As we continue to focus on the social determinants of health, we spend a significant amount of attention on the financial support needed for nutrition assistance. The Supplemental Nutrition Assistance Program (SNAP) is the largest food and nutrition assistance program, tasked with improving food security among low-income households. This program works by providing fiscal supplements to low-income households. Unfortunately, these subsidies are irrespective of the ability of these recipients to have access to healthy foods. Additionally, the locations of most low-income housing are in food deserts or areas with limited access to nutritious food.
Simultaneously, there is another federal effort to improve food access which is the Healthy Food Financing Initiative (HEFI). This program incents healthy food retail outlets to areas that lack nutritious, fresh food. A recent article in Health Affairs by Cantor et al. found that after the opening of such a food store, SNAP recipients had an improvement in their food security. Furthermore, they noted a decrease in added sugars, and a decline in the percentage of daily calories from solid fats, alcoholic beverages, and added sugars compared to a neighborhood with similar SNAP participants and no new supermarket.
Undeniably, what is exciting about this information is the benefit that occurs when two programs overlap. However, there is nominal coordination between federal programs where the goal is to improve social determinants by different means. Therefore, if we wish to have a meaningful impact, we must combine all our activities rather than having various agencies working in silos. Though each program attempts to affect those they serve significantly, we can’t fully take advantage of the totality of our efforts without coordination.
This same situation is apparent in subsidized housing and health care. A better safety net model would be to have an overarching agency that coordinates how to leverage each of our investments optimally. In this manner, we can better study the impact and iterate on the models. SNAP by itself did not show nutritional improvement, thus not reaching its desired effect. However, the combination of the two, HEIC and SNAP together, achieved the desired outcome. Just think about the possibilities if this type of partnership occurred between housing and healthcare subsidies.
If we advance our activities in a more coordinated fashion, we will obtain more meaningful results. Unquestionably, our country is one of the top spenders globally in both safety net social services and healthcare. Maybe if we better align all our agencies and efforts, we will improve what we are attempting to do and decrease healthcare costs by addressing the underlying social issues. We may then design public/private partnerships that will result in more meaningful outcomes at a lower price for the taxpayers. Let us focus not only on the dollars needed but also on how best to spend them in a coordinated fashion.