every day, and 10.1 million received a free or reduced-price meal. Current federal reim- bursement rates are, in most cases, $1.58 for free breakfasts, $1.28 for reduced-price breakfasts, and $0.28 for paid breakfasts. A high proportion of eligible children don’t participate in the National School Lunch Program or the School Breakfast Program. The benefits associated with receiving free or reduced-price meals through the NSLP or the SBP are not trivial. At least as defined by the reimbursement to schools, lunch for one child every day for a week is worth about $15.11 Still, a high proportion of eligible children don’t participate in the NSLP or the SBP. This can be ascribed to three main factors. First, as with SNAP, receiving free or reduced-price meals can carry a stigma, so some children or their parents may not want to participate. Second, as we’ve seen, many schools don’t participate in the SBP. Children at those schools can’t participate even if they are eligible. Third, despite being enrolled, some children, for a myriad of reasons, don’t always eat the meals provided. For example, a child might not want the meal VOL. 25 / NO. 1 / SPRING 2 0 1 5 95
Craig Gundersen served; a parent might decide a meal isn’t healthy enough; a child might have already eaten breakfast at home. This differs from SNAP—recipients spend virtually all their SNAP benefits, because they can decide what foods to purchase. How Food Assistance Programs Affect Health Because participation in these programs is not randomly assigned, and because some subsets of the eligible population have rela- tively low participation rates, I concentrate on studies that take seriously the issue of selection into these programs. (For a deeper discussion of selection and the challenges of making causal inferences about program impacts, see Maya Rossin-Slater’s article in this issue.) Though I touch briefly on other areas, I limit my review to two problems that have generated the most interest in recent years: food insecurity and obesity.121 also limit my discussion to the programs’ impact on low-income children. Theoretical Effect of SNAP As we’ve seen, households will participate in SNAP if the benefits they receive outweigh the stigma and transaction costs associated with receiving them. How does SNAP affect the health of those who choose to enter the program? In theory, SNAP’s effects on health should be clear in some areas. For example, it’s clear that receiving SNAP benefits (in compari- son to not receiving them) should reduce the probability of food insecurity, because the family now has more resources to spend on food. It’s hard to see how having more resources available for food could increase the chances of food insecurity. The case for a SNAP effect on childhood obesity, however, is not theoretically obvi- ous.13 Here, we have to consider two effects.
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