Reducing Nutrition-Related Disparities in America Through Food Stamp Nutrition Education and the Reauthorization of the Farm Bill

  • Date: Nov 08 2006
  • Policy Number: 200618

Key Words: Adolescent Health, Appropriations, Community Health Programs, Federal Appropriations, Federal Health Services, Food Stamps, WIC Women Infants And Children

The American Public Health Association:

Concerned about proposed budget cuts in the Food Stamp Program (FSP),1,2 about persistently low participation rates with an estimated 16 million individuals eligible but not participating,3 and about administrative changes in Food Stamp Nutrition Education (FSNE) that restrict state activities, reduce the federal investment in public health initiatives to decrease food insecurity and limit the Program's potential to prevent diet-related health disparities among low-income Americans, including obesity;4,5

Alarmed that both poverty and food insecurity rose for the fourth consecutive year in 2004 so that 37 million people, or 12.7 percent of all Americans, have incomes at or below the federal poverty level (FPL); 6 and that more than 38 million persons- 7 million more than in 1999 and nearly 12 percent of all American households- are food insecure, with almost 4 percent reporting hunger; 7 

Recognizing that the FSP has been shown to alleviate hunger and malnutrition,8 increase household food expenditures and available food energy and protein9 such that "by the mid-1990s, the nutrient intake of low-income people differed little from that of higher income people- a sharp contrast from 40 years ago- 10 and in reaching nearly 25.7 million persons11 each month," FSP is the centerpiece of the nation's nutrition safety net with the potential, through well-executed food stamp nutrition education and outreach initiatives, to: 
· Engage new stakeholders and stimulate significant amounts of voluntary effort in eliminating the disparities seen in low-income communities, 
· Incorporate native diets by engaging diverse populations to assure that dietary differences related to ethnic, cultural or other factors are addressed,
· Help create community conditions that promote and enable healthy eating, 
· Stimulate local economies,12 
· Improve the functionality and maximize the impact of other federal nutrition programs that serve low-income families,13 
· Play a major role in reversing the nation's obesity epidemic to which an estimated $75 billion in excess medical expenditures and 10 percent of state Medicaid dollars were attributed in 2000,14 and 
· Reduce the risk of other diet-related chronic diseases, such as type 2 diabetes and hypertension that disproportionately strike low-income Americans.15

Anticipating that reauthorization of the Farm Bill in 2007 and beyond will place agriculture, nutrition, and social services policy at a crossroads;16 that the needs of urban communities, rural communities and small farmers will be weighed against other economic interests; that the profound nutrition improvements called for in the 2005 Dietary Guidelines for Americans (DGA) require realignment of agriculture policy to better support public health policy, especially for fruits and vegetables;17 and that implementing policies recommended by domestic and international expert bodies would have significant public health impact; 18-25 

Concluding that high rates of food insecurity are also incompatible with achieving national goals for public education, a competitive work force, economically vibrant communities, and health care cost containment; and that reversing negative eating and exercise trends will require coordinated, multi-level social marketing approaches, the collective efforts of stakeholders from public and private sectors, and sustained governmental leadership at the federal, state, and local levels.

Therefore, the American Public Health Association calls on Congress and the U.S. Department of Agriculture and the U.S Department of Health and Human Services to implement agriculture and nutrition policies that invest in prevention, productivity, and economic revitalization by: 
1. Modernizing the federal statutes that authorize Food Stamp Nutrition Education (FSNE) so that states and localities may better address the need for environments that provide ready access to fresh, healthy food and safe, enjoyable physical activity among today's low-income, food stamp-eligible households. FSNE statutes should enable states to:
- Use scientifically-sound, consumer-driven approaches to reach more food stamp-eligible populations at a lower cost per person,20-22 namely outreach, mass media advertising, public relations, marketing and promotion, community development, public/private partnerships, and policy, systems, and environmental change- as well as traditional, direct nutrition education services;
- Conduct community needs assessments as part of comprehensive, integrated social marketing campaigns; ensure that targeting requirements allow FSNE programs to reach the majority of FSNE-eligible adults and families, no matter where they live and achieve program efficiency by providing flexibility to deliver campaign activities in suitable community locations such as grocery stores, low-wage worksites, schools, faith-based organizations, senior centers restaurants, parks, restaurants and recreation facilities; 
- Allow FSNE to support statewide farm-to-school and community-supported agriculture programs that develop and increase direct marketing opportunities to small farmers and related businesses, especially in low-income and children's foodservice venues; and
- Support evaluation to assure the effective delivery of FSNE campaigns, continued program improvement, mobilization of assets and achievement of goals set by local, state and federal stakeholders participating in FSNE. 

2. Increasing state participation by eliminating the requirement to maintain separate funding and record-keeping for FSNE and FSP outreach; harmonizing eligibility for FSNE with other nutrition, health and social support programs at least 185 percent of the federal poverty level, providing automatic enrollment in food stamps for children receiving free/reduced price school meals or participating in the WIC Program, requiring that information about family food stamp eligibility be provided to participants in child nutrition and WIC programs, offering statewide waivers to improve program operations rather than requiring county-by-county documents, encouraging multi-year state plans, and streamlining repetitive and redundant paperwork. 

3. Increasing food stamp minimum monthly benefits to provide more adequately for the generally higher cost of healthy, under-consumed foods, especially fresh fruit and vegetables, whole grain products, lower-fat milk products, and lean animal protein foods as per the Dietary Guidelines for Americans (2005).26 

4. Re-orienting FSP performance goals to provide incentives for reducing state rates of food insecurity, poor diet and physical inactivity in FSNE-eligible households and to initiate specific measures that promote fruits and vegetables and other healthy, under-consumed foods that are reflective of regional dietary practices by:
- Encouraging demonstration projects for bonus value food stamps, starting with fresh fruits and vegetables;
- Assisting states to assure that farmers' markets serving low-income neighborhoods are equipped to process electronic benefit transfer food stamps;
- Providing incentives to food stamp-certified retailers to offer a minimum amount of fresh fruits and vegetables, whole grains, low-fat dairy, and lean animal protein foods;
- Exempting fresh fruits and vegetables, whole grain products, low-fat dairy, and lean animal protein foods from the current prohibition that restricts retailers from offering price promotions to food stamp customers;
- Allowing states to set higher standards for retailer participation in the Food Stamp Program; 
- Expanding the Free Fruit and Vegetable Snack Program to all states, increasing funding for the WIC & Seniors Farmers' Market Nutrition Programs (FMNP), increasing authorization for the Department of Defense Fresh Fruit and Vegetable Program and for community food security efforts that include economic development, food policy councils, community supported agriculture, farm to school initiatives, and other direct marketing initiatives, especially those focusing on fruits and vegetables; and
- Establishing state and community surveillance systems to track food insecurity, poor diet and physical inactivity rates, monitor community conditions, and identify progress toward public/organizational policies that support/advance healthy eating, physical activity, and food security. 

5. Coordinating federal leadership, technical assistance and evaluation for nutrition improvement campaigns between the USDA and sister agencies of the Department of Health and Human Services including the Centers for Disease Control and Prevention, the Health Resources and Services Administration, the Food and Drug Administration and the National Institutes of Health to work as partners with units of state and local government, including public health agencies. Report on policy, systems and environmental changes that increase access to and promotion of healthy eating in organizations, communities, and states. 

6. In partnership with cognizant state agencies, issue a National Action Plan for improving the diets of low-income American families that is consistent with the latest Dietary Guidelines, thereby integrating the efforts of USDA and DHHS categorical programs, with priority placed on eliminating food insecurity, increasing fruit and vegetable intake, and increasing physical activity. 

1. Rosenbaum, D, Dean, S, and Neuberger, Z. House Reconciliation Bill Targets Food Stamp Program for Cuts. Center on Budget and Policy Priorities. December 6, 2005. http://www.cbpp.org/12-5-05fa.htm. (Accessed Mar 14, 2006)

2. American Public Health Association. Call Your Senators and Representative and Tell Them to Protect the Medicaid Program in the Deficit Reduction Act. Action Alert, November 2005.
3. Castner, L and Schirm, A. (2005) Reaching Those in Need: State Food Stamp Participation Rates in 2003. United States Department of Agriculture, Food and Nutrition Services. Washington, D.C. 
4. USDA Food and Nutrition Service. Food Stamp Nutrition Education (FSNE) Framework. Revised Draft -- May 2004. USDA Food and Nutrition Services Web site http://www.fns.usda.gov/oane/menu/FSNE/FSNE.htm . [Accessed July. 15, 2004].
5. USDA Food and Nutrition Service, Office of Analysis, Nutrition and Evaluation. Food Stamp Nutrition Education Guiding Principles. 
Web site: http://www.fns.usda.gov/oane/menu/FSNE/FSNE.htm [Accessed Dec. 8, 2005].
6. DeNavas-Walt, C. et. Al. Income, Poverty and Health Insurance Coverage in the United States: 2004 Current Population Reports. U.S. Census Bureau. 2005.
7. Nord, M. Andrews, M. and Carlson, S. Household Food Insecurity in the United States, 2004. USDA Economic Research Service, Economic Research Report Number 11, 2005.
8. Food Stamp Program. Expect More Program Assessment. White House and Office of Management and Budget. http://www.whitehouse.gov/omb/expectmore/summary.10001007.2005.html [Accessed June 7, 2006].
9. Editors: Fox, Mary Kay, Hamilton, William, Lin, Biing-Hwan. Effects of Food Assistance and Nutrition Programs on Nutrition and Health. Volume 4, Executive Summary of the Literature Review. Food Assistance & Nutrition Research Program, (USDA) - Food Assistance & Nutrition Research Report Number 19-4. http://ers.usda.gov/publications/fanrr19-4/fanrr19-4.pdf

10. Office of Analysis, Nutrition, and Evaluation. (2005). Making America Stronger: A Profile of the Food Stamp Program. United States Department of Agriculture Food and Nutrition Service. http://www.fns.usda.gov/OANE/Farm_Bill/FSPProfile.pdf

11. USDA Economic Research Service U.S. Department of Agriculture. The Food Assistance Landscape, March 2006. Economic Information Bulletin 6-2. 
12. Hanson, K. and Golan, E. (2002). Effects of Changes in Food Stamp Expenditures Across the U.S. Economy. Issues in Food Assistance, United States Department of Agriculture, Economic Research Service. 2002
13. United States General Accounting Office. Report to the Committee on Agriculture, Nutrition, and Forestry US Senate: Nutrition Education, USDA Provides Services through Multiple Programs, but Stronger Linkages among Efforts Are Needed, GAO-04-528. April 2004.
14. Finkelstein EA, Fiebelkorn IC, and Wang G. State-level estimates of annual medical expenditures attributable to obesity. Obesity Research 12(1); 1-7, 2004.
15. California Health Interview Survey-Ask CHIS 2003. Retrieved June 7, 2006, from http://www.askCHIS.org
16. American Public Human Services Association. Crossroads II, New Directions in Social Policy, Food Stamp Program, pages 99-111, 2005.
17. U.S. Department of Agriculture. Farm Bill Nutrition Forums. 2005 
http://www.fns.usda.gov/oane/Farm_Bill/FarmBillForums.htm. [Accessed Mar. 14, 2006].
18. Nutrition and Physical Activity Work Group, Gregory S (Ed). Guidelines for Comprehensive Programs to Promote Healthy Eating and Physical Activity. Human Kinetics. Champaign, IL 2002.
19. Committee on Assuring the Health of the Public in the 21st Century. The Future of the Public's Health in the 21st Century. Institute of Medicine. The National Academies Press, Washington, D.C. 2003.
20. Committee on Preventing Childhood Obesity. Preventing Childhood Obesity: Health in the Balance. Institute of Medicine, The National Academies Press, Washington, D.C. 2004. 
21. Food Research and Action Center (2005). Obesity, Food Insecurity and the Federal Child Nutrition Programs: Understanding the Linkages. Washington, D.C. http://www.frac.org/pdf/obesity05_paper.pdf . [Accessed Mar. 14, 2006].
22. Committee on Food Marketing and the Diets of Children and Youth. Food Marketing to Children and Youth: Threat or Opportunity? (Prepublication Copy) Institute of Medicine. The National Academies Press, Washington, D.C., 2006.American Public Health Association. Resolution on Overweight in Childhood, 2001-
23. American Public Health Association. Supporting the WHO Global Strategy on Diet, Physical Activity and Health. APHA Policy 2005-8. http://www.apha.org/legislative/policy/2005/2005-8.pdf [Accessed June 7, 2006].

24. American Public Health Association. Support for WIC and Child Nutrition Programs. APHA Policy 200319.http://www.apha.org/legislative/policy/2003/2003-019.pdf [Accessed June 7, 2006].

25. American Public Health Association : Maintaining the National Commitment to the
Nation's Health. APHA Policy 9601. http://www.apha.org/legislative/policy/96policy.pdf [Accessed June 7, 2006].
26. U.S. Department of Health and Human Services and U.S. Department of Agriculture, Dietary Guidelines for American, 2005, 6th Edition, Washington D.C.; U.S. Government Printing Office; January 2005.