Diet quality should become a core SNAP objective

By William Frist, MD, Dan Glickman and Ann M. Veneman

The United States has been a world leader in food assistance programs since it aligned its farm policy to provide food assistance to undernourished citizens during the Great Depression. That program has evolved to become what we now call the Supplemental Nutrition Assistance Program, or SNAP, which has been incredibly successful at reducing food insecurity for individuals living in poverty.

However, our nation now faces high rates of obesity and diet-related disease such as Type 2 Diabetes and heart disease, and rising health care costs.

As Congress considers reauthorizing SNAP as part of the 2018 Farm Bill, we believe it’s time to make nutrition a top priority for the program. That starts with eliminating sugar-sweetened beverages from SNAP. 

Despite spending nearly twice as much as other leading nations per person on health care each year, Americans are getting sicker in large part due to poor diet quality.

For many low-income families, the problem is no longer a lack of calories, but a difficulty in consistently being able to afford, access, and prepare healthy foods resulting in a lack of quality nutrients in their diets.

Poor diets are no accident: the current food environment makes it difficult for many Americans, not only SNAP recipients, to develop and maintain healthy eating habits.  

American’s dietary patterns have been heavily influenced by billions of food industry dollars spent marketing more profitable but less nutritious choices to both adults and kids. Unfortunately, neither America’s largest federal food program nor its health care system, are adequately addressing these issues.

Research shows that individuals receiving SNAP have diets slightly lesshealthy compared to most other Americans. Many of these same individuals are also Medicaid beneficiaries, whose diet-related health care costs contribute significantly to rising national health care expenditures.

Therefore, we must ensure that the federal government is leveraging these programs to improve nutrition, especially among low-income populations who are most at risk for poor health.

United by a common appreciation for the important role that SNAP plays in reducing poverty and food insecurity among low-income Americans, we strongly oppose any changes that would reduce the value of SNAP benefits or make them more difficult for qualified individuals to access.

SNAP provides food assistance to over 40 million individuals per month at an annual cost of $70 billion, only about $125 per person per month. Now is the time to spur positive changes in the program in four distinct priority areas.

First, prioritize nutrition in SNAP. We request that diet quality become a core SNAP objective. Specifically, we recommend eliminating sugar-sweetened beverages from the list of items that can be purchased with SNAP in addition to strengthening fruit and vegetable incentive programs.

We call for improved data so USDA and states can have insight into exactly how benefits could improve health. We also think stores that participate in SNAP should be held to higher standards regarding what food items they carry and how they market unhealthy foods to ensure that SNAP recipients have adequate access to healthy items — changes that would be particularly impactful in areas where grocery access is limited.

Second, strengthen SNAP-Education, which is the program’s nutrition promotion and obesity-prevention component. We think that states should receive more guidance and technical assistance on how to get the most impact from SNAP-Ed, and USDA must do much more to make SNAP-Ed the effective obesity prevention program Congress mandated in 2010.

Third, synchronize SNAP and Medicaid at both the federal and state level. Despite the link between diet and health, SNAP and Medicaid are often completely siloed. Because of this lack of coordination at the federal level, states are very limited in their ability to integrate these programs. The opportunities for collaboration — ranging from portfolio budgeting for nutrition and health to joint waivers for medically-tailored meals — are immense.

Finally, we believe there are significant opportunities to modernize program administration and better coordinate policies and data-sharing across federal programs.

Poor diets and their associated health care costs are a result of the complex interplay between an unhealthy food environment, dominating market influences, food accessibility, and time pressures, especially on low-income families.  

As a result, the solutions to these crises will undoubtedly be multifaceted, requiring significant time and resources. These recommendations are not a panacea for America’s obesity and health care crises, but they are important and effective first steps to pave the way for bolder reforms in the future.

Originally published in The Hill on March 12, 2018.

William H. Frist, MD is a nationally recognized heart and lung transplant surgeon, senior fellow at the Bipartisan Policy Center and former Republican Senate majority leader. Dan Glickman is senior fellow at BPC, former Secretary of Agriculture under President Clinton and represented Kansas in Congress from 1977-1995. Ann M. Veneman is former Secretary of Agriculture under President George W. Bush. They co-chair the center’s SNAP Task Force.