"www.fao.org/about/meetings/sustainable-food-systems-nutrition-symposium The International Symposium on Sustainable Food Systems for Healthy Diets and Improved Nutrition was jointly held by FAO and WHO in December 2016 to explore policies and programme options for shaping the food systems in ways that deliver foods for a healthy diet, focusing on concrete country experiences and challenges. This Symposium waas the first large-scale contribution under the UN Decade of Action for Nutrition 2016-2025. This presentation was part of Parallel session 2.3: Increasing access to healthy diets through social protection and income generation strategies"

2. REDUCING INEQUALITIES AND
IMPROVING NUTRITION IN NEW
YORK CITY
Sonia Angell, MD, MPH
Deputy Commissioner for the Division of Prevention and Primary Care
New York City Department of Health and Mental Hygiene

3. Premature Mortality Due to Heart
Disease by Race/Ethnicity, 2005-2014
Hispanic
Non-Hispanic White
Non-Hispanic
Black
Asian & Pacific
Islander
Overall
0
10
20
30
40
50
60
70
80
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Age-adjustedRateper100,000Population
Bureau of Vital Statistics
New York City Department of Health and Mental Hygiene

4. Social Determinants and
Premature Mortality
Poverty
Race by
Neighborhood
Premature
Mortality
Source: NYC DOHMH population estimates, matched from US Census Bureau intercensal population estimates, 2010-2013, updated June 2014. U.S. Census Bureau; American Community Survey, 2013 3-year
Estimates, Table S1701; generated using American Fact Finder (http://factfinder2.census.gov/). Bureau of Vital Statistics, based on events occurring in 2014. Population (based on zip code) defined as percent
of non-Hispanic black and Hispanic residents, per 2010 Census. : Neighborhood poverty (based on Community Districts) defined as percent of residents with incomes below 100% of the Federal Poverty Level,
per American Community Survey 2011- 2013. Population (based on zip code) defined as percent of non-Hispanic black and Hispanic residents, per 2010 Census. Self-Reported health – NYC DOHMH
Community Health Survey, 2011-2013

5. Make the Healthy Choice
the Easiest Choice
•Physical Access/Availability
•Pricing/Economic
•Communication/Media
•Point of Decision
•Education/Promotion
•Culture
•Attitudes/Beliefs
•Skills
•Knowledge
•Time
•Affordability
Individual
Health
Promoting
Behaviors
Environment
Source: Adapted from presentation by Dr. Heidi Blanch, CDC, NCCHPDP, DNPAO
Community Environment and
Systems

6. Spectrum of Opportunities
• Industry reformulation
• Procurement
– All of government
• Vulnerable/select populations
– Private sector institutions
• Feeding programs
• Labeling (packaged and restaurant foods)
• Marketing
• Pricing
• Media/awareness campaigns
• Change ingredients for home prepared foods
• Change habits of cooking for home prepared foods

7. Overview of Approaches
Citywide Local
Change the
Environment
• Food Standards for
NYC Agencies
• Trans Fat Restriction
• Reformulation: National
Salt Reduction Initiative
(National)
• Good Choice
• Food Standards
for FBOs and
CBOs
• Green Carts
• Shop Healthy
Activate the
Community
• Sodium Warning Label
• Calorie Labeling
• Media/Awareness
Campaigns
• Health Bucks
• Stellar Farmer’s
Markets

8. Leveraging Federal Assistance Programs:
Health Bucks
• Health Bucks
– For every $5 spent with Supplemental Nutrition
Assistance Program dollars customers receive a $2
Health Buck —a 40% increase in purchasing power

9. City Health Code:
Work in Restaurants
• Sodium Warning
Label
• Calorie Labeling
• Trans Fat
Restriction

10. City Hall: NYC Food Standards
• By Executive Order:
– Meals/Snacks Purchased & Served
– Food and Beverage Vending Machines
– Affects 260+ million meals and snacks
served by NYC agencies
• Collaboration and mentoring:
– Community groups and hospitals in
NYC
• Healthy Hospitals Initiative
– Localities across the US

11. Thank you!
Key Message: One size could fit all, but it doesn’t solve all.
Multi-level approaches with concurrent attention to gaps and
health equity is necessary.
Sonia Angell, MD, MPH
Deputy Commissioner for the Division of Prevention and Primary Care
New York City Department of Health and Mental Hygiene