1. Chapman, Nancy MPH, RD


Federal domestic nutrition programs are critical to food security, children's growth and development, and improved diet quality, yet federal spending on nutrition assistance faces potential severe reductions and has declined over the past 4 years. The engagement of nutrition professionals in nutrition policy is critical for evidence-based policy development. But that will require an understanding of the benefits of nutrition assistance to chronic disease prevention and economic development, as well as the process for development of Farm Bill nutrition policy. This article provides the basics that nutrition advocates will need.


Article Content

Among many issues, the 2018 Farm Bill will address food insecurity through the Supplemental Nutrition Assistance Program (SNAP) and other nutrition program funding. Title IV of the Farm Bill is the primary repository for food assistance and nutrition-related provisions and programs. The costs of these programs are calculated by the Congressional Budget Office and make up 80% of the 10-year projected total costs of the last Farm Bill of 2014. Nutrition professionals can help legislators understand how SNAP boosts recipients' ability to work and prevent chronic diseases and why low-income recipients' need for food security does not change because of the state they live in.


The past gains in food security and related health status of low-income Americans are being threatened by many current proclamations by politicians that welfare programs need to be trimmed in order to return to fiscal responsibility and to reduce the national debt.1 Decisions about the amount of funding available to food and nutrition assistance programs and the ultimate configuration of these programs will be shaped through budget bills, appropriation bills, and, most importantly, the Farm Bill. For the US Department of Agriculture (USDA) domestic food and nutrition programs that are designed to respond to economic conditions, spending has declined nearly 7% from the historical high of $109.2 billion set in fiscal year (FY) 2013 during the economic crisis to $101.9 billion in FY 2016. Federal domestic nutrition programs are critical to food security, growth and development, improved diet quality, and children's academic performance.2


Nutrition professional engagement in nutrition policy discussions requires an understanding of both the effects of food assistance programs on poverty, food security, and health and the elements of federal legislation that impact food security and nutrition. The program descriptions and evidence provided below will help to build this foundation for participation and advocacy.


"Nutrition matters. Farmers feed. There is no question that nutrition will be part of the Farm Bill,"3 noted Rep Glen Thompson, vice chairman, Agriculture Committee (PA-05).


Agriculture Production and Food Security

Since the first official Farm Bill in 1933,4 subsequent Farm Bills5 have set directions for food and agriculture policies to address economic, social, environmental, and, more recently, nutrition-related health concerns on a 2- to 6-year cycle. The first Farm Bill directed the federal government to purchase and remove surplus wheat and other farm products to stabilize market prices while using the surplus commodities to feed hungry children, elderly, and the poor. Later, food surpluses were distributed to those who received food stamps, which could be redeemed in supermarkets.6 These past gains in food security and related health status of low-income Americans may be threatened by recent demands to reduce the national debt by making savings in the 2018 Farm Bill.


Farm bills continue to address specific concerns about crop and livestock prices, new and established assistance for the incomes of farmers, the economy in rural areas, food insecurity, protection of natural resources, and research. Input from a broad constituency of stakeholders is obtained through hearings, and meetings inform the House and Senate Agriculture Committees whose members then compose different bills that must pass through their respective committees and chambers. The different versions that emerge from the House and the Senate include various provisions that must be reconciled in a conference committee. These provisions now run the gamut from food safety and foreign aid, conservation and bioenergy, research, nutrition programs, and crop insurance, to food systems and organic farming.


In North Dakota, Rep Gretchen Dobervich (Dist. 11) characterized the dilemma faced by members of the Agriculture Committee members as follows: "Feeding the nation requires many people working in direct agriculture production, distribution, research, rural development, conservation, and bringing crops to market. The federal Farm Bill keeps all the pieces working together to bring food from our farms to kitchen tables across America. In short, SNAP supports our economy and keeps our families healthy and strong."7


Figure 1 shows the cost estimates for the last (2014) Farm Bill and demonstrates the dominance of the food assistance and nutrition-related provisions in Title IV in the Farm Bill. Based on 10-year projections,8 the Congressional Budget Office projects that 80% of the Farm Bill funds nutrition programs, and those expenses are dominated by the SNAP at $70.9 billion.9 Of the remaining costs, approximately 8% goes to crop insurance, 6% to conservation programs, 5% to commodity programs, and the remaining 1% to trade, credit, rural development, research and extension, forestry, energy, horticulture, and so on.

Figure 1 - Click to enlarge in new windowFIGURE 1. Congressional budget office estimates of costs for the 2014 Farm Bill.

As budget resources decline, the Farm Bill debate may pit rural against urban needs, large cooperatives and agribusinesses against small, local farmers, direct income payments against conservation or insurance payments, SNAP eligibility for only the neediest recipients against those temporarily impoverished, SNAP benefits for any food against incentives for healthier foods, and research on nutrition against pest control or alternative energy sources. Nutrition professionals play an important role in helping legislators prioritize SNAP and understand how SNAP plays a positive role in recipients' lives, beyond the food they receive. Conflicts can arise during Farm Bill negotiations as priorities are debated. Throughout the rest of this article, the benefits of SNAP to health and poverty will be discussed along with ways that nutrition professionals can become a part of the policy process.


Emergence of Food and Nutrition Programs to Serve Individuals at Nutritional Risk

The earliest federal food stamp program began in 1939 during the Depression and ended in 1943. The Food Stamp Act of 196410,11 made this model a permanent part of federal food programs. On signing this Act, President Johnson noted that, "As a permanent program, the food stamp plan will be one of our most valuable weapons for the war on poverty."12


In 1967, Sen Robert Kennedy (D, Massachusetts) traveled to the South in response to a report by civil rights attorney Marian Wright, founder of the Children's Defense Fund, which detailed levels of childhood hunger unconscionable in the richest nation on earth. As a result of this trip, CBS television produced the seminal news report, "Hunger in America," which documented severe malnutrition. In response, President Richard Nixon sent a message to Congress in 1969 asking for a dramatically expanded and improved national food stamp program, and Congress enhanced the food stamp program in the Agriculture Act of 1970.13 Sen Bob Dole saved the program from proposed cuts in the 1980s, and President George W. Bush restored its funding after the 1996 welfare law deeply cut benefits. The 2008 Farm Bill renamed the food stamp program the SNAP, to more closely reflect the program's function (Figure 2).

Figure 2 - Click to enlarge in new windowFIGURE 2. Kay events and achievements of the supplemental nutrition assistance program.

In addition to SNAP, the Farm Bill sets the content and funding formula for the SNAP nutrition education program and also provides the authority for incentives for healthy food purchases with SNAP benefits through the Food Insecurity Nutrition Incentive Grant Program. Several other provisions included in recent Farm Bills stipulate the following:


* continuation of the historic commodity distribution programs;


* collection of information on dietary intake, food assistance participation, and food security through "What We Eat in America";


* authorization for school gardens, the farmer's market program, urban agriculture, and food hubs; and


* support for the Fruit and Vegetable Promotion Program.



The SNAP program has historically enjoyed strong bipartisan support, although there have been attempts to alter and reduce the benefits provided by the program. One of the most commonly suggested alterations is restricting some foods that can be purchased using SNAP benefits. Many legislators are concerned that SNAP benefits are being spent on foods that they deem unhealthy. Currently, individuals on SNAP have very similar purchasing behaviors as those not on SNAP. The USDA's Economic Research Service (ERS) conducted a well-controlled study that found, for example, that SNAP participants are no more likely to consume sugar-sweetened beverages than lower-income nonparticipants.14 These federal researchers also found similar amounts of alcohol consumption between SNAP and nonparticipants, despite SNAP restrictions against purchases of alcoholic beverages. Some antihunger advocates have warned that the emphasis on restriction provisions undermines the positive outcomes of the SNAP incentives for fruit and vegetable purchases,15 the overall SNAP benefit of promoting food security, and the personal dignity associated with choosing one's own food.


Although eating a healthy diet is integral to a healthy life, restricting the allowable foods for SNAP recipients affects far more than the participants' food intake and dignity. Such restrictions would place a heavy burden not only on food retailers in enforcing them, but also on food processors, farmers, food producers, and state and local governments. Because of the codependence of agriculturalists, retailers, and SNAP recipients, policy shifts, however small they may seem, can create turmoil in negotiations among stakeholder groups.16 Because so many individuals and organizations are affected by federal changes in SNAP policy, it is important that stakeholders, including SNAP recipients, work together to promote policies that are workable for all.


Characteristics of Recipients of USDA Food and Nutrition Programs

Critical to the discussion about nutrition programs is the question, "Who receives SNAP benefits?" The narrative regarding SNAP recipients often refers to those out of work or in between jobs. But, in fact, SNAP predominantly serves children and the elderly. USDA data17 show that


* 44 million low-income children, mothers, disabled individuals, and temporarily unemployed or underemployed receive SNAP benefits in 2016;


* more than three-fourths of SNAP households contain a child, elderly person, or nonelderly disabled person;


* 82% of benefits go to children, elderly, or nonelderly disabled participants;


* hunger is prevalent among the aging population, but only 9% of elders accept SNAP benefits, whereas most use food banks and pantries18; and


* Only 1 in 4 SNAP recipients are working households, including military families.



Because so many SNAP recipients are currently working, for them, their participation reflects a survival response to the current employment challenges of low wages, part-time hours, absence of paid sick leave, and lack of overtime pay. Many of the individuals on SNAP also have low literacy, arrest records, substance abuse problems, or other impediments to employment. In 2016, 6 of the 20 most common occupations, such as retail, food service, and janitorial services, had median wages around poverty level for a family of 3, and future jobs are expected to fall into low-paying industries.19


One silent group of SNAP recipients is individuals in the armed services. Using the 2013 Census data, the Government Accountability Office found almost 23 000 active-duty service members rely on SNAP benefits, and 25% of children at the Department of Defense schools were eligible for free meals.20 The Government Accountability Office has recommended that the Department of Defense improve its data collection and analysis to identify the extent of enrollment of active duty service members in food assistance programs such as SNAP.


The Supplemental Nutrition Assistance Program not only feeds the hungry, but it also helps pull individuals and families out of poverty. Twelve percent of the working poor households are lifted out of poverty when SNAP benefits are added to their gross income. For the very poorest SNAP households, benefits lift 14% of them to approximately 50% of the poverty rate.21 The addition of SNAP benefits lowered the prevalence of child poverty by 15.5% and the severity of child poverty by 21.3%. When inflation rates and food prices increase, SNAP benefits also cushion against food insecurity and poor-quality diets.22 For example, if a person is living in a higher-cost county of California, participation in SNAP may improve intakes of vegetables, fruits, and whole grains.23


Besides both boosting nutrition and curbing hunger, policy makers should recognize that food stamps boost the economy and that they are well targeted at the most nutritionally vulnerable. "An increase of $1 billion in SNAP expenditures is estimated to increase economic activity (gross domestic product) by $1.79 billion. In other words, every $5 in new SNAP benefits generates as much as $9 of economic activity," according to the USDA ERS.24 Because recipients can spend their SNAP benefits immediately, the nutritional benefit to the individual and the economic benefit to the farmer and the food distribution channel are realized precipitously.


Poverty, Food Security, and Health

Nutrition professionals have always assumed that there is a strong connection between SNAP benefits and health, but research and data are only now starting to fully support these convictions. Initially, the connection was most clearly found in food-insecure children. As far back as 1994, the detrimental impacts of food insecurity on children's nutritional health, growth, social behavior, cognitive development, and school performance resulting in lost opportunities for undernourished children and in lost contributions to society have been reported.25 Unless irreparable physiological damage has already occurred, federal nutrition assistance programs can often help a young child recover from most developmental deficits through improvements in environment and in nutrition.26


In regard to working adults, a recent ERS study27 examined how various levels of food insecurity, at moderate as well as severe levels, may be associated with 10 chronic diseases that lead to substantial medical care costs. This analysis showed that, even more than poverty and unemployment, food insecurity was associated with increases in the prevalence of hypertension, coronary heart disease, hepatitis, stroke, cancer, asthma, diabetes, arthritis, chronic obstructive pulmonary disease, and kidney disease. Recently, analysis of the 1999 to 2014 National Health and Nutrition Examination Survey data showed little evidence of a change in cardiovascular disease risk and systolic blood pressure for adults 40 to 79 years old with incomes at or below the federal poverty level, whereas those with higher incomes had a steady decline for these variables across survey years.28 As SNAP lifts families out of poverty, those individuals may be able to then obtain medical help to reverse their previous cardiovascular risk.


Food insecurity is quantitated by measurements of routine access to food and then related to states of health. In Seligman and colleagues'29 recent study, very-low-food-secure participants, compared with both low-food-secure and food-secure participants, had poorer diabetes self-efficacy, greater diabetes distress, greater medication nonadherence, higher prevalence of severe hypoglycemic episodes, higher prevalence of depressive symptoms, and more medication affordability challenges. Seligman et al29 also noted that the average food-insecure household cycles through adequate and inadequate food supplies 7 times each year, which might explain how food insecurity is associated with both hyperglycemic and hypoglycemic episodes correlating with the end of the benefit cycle.


Food insecurity also deleteriously shapes health behavior and outcomes related to human immunodeficiency virus-infected persons. Food insecurity contributed to poor antiretroviral therapy adherence, in part perhaps because the lack of food often exacerbates the antiretroviral therapy adverse effects. Study participants reported depressive symptoms related to food insecurity, physical feelings of hunger and fatigue, aggravating preexisting struggles with depression, and a chronic self-perception of social failure.30


Consistent with these findings are data showing individuals in the top 5% of income distribution gained approximately 3 years of life expectancy from 2001 and 2014, in contrast to the life spans of Americans in the bottom 5% of the income distribution that did not increase over this period, and differences in life expectancy across income groups increased. Using the US income data from 1.4 billion deidentified tax records between 1999 and 2014 and mortality data from the Social Security Administration death records to estimate race- and ethnicity-adjusted life expectancy at 40 years of age by household income percentile, sex, and geographic area,31 life expectancy for low-income individuals was positively correlated with the local area fraction of immigrants, fraction of college graduates, and government expenditures.


The evidence is clear that federal nutrition programs, especially in the form of SNAP benefits, have a direct impact on prevention of chronic disease in young and older adults and provide developmental boosts to children. One might consider investments in SNAP and other federal nutrition programs' important investments such as those in health insurance. Sharing the evidence on these health benefits is essential to shaping public health and Farm Bill policies.


Current Situation

The past gains in food security and related health status of low-income Americans are being threatened by many current proclamations that welfare programs need to be trimmed to return to fiscal responsibility and to reduce the debt.32 Decisions about the amount of funding available to food and nutrition assistance programs and the ultimate configuration of these programs will be made through budget bills, appropriation bills, and, most importantly, the Farm Bill. The President proposed more than $193 billion reductions in SNAP over 10 years that can be seen in the Table. After lengthy negotiations with the Agriculture Committee chairman, the House Budget Committee passed an FY 2018 budget that significantly shrank the White House-projected reductions to agriculture and food security programs to $10 billion over 10 years with language that expects able-bodied adults receiving SNAP to work or prepare for work and provide flexibility to states to tailor the program to best meet the needs of their SNAP-eligible populations.33 The fate of the FY 2018 budget remains uncertain, as imminent action on budget has been postponed until December 2017. The House Agriculture Committee chair, Rep Conaway (R, Texas), has argued that the final decision about how to achieve cuts in agriculture programs will occur through the legislative process for the 2018 Farm Bill.

TABLE SNAP Cuts Reco... - Click to enlarge in new windowTABLE SNAP Cuts Recommended in the President's 2018 Budget

Putting Forward Solutions That Make a Difference in Food Security, Nutrition, and Health

There is a large body of evidence that argues that food assistance programs are associated with lower poverty, food insecurity, child development deficits, and adult chronic diseases. There should be no justification for reducing nutrition benefits for those vulnerable to unemployment and poverty. Many politicians simply do not know who receives the nutrition benefits, why the working poor need benefits, how nutrition benefits ensure children develop to their full potential, and how adults need to be educated to live more healthy and productive lives.


Here are some concrete steps nutrition professionals can take to support nutrition-related programs.


Nutrition professionals play a key role in creating a picture that fills in the vivid human details of being poor in America and the critical nourishment food assistance provides when the job suddenly ends, food prices spike, and the struggles of depression, addiction, and chronic diseases go untreated. Use your own story or one of those you serve to bring the details of your local situation to your member of Congress. In the current political environment, personal accounts and friendly discussions prevail over strident lecturing or arguing about past opportunities. You can take several steps that can lead to successful exchanges with elected officials.


1. Share stories and life experiences of the most vulnerable that have led to jobs, military recruits, scholarly performances, and so on, with friends, family, and strangers who do not know the story of poverty and the role of SNAP and food assistance in making the United States stronger.


2. Write letters, submit editorials to local newspapers, provide testimony, and make visits to policy makers at local, state, and national levels. If legislation passes that moves the responsibility for nutrition programs to states, your connection with and information to local policy members build a strong foundation for the importance of nutrition.


3. Include a few beginning phrases or brief statements that disarm, not alarm, your policy maker.I understand you have supported finding lower cost healthcare options. One important way to lower costs is to invest in good nutrition as evidence shows that being food secure helps prevent chronic diseases that are expensive to treat.I understand that you want to help unemployed workers. Some of these workers have received SNAP and might benefit from a gradual phase out of benefits to ensure sudden food insecurity does not cause fatigue, depression, or conditions that handicap success at work and coaching to overcome these handicaps.I understand you strongly support personal responsibility. I agree and want you to know how food assistance, incentive for choosing fruits and vegetables, and nutrition education help individuals take responsibility for their health and become successful students and workers.


4. Reframe the current messages that stress potential increases in hunger with food assistance cuts and emphasize the return on investment of SNAP through the benefits of food security on improved health, school and work performance, fewer sick days, and ultimate economic and national security.


5. Shift from politically charged rhetoric to actual case studies and research evidence documenting the positive outcomes of nutrition programs. Sen Patty Murray (D, Washington), Rep Barbara Lee (D, California), and business executive Sherry Brennan, all 2017 Food Research and Action Center awardees, were once food stamp recipients who now serve the America that served them. Many members in both parties have received SNAP.



These steps should enable you to make a personal connection with your member of Congress or his/her staff. Many members of the House and Senate Agriculture Committees have never voted on a Farm Bill and would benefit from personal accounts regarding the benefits of federal nutrition investments in the Farm Bill that benefit both farmers' and communities' economic status and their constituents' health and well-being. This article provides the evidence to buttress support for investments in the nutrition components of the Farm Bill.



Heated discussions about budget priorities and Farm Bill options need calm, evidence-based arguments from nutrition professionals. There is a solid body of research that shows the strong connections among nutrition benefits, food security, and health, and nutrition professionals must use the evidence to justify their opposition to the cuts and the importance of making funding for nutrition provisions in the Farm Bill a priority. Without a clear and present understanding of the great return on the high cost of the SNAP and other food assistance programs, lawmakers will continue to shave off portions of these nutrition investments to fund their priorities.




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8. USDA Economic Research Service. Agricultural Act of 2014. Highlights and implications. Accessed July 6, 2017. [Context Link]


9. USDA Food and Nutrition Service. Supplemental Nutrition Assistance Program Participation and costs. 2017. Accessed July 20, 2017. [Context Link]


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13. Agriculture Act of 1970. No. 91-524, 84 Stat. 1358. November 20, 1970. Accessed June 20, 2017. [Context Link]


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15. Bartlett S, Klerman J, Olsho L, et al. Evaluation of the Healthy Incentives Pilot (HIP): final report, prepared by Abt Associates for the US Department of Agriculture, Food and Nutrition Service. 2014. Accessed July 5, 2017. [Context Link]


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18. Hamler-Fugitt L. Our dirty secret: many seniors going hungry. Lima News. 2017. Accessed July 1, 2017. [Context Link]


19. Keith-Jennings B, Palacios V. SNAP helps millions of low-wage workers: crucial financial support assists workers in jobs with low wages, volatile income, and few benefits. Center for Budget and Policy Priorities. 2017. Accessed July 6, 2017. [Context Link]


20. US Government Accounting Office. Military personnel: DOD needs more complete data on active-duty servicemembers' use of food assistance programs. Report to Congressional Committees. GAO-16-561. July 15, 2016. Accessed June 23, 2017. [Context Link]


21. Farson Gray K. Characteristics of Supplemental Nutrition Assistance Program households: fiscal year 2013. Table 3.1 USDA Food and Nutrition Service. 2014. Accessed July 23, 2017. [Context Link]


22. Nord M, Coleman-Jensen A, Gregory C. Prevalence of US food insecurity is related to changes in unemployment, inflation, and the price of food. US Department of Agriculture, Economic Research Service. ERR-167. June 2014. Accessed July 31, 2017. [Context Link]


23. Basu S, Wimer C, Seligman H. Moderation of the relation of county-level cost of living to nutrition by the Supplemental Nutrition Assistance Program. Am J Public Health. 2016;106(11):2064-2070. [Context Link]


24. Kirlin J. Supplemental Nutrition Assistance Program (SNAP) linkages with the general economy. USDA Economic Research Service. 2016. Accessed August 25, 2017. [Context Link]


25. Brown L. The link between nutrition and cognitive development in children. ERIC. 1994. Accessed July 15, 2017. [Context Link]


26. Cook JT, Frank DA, Levenso SM, et al. Child food insecurity increases risks posed by household food insecurity to young children's health. J Nutr Apr. 2006;136(4): 1073-1076. [Context Link]


27. Gregory CA, Coleman-Jensen A. Food insecurity, chronic disease, and health among working-age adults. US Department of Agriculture, Economic Research Service. ERR-235. July 2017. Accessed July 31, 2017. [Context Link]


28. Odutayo A, Gill P, Shepherd S, et al. Income disparities in absolute cardiovascular risk and cardiovascular risk factors in the United States, 1999-2014. JAMA Cardiol. 2017;2(7): 782-790. [Context Link]


29. Seligman HK, Davis TC, Schillinger D, Wolf MS. Food insecurity is associated with hypoglycemia and poor diabetes Self-management in a low-income sample with diabetes. J Health Care Poor Underserved. 2010;21(4):1227-1233. [Context Link]


30. Whittle HJ, Palar K, Seligman HK, et al. How food insecurity contributes to poor HIV health outcomes: qualitative evidence from the San Francisco Bay Area. Soc Sci Med. 2016;170:228-236. [Context Link]


31. Rosenbaum D, Bolen E, Wolkomir E, et al. Administration's 2018 budget would severely weaken and cut the Supplemental Nutrition Assistance Program. Center on Budget and Policy Priorities. May 31, 2017. Accessed June 15, 2017. [Context Link]


32. PBS Newshour. Hunger a persistent problem for poor Americans as Republicans mull SNAP cuts. 19, 2017. [Context Link]


33. Black D. House Concurrent Resolution 71 on the Budget FY 2018. House Budget Committee. Published July 21, 2017. Accessed July 21, 2017. [Context Link]