[Senate Hearing 109-934]
[From the U.S. Government Publishing Office]
S. Hrg. 109-934
A NEW INITIATIVE TO COMBAT CHILD HUNGER
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON FOREIGN RELATIONS
UNITED STATES SENATE
ONE HUNDRED NINTH CONGRESS
SECOND SESSION
__________
SEPTEMBER 26, 2006
__________
Printed for the use of the Committee on Foreign Relations
Available via the World Wide Web: http://www.gpoaccess.gov/congress/
index.html
U.S. GOVERNMENT PRINTING OFFICE
36-451 WASHINGTON : 2007
_____________________________________________________________________________
For Sale by the Superintendent of Documents, U.S. Government Printing Office
Internet: bookstore.gpo.gov Phone: toll free (866) 512-1800; (202) 512�091800
Fax: (202) 512�092250 Mail: Stop SSOP, Washington, DC 20402�090001
COMMITTEE ON FOREIGN RELATIONS
RICHARD G. LUGAR, Indiana, Chairman
CHUCK HAGEL, Nebraska JOSEPH R. BIDEN, Jr., Delaware
LINCOLN CHAFEE, Rhode Island PAUL S. SARBANES, Maryland
GEORGE ALLEN, Virginia CHRISTOPHER J. DODD, Connecticut
NORM COLEMAN, Minnesota JOHN F. KERRY, Massachusetts
GEORGE V. VOINOVICH, Ohio RUSSELL D. FEINGOLD, Wisconsin
LAMAR ALEXANDER, Tennessee BARBARA BOXER, California
JOHN E. SUNUNU, New Hampshire BILL NELSON, Florida
LISA MURKOWSKI, Alaska BARACK OBAMA, Illinois
MEL MARTINEZ, Florida
Kenneth A. Myers, Jr., Staff Director
Antony J. Blinken, Democratic Staff Director
(ii)
?
C O N T E N T S
----------
Page
Gerberding, Dr. Julie, Director, Centers for Disease Control and
Prevention, Waashington, DC.................................... 11
Prepared Statement.......................................... 14
Kunder, James, Acting Deputy Administrator, U.S. Agency for
International Development, Washington, DC...................... 3
Prepared statement........................................... 5
Lugar, Hon. Richard G., U.S. Senator from Indiana, opening
statement...................................................... 1
Morris, James T., executive director, United Nations World Food
Program, New York, NY.......................................... 24
Prepared statement........................................... 27
Veneman, Hon. Ann, executive director, United Nations Children's
Fund, New York, NY............................................. 29
Prepared statement.......................................... 31
Ward, Hon. George, senior vice president for international
programs, World Vision, Washington, DC......................... 20
Prepared statement........................................... 22
(iii)
A NEW INITIATIVE TO COMBAT CHILD HUNGER
----------
TUESDAY, SEPTEMBER 26, 2006
U.S. Senate,
Committee on Foreign Relations,
Washington, DC.
The committee met, pursuant to notice, at 9:00 a.m., in
room SD-419, Dirksen Senate Office Building, Hon. Richard G.
Lugar, (chairman of the committee) presiding.
Present: Senators Lugar and Sarbanes.
OPENING STATEMENT OF HON. RICHARD G. LUGAR, U.S. SENATOR FROM
INDIANA
The Chairman. This hearing of the Senate Foreign Relations
Committee is called to order.
This morning, the committee meets to examine the issue of
global child hunger and malnutrition. In recent years, the
committee has held hearings on global nutrition issues and the
intersection of hunger and the HIV/AIDS crisis. These inquiries
have underscored that societies and nations that experience
high levels of hunger and malnutrition rarely function well.
Consistent nutrition is an essential component of long-term
economic growth and geopolitical stability. We have also
reaffirmed that the most basic act of human charity is feeding
a hungry person. It's my belief that the United States should
extend such assistance wherever possible, both because we have
a moral responsibility to do so and because our security and
our prosperity depend upon what happens overseas.
We're extremely fortunate to be one of the great food
producers in human history. We're also fortunate that we have
many creative and compassionate leaders, some of whom are with
us today, who have applied their talents to addressing world
hunger, often in the face of desperate circumstances.
Tragically, many people around the world continue to face
hunger and malnutrition. An estimated 850 million people go
hungry. Most of them are among the world's poorest. For the
estimated 1 billion people around the world living on less than
$1 per day, obtaining adequate nutrition is a challenge under
normal circumstances. When this population faces a crisis that
intensifies food insecurity, such as the locusts that
devastated crops in West Africa 2 years ago, the drought in
Malawi last year, or the genocidal violence in Darfur,
obtaining sufficient nutrition is nearly impossible.
As we discovered in a 2004 hearing, the AIDS pandemic is
decimating the agricultural sector in sub-Saharan Africa. As a
result, the rate of malnutrition is actually increasing on the
African continent. This is a sobering trend, given the science
and technology at our disposal in the 21st century, and it must
be reversed. Although famine and starvation are the most severe
and visible forms of hunger, poor nutrition, which often goes
unnoticed, can also be deadly. And often, malnutrition is
caused not by scarce food supplies or by poor sanitation and
disease. Even adequately fed people can become malnourished if
their bodies are afflicted with diarrhea or parasites. In
addition, gender inequities, the lack of nutritional education,
and certain cultural practices have led to malnutrition in some
regions of the world.
Hunger and malnutrition are especially devastating to young
children. An estimated 5 to 6 million children die each year
from infections and disease caused by malnutrition. Nearly one-
third of the children in the developing world are underweight
or have had their growth stunted. Even before birth,
malnutrition impacts a child's development. We know that the
children of malnourished mothers often suffer irreversible
physical and cognitive damage.
Hunger and malnutrition also perpetuate poverty and
undermine economic growth, development, and political stability
in the developing world. Malnutrition often causes poor
performance in school, which, in turn, leads to an overall loss
in an individual's productivity. If the situation is common
among a nation's youth, it becomes very difficult to make
economic advances based on education.
Nations understood the critical link between malnutrition
and poverty when they pledged, in 2000--the year 2000--to meet
the Millennium Development Goals, the first of which is to
eradicate extreme poverty and hunger. Specifically, these goals
call on the world community to halve, by 2015, the proportion
of people who suffer from hunger. The primary measurement for
this goal is the percentage of children younger than 5 who are
underweight. Achieving the first goal goes hand-in-hand with
the fourth Millennium Development Goal, which is to reduce by
two-thirds the child mortality rate in the developing world.
As chairman of this committee and a former member of the
Agriculture Committee, I have advocated a nutrition program for
the poor and for children in our country and abroad, and I'm
hopeful that, as a result of our testimony today, we will
better understand the causes of hunger and the malnutrition in
children and the impact these conditions have on individual
health and the advancement of developing societies. Most
importantly, we hope to learn about new initiatives to address
this problem.
We're pleased to be joined today by a stellar panel of
experts who are on the front lines of the fight against hunger.
We welcome Mr. James Kunder, Acting Deputy Administrator for
USAID; Dr. Julie Gerberding, Director of the Centers for
Disease Control and Prevention; Mr. James T. Morris, executive
director of the World Food Program; Ms. Ann Veneman, executive
director of UNICEF; and Ambassador George Ward, World Vision's
senior vice president for international programs.
Each panelist will discuss his or her organization's
efforts to combat child hunger and malnutrition, and comment on
new initiatives to address this problem. We thank our witnesses
for being with us today. We look forward to an important and
hopefully enlightening discussion with each one of them.
Let me mention that the statements that each of the
witnesses has prepared will be placed in the record in full, so
you need not ask for permission that that occurs. It will. And
we will ask that you proceed--I will not have a rigorous time
limit. Our desire is to hear from you and to have a full
discussion of your testimony. I would suggest that, to the
extent that your remarks are in the 10-minute area, plus or
minus a bit, that that would be helpful. We expect that we'll
be joined by other members of the committee, and we'll have a
round of questions as they arrive and the testimony is
complete. But we'll hear from all five witnesses, so that all
five are heard completely, before we begin our questioning.
And I will ask that the witnesses testify in the order that
they are included in our agenda for the meeting. This is
somewhat different from the order that I introduced you in my
remarks, but let me just go through the order again. We will
have Mr. Kunder, Dr. Gerberding, Ambassador--or, rather,
President Ward, Mr. Morris, and then Secretary Veneman.
So, I will ask you, first of all, to start off, Mr. Kunder.
We welcome you back to the committee. And thank you for coming
today, for your testimony.
STATEMENT OF JAMES KUNDER, ACTING DEPUTY ADMINISTRATOR, U.S.
AGENCY FOR INTERNATIONAL DEVELOPMENT, WASHINGTON, DC
Mr. Kunder. Thank you, sir, and we very much appreciate the
committee holding this important hearing. I appreciate your
letting me go first. This is an extraordinarily distinguished
panel, and I am, by far, the least distinguished member of it,
so--I want to pay special tribute, as he leaves the presidency
of the World Food Program, to Jim. He has been an extraordinary
leader in the development community, and specifically on this
issue of battling hunger around the world. I've had the
opportunity to work with the superb organization he heads many
times while I was Director of USAID's Office of Foreign
Disaster Assistance. It is an extraordinary organization, and
he is an extraordinary individual, and he has made signal
contributions to the battle against hunger around the world.
The amount of assistance that the U.S. Government focuses
on food assistance and battling the problems that the chairman
has just outlined is substantial. In terms of contributions to
the World Food Program alone, the average contribution by the
U.S. Government in the last several years has been just short
of a billion dollars a year, so substantial U.S. Government
resources are going to this area. And, of course, one of the
critical issues is, as you pointed out, that there are many
drivers of the staggering and sad statistics that you noted. I
mean, not only is the assistance--direct food assistance and
direct nutritional assistance--critical, but building
institutions around the world and building government
capacities to take care of the needs of their own citizens are
equally important parts of the toolbox to battling child hunger
in the world.
USAID approaches this problem with a strategic plan that
has four basic components to it, and I'll summarize those very
briefly:
The first strategic component is to raise agricultural
production around the world, so there are substantial
investments in improving agricultural productivity. I
mentioned, during my statement to the committee just several
weeks ago, that, for example, we understand the role of
America's universities and agriculture extension services as
important components, so we invest in creating similar
institutions overseas.
The second is what we call the question of access to food,
and that has physical manifestations, in terms of
infrastructure. But it also has to do with incomes, because, as
all the witnesses know, and as the committee knows, many times
there is adequate food in the society, but the poorest of the
poor simply can't afford to access that food. And it has health
aspects, because if children are wracked with diarrhea and
other childhood diseases, the nutrients they are receiving
aren't sustaining their bodies. So, the second area we focus on
is access to food.
The third area is response in emergencies. And,
unfortunately, this is an area where an increasing share of
U.S. food assistance overseas is going for the many emergencies
we face around the world. That $970 million figure I mentioned,
in terms of the U.S. Government support for the World Food
Program--the proportion of that going to emergencies and the
share of our Food for Peace Program that is going to using food
for a long-term development component is, unfortunately,
increasing. That is to say, there are more and more crises
around the world that we're responding to.
And, fourth, in terms of USAID's strategy, we do focus
specifically on maternal and child nutrition interventions,
specific programs to improve feeding programs and access to
food by women and children around the world.
The issues that WFP has raised, and that Jim has raised, in
terms of the need for greater coordination, is, in our view,
right on the money. There are a lot of resources going into the
problems the chairman outlined, but what we need to do is
focus, make sure we're getting maximum use of the taxpayers'
dollars.
Just to give you one example that the staff at USAID
brought to my attention before this hearing, what we've done,
effectively, around the world, as we've tried to bring this
very successful polio eradication program to a conclusion, once
you reach the isolated target audiences for polio eradication,
we were doing vitamin A supplementation at the same time. The
unfortunate result of our relative success around the world is,
as the number of these polio immunization centers goes down,
then we lose the ability to reach into these very isolated
communities with vitamin A supplementation, as well. So, we've
got to think very carefully about how we're getting the
absolute maximum coordination in the field, so that these
various interventions, brought to the field by all the
organizations at this table, and many others, are achieving the
maximum synergy among them.
I'll stop there, Mr. Chairman. My testimony goes into great
detail about the various programs that USAID is doing. But we
very much support the ideas brought to the table by World Food
Program, UNICEF, and many other organizations about the need to
get better coordination in the field. We think this is a
particularly complex issue, because the drivers of childhood
malnutrition are so complicated. We invest, for example, in
improving community service organizations and community-based
organizations around the world. Now, at USAID, when we report
to the Congress, such efforts can show up as democracy-and-
governance interventions, and they may not show up as nutrition
interventions or food or health interventions. But, of course,
one of the ways we can most help achieve coordination and
effective targeting is to build up the community-based
organizations in Africa and Southern Asia and the other areas
in which we work.
So, this is an enormous coordination issue, as well as an
enormous resource issue, and we look forward to working with
the committee, with the organizations represented at the table,
and the hundreds of other NGOs and international organizations
involved in this fight, to improve the ability to tackle these
problems.
Thank you, sir.
[The prepared statement of Mr. Kunder follows:]
Prepared Statement of Hon. James Kunder, Acting Deputy Administrator,
U.S. Agency for International Development, Washington, DC
Mr. Chairman, thank you for the opportunity to join you again, this
time to share with you an overview of USAID's strategy to combat hunger
among children of the world. Here at the table with me are the true
experts in that field, but I am glad to represent the experts at U.S.
Agency for International Development (USAID) who partner with the
experts in these great organizations around the world.
Across the world some 10.8 million children under 5 years of age
die every year. Most of these deaths are preventable and almost all
occur in poor countries. I recognize the enormous impact of child
hunger and malnutrition on future development and as an underlying
cause of the deaths of these millions of children. For that reason, I
welcome this opportunity to discuss what USAID is doing to reduce this
awful and unnecessary blight on the world's future.
According to U.N. estimates, currently, 296 million undernourished
children live in the developing world. Other estimates are even higher.
For many of these children, the damage from hunger and malnutrition can
be life-long. Almost all nutritional deficiencies impair immune
function and other host defenses leading to a cycle of longer lasting
and more severe infections and ever-worsening nutritional status.
Hunger leads to physical stunting, lowers intelligence, and increases
susceptibility to diseases, dramatically increasing health care costs
and severely limiting their full potential to contribute to nation
building.
USAID programs recognize that well-nourished children rarely die
from diarrhea and common childhood infections, and maintaining good
nutritional status is an integral part of improving child survival.
USAID interventions are designed to decrease child and maternal
mortality; reduce crippling healthcare costs; and boost intellectual
and physical potential and national productivity.
I would like to tell you what USAID is doing in five key areas of
child hunger and nutrition: 1) Reducing micronutrient deficiencies; 2)
food fortification; 3) expanding exclusive breastfeeding and
appropriate infant feeding; 4) nutrition in emergencies; and 5)
sanitation, hygiene and nutrition.
1. REDUCING MICRONUTRIENT DEFICIENCIES
Vitamins and minerals--micronutrients--are essential components of
good nutrition. Without micronutrients, bodies and minds are weakened
and cannot resist many common diseases. For decades, USAID has been a
leader in addressing micronutrient deficiencies, primarily through
support of targeted supplementation and food fortification programs.
USAID supports developing countries to ensure national distribution of
vitamin A supplements to young children every 6 months and in the
development and implementation of programs that fortify commonly
consumed foods with combinations of vitamins and minerals missing or
limited in the diet.
USAID supported much of the initial research that identified the
crucial links between micronutrients and child health and then helped
developing countries deliver these essential nutrients to their
children. USAID supports advocacy, policy development, health worker
training and supervision, monitoring, logistics, and distribution
support.
Vitamin and mineral deficiencies contribute to extensive health
problems and deaths throughout developing countries. Three of them--
vitamin A, iron, and iodine--have been shown to profoundly affect child
survival, women's health, educational achievement, adult productivity,
and overall resistance to illness. More recently, with evidence from
new USAID-supported research showing the importance of zinc deficiency
and increased morbidity and mortality during diarrhea episodes, USAID
has included zinc in its programs.
Women and children commonly make up the most vulnerable segment of
societies with high rates of micronutrient deficiencies. Micronutrient
deficiencies can result in serious health consequences including birth
defects, maternal death, childhood mortality, blindness, anemia, and
increased vulnerability to infections. Additionally nonhealth
consequences include lower IQ, poor academic performance, and reduced
work productivity.
Vitamin A supplementation
Vitamin A deficiency alone affects as many as 120 million children
under 5, reducing their ability to survive common childhood illnesses
and causing a million child deaths each year. These children suffer
more severe and prolonged illnesses and are more likely to die from
common infections such as measles and diarrhea than a well-nourished
child. Approximately half a million children deficient in vitamin A
become blind every year. Half die within a year of becoming blind.
For more than 20 years, USAID has supported research into vitamin
A. Vitamin A mobilizes the body's immune system and makes it stronger,
and it heals submicroscopic cracks between cells in the body's armor--
the epidermis and intestine and lungs--which blocks invasion by outside
organisms. USAID-funded research has demonstrated that vitamin A
supplementation prevents child blindness and reduces child mortality by
an average of 23 percent in deficient populations. USAID is also
supporting groundbreaking scientific inquiry into the role of vitamin A
in reducing maternal deaths.
USAID-sponsored National Immunization Days (NIDs) for polio have
provided many countries with the opportunity to supplement children
with vitamin A at the same time, making this distribution mechanism one
of the most successful in the world. But as progress toward eradication
of polio is made, NIDs are being phased out in countries, and new
solutions need to be developed for vitamin A supplementation programs.
One of the solutions pioneered by USAID in the late 1990s was Child
Health Weeks, which are now the primary method of distribution in 15
percent of countries and achieve 70 percent coverage on average.
USAID and its partners have helped increase global vitamin A
coverage in children 6-59 months from 50 percent in 1999 to 68
percent in 2004. In 2004 alone UNICEF estimates that 500,000
children were saved.
USAID is currently working on vitamin A supplementation in
17 key countries where this is a major health problem.
Anemia prevention
Anemia affects about 2 billion people across the globe. Half of all
cases of anemia are due to iron deficiency. Iron deficiency anemia
often goes unreported because there are no outward symptoms to report.
The anemia prevention package promoted by USAID programs includes
deworming, malaria prevention and treatment, and iron supplementation
activities.
Overall, about 24 percent of maternal and 22 percent of perinatal
mortality in developing countries is attributable to iron deficiency
anemia. Even modest reductions in the severity of anemia can reduce
deaths. USAID's strategic approach is focused on two key areas. First,
USAID conducts research on the safe delivery of iron to women and
children, including those in malaria endemic areas. Second, USAID is
expanding Anemia Intervention Packages to tackle the main causes of
anemia, namely inadequate intake/poor absorption (food fortification,
iron supplementation), malaria (intermittent preventive therapy, bed-
nets, indoor residual spraying), and intestinal parasite (deworming).
In order to reduce the anemia that increases the risk of a mother
dying in childbirth, as well as the likelihood that the baby will be
born prematurely or with low birth weight, USAID has worked to raise
the profile of anemia control for women and children on country
national health agendas, and USAID is helping governments develop
programs to address the multidimensional problem with an integrated
approach.
Since 1995, USAID has supported anemia programs in more than 25
countries, including:
Nicaragua, where coverage with prenatal iron rose from 70
percent to 88 percent, and the prevalence of anemia in pregnant
women fell by one-third from 2000-2003. In the same time
period, coverage of children, ages 6-59 months, with iron
supplements improved from 37 percent to 62 percent, and anemia
fell from 29 percent to 23 percent.
India, where the prevalence of anemia fell by 25 percent
among participants in a USAID program to increase intake of
iron folic acid supplements (IFA) and control infections with
malaria and parasitic worms in pregnant women. Service delivery
was improved by using Anganwadi Centers as distribution sites
for IFA for both pregnant women and adolescents; and, using the
twice-annual ``catch-up'' rounds to distribute IFA to pregnant
women.
Iodine
In 1990, about 1.6 billion people, or 30 percent of the world's
population, lived at risk of iodine deficiency disorder (IDD); some 750
million people suffered from goiter, mainly because of chronically low
iodine intake. An estimated 43 million were affected by some degree of
brain damage as a result of inadequate iodine intake before or during
infancy and early childhood--largely the consequence of living in
mountainous or flood-plain regions where erosion has caused the local
soil and crops to contain too little iodine for healthy thyroid
function.
Since 1999, USAID has funded over $22 million for universal salt
iodization (USI) and elimination of iodine deficiency disorders in 43
countries through a partnership with UNICEF and Kiwanis. This has
resulted in a dramatic increase in the consumption of iodized salt.
Today, thanks to these efforts, 82 million newborns are now being
protected from learning disabilities caused by iodine deficiency
disorders. Overall consumption of iodized salt has increased in poor
countries from 20 percent of households in 1990 to over 70 percent
today. Successes include:
In sub-Saharan Africa, the regional average for households
using salt containing 15ppm or more of iodine is 64 percent.
Two notable countries are Uganda and Kenya, where USAID has
invested US $589,000 and $250,000, respectively, since 1999. As
a result, over 90 percent of households in both countries
consume adequately iodized salt.
In Asia, USAID has invested heavily in Bangladesh and
Indonesia. Both countries have obtained household coverage
rates that are significantly higher than the regional average
coverage of 49 percent-70 percent and 73 percent, respectively.
Zinc
Zinc supplementation, a simple and inexpensive intervention, not
only decreases the duration and severity of diarrheal disease, but also
reduces the risk of occurrence of diarrhea among children under 5.
In the last 6 years, USAID has sponsored research on zinc in both
the prevention and treatment of major illnesses like acute respiratory
infections, diarrheal diseases, malaria, and low birthweight.
Diarrhea remains a leading cause of child deaths worldwide. Every
year more than 1.5 million children under the age of 5 die as a result
of acute diarrhea despite the availability of effective low-cost
therapies to manage diarrhea cases. Clinical and field studies have
consistently shown that when children with diarrhea receive 20 mg of
elemental zinc for 10-14 days in conjunction with oral rehydration
solution, the duration of the episode shortens by 24 percent, severity
is reduced (24 percent less admission to hospital), and there is a
preventive effect for future episodes. Overall, diarrhea incidence
rates decrease 15 percent, and there is a 42 percent reduction in
treatment failure or death. USAID has been a major contributor to the
research leading to these findings. In 2004, WHO and UNICEF issued a
joint statement recommending the use of zinc during diarrhea as an
adjunct treatment to oral rehydration therapy (ORT).
USAID is disseminating and implementing these recommendations to
decrease the burden of disease related to diarrhea, and improve the
immunity of children by focusing on ensuring the availability of low-
cost, quality zinc products for international procurement by working
with the private sector internationally and in country.
By 2007, USAID will be supporting the introduction and expansion of
this program in 15 countries. In order to achieve this, USAID is
working with partners to ensure that policy is translating into
standard treatment guidelines and training materials for health
workers. Partnering with pharmaceutical companies is facilitating the
production of zinc dispersible tablets, and leveraging their marketing
and distribution divisions to accelerate the distribution of zinc to
public and private sector health facilities. NGOs and social marketing
groups subsidize the treatment for those with limitations to pay.
2. FOOD FORTIFICATION
Food fortification is perhaps the most generally applicable
approach to micronutrient deficiencies. Beginning in the 1940s, the
industrialized world has broadly embraced fortification, fortifying
flour, salt, milk, and butter and margarine with a range of nutrients.
Food fortification in now being introduced into the developing
countries as large-scale food processing has become available.
More than 2 billion people worldwide lack sufficient quantities of
zinc, vitamin A, iron, and iodine, which are now being added to
processed foods such as rice and sugar under USAID-supported programs.
USAID is improving the micronutrient content of basic foods by
expanding research, development, and dissemination of biofortified
crops--enhanced vitamin A, iron, and zinc maize; enhanced iron and zinc
beans; and vitamin A enhanced sweet potato--and through
supplementation.
Food fortification is a proven way for public and private sectors
to join in ending nutrition deficiencies for a sustainable solution.
USAID has been working to fortify foods for three decades and continues
to accelerate and expand food fortification programs as one of the most
effective, long-term strategies to reduce micronutrient malnutrition.
USAID and the Centers for Disease Control and Prevention (CDC) are
working together to improve monitoring and evaluations systems to
ensure public health impact.
Through the Global Alliance for Improved Nutrition (GAIN), USAID is
directly supporting 22 programs in 19 countries around the world that
fortify staple foods and condiments with iron, iodine, vitamin A, and
other micronutrients. When at scale, these programs are expected to
reach over 486 million people with fortified foods such as corn meal,
wheat flour, and soy sauce.
USAID and the Bill and Melinda Gates Foundation joined forces to
create GAIN and this successful collaboration continues in order to
identify new partners for this alliance. GAIN is an excellent example
of the public and private sectors working together for global change,
cited by Ending Child Hunger and Undernutrition Initiative. GAIN will
serve as a catalyst to mobilize the efforts, expertise, and resources
of the public and corporate sectors, toward the shared vision of
reducing micronutrient malnutrition. Commercial sector companies in
both developing and developed countries are critical partners in the
success of GAIN.
Since 1993, 30 countries have implemented food fortification
programs with USAID support, either through a centrally funded
program, bilaterals, or our partnership with GAIN.
With USAID funding, these 30 countries have fortified more
than 10 kinds of food, determined by food consumption patterns
in each country (for example, fish sauce in Vietnam and
cottonseed oil in Burkina Faso), with 6 different fortificants
(iron, folic acid, B vitamins, vitamin A, zinc, iodine).
In the 1970s, all Central American countries suffered from
high levels of vitamin A deficiency. With USAID assistance over
the past three decades, El Salvador, Guatemala, Honduras, and
Nicaragua all developed sustainable sugar fortification
programs. Today, vitamin A deficiency is virtually nonexistent
in these four countries.
Since 1997, Zambia has fortified maize meal and sugar with
vitamin A with USAID assistance. In a series of surveys, the
prevalence of vitamin A deficiency in children decreased from
65.7 percent in 1997 to 54.1 percent in 2003.
And fortification is cost-effective. Every $1 spent on vitamin A
fortification returns $7 in increased wages and decreased disability. A
dollar spent on iodized salt returns $28; iron fortification, $84.
3. EXPANDING EXCLUSIVE BREASTFEEDING AND APPROPRIATE INFANT FEEDING
More than two-thirds of malnutrition-related infant and child
deaths are associated with a failure to grow in children under 5 years
of age. Within this time period, the sharpest increase in malnutrition
occurs between 6 and 24 months of age, the time when children grow most
rapidly. This situation is made worse by the fact that less than a
third of infants in most countries are exclusively breastfed during the
first 6 months of life. In addition, early cessation of breastfeeding
and the introduction of nutritionally inadequate complementary foods is
a common occurrence. This compounds the danger for infants who are at
highest risk of mortality because of their exposure to disease and
limited access to health services.
Mothers and babies form an inseparable biological and social unit.
The health and nutrition of one group cannot be divorced from the
health and nutrition of the other. A well-nourished mother gives birth
to a healthy baby with sufficient nutrient stores to grow and develop.
To continue the child's well-being, the mother needs to have her
nutritional needs satisfied so that she can produce high nutritional
quality breast milk and actively take part in the care of her child. A
sick or malnourished woman is in danger of succumbing to illness and to
being unable to accomplish all the tasks of childbirth and child
rearing. USAID programs recognize the importance of women's nutrition
both to themselves, their children, and families and include them in
programs.
USAID also supports efforts to identify and support safer infant
feeding strategies in communities affected by HIV. Optimal infant
feeding is a key component of prevention of mother to child
transmission (PMTCT), as well as a critical intervention to ensure
overall child survival.
USAID supports programs to counsel all mothers about the risks of
mother to child transmission and the need to know their HIV status.
USAID's new Infant and Young Child Feeding (IYCF) program will develop
innovative interventions that build on 1) proven positive impact, 2)
effective behavior change and communication to target populations, and
3) improve household food quality through small- and large-scale
fortification.
Ensuring optimal nutrition involves various interventions
coordinated at key points in the healthcare setting and community.
USAID has developed the universally recognized and adopted Essential
Nutrition Actions (ENAs) consisting of proven, high impact, feasible
program interventions which, implemented at the community level, have a
significant impact on nutritional status and child survival. The Ending
Child Hunger and Undernutrition Initiative recognizes the importance of
these ``essential packages.'' These include:
Exclusive breastfeeding up to 6 months;
Appropriate infant and young child feeding through 23
months;
Optimal nutritional care of sick children;
Prevention of vitamin A deficiency;
Prevention of anemia;
Prevention of iodine deficiency; and
Optimal nutrition for women.
P.L. 480, Title II food assistance programs and community-based
maternal and child health and nutrition activities implemented by
USAID's child survival and health grants recipients are especially
effective ways to increase the impact of these life-saving
interventions. For example, between 40 and 50 percent of Title II
nonemergency resources support multiyear community-based maternal and
child health and nutrition programs that distribute food, much of it
micronutrient fortified, and monetize to fund the implementation of
proven interventions to improve child survival and nutrition. These
include promotion of exclusive breastfeeding and appropriate
complementary feeding, prevention and treatment of preventable
childhood diseases, including diarrhea, increased micronutrient
consumption, and improvements in antenatal care. Title II MCHN programs
also create linkages between health and nutrition activities and Title
II-funded activities in the agriculture sector so that improvements in
agricultural productivity and income translate into better nutrition
for households, mothers, and children.
USAID has been at the forefront of efforts to increase the focus on
and coverage of children in the 6-23 month age group, and to take a
preventative rather than curative approach to undernutrition. Title II
food-assisted development programs are encouraged to provide universal
coverage of all children under 2 rather than focusing only on those who
are currently malnourished. Recent USAID-funded research in Haiti, led
by the International Food Policy Research Institute, found that this
kind of food-assisted preventative program achieved significantly
greater impacts on child malnutrition--stunting and underweight--than
recuperative programs do.
In addition to food aid resources from USAID's Food for Peace
program, USDA administers the McGovern-Dole International Food for
Education (FFE) and Child Nutrition Program. The key objectives of the
FFE program are to reduce hunger and improve literacy and primary
education, especially for girls. By providing school meals, teacher
training, and related support, FFE projects help boost school
enrollment and academic performance. The FFE program also provides
nutrition programs for pregnant women, nursing mothers, infants, and
preschool youngsters, to sustain and improve the health and learning
capacity of children before they enter school.
In fiscal 2005, the FFE program made approximately $91 million
available to provide 118,000 tons of food to 3.4 million children in 15
developing countries in Africa, Asia, Latin America, and Eastern
Europe.
4. NUTRITION IN EMERGENCIES
Children in emergency and conflict situations are especially
vulnerable to hunger. USAID supports activities for the nutritional
rehabilitation of malnourished children in these situations. A new
program direction, pioneered by USAID, Community Therapeutic Care (CTC)
in Malawi and Ethiopia, has shown greater impact in rehabilitation than
traditional Therapeutic Feeding Centers in emergency situations.
CTC is a community-based approach of care for managing large
numbers of severely malnourished children and adults at home, using
outreach teams to promote community participation and behavioral
change. CTC aims to build community capacity to manage and to better
respond to repeated cycles of relief and recovery. Providing
appropriate Ready-to-Use-Therapeutic Food (RUTF) like ``Plumpynut,''
which is similar to F-100 Therapeutic Milk, is central to the home-
based care of the severely malnourished.
USAID is focused on establishing international guidelines on the
use of CTC and ensuring their adoption through training, monitoring,
and evaluation across implementing agencies. Current programs are
exploring the possibilities for local production of RUTF in
formulations appropriate to the population. Manufacturers of Plumpynut
are enthusiastic partners with USAID in devising ways to transfer the
technology involved in the preparation of rehabilitation foods.
5. SANITATION, HYGIENE, AND NUTRITION
Extensive research has established the important link between
diarrhea, intestinal parasites, and poor nutritional status of children
under 5. To reduce nutrition losses (macro- and micronutrients) and
maximize the impact of nutrition interventions, the incidence of
diarrhea and intestinal parasites needs to be reduced through hygiene
improvement.
Hygiene improvement focuses on the behaviors that are the key
determinants of diarrhea risk, especially drinking safe water, sanitary
disposal of feces, and washing hands with good technique at appropriate
times. Each of these practices typically results in a 30-40 percent
reduction in diarrhea prevalence. Solid evidence indicates that
improvements in sanitation alone or in sanitation and water supply
together are associated with significant increases in children's
nutritional status. Data from eight countries showed sanitation
improvements were associated with a reduction in height deficit,
relative to the reference standard, ranging from 22 percent and 53
percent for urban children and from 4 percent to 37 percent for rural
children.
CONCLUSION
USAID supports the objectives of the Ending Child Hunger and
Undernutrition Initiative (ECHUI). The face of child hunger is too
stark and the needs are too great. Forging a strong alliance of
collaborators from among national governments, international agencies,
the private sector, and other sectors of civil society has been an
important part of the way USAID nutrition programs have worked in the
past and will continue to work in the future.
The five nutrition areas I have described today: 1) Reducing
micronutrient deficiencies; 2) food fortification; 3) expanding
exclusive breastfeeding and appropriate infant feeding; 4) nutrition in
emergencies; and 5) sanitation, hygiene, and nutrition, all are
stronger because of the partnerships they bring to the table. And
partnerships will be important for the challenges these areas will meet
in the future.
Vitamin A supplementation programs have significantly increased
coverage rates since they were appended to NIDS. The winding down of
NIDS programs presents a challenge in terms of sustainability of
vitamin A supplementation coverage, and new partners and platforms will
need to be identified.
Since most children in poor countries suffer from more than a
single nutrient deficiency, the ability for nutrition programs to
deliver multiple nutrients at the limited points of contact is an
imperative. USAID, together with partners, is researching the optimal
combination of vitamins and minerals for women of reproductive age and
children.
Supplementation and nutritional rehabilitation programs are only a
short-term answer to chronic malnutrition. USAID will increase its
efforts to work with other agencies and host country counterparts to
improve the food and nutrition policy, strategy, and program
development in assisted countries in order to improve equity and
improved health benefits.
Despite considerable progress in iodizing salt and preventing IDD,
large differences exist in the consumption of adequate iodized salt
among regions of the
developing world. In 33 countries, less than half of households consume
adequately iodized salt, and 37 million newborns in the developing
world are born every year unprotected from iodine deficiency and its
lifelong consequences. Progress in ensuring universal salt iodization
needs to be accelerated.
Finally, food fortification presents a cost-effective, sustainable
alternative that shares the cost with some very important partners--
consumers and the private sector.
USAID has been combating child hunger for a long time. We will
continue to do so, in step with our existing partners, and welcoming
our new partners and initiatives. The millions of children who die,
before they reach the age of 5, of hunger-related causes, and the
hundreds of millions of undernourished children who will bear the
damage from hunger and malnutrition for the rest of their lives deserve
nothing less.
Thank you.
The Chairman. Thank you very much, Mr. Kunder.
Dr. Gerberding.
STATEMENT OF DR. JULIE GERBERDING, DIRECTOR, CENTERS FOR
DISEASE CONTROL AND PREVENTION, WASHINGTON, DC
Dr. Gerberding. Good morning, Mr. Chairman. It's really a
pleasure to be here on this important topic.
I don't think, in all of the hearings that I've appeared
in, in front of Congress, that I've ever been at one that's
more important, and I don't think I've ever read testimony
that's been more filled with the kind of humanitarian work that
we really can accomplish around the world. I just wish we could
do more of it.
I'm going to start by just reminding all of us of some of
the facts that have motivated our presence here today. In the
next 24 hours around the world, 1,200 children will die of
measles, 1,600 children will die from diarrhea caused by
rotavirus, about 3,500 people will die of malaria, 5,400 from
TB, and 8,200 from AIDS, and almost all of these people will
disproportionately be children. What's tragic about that is not
just the lives of these young people being lost, but these
lives represent preventable deaths, they represent infectious
diseases, and they represent, really, the ultimate vicious
cycle of poverty, lack of safe water, poor nutrition,
preventable infectious diseases, and death. And that circle is
spiraling, as we speak, in many corners of the world.
What's remarkable is that we are doing so much, and we can
do more about it. I asked today to present to you the
perspective of the CDC, but I wanted to make very clear that we
don't do anything by ourselves; we work in solid partnership
with many of the organizations here at the table and many of
the people around the world.
Our global role is not one that's very familiar to many
people. First and foremost, we do have the job of health
protection internationally, and that's something that some
people are familiar with because of pandemic planning and SARS,
and we do have a very important role to play in protecting
people at home and abroad from those emerging infectious-
disease threats. But we also do have a very important role in
promoting health around the world. Much of what we're talking
about today falls into that category.
But I agree with my colleague that perhaps the most
important role that we play is the role of health diplomacy.
When we roll up our sleeves as scientists, and take our science
to the streets in the farthest corner of the world, we are
putting a best-possible face on America. And that is something
that, I think, all of us feel in our hearts, as organizations,
it's a value that we exemplify, and we want to do our part to
make sure that people around the world value and respect and
appreciate what our democracy and what our citizens are really
willing to do to help make the world better for everyone.
I'd like to just spend a brief minute or two talking about
some of the specifics of the programs that we've accomplished,
and also acknowledging the tremendous reliance that we have on
not just our domestic partnerships, but our international
partnerships, as we succeed. So, I'm not going to mention each
other organization. I just want you to be aware of some of the
activities that are making the biggest difference.
Let me start with this group of people here in the
photograph. This is a CDC scientist who's in the streets of
Afghanistan, in Kabul, and he is responsible for a program
that's part of something called IMMPaCt, or the International
Micronutrient Malnutrition Prevention and Control Program. This
is a set of programs that we conduct with our partners that
really help, first of all, survey the problem of
undernutrition, and, second, design very targeted programs to
solve problems. In Afghanistan, there was a particular problem
of lack of iodine in the food supply and the diseases of
thyroid and other conditions that go along with that. So,
through an iodine fortification program, we've been able to
measure that in Kabul there now is a restoration of iodine
levels, and that the program has really contributed to better
nutrition in that community.
We're working, in Kenya, in Tajikistan, for door-to-door
food distribution. You know, in countries that have problems
with HIV infection, mothers are told not to breastfeed their
babies if they're HIV-positive, because that's a way of
transmitting the virus to the baby after birth; even if they've
taken antivirals during birth, they can still transmit, after
birth, if they're breastfeeding. But that mom is in a very
difficult situation, because often she does not have clean
water, and so, she doesn't have the materials she needs to make
safe baby formula or baby food. So, either her choice is: Risk
passing the virus via breastfeeding or risk exposing her child
to deadly diarrheal diseases, which have an equal, if not
greater, short-term fatality rate. So, we are working in these
countries to improve the distribution of commercially available
infant formula, but also our safe water system, which is a very
inexpensive intervention to try to bring safe water into
people's homes through water vessels that either contain
materials that help precipitate out the impurities or chlorine
bleach to help keep the water clean.
Ambassador Tobias, from the--when he was with the
President's program for AIDS, the PEPFAR program--and I,
visited a hut in the remote area of Uganda, and we asked the
gentleman in the hut, ``What do you think about this program to
deliver you antiviral drugs?'' And he said, ``Oh, I feel great.
I'm getting much better.'' And we said, ``Well, when did you
start to feel better?'' And he said, ``Well, first they brought
me a clean water vessel, and they brought antibiotics to treat
my diarrhea, and not only did my diarrhea get better, but all
of my children's diarrhea got better, and, the first time, they
started gaining weight, and we could really see that the
nutrition in our household improved.'' That antibiotic,
incidentally, also helped with the malaria that he was
harboring, and, between that and the bed net, he and his family
have much lower risk of developing malaria, which is the
complicating factor of HIV in many of these communities. Then
the patient got treated for his tuberculosis, which was
contributing to his malnutrition, and the children were also
screened and treated. Finally, after all of that, he got
started on antiretroviral therapy for his HIV infection.
So, through a series of very inexpensive interventions, we
set the stage so that the treatment for the HIV that we were
delivering had a chance of being successful. You cannot treat
HIV in adults and children if they're undernourished. And that,
I think, is a very important component of all the work we're
doing. It's that story about how problems come together to
affect people.
But solutions can also come together, and I'm very pleased
to tell you--I think there's a picture on the next graphic--of
a situation where we have a child who was suffering from very
profound undernutrition, a starving child, and then, through a
series of interventions that are reflected here in the table
among our partnerships, this child was able to enjoy not only
food replenishment, but replenishment with the hidden nutrients
that often go unnoticed--vitamin A, folate, iron, minerals,
things that without fortification of the food supply--it
doesn't matter how many calories you put in a child, they're
not going to be well nourished, because they don't have the
trace minerals to have those nutrients do some good.
Another example of bundling occurs in the context of
malaria--excuse me--in the context of measles. Measles is a
very important focus of CDC's work and partnership
internationally, and over the last few years, because of the
programs in Africa, we've been able to cut in half the number
of children dying from measles. So, the good news is a 50
percent reduction, the bad news is there are still more than
450,000 deaths caused by measles every year. But our program
now is bundling not only the measles vaccine, but an
inexpensive bed net; a worm pill, which is another reason for
anemia and undernutrition around the world with the neglected
tropical diseases; vitamin A shots, so that the measles vaccine
will work and the child will have less risk from many other
infectious diseases; and sometimes a hug so that that child
knows that somewhere some people in the world really care about
their growth and their opportunity to become adults and
contribute to the development of their country.
The last thing I wanted to mention is more sobering, even,
than these issues related to overt malnutrition, undernutrition
in hidden hunger. That relates to the complex role that we all
play in areas like Sudan, where there are very complicated
humanitarian situations. CDC, in conjunction with the United
Nations programs there, is called upon to do the nutritional
surveys. And I recall a day not too long ago at CDC when a team
of CDC scientists were heading to Sudan to do the kind of
nutritional survey in an environment where their security was
under threat, and the amount of preparation they needed in
terms of their own personal protection, and the amount of
preparation needed in terms of their situation there, was very
sobering to me, personally. And I wasn't sure that it was right
for people to go and put their lives on the line in this way.
But when I learned about the problem, and I learned about the
value of this, I realized that it was part of our job to step
up to the plate and do this. And we thank our partners for
doing everything they do to assure our security when we're in
these regions.
But the mission was to go into that area and to determine,
of all the people there who were hungry and undernourished,
which were the people that weren't so far gone that a food
supplement could save their lives. So, we were going in to help
determine where to target the food resources that we had so
that they would do the most good. And, of course, what that
means is that some people are so hungry that even refeeding is
too late.
So, I think we feel very passionate about our international
work in this regard, and we appreciate so much your attention
and the attention of this committee in allowing us to display
for more people the importance of the work, but also the
successes that we've had.
Thank you.
[The prepared statement of Dr. Gerberding follows:]
Prepared Statement of Dr. Julie Gerberding, Director, Centers for
Disease Control and Prevention, Washington, DC
Good morning, Mr. Chairman and members of the committee. I am
pleased to be here today to discuss the work of the Centers for Disease
Control and Prevention (CDC) in combating child hunger and malnutrition
in developing countries and our collaborations with other U.S.
agencies, multilateral and bilateral health organizations, and private
partners.
Since its inception, CDC has been active in applying its technical
skills to global health priorities of the United States, from the
pivotal role the agency played in the campaign to eradicate smallpox,
to CDC's current global portfolio, which includes science-based
activities throughout the world. CDC has initiatives to directly
address nutritional status of children through its micronutrient
malnutrition program, safe water and humanitarian response activities,
and infectious disease activities that impact nutritional status. CDC
also plays a lead role in global disease detection and pandemic
influenza preparedness efforts.
CDC has strengthened its commitment to global health by recently
establishing Health Protection Goals specifically focused on helping
people around the world live healthier, safer, and longer lives through
global health promotion, health protection, and health diplomacy. In
particular, through our health diplomacy activities we work to engender
trust, maintain high ethical standards, and engage the community;
strengthen the public health workforce and leadership both within CDC
and around the world; and meet country needs through our humanitarian
responses to national disasters and efforts to address ``core'' public
health issues--including improved availability and access to safe water
and adequate food and nutrition, the focus of my testimony today.
STATISTICS ON NUTRITIONAL CONTRIBUTORS TO CHILD DEATHS AND ILLNESS
The nutritional and infectious disease contributors to child deaths
and illness are well-documented.
Each year, undernutrition contributes to the deaths of about
5.6 million children younger than 5 in the developing world,
according to UNICEF. Another 146 million children younger than
in 5 are underweight and at increased risk of early death,
illness, disability, and underachievement (UNICEF, 2006).
UNICEF reports that in the least developed countries, 42
percent of children are stunted and 36 percent are underweight.
A vitamin A deficient child faces a 23 percent greater risk
of dying from ailments such as respiratory illnesses, diarrhea,
and malaria.
Lack of sufficient folic acid intake among women of
childbearing age contributes to an estimated 200,000 babies
born with crippling birth defects throughout the world.
Iron deficiency, one of the top 10 causes of global disease
burden (World Bank), contributes to about 60,000 deaths among
women in pregnancy and childbirth, and robs 40 percent to 60
percent of the developing world's children of their
intellectual development (UNICEF/MI).
Effective and inexpensive interventions such as food fortification,
supplementation, and dietary improvements have eliminated most
micronutrient malnutrition in developed countries and could result in
similar public health improvements in developing countries. CDC, in
partnership with other global public health leaders, is putting into
practice these interventions.
CDC INTERVENTIONS TO IMPROVE NUTRITIONAL STATUS
International Micronutrient Malnutrition Prevention and Control Program
(IMMPaCt)
In 2000, CDC established the IMMPaCt Program to support the global
effort to eliminate vitamin and mineral deficiencies, or hidden hunger.
Through the IMMPaCt program, CDC provides funding and/or technical
assistance directly to countries through cooperative and interagency
agreements with UNICEF, the World Health Organization (WHO), the U.S.
Agency of International Development (USAID), the Global Alliance for
Improved Nutrition (GAIN), and the Micronutrient Initiative (MI). With
these partners, CDC has assisted countries in assessing the burden of
hidden hunger through national surveys and surveillance systems that
allow countries to monitor the coverage and impact of their food
fortification and micronutrient supplementation programs. In addition,
computer and Web-based training tools and regional and national
training workshops developed by CDC have strengthened the capacity of
countries to assess the burden of malnutrition, track the effectiveness
of interventions strategies through surveillance systems, and plan
social marketing and health communication strategies to promote the
consumption of vitamin- and mineral-fortified foods.
In 2002, in collaboration with the WHO Eastern Mediterranean
Regional Office (EMRO), CDC provided funding support and consultation
toward a national micronutrient survey to generate baseline data on
iron status of adult women and preschool children in order to monitor
the impact of the recently initiated national flour fortification
program in Jordan.
CDC also worked with the Ministry of Health (MOH) and UNICEF-
Afghanistan on establishing salt iodization activities, including
building several iodized salt-producing plants. In 2004, CDC
subsequently helped the MOH and UNICEF-Afghanistan to plan and
implement the first national nutrition survey which provided estimates
of nutritional deficiency among children, women, and men in
Afghanistan, and showed that iodine status of the Kabul population is
already substantially better since an iodized salt production factory
started operating in 2003.
Through its International Micronutrient Reference Laboratory, CDC
has collaborated with global partners to establish and support a global
network of resource laboratories around the world to help improve and
monitor the quality of national micronutrient testing.
IMMPACT MULTISECTORAL PARTNERSHIPS TO SUPPORT IMPROVED NUTRITION
Fortification of flour and food with vitamins and minerals
To help improve nutrition worldwide, the CDC IMMPaCt Program helped
launch the Flour Fortification Initiative (FFI) in 2002. The Initiative
was formalized in 2005. The FFI Leaders Group, a network of government
and international agencies, wheat and flour industries, academia, and
consumer and civic organizations, was established to promote flour
fortification. FFI supports fortification of flour with essential
vitamins and minerals, especially folic acid and iron, as one important
way to help improve the nutritional status of populations, especially
women and children, around the world.
To more directly improve dietary vitamin and mineral intakes of
infants and young children, CDC recently implemented a cooperative
agreement with UNICEF CEE/CIS to begin a multisectoral initiative to
mobilize and engage the food industries, as well as the governments and
public health sectors in countries of Eastern Europe and Central Asia,
to strengthen breastfeeding promotion programs and to fortify all
commercially produced complementary food (foods added to a child's diet
during transition from breast milk) for infants older than 6 months of
age. Experience in the United States and Canada suggests that the
impact of such a partnership between the public sector and food
industry in that region of the world is likely to be enormous.
In many Asian and African countries, commercially produced infant
foods are either not commonly used or readily accessible through
markets in remote areas. Through the IMMPaCt program, CDC is actively
planning pilot interventions in Kenya and Tajikistan to assess the
feasibility of alternative approaches to sustainable distribution,
through small local markets and house-to-house sales, of easy-to-use,
``in-home'' fortificants to enrich baby foods. These efforts will
require public-private-civic sector partnerships to be nurtured and
strengthened over time.
CDC INFECTIOUS DISEASE INTERVENTIONS THAT IMPACT NUTRITIONAL STATUS
Global immunization
Over recent decades, the experience of national immunization
programs demonstrates that immunization is one of the ``best buys'' in
public health. Rapid implementation and use of the traditional vaccines
against childhood killer diseases has been the single most important
contributor to the reduction of child mortality in developing
countries.
Prevention of vaccine preventable diseases (VPDs) has the potential
to positively impact malnutrition. Pertussis infection (whooping cough)
is associated with coughing followed by vomiting that can last several
months. This has been shown to result in poor growth and lower than
normal weight for age, along with the potential to result in
malnutrition.
Several studies suggest that children vaccinated against measles
may have improved nutritional status compared with unvaccinated
children. Fewer deaths due to diarrhea and malnutrition have also been
reported in children vaccinated against measles. Infections, including
those preventable by immunization, have been shown to lower the body's
immune defenses leading to more infections, lowered nutritional intake,
and eventual malnutrition. For example, measles infections are
associated with lowered levels of vitamin A, which increases
susceptibility to diarrhea and pneumonia. These infections result in
poor appetite, lowered food intake, and the potential for malnutrition.
Studies from one African country demonstrated a decrease in the number
of malnutrition cases that was temporally related to a mass measles
vaccination campaign that improved control of measles.
In collaboration with WHO, UNICEF, and other agencies, CDC's Global
Immunization Division has been involved in international activities to
improve immunization coverage rates for all vaccine preventable
diseases. Global routine measles coverage increased from 71 percent in
1999 to 76 percent in 2004.
Overall, global measles-related deaths decreased 48 percent from
1999 to 2004, i.e., from 871,000 people to 454,000. CDC is also a
founding member of the Measles Partnership, which from 2001 to 2005
supported 40 African countries in conducting mass measles vaccination
campaigns. An estimated 213 million African children were vaccinated,
averting 1.2 million measles-related deaths. The Partnership is also
supporting measles vaccination in WHO's Eastern Mediterranean and
Southeast Asia region, where 60 million children are to be vaccinated
in 2006. These activities have the potential to impact on malnutrition
by greatly reducing the risk of developing measles infection.
In addition to providing measles vaccine during Partnership-
supported campaigns, vitamin A, antihelminthic (deworming) medication,
and bed nets (to prevent malaria infection) were also distributed
together in a number of countries. These integrated or ``bundled''
interventions are more efficient and effective. From 2001 to 2005, more
than 43 million children received doses of vitamin A, more than 13
million received deworming medication, and 1.5 million received
insecticide-treated bed nets to prevent malaria. Plans in WHO's AFRO
region for 2006 include vaccinating 64 million children and providing
10 million children with deworming medication, 20 million with vitamin
A, and 5 million with antimalarial bed nets. Integrated delivery of
child survival interventions are also planned in countries in other
regions as well, including Indonesia.
INTESTINAL HELMINTHES (WORMS)
More than 2 billion children globally are infected by intestinal
helminthes, with 155,000 deaths reported annually. The burden of
diseases caused by intestinal helminthes infection (39 million
disability associated life years (DALYs) is higher than that caused by
measles (34 million DALYs) or malaria (36 million DALYs). Intestinal
helminthes infection affects the nutritional status of children through
intestinal bleeding, malabsorption, competition for nutrients, loss of
appetite, and diarrhea. All of these effects are reversible after
treatment. Another benefit of treatment is better digestion of the
sometimes limited food available.
Drugs for deworming treatment are highly effective, widely
available, inexpensive, easy to administer during school or general
population drug campaigns, and without serious side effects. One caveat
is that treatment must be repeated every 6-12 months because of
reinfection. CDC has provided technical support to programs addressing
neglected tropical diseases (NTD), such as intestinal helminthes, in
more than 10 countries. NTD programs provide significant public health
value at low cost, less than $1 per person per year and represent
excellent examples of public-private partnerships through the generous
donations of drugs by Merck, Glaxo-Smith-Kline, Pfizer, and Johnson &
Johnson.
Safe water
In settings with poor access to safe water and hygiene, children
can become trapped in a vicious cycle of diarrheal illness and
malnutrition. Diarrheal infections kill nearly 2 million children less
than 5 years of age annually and can cause substantial short- and long-
term morbidity among survivors. Children with diarrhea frequently lose
their appetites and can't absorb food, which can lead to nutritional
deficiencies. Similarly, malnourished children are also at higher risk
for diarrheal diseases. Poor weight and height gains have been reported
among children with heavy diarrheal burdens early in life.
Where drinking water and hygiene practices are unsafe, improving
child nutrition may not be as simple as providing food aid.
Additionally, foods prepared with unsafe water or contaminated hands
may expose children to diarrheal pathogens, causing additional illness
and further compromising child nutrition.
This problem was highlighted during an early 2006 diarrhea outbreak
in Botswana--investigated by CDC and partners, including the Ministry
of Health, U.S. Office of Foreign Disaster Assistance (OFDA), Peace
Corps, UNICEF, and Doctors Without Borders--that killed more than 530
children. HIV-infected mothers in Botswana are provided free infant
formula during their children's first year of life in an effort to
prevent mother-to-child transmission of HIV, but water used to prepare
the formula is not always safe to drink. In this outbreak, diarrhea and
acute malnutrition were more common among children who were not
breastfed. The lesson learned is that food aid is likely to be most
effective when combined with additional interventions, such as safe
water.
The Safe Water System (SWS) consists of water treatment with
dilute, locally produced sodium hypochlorite solution, safe water
storage, and behavior change techniques. The solution is typically
marketed through commercial channels at an affordable price and is
promoted locally by project partners. Through partnerships with dozens
of public, private, and nongovernmental organization (NGO) partners,
the SWS has been implemented in 23 countries. Approximately 3 million
persons per month benefit from the program.
In Kenya, a partnership including CDC, USAID, WHO, Rotary
International, Population Services International, CARE, Emory
University, the Millennium Water Alliance, the Ministry of Health, the
Ministry of Education, and several private companies, is promoting and
distributing SWS products through the private sector, women's groups,
primary schools, clinics, hospitals, and religious organizations. In
Kenya, Uganda, and Nigeria, SWS products and handwashing supplies are
distributed to HIV-infected people to help prevent opportunistic
infections, improve their nutritional status, and protect the health of
other vulnerable family members. In Afghanistan, hygiene kits,
including SWS products and soap, are provided free to pregnant mothers
as an incentive to attend antenatal clinics and to help them develop
good hygienic habits before the birth of their children.
CDC has also collaborated with Procter & Gamble (P&G) Company to
develop and field test PuR, a water treatment product that clarifies
and disinfects water. PuR has been used in internally displaced
populations in Ethiopia to prevent illness and improve nutritional
status. CDC is also currently conducting a clinical trial of a new
water treatment product produced by Occidental Chemicals in
collaboration with Medentech, Inc. CDC has collaborated with P&G on
handwashing research, including a recent study in China that documented
a decrease in primary school absenteeism in children in a handwashing
promotion program. CDC is also part of the Public Private Partnership
for Handwashing that is coordinated by the World Bank.
Safe water also contributes to preventing Guinea worm disease
(GWD), a parasitic disease that affects resource-poor communities in
remote parts of Africa that lack safe drinking water. Infection is
painful and debilitating, with serious negative economic and social
consequences, such as loss of agricultural production and reduced
school attendance. GWD is targeted for eradication, and since the mid-
1980s the incidence of the disease has declined from more than 3
million cases per year to less than 12,000 in 2005. Transmission has
been stopped in 11 of 20 countries. CDC collaborates with many partners
in the global GWD eradication efforts, including the Global 2000
program of the Carter Center, UNICEF, and WHO. Eradication efforts
include simple interventions and CDC has been instrumental in
demonstrating that cloth filters and pipe filters can protect users
from GW-contaminated drinking water, identifying barriers to early case
identification and containment, and assessing the effectiveness of
health education and messages to inform villagers about GWD. CDC plans
to continue to assist ministries of health and other partners with
monitoring and evaluation activities, provide technical assistance
concerning surveillance, case detection and containment, and to work
with WHO and the Carter Center to reduce cases in the two remaining
most highly endemic countries of Ghana and Sudan to fully eradicate
this disease.
IMPACT OF MALARIA INTERVENTION ON CHILD NUTRITION
CDC also contributes to improved child nutrition through its
malaria prevention and control program. It is generally accepted that
poor nutrition may lead to increased susceptibility to infectious
diseases such as malaria along with immune and metabolic system
dysfunction that can then further impair nutritional status. Study
findings include these: 1) Over time, infections such as malaria may
impair growth in young children; 2) Anemia is a common result of both
nutritional deficiency and malaria and in areas of intense malaria
transmission, where children experience repeated and chronic malaria
infection, this nutritional/malarial anemia is likely to resemble iron
deficiency anemia and may require iron therapy along with antimalarial
treatment; 3) Persistent malaria may induce iron deficiency through one
or more mechanisms, including decreased iron absorption, enhanced iron
loss during an acute malarial episode, or making iron unavailable in
the body for red blood cell production; 4) Malaria-associated low birth
weight is a risk factor for increased neonatal and infant mortality;
and 5) Prevention of malaria and associated anemia through control
strategies such as insecticide-treated nets (ITNs) may help to improve
infant growth and weight gain.
CDC is actively involved in malaria research that may impact on
overall nutritional status of children. For example, CDC has measured
the impact of specific treatments and assessed the optimal frequency of
iron supplementation to address the anemia associated with malaria. In
other work, CDC has documented the beneficial positive impact of
insecticide-treated nets (ITNs) on anemia and growth in
infants; assessed the impact of ITNs on growth, nutritional status, and
body composition of primary school children; and is conducting an
ongoing study of IPT with different antimalarial regimens plus iron
supplementation in infancy to assess impact on malaria, anemia, and
growth. In addition, the synergy and heightened health benefit of
deworming and malaria interventions such as bed nets helps address the
combined anemia caused by malaria and intestinal worms (especially
hookworm).
President's Malaria Initiative activities
CDC is working to control malaria and its deleterious effects on
child survival, morbidity, and nutritional status through participation
in the President's Malaria Initiative (PMI), an intergovernmental
initiative led by USAID, as well as HHS/CDC, HHS/National Institutes of
Health (NIH), the U.S. Department of State, the U.S. Department of
Defense, and the White House. When PMI was launched in the summer of
2005, President Bush pledged to increase funding of malaria prevention
and treatment in sub-Saharan Africa by more than $1.2 billion over 5
years.
The goal of the President's Malaria Initiative is to reduce malaria
deaths by half in each target country after 3 years of full
implementation. The initiative helps national governments deliver
proven, effective interventions--insecticide-treated bednets (ITNs),
indoor residual spraying, prompt and effective treatment with
artemisinin-based combination therapies (ACTs), and intermittent
preventive treatment for pregnant women--to a majority (85 percent of
people at greatest risk--pregnant women and children less than 5 years
old).
Work is ongoing in Angola, Tanzania, and Uganda. In 2007, PMI will
target four additional African countries: Malawi, Mozambique, Rwanda,
and Senegal. In 2008, eight more countries will be added. The
initiative will eventually be implemented in 15 African countries most
affected by malaria.
HIV/AIDS
HIV/AIDS and malnutrition are both highly prevalent in many parts
of the world, especially in sub-Saharan Africa. There are well-
established links between HIV/AIDS and poor nutrition and food
insecurity. HIV, which causes weight loss and wasting, specifically
affects nutritional status by increasing energy requirements, reducing
food intake, and adversely affecting nutrient absorption and
metabolism.
PEPFAR recognizes that nutrition is important for people living
with HIV/AIDS (including pregnant women) and HIV-exposed children.
Within PEPFAR, CDC is helping to support efforts to provide appropriate
nutritional support and to create links with broader nutrition
programs.
Infants born to HIV-positive mothers (``HIV-exposed children''
including both infected and uninfected children) are at a substantially
higher risk of low birth weight, early malnutrition, and mortality in
the first 2 years of life than children born to mothers without HIV.
The risks are greatest for infants of mothers with more advanced
disease (Kuhn et al., 2005). These HIV-exposed infants are the major
focus of the prevention of mother-to-child HIV transmission (PMTCT) and
orphans and other vulnerable children (OVC) programs. Successful
outcomes for these children depend on early detection, strong
counseling, antiretroviral (ARV) provision, safe infant feeding and
follow-up and support system for the infant/mother pairs. Growth,
nutritional status and survival of HIV-infected children are also
improved by prophylactic cotrimoxazole, ARV therapy, and prevention and
treatment of opportunistic infections, while improved dietary intake
improves weight gain, growth, and recovery from opportunistic
infections and decreases risk of mortality. PMTCT programs target both
the HIV-positive pregnant women (and mothers) and their infants and
young children with these interventions.
The prevention of mother-to-child HIV transmission programs
encourage and support safe infant feeding. In settings where
breastfeeding is common and prolonged, transmission through breast milk
may account for up to half of the HIV infections in infants and young
children. The overall risk of mother-to-child HIV transmission (MTCT)
in nonbreastfeeding populations is 15-25 percent (without interventions
to reduce transmission) and in breastfeeding populations 20-45 percent.
To reduce the risk of HIV transmission, HIV-positive mothers are
advised to avoid breastfeeding and use replacement feeding when it is
acceptable, feasible, affordable, sustainable, and safe to do so.
Otherwise, exclusive breastfeeding for the first months of life is
recommended, followed by early breastfeeding cessation when conditions
for safe replacement feeding can be met. Available ARV prophylaxis
interventions can substantially reduce MTCT during pregnancy, labor,
and delivery but, so far, significant reduction of postnatal mother-to-
child HIV transmission has been less successful.
Safe infant feeding is still a major challenge. In resource-limited
settings, where large numbers of HIV-infected women and their infants
benefit from PMTCT programs, safe feeding of infants without breast
milk is difficult. Many women have inadequate access to clean water,
infant formula, and other safe, nutritionally complete products for
infants. Many mothers and health providers are unaware of the food
requirements of infants who do not receive breast milk, because
children in these countries have historically been breastfed for up to
2 years. Because of these issues, some infants born to HIV-infected
mothers receive inadequate nutrition as a result of efforts to prevent
HIV. Several research projects are currently underway to assess the
impact of HIV prevention programs on child survival overall and to
determine the best way to feed infants of HIV-positive women in
resource-limited settings.
CDC RESPONDS TO COMPLEX HUMANITARIAN EMERGENCIES
Through its International Emergency and Refugee Health program, CDC
works to document the nutritional status and needs of children in
complex humanitarian emergencies, food crises, and famines, and uses
the results to target the most vulnerable populations and improve
relief efforts.
Recent surveys have been conducted in Darfur, Sudan, Niger, Chad,
and tsunami affected areas of Indonesia. In addition, CDC provides
technical assistance to U.N. agencies and OFDA in response to
nutritional crises, such as the food crisis in Ethiopia in 2003, to
assess the magnitude of the problem and prioritize intervention
strategies and the Southern Africa crisis in 2003 where CDC assisted
UNICEF in reviewing all survey data from the region.
CDC supports innovative research to enhance field practice with the
goal of reducing morbidity and mortality. Examples include
investigating feasible interventions and programs to reduce
micronutrient malnutrition in food aid dependent populations and the
evaluation of new approaches to the treatment of severe malnutrition.
In addition, CDC has helped develop guidelines, manuals, and tools for
measuring nutritional status for both WFP and UNICEF. CDC has conducted
many trainings on improved practices for field level and country level
staff to strengthen overall capacity and enhance the competency of
international agencies.
CDC activities in Darfur are illustrative. Beginning in 2004, CDC
and partners conducted a series of nutrition surveys to determine the
extent of acute malnutrition among children living in conflict-affected
areas of Darfur. The most recent survey, completed on September 21,
2006, covered the entire 3.8 million persons currently affected by the
crisis. These surveys have assisted the United Nations in monitoring
the coverage and impact of their interventions over time, as well as
providing valuable data for planning humanitarian assistance for 2004
through 2007.
Another example is CDC's response to the food crisis in the West
African country of Niger. In 2005, an estimated 2.5 million people were
potentially at risk due to food insecurity. CDC conducted a series of
eight regional nutrition surveys in collaboration with UNICEF during
the crisis to document the extent and severity of the problem. The
results of the survey were used to improve the general food
distributions in the areas with the highest levels of malnutrition and
leverage funding from donor agencies.
CDC's involvement in fighting malnutrition in complex humanitarian
emergencies has a broad impact on the health of vulnerable children.
The surveys and assessments conducted by CDC have raised awareness to
the magnitude and severity of nutritional emergencies in crisis-
affected populations around the world and helped focus limited
resources on the most vulnerable.
CDC is committed to continuing to work with U.N. agencies and NGOs
to implement best nutritional practices in emergency settings and to
document the burden of malnutrition in emergency settings. CDC supports
international collaboration to improve training for U.N.,
international, and local aid staff. With our partners, we are working
to strengthen the capacity of agencies and staff in order to
effectively and efficiently implement nutrition programs.
CONCLUSION
CDC's unique contributions to addressing child hunger and
malnutrition around the world are through the scientific and technical
expertise we bring to partnerships for vitamin supplementation, food
fortification, and data collection activities of the IMMPaCt and
related programs, and the proven and effective interventions that
prevent and control the infectious diseases that lead to malnutrition
and are the major causes of deaths and illness in children in
developing countries. CDC also responds to the nutrition and health
needs of vulnerable populations who are affected by conflict, natural
disasters, and famine.
Collaboration with other Federal agencies is key to developing
strong multilateral, bilateral, and private partnerships around the
world.
CDC is committed to continuing to address these ``core'' public
health issues--including improved availability and access to safe water
and adequate food and nutrition.
Thank you for the opportunity to testify. I would be happy to
answer any questions you may have.
The Chairman. Well, thank you very much, Dr. Gerberding.
Mr. Ward, would you please proceed.
STATEMENT OF HON. GEORGE WARD, SENIOR VICE PRESIDENT FOR
INTERNATIONAL PROGRAMS, WORLD VISION, WASHINGTON, DC
Ambassador Ward. Mr. Chairman, thank you for holding this
important hearing on child hunger.
As the senior vice president for international programs at
World Vision, it's a privilege to be here with such a
distinguished panel.
World Vision is a Christian relief and development
organization dedicated to helping children and their
communities worldwide reach their full potential by tackling
the causes of poverty. We operate in nearly 100 countries. More
than 3 million donors and supporters, from every congressional
district, partner with us in fighting global poverty.
I'm also, today, representing the Alliance for Food Aid,
which is comprised of 15 private voluntary organizations and
co-ops that conduct international food programs.
Mr. Chairman, it's a great tragedy that there are 400
million hungry children in the world today. About one-third of
these children are under age 5 and underweight. Poor nutrition
during critical growth phases results in poor cognitive and
physical development. It's all the more tragic that the world
has the know-how to solve this problem, and yet has not done
so.
The solution does not require any new inventions, but it
does require focused attention. Child hunger can be solved one
child, one household, and one community at a time by empowering
caregivers with the necessary tools and resources.
One of the strengths that private voluntary organizations
like World Vision bring to the fight against child hunger is
that we are community-based. World Vision makes long-term 15-
year commitments to communities through our area development
programs. These programs integrate funding from public and
private sectors to produce targeted interventions in five main
areas: Clean water, food/nutrition, education, health, and job
creation. ``Integrated'' and ``long-term programming'' are the
watchwords for success.
Charities also provide an opportunity for private donors to
make a real, tangible difference in children's lives. For
example, in 2005 nearly 2.6 million children worldwide
benefited from World Vision child sponsorship programs, with
812,000 of these children supported by American donors.
USAID, through P.L. 480, Title II, funds many maternal
health and nutrition programs aimed at reducing childhood
malnutrition. Infants and young children in their first few
years of life require special foods with adequate nutrition
density, consistency, and texture. This is why a number of
Title II programs include wheat-soy or corn-soy blends that are
fortified with vitamins and minerals. World Vision operates
such programs in Haiti, Indonesia, Mozambique, Rwanda, Uganda,
and Zambia.
We note with concern that because of reduced funding for
development food aid programs, the level and coverage of Title
II maternal child health and nutrition programs are being cut.
The Alliance for Food Aid urges the continued and expanded use
of Title II food aid for these tested and successful programs.
UNICEF and the World Food Program have done an excellent
job in working together to create the new global initiative for
Ending Child Hunger and Undernutrition. This is a collaborative
public/private partnership that seeks resources to achieve
results. World Vision supports this initiative, which
recognizes that good nutrition and health go hand-in-hand.
Each year, 5-6 million children die each year from
infections that would not have killed them if they had proper
nutrition. Over 50 percent of all deaths of young children due
to infectious diseases, such as malaria, pneumonia, diarrhea,
and measles, have malnutrition as an underlying cause.
Mr. Chairman, I know you and other members of this
committee have been strong supporters of both international and
domestic child hunger programs. All of these programs are
important, and we thank you for your leadership.
On the international front, only people who are healthy and
educated can achieve peace and security. The journey to this
goal begins with proper child nutrition. We need congressional
leadership and support to ensure that these critical
international programs are funded and expanded.
Mr. Chairman, there are many difficult problems in this
world today that we do not know how to solve. Child hunger is
not one of them. It is my hope and prayer that, by working
together, we can rededicate ourselves to providing tangible
help many children need.
This concludes my testimony, Mr. Chairman. I'll be happy to
answer any of your questions.
[The prepared statement of Ambassador Ward follows:]
Prepared Statement of Hon. George Ward, Senior Vice President for
International Programs, World Vision, Washington, DC
Mr. Chairman, thank you for holding this critical hearing on child
hunger and malnutrition. It is a privilege to be here with such a
distinguished panel. My name is George Ward and I am the senior vice-
president for international programs at World Vision.
World Vision is a Christian relief and development organization
dedicated to helping children and their communities worldwide reach
their full potential by tackling the causes of poverty. We operate in
nearly 100 counties with 23,000 employees. World Vision has over 3
million private donors and supporters from every congressional district
within the United States who partner with us in fighting global
poverty.
I am also representing the Alliance for Food Aid, which is
comprised of 15 private voluntary organizations and co-ops that conduct
international food aid programs.\1\ The Adventist Development and
Relief Agency currently chairs the Alliance for Food Aid, and the
Alliance's executive director is Ellen Levinson.
---------------------------------------------------------------------------
\1\ Members of the Alliance for Food Aid include: Adventist
Development and Relief Agency International, ACDI/VOCA, Africare,
American Red Cross, Counterpart International, Food for the Hungry
International, Joint Aid Management, International Orthodox Christian
Charities, International Relief and Development, Land O'Lakes, OIC
International, Partnership for Development, Project Concern, United
Methodist Committee on Relief, and World Vision.
---------------------------------------------------------------------------
PVO CONTRIBUTIONS
Mr. Chairman, it is a great tragedy that there are 400 million
hungry children in the world today. About one-third of these children
are under the age of 5 and underweight. Poor nutrition during critical
growth phases results in poor physical and cognitive development.
It is all the more tragic that the world has the know-how to solve
the problem of child hunger and malnutrition and yet has not done so.
The solution does not require any new invention, but it does require
focused attention. Child hunger can be solved one child, one household,
and one community at a time. This solution requires empowering
children's caregivers with the necessary tools and resources. Clearly,
there is much work to be done.
One of the strengths that private voluntary organizations like
World Vision bring to the fight against child hunger is that we are
community based. World Vision makes long-term, 15-year commitments to
communities through our ``Area Development Programs.'' These programs
integrate funding from public and private sectors to produce targeted
interventions in five main areas: Clean water, food/nutrition,
education, health, and job creation.
Immunization, health screening and care, education, and adequate
nutrition are critical for ensuring the health and growth of young
children. Delivery of these services depends on the development of the
community as a whole. Private voluntary organizations therefore use a
combination of child services and community capacity-building
techniques to support the health and nutrition of the child. Integrated
and long-term programming are the watchwords for success.
Charities also provide an opportunity for private donors to make a
real tangible difference in children's lives. For example, in 2005,
nearly 2.6 million children benefited from World Vision child
sponsorship programs, with 812,000 of these children supported by U.S.
donors.
USAID FOOD AID PROGRAMS
Through P.L. 480, Title II, United States Agency for International
Development funds many Maternal Child Health and Nutrition programs
aimed at reducing childhood malnutrition by providing food aid for
children. Programs include supplemental food; monitoring the weight,
height, and health of the children; immunization, oral rehydration, and
other health interventions; clean water; and training mothers about
proper sanitation, nutrition, and managing health problems, such as the
commonly found respiratory and diarrheal diseases.
Infants and young children in their first 2 years of life require
special foods of adequate nutrient density, consistency, and texture.
In resource-constrained populations, children are at high risk of
suffering from micronutrient and protein deficiencies. This is why a
number of Title II Maternal Child Health programs include wheat-soy
blend or corn-soy blend that are fortified with vitamins and minerals,
including vitamin A, iron, and zinc. World Vision operates such
programs in Haiti, Indonesia, Mozambique, Rwanda, Uganda, and Zambia.
Maternal Child Health and Nutrition programs have been a great
success. Positive results are evidenced by reduced stunting and
improved weight and height among children. While children's health and
nutrition are improved, the broader community also benefits from the
educational and capacity-building components of the program.
We note with concern that because of reduced funding for
developmental food aid programs, the level and coverage of Title II
Maternal Child Health and Nutrition programs are shrinking. We urge the
committee to support continued and expanded use of Title II food aid
for these tested and successful programs.
ENDING CHILD HUNGER AND UNDERNUTRITION INITIATIVE
UNICEF and the World Food Program have done an excellent job in
working together to create the new global initiative for ``Ending Child
Hunger and Undernutrition.'' This is a collaborative public-private
partnership that seeks resources to achieve results. World Vision
supports it. The initiative also provides a tangible focus for
governments and private institutions to rally around to ensure the
first Millennium Development Goal of reducing hunger by 50 percent is
reached by 2015.
This initiative recognizes that good nutrition and health go hand-
in-hand. Many medical interventions for children can be successful only
with adequate nutrition. For example, 5-6 million children die each
year from infections that would not have killed them if they had proper
nutrition. Over 50 percent of all deaths of young children due to
infectious diseases--such as malaria, pneumonia, diarrhea, and
measles--have malnutrition as an underlying cause.
The ``essential package'' developed by this initiative will
drastically improve the nutrition and health of children. It includes:
Health and nutrition education; supplemental food; micronutrients;
household water treatment; hand-washing with soap; and deworming.
U.S. GOVERNMENT POLICY
Mr. Chairman, I know you and other members of this committee have
been strong supporters of both international and domestic child hunger
programs. While not under the jurisdiction of this committee, I think
it is critical to note the importance of the National School Lunch, and
Women, Infants, and Children supplemental feeding programs in fighting
child hunger in the United States.
On the international front, only people who are healthy and
educated can achieve peace and security. The journey to this goal
begins with proper child nutrition. We therefore thank you for your
continued support of the hunger-focused international food aid programs
like P.L. 480 and McGovern-Dole Food for Education program. These
initiatives are making a life-saving difference to millions of people
around the world. However, the emergency demands on the P.L. 480 Title
II resources have increasingly left little room for development
programs such as Maternal-Child Health and Nutrition. We need
congressional leadership and support to ensure that these critical
programs are funded and expanded.
Mr. Chairman, there are many difficult problems in this world today
that we do not know how to solve. Child hunger is not one of them. It
is my hope and prayer that by working together, we can rededicate
ourselves to providing the tangible help many children need.
This concludes my testimony, Mr. Chairman. I would be happy to
answer any of the committee's questions.
The Chairman. Well, thank you very much, Mr. Ward.
As I introduce the next speaker, Mr. Jim Morris, of the
World Food Program, I would just simply add, as many of you
know, that we have been good friends and workers together for
40 years, and I appreciate, especially, his being here this
morning as he concludes a remarkable tenure with the World Food
Program. His travels have been described in previous hearings
of our committee, and I know that he will be equally forceful
today. It's a very great pleasure and honor to have my friend
Jim Morris.
And would you please proceed.
STATEMENT OF JAMES T. MORRIS, EXECUTIVE DIRECTOR, UNITED
NATIONS WORLD FOOD PROGRAM, NEW YORK, NY
Mr. Morris. Thank you, Mr. Chairman. I appreciate your
comments. And there would be no way I could express my
appreciation for you.
Your opening statement reflected characteristic insight and
concern and commitment and passion for great humanitarian
issues around the world. And we're grateful for that.
If I might just open by saying that the international
humanitarian community is deeply, profoundly grateful to the
United States of America for the extraordinary generosity and
concern for people at risk around the world. The United States
helps us with enormous amounts of cash, brainpower, technical
capacity, and does it in a nice way, in a caring way. And I
worked for a man by the name of Eli Lilly for a number of
years, and he always said, ``If you're going to do something
nice for someone, do it in a nice way.'' And the United States
extends its concern and generosity in the nicest way possible.
Our partnership with USAID, with the Department of
Agriculture, the Department of State, the Department of Labor
is extraordinary. The historic contribution of our country
through Food for Peace, feeding more than 6 billion people
around the world, 135 countries over 50 years, the contribution
of the Peace Corps, the remarkable contribution, really, that
Julie mentioned, of PEPFAR, and the role of the land-grant
college system in the United States in educating much of the
agricultural leadership around the world, is extraordinary. And
I'm grateful for that.
The past 5 years have been a life-changing, life-affirming
experience for me. I've spent as much time as humanly possible
in the field. And I come from a fairly comfortable existence in
the United States. And I must say, the faces of children around
the world who are hungry and at risk, and are suffering, and
their mothers--often, their mothers, maybe age 25, look like
they're 75. The burden is extraordinary. The unfairness of life
for so many children who find themselves in these difficult
circumstances, not of their own making, to visit a child in a
hospice, and to have the nurse say, ``This child is infected
with HIV,'' and, ``Give the little girl a hug, because she
won't be here next week,'' or to visit a little girl in
Zimbabwe--small little girl, but she's 15 years of age, and her
mom and dad are gone, because of HIV, and suddenly she finds
herself mother and father, protector, caregiver for five or six
brothers and sisters, she's never had a childhood, she never
will, and she's completely compromised and completely
unprepared for what she faces.
If these issues, circumstances, affected a few children, it
would be sad, but these circumstances affect hundreds of
millions of children around the world. You know, more than half
the children under 5 years of age in Guatemala are chronically
malnourished. And if you go into the indigenous populations,
the numbers approach 70 or 80 percent. You go to North Korea,
and you see extraordinarily different standards between
children in South Korea and North Korea, all related to
nutrition.
And, in my judgment, the life of a child in Washington, DC,
in London or Indianapolis, the life of the child in Malawi or
Honduras or Bangladesh, the value of the child's life is the
same. And when the child is compromised, circumstances not of
their own making, the rest of the world must step in and help
to provide the physical requirements of the child. But, as
Julie said, you know, a child needs the arm of a caring adult.
And that is so important.
WFP and UNICEF have been working now for a couple of years
with our partners in the NGO community, with national
governments, with others in the U.N. to see if we could build a
movement, a partnership in the world that would say it's no
longer acceptable for children in the world in 2006 to be
hungry, it's unacceptable, it's sad, it's sinful, it's
reprehensible. And, as we've all said, it's a solvable problem.
We know how to do this. We know what it costs. We know what the
approaches are that will be effective. And we know how to build
the partnerships to get it done. This is an effort that
requires champions, political leadership, resources, and
commitment. And when the world understands the seriousness of
the issue and the solutions that are available to address the
issues, the world wants to respond. If there's one thing that
heads of state and heads of government all around the world
agree on, it's that women and children should not be at risk,
should not be vulnerable, should not starve. Eighteen thousand
children will die today of hunger, one every 5 seconds, all day
long. Four hundred million hungry children in the world, 146
million of them under the age of 5 years. We are talking about
a short-term approach to saving lives. Clearly, the longer-term
situation that Jim talked about, requiring agricultural
investment and more capacity to produce food around the world,
is really important. But there is a sense of urgency to look at
this in the short term, because so many children's lives are at
risk.
And, as you said in your opening statement, this is about
more than food; it's about health, it's about sanitation, it's
about water, it's about all sorts of things. We know, when we
make an investment in nutrition, it reduces poverty, it
improves educational outcomes, it produces productivity, either
by the individual life or by the country.
Our commitment is to find a way to double the rate of
reduction of underweight children under the age of 5 years from
about 1.7 percent to something approaching 2.6 percent. We know
how to approach these issues in a predictable way, a
preventable way, and a way that is affordable. China, Chile,
Thailand are tremendous examples where thoughtful approaches to
these issues have produced extraordinary results. And I must
say, Mr. Chairman, when you visit with people in Japan or
Germany, they talk about the role the United States played in
their country after World War II, in terms of providing food
for children, the impact that had on bringing their educational
systems alive. You know, I've talked to political leaders,
ministers, members of parliament in both countries, and their
emotional appreciation and resonance with what our country did
to feed their children after the war, they would say that this
made as much difference in the success, the prosperity of those
places, than anything that ever happened.
Our approach is to find a way to locate where the most
vulnerable children are. It's interesting that the 400 million
vulnerable children essentially live in 100 million households.
Three-fourths of the hungry children in the world are in 10
countries. Half the underweight children in Africa live in just
10 percent of the administrative districts. The opportunity to
approach this in a fairly narrow geographic situation, where
the concentration of children at risk is located, makes the
opportunity to address this easier. To work with national
governments--as Jim pointed out, is important, as is working
with community-based institutions. There are remarkable people
in every country of the world that spend their life focused on
the well-being of children. Just as we have community-based
organizations in our cities, coaches and YMCAs and Girl Scouts,
these same kinds of people exist around the world, and they
simply need help. We need to work with national governments, to
work with community-based institutions, and then to provide the
essential package of services that, first, deal with health,
hygiene, nutrition education. Julie also mentioned this issue
of micronutrients, parasite reduction, the importance of
sanitation in the household, and safe water. Handwashing with
soap makes all the difference in the world. So, a fairly
specific geographic approach with the provision of an essential
package of services.
We believe that the cost of addressing this is about $80
per annum per household--if you're looking at 100 million
households in the world over time, an annual cost of about $8
billion. And our research would tell you that we have the
infrastructure in place to address about a billion dollars of
opportunity immediately.
To find a way to build a movement that includes NGOs, donor
governments, host governments, the business community, we have
a partnership with a remarkable company, TNT, in the
Netherlands, 170,000 employees. Every one of their employees
has committed to feed a school child, and the company has
agreed to match it. We have a remarkable partnership with
Citigroup, in the U.S.--the same kind of commitment to
humanitarian issues.
Service clubs can also make a difference. What Rotary has
done in the last 25 years, working with CDC and with UNICEF and
many more, to virtually provide the leadership to eradicate
polio in the world, they've immunized almost 2 billion children
in the world over the last 25 years. It is extraordinary the
leadership that Rotary has provided for this issue, and the
success that's been made possible.
I'm optimistic that Rotary now, with Kiwanis and others,
may be willing to focus on the issue of eliminating child
hunger. The same goes for the faith-based organizations, youth-
serving organizations. I spent last week, one day, down at
Auburn University, and Auburn is spearheading an effort to
engage not only the American Land Grant University System, but
also colleges, across the United States in the issue of
eliminating child hunger. They gave me a check to feed 600 kids
for a year. I gave the commencement address at Georgetown
College in Kentucky last year. They gave a check to feed 1,400
children for a full year.
Somehow, there's an opportunity for everyone to be engaged
in this issue, for everyone to do just a little more. So little
goes so far in the issues that we are trying to address.
So, Mr. Chairman, that gives me the opportunity to talk
about the magnitude of the issue, the importance of the issue.
You know, I prefer that people look at this from a humanitarian
point of view, but--the economic perspective, the political
perspective, are also quite important--but, the fact of the
matter is, if millions of people are at risk around the world,
especially children, we're all at risk. And, you know, we're
all diminished if anyone's diminished. And it simply is not
acceptable today for so many children to perish every day, to
have their lives compromised from the very beginning, when the
resources and the technology and the willpower and the goodwill
are available to make a difference.
And so, my hope is that, over time, this extraordinary
movement, worldwide, will come together and find a way for
everyone to participate. And, at the end of the day, you know,
none of us ever feel as good about ourselves as when we're
doing something for someone else, especially a child, and that
opportunity is before us.
Thank you.
[The prepared statement of Mr. Morris follows:]
Prepared Statement of James T. Morris, Executive Director, United
Nations World Food Program, New York, NY
Good morning Mr. Chairman, distinguished representatives, ladies
and gentlemen. Thank you Mr. Chairman.
Few experiences have changed my life more than holding an acutely
malnourished child in my arms, as I did on a recent visit to Kenya. To
hold in my arms a 1-year-old girl who weighs little more than an
average newborn in the United States unleashes a tide of emotions. One
can't help but feel grief for this child's pain; shame that this should
be allowed to happen in the 21st century; anger that this child will
not be the last to suffer this fate.
In fact, 18,000 children will not make it through today. Their tiny
bodies will succumb to months and years of not getting the nutrition
they needed to survive. Millions more will have their growth stunted
forever, their minds dulled by malnutrition, and their futures limited
to a life of poverty and ignorance.
The OECD reports that international aid was higher in 2005 than in
any year in history. Industrialized countries gave US $107 billion in
foreign aid. Despite last year's record levels, funding for global
child health efforts have not increased significantly in the past 10
years and investments in agricultural research have declined.
CHALLENGE
Often we think about these sectors as if they are unconnected. But
while resources may flow through different channels, they serve the
same people, the same communities, and the same children. We must do
more to ensure that our investments in the agriculture, health, and
education arenas are working together on the same outcomes.
With a depressing regularity, we see the same communities that are
hit by drought struggling with poverty, child malnutrition, and HIV/
AIDS. In pockets--sometimes large, sometimes small--there are children
who have been battling hunger their whole lives. Hunger and related
diseases cause between 5 and 6 million deaths per year. The damage
caused by malnutrition is not just death--it affects just about every
stage and aspect of life.
The vast majority of the children who will die today from hunger
and related causes won't perish in a high-profile emergency. They'll
pass, unnoticed by anyone other than their families and neighbors, in
squalid slums or in remote dusty villages.
We are simply not doing enough for these children. In many cases,
we are not even reaching them, much less giving them a foothold on the
bottom rung of the ladder of development. The evidence is clear:
Investment in nutrition reduces poverty, increases educational
outcomes, and boosts productivity throughout the life cycle and across
generations.
RESPONSE
That's why WFP and UNICEF are working more closely than ever with
the widest possible group of partners to fight hunger. Our goal is
nothing less than to end child hunger and severe undernutrition within
a generation.
For a start, we are working to achieve the hunger target of the
first Millennium Development Goal (target 2). We will focus on
supporting country efforts to double the current annual reduction rates
of underweight children under 5. The causes of child hunger are
predictable, preventable, and can be addressed through affordable
means. Combined with improved research and technology, this once
idealistic notion of ending child hunger is now operationally feasible.
EVIDENCE
To be sure, there are long and short routes to improving nutrition.
Higher incomes and better food security improve nutrition in the long-
term. But malnutrition is not simply the result of food insecurity.
Many children in food-secure environments are underweight or stunted
because of infant feeding and care practices, poor access to health
services, or poor sanitation.
We have concrete historical examples of what strategies have worked
in places like post-war Europe and Japan, and in developing countries
like Chile, Thailand, and China, where hunger among children has been
dramatically reduced.
For example, improving the nutrition of pregnant women directly
contributes to child health. Good nutritional status also slows the
onset of AIDS in HIV-positive individuals. It increases malaria
survival rates and lowers the risk of diet-related chronic disease.
The highly concentrated nature of undernourished children in
countries makes it possible to target and support national and
community efforts. There are roughly 400 million hungry children in the
world today--with an estimated 146 million of them under the age of 5.
These children live in approximately 100 million households. In Africa,
over half of the underweight children live in just 10 percent of the
administrative districts.
We are proposing a set of urgent actions to address the needs of
children at most immediate risk of death or lifelong disability from
hunger:
First, that we locate the most seriously undernourished
children and the communities in which they live;
Second, that we identify and support local organizations to
reach them with essential interventions; and
Third, that we leverage complementary interventions, such as
childhood immunization, education, and food security efforts,
to the same underserved areas.
A significant part of our effort will be promoting an ``essential
package'' of health and nutrition interventions that can impact the
immediate causes of hunger. It includes the basic health, hygiene, and
nutrition practices we use daily, together with a set of life-saving
commodities--micronutrients, household water treatment, hand-washing
with soap, parasite control measures, and situation-specific household
food security interventions.
The annual household cost of these lifesaving interventions is
roughly USD $80. In many cases we have seen that even the poorest
households are prepared to reallocate their own sparse resources when
these key commodities are available for purchase. In other cases, some
component of community, national, or international assistance will be
required.
Over time, the total cost--with an increasing share provided by
national governments--to assist 100 million families to protect their
children from hunger and undernutrition is estimated at roughly $8
billion dollars per year. Of this amount, it is estimated that
approximately $1 billion dollars of new international resources could
be effectively programmed immediately. This investment can change
lives--even generations. And the costs of action are but a tiny
fraction of what we will shoulder by doing business as usual.
PARTNERSHIPS SECTION
An effort of this magnitude can only be undertaken by a strong
partnership with solid partners.
It will require the continued engagement of the United States
Centers for Disease Control and their unique capacities to strengthen
the surveillance systems and technical networks required to find and
more effectively target and evaluate antihunger interventions.
It will require continued leadership from the United States Agency
for International Development and the further engagement of its
technical contractors, uniquely placed to support the adaptation of
technical strategies to scale in a wide range of settings.
This effort will require expanded partnerships and strengthened
technical capacities among the larger international NGOs, the
community-based support networks, and the families in the most affected
areas.
It will require increased leadership and partnership with the
private sector, following the stellar examples of those companies that
have already joined this effort: Contributing their know-how in
marketing, logistics, and health communications--and their R and D
capacities developing new ways to deliver micronutrients, fortify food,
and make household water safe to drink.
In the long-term, it will require the success of agriculture and
education efforts like the ``Education for All Initiative'' and the new
partnership between the Rockefeller and Gates Foundation to launch a
green revolution in Africa and dramatically improve soil fertility and
increase the productivity of small farms.
No one organization or sector can do it all. Together we can
provide a framework that clearly identifies the opportunities,
eliminates some of the obstacles, and clears some of the smoke and
mirrors of who does what.
I can appreciate this might appear to some to be a daunting task,
but no more daunting than the task of polio eradication must have
appeared 25 years ago. The partnership that formed then and has grown
and succeeded throughout the world has now very nearly reached its
goal. It is a living reminder to us of what happens to so-called
``impossible feats'' when confronted with the steady and focused
efforts of committed individuals and institutions.
The choice that societies and communities have before them is
whether to act now to end child hunger and undernutrition in this
generation, or to wait for improvements in income and education to have
an eventual--long-term impact on child growth.
Because children are only children in the short-term, this
initiative is focused on their immediate needs. Growing minds and
bodies require daily nourishment, healthy care practices, and sanitary
living conditions.
We know what needs to be done if we are to meet the Millennium
Development Goals and provide the basic necessities not only for a life
of dignity and health, but also to make an economy work.
Mr. Chairman, distinguished committee members, thank you for the
opportunity to address you today on this most important issue.
The Chairman. Well, thank you very much, Mr. Morris.
And now, it's a real privilege to have Ann Veneman at this
table. In a part of my legislative life, I was chairman of the
Agriculture Committee for over 6 years and Ann Veneman was the
distinguished Secretary of Agriculture who brought such
leadership not only to our farm programs, our nutrition
programs, and our conservation programs in rural America. It's
wonderful that you are now serving the United Nations
Children's Fund.
We're delighted to have you, today, Ann. Would you please
proceed.
STATEMENT OF HON. ANN VENEMAN, EXECUTIVE DIRECTOR, UNITED
NATIONS CHILDREN'S FUND, NEW YORK, NY
Ms. Veneman. Thank you so much, Mr. Chairman. And it is my
privilege and opportunity to be before you, once again, in the
United States Senate.
It is also my privilege to be here with such a
distinguished panel. And I particularly want to add my words of
appreciation for my friend, Jim Morris. He--as you know, I've
worked with him both at USDA and now in my current position,
and I can tell you he is an extraordinary person who is doing
extraordinary work, and deserves a great deal of credit for all
he's doing to help the world's most needy.
As you indicated, Mr. Chairman, nutrition is a very
important part of what the U.S. Department of Agriculture does.
It is about 50 percent, or more, of the USDA budget. One of the
programs that we have always found to be most effective is the
Program of Women, Infants, and Children, a program that really
focuses on the nutrition of pregnant and lactating mothers and
children under 2 years old. And that has been one of the more
effective programs. And if you look at the kinds of issues
we're talking about today, indeed these issues are the very
same that we are addressing in our own country with the WIC
program. So, as others have stated, nutrition profoundly
affects the life of children at every stage of development,
from conception, basically, through early childhood years. And
proper nutrition will determine whether or not a child will be
healthy, whether or not they will learn, whether or not they
will develop properly, whether or not they'll reach their
ultimate full potential.
This spring, UNICEF released a report called--one of our
series of reports called Progress for Children. This one
focused on nutrition and particularly looked at how the world
was doing in reaching Millennium Development Goal number 1 on
addressing hunger. One of the measures of that success of--in
implementing that Millennium Development Goal--is how many
children under 5 years of age were--are underweight. And I must
say that the conclusions of that report are disturbing.
It is estimated that more than a quarter of the world's
children under 5 years old are seriously underweight. As Jim
Morris pointed out, that's about 156 million children in a--in
developing countries--27 percent in developing countries fall
into that category. Global rates have fallen only 5 percentage
points since 1990. So, we estimate that, at our current pace,
the world will not meet the promise of the Millennium
Development Goals to cut the rate in half--to cut the rate of
under-5's underweight in half--by 2015. It is estimated that
persistent undernutrition is a contributing cause in more than
5 million under-5 deaths every year.
But underweight children are really only part of the story,
and I think we've heard a lot of--about this today. While many
children may be eating enough to fend off hunger, many are
missing essential vitamins and minerals. Something as simple as
the lack of iodine can lower average IQ in iodine-deficient
children by up to 13 points. Vitamin A deficiency can make a
child significantly more likely to die from common childhood
diseases, like measles. And every year, iron deficiency means
that tens of thousands of pregnant women will not live to see
their babies born.
If you look at the findings of this report, you see that,
in India alone, 7.8 million babies are born underweight every
year, and 47 percent of the under-5 population in India is
underweight--48 percent of the under-5's are underweight in
Nepal; 48 percent are underweight in Bangladesh. Now, when you
compare this to the United States, the number is 2 percent.
In sub-Saharan Africa, if you look at it as a whole, there
is--there are 28 percent of the children, on average, who are
underweight. In South Africa, one of the more developed sub-
Saharan African countries, the number is 12 percent under-5's
underweight. In Ethiopia, nearly half of the children, or 47
percent, are underweight.
Millions of children in sub-Saharan Africa live in an
almost constant state of emergency, fueled by war, by famine,
and other crises. HIV/AIDS, as we've talked about, is putting
an additional strain on communities that are already struggling
to produce and to find food. And HIV/AIDS is leaving children
alone and vulnerable.
With so much at stake, we are long overdue for a new
approach. So, we believe that the End Child Hunger and
Undernutrition Initiative will help provide focus and resources
to address this issue of childhood hunger around the world.
Food aid alone is not enough. Reversing the current trends
requires a holistic approach, as many have talked about today,
including agricultural productivity, addressing all that helps
to keep children healthy and developing properly, including
healthy mothers during pregnancy, good nutrition and vitamins,
breastfeeding, better education, effective disease control,
policies that safeguard food access, access to clean water, and
sanitation. It has to be an integrated approach. And we must do
more to focus on children age 2 and under, where the majority
of the under-5 deaths occur. If a child falls behind in this
critical stage of under-age-2, he or she may never catch up.
In addressing the underlying causes of malnutrition, there
are simple, practical things that we can do to make a
difference. The global campaign to iodize salt, for example, is
bringing iodine to almost 70 percent of all households, and
protecting 82 million newborns per year against iodine
deficiency. The UNICEF-supported Accelerated Child Survival and
Development Program in West Africa has shown results--
preliminary results of a reduction of child mortality by 20
percent in some of the areas where we've implemented it. And
this is by delivering a simple integrated package of both
nutrients and healthcare to families in community-based
settings.
We have seen clear signs that point the way forward, and
evidence of the strategies that do work, and that do produce
results and make a difference. While the goals of this
initiative are ambitious, they are not impossible, and they
show a future where children can and will have equal
opportunity to fulfill their unique potential.
Thank you very much, Mr. Chairman.
[The prepared statement of Ms. Veneman follows:]
Prepared Statement of Hon. Ann Veneman, Executive Director, United
Nations Children's Fund, New York, NY
Mr. Chairman, members of the committee, thank you for this
opportunity to discuss the ``End Child Hunger and Undernutrition
Initiative,'' and the importance of nutrition to children.
It is a special pleasure to appear with my U.N. colleague, Jim
Morris, of the World Food Program, who will be ending his tenure next
year. He has been a valued partner and friend for several years, and so
committed to the work of the World Food Program. He has a record of
boundless energy, compassion, and creativity.
When I last appeared before a Senate committee, it was in my
capacity as the U.S. Secretary of Agriculture. Nutrition programs
accounted for some 60 percent of the USDA budget. At UNICEF, I continue
to pursue effective, strategic approaches to the health of mothers,
babies, and children, which was a hallmark of USDA's WIC, or Women,
Infants, and Children Program.
Nutrition profoundly affects life at every stage of development,
starting before a child is even born. It helps determine how healthy a
child will be, how fast she will grow, how easily she will resist
diseases, how well she will learn at school, and whether her own
children will reach their full potential.
It is critical that we understand the vital importance of nutrition
and how serious undernutrition is around the world. One underweight and
undernourished child is an individual tragedy. But multiplied by tens
of millions, undernutrition becomes a global threat to societies and to
economies.
``Underweight'' is the indicator that is used for undernutrition
because it is one of the most visible and easily measured attributes,
and because it correlates strongly with disease and premature death. A
few months ago, UNICEF released its ``Progress for Children'' report,
revealing where the world stands on the first Millennium Development
Goal, which seeks to cut in half by the year 2015 the global proportion
of underweight children.
The conclusions of that report, which I would offer for the
complete record of this hearing, are disturbing. Undernutrition is a
global epidemic. In a time of plenty, it is estimated that more than
one-quarter of the world's children under the age of 5 are seriously
underweight. In developing countries, about 146 million children, or 27
percent, fall into that category. Global rates have fallen only 5
percentage points since 1990. At our current pace, we will not meet the
promise of the Millennium Development Goals to cut the rate in half by
the year 2015.
[Editor's note.-- The report mentioned was not reproducible in this
hearing but will be maintained in the committee's permanent record.]
It is estimated that persistent undernutrition is a contributing
cause in more than 5 million under-5 child deaths every year. But
underweight children are just part of the story. While millions of
children are eating enough to fend off hunger, many are missing the
critical vitamins and minerals they need.
Something as simple as a lack of iodine in diets can lower the
average IQ in iodine-deficient children by up to 13 points. Vitamin A
deficiency can make a child significantly more likely to die from a
common childhood disease like measles. And every year, iron deficiency
means tens of thousands of pregnant women will not live to see their
babies born.
According to ``Progress for Children,'' only two out of seven
developing-country regions are making sufficient progress to meet the
Millennium Development Goal target. But there are bright spots in every
region, and there is particularly good news in China. The country with
the highest population on Earth already met the Millennium Development
Goal target regarding underweight children more than 10 years ahead of
schedule. The proportion of underweight children in China dropped from
19 percent in 1990 to 8 percent in 2002, thanks in part to a strong
government commitment to make nutrition a priority.
This dramatic progress shows we can make swift advances in a very
short time if we take a comprehensive approach to a child's needs.
The worst crisis is in South Asia, where almost one in two children
under age 5 is underweight, or 46 percent. In India alone, 7.8 million
babies are born underweight every year. That equates to the combined
population of the State of Virginia and the District of Columbia.
Sub-Saharan Africa, as a whole, has been largely stagnating, with
28 percent of its children under 5 years old underweight. In South
Africa, 12 percent of the children under 5 are underweight. In Niger,
the rate is 40 percent; and in Ethiopia, nearly half of all children
under 5, 47 percent, are underweight.
Millions of young children in sub-Saharan Africa live in an almost
constant state of emergency, fueled by war, famine, and other crises.
HIV/AIDS is putting additional strain on communities that are already
struggling to find adequate food, and leaving children alone and
vulnerable.
Examples from other individual countries show the rate of
undernutrition is 48 percent in Nepal and Bangladesh, 47 percent in
India, and 46 percent in Yemen and Timor-Leste. In Guatemala, the rate
is 23 percent, the highest in Latin America and the Caribbean. In
Albania, 14 percent of children under 5 are underweight, the highest
rate in Central and Eastern Europe and the Commonwealth of Independent
States.
Compare that to only about 2 percent in the United States.
We cannot blame this global epidemic on food shortages alone. These
numbers reflect broken health and education systems in countries, poor
governance and corruption, and a widespread failure to provide basic
services, such as clean water and sanitation. With 2.6 billion people
living without a simple toilet, diarrhea has become one of the world's
leading causes of child deaths and malnutrition.
We also know the importance of educating girls, and keeping mothers
healthy, especially in the developing world. Millions of women and
girls come into pregnancy too young and too often. Far too many are
malnourished themselves, and very few spend their teenage years in
school. This impairs their ability to bear, raise, and care for healthy
children. At least 20 million babies are born underweight every year in
developing countries, which puts them at a higher risk of an early
death.
With so much at stake, we are long overdue for a different
approach. We believe the ``End Child Hunger and Undernutrition''
initiative will provide focus and resources to address childhood
hunger. Food aid alone is not enough. Reversing the current trends
requires a holistic approach to what keeps children healthy and
developing properly. This includes healthy mothers during pregnancy,
breastfeeding, better education, effective disease control, and
policies that safeguard food access, even in times of crisis. There
must be a special focus on protecting children under age 2. If a child
falls behind during this critical development stage, he or she might
never catch up.
In addressing the underlying causes of malnutrition, there are
simple, practical things we can do that make a critical difference. The
global campaign to iodize salt, for example, is bringing iodine to
almost 70 percent of all households and protecting 82 million newborns
per year against deficiency. The UNICEF-supported Accelerated Child
Survival and Development program in West Africa has managed to reduce
child deaths by an estimated 20 percent in some areas by delivering a
simple, integrated package of nutrients and health care to families in
community-based settings.
It is time to believe in, and invest in, the scaling up of programs
that yield results for children. We have seen clear signs that point
the way forward and evidence that our strategies work. While our goals
are ambitious, they are not impossible, and they show a future where
children have an equal opportunity to fulfill their unique potential.
Thank you, Mr. Chairman.
The Chairman. Well, thank you very much, Secretary Veneman.
Let me begin the questions by noting that in your testimony
each of you has mentioned the importance of partnerships in
fighting hunger and malnutrition. The World Food Program and
UNICEF are partnering in their new initiative. Mr. Kunder gave
a few examples of partnerships in his written testimony, such
as the USAID/UNICEF/Kiwanis partnership to address iodine
deficiency and partnering with pharmaceutical companies to
develop zinc tablets. But, as I listen, each of you has
mentioned how some of your efforts intertwine. Can each of you
give some idea of who's in charge here? Now, that's not meant
to be provocative. Obviously, there are U.S. Government
agencies, there are faith-based initiatives, service clubs, and
the United Nations. But as Mr. Morris said, if you were to seek
out 10 top countries that have a majority of the problems, or
10 particular sectors, even in Africa--if there was a so-called
business plan for all of this--and maybe there is--perhaps
there would be some greater confidence that the goals are going
to be met, and that United States investments, whether they are
public or private, are on target, as opposed to solving one
problem, only to run into another. Dr. Gerberding was skillful
in pointing out that in a progression of four or five different
programs, you lead to the possible treatment for HIV/AIDS,
which would not be successful without the intervening steps in
front of that. And that shows a degree of sophistication which
is very, very important to describe.
But I'm just hoping for some reflections as to where the
business plan is, who's in charge, or if anybody ought to be,
and how we come to grips with the overall organization of the
effort.
Now, let me ask you, Secretary Veneman, because you have
presented a report that attempts to go into the Millennium Goal
No. 1 and the graph of child nutrition around the world in
which the red countries are those that are either not changing
or falling back, and the blue countries at least are on track
to reach this first target. Insufficient data is the case for
some situations such as all of the Korean Peninsula or Libya or
Argentina or some countries in sub-Saharan Africa. So, we
really don't know, I suppose, at this point. But at least there
is an attempt being made here, graphically, to portray, with
this goal, how we're doing, collectively.
Would you address that question, first of all, as to the
overall ``who's in charge''?
Ms. Veneman. Well, Mr. Chairman, I think it's a very
appropriate question, because I think that as I've come into
this world of development, and development agencies, one of the
things, I think, that we have to be addressing is, how do we
work closely together on issues related to poverty alleviation,
hunger, healthcare, and the whole range of issues that impact
people in the developing world. And so, it's critical that we
work in partnerships. And I think one of the ways that we
collectively address these issues is by having common goals, as
this nutrition initiative indicates--the Millennium Development
Goals, for example, are common goals--and that we collectively
measure results, collect data in a uniform way, so that we can
measure the progress that we're making.
One of the things that we hope to address with this
initiative is, it was begun as a partnership between WFP and
UNICEF, partly beginning--as I came into this job, Jim Morris
and I started talking about this partnership--we've tried to
make it as broad as possible. The World Bank's been very
involved. A number of NGOs have been very involved. WHO's been
very involved. So, it attempts to bring all of the parties
together in a cohesive way to address the issue, particularly
of child hunger, but recognizing how important hunger is to so
many other things--children's health, to education--you can't
learn if you don't have enough to eat--and also to bring in the
NGOs.
I began, in August, chairing a committee on nutrition,
which is all of the agencies of the U.N. that deal with
nutrition, as well as NGOs and governments, and many
universities, and that committee, also, is a major part of this
End Child Hunger Initiative. So, we are trying, really, to
address the very issue that you're bringing up, and that is,
how do we bring all of the various parties that are involved
together around common goals and trying to achieve common
results in areas which are most in need?
The Chairman. Now, at UNICEF--and you've mentioned the
partnership with Jim Morris and the World Food Program--you're
dealing as officials of the United Nations, so presumably you
have the attention of all of the countries that are members of
the United Nations. By definition, at least, that's the group
that you represent. The NGOs, I gather, could be international
organizations also, in some cases. The World Bank certainly has
many of the same constituents. But is this how you come to
grips with all of the governments or humanitarian resources of
the world? At least through the United Nations setup there, you
have some reporting situation.
Ms. Veneman. Well, I think that is a very important
question, as well, because--you know, particularly as the U.N.
has addressed this high-level panel on coherence, one of the
things we see is the importance of also--particularly donor
governments working in a cohesive manner within its own
agencies and with other governments and with the U.N. agencies
and with NGOs. So, I do think that we all have to work very
closely together to address the kinds of issues that we're
talking about. And what we hope to do with an initiative like
this is to rally all of the various parties around common goals
and trying to achieve common results. And I think that's one of
the best ways we can work to achieve the kind of results we
want to see and to help children.
The Chairman. Mr. Morris, do you have a comment on this
question?
Mr. Morris. Sure. Essentially, there's no one in charge.
Hopefully, we'll all be focused on those who need our help, and
that common mindset will draw us together. But, really, the
leadership needs to come from the country where the problems
are being addressed. The Government of Malawi needs to own the
responsibility and provide the leadership to draw us together.
They need to have one plan, one coordinating mechanism, one
system for monitoring and evaluation that we all buy into.
UNAIDS has really done a good job on what they call the ``three
in one'' theory of one plan, one mechanism, one evaluation
system to look at the HIV/AIDS issue country by country. And,
ultimately, the responsibility for addressing what we're
talking about is a country responsibility. And our job is to be
there to be helpful.
Now, there are very difficult issues of capacity and
resources, technical competency, that the rest of the world
will have to provide. But the only chance for this to be
sustained, and, really, to work, is if the country where the
work's being done is in charge.
The Chairman. Now, I know, from personal conversation, that
you have visited North Korea and Zimbabwe, to take two cases.
And clearly a number of children, or maybe others, were fed
through the efforts of the World Food Program, but, on the
other hand, on some occasions, for instance, the Government of
North Korea has taken the position that, ``We don't need you
this year.'' In an imperfect world, there is no real answer to
this, but the fact is that a number of people are starving
because they have governments that do not have a very good plan
or, in fact, are not particularly receptive, during certain
years, to this kind of aid. And I gather that the World Food
Program has, in a humanitarian way,
persisted to insist that there are still hungry people there,
despite the politics, and that you would like to help, or you
would like to insinuate help, in those situations.
Mr. Morris. Of the 191 members of the United Nations, you
couldn't have picked two better examples to discuss.
[Laughter.]
Mr. Morris. North Korea and Zimbabwe are both very
difficult places. We provided food, this past year, for more
than 5 million people in Zimbabwe. The last 5 or 6 years, we've
been providing food for a third of the population of North
Korea, with good support, by the way, from the United States.
Our job there is to save lives. And we've had to find a way to
do our work so that we can get food distributed to those who
need it.
Now, the Zimbabwe situation is very interesting. We've made
it clear to the Zimbabwe Government that we're there to help.
We're there, not in a political role, but a humanitarian role,
and our job is to get food to people who are most at risk,
absent any other consideration. We have 24 NGO partners at the
high point in Zimbabwe, World Vision being one of the best,
that enable us to distribute food to more than 5 million
people, and to do all the distribution through private
mechanisms.
I suspect that Zimbabwe does not have a plan to address the
kinds of issues that we are focused on. And I'm very concerned
about Zimbabwe. They have more than a million orphans because
mom and/or dad has died of HIV/AIDS. The predicament is
extraordinary.
In North Korea, you know, our job has been simply to get
food to millions of people who need it. Before we were there,
people were dying in that country. And with UNICEF, we've found
a way to turn the situation around, to reduce dramatically the
percentage of chronically and acutely malnourished children, to
reduce the percentage of children underweight. We've not made
much progress with the issue of anemia with women. It's been
steady.
North Korea came to us last year, all of us, and said,
``We're no longer in an emergency situation. We don't need you
to do emergency work. We want you to begin to do development
work.'' And our plan for North Korea this year is to provide
food for 1.9 million people, mostly in the northeast, away from
Pyongyang, where things are the most difficult. They've
recently had floods, and we've gone in to feed another 55,000
people during the crisis.
But these are two places that need to be more thoughtful
about addressing the issues that we're all concerned about. I
agree with you.
The Chairman. Mr. Ward, mention has been made of World
Vision in Mr. Morris's comments. Do you have an overall comment
about these issues?
Ambassador Ward. Yes, Mr. Chairman, I do.
I think, first of all, on the question--I'd just like, very
briefly, to return to the question of who's in charge. And I
think that needs to be answered in two ways. First, who's in
charge really needs to be the families in need, because unless
the families--they know best their needs, and they also are the
ones who are going to have to implement solutions. So, we need
to--we need to find solutions that they can adapt to and that
they can implement. And that's World Vision's way, is--
throughout the world, to work very, very closely, not just with
national governments, but also with community-based
organizations, at the grassroots level, to find solutions that
people can actually use and to find the kind of prioritized
interventions that Dr. Gerberding was talking about, so that we
can get in there and help people.
But I also think that we need--we need the international
partnerships. We need the partnerships that are really
blossoming now between international organizations, national
governments, and international NGOs in this field of food and
nutrition, and also in health. And we have, as unifying
principles, the Millennium Development Goals, which are very
clear, and which provide, perhaps for the first time in this
business, very clear targets.
So, we are working together, not--in Zimbabwe, for
example--not just with World Food Program, but also benefiting
from grants from USAID and feeding--we have a very active food
program in Zimbabwe, and we're able to continue, because we're
connected to the communities. It's--that's also true--for
example, I was, earlier this year, in Afghanistan, where we
work in a difficult situation, a situation where travel is
difficult, security is a challenge, but we're connected to the
community, and we find that very, very important in our work.
The Chairman. Dr. Gerberding, do you have a comment on this
question?
Dr. Gerberding. Thank you.
I've been thinking a lot about it, because this question
about who's in charge comes up in a lot of settings--terrorism,
hurricane preparedness, and so forth. And I feel very fortunate
to work in a department led by a secretary, Secretary Leavitt,
who sees the world as a network. And I really agree with him.
And I think what we're talking about here is a very complicated
network of organizations and individuals, from government and
nongovernment sectors who are all working on the same problem.
But there is no one in charge of the network, and I very much
agree that ultimately the decisionmaker has to be the Minister
of Health or the leader of the affected countries.
But I think what we're learning to do in these very
complicated times is to understand better what makes a
networked effect successful. And it really is having a very
clear goal and a very clear set of strategies so that, wherever
you are in the network, you understand the goal and the
strategies, you agree to the measures, but then you can
identify, ``Okay, if that's what we want to accomplish, what's
my part? What can my organization do? What can I bring to bear?
And how can I measure our own contribution to the overall
goal?'' And I think that's fundamentally what we're learning to
do.
UNICEF and the U.N. is an amazingly important convening
force to get us all around the table to decide and contribute
to the goals and the strategies, but once those are
established, then the network is, in a sense, self-governing,
because we know what we're supposed to be doing, and we work
really hard to be an effective contributor to that effort.
So, it's a different way of thinking. It's also a different
kind of leadership, because it isn't that ``I'm the boss'' sort
of leadership, it's ``What is my collaborative role here, and
how can I influence and bring other people to point in the same
direction?''
The Chairman. Mr. Kunder.
Mr. Kunder. Mr. Chairman, I'm very glad you asked us for
our reflections rather than the answer. [Laughter.]
Mr. Kunder. As you know, we've just had the committee lead
us in a lot of discussions on how we can coordinate even
better, even within the U.S. Government. And this larger
question of how we communicate to the international
communities, interventions, is critical. I would agree with Ann
Veneman that part of this is the framework of the Millennium
Development Goals, because we do have an overall framework. And
I would very much agree with Jim Morris that we--however we
look at this--have to keep the local, the country leadership,
out in front. Because if we all come in from outside and have a
great coordination plan, but if there's no buy-in at the
country level, it's not going to be sustained.
And I found myself agreeing with Dr. Gerberding, as well,
that part of this is a systems approach. And one of the things
we tried to point out in my testimony, is that, for example, in
USAID's work to try to do more with food fortification, part of
the problem is to pull apart these complex issues, like child
survival, and then really target the objectives on the
component problems, because while we're dealing with global
initiatives, global problems, and global organizations, I've
found that, certainly, there's an inverse relationship between
the complexity of the problem and the amount of mobilization of
resources and public support you can get around them. That's
why, as Jim was saying, one of the successes of the polio
immunization campaign is, in polio, you're targeting it. And
what we're trying to do is, by focusing on initiatives like
micronutrients or food fortification, the more you can target
it, the better we can get the focused coordination.
One last element that I think we haven't touched on--or
maybe Jim touched on just briefly--that is absolutely critical,
is we've got to get the private for-profit corporations
involved. And, I mean, not just something bold, like the recent
Gates-Rockefeller initiative on food production, but something
like food fortification. This is a critical way of spreading
the costs among producers and consumers, not just the taxpayers
here or in Malawi. And in the private sector, I think we're
just scratching the surface on the enormous resources that we
can bring to bear on addressing this problem of hunger.
Thank you, sir.
The Chairman. Yes, Jim.
Mr. Morris. Mr. Chairman, just one comment. Not answering
your question about who's in charge, but--I believe the
leadership of the United States of America is absolutely
critical in making progress on the humanitarian agenda. For the
United States to tell the world how important it is to address
the Millennium Development Goals of reducing hunger and poverty
for children, infant mortality, maternal health, HIV/AIDS,
universal primary education, gender equity, and--the leadership
of the United States on these issues bringing the world
together to talk about these issues, and for the world to know
how strongly our country cares about these issues. And, in
fact, the United States has earned, and deserves, the
opportunity to do that, shows great leadership on HIV/AIDS.
Eighty percent of the research money for AIDS comes from
National Institutes of Health, and PEPFAR has made the most
remarkable step forward on HIV in the last 20 years. The
McGovern-Dole school feeding program and of course Food for
Peace, both demonstrate sustained unprecedented humanitarian
commitment. And the world really, I believe, cries out for
leadership from our country on these issues.
The Chairman. Well, I agree. And let me just add as a
footnote, without extending this particular question, but
yesterday it was a privilege to visit with the President's new
envoy to Sudan, Andrew Natsios, who is well known to all of
you. He had many comments to make about that intervention and
this potential for success. But one of the elements of this is
a very practical one, that from certain tribes in the south who
have been very badly disadvantaged in the turmoil, about 2
million livestock have been taken. Now, in short, this is not
only a question of people shooting at each other, but, in a
very, very severe systemic way, the livelihoods of all of those
tribes, without their livestock and without their land, is very
grim. They could have some existence in refugee camps for
periods of time, at the sufferance either of the government or
of the rest of the world that might be able to inject some food
and nutrition, some hope, into that situation. But we are
faced--as a Nation, or as a world, as the case may be, if there
is to be some equilibrium and some future for all of Sudan--
with the replacement of about 2 million animals, in addition to
land-equity situations and emergency feeding. And this is often
the case, as Secretary Veneman has testified before, with
agricultural situations. They are enormous, in terms of simply
the productive facilities, the abilities of people to continue
on a normal livelihood; in this case, it is very much akin to
food.
Let me ask this, because there have been, as some of you
have touched upon, some recent remarkable initiatives with
regard to fighting hunger. And specific mention has been made
of the Gates and Rockefeller Foundations, and, in fact, a joint
initiative of the two, for an agricultural Green Revolution in
Africa, through programs that among other things, increase crop
production and improve irrigation. In general, there's been
testimony that the private sector in our country, corporate
America, and others, ought to do more. What I find to be
especially exciting in the past 12 months is the extraordinary
outreach of private foundations, people who have extraordinary
wealth that have decided to devote it to very important
humanitarian causes. Now, what I would like to gain from you is
some sense of how these initiatives, some of which are in the
area of agricultural research and long-term or intermediate
steps, as opposed to emergency ones or systemic feeding of
people, fit. If there was more philanthropy, to what extent
does it begin to fill the gap with regard to the financial
resources and, in some cases, the organization of these
efforts? Does anybody have a comment on that issue?
Yes, Ann.
Ms. Veneman. Well, I will be happy to attempt to address
some of this.
I think you bring up a very important point, and that is
the new focus, particularly brought about by the Gates and
Rockefeller Foundation, on the need to really address the root
of the problem, the root of hunger, in terms of food
production. In 2003, I held a Science and Technology Conference
in Agriculture, ministerial conference that brought together
over a hundred countries, and almost 120 people at ministerial
level. The main speaker, or one of the most impressive
speakers, was Norman Borlaug, who, as you know, started the
Green Revolution that was so successful in India. And he
basically challenged, particularly the African ministers that
were there, if we don't begin to address these issues in a
systemic way and take advantage of new technologies, whether
it's new seed varieties, utilizing fertilizers. One of the
things that came out of that conference was the need for both
water quantity and quality to produce food.
But I think that there are so many opportunities to apply
basic technologies, as well as better work with extension
systems. As I've traveled throughout Africa, one of the things
I've seen--you see extension stations, but they don't seem to
be having the kind of work and impact that they once had.
The other thing that came out of this conference we had in
2003 was, one of the--one of the findings was that the
foundations, like the Ford Foundation and the Rockefeller
Foundation, weren't engaged in food production and agriculture,
like they once were. And so, as this Gates-Rockefeller
initiative comes forward, I think it's a very important new
development to recognize how important it is, particularly for
Africa, to have the kind of thing, a Green Revolution, to
address the issue of food production, because I think whether
it's--you know, in some places, we see overpopulations of
cattle, because cattle are the measure of wealth; they don't
put their money in the bank, they--you measure your wealth by
how many head of cattle you have. In other places, like you
indicated, the Sudan, where they've lost their only, really,
source of wealth by losing all of their cattle, so the
agriculture end and, sort of, economic development of wealth
generation becomes very intertwined with the issue of proper
nutrition and hunger.
I think it's extraordinary what Gates is doing, what Warren
Buffet is doing, what others are now doing. And it's not just
private foundations. It's, how do we address corporate social
responsibilities? How do we better engage universities to work
together? How do we build capacity in universities in
developing countries to help address some of these issues? And
I think all of these are critical as we move forward.
The Chairman. Yes, Mr. Ward.
Ambassador Ward. Mr. Chairman, I think that the initiatives
that we've seen in recent months by the Gates Foundation, the
Rockefeller Foundation, and other foundations, are very, very
important, especially because they are focusing on using
technology to find new techniques and new ways of solving the
problems that we all face.
What will be important as we move into the future is to
find ways of disseminating that technology in a sustainable
fashion, and I think that's where governments and international
organizations and NGOs can play a large role. The--for example,
the Millennium Villages Project, which is run out of an
institute at Columbia University, is a project which is
attempting to bring in new agricultural technologies to
villages in various areas in Africa. We're partnering with them
in a way--to try to see if their scope for socializing these
techniques into our community development projects, our area
development programs throughout Africa, so as to give them
roots within the community and make them sustainable, so
they'll go forward on their own.
The Chairman. Ms. Gerberding.
Dr. Gerberding. Just thinking a little bit more generic,
you know, we are thrilled with what's happening with Gates and
Buffet, from a CDC perspective. But, to me, it reflects on two
out of the three most important things we need to do to solve
these problems. And you've mentioned innovation. And I think
the ability of the private sector to innovate probably exceeds
even that of some of our government research enterprises, in
that what this allows innovators to do is to take some risks.
And it's very difficult to take risks with government dollars,
but it is possible to take risks and stretch your brain and get
out of the box with these private-sector enterprises, because
that's what they expect us to do, and they understand why
that's important.
So, the innovation is definitely a part of this. But, also,
it's the scaling. And if you want to scale up a problem
solution that you have in one area, you have proof of
principle, and you want to make it more widely available, there
are not too many options. One is, you can get more investors.
Another is, you can get more money per investor. And third is
that you can get more value for the money that you have. And I
think these large-scale investments, whether it's the U.S.
Government through PEPFAR or the Gates-Buffett enterprise, the
Global Fund, some of the private-sector opportunities that are
coming to the--into play now, really allow us to scale in one
those three ways, in very exciting ways. I don't think any of
us have ever really been more excited that there is a much more
tangible possibility of solving some of these huge problems now
with this scaling opportunity that we have. But the third
thing--innovation scale--the third thing really is the issue of
sustainability. And that, I think, we have some ideas about
what is the requirement for sustainability. But I personally
believe we need much more work in this area, and I would really
look forward to learning from my colleagues on how we can
support a more sustainable uptake of these opportunities that
are in front of us now.
The Chairman. To underline your point, before this
committee we've had testimony with the Gates Foundation and
their fight against HIV/AIDS, that some type of inoculation for
prevention is possible, and even suggesting, maybe, within a
10-year period of time. And just to underline your point--this
is not exactly relevant to nutrition, but it is, in various
ways, as we've seen the intersection of this--but this type of
intensive research, with the risktaking that's involved, all of
the paths that don't work out, combinations that don't
register, perhaps could only be done by private initiative,
private foundations. So, the intersection, now, of these large
sums of money and this leadership is probably a very, very
important development.
Let me ask you for your comment, Mr. Kunder, and then I'll
recognize my colleague Senator Sarbanes.
Mr. Kunder. Just very briefly, sir. I--first of all--have
just two comments. One is, there are still some very basic
research agenda items that--have to be completed, and we're
still looking at what's the optimal combination for food
fortification. And some of this is basic social marketing
research. I've included some examples in my testimony of the
kinds of things we're using for fortification around the world.
It could be fish sauce in Vietnam, because that's what we've
found is the most culturally appropriate way to get these
micronutrients into the diet. And there are still tens of
millions of children who don't have properly iodized salt
around the world. So, there's some low-hanging fruit that still
has to be done. So, my comment is, as we rush to the future,
we've still got some basic problems to solve, and those require
funding, and they require some not-very-glamorous solutions,
but they're critical to improving children's nutrition.
Thank you, sir.
The Chairman. Excellent point.
I'd like to recognize, now, Senator Paul Sarbanes, the
distinguished member of our committee from Maryland. And would
you please proceed, Paul, with your statements or questions or
comments on this.
Senator Sarbanes. Well, maybe I'll fuse the two together
Mr. Chairman.
The Chairman. Excellent.
Senator Sarbanes. First of all, I want to commend Senator
Lugar for holding this hearing. I think it's an extremely
important hearing. And I want to underscore something he said
in his opening statement, and I'd just quote him, very quickly,
here, ``Although famine and starvation are the most severe and
visible forms of hunger, poor nutrition, which often goes
unnoticed, can also be deadly.'' And he goes on to develop the
point about the critical link between malnutrition and poverty,
how it really handicaps young people as they try to move ahead,
in so many ways. So, I think it's an extremely important point,
and it underscores the breadth of this problem.
I'd like to ask the panel this question. Regrettably, the
budget submitted by the President in fiscal 2007 reduced
funding for a number of programs that involve child survival
and health. The Child Survival and Health account itself was
substantially reduced. Development assistance was reduced.
International disaster and famine assistance were reduced.
There was a massive increase requested for the Millennium
Challenge Corporation.
Now, I support the Millennium Challenge Account, but I
think there is a disproportionate amount of resources being
provided to it. And, of course, the MCC has a large pipeline,
because they haven't been able to move the funds. At the time
that that program was sold to the Congress, it was asserted
that support for the MCA would not come at the expense of
established development programs, including those designed to
combat child hunger around the world.
Now, regrettably, that's not been the case, and I am
interested in hearing, from the panel, how severely you feel
these existing programs have been impacted by the diminishing
of resources available to carry the programs forward.
Mr. Kunder, why don't we let you come last, since----
[Laughter.]
Senator Sarbanes. In the----
Mr. Kunder. Sir, as you well know, I'm here both as a
administration witness and as a USAID witness, so you've put me
right on the cusp of----
Senator Sarbanes. All right, in the spirit----
Mr. Kunder [continuing]. This critical issue.
Senator Sarbanes [continuing]. Or rebuttal--no, I'll start
over here with Mr. Ward and come across the panel. [Laughter.]
Mr. Kunder. Sir, I'm more than glad to take a crack----
Senator Sarbanes. Yes.
Mr. Kunder [continuing]. At it.
Senator Sarbanes. All right. All right.
Mr. Ward.
Ambassador Ward. Yes, thank you very much, Senator.
I think we need to look at this question in the context of
the overall move by the administration to reform foreign
assistance, and to reorganize foreign assistance. Oh, and the--
I think, NGOs, in general, applaud the administration's
intention to rationalize some of the processes around foreign
assistance, but we look at the process with a bit of
trepidation, because, as we look at the priorities set forth in
the foreign--various foreign--in the foreign assistance
program, we would feel more comfortable if some basic
humanitarian needs were given a bit higher priority than they
seem to be, although we've had assurances that humanitarian
needs will not be neglected, and we appreciate the increases
that we've had in the past.
However, in the current budget, for example, food aid is--
the proposal for food aid is, we believe, far short of what the
requirements for food in the coming months will be, and we
believe that the Title II appropriation should be around $2
billion, which would provide for both relief and development
needs under Title II. And yet, the administration has not
requested that amount, given the--I suppose, the fiscal
constraints. But we would like to see the amount for food aid
programs increased so that we could address some of the
childhood nutrition programs that we've talked about today.
Senator Sarbanes. Yes.
Ms. Veneman.
Ms. Veneman. Thank you, Senator Sarbanes.
I haven't studied the budget in detail, so I don't feel
confident to comment on the specifics. I would say that UNICEF
is very grateful for the tremendous support of the U.S.
Government for the work that it does in education, in health,
in nutrition interventions, which are--have absolutely been
critical. And the United States is UNICEF's biggest donor.
But I would comment, just for a moment, on the MCC, because
I recently, in--at the end of July, was in Ghana, just before
the MCC agreement was signed between the State Department and
the president of Ghana. And one of the things I asked, in some
detail, in meeting with the officials in Ghana was, what kinds
of programs will the MCC fund? Will they be consistent with,
you know, support for things like education, improving
healthcare systems, particularly for children, and so forth?
And I was very pleased that the kinds of things that the MCC
was investing in, the kinds of programs they were negotiating
with governments, are very consistent with the kinds of things
we are collectively working on to try to address, to improve
the lives of people who are living in poverty, and particularly
children.
So, again, I think that we need to look at all of the kinds
of assistance, as a whole, to see whether or not the goals are
being achieved.
Senator Sarbanes. Mr. Morris. Mr. Morris, I might note that
you wrote a very moving column in the Washington Post, back in
the spring, and you started off that column, and I quote you,
``The U.N. World Food Program recently had to make a terrible
decision, one that would give even King Solomon pause: either
to halve''--cut in half, halve--``food aid rations for almost 3
million people in Darfur--one of the world's worst humanitarian
emergencies--or halve the number of recipients.'' And it helps
to underscore this problem, I think, that Chairman Lugar
outlined in this opening statement. But how do you see this
situation?
Mr. Morris. That particular decision in Darfur was a
decision to go from allocating 2,100 calories per day per
person to 1,100 calories per day per person, because we had to
be confident that we had at least 1,100 calories per person
through the long rainy season. At that time, the United States
was providing 85 percent of what we had to work with in Darfur.
The United States is overwhelmingly our most generous partner
in Darfur and the rest of Sudan. In August, we fed 2.6 million
people in Darfur. We couldn't get to another 400,000 because of
the violence in Darfur, but continued to support another
230,000 refugees across the border, in Chad. This is, of
course, a situation that cries out for a political solution.
These were people that were leading good lives, by their own
standards. They want to go home, but they're afraid to go home.
I've spent a lot of time in Darfur, and I've never seen people
so frightened.
But we were able--after we had that intense period of
advocacy, to get back to a point where we were providing people
about 1,850 calories a day, 85 percent of what they needed. But
we're about to face that same predicament again over the next
90 days.
Sir, as it relates to your basic question, I just have
these thoughts. The McGovern-Dole School Feeding Program, one
of the great things that the United States Congress has done,
is an extraordinary example of people on both sides of the
aisle working together with their focus on people who were at
risk. It started off with a $300 million annual appropriation.
It's now down to something in the neighborhood of $100 million.
There is no more powerful investment this country could make in
seeing that children are fed and go to school. The long-term
benefit of that short-term investment is enormous. And the
School Feeding Program is incredibly important.
Earlier, we were talking about Norman Borlaug. I would
remind you that Norman Borlaug is a graduate of the University
of Minnesota, the United States Land Grant College system. This
remarkable man had this opportunity to change the world because
of his experience at the University of Minnesota. There is
nothing much more important than a continuing, sustained,
growing investment in bringing the best young minds in our own
country to become competent in agricultural technology and
research, and we have to find a way to continue to bring the
emerging agricultural leadership from around the world to study
at our universities in our country. I was in Auburn this week.
I'm close to Purdue. The contributions American higher
education and the land-grant system can make are remarkable.
Now, there was a profound change in the world, the last 25
years--by and large, weather-driven. If you look at the report
the World Bank produced for its spring meeting that talked
about the change in natural disasters in the world, it said
that in 2005 there were 400 natural disasters, compared to 100
in 1975; 2.6 billion people affected by natural disasters
during the 10 years preceding 2005, compared to 1.6 billion
during the 10 years preceding that. The World Food Program used
to be 80 percent development/prevention/mitigation/moderating
program. Today we are 80-85 percent engaged in responding to
natural disasters. And so, this limited pot of money that is
available has been heavily skewed to saving lives in an
immediate set of circumstances, as opposed to investing in
programs around the world that, long term, once again, have a
huge payoff. We have a lot of experience working in Ethiopia,
where a very small investment of a few tons of food changes a
community. And still we are trying to respond to the tsunami
and to the Pakistan earthquake as well as the terrible loss of
livestock in Sudan, which Senator Lugar mentioned. Well, the
same thing has happened in northeast Kenya. You know, the
pastoral way of life in northeast Kenya has been obliterated.
If you go there, you just see the landscape replete with animal
carcasses. We used to spend 12 percent of overseas development
assistance on investment in basic agricultural infrastructure.
Today, it's 4 percent. Now, the United States, Canada, and the
United Kingdom are beginning to turn that around, but there is
no substitute, either on a macro or a micro basis, for
investment in basic agricultural infrastructure.
So, I would say that the United States is very good to us,
overwhelmingly good. But the magnitude of the issues that we
are faced with--juxtapose the natural-disaster issue, with the
conflict in the world. For instance, we fed 735,000 people in
Lebanon in the last 6 weeks. Then you add the HIV/AIDS issue on
top and you can see--the world is facing unusual challenges.
Senator Sarbanes. Dr. Gerberding.
Dr. Gerberding. I wish I had studied the big picture of the
Federal budget for this before I got here, but I didn't, so I
can't give you a direct answer to your question. What I can
tell you, from the CDC perspective, is that we have not had a
cut in the dollars that we have available for our contribution
to these activities. But we do agree completely with this
concern about the balance between the new urgent threats that
we are responsible for and the long-term urgent realities of
the problems that we need to handle. And because of the times
that we're operating in, and because of the terrorism issues
and the pandemic concerns and the natural disasters, we have
seen an unbalancing of our investment much more in the
direction of urgent threats. And I think all of us need to step
back and say, what are we going to do about the urgent
realities? We can't continue to pull on the same pie, when
we've got new challenges that are confronting us.
The other point I would like to make, from a CDC
perspective, is that we have, I think, learned something
remarkable in the context of the PEPFAR program, and that is
that when you invest, you get results. And that program is
succeeding in achieving its results, because it had clear goals
and strategy, but also because we scaled the investment to the
scope of the problem we were attempting to consider. And I
think, unlike, maybe, in past eras, when there was always a
question mark, ``Well, what is this money really doing?'' or,
``Are we really having an impact?'' we have now, I think,
developed irrefutable evidence that when you properly invest,
you get the true results, on a macro scale that you're looking
for. And I feel very proud of CDC's contribution to that, but I
also feel like I can look you in the eye and say, if you invest
here, we can deliver what you expect, and it will be a good
value for the American taxpayers, to consider these kinds of
longer-term investments.
Senator Sarbanes. Mr. Kunder, let me just sharpen the
question a little bit for you. I'm concerned that the
international NGOs that have been working in this field are
geared up to function at a certain level. They bring a lot of
expertise, a lot of committed and trained manpower and
womanpower. They raise some money privately to increase the
amount of resources that are available. If U.S. Government
support for their programs is reduced, then they're placed in a
very difficult position. They have this capacity that's been
built up. They have an available infrastructure. And then,
they're not making full use of it, which seems to be, if
nothing else, wasteful. I mean, there's an opportunity there
that is, sort of, being lost, where you can get a benefit at a
relatively small marginal or additional cost. And that's my
perception of one of the consequences of these reductions in
the budgeted amounts that are reflected in the submission by
the administration. So, I'd like you to, in addition to the
broader point, address that point, as well, if you would.
Mr. Kunder. Yes, sir. I'm going to try to answer your
question very directly and very specifically, because it's an
excellent question. In my honest perspective of what's
happening right now--back to this question of, sort of,
Millennium Challenge Account and traditional accounts--in his
new role as director of foreign assistance, what Ambassador
Tobias is trying to do is take a look at what the U.S.
Government is doing, in total, in any given country, trying to
apply the same kind of methodology that was developed in the
PEPFAR program over to the broader foreign assistance program,
demanding detailed country operational plans from each of our
mission directors, and, in fact, from the ambassador in the
country, trying to get a better look at all of the funding
streams, the refugee funding stream, the democracy and human
rights funding stream, the USAID funding stream and the PEPFAR
funding stream. Now, some of these are not under his direct
control, like the Millennium Challenge Account, because it's a
different statutory basis, but----
Senator Sarbanes. Now, the Millennium Challenge Account
requires a country--I don't quarrel with this objective--
requires a country to do a number of things----
Mr. Kunder. Yes, sir.
Senator Sarbanes [continuing]. Including having in place a
government that is proceeding according to bona fide and
accepted----
Mr. Kunder. Yes, sir.
Senator Sarbanes [continuing]. Standards, correct?
Mr. Kunder. Yes, sir.
Senator Sarbanes. All right. Now, what do you do about
hungry children in a country that doesn't have such a
government, and, therefore, is completely outside of any
possibility of qualifying for the Millennium Challenge Account?
If you're shifting all your resources to the Millennium
Challenge Account, you set out these criteria--I don't quarrel
with the criteria; it's just where we put the resources, and to
what extent. What happens to hungry children in countries that
couldn't begin to qualify for the Millennium Challenge Account?
Perhaps they have a dictatorial, autocratic government. Some of
these programs have been able to work in those countries in
order to address, specifically, the problem of hungry children.
Mr. Kunder. Yes, sir.
Senator Sarbanes. Now, what happens to hungry children in
those countries?
Mr. Kunder. The only thing I want to point out, sir, is
that this new system is attempting to take a look at whether
we're spending all the U.S. resources wisely to meet our total
priorities, including humanitarian priorities, and including
investing in people. And my honest perspective is that the jury
is still out, in terms of how this new process is going to
work--that Ambassador Tobias, my boss, is leading--in terms of
how we're going to allocate total U.S. Government resources.
Many of my USAID colleagues are concerned, going into the
process, that investing in people would come out on the short
end of the stick, quite bluntly. And what I've seen of the
process, so far, is that it has not gone in that direction at
all. And, of course, I'm talking about the entire list of U.S.
foreign-assistance recipients, which far exceeds the number of
Millennium Challenge countries around the world.
So, what we're going to have to do, I think, the Congress
and those of us in the administration will now take a look at
the totality of the resource allocation--Millennium Challenge
Account and this new system being put in place by Ambassador
Tobias--and see if it does align with the priorities. In my
view, what I've seen so far, it looks like it is.
I take your point that if we're taking some resources off
the top for Millennium Challenge Corporation, then that has to
be put into the scale, as well. But, as Ann Veneman just said,
from what we've seen so far, there does appear to be investment
of those funds into this broader issue of investing in people,
as well.
But the jury is still out, because we haven't gone through
a full cycle of this new paradigm.
Senator Sarbanes. We've had, and continue to have,
established programs to deal with some of these problems, that
seem to have worked fairly well. And my perception now is that
the resources devoted to those programs is being reduced.
That's what the budget reflects.
Now, the amount being committed to the Millennium Challenge
Account has been significantly raised. At the time the account
was argued to the Congress, we were told that it wasn't going
to result in diversion of resources. These were going to be new
resources, an initiative of further commitment.
Now, the amount of money being given to the Millennium
Challenge Account is quite high. The amount they've been able
to expend is much lower. There's a big reserve there. Now, they
say to you, ``Well, we're going to spend the funds. We need
this reserve, we're moving ahead,'' and so forth and so on.
They keep projecting times when they will have caught up on the
reserve, and so forth. But that keeps getting extended out,
that projection.
All I'm suggesting to you is that you shift some of that
money back to these existing programs. Let these NGOs go about
their business. Now, we've managed, in the Congress, to get
funding for UNICEF back up, every time; but the budget comes in
with cuts to UNICEF. We've made some adjustments for some of
these other programs, but we haven't succeeded in doing it
entirely. And, of course, the administration's budget request
always has an initial momentum. So, I'm simply suggesting to
you that you take a harder look at this and see if we can't get
these programs back up to their previous level so they can move
ahead. From what I hear, it's tremendously dispiriting to the
NGOs, and other groups that work off of these contributions, to
confront this situation. You can examine new approaches all you
want, but at least let's keep these other approaches working. I
mean, this is a real problem. You have a current crisis. And as
has been pointed out by the chairman in his statement and
people at the table, you're building a future crisis, too, by
falling short.
Mr. Kunder. Yes, sir. Well, message received. I mean, as
Jim was just saying, part of the issue here is that our budget
at USAID reflects the problem that he was mentioning at World
Food Program: To some extent, money that we had been putting
into nutrition programs and development programs, because of
the large number of crises in the world, has been diverted into
immediate response. But, long term, we certainly understand the
value added of the NGO community, and none of this is intended
to disadvantage the NGO community or fail to leverage what they
bring to the table.
Senator Sarbanes. Well, Mr. Chairman, I, regrettably, have
another hearing. This is a tremendously important subject,
though, and I, again, commend you for raising it, as well as
for the way you have pursued it over a sustained period of
time. This has been very important leadership.
Before I leave, I want to say, I understand, Mr. Morris,
that, shortly, you're going to be retiring as executive
director of the U.N.'s World Food Program. I understand the
chairman has already made some comments about that, but I think
I would be remiss if I did not add my own thanks for the
contributions you've made. You've really done a valiant job
over the years, and we're very grateful to you. And there are a
lot of children around the world who are grateful to you.
Thank you very much, Mr. Chairman.
The Chairman. Thank you very much, Senator Sarbanes. We
really appreciate your coming today.
Mention has been made, during the responses to Senator
Sarbanes, of the McGovern-Dole program. Obviously, you would
all be in favor of it. I would ask if you have any further
advice about the situation. Mr. Morris has outlined the
diminishing amounts of money coming from our Government, and
obviously there are many reasons why this may be so. I just
wanted to ask if anyone else on the panel has a comment on the
McGovern-Dole program.
Yes, Mr. Ward.
Ambassador Ward. Well, Mr. Chairman, I would just cite an
example in which this tremendously important program is helping
in ways that actually go far beyond just the provision of food
and nutrition.
In Afghanistan, girls had been--were denied, under the
Taliban, access to education. And one of the major goals of the
coalition in Afghanistan, and of NGOs that are working there,
is to increase the access of girls to formal education, and to
also help women who were teachers in the past to find their way
back into the teaching profession. And it's been through a
program funded by McGovern-Dole that we've been able to benefit
young girls in grades one through three by keeping them in
school and also sending them home with food rations that
benefit them and their families. This has materially reduced
problems, such as diarrhea and constant vomiting, that are
endemic in rural Afghanistan, and has really created a new sort
of environment in which there can be a culture of learning for
girls, as well as boys. So, this is an incredibly important
program, and we certainly support it and are grateful for the
assistance, for our ability to access it.
The Chairman. Just let me indicate that, as Senator
Sarbanes' questions indicated, we've had debate within the
committee. The Millennium Challenge budget comes before our
committee, and we've been supportive of that effort. Now,
sometimes the argument has been made that this subtracts from
various other categorical grant programs. And, as Mr. Kunder
has said, there is an attempt on the part of the State
Department to rationalize, with Ambassador Tobias now, all the
programs. It was a bold initiative, in my judgment, by
Secretary Rice. The jury is still out on how all this works,
what finally occurs. And Mr. Kunder is a large part of trying
to make certain it does work well. But this is certainly a
debatable area, as to how allocations go. And when we get over
to the Agriculture Committee and the budget there, we have a
whole new set of arguments, a potential new farm bill next
year. Many groups have pointed out this offers a remarkable
opportunity, in terms of nutrition in this country, as well as
abroad, which, indeed, it does.
So, these are important issues to be before the Senate, and
the Congress as a whole, as well as the administration,
because, essentially, eventually people negotiate and try to
work out, really, what the resources are that are going to
occur, and in what form. And that's the reason we've initiated
that question as a part of this panel.
Let me just ask, maybe as a final summary question--we've
raised the issues of the first Millennium Development Goal. And
Secretary Veneman and UNICEF provided this report, Progress for
Children, a report card on nutrition, as of--and this is number
4--as of May 2006. All of you, I'm certain, have seen the
report. Maybe there are other reports that offer indicators of
progress. Who's in charge? How do we organize this? How do we
know what is occurring? And at least this report does have maps
and statistics, and so forth.
Let me just ask, first of all, for reaction that any of you
might have to the report. And, second, are there other reports,
or is there other data, that ought to be made a part of this
record so that at least at this benchmark time, as we have
oversight of this area, we're aware of that and can include
that in this record?
Secretary Veneman, let me ask you, first of all, to comment
on the report you have thoughtfully produced and distributed to
all of us.
Ms. Veneman. Mr. Chairman, I appreciate this question,
because I think--as I said earlier, I think that being able to
access data, the best available data, to determine where the
gaps are in reaching agreed goals is absolutely critical to
putting resources in the right places. UNICEF began this
process awhile back to take--we do two of these Progress for
Children reports each year.
The Chairman. I see.
Ms. Veneman. And we began a process awhile back of taking
each Millennium Development Goal that applies to children--we
like to say ``Children are at the heart of the Millennium
Development Goals''--and to address each of those issues
separately and to measure the progress that we know has been
made, or not made.
On Thursday, I will be releasing the next in the series. It
will be on Millennium Development Goal 7 and the target,
particularly, on water and sanitation.
The Chairman. Is that what the area is, on 7?
Ms. Veneman. Right.
The Chairman. Water and sanitation.
Ms. Veneman. Well, it's on environment.
The Chairman. I see.
Ms. Veneman. Millennium Development Goal 7 covers the
environment, generally, but water and sanitation, and reducing
the number--I mean, the percentage of people without clean
water and sanitation, is the--one of the key targets there. It
will show that the world has made considerable progress in
addressing the issue of clean water. Sanitation is much further
behind. But, in fact, all of these issues, as you know, really
intersect with each other. I mean, as we've talked about today,
clean water and sanitation are critical to whether or not a
child actually can maintain accurate--or adequate nutrition,
because if they have diarrheal diseases, obviously they're
going to suffer from malnutrition, as well.
And so, we are looking--we, just last week, held a big
symposium on MDG4, child survival. And, again, the progress is
very uneven, but we are seeing some promising programs that do,
with an integrated, you know, nutrition-and-healthcare
approach, begin to reduce those absolute percentages in so many
of the areas. I think one of the most difficult has been
maternal mortality, very difficult to both measure and to get
good results.
Education, I think the--we've done a report on education,
showing that the world is making tremendous progress in
universal primary education, which is the measure of the
education goal, although it is lacking somewhat in the overall
gender-equity goal, and, particularly, there are still less
girls than boys in school, and that is something we have to
address worldwide.
So, I think as you look at the whole range, it is important
to look at the progress and see what kind of actions we need to
take in the next 9 years, before the deadline of 2015, to make
these a reality. I think if we all have a sense of urgency, we
can do it.
The Chairman. Mr. Morris.
Mr. Morris. I would call your attention to this remarkable
document that UNICEF produces each year, the State of the
World's Children. In terms of an analysis, as well as a factual
report on annual progress, this is the bible in the world.
I would also call your attention to our publication this
year, Hunger and Learning, which is one of the undergirding
documents of the Ending Child Hunger Initiative.
[Editor's note.--The publication mentioned were not
reproducible in this hearing but will be maintained in the
committee's permanent record.]
Reform of U.S. overseas development assistance is really
important, and I would hope that one of the longer term
measurements, on how the reform works is a measurement of the
outcome of improving child nutrition around the world. This is
at the base of all the Millennium Development Goals--hunger and
nutrition--you can't make progress on any of them if people are
starving and poorly nourished.
And my final comment, sir, would be, as we talk about
sustainability. I don't believe there is any better approach to
people being able to sustain themselves, than to be healthy, to
be well nourished, to be educated, and to be productive. That
gives them the capacity to take care of themselves, to sustain
their families, and ultimately their communities. We have a
huge debate about sustainability, but, I don't know how you
fill the bucket up, other than a drop at a time or addressing
the issues a child at a time.
And the fact of the matter is, parents around the world are
the same as they are in Indiana. They care about their kids.
And when they learn that washing hands with soap works, they'll
buy the soap. And communities, when they learn that children
are fed at school they will build new schools and their parents
will volunteer, just like they do in our hometown. And this is
not only the essence of community-building, but also the
essence of sustainability.
Thank you.
The Chairman. Yes, Mr. Ward.
Ambassador Ward. Mr. Chairman, I would just like to comment
on the importance of having really good data about outcomes in
our programs. And that is not an area in which, in the past,
either governments or NGOs have excelled. We know how much
money we've put in. We have, in the past, not always known
what's come out.
And we've realized this at World Vision, and, some years
ago, we formulated a series of transformational development
indicators that are very concrete. We're looking now at how
those transformational development indicators and the
Millennium Challenge Goals can really come together. And we're
using them in our programs to provide--and we survey each of
our programs every 3 years--to provide measurable data. So,
over time, we'll be able to present to our--to the growing
group of Americans who are concerned about these issues,
through vehicles, such as the ONE Campaign that unites NGOs and
private industry and so many others in advocacy for the poor,
will be able to present hard data that will hopefully be
compelling and provide a consensus for moving forward on these
issues.
The Chairman. Dr. Gerberding.
Dr. Gerberding. Just a quick observation. I couldn't agree
more with the importance of data and science and evidence
being, ultimately, the driver of all this, but I think we've
used data for a long time to try to draw attention to the
problems. I started out with some data about the number of
children who die from various conditions every day around the
world. But I think it's now time to use that data to deliver
the solutions and to let people know that it isn't just about
the problem. We know what to do. We have the solutions, and
it's a good investment in their resources to help us move those
solutions out into broader and broader communities. Success
sells. And I think we need to put as much emphasis on what does
work as we do on what are the problems remaining to be solved.
The Chairman. Mr. Kunder.
Mr. Kunder. Sir, we make available an annual report to the
Congress on the Child Survival and Health Account. I think this
gets at some of the questions of Senator Sarbanes--that is an
overview of how we are spending the money that the Congress has
entrusted to us in this area. Also, in preparation for this
hearing, one of the documents I read was something called
Infant and Young Child Feeding. It's what USAID calls a
``program and technical report.'' We'd be glad to make that
available to the committee, as well, for possible incorporation
in the record.
[Editor's note.--The information mentioned was not
reproducible in this hearing but will be maintained in the
committee's permanent record.]
Mr. Kunder. But it's a primer on some of the critical
issues that we've been discussing today.
The Chairman. That would be very helpful.
Let me just offer, anecdotally, that one of the great
points of emphasis of our committee has been governmental
corruption, or corruption of delivery systems. We've taken a
look at the inter-development bank businesses and the World
Bank and elsewhere. And the World Bank meeting has just been
seized with this problem in which there was quite an
international conversation about the rigor that the World Bank
and its bureaucracy ought to have with this. But it was a
healthy conversation, I think, with a good outcome.
For other purposes, we went to study weapons of mass
destruction in Albania, 2 years ago. I found one of the great
preoccupations of the Albanian Government was the Millennium
Challenge program. Albania had not been on the list of
countries being considered. And one reason was the pervasive
corruption in almost all elements of that government with a
closed society that had opened up but had all sort of problems.
But the fact was, the Albanians, seeing this program, wanted to
know, ``How do we get in line? What do we need to do?'' And
they appreciated that in order to do that, they would have to
clear up the pervasive corruption in their government. We could
hardly have asked for more than governments that were not even
involved in our programs to be seeking to be a part of that
situation.
I returned this year, and they've made a lot of headway.
They are on a provisional list, sort of a watchlist of people
taking a look, now, very carefully. But there was no data from
Albania. The data from Albania now is just beginning to come
in. And, as you've all pointed out, there are gaps in the
reports that we have looked at in which data are just not
available. This always leads us to believe, here on this
committee, as we examine international organizations, even
reputable banks and so forth, that without there being this
kind of oversight, this determination, on the part not just of
our country, but the world, to monitor the delivery of the
services--Does the bridge get built? Does the road ever
happen?--quite apart from whether the food is delivered.
Now, each of you have these problems in the organizations
that you head, or that you supervise. And they're not easy. And
the farther out you get into various difficult areas of the
world, the more that's going to be a problem. And, in some
cases, maybe you have to make compromises, that in order to
feed starving people, whether you're fastidious to a fault,
that somebody actually puts it in that place, to that person,
it sort of breaks down. But I raise this point, because I think
it is important that there are world standards that I believe
are improving for both data--reporting--and at least the
perception of corruption, if not the rooting out of it. And our
committee reports on this corruption did not really make great
waves in this country. But I would just say, abroad, this
really created some waves as the free press, or not so free
press in some places, began to pick up on this. And just making
Mr. Morris's point again, or Ms. Veneman's, often the country
itself has to take some responsibility for the plan, as well as
for the execution. And to the extent that there is a more
visible free press or NGOs really are pervasive, in terms of
their outlook, the quality of that delivery and what actually
happens to real people in this life is likely to improve, we
think.
So, all of these things are interrelated, and we've taken
advantage, maybe, of a conference or a hearing today on world
hunger to try to make that point about these intersections,
both governmentally, as well as even in the cultures, various
governments.
Let me ask, before we conclude the hearing, if anyone has a
final comment that you would like to make that would be a part
of our record today.
Yes, Mr. Kunder.
Mr. Kunder. If the committee would just indulge me for one
minute, sir. All of us lead organizations, have really
courageous and highly skilled technical people in the field,
and I just would like to note, for the record, that two of our
staff were killed in Nepal during the helicopter crash in the
last couple of days--Margaret Alexander, one of our senior
Foreign Service officers, and Dr. Bijnan Acharya, who was one
of our Foreign Service nationals from Nepal, one of those folks
who works for the U.S. Government and their own people around
the world very skillfully and courageously. And all of us lead
organizations where a lot of people have folks at risk all the
time, certainly in Darfur right now, just appreciate the
opportunity to mention this in front of the committee.
The Chairman. Well, I thank you for doing so, and for that
recognition.
Well, we appreciate the witnesses very much, your original
testimony, and your forthcoming responses to our questions.
The hearing is adjourned.
[Whereupon, at 11:15 a.m., the hearing was adjourned.]