ESTIMATED QUARTERLY PROJECTIONS BY CATEGORY OF PARTICIPANTS TO BE SERVED IN THE PROGRAM

This would be a monthly estimated average of 383 women, 248 infants, and 789 children.

The types of data to be collected and maintained are as follows:

(a) Financial records of all money received and disbursed. All cost allocation data shall be maintained.

(b) Food records-food authorizations issued to participants will be maintained.

(c) Medical records will be maintained including the following: height; weight head circumference for infants. Mortality and morbidity records kept when available; as well as homoglobin tests.

(d) Informed consent records.

(e) Civil rights records.

(f) Reports as required by FNS forms 187 and 187-1.

This data will allow the staff to evaluate the effectiveness of the project. In addition, the Monthly Field Reports will enable the staff to keep a continuing count of withdrawals, new enrollers, and total current participation. Reports will be submitted to FNS on a regular basis which includes patient data and expenditures as required.

Nutrition education to improve the general health status of participants and their families will involve counseling at sites by the project nutritionist, public health nurses, and expanded nutrition program aides. This will include consumer education, nutrition information related to specific conditions (anemia, overweight, etc.), as well as good general nutrition practices. Follow-up into homes will be conducted by outreach workers and public health nurses.

The project area includes six northern counties of the state of North Dakota which have been organized as "The Area Low Income Council Inc."

Names and addresses of each participating clinic :

Catherine P. Fitzpatrick, MD, MPH, Director, Division of Maternal and Child Health, North Dakota State Department of Health, State Capitol, Bismarck, ND 58505, Phone: (701) 224-2493.

Benson County Public Health Nursing Office, Court House, Minnewaukan, ND 58351, Mrs. Donna Rice, RN, Public Health Nurse, Phone: 473-5444.

Cavalier County Public Health Nursing Office, Court House, Langdon, ND 58249, Mrs. Fannie Valentine, RN, Public Health Nurse, Phone: 256-2402.

Eddy County Public Health Nursing Office, Court House, New Rockford, ND 58356, Mrs. Arlyss Lesmeister, RN, Public Health Nurse, Phone: 947-5311. Ramsey County Public Health Nursing Office, Court House, Devils Lake, ND 58301, Mrs. Marion Moen, RN, Public Health Nurse, Phone: 662-4318.

This project was notified of its approval January 3, 1975. Funding was received approximately February 15, 1975.

Monies for the project are currently in the State Treasury, Forms, accounting procedures, and recruiting of personnel are being implemented.

Based on the experience of projects in other areas we anticipate (1) improved nutritional status of participants and their families because of the availability of iron rich foods, foods of high quality protein, and vitamin C rich foods; (2) improved eating habits because of the foods available and thus a decrease in use of snack foods of little or no nutritional value; (3) gains in heights and weights of infants and children; (4) increased hemoglobin levels. Along with improved nutritional status other health services such as immunizations, well child care, maternity care, and general preventive health care to these persons are expected to increase.

Senator MCGOVERN. Mr. Goldberg, you may finish now? I understand that you were cut off in your remarks. Why don't you finish your comments, and then we will proceed with Mr. Hunt.

STATEMENT OF DAVID GOLDBERG, DIRECTOR, WIC PROGRAM, VERMONT DEPARTMENT OF HEALTH, BURLINGTON, VT.Resumed

Mr. GOLDBERG. I realize that we are short of time here so I will summarize my statement which is already on the record. I am the director of the WIC program for the State of Vermont, which is a single statewide program currently reaching about 17,000 women and children in this State.

We feel that WIC is a fairly well conceived program for two reasons: because it operates firstly from a recognition of the benefits of preventing problems before they become more serious or difficult to treat and more expensive as a drain on our public spending; and secondly, it is well conceived because it uniquely operates through health service programs as opposed to other child nutrition programs.

I think an illustration of the benefits of preventing health problems rather than treating them later can be seen by discussing mental retardation and the cost of providing services to children and adults who are mentally retarded. In Vermont, it costs about $8,000 a year to provide services for retarded people who are in the State training school. Private nursing care for retarded people is even more expensive. Our experience in Vermont coincides with the Department of HEW estimates that over a lifetime of maybe 40, 45, 50 years, this could amount to $500,000 in public spending to provide care for one retarded person. I think this contrasts rather dramatically with the approximately $300 a year that it would take to provide the kind of nutrition supplementation that WIC makes available in one year.

We feel also that WIC is succeeding in fulfilling some of the expectations that were outlined to Congress almost 3 years ago when this program was on the drawing board. We find in Vermont that it is bringing a dramatically larger population into contact with our public health services. We are also finding evidence that WIC seems to be effective in curing nutritional anemia. A sample of our clinic records that we were looking at recently showed that in their initial visits to WIC clinics, 27 percent of this particular sample had hematocrit readings that were below the normal range for their particular age group, and following up 6 months later, every single one of this particular group had hematocrit readings that were within the normal range for their age group. And while this certainly may not necessarily represent the entire picture, it is a sample, and I think it is good evidence that the program is fulfilling its promise.

Now, addressing S. 850, I think it contains some provisions that will correct some problems that we are facing with the WIC program right now despite its sound conception. Briefly, the increase in the nonfood allowance for outreach and nutrition education activities is going to permit us to get into an activity that has been described a number of times as one of those areas that WIC should be in now and is not; that is primarily nutrition education.

Second, there is provision in S. 850 that would provide more flexi bility than we currently enjoy in making foods available to participants, and we are encountering some problems in this regard. I would say that left to our own devices we could come up with a food package that is substantially similar to the one that the USDA has come up with. There is some flexibility required, that we do not have now, simply because there is a great variety of experience. There is nothing magical about the age of 6 months or 12 months.

I think on a local level we are in a better position to recognize these individual needs.

Finally, I think the expanded eligibility for women to 6 months post. partum as opposed to 6 weeks, is a much more realistic recognition of the time it takes a woman to recover from the nutritional stress of pregnancy, and extending the benefits to kids who are past 4 years old is another needed improvement in this program.

Now there was some discussion earlier about the adequacy of the proposed $300 million authorization, how far it would go and whether we could as a Nation afford to get into this kind of spending when we are suffering from some of the pressures that our economy is facing today. It must come down to a question of priorities, as the gentleman before me pointed out.

I would just like to illustrate this. A couple of months ago, there were two F-111's on a training mission that collided with one another over southern Vermont, and scattered scraps of metal and hardware over the hillsides. The next day the Pentagon informed us that these planes go for $18 to $20 million each. This crash represented a loss of $35 to $40 million. Now this is 10 times what we will spend in Vermont this fiscal year to provide nutrition supplementation for 17,000 people, women and children. And I have to raise the question that if we don't have enough funds to protect the health of our children, what will we be protecting with our military hardware.

So I think we have a good program in WIC.

I believe it is succeeding. We are seeing signs of this in Vermont, and I urge continuation of it.

Senator McGOVERN. Thank you very much, Mr. Goldberg. I certainly agree with the points you make on priorities. I appreciate your being with us today.

[The prepared statement of Mr. Goldberg follows:]

STATEMENT OF DAVID GOLDBERG, DIRECTOR, WIC PROGRAM, VERMONT DEPARTMENT OF HEALTH, BURLINGTON, VT.

I am David Goldberg, Director of a single statewide WIC Project operated by the Vermont Department of Health. The program in Vermont is currently providing nutritional protection to just over 17,000 women, infants and children.

I am grateful for the opportunity to appear before this Committee to express my support for the WIC provisions in S. 850. I am also pleased to report to you that, in my view, State and local WIC projects are making impressive gains in meeting the objectives expressed by Congress by the enactment of the WIC Program, which was in response, as you know, to vocal and well-documented alarm about the dangers of preventable malnutrition among the prenatal and early child population. To retreat on this commitment at this time is to ignore the weight of volumes of testimony and medical evidence, and to overlook the enthusiastic commitment of state and local health workers.

The WIC Program was soundly conceived as to most of its underlying principles. Firstly, it follows from an understanding that it is far more sensible, in terms of our use of human and fiscal resources, to prevent where possible chronic health problems and disease, rather than to attempt to treat them after their occurrence. Secondly, by operating in conjunction with health service programs, WIC underscores the link between proper nutrition and good health.

It will be several years before we will be able to measure the impact of this nutritional intervention by such measures as infant mortality rates, prematurity rates and other traditional indicators of populations at risk. However, in the thirteen short months since program operations began in Vermont, we have observed signs of the impact WIC can have on the health of participants, which I would like to share with you today.

First of all, there is the very direct and obvious impact of guaranteeing adequate amounts of good foods to infants and pregnant and nursing women. The difficulty increasing numbers of families are facing trying to purchase a proper diet is a topic getting a great deal of attention, and is well known to this Committee. Too many families in Vermont are forced to make unhealthy family budget decisions, such as whether to spend on home heating or putting enough food on the table. From the reports of many participating families, WIC is the deciding factor in determining whether there is enough food to eat in the house. Not only are key nutrients provided, but family funds are also freed up for the purchase of foods that would not be a part of the diet otherwise. People most often refer to fresh fruits and vegetable as foods that they can now afford due to their participation in WIC.

Secondly, the WIC Program is bringing a dramatically larger population into contact with our public prenatal and well-child health services. Through these services children are examined, immunized and screened for a variety of vision, hearing, dental and developmental health problems; expectant parents receive education about child development and the course of pregnancy. Most importantly, we are in a position to motivate the family to obtain preventive health services at a time when they are most concerned and ready to learn. In Vermont, as elsewhere, the high cost of health care is largely attributable to the tendency of people not to seek care until the need for crisis intervention occurs. Emphasizing the habits of prevention can only in the long run lead to incalculable savings in human suffering and public spending.

Thirdly, we have evidence now that the diet supplementation available through the WIC Program is effective in correcting nutritional anemia. A random sample examination of our clinic records indicated that, on entry into the WIC Program, 27% of those tested had hematocrit readings below the normal range for their age group; six months later, upon reexamination, every patient previously deficient had hematocrit reading within the normal range.

Despite our experience to date which leads to such optimism, there are problems with the WIC Program as it presently operates. The legislation before this Committee addresses some of these problems.

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