Racial disparities among food-insecure households disappear with SNAP participation

Key takeaways:

• There are racial disparities in food-insecure households that are not observed among SNAP participants.
• The results indicate that access to the program should be improved.

Persistent racial disparities among low-income households are not found in those that participate in the Supplemental Nutrition Assistance Program, or SNAP, highlighting the importance of access to the program, according to researchers.

Although experts have long known about racial disparities in food insecurity and related health outcomes, not much attention has been given to the role that SNAP plays in addressing those disparities, Laura J. Samuel, PhD, RN, FAAN, an assistant professor at the Johns Hopkins School of Nursing, told Healio.

Considering SNAP is the largest food assistance program, serving more than 40 million people each year and is known to reduce food insecurity, “this is an important gap,” Samuel said.

“Also, despite increased recent efforts to dismantle structural and systemic racism across society, there has been relatively less attention paid to structural racism in food systems,” she added. “Therefore, SNAP could play a critical role in addressing racial disparities in food insecurity, but its role in addressing disparities is not well understood.”

Samuel and colleagues conducted a cross-sectional study to evaluate SNAP access with regard to racial disparities in food insecurity and published their findings in JAMA Network Open.

The researchers used data from the 2018 Survey of Income and Program Participation and included 4,974 households — 65% of which were white, 22% of which were Black, 8% were multiracial or of ‘other’ race groups and 5% were Asian. They classified SNAP participation during the prior year based on if anyone in the household received SNAP benefits, and measured food insecurity during the year before using the validated 6-item U.S. Department of Agriculture Food Security Survey Module.

Samuel and colleagues found racial disparities in food insecurity among low-income households that were not participating in SNAP, with Black (prevalence rate [PR] = 1.52; 97.5% CI, 1.2-1.93) or multiracial (PR = 1.42; 97.5% CI, 1.04-1.94) households being more likely to be food insecure than their white counterparts.

However, Samuel said, among SNAP participants, Black households “are actually less likely to be food insecure than white households” (PR = 0.84; 97.5% CI, 0.71-0.99), indicating that access to SNAP should be improved.

But the SNAP enrollment process is not easy. Samuel said it is “cumbersome with accessibility gaps, and there are specific rules and requirements — like work requirements — for certain groups.”

“Our results suggest that these rules, requirements and processes should be formally evaluated to see if they are inadvertently driving disparities by disproportionately affecting food-insecure households that are Black or multiracial,” Samuel said. “As the U.S. Congress debates the reauthorization of the Farm Bill this year, these findings suggest that Congress should simplify SNAP enrollment and eliminate unnecessary requirements.”

One important message for primary care providers, Samuel said, is that food insecurity should be viewed not as a social problem, but rather as a health problem because of the associations between food insecurity with health care utilization, cardiometabolic health and dementia.

“Primary care providers play a critical role in addressing food insecurity by screening for food insecurity,” Samuel said. “Also, people experiencing food insecurity often need help accessing food assistance, and primary care providers can partner with health systems, social service agencies and community organizations to coordinate support for families facing food insecurity. Families also need primary care providers to advocate for improved access to SNAP.”