Monday, January 16, 2017

A more constructive approach to SSB restrictions in SNAP

An old debate

First, let me review the harsh back and forth in a somewhat typical week of debate about sugar sweetened beverages (SSBs) in the Supplemental Nutrition Assistance Program (SNAP).

The New York Times this week published an article about "lots of soda" in the shopping carts of SNAP participants.

This drew fire from the magazine Jacobin ("Reason in Revolt"), where Joe Soss noted several problems with the NYT article. For example, the NYT listed "milk" first among beverage choices for nonparticipant households, but the original USDA study (.pdf) showed no significant difference in the ranking of food choices for participants and nonparticipants.

The NYT reporter, Anahad O'Connor, said "cities, states, and medical groups" have urged changes to SNAP, such as restricting soda purchases. Meanwhile, O'Connor said, industry organizations have spent millions opposing the changes, so USDA has refused to approve the proposals.

One would think from the NYT article that all the good folks favor the restrictions, and all the bad folks oppose. O'Connor didn't say that the list of supporters for such proposals also includes conservative critics of SNAP, who sometimes include such proposals in an agenda that also has budget cuts, nor that the list of opponents includes anti-hunger organizations, who are concerned that the proposals would increase program stigma and food insecurity by discouraging participation among eligible people.

In truth, people who care about poverty, hunger, and health are painfully divided about SNAP restrictions.

A more promising discussion

Second, let's consider a different approach to this policy discussion.

I have a wish that leading anti-hunger organizations would more sympathetically consider supporting a pilot project that includes SNAP restrictions.

Here is a draft set of principles, which, if met, might make such a proposal deserving of support by anti-hunger organizations, legislators who care about food security, and the USDA.
  1. the policy to be piloted places a high value on both nutrition and food security, combining a policy of interest for public health nutrition goals (the SSB restriction) with policies of interest for food security goals (such as enhanced benefits for some participants who currently receive too little);
  2. the pilot is a true pilot (pilot scale, with genuine empirical curiosity about the outcome, and no assumptions in advance that the outcome will be favorable);
  3. the outcomes for the study include reduced SSB consumption (intended outcome) and questions about perceived stigma and SNAP participation (possible unintended outcomes);
  4. the pilot policy does not have other food choice restrictions beyond the SSB restriction (no hints at more broadly paternalistic plans to convert SNAP into WIC); and
  5. the research protocol has a trigger, enforced by the Institutional Review Board (IRB), ending the pilot in the event of any evidence that the pilot proposal threatens household food security.
I wish such a pilot SSB restriction were not caught up in our poisoned partisan struggle over the safety net more broadly. This is merely a small reasonable revision of the definition of SNAP eligible foods to exclude soda. It is not about "banning" soda, just about altering what can be purchased with SNAP benefits. If the proposed policy turns out to threaten food security, almost everybody in the public health nutrition community would drop their interest in it. And, if the proposal turns out to be successful, and perhaps even popular with SNAP participants themselves -- who may appreciate the health halo associated with the revised program -- then it may merit support within the anti-hunger advocacy community.

Update (Jan 19): A clear and empathetic essay from Marlene Schwartz at the Rudd Center published yesterday in the American Journal of Preventive Medicine.


Anonymous said...

Your desire to limit SNAP restrictions to SSB is inappropriate.

If we are to mold SNAP into a meaningful program focused exclusively upon nutrition and food security, we must consider value and thrift as part of the program's purpose. In that vein, good to restrict SSB but also must restrict traditionally overpriced veblen goods, like organic. Likewise overpriced fad foods; 'grassfed', 'GMO-free', 'all natural', 'free range', those sorts of vacuous sales tactics that typically sport excessive pricing without commensurate nutritive value absolutely should be restricted from the SNAP food basket.

Best would be for SNAP purchases to be restricted to basic food necessities, and have individual product labels meet nutrition and value criteria in order to obtain a "SNAP-eligible" status. This would be no problem in today's world of electronic SKU scanners. That would assure the best and most cost-efficient use of SNAP dollars, really stretching the family's food budget as originally intended by the USDA and compassionate supporters. Program funding would be diverted toward a simple certification system for food marketers to access, and away from frivolous food purchases by SNAP recipients. May even be possible in this way to reduce the overall SNAP budget, something that absolutely needs to happen.

Anonymous said...

While I don't disagree that limiting SNAP to food necessities could be a useful strategy, I think that the attention SSBs are getting has more to do with health than economics (related as they are). Your idea to cut out luxury items like organic foods is economical, but prevents access to (slightly) healthier options. I know the effect size is probably small, but that is hard to put a price on.

I don't think that anyone will argue that excluding SSBs from SNAP is going to improve the physical health of its recipients though, and therefore represents a good place to start in terms of making the program more efficient.

Bethany said...

I agree with the set of principles and pilot study that you have proposed. As a nutrition scholar and strong advocate for food security, I believe that SNAP is a wonderful program that benefits thousands of families who are financial insecure. Although the CDC confirms that there is not an extreme percentage difference between sugar sweetened beverage intake amongst income brackets, research tells us that as income and education increase so does nutrition knowledge and healthful eating. In an effort to guide lower income families to make healthier choices I would also like to see more restrictions to SNAP, specifically sugar sweetened beverages. I recognize the infringement of autonomy on the population who is eligible for this program. However, one must remember why SNAP, previously known as the Food Stamp Program, was initiated. According to the USDA website, the program was started to strengthen the agricultural economy as well as improve the nutrition status among low income households. It is a program that helps prevent hunger and maximize food dollars. Allowing participants to purchase food items that are low in nutrients and essentially “empty calories” is not in concurrence with the intentions of the program. In addition, there is an overwhelming amount of evidence in the literature that shows a correlation between these calorically dense/low in nutrient foods and chronic diseases. One example being the positive correlation between sugar sweetened beverages and obesity. Millions of tax dollars allocated to this program should be spent on nutrient dense foods that fuel the body and promote well-being. Restriction of unfavorable foods could possibly lead to more of a whole foods diet which in return could lead to healthier population. A healthier population would potentially decrease medical costs. I know I am using a simplistic language to explain complex policies but my point is that we need to construct food programs around evidence based nutrition research while also maintaining integrity and respect to the consumer. Implementation of restrictions could be another opportunity for the government to show they can be a leader and true promoter of public health by setting different standards for what can be purchased by SNAP and by providing education to why certain foods are not allowed.

Mariah Sterling said...

As a nutrition scholar, I agree that there are many aspects to be taken into consideration when it comes to those who are receiving SNAP benefits, but trying to implement SSB restrictions are just the "tip of the iceberg" with this issue. This program today is being abused far too much and not being used the way it was intended for. Too many people on this program buy very nutritionally poor food products, such as SSBs and junk food, but this component struggles with the issue of also wanting to provide food security to all people. People think that buying nutritious foods are going to be more expensive but what they don't realize is it equates to the same amount, if not cheaper. Not only would it be a cheaper grocery bill, but cheaper medical expenses as well because it would be improving your health. Setting certain food restrictions, such as the SSB, would not take away from a SNAP participants autonomy when they go grocery shopping; it would just change to them having to buy SSB (or other restricted food products) with their own money as opposed to their SNAP funded money. Implementing such a policy would help improve people's health and reduce the incidence of certain health problems like obesity and type 2 diabetes.

Rebecca Martin said...

I agree that changes need to be made to SNAP. I am aware that the main priority of SNAP is allowing people to have access to food. However, when SNAP users are spending all their SNAP dollars on sugar sweetened beverages and junk food, this will not result in improving the health of the population. Furthermore, with high rates of obesity among low income populations, comorbidities and diseases are likely to remain high as well. This will end up increasing tax payer dollars in health care costs. Although the issue of starvation exists among low income US populations, the issue of food insecurity and obesity among low income populations is also issue that needs to be addressed. I think it would be a good idea to restrict SNAP dollars to nutritious foods and beverages. Initially it may be a costly, time-consuming process but in the long run it would be worth it.