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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First, S. 850 would make WIC a "permanent" program. This assurance of continued operation makes possible better planning and in the long run more efficient program administration. To date, WIC projects have been necessarily very uncertain about the future, and this uncertainty has interfered with our ability to establish proper staffing patterns, to reallocate other state and local resources in order to best extend the benefits of the program, and to enter into ongoing working relationships with other agencies and groups serving the target population. Second, section (g) (3) would provide more flexibility on the local level than is currently permitted by the USDA in the selection of food items to make available to participants. Federal guidance in this respect should be limited to guidelines on the portion of RDA levels of nutrients to be provided. From our experience, local project personnel are in the best position to determine what food items would best suit the needs of individual participants. I am confident that our local judgments would be more sound than the narrow and sometimes confused judgments made by USDA in their selection of the WIC food package.

Third, section (d) of this bill provides for an increase in the share of funds available for non-food expenses. This section addresses one of the greatest deficiencies of the WIC Program as presently constituted: namely, the lack of a nutrition education component. We are missing a tremendous potential for punctuating the provision with information about why certain foods are being offered, and how proper nutrition is an essential ingredient of good health. Even while we are strictly prohibited from using WIC funds for such educational activities, we are experiencing a demand for consumer nutrition education, which we unfortunately are not in a position to respond to.

I would add that our experience in Vermont, with a single statewide project under one administration, suggests that administrative costs can be kept at 10%. However, the additional allowance is absolutely necessary if we are to engage in educational activities and strengthen the tie between WIC and other health services. I feel it is wise of Congress to guard against unnecessary growth of administrative apparatus.

Fourth, provisions in this bill to expand eligibility for children to five years old and for women up to six months postpartum are a welcome response to what I believe is the most often pointed out need for change in the program. Six months is a much more realistic period to expect a woman to recover from the nutritional stress of pregnancy. The expanded eligibility for children will reduce the gap between nutritional aid made available through WIC and that made available through school feeding programs.

Finally, Mr. Chairman, the $300 million funding level for next year proposed in this bill strikes me as the minimum necessary to ensure that local projects do not suffer cutbacks in caseload size. It has been estimated that the $130 million available during this fiscal year equals about $195 million on an annualized basis; that is, some WIC projects were funded starting in the middle of the year and will require considerably more to continue on a twelve month basis. In the case of Vermont, we will spend approximately $4.3 million this year; we estimate the cost of serving our currently approved caseload during the next fiscal year to be about $6.2 million, an increase of nearly 50%.

I am concerned that the growth of caseload, rises in the cost of food, and actions that will increase categories of eligible participants will thin out the effectiveness of the proposed $300 million funding. Further, I am concerned that actions in the House of Representatives will lead to an even smaller appropriation. Such a smaller appropriation will lead to cutbacks in project caseload size, which can only lead to terrific difficulties at the local level.

It seems clear to me that it will be up to this body to take the leadership in guaranteeing a continuation of the WIC Program at an appropriate level. I am aware of the difficulties posed by increasing government spending in the midst of the economic problems facing our country. However, when fundamental needs such as food are at stake, the failure of public response can only lead to worse problems. The resources are available to guarantee that all Americans are able to obtain a proper diet. As usual, the question comes down to a matter of priorities, and it strikes me that protecting the health of our infants and children should be at the top of our list of national priorities.

Two months ago, two F-111 fighter planes on a training flight collided over southern Vermont, scattering over the hillsides scraps of hardware that cost ten times what we will spend in twelve months to supplement the diets of 17,000 women and children in our state. How, with a straight face, can we expect people to believe that there just is not enough money for health protection?

Mr. Chairman, we understand the dangers of nutritional risk to the population that WIC serves, Congress has provided a program to address this problem, and it is working. S. 850 contains provisions which will strengthen the WIC Program. I believe you will find that funds appropriated for this purpose will be money well spent.

Thank you very much.

Senator McGOVERN. Mr. Hunt, we will be glad to hear from you

now.

STATEMENT OF PFILIP G. HUNT, VICE PRESIDENT, CORPORATE AFFAIRS, MORRISON, INC., MOBILE, ALA., AND PRESIDENT FOODSERVICE AND LODGING INSTITUTE

Mr. HUNT. Thank you, Senator.

I am Pfilip G. Hunt, vice president of Corporate Affairs, Morrison, Inc., Mobile, Ala. based food service company involved in public cafeteria food services, and providing food services for schools and colleges and universities, industrial plants, and office buildings.

I also have with me, Mr. Thomas W. Power, who is general counsel for the Foodservice and Lodging Institute here in Washington. In addition to my position with Morrison, I am also president of the Foodservice and Lodging Institute, located in Washington, which is a business organization comprised of a number of the country's largest food service and lodging organizations. The membership employs in excess of 600,000 employees and operates in excess of 10,000 individual establishments throughout the Nation.

Some of the members of the Foodservice and Lodging Institute are major participants in our national school lunch program, especially summer lunch programs.

We have a detailed, prepared statement which we have submitted for the record in its entirety, and what I will do is provide you with a brief summary of the key points that we have in that prepared statement.

No. 1 is that we oppose the administration's block grant proposal to basically eliminate all of existing child nutrition legislation. In our opinion, it undermines the entire program.

We feel that one of the best run Federal programs has been the national school lunch program, in terms of the dollars spent-they have been some of the best dollars spent for our money.

No. 2, we would recommend a continuation of the existing program on a permanent basis, particularly the summer lunch programs. No. 3, we would suggest changes in the summer lunch program to permit local sponsors to engage a food service management company to both administer the program and to furnish the meals, under established competitive bid procedures. And we would be pleased to submit language to accommodate this latter proposal.

1

No. 4, we would like to recommend a modest amendment to section 13(a)(1) of the act. The program presently gives preference to the use of local facilities, both food service facilities and recreational facilities. We believe that the intent here is to encourage the use of the existing food service and recreational facilities. And we suggest that the preference be limited to the situations only where

1 See p. 241.