Welcome to the Leading Voices in Food podcast, an educational series produced by the World Food Policy Center at Duke University. I'm Deborah Hill. You're listening to a segment in our Voice of Farming series. Have you ever wondered whether they are or antibiotics or hormones in your grocery store pork chops? Or what swine farmers do with their pig manure? Or maybe you're interested in buying locally grown foods, but you're not sure what that really means when you're in the grocery store. In this podcast, Marlowe Vaughn and Bob Ivey of Razorback farms in Goldsboro, North Carolina, tackle myths and misperceptions about the pork industry. Okay, so I'm a contract farmer. So that means that I grow pigs for another company. And I think people are under this misconception that I'm not a local farmer because I don't sell to like the local meat market or the local farmer's market. But I'm growing for the bigger picture. I'm growing for, you know, the majority of people in this country. The pork that you might go buy at your local Food Lion is my pork. You know I take such pride in that--knowing that I'm getting this healthy, nutritious pork to these local Food Lions or these local grocery stores at a really good price. I think it's important for the consumer to understand that I am your local farmer. Like I'm shopping just at the same grocery store you're shopping at. My kids are going to the same school your kids are going to. And taking that stigma away of I might be producing a larger volume. But it's also going to your Wal-Mart or your Food Lion these places where the majority of people, especially in this area, can afford to shop. We have 10 houses here in each one and holds 720 hogs. So that's the size of my farm. And I think, you know, people are under this misconception too that just because I'm a larger farm that makes me a factory farm. For a farmer like me, especially getting in the business, that's such a derogatory comment.  Because we're so much more than a factory that kind of makes it like we're just pumping animals out every single day. If that's what was going on, I think everybody would be a farmer. There's so much more that goes into farming than people understand. We're providing food for the majority of the people in this country. So I think that's what needs to be understood about larger farms is we operate just like any other business. My farm is a LLC. We're not factories, we're families. And 98% of the farmers in this country are families. So that's one of the things as a millennial farmer, I'm hoping to kind of change people's view on the size of the farm. And I think there's so much that people just don't understand. I've got a huge presence on social media and just trying to tell my specific Ag story. And everybody's story is different. As a millennial farmer, and other farmers around this country, we want to just tell our Ag story. Not only for ourselves but for the consumer. We want the consumer to see transparency. I think that's what being a farmer's all about. One of the common misperceptions is that that the integrator has them on antibiotics all the time. This integrator doesn't use any sub therapeutic antibiotics at all. Nor does it use growth hormones. So typically there's no medication given to the pigs except under the direction of a veterinarian and they take a sample. They can actually take and hang ropes in, in the barns, and the pigs, can chew on the ropes. And now with PCR technology they can take those ropes back to the lab and in less than a day they can have a diagnosis of the different diseases that are going on so that they can tailor their treatment specifically for what's happening on the farm. And that's really cool. I mean, just think about it. You do that with your child when you take it to the doctor and you know, they do a test for like strep throat right there and all that. We have that same technology now available to our industry. So it really cuts down on the use of drugs and also how we use them. So it's a really big story but no one really tells or discusses that. People still think raising hogs is done like it was 30 years ago and it's totally different now. The veterinarians we work with are through the integrator that they have. So we have very important relationships with them and we work with them daily. And to kind of touch on what Dad said, you know, I think people are under this misconception not only that we're overusing antibiotics, but also people don't realize that there are no hormones in pork or poultry. I mean we can't give our hogs any hormones because they don't exist. Those are some of the big buzz words that people like to harp on and they don't understand the truth behind them. There's so many misconceptions out there about what's going on these farms. And I think transparency is what the Ag industry is striving for. And we have been transparent but you know, farmers have been so busy farming for 30 years that we're just now getting on to talking about subjects that Dad talked about, like the new technologies out there that have evolved over the past 30 years. So I think it's really important for the average consumer to understand farmers are recyclers. Everything that we use on this farm is recycled and that includes our manure and our manure really is an asset to us. We use it to help fertilize our crops. We contract with another farmer that we work very closely with that does row cropping. He does corn, soybean and wheat rotation out here, so we worked side by side with him on how much manure to apply to those crops and when. We work with NC State soil and management teams to incorporate what kind of nutrient we need on that crop at a specific time and a specific date. We also take samples of the soil prior to applying our manure on those crops and then we actually take a sample afterwards and I carry them up to Raleigh where they kind of analyze it for us and make sure that we're applying properly. Every farm has got a waste management plan. We call it a nutrient management plan that's developed by the state. What Marlowe is required to do, she's required to go to school to learn how to manage the nutrients on our farm. Take a test that's approved by the state. And then if you're pumping manure on your crops, you have to take a sample of the soil. You have to know what crop is being grown, which means you know how much nitrogen or phosphorous or fertilizer it needs. And you have to record your pumping advance and all that in a book that's accessible to the state. And your equipment, in this case it could be it's a linear traveler, but it could be whatever manure application you use. It has to be calibrated so that you know that it's putting out the correct amount of manure. Manure is fertilizer and you don't want to waste your fertilizer because if you waste your fertilizer, you're throwing money away. So there's a lot of technology on the yield of crops, how they change in fields, and putting the right amount of manure, you know, for that crop to get the best yield. So farming has really changed. You have to be really tough and, and row crop farmers have to be really smart too. And fertilizer's the big input cost so they want to, you know, manage and do that appropriately. So a lot goes on there. Well, odor's a big deal. And again, we talked about earlier about how when we first built our farms, there were no homes around those farms. But now over time there's been a lot of urbanization and people would build right up close to them. The reason being is that they really, you know, the odor's, smells like a farm but it's not really obnoxious. Some of the things that we talked about earlier about feed and how we manage feed and nitrogen and to get more efficient as far as our manure management, that also helps with the odor. If you're not, you know, putting more nitrogen lagoons to break down and if you're putting these enzymes, this phosphorus, those type things and with pelleted feed, you've got a pellet that produces less dust in the barns and deaths is really an important vector for carrying odor, you know? All those things really help control the odor, and a lot of farmers, you know, are I mean they're not pumping every day. They, you know, they can, they need to pump when they can, but they also understand that, that if there's, you know, they're in a more sensitive area and they need to respect the weekends and those type things. If they can, they certainly will do that, because you know, they want to be a good neighbor. Just to kind of harp on what Dad said, we're on 80 acres on this specific farm and I used a center pivot to apply my fertilizer. Just a lot of talk about how often we're pumping. Last year I looked at my pumping records and I only pumped 19 days out of the year. So I think people are under this misconception too that, you know, on this farm everyday I'm just pumping manure and, and not managing odor properly. And I think that's very important to me specifically as a millennial farmer too. I think that's an important issue to be conscious of when I'm pumping, you know, and look out for my neighbors and have a really good relationship with my neighbors. Thank you for listening. If you would like to subscribe to the Leading Voices In Food podcast series, you can do so at Google Play, Stitcher, Radio Public or Apple podcasts, or by visiting our website at the Duke World Food Policy Center. This is Deborah Hill.

Welcome to the Leading Voices in Food podcast, an educational series produced by the World Food Policy Center at Duke University. I'm Deborah Hill. You're listening to a segment in our Voice of Farming series. Today I'm talking with Brandon Batten of Triple B Farms, a sixth generation farmer in Johnston County, North Carolina. Brandon's passion for agriculture comes from growing up on the farm and learning the ropes from his late grandfather. A graduate in biological and agricultural engineering from North Carolina State University. He advocates for using farm level research to make sure that the latest technology and advancements in all aspects of agriculture to reach the farmers that need them. My name is Brandon Batten and I farm with my father and uncle at Triple B Farms, Incorporated. The operation was started by my grandfather and grandmother in the late seventies. My grandfather was one of the youngest sons of a family of nine born to sharecroppers. And by the time he came along, there wasn't any farm left for him. So he started a public job and after serving some time in the military he decided to farm full time. The farm was incorporated in 1985 the same year that I was born. So that's kind of coincidental. I met my wife at NC State, Jessica. She was in the environmental engineering while I was in ag engineering. So we kind of crossed paths through that department. She is a storm water engineer for the county. So while she is a good sounding board and I guess kind of a shock absorber for me dealing with the stress and the everyday struggles of the farm, she does work off the farm primarily. But she does bring a different perspective to me as kind of what the public's seeing, and what the environmental issues are she's facing through her job that will eventually affect agriculture. So it kind of helps me stay abreast of the industry and the trends that the people that make the rules, the commissioners and the lawmakers and the legislatures. What rules are they passing for development will eventually affect agriculture. We have three small children, a son, Camden, who is three years old and twin five month old baby girls that are very exciting. In a family farm with multiple generations working side by side, figuring out who does what and transitioning roles when younger sons and daughters step into leadership is part of the challenge. It's a test of a family's personal relationship dynamic. But matching up skills, interests, and expertise helps bring out the best in everyone. Like I said, I farm with my dad and uncle. We a farm right around 800 acres total, tobacco fluke, flue cured tobacco, corn, wheat, soy beans, grass, hay, and beef cattle. This year we're also experimenting with some industrial hemp. So you know, that's kind of an emerging crop and will say a very, very hot topic right now. Everybody kind of has their specialty, you know. We just divide up naturally. Generally I do a lot of the planning and how much, you know, how many acres of what crop makes sense based on markets and market trends, and what the futures forecasts look like. I do a lot of the grain marketing, and just by virtue of being involved and being in touch and having the technology to look at the markets and decide if I think, you know, is this a profitable position to sell at? Not necessarily is this as high as it's going to get, because that's a very hard target to hit. And so I do the business accounting. I keep our checkbook, budgets, cash flows, income statements. All the boring stuff that nobody wants to do, I get to do. You know, probably the most important work I do is in the farm office. It's not always the most entertaining, but it's the most important for the business. It's almost a full time job just to keep records and paperwork up, in addition to the farming and everything else we do. Primarily my uncle and dad kind of handle the, I guess the delegation and the overseeing of the field work. But we all work together. We talk daily, multiple times a day. My father and uncle and I about planning, kind of where we are, what are we each doing that somebody may need to know about. And it works. It's sometimes a challenge to get it all done and sometimes one person has more to do than they can do, so they'll get some help from somebody else. But it works for us. Brandon credits the local food movement with driving a Renaissance in farming in many ways, particularly for millennial farmers. But in impoverished rural communities, food price remains the top concern for consumers. This means farmers have to weigh profit margins against a desire to do local good in their communities. The bigger markets lead to economies of scale and more profit. Focusing on local markets can actually mean higher prices for consumers and less return on investment, the profit after expenses and labor for farmers. My grandpa had a saying, if you can't pencil it out in the shade, you can't plow it out in the sun. So we're very conscientious of that and try to get a good, a realistic budget on the front end and figure out will this work if everything works good. And then what if everything doesn't work good? How's it going to work then? Because you certainly don't want to work hard to lose money. So that's really the question and the struggle right now, especially with the Ag economy like it is. Along those same lines of local markets there's a lot of demand for local produce. There's a lot of supply of local produce. You know, it's a struggle though because in a market that's already so established and so saturated, it seems to me like it's almost the race to the bottom. Because you have big produce growers that can do it cheaper than a husband and wife can, for example, in their four acres or whatever. But at the same time they have to make money too. So it is a struggle to when you pencil out, okay, I'm going to have to work this much and make this much. And then at the end of the day I'm going to have 50 cents a pound profit. It's tough to take on all that new work for basically nothing. So our beef cattle are primarily just feeder cattle. We have around 50 head of cows on the farm and that that's the bulls, the mama cows, and the calves. Right now we're primarily just selling feeders, feeder calves, steers, and heifers to market. We occasionally keep some and feed them out for our own personal consumption. That's the market that I'm looking to expand. You know, with the local food movement as I mentioned earlier, I feel like there's opportunity there for some farm raised beef. Especially maybe in my extended community we'll say, because one thing that I communicate with people when I get a chance is we still live in a very impoverished area as far as the standard of living goes. We're doing okay I mean. But as a whole Eastern North Carolina is very, very poor area and people that are struggling to feed their family don't care a whole lot about what's on the label other than the price. You know, they're not necessarily looking for grass fed, organic, whatever. For me as a farmer, if I could supply people in my community with a sustainably produced, humanely produced product that was good for them and good for my farm, I think that would be an excellent opportunity. But it's just a struggle at the same time because of the added regulations in licensing and things I would have to do to enter that market. I'm not sure that I could pass that cost on to my customers without going to Raleigh or a more urban area to sell my product. Brandon's operation sprawls across 28 miles and three different counties. He works with surprising variability and soil type and quality. He uses high-tech drone surveillance in fields where internet is available and old school sampling and surveillance in areas where the internet does not yet reach. Brandon's focus on efficiency and his love of technology are part of how he manages the farm. So our operation is spread out technically ever three counties. We have one farm that splits the county line. So we're three county farmers. But generally speaking from our center of operation we go about 13 to 15 miles kind of in every direction. We're not a very large farm by today's standards, but the opportunities for growth just weren't right here where we are. So we had to kind of expand and go out seeking some other other land in other places. Geographically, I think from furthest point we're about 28 miles kind of as a crow flies. But this is a variety of soil types and a variety of challenges. You know, some fields we tend are in city limits of small towns, and some are very remote that don't have cell service. So we kind of have the gamut of infrastructure so to speak. As far as commodities, right now on our farm, we have five commodities growing, being the tobacco, the corn and soy beans, and the hay, and the industrial hemp. We'll plant our winter wheat probably starting in October. So anytime we have three to four things in the field to be harvested or awaiting harvest. So we're kind of a year round farm. We don't really have a slack season anymore. It seems that used to we could kind of take a month off in the winter and kind of slow down and just do some shop work. But now there's something to do all the time. So I'm a kind of a self-proclaimed tech geek, I guess. So a couple of years ago I was fortunate enough to receive a grant to purchase a drone for our farm. And that kind of led to me starting my own drone business on the side. But living where we live is kind of a challenge because I can go and I can scout so much more efficiently. I can fly a field in just minutes and generate a tremendous amount of data. But because of our internet connection, it'll take a whole day to upload those pictures to be processed. And 10 miles away in Smithfield, I could get all the internet I want, but here it's just the shade better than dial up. So you know, a lot of our technology and our tractors have GPS that get cellular correction for RTK, real time kinematic, you know, self auto steer within an inch. But I have fields that don't have cell phone service. So you know, there's a challenge. We can't take our row markers off yet because you may lose signaling. As long as you have that backup you can still work. So I've done a lot of things like that. We were on a cloud based record keeping system now. We all have smart phones and it's kind of been admittedly kicking and screaming to get my dad and uncle to put down their little pocket notebooks and go to this system. But it's made my job a lot easier by having those records in real time and where everybody can put them into one central location, instead of when I need to do a report I have to go find everybody's notes and compile them. Now I kind of have it centralized where I can just pull it up and look at it. But they've been very open to the technology. They see the benefits of it, and they see that the importance of it going into the future, especially for my future. So they have been very supportive. It's just been somewhat of a challenge to kind of get that started. But it's going okay. Millennial farmers, like Brandon who grew up with technology as a part of their daily life are stepping out on Facebook, blogs, Instagram and other avenues and communicating with passion and honest transparency about their farm story. He feels that it's critical for people to become more connected to their food, and for farmers to tell the story of how they work, and why they do what they do on the farm. Technology is very crucial to what we do because I can't ... You know when my grandfather was taking care of the tobacco barns, he could stay there and he could check them four and five times a day and do exactly what each one needed for example. Now my uncle does a lot of the curing but we kind of tag team it. So I may check them in the morning and then it may be that night before I get back to them. So we've added automated curing controls to kind of control that environment through that time that I'm not there. So it's helping me manage it better and allowing me to be somewhere else to do something else. You know as technology changes and improves ... You know with fewer farmers we're going to have to become more efficient, and technology allows us to do that. A lot of the crops that we plant now are GMO, and I know that's a taboo word these days, but the benefits of GMO allows me to use less chemicals, less water, less inputs, and less time to produce more output on the back side. Especially in times with depressed markets like we're in right now, that yield becomes ever more critical. And with the technology I have, I'm able to kind of put exactly what I need, exactly where I need it, and when I need it, through the use of GPS and other technologies that we have on the farm to be as efficient as possible. In the next decade, I have no idea. I think that, you know, the local food movement is huge right now. I don't see that going away. I think we're kind of in a Renaissance, if you will, of the generation, say the millennials or the generation my age and just younger, that are kind of really interested in where their food is coming from and what's involved in getting that food because they have no clue. Maybe their grandparents had a farm but most likely not. And they really just have no clue about what's involved in putting that food in the grocery store. And I think as this generation grows and becomes more enlightened and involved ... It's not that they're anti agriculture. I think they're just thirsty for knowledge. And agriculture, in my opinion, has really failed to tell the story and tell how important these technologies are to us, and how we're trying to do the best we can with the least we can. And you know, our opponents are a lot more efficient at this and a lot louder than we are. So that's kind of one, I guess, torch I've picked up. It's just trying to tell the story of agriculture. I'm trying to tell John Q Public, you know, I'm not trying to kill you when I'm driving the sprayer through the field. And we're putting just such a small amount of product that it allows us to have less labor and it's safe. You know that's the biggest challenge, is just getting that message out there. So one thing I do, I have a weekly, right now it's on Facebook, but eventually it will be hopefully housed on its own blog. I call it Farm Facts Friday. So every Friday I'll put up a post about what's going on in our farm, whether it is safety or labor, immigration, tariffs, whatever challenge we're facing. And just indicate, give people an idea of what agriculture is facing from a farmer's perspective. And it has been way more popular than I ever thought it would be. You know, some of my posts have reaches of over 15, 16,000 which just blows my mind that that many people would see what thoughts I'm putting down. So I think that's going to be the story for the next decade, is just farmers have to do a better job at telling people what we do and why we do it, and being receptive to what they want to hear. I get frustrated sometimes. You see it often, you know, thank a farmer. And I think that's fine, but I'm doing my job, I'm doing what I love to do, and I'm doing my passion. I don't really need thanks for doing that. I just need an opportunity to tell you why I'm doing it and for you to be able to listen to me tell you why I do the things I do. Brandon also believes that farmers telling their stories can help consumers make more informed choices when dealing with misleading or confusing food marketing tactics. GMOs are genetically modified organisms and there's only 10 crops certified in the United States for GMO. So you see a lot of misinformation in non-GMO project and GMO-free on things like orange juice or tomatoes. And there's no such thing as a GMO orange or GMO tomato. So it's just marketing. You know, marketing is a great thing, but you need to be informed about what you're buying and what options are out there. And GMO-free does not always mean healthier. I'm a firm believer that if a person has an organic market and somewhere to sell that product, they should absolutely do it. But I'm also a firm believer that organic will not feed the world. So I think there's a place for both in agriculture, and I think that we need to stop fighting amongst ourselves in agriculture, and just kind of unite and tell our story together. That there is a place at the table for everybody Despite the many farm and family responsibilities on their plate, Brandon and his wife Jessica volunteer extensively in their community and in statewide organizations. He says such work is an important part of keeping rural communities vibrant and showing young people there are still many opportunities in agriculture and rural North Carolina. We're involved in a lot of stuff. We're involved in our local church where my wife attend with our kids. I'm a member of the local volunteer fire department. I serve on various boards and appointments, such as our county extension advisory board, a member of the board of directors for our local agricultural heritage museum. Currently my wife and I are members of the State Farm Bureau Young Farmer and Rancher Committee and there's probably a lot more. But it's very important to me being from a small town, from a small community, really an agricultural community, seeing that agriculture is the fabric that kind of holds that community together. And without agriculture then there's no community. Even the small towns around here wouldn't function without agriculture, be it the business that they provide to the workers or whatever. So with the exodus of people we're seeing from rural North Carolina especially, it's very important for me to stay involved and keep life in the community by giving back and giving my time. Because when I was a kid we had 4H and things like that, and there were adult leaders that had a lot of influence in how I turned out coming through those programs, learning leadership skills and public speaking, and things that you're going to use in the real world but you may not find very important at 13 to 17 years old. So I hope that I can kind of step into that role for some kids now and help them see that there is a future in agriculture and in rural North Carolina. Thank you for listening. If you would like to subscribe to the Leading Voices in Food podcast series, you can do so at Google Play, Stitcher, Radio Public, or Apple podcasts, or by visiting our website at the Duke World Food Policy Center. This is Deborah Hill.  

Welcome to the Leading Voices in Food podcast, an educational series produced by the World Food Policy Center at Duke University. I'm Deborah Hill. You're listening to a segment in our voice of farming series. Driving along the North Carolina coastline protected by the Outer Banks barrier islands, I pass swamps, canals and fields. I'm visiting an agricultural region called the Blacklands. Originally a cypress tree swamp, this area is rich in organic matter. Black land farmers grow corn, soybeans and wheat, potatoes, and a wide range of vegetables from onions to cucumbers to green beans. The soil is black and fertile and the black lands range across eight counties including Beaufort, Washington, Hyde, Tyrrell, Dare, Pasquotank, Carteret, and Pamlico counties. I'm visiting Middlecreek Farms, a family operation in Engelhard, North Carolina, now run by Dawson and Bethany Pugh. The day's plan to begin harvesting corn has been scrapped in the aftermath of a heavy rain and the farm crew works in the shop making repairs and doing equipment maintenance. I'm Dawson Pugh from Engelhard, North Carolina. My wife Bethany and I have four kids and we own and operate Middlecreek Farms. It's a family farm that is a fourth generation farm. I grew up here on the farm and that's all I've ever wanted to do. I mean, if you, if anybody ever asked me what I wanted to do, I wanted to farm and was able to come back to the farm in 1997 and I worked with my dad until 2003 and he decided that after the hurricanes in 2003 that he wanted to get out of it. So he told me that he would sell me the equipment and rent me the land, but he didn't want to farm anymore. So, then 2004 we, Bethany and I were able to start farming on our own, which was not how we thought that we would end up farming. We knew that, already hoped that one day we could take care of the farm, but I had no idea that my daddy would want to retire it so early. We're truly a family farm. Also, we have our office located on the property. It's an old farm house that we converted into our office. Along with the desk and a computer, you'll find a lot of toy tractors and a baby bed because our kids are here just about as much as they are at home. And I enjoy for them to come. I'm glad that they get to come and be here, too. Bethany is mom number one. But she takes care of all the bookkeeping, all the payroll, FSA, she's the office manager. She keeps us all going. Without her, we wouldn't be able to work. Farms in the Blacklands are still mostly family owned and range anywhere from 20 to 10,000 acres. Here as with many family farms, succession from generation to generation is an ongoing challenge. When young people choose not to go into farming and leave the area, older generations face difficult decisions. When I started, when Bethany and I took over the farm from Mom and Daddy, we were farming about 2,500 acres and we didn't really say, "Hey, we want to farm 4,000 acres." We just, it just kind of happened because we'd have neighbors that would decide that they were going to quit farming or, and they just come to us and say, "Would you like to farm our land?" And that's just kind of how it worked and kind of felt good about that. When I was a boy, there was a lot of farms, right, farmers. And their kids grew up and decided that they didn't want to come back to the farm. And then when they got to age they were to retire or they had to get out of farming, they just, there wasn't anybody there to take their place. Kind of sad. There's fewer and fewer farmers and I don't, I mean I feel lucky that my family farm, I love farm. I'm certainly thankful for the decisions that my dad made, his granddaddy made. And if it hadn't been for those decisions, we wouldn't be able to do this. I'm farming and I bought the farm from him. But that's an opportunity that I was given. I mean, I certainly didn't do it. I mean, we might've come up with the money to buy the equipment, but like I said, the decisions, the good decisions that they made, maybe some of the bad decisions they made, we all learn from those. That's why we're farming. I don't remember not working on the farm. I mean, I was here, I guess. I don't know when I actually started working. I know I, when I was 12 years old, I harvested the wheat crop. That was a big thing. I did it, the first day or two he would go and they helped me. They would move it up and down the road for me, but he would go help me open up a field and then he would get off and I'd harvest it. So I guess I started running the combine when I was 12 and I still love to run a combine, so. I don't see myself working until I'm 75 years old. Maybe having a baby that's a year and a half or a kid that's a year and a half might have extended that a little bit longer. But I would love to be able to, if they want to come, if my kids want to come back and farm, I'd love to be able to get them going and everybody feels comfortable. They feel comfortable. I feel comfortable. I don't want to step away from it completely. I don't just want to sell out, but I don't want to own it and be the boss until they're 50 years old either. I can go do what we want to do and then if it's busy time of the year and he needs some help, I'll be right here. And my daddy just because he sold his equipment and everything to me it didn't mean that he got out of it. He was right there if I needed help, he was there to help me. And he, we get along really good so he if sees I'm doing something way wrong, he won't mind telling me, but if I have a question or if I have something that I need to ask somebody, he's the first person I go to. Grain facility and we're getting ready to start one of the grain dryers up to dry some corn that we've been harvesting. We grow corn, soybeans, both of those for, corn for grain used for animal feed here in the state and soybeans used some for seed but most for soybean meal for the animals, livestock industry. And we grow fresh market red potatoes, red and yellow potatoes that are, that we bag and we're a partner in Pamlico Shores is the name of our business that we do potatoes and we pack those potatoes that go straight to grocery stores or sell to food service. We grow Madam Mesquite sweet onion. We don't grow many acres but we sell pretty much to, we don't do any commercial selling. We sell by the bag to and we also grow fresh market and processing green beans. Like any business, farms adapt and change over time to stay competitive. For Middle Creek Farms, this means working hard to retain a skilled and experienced work staff. It takes good crew to do it. And we have a really good group of guys that help us and that means a lot. I mean, we wouldn't be able to do the things we do without the awesome crew that we have. Ruben Murray, he's been with, he started working with my daddy when I was 16 so he's been here 26 years. And then three of our employees, they've been here for 10 to 15 years. And I want them to stay and we try to do things to keep good employees. I mean, we've started offering health insurance, 401k because we've got to compete with the other jobs. There's not a lot of jobs in Hyde County, but, so we've got to be competitive with those jobs. We've decided that we needed to offer some kind of benefit package to be able to keep good employees. When you started thinking about it and what it cost, it costs a lot of money to do it. But it costs a lot of money when you have good employees and then you lose them and then you got to try to find somebody else and they're not as good as... they'll learn. But it takes a lot of training and Bethany really took care of figuring all that out. But I guess the biggest hurdle that you got to think about is you got to think about, that you got to get over, is the expense of it and start thinking about the investment into the people. I said it costs a lot, but you're investing in good people that are going to stay with you. I mean, that means a lot. Thank you for listening. If you would like to subscribe to the Leading Voices in Food podcast series, you can do so at Google Play, Stitcher, Radio Public or Apple Podcasts, or by visiting our website at the Duke World Food Policy Center. This is Deborah Hill.

With our daily food now coming from around the world, keeping food safe needs to be a practice of prevention--at home and in commercial factories. Food safety and infectious disease expert Michael Osterholm helps to explain. About Michael Osterholm Michael Osterholm is the Regents Professor, McKnight Presidential Endowed Chair in Public Health, and the director of the Center for Infectious Disease Research and Policy at the University of Minnesota. He is a member of the National Academy of Medicine and the Council of Foreign Relations. In 2018 and 19, he served as science envoy for health security on behalf of the U.S. Department of State. He is the author of the 2017 book entitled Deadliest Enemy: Our War Against Killer Germs. He is widely regarded as a leading expert on infectious disease and recognized for his work far and wide.   Interview Summary Salmonella outbreak from eggs sickens 38 people in seven states. Ground beef producer issues recall due to deadly E. coli outbreak. Americans told to stop eating all romaine lettuce. General Mills' Gold Medal Unbleached flour is recalled over salmonella fears. These are but a few headlines and just from the past several months. Food safety outbreaks seem to be occurring more and more, with tragic consequences in some cases. Our guest, infectious disease epidemiologist Dr. Michael Osterholm, can explain why. Things have changed a lot with food policy over the years. Mike, when I was growing up, people spoke about trichinosis from not cooking pork sufficiently, but that was just about it. How's the picture different? Well, first of all, Kelly, thank you very much for having me on as a guest. It's a great honor. Let me just say that the epidemiology of foodborne disease has probably changed as much as any epidemiology or disease occurrence pattern in all the years I've been in this business. It's largely due to the fact that we eat very different foods today. When people say that we have the safest food supply in the world here in the United States, my response is we have the world's food supply. Today, we find food sourced from around the world. We find it produced in very different ways than it was 30 or 40 years ago where seasonal fruits and vegetables, leafy greens were just that seasonal. Today, we have them bring them 365 days a year. We chase the sun around the world often in low or middle income countries. We are very different about selection of what we have today. Thirty years ago in a grocery store, it was not unusual to have several thousand different choices to make. Today in the supermarket of the 21st century, we often see 65,000 to 100,000 different skews or potential items available. It's really the complexity and the location of where that food supply comes today that changes what it is that we're experienced with foodborne disease. Has that changed the likelihood that foodborne diseases will occur in outbreaks, or is it also affected the type of diseases that one gets transmitted through food? Well, we actually see both. It used to be that years ago, if one traveled to a developing world country or low income country, you worried about developing traveler's diarrhea. Today, you don't have to leave your home to develop traveler's diarrhea depending on what food item you're eating and how it is prepared. A good example is a parasitic disease called cyclospora. In this case, this is a disease that we often saw in low income and middle income countries. Today, we see it here now right in the United States occurring where product produced here. It's in part due to the fact that the workers likely play a major role in today. We see an ever changing complexion of who the workers are that are out in the fields doing the work to bring us our produce. We see this in terms of such things as a product like sprouts where today almost all the sprout seeds in the world actually come from outside the United States to make sprouts. Again, the potential for disease transmission is there, but we also see the complexity of even our U.S. system. For example, today in the ways that we grow cattle and pigs and poultry, we often see very large numbers of animals brought together in large confinement operations where a bacteria like E. coli or a virus like influenza in chickens can basically spread in such a way that it wasn't what we used to see when grandpa used to have the farm with 25 head of cattle. Even in the United States we see the potential for the development and the transmission of infectious agents very different. What are the most common foodborne illnesses and which are the most dangerous? Well, interestingly enough, it's actually in large part not due to production. In essence, if you look at the most common. Today, norovirus, which is a virus that causes vomiting and diarrhea 24 to 36 hours after exposure, is probably one of the leading pathogens we deal with and that is actually transplanted by food handler. But today, why is that important? Because we spend such a large proportion well up to half of all of our food dollars are spent eating out of the home and restaurants where again one sick food handler can transmit this virus to many, many different individuals with the type of food that they prepare. That's one thing. We do see, however, also a substantial number of salmonella inflections, camphylobacter, the kind of the E. coli bacteria infections that we often hear about with leafy green production. These are most often tied to production. They're tied to either contaminated water having contact with leafy greens or produce of some kind or transmission of salmonella or E. coli within cattle or poultry. These are all challenges today that we see in this country. How vulnerable are the major food companies to outbreaks would occur their products? Like we mentioned, General Mills Gold Medal Flour, that's a major company and a very common product. Are the companies legally liable for things that happened here? Are they reputationally liable? How are they vulnerable? Well, clearly food safety has become an ever increasingly complex issue to deal with. Surely these companies do realize that they are at risk. In most cases, we see companies doing everything they can that is reasonable to eliminate the risk of foodborne disease. For as many of the outbreaks that we hear about and the number of cases of disease, it's still a very, very small proportion. At most less than a percent of all meals ever result in a foodborne disease transmission in this country. We need to put that into perspective. It's just that when you have 300 million people eating three meals a day and munching a lot more in between that you have that potential for disease occurrence to happen. I think today we do have occasionally companies that are what I would call bad actors where they intentionally knew they had a problem and tended to cover it up. We've had some very notable ones with eggs, peanut butter, several companies where they falsified data to show that the product was safer than it really was by testing, but that's rare. That's very, very rare. On a whole, most companies are trying to do the right thing and they recognize the cost of not doing that both reputationally as you noted and as well as just strict liability. In the United States, where does the authority fall for testing and then monitoring food safety? Well, this is one of the challenges we have is is that there isn't one specific place. Food safety in this country has been carved up between the Food and Drug Administration, U.S. Department of Agriculture with some overlap in the Department of Commerce, for example, for seafood or talking about certain toxicological issues with the EPA. What we really need and I was part of the National Academy of Medicine at that time called the Institute of Medicine Committee some years ago that called for a single food safety agency in this country. I still support that very much. I think it would really dramatically improve our ability to respond. Today, for example, if you're a pizza manufacturing plant, if you basically have pizza and you put cheese on it, that falls under the FDA. But if you put cheese and meat on it, it falls under the USDA. There's real challenges in terms of trying to provide for a comprehensive coordinated effort. The same is true with the number of committees that varies from year to year, but as many as more than 20 committees on the hill in Congress has some authority over foodborne disease safety. That's a real challenge. To us right now, I think many of us would love to see a single food safety agency that would basically be fork to table. Then if an outbreak occurs, even including the investigative opportunity, to understand what's going on and stop it. Certainly seems to make sense. Why in the world hasn't it happened? Well, I think it's called territory. People all have government agency car gods where they have been doing this for years. There's congressional committees that don't want to give up their authority over this issue. Despite numerous recommendations to the contrary, we just don't seem to be able to get a single food safety agency, which I think would be a really of wise investment in food safety overall. I think the private sector would actually benefit from having a more comprehensive and coordinated food safety approach in this country. Mike, you alluded earlier to the fact that the food supply is so global. On a given day, one could eat foods that are coming in from a number of different countries. I imagine that makes monitoring even more complex. Is that right? It does. In fact, if you are actually requiring your food safety program to hinge on monitoring, you're already in trouble. What we've got to do is be out in the fields. We've got to be in the plants and making certain that we're doing everything we can to provide for the safest condition, good agricultural practices, good manufacturing practices. If you'd try to test your way out of a food safety problem, you're never going to do that. You just couldn't test enough product, and you've got to assure that that product's safe. Part of that is due to the fact not just the number of samples, but when we mass produce food today and we've been involved with outbreak where you can have many thousands of gallons of ice cream made or pounds of a product made, which the contamination is very, very sporadic. You could test it until you're blue in the face. You wouldn't pick up the contamination, but feed that to people who become the ultimate bioassay and you could have hundreds of thousands of cases with that mass produce food. Our job really is to also move food safety to the very origin of the food production process, to the fields, to wherever it may be and into the plants. That's hard to do and you have a very limited Food and Drug Administration with limited authority to be in other countries and that's where companies become very important. The secondary I just have to note has become an ever increasing challenge and it's one that is going to be even more of a challenge in the future related to climate change is water. The availability of potable water that's safe, that can be used for irrigation, that can be used for manufacturing, that can be used for washing equipment and hands and so forth is really a major issue for us around the world. I only see this becoming more and more of a problem as the availability of water and particularly potable water becomes more challenged with climate change. Mike, given that our listeners are living this day to day because we all eat, are there things people can do to minimize their risk? Well, I think first of all, the challenge we often see are not those of some mystery food, but just good hygiene in the kitchen. You have to assume that eggs are contaminated with salmonella or campylobacter. How many times in the kitchen do we forget that and we cross-contaminate our kitchens or we bring in raw meat, and we cut it on the cutting board, and then turn around and cut the salad up on that same cutting board. Just good safety practices in the kitchen themselves can be very, very important. The second thing is, again, buying food that is in a sense you might say from reputable sources. I mean, most of the major grocery stores and food sources today are buying from companies where they're putting the responsibility back on the food production companies to provide us a food supply. If they don't, they're not going to be sold. I think that it's clear that if you buy food from most grocery stores today, that's a safer bet than buying it from say unlicensed or unapproved sources. We see today more and more markets and so forth starting and that is a challenge in terms of assuring that food safety is being adhered to in those otherwise largely unregulated markets.

Welcome to The Leading Voices in Food Podcast, an educational series produced by the World Food Policy Center at Duke University. I'm Deborah Hill. You're listening to a segment in our Voice of Farming series. In North Carolina's coastal plain, hurricanes and flooding are a part of life as much as country fairs and sweet tea. On the way to Goldsboro, an agricultural town a little more than 50 miles from North Carolina's capital city of Raleigh, billboards advertise canned boiled peanuts, pork outlet stores and sporting goods. It's the kind of place where weather conditions are top of mind, and the weather channel plays on a big screen TV at the local Bojangles restaurant. I'm talking today with Bob Ivy and his daughter, Marlowe Vaughn, owners of Razorback Farms in Goldsboro where they raise pigs as a contractor for Maxwell Farms. Ivy and Vaughn closely follow the news, debates, and lawsuits over pig manure lagoons, odors, and water safety concerns, and they welcomed the opportunity to talk about their own farm operations, and they believe in the value of open communications. Good thing that now, there's so much technology as far as flood levels and all that. And one of the big things that farmers do when there's a big storm, is the sites where they can see where the rain is occurring, and what's happening with the Neuse or the Cape Fear. And they have these monitoring stations up and down the river. And actually I've got it in my phone, based on where that flood crests, you can know which roads are going to be flooded, and how it's going to impact your farm and those types of things. The integrator that Marlowe uses actually, in some cases, has moved pigs out, sold them early, in preparation for an event. And I know of two farms that they were worried about in they actually depopulated the farm before the event. Can't always do that, but you know which farms are or may be a little more risky, based on the weather reports, and I think everybody is very proactive on that. The other thing is teamwork. And teamwork sometimes just involves the integrator and the contractor, but there's a lot of teamwork with the state, state veterinarians. They get on the phone and talk with the integrators as far as, "What do you need? Where do you need it? Do you need generators?" If you have a mortality issue, they're willing to work with you at landfills and stuff to properly dispose of animals if there was something that was to occur. And usually the integrator is involved in an update, in that discussion, they're reporting that to these government agencies. And I've participated in a lot of those, and find it very interesting that you talk about, "Well we've had flooding, but no mortality." And then you hear on the news and you hear these elaborate stories about something really bad happening, and it's just doesn't match up with the facts that's been reported. And everybody's on that call, and so you really need to go and listen to those agencies. They're well-informed, they're kept updated, and they participate in trying to find solution for people that's having problems or are in trouble. So, it takes a lot of teamwork when you have a storm event. Preparing to mitigate or prevent environmental and public health impacts caused by hurricanes and tropical storm events is a year round collaboration for swine farmers, pork packing and processing companies, veterinarians, and state officials at the North Carolina Department of Environmental and Natural Resources. In North Carolina, hog producers have to have state permits, approved hog manure management plans, and log books detailing how many times they fertilize using hog manure. One of the big things that Marlowe is doing is she's preparing for a hurricane. She's been preparing for that since the spring. And so, there's times during the year when when you can't pump your lagoon, because there's no crop growing or those types of things. So that's heavily regulated. But when she can apply the nutrients from the manure to the fields and the crops, they have a level in the lagoon that it has to be reported to the integrator every week. The lagoon is designed so that it has a 24 hour storm event, on being sure that that's maintained in case you have a hurricane or those type things. And during the pumping season, she used to actually pump that lagoon down to the stop pump level. So, the farmers here in Eastern North Carolina are very comfortable in managing their lagoons, because we've had a lot of hurricanes, and so they're on top of their games. Getting ready, having that preparedness. Just like any other industry. In 1999, North Carolina was overwhelmed with rain from Hurricane Floyd and Hurricane Dennis. According to the National Hog Farmer, it was the country's worst weather disaster in 500 years. At the time, the North Carolina Department of Agriculture estimated 28,000 hogs of all ages had perished in the flood. The memory of that year stays with state regulators and pig farmers who work to minimize the risk of hog deaths and hog manure lagoon pollution in the future. We've learned so much, I mean, since Floyd hit in '99. It's going to be the 20 year anniversary this year, in September. So I think it's really important to understand how far we've come as an industry since we learned from that flooding system. We've had two farms, and I'm 34 years old now, and in a '99 I was 14. I don't think I really... All I really understood about that hurricane system and our farms is that my dad was gone for about a month and I was out of school for a couple of weeks. Now, being a modern farmer and getting so involved with the industry that I am now today, I've seen the growth and the transition and what these farmers do to prepare for farms. You know, we're preparing all year, and during a system, most farmers I know are sleeping on their farms. You know, when we're having a flooding system or know that something might be happening, command center where everybody knows what's going on. We're bringing in extra feed, we're getting our farms prepared. It's not something that we take lightly as farmers, and it's very important for us, not just for our farms, but for the environment. That's an important part of the future. I'm not doing this because I'm a fourth generation farmer. I'm doing this for my family, to pass it down to them, so maybe one day I'll have a fifth generation farmer if they wanted to get involved in the ag industry. I'm doing this for the future, in the future, not only for my family, but for the consumer. The other big thing about some of the farms is that conditions have changed a whole lot. There's been a bypass built around Goldsboro that blocks the Neuse River flood plain, and it causes some issues. And you can ride from Goldsboro to Raleigh and there's houses going up everywhere and there's roads going in, and all that impervious surface creates a lot more flooding. We have to have riparian buffers and those type things on our farm. But really, the urbanization and the growth from Raleigh and the adjacent towns, it has really caused a lot more flooding events when you do have a storm. And so you have to be ready for that too. And as an industry, typically what we see is not overtopping from the rain, but inundation from this flooding. In fact, the facilities were designed, and then because of all of this urbanization and all this runoff, suddenly farm that 20 years ago we're perfectly okay, now that they see a impact of waters actually running into the lagoons. And fortunately, we've had some really good programs in North Carolina, and a lot of those farms have participated with the government in those programs. And they have either enhanced their systems, or they have allowed them to be bought out. Like at the last hurricane, you hear a lot about pig mortality, or farmers flooding and all that, and they do flood. But typically it's the roads, and those type things, and the lagoons get inundated. Very few in the last storm actually overtopped. I think it's just a handful. And a lot of the ones that are in these sensitive areas now are looking at on moving those farms, and working with the government to have a buyout. Unfortunately, North Carolina has a moratorium, and we haven't been permitted to build a farm since 1996. That's when the moratorium started. So I find it very funny and very interesting that people, attack our industry in North Carolina when we haven't really been able to do anything but rebuild or improve the facilities on the sites that have been permitted because of this moratorium. Which is unfortunate, because a lot of people would probably move their farms as conditions change, if they were allowed to. And so it really interferes with, in my opinion, some good management practices that people could take advantage of in moving a farm, based on towns and cities growing up close to the farm. A lot of the farms that the integrators have built, in fact, I've participated in a lot of the site work and those type things. When we built the farms, we can show you photos and there was not a house around that farm, no houses around that farm. And then we can show today, where people were build their homes right up to the spray fields. In this County, in Wayne County, there's a setback that you can't build a hog house within 1500 feet of a residence. Well, in Wayne County, they have had the reverse of that, that you can't build a residence within 1500 feet of a hog house. So I find it interesting that people would talk about how bad it is, but that if that were true, people wouldn't be building three and four hundred thousand dollar homes right up to the property lines of a farm. And so, I think that that's a lot of misconceptions as far as North Carolina permitting them more hog farms, and when they do something on the farm, they are allowed to update it and modernize. And, if it's in a sensitive area, got programs so that we can move out of that area. So good story to tell again, that's seldom told. Thank you for listening. If you would like to subscribe to the Leading Voices in Food Podcast series, you can do so at Google Play, Stitcher, Radio Public, or Apple Podcasts, or by visiting our website at the Duke World Food Policy Center. This is Deborah Hill.  

E44: Chile’s Health Strategy: Warning Labels, Soda Taxes, and Marketing Limits So what happens when a country gets really serious...REALLY serious about tackling diet, nutrition, and chronic disease? Is there a country in the world that stands out for taking the most imaginative and strongest action? The answer is yes, and a person who knows a lot about this is our guest Barry Popkin. About Barry Popkin Barry Popkin is the W.R. Kenan Jr. Distinguished professor in the Department of Nutrition at the University of North Carolina-Gillings School of Public Health. Barry is a leading expert on taxes on sugar sweetened beverages and dietary changes around the world. He has been heavily engaged with the country I mentioned, and that country is Chile. Interview Summary What has happened in Chile has been impressive in scope and impact. Before we speak about what has been done specifically, can you explain please? What's made it possible for Chile to take action and in such impressive ways? Is it a combination. There was a legislator, senator by the name of Gerardi. A physician who had been a leader on environmental change and he created a coalition of senators and Congress and Congressmen that together were very interested in improving the health of Chile. Chile had an obesity level close to ours, and was the highest sugar beverage consuming country in the world. This was after the Mexican tax reduced Mexican sugary beverage consumption and child obesity was skyrocketing. And Chile has a government health program. So Gerardi pulled this coalition together and at the same time they had a set up scholars from the institute of Nutrition and Food Technology at the University of Chile that got together and worked with this group. And then they had a minister of health who then subsequently became the president by the name Michelle Bachelet. And she was a pediatrician. That combination of a passionate Minister of Health who truly believed in dealing with this problem of overweight, a group of academics that helped them, and this congressional coalition, without a major advocacy campaign, unlike any other country in the world, just essentially decided to do it. And they created the set of policies with what would be unusual kind of unanimity among the congressional groups and the president. And this is Bachelet. And they passed these laws that when a conservative government came in, which is in the last two years, they were kind of forced to retain because they had become popular. They were having a big impact and they could see it in healthcare issues and other things. Well is that impressive! And it's a really great example, isn't it, of how scientists and the people in elected offices and the public policy leaders can work together. So let me ask a particular question on what they've done around front of the package and labeling. What's happened with that? Okay, so Chile is the first country in the world to take what we found in cigarettes is very impactful: warning labels. And they put that warning label on a food that's high in added sugar, added saturated fat, added sodium, or if it has any additives of any of the above, high in energy. And so they created this system of nutrient profiling that had three phases. The first phase covered about 40% of the packaged foods. We were thinking these have junk food. They kept out of this real food. And they kept out of this certain categories of other healthy foods. So these packaged processed foods that were unhealthy - in the first year about 40% were covered. And then two years later the requirements got tighter. And then in the third or fourth year they got even tighter. And what they found from this warning labels to things, both industry responded by cutting the sodium, cutting the added sugar and making many more products healthy. And secondly, the public responded very well to this. Low and middle income households were changing their behavior. Now part of the reason is they have these warning labels, which is very important. And that it was linked to two additional policies. If you were in a school, public or private, you could not bring to that school any food or you could not eat it at that school, any food with that warning label. So what that meant was that we found that children were telling their parents - Mom, don't buy any of these warning label foods! Don't buy these unhealthy foods! In fact, we have three or four in our focus groups where the young, low income children tell their mothers I want salads for lunch now. So the fact is that was the first thing, linking it to school program. Not only feeding programs in the school. Whatever could be brought in or sold in the school, vending or whatever. The second thing they started doing was they started a fairly interesting comprehensive marketing law. Now what's unique about this marketing law was first--if you were a food that was labeled with a warning label, you could not have a character on the package. No more Tony the Tiger, even Santa Claus and Easter Bunny full of chocolate, no more figures of the Santa Claus or the Easter Bunny. So it really impacted consumer behavior and child behavior. But on top of that, for child-oriented TV program, for the first two years they banned these warning label products. I'd love to hear more about this. So because this is relatively new, has there been time to collect data and really understand them? Yeah. So we got one paper published and three in press that describe the marketing, the effects in schools, the effects on beverage purchases. Let me first describe the marketing because it's very interesting. So there's two kinds of marketing. There is marketing oriented toward children, which really focuses on them and children's programs. And then there's general marketing of the product which you see on sports events and regular soap operas and other kinds of TV. What happened was the child oriented marketing went way down and children had less exposure overall but not as much as you would think because all the marketing shifted to the non child-oriented program. So the total amount of marketing with did not change. But the orientation of the marketing became more adult oriented and less child oriented. So there was a slight change in child attitudes but not that much. So subsequently, this last summer, July, two years after the law was implemented, the government instituted a total marketing ban. From 6:00 AM to 10:00 PM, any warning label food cannot be shown on TV. That would mean if you're at a sporting event and are televising it, you can't see a Coca Cola product, Coca Cola with sugar in it. And secondly, after 10:00 PM, so between 10:00 PM and 6:00 AM, a warning message is put on any product that is marketed on TV or elsewhere that has the warning label. This is incredibly comprehensive to think about this suite of things, working together: the marketing, working with labeling, working with the schools, etc. So is there any way of knowing the impact of this in Chile, say compared to a country like Mexico where the tax has been the main thing that's been done? Yes. It's a very interesting difference. Up to that point, we thought tax with the only answer. And in Mexico, at the 10% act, we had that 6% reduction in purchases in the first year and an extra 4% in the second year. In Chile in the first 18 months of this law, we had at 25% reduction in sugary beverage purchases. And that's just the first year and it will continue to increase. So the fact is that for, and we've looked at some food groups, we haven't looked at all of them yet, but every unhealthy food group, we have seen a major, marked reduction. So not only does it affect the sugary beverages much more, but it affects other things. Now we don't know if that will be the same in other countries. But this has really then a guidance for other countries. Right now, four or five other countries have adopted, exactly verbatim, the Chile front of the package warning label system. Peru, Uruguay in Israel all have adopted it. Right now India's considering it and three or four other countries that haven't publicized it, put are doing studies and the ministries are going to introduce a similar kind of warning label law. So that that part has been very impactful. And it's the first front of the package label that we have seen impact purchasing. Up till now there have been positive labels or traffic lights with multiple colors based on if you're good or bad in a certain nutrients, and to have an impact on purchasing. So this is the first study to do that, which when it all the results are to be published this year will truly change how we begin to understand ways that we can impact consumer behavior. And manufacturing because the manufacturers are formulating. They have the technology to get rid of sodium, but it takes a regulation like Chile to do it. Do you see any possibility that Chile might use taxes as the strategy layered on to these other things? And if so, do you think there will be incremental benefit? Yes they will they will do that. They will see an incremental benefit on top of this. Their goal is to get rid of much of this unhealthy food as they can and shift people toward truly healthier food. So Barry, how in the world have the authorities Chile been able to prevail over what I imagine are pretty strong interest in the food industry? It's this coalition of the congressman and this high cost of healthcare. And in a government that has a public healthcare system--so the government's paying for it, which is one of the reasons why a number of other Latin American countries are truly going after regulations and taxes and other things, is because they're paying for healthcare for everybody. So the government feels the costs directly.

We speak today with someone whose work is credited with preventing 400,000 cases of blindness and saving as many as 1 million deaths per year. Dr. Alfred Sommer has earned this place in global history. He discovered that Vitamin A deficiency reduces immune responsiveness and resistance to infectious diseases such as diarrhea and measles. He proved that vaccination for smallpox as late as six days after infection can prevent the disease. He demonstrated the effectiveness of a simple and effective tool for monitoring the nutritional health of children at high risk of dying from malnutrition, and he identified an early accurate predictor of optic nerve damage, signaling when to start Glaucoma therapy. About Alfred Sommer Al Sommer is a professor of epidemiology, ophthalmology and international health at Johns Hopkins University, and is dean emeritus of the Johns Hopkins Bloomberg School of Public Health. He is a member of both the National Academy of Sciences and the National Academy of Medicine. His research focuses on child survival and blindness prevention strategies on micronutrient interventions and on the interface between public health and clinical medicine. For his contributions to global health, he has received many awards including the Albert Lasker Award for Clinical Medicine, the Danone International Prize for Nutrition, among others. Interview Summary You've done groundbreaking work on Vitamin A that has saved many millions of lives in developing countries. Could you relive some of the steps you took in this discovery process? And, can you explain the problems caused by Vitamin A deficiency? What we knew for years was that if you made animals or children (we had observational data from back in the late 1800s-early 1900s) Vitamin A deficient, then they develop a sequence of issues. And we were forever focused on the eye. The earliest manifestation is a child can't see after sunset. They suffer from what's called night blindness. More severe deficiency causes keratinization--a cornification of the outside of the conjunctiva of the eye (the white part of the eye) and then ultimately of the cornea (the clear part where you actually see through). With severe deficiency then that cornea can ulcerate and melt and entirely disappear, and you lose the eye within the course of a few minutes. What we now know, and we didn't know when I first got into this game, was that in fact, the eye signs are not the earliest manifestations. The earliest manifestations, in fact, are so prosaic, that people hadn't identified them with Vitamin A deficiency. The earliest manifestations are a diminution in the immune responsiveness, which means that children at risk--when they are infected with diarrhea or pneumonia or measles--have much less ability to fight off the infection, and therefore they have a much more severe clinical response, and a much higher mortality rate. When you started the work on this issue, what was the extent of the problem and where in the world was it as its most severe? The earliest studies--probably because that's where the clinicians were attuned--were actually from Europe and Japan by what would be at the turn of the 1900s. By the time I got involved, because an agency in New York that was starting a blindness prevention program thought it might be an important issue, was in the early 1970s. And that was primarily on the basis of a very informal survey that was undertaken at WHO's bequest back in the '50s by three giants in nutrition and ophthalmology. Don MacLaren, Oman, and Esposito basically broke up the world, they each visited about five countries, talked to pediatricians and ophthalmologists and asked about seeing these eye conditions because that's what people are focused on and that they tend to see it in the hospital. And often they were told yes we do in the diarrheal ward or the malnutrition ward see children who have either problems with night blindness or more critically have actually gone blind because of melting of their cornea. So there was a feeling that in the developing world, broadly, there were manifestations of deficiency. But nobody really knew how great the extent was, where it was most severe, who were the children who got it, and why did some children get it and other children did not get it, and what could be done about it. And that's when I entered the picture and was asked for some assistance. Being someone who always asks questions before they dive in, I said, well, do we have any sense of how severe it is and where one might find it? And at the time I was a resident in ophthalmology so I couldn't go very far away from Baltimore. So we picked first one country, El Salvador, then Haiti, where we actually conducted a randomized survey in the rural areas looking for the disease. We looked at where we would find it, how severe it was to develop manifestations that became WHO criteria, how frequently or how prevalent were these various manifestations to qualify a Vitamin A deficiency as a "public health problem." And we looked at the registries and the hospitals to see what they had recorded. And those showed that in fact, it was much more extensive in those two countries than anybody had previously thought. And that led me to write a manual for WHO on what are the ocular manifestations of Vitamin A deficiency, how to diagnose them, what are the criteria for a public health problem, and methodologically, how to go about carrying out a simple, representative survey in the population. So that would have been the early 1970s. That led me again to say, well, it looks pretty prevalent in these two places we've looked. Now we need to know more about why some children get another it and other children don't get it. And, why some are more severe than others and what can we do about it? This led me to put in a proposal that got funded and that I moved to Indonesia for three years where there was reasonable hospital-based evidence that there was a severe problem. And I then depicted it all the questions I would like to have answered before one can go about mounting some sort of an intervention program. So the first step was to document the extent of the problem. What was the next step? So when we went to Indonesia, we carried out three critical studies. One of them was essentially to examine everybody who came to the hospital with the eye size because that's what we were focused on historically. That's what Vitamin A deficiency was all about. Primarily because that was unique to Vitamin A deficiency. So I studied everybody that came in. We also carried out studies where we followed 6,000 children in six villages, examining them every three months for 18 months. That study was conducted with the thesis: why do some children get severe Vitamin A deficiency and some children living in the same village don’t. And then the third major study was a countrywide survey to document for Indonesia where the disease was most prevalent, and how severe might it be. Now some of those studies yielded data that we hadn't anticipated. So the one in which I examined all the children coming into the hospital--a lot of them came in for night blindness. That was simple. Our recommendation, which had been established by the World Health Organization on a committee that I sat on only a couple of years previously, was that could be treated with oral large dose Vitamin A. But a child who had more severe disease or early ulcers or keratinization of the cornea, they needed an emergency intra-muscular, water miscible Vitamin A injections. Now the problem with that nobody made water miscible Vitamin A. Vitamin A is an oil-soluble Vitamin, and around the world, you could find injectable Vitamin A, but it was all in oil. And one of the things we had discovered in reviewing the literature for this WHO technical committee, a couple of years previously, is that in rat experiments, if you inject a dose of oil miscible Vitamin A subcutaneously or intramuscularly in a rat or in a child, you don't impact the Vitamin A status at all. It just sits there like a lump. So sitting in a WHO room, we came up with the recommendation, based upon animal experiments, that really if you want it to be absorbed rapidly, that intramuscular injection has to be a water-miscible preparation. That would be like homogenized milk. That is that the fat is dispersed within the quart of milk; it doesn't come up to the top as cream. I get to Indonesia, the first child presents with actually a corneal ulcer. So that's a real emergency. I turned to my Indonesian colleagues, and I say get me some water miscible Vitamin A for injection. They looked at me like I was crazy, which I was because they had none. In fact, nobody had any, despite the WHO recommendation. Nobody had told the pharmaceutical industry to prepare injectable water miscible Vitamin A. So I was stuck initially without a recommended treatment. I knew that if I injected the oil miscible Vitamin A intra-muscularly, it wasn't going to have any impact. But I did remember some animal experiments in which when they gave the oily Vitamin eight to rats by mouth, it actually worked pretty quickly. So I got the injectable water miscible Vitamin A, sucked it up into a syringe, took off the needle and then squirted into the children's mouth. Right after doing that first child, I then telexed colleagues at Roche and asked them if they would produce some water miscible injectable Vitamin A. And of course, they were happy to do it. But, they said it's going to be three or four months by the time they formulate it, do toxicity testing, get permission from the Indonesian government and licensed to import it. So I was treating every child that came in for the next three or four months with this oil miscible old injectable stuff but putting it into their mouth instead of injecting it. And they seem to respond very rapidly. When I eventually got the ward a miscible injectable version, I decided, you know, giving this old stuff orally seems to work very well. Let's set up a randomized trial in which half the children who presented with corneal ulcers were given the old fashioned oil-miscible Vitamin A by mouth, and the other half were randomized to get the new water-miscible Vitamin A by injection. And the end of two months, we had done about 60 or 70 children, and their biochemical response and the clinical response was absolutely identical. Now, why this was critical? It took 5 to 10 years to convince my colleagues. Nobody else ever replicated this trial or attempted to replicate the trial. But nobody wanted to take away the injectable water-miscible Vitamin A, even though it was very hard to get. It took five to 10 years. Originally, I argued enough that we could get as an asterisk "if you don't have water-miscible Vitamin A for injection, give oil Vitamin A by mouth." Took five to 10 years before we could get them to move that up as the primary recommendation because it's so much safer. Anybody can do it. You don't need a healthcare worker to inject it. And that, therefore, paved the way for what became these large scale programs for distributing high-dose Vitamin A supplementation, because you did not have to do it by injection. You could do it by mouth by simply giving a small capsule or an equal amount on a spoon. So let's talk about the large scale expansion of the work you did. Because one challenge, of course, in making the initial public health discoveries of scaling things up so that they can work for hundreds, thousands or millions of people. So how did you address this issue? So yeah, I was again very fortunate. The head of UNICEF, while I was doing this work, was Jim Grant, probably the most effective UNICEF director general there was. The person who is his chief medical advisor was following my work on Vitamin A and would periodically ask me to come into the office in New York and brief Jim on what we were doing, and what we were finding. So I had a colleague who is in charge of the largest agency that had to do with the health of children who is interested in seeing whether or not this, in fact, was necessary, and whether or not it was effective. I also knew Nakajima at WHO, and he too got interested in whether or not this would be effective. I have to say that put me well-placed, to try and make the argument. I'm not sure it would have flown if it remained totally focused on blindness because there weren't a lot of global health champions who are interested in spending money and resources on preventing blindness. But it was soon after that I made this unexpected insight from that original study, where we were following new 6,000 children. Children who had early mild Vitamin A deficiency (just night blindness, the earliest ophthalmic clinical manifestation) were dying at much higher rates than the children who had no eye signs at all and had slightly better Vitamin A status. So that led us to do several randomized trials that demonstrated, convincingly, that distributing Vitamin A large dose capsules reduced the childhood mortality by about a third. Now again, nobody believed that either early on. So we had to replicate it. We got other people to replicate it. By 1992, and I think it was critical--there were still people arguing on both sides. Nobody actually had negative data, they just couldn't believe that 2 cents worth of Vitamin A could reduce child mortality by a third. So in 1992, these commentaries are still going back and forth. People are still debating. And I said this is ridiculous already. We already had six or seven randomized trials, and these are trials with 20,000 children. These are expensive, difficult to do trials and in four different countries. And so I called a meeting at the Rockefeller Retreat in Bellagio. In those days you could only have about 20-22 people. These were people who have been involved in these trials, people who were experts in child survival. And to make a long story short, we said we're just going to answer two questions: is Vitamin A deficiency bad for children, and if we improve their Vitamin A status with these large dose supplements, which have essentially no side effects whatsoever, will we reduce childhood mortality? And after going through all the data over the entire week, on Friday morning, everyone agreed that yes it would. And I said, okay. And I went to a side room, I wrote up a paragraph that said these are our conclusions from reviewing the data in detail collectively. Got everyone to sign it in blood and then asked everybody at the meeting when they went back home, because this was an international meeting, if they would publish their perspective of the results of this meeting in the favorite medical journals. So I published one in the Lancet, somebody published one in the British Journal of Ophthalmology, somebody published one in the Medical Journal of South Africa. And so within a few months, people who were respected in the child survival and nutrition pediatric area sort of swamped the medical literature with agreeing that in fact, this was an important potential program that could be effective. One of my concerns had always been would the right children get the supplement or only the healthier children get it, but it turned out in these trials that of course, they got it pretty right pretty well across the board. That led Jim Grant and Nakajima to host a major meeting to inaugurate the supplementation. UNICEF and I would go to Congress every year, a particularly a very supportive at that time House Committee on Hunger, and report what the research has shown. And we would talk about the implications for child survival if we could, in fact, get out this distribution. So, Congress would allocate funds each year for these programs. And very importantly, the Canadians took a very, and still retain, a leadership role in making these Vitamin A supplements available to countries. And these are now given out in over 50 countries around the world, probably reaching maybe about 60 or 70% of the children who need it. But again, what made it move forward was first being able to demonstrate that this impact on child survival. And this was back in the 80s and 90s when child survival was something that was on the top of the international health agenda. And everyone had these various programs from growth monitoring onward to improve child survival and reduce child mortality. So it hit at the right time on an issue that everybody was concerned about. I was fortunate to have engaged two critically influential people, the director generals of UNICEF and WHO, who followed the work through the research phase and saw the results come out positive repeatedly, and then bringing everything together and getting a general consensus as this was an important thing to do. So it's, in some ways, it was a very fortuitous series of events that came together, made this program move forward on a global scale. Once you made the discovery that supplementation could have such profound effects, I'm imagining that whether these programs got implemented within countries had a lot to do with political issues. And things like that that go beyond science. Is that true? And how did you navigate those things? Yeah. Now that's of course true. One of the advantages and one of the hang-ups at the same time was every country wanted to have its own randomized trial. And people did raise the issue of, is it ethical to do any more of these randomized trials after you've done of one, two or three and every one of them gives you a 35% reduction in mortality. How can you randomize children to a placebo? And the argument I could make early on, well, if we don't do this trial, the country is not going to launch a program, a nationwide program. And when we do the trial, at least half the children again get Vitamin A, the other half who survive are going to get Vitamin A at the end of the trial, since we're it ethically compelled to do that. And hopefully, it'll cause the country to change policy. By the time we had seven or eight trials, I couldn't even live with that argument anymore. And that's why we had the Bellagio meeting. And I just said, we have to do this. And then, of course, I would go and visit with the Minister of Health in dozens of countries, one by one, sometimes regional meetings to present the data and talk about the impact having their particular country, given their infant mortality rates, and child survival rates. And it wasn't too slow of a process once we had gotten through that Bellagio brief and WHO and UNICEF jumped on. One of the critical things I remember was making a visit to East Africa for an entirely different reason to set up some other studies, and I had a stop in Nairobi. And the person who picked me up at the airport happened to be the regional advisor for nutrition. And as he's driving me into Nairobi, he tells me that they just got a directive from Jim Grant that every one of the country offices for UNICEF needed to build Vitamin A supplementation into the budget for the coming year. So part of the political process that helped was visiting with Ministries of Health, talking to the Ministers and showing them the data in a relatively straight-forward, simplified fashion, because they've got a million other things to do it and not necessarily epidemiologists. But the other one was having UNICEF behind us where Jim Grant tells a regional office to direct the countries to put it Vitamin A into their programming for the coming year. So again, it was a constellation of things that came together. Some of it science and a lot of it was personal. Produced by Deborah Hill, Duke World Food Policy Center

What happens when a child is malnourished? Can such a child ever “catch up” later in life? Why does urbanization and obesity seem to go hand in hand—and what does this mean for food production? We’ll explore big picture food system questions today on the Leading Voices in Food with our guest Dr. Shenggen Fan. About Shenggen Fan Dr. Shenggen Fan, Director General of the International Food Policy Research Institute, also known as IFPRI. Dr. Fan joined IFPRI in 1995 and has conducted extensive research on pro-poor development strategies in Africa, Asia, and the Middle East. He is dedicated to inspiring ambition, to mobilizing action and to accelerating progress toward cutting global food loss and waste. He serves as a member of the lead group for the Scaling Up Nutrition Movement appointed by UN Secretary General Ban Ki-Moon, and serves as an advisor to many national governments including China and Vietnam on agriculture, food insecurity and nutrition. In his highly distinguished career, Dr. Fan has received many awards. In 2014, he received the Hunger Hero award from the World Food Program in recognition of his leadership in fighting hunger worldwide. And in 2017 received the Fudan Management Excellence Award. This award is referred to in China as the Nobel Prize for management. Interview Summary There are few people in the world who can see the food picture and the global food picture as you do. What do you believe are some of the key food issues facing the world? Well, there are a couple of challenges we are facing. Firstly we're facing the multi burden of malnutrition. So, on the one hand, we have 800 million people who are still hungry, meaning that they do not have enough to eat. In fact, for the last two or three years, that number has been rising because of conflict, climate change and so on. So that's the number one burden. Number two burden is hidden hunger. We actually don't see them, the lack of micronutrients, Iron, Zinc, vitamins, vitamin A and beyond. And we have more than 2 billion people who suffer from that. The third burden is overnutrition, you know-- overweight, obesity--and again, we have more than 2 billion people in the world who suffer from overweight. Obesity, as you know, overweight, obesity leads to noncommunicable diseases: heart diseases, strokes, diabetes, and beyond. So the burdens of malnutrition are the number one challenge that we're facing. And number two challenge is, yes, climate change. Climate affects our life, but climate change affects our food system much more than anything else though. Our crop yield will be affected. Even nutrition. The latest evidence shows that if global warming continues, the micronutrients or nutrition of certain crops will be affected negatively, which means that it will not only affect the amount of food we're going to eat but also affect the quality--the nutrition of the food that we're going to eat. So climate change is a big issue. The third challenge is urbanization. We know that when people move to cities, they demand more and better food. Just two or three years ago, we crossed a line of a 50/50, you know, 50 percent urban population, 50 percent rural population. I think today probably more than 52 to 55 percent and by 2052 two-thirds of our population will be in urban areas demanding more and better food, demanding more water and land and so on, and more construction for residential areas. That also affects the supply of our food. So I think we're facing all these challenges in the long-term. In the short run, the conflict, the droughts in many parts of Africa in South Asia have led to many people going hungry. And that sort of a shorter run impact is not going to go away soon. So the challenges are grave, and we must work together to make sure that people have enough to eat. That people have nutritious, healthy food to eat. You mentioned 800 million people are malnourished around the world and then more with hidden hunger beyond that. What are some of the consequences of this? I mean, we hear these large numbers, but what is the real effect on people in their lives of being malnourished. Well clearly, when people are malnourished, their human capital will be affected. Their physical capability and their cognitive skills will be affected. So once a child is malnourished or stunted, it's like a life sentence. The whole life of that child will be affected. So from our study, it shows that every year, you know, we lose trillions of dollars because of different burdens of malnutrition. Oh, it's a human development issue. It's an economic issue, and it's also a health issue, you know. Just to give you one example about the malnutrition problem in the US. So, for the last two years or three years, the United States life expectancy has declined. Obviously, there are many reasons, for example, the overuse of certain drugs and so on. But one important factor is the diet. It's a bad diet, leads to overweight and obesity. And again, that then leads to many noncommunicable diseases. That's in the US. So in Africa, in South Asia, you know, many countries lose 10 percent of the GDP equivalent every year because of malnutrition. So it is a serious problem for everybody in the world. Let's talk for a moment more about the climate change issue that you brought up. You said that climate change could affect the nutrients in foods, but I know it can also have an impact on where foods will grow. What does that picture look like as time goes forward? Absolutely. So we know that if the temperature of our planet increases by two degrees by 2050, by the end of the century, the amount of food produced will be affected in many parts of the world--particularly poor areas of our planet, Africa and South Asia. Many crops will lose the yield by 30 percent, in some extreme cases, it could be 50 percent. Could you imagine they would lose 30 percent, 50 percent of the yield in the next 50 to 100 years in many, many extreme areas? But equally important is the micronutrients. We have evidence that shows that vitamins and even proteins of our foods will be affected, which means many people will go either invisible hunger or hidden hunger. And if we don't address that, even more people will be affected. We will lose our human capital, our health, and our economic development. So if the warmer places in the world--say in Subsaharan Africa--are already having trouble feeding themselves, this will just exacerbate the problem. Now could one make the argument that areas that are far too cold to grow food will be able to with global warming, and the same amount of food might get produced overall it will just be moved to a different location? Well, this is true to some extent. But there are dry, hot areas in Africa and a certain hot, humid area in Asia, South Asia, that would be affected much more, much more unproportionately. And that's where the poor, hungry people and they do not have the capacity or have means to adapt to that. And while the Northern part of the planet, yes they may again begin to produce some of the crops that have never been produced, but that will not be able to offset the large loss from the southern part of the planet. And also, you know, the warmer climate in the northern part of the planet may also bring diseases, you know. Whether there's human diseases or animal disease or crop diseases that could affect our production negatively. To what extent do you think technology can save us from this? For example, can a genetically modified food to better resist drought, hot conditions and things like that help stave off this problem? Technology is critical here. Technology will help farmers to adapt to climate change. For example, the climate is getting warmer or getting colder, so the newer crops can adapt to the new climate so they can still produce more, even better food. We call that adaptation. We have seen lots of crops already in many parts of Africa, many parts of South Asia, so they begin to introduce new crop varieties--which is a technology--that can help to survive in a very hot environment or, very wet environment, or in various submerged environments. So we have seen that already, but more needs to be done. But, here I also wanted to mention another dimension, Kelly, and that is mitigation. So many technologies, many crop varieties can act and help mitigate the climate change by reducing carbon emission to our air. As you know, our agriculture and food system account for somewhere between 20 to 30 percent of the total carbon emission. And we have made tremendous progress in the energy sector, in the transportation sector, but our food and agricultural sector lags behind. So newer technology must also help mitigate the climate change to reduce the carbon emission to the air or help to sequestrate the carbon into the soil. Let's talk about rural areas a bit. What role can rural areas play in the context of food and what are some of the key actions that might be taken? Well, I think it's very critical, very critical. Part of the reason why people want to move to the urban area is because there's a lack of opportunity in rural areas. The environment has been degraded, such as water, land, the whole ecosystem. And, to a large extent, this is also related to agricultural food production. In Asia, many farmers in food production overuse fertilizers, others pesticides, water, and as a result, the water has been contaminated. The land has been degraded. And in some areas, even air has been polluted because of the burning of certain straws. So I think the rural areas have been to some extent sort of a degraded because of the different farming practices, but that does not mean there is no chance. There is a chance. How are we going to revitalize the rural areas? By fixing the environmental problem, by fixing the living conditions. For example, you know, if a young farmer or young people wanted to stay in rural areas--that person needs a good job. I do think agriculture, food, a range of service sector can provide a good job or even others go to distance working can provide a job in rural areas, rural towns. And then they also need entertainment, movie theaters, and the banking services, restaurant services. So if we can provide all the services, opportunities, and fix the environment, I think people will stay in rural areas without moving to the cities. You know, cities are already very crowded, housing is very expensive, traffic is terrible. So part of our strategy, from my institute, is to look at different ways, different strategies, different investment priorities to revitalize rural areas. So the young people can stay or even come back to rural areas to enjoy their work, to enjoy their lives. Such a great opportunity. As you know right, there are trade frictions around different countries. I think help with revitalizing the rural areas can also help avoid that problem. If you wanted to revitalize rural areas, you create a big demand, big demand for infrastructure, big demand for investment, big demand for services, big demand for food and so they will be more resilient to anti-trade shocks. What would you say some of the leading priorities are to ensure healthy and sustainable food systems around the world? I think number one is innovation, you already mentioned about innovation, but here I think it's not just the innovations in technology. I have already to said to that the newer technologies have multiple wins. They win in yield, they win in nutrition, and they win in the environment--you know, cutting down water, land use, energy use, cutting down the carbon emission. So newer technologies that we tried to introduce today must have all these wins. So that's number one. Second is innovation policy, which is very much ignored by many, but which is equally important. So how can we reform the current investment or support policy to agriculture? Right now, in this moment we are using $500 billion to subsidize farmers to use more water, more land, more energy or pesticides to produce staple foods like rice, wheat, and maize, at the cost of more nutritious, healthy or sustainable foods, vegetables, fruits, dairy products and beyond. So reforming subsidy policy. It's a gradually eliminating of this subsidy and then using that money to promote more nutritious and healthy food production I think it has great potential. And even further, I also wanted to propose taxing unsustainable foods, and use that money to support healthy, nutritious and sustainable food production. I think innovation policy is equally important. And finally, governance. How can we make sure that our politicians are accountable to nutrition, health, environment--our environmental outcome is very critical. So that comes back to your institute and my institute so we can help generate the data, generate a matrix, generate evidence to make sure that different stakeholders, including politicians, the private sector, our citizens are accountable to what do we want to achieve. At various times in our conversation, you mentioned food insecurity, you mentioned overnutrition, obesity, and you mentioned agriculture. How important is it to connect these areas, to look at the intersection of these areas and to bring together people who work in what are now pretty segmented areas. I think it's a system. So today we're talking about agri-food system. So agriculture is a system. Food is a system. So that system not only needs to produce food nutritious, healthy food for everybody, but also help to address environmental problems, climate change problems. So the agri-food system has to have two overarching goals. On the one hand, the healthy nutrition of everybody in the world, on the other hand is a good environment to help to mitigate climate change for everybody. Every stakeholder in this system, you know, farmers, processors, traders, consumers, even the government officials, the private sector must be part of that system to work together to achieve these two overarching twin goals. You've talked about some pretty daunting problems during our discussion. Are there are other reasons to be optimistic? Oh, I am, we have seen such successes in many different countries in Africa, South Asia, and here in the US. So we have seen successes here and there if we can really learn from the successes, and to generate knowledge, generate best-fit practices that people can use to accelerate the progress, I truly believe we can transform and reshape our agriculture system to achieve these two goals at the same time.   Produced by Deborah Hill at the Duke World Food Policy Center

Imagine presiding over one of the nation's major food assistance programs. The supplemental nutrition assistance program that helps feed more than $40 million Americans. And that this is just part of your job. Few people have seen the inner workings of federal and state food assistance programs as deeply as today's guest, Kevin Concannon, former Undersecretary of Food, Nutrition and Consumer services in the US Department of Agriculture, under President Obama. About Kevin Concannon In his time as Under Secretary, Kevin Concannon was responsible for funding and administering the Food and Nutrition Service and promoting healthy dietary guidelines through the Center for Nutrition Policy and Promotion. Working in partnership with state and local organization, he oversaw the Supplemental Nutrition Assistance Program known as SNAP )formerly known as the food stamp program), the child nutrition programs, including the national school lunch, school breakfast and summer food service programs, the Child and Adult Care Food (CACF) program, and the Supplemental Nutrition Program for Women, Infants, and Children (known as WIC) and more. Prior to his work at USDA, Kevin served as director of the State Health and Human Services Department in Maine, Oregon and Iowa. He has championed expanded services, improved access, alternatives to institutions, consumer choices, and affordable healthcare and diversity. Interview Summary Kevin, few people have had a career public service as you have. So on behalf of the nation, please accept my appreciation. And welcome to the show. Thank you so much. I'm pleased to fill in with you here today. I have felt very fortunate over the years to have those responsibilities and as I reflect back on those times--that went by, frankly in retrospect, far too quickly--I'm pleased with what we were able to get accomplished. Let's talk about the impact of food assistance programs like SNAP and WIC. Are they effective? Are they cost effective? Yes, they are on many, many fronts. Actually the, the food assistance programs, as you mentioned, serve more than $40 million people each day across the country. And people come on the program and go off over the course of the year so that there are actually in a calendar year there are millions more who benefit from the program. It not only provides the opportunity for individuals in households to access food in the US, but it also is one of the major components of the safety net, a frayed safety net, I would suggest, over the past decade or so if not longer. Where in the past, low income households in the across the US might have expected or been able to receive financial assistance in various forms, in many parts of the country that has disappeared. So by default, the SNAP program has become one of the major sources of household support for food that allows that household or individual then to use whatever other meager income they may have to spend that on housing or electricity or transportation and what have you. Can you make an argument that for every dollar invested, the nation gets more than a dollar return? Yes, actually, indeed. I know the Economic Research Service, a different mission area within the US Department of Agriculture, estimated that for each dollar expended by SNAP it creates between a $1.74 and a $1.80 by virtue of the multiplier effect. And some years ago, actually about five years ago, I sat in on a meeting at the Brookings Institution with major economists from around the country who were reflecting. The topic of that session was what worked in the last recession, that deep recession we had in 2009, 2010, 2011. And the opinion was unanimous that's the most effective intervention in terms of mitigating some of that distress in individual households as well as in the broader economy was the success of the SNAP program. Because as you know, it's very portable. The benefit distribution piggybacks onto the commercial electronic benefits systems. And it is portable in the sense that the program serves people in cities, in rural areas, in isolated parts of the country as well as in some of the most densely populated urban areas. You alluded to this just a moment ago, but you became Under Secretary in 2009 just after very significant significant economic downturn. How did that impact your work and what was going on with these programs? Well, you know, when I think back on my time as a federal employee in that role, I really, one appreciate, the importance of these various federal nutrition programs that were available to be deployed immediately. And fortunately, one of the first major acts that the Obama administration brought forth was one intended to mitigate or to mitigate the negative effects of the downturn and stimulate the economy. And additional benefits through the SNAP program resulted in a rather dramatic rise in enrollment, reflecting what was going on in American households. And I saw my particular role at that time is moving around and meeting with state officials, principally department heads in posts similar to what I had held in Iowa, Oregon, and Maine. So I had some familiarity with a discretionary role of state appointed leaders, not just the elected leaders. And I used that time period to both to press and to urge and to support state leaders who were availing themselves of options made available through federal policy to bring the program to individual households, individual communities across the country. And I think it really clearly had an impact. Again, not only individually but on the the respective economies of communities that were really being adversely affected by that downturn. Let's explore that a little further because there are differences across states and the percentage of people who are eligible for these benefits, who actually have them. That is due in part to customs across states and differences in leadership. Why is that the case that there are differences from state to state and the number of people who are enrolled? You know, that's one of the takeaways for me personally that I saw. I'd worked in three states, different states geographically, but at least at that point in their histories or when I was working there (not because of me, but because of the general political climate) these were I would say centrist states--centrist to the left of center--modestly, and the operating ethic in government at each of those states was to avail the state agency of options federally. What I learned during my federal years was that isn't the case across the country. That was disappointing to me to see states, at times where there was great need, but where politically the ideology of the state or the lack of a real, what I would describe as authentic commitment on the part of state leaders appointed or elected, where they were really disinterested or not that concerned about the circumstances of their populations. We measured states based on their poverty rates, and the rate of penetration, if you will, or engagement in the program. And I'm pleased to report that over time we increased the average participation based on estimated eligibility by double digits across the country. And we particularly focused on certain subpopulations that were underserved, including for example. People who are working part time often made the assumption--Gee, since I'm working, I won't be eligible for a benefit. Well, yes, in fact, based on household size and income you might be. Seniors were another group. Latinos or Hispanics were another large subpopulation that were underserved. So we focused with states on those populations in particular and an urged states to take steps to reach out to those populations. Some people may think that the differences from state to state are just economics. That some states don't want to spend money and want to use it for other reasons, but that turns out not to be the case. Is that right? That's exactly it. The irony is that the benefits that are provided through the SNAP program are 100 percent federally paid. As is true of the WIC, the special program for women, infants and children focused on the population of very young children, infants and pregnant women or new moms. And in both of those instances, it does not require the state to spend money on the benefit. In the case of SNAP, the state is required to pay a portion of the administrative costs. But the administrative costs associated with SNAP are a single digit when compared to the benefit amount itself. And the case can be made that just from a pure economic benefit point of view, it benefits the state. So when, states across the country, or sometimes counties within states, are less inclined to support the program it more typically reflects their etiology or political culture rather than an honest assessment of the need. What are some of the issues regarding incentivizing healthy foods and healthy eating within these programs? Well, you know, some of the challenges, as you may know--the SNAP program allows persons to purchase any foods in the US for which basically the criterion is there is a barcode that can be associated with it, or if it's sold in a store or in farmer's markets. The only limitation is you cannot buy hot food. But even with that, there are a couple of states, California being one and Arizona a second, and then maybe a third Missouri, where the state elected to allow certain populations to use the benefit in restaurants. The underlying rationale for that was really to help either disabled persons or seniors living alone and/or homeless people, but by and large that has not been adopted across the country. Now, back to your question on incentivizing healthy foods. The closest we've come to that has been the expansion of access to farmers markets. We went from, roughly in the beginning of the Obama administration, under a thousand farmers markets across the country that were authorized to process SNAP benefits to, at last count, in excessive of 7,000 farmers markets. There has been a very significant a pilot project in western Massachusetts that created a financial incentive for households to buy more fruits and vegetables that actually showed such incentives can work. And it was rigorously--it was a very expensive a project in terms of not so much the benefits as much as the evaluation, but it showed that you can incent people in certain directions. And I actually had some discussions with people in New York State, in New York City, that never came to fruition because we never quite settled on a subpopulation within New York City to both put some either voluntary or mandatory limits on purchasing of certain foods, like sugar-sweetened beverages as an example, and coupling this with some additional either purchasing benefits for the households that would participate in such. We never really got to settle on that. And I have resisted--the state of Maine, my own native state actually, submitted a request to put limitations on SNAP purchases. But there was no rigorous evaluation with it and frankly I personally couldn't--I couldn't overlook the fact that the state itself had basically a gutted it's public health programs during that particular administration. So it really did not on other fronts have much of a record of saying we're genuinely interested in trying to effect for the better the health of the populations. But we didn't outright said you can't do this. We said you have to resubmit it with a stronger evaluation. And of course I'm no longer there. So I don't know what the status of that is. So these programs have been around for many years. How do they fare under different political leaderships in DC? Well, it's interesting this very week as we're recording this a podcast, we expect within days the so-called Farm Bill of 2018 to be released. A House version was passed earlier this year that had what I would consider a number of a punitive elements in it as it pertained to the snap program around work requirements and any other restrictions. Happily, from my point of view, the Senate has more bipartisanship, at least on the Farm Bill issues, in the it has from the outset--the leadership of the committee has said they're not interested in, moving forward with those elements in the recognition that it would probably kill a bill in the Senate period. So, the politics of the Farm Bill are really important for one, the funding of the program, but also the authorizing of the policy elements in it. And, I'm enthusiastic about the changes that are forthcoming, or will be forthcoming when the new house is seated in January because, we clearly see more of a both a recognition among the members on the house side of the importance of the program. But more of a desire to say, how can we constructively address issues of food insecurity or folks just eating by virtue of where they live, not having access to healthier foods consistently. And programs like school meals this, this past week, actually just within the last couple of days, the current administration at USDA finalized federal regulations that will allow schools, if they so choose across the country, to weaken the nutritional values in the school meals program. This would be by allowing schools to delay their adherence, if you will, or meeting standards to lower sodium in the foods that are consumed, to not be as required to meet a new or existing standards for whole grains, and to reintroduce a higher fat content in the sugar-sweetened milks that are currently served in schools. A compromise was reached some years ago on allowing schools--for milk consumption--to continue to serve if they so chose, a flavored milk. But the requirement was, one, the sugar content can't be over a certain number of milligrams. Nor can there be a fat content above the nonfat level. Well the current administration has basically said we're not interested in sticking with that. And I think that's really unfortunate because it really shows to me the influence of industry. And it's not, you know--professional nutritionists and dieticians are not the voices that are asking for these changes. It's really coming from industry. And, I think regrettably so. One of the issues that comes up sometimes in the discussion of the SNAP program is fraud. What are your thoughts on that? Actually, ironically, I mean this used to be reflected here at USDA including Secretary Vilsack--would remark on this. We actually have a higher percentage of fraud in some of the major agriculture programs than we have in the SNAP program. But the actual percentage--there are two ways to measure fraud or misuse. One would be for the benefit to go to households that really don't qualify for it. Meaning their income is higher than would normally qualify them or they're not reporting significant income. The percentage of fraud in that regard--it's really more a payment errors, we would refer to it, because some of them are honest, honest mistakes--are in the single percentage. You know, they're like 2%, 2.5% fraud in the sense. A more potent version of it, in my view, is where SNAP benefits are sold by store. A household comes in, or a low income person comes in with their benefits on an electronic card like a debit card almost. And the store recognizes that they may have $100 in benefits: says to the household, I'll give you $50 in cash for that hundred dollar benefit and that percentage across the country is a little over 1%. So it's a very low percentage, but it's a troubling or worrisome percentage in the sense that people really latch onto what I'm talking about. People who are critical of needs based programs or safety net programs. So, we worked hard to utilize more data analytics, more undercover folks, but with more data analytics, helped us identify a stores across the country that might be engaged in doing this. And they are kicked out of the program if they're found doing this. Initially for a period of months, but then it can be a lifetime ban. And we stiffened those penalties during my time there. But it's a very small percentage compared to almost any other type program. But again, one that, even at House hearings, particularly with House not so much the Senate. The House members, particularly more politically conservative members, would try to amplify or try to state, often without much evidence that they thought this was more widespread than it really is. It is one of the most important aspects in terms of quality of life for people across the country these days. We didn't get to talk much about the women, infants and children's program by virtue of time limits, but as you probably recall WIC serves half of the births in the United States. One of the most important public health interventions we have. Because if you have healthy nutrition throughout pregnancy and good timely advice as a new parent--promoting as well the benefits of breastfeeding--you get better birth outcomes. And these better outcomes can extend over the life course. So again, a program not necessarily well known to the average person on the street, but pediatricians know it well. Obstetricians know well. And half the mothers and parents in the US would know it firsthand. Produced by Deborah Hill at the Duke World Food Policy Center