December Journal Club Review: Incentivizing a Healthy Diet for Recipients of Nutrition Assistance

December Journal Club Review: Incentivizing a Healthy Diet for Recipients of Nutrition Assistance

December’s journal club was led by Ben Rush (Graduate Student in Nutrition). Journal club review was written by Grant Hisao (Postdoc in Biochemistry).  

It is no secret that a healthy diet is a critical factor in a healthy lifestyle – good nutrition can reduce risks of heart disease, obesity, and diabetes. Unfortunately, healthy eating is unattainable for many individuals in poverty. One factor that has often been attributed to unhealthy diets in poor communities is the cost associated with healthier foods. While there is a debate on whether healthy foods actually cost more than unhealthy foods, consumers in general believe this to be true. In turn, this wrong assumption about the high cost of healthy food may cause individuals to purchase more high calorie, low nutrition foods that seem cheaper as opposed to fresh fruits and vegetables.

In our final Journal Club for the year 2019, we discussed incentive mechanisms that can promote healthier eating within poorer communities, specifically incentives associated with nutrition assistance programs.

Programs to Address Cost Barriers

Nutrition assistance programs are the primary mechanism used by the United States Federal Government to aid the hungry poor. Two of the largest federal programs are the Supplemental Nutrition Assistance Program (SNAP, colloquially known as  “Food Stamps”) and Women, Infants, and Children (WIC), which were discussed previously at two different Journal Clubs (Farm Bill; Food Insecurity). Both programs institute some restrictions on what products may be purchased with these benefits and encourage nutrition education, but neither program has a financial incentive specifically designed to encourage participants to buy healthier foods.

To address this issue, the U.S. Department of Agriculture (USDA) recently provided grant money to support initiatives that incentivize SNAP recipients to buy more produce. An example of such program is the Más Fresco (More Fresh) program, which is a pilot program administered by the University of California, San Diego (UCSD). The program started in February 2017 and is open to residents in the Southern California area (LA, Orange, San Diego). In this program, participants receive a match (up to $10, $20, or $40) for every SNAP dollar spent on produce at the program’s retail partner (Northgate Market), which could then be used by the participant to purchase more produce. Participants in this program enroll for a year and researchers are investigating the impacts of eating habits of participants.

Locally, a similar program called Double Dollars is available in the Madison area for purchases of produce at participating local farmers markets as well as the Willy Street Co-op. Participants are able to receive upwards of a $25 match per market day to spend on breads and cereals, fruits and vegetables, meats, fish, poultry, dairy products, and plants and seeds that grow food. The program is administered by the Community Action Coalition and is currently sponsored by private donations.

Incentives and Disincentives

UCSD researchers studying the impact of Más Fresco noted in their first progress report that over 80% of participants were purchasing more produce as a result of the program (and presumably eating more fruits and vegetables). To investigate the longer term impacts, researchers will conduct follow-up surveys with participants after their benefits expire. This will help determine whether program participants continue to practice healthy eating/purchasing even after losing financial incentives to do so.

While the longer term effects of such programs are still being researched, discussions continue on how to disincentivize unhealthy eating. One area of contention is the ability of SNAP recipients to use their benefits to purchase sugary drinks and unhealthy snacks. A 2014 study found that prohibiting the purchase of sweetened beverages using SNAP benefits would reduce rates of obesity and type-2 diabetes more significantly than any produce subsidy program (e.g. Más Fresco). In 2016, the USDA published a report summarizing the list of foods that are typically purchased using SNAP benefits. The report analyzed data collected in 2011 and found that sweetened beverages accounted for a substantial portion of purchases.

Despite criticism by entities such as local municipalities and health groups, the USDA has refused to make any changes to SNAP benefits, stating that more restrictions on food purchases would be unfair to SNAP recipients who already struggle with food insecurity and poverty shaming. However, it is also worth mentioning that food and beverage manufacturers have spent large amounts of money lobbying to prevent changes to these SNAP rules.

The ongoing discussion about SNAP benefits highlights the complexities of nutrition assistance programs and poverty in general. Though there isn’t a simple solution to the issues, it is important to remember that nutrition assistance provides vital support to our most vulnerable people, including many children, people with disabilities, and the elderly.