces. So, the first one would be how can we enhance opportunities for newer farmers, lower resource farmers? We talked about the fact that the average age of the current US farmer is 58. So that means we really need to build opportunities to have some incubator opportunities for smaller, newer farmers to, to join the agricultural system. Currently it's very hard to obtain farmland if it hasn't been passed down through your family. That's the most common way for people to get it. You know, land is becoming increasingly valuable. If it's anywhere close to an urban area, it's getting bought up by developers. So anything we can do to think about how to make farmland accessible will be very helpful. The middle size, mid-size farms are particularly challenged. The, the lower very small scale farms are the actually fastest growing of the farming sizes because they tend to be the ones who are doing well at farmer's market's, kind of the niche farm. But the mid-sized farms need a larger market than that, but they can't really compete with the really big farms that are highly mechanized. So we need to figure out some kind of like larger scale market systems than what a farmer's market would offer. We also need to rebuild aggregation and distribution systems. The local grocery store doesn't want to have 25 pickup trucks coming from all the different farms and they're used to having a huge truck that delivers all the food that they want. And often it's come from halfway across the country. But, so we have to figure out ways that the distribution system can work more efficiently for the smaller farms. and, and many other traditional food retailers just hasn't, haven't really grasped this notion of why it's important to sell local food. Although, that's changing quite a bit. So, that's an opportunity, I think, if you can help them figure out how to make the mechanics of it work. So the next bite-sized piece is kind of extending on what we just talked about with farmer opportunities and that's kind of rebuilding the larger local food infrastructure. Farming is hard work it's not something everybody wants to do but there are probably ways that we can make it easier. Most of our research dollars have gone into building enormous combines and things that have been helpful for the thousand acre corn farms, but more could be done. And with a lot of ingenuity to figure out how to take some of the backbreaking part out of smaller scale farming. because like produce production, fruits and vegetables, tends to be very hand intensive. So, there's a lot of opportunity there. The current food processing and distribution systems are really built on a national scale rather than local. S, if we can kind of rebuild those, and then the nice thing about that is that it offers job opportunities on the community level. One particular area in need of change is and particularly a problem in North Carolina is those people who raise, farmers who raise livestock. That's very hard for them to find a place that the animals can be slaughtered and packaged. I know it sounds a little gory, but that has to happen to get the meat to the table. Many of the slaughterhouses, because of inspection and various other things, they only serve much larger-scale farmers. And so, so some of the smaller farmers have to spend a good chunk of their day just driving the animals to the slaughterhouse. So ways to make that done on a smaller scale are very much needed. Farmers markets are growing in terms of interest and capacity, but they're not terribly available like a grocery store, 24 hour grocery store, they tend to be very limited in time. Part of that's because farmers need to be spending time on the land. So, if there are ways that we can figure out to get locally grown food into the hands of consumers, that aren't strictly dependent on farmers' markets, that, that's another opportunity. And then helping the chain supermarkets figure out how they can source local food. So they don't have the 25 pickup trucks, but they can work with other food distributors and aggregators to, to make the system work more effectively for everybody. So now let's flip to more of the consumer side of things. And again, particularly interested in the lower income consumers who tend to have the highest rates of chronic disease, obesity, and therefore are the biggest cost to the healthcare system. And have so many other challenges that if we can improve their dietary intake, it would go a long way for quality of life and health for them. Currently unfortunately, the cheapest foods tend to be the ones who are, that are least nutritious. You probably heard about all the high fructose corn syrup, which is a way to make use of connecting into agriculture again, you know. A lot of the corn crop that's grown isn't corn on the cob. It's either animal feed or a lot of it is made into high fructose corn syrup which is a, an easy way to add sweeteners. And it's very sustainable shelf-wise, shelf life and so it's used in many, many products. And, of course, sugar-sweetened beverages are a big part of that. We're clearly made the link between sugar-sweetened beverages and obesity as a problem. So so the, and the those kind of foods tend to be most easily accessible and affordable. So that's where a lot of our problems are. Also a lot of families have limited cooking capacity. They have not gone to school and learned about cooking. It's not a priority, they're working two jobs. So, figuring out ways to make cooking easier and more fulfilling and also being able to use healthier ingredients, those are all good things to, to consider. The current marketing systems, like farmers' markets and, and some of the CSAs or Community Supported Agriculture, they have a tendency to support more of the higher-end consumers. It is a nice opportunity for farmers to be able to market their goods. But, there are increasing ideas and opportunities to try to make those kinds of things available to lower income consumers. So a lot of energy and creative thinking could be put in to how to make that work. And then it becomes a win-win that, say that the smaller, newer farmers who don't have as many market opportunities. If they can build into something that, that also leverages federal food programs. And so brings in resources that also serves people in need of healthier food, can be a multiple win. So, building on that last idea of the consumer. And thinking about this notion of leveraging federal food programs. So, as a reminder, that includes like the SNAP program, which used to be called Food Stamps, which makes the kind of vouchers available. And now it's all done on credit card type things or EBT's, so it kind of minimizes the stigma of that. And then there's the WIC program, women, infants and children. Which especially is tailored to pregnant and breast feeding women and their young children. And that's various specific foods that are provided. Then the school lunch and breakfast program is a big opportunity for both locally produced food and then as a way to get healthier food to kids. The federal legislation that's being implemented now is significantly improving the quality of the school lunch program, which is a good thing. The dilemma now is that the kids are being expected to eat more vegetables and they're not always doing that. And, and in fact they're not participating in the school lunch program as much as they had. In the program, the economic basis of the program is set up so that you have to operate like a business. So you need, either the kids who qualify for free and reduced price lunch, if they participate then the school gets reimbursement from the government but they have to participate. And then there are the paying kids so, so the schools really need to get the kids to participate. So, creative ways to get kids to eat the school lunch is an important strategy, and one that will have a lot of benefits all around. So, another idea to put your creative energies toward. Not all the food benefits program, food benefit programs encourage healthy eating. There's a lot of debate about whether the SNAP program should eliminate soft drinks, things like that. Those are things that may come, but. But ways to make, say, healthy local food at the farmer's market available. You know, kids tend to respond when they meet the farmer that grew the food. Or if they have an opportunity in a local garden at their school to produce the food, they're more likely to eat the food. So if we can engage them more on those kinds of things, we can hopefully convert more kids from Moon Pies to fruits and vegetables. And then, fortunately the, the technology's developing to kind of reduce the stigma of these federal food programs. So by using these electronic benefits options, and that also can open the door for more use in different settings. Right now, it's a little bit challenging in farmer's markets, but with some of the new technology like the, the square or the box, whichever one that is. The, that you can use credit cards and then also eventually the cards for SNAP to be able to purchase food. So again, it gets money into the pockets of the farmers and also healthy food to the consumers. Okay, so our last bite-sized piece is moving consumers more towards healthy food choices. And after all, in the kind of venture world, you have to satisfy the customer and so if we can move them in the direction of supporting these local food systems then everything's going to fall into place more effectively. We've talked a little bit already about the fact that people are kind of losing the art of cooking and a lot of the schools are no longer offering home economics or cooking classes. Or if they are they're kind of dry. I think I remember learning how to make hot chocolate and maybe cookies. [LAUGH] Wasn't particularly helpful in terms of the kind of things we're trying to do. My own son in middle school was involved with a class that taught some cooking and they taught them how to take cookie dough and slice it and bake it. So, that was a little disappointing, cookies are one thing but at least if you can learn to make them from scratch. So, it could be a lot of fun, you know, and working with local farmers. Local, there are, the North Carolina has a nice system of a farm to school program, where they actually go out and pick up food from local farmers. And then schools can order that to fit in with their menu planning. And so if you, the kids could get to know where their foods coming from it would probably make them more excited about it and maybe they could teach their parents how to cook as well. We need to kind of get over this notion that convenience is everything. And that sitting down to a meal and enjoying it with family and friends is a good thing instead of just eating in the car from one meeting to the next. Or snack food along the way. A lot of time pressures, we're all very busy, so it tends to work against that. I have a very busy life, but I really enjoy going home and, and cooking dinner. I find it kind of therapeutic. So, if we can sort of build those kinds of and, and kind of cultivate that and make it easier for really busy people to also enjoy the slower side of food and cooking. And then we really need to get people to kind of think through where they're putting their resources. And the fact that in the U.S. we spend so much less of our expendable income on food than almost any country in the world. And think, you know, when you think about how critical it is for health the idea of really valuing food enough to spend a little money on it. In fact, rather than getting away as cheaply as we can, I think would move this whole field forward. So, to wrap it up, we're really talking about are really big, hairy issues here from the health of the global population to the economic viability of the agricultural world. So these are big issues but they can be broken down into, as we said, bite-sized pieces that, than can be tackled. And I'm really hoping that you guys will bite on this and will really sink your teeth into, and I'm getting carried away here. And because there's so many different things that, that you could do here that would be a huge contribution. And they can, many different pieces along the way. If you're more interested in the agriculture side, you can do that. And what we want to do there is open market opportunities for new, low resource farmers so that the field of agriculture doesn't die away with our aging farmers. And then on the consumer side, we want to make sure that we're reaching everybody, not just the higher-end consumers but those who suffer most from chronic disease. And try to get them access to healthy food that's enjoyable as well. Food has gotta be enjoyable. That's really the essence of what it's about. I mean, it is good for our health, but it really brings us together in so many ways. So, so lots of exciting opportunities here and I really look forward to hearing more about what ideas you've come up with.
