Guest newsletter written by Shu Wen Ng
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Thursday, November 17, 2022 | The Latest Research, Commentary, And News
From Health Affairs

Dear John,

Today's newsletter comes from the desk of Shu Wen Ng, associate
professor and distinguished scholar of Public Health Nutrition at the
Gillings School of Global Public Health, and faculty fellow of the
Carolina Population Center at the University of North Carolina at Chapel
Hill.

Food Assistance Incentive Programs

I am a health economist and public health nutrition policy researcher
focused on disease prevention and narrowing disparities via improved
health behaviors given financial, time, and biological constraints using
interdisciplinary tools and approaches.

For our paper in this month's issue, my coauthors and I estimated
differences in grocery purchase composition and expenditures
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among nearly 30,000 North Carolina SNAP enrollees who received a $40 per
month fruit and vegetable incentive, Healthy Helping, after the COVID-19
pandemic started compared to SNAP participants who did not receive such
an incentive.

Using transaction data from a large supermarket chain, we found Healthy
Helping enrollees had a $27 per month increase in and a doubling of
purchases of fruits, vegetables, nuts, and legumes.  Enrollees also
shifted the composition of food purchases in generally positive ways.

Program enrollees' spending at the supermarket chain increased by more
than the incentive amount ($57 per month), suggesting they shifted more
of their shopping to the participating retail chain during the
intervention.

Together, our findings suggests that these types of healthy incentive
programs can achieve double-duty action during a period of economic and
health uncertainty by improving the nutritional profile of grocery
purchases among a high-need population and by supporting local economic
development.

This adds to the literature to the success of the program. An earlier
policy brief
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found the prevalence of food insecurity among Healthy Helping
participants fell by 11 percentage points.

The Healthy Helping program involved the contributions of both
government and a local not-for-profit community-based organization and
is an example of one of the many innovative short-term relief programs
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implemented during the height of the COVID-19 pandemic.

In an earlier Forefront article
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with colleagues, we argue that some of the important and innovative
relief policy responses should be sustained until the adoption of the
next Farm Bill.

This measure would more adequately and permanently address
appropriations to support food and nutrition security and offer adequate
leeway for agencies to implement regulatory changes that build
resiliency in non-emergency times.

The pandemic made bare the wide-ranging disenfranchisement of low income
and historically marginalized populations from being able to attain food
security, safe housing and transportation, proper education, dignified
employment, and good health.

The recent White House Conference on Hunger, Nutrition, and Health and
its accompanying National Strategy
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called to focus the need for a multisectoral approach for sustained
action.

It is an ambitious but achievable strategy that needs to be followed by
real action and accountability.

Many of the proposed policies in the National Strategy are already
backed by evidence from within the US and across the globe.

For example, it is well established:
* School meals with higher nutritional standards have been shown to
reduce hunger and improve learning
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* The 2021 Child Tax Credit reduced household food insufficiency.
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And,
* Several countries in the Americas including Chile and Mexico have
shown howfront-of-package warning labels
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and accompanying marketing restrictions
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can teach children and families to make better choices;

* Sodium <[link removed]> and sugar
reduction <[link removed]> efforts in South
Africa and voluntary standards from the New York City National Salt and
Sugar Reduction Initiative
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(NSSRI) show the importance of setting targets and timelines to keep
industry accountable.

Such policies can help shift people away from ultra-processed products
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that are high in nutrients linked to poor health outcomes like diabetes,
hypertension, and cardiovascular diseases.

To shift consumption toward healthier options, there is also a need to
make them affordable, especially to lower income people.

The USDA's GusNIP program
<[link removed]>
has shown that expanded incentives for fruits and vegetables in SNAP
increases their purchases in terms of amounts and variety, as does new
evidence on increasing fruit and vegetable cash value benefits
<[link removed]> for WIC.

There is a further need for pilots to test the expansion of these
incentives beyond fruit and vegetables to other healthy items such as
whole grains and healthy proteins and oils.

Implementing pilots to test for new innovations and their scalability
and then implementing policies informed by evidence will require
significant investments.

These investments include re-engineering the broken system to center
equity to ensure resilience for emergency and non-emergency times and
most importantly into the children, adults, elderly, native-born,
migrants, and people of every political stripe, who reside in the
country seeking dignity, health and opportunities to do better.

These investments should be made wisely but should not be a partisan
issue.

If you enjoyed reading today's newsletter takeover by Shu Wen Ng, join
Health Affairs Insider
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to get access to curated newsletters written by health policy experts on
topics like social determinants, health equity, and more.

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Elsewhere At Health Affairs

Today on Forefront, David Anderson and Coleman Drake discuss how
changing the algorithm for default plan reassignment
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on the Marketplace to prioritize plans with zero premiums could enable
many people to maintain coverage without the burden of paying premiums.

Troyen Brennan and Aaron Kesselheim examine how patient assistance
programs can prop up high prices for medications
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Carmel Shachar and coauthors consider future directions to fix the
Family Glitch rule
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and suggest "big picture" initiatives to rebuild health care in the
United States.

Enjoying Forefront <[link removed]> articles?
Bookmark our website to never miss an update.

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How well do you know health policy?

Every week, we'll send out a quiz question covering Health Affairs
history and health policy trivia. Test your knowledge today on the
question below:

What does the No Surprises Act accomplish in health care?

Answer <[link removed]>

Daily Digest

Grocery Purchase Changes Were Associated With A North Carolina COVID-19
Food Assistance Incentive Program
<[link removed]>
Caitlin M. Lowery et al.

Rethinking Marketplace Automatic Reenrollment Algorithms
<[link removed]>
David Anderson and Coleman Drake

Accumulators And Maximizers: A New Front In The Battle Over Drug Costs
(Part 1)
<[link removed]>
Troyen Brennan and Aaron Kesselheim

The Family Glitch, Premium Stacking, And The Need To Revisit Health Care
Reform
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Carmel Shachar et al.

 

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mailto:[email protected]

About Health Affairs

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