The Health Equity Blog’s mission is to contribute to the discussion of health policy using evidence and research, to explore the opportunities for health equity through policy change, to raise awareness about health disparities, and to increase public advocacy for health equality.

According to the CDC, “Health equity is achieved when every person has the opportunity to ‘attain his or her full health potential’ and no one is ‘disadvantaged from achieving this potential because of social position or other socially determined circumstances.’”

Achievement of full health potential is necessary in all aspects of life – from running errands to relationships with loved ones. Some people are born into environments that limit their ability to achieve their full health potential. We believe that because society created many health inequalities, society can also fix them.

Monday, September 9, 2013

Should SSBs be banned from SNAP?

The Supplemental Nutrition Assistance Program (SNAP, formerly known as Food Stamps) is a federal program available to low-income individuals and families. The amount of SNAP benefits is based on income. 

Basics of SNAP

The Food and Nutrition Act of 2008 defines eligible food as any food or food product for home consumption. The Act does not allow: alcoholic beverages, tobacco products, hot food, any food sold for on-premises consumption and nonfood items. Some items that are considered ‘food items’ and can be bought with SNAP are: soft drinks, candy, cookies, ice cream, and bakery cakes. A full list can be found here: here.

Using SNAP to purchase sugar-sweetened beverages

Sugar-sweetened beverages (SSBs) are drinks sweetened with sugar, high-fructose corn syrup, or other caloric sweeteners. SSBs do not add nutritional value to a person’s diet. A diet high in added sugar increases your risk of cardiovascular disease, non‐alcoholic fatty liver disease, overweight and obesity, type 2 diabetes and a decline in the intake of essential nutrients. As stated above, The Food and Nutrition Act considerers SSBs a food item and therefore SNAP can be used to purchase these items.

Many groups advocate for banning SSB purchases using SNAP. New York City submitted a proposal to the U.S. Department of Agriculture to prohibit SSBs purchases using SNAP in Oct 2010. The USDA shot down the proposal. Other municipalities have drafted legislation with similar proposals but have been unsuccessful. In June 2013, the mayors of several major US cities sent a letter to congressional leaders against allowing SNAP to be used to buy SSBs.  The same week, the American Medical Association also said SSBs should be removed from eligible SNAP purchases and such a ban would lower weight-related health problems. In August 2013, 54 national and local health groups called on the USDA to allow pilot programs to explore banning soda and other unhealthy foods from SNAP purchases.

Since the current definition of ‘food’ eligible for SNAP benefits is a specific part of the Food and Nutrition Act, any change to this definition would require action by a member of Congress. So far Congress has not taken up the issue.

What would happen if SSBs were banned from SNAP?

Possible outcome #1: Health improvement among SNAP recipients.
In general, nutrition, early childhood development, and oral health advocate groups support a ban citing improved nutrition and overall diet. A ban might improve nutrition in a couple different ways. The SNAP recipient might consume fewer sugar-sweetened beverages - as a general rule, fewer empty calories consumed is better for an individual. Similarly, the SNAP money that would have been spent on SSBs, could go to purchase healthier items. According the Yale researchers, SSB purchases  account for 58 percent of beverages purchased by households receiving SNAP benefits. The leap to health benefits is not totally illogical. Recently, the CDC released findings that in 18 states, there were at least slight drops in obesity for low-income preschoolers. One of the reasons for the drop may be the changes made to the WIC  program in 2009 that banned purchases of several unhealthful food items. Since WIC and SNAP serve similar populations, there is evidence that suggests banning certain foods improves nutrition. However, suggesting that SNAP recipients would use the money that would have been spent on SSBs on healthful items is a big assumption.

Possible outcome #2: Decline in SNAP participation.
Anti-hunger advocacy groups, in general, are opposed to the ban. These groups believe that if there are additional restrictions on what SNAP recipients can purchase, it will add to the stigma already felt by low-income individuals. If an individual receiving SNAP wishes to buy a soda and a banana, the items need to be purchased separately - SNAP for the banana and one for the soda a second payment source. It therefore deepens the feeling of appearing different which might lead some individuals to not seek assistance from SNAP. In addition, the new ban could be confusing and hard to understand. Note that there are already items that SNAP does not cover such as diapers, dish soap, and prepared foods - all items that a family might buy at a grocery store. In this case, the SNAP recipient is already making two purchases and is familiar with the multiple transaction process.

Possible outcome #3: Increase administrative burden
There is an administrative cost associated with designating which items are banned. There are hundreds of SSBs and the government would have to decide what items are allowed and disallowed. The government making subjective decisions on what is right and wrong feels paternalistic. Especially because the banned items are only ‘bad’ for a certain group of people, those on SNAP, a population that is commonly disenfranchised in a variety of situations.  In addition, the new rules would have to be communicated to SNAP venders.

SNAP is authorized as part of the Farm Bill. The state of the Farm Bill is uncertain, highly political, and hotly debated. Separately the Farm Bill and SNAP are controversial, especially given the budget cuts at the federal level. I am not sure how I feel about SSB purchases using SNAP. Honestly, I do not feel like SSBs are the best items to purchase in general for anyone. As indicated in the graphs below, all Americans consume way too much sugar.

Source: www.yaleruddcenter.org/resources/upload/docs/what/policy/SSBtaxes/SSB_AddedSugars.pdf

However, telling a group of people they cannot purchases SSBs makes me uneasy, especially when sugar consumption is too high for Americans in general, not just Americans with SNAP benefits.

What I am 100% sure of is that I support funding SNAP. The program helps many individuals and families that truly need assistance getting food on the table. For up to date Farm Bill information regarding SNAP, the Food Research and Action Center is an excellent resource with background information, the current status of the bill and ways to contact Congress members.

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