We need to make sure kids have access to good food @ChildHealthUSA @bittman @AmerAcadPeds

CHW LogoCamping – I just returned from five glorious days of it in rural eastern Virginia – makes you see the world in a different way.  There is a greater intentionality to everything you do.  You have to consider and plan every sip of water, every trip to the “bathroom,” every bite of food.  As a break from contemporary urban living, that focused, mindful, pre-modern approach to everyday activities provides the kind of contemplation and relaxation that we all need to restore ourselves.

But when it’s your day-to-day reality, as it is for the poor in 21st century America, it has the opposite effect.   Constant decisions about trade-offs under conditions of scarcity lead to chronic stress with adverse effects on health.  Poor diet only makes that worse.  In the 1930s, George Orwell wrote about the nutritional challenges for English coal mining families in The Road to Wigan Pier.  Much of what he described still holds true.  First, fresh food is relatively more expensive than processed “food” of dubious nutritional quality.  When confronted with a choice between an apple (assuming you can find it) and an apple pie, you’ll get way more calories per dollar with the latter.  Without adequate package information and guidelines, it can be difficult to understand the drawbacks of that decision.  Thus, for a parent trying to feed her children on an outrageously limited budget, the apple pie may seem like the rational choice.  Moreover, even with the right intentions, decision fatigue can degrade the quality of those choices.  It’s just easier to give in to temptation when you are stressed.  (And as an aside, let’s stop making it sound like this is some moral failing of poor people. It’s the same phenomenon that leads me to eat way too much ice cream after coming home from a shift in the emergency department.  Just because I can afford it doesn’t make me a better person.)  Junk food is also a way for someone without many other pleasures to treat himself.  You might not have the time and money for a movie or a massage, so how about a cupcake.

The societal and economic costs of the obesity epidemic are well known, as is the fact that obesity is a worse problem for the poor, especially poor children.  But given all the above, the food deck is stacked against them.  Two proven interventions make it easier for kids to get the right foods they need: the school nutrition program, and the Supplemental Nutritional Assistance Program (SNAP – aka food stamps).   SNAP for children in particular has been demonstrated to have long-lasting (as in decades!) benefits on health.  Yet recent efforts threaten to undermine both of these.  The School Nutrition Association, now a partially-owned subsidiary of the food manufacturing industry, has opposed the guidelines issued under the 2010 Healthy, Hunger-Free Kids Act.  And legislative efforts in several states, including Wisconsin, would restrict what could be purchased with food stamps.  Missouri, for example, would ban the purchase of fresh seafood (though canned tuna and frozen fish stick would still be allowed), while the bill in Wisconsin would limit purchases of such luxury items as nuts, potatoes, natural peanut butter, and bulk dried beans.  (Canned beans and sugar-added peanut butter are fine, though.)  Aside from being frankly punitive, these measures make it less likely rather than more that poor children will receive the most nutritious food possible.

Camping for a week is fun; living with those kinds of restrictions all the time is not.  Let’s not make it harder for those who have to.  If we truly believe that all kids deserve an equal chance at a healthy life, the place to start is by supporting programs of proven effectiveness that can give them access to one of the most important building blocks of health: real food.

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