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March 27, 2020

Supporting Equitable Food Access During National Emergencies—The Promise of Online Grocery Shopping and Food Delivery Services

Author Affiliations
  • 1Department of Population Health, Section on Health Choice, Policy and Evaluation, New York University School of Medicine, New York, New York
  • 2School of Global Public Health, New York University, New York, New York
  • 3Department of Population Health, Section for Health Equity, New York University School of Medicine, New York, New York
JAMA Health Forum. 2020;1(3):e200365. doi:10.1001/jamahealthforum.2020.0365

As New Yorkers and public health practitioners, we’ve observed many health- and non-health-related emergencies that have affected our city during the past 2 decades, including 9/11, Hurricane Sandy, and COVID-19. These experiences have prepared us to share innovative strategies to address challenges related to food access during an emergency. In this article, we propose expanding the reach and strengthening the infrastructure of online grocery shopping and meal delivery services to provide swift support for vulnerable groups during a public health crisis.

Access to Food for Vulnerable Groups Is Threatened During Emergencies

During emergencies, everyone has a right to a sufficient supply of food, yet individuals with low income and older adults may face unique challenges. Both groups may have fixed incomes, which makes it incredibly difficult to stockpile food as a precautionary measure, and strategies to prevent transmission, such as ordering groceries online, may not be affordable, feasible, or even accessible for these individuals. For example, curbside pickup is often cheaper than home delivery, but it still costs extra. Addressing food insecurity during an emergency, therefore, becomes a matter of health equity and, in the case of COVID-19, a critical strategy to reduce transmission.

The Centers for Disease Control and Prevention (CDC) is coordinating the enormous task of slowing the transmission of COVID-19 in the United States and has released a report that describes actions communities can take to mitigate the spread of the virus.1 But the rapid development of COVID-19 has created several gaps in recommendations that address urgent public health issues. One such gap is the limited guidance on how to safely access food during a pandemic, especially for those who may be more affected socially or economically by risk of sickness or quarantine. The CDC’s report encourages individuals and families to secure a 2-week supply of food and learn how to get food delivered,1 but it does not provide specific mitigation strategies to address inequities in food access.

Food Access Solutions From the Public and Private Sectors

The House of Representatives and Senate recently passed the Families First Coronavirus Response Act, which will increase funding for food assistance programs.2 Simultaneously, New York State is guaranteeing pay for New Yorkers who have been quarantined and temporarily suspending the collection of debt owed to the state, which will help food-insecure families afford groceries. The US Department of Agriculture is allowing states to use the Summer Food Service Program to serve free meals to low-income children in eligible areas while waiving congregate feeding requirements (ie, mandates to serve meals in a group setting). As school districts begin to close due to COVID-19, schools in New York City and elsewhere have also started to provide grab-and-go breakfast and lunch at prespecified locations. The private sector is also offering solutions to bolster low-income workers’ earnings, which increases their ability to pay for food. For example, food delivery businesses, such as Instacart and DoorDash, have introduced policies to provide assistance to their employees who have to miss work because of quarantine or diagnosis of COVID-19. And other businesses are compensating employees for lost wages and offering paid sick leave. Meanwhile, the media has reported instances of US residents practicing kindness and compassion by buying groceries for their older neighbors.

Strategies to Reduce Food Inequities During Emergencies

Below, we offer several evidence-based suggestions aimed toward promoting equitable access to food. Improving the access to and infrastructure of online grocery shopping and online food delivery, in particular, provides an elegant solution to ensure that vulnerable groups are not left behind.

Public Sector Solutions

  • Expand the SNAP Online Purchasing Pilot to additional states and retailers and subsidize deliveries for those affected by emergencies.3 In conjunction, waive work requirements for public food assistance programs for those who cannot work because of an emergency.

  • Build infrastructure for online ordering and grab-and-go meal pick-up for food and nutrition programs that focus on the needs of older Americans.4

  • Encourage all school districts with children who rely on free or reduced-price school meals as a key source of daily nutrition to adopt online food ordering and grab-and-go meals and waive congregate feeding requirements.

  • Urge state governments to strictly enforce price gouging laws for food-related third-party websites and sellers during emergencies.

Private Sector Solutions

  • Online grocery stores (eg, Amazon Fresh) and food delivery services (eg, Grubhub) should waive food delivery fees for customers aged 60 years or older and provide a click-and-collect option at community sites during designated windows (ie, buy online and collect at the store).

  • Allow for flexible online food delivery time slots for “leave at my door delivery” and click-and-collect options to support individuals who are not home during the day (eg, shift workers).

  • Expand home delivery options in rural areas during emergencies to support low-income workers who live far from click-and-collect locations.

  • Use banner ads on websites and other marketing strategies to encourage relatives, neighbors, and other community members to help older adults order groceries and meals online.

Multi-Sector Solutions

  • Support the creation of online ordering options at food pantries and increase funding for food delivery services that allow for flexible delivery of rescued grocery products (eg, the Mobile Food Pantry Program) via government funds and corporate philanthropy.

  • Use a combination of government subsidies and corporate funds to provide personal protective equipment and hand hygiene supplies to employees of food delivery companies.

  • Promote healthy food items and meals using discounts and coupons from major online retailers and financial incentives from federal food assistance funds (eg, Double Up Food Bucks programs)5 with an emphasis on healthy, nonperishable items and perishable items with a long shelf life.

During times of crisis, the challenges of securing a sufficient and consistent supply of uncontaminated—and ideally healthy—food is highest among marginalized and vulnerable groups. By implementing the strategies outlined above, these groups can worry less about having sufficient access to food during an emergency and can prioritize implementing other personal and household protective measures.

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Article Information

Open Access: This is an open access article distributed under the terms of the CC-BY License.

Corresponding Author: Pasquale E. Rummo, PhD, MPH, Department of Population Health, New York University School of Medicine, 180 Madison Ave, 3rd Floor, Room 3-54, New York, NY 10016 (pasquale.rummo@nyulangone.org)

Conflicts Of Interest: None reported.

Centers for Disease Control and Prevention. Implementation of mitigation strategies for communities with local COVID-19 transmission. Published March 12, 2020. Accessed March 18, 2020. https://www.cdc.gov/coronavirus/2019-ncov/downloads/community-mitigation-strategy.pdf
Families First Coronavirus Response Act. HR 6201. 116th Congress (2019-2020). Accessed March 18, 2020. https://www.congress.gov/bill/116th-congress/house-bill/6201/text?r=88&s=1.
US Department of Agriculture. Supplemental Nutrition Assistance Program (SNAP) online purchasing pilot. Updated January 29, 2020. Accessed March 18, 2020. https://www.fns.usda.gov/snap/online-purchasing-pilot
US Department of Agriculture. Food and Nutrition Service. Assistance for Seniors Age 60 and Over. Accessed March 18, 2020. https://www.fns.usda.gov/program/assistance-seniors
Rummo  PE, Noriega  D, Parret  A, Harding  M, Hesterman  O, Elbel  BE.  Evaluating a USDA program that gives SNAP participants financial incentives to buy fresh produce in supermarkets.   Health Aff (Millwood). 2019;38(11):1816-1823. doi:10.1377/hlthaff.2019.00431PubMedGoogle ScholarCrossref
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