The Role of the Federal Government in Promoting Health Through the Schools: Report from the Department of Agriculture Statement of Betty Jo Nelsen, Administrator, Food and Nutrition Service, U.S. Department of Agriculture, Testimony Before the Subcommittee on Oversight of Government Management, Committee on Governmental Wfairs, US.Senate, November 14, 1991.
T
he Food and Nutrition Service provides both food and dietary guidance for children and adults. We assist those in need who do not have the means to provide for themselves and their families. Programs include the Food Stamp Program, the National School Lunch and School Breakfast Programs, the Child and Adult Care Food Program, the Food Distribution Programs, and the Special Supplemental Food Program for Women, Infants and Children, called WIC. Last year, one in six Americans participated in one or more food assistance program. Our domestic food assistance programs strive to ensure that all needy individuals, especially children, have access to a healthy and nutritious diet. We also provide nutrition education to ensure that participants make informed decisions about the food they eat. Many programs contain specific provisions for funding nutrition education. Most nutrition education funds (more than $128 million per year) go for the WIC Program. Counseling about diet and nutrition for infants and young children helps ensure a great start, even before they enter school. Preschool participation in federal food programs can continue through meals provided in the Child and Adult Care Food Program which operates both in family day care settings and in day care institutions. This initiative includes the popular and effective Head Start program. The Food and Nutrition Service spent approximately $28 billion on 13 domestic food assistance programs for FY 1991; $26 billion was spent on benefits. Approximately $22 billion, or about 85% of benefits, went to households with children, representing more than one-half the total USDA budget. The FY 1992 agriculture appropriations bill will: Support a caseload of 5.2 million participants in the WIC program this year. Expand the School Breakfast Program, with 32 million additional meals planned in FY 1992, and provide start up grants this year to help 550 more schools join the program. Increase the National School Lunch Program by $230 million. Provide additional funding for the Child and Adult Care Food Program anticipating 133 million more meals served in FY 1992, making this program the fastest mowing federal food assistance urogram.
Betty Jo Nelsen, Administrator, Food and Nutrition Service, US. Department of Agriculture, 14th Street and Independence A ve., SW, Washington, DC 20250.
138
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Aprll 1992, Vol. 62, No. 4
Increase the FY 1992 Summer Food Service Program to serve an additional 2.2 million more meals. Foster significant efforts toward coordinated program services to better serve and better administer programs for the poor.
PROGRAM DESCRI PTI ONS National School Lunch Program (NSLP)
Our oldest and largest child nutrition program, the National School Lunch Program, provides balanced, lowcost or free lunches to America’s school-age children. On an average day in FY 1990, an estimated 24.2 million children participated in the NSLP. Of those meals served, 12.6 million children paid full price, 9.9 million children received free meals, and 1.7 million children were served reduced-price meals, Virtually all public school children and most private school children have access to the NSLP. This program provides perhaps the only fully nutritious meal some children receive each day. School Breakfast Program (SBP) The School Breakfast Program has grown 4% per year since 1985 with 22% more schools serving breakfast in 1990 than in 1985. Currently, more than one-half of all children in schools with the lunch program also can eat school breakfasts. A nutritious breakfast enables children to start school ready to learn. If children do not eat breakfast, they may not be attentive, focused on tasks, or able to receivethe lessons of the day. A school breakfast can make a real difference in a child’s life. We must do more to encourage schools to implement a breakfast program. Program Improvements
We are taking steps to strengthen the nutrition value of the food provided and the nutrition information available to program managers and participants. These steps include lessening the sugar, salt, and fat content of USDA commodities and increasing the variety of foods available. We also are working with schools to lower the fat content of school meals and, thus, help children limit their total intake of fat to no more than 30% of total calories, as recommended in the Dietary Guidelinesfor Americans published last year. And, in partnership with the USDA Extension Service, we are giving food stamp recipients information on basic nutrition and shopping skills. A topic of continuing concern involves the effort to change school meals in accordance with the Dietary
Guidelines. In 1989, we awarded one-time demonstration grants, ranging from $39,000 to $50,000 to plan and implement menu modifications over a three-year period (School Years 1989-90 to 1991-92). These demonstrations are examining modifications to the lunch meal (or the breakfast meal at one site). In the first year, recipes and menus were analyzed to determine areas for possible change. Modifications were made for the second and third years. Grantees also are providing health or nutrition education as enhancements t o the projects. On September 11, 1991, Secretary Edward Madigan stated that by FY 1994 all U.S. food service personnel will possess the tools and training needed to improve the school lunch program to meet the USDA/DHHS dietary guidelines. Secretary Madigan stated that USDA will request in FY 1993 a 50% funding increase over 1992 levels for the Nutrition Education Training Program which provides nutrition education for school food service workers and students, provide materials for all school districts to use for training local workers, and provide new menu guides for 90,OOO schools. We will need no additional administrative funds but will redirect current efforts to make nutritious school meals our highest priority. NUTRITION EDUCATION The 1990 Dietary Guidelines for Americans recommends that people - adults and children over age two - limit their intake of calories from fat to no more than 30% of their diet and that they further distinguish between saturated fat and unsaturated fat. We are working to achieve this goal by educating parents, children, educators, and food service personnel in the school lunch program. For example, the Nutrition Guidance for the Child Nutrition Programs - a spinoff of the Dietary Guidelines for Americans - will be distributed without charge to more than 90,000 schools and approximately 165,000 child care workers next spring. Developed cooperatively with the U.S. Department of Health and Human Services, it provides school food service employees and child care workers with the information they need about nutrition to understand the goals set in the Dietary Guidelines. In addition, technical nutritional information publications are provided to school food service personnel..The Food Service Management Institute, designed to increase training resources for food service managers, opened last year in Mississippi. Secretary Madigan also supports expansion of the Nutrition Education and Training Program (NET). Established in 1977, NET was reauthorized for 5 years, fiscal years 1990 through 1994, by Public Law 101-147, November 10, 1989. NET builds positive food habits by teaching the fundamentals of nutrition to children, parents, educators, and school food service personnel through grants to state agencies. NET reaches children by coordinating learning experiences in the classroom, the school cafeteria, and the community. Teachers and school food service employees receive instruction about nutrition, education, and food service management. Parent involvement in NET activities also represents an important aspect of the program. The Cooperative Extension System (CES) provides a nationwide educational network that links research,
science, and technology to the needs of people where they live and work. Extension education combines the expertise and resources of federal, state, and local governments. One component of CES outreach is 4-H, a program of informal education for youth. Since 4-H work began in 1914, it has reached more than 50 million youth from all states, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, Micronesia, and Northern Marianas Islands. In FY 90, more than 5 million youth participated in 4-H programs, including more than 3 million youth reached through school enrichment programs. More than 1.2 million youth participated in food and nutrition projects, clubs and activities, including the 4-H Expanded Food and Nutrition Education Program which teaches nutrition, food safety, and fitness to low-income youth. Two programs illustrate the scope and diversity of CES nutrition education programs for youth. Nutrition f o r Life is a comprehensive nutrition education program designed for New York State schools, grades K-12. Through participatory, real-life nutrition situations, the program helps students develop problem-solving, decision-making, and resource management skills as well as valuing the wise use of personal and community resources. Each program unit identifies learning objectives related t o the program goal. At the K-6 level, the program engages students in exploring, experimenting, and experiencing nutrition, while reinforcing skills in language arts, math, social studies, science, health, art, and music. At the 7-12th grade level, teaching materials complement statewide curricula for health and home economics classes. Likewise, the Have a Healthy Baby program in Indiana works with pregnant adolescents in schools or individually in their homes. Topics include decisions affecting the baby; amount of weight to gain; what to eat during pregnancy; effect of habits such as tobacco, alcohol, and drug abuse on the baby; and what to feed the baby. Videotapes, discussion sessions, personalized “contracts,” and activities make the health messages concrete and relevant. Besides these programs, the Human Nutrition Information Service (HNIS) sponsored development of teacher’s guides on Dietary Guidelines for junior and senior high school home economics and health education teachers to incorporate information into classroom activities. Likewise, a nutrition education study initiated in 1991 by HNIS will assess nutrition education needs of pregnant teen-agers. Attention will be given to identifying effective formats and media for delivering nutrition information important to this audience. Based on needs assessment results, prototype materials will be developed, tested, and distributed. Finally, as part of the National Agricultural Library, the Food and Nutrition Information Center houses a lending library of materials developed from across the nation. This clearinghouse enables nutrition professionals to share materials developed in one state for use in another state.
ADDITIONAL INITIATIVES This year Secretary Madigan convened a USDA Nutrition Education Task Force to improve the eating behavior and promote the nutritional well-being of Americans with emphasis on educating and informing 1) children
Journal of School Health
Aprll 1992, Vol. 62, No. 4
139
about the importance of good eating habits, and 2) lowincome adults on ways to improve their diets, spend their funds wisely, and handle food safely. Participants include the Agricultural Research Service, Cooperative State Research Service, Economic Research Service, Extension Service, Food and Nutrition Service, Food Safety and Inspection Service, Human Nutrition Information Service, and the National Agricultural Library. This collaboration will produce a closer linkage between the Supplemental Food Program for Women, Infants, and Children, and the Expanded Food and Nutrition Education Program of the Cooperative Extension System. Both programs target low-income families with young children. While WIC provides nutrition education in addition to food assistance, pregnant women (especially teens) need more intensive help. The EFNEP program provides more intensive educational experiences to help families improve their diets. The USDA Subcommittee for Human Nutrition Education and Research meets monthly to share information, foster coordination, and reduce duplication of effort. The Department of Health and Human Services (DHHS) also has representation on this committee. Also, the Dietary Guidance Working Group meets monthly to discuss events related to the Dietary Guidelines published by USDA and DHHS. With representation from each departmental agency having nutrition as part of its mission, this body reviews documents to be published on dietary guidance to ensure the document is consistent with the Guidelines. DHHS also has representation on this committee. One example of children’s issues reviewed by the group includes the piece entitled “Nutrition Guidance for Child Nutrition Programs.” This publication was produced jointly by USDA and DHHS for use by all per-
140
Journal of School Health
Aprll 1992, Vol. 62, No. 4
sons involved in food assistance programs for children. The National Advisory Council for Maternal, Infant and Fetal Nutrition studies the WIC and Commodity Supplemental Food Programs and reports to the President and Congress biennially on ways to improve program operations. Two DHHS representatives, the Chief Nutritionist for the Maternal and Child Health Bureau, and an Assistant Surgeon General and Regional Health Administrator, serve as Council members. In addition, a DHHS epidemiologist serves as liaison to the Council to provide technical assistance. Also, the National Advisory Council for Commodity Distribution reports to the Secretary and to the Congress on matters related to commodity programs. This council meets twice a year and provides an annual report to Congress.
CONCLUSION Food and Nutrition Service programs are targeted primarily to help low-income families with children. In all cases, FNS works with appropriate federal agencies and state and local cooperative agencies to coordinate program efforts to maximize the benefit to clients. All such food programs depend on a working partnership with state and local governments. They also depend on continued support from American taxpayers. We can count on that support, however, only as long as the programs are perceived as effective. Even so, Government efforts alone cannot ensure that every individual need finds a response. Nor can they replace the personal quality of the help extended by private organizations and volunteers who minister to neighbors in need. Ensuring that America’s children have access to a nutritious diet is a job for all of us.
T
he Food and Nutrition Service provides both food and dietary guidance for children and adults. We assist those in need who do not have the means to provide for themselves and their families. Programs include the Food Stamp Program, the National School Lunch and School Breakfast Programs, the Child and Adult Care Food Program, the Food Distribution Programs, and the Special Supplemental Food Program for Women, Infants and Children, called WIC. Last year, one in six Americans participated in one or more food assistance program. Our domestic food assistance programs strive to ensure that all needy individuals, especially children, have access to a healthy and nutritious diet. We also provide nutrition education to ensure that participants make informed decisions about the food they eat. Many programs contain specific provisions for funding nutrition education. Most nutrition education funds (more than $128 million per year) go for the WIC Program. Counseling about diet and nutrition for infants and young children helps ensure a great start, even before they enter school. Preschool participation in federal food programs can continue through meals provided in the Child and Adult Care Food Program which operates both in family day care settings and in day care institutions. This initiative includes the popular and effective Head Start program. The Food and Nutrition Service spent approximately $28 billion on 13 domestic food assistance programs for FY 1991; $26 billion was spent on benefits. Approximately $22 billion, or about 85% of benefits, went to households with children, representing more than one-half the total USDA budget. The FY 1992 agriculture appropriations bill will: Support a caseload of 5.2 million participants in the WIC program this year. Expand the School Breakfast Program, with 32 million additional meals planned in FY 1992, and provide start up grants this year to help 550 more schools join the program. Increase the National School Lunch Program by $230 million. Provide additional funding for the Child and Adult Care Food Program anticipating 133 million more meals served in FY 1992, making this program the fastest mowing federal food assistance urogram.
Betty Jo Nelsen, Administrator, Food and Nutrition Service, US. Department of Agriculture, 14th Street and Independence A ve., SW, Washington, DC 20250.
138
Journal of School Health
Aprll 1992, Vol. 62, No. 4
Increase the FY 1992 Summer Food Service Program to serve an additional 2.2 million more meals. Foster significant efforts toward coordinated program services to better serve and better administer programs for the poor.
PROGRAM DESCRI PTI ONS National School Lunch Program (NSLP)
Our oldest and largest child nutrition program, the National School Lunch Program, provides balanced, lowcost or free lunches to America’s school-age children. On an average day in FY 1990, an estimated 24.2 million children participated in the NSLP. Of those meals served, 12.6 million children paid full price, 9.9 million children received free meals, and 1.7 million children were served reduced-price meals, Virtually all public school children and most private school children have access to the NSLP. This program provides perhaps the only fully nutritious meal some children receive each day. School Breakfast Program (SBP) The School Breakfast Program has grown 4% per year since 1985 with 22% more schools serving breakfast in 1990 than in 1985. Currently, more than one-half of all children in schools with the lunch program also can eat school breakfasts. A nutritious breakfast enables children to start school ready to learn. If children do not eat breakfast, they may not be attentive, focused on tasks, or able to receivethe lessons of the day. A school breakfast can make a real difference in a child’s life. We must do more to encourage schools to implement a breakfast program. Program Improvements
We are taking steps to strengthen the nutrition value of the food provided and the nutrition information available to program managers and participants. These steps include lessening the sugar, salt, and fat content of USDA commodities and increasing the variety of foods available. We also are working with schools to lower the fat content of school meals and, thus, help children limit their total intake of fat to no more than 30% of total calories, as recommended in the Dietary Guidelinesfor Americans published last year. And, in partnership with the USDA Extension Service, we are giving food stamp recipients information on basic nutrition and shopping skills. A topic of continuing concern involves the effort to change school meals in accordance with the Dietary
Guidelines. In 1989, we awarded one-time demonstration grants, ranging from $39,000 to $50,000 to plan and implement menu modifications over a three-year period (School Years 1989-90 to 1991-92). These demonstrations are examining modifications to the lunch meal (or the breakfast meal at one site). In the first year, recipes and menus were analyzed to determine areas for possible change. Modifications were made for the second and third years. Grantees also are providing health or nutrition education as enhancements t o the projects. On September 11, 1991, Secretary Edward Madigan stated that by FY 1994 all U.S. food service personnel will possess the tools and training needed to improve the school lunch program to meet the USDA/DHHS dietary guidelines. Secretary Madigan stated that USDA will request in FY 1993 a 50% funding increase over 1992 levels for the Nutrition Education Training Program which provides nutrition education for school food service workers and students, provide materials for all school districts to use for training local workers, and provide new menu guides for 90,OOO schools. We will need no additional administrative funds but will redirect current efforts to make nutritious school meals our highest priority. NUTRITION EDUCATION The 1990 Dietary Guidelines for Americans recommends that people - adults and children over age two - limit their intake of calories from fat to no more than 30% of their diet and that they further distinguish between saturated fat and unsaturated fat. We are working to achieve this goal by educating parents, children, educators, and food service personnel in the school lunch program. For example, the Nutrition Guidance for the Child Nutrition Programs - a spinoff of the Dietary Guidelines for Americans - will be distributed without charge to more than 90,000 schools and approximately 165,000 child care workers next spring. Developed cooperatively with the U.S. Department of Health and Human Services, it provides school food service employees and child care workers with the information they need about nutrition to understand the goals set in the Dietary Guidelines. In addition, technical nutritional information publications are provided to school food service personnel..The Food Service Management Institute, designed to increase training resources for food service managers, opened last year in Mississippi. Secretary Madigan also supports expansion of the Nutrition Education and Training Program (NET). Established in 1977, NET was reauthorized for 5 years, fiscal years 1990 through 1994, by Public Law 101-147, November 10, 1989. NET builds positive food habits by teaching the fundamentals of nutrition to children, parents, educators, and school food service personnel through grants to state agencies. NET reaches children by coordinating learning experiences in the classroom, the school cafeteria, and the community. Teachers and school food service employees receive instruction about nutrition, education, and food service management. Parent involvement in NET activities also represents an important aspect of the program. The Cooperative Extension System (CES) provides a nationwide educational network that links research,
science, and technology to the needs of people where they live and work. Extension education combines the expertise and resources of federal, state, and local governments. One component of CES outreach is 4-H, a program of informal education for youth. Since 4-H work began in 1914, it has reached more than 50 million youth from all states, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, Micronesia, and Northern Marianas Islands. In FY 90, more than 5 million youth participated in 4-H programs, including more than 3 million youth reached through school enrichment programs. More than 1.2 million youth participated in food and nutrition projects, clubs and activities, including the 4-H Expanded Food and Nutrition Education Program which teaches nutrition, food safety, and fitness to low-income youth. Two programs illustrate the scope and diversity of CES nutrition education programs for youth. Nutrition f o r Life is a comprehensive nutrition education program designed for New York State schools, grades K-12. Through participatory, real-life nutrition situations, the program helps students develop problem-solving, decision-making, and resource management skills as well as valuing the wise use of personal and community resources. Each program unit identifies learning objectives related t o the program goal. At the K-6 level, the program engages students in exploring, experimenting, and experiencing nutrition, while reinforcing skills in language arts, math, social studies, science, health, art, and music. At the 7-12th grade level, teaching materials complement statewide curricula for health and home economics classes. Likewise, the Have a Healthy Baby program in Indiana works with pregnant adolescents in schools or individually in their homes. Topics include decisions affecting the baby; amount of weight to gain; what to eat during pregnancy; effect of habits such as tobacco, alcohol, and drug abuse on the baby; and what to feed the baby. Videotapes, discussion sessions, personalized “contracts,” and activities make the health messages concrete and relevant. Besides these programs, the Human Nutrition Information Service (HNIS) sponsored development of teacher’s guides on Dietary Guidelines for junior and senior high school home economics and health education teachers to incorporate information into classroom activities. Likewise, a nutrition education study initiated in 1991 by HNIS will assess nutrition education needs of pregnant teen-agers. Attention will be given to identifying effective formats and media for delivering nutrition information important to this audience. Based on needs assessment results, prototype materials will be developed, tested, and distributed. Finally, as part of the National Agricultural Library, the Food and Nutrition Information Center houses a lending library of materials developed from across the nation. This clearinghouse enables nutrition professionals to share materials developed in one state for use in another state.
ADDITIONAL INITIATIVES This year Secretary Madigan convened a USDA Nutrition Education Task Force to improve the eating behavior and promote the nutritional well-being of Americans with emphasis on educating and informing 1) children
Journal of School Health
Aprll 1992, Vol. 62, No. 4
139
about the importance of good eating habits, and 2) lowincome adults on ways to improve their diets, spend their funds wisely, and handle food safely. Participants include the Agricultural Research Service, Cooperative State Research Service, Economic Research Service, Extension Service, Food and Nutrition Service, Food Safety and Inspection Service, Human Nutrition Information Service, and the National Agricultural Library. This collaboration will produce a closer linkage between the Supplemental Food Program for Women, Infants, and Children, and the Expanded Food and Nutrition Education Program of the Cooperative Extension System. Both programs target low-income families with young children. While WIC provides nutrition education in addition to food assistance, pregnant women (especially teens) need more intensive help. The EFNEP program provides more intensive educational experiences to help families improve their diets. The USDA Subcommittee for Human Nutrition Education and Research meets monthly to share information, foster coordination, and reduce duplication of effort. The Department of Health and Human Services (DHHS) also has representation on this committee. Also, the Dietary Guidance Working Group meets monthly to discuss events related to the Dietary Guidelines published by USDA and DHHS. With representation from each departmental agency having nutrition as part of its mission, this body reviews documents to be published on dietary guidance to ensure the document is consistent with the Guidelines. DHHS also has representation on this committee. One example of children’s issues reviewed by the group includes the piece entitled “Nutrition Guidance for Child Nutrition Programs.” This publication was produced jointly by USDA and DHHS for use by all per-
140
Journal of School Health
Aprll 1992, Vol. 62, No. 4
sons involved in food assistance programs for children. The National Advisory Council for Maternal, Infant and Fetal Nutrition studies the WIC and Commodity Supplemental Food Programs and reports to the President and Congress biennially on ways to improve program operations. Two DHHS representatives, the Chief Nutritionist for the Maternal and Child Health Bureau, and an Assistant Surgeon General and Regional Health Administrator, serve as Council members. In addition, a DHHS epidemiologist serves as liaison to the Council to provide technical assistance. Also, the National Advisory Council for Commodity Distribution reports to the Secretary and to the Congress on matters related to commodity programs. This council meets twice a year and provides an annual report to Congress.
CONCLUSION Food and Nutrition Service programs are targeted primarily to help low-income families with children. In all cases, FNS works with appropriate federal agencies and state and local cooperative agencies to coordinate program efforts to maximize the benefit to clients. All such food programs depend on a working partnership with state and local governments. They also depend on continued support from American taxpayers. We can count on that support, however, only as long as the programs are perceived as effective. Even so, Government efforts alone cannot ensure that every individual need finds a response. Nor can they replace the personal quality of the help extended by private organizations and volunteers who minister to neighbors in need. Ensuring that America’s children have access to a nutritious diet is a job for all of us.
