Three articles included in this issue of AJPH reflect current policy, practice, and opportunity in the public health, food, and nutrition arena. The timeliness of these articles is most welcome given the recent legislative accomplishments of the US Congress in its work on the 2019 Farm Bill, which was passed without major cuts to the Nutrition Title as previously proposed by the US House of Representatives in the 2018 version. And, on the equally hopeful side, there are early indications that both committees of the House and Senate intend to proceed on anticipated reauthorization of child nutrition programs.
As noted in the primer on US Food and Nutrition Policy, the reach of these principal federally sponsored domestic food programs has major public health impacts by reducing hunger and food insecurity while increasing healthy nutrition and related benefits for millions of Americans. Table 1 lists the programs and their budget for 2019. The Supplemental Nutrition Assistance Program (SNAP) serves more than 40 million individuals monthly, and its beneficiaries include children and adults—from newborns to our most senior citizens. SNAP remains one of the strongest components in domestic safety net and public health programs. Its enrollment numbers are significantly affected by the strength and contemporary state of the US economy as well as policy elements.
TABLE 1—
Programs of the US Food and Nutrition Service and Their Allocated Budgets for 2019
| Program Name and Abbreviation | Fiscal Year 2019 Budget, $ |
| Supplemental Nutrition Assistance Programs (SNAP) | 73 218 300,000.00 |
| National School Lunch Program (NSLP) | 12 091 834,000.00 |
| Women, Infants, and Children (WIC) | 6 005 000,000.00 |
| School Breakfast Program (SBP) | 4 816 238,000.00 |
| Child and Adult Care Food Program (CACFP) | 3 815 328,000.00 |
| Summer Food Service Program (SFSP) | 519 456 000.00 |
| The Emergency Food Assistance Program (TEFAP) | 306 083 000.00 |
| Commodity Supplemental Food Program (CSFP) | 238 120 000.00 |
| Fresh Fruit and Vegetable Program (FFVP) | 176 000 000.00 |
| Senior Farmers’ Market Nutrition Program (SFMNP) | 20 600 000.00 |
| Farmers’ Market Nutrition Program (FMNP) | 18 548 000.00 |
| Team Nutrition | 17 004 000.00 |
| Special Milk Program (SMP) | 8 065 000.00 |
| Food Distribution Program on Indian Reservations (FDPIR) | 998 000.00 |
Source. Adapted from https://www.obpa.usda.gov/32fns2020notes.pdf.
The Special Supplemental Nutrition Program for Women, Infants and Children program (WIC) is the second largest domestic nutrition and health program and is one of the nation’s most effective public health programs. Its impact on such a large number of infants and their mothers each year is a potent example of broad public health policy, health promotion, and future health care cost avoidance. Furthermore, WIC has the notable feature of serving all infants across the country who qualify under its income eligibility guidelines regardless of residency status. In communities across the United States, WIC works in tandem with SNAP, resulting in approximately half of WIC households qualifying for and receiving SNAP benefits.
As I noted, child nutrition legislation is expected to be the subject of congressional hearings this year, with the intention of updating and reauthorizing the Healthy Hunger-Free Kids Act of 2010 (HHFKA). The principal components of the HHFKA are WIC, the National School Lunch Program, the School Breakfast Program, and several smaller adjunctive nutrition programs.
The National School Lunch Program (NSLP) is provided daily in almost 100 000 US schools—from pre-K through grade 12. With updated nutrition policies and menu standards, it has resulted in a demonstrably improved food and nutrition environment in US schools. The NSLP directly feeds some 30 million students each day and, through the School Breakfast Program, serves close to half that number in school breakfasts. The stronger nutrition standards required by the HHFKA have been implemented in all participating schools and embraced by most parents and educators, professional nutritionists, pediatricians, and school nurses. However, these are aspects of the HHFKA school meals requirements that are not supported by the food industry and significant numbers of school food service representatives.
Considering both Farm Bill and child nutrition programs in the HHFKA, close to $100 billion is expended in these specific federal nutrition programs annually. It is obvious that practice and policies supporting food sustainability can be furthered at various stages in the growth, harvesting, processing, and presentation of foods. Using financial support and incentives through these core federal food and nutrition programs can incentivize sustainable food practices.
Diversification of crops, conservation practices, and more careful use of water, soil, and chemicals are essential to achieving food sustainability. Specific changes in practices and monitoring are required at all stages in the growth, harvesting, processing, and consumption of foods. The significant dollar impacts and associated regulatory influences of federal programs can be aligned to support food sustainability. Government policy and nongovernment farm and producer interests can also align to better support food sustainability.
On matters of nutrition and sustainable food systems, voices urging action in the public health community here in the United States and beyond are being raised. Earlier this year leading experts published a major report with recommendations in the EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems. This report is prompting needed discussions and proposed steps forward at various levels in the farm, food, and nutrition communities across many countries. It is very early in these discussions, but they have begun and they deserve engagement by all of us.
CONFLICTS OF INTEREST
The author has no conflicts of interest to declare.