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Do Sugary Drinks Undermine the Core Purpose of SNAP?

Do Sugary Drinks Undermine the Core Purpose of SNAP? Abstract Ross and MacKay (2017) argue that excluding sugar-sweetened beverages from the Supplemental Nutrition Assistance Program (SNAP) is ‘in principle morally permissible’ because it does not violate the central obligation that SNAP is meant to discharge—the obligation to ensure that citizens have secure access to food adequate to meet their nutritional needs. I query this argument, and suggest two other ways of understanding the core purpose of SNAP. According to the first, the core purpose of SNAP includes promoting good nutritional outcomes; thus, one might argue, including sugary drinks in SNAP undermines its core purpose. According to a second conception of SNAP, its core purpose ought to be much broader: promoting good nutritional outcomes, ensuring food security and providing secure access to other food-related goods, such as pleasure, social experiences and cultural expression. Introduction In ‘Ending SNAP-Subsidized Purchases of Sugar-Sweetened Beverages: The Need for a Pilot Project’, Ross and MacKay (2017) take up the issue of banning sugary drinks from the Supplemental Nutrition Assistance Program (SNAP), the USA’s largest food assistance program. SNAP is a nearly $70 billion program serving more than 40 million Americans, giving them an average monthly benefit of $125/person (FNS, 2017a). With only a few exceptions (alcohol, hot foods and foods meant to be eaten in the store), SNAP assistance can be used to purchase any foods from participating stores—including sugar-sweetened beverages (SSBs) and candy (FNS, 2017b). More than a dozen states have attempted to exclude sugary drinks from the foods eligible for purchase with SNAP assistance, both to improve the health of SNAP participants and to make the program more efficient; some public health advocates and policymakers have also endorsed the idea (Gittelsohn and Lee, 2013). However, the US Department of Agriculture (USDA), which must approve such changes, has always denied states’ requests (Ross and MacKay, 2017: 62). The issue of excluding sugary drinks or other foods from SNAP has been divisive, creating tension and distrust between advocates in the public health community and opponents in the public health and anti-hunger communities (Schwartz, 2017: S200). Ethicists and activists have raised a series of ethical concerns with excluding sugary drinks from SNAP. Some focus on the potential negative effects on SNAP participants, for example, increasing the stigma associated with using SNAP assistance and driving down participation rates (Barnhill, 2011; Chrisinger, 2017). Other ethical concerns center on the fair treatment and social equality of SNAP participants: excluding SSBs from SNAP, while using government funds to purchase sugary drinks in other contexts, is inconsistent and applies a double-standard, it is claimed (Kass et al., 2014; Schwartz, 2017). In the absence of broader efforts to reduce everyone’s consumption of SSBs, excluding SSBs from SNAP unfairly targets SNAP participants (Barnhill and King, 2013), it is claimed. It may also constitute expressive harm, as it sends the message that SNAP participants are uniquely unsuited to make choices for themselves, and undermines their dignity (Barnhill and King, 2013; Ross and MacKay, 2017; Schwartz, 2017). Another concern is that excluding SSBs or other foods from SNAP would constrain participants’ agency (Chrisinger, 2017). Complicating the ethical picture is evidence that many SNAP participants support excluding sugary drinks from SNAP. Long et al. (2014) found that 54 per cent of SNAP participants, surveyed in 2012, would support excluding sugary drinks from SNAP. Leung et al. (2017) found that 68 per cent of SNAP participants, surveyed in 2015, would support excluding sugary drinks from SNAP if the exclusion was paired with providing additional money for healthy foods. Ross and MacKay enter this fraught terrain with an interesting argument that excluding SSBs from SNAP is ‘in principle morally permissible’. This argument, as I interpret it, is that excluding SSBs from SNAP does not violate the central obligation that SNAP is meant to discharge—the obligation to ensure that citizens have secure access to food adequate to meet their nutritional needs. Based on this argument and other considerations, Ross and MacKay make the case for a pilot study of excluding SSBs from SNAP. In this article, I query Ross and MacKay’s ‘in principle morally permissible’ argument. I suggest that they may have misidentified the core purpose of SNAP, since the purpose they identify is consistent with a radically different kind of food assistance program, one in which participants have no food choice. I also suggest a modified, stronger version of their argument, according to which the core purpose of SNAP includes promoting good nutritional outcomes, and since including SSBs in SNAP undermines promoting good nutritional outcomes, therefore including SSBs violates the central obligation that SNAP is meant to discharge. I spell out this modified argument for consideration; however, I do not endorse it. This argument is based on a view of SNAP that I would like to question. I suggest an alternate conception of the SNAP program, according to which its purpose should be multi-fold: providing secure access to adequate food to meet caloric needs, promoting good nutritional outcomes, reducing poverty or mitigating its effects and providing secure access to adequate food to experience other food-related goods (such as pleasure, social experiences and cultural expression). Ross and MacKay’s Argument This commentary is focused on one section of Ross and MacKay’s paper (page 64) in which they argue that excluding SSBs from SNAP is ‘in principle morally permissible’. The first step in this argument is a methodological claim: to assess the ethics of a specific change to SNAP (i.e. excluding sugary drinks), we first need to know what is the moral justification of SNAP. This moral justification is a standard by which we should assess any change to SNAP, such as excluding sugary drinks: does the change conflict with the underlying moral justification of SNAP, for example, by making SNAP less effective at meeting morally important obligations? In order to figure out what SNAP’s moral justification is, Ross and McKay suggest, we need to look at how the program is structured, and look at its core features both historically and currently. As Ross and MacKay explain, SNAP was previously known as the Food Stamp Program (FSP), which was established in 1964 to make use of agricultural surplus while addressing hunger and food insecurity. They see the core purpose of SNAP now as providing adequate food to meet caloric needs (in line with the program’s historic aims of addressing hunger and food security) and also to meet nutritional needs. In other words, SNAP’s core purpose (in a descriptive sense) is to provide people with enough food, and furthermore food that meets their nutritional needs. In support of this view, Ross and MacKay point to how nutrition, and not just hunger, became a focus of the program over time. They cite recent legislative changes: the FSP was renamed the Supplemental Nutrition Assistance Program in 2008. They also cite language in a document produced by the USDA, which administers SNAP at the federal level: ‘SNAP’s stated purpose is “to alleviate hunger and malnutrition … by permit[ing] low-income households to obtain a more nutritious diet by … increasing their purchasing power”’ (Ross and MacKay, 2017: 23). The next step in Ross and MacKay’s argument is to look at the underlying moral justification of SNAP. They conclude that the ‘best moral justification for SNAP lies with governments’ duty to ensure their citizens have secure access to food adequate to meet their nutritional needs’ (Ross and MacKay, 2017: 64). SNAP is a core program with which the government fulfills this duty. But which nutritional needs, exactly, should SNAP aim to meet? Here Ross and MacKay have an interesting position. As will be discussed below, there is substantial disagreement in the literature about what the aims of SNAP should be. One point of relative agreement, however, is that SNAP should aim to prevent under-nutrition. Some claim that SNAP should also aim to prevent over-nutrition, for example, by helping to reduce consumption of sugary drinks that supply excess sugar and empty calories. However, there is disagreement on this point, with some denying that SNAP’s aims include preventing over-nutrition. Ross and MacKay seem to take an intermediate position: SNAP’s purpose is to address under-nutrition by providing nutritious food, such that people do not have to eat non-nutritious foods that lead to over-nutrition. The underlying moral obligation discharged by SNAP is to ensure that citizens have secure access to food adequate to meet their nutritional needs, and to discharge this moral obligation, ‘the US government must (i) ensure that all citizens can satisfy their caloric needs, with (ii) foods that meet scientifically designed nutrition standards’. That is, the government must ensure that people have secure access to enough nutritious food that people can, if they so choose, satisfy their caloric needs with nutritious food. While Ross and MacKay do not state explicitly that SNAP should aim to prevent over-nutrition, an implication of their view is that participants will be able to avoid over-nutrition: when people can meet their caloric needs with nutritious food, they can avoid over-nutrition because they need not consume non-nutritious foods (like SSBs) that lead to over-nutrition. But importantly, Ross and MacKay do not claim that the government must try to ensure that citizens do satisfy their caloric needs with nutritious food, just that the government must ensure that citizens can satisfy their caloric needs with foods that meet nutrition standards. Other advocates of the SSB exclusion take a different position, arguing that SNAP’s aim is to produce good nutritional outcomes, not merely to give people the opportunity to achieve good nutritional outcomes if they so choose. This is discussed more below. The last step in Ross and MacKay’s argument is to conclude that excluding SSBs from SNAP is ‘in principle morally permissible’ because excluding SSBs does not interfere with SNAP meeting its core purpose of ensuring citizens’ secure access to enough nutritious food to meet their caloric needs. They write that ‘the government's duty to satisfy (i) and (ii) [ensuring that all citizens can satisfy their caloric needs with foods that meet scientifically designed nutrition standards] does not imply an obligation to ensure that its citizens can purchase SSBs. Given that the principal moral justification for SNAP supports the satisfaction of (i) and (ii), it is therefore in principle permissible for Congress to implement an SSB ban’ (Ross and MacKay, 2017: 64). The reasoning here, as I interpret it, is that SSBs are non-nutritious food and therefore including SSBs in SNAP does not help SNAP achieve its core purpose (of ensuring that citizens have secure access to enough nutritious food to meet their caloric needs). Thus, excluding SSBs does not violate the central moral obligation toward citizens that SNAP is meant to discharge. In light of these considerations, Ross and MacKay conclude that ‘it is therefore in principle permissible for Congress to implement an SSB ban’. In later sections, Ross and MacKay respond to other objections to the SSB exclusion and make a positive case for a pilot study of an SSB ban as a first step in assessing whether an SSB ban is appropriate. It is important to emphasize that, on this interpretation of their argument, Ross and MacKay are not arguing that including SSBs undermines SNAP’s core purpose. They are just arguing that including SSBs is not necessary to achieve SNAP’s core purpose. But one could make a modified, stronger version of their argument. According to this modified argument, SNAP is meant to discharge the government’s obligations to ensure citizens’ access to food and to promote their health, and SNAP’s core purpose is to provide secure access to nutritious food and to promote good nutritional outcomes. Including SSBs undermines the purpose of promoting good nutrition outcomes, since SSB consumption is associated with poor nutritional outcomes, with weight gain and with diabetes risk (Malik et al., 2006; Vartanian et al., 2007; Greenwood et al., 2014; Imamura et al., 2015). Because including SSBs undermines this purpose of SNAP, the argument continues, it undermines the government’s effort to discharge specific obligations toward citizens. Including SSBs in SNAP is, for this reason, morally impermissible. This modified argument establishes the stronger conclusion that including SSBs in SNAP violates a specific moral obligation, whereas Ross and MacKay’s original argument only establishes that excluding SSBs from SNAP is in principle morally permissible. While I offer this stronger argument for consideration, I do endorse it here. An Undesirable Implication I fear that Ross and MacKay may have misidentified the core purpose of SNAP. The purpose they identify is consistent with a radically different kind of food assistance program, one in which participants have no food choice. If SNAP’s core aim is to ensure secure access to enough nutritious food to meet caloric needs, this can be achieved even if most nutritious foods are excluded—so long as enough nutritious foods are provided to meet caloric needs. The average supermarket carries 40,000 products, and people do not need access to most of them to assemble a nutritionally adequate diet (Food Marketing Institute, 2017). Securing access to food adequate to meet nutritional needs could be accomplished by restricting SNAP to a small selection of these 40,000 products, just as the Women, Infants and Children (WIC) program does.1 All that is required to fulfill the central duty underlying SNAP (as this duty is construed by Ross and MacKay) is to give people secure access to sufficient nutritious food to meet their caloric needs; for the purposes of fulfilling this duty, it does not matter what the food is, or what other food-related needs this food does or does not meet. For example, giving people baskets of nutritious food without allowing them any choice, and without meeting their specific food preferences, would fulfill this duty. Ross and MacKay acknowledge that their argument for excluding SSBs would also apply to excluding other foods that, like SSBs, do not meet nutritional standards. But the implications of their argument are much more radical than this; their argument supports this ‘choice-less basket’ approach to food assistance, in which participants are given no choice and most foods that are nutritious and healthful are not included. The choice-less basket system is consistent with the purpose and moral justification of SNAP identified by Ross and MacKay. But it is a radical departure from the current SNAP program. This suggests that Ross and MacKay may have misidentified the purpose of SNAP. They intended to identify a purpose of SNAP that fit the program in its current form; but a purpose that is consistent with a radically modified version of SNAP is not a snug fit—that is, it does not capture the actual structure of the program, and what the program actually accomplishes. If not the purpose identified by Ross and MacKay, what is the core purpose of SNAP? What Is the Purpose of SNAP? In the literature, there is significant disagreement about what kind of program SNAP is, and what it should aim to do. Some see SNAP as primarily a nutrition program, whereas others see SNAP as primarily an anti-hunger and food security program, or an anti-poverty program (Fisher, 2017: 110). For example, the anti-hunger organization the Food Research & Action Center writes that SNAP ‘plays a critical role in reducing hunger, malnutrition, and poverty, and improving family security, child and adult health, employment, and other outcomes’ (Food Research & Action Center, 2017). Other anti-hunger advocates also argue that SNAP is primarily an anti-poverty or anti-hunger program, and only secondarily a nutrition program, or not a nutrition program at all (Fisher, 2017: 110, 125). Some authors have pointed to SNAP’s authorizing legislation to argue that SNAP’s aims are nutritional aims (Barnhill, 2011; Ross and MacKay, 2017). But the legislation rings multiple bells, stating that SNAP’s aim is to increase low-income households’ food purchasing power, to alleviate hunger, alleviate malnutrition and improve nutrition, and thereby improve the health and well-being of low-income people, and strengthen the agricultural economy (Food and Nutrition Act of 2008, 2008, Section 2). Even allowing that SNAP is a nutrition program, we might disagree about what nutritional aims SNAP should have. As described by Andrew Fisher, the public health community has sought to ‘redefine what it meant for SNAP to be a nutrition program, beyond its traditional accomplishments in reducing hunger, to one of prevention of chronic diseases’ (Fisher, 2017: 113). That is, some argue that SNAP should aim to prevent over-nutrition and not just under-nutrition. Another source of evidence about SNAP’s aims are materials from the USDA, which administers the SNAP program at the federal level. In a report describing the SNAP program, the USDA highlights SNAP’s role in reducing food insecurity and improving nutrition (FNS, 2012). For example: ‘SNAP alleviates hunger and improves nutrition by increasing the food purchasing power of low-income households, enabling them to obtain a more nutritious diet by preparing food at home’ (FNS, 2012: 2). The USDA also emphasizes the anti-poverty effect of SNAP, noting ‘that SNAP would lift 3.9 million Americans—including 1.7 million children—out of poverty if its benefits were included in the official measures of income and poverty’ (FNS, 2012: 3). Given these differing views about the aims of SNAP, what should we conclude? What are the aims of SNAP, and how do we determine them? More pertinent, perhaps: what should be the aims of SNAP? A More Expansive View of the Aims of SNAP Return to the choice-less basket system described above. From a normative perspective, this choice-less basket system seems worse—quite meaningfully worse—than the present SNAP program. One moral problem with it, objectors could argue, is that denying SNAP participants choice undermines their dignity and social equality.2 We should also wonder if the choice-less basket system would be effective at reducing food insecurity, reducing poverty and improving nutritional outcomes. Even if people have access to sufficient food to meet their nutritional needs (in the minimal sense of being given a basket of nutritious food), will they use it effectively to meet their needs? The choice-less basket system also seems much worse than SNAP in another way: it does not meet SNAP participants’ basic food-related needs as well as the current SNAP program, and it seems worse for this reason. Food serves multiple purposes besides providing sustenance and nutrition (Resnik, 2010). Food provides pleasure and comfort. Food and eating are central to social life: sharing food is a way to express love, forge relationships and reinforce bonds. Specific foods are used to mark special occasions in culturally specific ways, such as serving cake and ice cream at a birthday party. What we eat expresses our personal and group identities (Guptill et al., 2013: 17–41). In short, food experiences have multiple kinds of meaning and value for individuals and groups. Making our own food choices has multiple kinds of value. Exercising food choice allows us to choose foods that have the most value for us—for example, foods that are pleasurable and comforting, culturally appropriate and express social identities. Exercising food choice is also experienced as intrinsically valuable by some people. Having food choice also has symbolic value: being afforded choice symbolizes that you are capable of making choices for yourself, and have a kind of equal social status (Barnhill and King, 2013). A food assistance program that allows significant choice, and thus allows people to achieve more of these food-related goods, seems intuitively like a better food assistance program, one that is doing a better job discharging relevant obligations. That is, my moral intuition is that the current SNAP program, as compared to the choice-less basket program, does a better job meeting morally relevant obligations. Based on this moral intuition, I would like to suggest that the core purpose of the SNAP program should be not only providing food security, meeting nutritional needs and reducing poverty, but also meeting some other food-related needs. This seems like a pretty close fit to the actual program: SNAP is structured to give participants significant food choice, and includes emphasis on nutrition education and economic empowerment (FNS, 2012), suggesting that the actual program is meant to encourage people to have a variety of new food experiences of their choice that meet their needs. Which food-related experiences, goods and choices does the government have a duty to ensure that we have the opportunity to have? Do governments have a duty to ensure secure access to food adequate to provide substantial pleasure? How about food adequate to allow socially significant experiences, and to allow cultural expression? We should expect disagreement on these issues. The right to food has been construed by some as a right not just to food that meets nutritional needs, but also to food that is culturally acceptable, and food that ensures a ‘physical and mental, individual and collective, fulfilling and dignified life free of fear’ (FAO, 2017). Others argue, however, for much more narrow entitlements to food and food-related goods.3 Assume, for the sake of argument, that the government does have a duty to provide secure access to food adequate to meet a range of food-related needs. Is SNAP the means through which that obligation should be fulfilled? SNAP is the largest food assistance program, and thus is a primary means through which the government could feasibly meet food-related needs. To my mind, it is a compelling thought that governments have a duty to ensure access to various food-related experiences (not just to ensure that caloric and nutritional needs are met), and that SNAP is the program that ought primarily to address these needs. I would like to suggest that this compelling thought warrants future exploration. However, I do not offer here a positive argument in support of this thought, nor a specific account of which food-related needs SNAP ought to meet. Conclusions I have suggested that Ross and MacKay might be construing the core purpose and moral justification of the SNAP program too narrowly. Rather than just being a food security and nutrition program, perhaps SNAP should be the means of providing citizens with a fuller range of food-related goods and experiences. I offer, as a suggestion, that the core purpose of SNAP is: to provide secure access to adequate food to relieve hunger and to experience other food-related goods such as pleasure, social experiences and cultural expression, and to promote good nutritional outcomes. This proposal needs to be worked out in detail. Which experiences ought SNAP to provide secure access to? Do citizens have an entitlement to these experiences and goods, and what is the normative basis of this entitlement? If the various aims of SNAP (i.e. enabling socially and culturally valuable experiences, promoting good nutritional outcomes) come into conflict, how should we balance these aims? Plausibly, there are some foods that are pleasurable, and play valuable social and cultural roles, yet need not be included in SNAP—for example, alcohol.4 It seems reasonable, as a general matter, to exclude some foods from SNAP, despite their social and cultural value, because including them makes the program less efficient, undermines the aim of improving nutritional outcomes or undermines the program’s other aims, and the balance of considerations favors exclusion. Excluding some foods is consistent with recognizing the positive value of those foods, and recognizing the importance of giving SNAP participants a great deal of food choice. Returning to the case of SSBs, consumption of SSBs provides personal and social goods: drinking SSBs is pleasurable and socially normative, and linked to positive social identities and positive experiences (Weiner, 1996; Noe, 2012; Barnhill, 2016). Nonetheless, excluding SSBs from SNAP might be justifiable, if exclusion has significant enough health benefits relative to its personal and social costs. The general point here is that while we need to recognize and characterize the positive of value of SSBs and other non-nutritious foods for SNAP participants, and recognize the value of food choice, there may still be a case for excluding some foods. Thus, I am inclined to support a sugary drink exclusion, but its ultimate justification depends upon the role that sugary drinks play in the lives of SNAP participants, the health benefit that plausibly can be achieved by excluding SSBs and a more detailed ethical view about how the aims of SNAP ought to be balanced when they conflict. That is a good topic for future research. Footnotes 1. WIC provides assistance to buy select categories of foods, such as whole grains, fruits and vegetables and milk (Food and Nutrition Service, United States Department of Agriculture, 2016). 2. These issues of social equality and dignity have gotten considerable attention in the literature on SNAP exclusions (Barnhill and King, 2013; Schwartz, 2017), and I will not delve into them again here. 3. See (Raponi, 2017) for a defense of the right to food, and a discussion of objections to it. 4. I thank an anonymous reviewer for suggesting this example. References Barnhill A. ( 2011 ). Impact and Ethics of excluding Sweetened Beverages from the SNAP Program . American Journal of Public Health , 101 , 2037 – 2043 . http://dx.doi.org/10.2105/AJPH.2011.300225 Google Scholar Crossref Search ADS PubMed Barnhill A. , King K. F. ( 2013 ). Evaluating Equity Critiques in Food Policy: The Case of Sugar-Sweetened Beverages . 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Do Sugary Drinks Undermine the Core Purpose of SNAP?

Public Health Ethics , Volume 12 (1) – Apr 1, 2019

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Oxford University Press
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© The Author(s) 2018. Published by Oxford University Press. Available online at www.phe.oxfordjournals.org
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1754-9973
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1754-9981
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10.1093/phe/phy002
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Abstract

Abstract Ross and MacKay (2017) argue that excluding sugar-sweetened beverages from the Supplemental Nutrition Assistance Program (SNAP) is ‘in principle morally permissible’ because it does not violate the central obligation that SNAP is meant to discharge—the obligation to ensure that citizens have secure access to food adequate to meet their nutritional needs. I query this argument, and suggest two other ways of understanding the core purpose of SNAP. According to the first, the core purpose of SNAP includes promoting good nutritional outcomes; thus, one might argue, including sugary drinks in SNAP undermines its core purpose. According to a second conception of SNAP, its core purpose ought to be much broader: promoting good nutritional outcomes, ensuring food security and providing secure access to other food-related goods, such as pleasure, social experiences and cultural expression. Introduction In ‘Ending SNAP-Subsidized Purchases of Sugar-Sweetened Beverages: The Need for a Pilot Project’, Ross and MacKay (2017) take up the issue of banning sugary drinks from the Supplemental Nutrition Assistance Program (SNAP), the USA’s largest food assistance program. SNAP is a nearly $70 billion program serving more than 40 million Americans, giving them an average monthly benefit of $125/person (FNS, 2017a). With only a few exceptions (alcohol, hot foods and foods meant to be eaten in the store), SNAP assistance can be used to purchase any foods from participating stores—including sugar-sweetened beverages (SSBs) and candy (FNS, 2017b). More than a dozen states have attempted to exclude sugary drinks from the foods eligible for purchase with SNAP assistance, both to improve the health of SNAP participants and to make the program more efficient; some public health advocates and policymakers have also endorsed the idea (Gittelsohn and Lee, 2013). However, the US Department of Agriculture (USDA), which must approve such changes, has always denied states’ requests (Ross and MacKay, 2017: 62). The issue of excluding sugary drinks or other foods from SNAP has been divisive, creating tension and distrust between advocates in the public health community and opponents in the public health and anti-hunger communities (Schwartz, 2017: S200). Ethicists and activists have raised a series of ethical concerns with excluding sugary drinks from SNAP. Some focus on the potential negative effects on SNAP participants, for example, increasing the stigma associated with using SNAP assistance and driving down participation rates (Barnhill, 2011; Chrisinger, 2017). Other ethical concerns center on the fair treatment and social equality of SNAP participants: excluding SSBs from SNAP, while using government funds to purchase sugary drinks in other contexts, is inconsistent and applies a double-standard, it is claimed (Kass et al., 2014; Schwartz, 2017). In the absence of broader efforts to reduce everyone’s consumption of SSBs, excluding SSBs from SNAP unfairly targets SNAP participants (Barnhill and King, 2013), it is claimed. It may also constitute expressive harm, as it sends the message that SNAP participants are uniquely unsuited to make choices for themselves, and undermines their dignity (Barnhill and King, 2013; Ross and MacKay, 2017; Schwartz, 2017). Another concern is that excluding SSBs or other foods from SNAP would constrain participants’ agency (Chrisinger, 2017). Complicating the ethical picture is evidence that many SNAP participants support excluding sugary drinks from SNAP. Long et al. (2014) found that 54 per cent of SNAP participants, surveyed in 2012, would support excluding sugary drinks from SNAP. Leung et al. (2017) found that 68 per cent of SNAP participants, surveyed in 2015, would support excluding sugary drinks from SNAP if the exclusion was paired with providing additional money for healthy foods. Ross and MacKay enter this fraught terrain with an interesting argument that excluding SSBs from SNAP is ‘in principle morally permissible’. This argument, as I interpret it, is that excluding SSBs from SNAP does not violate the central obligation that SNAP is meant to discharge—the obligation to ensure that citizens have secure access to food adequate to meet their nutritional needs. Based on this argument and other considerations, Ross and MacKay make the case for a pilot study of excluding SSBs from SNAP. In this article, I query Ross and MacKay’s ‘in principle morally permissible’ argument. I suggest that they may have misidentified the core purpose of SNAP, since the purpose they identify is consistent with a radically different kind of food assistance program, one in which participants have no food choice. I also suggest a modified, stronger version of their argument, according to which the core purpose of SNAP includes promoting good nutritional outcomes, and since including SSBs in SNAP undermines promoting good nutritional outcomes, therefore including SSBs violates the central obligation that SNAP is meant to discharge. I spell out this modified argument for consideration; however, I do not endorse it. This argument is based on a view of SNAP that I would like to question. I suggest an alternate conception of the SNAP program, according to which its purpose should be multi-fold: providing secure access to adequate food to meet caloric needs, promoting good nutritional outcomes, reducing poverty or mitigating its effects and providing secure access to adequate food to experience other food-related goods (such as pleasure, social experiences and cultural expression). Ross and MacKay’s Argument This commentary is focused on one section of Ross and MacKay’s paper (page 64) in which they argue that excluding SSBs from SNAP is ‘in principle morally permissible’. The first step in this argument is a methodological claim: to assess the ethics of a specific change to SNAP (i.e. excluding sugary drinks), we first need to know what is the moral justification of SNAP. This moral justification is a standard by which we should assess any change to SNAP, such as excluding sugary drinks: does the change conflict with the underlying moral justification of SNAP, for example, by making SNAP less effective at meeting morally important obligations? In order to figure out what SNAP’s moral justification is, Ross and McKay suggest, we need to look at how the program is structured, and look at its core features both historically and currently. As Ross and MacKay explain, SNAP was previously known as the Food Stamp Program (FSP), which was established in 1964 to make use of agricultural surplus while addressing hunger and food insecurity. They see the core purpose of SNAP now as providing adequate food to meet caloric needs (in line with the program’s historic aims of addressing hunger and food security) and also to meet nutritional needs. In other words, SNAP’s core purpose (in a descriptive sense) is to provide people with enough food, and furthermore food that meets their nutritional needs. In support of this view, Ross and MacKay point to how nutrition, and not just hunger, became a focus of the program over time. They cite recent legislative changes: the FSP was renamed the Supplemental Nutrition Assistance Program in 2008. They also cite language in a document produced by the USDA, which administers SNAP at the federal level: ‘SNAP’s stated purpose is “to alleviate hunger and malnutrition … by permit[ing] low-income households to obtain a more nutritious diet by … increasing their purchasing power”’ (Ross and MacKay, 2017: 23). The next step in Ross and MacKay’s argument is to look at the underlying moral justification of SNAP. They conclude that the ‘best moral justification for SNAP lies with governments’ duty to ensure their citizens have secure access to food adequate to meet their nutritional needs’ (Ross and MacKay, 2017: 64). SNAP is a core program with which the government fulfills this duty. But which nutritional needs, exactly, should SNAP aim to meet? Here Ross and MacKay have an interesting position. As will be discussed below, there is substantial disagreement in the literature about what the aims of SNAP should be. One point of relative agreement, however, is that SNAP should aim to prevent under-nutrition. Some claim that SNAP should also aim to prevent over-nutrition, for example, by helping to reduce consumption of sugary drinks that supply excess sugar and empty calories. However, there is disagreement on this point, with some denying that SNAP’s aims include preventing over-nutrition. Ross and MacKay seem to take an intermediate position: SNAP’s purpose is to address under-nutrition by providing nutritious food, such that people do not have to eat non-nutritious foods that lead to over-nutrition. The underlying moral obligation discharged by SNAP is to ensure that citizens have secure access to food adequate to meet their nutritional needs, and to discharge this moral obligation, ‘the US government must (i) ensure that all citizens can satisfy their caloric needs, with (ii) foods that meet scientifically designed nutrition standards’. That is, the government must ensure that people have secure access to enough nutritious food that people can, if they so choose, satisfy their caloric needs with nutritious food. While Ross and MacKay do not state explicitly that SNAP should aim to prevent over-nutrition, an implication of their view is that participants will be able to avoid over-nutrition: when people can meet their caloric needs with nutritious food, they can avoid over-nutrition because they need not consume non-nutritious foods (like SSBs) that lead to over-nutrition. But importantly, Ross and MacKay do not claim that the government must try to ensure that citizens do satisfy their caloric needs with nutritious food, just that the government must ensure that citizens can satisfy their caloric needs with foods that meet nutrition standards. Other advocates of the SSB exclusion take a different position, arguing that SNAP’s aim is to produce good nutritional outcomes, not merely to give people the opportunity to achieve good nutritional outcomes if they so choose. This is discussed more below. The last step in Ross and MacKay’s argument is to conclude that excluding SSBs from SNAP is ‘in principle morally permissible’ because excluding SSBs does not interfere with SNAP meeting its core purpose of ensuring citizens’ secure access to enough nutritious food to meet their caloric needs. They write that ‘the government's duty to satisfy (i) and (ii) [ensuring that all citizens can satisfy their caloric needs with foods that meet scientifically designed nutrition standards] does not imply an obligation to ensure that its citizens can purchase SSBs. Given that the principal moral justification for SNAP supports the satisfaction of (i) and (ii), it is therefore in principle permissible for Congress to implement an SSB ban’ (Ross and MacKay, 2017: 64). The reasoning here, as I interpret it, is that SSBs are non-nutritious food and therefore including SSBs in SNAP does not help SNAP achieve its core purpose (of ensuring that citizens have secure access to enough nutritious food to meet their caloric needs). Thus, excluding SSBs does not violate the central moral obligation toward citizens that SNAP is meant to discharge. In light of these considerations, Ross and MacKay conclude that ‘it is therefore in principle permissible for Congress to implement an SSB ban’. In later sections, Ross and MacKay respond to other objections to the SSB exclusion and make a positive case for a pilot study of an SSB ban as a first step in assessing whether an SSB ban is appropriate. It is important to emphasize that, on this interpretation of their argument, Ross and MacKay are not arguing that including SSBs undermines SNAP’s core purpose. They are just arguing that including SSBs is not necessary to achieve SNAP’s core purpose. But one could make a modified, stronger version of their argument. According to this modified argument, SNAP is meant to discharge the government’s obligations to ensure citizens’ access to food and to promote their health, and SNAP’s core purpose is to provide secure access to nutritious food and to promote good nutritional outcomes. Including SSBs undermines the purpose of promoting good nutrition outcomes, since SSB consumption is associated with poor nutritional outcomes, with weight gain and with diabetes risk (Malik et al., 2006; Vartanian et al., 2007; Greenwood et al., 2014; Imamura et al., 2015). Because including SSBs undermines this purpose of SNAP, the argument continues, it undermines the government’s effort to discharge specific obligations toward citizens. Including SSBs in SNAP is, for this reason, morally impermissible. This modified argument establishes the stronger conclusion that including SSBs in SNAP violates a specific moral obligation, whereas Ross and MacKay’s original argument only establishes that excluding SSBs from SNAP is in principle morally permissible. While I offer this stronger argument for consideration, I do endorse it here. An Undesirable Implication I fear that Ross and MacKay may have misidentified the core purpose of SNAP. The purpose they identify is consistent with a radically different kind of food assistance program, one in which participants have no food choice. If SNAP’s core aim is to ensure secure access to enough nutritious food to meet caloric needs, this can be achieved even if most nutritious foods are excluded—so long as enough nutritious foods are provided to meet caloric needs. The average supermarket carries 40,000 products, and people do not need access to most of them to assemble a nutritionally adequate diet (Food Marketing Institute, 2017). Securing access to food adequate to meet nutritional needs could be accomplished by restricting SNAP to a small selection of these 40,000 products, just as the Women, Infants and Children (WIC) program does.1 All that is required to fulfill the central duty underlying SNAP (as this duty is construed by Ross and MacKay) is to give people secure access to sufficient nutritious food to meet their caloric needs; for the purposes of fulfilling this duty, it does not matter what the food is, or what other food-related needs this food does or does not meet. For example, giving people baskets of nutritious food without allowing them any choice, and without meeting their specific food preferences, would fulfill this duty. Ross and MacKay acknowledge that their argument for excluding SSBs would also apply to excluding other foods that, like SSBs, do not meet nutritional standards. But the implications of their argument are much more radical than this; their argument supports this ‘choice-less basket’ approach to food assistance, in which participants are given no choice and most foods that are nutritious and healthful are not included. The choice-less basket system is consistent with the purpose and moral justification of SNAP identified by Ross and MacKay. But it is a radical departure from the current SNAP program. This suggests that Ross and MacKay may have misidentified the purpose of SNAP. They intended to identify a purpose of SNAP that fit the program in its current form; but a purpose that is consistent with a radically modified version of SNAP is not a snug fit—that is, it does not capture the actual structure of the program, and what the program actually accomplishes. If not the purpose identified by Ross and MacKay, what is the core purpose of SNAP? What Is the Purpose of SNAP? In the literature, there is significant disagreement about what kind of program SNAP is, and what it should aim to do. Some see SNAP as primarily a nutrition program, whereas others see SNAP as primarily an anti-hunger and food security program, or an anti-poverty program (Fisher, 2017: 110). For example, the anti-hunger organization the Food Research & Action Center writes that SNAP ‘plays a critical role in reducing hunger, malnutrition, and poverty, and improving family security, child and adult health, employment, and other outcomes’ (Food Research & Action Center, 2017). Other anti-hunger advocates also argue that SNAP is primarily an anti-poverty or anti-hunger program, and only secondarily a nutrition program, or not a nutrition program at all (Fisher, 2017: 110, 125). Some authors have pointed to SNAP’s authorizing legislation to argue that SNAP’s aims are nutritional aims (Barnhill, 2011; Ross and MacKay, 2017). But the legislation rings multiple bells, stating that SNAP’s aim is to increase low-income households’ food purchasing power, to alleviate hunger, alleviate malnutrition and improve nutrition, and thereby improve the health and well-being of low-income people, and strengthen the agricultural economy (Food and Nutrition Act of 2008, 2008, Section 2). Even allowing that SNAP is a nutrition program, we might disagree about what nutritional aims SNAP should have. As described by Andrew Fisher, the public health community has sought to ‘redefine what it meant for SNAP to be a nutrition program, beyond its traditional accomplishments in reducing hunger, to one of prevention of chronic diseases’ (Fisher, 2017: 113). That is, some argue that SNAP should aim to prevent over-nutrition and not just under-nutrition. Another source of evidence about SNAP’s aims are materials from the USDA, which administers the SNAP program at the federal level. In a report describing the SNAP program, the USDA highlights SNAP’s role in reducing food insecurity and improving nutrition (FNS, 2012). For example: ‘SNAP alleviates hunger and improves nutrition by increasing the food purchasing power of low-income households, enabling them to obtain a more nutritious diet by preparing food at home’ (FNS, 2012: 2). The USDA also emphasizes the anti-poverty effect of SNAP, noting ‘that SNAP would lift 3.9 million Americans—including 1.7 million children—out of poverty if its benefits were included in the official measures of income and poverty’ (FNS, 2012: 3). Given these differing views about the aims of SNAP, what should we conclude? What are the aims of SNAP, and how do we determine them? More pertinent, perhaps: what should be the aims of SNAP? A More Expansive View of the Aims of SNAP Return to the choice-less basket system described above. From a normative perspective, this choice-less basket system seems worse—quite meaningfully worse—than the present SNAP program. One moral problem with it, objectors could argue, is that denying SNAP participants choice undermines their dignity and social equality.2 We should also wonder if the choice-less basket system would be effective at reducing food insecurity, reducing poverty and improving nutritional outcomes. Even if people have access to sufficient food to meet their nutritional needs (in the minimal sense of being given a basket of nutritious food), will they use it effectively to meet their needs? The choice-less basket system also seems much worse than SNAP in another way: it does not meet SNAP participants’ basic food-related needs as well as the current SNAP program, and it seems worse for this reason. Food serves multiple purposes besides providing sustenance and nutrition (Resnik, 2010). Food provides pleasure and comfort. Food and eating are central to social life: sharing food is a way to express love, forge relationships and reinforce bonds. Specific foods are used to mark special occasions in culturally specific ways, such as serving cake and ice cream at a birthday party. What we eat expresses our personal and group identities (Guptill et al., 2013: 17–41). In short, food experiences have multiple kinds of meaning and value for individuals and groups. Making our own food choices has multiple kinds of value. Exercising food choice allows us to choose foods that have the most value for us—for example, foods that are pleasurable and comforting, culturally appropriate and express social identities. Exercising food choice is also experienced as intrinsically valuable by some people. Having food choice also has symbolic value: being afforded choice symbolizes that you are capable of making choices for yourself, and have a kind of equal social status (Barnhill and King, 2013). A food assistance program that allows significant choice, and thus allows people to achieve more of these food-related goods, seems intuitively like a better food assistance program, one that is doing a better job discharging relevant obligations. That is, my moral intuition is that the current SNAP program, as compared to the choice-less basket program, does a better job meeting morally relevant obligations. Based on this moral intuition, I would like to suggest that the core purpose of the SNAP program should be not only providing food security, meeting nutritional needs and reducing poverty, but also meeting some other food-related needs. This seems like a pretty close fit to the actual program: SNAP is structured to give participants significant food choice, and includes emphasis on nutrition education and economic empowerment (FNS, 2012), suggesting that the actual program is meant to encourage people to have a variety of new food experiences of their choice that meet their needs. Which food-related experiences, goods and choices does the government have a duty to ensure that we have the opportunity to have? Do governments have a duty to ensure secure access to food adequate to provide substantial pleasure? How about food adequate to allow socially significant experiences, and to allow cultural expression? We should expect disagreement on these issues. The right to food has been construed by some as a right not just to food that meets nutritional needs, but also to food that is culturally acceptable, and food that ensures a ‘physical and mental, individual and collective, fulfilling and dignified life free of fear’ (FAO, 2017). Others argue, however, for much more narrow entitlements to food and food-related goods.3 Assume, for the sake of argument, that the government does have a duty to provide secure access to food adequate to meet a range of food-related needs. Is SNAP the means through which that obligation should be fulfilled? SNAP is the largest food assistance program, and thus is a primary means through which the government could feasibly meet food-related needs. To my mind, it is a compelling thought that governments have a duty to ensure access to various food-related experiences (not just to ensure that caloric and nutritional needs are met), and that SNAP is the program that ought primarily to address these needs. I would like to suggest that this compelling thought warrants future exploration. However, I do not offer here a positive argument in support of this thought, nor a specific account of which food-related needs SNAP ought to meet. Conclusions I have suggested that Ross and MacKay might be construing the core purpose and moral justification of the SNAP program too narrowly. Rather than just being a food security and nutrition program, perhaps SNAP should be the means of providing citizens with a fuller range of food-related goods and experiences. I offer, as a suggestion, that the core purpose of SNAP is: to provide secure access to adequate food to relieve hunger and to experience other food-related goods such as pleasure, social experiences and cultural expression, and to promote good nutritional outcomes. This proposal needs to be worked out in detail. Which experiences ought SNAP to provide secure access to? Do citizens have an entitlement to these experiences and goods, and what is the normative basis of this entitlement? If the various aims of SNAP (i.e. enabling socially and culturally valuable experiences, promoting good nutritional outcomes) come into conflict, how should we balance these aims? Plausibly, there are some foods that are pleasurable, and play valuable social and cultural roles, yet need not be included in SNAP—for example, alcohol.4 It seems reasonable, as a general matter, to exclude some foods from SNAP, despite their social and cultural value, because including them makes the program less efficient, undermines the aim of improving nutritional outcomes or undermines the program’s other aims, and the balance of considerations favors exclusion. Excluding some foods is consistent with recognizing the positive value of those foods, and recognizing the importance of giving SNAP participants a great deal of food choice. Returning to the case of SSBs, consumption of SSBs provides personal and social goods: drinking SSBs is pleasurable and socially normative, and linked to positive social identities and positive experiences (Weiner, 1996; Noe, 2012; Barnhill, 2016). Nonetheless, excluding SSBs from SNAP might be justifiable, if exclusion has significant enough health benefits relative to its personal and social costs. The general point here is that while we need to recognize and characterize the positive of value of SSBs and other non-nutritious foods for SNAP participants, and recognize the value of food choice, there may still be a case for excluding some foods. Thus, I am inclined to support a sugary drink exclusion, but its ultimate justification depends upon the role that sugary drinks play in the lives of SNAP participants, the health benefit that plausibly can be achieved by excluding SSBs and a more detailed ethical view about how the aims of SNAP ought to be balanced when they conflict. That is a good topic for future research. Footnotes 1. WIC provides assistance to buy select categories of foods, such as whole grains, fruits and vegetables and milk (Food and Nutrition Service, United States Department of Agriculture, 2016). 2. These issues of social equality and dignity have gotten considerable attention in the literature on SNAP exclusions (Barnhill and King, 2013; Schwartz, 2017), and I will not delve into them again here. 3. See (Raponi, 2017) for a defense of the right to food, and a discussion of objections to it. 4. I thank an anonymous reviewer for suggesting this example. References Barnhill A. ( 2011 ). Impact and Ethics of excluding Sweetened Beverages from the SNAP Program . American Journal of Public Health , 101 , 2037 – 2043 . http://dx.doi.org/10.2105/AJPH.2011.300225 Google Scholar Crossref Search ADS PubMed Barnhill A. , King K. F. ( 2013 ). Evaluating Equity Critiques in Food Policy: The Case of Sugar-Sweetened Beverages . 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Journal

Public Health EthicsOxford University Press

Published: Apr 1, 2019

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