A chance to modernize WIC and school meal programs

This is part 1 of an ongoing series about food and nutrition security. Read part 2 here.

One in ten American households don’t have enough food to eat each day. The most recent report from the USDA says that 18 million U.S. households, or 13.5% of the population, are food insecure. That number is up 1 million households from the prior year. This inequity has profound implications for health, as chronic hunger can worsen chronic health conditions and often force people to make impossible choices between food and critical medications. And it drives up healthcare costs.

In the lead-up to the November election, there has been a lot of talk about the economy, but very little discussion of the hunger crisis in this country. For more than 50 years, two food security programs have been at the center of our response to this crisis. The Supplemental Nutrition Assistance Program (SNAP) currently provides over 42 million income-eligible individuals and families with debit cards that can be used to purchase food. And the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides an additional safety net for early nutrition. It gives federal grants to states for supplemental foods, healthcare referrals, and nutrition education for pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to age five who are at nutritional risk.

These programs and others like them are critical for addressing health and hunger, but they need to be expanded and improved. Currently, 60% of SNAP participants report that, even with benefits, eating healthy is unaffordable. Burdensome enrollment practices keep many eligible people from using these programs. And tribal communities have been hit especially hard in recent months with massive food shortages caused by government contracting problems for the Food Distribution Program, one of the largest food assistance programs on tribal lands.

With the election next week, HealthBegins spoke with two policy experts about how they think the election will affect food and nutrition policy, how to center equity in policy making, and where Upstreamists should focus their efforts to advance food and nutrition security. They each offer an important perspective on the complicated, complex, and often fraught food and nutrition system in our country. HealthBegins will lift up more critical perspectives as this series continues after the election.

In this first part, Greta Allen, policy director at the Colorado Blueprint to End Hunger, reflected on the future of WIC, the importance of building policy around culturally-affirming food, and increasing the power of communities who use food programs to influence policy. (The conversation below was edited for length and clarity.)

How could the November 2024 election affect food and nutrition security?

The current Congress has taken very little action on food and nutrition policy. I’m eager to see what level of appetite this new Congress has to hopefully elevate food and nutrition in ways that we haven’t seen in a long time, including through Child Nutrition Reauthorization. This is how Congress makes changes to permanent child nutrition programs like WIC and school meal programs. It is supposed to be reauthorized every five years, but has not been reauthorized since 2010. This is critical because, while the programs themselves go through an appropriations process for funding, a lot of programmatic changes can’t be made without reauthorization. That’s when we could talk about whether to lift up a universal school meals program nationwide. Or consider changes to WIC that would reflect modernization or allow kiddos or pregnant parents to stay on longer. Also, while the authority to administer WIC is permanent, its funding is not. WIC faced a serious budget fight in 2023 and almost lost its funding. There is an opportunity with reauthorization to make this permanent too.

What steps can we take to ensure no one is disproportionately harmed by food and nutrition policy?

First, we need to name that our current food and nutrition policies are already doing harm. We have made a commodity out of a basic human right and prioritized profitability over public health. I’m a registered dietitian, and it is interesting coming from that professional lens into the anti-hunger space. I was traditionally trained in what I consider to be a false narrative of choice when it comes to food access and healthy food, neglecting factors such as affordability, transportation, and limited nearby grocery options. Also, all of our nutritional best practices are dominated by White male research, and so we’ve whitewashed what a healthy diet is. We’ve discriminated against culturally-affirming food. So, I think there’s actually a lot of healing we need to do first in our food policy space and just name that.

We must allow people to choose culturally- and religiously-affirming food with their benefits. We need to invest significantly in our population-based food security programs like SNAP and WIC so all folks have the same level of access. But we’ve been seeing policies move around restricting choice in SNAP or saying folks can only use these benefits to purchase healthy foods. And, aside from that being incredibly burdensome from an administrative side, I think what it does is actually limit the autonomy that families need to meet the cultural, nutritional, and dietary needs within their limited budgets. Policies need to reflect that there’s no right or wrong choice when folks are in poverty; there is just surviving. Until we are able to help folks get to a point where everyone has equal access to our food systems, we can’t get into conversations around telling people to eat healthy or change the way they eat.

When I think about making sure no one is harmed, particularly around these policies, first and foremost, you have to engage folks that you’re intending for these policies to support and engage them on what they actually need. At the Colorado Blueprint to End Hunger, our policy agenda was built with input from a network of over 200 folks. We look to resource and lift up local champions because they have the answers and the solutions for what’s needed in their communities. And importantly, we move a little slower in order to make our policy work transparent, bringing full policies to network meetings to ask, “What is missing?” This is also something we’ve been doing in our state as Colorado explores Section 1115 waivers for Medicaid. My organization has been really loud in asking, “Are you talking to Medicaid members in Colorado? Are you asking them what they need and what they want from this?”

Regardless of the outcome of the upcoming federal and state elections, what should Upstreamists pay attention to when it comes to food, nutrition, and equity?

• The Supreme Court’s recent Chevron decision changed how much power administrative agencies—where many subject matter experts work to implement programs—have over the regulatory aspects of our policies. This concerns me because it changes the rulemaking process and the ability for experts within certain departments of our government to make decisions on how programs might need to be changed, scaled, or modernized. It could also have a chilling effect where agencies may be hesitant to engage in necessary rulemaking for fear of Supreme Court challenges. I don’t think we’ve seen the full effects yet.
  
• A lot of states are trying to do really innovative things with Medicaid Section 1115 waivers. I’ll be watching to see the proposals and the approvals. I think that will tell us a lot too about what we might end up seeing from Congress later. A lot of the Section 1115 waivers may contain pilots that the USDA (United States Department of Agriculture), CMS (Centers for Medicare & Medicaid Services), or other federal agencies follow. When they are successful, we tend to see policies come out of them.
• One thing that has caught my attention as an anti-hunger advocate is the Kroger-Albertsons supermarket merger. My state of Colorado was actually the first state to sue against that merger. Our Attorney General went across the state doing listening sessions with grocery workers, local producers and farmers, and consumers. And just the idea of two large grocery conglomerates combining in a market where there is already a lack of competition, that’s a huge concern, particularly in the rural parts of our state where some folks are already driving one to two hours to get to a grocery store that might have empty shelves.

What steps should the healthcare sector prioritize to advance food and nutrition security?

The very first step healthcare folks need to take is to listen to their community members and be very public and transparent about that. I would love to see folks who administer healthcare plans listen to their members, listen to folks who don’t have access to that healthcare coverage for whatever reason. And then invest significantly in ensuring any decisions they make are rooted in the voices of the people that these policies are planning to serve. That includes any waiver processes or any decisions to change investments that organizations might be doing.

It’s really easy to say, “This sounds great. We’re going to do this. It’s perfect. Everyone will love it,” and take the easy way. But then, without a doubt, someone will be left out and, even worse, harm could be done in the process. We really need to make sure that policy is rooted in what people actually need. And I think that my biggest fear is that we will continue to build these systems on top of old systems without bothering to think if they actually address the root cause of why people are food insecure in the first place.

The other piece is that there’s a cultural- and religious-affirming food piece that I really hope folks are talking about. Food is Medicine is truly a spiritual and cultural linkage to folks that have been here long before the predominantly White American, 20th century policymakers. I think to not honor that is a real misstep. And I get concerned about the whitewashing of the Food is Medicine concept in the foods we would prescribe or the foods we suggest.

I think that also goes, in part, to sourcing local foods. If healthcare and food policymakers want to scale Food is Medicine programs, they need to prioritize sourcing food locally. You can shift a food system that way if we have large Medicaid dollar investments.

What resources can help someone better understand food and nutrition policy and/or improve their work in this space?

• USDA’s 2023 Household Food Insecurity Report. Improving food and nutrition policy starts with understanding the scope of hunger in the U.S. But also why I would call people to read that report is when we are thinking of equity, you’ll see that Black, Indigenous, Latine, other people of color, single women, and mothers predominantly make up food insecure households. It’s not a coincidence that poverty and hunger disproportionately impact families and individuals from historically oppressed and marginalized communities. And I think it is really important when we have data from our own federal agencies that clearly point to those inequities.

• Colorado Blueprint to End Hunger’s Anti-Hunger Community Advocacy Toolkit. We developed this toolkit a few years ago with community leaders in our network to make policy-making more accessible. The guide helps communities assess and advocate for change in their local food system by building the public awareness and political will that is necessary for change. The toolkit includes tips for centering equity, questions to consider, and helpful resources. It’s available in English and Spanish. We are really proud of it. It can help folks who are thinking about how to scale their policy work in a way that’s accessible for folks.

For more information about the Colorado Blueprint to End Hunger’s work, visit: endhungerco.org

For more information about the intersection between Medicaid and food, connect with the Medicaid Food Security Network: medicaidfoodsecuritynetwork.org

For ideas on how to talk to people in your life about the stakes of the election for health equity, read HealthBegins’ Election Engagement Guide.

Kate Marple is a Boston-based writer who specializes in helping nonprofit, health care, and legal services organizations develop practices to ensure that the stories they tell are shaped by and benefit people directly impacted by the issue(s) those stories are about. Her website is https://whotellsthestory.org. 

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