A Proposal for Improved Healthfulness in the Supplemental Nutrition Assistance Program
Many Americans are in less than optimal health. Approximately two-thirds are overweight, half of whom are obese. Diabetes prevalence continues to climb with 25.8 million Americans suffering from the disease and an estimated 79 million more with prediabetes (CDC Diabetes 2011).
Economically disadvantaged people are at an even higher risk. The Centers for Disease Control and Prevention (CDC) reported that low-income populations in the United States are at increased risk for illness, while having reduced access to health care (CDC pp 13). Specifically, economically disadvantaged individuals have twice the prevalence of diabetes and a 19 percent higher prevalence of hypertension, compared with the highest-income population.
What are Healthful Foods?
The U.S. government issues nutritional guidelines and educational materials to help people make healthier choices.
Federal nutrition guidance emphasizes plant foods. Three-quarters of the MyPlate diagram is dedicated to vegetables, fruits, and whole grains. In its remaining section, on protein sources, the MyPlate recommendations encourage Americans to think beyond meat and poultry and incorporate legumes to meet protein needs. Legumes are good sources of protein, iron, zinc, and calcium. Unlike meat products, they are rich in fiber, potassium, and folate and have no cholesterol and little saturated fat.
Diets focused on foods from plant sources are associated with lower rates of obesity, diabetes, cardiovascular disease, hypertension, and certain forms of cancer, among other health problems (Craig 2009, Tonstad 2009), all of which currently pose a large personal financial burden, through health care costs, to individuals, governments, and businesses (Barnard 1995).
Food Assistance Programs
In contrast with federal nutrition guidance, nutrition programs for economically disadvantaged people put no emphasis on healthful foods. Rather, they put fatty meats and cheeses, sugary sodas, and candy on the same basis as healthier foods, and remove the natural price barriers that would otherwise limit consumption of these products. While this may serve the interests of the manufacturers of unhealthful foods, it raises consumers’ health risks.
The U.S. government began piloting programs to supplement the food purchasing power of low-income households in 1939. The Food Stamp Program was given legislative authority in 1964, and, in 1977, the program was incorporated into the Food and Agricultural Act (USDA SNAP History).
Today, the Food Stamp Program is called the Supplemental Nutrition Assistance Program (SNAP). SNAP is the largest nutrition assistance program in the United States, with approximately 40 million Americans participating each month. Administered by the U.S. Department of Agriculture (USDA), SNAP is designed to increase the food purchasing power of families and individuals with income below the poverty line.
To receive SNAP benefits, a household’s monthly income and assets must be below certain levels. For a family consisting of a single parent with two children to receive benefits, it must meet all of the following: a gross income of $1,984 or less per month, a net income of $1,526 or less per month, and less than $2,000 in assets, such as a checking or savings account. Based on net income, this family would receive between $68 and $526 per month, with the allotment increasing as net income decreases (USDA SNAP Eligibility). The federal government covers the full cost of SNAP benefits for food purchases, while the administrative costs are split about evenly between the federal and state governments. The estimated SNAP expenditures in fiscal year 2012 are more than $70 billion (USDA Budget Summary 2011).
SNAP benefits can be used for foods intended for human consumption, as well as food-producing seeds and plants for gardens. They cannot be used for alcoholic beverages, tobacco, vitamins, medicines, food for animals, lunch-counter items, or foods to be eaten in stores. In some jurisdictions, restaurants can accept SNAP benefits.
Aside from these limitations, retailers are free to accept SNAP funds for essentially any food product. Sodas, candy, doughnuts, and other snack pastries, fatty meats and cheeses, energy drinks, and luxury food items, such as caviar and foie gras, are all covered dollar-for-dollar with SNAP benefits. This is a lucrative deal for manufacturers of these products. However, the result is a distortion of the normal barriers to access to unhealthful foods.
A Healthier SNAP
A better approach allows retailers to accept SNAP payments for a simple set of healthful foods. Such a program would improve overall nutrition and contribute to better health of program participants.
These nourishing foods—whole grains, beans, vegetables, and fruits—are described below. They would come with simple food preparation tips to help people eat healthfully, even if they have very limited time for food preparation.
Consistent with SNAP’s role as a program designed to supplement participants’ food choices, SNAP clients would continue to be free to add whatever foods they may wish to purchase with personal funds. In other words, beneficiaries who wish to use their own funds for sodas or any other product are free to do so. But the foods covered by SNAP would be nourishing foods that contribute to overall good nutrition.
In this proposal, participating grocers must supply basic healthful foods, referred to as “Healthy Basics”:
- Grains: Oats, rice, pasta
- Vegetables: fresh, frozen, or low-sodium canned
- Beans: dried, low-sodium canned
- Fruits: fresh, frozen, or low-sodium canned
- Basic multiple vitamins
SNAP beneficiaries who limit their food purchases to these Healthy Basics and eat no other foods at all can easily achieve nutrition that is complete and superior to that of average Americans. However, most are likely to add products purchased with their own funds, and the resulting meal patterns would reflect these food choices.
Piloting Healthy Basics
In order to gauge the interest in a Healthy Basics program among SNAP recipients, we conducted two pilot studies. Foods similar to those described as Healthy Basics above were distributed to 32 individuals. Of these, 21 low-income individuals received a week’s worth of Healthy Basics foods delivered to their homes, and 11 received similar items in a USDA-designated food desert retail setting. Both groups were surveyed as to the acceptability and usefulness of the items.
On the basis of a structured questionnaire, shoppers in the retail setting were unanimously satisfied with their Healthy Basics groceries. None described any disappointment regarding the absence of candy, soda, or similar products. Individuals in their home settings found the Healthy Basics groceries satisfying in taste and, for the most part, easy to prepare.
Benefits for Health
By exclusively using foods from a Healthy Basics menu, a SNAP recipient could choose oatmeal with raisins for breakfast, an apple for a snack, sautéed mixed vegetables over brown rice for lunch, spaghetti with tomato sauce for dinner, and peaches with sliced bananas for dessert. Other wholesome meal ideas include lentils with brown rice and broccoli, or a chilled pasta salad with sliced carrots, tomatoes, and lima beans.
Individuals or families choosing solely from the Healthy Basics plan would enjoy excellent nutrition. Compared with an average American diet (Bowman 2011), the Healthy Basics plan has more than twice the fiber, iron, vitamin E, and folate; almost twice the potassium, calcium, and magnesium; almost 40 percent more vitamin D; and more than five times more beta-carotene. Using 2001-2002 NHANES data as a point of comparison, a Healthy Basics participant would consume 65 percent less fat and 85 percent less saturated fat, and the more than 400 milligrams of cholesterol consumed daily would be reduced to essentially zero.
If SNAP benefits excluded unhealthful, high-fat, or highly processed foods, but included healthful fruits, vegetables, legumes, and grains, then recipients could have a nutrient-dense diet that provided more than 1,800 calories a day.
Alternate Healthy Eating Index: A Dietary Measurement for Disease Prevention
The Harvard School of Public Health developed a scoring system to quantify the risk for developing chronic disease associated with various eating patterns. Called the Alternate Healthy Eating Index (AHEI), it was designed to be a better predictor of disease risk than the USDA’s Healthy Eating Index (McCullough 2002).
The AHEI puts a numerical value on several dietary patterns: daily servings for vegetables, fruits, nuts, and soy protein, the ratios of white to red meat products and polyunsaturated to saturated fats, the grams of grain fiber, percentage of trans fat, duration of multivitamin use, and alcohol consumption. A study including 105,886 participants showed that those with the highest AHEI scores had the lowest chronic disease risk, compared with those who had the lowest scores. The median score in this study was approximately 45 for men and 38 for women (McCullough 2002).
Based on this scoring system, an average American diet, as reported by the Center for Disease Control and Prevention’s National Health and Nutrition Examination Survey (NHANES), has an AHEI of approximately 45. In contrast, a typical food pattern drawn from the Healthy Basics plan for SNAP has an AHEI score of approximately 68.
These data suggest that prioritizing healthful foods in the SNAP program could help reduce the number of people who suffer from heart disease, type 2 diabetes, and other illnesses related to overweight and obesity.
In fiscal year 2010, an average of 40,301,878 people participated in SNAP each month. Participants receive up to $200 to use for SNAP each month, depending on their economic situation. The average monthly benefit used per person was $133.79, or 67 percent of the maximum benefit allowed.
Based on the USDA’s Thrifty Food Plan market basket (Carlson 2007), the cost of a varied meal plan with fresh and shelf-stable fruits, vegetables, legumes, and grains to yield a 1,800 calorie per day diet was calculated. The monthly cost, including a common multi-vitamin, was $121.02, which is almost $80 less than the $200 benefit provided by the most complete current program coverage.
Of the $121.02 per month cost of the Healthy Basics program, 67 percent is $81.09. The difference in cost savings between the current SNAP system and program based on Healthy Basics would have been $25.5 billion for FY 2010. Assuming no changes in participation rates, this would represent a projected savings of more than $255 billion dollars over a 10-year period. This projected savings far offsets any costs associated with implementing the plan.
Savings per Taxpayer
In 2010, there were 144,103,375 taxpayers (IRS). For this group, the total savings of $25.5 billion would be equivalent to an average savings of $176.90 per taxpayer per year.
Current challenges facing implementation of the Healthy Basics food plan include grocer and SNAP recipient compliance and comprehension. Similarly to the WIC program, the Healthy Basics uses a finite list of foods from which to choose. Grocers would need to be prepared with electronic barcode scanners to ensure proper foods were purchased and then reimbursed. With the expansion and increased oversight for the Electronic Benefits Transfers systems, current restrictions should be easier to enforce (no cigarettes or alcohol can be purchased using SNAP, for example) and allow for ease in regulating the Healthy Basics plan.
Many Americans are at risk of health conditions, and economically disadvantaged people are at particular risk of obesity, diabetes, and other health problems. The current SNAP provisions aggravate these problems by putting unhealthful foods on the same economic basis as more healthful choices. Compared with the current program, the Healthy Basics program would provide healthful foods, improved nutrition, and better health, at greatly reduced cost.
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