The following is a case study assignment during a graduate-level food policy course at NYU. NOTE: The commissioning of this brief is fictional and does not represent the opinions or intentions of the Department of Health and Mental Hygiene.

OVERVIEW

This brief, commissioned by the New York City Department of Health and Mental Hygiene (DOHMH), seeks to address the public health challenges of malnutrition and inadequate access to fresh fruits and vegetables among city residents. We propose expansion of the Health Bucks program to mitigate this challenge while also supporting new revenue streams for farmers. 

PROBLEM

There is an unacceptable amount of food insecurity and malnutrition in New York City. Over 50% of New Yorkers are overweight or obese,[i] while nearly 20% experience food insecurity.[ii] These challenges are exacerbated by COVID-19, during which the number of residents facing food insecurity have doubled while diet quality has decreased.[iii] New Yorkers in low-income neighborhoods face particular barriers to food access, including lack of grocery stores and inability to afford healthy food when available.[iv] While emergency relief has helped ensure New Yorkers remain fed, it is not a reliable or sustainable way to support food access and improved public health. Neither is reliance on food pantries, who have long reported that their resources were strained, even prior to the pandemic.[v]

POLICY SUGGESTIONS

Farmers markets address food insecurity and malnutrition by making fresh food accessible, supporting local food economies,[vi] and improving community resiliency.[vii] At the height of the pandemic, farmers markets were one of few reliable ways for farmers to sell their produce and for New Yorkers to stock up on items disappearing from stores.[viii]

Expanding the Health Bucks program is a unique opportunity to support food insecure New Yorkers, expand access to fresh fruits and vegetables, and support local farmers. DOHMH already implements Health Bucks, which provides Supplemental Nutritional Assistance Program (SNAP) users with $2 for every $2 spent at farmers markets, up to $10 per day.[ix] Expanding this program by doubling the amount to $20 per day would increase access to farm-fresh foods to those New Yorkers who need them most while also encouraging more consumer spending, increasing profits for farmers. As an unintended benefit, this expansion might also help mitigate rising food costs due to inflation, both to consumers’ budgets and farmers’ production costs.  

BENEFITS & RISKS

There are documented public health benefits to expanding a program like Health Bucks; a published evaluation indicated favorable opinions by both farmers and consumers and confirmed the program’s success in tackling health disparities and financial barriers to purchasing fruits and vegetables.[x]

There are several risks worth noting. The reimbursement process farmers must go through to secure SNAP dollars may prove burdensome, particularly if an increase in available funds for customers creates more paperwork. Sustainability is also a concern, as the program currently relies on a five-year grant from the USDA to operate.[xi] Increasing the amount of SNAP dollars available for use via Health Bucks may more quickly deplete the current pool of available funds, increasing the need for additional fundraising. Finally, if local farmers become too reliant on SNAP funds, they may also be more subject to political changes that could result in budget cuts and impact their revenue.

STAKEHOLDERS

o   Community Members and SNAP Beneficiaries: Community members and SNAP beneficiaries who will utilize the expanded Health Bucks program are critical stakeholders. We expect they will be happy to receive additional Health Bucks to spend. However, it may be prudent to evaluate whether members will reject being “nudged” to use more of their SNAP benefits in a specific way.

o   Department of Health and Mental Hygiene: DOHMH is credited with the creation and recent expansion of Health Bucks; in 2020, over $600K worth of Health Bucks were distributed among thousands of New Yorkers.[xii] The expansion of this program will likely provide a significant public health benefit by reducing the burden of chronic, diet-related diseases on populations of need. 

o   Hunter College New York City Food Policy Center: The leaders of the Food Policy Center have provided public testimony outlining their support for the expansion of the Health Bucks program, among others, to address food insecurity and malnutrition in New York City.[xiii]

o   New York State Health Foundation: The New York State Health Foundation is a grantmaking organization that commits itself to improving the health of New Yorkers. They recently identified “Healthy Food, Healthy Lives” as one of their grantmaking priority areas and made grants investing in nutritional incentive programs and localized food systems.[xiv] They could provide potential funds to support the expansion of Health Bucks as a temporary pilot and may also be a valuable partner if DOHMH wishes to seek state government funds to support longer-term sustainability of the program. 

o   Farmers Market Coalition: The Farmers Market Coalition is a national nonprofit working to strengthen farmers markets across the country and ensure farmers earn fair prices for their produce and labor. They have stated commitments to improving access to nutritious and affordable food by positioning farmers markets as solution to address health and food access inequities. They will likely react favorably to increasing SNAP acceptance at markets, since this connects farmers with new customers. They would be a valuable ally in ensuring that farmers are willing and satisfied partners. 

o   Greenmarket Farmers & Producers: Farmers may view expansion of this program as a positive opportunity to give back to local communities and increase their customer base.  The number of farmers who are authorized to accept SNAP benefits as payment has steadily increased since 2013, allowing farmers to grow their consumer base while improving healthy food access to low-income families.[xv] However, the process to become eligible to receive SNAP benefits, which is how farmers get reimbursed for accepting credits at the market, may be burdensome and serve as a barrier to participation.

o   City Government Officials: We are hopeful city officials will react positively to this expansion but are not fully confident of their support. Health Bucks is well liked and generally accepted as a public health win, but further expansion may not be financially feasible long term. Opposition may arise from City government is the program does not have as significant an impact on long-term health and cost savings for New Yorkers as other programs. Officials may also raise concerns about potential abuse of the program, which could create hurdles to implementation. However, the Mayor has designated improving access to healthy fruits and vegetables one of his key platforms.[xvi]

NEXT STEPS & RECOMMENDATIONS  

It is recommended that DOHMH begin building a case for the expansion of the Health Bucks program to address continued challenges of malnutrition and food insecurity faced by New York City’s low-income residents. First, we recommend that DOHMH commission an updated evaluation of the Health Bucks program, as the last one is about ten years old. Based on results from this evaluation, we recommend that leaders at DOHMH consult with the Farmers Market Coalition and GrowNYC to evaluate the appetite for this program’s expansion and the likelihood of adoption by farmers who currently sell or are interested in selling at greenmarkets. Next, we recommend evaluating interest from both the Mayor’s Office and the City Council on Health and ideally gaining their support. Finally, we recommend identifying and pursuing additional funding sources that can accommodate increases in reimbursements to farmers and building a plan for long-term sustainability after the conclusion of the current USDA grant.

APPENDIX

[i] “Obesity - NYC Health,” accessed October 11, 2022, https://www1.nyc.gov/site/doh/health/health-topics/obesity.page.

[ii] “Food Insecurity,” City Harvest, accessed October 13, 2022, https://www.cityharvest.org/food-insecurity/.

[iii] Charles Platkin MPH PhD, JD, “Testimony on the Status of Hunger in NYC and the Impact of COVID,” NYC Food Policy Center (Hunter College), June 28, 2021, https://www.nycfoodpolicy.org/testimony-on-the-status-of-hunger-in-nyc-and-the-impact-of-covid/.

[iv] “Healthy, Affordable Food,” New York Health Foundation, accessed October 13, 2022, https://nyhealthfoundation.org/what-we-fund/building-healthy-communities/healthy-affordable-food/.

[v] The, Hunter College NYC Food Policy Center, The Laurie M. Tisch Center for Food, Education & Policy, and, and The CUNY Urban Food Policy Institute., “NY Food 20/20: Vision, Research, and Recommendations,” September 2020.

[vi] Todd M Schmit and Miguel I Gómez, “Growing Farmers Markets in Northern New York:,” n.d., 1.

[vii] “Farmers Markets Play a Key Role in Resiliency Efforts | Health and Wellness | Parks & Recreation Magazine | NRPA,” accessed October 13, 2022, https://www.nrpa.org/parks-recreation-magazine/2022/april/farmers-markets-play-a-key-role-in-resiliency-efforts/.

[viii] “Farmers’ Markets Are Crisis Lifelines to U.S. Growers and Shoppers,” Bloomberg.Com, March 27, 2020, https://www.bloomberg.com/news/articles/2020-03-27/farmers-markets-are-a-lifeline-to-growers-hurt-by-coronavirus.

[ix] “Health Bucks - NYC Health,” accessed October 13, 2022, https://www1.nyc.gov/site/doh/health/health-topics/health-bucks.page.

[x] Gayle Holmes Payne, “Implementing a Farmers’ Market Incentive Program: Perspectives on the New York City Health Bucks Program,” Preventing Chronic Disease 10 (2013), https://doi.org/10.5888/pcd10.120285.

[xi] “Good Health, Good Value: NYC Receives $5.5 Million Grant to Make Healthy Food More Affordable - NYC Health,” 5, accessed October 17, 2022, https://www1.nyc.gov/site/doh/about/press/pr2021/good-health-good-value-nyc-receives-grant-for-affordable-healthy-food.page.

[xii] The City of New York, NYC Office of Food Policy, “Food Metrics 2021,” 2021.

[xiii] MPH, “Testimony on the Status of Hunger in NYC and the Impact of COVID.”

[xiv] “Healthy, Affordable Food.”

[xv] “Farmers Markets Increase Access to Fresh, Nutritious Food,” Farmers Market Coalition, accessed October 13, 2022, https://farmersmarketcoalition.org/education/increase-access-to-fresh-nutritious-food/.

[xvi] “Mayor Adams Takes Executive Action to Promote Healthy Food in New York City,” The official website of the City of New York, February 10, 2022, http://www1.nyc.gov/office-of-the-mayor/news/070-22/mayor-adams-takes-executive-action-promote-healthy-food-new-york-city.