Cover Page

Introduction to the US Food System

Public Health, Environment, and Equity

Roni Neff, Editor

Johns Hopkins Center for a Livable Future

Title Page

List of Figures and Tables


  1. I.1 Center for a Livable Future Concept Model
  2. I.2 Textbook Concept Model
  3. I.3 Child's Poster about Healthy Food Placed on City Buses
  4. I.4 Seniors Choosing Vegetables
  5. I.5 Cows at Albright Farm
  6. I.6 Students Eating Lunch
  7. I.7 Lunchables
  8. I.8 Baby Eating Spaghetti
  9. I.9 Green Buffers, Clean Water
  10. I.10 Man with Carrots
  11. 1.1 The Food System
  12. 1.2 Industrial Cattle Production Facility
  13. 1.3 Uniform Apples in Grocery Store
  14. 1.4 Farmers Market Apples
  15. 1.5 Meatscape (Reflecting “How the World is Used”)
  16. 1.6 Human Dignity: Workers Standing up for an Increase in the Minimum Wage
  17. 1.7 Wicked Problems
  18. 1.8 Even with Its Limitations, Our Food System Provides for Us in Many Ways
  19. P.1 Part 1 Concept Model
  20. 2.1 Clinician's Prescription for Fruits and Vegetables
  21. 2.2 US Deaths (in Thousands) Attributable to Modifiable Risk Factors, by Disease, in 2005
  22. 2.3 Obesity Prevalence among US Adults, Children, and Adolescents, 1960–2010
  23. 2.4 Worker Pouring Roundup for Use
  24. 2.5 Nearly One in Five Meat Processing Workers Is Injured Each Year
  25. 2.6 Salmonella
  26. 2.7 BPA Exposure Framework
  27. 3.1 Bee Pollination Directly or Indirectly Benefits about One Mouthful in Three of the US Diet
  28. 3.2 Soybean Monoculture Crop Being Sprayed by Crop Duster
  29. 3.3 Energy Expended in Producing and Delivering One Food Calorie in the United States
  30. 3.4 Sustainability Labels
  31. 3.5 Soil Degradation around the World
  32. 3.6 Farmland Conversion from 1982–2007. Every state lost agricultural land.
  33. 3.7 Food in the Path of Development, Produced in Counties Subject to Urban Influences
  34. 3.8 Links between Energy Prices and Food Prices
  35. 3.9 Lifecycle Greenhouse Gas Emissions from Common Proteins and Vegetables
  36. 3.10 Extreme Weather Events and Corn Yields
  37. 3.11 Gulf of Mexico Dead Zone
  38. 3.12 US Meat and Poultry Availability per Capita
  39. 3.13 How Much Consumers Think about Food Sustainability
  40. 3.14 Environmental Sustainability-Related Actions Consumers Take
  41. 4.1 Life Expectancy at Birth, 2011
  42. 4.2 Health Inequities Model
  43. 4.3 Population-Based Interventions May Increase Health Disparities
  44. 4.4 Cheeseburgers versus Salad: The Importance of Price (poster reflecting quote from focus group participant)
  45. 4.5 Corner Store
  46. 4.6 Restaurant Opportunities Center Protest
  47. 4.7 Carole Morison on her current farm
  48. 4.8a Charts from the Hands That Feed Us
  49. 4.8b Wages and Working Conditions for Food Chain Workers
  50. 5.1 Some Families Reduce Their Spending on Food in Order to Pay for Their Medicines
  51. 5.2 Restaurant
  52. 5.3 Breakfast
  53. 5.4 Deep Freezer
  54. 5.5 My Neighbor's Kitchen
  55. 5.6 Number 9,584
  56. 5.7 Hungry Child Asking Caseworker for Something to Eat
  57. 5.8 Oodles of Noodles
  58. 5.9 Child Enjoys a Crisp Apple at Lunch
  59. 5.10 Comparison of Select Coping Strategies by Food Security Level
  60. 6.1 Mobile Produce Truck
  61. 6.2 Local Food Hub Warehouse
  62. 6.3 Mayor Stephanie Rawlings Blake Announcing SNAP EBT Program at Baltimore Farmers Market
  63. 6.4 The Role of CFAs in the Design of Strategies for Change
  64. 6.5 Dynamic Community Food Assessment Process
  65. 6.6 Rose Street Garden, Baltimore
  66. 6.7 ABC Bulk Produce Markets: These markets stock the items that the city determines will be sold at a fixed price, about 13 cents a pound
  67. 6.8 The Line for One of Three “People's Restaurants” a Half Hour before Opening Time: Meals at these restaurants cost about 50 cents, and diners come from all socioeconomic groups
  68. P.2 Part 2 Concept Model
  69. 7.1 Some shoppers are willing to pay higher prices for healthy or organic food
  70. 7.2 Underwood Farm Feedlot Runoff, North Dakota
  71. 7.3 Rominger Brothers Farm
  72. 7.4 Corn Production
  73. 7.5 Visualization of the Market Structure of Subsectors of the US Food System
  74. 7.6 Sugar-Sweetened Beverages
  75. 8.1 Geographic Distribution of Districts of House (above) and Senate (below) Agriculture Committee Members in the 113th Congress (2013–2014)
  76. 8.2 Eroded Land During the Dust Bowl
  77. 8.3 A Poster Advertising “Plenty of Food for Everyone”
  78. 8.4 Government Inspectors at a Nebraska Meatpacking Plant in 1910
  79. 8.5 A Sampling of Governmental Agencies with Partial Oversight of US Food Safety
  80. 8.6 Total US Fresh and Processed Produce Imports (in Billions of Pounds)
  81. 8.7 “Every Child Needs a Good School Lunch,” 1941–1945
  82. 8.8 Pesticide Applied to Lettuce in Yuma, Arizona
  83. 9.1 Bugs and Scorpions in Market, China
  84. 9.2 “In Homes Where Children Are Well-Cared-For, You Will Usually Find Bond Bread,” 1928 advertisement
  85. 9.3 Crabs
  86. 9.4 Halal Food Store, Minneapolis
  87. 9.5 Seder Plate
  88. 9.6 Picking up a CSA Share at the Franciscan Center
  89. 9.7 “Danger—Men Cooking”
  90. 9.8 Zombie
  91. 9.9 Waverly Farmers Market
  92. 10.1 Mikaela Shiffrin Promotes Wheaties
  93. 10.2 Racecar with Red Bull Advertisement Targets Nascar Fans
  94. 10.3 Facts Up Front FOP System, a Facts-Based Label
  95. 10.4 Supermarket “Better for You” Advice
  96. 10.5 Jell-O Box Provides an Opportunity for Brand Promotion, 1915
  97. 10.6 The Quaker Oats Mascot Quickly Became a Familiar Face Due to Mass Marketing
  98. 10.7 As Health Concerns Grew, McDonald's Introduced Healthy Items, Such as Apple Slices, to Its Menu
  99. 10.8 Center for Consumer Freedom Advertisement Targets Ban on Large-Size SSBs, Depicts Mayor Michael Bloomberg as “The Nanny”
  100. 10.9 “More Matters” Social Marketing Campaign Logo
  101. P.3 Part 3 Concept Model
  102. 11.1 Farmer Plowing with Horse for Traction
  103. 11.2 Moving Westward: Nebraska Farm Family, 1888
  104. 11.3 Adoption of GE Crops in the United States, 1996–2013
  105. 11.4 Typical Relations among Farmers and Other Agents in Corn and Soybean Commodity Crop Growing Networks
  106. 11.5 US Corn Production, 1961–2011
  107. 11.6 Examples of Agriculture of the Middle Brands
  108. 11.7 Locally Grown Romanesco Broccoli from Malcolm's Market Garden in Augusta County, VA
  109. 11.8 Earthworms are One Sign of Healthy Soil
  110. 11.9 Frog with Partially Missing Hindlimb
  111. 12.1 US Beef, Pork, and Chicken Production, Carcass Weight in Billions of Pounds, 1910–2011
  112. 12.2 Average per Capita Availability of Animal Products, 2009
  113. 12.3 Average Consumer Prices and Farmers' Share of Retail Value for Selected Animal Products, 1950–2000
  114. 12.4 Aquaponics
  115. 12.5 Consolidation in Hog Production
  116. 12.6 IFAP Operations
  117. 12.7 Hogs and Pigs Inventory, 2007
  118. 12.8 Concentration in Animal Slaughter and Processing Industries
  119. 12.9 Waste Storage Pit for a Nine-Hundred-Head Hog Operation in Georgia
  120. 12.10 Clagett Farm Produces Grass-Fed Beef and a Variety of Organically Grown Vegetables
  121. 13.1 Cassava Tuber
  122. 13.2 When is Beef not Beef?
  123. 13.3 Honey: Nature's Food Processing
  124. 13.4 High-Pressure Processing Apparatus
  125. 13.5 Food Retort
  126. 13.6 1930 Iceberg Lettuce Advertisement
  127. 13.7 Many Consumers Prefer to Purchase Foods Wrapped in Protective Packaging
  128. 13.8 Old Soda Cans
  129. 13.9 Some Common Polymer Packages
  130. 13.10 Freezing Can Cause Undesirable Texture Changes in Foods Such as These Frozen Vegetables
  131. 14.1 Major Distribution Channels for US Food Products and Flows
  132. 14.2 Large-Scale Wheat Farm
  133. 14.3 Wholesale Food Warehouse
  134. 14.4 Subway Is the Largest Fast Food Chain in the US Food Service Sector
  135. 14.5 Fresh Produce Section in Walmart
  136. 14.6 Walmart Critics State That Substandard Wages Keep Many Employees below the Poverty Line
  137. 14.7 Number of Farms and Average Farm Size, 1900–2007
  138. 14.8 Percent of US Labor Force Working on Farms, 1900–1990
  139. 14.9 Market Shares for US Grocery Chains, 1929–2008
  140. 14.10 Private Label Penetration in the US Supermarket Sector
  141. 14.11 O Organics Is a Private Label of Safeway
  142. 14.12 Allocation of Food Expenditures by Channel, 1910–2010
  143. 14.13 Allocation of US Consumer Food Expenditures 1970–2008
  144. 14.14 US Food Expenditures 1930–2010 (as a Percentage of Disposable Income)
  145. 14.15 Number of US Farmers Markets, 1994–2011
  146. 14.16 Seasonal Produce at the Market
  147. 14.17 CSA Weekly Share Items
  148. P.4 Part 4 Concept Model
  149. 15.1 Bananas: Our Food Choices Shape the Food System
  150. 15.2 Times Have Changed!
  151. 15.3 Dole Honduras Ship Unloading Imports in San Diego
  152. 15.4 Changes in Calories and Sources of Calories in American Diets: 1977–1978 to 2007–2008
  153. 15.5 Parallel Trends in Rates of Overweight and Obesity, Calories Available in the Food Supply, and Introduction of New Large Size Portions, United States, 1960–2009
  154. 15.6 Contribution of Meal and Snacks to Energy, Sources of Energy, 2007–2008
  155. 15.7 McDonald's McGriddle Is Eggs, Bacon, and Cheese Sandwiched between Two Pancakes
  156. 15.8 Cereal Label Showing Nutrients
  157. 15.9 Vending Machines Facilitate Snacking
  158. 15.10 Change in Percentage Reporting Fruits and Vegetables
  159. 16.1 (a) Most People Are Thinking about the Healthfulness of Their Food; (b) Most Are Making Efforts to Improve Their Diets; (c) Taste and Price Lead the List of Reasons for Food Choices, but Healthfulness Is Third; Over One-Third of Respondents Count Sustainability as an Important Factor; (d) Although Consumers Do Take Some Control over Their Weight, They Describe Numerous Barriers, within and outside of Themselves; (e) Consumers Express Confusion about How Best to Eat Healthfully
  160. 16.2 Grains Are a Main Source of Carbohydrates
  161. 16.3 Spaghetti Sauce Label Featuring Organic Evaporated Cane Juice (Sugar)
  162. 16.4 Meats and Cheese Contain Saturated Fats
  163. 16.5 Trans Fats Levels Decline
  164. 16.6 Quinoa Contains All of the Essential Amino Acids
  165. 16.7 Supply Chain: Production to Consumption and Potential Points of Intervention
  166. 17.1 Socioecological Model
  167. 17.2 Farmer's Fridge Healthy Vending Kiosks
  168. 17.3 The Contiguous United States as Visualized by Distance to Nearest McDonald's
  169. 17.4 USDA Food Environment Atlas
  170. 17.5 Family Cigarette Grocery Store
  171. 17.6 2012 Baltimore City Food Environment Map
  172. 17.7 Bowl of Fruit on the Counter
  173. 17.8 Newer Supermarkets with Parking Areas Gained in Popularity Compared to Older, More Urban Ones without Them
  174. 17.9 Shuttered Supermarket in a Small Town
  175. 17.10 The Type and Quality of Food, the Atmosphere, and the Convenience of a Restaurant May Entice a Family to Eat out Instead of Eating In
  176. 17.11 Baltimore's Virtual Supermarket Program Delivers Groceries to Libraries, Senior Centers, and Other Community Sites
  177. 17.12 Volunteers at Atlantis Community Garden
  178. 17.13 Mentors and Youth at Youth Farmers Market
  179. 18.1 Diagram of the Socioecological Model
  180. 18.2 Meatless Monday Encourages Consumers to Cut Out Meat Every Monday
  181. 18.3 Students Picking Greens from Their School Garden
  182. 18.4 Real Food Wheel
  183. 18.5 Scene from a Corner Store Intervention: Fresh, Healthy Options Next to Snack Foods


  1. 1.1 Key Food System Challenges
  2. 2.1 Direct Medical Costs Associated with Diet-Related Disease in the United States
  3. 2.2 Work-Related Injuries and Fatalities Associated with Selected Food System Industries
  4. 2.3 Selected Pathogens Commonly Responsible for Food-borne Illness in the United States, 2000– 2008
  5. 2.4 The Twelve Conventionally Grown Fruits and Vegetblles Most Contaminated with Pesticides
  6. 3.1 Causes of Soil Degradation
  7. 3.2 Major Agricultural Impacts on Water Quality
  8. 5.1 Categorizations of Food Security Status as Measured by the USDA
  9. 5.2 Nutrition Assistance Programs Administered by the USDA FNS
  10. 5.3 Percentage of People Using Select Coping Strategies When Concerned about Food Sufficiency
  11. 7.1 Types of Market Structure in the US Food System
  12. 7.2 CR4 Scores for Food Manufacturing Industries
  13. 7.3 Estimates of Price Elasticities for Major Food and Beverage Categories
  14. 8.1 Examples of Food System Policies That Could Potentially Advance Public Health
  15. 9.1 Faith Traditions and Selected Food-Related Texts
  16. 10.1 Communications Channels and Marketing Techniques Commonly Used by Leading US Food and Beverage Companies
  17. 10.2 The Three Leading Food Categories Marketed to Children and Youth in the United States, 2006
  18. 10.3 Examples of Studies of the Nutritional Content of Food Advertisements, 1970s–2010s
  19. 10.4 Findings of the IOM Committee on Food Marketing and the Diets of Children and Youth
  20. 12.1 Percentage of US Food-Producing Animals from Large-Scale Operations, 2012
  21. 13.1 Selected Physical Unit Operations
  22. 13.2 Selected Thermal Unit Operations
  23. 13.3 Selected Temperature-Lowering Operations
  24. 13.4 Common Additives and Their Functions
  25. 13.5 Common Packaging Materials in the United States Today
  26. 14.1 US Food Distribution System, 1954–2007: Estbllishments, Sales, and Employment
  27. 14.2 Distribution of Employment in Food Manufacturing
  28. 14.3 Retail Store Numbers, Dollar Share and Sales, Grocery and Consumables, 2011
  29. 14.4 2011 US Food Service Industry Retail Sales
  30. 14.5 2012 Food Industry Forecast (Percentage of Food Executive Respondents)
  31. 15.1 Mean Daily Intakes of Energy and Selected Nutrients by Age and Gender, Race and Ethnicity, and Income Status in the United States, 2007–2008
  32. 15.2 Percent of Daily Mean Intakes of Select Nutrients Provided by Meals and Snacks in the United States, 2007–2008
  33. 15.3 Daily Mean Food Intakes and Their Contribution to Daily Energy and Sources of Energy in the United States, 2007–2008
  34. 15.4 Daily Mean Beverage and Water Intakes and Their Contribution to Daily Energy in the United States, 2007–2008
  35. 16.1 Carbohydrate Types
  36. 16.2 Types of Protein Sources, and Total Fat and Saturated Fat Content
  37. 16.3 Vitamins
  38. 16.4 Minerals
  39. 17.1 Examples of Interventions in Home, School, and Workplace Environments
  40. 17.2 Examples of Food Environment Interventions in Retail and Restaurants
  41. 18.1 Individual-Level Health Behavior Theories
  42. 18.2 Interpersonal-Level Theory
  43. 18.3 Comparing Impact of Interventions Targeted to Different Levels of the Socioecological Model (SEM)


Bob Lawrence

Bob Lawrence founded the Center for a Livable Future in 1996 and led its development into the thriving interdisciplinary academic center it is today. We all owe so much to his mentorship, vision, and personal example. As this book goes to press, Bob has announced his retirement; we will miss him greatly.


Helaine and Sid Lerner

The Lerners have been dedicated advocates for measures to improve our food system and supporters of the Center for a Livable Future's mission since its inception.


Andy Pasternack

Andy Pasternack of Jossey-Bass reached out initially about developing this book and stewarded its initial phases with kindness, thought, and patience. Sadly, he passed away before the book was completed.


Educators and students of the food system

Finally, the book is dedicated to the educators and students who will read it. Your enthusiasm for creating a better food system inspires us all. We hope this book gives you the tools you need to make it happen!


This textbook provides an overview of the US food system, with particular focus on the food system's interrelationships with public health, the environment, equity, and society. Through eighteen chapters and seventy-four focus and perspective boxes, authored altogether by one hundred and six food system experts, this book brings together information and perspectives reflecting the breadth of issues and ideas important to understanding today's US food system and to shaping its future. The readings highlight issues of public health, ecological impact, and implications for communities, equity and society more broadly; they address as well supply, demand, cost, stakeholder interests, history, power, politics and policy, ethics, and culture.

Student interest in the food system has grown dramatically since the new millennium, and academic courses and programs addressing the food system have proliferated. This book is intended to address the need for textbook material covering broad food system issues, and focusing on the food system's relationship with the public's health more specifically. Our aims are for the book to provide a resource to educators from a variety of disciplines, support their efforts to meet growing student demand for course work on food system topics, engage students, stimulate critical thinking, and, overall, to help students better understand our food system.

The book is a project of the Johns Hopkins Center for a Livable Future (CLF), an academic center founded in 1996 with the mission to “examine the complex interrelationships among diet, food production, environment and human health, to advance an ecological perspective in reducing threats to the health of the public, and to promote policies that protect health, the global environment and the ability to sustain life for future generations.” Figure I.1 presents the concept model that frames our activities ( Based at the Johns Hopkins Bloomberg School of Public Health, the CLF engages in research, education, policy, practice, and communications activities on diverse issues at the intersection of food systems and public health. This book advances the CLF's educational mission and builds on our experience as an interdisciplinary, food-system–focused academic center within a school of public health and within the Johns Hopkins University. The book reflects input from many CLF faculty members, staff, CLF-Lerner Fellows, research assistants, and colleagues across the public health school and the university, as well as many external colleagues.


Figure I.1 Center for a Livable Future Concept Model

This textbook is designed for use in food-system courses taught in many types of departments or schools, for example, public health, nutrition, environment, policy, planning, geography, nursing, business, and sociology, as well as in interdepartmental offerings. We expect it will be used in introductory courses at the advanced undergraduate and graduate levels. The book's chapters cover the core content of the food system and are presented with enough explanations to make it useful for those with little background in the food system, and it also shares the complexities stimulating to those with more knowledge and experience. The focus and perspective boxes add depth and fodder to enrich discussions and assignments. We also intend for the book to be useful to those outside of academia seeking a solid introduction to food-system issues.

For many students, learning about food systems goes beyond the academic. This book and its associated discussion questions and online instructional activities present content and exercises that engage students personally and professionally. Students are encouraged to leave the classroom and computer to supplement their learning in the real world—at the table, in the store, at farms or gardens, and in sites throughout their communities. Additionally, through sometimes provocative content, the book pushes students to think critically and to question popular assumptions—as well as the ideas put forward by the authors.

While challenging students, the activities and discussion questions also target most of the core competency areas for public health—all of which have relevance for other fields as well: analytical and assessment skills, policy development and program planning skills, communication skills, cultural competency skills, community dimensions of practice skills, ethical analysis skills, and leadership and systems thinking skills (Council on Linkages Between Academia and Public Health Practice, 2010).

Another strength of the book is the diversity of the chapter and focus and perspective authors, many of whom are leaders in their fields. The contributors approach their material from within a variety of disciplinary perspectives and languages. In some chapters, public health is emphasized throughout, in others, the authors approach the topic from their own lenses and encourage students to connect the information back to public health, environment, equity, and systems issues. This diversity of approaches can help strengthen students' understanding and can provide a foundation to help them interface with the range of food-system stakeholders and approaches.

This textbook aims to be comprehensive in the sense of addressing the major food-system topics, but it cannot possibly be comprehensive in the sense of covering every process, project, idea, and issue, not only because of the sheer number of these but also because this is a vibrant and growing field. Additionally, although the US food system is intimately intertwined with global food systems, this book would be many times longer if it sought to do justice to global issues as well as domestic ones.

What's Inside

What is the best way to organize a textbook about a system? By definition, all the parts interact and overlap. Figure I.2 provides a simplified visual organizing framework indicating primary ways in which the chapter content interrelates. Activities, drivers, and outcomes are numbered to reflect chapters in this book. Selected examples are shown for each category in the outer ring. We will return to this model in each section overview, highlighting the section's connection to the whole. Throughout the chapters, and the focus and perspective features, we have sought to minimize repetition, referring the reader to discussion elsewhere in the book. Nonetheless, some repetition is necessary in order to provide appropriate overviews within the context of particular chapters, and different authors often approach topics from quite different angles.


Figure I.2 Textbook Concept Model

Note: Numbers refer to Chapters


Introduction. Chapter 1, the introduction, begins by explaining food systems, systems approaches more generally, and what is meant by a “public health approach.” It then provides a broad overview of the US food system including its key dimensions, components, and challenges. Finally, it examines approaches to food-system change from the perspectives of public health and the human right to adequate food, and provides examples of changes underway.

Part 1: Outcomes. Part 1 provides the book's orientation and motivation by describing how the food system affects public health (chapter 2), the environment (chapter 3), equity (chapter 4), food insecurity (chapter 5), and community food security (chapter 6). (The last two, of course, are linked to the former three, but given their centrality, they merited their own chapters.) These chapters describe a wide variety of food-system impacts, both salutary and not, and help the reader understand that many of these impacts are not inevitable but rather are products of the specific ways in which our food system has evolved. Alternatives to the mainstream food system and their ramifications are also discussed. The food system also affects many other aspects of our world beyond these four, from the economy to community life. Such topics also appear in this part and are threaded through the rest of the book.

Part 2: Drivers of the Food System. Part 2 orients readers by discussing four of the major drivers (entities that exert force) that shape our modern food system and its potential alternatives: economics, policy, culture, and marketing. The food system's biophysical environment is also a driver, as shown in figure I.2, however, we opted to place the environment chapter (chapter 3) in the “Outcomes” part, given its dual role. Many of the later chapters return to these drivers, helping readers consider ways to use them to shape change.

The economics chapter (chapter 7) uses a set of case study examples to illustrate key economics concepts and in particular to describe some of the important market failures in our food system, for example, situations in which the food system does not provide optimal outcomes, and ways economics tools can be used to assess and address these problems. Turning to focus on government more directly, the policy chapter (chapter 8) describes the major food-system–related policies and how they operate, as well as explaining how modern food-system policy evolved, with an emphasis on the US Farm Bill. The culture chapter (chapter 9) discusses the cultural aspects of our relationship to food. Such factors undergird our food choices, our reactions to existing food-system offerings, and our openness to marketing and interventions to change our choices. Marketing by those seeking to convince us to buy their products (chapter 10) drives our food choices and even options. The chapter describes the marketing industry and efforts to bring about positive change.

Part 3: Food Supply Chain: from Seed to Sales. With part 3, the book begins a sequential journey through the major activities in the food chain up to the point when food enters consumers' hands. Chapters provide overviews of crop production (chapter 11), food animal production (chapter 12), food processing and packaging (chapter 13), and food distribution (chapter 14). The chapters describe sector history, structure, and operations, including discussion of policy, economic, and industry drivers, as well as impacts on public health, environment, and equity.

Part 4: Food in Communities and on Tables. Part 4 continues along the food chain with four chapters discussing what we eat and what happens when food reaches our tables and communities. We begin with an overview of the contours of current US diets (chapter 15), covering not only the “what” but also the “when” and “where,” and some of the population diversity in diets—“who.” The nutrition chapter (chapter 16) then explains what happens to this food inside our bodies, what we “ought” to be eating from a health standpoint and why. This nuts-and-bolts overview discusses key macronutrients and micronutrients as well as total diet and whole food approaches, and introduces the reader to the field of public health nutrition. The food environments chapter (chapter 17) reviews literature on how food availability within various environments affects our eating behaviors and how environments could be changed to help make the healthy choice (broadly defined) the easy choice. The preceding chapters have made clear that our current food system is profoundly unhealthy for people and the planet. Although some changes in our diets will occur naturally as the food system's problems lead to changed costs and incentives, it is not always clear that those changes will come in the desired time frame or will lead us in the desired direction. Chapter 18 focuses on interventions to change eating behaviors in desired directions. This concluding chapter provides a review of important theories that can guide intervention development and then provides example interventions targeting change from the individual to societal levels.

Focus and Perspectives Features

The book's main chapters are complemented and in some cases balanced by focus and perspectives features authored by experts in research, policy, and practice. The focus features are intended to provide additional interest and to help bring food-system issues alive for readers. They include articles digging deeper into topics of interest, case study examples, tables, and graphics. Perspectives pieces present analyses or viewpoints rooted in evidence (including lived experience in some cases). These are used to demonstrate some of the existing views among those working on food-system issues. We expect readers will disagree with some, many will make them think, some will inspire them, and some might even make them angry. In some cases the distinction is subjective between what should be categorized as a focus or perspective, and you might disagree with our choices. Note that because of page limits and the desire to present a variety of ideas and content, we did not attempt to balance each piece with a counterargument from a different author. We emphasize that the perspectives present their authors' views, not those of the chapter authors or editor.

Together, these chapters and the focus and perspectives features present a broad view of today's US food system in all its complexity (figures I.3–I.10). They highlight the challenges we face and provide reasons to be hopeful as well. The textbook also provides opportunities for students to examine the food system's (nay, the world's) stickiest problems and think critically about solutions.


Figure I.3 Child's Poster about Healthy Food Placed on City Buses

Source: Shydi Griffin, Baltimore City.


Figure I.4 Seniors Choosing Vegetables

Source: Local Food Hub.


Figure I.5 Cows at Albright Farm

Source: Mia Cellucci, CLF.


Figure I.6 Students Eating Lunch

Source: Johns Hopkins, Diversity Leadership Council


Figure I.7 Lunchables

Source: Michael Milli, CLS.


Figure 1.8 Baby Eating Spaghetti

Source: istockphoto.


Figure I.9 Green Buffers, Clean Water

Source: USDA.


Figure I.10 Man with Carrots

Source: Local Food Hub.

An instructor's supplement is available at Additional materials, such as videos, podcasts, and readings, can be found at Comments about this book are invited and can be sent to


  1. Council on Linkages Between Academia and Public Health Practice. (2010). Core competencies for public health professionals. Retrieved from


This book is a project of the Johns Hopkins Center for a Livable Future (CLF). We would like to thank the board and staff of the GRACE Communications Foundation for their help and encouragement.

The book builds on CLF's legacy of contribution and is a direct extension of its mission. It was developed with the collective effort and expertise of many on staff. In particular, thanks go to Pam Rhubart Berg for her extensive help with graphics and the online supplement, Brent Kim for many and varied contributions, Christine Grillo for rewrites and edits, Shawn McKenzie for ongoing support and wisdom, and Bob Lawrence for oversight and mentorship. Thanks also to other CLF staff members including Amanda Behrens, Dave Love, Jillian Fry, Leo Horrigan, Bob Martin, Shawnel McLendon, Mike Milli, Keeve Nachman, Anne Palmer, Joci Raynor, Allison Righter, Angela Smith, and Chris Stevens.

We have been so fortunate to work with the experts who provided the content for the book. In particular, we thank the chapter authors for choosing to contribute their time to develop and edit their chapters and supplementary materials. Much appreciation also goes to the focus and perspective authors, particularly those who developed new content for the book.

We owe much gratitude to the center's talented student research assistants and CLF-Lerner Fellows, in particular, Patti Truant, Susie DiMauro, and Kate Johnson, who served at different times as my “right hand” on the project. Others who contributed substantial effort include Ruthie Burrows, Karina Christiansen, Linnea Laestadius, Kathryn Rees, David Robinson, and Faith Tandoc.

We would like to thank proposal reviewers Molly Anderson, Frank J. Chaloupka, Kate Clancy, Hugh Joseph, Leslie Mikkelsen, Marion Nestle, Tasha Peart, and Angie Tagtow, who provided valuable feedback on the original book proposal. Jill K. Clark, Ardyth Harris Gillespie, and Hugh Joseph provided thoughtful and constructive comments on the complete draft manuscript. Feedback from these reviewers convened by Jossey-Bass was invaluable in improving the manuscript. Thanks also to Kate Clancy, Jessica Goldberger, Fred Kirschenmann, Jeffrey O'Hara, and Mary Story for review of particular content and for their helpful suggestions.

For many years, CLF had considered developing a textbook. The spark that got this project started came when Andy Pasternack of Jossey-Bass reached out to me. In turn, his interest in developing a food system and public health textbook was sparked by a conversation with food system leader Angie Tagtow. Seth Schwartz of Jossey-Bass was a wonderful steward for this project. He was responsive and patient as I figured out how to edit and format a book and provided wisdom to guide the project throughout. Justin Frahm and Susan Geraghty were supportive and helpful in the production phases.

Personally, I thank my husband, John McGready, and sons, Micah and Emmet, for their support, for taking on extra roles during crunch times, and for keeping me laughing. And, I thank my parents, Joanne and Martin Neff, for their ongoing support and encouragement.

—Roni Neff, editor, on behalf of the Johns Hopkins Center for a Livable Future

About the Editor

Roni Neff is an assistant professor in the Johns Hopkins Bloomberg School of Public Health, Department of Environmental Health Sciences, with a joint appointment in Health Policy and Management. She directs the Food System Sustainability and Public Health program at the Johns Hopkins Center for a Livable Future (CLF), where she has worked since 2006.

Roni has worked in food systems and in public health research, policy, and practice throughout her career. She has played a significant role in advancing the public health voice in food and agriculture policy and research, including through research, speaking engagements, and leadership work with the American Public Health Association. Her academic interests include food waste, food and agriculture policy, and food system workers.

She teaches two courses, “Baltimore Food Systems: A Case Study in Urban Food Environments” and “Food System Sustainability Practicum,” and lectures frequently in other classes and around the country. She has been recognized for excellence in teaching annually since developing the Baltimore class and received the Faculty Excellence in Service-Learning Award from Johns Hopkins' SOURCE program in 2014.

She received her PhD from the Johns Hopkins Bloomberg School of Public Health, MS from the Harvard School of Public Health, and AB from Brown University.