[House Hearing, 110 Congress]
[From the U.S. Government Publishing Office]
HEARING TO REVIEW SHORT AND LONG TERM COSTS OF HUNGER IN AMERICA
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON DEPARTMENT OPERATIONS,
OVERSIGHT, DAIRY, NUTRITION, AND FORESTRY
OF THE
COMMITTEE ON AGRICULTURE
HOUSE OF REPRESENTATIVES
ONE HUNDRED TENTH CONGRESS
SECOND SESSION
__________
JULY 23, 2008
__________
Serial No. 110-43
Printed for the use of the Committee on Agriculture
agriculture.house.gov
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COMMITTEE ON AGRICULTURE
COLLIN C. PETERSON, Minnesota, Chairman
TIM HOLDEN, Pennsylvania, BOB GOODLATTE, Virginia, Ranking
Vice Chairman Minority Member
MIKE McINTYRE, North Carolina TERRY EVERETT, Alabama
BOB ETHERIDGE, North Carolina FRANK D. LUCAS, Oklahoma
LEONARD L. BOSWELL, Iowa JERRY MORAN, Kansas
JOE BACA, California ROBIN HAYES, North Carolina
DENNIS A. CARDOZA, California TIMOTHY V. JOHNSON, Illinois
DAVID SCOTT, Georgia SAM GRAVES, Missouri
JIM MARSHALL, Georgia MIKE ROGERS, Alabama
STEPHANIE HERSETH SANDLIN, South STEVE KING, Iowa
Dakota MARILYN N. MUSGRAVE, Colorado
HENRY CUELLAR, Texas RANDY NEUGEBAUER, Texas
JIM COSTA, California CHARLES W. BOUSTANY, Jr.,
JOHN T. SALAZAR, Colorado Louisiana
BRAD ELLSWORTH, Indiana JOHN R. ``RANDY'' KUHL, Jr., New
NANCY E. BOYDA, Kansas York
ZACHARY T. SPACE, Ohio VIRGINIA FOXX, North Carolina
TIMOTHY J. WALZ, Minnesota K. MICHAEL CONAWAY, Texas
KIRSTEN E. GILLIBRAND, New York JEFF FORTENBERRY, Nebraska
STEVE KAGEN, Wisconsin JEAN SCHMIDT, Ohio
EARL POMEROY, North Dakota ADRIAN SMITH, Nebraska
LINCOLN DAVIS, Tennessee TIM WALBERG, Michigan
JOHN BARROW, Georgia BOB LATTA, Ohio
NICK LAMPSON, Texas
JOE DONNELLY, Indiana
TIM MAHONEY, Florida
TRAVIS W. CHILDERS, Mississippi
______
Professional Staff
Robert L. Larew, Chief of Staff
Andrew W. Baker, Chief Counsel
April Slayton, Communications Director
William E. O'Conner, Jr., Minority Staff Director
______
Subcommittee on Department Operations, Oversight, Nutrition, and
Forestry
JOE BACA, California, Chairman
EARL POMEROY, North Dakota CHARLES W. BOUSTANY, Jr.,
LINCOLN DAVIS, Tennessee Louisiana, Ranking Minority Member
NICK LAMPSON, Texas JERRY MORAN, Kansas
STEVE KAGEN, Wisconsin STEVE KING, Iowa
NANCY E. BOYDA, Kansas RANDY NEUGEBAUER, Texas
Lisa Shelton, Subcommittee Staff Director
(ii)
C O N T E N T S
----------
Page
Baca, Hon. Joe, a Representative in Congress from California,
opening statement.............................................. 1
Prepared statement........................................... 3
Boustany, Jr., Hon. Charles W., a Representative in Congress from
Louisiana...................................................... 4
Goodlatte, Hon. Bob, a Representative in Congress from Virginia,
prepared statement............................................. 6
Kagen, Hon. Steve, a Representative in Congress from Wisconsin,
opening statement.............................................. 7
Moran, Hon. Jerry, a Representative in Congress from Kansas,
prepared statement............................................. 6
Peterson, Hon. Collin C., a Representative in Congress from
Minnesota, prepared statement.................................. 5
Witnesses
Nord, Dr. Mark, Sociologist, Economic Research Service, U.S.
Department of Agriculture, Washington, D.C.; accompanied by
Steven Carlson, Director, Office of Research and Analysis, Food
and Nutrition Service, U.S. Department of Agriculture.......... 8
Prepared statement........................................... 10
Brown, Dr. J. Larry, Visiting Scholar, Harvard University School
of Public Health, Boston, MA; accompanied by Donald S. Shepard,
Ph.D., Professor and Economist, Schneider Institutes for Health
Policy, Heller School, Brandeis University, Waltham, MA........ 20
Prepared statement of Dr. Brown.............................. 22
Prepared statement of Dr. Shepard............................ 24
Cutts, M.D., Diana B., Faculty Physician, Hennepin Country
Medical Center; Assistant Professor of Pediatrics, University
of Minnesota; Principal Investigator, Children's Sentinel
Nutrition Assessment Program (C-SNAP), Minneapolis, MN......... 68
Prepared statement........................................... 70
Manalo-LeClair, George, Senior Legislative Director, California
Food Policy Advocates, Oakland, CA............................. 73
Prepared statement........................................... 75
Weill, James D., President, Food Research and Action Center,
Washington, D.C................................................ 79
Prepared statement........................................... 80
Submitted Material
McGovern, Hon. James P., a Representative in Congress from
Massachusetts, prepared statement.............................. 6
Submitted report from Joint Center for Political and Economic
Studies Health Policy Institute................................ 99
HEARING TO REVIEW SHORT AND LONG TERM COSTS OF HUNGER IN AMERICA
----------
WEDNESDAY, JULY 23, 2008
House of Representatives,
Subcommittee on Department Operations, Oversight,
Nutrition, and Forestry,
Committee on Agriculture,
Washington, D.C.
The Subcommittee met, pursuant to call, at 10:03 a.m., in
Room 1300, Longworth House Office Building, Hon. Joe Baca
[Chairman of the Subcommittee] presiding.
Members present: Representatives Baca, Pomeroy, Kagen,
Moran, and Boustany.
Staff present: John Riley, Lisa Shelton, Alejandra
Gonzalez-Arias, Tyler Jameson, Kristin Sosanie, Pam Miller, and
Jamie Weyer.
OPENING STATEMENT OF HON. JOE BACA, A REPRESENTATIVE IN
CONGRESS FROM CALIFORNIA
The Chairman. I would like to call the hearing of the
Subcommittee on Department Operations, Oversight, Nutrition,
and Forestry to review the short and long term costs of hunger
in America to order. With that, I would like to begin with an
opening statement and then call on Mr. Boustany to make a
statement and ask any of the ex officios who are here if they
want to make a presentation if they show up.
I would like to start with my opening statements.
Good morning to all of you. And thank you for being here
with the Subcommittee to examine the short and long term costs
of hunger and that is a very important subject now as we look
at what is going on in our country. I am especially grateful to
our outstanding witnesses for making the effort to be here
today. I appreciate your willingness to educate us. And I state
to ``educate us'' on the result of various studies you have
conducted. And the more education we receive, the better, more
knowledgeable we are in dealing with the problem. I would like
to acknowledge our new Ranking Member, Congressman Boustany who
has now taken over the responsibility and will be here. So I
would officially like to recognize him and then welcome him as
the new Ranking Minority Member.
With his medical background, I am sure that he will be able
to provide thoughtful questions and guidance. And I appreciate
you being a medical doctor and caring for many of the patients
in the past. And I am sure you do the same thing here in the
legislature as you look at policies and other directions. I
look forward to working with Members in the Subcommittee on
this issue.
And I would like to state that 35 million people in our
country are food insecure, at risk of going hungry. This is a
statistic that I use regularly to emphasize that hunger is not
just a global problem, but a daily fact of life in our own
states, towns and neighborhoods. Statistics are easily said,
but what is the real meaning? What do the numbers mean to those
of us who are fortunate enough to know where our next meal is
coming from? Who are these people who live and work among us?
Are we truly aware of the impact that hunger has on our daily
lives? What does this mean to us as Members of Congress?
And that is a deep meaning because when you look at really
the poor, the disadvantaged and others that are going hungry in
the true meaning of what it is like to put food on the table,
what information is available to us to guide us in making the
best policies? How can we best serve the needs of hungry
Americans, and at the same time, spend Federal dollars wisely?
Today, with the help of the experts on this panel, we will
begin to answer some of these questions, and I hope we will ask
questions to better understand the problems and carefully
create solutions that will best use our efforts and resources.
That is important, how we use our efforts and the resources.
Over the past 2 years while we were consumed with the work
in the 2007-2008 Farm Bill, some interesting studies were
published. These studies will help us to examine the connection
between nutrition programs and health, but both the health of
individuals and the health of local and state economies.
Although we have just successfully passed the farm bill and
invested more than $10 billion in nutrition, it is always
appropriate for us to take a look at how Congress spends its
hard-earned dollars.
Recent news showed us that food stamps are now feeding more
than 28 million people, a record number. It is vital that we,
both as Congress, as Members of Congress and citizens of this
country, that we fully understand the workings of our country's
largest supplemental feeding program. As I mentioned, hunger is
more than just a number. The impact of hunger hits families,
neighborhoods, towns and states. It is seen through poor
health, poor attendance at both our schools and at work, among
other things. But hunger is also expressed in dollars and
cents. As a father, a grandfather and as an American, I am
distressed by the human cost of hunger. But as a legislator, I
am also troubled by the numbers that illustrate how hunger can
mean a loss to funding for government entities. During these
times of tight budgets, nutrition programs may be some of the
best economic stimulus available. For example, I represent San
Bernardino, California. The studies from the California Food
Policy Advocates, who we will hear from today, show that
because of the low participation in food stamps--and there
again, low participation in food stamps in a lot of the areas
where people are not even aware, and our state is not even
taking advantage of the food stamps; which also means
additional revenue that goes back into each of the states,
cities and counties by that utilization.
But most important is feeding people that need help. San
Bernardino County is missing now an additional $371 million in
economic activity. And that is just the cost in my area. And I
am not sure what it would be for other counties, other states
and other cities. So today we will listen and learn from the
fine panel of witnesses about their work to quantify the impact
of hunger in our country. I hope this hearing will build an
important body of evidence so that we can continue to work
together to fight hunger.
[The prepared statement of Mr. Baca follows:]
Prepared Statement of Hon. Joe Baca, a Representative in Congress from
California
Good morning and thank you all for being here before this
Subcommittee--to examine the short and long term costs of hunger in
America.
I am especially grateful to our outstanding witnesses for making
the effort to be here today.
I appreciate your willingness to educate us on the results of the
various studies you have conducted.
Also, I would like to acknowledge our new Ranking Member,
Congressman Boustany, and thank him for his interest in this hearing.
With his medical background, I am sure he will be able to provide
thoughtful questions and guidance.
I look forward to working with you on this and other issues before
our Subcommittee.
Thirty-five million people in our country are ``food insecure.''
This is a statistic that I use regularly to emphasize that hunger is
not just a global problem, but a daily fact of life in our own states,
towns and neighborhoods.
Statistics are easily said, but what is their real meaning? What
does this mean to those of us fortunate enough to know where our next
meal is coming from? Who are these people who live and work among us?
How are we affected by them and their needs? Are we truly aware of the
impact the hungry have on our daily lives? And what does this mean to
us as Members of Congress? What information is available to us--to
guide us in making the best policy decisions? How can we best serve the
needs of hungry Americans and, at the same time, spend Federal funds
wisely?
Today, with the help of the experts on this panel, we will begin to
answer some of these questions, and, I hope, ask new questions to
better understand the problems and carefully create a solution that
will best use our efforts and resources.
Over the past 2 years--while we were consumed with work on the
2007-2008 Farm Bill--some interesting studies were published. These
studies will help us to examine the connection between nutrition
programs and health; both the health of individuals--and the health of
local and state economies.
Although we just successfully passed a farm bill that invests more
than $10 billion in nutrition--it is always appropriate for us to take
a look at the manner in which Congress spends our hard-earned tax
dollars.
Recent news shows us that Food Stamps are now feeding more than 28
million people--a record number. It is vital that we--both as Members
of Congress and as citizens of this country--fully understand the
intersection between hunger and our country's largest supplemental
feeding program.
As I have mentioned, hunger is more than just a number. The impact
of hunger hits families, neighborhoods, towns and states. It is seen
through poor health, and poor attendance at school and work, among
other things. But hunger is also expressed in dollars and cents.
As a father, grandfather, and a citizen, I am distressed by the
human costs of hunger. But as a legislator, I am also troubled by the
numbers that illustrate how hunger can mean a loss of funding for
government entities. During these times of tight budgets, those of us
who serve in government need to understand that nutrition programs may
be some of the best economic stimulus available.
For example, I represent San Bernardino County, California. The
study from the California Food Policy Advocates, who we will hear from
today, shows that because of low participation in food stamps, San
Bernardino County is missing out on an additional $371 million in
economic activity.
So, today we will listen and learn from this fine panel of
witnesses about their work to quantify the impacts of hunger in our
country. I hope this hearing will build on this important body of
evidence so we can work with determination and cooperation against
hunger.
The Chairman. So at this time, I would like to turn it over
to our Ranking Member, Congressman Boustany, to say a few
words.
OPENING STATEMENT OF HON. CHARLES W. BOUSTANY, Jr., A
REPRESENTATIVE IN CONGRESS FROM LOUISIANA
Mr. Boustany. Thank you, Mr. Chairman. And I want to offer
my thanks to you for holding this hearing on a very important
issue. We have done a lot of work on the farm bill, as you have
said, and we need to build off of this. So I am pleased that
the Subcommittee is starting this process. I want to offer my
greetings to our distinguished panel and I look forward to
hearing your testimony.
Clearly without question, this problem of the cost of
hunger in the United States is a serious problem. And we must
tackle this problem with policies and programs in an effective
way. While everyone is witnessing the effect of increasing
energy costs that we are all seeing at the pump, it is
important to understand how these high prices are impacting
other areas of our economy. The rising prices in grains, other
commodities, increased transportation costs, the regulatory
environment to ensure food safety and the safety of our food
products are causing food prices to rise. All of this is having
an impact. This rise is having a greater impact on low and
middle-income earners. Far too many families, working families,
face difficult decisions about how best to spend their money.
Choosing between food, fuel, housing needs or medical expenses
is a dilemma that many of these families are facing today. And
Congress, I believe, has a responsibility to take the lead in
finding ways to relieve this pressure.
As a surgeon, a heart surgeon, I understand how important a
healthy lifestyle can be in avoiding illness and living a more
active and productive life. And furthermore, I know firsthand
how important a person's eating habits can be in determining
how well they will recover from surgery or other medical
procedures and treatments. And in fact, back when I was in
training, in the early days, we used what we called perinatal
nutrition, intravenous nutrition in the intensive care unit.
Before we had this, patients basically died of starvation
in the intensive care unit because there was no way to feed
them. And one of the great advances in surgery was to come up
with ways to actually provide this IV nutrition as a bridge to
get people through critical illness to boost their immune
systems and boost their ability to ward off disease and to
heal. And without that, the mortality rates in intensive care
units were astronomical. And today we have seen significant
improvement in those mortality rates because of these advances.
That is in a clinical setting.
The same translates outside the clinical setting, outside
the hospital for families who can't afford to provide for their
nutrition. The prevention of a disease or illness is much
cheaper and preferred for the individual in terms of quality as
well as for our society than treatment of the problem at a
later stage. And I know our witnesses will address this topic.
And I look forward to hearing more about these costs and the
impact it is having on our society.
Finally in the most recent farm bill, significant increases
in funding were made available for the Food Stamp Program and
other supplemental nutrition programs. And I am interested to
hear today about how best to improve these programs in order to
achieve higher rates of participation by those families who are
in the greatest need of help. As I have said before, in regard
to other programs, particularly in the health care arena,
having coverage, meaning some sort of insurance or governmental
insurance product to cover health care doesn't necessarily mean
access to this care. There is still a disconnect in health
care.
And we are seeing the same thing, I believe, in these
nutrition programs where we have programs, but if families
aren't availing themselves of the program that is in place,
then it is not doing what we intended it to do. So we really
need to look at this.
So while improving access and delivery of these programs
will improve the lives of millions of deserving Americans,
simply adding more funding to the program will only raise the
burden of every American unless we are making sure that those
dollars are really being used in the most effective way.
So I am committed to tackling this problem of hunger in the
U.S. while also trying to be a responsible steward of the
American taxpayers' money. And I believe today's hearing is an
important one. And I believe that Chairman Baca has a
tremendous passion for this. He brings tremendous insight into
this problem. And I am pleased to work with him on this issue.
So I look forward to the testimony today, Mr. Chairman, thank
you. I yield back my time.
The Chairman. Thank you very much, Mr. Boustany.
I would request that any other Members here that have any
statements they can submit them for the record.
[The prepared statements of Messers. Peterson, Goodlatte,
Moran, and McGovern follow:]
Prepared Statement of Collin C. Peterson, a Representative in Congress
from Minnesota
Thank you Mr. Chairman.
When people think of the Agriculture Committee, one of the things
they rarely think of is hunger and the absence of food. from the farm
policy standpoint, we take great pains to ensure that the country's
farmers are able to continue to provide the nation with a safe, stable,
and abundant supply of food. Unfortunately, the benefits of that food
supply are not necessarily available to all and too many families have
to face the devastating effects of hunger.
With the completion of the 2008 Farm Bill, we took great strides in
fighting hunger here in the United States and abroad. We updated the
Food Stamp Program, indexed benefits to inflation, and even in these
times of budgetary constraints, provided $10 billion in new money for
important nutrition programs like The Emergency Food Assistance Program
(TEFAP).
But our work is not done, because the effects of hunger do not only
apply to those struggling to provide their families with a healthy
meal. The cost of hunger spills over into other areas of society, and
government as well--whether it be through health, education or economic
policies.
That's why I'm glad the Chairman and Ranking Member have called
this hearing today, to help us sort through the costs of hunger in the
short- and long-term. I look forward to the testimony of the witnesses
and thank you all for coming.
______
Prepared Statement of Hon. Bob Goodlatte, a Representative in Congress
from Virginia
I want to thank the witnesses for taking time out of their busy
schedules to join us today to discuss the short and long term effects
of hunger in America. I appreciate you sharing with us the information
you have found through research, studies and personal experiences.
While one may argue more can be done to address hunger, the
recently passed farm bill makes an unprecedented investment in
nutrition programs to the tune of $10.361 billion over current spending
levels. When we talk about the farm bill, many believe all of the
funding goes directly to farmers. The truth is that nearly 70 percent
of the $288 billion goes to the nutrition title alone. This Committee
has made an incredible commitment to nutrition funding that hasn't even
been implemented yet, and still much of today's testimony asks for more
funding.
Before we consider new spending, I think we owe it to the taxpayers
to evaluate the programmatic changes that will be made by the farm
bill. Like the rest of the Members, I will be interested to see how
USDA implements these new provisions. Furthermore, I think it is
important to note that the Food Stamp Program is designed to expand to
fit the need. Food stamp participation is at an all-time high of 28.1
million people. As more people are eligible and choose to participate,
the program will be able to accommodate their needs.
While it is easy to ask for more nutrition funding to solve the
problems, we in Congress have to ask ourselves the tough question--if
we increase funding for nutrition, where are we going to make cuts in
spending? Under PAYGO rules, to increase nutrition spending, we will,
have to cut spending on other meritorious programs or raise taxes.
Given our tight budget situation, I hope we can consider options beyond
providing additional money. Increasing spending without offsets only
adds to our Federal deficit--which also has the short and long term
effects on all of us, our children and the generations to come.
Thank you.
______
Prepared Statement of Hon. Jerry Moran, a Representative in Congress
from Kansas
Like most hearings in this Subcommittee, today's hearing is
important. It is important because the testimony we will hear is not
just about human suffering or about families sitting down to tables
without adequate food on them. This hearing is going to try to get at
the effect, the cost of hunger to our country.
It is clear that hungry students struggle to learn as well as those
with good nutrition. And if today's students are tomorrow's workforce
then we should be worried about under-performance in our economy.
Hungry students struggle to stay awake and pay attention in class. Or
even be in class. Many students cannot even make it to class and
employees to work because of the effect poor nutrition has on the body.
Unfortunately, those who cannot afford food likely cannot afford health
insurance. Without insurance, many of the malnourished in our country
will head to the Emergency Room when they are sick. ERs are the most
expensive way to deliver health care and so everyone else's health care
bills go up, which is one of the largest problems our country faces.
I am glad we have economists here today. This issue often involves
stories and anecdotes that tug at your heart strings. I appreciate
those stories because they draw me in and get me engaged in the issue.
But as this Committee makes decisions on programs that will affect
millions of people we must vote based on data and information that will
help communities, churches and individuals feed the hungry and help
lead them out of poverty.
That is why last year my colleague Jim McGovern and I requested a
hearing like this to look into Dr. Brown's study on the cost of hunger.
I would like to hear from our witnesses how close we are to a fully fed
nation and what programs can help accomplish that. It is very likely
that the investment in our food insecure households could outweigh the
cost to our nation's charities, health care providers, lost educational
opportunities and lowered workforce productivity.
______
Prepared Statement of Hon. James P. McGovern, a Representative in
Congress from Massachusetts
Hon. Joe Baca,
Chairman,
Subcommittee on Department Operations, Oversight, Nutrition, and
Forestry,
Committee on Agriculture,
Washington, D.C.
Dear Chairman Baca,
I commend you on holding today's hearing to review the short- and
long-term costs of hunger in America. As you know, I have long believed
that hunger is a political condition that, while solvable, requires
political leadership. Hearings like these are necessary steps in
raising awareness of the scourge of hunger and, specifically, on the
economic costs of hunger on our society.
Despite the efforts of the Federal Government and the best efforts
of the nonprofit, anti-hunger community, hunger is getting worse in
America. Too many go without food at some point during the year, and
this has a real cost to our nation. Last year, with the help of the
Sodexho Foundation, Dr. J. Larry Brown, Dr. Donald Shepard, Dr. Timothy
Martin, and Dr. John Orwat released a study titled ``The Economic Cost
of Domestic Hunger: Estimate Annual Burden to the United States.''
Stephen J. Brady, President of the Sodexho Foundation, should be
commended for funding this study and for his dedicated work in ending
hunger here in the United States. This important study found that the
minimum cost of hunger is $90 billion, and that the true cost is likely
much more than that. While I believe we have a moral responsibility to
end hunger once and for all, this study makes it clear that hunger is a
real financial burden on our country.
We have opportunities to end hunger in our nation. Although the
domestic nutrition title clearly is not enough to end hunger in
America, the farm bill is a good first step. Next year Congress will
reauthorize the Child Nutrition Programs, where we will have an
opportunity to invest in the school meal programs and after-school
feeding programs. But it's clear we must do more to end hunger once and
for all in America. I believe your hearing today is a good step in that
direction and that it will prove that doing nothing not only impacts
the person who is forced to go without food but that doing nothing
actually has a fiscal impact on this country.
Sincerely,
Hon. James P. McGovern,
Member of Congress.
The Chairman. Before I call on the witnesses, I would like
to call on Steve Kagen to say a few words. Our ex officios are
not here yet.
OPENING STATEMENT OF HON. STEVE KAGEN, A REPRESENTATIVE IN
CONGRESS FROM WISCONSIN
Mr. Kagen. Thank you, Mr. Chairman. I have to point out to
everyone that there are two doctors up here on the podium so it
is two to one, Joe.
The Chairman. Oh, I can be an honorary doctor.
Mr. Kagen. We will make you a doctor of nutrition. I will
just point out to everyone here in the room, everyone listening
across the country that we are seven meals away from anarchy.
If you take food away from people for seven meals in a row, as
we saw in Louisiana and parts of Mississippi with Katrina, we
human beings cease to be civilized human beings. So I take this
issue of nutrition, this other issue of housing, our economy
very seriously. But if our children are not getting the
nutrition that they require to develop into healthy productive
citizens, we will all pay that price over the long term.
In my district, northeastern Wisconsin in Green Bay, the
City of Green Bay, 45 percent of the children attending public
school now qualify for free or reduced meals at school. Now
that is a generational shift, and I think my district really
mirrors the country. I look forward to your testimony today.
And if I don't have the opportunity to hear you outright here,
I will be studying your testimony. I look forward to your
communications with our Committee. I think you will find that
all of us understand the value of good nutrition and aiming at
our target correctly, getting our resources to those who need
it the most. And I look forward to working together with you,
Mr. Chairman, to guarantee that hunger in America becomes
something, where it belongs, in our past. Thank you.
The Chairman. Thank you very much. With that, I would like
to introduce members of the panel that are here. I would like
to welcome you again. Thank you very much for taking time from
your busy schedule to inform us and give us the kind of
knowledge that will make the kind of programs more effective
and also deal with the problems that we have with hunger. We
want to be cost effective in the programs that we have as we
look at Federal and state to make sure that they are utilized
effectively and not just put in the money to address the issue.
We want to actually address the issue by allowing the people
that need the assistance that do qualify will get it in each of
our counties, in each of our states as well.
With that, I would like to thank Dr. Mark Nord,
Sociologist, Economic Research Service, USDA, Washington, D.C.
Welcome and thank you for being here. And he will be
accompanied by Steven Carlson, Director, Office of Research and
Analysis, Food and Nutrition Service with the U.S. Department
of Agriculture from Washington, D.C. And then we also have Dr.
J. Larry Brown from Harvard University School of Public Health,
Boston, Massachusetts, accompanied by Donald S. Shepard,
Economist, as well from the Heller School, Brandeis University
from Waltham, Massachusetts. And also we have Dr. Diana Cutts,
Principal Investigator of Children's Sentinel Nutrition
Assessment Program, and Faculty Physician of Hennepin County
Medical Center, and Assistant Professor at the University of
Minnesota, Minneapolis, Minnesota. And then, of course, we have
Mr. George Manalo-LeClair, Senior Legislative Director from the
California Food Policy Advocates from Oakland, California. And
then we have James D. Weill, President of Food Research and
Action Center from Washington, D.C. With that, let us begin by
asking Dr. Nord to begin with his testimony.
STATEMENT OF DR. MARK NORD, SOCIOLOGIST, ECONOMIC RESEARCH
SERVICE, U.S. DEPARTMENT OF AGRICULTURE, WASHINGTON, D.C.;
ACCOMPANIED BY STEVEN CARLSON,
DIRECTOR, OFFICE OF RESEARCH AND ANALYSIS, FOOD AND NUTRITION
SERVICE, U.S. DEPARTMENT OF
AGRICULTURE
Dr. Nord. Mr. Chairman, Members of the Committee, my name
is Mark Nord. I am a Sociologist with USDA's Economic Research
Service. My main expertise is in measuring and monitoring
household food security, by which we mean households'
consistent ability to afford adequate food. I appreciate the
opportunity to speak to you today about food security and how
USDA measures it. I am accompanied by Steven Carlson of the
Food and Nutrition Service, who will also be available to
answer questions.
I will begin with these national statistics and then I want
to go behind these statistics to describe how the food security
of these households was measured. The reason for giving some
detail on measurement is to provide as adequate an idea as
possible of what the statistics mean. Our two word labels
unfortunately don't really give adequate information about
whether the conditions in food-insecure households are serious
or not or how serious they are. Knowing the specific conditions
that the households in each category reported will give a more
complete picture of what the statistics mean.
So 2006, our most recently published statistics, 89 percent
of U.S. households were food secure throughout the entire year.
They had access at all times to enough food for an active,
healthy life for all household members. The remaining 10.9
percent were food insecure. They were unable at times during
the year to put adequate food on the table. These included four
percent with the more severe condition we describe as very low
food security. In these households, food insecurity was severe
to the extent that food intake of some members was reduced and
their eating patterns were disrupted at times during the year.
The statistics come from a nationally representative survey of
about 45,000 households and it is conducted by the Census
Bureau for USDA.
The food security of each household is assessed by a series
of questions about their food situation. Questions range in
severity from worrying about running out of food to not eating
for a whole day. So let's look at responses to those specific
questions to see what conditions were actually reported by
households in each range of food insecurity.
I should mention first that the food security of a
household is determined by how many of these conditions they
report. And to be classified as food insecure, a household must
report at least three indicators of food insecurity. The more
severe condition, very low food security is indicated by
reports of six or more indications of food insecurity. You can
think about the difference between low and very low food
security as the difference between the reduced quality of food
and reduced quantity or sufficiency of food intake. Households
classified as having low food security--so this is the part of
the food insecure population that is included in the 11 percent
but not the four percent--the low food secure households
basically report reductions in quality or variety of their
diets but typically report few, if any, indications of reduced
food intake. In 2006 households in this group, low food
security, that are represented by the middle blue bars here,
middle blue colored bars, and you is see they reported the
least conditions. They couldn't afford to eat balanced meals,
the food they bought didn't last, and they didn't have money to
get more and they were worried that their food would run out.
Few of them reported having to reduce the quantity of their
food intake.
On the other hand, households classified as having very low
food security--this is the four percent of households in the
more severe category--in 2006, almost all of them reported that
an adult had cut the size of meals or skipped meals because
there was not enough money for food, that they had eaten less
than they felt they should because there was not enough money
for food. And most reported that they had been hungry but did
not eat because they could not afford enough food. One in three
reported that an adult in the household did not eat for a whole
day because there was not enough money for food. This is what
it means to have very low food security, to experience these
conditions at times during the year.
It is important when interpreting these statistics to keep
in mind that food insecurity in the U.S. is not usually
chronic. So the prevalence on a given day, a typical day is
much lower than our statistics which reflect whether this
happened at any time during the year.
Two more quick graphics now to wrap up. Children are
usually protected from substantial reductions in food intake
even in households with very low food security among adults. In
2006, \6/10\ of 1 percent of households with children had
conditions so severe that children also were subject to reduced
food intake and disrupted eating patterns, that was about
221,000 households.
Over the last decade, the prevalence of food insecurity has
moved approximately in parallel with the national poverty rate,
it declined in the late 1990s, increased following the
recession in 2001, declined after 2004. The prevalence of very
low food security followed a similar pattern, except that it
has remained essentially flat at four percent since 2004. Mr.
Chairman, this concludes my statement. I will be glad to answer
questions the Committee may have.
[The prepared statement of Dr. Nord follows:]
Prepared Statement of Dr. Mark Nord, Sociologist, Economic Research
Service, U.S. Department of Agriculture, Washington, D.C.
Mr. Chairman and Members of the Committee, my name is Mark Nord,
and I am a sociologist with the USDA's Economic Research Service. My
main area of expertise is measuring and monitoring household food
security--the extent to which households can consistently afford
adequate food. I appreciate the opportunity to speak to you today about
how USDA measures household food security and to provide an overview of
recent food security statistics. I am accompanied by a representative
of USDA's Food and Nutrition Service, who will also be available to
answer questions.
Food security is a foundation for a healthy and well-nourished
population--and food security statistics are a measure of the strength
of that foundation. Information on unmet food need is of particular
interest to USDA because of its responsibility for the Federal food and
nutrition assistance programs.
I will begin with two or three salient food security statistics and
then go behind those statistics to describe how households' food
security was measured. Understanding the specific food conditions
households reported in order to be classified as food insecure, or as
having very low food security, may provide policy officials the best
sense of what the food security numbers mean and how serious the
conditions described by the statistics are. I will then conclude with a
few further national-level statistics.
Household Food Security in the United States, 2006
Most Americans can afford to put enough healthful food on the table
each day. USDA estimates that slightly more than 89 percent of U.S.
households were food secure throughout the entire year in 2006 (figure
1). Food secure households had access at all times to enough food for
an active, healthy life for all household members. The remaining 12.6
million households (10.9 percent) were food insecure at some time
during the year.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Source: Calculated by USDA, Economic Research Service using
data from the December 2006 Current Population Survey Food
Security Supplement.
About \2/3\ of food-insecure households--those with low food
security--obtained enough food to avoid substantial disruptions in
eating patterns and food intake, using a variety of coping strategies
such as eating less varied diets, participating in Federal food and
nutrition assistance programs, or obtaining emergency food from
community food pantries or emergency kitchens. But 4.6 million
households (4.0 percent of all U.S. households) had very low food
security--that is, they were food insecure to the extent that eating
patterns of one or more household members were disrupted and their food
intake reduced, at least some time during the year, because they
couldn't afford enough food.
Behind the Statistics: How Does USDA Measure Household Food Security?
USDA monitors the food security of the nation's households through
an annual food security survey conducted by the U.S. Census Bureau. The
survey is administered each December as a supplement to the Current
Population Survey (CPS)--the same survey that provides monthly
employment and unemployment statistics and annual income and poverty
statistics. A nationally representative sample of about 45,000
households complete the food security survey each year.
The food security of each interviewed household is assessed by a
series of questions about behaviors, conditions, and experiences that
are related to households' food access. The questions cover a wide
range of severity of food access problems, from worrying that food will
run out to not eating for a whole day. Each question asks whether the
condition or behavior occurred at any time during the previous 12
months and specifies a lack of money as the reason for the behavior or
condition in question so that reduced food intake due to voluntary
fasting or dieting does not affect the measure. The series includes 10
questions about food conditions of the household as a whole and of
adults in the household and, if there are children present in the
household, an additional eight questions about their food conditions.
The food security questions are listed in Appendix A.
The food security status of each household is determined by the
number of food-insecure conditions they report. Households are
classified as food secure if they report no food-insecure conditions or
if they report only one or two food-insecure conditions. They are
classified as food insecure if they report three or more food-insecure
conditions.
Food-insecure households are further classified as having either
low food security or very low food security. Households classified as
having low food security have reported multiple indications of food
access problems and reductions in the quality or variety of their
diets, but typically have reported few, if any, indications of reduced
food intake. Households classified as having very low food security
have reported multiple indications of reduced food intake and disrupted
eating patterns due to inadequate resources for food.
What Are the Food Conditions in Households with Low and Very Low Food
Security?
The responses of households in the December 2006 food security
survey clearly reflect the difference between low and very low food
security (figure 2). Households with low food security (about \2/3\ of
food-insecure households) reported mainly reductions in diet quality
and variety (they could not afford to eat balanced meals) and
difficulties and worries about food access. They typically report few
if any indications of reductions in quantity of food intake.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Source: Calculated by USDA, Economic Research Service using
data from the December 2006 Current Population Survey Food
Security Supplement.
The defining characteristic of very low food security is that, at
times during the year, the food intake of household members is reduced
and their normal eating patterns are disrupted because the household
lacks money and other resources for food. Households classified as
having very low food security in the 2006 survey reported the following
specific conditions:
98 percent reported having worried that their food would run
out before they got money to buy more.
96 percent reported that the food they bought just did not
last and they did not have money to get more.
94 percent reported that they could not afford to eat
balanced meals.
95 percent reported that an adult had cut the size of meals
or skipped meals because there was not enough money for food.
85 percent reported that this had occurred in 3 or more
months.
In 95 percent, respondents reported that they had eaten less
than they felt they should because there was not enough money
for food.
In 69 percent, respondents reported that they had been
hungry but did not eat because they could not afford enough
food.
In 46 percent, respondents reported having lost weight
because they did not have enough money for food.
33 percent reported that an adult did not eat for a whole
day because there was not enough money for food.
24 percent reported that this had occurred in 3 or more
months.
When interpreting food security statistics, it is important to keep
in mind that households are classified as having low or very low food
security if they experienced the condition at any time during the
previous 12 months. The prevalence of these conditions on any given day
is far below the corresponding annual prevalence.
How Does Food Insecurity Relate to Hunger?
Several years ago, USDA asked the Committee on National Statistics
(CNSTAT) of the National Academies to convene an expert panel to ensure
that the measurement methods used to assess households' access--or lack
of access--to adequate food were conceptually and operationally sound.
One of the central issues the CNSTAT panel addressed was the concept
and definition of hunger and the relationship between hunger and food
insecurity.
The CNSTAT panel recommended that USDA make a clear and explicit
distinction between food insecurity and hunger. Food insecurity is a
household-level economic and social condition of limited or uncertain
access to adequate food. Hunger is an individual physiological
condition that is a potential, although not inevitable, outcome of food
insecurity. By measuring and monitoring food insecurity, USDA provides
important information about the social and economic context in which
hunger may occur, and contributes to the effective operation of the
domestic nutrition assistance programs that provide millions of
children and low-income people access to food, a healthful diet, and
nutrition education.
Household Food Security in the United States, 2006--A Few More
Statistics
Children in most food-insecure households--even in households with
very low food security among adults--were protected from substantial
reductions in food intake. However in about 221,000 households (0.6
percent of households with children) one or more children were also
subject to reduced food intake and disrupted eating patterns at some
time during the year (figure 3). In some households with very low food
security among children, only older children may have been subjected to
the more severe effects of food insecurity while younger children were
protected from those effects.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Source: Calculated by USDA, Economic Research Service using
data from the December 2006 Current Population Survey Food
Security Supplement.
The prevalence of food insecurity varies considerably among
different types of households. In 2006, rates of food insecurity were
well below the national average for households with two or more adults
and no children (6.5 percent) and for households with one or more
members over the age of 65 (6.0 percent). Rates of food insecurity were
substantially higher than the national average for households with
incomes below the poverty line (36.3 percent), households with children
headed by single women (30.4 percent) or single men (17.0 percent), and
for Black and Hispanic households (21.8 percent and 19.5 percent,
respectively).
Over the last decade, the prevalence of food insecurity has moved
approximately in parallel with the national poverty rate, declining in
the late 1990s, increasing following the recession of 2001, and
declining after 2004 (figure 4). The prevalence of very low food
security has remained essentially unchanged since 2004.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Note: Two year rolling averages are presented for 1996-2001 to
smooth seasonal fluctuations.
Source: Calculated by USDA, Economic Research Service using
data from the December 2006 Current Population Survey Food
Security Supplement.
Mr. Chairman, this concludes my statement. I will be glad to answer
questions the Committee may have.
Appendix A
Questions Used To Assess the Food Security of Households in National
Surveys
1. ``We worried whether our food would run out before we got money
to buy more.'' Was that often, sometimes, or never true for you
in the last 12 months?
2. ``The food that we bought just didn't last and we didn't have
money to get more.'' Was that often, sometimes, or never true
for you in the last 12 months?
3. ``We couldn't afford to eat balanced meals.'' Was that often,
sometimes, or never true for you in the last 12 months?
4. In the last 12 months, did you or other adults in the household
ever cut the size of your meals or skip meals because there
wasn't enough money for food? (Yes/No)
5. (If yes to Question 4) How often did this happen--almost every
month, some months but not every month, or in only 1 or 2
months?
6. In the last 12 months, did you ever eat less than you felt you
should because there wasn't enough money for food? (Yes/No)
7. In the last 12 months, were you ever hungry, but didn't eat,
because there wasn't enough money for food? (Yes/No)
8. In the last 12 months, did you lose weight because there wasn't
enough money for food? (Yes/No)
9. In the last 12 months did you or other adults in your household
ever not eat for a whole day because there wasn't enough money
for food? (Yes/No)
10. (If yes to Question 9) How often did this happen--almost every
month, some months but not every month, or in only 1 or 2
months?
(Questions 11-18 Are Asked Only if the Household Included Children Age
0-18)
11. ``We relied on only a few kinds of low-cost food to feed our
children because we were running out of money to buy food.''
Was that often, sometimes, or never true for you in the last 12
months?
12. ``We couldn't feed our children a balanced meal, because we
couldn't afford that.'' Was that often, sometimes, or never
true for you in the last 12 months?
13. ``The children were not eating enough because we just couldn't
afford enough food.'' Was that often, sometimes, or never true
for you in the last 12 months?
14. In the last 12 months, did you ever cut the size of any of the
children's meals because there wasn't enough money for food?
(Yes/No)
15. In the last 12 months, were the children ever hungry but you
just couldn't afford more food? (Yes/No)
16. In the last 12 months, did any of the children ever skip a meal
because there wasn't enough money for food? (Yes/No)
7. (If yes to Question 16) How often did this happen--almost every
month, some months but not every month, or in only 1 or 2
months?
18. In the last 12 months did any of the children ever not eat for
a whole day because there wasn't enough money for food? (Yes/
No)
Household food security status is determined by the number of food-
insecure conditions reported. (Food-insecure conditions are indicated
by responses of ``often'' or ``sometimes'' to questions 1-3 and 11-13,
``almost every month'' or ``some months but not every month'' to
questions 5, 10, and 17, and ``yes'' to the other questions.)
Households are classified as food secure if they report no food-
insecure conditions or if they report only one or two food-insecure
conditions. They are classified as food insecure if they report three
or more food-insecure conditions.
Food insecure households are further classified as having low or
very low food security by the following criteria:
For households with no child present, 3-5 food-insecure
conditions indicates low food security and 6-10 indicates very
low food security.
For households with one or more children, 3-7 food-insecure
conditions indicates low food security and 8-18 indicates very
low food security. Five or more food-insecure conditions among
the children (that is, in response to questions 11-18)
indicates very low food security among children.
Attachments
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
The Chairman. Thank you very much, Dr. Nord.
Next I would like to call on Dr. Brown.
STATEMENT OF DR. J. LARRY BROWN, VISITING SCHOLAR, HARVARD
UNIVERSITY SCHOOL OF PUBLIC HEALTH,
BOSTON, MA; ACCOMPANIED BY DONALD S. SHEPARD, Ph.D., PROFESSOR
AND ECONOMIST, SCHNEIDER INSTITUTES FOR HEALTH POLICY, HELLER
SCHOOL, BRANDEIS UNIVERSITY, WALTHAM, MA
Dr. Brown. Thank you, Mr. Chairman, Members of the
Committee. The United States is actually very unique among
industrial democracies because we let so many of our people go
hungry; year after year. You have heard, and if you have seen
the reports from USDA and Census Bureau, say, over the last 5
or 6 years, it ranges from 33 to 38 million people living in
households that don't have enough to eat. So what we once
termed a hunger epidemic back in the 1980s has now actually
just become a real part of our national landscape. And we are
letting this problem remain virtually the same from year to
year, a little bit of fluctuation, but basically the same.
And before I turn to the results of our study on the cost
burden of hunger, I will at least mention some of the things
that we know about the health and cognitive effects of hunger,
what it does to the minds and bodies of children.
Two or 3 decades ago I used to teach my public health and
medical students that while hunger impacts one's health status,
it seldom has had an effect on the brain, at least
morphologically. We now know that this is not true. Science now
knows that there is no safe level of hunger. When a child is
forced to go without enough to eat, his body or her body
suffers and the brain function is impaired. And the same is
true for adults, particularly the vulnerable elderly. The body
and brain require sufficient energy just as our cars do in
order to run. A child sitting in the classroom without
breakfast does not have the cognitive capacity to take part in
the educational process. Her body, in other words, is there in
the classroom but her mind is elsewhere. She is not fueled to
learn. And when the body doesn't have enough nutrition, even on
a short-term basis, it goes into triage. Just like triage on
the battlefield, the body must decide how to allocate
insufficient nutritional resources. And the first priority is
to maintain critical organ function. The next priority of
course if there is enough dietary energy is for normal height
and weight gain, to maintain health.
And the final priority is for brain function. So that child
in the classroom may be present in body, but she came through
the schoolhouse door with one arm tied behind her back not
because she lacks innate ability, but simply because she
doesn't have the dietary wherewithal to learn.
So in short, Members, we now know in science that hunger
produces startling effects on the mind and body, things we just
did not know even 2 decades ago.
And while this is true for both adults and children, most
of the research is focused on the young because we can more
easily track their growth and their educational development.
Children without enough to eat, science now shows: get sick
more frequently, particularly in terms of preventable outcomes;
they have more difficulty overcoming illnesses once they occur;
they miss school more often due to illnesses; they experience
more behavioral disorders, aggressiveness and as well as sullen
and withdrawn behavior; and they do less well in terms of
grades and on standardized test scores.
So it is in this context of these outcomes that the Sodexho
Foundation commissioned me along with three other scholars to
look at the costs. In other words, the question was, do we pay
more in terms of illness and lost productivity in educational
outcomes than if there were no hunger in America?
So I am joined here today by Dr. Donald Shepard to my left,
an Economist from Brandeis, who has done similar cost burden
analyses including that of dengue fever. Sodexho is known for
its corporate interests, as you may know, and charitable
responses to hunger and to inform policy responses; and they
funded our interdisciplinary team. Now the bottom line is that
when people go hungry, it costs the nation in a variety of ways
and the first of these is charity.
There are 300 food banks across the nation. There are
50,000 soup kitchens and food pantries. And these facilities
have to rent or purchase offices and warehouses, freezers,
trucks and related materials. They also have literally
thousands upon thousands of volunteers for hours or days a week
helping to feed the hungry. And each of these activities,
including volunteers, has a cost. We figured that out. The
enormous charitable enterprise in the nation today as of last
year came to $14.5 billion each year.
I turn next to the cost of excess illness, that is illness
that is associated with hunger and food insecurity over and
above the typical presence of those outcomes in the general
population. We did this both for psychosocial function, that is
mental health, as well as physical health. And you might be
interested briefly in how we did it. We know that food-deprived
groups have higher rates of certain health outcomes. Iron
deficiency occurs at a rate that is 1.66 percent times more
likely. Activity limiting impairments, three times more likely,
headaches twice as high, nutrient deficiencies three to four
times as high. And in terms of mental health outcomes,
particularly in children, depression is 3\1/2\ times higher
than among non-hungry children. The need for special education
is twice as high and so on. I won't go further.
But Dr. Shepard and I will be happy to answer questions
about the calculation of these costs. What is worth noting now
is the health-related cost of hunger comes to nearly $67
billion annually. The final cost area is the limited education
and lower workforce productivity that is associated with not
having enough to eat.
According to a number of studies in the field, children
from food insecure homes are more likely than their non-hungry
peers to do less well on tests of mental ability and overall
school performance. They miss school 50 percent more, they get
suspended about twice as often, they have to repeat more
grades, they are less likely to complete high school. And as a
result, children who are so affected face an increased
likelihood of unemployment, limited employment, lower job
performance, and all of this impacts workforce productivity.
The cost of this workforce productivity loss comes to about
$9.2 billion annually. So when we add up the costs in these
three areas that I have cited, we can say that we pay a
staggering bill for hunger, more than $90 billion a year. That
is enough to get our attention, although I would like to stress
that the actual cost is no doubt higher due to the conservative
research techniques that we employed and the fact that we had
insufficient data for certain outcomes. This bill arguably
tacks onto the American public, it means that a typical
household in our country pays about $800 a year because hunger
exists.
This bill is paid in terms of charitable contributions and
related tax deductions as well as lowered workforce
productivity and competitiveness in the international market
system.
By contrast, in closing, this $90 billion bill, it recently
was estimated that we could virtually end hunger in America if
we increased spending for existing programs, food stamps, child
nutrition, elderly feeding by about $12 billion a year over
current spending. The very recent jump in food and fuel cost
may make this calculation somewhat higher. Former nutrition
advisor to President Nixon and my former college President, Dr.
Jean Mayer once noted, ``of all the dumb ways to save money,
not feeding children is the dumbest.''
While I prefer to speak a slightly different language,
perhaps less remarkable for its clarity, the economics are
clear, our nation pays far more to let hunger exist than it
would cost us to eliminate it. Thank you.
[The prepared statements of Dr. Brown and Dr. Shepard
follow:]
Prepared Statement of Dr. J. Larry Brown, Visiting Scholar, Harvard
University School of Public Health, Boston, MA
Mr. Chairman, Members of the Committee:
I thank you for your invitation to appear today as you consider the
health and economic costs of hunger in America. Although I have
appeared before this and other Committees on many occasions over the
years, I must begin with the bottom line: The United States is quite
unique among industrial democracies because we let so many of our
people go hungry, and we seem to be doing precious little to close this
gap. Year after year the Department reports that about 35 million
Americans live in households that do not have enough to eat. What was
once termed a ``hunger epidemic'' in our nation has now become a
continuing fact of life. We are letting this problem remain pretty much
the same from year to year. Clearly we can do better, and I applaud you
for holding this hearing to exercise the leadership to make a
difference.
Before I turn to the results of our study of the cost burden of
hunger, I will begin by reviewing what science knows about the health
and cognitive effects of hunger--what it does to the minds and bodies
of both children and adults. Some of this information may be new to
you, even to the two Members who also are physicians by training.
Two or 3 decades ago I used to teach my public health and medical
students that while hunger impacts one's health status, it seldom had
an effect on the brain. We now know that this is not true. Science now
knows that there is no ``safe'' level of hunger: when a child is forced
to go without enough to eat her body suffers and her brain function is
impaired. The same is true for adults, particularly the vulnerable
elderly. This is because the body and the brain require sufficient food
energy to function adequately. When it is not there, even temporarily,
the body and mind cannot function properly. Just as your car cannot run
without the proper fuel, so too is the mind impaired when it goes
without its own fuel.
A child sitting in the classroom without a breakfast does not have
the cognitive capacity to take part in the educational process. Her
body is in the classroom but her mind is not fueled to learn. This is
because when the body does not have enough nourishment, even on a
short-term basis, it goes into triage. Just like triage on the
battlefield, the body must decide how to allocate its insufficient
resources. Its first priority is to use whatever energy there is to
maintain critical organ function. Its next priority, if there is enough
nutrient energy, is to maintain health. Its final priority is for brain
function. As my colleague Carl Sagan bluntly put it when we discussed
these new research findings, ``better dumb than dead.'' That child in
the class may be present in body but she came through the schoolhouse
door too impaired to learn--not because she is dumb but because she
suffers cognitive impairment due to lack of nutrition. In short,
science now knows that hunger, not just in its absolute state but even
in the form of chronically ``mild'' under-nutrition, produces startling
effects in both the mind and body. While true for both adults and
children, most of the research has focused on the young because we can
more easily track their growth and educational patterns. Children
without enough to eat:
Get sick more frequently, particularly in terms of
preventable outcomes such headaches, stomachaches and colds,
They have more difficulty overcoming illnesses once they
occur,
They miss school more often due to these illnesses,
They have more behavioral disorders, such as aggressiveness
and classroom disruption, as well as sullen and withdrawn
behavior, and
They do less well in terms of their grades and do more
poorly on standardized test scores than do similar children who
get enough to eat.
It is in the context of these poorer health, behavioral and mental
outcomes that the Sodexho Foundation commissioned me, along with three
other scholars, to assess their cost to the nation. In other words, how
much more money do we pay in terms of illness, poor educational
outcomes and lost productivity than we would if no one went hungry in
America. I am joined today by one of my colleagues in this research,
Dr. Don Shepard, an economist from Brandeis University, who has done
similar cost burden analyses, recently one commissioned by the United
Nations regarding the cost of dengue fever. Sodexho, known for its
corporate interest not only charitable responses to hunger but to
informed policy responses to help end hunger altogether, funded our
interdisciplinary team from three major universities. Parenthetically,
I should mention that none of us receives a salary from Sodexho, and
the Foundation played no role whatsoever in our research or its
outcomes.
When people go hungry it costs the nation in a variety of ways,
some of which are not easily measurable. We dismissed cost areas for
which calculations were too difficult, and focused instead on four key
cost arenas that are more easily measurable, that is, where the
scientific literature is sufficient to develop cost burdens that are
both reasonable and conservative. The first of these is charity. It is
said that ``there is no free lunch.'' Somebody, somewhere, pays.
Charity operates the same way, and hunger charities exist throughout
the country, in each of your districts and in virtually every community
in the nation. More than 300 food banks exist, covering every state and
averaging six to a state (although they are not that equally
distributed). These food banks provide nutritional and other
commodities to more than 50,000 soup kitchens and food pantries. These
food banks and local charities have to rent or purchase offices,
warehouses, freezers, trucks and related materials. They have to have
full-time, paid staff, and their work is supplemented by literally
thousands upon thousands of volunteers who often spend from several
hours to a day or 2 a week helping to feed the hungry. Each of these
activities, even among volunteers, has a cost. We figured out what it
is. This enormous charitable enterprise comes to more than $14.5
billion each year.
We next turn to the excess cost of illness, that is, illness that
is associated with hunger over and above the typical levels that occur
in the population(s). We did this for both mental health services and
for medical and other forms of health care. You might be interested in
how we did this. As indicated earlier, we know that food-deprived
groups have higher rates of ill health: iron deficiency occurs at a
rate that is 1.66 times more likely; activity-limiting health
impairments are nearly three times as high; headaches nearly twice as
high; and nutrient deficiencies from three to four times normal levels.
In terms of mental health outcomes, particularly in children,
depression is 3.5 times higher than among non-hungry children; the need
for special education twice as high; and general psychosocial
dysfunction is seven times as high. As you're probably beginning to
see, it costs far less to feed children than it is to let them go
hungry and par a higher price after-the-fact. I will go no further now
in terms of how we attributed actual costs of these adverse outcomes,
but Dr. Shepard and I can take questions, or you can refer to the
detailed methodology in our research report. What is worth noting now
is that the health-related costs of hunger come to nearly $67 billion
annually. And please bear in mind that the actual costs certainly are
higher, quite a bit higher, because of our conservative methodology.
This is because for some outcomes, say Attention Deficit Hyperactivity
Disorder (ADHD), the research literature is insufficient to develop
likelihood ratios for excess outcomes. For yet other outcomes, we had
adequate data to compute direct costs but not for indirect ones. It is
the responsibility of researchers to be careful--conservative--and it
is for this reason that we know our estimate of $67 billion a year does
not capture the full cost in this arena.
The final cost arena is the limited education and lowered workforce
productivity that is associated with having too little nourishment.
According to a number of studies in this field, children from food
insecure homes are more likely than their non-hungry peers to do less
well on tests of mental ability and overall school performance. They
miss school 50% more; they get suspended about twice as often; and they
have to repeat more grades. They also are less likely to complete high
school. As a result, children so affected face greater likelihood of
unemployment or limited employment; poor judgment and lowered job
performance; and, as a result, lowered workforce productivity. The cost
of this productivity loss comes to $9.2 billion annually.
When we add the costs of each of these arenas (more than $14
billion for charity; nearly $67 billion for illness; and almost $10
billion in lowered education and productivity) we pay a rather
staggering bill for hunger--more than $90 billion each year. This is
enough to get our attention, although I stress again that the actual
cost is clearly higher than this, due to our utilization of
conservative research techniques and lack of sufficient data for some
outcomes known to be associated with hunger.
While this bill, sort of an additional tax on the American public,
is not evenly distributed across the population, it means that a
typical household in our country pays $500 a year. While this bill
often is not direct, it shows up in terms of higher taxes to cover the
costs of outcomes that the victims of hunger suffer. It also is paid in
terms of charitable contributions and related tax deductions, as well
as lowered workforce productivity and competitiveness in the
international market system.
By contrast to this $90 billion annual cost, it recently was
estimated that we could virtually end hunger in America if we increased
spending for existing nutrition programs (food stamps, school meals,
summer feeding and elderly feeding) by about $12 billion a year over
current spending. (The very recent jump in food and fuel costs may now
make this calculation somewhat higher).
Former nutrition advisor to President Nixon, Dr. Jean Mayer, once
noted that ``of all the dumb ways to save money, not feeding children
is the dumbest.'' While I prefer to speak a slightly different language
than his remarkable clarity, our economics are clear: our nation pays
far more to let hunger exist than it would cost us to eliminate it.
Thank you.
Copies of the research analysis, The Economic Cost of Domestic
Hunger: Estimated Annual Burden to the United States, is available to
download by going to www.sodexofoundation.com. For further information
from the researchers, e-mail: [Redacted]; [Redacted]; [Redacted]; and
[Redacted]. This research initiative was sponsored by Sodexho
Foundation, which has been working to eliminate the root causes of
hunger since 1996. Its work also includes a broad menu of child feeding
programs (summer and school year), and disaster response initiatives
such as Hurricane Katrina and the Gulf Coast.
______
Prepared Statement of Donald S. Shepard, Ph.D., Professor and
Economist, Schneider Institutes for Health Policy, Heller School,
Brandeis
University, Waltham, MA
Chairman Baca, Ranking Minority Member Boustany, and other Members
of the Committee. My name is Donald S. Shepard. I am a professor at the
Heller School, Brandeis University, in Waltham, MA, and lead the Cost
and Value Group in the Schneider Institutes for Health Policy. I am
honored to have the opportunity to testify today to the Subcommittee on
Department Operations, Oversight, Dairy, Nutrition, and Forestry. My
testimony is based largely on the study I co-authored entitled, ``The
economic cost of domestic hunger: Estimated annual burden to the United
States.'' The authors, in their order or listing, are Dr. J. Larry
Brown, Harvard School of Public Health, myself, Dr. Timothy Martin,
also of Brandeis University, and Dr. John Orwat, Loyola University. My
co-author, Dr. Brown has spoken about this study as well.
The scholarly literature is replete with studies that assess the
cost to society of adverse outcomes associated with social practices
such as smoking, alcohol abuse and obesity. The analysis of a cost
burden, the compilation of the direct and indirect economic costs of a
particular problem or policy, often provides helpful information to the
public and policy makers about the financial ramifications of a problem
and the potential savings that could result from reducing or
eradicating it. As Dorothy Rice, a pioneer in such studies, has noted,
they have been widely performed and proved useful to inform resource
allocation across such wide ranging areas as biomedical research,
public health, and injury prevention (Rice, 2000).
The cost of a particular societal burden includes all known private
and public sector spending, counting both direct and indirect costs.
Direct costs are those expenditures incurred as a result of the medical
treatment of some illness or problem, while indirect costs are the non-
medical expenditures incurred as a result of that illness, such as
missed days of work. The annual cost of health care associated with
alcohol abuse, for example, has been calculated at $22.5 billion, but
when indirect costs, such as lost productivity are factored in, the
total economic burden to the nation has been reported by various
scholars to run to nearly $200 billion annually. The costs of problems
like alcoholism frequently are as hidden as they are surprising, since
costs are not only borne by the user but their families and society at
large. The children of alcoholics are sick more often, are admitted to
the hospital 62% more often than other children, and remain in the
hospital 29% longer (Rice, 1999). Alcohol abuse significantly elevates
the likelihood of traffic accidents, particularly among teenagers, but
also among all ages. Alcohol abuse also is linked to increased
homicides and other violent crimes, as well as increased drowning and
suicides (Rice, 1999).
In recent years cost burden analyses have put the annual cost of
alcohol abuse at $185 billion (Harwood, 2000), smoking at $138 billion
(Rice, 1999), drug abuse at $161 billion (Office of National Drug
Control Policy, 2003), obesity at $79 billion (Finkeklstein, 2003), and
poverty at $500 billion (Holzer, 2007). The high societal costs of such
problems strongly suggest greater focus on reduction or prevention. So
commonly accepted is the premise of prevention that it is encoded in
various state and Federal laws. Most states require motorcyclists to
wear helmets because of the frequency of serious brain damage
associated with not wearing a helmet. Similarly, childhood vaccinations
are generally required as a condition for school entry, and
transportation workers may not use certain drugs and must accept random
screening on request to confirm their adherence.
It is notable that such decisions do not extend to all possible
adverse outcomes. Society does not, for example, require people to eat
only certain foods to avoid the costs to the nation of obesity. Neither
is smoking or alcohol use banned altogether, although their public use
is now greatly regulated to protect the public good.
The History and Prevalence of Hunger in America
The extent of domestic hunger has been fairly well understood since
at least the late 1960s, (Citizens' Board of Inquiry into Hunger and
Malnutrition, 1967). While professional and government entities were
unable to estimate precisely how many individuals were impacted, they
placed the number of chronically hungry Americans in the millions.
Revelations at the time spurred bipartisan Congressional hearings,
resulting the expansion or creation of programs that include Food
Stamps, School Breakfast, Elderly Feeding and WIC programs (Brown,
1970).
In 1985, a prominent group of medical researchers affiliated with
Harvard University announced the results of its research and field
investigations in half the states of the nation (Physician Task Force
on Hunger in America, 1985). Its members had traveled to the states to
investigate hunger first hand; yet unlike their predecessors, they had
the scholarly training to estimate the size of the problem the nation
faced, reporting that the number of Americans afflicted by hunger was
at least 20 million. Their report led to significant national news
coverage and, as in 1968, Congress took further action to ameliorate
the problem.
Although the estimate of 20 million people going hungry was
criticized in some quarters, other sources soon weighed in, with one
national pollster placing the estimate well above 30 million (Bregglio,
1992), a figure later corroborated by the university-based Center on
Hunger and Poverty in 1992 (Communication to Congressman Tony Hall from
J. Larry Brown, 1992), which had been consulted by Congressional
leaders as to the true extent of domestic hunger. In 1995, the Federal
Government implemented a standard measure to evaluate the extent of
hunger annually. Over the past ten years, with relatively minor
variations, this standard has indicated that about 35 million Americans
live in households with insufficient food. Like the Federal poverty
rate, which varies annually with changes in job opportunities, wages
and the overall economy, the extent of hunger rises and falls each year
as well and for similar reasons--but the variation is slight. This
Federal data set consistently indicates that over 12% of the nation's
people lack sufficient nutrition.
The extant standard for tracking hunger and food insecurity is
known as the Federal Food Security Module, and it is conducted by the
Department of Agriculture and the Bureau of the Census (Bickel et al.,
2000). In its annual census tracking, the Bureau asks a special set of
eighteen questions developed by the Department of Agriculture that is
applied to a broad national sample of households to determine the
adequacy of their diets: do they sometimes not have enough food for
their families, do they sometimes have to skip meals because of
insufficient income, do they ever have to put their children to bed
hungry. The researchers also ask questions about when such occurrences
happened and how often over the past year, since the number of positive
responses to such outcomes must reflect a repetitive or chronic problem
before the household actually is counted as vulnerable.
Unlike the earlier hunger estimates, the Federal measure reflects a
refined definition of the problem. The governmental report defines
hunger as a ``painful sensation'' in the stomach, and the measure of it
reflects a high degree of food deprivation or ``insecurity'' before a
household actually is considered to experience hunger. Some
nutritionists and medical experts consider this standard to be too
high. Since ``pain'' is only one of the possible sensations from
hunger, many victims of hunger do not actually feel pain as such. Thus,
people can be chronically hungry by any common understanding of the
term, yet be missed by the Federal definition because they do not
experience ``a painful sensation.''
Alongside the category of ``hunger,'' the Federal measure also
includes a new and more encompassing category of nutritional
deprivation known as ``food insecure.'' Households that are not
determined to be hungry, as such, may be food insecure if they run out
of food or do not know where the next meal is coming from, or if
parents have to cut back on the portions of food served, cut down on
the types of food categories available to the family, or have to rely
on soup kitchens or food pantries to feed their family. While many
consider this two-tiered measure--hunger and food insecurity--to be
useful in differentiating degrees of household food deprivation, some
experts consider the distinction to be tenuous. They note that since
hunger is more than a pain, and includes inadequate food resources to
nourish individuals and families, then food insecurity is hardly
different from hunger, if at all.
Federal Food Security Module outcomes for the years 2000-2006 are
reported in Table 1.
Table 1. Annual Levels of Hunger and Food Insecurity
------------------------------------------------------------------------
Number of Percent of Number of Percent of
Year Households Households Individuals Individuals
------------------------------------------------------------------------
2000 11.1 10.5 33.2 12.1
million million
2001 11.5 10.7 33.6 12.2
million million
2002 12.1 11.1 34.9 12.5
million million
2003 12.6 11.2 36.3 12.7
million million
2004 13.5 11.9 38.2 13.2
million million
2005 12.6 11.0 35.1 12.1
million million
------------------------------------------------------------------------
2006 12.6 10.9 35.5 12.1
million million
------------------------------------------------------------------------
Source: Department of Agriculture, Household Food Security in the United
States, 2006, Economic Research Service (ERR-49), November 2007.
To analyze the cost burden of domestic hunger, we treat the extent
of food deprivation in the nation as being the more encompassing number
combining both hunger and food insecurity. Two factors support this
treatment of the data. One, mentioned above, is that even households
that are considered to be food insecure actually experience hunger
(people don't eat enough to satisfy their needs, and are forced to cut
back in terms of satisfying their nutritional requirements). The other
factor supporting this decision is the scholarship in the field of
hunger and food security. For more than a decade now, scores of studies
and analyses have shown that even the most elementary forms of food
insecurity have detrimental effects on its victims. See, for example,
Murphy et al. (1998); Sahyoun and Sasiotis (2000), and Kleinman et al.
(1998). People who go without enough to eat are sick more often and
miss work more frequently. Children who live in food insecure
households (not necessarily categorized as hungry) are sick more
frequently, miss school more often, and do more poorly in school. The
research shows that food insecure children are more susceptible to
cognitive impairment (mental dysfunction), more likely to engage in
anti-social behaviors, and more in need of both medical and mental
health interventions (Center on Hunger and Poverty, 2002). In short,
there are significant ``cost burdens'' when people are hungry or food
insecure. Hence, we treat the burden of hunger and food insecurity as a
unified problem or cost center.
Approach
Because the cost burden of a problem such as hunger includes all
public and private expenditures, both direct and indirect, we reviewed
scientific literature to identify odds ratios for various adverse
outcomes known to be associated with hunger. These include the
following categories: (a) charitable efforts to feed the hungry; (b)
mental health and medical care to address problems such as anxiety and
depression, illnesses, nutrient deficiencies, physician visits and
hospitalizations; and (c) lowered economic productivity associated with
missed days of school, school suspensions, repeating a grade, overall
educational success and dropping out of school. We then reviewed
economic literature and, where relevant, expenditure data to establish
attributable costs for each of these outcomes.
Due to limited data availability, it was generally assumed that the
odds ratio for children and adults were the same. This was the most
plausible assumption that could be made in the absence of complete
data.
The Cost Burden of Charity
Charity is the practice of short-term relief when structural
factors (economic, policy and programmatic) are insufficient. A home
burns down or a job is lost and the family may be consoled with lodging
or other forms of short-term care until more lasting solutions come
into play. With respect to domestic hunger the charitable community has
played a significant role since the early 1980s (Physician Task Force
on Hunger in America, 1985), developing both immediate and long-term
strategies to address the problem of households without sufficient
nutrition.
With about 35 million Americans consistently living in households
that struggle each year to get enough to eat, (USDA, Economic Research
Service, ERR-47, 2007) the charitable response has shifted from
individual in nature to largely an institutional one. Tens of thousands
of ``emergency'' feeding programs now dot the landscape of the nation,
so many in fact that if they were evenly distributed, about one
thousand would exist in each of the fifty states. (Cohen, 2006).
The largest domestic hunger relief organization is America's Second
Harvest, an umbrella organization that represents a network of more
than 200 food banks and food rescue organizations across the country
that serve the smaller emergency programs mentioned above. Located in
every state, these entities collect canned, boxed and sometimes fresh
foods from industry and other sources, and then distribute it to a
variety of local programs to feed the hungry with actual meals or
periodic bags of groceries. Another 50 or so food banks exist outside
the Second Harvest system meaning that the nation has an average of
five food banks for each state (though not actually so distributed).
These 250-plus food banks exist to provide food pantries that
typically reside in church basements and social service agencies. These
facilities usually bag the food products to distribute weekly to
families depending on household size. The banks also service soup
kitchens, establishments where individuals and families can come for a
sandwich or even a hot meal. America's Second Harvest reports that its
food banks alone service more than 40,000 food pantries and soup
kitchens across the nation. In 2005, these Second Harvest programs fed
more than 24 million people (Cohen, 2006). When non-Second Harvest food
banks and other programs are factored in, the number of people fed
through charitable efforts in the nation is substantially higher.
It is the nature of charity that it typically is a donation: a
hungry household is given food. But the food itself is not free since,
somewhere along the line, it was paid for. Even the act of giving the
food was not free but relied on volunteer time and institutional
overhead, both of which have calculable costs. In this sense, America's
huge charitable enterprise, developed largely over the past 25 years,
is not free. In fact, its price tag, its economic investment to feed
the hungry, is more than $14 billion each year (see Table 2).
Table 2. Annual Cost Burden of Charitable Efforts To Feed Hungry
Americans
------------------------------------------------------------------------
Estimated Cost
Charitable Activities 2005
------------------------------------------------------------------------
Food Banks: products, operations and depreciation $3.8 billion
Local Feeding Programs: food pantries and soup kitchens $7.5 billion
Volunteer Support: volunteer hours and expenses (1. and $1.1 billion
2.)
Other National Feeding Programs (non-food bank related) $0.7 billion
Unaffiliated Local Programs $1.4 billion
---------------
Total costs $14.5 billion
------------------------------------------------------------------------
Illness and Psychosocial Dysfunction
We evaluated and summarize the economic costs of poorer health,
illness, increased utilization of psychological services, and other
psychosocial outcomes that are shown by research to be associated with
food insecurity. To estimate the cost of adverse health and mental
health outcomes, we first reviewed the scientific literature to
identify studies that show a link between food insecurity and adverse
health outcomes. Studies were chosen that calculated multivariate risk
ratios or odds ratios of these adverse outcomes to increase our
confidence that the associations were found after statistically
controlling for other explanatory factors. For some outcomes associated
with insufficient food, such as attention deficit hyperactivity
disorder (ADHD), we concluded that the existing likelihood ratio for
excess outcomes was insufficient to rely on. For yet other outcomes
such as iron deficiency, hospitalizations, and excess costs of fair and
poor health status, we were able to compute direct costs but not
indirect costs because available data did not provide a basis for
estimating indirect costs.
Medical conditions identified to have higher rates of adverse
conditions among those who are food insecure include iron deficiency
anemia (1.66 times more likely), headaches (1.92), stomach aches
(2.16), frequency of colds (1.54), activity-limiting health impairments
(2.95), specific nutrient deficiencies (2.85 to 4.39), more
hospitalizations and longer in-patient stays (1.3), and poorer overall
health status (2.9) (Table X1). Mental health conditions with a higher
rated of adverse conditions among the food insecure include anxiety and
irritability (1.95 times as likely), depression (3.50), withdrawn
behavior (1.74), psychosocial dysfunction (7.0), suicidal thoughts and
behaviors (5.00), and need for mental health services (1.93).
The cost of illness was then calculated for these conditions by
searching the cost of illness literature and calculating the fraction
of the cost attributable to food insecurity, as described in the
methods section. The total cost from a societal perspective for mental
health services and ill health, assuming these outcomes are
independent, comes to $66.8 billion annually, in 2005 dollars (Table
X3). The state of the literature allowed us to calculate both indirect
and direct costs for migraine headaches ($1.7B), colds ($0.4B), iron
deficiency ($0.2B), depression ($15.6B), anxiety ($9.2B), and suicide
($6.4B). However, we were only able to calculate direct costs for upper
GI disorders ($2.5B), hospitalizations other than for the conditions
listed here ($7.1B), and the excess cost of fair or poor health status
($23.7B) as reliable estimates for indirect costs were not available.
Education and Lowered Productivity
This impact was estimated through a two step process, as existing
literature did not permit the one-step estimation available for illness
and psychosocial dysfunction. According to a number of recent studies,
children from food insecure households are more likely than their non-
food insecure peers to experience higher rates of various forms of
educational trauma: Missed days of school were 1.6 times the risk, and
repeating a grade was 1.44 times the risk compared to a child without
food insecurity. These factors, in turn, were linked to a higher risk
of dropping out of school. This translated to the economic burden from
dropping out of school of lower lifetime earnings of $9.2 billion.
Summary of Burden
When summed for 2005, these burdens total $90.4 billion (Table 3).
The results can further be broken down by state based on the prevalence
of food insecurity in each state in 2005 (Figure 1).
Table 3. Minimum Total Cost Burden of Hunger in America
------------------------------------------------------------------------
2005 Direct
Cost Burden by Outcome and Indirect
Costs
------------------------------------------------------------------------
Charity $14.4 billion
Illness and psychosocial dysfunction $66.8
Less education and lowered productivity $9.2
---------------
Total costs $90.4 billion
------------------------------------------------------------------------
Figure 1.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Implications
This country's nutrition programs can be seen as a glass half full.
Were the Supplemental Nutrition Assistance Program (SNAP, formerly
called Food Stamps) and other government programs not in existence, the
burden would have been even greater than $90 billion. That is the part
of the glass that is full. Had those programs had the structure and
funding that the problem requires, however, there would have been
virtually no cost of domestic hunger. My colleagues and I would not
have estimated a $90 billion problem. That is the half empty part of
the glass.
Using round numbers, I would like to estimate the expansion in 2005
that might have funded the empty part of the glass. I will assume:
--The program cost $35 billion;
--Food stamps covered \2/3\ of those eligible; and
--Benefits, on average met about \3/4\ of the needs for those who
received them (higher food prices today might lower this
share).
Putting these two shares together, the program in 2005 covered
about half the food needs of those eligible (i.e., \2/3\ of \3/4\).
Thus, the spending of $35 billion represents about half the food needs
of eligible hungry Americans. There is another half, another $35
billion cost to serve eligible Americans, that was not being met. In
other words, additional funding of $35 billion would have addressed
substantial parts of the gap.
We can compare the economic burden of $80 billion against the
additional investment of $35 billion and see a return of about $2.28
for every increased dollar invested in terms additional support for
reducing hunger.
I am pleased that the farm bill passed by this Congress will take
useful steps towards expanding benefits under SNAP and help lower the
empty part somewhat. Further investments in funding, outreach, and
expanded benefits will ensure that the empty part of this glass is
completely addressed and that hunger in America can be largely
eliminated. Thank you very much.
Attatchment
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
The Chairman. Thank you very much, Dr. Brown.
Next we have Dr. Diana Cutts.
STATEMENT OF DIANA B. CUTTS, M.D., FACULTY PHYSICIAN, HENNEPIN
COUNTRY MEDICAL CENTER; ASSISTANT
PROFESSOR OF PEDIATRICS, UNIVERSITY OF MINNESOTA; PRINCIPAL
INVESTIGATOR, CHILDREN'S SENTINEL
NUTRITION ASSESSMENT PROGRAM (C-SNAP),
MINNEAPOLIS, MN
Dr. Cutts. Chairman Baca and distinguished Committee
Members. My name is Diana Cutts and I am truly honored to be
here today.
At Hennepin County Medical Center in Minneapolis,
Minnesota, I practice pediatrics, teach bright young medical
students and residents and direct research with Children's
Sentinel Nutrition Assessment Program, C-SNAP, a national
multi-site program which monitors the well-being of very young
children.
I have relied on my distinguished co-panelists to dazzle
you with information so I can instead share with you the
experience of taking care of kids. So please join me in clinic
this morning. I hope you have had a good breakfast and have
lots of energy. Place your stethoscopes around your necks, but
don't bother with white coats. They only scare the kids.
Julia is a 13 month old here after a 3 day hospitalization
for dehydration due to a virus. Looking at her vital signs we
see she is slowly regaining her weight. She screams bloody
murder the minute she sees us. But after we talk to her parents
and do our best possible exam, we decide she is on the mend.
Mom is told to bring her back in a few months and the clinic
quiets as she leaves.
Next up, Terrence, a 4 year old here to complete forms for
Head Start enrollment. A quiet little guy, he doesn't pass the
developmental screening. His mother, 5 months pregnant, accepts
our referral to the public schools for more extensive
evaluation. We are also concerned about mom's affect, she seems
depressed. We talk about maternal depression and refer mom to
mental health resources. Before they leave, one of the C-SNAP
interviewers approaches me. ``Dr. Cutts'' she says ``I hope it
was okay that I gave that family two bags of groceries.''
You see, we offer a bag of groceries to families who are
surveyed for our research. It turns out you have a background
in political science, and you ask me about our findings. So I
explained that although Minnesota is a birth place and home to
many large food corporations and has a very respectable state
food insecurity rate of 8.2 percent and is a top-ranking state
for most health ratings, HCMC rates of household food
insecurity for families with very young children are the
highest of any of the five C-SNAP sites: 35 percent compared to
an average of 15 percent for Baltimore, Boston, Little Rock,
and Philadelphia. The C-SNAP interviewer taps me again. ``Dr.
Cutts, I am really worried about that mom. She told me she
hasn't had much food in the last week because she was kicked
out of her apartment because the landlord defaulted on the
mortgage, and now she is living with some friends and her WIC
vouchers were lost when they moved.''
And now we contact the clinic social worker to meet with
mom. I turn to you to teach. Let's talk about the implication
of food insecurity in this family. In terms of mom's pregnancy,
poor maternal nutrition is associated with more risk of
prematurity, complications of delivery and low birth weight,
which increases the likelihood of infant mortality, infant and
child health problems, long-term developmental delays and even
later adult chronic disease. Food insecurity is also linked to
maternal depression, which has a trickle down negative impact
on children's health. For Terrance, there is an abundance of
research on children from infancy to adolescence showing
associations between food insecurity and lower cognitive scores
and more emotional and behavioral problems. Developmental
services to young children are the beginning of a societal cost
of food insecurity that may be carried on into school years and
throughout a lifetime.
I think back to the earlier patient we saw, Julia, the
screamer. Children in food insecure households are more
frequently hospitalized with an average hospital cost of over
$11,000, another economic cost of food insecurity. Children of
color like Julia are at highest risk for food insecurity which
contributes to health and achievement disparities by race and
ethnicity. As the morning goes on, we see little twins with
anemia, which is 2\1/2\ times more likely in food insecure
children, and when present, harms brain development. And then
an adolescent weighing nearly 300 pounds with multiple medical
and psychosocial problems whose C-SNAP survey many years ago
revealed some of the most severe food insecurity we had ever
encountered.
I plan to talk to you after clinic about the complex
relationships between food insecurity and obesity. We end with
a child whose asthma has relapsed because his family didn't
fill his prescriptions because they had to choose between
medicine, food or rent. Do all my patients' ills stem from food
insecurity? Of course not. But for too many of them, food
insecurity is an invisible constant companion to their health,
directly and indirectly influencing it in ways both immediate
and distant.
I am privileged to be their physician. But my reach as
their doctor is typically one child, one family at a time. Your
reach spans the country. And I urge you to think of our time
together in clinic as you consider legislation like the new
economic stimulus package. Temporarily increasing food stamp
benefits as part of the package would do much to directly help
the children I just told you about.
Other programs that address basic needs that compete with
the food budget, such as housing, energy and child care
assistance, are equally vital, particularly in our current
economic climate of rising food and energy prices.
No child deserves to be burdened with the consequences of
this fully preventable condition for the duration of his or her
life. And no responsible farsighted society should permit the
widespread incidence of an economic costly condition like food
insecurity that is guaranteed to produce a less healthy, less
capable and less productive population. I have been impressed
by the insightful questions you have asked as we saw patients
today and we will try to remember to give you all high marks on
your rotation evaluation, if I haven't gotten so hungry for
lunch that my memory is impaired. Class dismissed. Thank you.
[The prepared statement of Dr. Cutts follows:]
Prepared Statement of Diana B. Cutts, M.D., Faculty Physician, Hennepin
Country Medical Center; Assistant Professor of Pediatrics, University
of Minnesota; Principal Investigator, Children's Sentinel Nutrition
Assessment Program (C-SNAP), Minneapolis, MN
Chairman Baca and distinguished Members of the Committee, my name
is Dr. Diana Cutts. I am honored to be given the opportunity to share
with you my experience as a pediatrician and researcher at Hennepin
County Medical Center (HCMC) in Minneapolis, Minnesota.
At HCMC my colleagues and I provide care for a diverse, urban
population of children, including a significant immigrant population. I
work in both out-patient and in-patient settings in a large general
teaching hospital, usually supervising a team of bright young medical
students, interns, and residents. I have special interest in pediatric
nutritional problems and direct an interdisciplinary team of
professionals devoted to the care of children who are not growing well.
For the past fifteen years, I've also been involved in research on
childhood hunger and I am a Founder and Principal Investigator of the
Children's Sentinel Nutrition Assessment Program (C-SNAP), a national,
multi-site pediatric research program which focuses on the impact of
public policies on babies and toddlers under the age of 3 years.
As I thought about how I could best add to the discussion today, I
recognized the tremendous expertise and knowledge of those with whom I
sit. And I concluded--with some relief--that I could rely on them to
present specific policy information, while I could speak about a large
part of what I do--take care of patients and teach trainees. So--I am
going to ask you all to join me on rounds as my team this morning, as I
see children. Please place your stethoscopes around your necks, but
don't bother with white coats--they only scare the kids.
Our first patient is Julia, a 13 month old who is seen following
her recent 3 day hospitalization for dehydration due to a stomach
virus. You tell me her blood chemistries were markedly abnormal at
admission, but normalized with IV fluids. Looking at the vital signs
that the nurse has obtained, we see that she is regaining her weight
though still underweight. In the exam room she begins to scream the
minute she sees us, clutching her mother in fear. We examine her over
her protests. Mom is told to bring her back for her well child visit in
a few months. Her howls cease only as she is carried out of the clinic.
Suddenly, the clinic is a lot quieter.
Second on our schedule is Terrance, a 4 year old here to complete
forms for enrollment in Head Start. He's a busy pre-schooler, but does
not pass the developmental screening today. His mother, 5 months
pregnant, is also concerned and accepts our referral to the public
schools for more extensive developmental evaluation. Together in the
room, we talk with mom and I become concerned about mom's slightly
withdrawn and flat affect. She admits yes, she's tired, but she's also
a bit depressed. We talk about maternal depression and refer mom to
mental health resources. As we come out of the room, we worry about
whether mom has the energy to take care of Terrance, the baby, and
herself. The smartest among you anticipate that I will want to know if
you made sure that the family is enrolled in the WIC program.
As they leave for the lab to get Terrance's CBC and lead level, one
of the C-SNAP interviewers approaches me. ``Dr. Cutts,'' she says, ``I
hope it was okay that I gave that family two bags of groceries.'' I
explain to you that it is our practice to offer a bag of groceries to
families who are surveyed for our C-SNAP program, which has monitored
the rate of household and child food security and other hardships in
the clinic for the last 10 years. It turns out you have a background in
political science and you ask me more about our findings. So I explain
that although Minnesota is known as one of the top-ranking states for
most health parameters, the home to a large number of international
food corporations and a state with an overall state food insecurity
rate of 8.2%, our hospital's rates of household food insecurity for
families with children under three are the highest of any of the five
C-SNAP sites--35% compared to an average of 15% for the Boston,
Baltimore, Little Rock, and Philadelphia sites.
The C-SNAP interviewer taps me again. ``Dr. Cutts, I'm worried
about that mom. She told me that she hasn't had much food for the last
week because she was kicked out of her apartment building because the
landlord couldn't pay the mortgage, and now she is living with some
friends, and her WIC vouchers were lost when they moved, and . . .''
Our morning is unraveling pretty fast--we contact the clinic social
worker and try to get a message to mom in the lab to return to clinic
so she can meet with him.
I turn to you to teach--Let's talk about the implications of food
insecurity for her pregnancy and that not-yet-born child. Prenatal
nutrition is essential to a healthy pregnancy, but poor maternal
nutrition is associated with greater risk of prematurity, complications
of delivery, and low birth weight which increase the likelihood of
infant mortality, infant and child health problems, long-term
developmental delays, and even chronic disease, such as heart disease
and diabetes in adulthood. [i] In addition, maternal depression is more
than 2\1/2\ times as likely in food insecure households. [ii]
Depression impacts parenting in negative ways. We've offered mental
health and visiting nurse services, we've ensured that Terrance and she
stay enrolled in WIC, which will help protect his health and growth and
her well-being [iii]--is there more we should do?
What about Terrance's developmental delay? you ask, interrupting my
litany.I am impressed with your insightful question and will try to
remember to give you high marks on your rotation evaluation--I tell you
that C-SNAP research has shown that very young children who live in
food insecure households, even those meeting the level of only mild
food insecurity, are \2/3\ more likely to be at risk for cognitive,
motor or socio-emotional problems on screening tests when compared to
those living in food secure households. [iv] Kindergarteners who are
food insecure are more likely to have emotional and behavioral
problems, too. [v] In older school-age children, we know that food can
make a difference in school performance. Some of the strongest words of
support for school breakfast programs have come from the school staff
who provide time-out supervision for children who are disrupting a
classroom. They tell us that a dramatic decrease in these behaviors
follows institution of breakfast programs, in addition to improved
school attendance and improved standardized test scores. [vi]
At any rate, it's probably not a coincidence that this particular
child, whose mother described serious food insecurity, failed our
screening. Developmental services to toddlers and pre-schoolers are the
beginning of a societal cost of food insecurity that may be carried on
into school years and throughout a lifetime of economic and social
difficulties and diminished potential. [vii]
Even I'm getting tired of my long-winded responses to your
questions now and the nurse is getting worried about us being behind
schedule. I wisely decide to split you all up to send you each into the
rooms of the remaining waiting patients. And I sit down for a breather.
I think of the earlier patient we saw:
The little screamer, Julia, her family seemed okay, but I know from
my own local data that children of color, like Julia, are at highest
risk for food insecurity. Poor nutrition is an important contributor to
the health disparities that are seen in children of color [viii] as
well as poor children compared to more privileged children. Children
from food insecure households are 30% more likely to be hospitalized
because of their diminished reserve and vulnerability in the face of
typical childhood illnesses. [ix] An average pediatric hospitalization
for a child under three costs approximately $11,300, [x] so, at least
in part, these medical costs are actually another societal economic
cost of food insecurity. These kids can't just bounce back because
their immune systems are depressed from inadequate nutrition and they
often begin a cycle of weight loss and recurrent infections that then
perpetuate each other. I'll have to keep a close eye on Julia's growth
at the next visit. Could Julia's hospitalization have been avoided if
she was living in a more food secure environment? Oh, and was she well-
insured? Would hospital bills further erode the family's ability to put
nutritious food on the table?
I take a look at the schedule which tells me which patients you are
each seeing.
One of you is doing a follow-up for anemia in 6 month old twins.
Young children in food insecure households are 2\1/2\ times more likely
to have iron-deficiency anemia as children in food secure households.
[xi] And iron deficiency anemia influences young children's brain
development in detrimental ways, affecting attention, memory and
language and social ability as well as depressing their immune systems.
Gotta check in with mom about food security and watch their development
carefully as I see them at future visits.
Someone else is interviewing Stephanie, a 14 year old whom I've
known since she was 3 years old. She's struggled with childhood obesity
since infancy, really, and her last recorded weight was 278 pounds. She
began refusing to be weighed 2 years ago, so there's no weight recorded
today by the nurse. She's had surgery to remove her tonsils and
adenoids because of obstructive sleep apnea, a well-recognized
complication of obesity. And she complains of chronic back pain, among
other medical complaints. More threatening to her current well-being,
her behavior's become out of control--she's sampling every imaginable
risky behavior and not attending her alternative school. She's even
admitted to suicidal thoughts. [xii] I recall how C-SNAP data obtained
from this family years ago revealed the most severe food insecurity the
interviewer had ever encountered--and our subsequent discussion about
the apparent paradox of obesity co-existing with food insecurity due in
great part to tight food budgets forcing parents to choose low-cost
foods, which are mostly high in calories and very poor in nutrition.
[xiii] Many years later, we still have a long way to go to help people
understand this, and to impart the message that a piece of the response
to the obesity epidemic must be to address food insecurity.
We end our morning with Brandon, a 5 year old with a cough, and his
grandmother. He tells me a knock-knock joke. You tell me he has a
history of asthma and, in fact, was hospitalized 3 weeks ago for an
asthma attack and pneumonia. He was in the hospital for 4 days, but his
grandmother reports he was okay until 2 days ago, when his cough re-
appeared. I'm surprised when she tells me that he's not on any
medicines. She explains to me that the family was not able to afford to
fill the prescriptions that were given to them at hospital discharge,
stating the charge to them was well over $100, and that they needed the
money for food, the gas bill, and rent. We work out a plan to provide
the needed medications, and hopefully prevent another hospitalization,
while still preserving food security, energy access, and housing.
It's time to dismiss you all for your noon conference while I face
the chart documentation and a stack of phone messages that I need to
get to.
Do all of my patients' ills stem from food insecurity? Of course
not. But, my reality is that for more than a third of them, food
insecurity is a constant companion to their health, directly and
indirectly influencing it in both immediate and distant ways. None of
these children, who each came to clinic for a different reason, had a
placard around their neck or a physical sign identifying them as food
insecure. They are simply the typical pediatric patients seen daily all
over this country in medical clinics serving low-income populations. 29
million children in this country are considered low-income, nearly 40%
of our citizens less than 18 years old. [xiv]
These are the faces of child hunger in the United States, very
different from the visibly starved Appalachian babies I saw in LIFE
magazine when I was growing up, but no less real, no less impactful.
Food insecurity in childhood changes the trajectory of young lives in a
real and significant way. The quality of our communities is impacted,
and there are high, and rising, economic costs which we all bear.
I feel privileged to play a role in creating a healthy and bright
future for the children I see at HCMC. But my reach as their doctor is
typically one child, one family at a time. Your reach spans the country
and I urge you to think of our time together in clinic and boldly work
to create programs and policies that promote healthy and bright futures
for all children. For example, I know that Congress is considering
another economic stimulus package; I encourage you to make a
temporarily increased food stamp benefit part of the package, as it
would do so much to directly help the children I've just told you
about.
Nutrition assistance programs, such as the Food Stamp Program and
WIC, are the medicines needed to treat food insecurity and these
accompanying illnesses, but the programs need to be dosed at levels
that cure rather than just diminish the problem. The programs are also
critical and economically sound investments on the health end of the
equation, as they provide the physiological building blocks necessary
for proper growth, health, development, and learning. Better still
would be a society in which an adequate, nutritious diet is achievable
for every child without targeted intervention programs. Until that day
comes, preventive efforts are the best way to avoid the tangible and
long-lasting costs of food insecurity in childhood. Other programs that
assist low-income families with basic needs that compete with the food
budget, such as housing, energy, and childcare assistance, are equally
vital, particularly in our current economic climate of rising food and
energy prices.
No child deserves to be burdened with the consequences of this
fully preventable condition for the duration of his/her life, and no
responsible, far-sighted society should permit the widespread incidence
of a condition like food insecurity that is guaranteed to produce a
less healthy, capable, and productive population.
Class dismissed.
Thank you.
Endnotes
[i] Cook J.T. and Frank D.A. Food Security, Poverty, and Human
Development in the United States. Ann. N.Y. Acad. Sci. 2008; xxxx: 1-
16.
[ii] Casey P., Goolsby S., Berkowitz C. et al., Maternal
Depression, Changing Public Assistance, Food Security, and Child Health
Status. Pediatrics. 2004; 113(2):298-304.
[iii] Black M., Cutts D., Frank D.A. et al., Special Supplemental
Nutrition Program for Women, Infants, and Children (WIC) Participation
and Infants' Growth and Health: A Multisite Surveillance Study.
Pediatrics 2004: 114(1):169-176.
[iv] Rose-Jacobs R., Black M., Casey P., et al. Household food
insecurity: Associations with at-risk infant and toddler development.
Pediatrics 2008; 121:65-72.
[v] Stormer A. and Harrison G.G. Does household food insecurity
affect cognitive and social development of kindergarteners? California
Center for Population Research, University of California-Los Angeles,
November 2003.
[vi] Minnesota Department of Children, Families & Learning, Fast
Break to Learning--1999-2000 Executive Summary and Meals for Learning
2000 Report.
[vii] Murphy C., Ettinger de Cuba S., Cook, J. et al. Economic
Costs of Food Insecurity for Young Children: A Report from the
Children's Sentinel Nutrition Assessment Program (C-SNAP) and the Food
Research and Action Center (FRAC). Commissioned by the Partnership for
America's Economic Success and Pew Charitable Trusts. Forthcoming
October 2008.
[viii] The Impact of Food Insecurity on the Development of Young
Low-Income Black and Latino Children; and Protecting the Health and
Nutrition of Young Children of Color: The Impact of Nutrition
Assistance and Income Support Programs. Research Findings from the
Children's Sentinel Nutrition Assessment Program (C-SNAP); Prepared for
the Joint Center for Political and Economic Studies Health Policy
Institute, May 2006.
[xi] Cook J.T., Frank D.A., Berkowitz C., et al. Food Insecurity is
Associated with Adverse Health Outcomes Among Human Infants and
Toddlers. Journal of Nutrition. 2004; 134:1432-1438.
[x] Children's Sentinel Nutrition Assessment Program unpublished
data (excluding costs associated with birth), 2007.
[xi] Skalicky A., Meyers A., Adams W., et al. Child Food Insecurity
and Iron Deficiency Anemia in Low-Income Infants and Toddlers in the
United States. Maternal and Child Health Journal. 2006;10(2):177-185
[xii] Falkner, N.H. et al. Social, educational, and psychological
correlates of weight status in adolescents. Obesity Research 2001;
9(1):32-42.
[xiii] Drewnowski, A. and S.E. Specter. Poverty and obesity: The
role of energy density and energy costs. Am. J. Clin. Nutr.
2004;79(1):6-16.
[xiv] National Center for Children in Poverty. Poverty 101. http://
www.nccp.org/faq.html Accessed July 20, 2008.
The Chairman. Thank you very much.
Next I would like to have Mr. Manalo-LeClair.
STATEMENT OF GEORGE MANALO-LeCLAIR, SENIOR
LEGISLATIVE DIRECTOR, CALIFORNIA FOOD POLICY
ADVOCATES, OAKLAND, CA
Mr. Manalo-LeClair. Good morning, Mr. Chairman and Members
of the Committee. My name is George Manalo-LeClair, and I am
with the California Food Policy Advocates. We are a statewide
organization dedicated to improving access to nutritious and
affordable food for low-income Californians. I have come a long
way to do three things: One, to describe the problem of hunger
and food insecurity in California, the enormous problem that we
have. I also want to tell you about how the Food Stamp Program
is working to address part of that problem. However, it still
falls very short in reaching a number of households,
particularly working households in our state. And third, I want
to say thank you for recent improvements in the farm bill to
address nutrition. But because of our struggling state economy,
I am going to need to ask for additional help.
So let's start with the problem of food insecurity in
California. People are often surprised when I describe the
situation because it is in stark contrast to the image many
people have of the Golden State. The problem is real and well
documented. Since 2001 the University of California Los Angeles
has examined the problem of food insecurity through the
nation's largest state health instrument, the California Health
Interview Survey also known as CHIS. My written comments go
into greater detail on CHIS and its findings.
I just want to summarize the findings. As an example, a
woman I met just a few years ago, she was part of a culinary
training program in Silicon Valley, one of the more prosperous
parts of our state. And though she was working around food all
day, money was very tight, and at home she didn't have enough
for her and her children. So what she would do at meal times is
that every dinner she would pour herself a big glass of water
and drink it, and then pour herself another one and drink it.
She did this to fool herself into feeling full so she wouldn't
be tempted to take food away from her children. The CHIS data
make it clear that this woman is not alone. Over 2\1/2\ million
adults in California struggle to put food on the table. And
like this woman in Silicon Valley, many of those struggling are
surrounded by wealth and food.
It is ironic that in California the counties with the
greatest agricultural production output also have the highest
rates of food insecurity. And as this mom knows, hard work is
no guarantee against hunger. The majority of those experiencing
food insecurity in California are working. The combination of
high rents and low wages leave little resources for food. But
while we have seen the consequences that other panelists have
noted this morning, we have also seen a powerful tool at work,
the Food Stamp Program in our state. It serves over two million
people and brings in over $4 billion in economic activity. That
does much to address the problems discussed today.
However, one of the most troubling findings from CHIS is
that 77 percent of those struggling to put food on the table
who are likely eligible for food stamps were not getting them.
This is consistent with USDA's own estimates of over two
million people in California not participating in the program
and only 35 percent of working households are getting these
benefits in our state. So given that working families make up
the majority of those struggling, the Food Stamp Program can
and must do more.
Some help is already on the way, thanks to the changes in
the recently passed farm bill. So I want to extend our thanks
to the Chairman and Members for their work in this area as
California stands to be a big winner with these changes. But
while we are very grateful, we are compelled, given the scope
of the problem in our state, to ask for additional action. We
need action to improve access to the Food Stamp Program, to
make it more accessible to working families. We need action to
increase food stamp benefits not just to address rising food
costs, but also to make the cost of the program, the long
waits, the paperwork, the trips to the welfare office cost
beneficial to participants.
We also need to extend aid to populations whose
participation in the program is currently limited, such as
legal immigrants and childless adults. There are a number of
Congressional proposals that already exist that would move us
in this direction such as the Chairman's Nourish Act and the
McGovern-Emerson Feeding America's Families Act, and moving
these proposals forward would certainly help the situation. But
right now things are getting worse for our low-income
residents. Average gas prices in California are over $4.51 a
gallon. We have seen double-digit increases in basic foods like
bread and eggs, and demand for emergency food and food stamps
has increased.
We have enormous budget shortfall in our state, and we have
been hit hard by the mortgage and lending crisis, but there is
hope. Our legislative analysts have demonstrated that the Food
Stamp Program has broad economic effects on our state. Here is
the quick version of the analysis. When families get food
stamps in California, it frees up resources in their tight
budgets to be spent on taxable items like clothes and shoes. So
our state's general fund benefits as well as local
jurisdictions.
So we are requesting a short-term boost in food stamp
benefits to help our struggling families and our struggling
economy. We are pleased to hear that Speaker Pelosi is
considering a package that includes food stamps in overall
economic recovery. We strongly support efforts that help people
better afford a basic healthy diet. Given the importance of
agriculture and the food industry to our state's economy and
because of the revenue effect discussed earlier, such action
would go a long way to helping our families and our fiscal
situation. We appreciate the Committee's interest in this issue
and do hope that help is on the way. Thank you very much.
[The prepared statement of Mr. Manalo-LeClair follows:]
Prepared Statement of George Manalo-LeClair, Senior Legislative
Director, California Food Policy Advocates, Oakland, CA
Good morning, Mr. Chairman and Members of the Committee.
My name is George Manalo-LeClair and I am Senior Legislative
Director for California Food Policy Advocates. CFPA is a statewide
public policy and advocacy organization whose mission is to improve
access to nutritious and affordable food for low-income Californians.
I appreciate the opportunity to testify today, as California has
much to offer to this Committee's consideration of the short and long
term effects of hunger in America.
First, we have undertaken the largest statewide health survey in
the country and found the problem of food insecurity is
enormous in scope and impact.
Second, as our state has sought to address the problem,
policymakers have acknowledged and quantified the contribution
that Food Stamp Program benefits make, not only to families,
but also to our state and local economies.
Third, building upon this economic benefit, I'd like to make a
request for swift action to provide California residents
immediate relief in these tough times.
Food Insecurity in California
Let's start with the problem of food insecurity in California.
Though California has been number one in food and agriculture
production in the U.S. for more than fifty years, we have millions of
people struggling to put food on the table. We know this because in
2001, and biennially since, the University of California has conducted
a large scale, statewide study, called the California Health Interview
Survey (CHIS), to assess a broad range of health conditions, including
food insecurity.
CHIS has been a massive and reliable effort. CHIS is the largest
state health survey and one of the largest health surveys in the
country. Because of its large sample size, with over 50,000 households
interviewed, it generates statistically significant findings for the
entire state and for most of our 58 counties. This biennial survey is
conducted by the University of California at Los Angeles in
collaboration with the California Department of Public Health, the
Department of Health Care Services and the Public Health Institute
UCLA publishes the food insecurity findings every 2 years. I have
been a co-author of this research since its inception and have
participated in each biennial release.
At first, the scope of the food-insecurity problem seemed
unbelievably large, but over time the results have painted a consistent
picture. According to the most recent CHIS release in 2007,
approximately 2.5 million low-income adults in California struggle to
put food on the table.\1\ But this figure doesn't capture the full
extent of the problem since this survey measures food insecurity only
among adults. We know that these adults are not alone in their
struggles, and we know that despite their best efforts, parents aren't
always able to shield their kids from the consequences of hunger and
food insecurity. Before I quantify the full dimension of this
comprehensive understanding of how food insecurity affects real
households, let me give you an example of one parent's attempt to
protect her children.
---------------------------------------------------------------------------
\1\ UCLA Food Insecurity Brief, June 2007. http://
www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=225.
---------------------------------------------------------------------------
Several years ago I met a woman who was in a culinary training
program in our state's prosperous Silicon Valley. Money was really
tight for her and despite working around food all day, she just did not
have enough to provide for her family. At the dinner table she'd be
hungry, but there wasn't always enough food for her children and for
her. So to keep herself from taking food from her children, she'd pour
herself a big glass of water. And then another. And sometimes another
so that she would fool herself into feeling full and not be tempted to
take food that would otherwise go to the children.
Not all parents are this successful in shielding their children.
Based on the CHIS data, more than 7.5 million other people living with
these adults also experience food insecurity. Given that these
households share dinner tables, in many cases they must also share in
their struggles with food. Understood this way, over nine million
people in California--perhaps a quarter of the population--are being
affected by these struggles.\2\
---------------------------------------------------------------------------
\2\ Shared Tables, Shared Struggles. CFPA. November 2007. http://
www.cfpa.net/press/shared%202007/
shared%20tables%20shared%20struggles%202007.pdf.
---------------------------------------------------------------------------
The wealth of data provided by the CHIS survey presents a
surprising snapshot of who is hungry in the state:
In California, hard work is no guarantee against hunger; the
majority of households experiencing food insecurity are
employed. Low wages and high rents mean many working families
don't always have enough resources for food.
In California, hunger does not discriminate. Food insecurity
affects people of many races, though Latinos and African-
Americans experience it at higher rates. Immigrants are among
the hardest hit.
Food insecurity in California also knows no boundaries as it
is prevalent in all 58 counties. But some communities are hit
much harder than others. It is ironic that the counties with
the greatest agricultural production also have the greatest
percentage of their population struggling with food.
Families with children are much more likely than families without
children to struggle to put food on the table in California.
Consequences of Food Insecurity in California
It is clear that those lacking consistent access to adequate food
suffer profound consequences. Other panelists today are going to go
into greater detail on the health, employment and academic consequences
of food insecurity. I'd also like to acknowledge the connections we
have seen and measured, most notably that children in very low food-
insecure households miss more school and do less well academically. And
that those adults with food insecurity who experience health problems,
such as diabetes and other obesity related conditions, have
significantly more complications, more hospitalizations and more trips
to the emergency room because of their food insecurity. One challenging
finding is that in California those experiencing food insecurity are
more likely to be overweight or obese. The remarkably steep price tag
of obesity to our state--and the nation--is well documented.\3\
---------------------------------------------------------------------------
\3\ The Economic Costs Of Physical Inactivity, Obesity, And
Overweight In California Adults, State Department of Health Care
Services http://www.wellnesstaskforce.org/PDF/obese.pdf.
---------------------------------------------------------------------------
Addressing the Problem
The common factor among all of these struggling Californians is a
lack of income. Policy action to increase wages, to make housing more
affordable, and to adequately provide supports for the working poor
like child care and health care would go a very long way to address the
problem.
Short of this, we need a strong nutrition safety net. However, the
CHIS data make it clear that current efforts are failing to make much
progress in providing food security for low-income Californians.
Problems With Food Stamps in California
One of the most troubling findings of the California Health
Interview Survey was the severe underutilization of the Food Stamp
Program. More than 77 percent of those households identified as
experiencing food insecurity in California who had qualifying incomes
were not participating in the program. This means that essential help--
that Congress put in place precisely for these people in this
predicament--is not getting to those most in need.
These CHIS findings are consistent with USDA research on food stamp
participation in California. California has one of the worst food stamp
participation rates in the country, and USDA estimates that over two
million eligible Californians are not receiving food stamps.\4\ If more
Californians were receiving these valuable nutrition benefits, the
problem of food insecurity discussed earlier would be greatly reduced.
---------------------------------------------------------------------------
\4\ Reaching those in need. USDA. October 2007. http://
www.fns.usda.gov/OANE/MENU/Published/FSP/FILES/Participation/
Reaching2005.pdf.
---------------------------------------------------------------------------
The average monthly benefit per person in California is now just
over $100. With rising food costs, this amount falls short of providing
families with an adequate diet, but it certainly could make a
tremendous difference for those not currently participating.
Unfortunately, a number of state and Federal rules make it difficult
for struggling households, especially working families, even to
participate. More than 70 percent of the households eligible for food
stamps in California are working households.\5\ According to USDA,
California has the worst rate of food stamp participation among working
people in the country. Just 35 percent of eligible working households
in California participate in food stamps.\6\
---------------------------------------------------------------------------
\5\ Comparison of Participation Rates Working vs. Non-Working.
CFPA. April 2001. http://www.cfpa.net/foodstamps/Participation/
workpart.pdf.
\6\ State Participation Rates for the Working Poor. USDA. http://
www.fns.usda.gov/OANE/MENU/Published/FSP/FILES/Participation/
WorkingPoor2003.pdf.
---------------------------------------------------------------------------
When struggling working families don't get food stamps, it is not
just the families that miss out but our economy as well. As CFPA's
report Lost Dollars, Empty Plates points out, poor participation hurts
our economy as well. California is passing up over $2 billion a year in
Federal nutrition benefits. This money would certainly help families,
but in addition it could generate close to $4 billion annually in
economic activity.
Capturing the Economic Benefits of Food Stamps to California
Policymakers in California are working to improve the reach of food
stamps in our state. In response to interest from state legislators,
the non-partisan Legislative Analyst's Office published a policy brief
that has helped capture the economic benefits of food stamps to the
state.\7\
---------------------------------------------------------------------------
\7\ LAO Budget Analysis Food Stamp Program. http://www.lao.ca.gov/
analysis_2004/health_ss/hss_20_foodstamps_anl04.htm.
---------------------------------------------------------------------------
The direct benefits of food stamps to families in our state are
clear. But our analyst discovered that food stamps can also have
economic benefits for our state and local economies. Under this
analysis, food stamp dollars can lead to increased spending on taxable
items. Though food is not taxed in our state and food stamp law
prohibits taxes on food stamp purchases, increased food stamp funding
nonetheless can actually increase state general fund revenues. This is
so because when families get food stamps there is indeed increased
spending on food but, in addition, resources are freed up in tight
family budgets to be spent on taxable items such as clothes and shoes.
Under this so-called ``premise,'' this food stamp infusion generates
about 45% of the value of the food stamps in taxable activity. With a
state share of the sales tax pegged at 5%, one can see that increased
food stamp spending can have a significant and positive impact on our
state's strained general fund. And, because local communities receive a
share of sales tax revenues (and in many cases add on to the sales
tax), there are significant benefits from increased food stamp
participation for local jurisdictions as well.
While this analysis falls short of the standard of peer-reviewed
research, it is nonetheless embraced by the legislature, the
Schwarzenegger Administration and advocates. Recognizing this, this
analysis deserves further considerations and the Food Stamp Program
deserves further investment. If Food Stamp Program participation were
maximized in California, our state and counties could realize over $70
million a year in increased revenues. Given our state's fiscal crisis,
we can use all the help we can get.
Taking Action
Recent Progress
Some help is already on the way, thanks to changes in the recently
passed farm bill. We want to thank the Chairman and Members for your
efforts to improve food stamps. The actions taken will help stop the
erosion of food stamp benefits, will provide additional relief for
working families with high child care costs, and help remove several
disincentives to savings and asset development.
California stands to be a big winner with these changes. Support
for nutrition will increase by an estimated $700 million dollars over
the next 5 years. More than 800,000 California residents will feel
these benefits.
While we are very grateful for this new investment, given the scope
of the problem we are compelled to ask for additional action. We need
to bring benefits to those struggling families who aren't participating
in food stamps and we need to improve benefits for those that are.
California needs a combination of actions which:
1. Simplify the program and improve access for working people who
often can't complete program requirements because of work
commitments.
2. Increase benefits not only to address rising food costs and to
better support a healthy diet but also to better offset the
`costs' of participating in food stamps (long waits, lots of
paperwork, many trips to the food stamp office) to families.
3. Extend aid to populations whose participation in food stamps is
currently limited, such as legal immigrants and childless
adults.
Congressional proposals already exist which would continue the
progress already made by the farm bill and help families meet the
demands of rising food prices. There are a number of provisions from
the Chairman's ``Nourish Act'' that were not incorporated in the farm
bill that would help--most notably a restoration of benefits to legal
immigrants who are currently denied help. The McGovern-Emerson
``Feeding America's Families Act'' has additional provisions, which if
enacted would further improve benefits, help vulnerable childless
adults, and further support savings and asset development. If Congress
were to enact the provisions found in these two pieces of legislation,
the pain of hunger would be lessened in our state.
A New Opportunity To Help Struggling Families and Our Economy
We will soon have an updated picture of the problem of food
insecurity, as a new round of health survey data has been collected for
the next CHIS report. Though updated, it still won't capture the most
recent impacts of rising food and gas prices and other struggles. Our
state legislature recently convened hearings on the topic and it was
clear things were getting worse for low-income residents: Average gas
prices over $4.51 a gallon. Double digit increases for basic foods like
bread and eggs. There have been increased demands for emergency food
and food stamps. More needs to be done.
Our state economy needs help, too. We have an enormous budget
shortfall--currently estimated at more than $15 billion. Unemployment
is rising with preliminary estimates for June of a 6.9% unemployment
rate. And we have been hit hard by the mortgage and lending crisis.
A short-term boost in food stamp benefits could help our struggling
families and our struggling economy. The annual adjustment in food
stamp benefits scheduled for October 1st will fall well short of
providing what struggling families need for a bare-bones diet. Because
the data used to calculate these benefit levels is already out of date,
the new increase--on the day it is delivered--may already be more than
$40 a month less than what a family of four needs to purchase a
minimally adequate diet. Given this forecast, swift action is needed.
We are pleased to hear that Speaker Pelosi is considering including
food stamps in an economic recovery package. We strongly support
efforts to provide a temporary boost in basic food stamp benefit levels
to help people afford a basic healthy diet. We would welcome the
opportunity to help the Committee shape such a package--its passage
would minimize hunger by giving families a boost to meet these rising
demands.
We also need this boost to help our state's struggling economy.
Given the importance of agriculture and the food industry to our
state's economy, such action would go a long way in improving our
fiscal situation. We hope that any new stimulus package would include
this much-needed economic spark.
Thank you for your consideration.
The Chairman. Thank you very much.
Next is Mr. Weill.
STATEMENT OF JAMES D. WEILL, PRESIDENT, FOOD RESEARCH AND
ACTION CENTER, WASHINGTON, D.C.
Mr. Weill. Good morning. Chairman Baca, Members of the
Subcommittee, I am Jim Weill from the Food Research and Action
Center. And I deeply appreciate the opportunity to testify
today. We greatly appreciate as well the work you did to
produce such an excellent nutrition title in the farm bill.
The number of people living in households facing food
insecurity is far too high in this country and it has been
growing. It rose from 31 million in 1999 to more than 35
million in 2006. And the problem has been getting deeper as
well as broader. The large majority of that numerical growth in
that period was in the most severe subcategory, very low food
security or what USDA used to call food insecure with hunger.
And almost certainly the problem is considerably worse today
than in 2006 as families face declining wages and rising food
and energy prices. That is why it is important for Congress to
pass a temporary boost, as has been mentioned, in food stamp
benefits soon that will not only mitigate the impact of rapid
food inflation and the worsening economy, but will also provide
real stimulus.
Dollar for dollar, there is no better economic stimulus,
both conservative and liberal economists have recognized this,
there is no better economic stimulus expenditure than food
stamp benefits because they get into the economy so fast and
have multiplier effects.
But too many families were struggling with hunger before
the recent economic problems. So even if and when we get back
to the situation in 2006, we badly need long-term solutions as
well.
We need solutions because, as the panel has said, hunger
and food insecurity harm physical, social and cognitive
development, education, health and mental health and
productivity. They contribute to obesity, stress and
depression. They increase public and private health costs,
mental health costs, hospitalization and educational and other
costs. And even when parents skip meals to insulate their
children from hunger, the parents' own struggle, their stress
and depression, ultimately affects the children.
As Dr. Mark Nord indicated earlier, parents do a great deal
to protect children against the worst deprivation of food
insecurity in the household. But the children can suffer
considerable harm nonetheless.
We should be appalled that our society allows all of this
to happen. And it is well within our capacity to end hunger.
Yet we have more than 35 million people in households where
members are skipping meals, where unhealthy diets are routine
because of economic necessity, where children dread weekends
because there are no school meals and cupboards at home are
nearly empty. And these problems are interwoven with other
national challenges that we face. We are going to have to solve
the food insecurity problem: if we want an effective and cost-
effective national health strategy; if we want a successful
anti-obesity strategy; and if we want to improve schools and
student performance.
Food stamps alone can't end hunger in this country. We also
need better wages and stronger programs for economic security.
And we need stronger child nutrition programs, school meals and
WIC and summer and after-school food and childcare food. The
food stamps are the critical base of the strategy. The recent
farm bill, as you know, made some important improvements.
Again, we thank you, Mr. Chairman and the Subcommittee. But the
Food Stamp Program, or as it will be known from October 1, the
Supplemental Nutrition Assistance Program, or SNAP, has to be
strengthened further.
First, allotments just aren't enough to sustain health and
well-being. Benefits typically run out well before the end of
the month. The many Members of Congress, journalists, religious
leaders and others who, over the last 18 months have taken the
food stamp challenge, trying to live for a week on a typical
food stamp allotment, have spoken eloquently to the hardships.
Dr. Debbie Frank, a C-SNAP colleague of Dr. Cutts, has referred
to food stamps as the equivalent of a magical medicine or
vaccine, but one that we provide in a sub-therapeutic dose. We
need to make the dose adequate to create and sustain health.
We also need the program to reach many more low-income
people. This means removing some arbitrary barriers. But it
also means better efforts at all levels of government to
connect eligible people to benefits. Nationally only 67 percent
of those eligible actually receive benefits. And in many places
the number is far worse because there is too much red tape or
too little outreach or state and local rules purposefully
narrow participation.
When my organization looked at participation in 24 big
cities, the estimated rates were as low as 35 percent in San
Diego. USDA's study show some states with participation rates
as low as 49 percent, and 39 percent for working families. Of
course this harms low-income people, but it also harms local
economies. Every dollar of benefits that enter a community
produces nearly twice that much in economic activity.
So in sum, the cost of hunger is far too high to continue
to tolerate such losses rather than to seize the potential for
gains by making every American family food secure. There is too
much at stake, not only in terms of health and early childhood
development in education, but also productivity, economic
growth and community development. And we look forward to
working with you to make a stronger SNAP program a far more
reliable bulwark against hunger in this country. Thank you.
[The prepared statement of Mr. Weill follows:]
Prepared Statement of James D. Weill, President, Food Research and
Action Center, Washington, D.C.
Chairman Baca and Members of the Subcommittee, I am Jim Weill,
President of the Food Research and Action Center, and we deeply
appreciate the opportunity to testify at this important hearing today.
We greatly appreciate as well the work you did to produce an
excellent nutrition title in the farm bill over the past 18 months; and
we applaud your leadership in taking up so quickly the important
concern of what remains to be done to address hunger in America and its
harmful effects.
Before talking about the effects of hunger on the people of this
country, I would like to discuss very briefly the extent of hunger and
food insecurity. It is, after all, only because the problems of hunger
and food insecurity are so unnecessarily widespread in our country that
the effects are so significant for children and for adults, for our
nation's health and educational systems and outcomes, for our nation's
productivity, and for the economy as a whole and our fiscal well-being.
The latest official poverty data and hunger data from the Census
Bureau and the U.S. Department of Agriculture are for 2006, and they
tell us that, even as the economy grew in the early part of this
decade, lower-income Americans were receiving a shrinking share of the
economic pie. Because of inadequate wages and economic supports, the
number of people living in poverty rose from 31.6 million in 2000 to
36.5 million in 2006. The number of people living in households facing
food insecurity--the government phrase for families without the
resources to feed themselves enough, or unable for economic reasons to
purchase a healthy diet, or otherwise struggling with hunger--rose from
31 million in 1999 to 35.5 million in 2006. More than 12 million of the
people living in food insecure households were children.
The problem not only has been getting broader, it has been getting
deeper: almost all of the growth in food insecurity from 1999 to 2006
was in the most severe sub-category, what USDA now calls ``very low
food insecurity'' (and which was known, until 2 years ago, as ``food
insecure with hunger''). The number of people in households in this
most severe sub-category rose from 7.8 million in 1999 to 11.1 million
in 2006.
Almost certainly the numbers are considerably worse today. For much
of the last year the economic data have been dominated by rising food
and energy prices, stagnant or declining wages, and growing
unemployment, as well as severe housing problems. The food insecurity
numbers described earlier were for 2006. There is little doubt that the
2007 data, which will be released in November, will be worse, and that
the data for 2008, which we will not see released for another 16
months, will be worse still.
There are interventions needed now to mitigate the impacts of wider
and deeper food insecurity caused by the current inflation and economic
downturn. The suffering of families has deepened considerably. For
example, the Food Research and Action Center estimates that the monthly
cost of the Thrifty Food Plan (the food stamp market basket) has grown
by $40 for a family of four since food stamp benefits were last
adjusted for inflation--a huge impact on low-income families that
already had inadequate resources to purchase a healthy diet.
Most important, in the short run, is the need for a temporary boost
in food stamp benefits. This not only will help low-income families
grapple with weak economic conditions, including rapidly rising food
prices, but also will provide real economic stimulus to the nation's
economy. Dollar for dollar there is no better stimulus expenditure than
food stamp benefits because they get into the economy so fast: USDA and
the states can get them quickly onto beneficiaries' Electronic Benefit
Transfer cards, and hard-pressed beneficiaries will spend the boost
quickly. This has been noted in the last 6 months by economists and
budget experts ranging from Martin Feldstein to Robert Rubin, and from
Ben Bernanke to Peter Orszag.* It is essential that a significant
increase in food stamp help be part of any forthcoming economic
stimulus or economic recovery package.
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* These and other statements can be found at www.realstimulus.org.
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But we also must recognize that this nation had intolerably high
levels of food insecurity before the economic downturn and escalating
food price inflation, and will have them after economic recovery unless
we focus on long-term solutions as well.
Long-term solutions are essential because the damage from hunger
and food insecurity to individuals and families, to schools and the
health care system, and to our economy as a whole is so great. I am
just going to summarize how the harms play out, and then focus briefly
on a couple of particular points.
Maternal undernutrition can impair body, organ and cellular
growth in the fetus; increases the risk of certain birth
defects; and contributes to low infant birthweight, which is
strongly correlated with perinatal and infant mortality.
Food insecurity among very young children can cause stunted
growth, iron deficiency anemia and delayed cognitive
development. Cognitive delays then can last well beyond the
period of nutritional deficiency--the resulting impaired IQ,
motor skills and coordination can last into the elementary
school years and beyond.
Food insecurity harms children's physical growth and immune
systems, and causes weakened resistance to infection. Food
insecure children are far more likely to be reported in poor
health, to catch colds, and to have stomach aches, headaches,
ear infections and asthma.
Food insecurity in both early childhood and the school years
means that children lag their peers and learn less, and these
learning deficits cumulate. School-age children who are food
insecure are more likely to be absent from school, be
hyperactive; behave poorly; be held back; do worse on tests;
and be placed in special education.
All of these consequences of hunger and food insecurity result in
increased health, mental health, hospitalization, educational, juvenile
justice and other costs. As just one example, among children under age
3, according to one study, those who are food insecure are 90 percent
more likely to be in poor health and 30 percent more likely to require
hospitalization.
For adults as well, there is a broad range of adverse outcomes of
food insecurity. Some of them carry over from childhood. But food
insecurity during the adult years independently means lower
productivity and, as is true with children, means more doctor visits,
higher rates of hospitalization and longer hospital stays, and poorer
health.
Adult hunger and food insecurity also harm the children in the
household. Two examples show how not only does hunger harm adults and
children, but also how children will suffer even when adults bear the
brunt and the children have enough to eat. One example involves
depression, anxiety and stress; the other, overweight and obesity.
Often both of the parents or the single custodial parent in a
household do everything they can to protect the children from the
direct consequences of food insecurity or hunger: the children eat
first, and get ``enough'' to eat (it may be filling but not be an
adequate, healthy diet because of the resource constraints). But the
parents are often hungry or skipping meals to protect the children. The
resulting stress and depression with which food insecurity is
associated harm not only the parents but the children's health and
mental proficiency. Food insecurity adversely affects parent-child
relationships.
One survey of several thousand mothers of 3 year old children in 18
large cities found that mental health problems in mothers and
behavioral problems in their preschool-aged children were twice as
likely in food insecure households as in food secure households. In
discussing their findings, the researchers assert: ``Social policy can
address food insecurity more directly than it can address many other
early-life stresses, and doing so can enhance the well-being of mothers
and children.''
As to obesity, research has shown that obesity too can be a
consequence of food insecurity. Obesity among both adults and children
means more cardiovascular disease, diabetes, and hypertension. Among
adult food insecure women who have children, the reasons for obesity
may include the ways in which low-income mothers must cope with limited
resources for food--sacrificing at times their own nutrition in order
to protect their children from hunger and lower nutritional quality.
Food insecurity and poverty may also act as physiological stressors
leading to hormonal changes that predispose adult women to obesity.
But there are connections between food insecurity and obesity for
children as well. Children in food insecure households are more likely
to be at risk of overweight or to be obese. When children are both born
at low birthweight and live in a family suffering from food
insufficiency, they have a 27.8 times higher chance of being overweight
or obese at age 4\1/2\.
Finally, we must not forget that food insecurity harms seniors.
Food insecure elderly persons have been found to be 2.33 times more
likely to report fair or poor health status. And food insecurity among
elders increases disability, decreases resistance to infection, and
extends hospital stays. Moreover, many medications need to be taken
with food to assure their effectiveness. Too many seniors have to skip
meals in order to purchase medication, only to see a ``Take with food''
label on the prescription bottle because without food the drug will be
less effective. Medically this is self-defeating, and, ultimately,
costly. And from the patients' perspective it is a cruel ``Catch-22.''
What all this comes down to is that hunger and food insecurity not
only are unnecessary and immoral in our wealthy nation, but they are
vastly counter-productive in every important realm. They are a
hindrance to our accomplishment of a range of essential national goals:
At a time when the nation is looking for strategies to
broaden health insurance coverage and improve quality of health
care while controlling costs, eliminating food insecurity is a
necessary part of an effective and cost-effective national
health strategy.
As the nation struggles to address its obesity epidemic,
establishing food security and assuring that families have
resources adequate to purchase a healthy diet are essential
components of a successful anti-obesity strategy.
At a time when our scientific knowledge of the critical
importance of early childhood development has been growing by
leaps and bounds--although our policy development is having
trouble keeping pace--eliminating food insecurity is a
prerequisite to the strongest possible early childhood policy.
As the nation struggles with education policy and the
reauthorization of the No Child Left Behind Act, eliminating
food insecurity is a compelling and cost-effective strategy to
improve schools and student performance.
And as we struggle to restore economic growth, boost
productivity, improve our competitiveness, and keep deficits
under control, eliminating food insecurity is one important key
to improving the nation's economic and fiscal futures.
It is essential that we address hunger and food insecurity in this
nation and thereby eliminate the harms they cause. The Food Stamp
Program and other Federal nutrition programs have brought the nation a
long way; and the recent farm bill made some important improvements in
the Food Stamp Program. Again, we thank you, Mr. Chairman, and the
Subcommittee, for your leadership in accomplishing this. But the Food
Stamp Program (or, as it will be known from October 1st, the
Supplemental Nutrition Assistance Program, or SNAP) in particular must
be strengthened further so we can truly move towards eradicating hunger
and food insecurity in the midst of our great affluence.
This requires three broad strategies: making benefit allotments
adequate; opening eligibility to more needy people; and connecting more
eligible people with benefits, since only 65 percent of currently
eligible people, and barely half of eligible low-income working
families, participate in the program.
Food stamps alone can't end hunger in this country--we also need
stronger cash programs for economic security (refundable tax credits,
unemployment insurance and other investments) and stronger child
nutrition programs (school meals, WIC, summer and after-school food,
child care food). But food stamps are the critical base of the anti-
hunger strategy.
Let me first address the pre-eminent need--to make benefit
allotments more adequate. Food stamps are extraordinarily effective for
families, but allotments just aren't enough to sustain health and well-
being. It is the norm rather than the exception for a food stamp
recipient household's benefits to run out several days before the end
of the month--often in the third week of the month. The Thrifty Food
Plan, which is the underlying structure for the benefit amounts, has
never represented what a family needs to purchase a minimally adequate
diet, other than on an emergency basis. This shortfall of benefits was
bad enough before, but it has been exacerbated by program changes in
the 1980s and 1990s that, through several negative actions, cut
benefits. (One 1996 change, freezing the standard deduction from
income, was fixed prospectively by this year's farm bill; but much of
the damage that the 1996 law and earlier changes have caused to benefit
levels remains unremedied. As just two examples: benefits used to be
adjusted for inflation twice a year, but now it is only once a year,
which is particularly damaging in times of high inflation; and maximum
benefit allotments were cut across the board by three percent in 1996.)
As this nation seeks to reduce the effects of hunger and food
insecurity, adequate food stamp allotments are essential. SNAP benefits
should be based on a food plan that reflects what it actually costs to
feed a family a healthy diet, and the income counting rules that
determine what share of a full allotment a family gets should be based
in current economic realities.
The nation will need as well to have the program reach more low-
income people. This means removing some arbitrary barriers to access
for very needy people that are still in Federal law. But it also means
better efforts, at all levels of government, to connect already
eligible people to benefits.
Only 65 percent of eligible people actually receive food stamp
benefits. In many states, cities, towns and rural areas the number is
far worse, because there is too much red tape, or too little outreach,
or state and local rules narrow and discourage participation. Last
autumn the Food Research and Action Center released a report on Food
Stamp Access in Urban America. That analysis found that in 2007, in the
24 cities we looked at, the estimated rates of participation ranged
from a low of 35 percent in San Diego, California to 98 percent in
Detroit (Wayne County), Michigan. Three of the cities and counties with
the lowest rates were in California--San Diego, Los Angeles, and
Oakland (Alameda County).
When states or cities, or any areas, forego food stamp benefits, it
harms low-income people. But it also harms local economies. USDA has
found that every dollar of food stamp benefits, paid for by the Federal
Government, that enters a community produces nearly twice that much in
economic activity. In other words, there is nearly a 2:1 multiplier
effect. The food stamp benefits not only, therefore, reduce hunger and
poverty, but they create jobs and other economic benefits that further
combat hunger and poverty and boost the community economy.
But states and cities are foregoing many billions of these dollars.
Our 24 city study, for example, found that the cities were leaving
$2.27 billion in federally-funded food stamp benefits unclaimed.
The cost of hunger and food insecurity to individuals, families,
communities and the nation is far too high to continue to tolerate
these and other losses. It is too high a cost in terms of health,
education, productivity, mental health, economic growth, and community
development. It is within this nation's capacity to end hunger and food
insecurity. We look forward to working together with the Members of the
Subcommittee to make a stronger, more adequate and more accessible SNAP
program a far more reliable bulwark against hunger in America.
The Chairman. Thank you very much, Mr. Weill. And I want to
thank all of the panelists for their statements.
At this time, we will entertain questions from all of us,
and I will begin myself and then call on Mr. Boustany and then
Mr. Kagen to ask some questions as well. And my first question
is for Dr. Nord. Could you please clarify the difference
between food insecurity and hunger in terms of the gathered
data?
Dr. Nord. Can you repeat the question? I am not quite sure
I understood.
The Chairman. Could you please clarify the difference
between food insecurity and hunger in terms of the gathered
data.
Dr. Nord. The data that we collect in the current
population survey, which is our national annual survey, asks
questions about economic access to food. So it really is
directly a measure of that, of what we call food security, of
whether households can afford enough food. We do not ask the
kind of questions about physiological symptoms, about stomach
pain or weakness or those kind of symptoms that you might want
if that is the type--the kind of notion of hunger that you were
trying to measure.
So what we are measuring currently is economic access to
enough food. This is the context in which hunger may occur, but
we don't measure directly whether hunger ensues from those
conditions.
The Chairman. Okay. Thank you.
Mr. Brown the Sodexho study estimates that limited
education and workforce productivity costs Americans about $9.2
billion annually. Could you explain the statistics in more
detail?
Dr. Brown. I will, Mr. Chairman. But I would like to do
that by deferring to Dr. Shepard.
The Chairman. Sure.
Dr. Shepard. Thank you very much, Mr. Chairman. The way we
did that was to look at the increased rate of absenteeism and
of repeating a grade in school, which were higher for people
that were food insecure: 1.66 times the rate of absenteeism and
1.44 times the rate of missing a grade. Other literature, in
turn, showed that those are related to a higher risk of then
dropping out of school. And we related that to the economic
loss when somebody drops out of school and has, over the entire
rest of their life, has lower lifetime productivity. So linking
those together gave us the $9.2 billion of cost. It is very
likely conservative but that is what the available literature
allowed, sir.
The Chairman. Let me follow up on one of the things that
you mentioned and about which we are very much concerned. As we
try to address the dropout rate and the impact it is having on
us--and a lot of times--what affects then in numbers do we have
of the effects of hunger on the dropout rate too, as well as we
begin to address it? We know that there are a lot of problems
that cause dropout rates. But to what extent then does hunger
impact the dropout rate that we have? Because we have a high
number right now.
Dr. Shepard. We couldn't--as my colleague Dr. Brown
indicated, we searched literature for consequences of hunger.
And we couldn't find a study that directly linked hunger or
food insecurity with dropouts in one single study. So the
available literature allowed us to look at it through this two-
step process of first finding that the two factors I mentioned
of missed days and repeating grades were associated with
hunger. And then other literature, in fact, showed that those
studies--that those two factors were then related to dropouts.
And so it certainly occurs and would welcome further--
literature would further link directly the available literature
that showed it indirectly.
The Chairman. Right. And then the other effects that it
does have too as well is that hunger--is No Child Left Behind,
definitely has an impact on a lot of our teachers now that are
required to make sure that they are meeting the standards, to
leave no child behind. But yet at the same time consideration
is not given to the child that is undernourished or based on
hunger too that impacts not only that child's learning ability
but also you know the attendance as it was mentioned before.
Could you elaborate a little bit more? And what effects does it
really have on No Child Left Behind?
Dr. Brown. I can tell you what effects it has on education
and then you can extrapolate from that the No Child Left
Behind, Mr. Chairman. This is going to sound crass. But we can
easily take a child who is well nourished and doing well in
school, manipulate her dietary intake and easily impact the
next day her ability, or I should say her inability to
participate in the educational process through the processes
that I described about body triage of dietary energy that I
mentioned earlier.
In other words, simply missing a breakfast, one meal can
have a serious impact on a child's ability to learn. A child,
as you know from your own children, doesn't eat three meals a
day. They graze pretty much all day long. And this is because
children have small livers, and they store dietary energy in
the form of glycogen, and they have to continually replenish
their energy supply. And so the educational process for
children is very susceptible or very dependent on an adequate
supply of nutrient energy.
The Chairman. Thank you. The next question that I have is
for Dr. Shepard. Do the numbers that you use for food banks and
local feeding programs as charitable contributions include the
Federal funds?
Dr. Shepard. No. Dr. Brown also worked on that. But it was
the private fund, private charitable funds that amounted to $14
billion. So the Federal direct support we didn't--it is part of
the solution. We didn't consider that part of the consequence
in this analysis.
The Chairman. Okay. Thank you. Dr. Cutts, thank you for
your insight and your moving testimony. And as a pediatrician
who works directly with children and families who suffer from
hunger-related issues you are in an unique position to comment
on human impact and hunger in America. In your opinion, what is
the most important thing that the government can do to end
childhood hunger in America?
Dr. Cutts. Big question. You know, I think the theme that I
am hearing as I sit here very much is how the vital importance
of food stamps--and I would agree with that, it is the number
one hunger relief program in this country. And as I see the
issue of access, I am very concerned as I hear your concern.
I think especially as we see such disparities in hunger, I
think we see great disparity in the way people access the
program. And that is something that deserves a lot more
attention. I, for example, am particularly concerned about the
large immigrant population that I see who are children of
immigrants and U.S. citizens, 96 percent of them, who access
this program at very low rates, mainly due to fear. I am
concerned about rural populations, who I believe access at
lower rates due to stigma and the fact that they cannot remain
anonymous in their community as they access this assistance
program.
So I think one of the highest priorities would be to take a
look at this vital program, the number one assistance program
and to really scrutinize what is the issue about access and
utilization.
The Chairman. Okay. Thank you. Mr. LeClair, as a Member of
the California Delegation in Congress, your testimony is very
relevant to me and all of my constituents in the 43rd
Congressional District. In particular, the statistics that
California is missing out on an additional $4 billion in
economic activities annually because of the low food stamp
participation rate, are staggering. Earlier this year I wrote
Governor Arnold Schwarzenneger, urging him to invest more on
state funds and food stamps outreach enrollment efforts because
we want to be cost effective.
As we look at the needs, and all of you have indicated that
there is a need for an additional $12 billion, probably even
going higher, but at the same time we would like to do that.
But we also want to be cost effective in saying, are we really
utilizing food stamps? We just don't want to just put in
dollars, and we know that there is a need out there, but it is
not being utilized effectively. And that is part of the problem
that we have.
So from your perspective, what steps should we improve for
food stamp participation to make sure that we do do the
outreach that needs to be done and that people are aware that
there is a service for them as well? And I know that we changed
the index too, as well, to allow more people to be eligible in
this food stamp bill than in the previous ones. And then, of
course, the eligibility that becomes a problem, too, as well.
Who is actually eligible and to what extent can those
individuals apply? So can you please reply?
Mr. Manalo-LeClair. Sure. I think we take a number of steps
with regard to outreach to let, particularly, the working poor
know that they are eligible. Many people are under the
misconception that if you work, you can't get food stamps. We
need to start there. But that goes along with some efforts to
actually make the program work better and become more
accessible for people who are employed particularly during the
hours of 9 to 5. Just a quick story, I was outside a food stamp
office in Sacramento, and it was around 9 a.m. and a gentleman
ran by me, nearly knocked me over. I asked him what the hurry
was. He said, ``He had to get to work.'' What he had tried to
do is go to the food stamp office at 7:30 a.m. that morning and
get through the process before 9 a.m. so that he could get on
the job. I said, ``Is it okay for you to be late?'' He said,
``No. My boss is cool but not that cool.'' I think it is a good
example of how the Food Stamp Program can be--here in Congress
you can take some steps to make it easier for people who can't
jeopardize their employment to complete the process.
At the same time, we need to do a better job locally of
making sure that, particularly, the working poor knows that the
program is there and it provides substantial benefits. I think
that is one of the things that families need to know more about
in terms of what they can do to get help to support a healthy
diet. And one of the things Congress can do is help make those
benefits more substantial because working families do a bit of
math in their head when they consider participation in the Food
Stamp Program.
If it takes an average of 5 hours and three trips to the
food stamp office, and the perception is, you are only going to
get $10 or $20 in benefits, families recognize that they don't
want to take those risks and jeopardize their employment.
So, improving access and increasing the benefits to make
them more substantial, I think those kinds of steps would help
really reach that working poor population that is struggling in
our states.
The Chairman. Well, thank you. I think we can increase and
look at access, but yet how do we market it, and what kind of a
plan needs to be done, and what kind of collaboration can we do
with both the Federal, the state and the local entities in
informing people that they are eligible for food stamps?
And that is part of the problem. And that is what we see as
legislators out here saying, ``Well, we would like to increase
the funding, we see there is a need, but if it is
underutilized, then we have X number of dollars that come back
year after year after year because they are not being utilized
by people that need it.'' And when we look at your statistics
that come out and it says, okay, there is a high number of
people that are going hungry in the United States, yet we have
not done a good job in marketing. And that is what we need to
do, is to make sure that we work together with all entities,
and that includes our local churches and other organizations
within the community, about the eligibility.
And then changing the stigma, because I think the stigma of
food stamps also--you know, it is very difficult. Because I
received food stamps, and the stigma itself--it is like--I
don't want to be labeled as a person that was receiving food
stamps during that period of time. And I am glad that we have
debit cards now at least to change part of it. It at least has
a little integrity for someone that says, all right, I am on
food stamps. But as you said, you described a particular
individual that went to apply for food stamps and then had to
rush back to work.
And then somebody mentioned about the paperwork and the
bureaucracy that is there. That also needs to be addressed and
expedited. But at the same time, we also want to make sure that
people are eligible and not fraudulently just applying as well,
because we care about that in part of the concerns.
Thank you.
The next question, I guess I will turn it over to Mr.
Boustany.
Mr. Boustany. Thank you, Mr. Chairman.
Dr. Nord, you gave us some statistics at the outset of your
testimony. And nearly 11 percent were deemed food-insecure. Do
we have more of a breakdown, rural versus urban, elderly,
without transportation? Is there information available there?
Dr. Nord. We do publish a breakdown by a number of
demographic and economic categories. We have, for example,
metropolitan-nonmetropolitan.
Household structure is a fairly important factor. For
example, single women with children have a rate of food
insecurity around--I am just looking here--30 percent compared
to a national average of 11. So household structure matters.
Income, of course, we would expect that. So the rates for
households with incomes below the poverty line are around 30,
33 percent.
We publish information for metropolitan versus
nonmetropolitan areas, which is kind of a proxy for rural.
There is not a great deal of difference there. There is a
little bit more hardship in the more urban core areas and in
the most rural areas.
Mr. Boustany. Right.
Dr. Nord. But the differences are not stark.
Mr. Boustany. Well, the reason I raise that is because, if
we are going to really try to target strategies dealing with
this, we need to know what populations we are dealing with.
Because one strategy perhaps for, say, urban Chicago is going
to be different from rural Arkansas. And so I think it is
really important to try to focus down and take that 11 percent,
10.6 percent number that we have and really try to get those
different groups, so we can target strategies.
Mr. Carlson, from your standpoint, clearly we have
increased funding for the program in the farm bill. But I know
it is difficult for the Department here in Washington to make
recommendations that would apply state by state, community by
community. But I think one thing you could do would be to give
us information on what kind of metrics should we be looking at
and asking the states to provide to help us kind of focus in on
these kind of individual strategies.
Should the states be reporting information on steps to
improve efficiency in the program, outreach and those kinds of
things? Are we getting reporting data currently?
Mr. Carlson. Yes, sir, there is a significant amount of
information available about both what states are doing and what
they are achieving. We report every year on the rate of
participation among people who are eligible for food stamp
benefits by state. We have an annual report on the
characteristics of the people who are receiving food stamp
benefits.
Many states have engaged in a variety of outreach
activities to try to reach those who are eligible for those
benefits, supported in many ways by the Federal Government
itself. We are in the fifth year of a national media campaign
to inform people about the availability and benefits of the
Food Stamp Program. There are numerous flyers, brochures and
other information out there. There is a toll-free hotline
number. We have put out almost $13 million in grants to states
and communities to help them improve access.
So there is a significant effort underway and a significant
amount of information about what is being achieved.
Mr. Boustany. And clearly that is a big effort, but it is
still not reaching far enough, because when a state like
California claims that we have access--now, I don't want to
cast blame on the Department, because I don't think the
Department can do this alone. I think it has to be a top-down
and a bottom-up effort. And I want to get into this aspect of
it.
But is the Department sharing best practices and
information in that regard? Is this information that you are
collecting, is it being used in a very thoughtful way to
provide guidance to the states?
Mr. Carlson. We believe it is, sir. The agency has created
an outreach coalition, consisting of partners here in
Washington and across the country. Our regions work very
closely with states across the country to ensure that
information on best practices is available.
And I would point out, if I may, that we agree
wholeheartedly that more can be done and that more needs to be
achieved. But in talking about the fact that only \2/3\ of all
the people who are eligible for benefits receive them, it is
also important to understand that about 80 percent of the
benefits that we could pay out if everyone who was eligible was
participating in fact are being paid out.
So we are doing a pretty good job. We, in partnership with
the states and communities across the country, are doing a
pretty good job of reaching those who are in greatest need.
Mr. Boustany. I thank you for your answer.
Dr. Brown, in your testimony you spoke about we could come
close to seriously ending this problem if we strengthen
nutrition programs and, particularly, invested $10 billion to
$12 billion more over current spending.
We have taken that step in the farm bill, a little over $10
billion. But clearly, with today's inflation, energy costs,
everything else, that number is going to be higher. So, in a
sense, we are chasing this on the expenditures, but it seems to
me we still have a lot of inefficiencies. As we heard from the
State of California, that even though the program is there,
many folks aren't accessing it.
What else do you recommend besides the additional
investment of dollars?
Dr. Brown. I actually have been sitting here impressed with
the demeanor of each of you, your bipartisanship, your clear
concern about the problem, both physicians and non-physicians
and pretend physicians up there--or honorary ones, I should
say, Mr. Chairman.
[Laughter.]
The Chairman. Thank you for that clarification.
Dr. Brown. So with the great respect that I have for you,
and seeing you and hearing you, I want to say in response to
that question that sometimes I think we make problems more
difficult than they actually are.
Other industrialized nations have virtually eradicated
hunger. The percentage of hunger that we have in our nation,
hunger, food insecurity, is excessively high compared to other
western democracies. If we were hearing that our military
members were going hungry, we would figure out a way to fix
that in about a week.
And they are not going hungry, except when they come back.
We now are seeing soldiers coming back from Iraq and
Afghanistan who are appearing in soup kitchens and food
pantries across the country. That is a parenthetical statement.
We do know how to fix problems, and we can end hunger in
America, as other nations have done.
The low participation rate, in my view, is not one of the
bigger problems. And I will explain why. I am not saying it is
not a problem at all, as you are suggesting. We want everybody
who is needy and eligible to receive assistance. So let's just
stipulate to that. But we can increase the low participation
rate, if we do several things.
Many elders will tell you that they will not bother
applying for food stamps because of the limited minimum level
or the bureaucratic hassles that they have to go through--
having to come out of their homes, going to the office, and so
on. Similarly, a lot of families get knocked off through what
we in the social science community euphemistically refer to as
``bureaucratic terrorism.'' That is, if you call somebody back
to the office enough times, you are asking them for such
ridiculous amounts of detailed information or they have to take
off work to come back, they are not going to be on the program.
So, recognizing that what you are raising about the low
participation levels is a legitimate thing to raise, I think
that is not the main thing to raise. The main thing to raise
are the minimum levels, figuring out ways that we can ease the
bureaucratic requirements, while still maintaining the
economic, financial integrity of the program and providing food
stamps at a level sufficient enough to help people have enough
to eat throughout the month.
Mr. Boustany. And the figures you gave us, the $10 billion
to $12 billion over current spending, would that cover those
bureaucratic changes? Or do you think it is going to take--I
mean, you gave us the $10 billion to $12 billion. Let's accept
it is going to be a little higher because of inflation, fuel
costs and everything else.
Dr. Brown. Yes.
Mr. Boustany. That figure that you are basically citing,
does that cover all these bureaucratic changes, or is it going
to take more beyond that?
Dr. Brown. No, no. By the way, this figure came from the
national anti-hunger organizations, including Mr. Weill's
organization and about 10 other national hunger organizations,
Bread for the World and so on.
We were simply looking at the system as it is and saying,
what degree of further input--and all of that is not food
stamps, but the bulk of it is--what degree of further input or
expansion of existing programs could virtually eliminate hunger
in the nation? And we came up with that figure.
But if we do that, we also ought to take the steps that you
keep asking questions about, about increasing the participation
rate. So I don't mean to minimize it. I am simply saying that
is not the biggest issue.
Mr. Carlson said, for example, that they are serving about
80 percent of the need there. As a rule of thumb, that is
fairly high for a Federal program, because you are always going
to have some people who don't want the program, who are moving,
whatever. So for the WIC program, for example, it is a bit over
that now, but everybody is pretty satisfied that we have high
participation in the WIC program.
Mr. Boustany. I appreciate your thoughtful answer.
Mr. Chairman, I have one more question, if I could.
The Chairman. Sure.
Mr. Boustany. Dr. Cutts, you spoke on what you and your
colleagues are doing at the medical center to help families
learn about and begin participating in the Food Stamp Program.
Tell us in more detail about what steps are being taken at
the ground level in a hospital such as yours to really educate
families on all these programs, whether it is the Food Stamp
Program or WIC or other local programs.
I mean, for instance, in my hometown we have a food bank.
We also have a program called Meals on Wheels that takes care
of the elderly that cannot get out.
Do you have a formalized program in the hospital, an
outreach program?
Dr. Cutts. Let me try and answer your question.
In terms of the children, the young children who we survey
for C-SNAP, part of that process with every family is to offer
resources. And as that project was conceptualized, it was
important to us that we not, as a colleague might say, ``We
don't cure a fever by taking a temperature.'' We are not just
collecting data; we are doing an intervention at the time that
the data is collected.
So for that population, through the research we are doing
an intervention. I think in the broader scale at this
institution, it is a much harder question to answer. HCMC is a
county-supported hospital. And like most county hospitals,
which are dwindling, as you know, in number, the finances of
that equation are extremely tenuous. Our social work staff has
been cut and cut and cut. And I know I am not telling you
something you wouldn't be aware of.
So I would ask you, whose responsibility and where does
that funding come from to do what needs to be done to do an
intervention such as the one you propose? It is a real concern.
And I think it is going to take time, it is going to take
money. And I think there are some ideas about how it could be
done, and been trialed in various situations, that would be
lovely to see funding to do locally.
Mr. Boustany. Thank you.
The Chairman. Thank you.
I have a question for Mr. Weill.
Since you are familiar with our budget challenges, as well
as the new changes in nutrition policies we passed in the farm
bill, could you comment on how much more funding do you think
Congress should legislate? And then specifically, any
additional funding that would be a PAYGO problem that would get
scored for it? And if so, could you get 90 percent
participation? Wouldn't that cover a large portion of the
remaining needs?
Mr. Weill. Well, I hope you are not asking me to describe
in detail where the money is going to come from.
I will say that the short-term stimulus that I and others
on the panel talked about presumably wouldn't be subject to
PAYGO rules. In the long term, we need to invest what is needed
to address this problem. Dr. Brown has given you an approximate
figure. And I think that if we invested that much money, it
would have a profound effect on the food-insecurity rates in
this country, on the hunger rates, and a profound positive
effect on schooling and health and health-care costs and so on.
And so I think we are all agreed that the two most
essential things to be done are to increase benefits across the
board to more adequate levels for all beneficiaries in the
program, as well as increasing the minimum benefit again--and
we appreciate that the Committee did that in the farm bill, and
that is an incredibly important step forward--and to improve
access and get participation rates up around 90 percent, which,
as indicated, as you know, is close to the best one can do in
these programs.
If that costs in the neighborhood of $10 billion to $15
billion a year and PAYGO rules are still in effect next year,
there are many places, obviously, to find that money. I would
point out that the program spends a considerably smaller
portion of the Federal budget or of the gross domestic product
than it did 20 years ago, before there were some program cuts
in the 1980s and 1990s--or maybe 30 years ago--before there
were program cuts, before other changes reduced spending on the
program as a share of the economy as a whole.
So we are talking about, in a sense, restoring strength to
the program and restoring the program as a spending mechanism
as a share of the economy to where it was a while ago, not
adding vast new sums that this country has never spent before
or contemplated before.
The Chairman. Thank you.
And one final question, and I am going to throw it open to
any one of you that would like to answer the question or try to
attempt to answer the question.
As we look at the need for food stamps and benefits and
access to it, and we have explored some ideas, and trying to be
cost-effective, too, at the same time, and allowing individuals
to participate, and knowing the responsibility of the Federal
and knowing the responsibility of the state and local
communities and others. I know that there is a cost factor
here, but have we ever utilized mobile social workers when we
talk about seniors and others that are not even applying for
food stamps that can go to their location instead of someone
having to go to a county agency to apply for food stamps?
Have we tried that both at the Federal or state, utilizing
mobile units that can go out there with social workers to try
to get people that are eligible to apply for food stamps, since
we have a high number of people that are going hungry?
Mr. Carlson. Mr. Chairman, if I might, there have been a
number of efforts in that direction. The one that comes
immediately to mind, perhaps not exactly what you are
describing, but a program in the State of Michigan known as MI
CAFE, where workers are periodically outstationed in senior
centers, elderly housing and so forth, places outside of the
normal welfare office where people work, live and play.
I think what we learned from much of that experience is
that it can be effective. It can also be relatively
inexpensive. And it really reinforces the notion that, in many
instances, having information about potential eligibility and
benefits is not enough, that many of these populations require
more intensive, hands-on assistance in order to understand what
the program rules and requirements are, in order to obtain the
benefits they are entitled to.
The Chairman. Thank you.
Would anybody else like to----
Mr. Manalo-LeClair. Yes, I would also like to mention a
promising strategy in California, and it also goes back to
address some of the earlier topics of stigma in the program.
In California, both in the Central Valley and in Los
Angeles, there have been mobile units that have gone to
community health clinics, where people are receiving services,
but also there has been tremendous efforts to enroll people in
various health care programs such as our State Children's
Health Program as well as Medicaid.
And with this effort, it works very well in terms of going
to where needy people are, but it also helps remove the stigma,
because food stamps, if they are seen more as a health program,
the working poor is more receptive to it.
And so, this is clearly an outreach strategy, but one of
the other things I mentioned earlier is the need for improved
access. If we can do more work, both at these mobile locations
but throughout the state, of connecting people who do get
health care services so that food stamps become sort of add-on,
a nutrition benefit that supports the health investment that we
are making through programs like Medicaid. If we can do more to
align those programs and connect them, I think we could do a
much better job of removing stigma, reaching those working
people who are struggling in our state.
The Chairman. Thank you.
Mr. Weill?
Mr. Weill. There is more and more outreach and prescreening
being done by food banks, by anti-hunger advocates in the
community, in public housing, by health providers, by earned
income tax credit organizations. So a lot of prescreening is
being done that tells people whether they are probably eligible
or not, and roughly for how much.
And what has been found is that when people learn how much
they would be eligible for--when they don't know, they tend to
estimate low. When they find out how much they would be
eligible for, even though it is not adequate, it surprises them
on the high side, and they are more likely to apply. And then
the actual processing is done by state employees.
I would just add, there is an interesting model in New
Orleans, in Louisiana, at Kingsley House, a program called
Walkers and Talkers, that goes door to door doing both Medicaid
and SCHIP outreach and food stamp outreach that has been very,
very successful.
The Chairman. Thank you.
Dr. Shepard?
Dr. Shepard. Yes, there has also been interesting work with
other behaviors that are stigmatized that might be useful here,
with people who have drug or alcohol problems, where there is a
similar goal of trying to engage them in treatment. An approach
that has been very promising there is called response-driven
sampling, in which members of that community recruit their own
friends and colleagues and, in some programs, get incentives.
So perhaps a person might get a bag of groceries for bringing
in somebody else who proves to be eligible for this program.
So a model like that might provide double duty of both
being a relatively inexpensive way of bringing people in,
because you are not paying them except when they are
successful, as well as providing some additional help to
members of this community for doing this extra service.
The Chairman. Thank you.
And one final question--I am going to call on Mr.
Boustany--is we have increased on the farm bill and allowed
veterans and our military personnel now--and maybe statistics
that would tell us how many of our military personnel are
actually utilizing food stamps. And hopefully that we can do a
study there, too, as well, to see if it is cost-effective, are
they utilizing it, and to what extent are the military
personnel utilizing food stamps that they are eligible for?
Are there any numbers that have been done at this point in
reference to the military?
Mr. Carlson. Mr. Chairman, the information we have in
answer to that question is relatively old, but the Department
of Defense has done periodic examinations of military personnel
and their utilization of food stamps. My recollection is, the
last time they looked at this, they estimated roughly 10,000 to
12,000 service members qualified for and received food stamp
benefits.
That was a number of years ago, so the situation may have
changed. But I don't believe we have more current information.
The Chairman. Thank you.
Mr. Weill, did you want to----
Mr. Weill. We did an estimate of the number of veterans who
received benefits about a year ago, and I am trying to remember
exactly what it was. It was well in excess of a hundred
thousand at any given time. We will provide that to the
Committee, because I don't trust my memory on the exact number.
The Chairman. I appreciate that very much. Thank you.
Mr. Boustany?
Mr. Boustany. Thank you, Mr. Chairman. Just a few more
questions, and then perhaps a comment.
A couple of you just made note of some best practices that
are very useful and interesting. And that is, how do you bring
a service closest to the person or family in need? And that is
more of what we need to get from you, so that we can share that
type of information.
I recently partnered with our State Secretary of Health and
Hospitals back home in my Congressional district to hold SCHIP
enrollment programs. And we got the press to participate so
that the impact was outside the room, as well, and urged
businesses, schools, churches to get the word out. And it has
been very successful. And I intend to hold one in each of the
parishes--we have parishes in Louisiana instead of counties--I
am going to hold one in each of my parishes. The two have been
very successful so far.
I think you rightly point out the linkage between
nutrition, health care, education and workforce. These are
linked. And one of the things I have tried doing in my
hometown, and I want to expand this effort, is to get all the
nonprofits together and ask them to coordinate their efforts.
Because a lot of them are duplicating efforts and actually
spending money in duplicative ways, whereas I think, if they
coordinated efforts, you can leverage what you have. And,
actually, the byproduct of that is greater than the sum of the
parts. And that is something that perhaps might work in
different communities and states.
I guess the final challenge is, how do we structure a
layered safety net? Because today we have focused on the
Federal program, but how do we bring these nonprofits into the
equation, our churches into the equation, to make sure that we
do have a structured safety net so that perhaps no family goes
hungry? That may be the mechanism by which we get beyond that
80 percent participation and get close to 100 percent
participation.
So if anyone wants to comment on any of those. I guess it
is really not a question, but I just wanted to throw that out.
Thank you.
The Chairman. Dr. Brown?
Dr. Brown. Congressman, I am glad that you raised those
points, in particular the last point. Because I have often
heard, in talking with Members and also various
Administrations--and because I go back a while, I am talking
about Democratic and Republican Administrations--and I have
heard people talk about the public-private initiative to reduce
hunger in the nation. And I think that it is important to
remember that, while we do need that public-private initiative
and the type of activities that you have just suggested and
other Members have suggested in terms of outreach and pulling
people in and so on, that our goal is not to create more and
more charity in America. It is to have a nation where we need
very little charity at all.
We don't want to become or continue to be a nation of soup
kitchens and food banks. That is not really America. That is
not what our aspirations are all about.
And while it is much more productive in terms of nutrient
efficiency to feed people through food stamps, and also does a
lot more for their own integrity, our goal isn't even to have a
nation where we have more and more people on food stamps.
We want to have a nation where people can be independent,
self-sufficient and feed themselves in their own homes from
money that they earn in the marketplace. That is the long-term
goal.
But the first thing we ought to do is to have a vision of
our society where we don't have this enormous charitable
sector, because we have expanded programs, they reach people
adequately. And then we can begin working on those economic
issues that pertain to employment and wages and so on, so that
we can start decreasing the food stamp roles as well.
Mr. Boustany. But, Dr. Brown, I am deeply troubled by the
fact that we have 35 million Americans who--we really haven't
made a dent in that. It seems to be a constant and slightly
growing figure.
And so I would submit that we have to look at all the
possible tools available. And this great country has a strong
tradition of charitable giving. So I wouldn't just shove it
aside. I think it is an important component. And I do think it
helps to get beyond the stigma question that most of you have
pointed out that is a barrier to the Federal program working.
So I am just simply saying that we have to have--we ought
to make use of a coordinated, layered effort to reduce hunger.
Because that is ultimately the goal. And one way or another,
somebody is paying for it, whether it is the taxpayer or
charitable contributions. To my mind, as long as we are taking
care of the problem and doing it as efficiently as possible, I
think that is my measure of success.
Dr. Brown. Yes. Congressman, the last thing that I want to
do is get rid of that charitable sector right now, because
these are the people who literally have their fingers in the
dike. I am saying, but what is our longer-term vision, a decade
or 2 down the road?
Speaking of stigma, I can tell you that one of the worst
things is to watch a family take their children into a soup
kitchen to feed them. I mean, think how dehumanizing that would
be for any of us to have to do that. They are grateful for the
food, they are very grateful for the food, but it feels awful
to have to go into facilities like that.
Mr. Boustany. No, I have been in soup kitchens, and I
understand that. And, of course, my time at the Charity
Hospital in New Orleans, where we treated the poorest of the
poor, gave me plenty of experience with the difficulties we had
with postoperative patients who we discharge and there is
nothing out there to provide for them. So I am very, very
sympathetic to all this. And, ultimately, what we want to do is
to try to take care of the problem. And I guess the bottom line
is I am disturbed by this 35 million figure, that we just
haven't seemed to have found a way to reduce that.
Thank you.
The Chairman. Thank you very much, Mr. Boustany.
And, yes, you are correct in terms of trying to find the
solution to reduce the hunger here in the United States, not
only the 35 million or potentially even more now that are
losing their jobs and foreclosing and have lost--and the high
gas prices. It is either we pay now or pay later. And the
burden is on our taxpayers to address this particular problem.
And, hopefully, we can find effective ways to provide the
kind of assistance, because, in the long run, it is going to
help both the public and the private sectors that are both
impacted in terms of our costs, and our schools, too, as well,
that are impacted. So we look at hospitals that are impacted,
with the problems that are there, along with the physicians and
other individuals.
So, in closing, before we adjourn, I would like to thank
each of you for participating in today's hearing, on your
thoughtful testimony. Your knowledge and research will, I hope,
be used by Congress to find the best policies and solutions to
end hunger in America. That is, hopefully, that we can do that.
We can look at short and long range to take care of many of the
people that are there, too, as well. It will also help make us
more aware of both economic and human effects on hunger in our
own communities and neighborhoods.
And, again, I want to thank each one of you for your
testimony here today.
And then I will allow Mr. Boustany to have a closing
statement. And then I will, before adjourning, read some little
comments.
Mr. Boustany. Thank you, Mr. Chairman. This has been a good
dialogue. I appreciate your thoughtful approach to all this and
the efforts you are making. And I found this a helpful start
for us here in Congress, as we try to deal with this difficult
problem.
And so I look forward to working with Chairman Baca as we
try to dig into this a little further and to continue to work
with you. And I congratulate you on the great work that you are
doing in the trenches. Thank you.
The Chairman. In a bipartisan fashion, even though he is
here right now, I will allow Mr. Moran to either make a
statement or ask a question at this point.
Mr. Moran. Mr. Chairman, thank you very much.
I just would like to indicate that my absence from this
hearing does not reflect my interest, but the schedule on the
House floor. And I appreciate the opportunity to read the
testimony of the witnesses that you all have heard from this
morning.
These are important topics. And I appreciate the attention
that this Subcommittee is giving to the issue of hunger in the
United States.
I am also grateful that one of our other subcommittees in
Agriculture held a hearing last week regarding hunger issues in
the world. And I think it is important for this Committee to
recognize its role not only in farm and agricultural policy but
in the nutrition aspect of our jurisdiction.
So I thank the Chairman for his interest in this topic, and
I am glad to join him here briefly, both he and the Ranking
Member, Mr. Boustany.
Thank you, Mr. Chairman.
The Chairman. Thank you, Mr. Moran.
With that, before we adjourn, under the rules of the
Committee, the records of today's hearing will remain open for
10 days to receive additional material and supplement the
written responses from witnesses to any questions posed by
Members of the panel.
With that, the hearing of the Subcommittee on Department
Operations, Oversight, Nutrition, and Forestry is adjourned.
Thank you.
[Whereupon, at 11:34 a.m., the Subcommittee was adjourned.]
[Material submitted for inclusion in the record follows:]
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