The U.S. Department of Agriculture (USDA) has just launched a pilot in New York State allowing Supplemental Nutrition Assistance Program (SNAP) participants to buy food online with their benefits. Amazon and ShopRite are the initial New York City retailers and Walmart will serve upstate shoppers. More retailers and cities will soon follow, and if the pilot succeeds in the next two years, the USDA plans to extend it retailers nationwide, covering the nearly 40 million Americans who received $60 billion in SNAP benefits in 2018.

In one fell swoop, SNAP participants will have access to vastly broader food options, at competitive prices, from their living rooms. When this happens we will have to rethink the conventional notion of a food desert—a neighborhood with limited supermarket access.

For those who have worked for decades to make healthful food available in low-income communities, the pilot has the potential to be a game-changer, enabling them to shift attention from physical access to supermarkets to the economic inequality at the root of food insecurity. But if the SNAP pilot will actually make people healthier, six questions demand attention:

1. Does Online Shopping Mean Healthier Choices?

Behavioral economics suggests that shopping online leads people to make fewer unhealthy impulse purchases: the time lag between purchase and delivery causes us to think twice about our cravings, and two-dimensional pictures generate a less visceral impulse than real food on a shelf. On the other hand, market research shows that online grocery shoppers buy more shelf-stable, processed items than fresh food, and that home delivery encourages purchases of heavy items like cases of soda. Online platforms also reinforce habitual purchases, by pre-filling shopping carts with previous items, setting up “subscription” options, and suggesting alternatives. Research is needed to understand how online choice architecture affects food buying and how strategies like web design and government incentives may nudge shoppers to healthier foods.

2. Will Shopping at Home Make People Less Active and More Lonely?

Most people, particularly those with limited budgets, shop at multiple stores, some far from home, to get the best value. Online retail eliminates the need for some of these trips, saving time and travel costs, which can be significant for those with low-incomes living in neighborhoods with limited transit. For frail or physically disabled shoppers, ordering from home and having the food delivered can increase independence and self-sufficiency and may ease the burden of caregivers responsible for grocery shopping. But this convenience can be a double-edged sword. Trips to the supermarket are often important opportunities for physical activity and social interaction, especially among older adults, and if not replaced by equivalent activities, their loss may lead to isolation and physical debilitation.

3. Will Local Food Retailers be Able to Compete?

Online retailers may lower food costs, enabling SNAP participants to afford healthier food. Some local supermarkets will innovate to remain competitive, improving food quality, variety, service, and the in-person shopping experience. Over time, however, some may fail, potentially reducing competition and food access. And the loss of supermarkets means that the $1.80 currently generated in local economies for every SNAP dollar spent would flow elsewhere. Policymakers will need to help brick-and-mortar retailers stay in business through investments in public distribution infrastructure, commercial rent control, tax benefits, and other support.

4. Will it Be Bad for Worker Health?

Good jobs paying living wages are important determinants of health. But many employees who work for companies like Walmart and Amazon earn salaries so low that they themselves qualify for SNAP benefits. SNAP dollars spent online may flow from local supermarkets to retailers whose workforces are located beyond the wage and labor laws, and unions, of the cities in which they sell. Policymakers will need to redouble their efforts to create new good food jobs for those lost.

5. Will it Increase Environmental Health Problems?

In cities where conventional grocery shopping is typically done by foot and mass transit, switching to home package delivery will increase vehicle miles, traffic congestion, local air pollution, and greenhouse gas emissions. These are all likely to exacerbate chronic health problems such as asthma, which are suffered disproportionately by the low-income communities that use SNAP. Avoiding these and other potential adverse environmental effects, such as excess packaging waste, requires design solutions like centralized package delivery and transportation planning to streamline vehicle movement, and systems for reusable packaging.

6. Will it Create a Digital Food Divide?

Without planning, the lack of internet access may become the new barrier to food access, perpetuating instead of reducing health disparities. Investments in high speed digital access and computer centers in low income communities, combined with computer literacy programs, are essential to help SNAP participants navigate supermarket websites and apps, and research prices and nutrition information. Online shopping need not be done in isolation but can become a collaborative activity in community centers and libraries, with accompanying assistance in nutrition, food preparation, and household budgeting. Web programmers working with public health researchers have the opportunity to design applications to help SNAP participants search for the best prices, values, and healthy ingredients, and to create accessible interfaces for people with visual or cognitive limitations.

SNAP is moving online, whether we like it or not, and ignoring the fact that in a few years some 40 million people will change their grocery shopping habits would be a serious mistake. As the physical barriers to food fall away for SNAP participants, it will be up to policymakers and the public health community to ensure that the food retail sector—virtual as well as brick and mortar—supports healthy diets and true access for all.

Top photo CC-licensed by Sam Beebe.