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HHS Partners With Instacart to Advance Food as Medicine

The federal government has tapped an unlikely accomplice, Instacart [[link removed]], to combat diet-related disease. The Department of Health and Human Services and the Silicon Valley grocery delivery app want to help doctors prescribe healthy foods the same way they would prescribe a drug like a statin to control high cholesterol. As health interventions that treat “food as medicine” attract public support, Instacart sees an opportunity to capture more grocery deliveries through this partnership with HHS. However, with so many ways to approach food as medicine, some critics think [[link removed]] it’s hypocritical and ultimately counterproductive for the government to partner with a company like Instacart, whose gig-worker business model drives the economic inequality at the root of nutrition disparity.

Diet-related diseases such as heart disease, high blood pressure, and type-2 diabetes are the leading cause of early death in the U.S [[link removed]]. Perversely, Americans with fewer resources to put food on the table are more likely [[link removed]] to develop these conditions. Nutrient-dense diets tend to be more expensive: in 2013, one study found [[link removed]] the healthiest diet patterns cost on average $1.50 more per day than the least healthy ones and recent pandemic-driven inflation led to a sharper increase in prices for healthy foods compared with unhealthy options [[link removed]].

Beyond cost, food manufacturers and restaurants heavily market foods and meals high in salt, added sugars, and saturated fats that are linked to diet-related diseases. In many American food markets, these products are more ubiquitous, convenient, and easily accessible than nutrient-dense meals.

Public health advocates think the healthcare system could do more to connect people with healthy food or even freely provide it. A growing number of non-profits, hospital systems, and health insurance companies are piloting prescription programs [[link removed]] for fresh produce and post-discharge meals [[link removed]] to treat diet-related diseases. These efforts are attracting government support; the Biden administration permitted select states [[link removed]] to use Medicaid funds to cover interventions such as nutrition classes, medically tailored meals, and fresh food stipends.

Last year, Congress directed Health and Human Services to increase access to these types of initiatives, broadly referred to as “food as medicine.” Two weeks ago, HHS announced [[link removed]] a partnership with the startup-turned-behemoth Instacart to help fulfill this mandate. The public-private partnership will involve research, public outreach, and testing different “food as medicine” program designs to shape policy and potential public support.

Instacart has recently made big moves to brand itself as an essential grocery delivery go-between for healthcare providers and nutrition advocates. Founded in 2012, Instacart is a Silicon Valley darling that lets people hire shoppers to collect and deliver their groceries. It attracted billions [[link removed]] from venture capital to expand nationally and recorded its first monthly profit [[link removed]] in April 2020, after grocery delivery exploded during the pandemic. Instacart went public last year and it’s looking for new revenue streams to remain profitable, including advertising and monthly membership fees [[link removed]].

In September 2022, as a part of the White House’s Conference on Hunger, Nutrition, and Health, Instacart launched [[link removed]] a health division that covers a wide array of partnerships with nonprofits [[link removed]], academic researchers [[link removed]], healthcare [[link removed]] providers [[link removed]], and even an insurance company [[link removed]]. Its efforts include a sponsored issue of a medical journal, inclusion in a Medicare Advantage plan that provides grocery allowances to eligible seniors, the aforementioned platform [[link removed]] for doctors to deliver select foods to patients, and foundation-funded produce stipends to help families in food deserts buy fruits and vegetables for delivery. Instacart has also enabled [[link removed]] more than 8,000 grocery stores representing 70 different chains to accept payments from SNAP EBT cards online and enabled [[link removed]] shoppers to use Temporary Assistance for Needy Families (TANF) funds on delivery fees.

Health-focused food delivery isn’t new. For decades, community organizations such as Meals on Wheels [[link removed]] and Food and Friends [[link removed]] have delivered medically tailored meals to seniors, disabled people, or people living with cancer or HIV. Tapping federal and philanthropic funds to help more people access healthy foods is all well and good, but partnering with Instacart raises concerns about the federal government’s preferred model for “food as medicine.”

Instacart’s business model relies on skirting labor law by hiring workers as independent contractors. Unlike employees, independent contractors do not receive a minimum wage, overtime, workers compensation, unemployment insurance, healthcare, discrimination protection, or protections to form a union. Instacart and other gig companies such as Uber, Lyft, and DoorDash claim that their independent contractor status allows workers to set their schedules and work for multiple delivery apps. But in practice, Instacart uses behavioral psychology [[link removed]] and obtrusive sounds and penalties [[link removed]] to pressure workers to deliver at certain times and accept low-paying orders they might otherwise reject.

The proliferation of gig work has only exacerbated economic inequality, a root cause of nutrition disparity. While reliable data is hard to come by, one review of tax forms found [[link removed]] the number of people making money from gig work tripled between 2017 and 2021. According to another survey [[link removed]], the portion of workers who rely on gig work as their primary source of income increased from 21% in 2021 to 61% in 2023. Yet another survey [[link removed]] found that 40% of gig workers said they experienced food insecurity compared to 19% of non-gig workers.

Instacart and other gig companies lobby hard to ensure that their workers remain contractors and avoid employee protections. Uber and Instacart successfully supported a ballot initiative [[link removed]] in California to carve out gig workers from laws that crack down on worker misclassification, and they’re backing a similar proposal in Massachusetts [[link removed](2022)].

Instacart shopper pay varies wildly. While some shoppers report earning $25 [[link removed]] or $30 [[link removed]] an hour, a survey by The Washington Post estimated the average Instacart worker made just $7.15 per hour [[link removed]] in 2019, factoring in unpaid time spent waiting for orders. Another survey [[link removed]] in 2020 found nearly 30% of gig workers made less than their state minimum wage. Wages fell even lower in August after Instacart cut [[link removed]] its minimum order base pay from $7 to $4. Gas costs and vehicle wear and tear further eat into workers’ meager earnings.

Tech companies are too often viewed as innovative saviors that will deliver us from society’s most intractable ills, but problematic business models can actually send us in the wrong direction.

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What We're Reading

Since food companies show no signs of lowering prices, a new report [[link removed]] and op-ed [[link removed]] outline some of the tactics policymakers can use to prevent food company greedflation. (Groundwork Collaboration and Vice)

A new report breaks down the ways dominant global grain traders abuse their market power to profit off disruption in the food system and drive up prices. ( SOMO [[link removed]])

In Florida, corporate interests literally wrote the bill on cannabis legalization to corner this new market. One Florida-based giant, Trulieve, has since acquired dozens of cannabis companies (and their valuable licenses) across the country and now sells over half of legal weed in some states. ( More Perfect Union [[link removed]])

About the Open Markets Institute

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Written by Claire Kelloway

Edited by Anita Jain and Phil Longman

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