Preventive Medicine Column
Dr. David L. Katz
There was a debate last week in the New York Times over the “proper” use of SNAP (formerly “food stamps”) funds. The basic question is whether use of food assistance dollars should be restricted so as to preclude unhealthful food choices: soda, fast food and so on.
As one might expect, “my” clan-health experts, nutritionists and public health practitioners — whom some of you no doubt see as the food police — generally advocate for such restricted use of SNAP. The basic argument is that the burden of obesity and chronic disease falls disproportionately on the socioeconomically disadvantaged who depend on SNAP; and there is no legitimate basis to use tax dollars to propagate this problem. They are opposed, however, by similarly well-intentioned anti-hunger professionals and activists, who contend that those facing food insecurity should not be precluded from using food assistance to buy what they want to eat.
If we could walk the proverbial few steps in one another’s moccasins, we might acknowledge that there are legitimate arguments on both sides of this divide. We might also acknowledge a third option.
This debate is really over whether, and how, to wield a stick. Restricting food choices — however good the intentions — is a stick. Justified or not, it is rather heavy-handed.
But we could sidestep this contentious debate altogether — or at least defuse its inflammatory potential — by making use of a carrot instead.
We can characterize the current situation in very blunt terms. We, the taxpayers of the U.S., send $100 billion or so to the federal government each year to subsidize the USDA’s SNAP program. Those funds help (relatively) poor people procure relatively poor food (thanks to the prevailing inverse association between food cost and nutritional quality) — so they can get to really poor health.
There is, of course, substantial overlap between the population relying on SNAP (which has grown tremendously during this period of economic hardship) and the population relying on Medicaid. And so, we are also on the hook for a vastly larger allocation of tax dollars to Medicaid to pay the costs associated with poor health, and propagated by poor food (among a short list of other major influences).
We, the taxpayers, lose; we are spending some of our heard-earned money to create a problem, and more of our heard-earned money to — at best — only partially fix it.
The government loses because this inefficient allocation of funds siphons money away from other worthy causes: everything from education, environmental protection, and military preparedness, to the maintenance of our increasingly questionable infrastructure.
And the SNAP participants lose the most of all. They are the ones left to struggle with the combination of poverty and chronic disease.
While some restrictions on the use of SNAP dollars certainly makes sense to me, what makes far more sense is to incentivize the more nutritious food choice, from soup to nuts, so that more nutritious always means less expensive.
Using a system that can objectively stratify the nutritional quality of any food or meal (the NuVal™ system I helped develop is an example), the purchasing power of ‘food stamps’ could be linked to overall nutritional quality: The higher the nutritional quality, the lower the cost. Even a tiny improvement in health outcomes associated with this initiative could pay for it 10 times over (several of the world’s leading health economists have collaborated with me on developing this concept, and concur — although we all agree on the need to prove it). Everyone wins.
Admittedly, it will require more than a ‘snap’ of our fingers to implement, test and validate this win-win-win approach. But it is eminently feasible; and sure beats beating one another with sticks in unending debate while getting nowhere.
Power – health — and carrots — to the people.
Dr. David L. Katz; www.davidkatzmd.com