Biden-Harris National Strategy on Hunger, Nutrition, and Health

WH I T E HO U S E NA T I O N A L ST R A T E G Y O N HU N G E R, NU T R I T I O N, A N D HE A L T H 1 BIDEN-HARRIS ADMINISTRATION NATIONAL STRATEGY ON HUNGER, NUTRITION, AND HEALTH SEPTEMBER 2022 WH I T E HO U S E NA T I O N A L ST R A T E G Y O N HU N G E R, NU T R I T I O N, A N D HE A L T H 2 Today I am convening the first White House Conference on Hunger, Nutrition, and Health in over 50 years. Yes, there is still hunger in America. But over the past 50 years, we have learned so much more about nutrition and the role that healthy eating plays in how our kids perform in the classroom and about nutrition and its linkages to disease prevention. This important conference and the commitment to a national strategy on ending hunger and healthier eating will build on the research and knowledge we now have to make America truly a stronger, healthier nation. With this gathering of elected officials; advocates and activists; and leaders of business, faith, and philanthropy from across America, we are mobilizing the will to meet a bold goal: to end hunger in America and increase healthy eating and physical activity by 2030 so fewer Americans experience diet- related diseases. This national strategy will serve as the playbook to meet this vital goal. It calls for a whole-of- government and whole-of-America approach to addressing the challenges we face. When families can’t afford healthy food options, it’s harder for children to succeed in school, and it can lead to mental and physical health challenges for the whole family. For so many families—including families of color, those living in rural communities and territories, and low-income families—structural inequality, such as disparities in educational and economic opportunities and lack of access to health care, safe housing, and transportation, make the impact of hunger and diet-related diseases even more severe. The pandemic made these problems worse, reinforcing the need for urgent, sustained action. Despite these challenges, we know what to do. This national strategy builds on the historic strides that my Administration has already made to bolster economic security for American families and cut child poverty across the country. And it harnesses our greatest resource—our fellow Americans. Everyone has an important role to play in addressing these challenges: local, State, territory and Tribal governments; Congress; the private sector; civil society; agricultural workers; philanthropists; academics; and of course, the Federal Government. In developing this national strategy, my Administration has listened to and learned from many remarkable advocates, including people who have experienced hunger and diet-related diseases themselves. To all of you, I am grateful for your unwavering commitment to meet this moment. Together, we can build a healthier future for all Americans. J WH I T E HO U S E NA T I O N A L ST R A T E G Y O N HU N G E R, NU T R I T I O N, A N D HE A L T H 3 Table of Contents Executive Summary ........................................................................................................................ 4 Current Hunger, Nutrition, and Health Landscape ......................................................................... 6 The National Strategy ..................................................................................................................... 8 Pillar 1—Improve Food Access and Affordability: End hunger by making it easier for everyone—including individuals in urban, suburban, rural, and Tribal communities, and territories—to access and afford food. .................................................................................... 8 Pillar 2—Integrate Nutrition and Health: Prioritize the role of nutrition and food security in overall health—including disease prevention and management—and ensure that our health care system addresses the nutrition needs of all people. ....................................................... 17 Pillar 3—Empower All Consumers to Make and Have Access to Healthy Choices: Foster environments that enable all people to easily make informed, healthy choices, increase access to healthy food, encourage healthy workplace and school policies, and invest in public education campaigns that are culturally appropriate and resonate with specific communities. .......................................................................................................................... 22 Pillar 4—Support Physical Activity for All: Make it easier for people to be more physically active—in part by ensuring that everyone has access to safe places to be active—increase awareness of the benefits of physical activity, and conduct research on and measure physical activity. .................................................................................................................... 28 Pillar 5—Enhance Nutrition and Food Security Research: Improve nutrition metrics, data collection, and research to inform nutrition and food security policy, particularly on issues of equity, access, and disparities. .......................................................................................... 31 Appendix: Acknowledgments ....................................................................................................... 36 Appendix: Development of the Strategy....................................................................................... 37 References ..................................................................................................................................... 39 WH I T E HO U S E NA T I O N A L ST R A T E G Y O N HU N G E R, NU T R I T I O N, A N D HE A L T H 4 Executive Summary More than 50 years since the first White House Conference on Food, Nutrition, and Health, the U.S. has yet to end hunger and is facing an urgent, nutrition-related health crisis—the rising prevalence of diet-related diseases such as type 2 diabetes, obesity, hypertension, and certain cancers. The consequences of food insecurity and diet-related diseases are significant, far reaching, and disproportionately impact historically underserved communities. Yet, food insecurity and diet-related diseases are largely preventable, if we prioritize the health of the nation. The Biden-Harris Administration envisions an America where no one wonders whether they will have enough money to put food on the table, where the healthy food choice is the easier choice, and where everyone has the same opportunity to be physically active. Transformative programs, policies, and system changes are needed within and outside government to achieve this vision. There is no silver bullet to address these complex issues, and there is no overnight fix. Making progress requires collective, sustained action and mobilization across every segment of society. That is why President Biden announced a goal of ending hunger and increasing healthy

Biden-Harris Administration envisions an America where no one wonders whether they will have enough money to put food on the table, where the healthy food choice is the easier choice, and where everyone has the same opportunity to be physically active. Transformative programs, policies, and system changes are needed within and outside government to achieve this vision. There is no silver bullet to address these complex issues, and there is no overnight fix. Making progress requires collective, sustained action and mobilization across every segment of society. That is why President Biden announced a goal of ending hunger and increasing healthy eating and physical activity by 2030 so fewer Americans experience diet-related diseases— while reducing related health disparities. 1 To advance the President’s goal—and build on the federal government’s existing work to address hunger and diet-related diseases—this strategy identifies ambitious and achievable actions the Biden-Harris Administration will pursue across five pillars: 1. Improving food access and affordability, including by advancing economic security; increasing access to free and nourishing school meals; providing Summer Electronic Benefits Transfer (EBT) benefits to more children; and expanding Supplemental Nutrition Assistance Program (SNAP) eligibility to more underserved populations; 2. Integrating nutrition and health, including by working with Congress to pilot coverage of medically tailored meals in Medicare; testing Medicaid coverage of nutrition education and other nutrition supports using Medicaid section 1115 demonstration projects; and expanding Medicaid and Medicare beneficiaries’ access to nutrition and obesity counseling; 3. Empowering all consumers to make and have access to healthy choices, including by proposing to develop a front-of-package labeling scheme for food packages; proposing to update the nutrition criteria for the “healthy” claim on food packages; expanding incentives for fruits and vegetables in SNAP; facilitating sodium reduction in the food supply by issuing longer-term, voluntary sodium targets for industry; and assessing additional steps to reduce added sugar consumption, including potential voluntary targets; 1 Ending hunger will be measured by a reduction in the number of households with insufficient food (defined as very low food security) to less than 1% of households and cut the number of households struggling to put enough nutritious food on the table (defined as food insecurity) in half.  WH I T E HO U S E NA T I O N A L ST R A T E G Y O N HU N G E R, NU T R I T I O N, A N D HE A L T H 5 4. Supporting physical activity for all, including by expanding the U.S. Department of Health and Human Services’ Centers for Disease Control and Prevention’s (CDC) State Physical Activity and Nutrition Program to all states and territories; investing in efforts to connect people to parks and other outdoor spaces; and funding regular updates to and promotion of the Physical Activity Guidelines for Americans; and 5. Enhancing nutrition and food security research, including by bolstering funding to improve metrics, data collection, and research to inform nutrition and food security policy, particularly on issues of equity and access; and implementing a vision for advancing nutrition science. The federal government cannot end hunger and reduce diet-related diseases alone. The private sector; state, Tribal, local, and territory governments; academia; and nonprofit and community groups must act as well. This strategy details Calls to Action for all these entities to do their part. Taken together, these collective efforts will make a difference and move us closer to achieving the 2030 goal. WH I T E HO U S E NA T I O N A L ST R A T E G Y O N HU N G E R, NU T R I T I O N, A N D HE A L T H 6 Current Hunger, Nutrition, and Health Landscape President Biden has set out a goal of ending hunger and increasing healthy eating and physical activity by 2030 so fewer Americans experience diet-related diseases—all while reducing health disparities. In 2021, 1 in 10 households experienced food insecurity, meaning their access to food was limited by lack of money or other resources. 1 Nearly 4% of households in 2021 experienced very low food security, meaning they were regularly skipping meals or reducing their intake because they could not afford more food. 2 When someone experiences very low food security, they are most likely to also experience hunger. 3 Moreover, diet-related diseases are some of the leading causes of death and disability in the U.S. New data show that 19 states and two territories have an obesity prevalence at or above 35%, more than double the number of states from 2018. 4 One in 10 Americans have diabetes. 5 One in 3 people will have cancer in their lifetime. 6 And, more than 4 in 10 Americans have hypertension (high blood pressure), 7 which is linked to the leading causes of death for Americans: heart disease and stroke. 8 The toll of hunger and diet-related diseases is not distributed equally; these challenges disproportionately impact communities of color, people living in rural areas, people living in territories, people with disabilities, older adults, LGBTQI+ people, military families, and Veterans. 9 Impacts of Food Insecurity & Diet-Related Diseases: Individual and Societal Costs 10 The COVID-19 pandemic exacerbated food insecurity, diet-related diseases, and health disparities. At the start of the pandemic in early 2020, the percentage of food insecure households with children reached 14.8%, up from 13.6% in 2019. 11 This increase disrupted a decade-long downward trend. 12 Devastatingly, diet-related diseases also increase the risk for severe symptoms and death from COVID-19. One study estimated that nearly two-thirds of  WH I T E HO U S E NA T I O N A L ST R A T E G Y O N HU N G E R, NU T R I T I O N, A N D HE A L T H 7 COVID-19 hospitalizations in the U.S. were related to obesity, diabetes, hypertension, and heart failure. 13 Diet-related diseases are caused in part by poor eating patterns

increase disrupted a decade-long downward trend. 12 Devastatingly, diet-related diseases also increase the risk for severe symptoms and death from COVID-19. One study estimated that nearly two-thirds of  WH I T E HO U S E NA T I O N A L ST R A T E G Y O N HU N G E R, NU T R I T I O N, A N D HE A L T H 7 COVID-19 hospitalizations in the U.S. were related to obesity, diabetes, hypertension, and heart failure. 13 Diet-related diseases are caused in part by poor eating patterns including excess calorie intake— and the failure to meet the Physical Activity Guidelines for Americans. 14 The vast majority of Americans do not eat enough vegetables, fruits, or whole grains and eat too much saturated fat, sodium, and added sugars. 15 And, only 23% of Americans meet physical activity recommendations. 16 Regular physical activity can reduce the risk of heart disease and diabetes, help manage weight, strengthen bones and muscles, and improve people’s ability to do everyday activities. 17 However, a complex web of factors causes food insecurity and contributes to diet-related diseases and health disparities. Education and job opportunities; access to health care, safe housing, and transportation; and neighborhood design all affect an individual’s ability to obtain food, make healthy choices, and remain physically active. For example, people who live in communities without grocery stores offering affordable and healthy food options may face compounding challenges, particularly if they also do not have access to transit that allows them to travel to a nearby grocery store. 18 Disparities in food insecurity and diet-related diseases exist in part because of persistent structural inequities. For example, people who lack access to food outlets that sell healthier foods tend to be lower-income, Black, or Hispanic; live in rural areas; and are geographically concentrated in the south. 19 And, people living in territories, Alaska Natives, and Native Hawaiians are highly dependent on food imports, leading to less access to healthy and affordable foods. Additionally, children from low-income families typically have fewer opportunities to be physically active because of lesser access to safe streets and playgrounds. 20 WH I T E HO U S E NA T I O N A L ST R A T E G Y O N HU N G E R, NU T R I T I O N, A N D HE A L T H 8 The National Strategy This strategy outlines the Biden-Harris Administration’s plan to drive transformative change to end hunger and reduce diet-related diseases and disparities. By outlining ambitious, achievable, and sustainable actions the federal government will take to fundamentally shift the country’s food, nutrition, and health policies across five pillars, this strategy creates a path to achieving our goals over the next decade. The federal government cannot make these transformative changes alone. Accelerating this work will require actions by state, Tribal, local, and territory governments; academia; civil society; philanthropy; the private sector; and other partners. This strategy includes recommended steps these other sectors of society must take to reach our 2030 goal. Pillar 1—Improve Food Access and Affordability: End hunger by making it easier for everyone—including individuals in urban, suburban, rural, and Tribal communities, and territories—to access and afford food. A critical step to reduce hunger and associated disparities is helping all Americans become economically secure. Toward this end, President Biden signed into law the American Rescue Plan (ARP), which helped drive a historic and historically equitable jobs recovery. 21 The expansion of the Child Tax Credit (CTC) through the ARP in 2021 helped cut child poverty nearly in half 22 —driving it to record lows, including for all racial and ethnic groups measured— reduced food insecurity by roughly 26%, 23 and led to the lowest share of households with children that were food insecure on record. 24 The Administration has also partnered with Congress on historic legislation that will lower costs for American families—including health care costs— so they do not need to make the choice between putting food on the table and covering other essential needs. The Biden-Harris Administration is committed to continuing progress in reducing food insecurity for American households by pushing for Congress to permanently extend the expanded, fully refunded CTC and expanded Earned Income Tax Credit. The Administration will continue to work with Congress to: raise the minimum wage to $15 an hour; close the Medicaid coverage gap; invest in affordable, high-quality child care; and expand the Housing Choice Voucher program to ensure low-income families, older adults, and people with disabilities can afford decent, safe, accessible, and sanitary housing. The Biden-Harris Administration will continue to advance policies that increase worker power and workers’ rights to collectively bargain—including for the workers who grow, produce, and process our food, transport it to grocers, and stock grocery store shelves. Further, the Department of Defense (DoD) will implement the new Basic Needs Allowance created by Congress, which will ensure military households earn salaries sufficient to meet their basic food needs. Along with advancing policies that bolster families’ economic security, below are additional steps the Biden-Harris Administration will pursue to improve food access and affordability.  WH I T E HO U S E NA T I O N A L ST R A T E G Y O N HU N G E R, NU T R I T I O N, A N D HE A L T H 9 A. Help more individuals experiencing food insecurity benefit from federal assistance programs. Federal nutrition assistance programs such as the Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and the Child Nutrition Programs, increase food security and well-being and help lift tens of millions of Americans out of poverty. The Biden-Harris Administration has taken pivotal steps to dramatically expand access to and strengthen these programs. For example, building on the ARP’s temporary increase in SNAP benefits, the U.S. Department of Agriculture’s (USDA) Thrifty Food Plan update