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

摘要

Policy Points 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 (FVs) is associated with increased risk of diet‐related diseases. Yet, there are no US government programs to support increased FV 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 FV 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 FVs. Second, we evaluated Congress's power to implement a national retail‐based FV 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 FVs; 74 programs (six multistate, 22 state including DC, and 46 local) administered by state and local governments and NGOs that incentivize the purchase of FVs for various subpopulations; and two state laws and 11 state bills to provide tax exemptions for FVs. To create a national FV 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 FV subsidy program. Results also highlight the value of state and local participation to leverage existing networks and stakeholder knowledge.