On Tuesday, the RAND Corporation published the results of a preliminary study on South Africa’s HealthyFood initiative, a benefit program sponsored through the nation’s largest private insurance company. The program provides some 260,000 South African households with up to a 25 percent rebate on healthy food purchases — “cash for carrots,” if you will — and the encouraging numbers suggest that similar initiatives could work right here in America.

While the study does suffer from some methodological snags — the biggest being that households’ eating habits were self-reported rather than observed — its authors conclude that the right level of rebates can be a strong catalyst for healthier eating habits. For instance, the survey of 350,000 HealthyFood participants and nonparticipants found that “a 10% and 25% discount on healthy food purchases is associated with an increase in daily fruits and vegetables consumption by 0.38 (95% CI: 0.37 – 0.39) and 0.64 (95% CI: 0.62 – 0.65) servings, respectively,” and that rebate participants were more likely to eat three or more servings of wholegrain foods daily while being less likely to eat foods high in sugar, salt, fried foods, processed meats, and fast food.

Admittedly, the report does not find that the healthier eating habits significantly reduced overweight rates or participants’ average BMIs. However, it does see a statistically significant correlation between higher discount rates and lower obesity, suggesting that the right amount of financial motivation can spur enough eating habit changes to make a dent in obesity rates on the macro level.

So could a similar program work in the U.S. — particularly for low-income Americans who struggle with food insecurity, and often have to resort to high-fat and high-calorie diets to get more nutritional “bang-for-the-buck”? There’s not a whole lot of data on the matter yet. But that will soon change, as a 2011 pilot program under the Supplemental Nutrition Assistance Program (SNAP) — the “Healthy Incentives Pilot” — mimics the HealthyFood initiative, offering inflated discounts of up to 30 percent cash back on healthy food purchases, and its results will be published later this year. If the findings track South Africa’s, then it could be a game changer for low-income communities often beset by unhealthy food habits and high obesity rates. And incentivizing healthy eating with rebates could be a more effective policy than more blunt and restrictive initiatives, like South Carolina Gov. Nikki Haley’s (R) controversial push to limit food stamp purchases to healthy items.

Still, the funding element is key, as the study found that higher rebate levels were required to change the eating habits of people who were entrenched in subpar diets. The South African program offers monthly discounts of up to $500 for a family and $250 for individuals — significantly higher than the average monthly SNAP allotment, which is supposed to be a supplemental benefit (although it doesn’t actually work that way in reality). But South Africa’s example suggests that, given sufficient financial backing, cash for carrots could be a worthwhile undertaking throughout America.

Confederate flag flying on grounds of South Carolina's state capitol

State Rep. Kris Crawford’s comments came during the early stages of the state Medicaid debate in late January. Crawford suggested that it was politically beneficial for Republicans (who run a Statehouse that flew the Confederate flag in front of it as recently as December 2011) to oppose any political initiatives spearheaded by a black man:

Rep. Kris Crawford, a Republican from Florence and also an emergency room doctor, supports the expansion but expects the Republican caucus to vote as a block against the Medicaid expansion.

“The politics are going to overwhelm the policy. It is good politics to oppose the black guy in the White House right now, especially for the Republican Party,” Crawford said.

South Carolina’s voter ID law was blocked last year by the Department of Justice on grounds that it violated the Voting Rights Act. The author of the law admitted to receiving, and responding positively to, racist emails in support of the law.

Governor Nikki Haley’s (R) steadfast opposition to the Medicaid expansion is becoming increasingly lonely; a wave of Republican governors have recently accepted federal assistance in providing health care for their poor citizens. South Carolina hospitals, who strongly support the expansion, have gone so far as to ask that their taxes be raised to pay for it.

(HT: David Graham.)

Gov. Nikki Haley’s (R-SC) state has a serious weight problem — and she knows it. That’s why last week, flanked by public health officials, Haley announced that she will push for a controversial overhaul of South Carolina’s nutritional assistance program that would limit food stamp purchases to “healthy” items. It’s a well-meaning idea meant to tackle the state’s rampant obesity epidemic and its resulting health care costs — unfortunately, the proposal isn’t the most effective way to tackle obesity, and implementing it could end up preventing low-income Americans from receiving adequate nutrition.

Any changes to a state’s food stamp program require a waiver from the federal government, and no state has successfully received one to date. The Charlotte Observer reports that Haley will hold group meetings with food stamp recipients, public health advocates, food makers, and various other officials to determine which foods should be purchasable with food stamps — and which shouldn’t — before requesting the waiver, in an effort to sway the federal government by putting up a unified front. That means that the specifics of Haley’s plan have yet to be fleshed out, and her office did not respond to ThinkProgress’ request for more details.

Still, Haley’s statements on the matter suggest that she wants to discourage South Carolina residents from using food stamps to purchase high-fat, high-calorie, and high-sodium products. “That $1 billion [in federal nutritional assistance] no longer will go to candy and chocolate and sodas and chips — it’ll be going to apples and oranges and things that are healthy,” she said.

That’s certainly an admirable goal considering South Carolina’s abysmal public health statistics: a full third of the state’s 4.7 million resident are obese, making it the eighth most obese state in America; another third are overweight; and the state ranks second in the country for obesity-related diabetes risk. Furthermore, the cost of treating obesity-related illnesses for low-income Americans accounts for almost 12 percent of national Medicaid spending — and likely an even higher percentage in South Carolina, where 18 percent of residents are on the federal Supplemental Nutrition Assistance Program (SNAP).

But the efficacy — and the practical logistics — of Haley’s approach remains an open question. Proposals to limit food stamp purchases are a source of fierce debate among both public health and poverty advocates — not to mention supermarkets and food makers who argue that the transaction costs of separating SNAP from non-SNAP products would be too high or hurt product sales.

Read more

The majority of South Carolina’s 85 school districts aren’t following the state-mandated guidelines for sexual health education, a new report finds. Despite the fact that state lawmakers passed a Comprehensive Health Education Act (CHEA) in 1988 in an attempt to hold public schools to the same sex ed standards, health classes across South Carolina are falling short — with direct consequences for the state’s teens, who are having more unsafe sex than they were five years ago.

The report reveals that three out of every four South Carolina school districts weren’t following at least one guideline in the state’s sex ed law. Researchers found that many public schools’ health curricula didn’t adhere to standards about scientific accuracy, and included little to no instruction about preventative health measures like birth control or condoms. And even though state law attempts to establish comprehensive sexual health courses for South Carolina students, the researchers discovered that shame-based abstinence education still dominate many classrooms:

It was also revealed that discriminatory and misleading curricula and instructional materials still exist in some school districts. Students in some school districts are exposed to reproductive health education that includes outdated gender roles, idealized family structures, and medically inaccurate information. A number of districts report using abstinence-only-until-marriage (AOUM) curricula, and these program materials are often rife with incomplete, misleading, and blatantly incorrect information.

Specifically, students within these programs are commonly presented misinformation regarding human papillomavirus (HPV) and condom efficacy. Such materials commonly do not include scientific discussions of condoms as a preventive measure to reduce transmission of sexually transmitted diseases. It is recommended the CHEA be amended to require instruction in reproductive health education evidence-based and medically-accurate.

And that type of inadequate instruction is South Carolina is having a negative impact on the state’s adolescents, whose rates of condom use are actually declining — an estimated 58 percent of sexually active teens used condoms in 2011, compared to 67 percent in 2005. South Carolina, ranked a lowly 42nd in the nation in overall sexual health, consistently has some of the nation’s highest rates of HIV infections, gonorrhea and chlamydia cases, and teen births.

“We hope this report stimulates conversations at the state and local levels about health education, sexuality education, teen pregnancy prevention, and how all adolescent health risk behaviors affect high school graduation rates and, ultimately, the future of South Carolina,” one of the research analysts told the Palmetto Public Record. A similar conversation is already beginning in other deeply conservative states like West Virginia, Mississippi, and Alabama, where some lawmakers are considering updating sexual education standards in light of the failures of abstinence-only education.

Two and a half years, two elections, and one Supreme Court case after Obamacare was enacted as the law of the land, a South Carolina lawmaker is threatening any official who helps implement the measure with a five-year prison sentence.

State Rep. Bill Chumley (R), who represents Spartanburg, pre-filed legislation last week to criminalize the legally-required implementation of Obamacare. U.S. News & World Report has more:

If his bill becomes law, any state official caught enforcing the healthcare law would be guilty of a misdemeanor and “must be fined not more than one thousand dollars or imprisoned not more than two years, or both.”

Federal officials caught enforcing the law, however, would be given stiffer punishment under the proposal.

Any federal employee or contractor enforcing the law “is guilty of a felony and, upon conviction, must be fined not more than five thousand dollars, or imprisoned not more than five years, or both,” the bill proposes.

Of course, Chumley’s proposal is as unconstitutional as it is ridiculous. The Constitution establishes federal law as the supreme law of the land, trumping state law.

Still, Chumley’s is not a lonely quest. Though Gov. Nikki Haley (R) hasn’t weighed in on the proposal yet, state Sen. Lee Bright “is proposing similar legislation in the legislature’s upper chamber.” Republicans handily control both chambers of the legislature.

Unfortunately, conservative lawmakers in South Carolina are not the only ones to embrace such an extreme proposal. Last month, nine Wisconsin legislators backed a similar bill expressing their belief that Obamacare is unconstitutional and threatening to arrest any officials who tried to implement it in the state.