Food Insecurity in the COVID-19 Era: A National Wake-up Call to Strengthen SNAP Policy
Authors: Julia A. Wolfson, Cindy W. Leung
Journal: Annals of Internal Medicine (2024)

Editorials2 January 2024Food Insecurity in the COVID-19 Era: A National Wake-up Call to Strengthen SNAP PolicyFREEJulia A. Wolfson, PhD, MPP, Cindy W. Leung, ScD, MPHJulia A. Wolfson, PhD, MPPDepartment of Health, Policy and Management and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, Cindy W. Leung, ScD, MPHDepartment of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MassachusettsAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M23-3363 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Food is a critical social determinant of health. In the United States, food insecurity, defined as limited or uncertain access to sufficient nutritious food for an active and healthy life (often due to insufficient financial resources), is a persistent and intractable public health concern that affects roughly 1 in 10 U.S. households every year (1). Food insecurity is associated with many adverse physical and mental health outcomes and notable health disparities across the lifespan (2, 3). Food insecurity rates in the United States rise and fall after economic shocks (1). The COVID-19 pandemic shone a sobering spotlight on the precarity of food security (sufficient access to affordable, nutritious food) for many people in the United States. In 2020, as society shut down and unemployment skyrocketed, long lines and unprecedented demand at food banks unveiled the depth of a burgeoning food insecurity crisis. Indeed, research from the early months of the pandemic showed that food insecurity had tripled compared with the year before (4, 5). However, national estimates of food insecurity (measured annually in the Current Population Survey and published by the U.S. Department of Agriculture [USDA]) showed that the prevalence of food insecurity was virtually unchanged between 2019 (10.5%) and 2020 (10.5%) and even decreased in 2021 (to 10.2%) (1). The study by Troy and colleagues (6) adds to an emerging body of evidence illuminating how the COVID-19 pandemic and the policy responses to it are associated with food insecurity rates among important high-risk subpopulations.Using a large, nationally representative sample of low-income U.S. adults from the National Health Interview Survey (NHIS), Troy and colleagues compared food insecurity rates in 2021 and 2022 versus prepandemic rates in 2019 (6). They found that among low-income adults, the prevalence of food insecurity decreased from 20.6% in 2019 to 15.5% in 2021 and then rebounded to 20.1% in 2022. Trends were similar among low-income adults with diet-sensitive chronic health conditions. Most striking, among low-income adults receiving benefits from the Supplemental Nutrition Assistance Program (SNAP participants), the prevalence of food insecurity decreased from 34.6% in 2019 to 21.6% in 2021. Consistent with the other findings, food insecurity among SNAP participants climbed again in 2022 (though not to prepandemic levels), to 27.0%.Neither the findings in Troy and colleagues' study nor the national food insecurity trends reported by the USDA reflected the stark increase in food insecurity that antihunger and public health advocates had feared in 2020 and 2021. Why? The robust policy response strengthening SNAP and other aspects of the social safety net is likely a key part of the explanation. SNAP, more commonly known as food stamps, is the nation's largest nutrition assistance program. SNAP provides low-income households with money for food and is therefore the first line of defense in addressing food insecurity in the United States. Within the first year of the pandemic, Congress and the USDA enacted several policy changes to strengthen SNAP benefits and provide more flexibility for SNAP enrollment and certification processes. For example, work requirements and time limits for receiving benefits were relaxed and application processes were streamlined by waiving in-person interview requirements, allowing telephonic signatures, and extending certification periods. SNAP benefit levels were temporarily increased multiple times by raising all households to the maximum benefit levels (in 2020), by increasing the maximum benefit amount by $95 per month (in 2021), and by another temporary 15% increase in benefits. In a separate policy action, the Thrifty Food Plan, which is used to calculate SNAP benefits, was revised in October 2021, leading to a permanent 21% increase in SNAP benefits over prepandemic benefit levels. These policy changes, combined with other economic stimulus measures (such as the expanded Child Tax Credit, economic stimulus payments, and expanded unemployment benefits), were instrumental in supporting families and reducing food insecurity during the difficult circumstances and uncertain economy of the pandemic.According to the USDA, food insecurity increased from 10.2% in 2021 to 12.8% in 2022, which was the largest single-year increase since the Great Recession in 2008 (1). Troy and colleagues showed similar patterns using data from the NHIS (6). Many of the pandemic-era nutrition and economic policy changes were temporary and had expired by 2022. Evidence is mounting that removing these critical supports risks reversing progress made in supporting low-income families and reducing health disparities. For example, the temporary increases in SNAP benefits resulted in a 9% overall decrease in food insufficiency and a 13.5% decrease in food insufficiency among households with children (7). Since the SNAP benefit increases were discontinued, overall and child food insufficiency have both increased by approximately 21% among SNAP-participating families (8). Similarly, after the 2021 expansion of the Child Tax Credit expired, child poverty more than doubled, from a historic low of 5.2% to 12.4%—the largest increase in more than 50 years (9).The emerging evidence on the current state of food insecurity should be a national wake-up call to strengthen SNAP and other economic safety-net policies. The policy changes implemented during the pandemic were critical in alleviating food insecurity in some families and preventing worsening food insecurity in others, thereby demonstrating that, with strong policies, food insecurity can be reversible and preventable. We are now witnessing the sobering consequences of removing these vital food and economic supports on food insecurity and its health sequelae, as demonstrated by Troy and colleagues and others. As more data become available, additional research using longitudinal data and strong designs will be needed to understand the overall effect of the nutrition and economic policies enacted during the COVID-19 pandemic on food security, diet, health, and economic outcomes. That said, the Farm Bill, the omnibus legislation authorizing SNAP, will be renewed in 2024. The Farm Bill is a timely opportunity to build on the lessons learned during the pandemic and make SNAP a more nimble, streamlined, and robust program to promote public health (10). Available evidence shows that it is both feasible and effective to extend pandemic-era SNAP policy changes to the status quo. The political window to strengthen and leverage SNAP as a dual-pronged intervention to reduce food insecurity and promote health is now.References1. Rabbitt MP, Hales LJ, Burke MP, et al. Household Food Security in the United States in 2022. Report no. ERR-325. Economic Research Service, U.S. Department of Agriculture; October 2023. Google Scholar2. Gundersen C, Ziliak JP. Food insecurity and health outcomes. Health Aff (Millwood). 2015;34:1830-1839. [PMID: 26526240] doi:10.1377/hlthaff.2015.0645 CrossrefMedlineGoogle Scholar3. Bruening M, Dinour LM, Chavez JBR. Food insecurity and emotional health in the USA: a systematic narrative review of longitudinal research. Public Health Nutr. 2017;20:3200-3208. [PMID: 28903785] doi:10.1017/S1368980017002221 CrossrefMedlineGoogle Scholar4. Fitzpatrick KM, Harris C, Drawve G. Assessing U.S. Food Insecurity in the United States During COVID-19 Pandemic. Accessed at https://fulbright.uark.edu/departments/sociology/research-centers/community-family-institute/_resources/community-and-family-institute/revised-assessing-food-insecurity-brief.pdf on 28 April 2020. Google Scholar5. Wolfson JA, Leung CW. Food insecurity and COVID-19: disparities in early effects for US adults. Nutrients. 2020;12:1648. doi:10.3390/nu12061648 CrossrefMedlineGoogle Scholar6. Troy AL, Ahmad I, Zheng Z, et al. Food insecurity among low-income U.S. adults during the COVID-19 pandemic. Ann Intern Med. 2024;177:260-262. doi:10.7326/M23-2282 LinkGoogle Scholar7. Schanzenbach DW. The Impact of SNAP Emergency Allotments on SNAP Benefits and Food Insufficiency. Northwestern University Institute for Policy Research; 27 January 2023. Google Scholar8. Richterman A, Roberto CA, Thirumurthy H. Associations between ending Supplemental Nutrition Assistance Program emergency allotments and food insufficiency. JAMA Health Forum. 2023;4:e232511. [PMID: 37566430] doi:10.1001/jamahealthforum.2023.2511 CrossrefMedlineGoogle Scholar9. Parrott S. Record Rise in Poverty Highlights Importance of Child Tax Credit; Health Coverage Marks a High Point Before Pandemic Safeguards Ended. Center on Budget and Policy Priorities; 12 September 2023. Accessed at www.cbpp.org/press/statements/record-rise-in-poverty-highlights-importance-of-child-tax-credit-health-coverage on 11 December 2023. Google Scholar10. Bleich SN, Moran AJ, Vercammen KA, et al. Strengthening the public health impacts of the Supplemental Nutrition Assistance Program through policy. Annu Rev Public Health. 2020;41:453-480. [PMID: 32237988] doi:10.1146/annurev-publhealth-040119-094143 CrossrefMedlineGoogle Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Julia A. Wolfson, PhD, MPP; Cindy W. Leung, ScD, MPHAffiliations: Department of Health, Policy and Management and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MarylandDepartment of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MassachusettsDisclosures: The authors have reported no disclosures of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M23-3363.Corresponding Author: Julia A. Wolfson, PhD, MPP, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205; e-mail, jwolfso7@jhu.edu.This article was published at Annals.org on 2 January 2024. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoFood Insecurity Among Low-Income U.S. Adults During the COVID-19 Pandemic Aaron L. Troy , Isabella Ahmad , ZhaoNian Zheng , Rishi K. Wadhera Metrics Current IssueFebruary 2024Volume 177, Issue 2Page: 255-256KeywordsFoodFood insecurityHealth economicsNutritionPrevention, policy, and public healthPublic policy ePublished: 2 January 2024 Issue Published: February 2024 Copyright & PermissionsCopyright © 2024 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...