Reduce health expenditures by putting the N back in SNAP

With the nation’s attention still riveted on Obamacare, if we collectively remain focused on the health insurance component of health care, we could miss a crucial opportunity to improve the primary driver of our collective health: food.

Health care is important, yes, but it is not the only determinant of our well-being. The rest lies in what keeps us healthy, prevents chronic disease, and what the government subsidizes. As a physician, I find it inexcusable that the federal government’s principal nutrition program actually contributes to the largest health care crisis we have ever faced, not to mention the skyrocketing costs associated with treating our very sick nation.

Last month, an automatic, $5 billion cut to the Supplemental Nutrition Assistance Program (SNAP) took effect, substantially reducing benefits for poor Americans in every state. The debate over further program cuts rages on, but to save money and improve the health of low-income Americans we urgently need to implement more sweeping and fundamental changes in the farm bill.

We need these improvements to achieve the program’s original purpose as a strategy to improve nutrition, not just alleviate hunger. Somewhere along the way, we omitted the N in SNAP and lost sight of its intent. By distinguishing health from health care, junk from food, and band-aids from prevention, we can reduce costs and strengthen the program’s public health benefits.

Diet-related diseases are by far the leading cause of death in our country. The chronic illnesses that accompany the standard American diet — heart disease, diabetes, Alzheimer’s, even many cancers — are responsible for seven out of every ten deaths in the United States. The Centers for Disease Control estimates that almost half of American adults have at least one chronic illness, while more than a third of adults are obese.

These diseases are the largest strain on our health care system and, perhaps, on the federal budget. The direct costs alone are astronomical — well over a half trillion dollars every year — while the indirect costs through lost productivity and decreased quality of life are almost immeasurably massive. Medicaid, Medicare, and other taxpayer-funded programs pay for most of these expenses. The farm bill will affect nearly all of the range of factors that influence our health, and our health care expenditures will not be lowered with Obamacare alone.

These diet-related diseases follow a socioeconomic gradient, with the burden falling disproportionately on minorities and the poor — including SNAP participants. Poor Americans are more likely to suffer from chronic illness, and studies have even demonstrated a causal link between SNAP participation and obesity. One California survey, for example, found that obesity prevalence was 30 percent higher in SNAP participants compared with non-participants, even after controlling for other socioeconomic factors.

We urgently need systemic change, and the most effective way to save money while improving the health of low-income Americans is to reform SNAP. Congress should remove fatty meats and dairy, soda, candy and other junk foods from the program and trim the program down to a set of healthy, basic foods such as whole grains, beans, fruits and vegetables. The Physicians Committee for Responsible Medicine offers a healthy basics proposal that would result in cost savings from improved health far larger than the cuts themselves.

Although some have argued that these foods could be expensive or restrictive for SNAP participants, compared with the long-term health care costs that unhealthful diets incur, nutrient-dense staples such as brown rice, beans and vegetables cost very little. The program already excludes alcohol and cigarette purchases — why should nutrient-devoid, processed junk that sickens participants be any different?

Americans have ample reason to debate health care. We must, however, widen the scope of our discussion to include our actual health — and the farm bill and SNAP, which far too often function as a safety net for junk food manufacturers and the livestock industry while the poor slip through the cracks into an unbeatable cycle of chronic disease.

We have an opportunity to rectify this disservice to those who are among the most vulnerable. Let’s stop subsidizing sickness and instead use SNAP to help get our country back on track to physical and fiscal health.

Neal Barnard is president, Physicians Committee for Responsible Medicine.


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  • rbthe4th2

    PCRM advocates vegan only, and that I can’t agree with. Everything else, yes. The fact is, the latest info I saw come out says that it costs an extra $1.50 a day for good food. So you’re talking $600 a year. I’ve not seen the stats on that.
    I think the other part is that there is no emphasis on safe playgrounds, places to play. While some have them, what about getting the kids to and from there?
    I also don’t see emphasis on pick your own farms and other places, farmers markets. I use these a lot.

  • LeoHolmMD

    Correct. A completely typical irrational bureaucratic across the board budget cut to a program that was irresponsible to begin with. Why not reform it and save tons of money in long term care costs? PCRM is one of the few organizations that takes this issue up appropriately.

  • Halona Black

    I teach cooking classes to children and families that receive SNAP benefits. Many families are overdependent on processed foods that are more expensive than just buying the real food and making it yourself. The problem is that many families see this as a time sucking process — and it doesn’t have to be. I would love to be able to work with the SNAP program to create a cookbook or create a series of classes directly for this population. — Halona Black

  • Dorothygreen

    If I had the money and some clout I would start a Committee for Sustainable, Affordable Nutrition for Everyone – SANE. I would ask vegans and the Paleos and all those who have
    creative healthy diet approaches in between to join hands and fight for the creative destructive of the SAD (standard American Diet). The base of all healthy approaches is vegetables and low glycemic fruit, healthy fats and

    One SANE organization to lobby for healthy food composed of all the physicians, nutritionists, dietitians, journalists, bloggers etc. The SANE website/program would be a venue that is supported by all who care as Dr. Bernard that our diet is the leading cause of high health care costs, disabilities and deaths. It would be a lobby, unified voice to Congress with the simple goal of making vegetables and low glycemic fruit,
    healthy proteins and fat cost less, be more accessible and grown sustainably.

    It could be fashioned after the RISK model (The tobacco model) with an excise tax like the tobacco tax, education (like Holana’s program), no more subsidies for Big AG (we know the money does not go to the local farmers and Big Food. The tax would be on all ingredients in foods with a glycemic index greater than 50, vegetable oils with greater than 50% omega 6, corn fed animal meat and all added sodium. (this can be done, not as easily as the tobacco tax but doable). Trans fats will be outlawed.

    Our food system is the most significant part of our infrastructure. These reform efforts should be included in all conversations regarding improving our infrastructure.
    Nice that MIchelle Obama is working on “obesity” but this needs to be a grass roots effort. Those who receive SNAP as it exists now and find it a chore to cook and those who are seriously addicted to sugar, fat and salt (we all have this propensity) have to become part of the solution, just as tobacco smokers had to accept that they pay more upfront, because it is so well documented that it is a leading RISK factor for chronic preventable diseases. And, you know, it worked. That was the greatest factor in the tobacco model than led to folks quitting. So, no more free bread, cookies, chips, candy, soda. This is not charity, this is supporting Big Ag and Big food and enabling addition and obesity.

  • Jane M Kieffer Rath

    This is a great dream, but being on SNAP and asking the people I meet at the grocery store why they are buying the microwave pizzas and other processed premade foods and they tell me their landlord has never fixed the oven and only one burner works so they are feeding eight people from a microwave and one burner. I can feed my family of six healthy food on SNAP because I have a really well-equipped kitchen. Most people on SNAP who rent usually rent from slumlords who don’t make timely repairs, if they make repairs at all. It is such a huge complex problem.