Six Health-Focused Fixes for SNAP

By CHRISTINA BADARACCO

The $867 billion Farm Bill squeaked through our polarized Congress at the end of last year, though it was nearly derailed by arguments over work requirements for SNAP recipients. That debate was tabled after the USDA crafted a compromise, but it is sure to continue at the state level and in the next round of debates. While Republicans tend to favor work requirements and Democrats tend to oppose them, here’s something both sides can agree on: SNAP should help Americans eat healthy food.

The Supplemental Nutrition Assistance Program (SNAP)—formerly known as food stamps—provides financial resources to buy food and nutrition education to some 40 million low-income Americans. Costing taxpayers almost $80 billion per year, the program serves Americans across the spectrum of ages, ethnicities, and zip codes. Simultaneously, we reached a deficit of almost $800 billion in 2018. So how can we ensure this at-risk population of Americans can access nutritious food and better health outcomes within the confines of our current resources?

Studies have proven time and again how participation in SNAP reduces rates of poverty and food insecurity. And the program has improved substantially in recent years, with recipients now using debit-style cards to buy groceries and receiving increased benefits at thousands of farmers markets across the country.

Despite these clear benefits, SNAP dollars often don’t support healthy diets. In fact, a 2015 study determined that SNAP participants had poorer diets, with more empty calories and less fresh produce, than income-eligible non-participants. In 2017, another study found that participants have an increased risk of death due to diet-related disease than non-participants. The authors reported that the discrepancy might be partly caused by individuals who think they have high risk of poor health and/or struggle to pay medical bills are more likely to put in the effort to enroll in and redeem SNAP benefits. A recent survey of Americans across the country showed that foods purchased using SNAP benefits were higher in calories and unhealthy components, like processed meat and sweeteners, than those purchased by non-participants of the same income level.

What’s
going on? As a dietitian, my previous work with low-income patients at a
prominent Boston hospital opened my eyes to the numerous barriers many of them face
in following a healthy diet. My role involved counseling patients ever-so-briefly
on improving their diets and checking boxes on a computer screen to send them
on their way to receive their nutrition assistance benefits.

Many
low-income residents live far away from high-quality grocery stores and
farmers’ markets, and lack a consistent or safe way to get there. They can’t
afford some of the most nutritious and fresh foods, and/or lack time to prepare
meals from scratch. So, they end up getting the most calories for their dollar
by eating energy-dense fried fast food or frozen foods, ready to fill a hungry
belly at a moment’s notice. Indeed, the SNAP allotment falls just above $2 per
person per meal (for the highest earning single person). This population has a higher
risk of being overweight and sick because unhealthy food is cheaper and more
widely available. But the reason why diet and health are in many ways worse
among recipients compared to others at a similar income level warrants further
study; indeed, this is an area that researchers continue to investigate.

Moving forward, we need to ensure that SNAP helps struggling
Americans eat food that is actually good for them and promotes good health,
supporting family life and preparation for the working world. Here are six suggestions
for future farm bills:

  1. Prescribe produce. Because the majority of SNAP households have at least one member on Medicaid or the Children’s Health Improvement Program (CHIP), integrating a healthy food prescription program and more robust nutrition education for these recipients as part of Medicaid could better promote shared health outcomes. The bipartisan Food is Medicine Working Group, founded in early 2018, was instrumental in integrating language about a pilot produce prescription program into the recently-passed Farm Bill. That pilot can yield real data about the health benefits of such programs, which can then be expanded based on justifiable outcomes. Connecting health and nutrition via enrollment in federal programs provides a unique opportunity to drive progress.
  • Make
    shopping safe.
    Given that public health
    research has shown strong associations between community violence and food
    insecurity, attempts to increase food access must focus on improving safe access. Farmers’ markets and
    healthy corner stores receiving funding through the Healthy Food Financing
    Initiative (HFFI) can be incentivized to open at police stations or schools,
    with built-in added security to allow families to use their benefits.  
  • Leverage
    purchasing power.
    Expand funding for food
    hubs through the Local Food Promotion Program to support centralized purchasing
    of healthy staples for SNAP recipients within concentrated communities of
    beneficiaries to lower marginal costs and increase access. Food could be
    distributed to community centers via a model like a community supported
    agriculture (CSA) or meat share.
  • Incentivize healthy eating. It’s possible to improve diets without substantially increasing costs by expanding incentives for buying healthy foods and adding disincentives for unhealthy foods. Thousands of farmers’ markets currently offer double dollars incentive programs—funded through Food Insecurity Nutrition Incentives (FINI) and/or philanthropy—so expanding this beyond farmers’ markets could make a huge impact.
  • Connect
    growers and eaters.
    Better connecting SNAP
    recipients to urban agriculture or community gardens can address the lack of
    understanding among Americans about where and how food is grown while also promoting local food
    production. This could involve expanding the jurisdiction of the Food
    and Agricultural Service Learning Program (FASLP) beyond children to include
    adults using SNAP.
  • Teach food literacy. SNAP-Ed can be a valuable tool to teach basic nutrition to recipients, but is wholly underutilized and should focus on teaching more hands-on cooking skills to people without basic food literacy. This is critical at a time when Americans spend less time than ever preparing food. Emphasizing or incentivizing programming in teaching kitchens—perhaps in existing schools or community centers, where families can receive a meal and learn hands-on skills—may translate to improved home cooking skills.

Debates
over the next Farm Bill are sure to be as contentious as the last. But
policymakers across the political spectrum can agree that our tax dollars
should support better health and nutrition for SNAP recipients. Implementing
these solutions can improve the diets of SNAP recipients, with a longer-term
benefit of boosting health and reducing healthcare costs. That will require better
cooperation across programs, creativity on the part of state agencies
administering these programs, and reprioritizing programs and dollars to
support health outcomes.

Christina Badaracco is a registered dietitian who writes regularly about food, agriculture, and public health. She is the co-author of The Farm Bill: A Citizen’s Guide (Island Press, 2019).

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