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House Select Committee on the Climate Crisis Report Includes Major Agriculture Policy and Food Waste Reduction Recommendations, Including Several Submitted by FLPC and FBLE

via CHLPI Blog

by Ali Schklair and MJ McDonald

Front cover of 'Solving the Climate Crisis' report

 

In June 2020, the House Select Committee on the Climate Crisis (Select Committee) released Solving the Climate Crisis, a comprehensive set of recommendations to confront climate change and resulting economic and racial inequities. Created in January 2019 by House Resolution 6, the bipartisan Select Committee spent 17 months interviewing scientists and stakeholders and gathering input through hearings and written comments. The Select Committee’s efforts ultimately culminated in hundreds of policy recommendations focused on 12 key pillars. As a member of the Farm Bill Law Enterprise (FBLE), Harvard Law School Food Law and Policy Clinic (FLPC) responded to a number of the Select Committee’s questions on ways to mitigate and adapt to climate change through two separate submissions: (1) on behalf of FBLE, FLPC submitted recommendations on agriculture policy and, (2) FLPC submitted recommendations on food loss and waste reduction policy. We are pleased to see that many of FBLE and FLPC’s recommendations were included in the Select Committee’s report. This post highlights where the Committee adopted recommendations in line with FLPC’s submissions and notes opportunities where the Select Committee could make its recommendations even more effective.

One of FBLE’s key recommendations was to move the United States agricultural system away from reliance on annual crops and toward a more sustainable perennial system. The SCCC report recognized the significant climate benefits agroforestry offers and recommends that Congress fund agroforestry research and establish a grant program (through existing conservation program funding) to support farmers transitioning to agroforestry.

FBLE also recommended that conservation compliance requirements be revised to include climate-friendly practices.  Set forth in the Conservation Title of the Farm Bill, conservation compliance requires producers to follow a conservation plan approved by the Natural Resources Conservation Service when planting crops on highly erodible land and prohibits producers from planting on wetlands. FBLE recommended that government funds only be awarded to producers who incorporate conservation and climate measures on their land, as opposed to producers who meet the minimum requirements for highly erodible lands and wetlands.  FBLE also noted that even if conservation compliance requirements remained unchanged, the U.S. Department of Agriculture (USDA) must increase enforcement of the requirement for them to be effective.

In line with FBLE’s submission, the Select Committee recommended that enforcement of the conservation compliance requirements be improved.  However, the Select Committee’s enforcement strategy focused mostly on administrative changes, rather than conservation compliance. To further promote conservation compliance, the Select Committee recommended that Congress increase funding to restore native grasses and wetlands and expand the sodsaver policy. Currently, this policy only applies to six states, so expansion would be beneficial.  Nevertheless, the change falls short of FBLE’s recommendation that subsidies be made conditional on enhanced conservation compliance.  Therefore, the Select Committee’s suggested changes may be too minor to achieve the Committee’s purported goals.

Crop insurance offers an additional opportunity to incentivize climate-friendly farming practices.  As FBLE suggested, the Select Committee recommended that the USDA provide more resources to the Whole Farm Revenue Protection Program, an insurance program that provides coverage for all of a farmer’s crops, thus eliminating the need to insure each crop individually. The Select Committee further suggested that Congress increase the USDA’s capacity to help farmers enroll in the program and offer higher incentives for incorporating crop diversification and climate conscious farming practices. Finally, the Select Committee included FBLE’s recommendation to offer discounts on crop insurance to farmers who use climate-friendly practices.

FBLE also made a number of recommendations regarding improvements to conservation programs to help achieve climate goals. FLPC is pleased to see that the Select Committee included many of FBLE’s Conservation Reserve Program (CRP) recommendations in its report, including expanding acreage protected under the CRP, increasing rental rates, lifting administrative barriers to CRP enrollment, extending CRP contract limits and allowing permanent easements. the Select Committee also addressed FBLE’s recommendations for improving the Environmental Quality Incentives Program (EQIP), and included the recommendation to make practices that promote carbon sequestration and reduce greenhouse gas emissions eligible for conservation incentive contracts. FLPC is disappointed, however, that the Select Committee did not take up FBLE’s recommendation to cut funding for Concentrated Animal Feeding Operations (CAFOs). Despite the environmental harm caused by methane gas emissions from these operations, the Select Committee did not address CAFOs in its report.

All of these suggested policy changes can greatly reduce agriculture’s impact on climate change. However, in order to sustain this progress, Congress must invest in future developments of our agricultural system.  FBLE recommended many ways Congress could contribute to ongoing research on climate-friendly farming practices.  The Select Committee included the recommendation to formally authorize regional USDA Climate Hubs, which will produce practical science-based research and provide general support to farmers engaged in climate-friendly farming.  Further, while not included in FBLE’s recommendations, FLPC agrees with the Select Committee’s recommendation that Congress should provide financial and technical support to beginning, young, and socially disadvantaged farmers working to adopt climate-smart practices.

In addition to the recommendations submitted as a member of FBLE, FLPC submitted its own recommendations on food loss and waste reduction policy opportunities. For years FLPC has supported local, state, and federal policies that divert excess food to people in need and prevent the economic and environmental impact of food waste. FLPC submitted several food loss and waste policy recommendations to the Select Committee and is excited the Committee demonstrated its commitment to reducing food waste and increasing food recovery in its final report. The Select Committee recommended that Congress support implementation and provide funding for the Winning on Reducing Food Waste initiative and provide financial resources to reduce food waste by 50 percent by 2030. The Committee also called for Congress to increase support and investments in food waste reduction initiatives in homes, schools, grocery stores, and restaurants, as well as on the farm, throughout the government, and in landfills. These recommendations align with FLPC’s submitted recommendations. Although the Select Committee’s recommendations are broad, they specifically suggest that funds and resources be provided for food waste reduction efforts.  FLPC’s submission detailed a number of specific ways that Congress support and invest in food waste reduction, should Congress decide to create targeted solutions in upcoming legislation.

For example, Congress could provide funding for a national food waste educational campaign or for comprehensive research and tracking on the amount of food lost or wasted at each stage of the supply chain.  Additionally, funding could be allocated to the USDA to study imperfect produce waste and potential solutions and to research and create grant programs for innovative technologies that limit food waste. To divert food waste from landfills, Congress could increase funding to support the construction of composting and anaerobic digestion facilities, provide research and development funding for food recycling technologies, and fully fund the Compost and Food Waste Reduction Pilot Projects grant that was included in the 2018 American Agricultural Act (2018 Farm Bill), while providing funding to states and localities that seek to implement organic waste bans. Congress has many opportunities to invest in food loss and waste reduction, thereby leading our nation in the fight against the global climate crisis.  We hope Congress will consider the many food waste reduction opportunities supported by FLPC and the Select Committee.

FLPC looks forward to seeing all of these recommendations incorporated into U.S. agricultural policy. One bill that already addresses many of these issues is the Agriculture Resilience Act (H.R. 5861). Introduced by Representative Chellie Pingree, the bill would increase funding and support for farmers committed to climate-friendly farming practices, such as land conservation and carbon sequestration. The bill would also encourage the use of digesters to convert methane emissions from livestock and food waste into renewable energy. To help reinforce SCCC’s recommendations, FLPC hopes that Congress considers passing the Agriculture Resilience Act to achieve a climate-friendly and resilient agricultural system.

Amid Pandemic, New Research Provides a Roadmap to Fight Hunger and Climate Change through Increased Food Donation

via Globe Newswire

Today, the Harvard Law School Food Law and Policy Clinic (FLPC) released a first-of-its-kind interactive resource to inspire long-term policy solutions to food waste, hunger, and climate change: The Global Food Donation Policy Atlas. In partnership with The Global FoodBanking Network (GFN), and with the support of the Walmart Foundation,  The Global Food Donation Policy Atlas maps the laws and policies affecting food donation around the globe and provides recommendations to prevent unnecessary food waste and improve food distribution to those in need. The research released today focuses on Argentina, Canada, India, Mexico, and the United States, the first five of 15 countries participating in this project.

While hunger everywhere is on the rise due to the impacts of COVID-19,  one-third of all food produced for human consumption goes to waste, according to the Food and Agriculture Organization of the United Nations (FAO). There has long been a need for countries to bridge the gap between surplus food and the growing need for food for the most vulnerable; the pandemic has profoundly exacerbated that need. The Global Food Donation Policy Atlas provides guidance so food system actors will be more likely to distribute safe, surplus food to food insecure populations, instead of sending it to the landfill.

The Global Food Donation Policy Atlas looks at six main barriers to food recovery: food safety for donations, date labeling, liability protection for food donations, tax incentives and barriers, government grants and funding, and food waste penalties or donation requirements. It identifies several opportunities for governments to prevent unnecessary waste and to promote food donation. Examples of policy recommendations that apply across several countries include:

  • Clarify national food safety guidance as to the rules that apply to donated products;
  • Establish clear, federal guidelines for dual-date labeling, featuring expiration dates to convey when food is no longer safe to eat or “best by” dates for food that may safely be consumed and donated once the date has passed;
  • Offer liability protection to food donors and food recovery organizations that act in good faith; and
  • Remove tax barriers and provide incentives so it is less expensive to donate food than it is to dispose of it.

“It’s more important than ever for policymakers, government agencies, food donors, companies, food banks, and the public to understand the impact of unnecessary food waste in their countries and the need to change it,” said Emily Broad Leib, Faculty Director at FLPC and Clinical Professor of Law at Harvard Law School. “The Global Food Donation Policy Atlas is the first research study to compare food donation policies and best practices across the world, providing us with the global perspective we need to address this complex issue,” Broad Leib concluded.

Food banks worldwide depend largely on product donations to provide food to those facing hunger. Due to the COVID-19 pandemic, many food banks are seeing increases in demand for service. Through a combination of research and on-the-ground field work with food bank staff, food industry professionals, government officials, and food recovery organizations, FLPC researchers developed accessible country-specific legal guides and policy recommendations to outline best practices and long-term solutions for increased food donations.

“The COVID-19 pandemic is unlike any situation we have ever experienced before. Food bank organizations in our network are struggling to meet demand and get food to those who need it most,” said Lisa Moon, President and CEO of GFN. “The release of this project is extremely timely as it provides a roadmap for organizations and shines a light on global food system challenges for policymakers.”

FLPC will release similar reports for ten additional countries in the coming year: Chile, Colombia, Costa Rica, Dominican Republic, France, Guatemala, Peru, Singapore, South Africa, and the United Kingdom.

“Walmart Foundation has a long-standing commitment to increasing access to healthier foods in communities around the world and we are pleased to support the Global Food Donation Policy Atlas, because of its potential to accelerate effective and sustainable solutions,” said Eileen Hyde, Director of Sustainable Food Systems and Food Access for Walmart.org. “This project provides not only groundbreaking research to address the complexity of public policy relating to food donations, but it also presents clear opportunities to improve how surplus food gets to communities that need it.”

Legal guides, policy recommendations, executive summaries, and an interactive map to compare food donation laws and policies across countries are available at atlas.foodbanking.org/.

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ABOUT THE HARVARD FOOD LAW AND POLICY CLINIC

The Harvard Law School Food Law and Policy Clinic (FLPC) serves partner organizations and communities by providing guidance on cutting-edge food system issues, while engaging law students in the practice of food law and policy. FLPC’s work focuses on increasing access to healthy foods, supporting sustainable production and regional food systems, promoting community-led food system change,  and reducing waste of healthy, wholesome food. FLPC is committed to advancing a cross-sector, multi-disciplinary and inclusive approach to its work, building partnerships with academic institutions, government agencies, private sector actors, and civil society with expertise in public health, the environment, and the economy. For more information, visit http://www.chlpi.org/flpc/.

ABOUT THE GLOBAL FOODBANKING NETWORK
The Global FoodBanking Network (GFN) is an international non-profit organization that nourishes the world’s hungry through uniting and advancing food banks in 40+ countries. GFN focuses on combating hunger and preventing food waste by providing expertise, directing resources, sharing knowledge, and developing connections that increase efficiency, ensure food safety, and reach more people facing hunger. Last year, 943 GFN member food banks rescued over 500 million kilograms of food and grocery products and redirected it to feed 9.6 million people through a network of more than 55,000 social service and community-based organizations. For more information, please visit www.foodbanking.org.

ABOUT THE WALMART FOUNDATION

By using our strengths to help others, Walmart and the Walmart Foundation create opportunities for people to live better every day. Walmart has stores in 28 countries, employing more than 2.3 million associates and doing business with thousands of suppliers who, in turn, employ millions of people. Walmart and the Walmart Foundation are helping people live better by accelerating upward job mobility for the retail workforce; addressing hunger and making healthier, more sustainably-grown food a reality; and building strong communities where we operate. We are not only working to tackle key social issues, but we are also collaborating with others to inspire solutions for long-lasting systemic change. To learn more about Walmart’s giving, visit giving.walmart.com.

How ‘Upcycled’ Ingredients Can Help Reduce The $940 Billion Global Food Waste Problem

via Forbes

by Robin D. Schatz

ReGrained, which turns spent brewing grains into granola bars and snack puffs, is just one of 70 companies in the Upcycled Food Association. REGRAINED

Jam made with bacon scraps; fish jerky that turns unwanted fish into something delicious; granola bars and snack puffs crafted from spent brewing grams.

These are just a few examples of how entrepreneurial ingenuity is transforming food byproducts and scraps into novel and often very nutritious products for human consumption, creating new sources of protein, other nutrients and fiber in the process—and keeping it all out of landfills.

“Upcycling,” the new term of art, is one way to reduce reduce food waste and help the environment. But until now, there hasn’t been a single standard definition of upcycling, even as the number of startups tackling food waste grows and consumers show more interest in buying products made with upcycled ingredients.

Today, May 19, a task force comprised of food industry players, academic researchers an1d nonprofits is unveiling the first formal definition of the term upcycling. The group says the adoption of a single term and definition by the industry will lead to a powerful new product category that will encourage both the food industry and consumers to embrace products with upcycled ingredients. A 2019 report from Future Market Insights estimated the current value of the upcycled food industry at more than $46 million and projected a 5 percent compounded annual growth rate.

Food waste and loss cost the global economy more than $940 billion a year, according to a study by the United Nation’s Food and Agriculture Organization. Proponents of upcycling say the practice could help reduce the more than 70 billion tons of greenhouse gases generated by food loss and waste, while creating new jobs and innovative products.

The Upcycled Food Association, a Denver-based nonprofit with about 70 member companies, formed just six months ago. Its members, mostly in the U.S., produce some 400 upcycled food products. Realizing a need for clarity, the group immediately established a task force to define upcycled food. Participants included researchers from Harvard University and Drexel University, along with representatives of nonprofits such as ReFed, which aims to reduce food waste, the World Wildlife Fund and NRDC (Natural Resources Defense Council).

Here’s the definition the task force came up with: Upcycled foods use ingredients that otherwise would not have gone to human consumption, are procured and produced using verifiable supply chains, and have a positive impact on the environment.

Upcycled food provides protein, fiber and nutrients that might otherwise have gone to waste. UPCYCLED FOOD ASSOCIATION

Upcycled ingredients must add value to a product and help to reduce food waste. Hot dogs and baby carrots don’t count, Turner Wyatt, CEO of the Upcycled Food Association, told me. The group doesn’t want to see big food companies engage in “greenwashing” by rebranding products that won’t mitigate the food waste problem and have been around for years.

“The main goal is to get them to adopt upcycled food ingredients into their food products, putting it all to use and making sure it goes to feed people,” Wyatt added. “We want upcycled to be a word with integrity in the food system.”

 

Upcycled Food Association’s infographic accompanies the May 19 release of the first formal industry definition of upcycling. UPCYCLED FOOD ASSOCIATION

Upcycling is clearly gaining momentum. In 2019, Future Market Insights estimated the upcycled food industry was worth more than $46 billion, with a predicted 5% compound annual growth rate. A study from the food product consultancy Mattson said that more than half of consumers want to buy more upcycled foods. And a 2017 study from Drexel University found that consumers view upcycled food as having similar environmental benefits to organics.

“Upcycled food needs a clear definition in order to be meaningful and relevant,” Jonathon Deutsch, co-author of the 2017 Drexel study and a member of the task force, said in a statement.

 

Environmental benefits of upcycled food UPCYCLED FOOD ASSOCIATION

Another task force member, Emily Broad Leib, clinical professor of law, director of the Harvard Law School Food Law and Policy Clinic, and deputy director of the Harvard Law School Center for Health Law and Policy Innovation, said in a statement that scaling up the use of upcycled foods would help make the food supply chain more efficient and resilient. “This upcycled foods definition serves as a strong starting place to help businesses, consumers, and other users align around a common meaning and usage of the term.”

Later this year, the Upcycled Food Association will use its new definition as jumping-off point to develop a product certification program. To learn more about the definition of upcycling and the industry’s future, you can sign up for the association’s free public webinar on May 27. You can also find the full infographic and the task force’s report on the Upcycled Food Association’s website.

Don’t repeat the mistakes of 1918

via Boston Globe

by Carol Rose and Robert Greenwald

A positive COVID-19 serological test at a laboratory in Colmar, eastern France, on April 14, the 29th day of a strict lockdown in France to stop the spread of COVID-19.

A positive COVID-19 serological test at a laboratory in Colmar, eastern France, on April 14, the 29th day of a strict lockdown in France to stop the spread of COVID-19.SEBASTIEN BOZON/AFP VIA GETTY IMAGES

During the 1918 influenza pandemic, local governments in the United States placed special placards on the doors of homes where sick people were subject to quarantine. The measure was an attempt to contain the spread of a virus that ultimately killed nearly 700,000 people in the United States alone. Sadly, this well-intentioned move backfired: Many doctors chose not to report cases in order to prevent homes from being quarantined. Families of sick people sought to evade the stigma of a placard on their homes by not seeking medical attention.

In light of today’s coronavirus crisis, it’s useful to recall this history and to avoid repeating the mistakes of the past. Yet in an executive order dated March 18, the administration of Governor Charlie Baker directed local boards of health to submit to first responders the home addresses of people who have tested positive for the virus. The idea is that police, fire services, and EMTs should know which homes have COVID-19 cases so that responders can adequately protect themselves.

Protecting the health of first responders is certainly an important priority that the state needs to address; however, some public health experts have noted that disclosing addresses does not ensure a first responder would be safe from exposure from asymptomatic people or from those who are infected but remain untested. It may seem counterintuitive, but this order could indeed do more harm than good.

This truth is that we do not know — and at this point cannot know— who has COVID-19 and who does not. Recent estimates are that as many as 1 in 4 cases may be asymptomatic. Thousands of people who have fallen sick and who may have the virus have been unable to obtain a test, and so won’t appear on any list of homes provided to responders. Providing the addresses to first responders of people who have tested positive thus makes no sense — from either a public health or patient privacy perspective. To protect public health, we cannot create lists that give our responders a false sense of security and instead they must treat everyone as a potential carrier of the virus.

First responders deserve the best equipment, and the best policies, to ensure their safety. But the harsh reality is that our first responders continue to lack sufficient personal protective equipment and, system-wide, we don’t have enough COVID-19 tests. Emergency medical technicians, paramedics, firefighters, and police officers — like our doctors, nurses, and other front-line essential workers — are being asked to continue to do their jobs amid acute conditions, without the equipment they need to keep themselves safe.

Thankfully, government officials in Massachusetts are taking important steps to address the lack of PPE and tests for front-line workers. The Baker administration and Mayor Marty Walsh of Boston announced plans to set up additional testing sites that give priority to first responders. These sites should be open to all workers who are putting themselves at risk, whether they are first responders or grocery store workers.

Ultimately, we must listen to public health consensus during public health emergencies. And the public health experts are clear: The twin threats of community-level transmission and a lack of wide-scale testing make the use of home addresses dangerously ineffective. Worse, since screening is critical to slowing the spread of the disease, disclosing addresses of confirmed cases will undermine public health efforts by deterring some people from seeking testing and treatment — just like during the 1918 influenza.

Sometimes public health needs overtake our normal expectations of privacy or other civil liberties. But disclosing the home addresses of people who have tested positive is not one of those cases. First responders, like all of us, should treat every person they interact with as a possible COVID-19 patient. Relying on the training of our first responders, not the home addresses of those stricken by the virus, is the best way to ensure public health and safety for everyone.

Carol Rose is the executive director of the ACLU of Massachusetts. Robert Greenwald is a clinical professor of law at Harvard Law School and the faculty director of the Law School’s Center for Health Law and Policy Innovation.

The covid-19 crisis is going to get much worse when it hits rural areas

The recently closed Pickens County Medical Center in Carrollton, Ala., on March 26.

The recently closed Pickens County Medical Center in Carrollton, Ala., on March 26. (Jay Reeves/AP)

Michelle A. Williams is dean of the Harvard T.H. Chan School of Public Health. Bizu Gelaye is an assistant professor at Harvard and Massachusetts General Hospital. Emily M. Broad Leib is a law professor, director of the Harvard Law School Food Law and Policy Clinic and deputy director of the Harvard Law School Center for Health Law and Policy Innovation.

 

Over the past few weeks, our urban centers have scrambled to mobilize in response to the mounting covid-19 cases. But be forewarned: It’s only a matter of time before the virus attacks small, often forgotten towns and rural counties. And that’s where this disease will hit hardest.

 

Covid-19 is infiltrating more of the country with each passing day. Colorado, Utah and Idaho are grappling with sudden clusters in counties popular with out-of-state tourists. Cases are also skyrocketing in Southern states such as Georgia, Florida and Louisiana. So far, sparsely populated communities have been better insulated from the spread. But since no place in the United States is truly isolated, there’s simply no outrunning this virus. Every community is at imminent risk.

 

Rural communities could fare far worse than their urban and suburban counterparts. Rural populations are older on average, with more than 20 percent above the age of 65. Rural populations also tend to have poorer overall health, suffering from higher rates of chronic illnesses such as heart disease, diabetes and lung conditions, all of which put them at greater risk of becoming severely ill — or even dying — should they become infected.

 

Rural areas also already suffer from a rural mortality penalty, with a disparity in mortality rates between urban and rural areas that has been climbing since the 1980s. Chronic financial strain and the erosion of opportunity have contributed to “deaths of despair” as well as a rise in conditions such as heart disease, Type 2 diabetes and stroke. Add in prolonged social distancing and the economic downturn, and these trends will surely worsen.

 

Long before the novel coronavirus emerged as a threat, America’s rural hospitals were already in dire financial straits. About 1 in 4 are vulnerable to being shuttered, with 120 having closed in the past decade. With the pandemic looming, many of these health systems have been forced to cancel elective procedures and non-urgent services such as physical therapy and lab tests, which in some cases account for half of their revenue. As cash flow wanes, the American Hospital Association warns that even more hospitals could be forced to shut their doors exactly when patients need them most.

Rural counties have just 5,600 intensive care beds total, compared with more than 50,000 in urban counties. In fact, half of U.S. counties do not have any ICU beds at all. And even if these counties are somehow able to scale up their infrastructure, experts are afraid there will not be enough health-care workers to staff them. The time to prepare rural America is now. Fortunately, rural health systems will get some relief from the stimulus bill, which allocated $100 billion to health-care providers. But it is critical that we find additional ways to alleviate the burden on these health systems to the greatest extent possible.

 

One way to do that is by expanding telemedicine capabilities, which will allow millions of Americans to be seen by care providers even if there’s no room for them in hospitals. The Centers for Medicare & Medicaid Services recently issued guidelines that expand access to telemedicine for Americans on Medicare. That directive now includes federally qualified health centers, rural health clinics and hospices, so they, too, can be reimbursed for serving patients remotely.

 

Of course, telemedicine is far from a panacea, as broadband access remains limited in so much of rural America. The stimulus included an additional $100 million for rural broadband access, but this will not be enough. In the long term, policymakers must continue to close the “digital divide,” recognizing that Internet access is both an economic and health necessity. In the short term, Internet service providers should consider rolling out mobile Internet units and providing WiFi hotspot access to temporarily increase connectivity.

More importantly, we must expand the social safety net, especially the Supplemental Nutrition Assistance Program, child nutrition programs, Supplemental Security Income, housing assistance and Medicaid. Lawmakers must also ensure the availability of these programs to rural residents. For example, unlike their urban counterparts, many rural children cannot come to schools each day to pick up meals. The Agriculture Department launched a pilot program to deliver meals to rural children in some regions, but initiatives such as this should be more widespread.

 

It is clear the battle against covid-19 will look vastly different in the heartland than in our cities. The U.S. Navy won’t be docking a floating hospital in Nuckolls County, Neb. But if what’s happened in America’s coastal cities can teach us anything, it’s that the coming weeks will determine the trajectory of this virus. And we don’t have a moment to waste.

HLS clinics and students fight for the most vulnerable amid COVID-19

via Harvard Law Today

by Brett Milano

Computer screen showing Zoom session between three people

Zack Manley ’21 (upper left) and Norah Rast ’21 meet with Clinical Professor Sabi Ardalan ’02 (upper right), director of the Harvard Immigration and Refugee Clinical Program, to discuss legal strategy to get their client, an asylum seeker, out of Stewart Detention Center, where several employees and immigrants have tested positive for COVID-19. They recently won a stay of their client’s deportation and are appealing his case to the U.S. Court of Appeals for the Eleventh Circuit.

For the Clinical Program at Harvard Law School, the past weeks of the COVID-19 pandemic have been a time to mobilize. As the clinics have moved to working remotely, their work has continued with new urgency—and often, with new challenges as well.

“The Law School’s clinics and student practice organizations have been incredibly nimble in their ability to continue to advocate for their existing clients and also to take on the emerging legal needs of community members related to the COVID-19 outbreak,” says Dan Nagin, Clinical Professor of Law and Vice Dean for Experiential and Clinical Education. “Clinical directors and supervisors and their students are using a variety of technology—from Zoom to FaceTime to telephone—to be accessible to each other and to their client communities, and to meet the pressing legal needs of the most vulnerable. Many courts and agencies have ongoing and active dockets and are conducting hearings remotely, and students, staff, and faculty at clinics and student practice organizations across HLS are continuing to do critical work in a variety of legal areas.”

“This work also includes absolutely vital policy advocacy by clinics to ensure that governmental responses to the pandemic take into account questions of equity and access to healthcare, financial assistance, and other supports,” Nagin added.

Each clinic has also adapted to working online. “Zoom is our new best friend,”  says Clinical Professor Robert Greenwald, faculty director of the Center for Health Law and Policy Innovation (CHLPI). “I’ve learned to teach online, and I’m now a savant at Google Docs. I have AirPods attached to my head for 12-15 hours each day. But we’ve adjusted.”

CHLPI, he says, remains on the front line of advocating for the care and treatment of low-income populations. “We are working to secure testing and treatment, as well as all other necessary health care, for those who are most vulnerable, including many people living with AIDs, racial and ethnic groups that are historically disenfranchised, and the growing number of people who are uninsured.”

The work involves numerous efforts on both the local and national levels. They have called on the Trump administration to use its emergency authority to allow for early and extended drug refills, and to fill gaps in the next stimulus package, including an increase in Medicaid funding and an extension of no-cost testing and treatment. They are also working with several partners, such as Feeding America and the national Food is Medicine Coalition, to address the food and nutrition needs of vulnerable populations. And they are working to promote equal health access within Massachusetts, calling on Governor Charlie Baker to collect and publish testing data related to race and ethnicity to identify the hardest-hit groups.

Robert Greenwald as seen through a video conferencing screen

Robert Greenwald, faculty director of the Center for Health Law and Policy Innovation, has shared his public health expertise with multiple national media outlets during the COVID-19 crisis, including in an April 8 interview with WNBC on privacy concerns with police departments maintaining a list of addresses of confirmed coronavirus cases.

CHLPI has also taken on the challenge of preserving the Affordable Care Act. Two students, Isaac Green ’22 and Will Dobbs-Allsopp ’20, are currently working to get the Trump administration and 18 state attorneys general to withdraw from a Supreme Court challenge to the ACA. Though the administration seems determined to overturn the act, Dobbs-Allsopp says, grassroots efforts on the local level could make the difference. The clinic is planning to work with community health groups in different states.

“At the end of the day, attorneys general are politicians who respond to political pressure. People’s interest in universal health coverage has picked up, and you’re going to see some interesting polling in the next few weeks,” Dobbs-Allsopp says. “They’re realizing that getting rid of this law means the disease will persist and the economy will get even worse.”

In addition to the work we’re doing with individual clients, we are asking what work we can be doing to fight the systemic causes of poverty, so that these issues don’t keep coming up.

Kiah Duggins ’21, Harvard Legal Aid Bureau president

The Harvard Legal Aid Bureau (HLAB) correctly predicted that the virus would disproportionately affect minority and impoverished communities—an idea that is only now beginning to hit the mainstream. HLAB’s President Kiah Duggins ’21, who works closely with HLAB Faculty Director Esme Caramello ’99, cites the inaccuracy of New York Governor Andrew Cuomo’s reference to the virus as “the great equalizer.”

“The narrative is that anyone can get the virus, which is true. But low-income workers are either on the frontlines without adequate protection, or they’re disproportionately in danger of losing their jobs,” Duggins says. “And as the numbers come out, we’re seeing that black people are dying at disproportionately high rates.”

She adds, “This has raised interesting discussions about our mission, because a lot of the issues that Americans are facing because of the crisis have been faced by lower-income people forever. The crisis has elevated that in the public consciousness. So, in addition to the work we’re doing with individual clients, we are asking what work we can be doing to fight the systemic causes of poverty, so that these issues don’t keep coming up.”

This, she says, includes working with Greater Boston Legal Services and City Life/Vida Urbana in Jamaica Plain.

“Even before the crisis we were trying to promote racial and economic justice, to empower those communities directly,” Duggins says. “And the crisis has made it clear how the causes and consequences of poverty affect these communities. So we’re now able to get things done, like an eviction moratorium or rent suspension. People who weren’t supportive before are supportive now because it affects a broader swath of people.”

A group of HLAB members standing in front of MA House of Representative steps. Many are holding signs or banners.

In early March, the Harvard Legal Aid Bureau, Greater Boston Legal Services and City Life/Vida Urbana organized a rally in front of Boston Housing Court to make the case for a complete halt to any evictions while the state of emergency in Massachusetts remains in effect. On April 2, the Massachusetts House of Representatives passed legislation based on HD.4935, an act providing for a moratorium on evictions and foreclosures during the COVID-19 emergency.

HLAB has also been working to help the University support lower-income Harvard students who were approved to continue living in on-campus housing. “Many of the members of HLAB are lower-income and people of color, so the worlds are more interconnected than you might think. We want to make sure we’re creating healthy lawyers,” Duggins says.

The Harvard Immigration and Refugee Clinic (HIRC) is continuing its mission of advocating for immigrant justice. And it’s now, more than ever, trying to respond to the health-threatening conditions within immigration detention centers.

“We’re continuing our work on behalf of clients, including litigation and policy advocacy,” says HIRC Director and Clinical Law Professor Sabrineh Ardalan ’02. “We’re focusing on getting clients out of immigration detention, given the conditions and risks of being detained right now due to COVID-19.”

One of the HIRC clients, she notes, is an asylum seeker detained at the Stewart Detention Center in Georgia, where conditions are dire. “He sleeps in a room with more than 60 people in bunk beds, so there is no social distancing. At meals, they sit four to a table and he works in food prep, where there are 30-40 people who work the shift. Very few guards have protective gear, and there are documented reports of officials and immigrants with COVID-19 in the facility.”

Circumstances in Massachusetts detention facilities, Ardalan says, are also dismal. The Crimmigration Clinic, directed by Phil Torrey, has filed habeas petitions to seek the release of two immigrant clients detained at the Franklin County House of Correction in Greenfield, Mass. The petitions argue that these individuals are being held in violation of their Fifth Amendment rights and both have lodged claims concerning potential COVID-19 exposure. Sarah Libowsky ’20 and Michael Hur ’20 are tentatively scheduled to argue one of the habeas petitions on April 16 before Judge Mark G. Mastroianni, in the U.S. District Court for the District of Massachusetts.

Similarly, the Harvard Immigration and Refugee Clinic at Greater Boston Legal Services, led by Nancy Kelly and John Willshire Carrera, joined the American Civil Liberties Union of New Hampshire in filing an emergency federal habeas lawsuit on behalf of an indigenous Guatemalan asylum seeker detained in Strafford, New Hampshire, and managed to secure his release from detention.

HIRC attorneys and its social work team are also trying to respond to the needs of immigrant clients who are not detained, but who are in precarious circumstances due to COVID-19. “Some are worried about how to pay rent and feed their families. Others are still going to work, because remote work isn’t an option, and their health is at risk because of it,” Ardalan says. Immigrant families may be afraid to access the health care and services they need, due to concerns about immigration enforcement.

HIRC has joined the Massachusetts Law Reform Institute and Prisoners’ Legal Services of Massachusetts, among dozens of other organizations, in submitting a letter to Immigration and Customs Enforcement (ICE) and local county sheriffs and jail wardens of the facilities that contract with ICE, urging them to cease local immigration enforcement operations and arrests and release immigrants in custody in light of the pandemic.

“It has been very difficult. A variety of lawsuits have been filed across the country with mixed results,” Ardalan says. One encouraging sign, she says, is that some local courts and officials have proved willing to step in and order immigrants’ release from detention. “I hope that all our advocacy efforts will bear fruit, because circumstances are so dire.”

Screenshot shows a Zoom meeting with 9 women holding signs that read 'free her'

The Harvard Prison Legal Assistance Project is advocating for immediate release of vulnerable inmates who pose no public risk to protect the incarcerated community from COVID-19.

The Harvard Prison Legal Assistance Project (PLAP) has also been working to keep incarcerated people safe from COVID-19. PLAP hosted a Zoom phone bank on April 3 as part of the Massachusetts week of action, organized by Families for Justice as Healing and the National Council for Incarcerated and Formerly Incarcerated Women and Girls. PLAP is calling on district attorneys, sheriffs, the governor, elected representatives, and the Massachusetts Department of Corrections to demand immediate release of vulnerable inmates who pose no public risk to protect the incarcerated community from COVID-19.

Harvard’s Federal Tax Clinic has remained busy even as the IRS itself has largely shut down. That means pressing forward with cases that were underway before the pandemic hit. “We deal with people having some kind of problem with the IRS—either they owe and they need to work out payments, or the IRS says they owe more than they think,” says Clinic Director T. Keith Fogg. Clients are currently having difficulty reaching anyone at the IRS—which has closed its last operating service center, causing cases in the administrative stage to be put on hold. Yet cases in court are still moving forward remotely, so there is still plenty of work for clinic students.

The clinic is also working with direct consequences of the pandemic, including laying some groundwork for the post-recovery era. For one thing, Fogg says, we can probably expect a shift to more email filing and electronic signatures in the future. And the recent implementation of the CARES act, which provides a $1200 rebate to some workers, has also opened work possibilities.

“We’ve been talking a fair amount to people at the IRS about implementing their procedures during the crisis, and explaining to the community what new provisions mean,” Fogg says. The clinic is already engaged in advocacy to reduce the number of people who need to file a tax return to receive the rebate (the IRS has already exempted regular social security recipients). Advocacy efforts are ongoing to exempt recipients of Supplemental Security Income and Veterans benefits who desperately need the financial help.

Faculty and students at the Food Law and Policy Clinic (FLPC) have also stepped up their work during the pandemic, writing briefs aimed at saving tons of food that could feed the hungry, and working to inform the response to COVID-19, including congressional legislation. In the early stages of the crisis, FLPC acted quickly to outline avenues for donating excess food in the wake of campus and business shutdowns to help feed the hungry. Since then, the clinic has developed and amplified several other resources on using food donation to support food banks and other food recovery organizations, which are facing both an increase in demand and limited resources.

“There are already so many people who were in vulnerable situations,” says Emily Broad Leib ’08, director of FLPC and deputy director of the Harvard Law School Center for Health Law and Policy Innovation. “The crisis has exacerbated food access challenges for those people, and it has added so many more individuals and families in need. Workers are losing jobs, especially those doing hourly work—many, in fact, who work in the food industry. We are going to see a huge increase in people who suddenly need help getting basic needs met, especially food.”

Screen shot of Emily Broad Lieb speaking on a podcast about food law

On “Food Talk with Dani Nierenberg” on March 25, Emily Broad Leib, director of HLS’ Food Law & Policy Clinic, talked about food law and policy concerns in the COVID-19 crisis, including protecting and promoting better wages for food workers.

The FLPC has also responded to new concerns about food safety by preparing an issue brief with recommendations for federal and state governments to facilitate food delivery during the crisis using existing food assistance programs, such as the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

They also have come up with proposals for getting food from food banks and other organizations delivered directly to people’s doors, and for getting Congress to  support these community-based food delivery organizations. Their recommendations include investments in technologies that connect food donors to recovery organizations.

“We make the point that these technologies can be really responsive to the challenges of the moment,” says Broad Leib, “but most of them have been developed by small nonprofits. Helping them scale up quickly to meet the needs of the growing number of people who need food support is going to require an investment.”

Waste not, want not

via Harvard Law Today

by Emily Newburger

man in green shirt holds a box of produce that reads "stay home we deliver"

Delivering food ordered online while in home isolation during quarantine. Stay home we deliver sign on box.

During a pandemic, a lot of things come to a halt, but one thing that never ceases is our need for a reliable supply of safe, nutritious food. Harvard Law School Professor Emily Broad Leib ’08, director of the HLS Food Law and Policy Clinic (FLPC), and her students have been working furiously to ensure that the most vulnerable—and ultimately the rest of us—are fed.

Broad Leib and the clinic have long been a resource for food producers, food-focused nonprofits, government agencies, legislators, policy experts, and other food system stakeholders. But since early March, as the COVID-19 crisis has grown, she and a team of students and clinic staff have worked around the clock, writing briefs aimed at saving tons of food that could feed the hungry, and working to inform the response to COVID-19, including legislation that Congress has been hammering out.

According to Feeding America, a national network of food banks, one in seven Americans relied on food banks to get enough to eat before the pandemic. The clinic is a national leader in policy efforts to prevent food waste and promote food recovery, which it undertakes by partnering to provide legal and policy support to a range of programs that pick up excess food from universities, restaurants, and other organizations and get it to food banks.

As universities suddenly began to move to online learning and close down most campus operations, and many businesses reduced hours or shut their doors, Broad Leib knew this would leave behind excess food. The clinic mobilized quickly to prepare a handout urging organizations not to shutter without passing on food that could feed the hungry, explaining liability protections and tax incentives for food donations, and providing information on where and how to donate food. Many organizations responded, including Harvard Law School, which now has a food donation program in the works.

Broad Leib also understood that the basic problem the clinic has been addressing was about to grow dramatically. “There are already so many people who were in vulnerable situations,” she says. “The crisis has exacerbated food access challenges for those people, and it has added so many more individuals and families in need. Workers are losing jobs, especially those doing hourly work—many, in fact, who work in the food industry. We are going to see a huge increase in people who suddenly need help getting basic needs met, especially food.”

COVID-19 also adds a complex new layer to concerns about food safety. Not only are more people going to need food; they also need safer ways to get it. As the emphasis on the importance of social distancing has increased, new ways must be found to deliver food directly to seniors and immunocompromised individuals in their homes.

In response, the clinic put out a brief with recommendations for federal and state governments, as well as for agencies such as FEMA and the USDA, looking at opportunities under existing government programs, including the Supplemental Nutrition Assistance Program and the Special Supplemental Nutrition Program for Women, Infants, and Children, to facilitate food delivery during the COVID-19 crisis. They also have come up with proposals for getting food from food banks and other organizations delivered directly to people’s doors, and for getting Congress to supplement existing community-based food delivery organizations.

This is probably one of the most meaningful projects I have worked on since coming to law school, if not in my life.

Jesse Lazarus ’22

The clinic shared its brief with contacts in Congress on March 23 as the House and Senate, the president, executive agencies, and state governments across the country debated many of these policies. They have been working closely with members of Congress, helping support congressional requests to the USDA to use its authority to support food delivery. The team is also tracking state and local policies to stay on top of the best models for how state and local governments are ensuring vulnerable people stay fed in this crisis.

The brief also encourages investment in a growing number of technology solutions that match food donors to recovery organizations that pick up and deliver the donated foods, such as Food Rescue Hero and Replate.

“We make the point that these technologies can be really responsive to the challenges of the moment,” says Broad Leib, “but most of them have been developed by small nonprofits. Helping them scale up quickly to meet the needs of the growing number of people who need food support is going to require an investment.”

Jesse Lazarus ’22, a student in Broad Leib’s Food Law and Policy seminar, played a major role in preparing this brief, focusing on public-private partnerships, describing existing efforts, and making policy recommendations to expand home delivery. “This is probably one of the most meaningful projects I have worked on since coming to law school, if not in my life,” says Lazarus. “It is an experience I will likely recall for many years to come, as I think back on this incredibly challenging time for the U.S. and the world.”

Broad Leib and the clinic also focused on anticipated new challenges to the food system as a whole, in particular the loss of market access for the many farmers and producers who sell in farmers markets or depend on large purchases by schools and universities. The clinic collaborated with the National Sustainable Agriculture Coalition to propose legislative actions to unlock already appropriated funding to these farmers, and to redirect funds that will be underutilized during this crisis. “Local foods are now a $12 million business in the U.S.,” Broad Leib says. “We don’t want these food producers to go out of business or sell their farms.”

Brianna Johnson-King ’21, a student now in the clinic for her second semester, worked on that brief, researching what flexibility existing statutes allowed. She found, for example, that a statute that supplies vouchers to low-income seniors to purchase food at farmers markets could also allow the government to make bulk purchases directly from farmers for distribution to seniors, a step that could help ensure the money is flowing to small farmers even if farmers markets are closed during COVID-19.

Johnson-King grew up in rural Ohio and has a strong interest in agriculture and the farmer’s perspective. As she researched and wrote for the brief from home, she kept the TV on in the background. The situation worsened from hour to hour as more cities and states announced shutdowns and farmers markets voluntarily closed. She says she felt the pressure: “In the back of my mind, I’m thinking, ‘Are we going to get this out in time for Congress to have a chance to act on any of it?’”

The clinic got that brief out by March 23 and followed it up with a companion document for state governments. By March 27, both the Senate and House had passed the Coronavirus Aid, Relief, and Economic Security Act, which includes funding for direct assistance to food producers, and President Trump had signed it into law. “The act does not directly address the changes we recommended; however, it still provides funding for the local and regional producers we aim to help,” Johnson-King says.

Broad Leib believes they are gaining traction. The clinic is involved in ongoing discussions with members of Congress on other aspects of the brief that may find their way into the next relief package. She is also looking ahead to the impact that COVID-19 may have on the food supply chain as a whole. “I don’t intend to cause panic, but I am certainly thinking about that.”

“A lot of the workers harvesting our crops are coming across the border,” says Broad Leib. “We need to be sure that we are keeping them safe and taking care of them. At the same time, we hear that in agriculture and manufacturing, trying to do social distancing and keep workers safe means having fewer people work at one time. That means we will have to be creative about meeting demand.” But Broad Leib also sees opportunities: “This may be the time for us to be more thoughtful about how we are regulating food and compensating and protecting workers—supporting food from farm to fork. If what comes out of this is that we better appreciate the value of the people and the resources that go into producing our food, that will be a silver lining.”

“It’s been a really chaotic and frightening time,” Broad Leib says. “It’s as if everywhere we turn there are ways this crisis is impacting the food system.” She goes on: “I’ve been blown away at the number of our students who have reached out and asked to help, even during spring break. They dove in to this important work while they were also in the midst of moving, transitioning to remote learning, and figuring out their new lives. It’s been amazing. Our students are always amazing, but never more so than in this time.”

See the Food Law and Policy Clinic’s COVID-19 Response website for more information and resources.

Emily Broad Leib named clinical professor of law

via Harvard Law Today

photo of Emily Broad Leib sitting on a rock bench in front of a grass lawn

credit: Jessica Scranton

Emily Broad Leib ’08, founder and director of the Harvard Law School Food Law and Policy Clinic, has been named clinical professor of law at Harvard Law School. She was formerly an assistant clinical professor at HLS.

A national leader in food law and policy, Broad Leib founded the first food law and policy clinic in the country at Harvard Law School. She has used her position to advocate for improvements to the laws and policies that govern America’s food system, including in the area of food waste. She also serves as deputy director of the Harvard Law School Center for Health Law and Policy Innovation.

“Emily Broad Leib is a superb teacher and is internationally respected for her groundbreaking work on food law and policy,” said John F. Manning ’85, the Morgan and Helen Chu Dean of Harvard Law School. “Through her commitment, intellectual leadership, and teaching, she has inspired countless students and attorneys to pursue options within the legal system to improve the food system and enhance the well-being of others.”

“I am humbled by my promotion to clinical professor, and full of gratitude at the opportunity to continue working alongside the committed and inspiring faculty, staff, and students of the HLS community. It has been a pleasure to make my home at such a supportive institution that has provided the resources and vision for me to build the first clinic in food law and policy, to develop opportunities for students to learn and participate in the vital field of food law, and to see the impact the Food Law and Policy Clinic has had and will continue to have on policies that impact the environment, health, and social justice,” Broad Leib said.

Broad Leib joined HLS’s Center for Health Law and Policy Innovation in 2010 as a senior clinical fellow. The following year, in 2011, she founded the Harvard Law School Food Law and Policy Clinic (FLPC), which provides legal advice to nonprofits and government agencies, while educating law students about ways to use law and policy to impact the food system.

Broad Leib focuses her scholarship, teaching, and practice on finding solutions to some of today’s biggest food law issues, aiming to increase access to healthy foods, eliminate food waste, and support sustainable food production. She has published scholarly articles in the California Law Review, Wisconsin Law Review, the Harvard Law & Policy Review, and the Food & Drug Law Journal, among others.

In 2015, she was an inaugural recipient of Harvard University’s Climate Change Solutions Fund. Her project “Reducing Food Waste as a Key to Addressing Climate Change,” was one of seven chosen from around the university to confront the challenge of climate change by leveraging the clinic’s food law and policy expertise to identify systemic solutions to reduce food waste, which is a major driver of climate change.

Under Broad Leib’s direction, FLPC has been advocating for the standardization of date labels since the release of its 2013 report “The Dating Game: How Confusing Food Date Labels Lead to Food Waste in America.” FLPC has also worked with members of Congress on legislation to reform the expiration date system, and Broad Leib testified for Congress on date labels and other areas of federal policy that impact the amount of food that goes to waste. She led work with the two largest food trade associations to implement a voluntary standard for date labels, which will go into effect this year. Last summer, the clinic released a follow up issue brief “Date Labels: The Case for Federal Action.”

Beyond date labels, Broad Leib has led the clinic in supporting food producers, businesses, and government agencies in understanding and improving laws relevant to food waste and food recovery. The clinic’s work has included consulting to government agencies and legislators at the federal level and in nearly two dozen states, and publication of scores of policy reports and toolkits, including Opportunities to Reduce Food Waste in the 2018 Farm Bill (2017) and Food Safety Regulations and Guidance for Food Donations: a 50-State Survey of State Practices (2018) and a number of resources to support states and localities in addressing food waste through policy, including “Bans and Beyond: Designing and Implementing Organic Waste Bans and Mandatory Organics Recycling Laws” (2019) and “Keeping Food Out of the Landfill” (2016).

Drawing on this expertise, in 2019, Broad Leib launched the Global Food Donation Policy Atlas project, through which she and clinic staff and students are partnering with local food donation agencies in fifteen countries around the globe to compare and analyze the laws relevant to food donation, and make recommendations for best practices that can help more safe, wholesome food make it to those in need.

In 2016, she was named by Fortune and Food & Wine to their list of 2016’s Most Innovative Women in Food and Drink. Her groundbreaking work has been covered in such media outlets as The New York Times, the Los Angeles Times, the Boston Globe, The Guardian, TIME, Politico, and the Washington Post. She has appeared on CBS This Morning, CNN, The Today Show, and MSNBC.

In 2016, Broad Leib partnered with colleagues around the country to found the Academy of Food Law and Policy, the first-ever academic association for the growing number of faculty and scholars teaching and writing in the field of food law and policy. She served as the founding co-chair of the Academy’s Board of Trustees from 2016 to 2019.

After graduating from HLS, Broad Leib spent two years in Clarksdale, Mississippi, as the Joint Harvard Law School/Mississippi State University Delta Fellow. She directed the Delta Directions Consortium, a group of university and foundation leaders who collaborate to improve public health and foster economic development in the Delta region. In that role, she worked with community members and outside partners, and with support from more than 60 HLS students, to design and implement programmatic and policy interventions on a range of critical health and economic issues in the region.

Broad Leib’s fellowship work in Mississippi inspired the Mississippi Delta Project, a student practice organization at HLS that provides opportunities for current students to continue advocating for similar issues in the Mississippi Delta region. Broad Leib continues to support that organization as the faculty supervisor. She is also the faculty supervisor for the Harvard Law School Food Law Society.

In 2013, she was appointed deputy director of the Center for Health Law and Policy Innovation. In 2015, she was named an assistant clinical professor of law.

Broad Leib received her J.D. from Harvard Law School and her B.A. from Columbia University.

Harvard Law School clinician testifies in support of Massachusetts food and health pilot program

A wooden box with a caduceus and the inscription: 'Food is Medicine' holds fresh producevia Harvard Law Today

Food insecurity and hunger cost the Commonwealth of Massachusetts nearly $1.9 billion in avoidable health care costs every year.

Today, a team of attorneys from the Center for Health Law & Policy Innovation of Harvard Law School (CHLPI) and Community Servings, a nonprofit food and nutrition program, testified at a hearing on proposed legislation to establish a food and health pilot program in the state of Massachusetts.

Harvard Law School Clinical Instructor and CHLPI staff attorney Katie Garfield ’11 and Jean Terranova, Community Servings’ director of food and health policy, testified before the Joint Committee on Public Health at the Massachusetts State House.

The new legislation, titled An Act Relative to Establishing and Implementing a Food and Health Pilot Program, is the first major result of a report CHLPI and Community Servings released last summer—the “Massachusetts Food is Medicine State Plan.” The legislation, introduced by Massachusetts Sen. Julian Cyr (D-Truro) and Rep. Denise Garlick (D-Needham), provides a blueprint to successfully integrate nutrition services into health care delivery and financing in the Commonwealth—a proven strategy to improve health outcomes and reduce health care costs for people experiencing food insecurity and living with chronic illness.

The legislation would require the Executive Office of Health and Human Services (EOHHS) to establish a Food and Health Pilot Program that equips health care systems to connect MassHealth enrollees with diet-related health conditions to one of the three appropriate nutrition services, with the expectation that health outcomes will improve and cost of care will decrease.

“Massachusetts has long been a national leader in health care policy,” said Garfield in testimony before the committee. “However, we continue to struggle with two issues that play a fundamental role in driving health outcomes and health care costs: food insecurity and diet-related disease. … A growing body of evidence indicates that connecting these individuals to “Food is Medicine” interventions may be an effective, low-cost strategy to improve health outcomes, decrease use of expensive health care services, and improve patient quality of life.”

Published in June 2019, the “Massachusetts Food is Medicine State Plan” is a product of a two-year, community-driven initiative that engaged more than 400 people from across the state. The initiative sought to identify health and food system reforms to improve access to critical nutrition interventions and change the culture and practices of the health system.

CHLPI and Community Servings also launched Food is Medicine Massachusetts (FIMMA), a multi-sector coalition comprised of more than 50 organizations representing nutrition programs, patient advocacy groups, health care providers, health insurers, academics, and professional associations.

CHLPI advocates for legal, regulatory, and policy reforms to improve the health of underserved populations with a focus on the needs of low-income people living with chronic illnesses. Community Servings provides medically tailored, nutritious meals to chronically and critically ill individuals and their families.

Food as medicine: Massachusetts bill would give Medicaid recipients fresh food and grocery money

via The New Food Economy

by Jessica Foo

 

Massachusetts lawmakers want to know: What happens when Medicaid recipients get healthy food as part of their healthcare?

The answer might sound obvious and even tautological—newsflash: healthy eating makes people healthier—but Democratic state senator Julian Cyr and house representative Denise Garlick want details. So this week they introduced a first-of-its-kind bill that would establish a pilot program to give individualized nutrition services—including meals, groceries, or grocery money—to residents enrolled in Medicaid and then measure the impact of doing so on people’s well-being and the state’s bottom line.

“If you look at the amount of dollars that we spend on healthcare in Massachusetts, we spent over $60 billion last year,” Cyr said in a phone interview, referring to a finding in a recent state report on the expenditures through Medicaid, Medicare, and private insurance.

MassHealth, the state- and federally funded Medicaid program that provides health insurance to low-income Massachusetts residents, spent $17 billion on health care in 2018. The program has varying eligibility thresholds for residents, based on factors including age, disability, and family size. A family of four must earn under $34,248 per year to qualify.

Before becoming a legislator, Cyr worked at the state department of public health. Inspired by the local food initiatives taking hold in his district, which includes Cape Cod, Martha’s Vineyard, and Nantucket, he says he wanted to know how centering nutrition in the healthcare system would affect people statewide. He teamed up with Rep. Garlick, who also has a background in nursing and public health, to sponsor the legislation in the house. (Garlick didn’t respond to requests for comment.)

Food as medicine is an age-old idea—some people speculate that Greek physician Hippocrates was a proponent of the approach—that has gained popularity in the American medical system in recent years. Today, plenty of localities fund programs to give food stamp users with specific health needs money to spend at farmers’ markets. A California hospital is piloting a program that places doctors in grocery stores to guide shoppers towards healthier purchases. And the state of California itself is currently experimenting with delivering pre-made meals to people with congestive heart failure.

Plenty of localities fund programs to give food stamp users with specific health needs money to spend at farmers’ markets.

These examples illuminate the wide scope that medically tailored nutrition can encompass. The proposed pilot program in Massachusetts would include all of the following: pre-made meals, pre-selected groceries, and money for nutritious foods. The range speaks to the various and specific needs that patients have. For example, people with relatively severe health issues, such as congestive heart failure, type 2 diabetes, and kidney disease, might receive pre-made meals delivered to their homes, while those with high blood pressure or pre-diabetes might get subsidies to use at the grocery store.

“There are different populations that are in need of different nutrition interventions,” explains Sarah Downer, an associate director and law instructor at Harvard Law School’s health law and policy clinic. She says that pre-made and delivery meals “are really for people who have […] trouble shopping and cooking for themselves—it’s not the right nutrition intervention for everyone.”

“This [pilot program] would look at the efficacy of a suite of those services, the ability to triage individuals and find the correct service for them, link them to it, and then see what the impact is on utilization and costs across the board.”

Pre-made and delivered meals were correlated to a halving of inpatient hospital admissions and a 16 percent reduction in health care costs.

Downer led the research team that recently published a comprehensive report on the potential benefits that food can have on the Massachusetts health care system, which in turn informed the development of this proposed legislation. The report highlighted a range of findings linking nutrition with health. In a 2019 study of over 1,000 participants, for example, pre-made and delivered meals were correlated to a halving of inpatient hospital admissions and a 16 percent reduction in health care costs.

The exact details of the pilot program still need to be hammered out. As it stands, implementation would be guided by a commission of public health officials, medical experts, and representatives of nonprofit health care organizations. By incorporating nutrition into the daily lives of MassHealth recipients, the state—which devoted nearly a quarter of its budget to the program last year—also stands to benefit economically.

As mentioned above, it feels increasingly redundant to spout how healthy eating can benefit health. Massachusetts lawmakers appear to have decided that it’s time to calculate just how valuable that benefit is.

Harvard Law School & NVHR Launch Updated Data on Discriminatory Hepatitis C Treatment Restrictions in 52 Medicaid Programs and Send Letter to CMS Urging an End to State Violations of Federal Medicaid Law

Via CHLPI

The National Viral Hepatitis Roundtable (NVHR) and the Center for Health Law and Policy Innovation of Harvard Law School (CHLPI) today launched an update to “Hepatitis C: State of Medicaid Access,” an interactive project grading all 50 state Medicaid programs, as well as the District of Columbia and Puerto Rico, according to access to curative treatments for hepatitis C, the nation’s deadliest infectious disease. NVHR, CHLPI and other leading viral hepatitis advocates today also sent a letter to the U.S. Centers for Medicare and Medicaid Services (CMS) urging the agency to take action to end discriminatory state treatment restrictions, which, according to CMS guidance, violate federal Medicaid law. More than half of all state Medicaid programs still impose some form of illegal restriction.

“The hepatitis C virus is the deadliest infectious disease in the U.S., killing 20,000 Americans every year, and the opioid epidemic and an increase in unsafe injection drug use have caused acute cases of hepatitis C to more than triple since 2010. Eliminating treatment access restrictions is a necessary step toward ending HCV in the United States,” said NVHR Director Lauren Canary. “The collaborative advocacy of NVHR, CHLPI, and the entire viral hepatitis community have created real momentum and led to a significant reduction in treatment restrictions; however, there is still more work to do, as some states persist in imposing these discriminatory restrictions.”

Hepatitis C: State of Medicaid Access grades each Medicaid program according to its overall “state of access.” Each grade is determined by curative treatment restrictions related to three areas: 1) liver disease progression (fibrosis) restrictions, 2) sobriety/substance use requirements, and 3) prescriber limitations – all of which contradict not only CMS guidance but also recommendations from the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA). The analysis provides suggestions for each state to reduce its treatment access requirements.

“At least 2.4 million Americans are currently infected with the hepatitis C virus and HCV is contributing to an increase in liver cancer, the fastest-growing cause of cancer mortality in the U.S. We have the tools to eliminate hepatitis C, but turning the promise of a cure into reality for all requires leadership, resources, and the removal of all discriminatory HCV treatment access restrictions,” said Robert Greenwald, Clinical Professor of Law at Harvard Law School and the director of CHLPI. “CHLPI and NVHR are dedicated to ensuring that all individuals living with HCV are able to access a cure for the disease, and we urge all states to stop illegally restricting access to treatment.”

Highlights of the Hepatitis C: State of Medicaid Access analysis, as well as notable advocacy successes since the 2017 launch of the report, include:

  • When CHLPI and NVHR launched the report in 2017, more than half of Medicaid programs (52 percent) received a “D” or an “F” for imposing discriminatory restrictions on hepatitis C cures. Currently, only 15 percent of programs (8 jurisdictions) receive those grades;
  • States that received a “D” or “F” grade due to access restrictions: Alabama, Arkansas, Minnesota, Mississippi, Montana, Puerto Rico, South Dakota, and Texas;
  • States that received an “A” grade: Alaska, California, Colorado, Connecticut, Delaware, Idaho, Louisiana, Maine, Massachusetts, Missouri, Nevada, New Jersey, New Mexico, New York, Oregon, Pennsylvania, Rhode Island, Vermont, and Washington;
  • Washington (A) removed Medicaid restrictions after a federal court declared for the first time that widespread restrictions to hepatitis C treatments were illegal. The removal of restrictions paved the way for the state’s groundbreaking plan to eliminate the hepatitis C virus entirely;
  • In Rhode Island (A-), strong local advocacy and the threat of litigation led the state to remove liver disease restrictions and cover treatment for all beneficiaries living with HCV;
  • Illinois (B-), which once had the most severe liver disease restrictions, has since removed those restrictions. However, some managed care organizations in the state have not followed suit;

“Although the advent of highly effective curative therapies has helped avert thousands of premature deaths from hepatitis C, we are still seeing troubling trends related to the disease, including a three-fold spike in acute cases of hepatitis C since 2010; an increase in vertical transmissions of the disease from infected pregnant adults to infants – in 2017 alone, there were 18,927 newborns exposed to hepatitis C; and people from certain racial and ethnic minorities are dying at disproportionate and increased rates from hepatitis C infections,” added Canary. “The consequences of hepatitis C treatment restrictions are not academic for people living in places like Texas (Grade: D+), which has the highest liver cancer mortality rate in the country; or Montana (Grade: F), which has one of the highest rates of perinatal HCV exposure; or West Virginia (Grade: C), which has the highest rate of new HCV infections.”

Americans insured through Medicaid have a 3-fold higher prevalence of hepatitis C compared to their privately insured counterparts. In 2015, CMS issued guidance that prior authorization requirements should not result in the denial of access to treatment. NVHR, CHLPI and other leading hepatitis advocates today sent a letter to CMS urging the agency to take action to end illegal access restrictions by states.

“Since the release of Hepatitis C: State of Medicaid Access and the increased transparency to egregious treatment restrictions in state Medicaid programs, many states have loosened or removed restrictions…Unfortunately, several state Medicaid programs are still standing in the way of the medical standard of care by imposing discriminatory prior authorization criteria to restrict access based on liver disease severity, provider specialty, and substance abuse,” said the advocates in the letter. “Despite clear [CMS] guidance…state Medicare programs still deny coverage to Medicaid enrollees with hepatitis C infection…We call upon CMS to take seriously this continue state-sanctioned discrimination impacting persons living with hepatitis C throughout the United States. Please do your part to prioritize this issue and to call upon state Medicaid programs to open access to curative hepatitis C therapy.”

To view the full “Hepatitis C: State of Medicaid Access” report, visit www.stateofhepc.org

Harvard Group Recommends Increased Nutrition Education For Doctors

Via Forbes
By Tommy Tobin

Many chronic conditions, such as obesity and diabetes, are related to diet and nutrition. Although many diet-related diseases are highly correlated with poor health outcomes, U.S.-trained doctors receive little or no training in nutrition. A new report published last week by the Harvard Law School Food Law and Policy Clinic (“FLPC”) aims to address this knowledge gap by recommending increased nutrition education in undergraduate, graduate, and continuing medical training.

With its report, Doctoring Our Diet: Policy Tools to Include Nutrition in U.S. Medical Training, Harvard’s FLPC focused on integrating “nutrition as an essential component of U.S. medical education” and allowing doctors “to support better outcomes for individual patients and to address the most common and costly health risks facing our country.”

Unfortunately, there is a lack of attention to nutrition education in medical training. As one recent headline put it, “[y]our doctor may not be the best source of nutrition advice.” Other researchers writing in a medical journal were less reserved: “It cannot be a realistic expectation for physicians to effectively address obesity, diabetes, metabolic syndrome, hospital malnutrition, and many other conditions as long as they are not taught during medical school and residency training how to recognize and treat the nutritional root causes.”

The authors of the Harvard FLPC report identified several medical education stages in which to increase nutrition training and recommended policy mechanisms to address the lack of nutrition training:

  •  For undergraduate medical education, amending accreditation standards to require nutrition training and offering additional grant funding to create nutrition education programming.
  •  For graduate medical education and board certifications, requiring nutrition education in medical schools and incorporating nutrition-related questions in required examinations.
  • After formal medical education, states should integrate nutrition education into continuing education and require—or strongly encourage—physicians to take nutrition education courses as part of maintaining their license.

The report’s authors note that “increased nutrition education for doctors at every stage of their career can ultimately improve outcomes for individual patients, advance population health, and change the healthcare landscape for the better.”

The FLPC report’s publication comes during a dust-up within nutrition science concerning a recent article in the Annals of Internal Medicine on guideline recommendations for meat in consumer diets. According to the New York Times, the article and its associated guidelines “raise uncomfortable questions about dietary advice and nutritional research, and what sort of standards these studies should be held to,” and has faced substantial criticism from public health advocates. It is possible that the increased funding and training in nutrition recommended in the FLPC report could encourage further medical research into nutrition and its role in disease prevention and mitigation.

Given the important association between diet and nutrition and many chronic health conditions, the FLPC report makes considerable sense. Time will tell how palatable the authors’ recommendations are for the relevant decision-makers.