Bridging the Gaps among Food and Farm Policy, Health, and Health Care Costs

After the House rejected its version of the Farm Bill, many are left wondering, what’s next for federal agriculture and nutrition policy?  During the final day of floor debate on June 20, the Bipartisan Policy Center (BPC) hosted a Bridge Builder Breakfast, convening stakeholders from across multiple sectors to discuss the role of federal food and farm policy, including the Farm Bill, in our current health and fiscal crisis. Just two days earlier, the American Medical Association took the step of classifying obesity as a disease, further sharpening the issues surrounding the health and financial consequences of obesity.

As we all know well, obesity rates have skyrocketed and fully two-thirds of American adults and one-third of children are overweight or obese. The rise in obesity and related chronic diseases burdens the delivery of health care and contributes to escalating health care costs, which are the primary driver of the U.S. debt. While historically health has not been a big part of the discussions around food and farm policy, it is time to better integrate these siloed conversations given the significant impact of federal food and farm policy on our diet, health, and health care costs.

The BPC forum, “Food and Farm Policy: Impacts on Health and Health Care Costs,” brought together experts to do just that: begin to integrate issues of health and health care costs into the debate around food and farm policy, including the current farm bill. BPC was pleased to welcome a diverse and impressive group of panelists: Jillian Fry, Project Director at Johns Hopkins Center for a Livable Future; Robert Guenther, Senior Vice President of Public Policy at United Fresh Produce Association; Katherine (Kate) Houston, Director of Government Affairs at Cargill Inc.; Eric Olsen, Senior Vice President of Government Relations at Feeding America; and Representative Charles Stenholm, Former Representative from Texas and Senior Policy Advisor at OFW Law. Former Deputy Secretary of Agriculture Kathleen Merrigan provided a keynote address, and BPC’s co-chairs of the Nutrition and Physical Activity Initiative, former Secretaries of Agriculture Dan Glickman and Ann M. Veneman, provided opening and closing remarks. Key themes from the discussion included the need to create a forum for reasoned cross-sector dialogue about the promotion of good nutrition in food and farm policy, the importance of increasing consumer demand for nutritious foods to drive farm and industry production, and the role of consumer-facing incentives and restrictions in federal food policy.

In his opening remarks, Secretary Glickman summarized the impact of food and farm policy on our health: “What we grow, sell, and consume affects our health in a variety of ways, and through our food and farm policies, whether we’re talking about federal feeding programs, farm subsidies, crop insurance, or dietary guidelines, federal policy plays a big role.”  Deputy Secretary Merrigan highlighted the “lost opportunity…around nutrition” in the current Farm Bill debate and challenged stakeholders to identify win-win opportunities for food and farm policy and health. “I didn’t really see a debate around…the synergies that are there between the nutrition programs and farm programs and the opportunities to make this a whole different game.”

Panelists were unanimous in their call for increased dialogue on these issues, particularly at the Federal level, and the need to make nutrition a higher priority in food and farm policy. Former Representative Charlie Stenholm suggested that “Having this panel in front of a subcommittee on nutrition in the House would have been very productive” which Secretary Veneman echoed in her wrap up, asking:  “Why can’t we sit down and have the hearings, have the debate about what nutrition policy should really be in this country?  I agree with what Kathleen [Merrigan] said, there really has been a lost opportunity to talk about nutrition in this debate and in this country.”  The food industry also stands to benefit from making nutrition a greater focus. As Kate Houston of Cargill remarked, “There’s a great opportunity to say, how do we find ways to keep food affordable, to keep food convenient and also make it nutritious?”

At BPC, we seek to highlight the role of nutrition and physical activity in promoting health, preventing disease, and containing health care costs. We believe it is critical to evaluate how agriculture and nutrition policies can support that role and identify opportunities for realignment where needed. The event reinforced several recommendations from our Nutrition and Physical Activity Initiative’s June 2012 report, Lots to Lose: How America’s Heath and Obesity Crisis Threatens our Economic Future. Among its 26 recommendations on ways to make families, schools, workplaces, and communities healthier, the report identified strategies to better align agriculture and nutrition policy to reflect and support dietary guidelines.*

One opportunity discussed in our report and by event panelists was the nation’s largest nutrition assistance program–the Supplemental Nutrition Assistance Program (SNAP), formerly known as the Food Stamp Program. Recently, there has been increased discussion of ways to improve the nutritional profile of this program which serves nearly 48 million Americans. Panelists debated various ideas ranging from education through SNAP-Ed to consumer incentives for purchasing fruits and vegetables to restrictions on unhealthy foods. The notion of restrictions has been a hot button issue. USDA has supported some incentives programs, such as Double Up Food Bucks in Michigan and the Healthy Incentives Pilot in Massachusetts, but has denied a New York State request for a waiver to add sugar-sweetened beverages to the unallowable purchase list with SNAP.

In general, panelists were more supportive of incentivizing healthy foods as opposed to restricting unhealthy foods. Jillian Fry of Hopkins observed that restrictions could unfairly target SNAP participants, “We don’t want to demonize a certain population of people.Obesity and overweight exist at every income level in our country.” Eric Olsen from Feeding America added that restrictions such as those seen for pregnant and nursing mothers and young children in the WIC program would not be appropriate for SNAP beneficiaries. “WIC is aimed at a targeted population with specific nutritional needs…whereas SNAP serves a general population.”

In our June 2012 report, we noted the need for a comprehensive study and evaluation of actual SNAP purchases (rather than self-reported survey data) in order to better understand food purchasing patterns and assess the implications of proposed changes in program design. A first step would be to require retailers to report data on purchases in a manner that addresses privacy concerns. Many large retailers already collect such purchasing data, however, USDA currently only requires retailers to report the total amount for reimbursement, rather than specific items purchased.

There are many challenges with attempting to improve SNAP, both administratively and nutritionally; however, there has been insufficient effort to explore these opportunities at the Federal level. As Robert Guenther noted, “This [legislative] debate has been too focused on cuts.”  In focusing on the budget, we neglect discussion on how to improve the nutritional characteristics of the program. The great reach of our federal nutrition programs, such as SNAP and WIC, provides an opportunity to improve the nutrition and health of these millions of participants. Furthermore, alignment of nutrition assistance programs with the federal dietary guidelines could result in changes to the food system more broadly and thus could improve the nutrition and health of Americans outside of these programs as well.

This potential for systemic change rests on the answer to a key question: Are the goals of federal food and farm policy solely to keep people fed and ensure a strong farm sector, or is the goal to also provide for better nutrition and health?  While BPC and our panelists strongly agree on the latter, many other tough questions must be answered as our nation determines how to best meet that objective. For example, how can we elevate nutrition as a key priority during tough decisions regarding food and farm policy?  Should nutrition assistance programs like SNAP remain a part of the Farm Bill, which is balancing allegiances to rural agriculture and urban nutrition interests?  If all Americans eat as recommended by the Dietary Guidelines for Americans, how do we ensure sufficient, affordable domestic production to meet demand?  And finally, how can we create a new culture around healthy eating so that consumers are more likely to choose healthier foods?

Moving the needle on obesity, chronic disease, and high health care spending is going to require a multipronged approach where nutrition is widely viewed as a priority in food and farm policy. While the Farm Bill is an important part of this conversation, it is not the only determinant of our nation’s food and farm policy or what we eat. We plan to continue engaging cross-sector stakeholders to assess efforts to ensure an adequate, affordable, and nutritious food supply and advance strategies for further progress in the public, private, and non-profit sectors. The future of our health, our health care system, and our economy depend on it.

Click here to view video of the event.

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* Our report’s specific recommendations included:

1. USDA, in collaboration with other stakeholders, should identify and address barriers to increasing the affordability and accessibility of fruits, vegetables, and legumes. 
2. Congress should continue sustained support for relevant research by offices of USDA to provide the information necessary to determine the impacts of food and farm policy.
3. USDA should identify and pursue additional opportunities to promote health and nutrition through its nutrition assistance programs and ensure that all its nutrition assistance programs reflect and support federal dietary guidelines.