On September 28, 2022, President Joe Biden hosted the first White House conference on hunger, nutrition, and health since the Nixon administration more than 50 years ago.
The 1969 White House Conference was prompted by a shocked recognition by the media and Congress that hunger and undernutrition were widespread in the United States. It was also a huge undertaking. Led by Jean Mayer, PhD, ScD, a nutrition scientist at the Harvard School of Public Health and special consultant to the president, this unprecedented effort to fight hunger in the United States was preceded by the work of 475 experts organized in 26 panels and 300 people who participated in eight working groups that developed policy recommendations for consideration by a larger group of more than 3,000 conference attendees. Conference participants included civil rights activists, people with lived experience, advocates, academics, doctors, policy makers and members of the private sector. The full conference lasted three days and was followed by a report containing 1,800 policy recommendations, 1,600 of which were completed within two years of the conference.
The recommendations encompassed a number of transformative policies and programs that have changed the food landscape, including the expansion of the Food Stamp Program (now the Supplemental Nutrition Assistance Program or SNAP) and the National School Meals Program, the launch of the school breakfast program, the creation of the Supplementary Feeding Program for Women, Infants and Children (WIC) and the predecessor of the Dietary Guidelines for Americans. The conference and the implementation of its recommendations received strong bipartisan support.
An updated approach
The 2022 White House Conference took a different approach. The conference was convened by the Domestic Policy Council (DPC), led by Ambassador Susan Rice. Prior to the conference, the DPC organized regional listening sessions, various sectoral listening sessions and opened a portal for the general public to share ideas, experiences and suggestions. The conference was further informed by contributions from more than 40 partner meetings across the country to share opportunities and ideas. The conference recommendations were developed by an inter-agency working group of 25 agencies and regional commissions tasked with ensuring that a “whole-of-government approach” leads to the development of transformative recommendations for the final report. The product of these activities was the National Hunger, Nutrition and Health Strategy, which included dozens of recommendations organized into five pillars: improving food access and affordability, integrating nutrition and health, providing all consumers the means to make and have access to healthy choices, support physical activity for all and improve research on nutrition and food safety.
On September 28, 2022, 600 participants gathered in Washington, DC to welcome the release of the national strategy. Unlike the first White House conference, a new set of transformative policies were not announced. The recommendations were created in advance and included a mix of what is being done, what will be done, what could be done through agency initiatives, executive orders, regulations, laws and of credits. This conference is characterized by a series of presentations rather than a working meeting between the assembled experts, as was the case in the 1960s.
Recommendations in the national strategy
Beyond the federal government, the National Hunger, Nutrition and Health Strategy makes additional calls to action for a “whole of society response” aimed at state, local and territorial governments, employers and the private sector. These many and varied calls to action include recommendations for state and local governments to maximize enrollment in federal nutrition programs and provide additional incentives at the state and local levels for people to buy healthy foods, health insurance companies cover nutrition services such as prescription production and medically tailored meal management, and that philanthropy supports research studies to strengthen and diversify the nutritional science pipeline. Many of these efforts are framed in terms of what these entities should do rather than what they must or will do; evidence-based guidelines or interventions were not provided. The engagement of the private sector, which distinguished this conference from the first, was mentioned only in passing, and only then to announce their funding, not the details of their commitments. Non-federal financial investments included more than 60 public and private entities committing a total of $8 billion to conference goals, with the Food, Nutrition, and Health Investor Coalition investing $2.5 billion in companies exploring solutions innovative solutions to hunger and food insecurity.
Improve strategy
Developing the recommendations required a colossal effort. However, if this conference is to have anything close to the impact of the first White House conference, there must be a systematic effort to prioritize, implement, and evaluate progress on the national strategy recommendations. The DPC should oversee this process and hold agencies accountable for their responsibilities under the implementation plan.
To identify the most impactful recommendations, the prioritization process should begin with estimates of the effect size and population reach of each of the proposed recommendations. This process should include an estimate of the impact each recommendation will have on hunger, food and nutrition insecurity or diet-related chronic diseases. It should identify the proportion of the population positively affected if the recommendation is implemented. Prioritization should also consider cost, cost-effectiveness and time required for implementation. All of these considerations contribute to determining whether the proposed recommendation can realistically be implemented.
After prioritization, the DPC should work with relevant agencies to determine how each recommendation will be implemented. Implementation plans should indicate which agency or office is responsible for carrying out the recommendation, the mechanism for implementation – whether by executive order, regulation, appropriations, or congressional legislation – and any need for time, cost and resources.
Finally, the DPC must develop a plan for evaluating the progress of the National Strategy. This plan should include the metrics that will be used to define success and should outline how the DPC will hold agencies accountable for accomplishing their assigned tasks. Beyond federal actions, the plan should also outline how the private sector will be held accountable for its commitments, as well as how progress on “whole of society” actions will be assessed. The DPC should establish a schedule for publishing regular and public reports on the progress of the National Strategy.
Summary
The conference atmosphere was celebratory, in part because it was the first White House conference in more than 50 years and because conference attendees included many practitioners and public health advocates who hadn’t seen each other in person for two years. The significance of the day was further underscored by President Biden’s keynote address, the active participation throughout the day by secretaries from the United States Department of Agriculture (USDA) and the Department of Health and Human Services social workers, Tom Vilsack and Xavier Becerra, Senators Mike Braun (R-IN), Cory Booker (D-NJ) and Debbie Stabenow (D-MI), Congressmen Rosa DeLauro (D-CT) and Pingree (D- ME), and the presence of chef José Andrés. Standing ovations greeted mention of the need to restore the expanded child tax credit, expand SNAP and institute universal free school meals. Emphasis has been placed on the bipartisan – or some have said non-partisan – nature of these issues.
The challenge moving forward is how to translate the excitement of the day into continued action for the future. USDA Secretary Vilsack perhaps said it best: “Let’s keep the momentum going today, in new and meaningful ways, so we can fully experience this important time for our children, for our communities and for our country. However, without a concrete plan to support and support the implementation with real and transparent accountability, the laudable and ambitious goals of the conference will not be achieved.
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