For many years, I've been criticizing the Supplemental Nutrition Assistance Program (SNAP), which was, back in the day, called the food stamps program. This is a program that's long overdue for a major overhaul; it arguably does more harm than good. The incentives are all wrong, and as we have seen illustrated with shocking clarity in the last couple of years, it's rife with fraud.
One of the major problems with the SNAP program is that it allows the purchase of too much junk. Any such food assistance should be severely limited to lean portions of healthy foods; before anyone cries out, "Oh, you can't tell people what they can and can't eat," the obvious reply is "...if I'm paying for it, I can and I will."
Now we have another reason to overhaul (or eliminate) this ill-founded program: It's making people sick. Edward Archer, PhD., MS., has some compelling arguments for the harm SNAP is doing to its recipients.
For most of human history, the rich were well-fed and rarely worked whereas the poor were often overworked and underfed. Yet in 21st century America, many of our poorest citizens resemble the rich of the past because they rarely work and suffer from the ‘Diseases of Affluence’ — obesity and diabetes (Fig. 1). This unprecedented reversal in the relation between labor, diet, and disease is an unintended consequence of America’s ‘War on Poverty’.
When our nation’s poor were overworked and underfed, it was sound public health policy — morally, physiologically, and economically — to provide food and material support. However, as my research shows (see also here, here, and here), giving ‘free food’ to non-working (sedentary) people is not only an exercise in misplaced empathy but an unmitigated public health disaster.
The largest single health issue facing poor people in the United States is obesity. Any snippet of video taken in one of the poorer sections of any of our major cities will reveal that. And obesity alone is the source of many, many other health problems, from high blood pressure to diabetes to even immobility in extreme cases. With the SNAP program, American taxpayers are funding these problems, and given that the people on these programs are generally also on some taxpayer-funded health program, we're paying for their illnesses, too.
By not understanding the causal relations between physical activity, diet, and metabolic health, the US government spent trillions of dollars over the past 50 years causing cardiometabolic diseases such as obesity, diabetes, and heart disease in our poorest citizens — and will spend many trillions more treating these diseases with pharmaceuticals like GLP-1s.
This is key. I've been saying and writing for years that this program needs, at the very least, a serious overhaul. The Trump administration, most notably Health and Human Services under Robert F. Kennedy Jr., has been trying to at least nibble at the edges of reform by disallowing things like candies and sugary drinks. Still, clearly we need to cut much deeper. I've advocated for years replacing the existing system completely with community food banks, where any person who now qualifies for SNAP can go and receive a weekly ration: Rice, dry beans, potatoes, lean chicken or turkey, milk, and cheese if there are children in the household. Recipients who do not live near a food bank get a voucher to receive the same ration at a local grocer; the voucher would be an 8 1/2" by 11" printed coupon plainly marked "Supplemental Nutrition Assistance Food Voucher." Embarrassing? Yes. Remember, incentives matter.
If we are to start making America healthy again, this is an important step. And, surprisingly, as Dr. Archer points out, we have an interesting example just off our coast - in Cuba, of all places.
The collapse of the Soviet Union in 1991 reduced Cuban foreign trade by 80 percent. This led to severe shortages of fuel, food, and essential supplies. As a result, the number of calories consumed per person per day plummeted from ~2900 in 1989 to ~1940 in 1993. And as Cubans were forced to ‘eat less’, they were also forced to ‘move more’. Shortages of diesel and gasoline increased walking and cycling such that the number of physically active adults doubled (from 30 percent to 67 percent of the population).
This natural experiment in ‘moving more & eating less’ caused reductions in diabetes mortality by 51 percent, ischemic heart disease by 35 percent, stroke by 20 percent, all-cause mortality by 18 percent — and reduced the prevalence of obesity by 50 percent. For a real-world comparison, GLP-1s reduce cardiometabolic disease mortality by less than 3 percent.
I hesitate to point to Cuba as an example of policy, but in this case it was an unwilling policy change forced by the collapse of their patron state, the Soviet Union, and any positive effect was unintended and unavoidable. But the results are there: Reduced calorie intake and increased exercise, and a concomitant reduction in obesity-related diseases.
There's really no way to make the sedentary poor get off their butts and walk more. But we can deal with their food issues. If a poor family qualifies, they get a ration of lean, healthy foods. Nothing fancy. Nothing pre-prepared, including "take and bake" items. Nothing sugary. No candy, no sugary drinks, no chips, no junk food, no kidding. If anyone wants any of those things, they pay out of pocket, or they get a job.
It's a major stated goal of the Trump administration to Make America Healthy Again. Dealing with this plague of obesity and all the problems that come with it would be a great place to start, and that begins by overhauling how we provide food assistance.
