New Study Reviews Health Impact of Banning Sugar-Sweetened Beverages in SNAP
Concludes that a combination of voluntary restrictions, incentives, and education
may hold promise for improving nutrition
April 30, 2014 - SNAP Decisions, a new study released today by the Illinois Public Health Institute (IPHI), assessed the intended and unintended health impacts of a proposed Illinois ban on sugar-sweetened beverages (SSBs) from the Supplemental Nutrition Assistance Program (SNAP), formerly known as the food stamp program. Various forms of the ban on SSBs, which include soda, sports drinks, energy drinks, sweetened tea and coffee drinks, and fruit drinks, have been introduced into the Illinois General Assembly in the last few years. The SNAP Decisions report and executive summary can be viewed at these web-links:
Using a process called Health Impact Assessment (HIA), IPHI considered a range of possible health effects of the proposed policy, and found that a ban by itself may not achieve the nutrition goals its sponsors seek. This is because most SNAP participants use a mix of cash and SNAP benefits for groceries, and many would simply switch how they pay for the beverages. With incentive initiatives that provide additional resources to purchase healthier options showing promise in other states, the team found that SNAP participants in Illinois might be more likely to reduce their purchases of SSBs in a voluntary program that includes restrictions on SSB purchases, incentives to purchase healthy items like fresh fruits and vegetables, and a strong nutrition education program.
"This health impact assessment reveals a very complex set of issues, including whether a ban would even be effective, and concerns about singling out low-income people for a society-wide problem," said Jess Lynch, the lead author of the study. "Clearly, there is no 'silver bullet' that will solve all the issues related to obesity and malnutrition in the U.S. Obesity and related chronic diseases are driving health care costs and impairing quality of life on an unprecedented scale. Simply exhorting people to eat right and exercise has proven inadequate to solve the problem. Effective policy levers need to be explored as part of the solution."
Excess SSB consumption is a society-wide problem, and the study identified potential health harms (such as stigma-related stress) that might result from a policy that singles out low-income people. In response, the assessment recommends that policy-makers consider focusing their attention on policies that have more universal application, such as improving school and community beverage environments and imposing a tax on SSBs.
Other findings in the report include:
- Per-capita sugar consumption increased dramatically over the latter half of the 20th century in the United States. Americans consumed an average of 43 pounds, or 39% more sugar per year in 2000 than they did on average between 1950 and 1959.
- Consuming more than recommended amounts of sugar has been shown to contribute to increased prevalence of diabetes, oral health problems, and obesity and thus obesity related health conditions such as heart disease, stroke and some cancers.
- More than half of all added sugars in the American diet are from SSBs.
- Youth exposure to poor nutrition, both in terms of food insecurity and unhealthy eating, is associated with serious health risks throughout life related to cognitive and physical development, mental health, educational outcomes, obesity and related chronic conditions, and oral health. In Illinois, nearly half (46%) of SNAP participants are children, and 71% of all households using SNAP have at least one child under the age of 18.
- The cost of healthy foods and beverages, access to healthy food, and targeted marketing of unhealthy foods and beverages are substantial barriers to healthy eating for low-income households.
- There is inconsistent evidence on whether SNAP participants purchase or consume SSBs more frequently than the overall population. While the USDA cites research showing similar patterns of consumption across economic groups, more recent studies show that purchase and consumption of sugary drinks are higher in low-income populations than the population as a whole.
- Most SNAP households spend significantly less on SSBs than they spend out-of-pocket overall on food and beverages in a month. This suggests that if restrictions were in place, SNAP participants could shift from SNAP to cash out-of-pocket to purchase SSBs. Focus group participants also reinforced this finding, suggesting that in general they thought that SNAP recipients would shift how they pay for SSBs, if the proposed ban were implemented. These substitutions would undermine the proposed policy's goal of reducing SSB purchases to improve health.
- Both retailers and SNAP participants interviewed for the study cited consumer education and the cost of foods and beverages as barriers to healthier eating. Both groups were concerned about how to make healthy foods more affordable.
- There is a lack of knowledge among some consumers regarding the healthiness of various categories of SSBs. The SNAP participants who participated in the focus groups understood that soda is unhealthy. Many of those same individuals believed other drinks that have comparable amounts of added sugar such as fruit drinks, sports drinks, and energy drinks, were healthier than soda. Likewise, this holds true for parents in the general population, not just SNAP recipients. The Yale Rudd Center for Food Policy Sugary Drinks F.A.C.T.S. report found that, "parents believe that drinks like Capri Sun, Sunny D, Gatorade, and Vitamin Water are healthful products to serve their children."
The SNAP Decisions HIA was conducted in partnership with an advisory group representing food security advocates and experts, nutrition and oral health experts, public health organizations, physician groups, SNAP Education program leaders and state agency staff.
HIA is a fast-growing field that helps policy-makers by bringing together scientific data, health expertise and public input to identify the potential-and often overlooked-health effects of proposed new laws, regulations, projects and programs. It offers practical recommendations for ways to minimize risks and capitalize on opportunities to improve health. HIA gives federal, tribal, state and local legislators, public agencies and other decision makers the information they need to advance smarter policies today to help build safe, thriving communities tomorrow. The SNAP Decisions HIA was supported by a grant from the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and the Pew Charitable Trusts.
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