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Rural communities like this one face many unique health challenges, but often lack representation in medical research. HHRA hopes to change that.

Archived Blog Posts
  • Eaters Deserve More Complete Information About Nutrition and Health Impacts on Food Labels  

    Multiple lines of evidence point to consumer food choices as major contributors to diet-related disease, and poor health and fitness. In a peer-reviewed journal article published today, authors Chuck Benbrook and Robin Mesnage cite studies indicating that “Some 90% of the estimated USD 4.3 trillion in annual health care costs in the US is triggered or made worse by poor food quality and diet-related disease.” Benbrook is the founder and former executive director of the Heartland Health Research Alliance (HHRA). The authors recommend novel metrics on both the nutrient density of food, and how to more accurately and usefully characterize the degree of food processing and its impacts on public health. The article is open access in the journal Foods and entitled “Enhanced Labeling to Promote Consumption of Nutrient Dense Foods and Healthier Diets.” The core nutrient density metric is a ratio: the percent of daily nutrient needs satisfied by a serving of food relative to the percent of a 2000 calorie daily diet taken up by the serving of food. This single metric is unmatched in comprehensively reflecting the nutritional quality of food. A graphic option to convey the metric on packaging is presented in Figure 3 in the new paper: A novel graphic is presented in Figure 5 to which integrates both the nutrient density and food processing metrics and graphics in a single graphic, shown below. The impacts of ultra-processed food (UPF) on public health outcomes is among the hottest topics in nutrition, medical, and public health journals, and media coverage on food quality and health outcomes. At the request of the journal, the authors developed a video abstract that explains the paper’s goals, methods, and key findings and recommendations. The authors conclude their paper with these observations: Transparent and accurate food product-specific ingredient and nutrient composition data should determine the content of nutrition health labeling. Efforts to soften the message should be resisted in light of the overwhelming need for new food labels that help bring about substantial improvements in food nutritional quality and dietary choices. Benbrook and Mesnage’s paper builds on public comments HHRA submitted in response to the US Food and Drug Administration (FDA) proposed rule in 2023 to update the definition of the term “healthy” on food labels. The proposed role would require foods labeled “healthy” to contain minimum amounts of foods recommended by USDA’s Dietary Guidelines, and to limit saturated fat, sodium, added sugar and other less healthy nutrients. Entitled “Food Labeling: Nutrient Content Claims; Definition of Term `Healthy’”, the comments recommended new  nutrition/health messaging on the front of food packaging. Co-authors of comments included the chair of HHRA’s Policy Advisory committee Dr. Kathleen Merrigan, HHRA science advisors, and other experts working on how changes in farming systems and technology can increase the nutritional quality of food: Dr. Hannah Flower, Dr. Donald R. Davis, Dr. David Montgomery and Anne Biklé. In the comments, the authors introduced “NuCal” as a name for their new system. Resources HHRA February 2023 comments to the FDA. Benbrook and Mesnage (2024). Enhanced Labeling to Promote Consumption of Nutrient Dense Foods and Healthier Diets, Foods. https://doi.org/10.3390/foods13213377 Video Abstract: “Enhanced Labeling to Promote Consumption of Nutrient Dense Foods and Healthier Diets”

  • HHRA Weighs in on Key Pesticide Issues Under Review by the National Organic Standards Board

    HHRA and ORG-Tracker, represented by Dr. Chuck Benbrook and Dr. Brian Baker, submitted comments to the Agricultural Marketing Service at the USDA in advance of the National Organic Standards Board (NOSB) meeting in Portland, Oregon, from October 22nd to 24th, 2024. Drs. Benbrook and Baker will both attend the conference and deliver public comments. ORG-Tracker is a project carried out by HHRA. It aggregates pesticide residue data from inspections of organic farms carried out by certifiers. The tables generated by ORG-Tracker utilize the results of certifier testing to compare residue frequency and risk levels to food produced on conventional farms. The team is working to more effectively highlight gaps and challenges faced by certification agencies to answer questions like What crops should we be testing, and where? Is a pesticide residue found in an organic sample likely caused by accident, pesticide drift, or an intentional and illegal application? How can we modify organic programs to better mitigate risk? The comments delivered to the USDA discuss risk-based certification, pesticide residue testing, and policies impacting the incorporation of so-called inert ingredients in the biopesticides approved for use on organic farms. They argue for a more rigorous, comprehensive, and health-focused approach to risk oversight. Regarding residue testing, they advocate for more expansive and effective data aggregation to inform consumers and the organics community. Finally, for inert ingredients, they recommend further review of current policy, including increased transparency of ingredients in pesticide products. Thank you to Drs. Benbrook and Baker for your advocacy and hard work!   The three sets of comments are posted on HHRA’s website as part of our policy program: Comments to the NOSB on the Risk-Based Certification Discussion Document Under Consideration During the October 2024 Meeting in Portland, Oregon Written Comments on the NOSB Discussion Document “Residue Testing for the Global Supply Chain” Comments on the Inert Ingredients in Organic Pesticide Products Proposal dated August 13, 2024   Drs. Benbrook and Baker also submitted and presented comments at the Spring 2024 meeting of the NOSB, which are available on HHRA’s Policy and Regulatory Reform page.

  • Dr. Kimberly Yolton joins HHRA board

    Dr. Yolton is a developmental psychologist and epidemiologist serving as Professor of Pediatrics at Cincinnati Children’s Hospital Medical Center. Her interests include exposures and experiences that may alter a child’s developmental trajectory from infancy through adolescence. She collaborates on research projects on typical child development as well as those focused on the impact of exposures to environmental toxicants, opiates and stress during early development.

  • Paul Hartnett, HHRA’s Executive Director

      Paul Hartnett has served as HHRA’s CFO since our founding . With the departure of Russell King, Paul has now joined the board and Executive Director. We thank Russell for his service and wish him the best in his future endeavors.

  • Heartland Study Enrolls 1,000th Mother-Infant Pair

    July 19, 2024 – In June of this year, the Heartland Study achieved a major milestone, enrolling its 1,000th mother-infant pair. Enrollment is now at 50% of goal. The objective of the Study is to help fill major gaps in our understanding of the impacts of herbicides on maternal and infant health. Currently in Phase 1, the Study is focused on evaluating associations between herbicide concentrations in body fluids and tissue samples from pregnant women and infants, and pregnancy/childbirth outcomes. Phase 2 is designed to evaluate potential associations between herbicide biomarkers and early childhood neurological development. Much appreciation for the mothers enrolled, and the entire Heartland Study Team including scientists, support staff and clinicians for this tremendous achievement, and for our funders to making this work possible. Read more about the study including peer-reviewed studies published in Chemosphere and Agrichemicals at our publications  page. The investment required to conduct this study exceeds $1 million each year. You can support this important work by making a donation here.

Side Effects of Rural Living: Health Disparities in the Heartland

by Grace Koch | Nov 17th, 2021
by Grace Koch | Nov 17th, 2021
Rural communities like this one face many unique health challenges, but often lack representation in medical research. HHRA hopes to change that.

Thursday November 18th, 2021 is National Rural Health Day. This year the National Organization of State Offices of Rural Health (NOSORH) is specifically highlighting health equity in rural communities. One of the goals of HHRA’s flagship project, The Heartland Study, is to analyze the impact of pesticide exposures on human health, especially on reproductive impacts, healthy pregnancies and children’s development. Our research is already documenting rising levels of herbicide use and exposures across all citizens in the Midwest and rural communities in particular.

Factors impacting the health of rural populations are often underexplored in large scale clinical research projects carried out in large urban centers. According to the U.S. Census Bureau, 97% of land in America is considered rural. Recognition of rural health disparities, and the factors driving them, is an important part of HHRA’s current and future research.

Rural Health Disparity

A whole host of compounding factors have created significant health disparities for rural communities. Rurality is generally classified as any area outside of an urban area. The Census Bureau defines rural as any population, housing, or territory NOT in an urban area. In 2020, there were approximately 57.23 million people living in rural areas in the United States, about 17% of the overall population (Source).

Rural communities are often geographically isolated from the many resources urban and suburban people take for granted. Something as simple as a yearly doctor’s appointment, or finding a healthcare specialist, can be difficult for rural families, due to long distances they may have to travel and limited transportation options. Census data of medical doctors in the US shows that rural areas only have 11 MDs per 10,000 people, compared to 31 per 10,000 in urban/metro areas. In addition, the extent and quality of healthcare services varies greatly across rural regions of the country.

Source: March of Dimes

Data from March of Dimes shows how access to hospitals in the Heartland state of Iowa are limited to only a few counties (see map). Many families in rural counties have little or no access to a nearby hospital or birth center. This distance can complicate a person’s ability to get appropriate treatment for serious health problems, especially for rural individuals who don’t have a car, money, or access to transportation.

Lack of access to healthcare resources has a direct impact on the health and quality of life of rural communities. These populations have statistically higher rates of disease and disability, pain, increased mortality, and shorter life expectancies. The top five leading causes of death (heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke) are all higher in rural populations compared to urban populations.

In the Heartland State of Indiana, for example, cancer related deaths are far higher in rural/nonmetro counties than in urban/metro counties (see chart below).

Source: RHIhub

Food insecurity is also higher among rural populations. According to the USDA Economic Research Service report in 2020, 11.6% of rural households are food insecure, compared to 10.5% for the nation as a whole. Child poverty and food insecurity is also higher in rural areas, with 16.1% of rural households with children being food insecure, compared to 14.8% overall.

Inequality and Social Determinants of Health in Rural Populations

One rural population that is particularly vulnerable to pesticide exposure is farmworkers. HHRA hopes to translate Heartland Study materials into Spanish and other languages to promote participation by farmworker communities.

Health inequalities are often exacerbated by social determinants of health. Rural Americans are more likely to be low in socioeconomic status or be unemployed, have less post-secondary education, and are less likely to have healthcare coverage by employers or through Medicaid.  In addition, rural households have less access to community social programs, foodbanks, and SNAP program benefits.

Social inequities and health disparities go hand in hand. Social determinants of health like income, education, health literacy, environmental health, gender identity, and race/ethnicity all impact an individual’s physical and mental health.

The data backs this up – adults of racial and ethnic populations, living in rural areas, face more health disparities than white adults. A 2017 CDC report showed that Indigenous, Hispanic, and Black individuals in rural areas were more likely to have higher rates of poor health, report multiple chronic conditions, and are at most risk for obesity.

Rural communities may also face more environmental challenges that can impact health. Overall access to safe drinking water, healthy food options, and stable housing is a problem for many rural communities. Hazardous materials often end up in rural areas, contaminating local environments. In farming areas, heavy use of agricultural chemicals can expose both farmers and non-farmers to toxic pesticides in air, water and dust and soil particles. These additional routes of exposure to possibly toxic chemicals are at the crux of HHRA’s scientific research on the impacts of pesticide exposure on reproductive health, pregnancy outcomes and children’s development in the Midwest. By including rurality in our research, we hope to better understand the connections between farming practices, pesticides and other toxins unique to rural areas and public health outcomes.

HHRA is committed to taking account of the impacts of the unique risk factors and unequal access to healthcare services in specific rural areas, as well as gleaning insights from rural-based clinical research. Progress in understanding these factors will help HHRA address how access to food and farming systems impact public health outcomes in the Heartland and beyond. 

We are committed to enrolling at least 30% of participants in our flagship project, The Heartland Study, from rural areas. Most clinical research on pregnancy and reproduction takes place in urban research hospitals, and the unique health challenges faced by rural women are often not explored. We want to change that.

This is why HHRA is working to build research capacity in rural hospitals and why we will be recruiting more rural hospitals into The Heartland Study. 

We are also hoping to raise adequate funding for 2022 to translate our clinical research documents into other languages. Inclusivity starts with ensuring everyone has a seat at the table, where their voice can be heard.

This #GivingNovember please help us expand our reach to rural families and healthcare providers in the Heartland.  You can do so my making a contribution, signing up for the HHRA newsletter and following us on social media.

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