Our Department, along with the Department of Agriculture, has adopted a useful framework for discussing human nutrition activities which encompass studies in three major areas: biomedical and behavioral sciences, food sciences, and nutrition education. A word about each of these is in order.

Biomedical and behavioral sciences: Studies in these aspects of human nutrition research include the consequences of food or nutrient intake and its utilization by the intact organism as well as the metabolic and behavioral mechanisms involved. And specific examples are included in the complete testimony, Mr. Chairman. With respect to food sciences, studies in the food sciences aspects of human nutrition research are primarily concerned with the nutritional quality, content, or composition of foods, or with the bioavailability of nutrients in foods.

Finally, research in nutrition education includes studies of dietary practices, food consumption patterns and their determinants, and studies on methods for informing and educating the public about nutrition, health and dietary practices.

The Department of Health and Human Services and the Department of Agriculture have adopted the seven critical goals identified in the 1980 report of the Joint Subcommittee on Human Nutrition Research and they are outlined, again, in my testimony.

These seven have been useful in the strengthening and coordination of the human nutrition research planning activities of the Department. Like USDA, we have developed structures and approaches within the Department to enhance nutrition coordination. This is reflected, for example, in the work of the Nutrition Policy Board.

Among the other mechanisms which have been useful in mapping the future direction and ongoing coordination of our human nutrition research program are the health promotion/disease prevention nutrition objectives of the eighties, the Clinical Nutrition Research Units, and projects directed to specific issues such as the work of our task force reviewing the National Academy of Sciences report entitled "Diet, Nutrition, and Cancer."

The Department has recognized nutrition as an essential component of disease prevention and health promotion and has included it as one of the key initiatives to improve national health, to improve the quality of life, and to lower health care costs.

Although those objectives are currently being reviewed and finetuned, I would like at this time, Mr. Chairman, to submit a copy of these 15 measurable objectives on nutrition into the hearing record. I have a copy of it here, Mr. Chairman.

Mr. WALGREN. Without objection.

[The document mentioned above follows:]

Appropriate nutrition is necessary for optimal growth and development, physical activity, reproduction, lactation, recovery fro illness and injury and maintenance of health throughout the life cyc.e. A variety of health problems can occur when persons have deficits of essential nutrients or have excessive or inappropriate consumption of some nutrients. While the role of nutrition in health problems is not fully understood, epidemiologic and laboratory studies offer important insights which may help people in making food choices to enhance their prospects of attaining or maintaining health.

Current data indicate an inappropriate nutritional status for a substantial proportion of the American public. For example, for people aged 20 to 74 about 14 percent of men and 24 percent of women are classified as obese. The rates are significantly higher for women regardless of their economic status. Iron and folic acid deficiencies are common among pregnant or lactating women. It has been estimated that between 10 to 15 percent of infants and children amony migratory workers and certain rural poor populations suffer growth retardation due to dietary inadequacies. And the average daily sodium ingestion is substantially higher for the U.S. population generally than the recommended intake levels.

But some progress has been made over the last decade. Studies indicate that people have begun to consume less total fat, saturated fat and cholesterol. Prevalence of breast feeding has increased to a point where it is the mode of feeding for 45 percent of newborns in the country. And, a number of recent surveys indicate that more people are interested in nutrition, are more aware of the actions they can take to maintain health through their daily eating patterns, and have initiated changes in their nutritional practices.

2. Priority Objectives

To provide a measure of progress, national objectives have been established as quantifiable goals designed to improve health, reduce risk factors, increase awareness and improve protection and surveillance. Of the 17 nutrition-related goals listed in Objectives for the Nation, the 15 initially identified as priorities for the Federal effort are listed below.

By 1990, the proportion of pregnant women with iron deficiency anemia (as estimated by hemoglobin concentrations early in pregnancy) should be reduced to 3.5 percent. (In 1978, the proportion was 7.7 percent.)

By 1990, growth retardation of infants and children caused by inadequate diets should have been eliminated in the United States as a public health problem. (In 1972-73, it was estimated that 10 to 15 percent of infants and children among migratory workers and certain poor rural populations suffered growth retardation due to dietary inadequacies.)

O

Reduced risk factors

By 1990, the prevalence of significant overweight (120 percent of "desired" weight) among the U.S. adult population should be decreased to 10 percent of men and 17 percent of women, without nutritional impairment. (In 1971-74, 14 percent of adult men and 24 percent of women were more than 120 percent of "desired" weight.)

By 1990, 50 percent of the overweight population should have adopted weight loss regimens, combining an appropriate balance of diet and physical activity. (Baseline data unavailable.)

By 1990, the proportion of adults aged 18 to 74 with mean serum cholesterols above 230 mg/dl should be reduced by at least 50 percent. (In 1971-74, for male and female adults aged 13 to 74, the mean serum cholesterol level was 223 mg/dl and about 35 percent of adults had levels greater than 230 mg/dl.)

*By 1990, the average daily sodium ingestion (as measured by excretion) by adults should be reduced at least to the 3 to 5 gram range. (In 1979, estimates ranged between averages of 4 and 10 grams sodium. NOTE: One gram salt provides approximately .4 grams sodium.)

By 1990, the proportion of women who breastfeed their babies at hospital discharge should be increased to 75 percent and 35 percent at six months of age. (In 1978, the proportion was 45 percent at hospital discharge and 21 percent at 6 months of age.)

Increased public/professional awareness

By 1990, the proportion of the population which is able to correctly associate the principal dietary factors known or strongly suspected to be related to disease, should exceed 75 percent for each of the following diseases: heart disease, high blood pressure, dental caries and cancer. (Baseline data

largely unavailable. About 12 percent of adults are aware of the relationship between high blood pressure and sodium intake.)

By 1990, 70 percent of adults should be able to identify the major foods which are: low in fat content, low in sodium content, high in calories, high in sugars, good sources of fiber. (Baseline data unavailable.)

By 1990, 90 percent of adults should understand that to lose weight people must either consume foods that contain fewer calories or increase physical activity · or both. (Baseline data unavailable.)

*NOTE:

Same objective as for High Blood Pressure Control.

3.

o Improved services/protection

By 1990, the labels of all packaged foods should contain useful
calorie and nutrient information to enable consumers to select
diets that promote and protect good health. Similar

information should be displayed where nonpackaged foods are
obtained or purchased.

By 1985, the proportion of employee and school cafeteria managers who are aware of, and actively promoting, USDA/DHIS dietary guidelines should be greater than 50 percent.

By 1990, all States should include nutrition education as part of required comprehensive school health education at elementary and secondary levels. (In 1979, only 10 States mandated nutrition as a core content area in school health education.)

By 1990, virtually all routine health contacts with health professionals should include some element of nutrition education and nutrition counseling. (Baseline data unavailable.)

Improved surveillance/evaluation system

Berore 1990, a comprehensive National nutrition status monitoring system should have the capability for detecting nutritional problems in special population groups, as well as for obtaining baseline data for decisions on National nutrition policies.

Those objectives represent a continuation of the Department's commitment to the development and dissemination of nutrition knowledge. They lend themselves to programs which can be implemented through State and local efforts; their achievement requires participation from the private sector; and, they relate to the needs of the hard-to-reach and individuals of greatest need.

Role of the Federal Government

A pluralistic process involving public and private participants from many sectors and backgrounds is necessary if the nutrition objectives are to be achieved by 1990. The role of the Federal Government in this process is to lead, catalyze and provide strategic support. In assuming this role the DIIIIS will:

Develop and implement consumer education programs on a variety of nutrition-related topics;

Support nutrition services through Federal and State health programs;

Conduct further research to enhance information on the relationship between nutrition and health;

4.

5.

Work with the publishing industry to enhance the amount and quality of textbook copy at all grade levels devoted to nutrition.

Refine policies on food labeling;

Support education of health professionals in nutrition;

Monitor nutritional status; and,

Work with the food industry to increase the number of food products with high nutritional quality.

The tables on the following pages identify, by objective, the activities supported by the Department of Health and Human Services that contribute to achievement of the nutrition priority objectives. Included within the tables are activities undertaken jointly by Federal agencies, State and local governments, and private sector organizations. Continuation

activities and those planned for Fiscal Year 1982 and beyond are listed in the tables.

Coordination

Achievement of the objectives will require the development of activities which supplement and complement those of the Federal Government. Public health agencies and voluntary health organizations could offer nutrition education and weight reduction courses for the general public. Activities which affect high risk populations are especially important, e.g., local health departments could offer outreach nutrition programs for low income and minority women who do not have a history of using available services. A range of possible activities contributing toward achievement of the nutrition objectives has been described in lealthy People: The Surgeon General's Report on Health Promotion and Disease Prevention and Promoting Health/Preventing Disease: Objectives for the ilation. The Department of Health and Human Services will support those activities that are consistent with the Federal role of leading, catalyzing and providing strategic support. State, local and private organizations will supplement this effort through activities that are compatible with their organizational mandate and available resources.

Summary of Federal Efforts

The DIIS efforts listed below are necessary for the achievement of the nutrition objectives by 1990. Host are already underway and it is anticipated that some will extend through 1990. Those yet to be initiated but anticipated for Fiscal Year 1982 and beyond are noted with an asterisk (*). The ability to engage in these efforts is contingent upon the availability of Federal fiscal and manpower resources. Those Federal efforts ascertained to produce the most progress toward achievement of the nutrition objectives will receive first priority in allocation of

resources.