CHAPTER 5 HOW BIG FOOD AND BIG AG CONTROL FOOD POLICY

In February 2017, not long after Donald Trump was sworn into office, the members of the House Agriculture Committee convened a hearing on Capitol Hill to address a controversial issue: Should the government stop people from using food stamps to pay for soft drinks and other junk foods? Two months prior to the congressional hearing, the federal government released a report showing that $7 billion in food stamps are spent on sugary beverages every year.¹ That’s 20 to 30 billion servings of soda a year that we give to the poor.² Seventy-five percent of the foods purchased with SNAP are ultraprocessed junk food: Oreo cookies, Lay’s potato chips, ice cream, and more. It’s no surprise that studies show that people who use SNAP have high rates of heart disease, diabetes, and death compared to the rest of the population.³

While Uncle Sam can’t force anyone to eat fruits and veggies, the government can at least make sure that taxpayer dollars aren’t used to subsidize the Frankenfoods that are driving the belt-popping rates of obesity and chronic disease.

For many nutrition experts, the central question of the hearing was a no-brainer, but due to the influence of Big Food’s money in politics, making positive change is never easy.

PRIORITIZING NUTRITION QUALITY, NOT JUST QUANTITY

The government created the food stamps program, known as SNAP, or the Supplemental Nutrition Assistance Program, in 1964 to help malnourished Americans. Today the program is a crucial safety net that helps needy families put food on their tables and avoid hunger and food insecurity. And it does a great job at doing exactly that. While the health of those on SNAP is better than those who are eligible but have not signed on, the health of those on SNAP is still dismal. SNAP is the country’s largest food assistance program, providing benefits to more than 40 million low-income Americans each month at a cost of tens of billions of dollars a year. SNAP beneficiaries cut across all races and age groups. Roughly 36 percent of them are white, 25 percent are African American (though they make up only 12 percent of the population), 17 percent are Hispanic, about 4 percent are Asian or Native American, and the rest are unknown.⁴ Millions are veterans, seniors, or people with disabilities. Almost one in two SNAP recipients is a child.

SNAP is a vital anti-poverty, anti-hunger tool. No doubt about it. But that is why other aspects of the program desperately need reform. The most pressing food problem for low-income households is no longer a lack of calories—it’s a lack of good calories. Thanks to federal supports for corn, soy, and grains, junk food is now cheaper than ever (with the help of taxpayer dollars), and consumers are exposed to a conveyor belt of empty, disease-producing calories. We have solved the calorie problem. But we now have to solve the problem of nutrient deficiency because processed food has many calories but very few nutrients. Many people only think about provisions for farmers when they hear about the Farm Bill, but its second and most costly component is the food stamps program. In fact, nutrition programs have historically accounted for a majority of the Farm Bill funding.

While SNAP has succeeded in providing food security to more than 40 million Americans, it has failed to protect them in any meaningful way from the ravages of obesity and diet-related diseases. In fact, the food stamps program only increases the likelihood of the most vulnerable Americans consuming an unhealthy diet. In one study, researchers at the Harvard School of Public Health examined the diets of nearly 4,000 adults who lived below the federal poverty level. They looked at differences between SNAP participants and nonparticipants. They found that SNAP recipients consumed 44 percent more fruit juice, 56 percent more potatoes, 46 percent more red meat, 39 percent fewer whole grains, and, among women, 61 percent more soft drinks. Overall, they found that SNAP participants were in dire need of nutrition interventions. “Although the diets of all low-income adults need major improvement,” they reported, “SNAP participants in particular had lower-quality diets than did income-eligible nonparticipants.”⁵

In another study, the researchers found that children living in SNAP households consumed high levels of empty calories, soft drinks, and processed meats.⁶ The findings dovetail with studies by the Mayo Clinic as well as research carried out by the USDA itself, which administers the SNAP program.⁷

BIG FOOD TARGETS THE VULNERABLE

So why do SNAP recipients eat so poorly? Part of the reason is that grocery stores and food companies know exactly when SNAP benefits are distributed each month. They time their junk-food marketing on those days to target SNAP recipients. A 2018 study in the American Journal of Preventive Medicine found that shoppers in poor New York City neighborhoods were two to four times more likely to encounter soda displays and sugary drink advertisements in grocery stores during the first week of the month,⁸ the same week people get their food stamps. Yet the ads for low- and zero-calorie drinks didn’t spike during these periods. Meanwhile, wealthier neighborhoods (where there are few food stamp recipients) didn’t see the same increase in junk-food ads during the first week of the month. The implication is clear: Big Food aims its junk-food ads at low-income Americans with a laser focus. The retailers target SNAP recipients with the worst and most profitable foods.⁹

So why do companies target SNAP recipients with junk foods instead of health foods? It’s simple: Soft drinks are far more profitable than fresh produce. As my friend David Ludwig, a leading obesity expert at Harvard Medical School, explains it, “There’s a massive profit margin on sugary beverages, more so than for fruits, vegetables, meats, and seafood. They get heavily advertised, put at the front of the store, and put on special sales, specifically targeting SNAP recipients.”

Almost every other government food program—from school lunches to military food programs to WIC (the Special Supplemental Nutrition Program for Women, Infants, and Children)—has at least some nutrition standards. But SNAP has none. And it’s created a huge economic and public health catastrophe. A 2017 study by Dariush Mozaffarian and his colleagues at Tufts followed almost half a million adults over a decade and found that SNAP participants had substantially worse health than other Americans: twice the rate of heart disease, three times greater likelihood to die from diabetes, and higher rates of metabolic diseases.¹⁰ SNAP beneficiaries account for at least 65 percent of the adults on Medicaid and 14 percent of people on Medicare.¹¹ The math is simple: Providing healthy and nutritious foods to SNAP recipients would reduce chronic disease rates and sharply lower health care costs. It would benefit the millions of people who depend on SNAP and ultimately save taxpayers billions or potentially even trillions of dollars.

The federal government has a duty to set nutrition standards for the food stamps program, which it ignores. Increasing access to healthier foods and removing obvious junk foods from the program would reduce obesity and diabetes rates and dramatically lower health care costs. As David Ludwig puts it, “We’ve allowed SNAP, due to food industry lobbying and neglect, to become a conveyor belt of terribly unhealthful calories. With modest reforms, we can continue to address the important problem of hunger in the United States and at the same time help reduce diet-related chronic diseases that are devastating low-income communities.”

POLITICAL SWAY

To give you an idea of how challenging it can be to introduce even modest reforms into public programs like SNAP, let’s go back to our 2017 hearing of the House Agriculture Committee, which oversees the roughly $900 billion Farm Bill that includes SNAP. Some on the panel of food and poverty experts at the hearing argued that eliminating sugary drinks from the program was a badly needed measure that could improve the health of millions of Americans, sharply reducing health care costs in the process. Other experts who opposed them said the restrictions would stigmatize SNAP users and create too much red tape. “Confusion at the checkout aisle,” they cried.¹² This is a specious argument because SNAP already limits certain purchases, such as certain energy drinks, alcohol, and hot foods. Every checkout clerk knows what’s covered and what’s not, plus the government publishes a list.¹³

But the most striking comments came from the lawmakers themselves. One by one, dozens of congressmen and women took turns dismissing the link between junk-food diets and obesity. Congressman Roger Marshall, an obstetrician from Kansas, said a lack of exercise was the primary factor driving obesity rates. Then Congressman David Scott from Georgia took the floor and attacked what he called the food police. Preventing SNAP recipients from using their food stamps to pay for Mountain Dew, Coke, and Oreo cookies was not only cruel, he argued, but practically a violation of their constitutional rights as well. He ignored the fact that other government programs enforce nutrition standards without violating constitutional rights, such as school lunches and the WIC program.

“Look at the complexity you’re going to put into the grocery store,” he barked. “Who’s going to pick up that extra cost to have the food police there monitoring, and why? I think that a better way of going about solving many of these things is to look at how we educate people. You can’t force them. You can’t deny them their freedoms to be able to make choices without violating their pursuit of happiness.” Oh yes. Coke = Happiness. Pursuit of happiness. Not sure that’s what Thomas Jefferson had in mind in the Declaration of Independence.

Congressman Scott then made a series of claims even though decades of research on diet and exercise contradicted him. “Sodas, candy, sweet things—that’s not what makes us obese. It is the lack of our children exercising,” he insisted. “Look at the history of this country. Look at us 30 years ago, 20 years ago. What has happened? Our children, and us, we don’t exercise. We don’t have physical education in the schools anymore.”

Scott’s argument was a masterful attempt to distract attention from the real issue, America’s diet, and shift the blame onto exercise. Of course, exercise is part of the obesity problem, but you can’t exercise your way out of a bad diet. It sounded as if Scott’s statements had been taken straight from the food industry’s playbook—and that was no coincidence. Lobbying reports show that Big Food companies and their deep-pocketed trade groups routinely shower the members of the House Agriculture Committee with campaign contributions and political gifts. Guess who is a top recipient. Congressman Scott.

If lawmakers were required to wear the logos of their corporate sponsors, Scott would look like a NASCAR driver sponsored by Big Food. Since 2006, Coca-Cola has given him more than $42,000 in direct financial donations. The company was his single largest campaign contributor in 2018, followed closely by the National Confectioners Association, the biggest trade and lobbying group for the candy industry.¹⁴ Scott took an additional $105,000 from an influential political action committee, the Blue Dog PAC, which is funded by a roster of food industry giants that includes Coke, Pepsi, the American Beverage Association, Dunkin’ Brands (the parent company of Dunkin’ Donuts), and the Grocery Manufacturers Association, the largest (now relaunched) food industry lobbying group.

Scott wasn’t the only one at the hearing who benefited. Top contributors to Congressman Roger Marshall were sugar industry giants Archer Daniels Midland and American Crystal Sugar, one of the country’s largest sugar producers.¹⁵ The sugar industry was a top contributor to both the chair of the House Agriculture Committee, Frank Lucas, and the committee’s ranking member, Collin Peterson.¹⁶ In total, the forty-six members of Congress that make up the House Agriculture Committee took roughly $1.2 million in campaign contributions from the soda and sugar industries between 2015 and 2018.¹⁷ While the hearing was full of theatrics, it ended with a collective shrug from Congressman Scott and the other members of the committee, who decided not to implement any junk-food restrictions on SNAP programs. Congress: bought and sold. Government of the corporations, by the corporations, and for the corporations.

The food industry is no fool. Junk-food companies are acutely aware that sugary-drink restrictions on SNAP would wipe away billions of dollars of their annual revenue. So behind closed doors, their lobbyists have worked closely with lawmakers and government officials to stop that from ever happening. Many anti-hunger groups and national food banks, like the Food Research and Action Center, or FRAC, have also used their political influence to resist efforts to ban sugary drinks from SNAP. SNAP is just one of many government food policies that suffer from a systemic problem. Instead of prioritizing public health and the interests of society, lawmakers and government agencies are often forced to do the bidding of Big Food. That explains why the $7 billion question at the heart of that 2017 hearing on SNAP and sugary drinks was decided long before the hearing even began.

FOOD FIX: PRIORITIZE NUTRITION—PUT THE “N” BACK IN SNAP

Every semester, Pamela Koch, a professor at Columbia University who researches the connections between a sustainable food system and healthy eating, gives the students in her community nutrition class a fascinating assignment. She makes them eat on a $40 budget for exactly one week, so they see what life is like for the average low-income SNAP recipient. Students have to buy all their food from SNAP-eligible locations, like supermarkets and small grocery stores. That means there’s no stopping and picking up a $10 salad and a $4 bottle of kombucha from Whole Foods. Often, they can’t even afford to buy lunch. “It’s an eye-opening experience for them,” Koch says. “Truthfully, the amount that people are given for SNAP is based on what’s called the thrifty food plan, which is unrealistic in a lot of ways.”

The assignment shows her students why SNAP is so vital for people who are food insecure—people who often have no idea where their next meal is coming from. It also makes it crystal clear why food insecurity and obesity go hand in hand: When you only have $40 a week for food, you have to buy cheap food that comes in large quantities: big bottles of soda, boxes of cookies, bags of potato chips, processed meats, sugary breakfast cereals, Wonder Bread, and on and on and on. Since people on SNAP are not allowed to buy hot foods, you can’t go to your grocery store and buy a $5 rotisserie chicken, but you can stock up on 2-liter bottles of 7Up and frozen chicken nuggets. Is it any surprise that these toxic foods are the most popular purchases for people on SNAP?

How do we make sure that SNAP recipients have access to nutritious and affordable foods? We can’t just eliminate soda and expect that the program will be fixed.

Koch and other experts say the real way to fix SNAP is to combine junk-food restrictions with incentives to buy healthy foods. A study published in JAMA Internal Medicine in 2016 shows how this would work. Researchers recruited adults in the Minneapolis area who were living below the federal poverty line and were not already on SNAP. Then they split them into groups and gave them debit cards with money for food—the same way SNAP benefits work. One group was not allowed to buy sugary drinks, candy, and other junk foods. Another group was told they would receive a 30 percent financial incentive to buy fruits and vegetables. In other words, their money would go much further if they spent it on fresh produce. A third group got both the junk-food restrictions and the healthy food incentives. The fourth group, which served as the control, just received the standard SNAP benefits.

After three months, the group that ate the smallest amount of junk food and the largest amount of fresh produce was the group that had both the healthy incentives and the junk-food prohibition. Even more interesting was that the incentive-only and the prohibition-only groups didn’t see much of a difference in their diets. That is pretty solid evidence that the best way to reform SNAP is to eliminate the worst foods while making the best foods more affordable and accessible.¹⁸

FOOD FIX: OFFER INCENTIVES FOR HEALTHY FOODS

Some successful real-world experiments are finding ways to enable and encourage SNAP participants to eat healthy, whole food. The USDA makes fresh vegetables and other healthy ingredients at farmers’ markets more affordable for SNAP participants through its Food Insecurity Nutrition Incentive Program. Many states are also starting to step up to the plate with their own healthy food programs for SNAP participants. In 2017, Massachusetts launched a program that gives SNAP recipients extra money for every dollar they spend on fruits and vegetables grown by local farmers. More than 35,000 SNAP recipients in Massachusetts have taken advantage of the program, including people like Rebecca Martin, a single mother with disabilities from Northampton who purchases seedlings with her extra SNAP benefits and uses them to grow fruits and vegetables in a community garden near her home. Rebecca says the program not only boosted her family’s health and well-being but also helped her reverse a painful chronic condition.¹⁹

At the popular Birdhouse Farmers Market in Richmond, Virginia, SNAP participants can stock up on locally grown mushrooms, apples, kale, and other fresh veggies while participating in family activities like cooking demos and classes that teach them how to compost. Nearly half of the more than 225 farmers’ markets in Virginia are authorized to accept SNAP benefits. Thanks to a statewide program called Virginia Fresh Match, Birdhouse is among the farmers’ markets where SNAP dollars are worth double their value when they’re used to buy fruits and vegetables.²⁰

Across the country, in Michigan, another program has found a way to give incentives to SNAP recipients to eat healthier: For every $10 in food stamps they spend on locally grown produce, they receive a $10 coupon that enables them to buy additional fruits and vegetables of any kind. The program, called Double Up Food Bucks, was such a hit that it has spread to more than twenty-five other states, including Alabama, Arkansas, California, and North Carolina.²¹

All these programs serve a double purpose. They encourage low-income Americans to use their SNAP benefits for healthy foods instead of junk foods, and they increase business for America’s small farmers, who need all the support they can get (more on this in Chapter 15). Unfortunately, healthy incentives have not been a priority for the federal government. The 2014 Farm Bill, for example, contained just $100 million in funding (out of $70 billion) for these healthy incentives programs. While that may sound like a lot, it’s insignificant compared to everything else in the Farm Bill, like the billions in support to grow and insure commodity crops and animal feed. It’s also a drop in the bucket compared to the billions in SNAP money that pays for soft drinks and junk foods.

Imagine if all the supports the government poured into commodity crops and soft drinks were used to ensure that every city or town in America could provide locally grown produce to low-income families at little or no cost. Thankfully a group of experts at Tufts’ Friedman School of Nutrition Science and Policy did the math, and they found the following: Providing a 20 percent incentive for fruit and vegetable purchases to Medicaid and Medicare beneficiaries would prevent at least 1.93 million cardiovascular disease events and a net savings of $40 billion in health care costs. An even broader 20 percent incentive for nuts, fish, whole grains, and olive oil would prevent 3.31 million cardiovascular events and a net savings of $102.4 billion in health care costs after the cost of the healthy food incentives.²² Not bad for a bit of fresh food.

FOOD FIX: POLICY ACTIONS FOR FIXING SNAP

We know what needs to be done to fix SNAP—and there is surprising agreement across the political aisle. In March 2018, the Bipartisan Policy Center, a respected think tank that combines the best ideas from Democrats and Republicans, issued a report entitled Leading with Nutrition: Leveraging Federal Programs for Better Health on ways to improve SNAP.²³ The group came up with a series of recommendations, including some that I and others have long advocated for.

Make diet quality a core element of SNAP. Congress can add a diet-quality component to SNAP under the next Farm Bill or through a presidential executive order. Or the USDA could make a policy change and then check progress by tracking the nutrition content of SNAP recipients’ diets and publishing studies.

Eliminate sugary drinks from the list of items that can be purchased with SNAP benefits. As we’ve seen, virtually every major health organization—WHO, the CDC (Centers for Disease Control), the National Academy of Medicine, the USDA, and Health and Human Services—urges people to limit them. The average low-income adult consumes three servings of sugary drinks a day. Just one soda a day increases the risk of diabetes by 32 percent.²⁴ The USDA needs to promote healthy diets and improve the health of the poor by removing sugary drinks from the food stamps program. Right now.

Strengthen incentives for purchasing fruits and vegetables. Congress should up the paltry $100 million in the last Farm Bill for healthy incentives programs. How? By diverting subsidies for crop insurance and commodities to the programs we discussed in the last section that make fruits and vegetables more affordable and accessible. These programs should be available at farmers’ markets and large supermarkets and grocery stores in low-income neighborhoods. We know that combining restrictions on soda purchases along with incentives for buying fruits and veggies improves the nutritional quality of diets much more than either measure alone.²⁵ And a report from the USDA found that a majority of families using the SNAP healthy incentives programs reported buying larger amounts and greater varieties of vegetables as a result of it.²⁶

Authorize funding for the USDA to launch experimental new pilot programs. The small pilot programs that encourage SNAP users to purchase more fruits and vegetables have been so successful that Congress should authorize more funding for innovative programs for SNAP users. According to the Bipartisan Policy Center’s report, an investment of $100 million over five years would allow the USDA to pilot a range of other programs. The USDA could look at encouraging not only healthy eating but also sustainable diets and environmental change strategies and a program that delivers low-cost nutritious meals to SNAP users with disabilities and others with special needs.

Align SNAP and Medicaid. Many SNAP users are also Medicaid beneficiaries. Because poor diet is responsible for so many chronic conditions and procedures that drive up Medicaid costs, these two programs need to align. How about pilot programs using SNAP funds that deliver highly nutritious meals to SNAP and Medicaid recipients suffering from malnutrition, chronic disease, or disabilities that limit their ability to prepare home-cooked meals? Studies show that these kinds of services can improve health outcomes and reduce Medicaid costs.²⁷ Using SNAP to prioritize nutrition for Medicaid patients is just plain common sense. It can save lives and prevent billions of dollars in unnecessary medical costs.

On a more personal level of action, I urge you to ask your elected leaders about this. These are your tax dollars at work. Find out where your local member of Congress stands on SNAP reform. Are your elected leaders in the pocket of Big Food? Find out on Food Policy Action’s website if they vote for Big Food or for you. You can look up your member of Congress and their voting records on food and agriculture issues. Find out if they have the courage to stand up to the big moneyed interests. And if they are failing on this issue, write to them or tell them about it at your next town hall. Tell them you want your tax dollars to be better spent. Reforming SNAP will improve the health of millions of Americans, and it will help reduce the enormous strain on our health care system.