It’s Expensive to be Poor in America: The High Cost of Obesity Calls for Sensible SNAP Reform

Obesity has been labeled a “silent killer,” a modern-day epidemic plaguing the nation. Diet-related disease is the leading cause of death in the United States – accounting for over 1000 deaths per day, it surpasses those related to tobacco, drugs, and alcohol. 8.2 percent of total Medicaid spending goes toward obesity-related illnesses, causing some states to spend over 20 percent of their Medicaid dollars on treating these conditions. Largely as a result of this sizeable spending, suggested reforms of the Supplemental Nutrition Assistance Program, (SNAP, commonly referred to as “food stamps”), often contain propositions aiming to limit the types of food one can purchase using these benefits. While such actions may seem valuable in combating the prevalence of obesity-related illness, they revoke a basic freedom of nutritional choice from many and attack a symptom of the issue rather than addressing the root cause. Instead, policies which incentivize, but do not mandate, dietary shifts should be the main focus of SNAP reform.

The revelation that low-income families disproportionately suffer from diseases associated with malnutrition is hardly groundbreaking information. A 2010 study from the Harvard School of Public Health found that obesity rates among SNAP participants were 30% higher than non-participants when adjusted for socio-demographic characteristics, food insecurity, and participation in other programs.

With taxpayers footing the roughly $70 billion bill for SNAP each year and obesity-related Medicaid spending climbing new heights, questions have been raised regarding participant’s ability to purchase unhealthy foods through the program. Perhaps the most notable critic is former New York City Mayor Michael Bloomberg, who publicly advocated for the removal of junk food and sugary drinks from SNAP. Although there may be merit in studying the ways in which SNAP fails to serve its participants most effectively, giving taxpayers and the government the power to determine what others can and cannot eat is an unethical and degrading proposition – these ideas only perpetuate the myth that food stamp users make poor shopping decisions. One’s income level should in no way limit their liberty to make decisions as personal as diet.

Moreover, this method of addressing SNAP’s shortcomings is merely an attack on a situation’s byproduct without an examination of its initial cause. Indeed, SNAP households spend about 10 percent of food dollars on sugary drinks. Yet, peer into a non-SNAP household’s shopping cart and you’ll find that it contains roughly the same amount of sweetened beverages: about 7 percent of total food purchases. Yes, food-stamp recipients are buying soda – that is, because Americans enjoy drinking soda. Furthermore, it is important to note that labeling elevated rates of obesity as a direct result of the SNAP program is largely misguided. SNAP participants are oftentimes stressed, poor, and have less access to fresh and healthy foods – qualities which make obesity more likely for reasons unrelated to their use of food stamps.

This last characteristic – lack of access – is incredibly important in understanding the root cause of obesity in lower-income areas. There is a disproportionate lack of grocery stores, farmers’ markets, and healthy food providers in disadvantaged neighborhoods. More than half of all ZIP codes with a median income below $25,000 can be classified as  “food deserts,” or areas vapid of healthful whole foods. This proportion is more than double the share of food deserts across all ZIP codes. To make matters worse, convenience stores which may seem like oases in these deserts tend to sell food at prices significantly higher than those elsewhere, perpetuating the existence of the poverty tax.  Not a literal tax, this term refers to the fact that low-income people tend to pay higher prices for goods and services provided in poverty-stricken areas. This issue is one largely centered around access  – while individuals who have the means to utilize reliable transportation can look for cheaper alternatives elsewhere, those without it bear the brunt of the higher local prices. If healthy choices are not accessible, eliminating the few options which remain available will only worsen participants’ struggles. What the suggested SNAP reforms often fail to recognize is that people frequently don’t have a choice in what they can or cannot buy.

In reality, there are many ways to effectively reform SNAP by incentivizing healthy decisions and simultaneously protecting the freedoms of its users. Firstly, government subsidies can promote certain actions without setting rigid restrictions. For example, earlier this month, researchers at the Friedman School of Nutrition Science and Policy at Tufts University and the Harvard T.H. Chan School of Public Health published a paper outlining effective approaches for modifying SNAP. One method explored was to incentivize the purchase of healthy foods by offering a 30% subsidy on products such as fruits and vegetables, nuts, whole grains, and fish. As a result, participants maintain the option of buying less healthy foods – they simply receive 30% less for their dollars by choosing to do so. The Healthy Incentives Pilot tested this theory on a small scale and observed a 25 percent increase in fruit and vegetable consumption. It was estimated that over the course of a few decades, this idea would save billions of dollars in health care spending and help prevent hundreds of thousands of cardiovascular issues.

Another approach, piloted in California, attempts to mitigate the issue of food access. Through the California Nutrition Incentives Act, grants are awarded to certified farmers’ markets that double the amount of nutrition benefits available to low-income consumers when purchasing fresh California produce. The program also allows up to one-third of the grant funds to be awarded to small businesses that provide such matching nutrition incentives, in order to reach low-income Californians residing in food deserts with limited access to farmers’ markets. Grants are prioritized in disadvantaged communities with a high prevalence of diabetes and obesity to ensure a focus on expanding access to fresh, healthy food.

Earlier this year, Trump threatened to veto any version of the Farm Bill, which typically allocates over 80 percent of its funding toward SNAP, that did not include stricter working requirements for SNAP eligibility. Consequently, the debates over this year’s bill were centered around work requirements, largely overlooking the need for a focus on nutrition. Nevertheless, the Farm Bill’s reauthorization recurs every five years; in the meantime, Congress should support pilots that research the effectiveness of various proposals in order to further understand which initiatives have the opportunity to be most effective. As a result, methods which best enhance the effectivity of SNAP and lower healthcare spending can be more solidly advocated for during the next cycle. Call for such action has been heavily supported by former Cabinet Secretaries of Agriculture Dan Glickman, Ann Veneman, and Tom Vilsack: “Once we have a more robust understanding of which interventions are most successful at encouraging Americans to make the healthiest choices, we can ensure that both SNAP and non-SNAP recipients have diets that lead to health and longevity”. Rather than stripping struggling citizens of the right to make their own dietary decisions, working to reform SNAP can benefit both participants and taxpayers alike. By incentivizing healthy decisions through government subsidies and working to combat food deserts, we can begin to target the foundation of the issue in order to bring meaningful and necessary change to the lives of over 40 million individuals which rely on the nation’s largest food and nutrition program.

Photo: 840927089_7efce33ef7_o, brunurb