Q&A: CEO Celia Cole discusses Feeding Texas’s efforts to combat food insecurity

Celia Cole is the CEO of Feeding Texas, a statewide network of food banks and non-profits aimed at combating food insecurity in Texas. Cole is an expert in food and nutrition policy, and serves on the Partnership for a Healthy Texas advisory committee, as well as the Texas Food Policy Roundtable advisory committee. 

In this Q&A, Cole talks about how SNAP benefits are impacting Texas households and how Feeding Texas is advocating for policies and initiatives to fight a critical social determinant of health: hunger.

 

Get the latest state-specific policy intelligence for the health care sector delivered to your inbox.

 

Soraya Marashi: The Texas Health and Human Services Commission (HHSC) has been extending emergency SNAP benefits on a month-to-month basis for over a year now. Gov. Abbott just announced that HHSC will provide more than $310 million in emergency SNAP benefits to program members for the month of November. How has this been benefiting Texas families?

Celia Cole: “When the pandemic hit, it threw hundreds of thousands of people in Texas out of work overnight. Obviously, one of the most immediate needs that families face when they lose a job is being able to feed themselves, particularly families that have limited savings and other assets to fall back on. We know a lot of the Texans that were thrown out of work during the pandemic were in the industries that were really hard-hit. 

A lot of the impacted workers were low-income workers to begin with, and they’re likely the same people that don’t typically have a lot of savings to fall back on. The emergency allotment [just] gives the states the option to just give everyone the maximum benefit for their household size without the need to look at those details around income and other assets and expenses. And that just gave people struggling to feed their families thrown out of work an immediate cushion when it came to being able to afford food. 

I think in many ways [food] is a stabilizing support. There’s just all of this uncertainty that was created for many families when COVID hit, and giving people the security at least of being able to know they can put food on the table, I think in terms of stress, and being able to then focus on other things, is really important. I think that that gets overlooked.

A benefit [of the extension of emergency SNAP benefits] other than just helping the hundreds of thousands of Texans that lost their livelihoods overnight is it made it a lot easier for the state to get people certified and signed up for benefits … with a real emphasis on program integrity. So making sure the right people get the right benefits, it takes a lot of work. It’s a time-consuming process to apply and get certified and get your benefit. And this streamlined the process both for people applying, but also for those state workers who were also sort of inundated overnight with an increase in people needing help.”

SM: How does addressing the social determinants of health of a community, such as access to food, contribute to greater community health as a whole?

CC: “I think food security is widely recognized as a primary social determinant of health, and food banks, in addition to helping people stay nourished, are also really focused on the kind of food we give people, and address diet-related illnesses. So it’s very important for us to make that connection in our work.

If you can afford food, it reduces a lot of other stressors … We know that if people are not eating enough or not [eating] the right food, then it leads to all sorts of diet-related illnesses, which [include] diabetes, hypertension … all sorts of things. We also know that it affects kids’ health in particular, and their ability to learn. And then obviously for elderly people with chronic illnesses … again, food insecurity can really exacerbate those age-related illnesses and other chronic illnesses. 

I think the other thing about food insecurity and its relationship with poor health outcomes is that those poor health outcomes in turn fuel the cycle of food insecurity … The worse health you’re in, the less likely you’re going to be able to work, the more likely you’re going to have out-of-pocket health care costs. That, in turn, reduces the economic resources that you have to feed your family and pay for all the other things you need, and the cycle of food insecurity continues.

If we can keep people fed, we can keep people healthy. We can also significantly lower those health care expenditures, and so that just supports the overall economic health of the state.”

SM: What demographics are accessing SNAP benefits in Texas the most? What can be done to make them more accessible?

CC: “[People] who are disproportionately likely to be food insecure are also more likely to use SNAP benefits. And food insecurity disproportionately affects families with children. It disproportionately affects communities of color, and the BIPOC population. It disproportionately affects people living in rural areas where access to food and jobs can be really limited. It affects seniors a lot, who face a lot of trade offs between food and medicine. 

They were the same populations, in many cases, that were also most likely to be disproportionately hit by COVID. And so, generally speaking, people who are more likely to face food insecurity are also going to be more likely to seek out food stamps, with some exceptions, because there are some barriers to participation that can fall harder on certain populations than others. 

One example might be seniors who … struggle to get through the application process and understand what documentation they need. Texas uses a largely online process for applications. And so when COVID hit and obviously local offices in person access really shut down, I think people were forced to rely even more on the remote online option options for applying. And you know, we just know from research that seniors typically struggle more with technology. People living in areas with limited broadband also struggled to access SNAP …

I think the state of Texas has done a really great job over the years trying to make the program more accessible. And at the same time, kind of balancing the cost of administering the program. So they’ve been looking for ways both to make it easier for people to access the benefit, but also to streamline the process for their workforce. And they’ve really faced challenges over getting enough money from the legislature to run the program. 

So they’ve sort of tried to address that by finding more cost-effective ways of having an online application, reducing the number of touches on each case, and reducing face-to-face [contact] and limiting foot traffic in local offices. I think right now the state is facing the same challenges that every employer is facing, which is they’re having a hard time keeping staffing up. There’s a lack of tenure and there’s a lack of staff, and when you combine that with the increase in need … it’s been very challenging for them.”

SM: What are some policies that Feeding Texas is advocating for to help combat food insecurity and ensure healthy Texas communities?

CC: “First of all, we’ve been advocating for state and federal resources for food banks to … help us [acquire and] distribute that greater volume of food, and we’re really grateful for the leadership of both state and federal affairs throughout COVID. They’ve sunk a lot of additional resources into the terrible food system. 

Most recently, the legislature appropriated $95 million to invest in food bank capacity to meet the increased need, and that’ll be a statewide investment that will help us meet the need during this pandemic and future pandemics and disasters. So I think that that’s something we’ve advocated successfully for, and I want to credit our state and federal officials for coming through on [that].

We’ve been working … to ensure that SNAP benefits are adequate to keep the emergency allotments in place. We advocated for an increase in emergency allotments for the families that were already getting the maximum to begin with. We’ve been advocating for an increase in the Thrifty Food Plan, which is the basis on which SNAP benefits are determined … 

Getting back to the issues around social determinants of health … We know that housing access and health [insurance] access, transportation, all of those things can also impact food insecurity. So we’ve been pushing for the child tax credit to be extended. We’ve been pushing for … Medicaid expansion … We’ve also been pushing for increased investments in the Child Nutrition Programs. Those are the end of school and after-school food programs that are another really important component of the federal nutrition safety net.”

SM: What other initiatives is Feeding Texas engaged in to create healthier Texas communities?

CC: “One of the things that we’ve been working a lot on over the last few years is strengthening our partnerships with health care, both with providers and managed care organizations and hospitals. We call them ‘food Rx partnerships’ because food is medicine. Some food banks are partnering with health care clinics and providers to do food insecurity screenings when our patients come in and they see a diet-related illness. It’s a simple screen to tell if they’re food insecure. And if that person is positive for food insecurity, then the health care provider makes a referral to the food bank. Then they go pick up the healthy food box. So that’s the most common example of those partnerships. 

But we also work to combine the provision of healthy food with education and sometimes more clinical interventions like providing blood sugar testing and blood pressure checks and things like that. So, the various partnerships that are happening right now are kind of in the pilot phase and are occurring kind of across the continuum. And I think the next step is looking to see how we can more meaningfully engage managed care organizations in the process.”

This interview was edited for clarity and length.