Don't cut aid to hungry

You might think that in the United States, one of the richest countries in the world, the very idea that Americans would be struggling to afford food would be absurd.

Yet, as a physician, I see many patients in this exact situation. Some patients tell me about forced choices between food and medicine. Some go without food so that their children will have enough to eat. One mom with diabetes recently told me how she tries her best to buy healthy food for her and her kids but, by the end of the month, she just has to "make sure they don't go hungry." Even those that can afford food often can't afford more expensive healthy foods. When patients face these kinds of barriers, I feel helpless.

On Nov. 1, Congress delivered a financial and health blow to millions of Americans. It cut the food-stamp program, more formally known as the Supplemental Nutrition Assistance Program (SNAP), by $5 billion. Aid has fallen to just $1.40 per meal for the average SNAP recipient, and the farm bill moving through Congress would cut SNAP even more.

My experience with patients is not unique. According to the U.S. Department of Agriculture, 17.6 million American households (14.5 percent) struggled to afford food in 2012. In other words, they were food-insecure.

In an analysis of the Public Health Management Corp.'s Household Health Survey that I performed with colleagues at the University of Pennsylvania, we found that nearly one in five people in Philadelphia in 2012 had skipped a meal or reduced meal sizes because they were unable to afford enough food.

Cuts to food assistance will have a profound effect on U.S. families. The Health Impact Project (a collaboration between the Robert Wood Johnson Foundation and the Pew Charitable Trusts) estimates that, because of the proposed cuts, millions of families will lose their SNAP benefits, and many families who are just getting by will become food-insecure. Food insecurity is linked to poor overall health, worse mental health, behavioral problems in children, diabetes, obesity, hypertension, and depression. With less funding for food assistance, the health of Americans will suffer.

These cuts will also hit the wallets of families. The Health Impact Project estimates these changes will raise the U.S. poverty rate by more than half a percent. Poverty is more hazardous to health than many diseases. Poverty makes it hard to eat, hard to afford good housing, and hard to create a stable place for children to grow and thrive. I can prescribe medications to treat chronic conditions, but I'm only addressing a small part of what causes poor health.

Cuts to food assistance could also cause complications for patients with chronic diseases. If my patients with diabetes can only afford cheap foods high in sugar or miss a meal, their blood sugar can rise and fall to dangerous levels. These complications are not just dangerous, they are also expensive.

At a time when the country should be focused on improving health and reducing health-care costs with the rollout of the Affordable Care Act, it does not make sense to gut funding for food-assistance programs and push more Americans into poverty. As a physician, I urge Congress to restore funding to SNAP and take further cuts in the farm bill off the table. If Congress wants to find budget cuts, it should look elsewhere. The country with the largest economy in the world shouldn't leave citizens struggling to afford food.