Power Elaine M, Little Margaret H, Collins Patricia A
School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario K7M 3N6, Canada
Department of Gender Studies, Queen's University, Kingston, Ontario K7M 3N6, Canada Department of Political Studies, Queen's University, Kingston, Ontario K7M 3N6, Canada.
Health Promot Int. 2015 Mar;30(1):184-93. doi: 10.1093/heapro/dau080. Epub 2014 Sep 25.
Food insecurity is an urgent public health problem in Canada, affecting 4 million Canadians in 2012, including 1.15 million children, and associated with significant health concerns. With little political will to address this significant policy issue, it has been suggested that perhaps it is time for Canada to try a food stamp-style program. Such a program could reduce rates of food insecurity and improve the nutritional health of low-income Canadians. In this article, we explore the history of the US food stamp program; the key impetus of which was to support farmers and agricultural interests, not to look after the needs of people living in poverty. Though the US program has moved away from its roots, its history has had a lasting legacy, cementing an understanding of the problem as one of lack of food, not lack of income. While the contemporary food stamp program, now called Supplemental Nutrition Assistance Program (SNAP), reduces rates of poverty and food insecurity, food insecurity rates in the USA are significantly higher than those in Canada, suggesting a food stamp-style program per se will not eliminate the problem of food insecurity. Moreover, a food stamp-style program is inherently paternalistic and would create harm by reducing the autonomy of participants and generating stigma, which in itself has adverse health effects. Consequently, it is ethically problematic for health promoters to advocate for such a program, even if it could improve diet quality.
粮食不安全是加拿大一个紧迫的公共卫生问题，2012年影响了400万加拿大人，其中包括115万儿童，并且与重大的健康问题相关。由于解决这一重大政策问题的政治意愿薄弱，有人建议或许加拿大是时候尝试实施一项食品券式计划了。这样一个计划可以降低粮食不安全率，并改善低收入加拿大人的营养健康状况。在本文中，我们探讨了美国食品券计划的历史；其主要推动力是支持农民和农业利益，而非照顾贫困人口的需求。尽管美国的这一计划已背离其初衷，但其历史留下了持久的影响，强化了将该问题理解为粮食短缺而非收入短缺的观念。虽然当代的食品券计划，现称为补充营养援助计划（SNAP），降低了贫困率和粮食不安全率，但美国的粮食不安全率仍显著高于加拿大，这表明食品券式计划本身并不能消除粮食不安全问题。此外，食品券式计划本质上具有家长式作风，会通过降低参与者的自主性并产生污名化来造成伤害，而污名化本身就会对健康产生不利影响。因此，即使该计划可能改善饮食质量，健康促进者倡导实施这样一个计划在伦理上也是有问题的。
