New York City is tackling the twin problems of food insecurity and affordability at the same time by introducing what it calls Health Bucks: food stamp clients who shop in farmers markets will get coupons worth two dollars for every five dollars they spend.

This also helps to keep money in neighborhood economies, since the US Department of Agriculture reckons that every one dollar in food stamps spent generates $1.79 in local economic activity.

The initiative comes from Lilliam Barrios-Paoli, the city's deputy for health and human services (right), appointed by Mayor Bill de Blasio after he admired her work as Commissioner for Ageing under his predecessor Michael Bloomberg. Her brief is especially to tackle food poverty.

Barrios-Paoli wrote in the Daily News yesterday: "While we're a thriving metropolis that is proud of its rich culinary depth, New York has too many residents who are unable to even eat."

She added that people can apply for benefits online, and City Hall is "working with more than 70 groups to help guide New Yorkers through the application process in their communities".

According to Michelle Simon, a public health lawyer who specialises in food politics, the majority of Americans may have heard about healthy eating, but the idea of having a healthy diet is "far out of reach, either because it's not available at all or because it's too expensive".

Rick Luftglass, Executive Director of the Laurie M. Tisch Illumination Fund, welcomes the initiatives in New York City: "It now has Green Carts, Healthy Bodegas, Health Bucks, more farmers markets in low-income neighborhoods, urban farms, mobile markets, nutrition guidelines for schools and childcare centers, and an incredible array of organizations committed to making changes".

But unfortunately, the federal budget for SNAP (Supplemental Nutrition Assistance Program) has been cut. This is the largest program of the United States government to tackle food poverty, participated in by many farmers markets. It has multiple benefits: recipients of the aid get increased access to healthier and fresher foods, farmers increase their customer base and sales, and more locally grown food is eaten, reducing the carbon cost of food miles. There are 136 farmers markets throughout New York City [link to map].

But the recent cuts mean that the money has to go further. Healthy food suppliers have a role to play in educating their customers better in what is good to eat and what is bad, says Simon.

City Hall and Barrios-Paoli will be working with lots of community groups, amongst them groups funded by the Laurie M. Tisch Illumination Foundation, which has a program called "Healthy Food & Community Change". Programs funded include: LISC NYC's Communities for Healthy Food NYC, and City Harvest's Healthy Neighborhoods Initiative.

LISC works in partnership with Community Development Corporations (CDCs) that take a comprehensive approach to neighborhood improvement: affordable housing, jobs, developing neighborhood economies, and expanding educational opportunities. Healthy food is seen as an integral aspect of what makes a healthy, vital community.

There are also public-private partnerships, which grew out of the successes of the NYC Green Cart Initiative, a partnership between the NYC Department of Health and Mental Hygiene and the Laurie M. Tisch Illumination Fund, as well as Karp Resources and numerous nonprofits. The Green Cart permit system allows individuals to operate a food cart selling whole, raw fruits and vegetables in designated areas of the city. Frozen or processed produce is not allowed, and for food safety reasons, vendors cannot cut, slice, peel or process fruits or vegetables.

A Fruit and Vegetable Prescription Program (FVRx), in New York, issues prescriptions for healthy food to overweight and obese children who are at risk of developing diet-related diseases, such as type 2 diabetes and heart disease. 58% of adults in NYC are overweight or obese, and 40% of elementary school students. It's the poorest communities who remain disproportionately burdened by diet-related diseases.

Health care providers and farmers market partners work together to identify and enroll overweight and obese children as participants in FVRx. They include NYC Health and Hospitals Corporation.

Another initiative is Share Our Strength, which last summer campaign to popularise the NYC Summer Meals Program, which was led by the Mayor's Office, the Department of Education and other city agencies in partnership with the New York City Coalition Against Hunger.

But Luftglass argues that NYC has a way to go yet. As a city it is one of the largest purchases of food in the United States so it has potentially massive leverage to force suppliers to make available good quality and affordable food. He says that public institutions can really make a difference this way through their buying power.

"The sheer volume that public institutions buy is enormous – public hospitals, public schools and other entities serve huge a number of New Yorkers, and disproportionately the people served by those institutions are the poor, the unemployed, the underemployed, low-wage workers, and families who are scraping by and need extra support or a boost," he says. To make change, "the agencies and stakeholders have to sit together to identify opportunities and impediments".

Barrios-Paoli will need to work hard to get more bang for her healthy bucks.