Strengthening WIC to improve health: A prescription for change
We’ve all been told to eat more fruits and vegetables. But did you know that diets that are too low in produce are linked to cancer, diabetes, obesity and cardiovascular disease? Or that these conditions have become risk factors for severe illness and mortality from COVID-19? Or that, for children, an unhealthy diet can lead to problems in cognitive, language and behavioral development? Despite being a key driver of both health outcomes and health care costs, access to nutritious foods remains out of reach for many families.
How are we responding?
Increasingly, public health experts and community advocates are calling on U.S. health care leaders to directly address the connection between food and health. They argue that by integrating services like produce prescriptions and medically tailored meals into patient care, we can better support people in managing a range of serious diet-related health conditions. While initial evidence is compelling, sustaining and scaling many of these “food is medicine” interventions will take time and change — including new approaches to insurance coverage and the technology to support nutrition referrals.
In the meantime, one existing program already has these key structures in place and is poised for immediate, widespread impact: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
What is the role of WIC?
Since the 1970s, WIC has worked to improve the health of low-income families by providing nutrition assistance to pregnant and postpartum individuals, infants and children for their first five years of life, when a child’s palate is developing and proper nutrition is particularly critical. Like other food medicine models, WIC is embedded in the health care system. Health professionals determine an applicant’s “nutritional risk” — an eligibility requirement alongside income thresholds and residency — and enrollees receive a prescribed set of federally-approved nutritious foods and health education each month.
Why is WIC falling short?
Today, WIC provides over 6 million participants with WIC food packages, one component of which is $9-$11 per month for women and children to purchase fruits and vegetables. Despite this support, WIC-eligible individuals are still less likely than higher-income individuals to meet dietary guidelines for fruits and vegetables. The reason? In part, because the WIC monthly allowance is simply too low to cover the costs of supporting the recommended daily fruit and vegetable intake.
According to the National Academy of Medicine, the WIC fruit and vegetable benefit would need to be $23-$45 per month (depending on daily caloric needs for the individual) “to meet [just] half of the recommended intakes of vegetables and fruits.” An increase from the standard WIC package has produced beneficial results.
A growing body of evidence suggests providing financial incentives to support healthy eating, whether in the form of a prescription, voucher, subsidy, or other mechanism, can improve health and reduce long-term health care costs. An evaluation of the most recent revision to the WIC Food Package, which included the addition of the fruits and vegetable voucher, showed improved health outcomes for both mothers and their children.
In addition, these findings, Vouchers 4 Veggies-EatSF, a produce prescription program where one of us serves as executive director, examined the impact of providing an additional $40 per month in produce vouchers to pregnant WIC recipients, in partnership with the San Francisco Department of Public Health. Participants reported being more food secure and having a more nutritious diet. Data also suggested they were less likely to experience a preterm delivery — an experience that not only takes an emotional toll on the family and can lead to long-term health effects for the baby, but also can cost the health care system tens of thousands of dollars. Thus, ensuring adequate benefits for fruits and vegetables will be an important policy strategy to support better health outcomes and lower health care costs.
Is there potential for change?
The last revisions to the WIC Food Package occurred almost 15 years ago, making change long overdue. This March, in response to the ongoing COVID-19 pandemic and increase in food insecurity, President Biden signed the American Rescue Plan Act of 2021 (ARPA) into law, allowing states to temporarily increase the WIC fruit and vegetable benefit to $35 per person, per month. In doing so, federal leaders followed the science and critically strengthened WIC’s ability to support families across the U.S. but only through September.
What happens after the pandemic?
The height of the COVID-19 crisis may pass in the coming months. But the challenges of food access, nutrition and health are long-term issues that require long-term solutions. Even prior to 2020, one in nine Americans lived in a household that was food insecure, or unable to consistently access enough food for an active, healthy life. For households with young children, these numbers were even higher.
In a March 2021 report, the Center for Health Law and Policy Innovation of Harvard Law School (CHLPI), where two of the authors work, therefore recommended, among other policies, the permanent expansion of the WIC fruit and vegetable benefit to $50 per person, per month. Hearings are already underway for Child Nutrition Reauthorization, the legislation that typically includes WIC. This process presents an opportunity to seize on lessons learned from the pandemic and build bold, long-term policies to support the health of families across the United States.
By strengthening WIC we can take an important first step towards advancing the role of food as medicine and set the stage for broader change.
Kathryn Garfield is clinical instructor of Health Law and Policy Clinic at Harvard’s Center for Health Law and Policy Innovation.
Emma Scott is a clinical instructor of Food Law and Policy Clinic at Harvard’s Center for Health Law and Policy Innovation
Cissie Bonini is the executive director of the Vouchers 4 Veggies-EatSF.
Hilary Seligman is a professor of Medicine, University of California San Francisco.