SECTION: CAPITOL HILL HEARING TESTIMONY

LENGTH: 2159 words

COMMITTEE: SENATE AGRICULTURE, NUTRITION AND FORESTRY

HEADLINE: 2002 FARM BILL

TESTIMONY-BY: DR. DEBORAH A. FRANK, DIRECTOR,

AFFILIATION: GROWTH AND DEVELOPMENT CLINIC

BODY:
July 19, 2001

Testimony

Before the Committee on Agriculture, Nutrition and Forestry, U.S. Senate

Food Stamp Program: Prescribing a Miracle Drug

Statement of Dr. Deborah A. Frank, Director, Growth and Development Clinic for Children at Boston Medical Center, and Principal Investigator, Children's Sentinel Nutrition Assessment Program

Senator Harkin and members of the committee,

I am honored to come before you representing the pediatric researchers of the Children's Sentinel Nutrition Assessment Program (C-SNAP) and pediatric clinicians who daily treat malnourished American children. It is for those children that we speak, since they are too young to speak for themselves. Over a three-year period, C-SNAP monitored the impact of current public policies and economic conditions on the nutritional and health status of low-income children less than 3 years old in six medical institutions in Baltimore, Boston, Little Rock, Los Angeles, Minneapolis and Washington. The C-SNAP research was principally funded by the W.K. Kellogg Foundation, as well as other foundations and private donors. If you could join physicians on the ward and in the clinics and sit in on our scientific meetings, I do not think it would be difficult to enlist your support for expanding Food Stamps to protect the health of America's people. There is hard medical data, found in the attached bibliography, that Food Stamps make a dramatic difference in the food security of families with children who live pay-check-to-pay-check; and even clearer medical evidence that food security is essential for health. The stories of the families we care for confront us daily with the stark reality, not found in any medical textbook, that as the cost of housing and energy prices increase, disproportionate to wages and benefits, many working poor and low-income parents face the often insurmountable balancing act trying to find resources to pay rent, have gas to get to work, and still put enough food on the table to keep their children healthy and learning. As community health providers our teams dedicate an incalculable amount of time to assisting families with the pitfalls and traps of filling out applications, understanding requirements and re- certifying for the FSP, the application which for which is much longer (and harder to understand) than the one I fill out each year for my medical license.

As clinicians and scientists we know that food insecurity (defined by the USDA as "limited or uncertain availability of nutritionally adequate safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways") is not a political or a sentimental issue but a major and preventable health problem. Nationwide and state-based rates of food insecurity are well known and documented, but they do not tell the whole story for the most vulnerable children. In the state of Minnesota, for example, between 1996-1998 the prevalence of food insecure households was almost 10% of the state's population. However, in our C-SNAP sample of poor families with young children living in the Minneapolis-St. Paul area, the prevalence of food insecurity was an astonishing 24%.

Food insecurity threatens health at all stages of life, but particularly in prenatal life and early childhood when the critical growth occurs. Hunger threatens the well being of the next generation even in the womb. It is the first step in a continuum between poor nutritional status and ill health. The nutritional status of a woman as she enters pregnancy, and the amount of weight that she gains during pregnancy, are critical predictors of infant birth weight. Mothers' nutritional status is a critical predictor of low birth weight, the most important contributor to infant mortality. The lower the birth weight the more likely that a child who survives will suffer from lasting impairments and school failure. Even into adulthood low birth weight's effects are seen as a strong predictor of cardiovascular disease.

Likewise, micronutrient deficiencies that arise from inadequate maternal nutrition--even in the presence of adequate maternal weight gain in pregnancy-- can have devastating consequences. There is a well-established relationship between inadequate maternal folate intake at the time of conception and the risk of neural tube defects (spina bifida) in children. This is a particular concern since non-elderly food insecure woman have been shown to have seriously inadequate intake of folate, along with other critical micronutrients such as Vitamin E and calcium.

After birth, nutrition continues to exert major influences on health and development. At all ages malnutrition impairs immune function leading to the infection/malnutrition cycle. With any acute illness all children lose weight. However, in privileged homes once the acute illness is resolved, children rapidly rebound increasing their dietary intake to restore normal growth . For many low-income families, where food supplies are uncertain even for feeding well children, once a nutritional deficit has occurred due to normal childhood illnesses scarce resources oftentimes means there is no additional food to restore a child to their former weight and health. The child is then left malnourished and more susceptible to the next infection, which is likely to be more prolonged and severe, and followed by even greater weight loss. It is this infection/malnutrition cycle, which in this country often manifests itself in preventable recurrent illnesses and utilization of costly health resources (the famous spend now on Food Stamps-- or pay later with Medicaid, SSI). This relationship between malnutrition and infection persists throughout the life span and is well established as a factor contributing to mortality and morbidity in the elderly.

Even with refeeding and medical care, malnutrition can inflict concurrent and lasting deficits in cognitive development: posing serious implications for the malnourished child's future ability to participate in the knowledge economy. The last two prenatal trimesters and the first years of life constitute a critical period of brain growth, a time when the brain has biosynthetic ability to generate new brain that it will never have again. Different regions of the brain undergo their critical development at different developmental periods. Lack of nutrients available to the brain during a critical period will lead to deficits in the part of the brain under development. As knowledge of the importance of nutrition for proper brain functioning has evolved, awareness has grown that although brain size and structure can be most affected by malnutrition in early life, brain function can be seriously affected at any age.

Even long before seeing any measurable deficits in body size, malnourished children may miss many opportunities for learning. The first physiologic strategy in the face of inadequate nutritional intake is for a child to decrease their "discretionary activity," their voluntary exploration of the environment and interactions with other people. Such discretionary activity is essential for children's learning about the inanimate and social world. Once the health professional can notice signs and symptoms of malnutrition in a child physiologically, there have already been many opportunities of missed learning that were not detected previously. Early and concurrent malnutrition are critical and entirely preventable causes of school failure from cognitive impairments, attention and behavioral difficulties. As my neighbor, a 5th grade teacher for new Americans worried about a hungry little girl in her class described to me - "she's sick a lot, she comes to school, but some days it is like she is not there - her skin is dull, there is no spark in her eyes, she wants so much to please, but some days she can remember and learn and the next day she can't." Scientists have confirmed the observations of this gifted teacher in large samples of American children. A recent article by Dr. Alaimo in the journal of Pediatrics, which is appended to the testimony, based on the government's own NHANES III data shows that food insufficient children (whose families "sometimes or often did not get enough to eat") aged 6-11 have significantly lower arithmetic scores, and are more likely to repeat a grade, and have more trouble getting along with other children. Food insufficient teenagers were 3 times more likely to be suspended from school than l food sufficient teens. No amount of standardized testing will alleviate the impact of hunger on children's ability to learn - to educate children first you must feed them. From conception through high school tomorrow's future work force must be sufficiently well-nourished to participate fully in an information economy.

In light of the multidimensional health and developmental effects of food insecurity and inadequate nutrition on humans during the life cycle, it is very disturbing that C-SNAP, in a survey of 8000 families with children under 3, found those whose food stamp benefits were terminated or decreased show significantly increased rates of food insecurity, a finding confirmed by many other surveys of poor families. We have also shown that families of young children under 3 on waiting lists for subsidized housing and those who have experienced housing instability (more than 2 moves in the past year) are substantially more likely than others to suffer food insecurity. Other work by my colleague, Dr. Jennifer Kasper, found legal immigrants, our new Americans, and their children are even more likely to be food insecure than other poor families (a finding we have confirmed in C-SNAP). These increased rates of food insecurity among the families of the youngest Americans trouble us greatly, since we have also found in C-SNAP that food insecurity is strongly associated with not only with poor maternal health and depression which impede parenting, but with children under 3 being in poor health, anemic, and requiring increased numbers of hospitalizations. (I would point out that a single 48-hour hospitalization, besides being traumatic for child and family, costs federal benefit programs more than a year's food stamp benefits for a child!)

I have been told that the Kennedy-Spector bill (S.583/H.R. 2142) would restore food stamps to legal immigrant families, provide outreach and information to eligible families who do not know they are eligible, and increase the minimum monthly benefit, measures which in medical terms I would call STAT (urgent) to protect poor Americans and their children whose health is in acute jeopardy. At our Little Rock, Arkansas C-SNAP site, a 17 month old diagnosed with Failure to Thrive from a rural, poor household with a net income less than $1300 a month, kept running out of her month-long prescription of the nutritional supplement Pediasure. When the hospital social worker inquired the parents confessed that they and the child's 7 other siblings were sharing it with her because their Food Stamps and WIC allotment was not enough to get them through the month. Even in the rural areas where our food is raised, many families are hungry.

I have also been informed that there have been suggestions to no longer offer shelter cost deductions in calculating families' food stamp benefits. If pediatric housestaff suggested a similar measure to me on the wards, I would tell them I thought the idea was NSG (not so good)!

The WIC program, a critical source of foods high in nutrient density, was designed at a time when it was anticipated that it would serve as a supplement rather than as a sole source of nutrition and thus does not provide adequate energy for participants, except infants under 4 months of age. From our C- SNAP research we have found that WIC receipt did not buffer children from the health consequences of the loss of food stamps. Both programs together are necessary (although at current food stamp benefit levels, not always sufficient) to protect the health of young children.

Distinguished members of the committee, I am here today to urge you to prescribe a miracle drug for America's families. This miracle drug decreases premature birth, enhances immune function, improves school achievement and behavior, and saves millions of dollars in hospital stays and visits to emergency rooms each year; yet millions of American children and their families are deprived of this drug and those who get it often do so in doses in adequate to protect their health. This miracle drug is enough nutritious food. The pharmacy that dispenses it is the Food Stamp Program, and you are the physicians that prescribe it.

In conclusion, hunger is a child health problem, hunger is an adult health problem, hunger is an education problem, an economic problem, and an American problem. With appropriate political will it could be no problem.



LOAD-DATE: July 23, 2001