During emergencies like the COVID-19 crisis, lower income and older individuals face an extra disadvantage: they do not have the same kind of access to healthy foods that younger, richer people do. Public health and policy researchers at New York University looked into ways food delivery programs to these communities and online grocery shopping can be expanded to reach vulnerable groups during a health crisis.

“While our familiarity is New York-centric, our recommendations are definitely national,” Pasquale Rummo, an assistant professor in the Department of Population Health at NYU Langone Health at NYU Grossman School of Medicine and the co-author of a recent article on food delivery disparities, told TheDoctor.

Only select retailers and certain states are accepting the SNAP Purchasing Pilot.

Being able to buy from Whole Foods or use Instacart to get hygiene products and food delivered without having to physically walk into a store is the way forward during this pandemic, he explained, but this is often a barrier for older individuals. Poorer, urban neighborhoods often have little access to stores selling fresh food, and this not only affects residents' food choices, it potentially increases their risk of chronic disease. Similarly, a lack of meal delivery options and convenient low-cost online shopping means vulnerable people don't have a safe way to shop for healthy food.

The way to fix this, beyond expanding meal delivery programs, is that the online food stamps program for SNAP users, the SNAP Purchasing Pilot, needs to be extended to other states. And then policymakers have to raise awareness of its availability among poor residents of food deserts, particularly older adults 60 and over, who are both less aware of and less apt to shop online.

SNAP Online Purchasing began April 2019 in New York State, and was followed by Washington in January of this year. In early March 2020, Alabama and Oregon also launched SNAP Online Purchasing and Iowa joined March 11.

SNAP recipients can buy food items and have them delivered using their EBT cards — which are like debit cards for food stamps — through the Purchasing Pilot. Delivery fees and some other items are not covered by the program. At this time, only select retailers are accepting the Purchasing Pilot: Alabama allows it at Wright’s Markets; Iowa, Oregon and Washington State allow it at Amazon and WalMart; and New York allows it at Amazon, WalMart and ShopRite.

“Awareness of the SNAP Online Purchasing Pilot is low and the willingness to shop for groceries online is [also] low, especially for older adults,” said Rummo. His advice is different for older versus younger low-income adults. Stores could use banner ads to teach older adults how to use online shopping. Lower-income adults who are under 60 may not have access to all the types of tech enjoyed by the middle and upper classes, but are generally savvier about online shopping.

Rummo hopes that his research will help both underserved groups, in the way that people had to expand their outreach after disasters like Hurricanes Sandy and Katrina, which disproportionately pummelled the poor and elderly. “Because of Coronavirus,” he speculates, “the willingness to shop for groceries online will increase. The awareness will marry nicely with the willingness.”

The article appears in JAMA Health Forum.