Institutional food as a lever for improving health in cities: the case of New York City.
OBJECTIVE
To describe and examine the factors that most facilitate and impede the provision of healthy foods in a complex institutional food system.


METHODS
Comparative case study of three institutional food settings in New York City.


METHODS
Document review and interviews with relevant city government staff.


RESULTS
Factors that facilitate and impede the provision of healthy food vary across institutional food settings, and particularly between centralized and decentralized settings. Generally pro-health factors include centralized purchasing and the ability to work with vendors to formulate items to improve nutritional quality, though decentralized purchasing may offer more flexibility to work with vendors offering healthier food items and to respond to consumer preferences. Factors most often working against health in more centralized systems include financing constraints that are unique to particular settings. In less centralized systems, factors working against health may include both financing constraints and factors that are site-specific, relating to preparation and equipment.


CONCLUSIONS
Making changes to institutional food systems that will meaningfully influence public health requires a detailed understanding of the diverse systems supporting and shaping public food provision. Ultimately, the cases in this study demonstrate that agency staff typically would like to provide healthier foods, but often feel limited by the competing objectives of affordability and consumer preference. Their ability to address these competing objectives is shaped by a combination of both forces external to the institution, like nutritional regulations, and internal forces, like an agency's structure, and motivation on the part of staff.
The City University of New York School of Public Health, New York, NY, United States. Electronic address: emma.tsui@lehman.cuny.edu.
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EK
Tsui
The City University of New York School of Public Health, New York, NY, United States.
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J
Wurwarg
The City University of New York School of Public Health, New York, NY, United States.
J
J
Poppendieck
The City University of New York School of Public Health, New York, NY, United States.
J
J
Deutsch
The City University of New York School of Public Health, New York, NY, United States.
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Freudenberg
D002947:Cities; D003132:Commerce; D005502:Food / Q000592:standards*; D005522:Food Services; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D009519:New York City; D009753:Nutritive Value
Food security; Foodservice; Institutional food; New York City; Nutrition; Public procurement