Policies to reduce food insecurity: An ethical imperative

Highlights

• •Though a quarter of U.S. households receive food assistance, more than 11% experience food insecurity.
• •Thus, expanding food and nutrition assistance programs is an ethical imperative.
• •Based on empirical evidence and theory, we articulate an ethical framework to guide expansion.
• •Just food policies should (1) embrace compassion, (2) create opportunity, (3) consider essential needs, and (4) promote knowledge and empathy.

Abstract

A quarter of U.S. households receive food assistance, yet more than 11% still experience food insecurity annually. We argue that an expansion-oriented approach to food and nutrition assistance policy is an ethical imperative. Drawing on values from the Capability Approach and Social Empathy Model and supported by empirical evidence, we propose an ethical framework characterized by four principles that can be used to assess and inform the development of just food policies. We argue that policies should (1) embrace compassion, (2) create opportunity, (3) consider essential needs, and (4) promote knowledge and empathy. In an applied case, we evaluate current SNAP policy in terms of those principles and offer recommendations to promote justice in the design and implementation of SNAP and other food policies.

1. Introduction

In fiscal year 2018, the federal government spent $96 billion on the 14 food and nutrition assistance programs operated by the United States Department of Agriculture (USDA) [1]. The largest of the USDA's programs, the Supplemental Nutrition Assistance Program (SNAP), alone operated at a cost of nearly $65 billion, reaching an estimated 39.7 million participants [1]. Of these programs, the ones that directly provided meals served 9.5 billion breakfasts, lunches, and suppers to hungry Americans1 [1]. All told, one out of every four Americans benefits from a USDA food and nutrition program over the course of a year [2]. Despite this sizeable commitment, 11.1% of American households – 14.3 million homes – experienced food insecurity in 2018, meaning that they were “uncertain of having, or unable to acquire, enough food to meet the needs of all their members, because [of] insufficient money or other resources” [3]. Reflecting their high level of need, a substantially higher portion of households receiving food assistance are also food insecure. Among eligible households in 2018, 47.5% of those receiving SNAP, 39.5% of those where children got free or reduced price lunches at school, and 36.9% of those receiving from the Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) were food insecure [3]. Of particular concern, 4.3% of all households – 5.6 million homes – experienced very low food security [3], meaning that one or more household members experienced disruptions to their food intake or normal eating patterns. Rates of very low food security range between 12.3% among households receiving WIC to 21.7% in homes receiving SNAP [3].

Two general and diverging perspectives can be used to frame a policy response to this series of facts. The first of these is retrenchment [4,5], characterized by the restriction or elimination of food and nutrition assistance benefits, new eligibility requirements to curtail participation, and movement toward restricting choice by benefit recipients. Traditionally, retrenchment is associated with more conservative principles of governance [4] and recently has been accompanied by rhetoric which casts food and nutrition programs as wasteful and recipients of these programs as undeserving [6]. The second broad perspective might be best described as expansion, characterized by the maintenance of choice for beneficiaries, efforts to reduce barriers to participation and stigma, and more generous benefits and eligibility rules. Underlying this second perspective are more progressive principles of governance, a view of structural (rather than individual) factors as fundamental causes of food insecurity and hunger, and the notion that access to food is an ethical issue that requires attention from the government. Both perspectives have long been present in federal food and nutrition assistance policymaking. For example, there have been repeated calls over time to restrict the types of food that can be purchased with SNAP benefits (retrenchment) [7,8]. In contrast, there are also efforts like the recently-implemented Community Eligibility Provision, which allows schools where a sufficient proportion of the student body is deemed eligible on the basis of administrative data to make free lunch and breakfast available for all children, irrespective of individual eligibility (expansion) [9].

2. An ethical approach to food and nutrition assistance policies

In this paper, we argue that an expansion-oriented approach to food and nutrition assistance programs is an ethical imperative. To do so, we first call on empirical evidence to clarify the need for expansion. Next, we ground our argument in principles from the field of social work, whose professional code of ethics offers important values statements that support this approach. Last, we draw on theoretical frameworks from both social work and economics, which help to translate the ethical values we embrace into explicit statements about the nature of an ethical approach to food and nutrition assistance. Throughout, we demonstrate the application of our ethical framework using SNAP as an example, selected because of its place as the largest of the food and nutrition assistance policies.2

2.1. Empirical evidence

As noted above, despite a substantial financial commitment on the part of the federal government, many U.S. households still experience food insecurity. Indeed, at no time during the past 20 years has the rate of food insecurity fallen below 10% [11]. We argue that the intransigence of this problem points to an urgent need for expansion, made even more immediate by the tremendous increases in food insecurity and other forms of hardship brought on by the COVID-19 pandemic.

We underscore the evidence in support of this position by providing empirical evidence to respond to two common arguments typically associated with retrenchment. First, despite arguments to the contrary [12], there is little-to-no evidence of misspending or fraud in the USDA programs. For example, despite its size and scope, 93% to 95% of federal spending on SNAP has gone directly to benefits in the past 10 years [1]. Both overpayment and underpayment of SNAP benefits have fallen overtime, such that both rates remain at near-historic lows [13], and only about 1.5% of all SNAP benefits are sold for cash [14]. Second, despite rhetoric that frames recipients of benefits as unfairly benefiting from government largesse (see, e.g., the labeling of the broad based categorical eligibility (BBCE) provision of SNAP as a “loophole” that unfairly expands eligibility [15]), most food and nutrition assistance benefits go to recipients who are typically understood to be “deserving” of support. More than two-thirds of SNAP participants are either children (44%), older adults (13%), or nonelderly persons with disabilities (10%) [16]. Of the remaining USDA programs, the primary ones are either restricted to or aimed at children (and their parents): WIC; the National School Lunch and School Breakfast Programs; the Child and Adult Care Food Program; and the Summer Food Service Program. Thus, there is little support for retrenchment on the basis of fraud, inefficiency, or a tendency for those who are “underserving” to receive benefits.

2.2. Values

In articulating the values that we incorporate into our framework, we draw on key ethical principles from the social work tradition. While the National Association of Social Workers’ (NASW) Code of Ethics [17] is not specifically focused on food and nutrition assistance, it underscores the need for an expansionist approach by identifying a set of core values and accompanying ethical principles. Though meant primarily as a guide to ethical practice for social workers, the Code can also be applied to policymaking more broadly and to food and nutrition assistance programs in particular. Two values are especially relevant: social justice and a belief in the dignity and worth of the person. These values are embodied by ethical principles that direct social workers to (a) challenge injustice by “ensur[ing] access to needed information, services, and resources; equality of opportunity; and meaningful participation in decision making for all people” and (b) upholding individual dignity and worth by “promoting [individuals’] socially responsible self-determination and capacity and opportunity to change and to address their own needs” [17].

2.3. Theoretical frameworks

Supported by empirical evidence, these social work principles suggest that an ethical approach to food and nutrition assistance programs must be based on the ability of these programs to promote justice and ensure dignity by supporting equality of access and opportunity and the right of all people to self-determination. To operationalize these principles, we turn to two existing frameworks: Amartya Sen's Capability Approach [18,19] and Elizabeth Segal's Social Empathy Model [20]. Collectively, these frameworks formalize what an ethical commitment to just food and nutrition assistance policies might look like and provide a mechanism by which to inculcate these values and drive policy change.

2.3.1. The capability approach

Briefly, the Capability Approach conceptualizes ‘capabilities’ as realistic opportunities to achieve those aspects of wellbeing that are desired by individuals, including experiencing states of being (e.g. food security), and engagement in activities (e.g. grocery shopping) [19]. In his description of the Capability Approach, Sen emphasizes truly free choice rather than proscribed outcomes, by focusing on capability to achieve a desired aspect of wellbeing rather than enumerating essential components of wellbeing [21]. Further, this framework considers capabilities holistically, emphasizing people's need to achieve sets of capabilities and recognizing that freedom to achieve a form of wellbeing is not truly present if that achievement requires sacrificing another important aspect of wellbeing. For example, if you must choose between keeping your job or caring for your child, you do not have the capability to achieve those aspects of wellbeing [18]. This framework also identifies individual and systemic constraints on capabilities, such as health status or racial segregation [19].

The Capability Approach is a philosophical framework and not a theory of social justice. As such, it describes the function and structure of the world as it is rather than dictating how things ought to be [21]. Nonetheless, Sen readily recognizes the utility of the Capability Approach as a framework on which to build theories of justice [21]. We draw on the Capability Approach because it attends to issues of self-determination and acknowledges limits to true freedom when achieving a necessary outcome, like food security, is in competition with other essential needs or is limited by personal or systemic barriers.

2.3.2. Social empathy model

While the Capability Approach concretizes the challenges food policies must consider, the Social Empathy Model articulates the ethical principles which could drive investment in developing just food policies and describes processes to integrate those principles into policy responses. The Social Empathy Model describes moving through and between the three processes of experiencing empathy fully, seeking and gaining deep, complex, contextual understanding, and recognizing and embracing social responsibility [20]. This framework was developed to combat structural inequalities and disparities and emphasizes the need for the powerful and privileged to develop social empathy for the marginalized as a means to reduce inequality, decrease domination of some by others, increase compassion in the shaping of powerful policies and structures, and reduce adherence to stereotypes and differences as justifications for inequity [20, 22]. The Social Empathy Model underscores the importance and viability of developing social empathy in individuals and groups as a mechanism for promoting justice in policy design [20]. Empathy can be taught and learned, particularly through direct experiences and modeling, suggesting the plausibility of educating and training policymakers and constituents and the vital importance of careful framing in policy advocacy efforts [22].

3. Elements of just food policies

We integrate aspects of the Capability Approach and the Social Empathy Model to propose an ethical framework to assess the justice of current food policies and to inform the development of just food policies moving forward. This framework includes four primary principles.

First, just food policies will embrace values of compassion and freedom. Such policies will use empathy to counter shame and stigma, which have long been associated with receipt of public assistance. This includes recognizing individuals’ dignity and freedom and conveying trust in and respect for food assistance beneficiaries by enhancing freedom to make individual food choices.

Second, just food policies will create opportunity for all people to experience food security, by accounting for personal and systemic barriers that limit pursuit of this outcome. Such policies may provide differential support for individuals facing personal barriers, such as disability status or poor health. Further, such policies will actively reduce systemic barriers such as work requirements or immigration penalties for beneficiaries. Finally, realistic opportunities to experience food security may require increased generosity in food and nutrition benefits to address the persistent presence of food insecurity under current policy.

Third, just food policies will consider other essential needs in concert with food assistance needs. Such policies will incorporate collaboration across nutrition assistance programs as well as coordination with policies and programs addressing other vital needs such as health, education, child care, and elder services.

Fourth and finally, just food policies will promote knowledge and empathy in policymakers, constituents, and beneficiaries. Such policies will include training in scientific knowledge around food insecurity as well as empathy development for policymakers, designed to infuse food policies with informed compassion. Training and education will also encompass communities, program staff, and advocates, to promote the discussion and framing of food policies in compassionate terms.

4. Current policies: evaluation and recommendations

4.1. Evaluation

How do our current food and nutrition assistance fare according to the four principles of our ethical framework (embracing compassion, creating opportunity, considering essential needs, and promoting knowledge and empathy)? Somewhat well, as it turns out. For example, a number of characteristics of SNAP are specifically aimed at promoting compassion and freedom. Currently, all SNAP benefits are administered using Electronic Benefits Transfer (EBT) cards, which were implemented in part as an effort to reduce the stigma that previously occurred when using food stamp coupons for purchasing food [23]. Likewise, the USDA has been steadfast in resisting efforts to restrict what SNAP benefits can be used to purchase. Currently, eligible households can buy most foods in stores that accept SNAP, with the exception of alcohol and tobacco products, hot and prepared foods, and a few other types of items [24]. However, it should be noted that SNAP is transmitted as an in-kind benefit (rather than as cash), which both restricts choice and creates stigma by cultivating a perception of recipients as not to be trusted to spend their benefits on food.

SNAP also fares well with respect to its ability to address personal and systemic barriers and to promote realistic opportunities for food security. Most generally, SNAP is authorized as an entitlement program, meaning that all who are eligible can receive benefits. In addition, the BBCE provision allows states to expand eligibility beyond the federal cutoffs for income and assets. As a consequence, among all nutrition programs, SNAP reaches the greatest number of Americans. Estimates suggest that half of all children will use SNAP at some point before age 18 as will half of adults between the ages of 20 and 65 [25,26]. In addition, the SNAP-Ed program provides education to help recipients use their benefits wisely and prepare nutritious foods [27]. Finally, the USDA has engaged in efforts to expand access to SNAP; currently, 260,000 retailers accept SNAP including big box stores, supermarkets, farmers’ markets and convenience stores [28].

However, there is also evidence that SNAP benefits may not be sufficient, because the structure of the program does not acknowledge the resources necessary to prepare healthy foods and benefits do not vary across areas with vastly different costs-of-living or meet families’ food needs throughout the month [29], [30], [31]. The structure of the program also does not adequately meet the needs of important subgroups of the population. For example, while there is accommodation to persons with disabilities, and SNAP provides essential benefits to many Americans who have a disability but do not qualify for SSI or SSDI [32], SNAP benefits are not sufficient to eliminate the high rates of food insecurity experienced by households that have a person with a disability [33,34 this issue], nor is the program meaningfully set up to accommodate the wide range of other personal circumstances that act as practical barriers to achieving food security. As important, aspects of the program – like the ban on eligibility for recent immigrants – create profound barriers among segments of the population at high risk for food insecurity [35].

As a nutrition assistance program, SNAP does not focus explicitly on meeting other needs. However, a growing body of research points to many additional benefits to SNAP participation including improvements to health, nutrition, and academic outcomes, improved health care use and lower health care costs, and long-term self-sufficiency [36], [37], [38]. Perhaps most notably, SNAP is a surprisingly effective anti-poverty program, raising more people out of poverty than any other means-tested program, 3.2 million in 2018 [39]. Comparably, SNAP does less well with respect to its ability to cultivate knowledge and empathy. This is true not only because the program was not designed with these aims in mind, but also because of SNAP's place in the broader US Social Welfare system, which is heavily comprised of targeted and means-tested (rather than universal) benefits intended to serve as a safety net of last resort and which are widely recognized as stigmatizing [40].

4.2. Recommendations

Based on our framework, we offer a set of recommendations to maintain and strengthen the SNAP program. First, consistent with the need for just policies to embrace compassion, we support the continued use of EBT cards and the maintenance of freedom of choice for recipients, both of which reduce stigma and assure dignity. Second, and in line with our recommendation that policies create opportunity, we argue for the need to maintain BBCE, which will preserve access to food for millions of Americans. Similarly, to ensure access and to address the multiple barriers to food security for this group, we argue for the need to restore benefits to recent immigrant families. But, in light of the persistent problem of food insecurity, we recommend both the expansion of benefits to meaningfully address the food needs of low-income households and serious consideration toward adopting a flexible benefit structure that acknowledges differences in the standard of living and the barriers that affect at-risk households.

Consistent with Segal's Model [20], the fourth principle of our framework for ethical food assistance emphasizes the need for policies that are structured to cultivate social empathy. The means by which to accomplish empathy via the SNAP program and other food and nutrition assistance programs are not straightforward, however. Social work models like the Liberation Health Model [41] describe mechanisms by which clinical interactions can be used to build critical consciousness and thus could be modified to explicitly focus on social empathy, but generating widespread empathy will likely require policy-level modifications. An initial step toward cultivating empathy could be public marketing strategies, which seek to educate the public and policymakers about the challenges of achieving food security and to reduce stigma about receiving food assistance. Further modifying the structure of some programs will also help. For example, substantially increasing the reimbursement rate for breakfasts and lunches and relaxing eligibility criteria would allow schools to increase the quality and diversity of food offerings, which would likely decrease stigma by increasing participation, in turn increasing food security.

The recommendations offered above represent modifications to existing programs. However, a more ambitious ethical approach to food and nutrition assistance might involve a full restructuring of the US social welfare state. Researchers frequently point to the additional benefits of the SNAP program, most notably the large-scale reductions in poverty noted above. However, these benefits point as much to the inadequacy of the US social welfare system in meeting the needs of low-income families as they do to the successes of SNAP and other nutrition programs. Instead, and consistent with the need for policies to consider all essential needs, one might conceive of a far broader series of supports: universal basic income and universal health insurance programs characterized by ease of access, straightforward recertification and elements to limit stigma. Alongside these could be targeted food and nutrition assistance programs (and other benefits), that could more flexibly and effectively address the needs of those families who continue to struggle to put adequate and sufficient food on the table. Though expensive, if properly conceived and well-implemented, this platform of programs would go a long way toward establishing an equitable approach to meeting the food and nutrition needs of US families.

Funding

This work was supported in part by a travel grant from the Ingestive Behavior Research Center at Purdue University.