Presidential Assistant for Nutrition. (l0)

The belief of the l969 White House Conference participants that DHEW was the best existing vehicle for institutionalization of nutrition policy was reflected in their call for delegation of Presidential powers to the DHEW Secretary for formulating

Executive Orders relatineto nutrition Dolicv, and their reouest that the Food Stamp and Commodity Distribution programs be transfered to DHEW from USDA.

On balance, the l969 Conference urged:

Greater centralization of program responsibility within
DHEW.

Enhancing visibility for nutrition concerns by designation
of a Special Presidential Assistant for Nutrition.

A fair assessment of the tone of the l969 Conference was that a hope that something was about to happen had been generated. Regrettably, these high expectations and hope gave way to frustration.

C. The View in l974

The Panel on Nutrition and Government at the National Nutrition Policy Study hearings concluded that, as of June l974, nothing had been done to implement any of the l969 Recommendations except a move by the administration to consolidate the Food Stamp Program with other income-maintenance efforts in DHEW. Even this action appears not to be what the panelists had in mind in l969: They wanted centralization of programs as part of a comprehensive policy. The Administration proposal, on the other hand, appears as an effort to make the Food Stamp Program compete for already scarce welfare dollars; this is viewed by many as a first step towards elimination of the program entirely.

The basic position of the Administration is that
families should make their own spending decisions
by receiving income assistance in cash, rather than
in kind. Thus, the transfer of food stamps and
related 'nutrition programs' is perceived as a step
towards welfare reform, not nutrition reform...
This may be a reasonable policy, but it preempts
a national policy for nutrition as a health goal.
Nutrition would be associated with the "W" in HEW
rather than the "H". (ll)

As panelists observed in subsequent discussion at the June hearings:

What is to be gained by urging the transfer
to HEW if nutrition programs are to be buried
under income-maintenance programs? Will the
transfer be more of a setback to nutrition than
a gain? (l2)

Concern that government was abandoning its commitment was not alleviated by a review of the Office of Management and Budget's l44 Presidentially approved Federal objectives in l974. Only two objectives related to nutrition:

"develop a more cost-effective child nutrition program"

and

"rationalize eligibility requirements for food stamps"

Both of these objectives were submitted by the Department of Agriculture. (l3) Concern among participants at the l974 hearings about the income-maintenance obsession of the administration ran deep:

The failure of the federal government to design
and implement a national nutrition policy and
organization is largely due to a policy viewpoint
which associates nutrition with "income maintenance
rather than health policies." (l4)

In denouncing this parochial viewpoint, Panel Co-Chairman
Dr. D. Mark Hegsted of Harvard observed that:

The first and primary responsibility of the Food
and Nutrition Policy must be the maintenance and
improvement of health. The major responsibility
must fall on the health system --that is, physicians,
nurses, dietitians, nutritionists, dentists, health
auxiliaries of all kinds. And in this system, the
physician must play a primary role. (l5)

The panel felt administration myopia went even deeper than narrowness of conception:

The Executive Branch senses no urgency to create
policy planning, coordinating or surveillance
arrangements. ./"it7will take a great deal of
convincing before it recognizes a priority for
nutrition policies, and nothing is in sight which is
likely to be convincing. (l6)

The panel connected this philosophy of inaction with the present emphasis of government managers on:

compelling evidence /without whicH7 the
claims of'nutrition advocates receive polite
consideration and short shift. (l7)

Panelists believed that: \

absent any scientifically-based and authenticated
standards of nutritional adequacy, and absent
any ongoing surveillance system linked to such
standards, the policymakers will not assign
serious priority or resources to the improvement
of nutrition and health. (l8)

WuLLiimj is being tec ax rhe tor police levels tc
accelerza tie fozaulatinB of the baselime. (ipi

Ifitt this depressing assessment of the status of administration in Lei est ir. nntritior pclicv, it is not surprising that, as of 19"*, eauciis ir mrcritior pclicv wbc were calling for central izartiom of programs in DHEH only 5 vears age, Bow believe:

TIM i' Imi Mi i im; in the federal government is
pluralistic. It is shared, negotiated. and
bargained. *ut the strategic directions and mejox
policy choices are focused it the hands of a few:
the White Rouse, the 0»tE, and the Domestic
Council. Polirr goals, organizational changes,
objectives, funding, new leEislatior--ihese
decisions are settled at the highest levels. The
Departments and agencies may propose, tart the
power centers dispose. '2C-

And how do the experts site up the quality of decisionmaking at these "power centers"? The panel concluded that:

1. Nobody it the Executive Office of the President is in charge of the nutrition police question.

2. No single focus exists anywhere in the executive branch
of the government to assess and advocate nutrition poli-
cies.

3. No overall co-ordinating machinery exists at either
the executive office level or the interdepartmental
level for nutrition planning, prograa management or
R§D. (21)

It seems fair to observe, in summary, that views have shifted significantly since 1969. If any single quotation could crystallize this change, it eight sound like the following observation last June:

The recommendations of the White House Conference
for government organization may not have been the
most appropriate. Political and financial realities
must be considered in the development of any systen
which will be effective. Ul)

Despite this growing cynicism, the Panel on Nutrition and Government like the White House Conference before it, still recommended creating a Federal Nutrition Office. (23) But, in l974, interest has shifted towards creation of an independent office with direct access to recalcitrant policy-makers, rather than buried in DHEW.

D. The Case for a Federal Nutrition Office

The proposed formalized National Nutrition Plan outlined in Chapter I can never be written, much less implemented, unless the present federal effort in nutrition is substantially revamped.

This means either creating a new office, or giving an existing office additional functions. The staff of the Senate Select Committee on Nutrition and Human Needs believes that the case for a new office is stronger than the argument for expanding an existing department.

To begin with, which department can exclusively claim jurisdiction over this field? As we have seen, nutrition cuts across issues affecting many departments. Nutrition policy affects agriculture, commerce, exports, foreign relations, health and even national defense. As Senator McGovern has suggested:

It is a subject whose jurisdiction cuts across
a dozen federal agencies. I think that is part
of our problem. Great progress has been
made, but these is a desperate need for
direction and coordination of these activities
which cut across so many lines of Federal
responsibility. (24)

Furthermore, assignment of the nutrition policy function to any single existing agency could permanently cast nutrition policy into a restrictive mold. If assigned to agriculture, nutrition policy might merely be a method of expanding demand for farm products. After all, this is the way the food stamp and school lunch programs are often defended by USDA officials even now.

Placing policy solely within DHEW, as recommended in l969, while possibly preferable on a number of grounds, also has drawbacks. It still does not reconcile the educational, health and welfare dimensions of a comprehensive nutrition policy.

The current global food crisis suggests that it is no longer feasible to have a purely domestic nutrition policy--if that ever was the case--yet assigning the new office to a "domestic" cabinet department would inevitably have such an effect. The international dimension of nutrition policy might continue, as in recent years, to be subordinated to the dictates of foreign policy rather than humanitarian goals.

It seems clear that the multi-dimensional character of "nutrition"as a policy focus leaves only one alternative:

am sagipi,CTitag-it 'cfflog,. (mttifi.te Oim- erlfting riapartaont.

(DnBBttiiarc T€ ax litfimitntfieTnt .t*ff ic* *wt,def .not oniv ithe ^inrise£iicr!tt(infflJl imnsnttlf «itiitJfc cwtihsmK'.is* *-ight occur anon* she x/swu anHinii.. !imtt mBSttDw siu&rsitiays tone 'oot|paMrtnle dispute -amoJKt rfcc 'iauJhi--,r«Tl dnisjriuplliijnes as weOU.. ifteell darfifioroncsef; assist a»mEf iftnrtrasrx,. imttiniitiaiiuL'rttB, iput!loic Iheoiltjfc 'orf i ic;i«ls, *aod ,o*h*x-s as ttnD aftrikrih dlnsariiniEjiaw *tm>ufl.i otaujn*ft* uhe ifieiid. tUftis ,«*oar',-s eaonresssf snrannnr J ami; tihe rt*tit»2 prtyfiessaori mhat ,adinin:fes>txa.ttaaro mclis*- iter rimy:.«rT.iit th* -hewltjr component -of .nutrition TumTlffi vmsiJiw ilmuunt meal -near"* :ass«e*rTiori ibv -ag.rononi£>ts tthat itibe ttwcfanxZ^qv- inff jfimrfi -rornnucrtamri In*s inat ibonf linbogcatoc .into muff It Uttiiam jpDlotrw-TKat^.'nj!..

tTf uny-thanf -roths Tleafr,, it is .Phat inwta-itrion ,policy
iiust -nnt iic -the rrrivinof -of am ff.nflr ;x-.-.spocTrivc,

5ftn0*her w±rtme trF Treating an andepondent -of-fice .is vissiIriility.. 1-t is a 1« -harder t-c hide "Che 'ejcis,toace -of -any ,a,gonc,y with its Md ItaLLcriwad and -nati-onel director. An agwnr,y withiai * IfiJ'gffl ogpar-,mnr- however, if easier tc suppress. The Sate -of -the THHFitw -of T/onrtrehens ive health Planning is iastructirs. during -the -aud-sixties -the 'Gongoe&s tlirectod the -ostabliuiuuini xff a -sysfreai designed to oncourage coapvehaosive -haalth ylamtiT^ at -the State and local level. Bach state Mas to .create a single agaacv -to integrate -health planning .within its boundaries into a single comprehensive plan. The plan was to be hasoe on a consensus developed aaong both oonsMaars and providers -of ne£l-Ch aerrvioas.

Bat CHP, including its ambitious progTa* -for training aulti^discipliBaTy profess iooa Is a-t -to* graduate Laval . floundered because of lack of visibility at the .national level. State and local officials were aavar .able tc loak tc Washington for di-vec-tion. The Office of -Coasrehaasive Health Planning Mas buried alive in Brt£b ..ahe-re it reoaias tc tfeis day. «fe still a-re oo aeare-r to -coapxaheosive health planning.

Independence, -of -course, is oo guarantee of .visibility. There can never be an orgajiitatioaal substitute for Presidential interest. But a Federal Food and fciutxition Office «ho&e iixector has access to tbe Presidaot can .never disappear eatirelv. FuTtheTmore, visibility facilitates iategritv. If a aighir visible public official is raaoved, it almost always en&utes ventilation of a *a>or policy issue.

Functions of the FodaTal Food and Nutrition Office

As Senator Mc&ovarn outlined to the jaeabers of the Facel on Nutrition and Governaeat, an independent office would be responsible for setting forth national policy and priorities in this vital area: The director of sucf an office would have independent access to the President in addition to maintaining close liaison *ith other federal agencies.

Tbe vicGovern plan, in bri#f, would create an independent office of cabinet status in terms of visibility and access, but not a large new bureaucracy. Tlie purpose riC the office would be planning and coordination, not program administration. As we have alreadv seen, it i* n'jt ^o^sible to -ifparate out the