A "Menu" of Policies to Improve Diets


Jacob A. Klerman
Principal Associate, Social & Economic Policy
 

Lauren Olsho
Principal Associate, U.S. Health
The Supplemental Nutrition Assistance Program (SNAP) and American nutrition assistance programs more broadly are intended to eliminate hunger and improve diet. However, American diets in general are poor; we consume too few fruits, vegetables, and whole grains. The diets of SNAP participants are no better, and perhaps worse.

A recent special issue of the American Journal of Preventive Medicine includes three articles by Abt researchers considering the likely effects of three different, but complementary, approaches to improving the diets of SNAP participants. The articles’ policy insights build on two recent Abt studies: The Healthy Incentives Pilot (HIP) and the Summer EBT for Children Demonstration (SEBTC). These studies provide the strongest possible scientific evidence for making policy: They compare outcomes for very large samples of otherwise similar households, some of which were randomly assigned to a policy innovation, while others did not have access to the policy innovation. Across these two studies, findings about three possible policy approaches stood out.

1. More food assistance. Good food is expensive. Perhaps more food assistance would improve diets while also reducing hunger. In half of the places implementing SEBTC, income-eligible households with children received additional food assistance during the summer based on SNAP rules. The additional food assistance benefits could purchase almost any foods—both good foods and less healthy ones.  These households reported much lower levels of severe and moderate food security (a third and a fifth, respectively).  They also increased their intake of good foods, but not by much. On average, households received about another $100 per month of food assistance (about a quarter of the SNAP benefit among participating households receiving SNAP). This additional food assistance increased children’s intake of fruits and vegetables by 6% and whole grains by 10%.
 
2. Assistance to increase the purchase of “good foods.” In the other half of the places implementing SEBTC, income-eligible households whose children were out of school for the summer received similar amounts of additional food assistance based on the Special Supplemental Nutrition Program for Women, Infants, and Children Program (WIC) rules. Benefits could purchase specified quantities of foods selected for their nutritional value.  These households who received the benefit based on WIC rules had improvements in food security similar to households who received the benefit based on SNAP rules.  However, receiving the benefit according to WIC rules increased intake of healthy foods a lot, and much more than those households receiving a similar benefit based on SNAP rules. An average benefit of about $100 per household per month increased school aged children’s consumption of fruits and vegetables by 20% and whole grains by 43%. The value of the additional assistance under SEBTC-WIC and SEBTC-SNAP interventions was approximately the same, so comparisons of outcomes can be interpreted as the pure effect of a requirement to use existing food assistance to purchase good foods. The results suggest that requiring that the assistance be spent on good foods sharply increases intake of good foods—twice as much, three times as much, or more.
 
3. Rebates for purchasing “good foods.” The HIP provided SNAP households with a 30% “rebate” for the purchase of fruits and vegetables, substantially lowering the cost of some good foods. However, impacts were moderate; adult fruit and vegetable intake increased by about a third of a serving (14%).

These three papers (see the end of the blog post) provide strong research evidence about the likely impacts of these three policy approaches. Each has advantages and disadvantages.

The bottom line?

More assistance substantially improves food security. More assistance also provides some increase in intake of good foods. Rebates provide a large increase, and requirements the largest increase.

Providing more food assistance is expensive. In as much as people use the rebates, they will be expensive, too. In contrast, beyond some minor administrative costs, requiring people to use some portion of their current SNAP benefit to purchase good foods would have no additional benefit cost.

However, while the goal of improving nutrition is laudable, requirements are coercive. Opinions differ as to whether such coercion toward a better diet is appropriate—in general and especially when only the poor are being coerced.

As a society, we thus face a choice. Are the improvements in nutrition enough to justify the coercion?
 
Read more about the three articles:  
 
The AJPM articles
  • Collins, Ann and Jacob Alex Klerman. 2017. “Improving Nutrition by Increasing SNAP Benefits.” Special Issue of American Journal of Preventive Medicine
  • Olsho, Lauren, Jacob Alex Klerman, Susan Bartlett, and Chris Logan. , 2017. “Rebates to Incentivize Healthy Nutrition Choices.” Special Issue of American Journal of Preventive Medicine.
  • Klerman, Jacob Alex, Ann Collins, and Lauren Olsho. , 2017. “Improving Nutrition by Limiting Choice in SNAP.” Special Issue of American Journal of Preventive Medicine.  
 
Project Final Reports  
Other Journal Articles
  • Klerman, Jacob Alex, Anne Wolf, Ann Collins, Stephen Bell, and Ronette Briefel. Forthcoming 2017. “The Effects the Summer Electronic Benefit Transfer for Children Program has on Children’s Food Security.” Applied Economic Perspectives and Policy.
  • Gordon, Anne R., Ronette Briefel, Ann Collins, Gretchen Rowe, and Jacob Klerman. 2016. “Delivering Summer Electronic Benefit Transfers for Children (SEBTC) Through SNAP or WIC: Benefit Use and Impacts on Food Security and Diet Quality.” Journal of the Academy of Nutrition and Dietetics.
  • Olsho, Lauren, Jacob Klerman, Parke Wilde, and Susan Bartlett. 2016. “Financial incentives increase fruit and vegetable intake among SNAP participants: a randomized controlled trial of the USDA Healthy Incentives Pilot.” American Journal of Clinical Nutrition.
  • Olsho, Lauren E.W., Jacob Alex Klerman, Lorrene Ritchie, Patricia Wakimoto, Karen L. Webb, Susan Bartlett. 2015. “Impacts of the USDA Fresh Fruit and Vegetable Program on Child Fruit and Vegetable Intake.” Journal of the Academy of Nutrition and Dietetics. 115 (8), 1283-1290.
  • Klerman, JA, L Olsho, K. Lawrence, and S. Bartlett. 2014. “Regression Discontinuity in Prospective Evaluations: The Case of the Fresh Fruits and Vegetables Program.” American Journal of Evaluation.
  • Klerman, Jacob, Parke Wilde, Susan Bartlett, and Lauren Olsho. 2014. “The Short-Run Impact of the Healthy Incentives Pilot on Fruit and Vegetable Intake.” American Journal of Agricultural Economics
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