Advocacy as an NP

Nurse practitioners (NPs) are at the intersection of healthcare and community well-being, uniquely positioned to advocate for policies that improve public health outcomes. One pressing area where NPs can lead the charge is food system reform, particularly in increasing access to healthy food options and reducing the prevalence of pesticides and herbicides in America's food supply. This advocacy, however, can require navigating the considerable influence of lobbying forces that might be determined to maintain the status quo. By leveraging their expertise, NPs can play a pivotal role in addressing these challenges and shaping a healthier future. THE IMPORTANCE OF HEALTHY FOOD ACCESS Access to nutritious food is a cornerstone of public health. Poor nutrition is linked to chronic diseases such as obesity, diabetes, cardiovascular conditions, and certain cancers.1,2 In one of the wealthiest countries on Earth, it is alarming that the United States (US) food landscape is characterized by widespread food deserts—areas where fresh, affordable, and healthy food is scarce. This disproportionately affects low-income and marginalized communities, exacerbating health disparities.3,4 There is an urgent need for healthier food options. According to the Centers for Disease Control and Prevention (CDC), over 40% of American adults have obesity, and diet-related diseases are among the leading causes of preventable death.5 NPs, as trusted healthcare providers, witness firsthand the devastating effects of poor nutrition. They are ideally placed to advocate for policies that promote greater availability of healthy, affordable food options. Key policy goals include expanding federal programs such as the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) to include more incentives for enrollees to purchase fresh produce. These incentives should also include supplying resources and support for farming communities and facilities based on quality, pathogen-free, organic food rather than mass-produced, contaminated food. Additional measures could focus on supporting urban agriculture, farmers' markets, and farm-to-school programs, all of which could bring fresh, locally grown food into underserved communities. THE DANGERS OF PESTICIDES AND CHEMICALS IN FOOD PRODUCTION The prevalence of pesticides, herbicides, and other chemicals in food production raises significant concerns for public health. The US Environmental Protection Agency (EPA) monitors pesticide use, but some chemicals approved for use in agriculture have been linked to serious health risks, including endocrine disruption, neurological damage, and cancer. Children, pregnant women, and farmworkers are particularly vulnerable.6-8 While these chemicals are often justified as necessary for large-scale agricultural productivity, their widespread use poses long-term risks to ecosystems and human health. Studies have found residues of glyphosate, a controversial herbicide, in a variety of food products, sparking debates about its safety and regulation.6 NPs have a unique opportunity to educate their patients and the public about these risks and advocate for stronger regulations to limit harmful chemicals. This includes supporting legislative efforts to phase out toxic pesticides, encouraging organic farming practices, and promoting integrated pest management systems that minimize chemical use. BARRIERS TO REFORM: NAVIGATING THE INFLUENCE OF POWERFUL LOBBYING FORCES The food industry and chemical manufacturers wield enormous influence through lobbying efforts, often resisting policies that threaten their profits. Organizations representing agribusiness, chemical companies, and processed food manufacturers invest heavily in shaping legislation, often prioritizing short-term economic gains over public health.9 For example, the pesticide industry has a history of lobbying against stricter safety regulations and funding research that downplays the risks of their products. In fact, the EPA was likely influenced by the industry and subsequently pressured to revise their findings on glyphosate to indicate it is non-carcinogenic to humans.10 Similarly, large food corporations lobby against policies aimed at reducing sugar, salt, and unhealthy fats in processed foods.10 Navigating this political landscape requires strategic advocacy. The abundance of information disseminated online, through government publications, and through public health associations provide enormous amounts of data, but many people are uninterested or do not have the time to learn more about effective advocacy. This highlights the unique position of NPs to deliver and share vital health information with both their patients and the broader community. NPs can collaborate with other healthcare professionals, community organizations, and public health advocates to amplify their message on behalf of their patients. By building powerful coalitions, NPs can counteract the influence of well-funded lobbying groups and push for evidence-based policies that prioritize public health over corporate interests. STRATEGIES FOR ADVOCACY NPs can inform and advocate for populations by initially educating individual patients about the impact of diet and environmental toxins on health. Providing practical advice on choosing organic or locally grown produce, reading food labels, understanding ingredients and chemicals, and avoiding highly processed foods empowers individuals to make healthier choices. Referral to registered dietitians is an available option and can provide comprehensive education to communities and families. This grassroots approach builds awareness and creates demand for healthier food options. Advocacy extends beyond individual patient care. NPs should work with community organizations to address barriers to healthy food access, such as poverty, transportation issues, and zoning laws. Hosting workshops, participating in local food councils, and supporting community gardens are practical ways to drive change at the local level. Becoming involved in city, county, or regional events are also opportunities to create awareness and are effective in engaging residents. NPs can influence policy by engaging with legislators, attending public hearings, and submitting written comments on proposed regulations. Joining professional NP organizations such as state NP associations and the American Association of Nurse Practitioners (AANP) provides a platform for collective action, enabling NPs to advocate for policies that promote sustainable agriculture and food safety. Producing and disseminating research on the health impacts of diet and environmental toxins and evidence-based practice strengthens the case for reform. NPs can collaborate with academic institutions and public health agencies to highlight the connection between food systems and health outcomes. The “Dirty Dozen” and “Clean Fifteen” are annual lists published by the Environmental Working Group (EWG) that rank fruits and vegetables based on pesticide contamination levels. The Dirty Dozen highlights produce with the highest pesticide residues, such as strawberries and spinach, while the Clean Fifteen includes items like avocados and sweet corn that tend to have minimal residues. These lists help consumers make informed choices about when to prioritize organic produce to reduce pesticide exposure.11 Leveraging media and technology are additional and important ways to promote information. Social media, blogs, and webinars are powerful tools for raising awareness and mobilizing support. Additionally, there are apps available for mobile phones that scan and interpret nutritional values and types of harmful additives in many food and cosmetic items. A few currently available apps include YUKA, EWG's Healthy Living, and Fooducate. NPs can use these platforms to share success stories, highlight disparities, and advocate for policy changes, reaching a broader audience and building momentum for action. EMERGING OPPORTUNITIES FOR CHANGE Recent policy initiatives suggest a growing recognition of the need for food system reform. For example, the Healthy Food Financing Initiative (HFFI) provides grants and loans to increase access to healthy food in underserved areas. The HFFI aims to enhance access to nutritious foods in underserved urban and rural communities, create and sustain quality jobs, bolster food supply chain resilience, and revitalize low-income areas. This public-private partnership is managed by the Reinvestment Fund on behalf of US Department of Agriculture (USDA) Rural Development.12 Additionally, the Farm Bill, reauthorized every five years, presents an opportunity to advocate for policies supporting sustainable agriculture and reducing pesticide use. As of the time of writing of this article, the American Relief Act, 2025, which extended the Agriculture Improvement Act of 2018 (commonly known as the 2018 Farm Bill), had expired on September 30, 2025. The USDA's Farm Service Agency (FSA) may continue to operate many programs, either due to ongoing funding authority under the Farm Bill or through alternative authorizations.13 At the local level, USDA and county agencies may sustain operations temporarily through appropriations or continuing resolutions, but other smaller or pilot programs may be affected. Because of persistent legislative gridlock over spending priorities, nutrition funding, and climate provisions, most analysts expect a new Farm Bill to be debated during a lame-duck session after the 2025 elections. This period presents a narrow but critical window for NPs and other advocates to engage Congress and advance policies supporting regenerative farming, environmental resilience, and pesticide reduction.14-16 Some states have introduced policies to restrict pesticide use near schools, incentivize organic farming, and promote healthier school lunches. For example, the Healthy Schools Act, enacted by the California Legislature in 2000, establishes specific guidelines for pesticide use in schools and childcare centers. It outlines responsibilities for school and childcare staff, pest management professionals, and the Department of Pesticide Regulation. Additionally, the Act promotes the adoption of integrated pest management, a strategy focused on using low-risk and effective pest control methods, to protect the health and safety of students and staff at these facilities.17 While this is a step in the right direction, more resources could be spent on identifying and procuring a more robust predatory insect population to act as pest control and avoid toxic chemical exposure. NPs can seize these opportunities and more by staying informed about legislative developments and engaging with policymakers to shape these initiatives. The food industry and toxic chemical exposure related to it are important components of health and safety and should be prioritized by all health care professionals and policymakers. THE ROLE OF FUTURE POLICIES Looking ahead, innovative policies and courageous policymakers are needed to address the root causes of unhealthy food systems and environmental degradation. Key areas for focus include: Incentivizing sustainable agriculture and creating policies that reward farmers for adopting regenerative practices such as crop rotation, reduced chemical use, humane animal treatment, and soil health improvement can help transition the food system toward sustainability. Updating food safety standards to reflect the latest scientific evidence is critical. This includes stricter limits on pesticide residues, transparent labeling requirements, and better monitoring of emerging contaminants. Raising animals for consumption is half of US agriculture, and animal products have the potential to exacerbate the spread of food-borne illnesses.18,19 NPs are expertly educated in prevention of illness and health promotion and can be an integral part of preventing illness through advocating for policies that ensure animals raised for meat and consumption are humanely raised and legitimately healthy. Addressing climate changes in certain regions is important. Modest changes in temperature have been suggested to affect agriculture sustainability. Climate change can exacerbate food insecurity by disrupting agricultural production of both plants and animals. Animals' optimal body core temperature is often maintained within 2 to 3° C and deviations outside of this range can cause decreases in performance, production, and fertility. Larger deviations in temperature can ultimately cause death of the animals. Policies that promote climate-resilient crops, promote responsible processes, and reduce the carbon footprint of food production can enhance food security while also decreasing or limiting the impact on the environment and the animals raised as food.20 Ensuring that all communities, regardless of income or location, have access to healthy food requires addressing barriers and unintended consequences of regulatory policies that might affect marginalized communities. For example, urban farming has been restricted in some areas due to zoning laws enacted over concerns of aesthetics, property value, or sanitation. Policies that target food deserts, reduce poverty, and improve education can create a more equitable food system.3 CONCLUSION NPs have a critical role in advocating for healthier food systems that prioritize public health. By recognizing and addressing issues such as limited access to nutritious food, the harmful effects of pesticides, and the influence of powerful lobbying forces, NPs can help shape policies that create a healthier, more sustainable future. The path forward requires persistence, collaboration, and a willingness to challenge entrenched, powerful interests. However, the potential rewards—a healthier population, reduced healthcare costs, and a more sustainable planet—make this effort essential. As trusted voices in healthcare, NPs are well-equipped to lead this charge, ensuring that food system reform remains a priority on the national agenda.