March 28, 2025 • 16 mins
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Health Affairs' Jeff Byers welcomes Seth Berkowitz of UNC School of Medicine back to the program to discuss nutrition in the US, the current state of SNAP benefits, and his upcoming paper to be featured in our April 2025 theme issue on food, nutrition, and health.
Preorder the April 2024 theme issue of Health Affairs.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Jeff Byers (00:39):
Hello and welcome to Health Affairs This Week. I'm
your host, Jeff Beyers. We'rerecording on 03/24/2025. Before
we begin, just as a heads up, wehave a theme issue on food,
nutrition, and health coming outin April. You may have noticed
an extra episode in your podcastfeed this week.
That's because we have a specialfour part podcast series leading
(01:01):
up to and through the release ofthe issue. The first episode is
on water insecurity. Check itand the other three episodes
out, and watch for the issue'srelease in early April. Also, as
a heads up, our next insiderevent is April 23 with Brady
Post on-site neutral payments.As a quick plug, today, I'm
joined by Seth Berkowitz fromUNC School of Medicine.
(01:24):
Seth used to write an insidernewsletter on social
determinants of health. He wrotean article in the said theme
issue on food nutrition health,will appear on Health Podicy to
discuss that paper, and joins ustoday to talk about SNAP
benefits. Seth, welcome back tothe program.
Seth Berkowitz (01:41):
Thanks so much for having me. I'm excited to be
Jeff Byers (01:43):
Yeah, so today we're gonna talk about SNAP benefits.
So Tennessee passed in the housethat built up ban candy and soda
purchases from SNAP benefits. SoI wanted to ask you, as someone
that looks at the intersectionof food and health, what is the
goal of such a ban, and is thiscontroversial? You know, I was
asking a leading question, whymight this be controversial? But
(02:05):
tell me it's controversial firstbefore I ask that.
Seth Berkowitz (02:07):
Yeah. I think I think this is I think this is
controversial, so I think you'reon on firm ground, saying that
there's a bit of a controversyhere.
Jeff Byers (02:14):
Well, what's the goal, and why is it
controversial then?
Seth Berkowitz (02:17):
Yeah, so the goal I think is the non
controversial part. So I thinkthe goal is, I guess I should
say the sort of ostensible goalor the stated goal, is to reduce
the use of SNAP benefits on foodproducts that are considered
less healthy, and then thereforereduce the overall consumption
of those products and improvehealth and and diet quality
(02:39):
overall. So that that's sort ofthe idea that I think
proponents, at least if takingthe arguments at face value, are
trying to lead you out. Two, Ithink it's controversial for two
reasons. So people who areopposed to these kinds of
proposals, think, will arguethat one, it doesn't seem to
actually be that effective inreducing consumption of these
foods.
(03:00):
And two, that there might besome ulterior motives that might
have to do with things likesocial control or a view of SNAP
as charity such that thesupposed benefactors can try to
exert more control over howpeople using the program expend
those resources and those kindsof things. I think that rubs a
(03:23):
lot of people the wrong way. Andso I think that's another sort
of source of controversy here inaddition to concerns about
whether it actually is likely toachieve the stated impact.
Jeff Byers (03:33):
Can you walk me through whether those kind of
things do actually achievethose? Because it seems those
are two different arguments,right, or two different ideas.
Seth Berkowitz (03:41):
As best we know, programs like this are very
unlikely to substantiallyimprove diet quality, or, you
know, reduce consumption of theprohibited items and those kinds
of things. And the reason thatI'm fairly confident saying that
is this is one of the few areasof health policy that we
actually have a randomized trialon. So there's a great
randomized trial that I was notinvolved in conducting, I think
(04:03):
was a really well done studydone by Lisa Harnack's group in
Minnesota. And so they tookpeople currently on SNAP, they
allocated them to various sortof permutations of benefit
design, some of which includedincentives for purchasing
healthier foods, some of whichremoved the ability to purchase
(04:26):
like sugar sweetened beveragesand candy bars and those kinds
of things, and then sort of anormal control condition. You
know, they found, as otherprevious studies had found, that
the incentive group actuallyworked well, so incentivizing
healthier food purchases doeslead to more purchase of those
things, which was good.
The group that sort of bannedthe, or removed the ability to
(04:46):
purchase certain foodsconsidered unhealthy did not
lead to changes in theconsumption of those foods. You
couldn't purchase them with thebenefits, but people could still
purchase them in other ways, theoverall change, overall
consumption went down. But Ithink importantly, the
participation in the program forthe people in group that
(05:06):
received the ban on some ofthese things was almost 10%
lower, 10 percentage pointslower than the other groups. So
not only did it not changeactual consumption, which is
what we think would lead toimprovements in health for the
people who continue toparticipate, but a lot of
people, a lot more people kindof dropped out altogether, and
so we're not getting benefits.So I think the likelihood that
(05:27):
it will actually improve overalldiet quality is low.
And I think there could well beunintended consequences where
people either don't utilize theprogram or don't utilize as much
of the program. And there couldeven be worse outcomes when you
put on these sort of extrastrictures and everything to the
way the program's run.
Jeff Byers (05:45):
Gotcha, gotcha. And just really quick, going back on
the control aspect of likecontrol of benefits, can you go
a little bit more into why thatmight be controversial?
Controversial? So we went intothe consumption.
Seth Berkowitz (05:57):
Yeah, so I think there a couple reasons. So I
mean, in my mind, the essence ofcharity is that it's
discretionary, right? So if youthink of what a church or a
private organization orsomething does, they kind of get
to pick and choose who they maywant to give programs to, what
they want to focus on and thosekinds of things. And that's
private sector and I think seemsfine. When you start talking
(06:20):
about like an actual governmentprogram, something that people
have a legal right to when theymeet the qualifying conditions
and those kinds of things,you're not really talking about
charity anymore.
And I think sort of part of ouroverall institutions of income
provision in The US, certainlysince the 1996 welfare reform,
have included a key role forSNAP as a way to support
(06:42):
people's food budgets andpeople's income when, you know,
they're in dire circumstances.You know, so adding on
additional restrictions andother things to that to, you
know, a group that are you'realready not we're already not
providing cash. You can't spendyour SNAP benefits on
everything. We already restrictthe way that the food purchase
is going to be spent. Famouslyin most states, can't purchase
it on hot foods or things thatare going to be consumed
(07:05):
on-site.
It's only for groceries and fooditems that you're meant to take
out of the store and thenprepare at home and things like
that. So there are alreadythings there. So adding on
additional restrictions, Ithink, strikes many people as
sort of going against thepurpose of the SNAP program to
sort of provide this foodassistance for people who are in
(07:26):
dire straits. I'll say maybejust, I don't know, to me this
is funny, I don't know if thelisteners will think it's a
funny anecdote, but sort of afunny anecdote, because these
kinds of discussions come up allthe time, and so I've had many
conversations like these overthe years, I was talking to
someone who's in this space, aresearcher in this space like I
am, and this kind of thing cameup, and I said, I don't think
these restrictions are veryworthwhile, and he said that,
(07:50):
well, we should put these on,people won't use their SNAP
benefits to buy sugar sweetenedbeverages or candy bars or those
kinds of things. I said, well,we could have even more health
benefits if we put thoserestrictions on what you can use
dollars to buy, right?
Mean, if only one in sixAmericans use SNAP to buy their
foods, but if 100% of Americansuse dollars to buy their food,
(08:11):
then we could have six times thebenefit. And he said, well, SNAP
is money from the government, sothat's okay to put restrictions
on, but I mean, puttingrestrictions on people's own
money, that's not okay. I waslike, my friend, I've got bad
news for you about where dollarscome from. They come from the
government as well, and youknow, we really think that this
(08:33):
would just be beneficial forpopulation health overall, but
we're not doing it just tocontrol a certain segment of the
population, then I don't see anyargument you could make about
what the health benefits ofrestricting snap purchases would
be that wouldn't also apply tohow dollars might be restricted.
Jeff Byers (08:50):
I'm going to throw out MAHA as far as like when
looking at potential MakeAmerica Healthy Again goals,
will such initiatives like thiscome more from states or federal
policy?
Seth Berkowitz (09:02):
Yeah, I mean, think there's broad recognition
that diet and nutrition play akey role in health, that diet
and nutrition in The US overallis not where it should be, and
that's a key contributor to ourrelatively poor population
health. I think a lot of peopleare getting behind the idea that
we need to do something aboutthat. I think there likely to be
(09:23):
action at the federal level inthat. It's been a priority
that's been expressed. However,The US is a very federalized
system, and so action from thestate and the federal, sort of
the national government canoccur in parallel.
And I think to the extent thatwe're just sort of catching the
zeitgeist here and saying, yeah,we really need to pay attention
to these issues, then we may seeit at the state level in
(09:46):
addition to the federal level.Often these things are kind of
complementary as well, right? Imean, one of the great things
about our federal system is, youknow, states are sort of
laboratories in some sense wherethey can experiment with
different policies that might,you know, get adopted and
implemented nationally, and so Ithink we'll see a lot of that,
you know, during this period aswell, there'll probably be some
(10:08):
federal initiatives, there'llprobably be some state
initiatives, those stateinitiatives might get taken
national when they're successfuland that kind of thing. So I
think we'll see it coming fromboth levels.
Jeff Byers (10:17):
Okay, great. So, speaking of that, we know when
you're talking about theintersection of food and health,
that food plays obviously a bigrole into the health of
individuals. You know, The USlife expectancy lags behind
other countries. I think there'slot of evidence on that. Like,
evidence and how does food playinto that?
Seth Berkowitz (10:36):
Yeah, so I think The US population health does
lag, life expectancy lags. Ithink we develop chronic
conditions earlier in life thanmany countries, and so the
number of years lived withchronic conditions is more even
in the setting of shorter lifeexpectancy, and I think diet
plays a key role in that.There's essentially no
(10:58):
demographic or income group inThe US that is really hitting
dietary guidelines and has avery high quality diet. There's
room for improvement in allareas. And I think that's the
kind of thing that has effectsover the life course.
It starts in maybe even inutero, but certainly at least in
childhood, and continuesthroughout adulthood as well.
(11:19):
And so I think there are a lotof ways that we could make
America healthier overall byfocusing on diet and nutrition.
So there's a lot of ground to becovered there.
Jeff Byers (11:29):
You know, it's interesting you talked about
that restrictions on SNAPbenefits doesn't seem to help
consumption patterns that much,and you talked about incentives
helping healthier consumptionhabits. You wrote a book
recently. I can't remember thename of it. Please tell me it
one more Yeah, called equalcare. Equal care.
(11:49):
Was there anything in your bookabout those potential incentives
to make diet better?
Seth Berkowitz (11:55):
So one of the key arguments in the book and
one of the key reasons we thinkthat the American diet is less
healthy than it should be, isthat in general healthier foods
just cost more than less healthyfoods. And so when income is
scarce, there's sort of thispressure or sort of incentive, a
gradient pushing you towardsless healthy, but more
(12:17):
calorically dense foods. And soin the book overall, one of the
things to talk about is theimportance of income support
programs for health, for gettingincome to people during times in
their life like childhood orolder age or periods of
disability when they're notgonna get an income from their
jobs in order to supportpeople's ability to stay healthy
during those periods becauseit's the accumulation of
(12:38):
episodes of deprivation andthings like that that lead to
this poor health overall. And sothings like nutrition incentives
I think are very squarely inline with those kinds of things
where our goal is to reachpeople at times in their life
where it's really difficult forthem to afford a healthy diet,
have a program that makes thatpossible. And we would reap the
(13:00):
benefits at a population levelby making sure that people
aren't falling into thesesituations where it's just
really not that feasible forthem to follow a healthy diet.
Jeff Byers (13:07):
Yeah, so it's also interesting when you mentioned
that healthier foods areexpensive. And I think everyone
listening to this probably knowsthat grocery costs are going up.
What as a fine as we kind ofclose out this conversation and,
you know, using the Tennesseesoda and candy house ban, what
can we see, especially in thelight of increasing grocery
(13:30):
costs, what might we see forfood policy going forward to
support making Americans healthyagain, for lack of a better
term?
Seth Berkowitz (13:38):
Yeah, no. So I think it's a really important
question. I think this isactually an instance where the
current iteration of SNAP doesvery well, and people may not
always appreciate it. So SNAP isindexed to the cost of a healthy
diet. So the USDA calculatessomething called the Thrifty
Food Plan, which is meant to bewhat the cost of sort of a
minimum level of healthy dietwould be.
(14:00):
It adjusts that benefit level onthe basis of food price
inflation. And so SNAP actuallyprovides very good protection
against some of these things.And so that's an element of the
program that I think is reallyimportant, and we may want to
continue. As probably many, Iknow you know this Jeff, many
listeners may know as well,there was an important
(14:21):
methodological improvement inthe way that Thrifty Food Plan
was calculated that went intoeffect in 2022 or 2023 that
really sort of made it matchbetter with what the cost of a
healthy diet is right now. Andthat has been an important,
again, sort of improvement inSNAP over the last few years.
There is always discussion aboutrolling those kinds of things
(14:43):
back, and I think that would beanother step back in population
health for exactly the reasonthat you said, which is that
right now SNAP is well designedto be able to buffer people
against food price inflation,but if you sort of recalculated
some of these things or removedthat, then the value of the SNAP
benefit would decline and itwouldn't be able to do as good a
job at protecting people's foodsecurity and ability to afford a
(15:06):
healthy diet.
Jeff Byers (15:07):
Yeah, well, Seth Berkowitz, thank you again for
joining us again on HealthAffairs this week. Make sure the
listeners, you check out theApril theme issue of Health
Affairs where Seth has a paper.Seth, are you able to share what
the not breaking embargo, whatit's on?
Seth Berkowitz (15:23):
Yeah. So the the paper is about, a way to put
together the concepts of income,food security, nutrition
security, diet quality, andhealth. These are all kind of
interrelated constructs thatplay a big role in understanding
how these factors shape health,but they're a little bit
related, they're a little bitdistinct, they kind of can get
(15:44):
jumbled up, so it's a way to tryto provide a clear way to think
about how these things fittogether.
Jeff Byers (15:49):
Yeah, well, listeners, become readers and
check that out and listen to ahealth policy to hear Seth talk
about that. And also, justinteresting stuff as it's kind
of an ever evolving nature withthat intersection of health,
diet, and income. So a lot ofinteresting stuff coming from
that. And with that, again, SethBerkowitz, thanks again for
(16:11):
joining us today, and thanks toyou, the listener, for joining
us. If you enjoyed this episode,send it to The Fitness
Influencer in your life.
Thanks, and we'll see you nextweek.
Hello and welcome to Health Affairs This Week. I'm
your host, Jeff Beyers. We'rerecording on 03/24/2025. Before
we begin, just as a heads up, wehave a theme issue on food,
nutrition, and health coming outin April. You may have noticed
an extra episode in your podcastfeed this week.
That's because we have a specialfour part podcast series leading
(01:01):
up to and through the release ofthe issue. The first episode is
on water insecurity. Check itand the other three episodes
out, and watch for the issue'srelease in early April. Also, as
a heads up, our next insiderevent is April 23 with Brady
Post on-site neutral payments.As a quick plug, today, I'm
joined by Seth Berkowitz fromUNC School of Medicine.
(01:24):
Seth used to write an insidernewsletter on social
determinants of health. He wrotean article in the said theme
issue on food nutrition health,will appear on Health Podicy to
discuss that paper, and joins ustoday to talk about SNAP
benefits. Seth, welcome back tothe program.
Seth Berkowitz (01:41):
Thanks so much for having me. I'm excited to be
Jeff Byers (01:43):
Yeah, so today we're gonna talk about SNAP benefits.
So Tennessee passed in the housethat built up ban candy and soda
purchases from SNAP benefits. SoI wanted to ask you, as someone
that looks at the intersectionof food and health, what is the
goal of such a ban, and is thiscontroversial? You know, I was
asking a leading question, whymight this be controversial? But
(02:05):
tell me it's controversial firstbefore I ask that.
Seth Berkowitz (02:07):
Yeah. I think I think this is I think this is
controversial, so I think you'reon on firm ground, saying that
there's a bit of a controversyhere.
Jeff Byers (02:14):
Well, what's the goal, and why is it
controversial then?
Seth Berkowitz (02:17):
Yeah, so the goal I think is the non
controversial part. So I thinkthe goal is, I guess I should
say the sort of ostensible goalor the stated goal, is to reduce
the use of SNAP benefits on foodproducts that are considered
less healthy, and then thereforereduce the overall consumption
of those products and improvehealth and and diet quality
(02:39):
overall. So that that's sort ofthe idea that I think
proponents, at least if takingthe arguments at face value, are
trying to lead you out. Two, Ithink it's controversial for two
reasons. So people who areopposed to these kinds of
proposals, think, will arguethat one, it doesn't seem to
actually be that effective inreducing consumption of these
foods.
(03:00):
And two, that there might besome ulterior motives that might
have to do with things likesocial control or a view of SNAP
as charity such that thesupposed benefactors can try to
exert more control over howpeople using the program expend
those resources and those kindsof things. I think that rubs a
(03:23):
lot of people the wrong way. Andso I think that's another sort
of source of controversy here inaddition to concerns about
whether it actually is likely toachieve the stated impact.
Jeff Byers (03:33):
Can you walk me through whether those kind of
things do actually achievethose? Because it seems those
are two different arguments,right, or two different ideas.
Seth Berkowitz (03:41):
As best we know, programs like this are very
unlikely to substantiallyimprove diet quality, or, you
know, reduce consumption of theprohibited items and those kinds
of things. And the reason thatI'm fairly confident saying that
is this is one of the few areasof health policy that we
actually have a randomized trialon. So there's a great
randomized trial that I was notinvolved in conducting, I think
(04:03):
was a really well done studydone by Lisa Harnack's group in
Minnesota. And so they tookpeople currently on SNAP, they
allocated them to various sortof permutations of benefit
design, some of which includedincentives for purchasing
healthier foods, some of whichremoved the ability to purchase
(04:26):
like sugar sweetened beveragesand candy bars and those kinds
of things, and then sort of anormal control condition. You
know, they found, as otherprevious studies had found, that
the incentive group actuallyworked well, so incentivizing
healthier food purchases doeslead to more purchase of those
things, which was good.
The group that sort of bannedthe, or removed the ability to
(04:46):
purchase certain foodsconsidered unhealthy did not
lead to changes in theconsumption of those foods. You
couldn't purchase them with thebenefits, but people could still
purchase them in other ways, theoverall change, overall
consumption went down. But Ithink importantly, the
participation in the program forthe people in group that
(05:06):
received the ban on some ofthese things was almost 10%
lower, 10 percentage pointslower than the other groups. So
not only did it not changeactual consumption, which is
what we think would lead toimprovements in health for the
people who continue toparticipate, but a lot of
people, a lot more people kindof dropped out altogether, and
so we're not getting benefits.So I think the likelihood that
(05:27):
it will actually improve overalldiet quality is low.
And I think there could well beunintended consequences where
people either don't utilize theprogram or don't utilize as much
of the program. And there couldeven be worse outcomes when you
put on these sort of extrastrictures and everything to the
way the program's run.
Jeff Byers (05:45):
Gotcha, gotcha. And just really quick, going back on
the control aspect of likecontrol of benefits, can you go
a little bit more into why thatmight be controversial?
Controversial? So we went intothe consumption.
Seth Berkowitz (05:57):
Yeah, so I think there a couple reasons. So I
mean, in my mind, the essence ofcharity is that it's
discretionary, right? So if youthink of what a church or a
private organization orsomething does, they kind of get
to pick and choose who they maywant to give programs to, what
they want to focus on and thosekinds of things. And that's
private sector and I think seemsfine. When you start talking
(06:20):
about like an actual governmentprogram, something that people
have a legal right to when theymeet the qualifying conditions
and those kinds of things,you're not really talking about
charity anymore.
And I think sort of part of ouroverall institutions of income
provision in The US, certainlysince the 1996 welfare reform,
have included a key role forSNAP as a way to support
(06:42):
people's food budgets andpeople's income when, you know,
they're in dire circumstances.You know, so adding on
additional restrictions andother things to that to, you
know, a group that are you'realready not we're already not
providing cash. You can't spendyour SNAP benefits on
everything. We already restrictthe way that the food purchase
is going to be spent. Famouslyin most states, can't purchase
it on hot foods or things thatare going to be consumed
(07:05):
on-site.
It's only for groceries and fooditems that you're meant to take
out of the store and thenprepare at home and things like
that. So there are alreadythings there. So adding on
additional restrictions, Ithink, strikes many people as
sort of going against thepurpose of the SNAP program to
sort of provide this foodassistance for people who are in
(07:26):
dire straits. I'll say maybejust, I don't know, to me this
is funny, I don't know if thelisteners will think it's a
funny anecdote, but sort of afunny anecdote, because these
kinds of discussions come up allthe time, and so I've had many
conversations like these overthe years, I was talking to
someone who's in this space, aresearcher in this space like I
am, and this kind of thing cameup, and I said, I don't think
these restrictions are veryworthwhile, and he said that,
(07:50):
well, we should put these on,people won't use their SNAP
benefits to buy sugar sweetenedbeverages or candy bars or those
kinds of things. I said, well,we could have even more health
benefits if we put thoserestrictions on what you can use
dollars to buy, right?
Mean, if only one in sixAmericans use SNAP to buy their
foods, but if 100% of Americansuse dollars to buy their food,
(08:11):
then we could have six times thebenefit. And he said, well, SNAP
is money from the government, sothat's okay to put restrictions
on, but I mean, puttingrestrictions on people's own
money, that's not okay. I waslike, my friend, I've got bad
news for you about where dollarscome from. They come from the
government as well, and youknow, we really think that this
(08:33):
would just be beneficial forpopulation health overall, but
we're not doing it just tocontrol a certain segment of the
population, then I don't see anyargument you could make about
what the health benefits ofrestricting snap purchases would
be that wouldn't also apply tohow dollars might be restricted.
Jeff Byers (08:50):
I'm going to throw out MAHA as far as like when
looking at potential MakeAmerica Healthy Again goals,
will such initiatives like thiscome more from states or federal
policy?
Seth Berkowitz (09:02):
Yeah, I mean, think there's broad recognition
that diet and nutrition play akey role in health, that diet
and nutrition in The US overallis not where it should be, and
that's a key contributor to ourrelatively poor population
health. I think a lot of peopleare getting behind the idea that
we need to do something aboutthat. I think there likely to be
(09:23):
action at the federal level inthat. It's been a priority
that's been expressed. However,The US is a very federalized
system, and so action from thestate and the federal, sort of
the national government canoccur in parallel.
And I think to the extent thatwe're just sort of catching the
zeitgeist here and saying, yeah,we really need to pay attention
to these issues, then we may seeit at the state level in
(09:46):
addition to the federal level.Often these things are kind of
complementary as well, right? Imean, one of the great things
about our federal system is, youknow, states are sort of
laboratories in some sense wherethey can experiment with
different policies that might,you know, get adopted and
implemented nationally, and so Ithink we'll see a lot of that,
you know, during this period aswell, there'll probably be some
(10:08):
federal initiatives, there'llprobably be some state
initiatives, those stateinitiatives might get taken
national when they're successfuland that kind of thing. So I
think we'll see it coming fromboth levels.
Jeff Byers (10:17):
Okay, great. So, speaking of that, we know when
you're talking about theintersection of food and health,
that food plays obviously a bigrole into the health of
individuals. You know, The USlife expectancy lags behind
other countries. I think there'slot of evidence on that. Like,
evidence and how does food playinto that?
Seth Berkowitz (10:36):
Yeah, so I think The US population health does
lag, life expectancy lags. Ithink we develop chronic
conditions earlier in life thanmany countries, and so the
number of years lived withchronic conditions is more even
in the setting of shorter lifeexpectancy, and I think diet
plays a key role in that.There's essentially no
(10:58):
demographic or income group inThe US that is really hitting
dietary guidelines and has avery high quality diet. There's
room for improvement in allareas. And I think that's the
kind of thing that has effectsover the life course.
It starts in maybe even inutero, but certainly at least in
childhood, and continuesthroughout adulthood as well.
(11:19):
And so I think there are a lotof ways that we could make
America healthier overall byfocusing on diet and nutrition.
So there's a lot of ground to becovered there.
Jeff Byers (11:29):
You know, it's interesting you talked about
that restrictions on SNAPbenefits doesn't seem to help
consumption patterns that much,and you talked about incentives
helping healthier consumptionhabits. You wrote a book
recently. I can't remember thename of it. Please tell me it
one more Yeah, called equalcare. Equal care.
(11:49):
Was there anything in your bookabout those potential incentives
to make diet better?
Seth Berkowitz (11:55):
So one of the key arguments in the book and
one of the key reasons we thinkthat the American diet is less
healthy than it should be, isthat in general healthier foods
just cost more than less healthyfoods. And so when income is
scarce, there's sort of thispressure or sort of incentive, a
gradient pushing you towardsless healthy, but more
(12:17):
calorically dense foods. And soin the book overall, one of the
things to talk about is theimportance of income support
programs for health, for gettingincome to people during times in
their life like childhood orolder age or periods of
disability when they're notgonna get an income from their
jobs in order to supportpeople's ability to stay healthy
during those periods becauseit's the accumulation of
(12:38):
episodes of deprivation andthings like that that lead to
this poor health overall. And sothings like nutrition incentives
I think are very squarely inline with those kinds of things
where our goal is to reachpeople at times in their life
where it's really difficult forthem to afford a healthy diet,
have a program that makes thatpossible. And we would reap the
(13:00):
benefits at a population levelby making sure that people
aren't falling into thesesituations where it's just
really not that feasible forthem to follow a healthy diet.
Jeff Byers (13:07):
Yeah, so it's also interesting when you mentioned
that healthier foods areexpensive. And I think everyone
listening to this probably knowsthat grocery costs are going up.
What as a fine as we kind ofclose out this conversation and,
you know, using the Tennesseesoda and candy house ban, what
can we see, especially in thelight of increasing grocery
(13:30):
costs, what might we see forfood policy going forward to
support making Americans healthyagain, for lack of a better
term?
Seth Berkowitz (13:38):
Yeah, no. So I think it's a really important
question. I think this isactually an instance where the
current iteration of SNAP doesvery well, and people may not
always appreciate it. So SNAP isindexed to the cost of a healthy
diet. So the USDA calculatessomething called the Thrifty
Food Plan, which is meant to bewhat the cost of sort of a
minimum level of healthy dietwould be.
(14:00):
It adjusts that benefit level onthe basis of food price
inflation. And so SNAP actuallyprovides very good protection
against some of these things.And so that's an element of the
program that I think is reallyimportant, and we may want to
continue. As probably many, Iknow you know this Jeff, many
listeners may know as well,there was an important
(14:21):
methodological improvement inthe way that Thrifty Food Plan
was calculated that went intoeffect in 2022 or 2023 that
really sort of made it matchbetter with what the cost of a
healthy diet is right now. Andthat has been an important,
again, sort of improvement inSNAP over the last few years.
There is always discussion aboutrolling those kinds of things
(14:43):
back, and I think that would beanother step back in population
health for exactly the reasonthat you said, which is that
right now SNAP is well designedto be able to buffer people
against food price inflation,but if you sort of recalculated
some of these things or removedthat, then the value of the SNAP
benefit would decline and itwouldn't be able to do as good a
job at protecting people's foodsecurity and ability to afford a
(15:06):
healthy diet.
Jeff Byers (15:07):
Yeah, well, Seth Berkowitz, thank you again for
joining us again on HealthAffairs this week. Make sure the
listeners, you check out theApril theme issue of Health
Affairs where Seth has a paper.Seth, are you able to share what
the not breaking embargo, whatit's on?
Seth Berkowitz (15:23):
Yeah. So the the paper is about, a way to put
together the concepts of income,food security, nutrition
security, diet quality, andhealth. These are all kind of
interrelated constructs thatplay a big role in understanding
how these factors shape health,but they're a little bit
related, they're a little bitdistinct, they kind of can get
(15:44):
jumbled up, so it's a way to tryto provide a clear way to think
about how these things fittogether.
Jeff Byers (15:49):
Yeah, well, listeners, become readers and
check that out and listen to ahealth policy to hear Seth talk
about that. And also, justinteresting stuff as it's kind
of an ever evolving nature withthat intersection of health,
diet, and income. So a lot ofinteresting stuff coming from
that. And with that, again, SethBerkowitz, thanks again for
(16:11):
joining us today, and thanks toyou, the listener, for joining
us. If you enjoyed this episode,send it to The Fitness
Influencer in your life.
Thanks, and we'll see you nextweek.
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