Coronavirus (COVID-19): Press Conference with Sara Bleich, 06/18/20

You’re listening to a press conference from the Harvard T.H. Chan School of Public Health with Sarah Bleich, professor of public health policy. This call was recorded at 11:30 am Eastern Time on Thursday, June 18.


MODERATOR: Dr. Bleich, do you have any opening remarks?

SARA BLEICH: Sure. Nice to talk with you all this afternoon and thanks for the invitation. So I’ll start by stating the obvious. Obviously, there’ve been two million infections due to COVID-19 and over 115,000 deaths. And I am particularly interested in the fact that black and brown populations are disproportionately impacted by the epidemic. And so it’s about a quarter. So at the end of last month, it was about 22,000 black deaths as a response to the COVID-19 pandemic.

And so we know that there have been massive stimulus bills. There’ve been three so far that have increased appropriations and program flexibilities across nutrition assistance programs. And I come at this topic from a food policy, nutrition policy perspective, and those have made a number of important changes. So, for example, there have been emergency SNAP benefits that have been allocated to families, SNAP, the Supplemental Nutrition Assistance Program, which many of you may know as food stamps. So many families for a two month period their amount, if they hadn’t been at the maximum amount, has been increased to the maximum. Pandemic benefits had been allocated to parents that have children who otherwise would have received meals at school. So there been a number of changes on the federal side to try to help feed families during this period.

But more needs to be done and hopefully the more will come from the Heroes Act, which has passed in the House but is currently under debate in the Senate. One of the most critical things that the Heroes bill would do for nutrition policy is that it would increase the overall size of the SNAP benefit by fifteen percent from July 1st to September 30th. And that would be important, number one, because the SNAP benefit has been shown to be inadequate. Many families run out of money over the course of the month. And number two, the changes in the Family First Act, which created those emergency benefits, they leave out all the families that are already receiving the maximum benefit from the program, which is about 40 percent of the families.

I think it’s important obviously when we think about the problem of COVID-19, which has had a massive economic toll, a massive human toll, we also have to think about its intersection with the recent protests around the murder of George Floyd in Minneapolis and what has happened as a result of that and the protests is that there have been closures to retail businesses on a temporary basis. But in some cases, stores have been burned, which has meant that areas where access to food was not good has gotten much worse.

And so, as I think we think about this whole issue, one of the things that is important to keep attention on is the idea of food justice. So we have to think about the economic recovery. We have to think about testing. We have to think about getting children back to school. But at the same time, we have to think about making sure that children and adults are fed. And so the food justice theme needs to continue to weave itself through the conversations about how do we manage the recovery around COVID-19. And I’ll stop there.

MODERATOR: Thank you, Dr. Bleich. First question.

Q: Hi. Thanks very much for doing this. I have a sort of a broader public health policy question for you that I was hoping to ask. I just curious to get your thoughts sort of on the administration’s messaging and arguments right now about where things stand with the U.S. epidemic. Not sure if you saw Vice President Pence’s op ed in The Wall Street Journal, but basically the message was framing 750 deaths or so a day in 20,000 cases or so a day as a sign of progress because that is down from where it was. And, you know, at the same time, it’s like the White House task force has kind of receded from public view and sort of lost their bully pulpit. So, look, I’m just trying to get a sense of what you think of, like from a policy perspective, of the messaging or lack thereof coming from the administration.

SARA BLEICH: Yes. So my sense and I was reading – I read that and I read a couple other similar reports this morning – it seems like the Trump administration’s posture right now is that COVID-19 is very much in their tail lights and that we are on the upswing and that things are going well. I think that from a public health policy perspective, all the evidence points to the contrary. So cases have been flat, in terms of the number of deaths, have been flat at a thousand for a long time until quite recently. We’re seeing surges in areas like Florida where there has been more rapid reopening.

And so there’s a lot of concern from the public health side that as we move into the fall, there’s going to be a big ramp up of cases. And what that’s going to mean is longer school closures and longer gaps of time that children are kept out of school. So I think that your interpretation of what the Trump administration is signaling about their sense of the severity of the problem is right. And from a public policy perspective, I would say that it’s quite concerning.

Q: How important, I guess, is that type of messaging coming from the top or coming from the White House like and also sort of not just messaging, but like the the behavior aspect, whether that’s proper hand hygiene, mask wearing. Does that actually trickle down to sort of individual behavior?

SARA BLEICH: I think so. This more speaking from just sort of anecdotal personal opinion, but but certainly if you don’t see people in leadership who are taking the precautions, which you are being asked to do, then I think it encourages a very cavalier attitude about the need to wear masks, the need to wash hands, the need to wear gloves and take many precautions. And I think from a broader political perspective, I think it makes it very difficult for governors and mayors then to make decisions. If the federal government is saying this is no longer a serious problem, then that creates huge pressure on local government to begin reopening, even in the face of numbers that if they’re not going up, they’re stagnating.

And so I think that from a signaling perspective, it sends a mixed message, which is confusing, and particularly because while many people will get infected, most will not get severely sick. And so it’s easy to say this won’t happen to me. And it’s that sort of attitude that’s going to keep us in this situation for a very long time.

Q: Thank you.

MODERATOR: Next question.

Q: Thank you. So I’d love to hear more about the concept of food justice and the opposite side of coin, food injustice, and how that relates to the current context in light of protests, which really are about racial injustice, but also systemic injustice in the food policy area.

SARA BLEICH: So that’s a big question. Let me do my best. And you circle back if I don’t quite nail it.

Q: OK.

SARA BLEICH: So I think the number one point is that food justice is not at odds with racial justice. They should be happening in lockstep and both are very important. I think the challenge is that racial justice and addressing issues around systemic racism is a long game. It is something that requires immediate attention. It is not something that will get an immediate solution, unfortunately. We have to eat to survive, and so as we are thinking about the ways in which police departments must change, as we are thinking about funding streams for police departments, their relationship with the community, we at the same time have to think about the daily need for children and adults and families to eat hopefully three meals a day.

And so I think that we should imagine food justice, as, you know, does everyone have an equal opportunity to nutritious food on a daily basis? The answer to that question right now is no. The answer to that question before COVID-19 was no. But obviously it’s getting much, much worse. So prior to COVID-19, about one out of six children were considered food insecure, meaning they lack reliable access to nutritious food. Now, that number is at about one out of four, or twenty five percent of kids and it’s probably going to go up.

And so, you know, if you think about then to the first part of your question about the flip side of the coin, food injustice is this idea that not all children around the country and people in general have an equal opportunity to eat right now. And that is highly problematic because it sends a huge ripple effects across the economy and it makes it hard for very basic things to happen, like learning, like working, all the things we need fuel to make our bodies go. So sort of the last point I’ll make, which is a which is a bit of a repeat is food justice and racial justice are both important and they both have to continue together. But I would argue that immediately we have to think about the importance of feeding people as we take the long view towards more just society as it comes to race relations.

Q: Just a quick follow up. Are there any reforms and policies that are sort of bubbling up right now?

SARA BLEICH: Well, from a food justice perspective, I would say that one of the most promising is what’s in the Heroes Act right now. And so the Heroes Act, as you know, be the fourth stimulus bill. And the House version, which passed last month and now it’s with the Senate, the House version has a number of provisions for the SNAP program, which prior to COVID-19 touched about 38 million Americans each month. And that number increased by about 40 percent in March. And so it’s probably gone up more since then, but it’s definitely going up quickly.

But what the Heroes bill includes is an increase to the overall size of the SNAP benefit, and it would be a 15 percent increase. And that’s the equivalent of about twenty five dollars per person per month or one hundred dollars for a family of four. Now, that’s important because SNAP has a very long history, a proven track record of lifting families out of poverty and reducing food insecurity. And we saw during the ARRA boost during the last recession that there was a temporary increase in SNAP. At that time, it was about 13 percent, which was about eighty dollars for a family of four in a month. And that increase reduced food insecurity.

It helped increase access to food and it decreased this problem that families on SNAP have, which is they’re running out of food over the course of the month because they simply run out of money. And so if if we think of food justice as, at the very least, give people financial resources to access food, then the the increase, the 15 percent increase that the Heroes bills calling for would do that. Now, it’s not going to solve the problem of is that food nutritious? But it is a very important starting point.

Q: OK, thank you very much.

MODERATOR: Next question.

Q: I thought I would just follow up on what you were saying earlier about the SNAP program increase that it does in the heroes, that it doesn’t address the issue of whether it’s nutritious or not. So what else needs to be done on that issue?

SARA BLEICH: Yeah. So so that’s a really good question. There are a number of different things that could happen to sort of improve the public health footprint of the SNAP program. And there’s been a sort of a growing interest in thinking about how do we make the program more health focused and not just lifting families out of poverty and reducing food insecurity, but that’s a very small part of the focus of the program. So what would you do?

I would say there are two things that immediately come to mind. The first is right now you can use your SNAP benefits to purchase sugary beverages. And I would say that we know that sugary beverages are strongly linked to lots of adverse health conditions like obesity and diabetes and dental carries, we know that low-income populations who are on SNAP are also more likely to be in the Medicaid program. And so if we said that you can no longer use your snap benefits to purchase sugary beverages and carve those out, that would potentially have a big impact on pulling out the largest source of added sugar in the diet of participants who are on the SNAP program.

Now, this is a debate that has raged in nutrition policy community for years, if not decades. And there are strong, very strong opinions on both sides of the aisle, I think both of which warrant attention. I would say on balance, if we have to consider the pros and the cons, the potential benefits of saying to families, you may use your own money, of which 75 percent of SNAP families have income from other sources, but you can’t use this pot of money to purchase sugary beverages, that might go a long way in actually improving the health profile of the program. So that’s one thing.

A second thing to give you a second example, Christine, is the way the program is administered is federally states have to administer benefits to every recipient one time per month. However, states have discretion over how many days they spread those benefits. So in Rhode Island, for example, everyone in the state who’s on SNAP gets their benefits on a single day. In a state like Massachusetts, it’s over about a two week period. The issue from a public health perspective is states which have shorter issuance periods, meaning everyone’s getting their benefits over, say, one to three days, there’s a big incentive for supermarkets, of which there are 240,000 or so that are authorized to accept SNAP benefits around the country, there’s a huge incentive for them to market unhealthy things in the beginning of the SNAP benefit month.

And so if you could spread out the benefits, then that might help reduce the power of marketing on people’s decision making when they go into the grocery store. And that’s important because 80 percent of SNAP benefits are spent in the first two weeks. There’s just a general expectation that the benefits come, they get spent very quickly, and so that allows supermarkets to respond with marketing to try to capitalize on that behavior. Those are two examples of how you could increase the public health profile of the program.

Q: Thank you.

SARA BLEICH: You’re welcome.

MODERATOR: Dr. Bleich., I had a quick follow up on that. So you said the supermarkets have an incentive to market unhealthy foods during that period. Is there a greater markup on unhealthy foods compared to fresh fruits and vegetables and that type of thing? Or what’s their incentive?

SARA BLEICH: So, two ways to answer that question, the first is there’s one study which has looked at this question of do supermarkets up sell things like sugary beverages when SNAP benefits come out. And what the research suggests is that it’s not as if you’re getting a bargain, it’s just that they’re being heavily promoted to you. So rather than saying a case of soda is five dollars, you’re being told that it’s two for 10. So you’re not actually getting a price break, but the marketing changes around the beginning of the SNAP issuance month.

Your other question was about the markup. And one of the most expensive things sell in the grocery store is produce because it’s perishable. One of the areas where the margin is highest is among things like soda, which have a long shelf life and can be marked up a lot. And so there’s just a huge amount of incentive for grocery stores to sell a lot of these products and they also get slotting fees for them. I think roughly three quarters of the grocery store is sort of sold for slotting fees for things like chips and cereal and soda. And so there’s a lot of incentive for markets then to sell more of these products.

MODERATOR: OK, that makes sense why there’s so many chips and soda and there’s an entire aisle dedicated to those. OK, thank you. I had – so our family lives in Cambridge and the Cambridge public school system has been very conscientious about making sure that food is available for kids who have not been able to get to school. Do you know of any plans to continue food programs for kids who are unable to get to school through the summer or possibly in the fall at the state or federal level?

SARA BLEICH: Yeah. So what has happened and a lot of this was through the Family First Act, which was the second stimulus bill, is a lot of waivers got put in place to create flexibilities for the school lunch program. And that was important because there were a lot of rules which said you have to follow nutrition guidance during the school year, children have to be eating together when they have meals and food cannot be packed up and picked up by an adult. And so all that stuff has been waived.

And so now what students can do is they can go to local schools in their area, and this varies based on school district, and they can pick up food that has been boxed up for several days at a time. I will get to your question on sort of what’s to come, but it’s important to know that this system as created a lot of challenges. And so, number one, we have to worry about the nutrition piece of this because the nutrition regulations that are put in place during the school year no longer apply. The quality of the food that kids are receiving is different than the sort of whole grain requirements and the sodium requirements. And so we should be thinking about what is the impact of this period on children’s diet.

The other practical thing to think about is the impact on school food infrastructure, because there’s rules in terms of how schools have to pack up this food. And so if you, for example, are picking up five days of food and that includes milk, you won’t get a gallon of milk. You’ll get, if you have two children, you’ll get 10 little containers of milk. And so there’s huge packaging costs that schools have to absorb. And there’s a lot of concerns about schools going bankrupt over this period because of all the additional costs into distributing the food, into creating safety measures to avoid community spread of COVID-19. And so then then your other question, Nichole, is well, what’s to come in the fall? And it’s really unclear.

I mean, I think we don’t know if schools are going to be opening in the fall. It looks like in many states it’s going to be a blended model where students are in school a few days and they’re learning online a few days. My guess is that while schools are in any type of closure, there’ll be some sort of supplement that families are receiving to help feed them. That will probably come in the form of school meal sites, which we’re already seeing. And there’s a big push right now, and this is included in the Heroes bill, to extend pandemic EBT benefits. These are the benefits that families with children who would otherwise be receiving school meals at school, these are extending those benefits for a longer period of time. They are originally authorized for two months. And the idea is, let’s extend those longer because the expectation is children will not be back in school full time in the fall.

MODERATOR: OK. Thank you. That’s very helpful. I have a question from a freelance writer working on a pandemic SNAP story and her audio was not working, so I’m going to read it for her. She would like to know why are the benefits used up in two weeks? Are they insufficient to last for weeks or people don’t have the tools that they need to spread out the funds?

SARA BLEICH: Yeah. Great question. So why are the benefits used up? They’re insufficient. So the maximum benefit is 646 dollars a month. The average family gets 140 dollars. And so it’s not a lot of money. It’s a $1.40 per person per meal. If you just think about that for a second, that can’t feed the average person, particularly over a long period of time.

And it’s widely recognized by the National Academy of Medicine. They had a report about this a few years ago by academics, by many policymakers, that the program is inadequate. And part of that is reflected in the name change. It went from food stamps to be the Supplemental Nutrition Assistance Program to underline the point that it is not meant to take control or to to be responsible for the entirety of the diet. That said, it’s still important to increase it, to make it more able to meet the needs of families.

And so what typically we see happening is that in that first week of the SNAP benefit month, about 50 percent to 60 percent of benefits are spent. And by that second week, about 80 percent of the benefits are spent. And that matters from a public health perspective, because what we see is that over the course of the month, so as you move away from when you received your benefits, we see more hospital admissions for a dietary related diseases. We see more behavioral issues for children with school. And then, not surprisingly, we see more food insecurity, which is associated with a host of adverse health outcomes.

Now, there have been, to your point about, well, can people budget better and that sort of thing. There have been pushes to say, look, if money is being spent very quickly in the beginning a month, what if we split the issuance? Meaning you’d get half of the money for two weeks and half the money for the next two weeks. And there are arguments on both sides of that. It’s not going to solve the adequacy problem, but it would spread the benefits out over a longer period of time. Generally, the poverty groups are very much against that and view that as very paternalistic and sort of say, look, let people have their benefits, let them spend them how they want to spend them. But let’s focus on the fact that the benefits themselves are not sufficient and not look for these work arounds to spread the money out over the course of the month.

MODERATOR: OK, great. Thank you. And I think you may have answered some of this, but there’s just a lag between your answers and the questions. She would also like to know if the expanded benefits for the SNAP during the pandemic will continue. I think you may have answered that already.

SARA BLEICH: Yeah. So I mean it’s, here at this point, pandemic benefits were approved for a two month period, and that was part of the Family First Act. The Heroes Act, which is sitting in the Senate, a big piece of that is saying let’s extend pandemic EBT benefits for a longer period of time. Right now, the period would go in through the end of September. But that has to get through the Senate. And so it’s unclear if that’s going to happen.

MODERATOR: OK. So the pandemic is for kids only, I think. And is that different from the expanded SNAP?

SARA BLEICH: Yes. So there are two different things. So Pandemic EBT is for households with children who would otherwise receive school meals. So you could have, prior to the pandemic started, you could be in SNAP and your child could be in receiving school meals. You could also have never been in SNAP and your child is receiving school meals say, for example, because you live in a community eligibility area, meaning that more than 60 percent of people in the area are at a certain income threshold, low income and so everyone just becomes part of the program, and you don’t have to actually file the paperwork. But to say that simply, pandemic EBT is for all children who would otherwise be receiving free or reduced lunch at school.

The emergency benefits are separate. The emergency benefits say anyone who is not at the maximum SNAP benefit, 646 dollars per person per month, they will receive that maximum amount. So that is only for SNAP households. And importantly, 40 percent of households are already at that max benefit, so they can’t receive any additional income support based on the emergency supplement. Does that make sense?

MODERATOR: Yes, she said, that makes sense.

SARA BLEICH: It’s okay to be confused. I think it’s not that easy.

MODERATOR: Thank you for explaining it. And do you think the expanded SNAP will be continued?

SARA BLEICH: I think you mean the emergency benefits?

MODERATOR: I believe so, yes.

SARA BLEICH: Unclear. I think a lot hinges on the Heroes Bill.

MODERATOR: And how is that Heroes Bill looking right now in the Senate? Is it looking promising or is it looking like it’s stuck?

SARA BLEICH: Yeah, this goes back to the earlier question, I’m not sure who asked it, but this idea of if the Trump administration is signaling that we are sort of over the hump and things are getting better, then does that then take the wind out of the sails for the Congress to act very quickly? I mean, I think and I’m guessing most people on the call would agree that the pace with which Congress passed the first three stimulus bills is probably a record, particularly given the size of the Cares Act. But now things are slowing down and so the House was in a big rush to get the Heroes Act passed, but now the Senate is taking its time. And I think that we have to worry if the Trump administration is signaling that, you know, we’re on the downside of this, then there becomes much less push and urgency around getting this next stimulus 4.0 passed.

MODERATOR: OK. Looks like that may be our last question for today. Dr. Bleich, did you have any final statement or any final thoughts you’d like to share?

SARA BLEICH: I would just hope as you’re covering this pandemic from many different angles, that the importance of food and food justice and the federal response remains on your radar. Thanks for your time today.

This concludes the June 18 press conference.

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