Introduction:
The 2018 Farm Bill represents a major opportunity to reduce disparities in diet and health. The largest component is the Supplemental Nutrition Assistance Program (SNAP), feeding 1 in 6 Americans. Potential options include subsidizing fruits & vegetables (F&V), restricting sugar-sweetened beverages (SSBs), or implementing a broader food incentive/disincentive framework that preserves choice. Their comparative health impacts and cost-effectiveness are not established.
Methods:
Using a validated microsimulation model (CVD PREDICT), we estimated changes in CVD events, quality-adjusted life-years (QALYs), costs, and cost-effectiveness of 3 policy scenarios in SNAP adults: 1) 30% subsidy on F&V; 2) 30% F&V subsidy + SSB restriction; and 3) 30% subsidy on F&V, whole grains, nuts/seeds, seafood, plant-based oils, and 30% disincentive on SSBs, junk food, and processed meats. Model inputs included national data from NHANES (2009-2014), policy effects from SNAP pilots and food pricing meta-analyses, diet-disease effects from meta-analyses, and policy, food subsidy, and healthcare costs.
Results:
From a societal perspective, all 3 scenarios were cost-savings at 5, 10, 20 y and lifetime (
Table
). At 5 y, a F&V subsidy would prevent 32,218 CVD events, gain 18,072 QALYs, and save $1.04B ($6.05B lifetime). Corresponding values for a F&V subsidy + SSB restriction were 63,898, 45,772, and $4.47B ($38.83B); and for a broader incentive/disincentive framework that preserved choice, 65,078, 26,663, and $3.98B ($29.90B). Government affordability varied by program duration and by whether subsidy costs for SNAP adults or all SNAP participants were included. Scenario 3 was generally most cost-effective or -saving, followed by scenario 2 and then scenario 1; all were cost-effective over a lifetime from a government affordability perspective.
Conclusions:
Financial incentives/disincentives through SNAP could generate substantial health benefits and be cost-effective or cost savings.
Cost Effectiveness of Subsidizing Fruit and Vegetable Purchases Through the Supplemental Nutrition Assistance Program