[Senate Hearing 111-241]
[From the U.S. Government Publishing Office]
S. Hrg. 111-241
IMPROVING NUTRITION FOR AMERICA'S
CHILDREN IN DIFFICULT ECONOMIC TIMES
=======================================================================
HEARING
before the
COMMITTEE ON AGRICULTURE,
NUTRITION, AND FORESTRY
UNITED STATES SENATE
ONE HUNDRED ELEVENTH CONGRESS
FIRST SESSION
__________
MARCH 4, 2009
__________
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):
Improving Nutrition for America's Children in Difficult Economic
Times.......................................................... 1
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Wednesday, March 4, 2009
STATEMENTS PRESENTED BY SENATORS
Harkin, Hon. Tom, U.S. Senator from the State of Iowa, Chairman,
Committee on Agriculture, Nutrition, and Forestry.............. 1
Bennet, Hon. Michael F., U.S. Senator from the State of Colorado. 4
Casey, Hon. Robert, Jr., U.S. Senator from the State of
Pennsylvania................................................... 23
Chambliss, Hon. Saxby, U.S. Senator from the State of Georgia.... 3
Klobuchar, Hon. Amy, U.S. Senator from the State of Minnesota.... 16
Panel I
Bartlett, Susan, Senior Associate, ABT Associates, Cambridge,
Massachusetts.................................................. 7
Boldt, Connie, School Food Director, Knoxville Community School
District, Knoxville, Iowa...................................... 8
Wilson, Katie, School Nutrition Director, Onalaska Public
Schools, Onalaska, Wisconsin................................... 5
Panel II
Hecht, Kenneth, Executive Director, California Food Policy
Advocates, Oakland, California................................. 30
Nolan, Lucy, Executive Director, End Hunger Connecticut,
Hartford, Connecticut.......................................... 33
Paige, David, M.D., Professor, Johns Hopkins Medical School,
Baltimore, Maryland............................................ 27
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APPENDIX
Prepared Statements:
Harkin, Hon. Tom............................................. 50
Bennet, Hon. Michael F....................................... 52
Roberts, Hon. Pat............................................ 53
Bartlett, Susan.............................................. 54
Boldt, Connie................................................ 72
Hecht, Kenneth............................................... 76
Nolan, Lucy.................................................. 84
Paige, David................................................. 92
Wilson, Katie................................................ 98
Document(s) Submitted for the Record:
Campaign To End Obesity, prepared statement.................. 106
National Milk Producers Federation, prepared statement....... 110
National WIC Association, prepared statement................. 117
Oregon Hunger Relief Task Force, prepared statement.......... 122
Question and Answer:
Harkin, Hon. Tom:
Written questions for Kate Wilson............................ 126
Written questions for Susan Bartlett......................... 126
Written questions for Ken Hecht.............................. 127
Lincoln, Hon. Blanche L.:
Written questions for Connie Boldt........................... 129
Written questions for David Paige............................ 129
Written questions for Ken Hecht.............................. 130
Bartlett, Susan:
Written response to questions from Hon. Tom Harkin........... 131
Boldt, Connie:
Written response to questions from Hon. Blanche L. Lincoln... 136
Hecht, Ken:
Written response to questions from Hon. Tom Harkin........... 139
Written response to questions from Hon. Blanche L. Lincoln... 144
Wilson, Katie:
Written response to questions from Hon. Tom Harkin (with
attachments)............................................... 148
Written response to questions from Hon. Blanche L. Lincoln... 151
Follow on questions for the record, USDA......................... 167
IMPROVING NUTRITION FOR AMERICA'S
CHILDREN IN DIFFICULT ECONOMIC TIMES
----------
Wednesday, March 4, 2009
U.S. Senate,
Committee on Agriculture, Nutrition, and Forestry,
Washington, DC
The committee met, pursuant to notice, at 9:36 a.m., in
room 216, Hart Senate Office Building, Hon. Tom Harkin,
Chairman of the committee, presiding.
Present or submitting a statement: Senators Harkin, Casey,
Klobuchar, Bennet, Chambliss, and Thune.
STATEMENT OF HON. TOM HARKIN, U.S. SENATOR FROM THE STATE OF
IOWA, CHAIRMAN, COMMITTEE ON AGRICULTURE, NUTRITION, AND
FORESTRY
Chairman Harkin. The Senate Committee on Agriculture,
Nutrition, and Forestry will come to order.
We welcome everybody here. It looks like there is a little
bit of interest maybe in the topic we are on this morning.
Today's hearing continues this committee's ongoing efforts
to address issues in child nutrition and health. In our first
hearing in December of last year, I spoke very bluntly about
the real and damaging long-term health problems that we face in
this country. Overweight, obesity, even among our children have
reached epidemic levels in America, raising the specter that
our children will have shorter life spans than we have for the
first time in history.
Compounding these problems is a health care system that is
ill-equipped to prevent disease. I feel we must reorient our
health care system so that it focuses on preventing diet-
related illnesses and promoting good nutrition and wellness.
As the witnesses in our last hearing outlined very clearly,
USDA's Child Nutrition Programs are a tremendous opportunity to
make a lasting impact on the nutrition and eating habits of our
children. A stronger targeted investment in those programs must
be a part of a comprehensive Federal response to poor nutrition
among our children.
Our witnesses today will present us with some of the
particular challenges and opportunities that we face in
improving child nutrition, both when kids are in school and
when they are not.
Again, I emphasize that we must start early. The WIC
Program has long been one of our nation's most effective public
health programs and has proven itself time and time again. Our
child care settings also present us with a unique and often
overlooked opportunity to reach children before they enter
kindergarten and expose them to the right kinds of foods and
eating habits.
With over 30 million kids eating federally assisted
lunches, the National School Lunch Program is perhaps our best
opportunity to improve child nutrition and health. Research has
shown that children who eat school lunches have higher intakes
of a range of essential vitamins and minerals than children who
consume lunches from other sources.
However, while the quality of school meals has gradually
improved over the years, much work remains to be done to bring
them in line with the dietary guidelines. We know, for example,
that two-thirds of elementary schools offer meals that exceed
the standards for saturated fat, which is commonly linked to
heart disease.
One of the solutions is to improve school meals, offering
foods that have more of the kind of what I call the good stuff,
the vitamins and minerals, less of the bad stuff, less sugar,
sodium, fats. That means more low-and no-fat milk, leaner
meats, whole grain products, fruits and vegetables,
particularly fresh fruits and vegetables.
Now, while that may seem like an easy recommendation in
principle, many school districts will tell you that it is much
more difficult to put this into practice for a variety of
reasons, one of them being cost. Fresh fruits and vegetables
and whole grains tend to cost more than the less-healthful
alternatives, so it is not surprising that some school food
service directors find it difficult to offer these foods given
their limited budgets, budgets which are stretched thin, and
especially in an economic downturn.
That being said, there are school districts out there that
are working within their current budget and still going the
extra mile for their kids by creating an overall nutrition
environment. This teaches kids the importance of eating
healthy, provides more healthful meals for them to eat,
encourages healthy living by requiring regular physical
activity and education. We will hear testimony today from one
of those from my home State of Iowa, in Knoxville.
Perhaps the most important question that it raises for this
committee is how Congress can best help places like Knoxville
to continue their good work and to help other districts to
emulate what they are doing. One welcome sign of help came in
the President's recently released budget in which the President
proposed $1 billion per year in additional funding for child
nutrition. This is a strong indication of how serious the new
administration is about ending childhood hunger and teaching
healthy eating habits at an early age. Now Congress must make
good on this proposal by dedicating real resources in our
budget.
A significant investment in the Child Nutrition
Reauthorization by Congress would be its own downpayment on
comprehensive health care reform that would acknowledge the
very real budget difficulties that school districts, day care
centers, and other providers face while also ensuring that kids
are getting the most balanced, nutritious meals possible. I
have said many times, and I will keep saying it, that if we are
going to have meaningful health reform in this country, what
our kids eat and how they exercise and whether they exercise is
a big part of health reform in this country.
So I look upon our challenge this year in this committee to
reauthorize the child nutrition bill as being a part of the
whole health care reform in America by getting to these kids
early in life and making sure they get the best possible foods
and exercise.
So I look forward to working with my Ranking Member and
good friend, Saxby Chambliss, and all the members of this
committee to get a good child nutrition bill that both does the
right funding levels, but also perhaps does some redirection
and guidance and support for healthier meals in our schools, in
our child care centers, in our adult care facilities, and also
in the Women, Infants, and Children Supplemental Feeding
Program.
[The prepared statement of Hon. Tom Harkin can be found on
page 50 in the appendix.]
Chairman Harkin. With that, I will turn to our Ranking
Member, Senator Chambliss.
STATEMENT OF HON. SAXBY CHAMBLISS, U.S. SENATOR FROM THE STATE
OF GEORGIA
Senator Chambliss. Thank you very much, Mr. Chairman.
Let me first of all thank our witnesses for being here to
help us deal with this critical issue of reauthorizing our
Child Nutrition Program. I want to particularly welcome my
school nutrition folks from Georgia who are here and who do
such a great job of making sure that Georgia's children are
prepared to be educated.
Mr. Chairman, I want to thank you for holding this hearing
today and I appreciate the bipartisan approach that we have
taken on nutrition issues in the past and look forward to
continuing to work together as we reauthorize the Child
Nutrition Programs.
I would like to thank today's witnesses for their
thoughtful testimony regarding school meals, the Summer Food
Service Program, the Special Supplemental Feeding Program for
Women, Infants, and Children, and the Child and Adult Care
Feeding Program. These programs have a proven track record of
not only alleviating hunger in the United States, but also
improving the nutritional intake of children and their
families.
Given the current state of our nation's economy, we are
seeing increased demand for these programs. Many times, the
School Breakfast and Lunch Programs are the only source of food
for many students. Today's witnesses will shed important light
on the challenges that that program faces in providing healthy
meals on a day-to-day basis.
As we strive to improve the country's nutrition safety net,
the committee values and depends on the testimony from experts
on the front lines of the fight against hunger. I know from the
schoolteachers in my family of the importance of good
nutrition. Good nutrition is not only important for good
health, but also for proper cognitive development.
According to the Georgia Department of Education, over
1,177,000 lunches and 499,000 breakfasts are served each day in
Georgia schools. I applaud the dedication of school nutrition
providers and their efforts to feed kids healthy meals and
recognize the very early and significant influence they have in
developing good nutrition habits in school children.
As the Agriculture Committee moves forward in the
reauthorization process, my goal is to ensure that all eligible
children can easily access these important nutrition programs.
I believe that all of us on the committee also share the goal
of better utilizing these programs as tools to improve
nutritional intake as well as combat hunger.
And just in closing, let me say that we made a number of
changes in the School Lunch Program in our farm bill and we
tried to make sure that we could take advantage of a lot of
local situations in providing fruits and vegetables at the
local level for our school nutritionists. We hope that with the
implementation of that program, that all of our child nutrition
folks across the country, both in schools and out of schools,
are going to be able to take advantage of that and make sure
that not only children benefit, but when the children benefit
from that program, farmers benefit from it. So it is simply a
win-win proposition that we inserted in the farm bill and we
look forward to seeing the implementation of that as we move
ahead.
Mr. Chairman, I look forward to hearing from our witnesses.
Thank you.
Chairman Harkin. Thank you very much, Senator Chambliss.
Did you have anything, Senator Bennet?
STATEMENT OF HON. MICHAEL F. BENNET, U.S. SENATOR FROM THE
STATE OF COLORADO
Senator Bennet. Mr. Chairman, thank you. I just want to say
thank you to you for holding this hearing. Thanks for having
me. I am telling you, as a former school superintendent and the
father of three school-age kids, I know how important this is.
Kids can't learn if they are hungry during school. So I feel
like it is very appropriate that this is my first hearing with
you and I would just ask that the remainder of my opening
statement be included in the record.
[The prepared statement of Hon. Michael F. Bennet can be
found on page 52 in the appendix.]
Chairman Harkin. Thank you very much, Senator Bennet, and
welcome to the committee. It is going to be a good year and we
are on something that you can help us a lot on because of your
experience as being a former superintendent, on this whole
issue of school lunches and school breakfasts, so we look
forward to your involvement in the development of this
reauthorization bill.
We will turn to our first panel. Dr. Katie Wilson has been
a School Food Service Director for 21 years, has a Bachelor's
degree in dietetics, a Master's degree in food science
nutrition, and a Ph.D. in food service. Katie recently served
as the Chair for the School Nutrition Association Nutrition
Standards Task Force, developing nutrition standards for
reimbursable meals and foods sold outside the meal program
throughout the school day. Dr. Wilson is presently serving as
President of the School Nutrition Association and she hails
from Onalaska, Wisconsin.
Next will be Dr. Susan Bartlett, a Senior Associate with
Abt Associates, a public policy research and consulting firm.
Dr. Bartlett has over 30 years of experience conducting policy
research on national and State programs designed to assist low-
income individuals and families. She has directed numerous
studies of USDA's Food and Nutrition Assistance Programs,
including the National School Lunch and School Breakfast
Programs, Supplemental Nutrition Assistance Program, the Food
Stamp Program, and the WIC Program. Dr. Bartlett holds a Ph.D.
in urban and regional studies from MIT.
Next will be Connie Boldt, who has served as the School
Food Service Director for the Knoxville Community School
District in Knoxville, Iowa, for the past 12 years. Prior to
joining that school district, she was the Director of Catering
Services at Central College in Pella, Iowa. She graduated from
Central College and received her graduate degree from Iowa
State University in 1986.
We welcome you here. Your statements will be made a part of
the record in their entirety and we would ask if--the clock
probably says 5 minutes, but if it goes to seven or eight, that
is fine, but if you keep it between five and 10 minutes, I
would certainly appreciate it so we can kind of have a give and
take.
We will go in the order in which I just announced, so we
will start with you first, Dr. Wilson. Welcome and thank you
for your service as President of the School Nutrition
Association.
STATEMENT OF KATIE WILSON, SCHOOL NUTRITION DIRECTOR, ONALASKA
PUBLIC SCHOOLS, ONALASKA, WISCONSIN
Ms. Wilson. Thank you. Chairman Harkin, Senator Chambliss,
and members of the committee, I am Dr. Katie Wilson, President
of the School Nutrition Association and a School Nutrition
Director in Onalaska, Wisconsin. With me today is our SNA
executive team, our legal counsel, Marshall Matts, and as you
see, a number of my colleagues.
We are meeting here at a time of unprecedented economic
challenge for our country. School food programs are a key part
of the vital safety net for a growing number of our school
children. For some students, school breakfast is the first meal
they have eaten since the day before. There are students who
come to school on Monday not having eaten since Friday.
As a country, we have gone from discussing millions to
billions to trillions of dollars, simply overwhelming for most
of us, yet at the same time, each of us in a Child Nutrition
Program sit at our desks and struggle to balance pennies. The
average cost of producing a school lunch is $2.92, based on our
internal study. Currently, local schools receive a Federal
reimbursement of $2.57 for every lunch provided to a child with
income below 130 percent of the poverty line. On average, our
reimbursement for a free meal is 35 cents less than it costs to
produce that meal. It is hard to believe, but many families
cannot afford the 40 cents for lunch or the 30 cents for
breakfast that is charged for a reduced-price meal. We see
checks for just a few dollars that are returned due to
insufficient funds.
While we have dramatically improved the appeal and
nutritional quality of school meals, there are no Federal
guidelines for foods and beverages sold by schools outside the
cafeteria. This can take the emphasis off nutrition. We are
adding more fruits, vegetables, and whole grains to both
reimbursable and competitive food offerings, but this further
increases the cost of preparing those meals. We need the money
to offset these costs.
School administrators are also short of funds and are
therefore charging School Nutrition Programs more and more of
the overhead costs of running the entire school. This is called
an indirect cost of the program. In short, money that you
appropriate for school meals may be used for energy,
telephones, or even personal costs in a principal's office.
Neither the statute nor the regulations put any cap on indirect
costs, and some districts pay as much as 15 to 18 percent of
their budget.
Free and reduced-price meal certification is used for many
services provided in the school, including Title I funding, yet
the school food service account pays the full cost of
collecting and keeping that information.
Mr. Chairman, as you approach reauthorization, we ask the
Congress to take a comprehensive look at the Federal Child
Nutrition Programs and realize that we are struggling with
competing needs and policy goals.
We support a consistent national interpretation of the
dietary guidelines for two reasons: Science and cost
considerations. All children need the same nutrients to grow no
matter where they live in this country--Iowa, Georgia, or
California. Why would we allow 50 or more different
interpretations of the dietary guidelines when it comes to the
National School Lunch and Breakfast Programs? When USDA changes
the meal guidelines, all vendors change their specifications to
accommodate the latest science. If, however, there are 50
different markets and not just one, it greatly increases the
cost of doing business. This increased cost is passed on to my
program. We also would like to see, first and foremost, the
increased reimbursement for all lunches served by 35 cents and
20 cents for breakfasts. We need the Federal reimbursement rate
to be updated twice a year to keep pace with inflation, as
opposed to the current annual adjustment. Many vendors escalate
their prices monthly.
The free meal program should be expanded to include all
children who fall below the WIC income guidelines, or 185
percent of the poverty level. If the family qualifies for WIC,
they should qualify for free meals.
Lastly, ten cents in USDA commodities for each Breakfast
Program is needed. We receive about 20 cents in commodities for
each school lunch, but there is no commodity support for
breakfast.
Considering nutrition standards, whatever that standard is,
it must be applied consistently throughout the school
environment. Students must not be allowed to be able to buy
something in the gym that we cannot sell in the cafeteria. This
is a conflicting message about what is healthy.
In addition, we ask that you require USDA to implement the
Dietary Guidelines for Americans in a practical and consistent
manner all over the country. We know we are asking for a lot,
and we realize that it makes your life more complicated, but
our children need this in order to be well nourished and
prepared to learn.
In closing, we would like to thank the Senate for its
leadership in providing recent equipment assistance funding.
While school nutrition personnel are great innovators in
serving wholesome foods, they cannot efficiently serve meals if
our equipment is obsolete or in need of repair.
Mr. Chairman, we have attempted to outline a few funding
issues and other priorities today. We will provide staff with a
list of administrative changes that could make the programs
more effective and easier to administer. We greatly appreciate
this hearing and your commitment to our children and child
nutrition. The time to act is now and the funding is
imperative. Thank you.
[The prepared statement of Ms. Wilson can be found on page
98 in the appendix.]
Chairman Harkin. Thank you very much, Dr. Wilson.
Now we will turn to Dr. Bartlett. Dr. Bartlett, welcome.
Please proceed.
STATEMENT OF SUSAN BARTLETT, SENIOR ASSOCIATE, ABT ASSOCIATES,
CAMBRIDGE, MASSACHUSETTS
Ms. Bartlett. Thank you, Mr. Chairman, for the opportunity
to address this committee. My name is Susan Bartlett and I am a
Senior Associate at Abt Associates, headquarters in Cambridge,
Massachusetts. Abt Associates is a public policy research and
consulting firm that applies scientific research, consulting,
and technical expertise to a wide range of issues in social,
economic, and health policy.
Under contract to the Food and Nutrition Service in the
Department of Agriculture, Abt carried out the School Lunch and
Breakfast Cost Study II, which was designed to estimate the
national average cost of producing reimbursable meals in the
National School Lunch Program and the School Breakfast Program.
The study, which was carried out during the school year 2005 to
2006, provides a detailed examination of the cost of producing
reimbursable meals in the school meals program and was designed
to allow FNS to assess the adequacy of reimbursement rates.
Today, I would like to present key findings from this study.
The study was carried out in a nationally representative
sample of 120 school food authorities across the United States.
Within these districts, we selected a representative sample of
approximately 350 schools and collected extensive data on the
costs and revenues associated with producing school meals
through reviews of financial statements, meal production
records, recipes, invoices, observations of meals taken by
students, and interviews with SFA and school district
officials.
The study examined the costs of meals charged to the SFA's
accounts, or the reported cost. It also examined the unreported
costs, which are the costs incurred by the school district in
support of SFA operations but not charged to the SFA account.
Together, the reported costs plus the unreported costs
represent the full costs of meal production.
I think one point about the methodology that should be
noted here, because I think we may discuss it more later, is
that the methodology allocates the SFA administrative costs and
overhead to all production, so including lunches, breakfasts,
and non-reimbursable meals, which includes competitive foods.
So key findings from the study. No. 1, in most SFAs, the
reported costs of producing lunches were less than the Federal
subsidy for free lunches. The national mean cost of producing a
reimbursable lunch in the 2005 to 2006 school year was $2.36
and the subsidy for free lunches at the time, which includes
the cash as well as commodity assistance, was $2.51. As a
result, in almost 80 percent of SFAs, the reported cost was
less than the Federal subsidy.
However, in contrast, in most SFAs, the reported costs of
producing reimbursable breakfasts were greater than the Federal
subsidy. The national mean cost of a reimbursable breakfast was
$1.92, again in 2005 to 2006, compared to the severe need
reimbursement rate of $1.51. As a result of this, in almost
two-thirds of the SFAs, the cost of producing breakfast
exceeded the reimbursement. In only a third of the SFAs the
costs were less than the subsidy.
For the average SFA, revenues from reimbursable meals
exceeded the reported costs of producing those meals. On
average, revenues exceeded costs by about 15 percent. In
contrast, revenues from non-reimbursable meals fell short of
the cost of producing those meals by approximately 30 percent.
While reimbursable lunches and breakfasts taken together
generated a surplus, this is due entirely to the surplus
generated by reimbursable lunches.
Consistent with the relationship between the subsidy rate
and the reported meal costs, revenues from reimbursable lunches
exceeded costs of producing them by an average of 16 percent.
Revenues from breakfasts fell short of the cost of producing
those meals by an average of 4 percent.
If we look at the full cost of producing school lunches, we
come to somewhat different findings. Nearly all school
districts provide in-kind goods and services to SFAs that are
not charged to school food service accounts and therefore go
unreported. In most SFAs, the full cost of producing
reimbursable lunches, including these unreported costs,
exceeded the costs. In 68 percent of the SFAs, the full cost of
a reimbursable lunch was more than the subsidy.
Looking across all school meals programs, the SFA revenues
fell considerably short of covering these full costs. On
average, revenues covered just over 80 percent of full costs.
Costs exceeded revenues for reimbursable lunches, breakfasts,
as well as competitive meals programs.
Those are the key findings on our cost findings. Thank you
very much, and I would be happy to answer any questions on
methodology or results.
[The prepared statement of Ms. Bartlett can be found on
page 54 in the appendix.]
Chairman Harkin. Thank you very much, Dr. Bartlett.
Now we will turn to Ms. Boldt.
STATEMENT OF CONNIE BOLDT, SCHOOL FOOD DIRECTOR, KNOXVILLE
COMMUNITY SCHOOL DISTRICT, KNOXVILLE, IOWA
Ms. Boldt. Good morning, Chairman Harkin, Senator
Chambliss, and members of the committee and other guests. Thank
you for giving me the opportunity to tell you about the
Knoxville Community School District's experience with the
HealthierUS School Challenge.
I am Connie Boldt, the Food Service Director for the
district, located in Knoxville, Iowa. Knoxville is located in
south-central Iowa with a population of approximately 10,000.
The school district has five buildings and serves about 1,600
lunches daily.
Knoxville's elementary schools, East, West, and North Star,
each receive the HealthierUs School Gold Award. The Knoxville
School District, supported by the Board of Education and the
administration, promotes healthy lifestyles for students,
staff, and families. The district feels this is a part of the
total learning environment and will contribute to academic
achievement as well as positive lifestyles.
Serving healthy meals that students will eat isn't the
easiest thing to do. It requires money and time. But the
benefits for classroom achievement and healthy lifestyles are
more than enough to make the effort.
When mandated, the district developed a wellness policy by
convening a committee with strong convictions to improve
students' lifestyles. It addressed many areas, including
physical and nutrition education, support for parents' efforts
toward healthy lifestyles, staff health and wellness, National
School Lunch and Breakfast Programs, and competitive foods.
Written into our wellness policy were specific requirements for
all food in all grades, K through 12, including a la carte,
breakfast, and lunch.
The Wellness Committee's requirements for school meals
included, but were not limited to, offer a variety of fruits
and vegetables, with an emphasis on fresh, and serve whole
grains whenever possible, with a goal of at least half by 2008-
2009. Even though I was a member of the committee, as a Food
Service Director, I was concerned that these requirements were
challenging and too vague. I was also concerned about the
overall cost to the program and how I was going to do this.
The wellness policy went into effect for the 2006-2007
school year. Implementation of the wellness requirements was
phased in. We started by adding one fresh fruit or vegetable to
every lunch menu. We used common fruits and vegetables, like
apples, oranges, and carrots. Popularity of the fresh foods
increased over time and we now include more seasonal produce,
such as melons, kiwis, green peppers, and cucumbers. These
additions were welcomed by our kids and staff.
Then came our School Meals Initiative Review in December of
2006. Our Department of Education consultant, Jane Heikenen,
introduced me to the HealthierUS School Challenge. This
certification program recognizes elementary schools that take a
leadership role in helping students learn to make healthy
eating and active lifestyle choices. Given our district's
commitment, these guidelines appeared to be the missing link to
our wellness policy.
To achieve the Gold Award, a number of criteria had to be
met, including school lunches that demonstrate healthy menu
planning practices and principles of the Dietary Guidelines for
Americans; nutrition education activities in at least two
grades; physical activity opportunities at every grade level;
student average daily participation of 70 percent or greater;
and competitive foods could not be sold on the elementary
campus during the school day.
So in early 2007, we started working toward the guidelines
by testing whole grain recipes that we could produce. Second,
we modified our current school recipes to include more grains.
These changes were well accepted and possibly some not even
noticed. During the past 2 years, we also found that we must
handle these products differently. The whole grain does not
seem to have a long shelf life and quickly becomes stale, thus
encountering more waste and increased costs.
Also in the fall of 2000, we increased legume menu items.
In other words, this meant more beans. We now offer baked
beans, refried beans, kidney beans in chili, and commodity
pinto beans in taco meat at least once a week. We started with
about 5 percent choosing more legumes and now have increased to
about 15 or 20 percent of our students making that choice.
While food service was working on food served, the
principals and elementary teachers worked on the physical and
nutrition education requirements. I was pleased to learn that
our district had met these requirements without modification.
The final criterion to be met was 70 percent average daily
participation, and in October of 2007, the elementary schools
averaged 81 percent.
We did it. In July of 2008, we learned we had achieved the
Gold Award. Even though we have a Gold Award, we continually
look for new ways to incorporate the foods that support the
HealthierUS School Challenge into our menus, curriculum, and
daily lives of our students.
However, increased food costs will make reapplying for the
HealthierUS School Challenge more difficult in the future. In
fact, the implementation of the HealthierUS School Challenge
criteria came with an increased cost. Some items were as high
as 76 percent more than the traditional item we were
purchasing. In addition, not only has the cost of fresh fruits
and vegetables increased, the labor to prepare them has also
increased. I now figure about ten to 20 cents more per serving.
Finally, the banner in the hall we received is really
awesome and the plaque in the school is quite impressive, but
we didn't do it for the plaque or the banner. We did it for the
sake of the kids, and I am proud of the Knoxville Elementary
Schools for having achieved this. But as I said before, serving
healthy foods is not without a cost and my budget is suffering.
Please help us implement this great opportunity to serve
children nutritious foods in more schools throughout the Nation
by supplementing reimbursement. It costs more money to prepare
and serve the meals at Knoxville Schools than what we receive
in reimbursement. I support the SNA's request for an additional
35 cents for all lunches and 20 cents for all breakfasts
served. In addition, I think the HealthierUS School Challenge
should receive money to support their commitment to fresh
fruits and vegetables and whole grains.
Thank you for giving me this opportunity to share our
experience with the HealthierUS School Challenge. It has made a
difference.
[The prepared statement of Ms. Boldt can be found on page
72 in the appendix.]
Chairman Harkin. Ms. Boldt, thank you very much for the
testimony and for great leadership. I am sure we will have some
questions for you.
I would like to start this round of questioning by looking
at the cost and reimbursement. This is something we grapple
with a lot here, too, and I think all of us here are interested
in making sure that we adequately reimburse schools, but we
have to have a better handle on what that means. So I am struck
by the very different testimony here between you, Dr. Wilson,
and Dr. Bartlett, with respect to the costs of producing a
reimbursable meal.
Dr. Bartlett suggests that, by and large, the Federal
reimbursement for a free meal is sufficient to cover its cost--
correct me if I am wrong on that. Dr. Wilson concludes the
opposite finding, a 35-cent gap between reimbursement and
production costs. So I would like to try to see if we can
figure out why we have such a significantly different
conclusion from two very qualified individuals. That is one
thing.
And then on competitive foods, with respect to non-
reimbursable meals, such as a la carte lines, again, the
testimony concludes very different things. Dr. Wilson, you say
that you need the money from competitive foods to cover gaps in
the school food service budget. Dr. Bartlett, your study found
that such foods such as a la cartes are actually the reason for
those budget gaps and that Federal reimbursement for free
lunches are subsidizing food provided through a la carte lines.
I would like to try to examine this and see if we can get
to the bottom of this because it has very significant policy
ramifications here for us. So, again, without trying to pick
one or the other, I don't know, I am just trying to figure out
why we have such different conclusions here.
Dr. Wilson, how do you square your testimony on the costs
of competitive and a la carte foods in light of the fact that
the testimony from Dr. Bartlett arrives at conclusions that are
almost totally different from your own? And I am going to ask
Dr. Bartlett the same question, too.
Ms. Wilson. OK. Well, thank you for the chance to answer
that question. First of all, I think that in the reimbursement
rate for the reimbursable meal and the 35 cents that we are
talking about, I do have some State statistics, one from
Minnesota in itself that shows overall in the State of
Minnesota, it is $2.99 average to prepare and serve that meal.
I think sometimes what happens is the data--for instance,
from 2005-2006 is when the study was done and the data may have
been from that year or even a year later, I will cede to Dr.
Bartlett to let us know that, but just from the year 2005-2006
to today's environment, I see a drastic increase in costs in my
program, the whole grains, the fruits and vegetables, my labor
costs, which Ms. Boldt referred to. Labor costs have gone up
also considerably in our programs, and so the gap continues to
rise. Even from 2005-2006 to the 2008-2009 school year, the gap
is getting bigger and bigger and bigger.
This year is the very first year many of us saw fuel costs
on our invoices, saw bread and milk bids that said, you know
what? We can raise your prices within a 30-day notice, and that
is a bid, so based on the price of commodities the bid price
can go up. I have been in the business 21 years and have never
seen those things on bids before or on invoices.
Chairman Harkin. Tell me, what was the reimbursement rate
in 2006 and 2007 when this study was done and what is the
reimbursement rate today.
Ms. Wilson. In 2005-2006?
Chairman Harkin. Yes.
Ms. Wilson. Do you have the numbers or rate?
Chairman Harkin. What was the reimbursement rate?
Ms. Wilson. The reimbursement rate was $2.51, which was
cash of about $2.37 and commodities of, like, 17 or 18 cents.
Chairman Harkin. So two-fifty----
Ms. Wilson. One, including cash and commodities, yes.
Chairman Harkin. Two-fifty-one. And today it is what? What
is the reimbursement rate?
Ms. Wilson. Well, we have $2.57 plus about 20 cents, 21
cents in commodities.
Chairman Harkin. So it is $2.77----
Ms. Wilson. Mm-hmm.
Chairman Harkin [continuing]. Is the reimbursement rate. So
the reimbursement rate has gone up, so even though your costs
have gone up, the reimbursement rates have gone up, too.
Ms. Wilson. But I don't think they have kept pace with
labor, particularly labor and food costs.
Chairman Harkin. What you are saying is that this snapshot,
this study that was done in 2006-2007, is that when it is? Is
that the basis?
Ms. Bartlett. Five-six.
Chairman Harkin. Two-thousand-five and 2006. What your
point is is that since that time--we are talking about 2 years,
three maybe, 3 years--that the increase in the costs have far
exceeded the increase in the reimbursement rate?
Ms. Wilson. Yes, sir, that is----
Chairman Harkin. So the reimbursement rate went up about 10
percent, just my back-of-the-envelope figuring, 10 percent. Do
you have any data on how much the other associated costs have
gone up in those 3 years, that period of time?
Ms. Wilson. Well, I know some of the studies--we studied
the top 100 districts in the country and some of those costs--
and we can get you exact data, but I know even from my own
personal experience, it is anywhere from 11 to 14 percent in
costs that I have experienced in the 2008-2009 school year, and
that includes labor and food costs.
And then the indirect costs, also, as schools have begun
to--I know we talked about in-kind costs that school districts
provide for the Food Service Program. In 2005- 2006, schools
weren't as pinched as they are now overall, and so as school
districts themselves see their budgets shrinking and needing to
do more and more with less, they are looking to the Food
Service Program to provide more and more indirect costs to help
them run the entire school program rather than just food
service. So there are not so many of those in-kind gifts
anymore as we see in our programs.
Chairman Harkin. Dr. Bartlett, I will ask you the same
question. How does your data that you have are really different
than what the data I have heard from Dr. Wilson?
Ms. Bartlett. Sure. Indeed, the study was based on 2005 to
2006 data, so things could have changed over time, all the
things that we have talked about.
A couple of points. One, the study that we did was a
nationally representative sample, so we sampled districts
across the country and when things are weighted up, it looks
like the entire country, not just restricted to, say, the
largest districts.
I think I can tell you what we did, and I think this,
though, is probably the main point of difference, is that--and
it has to do with allocating the administrative and overhead
costs of meal production. When we look at reported costs, we
look at all the expenses that are on an SFA's expense
statement. Some of those costs are directly related to food
production, the costs of the food, the costs of the cooks to
prepare the meals. So those get directly allocated to the meals
that they are attributable to.
But then there are costs like the SFA director, secretary,
things like that, warehousing of foods, those kinds of
administrative costs that are part of food service, or belong
to food service, but not directly attributable to any one given
meal. So the question is how to allocate those.
We followed what are considered generally accepted
accounting practices and we allocate those non-production costs
across lunches, breakfasts, and non-reimbursable foods. So they
each pay a share based on the food and labor that--the direct
production labor. So I think that kind of loading of the
overhead costs across all meals may be one of the major
differences.
Chairman Harkin. So it seems to me that the real, I don't
want to say culprit here, but the real question we have to get
at is these indirect costs. Is that right or not? Is that the
main difference we are seeing here, is how you allocate those
indirect costs?
Ms. Wilson. Well, I think that, if I could answer that, the
thing is that when we set up our budget, and if we are
warehousing our food or if we are working my salary, for
instance, is also set up across--the budget is separate. The
competitive foods or a la carte, breakfast, and school lunch
all have separate line items in my budget, the costs and the
revenues, and so that is broad-based. My secretary is broad-
based over those.
And when we talk about some of the indirect costs, I am
talking about all of a sudden, because you store your food in
the warehouse and you have a quarter of that warehouse, the
district, because they are so pinched for finances, decides the
Food Service Program can just pay for the entire cost of the
warehouse and everybody who is running the warehouse, whether
it stores desks or paper or supplies for the school building,
and then a quarter of it might store some food over in the
corner.
We know people that pay for maintenance people that really
have nothing to do with food service. They might mop the
building that the kitchen is attached to. And so as these costs
are pinching districts, they are looking. Electricity, all
garbage pick-up--instead of charging the Food Service Program
just for what the food service does in garbage pick-up, you
might be charged for all the garbage pick-up in the district.
And so those are some of the indirect costs that we are seeing,
and there is no cap in the statute to prevent some of that from
happening.
Chairman Harkin. Have you seen over your experience that
schools are shifting more and more of these indirect costs to
the School Lunch Program?
Ms. Wilson. Yes, sir, they definitely are.
Chairman Harkin. Did you pick any of that up in your
studies at all, Dr. Bartlett?
Ms. Bartlett. We did look at indirect costs, which we--most
districts have indirect cost rates that they apply to school
food service as well as other Federal grant programs, and
indeed to pick up costs of--I mean, different districts
obviously have different rates that include different things.
We did not find--we found that while most districts had
indirect cost rates, that only about 16 percent of the
districts actually charged the school----
Chairman Harkin. About 16 percent?
Ms. Bartlett. Sixteen percent charged indirect costs as a
line in their expense statement. So while that gets applied to
some, it did not get applied to most. So in terms of those
kinds of costs.
Chairman Harkin. Well, I just raise the question, if 16
percent is the mean on this, then I raise the question of why
other school districts can't meet the mean if they are higher
than that.
Ms. Bartlett. In terms of--no, this is just what percent of
districts are charged at all for the indirect costs. When you
look----
Chairman Harkin. When you are saying 16--tell me what the
16 percent is now. I thought that was the----
Ms. Bartlett. No. Sorry.
Chairman Harkin [continuing]. Of the total that was----
Ms. Bartlett. If you looked at school districts, what
percent of the districts themselves get charged these kind of
indirect costs on their expense statement.
Chairman Harkin. Oh, I see. I see.
Ms. Bartlett. We only found that those kinds of indirect
costs showed up on 16 percent of the budgets. The rest of them
were not charged for those. Again, we also have to make sure--
partly when we talk--be clear about talking about what we mean
by indirect costs, because we also talk about the overhead
costs of the school food, the manager, the SFA director, and
those. Those are kind of costs that are on the expense
statement of the SFA.
Chairman Harkin. I have taken more than enough time.
Senator Chambliss?
Senator Chambliss. That actually is an area that I wanted
to address, too. I think Senator Harkin has pretty well covered
it, but it looks like, Dr. Wilson, that in your particular
case, there are some charges being assessed against the program
that ought not to be assessed. We don't need to put you at odds
with your school board and the other folks who are assessing
these costs, so I think this is an area that we need to address
in this legislation and your testimony this morning on that has
been very valuable.
Ms. Boldt, I am just curious, do you know what happens in
your system? Do you know whether these indirect costs are
charged to your program?
Ms. Boldt. No, I really can't answer that.
Senator Chambliss. I think that is something that all
members of the committee are going to need to look very closely
at from a State-by-State standpoint, but certainly, Mr.
Chairman, it is something that we need to address in the
reauthorization.
Ms. Wilson. We have one example from Georgia, if you would
like to just hear some numbers.
Senator Chambliss. Yes.
Ms. Wilson. This is from, in Georgia, quite a large
district said to me they pay $1,140,000 in indirect costs,
$395,000 for six maintenance people that work throughout the
entire district, $220,000 for utilities that are used in the
buildings that they are housing kitchens in, and $84,000 are
from uncollected meal costs. So that just gives you some
numbers of a district in Georgia.
This has truly been--the difference is that it has exploded
since 2005-2006, these kinds of costs, because school districts
are also really in trouble as far as finances are concerned.
Thank you.
Senator Chambliss. These are obviously very difficult
economic times and every area of our economy, and I know school
districts are looking for every way they can to try to recoup
the tremendous overhead that they are seeing because they have
got the same fuel cost and labor cost increases that you
alluded to that you are being charged with. But that is not
right. I expect I will get a call from that nutritionist,
probably the chairman of that school board.
[Laughter.]
Senator Chambliss. But it is something we need to look at.
Dr. Wilson, if USDA were given the authority to regulate
food sold in competition to the National School Lunch Program,
do you see a need to continue the requirement for all school
districts to have local wellness policies?
Ms. Wilson. That is a very interesting question. We really
truly believe that USDA needs the authority to regulate
everything in the district, because then we can all conform to
dietary guidelines. While wellness policies were really a good
idea and everybody meant well, we have some very excellent
policies in this district that were done well with good
committees, and then we have some policies where it was
somebody who was pestering the superintendent and they needed
something to do, and so they are now--we just heard a speaker
yesterday, that he talked about the philosophy of nutrition
rather than the science of nutrition, and many of these local
wellness policies are not dealing with the science of
nutrition. They are dealing with the philosophy of food or
eating or a personal philosophy and how someone eats because
they became the chair of that wellness policy.
So even though they were intended to do good, they didn't
always do what they were intended to do across this country,
and so, yes, we truly believe that with USDA, just like the
National School Lunch Program and Breakfast Program, we have
national standards, a meal pattern that we all need to follow.
And so if USDA had the jurisdiction over everything, from bell
to bell during that school day, that then we would all follow
dietary guidelines irregardless of what our philosophy of what
nutrition might be.
Senator Chambliss. Ms. Boldt, I first of all applaud your
accomplishment of receiving that Gold Award for HealthierUS
School Challenge, especially since you incurred additional cost
for some of the products that you provided. We oftentimes talk,
when we talk about education in general, about the fact that,
really, good education starts at home. If you don't have strong
support from parents, then it makes it much more difficult to
educate a child. Did you find that same experience with trying
to achieve this goal that you were successful in achieving,
that you had great support both from your PTA or other parental
organizations as well as your school board, and how big a
factor was that in achieving this award?
Ms. Boldt. We did have pretty good support across the
board. We also had in our wellness policy that we make efforts
to encourage the parents and support for them, like with
information, different kinds of things that we can do to help
them at home, also. So we have included that in our wellness
policy.
Senator Chambliss. Dr. Bartlett, did your study look at the
impact of school policies regarding a la carte or vending sales
and how the volume of such sales may influence the resources
available to school food service personnel?
Ms. Bartlett. We really just focused on looking at the
costs of those different components of the program and
collected data on that at the point in time, 2005 to 2006.
Senator Chambliss. OK. Thank you, Mr. Chairman.
Chairman Harkin. Thank you, Senator Chambliss.
We welcome Senator Klobuchar, both for questions and if you
have an opening statement you want to give.
STATEMENT OF HON. AMY KLOBUCHAR, U.S. SENATOR FROM THE STATE OF
MINNESOTA
Senator Klobuchar. Well, thank you very much, Senator
Harkin. Thank you to the witnesses.
I have spoken on this issue a bit before from my
perspective, being a mother with a 13-year-old and really
seeing a tale of two schools, one, the school she attended in
Minneapolis that was 90 percent free and reduced lunch for a
number of years, and now in Arlington, Virginia, two public
schools, which is a little different demographic make-up, and
just seeing the differences in the school with less free and
reduced lunch kids in terms of their fitness and their moms
packing them carrots and things like that, and then seeing in
the inner-city school just the vending machines being used a
lot, I think a lot of kids going for maybe the less healthy
alternative when there were choices and then some healthy food
given out, as well.
Minnesota, as you have noted, has put a lot of emphasis on
this. But even despite our State's emphasis to see the
difference between the schools and the nutrition these kids are
getting is very stark, and also see the huge obesity problem
with some of these kids. I am worried it is going to get worse
as our economy gets worse because oftentimes it is cheaper to
go out, as we all know, and buy less nutritional food. And so I
am very concerned about this obesity issue.
The other reason I am interested in this is we have a lot
of food that is produced in Minnesota. We have a lot of food
that is processed in Minnesota. I have gotten some information
about the need, as you have talked about, Dr. Wilson, for some
national standards and how this is contributing to cost, the
fact that we don't have these national standards, and I wanted
to lead with that and I know you were referencing it in your
questions with Senator Chambliss, but how you think this could
work to give the Secretary of Agriculture this discretion.
I personally think it sounds like a good idea to me, sort
of seeing this patchwork of things going on, and as we look at
how to reduce costs. But at the same time, my whole focus is to
make these meals as healthy as possible and to limit some of
the--and I don't know what you are calling them here--bad
competitive choices, and then also how we work that with the
States, because I could see some of them would want to be
doing--they might have different kinds of food that they have
available in their States that are healthy. So a long question.
Ms. Wilson. OK. Well, thank you. I think, first of all, the
whole idea of standards is that--and let me, if I could, just
give you an example. If you are a manufacturer in the school
market and you make a small bag of graham crackers and you make
it for 1.5 ounces, but five miles down the road, their
standard, their wellness policy says, no, you can have up to
two ounces. And then the next one says, well, we are going o do
2.5 ounces. Well, now I go back to that manufacturer and I say,
well, my district just said one ounce. So now there are four
different bags of the exact same graham crackers, and to me,
that is very costly.
Most of our school districts are smaller. We aren't all
metropolitan districts. So when you can't buy hundreds of
thousands of them at the same time, the manufacturer is not
going to make them just for you. So, first of all, without
standards, we are eliminating a number of products that all of
us could potentially use, because the manufacturer will make
the product if we have a standard that a snack has to be two
ounces or whatever we come up with as standard. That product
will be made for all of us and we will all buy it at a much
lesser cost than if we first--it would eliminate some things
for smaller districts, and I am talking about the majority of
districts in this country, but it would also cost most of us
more if we are asking a manufacturer to make three and four and
five different sizes of the same product.
As far as nutrition is concerned and doing local kinds of
things, I truly encourage local produce, local kinds of things
that maybe are made in your community. But there, too, when we
looked at our standards, we are looking for a range of things.
It is very difficult to hit a sugar number, for instance, in
milk and say, this is the number. We are not going anywhere
else. This is the number. It is much better to do things in
ranges because you and I both know that 1 day we do really
well, and last night I was at a gala that had a fabulous
dessert and I enjoyed every minute of it. So, you know, we
can't do that every single time----
Senator Klobuchar. We have a lot of those problems in our
occupation.
[Laughter.]
Ms. Wilson. Absolutely.
Senator Klobuchar. There is a lot of too many choices.
Ms. Wilson. So we look at choices. We have a range for
fiber in our standards. We have a range for sodium, so that we
can, over the period of a week, look at things. And if I have
something that is local in my district or made in my State that
I want to use, it will fit within a range because I will
balance that throughout the rest of the week. So I think it
very nicely fits into standards if you have some ranges and
some standards, though, that we all need to meet. And again, it
is not based on somebody's philosophy. It is based on the
science of nutrition.
Senator Klobuchar. And how would it work with these a la
carte choices, because I have seen myself they go for the
fries----
Ms. Wilson. And the standards do work. The standards are--
if the USDA Secretary has the opportunity to eliminate the time
and place rule and they have the authority to say that here are
the standards for the entire school during the school day----
Senator Klobuchar. Right.
Ms. Wilson [continuing]. You all need to meet them, whether
it is in my a la carte line or in the school store or the young
person that is selling to keep their club afloat and they have
a little table outside the cafeteria----
Senator Klobuchar. You might have limited my ability to
sell Life Saver lollipops for the high school prom?
Ms. Wilson. Perhaps, because----
Senator Klobuchar. OK. That is what I did.
[Laughter.]
Senator Klobuchar. I mean, on the student council.
Ms. Wilson. Sell recycled wrapping paper. It is much
better.
Senator Klobuchar. All right. So what about the vending
machines and how would they fit into this----
Ms. Wilson. They all fit within. Within the school
building, under the authority of the USDA Secretary, everything
within that building for the school day would have to meet the
standard. And now there, too, I am not competing against the
football coach, because if I have the most wonderful program,
even my a la carte meets the standard, and a football coach,
they are going to go to State, so they need to raise money to
get on that nice bus and get down to State, we all support
that. And if the football coach is going to sell something out
there in the hallway, I guarantee you students will come and
purchase it. They want to support their team. That is part of
being in school. We don't want to be the adversary to that and
that is what becomes--that is where the problem becomes a
problem, because they take their $1.50 or their $2.50 and they
are going to support that football coach, and they all mean
well. They all have good meaning, but it is not always in the
best interest of the science of nutrition. So the standard
needs to be bell to bell in every area of that building for us
all to be in the same thing for kids.
Senator Klobuchar. Ms. Boldt, what do you think of that?
Ms. Boldt. I agree 100 percent. That is exactly what
happens in school districts.
Senator Klobuchar. Dr. Bartlett, any thoughts on how we can
do this? I just want to fix this, because I think people are so
well intentioned here and they want to have healthier kids, but
somehow these things keep falling through, and these kids are
smart and they find ways to find this food. That is what I have
seen.
Chairman Harkin. They find what?
Senator Klobuchar. They find unhealthy food wherever they
can find it. It is a true fact. Also, sometimes their parents
don't have the money to give them, or they are not at home
learning some of this nutrition, so when they get to school,
they are looking for the vending machine that has the--I am not
going to say a brand name, just like when I brought up American
Girl at the Commerce Committee, I got letters. But they find
something that is very non-nutritional and that is what they
eat for lunch, so----
Ms. Bartlett. I have to say it certainly seems right. Our
study didn't particularly focus on--we did not look at the
nutritional quality of the different foods, but certainly my
experience as a parent shows that there is a lot of unhealthy
stuff going on.
Senator Klobuchar. OK. Well, thank you very much and we
look forward to working with you.
Chairman Harkin. Dr. Wilson, you talked about the plethora
of different wellness policies all over this country. In the
last reauthorization of the child nutrition bill, I had offered
an amendment that would have had a wellness policy developed by
the Institute on Medicine that would have applied to all
schools all over America. I lost that amendment.
Then we decided, well, we will just have a wellness policy
that each school would develop. I think we thought that at
least, that way, at least schools would have to start thinking
about what is a wellness policy. But you are right. They
differ, as school districts differ all over the country. So I
am glad to hear you say that not based on science. Of course,
it is not based on Institute of Medicine guidelines.
And then now, I am just delighted to hear you now
advocating for the Secretary to have the authority for all
schools. I have often said, what sense does it make if you have
the authority for school lunches in the lunchroom or in the
cafeteria, but you can go right outside the door and there are
all the vending machines. I also like your testimony when you
said that the signal, the message we send to kids if you have
all these sugary drinks and candies and stuff in the gym but
not in the rest of the school, are we saying to kids that is
the healthy thing to eat in the gym? So I really appreciate
your testimony on that.
I think we have to come to grips with this in terms of
having the dietary guidelines be standardized for the whole
country and for every school. The only thing that I would think
about in terms of a wellness policy beyond that is for the
physical activity of kids and making sure that we have some
wellness policies that develop in accordance with that so that
kids get adequate exercise and that type of thing in a school
setting. That is a little bit outside of your purview, but I am
just saying that that should be also a part of the wellness
policy.
But I want to delve into one other thing and that is the
idea that on this increasing the reimbursement, we have the
inflation thing standard in there now that goes up with
inflation. But I think what I am beginning to see is that we
don't have a real good grip on these indirect costs, and there
is no cap on them. There is no inflationary guideline on them
whatsoever. And I think it would probably be fairly easy for a
school district to think, well, if I have got to cut corners, I
will just shift it over to that School Lunch Program. After
all, they are going to get more money because they have got an
inflationary increase. I think somehow we are going to have to
take a look at that and how we might want to address it. I
don't have a formula or anything in my head, but somehow, we
have got to address how much of that shifting can go on from
the indirect costs.
But I also want to address a question to you, Ms. Boldt,
about what you have done in your school. I read your testimony
and in listening to you and what you have done, you were able
to do it within these guidelines, right, and within the
reimbursement that you have, you were able to do all of this.
Ms. Boldt. I truly don't have the bottom line yet. I do
suspect that our costs were higher, but I am not quite sure yet
where the bottom line is.
Chairman Harkin. Well, you have been doing this for 2
years?
Ms. Boldt. We are in our second year.
Chairman Harkin. Two years now, and you have gotten all the
healthier foods. But somehow, you have been able to do that
within the reimbursement that you have been getting.
Ms. Boldt. I am not quite sure if we are within
reimbursement or if we have tapped into some, you know,
savings, so to speak. We also have an a la carte competitive
foods that fit our wellness policy that also supplement total
program costs.
Chairman Harkin. But you have control over that, too,
right?
Ms. Boldt. Yes.
Chairman Harkin. Yes. You have control over that a la carte
line, so----
Ms. Boldt. Yes.
Chairman Harkin [continuing]. You are also putting good
foods and fresh vegetables and things like that in the a la
carte line.
Ms. Boldt. Yes. It is also regulated, the 35 percent fat
and saturated fats and----
Chairman Harkin. I just wonder if--I am proud of what you
have done. You have got the certificate. You have got the
banner hanging in the hallway. But if we want to replicate what
you are doing around the country, I wonder if we need to have
some more financial incentives or bonuses. For example, do you
think that more schools would become HealthierUS Gold Schools
if they received not only a plaque and a commendation, but a
significant financial bonus at the end of the year for
maintaining those strong standards?
Ms. Boldt. It would definitely be of assistance for the
budget.
Chairman Harkin. Well, I think that is something that we
ought to----
Ms. Boldt. Because I did do----
Chairman Harkin [continuing]. We ought to think about. If
they meet these, they get some kind of a bonus or some kind of
an incentive, to give some kind of a financial incentive for
this at the end of the year. And I think maybe that is
something that we could look at. I don't know, Dr. Wilson, if
you have thoughts on that.
Ms. Wilson. Well, I think there are a lot of possibilities
and it certainly is worth exploring, Senator Harkin. I do--
again, will go back to the indirect costs, and if that would be
something that would be decided upon, then we have to have the
other piece that says that that stays within the Food Service
Program to continue to do those activities and increase the
healthy environment in that program. As long as that money
isn't looked upon from the school district as a school district
bonus but maybe it is used to do healthy things in the
cafeteria and increase physical education, it has to be tied to
that award, then, so they can't--but it is certainly something
to explore, yes.
Chairman Harkin. All right. Well, Ms. Boldt, I think you
point out that it is very difficult to do what you have done in
figuring out this 51 percent of whole grain items, bringing in
more fresh fruits and vegetables. I think the important part of
your story is that you did it and you didn't give up and you
kept at it and you made it work without any extra money, at
least as I understand it, for the meals. So I think that is a
tremendous achievement and you ought to be very proud of it. I
just again am thinking about how we replicate what you have
done around the country, and I think maybe some financial
incentives and bonuses might be a thing that we could do.
Now, I am told that there are, Dr. Bartlett, OMB guidances
on indirect costs. Do you know what those are? Can you address
that at all, that there is OMB guidance on indirect costs and
what can be assessed to the School Lunch Program.
Ms. Bartlett. Indeed, sort of their restricted rates and
unrestricted indirect cost rates that have to be approved, so--
--
Chairman Harkin. By whom?
Ms. Bartlett. I believe by the school district.
Chairman Harkin. By the----
Ms. Bartlett. Or the education--I am not 100 percent
certain who sort of finally approves them, but I do believe
that they do have to--I don't believe that a school district
can just say, we are going to charge X percent and put all
these things in it, but sort of exactly what goes in those
rates is----
Chairman Harkin. But Dr. Wilson just read what was going on
in Georgia----
Ms. Bartlett. Right.
Chairman Harkin [continuing]. And all that. I mean, I don't
know if that is within OMB guidelines or not.
Ms. Bartlett. It seems odd, doesn't it. I don't know the
answer to that question.
Chairman Harkin. Do you know that, Dr. Wilson?
Ms. Wilson. I don't believe there is any kind of--there is
some minor language, and I am not familiar exactly, but it
doesn't put any kind of a cap or what it can be or how often.
And I was just handed a note that a director here at this
conference told us, reported to us 2 days ago that they were
not assessed indirect costs for quite a--until this year, so
the district decided to go back 8 years to recap what they
considered indirect costs on the Food Service Program--
electricity, garbage----
Chairman Harkin. Is this the school you were talking about
earlier, or is that a different school?
Ms. Wilson. No. They said they don't remember what school
district it is, but the director reported out to us at the
conference that their district is going back 8 years to what
they have assessed as indirect costs that should have been
charged--garbage, electricity, and somebody mopping the floor
in the cafeteria, those kinds of things.
So there is no cap to it, as to what can be done or how
much or what it could, you know, what indirect costs are
allowable that have to do with food service, so----
Chairman Harkin. This is all very interesting. I mean, not
interesting, kind of alarming in a way. You said it is like 15
to 18 percent? I forget which one of you said that.
Ms. Wilson. That was in our testimony.
Chairman Harkin. Fifteen to 18 percent of the costs are
indirect costs.
Ms. Wilson. Of their budget.
Chairman Harkin. Of their budget.
Ms. Wilson. They are taking 15 to 18 percent----
Chairman Harkin. Did you have a figure on that, Dr.
Bartlett?
Ms. Bartlett. I don't have an exact figure on that. When we
look at reported costs, we see that about 45 is labor, 45 is
food, and there is 10 percent other, of which the indirect
costs would be included in that. So on average----
Chairman Harkin. In the ``other''?
Ms. Bartlett. Correct. So on average, it would be less than
10 percent.
Chairman Harkin. So they are saying 10 percent. You are
saying 15 to 18 percent.
Ms. Bartlett. Again, I----
Chairman Harkin. Do you have a methodology for how we could
look at that? I would like to get to kind of the bottom of
this, also.
Ms. Wilson. Well, we definitely can send you our statistics
in the study that we did to get to that number. But again, I
think not that the data is skewed in any way from either place,
it is just that the time has changed. And from 2005-2006 to
2007-2008 and 2008-2009, my costs have drastically--and I am
going to use the word ``drastically''.
Chairman Harkin. Well, that would be 50 percent. I mean, if
it went from 10 percent to 15, that is a 50 percent increase in
2 years.
Ms. Wilson. And many districts have just recently decided
to start charging these indirect costs. You know, also, we can
have 3 months of operating budget in a fund balance, and that
is to purchase equipment. I want to start cooking from scratch,
reopen my bakery, do fresh fruits and vegetables. I need
equipment to do that. And so we sometimes will build a month or
two of a fund balance so that when the dishwasher breaks down,
I can repair that or replace it. I have now replaced--you know,
in the State of Texas, they took out all their deep fryers, but
they had to use their fund balances, if they even had them, to
try to replace that equipment with cooking equipment. But a
district might look at that 2 months' worth of money and say
that that could be used for indirect costs.
Chairman Harkin. Well, I think we are going to have to look
at these OMB guidelines and take a look at them. The only
concern I have about putting a cap on something, that becomes a
ceiling, too. In other words, everybody goes to that----
Ms. Wilson. It has to go there, right.
Chairman Harkin. If the mean is ten or 12 or 14 percent,
whatever it is, there are some obviously way below that, and if
all of a sudden they can say, gee, now we can shift all these
costs over, then we will find that happening. That is the only
problem I have with putting a cap on it.
Senator Chambliss. I think the problem we have got, Mr.
Chairman, is that with the cost of fuel particularly
increasing, skyrocketing in such a fast manner, all school
boards had a significant issue all of a sudden that they didn't
anticipate at the beginning of the year and they were looking
for pots of money----
Chairman Harkin. Yes.
Senator Chambliss [continuing]. And for other folks to help
them defray expenses, and with the cyclical nature of fuel
costs, or my son-in-law is a produce farmer and cabbage can
cost anywhere from $3 to $12 a box, it makes it difficult from
a cookie cutter approach to try to figure out how we cap them,
or maybe we can figure out a way to look at the food consumed
away from home provision, which I understand is the index we
use, not the CPI, that maybe we can look at that and try to use
a factor in there that is maybe a little more reasonable and
will help both ends of this issue. But it is something we have
got to look at.
Chairman Harkin. Yes, we are going to have to look at it.
If you have the answer, let me know, will you? I don't know
that I have the answer.
[Laughter.]
Ms. Wilson. Could you let us all know?
Chairman Harkin. What is that?
Ms. Wilson. We would like all to know if you find the
answer.
Chairman Harkin. Yes, I don't know. This is something
definitely we are going to have to have our staffs work on and
stuff.
Senator Casey has joined us from Pennsylvania. Senator
Casey?
STATEMENT OF HON. ROBERT CASEY, JR., U.S. SENATOR FROM THE
STATE OF PENNSYLVANIA
Senator Casey. Mr. Chairman, thank you very much, and I
want to commend you on presiding over this hearing and
highlighting this important issue.
Very few issues we confront in Washington have as much
importance, I think, not only to the life of a child and his or
her family but to the family of America and for our long-term
economic security. We can't divorce or separate the issue of
child nutrition and what happens to children in our schools and
our communities, we can't separate that from job creation and
skill development and economic growth and all of those issues.
I do want to thank those in the audience and, of course,
our panel for the work you have done over many, many years,
laboring, literally laboring in this vineyard for so long and
so passionately. We are in a time period now where a lot of
these issues can be addressed, but we are in a time of tight
budgets and economic difficulty, so it is not going to be easy
to do what we hope to do.
But I do want to thank Dr. Wilson especially. We met the
other night, along with many of your colleagues. You all look
well rested, so apparently people didn't stay up too late. But
Dr. Bartlett and Ms. Boldt, we want to thank you, as well, for
your testimony.
I know that we are running late, we are on the second
round, and I apologize for being late. I just wanted to present
one question for the panel before we conclude, just to get your
sense of some of the practices that are working, some success
stories, so to speak.
We have heard from a number of experts in school nutrition
that one of the biggest problems with administering the various
meal programs is that you have different paperwork, you have
got different eligibility and oversight requirements. And I
just wanted to ask a broad question for each or all of you.
What would you recommend as to addressing this problem to make
the programs easier to administer? You may have covered this
already, but I just wanted to get a sense from the experience
we have had in Pennsylvania, and we have some Pennsylvanians in
the crowd. We won't ask you to stand up. But if there are best
practices that you have identified that would help on these
questions of administration.
Ms. Wilson. Well, thank you, and I think that we can get
some wonderful examples from districts across this country that
are doing really great things, that have become innovative, and
I know we have to be very creative. But if I could say one
thing administratively, and we haven't even talked about it
here, but it could be another way to really help our programs,
and it was in our testimony, and that is that we collect all
the income data in every individual school district and then
everybody in the district uses that income data for all
different Federal programs. But all of that cost is in our
program, in the School Nutrition Program, and that is a cost
when you are collecting all of this income data.
The other thing is that then we do verification, and we
have to go through that whole process. But everybody uses that
information. And so if we could look at another way somewhere
else to collect this income data to be accountable.
And then the other big piece is that the free category, if
we could eliminate free--I am sorry, eliminate reduced category
and make those children all free, because they qualify in WIC
and then they come to school in kindergarten and they don't
qualify for free meals at the same level. So to eliminate that
reduced-price category would really also help streamline our
programs. These are ways that we can streamline the spending
and the administrative burden that is on these programs that
are very well audited and very well accounted for. Thank you.
Senator Casey. Anyone else?
Ms. Bartlett. I have to say, I defer to my colleagues since
they have more direct experience. But just a couple of points.
Abt is doing another study that is trying to ease some of--
looking at how to ease some of the administrative burden in
terms of the verification that has to be done for school
lunches and working with States to help them use Medicaid data
to directly verify income. So certainly moving in that
direction is a way to streamline that would be useful. That is
one idea.
Senator Casey. Thank you very much.
Mr. Chairman, thank you. I know my time is up, but we are
critically concerned about this issue and I think these issues
that involve children, just like we made progress recently on
children's health insurance, this issue, as well, I think is a
matter of basic justice for children and for families. We have
got to do everything possible to get this right. Thank you very
much.
Chairman Harkin. Thank you.
I have just one last question I wanted to follow up with
Dr. Wilson, and that is this difference in the competitive
budget. Are reimbursements--for example, Dr. Bartlett said
their study found that a la carte lines are actually the reason
for the budget gaps, that Federal reimbursements for free
lunches are subsidizing food through a la carte lines. But you
say you need the money from competitive foods to cover gaps in
the school food service budget, and that is still something I
am trying to wrestle with and trying to figure out. Are
reimbursements subsidizing the competitive foods?
Ms. Wilson. Well, I really think that--I don't know a
district--I don't know a State department that would allow that
to occur, because we have to keep our a la carte budget
separate from our reimbursable budget. And so when we are
reviewed once every 5 years, that is one of the things they
check, and so some of those districts may not have been
reviewed correctly or something because we are not allowed to
use any money from the reimbursable program to subsidize a la
carte. If they see that there is a problem in budget there, if
you don't bring even your labor that is doing the a la carte
over to that side of the line item, our State department would
say to us, we need to see labor here, because it has to account
for the exact cost.
So I am not sure where they were at or what districts they
were in, but we absolutely have a la carte to subsidize the
rest of my programs. You know, we are not all in this to keep
increasing the number of programs that we have in our School
Nutrition Program and we have two reasons for a la carte. One
is that it does definitely subsidize my Breakfast and Lunch
Program. The second is that I am trying to meet the needs of
all children, and I want those children to stay in school and
obtain their nutritional foods from me. And so I, too, have
very strict restrictions on what I sell in that a la carte
line. It is not a bunch of stuff that they can go to the gas
station and buy. I am very, very restrictive. But it is
definitely--it is priced accordingly so that if you buy a la
carte items, that money is being used to subsidize the rest of
my program.
Chairman Harkin. So the money flows one way, but not the
other way.
Ms. Wilson. Our State wouldn't allow it. It is not allowed.
Chairman Harkin. But it allows it the other way, from
competitive foods to the school lunch----
Ms. Wilson. It is part of the entire food service fund, but
we can--and that is why I started a la carte in the district I
am in.
Chairman Harkin. Dr. Bartlett, when I read your testimony,
it seemed to indicate that actually the school lunch Federal
reimbursements are subsidizing the a la carte lines. I am
trying to wrestle with this.
Ms. Bartlett. Right. I do think that the main difference
has to do with the allocation of the overhead kind of costs. We
certainly recognize the SFA director, things like that, how
that gets allocated to the different meals. Our methodology
which we applied this study and which we applied--we did a
similar study--the same study 14 years ago--found the same
results of a cross-subsidization. And it is these sort of
overhead costs that get allocated to lunch, breakfast, and
competitive foods, arguing that those programs, those products
should bear some of those kind of overhead costs. As I said, we
had the same finding before and the practice that we follow are
generally accepted accounting practices, to allocate those kind
of costs that come up with the average costs of meals.
And in terms of the districts, it was a nationally
representative sample. I think it is sort of--it is not due to
peculiarities in the districts that we studied.
Chairman Harkin. I will have to think about that. I will
have to think about that. I think I understand what you are
saying, is that if you have the set-up for the School Lunch
Program, School Breakfast Program, then you introduce a la
carte lines, they are utilizing the space and the overhead and
all that kind of stuff, so that really does subsidize the a la
carte line, not in kind of a money flow, it is just that you
are saying that the whole arrangement then covers any costs of
the a la carte line----
Ms. Bartlett. Right.
Chairman Harkin [continuing]. Is my way of thinking about
it, anyway.
Ms. Bartlett. Exactly.
Chairman Harkin. But again, if a la carte lines have to
meet dietary guidelines and meet all the dietary guidelines and
stuff, well, I guess I am not so worried about it then. It is
just the problem there are a lot of the a la carte lines that
don't do that right now. I don't much care how that food gets
out there as long as it is good food.
Well, that is really all I have. Senator Chambliss, do you
have any follow-ups at all?
Senator Chambliss. Thanks, ladies.
Chairman Harkin. Great panel. Thank you all very much.
Thank you, Dr. Wilson and Dr. Bartlett. Thank you, Connie.
Thanks for what you did in Knoxville. It is a great example.
We will call our second panel up. That is Dr. David Paige,
Mr. Kenneth Hecht, and Ms. Lucy Nolan.
[Pause.]
Chairman Harkin. We welcome our panel. Dr. David Paige,
Professor of Population and Family Health, with a joint
appointment in International Health and Human Nutrition at the
Johns Hopkins Bloomberg School of Public Health, and a joint
appointment in pediatrics at the School of Medicine. Dr. Paige
is a recognized expert in the area of community health and
maternal and child nutrition. His groundbreaking studies of
lactose intolerance in children, his pioneering effort in
establishing a Supplemental Feeding Program for Disadvantaged
Women, Infants, and Children, and his design and implementation
of community-based programs define the scope of his interest.
Mr. Kenneth Hecht is Executive Director and one of the co-
founders of California Food Policy Advocates. Begun in 1992,
CFPA is California's State-wide nutrition policy and advocacy
organization whose mission is to improve the health and well-
being of low-income Californians by increasing their access to
nutritious, affordable food. Upon completion of law school, Mr.
Hecht worked for 15 years as a public interest attorney, first
at San Francisco Neighborhood Legal Assistance Foundation and
then as Executive Director of the San Francisco Legal Aid
Society. Right away, you are a friend of mine. That is how I
started my whole career, is as a legal aid attorney, Mr. Hecht.
We are glad you are here.
And Lucy Nolan, the Executive Director of End Hunger
Connecticut, a nonprofit organization dedicated to ending
hunger in Connecticut. Their goal is to raise awareness of
hunger in the State of Connecticut, promote funding for and
access to nutrition assistance programs, and to speak out to
help eliminate the root causes of hunger. She received her B.A.
from Ohio Wesleyan University and her Juris Doctorate from the
University of Connecticut School of Law.
We welcome you all here to this discussion on the
reauthorization of the child nutrition bill. Your testimony
will be made a part of the record in its entirety and if you
would just summarize in several minutes, we would appreciate
it.
Dr. Paige?
STATEMENT OF DAVID PAIGE, M.D., PROFESSOR, JOHNS HOPKINS
MEDICAL SCHOOL, BALTIMORE, MARYLAND
Mr. Paige. Yes. Thank you, Mr. Chairman, Senator Casey,
other members of the committee. As you noted, I am at the Johns
Hopkins School of Public Health and in the School of Medicine.
I am a member of the Maryland State WIC Advisory Panel and
direct a WIC Program out of Johns Hopkins and I am also
testifying today on behalf of the National WIC Association and
a copy of their testimony will be appended, and I acknowledge
my good colleague, Reverend Douglas Greenaway, who is the
Executive Director of that fine association.
My comments this morning will focus on the critical role of
the WIC Program, the role that it plays in securing the
nation's health. The past 36 years with respect to the program
has demonstrated that it is a potent force in improving the
health, nutrition, and well-being of women, infants, and
children living in poverty. And it is really poverty that we
are talking about with respect to the problems of under
nutrition and poor nutrition.
Today, over 13 million children below 18 years of age, 18
percent of the population, is living below the Federal poverty
level, which for 2009 is set at $22,000, and the number rises
to 21 percent when we look at children below 5 years of age,
the population that WIC serves, and even higher in the African-
American population, Hispanics, and children living in female-
headed households. So we have a considerably large number of
children and families at risk.
Moreover, between 2000 and 2007, the number has risen
considerably, a 15 percent increase, another 1.7 million
children that we are dealing with. The Census Bureau estimates
that over 12 million children are food insecure as measured by
generally accepted standards. Of course, we know the number
will escalate in the current economic situation.
WIC is very effective in reaching this population. Seventy-
five percent of all of the WIC enrollees are below 100 percent
of poverty level, with about 35 percent below 50 percent of
poverty and another 35 to 40 percent between 50 to 100 percent
of poverty.
I would like to focus briefly, if I can, on some of the
risks that exist within this population and the role that WIC
plays. I will try to do this briefly. Poverty in general, the
overarching issue, results in poor health. Among pregnant
women, 60 percent who enter the WIC Program have a clinical or
medical condition at certification. Thirty-eight percent have
obstetrical problems, 27 percent are anemic, and about the same
number have low weight gain during pregnancy. These are
critical issues, critical determinants with respect to low
birthweight and pre-term birth.
The WIC Program is very effective in reversing these
conditions, these negative outcomes. There have been multiple
studies, independent studies, that show clearly that WIC has
been very successful in increasing birthweight as well as
reducing pre-term birth. I won't go into all of the specifics.
They are in the testimony.
There is supporting all this a comprehensive review by GAO
which clearly indicates that WIC is effective in lowering the
incidence of low birthweight and pre-term birth, and also at
the same time extraordinarily cost effective. There have been
multiple studies showing the cost effectiveness of the program.
Even a simple reduction of one or two nights in the neonatal
intensive care unit or 1 day in terms of a woman's extra stay
in the hospital will more than compensate for the WIC benefits.
So this has been an extraordinary accomplishment on the part of
the program.
I would like to identify one other risk factor and that is
infant mortality. Infant mortality in the U.S., as we all know,
is lamentably very high and is among the highest among
industrialized countries, even the highest, depending on some
parameters that may be used. Reducing low birthweight and
reducing pre-term birth is an effective way of reducing infant
mortality. A number of studies validated by the GAO speak to
the reduction of infant mortality. Our own work in the mid-
1990's further reinforces that particular issue with reduction
to infant mortality.
I would like to briefly discuss the preschool population,
and that indicates that there are more subtle problems that
exist in this population and we need to be very clear and we
need to reach out to increase the enrollment of this population
at risk.
I also want to mention that the Centers for Disease Control
has done multiple studies in this area which show the
effectiveness of the program regarding improved weight gain,
improved overall health, as well as a sharp reduction in anemia
in the preschool population.
I would like to address two other areas briefly, obesity,
which I know is an interest of the committee and of yours,
Senator Harkin. We need to think of obesity as poverty induced,
resulting in food insecurity and obesity as part of this
continuing spectrum of issues that we are dealing with in
populations in poverty. Of course, obesity is not limited to
only the population in poverty. Nevertheless, this is a very
important population group that is suffering from the epidemic
of obesity as a result of the inadequate food purchasing,
calorie-dense foods that are available, inadequate numbers of
supermarkets and other choices that exist in many of our poor
communities, both urban as well as rural throughout our
country. And we need to do a great deal in this area and
perhaps a question and answer can address this even more fully.
Breastfeeding is another crtical area that I would like to
speak to very briefly. When we talk about addressing obesity,
we need to start pre-conceptionally, peri-conceptionally and
during the conceptional period. But the first time we can
really introduce a remedy is postnatally providing
breastfeeding. Human milk is the most important nutritional
head start that we can provide to our newborns. Human milk is
species-specific. It is a living tissue that provides both the
anti-infectious agents, the antibodies, the other elements that
we need to improve the well-being, and WIC is very dedicated,
as you well know, to trying to improve the number of
individuals who do elect to breastfeed. Nevertheless, in the
lower economic tiers, this has become very difficult. Socio-
economic factors are the major impediment in this population
and we need to do a great deal, and perhaps we can explore this
further in question and answer.
I would just like to move to some recommendations very
quickly with regard to the administration of the WIC Program. I
would argue that we enroll all infants, women, and children
below 185 percent of the poverty level. This is cost effective,
it is smart policy, and we will set the tone and the health
infrastructure to help this population move out of poverty,
become well educated, and move forward in eliminating this
problem.
Enroll all Medicaid recipients. I think this makes sense
and is comparable with enrolling everyone below 185.
I would like to argue the fact that we give the States the
option to certify children up to 1 year, which this will
maximize program effectiveness. This is also a very smart,
cost-effective measure that combines remediation and
prevention, because we need to be more efficient and clever
about integrating the remediation arm and the preventive arm
that is implicit in the WIC Program.
I would also argue that we establish linkages with the
social services community, more direct linkages, in a
coordinated and collaborative manner, and this will improve
communication and better target nutrition.
Streamline uniform qualifying application, as we addressed
earlier.
Expansion of the WIC for electronic benefits, MIS and EBT
funding.
I would like to point out one area that doesn't get
attention, if I may, and that is the military families who an
individual of that family serving in the combat zone gets extra
pay, but that then counts against them in terms of the WIC. And
it is a small matter, but for that subgroup of individuals,
they really deserve to not be thrown off the WIC Program. And
since this has been brought to my attention, I thought that I
would bring it to a higher authority with respect to improving
on that.
The other issues, I will leave for discussion, and they are
in the written testimony, but we also need to address the
obesity epidemic and move forward on this, and I thank you very
much for the opportunity to testify before you today.
[The prepared statement of Mr. Paige can be found on page
92 in the appendix.]
Chairman Harkin. Thank you very much, Dr. Paige.
Mr. Hecht?
STATEMENT OF KENNETH HECHT, EXECUTIVE DIRECTOR, CALIFORNIA FOOD
POLICY ADVOCATES, OAKLAND, CALIFORNIA
Mr. Hecht. Good morning. Thank you, Chairman Harkin and
other members of the committee for this opportunity. I am from
California Food Policy Advocates, a State-wide nutrition policy
organization where we work to increase access for low-income
Californians to nutritious, affordable food.
As with much of the conversation this morning, our focus
has been on school programs, but we have recently come to
realize that by the time kids come to school, it may be too
late to stop them from becoming obese. And as the studies show,
obesity is exceedingly difficult to reverse, so that an obese
preschooler is very likely to go on to be an obese adolescent
and then an obese adult, with all of the disastrous
consequences that that holds for the individual and really for
the country. It seems to us absolutely indispensable to health
care reform that we get it right when the kids are first
starting out in our preschools and our schools.
We had the opportunity at California Food Policy Advocates
to participate in two studies, which has taught me all I know
as a lawyer about nutrition. One was in Los Angeles, where we
did observations in child care homes and centers, and another
was done by mail to about 500 randomly sampled centers and
homes throughout the State of California. The results were
remarkably consistent and each fortified the other, and I would
like to talk about those results.
We have also had an opportunity to participate in two
State-convened panels on child care nutrition generally and on
the Child Care Food Program specifically and our
recommendations come also from those two panels and are
consistent with those two panels.
First, just a moment on obesity. One in four children in
the two to five age bracket is obese or overweight before ever
reaching kindergarten--one in four. And as I said, this is
exceedingly difficult to reverse, so it is the beginning of a
long, long problem.
At the same time, we still have concern for hunger and food
insecurity. I think the number mentioned so far was 12 million
children in that preschool bracket, and that turns out to be
almost 20 percent, almost one in five, children is living in a
household that is deemed by the government to be either food
insecure or hungry.
A few moments on the Child Care Food Program. It is a big
program. It is serving three million children throughout the
country. About a third of them are in family child care homes,
very small operations, and about two-thirds are in child care
centers, which tend to be a bit larger. The program is now
spending about $2 billion a year.
In addition to providing reimbursement, which, of course,
is critical to the agencies, the Child Care Food Program also
provides three monitoring visits every year, which is more than
licensed child care homes and centers will receive in any
State, I believe. It provides nutrition education, training,
technical assistance, or at least it used to until the
reimbursement went away and the money had to be focused on
other things and away from these important services.
The Child Care Food Program is based on a very simple
concept of meal patterns, which are really the food groups.
There is milk, fruit and vegetables, grains, proteins, and that
sets--there are a minimum which set the quantity of those foods
so that children should get enough nutrients, but what it
doesn't address at all is the quality of those foods and it
doesn't limit the numbers of calories. In other words, the
Child Care Food Program set-up at the moment is not responsive
to obesity. The meal patterns were set in place before we were
aware of the obesity epidemic and they have not been changed
since.
USDA has commissioned a study from the Institute of
Medicine, which is to start next year, and I think it is a safe
estimate that the results of that study will not be implemented
for another 4 years, 5 years, and our recommendations are what
we believe are sort of consensus, unarguable changes to the
program that don't interfere with but actually work well with
meal patterns.
A moment on our studies. Our two studies found that the
child care facilities that participated in the Child Care Food
Program had better nutrition than the facilities that did not.
We found that Head Start was at the top of the pack and that
food brought from home--I am glad there are no mothers left on
the panel at the moment--was the worst. It had the least good
nutrition to it. But within that, there was a range of
nutrition that was better in the Child Care Food Program than
not.
Even in the Child Care Food Program, there are problems,
which is what my recommendations will go to. For example, whole
milk is being served in 50 percent of the Child Care Food
Program sites, and I think it is absolute consensus
scientifically that from the age of two on, children should not
be receiving whole milk. They should be receiving either non-
fat or low-fat milk. Similarly, only 27 percent, about a
quarter, of the homes and centers that were on the Child Care
Food Program were serving any whole wheat at all. So there is
room for improvement.
Our recommendations follow the following principles. One,
we want it to be consistent with the WIC Program, which is
serving roughly the same population. The WIC Food Program, as
you know, has recently experienced a real transformation in its
food package and it is terrific, based on lots of study, lots
of input from scientists and nutritionists all over the place,
and we really try to borrow from that.
Second, we are trying to make the recommendations simple,
because in the homes particularly, there is not much time to
fuss with complicated nutrition requirements.
Third, we are trying to make it inexpensive so that the
nutrition reimbursement goes as far as possible.
Some recommendations on the nutrition. First, we urge that
the reimbursement be increased. As we heard in the first panel,
really, the costs have run away from all of the nutrition
programs, and in the Child Care Food Program, where there is
intensive paperwork, the reimbursement has been lost.
But with the increase in reimbursement we are asking that
nutrition improvements within the meal patterns be linked, and
we are asking for the things that we all know are good, and I
think there is plenty of science to back it up--low-fat milk,
more fresh fruits and vegetables, more whole grains, less
sodium, less sugar, less fats. Not rocket science.
Second, as I mentioned, we would like the nutrition as well
as the messages, the nutrition education, to be absolutely
consistent with the WIC Program, which is doing a great job and
we ought to grab onto it.
Third, we are proposing that there be some changes in the
health environment in these facilities in order to maximize the
benefit of the Federal reimbursement. Every program ought to
have water easily accessible to the kids. We ought to have
limits on screen time. We ought to get those kids outside and
moving, and if it is bad weather, they ought to be moving
inside. So physical activity is important.
In the school programs, we have a concept called foods of
minimal nutritional value. We would import some of that into
child care to be sure that the kids aren't having sodas,
candies, the things that we all know they shouldn't be having.
And finally, we need to devise some strategies to work with the
moms and dads who are sending food from home and don't know
better.
In order to have these benefits make any difference at all,
we need to grow these programs. There are two ways in which we
would recommend opportunities for growth. One has to do with
access and participation. There ought to be categorical
eligibility into these programs so it is easy to get in for the
kids who have already been means tested or their families have
been means tested.
Second, there are areas of our State, I suspect other
States, where there cannot be family child care homes because
there is no sponsoring organization in that portion of the
State, and we would recommend that where there is no sponsoring
organization that the State be the sponsor of last resort, or
the State might delegate that responsibility, so that children
won't be deprived of a family child care home on CACFP simply
because there is not a sponsor in the neighborhood.
Finally, there are ways to simplify and streamline this
program. When the Child Care Food Program operates on a school
campus, it ought to operate under the school lunch rules and
regulations. We ought to defeat these kinds of silos that make
administration complicated and expensive.
Finally, we need money to train. The Federal money to
train, the State money to train has really dried up and is not
coming back any time soon at the State level. I think it has to
be Federal reimbursement so that the sponsors are trained, the
providers are trained, the providers are in a position to
provide indispensable nutrition education to the kids and to
their families so that we really spread the right obesity
prevention strategies throughout our communities.
Thanks a lot.
[The prepared statement of Mr. Hecht can be found on page
76 in the appendix.]
Chairman Harkin. Thank you very much, Mr. Hecht.
And now we will turn to Ms. Nolan.
STATEMENT OF LUCY NOLAN, EXECUTIVE DIRECTOR, END HUNGER
CONNECTICUT, HARTFORD, CONNECTICUT
Ms. Nolan. Good morning. Thank you, Mr. Chairman and
members of the committee, for inviting me to present testimony
today on behalf of meals served to children out of the school
day. These meals are one of the best ways to improve nutrition
for America's children in tough economic times, as you all
know.
I am here today to talk specifically about the After-School
Programs and Summer Nutrition Programs. These programs are
designed to provide nutritious meals and snacks to children
when school is out. We know that when children participate in
Federal food programs that they do better with their weight,
and that children when they are out of school gain weight. We
have science behind that.
We really need to make sure that we can provide these
children with these meals and snacks that are nutritious, and
sponsors are trying to increase the quality of the food that
they served. We have worked with a community in Middletown
where they really worked hard to have better food that the kids
will eat, but also increase their fresh fruits and vegetables.
They need funds to do this. They can't do it with the funds
that they have now.
I just very quickly would like to say, in Connecticut with
our School Nutrition Program, we have schools that certify as
healthy schools, and when they certify as a healthy school,
they are given ten cents extra per meal served from the prior
year. I suggest this would be a great way to incentivize other
Summer Nutrition or After-School Nutrition Programs, as well,
and give them the funds to be able to get the healthier foods.
These programs are really great because they combine food
with activity. We see a lot of kids that go in and they
swimming because they can get a meal, or they can do arts or
after school they can do their homework, they can play
basketball. They get some of the physical activity that they
might not get if they are sitting at home.
So it is key to us. We really feel that it is really
imperative that we keep these programs as activity-based, as
well, because as you say, it helps us look at the whole child
and look at the future of our children and look at them as both
health and as psychological health of our kids and getting them
food and activity.
I would suggest that we need to increase access to these
programs. Right now, the Summer Nutrition Program nationally
serves one in five eligible children. In Connecticut, we served
one in four. We are No. 8 in the country. I mean, that is
pretty terrible. It is great because we are No. 8, but it is
really pretty terrible.
So right now, the area eligibility is at 50 percent. We
suggest that we go to before 1981 standards of 33 percent, and
at the very least, we use the current and non-food Federal
funding for programs such as the 21st Century Learning Grants
of 40 percent so that we have at least the same basis in that
way and we can grab more children.
I also think that we can create partnerships with farmers
and farms on these programs. Again, in Middletown, we had a
partnership with a CSA, Long Lane Farm that is part of Wesleyan
University, and they came in every week and taught the kids.
They planted something with the kids. They taught them about
farming. They taught them where their food came from. They
brought them foods that they could try. As anyone with kids
knows, if other kids are going to eat something, they might try
it, whereas they might not at home if it is their siblings or
their mother goading them.
Nutrition education is key. The expanded Food and Nutrition
Education Program, we can work with them, FNEP. Again, using
the healthy food incentives would be really helpful as a way we
can--we have these programs. Let us use the nutrition and the
program together to increase nutrition.
Outreach is absolutely necessary. We have found in
Connecticut, we give out in End Hunger Connecticut five grants
of $750 to communities, to sponsors, as a way to buy things
that are non-food related. So maybe they raffle off bikes. A
kid would come every day, and every time they get a raffle
ticket. At the end of the summer session, they would raffle it
off and somebody would win the bike. It would have them come.
They would want to come. They would tell their friends. They
would have smoothie days, things like that. We increased last
summer alone, with those, just those five sites, we served an
18,000 additional meals and over 400 kids daily in those sites,
and that is a $3,000 investment.
We really do need to get people out there and do outreach
because we can get to families. We can hang door knockers. We
can get out flyers to schools before school is over. But it is
really key that we let people know that these programs are
happening. We also need funding for startup and expansion and
transportation funds.
And finally, the summer meals and also the after-school
snacks and breakfast should receive commodity support, and in
the rural areas perhaps cash in lieu of commodities because it
is more cost effective.
After-school snacks, there is really not enough food for an
after-school snack. I have a son who eats lunch at 10:30 in the
morning and then goes off and plays football. I know he is not
in an after-school program, but I worry about him practicing
football until 6. Kids need something in between, particularly
if they are eating early.
You guys last year, excuse me, with the Economic Stimulus
Plan, we added two more States to the supper programs and we
would like to see that all over the country because they are
really just key programs. We can feed kids all year long. They
can feed them during the weekends. They can feed them after
school, families who get home late. It is just enough food for
our children. We need to feed them what they really need. And
then we can also do that through the National School Lunch
Program, which would be great.
The final thing that I would like to add is that we would
really, really like to see this as a year-round seamless
program, the Child Nutrition Programs. When you have a sponsor
doing Summer Nutrition and them somebody else doing After-
School, the rules are all different, CACFP, they are all
different. People don't do they because they are just so
difficult to navigate. We would put all the out-of-school meal
programs together, create one program with identical
eligibility procedures, identical reimbursement, and
administration. It could really streamline these programs, save
money, and feed kids at the same time. We don't need a mishmash
of programs right now. We need one whole program that will do
the best thing and would be the best economically, as well.
So those are my recommendations. Thank you very much.
[The prepared statement of Ms. Nolan can be found on page
84 in the appendix.]
Chairman Harkin. Thank you very much, Ms. Nolan.
Let me pick up on what you were just saying there. You are
saying that we ought to put together the Summer Feeding
Program, After-School Programs, the supper programs--what else
am I missing here----
Ms. Nolan. CACFP.
Chairman Harkin. Right, the Adult and Child Care Programs,
put them all together sort of under one guideline, one
operational kind of a program. Is that what you are saying,
that they should all be together?
Ms. Nolan. I am saying that we are at a position now where
kids aren't eating on weekends. They are not eating during
school vacations. And so if we can put them all together and
have one common program where kids can then get these meals
during the year and everything is--right now, we have sponsors
who--with the After-School Program, and I know in CACFP with
shelters, I have talked with people in homeless shelters and it
is just too difficult for them to keep all the--to make sure
that they have all the little things that they need to have to
give to our State Department of Education to get the funding.
And so if we can have something that is just everybody could
have it together, I think the administration would be easier,
kids would eat, and more people would be sponsors.
Mr. Hecht. May I add an example to that?
Chairman Harkin. Sure.
Mr. Hecht. We have a private program in California that has
operated since the last reauthorization in which sponsors of
summer food are permitted to go on serving snacks during the
school year to children under the summer food rules so they
don't have to grapple with two sets of rules and regulations
and reimbursements. The numbers of sponsors has gone up
enormously. The number of kids participating has gone up
enormously. If we had a community-based program and a school-
based program, just two programs instead of as many as we have,
it would be enormously better and cheaper with money that could
then get poured into nutrition.
Chairman Harkin. Hmm.
Mr. Hecht. It was a recommendation that was made several
administrations ago but didn't go anywhere, but it is terrific.
Chairman Harkin. I will take a look at that. Also, you
mentioned about in the Summer Feeding Program that a lot of
times, what attracts kids is not the food, it is the other
ancillary activities, swimming and games and things like that.
I am sure you are not saying that the food doesn't have some
part of it, but there is another aspect to this. If that is so,
then what kind of suggestions would you have that we might
institute that would draw kids in for the Summer Feeding
Programs? I mean, we have the Ys, for example, YMCAs all over
the country that are really involved in wellness programs. They
have embarked on this several years ago. So would that be
something that could be a part of this? Maybe churches could be
involved in this, too? I am just kind of searching. How do you
promote all these activities that then you can get food to
these kids?
Ms. Nolan. Our grant program is called ``Operation
Participation'' as a way--because we want kids to participate,
and what we found is that if you get this little--something to
get them, they will tell their friends who will then come. And
simple things like in one community, we had police officers and
firefighters come every Friday and read to them, and there was
this big trunk and it was the mystery of what was in the trunk.
And at the last day, they would read some clues as to what was
going on and the kids would have to guess. And at the last day
of the feeding program, they opened up the trunk and they all
got T-shirts that said, ``I participated in the Summer Feeding
Program.''
The raffle that I talked about, we got kids who came
because they wanted that bike so badly. There were two bikes
and they wanted them so badly that they came to make sure that
their names were in the raffle.
We have had art supplies that have come, and so we have
really been able to--kids will come and do art because they
know that that is there. And we can streamline eligibility with
the Federal funding for the summer programs using the 21st
Century, you know, doing the 21st Century Program. So we can
use that as a way to get kids.
But what we found is, and I think you are right, the food
is certainly a pull, but they want a whole experience, and this
is a way we--what we have done is been able to build the
community into these summer sites, so we have the police
officers come, the firefighters. We have had raffles where kids
come and they are able to do a raffle.
Chairman Harkin. I guess what is on my mind is I am
thinking that since we are limited in what we can do here, we
can provide the funding and we should increase the funding for
the Summer Feeding Program, the Child and Adult Care Program,
After-School Programs, but should we somehow link it to certain
activities that the local community has to engage in to be able
to participate, in other words, providing those kinds of
sports, activities, things like that for kids rather than just
setting up, as I have seen in some places where they just go to
a park and they bring a lot of food and kids come to the park
and they can have a lunch or something, which I don't think
works very well. In other words, encouraging local communities
to think about how they do the things you are talking about,
getting the local firefighters, police, and stuff like that
involved.
Mr. Hecht. Let me sharpen the question just a minute. In
California, over 80 percent of the children who eat summer food
meals eat them at school, during summer school generally, and
we are starting to see that beleaguered school districts aren't
going to be able to offer as much summer school as they have in
the past, so there are going to be more children unanchored to
a program or a school that gives them a summer food meal. So
there is a serious problem, I think increasing this coming
summer, at least in California, of children who are not going
to be close by some activity, either academic or recreational,
where we can plop a Summer Food Program.
Ms. Nolan. I also--I think that if we could do--if there is
some kind of a pilot that we could do to try this out, maybe
State by State and having where they are connected, it would be
helpful. I think that it would be something that you would see
some more significant usage of the program.
Chairman Harkin. And I also want to see what role we have
for the Ys around the country, because they are really into
wellness and promoting wellness, and perhaps this is something
that we ought to be looking at as part of this.
Ms. Nolan. Boys and Girls Clubs, I think.
Chairman Harkin. And Boys and Girls Clubs, too. Yes, Boys
and Girls Clubs, too.
Senator Chambliss?
Senator Chambliss. Thanks, Mr. Chairman.
I like your idea, Ms. Nolan, of trying to create some sort
of umbrella out there. What we tend to do as policymakers here
in Washington all too often is that we create these programs
and they are all great programs. You all have talked about your
individual ones. All of a sudden, somebody comes in with
another idea and we create a fourth panelist on this panel all
of a sudden who has a great program and we throw money at it.
Mr. Hecht, you make a great point that throwing money at it
is not necessarily the answer to it. Certainly everybody can
use more funding, but if you had them all under one umbrella
and you restructured the programs so you don't have the
overlap, you are going to wind up saving a lot of money to be
able to be spent on additional meals and what not. So I think
are some very good ideas that you all have tossed out there.
Ms. Nolan, it is pretty obvious that what you are doing
with kids in your program is you are letting them have fun. If
kids have fun, they are going to show up.
Ms. Nolan. Right.
Senator Chambliss. There is probably a lot of peer pressure
bringing in other kids, too, if they know they are having fun.
So obviously you are doing a lot of the right things.
Dr. Paige, I was curious about in your statement that
everybody at 185 percent of poverty level ought to be
automatically enrolled. What you are saying there is that all
of those folks are eligible now. They are just not enrolling.
And you are not talking about an expansion, you are just
talking about making sure that folks that are eligible do get
enrolled again, which I am sure there are probably some of
those parents who, when they leave the hospital, maybe they
don't know about the program or some of them want to do it on
their own rather than depending on the government. But that is
an interesting concept you throw out there, that it will save
us money in the long run if you do have more families
participating in the program.
Mr. Paige. Currently, Senator Chambliss, there is not a
sufficient appropriation to meet the entire need were we to be
successful through our outreach efforts to bring all of the
eligibles into the program. So my own view is that not only
will the nutritional risks be addressed, but we will have the
opportunity to develop a more comprehensive preventive program.
It is hard to measure the prevention, but when we are talking
about newborns and we are talking about pregnant women, there
is a strong, compelling case to be made that prevention is as
important as the remediation that we attempt to do by
identifying nutritional risk.
So it is from that perspective, that broad-based public
health preventive perspective, and it is not simply empty
rhetoric. We know through the data that when we can begin to
provide a nutritional infrastructure, we can start with a
comprehensive program prenatally. We can deal with the range of
obstetrical and behavioral problems. We can start this
nutrition education. We are talking about obesity and we are
talking about where to start, as I mentioned quickly in my
prepared comments.
But my own view is that we need a vertical, comprehensive,
integrated, coherent program of all of the nutritional
programs, not just WIC. What we have now is a fractured system.
It is a good system. WIC is a wonderful system. But it needs to
be integrated with Head Start and it has to have a linkage into
the schools. We have to have, as was mentioned earlier, a
standard, unified approach with regards to qualifying as well
as reducing the burden on the client to continue to qualify for
many of these programs. We can be much smarter about it. We can
integrate it. We can move to a streamlined approach.
We can locate these programs with health programs so that
we are dealing in a more comprehensive, unified approach to
deal with the nutritional risks that exist within the
population that we are serving. We can make effective use and
economical use of the personnel back and forth between this, an
electronic system that would communicate back and forth in
terms of immunizations, in terms of social services.
We have complex problems here. We have poverty that feeds,
if you will take the metaphor, the malnutrition that exists and
we have to be clever about it. It was mentioned by my
colleagues here that we must have a more comprehensive,
effective system, particularly as money becomes less available,
we have to be smarter about the way we run these programs. We
have to start pre-conceptionally in the schools with our young
women and young men in terms of health issues, and we have to
address the--obesity is not an isolate. Low birthweight is not
an isolate. These are part of a continuum that exists within
the community and we keep looking at it.
We are the best country in the world. We really have the
best programs in the world. But we are not clever about the way
we apply them in our lower-tier population that needs a
consistent, coordinated message that moves over time, because
after two or 3 years, we have our children graduating from WIC
and they are going into school and they get a different
message, and they get a different message in every State and in
every community with respect to good nutrition. It is a more
amorphous concept than simply saying good nutrition.
So we need Federal standards and guidance with regard to a
unified message. We need a streamlined, integrated approach. We
need a vertical, coherent, logical approach that is built on
sound nutrition science with a core that is, I would say,
federally suggested with the embroidery around it in terms of
the expression of the communities and the States that we are
dealing with and we have not been clever enough to accomplish
that, and it is very cost inefficient. We are losing tremendous
amounts of money.
The client burden--forget even the client burden. Going
from one doctor to get a hematocrit and then going to--a blood
count, and then going to another place to get another blood
count, and then having to carry that information, that is not
an efficient system and it doesn't lead to good care, either.
Senator Chambliss. Mr. Hecht, your comment about one in
four children are obese before entering kindergarten is an
interesting statistic, because child obesity obviously is a
problem that all of us are concerned about now, and the fact
that it does go up rather than going down is also pretty
alarming. Is there a direct correlation between that statistic
and the economic strata which those children come out of?
Mr. Hecht. Yes and no. I wish I could give you a simpler
answer. There is no question but that it costs more to have
healthier food and that the families with less money are having
a hard time helping their children have healthy diets. On the
other hand, as Dr. Paige mentioned, there is obesity at every
income stratum and it is not isolated to the low-income areas,
but the causes of it seem clearer at lower incomes and the
consequences seem much more severe.
Senator Chambliss. Last, Mr. Hecht, you mentioned in your
testimony and in your written statement that this paperwork in
your program is a real problem. Is there any way for your
providers to go online to do this versus having all this
paperwork to complete? And second, what can we do to eliminate
that paperwork? I have no idea what it is or what all the
requirements are, but what can we do about it?
Mr. Hecht. That is a very welcome question. Yes, there are
ways that our providers can begin to use computers to go online
to file some of the information that they need to. The next
group up, the sponsoring organizations, are doing that much
more. Some of the providers, particularly if they are in the
family child care homes, have difficulty either owning or being
adept at some of the computer technology.
The paperwork is extremely burdensome in the family child
care homes and in the centers. There has been a Paperwork
Reduction Task Force meeting. Some of those recommendations
have been met, some have not. It ought to be carried on. There
are some questions that are asked of providers, if they serve
the same number of children day after day, is that real or are
they making that up, which is sort of a blunt instrument for
trying to make sure that there are no fraudulent claims being
made in child care. But the paperwork requirements that have
been put in place to try to stop that are really very blunt and
are burdensome to the providers and to the sponsors and not
very adept at catching any problem if there is a problem.
Senator Chambliss. Thanks, Mr. Chairman.
Chairman Harkin. Thank you very much.
Senator Casey?
Senator Casey. Mr. Chairman, thank you very much, and I
want to thank Senator Klobuchar for letting me jump the line
here. I am grateful for that.
I was looking at some of the particulars, Dr. Paige, of
your testimony as well as both of our other witnesses and some
of the numbers in here are just staggering and worthy of
repetition many, many times, even though it is bad news,
because we need this information to focus us on the urgency of
this.
The 13 million American children below the age of 18 living
in families with incomes below the poverty level is a stunning
number in and of itself. The percent of children in poverty
increases to 21 percent in children below the age of five. The
section on low birthweight, where you are highlighting that
problem, but you also have some good news there. Based upon the
data, the WIC Program reverses many of the negative outcomes
that we are talking about.
And then, of course, under the section on infant mortality,
this line I have never seen before and it really--we know it is
true, but we don't see this very often, that the disease burden
among the survivors is lifelong.
Mr. Paige. Yes.
Senator Casey. And it is just staggering what our challenge
is. So it leads to my question on the WIC Program. We have, as
we know, we are in the midst, I should say, of a terrible
economic crisis, a lot of families living through that trauma
and we have limited budgets and limited resources. But I guess
I would ask you, Doctor, if you could, and I know it is
difficult to do this, but to rank some of the recommendations
that you make in terms of the three most urgent or the few that
are most urgent in light of the need and the gravity of the
problem, but also in the context of the budget realities we
have.
Mr. Paige. Thank you, Senator Casey. Thank you for
highlighting those very significant numbers. I might add that
those numbers that you have just read escalate dramatically in
our minority populations. In female-headed households in
Baltimore or in Washington, we are looking at 60 percent
poverty. So these are extraordinary problems that we are
dealing with nationally.
I would also like to comment briefly, if I may, and I will
be very brief, regarding the lifelong burden. Over the last
eight to 10 years, the research has been prolific in the area
of fetal growth restriction and low birthweight, the result
thereof, and adult disease burden. The adult disease burden is
in terms of shifts in the internal physiology--anatomy and
physiology of the fetally growth restricted that results in
heart disease at age 50 and 60 and results in diabetes and
results in a number of disease burdens that up until very
recently we thought were very isolated, circumscribed, age-
specific problems, and we are much wiser now.
So when we quote statistics regarding the dollars saved in
the neonatal intensive care unit, that really is just the
beginning. We have the disease burden just moving through time.
And underpinning that are the congenital anomalies that exist
as a result of the inadequate nutrition and environmental
hardships that exist that are continuing.
So now to your question. I really can't answer the question
entirely. I can just say philosophically, my own view is to
start at the beginning to try to maximize and optimize the
embryo, where we have many, many problems. We don't think of
the embryo. We think of the fetus and we think of 30 weeks and
34 weeks, where there is a more tangible human experience. But
the embryo is undergoing enormous development and requires the
best nutrition. So we have to get our women into the program
very early.
We have to increase education, not just for our poor women,
but for our population in general. These are not problems
unique to this population, they are just escalated in this
population.
So my own view is to start peri-conceptionally, move
through pregnancy and infancy into childhood. But you note in
my testimony, I try to make the point that in the one-to 4-
year-old, these are youngsters who are already walking. They
are cute, but they no longer have that intense position in the
household as a newborn, so it is easy to forget them and the
risks that they face in terms of the nutritional factors that
are required for interaction, for cognitive development. So we
pay a penalty if we sacrifice our one-to 4-year-olds and only
concentrate.
So it is a complex question. There is a hierarchy. My own
view is to maximize, optimize fetal growth, pregnancy, and the
early infant period, and I think we need to address the
preventive elements of the WIC Program in this in terms of now
only the food, which is absolutely critical, it is the
substrate that makes it all work, but the education and the
continuing education that exists, and you heard in my earlier
response, I see it as a vertical issue. I see that we have to
protect this newborn right through the one-to 4-year age, right
through Head Start, right into school. We need it in a coherent
manner and that would be an attempt at answering your question,
Senator.
Senator Casey. Thank you, and I know I am over time, so I
will just present this to Ms. Nolan as something we will be
sending to you. I have worked hard on the Summer Food Program.
In our State, we have a large portion of our State which is
rural, and I will ask you a question for the record that I will
preview now. I just ask for your recommendations about how to
make that program more effective in rural areas, the Summer
Food Program in rural areas. But we are about a minute-and-a-
half over, so we will submit that for the record. Thank you
very much.
Chairman Harkin. Thank you.
Senator Klobuchar?
Senator Klobuchar. Thank you very much.
Thank you to all of you for your good work. I was very
interested, Mr. Hecht, and kind of shocked at the statistic
that you put out there on the two-to 5-year-olds with 25
percent of them being obese or overweight. Could you explain,
and I know you talked a little bit demographically earlier, but
could you explain, just take a little time to explain why you
think this is happening?
Mr. Hecht. Well, I think there are two parts to it. One is
calories in and one is calories out. I think it is as simple as
that, that the children are not getting movement either at
child care or at home. There is a tremendous amount of screen
time, as I am sure you know, and every reputable body says
there shouldn't be any before a child is one, one or two, and
then there should be perhaps an hour of limited quality
education type of TV if there is any. But in so many homes, the
TV is just on all day.
And on the food side, as we all know, Adam Jernowski [ph.]
has done good studies, others, as well, that show that
healthier food is more expensive to purchase, and so it is--and
in some cases, less accessible. So it is both access and
affordability that makes it very difficult for low-income
families to feed their children the kinds of food they would
like or for child care providers to have the kinds of food they
like.
On the other hand, we found a very interesting thing which
we are still developing, but I think it is solid, is that the
families that paid more for child care got less in terms of
nutrition because they weren't always going to the programs
that had the Child Care Food Program with the Federal
reimbursement. So for all the bashing, the Child Care Food
Program is a good program. It needs to get better, but it is a
good program.
Senator Klobuchar. Very good. Thank you. You know, speaking
of that program, are you recommending that we change the law to
mandate that--because you were talking about some of the issues
with it--that the changes for child care sites, that these
changes for child care sites you have suggested, that it should
be a mandate in terms of receiving the nutrition dollars?
Mr. Hecht. Yes, I do.
Senator Klobuchar. And what do you think would be the best
recommendations to try to change the program?
Mr. Hecht. I would go in two directions. One are the, what
I think are modest recommendations with regard to the quality
of food, that we really borrow from the WIC food package change
and increase fresh fruits and vegetables, whole grains, get
water into those kids, low-fat milk, and limit sodium, salt--
sodium and sugar and fats. And then the surrounding
environment, which includes some of the screen time, physical
activity, not having certain kinds of food around where the
children are, what we now referring to as foods of minimal
nutrition value in the schools. There are just some things
everybody knows kids shouldn't have and those ought not be
there. I think those are practical, implementable suggestions,
in addition to increased reimbursement, of course.
Senator Klobuchar. On the other thing, when you were
talking about the early childhood on and the mothers and
whether or not some of these kids are just preprogrammed, which
is a scary thought, based on the nutrition they have received
before they were born, I listened to that because I think that
is an issue that we see that just makes it so hard for these
little kids.
Dr. Paige, you wanted to----
Mr. Paige. I was just going to jump in and say,
paradoxically, many of the low birthweight infants are at risk
for obesity because given their reduced size, organ size and
shifts in hormones and so on--I have lectures here that I won't
bore you with--given those shifts, when they are born into a
calorie-abundant environment, they tend to increase weight more
quickly and their feedback systems with respect to satiety and
control are also in many ways interfered with. And as a result,
we have this paradox of low birthweight, and it may account--
the question was asked earlier why demographically would we see
a tilt perhaps in this population of economically
disadvantaged, and this is arguably an important issue that is
being pursued scientifically. But there is enough evidence at
the moment to at least underpin the logic of it, yes.
Senator Klobuchar. When you talked, Dr. Paige, about how
you can make it easier for people, and clearly how we do a
better job here is to get this nutrition information and get it
out there and make it easily as accessible as possible to low-
income families from the very beginning, so you talked about
how difficult it is to access the information and trying to do
it on a site basis. Could you just elaborate a little on that
in terms of making it--what would be your dream of how to make
this accessible to low-income mothers?
Mr. Paige. Well, we have been very clever about doing this
internationally in terms of providing star power and other
agents of change within a community with regard to musicals and
other elements that are quickly identifiable by many of us in
the population. We need also that for attention. But then a
consistent message, as well. We have a very fractured message
across the spectrum of services that we provide.
So we need that reinforcement, and then my dream--I am
coming back to the same theme, though--is that we are working
in a cooperative, integrated manner with the food programs that
are out there, with the school program, in a consistent
message, as well. There are conflicting information. We see in
the newspaper frequently, even for us on an upper-tier, maybe,
suddenly the scientific information or the food information has
changed and the sands have shifted under us. It is both proper,
but this is happening on a continuing basis in terms of the, I
will say it again, the fractured message that exists out there.
I think I will stop there and get your response.
Senator Klobuchar. OK. Well, I am out of time to do my
response. Could I just ask one more question, Senator Harkin?
It was actually the question that Senator Casey was going to
ask you, Ms. Nolan, about how you would replicate this idea on
a rural basis.
Ms. Nolan. Well, there--one wouldn't believe it, but we do
actually have a fair amount of rural poverty in Eastern
Connecticut and one of the things that has been an issue is the
transportation. I think that if there is a way that we can
increase transportation to those places, some people say that
we can increase the time in which--or lessen the time that the
food has to be there so that maybe somebody can drop it off and
then have the kids come in, or have it for a longer time. There
are a number of things. There are a number of people who have
worked on this and I will be happy to get you something really
written up that explains it fully.
Senator Klobuchar. Thank you very much.
Ms. Nolan. You are welcome.
Mr. Paige. May I just add, Reverend Greenaway reminds me
that the National WIC Association is launching on Tuesday a
partnership with Sesame Workshop, which is specific to my
general comment regarding utilizing the various outlets of
communication and advertising and----
Senator Klobuchar. So how are they doing that? Are they
showing Sesame characters eating spinach?
Mr. Paige. Well, we will both watch on March 10.
[Laughter.]
Senator Klobuchar. That is good.
Mr. Paige. But whether that is or is not successful, we
need an approach that addresses it in the language, in the
venue that people are comfortable and operate with.
Reverend, do you want to answer? Are they going to eat
spinach?
Rev. Greenaway. Well, we have a partnership with Sesame
Workshop which will provide Healthy Habits for Life kits, which
are a combined video and reading material, educational tool for
WIC families that emphasizes ``eat a rainbow,'' so all of the
fruits and vegetables. Talking Broccoli will be there and
Cookie Monster tomorrow. Cookie Monster will be talking about
sometime and anytime food. And those who have little children
know that when they go to the grocery store, they go, ``Oh, no,
Mommy, that is sometime food, but carrots are anytime food.''
It is that kind of nutrition message that we are trying to
reinforce with Sesame Workshop that we have been communicating
within the WIC clinic all along, but now we have a great
collaborative partnership to do that. We are putting in the
hands of WIC families already five million of these Healthy
Habit kits, which include a DVD that they can play at home and
they are already a big hit.
Senator Klobuchar. OK.
Mr. Paige. I would add that within the WIC Program, as
well, we are looking for ways to use internet-based education
and other efficient methods that use modern technology to
reinforce the message, provide DVDs and a range of information
so that there can be an interactive chat room on the internet.
These are--each one will not solve the problem, but in a
coordinated effort that provides this broad-based approach, we
can make progress.
And as I said, we have been very successful, the U.S. has,
in achieving this internationally, but we haven't been clever
enough to apply it consistently here in our own homes and our
own country.
Senator Klobuchar. Thank you very much.
Chairman Harkin. Thank you all. I just have one other area
that I would like to cover with you, Dr. Paige, and that is the
area of breastfeeding. Twenty-eight years ago this year, when I
was a member of the House, I was one of the honorary co-chairs
of the National Breastfeeding Coalition. That group had formed
to protest the activities then of the Nestle Corporation in
terms of their provisions of infant formula to not only poor
families around the world, but also how they were providing it
to mothers in hospitals. As soon as they gave birth, they got a
nice package of infant formula.
That coalition was, I think, fairly successful at that time
in terms of the boycott and Nestle agreed to change a lot of
its practices at that time, in the mid-1980's, although I
understand that now it has crept back in, that there are still
these packages given to mothers in hospitals as soon as the
child is born. They get these packages of infant formula and
things like that. I don't know how extensive that is, but I
have heard that it has kind of crept back in.
And since that time, even in my own family, we have been
heavily involved in promoting breastfeeding. But we found, as
you kind of alluded to, I think, and that is among low-income
women, the incidence of breastfeeding is the lowest. Among
higher-income women, it is the highest. So what are the
barriers? What are the barriers getting low-income women
focused more on breastfeeding?
Mr. Paige. What is interesting is that if you look at the
data in the 1960's and 1970's--and let me also say I have not
only been aware but a strong supporter of yours at arm's length
in terms of everything you have done in this regard. In the
1960's and 1970's, through the early 1970's, the level of
breastfeeding among the low-income population was quite high.
In the course of a generation, a generation and a half, we have
reversed this.
It is the attraction of formula, and this attraction starts
in the hospital when there is a discharge pack. Our colleagues
in the infant formula business are clever about this. They say,
yes, breast is best, but when you need to go out for an evening
or so, and slowly both the commitment as well as the lactation
begins to erode and you have a quick move to formula.
Yes, in the hospitals they are now giving out infant
formula packs. Our own data shows clearly that there is a
marked difference between those who receive the pack versus
those who do not in terms of the rapid decrement in
breastfeeding. This is a problem that has resurfaced.
I am all for enterprise and entrepreneurial activity, but I
do think we have a responsibility here to our newborns to
eliminate that practice.
Chairman Harkin. You talked about peer counseling. I think
that is extremely important--extremely important.
Mr. Paige. We have been--thank you for raising that,
Senator Harkin. We at Hopkins have been working aggressively in
this area and the data shows clearly that the--not just the
individuals, but the clinics that have peer counselors present
do much better in terms of initiation and duration.
Chairman Harkin. Yes.
Mr. Paige. This program is an extraordinarily strong
program.
Chairman Harkin. The other thing, Dr. Paige, is that there
has been a shift. In the 1960's and 1970's, fewer women in the
lower economic strata were employed. They were at home. That
shifted because of the erosions of the economy and their
husbands' pay, things like that. There are more and more women
in the workforce. And what has happened is--let me take an
example.
My oldest daughter has a very nice job in California. Her
company provides all kinds of benefits for breastfeeding. They
have a room. They have refrigeration. You can pump. They just
provide all that kind of stuff. But she doesn't have a minimum-
wage job. See, most of the low-income women, they go to work at
7-Eleven or Casey's or in a department store, things like that.
They just don't provide that kind of help, so they are caught.
They may want to breastfeed, but they don't have the ability to
do so.
Mr. Paige. Yes.
Chairman Harkin. So what I am hoping is that we would--I
hope this administration, I hope the Obama administration and I
hope others will start talking about a national effort to
provide support for new mothers in the workplace so that they
are able to breastfeed their children. We just don't have that
at all in this country and we need that national effort. It is
also the workplace that we have got to start looking at. So
there are a lot of areas. I hope you will start looking at
that, too, of how we change that attitude, that mindset that we
have in this country.
Mr. Paige. Yes.
Chairman Harkin. I mean, I have seen personally and I have
heard many stories of women who take their children someplace,
maybe a restaurant, they are breastfeeding, and they are told
to stop.
Mr. Paige. Let me just jump in on that. My doctoral
student, who is now my colleague, Dr. Gross, was at Toys 'R Us.
This is in the State of Maryland about eight or 9 years ago.
She was breastfeeding in Toys 'R Us, of all places, and she was
asked to leave. She then went on a tear. She was angry and
educated and she got the law changed in the State of Maryland
that someone can discretely or appropriately breastfeed in
appropriate establishments.
You have raised the points that have been at the center of
my concern for many, many, many years in terms of how we begin
to change the culture, the workplace culture and even the
community culture, because there is a lack of receptivity to
breastfeeding, whether it is on a train or at home. Some of the
strongest negatives exist within the family itself. So we have
a great deal of work to do in this particular area.
The peer counselors have been very effective in
breastfeeding and I think they can also work in other areas of
WIC in terms of even the issue of obesity, in terms--our
communities tend to respond more immediately to the
exhortations of folks from the community. They are a powerful
force.
Chairman Harkin. We have got to focus on this, because
President Obama has suggested and has supported this visiting
nurse program and put it into his budget, by the way, for next
year, which is laudable, and that is visiting nurses to go to
homes, low-income, poverty homes where we have pregnant
mothers-to-be and to work with them on their nutrition and
stopping smoking and don't drink alcohol and that kind of peer
counseling. All of that is well and good. Hopefully, we can try
to expand that beyond that to also as an encouragement for them
to breastfeed, at least for the initial stages of the baby's
life.
Mr. Paige. The decision to breastfeed is really made
prenatally, usually, the data suggests, in the seventh or
eighth month, as the realization, recognition of a new life to
be born and a responsibility, and we need to bring in our
obstetrical community, our nursing community. As I said several
times, we need to be clever about it and we need to shape this
in a way that is also consistent.
I would add, not a polemic but just a fact that many of the
WIC women, while they initiate, the numbers begin to approach
Healthy People 2010 goals, many--a large number abandon
breastfeeding within the first three or 4 weeks. So those who
do elect do not have a--we do not have the structure either in
our health system or in WIC or in any of the social services to
reinforce that decision on the part of the mother and she
becomes quickly discouraged. There is no support internally or
externally and there is abandonment.
Chairman Harkin. Well, listen, thank you all very much.
This has been a great panel and I thank you for your leadership
in this area, all of you, in this whole area. We invite your
continued input and advice to us as we develop this
reauthorization of the child nutrition bill.
I thought the two panels were very good. We focused on the
school-based programs and we focused on the non-school-based
programs, Child and Adult Care, WIC Programs, After-School,
Summer Feeding Programs, and we have to think about how we
streamline them, make them more effective. And one word I would
add is how we leverage, leveraging money. In other words, if we
are putting things out there, what can we get communities then
to add on to in terms of leveraging those dollars a little bit
better out there.
But thank you all very much and the committee will stand
adjourned until the call of the Chair.
[Whereupon, at 12:07 p.m., the committee was adjourned.]
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A P P E N D I X
March 4, 2009
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