A Changing Climate Means A Changing Society. The Island Press Urban Resilience Project, Supported By The Kresge Foundation And The JPB Foundation, Is Committed To A Greener, Fairer Future.​ This Op-Ed Was Originally Published April 11, 2019 on The Health Care Blog

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.
  2. 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.  
  3. 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.
  4. 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.
  5. 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.
  6. 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.

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