HEALTHY FOOD

INITIATIVES FOR THE

EMERGENCY FOOD
SYSTEM
Written by Christine Benson
University of Washington, School of Public Health
Winter Quarter 2016
Nutrition 531: Public Health Nutrition

A POLICY BRIEF
FOR LOCAL
GOVERNMENTS
ADVOCATING
FOR THE
ADOPTION AND
PROMOTION OF
NUTRIENT
ASSESSMENT
TOOLS AND
GUIDELINES
FOR LOCAL
FOOD BANKS

Healthy Food Initiatives for the Emergency Food System

March 2016

EXECUTIVE SUMMARY

Healthy Food Initiatives improve the nutritional quality of foods that are offered at food banks
and food pantries. These initiatives increase access to healthy foods for low-income people and families
utilizing the emergency food system. People who are low-income and food insecure have poorer quality
diets, consuming fewer fruits and vegetables and lower amounts of essential nutrients. They also have
higher rates of chronic diseases including heart disease, diabetes and high blood pressure.
In 2014, 14.5% of U.S. households were considered food insecure, lacking reliable access to
affordable and nutritious meals. Today, the majority of people visiting food banks have relied on them
for at least 6 months as a steady supply of food for their household. Yet food banks often do not offer
enough of the nutritious foods these populations need to contribute to an overall healthy diet.
Assessments of the nutritional quality of food banks have found that available foods are inconsistent
with dietary guidelines. Although some food banks have attempted to create and implement healthy
food policies, most are staffed by volunteers and lack the capacity to make significant organizational
changes on their own.
Local governments have a responsibility to help people in their communities who are food
insecure get access to healthy foods. By supporting the adoption of healthy food initiatives,
governments can help anti-hunger organizations increase the quantity and quality of available healthy
food. Healthy food initiatives at food banks have been shown to increase fruit and vegetable
consumption and improve the health outcomes of the populations they serve. They also help food
banks set nutrition-related goals, measure progress, and link programs to health improvements. By
advocating for these programs, local governments can help to decrease hunger, increase healthy eating
opportunities, and improve the lives of vulnerable populations.

Healthy Food Initiatives for the Emergency Food System

March 2016

The Emergency Food System is a Response to Food Insecurity. In 2014, the U.S. Department of
Agriculture (USDA) reported that 14.5% of households nationally were food insecure, defined by the
World Health Organization as not having access to adequate amounts of affordable, safe and nutritious
food needed to sustain a healthy and active life.1,2 In addition to other federal food subsidy programs,
the emergency food system (EFS) was created as a way to address the needs to those who didnt have
the means to feed themselves and their families. This network of organizations works to alleviate
hunger by providing free food to those in need. The EFS includes anti-hunger organizations, food banks,
food pantries, soup kitchens, mobile food pantries, and meal delivery services. A 2013 report by the
USDA Economic Research Service found that in households with incomes < 185% of the federal poverty
level, food pantries were used at least once in the previous 12 months in 28% of food secure
households, 30% of households with low food security (characterized by a decreased quantity and
variety of foods during a given month), and 42% of households with very low food security (those that
periodically skipped meals because of an inability to purchase foods). As the divide of wealth in the
country has gotten wider, what was once a considered a temporary relief for people who had fallen on
hard times is now becoming a regular part of daily life. The majority of clients visiting food pantries
today have relied on them as a steady source of food for at least 6 months.3 This makes the EFS an
integral player in the diets of many low-income families.

Food Pantry Clients have Poorer Diets than the General Population. Research has shown that
people in the U.S. who utilize food pantries consume diets of lower nutritional quality than the general
population.4 Poverty and food insecurity are associated with low fruit and vegetable consumption,
leading to lower intakes of vitamins A and B6, calcium, magnesium, and zinc.5,6 They also have higher
intakes of fat with a lower frequency of weight loss behaviors.7 This may be why food insecurity is
associated with increased risks of hypertension, hyperlipidemia, diabetes, and cardiovascular disease all diet-related conditions.8 Food-insecure individuals are also more likely to report heart disease,

Healthy Food Initiatives for the Emergency Food System

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diabetes, and high blood pressure and to have multiple chronic conditions.9 A 2014 Feeding America
survey among food pantry users found that 58% of households had at least one member with high blood
pressure and 33% with at least one person diagnosed with diabetes. These rates were even higher
among seniors. In the same survey, nearly half of all respondents reported being in fair or poor health.10

Attempts to Improve the Emergency Food System Food have Lacked Support. Awareness about
the pervasiveness of chronic disease and obesity among low income populations has been increasing.11
Even though local governments may recognize the vital role food pantries play in the diets of food
insecure people, relatively little has been done to help measure or improve the nutritional quality of
foods offered through the EFS.12 This has left improving EFS foods solely in the hands of the food banks
which are usually understaffed and run by volunteers. In 2011, a national online survey of 137 U.S. food
banks found that the majority reported having a substantial commitment to nutrition, but only 39% had
some type of nutrition policy or guideline.13 Guidelines and policies that were in place were designed
and executed by the food pantry themselves, often by people with little to no nutritional training. In an
effort to address the issue on a larger scale, the Greater Pittsburgh Community Food Bank developed a
program that allowed them to measure the nutritional quality of all EFS food throughout the city for one
year. They found that the majority of food available was inconsistent with dietary guidelines. They also
surveyed food bank clients and learned that 40% to 50% were concerned about their nutritional needs
and wanted to learn how to reduce cholesterol levels, salt and fat intake and increase fiber, calcium and
iron.14 A similar survey by the Food Bank of Central New York found that EFS users preferred to receive
meat, poultry, fish, fruits and vegetables over soda, candy and snacks.15 With growing interest among
food banks and the support of clients wanting healthier options, the time for instituting healthy food
initiatives at local food banks is now.

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Local Government Agencies are Key Players in Developing and Implementing Food Policies
and Food System Planning, and they have a vital role to play in improving the EFS food
environment.16 With the health of low-income populations at stake, local governments have a
responsibility to support policies that encourage the measurement, procurement, and delivery of
healthier food options at food pantries.

Recommendations how Local Governments can Help Improve Nutrition Quality in the EFS.
There are three key components for any government program supporting healthy food initiatives at
local food banks. First, to assist organizations with the adoption and implementation of nutrient
assessment tools and healthy food procurement guidelines. Tools help food banks better understand
the nutritional quality of foods being offered, while guidelines encourage and support the acquisition of
healthier foods. Second, governments can provide or redirect funds to support new infrastructure that
ensures food banks have the means to store, transport and deliver heathier foods to their clients. Third,
to ensure that food banks continue to thrive during and after making dietary improvements, the
government can use their unique position to strengthen and encourage donations to food banks.

A Number of Tools Currently Exist for Assessing the Nutritional Quality of Foods in the EFS. A
2013 survey of Feeding America food banks found that many had created their own nutrient quality
assessment tools using nutrition facts labels and reference food intakes. By ranking foods according to
these systems, food banks were able to get a snapshot of the nutritional value of what was available.11
For instance, the Oregon Food Bank created a unit of measurement called the MyPyramid Day, which
assessed available foods by the number of units required daily from each of the MyPyramid food groups
(grains, fruit, vegetables, milk, meat/beans) for a 2,000 calorie a day diet. Unfortunately, due to the
nature of fortification of many calorie-dense snack foods, many of these systems gave a good ranking to
snack foods that were high in sugar, fat and sodium.12 To address this problem, the Greater Pittsburgh
Community Food Bank developed the Choose Healthy Foods Program (CHOP). This tool uses a method
4

Healthy Food Initiatives for the Emergency Food System

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(the Nutrient-Rich Food Algorithm 6.3) to rank foods not only for nutrient content but also for nutrient
density. The algorithm identifies six nutrients to encourage (protein, fiber, vitamin A, vitamin C, calcium
and iron) and three to limit (salt, sugar and saturated fat). By subtracting ingredients to limit from those
to encourage, each food can be given a score that identifies it as either (1) choose frequently, (2)
choose moderately, or (3) choose sparingly.14 The Choose Healthy Foods Program is available for free of
charge by contacting the Greater Pittsburgh Community Food Bank nutrition department.

Healthy Food Guidelines Further Support Nutrition Quality at Food Banks. In addition to the
adoption of a nutrient quality assessment tool, food banks can implement healthy food guidelines.
Guidelines complement assessment tools by encouraging the donation of healthier foods (such as fresh
fruits and vegetables) and discouraging the donation of unhealthy foods (like candy and soda).
Guidelines are usually suggestive and can be tailored to individual food banks or applied regionally.
Many existing guidelines are based off assessment tools or other dietary recommendations like the
Dietary Guidelines for Americans or MyPyramid.11 Guidelines have also been used to demonstrate food
banks commitments to nutrition to financial donors, and to inform food donors about best practices.

Assessment Tools and Guidelines Can Improve Diets and Health. Wider implementation of tools
and guidelines would not only improve procurement of healthier foods at food banks, but also create
the ability to link these changes to better health outcomes Though still early into implementation, by
adopting both a nutrient quality assessment tool and healthy food guidelines, a Connecticut food bank
was able to report a successful increase in fruit and vegetable intake among clients.17 In a diabetesfocused intervention, guidelines for diabetes-approved foods reportedly improved food bank clients
glycemic control across three states.18 Since many food banks dont have the time or resources to track
and monitor changes in their clients diets, there is a lack of existing data in support of these initiatives.
Investment from local governments would also help add to the science that supports these programs.

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Local Governments Can Help Food Banks Overcome Barriers to Healthy Food Procurement.
Potential barriers to adopting healthy food initiatives include a lack of infrastructure to support
increases in fresh, more perishable foods and potential product shortages. Healthier options such as
fruits, vegetables, dairy and meats require more refrigeration than processed foods. They also spoil
quicker than shelf-stable foods. Food pantries may need more resources in order to safely transport,
store and distribute more healthy foods. To help overcome this barrier, local governments can tailor
grant language to target barriers to healthy food procurement. Funding infrastructure such as
refrigerated trucks, cold storage, better inventory systems, paid staff positions, and client choice
platforms can make the transition to healthier food offerings more feasible for food pantries.
Another concern is that procurement guidelines will compromise relationships with food donors
and lead to food shortages. Although this has not been supported by research, local governments can
help offset any potential reductions by helping food banks create new donation opportunities such as
those from farmers markets and grocery stores. They can also create maps or databases that link
donors to nearby anti-hunger organizations and inform food-donating businesses and institutions about
the Good Samaritan law and best practices. Governments can also promote food donation by creating
tax incentives, providing technical assistance, or instituting food waste prevention policies.

Government Support of Healthy Food Initiatives is the Next Step for Improving the EFS.
Healthy food initiatives allow food pantries to assess the nutrient quality of available foods as well as set
nutrition-related goals, guide food purchases, demonstrate commitment to financial donors, and
ultimately link health outcomes to food offerings. Specifically, guidelines can be used to restrict the
distribution of certain foods such as soda or candy while focusing procurement efforts on fresh fruits
and vegetables. By assisting with the adoption of healthy food initiatives, local governments can lend
power and support to these underfunded, over-utilized organizations while improving the health of lowincome populations who rely on these systems.

Healthy Food Initiatives for the Emergency Food System

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References
1. Coleman-Jensen, A., Nord, M., & Singh, A. (2014). Household food security in the United States in
2012. In U.S. Household Food Security: Statistics and Analysis for 2012 (pp. 1-56). Nova Science
2. The World Health Organization. (n.d.) Food Security. Retrieved on January 14, 2016 from
http://www.who.int/trade/glossary/story028/en/
3. Seidel, M., Laquatra, I., Woods, M., & Sharrard, J. (2015). Applying a Nutrient-Rich Foods Index
Algorithm to Address Nutrient Content of Food Bank Food. Journal of the Academy of Nutrition and
Dietetics, 115(5), 695.
4. Seligman, H., Bindman, K., Vittinghoff, A., Kanaya, B., & Kushel, E. (2007). Food Insecurity is
Associated with Diabetes Mellitus: Results from the National Health Examination and Nutrition
Examination Survey (NHANES) 19992002. Journal of General Internal Medicine, 22(7), 1018-1023.
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costs. American Journal Of Clinical Nutrition, 79(1), 6-16.
6. Hanson, K., & Connor, L. (2014). Food insecurity and dietary quality in US adults and children: A
systematic review. The American Journal of Clinical Nutrition, 100(2), 684.
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among Low-Income NHANES Participants1,2. The Journal of Nutrition, 140(2), 304-10.
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10. (2014). Hunger in America 2014: Executive Summary. Feeding America. Retrieved on January 20,
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11. Handforth, B., Hennink, M., & Schwartz, M. (2013). A Qualitative Study of Nutrition-Based Initiatives at
Selected Food Banks in the Feeding America Network. Journal of the Academy of Nutrition and
Dietetics, 113(3), 411.
12. Hoisington, A., Manore, M., & Raab, C. (2011). Nutritional quality of emergency foods. Journal of the
American Dietetic Association, 111(4), 573-6.
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A Study of Food Bank Organizational Culture, Capacity, and Practices. Journal of Hunger &
Environmental Nutrition, 8(3), 261-280.
14. Seidel, M., Laquatra, I., Woods, M., & Sharrard, J. (2015). Applying a Nutrient-Rich Foods Index
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Dietetics, 115(5), 695.
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Emergency Food System. Journal of Hunger & Environmental Nutrition, 6(2), 179-187.
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Policy Making: Improving Access to Healthy, Local Food Alongside Other Priorities.International
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18. Seligman, H., Lyles, C., Marshall, M., Prendergast, K., Smith, M., Headings, A., . . . Waxman, E.
(2015). A Pilot Food Bank Intervention Featuring Diabetes-Appropriate Food Improved Glycemic
Control Among Clients In Three States. Health Affairs (Project Hope), 34(11), 1956-63.