Promoting Fruits and Vegetables Through Financing Policies: The Healthy Diné Nation Act
A Law and Health Policy Project Bright Spot
Check out these success stories of increasing fruit and vegetable intake across the Nation.
Legal and policy approaches can be important tools for achieving healthier communities. The report, The Role of Law and Policy in Achieving the Healthy People 2020 Nutrition and Weight Status Goals of Increased Fruit and Vegetable Intake in the United States, provides evidence-based information and identifies priority areas that can help communities achieve Healthy People 2020 objectives.
This Bright Spot tells how the Navajo Nation helped their citizens’ access and consume more fruits and vegetables.
Challenge: Low access to healthy foods
The Navajo Nation covers 27,000 square miles, an area bigger than West Virginia. However, a 2014 report by the Diné Policy Institute found only 10 full-service grocery stores operating on the Navajo reservation, meaning that many people living there are more than 100 miles from a grocery store. Given the distance, many residents rely on gas stations and convenience stores, which sell mostly high calorie, heavily processed foods.
Low access to healthy foods takes a significant health toll on the community. For example, according to the Centers for Disease Control and Prevention (CDC), American Indians and Alaska Natives have the highest prevalence of diabetes in the United States.1 That’s why the Diné Community Advocacy Alliance, a grassroots organization, worked to change the Navajo Nation’s food environment and improve community health.
Strategy: Taxes to encourage healthier choices
In 2014, the Navajo Nation changed its tax policies to encourage the consumption of healthy foods—such as fresh fruits and vegetables—by reducing the costs of those foods relative to other, less healthy foods with “no-to-minimal nutritional value” through Navajo Nation Legislation No. 0290-13 and the Healthy Diné Nation Act.2, 3 Navajo Nation Legislation No. 0290-13 eliminated a 5% sales tax on healthy and native foods including fresh fruits and vegetables, nuts, nut butters, and seeds.
In addition, the Healthy Diné Nation Act increased the price of sugar-sweetened beverages and foods that have been “stripped of essential nutrients” and are high in salt, saturated fat, and sugar by applying a 2% tax to these unhealthy foods. The Act applies to all retail purchases on the reservation, from families shopping at local trading posts to restaurants buying from distributors.
Impact: Similar interventions have shown success
Research on similar policy interventions points to the effectiveness of giving people a financial incentive to buy fruits and vegetables. For example, a study of 7,500 households receiving Supplemental Nutrition Assistance Program (SNAP) benefits found that adding a financial incentive to purchase fruits and vegetables led to a 26% increase in consumption of these foods.4
A 2017 systematic review of studies on the effect of food-pricing interventions on retail sales, consumer purchasing, and consumption of healthy foods also found that pricing interventions increased access to and consumption of these foods.5
Policies like the Healthy Diné Nation Act need further study to measure the impact of pricing strategies on access to fruits and vegetables and on creating sustained changes to people’s fruits and vegetables intake. But collaborations like this one between the Navajo Nation government and the Diné Advocacy Community Alliance can inspire advocates in other locations to promote and improve fruit and vegetable consumption in a similar way.
Lesson Learned: Maximize the impact
Using revenues from taxes on unhealthy foods and beverages to fund community wellness and public health programs can help maximize the effects of these fiscal interventions. Taking an approach that simultaneously incentivizes healthy foods, de-incentivizes foods with no-to-minimal nutritional value, and funds public health programs offers a multifaceted opportunity for significantly improving the health and well-being of a community.
- 1. Centers for Disease Control and Prevention. CDC and Indian country working together. Atlanta (GA): Centers for Disease Control and Prevention, U.S. Dept of Health and Human Services; 2017. Available from: https://www.cdc.gov/chronicdisease/pdf/CDC-indian-country.pdf
- 2. Navajo Nation Legislation No. 0290-13. http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&cad=rja&u...
- 3. Navajo Nation Code Ann. tit. 24, § 11 (2014) CN 54-14. Available from: http://www.navajonationcouncil.org/Code%20Page.html
- 4. Bartlett S, Klerman J, Olsho L, et al. Evaluation of the healthy incentives pilot (HIP): final report. U.S. Department of Agriculture, Food and Nutrition Service, 2014 Sep. Available from: https://www.fns.usda.gov/snap/healthy-incentives-pilot-final-evaluation-report
- 5. Gittelsohn J, Trude ACB, Kim H. Pricing strategies to encourage availability, purchase, and consumption of healthy foods and beverages: a systematic review. Prev Chronic Dis. 2017; 14: E107. doi: 10.5888/pcd14.170213