As practicing physicians, we spend much of our time treating the downstream consequences of inequities: unmanaged diabetes, recurrent pneumonia, delayed care due to insecure transportation or housing. Yet upstream of those clinical crises sits one of the most fundamental determinants of health: access to nutritious food. In rural and semi-rural states like New Hampshire, the federal Supplemental Nutrition Assistance Program and Special Supplemental Nutrition Program for Women, Infants, and Children are critical components of that food access infrastructure, and it is facing a devastating disruption.
On Oct. 1, the U.S. government entered a shutdown because Congress did not pass a continuing resolution for federal appropriations. Among the many programs now at risk is SNAP and WIC, which provide low-income households with monthly benefits to buy groceries. According to federal guidance, the U.S. Department of Agriculture has indicated that no new funds will be distributed on Nov. 1, unless the funding gap is resolved.
In New Hampshire, roughly 75,000 Granite Staters rely on SNAP benefits and at least 13,000 people receive WIC benefits each month. With November’s benefits not being issued, we face a “food security cliff.” At the same time, rural geography, limited grocery access and transportation constraints magnify the risk: a missed benefit can mean skipped meals, nutritionally inadequate diets, increased use of emergency food networks and worsening of chronic health conditions.
From a health-equity standpoint, the halt of SNAP and WIC in New Hampshire threatens to exacerbate existing disparities. Losing access to consistent healthy food can cause real physiologic impacts: weakened immune responses, heightened vulnerability for infections, and declines in cardiovascular disease and metabolic health.
SNAP and WIC stoppages hit low-income rural residents, seasonal workers, older adults and families in remote areas with limited healthy food access the hardest. Reduced food assistance drives higher hospitalizations, more emergency room use and added strain on already stretched rural New Hampshire health systems.
The state has therefore activated a contingency plan in partnership with the New Hampshire Food Bank, including mobile pantry roll-outs and increased food-bank distributions targeted to SNAP recipients. However, even the Food Bank’s Executive Director candidly stated, “There is no way that we can replace [SNAP].”
Given that SNAP and WIC are both a food-security and a health-equity lifeline, we urge New Hampshire’s policymakers, healthcare leaders, and community organizations to take these actions immediately:
- Cross-link health systems and food security interventions: In your clinical, home‐visit and public health work, actively screen for food insecurity, especially given the interruption, and connect individuals to food-pantry networks and mobile distributions.
- Support the mobile pantry/food bank surge capacity with food and/or monetary donations. The New Hampshire Food Bank’s plan for deploying up to 20 new mobile pantry sites twice weekly should be prioritized and resourced — it will be a vital bridge.
- Encourage New Hampshire’s congressional delegation to press for immediate resolution of the shutdown and restoration of SNAP and WIC funding. Failure to act is a public health crisis in the making.
- Whether the shutdown ends swiftly or drags on, this moment underscores that rural food security programs must be built with redundancies and local buffers. Health equity work must include ensuring that safety nets like SNAP are stable, accessible and consistent.
Nutrition assistance programs like SNAP and WIC are often perceived as social welfare support, but from the perspective of healthcare and public health, they are fundamental preventive infrastructures. In New Hampshire, the looming halt of SNAP and WIC benefits are a healthcare red-flag. The decision-makers in Washington D.C. and Concord must act, because every day of delay means worse healthcare outcomes and increased downstream costs for families and health systems alike.
If we truly believe every Granite Stater deserves the chance to be healthy, safe and well-nourished, then protecting food aid flows, especially through this shutdown, is urgent.
Frances Lim-Liberty and Anais Ovalle are physicians at Dartmouth Health. Lim-Liberty is based in New London and Ovalle in Lebanon.