Food subsidy programs and the health and nutritional status of disadvantaged families in high income countries: a systematic review

Abstract

BackgroundLess healthy diets are common in high income countries, although proportionally higher in those of low socio-economic status. Food subsidy programs are one strategy to promote healthy nutrition and to reduce socio-economic inequalities in health. This review summarises the evidence for the health and nutritional impacts of food subsidy programs among disadvantaged families from high income countries.MethodsRelevant studies reporting dietary intake or health outcomes were identified through systematic searching of electronic databases. Cochrane Public Health Group guidelines informed study selection and interpretation. A narrative synthesis was undertaken due to the limited number of studies and heterogeneity of study design and outcomes.ResultsFourteen studies were included, with most reporting on the Special Supplemental Nutrition Program for Women, Infants and Children in the USA. Food subsidy program participants, mostly pregnant or postnatal women, were shown to have 10–20% increased intake of targeted foods or nutrients. Evidence for the effectiveness of these programs for men or children was lacking. The main health outcome observed was a small but clinically relevant increase in mean birthweight (23–29g) in the two higher quality WIC studies.ConclusionsLimited high quality evidence of the impacts of food subsidy programs on the health and nutrition of adults and children in high income countries was identified. The improved intake of targeted nutrients and foods, such as fruit and vegetables, could potentially reduce the rate of non-communicable diseases in adults, if the changes in diet are sustained. Associated improvements in perinatal outcomes were limited and most evident in women who smoked during pregnancy. Thus, food subsidy programs for pregnant women and children should aim to focus on improving nutritional status in the longer term. Further prospective studies and economic analyses are needed to confirm the health benefits and justify the investment in food subsidy programs.

Household Food Insecurity Is a Stronger Marker of Adequacy of Nutrient Intakes among Canadian Compared to American Youth and Adults

“…To the extent that these programs affect food access and food selection patterns among those struggling with compromised food security, they could contribute to a blunting of differences between food-secure and food-insecure households in the United States relative to Canada. The literature on the effects of food programs on nutrition is complex, with a recent review finding limited high-quality evidence of the impacts of food subsidy programs (including SNAP and WIC) on the health and nutrition of recipients, although there was evidence of small increases in targeted nutrients and foods in relation to WIC participation (55). If these programs were to reduce dietary compromises associated with food insecurity, we would have expected significant effects of the program authorization variable on usual intake and larger gaps between those in food-secure and food-insecure households in the United States once we statistically removed those significant effects, neither of which was observed.…”

Food Insecurity, Poor Diet Quality, and Suboptimal Intakes of Folate and Iron Are Independently Associated with Perceived Mental Health in Canadian Adults

“…In the US, for example, food subsidy programs such as the US Department of Agriculture’s Supplemental Nutrition Assistance Program (SNAP) for Women, Infants, and Children (WIC) exist to improve food security for low-income individuals and households. Evidence suggests that participation in these programs contributes to small increases in the intake of targeted nutrients and foods, and that the nutrition education component of the programs (SNAP-Ed) improves skills in food resource management [68,69,70]. Thus, contextual factors such as food and nutrition assistance programs, food supply, food pricing, and other policies and programs need to be explored as means to ameliorate food insecurity, improve diet quality, and foster mental health within populations.…”

Has the UK Healthy Start voucher scheme been associated with an increased fruit and vegetable intake among target families? Analysis of Health Survey for England data, 2001–2014

“…A systematic review, which synthesised evidence from 14 studies of food subsidy programmes, concluded that food subsidy programmes successfully increase the intake of targeted foods, particularly in pregnant women, by 10%–20% 11. Eleven of these studies were from the USA and nine of them examined WIC, while two were from the UK.…”