Question. As I understand it, WIC is based on the idea of preventing health problems with nutrition supplementation. What are some of the benefits of a preventive approach to health problems? Answer. Senator, testimony presented to this Committee has described how nutrition intervention is a factor in preventing physical and mental birth defects and early childhood development disabilities. Mr. Stickle of the March of Dimes Foundation has described how that organization, after successfully conquering polio, has turned its energies to the prevention of birth defects. This is because some disease, while preventable, cannot be treated once the damage is done, or can only be treated with enormous effort and cost. One example that we screen for at our well-child clinics is amblyopia-lazy eye-which is much more likely correctable if detected before the child is four years old or so. The general feeling is that if amblyopia is not detected by the time the child is six or seven years old, the chances of correcting the problem are very slim. Preventing these health problems can lead to potential savings of astronomical amounts in public spending. For example, there has been testimony that some forms of mental retardation are preventable, and that proper prenatal and early infant nutrition is an essential component of the preventive picture. In Vermont, it costs the state about $8,000 a year to provide care for a retarded person at the state training school, or about $10,000 a year in private nursing care. This amounts to between $300,000 and one half million dollars in costs over the lifetime of a person requiring such care, compared to about $300 a year that it costs us now to provide nutritional supplementation to a pregnant woman or an infant. The Vermont Department of Mental Health, in a report prepared last year for the Vermont House Appropriations Committee on the causes and prevention of mental retardation, listed "implementation on as broad a basis as possible of the (WIC) nutrition supplement program presently being administered by the Department of Health" as a preventive approach that "could reduce substantially the incidence of mental retardation." This is all aside from the incalculable costs to the public in welfare and corrections spending for persons whose fullest potentials have not been realized because of early deprivations. Mr. Robinson from North Dakota, who testified earlier, stated that he feels that his efforts for day care feeding are more effective than his former work with teenagers in corrections. By the time the corrections officer has contact with the youthful offender, he stated, it is too late. Question. S. 850 provides for an authorization of $300 million for the WIC Program. How much expansion over present program levels would this allow? Answer. I doubt whether a funding level of $300 million will allow for a great deal of caseload expansion, if any. This funding level would allow us to feed our present caseload for a while longer, as S. 850 proposes for four year old children and postpartum women. It has been estimated, by the Select Committee on Nutrition and Human Needs and by the Children's Foundation, that the cost of serving the presently approved caseload over a twelve month period would be about $220 million. This increase over the $130 million available during the current fiscal year is due to the practice of funding new projects in the middle of or three-quarters through the fiscal year. For the next twelve months, it will require two to four times more to keep some of these projects going. This factor alone will limit how much expansion $300 million would permit. Perhaps a look at the cost of the Vermont project will illustrate the impact of the proposed $300 million funding level. Vermont has requested $6.2 million for the coming fiscal year to serve our currently approved caseload. We would like to expand our caseload, but the Agriculture Department has asked all states to submit provisional requests based on current caseload levels. In any event, the provisions of S. 850 to extend the duration of eligibility for children and postpartum women, changes which I support by the way, will add $1,450,000 to our projected food budget. The provision to increase the non-food share from 10% to 25%. another beneficial improvement of the program, would increase our proposed budget by an additional million dollars. Together. these changes would increase Vermont's funding needs by about 40%. I don't know whether the impact on Vermont's budget is typical for other states, Senator Leahy, but if so, then a 40% increase in cost over the present annualized spending level of $220 million would bring the total cost to over $300 million. This is why I have my doubts about whether the authorization in this bill is adequate to allow the WIC Program to serve many more participants than we currently reach. In Vermont we estimate that nine or ten thousand more women and children may be eligible for WIC benefits, in addition to our currently approved caseload. I doubt whether we could make a significant dent in this unmet need under the proposed authorization. Question. I notice in your prepared statement that you support the language in S. 850 that would permit more flexibility regarding which foods to make available. Why do you see this flexibility as being needed? Answer. There is a tremendous degree of variation from family to family in the makeup of the diet, and as much variation from infant to infant in the development of diet patterns. If the WIC Program is going to be successful in supplementing diets, then there must be flexibility to reflect this reality. While the food package that the USDA has come up with is, in my view basically very sound, we would not adhere to it as rigidly as we have been directed to by the federal agency. I would propose that, on the federal level, requirements be established as to what percent of a woman or infant's RDA for various nutrients be provided, and leave it to professionals on the local level to decide which particular foods would do the job best. It would certainly be appropriate for the USDA to share the benefit of its expertise by suggesting various food packages that would meet these requirements, but for these food packages to be considered immutable, as is the case now, leads to problems. For example, current regulations lead to our requiring formula for infants who cannot use it, while on the other hand regulations prevent us from making available formula to children over one year old who require it. This does not serve the purpose of the program. Another example is how cereals are chosen by USDA as allowable for distribution in the WIC Program. They are selected solely on the basis of iron content. This has severely limited the variety of cereals available, and as a consequence necessarily leads to reduced amounts of cereals consumed. This also does not serve the purpose of WIC. Just this past Autumn, new Food and Drug Administration labelling requirements resulted in cereal manufacturers reducing the iron content in a number of products. As a result, there are now only five cereals that meet the USDA standard for iron content for the WIC Program. One of these cereals we refuse to distribute in Vermont because of its excessive sugar content; we feel that distributing this cereal-King Vitamin-would shoot holes in our efforts to treat and prevent dental disease which is rampant among Vermont children. Three of the other cereals available are actually geared to the RDA levels of children four years or older. I cite these examples to point out how well-intentioned federal guidelines, when administered inflexibly as they have been, lead to practices which actually interfere with our stated goals. I believe the language in S. 850 would address these problems. Senator CLARK. The committee stands in recess. We will return right after the vote. [A brief recess was taken.] Senator CLARK. The committee will come to order. We are going to come back to David Goldberg following this panel. I know that Senator McGovern wanted to visit with him, and he will be coming in shortly. [Mr. Goldberg's testimony resumes on p. 233.] Senator CLARK. Now we are going to hear now from Harold Poore, day care specialist, Division of Community Services, Iowa Department of Social Services of Des Moines, as well as Mr. Edward Ellis, executive director, Kentucky Youth Research Center, Frankfort, Ky., and George M. Robinson, State day care supervisor, Child Welfare Services, Social Service Board of North Dakota, Bismarck. Gentlemen, each of you will have 10 minutes. We will start with Mr. Poore, and then Mr. Ellis and Mr. Robinson. STATEMENT OF HAROLD POORE, DAY CARE SPECIALIST, DIVISION OF COMMUNITY SERVICES, IOWA DEPARTMENT OF SOCIAL SERVICES, DES MOINES, IOWA Mr. POORE. Thank you Senator Clark. My name is Harold Poore and I am day care unit director for the Iowa Department of Social Services. I am here today on behalf of children in child care centers, Head Start programs, and the many children in family day care homes. I wish to thank the committee for the opportunity to testify at this hearing in support of Senate bill 850. My main reasons for supporting S. 850 is because of the kind of nutrition programs that it could provide children in their formative years, and especially those from low income families. The plan for reimbursement of snacks and meals would also have positive benefits in the operation of centers and family day care homes. This is especially important to infants, toddlers and preschoolers because, by and large, we have deserted the kids from the time they are born until they are old enough to enter kindergarten or first grade. And this is essentially the situation unless a child is fortunate enough to get in a Head Start program or in a good child care center program. In Iowa we have 671 licensed preschool and child day care centers with a licensed capacity of 19,184. The Child Nutrition Programs Division of the Iowa Department of Public Instruction has provided us with some projected special food service program statistics.* The estimated daily attendance of children participating in this program is 11,197 at 185 different facilities. The projected Federal reimbursement for snacks and meals for fiscal year 1975 is $476,770. Reimbursement for non food assistance is projected at $50,000. Total value for USDA donated commodities is projected at $17,686. This is a projected total to Head Start programs and child care centers of $544,456 in fiscal year 1975. Now then, in comparison and using the current program figures and the new proposed reimbursement formulas, the projected Federal reimbursement would be $955,595 for snacks and meals, $95,000 for nonfood assistance, and $93,091 for commodities, for a total of $1,098,686. The Federal reimbursement for just the current program level would almost double under S. 850. This proposed system of reimbursement would be of assistance to a center's operation under a very limited budget, and especially in an inflated economy. The new proposed system would also be helpful in helping new centers get under way. The performance funding that would be provided for under this bill would also allow for growth in numbers of centers and the number of children that could be served. At this point I would like to say that I cannot see any benefit to implementing the USDA's proposed block grant approach. It would simply be a disasterous retreat from current program levels of operations, and it would absolutely prevent any expansion or any new program efforts at meeting the nutritional needs of children. *See attachments A and B, pp. 210-211. Generally when we talk about child care or day care programs, we are usually referring to child care centers. The children that are overlooked or forgotten are those cared for in family day care homes. Even a review of materials from OCD, or from any publishing house, will generally relate to center care rather than family day care. This is even true of the current food reimbursement program for centers that excludes family day care homes. In Iowa we have 1,268 licensed family day care homes that have a capacity to serve about 5,000 children. These are voluntarily licensed homes. If the Iowa General Assembly passes legislation to provide for mandatory registration of family day care homes-which was voted out of the committee yesterday-a very conservative estimate would be 5,000 homes with a capacity to serve about 20,000 children. Under the current program none of these homes are allowed to participate, and consequently, none of the children are allowed to benefit from the food reimbursement program. Under S. 850, suppose a family day care home received only $65 per month per child in tuition, and then received $23.94 per month Federal reimbursement for each child. In this example, the $23.94 could make a tremendous difference in the nutrition program for that child and to the day care home mother's budget. Family day care becomes a major concern when we discuss nutrition because more day care is provided in this kind of setting than any other. Beyond this, family day care is the major provider for infants and toddlers. One reason is because the majority of centers are not equipped or staffed to care for these children. Another reason is that usually family day care is more conveniently provided in the same neighborhood where the working parent lives. This is not infrequently a low income neighborhood where noon lunches may not provide adequate nutrition for development of the child. For some comparative figures between center and family day care, we might look at the WIN program. The most recent statistics released from HEW for the quarter ended September 30, 1974. As of that date, the Iowa WIN program had 735 children in family day care, and only 169 in center care. And to expand that geographically, for region 7-which includes Iowa, Missouri, Kansas, and Nebraska-there were 1,676 children in family day care and 535 in center care.2 Along this same line it should be pointed out that family day care is definitely the greatest resource for care in rural Iowa, and in rural areas of other States. And even in our cities and towns, family day care is a major resource for child care.3 For example, in Des Moines and Polk County, we have 500 licensed family day care homes. All of the children we have talked about in the work incentive program, and many of the children of working parents, come from low-income families where food costs may be extremely high and where diet, in many cases, may consist only of carbohydrates. Consequently, as discussed under this bill, family day care homes is an area where we can reach many infants, toddlers, and preschoolers 1 See attachment C, p. 211. 2 See attachment D. p. 212. * See attachments E and F, pp. 214–215. with a food reimbursement program and provide them with an adequate and nutritious diet. Not only is this important in terms of diet and nutrition, but it is important to the provider who may be receiving a minimal fee for caring for children and cannot afford the proper kinds of foods for snacks and lunches. In closing we can only repeat that the effects of a balanced diet with adequate nutrition has a profound effect on the development of a child in its formative years, whether they are in centers or family day care homes. For all these children, we must be supportive of this legislation. And with that, I thank you very much. Senator CLARK. Thank you very much. As I understand your statement, you are saying that S. 850 would help meet a large unmet need in the State of Iowa, as well as the rest of the country, and you are speaking strongly in support of that legislation. Mr. POORE. That is right. Senator CLARK. It is interesting-I just asked for the figures about what the S. 850 with all of the amendments now would actually cost the Federal Government to try and fulfill the needs that the people today have talked so much about. The total cost is about $500 million over and above what we are now spending on nutrition programs. Now, I certainly share the view that has been expressed here this morning that in a time of great economic pressure that we be cautious about new spending programs, but I am disturbed that while we are talking about how tight we have to be on these nutrition programsand these nutrition programs are the most basic kind of right we could have, namely to feed people and to avoid mental and physical retardation that at the same time the President can come to the Congress and say, "give me some $722 million additional for the next 6 weeks for military aid to Vietnam." It seems to me that if we can be talking about programs of that kind, then certainly we could afford the kind of money we are talking about for S. 850-the McGovern bill-for a basic child nutrition program. Mr. POORE. I would certainly hope so. Senator CLARK. I would hope so too. Now that we have saved that $722 million I think we should be able to put some of it into the most basic kind of American right-the right not to be hungry and not to suffer permanent physical and mental disabilities because of that lack of nutrition. [The attachments to Mr. Poore's statement follow:] ATTACHMENT A CHILD NUTRITION PROGRAMS DIVISION, IOWA DEPARTMENT OF PUBLIC INSTRUCTION Number of sponsors approved as of March 1, 1975-- Average daily attendance as of March 1, 1975: (estimate). Number of meals served (projected for fiscal year 1975): Breakfast Lunch 103 185 11, 197 354, 555 809, 227 Suppers Supplements (a.m. and p.m.) Total meals-- 15, 307 1, 242, 409 2, 421, 498 |