Regulate the Poor

Right on cue, the LA Times has an article that focuses on a study from the Robert Wood Johnson Foundation on how best to regulate the poor by figuring out how to micro-manage what someone using SNAP (Supplemental Nutrition Assistance Program) can or cannot buy, and what purchases will be “rewarded.”

The article is “Can food stamps help improve diets, fight obesity and save money?” and the answers are possibly, probably not and the only part that is actually going to motivate any legislator. The hook is “health” and “diabetes prevention,” and the argument runs as follows (emphasis added):

Prohibiting the use of federal food stamps to purchase sugar-sweetened beverages and subsidizing the purchase of fruits and vegetables with the coupons would improve nutrition, foster weight loss and drive down rates of Type 2 diabetes among the program’s 47.6 million recipients, according to a new study.

In so doing, the $79.8-billion Supplemental Nutrition Assistance Program (SNAP) might also reap taxpayers untold future savings for the federally funded care of diabetes and other obesity-related ills among Medicaid recipients.

The benefits of making such changes to the program — more commonly known as food stamps — would be small and might take a decade to see. But while food stamp recipients often respond to rule changes by paying for disallowed items from their own pockets, such directives can, on balance, nudge their purchasing and consumption habits in positive directions, says a group of medical and health economics researchers from Stanford University and UC San Francisco.

OK, two kinds of regulation – one prevents purchase of a sugar-sweetened beverage using SNAP and the other provides an automatic discount on any fresh fruit or vegetable. The second measure would actually answer one of my questions from yesterday’s post, namely how can we make presumptively healthy foods more affordable to the consumer, by providing an immediate and automatic discount on a produce purchase. The other is just good old fashioned class puritanism, forbidding social inferiors pleasures and treats in the name of future rewards to the social superiors in the form of reduced Medicaid costs.

The study is justified by pointing out that SNAP users are “more obese than the general population and carries a far higher burden of Type 2 diabetes.” OK, how much more obese and how much higher a burden? Let’s get the numbers out there so we have the complete picture. The article then cites some statistics from the study:

On a daily basis, the average SNAP recipient takes in 157 calories from sugar-sweetened beverages, versus 140 calories for a matched comparison group of non-SNAP recipients.  A ban on the purchase of sweetened drinks with food stamps would prompt SNAP recipients to increase their purchase and consumption of fruit juices, the authors calculated.

But they reckoned that the average net caloric intake would decline by 11.4 calories per day. And a prohibition on the purchase of sugary drinks with food stamps would drive down the average recipient’s glycemic load — a measure of blood sugar response to diet — by 2.7 grams per day.

A savings of 11.4 calories per day. That’s it? That’s the difference between the soda consumption habits of the SNAP group and the control group? (There is no word as to whether the ban would extend to non-caloric sweetened beverages, so that regular cola is off limits but diet cola is OK) Banning sodas is expected to increase purchase of fruit juices. Fruit juices cost twice ans much per ounce on average as sodas ( I can get a 2 liter bottle of 7Up for $1.00 vs. a 1.3 liter bottle of fruit juice for $3.00, for example, just using the shoppers out this week), and will burn a hole in the SNAP balance that even a 30% discount on fruits and vegetables can’t cover. (Please note this is not an argument in favor of drinking soda, but one which points out the most overriding issue about being poor – making the money go as far as possible.) So, we’ve cut off one source of calories to reduce calorie counts by 11+ calories per day. The reduction in glycemic load is provided for removing sodas, but does not appear to take into account drinking fruit juice, which naturally has a lot of sugars.

Hmm, wouldn’t putting PE back into schools do more about this than banning poor people from drinking a can of Pepsi paid for by SNAP? You’d get energy expenditure to eat up those tiny calorie differences and the enormous benefits of physical activity, which is cited over and over as more effective in preventing and reducing the effects of diabetes than changes to diet. It seems especially important when factoring in the next two statements:

Over 10 years, the average food stamp recipient’s weight would decline by 1.15 pounds as a result. Some 422,000 people would not become obese — the equivalent of a 2.4% decline from current obesity prevalence rates among SNAP participants.

And over a decade, 240,000 SNAP recipients would not be diagnosed with Type 2 diabetes, a 1.7% decline in the incidence of the metabolic disorder, which increases by two to four times the risk of stroke and heart attack.

I’m not sure how not gaining 1.15 pounds over the course of 10 years translates into almost a half-million people not being obese. Restricting soda purchases with SNAP cards will result in a weight loss that could be erased by one week’s worth of indulgence and by projecting a less than 2% rate of diabetes decline, the ostensible public health justification for making soda off limits. In short, this is just a manipulative way to push and anti-soda agenda by declaring to the poor that yet another small corner of pleasure is denied to them.

What really gets my dander up is that the absolutely excellent food suggestion, making fresh produce cheaper right at the time of sale in a way that does not damage the bottom line for the grocer or the grower, and can actually make those food dollars go further, is sniffed at as not at all useful for fighting the dreaded diabetes.

Subsidizing the purchase of fruits and vegetable with food stamps resulted in health gains that were somewhat harder to measure. It certainly increased the purchase and consumption of fruits and vegetables among a population even less likely than the general popution [sic] to take in the recommended five portions a day.

Although the program puts food on many American tables, the health and nutrition status of food stamp recipients is poorer than average. The policy change would increase the fruit and vegetable intake of the average recipient by about a quarter-cup per day. That change would, in turn, boost the proportion of recipients meeting federal recommendations for daily fruit and vegetable consumption from a dismal 1.3% to a slightly less dismal 3.4%.

The fruit and vegetable subsidy would not change the average number of calories consumed by the average food stamp recipient, nor change the average glycemic load. Consequently, the policy had no noticeable effect on the incidence of obesity or Type 2 diabetes among recipients.

Still, the fruit and vegetable subsidy appears to be an easier policy prescription to sell, perhaps because it would not challenge the powerful beverage industry and because it would induce behavior change by enhancing access to nutritious foods rather than restricting access to those with no nutritional value.

Shall we we unpack this? OK, the good news – people who are least likely to buy really good and nutrient- (though not always calorie-) packed produce will be able to buy more. It’s all carrot, no stick. The next paragraph acknowledges that produce consumption among SNAP recipients is low and their overall nutrition profile is poorer than the wider population. Then we play games with how “dismal” they are at meeting federal health recommendations on how much fresh produce to eat. Gee, we’d only go from 1.3% to 3.4% (a more than 50% increase) who would get the full recommended amount. And then we get the crushing news that eating a little more vegetables probably won’t directly and immediately lower obesity or diabetes. Please note the absence of other health benefits of eating fresh produce, such as lowered rates of cancer. Then, the grudging admission that more people will supporting making vegetables cheaper rather than banning sodas, probably because of the big bad beverage industry.

  • How does that percentage compare to the general population? I doubt much more than that.
  • How many people will increase their overall consumption of fresh produce, even if they don’t hit the 5 a day recommendation?
  • How will the reduction in produce prices have a follow-on effect of enabling more food purchases because there’s more money to go around?
  • Why is a 1.7% decline in diabetes over 10 years so much more important than an immediate, right now increase of 2.1% of the SNAP population finally getting 5 full servings of fruits and vegetables? Especially when you consider the ten year effects of eating more of this kind of food?

I’d like to see the percentage discount idea taken even further. How about automatic discounts on milk and meat? And for meat, I wouldn’t even require it to be fresh. Frozen chicken thighs? Frozen fish? A frozen turkey? Some hamburger patties? It’s all good, and not likely to go bad as quickly as fresh meat.

In short, the measure that will unequivocally make a SNAP recipient’s life better, getting more fresh food for a smaller amount of money, is deprecated while the whale hunt to harpoon the soda industry is praised and promoted far beyond its marginal benefits.

Also, while we’re at it, can we have a serious talk about where SNAP recipients often end up shopping? Corner Quickie-Marts and liquor stores because that is what they can walk to from their homes. What do you think these places sell? Soda, liquor, cigarettes, ice cream, snacks, frozen dinners/pizza, stuff that doesn’t spoil and risk the profit margins of the store operator. It’s hard to buy fresh produce when it’s not there to buy. It’s hard to describe to people who take cars and gasoline and Ralphs for granted what it’s like to live with limited transportation (you try lugging the groceries and the kids on the bus that only runs once per hour) and limited shopping options.

There are a lot of great restaurants within walking distance of my house. Only a few are affordable to someone who is on SNAP.  There are three liquor stores. There are two small markets that have fresh vegetables. One is all “organic” and “local” and costs an arm and a leg and isn’t open after 5:00 PM, when parents get off work. The other is an old store that predates the arrival of the major grocery chains and has a small selection of OK produce at somewhat high prices, mostly fruit and onions. It also has a small meat and deli counter. That’s all you have for grocery shopping in my neck of the woods without getting in a car or on a bus, or walking at least 3/4 mile.

If you want to help low-income people with little food security and poor health, stop wasting your time trying to dictate what they can’t buy. They’ll buy better stuff all on their own if it isn’t priced out of reach.

Anglachel

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Posted in Culture, Economics, Food, Health, Obesity, Politics

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