Susan Blumenthal

Susan Blumenthal, M.D., director of the Health and Medicine Program at the Center for the Study of the Presidency and Congress

Rear Admiral Susan Blumenthal, MD, MPA (ret.), is director of the Health and Medicine Program at the Center for the Study of the Presidency and Congress, which recently released the “SNAP to Health” report with the Harvard School of Public Health and others.  The report outlines 10 recommendations to enhance the nutritional effectiveness of the Supplemental Nutrition Assistance Program – formerly known as the Food Stamp Program – with a strong focus on the dual public health concerns of food insecurity and obesity. Blumenthal, a Clinical Professor at Georgetown and Tufts schools of medicine, served for more than two decades in senior federal health leadership positions including U.S. Assistant Surgeon General, the first Deputy Assistant Secretary for Women’s Health in HHS, a White House Health Advisor and as Medical Advisor at USDA. She has worked to advance a multitude of public health issues ranging from women’s health issues to mental health to ending AIDS to information technology to obesity prevention.  Public Health Newswire asked her more about the “SNAP to Health” report and the ways in which the report’s recommendations could improve nutrition in SNAP.


In 2008, the federal Food Stamp Program became the Supplemental Nutrition Assistance Program.  How has the program changed, particularly in its effort to improve nutrition for the 46.7 million Americans who rely on SNAP?
In many ways, the name change was in “name” only. The farm bill renamed the Food Stamp Program as the Supplemental Nutrition Assistance Program. Today, 1 in 7 Americans is enrolled in this $76.5 billion federal food assistance program. The new name was supposed to reflect a focus on strengthening nutrition and “putting healthy food within reach” for low-income households. However, the name change was not paired with significant policy changes to SNAP that would improve the nutritional quality of participants’ diets, with the exception of some recent modifications to its state-led educational component – SNAP-ed – which helps low-income Americans learn about making healthy eating and active lifestyle choices.

In response to the growing obesity epidemic in America, recent congressional legislation has addressed the need to improve nutritional health among people enrolled in federal food assistance programs, including the Special Supplemental Nutrition Program for Women, Infants and Children and the Healthy, Hunger-Free Kids Act of 2010 aligning these programs with the Dietary Guidelines for Americans. However, these kinds of policy changes to improve nutrition and prevent and reduce obesity have not yet been applied to SNAP. It is our goal that the SNAP report will provide helpful guidance and recommendations to change this.

You have previously addressed a public health paradox in that one in six Americans is food insecure while two-thirds of Americans are overweight or obese. Could you share more with us about the recommendations from your project’s report about how SNAP could be strengthened to ensure access to healthy, nutritious foods?
Using a public health approach, our project team comprised of leading experts in the field identified a set of 10 important recommendations to improve nutrition for SNAP beneficiaries. The recommendations range from maintaining current funding levels for SNAP to ensuring access and incentives for healthy, nutritious foods to partnering with other federal departments to build innovative and integrated national strategies that can strengthen the effectiveness of SNAP. The report offers a greater emphasis on improving public health outcomes for the program and underscores the need for data collection to learn more about what participants are purchasing with their benefits.

Taken together, these recommendations constitute a fresh approach to improving nutritional health and preventing obesity among SNAP recipients. In combination, these policies would be more effective than any individual strategy applied alone. The hope is that they will catalyze greater awareness about the public health impact and potential of this important federal food assistance program. I encourage others to learn more about the recommendations by reading the “SNAP to Health” report.

The “SNAP to Health” report finds that “almost one-half of all youth in the United States will be enrolled in SNAP at some time before their 19th birthday.” How do the recommendations outlined in the report address this issue for children in America?
The current structure of the SNAP program is a missed opportunity to improve children’s health because it currently focuses exclusively on food and beverage quantity rather than quality. Fifty percent of SNAP’s participants are children. Growing children require a nutritious diet to develop, grow and achieve optimal physical and mental health. Children living in poverty are more likely to experience adverse health conditions, including low birth weight, developmental delays, dental problems, learning and social skills difficulties as well as behavioral problems. When the Food Stamp Program was established in 1964, food insecurity among youth was associated with underweight and inadequate caloric intake. Federal food assistance programs have helped to address this public health problem. Fifty years later, food insecurity among youth is now often associated with overweight, obesity and poor dietary quality.  Given the concurrent hunger and obesity epidemics for our nation’s youth, public health policies are needed that would restructure SNAP so that it provides children with higher quality nutritious foods. The “SNAP to Health” report suggests several strategies, including the possible consideration of a defined food package as is provided in the WIC program, to harness the public health potential of the program to improve the nutrition and health of low-income children.

We know that food and nutrition issues hit low-income families hardest. What challenges lie ahead to meet the health needs of these communities?
As the program is currently configured, SNAP recipients face numerous barriers to achieving nutritious diets. Some impediments include: the limited availability and often higher cost of healthy foods in many low-income urban and rural neighborhoods; the heavy marketing and low cost of high-calorie, unhealthy foods; a SNAP benefit level that is too low for many households to be able to purchase healthy foods throughout the month; and a lack of nutrition knowledge and cooking skills for some participants. There are also broader macro-level factors that shape food production, manufacturing, marketing and distribution that influence SNAP participants’ food choices and make it difficult to consistently eat healthy foods. Federal subsidies for corn and soy, for example, make these processed products cheaper and encourage the production and consumption of unhealthy foods.

A “health in all policies approach” is needed that mobilizes all sectors of society to fuel a prevention revolution in America.

A “health in all policies approach” is needed that mobilizes all sectors of society to fuel a prevention revolution in America. Initiatives that are underway by the government and private sector to address the dual public health problems of food insecurity and obesity are helping to address some of these barriers but more resources and intensified efforts through public-private sector partnerships are urgently needed.

Currently the reauthorization of the farm bill that funds SNAP is being debated in Congress and significant cuts have been proposed. How concerned are you about the impact of potential budget cuts on the program and its recipients?
I’m very concerned. There has been a dramatic rise in SNAP participation since the start of the current economic recession. Since 2007, SNAP has seen a 60 percent increase in participation. A reduction in SNAP spending would jeopardize the health and well-being of the 46.7 million Americans enrolled as of August 2012, including millions of children, for whom SNAP is a food lifeline. Cuts would hurt the working poor, put an additional burden on other safety net programs and threaten the economies of low-income communities. Moreover, since every dollar of SNAP benefits generates up to $1.80 in economic activity, supporting this program makes economic sense for businesses, communities and our country.

The reauthorization of SNAP in the farm bill could provide a vehicle to align farm and food policy with national public health priorities. The reauthorization process as well as future legislation and actions by the executive branch of our government provide opportunities to reformulate SNAP as a program that would serve not only as an invaluable safety net for low-income households, but also as a public health tool to fight the concurrent threats of food insecurity, poor nutrition and obesity among low-income Americans.

As a lifelong public health advocate, what promise does SNAP bring to improving food insecurity and reducing obesity rates in years to come?
Food insecurity and obesity are major public health problems in our country today. Currently, one in six people in America is food insecure, while two-thirds of adults and one-third of children are overweight or obese. The highest rates of obesity are among low-income Americans and for young children in this population group, the prevalence of overweight and obesity now exceeds underweight by about seven to one. Food insecurity, poverty and obesity are associated with significant health, social, economic and national security consequences. I believe SNAP represents an important opportunity to improve health, particularly among children.

Healthy nutrition is a cornerstone in the prevention of disease and the promotion of good health. Ultimately, the public is triple paying for some poor quality foods and beverages purchased with SNAP benefits. They pay for it directly in the stores, then again with the missed opportunity of improving nutrition of SNAP participants now and then again through the health care costs to Medicare and Medicaid of individuals who suffer from chronic diseases linked to consumption of these unhealthy products. The total annual medical cost of obesity in the United States is now a staggering $190 billion.

Our “SNAP to Health” report calls for enhanced collaboration between the U.S. Department of Health and Human Services and the U.S. Department of Agriculture and why we recommend that a national strategy should be established to reduce and prevent the co-existing public health problems of food insecurity and obesity among low-income Americans. To achieve this goal, the perspectives, advocacy and input of the public health community are urgently needed to develop evidenced-based policies that promote a healthier future for SNAP beneficiaries today and in the years ahead.