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Making SNAP More Healthful
Punam Ohri-Vachaspati, PhD, RDArizona State University
Karen Sell, RDArizona Department of Health Services
Collaborators: Christopher Wharton, PhD; Will Humble, MPH; Robin DeWeese, MS; Wesley Tucker, MS
Outline
o Why should we care? o SNAP’s impact on health status o SNAP’s impact on diet quality o How prevalent are unhealthy purchases
among SNAP shoppers o Who can make changes to SNAP o Suggested Strategies for Improving
SNAP
Why Should We Care?
o SNAP targets household in most need
o In 2011, SNAP included Over 44 million participants Over $71 billion in benefits
Increased from $50 billion in 2009
o Greater scrutiny of federal assistance programs Effectiveness Impact on health
o Opportunity to impact diets of 1 in 7 Americans
www.fns.usda.gov.
SNAP Users Have Less Healthy Diets
o Children from SNAP households eat more calorie-rich foods
o SNAP participants consumemore solid fats, added sugarsfewer fruits and vegetables and whole
grainmore soda (and sugar sweetened
beverages)Cole and Fox, USDA 2008; Leung and Viallamor, Public Health Nutr 2011
SNAP Users Purchase Less Healthy Foods
o SNAP households buymore than twice as much SSB compared to
WIC only households70% of SSB purchased with SNAP benefits
o Estimated SSB purchase by SNAP users - over $2 billion / year
Andreyeva et al., Am J Prev Med 2012;
Higher Risk of Obesity Among SNAP Users
Higher rates of overweight and obesity among
Women participating in SNAP (especially among those who are food insecure)
Young girls from SNAP households
Male SNAP participants
Ver Ploeg and Ralston, USDA 2008; Leung and Viallamor, Public Health Nutr 2011;
Who Can Make Changes to SNAP
o Two mechanisms at State levelchanging policies that do not have an impact on
federal requirements for the functioning of the program – EBT cards at farmers’ markets
applying for a waiver (from the FNS) related to federal SNAP rules if the proposed change would result in more efficient administration of the program
To date, no waivers have been granted that affect policies related to participants’ food choices or food environment
Strategies for Making SNAP Healthier
1. Improving SNAP Participant’s Access to Healthy Foods
2. Incentivizing Purchase of Healthy Foods for SNAP Participants
3. Restricting Purchase of Unhealthy Foods With EBT Cards
4. Including Public Health Approaches to Expand SNAP-Ed Outreach
Improving SNAP Participant’s Access to Healthy Foods
Recommendations
State/ Federal Initiative
EvidenceaPolitical
Feasibilityb
Implementn Feasibilityc
Require SNAP vendors to carry healthier fare
Federal (State, indirectly)
Medium Weak Medium
Encourage healthier food retailers to locate in underserved communities
State Medium Strong Medium
Accept SNAP benefits at farmers’ markets State Strong Strong Strong
Innovative modes for redeeming SNAP benefits
Federal N/A Medium TBD
a Based on research studies and expert recommendations and commentary.b Based on state and federal political and administrative support and potential acceptability to advocates and stakeholders.c Based on level of complexity in implementation and cost of implementation.
Possible Objections Arguments
More stringent guidelines will make it harder to buy food using EBT in food deserts.
• Improved selection at stores in food deserts will improve the local food environment.
• Improved selection at stores will increase stores’ revenues.
Farmers’ markets in low-income areas are not sustainable.
• SNAP redemption at farmers’ markets has been increasing.
• Wireless/EBT terminals increase sales.• Encouraging farmers’ markets to locate in
low-income neighborhoods and providing culturally appropriate means of promotion and transport can improve participation rates.
Improving SNAP Participant’s Access to Healthy Foods
Incentivizing the Purchase of Healthy Foods for SNAP Participants
RecommendationsState/
Federal Initiative
EvidenceaPolitical
Feasibilityb
Implementn Feasibilityc
Provide POS incentives for buying healthy foods Federal/
StateUnder study Strong Under
study
Incentivize use of EBT at farmers’ markets State /
Local Medium Strong Strong
a Based on research studies and expert recommendations and commentary.b Based on state and federal political and administrative support and potential acceptability to advocates and stakeholders.c Based on level of complexity in implementation and cost of implementation.
Incentivizing the Purchase of Healthy Foods for SNAP Participants
Possible Objections Arguments
Increasing fruit/vegetable intake will not reduce both calorie intake and weight.
•Fruit/vegetable intake has benefits beyond weight loss, such as reduced cancer and other chronic disease risks.
•Education can accompany the promotion of fruit/vegetable intake to reduce consumption of unhealthy foods, reduce caloric intake, and result in weight loss.
More money in SNAP benefits for fruit/vegetable will free up money for unhealthy foods.
•Being studied through a USDA-funded pilot program.
•Less likely at farmers’ markets, where most SNAP-eligible foods are fruit/vegetables.
•Since staples will not have to be sacrificed, more purchases of fruits/vegetables at stores are possible.
Restricting Purchase of Unhealthy Foods With EBT Cards
RecommendationsState/ Federal Initiative
EvidenceaPolitical
Feasibilityb
Implementn Feasibilityc
Exclude energy-dense, nutrient-poor foods Federal Strong Weak Low
Exclude sweetened beverages Federal Strong Weak Medium
a Based on research studies and expert recommendations and commentary.b Based on state and federal political and administrative support and potential acceptability to advocates and stakeholders.c Based on level of complexity in implementation and cost of implementation.
Possible Objections Arguments
SNAP participants will experience loss of freedom of choice.
Restrictions are not absolute; SNAP participants can continue to purchase sweetened beverages using non-SNAP funds.
Modest restrictions are justified, given the overall program goal of improving participants’ diet.
Precedents exist with the exclusion of certain foods within SNAP (hot foods, prepared foods) and other federal nutrition programs such as WIC and NSLP.
Will result in embarrassment and stigmatization and reduce SNAP participation.
SNAP restricts other purchases.Pilots needed to assess additional stigmatization.Assess alternate mechanisms for identifying qualifying items
Stigma is not the top reason for why eligible participants do not participate in SNAP.
Restricting Purchase of Unhealthy Foods With EBT Cards
Possible Objections Arguments
Increased program complexities and cost.
WIC restricts purchases to specific items Pilots needed to study implementation challenges
Experiment with alternate ways to identify qualifying foods
No standards to judge food healthfulness.
Other federal nutrition programs such as NSLP restrict foods based on the USDA’s definition of foods of minimum nutritional value.
WIC packages include only healthy foods.
SNAP participants will use other resources to purchase SSB.
Food purchased with SNAP benefits is tax-free. Sweetened beverages will cost more if purchased with other resources.
Sweetened-beverage consumption is price-sensitive; with higher costs, consumption is likely to go down.
Restricting Purchase of Unhealthy Foods With EBT Cards
Including Public Health Approaches to Expand SNAP-Ed Outreach
RecommendationsState/
Federal Initiative
EvidenceaPolitical
Feasibilityb
Implementn Feasibilityc
Combine nutrition education with public health approaches Federal Strong Medium Medium
Create guidelines that allow promotion of healthy foods and dissuasion of energy-dense, nutrient-poor foods
Federal Strong Low High
Use multimedia approaches to deliver messages
Federal/ State Strong Strong High
a Based on research studies and expert recommendations and commentary.b Based on state and federal political and administrative support and potential acceptability to advocates and stakeholders.c Based on level of complexity in implementation and cost of implementation.
Including Public Health Approaches to Expand SNAP-Ed Outreach
Possible Objections Arguments
Adding incorporation of public health approach will require retraining program deliverers.
SNAP-Ed has an organized infrastructure to retrain and retool staff.
Many communities are already making the transition from education- and service-based initiatives to adding policy, systems, and environmental approaches.
Discouraging consumption of unhealthy choices may be considered paternalistic.
Restrictions are not absolute; SNAP participants can continue to purchase sweetened beverages using non-SNAP funds.
Modest restrictions are justified, given the overall program goal of improving participants’ diet.
Precedents exist with the exclusion of certain foods within SNAP (hot foods, prepared foods) and other federal nutrition programs such as WIC and NSLP.
White Paper
http://www.snaptohealth.org/wp-content/uploads/2012/02/SNAP_White_Paper_FINAL.pdf
