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Food Policy: A focus for professionals from many backgrounds

Researchers from the University of Nevada note that in the span of one generation, Native American food problems changed from one where children were often smaller and thinner than peers to one where obesity-related illnesses were an issue (http://digitalscholarship.unlv.edu/cgi/viewcontent.cgi?article=1050&context=env_occ_health_fac_articles). They correlate this to the food commodity programs, noting that food was more readily available but it was food that was very different than what was traditionally eaten by these populations: more sugar, more fat, less fiber.

The diabetes epidemic, more extreme in the Native population than in the U.S. population as a whole, has been blamed on an influx of foods like refined sugar, white flour, and potatoes, and also on the loss of traditional foods, some of which are believed to have offered specific protection. (Nopal cactus, once consumed by Native peoples of the Southwest, is now taken in supplement form as a blood sugar regulator.)

Nutrition is more than calories; malnutrition is more than the lack thereof. In the United States and around the world, there is a tendency for traditional malnutrition to be replaced quickly with obesity. Much of what people are eating today is higher in calories but lower in nutrition and satiety than what their ancestors thrived on, and different populations are affected to different degrees.

Governmental organizations have a unique role. Because they help feed so many, their policies can compound issues or help solve them. In addition to managing the Food Distribution Program on Indian Reservations (FDPIR), governmental units administer the following:

  • Supplemental Nutrition Assistance Program (SNAP): The program formerly known as food stamps, allows low-income people to pay for food purchases with a debit card.
  • Women, Infants, and Children (WIC): This program serves pregnant women, new mothers, and children up to age five.
  • Emergency Food Assistance Program (TEFAP): This national program distributes foods to state organizations (often food banks); what's available depends on what surpluses have been bought.
  • National School Lunch and National School Breakfast Programs: These programs offer free meals to some children, reduced cost meals to others.
  • Child and Adult Care Food Program: CACFP program provides food for child and adult care programs.

The degree of regulation – when approached from a nutritional standpoint -- varies widely. Policy makers and public health professionals alike are asking themselves when are they increasing strength and disease resilience and when they are simply adding calories. Program impact depends not only on population and program but also, in many cases, on the way in which the individual state implements the program. Even minor changes in policy matter. Policy makers must know when to restrict options, when to incentivize, when to educate, and when to increase funding or improve quality.

Nutrition Policy Successes

In a nation where obesity seems to be spiraling ever more out of control, some programs are seeing successes. Take WIC, which combines nutrition education with vouchers that are used to purchase specific types of food. A particular credit may be used only for purchases of beans or peanut butter, another only for approved whole grain products. According to the State of Obesity, 31 states have seen declines in obesity rates among two- to four-year-old program participants (http://stateofobesity.org/wic/).

SNAP represents the opposite regulatory extreme. It classifies candy, soda, and pastry as food and makes them just as eligible as other foods. SNAP does have an educational component, with public health professionals in different states focused, in slightly different ways, on helping low-income populations improve their food choices.

Of particular interest to health professionals are sugary beverages: food products disproportionately implicated in the rise of both obesity and diabetes (https://www.hsph.harvard.edu/nutritionsource/sugary-drinks-fact-sheet). Researchers from Stanford and the University of California modeled the effects of such a ban, concluding that it would lead to significant reductions in both conditions (http://content.healthaffairs.org/content/33/6/1032.abstract).

The Illinois Public Health Institute reached a different conclusion. While they did not deny the adverse health effects of sugary beverages -- noting strong evidence for their contribution to everything from cavities to chronic illness – their recommendations did not include an out-and-out ban. SNAP benefits, after all, vary according to need. The Illinois-specific study found that a majority of SNAP users spent some of their own money on food – and that their out-of-pocket spending was greater than the average amount spent on sugary beverages.

One of the many recommendations put forth: piloting a combined ban/ incentive policy whereby people could choose to stay on the current program or voluntarily enroll in one that did not cover sugar sweetened beverages but did provide extra money to be used on healthy products. Another potential strategy was one that targeted the whole population: an excise tax on sugary beverages, one that would be large enough to decrease consumption.

The SNAP to Health Initiative brings together many experts, representing disciplines such as public health, health policy, and nutrition epidemiology (the latter being the study of nutrition as it relates to the etiology of disease).

Complex Issues

A 2010 Hearing to Review the Food Distribution Program on Indian Reservations brought together diverse voices. The transcript illustrates the complex issues surrounding implementation of even a single program (https://www.gpo.gov/fdsys/pkg/CHRG-111hhrg57927/html/CHRG-111hhrg57927.htm). Among the points noted:

  • That the commodity foods now offered are different than what was offered in decades past, with some former offerings removed because they do not meet nutrition guidelines
  • That some participants are switching to SNAP, which provides less nutritional control
  • That Native peoples could benefit from more offerings that reflected their traditional diet (which for some would include salmon and cranberries)

Food policy continues to be a focus for professionals from many backgrounds. The Food Research & Action Center (FRAC) advocates for better food policy across programs (http://frac.org/). Among its successes: leading the 1980’s campaign that prevented ketchup and relish from being counted as vegetables by school lunch programs.

FRAC can provide information about a number of current issues.