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Collaborative Initiatives at MIT Massachusetts Intstitute of Technology @
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FoodandHealth:UsingtheFoodsystemtoChallengeChildhoodObesity
FinalReportontheCurbingChildhoodObesityProject,PhasesIandIIIncludingAbstractandMainText
October2009
Abstract
Dramaticincreasesinearlyonsetofadultmedicalconditionsassociatedwithchildhoodobesity
andtheneedtocontainhealthcarecostshaveplacedobesityatthecenterofindustry,public
health,politicalandmedicaldebate.Theseindependentfieldsmustworktogetherifweareto
implementrealchange.
Utilizingauniquedesignapproach,ColumbiaUniversityandMITwiththesupportoftheUnited
HealthFoundation,joinedforcestostudyabroadsystem‐basedviewofobesity.Themain
conclusion–thefoodsystemandhealthareintegrallylinked.Toensurethateffortstofight
obesityaresustainable,wemustdevelopanationalfoodsystembasedonaccess,affordability,
qualityandhealth.
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ProjectTeamTheCollaborativeInitiativesatMIT
TenleyE.Albright,MD DirectorKenKaplan AssociateDirectorEleanorCarlough DirectorofProgramCherylHardwick FinanceManagerPattyLauria OfficeManagerTheUrbanDesignLabattheEarthInstituteatColumbiaUniversity
MichaelConard ProjectDirector,AssociateProfessorofArchitectureRichardPlunz ProfessorofArchitectureKubiAckerman DesignResearchAssociateCindyChiou PublicHealthResearchAssociateDimitrisVlachopoulos DesignResearchAssociateLindseySchubiner ResearchAssistantExpertConsultants
SusanRoberts,JD,MS,RD FoodsystemlegalandnutritionexpertMichaelRosenbaum,MD AssociateProfessorofClinicalPediatricsattheColumbia UniversityMedicalCenterMarcoSteinberg DirectorofStrategicDesignFinnishInnovationFundAdvisoryBoard
PaulaA.Johnson,MD ExecutiveDirector,ConnorsCenterforWomen’sHealth andGenderBiologyandChiefoftheDivisionofWomen’s HealthatBrighamandWomen’sHospital
KennethMoritsugu,MD,MPH, (RearAdmiral)FormerActingSurgeonGeneral
MichaelPorter,MBA,PhD Professor,HarvardBusinessSchool
GeorgeRabstejnek ChairofCenterforTechnologyCommercialization,Vice ChairmanoftheMassachusettsEyeandEarInfirmary
AlfredSommer,MD,MHS ProfessorofEpidemiologyandInternationalHealthand DeanEmeritus,JohnsHopkinsUniversityBloomberg SchoolofPublicHealth
RoxanneSpillett President,BoysandGirlsClubofAmerica
LouisSullivan,MD Chairman,TheNationalHealthMuseum;Founder, PresidentEmeritus,MorehouseSchoolofMedicine
JimTallon PresidentofUnitedHospitalFund
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MainText
Ithasbeenshownthatonceachildhasbecomeobeseitisdifficulttoreverse.1Atthispointit
becomesalifetimestrugglechallengingtheindividualandfamilies,taxingthemedicalsystem,
anddrivinghealthcarecoststounsustainablelimits.Thesepressuresmakeitimperativethat
nationalprogramstopreventtheincidenceofchildhoodobesitypopulation‐widebe
developed.
InSeptember2007,withthesupportoftheUnitedHealthFoundation,theCollaborative
InitiativesatMITandtheUrbanDesignLabattheEarthInstituteatColumbiaUniversityjoined
togethertostudyChildhoodObesitythroughadesignlens.Basedonanearliersystems‐based
studyonStroke2,thegoaloftheprojectwastotakeacomprehensivesystems‐basedviewof
obesityatmultiplescalestoassesspotentialgapsinthemethodsbeingusedtocombatthe
dramaticriseinchildhoodobesityandtodevelopnewapproachestocurbingtheepidemic.
Design,asadiscipline,considerstheinterdependenceofdiversespecialtieswithinasystem.A
design‐basedanalysisrequiresknowledgeoftherelationshipbetweenvariouspartsofthe
system;anunderstandingofthelong‐rangeeffectofchanginganyonepartofthesystem;and
anawarenessthatapproachinganyonepartofacomprehensivesystemindependentlywill
havelimitedaffect.Todate,applicationofdesignresearchmethodstobroadsocialissueshas
beenlimited,butthepotentialvalueofsuchanapproach,whichconsidersabroadrangeof
factorsaffectinganissueanddetermineswherethepivotalintersectionsoccur,isgreat.
Whatresultedwastheidentificationoftwomajorgapsintheefforttofightchildhoodobesity.
1. alackofcoordinationamonginterventioneffortsleadingtoanendlesscycleof“start‐
up”programs.
2. areluctancetotakeonthelargerfoodsystem
Theteamchosetotargetthechallengeofthefoodsystemasthekeytomountingasustainable
nationalefforttochangethetideofchildhoodobesity.Manygroupsaroundthecountryare
workingtoaddresstheissueofobesityasitaffectschildren.Fromlocalcommunitygroupsto
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nationalfoundationsthereisagrowingmomentum.However,successfulprogramsareoften
limitedbythelargerfoodenvironment.Forexample,asuccessfulschoolprogramislimitedby
achild’shomeenvironmentorthecommunityenvironment;asuccessfulcommunityprogram
islimitedbythesurroundingretailenvironment.Isolatedinterventionsareworkingupstream.
Astrongintegratedfoodsystembasedonaccess,affordability,qualityandhealthwillsupport
themanycommunityinterventionstakingplaceacrossthecountryandenablelong‐term
change.Achievingthisgoalwillrequirenewcollaborationsamongindustry,health,agriculture,
academia,non‐profit,andgovernmentdomainsaswellasthedevelopmentofnewbusiness
modelsfocusedonprovidingahealthyfoodsupply.
Methodology:
Todatetheprojecthascompletedtwophases.PhaseI:in‐depthdesignbasedresearch.Phase
II:stakeholderassessment.
Theprojectteamwasledbyanarchitectapplyingdesignprinciplestotheissueofchildhood
obesity.Toaugmenttheirknowledgebasetheteamworkedwithagroupofadvisors3.Usinga
combinationoftraditionalliteraturereviewanddesignmethodstheteamstudiedexisting
researchonanextremelybroadrangeoftopicsrelatingtoobesity,reviewingprofessional
journals,popularandspecializedbooks,nationalandinternationalreports,andsurveydataata
numberofdifferentscales;researchingandvisitingcurrentinterventionprogramsnationwide;
andinterviewingover150expertsinareasrelatedtotheissueaswellasbehavioral
economists,traditionaleconomists,transportationexperts,businessleaders,andothers.
The team’s broad research effort involved a detailed consideration of the socio‐cultural
changes that have occurred thatmay be responsible for the sudden increase in the rates of
childhoodobesityaround1980.4Someofthesocialtopicsresearchedinclude:
Markettrends(foodconsumption,foodpricing,foodmarketing);
Lifestylechanges(timeusepatterns,familystructure,consumptionhabits);
Policy(theFarmBillandagriculturalsubsidies,foodpolicy,andeducation);
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Socioeconomic factors (shift to a postindustrial economy, socioeconomic disparities,
economicinsecurity);
The built environment (land use patterns, urban/suburban development,
transportation,urbanrenewal).
Tocontextualizetheproblemandgaininsightintoitsgeographicaldimension,theteam
researchedtheprevalenceofobesityfromavarietyofspatialscales,includingglobal,national,
andmunicipallevels.Finally,theteamexaminedthecurrentliteratureonpharmacological,
hormonal,andepigeneticfactorscontributingtoobesity.
Anumberofdesigntoolswereusedtoanalyzethedatagatheredintheearlystagesofthe
study:
ProbePresentations
“Probes”aredesigntoolsintendedtoprovideanopportunityfortheresearchteamtoexplore
specifictopicsmoredeeplythroughvisualizationandmodelingandtoassesspotential
interventionstrategies.Theteamresearched,analyzed,andpresentedfindingsonaspecific
probetopicinabrief,intensiveperiodoftime.Thisprocesschallengedtheteamtoapplyearly
researchdirectionstopotentialrealisticsolutionstothechildhoodobesityepidemic.
Selectedprobesconductedinclude:
• ChildhoodObesityandtheBuiltEnvironment:StrategiesforUrban,Suburban,and
RuralCommunities
• ScenariosandTrendsinChildhoodObesityandtheFoodSystem
• PhysicalActivityandChildhoodObesity:EvaluationofResearchandSuccesses
• ChildhoodObesityandFoodSystems:TheCarbonFootprintofFood
• FoodCultureandFoodAccess:PotentialContributorstoandSolutionsforChildhood
Obesity
• ChildhoodObesityinNewYorkCityandState:EvaluationofCurrentEfforts
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Intervention Evaluation Tools
The primary environmental factors contributing to energy expenditure and intake, the two
components of the “energy equation.” Dotted lines represent strong correlations between
factors on either side of the equation.The diagram can be used to begin to map the scope
of various proposed interventions or combinations of interventions. Because of the
complex, multi-variant nature of the problem, it is necessary to address as many of the
environmental contributors as possible.
InterviewCoding
Anadditionaltoolinvolvedcodingthenotesfromnumerousinterviewsconductedwithexperts
andengagedcommunitymembers.Theprocessenabledtheteamtoextractthemesthat
reoccurredwithparticularinterestininterviewees’opinionsonthechallengestheyhavefaced
intheirwork,potentialfutureopportunities,andtheirperspectivesontheproblemof
childhoodobesityandeffortstoaddressit.
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Matrices
Theresearchteamcompiledtwomatricestofacilitatedatareview.Thefirstwasamatrixof
115existingobesityprogramsaroundthenation.Theseprogramswereclassifiedaccordingto
thetargetagegroup,scale,andareasofconcentration.Theprogramswerethenmappedto
establishspatialconcentrationsandpotentialoverlaps.
Thesecondmatrixwasasearchabledatabaseoutlining600+publishedarticlesandreportson
thecomplexissuessurroundingchildhoodobesity.Thisenabledtheresearchteamto
determinetheemphasesofthevariousdisciplinaryfieldsandpotentialgapsintheresearch.
Whenreviewingthesestudiesandreports,theobesity‐relatedfactorsweredividedintermsof
energyintake,energyexpenditure,medicine,andtrends.Thesewerefurthersubdividedinthe
followingmanner:
• EnergyIntake:Production(agriculture,foodindustry,processing),
Distribution/Access(builtenvironmentdistribution,marketsupply,schoollunches,
schoolvending,foodcosts)andConsumption(education,foodtype,foodquality,
lifestyle,media,marketing);
• EnergyExpenditure:BuiltEnvironment,Education,andLifestyle;
• Medicine:Biology,Treatment,Costs(economicandhealth);
• Trends:Children,Ethnicity,Geography,Income,PoliticalSystem,andRegulation.
Fromthisbodyofresearchtheteambuiltacomprehensivemodelofthecausesofchildhood
obesityandcurrentinterventionsanddevelopedseveralrecommendationsforchangeonlocal,
stateandnationallevels.
PhaseIIinvolvedputtingthePhaseIrecommendationsinfrontofvariousstakeholderstogain
insightandtobuildthefoundationofsupportneededtoeffectnationalchange.Thefindings
werepresentedtoindustryleaders,agriculturespecialists,non‐profitorganizations,
economists,farmers,marketingexecutives,nutritionists,doctorsandgovernment
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representativestoidentifyreal‐worldbarrierstodevelopingtheteam’sdesign
recommendations.
Findings:
Theratesofchildhoodobesityhaveincreasedby325%sincetheearly1960swithdramaticand
steadygrowthsince1980.8
Thedatagatheredduringtheprojectbothsupportstheintuitiveunderstandingofobesityand
challengesexpertstolookbeyondtheobviousanswers.Thebottomlineisclear:thereisan
obesityepidemicbecause,ingeneral,peopleareconsumingmorecaloriesthantheyareusing.
Addtothat,thefactthatmanyofthehealthyfoodsthatarebeingconsumedaredecreasingin
nutritionalvalueandthehealthrisksbecomeevengreater5.
“The10‐to12‐poundincreaseinmedianweightweobserveinthepasttwo
decadesrequiresanetcaloricimbalanceofabout100to150caloriesperday.
Thesecalorienumbersarestrikinglysmall.Onehundredandfiftycaloriesper
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dayisthreeOreocookiesoronecanofPepsi.Itisaboutamileandahalfof
walking.”6
Thehighestlevelofriskisinlow‐incomeneighborhoodswheretheavailablefoodstendtobe
high‐fat,low‐costoptionsandtherearefeweropportunitiesforsafe,accessible,physical
activity.7However,whileincreasingphysicalactivityisacriticalcomponentofbuildinga
healthierpopulation,itcannotaffectapopulation‐wideshiftinobesityratesunlessthecaloric
intakeisaddressed.11
Environmentalfactorsthatarecontributingtothechildhoodobesitycrisisinclude:
o Asteadyincreaseinthecostsof‘healthy’foods–definedforthepurposesof
theprojectasfreshfruitsandvegetablesandminimallyprocessedfoodthat
islowinaddedsugar,fat,andsalt
Sincethe1980s,thecostofhealthyfoodssuchasfruitsandvegetableshasrisenmuchmore
rapidlythanthecostofunhealthyfoods.Averageabsolutepricesforfreshfruitsand
vegetablesrosebetweenfiveandsixpercentfrom1987‐2007whilepricesforsugars,sweets,
fatsandoilsrosebetweentwoandthreepercentduringthatsameperiod.8Inarecentstudy
publishedintheAmericanJournalofClinicalNutritionresearchersfoundthat$1couldbuy
1,200caloriesofpotatochips,875caloriesofsoda,250caloriesofvegetablesor170caloriesof
freshfruit.9
Compoundingthecostofhealthyfoodoptionsisaconsiderationofthetimeandeffort
necessarytopreparethem.10
o Theriseof‘fast’foods,packagedandhighlyprocessedfoodsthatareoften
highfatandlowcost
Theslowerriseinabsolutecostsofprocessedfoodsupplementssuchassugars,fatsandoils
notedabovehascontributedtotheriseinhighlyprocessed,energy‐densefoodswhichtendto
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costmuchlesspercaloriethanhealthyfoods.Inaddition,thesefoodsareoftenmore
convenientandeasilyaccessibleprovidingincentivestofamilieswithlimitedfoodbudgets,
hecticlifestyles,orlimitedaccesstoalternatives.
o Increaseingovernmentfoodsubsidiesthatsupportproductionoflowcost,
‘fast’foods
Thecurrentfoodsystemwasdevelopedwithaneyetoquantitynotquality.Federalincentives
tosupportthecurrentsystemtaketheformofdirectsubsidiesforcommoditycrops11,and
relativelyinexpensivefossilfuelsusedforfertilizer,machinery,andprocessing.Theresultisa
reductionincropvarietyandariseinlow‐costprocessedfoods.
o Anincreasinglywidespreadandcomplexfoodsystem,whichleadstogreater
packaging,transportationandenvironmentalcosts–valueaddedinputs,
decreasingtheprofitmargin,orfarmshareofthefooddollar
Inahighlyglobalizedfoodsystemitisofteneasierandmoreprofitabletoshipfoodaroundthe
worldforprocessinganddistributionthantosellfreshfoodgrownandtransportedlocally.
Thisisdue,inpart,toalackofregionaltransportationinfrastructure.
o Changesinlifestyleandurbandevelopmentthatareloweringtheratesof
physicalactivity,particularlyinlowereconomicpopulations
Activitylevelsinthepopulationatlargehavedecreased.Thesechangesaremoredramaticin
low‐incomeurbanpopulationswheretheopportunitiesforrecreationalphysicalactivityare
lessprevalent.12Changesinthebuiltenvironment13,suchasrezoningefforts,andcreativeuse
ofmoderngamingtrendsarealltoolsbeingexploredtoincreaseopportunitiesforphysical
activity.
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o Arisein‘fooddeserts,’areaswithlimitedaccesstogrocerystoresorfresh
foods
Inmanycommunitiesacrossthenation,ruralandurban,andatallincomelevels,thereareno
supermarketsorotherhealthyretailoptions.ThesecommunitiesaredefinedasFood
Deserts14.Thisisofparticularconcerninlow‐income,underservedneighborhoodswhichare
alreadymostatriskforchildhoodobesity.15Intheseneighborhoods,thelackofhealthyretail
optionsisoftencompoundedbyahighconcentrationof“fringe”retailerssuchas,gasstations,
liquorstores,bakeries,pharmaciesandconveniencestoreswhichgenerallysellhighly
processedfoodswithlongershelflifeandeasystorageoptions.
FoodDesertsareattributedtomanythings:businesspracticesofgrocerychainsthathave
determinedstorelocationsbasedonmedianincomesnotpopulationlevels;thecostsofstoring
freshhealthyfoods;and,inurbanenvironments,thecostsassociatedwithretailspace.
Lendingweighttotheargumentthatgreateraccesslessenstheriskofchildhoodobesityare
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studiesshowingthatthepresenceofasupermarketreducedtheprevalenceofoverweightand
obesemembersofthesurroundingcommunity.16
Astheaboveillustrates,theenvironmentalfactorscontributingtoobesityfallintofour
categories:affordability,access,qualityandphysicalactivity.Thefirstthreeoftheseare
directlyrelatedtothefoodsystemandaretheoutcomesofasystembuiltonincreasingthe
quantityoffoodwithoutanawarenessofthepossiblehealthconsequences.
TheFoodsystemandHealth
Someofthedirecthealthconsequencesofobesityinclude:typeIIdiabetes,arthritis,asthma,
sleepapnea,highbloodpressure,highcholesterol,gallstones,fattyliver,pseudotumorcerebri,
heartdisease,anddepression.Manyofthesetypicallyadultonsetdiseasesarenowbeingseen
inchildren.Thecostoftreatingchildhoodobesityisapproximately$14billionannually,
diabetes$150billion,obesityatlarge$147billion.17
Typically,interventionstofightobesityhavebeendoneonanindividualbasis.Eachofusmust
affectourowncalorieintake/expenditurebalancetoimproveourownhealth.However,to
effectpopulationwidechangerequiresalargerenvironmentalshift.Thefoodsystem
representsthatbroaderenvironmentalchallenge.Asasystemitiscomprisedofseveralparts–
eachactingindependentlybuthavingconsequencesallalongtheline.Initssimplestformthe
foodsystemiscomprisedofproduction,processing,transportation,retail,consumption.
Changingjustonepieceofthepuzzlewillnothavethepowertochallengethesystemof
obesity.
Tobetterunderstandtherelationshipbetweenthefoodsystemandhealthithelpstolookat
thegrowthofthemodernfoodsystem.Overthecourseofthelastcentury,theU.S.
foodsystemhasdevelopedintoanincrediblyefficientmachinecapableofadequatelyfeedinga
growingpopulation.Evenrelativelylateinthe20thCentury,between1970and2006,the
poundsoffoodavailablepercapitaincreasedby16%.18
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Overtimetherehasbeenanincreaseinyields,laborspecialization,efficiency,foodchoice,
varietyandconveniencecoupledwithadecreaseinperishabilityandtheproportionofincome
Americansspendonfood19.However,thesegainshavecomewithsubstantialnegativehealth
effectsandtheyhavecreatedtheenvironmentalproblemssupportingtheobesityepidemic–
lackofaccess,affordabilityandquality.
o Increasedyields,haveledtoincreasedcaloricconsumption‐oftenwithalowernutrient
content.ResearchersattheBiochemicalInstituteattheUniversityofTexasinAustin
studied50‐yearchangesinU.S.Dept.ofAgriculturefoodcompositiondatafor13nutrients
in43gardencrops.Theteamfounddeclinesinconcentrationsofsixnutrientsfromthe
1950sto1999.20Quality
o Advancesinprocessing,whichdecreasedperishability,ledtoincreasedconsumptionof
high‐fat,low‐cost“convenience”foods.Somesourcesshowasmuchas90%ofU.S.Farm
productionallocatedforprocessedfoodswithonly10%reachingtheconsumerfreeof
processing.21Access,quality
o Increasedlaborspecializationandconveniencedecreasedthegeneralpopulation’s
connectiontoandunderstandingoffood.Access,quality
o Increasedfoodchoiceandvariety,aswellascorporateconsolidationledtoincreased
marketingoflesshealthyprocessedfoodsandbroaderdistributionmodels.Access,quality
o Increasedsupportofcommoditycropsledtoadecreaseinagriculturallandavailablefor
otherfruitsandvegetables,decreasingsupplyandincreasingcosts.Italsochangedthe
farmingbusinessmodelforcingsmallfarmersoutofbusinessinfavoroflarge
conglomerates.ArecentTIMEarticlenotesthenumberofU.S.farmshasdecreased“from
6.8milliontofewerthan2‐million”since1935“withtheaveragefarmernowfeeding129
Americans,comparedwith19peoplein1940.”22Access,affordability
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“IfAmericansweretofullymeettherecommendationsfromthe2005Dietary
Guidelinesforfruits,vegetables,andwholegrains,weestimatetheincreased
demandwouldrequireU.S.agriculturetoharvestamaximumof7.4million
acresofadditionalcroplandperyear.This1.7‐percentincreaseisrelatively
small,giventhetotalU.S.croplandof433.5millionacresinthe2002Censusof
Agriculture.23
Justaschangingonlyonepartofthefoodsystemwillnothavetheaffectofaddressingthe
systemasawhole,addressingonlyonepartofthesystemfailurewillnotbeenoughtoeffect
population‐widechange.Addressingtheissuesofaccess,affordabilityandqualityindividually
wouldhavesomepositiveeffectbutisunlikelytostemthetideoftheobesityepidemic.
However,addressingthemcollectivelybyreworkingthenationalfoodsystemwillbuildasolid
foodinfrastructuretosupportapopulation‐widechangeinbehavior.Thisinturnwillprovidea
platformtosupporttargetedinterventionstocurbchildhoodobesityandenableprograms
aimedatpromotinghealthylifestylestobesustainable.
ResponseandRecommendations
Webelievethedevelopmentofintegrated,regional‐scalesystemsnationwide,withproduction,
transportation,processingandretailinfrastructuretosupportthem,havethepotentialto
provideaviablealternativetothecurrentfoodsystem.These“foodsheds”24wouldbesimilarto
theconceptofwatersheds,wherethemajorityoffoodforaregionwouldbeproducedwithin
thatregion.PreliminaryresearchoftheNortheastRegionsuggeststhatthereisthepotential
fortheregiontoprovideamajorityofitspopulation'sbasicfoodneeds.Tradebetweenregions
wouldprovideformorevariedfooddemands.
Suchsystemswouldseektooptimizeandmaximizeregionalproductionandcapacityforself‐
sufficiencywhileallowingforclimaticandgeographicvariabilitythatmakessomeareas
inherentlymoresuitableforcertaintypesofproductionthanothers.Thismodelwould
increaseaccessbyincreasingregionalsupplyandretailoutlets,affordabilitybydramatically
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decreasingproduction,processingandtransportationcostsandimprovequalitybydecreasing
thedistancefromfarmtoplatelesseningtheneedforlongshelf‐life,processedfoodsbetter
suitedtotravelinglongdistances.
Suggestedcomponentsofthismodelcreateatieredstructurewithineachregion.
RegionalFoodshedModel–Theoverarchingconceptwhichincludesnewbusinessmodels
linkingproduction,processing,transportation,retail,consumereducationandhealthoutcomes
withinagivenregion.
1. CooperativeFoodTerminals‐anchoredbyaNationalChainretailer,theseFoodTerminals
wouldincorporategreenmarkets,healthypreparedfoods,financialandhealtheducation
andlocalproductionatonelocation.
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2. MobileMarkets‐thesemobileunitswouldbringgoodsandservicesdirectlyto
communities.
3. 10x10andLawntoFarm–educationprogramsaimedatteachingthevalueoffood‐
economically,environmentallyandpractically.Theyalsoincreaseawarenessofregional
identities,productioncapacitiesandclimate,andtheaffectoffoodonpersonalhealth.
4. HealthyFoodIndex–thisindexwillservetomeasuretheimpactofregionalchangestothe
foodsystemintermsofaccess,affordability,consumptionhabitsandhealth.Bymeasuring
impactregionally,theHFIwillbeabletoquantifyeffectivemeasuresincentivizing
replicationandpolicychange.
Inordertoimplementsuchasystemitisvitalthatindustry,government,agricultureexperts,
farmers,academicsandhealthprofessionalsworktogethertobuildviablemodelsand
measuresofhealthoutcomes.TheColumbia/MITteamhasspentthepastseveralmonths
buildingthefoundationofsuchrelationships.Mostexciting,perhaps,isthebuy‐inand
enthusiasmofmanyofthemajorfoodretailandproductionleaders.
Finally,theRegionalFoodshedmodelhaspositiveimplicationsinotherareassuchasfood
security–ensuringthatregionsareself‐sufficient,andtheeconomy–recovering“farm‐share”
oftheagriculturaldollarbydecreasingvalue‐addedinputs,providingjobs,reclaimingunused
landandmakingfarmingaviablebusinessopportunity.
Ultimately,however,thegoalistoimprovethehealthofchildrenandfamiliesnationwide.
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1LeibelRL,RosenbaumL,HirschJ.Changesinenergyexpenditureresultingfromalteredbodyweight.NewEnglandJournalofMedicine.1995;332(10):621‐628.2StrokePathwaysProjectdonebytheCollaborativeandProfessorMarcoSteinbergattheHarvardGraduateSchoolofDesign.strokepathways.org3PaulaA.Johnson,M.D.,ExecutiveDirector,ConnorsCenterforWomen’sHealthandGenderBiologyandChiefoftheDivisionofWomen’sHealthatBrighamandWomen’sHospital;RearAdmiralKennethMoritsugu,M.D.,M.P.H.FormerActingSurgeonGeneral;MichaelPorter,Professor,HarvardBusinessSchool;GeorgeRabstejnek,ChairofCenterforTechnologyCommercialization,ViceChairmanoftheMassachusettsEyeandEarInfirmary;AlfredSommer,ProfessorofEpidemiologyandInternationalHealthandDeanEmeritus,JohnsHopkinsUniversityBloombergSchoolofPublicHealth;RoxanneSpillett,President,BoysandGirlsClubofAmerica;TheHonorableLouisSullivan,M.D.,Chairman,TheNationalHealthMuseumandPresidentEmeritus,MorehouseSchoolofMedicine;JimTallon,PresidentofUnitedHospitalFund;MarcoSteinberg,AssociateProfessor,HarvardUniversity,GraduateSchoolofDesign8CDCNHANESdata.Retrievedfrom:http://www.cdc.gov/nchs/products/pubs/pubd/hestats/overweight/overwght_adult_03.htm5Halweil,B.StillNoFreeLunch:NutrientlevelsinU.S.foodsupplyerodedbypursuitofhighyields.TheOrganicCenterCriticalIssueReport,September2007.6CutlerDM,GlaeserELandShapiroJM.WhyHaveAmericansBecomeMoreObese?JournalofEconomicPerspectives:v17,No3,Summer2003.7FrenchSA,StoryM,andJefferyRW.EnvironmentalInfluencesonEatingandPhysicalActivity.AnnualReviewofPublicHealth,Vol.22:309‐335,May2001.CumminsS,MacintyreS.Foodenvironmentsandobesity—neighborhoodornation?InternationalJournalofEpidemiologyVolume35,Number1February2006.HayneCL,MoranPAandFordMM.RegulatingEnvironmentstoReduceObesity.JournalofPublicHealthPolicy,Vol.25,No.3/4(2004),pp.391‐407.DrewnowskiA,RehmCD,andSoletD.Disparitiesinobesityrates:AnalysisbyZIPcodearea.SocialScience&Medicine.2007December;65(12):24588LeibtagE.“CornPricesNearRecordHigh,ButWhatAboutFoodCosts?”AmberWaves,Vol.6,No.1,USDAEconomicResearchService,February2008.9DrewnowskiAandSpecterSE.Povertyandobesity:theroleofenergydensityandenergycosts.AmericanJournalofClinicalNutrition,Vol.79,No.1,6‐16,January2004.10BitlerMandHaiderSJ.AnEconomicViewofFoodDesertsintheUnitedStates.PreparedfortheJanuary23,2009,NationalPovertyCenter/UnitedStatesDepartmentofAgriculture‐EconomicResearchService(USDA‐ERS)conference“UnderstandingtheEconomicConceptsandCharacteristicsofFoodAccess.”
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11Therearefivecropsthatreceivedirectfederalcommoditysupport(subsidies)fromtheUSDA:corn,soybeans,cotton,rice,andwheat.Theoverallregulatoryenvironment,(whichincludessuchthingsasaprohibitionontheproductionoffruitsandvegetablesonlandthathasbeenreceivingsubsidiesforcommoditycrops)disincentivizestheproductionofhealthyfoods.12IHYenandGAKaplan.“Povertyarearesidenceandchangesinphysicalactivitylevel:evidencefromtheAlamedaCountyStudy.”AmericanJournalofPublicHealth,Vol.88,Issue111709‐1712,1998.13Thehuman‐madephysicalenvironment14PublicLaw110‐246,June18,2008,122Stat.pg.2039.TheFood,Conservation,andEnergyActof2008(2008FarmBill),TitleVI,Sect.7537subsectiona,pg.2039:“DEFINITIONOFFOODDESERT.–Inthissection,theterm“fooddesert”meansanareaintheUnitedStateswithlimitedaccesstoaffordableandnutritiousfood,particularlysuchanareacomposedofpredominantlylower‐incomeneighborhoodsandcommunities.”15GallagherM.ExaminingtheImpactofFoodDesertsonPublicHealthinChicago.MariGallagherResearchandConsultingGroup2006.BlanchardTC,LysonTA.RetailConcentration,FoodDeserts,andFoodDisadvantagedCommunitiesinRuralAmerica.FromRemakingtheNorthAmericanFoodSystem:StrategiesforSustainability(HinrichsCC,LysonTA,eds.)UniversityofNebraskaPress,2008.16CumminsC,MacintyreS.Foodenvironmentsandobesity–neighborhoodornation?InternationalJournalofEpidemiology2006;35:100‐104.17Thesefiguresarefromdifferentstudiesusingdifferentmethodologiesandarethereforenotcomparative.ChildhoodObesity:Costs,TreatmentPatterns,DisparitiesinCare,andPrevalentMedicalConditions.ThomsonMedstatResearchBrief,2006.http://www.medstat.com/pdfs/childhood_obesity.pdf.AmericanDiabetesAssociation,EconomicCostsofDiabetesintheU.S.in2007DiabetesCareMarch200831:596‐615;doi:10.2337/dc08‐9017Finkelstein,EA,Trogdon,JG,Cohen,TJ,Dietz,WH.Annualmedicalspendingattributabletoobesity:payer‐andservice‐specificestimates.HealthAffairs[serialonline],2009Jul.Availableathttp://content.healthaffairs.org/index.dtl.18USDA,EconomicResearchService.“ERSFoodAvailability(PerCapita)DataSystem,”2008,www.ers.usda.gov/data/foodconsumption/.19USDA,EconomicResearchService.“FoodCPIandExpendituresBriefingRoom,”www.ers.usda.gov/briefing/cpifoodandexpenditures/20Includesa6percentdeclineforprotein,a16percentdeclineforcalcium,a9percentdeclineforphosphorus,a15percentdeclineforiron,a38percentdeclineforriboflavin,anda20percentdeclineforvitaminC.Theteamdidn’tfindanynutrientsthatincreasedinthelast50years,althoughthiaminandniacinbarelychanged.
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DavisDRetal.,ChangesinUSDAFoodCompositionDatafor43GardenCrops,1950to1999,JournaloftheAmericanCollegeofNutrition,Vol.23,No.6,2004,pp.669‐682.21Martinez,SteveW.TheU.S.FoodMarketingSystem:RecentDevelopments,1997‐2006,ERR‐42.U.S.Dept.ofAgriculture,Econ.Res.Serv.May2007.22WalshB.GettingRealAbouttheHighPriceofCheapFood.TIMEinconjunctionwithCNN;August21,2009[Internet]www.time.com23 Buzby JC. Possible implications for U.S. agriculture from adoption of select dietary guidelines. Economic Research Report No. 31, U.S. Department of Agriculture, Economic Research Service, November 2006. 24 We acknowledge Fred Kirschenmann; Distinguished Fellow, Leopold Center for Sustainable Agriculture; President, Stone Barns Center for Food and Agriculture, who brought the Foodshed concept to our attention.