July 19, 2005
FOOD AND NUTRITION
PROGRAMS:
Reducing Hunger, Bolstering Nutrition
By
Dorothy Rosenbaum and Zoё Neuberger
Following the creation and
expansion of the domestic food assistance programs in the second half of
the 20th century, severe hunger, which had been a significant national
problem, has become rare. The food assistance programs were developed in
several steps. Concerns about
the nutritional status of young men drafted for service in World War II
led to the enactment of the National School Lunch Act in 1946.[1]
The Food Stamp Program was established on a pilot basis in the early
1960s, and extended nationwide in the early 1970s,
to help low-income families and individuals purchase a nutritionally
adequate diet. The Special Supplemental Nutrition Program for Women,
Infant, and Children, popularly known as WIC, was created in the early
1970s to improve the health of low-income pregnant women, new mothers,
infants, and young children who are found to be at nutritional risk.
In the 1960s, various
studies found hunger to be a significant problem in the United States.
Today, it has become relatively rare, although it still exists. In
addition to easing one of the
major burdens of poverty — being unable to put enough food on the table —
the nutrition assistance programs also have been found to improve birth
outcomes and increase children’s intake of key nutrients.[2]
Food and nutrition programs have made severe
hunger in America rare. Before the federal government provided food stamps and other forms of food
and nutrition assistance, hunger and severe malnutrition could be found in
many low-income communities in the United States. In the late 1960s, the
Field Foundation sponsored a team of doctors that documented serious
hunger and malnutrition in the South, Appalachia, and other poor areas.
The findings of this study, as well as other studies conducted at that
time, formed the basis for the 1968 CBS television documentary “Hunger in
America,” which showed children suffering from diseases related to severe
malnutrition that usually are thought of as occurring only in third-world
countries.
A similar team of physicians returned to very poor areas of the United
States in 1977 — after food stamps and other nutrition assistance programs
were made available nationwide — and found marked reductions in
malnutrition and related problems. The physicians’ report explained:
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Food and Nutrition Programs |
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Food Stamps
help more than 25 million people with low incomes afford an adequate
diet. Food Stamps provide electronic debit cards that can be used
only to purchase food. The average family receives a card that allows
it to purchase about $200 a month in food. The average food stamp
benefit equals $1 per person per meal.
WIC
— short for the Special Supplemental Nutrition Program for Women,
Infants, and Children — provides nutritious foods, nutrition
counseling, and health care referrals to about 8 million low-income
pregnant and postpartum women, infants, and children under five. WIC
provides vouchers that may be used only for specific nutrient-rich
foods, as well as nutrition education.
The School Lunch and School Breakfast programs provide
free and reduced-price meals to over 22 million school children from
low-income families. School meals must meet certain nutritional
standards.
See Appendices for state-by-state data on the number of program
participants.
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Our first and overwhelming impression
is that there are far fewer grossly malnourished people in this country
today than there were ten years ago. Malnutrition has become a subtler
problem. In the Mississippi delta, in the coal fields of Appalachia and
in coastal South Carolina — where visitors ten years ago could quickly see
large numbers of stunted, apathetic children with swollen stomachs and the
dull eyes and poorly healing wounds characteristic of malnutrition — such
children are not to be seen in such numbers. Even in areas which did not
command national attention ten years ago, many poor people now have
food.…This change does not appear to be due to an overall improvement in
living standards or to a decrease in joblessness in these areas…. The Food
Stamp Program, the nutritional components of Head Start, school lunch and
breakfast programs, and …. [WIC] have made the difference.[3]
The Food
Stamp Program
Summarizing this and other research,
Rebecca Blank, a noted economist and dean of the Ford School of Public
Policy at the University of Michigan, has observed that “evidence of severe malnutrition-related health
problems has almost disappeared in this country. The primary reason is Food Stamps.”[4]
The Food Stamp Program serves the following functions:
The Food Stamp Program
helps poor families and individuals purchase an adequate diet.
The Food Stamp Program is not restricted to specific subgroups of
people. It serves a wide range of low-income people, including families
with children, elderly people, and people with disabilities. About 80
percent of food stamp recipients live in households with children. Some
31 percent of recipients — nearly one-third — are elderly people or people
with disabilities.
The Food Stamp Program
increases the amount that low-income households spend on food and is
designed to target the most assistance to those who need the most help.
Two research studies published in 1980 compared national food sales and
consumption data for periods of time before and after the establishment of
the Food Stamp Program and its expansion nationwide. These studies found
substantial increases in food sales in low-income counties and in nutrient
availability among the low-income population.[5]
Subsequent studies have consistently found that participation in the Food
Stamp Program significantly increases household food expenditures and thus
the nutrients that are available to low-income households.[6]
Food stamps are targeted to those with
the greatest need for help in purchasing food. Ninety percent of the
households that receive food stamps have incomes below the poverty line.
More than a third of food stamp recipients have incomes below half
of the poverty line — about $7,800 on an annual basis for a family of
three in 2004. Very poor households receive more food stamps than
households closer to the poverty line, significantly increasing their food
purchasing power.
The Food Stamp Program delivers
benefits accurately and efficiently.
The Food Stamp Program is highly
effective at reducing hunger in part because it provides benefits (in the
form of a debit card) that can be used only to purchase food. Research
has shown that the requirement that food stamp benefits be spent only on
food increases food expenditures two to nine times more than would
the provision of a similar amount of cash aid.[7]
Moreover, efforts by USDA and the
states have greatly reduced the receipt of benefits by households that are
not eligible for food stamps. USDA reports that fewer than two percent of
food stamp benefits are issued to households that do not meet all of the
program’s eligibility requirements. Rates of both erroneous
“overpayments” and “underpayments” have fallen for six years, consistently
setting new all-time lows.
The national food stamp error rate is
now below 6 percent, a level that until recently automatically qualified
states for enhanced funding due to exemplary performance. Moreover, this
is a combined error rate and represents the sum of the
overpayment error rate (4.5 percent) and the underpayment error
rate (1.4 percent). The underpayment error rate measures errors in which
eligible, participating households received fewer benefits than the
program’s rules direct. Some have mistakenly spoken of the combined error
rate as if it were a reflection of the level of excess federal
expenditures that occurred due to errors. This is incorrect because the
combined error rate includes underpayments that save the federal
government money.
The net loss to the federal government
(i.e., the benefits lost through overpayments minus those saved by
underpayments) is three percent. The food stamp error rate compares quite
favorably to error rates for most other government programs for which data
are available. For example, the Internal Revenue Service estimates that
federal taxes were underpaid by at least 15 percent in 2001.[8]
Food stamps help low-paid working
families make ends meet.
Leaders from across the political spectrum generally agree
that a family supported by a full-time, year-round worker should not have
to be poor and should not have to raise its children in poverty. For
families supported by minimum-wage workers, food stamps are essential to
meeting this goal. Even if one counts the Earned Income Tax Credit
and does not subtract any work expenses except payroll taxes, a family of
four headed by a full-time minimum-wage worker will fall far below the
poverty line without food stamps. Food stamps make it possible for
this family to approach the poverty line. (See Figure 1.)
The Food Stamp Program reduces poverty. Food stamps help to lessen
the extent and severity of poverty. Census Bureau data on family disposable
income (which account not only for cash income but also for the value of
food stamps and a range of other non-cash benefits and taxes) show that[9]:
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Figure 1 |
 |
The Food Stamp Program insures
against economic risks. Food stamps offer protection
from economic risks both for households and for the economy. If a parent
loses her job or has a job that pays low wages, food stamps can help her
protect her children
from the risk of going without sufficient food, until she is able to
improve her circumstances. In this sense, the Food Stamp Program offers a
form of insurance.
This insurance function can be seen in
the program’s quick and effective response to the recent economic
downturn, when an increasing number of people lacked the earnings
necessary to feed their families adequately. As can be seen in Figure 2,
the Food Stamp Program responds to declines in employment and increases in
poverty during economic downturns by providing food assistance during
those times to a larger number of low-income families. Conversely, when
the economy experienced robust growth in the late 1990s and the number of
people who were poor fell, the number of people receiving food stamps also
declined.
In addition to
providing protection against economic risks for individuals and families,
food stamps also provide a measure of countercyclical protection for the
local and national economy. Because of its quick and automatic
response to increased need, food stamps help maintain overall demand for
food during slow economic periods. This is important because when
unemployment increases, consumption can decline (since people have less
money to spend); that can create a negative cycle of increasing
unemployment and declining economic activity. Programs like food
stamps slow this negative cycle by partially compensating for people’s
loss of income. A USDA study found that every $5 of food stamps
generates almost $10 in total economic activity.[10]
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Figure 2 |
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The WIC and
School Meals Programs
Evidence also is strong for the
efficacy of WIC and the child nutrition programs. These programs have
been found to produce the following effects.
The WIC program improves birth outcomes
and reduces health care costs. Babies with low birth weights are more likely to die in
infancy or to become disabled or ill. A large body of research has
consistently found that WIC contributes to healthier births, including
increases in average birth weight and a reduction in the incidence of low
birthweight.[11]
A 1992 Government Accountability Office (GAO) analysis of the research on
WIC — the only meta-analysis of multiple studies conducted to date —
concluded that pregnant women who received WIC benefits were much less
likely to have low-birthweight babies. The GAO estimated that prenatal
WIC participation reduced the proportion of low-birthweight babies by 25
percent and the incidence of babies born with very low birthweight by 44
percent.[12]
While it is possible that the magnitude of these effects has decreased
since the time of the GAO analysis, the most recent comprehensive
literature review, published by USDA in October 2004, found that more
recent studies have continued to find that WIC participation during
pregnancy reduces the incidence of low birthweight and has a positive
impact on other birth outcomes.[13]
Improved birth outcomes lead to health care savings. The GAO
analysis of the research on WIC estimated that each $1 spent on WIC for
pregnant women generated $2.89 in health care savings during the first
year after birth and $3.50 in savings over 18 years.[14]
These savings help to reduce the amount the government spends on Medicaid,
since Medicaid covers a large share of medical care costs for low-income
infants.
WIC and school meal programs increase
children’s intake of key nutrients. There is considerable evidence that WIC and the school meals
programs increase children’s intake of key nutrients and have other
significant benefits.
-
WIC has been
found to decrease the prevalence of anemia and insufficient iron intake
among children.[15]
Recent research on the diets of children who participate in WIC has shown
that participation in the program increases intakes of vitamins B6, folate,
and iron and may decrease consumption of added sugar. In addition,
one recent study found that among children in households with income below
130 percent of the poverty line, WIC participants consumed less fat and
more carbohydrates than non-participants.
-
The research also
indicates that children who participate in the school lunch program
consume more protein, vitamin B12, riboflavin, calcium, magnesium,
phosphorus, zinc, and fiber at lunch — and less added sugar — than
children who do not eat school lunches. Past studies also found that
lunches consumed by participants provided more fat and saturated fat than
other lunches. In response, USDA has implemented a national initiative to improve the nutritional
quality of school meals to address this problem.[16] More schools now offer meals that are lower in
fat and sodium while still offering recommended amounts of the key
nutrients.
-
Recent studies indicate that physicians
and caregivers rate the health status of children participating in WIC as
better than similar children who do not participate in the program.
In addition, WIC participation appears to increase the likelihood that
children will complete their immunizations on time. It also improves
children’s ability to obtain preventive and curative health services.[17]
Millions of
Americans Face Food Insecurity
Severe hunger is rare
in the United States, thanks in large part to the food and nutrition
programs. Census data show, however, that in 2003, between 23 million and
28 million people in the United
States with low incomes lived in households that experienced “food
insecurity,” a less severe condition that arises when a household has
difficulty securing adequate food throughout the year due to a lack of
resources.[21]
Some of these low-income families and individuals are unable to get
food stamps because of bans imposed by Congress that prohibit the
provision of food stamps to certain categories of low-income people. For
example, most “new Americans” — legal immigrants who have become permanent
residents of the United States — are barred from receiving food stamps
during their first five years in the country, no matter how low their
incomes are or how hard they work. As a result of this ban, food
insecurity and hunger among immigrants increased in the latter half of the
1990s.[22]
In addition, many unemployed people without children face a
three-month time limit on receipt of food stamps.[23]
A USDA study found that 40 percent of such adults in South Carolina
were food insecure, and 23 percent showed signs of experiencing hunger,
when they were surveyed 12 months after they left the Food Stamp Program.[24]
In addition, not all individuals and families who are eligible for food
and nutrition assistance receive it. USDA estimates that only 54
percent of the people eligible for food stamps receive them; participation
rates are relatively low for seniors, working families, and families with
members who are legal immigrants who have resided in the United States
for more than five years and thus can qualify for food stamps.[25]
Although the school meal programs are widely available, one recent study
found that in the areas examined, nearly one in four children eligible for
free meals (23 percent) was not enrolled in the free and reduced-price
lunch program.[26] Nearly one in five children in a
school that offers the school lunch program does not have access to the
School Breakfast Program because the school does not offer it.
Finally, many households that receive nutrition assistance still struggle
to make ends meet. In many cases, the combination of households’
earnings, nutrition assistance, and other income sources do not cover the
households’ rent, utility, food, child care, health care, and other bills.
Such households must juggle their limited resources and expenses and
sometimes have difficulty affording adequate food.
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Appendix A
Food Stamp
Program Participants, Year-to-Date, Fiscal Year 2005 |
|
|
Children |
Elderly |
Persons with
Disabilities |
Total |
|
U.S. Total |
12,920,000 |
2,200,000 |
3,200,000 |
25,490,000 |
|
|
|
|
|
|
|
Alabama |
270,000 |
42,000 |
75,000 |
540,000 |
|
Alaska |
28,000 |
2,000 |
4,000 |
54,000 |
|
Arizona |
306,000 |
28,000 |
41,000 |
547,000 |
|
Arkansas |
183,000 |
25,000 |
41,000 |
370,000 |
|
California |
1,340,000 |
32,000 |
12,000 |
1,987,000 |
|
Colorado |
130,000 |
19,000 |
38,000 |
252,000 |
|
Connecticut |
92,000 |
21,000 |
36,000 |
203,000 |
|
Delaware |
32,000 |
4,000 |
7,000 |
61,000 |
|
Dist Columbia |
40,000 |
5,000 |
10,000 |
89,000 |
|
Florida |
675,000 |
234,000 |
211,000 |
1,465,000 |
|
Georgia |
465,000 |
72,000 |
99,000 |
913,000 |
|
Hawaii |
39,000 |
15,000 |
10,000 |
94,000 |
|
Idaho |
48,000 |
5,000 |
13,000 |
94,000 |
|
Illinois |
565,000 |
85,000 |
169,000 |
1,140,000 |
|
Indiana |
279,000 |
36,000 |
81,000 |
554,000 |
|
Iowa |
96,000 |
12,000 |
28,000 |
203,000 |
|
Kansas |
84,000 |
14,000 |
24,000 |
176,000 |
|
Kentucky |
247,000 |
47,000 |
104,000 |
566,000 |
|
Louisiana |
376,000 |
55,000 |
81,000 |
734,000 |
|
Maine |
55,000 |
22,000 |
33,000 |
151,000 |
|
Maryland |
142,000 |
24,000 |
40,000 |
285,000 |
|
Massachusetts |
181,000 |
28,000 |
62,000 |
357,000 |
|
Michigan |
506,000 |
78,000 |
160,000 |
1,030,000 |
|
Minnesota |
130,000 |
22,000 |
35,000 |
257,000 |
|
Mississippi |
194,000 |
36,000 |
56,000 |
380,000 |
|
Missouri |
362,000 |
55,000 |
104,000 |
761,000 |
|
Montana |
37,000 |
6,000 |
10,000 |
80,000 |
|
Nebraska |
57,000 |
12,000 |
15,000 |
117,000 |
|
Nevada |
62,000 |
11,000 |
14,000 |
123,000 |
|
New Hampshire |
24,000 |
4,000 |
10,000 |
52,000 |
|
New Jersey |
194,000 |
44,000 |
59,000 |
388,000 |
|
New Mexico |
128,000 |
15,000 |
24,000 |
240,000 |
|
New York |
790,000 |
293,000 |
275,000 |
1,754,000 |
|
North Carolina |
391,000 |
70,000 |
105,000 |
791,000 |
|
North Dakota |
20,000 |
4,000 |
5,000 |
42,000 |
|
Ohio |
489,000 |
81,000 |
202,000 |
997,000 |
|
Oklahoma |
211,000 |
29,000 |
48,000 |
423,000 |
|
Oregon |
186,000 |
32,000 |
52,000 |
429,000 |
|
Pennsylvania |
467,000 |
95,000 |
185,000 |
1,033,000 |
|
Rhode Island |
40,000 |
6,000 |
10,000 |
77,000 |
|
South Carolina |
264,000 |
35,000 |
59,000 |
517,000 |
|
South Dakota |
27,000 |
4,000 |
5,000 |
56,000 |
|
Tennessee |
381,000 |
81,000 |
113,000 |
844,000 |
|
Texas |
1,407,000 |
205,000 |
179,000 |
2,427,000 |
|
Utah |
73,000 |
6,000 |
14,000 |
131,000 |
|
Vermont |
18,000 |
7,000 |
7,000 |
45,000 |
|
Virginia |
232,000 |
54,000 |
77,000 |
485,000 |
|
Washington |
221,000 |
44,000 |
70,000 |
503,000 |
|
West Virginia |
109,000 |
21,000 |
50,000 |
261,000 |