Month: September 2020

The New York State Assembly Standing Committee on Social Services, Standing Committee on Agriculture, and Task Force on Food, Farm & Nutrition Policy recently held a hearing on the impact of COVID-19 on food insecurity in New York State. NYHealth submitted the following written testimony on the widespread ramifications of food insecurity for New Yorkers during the pandemic. 

September 17, 2020

Distinguished members of the Assembly Standing Committee on Social Services, Standing Committee on Agriculture, and Task Force on Food, Farm & Nutrition Policy:

The New York Health Foundation (NYHealth) appreciates the opportunity to submit written testimony regarding the impact of the COVID-19 pandemic on food insecurity in New York State.

As of early September 2020, the COVID-19 pandemic has killed more than 25,000 New Yorkers and sickened an additional 430,000.^[1] A dire consequence of the resulting economic recession is the impact on food security. Mass losses in employment in the State have curtailed New Yorkers’ ability to afford food. Stay-at-home orders and social distancing measures have also cut off reliable pathways to food access, such as meals provided in community settings (e.g., houses of worship, senior centers) and schools. Many New Yorkers have been forced to choose between their need for food and their own sense of safety, given the risks of contracting or spreading COVID-19 while accessing food during the pandemic. In these extraordinary circumstances, funding programs and supporting sound policies to improve food security are more vital than ever before.

NYHealth’s Work to Improve Food Security

NYHealth is a private, independent foundation that works to improve the health of all New Yorkers, especially the most vulnerable. Our work has provided us with in-depth knowledge of food insecurity’s widespread ramifications for the health of children, families, and the communities they live in. In particular, our program, Building Healthy Communities, supports expanding access to nutritious, affordable foods.

Since 2014, we have invested millions of dollars to improve food security across the State. NYHealth has supported the creation of more than 85 new healthy food access points like farmers markets, mobile markets, and grocery and corner stores; supported the establishment of regional food hubs in New York City and the North Country; and expanded access to and demand for nutritious, affordable foods, including nutrition incentive programs that encourage Supplemental Nutrition Assistance Program (SNAP) use. NYHealth’s investments also helped secure universal free school lunch for New York City’s 1.1 million public school children.

Since March 2020, NYHealth has committed an additional $5 million to support COVID-19 response efforts, with a significant proportion of these dollars being directed toward organizations that ensure New Yorkers have the healthy food they need. NYHealth grantees that connect New Yorkers to a range of benefits and services tell us that their clients are overwhelmingly requesting food ahead of any other need. Federal data confirm this trend; according to Hunger Free America, SNAP enrollment in New York City in April 2020 increased by nearly 69,000 people—the largest one-month jump ever.[2]

NYHealth collaborates with New York State’s Departments of Health and Agriculture and Markets on efforts to improve food security. NYHealth applauds the State’s continued recognition and focus on the role that access to healthy food plays in maintaining good health and preventing disease, especially in response to COVID-19. The State has worked rapidly to launch new initiatives to ensure that New Yorkers have access to food, as well as support businesses and farms to supply and distribute food across the State. Nourish New York, for example, has brought a critical infusion of dollars to New York State food banks, farmers, and communities.

New Data on New Yorkers’ Food Scarcity During COVID-19

At this critical juncture, NYHealth would like to provide the Committee with new data that shed light on the growing and stark food insecurity challenges facing New Yorkers. This analysis can support the State in its continued efforts to design programs and target resources.

The data presented here are from an upcoming NYHealth analysis based on the COVID-19 Household Pulse Survey, which is administered by the U.S. Census Bureau in collaboration with multiple federal agencies. The survey provided near real-time data on household experiences, including with food scarcity, during the coronavirus pandemic from April 23, 2020, until July 21, 2020. The survey makes it possible to produce estimates by state, including by race and ethnicity, age groups, and income categories. It also assesses the degree to which New Yorkers accessed free meals and groceries, where they did so, and whether they used federal stimulus checks for food-related expenses. Further information about the survey is available on the Census Bureau website.^[3]

Below are key findings from the NYHealth analysis of the COVID-19 Household Pulse Survey data for New York State. Many of the findings highlight the increasing food scarcity rate, which is defined as the percentage of the adult population in households that either sometimes or often did not have enough to eat in the last seven days:

• From April through June, approximately 1 in 10 New Yorkers reported household food scarcity in the prior week. There was an uptick in food scarcity in July, when the rate surpassed 12% (see Exhibit 1 below). The food scarcity rate in New York State was generally consistent with the national rate, but higher than those reported in neighboring states.
• A larger proportion of households with children experienced food scarcity than households without children.
• There are stark disparities in food scarcity by race and ethnicity (see Exhibit 1 below). Between 17% and 25% of Hispanic New Yorkers and 15% and 22% of Black New Yorkers experienced household food scarcity over the survey period. These percentages were three to four times higher than among white New Yorkers.
• Food scarcity is increasingly affecting households that did not struggle to access food prior to the pandemic. In April, nearly a quarter of adults in households with food scarcity reported being food sufficient prior to the pandemic; but by July, that figure had risen to more than one-third of respondents.^[4]
• Mass losses in employment have likely contributed to increases in food scarcity. Nearly 60% of New Yorkers reported in July that they or someone in their household had lost employment income since the start of the pandemic. In July, the rate of food scarcity was higher (more than 17%) for those who reported lost household employment income during the pandemic in comparison to those who did not (5%) (see Exhibit 2 below).
• The federal Economic Impact Payments—known as stimulus checks—did not appear to make much difference in the food scarcity rate for those who reported lost employment income (see Exhibit 2 below). This raises concern that benefit programs, such as stimulus checks and Pandemic Unemployment Assistance, may not be enough to keep some New Yorkers food sufficient.
• Nearly three-quarters of New Yorkers reported in July that their household had spent or was planning on spending their stimulus check in whole or in part on food-related expenses—more than any other expense category.
• In July, nearly 11% of New Yorkers reported that their households were accessing free meals or groceries. School programs and food pantries were the most used access points (see Exhibit 3 below). If free meal and grocery programs were not available, rates of food scarcity would likely be higher, especially among communities of color.

In summary, food scarcity is New York is high relative to other states and increased during the coronavirus pandemic. An increasing share of food-scarce New Yorkers are newly food scarce, and therefore may require enhanced outreach and support in enrolling in food assistance programs for the first time. The dramatic disparities in food scarcity by race and ethnicity also indicate that current food assistance programs are not sufficiently addressing the needs of communities of color. Finally, the popularity of schools and pantries as access points for free food and groceries can potentially inform the design of food assistance programs.

Moving Forward

The COVID-19 pandemic has upended almost every aspect of New York State’s food system. As the implications of increased food insecurity continue to evolve, we offer the following recommendations:

• Expand policy solutions that make it easier and more convenient for New Yorkers to access food, including:
  • Establishing a statewide universal school lunch program that would allow all of New York’s children to eat lunch (regardless of income and without fear of shame or stigma), expanding upon New York City’s success. In the short term, this could be achieved by advocating for the U.S. Department of Agriculture’s (USDA) Summer Food Service Program and Seamless Summer Option waiver, set to expire December 31, 2020, to be extended into next year;^[5]
  • Supporting public education campaigns that increase awareness of and enrollment in The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), using trusted messengers;
  • Making nutrition incentive programs (e.g., New York City’s Health Bucks or Double Up Food Bucks, which can double the value of federal food benefits, such as SNAP, at participating markets and grocery stores) available for use in more supermarkets; and
  • Supporting the creation of regional food plans to better understand and strengthen our food systems.
• Maximize currently available flexibility in nutrition benefits programs, including SNAP and WIC. The State should continue to leverage opportunities, including extended re-certification timelines for benefits, removal of barriers to enrollment (e.g., in-person office visits), and expansion of the SNAP Online Purchasing Pilot. Early results from the pilot program showed that adoption of online grocery shopping has the potential to improve healthy food access for low-income consumers. This past summer, the State legislature passed a bill that would expand the online purchasing pilot, and it is awaiting delivery to the Governor.[6]
• Advocate at the federal level for the extension of Pandemic Electronic Benefit Transfer and WIC COVID-19 waivers past September, which would require congressional action.
• Minimize hurdles for community-based organizations and human service agencies working on the frontlines by quickly addressing contracting and payment delays that impede their abilities to retain staff and deploy resources.
• Collect and assess data to understand the depth of the crisis across the State. NYHealth plans to share our full analysis described above with the Committees via email upon the report’s publication. We are available to discuss performing additional analyses that may be helpful to the Committees. A second phase of the Census Bureau survey began in mid-August and will collect data through the end of October.^[7] We plan to publish an updated analysis of food scarcity that will include this second time period.

NYHealth is grateful for the shared recognition among stakeholders of the role that healthy food access plays in contributing to healthy people, as well as promoting vibrant neighborhoods and stronger local economies. We look forward to continuing our partnerships with the State and other anti-hunger organizations that are working to lift up food security programs that we know work, and that support the health of New Yorkers and the New York State economy.

^[1] New York State Department of Health. “NYSDOH COVID-19 Tracker.” Accessed September 2020. https://covid19tracker.health.ny.gov

[2] Hunger Free America. “In April, NYC had largest one-month actual increase in SNAP food aid participation in modern history.” Press Release. Accessed September 2020. https://www.hungerfreeamerica.org/blog/april-nyc-had-largest-one-month-actual-increase-snap-food-aid-participation-modern-history

^[3] U.S. Census Bureau. “Household Pulse Survey.” Accessed September 2020. https://www.census.gov/data/experimental-data-products/household-pulse-survey.html

^[4] Food sufficiency prior to the pandemic is defined as a household having enough of the kinds of food wanted or having enough food, but not always the kind wanted, before March 13, 2020.

^[5] Food and Nutrition Service. “COVID–19: Child Nutrition Response #56.” USDA. Accessed September 2020. https://www.fns.usda.gov/disaster/pandemic/covid-19/cn-extension-SFSP-SSO

[6] S. 8247A, 2020 Leg., 2019-2020 Sess. (N.Y. 2020).

^[7] U.S. Census Bureau. “Household Pulse Survey – Phase 2.” Accessed September 2020. https://www.census.gov/data/experimental-data-products/household-pulse-survey.html

Appendix – Data Tables and Graphs

Exhibit 1. Food Scarcity in New York State

Percentage of adults in New York households where there was either sometimes or often not enough to eat in the last seven days.

Note: For overall rate, all adults who responded to food scarcity question are included in the denominator. For rates by race/ethnicity, age, income, and state categories, only adults in each respective category who responded to food scarcity question are included in the denominator. Rates are calculated across a three-week period.

Source: NYHealth analysis of U.S. Census Household Pulse Survey. U.S. Census Bureau. “Household Pulse Survey Public Use File.” Accessed September 2020. https://www.census.gov/programs-surveys/household-pulse-survey/datasets.html

Exhibit 2. Food Scarcity by Household Employment Income Loss

Percentage of adults that lost/did not lose household employment income since March 13, 2020, who reported household food scarcity in the last seven days.

Note: For overall rate, all adults who responded to food scarcity question are included in the denominator. For rates by household employment income loss/no loss, all adults who responded that they did/did not experience a household employment income loss are included in the denominator. For rates by household employment income loss and Economic Impact Payment (stimulus check) receipt, all adults who responded that they experienced a household employment income loss and that they or someone in their household received or plan to receive a stimulus check are included in the denominator. Stimulus check data are available beginning the week of May 28, 2020. Rates are calculated across a three-week period.

Source: NYHealth analysis of U.S. Census Household Pulse Survey. U.S. Census Bureau. “Household Pulse Survey Public Use File.” Accessed September 2020. https://www.census.gov/programs-surveys/household-pulse-survey/datasets.html

Exhibit 3. Free Food Access Points

Percentage of adults in households that accessed free meals or groceries in the last seven days at a particular food access point (categories not exclusive).

Note: All adults who responded that their household accessed a free meal or groceries in the preceding seven days are included in the denominator. Respondents could select multiple answers for where they or someone in their household accessed a free meal or groceries. Not all access sites are included because of low counts. Some school programs offered free meals via delivery, so some home delivery responses might be part of a school program. Responses for shelters may be artificially low, because the populations that most use shelters may have been less likely to have had access to a cellphone or email to be part of the survey sample. Rates are calculated across a three-week period.

Source: NYHealth analysis of U.S. Census Household Pulse Survey. U.S. Census Bureau. “Household Pulse Survey Public Use File.” Accessed September 2020. https://www.census.gov/programs-surveys/household-pulse-survey/datasets.html

 

The National Academies of Sciences, Engineering, and Medicine recently released for public comment a discussion draft of a preliminary framework to assist policymakers in planning for equitable allocation of a vaccine against COVID-19. NYHealth provided the following public comments supporting the Academies’ framework, including the mitigation of health inequities, as well as offering recommendations for countering vaccine misinformation and disinformation. 

September 4, 2020

To the National Academies of Sciences, Engineering, and Medicine’s Committee on Equitable Allocation of Vaccine for the Novel Coronavirus:

The New York Health Foundation (NYHealth), a private, independent philanthropy, appreciates the opportunity to submit comments regarding the Discussion Draft of the Preliminary Framework for Equitable Allocation of COVID-19 Vaccine.

Statements of Support

Mitigation of Health Inequities

NYHealth applauds the Committee for the Framework’s grounding in sound ethical and scientific principles. We particularly support the inclusion of “mitigation of health inequities” as a foundational principle. The Framework importantly emphasizes that the staggering racial and ethnic disparities in COVID-19 infections and deaths are not biologically mediated, but result from “structural inequalities, racism, and residential segregation.” As in many other states, minority communities in New York have been disproportionately sickened and killed by COVID-19. Black and Latino residents have died at more than twice the rate of white residents in New York City and at more than three-and-a-half times the rate of white residents in New York State.^[1],[2] A vaccine allocation strategy that fails to recognize the structural factors driving these health disparities would ultimately serve to reinforce them. It is vital that the risk-based allocation criteria used in the Framework ethically and effectively prioritize the communities of color hardest hit by the pandemic.

Identification of Local Areas at Risk

Within the population groups included in the four phases of vaccine allocation, the Committee recommends that vaccine access be prioritized for geographic areas identified as vulnerable through the CDC’s Social Vulnerability Index, which is calculated at the census tract level. Localized indexes like this would allow state, local, tribal, and territorial authorities to identify neighborhoods at highest risk for COVID-19 infection that might otherwise be diluted by data collected on a larger geographic scale (e.g., county). The use of localized data is especially important in New York City, where neighborhoods within a few miles of each other have experienced drastically different rates of COVID-19 infections and deaths.^[3]

Free Access to COVID-19 Vaccine              

As identified in the Framework, costs associated with COVID-19 vaccine would serve to reinforce disparities by race, ethnicity, socioeconomic status, and immigration status. We support the Committee’s call that Medicare and Medicaid should require free vaccine administration, providers should not charge private plans or consumers, and private insurers and employers should not charge cost-sharing for vaccine administration.

Recommendations

Prepare for Vaccine Misinformation and Disinformation

We recognize that, although this discussion draft outlines the preliminary framework for the equitable allocation of COVID-19 vaccine, the final report will address other aspects of the Statement of Task, including vaccine hesitancy.

The impact of misinformation on vaccine hesitancy and refusal are critical issues that the Committee’s final report must address through mitigation strategies and measures. Misinformation (drawing conclusions from incorrect facts) and disinformation (the deliberate spread of incorrect information) continues to deepen the COVID-19 crisis by eroding trust in public health officials, delaying action by authorities, and jeopardizing infection control strategies.^[4] Now, the spread of this same misinformation and disinformation is upending future COVID-19 vaccination efforts. According to a recent poll, 35% of adults say they will not get a coronavirus vaccine if one becomes widely available, even though more than 1,000 people continue to die from the disease every day.^[5]

Vaccine misinformation can spread over social and digital media networks at near light speed, often driven by bots, autonomous programs that can spread spam or a virus over the internet. For example, the Public Good Projects (PGP), an NYHealth grantee, uses a software platform called Project VCTR (Vaccine Communication Tracking and Response) that collects publicly available media data related to vaccines.^[6] Nationwide, in the last 30 days, it recorded more than 340,000 mentions on social and digital media of negative attitudes related to vaccines.^[7] PGP found that messages in opposition to vaccines have more than doubled during the COVID-19 pandemic.^[8]

There are strategies to mitigate the spread of this misinformation. Project VCTR’s purpose is to track and contextualize vaccine opposition to inform health organizations and journalists. Supervised by a team of public health practitioners, it functions much like a disease surveillance system, sending out weekly updates on misinformation trends circulating through media sources. In March, PGP also launched Project RCAID (Rapid Communication, Analysis, Interpretation, and Dissemination) to track misinformation related to COVID-19. Tools like this are just one arm of the multidisciplinary strategy needed to combat the deadly impact of misinformation. Should it be helpful to the Committee, we would welcome the opportunity to discuss how the PGP model could be used within the Framework.

This Framework should not underestimate the influence and damage misinformation and disinformation wreaks on public health, especially as it pertains to vaccines. As we enter a critical phase of the COVID-19 pandemic, it is crucial that public health officials and other stakeholders support the creation of tools and strategies that prevent, detect, and respond to misinformation and disinformation and proactively support access to these tools by public health partners.

Given the importance of the issues that will be addressed in the final report, we recommend that the Committee also release an “Interim Final Report” for public comment.

Thank you for the opportunity to provide input on this important matter.

Respectfully submitted,

David Sandman, Ph.D.
President and CEO
New York Health Foundation

^[1] New York City Department of Health and Mental Hygiene. “COVID-19: Data.” https://www1.nyc.gov/site/doh/covid/covid-19-data.page

^[2] New York State Department of Health. “NYSDOH COVID-19 Tracker: Age Adjusted Rate of Fatality COVID-19 Cases per 100,000 by Race/Ethnicity Group.” https://covid19tracker.health.ny.gov/views/NYS-COVID19-Tracker/NYSDOHCOVID-19Tracker-FatalityDetail?%3Aembed=yes&%3Atoolbar=no&%3Atabs=n

^[3] New York City Department of Health and Mental Hygiene. “COVID-19: Data.” https://www1.nyc.gov/site/doh/covid/covid-19-data.page

^[4] Igoe, Katherine. “Establishing the Truth: Vaccines, Social Media, and the Spread of Misinformation.” Harvard T.H. Chan School of Public Health. July 10, 2019. https://www.hsph.harvard.edu/ecpe/vaccines-social-media-spread-misinformation/

^[5] Gallup. “One in Three Americans Would Not Get COVID-19 Vaccine.” August 7, 2020. https://news.gallup.com/poll/317018/one-three-americans-not-covid-vaccine.aspx

^[6] The Public Good Projects. Accessed September 3, 2020. https://projectvctr.com/

^[7] The Public Goods Project. . “Project VCTR: National Dashboard.” Accessed September 3, 2020. https://projectvctr.com/

^[8] Byrd, Brian and Joseph Smyser. “Lies, Bots, and Coronavirus: Misinformation’s Deadly Impact on Health.” Grantmakers in Health. July 17, 2020. https://www.gih.org/views-from-the-field/lies-bots-and-coronavirus-misinformations-deadly-impact-on-health/