[Senate Hearing 110-866]
[From the U.S. Government Publishing Office]
S. Hrg. 110-866
PROMOTING HEALTH, PREVENTING
CHRONIC DISEASE, AND FIGHTING HUNGER:
ASSESSMENT OF USDA FOOD ASSISTANCE
AND CHILD NUTRITION PROGRAMS
IN THE ECONOMIC DOWNTURN
=======================================================================
HEARING
before the
COMMITTEE ON AGRICULTURE,
NUTRITION, AND FORESTRY
UNITED STATES SENATE
ONE HUNDRED TENTH CONGRESS
SECOND SESSION
__________
DECEMBER 8, 2008
__________
Printed for the use of the
Committee on Agriculture, Nutrition, and Forestry
Available via the World Wide Web: http://www.agriculture.senate.gov
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COMMITTEE ON AGRICULTURE, NUTRITION, AND FORESTRY
TOM HARKIN, Iowa, Chairman
PATRICK J. LEAHY, Vermont SAXBY CHAMBLISS, Georgia
KENT CONRAD, North Dakota RICHARD G. LUGAR, Indiana
MAX BAUCUS, Montana THAD COCHRAN, Mississippi
BLANCHE L. LINCOLN, Arkansas MITCH McCONNELL, Kentucky
DEBBIE A. STABENOW, Michigan PAT ROBERTS, Kansas
E. BENJAMIN NELSON, Nebraska MIKE JOHANNS, Nebraska
SHERROD BROWN, Ohio CHARLES E. GRASSLEY, Iowa
ROBERT P. CASEY, Jr., Pennsylvania JOHN THUNE, South Dakota
AMY KLOBUCHAR, Minnesota
KIRSTEN GILLIBRAND, New York
MICHAEL BENNET, Colorado
Mark Halverson, Majority Staff Director
Jessica L. Williams, Chief Clerk
Martha Scott Poindexter, Minority Staff Director
Vernie Hubert, Minority Chief Counsel
(ii)
C O N T E N T S
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Page
Hearing(s):
Promoting Health, Preventing Chronic Disease, and Fighting
Hunger: Assessment of USDA Food Assistance and Child Nutrition
Programs in the Economic Downturn.............................. 1
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Monday, December 8, 2008
STATEMENTS PRESENTED BY SENATORS
Harkin, Hon. Tom, U.S. Senator from the State of Iowa, Chairman,
Committee on Agriculture, Nutrition and Forestry............... 1
Casey, Hon. Robert P., Jr., U.S. Senator from the State of
Pennsylvania................................................... 4
Klobuchar, Hon. Amy, U.S. Senator from the State of Minnesota.... 5
Lugar, Hon. Richard G., U.S. Senator from the State of Indiana... 4
Panel I
Chilton, Mariana, Ph.D., Mph, Co-Principal Investigator,
Children's Sentinel Nutrition Assessment Program, and Principal
Investigator, Philadelphia Grow Project, Department of Health
Management and Policy, Drexel University School of Public
Health, Philadelphia, Pennsylvania............................. 12
Duff, Carolyn L., RN, MS, NCSN, School Nurse, A.C. Moore
Elementary School, Columbia, South Carolina, on behalf of the
National Association of School Nurses.......................... 14
Fox, Mary Kay, Senior Researcher, Mathematica Policy Research,
Cambridge, Massachusetts....................................... 9
Kennedy, Eileen, Dean, Friedman School of Nutrition Policy and
Science, Tufts University, Boston, Massachusetts............... 7
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APPENDIX
Prepared Statements:
Chambliss, Hon. Saxby........................................ 38
Grassley, Hon. Charles E..................................... 39
Roberts, Hon. Pat............................................ 41
Chilton, Mariana............................................. 42
Duff, Carolyn L.............................................. 47
Fox, Mary Kay................................................ 53
Kennedy, Eileen.............................................. 58
Question and Answer:
Grassley, Hon. Charles E.:
Written questions submitted to all panelists................. 64
Written questions submitted to Eileen Kennedy................ 64
Stabenow, Hon. Debbie:
Written questions submitted to all panelists................. 66
Written questions submitted to Mariana Chilton............... 66
Written questions submitted to Eileen Kennedy................ 66
Written questions submitted to Carolyn L. Duff............... 66
Chilton, Mariana:
Response to written questions from Hon. Charles E. Grassley.. 67
Response to written questions from Hon. Debbie Stabenow...... 68
Duff, Carolyn L.:
Response to written questions from Hon. Charles E. Grassley.. 72
Response to written questions from Hon. Debbie Stabenow...... 72
Fox, Mary Kay:
Response to written questions from Hon. Charles E. Grassley.. 76
Response to written questions from Hon. Debbie Stabenow...... 76
Kennedy, Eileen:
Response to written questions from Hon. Charles E. Grassley.. 78
Response to written questions from Hon. Debbie Stabenow...... 79
PROMOTING HEALTH, PREVENTING
CHRONIC DISEASE, AND FIGHTING HUNGER:
ASSESSMENT OF USDA FOOD ASSISTANCE
AND CHILD NUTRITION PROGRAMS
IN THE ECONOMIC DOWNTURN
----------
Monday, December 8, 2008
U.S. Senate,
Committee on Agriculture,
Nutrition, and Forestry
Washington, DC
The committee met, pursuant to notice, at 1:06 p.m., in
room 328-A, Russell Senate Office Building, Hon. Tom Harkin,
Chairman of the committee, presiding.
Present or submitting a statement: Senators Harkin, Leahy,
Lugar, Casey, and Klobuchar.
STATEMENT OF HON. TOM HARKIN, U.S. SENATOR FROM THE STATE OF
IOWA, CHAIRMAN, COMMITTEE ON AGRICULTURE, NUTRITION AND
FORESTRY
Chairman Harkin. The Committee on Agriculture, Nutrition,
and Forestry will come to order.
Today, we begin a process to reauthorize what we call the
Child Nutrition Programs. That is the School Lunch and the
School Breakfast and, of course, the Women, Infants, and
Children Supplemental Feeding Program.
At the outset, I just want to say that what this hearing is
about today, and what the other hearings will be about is not
just about childhood nutrition or what our kids eat and how
they get it and all that. What it really is a part of, is the
debate, that this Congress will have and this new President
will have on fundamentally reforming the health care system of
America.
There is nothing more important to the well-being of our
people than their nutritional intake, especially when they are
young, when they are kids, and not just kids in school. I mean
even before that, during the times when their brains are
forming, from birth through maybe 3 years of age.
We are about this right now. We are starting it. I am on
the Health Committee. Senator Kennedy has charged me with the
responsibility of heading a working group on prevention,
wellness, and public health. I have to tell you that prevention
and wellness, public health, have been a footnote and an
asterisk in all the debates we have had about health care in
the past. I keep saying many times that we don't have a health
care system in America, we have a sick care system. If you get
sick, you get care, one way or the other--Medicare, Medicaid,
Title 19, charity, emergency room, community health center,
some way or another.
We are very good at patching, fixing, and mending. We will
spend billions, untold--no, trillions on patching, fixing, and
mending. But what do we do up front to keep people healthy and
out of the hospital, to keep them well? Where are the
incentives? All the incentives are on the other side. Where are
the incentives to keep people well and healthy?
So this whole debate, I say to our witnesses and I say to
others who are here and those who may be watching, that this is
going to be a part of our health care debate, a big part of it,
and it is going to be a part of the prevention and wellness
part of that debate, how we get adequate nutritional foods to
our kids in school and before school. I could go into our
summer feeding programs and other things, too.
But it seems that we are in this situation where it is not
only just the lack of food that causes bad health care problems
and hunger and malnourishment. Too much food, or too much of
the wrong food, also leads to bad health problems. Or the
ingestion of too much of things that aren't really listed as
food.
I am talking here about sodium. We have become a sodium-
saturated society, to the point where now kids are getting
hypertension when they are ten, 11, 12 years old. Saturated
fats, the American Academy of Pediatrics recently came out with
guidelines for giving statins to kids as young as 8 years old
with elevated cholesterol levels. Adult onset diabetes, which
was unheard of in children until recently, is now growing at an
alarming rate, kids as young as ten, 11, 12 years old with
adult onset diabetes.
And then you take a look at what our kids are eating in
schools. I must say at the outset, I tried in 1996, I first
offered an amendment to get vending machines taken out of
schools. As you can see, I was a spectacular failure at that.
They are still there. To some extent, some schools are putting
better things in the vending machines, better foods, nutritious
foods, but they are still there.
And then we have these a la carte lines for kids in school.
Why, they might as well be eating at McDonald's. They get all
the kinds of fats and starches and sugars and sodium they need,
they want. Go through the a la carte line.
I just feel so strongly that we have to be thinking about
the reauthorization of these Child Nutrition Programs, not just
in the context of nutrition, but also in the context of the
overall wellness of our society and health care reform. This is
a big part, I submit to you, of all of our health care reform
that we are going to be talking about.
Again, I think today's hearing deals with a crucial part of
this. Scientific studies are confirming what common sense has
told us for generations, that good childhood nutrition, healthy
eating habits when you are young determine your health for a
lifetime.
Now, we know there are a lot of factors. People say, well,
Harkin, your folks think too much on what these kids eat. They
are not getting enough exercise. Well, I agree with that. We
are building elementary schools without playgrounds. That is
beyond the purview of this committee, I think, at least right
now, anyway. Sure, kids need more exercise, but that doesn't
mean that they can't eat better even if they don't have the
playgrounds to play on.
Communities need wellness programs, too, walking paths,
sidewalks to school so kids can walk to school, things like
that.
So again, I just make my statement a part of the record. I
don't need to go on anymore on that. I don't need to read my
statement at all, just make it a part of the record.
But I just want to make it clear, and to my witnesses, I
thank our witnesses. I have read all of your testimonies. They
are right on target, every one of you. You are just right on
target about what we have got to be doing with our kids in
school. And I am going to ask provocative questions, not just
of you, but as we go through this process, provocative
questions. Why do we need so many starches, fats, and sugars in
our foods that kids eat in school? Why do they need so much
sodium?
I have a little elevated blood pressure, Dick, so I am
watching my salt intake. I have been watching my salt intake
for a while. I have lunch at my desk, so I have my assistant go
down and get me a low-sodium soup at the servery down there.
Well, they have changed over. They no longer have low-sodium
soup. So I said, well, go down and ask them what the lowest-
sodium soup is they have got. So she just brought it about an
hour or so, so I had soup at my desk, and they said this is the
lowest they have got. I had one spoon of that. One spoon, I
think, is probably more salt than I take in the entire day.
I say these things because we have really got to focus on
what our kids are eating in school and the nutritious foods.
Someone said, well, it costs more money. If you are going to
have more nutritious food, it is going to cost more money. I am
not certain. One of you, I forget which one of you had the
testimony about the Minnesota deal, and I want to get into
that. I don't know about that, about the Minnesota study.
But my response is, if the nutritious foods cost a little
bit more, so what? We ought to be willing to pay it as part of
prevention and wellness and think about it in that context, of
what it is going to mean for these kids to have better diets
and better nutritious foods and what it is going to mean for
the lack of the cost in our health care system later on.
So with that, I welcome you. This is our first hearing on
this issue. I wanted to get the ball rolling. I will chair a
hearing on the Health Committee on Wednesday dealing with
wellness and prevention, but Dick, I may have said this before
you came in, but I see this whole debate and the
reauthorization of this as not just singular, but as part of
our health care reform debate and how we are going to look at
wellness and prevention and getting to these issues finally and
these issues in our school lunches, our WIC Programs, things
like that, by providing more nutritious foods. I read our
witnesses' testimony and they have got a lot of good
suggestions and I look forward to those.
Chairman Harkin. Well, I have gone on too long. I just
wanted to thank you again. I will now yield to the first person
that came here. I will yield to Senator Casey for any opening
statement.
STATEMENT OF HON. ROBERT P. CASEY, JR., U.S. SENATOR FROM THE
STATE OF PENNSYLVANIA
Senator Casey. Well, Mr. Chairman, thank you very much for,
first of all, calling this hearing. Even at this time of the
year when we are in transition, I think it is important we get
a head start on such a critical issue for the country, not to
mention the most important people that we are directing our
attention to, and that is the children and the families that
will benefit from the work that is done by our witnesses, the
work that is done by the Congress, and the work that must be
done by the new administration.
I do want to thank you for taking this time to call the
hearing, but I also want to thank you in a wider sense for the
witness and the advocacy that you have provided over many years
on these issues. These are issues that were neglected by the
current administration, in my judgment. We don't need to get
into that, but I think they were. That is not a news bulletin,
I don't think, to some people in this room. But we can't look
backwards. We have to look forward, and we have got a lot of
work to do.
I think there are certainly some priorities that we need to
focus on. Certainly, one of them--I will mention four quickly--
increasing reimbursement rates to schools. Two, including more
kids in both Lunch and Breakfast Programs. Three, decreasing
administrative burdens and costs to schools. And four,
maintaining service to children in the summer months.
There is a lot more to talk about. I will submit my
testimony for the record.
But I think what summons us here, whether it is Senator
Harkin or Senator Lugar or Senator Klobuchar or any of us, and
certainly anyone in the room and especially our witnesses, I
think what summons us here is our conscience and the moral
gravity of this issue, especially at a time of economic crisis,
but no matter what, even if it was a time of strong economy,
which it isn't, it would still be an important and central
issue to us.
I was just handed by Dr. Chilton, who I am going to be
talking about a little later, but she handed me a postcard
entitled, ``Witness to Hunger,'' December 11-18, 2008, and it
is a picture of a child in the city of Philadelphia, a
beautiful child in that city, a city I know pretty well. There
is a lot of hope in that child's face. Our obligation is to
make sure that the spark and the life in that child is not
diminished by our failure to do what is right with these
programs. I don't think that is too grand or too broad a goal.
I think this child reminds us more than anything else what our
obligation is.
Thank you, Mr. Chairman.
Chairman Harkin. Thank you, Senator Casey.
Senator Lugar.
STATEMENT OF HON. RICHARD G. LUGAR, U.S. SENATOR FROM THE STATE
OF INDIANA
Senator Lugar. Mr. Chairman, I appreciate very much your
calling the hearing, likewise. I would just indicate that the
authorization need for WIC and other child programs offers a
bold opportunity which you have outlined and we will have to
see how other committees progress on the problems of health for
all Americans at all ages. But this is an important problem for
adults as well as for children.
I appreciate the fact that you have raised in previous
years these standards with regard to sodium, calories, and
various inputs of programs for which we bear some
responsibility. Granted, this is a debate that will go on not
only in this committee, but in our society for some time, it
does offer an exemplary moment to try to even get the facts,
the calorie count or the sodium count for the foods that we are
putting into schools, sometimes an idea resisted by restaurants
or other purveyors of food in our general society so that we
begin to have some benchmark of what we are talking about, as
opposed to too much or too little, a much more precise
definition.
At least we are beyond, I think, the debates that both of
us have endured as to whether we should even have a National
School Lunch Program. This was decided, thank goodness, about
14 years ago during a tempestuous period in which new
federalism had arisen and the thought was maybe States would do
these programs and maybe they wouldn't. But at least we have a
basis now of a national program, and we are going to be arguing
about the specifics of it, so that is progress.
I look forward to once again applauding the witnesses you
have for excellent testimony and for a good start for our year.
Chairman Harkin. Thank you, Senator Lugar, and I would be
remiss if I didn't thank you for your leadership through all
the years, as former Chair of this committee, and all your
great leadership on nutrition and our School Lunch and School
Breakfast Programs. You have been here a lot longer than I--
well, not a lot longer, but somewhat longer than I have been
here anyway, Dick.
Senator Lugar. Who is counting?
[Laughter.]
Chairman Harkin. And I thank you for your leadership and
look forward to working with you on this issue next year.
Senator Klobuchar.
STATEMENT OF HON. AMY KLOBUCHAR, U.S. SENATOR FROM THE STATE OF
MINNESOTA
Senator Klobuchar. Thank you very much, Chairman Harkin,
and thank you for holding this hearing and the leadership of
the other two Senators. I remember in the farm bill debates how
Senator Lugar would always raise this issue, and how my friend,
Senator Casey would, as well.
I just came back from a 22-county tour of my State. As we
remember, I made the promise that I would visit all 87 counties
every year.
Chairman Harkin. Have you thawed out yet?
Senator Klobuchar. I am fine. There was a little snow. But
it was just enlightening and somewhat inspiring to meet some of
the people along the way and the struggles that they are
facing. The woman we met at a cafe near Litchfield, Minnesota,
that had told me that she was a teacher, but in order to make
ends meet, because her husband had lost his job, that she was
working as a waitress two nights a week and then she was
stamping meat at the local butcher 1 day a week.
The letters that we have received from people through our
State, including the woman who wrote that she and her husband
put their three daughters to bed and they kiss them goodnight
and then they sit at their kitchen table and look at each other
and wonder how they are going to pay the bills. Or the guy that
wrote in that said that his wife had inherited some money from
her father and they thought they were going to use that money
for their daughter's wedding and now they have no money so they
are using it for their expenses, including food and for their
heating.
And we heard these stories time and time again in our
State. The statistics certainly bear it out in our State. The
unemployment rate is at its highest in 22 years. The heating
costs, despite the downward trend with oil, are expected to go
up. And we know that on the national level, the number of
individuals relying on Food Stamps has risen to an all-time
high of over 31 million Americans, and that is one out of every
ten people in the country.
So what I am seeing in our State is that more and more
people are skipping meals. In 2007, Minnesota had one of the
largest increases in food insecurity in the country. It sounds
like sort of an innocuous phrase, but the meaning is that
someone doesn't know where their next meal is coming from.
Nine-and-a-half percent of Minnesotans suffer from food
insecurity. That is about one in ten. In 2008, a record number
of people in our State have visited the food banks.
The Iron Range of Northern Minnesota, where my Grandpa was
an iron ore miner, has been especially hard hit by the economic
downturn, especially recently, because some of the mines closed
down because steel demand has gone down internationally. So far
in 2008, food pantry visits up on the Iron Range are up 22
percent, and 40 percent of the food distributed by the Duluth
food bank, the largest town in Northern Minnesota, feeds
children.
That is what we know. We also know that getting kids
breakfast and getting them meals in school is needed now more
than ever. When I was county attorney, we would make this a
major focus because we knew it helped to keep kids in school,
that they did better when they were in school, and that they
got the food that they need. The Center on Poverty and Hunger
notes in their recent report, serving breakfast to school
children who don't get it elsewhere significant improves their
cognitive or mental abilities, enabling them to be more alert,
pay better attention, and do better in terms of reading, math,
and other standardized test scores.
So as we go forward this year and talk about the education
policy in this country and health policy, we have to remember
the significant role that child nutrition plays.
Thank you very much, Mr. Chairman.
Chairman Harkin. Thank you, Senator Klobuchar.
I thank our panel for coming. I will introduce you all. I
will just go from my left to my right. I ask if each of you can
sum up your statement in several minutes, we would appreciate
it, and then we will get into an open discussion.
First is Dr. Eileen Kennedy, the current dean of the
Friedman School of Nutrition and Science and Policy at Tufts
University. She worked at USDA in the late 1970's and early
1980's, and I am also told in the 1990's, also, serving as
Chief of the Nutrition Policy Branch in the Food and Nutrition
Service. She is a recognized expert on child nutrition and
public policy strategies for chronic disease prevention.
Dr. Kennedy, thank you for being here. I will say this. All
of your testimonies will be made a part of the record in their
entirety. If you would just sum it up, I would be very pleased.
Dr. Kennedy.
STATEMENT OF EILEEN KENNEDY, DEAN, FRIEDMAN SCHOOL OF NUTRITION
POLICY AND SCIENCE, TUFTS UNIVERSITY, BOSTON, MASSACHUSETTS
Ms. Kennedy. Thank you, Mr. Chairman and committee members.
I am delighted to be here. I have spent the past 30 years of my
career conducting research, looking at the health and nutrition
effects of government policies and programs, not just in the
U.S. but worldwide. In a book we published last year, Richard
Deckelbaum and myself looked at 60 years of nutrition in the
United States, past, current, and what the future challenges
are. Major problems of nutrient deficiencies, inadequate
energy, poor growth, have been mitigated in part by the
collective action of public- private sector agriculture, food
and nutrition, but a part of the success is due to the
nutrition programs.
National evaluations of School Lunch and School Breakfast
have shown that the programs have achieved their goals. WIC has
demonstrated clearly positive impact on improving dietary
patterns and nutritional status.
So while problems of undernutrition and food security are
still critical, we now have what I call the double burden of
disease. We have undernutrition side by side in the United
States with problems of overweight, obesity, and chronic
diseases.
My remarks today are focused on how can Federal Child
Nutrition Programs afford potentially effective ways of
promoting healthier lifestyle. Obviously, the economic downturn
we are now experiencing makes the role of Child Nutrition
Programs even more essential. I do quote some statistics from a
report of only 2 weeks ago from the Center on Budget and Policy
Priorities that projects that over the next little bit, child
poverty will increase to the tune of about 2.6 to 3.3 million
more children, and when we look at number of children in deep
poverty, that is less than half the poverty-level income, 1.5
to two million more children will be in deep poverty.
So given these alarming statistics, the role of Child
Nutrition Programs, School Lunch, School Breakfast, and WIC
become even more essential, and let me start with School Lunch-
School Breakfast.
Tufts University has been involved with the city of
Somerville for the past 5 years in a project called Shape Up
Somerville. Somerville is a small town outside of Boston, very
racially, ethnically diverse, high participation of households
on Food Stamps, high probability of free school lunches, and
Shape Up Somerville was a joint effort with the city to look at
ways of systematic change in school lunch and physical activity
as a way of promoting healthier lifestyles. It is what I call
an environmental change intervention including before, during,
after school activities, school lunch, a la carte items,
competitive food, walking to school with parents, after-school
physical activity, in-school physical activity, let me quote
something last week from the Boston Globe, and this is a quote.
``Pedestrians in this city of 77,500 stride onto bright,
recently striped crosswalks. In school cafeteria, fresh produce
has replaced canned fruits and vegetables and the high school
retired its fryolator. The neighborhood restaurant now serves
wheat oatmeal with bananas in addition to bacon and eggs.''
Shape Up Somerville has been successful in a very rigorous
evaluation. Children in first, second, and third grade gained
significantly less weight than children in comparison schools,
and we are in an environment where we are not worried about, on
average, underweight. We are worried about heavy children.
The school lunch now includes more fruits, vegetables,
whole grains. Popular items in vending machines like chips and
sodas were replaced by water, yogurts, healthier options. And I
always get the question, what happened to revenue in schools?
Initially, the revenue from vending machines went down. A year
later, it was up. So I think it is the difference between
short-term and long-term.
We are now replicating Shape Up Somerville around the
country in urban as well as rural areas to look at commonality
of what are the core components that are important. I think
this is clearly an example of retooling schools to have more
emphasis on health and wellness policies.
Availability of healthier competitive foods, I think has to
be something which is addressed much more seriously in Child
Nutrition Reauthorization in 2009. Federal standards are long
overdue for competitive foods. The recent Institute of Medicine
report on nutrition standards for foods that compete with
school meals, provides a framework for developing such
guidelines.
I have some comments on WIC, looking at synergies between
WIC and Child and Adult Care Food Programs. Rather than seeing
them as distinct programs, the health benefits of both WIC and
Child Care would be enhanced by coordination rather than
competition.
Let me just end, since my time is up, on a personal note. I
am a product of school lunch throughout elementary and high
school. My mother was what was affectionately called by my
friends, ``a school lunch lady'', and she took pride in
delivering healthy school meals to kids. My sister was formerly
a Food Stamp recipient and is now a successful businesswoman in
Massachusetts and a former elected town official for
Winchester, Massachusetts. My own research relates to the WIC
Program and how every dollar spent on WIC prenatally results in
$3 in health care savings.
And I bring this up because I have seen the Child Nutrition
Programs up close and personal and I am a firm believer that
investing in children is investing in the future, and I think
we have the opportunity to look at in a bold, new, innovative
direction repositioning the Child Nutrition Programs to be,
more so than ever before, health nutrition programs. We can
look at Child Nutrition Programs, but we also need to look at
the other food security programs, like Food Stamps in tandem.
Thank you, and I would be happy to answer questions.
[The prepared statement of Ms. Kennedy can be found on page
58 in the appendix.]
Chairman Harkin. Thank you very much, Dr. Kennedy.
And now we will turn to Ms. Fox. Mary Kay Fox is a senior
researcher with Mathematica Policy Research. Her work is
focused on the effects of food assistance and nutrition
programs on child nutrition and health as well as analyzing the
nutrition and health profiles of low-income populations.
Welcome, Ms. Fox.
STATEMENT OF MARY KAY FOX, SENIOR RESEARCHER, MATHEMATICA
POLICY RESEARCH, CAMBRIDGE, MASSACHUSETTS
Ms. Fox. Thank you. Good afternoon, Mr. Chairman and
members of the committee. I am very pleased to be invited here
to testify today.
As Senator Harkin said, I work with Mathematica Policy
Research and I have done a lot of work over the past two
decades on the school nutrition programs. I was asked today to
give you a brief snapshot of what we know from this research
about what is going well with the school meal programs and what
might not be going so well in terms of the meals that are
served to health care and actually how these meals might be
influencing their diets and their overall health.
So I have broken my main comments down into three
questions. The first one is, what do we know about how school
meals contribute to children's needs for essential nutrients?
This is the overarching goal of the School Lunch Program back
from when it was established in 1946. And the answer is that
there is actually very convincing evidence that children who
eat school meals have higher intakes of a range of essential
nutrients and minerals than children who consume meals from
other sources. And there is evidence that the difference is due
to the fact that school meals have a more nutrient-dense mix of
foods than other meals so that the nutrient density of the
foods is contributing to the difference rather than the fact
that school meal participants are just consuming more food.
An important question in whether these differences in meal
intakes actually translate into meaningful differences in
children's overall diets, and for years, we really couldn't
answer this question very well because the benchmarks that we
had to use in assessing children's dietary intakes didn't allow
us to do that very well.
But the most recent national study of the school meal
programs, the Third School Nutrition Dietary Assessment Study,
or SNDA-III, was actually able to fill this gap by applying the
most up-to-date reference standards for nutrient intakes and,
using assessment methods recommended by the Institute of
Medicine, and SNDA-III found that middle school and high
school-age children who participated in the School Lunch
Program were significantly less likely than comparable-aged
children who didn't--comparable children on a number of socio-
demographic characteristics, not just their age, were
significantly less likely to have inadequate intakes of a
number of essential vitamins and minerals. The differences were
most pronounced among high school-aged children and especially
girls.
And so these data document the important role that the
Lunch Program plays in the diets of these older children who
have the most autonomy in making food decisions. They have the
greatest nutritional needs. And unfortunately, they often have
the poorest diets.
My second question is, what do we know about how well
school meals promote the dietary guidelines for Americans, and
this is getting into the comments that you made at the
introduction, Senator Harkin, thinking more about overall
health and reduction or prevention of chronic disease. And the
answer here is that this is the area in which we know the
school meal programs currently fall short.
The standards for school meals never really referenced the
dietary guidelines explicitly until 1994, when the Healthy
Meals for Healthy Americans Act made compliance with the
dietary guidelines a requirement. So they have been at it now
for close to 12 years and they have made some improvements.
There is evidence that the levels of fat and saturated fat in
school meals have come down, but the current research shows
that there is substantial room for additional improvement.
For example, SNDA-III, which collected data 8 years after
schools were supposed to be compliant with the dietary
guidelines, found that only about a third of elementary schools
and only about a quarter of secondary schools were providing
lunches that were consistent with the dietary guidelines'
recommendation for saturated fat. And following up on the
sodium that you mentioned, Senator Harkin, only 1 percent of
schools provided lunches that met the standard for sodium.
So in looking past the meals to looking at children's
diets, SNDA-III found no significant differences in total fat,
saturated fat, or sodium intake of children who did and did not
participate in the school meal programs. So despite high levels
of saturated fat and sodium in the school meals, school meal
participants did no worse than the non- participants, and the
main reason for this is that both groups of children had
excessively high intakes of both saturated fat and sodium.
Roughly 80 percent of children had saturated fat intakes that
exceeded the recommended levels in the dietary guidelines, and
90 to 95 percent of children had sodium intakes that exceeded
recommendations.
My third question is what do we know--oops, I am over time.
Can I go a little longer? What do we know about how school
meals contribute to childhood obesity. I will go through this
pretty quickly. And the answer there is there really isn't any
convincing evidence that school meals contribute to childhood
obesity. There have been studies done, but they have yielded
conflicting results, and some of the studies that examined the
relationship did not control for important factors that would
influence both obesity and school meal participation, and so
therefore they yielded conflicting results.
Studies that have looked at the relationship between the
Breakfast Program and obesity have also reported mixed results,
but at least one of those studies reported that participation
in the School Breakfast Program was associated with a decreased
likelihood of obesity, so that perhaps the Breakfast Program
may have some protective effect, perhaps by encouraging
children to consume breakfast on a more regular basis. But the
jury is out on that question.
In my written testimony, I do have some observations about
implications for these research findings, but I will stop now--
--
Chairman Harkin. Take a couple more minutes.
Ms. Fox. Take a couple more minutes? OK. Thank you. Scurry,
scurry, scurry.
So what are the implications of these research findings for
the future of Child Nutrition Programs? Clearly, a No. 1
priority for the future is making school meals healthier for
children by improving the extent to which they conform to both
the nutrient and food-based principles of the dietary
guidelines. An ongoing Institute of Medicine panel is currently
reviewing existing nutrients and standards and meal patterns
with this exact goal in mind.
The committee's final report, which is due out in late
October 2009, will provide a foundation with recommended
revisions to existing meal patterns and nutrient standards for
both the School Lunch and Breakfast Programs and this will
provide a framework for moving forward in improving the
healthfulness of school meals. However, to be effective, the
framework needs to be supported in several important ways, and
I can't get into all of the ideas that I would have, but I
wanted to mention three today.
The first is that schools need support in promoting healthy
food choices. The old adage that you can bring a horse to water
but you can't make him drink comes to mind, and we have
examples of this in the SNDA-III data. Nine out of ten schools'
daily lunch menus in SNDA-III offered children a fruit or a
juice or vegetables that were not French fries. But when you
look at what children who consumed lunches took, only 45
percent of kids included a fruit, and only 30 percent of kids
included a vegetable that wasn't a French fry. So it has to be
a collaborative and supportive process where nutrition reform
efforts are supported by nutrition education and policies that
support and promote healthy eating.
I would encourage the committee to consider funding
demonstration projects similar to the ones that are being
funded for healthy eating initiatives in the C-SNAP Program,
because there really isn't a lot of information out there about
how you do this and do it well and get children to accept new
and healthier menus.
Finally, and this is also something else you mentioned,
Senator Harkin, it is important to consider the potential
impact of new meal standards on program costs. The IOM panel is
looking at this issue, but it can only do it in a limited way.
An ongoing FNS study will be collecting data on what schools
are actually paying for food in the upcoming school year, 2009-
2010, and ideally, the new recommendations should be examined
with the new cost data on what food purchases actually cost to
look at the implications of the changes on the cost of school
meals and potential implications for reimbursement rates before
anything is implemented in a national fashion.
Thank you.
[The prepared statement of Ms. Fox can be found on page 53
in the appendix.]
Chairman Harkin. Thank you very much. Reset that clock for
5 minutes. If you go over by a minute, that is fine.
I will yield to Senator Casey for the next introduction.
Senator Casey. Mr. Chairman, thank you very much. We are
honored to have a Pennsylvanian here from Drexel University,
Dr. Mariana Chilton, who is both co-principal investigator of
the Children's Sentinel Nutrition Assessment Program as well as
principal investigator of Philadelphia's GROW Project. She is
at Drexel, as I mentioned. She has degrees from Harvard and
Penn, great schools in their own right, maybe not as good as
Drexel, but they are pretty good, I guess.
In terms of her newest area of research, it includes
assessing the health impacts of hunger and food insecurity in
the Philadelphia area. This community-based research focuses on
women and children, nutritional status, and human rights. She
is currently teaching health behavior and community health in
the full-time Master's of Public Health Program, and health and
human rights in the doctoral program.
Dr. Chilton, we are honored to have your testimony here and
we are grateful for your willingness to be part of this
hearing.
STATEMENT OF MARIANA CHILTON, PH.D., MPH, CO-PRINCIPAL
INVESTIGATOR, CHILDREN'S SENTINEL NUTRITION ASSESSMENT PROGRAM,
AND PRINCIPAL INVESTIGATOR, PHILADELPHIA GROW PROJECT,
DEPARTMENT OF HEALTH MANAGEMENT AND POLICY, DREXEL UNIVERSITY
SCHOOL OF PUBLIC HEALTH, PHILADELPHIA, PENNSYLVANIA
Ms. Chilton. Thank you very much. Chairman Harkin and
distinguished members of the committee, I am honored to speak
to you as a research scientist at the Drexel University School
of Public Health in Philadelphia, Pennsylvania, and also as a
member of the National Network of Pediatric Researchers on the
Children's Sentinel Nutrition Assessment Program. We call it C-
SNAP for short.
I represent the States of Maryland, Massachusetts,
Arkansas, Pennsylvania, and Minnesota, not to mention we use
data from California and Washington, D.C., and I present to you
today the scientific evidence from more than 30,000 children
and their families across the nation. All 30,000 that we meet
and touch in our emergency rooms and in our clinics are
witnesses to hunger.
One of these witnesses, Angela Sutton, a mother of two
young children, struggles to feed her children in inner-city
Philadelphia. When I asked her how she wanted to improve her
children's health, she said, ``I want to march right down to
Washington and put my babies on the steps of Congress.''
Senators, during this major economic recession, how you write
policies for these children on your steps can make a remarkable
difference in the health and well-being of the American
population.
With the Child Nutrition Reauthorization, we get two for
one. We can prevent hunger and we can prevent nutrition-related
diseases, such as diabetes, heart disease, and obesity.
Let us start with hunger and food insecurity. We see in the
USDA's recent release of data on hunger in America that 12.4
million children were in food insecure households in 2007. My
colleagues and I looked deeper into the numbers and we were
stricken by the new rates among the youngest children in
America, those who had yet to reach first grade. Among these
young children, very low food security, what used to be known
as food insecurity with hunger, doubled from 4 percent to 8
percent between the years 2006 and 2007. This increase of
124,000 persons is a sign of an impending national disaster.
Committee members, you have the tools and the resources to
handle this crisis. If you see the Child Nutrition
Reauthorization and health care reform as one in the same, you
will protect our youngest citizens from the ravages of the
recession.
Hunger is a major health problem. In the data on over
30,000 families collected by C-SNAP, we demonstrate that
children living in food insecure households were 30 percent
more likely to have a history of hospitalization. They were 90
percent more likely to be reported in fair or poor health. We
have found that infants and toddlers who lived in food insecure
circumstances were 73 percent more likely to be at
developmental risk compared to infants and toddlers in food
secure households. Clearly, we must intervene early in a
child's life. Every child's brain architecture is laid down
during the first 3 years of life, forming the foundation on
which to build human capital. The Child Nutrition
Reauthorization can build that capital.
The Women, Infants, and Children Program and the Child and
Adult Care Food Program should be considered two of the most
important building blocks for the health and well-being of
America's children. With approximately 50 percent of the
children born in the United States participating in the WIC
Program, the breadth and the reach of the WIC Program can, as
our research shows, improve children's growth outcomes.
Similarly, the Child and Adult Care Food Program can be
considered one of the most effective tools to fight hunger and
to promote early childhood health. We already know that child
care helps the development and school readiness of a child. We
applaud Senator Casey's initiative to improve the availability
and the quality of child care. But an investment in child care
without similar widespread attention to nutrition ultimately
wastes that educational effort.
The same goes for School Breakfast and School Lunch.
Through these programs, you have an opportunity to infuse
America's children with healthy diets that will prevent
childhood obesity and thus prevent diabetes and cardiovascular
disease. Because these programs can prevent disease, we must
ensure that they work well administratively and are broadly
available.
We already have a great example from Philadelphia.
Philadelphia has had a universal service School Lunch Program
for the past 17 to 18 years. It has done away with individual
applications in areas where the majority of the children are
clearly eligible by population-based estimates of poverty. This
program has reduced stigma and improved the nutritional health
of children. We recommend universal service programs be
replicated in major inner cities and low-income counties across
the nation. The Senate ought to consider the same idea for the
Child and Adult Care Food Program.
Finally, the Child Nutrition Reauthorization process must
take into account the true context of family poverty. Crystal
Sears of Philadelphia has three children, all with major health
problems. For her, it is a full-time job to keep her children
and herself whole. From her perspective, Federal programs are
good, but they don't go far enough. ``There are some
benefits,'' she says. ``They provide our children with
vaccinations. I can get some medical care. But the rest of me
is just dangling out there, hanging on a rope.''
Senators let us not leave this generation dangling and
unmoored. A young child in its most critical moments of
cognitive, social, and emotional development does not have time
to wait. By treating the Child Nutrition Reauthorization as if
it is medicine, an immunization against preventable chronic
disease, you can boost the health and well-being of an entire
generation.
Thank you.
[The prepared statement of Ms. Chilton can be found on page
42 in the appendix.]
Chairman Harkin. Thank you very much, Dr. Chilton.
And for our final witness, we have Carolyn Duff, an RN, a
practicing school nurse at A.C. Moore Elementary School in
Columbia, South Carolina. Today, Ms. Duff will be sharing her
experiences of the past 12 years in dealing with nutritional
challenges of school children.
Ms. Duff, welcome to the committee. Please proceed.
STATEMENT OF CAROLYN L. DUFF, RN, MS, NCSN, SCHOOL NURSE, A.C.
MOORE ELEMENTARY SCHOOL, COLUMBIA, SOUTH CAROLINA, ON BEHALF OF
THE NATIONAL ASSOCIATION OF SCHOOL NURSES
Ms. Duff. Thank you, Chairman Harkin and committee members.
As Chairman Harkin said, I am a school nurse and I have
practiced at A.C. Moore Elementary School in Columbia, South
Carolina, for the past 12 years, and I am privileged to be here
today representing the National Association of School Nurses.
I commend the committee for bringing attention to the needs
of school children at a time when there are so many pressing
matters related to the downturn in our economy. Through my
testimony, I hope to relay how school nurses have daily
experiences with children who have severe nutrition issues by
sharing stories from my own practice.
In my school, over 50 percent of the students receive free
or reduced meals. Given the country is in the middle of a
recession, the number of eligible children is expected to
increase in the coming year. More and more of the working poor
are entering the ranks of the unemployed, impoverished, and
homeless families. This reality is precisely why the USDA
Breakfast and Lunch Programs are essential in curbing the
hunger of school children.
Many of the poor families I work with are from single-
parent households. Usually the parent is a young and uneducated
mother who struggles to make ends meet. Their lives are chaotic
and things that most of us here take for granted, like
transportation, child care, supportive extended families, a
regular paycheck, and access to health care, are simply not
there for them. They depend on school meals to feed their
children.
One young mother comes to mind, Mrs. J. She has two
children, a boy in first grade and a little girl in second
grade. I will call them Dan and Dora. The family is homeless.
The children cannot ride the bus to school because they have no
address, and where they slept last night will not be the same
place where they will sleep tonight.
Last week, first thing in the morning, Dora brought her
little brother to me because he was crying inconsolably. I
thought he had fever. His face was bright red. When I calmed
him down, he told me that the reason he was crying is because
he missed breakfast. Dora, his sister, explained that their
mother overslept and hurried them off to school, but the
cafeteria had already closed. The children couldn't get food
and the mother had provided them nothing before school. She
said that all they had eaten since lunch at school the day
before was some chips at their cousin's house, where they had
slept that night. Clearly, these children are not eating many
full meals outside of school.
I would like to tell you what I see routinely when students
are not part of the meals program. Many students who visit my
health office mid-morning are sent by teachers because the
students are sleeping in class with their heads on the desks.
Teachers can't tolerate that. The first question I usually ask
the students is, what did you have for breakfast, and usually
the answer is, nothing.
That is the answer I got one morning from a fourth grade
boy. I will call him John. John said he gets himself off to
school in the morning because his dad, a single parent, gets
himself off to work very early. When I called John's dad to let
him know that John fell asleep in class, I suggested John be
signed up for the breakfast program at school. After several
attempts at sending the form home and trying to get it filled
out, I called Mr. John again and I asked if I could fill out
the form for him over the phone. He gave me the information,
and then I sent the form home for his signature. I believe Mr.
John cannot read. He was not going to tell me that, but he
seemed grateful that I figured out a way to handle the
situation. His son is now a much more energetic and attentive
student.
School nurses have a public health perspective and know
well that prevention of chronic illnesses, such as
cardiovascular disease and diabetes, must begin in childhood. I
have a kindergarten student this year. I will call her Connie.
I discovered during a health assessment that she has a BMI of
99.5 percent, the top of the obese range. Just walking up a
short flight of stairs, she is out of breath. Her poor
nutritional status is obvious. She has four very deep cavities
in her teeth and she has dark pigmented skin folds at the back
of her neck, a condition called acanthosis nigricans, or AN. AN
is related to obesity and is a reliable predictor of a
progression to Type II diabetes, previously known to occur only
in adults. This little girl is 5 years old. She will have a
very short and poor quality of life if something is not done
right now.
I am working with her mother to connect her to services.
Connie's mother is a single mother with four children and has
multiple health, financial, and family issues of her own. I am
hoping that Connie will stay at my school through the fifth
grade so that I can see her progress toward improved health
status as she eats a more nutritious diet and grows into her
weight. The free school meals will be a key intervention in her
health care plan.
As a school nurse, my most important role is to support
children in any way that will ensure that they are in school
every day and are ready to learn. Both teachers and school
nurses know from experience that healthy children learn better.
Poverty and hunger are not hidden problems in schools.
Speaking on behalf of our Association, I appreciate the
opportunity to tell you what school nurses know about the
important role school meals assistance plays in the lives of
children and their families. Thank you, and I am happy to
answer questions.
[The prepared statement of Ms. Duff can be found on page 47
in the appendix.]
Chairman Harkin. Thank you very much, Ms. Duff. We thank
you all for your testimonies.
I was just asking Mr. Miller back here, who knows all of
this stuff and has been involved in these issues for many
years, about what you were just saying. I think a lot of times,
Ms. Duff, we have looked upon hunger and obesity as two
distinct kinds of things. It is hunger or it is obesity. As you
pointed out, and I underlined it, you said they have got to be
addressed jointly, that it is not a zero-sum kind of game.
These both have to be looked at at the same time. I think that
is very profound and I think that we have to be thinking of
that. We maybe tend only to think about hunger and then obesity
is over here. But the two go together very well and we have to
address both of those.
I would like to open it up for a general discussion here.
Again, I will start with Dr. Kennedy. I think one of the things
you pointed out was that there are other things that have to be
involved. You talked about the Shape Up Somerville Program. Are
you doing anything to replicate this anywhere? When you hear
these, when I read it and when I heard you talk about it, it
just sounds so common sense, but are we replicating this
anyplace else?
Ms. Kennedy. We are, Senator Harkin. Fortunately, we have
the opportunity, and in a very rigorous way we are looking at
urban areas in the United States in comparison to matched areas
based on demographic characteristics that don't have this
approach, and also we are looking at it in rural areas, because
the infrastructural constraints may be different.
As has already been pointed out, distance to services in
rural areas are very different than urban areas. So, for
instance, some of the Shape Up Somerville activities, like
walking to school clubs, might not be as feasible in rural
areas, so what is the counterpart of that? How do you, apropos
to the earlier comment, how do you incorporate physical
activity into schools that don't have a playground?
We need to think about the core operating principles, and
from the point of view of implementors, how do you actually get
it done? I don't think anyone is against, or no one I have
heard of, having healthier school meals and more physical
activity. But within the constraints under which schools are
operating, how do you do this, and that is going to vary
somewhat by urban-rural. It also may vary by different locales
based on constraints schools are facing.
Obviously, schools that have the opportunity to have more
parental and community involvement have resources added, but
schools that don't have the luxury of having the backstopping
of community organizations have to look at innovations, and
this is where I think in Child Nutrition Reauthorization, to
look at various kinds of pilots in order to move the school
nutrition programs in the direction of more health and
wellness.
Chairman Harkin. The other thing you brought out in your
testimony was that you mentioned that handing out pamphlets
doesn't work, that there has to be more to it. Of course, I
think about incentives. What kind of incentives can we build
into the WIC Program, for example, to get better foods? Now,
some of you mentioned in your testimonies--maybe you did, Dr.
Kennedy--about that pilot program that we put in the Food Stamp
Program that is just starting now to give incentives for Food
Stamp recipients to buy healthier foods in stores. Is there
something like that we could do in the WIC Program?
Ms. Kennedy. The implementation now that USDA is undergoing
of the new food package regulations that are based very heavily
on the Institute of Medicine report, where there is more
emphasis in the WIC food package on fruits, vegetables, whole
grains, and low-fat dairy, is obviously a step in that
direction. I think, again, in looking at gains we have made in
the United States over the past 60 years, if you are targeting
overweight and obesity as a primary problem both in children,
and Senator Lugar's comment is well taken, and adults, the WIC
food package or the school meals have to be part of the
solution, but it is not the totality of the solution.
This is why I made a plea in my testimony to look much more
specifically at the potentiality of linking the WIC services to
Child and Adult Care Food Program. Children, particularly low-
income children, are spending a disproportionate share of their
day in child care. We are trying to achieve the same goals in
WIC and Child Care, better dietary patterns, healthier
lifestyles. We know from the point of view of the preschool age
period it is developmentally so important, including the
development of lifelong eating habits.
What we found in the Shape Up Somerville experience, which
was targeting first, second, and third graders, was that 44
percent of those children, by the time they got in those early
grades, were already either overweight or at risk of
overweight. What this implies is you have to start earlier. If
you want a healthy lifestyle, you have to start with the
preschool years and one vehicle for that at the Federal level
is this synergy between WIC and Child and Adult Care Food
Program.
Unfortunately, what we have seen since the means test was
passed for homes and child care in 1996 and implemented in
1997, what we have seen is a decline in the number of homes
participating in Child Care, and again, Senator Casey, I think
this is apropos to your point, where you talked about
decreasing administrative burdens. If you have a woman who is
running a child care facility with three or four children, they
don't want to spend half their day doing paperwork to qualify.
Without losing the essence of what we are trying to accomplish
in Child Care, how do we make it more of a health program? I
think you have the opportunity to think about this in the Child
Nutrition 2009 Reauthorization.
Chairman Harkin. Good suggestion. I just have one more
before I yield to my colleagues. I want to know about this
Minnesota study. People always told me these healthier foods
cost more, and my response has always been, well, OK. It is
still a good investment. It is still the best investment to get
them healthier food. But you say the Minnesota study indicates
that it didn't cost that much more, is that right?
Ms. Fox. I will have to send you the paper. I don't want to
misstate anything. Basically, it was a regression analysis that
followed meal purchases and menu plans in 330 school districts
in Minnesota, and what they found when they compared food
prices to the healthfulness of the menus, that there wasn't the
association that was expected, that the healthier meals cost
more.
And then they went back and did focus groups with food
service directors to try to figure out why they got this
counterintuitive result and they went back in and looked more
closely at the components of the cost data and what they found
was that many of these school districts that were serving
healthier meals were spending more on labor because there was
more chopping, slicing, dicing, and cooking, but they were
spending a lot less on expensive pre-prepared, processed,
packaged foods, so the per unit cost.
Now, there are all kinds of caveats in the report, that
obviously it is based on one State. They have got certain
purchasing agreements in place and a menu that started in a
certain place and so forth. But it is certainly something to
look at, and I would be happy to send it to you.
Chairman Harkin. I wish you would, because what I would
like to do is see if we can't provide some support, read that
as money, to other places around the country to do similar kind
of studies, get a handle on this and find out. Maybe I have
been wrong all along, that they just necessarily cost more.
Maybe what you are pointing out, really that they balance each
other off and that nutritious foods don't really cost that much
more.
Ms. Fox. I think there is probably a lot of variability,
but this is at least one hopeful sign that it doesn't have to
always be in one direction.
Chairman Harkin. Thank you very much. I have questions for
other witnesses, but I am trying to do a 7-minute round here
and I will yield to Senator Casey, and then Senator Lugar and
then Senator Klobuchar.
Senator Casey. Mr. Chairman, thank you. I am yielding to
Senator Klobuchar because of your schedule.
Chairman Harkin. Okay.
Senator Klobuchar. Thank you very much. I have to go train
our new Senator on the nuts and bolts of setting up an office,
so I will just take 5 minutes.
Chairman Harkin. You have a new Senator?
Senator Klobuchar. Well, incoming Senator Begich. He
couldn't go to the orientation that we all did.
Chairman Harkin. Oh.
Senator Klobuchar. Oh, you thought that the Minnesota race
had been determined?
Chairman Harkin. I thought that was settled.
[Laughter.]
Senator Klobuchar. Oh, no, Chairman Harkin. I would let you
know that.
Chairman Harkin. Did I miss something here?
Senator Klobuchar. No, no, no. OK. Sorry for throwing that
in there.
I want to thank all the witnesses, and I actually had some
questions, Ms. Fox, that Senator Harkin, the Chairman, asked,
but just about this Minnesota study, if you could send it, as
well. I do think just intuitively, when you think of these
packaged foods and some of them, they seem cheap but they are
not always that cheap. It is cheaper to make a peanut butter
sandwich, as I know from my daughter's lunches, and throw an
apple in sometimes than the prepackaged things that you can
buy.
But I was thinking, Dr. Kennedy, of what you were saying
about this relationship. I hadn't really thought of it so
intensely until you brought it up, until yesterday when I saw
an ad for a fast food restaurant that was clearly pushing this
because of the economy and they were showing their basically
basket of bad-looking food and they said that you could feed
each family member of four, which I have never heard before on
a fast food ad, because people are suffering, for $1.99 or
something by using this. So it made me think about it, as I
looked at this food and it looked really fattening. It made me
think about how that it is going to get worse possibly because
of the economy, that people are going to be getting more and
more and more of the cheaper fast food, and so that will be an
issue.
I just wondered if you could just talk a little bit more
about in the school lunch setting, the relationship here
between the cheaper fried food and the obesity.
Ms. Kennedy. Yes. Excellent observation. Clearly when one
is income constrained, what you try to do with your food dollar
is maximize caloric intake, and I am not suggesting that is
good, but fast food restaurants are a great value for dollar on
the calories you get per dollar spent.
We have actually looked at this over the past 50 years, all
of your nutrition programs, and see that particularly School
Lunch, School Breakfast, and WIC, provide more nutrient-dense
foods within the calorie allotment that is given. If you look
at the last national evaluation of the WIC Program, what you
see in children's diets, is that more expensive nutrients like
calcium, iron, a range of vitamins, were increased while
participating in the WIC Program. The same thing in School
Lunch-School Breakfast. These programs effectively move
participants to have more nutrient density in the diet because
households can't afford to necessarily buy these more expensive
foods.
Nutrient-dense foods need not be more expensive, but it
takes a lot more planning and thinking about how you get not
only calories, but nutrients out of the dollar, which gets back
to my earlier comment about information given to parents. In my
testimony, I do talk about the fact that in interviews we did
as part of a National Governors Association bipartisan project,
that moms who really wanted to make the right choice reported
over and over again that they were getting different messages
from pediatricians, from WIC, from Head Start, from child care.
We have the opportunity to think about how do we use our safety
net to not only get across a consistent nutrition education
message, but nest this in the concept of parenting skills.
Senator Klobuchar. I mean, I was always looking for the
easy way out when my daughter was in elementary school, but I
finally decided bringing a lunch was so much better because of
all these bad choices. There were some good choices, but there
are some really bad choices that the kids would choose which
really resonated with what you are talking.
You talked about this national science-based standard for
foods that compete with the lunches. How do you think we could
do this, because the truth is, if they have got French fries to
choose from or a yogurt, they are probably going to choose the
French fries.
I think what you have to do is move in the direction of
having the healthy choices available in schools. I actually
think we have an opportunity both for rigorous standards for
the School Lunch-School Breakfast, but also national rigorous
standards for competitive foods that the private sector will
step up to the plate as they see consumer demand in schools and
you will have a broader range of healthier products available.
Senator Klobuchar. I just don't think we should have those
bad choices, at least for elementary schools.
Ms. Kennedy. Right, and this is what we did in Shape Up
Somerville. We removed the chips and the sodas and replaced it
with waters, yogurts, et cetera. Now, initially, revenues went
down----
Senator Klobuchar. Yes, I know.
Ms. Kennedy [continuing]. But over the course of the first
year, they bounced back up and schools were not adversely
affected. The low-income schools rely on these revenues, so it
is possible to do it.
Senator Klobuchar. Right.
Ms. Kennedy. I totally agree with you.
Senator Klobuchar. Another thing along those same income
lines, again, personal experience. My daughter was at a school
in Minneapolis for 2 years that was 90 percent free and reduced
lunch and it was an inner-city school, and now she is in the
Arlington schools in Virginia, a very different population. So
I don't see this as Minnesota versus Virginia schools but
demographically, two very different situations.
The Virginia schools, they have gym every single day. These
kids are out there, no matter what. And this school she was in
had a gym. It wasn't as good, like you said, but they could
have been doing it. It was only 3 months out of the year, and
there was no comparison between the physical actively. And in
this school where she is now, they are giving them pedometers
when they take health, so she is walking the stairs at home,
the half-hour before she is going to bed, because she hasn't
gotten enough steps in, running in place.
But that kind of philosophy, if we could somehow get that
across the board, could fit as a status thing to me, that at
some of these urban schools that are doing less with the
mandatory physical education, and I am someone who had like the
second-to-the-worst softball throw in fourth grade. But my
point is that somehow they have made gym something that my
daughter looks forward to, even though she is not athletic----
Ms. Kennedy. Making it fun.
Senator Klobuchar. And so that has got to be a piece of
this. Do you see, is there a demographic--I will ask someone
else--demographic differences so that some of these poorer
schools are getting less physical education, because that is
what I saw. I don't know. Does anyone know?
Ms. Duff. In South Carolina, recently, we have passed a law
to increase the hours of physical education in all our schools.
It is gradually being funded. Funding is part of the problem.
We have to hire a lot more teachers and some of them have to be
part-time teachers to cover more addition physical education
classes.
But in my own school district, our students have physical
education twice a week, and they go outside. They engage in a
variety of physical sports and activities and the students do
look forward to it.
Senator Klobuchar. I mean, I just would say that it seems
the hour--the 45 minutes, not an hour, probably like 45 minutes
a day, you really can't beat that because it sets up this
routine, I think. But anyway, thank you very much.
Chairman Harkin. Thank you, Senator Klobuchar.
It kind of raises the question I am going to ask after I
recognize Senator Lugar, but what you are talking about are
competitive foods. I started thinking about this. Where did
that name ever come from? Why are they called competitive foods
and when did they come in?
When I was a kid in school, when they started the School
Lunch Program, we never had competitive foods. We never had
vending machines, either. Anyway, I won't get into that, but
why do we allow competitive foods? I make a provocative
question. Should we just ban competitive foods? If you are
getting part of the School Lunch and School Breakfast Program,
you just can't have competitive foods, or whatever they are
called, a la carte lines and vending machines and all those
kinds of things like that. Maybe we ought to just say, enough.
Anyway, I just throw that out there.
Senator Lugar, I didn't mean to interrupt you, but thank
you.
Senator Lugar. Mr. Chairman, I will just follow along your
idea. First of all, I liked the challenge in this
reauthorization, which may come at a time that the new
administration, the new Congress are discussing health care for
all Americans, the more comprehensive approach there, that our
role can be a very important one in talking about the
nutritional part of it for our children, likewise for mothers
in the WIC Program or for others who are involved in this. I
like that idea and I am hoping we can draft something that
would be consistent with this.
It seems to me that we have discussed, certainly Ms. Duff
has illustrated a dramatic example of the food safety net that
still needs to be cast a good bit wider. This committee has
made a lot of progress over the years with regard to summer
feeding programs. We discovered a hiatus there of several
months in which the children were not in a regular school
operation, but there were park services, social groups,
sometimes the schools themselves that regrouped so that there
was not this gap.
I am not certain how we phrase this, but essentially we
know that the comprehensive medical changes are hugely
expensive and our country is trying to grapple with how rapidly
can you take this on, along with Social Security reform or
other monumental tasks of this sort. But this is perhaps a less
expensive part of that, and I mention that because whatever we
do is going to be challenged in a budget way as to whose budget
is paying for this. Is this United States Department of
Agriculture or which situation, so that any increases we make
are going to be challenged, as they will be in a period of
deficit finance.
What I want to get to, though, is the point that you were
raising again, and this is from your testimony, Ms. Fox, about
the fact that in some programs, in fact, the good fruits and
the good vegetables and the other items that all of us believe
are nutritious were presented to students. But I think you
point out in one instance, only 45 percent of the choices were
the good fruits and vegetables. In another case, 30 percent in
some other choice people had to make.
Senator Harkin is suggesting, I think, why is there a
choice? Well, we say, my goodness, what kind of a country is
this? We are Americans and we reserve the right to choose to
eat whatever we want, whether we are children or adults or so
forth. After all, what we ought to be doing, as everybody
suggests, is presenting more information, more constructive
advice as to why this is a good choice for a child who is six,
seven, eight, nine, or what have you, presumably has the
comprehension of all of this research, the argumentation, but
also some familiarity with the habits of parents who may not
share those thoughts, or even grandparents who have very strong
ideas about what they like.
And so again and again, we are going to be faced with this
predicament that we present better and better information to
people, and even have the food lying in front of them, but as
you said, you can lead the horse to water and so forth, it
really does pertain to this situation.
What I am wondering is, first of all, what is your thought
about how far choice ought to go in this predicament? Is this a
case in, let us say elementary school feeding programs where,
in fact, the only thing there on the counter happens to be in
conformity with dietary guidelines? But then, second, the
statistician in all of this sort of gropes with this thought.
Can we at the same time begin to challenge students in the same
way that the pedometer may challenge students to do the right
thing with regard to steps and walking and so forth, to get
better information about how many calories are in this or what
is the Vitamin A content, or for that matter--and challenge
students to do the math, to help construct for themselves a
healthy pattern which may, in fact, be a source of discussion
or debate with the family.
In other words, I grope, as many of us do, for any
information about some of the food that I have consumed in a
restaurant or someplace that I don't control the situation, and
there is debate in our society as to whether this information
should be available at all. How do we make this kind of
information universally available, and while we are involved
with our courses with students, as you have been involved in
the math of it, make this an attractive option for people to be
doing the right thing and understand the reasons and have
pride, really, in what their score may be? Can you make any
comment about this?
Ms. Fox. I think what you just said spells out how complex
the whole situation is in terms of offering an individual
decisions and the influence of the family and also the
influence of what else is out there when they are making a
decision.
I think there clearly is evidence from programs like Shape
Up Somerville and other programs that have been implemented
sort of in a research setting that things can be changed in a
way that children will adjust and move toward the healthier
choices.
I think when you are talking about trying to do that on a
more broad-based way in schools that may have more or less
motivation and resources, you know, physical and motivational
resources to implement something like that, that there really
is a need to try to put some models together and that is sort
of what I was alluding to when I talked about having some
demonstration projects, to put some models together that school
districts that do want to make these changes from, whether it
is eliminating competitive foods or making the not so great
choices like French fries, instead of having them every day,
offer them once a week. You know, instead of having pizza with
pepperoni on it every day, offer pizza with no pepperoni once a
week. I mean----
Senator Lugar. So the district might make the choice.
Ms. Fox. Right.
Senator Lugar. In other words, to get to Somerville, that
is a broad group of people, but so is a district.
Ms. Fox. Right.
Senator Lugar. So as opposed to the individual child making
the choice or the nutrition director at the school, you do this
in a geographic or organizational pattern.
Ms. Fox. Right. Well, the school district would have to
make choices about what they are going to make available and
how they are going to market it and that sort of thing, and
then there has to be support to help and encourage and provide
encouragement and information to the children to be able to
make those individual choices.
I personally don't--I mean, competitive foods is a
different story. But in terms of really limiting choice within
the context of school meals, I think we should try to make them
as healthy as they possibly can and allow students a variety of
choices that they can mix and match in a variety of ways and
still come out with a reasonably healthy meal.
Senator Lugar. Thank you.
Ms. Fox. That is sort of my opinion.
Senator Lugar. Thank you, Mr. Chairman.
Chairman Harkin. Well, Dick, you just again bring up an
interesting thing about the choices that these kids have and
why kids pick some of these bad foods and stuff. Again, it
spills over into so many areas outside of our jurisdiction, but
I think a lot of it has to do with marketing. I mean, they
market to kids, and this goes back to a decision made back in
1980 or 1981, somewhere in that range of time, by the FTC. The
Federal Trade Commission right now has more authority to
regulate advertising to you than to your grandkids because they
exempted kids. There are two ways FTC can regulate advertising.
One is on truthfulness and one is on unfairness. For you, for
us as adults, they can regulate advertising based on both. For
children, they can only do it based on truthfulness, but not on
fairness.
Some people have been saying that it is inherently unfair
for people to market to kids because they don't understand the
difference, but that jurisdiction was taken away from them
around 1980, 1979, 1980, 1981, somewhere in that timeframe. So
these kids get all this stuff marketed to them and of course
then they are going to pick these foods because that is who
their heroes tend to--see, Spiderman likes this stuff. I am
talking about younger kids and things like that. So they come
to school with all of that.
I have made the statement before that it seems to me
schools ought to be sanctuaries for kids, places where they
come and they learn, they grow, they develop. They shouldn't
just be another marketplace where vendors can market items, and
sometimes to the extent where some vendors have exclusive
marketing agreements with secondary schools, Coke, Pepsi. I
have been to schools where they have got these exclusive
contracts, and, of course, they provide money for band uniforms
and sports and all that kind of stuff and they get these
exclusive contracts, one soft drink over another.
I was at one school once and they had seats, chairs for
kids with the Coca-Cola emblem on them. They are sitting in
school sitting on Coca-Cola seats. Well, you think at first,
well, so what? But it is that brand identification that they
instill in kids.
I just, for some reason, I think that we have got to get
away from that and come back to this idea of wholesome,
nutritious foods, and at least if there is going to be a
choice, it ought to be a choice among nutritional foods,
perhaps not a choice between nutritional and non-nutritional
foods. Maybe provide the choice, but at least put some
guidelines out there that hopefully we can get before next
October, anyway.
I didn't mean to go on that. We are graced with the
presence of Senator Leahy, another former Chairman of this
distinguished committee. Senator Leahy?
Senator Leahy. You see it is the former chairmen who show
up here, the Chairman and former chairmen because we are the
ones who understand how important it is.
I was interested in listening to the conversations. I have
been in some schools, maybe a couple of different schools, same
demographics, same size, same budget, one with really good
nutritional food and the education that goes with it, others
with stuff that is scary, you know, green glop on Monday and
blue glop on Tuesday, or the kinds of things you talked about
before, other stuff.
I think on this, the food assistance, it is a chance to
learn how well equipped the Department is in helping the
American people prevent chronic disease and fight hunger. It is
a significant economic crisis in the country today and hunger
becomes one of the first things that we see in the wealthiest
nation on earth, a nation that spends millions of dollars to
get rid of excess food. You see hungry people. So I am glad to
see those who are here today, our friends from USDA who can try
to work to respond to a growing demand.
This is one of the most severe periods of economic turmoil
in modern history, and as I said, when times are tough, more
Americans go hungry. I think nobody has to be a genius to know
that hunger is going to get worse. It is not going to get
better as the recession goes on. Hunger is a leading indicator,
an indicator during tough economic times, but it is a lot more
than just statistics. It is deeply personal. It takes its toll
one child at a time, one family at a time. Parents, as they are
out there trying to get work, going without food because they
want to at least feed their children, or children embarrassed
to say when they go to school why they are hungry, because
their family can't feed them.
Right now, in my own home State of Vermont, nearly one in
ten people are, as these statistics call it, hunger insecure.
Hunger insecure. I cannot begin to tell you what they are going
through. These people are running out of food. They reduce the
quality of food their family eats. They feed their children
unbalanced diets. They skip meals altogether so families can
afford to feed their children. The current economic condition
severely affects this food security. Then they show up at Food
Stamp and food shelves, and the food shelves are strained far
beyond their resources.
My wife and I, one of the areas we prefer sending money for
charity are food shelves, and I hope everybody else will do the
same thing, because I talk to the heads of these food shelves.
I know how they try to stretch every bit of food. They say they
cannot begin to meet the demand. So we have to do a lot more to
help that. The Agriculture Department has to be our partner in
that.
Hunger is just one of the problems--poor-quality diets,
nutrition deficiencies, obesity,developmental delays, increases
in aggression, depression, hyperactive behavior, poor
academics. Any teacher will tell you, a hungry child is a child
that can't learn. These are problems that face everybody in
these hunger insecure homes.
So that is the only thing I am going to talk about because
I think that we will in the various committees be looking at
things, everything from auto bailouts on through. Bailing out a
hungry table with hungry children while parents try to find
work, I think goes not just to the economics of this country,
it goes to the morality of the United States.
I think one of the ways that can stimulate that is the Food
Stamp Program. I think there has to be an increase in Food
Stamp benefits. Temporarily increase Federal reimbursement for
school meals. We are in the school year. That might help. Find
how to get more resources for our food banks around the
country.
Mr. Chairman, I would like to ask just a question about a
point made in Dr. Kennedy's testimony. You had said, as I
understand it, reading it, that you would like to see a
temporary increase in the level of Food Stamp benefits to help
low-income families. Do you have a level in mind, or how much
of a bump the Food Stamp benefits should be? Am I putting you
on the spot?
Ms. Kennedy. No, no. Part of it has to be what is
practical. The changes that have taken place in the level of
reimbursement for the Thrifty Food Plan have gone in the
negative direction over the past few years. The Thrifty Food
Plan used to be at 103 percent of the value of the Thrifty Food
Plan, because there is a lagged effect. That 3 percent was
eliminated.
So it is not simply increasing the level of the Thrifty
Food Plan, the Food Stamp benefit, which I will get back to in
a moment. We in Massachusetts, after a number of years of
seeing downward trends in Food Stamp participation, suddenly
are seeing this sharp uptick because of the economic downturn,
but simultaneously, we are seeing increased participation in
emergency feeding sites. And so if they are not getting it from
Food Stamps, they need to get it from emergency sites.
I will give you a number, and I know the reaction often is,
oh, it is not possible because the Food Stamp Program is so
expensive, but I would say a 10-percent increase. Now, what is
the pragmatics in the current budgetary environment, but that
is enough of a padding there that it would be significant. It
would be expensive.
Senator Leahy. Does anybody else want to add to that? Ms.
Fox?
Ms. Fox. I think that it would be terrific. The increases
that we have seen in the past have been much, much smaller than
that.
Senator Leahy. I didn't expect you to jump up and disagree.
[Laughter.]
Senator Leahy. Dr. Chilton?
Ms. Chilton. If I could say a few words about using Food
Stamps as an economic stimulus, I think that would be
incredibly important. I don't know what the percentage increase
should be, but I have to tell you that based on our research
that we have done in Boston and in Philadelphia, we have found
that if a family is receiving the maximum allotment of Food
Stamps, which used to be $542 for a family of four, even if
they are receiving that maximum allotment, they still would not
be able to afford everything that the Thrify Food Plan says
that they can buy with that money.
As a matter of fact, in Philadelphia, they would be about
$2,000 in the hole trying to buy the Thrifty Food Plan with the
maximum allotment of Food Stamps. So a 10-percent increase
won't bring you up to what the Food Stamp Program is supposed
to do.
I also have to say that children who are on Food Stamps,
there is a significant health effect. The more Food Stamps that
a family receives, the better the developmental outcomes, the
greater the reduction in hospitalization rates, and the greater
the reduction in poor health. So you are not just getting a
return on the dollar, but you are also stimulating and boosting
the minds and the bodies of the very young children that need
these Food Stamps the most.
Senator Leahy. Thank you. Ms. Duff, did you want to add
anything to that?
Ms. Duff. I second that motion. Yes, I agree.
Senator Leahy. Mr. Chairman, I think the reason here is
that this is sort of important. I mean, none of us around this
table are going to go hungry except by choice, and our children
won't go and our grandchildren won't go hungry except by
choice. But I can walk you out of here and I could say this in
a hearing room in any city in this country and within a few
blocks show you really severe hunger. And if you go into some
of the rural areas, whether it is in Pennsylvania or Indiana or
Iowa or Vermont, you have these real pockets of hunger, and
with the hunger comes desperation. They don't know where to go,
especially in families that have never faced that before. In
the hard economic times, they are facing it for the first time
in their lives and the difficulty of it.
So thank you for holding the hearing, Mr. Chairman.
Senator Lugar. Mr. Chairman, this is a point of query. Do
we know or does staff know what the Federal budget is for Food
Stamps now? In other words, what benchmark do we have to think
about the 10 percent increase if that were to be a part of this
economic stimulus package?
Chairman Harkin. This is Derek Miller, who is my staff
person on this. He knows all this stuff.
Mr. Miller. A 10-percent increase in the Food Stamp
allotment through the end of the fiscal year with a January 1
effective date is about $4.3 or $4.4 billion. And that is what
was included in the most recent stimulus bill that was brought
before----
Senator Lugar. It is included?
Mr. Miller. Correct.
Chairman Harkin. Thanks for asking the question. I didn't
know the answer to that, either, Dick. Thank you.
Senator Casey from Pennsylvania?
Senator Casey. Mr. Chairman, thank you, and I am sorry I
had to run out and I apologize to our witnesses.
First of all, I want to thank our Chairman and both Senator
Leahy and Senator Lugar, who all three have done decades of
work on these subjects and on these priorities. So we want to
thank them for their leadership on these important issues.
I guess I wanted to start with Dr. Chilton on something
that just leaped off the page of your testimony, where you
talked about food insecurity and you said, and I am quoting
from the first page of your testimony, ``Last year, 12.4
million children,'' and you have highlighted that, ``were in
food insecure households, according to the USDA. Yet again,''
you say, ``17 percent of households with children in the United
States had lived in food insecure homes,'' unquote. But that
12.4 million children, that is literally the entire population
of the State of Pennsylvania, a very large State, as you know.
That number alone, I think, tells the story. I can't even
comprehend of that many children facing food insecurity, so you
really put it into perspective when you highlighted that.
I wanted to ask you, as I mentioned in my opening, the
postcard that you showed me, the Witness to Hunger postcard.
Can you give a sense of, from your research or from your own
observations or from the testimony from others, what you are
seeing in the last few months, kind of in real lives like these
children's lives, versus what we were seeing a year ago or 5
years ago? I mean, is there a way to define it beyond the
numbers in terms of the kind of urgency to it or the kind of
real world circumstances that we are seeing? I know it is hard
to sum up without data, but is there another way to convey
that?
Ms. Chilton. Thank you very much for asking the question,
and I think I can convey it. I will base it on my research with
40 women, only 40 women in Philadelphia, but I have basically
given them the opportunity to take photographs and to record
their experiences with hunger and poverty in inner-city
Philadelphia. The way they talk about it is having to reduce,
or losing hours that they can put in at their jobs because of
cuts that are happening in their workplaces and having to take
on second and sometimes third jobs. This becomes very
difficult, especially for a female head of household who needs
to--who are doing janitorial services, for instance, between 9
p.m. and 4 a.m. and how do they afford child care.
So from these women's perspectives, I think it is really
the reduction in hours at work. It is the extremely low pay and
low wages that they actually earn. And also trying to arrange
child care for their young children and trying to keep it
together emotionally, financially, and just in their everyday
lives. It creates an enormous sense of anxiety and depression
in these women's lives, which then in turn makes it even worse
for them to be able to find a job.
So we are seeing that on the ground in Philadelphia. I am
sure that we are seeing that in other cities, as well. We also
have a clinic for children with failure to thrive at St.
Christopher's Hospital up in North Philadelphia. Failure to
thrive is severe undernutrition, and there we work with our
families over the course of about 18 months to try to get a
young child that has fallen off the growth curve to get back
onto the growth curve so that they can develop well, socially,
emotionally, and cognitively.
And we have found that even in those families, with the
economic downturn and also the hike in food prices, that
families are stretching their food. They are watering down
formula. They are taking on more jobs, which puts more strain
on the household. Then again, the child begins to lose weight.
And when you see food insecurity manifest in a loss of weight,
you know that that food insecurity is very severe, because you
can actually have food insecurity which affects a child's
behavior and their emotional well-being and their cognitive
performance, but when you see it have an effect on their growth
and their growth potential, you know you are dealing with
something very severe.
And I have to say that if we do not boost Child Nutrition
Programs, we will see a major downturn in child health and
well-being and we would lose out on a generation. And this is
an emergency. A young child between the ages of zero and three,
any interruption in nutritional quality can have lifelong
consequences. So this is our window of opportunity right now.
Those first 3 years of life, that is where we can make a true
difference.
Senator Casey. Thank you. I know I may be plowing ground
that has already been covered and questions that have been
pursued before, but one of the near-term questions we have in
front of the Congress, of course, is the stimulus legislation,
which I have my own strong feelings about what should be in
that and I believe that part of that should be Food Stamps, an
increase in Food Stamp availability.
Now, for those who aren't as concerned about or aren't
convinced by the gravity of the situation for those who are
food insecure, there is also a good taxpayer argument for it,
which is always nice when you can help people and also do
something that is efficient. In this case, Mark Zandy and, I
guess, others, have told us that if you spend a buck on Food
Stamps, you get $1.60, $1.70 back. So there is a good return on
it.
But talk to us--and this is for any of our witnesses--talk
to us about the situation as you would perceive it, as you see
it, if we don't act in January. Say we pass a stimulus bill and
everyone pats each other on the back and says, yay, we have got
a stimulus bill, and there is nothing in there for Food Stamps
and we have to wait for the regular budget process to play out
over the next year. Talk to us about that. I don't know whether
Dr. Kennedy or Ms. Fox or Ms. Duff.
Ms. Kennedy. We have looked at that and we know that
households on the Food Stamp Program at a very low level of
expenditures have a better dietary pattern than non-Food Stamp
households at a similar level. However, having said that, most
households at the spending of the Food Stamp level do not have
a nutritionally adequate diet. I don't think any of us--long
term, I am not talking about being on it for a week--long term
at the spending level of the Thrifty Food Plan would have a
nutritionally adequate diet. It is very, very difficult given
the way--and when I was in USDA, I actually was involved in the
revision of the Thrifty Food Plan to adhere to dietary
guidelines. You almost have to have a Ph.D. in nutrition to
make it work.
So let us be realistic. Increments in the level of the
Thrifty Food Plan would help income-constrained households.
In my earlier comments, I talked about the fact that hunger
tracks with poverty. Food Stamp participation tracks with
poverty. Poverty rates are going up. Over the next year, there
is going to be an exponential growth in demand for Food Stamps
and I think we want to look at what is realistic in order to
ensure food security of income- constrained households who are
unemployed through no fault of their own. Companies have
closed. So I would think about looking at, and I say temporary
because I know this is not very popular, but a temporary
increase in the level of funding of the Thrifty Food Plan
because we are in a very dire situation.
I would also look at ways of making sure that individuals
who are eligible for Food Stamps maximize their participation
in free School Lunch-School Breakfast, maximize their
participation in the WIC Program, so you take the advantage of
all of the programs that are there, the full mosaic of the
safety net, so that you are not saying one or the other. You
are looking at, through referrals, through advertisement,
through community action, getting the multiple participation,
which I think will help to the maximum extent curb food
insecurity and hunger.
Senator Casey. Anybody else?
Ms. Duff. Increasingly we can expect greater dependence on
free school meals for children. Families will depend on school
meals more and more. Students who didn't qualify for meals
assistance in the beginning of this school year will probably
qualify now, and school nurses take an active role in that. We
look at whether or not they qualified in the beginning of the
school year. We try to go back and review that list and contact
those families who did not qualify and assist them in
reapplying so that they will have free school meals for their
children.
Senator Casey. Thank you very much.
Chairman Harkin. Ms. Duff, first of all, I was startled to
hear school nurses are serving students in 75 percent of U.S.
public schools. Are you telling me one out of four schools
don't even have a school nurse?
Ms. Duff. That is correct.
Chairman Harkin. What do they have?
Ms. Duff. Nothing. They don't have anyone who attends to
health care of children, not anyone trained, anyway. They have
the secretary, who gives medicines that are controlled
substances that have all sorts of side effects, and they are
not trained in emergency care. They call 911 if they need
something.
Chairman Harkin. I think that is shocking. But I wanted to
read something that you said here, which corresponds a lot with
my thinking. You say, not only do the programs--you are talking
about Breakfast and Lunch Programs--not only do the programs
assist with the economic difficulties of poor families, they
are part of a prevention strategy, an effort to protect the
health of children. Prevention is the positive, logical, and
cost-beneficial approach to achieve education goals and to
prevent chronic diseases. Again, going back to what I alluded
to in my opening statement, that this is all kind of part of
the health care reform that we will be looking at.
Dr. Chilton, let me ask you, it came to my mind when you
were talking about the nutritional aspects of kids and what
they are eating, some people have advised that perhaps one of
the best things we could do for a lot of kids in our schools is
just to provide them at least in the morning with a
multivitamin.
Ms. Chilton. That is hogwash.
Chairman Harkin. Why? If they have a multivitamin, at least
they have got the nutritional underpinnings of Vitamin A and D
and B and the B-complex vitamins, maybe folates and other
things like that you could put into a multivitamin. At least
you would have that.
Ms. Chilton. Right. Micronutrients are extremely important,
but to suggest that you give a young child or a child that is
supposed to learn a vitamin does not deal with having enough
food and enough calories. So you need to have the energy
balance in a child. You also need to have roughage. You need to
have enjoyment with food. You need to teach a child good
habits, color on the plate, five a day.
To suggest that we would give a child a multivitamin and
this would somehow enhance their cognitive potential of
American society is absolutely backwards thinking. It goes
against the CDC recommendations of fresh fruits and vegetables.
It is going backwards. I highly recommend that we fight back on
that argument to say that fresh fruits and vegetables, a
nutritious, fully balanced meal with enough nutrient-dense
calories is the best way to go for our young children and for
the American people.
Chairman Harkin. Let me see. Dr. Kennedy, you mentioned the
school districts and the wellness policies that we put into our
last reauthorization of this bill in which we mandated that by,
I think it was 2005 or 2006, somewhere in there, that every
school district had to have a wellness policy. I ask this of
all of you. Have you looked at these? We didn't say exactly
what they had to be. We wanted to have people think about their
wellness policies and what the school districts would come up
with. Do you have any knowledge of the different varieties of
different wellness policies, and are they generally good,
generally poor, or just do they run the gamut?
Ms. Kennedy. Enormous variation in what is actually going
on in health and wellness. Some school districts see this as an
unfunded mandate. They have to have it, but there are no
resources to come along with it. Others have taken it very
seriously.
I think, again, getting back to Somerville as an example,
part of what was so exciting about--and it has been sustained
even after the research dollars are gone--what was so exciting
is looking at how you bring together the resources of the
community, so we are not talking about incremental money, with
the existing organizations of the community, existing staff.
How do you make a community healthier?
And part of it is charismatic personalities. I have to say,
the Mayor of Somerville, Mayor Curtatone, wanted this to
succeed, and we can get into a discussion of ``Are leaders born
or created?'', but I think we can excite people when we show
examples. We keep talking about prototypes or pilots. But when
you can show in very diverse communities how it is possible to
make this happen, it is not pie in the sky, you can actually do
it in your community, can excite a community. I think the onus
is on the Federal Government to try to provide some of the
information, some of the models on, with these constraints,
here is how you might do it. But at the moment, what I have
seen, it is not just in Massachusetts but in other parts of the
United States, there is enormous variability in what is going
on.
Chairman Harkin. There was some suggestion that perhaps,
since have that out there, that perhaps we should have the
wellness policies at least follow some guidelines that would be
promulgated by the Institute of Medicine. Would that be a next
step, to kind of standardize them a little bit?
Ms. Kennedy. I think there is a wonderful resource there
with the Institute of Medicine. Clearly, what you get from
them, whether you are talking about nutrition standards for
competitive foods or the current committee that is looking at
nutrition for School Lunch-School Breakfast, or in this case
health and wellness policies, you are getting rigor, science-
based--or a science-based framework that provides a national
floor such that a child in State X is not disadvantaged vis-a-
vis a child in State Y. So I would think that would be one
route to go that would be very promising.
Chairman Harkin. Dr. Chilton, you said it is time to take
lessons from public health where we consider population
characteristics and socio-economic status to decide where to
establish health centers and clinics. The Child Nutrition
Programs ought to follow suit. What would that mean in
practice? What kinds of Federal policy changes might you
recommend if we were to implement that statement?
Ms. Chilton. I think the first place to start would be with
School Breakfast and School Lunch. Pretty much around the
country, families have to individually apply in order to
qualify for free school lunch. In the past 17 years in
Philadelphia, we have done away with that, where in
Philadelphia if the school is in a neighborhood that has 70
percent or less--or it has 75 percent of the families that are
living at the poverty line or below, then that child--that
completely reduces the need for an individual application.
What this has shown is it has reduced a stigma. It has
enhanced the nutritional health of the children. It has made it
easier in order to participate in the School Lunch Program. The
same thing for School Breakfast.
Sadly, this fall, there was some idea that this program
might be threatened in the Philadelphia School District. We
think you need to go the opposite way, that pretty much in
every major inner city that has very high rates of poverty, it
should be universal service. There should be no individual
application for School Breakfast or for School Lunch. The
application process and the administrative process for School
Breakfast and School Lunch, and might I add, the Child and
Adult Care Food Program, are true barriers to improving the
health and wellness of children.
And so I suggest that in public health, if you think about
the Ryan White Care Act, where if you have a certain number of
people who have been diagnosed with HIV or AIDS, then there are
health centers that get put into place. There are therapies
that get put into place automatically, no questions asked.
In this same way, we have to think about our nutrition
programs as actual public health programs that can truly
prevent chronic disease. And if we really think about all of
our welfare programs and the safety net programs in public
health and started using some of our own tools, we would really
enhance the health and well-being of children in the inner
city, and might I also add in counties, in rural counties where
poverty is very high.
Chairman Harkin. Well, I guess that kind of brings us back
to where we started, that really these programs are part of our
public health environment and we ought to be considering them
as such. If you are talking about public health, then you are
looking at prevention and wellness and we ought to be focusing
on that.
I think it is time to make some fundamental changes in our
health care system in America, but I also think it is time for
some fundamental changes in our School Lunch and our School
Breakfast and our WIC feeding programs. To the extent that we
really promote nutritious foods, that we, again, not just think
about our schools as marketplaces for vendors on which to hock
or sell whatever they may have, but really as sanctuaries for
kids to be healthy, where health is promoted and where it is
stimulated and in an environment where kids can have these
healthy choices.
We started the School Snacks Program, the fresh fruit and
vegetable snack program, and every school that has ever entered
that program, not one school has asked to drop out, and it is
all voluntary. We put that in the 2002 farm bill as a pilot
program, to test it out in four States. In this last farm bill,
we have gone nationwide with it. It is going to take a while to
ramp it up.
But what we found is when you provide free fresh fruits and
vegetables to kids in schools as a snack, they will eat them.
Now, if they have got to pay a buck for them, they might put
their buck in the vending machine and get a Coke or something,
or a Pepsi. I don't mean to pick on Coke here. A Pepsi or
whatever, or they might get a bag of chips or whatever. But if
they are free, they will eat them, and when they eat them, they
find out the hunger pangs aren't there anymore and they don't
go to that vending machine as often, and we have found this to
be true. So kids are healthier.
So we have to provide those kinds of environments in
schools and we are going to continue on this committee and in
this bill to try to make those changes that will move us in the
direction of getting healthier foods and more nutritious foods,
especially in the WIC Program, the Women, Infants, and Children
Feeding Program.
And I might digress a little bit here. I thought we had
gotten away from this 20-some years ago. Twenty-seven years
ago, I was the Honorary National Chairman of the Breastfeeding
Coalition and we were making changes to promote nursing in the
WIC Program and in hospitals and that kind of thing. Well, we
did for a while and then it seems like we have backtracked a
little bit now. How do we, while at the same time providing the
necessary components of a WIC package, how do we really promote
and enhance nursing, breastfeeding for infants? We know that is
the best, it is the most wholesome, it is the most nutritious.
It builds up immunities in babies.
Of course, there are societal problems here, too. Many low-
income women who have babies find that the workplace they are
working in does not provide the kind of support if they want to
breastfeed their child. If they are working in the fast food
industry or something like that, they just simply don't have
that wherewithal.
Some companies, larger companies, have provided those kinds
of facilities for women, but as I said, a lot of low- income
women who are working jobs that are minimum wage or slightly
above just don't have that available. So we have to figure out
societally how do we provide that kind of support, also.
But to the maximum extent that a mother can nurse her
child, how do we provide that in that WIC package? How do we
promote that in that WIC package and give incentives in that
WIC package? If you do this, you will get more of something
else. See, it is all incentives, isn't it, to build the
incentives in so they see some benefit that they will obtain
above and beyond the health of the child, which if they have
gotten all the information from the industry, they will be
told, well, infant formula is every bit as good as mother's
milk and all that kind of stuff, which we know is not so. So
how do we build the incentives in that?
I ask these questions so I hope that you will continue to
think about these, the panel we have here, those of you. You
are all experts. And continue to give us the benefit of your
advice as we go through. This is obviously the first of our
hearings and we are going to have a lot more early next year.
We are open for any suggestions and advice that you might have
in these areas.
And the Child and Adult Care Food Program, which is sort
of--not too many people know about it. They know about School
Lunch, School Breakfast, Food Stamps, maybe a little bit about
WIC, but not too many people know about the Child and Adult
Care Food Program, which, again, more and more of our kids in
day care centers, what are they eating? What kind of snacks are
they having? These are kids in those early formative years,
from one to three or 4 years of age, and they need nutritious
food. So how do we change that program and how do we get more
nutritious foods in that program on a reimbursable basis again?
So these are the things that I think a lot about and how we
provide the funding for it. Again, we are talking about budgets
and everything and how tough the budget is. But again, it is
that same thing. We can't afford to do it. Well, if we continue
to do what we are doing, we are paying for the results of this
later on in obesity and diabetes and chronic illnesses and
chronic diseases and we pay a lot more for it later on than if
we just decided to pay for a little bit more up front for these
nutritious foods.
So with that, I would thank you all for being here. I would
just close this by asking if any of you have any final thoughts
or suggestions or advice that you would have for us here. I
would just go down the row again. Dr. Kennedy?
Ms. Kennedy. Senator Harkin, I applaud your efforts to have
the nutrition programs moved more in the direction of health
programs. I think there is enormous potentiality for prevention
with the basic underpinning that nutrition is a key part of
preventive health strategies. I think whatever can be done to
use Child Nutrition Reauthorization 2009 with much more of an
emphasis on health and wellness is going to benefit children
and all Americans.
Chairman Harkin. Well, keep giving us the benefit of your
wisdom and experience on this, Dr. Kennedy.
Ms. Fox?
Ms. Fox. I completely agree. I was very--I was thrilled
with your opening comments. They were right on point and very
compatible with my way of thinking. If this is the path you are
going to take this over the next few months, I think good luck,
and if there is anything we can do to help you with convincing
some of your other colleagues--and I would just put in another
plug for the Child and Adult Care Food Program. I really would
like to see the focus on that program moved to the level that
the school meal programs have received over the past 15 years,
because that is the younger generation where they are forming
their food habits and preferences and we really haven't done
anything with that program. It is focused on nutrition and
health.
Chairman Harkin. Yes. Thank you.
Dr. Chilton?
Ms. Chilton. I, too, I am so amazed at the language that
you use about public health, early childhood nutrition, and
child development. It is so welcome to my ears, and to hear you
talk about a school as being a sanctuary is extraordinary and I
am so impressed. I think that if you keep on beating that drum,
you will have enormous success.
One of the things that I think hasn't been talked about as
much here is that we have the USDA programs, then we have
Health and Human Services, and then we have the Department of
Education, and how about Labor? All of these agencies are so
important to ensuring that there is a structure in place in
which we can get good nutrition to children.
And if I could suggest that we reinvigorate--I can't
remember the name of this particular panel, but it is like a
cross-agency nutrition assessment panel that has someone
looking at nutrition in Health and Human Services, the USDA,
the Department of Education, et cetera, that we set up
benchmarks and goals in the same way that we have Healthy
People 2010, we will have Healthy People 2020. We need to have
some high standards for early childhood nutrition and for child
nutrition and health, understanding that a school environment
is just as important as the nutrition that we are going to
infuse in there.
And that is what public health is all about. It is about
ensuring the conditions in which people can be healthy, and so
I hope that we can have a very broad understanding of those
conditions and how we can work to improve them. Thank you.
Chairman Harkin. Thank you very much, Dr. Chilton. Again,
you hit the point that--all of you have touched on this, and
that is that, again, to the extent that we can on this
committee, to the extent that I can as Chairman, get people to
just not think about this just as a silo. Here is the School
Lunch and here is the School Breakfast and here is this. This
is all part of public health. It all blends into the whole
public health spectrum of America and it has got to be
addressed that way, without thinking about just, well, we are
just going to provide food to kids in schools and not worry
about the health aspects of it. So hopefully, we will start
moving in that direction, I hope, anyway.
Ms. Duff?
Ms. Duff. Well, I appreciate very much the support for
school meals assistance and the recognition that school meals
is very much part of overall school health, and the health of
children, and that school meals assistance is just one little
thing that we can do to enhance the health of the family and
that it shouldn't stop there. In schools, students that are
connected to free and reduced meals have many, many problems.
The fact that they qualify for meals assistance, for school
nurses, anyway, is a red flag. We know that those families need
many more services, and we don't just sit back and make sure
they get their lunch. We actually make contact. We do
assessments of the students and connect them to health
services. I really appreciate the recognition of this committee
that school health and school nursing is part of the public
health system that we have in the United States.
Chairman Harkin. A last provocative question. Do you think
that perhaps we might build some incentives in, to the extent
that if a school that is receiving Federal funds for breakfasts
or lunches, that they would get a bump-up or a boost-up or
something like that if, in fact, that school had a physical
exercise program for each of their students that would involve
so many hours a week of physical exercise?
By the way, you notice I used physical exercise, not
physical education. I have never understood physical education.
I do understand physical exercise, and providing physical
exercise for kids. If they do that and meet certain kinds of
guidelines for that, they might get a boost.
I don't know. I am trying to think of ways in which we
blend these things together, incentive schools to do these
kinds of things, so if you have any thoughts on that, let me
know about it later on.
I thank you all very much for taking time. I thought it was
a very good session, a very good panel. I think this is really
a good kickoff for our next year's work in reauthorizing the
Child Nutrition Act.
Thank you all very much, and the committee will stand
adjourned, subject to the call of the Chair.
[Whereupon, at 3:08 p.m., the committee was adjourned.]
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A P P E N D I X
December 8, 2008
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QUESTIONS AND ANSWERS
December 8, 2008
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