October 13, 2021
In addition to persistently high COVID-19 cases and deaths in the United States, an increasing number of Americans also suffer from diet-related diseases, including heart disease, diabetes, cancer, and obesity. Both COVID-19 and diet-related diseases are impacted by poverty and hunger. Furthermore, structural racism drives inequity in hunger, poverty, and poor health.
Government programs that address multiple risk factors for persistent and inequitable health outcomes must be prioritized. As proven anti-hunger and anti-poverty programs, the federal nutrition programs are essential tools for improving health and supporting an equitable recovery from the pandemic.
High rates of food insecurity, diet-related disease, and COVID-19 are interrelated
Throughout the pandemic, heart disease and cancer have remained the two leading causes of death in the United States, with COVID-19 as the third. While not a cause of death itself, obesity is a risk factor for heart disease, diabetes, and cancer. Obesity among adults continues to increase in every state, and the increase in obesity among children and adolescents has accelerated during COVID-19. Furthermore, the impact of these diseases and COVID-19 are not separate; rather, diet-related diseases lead to more severe COVID-19 outcomes.
Food insecurity and diet-related disease often coexist. At first glance, the co-occurrence of food insecurity and obesity may seem paradoxical. However, both food insecurity and obesity can be independent consequences of low income and the result of poverty and lack of access to healthy foods. Poverty and inconsistent access to food lead to stress and/or disordered eating, which drive inflammation in the body that underlies diet-related disease, including obesity. In addition, neighborhoods that have suffered from disinvestment lack access to healthy foods (e.g., food desserts or food apartheid) and have an overabundance of unhealthy foods (e.g., food swamps). This leads to difficulty accessing nutritious foods, which is also a risk factor for diet-related disease. A explains how hunger, poverty, and poor health are interrelated in a vicious cycle and why each increases susceptibility to COVID-19.
Structural racism is a driver of disparities
Structural racism refers to the ways society historically and currently fosters racial discrimination and the unjust distribution of resources through mutually reinforcing systems (e. g., education, jobs, housing, credit, healthcare, and the criminal justice system). This mutual reinforcement across systems makes structural racism self-perpetuating. Structural racism is a fundamental cause of poor health,1 obesity, and food insecurity and has been associated with disparities in COVID-19 mortality at the state and county level.
FRAC’s recent report on disparities during COVID-19 reviews how the systemic drivers of inequities in hunger, poverty, and health differ by population. Understanding how the root causes of these disparities differ by community is critical when implementing policy solutions. For example, prior to COVID-19, Latinx communities experienced disproportionate discrimination from immigration enforcement and the 2019 public charge ranule (blocked permanently in March 2021), resulting in the distrust of public services. This has had important implications for program participation and access to vaccines during COVID-19.
Role of the federal nutrition programs
The federal nutrition programs are important tools to address both COVID-19 and obesity. The Supplemental Nutrition Assistance Program (SNAP), the Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC), school meal programs like the School Breakfast Program and National School Lunch Program , and the Child and Adult Care Feeding Programs (CACFP) are all proven anti-hunger and anti-poverty programs and result in an overall increase in health and well-being2 (see evidence for: SNAP, child nutrition, and older adult programs).
Obesity reduction is one example of the positive health impacts of the federal nutrition programs. The implementation of the Healthy, Hunger-Free Kids Act of 2010 is associated with lower obesity rates for children in poverty, and school meals were recently found to be the healthiest source of food in the American diet. Similarly, after changes to the WIC food package in 2009, WIC participation has been associated with reduced obesity among participants ages 2 to 4 years old. Participation in SNAP during early childhood is associated with a lower risk for obesity as adults.
The pandemic has had profound impacts on every sector of society, from hunger to employment, which the federal nutrition programs help address. The federal nutrition programs have been essential supports for Americans during COVID-19, particularly expansions to the programs that include increased flexibility in applications and enrollment, the development of Pandemic Electronic Benefit Transfer (P-EBT), increased monthly benefits for SNAP, and increased fruit and vegetable vouchers for WIC. To ensure a robust and equitable recovery, expansions made during the pandemic must be made permanent so that households that continue to struggle are not left behind in the recovery. Investments in the child nutrition programs included in the House Build Back Better Act are crucial supports for the education and health of children and their families.
Broader systemic change
The Biden Administration has prioritized equity in all policies. On his first day in office, President Biden issued an Executive Order requiring all government agencies to evaluate the equity impact of their programs and develop a comprehensive approach to advancing equity for all (see FRAC’s response to the US Department of Agriculture on improving equity within the federal nutrition programs).
Ultimately, the federal nutrition programs must be part of a broader approach to uproot systems of oppression. At a policy level, this will require prioritizing laws and programs that are able to reduce disparities across multiple systems, such as programs that improve access to quality education, housing, and/or food, or that provide additional income to households with modest economic resources.
The House Build Back Better Act presents precisely such an opportunity to address structural racism. Passage of the full size and scope of the bill would reduce racial disparities in poverty, hunger, housing, and education. On September 29, nearly 800 organizations joined together in a letter urging passage of the Act. In addition, FRAC supports a range of bills that address additional priorities for families struggling against hunger.
1: Momentum to address structural racism to eliminate health disparities is building. Many professional health organizations have declared structural racism as a determinant of health (see: the American Public Health Association (leading the charge in 2000), the American Academy of Pediatrics, the American Medical Association, the American Heart Association, and the Centers for Disease Prevention and Control). Many state and local leaders have also declared racism a public health crisis.
2: While some research finds mixed evidence of the positive impacts of the federal nutrition programs, this research is complex because hunger, poverty, and poor health often occur at the same time. By design, these programs provide the most resources to those individuals with the greatest need. Therefore, individuals who are more likely to have low incomes and enroll in nutrition programs are also more likely to be food insecure and have diet-related chronic diseases. Many studies that account for this self-selection find that the federal nutrition programs improve food security, reduce poverty, improve educational outcomes, and improve health.