by Marion Nestle

Currently browsing posts about: Policy

Mar 2 2017

Don’t we need a millennium development goal for social rank?

Yes, says Martin Tobias’s must-read commentary in The Lancet.

The commentary cites a paper in the same issue arguing that low social rank, meaning “powerless to determine your own destiny, deprived of material resources, and limited in the opportunities open to you,” has a profound effect on lifestyle and life chances.  Its authors base these views on a study of 1·7 million adults followed up for mortality (all cause and by cause) for an average of 13 years.

Even with use of a crude categorisation of social rank based on occupation (professional, intermediate, and unskilled), the study was able to quantify the social gradient in mortality: an approximately 20% increase in risk per unit decrease in rank.

Tobias’ commentary recommends evidence-based strategies to minimize the impact of social hierarchy on health:

Invest in children

  • Early childhood development enrichment programs

  • Intensive parent support (home visiting) programs

  • Enrollment of all children in early childhood education

Get the welfare mix right

  • Regulate markets as necessary

  • Implement income transfer policies that redistribute resources (ie, progressive tax and benefit regimes)

  • Optimize balance between targeted and universal social protection policies through benefit design that minimizes both undercoverage and leakage

  • Eliminate child poverty through monetary and non-monetary support for families with dependent children

Provide a safety net

  • Provide income support or tax credits

  • Provide social housing

  • Subsidize childcare

  • Provide free access to health care (especially preventive services)

Implement active labor market policies

  • Provide job enrichment programs

  • Democratize the workplace (involve employees in decision making)

  • Provide career development and on-the-job training

  • Provide fair financial compensation and intrinsic rewards

  • Promote job security

  • Discourage casualization of the workforce

Strengthen local communities

  • Foster regional economic development

  • Promote community development and empowerment

  • Encourage civic participation

  • Create mixed communities with health-enhancing facilities

Provide wrap-around services for the multiply disadvantaged

  • Coordinate services across government and NGOs

  • Provide intensive case management when necessary

  • Foster engagement of the targeted families and individuals

Promote healthy lifestyles

  • Strengthen tobacco control and addiction services

  • Improve the diet of poor families (eg, through subsidizing fruit and vegetables, community gardens, purchasing co-ops, school meals)

  • Provide green space and subsidized sport and recreation facilities

Ensure universal access to high quality primary health care

  • Subsidize practices serving high need populations

  • Provide additional nursing and social worker support for practices in disadvantaged areas

  • Assist patients with clinic transport and childcare

  • Provide services free at point of use

  • Provide conditional cash transfers (to increase demand for clinical preventive services)

The paper is open access.  Spread it around.  Pick the recommendation you think most important, and get to work!

Dec 17 2015

House spending deal: food issues summarized

Thanks to Helena Bottemiller Evich of Politico Pro for doing the homework on food issues covered by the omnibus spending deal just agreed to by the House.  Here’s my quick summary of her summary.

  • GMO labels: the effort to preempt local and state GMO labeling initiatives failed as a result of the efforts of 30 representatives who opposed the measure.
  • Country of origin labels repealed: the meat industry scores a win in the House vote to repeal the measure.
  • Dietary guidelines: I discussed this one in yesterday’s post.  The House wants to block their release on the grounds that they are not sufficiently scientific (translation: the meat industry doesn’t like advice to eat less meat).
  • The Clean Water Act: it survives.
  • GMO salmon: it will have to be labeled.
  • Food safety funding: up more than $132 million to $2.72 billion in discretionary funding. This is a big win for the FDA. It also proposes $1 billion for the USDA’s Food Safety and Inspection Service, also above the president’s request.
  • Trans fat ban”: delayed until FDA’s formal rules go into effect in June 2018.
  • School lunch flexibility: Riders allow schools to ignore whole grain requirements and block sodium restrictions pending further research.
  • Chinese chicken out of schools: Prohibits purchasing chicken that was processed in China for school meals or other federal nutrition programs.
  • More kitchen equipment: Schools get another $30 million for school equipment grants.
  • Horse slaughter: Banned.

Caveat: this is the House deal only.  The House has to vote on the actual bill, then the Senate.  Then the two bills need to be reconciled and the President needs to sign.  Until then, everything is up for grabs.