Will The White House’s Pledge To End Hunger And Reduce Diet-Related Diseases Succeed?

On September 28, 2022, President Joe Biden hosted the first White House Summit on Hunger, Nutrition and Health since the Nixon administration more than 50 years ago.

The 1969 White House Conference was prompted by the alarming recognition in the media and Congress that hunger and malnutrition were rampant in the United States. It was a lot of work too. Led by Jean Mayer, PhD, ScD, a food scientist at the Harvard School of Public Health and a special adviser to the president, this unprecedented effort to address hunger in the United States was preceded by the work of 475 experts organized in 26 panels and. 300 people participated in eight working groups that developed policy recommendations for consideration by a large body of more than 3,000 conference participants. Attendees at the conference included civil rights activists, those with lived experience, lawyers, academics, doctors, policy makers, and members of the private sector. The full conference lasted three days and was followed by a report containing 1,800 policy recommendations, 1,600 of which were finalized in the two years of the conference.

The recommendations included a number of reform policies and programs that changed the food landscape—including the expansion of the Food Stamp Program (now the Nutrition Assistance Program or SNAP) and the National School Lunch Program, the implementation of the School Breakfast Program, the creation of the Nutrition Program for Young Women and Children (WIC) ), and the forerunner of the Dietary Guidelines for Americans. The conference and the implementation of its recommendations received strong bipartisan support.

The Revised Method

The 2022 White House conference took a different approach. The conference was called by the Domestic Policy Council (DPC), chaired by Ambassador Susan Rice. Prior to the conference, the DPC hosted regional listening sessions, cross-sectoral listening sessions, and opened a portal for the general public to share ideas, information, and suggestions. The conference was also informed by ideas from more than 40 partner organizations across the country to share opportunities and ideas. The conference recommendations were developed by an interagency team consisting of 25 agencies and regional commissions tasked with ensuring that “the whole of government” drives the development of reform recommendations in the final report. The product of these activities was the National Strategy for Hunger, Nutrition, and Health, which included a number of recommendations organized into five pillars: improving food availability and accessibility, integrating nutrition and health, empowering all consumers to make and have access to healthy choices, supporting physical activity for all, and developing nutrition and food security research.

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On September 28, 2022, 600 attendees gathered in Washington, DC, to greet the release of the national strategy. In contrast to the first White House Conference, a new series of reform policies was not announced. Recommendations were created in advance and included a mix of what is being done, what will be done, what can be done about agency programs, executive orders, regulations, and legislation, and budgets. The conference consisted of a series of presentations rather than a working meeting between the assembled experts, as was the case in the 1960s.

Recommendations for the National Strategy

Beyond the federal government, the National Strategy on Hunger, Nutrition, and Health makes additional calls to action for a “whole of society response” aimed at state, local, and regional governments, employers and the private sector. These many and varied calls to action include recommendations that state and local governments increase enrollment in nutrition programs and provide more incentives at the state and local levels for people to buy healthy foods, that health insurance companies cover nutrition services such as prescriptions and prescriptions. prepared foods, and that philanthropy supports research studies to strengthen and diversify the food science pipeline. Most of these efforts are related to what these companies need to do rather than what they need to do or will do; guidelines or evidence-based interventions were not provided. The negotiation of private companies, which distinguished this conference from the first one, was mentioned only in passing, and only to announce their funding, not the details of their obligations. Non-coalition investment includes more than 60 public and private organizations committing a total of $8 billion to the conference’s goals, and the Food, Nutrition, and Health Investor Coalition has invested $2.5 billion in companies exploring new solutions to hunger and food insecurity.

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Developing a Strategy

The development of the recommendations has been a major effort. However, if this conference is to have anything close to the impact of the first White House Conference, there must be a systematic effort to prioritize, implement, and evaluate progress on the National Strategy recommendations. The DPC should oversee the process and hold agencies accountable for their activities under the implementation plan.

To identify recommendations with the greatest impact, the prioritization process should begin with estimates of the effect size and population reach of the suggested recommendations. This process should include an assessment of the impact each recommendation will have on hunger, food and nutrition security, or food-related chronic diseases. It should identify the part of the population affected if the recommendation is implemented. Prioritization should also consider cost, cost savings, and time required for implementation. All of these considerations have an impact on whether the proposed recommendation can be properly implemented.

After prioritization, the DPC must work with relevant agencies to determine how each recommendation will be implemented. Operating plans must indicate which agency or office is responsible for making the recommendation, the method of implementation—whether by executive order, regulatory enactment, appropriations, or legislation from Congress—and at any time, costs, and resource requirements.

Finally, the DPC should develop a plan to assess the progress of the National Strategy. This plan should include metrics that will be used to define success and should demonstrate how the DPC will hold agencies accountable for completing the tasks assigned to them. Beyond the actions of the organization, the plan should also show how the private sector will be held accountable for its responsibilities, and how the progress of “whole society” actions will be evaluated. The DPC should establish a timetable for issuing regular, public reports on progress under the National Strategy.

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To summarize

The atmosphere at the conference was celebratory, in part because the event was the first White House Conference in more than 50 years and because the conference attendees included many public health practitioners and lawyers who had not seen each other in person for two years. The importance of the day was also emphasized by the speech of President Biden, the active participation throughout the day by the secretaries of the US Department of Agriculture (USDA) and the Department of Health and Human Services, Tom Vilsack and Xavier Becerra, Senators Mike Braun (R-IN), Cory Booker (D -NJ), with Debbie Stabenow (D-MI), Congressional Representatives Rosa DeLauro (D-CT) and Pingree (D-ME), and the presence of Chef José Andrés. A standing ovation greeted mention of the need to restore the expanded child tax credit, expand SNAP, and institute free school meals worldwide. Emphasis was placed on the bipartisan—or some would say nonpartisan—nature of these issues.

The challenge going forward is how to translate the enthusiasm of the day into sustainable actions for the future. USDA Secretary Vilsack perhaps said it best, “Let’s keep today’s momentum going, in a new and stronger way, so we can fully meet this critical time for our children, our communities, and our country.” However, without a concrete plan to sustain and provide operational support with real and transparent accountability, the laudable and ambitious goals of the conference will not be achieved.

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