Legal Feasibility and Implementation of Federal Strategies for a National Retail‐Based Fruit and Vegetable Subsidy Program in the United States

Abstract

Suboptimal intake of fruit and vegetables is associated with increased risk of diet‐related diseases. A national retail‐based fruit and vegetable subsidy program could broadly benefit the health of the entire population. Existing fruit and vegetable subsidy programs can inform potential implementation mechanisms; Congress's powers to tax, spend, and regulate interstate commerce can be leveraged to create a federal program. Legal and administrative feasibility considerations support a conditional funding program or a federal‐state cooperative program combining regulation, licensing, and state or local options for flexible implementation strategies. Strategies to engage key stakeholders would enable the program to utilize lessons learned from existing programs. Context Suboptimal intake of fruit and vegetables (F&Vs) is associated with increased risk of diet‐related diseases. Yet, there are no US government programs to support increased F&V consumption nationally for the whole population, most of whom purchase food at retail establishments. To inform policy discussion and implementation, we identified mechanisms to effectuate a national retail‐based F&V subsidy program. Methods We conducted legal and policy research using LexisNexis, the UConn Rudd Center Legislation Database, the Centers for Disease Control and Prevention Chronic Disease State Policy Tracking System, the US Department of Agriculture's website, Congress.gov, gray literature, and government reports. First, we identified existing federal, state, local, and nongovernmental organization (NGO) policies and programs that subsidize F&Vs. Second, we evaluated Congress's power to implement a national retail‐based F&V subsidy program. Findings We found five federal programs, three federal bills, four state laws, and 17 state (including the District of Columbia [DC]) bills to appropriate money to supplement federal food assistance programs with F&Vs; 74 programs (six multistate, 22 state [including DC], and 46 local) administered by state and local governments and NGOs that incentivize the purchase of F&Vs for various subpopulations; and two state laws and 11 state bills to provide tax exemptions for F&Vs. To create a national F&V subsidy program, Congress could use its Commerce Clause powers or its powers to tax or spend, through direct regulation, licensing, taxation, tax incentives, and conditional funding. Legal and administrative feasibility considerations support a voluntary conditional funding program or, as a second option, a mandatory federal‐state cooperative program combining regulation and licensing. Conclusions Multiple existing programs provide an important foundation to inform potential implementation mechanisms for a national F&V subsidy program. Results also highlight the value of state and local participation to leverage existing networks and stakeholder knowledge.

Exploring Pathways of Socioeconomic Inequity in Vegetable Expenditure Among Consumers Participating in a Grocery Loyalty Program in Quebec, Canada, 2015–2017

“…Beyond the implementation of marketing strategies within any one given organization, governments can leverage their regulatory role to boost vegetable consumption ( 151 ). National retail-based subsidy programs have been proposed as a viable mechanism to boost vegetable consumption ( 152 ). However, national subsidy programs are not well-established as of yet, and the administrative mechanisms by which federal governments can implement such programs are dependent on local contexts.…”

“…The success of such programs rely on the voluntary participation of food retailers who also need to be willing and incentivized to participate by a sufficient exchange in value ( 152 ). Governments may also leverage taxation mechanisms to grant incentives (i.e., exemptions) for healthy foods like vegetables, or penalize unhealthy foods like sugar-sweetened beverages to generate revenue for spending on direct programs ( 152 , 153 ).…”

“…However, national subsidy programs are not well-established as of yet, and the administrative mechanisms by which federal governments can implement such programs are dependent on local contexts. Effective federal-or state-level vegetable subsidy programs can leverage governmental spending power to directly influence prices, for example, with the provision of free vegetables or rebates/coupons to certain groups of the population (144)(145)(146)(147)152). The success of such programs rely on the voluntary participation of food retailers who also need to be willing and incentivized to participate by a sufficient exchange in value (152).…”

“…Effective federal-or state-level vegetable subsidy programs can leverage governmental spending power to directly influence prices, for example, with the provision of free vegetables or rebates/coupons to certain groups of the population (144)(145)(146)(147)152). The success of such programs rely on the voluntary participation of food retailers who also need to be willing and incentivized to participate by a sufficient exchange in value (152). Governments may also leverage taxation mechanisms to grant incentives (i.e., exemptions) for healthy foods like vegetables, or penalize unhealthy foods like sugarsweetened beverages to generate revenue for spending on direct programs (152,153).…”

Marketing to Children in Supermarkets: An Opportunity for Public Policy to Improve Children’s Diets

“…Public health experts call on food manufacturers and retailers to utilize the power of the supermarket environment to encourage more purchases of fruits and vegetables [86], as well as healthier packaged food options [64]. However, no country currently regulates the common in-store marketing techniques for child-targeted products examined in this paper, including shelf placement, special displays, and price promotions [7].…”