[House Hearing, 111 Congress]
[From the U.S. Government Publishing Office]
IMPROVING CHILDREN'S HEALTH:
STRENGTHENING FEDERAL
CHILD NUTRITION PROGRAMS
=======================================================================
HEARING
before the
COMMITTEE ON
EDUCATION AND LABOR
U.S. House of Representatives
ONE HUNDRED ELEVENTH CONGRESS
SECOND SESSION
__________
HEARING HELD IN WASHINGTON, DC, MARCH 2, 2010
__________
Serial No. 111-47
__________
Printed for the use of the Committee on Education and Labor
Available on the Internet:
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COMMITTEE ON EDUCATION AND LABOR
GEORGE MILLER, California, Chairman
Dale E. Kildee, Michigan, Vice John Kline, Minnesota,
Chairman Senior Republican Member
Donald M. Payne, New Jersey Thomas E. Petri, Wisconsin
Robert E. Andrews, New Jersey Howard P. ``Buck'' McKeon,
Robert C. ``Bobby'' Scott, Virginia California
Lynn C. Woolsey, California Peter Hoekstra, Michigan
Ruben Hinojosa, Texas Michael N. Castle, Delaware
Carolyn McCarthy, New York Mark E. Souder, Indiana
John F. Tierney, Massachusetts Vernon J. Ehlers, Michigan
Dennis J. Kucinich, Ohio Judy Biggert, Illinois
David Wu, Oregon Todd Russell Platts, Pennsylvania
Rush D. Holt, New Jersey Joe Wilson, South Carolina
Susan A. Davis, California Cathy McMorris Rodgers, Washington
Raul M. Grijalva, Arizona Tom Price, Georgia
Timothy H. Bishop, New York Rob Bishop, Utah
Joe Sestak, Pennsylvania Brett Guthrie, Kentucky
David Loebsack, Iowa Bill Cassidy, Louisiana
Mazie Hirono, Hawaii Tom McClintock, California
Jason Altmire, Pennsylvania Duncan Hunter, California
Phil Hare, Illinois David P. Roe, Tennessee
Yvette D. Clarke, New York Glenn Thompson, Pennsylvania
Joe Courtney, Connecticut
Carol Shea-Porter, New Hampshire
Marcia L. Fudge, Ohio
Jared Polis, Colorado
Paul Tonko, New York
Pedro R. Pierluisi, Puerto Rico
Gregorio Kilili Camacho Sablan,
Northern Mariana Islands
Dina Titus, Nevada
Judy Chu, California
Mark Zuckerman, Staff Director
Barrett Karr, Minority Staff Director
C O N T E N T S
----------
Page
Hearing held on March 2, 2010.................................... 1
Statement of Members:
Kline, Hon. John, Senior Republican Member, Committee on
Education and Labor........................................ 4
Prepared statement of.................................... 5
Miller, Hon. George, Chairman, Committee on Education and
Labor...................................................... 1
Prepared statement of.................................... 3
Questions submitted for the record....................... 55
Shea-Porter, Hon. Carol, a Representative in Congress from
the State of New Hampshire, submission for the record:
Issue brief, ``Federal Child Nutrition Programs Are
Important to Rural Households,'' from the Carsey
Institute.............................................. 50
Statement of Witnesses:
Gettman, Lucy, director of Federal programs, National School
Boards Association......................................... 29
Prepared statement of.................................... 31
Morrison, Carolyn, president, National CACFP Forum; executive
director, Child Care Development Services.................. 13
Prepared statement of.................................... 15
Rivas, Dora, president, School Nutrition Association (SNA);
executive director, Food and Child Nutrition............... 7
Prepared statement of.................................... 9
Response to questions submitted for the record........... 56
Saluja, Kiran, MPH, RD, deputy director, PHFE WIC Program.... 20
Prepared statement of.................................... 22
IMPROVING CHILDREN'S HEALTH:
STRENGTHENING FEDERAL
CHILD NUTRITION PROGRAMS
----------
Tuesday, March 2, 2010
U.S. House of Representatives
Committee on Education and Labor
Washington, DC
----------
The committee met, pursuant to call, at 2:35 p.m., in room
2175, Rayburn House Office Building, Hon. George Miller
[chairman of the committee] presiding.
Present: Representatives Miller, Kildee, Scott, McCarthy,
Wu, Holt, Loebsack, Shea-Porter, Fudge, Polis, Sablan, Chu,
Kline, Petri, and Roe.
Staff Present: Aaron Albright, Press Secretary; Ali Al
Falahi, Staff Assistant; Tylease Alli, Hearing Clerk; Andra
Belknap, Press Assistant; Calla Brown, Staff Assistant,
Education; Jody Calemine, General Counsel; Carlos Fenwick,
Policy Advisor; Patrick Findlay, Investigative Counsel; Denise
Forte, Director of Education Policy; David Hartzler, Systems
Administrator; Kara Marchione, Education Policy Advisor; Sadie
Marshall, Chief Clerk; Alex Nock, Deputy Staff Director;
Lillian Pace, Policy Advisor, Subcommittee on Early Childhood,
Elementary and Secondary Education; Meredith Regine, Junior
Legislative Associate, Labor; Alexandria Ruiz, Administrative
Assistant to Director of Education Policy; Melissa Salmanowitz,
Press Secretary; Gabrielle Serra, Detailee, Child Nutrition;
Dray Thorne, Senior Systems Administrator; Daniel Weiss,
Special Assistant to the Chairman; Kim Zarish-Becknell, Policy
Advisor, Subcommittee on Healthy Families and Communities;
Stephanie Arras, Minority Legislative Assistant; James
Bergeron, Minority Deputy Director of Education and Human
Services Policy; Kirk Boyle, Minority General Counsel; Allison
Dembeck, Minority Professional Staff Member; Ryan Murphy,
Minority Press Secretary; Susan Ross, Minority Director of
Education and Human Services Policy; and Linda Stevens,
Minority Chief Clerk/Assistant to the General Counsel.
Chairman Miller. A quorum being present, the committee will
come to order to conduct a hearing on Improving Children's
Health: Strengthening the Federal Child Nutrition Programs.
I want to welcome our witnesses and thank you for taking
your time to be with us. I am going to introduce you in a
moment. But first we are going to have opening statements by
myself and by Representative Kline.
The statement starts out saying ``This morning,'' so we
will change it right away to say, This afternoon, we will
examine how stronger nutrition programs can help fight the
childhood obesity epidemic and help improve our students'
learning and health.
Today, almost one in three children are obese. Childhood
obesity affects all aspects of children's lives from their
physical well-being to their academic success to their self-
confidence. The health of our children should be the top
national priority.
As many of you know, First Lady Michelle Obama recently
announced that ending childhood obesity will be her first major
policy initiative. Last month she launched the Let's Move!
Campaign to ensure that children born today will grow up as
healthy adults. Mr. Kline and myself were both at the White
House when she met with the bipartisan group on what
contributions we might make as we consider the reauthorization.
By offering a realistic goal of making children healthier and
more active within a generation, she has set the stage for
dramatic improvement.
To help achieve this goal, her initiative contains four key
pillars: getting parents more involved and informed about
nutrition and exercise; making healthy foods more accessible
and affordable; increasing attention to physical activity; and
improving the quality of food in the school meal programs.
The first lady and I both know that the government alone
can not curb this epidemic. Individuals, families, communities,
and the private sector all share responsibility. I welcome her
involvement and look forward to working with her on this
initiative.
This committee can play a key role in this effort, and
today's hearing provides an opportunity to hear from
stakeholders. For over 60 years, the child nutrition programs
have helped families who have struggled with the choices of
putting food on the table or paying another bill. The School
Lunch and School Breakfast Programs and the Child and Adult
Care Food Program and the WIC Program have provided a
nutritional safety net for these families, serving nearly 45
million individuals across the country.
Studies show that pregnant women who participate in the
Womens, Infants, and Children Program have healthier
pregnancies and healthier babies. Studies have also shown that
low-income women are less likely to breastfeed than high-income
mothers. Thanks to Federal, State and local efforts, the WIC
Program has improved breastfeeding rates among WIC mothers in
this population.
The Child and Adult Care Food Program also provides
critical nutritional support to young children. This program
helps make nutritious meals and snacks possible for 3 million
children in child-care centers, family child-care homes, Head
Start and after-school programs.
The meals children receive in these programs are more
nutritious and well-balanced than in other child-care programs.
Despite this success, the tough economic times, and the
paperwork requirements, have forced some sponsors to make the
difficult decision to stop administering this program.
In South Central L.A., one of the highest risk areas of
hunger and obesity in California, no organization was able to
sponsor this program this year. We will go into some detail on
that during the question period. As a result, more than 5,000
low-income young children lost access to healthy meals and
snacks.
If we are serious about improving children's health, we
will have to make these programs and other critical sources of
nutrition a priority. But the discussion doesn't end there.
As the First Lady said, we must also consider the role
schools play in providing children with nutrition that meets
the requirements to promote academic achievement. We expect
children to come to school prepared to learn, but studies show
that hunger and poor nutrition can be major barriers to their
success.
Our work to reauthorize the child nutrition programs
presents a great opportunity to change the way children eat, to
expand their access to nutritional meals, and to end the child
hunger crisis in our country. We must ensure that schools have
the support they need to provide high-quality meals, and safe
meals, so that children can make healthy choices. We must
ensure that all eligible children can access these programs by
removing barriers families face when enrolling in the school
meal programs, like confusing application forms.
Today we will learn more about the work that lies ahead to
provide all children with the healthy, nutritious, and safe
meals they need to lead healthy and successful lives. I want to
thank our witnesses for joining us today, and I look forward to
hearing your testimony.
Now I would like to recognize Mr. Kline, the senior
Republican, for the purposes of an opening statement.
[The statement of Mr. Miller follows:]
Prepared Statement of Hon. George Miller, Chairman,
Committee on Education and Labor
Good Morning.
This morning we'll examine how stronger nutrition programs can help
fight the childhood obesity epidemic and help improve our students'
learning and health.
Today, almost one in three children are obese.
Child obesity affects all aspects of children's lives from their
physical well-being, to their academic success to their self-
confidence.
The health of our children should be a top national priority.
As many of you know, the First Lady, Michelle Obama, recently
announced that ending childhood obesity will be her first major policy
initiative.
Last month, she launched the ``Let's Move'' campaign to ensure that
children born today will grow up to be healthy adults.
By offering a realistic goal of making children healthier and more
active within a generation, she has set the stage for dramatic
improvements.
To help achieve this goal, her initiative contains four key
pillars:
Getting parents more involved and informed about nutrition
and exercise;
Making healthy foods more accessible and affordable;
Increasing attention to physical activity; and
Improving the quality of food in the school meal programs.
The First Lady and I both know that the government alone cannot
curb this epidemic.
Individuals, families, communities and the private sector all share
responsibility. I welcome her involvement and look forward to working
with her on this initiative. This committee can play a key role in this
effort and today's hearing provides an opportunity to hear from
stakeholders.
For over sixty years, the child nutrition programs have helped
families who have struggled with the choices of putting food on the
table or paying another bill. The school lunch and school breakfast
program, the Child and Adult Care Food Program, and the WIC program
have been a nutritional safety net for these families--serving nearly
45 million individuals across the country. Studies show that pregnant
women who participate in WIC have healthier pregnancies and healthy
babies.
Studies have also shown that low-income women are less likely to
breastfeed than higher-income mothers. But thanks to federal, state and
local efforts, the WIC program has improved breastfeeding rates among
WIC mothers in this population.
The Child and Adult Care Food Program also provides critical
nutrition support to young children. This program helps make nutritious
meals and snacks possible for three million children in child care
centers, family child care homes, Head Start and after-school programs.
And we know that that the meals children receive in these programs
are more nutritious and well-balanced than in other child care
programs. But despite its success, tough economic times and paperwork
requirements have forced some sponsors to make the difficult decision
to stop administering this program.
For example, in South Central Los Angeles, one of the highest-risk
areas for hunger and obesity in California, no organization was able to
sponsor this program last year.
As a result, more than 5,000 low income young children lost access
to healthy meals and snacks. If we are serious about improving
children's health, we have to make these programs, and other critical
sources of nutrition, a priority.
But the discussion doesn't end there.
As the First Lady has said, we must also consider the role schools
play in providing children with healthy meals and environments that
promote academic achievement.
We expect children to come to school prepared to learn.
But studies show that hunger and poor nutrition can be major
barriers to their success.
Our work to reauthorize our child nutrition programs presents a
great opportunity to change the way children eat, to expand their
access to nutritious meals and to end the child hunger crisis in our
country.
We must ensure that schools have the support they need to provide
high-quality and safe meals so kids can make healthy choices.
We must also ensure that all eligible children can actually access
these programs by removing barriers families face when enrolling in the
school meal programs, like confusing application forms.
Today we will learn more about the work that lies ahead to provide
all children with the healthy, nutritious and safe meals they need to
lead healthy and successful lives.
I want to thank our witnesses for joining us today. I look forward
to hearing their testimony.
______
Mr. Kline. Thank you, Mr. Chairman, and good afternoon to
all. Welcome to our witnesses.
Today we will examine Federal child nutrition programs with
an eye toward improving children's health. Childhood obesity
rates are a serious concern for parents and families, and they
present a challenge to the health of our Nation as a whole.
What children eat at school certainly plays a role in their
overall nutrition. So I welcome this opportunity to look at
what parents and local schools are doing to promote healthy
eating habits.
The last time we reauthorized the Federal nutrition
programs, Congress called on school districts to establish
local wellness policies as a way to promote good health and
engage parents in a discussion about nutrition and physical
activity. In fact, it was my friend, Mike Castle, who took the
lead on addressing children's health with these local wellness
policies. Local policies are the most direct and responsive
strategy for promoting healthy eating habits at home and at
school. They allow schools to get buy-in and involvement from
parents and students. They account for demographic and economic
differences as well as local food preferences. And they avoid
the dangers of a one-size-fits-all Federal approach to school
menu planning.
Of course, the School Breakfast and Lunch Programs are not
the only initiatives to support child nutrition. When Congress
reauthorizes child nutrition programs, we will also look at the
Child and Adult Care Food Program and the Women, Infants and
Children program, commonly known as WIC. Together these
programs help combat hunger and promote nutrition through
meals, education, and subsidies to low-income Americans. Our
goal in renewing these programs should to be strike the
appropriate balance between Federal support and local
leadership.
With local wellness policies and other initiatives, school
districts are exploring a broad range of policies to promote
better health and combat hunger. I would caution as we prepare
to renew and extend these programs, that we not confuse support
for a healthy school environment with Federal mandates for what
children and their families are allowed to eat.
One report from the Institute of Medicine concluded that
radical changes might actually undermine participation in the
School Lunch Program, saying, ``If school children are not
satisfied with the taste of food served in school meals,
participation in the school meal programs is likely to
decrease.'' That is not to say that school meals should not be
nutritious; but ultimately, good health habits begin at home.
That is why it is important for local schools to have the
flexibility to work with parents to develop policies that work
for their students.
Local schools also need the flexibility to determine what
food is sold outside the cafeteria. Many schools are
voluntarily including healthy snacks in their vending machines
or at extracurricular events, but ultimately it is local
control over food policy that allows for innovation while still
responding to each school's unique circumstances.
We have all heard the outrageous stories in which a piece
of banana bread at a bake sale does not meet the nutritional
standards, but a bag of chips meets the requirements. Clearly,
arbitrary nutritional mandates can backfire when they override
common sense. I hope we will keep these cautionary tales in
mind as we explore how parents and local schools can improve
children's health.
Thank you Mr. Chairman. I yield back.
[The statement of Mr. Kline follows:]
Prepared Statement of Hon. John Kline, Senior Republican Member,
Committee on Education and Labor
Thank you Chairman Miller, and good afternoon. Today we will
examine federal child nutrition programs with an eye toward improving
children's health. Childhood obesity rates are a serious concern for
parents and families, and they present a challenge to the health of our
nation as a whole. What children eat at school certainly plays a role
in their overall nutrition, so I welcome this opportunity to look at
what parents and local schools are doing to promote healthy eating
habits.
The last time we reauthorized the federal nutrition programs,
Congress called on school districts to establish local wellness
policies as a way to promote good health and engage parents in a
discussion about nutrition and physical activity. In fact, it was
Representative Mike Castle who took the lead on addressing children's
health through these local wellness policies.
Local policies are the most direct and responsive strategy for
promoting healthy eating habits at home and at school. They allow
schools to get buy-in and involvement from parents and students. They
account for demographic and economic differences, as well as local food
preferences. And they avoid the dangers of a one-size-fits-all federal
approach to school menu planning.
Of course, the school breakfast and lunch programs are not the only
initiatives to support child nutrition. When Congress reauthorizes
child nutrition programs, we will also look at the Child and Adult Care
Food Program and the Women Infants and Children program, commonly known
as WIC. Together, these programs help combat hunger and promote
nutrition through meals, education, and subsidies to low-income
Americans.
Our goal in renewing these programs should be to strike the
appropriate balance between federal support and local leadership. With
local wellness policies and other initiatives, school districts are
exploring a broad range of policies to promote better health and combat
hunger.
I would caution as we prepare to renew and extend these programs
that we not confuse support for a healthy school environment with
federal mandates for what children and their families are allowed to
eat. One report from the Institute of Medicine concluded that radical
changes might actually undermine participation in the school lunch
program, saying ``If schoolchildren are not satisfied with the taste of
foods served in school meals, participation in school meal programs is
likely to decrease.''
That is not to say that school meals should not be nutritious. But
ultimately, good health habits begin at home. That's why it is
important for local schools to have the flexibility to work with
parents to develop policies that work for their students.
Local schools also need the flexibility to determine what food is
sold outside the cafeteria. Many schools are voluntarily including
healthy snacks in their vending machines or at extracurricular events.
But ultimately, it is local control over food policy that allows for
innovation while still responding to each school's unique
circumstances.
We've all heard the outrageous stories in which a piece of banana
bread at a bake sale does not meet nutritional standards, but a bag of
chips meets the requirements. Clearly, arbitrary nutritional mandates
can backfire when they override commonsense.
I hope we'll keep these cautionary tales in mind as we explore how
parents and local schools can improve children's health. Thank you
Chairman Miller, I yield back.
______
Chairman Miller. Thank you.
Pursuant to committee rule 7(c), all members may submit an
opening statement in writing which will be made part of the
permanent record.
And now I would like to introduce our panel of witnesses
for this hearing. First witness, Ms. Dora Rivas, is currently
serving as president elect of the School Nutrition Association
after serving as a member of the membership committee in 2005
to 2006. Ms. Rivas has been in food service for 36 years. In
January 2005 she took the role of food and child nutrition
services executive director for the Dallas Independent School
District. Ms. Rivas is certified with the Texas Association of
School Nutrition and credentialed as a school nutrition
specialist with the School Nutrition Association. She also is a
registered dietitian with the American Dietetic Association.
Carolyn Morrison is the president of the National Child and
Adult Care Food Program Forum and the CEO of the Child Care
Development Services in Gresham, Oregon. In addition to being
current and past president of the National Child and Adult Care
Food Program Forum, she has served on numerous national and
USDA committees and task forces to improve this program. Ms.
Morrison has served on the advisory board of the National Food
Service Management Institute, the California Child and Adult
Program Roundtable, and California Food Policy Advocates, and
the Oregon Sponsors Alliance.
And I believe our colleague, Congresswoman Chu, will
introduce the next witness.
Ms. Chu. Today I have the pleasure of introducing one of my
own constituents, Kiran Saluja, who is the deputy director of
the Public Health Foundation Enterprises' WIC in Irwindale,
California. This organization is a nonprofit agency that has
been providing WIC services in the Los Angeles and Orange
County areas for over 34 years. She oversees 54 WIC centers
that are throughout the two counties, serving 325,000 clients
every month. And I am pleased to report that in my district,
she oversees seven WIC locations who serve over 46,000 people.
Ms. Saluja first joined the Public Health Foundation WIC in
1984 as a nutritionist. She is a registered dietitian and a
member of the National WIC Association, the American Public
Health Association, and the American Dietetic Association. She
has focused much of her work on breastfeeding and is a strong
and vocal advocate for healthy babies and families.
Thank you, Ms. Saluja, for joining us today, and I look
forward to your testimony.
Chairman Miller. Thank you and welcome.
Our next witness will be Lucy Gettman who is the director
of Federal programs for the National School Boards Association.
Ms. Gettman began her career as an advocacy coordinator for the
Children's Hunger Alliance in Ohio. She has held policy and
professional positions with the Ohio Attorney General, the Ohio
Student Aid Commission, and the Interuniversity Council of
Ohio.
Immediately prior to her work with the National School
Board Association, she was director of Federal relations for
the Reading Recovery Council of North America. Ms. Gettman
currently specializes in early childhood education, child
nutrition education technology and literacy issues for the
National School Board Association.
Welcome to all of you. Your prepared testimony will be
placed in the record in its entirety. You are going to be given
5 minutes to explain the highlights of your testimony. And in
front of you, you see the small boxes. When you begin, a green
light will go on. When you have used up 4 of your 5 minutes, an
orange light will go on and you may want to think about
wrapping that up. And then, when a red light goes on, your time
will have expired.
So, welcome. We look forward to your testimony and the
responses you will have to the members of the committee's
questions. Ms. Rivas, we will please begin with you.
STATEMENT OF DORA R. RIVAS, MS, RD, SNS, EXECUTIVE DIRECTOR,
FOOD AND CHILD NUTRITION SERVICES, DALLAS INDEPENDENT SCHOOL
DISTRICT
Ms. Rivas. Thank you. Chairman Miller, members of the
committee, thank you very much for continuing the extraordinary
tradition of this hearing. We deeply appreciate the courtesy.
Our two highest priorities on our issue paper in general
are to expand access and improve the nutritional content of the
meals in the environment of the local school.
First, we have several suggestions to expand access. We
recommend that direct certification and direct verification be
a high priority, that you continue to expand its use for child
nutrition. We recommend the statute be amended to allow for
community eligibility in high-poverty areas so that children do
not have to individually fill out the applications. The Hunger-
Free Schools Act, H.R. 4148, has a provision that embraces this
concept.
We support expansion of the Summer Food Service Program and
the After-School Child Care Program. We support the Healthy
Start Act introduced by Representatives Stephanie Herseth
Sandlin and Jo Ann Emerson to provide 5 cents in USDA
commodities per meal for the School Breakfast Program. And that
is H.R. 4638.
We urge the Congress to expand the Free Meal Program
gradually over time, to make the income guidelines consistent
with the income guideline in the WIC Program. H.R. 3705 has
been introduced to do this and we support that approach.
Finally, we ask that you close a major loophole in the
statute which allows funds that you appropriate for school
meals to be used for expenses unrelated to providing those
school meals. There is no provision in the statute or in the
regulations that govern what expenses can be reimbursed with
this funding. Furthermore, when a charge is made that we
believe to be inappropriate, there is no recourse. There is no
appeal process to USDA. Our suggested amendment is written in
the testimony.
Second, with regard to nutrition integrity, we have a few
suggestions. SNA, in partnership with the First Lady, Michelle
Obama's Let's Move! Campaign has committed to further improving
healthy school meals and advancing nutrition education for
America's children. I encourage you to go to our Web site to
learn more about that partnership on the First Lady's Let's
Move! Campaign.
We urge the committee to increase the reimbursement in all
meal categories. We urge you to also amend the statute and
require the Secretary to establish a consistent national
application of the most recent dietary guidelines for all meals
reimbursed by the Department of Agriculture.
The current statute is defective in two important respects.
First, it requires meals to be consistent with the goals of the
dietary guidelines. That is not specific enough. The meals must
be consistent with the guidelines, not just the goals of the
guidelines.
Second, someone must be in charge of deciding if the meals,
are, in fact, consistent with the guidelines. That
responsibility must rest with the Secretary. If every State and
local community can decide if they are meeting the guidelines,
then there is no standard at all. Children need the same
nutrients, regardless of where they live. It is basic science.
The country is spending a lot of money to develop the IOM
report and to craft the dietary guidelines. They should be
followed consistently.
The time has clearly come to end the so-called time-and-
place rule and give the Secretary the authority needed to
regulate the nutritional quality of all foods and beverages
sold on the school campus during the school day. The Secretary
should be required to promulgate regulations to guarantee that
all foods and beverages sold in schools are consistent with the
most recent edition of the Dietary Guidelines for Americans,
taking into consideration the recommendations of the Institute
of Medicine and SNA's recommendation for national nutrition
standards.
While it is mostly a matter of science, let me also mention
that the current multiplicty of nutrition standards across the
country is driving up the cost of the program. The more product
specifications that exist in the school market, the higher the
cost of production and the cost of the program. Again, our
specific amendments with regard to consistency is included in
our written testimony.
We must finally establish an effective nutrition education
program in the school.
Chairman Miller, members of the committee, thank you again
for continuing this special tradition. We pledge to work
closely with the majority and the minority to craft a
reauthorization bill that is both faithful to our children and
responsive to the deficit.
I would be pleased to answer any questions that you may
have.
Chairman Miller. Thank you very much.
[The statement of Ms. Rivas follows:]
Prepared Statement of Dora Rivas, President, School Nutrition
Association (SNA); Executive Director, Food and Child Nutrition
Chairman Miller, Members of the Committee, thank you very much for
continuing the extraordinary tradition of this hearing. We deeply
appreciate the courtesy.
I am Dora Rivas, the President of the School Nutrition Association
(SNA) and the Executive Director of Food and Child Nutrition in Dallas,
Texas. With me are 1,000 of my best friends. Each day my 55,000
colleagues in SNA serve over 31 million children in 100,000 school
districts. Representatives from countries around the world now
regularly attend our conventions to learn how the American school
nutrition programs are operated and implemented. It is a most special
American success story and this great Committee is very much a part of
that history.
Mr. Chairman, as we meet to craft the 2010 Child Nutrition
Reauthorization, we do so with the full realization that it will not be
easy to reconcile the needs of our children with the massive public
debt we face as a country. Investing in our children and preparing them
to learn and compete in a global economy must remain one of the
country's highest priorities. However, we appreciate the challenge you
will face in implementing the President's proposal to increase funding
for this critically important program.
Given the time of the day, with your permission, I will make the
SNA 2010 Issue Paper a part of the hearing record and confine my
remarks to two of our highest priorities: Expanding program access and
improving the nutritional content and environment of the local school.
Program Access
Extending the reach of the child nutrition programs, while
improving their efficiency, is one of the two major themes in our Issue
Paper. To this end, we are proposing several changes in the statute:
We recommend that direct certification and direct
verification be a high priority and that you continue to expand its use
for child nutrition. The cost of collecting and verifying income data
for the 20 million children who receive free and reduced price meals is
significant. Further, it takes our limited personnel away from the
mission of improving the nutritional quality of the meals. We are
nutritionists, not accountants, and the more you can do in this area
the better.
We recommend that the statute be amended to allow for
community eligibility in high poverty areas so that children do not
have to individually fill out the applications. The Hunger Free Schools
Act, H.R. 4148, has a provision that embraces this concept.
We support expansion of the Summer Food Service Program
and the After School Child Care Program.
We support the Healthy Start Act introduced by
Representatives Stephanie Herseth Sandlin and Jo Ann Emerson to provide
five cents in USDA commodities, per meal, for the school breakfast
program.
We urge the Congress to expand the ``free'' meal program
to make the income guideline consistent with the income guideline in
the WIC program. If the younger child qualifies for WIC, the older
sibling should qualify for fee school meals. This would mean raising
the income guideline from 130% of poverty to 185% of poverty. The
current reality is that many children who qualify for ``reduced price
meals'' simply do not have 40 cents for lunch or 30 cents for breakfast
to purchase the meal. Each day we are confronted with children who do
not have this small amount. At the end of each year, there are children
who owe the school money for meals that have been provided. We see
checks for only a few dollars that are returned for insufficient funds.
Our anecdotal data indicates that the breakfast fee is actually the
larger barrier to participation but we urge you to raise the income
level for both programs.
Finally, given the size of the programs and the
significant annual appropriation, we ask that you close a major
loophole in the statute which allows funds that you appropriate for
school meals to be used for expenses completely unrelated to providing
school meals. There is no provision in the statute, or in the
regulations that govern what expenses can be reimbursed for this
funding. As a result, we are frequently required by local schools to
pay for: sanitation for the entire school; electricity for the school;
personnel completely unrelated to the meal program; school
construction; and a disproportionate percentage of the overhead
operating costs of the school building, among other expenses. Further,
when this happens there is no recourse. There is no rule and no appeal
process to USDA.
Therefore, we are asking for an amendment as follows:
suggested amendment
Section 10 of the Richard B. Russell National School Lunch Act is
amended by adding new subsections as follows:
``(c) The Secretary shall identify those expenses that are
reasonable and necessary for providing meals under this Act and the
Child Nutrition Act of 1966.
(d) School food service authorities may reimburse only those
expenses identified by the Secretary under subsection (c).
Nutrition Integrity
As we all know, our country is facing an obesity epidemic. Obesity
is now a major public health problem that is significantly increasing
the cost of health care. While the school lunch and breakfast programs
are a part of the solution, not part of the problem, there are some
other changes that must be made within the school. This is why SNA, in
partnership with First Lady Michelle Obama's Let's Move! campaign, has
committed to further improving healthy school meals and advancing
nutrition education for America's students. To learn more about SNA's
partnership with the First Lady's Let's Move! campaign, I encourage you
to visit our website at http://www.schoolnutrition.org/
Blog.aspx?id=13585&blogid=564.
The time has clearly come to end the so-called ``time and place
rule'' and give the Secretary the authority needed to regulate the
nutritional quality of all foods and beverages sold on the school
campus during the school day. The Secretary should be required to
promulgate regulations to guarantee that all foods and beverages sold
in school are consistent with the most recent edition of the Dietary
Guidelines for Americans, taking into consideration the recommendations
of the Institute of Medicine and SNA's recommendations for National
Nutrition Standards. This must be implemented as soon as is
practicable.
We urge you to also amend the statute and require the Secretary to
establish a consistent national application of the most recent Dietary
Guidelines for all meals reimbursed by the Department of Agriculture.
The current statute is defective in two important respects:
First, it requires meals be consistent with the ``goals'' of the
Dietary Guidelines. That is not specific enough. The meals must be
consistent with the Guidelines, not just the goals of the Guidelines.
Second, someone must be in charge of deciding if the meals are, in
fact, consistent with the Guidelines. That responsibility must rest
with the Secretary. If every state and local community can decide if
they are meeting the Guidelines, there is no standard at all. Children
need the same nutrients regardless of where they live. It is basic
science. The country is spending a lot of money to develop the IOM
report and to craft the Dietary Guidelines. They should be followed
consistently.
While it is mostly a matter of science, let me also mention, that
the current multiplicity of nutrition standards across the country is
driving up the cost of the program. The more product specifications
that exist in the school market, the higher the cost of production and
the cost of the program.
We therefore suggest that the following amendment be included in
the Committee's bill:
suggested amendment
``Section 9 (f) (1) (A) of the Richard B. Russell National School
Lunch Act is amended to read as follows: ``(A) are consistent with the
most recent edition of the Dietary Guidelines for Americans as
prescribed by the Secretary; and''.
3. We must finally establish an effective nutrition education
program in the school. The investment you are making in the school
nutrition programs is significant and the country's health care bill is
even bigger. Yet for all of the words about obesity we still do not
have an effective nutrition education program in the school. The
Department, with SNA and other stakeholders, must do the research
necessary to figure out how to communicate effectively with children
about nutrition. Some schools are attempting to utilize computers that
dictate to students the number of calories in a food item and the
amount of physical activity it will take to burn off those calories.
When the Nutrition Education and Training Program was first enacted
in the 1970s, it was funded with 50 cents per child, per year. That
level lasted for only one year and then it was reduced over time. We
request that a new nutrition education program be established, funded
and modernized so it can communicate more effectively with children in
today's modern world. The First Lady, with bipartisan support, is
asking all of us to give greater attention to the obesity challenge. It
must include a nutrition education program in the schools.
Conclusion
Chairman Miller, Members of the Committee, thank you, again, for
continuing this special tradition. We pledge to work closely with the
majority and the minority to craft a reauthorization bill that is both
faithful to our children and responsive to the deficit. I would be
pleased to answer any questions that you may have.
Thank you.
2010 legislative issue paper
President Obama proposed an additional $1 billion for Child
Nutrition Reauthorization to eliminate childhood hunger and serve our
children. SNA believes every penny of this increase--and more--is
needed to make additional improvements in child nutrition programs.
Therefore, SNA urges Congress to increase funding for child nutrition.
SNA's priorities for Reauthorization include:
Top Priorities
Expand the ``free'' meal category from 130% of poverty to
185%, consistent with the WIC income eligibility guidelines
(eliminating the reduced price meal category).
Increase the per meal reimbursement for all meals in order
to keep pace with rising costs and implementation of the Dietary
Guidelines for Americans. The current Federal reimbursement of $2.68
for a ``free'' school lunch is 35 cents less than the average cost of
production.
Require the Secretary to establish a consistent national
application of the Dietary Guidelines for Americans, for all
reimbursable meals, in accordance with recommendations of the Institute
of Medicine (IOM), which benefited from SNA's Recommendations for
National Nutrition Standards.
Grant the Secretary the statutory authority to regulate
the sale of all foods and beverages on the school campus, consistent
with the most recent edition of the Dietary Guidelines for Americans,
in accordance with SNA's Recommendations for National Nutrition
Standards and the recommendations of IOM (ending the ``time and place''
rule).
Require the Secretary to determine which school expenses
and indirect costs can be paid for with school food service funds.
Additional Priorities
Funding
Allow for community eligibility in high poverty areas.
Provide USDA commodities for each school breakfast served.
Expand after school and summer meal programs.
Re-establish entitlement funding for equipment assistance
in all schools.
Administrative provisions
Require the Secretary to establish an expedited food
safety coordination and recall communication system.
Address childhood obesity by establishing an effective
nutrition education curriculum and increasing the consumption of
fruits, vegetables and whole grains.
Utilize technology to simplify program administration and
enhance financial accountability.
Establish a seamless application and reimbursement process
for all school, preschool and child care food programs.
Maximize the use of direct certification and direct
verification.
SNA Partners With First Lady Michelle Obama's
Childhood Obesity Initiative
School Nutrition Professionals Commit to New Nutrition Programs and
Goals
National Harbor, MD (February 9, 2010)--The School Nutrition
Association (SNA), representing 55,000 school nutrition professionals,
is proud to support First Lady Michelle Obama's childhood obesity
initiative. SNA and its members have agreed to a number of key steps to
further improve the nutritional quality of school meals and advance
nutrition education for America's students. Commitments include:
Challenge school nutrition programs to achieve US Department of
Agriculture's HealthierUS School Challenge Certification, significantly
increasing the number of schools nationwide meeting the program's
goals:
SNA will work with USDA to eliminate current barriers for
recognition, ensuring more schools can participate in the program;
provide training and mentoring to assist school nutrition programs in
meeting the HealthierUS School Challenge requirements; and promote the
program through conferences and meetings, publications and events
SNA's goal is to increase the number of HealthierUS
Schools from the current 600 to 2,000 in year one, and with the support
of other education community partners, reach 10,000 HealthierUS Schools
by year five
Encourage school nutrition directors to partner with the Center for
Disease Control's Coordinated School Health Programs to improve the
school health environment. SNA will offer educational programs and
training on successfully implementing the Coordinated School Health
Program.
Challenge school nutrition program directors to accelerate the time
frame for meeting the Institute on Medicine's (IOM) National Nutrition
Standards for school meals. To meet this goal, SNA will initiate the
following during the 2010-2011 school year:
Develop and promote the LAMP Awards (Leading Advancements
in Menu Planning), a recognition program encouraging school districts
and industry members to use innovative menu plans, recipe and product
development, and other tools to achieve IOM goals prior to the timeline
for implementation
Partner with local fruit and vegetable growers through
Farm to School Programs to promote consumption of more fresh fruit and
vegetables
Partner with industry to provide more affordable whole
grain products and to develop nutrition education campaigns influencing
students to consume more nutrient-dense foods at a critical time in
their development
Advance nutrition education opportunities for all students. With
the First Lady and federal officials, SNA plans to partner with media,
technology, and education program leaders to bring turnkey nutrition
education into the classroom, cafeteria, and home.
``First Lady Michelle Obama recognizes how crucial school meals are
to the health and academic success of America's children, and school
nutrition professionals are proud to support the First Lady's effort to
combat childhood obesity and strengthen under-funded school meals
programs,'' said School Nutrition Association President Dora Rivas, MS,
RD, SNS, and executive director of Food and Child Nutrition Services
for the Dallas Independent School District in Texas.
``Since announcing her initiative, the First Lady has eloquently
shared her own struggles as a working mom to foster healthy lifestyles
for her children,'' said Rivas. ``The School Nutrition Association
looks forward to working with the First Lady to encourage America's
families to get involved in school nutrition programs and promote
physical activity and healthy eating at home.''
``The school cafeteria is a classroom for students--an opportunity
for them to learn about nutrition and well-balanced meals. School
nutrition programs need the support of parents and families to
succeed--whether joining students for lunch or making time to talk with
them about the food they eat at school, taking an interest in a child's
eating habits can lead to a lifetime of good choices. After all, when a
child has tried new fruits and vegetables at home, he or she is more
likely to pick up those items when they walk through the lunch line.''
The First Lady's initiative was launched just as Congress prepares
to reauthorize the Child Nutrition Act, a critical opportunity for
legislators to enhance the National School Lunch and Breakfast Programs
for 31 million American children who benefit from school meals each
day.
``SNA has been calling on Congress to increase the school meal
reimbursement to keep pace with rising costs. We hope the First Lady's
activism will encourage legislators to provide school lunch
professionals with the support they need to offer an even greater
variety of fruits, vegetables and whole grains to students,'' said
Rivas.
The School Nutrition Association is a national, non-profit
professional organization representing more than 55,000 members who
provide high-quality, low-cost meals to students across the country.
The Association and its members are dedicated to feeding children safe
and nutritious meals. Founded in 1946, SNA is the only association
devoted exclusively to protecting and enhancing children's health and
well being through school meals and sound nutrition education.
______
Chairman Miller. Ms. Morrison.
STATEMENT OF CAROLYN L. MORRISON, CHIEF EXECUTIVE OFFICER,
CHILD DEVELOPMENT SERVICES, INC.
Ms. Morrison. Good afternoon, Mr. Chairman and members of
the committee. My name is Carolyn Morrison, and I am president
of the National CACFP Forum and a sponsor of the USDA Child and
Adult Care Food Program in Oregon. Thank you for the
opportunity to join you this afternoon to discuss the key role
the Child and Adult Care Food Program plays in ensuring young
children have access to good nutrition, and to offer
recommendations for reauthorization.
Program improvements can also help reduce childhood
overweight and obesity, a priority about which our First Lady
is so passionate. Every day across the country, millions of
low-income families rely on the healthy food their children
receive in child-care programs because of this USDA program. We
all know hunger stifles a child's health, intellect,
creativity, capacity to learn and to be at their best. This
program's resources support good nutrition and prevent
childhood obesity by offering healthy food and teaching young
children, and their caregivers, about healthy lifestyles and
meal patterns.
As a middle-class mom who decided to be a child-care
provider in the early eighties, I learned firsthand from my
exposure to low-income children who were in my care. I will
never forget the 4-year-old boy who wondered why I cooked and
didn't just go out and buy fast food. Johnny's mom was poor and
struggled to make ends meet. She loved her kids but hadn't the
resources, knowledge, or energy to feed them well. The only
nutritious meals her children received for many years were
those that she received in child care or when they were at
school.
Given the crucial role early childhood nutrition plays in
supporting the good health, cognitive growth, and development
of a child, and the lack of knowledge and/or resources of many
working families, expanding access to the program is vital to
ensuring that all children in care settings have the
opportunity to grow strong and live healthy productive lives.
For many children in child care, like Johnny, the daycare
program they attend is their primary source of food. They spend
10 to 12 hours each day in care and receive most, if not all,
of their meals while there. Allowing child-care facilities the
option of serving a third meal service, as was previously
allowed, is an opportunity to improve child nutrition through
this reauthorization.
The program is an essential source of support for family
child-care provider centers and Head Start programs. Program
resources include training and technical assistance, on-site
visits, and reimbursement for food and meal preparation costs.
The program also serves as an important tool in creating and
maintaining accessible, affordable, quality child care for
working families.
Reducing the program area eligibility test from the current
50 percent to 40 percent could accomplish, through
reauthorization, improved access to healthy meals for many more
young children.
Increasing the availability and the consumption of fresh
fruits and vegetables, whole grains, and lower fat dairy
products for young children in child care is essential to
improve development and health, and to prevent obesity at the
one-time, early childhood, when it can have the most long-term
effect.
Updating the program nutrition standards and meal pattern
to make them consistent with the most recent Dietary Guidelines
for Americans could be accomplished through reauthorization.
Improving meal quality will require enhanced meal
reimbursements.
The network of program sponsors is breaking down. Sponsors
are choosing to discontinue offering the service because they
cannot afford to continue to operate, given the paperwork and
oversight responsibilities. Nationally, 27 percent of sponsors
have chosen to leave the program. This is an especially serious
problem in Los Angeles where a sponsor chose to close, leaving
5,000 children and over 700 providers unserved in a very low-
income community.
A large challenge in my State of Oregon is the size and the
geography of our State. While 67 percent of all caregivers are
concentrated in 6 of our 36 counties, providers in the very
rural areas deserve to participate as well.
Sponsor administrative reimbursement rates should be
brought up to the level necessary to provide quality nutrition
and wellness education, cover the cost of transportation for
serving rural areas, cover the cost of additional visits and
the time spent in helping low-income providers overcome
literacy and language issues.
Retention of caregivers is challenging as they must remain
eligible for the program by meeting training requirements. We
have worked to meet this challenge by developing and offering
on-line training and healthy nutrition. This positively
impacted our retention of child-care providers in the program
as they now have access to mandatory training, regardless of
where they live.
Among other topics, these trainings focus on serving more
fresh fruits and vegetables, low-fat milk and whole grains, and
have a secondary benefit of helping them meet licensing
requirements. Partnerships with local colleges and universities
have enabled us to develop these resources, as there simply
isn't enough money from the sponsor reimbursement to develop
them.
In closing, we strongly support legislation introduced by
Representative Tonko, the Access to Nutritious Meals for Young
Children Act, which includes the recommendations I have
discussed today. And lastly, I would like to invite each of
you, when you are home in your districts, to visit child-care
centers, homes, and sponsoring organization to see firsthand
the importance and opportunities available through the program
for playing a role in improving children's health, their lives,
and reversing the childhood obesity epidemic.
Thank you very much for this opportunity to share this
information with you on behalf of all the sponsors.
Chairman Miller. Thank you.
[The statement of Ms. Morrison follows:]
Prepared Statement of Carolyn Morrison, President, National CACFP
Forum; Executive Director, Child Care Development Services
Good afternoon, Mr. Chairman and Members of the Committee, I am
Carolyn Morrison, President of the National CACFP Forum, an
organization that serves to promote, protect and perfect the Child and
Adult Care Food Program (referred to as the CACFP); and Executive
Director of Child Care Development Services, Inc. (CCDS), an Oregon
sponsor of the CACFP. Thank you for the opportunity to join you this
afternoon to discuss the key role the Child and Adult Care Program
plays in ensuring young children have access to good nutrition and to
offer recommendations for strengthening the program through the Child
Nutrition Reauthorization. A well-conceived reauthorization bill,
focused on the right program improvements for CACFP, can help to reduce
hunger, childhood overweight and obesity, improve child nutrition and
wellness, and enhance child development and school readiness.
Every day, across the country, millions of low-income families rely
on the healthy food their children receive in child care through the
USDA Child and Adult Care Food Program. CACFP reimbursements, nutrition
requirements and training support high quality nutrition experiences
for over 3 million children in child care: more than two-thirds of them
in child care centers, and the rest in family child care homes.
Ensuring young children are well-fed in child care promotes their
health, creativity, capacity to learn and be at their best.
As a middle class mom who decided to be a child care provider in
the early 80's, I learned this first hand from my exposure to low-
income children who were in my care. I will never forget the 4-year old
boy who wondered why I cooked and didn't go get fast food. Johnny's mom
was poor and struggled to make ends meet. She loved her kids, but did
not have the resources, knowledge or time to feed them well.
Unfortunately, under the current system healthy CACFP meals and
snacks are out of reach for millions of young children in child care.
Over half the children in child care are in centers or family child
care homes that do not participate in CACFP. Family child care homes'
participation in CACFP, which had been one of the fastest growing
nutrition programs, has dropped 27 percent since the introduction of a
complex two-tiered reimbursement system in 1997. (Thirteen states have
had a drop of 42% or more.) Given the crucial role early childhood
nutrition plays in the cognitive growth and development of a child, and
the lack of knowledge and/or resources of many working parents,
expanding access to CACFP is vital to ensuring that all children in
care settings have the opportunity to grow strong and live healthy,
productive lives.
For many children in child care like Johnny, the child care program
they attend is their primary source of food; they spend 10-12 hours
each day in care and receive most, and some days all, of their meals
while there.
CACFP is a vital source of support for family child care providers,
centers and Head Start Programs. CACFP sponsoring organizations play a
critical role in ensuring child care providers can participate in this
program and serve healthful meals to children under their care. CACFP
resources, including training and technical assistance, on-site visits
and reimbursement for food and meal preparation costs, support:
providing good nutrition and preventing childhood obesity
by teaching children and caregivers about healthy lifestyles and meal
patterns, and
creating affordable, quality child care.
Numerous studies throughout the years have demonstrated that the
CACFP is vitally important to providing young children with the
necessary nutritional support to have a healthy start in life as well
as contributing to an improved overall quality of care. (Please see
Appendix A for summary of research.)
The reauthorization of the Child Nutrition Programs provides an
important opportunity to make the necessary improvements to increase
program access and nutrition quality, and protect the quality of CACFP
services for children in child care by:
Increasing CACFP reimbursements to improve nutrition and
stem participation declines;
Raise program reimbursement to support sponsoring
organizations' nutrition and wellness education requirements, reaching
and teaching low-literacy providers and rural transportation costs;
Reducing the CACFP area eligibility test from 50 percent
to 40 percent;
Allowing child care centers and homes the option of
serving a third meal service (typically this would be a supper or an
afternoon snack), as was previously allowed;
Updating the CACFP nutrition standards and meal pattern to
make them consistent with the most recent Dietary Guidelines;
Streamlining program requirements, reducing paperwork, and
maximizing technology.
Increase CACFP reimbursements to stem participation declines and
improve nutrition. Purchasing, preparing and serving more nourishing
meals and snacks are more expensive. Increasing the availability and
consumption of fruits and vegetables, whole grains, and lower fat dairy
products for young children in child care is absolutely essential to
improve development and health and to prevent obesity at exactly the
time--early childhood--when it can have the most long-term effect. This
effort needs to be supported by adequate meal reimbursements. At the
same time, family child care participation declines created by
reimbursement cuts need to be reversed. Higher reimbursements will
assure that more children participate in CACFP, both attracting more
child care centers and helping to stem the loss of family child care
providers. A study done in Oregon found that inadequate reimbursement
rates and paperwork were the top two reasons for providers to leave
CACFP.
Raise program reimbursement to support sponsoring organizations'
nutrition and wellness education requirements, reaching and teaching
low-literacy providers, rural transportation costs and sustain family
child care providers participation in the food program. Access to
healthy meals is threatened by the breakdown in the network of CACFP
sponsors, the non-profit community-based organizations supporting the
participation of family child care homes in CACFP. Unable to make ends
meet due to high program costs and the loss of economies of scale as
providers dropped out of the program, 28 percent of sponsors stopped
sponsoring the program in the last dozen years. In a 2006 USDA report,
researchers reported that ``Costs reported by sponsors on average were
about 5 percent higher than allowable reimbursement amounts.''
Sponsors' administrative reimbursement rates should be brought to the
level necessary to provide quality nutrition and wellness education,
cover the transportation costs of serving family child care homes in
rural areas, and cover the costs of additional visits, and the time
spent in helping low-income providers overcome literacy and language
issues. Due to a recession influenced Consumer Price Index, sponsors
administrative reimbursement rates were recently reduced by one dollar
per home per month, forcing the elimination of jobs in these community-
based organizations.
In the worse cases this has created situations such as the crisis
in Los Angeles where yet another long term dedicated sponsor could no
longer remain viable within the reimbursement rates. The loss of this
sponsor left 5,000 children and over 700 providers unserved in a very
low income community. The cumulative impact of so many sponsors
dropping out is limited access to CACFP. Limited service can be a
significant problem in both urban and rural areas.
In my state over the last 10 years, the number of sponsors dropped
from18 to only 10. A large challenge for serving Oregon is the size and
geography of our state. While 67% of all caregivers are concentrated in
6 counties, providers in the very rural areas deserve to participate as
well.
Retention of caregivers is challenging as they must remain eligible
for the CACFP by meeting training requirements. We have worked to meet
this challenge by developing and offering online courses. Online
training in health and nutrition positively impacted our retention of
child care providers in the CACFP as they now have access to mandatory
training, regardless of where they live. Among other topics these
trainings focus on serving more fresh fruits and veggies, low fat milk
and whole grains and have a secondary benefit of helping them meet
licensing requirements Partnerships with local colleges and
universities have allowed us to develop resources as there simply isn't
enough money from sponsor reimbursements to develop these resources.
Reduce the CACFP area eligibility test from 50 percent to 40
percent to streamline access to healthy meals for young children in
child care. Area eligibility, the most successful and inclusive CACFP
eligibility mechanism, allows family child care homes in low-income
areas to automatically receive the highest CACFP reimbursement rates.
This ``area eligibility'' test has proven extremely effective because
it substantially decreases the paperwork for providers and families by
eliminating the need to individually document each child's household
income.
Currently, family child care homes only qualify for area
eligibility in areas with 50 percent or more low-income children (as
defined by local census data or the percentage of children in the local
school eligible for free and reduced price meals.) The threshold is too
high to appropriately target many communities with struggling families.
This is especially true in rural and suburban areas which do not
typically have the same pattern of concentrated poverty seen in urban
areas.
Reducing the area eligibility test to a 40 percent threshold would
lead to many more child care providers who serve low-income children
becoming eligible, and many children in need being served healthy CACFP
meals and snacks. When confronted with the complex CACFP eligibility
requirements to be met outside of the areas currently eligible most
providers choose not to participate. It is easier just to resort to
serving cheaper, less nutritious meals and operate without the CACFP
standards, oversight, and required paperwork. It is not uncommon for
providers to forgo offering even the less costly meals and simply let
children rely on food sent from home which is often less than
nutritious.
Allow child care centers and homes the option of serving a third
meal service (typically this would be a snack or supper), as was
previously allowed. As parents work longer hours to make ends meet,
many more young children are spending more of their waking hours in
child care on work days. National child care standards, based on the
best nutrition and child development science, specify that young
children need to eat small healthy meals and snacks on a regular basis
throughout the day. Child care centers and homes used to receive
funding for three meals, until Congress in 1996 cut out one meal to
achieve budget savings. This penny-wise and pound-foolish step harms
children's nutrition and health and weakens child care. We should
restore CACFP support to the full complement of meals young children
need and stop short-changing young children at a time when they can
least afford it.
Improve the nutritional value of the meals and snacks and the
promotion of health and wellness in child care participating in CACFP.
Direct the Secretary of Agriculture to issue proposed regulations
updating the CACFP meal pattern, including recommendations for the
reimbursements necessary to cover the costs of the new meal pattern,
within 18 months of the publication of the IOM CACFP Meal Pattern
report. In the interim, USDA should issue guidance, and provide
education and encouragement for serving healthier meals and snacks
consistent with the Dietary Guidelines with an emphasis on increasing
consumption of whole grains, fruits and vegetables, and lower fat dairy
and protein foods.
Streamline program requirements, reduce paperwork, and maximize
technology to improve program access. This can be accomplished through
the following no or very low cost proposals which will improve CACFP's
ability to reach low-income families: 1) allow CACFP sponsoring
organizations to plan multi-year administrative budgets using carryover
funds, and to keep their earned administrative reimbursement using a
``homes multiplied by rates'' system; 2) direct the Secretary of
Agriculture to reduce paperwork by eliminating ineffective and poorly
targeted requirements including ``block claiming;'' 3) restore the
right to advance funds; 4) allow CACFP family child care providers to
facilitate the return of family income forms; 5) eliminate a barrier to
participation by allowing the use of the last four digits of the social
security number; 6) continue the USDA Paperwork Reduction Initiative;
and 7) streamline program operations, increase flexibility, and
maximize technology and innovation to reduce parent paperwork and allow
sponsoring organizations and providers to operate most effectively.
(Please see Appendix B for more details on the paperwork reduction
proposals.)
In conclusion, while the CACFP has been and continues to be an
important and beneficial child nutrition program, I would encourage the
Committee to consider improvements to the program.
We strongly support legislation introduced by Representative Tonko,
the Access to Nutritious Meals for Young Children Act. The program
improvements in this bill will help to improve child nutrition, reduce
hunger, and enhance child development and school readiness. Program
improvements will also help reduce childhood overweight and obesity, a
priority about which our First Lady is so passionate.
I encourage you to visit sponsoring organizations and child care
homes in your districts. Seeing the program benefits first hand will
further underscore the importance and opportunities available through
the CACFP for playing a role in improving children's lives and
reversing the childhood obesity epidemic. I am certain sponsors and
providers would be thrilled to have you visit their programs personally
to see the good work of this important program.
Thank you for this opportunity to share this information with you
on behalf of sponsors across the country.
appendix a
Food Research and Action Center
Child and Adult Care Food Program Benefits
Research has demonstrated CACFP's clear role in helping to assure
good nutrition and high-quality, affordable child care. The program is
a well documented success:
The U.S. Department of Agriculture's Evaluation of the
Child and Adult Care Food Program found that children in the Child and
Adult Care Food Program received meals that were nutritionally superior
to those served to children in child care settings without the Child
and Adult Care Food Program.
The Journal of the American Dietetic Association published
a study, Dietary Intake of Children In Urban Day Care Centers,
comparing the intake of children at a center using the Child and Adult
Care Food Program versus a non-participating center and found that
children at the participating center had significantly higher intakes
of many key nutrients, including protein, minerals, vitamins, and
consumed significantly more servings of milk and vegetables, with fewer
servings of fats and sweets, than the children at the non-participating
center. Children from the participating center also had fewer days of
illness than children from the non-participating center.
The Economic Research Service's Maternal Employment and
Children's Nutrition Volume 1, Diet Quality and the Role of CACFP
reported, ``An association was found between program participation and
better overall diet quality (more fruit, milk and variety, and less
total fat); reduced likelihood of food energy consumption below 90
percent of the average requirements; and lower levels of soda, other
soft drinks, and added sugars. These differences especially favor
children in low-income households.''
Findings from a recently completed study, It's 12 O'clock
* * * What Are Our Preschoolers Eating For Lunch?, found that when
comparing the meals and snacks children brought from home to eat in
child care without CACFP to the meals and snacks served in child care
with CACFP, meals and snacks brought from home had significantly poorer
quality than meals and snacks served by CACFP providers. (Children were
sent to child care with a wide range of foods including items such as a
McDonald's McGriddle with sausage.) Meal quality was higher for the
CACFP meals which generally featured more fruits and vegetables, lean
meat and milk.
A study conducted by the Midwest Child Care Research
Consortium reported, that ``participation in the USDA Food Program was
associated with quality. This association held true for family child
care providers and for infant/toddler center-based regardless of the
provider's education level.'' In the report, Child Care Characteristics
and Quality, researchers recommended using CACFP as a way to expand
training and educational opportunities because ``the USDA Food Program
has been an important way to augment the quality of programs serving
low-income children.''
The Families and Work Institute's Study of Children in
Family Child Care and Relative Care, cited participation in the Child
and Adult Care Food Program as one of the major factors associated with
quality care, reporting that 87 percent of the family child care homes
considered to be providing good quality child care participated in the
Child and Adult Care Food Program.
The U.S. General Accounting Office's report, Promoting
Quality in Family Child Care, cited the effectiveness of the program:
``Because of its unique combination of resources, training, and
oversight, experts believe the food program is one of the most
effective vehicles for reaching family child care providers and
enhancing the care they provide.'' \i\
---------------------------------------------------------------------------
\i\ Improving Children's Health: Strengthening Federal Child
Nutrition Programs
---------------------------------------------------------------------------
appendix b
Improve CACFP's Ability to Reach Low-income Families by Streamlining
Program and Paperwork Requirements (No or Very Low Cost
Proposals)
Allow CACFP sponsoring organizations to plan multi-year
administrative budgets, the use of carryover funds (similar to WIC) and
the option to keep their earned administrative reimbursement using a
``homes multiplied by rates'' system similar to the new system recently
enacted in the Summer Food Service Program. Taking a lesson from the
success of these administrative mechanisms in the WIC and Summer Food
Service programs, sponsoring organizations should be given the
flexibility needed to use their earned reimbursement to provide the
best services to child care providers in CACFP. This would allow
sponsors to make adjustments to budgets to account for the level of
provider participation which is often difficult to predict. Under the
current system, if a sponsor saves in an attempt to set aside funding
for a future purchase, for example to buy needed equipment instead of
paying more through a lease, they are penalized by the reimbursement
structure and lose the reimbursement. In addition, sponsoring
organizations, which now have to bring their budgets to a full and
complete stop at the end of the fiscal year, are sometimes forced to
cut back on necessary spending towards the end of the year to insure
their costs do not exceed earned reimbursement.
Direct the Secretary to reduce paperwork by eliminating
the ineffective and poorly targeted block claiming requirement. The
block claiming requirement has accomplished little except to generate
an enormous amount of unnecessary wasted time spent filling out
meaningless paperwork, driving around using up expensive gasoline, and
alarming child care providers and parents for very little reason. A
poorly defined edit check, such as the block claiming requirement,
defeats the purpose and can actually be counterproductive as it pulls
valuable resources away from legitimate control functions and
programmatic objectives. Because the CACFP block claiming lacks
specificity it identifies and funnels a large portion of false
positives (legitimate claims) into higher intensity oversight,
overwhelming other effective system of controls. All indications are
that the vast majority of providers identified as block claiming under
the rule are not over-claiming but are accurately recording a normal
attendance pattern. These normal attendance patterns are reflective of
a wide range of legitimate situations including homes with a small
number of children.
Restore the right to advance funds for sponsors and child
care centers to cover program costs upfront. Some child care centers
find it too expensive to pay all the CACFP food costs up front for
several months before the first CACFP payment arrives. Advance funds,
when a state chooses to offer them, can help to bridge that initial gap
and ease the way for centers serving many low-income children to
participate in CACFP. Some sponsoring organizations face similar
problems and rely on advance funds. Sponsors regularly wait for up to
two months before their claims for reimbursement are paid by the State.
PL 104-193 reversed a long standing provision of the law and allowed
states the option to eliminate advance funds. The right to advances
should be restored to address access problems generated in areas where
the funds have been removed.
Allow CACFP family child care providers to facilitate the
return of participating children's family income form. For parents
willing to share their forms with their family child care providers
this option could make participation in the program much easier.
Parents can just hand their CACFP forms with their provider when they
bring their child to child care. If the parent forgot to sign the
document or failed to include other important information, the provider
will be able to tell the parent right away and explain how to remedy
it.
Eliminate a barrier to participation by allowing the use
of the last four digits of the social security number. Many parents are
concerned about giving their full social security number on CACFP
applications because of fears of identity theft. Using just the last
four digits, like so many receipts and records these days, will allay
parents fear and make them more willing to return the necessary CACFP
forms for their children to participate in the program.
Continue USDA Paperwork Reduction Initiative. We recommend
USDA continue to build on the success of its Paperwork Reduction
initiative including reconvening the work group.
Streamline program operations, increase flexibility, and
maximize technology and innovation to allow sponsoring organizations
and providers to operate most effectively. There are a wide range of
possibilities for accomplishing this goal, a number are listed below:
Allow the use of existing attendance records instead of
re-counting heads at meal time and snack time. Detailed attendance
records are kept every day at child care programs. These records are
sufficient, when coupled with food purchase and meal service counts, to
determine consumption of meals and snacks each day.
Allow total counts of meals and snacks served; stop
requiring a name list and check-marks to indicate each individual child
ate which meal and snack. Total numbers are sufficient for ensuring
accountability of public funds to serve nutritious meals and snacks.
States should also accept electronic print-outs of daily
attendance records. Currently, not all states allow this, and instead
require providers to manually prepare an additional list to document
attendance for CACFP records separate from the attendance records they
keep for the child care center as a whole.
Establish permanent operating agreements for eligible
child care programs with an annual update only if an update is needed
to reflect program changes and to ensure continued compliance. If there
have been no changes, there should be no update required. This would
alleviate one of the many layers of paperwork involved in program
participation.
Require states that require both income eligibility and
enrollment forms to combine the forms into one. Parents should not have
to complete two nearly duplicative forms.
On parent information forms, collect only the last four
digits of the Social Security number to prevent identify theft and
ensure parent participation in the eligibility process.
Allow states to collect scanned documentation in place of
duplicate paper copies. This would cut down on the need to make
multiple copies of documentation, and to maintain those copies at the
child center (and, for multi-site operators, reduce the duplicate
paperwork also kept in the headquarters office). This would also reduce
the quantity of paper and help CACFP to ``go green.''
Allow two-year contracts with food vendors where possible.
Allowing the opportunity to lock in a good rate for a two-year contract
would be better than annual reapplications, and would save providers
and state and federal agencies valuable time and money.
______
Chairman Miller. Ms. Saluja.
STATEMENT OF KIRAN SALUJA, MPH, RD, DEPUTY DIRECTOR, PUBLIC
HEALTH FOUNDATION ENTERPRISES, INC.
Ms. Saluja. Good afternoon, Mr. Chairman, Ranking Member
Kline, distinguished members of the committee, staff, and thank
you so much, Congresswoman Chu, for the very nice introduction.
I am Kiran Saluja. I am here from Los Angeles. I work with
this very large organization that Dr. Chu told us about. And I
am also here as the voice of the National WIC Association,
which essentially is an advocacy voice of over 12,000 service
agencies that provide WIC services to over 9.2 million
participants throughout the country. Of these 9.2 million, 7
million are infants and children under the age of 5.
And exactly what we are talking about here today,
preventing childhood obesity, really needs to start in the WIC
program. And I am here to tell you that we have a solution. We
can actually start to prevent childhood obesity from the day
the child is born, and the way we do it is by ensuring that
this child gets exclusively breastfed. Not only does he get
exclusively breastfed at birth, but he gets some duration,
because, according to the Centers for Disease Control and
Prevention, we can prevent 15 to 30 percent of childhood
obesity if the child is breastfed. The greatest protection
happens when the child gets no formula, no solids, and it goes
on to at least 6 months.
Now, this is the magic pill. Why haven't we embraced it?
Well, it certainly isn't for lack of effort, because I want to
thank all the members of this committee. I want to thank
Chairman Miller specifically, and Representative Carolyn
McCarthy, the chair of the Healthy Families Subcommittee.
Thanks to all of you, the Ag Appropriations Committee bill
provided a major expansion. They quadrupled the breastfeeding
peer counseling moneys in the last bill. They created a new
breastfeeding performance bonus, which is very unusual and was
extremely welcomed by WIC agencies and provided new funding for
evaluation of program effectiveness.
The WIC food package was like manna from heaven for all the
WIC providers. We had been waiting for it to change, and in
October of 2009 it did change, and it is a fabulous tool for us
to really get out there with good nutrition messages. And, it
has a little extra food for the fully breastfeeding mother,
which helps us package exclusive breastfeeding.
Now, you might say, well, what is WIC doing with
breastfeeding? Well, our rates are increasing but they are
increasing very slowly. And we are lagging behind the national
data because non-WIC moms do better than WIC moms. And so why
is that happening? Well, I am here to ask you for five things.
Everybody is asking you, so I am sorry.
I have five asks. Number one, we would really like you to
direct Food and Nutrition Services to restore the $2 increment
that the fully breastfeeding moms had when they had that little
extra edge. It doesn't sound like a lot, but that $2, you know
that WIC staff out in the field can really leverage it when
they are working with a mom when she is kind of vacillating: I
don't know, what should I do? Well, you know you get extra
fruits and vegetables. So, we would really like to see that put
back in.
We would like you to make us some time, so we can help
mothers where they need the support. And you might say, well,
how I am going to do that? I can't create time. Well, yes, you
can. You can help us by extending certification for children--
that is 40 percent of our participants--to 1 year. We do that
for breastfeeding moms. We do that for infants. We should do it
for children. That would release precious minutes that
breastfeeding mothers need for support.
Now, what about barriers external to WIC, because everybody
doesn't live in the WIC world. If they did, trust me, we
wouldn't have childhood obesity and we would have everybody
breastfeeding because that is how committed your WIC staff is
out there. Well, the external barriers to breastfeeding really
mean comprehensive policy changes in the institutions that our
mothers go to outside of WIC, because we really need to
optimize this money that has been put into WIC to do what we
should be doing. And I am really speaking specifically of
unsupportive infant feeding policies in health care systems. I
am speaking of the intense direct marketing of infant formula,
and I am speaking of poor community and workplace support.
So what I am asking you all is to really--I hate the
cliche, think outside the box, but think outside the box and
work with Members of Congress and figure out how can we tackle
this problem, how can we pass legislation that says if there
are Medicaid births happening in a hospital, that hospital
should not sabotage breastfeeding, it should support
breastfeeding. And you might say, how does it sabotage breast
feeding? Babies get given formula bottles right at birth.
Mothers get separated from their babies. It is not that people
want to be mean, it is just the policy. It is like an archaic
policy that needs to be changed and there are hospitals now
that have embraced policies. Outcomes are different.
Oregon has some very wonderful hospitals. Northern
California does. Throughout the country we have some very good
models. I would love us to have many more of them throughout
the country.
What about marketing of infant formula? You might say,
well, you know--my time is almost up--moms get very confused
with marketing messages. They come to WIC and they say, Can I
have that breast milk in a can? And we are like, there is no
such thing. And it is because they get free formula when they
leave the hospital, they get formula, coupons, and free formula
at their doorstep.
This has to stop. We are spinning our wheels in the WIC
program. Our mothers are suffering and our babies are getting
fatter and none of us really want that. I know my time is up so
I will not keep that beautiful quote that I had at the end.
I had two more asks, but they are in my written testimony.
Thank you for indulging me. I really appreciate your attention.
Chairman Miller. Thank you very much.
[The statement of Ms. Saluja follows:]
Prepared Statement of Kiran Saluja, MPH, RD,
Deputy Director, PHFE WIC Program
Good morning Chairman Miller, Ranking Member Kline and
distinguished Members of the Committee. I am honored by this
opportunity to address the Committee and applaud your commitment to WIC
and the Child Nutrition Programs.
I am Kiran Saluja, Deputy Director of the non-profit Public Health
Foundation Enterprises WIC Program in Irwindale, California. PHFE WIC
is the largest local agency WIC Program in the nation serving 326,350
participants every month. In our agency, we enroll 60,000 newborns
annually, delivered at over 80 birthing hospitals in the nation's most
ethnically and culturally diverse, densely populated counties--Los
Angeles and Orange County, California.
I am testifying today on behalf of the National WIC Association
(NWA), the education and advocacy voice of the over 9.2 million
participants and 12,200 service agencies of the Special Supplemental
Nutrition Program for Women, Infants, and Children, known as WIC. A
copy of the Association's 2010 WIC Reauthorization recommendations and
statement on WIC's Role in Preventing Maternal and Childhood Overweight
and Obesity have been attached to my submitted testimony.
I am honored to have this opportunity to share some of our
breastfeeding promotion, support and advocacy strategies and our
successes.
``Breastfeeding is a natural ``safety net'' against the worst
effects of poverty. If the child survives the first month of life (the
most dangerous period of childhood) then for the next four months or
so, exclusive breastfeeding goes a long way toward canceling out the
health difference between being born into poverty and being born into
affluence. * * * It is almost as if breastfeeding takes the infant out
of poverty for those first few months in order to give the child a
fairer start in life and compensate for the injustice of the world into
which it was born.''
These words by James P Grant, former Executive Director of UNICEF,
may well have been written for the millions of infants and children
served by the WIC Program. This is because WIC, along with AAP, CDC,
WHO and many other health organization, has long understood that
breastfeeding offers far-reaching benefits for mothers and babies.
These organizations unanimously support exclusive breastfeeding as the
preferred, normal and species specific way to feed babies for at least
the first six months of a baby's life. Increasing exclusive
breastfeeding rates among low-income women is a key strategy for health
improvement in general--and particularly for the prevention of
childhood obesity.
The collective efforts of WIC Programs across the country at
promoting and supporting breastfeeding have resulted in an increase in
breastfeeding rates. According to the most recent WIC Participant
Characteristics Report, breastfeeding rates are at record highs--58%
initiation and 28% at 6 months. It is true however that despite the
continued rise in breastfeeding rates overall, these rates are lower
than the Healthy People 2010 goal of 75% breastfeeding initiation and
50% at 6 months. At PHFE WIC our comprehensive collective efforts have
demonstrated an increase in the numbers of infants breastfed at newborn
enrollment. The dramatic effect of the changes to the WIC food package
was most apparent in October 2009 when the rate of exclusively
breastfed newborns enrolled in the PHFEWIC program jumped to a record
high of 44.8%. [see graph on next page]
There is also a slow but definite increase in the DURATION of
breastfeeding among PHFEWIC's 60,000 infants as is seen in the graph
below. Notice all ages depicted (2, 4, 6, 12 months) show a steady
upward trend.
Last year, in the Agriculture Appropriations bill, Congress created
huge opportunities for WIC to make quantum improvements in
breastfeeding rates, which the WIC community is really excited about.
The WIC community is grateful to Representative Carolyn McCarthy, Chair
of the Healthy Families and Communities Subcommittee, and to Chairman
Miller for their vision and leadership in promoting increased funding
for WIC breastfeeding initiatives through legislation extending WIC and
the Child Nutrition Programs through September 2010 signed into law
last year. The bill provided a major expansion of Breastfeeding Peer
Counselor (PC) programs by increasing funding fourfold, as well as
supporting (1) creation of a new performance bonus for states that
achieve high rates or increased current rates of exclusive
breastfeeding and (2) new funding for evaluations of program
effectiveness. (Aside from the WIC appropriations, coverage for
breastfeeding support, including the use of Peer Counselors, was
written into all pending versions of health care reform legislation,
since it has been approved and recommended by the US Preventive
Services Task Force.)
As you know, the increase in PC funding represents a substantial
increase, from $20 million to $80 million this fiscal year, which
should enable state and local WIC agencies to assist many, many more
WIC mothers with effective support for increased breastfeeding
initiation, duration and exclusivity.
Coupled with the major policies around breastfeeding and infant
feeding that were a key component of the WIC food package changes we
implemented last October, this incredible boost in breastfeeding
investment means that a real opportunity now exists for the WIC
community to achieve--and document--increased rates of exclusive
breastfeeding in a population that is disproportionately impacted by
the poor health outcomes including obesity, diabetes, and other chronic
disease, which breastfeeding can help prevent.
Robust and well-designed evaluations of peer counseling and other
breastfeeding interventions are critical in assisting state and local
WIC agencies determine the most efficient and effective strategies for
increasing the rates and duration of exclusive breastfeeding in our
diverse population. The new WIC breastfeeding performance bonus can
then be used to encourage state and local WIC agencies to adopt
breastfeeding promotion and support strategies that really work. The
performance bonus is a groundbreaking policy. For the first time in our
history, this new provision challenges WIC to go beyond our important
core function of serving all the families we can, to actually beginning
to work towards concrete and measurable public health outcomes.
In 2005, the Institute of Medicine (IOM) recommended an enhanced
breastfeeding food package to encourage and support mothers who choose
to fully breastfeed. The USDA Food and Nutrition Service (FNS), in
publishing its Interim Final Rule on the WIC Food Packages correctly
emphasized the distinction between the fully breastfeeding food package
and other food packages for women when it set the fruit and vegetable
cash value vouchers for this food package at $2 above the value for
other food packages for women. These changes in the WIC Food Package
provided WIC staff unprecedented opportunities to market the enhanced
food benefits for ``fully'' (i.e., exclusively) and ``mostly''
breastfeeding mothers and babies. The fiscal year 2010 Agriculture
Appropriations Act directed FNS to increase the fruit and vegetable
cash value voucher to the IOM recommended value for all women to $10,
eliminating that important distinction.
I urge the Committee to:
A. Maintain the enhanced value of the fully breastfeeding food
package, as recommended by the IOM and as proposed by FNS in the
Interim Final Rule, and direct FNS to set the breastfeeding fruit and
vegetable cash value voucher for the breastfeeding package at $12 vs.
$10 for all other women.
B. Maintain funding for robust and strategic evaluations of WIC,
including the impact of breastfeeding, and food package changes on
participant health behaviors and outcomes.
C. Support the Breastfeeding Performance Bonus and provide $10
million in performance bonus payments (to be treated as program income)
to State agencies that demonstrate the highest proportion of breastfed
infants, as compared to other State agencies participating in the
program; or the greatest improvement in proportion of breastfed
infants, as compared to other State agencies. When providing
performance bonus payments to State agencies, FNS should consider a
State agency's proportion of participating fully breastfed infants.
WIC's breastfeeding education and promotion efforts are well in
sync with the enhanced foods of the new WIC food packages for babies as
well as mothers. Throughout the nation WIC staff received intensive
training in how they would no longer be routinely providing infant
formula in the first month, instead offering lots and lots of
breastfeeding support. To reach extended duration and have mothers
breastfeed fully to one year, the extra foods for babies at six months
are expected to prove an added bonus. Staff is spending more time
counseling new mothers and at subsequent visits working with mothers to
resolve breastfeeding challenges to keep mothers as mostly or fully
breastfeeding. All of this takes time. To allow sufficient time for
ongoing breastfeeding support we must look at releasing precious
minutes from other activities.
Currently states have the option to certify infants and
breastfeeding women for one year at a time. However, the current
eligibility period for children--who make up nearly two-thirds of those
enrolled in WIC--remains every 6 months. This simple change would allow
WIC frontline staff to redirect their focus from costly paperwork to
the provision of nutrition education, enhanced breastfeeding support
and anticipatory guidance.
I urge the Committee to give States the option to certify children
for one year.
Peer Counseling Funding
The needs of WIC mothers for breastfeeding support vary greatly
with culture, age, education, assimilation, employment, family support
or lack thereof, and a host of other variables. Hospital practices are
critical to affect positive or adverse outcomes. At PHFEWIC some of our
WIC sites enjoy very high Fully Breastfeeding rates; at some sites over
80% of newborns do not use any infant formula and at two months over a
third of the babies are still Fully Breastfed. However, at some of our
sites the picture is quite the reverse!
At the sites with very low breastfeeding rates we have found Peer
Counselors to be the solution! The additional funding for Peer
Counselors was met with roars of approval and has infused WIC programs
with the hope that they can really step up the support for our mothers.
We, at PFFE WIC, are excited at the prospect of tripling the number of
our Breastfeeding Peer Counselors from 7 to 21 of our 54 sites! Peer
Counselors are undoubtedly an integral part of a spectrum of
breastfeeding support however we must be realistic that we cannot
provide their level of services and support out of regular Nutrition
Services funding. The WIC community is grateful that this Committee and
our partners at USDA recognize that Peer Counseling services are
resource and funding intensive and have provide targeted funding for
expanding the Peer Counseling program.
The National WIC Association applauds the Committee for its support
for Peer Counselors and urges that $83 million be targeted for special
nutrition education such as breastfeeding Peer Counselors and other
evidence based diversified breastfeeding related activities. We urge
Congress to give WIC agencies the flexibility to work collaboratively
with health care partners to find the most successful methods for
supporting exclusive breastfeeding for six months in each community.
Breastfeeding Broken Hospitals
It is my dream to see that every WIC baby gets a fair start in life
through exclusive breastfeeding I want them to get the documented
benefits, which include significantly reduced risk for infections and
for chronic diseases such as diabetes, asthma, and obesity among
children, as well as fewer visits to the doctor's office, fewer days of
hospitalization, and fewer medications than children who are formula-
fed. Newer studies from Europe have even demonstrated that breastfed
children scored significantly higher on cognitive and IQ tests than
control group children.
I have spent the past 25 plus years of my life working to realize
my dream of seeing every WIC mom and baby breastfeed. WIC is unique in
that it is the only federal nutrition program with a mandate, backed by
serious funding, to promote and support breastfeeding. WIC
breastfeeding education ensures that all enrolled pregnant women learn
about the whys and ``how to-s'' of breastfeeding. They receive
individual education, share their experiences in small groups, and get
consistent support and encouragement to exclusively breastfeed.
Thanks in large part to the WIC Program's efforts, breastfeeding
initiation rates among low-income women have increased in the last
decade. However, exclusive breastfeeding rates remain challenged--
indicating widespread supplementation of breast milk with formula.
Using formula undermines breastfeeding because it interferes with a
mother's ability to establish her breastmilk supply. Duration of
breastfeeding beyond the first few months is also rare in the WIC
population. Data from the CDC reported in 2009 in the Breastfeeding
Report Card indicated that only one in three babies in the country were
exclusively breastfed at three months and a mere 13.6 percent at 6
months.(1) I can say with a great degree of assurance that WIC babies
were a very small fraction of those numbers. In California, only about
18% of WIC mothers are still breastfeeding after the first three
months. At my larger agency exclusive breastfeeding drops off rapidly
with 41 percent of our mothers breastfeeding in the first month to
merely 12 percent breastfeeding exclusively at 6 months.
Why are exclusive breastfeeding rates so low? In the face of
intensified marketing of infant formula, inadequate infant-feeding
policies in healthcare systems, and poor social supports, attempts to
increase breastfeeding among WIC mothers to meet their self expressed
goals can only be successful with comprehensive policy change in the
institutions serving them. In particular, maternity hospital policies
directly influence all future breastfeeding behaviors by either
facilitating or undermining them. Sadly, breastfeeding too often
starts--and ends--in hospitals during the first few hours of life.
While some hospitals throughout the nation work collaboratively with
breastfeeding professionals to assure a positive in-hospital
breastfeeding experience, far too many are breastfeeding-broken
hospitals.
By way of example, I would like to address a situation with which I
am most familiar. Los Angeles County has the lowest breastfeeding
rates--and the worst disparities--in California. Unless a baby is born
in one of four hospitals on the more affluent West side of the county,
there is less than a 50% chance that a mother will breastfeed
exclusively, especially if that baby's mother is low income and non-
white. Nine out of California's 15 maternity hospitals with the worst
rates of exclusive breastfeeding initiation are located in Los Angeles,
with Orange County close behind.
WIC mothers who wanted to breastfeed and were confident that they
could breastfeed are systematically undermined at every step once they
enter breastfeeding-broken hospitals. Where mammals should be kept
together with their young, babies are routinely taken away from their
mothers at the very moments and hours that the breastfeeding instinct
is the strongest and ``skin to skin'' contact is critical. Instead,
babies are bundled into warmers and tucked into plastic bassinets with
little bottles of infant formula conveniently placed inside. Mothers
``recover'' alone and babies are brought to them, often after a formula
feed, sated and sleepy. Mothers feel dejected when the newborns nuzzle
lazily at the breast, but show no desire to latch on.
This scene is repeated every few hours and the mother is convinced
that her baby does not ``like her breast''. She is unsure of how to
hold her baby, hold her breast, may be in pain, and further may not
speak the language of the hospital staff or be intimidated by the
system. Many nurses, with busy charting demands and perhaps lacking
breastfeeding related training, may add to the new mother's self doubts
by passing unhelpful comments ``Oh, your breast are so big''; ``don't
you know how to put your baby to the nipple''? Etc. At other times the
baby may instinctively start suckling at the breast but, having
previously been imprinted by the rubber nipple of the formula bottle
which has a very different flow pattern, may not know how to ``milk''
the breast. The sucking is ineffective, milk flow slow and this of
course frustrates the baby; the baby cries and gets off the breast, a
caring nurse or relative offers another bottle, the baby guzzles
hungrily and the die is cast! And another one bites the dust! One more
WIC mother and baby leave the hospital, at best breast and formula
feeding or, at worst, fully formula feeding! Their next stop is WIC * *
* not for breastfeeding support but for infant formula!
Every day frontline WIC staff experience frustration when they see
firsthand how breastfeeding-broken hospital policies and practices
sabotage a WIC mothers' desire to breastfeed in the critical first few
days of life. These moms--who have previously indicated their desire to
breastfeed--return to WIC for their first post-partum appointment
already bottle-feeding, with their milk supply already compromised.
Until breastfeeding-broken hospital policies change, WIC
breastfeeding educators and mothers will continue to swim upstream.
Until we address the wider issue of breastfeeding-broken hospital and
healthcare policies and practices through strategic reforms, WIC will
not see maximum returns from its huge investment in breastfeeding
promotion and support: concrete and measurable health improvements for
low-income families. Failure to address the stark differences in
breastfeeding rates in the U.S. will exacerbate the deepening health
and social inequities we face, and continue to generate increased
public costs we cannot afford.
An important place to start to help WIC succeed in its
breastfeeding support and promotion efforts would be to fix the
breastfeeding--broken hospitals! While I recognize this may be beyond
the purview of this Committee, I am compelled to ask you to work
collaboratively with your colleagues on the Energy and Commerce
Committee and Ways and Means Committee to pass legislation that
requires that all hospitals that receive Medicaid funds adhere, at a
minimum, to a set of model policies that do not sabotage breastfeeding,
and at best initiate steps to become a Baby Friendly Hospital.
Formula Marketing
Families with new babies are in a constant state of learning--
feeding, changing, bathing, and soothing the baby. This can be a
bewildering experience. New mothers are insecure about their breast
milk supply; whether they are producing enough of this elixir that
cannot be measured in ounces in a calibrated bottle and which the baby
wants at very frequent intervals in the first few days. This in a world
where formula feeding defines the normative model for infant behavior;
families expect a baby to eat every three hours, sleep in between, and
finish 2-3 ounces at a feeding. BUT THAT IS NOT THE BREASTFED BABY
NORM! This baby eats a little bit all the time; newborns have teeny
tiny stomachs that get filled up quickly. Moreover, mother's milk,
being the perfect food, is digested quickly! WIC can promote
breastfeeding to our sincerest heart's content, but how do we get
breasts and apparently always hungry newborn breastfed babies to
compete with the images of the contented cherubic formula fed babies
promoted by Madison Avenue?
Advertisements about ``comfort proteins''--there is no such thing--
in one type of infant formula float around a happy baby on TV, while
DHA supplemented formulas claim to be just like ``mother's milk in a
can'' and new ``designer formulae'' hit the market at regular intervals
(Lipil today, Premium tomorrow, Lactofree today and Sensitive
tomorrow!). With smart salespersons who regularly stalk hospital
nurseries and pediatrician's offices, new formulae find willing
peddlers in health care staff who want to ``help'' mothers with a can
of the latest sample! Can mother's milk compete in this market?
Coincidently, just when WIC education about the miracles of
colostrum (the first milk) and the innumerable benefits of breast milk
begins to resonate with mothers at about two weeks post partum there is
an incredibly timed delivery of FREE INFANT FORMULA, or/and coupons for
formula at the mother's doorstep. For the family this is like manna
from heaven! The formula is given to the baby and the mother's
breastmilk, produced by the body in a demand-supply continuum, further
diminishes. What chance does breastmilk have in this battle for the
baby share? Not a lot, as is evidenced by the billions of dollars spent
by WIC on infant formula.
Infant formula companies battle for market share against a unique
product: breast milk, a living food that contains hundreds of active
biological substances that cannot be manufactured and are not present
in infant formula. Truly a ``designer'' food, breast milk varies from
woman to woman, from day to day and from hour to hour in response to
the needs of that particular baby who was birthed by the mother. As
breastfeeding rates have slowly and steadily increased, particularly
among low-income women, the formula industry has grown more aggressive
in its attempt to regain market share, particularly by pushing formula
supplementation (i.e., combining breastfeeding and formula feeding).
In 1994, the United States signed on to the International Code for
Marketing of Breastmilk Substitutes of the World Health Organization,
which prohibits direct marketing of infant formula to mothers and
health care providers. However, there are increasing reports that U.S.
formula companies are violating the WHO Code through a number of means:
routine and widespread direct marketing, including saturation
advertising to mothers with billboards and magazine ads; detail
marketing to healthcare providers; and provision of free formula to new
and expectant mothers via discount coupons, direct free shipments of
formula, and hospital discharge packs.
A 2006 Government Accountability Office (GAO) report documented
marketing practices and how much formula manufacturers spend on them.
As the U.S. birth rate levels off, growth in the domestic infant
formula market is primarily being driven by price increases, not by the
quantity of formula sold. To maintain profitability, formula
manufacturers have raised their prices by creating a dizzying array of
new product lines and additives that come with attractive--though
scientifically questionable--health claims. Examples of claims for more
recent formulations tout relief for ``fussy babies'' or ``gas.''
Although these products include FDA-approved ``designer''
ingredients, which have been ``generally recognized as safe'' according
to FDA standards, the direct health benefits of these additives have
not been proven. The most disturbing direct advertising for these more
expensive ``new'' formulas subtly undermines the obvious and proven
superiority of breastfeeding by positioning formula as more and more
equivalent to breast milk, as demonstrated by the following text on a
company website: ``Closer Than Ever to Breast Milk! * * * The first and
only infant formula that has a unique blend of prebiotics, nucleotides,
and antioxidants--nutrients naturally found in breast milk. Plus, it
has DHA and ARA, ingredients shown to help your baby's brain and
eyes.'' WIC providers report that this kind of marketing is causing
confusion among WIC participants using infant formula, who sometimes
ask if WIC provides ``the breast milk in a can.''
Thus another important way to help WIC promote and support
breastfeeding, would be for the Committee in collaboration with your
partners in Congress to make a determined effort to eliminate or
sharply curb the blatant direct marketing of infant formula, which
violates the WHO code and targets vulnerable low income women of color.
Breastpump Funding
WIC mothers at 3--4 weeks post partum face a whole new set of
obstacles to their breastfeeding goals. The few, the determined, those
that WIC staff are able to ``rescue'' and who are still breastfeeding
without formula may have to think about returning to work!
California and twenty-four states, the District of Columbia and
Puerto Rico have laws related to breastfeeding in the workplace
(Arkansas, California, Colorado, Connecticut, Georgia, Hawaii,
Illinois, Indiana, Maine, Minnesota, Mississippi, Montana, New Mexico,
New York, North Dakota, Oklahoma, Oregon, Rhode Island, Tennessee,
Texas, Vermont, Virginia, Washington and Wyoming).
Many WIC programs advocate for their working breastfeeding mothers
and many, thanks to the support of this Committee and Congress, have
breastpumps that are loaned free of charge to WIC participants so they
can pump breastmilk while at work. Needless to say, at PHFEWIC, we do
not have enough breastpumps to support all our working mothers. Pumps
are given preferentially to those women whose babies are in the
Neonatal Intensive Care Units (NICUs) with only the remaining pumps
going to the WWPP (working women pump program). A study of this program
showed that WIC working mothers, who received a pump from the WIC
program, exclusively breastfed for 120 days MORE THAN comparable
working mothers who were not able to get a breastpump from WIC. (JHL,
2008, Meehan et al).
In 1999, Congress approved a National WIC Association proposal to
allow the use of food dollars for the much needed purchase of breast
pumps to support working mothers. In 2005-2008, as the nation began to
experience a growth in the numbers of women and families in poverty and
an increase in the working poor, the Program was forced to turn to
contingency funds to support rapidly expanding caseload. USDA placed
restrictions on the use of those funds, preventing WIC agencies from
purchasing breastpumps with those resources. I urge the Committee to
direct USDA to allow use of contingency funds for breast pump purchase
to guarantee breastfeeding mothers the critically necessary feeding
aids to support their healthy breastfeeding choice in the workplace.
Federal Breastfeeding Support
Appreciating the external challenge we face in the WIC Program,
Congress has recognized the importance of WIC breastfeeding promotion
and support and has steadily increased the funding available to support
this effort. WIC staff has not only embraced, but championed
breastfeeding personally and professionally. Within WIC we have clearly
established breastfeeding as the expectation and the norm.
Like other WIC agencies across the nation, PHFEWIC has embraced the
culture of breastfeeding and assures a breastfeeding--friendly work
environment. The 700 or so employees at PHFEWIC give birth to 22 to 28
babies every year and largely due to an effective employee perinatal
support program almost all of our staff breastfeeds exclusively in the
hospital, at six weeks, and when they return to work. Indeed, we have
some very long term breast feeders (beyond 2 years) and even have staff
that have tandem breastfed (2 babies, different ages: 2 months and 17
months). Our staff enjoys incredible support from the time they report
their pregnancy until they stop breastfeeding. They are better
counselors for having had such good personal experiences and working in
such supportive environments. Staff support for breastfeeding is a
common thread for WIC programs throughout the nation. For staff, WIC is
the breastfeeding mecca.
Our participants, however, live in the REAL world! They make forays
into the WIC breastfeeding world once a month, but then return to their
``formulagenic'' world and may access other services and programs--many
of them federally funded--that are not breastfeeding friendly. As an
example, WIC moms who are TANF recipients are required to attend
trainings after they have delivered their babies. They are discouraged
to attend with their newborn-3 month old babies; this is NOT a
breastfeeding friendly policy. Staff at various assistance programs
have been known to ask women to leave the premises if they breastfeed
their babies. This, too, is NOT a breastfeeding friendly policy.
The bottom line here is that we must do everything in our power to
support WIC in its efforts to make breastfeeding the cultural norm.
On behalf of the National WIC Association, I urge the Committee to:
a. Emphasize ``breastfeeding promotion and support'' as an integral
part of nutrition education and add such language (breastfeeding
promotion and support) to each citation related to WIC for nutrition
education in the Child Nutrition Act of 1966.
b. Ensure that ALL federal programs serving families, in
particular, but not limited to the Supplemental Nutrition Assistance
Program and the Child Care and Adult Food Program are breastfeeding
friendly and that the employees have, at a minimum, a clear
understanding that breastfeeding mothers and babies will be supported.
WIC-led Collaboratives
Slightly more than one out of every two infants born in the US
participates in the WIC program. For the PHFEWIC program this
translates into 5000 new babies each month. While we can, (and we HAVE)
changed WIC policy, procedures, food benefit packages, created special
funding for Peer Counselors, and recognized the need to fund the
purchase of breast pumps, the reality is that WIC breastfeeding efforts
do not exist in a vacuum. Our families live in the REAL world, not the
breastfeeding utopia that many WIC sites have become. The best news is
that we have willing and eager partners that are hungry to join hands
with us and collaborate to effect the environmental changes that will
ultimately lead to the optimal duration of exclusive breastfeeding.
WIC Programs across the nation work hard to collaborate with all
manner of partners to encourage breastfeeding success. In the Los
Angeles area the various local agencies that provide WIC services came
together over 15 years ago and partnered with the La Leche League,
local lactation professionals, hospital staff and breastfeeding moms to
form a coalition: The Breastfeeding Task Force of Greater Los Angeles.
Today this Task Force is a respected national entity, sought out by
local, state and federal funders to provide a myriad of programs and
projects to impact breastfeeding. WIC and the Task Force collaborate on
privately funded projects to advocate for WIC participants, to make the
workplace more breastfeeding friendly, and to keep up the pressure to
move hospitals along the path to becoming Baby Friendly.
Exemplifying collaborative partnerships, NWA is hosting a special
Breastfeeding Summit here in Washington D.C. on Tuesday, March 9, 2010
to shine the spotlight on the assortment of successful WIC initiatives
throughout the nation and to promote, support and advocate for
breastfeeding mothers and babies enrolled in the WIC program. As the
nation's premier public health nutrition and prevention program with a
clear funded mandate to promote breastfeeding, WIC is staking it's
rightful claim as the nation's breastfeeding support and promotion
leader and inviting partners to join hands with us.
Full engagement and leadership in local or state collaboration
efforts focused on breastfeeding promotion, while desirable and
necessary, present challenges for many WIC programs due to resource
limitations and staffing constraints. Resources are sorely needed to
create WIC--led breastfeeding collaboratives which aim to bring key
stakeholders together to ensure seamless breastfeeding support for low
income women in their communities.
WIC mothers and babies need the same opportunities and support to
breastfeed their babies fully like their wealthier, more educated,
mainly white sisters, who are outside of the WIC world. Our challenge
is to reduce the chasm between the breastfeeding rates among WIC and
non-WIC populations and have good credible sources of data to evaluate
our progress. Across the nation, dedicated, creative and indefatigable
WIC staff roll up their sleeves everyday and get ready to promote and
support breastfeeding.
There is a new enthusiasm in the air, the buzz around the
supportive food package, the funding for Peer Counseling, the growing
recognition that breastfeeding can play a major role in improving the
health and well-being of an entire new generation of citizens. We are
pinning our hopes on you. I want to sincerely thank you, members of the
Committee, for allowing me to share a bit of my passion with you today.
______
Chairman Miller. Ms. Gettman.
STATEMENT OF LUCY GETTMAN, MA, MSW, DIRECTOR OF FEDERAL
PROGRAMS, NATIONAL SCHOOL BOARDS ASSOCIATION
Ms. Gettman. Chairman Miller, Ranking Member Kline, my name
is Lucy Gettman. I am director of Federal programs for the
National School Boards Association. As a former child nutrition
advocate, and now an advocate for school boards, I thank you
for the opportunity to address the committee on this important
issue affecting children enrolled in our public schools.
The National School Boards Association represents the
Nation's nearly 15,000 local school districts and over 95,000
local school board members by working with and through our
State School Boards Associations. At the organizational level,
NSBA's School Health Programs Department assists school
policymakers and educators to make informed decisions about
health issues affecting the academic achievement and healthy
development of students and the effective operation of schools.
Services are provided with and through NSBA's member State
associations and school boards in partnership with other
national organizations such as the National Association of
State Boards of Education, the Alliance for a Healthier
Generation, and Action for Healthy Kids.
Additionally, NSBA is very proud of its efforts to promote
nutrition in the schools and to prevent childhood obesity
through Web-based services, educational programming, and
publications. A summary of our efforts is provided as an
appendix to our statement.
Without question, local school districts believe that child
nutrition is vitally important to fostering a healthy and
positive learning environment for children to achieve their
full potential. Healthy students learn better. Children and
youth who eat nutritious foods and stay active are healthier,
perform better in school, and learn behaviors that will keep
them healthier throughout their lifetimes.
School boards are acutely aware of the importance of
ensuring that children have access to healthy and nutritious
food, and many have already taken steps at the local and State
level to improve nutrition and healthy eating. One such example
is the State of Delaware, where a public/private partnership of
education and health stakeholders, including the Delaware
School Boards Association, established the Edith P. Vincent
Healthy School Awards to recognize the work of public schools
championing children's health, including nutrition.
NSBA's Health Programs Department maintains many examples
of school district efforts to improve student health and
nutrition on its promising district practices database. Healthy
nutrition success stories include a district in Kentucky that
increased breakfast participation rates to 95 percent; a
district in New Jersey that holds monthly coordinated health
team meetings to discuss increasing use of fruits and
vegetables, coordinating with food services and meeting with
the PTA. There is a Pennsylvania district that created its own
wellness brand to establish a new culture in the district to
promote health. And there is an Arkansas district that
implemented a water-only policy for sale in the district's
vending machines.
There are many other examples of local initiatives because
the commitment to increasing student access to healthy and
nutritious food is not unique. What is unique, however, are the
circumstances of each school district. What is successful at
one won't necessarily work at another. The geography, economy,
demographics and resources available in the community vary for
each district. The challenges, opportunities, and responses to
local circumstances will also vary.
Local decision-makers and stakeholders are in the best
position to understand and meet the needs of each district,
including child nutrition, with the Federal Government playing
an important supportive role. Therefore, I have the following
recommendations for strengthening nutrition programs in the
child nutrition reauthorization.
Recognize local school district authority and the variance
among local circumstances and laws or policy addressing child
nutrition.
Next, refrain from imposing additional regulations or
mandates on schools outside of the federally subsidized School
Lunch and Breakfast Programs, and adequately reimburse schools
for the cost of these services.
In addition, support school districts, local communities
and States that are assuming greater responsibility for health
and nutrition through incentives and grants that enable them to
further expand their local commitment.
And finally, ensure that adequate resources are available
for school nutrition programs, for the meals and
administration, the equipment and facility improvements,
training for staff education and other stakeholders, for
nutrition education and support of local initiatives.
These recommendations are based on NSBA's resolutions,
which are determined by a national 150-member delegate
assembly, members of which are selected by their States to
collectively establish policy representing the perspective of
95,000 local school board members. The process is annual and
ongoing, and the policy development begins in local communities
in the States and culminates at NSBA's annual convention each
spring.
In conclusion, reauthorization of the Child Nutrition Act
is an opportunity to celebrate the progress made since the 2004
reauthorization and to envision an even healthier future for
our children. Improving the quality of and expanding access to
school meals is important to our children and our Nation.
School districts are vital partners in the effort to assure a
healthy and positive learning environment for children to
achieve their full potential. The Child Nutrition Act
reauthorization is an opportunity to acknowledge and support
this local leadership and authority.
Thank you again for the opportunity to comment. NSBA looks
forward to a continuing conversation and collaboration about
this critical issue. Thank you.
Chairman Miller. Thank you.
[The statement of Ms. Gettman follows:]
Prepared Statement of Lucy Gettman, Director of Federal Programs,
National School Boards Association
Mr. Chairman: My name is Lucy Gettman, director of federal programs
for the National School Boards Association (NSBA). As a former child
nutrition advocate and now an advocate for NSBA, I thank you for the
opportunity to address the Committee on this important issue affecting
children enrolled in our public schools. The National School Boards
Association represents the nation's nearly 15,000 local school
districts and over 95,000 local school board members by working with
and through our state school boards associations.
At the organizational level, NSBA's School Health Programs
department assists school policymakers and educators to make informed
decisions about health issues affecting the academic achievement and
healthy development of students and the effective operation of schools.
Services are provided with and through NSBA's member state associations
of school boards, in partnership with other national organizations,
such as the National Association of State Boards of Education, Alliance
for a Healthier Generation, and Action for Healthy Kids.
Additionally, NSBA is very proud of its efforts to promote
nutrition in the schools and to prevent childhood obesity through web-
based services, educational programming, and publications. A summary of
our efforts is provided as an appendix to our statement.
Without question, local school districts believe that child
nutrition is vitally important to fostering a healthy and positive
learning environment for children to achieve their full potential.
Healthy students learn better. Children and youth who eat nutritious
foods and are active stay healthier, perform better in school and learn
behaviors that will keep them healthier throughout their lifetimes.
School boards are acutely aware of the importance of ensuring that
children have access to healthy and nutritious food and many have
already taken steps at the local and state level to improve nutrition
and healthy eating. One such example is the state of Delaware, where a
public/private partnership of education and health stakeholders
including the Delaware School Boards Association established the Edith
P. Vincent Healthy School Awards to recognize the work of public
schools championing children's health, including nutrition.
NSBA's School Health Programs maintains many examples of school
district efforts to improve student health and nutrition on its
Promising District Practices database. Healthy nutrition success
stories include:
A district in Kentucky that increased breakfast
participation rates to 95 percent.
A district in New Jersey that holds monthly coordinated
health team meetings to discuss increasing use of fruits and
vegetables, coordinate with food services, and meet with the PTA.
A Pennsylvania district that created its own ``wellness
brand'' to establish a new culture in the district to promote health.
An Arkansas district that implemented a water-only policy
for sale in the district's vending machines.
There are many other examples of local initiatives, because the
commitment to increasing student access to healthy and nutritious food
is not unique. What is unique; however, are the circumstances of each
school district. What is successful at one won't necessarily work at
another district. The geography, economy, demographics, and resources
available in the community vary for each district. The challenges,
opportunities and responses to local circumstances will also vary.
Local decision makers and stakeholders are in the best position to
understand and meet the needs of each district, including child
nutrition, with the federal government playing an important supportive
role.
Therefore, I have the following recommendations for strengthening
nutrition programs in the child nutrition reauthorization:
Recognize local school district authority and the variance
among local circumstances in laws or policy addressing childhood
nutrition.
Refrain from imposing additional regulations or mandates
on schools outside of the federally subsidized school lunch and
breakfast programs and adequately reimburse school districts for the
cost of those services.
Support school districts, local communities and states
that are assuming greater responsibility for health and nutrition
through incentives and grants that enable them to further expand their
local commitment.
Ensure that adequate resources are available for school
nutrition programs, for meals and administration, equipment and
facility improvements, training for staff, educators and other
stakeholders, nutrition education and support for local initiatives.
These recommendations are based on NSBA's Resolutions, which are
determined by a national 150-member Delegate Assembly, members of which
are selected by their states to collectively establish policy
representing perspectives of 95,000 local school board members. The
process is annual and on-going in that the process of policy
development begins in the states and culminates at NSBA's annual
convention each spring.
Conclusion: Reauthorization of the Child Nutrition Act is an
opportunity to celebrate the progress made since the 2004
reauthorization and to envision an even healthier future for our
children. Improving the quality of and expanding access to school meals
is important to our children and our nation. School districts are vital
partners in the effort to assure a healthy and positive learning
environment for children to achieve their full potential. The Child
Nutrition Act reauthorization is an opportunity to acknowledge and
support this local leadership and authority.
Thank you again for the opportunity to comment. NSBA looks forward
to a continuing conversation about this critical issue.
appendix
Efforts to Improve Child Nutrition
March 2010
The National School Boards Association (NSBA), through its School
Health Programs department, supports NSBA's commitment to help school
policymakers and educators make informed decisions about health issues
affecting the academic achievement and healthy development of students
and the effective operation of schools. Services are provided with and
through NSBA's member state associations of school boards, and in
partnership with other national organizations such as the National
Association of State Boards of Education, Alliance for a Healthier
Generation, and Action for Healthy Kids. NSBA receives funding from the
Centers for Disease Control and Prevention (CDC) to support much of its
work on health issues.
Web-based services through NSBA's School Health Programs webpage
(www.nsba.org/SchoolHealth)
``101'' Packets on school health topics such as Wellness,
Childhood Obesity, Nutrition, and Physical Activity provide the data,
background information, research and sample policies to support local
school board decision making. ``Promising District Practices'' website
provides the ``stories'' of how school districts have acted to address
healthy eating and physical activity.
A Childhood Obesity web page launched in January 2010
provides easy access to data, research, and tools for making policy and
environmental change.
``Updates and Special Announcements'' alert school
officials to new research and reports on a wide range of health topics,
including nutrition, to inform decision making. Users can sign up to
obtain the ``Updates'' via an RSS feed.
Searchable database of research, information and sample
policies provides essential information on a wide variety of school
health topics including nutrition.
Educational Programming
NSBA's annual conference (April 4-7, 2009, San Diego, CA):
several sessions focused on school nutrition and wellness were
presented in partnership with such organizations as the Alliance for a
Healthier Generation, Action for Healthy Kids, and the School Nutrition
Association. The 2010 conference (April 10-12) in Chicago also will
have multiple sessions on school nutrition and related health issues,
including a session provided by the California School Boards
Association on collaborative leadership for addressing health issues.
Symposium on Childhood Obesity (July 2008, Little Rock,
AR): 12 state teams that included members of state boards of education
and local school board members convened to develop action plans to
drive childhood obesity initiatives/policy change in their states.
Follow-up technical assistance was provided to these state teams.
Webcast: On December 1, 2009, in partnership with the
Missouri School Boards Association's Education Solutions Global Network
(www.esgn.tv), NSBA hosted a webcast on strategies for addressing
childhood obesity, which targeted school board members and other state
and local elected and appointed policymakers.
Publications
Content in the American School Board Journal, including a
special report focusing on ``Health and Leadership'' in addressing
childhood obesity (February 2009--access online at www.asbj.com).
Participation in the development of Leadership for Healthy
Communities Action Strategies Toolkit, a new toolkit for state and
local policymakers to develop policy measures addressing issues around
childhood obesity, including nutrition in schools (in partnership with
Leadership for Healthy Communities, a national program of the Robert
Wood Johnson Foundation).
______
Chairman Miller. Thank you very much to all of you for your
testimony.
Ms. Morrison, can you just--I only have 5 minutes, so I
need a better explanation--not better, but a more expansive
explanation than you have in your paper of what happened. Why
did these agencies in Los Angeles decide they could no longer
participate?
Ms. Morrison. The program was being sponsored by an
organization, a multiservice organization, and the CACFP
administrative compensation for the program did not--it was not
financially viable for the organization to continue supporting
that program. There is not enough money for the administrative
reimbursement to support the program and to be able to
accomplish the requirements.
Chairman Miller. And that is separate from the food
package.
Ms. Morrison. That is separate from the food, meals, yes.
Chairman Miller. So your understanding is that it is a
question of the cost of administration.
Ms. Morrison. That is true. It is the cost of
administration of the program that is causing sponsors to
discontinue sponsoring the program.
Chairman Miller. And you would attribute that to what? I
mean why has that changed all of a sudden?
Ms. Morrison. Well, one of the things that happened in the
last year is the reimbursement for administration was reduced
because of the tie to the Consumer Price Index, which went
down. That caused the reimbursement rate for certain level of
homes to go down. Also, the administrative burdens of
paperwork, and the additional block claiming that has become a
requirement, caused programs to close because it requires more
visits and it can't be accomplished without increasing the
reimbursement for the administration.
Chairman Miller. All right. Thank you for that.
Ms. Rivas, you make two recommendations with respect to the
dietary guidelines. And one is that it is no longer sufficient
to simply try to meet the goals--that it is sufficient that you
are attempting to meet the goals of the dietary guidelines. You
think that dietary guidelines in and of themselves have to be
met. Is that a fair statement?
Ms. Rivas. Well, currently, we have national guidelines
that follow the dietary goals. Recently, USDA contracted with
the Institute of Medicine to further look into the dietary
guidelines in order to look at the overall problem of reducing
childhood obesity.
And so, currently, what we want to be able to do is
increase our reimbursement so that we can go ahead and meet
those guidelines. But we need the Secretary of Agriculture to
be given the authority to be able to define those guidelines so
we can consistently apply the same specific guidelines.
Chairman Miller. You need him to define how they apply to
the school nutrition programs.
Ms. Rivas. Pardon?
Chairman Miller. You need the Secretary to have the
authority on how they apply to the school nutrition program and
how there would be compliance.
Ms. Rivas. How the guidelines for the Institute of
Medicine's new recommendations are going to be applied
consistently throughout the country.
Chairman Miller. And you have landed that on the Secretary
of--and you think that is the place.
Ms. Rivas. Well, we currently have meal patterns. But we
have new recommendations from the Institute of Medicine that
have been offered through the Institute of Medicine, and we are
needing some additional guidance to be able to implement those
guidelines nationally so that they are consistent. Currently,
many States and local districts are making changes to their
local standards, and that increases costs because there are
different versions that are being applied nationally. Being
able to apply them consistently and have the Secretary of
Agriculture define what those guidelines are will make our
programs more consistent and reduce the overall cost of our
programs.
Chairman Miller. Thank you. I am delighted when I read in
your testimony that, you know, you have joined up with First
Lady Michelle Obama in this campaign for healthy eating and
healthy meals, and trying to use, as she explained it to us,
trying to use these programs as teachable moments, as part of
the classroom, as she would say; whether it is the school
garden or the Lunch or Breakfast Program, to do this.
And I was discussing diabetes with some people yesterday,
and when you think that 23 million children and adults in the
United States have diabetes--the number of children under the
age of 20, it is 186,000 individuals. And so it would seem to
me that as we talk about obesity and diabetes and diet, that
there is a moment here to really do an education; that if you
are going to have this explosion of diabetes in the adult
population, some kind of work with the children while you have
these moments around the school nutrition programs could
conceivably, if well structured and properly delivered, could
conceivably have a lifetime of benefits for those individuals.
And I don't know how you are thinking about this but----
Ms. Rivas. Absolutely. We see--the School Nutrition
Association sees this as a wonderful opportunity to utilize the
school cafeterias as a learning laboratory for healthy eating
so that we can improve the eating habits of our children. We
support coordinated school health programs so that we can work
together with the total school community to be able to promote
the School Lunch Program. We have healthy meals that provide
healthy entrees, more fresh fruits and vegetables, more whole
grains, and they model what the healthy meal is. And if our
students participate in their program they are able to take
that message home.
And so in partnership with the total school community, I
think that we can work toward having healthier students and
then reducing all of the chronic illnesses that result from
unhealthy eating.
Chairman Miller. Thank you. Mr. Kline.
Mr. Kline. Thank you Mr. Chairman. And again, thanks to the
witnesses for your testimony, for being here today.
I was struck that it seems every one of you, you do have
something in common out there, that every program does seem to
need more money. We have heard calls for adequate resources,
enhanced meal reimbursements, covering the cost of
transportation and delivery and so forth. So I do--we have got
that message.
We don't actually have the money, but we do have the
message that there is more money required. We have some
difference of opinion, it seems to me, here about the role of
the Federal Government, how much it is going to be, how much it
is going to be dictated by the Secretary of Agriculture.
I think, Ms. Rivas, it was your position there ought to be
greater input at that level. And I think, Ms. Gettman, you were
emphasizing, representing the National School Boards
Association, that there ought to be more local control and that
the Federal Government ought to be careful about how it
intrudes in that.
It does seem to me that the child nutrition initiatives at
the school or school district, local level, allow for more
input and support from parents, which I think we all would
agree is very helpful. The more parents are involved in
education in general, the better we are. And not just on
nutrition.
Could you address that, involving parents and how that
would relate to how much the Federal Government dictates in
this process? Ms. Gettman, to you.
Ms. Gettman. Thank you. Mr. Chairman, members of the
committee, parents absolutely play an absolutely critical role
in the success of all of our collective efforts. And to
maximize and capture the collaborative potential between local
school districts, families, and communities is absolutely
paramount. One thing to keep in mind is that local school board
members are either appointed by or elected by and from their
communities. Many of them are parents. Many of them are
educators or providers or business leaders in the community.
And they are the perfect leverage point to optimize the
collaborative potential with communities.
Another dimension that we reflect on with regard to the
role of parents is that the teachable moments that were brought
up earlier in this hearing can be maximized at the local school
district level, either through professional development with
in-school staff or through PTA, basically the role of local
school districts as hubs of their communities. Local school
district initiatives can absolutely magnify parent education,
parent engagement, parent involvement, ultimately resulting in
improved child nutrition.
Mr. Kline. Thank you. I know that one thing about the local
school board is that you can reach out and touch it. I think my
daughter has been involved in such a battle here lately, as a
mother of two children in the public schools.
I just want a clarification here. I am trying to think, Ms.
Rivas, whether it was you or not, but I am going to turn to you
because I think it falls into the realm that you were
discussing. I want to talk just for a second or have you
address the issue of the so-called competitive foods, you know,
where you have--so often you have the athletic organizations of
the school and organizations who have bake sales and they cook
the famous brownies and banana bread and that sort of thing.
Is it your position, or the position of your organization,
that this should fall into these same guidelines that the
Secretary would promulgate?
Ms. Rivas. That is correct. We support local policy and
menu planning, but with sound science. However, you know, our
role as food service directors is to teach children, you know,
good basic nutrition. As they go through the cafeteria line, we
try to teach them what a good balanced meal is. And I think
when we are talking about, you know, meals served outside of
the classroom, very often they do not support that same
message.
And so we are urging Congress to eliminate the time-and-
place rule, because what messages we are trying to send in the
cafeteria in promoting the recommended dietary guidelines and
the Institute of Medicine recommendations, they need to be
consistent messages throughout the whole campus.
Mr. Kline. Okay. So you----
Ms. Rivas. And so we----
Mr. Kline. You do want to regulate the bake sale.
Ms. Rivas. We want to have the Secretary to determine what
those guidelines should be so that we are consistent, both in
the cafeteria and outside of the cafeteria, because what we are
trying to do is have the students participate in the program.
And when students are tempted to go outside of the cafeteria,
they are not drinking their milk, which is a very, you know--
which is a real critical part of their growth and development.
We want to encourage healthy eating.
Mr. Kline. My time has long since expired, so thank you. I
think I have got the answer. We want to regulate the bake sale,
and that is what I was trying to get at. And I do believe I
understand your position now so I will yield back. I know there
are others who have questions.
Chairman Miller. Thank you. Congresswoman McCarthy.
Mrs. McCarthy. Thank you. And I want to thank Chairman
Miller for having this hearing today. This is something that
the committee and the subcommittee have been working on for
several years now. And I want to thank the panel, for bringing
the information to a wider audience. I think that, you know,
when we start looking at--and obviously with Mrs. Obama
speaking about this constantly, it has finally moved up the
radar, which a lot of you have already known for a long time
that we need to change these things. We have worked here in a
pretty hard way on issues that we are ready for ourselves, for
the child nutrition reauthorization. The benefits of
breastfeeding are well-recognized, as we discussed today.
And just thinking back, I spent over 30 years as a nurse
and a lot of times I had to work on the OB-GYN floor. And it is
there that we need to make sure that our nurses and our doctors
are trained in this, giving the benefits of what the child
could go through by breastfeeding.
That is why last year I worked hard to get the $5 million
in the Ag appropriations for breastfeeding performance bonuses
awards, and why I introduced legislation addressing this issue.
Aside from the bonuses, I am also looking at how we can utilize
volunteers such as those in the National Service AmeriCorps
Programs to assist with meeting the goals of child nutrition
programs, especially for WIC.
I guess the question that I would ask is what are the
greatest hurdles that we are facing on breastfeeding success
with the WIC mothers? And beyond peer counseling funding, what
additional resources would support WIC in its efforts to
promote breastfeeding? Would additional human resources,
possibly through volunteers, be helpful in the cause that you
are looking at? Ms. Saluja.
Ms. Saluja. Thank you for your question. It kind of puts it
back to where--I mean, I hate for you all to think I am going
to keep digging up that old tree or barking up the old tree.
But the reality is we can put a lot of effort into promoting
breastfeeding. We can put a lot of human resources into
supporting it. But until we fix the institutions that don't
make it happen right, it is just going to be more--throwing
more money at the problem and hoping it goes away.
So the way I really, I want to really acknowledge that the
peer counseling money is phenomenal because that is really what
helps. You know, the peer-to-peer support, friends working with
friends, people who look like you, understand your situation.
Moms, when they go to deliver, though, when they--you know, the
human-made issue that happens when they get confused by the
messaging, when they don't have--when the baby is crying and
doesn't take their breast, that becomes very difficult for
them.
So perhaps there is a place for some help that happens, but
at a community task force collaborative level where we could
really bring a million people marching the streets saying,
Hospitals, you need to change. Everybody needs to sing the same
tune.
You know, the other programs that our moms access, for
example, the SNAP program where they go to apply for food
stamps or the Child Care Food Program where they might be
leaving their children, all these programs need to be in sync
that we have the same message: We are here to support exclusive
breastfeeding and long-term breastfeeding as a vehicle to
prevent childhood obesity--and all the other fabulous things
that come along with it.
Volunteers, there is definitely a place for volunteers. I
would leave it to local programs to figure out how best they
can use them. We can never have enough human resources, but
what we really need is systems change. Perhaps these could be
the detail people. You know, we know that formula companies
have detail people. They change the name of a formula, they get
to the doctor's office and boom, there is a new thing on the
horizon. We don't have breastfeeding detail people. Maybe the
volunteers could become the breastfeeding detail that go out
and do these, you know, luncheons with docs.
I think there is a way to do this. We have to kind of think
through this; locally and collaboratively working together. But
we have got to get rid of the problems that have been created
by the external environment, so that our moms and babies don't
suffer needlessly. And WIC doesn't have to, you know, do
conniption fits to make this happen.
Mrs. McCarthy. One of the things--and quickly, because my
time is almost up. We have a couple of programs working in my
district in the underserved schools where we have brought child
nutrition back in with an exercise program, working together.
One of the things that I didn't hear anybody talk about was the
data that we have so far for 3 years that this program is in
place, is that the marks all went up. The children actually
started getting higher grades across the board. And I think
that we are overlooking that on nutrition. Exercise, actually
increases marks for the children. And let's face it, our young
women and boys, at that age, they need to move around a little
bit more. And we have constrained them in so many ways. So I am
not saying, you know, a free-for-all. I don't believe in that.
But I know 2 or 3 minutes of exercise in between classes or
whatever, or subjects, has helped them quite a bit.
Thank you for your testimony.
Chairman Miller. Thank you. Mr. Roe.
Mr. Roe. Thank you Mr. Chairman. I want to, since this is
an Education and Labor meeting I want to give you all an A.
Since I have been here, you are the best panel we have had at
staying within 5 minutes. Mr. Chairman, thank you for selecting
these excellent witnesses today.
And I want to start at birth, because that is what I did
for a living was birth babies. And one of the things that, I
totally agree with you, I think several things I ran across. We
worked in a birthing center. And one of the issues you run
across for the mother is work, going back to work and
breastfeeding. I think that is a huge issue, basically your
education level and cultural issues. But we really emphasized
that in our practice, and we delivered about 1,200 babies a
year. And so we emphasized that and had a very high percent
that breastfed. The problem with it is that many moms work now,
and it is difficult in the workplace, unless it is an unusual
work environment, for them to be able to do it. So I pitch that
out with no solutions, just a point that I think that is a
problem.
But, absolutely, what you say is true. And also how we grow
up. And I think it is extremely important to start in the
schools. And we, as Congresswoman Slaughter did, we started a
program in our city in Johnson City, Tennessee, called Up and
At 'Em, and we weighed all the children in elementary school
and found that 39 percent were overweight or at risk, and 1
percent were underweight. And we began a program called Up and
At 'Em where we introduced exercise as you were talking about,
in the elementary school level. And hopefully that will be a
lifestyle; because growing up, my mother didn't allow me to
stay in the house. I mean you had to be outside playing. You
had to go out. And we only ate when we ate. There weren't any
restaurants. And I was in a very rural county, so there were no
fast food restaurants where I lived. So we ate vegetables and
fruits, and that is how we grew up, and that is how I continue
to eat today. So we are what we eat. And I think that is a
situation where that is got to begin at birth.
One of the problems I have with the program, I guess, is
that when you are--it is $2.68 we pay for a meal and it costs
the schools $3.03, or approximately that, in our area to
produce a meal. So they are in the hole already.
I think you brought that point up, Ms. Rivas, and I
certainly am sensitive to that. You can't continue to do that.
The other thing, where school cafeterias have, I guess,
expense back to the lunch program, where you are paying for a
lot of things that don't have anything to do with food.
The other thing, I would recommend that you look at what we
did in our local community, which was very helpful in saving
money, was we did an energy audit for all our buildings. And we
found out that one of the biggest energy consumers that we had
were the old ovens and stuff that you prepared the food with,
and we were able to go in with a company that actually found
enough energy savings to replace all of that more modern
equipment at no cost. So I would look at those opportunities
out there.
The other thing I think, Ms. Morrison, you brought up that
was interesting, I would like to hear your comment. We did this
on the VA Committee where we budget now for 2 years, is to
budget--can purchase over a 2-year period of time. That makes
good sense if you can use best practices like that.
And any comments that any of you have about what I have
said. Ms. Morrison, you are--yes, Ms. Saluja.
Ms. Saluja. If I could begin at the birth piece, I really
appreciated your comments. I congratulate you on your practice.
The thing that you mentioned, though, it is a very common
misconception that people hold, that well, yeah, you want to
breastfeed but you are going back to work. The reality is that
there again, working women, women of color, lower-income moms,
are disproportionately affected by that, and it is seen as a
hindrance. It really isn't.
And again, WIC comes into play there. We have money for
breast pumps. The WIC program--I will speak personally. From my
experience for the last 10 years, we have been putting pumps
out in work sites. We have actually legislation in 36 States, I
believe--it is in my testimony, I may have the number wrong--
that actually provide lactation accommodation at the work site.
And in Los Angeles, I am so proud to tell you we have never
had an employer turn us down. We are the advocates. The mother
comes to us and says, WIC, I am ready to go back to work. There
are certain conditions. She is exclusively breastfeeding. She
is going back to work. We call the employer, we tell them about
the California law. They welcome them with open arms. We have a
place, we give the pump for free. They give it back to us when
they are done. And in fact I want to tell you that this working
woman pump program in Los Angeles, we have actually done a
study on it, it gives us 120 extra days of exclusive
breastfeeding, just because the mother had the support and the
location was provided for her at the work site. Having said
that, I would really urge that we look to see that USDA allows
us to use contingency funds if needed to buy additional pumps,
because that is going to be our next challenge, as you so well
pointed out.
And I also want to recognize that Representatives Caroline
Maloney and Carolyn McCarthy have introduced legislation to
provide tax credits for workplaces offering lactation
facilities. We do need to make this a recommendation that
breastfeeding and working are not incompatible but should be
encouraged, because, as I just told you all, and I am sure you
knew, it is the duration of exclusive breastfeeding that is
going to help us put the first line of defense against
childhood obesity. Thank you.
Chairman Miller. Did you also ask for Ms. Morrison to
respond? If there is no objection, just let her.
Ms. Morrison. Do you want me to go ahead and answer the
question? Okay. Thank you for the question. What we are
proposing is that we are allowed to have--well, Business 101,
you don't plan a budget without having contingency funds or to
try to have carryover. And with the Child Adult Care Food
Program regulations we aren't allowed to have carryover. It is
very difficult. Is that enough of an answer for you?
Mr. Roe. Thank you, Mr. Chairman.
Chairman Miller. Thank you. Mr. Scott.
Mr. Scott. Thank you, Mr. Chairman. Have any of the
panelists, are any of the panelists aware of any successful
Farm to School Programs, where you work with local farmers to
sell food to the local school system?
Ms. Rivas. I know that across the country we have a number
of successful Farm to School Programs, and we work through the
United States Department of Agriculture through the Commodity
Program to direct Farm to Schools to our school district in
Dallas.
But there are a number of them across the country.
Mr. Scott. And are they helpful? Should they be encouraged?
Ms. Rivas. Absolutely. We are able to get a greater variety
of fruits and vegetables that students have not been exposed
to, and so it is a very successful program, and we would be
glad to provide you with a list of some successful programs.
Mr. Scott. Thank you.
Mr. Holt. Would the gentleman yield?
Mr. Scott. Yes.
Mr. Holt. Representing the Garden State, I would just like
to bring to the gentleman's attention H.R. 4710, introduced by
myself, Mr. Sestak, Mr. Boyd, Mr. Blumenauer, Mr. Ellison, and
Mr. Davis, to amend the School Lunch Program for Improving Farm
to School Programs.
Mr. Scott. Good.
Chairman Miller. And I think Mr. Scott wants to be on that
bill.
Mr. Holt. That was my question.
Mr. Scott. I think so. I think so. I thought I was already
on it, as a matter of fact.
Ms. Rivas, is it any more expensive to provide healthy
meals than unhealthy meals?
Ms. Rivas. Yes. We currently provide healthy meals, and so
I kind of want to start with that. Because we currently meet
the dietary guidelines and provide no more than----
Mr. Scott. It is more expensive to provide----
Ms. Rivas. It is significantly more to offer more whole
grains and more fresh fruits and vegetables.
Mr. Scott. One of the curiosities about this program, as I
understand it, is the reimbursement rate is the same all over
the country. Low-cost areas and high-cost areas, where the cost
of food and personnel may be vastly different, the
reimbursement rate for the school meals is exactly the same. Is
that right?
Ms. Rivas. That is correct.
Mr. Scott. Does that make sense?
Ms. Rivas. Does that make sense?
We all have different challenges, and school food service
directors struggle with that. We all do have varying labor
costs, food costs, and fuel costs, but I think the overall
problem is that it is currently totally underfunded. So all of
us are struggling with a tight budget and need increased
reimbursement, and we are urging Congress for 35 cents more
across the board both for breakfast and for lunch. We are
wanting to meet the Institute of Medicine's new recommendations
of offering more fresh fruits and vegetables, and in order to
do that, we need higher reimbursement.
Mr. Scott. How much of your budget, Ms. Rivas, is used up
in administration and trying to find out who is eligible and
who is not eligible? It seems to me in many schools where
virtually everybody is already eligible, it makes no sense to
waste money. You could serve everybody for the cost of fooling
with the eligibility standards.
Ms. Rivas. And that is one of our recommendations. You do
reach a certain threshold where at a certain point when you
have certain districts that have certain levels of free and
reduced lunch participation it is more cost effective to be
able to eliminate the process of applications.
Mr. Scott. In Virginia, we have a tough budget situation,
and there is consideration being given to dispensing with
school breakfast. Can someone say how important the School
Breakfast Program is?
Ms. Rivas. I can certainly do that. I have been involved in
a number of districts where we have had programs that we have
expanded breakfast through grab and go breakfast, breakfast in
the classroom, and our teachers are our best advocates for it
because what they see is that their students are more attentive
in the classroom, there are less students going to the nurse's
office because they are hungry, and there is research to show
that especially when it comes to analytical skills and math and
science they are able to mentally be able to accept all those
concepts a lot easier when they have had breakfast.
Mr. Scott. Thank you, Mr. Chairman.
Chairman Miller. Thank you.
Ms. Fudge.
Ms. Fudge. I thank you, Mr. Chairman, and thank all of you
for your testimony today.
Ms. Rivas, the U.S. health care costs due to obesity is
estimated to be about $150 billion a year, half of which is
paid through Medicaid and Medicare. With nearly $1 of every $6
of our economy spent on health care, we cannot afford to
continue to sell junk food in schools. Too many children in my
district which I represent, one of the poorest districts in the
country, depend on food served in schools, most of them. Now I
am talking about Cleveland, Ohio, which is a part of my
district. And I am certainly not willing to gamble with their
heath. Getting unhealthy food out of schools is a no-cost way
to address the high cost of obesity.
My question is, from the perspective of the School
Nutrition Association, do you think that a minimum nutrition
standard for food sold outside of school meals Nationwide is
needed to protect the integrity of the School Lunch Program and
the health of all of our children in all States?
Ms. Rivas. Absolutely. The School Nutrition Association
totally urges Congress to eliminate the time and place rule.
Because we absolutely believe that the health of our student--
that we are investing in the future of our country when we have
well-nourished, healthy students; and being able to teach that
same message of healthy meals both inside and outside of the
cafeteria is critical to them developing healthy eating habits
in the future and eliminating chronic illnesses as well.
Ms. Fudge. So there should be a minimum standard?
Ms. Rivas. Absolutely. We are recommending that the
standards be set by the Secretary of Agriculture following the
recommended dietary allowances or guidelines for Americans.
Ms. Fudge. Thank you.
Ms. Morrison, in your testimony, you recommend that
Congress reduce the Child and Adult Care Food Program area
eligibility test from 50 percent to 40 percent to streamline
access to healthy meals. While this reduction will have a
positive affect on all rural and suburban communities, will it
also have a positive effect on urban areas? And, if so, how?
Ms. Morrison. Certainly. The percentage of low-income
children or families in urban areas is no different than in the
rural areas. If you have a district that has 50 percent, in
fact, it is going to impact them more in the urban areas
because you will have more children concentrated in an urban
area that would be impacted by reducing that eligibility to 40
percent than you would in a rural area. So the answer to your
question is it would have a greater impact in an urban area.
Ms. Fudge. Ms. Gettman, Nationwide, 30 percent of school
districts prohibit the sale of unhealthy food in school vending
machines. Two-thirds of States have weak or no nutrition
standards for food sold outside of meals. One of your
recommendations is that Congress refrain from imposing
additional regulations or mandates on schools outside of the
Federally subsidized school lunch and breakfast programs. If
Congress adopts your recommendation and does not work to create
Nationwide nutrition standards for food outside of meals, how
will we ensure that our children are only offered the
healthiest food?
Ms. Gettman. Thank you.
A couple responses that come to mind include that schools
and school districts are moving in the right direction. As the
information you just shared demonstrates, a fairly significant,
although certainly not all school districts, are already moving
in the direction of making that local determination of what is
appropriate for students to have access to in their schools.
I think one thing that we haven't talked about too much is
that, in light of the direction that many school districts and
States are going to with regard to implementing standards for
school nutrition, that I am not sure we have asked the question
whether national standards would necessarily improve over those
which already exist in some States and schools. I think
sometimes the flip side of uniformity is maybe we haven't
reached quite as high as we would like to.
I think it is also important to honor the fact that long-
term solutions are more effective when they are locally
initiated and there is local engagement and the innovation is
coming from the local level. And so that is where I think we
would recommend some attention and resources being devoted.
I would also give some thought to any unintended
consequences to having national standards, and I already
mentioned, it is possible that national standards could be
weaker than those that already exist in some States or in some
school districts.
And, also, as Mr. Kline brought up, we want to make sure
that our approach deals with all the environments and climates
and contacts that children have. So it is not just in school,
but it is also at home and in the community. So that students
who do not have access to low-nutrition foods in vending
machines, for example, aren't just bringing them in or buying
them elsewhere or eating differently at home than they do in
school.
So I think it is important to take as comprehensive an
approach as possible and to recognize that successful solutions
to these issues need to have strong engagement from the local
level.
Ms. Fudge. Thank you very much.
Thank you, Mr. Chairman. I yield back.
Mr. Kildee [presiding]. Mr. Polis.
Mr. Polis. Thank you, Mr. Chairman.
I couldn't agree more that nutritional education is
essential for our country to tackle the obesity epidemic.
My first question is for Ms. Rivas.
Numerous scientific studies have shown the benefit of low-
fat, high-fiber, plant-based options for adults and children;
and several organizations have promoted vegetarian or meals
with a reduced meat as important options for chronic disease
prevention.
For example, the American Heart Association, American
Diabetes Association, the American Institute for Cancer
Research promote plant-based foods for chronic disease
prevention; and the American Medical Association and the
American Public Health Association have called on Federal food
assistance programs to emphasize vegetables, fruits, legumes,
grains, and nondairy vegetarian foods.
Based on the scientific research, it seems that we could be
making tremendous progress in improving our children's health
and bringing down health care costs by expanding access to
healthy vegetarian choices and reducing children's intake of
fat, saturated fat, and cholesterol.
Many students also prefer such options for moral,
religious, allergic, or other reasons. For instance, many
children are allergic to milk, are lactose intolerant, as I
happen to be, or choose not to drink milk for other reasons.
But they miss out on vital nutrients because they don't have
access to nondairy milk substitutes.
So my question is two-fold. Should we encourage healthful
vegetarian menu items in the national school lunch and
breakfast programs by making them more affordable and providing
incentives for schools, especially low-income schools to
provide them; and, secondly, do you believe that schools should
offer nondairy milk alternatives that meet nutritional stands
established by USDA for school lunches for kids that can't
drink milk or won't drink milk?
Ms. Rivas. Currently, and we can make an operations--the
School Nutrition Association did an operations report on trends
in menu planning in the last year, and the majority of school
districts are currently offering vegetarian options as a choice
in their menu planning. In many cases, some of the vegetarian
options, because they are not very popular, are more expensive.
When we have special diets for our students, some of those
substitutions are also higher, and so they are more expensive
and all the more reason why that additional reimbursement is
very helpful in being able to expand those menu options.
Mr. Polis. The second part with regard to the milk?
Ms. Rivas. Currently, we offer a variety of milk, and
school districts can choose to offer, as well, milk alternate
substitutions. The cost of a comparable milk substitute is
probably about four or five times the price of an 8-ounce
carton of milk. And so, again, it is more expensive to be able
to do that, but many school districts are absorbing the costs.
Mr. Polis. What can be done to bring down those prices of,
let's say, soy milk or almond milk or other milk products.
Ms. Rivas. I think most students accepting that choice.
Because when we put the soy milk option on the line, a milk
carton might cost us 20 cents. A soy alternate is about 75
cents. And so when we put that on the line, very few students
take that choice. I am not really sure how to get industry to
be able to reduce those costs, but, obviously, the more
students that are exposed to it and learn to accept that, then
that also lowers that cost. But, it is basically because it is
not a high-volume item that it is going to cost us more.
Mr. Polis. Finally, can you share with us your
recommendation on how we can strengthen nutrition education and
in particular what role the TEAM Nutrition Network can play to
promote and support healthy eating and physical activity by
children?
Ms. Rivas. A number of years ago, there used to be funds
that were designated for nutrition education at the rate of
about 50 cents per student; and those funds were eliminated.
Certainly more funding for nutrition education would be
necessary to be able to expand nutrition education. We are also
working with the coordinated school health programs in the
school to work on incorporating nutrition education into the
classroom curriculum.
Mr. Polis. You mentioned earlier a majority of schools have
vegetarian options. By majority, did you mean perhaps a slight
majority, 50, 60, 70 percent, or do you mean the vast majority?
Ms. Rivas. I think it is closer to the 90 percent. I don't
know the exact figure, but from what I recall it was between 90
and 96 percent.
Mr. Polis. Thank you. Yield back.
Chairman Miller [presiding]. Ms. Chu. Congresswoman Chu.
Ms. Chu. Thank you, Mr. Chairman.
Ms. Rivas, I understand that school districts bear
significant administrative costs in administering the Federal
School Lunch Program, and one of those costs has to do with
what they pay the school district itself for the cost of just
being there. And I understand that there isn't any
standardization with regard to what the school district can
charge. One of my school districts just told me about an
example where they are charged for the full cost of using the
multi-purpose room all day long, when, in reality, the children
only use it half an hour each day. So what can be done about
this? I know that you talk about eliminating the administrative
costs entirely, but could there be some standardization that
can be done across States?
Ms. Rivas. Well, USDA currently allows some costs to
producing--or indirect costs that go to producing the meal as
an allowable cost. But currently there are no specific
guidelines to be able to determine what those indirect costs
are. So we urge you to have the Secretary of Agriculture define
those guidelines more clearly so that nationally we are able to
have more consistent guidance in what districts are able to
charge school districts. So to prevent some of the school
districts for charging, like the example that you used, for the
multi-purpose room that is only used minimally.
Ms. Chu. Should it be done by the Secretary? Should it be
done State by State? I am wondering what the best way to go
about doing this is.
Ms. Rivas. The most consistent way is to be able to set
some general guidelines. But from--this is a national program.
It is funded nationally. The guidelines for the menu planning
all come from the Secretary of Agriculture; and they, I think,
would be the best body to be able to determine what those
guidelines--because they know what those expectations are for
producing that meal. They established the guidelines for
producing that meal. So what would be allowable I think would
be best determined by the Secretary of Agriculture.
Ms. Chu. And there are also the administrative costs of
verification. I know that you talked about one way of
streamlining would be to have to whole communities qualify for
free lunch programs, but not all communities would be able to
qualify in that manner. So what are other ways that there could
be to streamline the verification?
Ms. Rivas. I am not familiar with all of the variety of the
ways that that can be done. But I know that there is a certain
threshold that a school district begins to achieve that after a
certain level of percentage of free and reduced or it gets to
where it is more cost effective to eliminate the whole
application process. There is a big amount of expense that goes
to processing applications and verification.
So there is a threshold, and we just urge you to consider
that. Because it would be a more cost-effective way for those
communities to be able to reduce the cost to the students as
well as to expand participation.
I had experience with a Provision 2 program where we had
about 84 percent free and reduced, and when we went to that
program we were able to eliminate the stigma that students had
about the program, and we were able to increase breakfast from
30 percent to 50 percent. We were able to increase middle
school and high schools over 10 to 15 to 20 percent at varying
schools. So it is a very good option, especially in those
communities that have--where the threshold is to where it
costs, you are putting more money into file cabinets as opposed
to on the plate of children.
Ms. Chu. And there are relatively high percentage rates of
fully subsidized students and fully paying students, but I
understand there is a shockingly low rate of students that are
at the subsidized level. In my district, we are saying it is
only 7 percent versus those who are subsidized being from 60 to
90 percent. What would be the cost and benefits of allowing
students at the reduced lunch level to be fully subsidized?
Ms. Rivas. That is another area that--or recommendation
priority that the School Nutrition Association has. Sometimes
there is a very small percent of students at that reduced
category that are having to pay 40 cents. And, frankly, when
you get some of those students and you have families of four or
five children in that household, it gets very unaffordable for
families. And very often our own cafeteria supervisors, even
though many of them are struggling with their own personal
budgets, take money out of their own pockets to be able to make
sure that the children have a meal.
So our recommendation is that over time we have that scale
adjusted to where we begin incorporating the guidelines to
include the reduced student and expand to where they eventually
are also fully subsidized like the free students are.
Ms. Chu. Thank you. I yield back.
Chairman Miller. Thank you.
Mr. Kildee.
Mr. Kildee. Thank you, Mr. Chairman.
Ms. Rivas, several years ago, Bill Goodling and I put a
program in for fresh fruits and vegetables being made available
throughout the day in the classroom, various places. I visited
one of the programs in my district. It was very, very
successful, very popular with the teachers and the students.
Could you comment on that program?
Ms. Rivas. That is a wonderful program, and I personally
have that experience with the Dallas School District. We have
over 20 or 30 programs right now where we receive funding for
fresh fruits and vegetables. And we have volunteers, they come
in, they help distribute a variety of fresh fruits and
vegetables.
Again, many of these children are not exposed to some of
these fresh fruits and vegetables. They have never seen a kiwi
fruit or star fruit or watermelon because they can't afford it
at home. And so our staff, along with parent volunteers,
deliver it to the classroom for a midmorning or midafternoon
snack; and it is a very successful program.
Mr. Kildee. Well, what I noticed in two or three schools I
visited, that cuts across the socioeconomic lines.
Ms. Rivas. Absolutely. It is available to all students, and
so it is part of a nutrition education program. And part of
that program requires that you provide nutrition education as
part of that program.
Mr. Kildee. I remember I went to a rather wealthy--probably
the wealthiest school district in my district, and nothing was
being wasted, very little. You could see very little waste. It
was an extremely popular program. So we had a study in a
poverty area and a study in an area that was not--the opposite
of poverty.
Let me ask you this question, too. I started the first
School Breakfast Program when I was a teacher in Flint Central
High School in Flint for a small number of students. Does the
School Breakfast Program have any affect upon attendance at the
school?
Ms. Rivas. As I was mentioning the benefits of the
breakfast program, attendance was one that I forgot to mention,
along with improved attention in the classroom, behavior in the
classroom, being able to learn certain math and analytical
skills, attendance, going less often to the nurse's office, all
of these are great benefits of the breakfast program.
Mr. Kildee. Especially among the poor. Very often, they
left home in the morning without any breakfast, so quite
anxious to get to school to get their breakfast. And generally,
once they got there, they stayed there, not always, but they
stayed there. So you do see an affect on----
Ms. Rivas. I have had some students having been involved
with the breakfast program where I had breakfast in the
classroom at one school and the student happened to be rezoned
to another school where they did not have breakfast in the
classroom, and he wanted to go back to the other school because
they had breakfast in the classroom there because they really
needed that breakfast in the morning.
Mr. Kildee. Thank you very much. I thank all of you very
much.
Chairman Miller. Thank you.
Mr. Holt.
Mr. Holt. Thank you, Chairman Miller; and I wanted to
acknowledge the subcommittee Chair, Carolyn McCarthy, for
working on the Child Nutrition Program. It is really more
important now than ever. I am finding in schools in my district
in these tough economic times the number of children who need
the lunches and the breakfasts are--the number is greater than
ever.
As you may have gathered from my interchange with Mr.
Scott, I have a real interest in the Farm to School Programs.
You probably know it is a key priority of Agriculture Secretary
Vilsack, and First Lady Michelle Obama has planted a garden and
so forth. And it not only--this program not only provides the
fresh--fresher food, but it also has an important educational
component that I think lasts into adulthood.
So I am pleased that some of us have introduced the Farm to
School Improvements Act, which provides competitive grant and
technical assistance for the use of local foods. That improves
the relationship between schools and the local providers and
provides mandatory funding each year for the program. So it
does provide local economic benefit. But I think--and it
provides an important educational component, as I say.
Ms. Rivas, as President of the School Nutrition
Association, I would like to ask you about a couple of things.
First, starting with the breakfast program. You recommend
providing commodity foods for breakfast, which can be used if
you already have them for the lunch program but that are not
available there. What about Farm to School? Did you see a role
for that in the breakfast programs?
Ms. Rivas. We are urging Congress to consider five
additional cents for commodity and the Farm to School Program,
and that value would certainly be a wonderful thing to have.
And you are absolutely right about the vegetable gardens and
providing the nutrition education aspect to the students'
knowledge. Because once they see and are exposed to those
fruits and vegetables and they see it growing in the
neighborhood garden or their school garden, they are able to
see that it isn't something that you just pick up at the
grocery store but they can grow it at home, and they take those
messages home to their parents.
But any financial assistance for the breakfast program, the
Institute of Medicine guidelines have increased the
requirements in the breakfast category to expand more fresh
fruits and vegetables as well, and so that funding is very
critical to meeting those guidelines as well.
Mr. Holt. Despite being authorized, the existing Federal
Farm to School Program hasn't been funded. So what would you
say about making the funding mandatory?
Ms. Rivas. Absolutely.
Mr. Holt. That is it. That is a softball question.
Chairman Miller. I thought it was a trick question.
Ms. Rivas. Any funding you can make mandatory we will
graciously accept.
Mr. Holt. Not a trick question. A key pillar of the First
Lady's Let's Move! campaign to solve the problem of obesity is
to serve healthier foods. She is encouraging or actually
working toward the goal of doubling the number of schools that
participate in the HealthierUS School Challenge. What does it
take to become a HealthierUS school? How can we help more
schools get there? Is doubling a reasonable goal?
Ms. Rivas. I think it is a reasonable goal, and we at the
School Nutrition Association have been working closely with
USDA. They are looking at some of the paperwork criteria to
make it easier for school districts to be able to apply to it.
Because when we used to see an application that we had to fill
out, it made it more complicated. But the benefits of the
HealthierUS schools is that not only does it have requirements
in the menu planning, which is very key to the HealthierUS
schools requirements, but it also has a component for physical
activity.
In the First Lady's Let's Move! campaign, one of the
pillars is school meals, but one of the other pillars is
physical activity. So the HealthierUS schools is a wonderful
recognition that school districts can achieve that promotes
both nutrition and nutrition education, and physical activity.
So it is a wonderful program, and the School Nutrition
Association is going to be really encouraging more of our
members to participate. We are going to be promoting it at our
meetings and conferences and publications and everywhere we can
to help school districts.
Mr. Holt. Thank you, Ms. Rivas.
And I thank the other witnesses, and I am sorry time
doesn't allow for discussion with those excellent witnesses
now, too.
Thank you.
Chairman Miller. Thank you.
Congresswoman Shea-Porter.
Ms. Shea-Porter. Thank you.
Thank you all for being here.
Better nutrition creates better health, greater
productivity, and lowers health care costs; and, right now, we
are talking about that quite a bit on the Hill. So the work
that you do actually makes a big difference in the lives of
these children and these adults, and I want to thank you for
that.
We had a recent report by the Carsey Institute, which is
out of the University of New Hampshire, which happens to be my
alma mater. But it had a disturbing note. It said that 55
percent of income-eligible rural households with children did
not participate in the National School Lunch Program. Can you
identify any barriers to that?
Ms. Rivas. I am not familiar with that community, but I
know that one of the barriers is that there very often is a
social stigma related to the application. And so more funding
to be able to have technology, make applications online and
easier to access and reduce that stigma that students might
have regarding making meals available to them would be helpful.
But I think in a community where there is a high poverty
area, the community eligible type of program or community
eligibility would be very helpful. Because, in that case then,
students wouldn't have to fill out an application; and, that
would reduce the cost of the application process to the school
district.
Ms. Shea-Porter. Clearly, it has to be addressed; and, Mr.
Chairman, I would ask that we submit a copy of the report for
the committee.
Chairman Miller. No objection.
Ms. Shea-Porter. I didn't think you would mind.
[The information follows:]
------
Ms. Shea-Porter. The other thing I wanted to ask is that I
know that the President's wife is going to put this terrific
program into place, and I know that she has shown great
commitment for children and for nutrition and obesity. And the
issue, obviously, of obesity and then diabetes, et cetera, is
enormous. And Mrs. Obama has talked about these pillars.
I can remember--I think it was last year, when we had
Richard Simmons here and he was talking about the necessity for
exercise and how children just weren't getting enough exercise,
and I was remembering when my own kids were in school the
punishment would be, if a child was hyperactive or needed to
move around, was they weren't allowed to move around. They had
to sit in their seat. If they couldn't stay still, they would
miss recess, and they would have to sit in their seat. So it
seemed like it was the exact opposite of what we hoped the
result would be.
So my question is, while we start to integrate these
programs and we bring in more people, will you all be part of a
team if you are in a school and in such a setting, a day care
setting or wherever, where you will actually be included in
some of the decisions that are made by principals and teachers
as part of the education process to say that not only is it
about food and good food so that children don't have too much
sugar and too much whatever it is in the food, too many
carbohydrates, but that we also make sure that the policies in
the classrooms and on the playground make sense? Because what
Mr. Simmons was talking about was a very real problem, that the
kids aren't exercising enough. So will your voices be heard?
Will you be part of that integrated approach?
Ms. Rivas. Yes. And I would suggest that you go to the
schoolnutrition.org Web site. Because in there we have the
press release where one of our initiatives in partnering with
the First Lady was to include working to make coordinated
school health a concept that is one that more of our members
embrace.
I think very often what we have found is that, when you
work in partnership with a total school community, we are more
successful in improving the total school environment not only
from the menu planning aspect but to the physical activity as
well as even the vending programs at the school, because we are
all supporting each other toward that same effort of reducing
childhood obesity and improving the health of our students.
Ms. Shea-Porter. Let me indicate that I have great sympathy
for a principal that is exasperated enough to say, what other
tools do we have? But it does seem to be counterproductive for
what we are trying to do here.
I would suggest that even school boards and others who are
involved in budgetary decisions about physical exercise need to
be part of that. So that it is not just nutrition, it is not
just one component, but it is looking at the whole child and
all of the different issues to really, really change the
direction that we have been heading in.
Thank you and thank you all for being here.
Chairman Miller. Thank you all so very much for your
testimony.
I would ask--and Mr. Kline may have an additional
question--but, Ms. Saluja, you made a recommendation I think I
can follow up on, and that is I was stunned by your description
of the ``breastfeeding broken'' hospitals. And I will take your
suggestion to talk to Mr. Waxman and Mr. Rangel about this.
It is just not acceptable that in the year in which--over a
year now we have spent discussing how to drive down long-term
health care costs that the recommendations from the Institute
of Medicine on breastfeeding would not be incorporated into the
birth of those children with the mothers in those programs. So
I appreciate very much that recommendation.
Thank you all. We look forward to this reauthorization. I
think you have all made a lot of very good recommendations,
some of which we have discussed with you previously and some
which we have yet to follow up on. Be assured they will get the
full attention of the committee.
Mr. Kline, do you have anything further than that?
Mr. Kline. Again, just thank the witnesses.
Chairman Miller. Thank you so much; and, without objection,
members will have 14 days to submit additional materials or
questions for the hearing record.
Without objection, the hearing is adjourned. Thank you.
[Questions submitted to Ms. Rivas and their responses
follow:]
[Via Facsimile],
U.S. Congress,
Washington, DC, March 16, 2010.
Ms. Dora Rivas, MS, RD, SNS, Executive Director,
Food and Child Nutrition Services, Dallas Independent School District,
Dallas, TX.
Dear Ms. Rivas: Thank you for testifying at the Committee on
Education and Labor's hearing on, ``Improving Children's Health:
Strengthening Federal Child Nutrition Programs,'' on March 2, 2010.
Representative Dave Loebsack (D- IA) has asked that you respond in
writing to the following questions:
1. You mention a number of ways that the existing child nutrition
programs could be improved to increase access. Drawing from your
experience, could you give us a sense of what it would mean for
students and even school administrators if schools in Dallas that serve
predominantly low-income children could offer free meals to all their
students?
2. You also mention a number of ways that the existing child
nutrition programs could be improved to increase access and streamline
administration for schools. In your experience, can you discuss how
well direct certification has worked and in more detail, expand upon
what you see as the benefits to expanding the type of income data used
to directly certify kids?
Representative Jared Polis (D-CO) has asked that you respond in
writing to the following questions:
In your response to my question during the hearing, you mentioned
that 90%-95% of schools offered a vegetarian option in the school lunch
menu. However, according to the School Nutrition Association 2009
Operations Report:
About 64% offered a vegetarian option in at least one
school in the district.
About 20% offered a vegan option in at least one school
(9% offered it to elementary students, 12% to middle schools, and 20%
to high schools).
About 14% of schools offered soy or rice milk in at least
one school in the district.
First, I would like to know if you could comment on whether the
above more accurately reflect the availability of vegetarian options in
our public schools. Second, I'm interested in the availability of
healthful (low-fat, high-fiber) plant-based options and not in the
options such as cheese pizza that might count under the ``vegetarian''
definition, but are nevertheless high in fat, saturated fat, and
cholesterol. Thus, I would like to reframe the following questions and
would appreciate your response:
1. Do you think that we should educate students about the benefits
of low-fat, high-fiber, plant-based (vegan) options?
2. Should we encourage such options in the National School Lunch
and Breakfast Programs by making them more affordable and providing
incentives for schools, especially high-poverty schools, to provide
them?
3. Do you believe that schools should offer nondairy milk
alternatives that meet nutritional standards established by USDA (be
eligible for reimbursement under the National School Lunch and
Breakfast Programs) with school lunches for those kids that don't want
to or can't drink milk?
Please send an electronic version of your written response to the
questions to the Committee by close of business on March 25, 2010. If
you have any questions, please do not hesitate to contact the
Committee.
Sincerely,
George Miller,
Chairman.
______
3700 Ross Ave.,
Dallas, TX, April 14, 2010.
Committee on Education and Labor, 2181 Rayburn House Office Building,
Washington, DC 20515.
Thank you for the opportunity to respond to additional questions
following my appearance at the March 2, 2010 hearing before the
Committee on Education and Labor--``Improving Children's Health:
Strengthening Federal Child Nutrition Programs.'' I appreciate the
opportunity and would be pleased to offer any further clarification on
these responses, or to respond to any other school nutrition issues the
Committee members may have.
Questions from Rep. Dave Loebsack (D-IA)
1. Providing universal free school meals to Dallas schools with a
high percentage of students from low-income families would dramatically
increase access to school meals, reduce the stigma of participation in
the National School Lunch and Breakfast Programs and relieve pressure
on the school district's Child Nutrition Services Department.
Due to current economic conditions, an increasing number of
America's children are going without school meals because their
families cannot afford the reduced price meal charge of 40 cents per
child. According to an October 2009 School Nutrition Association
survey, 45 percent of school nutrition directors reported an
``increase'' in the number of unpaid student meal charges in the 2008-
2009 school year, with 15 percent noting a ``strong increase.''
Some families are unaware that they are eligible for reduced price
meals or are embarrassed that they cannot afford the full price for
school meals and avoid going through the application process. This
trend of some students going hungry and not participating in the
program or not being able to pay for their meals is placing a financial
burden on school nutrition programs nationwide, reducing their
resources to make further nutritional enhancements to the meals or even
meet operational costs.
If Dallas ISD had the opportunity to eliminate the application
process, the significant savings in paperwork reduction would result in
more students having access to healthy schools meals, eliminate social
stigma and redirect efforts to increasing productivity, and increasing
focus on improving quality school meals through more staff training on
food safety, quality meal production and being able to use the
cafeteria as a learning laboratory for nutrition education.
Universal school meals would ensure no child in an eligible school
would miss a school meal, would eliminate unpaid meal charges and would
lift the substantial burden of processing applications for the free and
reduced price program.
2. Eligibility for free meals shares income guidelines with other
federal assistance programs, such as the Supplemental Nutrition
Assistance Program (SNAP), the Special Supplemental Nutrition Program
for Women, Infants and Children (WIC), and other programs offered by
other federal agencies.
Multiple applications for programs with similar eligibility
standards takes time unnecessarily, demands resources, and increases
the potential for mistakes. Direct certification takes advantage of
income verification work that has already been done, reduces errors,
speeds the provision of benefits to eligible children, and helps local
school food service personnel by reducing paperwork, allowing them to
focus on serving quality meals. Direct certification may also help
qualify children for free meals that right now may be unwilling to
apply because of the perceived stigma of participation in the program
discussed in response to your prior question.
There are several examples of direct certification being used
throughout the country, while schools and states anxiously await the
opportunity to submit applications for the $22 million in direct
certification grants included in the FY 2010 Appropriations Act. I
believe that direct certification has been a positive experience for
USDA, for the schools using direct certification, and, most
importantly, for the children receiving the meals.
Questions from Rep. Jared Polis (D-CO)
Thank you for your inquiry on vegetarian options in school meals.
When I testified before the committee I did not have a copy of School
Nutrition Association's 2009 Operations Report on hand, and I apologize
for misstating the findings on vegetarian options. You are correct that
the study found that about 64 percent of school districts reported
offering a vegetarian option. Let me also assure you that this
percentage is growing.
In my initial response to you, I believe I was confusing the
percentage of districts offering the following:
Fresh fruits/vegetables--98.8%
Whole grain items--96.3%
Salad bar/pre-packaged salads--91.1%
As you know, school meals must meet federal nutrition standards
limiting fat. No more than 30 percent of the meal's calories can come
from fat and less than 10 percent from saturated fat. Vegetarian
options being served in schools must meet these requirements, which is
why many schools are making their cheese pizza and other entrees with
low-fat cheeses.
In response to your specific questions:
1. School Nutrition Association (SNA) strongly supports efforts to
promote nutrition education. The Association's 2010 Legislative Issue
Paper calls on Congress to ``address childhood obesity by establishing
an effective nutrition education curriculum and increasing the
consumption of fruits, vegetables and whole grains.'' Nutrition
education is a critical step in addressing childhood obesity is
teaching children the basics of healthy eating. The school cafeteria
should be a classroom in this regard, and school nutrition programs can
be a partner in developing effective nutrition education curriculum.
2. School nutrition programs do need financial assistance to offer
additional servings of fruits, vegetables, whole grains and legumes and
to meet the Institute of Medicine's recommendations for updating
national nutrition standards for school meals. In fact, SNA called on
Congress to increase the per meal reimbursement for all meals in order
to keep pace with rising costs and implementation of the Dietary
Guidelines for Americans. Restoring equipment assistance is vital to
helping schools develop the capability to serve these very desirable
foods. Offering more plant-based options means that schools will need
greater refrigeration capacity and more steamers for healthy
preparation of these items. SNA appreciates the equipment assistance
provided as part of the American Recovery and Reinvestment Act. The
applications from schools far outpaced available funding, demonstrating
that the need for this assistance is significant. It is for this reason
that SNA has requested that Congress re-establish entitlement funding
for equipment assistance in all schools to meet this need.
3. As you noted, some schools are already offering students
nondairy milk alternatives, with about 14 percent of school districts
serving soy or rice milk, according to SNA's 2009 Operations Report. In
fact, federal regulations require schools to offer a milk alternative
to students with special dietary needs. However, as schools determine
whether to offer nondairy milk alternatives they must also balance the
additional cost, student demand for the product, as well as product
waste on perishable food items.
Sincerely,
Dora Rivas.
______
[Whereupon, at 4:15 p.m., the committee was adjourned.]