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 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 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 implemented during the height of the COVID-19 pandemic.

In an earlier Forefront article 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, 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;
The 2021 Child Tax Credit reduced household food insufficiency.

And,

Several countries in the Americas including Chile and Mexico have shown how front-of-package warning labels and accompanying marketing restrictions can teach children and families to make better choices;
Sodium and sugar reduction efforts in South Africa and voluntary standards from the New York City National Salt and Sugar Reduction Initiative (NSSRI) show the importance of setting targets and timelines to keep industry accountable.

Such policies can help shift people away from ultra-processed products 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 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 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 to get access to curated newsletters written by health policy experts on topics like social determinants, health equity, and more.

Today on Forefront, David Anderson and Coleman Drake discuss how changing the algorithm for default plan reassignment 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.

Carmel Shachar and coauthors consider future directions to fix the Family Glitch rule and suggest "big picture" initiatives to rebuild health care in the United States.

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