Shireen Abdullah (0:00)

Podcasting from Dallas, Texas, I am Shireen, and this is the Yumlish podcast. Yumlish is working to empower you to take charge of your health through diet and exercise and reduce the risk of chronic conditions like type 2 diabetes and heart disease. We hope to share a unique perspective and a culturally relevant approach to managing these chronic conditions with you each week.

Shireen Abdullah (0:32)

Dr. Lindsay Haynes Maslow is a professor in the Department of Health Policy and Management at UNC Chapel Hill. She’s an expert on the intersection between public health and nutrition, as well as the impact of government policies and programs on health behaviors among disinvested communities. Welcome, Dr. Haynes-Maslow.

Lindsey Haynes-Maslow (0:51)

Thank you so much for having me.

Shireen Abdullah (0:52)

Such a pleasure having you on. So I want to dive into our topic for the day, but before we do, I want to understand a little bit more. And can we start up with you sharing a little bit about what led you to focus your work on nutrition policy and community health? How did that intersection happen?

Lindsey Haynes-Maslow (1:10)

Yeah, that actually started out when I was an undergraduate student and working as an administrative assistant in pediatric cardiology at a hospital here. And literally, my job was to check patients in, collect copays, and get them set up for their appointment. And I very quickly, and I’ll point this out, this was before the Affordable Care Act had passed. So I very quickly started noticing there would be patients, patients, parents that would get very anxious when I started to ask for the copay.

Lindsey Haynes-Maslow (1:44)

And I will never forget that there was one mom, and the copay amount was $5. And she literally just started to tear up and said, is there any way you can put me on a payment plan? And at that point, I was just thinking if $5 and trying to get access to health care is not going to be enough for what can we do to, if anything, prevent people from accessing the healthcare system?

Lindsey Haynes-Maslow (2:11)

And I want to make sure, like everybody knows, that if you need to go access health care, you need to go to the hospital. You should. But I was very much focused on what can we do to prevent those individuals that may not have to access it. And so, since I was already in a public health degree program, I started looking at “what are the main drivers and reasons that people need to go to the hospital or need to access health care.”

Lindsey Haynes-Maslow (2:35)

And it really always came back down to a lot of diet-related chronic illnesses. A lot that you talk about on your show: diabetes, heart disease. And obviously, when you look at, you know, diet-related chronic diseases, you understand that that has to do with food. I jumped into this thinking that it would really be about just education, and let’s give everybody nutrition education, and it will be fine. I very clearly realized that I was pretty naive in that food access is a multi-level problem.

Lindsey Haynes-Maslow (3:06)

There’s a lot of barriers, there’s a lot of intricacies and complexities, and depending on the community, where you live, how old you are, just a lot that goes into there. So I think that’s something that really inspired my focus on one policy. Just recognizing that policy had so much power in driving what people did and what they couldn’t do. And then also just the combination of being in the Department of Health Policy, but also working closely in nutrition.

Lindsey Haynes-Maslow (3:34)

I felt like I could speak both languages because I will say, even though you work at a federal agency or you know, think you work in a similar field, people often don’t talk the same language.

Shireen Abdullah (3:46)

That’s helpful. You know, this, this takes me to sort of this, this next framing that I wanted to set up for the interview here today, which is like, from your perspective and you know, the experience that you also shared, what are some of the biggest barriers communities face today when trying to access nutritious foods? You know, you mentioned the example there from, you know, an event, an experience that you had. So I’d like to understand, like, what do you see as some of those biggest challenges there, and then how do these challenges contribute to chronic diseases?

Shireen Abdullah (4:18)

So in our podcast, we focus a lot, as you mentioned, on type 2 diabetes, heart disease. Where do you see that intersection? How does that happen?

Lindsey Haynes-Maslow (4:24)

Yeah, I like to talk about the framework of what we call Five A’s of access. So food access. We talk about availability. So one, is there even a store close to you? Can you even buy food?

Lindsey Haynes-Maslow (4:37)

And then there’s accessibility. Can you even get there if you don’t have a car? Can you walk there? Or is there public transportation?

Lindsey Haynes-Maslow (4:44)

There’s also acceptability. Again, this is really important for certain communities. Is the food culturally appropriate?  Is something you’re actually going to eat? We need to make sure that people want to eat the food that they’re consuming. And we also want to respect tradition, heritage, any of that, but also making sure that people have access to culturally appropriate foods.

Lindsey Haynes-Maslow (5:06)

And then one thing that I don’t think people often think of is accommodations. So we often think that stores are open 24 hours a day. That’s not the case. I’m sure we all have run into the grocery store, and it’s already closed. Or maybe you had to run into a corner store, convenience store. Again, maybe that is not open.

Lindsey Haynes-Maslow (5:24)

So one, what are the hours of operation? What if I receive food assistance benefits? Do they actually accept that payment? Will they accept my SAP card or my, my WIC benefit? So I think that’s also important.

Lindsey Haynes-Maslow (5:37)

But, the most, I would say the biggest challenge that I have heard over the past decades is just affordability, the cost of food. And that is just every interview, every focus group, cost of food always comes up. And I think what’s really important—I think you asked, you know, additionally, you know—how does that interact with those that do have, you know, chronic diseases?

Lindsey Haynes-Maslow (5:59)

And I’ll say, I mean, clearly right now I don’t know if anybody’s watching food prices, gas prices; I’m sure we all are. But unfortunately, when prices get high, and people need to cut back on their budgets, normally the first thing that is to go is food. They start skipping meals, they start maybe eating less.

Lindsey Haynes-Maslow (6:19)

I’ve seen people water down food and beverages to actually make it seem like it is more. And you have issues with, you know, food; you’re reducing the amount of food you’re consuming. Again, if you have a diet-related chronic illness, that’s not going to be very helpful because your body’s trying to understand, okay, what’s going on, I’m not getting enough food in my body.

Lindsey Haynes-Maslow (6:40)

And then, just in addition to that, the second thing that I normally find that people usually cut when it comes to budget is their medications. So oftentimes people will say, well, I couldn’t afford my diabetes medication this month, so I’m now taking pills every other day, or I’m having my medications.

Lindsey Haynes-Maslow (6:57)

And I think what this really leads to is a very scary event because what’s likely going to happen and what research and studies have shown is that when you do have uncontrolled diet-related chronic illnesses, you end up having to go to the ER to seek care to help, you know, you know, any of the problems you’re dealing with.

Lindsey Haynes-Maslow (7:15)

This could be, possibly someone is dealing with type 2 diabetes, and they might need a foot amputation, or they’re having trouble seeing, just a lot of other issues, or maybe their glucose level cannot be controlled because again, they’re not eating enough food and they’re not taking their medication.

Lindsey Haynes-Maslow (7:31)

And unfortunately, I will say that, as everybody probably knows, if you’ve ever accessed health care in the United States, the most expensive way to access it is through the ER. So it even sets people farther back because now they’re looking at an ER bill that wasn’t just going to be a $5 copay or a $25 copay. But now we’re looking at into thousands of dollars.

Shireen Abdullah (7:51)

I want to get into food policy a little bit. So now your work really looks into how policies and systems shape food environments. And I want to talk about some successful examples in just a second. But before I do, help us just understand the landscape a little bit. So how do local, state, federal policies influence both food access and then nutrition in communities? Because that’s like a whole other piece.

Lindsey Haynes-Maslow (8:18)

Yeah, I think that’s always really important to recognize that I may have access to a lot of foods, but maybe they’re only fast food and convenience stores. So I think it’s important food access and, also actually, the quality of food. But I definitely view local and state policies as a way how you physically shape the food environment. Like, what does that community’s food environment look like?

Lindsey Haynes-Maslow (8:42)

Local communities and town councils, they can pass zoning ordinances which can make it easier for you to access places. So maybe there’s an ordinance that now is promoting or giving incentives to put a farmer’s market in a community.

Lindsey Haynes-Maslow (8:56)

Or you can also restrict places. So you can also have a zoning ordinance that says there can’t be a corner store within this community or so many miles outside of school, because we don’t want children accessing certain food before a certain age. So I think that’s really important. Just realize at the local level, it really basically shifts kind of how.

Lindsey Haynes-Maslow (9:16)

What does your food environment look like, and more at the state level, I think this is a trend that actually has been starting for the past few months is they really can control. You know, essentially right now we’re looking at a lot of states putting in waivers and restrictions on what their SNAP recipients—so the Supplemental Nutrition Assistance Program—what they, can actually buy.

Lindsey Haynes-Maslow (9:36)

So states are now restricting SNAP recipients from trying to purchase sugar, sweetened beverages, or candy, or junk food. Again, these are much more affordable foods. They’re not as healthy, but it’s food over something, which is a debate that I think nutritionists and policymakers often have.

Lindsey Haynes-Maslow (10:00)

But I think that’s really important to recognize that states can do a lot. They can also even pass sugar-sweetened beverage taxes. So there’s a lot that states can do on shaping that. What the actual state and community food environment is. I think stepping a little bit further back is our federal food and nutrition policy, which I truly view as the backbone and foundation of our food policy system in this country.

Lindsey Haynes-Maslow (10:29)

This is where we should be making sure that both states and local communities have the funding and the needs that they require to help improve food access. So you think about large programs like SNAP or like WIC, and again, that’s the supplemental special program for Women, Infants, and Children, and just a lot of other programs that they can do to incentivize individuals purchasing healthier foods if they want to.

Lindsey Haynes-Maslow (10:58)

Or again, they can possibly restrict certain types of foods. I think that’s always really important to recognize that where you are within federal, state, and local policy, it really depends on how you’re working together. I would say an ideal world, local, state, and federal policy should be working towards the same goal when it comes to food access and diet quality.

Lindsey Haynes-Maslow (11:22)

Just, unfortunately we all, we all tend to know we move at our own pace, and we tend to not always talk with our other counterparts. So one thing that I think that’s really important for folks listening on this podcast to remember is that even though your local government or state government is doing something that’s completely different than the federal government, that’s how it can work.

Lindsey Haynes-Maslow (11:43)

Ideally, we would want to work; we would want to see everybody working towards the same goal.

Shireen Abdullah (11:48)

Which, of course, takes me to the next question, which is like, can you point us to some specific examples of policy changes that have made a meaningful difference in, in improving access to healthy foods?

Lindsey Haynes-Maslow (11:59)

Yeah, I mean, so I will say the Supplemental Nutrition Assistance Program, SNAP, it really was actually started as an anti-hunger program, but over the years has really been focused on actually improving diet quality. Similar to Snap, there’s WIC, which really makes sure that you know those children that are five and under, and even the moms are getting access to more nutritious foods.

Lindsey Haynes-Maslow (12:24)

A WIC has been shown study after study to improve diet quality and outcomes for both moms and the children. So that’s a really, really great program. I think again, if anybody has children on this show, you probably or, or listening, you probably know about the National School Lunch Program. So again, the federal government actually started this after World War II because they found that there were too many food-insecure individuals to go fight in World War II, and they were malnourished.

Lindsey Haynes-Maslow (12:53)

So they actually started funding, you know, either free or reduced-price lunches and even breakfast for individuals that were at a lower income level. So, when you think about the way you can truly impact some of these areas, I would say it sounds very basic. But truly, just giving food to people or giving funding to people to use to spend on food is an amazing lever and being able to make positive outcomes.

Lindsey Haynes-Maslow (13:20)

SNAP has lift people out of poverty. It’s made children have better academic achievements. We see actually adults that are on food assistance programs, they actually have better mental health, physical health, just because, again, they’re not having to worry about where am I going to get money from to pay this next bill. So we have a lot of programs that have been very successful.

Lindsey Haynes-Maslow (13:44)

I’ll talk about this a little bit later. Some of them, unfortunately, were eliminated during the one big beautiful bill. So, unfortunately, some progress and actually evidence-based programs that we saw reduced health care costs, those programs were eliminated. But I think it’s really important to realize that the federal government does have a lot of power when it comes to this. But I think that very basic is truly access to the actual food and then helping people access that food. And that usually comes in the form of being able to purchase it.

Shireen Abdullah (14:19)

A moment ago, you talked about more at the local level and how the, the policies that sit at the local level just really influence that immediate food environment. What role do programs at the community level? So now I’m specifically talking about food banks, any local initiatives, nutrition programs that are offered locally. How do these various programs, how do they play in improving diet quality and health outcomes?

Lindsey Haynes-Maslow (14:46)

Yeah, I mean, I absolutely love our charitable food assistance programs at the local level. I mean, they know the community, they know the landscape, they know their community members. But they really should be seen as an emergency approach to, you know, food access or food insecurity. I get you will often hear, especially when SNAP was basically shut down over when we had the government shutdown, and then people weren’t actually receiving payments.

Lindsey Haynes-Maslow (15:16)

Many food pantries, food banks were basically saying we do not have the capacity to be able to even serve even a small portion that SNAP recipients would get. So while they are great at being able to be attuned to what’s going on in the community, they’re usually volunteers from the community. Again, they’re a safe place; people trust them, they feel more comfortable.

Lindsey Haynes-Maslow (15:40)

I would probably feel more comfortable going to a food pantry than going into a formal department of social service office to recertify my application to actually, actually get benefits for food assistance. So it’s also just a little bit more comforting and just a more welcome place to be. But it is a band-aid approach to what should be addressed at a higher systemic level.

Lindsey Haynes-Maslow (16:00)

So I think again, absolutely love community-based programs. They are needed, but they should not be the only solution to food access. If that is the case, we should truly have failed our public

Shireen Abdullah (16:17)

 For healthcare leaders who are listening to this episode today. So I’m talking about any kind of healthcare leaders, educators, community organizations who are also listening. What practical steps can they take today, starting today, to improve food access and nutrition in their communities?

Lindsey Haynes-Maslow (16:32)

I know this sounds pretty basic. One, ask questions and walk around the community. Asking questions to me is the best way to understand, okay, what is this individual’s perspective in the community?

Lindsey Haynes-Maslow (16:46)

Okay, what about this? You know, maybe a small grocery store owner, what do they believe the community is dealing with? Talk to community members in the different neighborhoods. I would say just in general, I think one of my biggest moments, and this is when my research really started turning into it’s not just nutrition education. We need to focus on larger systemic issues.

Lindsey Haynes-Maslow (17:09)

I was doing a focus group in a Section 8 public housing community, so lower-income housing. And I remember asking about, just in general, you know, how do you feel about food access in your community? And a woman looked at me and said, when we finish this focus group, I want you to do one thing for me.

Lindsey Haynes-Maslow (17:27)

Go see our chain, local grocery store, and then I want you to take a look at the produce section. And then I want you to drive over to the white side of town that’s more affluent. It’s the same chain grocery store, and I want you to look at their produce section, and you tell me what you think. And so I did. I went over, and I will be honest, it was truly night and day. The foods that they were getting closer to public housing. It was, you know, not very well in terms of variety.

Lindsey Haynes-Maslow (17:59)

The produce wasn’t always good; it wasn’t always ripe, or it was overly ripe. So again, again, when you focus on that, the fact that, you know, if I only have $5 to spend, am I going to spend it on something that may or may go bad in a day, or it’s already bad right now?

Lindsey Haynes-Maslow (18:16)

So then I went over again to the other side of town, and completely different. I have, you know, five different varieties of apples, there’s different types of berries, the lighting in the store is different. So they actually spotlight some of the produce shelves and, counters, and areas, and displays. So that’s when I think I really realized, and again, this is for any leader asking the questions and walking around. It’s something that is so basic.

Lindsey Haynes-Maslow (18:44)

But I think in this very fast-paced virtual world we live in, sometimes we forget those very basic human steps. So we do have, in the research world and even we do this with our practice-based organizations, community-based organizations, we actually encourage them to do food environment scans that literally is, you know, “Do we have a grocery store?” “Do we have Public transportation?” You know, “How many corner stores or convenience stores are here?” “Do we have a farmer’s market?” “Do we have mobile markets?”

Lindsey Haynes-Maslow (19:12)

But really trying to assess, you know, okay, if we just built a new road and now we’ve got a four-lane highway that’s splitting a community in half, and that community maybe doesn’t have that access to personal vehicles to drive, they’re not going to walk across four lanes of a highway.

Lindsey Haynes-Maslow (19:30)

So again, just truly thinking about what are the policies that we’re passing and how does that actually impact the community. So I know that old phrase of like just walking in somebody else’s shoes, and it shows a lot.

Shireen Abdullah (19:44)

Show us the light at the end of the tunnel here. Right? So where do you see perhaps some of the biggest opportunities for progress in nutrition policy and in community health?

Lindsey Haynes-Maslow (19:55)

We were making, I think, in general, within the public health and nutrition community, a lot of progress. Up until about 18 months ago, we were really going with a food-as-medicine movement; healthcare was really getting into focusing on how can we make sure that we’re screening for food insecurity, more food access issues if people say they need access to resources, you know, if they’re on Medicaid.

Lindsey Haynes-Maslow (20:20)

In North Carolina, we had Medicaid. It was a healthy opportunities pilot, which our state ended. But if you needed food access resources, your provider, your healthcare provider, would actually give that to you. So this, this answer is a little bit, I will say in the past 18 months, I’ve seen a lot of programs been, it’s been eliminated.

Lindsey Haynes-Maslow (20:41)

So nutrition education has been eliminated. At the same time, we reduced the amount of funding that people received on SNAP. At the same time, we also implemented new work requirements for those on SNAP that are even stricter than previously than we’ve had in history. So what I’m focused on is the opportunity to start building back what we’ve actually torn down and building it back in a better and more intentional way.

Lindsey Haynes-Maslow (21:05)

So I hope that if anybody is listening, that when the time comes and we are ready to organize and say, what do we want this food system to look like and how do we make it work for everybody, not just those that we deem deserving and those that are not deserving, I really do think that opportunity is here for us to say what do we want to envision our food and nutrition policy system to look like in the coming years?

Shireen Abdullah (21:31)

Thank you so much for that, that perspective here. These conversations are so important to have and really to understand what are the types of things that can be done at a local level and feel empowered in the influence that you can have in the community as well. So I really appreciate that perspective.

Shireen Abdullah (21:47)

We are wrapping up the episode here. At this point, though, I’d love for our listeners to know from you, Dr. Haynes Maslow, how they can connect with you. Just stay informed with your work.

Lindsey Haynes-Maslow (21:58)

Yeah, so most of my work, I will say, I’m very active on LinkedIn, so you can find me on LinkedIn. I also have on my website at UNC Chapel Hill. I often have a running list of studies that I’m publishing or work that I’m doing. I would share my social media account, but that’s basically pictures of flowers and our goats, chickens, and livestock guardian dogs. I don’t think that’s helpful to anybody except myself.

Lindsey Haynes-Maslow (22:25)

But no, very active on LinkedIn. People can contact me at the university email, and I’d be more than happy to have a conversation.

Shireen Abdullah (22:33)

Love it. Thank you so much for your time again, and to our listeners. Thank you for tuning into another episode of the Yumlish Podcast. Hope you enjoyed this episode! Head over to our social media and answer this quick question, which is what changes in your community would it make easier for people to access healthy, affordable food? So we want to hear from you again. Head over to @Yumlish on Facebook, on Instagram, and, again, find this podcast post and comment below to tell us what changes in your community would make it easier for people to access healthy, affordable foods. We’ll continue the conversation there.

Shireen Abdullah (23:08)

Again, thank you so much for your time. Dr. Haynes Maslow, it was a pleasure.

Lindsey Haynes-Maslow (23:12)

Thank you for talking with me.

Shireen Abdullah (23:15)

Thank you for listening to the Yumlish podcast. Make sure to follow us on social media @Yumlish_ on Instagram and Twitter and @Yumlish on Facebook and LinkedIn for tips about managing your diabetes and other chronic conditions and to chat and connect with us about your journey and perspective. 

Shireen Abdullah (23:35)

You can also visit our website, yumlish.com, for more recipes, advice, and to get involved with all of the exciting opportunities Yumlish has to offer. If you like this week’s show, make sure to subscribe so you can hear more from us every time we post. Thank you again, and we’ll see you next time. Remember, your health always comes first. Stay well.

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Connect with Lindsey Haynes-Maslow!

Website URL: https://sph.unc.edu/adv_profile/lindsey-haynes-maslow-phd/

LinkedIn URL: https://www.linkedin.com/in/lindsey-haynes-maslow-81b0008/