This dissertation focuses on the ways that grassroots activists and urban gardeners in three United States cities have advocated for and organized the cultivation of urban land over the last half century. Since the 1970s, organized gardening activities have been sustained in many large cities across North America and beyond. However, community gardens continue to be viewed as temporary land uses in almost every case. Drawing on 55 interviews and thousands of pages of historical documents, I demonstrate how urban agriculture has come to be seen as a legitimate long-term land use in Milwaukee, Philadelphia, and Seattle in different ways that relate to key organizational decisions as well as to the local culture, economic conditions, and policy context. Comparing the cities’ cultural contexts, I highlight the importance of local civic conventions for organizational advocacy and social movement organizing by illustrating how civic conventions in the form of policy infrastructure have created important leverage points and interfaces between community-based organizations and the local government, while civic conventions in the form of widely shared ideas have been important to movement formation and mobilization. Comparing the political-economic conditions of each city, such as the availability of public resources and policy at larger scales of government, I demonstrate how the evolving role of gardens in the urban milieu has interacted with distinct growth strategies and political processes at work in each locale. In all three cities, the main garden organizations came to emphasize an economic framing—employment in Milwaukee, blight removal in Philadelphia, and neighborhood amenity creation in Seattle. I show how the different organizations’ economic frames have succeeded to varying degrees in convincing city officials that garden sites deserve long-term land access, funding, and other forms of public support. Even though all three frames have been effective in lengthening land tenure, however, economically focused arguments cohere with processes perpetuating inequality in urban environments, which has set the stage for present and future conflicts. Building on my qualitative historical analysis, I use a unique longitudinal dataset of organization-affiliated gardens to demonstrate how the different priorities emphasized by each city’s main garden organization are reflected in the changing locations of their gardens over time. I show how across the cases, specific sustained organizational priorities are connected to different outcomes in the proximity of gardens to low-income residents, immigrants, and people of color. As cities become increasingly important sites of contestation over governance and resource allocation in the 21st century, understanding how community-based organizations such as urban agriculture organizations interact with local government is critical—not only how these organizations secure resources from public sources, but also how they win policy victories in the face of elite opposition. In developing and defending community gardens, the urban agriculture organizations that are the focus of this dissertation provide instructive cases for understanding both the constraints imposed by organizational environments and the potential power that everyday people have to reshape land use patterns and urban systems.

This dissertation examines the privatized social safety net provided by the U.S. food banking system and the implications of relying on this network of nonprofit organizations to address the issue of hunger. U.S. food banks have been collecting and redistributing food waste to other nonprofit organizations that provide food directly to people since the late 1960s, and prior literature criticizes food bank structures for perpetuating inequities and detracting from efforts to enact systemic changes to the political economic system that produces hunger and poverty (e.g., Fisher, 2017; Poppendieck, 1998; Riches, 2018). However, the Covid-19 pandemic represented a moment of significant changes in both food banking and the framing of hunger and inequality in the United States. During this period, food banks were frequently represented in media portrayals as a response to hunger, and food banks became more central to the U.S. public and private social safety nets. Since Covid-19, food banks received increased resources, expanded to serve new organizations and people, made programmatic changes, and grew their focus on equity throughout their work. I found food banks have begun to shift their attention away from predominately being supply-driven, gleaning organizations that procure excess food toward being organizations increasingly focused on ending hunger and poverty. Thus, I examine how food banks and their administrators changed during the Covid-19 pandemic as well as how they situated their work within larger questions of how to address hunger and poverty. To examine how U.S. food banks address hunger and poverty, I specifically explore: (1) How food banks distribute resources to address hunger, and what models, programs, and metrics they use to define their missions, guide their decisions, and reach goals; (2) How food banks respond to broader social and political contexts and changing ideas regarding hunger and poverty; and (3) How food bank resources are distributed locally, regionally, and nationally, and how this influences the distribution of food to people in relation to poverty, race, and urbanicity. I draw on 62 interviews conducted from 2021 to 2022 with food bank administrators from across the United States, archival materials on food banking, and geospatial analysis of a nine-state Food Bank Census. I find food banks are working to center addressing hunger’s root causes, but these changes are happening unevenly within the food bank sector and within individual food banks. Food banks are also grappling with competing ideologies around the root causes of poverty, which has led their structures to have be a patchwork of different ideological approaches to hunger. These findings elicit further questions of why food banks are implementing structures based on disparate ideologies for addressing hunger. Below, I briefly address findings from each of the above-listed questions and the further inquiries they provoked. I find that food banks’ missions, programs, and metrics align with three models of addressing hunger and poverty—the traditional charity model, the personal responsibility model, and the systemic change model. Under the traditional charity model, food banks alleviate hunger through food provision. However, some food banks are increasingly taking steps to end hunger and poverty using either individualized approaches under the personal responsibility model or structural approaches under the systemic change model. I find most food banks have missions and operate programs that fall under a hybrid of the three models, but I find that food bank metrics align heavily with the traditional charity model. I further explore why food banks simultaneously operate approaches rooted in multiple ideologies of addressing hunger. I find that food bank programs and metrics are heavily influenced by their efforts to please funding sources and signal their legitimacy as an effective response to hunger. Their economic model of fundraising through private dollars and administering government programs means that food banking activities are all influenced by economic and political elites. Food bank programs are thus responsive to philanthropic trends of how to address hunger and poverty. However, they rarely discontinue programs, which has led to durable impacts from early donor trends. I find their metrics are the most mismatched with their missions because this is the key means they use to signal legitimacy to funding sources, which leads to an emphasis on always showing growth or success. Food banks’ agency in determining their own metrics of success is further limited by specific reporting requirements from funding sources. Additionally, I explore food banks’ political advocacy and how they frame their own politicization. Food banks play a key role in framing to the public and policymakers how hunger in the U.S. should be resolved. I find that many food banks frame themselves as politically neutral, despite all food banks in my sample being involved in some form of political action. For example, food banks conduct educational campaigns about hunger, lobby for public policies, and control the distribution of billions of dollars of resources annually. For this reason, I further explore why food bank administrators depoliticize their work and how these efforts to depoliticize their work limit the scope of their political advocacy. I find that political advocacy work can be challenging to food banks’ efforts to maintain legitimacy in the eyes of the donors and public, especially as they begin to engage in practices that are in contradiction to the status quo. I further explore how food banks engage in politics to either effect change or uphold the status quo regarding social safety net policies and inequality. While food banks generally uphold the status quo, they are also increasingly creating systemic change through political organizing for social justice. I also find that food banks are increasingly using their economic and political power to effect systemic changes to the political economic system, such as through advocating for living wage policies. Despite the challenges food banks face in engaging in politically divisive debates, I find that food banks are increasingly able to draw on new narratives that question the political economic system that has produced both hunger and the food banking system. Food banks are thus engaging in a two-part approach—feeding people who are experiencing food insecurity today while trying to prevent it in the future. Lastly, to examine the constraints of relying on localized and privatized social safety nets, I examine geographical disparities in both food banks and their resources. I do not find evidence that such resources respond to levels of community need. Instead, I find resource differences based on racial demographics and urbanicity, which lead to an uneven social safety net that perpetuates existing inequities. These findings raise questions about how one’s local food banking infrastructure can dramatically impact the available social safety net and why we are increasingly relying on these private systems to administer federal social safety net programs. Together, these findings point toward the need to revisit the taken-for-granted assumptions of how to address hunger. Instead of trying to best redistribute the corporate food system’s excesses to people experiencing poverty, a better social safety net could be built through centering the needs of people experiencing poverty and changing the systemic structures that produce poverty in such a wealthy nation.

Introduction: The diagnosis of non-ST-elevated myocardial infarction (NSTEMI) depends on a combination of history, electrocardiogram, and cardiac biomarkers. The most sensitive and specific biomarkers for cardiac injury are the troponin assays. Many hospitals continue to automatically order less sensitive and less specific biomarkers such as creatine kinase (CK) alongside cardiac troponin (cTn) for workup of patients with chest pain. The objective of this systematic review was to identify whether CK testing is useful in the workup of patients with NSTEMI symptoms.

Methods: We undertook a systematic review to ascertain whether CK ordered as part of the workup for NSTEMI was useful in screening patients with cardiac chest pain. The MEDLINE, Embase, and Cochrane databases were searched from January 1995–September 2020. Additional papers were added after consultation with experts. We screened a total of 2,865 papers, of which eight were included in the final analysis. These papers all compared CK and cTn for NSTEMI diagnosis. 

Results: In each of the eight papers included in the analysis, cTn showed a greater sensitivity and specificity than CK in the diagnosis of NSTEMI. Furthermore, none of the articles published reliable evidence that CK is useful in NSTEMI diagnosis when troponin was negative. 

Conclusion: There is no evidence to continue to use CK as part of the workup of NSTEMI acute coronary syndrome in undifferentiated chest pain patients. We conclude that CK should not be used to screen patients presenting to the emergency department with chest pain.