Mr. REID. I agree with that; what I am asking you is, from an administrative standpoint, whether you think it is wise to setup a series of separate programs or whether it should all be together in one, coherent program?

Mrs. BURNETT. I believe if it is justifiable, then it could be for all people. It is well known setting up an arbitrary line of 65 means many of those under that have great need of it, would have to wait. Anyone hungry can't wait very long.

Mr. REID. Thank you.

Mrs. BURNETT. Thank you, Mr. Chairman.

Mr. BRADEMAS. Mr. Hansen.

Mr. HANSEN. Thank you, Mr. Chairman.

I want to express my appreciation for your participation this morning. You made reference to the percentage of senior citizens, those over the age of 65 of the population.

Does this percentage hold true in both urban and rural areas as far as you know?

Mrs. BURNETT. Progress has gone by some of the rural counties. I know in an area like Elkhart County it is the largest area or income producing area and the average age of a dairy farmworker is much higher than it is with the other part of the population most of them averaging out to approximately 55 and 60. So, the rural area you will have a higher percentage of aged of those who would be qualified under this bill.

Mr. HANSEN. I grew up on a dairy farm and spent a great deal of my early years milking cows the days before milking machines. I have had some exposure to the dairy business.

Mrs. BURNETT. We had 1,900 dairy farms 9 years ago and there aren't 600 now.

Mr. HANSEN. I was glad to hear your response because I think it emphasizes need to look at another group of older people. I am not sure this legislation effectively reaches. There are of course, substantial numbers of older people in rural areas.

The program anticipated with this legislation as with most programs really are best calculated to meet the needs of older people who live in a more concentrated area as this. It is cheaper on a per diem basis to provide food for large groups who are fairly close together. Would you have any suggestion on any changes in this legislation or on any other types of programs that would respond to the nutritional needs of those in those areas that are sparsely populated.

Mrs. BURNETT. Most of our rural areas are centered around a church or school community and the involvement of the people of that community the responsibility would certainly be emphasized and some sort of provisions could be set up perhaps to make and buy food for a church kitchen. I am sure it could do very well.

Mr. HANSEN. Would the success of this program in the rural areas depend on your judgment in a large measure to the ability to mobilize available volunteer help that could be utilized in administering and implementing the program?

Mrs. BURNETT. There are people well qualified to discuss this coming up after me and they will be discussing this later.

We have one woman who is a magnificent volunteer and I will not take one word from her testimony.

Mr. HANSEN. Let me ask one question bearing on the point you made. You said there are approximately 150,000 trained home econ omists who might be available on some basis paid or part paid. Are they out of work?

Mrs. BURNETT. They are not out of work. They are homemakers, they are raising children. We are trying to organize the home economists organizations in this country. Many of them have independent resources, not all of them are qualified to work in the area of nutrition, but it is an easily available source.

Mr. HANSEN. It strikes me that is an asset of enormous value in designing programs.

We again appreciate your testimony.

Thank you, Mr. Chairman.

Mrs. BURNETT. Thank you.

Mr. BRADEMAS. I have one or two questions.

I, too, must say I am quite encouraged by your observation there are so many trained home economists in the country who might represent a valuable source of supply of trained persons to help make such nutrition programs effective at a local level.

I had not been aware of that and it is very encouraging indeed. I was struck by your reference to the study which makes the point that the Mississippi Delta poor were not very willing to change their food habits.

Mrs. BURNETT. There are others, Chicago has one, but I could not put my hands on it.

Mr. BRADEMAS. The reason I refer to that, of course, is it might well be the case, might it not, that this would be a true observation with respect to the Mississippi Delta poor but might not necessarily be the case with respect to older persons elsewhere in the United States.

In other words, one ought not generalize from that rather unusual kind of situation for the whole country.

Mrs. BURNETT. I don't know.

I would refer you to Miss Marsh. I am sure she will document it here.

Mr. BRADEMAS. I just have one other question, an observation and a question. I was interested to see that at the outset of your statement you pointed to the omissions of the recommendations from the final report on the White House Conference on Nutrition as they relate to the aged.

This is an omission that I understand has now been corrected and indeed only this week we had testimony on this bill before a subcommittee in Washington. Mr. Huggin of the National Association of Senior Citizens called this fact to our attention. We did include in the hearing transcript the recommendations. We are very glad you called it to our attention as well.

The other point you mentioned was also news to me and follows the problem with respect to the White House recommendations and that is your observation that on March 30 you talked with Governor Whitcomb about the recommendation a State conference be held on the subject of food and nutrition and health following one of the recommendations of the White House Conference.

You say simply in your statement "no State action has been taken up to this time."

Can you enlighten us on that particular matter? I had not been aware of your correspondence or conversation with the Governor. What is the problem?

Mrs. BURNETT. The machinery is available. Well, I am tempted to make a comment but I think none is necessary.

Mr. BRADEMAS. I am distressed to hear that and I would hope that on a matter of this consequence, with 10 percent of the citizens in the State of Indiana being older citizens, I would hope that the Governor would take another look at the recommendation I believe you and your associates have put to him and would call at the earliest possible time a State conference on nutrition and health as the White House conference has recommended. It would seem to be very much in order.

I would certainly do everything possible to give the Governor cooperation in the event he chose to call such a conference.

Mrs. BURNETT. I have one more comment.

Mr. BRADEMAS. Please.

Mrs. BURNETT. At the present time in the entire State of Indiana there are only three community nutritionists. Since the closing of the area State board of health offices there are only now two community nutritionists, one working out of La Porte, working out of her apartment, and one working out of Fort Wayne. These are paid by the State board of health and what is no longer a division of nutrition but as a nutrition part of the health education division of the State board of health.

The only other community nutritionist is Theresa Samuels and she is working for the Marion County Health and Hospital Board. So, that is a very small number to work in such a large area.

Mr. BRADEMAS. Thank you.

Your testimony has been most helpful. We are grateful for you having come.

Our next witness is Dr. Frederick Kuhn of South Bend.

STATEMENT OF DR. FREDERICK KUHN

Dr. KUHN. My name is Dr. Frederick L. Kuhn. I have been engaged in the general practice of medicine with a special interest in industrial and preventive medicine. I have previously been the medical director of the Studebaker-Packard Corp. and am presently serving several large industrial firms in this area. Throughout my career I have had a particular interest in nutrition as a means of disease prevention.

The strength of our Nation is no greater than the physical and mental health of our people, and the health of our people is no greater than their nutrition.

When I speak of nutrition I refer to the adequate feeding of a body and mind. Nutritious food should be taken in a clean, happy environment. Emotions play a great part in the digestion and assimilation of nutrients, especially in the elderly person.

Nutrition in the United States today is in a period of transition and is rapidly becoming an important part of environmental medicine and health, taking its proper place within the framework of preventive medicine, industrial medicine and hygiene, public health and pollution control.

The National Vitamin Foundation has shown that many of our elderly citizens are not receiving proper nutrition by clinical and biochemical criteria. We can not say, just because there is such excess of food in America today that each citizen is well nourished.

There are different varieties of malnutrition to be considered. Much of the clinical malnutrition is "conditioned malnutrition" due to physical and mental stress. Today, we must not regard the science of nutrition as the study of deficiency diseases in poor and ignorant people, produced entirely by a lack of food.

Clinical nutrition has not yet gained status in the curriculum of our medical schools. Biochemistry during the past decade has focused its attention on cellular metabolism, while the internal medicine specialist is interested mainly in treating physical illness due to malnutrition after the diseases has occurred. These men must join efforts with the nutritionist in treating the whole man. They have each developed much knowledge within their own spheres, but few are correlating the vast quantities of research material.

The new concept recognizes that the many forms of malnutrition should be classed as metabolic diseases, and that good nutrition plays a role in the convalescence of practically every disease. Those who will handle cases of malnutrition must have knowledge of the interrelationship of trace minerals, vitamins, other nutrients and metabolites as they affect the reaction of the patient to the stress of disease.

It is no longer a question of deficiency disease, but one of metabolic imbalance which contributes to the individuals illness. With this in mind, obesity constitutes the most widespread form of malnutrition in the United States today.

Without trace minerals in the diet the body has difficulty in burning fat deposits in the walls of the blood vessels. A diet deficient in the important trace minerals such as zinc, copper, manganese, molybdenum, cobalt, iron, and iodine results in such diseases as atherosclerosis, decrease in the elasticity of the walls of the blood vessels, hyperglycemia, liver, and nervous disorders.

All age groups need trace minerals but the senior citizen has a special need for balanced nutrition. Think of the help we can give the elderly diabetic and arthritic. The improvement in the condition of the blood vascular system has decreased the incidence of coronary and vascular thrombosis. This fact would, in itself, be adequate cause to institute a program of at least one nutritious meal each day for our elderly citizens.

We have allowed the top soil of our land to be washed down our rivers and have tried to rebuild with fertilizers containing phosphates. The trace minerals so important to the intricate process of vitamin and nutrient metabolism and assimilation are diminishing from the fruit and vegetables we feed our oldsters. The trace minerals that have not been washed away are rendered less effective by the fertilizers in the soil.

This problem is really one of disturbed ecology, environmental health, and pollution control. The remedy is not easy, nor will it come quickly, but in the meantime we can keep many of our oldsters healthy and free of debility by supplementing their diets with oral trace minerals when deficiency of these most important elements is found to exist, for without them many vitamins are not utilized by the body even though present in the diet.

I would like to stress the importance of the social worker and psychologist as a part of our team. The elderly person often becomes self-centered. He should not be pampered. He should be well fed but should be given some of the responsibilities of the nutrition program itself.

Service centers should be within walking distance, yes, but those who can't walk should not have a tray slid under their door. We should not forget the importance of eating with someone.

A more agile oldster, especially a self-centered one, can gain much psychotherapeutic value in giving enough of his own time and energy to personally take part of the meals to these chair patients, talk to them, eat with them, and forget themselves. The governmental agencies need not be overly burdened financially in delivering meals to the borderline debilitates.

While a Flight Surgeon in the Army Air Corps I often saw our motto. There was a large eagle, and in one wing was cradled an injured flier, and underneath was the inscription, "The Air Force takes care of its own."

I would like to see this spirit spread among our oldsters. A fiery spirit—one of individualism with Government help and guidance. Mr. BRADEMAS. Thank you, Dr. Kuhn.

I would just like to say that I find your statement generally impressive but particularly sensitive on one of the major points in the bill before us; namely, your awareness, your indication of your awareness that it is important not only to provide nutritionally balanced meals to older citizens but that it is also important as the language of the bill contemplates that there should be provided a setting conducive to the older persons feeling that there are other persons with him, that there is a sense of community among the older persons and that the program should be provided as near as possible to the residence of the eligible individuals.

I just wanted to make that observation and I was pleased to see that. Dr. KUHN. Thank you, it is very important.

Mr. BRADEMAS. Mr. Reid.

Mr. REID. Thank you.

Dr. Kuhn, I want to thank you for your very thoughtful, indeed, provocative and important testimony.

First, could you define for the purpose of the hearing a metabolite? Dr. KUHN. A metabolite is a substance that is caused by the burning of other substances in the body.

Mr. REID. What would be an example?

Dr. KUHN. Let us note chromium and its ability to metabolize glucose to glycogen, which is a metabolite that can be used by the cells in the body.

Mr. REID. You talk about obesity here.

Do you think it is possible, that in giving micronutrients to people troubled with obesity and atherosclerosis to in effect through an adequate diet including important trace minerals such as you have mentioned, to burn up deposits that have been stored?

In other words, instead of having to clear out an artery by surgical means might it be possible to do that by micronutrients as a means to destroy the fat deposits in people who have it already in their systems? Dr. KUHN. Yes.