An agenda for ending food insecurity

Guidelines and voluntary efforts won't get the job done. It's time for regulatory action to improve the nation's food supply.

I ended part one of this two-part series by asking if the time has come to develop a new agenda for improving the American diet and ending the food insecurity that plagues millions of lower-income families.

Making those changes will require breaking down the many barriers that currently exist and are being worsened by the food cost inflation now racing through the nation’s grocery stores. While overall inflation is slowing from last year’s rapid pace, food prices jumped 11.8% in January, nearly twice the overall inflation rate. Food inflation hits lower income families hardest since they spend a larger proportion of their incomes on food.

Price isn’t the only barrier to better nutrition for the poor. Many low-income communities, especially in the inner city and rural areas, do not have well-stocked grocery stores. They are called food deserts, served largely by overpriced convenience stores that do not stock fresh fruits and vegetables and are jammed with junk food, candy and soda pop.

Many low-income families that cook at home also must travel long distances to purchase fresh ingredients. That task may be hampered by work schedules that entail long hours, often at multiple jobs. Those that do not own a car or lack access to convenient public transportation must add a taxi tax to their weekly food shopping bill.

Food as medicine

In recent years, the health care industry has begun stepping in to address the health problems caused by inadequate nutrition, whether its outright hunger, consumption of too many calories or imbalanced diets. Nutrition scientists have long recognized poor nutrition is directly responsible for a substantial share of the incidence of heart disease, many cancers and diabetes, which are the three largest causes of ill-health in the U.S.

Under the rubric of using “food as medicine,” providers, insurers and some government agencies have begun experimenting with programs to address the multiple causes of food insecurity. Some providers are prescribing and being reimbursed for delivering dietician-designed meals for specific medical conditions. Others are working with local social service agencies to deliver grocery boxes to patients’ homes. Some are even offering targeted vouchers for fruits and vegetables that can be prepared in the home.

In a comprehensive review of these initiatives last week in STAT (subscription required), reporter Nicholas Florko reported a consortium of food companies, private foundations and patient advocacy organizations recently launched a $250 million research initiative to prove the value of food as medicine. The move came after the Biden administration threw its support behind insurance companies reimbursing providers for prescribing food. The CMS Innovation Center also plans to launch a pilot project that will pay for medically-prescribed food for sick seniors, which isn’t yet part of Medicare’s reimbursement policy.

Other parts of the government have long recognized the need to include nutrition as part of its anti-poverty and childhood development programs. Food stamps, now known as the Supplemental Nutrition Assistance Program or SNAP, reach more than 40 million low-income households. But while the Biden administration’s Thrifty Food Plan, unveiled in August 2021, sharply increased the value of the benefit, it still is less than the cost of an average meal in more than a fifth of U.S. counties, according to the Urban Institute.

The four-decade-old supplemental nutrition program for Women, Infants and Children, or WIC, reaches over 6 million pregnant women and young children up to age 5. But to qualify, you must earn below 185% of the federal poverty level. Researchers at the Center for Budget and Policy Priorities found women who participate in WIC give birth to healthier babies, feed their children more fruits and vegetables, and receive more preventive medical care.

Both programs have had a positive spillover effect for those not in the programs. Low-income neighborhoods and rural areas with higher percentages of their residents on SNAP and WIC are more likely to house stores that sell the fresh fruits and vegetables and healthier foods. In other words, the programs help combat the food desert status that characterizes some areas of the country.

Members of the reactionary Freedom Caucus are looking to end both programs, and we’re likely to see both programs come under attack by Republicans in the House when the farm bill comes up for reauthorization later this year.

Meanwhile, in the Senate, the chairman of the Agriculture Committee’s subcommittee on food and nutrition, John Fetterman of Pennsylvania, checked into Walter Reed National Military Medical Center last week for depression and the lingering aftereffects of the stroke he suffered last summer. Sen. Cory Booker of New Jersey, a member of the subcommittee, has vowed to fight for a program that allows state Medicaid programs to provide nutritious food as part of their benefit packages.

Bring industry to the table

Food as medicine is a great concept. But why are we asking the health care system – notoriously overpriced and poorly coordinated in how it delivers care – to be the primary engine for correcting the shortcomings in America’s food supply?

A waltz around any major grocery store in any American town reveals a series of food choices guaranteed to undermine the health and well-being of those who partake in many of the proffered products. The aisles are filled with sugar-laden breakfast cereals and beverages; salt-saturated cans of vegetables, soups and legumes; starch-heavy prepared and frozen foods; and an endless array of snacks, chips and candy to tempt young and old alike.

Poor nutrition isn’t just a problem for the poor. Given the existing food environment, even a middle-class, dual-income family is hard pressed to maintain a healthy diet. The long work hours and daily stressors that characterize contemporary American life leaves little time for food preparation and leisurely family meals. It is far easier to give in to the convenience and allure of processed foods, whose tastes, smells and textures have been engineered by industry scientists to appeal to our primitive taste buds.

The restaurant industry, especially the fast-food component, which caters to people who can’t afford more expensive restaurants, is no friend to good nutrition. Dining out now consumes 40% of the average American household’s food budget. Fast-food offerings high on fats, starch, salt and sugary beverages create the dietary equivalent of a carcinogen, where long-term exposure at sufficient doses leads to higher rates of obesity, heart disease, cancer and diabetes.

The restaurant and food industries have successfully fought almost every policy initiative aimed at regulating their food offerings. They also fight against any tax on the least healthy components of the food supply – something states have no problem doing for tobacco and alcohol because of their detrimental health impacts.

For instance, no state levies a tax on sugar-laced beverages, whether soda pop, iced tea or sports drinks. Years ago, Arkansas and West Virginia levied a low per-gallon tax on soda distributors. But Sen. Joe Manchin’s state last year repealed the tax starting in 2024. The Navajo Nation is the only legal jurisdiction to tax “junk food,” which includes not just sweetened beverages but snacks high in salt, saturated fat, and sugar.

This well-heeled resistance must be overcome. The Biden administration needs to make improving the American diet a priority and make its health-oriented departments take the lead. Unfortunately, regulation was the missing element in the food program the administration outlined last September.

The U.S. nutrition problem will not be solved until the federal government develops a food regulatory system that requires food, meat and beverage manufacturers to deliver products that actually generate a healthy diet for average Americans. The industry’s trade associations insist they’re working on it. McDonald’s now offers salads.

Token changes won’t get the job done. Asking the food industry to voluntarily deliver a healthy diet is like asking the fossil fuel industry to deliver clean energy. There’s simply too much money to be made from selling junk. Only government regulation can force food corporations to make the transition that is essential to promoting better health through a better diet.