Sara Bleich: Ideas for Flattening the Hunger Curve

This interview is part of a cross-disciplinary series examining the real and possible effects of the COVID-19 crisis.

Sara Bleich is the Carol K. Pforzheimer Professor at the Radcliffe Institute, a professor of public health policy at the Harvard T.H. Chan School of Public Health, and a member of the faculty at the Harvard Kennedy School of Government. Her research provides evidence to support policies aimed at preventing obesity and diet-related diseases, particularly among high-risk populations. She was a 2015–2016 White House Fellow, serving as a senior policy advisor to the US Department of Agriculture and the First Lady’s Let’s Move initiative, and has received competitive awards from organizations such as the National Institutes of Health and the Robert Wood Johnson Foundation. She is an appointed member of the National Academies of Sciences, Engineering, and Medicine’s Roundtable on Obesity Solutions. 

In a recent survey of US households by the Brookings Institution, nearly one-fifth of mothers with young children in the United States say their kids are not getting enough to eat, a rate that is three times as high as the worst of the Great Recession. What could federal lawmakers do right now to help?

To help mothers with young children get enough to eat right now, two things federal lawmakers can do are make changes to the Supplemental Nutrition Assistance Program (SNAP), sometimes known as food stamps, and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), both administered by the US Department of Agriculture (USDA). SNAP is by far the largest federal nutrition safety net program, serving 38 million people in the United States—nearly half of whom are children—and providing monthly financial assistance to purchase food. SNAP serves as an automatic stabilizer during economic downturns: as incomes fall and more people become eligible for the program, spending increases. WIC assists more than 6 million women and young children monthly—including roughly half of all infants born in the United States—and provides supplemental food and beverages which can be thought of as a nutrition prescription program. 

Key changes that would help families include:

• Increasing monthly SNAP benefits by 15 percent ($100 per month for a family of four). This is because the assumptions used to calculate monthly benefits are unrealistic, and current SNAP benefit levels are insufficient for participants to afford nutritious food throughout the month.
• Expanding the ability to use SNAP and WIC benefits online. SNAP benefits can currently be used online in only 13 states and the District of Columbia, while WIC benefits can be used online in only 11 states and the District of Columbia. This will dramatically increase food access, potentially offer more competitive pricing, and mitigate concerns about viral exposure in stores.
• Increasing WIC benefits by boosting the fruit and vegetable cash value vouchers, which currently range from $8 to $11. This would support healthy dietary intake and development during the pandemic. 

These changes are critical; families should not have to worry about feeding their children when trying to balance homeschooling and teleworking against a backdrop of unprecedented food supply issues and economic disruptions. Congress has already made some key changes to both SNAP and WIC in response to COVID-19. Changes to SNAP include providing funds for all SNAP households up to the maximum benefit for two months ($646 for a family of four; known as emergency benefits); providing SNAP households with children with approximately $114 per child per month (known as pandemic-EBT); a $15.8 billion appropriation for expanded SNAP enrollment due to rising unemployment; a temporary suspension of work requirements for able-bodied adults without dependents; and state waivers to allow for re-enrollment flexibilities. Key changes to WIC include a $500 million appropriation to support increased enrollment as well as state waivers to facilitate enrollment, benefit issuance, and food package substitutions.

It is also important to bear in mind that many school districts across the country are doing amazing things to provide nutritious meals to schools under these pandemic conditions. 

In the absence of additional federal legislation, are there ways that state leaders can step in? And what about federal agencies? Are there levers that the USDA and other agencies can pull without having to go through Congress?

States play a critical role in our nation’s social safety net. Welfare reform in 1996 and subsequent legislative and regulatory changes gave states increased administrative discretion over SNAP and other programs. In analysis of state-level SNAP policies from 1996 to 2014, the USDA found significant variability related to eligibility, transaction costs, stigma, and outreach. When we look at school-based federal nutrition assistance programs, we also see tremendous state and local variance. 

During the COVID-19 crisis, we are seeing differences in state approaches to federal nutrition assistance, through meal-provision guidance provided during school-closure announcements; through waivers sought from the USDA; and through communication and outreach. The more progressive states are maximizing the provisions and flexibilities provided and mobilizing their partnerships with local authorities, industry, and anti-hunger groups, among others, for targeted services such as meal delivery.

The USDA and Health and Human Services (HHS)—individually and collectively, along with other federal departments and agencies—have tremendous ability to provide technical assistance and capacity-building during this time. This work has and should include more efforts to quickly identify and raise up what’s working and disseminate these best practices across the nation. Through existing and forthcoming grant mechanisms, the USDA and HHS also have the ability to support time-sensitive research and evaluation that would have the greatest potential to address our country’s food security and chronic disease prevention needs. 

One of the most immediate needs for children is the USDA Summer Meals Program. This program reaches only 16 percent of children that receive federal food and nutrition assistance during the regular school year, or less than one-sixth of children that receive free or reduced-price meals during the school year. After two to three months of missed meals from schools, we need to do better, and the USDA, among other departments, has existing authority to improve participation this summer and develop innovative partnerships to also enhance enrichment and physical activity.

It’s not entirely surprising that the pandemic has led to an increase in food insecurity—tens of millions of people have filed for unemployment over the past several weeks. But were there things we could have been doing to provide more support? How does the safety net of today compare with that of 10 years ago?

SNAP is a proven policy approach to reduce food insecurity, and it is by far the largest federal nutrition assistance program. Therefore, the single biggest thing that could have been done to provide more support would have been to increase the size of the overall SNAP benefit. During a crisis, SNAP is also one of the easiest and fastest ways to get money into the hands of low-income Americans—benefits can be easily adjusted because recipients get them on a debit card.

In terms of how the safety net today compares to 10 years ago, it was smaller prior to the start of COVID-19. SNAP enrollment was 40 million in 2010, compared with 38 million today. It is lower now because SNAP is designed to expand during economic downturns and contract when the economy improves. SNAP participation increased by 76 percent from 2007 to 2014, hitting a high-water mark of 46.5 million. The increase was due to both more people being eligible and greater participation among eligible people (participation increased from 69 percent in 2007 to 83 percent in 2014). SNAP participant enrollment has increased by at least 40 percent since the start of COVID-19 and is expected to rise significantly more. WIC is similarly designed to be responsive to the economy. In 2010, participation in WIC was above 9 million and now it is above 6 million. Like SNAP, enrollment in WIC is expected to increase considerably due to COVID-19.

It’s important to keep in mind that the Trump administration developed three rules aimed at reducing SNAP enrollment, including a measure covering stricter work requirements. A federal court halted this rule from taking effect, and work requirements have been suspended by Congress in response to the pandemic. The Public Charge Rule, among other immigration policies, has had and might continue to have a chilling effect on participation in federal food and nutrition assistance programs. This context is important to keep in mind as we try to evaluate food security and federal nutrition assistance during and after COVID-19.

There can be a stigma around hunger—as if you’re an outcast if you don’t have enough to eat. But the numbers and the reporting suggest that COVID-19 is driving food insecurity into the mainstream. It’s awful; more people are suffering. But could this development also be a catalyst for change?

Going into COVID-19, food insecurity—lack of reliable access to nutritious food—affected 11 percent of the country. Among low-income families, food insecurity was at about 30 percent prior to the pandemic. In the next year, one in four children (18 million) is expected to experience food insecurity. There is no question that COVID-19 will drive food insecurity into the mainstream, which may very well catalyze important change to the large nutrition assistance programs. If the overall SNAP benefit were permanently (or even temporarily) increased by 15 percent, that would be a significant silver lining to the pandemic.

What do the data say about outcomes for children who grow up hungry? Are there effects in development, education, job, relationships, etc.?

Inadequate nutrition can leave young children with permanent developmental damage. Specifically, food insecurity for children is associated with increased risks of birth defects, poor health (e.g., asthma), lower nutrient intakes, cognitive problems (e.g., aggression), mental health programs (e.g., depression), and hospitalization. Research suggests that parents or primary care givers protect their children from compromised dietary quality during food shortages, but this pandemic might be particularly long and harsh for many families. Equally problematic, food insecurity often co-occurs with being overweight. There are many commentaries and studies examining how COVID-19 may exacerbate childhood obesity during this unprecedented time of school and park closures, missed meals from schools that are generally healthier than meals served at home, and the social and emotional trauma associated with the pandemic.

Interview was edited for length and clarity. 

Read more about Sara Bleich’s research in the Winter 2019 issue of Radcliffe Magazine.