[House Hearing, 114 Congress]
[From the U.S. Government Publishing Office]
.
SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM
=======================================================================
HEARINGS
BEFORE THE
SUBCOMMITTEE ON NUTRITION
AND THE
COMMITTEE ON AGRICULTURE
HOUSE OF REPRESENTATIVES
ONE HUNDRED FOURTEENTH CONGRESS
FIRST SESSION
__________
JULY 15, 2015;
OCTOBER 27, 2015; AND
NOVEMBER 18, 2015
__________
Serial No. 114-3
__________
Part 3
__________
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Printed for the use of the Committee on Agriculture
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COMMITTEE ON AGRICULTURE
K. MICHAEL CONAWAY, Texas, Chairman
RANDY NEUGEBAUER, Texas, COLLIN C. PETERSON, Minnesota,
Vice Chairman Ranking Minority Member
BOB GOODLATTE, Virginia DAVID SCOTT, Georgia
FRANK D. LUCAS, Oklahoma JIM COSTA, California
STEVE KING, Iowa TIMOTHY J. WALZ, Minnesota
MIKE ROGERS, Alabama MARCIA L. FUDGE, Ohio
GLENN THOMPSON, Pennsylvania JAMES P. McGOVERN, Massachusetts
BOB GIBBS, Ohio SUZAN K. DelBENE, Washington
AUSTIN SCOTT, Georgia FILEMON VELA, Texas
ERIC A. ``RICK'' CRAWFORD, Arkansas MICHELLE LUJAN GRISHAM, New Mexico
SCOTT DesJARLAIS, Tennessee ANN M. KUSTER, New Hampshire
CHRISTOPHER P. GIBSON, New York RICHARD M. NOLAN, Minnesota
VICKY HARTZLER, Missouri CHERI BUSTOS, Illinois
DAN BENISHEK, Michigan SEAN PATRICK MALONEY, New York
JEFF DENHAM, California ANN KIRKPATRICK, Arizona
DOUG LaMALFA, California PETE AGUILAR, California
RODNEY DAVIS, Illinois STACEY E. PLASKETT, Virgin Islands
TED S. YOHO, Florida ALMA S. ADAMS, North Carolina
JACKIE WALORSKI, Indiana GWEN GRAHAM, Florida
RICK W. ALLEN, Georgia BRAD ASHFORD, Nebraska
MIKE BOST, Illinois
DAVID ROUZER, North Carolina
RALPH LEE ABRAHAM, Louisiana
JOHN R. MOOLENAAR, Michigan
DAN NEWHOUSE, Washington
TRENT KELLY, Mississippi
______
Scott C. Graves, Staff Director
Robert L. Larew, Minority Staff Director
______
Subcommittee on Nutrition
JACKIE WALORSKI, Indiana, Chairwoman
RANDY NEUGEBAUER, Texas JAMES P. McGOVERN, Massachusetts,
GLENN THOMPSON, Pennsylvania Ranking Minority Member
BOB GIBBS, Ohio MARCIA L. FUDGE, Ohio
ERIC A. ``RICK'' CRAWFORD, Arkansas ALMA S. ADAMS, North Carolina
VICKY HARTZLER, Missouri MICHELLE LUJAN GRISHAM, New Mexico
DAN BENISHEK, Michigan PETE AGUILAR, California
RODNEY DAVIS, Illinois STACEY E. PLASKETT, Virgin Islands
TED S. YOHO, Florida BRAD ASHFORD, Nebraska
DAVID ROUZER, North Carolina SUZAN K. DelBENE, Washington
RALPH LEE ABRAHAM, Louisiana
JOHN R. MOOLENAAR, Michigan
(ii)
C O N T E N T S
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Page
Subcommittee on Nutrition--Wednesday, July 15, 2015
Conaway, Hon. K. Michael, a Representative in Congress from
Texas, opening statement....................................... 361
Lujan Grisham, Hon. Michelle, a Representative in Congress from
New Mexico, prepared statement................................. 360
McGovern, Hon. James P., a Representative in Congress from
Massachusetts, opening statement............................... 359
Walorski, Hon. Jackie, a Representative in Congress from Indiana,
opening statement.............................................. 357
Prepared statement........................................... 358
Witnesses
Baron, Hon. Jon, Vice President for Evidence-Based Policy, Laura
and John Arnold Foundation, Washington, D.C.................... 361
Prepared statement........................................... 363
Weill, J.D., James D., President, Food Research and Action
Center, Washington, D.C........................................ 366
Prepared statement........................................... 368
Sullivan, Ph.D., James X., Rev. Thomas J. McDonagh, C.S.C.,
Associate Professor of Economics; Director, Wilson Sheehan Lab
for Economic Opportunities, University of Notre Dame, South
Bend, IN....................................................... 374
Prepared statement........................................... 375
Everett, Jeremy K., Director, Texas Hunger Initiative, Baylor
University, Waco, TX........................................... 380
Prepared statement........................................... 382
Subcommittee on Nutrition--Tuesday, October 27, 2015
McGovern, Hon. James P., a Representative in Congress from
Massachusetts, opening statement............................... 401
Submitted report............................................. 439
Walorski, Hon. Jackie, a Representative in Congress from Indiana,
opening statement.............................................. 399
Prepared statement........................................... 400
Witnesses
Ratcliffe, Ph.D., Caroline E., Senior Fellow and Economist,
Center on Labor, Human Services, and Population, Urban
Institute, Washington, D.C..................................... 403
Prepared statement........................................... 404
Riley, Ruth, former WNBA Athlete and Olympic Gold Medalist,
Granger, IN; on behalf of NBA Cares............................ 409
Prepared statement........................................... 410
Submitted questions.......................................... 456
Ochoa, Jr., M.D., F.A.A.P., Eduardo, Little Rock, AR; on behalf
of Children's HealthWatch...................................... 411
Prepared statement........................................... 413
Submitted report............................................. 447
Haskins, Ph.D., Ron, Senior Fellow, Economic Studies and Co-
Director, Center on Children and Families, Brookings
Institution, Washington, D.C................................... 417
Prepared statement........................................... 419
Full Committee--Wednesday, November 18, 2015
Conaway, Hon. K. Michael, a Representative in Congress from
Texas, opening statement....................................... 459
Prepared statement........................................... 461
McGovern, Hon. James P., a Representative in Congress from
Massachusetts, opening statement............................... 462
Peterson, Hon. Collin C., a Representative in Congress from
Minnesota, opening statement................................... 462
Witnesses
Doar, Robert, Co-Chair, National Commission on Hunger; Morgridge
Fellow in Poverty Studies, American Enterprise Institute,
Washington, D.C................................................ 463
Chilton, Ph.D., M.P.H., Mariana M., Co-Chair, National Commission
on Hunger; Associate Professor, Department of Health Management
and Policy, Dornsife School of Public Health, Drexel
University; Director, Center for Hunger-Free Communities,
Philadelphia, PA............................................... 465
Joint prepared statement..................................... 467
National Commission on Hunger, submitted report.............. 499
SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM
(PAST, PRESENT, AND FUTURE OF SNAP: DEVELOPING AND USING EVIDENCE-BASED
SOLUTIONS)
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WEDNESDAY, JULY 15, 2015 *
House of Representatives,
Subcommittee on Nutrition,
Committee on Agriculture,
Washington, D.C.
The Subcommittee met, pursuant to call, at 1:30 p.m., in
Room 1300 of the Longworth House Office Building, Hon. Jackie
Walorski [Chairwoman of the Subcommittee] presiding.
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* Editor's note: the June 25, 2015 hearing entitled, Supplemental
Nutrition Assistance Program (Past, Present, and Future of SNAP: How
Our Welfare System Can Discourage Work) while it is listed as part 2 of
the Supplemental Nutrition Assistance Program series of hearings, it is
considered a stand-alone hearing for the purposes of the numbering of
pages for the entire series.
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Members present: Representatives Walorski, Crawford, Davis,
Yoho, Abraham, Moolenaar, Conaway (ex officio), McGovern, Lujan
Grisham, Aguilar, Plaskett, and DelBene.
Staff present: Anne DeCesaro, Carly Reedholm, Mary Nowak,
John Konya, Lisa Shelton, Liz Friedlander, and Nicole Scott.
OPENING STATEMENT OF HON. JACKIE WALORSKI, A REPRESENTATIVE IN
CONGRESS FROM INDIANA
The Chairwoman. Good afternoon. Welcome to today's hearing
on developing and using evidence-based solutions in SNAP. We
will explore what kind of research is needed to develop more
evidence-based solutions, and what can be done to improve the
quality and quantity of data, and how research can be used to
improve the program. This is the seventh in our Past, Present,
and Future of SNAP series. Today's hearing builds on themes
presented throughout the series, and provisions included in the
2014 Farm Bill.
As we continue these discussions, I want to reiterate this
process is not just about the bureaucracy behind SNAP. It is
about helping people. We are here to ensure people will get a
job, support their family, and ultimately become financially
independent. We repeatedly heard calls for more flexibility so
that both governmental and non-governmental organizations can
better serve recipients. As we work to make that possibility a
reality, we must also be mindful of our duty to be good
stewards of hard earned taxpayer dollars. Giving more
flexibility must be accompanied by measures that provide for
robust accountability, oversight, and feedback. This will
ultimately protect recipients, and ensure taxpayer dollars are
well spent.
Unfortunately, most of the research currently funded by the
Department of Agriculture revolves around the process, like
application timing, inaccuracy, and recipient characteristics,
such as gender, age, and family composition. This approach
misses the forest through the trees. Instead the Department
must move beyond the basics of measuring the ``numbers served''
and develop new data points that focus on outcomes, like well-
being, changes in earnings, and family stability. This shifts
the conversation from ``serving the most'' to ``being the
best.'' This leads to better outcomes because we are better
able to judge what works and what doesn't.
Measuring outcomes is not a new concept. In fact, in our
third hearing on the role of the charitable sector, Jonathan
Webb, with Feed the Children, suggested developing a set of
outcome measures similar to those used in international food
aid programs. The 2014 Farm Bill planted the seeds of an
outcome-based approach. The much discussed SNAP work pilots
allow ten states to test various approaches to serving
recipients. In exchange for a share of Federal funds, they must
agree to comprehensive external evaluation aimed at measuring
increases in employment and overall household incomes. The
pilots' emphasis on outcomes was a great bipartisan step
forward to promote innovation and flexibility, and strong
accountability. I look forward to monitoring the process of
these pilots. They will help to provide a window into what
works and what doesn't so that limited taxpayer dollars can be
used effectively as possible in providing a safety net to those
in need, and means to climbing the economic ladder.
Thank you to all of our witnesses for being here today, and
I am anticipating a great discussion.
[The prepared statement of Mrs. Walorski follows:]
Prepared Statement of Hon. Jackie Walorski, a Representative in
Congress from Indiana
Welcome to today's hearing on developing and using evidence-based
solutions in SNAP. We will explore what kind of research is needed to
develop more evidence-based solutions, what can be done to improve the
quality and quantity of data, and how research can be used to improve
the program. This is the seventh in our Past, Present, and Future of
SNAP series, and will build on themes presented throughout the series
and provisions included in the 2014 Farm Bill.
As we continue these discussions, I want to reiterate this process
is not just about the bureaucracy behind SNAP, it's about helping
people. We're here to ensure people get a job, support their family,
and ultimately become financially independent.
We have repeatedly heard calls for more flexibility so that both
governmental and non-governmental organizations can better serve
recipients. As we work to make that possibility a reality, we must be
mindful of our duty to be good stewards of hard-earned taxpayer
dollars. Giving more flexibility must be accompanied by measures that
provide for robust accountability, oversight, and feedback. This will
ultimately protect recipients and ensure taxpayer dollars are well-
spent.
Unfortunately, most of the research currently funded by the
Department of Agriculture revolves around the process, like application
timing and accuracy, and recipient characteristics, such as gender,
age, and family composition. This approach misses the forest through
the trees. Instead, the Department must move beyond the basics of
measuring the `number served' and develop new data points that focus on
outcomes like well-being, changes in earnings, and family stability.
This shifts the conversation from `serving the most' to `being the
best' leads to better outcomes for more people because we're better
able to judge what works and what doesn't.
Measuring outcomes is not a new concept. In fact, in our third
hearing on the Role of the Charitable Sector, Jonathan Webb, with Feed
the Children, suggested developing a set of outcome measures, similar
to those used in international food aid programs.
The 2014 Farm Bill planted the seeds of an outcome-based approach.
The much discussed SNAP work pilots allow ten states to test various
approaches to serving recipients. In exchange for a share of Federal
funds, they must agree to comprehensive, external evaluation aimed at
measuring increases in employment and overall household incomes. The
pilots' emphasis on outcomes, was a great, bipartisan step forward to
promote innovation and flexibility, and strong accountability.
I look forward to monitoring the progress of these pilots, as they
will help to provide a window into what works and what doesn't so that
limited taxpayer dollars can be used efficiently as possible in
providing a safety net to those in need and a means to climbing the
economic ladder.
Thank you to all our witnesses for being hearing today and I am
anticipating an engaging discussion.
The Chairwoman. I would now like to recognize Ranking
Member McGovern for his opening statement.
OPENING STATEMENT OF HON. JAMES P. McGOVERN, A REPRESENTATIVE
IN CONGRESS FROM MASSACHUSETTS
Mr. McGovern. Thank you very much, Chairwoman Walorski, for
holding today's hearing, and thank you to the witnesses for
being with us. I look forward to your testimony. This is our
seventh hearing on SNAP, and I still have a lot of questions as
to where all this is headed. We are told that the purpose of
all these hearings is to make SNAP better. No program is
perfect. There is always room for improvement. But I worry
that, for some of my colleagues, improvement is code for cuts.
It makes me nervous that we are going down a path that I worry
could actually make hunger worse in this country.
In past hearings we have heard a lot about case management.
Well, I am all for case management, but show me the money. Case
management is expensive, and no one's talking about increasing
SNAP funding to pay for it. We shouldn't take money away from
the food benefit to pay for case management. We shouldn't rob
Peter to pay Paul. Likewise, we have heard a lot about work
requirements, but SNAP is not a jobs program. It is a food
program. If my friends who are critics of this program want to
talk about jobs, then we should talk about how our job training
programs are woefully under-funded. There seems to be little
appetite to provide more money there too.
Today's hearing is about SNAP and evidence. Well, let us
look at the evidence. According to USDA data, SNAP enrollment
is at the lowest level it has been in nearly 4 years. SNAP
caseloads are coming down from their peak in the middle of one
of the country's worst recessions, and they are expected to
continue to decline. That is how the program is designed to
work, and it is working. We also have evidence from Children's
HealthWatch that receiving SNAP is associated with important
health outcomes for children. Children whose families received
SNAP were less likely to be food insecure, less likely to be
underweight, and less likely to be at risk of developmental
delays. If we are talking about investing in our future, I
can't think of a better investment than making sure that our
kids have enough to eat.
One of the things that frustrates me a little bit about
some of the hearings that we have had is that we haven't heard
directly from anybody at the Food and Nutrition Service at
USDA, those directly responsible for administering SNAP. I
understand FNS has a whole team doing research on evidence-
based outcomes on SNAP. It would seem to me that we should be
hearing from them directly.
And if we are focusing on evidence, we should look at the
body of evidence that shows the SNAP benefit is too low, that
people run out of money to pay for groceries mid-month and have
to turn to food pantries and food banks to feed them through
the end of the month. We should be looking at the evidence that
shows that more and more seniors are experiencing hunger.
Seniors are the population with the most number of folks who
are eligible for SNAP, but who aren't enrolled. Why is that? Is
it because they don't know that they are eligible? Is it that
they are ashamed to ask for help? We should be examining those
issues more closely, and we also ought to be looking at hunger
among our veterans. These are the men and women who bravely
fought for our country, and I don't think we are doing enough
to support them. They and their families have sacrificed a
great deal.
Today's hearing is about evidence, and the evidence shows
us that SNAP works. SNAP is helping millions of struggling
families around the county put food on the table, and as this
economy improves, more and more people are getting back on
their feet, and off of SNAP. SNAP is working, and my hope is
that this Committee will look for ways to strengthen it so that
we can continue to give families a hand up when they need it. I
yield back my time.
The Chairwoman. Thank you, Mr. McGovern. The chair would
request that other Members submit their opening statements so
the witnesses may begin their testimony, and to ensure there is
ample time for questions.
[The prepared statement of Ms. Lujan Grisham follows:]
Prepared Statement of Hon. Michelle Lujan Grisham, a Representative in
Congress from New Mexico
We should be rewarding and incentivizing those states that
eradicate hunger.
The Chairwoman. The chair would also like to notify Members
they will be recognized for questioning in order of seniority
for Members who were here at the start of the hearing. After
that, Members will be recognized in order of arrival. I
appreciate the Members' understanding.
Witnesses are reminded to limit their oral statements to 5
minutes. All the written statements will be included for the
record. And I would like to now welcome our witnesses to the
table. John Baron, Vice President of Evidence-Based Policy,
Laura and John Arnold Foundation, Washington, D.C. James Weill,
President, Food Research and Action Center, Washington, D.C.
Special welcome to James Sullivan, Associate Professor of
Economics, University of Notre Dame, and Wilson Sheehan Lab for
Economic Opportunity, Notre Dame, Indiana. Dr. Sullivan has
been at Notre Dame since 2002, researching poverty and the
effects of anti-poverty programs in the U.S. In 2012 Dr.
Sullivan co-founded the Lab for Economic Opportunities, which
partners with Catholic Charities to find research-driven
solutions to poverty. Dr. Sullivan, thanks for your testimony,
I appreciate you appearing before this Committee today. Thank
you for your continued efforts to find research-based solutions
to poverty in the United States.
Next I would like to recognize Chairman Conaway to
introduce the final member of the panel.
OPENING STATEMENT OF HON. K. MICHAEL CONAWAY, A REPRESENTATIVE
IN CONGRESS FROM TEXAS
Mr. Conaway. Well, thank you, gentlelady. It is my pleasure
to introduce Jeremy Everett. Jeremy's dad and I are good
friends. Jeremy's the founding Director of the Texas Hunger
Initiative at Baylor University. Under his leadership, THI
thinks outside the box to develop and implement true public-
private partnerships with all levels of government and types of
community-based organizations to reduce hunger in Texas and
beyond. He is also in town this week because he is currently
serving on the National Commission on Hunger, which was created
by Congress in 2014. I have heard that they had a great hearing
yesterday, and that we look forward to recommendations from
that effort later in the year.
Jeremy has been doing important research-based work in this
space for a long time, and we are honored to have him here
today. And, in spite of what our Ranking Member said about who
else he wanted to hear from, we are excited about hearing from
these witnesses today, because they are the ones that are the
experts. And with that, I yield back.
The Chairwoman. Thank you, Mr. Chairman. Mr. Baron, please
begin your testimony when you are ready.
STATEMENT OF HON. JON BARON, VICE PRESIDENT FOR
EVIDENCE-BASED POLICY, LAURA AND JOHN ARNOLD FOUNDATION,
WASHINGTON, D.C.
Mr. Baron. Chairwoman Walorski, Ranking Member McGovern,
and Members of the Subcommittee, I appreciate the opportunity
to testify regarding evidence-based solutions in the
Supplemental Nutrition Assistance Program, or SNAP Program. I
am testifying on behalf of the Laura and John Arnold
Foundation. My testimony will first discuss how evidence-based
reforms and other entitlement programs, such as welfare and
Unemployment Insurance, have identified several highly
effective strategies for increasing participants' success in
finding employment, while simultaneously reducing government
spending. Then I will offer some concrete ideas for advancing
similar reforms within SNAP.
In welfare policy in the 1980s and 1990s a large number of
randomized control trials of state and local welfare-to-work
programs were conducted across the United States. Such studies
are widely considered the gold standard method of evaluating
program effectiveness, and this was the first time that such
rigorous randomized methods were deployed on a large scale in
social spending instead of the usual evaluation methods, which
often produce much less reliable answers.
Some of the welfare studies found modest effects. Some of
them found no effects. But one trial in Riverside County,
California in the late 1980s of a work-focused welfare-to-work
program was a blockbuster. The program was found to increase
employment and earnings by 40 percent over 5 years for single
parent long-term welfare recipients, compared to the control
group, and to produce net savings to the taxpayer of over $20
million county-wide by reducing participants use of welfare and
food stamps.
Around the same time, a different randomized controlled
trial in Los Angeles, of their welfare-to-work program, which
provided remedial education to welfare recipients, found no
meaningful effects. Based on these findings, Los Angeles
scrapped its program, borrowed the key elements of the Work
First Riverside model, and implemented it county-wide in Los
Angeles County. When the Los Angeles Program was tested in a
subsequent randomized control trial, it was found, lo and
behold--also to produce impressive effects--about a 25 percent
increase in employment and earnings, and net savings to the
taxpayer of about $30 million.
Riverside, and Los Angeles, and several similar studies
that followed had a major influence on national welfare policy,
helping to build the political consensus for the work
requirements in the 1996 Welfare Reform Act. In my written
testimony I describe a randomized trial in a different
entitlement program, Unemployment Insurance, UI, that has
recently identified a highly effective strategy developed by
the State of Nevada for assisting UI claimants to find
employment.
Now, in SNAP, building similar evidence-based solutions
that produce important improvements in participants' lives is
possible. The Agriculture Department's ten state pilot program
that you referred to, Madam Chairman, is a valuable step, and
it was great to see that that program is using randomized
trials to evaluate the ten different state pilots. But to build
a body of proven effective strategies within SNAP, as in
welfare, will require a much larger effort, and specifically
strategic trial and error. In other words, rigorously testing
many promising reforms to identify the few that are effective.
The instances of effectiveness that I just described in
welfare and UI are exceptions that have emerged from testing a
much larger pool of strategies. More generally, most
innovations, typically 80 to 90 percent, are found to produce
weak or no positive effects when rigorously evaluated, a
pattern that occurs not just in social spending, but in other
fields where randomized trials have been carried out, including
medicine and business.
Now, my written testimony offers several concrete
suggestions to greatly accelerate the rate of innovation and
rigorous evaluation in SNAP, and to do it in a cost-effective
way. First, we suggest that the Federal Government incentivize
states to use their existing funds for SNAP employment and
training to rigorously evaluate new employment and training
strategies. One important incentive, similar to what was done
in welfare would be to allow states to share in any budget
savings that result from an employment and training strategy
that is demonstrated through a rigorous evaluation to be
effective. Another incentive, also used in welfare, would be
for the Federal Government to fund \1/2\ the cost of these
state level evaluations, with states funding the other \1/2\.
Our second main recommendation, designed to maximize the
number of strategies that can be evaluated within a given
budget, would be to use low cost randomized trials as a main
evaluation method, and my written testimony describes how such
methods are increasingly possible in social spending by using
administrative data to measure the outcomes.
In conclusion, there is every reason to believe that, with
robust state level innovation and rigorous evaluation in SNAP,
we can succeed in identifying highly effective strategies for
increasing workforce success and self-sufficiency of program
participants.
[The prepared statement of Mr. Baron follows:]
Prepared Statement of Hon. Jon Baron, Vice President for Evidence-Based
Policy, Laura and John Arnold Foundation, Washington, D.C.
Chairman Walorski, Ranking Member McGovern, and Members of the
Nutrition Subcommittee:
I appreciate the opportunity to testify regarding evidence-based
solutions in the Supplemental Nutrition Assistance Program (SNAP). As
brief background, I serve as Vice President of Evidence-Based Policy at
the Laura and John Arnold Foundation (LJAF). Our mission is to address
our nation's most pressing and persistent challenges using evidence-
based, multi-disciplinary approaches. LJAF is a 501(c)(3) private
foundation, and, as such, does not advocate for specific legislation or
financially benefit from its activities or research. I am also the
founder and former President of the Coalition for Evidence-Based
Policy, a nonprofit, nonpartisan organization that worked with Federal
policy officials from 2001 to 2015 to advance important evidence-based
reforms in government social spending, many of which were enacted into
law and policy.
My testimony will briefly discuss how evidence-based reforms in
other entitlement programs--welfare and unemployment insurance--have
succeeded in identifying several highly-effective strategies for
increasing participants' workforce success and self-sufficiency, while
simultaneously reducing government spending. Then, I will offer a few
concrete ideas for advancing similar reforms in SNAP.
1980s/90s welfare policy:
Rigorous evaluations identified welfare-to-work strategies that
increased participants' employment/earnings by 20 to 50 percent, and
produced net government savings of $2,500 to $7,500 per person.
In the 1980s and 1990s, government, foundations, and leading
researchers sponsored or carried out a large number of
randomized controlled trials (RCTs) of state and local welfare
reforms. RCTs are widely considered the strongest, most
credible method of evaluating program effectiveness. Three
major reform efforts--two in California and one in Oregon--were
found to be especially effective. Focused on moving welfare
recipients quickly into the workforce through short-term job-
search assistance and training (as opposed to longer-term
remedial education), these initiatives produced gains of 20 to
50 percent in participants' employment and earnings.
Remarkably, they also produced net savings to the government,
through reduced costs for welfare and food stamps, of $2,500 to
$7,500 per person, or more than $20 million for each of the
three programs.\1\
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\1\ These are 2014 dollars. The program models are: (i) the
Riverside Greater Avenues for Independence (GAIN) Program (Stephen
Freedman, Daniel Friedlander, Winston Lin, and Amanda Schweder, The
GAIN Evaluation: Five-Year Impacts on Employment, Earnings, and AFDC
Receipt, Working Paper 96.1, MDRC, July 1996; James Riccio, Daniel
Friedlander, and Stephen Freedman, GAIN: Benefits, Costs, and Three-
Year Impacts of a Welfare-to-Work Program, MDRC, September 1994); (ii)
Los Angeles Jobs--First GAIN (Stephen Freedman, Jean Tansey Knab, Lisa
A. Gennetian, and David Navarro, The Los Angeles Jobs--First GAIN
Evaluation: Final Report on a Work First Program in a Major Urban
Center, MDRC, June 2000); and (iii) Portland Job Opportunities and
Basic Skills Training (JOBS) Program (Susan Scrivener, Gayle Hamilton,
Mary Farrell, Stephen Freedman, Daniel Friedlander, Marisa Mitchell,
Jodi Nudelman, Christine Schwartz, National Evaluation of Welfare-to-
Work Strategies: Implementation, Participation Patterns, Costs, and
Two-Year Impacts of the Portland (Oregon) Welfare-to-Work Program,
MDRC, May 1998; Gayle Hamilton, Stephen Freedman, Lisa Gennetian,
Charles Michalpoulos, Johanna Walter, Diana Adams-Ciardullo, Anna
Gassman-Pines, Sharon McGroder, Martha Zaslow, Jennifer Brooks, Surjeet
Ahluwalia, Electra Small, and Bryan Ricchetti, National Evaluation of
Welfare-to-Work Strategies: How Effective Are Different Welfare-to-Work
Approaches? Five-Year Adult and Child Impacts for Eleven Programs, MDRC
and Child Trends, December 2001).
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According to Federal officials and others involved in the
reform efforts, these findings helped build political consensus
for the strong work requirements in the 1996 welfare reform
act, and they played a central role in shaping many of the
work-first state-level reforms that followed. The scientific
rigor of the findings was critical to their policy impact.\2\
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\2\ Judith M. Gueron and Howard Rolston, Fighting for Reliable
Evidence, Russell Sage Foundation, 2013, chapters 9 and 10. Ron
Haskins, ``What Works Is Work: Welfare Reform and Poverty Reduction,''
Northwestern Journal of Law and Social Policy, vol. 4, no. 1, 2009, pp.
29-60. Ron Haskins, in Rigorous Evidence: The Key To Progress Against
Crime and Substance Abuse? Lessons From Welfare, Medicine, and Other
Fields, Proceedings of a National Policy Forum Sponsored by the U.S.
Department of Justice and Coalition for Evidence-Based Policy, June 14,
2004, pp. 30-36. Judith M. Gueron, ``Building Evidence: What It Takes
and What It Yields,'' Research on Social Work Practice, vol. 17, no. 1,
January 2007, pp. 134-142.
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Unemployment Insurance (UI):
A recent RCT of Nevada's Reemployment and Eligibility Assessment
program for UI claimants found a $2,789 (18 percent) increase in
earnings per claimant, and a net government savings of $715 per
claimant.
Nevada's Reemployment and Eligibility Assessment (REA)
program is a mandatory program for new UI claimants which
provides an in-person review of their UI eligibility, and
personalized reemployment services (e.g., job search
assistance), during a single interview session. The program,
evaluated in a Department of Labor-funded RCT across the state
in 2009-2011, was found to produce a $2,789 (18 percent)
increase in earnings per claimant, a four percentage point
increase in their employment rate, and a net savings to the UI
system of $715 per claimant, 18 to 26 months after random
assignment.\3\
---------------------------------------------------------------------------
\3\ Eileen Poe Yamagata, Jacob Benus, Nicholas Bill, Hugh
Carrington, Marios Michaelides, and Ted Shen, Impact of the
Reemployment and Eligibility Assessment Initiative, Impaq
International, June 2011. Marios Michaelides, Eileen Poe-Yamagata,
Jacob Benus, and Dharmendra Tirumalasetti, Impact of the Reemployment
Eligibility Initiative In Nevada, Impaq International, January 2012.
Coalition for Evidence-Based Policy, Top Tier Evidence Summary of the
Nevada Reemployment and Eligibility Assessment Program, February 2014,
linked here (http://toptierevidence.org/wp-content/uploads/2014/09/
Nevada-REA-Near-Top-Tier-summary.pdf).
---------------------------------------------------------------------------
The Department of Labor is currently funding an expansion of
the Nevada REA program to other states, along with a
replication RCT to determine whether the findings from the
Nevada study will generalize to other sites.
In SNAP: Building similar evidence-based solutions, with large
effects, is possible:
The Department of Agriculture's ten-state pilot program, authorized
by Congress last year to fund and rigorously evaluate employment/
training projects for SNAP participants, is a valuable first step.
The program embodies two core elements that experience in
welfare and other areas suggests are essential to successful
reform: (i) rather than prescribing or circumscribing the types
of projects to be funded, the program used a competitive
process to select a diverse array of state-initiated projects,
thus tapping into promising entrepreneurial approaches
generated by the field; (ii) the program requires that each
state project be evaluated in a randomized controlled trial so
as to credibly determine whether it produces the hoped-for
effects on participants' employment, income, economic well-
being, and use of public assistance.
However, building a body of proven-effective approaches--as in
welfare--will require a greatly expanded effort, because experience
suggests only a subset of tested approaches will be found to work.
Well-conducted RCTs, by measuring programs' true effect on
objectively important outcomes such as earnings, income, and
receipt of public assistance, are able to distinguish those
that produce sizable effects from those that do not. Such
studies have identified a few social interventions that are
truly effective--such as those described above--but these are
exceptions that have emerged from testing a much larger pool.
Most, including those thought promising based on initial
studies, are found to produce small or no effects--underscoring
the need to test many interventions. This pattern occurs across
a broad range of fields where rigorous evaluations have been
conducted. For example:
Education: Of the 90 interventions evaluated in RCTs
commissioned by the Institute of Education Sciences (IES)
since 2002, approximately 90 percent were found to have
weak or no positive effects.\4\
---------------------------------------------------------------------------
\4\ Coalition for Evidence-Based Policy, Randomized Controlled
Trials Commissioned by the Institute of Education Sciences Since 2002:
How Many Found Positive Versus Weak or No Effects, July 2013, linked
here (http://coalition4evidence.org/wp-content/uploads/2013/06/IES-
Commissioned-RCTs-positive-vs-weak-or-null-findings-7-2013.pdf).
Employment/training: In Department of Labor-commissioned
RCTs that have reported results since 1992, about 75
percent of tested interventions were found to have found
weak or no positive effects.\5\
---------------------------------------------------------------------------
\5\ This is based on a count of results from the Department of
Labor RCTs that have reported results since 1992, as identified through
the Department's research database (link (http://wdr.doleta.gov/
research/keyword.cfm)). We are preparing a short summary of these
findings, to be released shortly.
Medicine: Reviews have found that 50 to 80 percent of
positive results in initial (``phase II'') clinical studies
are overturned in subsequent, more definitive RCTs (``phase
III'').\6\
---------------------------------------------------------------------------
\6\ John P.A. Ioannidis, ``Contradicted and Initially Stronger
Effects in Highly Cited Clinical Research,'' Journal of the American
Medical Association, vol. 294, no. 2, July 13, 2005, pp. 218-228.
Mohammad I. Zia, Lillian L. Siu, Greg R. Pond, and Eric X. Chen,
``Comparison of Outcomes of Phase II Studies and Subsequent Randomized
Control Studies Using Identical Chemotherapeutic Regimens,'' Journal of
Clinical Oncology, vol. 23, no. 28, October 1, 2005, pp. 6982-6991.
John K. Chan et. al., ``Analysis of Phase II Studies on Targeted Agents
and Subsequent Phase III Trials: What Are the Predictors for Success,''
Journal of Clinical Oncology, vol. 26, no. 9, March 20, 2008. Michael
L. Maitland, Christine Hudoba, Kelly L. Snider, and Mark J. Ratain,
``Analysis of the Yield of Phase II Combination Therapy Trials in
Medical Oncology,'' Clinical Cancer Research, vol. 16, no. 21, November
2010, pp. 5296-5302. Jens Minnerup, Heike Wersching, Matthias
Schilling, and Wolf Rudiger Schabitz, ``Analysis of early phase and
subsequent phase III stroke studies of neuroprotectants: outcomes and
predictors for success,'' Experimental & Translational Stroke Medicine,
vol. 6, no. 2, 2014.
Business: Of 13,000 RCTs of new products/strategies
conducted by Google and Microsoft, 80 to 90 percent have
reportedly found no significant effects.\7\
---------------------------------------------------------------------------
\7\ Jim Manzi, Uncontrolled: The Surprising Payoff of Trial-and-
Error for Business, Politics, and Society, Perseus Books Group, New
York, 2012, pp. 128 and 142. Jim Manzi, Science, Knowledge, and
Freedom, presentation at Harvard University's Program on Constitutional
Government, December 2012, linked here (https://www.youtube.com/
watch?v=N4c89SJIC-M).
In other words, strategic trial-and-error is needed. By
rigorously testing many promising approaches, we can identify
the few that are effective and merit larger-scale
---------------------------------------------------------------------------
implementation.
The Federal Government could greatly accelerate evidence building
within SNAP by creating strong incentives for states to use their
existing funds to rigorously test new employment/training strategies.
States currently receive substantial Federal funds--and
often contribute their own funds--to provide employment/
training services to SNAP participants, but have little
incentive to use these funds to rigorously test new strategies.
Specifically, in FY 2013, the states received approximately
$290 million in Federal funds to provide such employment and
training services, and many states contribute their own funds
to supplement the Federal funding. Yet, states currently have
little incentive to use these funds to develop innovative new
strategies and rigorously evaluate them, because any budget
savings from strategies demonstrated successful in increasing
participants' employment and earnings, and reducing their use
of SNAP, would accrue only to the Federal Government (in the
form of reduced SNAP expenditures).
By contrast, in welfare policy, in the years leading up to
the 1996 reforms, states had strong incentives to use existing
funds to rigorously evaluate welfare-to-work strategies. First,
welfare was jointly funded by the states and the Federal
Government, and under Federal policy, if states could
rigorously demonstrate (usually through an RCT) that a new
welfare-to-work strategy successfully reduced welfare
expenditures, both the state and the Federal Government would
share in such savings. Second, the Federal Government gave the
states great flexibility to innovate, by granting them waivers
from Federal welfare rules, but in return required the states
to rigorously evaluate their innovations to determine their
effectiveness. Third, the Federal Government funded \1/2\ the
cost of each state-level evaluation, and helped manage and
monitor the evaluation design and implementation so as to
ensure scientific rigor.
To create similar incentives in SNAP, we suggest that states
be allowed to share in any budget savings resulting from an
employment/training strategy rigorously shown to be effective--
i.e., shown, in a rigorous evaluation (wherever feasible, an
RCT), to increase the employment and earnings of SNAP
participants, and to reduce their use of SNAP and other public
assistance.
In addition, we suggest that--as in welfare--the Federal
Government fund \1/2\ the cost of the evaluation studies of
state-developed employment/training strategies (with states
funding the other \1/2\) and collaborate with states in the
design and implementation of such studies to ensure their
scientific rigor.
To maximize the number of strategies that can be evaluated within a
given evaluation budget, we suggest using low- or modest-cost RCTs as a
main evaluation method.
Recently, researchers have shown it is possible, in many
instances, to conduct sizable RCTs at low or modest cost by
using administrative data that are already collected for other
purposes to measure the key outcomes, rather than engaging in
original--and often costly--data collection (e.g., researcher-
administered interviews, observations, or tests). Such an
approach could likely be applied in many SNAP RCTs--i.e.,
states that are rigorously evaluating state-developed
employment/training strategies could often use state UI records
and other administrative data to measure key outcomes including
employment, earnings, and receipt of SNAP and other public
assistance. Such leveraging of existing data can enable many
more RCTs to go forward, by dramatically reducing their cost.
As an illustrative example in another entitlement program,
the Department of Labor-funded RCT of the Reemployment and
Eligibility Assessment (REA) program, described above, cost
about $320,000 through the 12 to 18 month follow-up, based on
the researchers' rough estimate--a small fraction of the usual
multimillion-dollar cost of major RCTs. Even though the study
had a very large sample--33,000 UI claimants in Nevada and over
100,000 in three other states implementing different REA
strategies--it was conducted at modest cost by measuring all
outcomes using administrative data on UI receipt and earnings
that the states collect already for other purposes.
In 2012, the Coalition for Evidence-Based Policy developed a
brief (http://coalition4evidence.org/wp-content/uploads/2012/
03/Rigorous-Program-Evaluations-on-a-Budget-March-2012.pdf)
with five additional examples of sizable, well-conducted RCTs,
in diverse program areas, that cost less than $300,000. These
studies all produced valid evidence of practical importance for
policy decisions and, in some cases, identified program
strategies that produce budget savings.\8\
---------------------------------------------------------------------------
\8\ Coalition for Evidence-Based Policy, Rigorous Program
Evaluations on a Budget: How Low-Cost Randomized Controlled Trials Are
Possible in Many Areas of Social Policy, March 2012, linked here
(http://coalition4evidence.org/wp-content/uploads/2012/03/Rigorous-
Program-Evaluations-on-a-Budget-March-2012.pdf).
We suggest reserving the use of traditional, more comprehensive
(and costly) RCTs for the evaluation of strategies with a very strong
signal of sizable impacts from prior studies--including, for example,
---------------------------------------------------------------------------
low-cost RCTs.
The main goals would be (i) to determine whether the prior
impacts can be successfully reproduced and sustained over time,
and (ii) to identify the conditions and populations in which
the strategy is most effective. When focused on especially
promising strategies, such studies can thereby supply valuable
evidence to guide decisions about whether and how to scale up
the strategy so as to optimize its impact. However, using such
comprehensive RCTs to evaluate strategies without a highly
promising evidence base can be a costly and inefficient use of
evaluation funds, because of the high likelihood of finding no
meaningful impacts, discussed above.
Conclusion: A robust Federal effort to stimulate state-level
innovation and rigorous evaluation in employment/training of SNAP
participants can succeed in identifying strategies that produce
important gains in employment and earnings, and net savings to the
taxpayer.
The Chairwoman. Thank you, Mr. Baron. Mr. Weill, please
proceed with your testimony.
STATEMENT OF JAMES D. WEILL, J.D., PRESIDENT, FOOD RESEARCH AND
ACTION CENTER, WASHINGTON, D.C.
Mr. Weill. Chairwoman Walorski, Ranking Member McGovern,
Members of the Subcommittee, thank you for the opportunity to
testify this afternoon. I am Jim Weill. I am President of the
Food Research and Action Center, commonly known as FRAC. For 45
years FRAC has worked to implement and strengthen SNAP and
other nutrition and anti-poverty programs in order to reduce
hunger and improve nutrition and well-being. My written
testimony details the very extensive body of evidence that
already shows how successful SNAP is in reducing hunger,
malnutrition, and poverty, and improving child and adult
health, and other outcomes. And it points out that these
outcomes would be at deep risk if the program were weakened, or
subjected to demonstration projects based on misconceptions or
stereotypes.
The key purposes of SNAP, defined in the statute, are to
address hunger among low-income households that suffer from
limited purchasing power, to assist those households in
obtaining a more nutritious diet, to bolster normal channels of
trade, and to strengthen the agricultural economy. The first
set of research findings, summarized in my written testimony,
is that SNAP is fulfilling these core purposes, and in
particular it boosts food purchasing power for needy Americans,
and thereby reduces significantly the prevalence of food
insecurity and malnutrition. By doing so, the research shows,
SNAP produces important positive effects on health, on mental
health, on child development, on employability, and on other
desirable outcomes. The positive impacts on child health are
particularly notable, and those effects can be long lasting.
For example, a recent compelling report says that the exposure
to SNAP in utero, or in early childhood, reduces the incidence
of metabolic syndrome in adulthood, and reduces obesity,
hypertension, diabetes, and heart disease.
SNAP and its impacts, moreover, reach a very broad and
diverse population of rural, urban, and suburban people in
need: 70 percent of recipients live in households with minor
children, 11 percent in households with seniors, 18 percent in
households with people with disabilities. Many beneficiaries
are struggling veterans. And in many ways the program has
become a work support program. When the adults in the household
are not seniors, or persons with disabilities, they typically
are working, albeit at low wages, or are very recently
unemployed. Among SNAP households with at least one working age
adult not receiving disability benefits, more than \1/2\ have a
member who works while receiving SNAP, and more than 80 percent
work either in the year prior or the year after receiving SNAP.
These rates are even higher for SNAP households with children.
And, as we have learned most profoundly in the Great Recession,
SNAP is very responsive to national or local economic
downturns.
SNAP not only reduces hunger, it alleviates poverty and
supports family economic stability. According to one new
analysis, SNAP lifted ten million people above the poverty line
in 2012. Exposure to SNAP in early childhood increases women's
economic self-sufficiency, with greater high school graduation
rates, higher earnings, and lower rates of welfare received in
adulthood.
There is one serious SNAP shortcoming, and that is its
inadequate benefit levels. But the nation has just run a large
natural experiment with more adequate SNAP benefits, and the
early research shows that it worked. The American Recovery and
Reinvestment Act began an increase in benefits in April 2009, a
boost that was cut off in late 2013. While it was in effect,
research shows, the boost reduced food insecurity and improved
the health of young children. But there needs to be more
extensive research on the impact of the boost on food
insecurity and health. It is disconcerting how little interest
there has been about this in the research community.
And finally I will just summarize quickly some examples
from my written testimony of recent policy changes, Federal and
state, that should be evaluated for their impact on hunger and
on SNAP's effectiveness. Last year's farm bill created pilots
to provide incentives for SNAP consumers' purchases of fruit
and vegetables. As Mr. Baron indicated, the farm bill also
created a substantial demonstration project for ten states'
innovative employment and training strategies. The improvements
made last year in the Federal child care program also should be
evaluated to see if more work--supporting child care will lead
to higher rates of food security, as well as less joblessness;
and the President's proposal to help states streamline SNAP
processes for seniors could provide evidence of ways to improve
the far too low senior SNAP participation rate, and thereby
lower their food insecurity and health costs. And last, as more
states adopt higher state minimum wages, while the Federal
minimum wage and other states are lagging behind, that provides
a natural opportunity to examine the evidence that higher
minimum wages can be a significant solution to food insecurity,
and also bring down SNAP participation rates.
So, in conclusion, SNAP is fundamentally sound and
successful. There are ways to make it even better. Indeed,
there is already a body of research on this that I haven't been
able to do full justice to today, but I hope the Subcommittee
will explore that existing body of research, and where it
leads, further.
[The prepared statement of Mr. Weill follows:]
Prepared Statement of James D. Weill, J.D., President, Food Research
and Action Center, Washington, D.C.
Thank you for the invitation to testify this afternoon.
I am Jim Weill, President of the Food Research and Action Center
(FRAC). FRAC works through research, advocacy, outreach, and
identification and dissemination of best practices to reduce poverty
and end hunger in America. For 45 years FRAC has been engaged in
efforts to implement and strengthen the SNAP (formerly ``food stamp'')
program in order to reduce hunger and improve nutrition; and I
personally have been involved in work around SNAP and other key means-
tested programs like Medicaid, Supplemental Security Income, and school
meals since the 1970s, in jobs at the Legal Assistance Foundation of
Chicago, the Children's Defense Fund, and--since 1998--FRAC.
I will be primarily discussing today the rich veins of evidence
showing how successful SNAP is in reducing hunger, malnutrition and
poverty, and improving family security, child and adult health,
employment and other outcomes. In discussing what research to undertake
and which evidence-based solutions to pursue, it is crucial to
understand the substantial body of first-rate evidence on the program
that already exists.
The evidence demonstrates that SNAP is a great example of how
government at its best can work well for people. Senator Bob Dole,
among others, described the Food Stamp Program as the most important
social program advance since the creation of Social Security. That
insight has since been buttressed by more and more evidence of SNAP's
strengths and positive outcomes--outcomes that would be at deep risk if
the program were weakened or if new demonstration projects or program
changes were developed without understanding what we already know. SNAP
is a key part of a safety net that not only reduces hunger but supports
work, family stability, child development and opportunity. Damaging
SNAP by building in ill-conceived changes based on misconceptions or
stereotypes would result in irreparable harm to people who are trying
desperately to put food on the table and to move out of poverty. SNAP
is targeted and effective. It is a critical support to millions of poor
and hungry people in our country.
The first and most significant set of findings is that SNAP
fulfills its core purpose: it reduces food insecurity and malnutrition,
and that result is crucially important to the nation as a whole and to
every state and community. A number of studies, including many
published in the last couple of years, find that participation in SNAP
quite significantly reduces the prevalence of food insecurity among
households and among both adults and children in those households.\1\
One study showed that SNAP reduces the childhood food insecurity rate
by at least 8.1 points.
---------------------------------------------------------------------------
\1\ For citations and additional studies on SNAP's role in reducing
food insecurity, see FRAC's SNAP and Public Health: The Role of the
Supplemental Nutrition Assistance Program in Improving the Health and
Well-Being of Americans, as well as the April 2015 issue of Food
Insecurity and Hunger in the U.S.: New Research. Both publications are
available at www.frac.org.
---------------------------------------------------------------------------
As I will discuss in detail later, the effects of SNAP on reducing
food insecurity would be much greater if monthly SNAP benefits were
more adequate. But even with the constraint of benefits being too low,
the program still has important impacts on reducing hunger and food
insecurity.
Addressing hunger and malnutrition among low-income people is the
core Congressional goal in SNAP, and it should be: reducing hunger must
remain a paramount national goal. Food insecurity has a range of severe
negative effects for children and adults.\2\ Food insecurity is
associated with some of the most costly health problems in the United
States, including diabetes, heart disease, depression, obesity, and
pregnancy complications (e.g., gestational diabetes and iron
deficiency). And among seniors, food insecurity has been linked with
poor or fair health status, diabetes, anemia, depression, disability,
limitations in daily activities, decreased quality of life, and lower
intakes of calories and key nutrients. In addition, because of limited
resources, individuals in food insecure households often are forced to
choose food over medication, postpone preventive or needed medical
care, dilute or ration infant formula, or forgo the foods needed for
special medical diets (e.g., diabetic diets). Such practices and
behaviors not only exacerbate disease and compromise health, but also
increase expensive physician encounters, emergency room visits, and
hospitalizations.
---------------------------------------------------------------------------
\2\ For citations and additional studies on the consequences of
food insecurity, see FRAC's SNAP and Public Health: The Role of the
Supplemental Nutrition Assistance Program in Improving the Health and
Well-Being of Americans, as well as the April 2014 and July 2014 issues
of Food Insecurity and Hunger in the U.S.: New Research. These
publications are available at www.frac.org.
---------------------------------------------------------------------------
The consequences of food insecurity--and even marginal food
security--are especially detrimental to the health, development, and
well-being of children. Research shows a clear link between food
insecurity and low birthweight, birth defects, iron deficiency anemia,
more frequent colds and stomachaches, untreated dental caries,
developmental risk, mental health problems, and poor educational
outcomes for children--all of which have serious health and economic
consequences in both the short term and long-term.
As I will discuss, by reducing food insecurity, improving diets and
connecting beneficiaries to food through normal means of commerce, SNAP
has a range of proven positive effects on health, mental health,
employability, and other desirable outcomes.
Moreover, in looking at these positive impacts, it is important to
maintain focus on how broad and diverse is the population of people in
need that SNAP serves and benefits:
About 70 percent of SNAP recipients live in households with
minor children;
Eleven percent live in households with seniors;
Eighteen percent live in households with people with
disabilities;
Many beneficiaries are struggling veterans; and even low-
paid enlisted active duty military families participate; and
When the adults in the household are not seniors or persons
with disabilities, they typically are working--at low wages--or
are recently unemployed. Among SNAP households with at least
one working-age adult not receiving disability benefits, more
than \1/2\ have a member who works while receiving SNAP, and
more than 80 percent work either in the year prior or the year
after receiving SNAP. The rates are even higher for SNAP
households with children.\3\
---------------------------------------------------------------------------
\3\ Rosenbaum, D. (2013). The Relationship Between SNAP and Work
Among Low-Income Households. Center on Budget and Policy Priorities.
Available at: www.cbpp.org/cms/?fa=view&id=3894.
SNAP is also there when natural disasters like hurricanes,
tornadoes and floods strike. Indeed in 2005, in a report from President
Bush's White House on government action in the aftermath of Hurricanes
Katrina, Rita and Wilma, the Disaster SNAP program was singled out for
its responsiveness and effectiveness.
And, as we have learned most profoundly in the Great Recession,
SNAP is appropriately and effectively responsive to national--or
regional or local--economic downturns, when joblessness rises, and
wages and hours for workers who hang on to their jobs often are
reduced.
These diverse groups of Americans--whether people with
disabilities, seniors, low-paid working families, families facing
unemployment, veterans or people affected by natural or man-made
economic disasters--turn to SNAP when facing severe need. And their
need is great: 83 percent of households on SNAP have incomes at or
below the Federal poverty line ($19,530 for a family of three in 2013--
the year of this SNAP data analysis).\4\ Indeed, 58 percent of them
have incomes at or below \3/4\ of the poverty line.
---------------------------------------------------------------------------
\4\ Farson Gray, K. (2014). Characteristics of Supplemental
Nutrition Assistance Program Households: Fiscal Year 2013. Report No.
SNAP-14-CHAR. Alexandria, VA: U.S. Department of Agriculture, Food and
Nutrition Service, Office of Policy Support.
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It is this intimate connection to great human need that explains
the caseload trends. The weak performance of the economy in the years
before the Great Recession, and then the huge pain of the Recession,
were key drivers of SNAP participation growth. Even as employment now
slowly recovers, moreover, the problem of low wages--for example, the
Federal minimum wage hasn't gone up since 2009 and in real, inflation-
adjusted, terms is at only \3/4\ of the level typical in the 1960s and
1970s--means that more low-wage working families turn to SNAP for help.
The weakening of other parts of the safety net--unemployment insurance,
housing assistance, TANF, etc.--also causes an erosion of family
incomes that increases the need for SNAP benefits.
There is an additional explanation for the widespread need, over
time, for SNAP's help. The American economy operates in such a way that
very large numbers of people cycle into and out of poverty, hunger and
other hardship. Mark Rank, an expert on poverty at Washington
University in St. Louis, calculates that \1/2\ of all children in the
U.S. reside in a household that receives SNAP benefits at least once
during their childhood,\5\ as do \1/2\ of all American adults at some
point between the ages of 20 and 65.\6\
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\5\ Rank, M.R. & Hirschl, T.A. (2009). Estimating the risk of food
stamp use and impoverishment during childhood. Archives of Pediatrics
and Adolescent Medicine, 163(11), 994-999.
\6\ Rank, M.R. & Hirschl, T.A. (2005). Likelihood of using food
stamps during the adulthood years. Journal of Nutrition Education and
Behavior, 37(3), 137-146.
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And, contrary to stereotypes, these beneficiaries are as diverse as
America--they come from all races and ethnic groups; they are rural,
suburban and urban. They are as diverse as is American poverty and
hunger. Indeed, rural food insecurity rates are higher than metro area
rates; and food insecurity rates are roughly the same in every region
of the country, albeit they are highest in the South.\7\
---------------------------------------------------------------------------
\7\ Coleman-Jensen, A., Gregory, C., & Singh, A. (2014). Household
Food Security in the United States in 2013, ERR-173. Washington, DC:
U.S. Department of Agriculture, Economic Research Service.
---------------------------------------------------------------------------
Let me return now to the many specific ways in which SNAP benefits
struggling Americans.
SNAP not only reduces hunger, but it alleviates poverty and
supports family economic stability.\8\ SNAP is as effective as low-
income tax credits in lifting people out of poverty. According to a new
analysis, SNAP lifted 10.3 million people above the poverty line in
2012, comparable to the number lifted out by the Earned Income Tax
Credit and Child Tax Credit together: 4.9 million of those lifted out
of poverty were children. And the SNAP program was far more effective
than any other government effort (e.g., EITC/CTC; housing assistance;
Supplemental Security Income; TANF), other than Social Security, in
lifting people above \1/2\ the poverty line.
---------------------------------------------------------------------------
\8\ For citations and additional research on SNAP's role in
alleviating poverty, see FRAC's SNAP and Public Health: The Role of the
Supplemental Nutrition Assistance Program in Improving the Health and
Well-Being of Americans at www.frac.org.
---------------------------------------------------------------------------
In some state estimates of particular note for the Subcommittee,
SNAP lifted 224,000 people above the poverty line in Indiana; 913,000
in Texas; 342,000 in Pennsylvania, 141,000 in Massachusetts; 419,000 in
Ohio; and 338,000 in North Carolina.\9\
---------------------------------------------------------------------------
\9\ Sherman, A. & Trisi, D. (2015). Safety Net More Effective
Against Poverty Than Previously Thought. Center on Budget and Policy
Priorities. Available at: www.cbpp.org/research/poverty-and-inequality/
safety-net-more-effective-against-poverty-than-previously-thought.
---------------------------------------------------------------------------
SNAP also helps support families by improving housing security.
Families receiving housing subsidies, SNAP, and WIC benefits are 72
percent more likely to be housing-secure (i.e., defined as living
without overcrowding or frequent moves within the last year), compared
to those families receiving housing subsidies alone.\10\
---------------------------------------------------------------------------
\10\ Sandel, M., Cutts, D., Meyers, A., Ettinger de Cuba, S.,
Coleman, S., Black, M.M., Casey, P.H., Chilton, M., Cook, J.T.,
Shortell, A., Heeren, T., & Frank, D. (2014). Co-enrollment for child
health: how receipt and loss of food and housing subsidies relate to
housing security and statutes for streamlined, multi-subsidy
application. Journal of Applied Research on Children, 5(2), Article 2.
---------------------------------------------------------------------------
And SNAP helps long-term economic security. In one seminal analysis
published by the National Bureau of Economic Research, and looking at
the long-term effects of SNAP, exposure to SNAP in early childhood
increased women's economic self-sufficiency in terms of greater high
school graduation rates (18 percent higher), higher earnings, and lower
rates of welfare receipt in adulthood.\11\
---------------------------------------------------------------------------
\11\ Hoynes, H.W., Schanzenbach, D.W., & Almond, D. (2012). Long
run impacts of childhood access to the safety net. NBER Working Paper,
18535. Cambridge, MA: National Bureau of Economic Research.
---------------------------------------------------------------------------
SNAP improves beneficiaries' dietary intake, health and well-
being.\12\ Extensive research shows that SNAP improves dietary intake.
And the higher the level of SNAP benefits is, the larger is the
positive nutritional effect of program participation.
---------------------------------------------------------------------------
\12\ For citations and additional research on SNAP's role in
improving dietary intake, health and well-being, see FRAC's SNAP and
Public Health: The Role of the Supplemental Nutrition Assistance
Program in Improving the Health and Well-Being of Americans, as well as
the April 2015 issue of Food Insecurity and Hunger in the U.S.: New
Research. Both publications are available at www.frac.org.
---------------------------------------------------------------------------
Numerous studies--many of them recent--demonstrate the favorable
impact of SNAP participation on physical and mental health. Indeed, the
notion that ``food is medicine'' is growing in resonance.
SNAP has a powerful impact on child health. Young children in food-
insecure households that receive SNAP benefits are less likely to be at
developmental risk, in fair or poor health, and overweight, and they
have fewer hospitalizations than comparable non-participants. SNAP also
has been linked with lower rates of nutrient deficiency and lower rates
of failure to thrive among children.
SNAP improves adult health in terms of increasing the probability
of reporting excellent or good health, as well as having fewer sick
days and doctor's visits. In addition, exposure to SNAP in utero or in
early childhood reduces the incidence of metabolic syndrome (obesity,
hypertension, diabetes, heart disease) in adulthood.
On the other hand, a loss or reduction in SNAP benefits has
detrimental impacts on health. Families with young children whose SNAP
benefits were recently lost or reduced due to an increase in income
have higher odds of poor child health and developmental risk, household
food insecurity, forgoing medical care for family members, or making
health care trade-offs (e.g., paying for health care costs instead of
paying for food or housing).
SNAP is a public-private partnership that works efficiently and
accurately. SNAP makes good use of regular channels of commerce--retail
stores and Electronic Benefit Transfer (EBT) systems--rather than
requiring constructing new, costly delivery systems. SNAP relieves
pressure on overwhelmed food banks, pantries, religious congregations,
and other emergency food providers across the country. They recognize
SNAP as the cornerstone of national, state, and local anti-hunger
efforts, and are the first to note their total inability to meet added
demand that would come from weakening SNAP.
SNAP benefits create markets, economic growth and jobs in urban and
rural communities--at grocers, farmers' markets, military commissaries,
manufacturers, and farms. Because SNAP benefits are so urgently needed,
they are spent quickly--97 percent of benefits are redeemed by the end
of the month of issuance--and therefore have great positive economic
effects. Moody's Analytics and USDA estimate that the economic growth
impact of SNAP ranges from $1.73 to $1.79 per $1 of SNAP benefits.
* * * * *
In the midst of all of these quite considerable strengths of the
SNAP program, the most serious shortcoming is its inadequate benefit
levels. Benefits are not adequate to get most families through the
whole month, let alone to allow them to buy the foods needed for a
quality diet. Benefits are inadequate even though SNAP recipients use a
variety of savvy shopping practices to stretch their limited food
dollars, such as clipping coupons, using shopping lists, looking for
deals by comparing store circulars, purchasing generic brands, buying
in bulk quantities, and shopping at multiple
stores.\13\-\15\
---------------------------------------------------------------------------
\13\ Bradbard, S., Michaels, E.F., Fleming, K., & Campbell, M.
(1997). Understanding the Food Choices of Low Income Families: Summary
of Findings. Alexandria, VA: U.S. Department of Agriculture, Food and
Consumer Service, Office of Analysis and Evaluation.
\14\ Seefeldt, K.S. & Castelli, T. (2009). Low-income women's
experiences with food programs, food spending, and food-related
hardships: evidence from qualitative data. Contractor and Cooperator
Report, 57. Washington, D.C.: U.S. Department of Agriculture, Economic
Research Service.
\15\ Wiig, K. & Smith, C. (2009). The art of grocery shopping on a
food stamp budget: factors influencing the food choices of low-income
women as they try to make ends meet. Public Health Nutrition, 12(10),
1726-1734.
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Researchers, advocates, and food pantries have been saying for
years that SNAP benefits are inadequate, but in 2013 the prestigious
Institute of Medicine, after a thorough study, outlined the factors
that explain why the SNAP allotment is not enough to get most families
through the month with a minimally adequate diet (e.g., the lag in SNAP
benefits keeping up with inflation because of budget cuts made by
Congress; the failure to fully account for shelter costs when
determining family income available for food costs so that SNAP
benefits are lower; the unreasonable assumptions about the amount of
time beneficiaries have to purchase and prepare food).\16\
---------------------------------------------------------------------------
\16\ Institute of Medicine and National Research Council Committee
on Examination of the Adequacy of Food Resources and SNAP Allotments.
(2013). Supplemental Nutrition Assistance Program: Examining the
Evidence to Define Benefit Adequacy. Washington, D.C.: National
Academies Press.
---------------------------------------------------------------------------
An analysis by FRAC finds that SNAP benefits are inadequate, in
part, because they are based on the U.S. Department of Agriculture's
(USDA) impractical Thrifty Food Plan. The plan: includes lists of foods
that are impractical to find in many communities or impractical given
time constraints; lacks the variety called for in the Dietary
Guidelines for Americans; unrealistically assumes adequate facilities
and time for food preparation; unrealistically assumes food
availability, affordability, and adequate transportation; particularly
costs more than the SNAP allotment in many parts of the country; and
ignores special dietary needs.\17\
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\17\ For this and additional information on the weaknesses of the
Thrifty Food Plan, see FRAC's Replacing the Thrifty Food Plan in Order
to Provide Adequate Allotments for SNAP Beneficiaries at www.frac.org.
---------------------------------------------------------------------------
On the other hand, the nation has just run a large natural
experiment involving providing more adequate benefits, and it
worked.\18\ Average benefits starting in April 2009 reflected a
temporary boost in monthly allotments pursuant to the American Recovery
Reinvestment Act (ARRA). Unfortunately, the temporary ARRA boost was
cut off on November 1, 2013, and benefits then were reduced for all
SNAP participants. But the ARRA boost had very important positive
effects while it was in effect. It helped reduce the ratio of food
insecurity by 2.2 points and reduce very low food insecurity by 2.0
points among low-income households between December 2008 (pre-ARRA) and
December 2009 (about 8 months post-ARRA). SNAP households also
exhausted benefits later in the month with the ARRA boost--they were
able to save slightly more benefits for use at the end of the month.
Two years after the ARRA boost started, young children in households
receiving SNAP benefits were significantly more likely to be ``well''
than children from non-participating low-income households; such a
difference was not observed prior to the benefit boost.
---------------------------------------------------------------------------
\18\ For citations and additional studies on the ARRA boost and its
impacts, see FRAC's SNAP and Public Health: The Role of the
Supplemental Nutrition Assistance Program in Improving the Health and
Well-Being of Americans, as well as the April 2015 issue of Food
Insecurity and Hunger in the U.S.: New Research. Both publications are
available at www.frac.org.
---------------------------------------------------------------------------
Prior to the temporary boost, caloric intake declined by as much as
25 percent at the end of the month among SNAP participants. However,
the ARRA boost eliminated this decline, leading researchers to
conclude, when the boost expired, that: ``now that the ARRA-induced
benefit boost has been eliminated, it is likely that SNAP recipients
are again experiencing a monthly cycle in caloric intake.''
Another USDA report estimates that increasing the maximum SNAP
benefit by ten percent would reduce the number of SNAP households with
very low food security by about 22 percent.\19\
---------------------------------------------------------------------------
\19\ Nord, M. (2013). Effects of the Decline in the Real Value of
SNAP Benefits from 2009 to 2011, ERR-151. Washington, D.C.: U.S.
Department of Agriculture, Economic Research Service.
---------------------------------------------------------------------------
* * * * *
Given this extensive body of research, as the Committee considers
``Developing and Using Evidence-Based Solutions'' in SNAP, I would
close with the following points and recommendations:
The statutory language and the history of SNAP define the purposes
that frame the solutions we should seek. The SNAP program is explicitly
designed:
(1) to address hunger and malnutrition among low-income households
suffering from limited purchasing power;
(2) to assist those households in obtaining a more nutritious diet;
(3) to bolster normal channels of trade--i.e., to assure that low-
income people can use regular grocery stores rather than
have to rely on a system like pantries; and
(4) to strengthen the agricultural economy.
The program has succeeded remarkably well in achieving these goals,
even across several decades of demographic, economic, fiscal and
political change. If anything, the program is more essential and
effective than it was 20 or 30 or 40 years ago.
For that reason, I recommend that the first priority be to look at
the existing body of evidence as to how SNAP is fulfilling these core
statutory purposes and see how to build on that evidence base and
implement key findings. In particular, there needs to be more in-depth
research on the impact of the ARRA boost to monthly SNAP allotments on
food purchasing power, food insecurity, adult and child health, and
other outcomes. Does the research demonstrate that this is a solution
to food insecurity and to bad health and other outcomes that food
insecurity causes so as to justify raising benefits on a long-term
basis?
I would also recommend that the Committee look at new developments
in SNAP and related programs coming out of the farm bill and other
recent developments in Federal and state policy to see what evidence is
emerging from them that the Committee can build on. Here are five
examples:
Last year's farm bill created the Food Insecurity Nutrition
Incentive Grant Program (``FINI'') to provide incentives at the
point of sale for SNAP consumers' purchases of fruits and
vegetables. By enhancing purchasing power in a targeted way,
this farm bill-created set of pilots could provide important
evidence of strategies to strengthen SNAP to further reduce
food insecurity and improve nutrition.
The farm bill also created a substantial demonstration
project that will fund ten states' innovative employment and
training strategies (SNAP E&T), plus an independent evaluation
of their results. USDA announced the ten pilots in March. There
will be much to learn from these pilots about the ways in which
SNAP E&T can better lead to good jobs that build food security
and economic stability and security.
There is much evidence that the absence of affordable child
care is a barrier to stable employment and to families getting
and keeping jobs with family-supporting wages. The
reauthorization and strengthening last year of the Child Care
and Development Block Grant (CCDBG) has the potential to
ameliorate some of this problem, especially if CCDBG is
adequately funded. It will be important to see whether child
care support can be better integrated with SNAP, and with SNAP
E&T, reach more adequate numbers of low-income families needing
help, and help lead to higher rates of food security.
We know that the SNAP participation rates of seniors have
been considerably lower than the rates for other groups. There
are many reasons for this--e.g., seniors are less willing to
grapple with the unnecessary red tape and wait times that
prevail in many states. The President has proposed an
initiative to help states streamline application processes for
the elderly. It would be important to fund that and determine
the extent to which it could raise senior SNAP participation
rates and lower senior food insecurity, and thereby lower the
resulting health costs for Medicare, Medicaid and other
systems.
As more states adopt higher state minimum wages, but the
Federal minimum wage and other states lag behind, there is an
opportunity for researchers to look at whether there is
evidence--and the robustness of the evidence--that higher
minimum wages are a significant solution to food insecurity and
also bring down SNAP participation rates. We need clearer
understanding of how families' work, bolstered by higher
minimum wages, other wage supports like health coverage, and
other supports, produces greater self-sufficiency.
Conclusion
In taking a close look at SNAP, I hope this Committee and
Subcommittee will first apply the principle of doing no harm. This is
particularly crucial because the program is so successful and so
important to so many people in every community in America. There are
ways to make SNAP an even better support for food security, poverty
reduction, nutrition, health, learning and work, and those strategies
grow out of the rich research basis on how effective SNAP already is. I
appreciate the opportunity to be here today and discuss some of them.
The Chairwoman. Thank you, Mr. Weill. Dr. Sullivan, please
proceed.
STATEMENT OF JAMES X. SULLIVAN, Ph.D., REV. THOMAS J. MCDONAGH,
C.S.C., ASSOCIATE PROFESSOR OF ECONOMICS; DIRECTOR, WILSON
SHEEHAN LAB FOR ECONOMIC
OPPORTUNITIES, UNIVERSITY OF NOTRE DAME, SOUTH BEND, IN
Dr. Sullivan. Chairwoman Walorski, Ranking Member McGovern,
and other Members of the Subcommittee, thank you for inviting
me to participate in today's hearing. I am talking to you today
because the impact of social programs has been the focus of
much of my academic research, and recently I co-founded the
Wilson Sheehan Lab for Economic Opportunities, a research
center at the University of Notre Dame that implements impact
evaluations to identify innovative, effective, and scalable
programs that help the disadvantaged move to self-sufficiency.
We work with some of the largest private providers of services
to the poor in the country, such as the Catholic Charities
Network, as well as state and local agencies. While these front
line providers are driven by compassion and motivation for
helping the poor, most of them design and launch programs
without solid evidence of effectiveness. The same could be said
of many national programs, most of which are not evaluated, or
are evaluated with unreliable methods.
One of the greatest advances in the social sciences in
recent decades is the development and application of methods
that allow us to determine whether social programs are having
their intended effect. The gold standard of these approaches is
the randomized controlled trial. Nowadays gathering evidence is
commonplace in many sectors. The medical profession runs tens
of thousands of experiments each year to test the effectiveness
of new interventions. These experiments have led to vast
improvements in health care all across the globe. Shouldn't the
same commitment to proven effectiveness apply to our social
programs? Using evidence to steer resources towards the most
effective programs would allow us to do more good with the
limited resources available.
Despite its size and importance, there is little hard
evidence of the impact of SNAP. There is some promising quasi-
experimental evidence showing that in utero exposure to the
food stamp program is associated with increased birth weight
and lower rates of obesity and heart disease in adulthood. But
this evidence is for those exposed to food stamps in the late
1960s and early 1970s. There is a clear need for rigorous
experimental evidence of the impact of SNAP in its current
form.
Evaluating SNAP can be challenging, given its structure. It
is much easier to conduct experiments when a program is rolled
out, expanded, or changed in significant ways, or when the
program is not made available to all those who might be
eligible. SNAP is an entitlement program that has been around
for more than 5 decades, and there has been relatively little
experimentation with program rules. I applaud this
Subcommittee's efforts to generate more evidence to guide the
future of nutrition policy. There are a number of strategies
that can help develop a strong base of evidence and improve
policy. Let me highlight just a few.
First, policymakers should incentivize innovation. Programs
can't be built on evidence of effectiveness if there is no
evidence. The most innovative ideas for social programs
frequently come from states and local providers, but they need
funds to experiment with new ideas. The most recent farm bill
made important strides towards encouraging innovation by
authorizing $200 million to support pilot projects designed and
implemented by state agencies to reduce SNAP dependency and
encourage work. These grants create a pipeline of innovative
programs that, if proven effective, can be scaled up to ensure
broad impact.
Second, the program needs to be rigorously evaluated,
otherwise there is no way to know whether the program is being
implemented correctly, and having its intended effect. If a
funding agency does require an evaluation, it often does not
require the evaluation to employ the best experimental or
quasi-experimental methods possible, which limits the extent to
which this evidence can shape future policy.
Third, researchers need greater access to administrative
data. Collecting survey data for an evaluation can be an
expensive proposition. In many instances, administrative
records already collect information on key outcomes, such as
employment, earnings, program participation, and many others.
But these data are often not available for evaluation purposes.
Some cities and states have established administrative data
repositories that can be used for evaluation, but there needs
to be a national effort. The Ryan-Murray Act represents an
excellent step towards greater access to data. This legislation
would create a commission to study how administrative data
might be compiled in order to facilitate research and
evaluation. This would make possible countless studies of
government programs, resulting in the design of more effective
policies.
Advances in technology and data collection have greatly
expanded opportunities to implement high quality evaluation of
social programs. By encouraging innovation and evaluation, and
by targeting support at interventions shown to be successful,
policymakers will ensure that our social programs are more
effective at helping vulnerable populations get ahead. We at
the Wilson Sheehan Lab welcome this transformation in the way
we fight poverty in America. Thank you.
[The prepared statement of Dr. Sullivan follows:]
Prepared Statement of James X. Sullivan, Ph.D., Rev. Thomas J.
McDonagh, C.S.C., Associate Professor of Economics; Director, Wilson
Sheehan Lab for Economic Opportunities, University of Notre Dame, South
Bend, IN
I. Introduction
Chairwoman Walorski, Ranking Member McGovern, and other Members of
the Subcommittee, thank you for inviting me to participate in today's
hearing, ``Past, Present, and Future of SNAP: Developing and Using
Evidence-Based Solutions.'' I am talking to you today because examining
evidence on the impact of programs designed to help the marginalized
and disadvantaged has been the focus of much of my academic research
over the past 15 years.
Recently I co-founded the Wilson Sheehan Lab for Economic
Opportunities (LEO), which is a research center at the University of
Notre Dame that identifies innovative, effective and scalable programs
that help those in need move to self-sufficiency. The Wilson Sheehan
Lab has partnered with some of the largest private providers of
services to the poor in the country, including the Catholic Charities
network, as well as state and local governmental agencies, to examine
evidence of program effectiveness. These projects include programs to
promote community college completion, comprehensive case-management
programs, homeless prevention services, and diversion programs for
first-time, non-violent offenders. This evidence allows resources to be
channeled to the programs that will have the greatest impact on the
lives of the most vulnerable.
As I have learned through my work at the Wilson Sheehan Lab, the
idea of impact evaluation is a foreign concept to many local service
providers. While these front-line providers are driven by compassion
and motivation for helping the poor, most of them design and launch
programs without solid evidence of effectiveness. They typically
measure outputs or track outcomes for program participants, but rarely
are the programs evaluated using rigorous methods. The lack of evidence
of what works and what doesn't is not unique to local programs. The
same could be said of many national programs that operate on a much
larger scale.
II. The Need for Greater Evidence on the Impact of Social Programs
The New Era of Experiments
One of the greatest advances in the social sciences in recent
decades is the development and application of methods that allow us to
determine whether social programs are having their intended effect. The
general idea behind these methods is simple: one can determine the
impact of a program by comparing outcomes for a group of people who are
exposed to an intervention (the treatment group) to those for a group
who are not (the control group). The control group is supposed to
reflect the counterfactual--what the outcomes for the treatment group
would be if they had not been exposed to the intervention. The gold
standard approach is the randomized controlled trial (RCT), in which
individuals are assigned to either the treatment or control group
randomly. In cases where an RCT is not feasible, quasi-experimental
approaches are available that are intended to mimic the research design
of an RCT. For example, one might compare those eligible for a program
to those just barely ineligible; or compare program participants to
those on a waiting list. These alternative approaches typically do a
much better job of determining the impact of interventions than
nonscientific approaches such as tracking outcomes for program
participants. However, if the control group does not appropriately
reflect the counterfactual, the quasi-experimental results are not
reliable.
Nowadays, gathering experimental evidence is commonplace in many
sectors. The medical profession runs tens of thousands of experiments
each year to test the effectiveness of new pharmaceuticals, medical
procedures, devices, or treatment regimens.\1\ These experiments have
led to vast improvements in healthcare all across the globe. Large
companies are constantly running experiments in an attempt to better
target resources, attract new customers, or avoid spending money on
projects that don't work. Google runs 20,000 experiments each year
while Capital One runs three times that many.\2\ Shouldn't the same
commitment to proven effectiveness apply to our social programs?
---------------------------------------------------------------------------
\1\ Manzi, J. (2012). Uncontrolled: The Surprising Payoff of Trial-
and-Error for Business, Politics, and Society. New York: Basic Books.
\2\ Prigg, M. (2012, February 6). ``The human search engine.''
London Evening Standard. Retrieved fromhttp://www.standard.co.uk/news/
techandgadgets/the-human-search-engine-7315344.html; Brooks, D. (2012,
April 26). ``Is Our Adults Learning?'' The New York Times. Retrieved
from http://www.nytimes.com/2012/04/27/opinion/brooks-is-our-adults-
learning.html?_r=0.
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The Impact of Evidence
By steering resources towards the most effective social programs,
evidence of what works and what doesn't can significantly improve the
lives of the poor. All too often innovative, promising interventions
are not brought to scale because program operators are unable to
demonstrate effectiveness. Greater evidence of impact for these
successful programs would attract the resources necessary to serve more
disadvantaged individuals and families. For example, several RCTs have
shown that the Nurse-Family Partnership, a home visitation program for
new, mostly low-income mothers, has improved outcomes for both mothers
and children.\3\ This evidence has helped spur a national home visiting
initiative.\4\
---------------------------------------------------------------------------
\3\ http://toptierevidence.org/programs-reviewed/interventions-for-
children-age-0-6/nurse-family-partnership.
\4\ See Chapter 2 of Haskins, R., & Margolis, G. (2014). Show Me
the Evidence: Obama's Fight for Rigor and Results in Social Policy.
Brookings Institute Press.
---------------------------------------------------------------------------
On the other hand, ineffective programs often persist because there
is no evidence to show they don't work. These programs squander
precious resources that could have greater impact elsewhere. Or worse,
they may cause harm to those they intend to help. One notable example
is Scared Straight--a program that aimed to deter juvenile delinquency
by exposing at-risk youth to prison life and adult inmates. The program
gained national attention when it was featured in the 1978 Academy
Award winning documentary, Scared Straight! Based on anecdotal evidence
of success from several studies that did not meet minimal scientific
standards, many states and other countries adopted the program. When
the program was eventually evaluated using experimental methods,
several studies showed that the program actually ``led to higher rates
of offending behavior.'' \5\ A 2004 Washington State Institute for
Public Policy cost-benefit report concluded that $1 spent on a Scared
Straight program resulted in an additional $264 in costs in today's
dollars.
---------------------------------------------------------------------------
\5\ Petrosino, Andrew, Carolyn Turpin-Petrosino, Meghan E. Hollis-
Peel, and Julia G. Lavenberg (2013). `` `Scared Straight' and other
juvenile awareness programs for preventing juvenile delinquency.'' The
Cochrane Collaboration.
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By guiding funds away from ineffective programs, high quality
impact evaluations allow us to do more good with the limited resources
available. This not only produces better results for those in need, but
also for the economy as a whole.
Evaluating Social Programs
There are many examples where large-scale experiments have informed
social policy. In the early 1990s more than 30 experiments were run at
the state level to test the impact of changes in features of welfare
programs. The results of these experiments--most noticeably the effect
of work incentives on employment--helped shape landmark national
welfare reform legislation in 1996.\6\ Other notable experiments
include the Head Start Impact Study and the U.S. Department of Housing
and Urban Development's Moving to Opportunity demonstration project.
Experiments such as these are becoming much more common.
---------------------------------------------------------------------------
\6\ Grogger, J., & Karoly, L.A. (2005). Welfare Reform: Effects of
a Decade of Change. Cambridge: Harvard University Press.
---------------------------------------------------------------------------
However, when Google alone runs thousands more experiments than the
government agencies that oversee social programs, it is clear we have
not come far enough. And the fact of the matter is that funding
decisions are typically made without information on program
effectiveness. Only about one percent of non-defense discretionary
dollars are backed by any hard evidence.\7\ Most domestic social
programs are not evaluated, or are evaluated with unreliable methods.
For example, in 2009 Federal agencies spent about $18 billion on 47
employment and training programs, but as a recent GAO report concluded:
``little is known about the effectiveness of most programs.'' \8\
---------------------------------------------------------------------------
\7\ Nussle, Jim and Peter Orszag (2014). ``Let's Play Moneyball,''
in Moneyball for Government. J. Nussle, & P. Orszag, eds. Disruption
Books.
\8\ U.S. Government Accountability Office, ``Providing Information
on Colocating Services and Consolidating Administrative Structures
Could Promote Efficiencies,'' GAO-11-92: Published: Jan 13, 2011.
http://www.gao.gov/products/GAO-11-92. Discussed in Barnes, Melody and
John Bridgeland (2014). ``Making Moneyball Work,'' in Moneyball for
Government. J. Nussle, & P. Orszag, Eds. Disruption Books.
---------------------------------------------------------------------------
Evaluating SNAP
Although SNAP is the nation's largest cash or near cash means-
tested transfer program (with costs exceeding $70 billion annually in
recent years),\9\ there is little hard evidence on the impact of the
program. While no large-scale experiments have evaluated SNAP,\10\
there is some promising quasi-experimental evidence from recent
research showing that in utero exposure to the food stamp program is
associated with increased birthweight and lower rates of obesity and
heart disease in adulthood.\11\ But this evidence is for those exposed
to food stamps in the late 1960s and early 1970s. There is a clear need
for rigorous, experimental evidence of the impact of SNAP in its
current form. Is SNAP the best way to improve nutritional outcomes for
the disadvantaged? The honest answer is that we don't know. Bringing
evidence to bear on this question would allow us to better help those
struggling to put food on the table.
---------------------------------------------------------------------------
\9\ http://www.fns.usda.gov/pd/supplemental-nutrition-assistance-
program-snap.
\10\ See http://www.fns.usda.gov/ops/supplemental-nutrition-
assistance-program-snap-research for a list of recent SNAP research,
which includes some small-scale RCT studies.
\11\ Almond, D., H. Hoynes, and D.W. Schanzenbach. 2011. ``Inside
the war on poverty: The impact of food stamps on birth outcomes.''
Review of Economics and Statistics 93(2): 387-404. Almond, D., H.
Hoynes, and D.W. Schanzenbach. 2012. ``Childhood Exposure to the Food
Stamp Program: Long-run Health and Economic Outcomes,'' NBER Working
Paper No. 18535.
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An important challenge to evaluating SNAP is that the structure of
the program can make it difficult to implement the most rigorous
experimental or quasi-experimental methods. It is much easier to
conduct experiments when a program is rolled-out, expanded, or changed
in significant ways, or when the program is not made available to all
those who might be eligible. Food stamps is an entitlement program that
has been around for more than 5 decades, and although there have been
notable changes to the program, these reforms are modest compared to
those for other programs such as AFDC/TANF or the Earned Income Tax
Credit.\12\ Also, because states are given limited flexibility to
experiment with changes to program rules it is difficult to gather
evidence on the effectiveness of possible improvements to SNAP.
---------------------------------------------------------------------------
\12\ For further discussion see Hoynes, H.W., & Schanzenbach, D.W.
(2015). U.S. Food and Nutrition Programs. NBER working paper 21057.
---------------------------------------------------------------------------
The most recent farm bill made some important strides towards
encouraging more policy based on evidence by authorizing $200 million
to support ten pilot projects designed and implemented by state
agencies to reduce dependency and encourage work.\13\ Each of these
pilots is required to have an independent evaluation that compares
outcomes for households participating in the pilot to a ``control
group'' of households not participating in the pilot. The legislation
also requires the participating states to make administrative data
available in order to track outcomes. It is important for pilot
programs such as these to require or incentivize grantees to evaluate
their pilots using the best experimental or quasi-experimental methods
possible in order to generate the kind of evidence needed to shape
future food assistance policy.
---------------------------------------------------------------------------
\13\ http://www.fns.usda.gov/2014-snap-e-t-pilots.
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III. Promoting Evidence-Based Policy
I applaud this Subcommittee's efforts to seek ways to generate more
evidence to guide the future of nutrition policy. There are a number of
strategies to encourage the development of a stronger base of evidence
and to ensure that this evidence is used to target resources towards
programs that work and away from those that don't. Let me highlight a
few:
1. Incentivize Innovation
First, you can't expect programs to be built on evidence of
effectiveness if there is no evidence. The most innovative ideas for
social programs frequently come from states or local providers. But
state and local agencies and private service providers often lack the
resources to put these ideas into practice. Thus, we need funds to
encourage providers to experiment with new, promising ways to help
those in need, and to build strong evidence for innovative programs. A
nice example of this approach is the Department of Education's
Investing in Innovation (i3) initiative, which has distributed more
than $1 billion in grants using a tiered-evidence model to fund
programs to improve student achievement. The lowest tier, or
``Development,'' i3 grants provide support for promising initiatives
that currently lack rigorous evidence. Grants such as these create a
pipeline of innovative programs that, if proven effective, can be
scaled up to ensure broad impact.
2. Incentivize Programs To Be Based on Rigorous Evidence
Second, new funding should go predominantly to programs that can
provide solid evidence of effectiveness. In this tiered-evidence
approach, funds are allocated by merit-based competitions, as opposed
to formula grants where geography or other factors are more important
than rigorous evidence. These competitions create a market for proven
solutions. Here, again, the i3 initiative offers an excellent
framework. The evidence requirement for the top tier, or ``Scaleup,''
i3 grants includes one or more well-designed and implemented RCTs or
quasi-experimental studies.\14\ Such a tiered-evidence model could be
incorporated into future SNAP pilot programs, similar to the one
authorized in Section 4022 of the most recent farm bill.
---------------------------------------------------------------------------
\14\ For further discussion of the tiered-evidence model see
Haskins and Margolis (2015).
---------------------------------------------------------------------------
3. Require Initiatives To Be Rigorously and Continuously Evaluated
Third, even when new programs are grounded in solid evidence, it is
important to ensure that they are rigorously evaluated. Otherwise,
there is no way to know whether the program is being implemented
correctly and having its intended effect. Many government grants that
support social programs require grantees to evaluate the program being
funded. A typical evaluation might only track outcomes for program
participants. In the case of a SNAP pilot to promote work, this might
mean that the grantee provides information on earnings and employment
for program participants. While this information is valuable, it is not
sufficient for determining a program's impact, because we don't know
the counterfactual--what the outcomes for these participants would have
been had they not participated in the program. Better information about
program impacts would be available if evaluations were required to be
well-designed and well-implemented experiments or quasi-experiments.
A program should continue to be evaluated as it is scaled-up, even
when there is clear initial evidence of success from an RCT. Program
impacts can sometimes be difficult to replicate in other settings. For
example, experiments testing the impact of re-employment bonuses in
Illinois showed strong evidence of success, but subsequent studies of
similar programs in other states were less promising.\15\ Positive
results can be hard to replicate because the expanded program may not
be implemented correctly, or the success of the initial program may
hinge on a feature of the intervention that is hard to replicate, such
as an extremely talented program operator.
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\15\ Meyer, Bruce D. (1995). ``Lessons from the U.S. Unemployment
Insurance Experiments,'' Journal of Economic Literature, Vol. 33, No.
1. (Mar., 1995), pp. 91-131.
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Evidence of program impact is also helpful when the results are
less promising. Often times, modest or negative results can uncover
issues with program design or implementation. In this way, evidence
promotes an environment of learning that leads to better programs.\16\
But if evaluations of a program continue to produce disappointing
results, then the funds for this program should be reallocated towards
efforts with evidence of success. There tends to be a fair amount of
inertia in social policy--funding today goes to the same programs that
were funded in the past. Even when hard evidence shows a program is
ineffective, it is often difficult to pull the plug. Consider the case
of the Even Start Literacy Program, a national initiative established
in 1989 that was designed to improve both child and parent literacy.
Three national evaluations showed that the program had little impact--
children and parents in the treatment group ``did not gain more than
children and parents in the control group.'' \17\ Even after the
release of these findings more than $1 billion were allocated to the
program, and it was more than 10 years before the program was finally
defunded.\18\ In order to best leverage evidence to improve outcomes
for children and families, there needs to be willingness to shut down
ineffective programs.
---------------------------------------------------------------------------
\16\ Sperling, Gene (2014). ``A Continuum Approach,'' in Moneyball
for Government. J. Nussle, & P. Orszag, eds. Disruption Books.
\17\ U.S. Department of Education, Planning and Evaluation Service,
Elementary and Secondary Education Division, ``Third National Even
Start Evaluation: Program Impacts and Implications for Improvement,''
Washington, D.C., 20202. http://www2.ed.gov/rschstat/eval/disadv/
evenstartthird/toc.html.
\18\ Bridgeland, John and Peter Orszag (2013), ``Can Government
Play Moneyball?'' The Atlantic, July/August. http://
www.theatlantic.com/magazine/archive/2013/07/can-government-play-
moneyball/309389/.
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4. Provide Greater Access to Administrative Data
Fourth, one of the most significant barriers to high quality impact
evaluations is limited access to administrative data. Collecting data
on participants in an evaluation can be an expensive proposition. An
hour long survey can cost upwards of $500 per completed survey. In many
instances, administrative records already collect information on key
outcomes such as employment, earnings, program participation, college
enrollment, income, criminal history, and many others. Moving to
Opportunity and other large scale impact evaluations have relied
heavily on these kinds of administrative data. The problem is that
these data are often not available for evaluation purposes. Some cities
and states have established administrative data repositories that can
be used for evaluation, but there needs to be a national effort. One
promising example is the National Student Clearinghouse that compiles
student enrollment and degree information for more than 3,600 colleges
and universities across the country. The data from this clearinghouse
provide researchers, educators, and policymakers with the information
necessary to advance evidence-based education policies.
In conversations with Chairman Ryan's staff prior to the
introduction of the Ryan-Murray commission bill, we discussed a
document I wrote about how a clearinghouse for program and survey data
might work.\19\ This clearinghouse could provide policymakers and
researchers access to administrative data on dozens of government
programs. These data would be accessible, on a restricted basis,
through a centralized but secure information system that would allow
users to link participants across programs, to respondents in surveys,
and to other administrative data sources. These data would provide
critical information on program impacts that is currently unavailable
to policymakers and researchers. This would make possible countless
studies of government programs, and as such, would transform the way
researchers analyze and evaluate these programs, and provide
policymakers with better evidence of program impact and effectiveness,
resulting in the design of more effective government programs.
---------------------------------------------------------------------------
\19\ Sullivan, James X. (Forthcoming), ``Promoting Greater
Understanding of the Impact of Federal Programs: What a Clearinghouse
for Program and Survey Data Might Look Like,'' Wilson Sheehan Lab for
Economic Opportunities Policy Brief.
---------------------------------------------------------------------------
The Ryan-Murray Evidence-Based Policymaking Commission Act of 2015
represents an excellent step towards greater access to data to evaluate
programs. This legislation would create a commission to study how
administrative data on Federal programs and other data might be
compiled in order to facilitate research and evaluation. The commission
would also study the feasibility of a national clearinghouse for such
information.
5. Disseminate Evidence on What Works
Finally, policymakers, educators, service providers, and
researchers need a way to track down easily the existing body of
evidence on what works and what does not. A national repository of
well-designed, well-implemented impact evaluations would help promote a
broader culture of evaluation. An important challenge here is that the
body of evidence on social programs is far larger than the body of good
evidence. Stakeholders need a way to filter out unreliable studies to
ensure that policy decisions are guided by the most reliable evidence.
This means that we need clear standards for what constitutes solid
evidence. Ideally, an independent entity would assess evaluations and
identify those that are reliable.
A well-designed model of how to synthesize a large body of evidence
is the What Works Clearinghouse, which is run by the U.S. Department of
Education's research arm: the Institute of Education Sciences (IES).
For this clearinghouse, IES reviews research on education programs and
policies, and highlights those that are of the highest quality. The
U.S. Department of Labor offers a similar service for labor topics
through the Clearinghouse for Labor Evaluation and Research (CLEAR).
Outside the government, the Coalition for Evidence-Based Policy
provides a nice one stop shop for what works in social policy. It has
established the highest standards for identifying social programs that
are supported by well conducted RCTs.\20\
---------------------------------------------------------------------------
\20\ http://evidencebasedprograms.org/.
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IV. Conclusions
Advances in technology and data collection have greatly expanded
opportunities to implement high-quality evaluations of social programs.
Evidence from these evaluations can help in the design of programs that
yield better results and guide policy on how best to allocate scarce
resources. By encouraging innovation and evaluation and by targeting
support at interventions shown to be successful, policymakers will
ensure that our social programs are more effective at helping
vulnerable populations get ahead. We at the Wilson Sheehan Lab welcome
this transformation in the way we fight poverty in America.
The Chairwoman. Thank you, Dr. Sullivan. And I do want to
get to Mr. Everett. Please proceed with your testimony. After
that we are going to break to vote and come back for questions.
So, Mr. Everett?
STATEMENT OF JEREMY K. EVERETT, DIRECTOR, TEXAS HUNGER
INITIATIVE, BAYLOR UNIVERSITY, WACO, TX
Mr. Everett. Thank you, Chairwoman Walorski, Ranking Member
McGovern, and Members of the Subcommittee on Nutrition for the
opportunity to speak before you today. My name is Jeremy
Everett. I am the Director of the Texas Hunger Initiative at
Baylor University. THI is a collaborative capacity building
project that develops and implements strategies to end hunger
through research, policy, and community engagement.
Headquartered at Baylor University, with 12 regional offices
across the state, THI convenes Federal, state, and local
government stakeholders with nonprofits, faith communities, and
business leaders to create an efficient system of
accountability that increases food security, and is an
evidence-based collaborative model, a model we call informed
engagement.
Informed engagement is a cyclical process of research
informing on the ground strategy, and subsequently on the
ground strategy informing research. This process leads to
evidence-based solutions that have the potential to make
Federal nutrition programs more efficient for the state, and
more impactful for low-income Americans. Our work within local
communities across the state is guided by three core
assumptions. First, hunger and poverty are too complex for
sectors to address independently of one another. Second, public
and private partnerships are an effective means for
coordinating access to SNAP and other Federal nutrition
programs within a larger continuum of care. And third, research
and evaluation provide a foundation for practical evidence-
based solutions.
Assumption one, hunger and poverty are too complex for
sectors to address independently of one another. When the Texas
Hunger Initiative began in 2009, we identified thousands of
organizations working tirelessly to address food security in
Texas, however, there were still more than five million Texans
living in food insecure households. A big reason for this is
they were not coordinating with each other. We realized that
our first priority needed to be building public and private
partnerships.
Assumption two is that public and private partnerships are
an effective means for coordinating access to SNAP and other
Federal nutrition programs within a larger continuum of care.
In congruence with Baylor's aspiration of informed engagement,
THI, and its partners across the State of Texas, are fostering
public and private partnerships to maximize the efficiency of
nutrition programs and develop local solutions to address
hunger. Public and private partnerships are collaborations
among state agencies and local organizations that bridge local,
state, and Federal resources to maximize the efficiency of
programs, while increasing community ownership.
Our third assumption, research and evaluation provide a
foundation for practical evidence-based solutions. As a part of
the informed engagement process, our work building public and
private partnerships are continuously evaluated. Being at a
university, we are in a unique position to engage in research
and evaluation that is both collaborative and actionable. Every
project we engage in is informed by existing research on food
security, and evaluated by a research team.
Because community-based initiatives are innovative, and
often in a continuous state of development. We utilize the
aspects of developmental evaluation. Our goal is to make sure
that our programmatic decisions are informed by research and
evaluation, and that research and evaluation are informed by
what we are doing programmatically. When public and private
partnerships are carefully informed by research and evaluation,
stronger networks are likely formed between clients and local
organizations, thus building a foundation for increased social
capital for low-income families.
Social capital, a measure of trust, and reciprocity in
social networks, is positively associated with household food
security independent of household level socioeconomic factors.
Thus social capital is a compliment to anti-hunger and anti-
poverty programs because it strengthens the assets and
resources that exist within disadvantaged communities. Stronger
networks, social capital, and Federal nutrition programs are
all important components for building food security.
Our efforts at the Texas Hunger Initiative demonstrate
informed engagement, and are building a foundation for
evidence-based solutions. We believe that allocating resources
to the Hunger Free Communities line in the farm bill will
expand the capacity of informed engagement in public and
private partnerships, resulting in greater local coordination,
strengthened social networks for low-income Americans. And when
public and private partnerships are carefully informed by
research and evaluation, stronger networks are likely formed
between clients and local organizations, thus building a
foundation for increased social capital for low-income
families.
We believe that this has the potential to reduce the need
for long-term Federal assistance. When we invest in these
efforts and build them up on scalable, evidence-based
solutions, we exhibit both the willpower and the know-how to
build public and private infrastructure to strengthen families
and build communities. Thank you.
[The prepared statement of Mr. Everett follows:]
Prepared Statement of Jeremy K. Everett, Director, Texas Hunger
Initiative, Baylor University, Waco, TX
Thank you, Chairwoman Walorski, Ranking Member McGovern, and
Members of the Subcommittee on Nutrition for the opportunity to speak
before you today. My name is Jeremy Everett. I am the Director of the
Texas Hunger Initiative (THI) at Baylor University. THI is a
collaborative, capacity-building project that develops and implements
strategies to end hunger through research, policy, and community
engagement. Headquartered at Baylor University with 12 regional offices
across the state, THI convenes Federal, state and local government
stakeholders with nonprofits, faith communities and business leaders to
create an efficient system of accountability that increases food
security in Texas. This evidence-based, collaborative model is called
informed engagement.
Informed engagement is one of Baylor University's aspirational
statements that comprise a new 10 year vision called Pro Futuris. Under
the banner of informed engagement, the university aims to address
problems facing the local and global community by leading initiatives
to form stronger community partnerships and ``support research that
provides a foundation for effective solutions'' (Baylor University,
2015). Informed engagement is a cyclical process of research informing
on-the-ground strategy and, subsequently, on-the-ground strategy
informing research. This process leads to evidence-based solutions that
have the potential to make Federal nutrition programs more efficient
for the state and more impactful for low-income Americans.
Our work within local communities across the state is guided by the
following core assumptions: first, hunger and poverty are too complex
for sectors to address independently of one another; second, public and
private partnerships are an effective means for coordinating access to
SNAP and other Federal nutrition programs within a larger continuum of
care; third, research and evaluation provide a foundation for practical
evidence-based solutions.
Assumption One: hunger and poverty are too complex for sectors to
address independently of one another.
It is estimated that 27 percent of children live in food-insecure
households in Texas, which is higher than the national average (21%)
(Feeding America, 2014). This means they had difficulty meeting basic
food needs at least some time during the year (Coleman-Jensen, Gregory,
& Singh, 2014). When the Texas Hunger Initiative began in 2009, we
identified thousands of organizations tirelessly working to address
food security in Texas; however, there were still over five million
Texans living in food-insecure households. A big reason for this was
that many agencies, churches, and food pantries were trying to address
the problem on their own. They weren't coordinating with each other. We
realized that our first priority needed to be building public and
private partnerships.
Assumption Two: public and private partnerships are an effective
means for coordinating access to SNAP and other Federal nutrition
programs within a larger continuum of care.
In congruence with Baylor's aspiration of informed engagement, THI
and its partners across the State of Texas are fostering public and
private partnerships to maximize the efficiency of nutrition programs
and to develop local solutions to address hunger. Public-private
partnerships:
are collaborations among state agencies and local
organizations;
bridge local, state, and Federal resources to maximize the
efficiency of these programs;
can be arranged at both the state and local levels, and can
operate as formal or informal collaborations; and
decrease access barriers, build local and state networks,
and increase community ownership.
More specifically, our public-private partnerships increase access
to Federal programs including SNAP and child nutrition programs, such
as the Summer Meals and after school Meals programs. My colleague
Dustin Kunz testified before the full Committee on April 15 about our
partnership with the Texas Health and Human Services Commission (HHSC)
and a network of over 1,200 community-based organizations to increase
statewide access to benefits such as SNAP. This partnership decreases
the need for government offices across the state while ensuring that
eligible individuals and families have access to a continuum of care
where SNAP is one, crucial part of the solution.
Assumption Three: research and evaluation provide a foundation for
practical evidence-based solutions.
As part of the informed engagement process, our work building
public-private partnerships is continuously evaluated. Being at a
university, we are in a unique position to engage in research and
evaluation that is both collaborative and actionable. Every project we
engage in is informed by existing research on food security and
evaluated by our research team. Because community-based initiatives
``are innovative and are often in a state of continuous development,''
we utilize aspects of developmental evaluation (Gamble, 2008, p. 12).
Our evaluation ``focuses on the relationships between people and
organizations over time, and the problems or solutions that arise from
those relationships'' (Kania & Kramer, 2013). Our goal is to make sure
our programmatic decisions are informed by research and evaluation and
our research and evaluation is informed by what we're doing
programmatically.
For example, we've conducted focus groups to understand the
experience of families as they access assistance, and we used the
information gathered to inform how we support local organizations.
We've surveyed local organizations to understand their capacity to
serve as access points for nutrition programs and used the results to
try to determine what types of organizations might best fill this role.
We've also developed maps that show high-poverty Census tracts that do
not have sufficient access points for nutrition programs to make sure
that we are investing in communities with the highest need. And we've
written case studies that document the process of building coalitions
and use the experiences we've gathered to inform how we build
coalitions and public and private partnerships moving forward.
By investing in the capacity of local organizations, they are
better equipped to build social capital and networks for low-income
families. When public and private partnerships are carefully informed
by research and evaluation, stronger networks are likely formed between
clients and local organizations, thus building a foundation for
increased social capital for low-income families. A study demonstrates
that ``social capital--a measure of trust, reciprocity and social
networks--is positively associated with household food security,
independent of household-level socioeconomic factors'' (Martin, et al.,
p. 2645). The authors posit that social capital is a complement to
anti-hunger and anti-poverty programs because it ``strengthens the
assets and resources that exist within disadvantaged communities.''
Stronger networks, social capital, and Federal nutrition programs are
important components for building food security.
Our efforts at the Texas Hunger Initiative demonstrate informed
engagement and are building a foundation for evidence-based solutions.
We believe allocating resources to the Hunger Free Communities line
item in the farm bill will expand the capacity of informed engagement
and public and private partnerships, resulting in greater local
coordination and strengthened social networks for low-income Americans.
When public and private partnerships are carefully informed by research
and evaluation, stronger networks are likely formed between clients and
local organizations, thus building a foundation for increased social
capital for low-income families. And we believe this has the potential
to reduce the need for long-term Federal assistance. When we invest in
these efforts and build them upon scalable, evidence-based solutions,
we exhibit both the will-power and the know-how to build public and
private infrastructure to strengthen families and communities.
References
Baylor University (2015). Pro Futuris: A strategic vision for
Baylor University. Aspirational statement three: Informed engagement.
http://www.baylor.edu/profuturis/index.php?id=91150
Kania, J. & Kramer, M. (2013). Embracing emergence: How collective
impact addresses complexity. http://www.ssireview.org/blog/entry/
embracing_emergence_how_collective_impact_addresses_complexity
Martin, K.S., Rogers, B.L., Cook, J.T., & Joseph, H.M. (2004).
``Social capital is associated with decreased risk of hunger.'' Social
Science & Medicine 58, 2645-2654.
About the Texas Hunger Initiative at Baylor University
Who We Are
The Texas Hunger Initiative (THI) is a collaborative, capacity-
building project focused on ensuring that develops and implements
strategies to end hunger through research, policy, and community
engagement. Headquartered at Baylor University with 12 regional offices
across the state, THI convenes Federal, state and local government
stakeholders with nonprofits, faith communities and business leaders to
create an efficient system of accountability that increases food
security in Texas.
What We Do
Developing Public-Private Partnerships
In the context of THI's work, public-private partnerships (PPPs)
are collaborations between state agencies and community-based
organizations that maximize nutrition program access by increasing
scalability and local community empowerment. PPPs bridge local, state,
and Federal resources to maximize the efficiency and reach of these
programs. PPPs can be arranged at both the state and local levels, and
can operate as formal or informal collaborations.
Increasing Access to Nutrition Programs
THI increases access to nutrition programs by partnering with
schools and their districts, nonprofits, and congregations to maximize
efficiency and reach of service delivery.
Child Hunger Outreach
Summer Meals
Since summer 2009
200+ more Summer Meals sponsors were added
1,300+ more Summer Meal sites were added
48,000+ more kids per day receive Summer Meals
5 million more Summer Meals served \4\
School Breakfast
Since 2009-2009 school year
65 million more school breakfasts served
337,000 more kids per day eat school breakfast \5\
Food Planning Associations
Food Planning Associations (FPAs) are collaborations of
organizations and individuals who are committed to making their
communities food secure through strategic planning and program
coordination. FPAs are comprised of individuals representing a variety
of sectors including nonprofit, business, health, schools, government,
and more.
THI supports 12 FPAs across the state.
Community Partner Program
THI and its subcontractors are partnering with Texas Health and
Human Services Commission to recruit a network of community-based
organizations to assist eligible Texans in utilizing public benefits
through an online application system.
Total Community Partners: 1,200+
Community Partners represent the following sectors:
Health & Disability: 395
Early Childhood Intervention & after school
Enrichment: 264
Protective & Rehabilitative: 61
Employment & Skill Training: 51
Education: 40
Family Services: 17
Community Development: 12
Government: 9
Community Center: 7
Other: 281 \6\
1. S.A. Andersen, ed. (1990). ``Core Indicators of Nutritional State
for Difficult to Sample Populations.'' The Journal of
Nutrition 120, 1557S-1600S.
2. Coleman-Jensen, A., C. Gregory, and A. Singh. Household Food
Security in the United States in 2013, ERR-173, U.S.
Department of Agriculture, Economic Research Service,
September 2014.
3. Gundersen, C., et al. Map the Meal Gap 2014: Highlights of
Findings for Overall and Child Food Insecurity. Feeding
America, 2014.
4. Texas Hunger Initiative analysis of Texas Department of
Agriculture 2008-2009, 2009-2010, 2010-2011, 2011-2012,
2012-2013, 2013-2014 SSO & SFSP Program Data
5. Texas Hunger Initiative analysis of Texas Department of
Agriculture 2008-2009, 2009-2010, 2010-2011, 2011-2012,
2012-2013, 2013-2014 NSLP & SBP Program Data
6. Texas Hunger Initiative analysis of SalesForce data.
The Chairwoman. Thank you, Mr. Everett. I would like to
advise Members that a series of votes has been called. I
anticipate this series of votes to last approximately 20
minutes. I would ask that the Members return to the hearing as
quickly as possible from voting. This hearing will stand in
recess, subject to the call of the chair.
[Recess.]
The Chairwoman. The Committee will come back to order, and
we are actually moving into the question portion, so I would
like to direct my first question to Dr. Sullivan.
In reviewing existing SNAP research funded by the
Department of Agriculture, is it sufficient enough to improve
the program and identify evidence-based solutions in the world
today that we live in?
Dr. Sullivan. Thank you for the question. I mentioned in my
written testimony a number of challenges in evaluating the SNAP
program broadly. These challenges arise because the program is
an entitlement that is available universally, and so we lack a
group to which we can compare the effects of the program. One
might want to compare the effects of the food stamp program for
participants to those that look like the participants, but
don't participate. But eligible households, because it is an
entitlement, are eligible to receive the benefits. So what this
means is that we are limited in the kinds of rigorous studies
that we can do of the food stamp program. One of the easy ways
to address that would be to run pilot projects that we can
evaluate in an experimental way, and that is the kind of things
that have been done, and encouraged, and funded by the most
recent farm bill.
So pilot projects are a nice way to test additional
features. Unfortunately, they are limited in terms of the
ability to test the overall program. If I wanted to test the
overall program, I would rewind the clock to 1964, when we were
first rolling this out, and roll it out gradually, and
construct a rigorous research design around that rollout. But,
unfortunately, I can't roll back the clock, so we can't do
that.
The Chairwoman. And this Committee has been consistent from
the start that we believe in SNAP.
Dr. Sullivan. Yes.
The Chairwoman. We are not looking at tearing apart a
program. We are looking at the areas where we make this work
better, and some of the things that all of you have talked
about today. Do you believe there is space within the program
to do an evaluation?
Dr. Sullivan. The current program? I mean, absolutely, and
I think that the idea of pilots is a great place to start,
right, because you can allow the innovators, those at the local
level, to experiment with new ideas, and test them rigorously
to find out what works and what doesn't amongst these new
ideas. And then once you start with a pilot, and you build a
body of evidence on what works, you can scale those effective
programs up, and you can run a larger demonstration project.
And then you evaluate it again.
And once you build the evidence on the effectiveness of a
demonstration project, now let us scale it up to a larger
level. Maybe it becomes state waivers. Or, another way to test
this on a broad scale, there will be much broader support for
those kinds of initiatives if they are built off of evidence at
the local level that these kinds of changes really work.
The Chairwoman. I appreciate it. Mr. Everett, your work
extends well beyond SNAP to actually address hunger in Texas.
Can you talk a little bit about what it is you are researching
and evaluating?
Mr. Everett. We have an interdisciplinary research agenda.
So one of the things we research is what we call the Community
Partner Program, looking at how we can incorporate private
organizations, nonprofits and congregations, into becoming
access points for the SNAP program, or Medicaid, Medicare,
CHIP, and so forth. On the local level we have been able to do
this by reducing the number of Health and Human Service offices
we have around the state, which has saved us a lot of money as
a state in bureaucratic spending.
We are looking at that. We test that to find out what makes
a good community partner organization, what makes a good access
point, and what organizations build strong social networks for
low-income families so that we can hopefully get them into
gainful employment. We look at the Summer Meals program, how we
can help organizations, sponsoring organizations, around the
country be able to operate that program in the black.
A lot of organizations lose money. If they are losing money
when running that program, then oftentimes that requires
additional investment, maybe from other organizations, like
foundations, or it could cause them to get out of the program
altogether. And so we run programs there. We have tested
nutrition levels of the Breakfast in the Classroom Program, and
its potential impacts on academic performance. You name it. It
is a pretty wide range of evaluation projects.
The Chairwoman. I appreciate it, thank you. And I would now
recognize Ranking Member McGovern, for 5 minutes.
Mr. McGovern. Thank you very much, Chairwoman. First of
all, thank you all for being here. This is very interesting.
Mr. Everett talked about better coordination. I agree. I wish,
within the Federal Government, all the relevant agencies that
deal with issues of hunger and poverty were better coordinated,
would meet on a regular basis, and talk about how they can work
better together.
That is one of the reasons why I have been urging the White
House to do a White House conference on food, nutrition, and
hunger to try to bring everybody who has a role in this
together, and lock them in a room, and say, ``Okay, what is the
plan here?'' And I am all for evidence-based evaluation, but we
are talking about a program, in SNAP, that has one of the
lowest error rates of any Federal program. This is not a
program that is fraught with waste and abuse. It is a program
that is actually run pretty well.
And the majority of people on the program are kids, senior
citizens, and members of the disabled community. And the
majority work, and some people work full time, and yet still
earn so little that they are on the benefit. So those people
don't need another evidence-based study to try to incentivize
them to work. Those people are working. I think what they
probably want is a study as to that would show what an increase
in the minimum wage to a livable wage would mean for them, so
that their work actually pays something, so that they don't
have to rely on public assistance. Let us define the context
here.
I see the reality when I am back home, and in various
places around the country. The fact is that the benefit, as Mr.
Weill pointed out, is inadequate. Most SNAP families end up at
food pantries and food banks before the month is out. And it is
not that they don't know how to budget their money properly. It
is not a very generous benefit, contrary to what you might hear
on some talk radio shows. I have two sisters who are school
teachers in Massachusetts. A lot of the kids that come to class
on Monday, it is clear that they haven't eaten most of the
weekend. They can't concentrate.
Dr. Sullivan, you referred to the thousands of studies of
medical treatments, including drugs. I think of SNAP as
providing medicine for people, because I do think food is
medicine. But I want more research on the adequacy of the
dosage. Isn't that an important research goal within the
framework that you are describing? Isn't that indeed the most
urgent research question?
Dr. Sullivan. I would agree that it would be wonderful to
study what the impact of food stamp generosity is on the well-
being of recipients. And Mr. Weill mentioned a natural
experiment was, when we expanded the generosity in 2009
temporarily. And the challenge is what kind of evidence can we
collect when we do those kinds of things? We expanded food
stamp generosity at the same time that a lot of other things
were going on in the macroeconomy that made it difficult for
low-income families. As a result, it is really challenging to
determine exactly what the impact of that expansion was.
Mr. McGovern. Well, I can tell you when we took back that
food stamp generosity, when the Recovery Act monies ran out,
all of us heard from constituents who complained that food
prices didn't go down, that they could afford less, and that
they were ending up relying more and more on food banks. I am
interested in making sure, especially amongst our kids, that
they have adequate food, but also they have access to
nutritious food.
Dr. Sullivan. Yes. I agree with you, but let me be clear on
what I am pushing here, is that I would like to have the solid
scientific evidence that shows that food stamps is improving
nutritional outcomes so that we can put an end to this debated
question that some people saying that it is effective, some
people are saying that it is not. If we can generate the kind
of evidence that will convince policymakers and other
stakeholders that it is clearly effective, then it is much
easier to design policies and expand them.
Mr. McGovern. Now, I don't disagree with the what you are
saying here. But the problem is there are a lot of Members of
Congress who are instinctively against SNAP because they think
it creates dependency, when the evidence is the opposite. But,
an important question here is whether or not the benefit that
we currently have is adequate to meet the nutritional needs of
families, and especially our kids, and I don't think it is. And
I see that evidence when I go to schools, and I see kids that
show up on a Monday morning unable to concentrate because they
are hungry.
Dr. Sullivan. Yes.
Mr. McGovern. I think that is an area we should be focusing
attention on. I thank the Chairwoman.
The Chairwoman. I now recognize Mr. Abraham, for 5 minutes.
Mr. Abraham. Thank you, Madam Chair. What we have been
talking about today is more than just counting the number of
people receiving the benefits, which would seem like it could
be very expensive. Dr. Sullivan, you mentioned in your
testimony that better administrative data might be a solution.
Can you expand on that a little bit?
Dr. Sullivan. Sure. So there are lots of administrative
data that give us information on SNAP, and many other programs,
that allow us to track participation in the program, and other
things like earnings, employment, et cetera. And what I was
commentating on, in terms of administrative data, is that this
provides an incredible opportunity to determine the impact of
these programs.
So, for example, if I want to know what the effect of SNAP
is on employment, I could write a survey and track down SNAP
participants and non-participants, but that would be really
expensive, and hard to do, but administrative data from UI
earnings records already has those outcomes for us. And if I
were able to have access to those kinds of data, it would make
it much easier for us to conduct these kinds of experiments.
When I referred to the Ryan-Murray Act, that is an effort to
create a commission to really explore broader ways to create
greater access to this. And the end result of that is that we
have better information, and from better information we end up
having better policy.
Mr. Abraham. Mr. Everett, what role does administrative
data play in your field?
Mr. Everett. It plays an important role, because we are
constantly evaluating data that the state collects, or that the
Federal Government collects. Oftentimes the data sets don't
match, and so Dr. Sullivan and I were discussing earlier that
we have dedicated research analysts who just clean data to make
sure that it is accurate, so that our projections that we are
making as a state, or as a Federal Government, as it relates to
nutrition programs, are accurate. And so it is a core
component--so more transparency would increase our ability to
serve the state and the Federal Government more fully.
Mr. Abraham. Okay. Thank you. Most SNAP research now is
paid for with discretionary funding, and our discretionary
appropriations. And as recently as 2016, the agricultural
approps bill favored reported by the approps on July 8 included
a rider to increase oversight on research, and this goes to Dr.
Sullivan and Mr. Baron. In reviewing the existing the SNAP
research funded by the Department of Agriculture, in your
opinion, is it sufficient?
Mr. Baron. There are other policy areas, as I mentioned in
my written statement and in my oral statement, like welfare,
where there have been a large body of rigorous evaluations that
have built a sizable body of strategies that have been shown
effective in a variety of goals, including increasing workforce
participation and success of program participants. In SNAP
there have not been. There have not been a body of such
studies.
There have been some, and there have been an increasing
number in recent years, including the ten state pilots that are
going forward, that have been scientifically rigorous enough to
provide a credible answer about whether the program worked or
not. And an area that Congressman McGovern touched on, one of
the positive examples of a recent rigorous randomized trial
that was done, sponsored by the Department of Agriculture, was
providing summer electronic benefits for children, they don't
get school lunches during the summer, so electronic summer
benefits was a way of expanding the food benefits they receive.
And it was tested in a rigorous evaluation to determine the
effect on child hunger, and it did find an effect. But the
number of studies like that that are done within SNAP to try to
identify what works is very small, compared to other areas.
Literally a handful of examples. I think there is a need for a
much more robust effort at innovation at the state and local
level, coupled with rigorous evaluation.
Mr. Abraham. Dr. Sullivan, real quick. I have about 30
seconds.
Dr. Sullivan. I would agree with Mr. Baron. I might start
by just saying that there is a lot of good information and
research out there on the SNAP Program. We know a lot about the
SNAP Program, like what drives changes in caseloads, and that
the macroeconomy plays a large role. We know that SNAP is
fairly well targeted, and that a lot of people who receive SNAP
are at or near the poverty line.
But when I say things like there isn't a lot of hard
evidence on the impact of SNAP, I am talking about what Mr.
Baron was referring to, that there is a lack of this kind of
experimental evidence that would provide the convincing
evidence that would shape policy.
Mr. Abraham. Thank you. Madam Chair, I yield back.
The Chairwoman. I now recognize Ms. DelBene.
Ms. Delbene. Thank you, Madam Chair, and thanks to all of
you for being here with us today. Many of you have talked about
the efforts of finding and using evidence in the SNAP Program,
and in my State of Washington, we have already developed a
number of effective strategies to help families achieve self-
sufficiency. Washington's employment and training program has
helped over 11,000 people find jobs, and in one study less than
\1/2\ of those enrolled in the program remain on government
assistance 2 years after they enrolled. So Washington's program
has been a model, and we used it as a model to help create the
ten employment and training pilots that were in the farm bill.
I was wondering, Mr. Weill, if you can explain further how
employment and training programs might be able to help us
develop further strategies to help expand opportunity, and make
sure that we reduce hunger at the same time.
Mr. Weill. Thank you, Congresswoman. Washington has one of
the strongest SNAP E&T programs in the country. It has done a
much better job than most other states. There are a number of
attributes. The most important one, in some ways, is that there
is really strong coordination with other agencies, with
community colleges, with nonprofits, and other state agencies.
And also the state has used the available Federal money. We are
talking about work demonstrations here, and we have all talked
about the ten state pilots, but the fact is that there are
large streams of Federal money that a lot of states, unlike
Washington, aren't really using. Most of the Federal E&T
discretionary money is used by five states. So we need more
states to follow the examples of states like Washington that
have done a good job.
Not all the evidence in the world has to be from randomized
control trials. As Dr. Sullivan's written testimony indicated,
there are good workarounds for a lot of these research
problems. The problem then is getting states to pick up on what
is proven research. And the evidence that the states are good
at picking up on what is proven is not itself overwhelming.
Ms. Delbene. I also wanted to follow up on something you
mentioned in your testimony. You talked about the primary goals
of SNAP being addressing hunger and malnutrition, assisting
households obtain a more nutritious diet, strengthening the
agricultural economy, and doing so through normal channels of
trade. Can you elaborate on what the research tells us about
how SNAP is meeting those goals today?
Mr. Weill. As my written evidence suggests in more detail,
we know that SNAP reduces food insecurity, both among children
and adults, and it does that by increasing their purchasing
power. So it is accomplishing that goal. As Mr. McGovern
suggests, it could do more if benefits were more adequate, but
it is certainly achieving the goal to a significant degree that
is important to the society.
Also, since all SNAP benefits run through grocery stores,
big box stores, farmers' markets, it is doing that through
normal means of commerce, and it is a boost to the agriculture
economy. So it is meeting its statutory goals, and doing so in
a very effective way.
Ms. Delbene. And what else should we be studying? Do you
have other ideas on things we aren't looking at today that we
should be looking at?
Mr. Weill. Well, there are a lot of state choices and state
activities that some states do and other states don't that get
in the way of eligibility and benefits. Just as one example,
some states use the very outdated, very low basic assets test,
which keeps, particularly, seniors, but also working families,
out of the program. But a lot of other states have chosen the
option to do away with, or substantially raise that asset test.
One important question that could be looked at is the impact of
the asset tests on keeping working families and others out of
the program, reducing participation, and hurting food security.
There are state choices on income levels, on certification
periods (how long people can be in the program before they have
to go through difficult bureaucratic means to get re-certified
for a second period). A bunch of options that vary from state
to state that are natural experiments to research what is most
effective and what isn't.
Ms. Delbene. Thank you. I will yield back.
The Chairwoman. Thank you. The chair recognizes Mr. Yoho,
for 5 minutes.
Mr. Yoho. Thank you, Madam Chairman. I appreciate you all
being here to discuss this so we can reform the nutrition
program so we get the best benefit for the end-user, and that
the American taxpayers' dollars go to wise use.
Mr. Weill, you just said that the studies determined that
SNAP has decreased food insecurity. I think I just heard you
say that?
Mr. Weill. Yes, that is correct.
Mr. Yoho. No offense, but those are kind of common sense
things, that if we put more money into the system, in people's
hands, it is going to increase their buying and purchasing
power. Have we done beyond that, to saying why are people in
that situation in the first place? And I know we are coming out
of a terrible economic time, but what is the breakdown to where
people are in that, and we have such a high number of people on
food assistance?
And, again, I have said this in this Committee before,
being a veterinarian, I have dealt with every species of
animals, whether the parent raises that child, or that
offspring, and then teaches it the way to go and weans it. We
are the only species on the planet that seems to be going
backwards. Are we looking at the underlying cause of why we are
here, and having so many people on nutrition programs?
Mr. Weill. The very, very large majority of adults on the
program are people with disabilities, are seniors, and are
working parents.
Mr. Yoho. All right. If we took that category out, and we
looked at able-bodied people, and not looked at the poor, the
elderly, the disabled, but look at that one group of
individuals, how much does that account for the spending on
nutritional programs?
Mr. Weill. I don't know off the top of my head what
percentage of the SNAP budget goes to households with working
age adults who aren't disabled, but I can tell you that
significantly more than the majority of those adults who aren't
disabled on SNAP are currently working, but they are working at
very low wages, and possibly only part time, because they would
like to work full time but can't. Or they have worked very
recently, and they are now unemployed for 2 or 4 months, and
they are receiving SNAP during relatively short periods of
unemployment.
In some ways the public view of most able-bodied adult SNAP
recipients as people who haven't worked for very long periods
of time is very inaccurate. The number of people who aren't
currently working and are on SNAP, compared to those who are
working at low wages, or who were working recently, or who will
be going back to work soon, the number of people who fall in
that category is relatively small.
Mr. Yoho. Is anybody else----
Mr. Weill. There are, but it is a large program. There are
a lot of people in that category, but it is a small proportion.
Mr. Everett. Okay. Sure. I would love to address that.
Right now we have less social mobility than we have had since
1929 as a nation, so part of the problem is definitely wages.
So in Texas right now we have the most people working in
minimum wage conditions that are utilizing the SNAP program
than any other state. So the program has become essentially a
work support program.
So the conditions in many of our communities are such where
educational outcomes--the issue that we are dealing with with
SNAP, or with hunger, is merely a part of the larger umbrella
issue of poverty. And, as you know, poverty is incredibly
complex, and people are poor for a myriad of reasons, but
access to quality health care, access to quality education,
access to housing, and so on and so forth, all have direct
impact on the outcomes, in terms of utilization of the SNAP
program.
Mr. Yoho. I am going to reclaim my time, because what you
described is a situation where it is an ongoing process, and we
are not going to work ourselves out of this until we change
something. And we have had the War on Poverty for 50 years. We
put $20 trillion into that, and we are going backwards in that
process. Somewhere the cycle has to be brought--and I am all
for helping people get into a system, get them educated, get
them to move beyond that so that we break that cycle. But what
I hear on these programs is we are just following the same
thing over and putting more money in there. We have to break
that cycle, and that is what I am looking for. The panels, as
they come in here, how do we break this cycle? How do we get
beyond this? You know, as you guys--well, I don't want to get
into that. That is where I would really like to hear from you
guys.
And let me ask you this. I mean, you are in a faith-based
organization, right?
Mr. Everett. Yes, Baylor University, yes.
Mr. Yoho. Yes. Texas Hunger Initiative----
Mr. Everett. Yes.
Mr. Yoho.--do you feel that that is an integral part of
helping people get food outside of government? If it is faith-
based versus just a government program, do you see a need for
those?
Mr. Everett. Absolutely. I think one of the things that I
mentioned in my opening remarks was the importance of public
and private partnerships. When you have organizations like
congregations and local nonprofits that have an intrinsic
interest in ensuring that people not only have access to
benefits, but also have access to gainful employment, because
that is a part of their mission and purpose, that that is----
Mr. Yoho. I am going to have to cut you off because I am
out of time. Thank you for your answer.
The Chairwoman. Yes, and to the Members, I apologize, we
have another set of votes coming. Mr. Aguilar, the chair
recognizes you for 5 minutes.
Mr. Aguilar. Thank you, Madam Chair, and I want to thank
the panel for joining us here today. This question is for Mr.
Weill. I am looking at March 2015 data for Cal-Fresh recipients
in my county of San Bernardino in California. In the first
quarter there were 397,000 people in my county on Cal-Fresh
living in 177,000 households. My question is, how would an
evidence-based solution assure me that these folks, whether
they are children, elderly, or disabled, would benefit from
evidence-based solutions to SNAP alone? And I want to be sure
that the people in my community are receiving the assistance
that they need to avoid food insecurity.
Mr. Weill. So I am not a researcher, but I would disagree a
little bit with Dr. Sullivan. I think there are workarounds for
randomized control experiments that can be done in the SNAP
Program to show how effectively or not effectively the program
is reaching people in your county. And those would include
determining the proportion of the estimated eligible people in
the county who are actually participating, as compared to
surrounding counties.
It would include looking at data--when people apply for
benefits, most people are really desperate; they have just lost
jobs, lost other sources of income--on how quickly people get
into the program, which can be done through administrative
data. I know some counties in California are very slow in
processing applications. Also, looking at the quality of the
employment and training program in the county, and other
aspects of discretionary county decisions and policies in the
county, and comparing them not just to other states, but to
surrounding counties in California. And I will be glad to
provide your staff with data sources as to how to get that in
your county.
Mr. Aguilar. Thank you, I appreciate it, sir. Mr. Baron,
earlier you cited Riverside County as an example of an
evidence-based solution from something that you mentioned, from
studies in the 1990s, and I am not sure if it is the best
example. The study cited participation rates of 57 and 60
percent, respectively, for education and training, but parents
are only a small part of the equation, as the panelists have
mentioned, and Mr. McGovern mentioned. What about kids that
received benefits, seniors, veterans under care, people with
disabilities, and those living with individuals with
disabilities? I just question the actual number of people who
benefited.
And I would also say, just for context, that region, which
is just a few miles away from my district, had an unemployment
rate of near 15 percent a few years ago. So I would question
the long-term benefits of the reforms and the programs that you
cite.
Mr. Baron. Well, it is a good question. One thing that was
unique about the Riverside study was that it was a
scientifically rigorous study, and it had a 5 year follow-up.
And there was no question that it produced a meaningful
improvement in people's life outcomes, an improvement of about
40 percent in their employment and earnings. And because they
were employed and earning, it produced sizable savings to the
government of several thousand dollars per person in food
stamps and welfare.
It was done with a very wide slice of welfare participants.
And in Los Angeles County, where it was replicated, it was
implemented for every welfare participant in all of Los
Angeles, and also shown to be effective. Los Angeles County, at
the time, had the largest welfare population in the United
States. So for that particular study, this particular approach
of moving people from welfare into the workforce, was
demonstrated credibly in one county, and then demonstrated
credibly on a very large scale for a large number of people in
another county, for single parent, long-term welfare
recipients, as well as two parent participants, to have large
effects. And that is why it had such an important policy
impact.
Mr. Aguilar. I appreciate it. Mr. Everett, your colleague,
Mr. Kunz, testified before our Subcommittee in April, and he
mentioned some of the great things that you guys are doing to
increase SNAP participation. Do you rely on volunteers for all
of your outreach, or do you work with the State of Texas to get
some SNAP outreach funding for materials?
Mr. Everett. Well, we have regional offices with field
staff that work with about 1,200 community partner
organizations. So many of those community partner organizations
might have case managers that are employed by their local
nonprofit that act as a navigator for SNAP accessibility.
Mr. Aguilar. Do each of those regional offices have full
time----
Mr. Everett. They do.
Mr. Aguilar.--full time staff members?
Mr. Everett. They do.
Mr. Aguilar. Within your--okay, I am sorry. I am out of
time. Thank you so much. I appreciate it.
The Chairwoman. Thank you. The chair recognizes Congressman
Davis, for 5 minutes.
Mr. Davis. Thank you, Madam Chair, and thank you for
convening this hearing. And I appreciate the Ranking Member,
Mr. McGovern, who is very passionate about these issues, and I
just wanted to see how fast he would turn around when he heard
his name.
Mr. McGovern. You got my attention.
Mr. Davis. Yes. But this is a great opportunity to hear
some innovative approaches. Some of the longest debate that we
had during our farm bill negotiations were obviously related to
the programs that funded our food and nutrition programs. And I
am glad to hear many of the witnesses today. I have read your
testimony, and thanks for being here.
I am from Illinois, and part of the farm bill, we
authorized ten pilot programs to be able to look at a valuable
first step to building the solution for making some of the
meaningful improvements that many of you are talking about. And
I am excited to see that Illinois is a grantee. I frankly
didn't think our governor at the time, who is no longer
governor, would actually make the application. I am glad he
did. I actually had to apologize for calling him out in the
newspaper.
Mr. Baron, what advice would you give a state like Illinois
to ensure that this pilot program is successful?
Mr. Baron. There have been a lot of studies that have been
done, not specifically in food stamps, but in other areas, in
Unemployment Insurance and employment programs for hard to
employ populations. There have been a number of rigorous
studies that have been done in welfare-to-work that have
identified, in a few cases, not many, some highly effective
approaches for increasing the workforce success of low-income
families.
If I were a state, or advising a state, my suggestion would
be to look very carefully at what has been learned in those
prior studies. There are a few programs, even if they are in
different program areas, but with low-income populations, that
have produced really large impacts on peoples' life outcomes,
and to see whether adaptations of those programs for a food
stamps population could be tested. So the short answer is I
would look to the prior research to identify what is most
promising, and try that in food stamps.
Mr. Davis. Excellent. Thank you. Thanks for your advice,
and we may have our new Administration in Illinois reach out
for some more suggestions on how to be successful.
Dr. Sullivan, in your testimony you talked about how the
structure of SNAP makes it difficult to gather evidence on the
real effectiveness of the program. And if you have already
mentioned this before I got here, or if you mentioned it to a
previous question, I apologize for the redundancy, so feel free
to move even beyond with some other suggestions. But, from your
perspective, what changes should be made in order to get the
most accurate data? And how can we take what you are learning,
quantify results, and move them into the public policy realm?
Dr. Sullivan. Thank you. Let me address the second one,
because it is closely related to what Mr. Baron was saying, and
that is at the Wilson Sheehan Lab, we sometimes refer to this
as innovate, evaluate, replicate. So these pilots are an effort
to incentivize innovation, so we see state agencies
experimenting with new things. We need to rigorously evaluate
these pilots, and that is what is being done, and we need to
continue to encourage that kind of rigorous evaluation, and
then use that research to inform future decisions. So if the
pilot is working, then we use that information to scale it up.
We say, these are the kinds of programs that are worth
investing more dollars in.
If the pilot is not working, that doesn't necessarily mean
that we shut it down right away. When we are working with an
agency doing an evaluation, the first question we ask when we
get modest or negative evidence is why? Why is the evidence not
as promising as we had hoped, and can the evidence help us
steer or redirect a program in a way to make it better? So the
evidence is an opportunity to improve the impact of the
programs that we are designing.
Now, if a program continues to demonstrate--or lack to
demonstrate effectiveness, then that is when we start thinking
about reallocating resources towards programs and pilots that
have actually demonstrated real impact.
Mr. Davis. So are there any other ideas that you may have
that we have yet to ask you a question on that you feel may be
helpful for us to develop a new policy, and more innovative
policies?
Dr. Sullivan. Well, the pilots are a nice place to start,
and what I would encourage is the opportunity to build off of
that. And there are other models in other agencies. The U.S.
Department of Education has a good model, a tier-based model
that, once there is a pilot that has demonstrated
effectiveness, there are funds available to scale that pilot
up, and then evaluate it again. And then, when there continues
to be evidence of effectiveness, then we scale it up even
further, say within a large scale demonstration project. So
there is this gradual accumulation of evidence so that we can
support better policy.
The Chairwoman. Thanks. The chair now recognizes
Congresswoman Lujan Grisham, for 5 minutes. And again, I
apologize, we are up against another vote.
Ms. Lujan Grisham. Thank you, Madam Chair, for this
opportunity to continue to look at ways to make this program,
SNAP, that I really care about and believe in, as effective as
possible in meeting its goals--and doing what it ought to do,
which is help this country eradicate hunger. I am from a state
that is--I bet every one of the Members of the Subcommittee and
entire Agriculture Committee could repeat New Mexico's
statistics. New Mexico has one of the worst hunger problems in
the country for both children and adults. And we went from last
to fourth this year, so that is in the right direction, but it
is still deplorable that my constituents face hunger every
single day. And I recognize that this is a program whose intent
and ability to do something about that is meaningful.
As a longtime state bureaucrat, Mr. Baron, I love any ideas
that incentivize me, as a policymaker in that regard, to think
of ways to improve programs, and if there are savings, to keep
it. But, and here is my big but, that in the context of states,
particularly like mine, who are in significant budgetary
problems, and are suffering from one of the weakest economies
in the country, and an Administration who I disagree with, in
terms of how they feel about any public benefits, those kinds
of incentives can be very counter-productive, and create
exactly the opposite intent, of innovation and productive
reform. I really want you to talk to me a little bit about
that, but I am going to give you some stats to illustrate how
this can go wrong.
Right now New Mexico, our proposed work requirements are
for seniors and children. I want to tell you that our work
requirements are also for unpaid work, which means I am already
not getting enough for child care and housing, now I have to
volunteer in places that are far away, in a state that has no
public transportation really, because we are a rural and
frontier state, so we are slow to get that off the ground. And
think about it in the context of all of our friends now who
have often unproductive and unwanted audits in health care,
where we incentivize the independent auditors, that they get to
keep anything that they find, so they find stuff that really
isn't fraud, but is a mistake. It really shuts down a lot of
our direct care providers in the health care system. That is
going on in New Mexico as well.
And one more thing. When we are putting up barriers just in
the application process, as in New Mexico, because of those
changes in the applications, most applicants wait months before
they can get our computer system to look at those applications.
SNAP benefits processing has fallen by 23 percent, and this is
a design as part of reforming the program: 20,000 lost their
food benefits. The state did nothing about it, and the only way
to address the delays, and the barriers, and the applications,
and the computer system, and the work requirements is courts
are now involved, mandating that the state do something.
So that is an extreme example of how it goes completely the
other way. Talk to me about some of those protections,
balances, so that when we do our job, that hunger doesn't get
worse, and that we are focusing on supporting those
constituents who need us most, and who need this program most,
and so we can be sure get the services and benefits that they
need.
Mr. Baron. If the Federal Government were to incentivize
state level innovation, I agree with you, it would need to
circumscribe the types of innovations that would be allowed.
There would be great flexibility, but you don't want to allow
experimentation that is likely to cause harm.
But within circumscribed limits, there are probably many
different strategies--useful strategies, plausible strategies--
that could be tested. What was done in welfare, starting in the
Bush Senior Administration was that the Federal Government,
HHS, allowed states to try their own welfare reform
innovations, and HHS waived provisions of Federal law to allow
those state innovations--but HHS required a rigorous randomized
trial to determine whether that innovation worked or did not
work. And that is the reason why you have such a large body of
scientific evidence that was built about what works in welfare.
When President Clinton came into office, he said, I am
going to continue the state level waivers, the innovations that
I agree with, and the ones that I disagree with.
Ms. Lujan Grisham. All right. And I am going to reclaim----
Mr. Baron. Yes.
Ms. Lujan Grisham.--the 6 seconds that I have, but I really
encourage this Committee to remember that there are states
who--even without waivers, and exceptions, and changes have not
done the jobs that we intend, as policymakers, for these
programs, and we have a responsibility to require
accountability in any of these kinds of designs.
The Chairwoman. Thank you. I do appreciate the panel's help
in understanding how we can better balance flexibility and
accountability to help our recipients climb the economic
ladder. You have certainly given us plenty to think about as we
continue our look at the past, present, and future of the SNAP
Program. No system is perfect, we understand, but we can always
do better.
Under the rules of the Committee, the record of today's
hearing will remain open for 10 calendar days to receive
additional material, supplementary written responses from the
witnesses to any question posed by any Member. This hearing of
the Committee on the Agriculture, Nutrition Subcommittee, is
adjourned.
[Whereupon, at 3:18 p.m., the Subcommittee was adjourned.]
SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM
(PAST, PRESENT, AND FUTURE OF SNAP: BREAKING THE CYCLE)
----------
TUESDAY, OCTOBER 27, 2015
House of Representatives,
Subcommittee on Nutrition
Committee on Agriculture,
Washington, D.C.
The Subcommittee met, pursuant to call, at 10:00 a.m., in
Room 1300 of the Longworth House Office Building, Hon. Jackie
Walorski [Chairwoman of the Subcommittee] presiding.
Members present: Representatives Walorski, Crawford, Yoho,
Abraham, Moolenaar, McGovern, Adams, Aguilar, Plaskett,
Ashford, and DelBene.
Staff present: Anne DeCesaro, Haley Graves, Jadi Chapman,
Mollie Wilken, Faisal Siddiqui, John Konya, Lisa Shelton,
Nicole Scott, and Carly Reedholm.
OPENING STATEMENT OF HON. JACKIE WALORSKI, A REPRESENTATIVE IN
CONGRESS FROM INDIANA
The Chairwoman. Good morning. Welcome to today's Past,
Present, and Future of SNAP hearing on Breaking the Cycle. I
would like to welcome you here this morning. I am so
appreciative for all of our witnesses who have come, for our
Members as well. Thank you for coming to the Nutrition
Subcommittee, and thank you for making time in your schedules
to be here.
This is the latest hearing in our series, the Past,
Present, and Future of SNAP. Today, we are examining how to
break the cycle of poverty.
This hearing was inspired by a visit I made last year to
Concord High School in Elkhart, Indiana, in my district. I am
sure my colleagues here are very familiar with how these visits
typically go. You answer questions from the brightest students
gathered in the auditorium or the classroom, and they ask
questions like how does a bill become law, what is it like to
be in Congress, what is your position on such-and-such an
issue? However, one student's question that day caught me off
guard, and it was a young woman who stood up in that class and
said, ``How do I break the cycle of poverty?'' And I will never
forget this as long as I live. The student stood up in front of
her peers and bravely told her story that day of her family
receiving SNAP. While in high school, she got a job to start
saving for college because she recognized the value of a
college degree. She is trying to break out of the poverty
cycle, trying to do the right thing as a young woman, yet feels
intense pressure on all sides to maintain the status quo. She
wanted to know how can she as a young woman, break the cycle of
poverty. That day will resonate with me forever, and that is
why we are here today.
In our past hearings, we have examined the conditions
necessary to help adults climb the economic ladder, and the way
community organizations serve as vital conduits and bridges to
other support services. But what about adolescents and kids?
Studies have shown that children who grow up in impoverished
conditions are more likely to have lower academic achievement,
and are more likely to live in poverty as adults. How do we
give today's youths an off-ramp from this?
SNAP is only one piece in the social safety net puzzle for
families, so we have to recognize that this one program can't
do it all. And as we saw in a previous hearing, sometimes that
puzzle can inadvertently create disincentives to work. The
welfare cliff, for example, forces recipients to consider
foregoing raises or promotions, or work altogether, because the
increase in earned income isn't enough to replace the loss of
SNAP and other benefits. America is the land of opportunity,
not the land of we will have to think about it.
SNAP tries to help young people break the cycle of poverty
by exempting formal college savings, like 529 plans, and income
from full-time students under 18 from eligibility calculations.
Are these effective? Is there more we can do to aid children to
break the cycle of poverty?
Today, we will hear from witnesses who can attest to the
impact poverty has on children, the challenges they face as
they transition into adulthood, and ways we can help them
increase their chance at success.
I thank each of our witnesses today so much for being here,
and I would like to take a moment to introduce one witness here
today from my district, Ruth Riley.
Ms. Riley played for the University of Notre Dame and was a
member of the 2001 National Championship Women's Team, won a
WNBA Championship with the Detroit Shock, and a gold medal with
the U.S. Olympic team in 2004. Before she won championships on
the basketball court, Ruth was raised in a single-parent
household that relied on food stamps and free and reduced
lunches. In 2012, Ruth became an ambassador for Share our
Strength, a nonprofit organization committed to ending
childhood hunger, as part of their No Kid Hungry campaign.
Thank you, Ms. Riley, so much for being here today.
[The prepared statement of Mrs. Walorski follows:]
Prepared Statement of Hon. Jackie Walorski, a Representative in
Congress from Indiana
Good morning and welcome to our hearing of the Nutrition
Subcommittee. Thank you all for making time in your schedules to be
here and thank you to today's witnesses for your participation.
This is the latest hearing in our series, The Past, Present, and
Future of SNAP. Today, we are examining how to break the cycle of
poverty.
This hearing was inspired by a visit I made last year to Concord
High School in Elkhart, Indiana, in my district. I'm sure my colleagues
are familiar with how these visits typically go, answering questions
from the bright students gathered in the auditorium or classroom. How
does a bill become a law? What's it like being in Congress? What's your
position on such-and-such issue? However, one student's question that
day caught me off guard: How do I break the cycle of poverty?
The student stood up in front of her peers and bravely told her
story of her family receiving SNAP. While in high school, she got a job
to start saving for college because she recognized the value of a
college degree. She is trying to break out of the poverty cycle, trying
to do the right thing, yet feels intense pressure on all sides to
maintain the status quo. She wanted to know: How do I break the cycle
of poverty? That day still resonates with me and, as I said, is why we
are here today.
In our past hearings, we've examined the conditions necessary to
help adults climb the economic ladder and the way community
organizations serve as vital conduits to other support services. But
what about adolescents and kids?
Studies have shown that children who grow up in impoverished
conditions are more likely to have lower academic achievement and are
more likely to live in poverty as adults. How do we give today's youth
an off-ramp from this?
SNAP is only one piece in the social safety net puzzle for
families, so we must recognize that this one program can't do it all.
And as we saw in a previous hearing, sometimes that puzzle can
inadvertently create disincentives to work. The ``welfare cliff,'' for
instance, forces recipients to consider foregoing raises or promotions,
or work altogether, because the increase in earned income isn't enough
to replace the loss of SNAP and other benefits.
America is the Land of Opportunity, not the Land of ``Well, I'll
Have to Think About It.''
SNAP tries to help young people break the cycle of poverty by
exempting formal college savings, like 529 plans, and income from full-
time students under 18 from eligibility calculations. Are these
effective? Is there more we can be doing to aid children to break the
cycle of poverty?
Today, we'll hear from witnesses who can attest to the impact
poverty has on children, the challenges they face as they transition
into adulthood, and ways we can help them increase their chance at
success.
I thank each of our witnesses who are here today and I would like
to take a moment to also introduce one witness here today from my
district, Ruth Riley.
The Chairwoman. I would now like to recognize Ranking
Member McGovern for his opening statement.
OPENING STATEMENT OF HON. JAMES P. McGOVERN, A REPRESENTATIVE
IN CONGRESS FROM MASSACHUSETTS
Mr. McGovern. Well, thank you very much. And I want to
thank the witnesses for being here. I think this is an
important hearing.
And let me just begin by saying that I agree with our
Chairwoman that SNAP can't do it all, but what it is supposed
to do, which is to make sure that people don't go hungry in
this country, I think it needs to do it better. And if we are
going to break the cycle of poverty, quite frankly, it is going
to require a hearing with more than just the Agriculture
Committee, because a lot of our antipoverty programs, a lot of
the issues that happen when people hit this so-called cliff,
fall under the jurisdiction of multiple committees.
One of the things that I have been urging, unfortunately
unsuccessfully thus far, the White House to do is to host a
conference--a White House conference on food, nutrition, and
hunger, because there are a lot of good things happening all
across the country in combating hunger. What we need is a
clearinghouse to be able to highlight best practices, but we
also need to talk very candidly about ways that we can sew up
some of the holes in the social safety net to make sure that
people don't fall through the cracks, so that we are helping
people move beyond SNAP and hopefully breaking the cycle of
poverty.
We have had multiple hearings in this Committee. We have
had seven hearings to be exact. We have heard a lot about SNAP,
we have talked about comprehensive case management models and
innovative public-private partnerships. Look, I am all for
strengthening SNAP's job training program, but the real problem
is that we don't have enough slots available to meet the need
for workers looking to improve their skills. Bolstering our job
training programs is expensive. I support it, but it is
expensive. And we want to have much more robust case
management. That is going to cost more as well. I am all for it
and I think that is an important way to help people break the
cycle of poverty. But if we are going to do that, we need to
make sure that the funding is there. And what I am very
strongly against is robbing Peter to pay Paul. I don't think we
should lessen our commitment to food and nutrition programs,
and divert those monies to someplace else, because, in my view
and based on my experience, the SNAP benefit as it is currently
constructed is inadequate for families. Go to any food bank in
this country and at the end of the month, people are lined up
because they have run out of their SNAP benefit. And by the
way, the SNAP benefit that is available for people today is
less than it was a few years ago because of actions that this
Congress has taken to cut the benefit.
SNAP in and of itself is not a jobs program; it is a food
program. That is why I am especially pleased that Dr. Ochoa is
here with us today, and that his testimony focuses on what the
body of evidence says about SNAP's positive effect on
children's health. We know that access to adequate nutritious
food during childhood is key to healthy development and future
economic productivity. We need to get this right. We need to do
this better.
So let me remind my colleagues that \1/2\ of all SNAP
recipients are children, and the last time I checked children
weren't expected to work, unless we want to repeal the child
labor laws. But the majority of people on this program are
children, are senior citizens, are those who are disabled. Of
those who work, the majority work, but they earn so little that
they still qualify for SNAP.
And so I look forward to the hearing today. We need to
figure out how we can do this better, but I worry that in this
Committee sometimes we look at SNAP to be the remedy for
everything. This is a program to make sure people do not go
hungry in this country, and the benefit is inadequate. We need
to bring in other committees. We need to get the White House
more engaged in this debate and in the challenges before us,
and we need to figure this out, and I think we can probably
find some bipartisan consensus on that.
So with that, I yield back my time.
The Chairwoman. Thank you, Mr. McGovern.
The chair would request that other Members submit their
opening statements for the record so the witnesses may begin
testimony to ensure there is ample time for questions.
The chair also would like to notify Members that they will
be recognized for questioning in order of seniority for Members
who were here at the start of the hearing. After that, Members
will be recognized in order of arrival. I appreciate Members'
understanding.
Witnesses are reminded to limit your oral statements to 5
minutes. All of the written statements will be included in the
record.
I would now like to welcome the witnesses to the table.
Caroline Ratcliffe, Senior Fellow, Urban Institute, Washington,
D.C. Thank you so much for being here. The aforementioned Ruth
Riley, former WNBA Athlete and Olympic Gold Medalist. Dr.
Eduardo Ochoa, Jr., M.D., Little Rock, Arkansas, on behalf of
Children's HealthWatch. Thank you so much for being here. And
Dr. Haskins, Senior Fellow, Brookings Institution, Washington,
D.C.
With that, Dr. Ratcliffe, please begin with your testimony
when you are ready.
STATEMENT OF CAROLINE E. RATCLIFFE, Ph.D., SENIOR
FELLOW AND ECONOMIST, CENTER ON LABOR, HUMAN SERVICES, AND
POPULATION, URBAN INSTITUTE,
WASHINGTON, D.C.
Dr. Ratcliffe. Thank you. Good morning, Madam Chair, and
Members of the Subcommittee.
My name is Caroline Ratcliffe and I am an Economist and
Senior Fellow at the Urban Institute. The Urban Institute does
not take policy positions. The views I am presenting today are
my own. I will describe findings from my research on childhood
poverty. This research is closely connected with this
Subcommittee's work on SNAP, as poor children are substantially
more likely to be food-insecure than their non-poor
counterparts.
My research highlights obstacles poor children face in
reaching milestones, such as completing high school, graduating
from college, and maintaining consistent employment. This
research helps us understand what it would take to break the
cycle of poverty. This research is based on data that tracks
families over 40 years, and follows children from birth
throughout childhood and into adulthood.
I will answer three questions. In answering these
questions, I get at issues of economic mobility, and how
poverty and economic vulnerability cycles through to the next
generation.
The first question is just how many children are we talking
about when considering poverty. Well, roughly one in five
children currently lives in poverty. Nearly two in five
children are poor for at least 1 year before they reach their
eighteenth birthday. That means that roughly 29 million of
today's children are expected to live below the poverty line
before age 18. Further, one in ten children is persistently
poor; meaning, they spend at least \1/2\ of their childhood
living in poverty. Importantly, persistently poor children do
not enter poverty and stay there. Rather, they tend to cycle
into and out of poverty.
Moving to the second question: How does childhood poverty
link with adult success. Children who have been poor for at
least 1 year before age 18 are less likely to reach important
adult milestones, such as graduating from high school,
enrolling in and completing college, and maintaining consistent
employment. Although 93 percent of children who were never poor
complete high school by age 20, only 78 percent of children who
have ever been poor do so. And when looking at the subset of
children who are persistently poor, the disparity is even
greater. As these poor children become adults with limited
education, there are implications for their long-term economic
well-being, as lower-educated groups have lower wages and
higher unemployment rates. Overall, these data show that when
these poor children enter adulthood and have their own
children, poverty and economic vulnerability, as well as food
insecurity, will cycle through to the next generation.
Moving to address the final question: Among children who
have experienced poverty, what are key indicators of their
future success beyond poverty. There are three important
dimensions. First is parents' educational attainment. Among
children who have experienced poverty, children with less-
educated parents, particularly a parent with no high school
degree, have lower educational achievement. This relationship
persists even after taking account of the length of time
children spend in poverty, and other family and neighborhood
characteristics. So it is not just poverty. Parents' education
matters above and beyond poverty.
The second is residential instability. Among children who
have experienced poverty, children who move for negative
reasons, such as an eviction or the family's need for lower
rent, are worse-off educationally than children who never move.
Moves that happen for negative reasons can exacerbate already
tenuous circumstances for children, particularly if the move
results in the need to change schools during the school year.
Third, place matters. Children who grow up in disadvantaged
neighborhoods fare much worse. Among children who have been
poor, children in more advantaged neighborhoods are
substantially more likely to complete high school by age 20
than children from the most disadvantaged neighborhoods.
In closing, these data show that childhood poverty and the
cycle of poverty are complex issues. If we want to break the
cycle of poverty and food insecurity, there should be close
coordination across safety net programs. SNAP exists in the
context of other programs and policies, so it would be
beneficial to connect SNAP reforms with other antipoverty
programs, such as those that assist with savings and asset
building, education and training, childcare and other work
supports. SNAP has taken important steps in this direction by
making it easier for families to save in years when they have
higher income, without giving up future SNAP eligibility in
downtimes. Savings and assets give people the tools to protect
their families in tough times, and invest in themselves and
their children. Further reforms in this direction can help
families create a more stable environment for children.
Thank you.
[The prepared statement of Dr. Ratcliffe follows:]
Prepared Statement of Caroline E. Ratcliffe, Ph.D., Senior Fellow and
Economist, Center on Labor, Human Services, and Population, Urban
Institute, Washington, D.C.*
---------------------------------------------------------------------------
* The views expressed are those of the author and should not be
attributed to the Urban Institute, its trustees, or its funders.
---------------------------------------------------------------------------
How Does Child Poverty Relate to Adult Success?
Good morning, Madam Chair, and Members of the Subcommittee. Thank
you for the opportunity to speak today.
My name is Caroline Ratcliffe, and I am an Economist and Senior
Fellow at the Urban Institute. The Urban Institute, a nonprofit
research organization, brings decades of objective analysis to policy
debates and is dedicated to using research to elevate the debate on
social and economic policy. The Urban Institute does not take policy
positions. The views I present today are my own.
Rather than focus on the Supplemental Nutrition Assistance Program
(SNAP), I will describe findings from my research on childhood poverty,
with a particular focus on how it relates to adult success. This
research puts a spotlight on the obstacles poor children face in
reaching milestones important to any young person--such as completing
high school, graduating from college, and maintaining consistent
employment--and helps us understand what it would take to ``break the
cycle'' of poverty.
My research is based on data from the University of Michigan's
Panel Study of Income Dynamics, which tracks families over 40 years.
These data follow children from birth, throughout childhood, and into
adulthood. I will focus my testimony on answering three questions.
1. When considering child poverty, just how many children are we
talking about?
2. How does childhood poverty link with adult success?
3. Beyond childhood poverty, what matters for the future success of
poor children?
In answering these questions, we get at issues of economic mobility
and how poverty and economic vulnerability cycles through to the next
generation.
1. Childhood Poverty: Just How Many Children Are We Talking About?
Following children from birth through age 17 shows a much greater
prevalence of poverty than the annual U.S. poverty statistics suggest.
While roughly one in five children currently lives in poverty (21.1
percent), nearly twice as many (38.8 percent) are poor for at least 1
year before they reach their 18th birthday (Figure 1). Translating
these percentages to numbers of children, roughly 29 million of today's
children are expected to live below the poverty level for at least 1
year before age 18. Black children fare much worse; fully \3/4\ (75.4
percent) are poor during childhood. The number for white children is
substantial, yet considerably lower (30.1 percent). Poor children are
also substantially more likely to be food-insecure than their near-poor
and non-poor counterparts.
Figure 1
Percentage of Childhood Poor, by Race
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Source: Urban Institute tabulations of Panel Study of Income
Dynamics (PSID) data.
Notes: Tabulations are weighted and include children born
between 1968 and 1989. Persistently poor children are poor at
least \1/2\ the years from birth through age 17. Ever-poor,
nonpersistently children are poor at least 1 year, but fewer
than \1/2\ the years, from birth through age 17.
This research also examines a longer-term measure of poverty-
persistent childhood poverty. A child is defined as persistently poor
if he or she spends at least half of his or her childhood living in
poverty. Among all children, one in ten (10.5 percent) is persistently
poor (Figure 1). Again, translating this to the number of children, we
expect that nearly eight million of today's children will spend at
least \1/2\ their childhoods in poverty. Again, black children fare
worse. Roughly four in ten (38.5 percent) black children are
persistently poor, while fewer than one in 20 white children (4.3
percent) are persistently poor.
Persistently poor children tend to cycle into and out of poverty.
Over \1/2\ (58 percent) of persistently poor children have three or
more spells of poverty, and, thus, periods of economic instability.
Are there early markers that help identify children who are likely
to be persistently poor? Yes. Children born to poor parents who have
not completed high school are particularly vulnerable to persistent
childhood poverty. Among children born to poor parents, children whose
parents did not complete high school are 30 to 45 percentage points
more likely to be persistently poor than children whose parents have
some education beyond high school.
2. How Does Childhood Poverty Link with Adult Success?
Children who have been poor for at least 1 year before they turn 18
are less likely to reach important adult milestones, such as graduating
from high school, enrolling in and completing college, and maintaining
consistent employment, than children who have never been poor.
Persistently poor children fare even worse.
Although more than nine in ten never-poor children (92.7 percent)
complete high school by age 20, only three in four ever-poor children
(77.9 percent) do so (Table 1). When looking at the subset of children
who are persistently poor, the disparity is greater. Less than \2/3\ of
persistently poor children (63.5 percent) complete high school by age
20. Put another way, over \1/3\ of persistently poor children do not
complete high school by age 20.
Some of these youth are likely leaving high school to help support
their families. Research by my Urban Institute colleagues finds that
nearly \1/3\ of out-of-school youth (ages 16-18) without a high school
degree are working, with roughly \1/2\ working at least 40 weeks of the
year for an average of 30 hours a week (during the weeks they work). On
average, the earnings of these working youth account for about 20
percent of family income.
Lower levels of educational success among poor children persist
beyond high school completion. While 37 percent of never-poor children
complete a bachelor's degree by age 25, only three percent of
persistently poor children do so. It's unclear whether poor children
gain ground after age 25, but the pattern between ages 20 and 25
suggest that any gains are likely limited.
Table 1
Educational Achievement and Employment by Childhood Poverty Status
(percent)
----------------------------------------------------------------------------------------------------------------
Among Ever Poor
---------------------------------
Never poor Ever poor Not
persistently Persistently
poor poor
----------------------------------------------------------------------------------------------------------------
Educational attainment:
High school diploma by age 20 92.7 *** 77.9 83.3 *** 63.5
Postsecondary enrollment by age 25 69.7 *** 41.4 47.6 *** 22.8
Completed college by age 25 36.5 *** 13.0 16.2 *** 3.2
Consistently employed ages 25-30 70.3 *** 57.3 63.6 *** 35.4
----------------------------------------------------------------------------------------------------------------
Source: Urban Institute tabulations of Panel Study of Income Dynamics (PSID) data.
Notes: Tabulations include children born between 1968 and 1989. Statistical significance for the ``never poor''
and ``ever poor'' columns is based on the difference between individuals who are never poor and those who are
ever poor in childhood. Significance for the ``not persistently poor'' and ``persistently poor'' columns is
based on the difference between individuals who are ever poor but not persistently poor and those who are
persistently poor in childhood.
* p < 0.1. ** p < 0.05. *** p < 0.01.
As these poor children become adults with limited education,
implications arise for their long-term economic well-being. Lower-
educated groups have lower wages and higher unemployment rates.
In fact, when following people up through age 30, we find that
people who were poor as a child are less likely to be consistently
employed as a young adult (between ages 25 and 30). They are also more
likely to spend multiple years in poverty as a young adult (between
ages 25 and 30).
Overall, ever-poor and persistently poor children have
substantially worse educational and employment outcomes than their
never-poor counterparts. The data suggest that when these children
enter adulthood and have children, poverty and economic vulnerability,
as well as food insecurity, will cycle through to the next generation.
3. Beyond Child Poverty What Matters for the Future Success of
Children?
Among children who have experienced poverty, what are the key
markers--beyond poverty--of their future success? There are three
important dimensions.
First, parents' educational attainment at the child's birth is
importantly related to children's academic achievement, with lower
educational attainment among children with less-educated parents. This
relationship persists even after controlling for family and
neighborhood characteristics, including duration of childhood poverty.
Compared with ever-poor children whose parents did not complete high
school, children whose parents have more than a high school education
are 30 percent more likely to complete high school by age 20, more than
twice as likely to enroll in post-secondary education by age 25, and
nearly five times more likely to complete college by age 25.
The relationships differ somewhat for children whose parents have
only a high school education. Ever-poor children whose parents have a
high school education (versus not completing high school) are more
likely to complete high school and enroll in college or another post-
secondary program (by 11 and 60 percent, respectively), but they are
not statistically significantly more likely to complete a 4 year
college degree. That is, they are more likely to get some post-high
school education but not get through a 4 year college program by age
25.
Among poor children, parents' educational attainment is not related
to whether the child is consistently employed as a young adult. But,
there is more to the story. Although no direct relationship with young
adult employment is found, it is well established that lower
educational achievement brings lower average wages and dampened
opportunities for upward mobility.
So, it's not just poverty. Parents' educational attainment matters
above and beyond poverty. The limited education of today's parents can
create a vicious cycle that hinders future generations.
Second, residential instability is related to lower academic
achievement for ever-poor children, in both high school and college
completion. Ever-poor children who move for a negative reason (such as
eviction or the family's need for lower rent) are worse off
educationally than ever-poor children who never move. Children with two
or more negative moves are 13 to 15 percent less likely to complete
high school by age 20, 35 to 36 percent less likely to enroll in post-
secondary education by age 25, and 60 to 68 percent less likely to
complete college by age 25 than children who never move. Children with
multiple negative moves also have worse educational outcomes than
children who move for positive or neutral reasons.
Moves that happen for a negative reason can exacerbate already
tenuous circumstances for children, particularly if the moves do not
coincide with changes in the school year or promotional moves (e.g.,
from elementary to middle school).
Third, place and neighborhood characteristics matter for ever-poor
children, even in models that take account of the length of time
children spend in poverty and other family characteristics. Children
who grow up in disadvantaged neighborhoods fare much worse. Among
children who have been poor, children in more advantaged neighborhoods
(where poverty and unemployment rates are near five percent) are 22
percent more likely to complete high school by age 20 and are roughly
15 times more likely to complete a 4 year college degree by age 25 than
children in the most disadvantaged neighborhoods (where poverty rates
top 50 percent and unemployment rates are over 25 percent).
Part of the story may be schools. Research suggests greater college
enrollment is associated with high school characteristics that more
likely exist in better neighborhoods, such as higher teacher
expectations, social norms toward attending college, and greater staff
support for college enrollment.
Summary and Policy Suggestions
To summarize, one in every five children currently lives in
poverty, but nearly twice as many experience poverty at some point
during their childhood. Among the strains of poverty, poor children are
more likely to experience food insecurity. Ever-poor children are less
successful than their never-poor counterparts in their educational
achievement, which can erode employment prospects and wages throughout
a lifetime.
Moreover, the educational achievement of one generation ripples
through to the next. Even among the subset of ever-poor children,
children of less-educated parents are less likely to achieve important
educational milestones than their peers with more highly educated
parents. Education and training programs, bundled with work supports
such as child care subsidies, could improve financial well-being and
stability for parents with limited education. Higher educational
achievement has been clearly linked with higher employment rates and
earnings, and receipt of child care assistance has been found to
increase the economic well-being of low-wage unmarried mothers.
Beyond childhood poverty and parental education, residential
instability stands out as important to children's future success.
Household moves that happen for negative reasons are particularly
related to worse outcomes. Federal policy allows some vulnerable
children (homeless and foster care children, for example) to remain in
the same school when moving across school boundary lines. However, most
low-income children are left out. More flexible policies on this front
would provide greater stability for children and help them succeed in
school.
Also, place matters. Children who grow up in more disadvantaged
neighborhoods fare much worse. Place-conscious strategies that both
address current neighborhood conditions and help poor families move out
of disadvantaged neighborhoods to better neighborhoods with better
schools would help children succeed.
Finally, savings and assets can provide a vital cushion for low-
income families. One positive savings advancement is in SNAP, which has
taken steps over the years to liberalize rules related to the level of
assets families can have and still participate in the program. This
liberalization eases disincentives for families to save in years when
they have higher incomes.
Beyond SNAP asset limits, other steps could be taken to actively
encourage low-income families to save, and such savings could be used
to provide stability when economic difficulties hit families. This
encouragement would entail redirecting some of the $384 billion in
Federal asset-building subsidies, which primarily benefit higher-income
families, to lower-income families. Promising policies to promote
asset-building among low-income families include promoting emergency
savings with incentives linked to savings at tax time and offering
matched savings such as universal children's savings accounts. Research
shows that low-income families can save and build assets over time. By
more efficiently and equitably promoting saving and asset building,
more people will have the tools to protect their families in tough
times and invest in themselves and their children.
Additional Information
Acs, Gregory, Pamela Loprest, and Caroline Ratcliffe. 2010.
``Progress toward Self-Sufficiency for Low-Wage Workers.'' Washington,
D.C.: Urban Institute.
Baum, Sandy. 2014. ``Higher Education Earnings Premium: Value,
Variation, and Trends.'' Washington, D.C.: Urban Institute.
Ratcliffe, Caroline. 2015. ``Child Poverty and Adult Success.''
Low-Income Working Families brief. Washington, D.C.: Urban Institute.
http://www.urban.org/research/publication/child-poverty-and-adult-
success.
Ratcliffe, Caroline, and Signe-Mary McKernan. 2012. ``Child Poverty
and Its Lasting Consequence.'' Low-Income Working Families Paper 21.
Washington, D.C.: Urban Institute. http://www.urban.org/research/
publication/child-poverty-and-its-lasting-consequence.
___. 2012. ``Child Poverty and Its Lasting Consequence: Summary.''
Low-Income Working Families fact sheet. Washington, D.C.: Urban
Institute. http://www.urban.org/research/publication/child-poverty-and-
its-lasting-consequence-summary.
___. 2010. ``Childhood Poverty Persistence: Facts and
Consequences.'' Low-Income Working Families brief. Washington, D.C.:
Urban Institute. http://www.urban.org/research/publication/childhood-
poverty-persistence-facts-and-consequences.
Roderick, Melissa, Vanessa Coca, and Jenny Nagaoka. 2011.
``Potholes on the Road to College: High School Effects in Shaping Urban
Students' Participation in College Application, Four-Year College
Enrollment, and College Match.'' Sociology of Education 84 (3): 178-
211.
Scott, Molly, Simone Zhang, and Heather Koball. 2015. ``Dropping
Out and Clocking In: A Portrait of Teens Who Leave School Early and
Work.'' Low-Income Working Families brief. Washington, D.C.: Urban
Institute. http://www.urban.org/research/publication/dropping-out-and-
clocking.
The Chairwoman. Thank you, Dr. Ratcliffe.
Ms. Riley, please proceed with your testimony.
STATEMENT OF RUTH RILEY, FORMER WNBA ATHLETE AND OLYMPIC GOLD
MEDALIST, GRANGER, IN; ON BEHALF OF NBA CARES
Ms. Riley. Good morning, Chairwoman Walorski, Ranking
Member McGovern, and Members of the Committee.
I would like to thank you for this opportunity to share my
experience on the importance of the Supplemental Nutrition
Assistance Program, or what my family called food stamps.
This is an issue that is woven into the very fabric of my
childhood. My father walked out when I was 4 years old. He left
my mom to raise my older sister, younger brother, and myself on
her own. She found herself doing whatever blue collar work she
could to provide for us, but it wasn't easy.
Besides the rare instances that I would wake up in the
middle of the night and find her crying at the kitchen table
because she was trying to navigate through our family's
finances, I was pretty oblivious, as most children are, to the
level of poverty we lived in. I knew there were some times when
my mom paid for our groceries with what looked like Monopoly
money instead of cash. Off and on throughout my childhood I
would have this little ticket that would get me a free
breakfast or lunch at school. But as a kid, I had limited
knowledge of food stamps or free and reduced lunch programs. I
just knew that somehow, when we needed it, there was always
food.
Because I had this food, I was able to learn and focus in
school, which ultimately led me to graduate with honors from
the University of Notre Dame. It fueled my real passion,
basketball. I am grateful and proud of the success that I have
had winning championships on the collegiate, professional, and
Olympic levels. I often joke that when I was growing up, I was
tall, lanky, and uncoordinated. But looking back, I can't
imagine what my path would have been like if I was tall, lanky,
uncoordinated, and hungry. When times were tough, the nutrition
I received through programs like food stamps and school meals
helped me grow stronger. It saw me through all the numerous
hours of training before and after school, lifting with our
football coaches and playing pick-up games with the boys. It
was all very physically demanding, and I couldn't have done it
if I didn't have enough to eat.
We live in the land of wealth and opportunity, so
acknowledging that one in five children in this country lives
in a family struggling to put food on the table is hard. It is
easy to feel compassion about hungry children when it is in the
abstract, but it is tough to admit that our next-door
neighbor's child might not have enough food they need to
thrive. I say thrive because in America, it is often not the
case of life or death or survival, it is the fact that kids
don't have the nutrition they need to learn and physically
grow. By not providing them with that, as a society, we are
also not providing them with the opportunity to be successful,
to go to college, and to break the cycle of poverty instead of
getting stuck in it.
We talk about educational reform, but we don't talk about
the fact that hungry kids can't concentrate and learn. We talk
about health care, but we don't talk about the stunted
development and avoidable health issues that rise from the lack
of proper nutrition. We talk about jobs, but we overlook the
impact of hunger-related issues on creating a job-ready
generation.
SNAP is critical to ending childhood hunger. I can tell you
firsthand that when programs like SNAP work in tandem with
other programs like school meals, we can make sure that kids
are getting the three meals a day they need to grow strong. For
example, school breakfast ensures that kids start their days
with healthy meals to fuel their brains, while allowing parents
to stretch SNAP dollars longer into the month instead of
running out early. This way, when the money is extremely tight,
we can guarantee that kids are still getting the healthy food
they need.
My mom taught me to dream big and then to work extremely
hard to achieve those dreams. My dream as a little girl growing
up on a farm in Indiana was to play in the Olympics, and I was
fortunate to see that dream fulfilled in Athens in 2004, when I
stood on the podium and received a gold medal. Today, my dream
is equally as bold, and I believe, achievable. I want to see a
nation where no child goes hungry, a nation where every child
has the ability to get the nutrition they need to grow up smart
and strong, a nation where every little girl dares to dream her
dream, and gets the food and support she needs to grow up and
achieve them.
Thank you.
[The prepared statement of Ms. Riley follows:]
Prepared Statement of Ruth Riley, Former WNBA Athlete and Olympic Gold
Medalist, Granger, IN; on Behalf of NBA Cares
Good morning, Chairwoman Walorski, Ranking Member McGovern, and
Members of the Committee. I would like to thank you for this
opportunity to share my experience on the importance of the
Supplemental Nutrition Assistance Program, or what my family called
``food stamps.''
This is an issue that is woven into the fabric of my childhood. My
father walked out when I was 4 years old. He left my mom to raise my
sister, brother, and I on her own. She found herself doing whatever
blue collar work she could find to provide for us. It wasn't easy.
Besides the rare instances I would wake up in the night to find my mom
crying at the kitchen table as she was trying to navigate our family's
finances, I was pretty oblivious, as most kids are, to the level of
poverty we were living in.
I knew there were some times when my mom paid for our groceries
with what looked like monopoly money instead of cash. Off and on
throughout my childhood I would have a little ticket that got me a free
breakfast or lunch at school. But as a kid, I had limited knowledge of
food stamps or free and reduced price school meals. I just knew that,
somehow, when we needed it, there was always food.
Because I had this food, I was able to learn and focus in school,
which ultimately led me to graduate with honors from the University of
Notre Dame. It also fueled my real passion. Basketball. I'm grateful
and proud of the success I've had in winning championships at the
collegiate, professional, and Olympic levels. I often joke that growing
up I was tall, lanky and uncoordinated. Looking back, I can't imagine
what my path would have been if I'd been tall, lanky, uncoordinated
and hungry. When times were tough, the nutrition I received through
programs like food stamps and school meals helped me grow stronger. It
saw me through all the numerous hours of training before and after
school, lifting with the football coaches and playing pick-up games
with the guys. It was all physically demanding and I could not have
done it if I hadn't had enough to eat.
We live in a land of wealth and opportunity, so acknowledging that
one in five children in this country lives in a family struggling to
put enough food on the table is hard. It's easy to feel compassion
about hungry children when it's in the abstract, but it's tough to
admit that our next-door neighbor's children might not have the food
they need to thrive. I say thrive because, in America, it's often not
the case of life or death or survival. It's the fact that kids don't
have the nutrition they need to learn and physically grow. By not
providing them with that, as a society, we're also not providing them
with the opportunity to be successful, to go to college, and to break
the cycle of poverty instead of getting stuck in it. We talk about
educational reform, but we don't talk about the fact that hungry kids
can't concentrate and learn. We talk about health care, but we don't
talk about the stunted development and avoidable health issues that
rise from a lack of proper nutrition. We talk about jobs, but we
overlook the impact that hunger-related issues have on creating a job-
ready generation.
SNAP is critical to ending childhood hunger. I can tell you, first
hand, that when programs like SNAP work in tandem with other programs
like school meals, we can make sure that kids are getting the three
meals a day they need to grow up strong. For example, school breakfast
ensures that kids can start their days with a healthy meal to fuel
their brains, while also allowing parents to stretch SNAP dollars
longer into the month instead of running out early. This way, even when
money is extremely tight, we can guarantee that kids are still getting
the healthy food they need.
My mom taught me to dream big and then to work extremely hard to
achieve those dreams. My dream as a little girl growing up on a farm in
Indiana was to play in the Olympics, and I was fortunate to see that
dream fulfilled in Athens in 2004 as I stood on the podium to receive
my gold medal. Today, my dream is equally as bold, and I believe,
achievable. I want to see a nation in which no child goes hungry. A
nation where every child has the ability to get the nutrition they need
to grow up smart and strong. A nation where every little girl dares to
dream her dreams, and also gets the food and support she needs to grow
up and achieve them.
The Chairwoman. Thank you, Ms. Riley.
Dr. Ochoa, please proceed with your testimony.
STATEMENT OF EDUARDO OCHOA, Jr., M.D., F.A.A.P., LITTLE ROCK,
AR, ON BEHALF OF CHILDREN'S HealthWatch
Dr. Ochoa. Thank you, Madam Chair, and Members of the
Committee, and good morning.
My name is Dr. Eddie Ochoa, and I have the opportunity to
give this testimony as a member of Children's HealthWatch, a
nonpartisan network of pediatricians, public health
researchers, and children's health and policy experts committed
to improving children's health in America.
I am a general pediatrician, and I practice at Arkansas
Children's Hospital in Little Rock, as a faculty member of the
University of Arkansas for Medical Sciences.
Little Rock is one of five sites in the Children's
HealthWatch research network, along with Baltimore, Boston,
Minneapolis, and Philadelphia. Our mission is to improve the
health and development of young children by informing policies
that address and alleviate economic hardships. We do this by
interviewing caregivers in emergency departments and clinics on
the frontlines of care in these five sites. We have interviewed
60,000 caregivers since 1998 to determine the impact of public
policies on child health and development of real children.
Justin is one such real child. Hospitalized twice in his
first 2 years of life for poor growth, I saw him in my clinic.
He lives in the Mississippi Delta region of Arkansas with his
parents and two siblings. The family drove over an hour each
way to come see me. Justin's father works at a sawmill but his
wages fluctuate. When he brings home less money in a month, the
family is eligible for the Supplemental Nutrition Assistance
Program, but with an uptick in his pay, they lose eligibility
for SNAP and a crucial support for supporting Justin's and the
whole family's health. The increased pay does not match the
value of the SNAP benefit, and thus, Justin's health can
fluctuate with his father's pay and his family's eligibility
for SNAP.
Speaking of health, intuitively all of us in this room
would probably guess that being hungry or food-insecure is not
good for a young child like Justin. In fact, there is a wealth
of scientific evidence demonstrating the hazard that food
insecurity poses to health across the whole lifespan, starting
in pregnancy and early childhood. Adequate nutrients are
required to support healthy development, but food insecurity
can compromise it. The USDA estimates that nearly 20 percent of
all U.S. hospitals with children under 6 experienced food
insecurity in 2014, reporting limited or uncertain availability
of enough food for an active healthy life.
We know that household food insecurity increases the risk
of developmental delays by approximately 70 percent in early
childhood. More specifically, compared to food-secure children,
food-insecure children are twice as likely to be in fair or
poor health, and are 30 percent more likely to have been
hospitalized after birth.
We have strong solutions to this grave national problem.
The furthest-reaching of these is SNAP. It is truly a health
intervention, helping to protect the health and well-being of
those who participate in the program. For example, research has
shown that SNAP lowers the risk of household and child food
insecurity, reduces the risk of anemia, obesity, and poor
health for children and adults, and lowers the risk of
hospitalization for failure to thrive, and reports of child
abuse or neglect. Moreover, it enhances intake of B vitamins,
iron, calcium, and improves children's academic performance.
At Children's HealthWatch, we call SNAP a vaccine because,
like a vaccine, it protects children's health now and in the
future, and also has wider community benefits. Our research on
families with young children has shown that SNAP significantly
reduces food insecurity for the whole family, and importantly,
reduces food insecurity among children. Children whose families
receive SNAP, compared to those who are likely eligible but did
not receive it, were also significantly less likely to have
developmental delays and less likely to be underweight for
their age. Families as a whole also were better able to make
ends meet when they participated in SNAP. Those who
participated were less likely to have had to choose between
paying for medical care and paying for other basic needs like
food, housing, or utilities. But like a vaccine, it is
essential to be able to apply SNAP in the proper dose, and for
the necessary course or length of time in order for it to have
the maximum impact on children and families.
If you will allow me to make another child health
connection here, food insecurity and hunger can be likened to a
problem like asthma, which needs the right medicine when there
is a breathing crisis and a different, long-term medicine when
there--to keep another crisis at bay. It is certainly true that
asthma is a big problem in the U.S., but hunger in America is
an even bigger problem, and it is not easy to know who is food-
insecure and who is not. I will come back to that idea in a
second.
In order to manage asthma properly, so-called rescue
medication is essential to deal with the immediate crisis
because medicine is not enough as a long-term strategy. Food
assistance for hungry children and families must be as robust
on the long-term side via systemic programs such as school
meals, summer feeding, WIC, in addition to the cornerstone that
SNAP is. It is also dependent on the emergency food assistance
networks across America.
As you might imagine, though it exists everywhere in the
U.S., the severity of food insecurity differs by state, and
rates can be very high in some states. Where I live in
Arkansas, Children's HealthWatch research based on data from
the caregivers in our emergency department shows that nearly
one in four families with a child under the age of 4 in the
home is food-insecure. This is against a backdrop of 27.7
percent of Arkansas households with children being food-
insecure, and having the second highest overall rate of food
insecurity in America. We highlighted these findings in a
report titled Doctor's Orders, released this past spring. We
also made note of the fact that food insecurity coexists with
other household insecurities, as have previously been
mentioned, like rent and utilities.
I mentioned earlier that food insecurity is often not easy
to spot. That is why we developed a shortened version of the 18
item USDA screener, and validated what we call the Hunger Vital
Sign. The Hunger Vital Sign emphasizes that just like blood
pressure or weight, which a nurse checks at every visit, we can
use this as a marker of food insecurity in the home. And, in
fact, last week, the American Academy of Pediatrics released a
statement, Promoting Food Security for All Children, that
recommends the use of this Hunger Vital Sign by all
pediatricians.
I thank you again for the invitation to provide this
testimony.
[The prepared statement of Dr. Ochoa follows:]
Prepared Statement of Eduardo Ochoa, Jr., M.D., F.A.A.P., Little Rock,
AR; on Behalf of Children's HealthWatch
Chairwoman Walorski, and distinguished Members of the Committee, my
name is Dr. Eduardo Ochoa. I am honored to have the opportunity to give
this testimony as a representative of Children's HealthWatch, a
nonpartisan network of pediatricians, public health researchers, and
children's health and policy experts committed to improving children's
health in America. I am a general pediatrician and I practice at
Arkansas Children's Hospital in Little Rock as a faculty member of the
University of Arkansas for Medical Sciences.
Little Rock is one of five sites in the Children's HealthWatch
research network, along with Baltimore, Boston, Minneapolis and
Philadelphia. Our mission is to improve the health and development of
young children by informing policies that address and alleviate
economic hardships. We accomplish this mission by interviewing the
caregivers of young children on the frontlines of pediatric care, in
urban emergency departments and primary care clinics. Since 1998, we
have interviewed over 60,000 caregivers and analyzed those interviews
to determine the impact of public policies on the health and
development of real children.
Justin is one such real child. Hospitalized twice in his first 2
years of life for poor growth, I saw him in my clinic. He lives in the
Mississippi Delta region of Arkansas with his parents and two siblings.
The family drove over an hour each way to come to see me. Justin's
father works at a sawmill, but his wages fluctuate. When he brings home
less money in a month, the family is eligible for the Supplemental
Nutrition and Assistance Program (SNAP). But with an uptick in his pay,
they lose eligibility for SNAP, and a crucial support for supporting
Justin's, and the whole family's, health. The increased pay does not
match the value of the SNAP benefit and thus Justin's health can
fluctuate with his father's pay and his family's eligibility for SNAP.
Speaking of health, intuitively all of us in this room would
probably guess that being hungry or food-insecure is not good for a
young child like Justin. In fact, there is a wealth of scientific
evidence demonstrating the hazard that food insecurity poses to health,
across the whole lifespan, starting in pregnancy and early childhood. I
want to give you a brief overview of the sorts of harm it can do--being
a pediatrician, I have mainly focused here on impacts on children.
Adequate prenatal nutrition is critical to ensure normal development of
children's bodies and brains and to bolster child food security. Of
particular concern during this period is the greater risk of food-
insecure mothers entering pregnancy with insufficient iron stores and
with low-folate diets. Poor iron and folic acid status are linked to
preterm births and fetal growth retardation, respectively. Prematurity
and intrauterine growth retardation are critical indicators of medical
and developmental risks that affect not only children's short-term
well-being but also extend into adulthood. Children born to mothers who
were food-insecure during pregnancy also are at increased risk of birth
defects, including cleft palate and spina bifida, among others.
Finally, research shows that women who were marginally food-insecure
and had restricted their eating in an unhealthy way prior to becoming
pregnant are more likely to gain excessive weight during pregnancy,
which puts the mother at risk for gestational diabetes and obesity
postpartum, and can predispose the baby to chronic disease through the
phenomenon of prenatal nutritional programming. The first few years of
a child's life are marked by the most rapid brain and body growth of a
child's entire lifetime--including dramatic changes in cognitive,
linguistic, social, and emotional development and in self-regulation,
setting the stage for school readiness and adult well-being.
Adequate nutrients are required to support healthy development, but
food insecurity can compromise it. The U.S. Department of Agriculture
(USDA) estimates that 19.9 percent of all U.S. households with children
under 6 years of age experienced food insecurity in 2014, reporting
limited or uncertain availability of enough food for an active, healthy
life. We know that household food insecurity increases the risk of
developmental delays by approximately 70% in early childhood. More
specifically, compared to food-secure children, food-insecure children
are twice as likely to be in fair or poor health and are 30% more
likely to have been hospitalized since birth. Mental health problems
such as depression and anxiety disorders in mothers and behavior
problems in preschool age children are more common when mothers are
food-insecure.
But food insecurity does not have to reach the level of outright
hunger to cause these problems. Even mild nutritional deficits during
critical periods of brain growth among infants and toddlers, also known
as marginal food security, may be detrimental, as they are associated
with higher odds of child fair or poor health status, hospitalizations,
and mothers' depressive symptoms and fair or poor health status,
compared with children and mothers in food-secure households.
Food insecurity has also been identified as a serious risk factor
for long-term poor health among older children; repeated or persistent
exposure to food insecurity appears to be particularly toxic. For
example, food insecurity's impacts on health differ according to age
and gender, with younger children experiencing general health impacts,
older youth having higher odds of chronic conditions, asthma, and worse
mental health, including aggression and thoughts of suicide, and some
adverse effects persisting for girls but not boys. Furthermore, food
insecurity is linked to developmental consequences for both girls and
boys during kindergarten through third grade, and impaired social
skills development and reading performance for girls.
What this body of evidence demonstrates clearly is that food
insecurity is detrimental on nearly every aspect of physical and mental
health. Yet, we have strong solutions to this grave national problem.
The furthest reaching of these is the Supplemental Nutrition Assistance
Program (SNAP). SNAP is truly a health intervention, helping to protect
the health and well-being of those who participate in the program. For
example, research has shown that SNAP lowers the risk of household and
child food insecurity, reduces the risk of anemia, obesity, and poor
health for children and adults, and lowers the risk of hospitalization
for failure to thrive & reports of child abuse/neglect. Moreover, it
enhances intake of B vitamins, iron and calcium, and improves
children's academic performance. It has long-lasting effects too--a
longitudinal study found that for those who participated in SNAP in
early childhood, SNAP lowered the risk of adult metabolic syndrome and
thus also lowered the risk of diabetes and cardiovascular disease and
it increased the likelihood that women would be self-sufficient in
adulthood.
At Children's HealthWatch, we call SNAP a vaccine, because like a
vaccine, it protects children's health now and in the future and also
has wider community benefits. Our research on families with young
children has shown that SNAP significantly reduces food insecurity for
the whole family and importantly, reduces food insecurity among
children. Children whose families received SNAP, compared to those who
were likely eligible but did not receive it were also significantly
less likely to have developmental delays and less likely to be
underweight for their age (underweight is an indication of
undernutrition). Families as a whole also were better able to make ends
meet when they participated in SNAP--those who participated in SNAP
were less likely to have had to choose between paying for medical care
and paying for other basic needs like food, housing, or utilities.
But like a vaccine, it is essential to be able to apply SNAP in the
proper dose and for the necessary course or length of time in order for
it to have the maximal impact on children and families and ensure their
long-term success. The Institute of Medicine found the SNAP benefit is
inadequate to purchase a healthy diet ad recommended revisiting the
base calculation. The dose matters--research we recently released
showed that compared to families participating in SNAP when the
American Recovery and Reinvestment Act (ARRA) increase to benefits was
in place, among our families with young children household and child
food insecurity increased significantly when the amount of the SNAP
benefit was reduced for all participants in November 2013.
If you will allow me to make another child health connection here,
food insecurity and hunger can be likened to a problem like asthma,
which needs the right medicine when there's a breathing crisis, and a
different, long-term medicine to keep another crisis at bay. It is
certainly true that asthma is a big problem in the U.S.--the CDC
estimates that one in ten children had asthma in 2009 and everyone in
this room probably knows someone with asthma, if they don not have it
themselves. But hunger in America is an even bigger problem, and it is
not easy to know who is food-insecure and who is not. I'll come back to
that idea and tell you how we have found a way for health providers to
find this out quickly in the clinical setting.
In order to manage asthma properly, so-called rescue medication is
essential to deal with the immediate crisis, but this medicine is not
enough as a long-term strategy. Children with poorly controlled asthma
are at a higher risk of dying from their disease, and children with
food insecurity are at higher risk of being in poor health now, which
affects them far into their future--potentially changing their level of
academic success and subsequent workforce participation. Therefore,
food assistance for hungry children and families must be as robust on
the long-term side, via systemic programs such as school meals, summer
feeding, CACFP, and WIC, in addition to the fundamental cornerstone,
SNAP, as on the emergency side, via the emergency food provision
networks across America. The systemic programs have the advantages of
population-level application, supporting a healthy diet, and in the
case of SNAP, a kitchen-table intervention, the ability to purchase and
prepare meals in the home. In contrast, the emergency assistance
networks, like the rescue medication, have the ability to rapidly
respond to immediate needs. America's hungry children clearly need
both, in order to address short-term crises and also provide them the
longer-term nutritional foundation to give them the chance to develop
appropriately, perform better in school, and succeed in the workforce
as healthy adults.
As you might imagine, though it exists everywhere in the United
States, the severity of food insecurity differs by state and can be
very high in some states. Where I live in Arkansas, Children's
HealthWatch research based on data from caregivers we surveyed who come
into the only pediatric emergency department in the state shows that
nearly one-in-four (22.7%) families with a child under the age of 4
years in the home is food-insecure. This is against a backdrop of 27.7%
of Arkansas households with children being food-insecure, and having
the second-highest overall rate of food insecurity in America. We
highlighted these findings in a report titled ``Doctor's Orders''
released this past spring.
Our report also made note of the fact that food insecurity co-
exists with other household insecurities like difficulty paying for
utilities and struggling to maintain stable housing, and that families
who were food-insecure were also more likely to make trade-offs between
paying for these basic needs and paying for health care. So you can see
that in addition to addressing food insecurity and leading to improved
child health, a program like SNAP also leads to a healthier household
that is more likely to meet important needs for all its members. As I
see all the time in my clinics, low-income parents often face many of
these interlocking needs all at once, and if there is a child in the
home with a special health care need, the extent to which food, housing
and energy needs are addressed in a coordinated fashion puts those
families and children in a much healthier place. In fact, research has
demonstrated that when eligible families receive support for both food
(WIC and SNAP) and SNAP, they are more likely to be stably housed. If
we want children to do well, then we have to care for the whole
household. When more households in a community can meet their needs, we
have healthier communities.
I mentioned earlier that food insecurity is often not easy to spot
or hear, like the wheezing that marks an asthma attack. That is why in
2010 Children's HealthWatch did specific research to narrow down the
gold standard 18 item USDA food insecurity screener to a two item,
validated screening tool that can be used in most clinical settings. We
call it the Hunger Vital Sign (HVS) to emphasize that just like blood
pressure or weight which the nurse checks at every medical visit, we
need to also be thinking about hunger. With responses to these two
questions, any nurse, medical student or doctor could identify a person
in household at risk of food insecurity. In fact, last week the
American Academy of Pediatrics released the policy statement
``Promoting Food Security for All Children'', which recommends that the
Hunger Vital Sign be used by pediatricians at scheduled health
maintenance visits and other times when indicated. At our institution
in Little Rock, pediatric trainees have taken on the pilot project of
using the HVS in `continuity clinics', where they see a panel of
patients throughout their residency, to identify food insecurity. Thus
far, they are finding positive screens at about the rate our emergency
department surveys have found, but we will fully analyze the data in
the near future.
Using a tool like the HVS will surely get to the level of need our
patients have, but then what do we do in response? As our `Doctors
Orders' report describes, we have implemented strategies in our
hospitals and clinics to try to address food insecurity when we find
it. Starting for the youngest patients, we have entered into a
partnership with our state health department to place a WIC office
inside our hospital. I should note that we modeled this and other ideas
on other sites in our Children's HealthWatch network, specifically
Boston Medical Center and Hennepin County Medical Center in
Minneapolis. By offering our youngest patients more seamless WIC
certification on campus, we hope to address some of the logistical
barriers our families have to receiving WIC benefits for which they are
eligible. We have also partnered with our state human services
department to enable our hospital financial counselors to help families
through the SNAP application process as those families apply for
Medicaid. Through a partnership with the USDA and again with our state
human services department, we are a site for summer and year-round
meals in our cafeteria and have fed over 10,000 children thus far on
our campus. Lastly, through partnerships with a local food pantry, we
also provide emergency food bags to families that have an urgent need
for food. I have personally seen the relief on the faces of parents
when we are able to send them home with enough food to get them through
a few days.
I mentioned earlier that I practice general pediatrics, and am one
of many providers on our faculty. We have a panel of nearly 30,000
Medicaid patients, and intend to build a new primary care clinic within
a year, which will be located in an area of Little Rock with a high
proportion of Latino and African-American children. As the lead medical
director for this clinic, I am helping to design the space and I plan
to have financial counselors on staff who can help our families apply
for SNAP and Medicaid, utilize community health workers as part of our
care teams, and be a location for distribution of meals for children
who come to our clinic. We are also exploring ways to incorporate the
Hunger Vital Sign into our electronic medical record, as has been done
in medical settings across the country.
Real children in real families have real needs that can come up
unexpectedly. Gabby was a playful and happy 2 year old in perfectly
good health until an illness struck her that caused multiple prolonged
seizures that to this day are difficult to control and have caused
extreme disability. Gabby's father had a full-time job with a railroad
company and was able to weather this situation because Gabby's mom
could provide full-time, round-the-clock care to Gabby while he worked.
Unfortunately, this was before the Great Recession. When the Recession
struck, Gabby's father had his hours reduced, his benefits cut, and
ultimately became uninsured. Gabby's health worsened along with his
family's crisis. Arkansas had not yet expanded Medicaid under the
Affordable Care Act. As we cared for Gabby in our clinic for children
with complex medical problems, we were able to help the family apply
for SNAP, receive emergency food and other assistance. Remember not
just one bad thing happens at a time--slowly, with SNAP and other
supports to bridge the gaps that Gabby's family could no longer afford
on a lower income, Gabby started to improve. Today Gabby is in better
shape, with a combination of medications and an electronic device to
control seizures, her parents are both insured, and the family receives
supports to help with food, their mortgage payment, and other household
necessities. It is essential for families like Gabby's that our systems
of support are strong and sufficient. These essential programs,
especially SNAP, must be there for families like Gabby's in times of
need. SNAP would not have prevented Gabby's particular illness, but it
can prevent health complications for children like her and support
health and healthy development for many others.
Thank you again, Chairwoman Walorski, for the opportunity to
address this Subcommittee today on behalf of Children's HealthWatch and
on behalf of the children for whom we all care in our clinics.
The Chairwoman. Thank you, Dr. Ochoa. We appreciate it.
Dr. Haskins, you may proceed.
STATEMENT OF RON HASKINS, Ph.D., SENIOR FELLOW,
ECONOMIC STUDIES AND CO-DIRECTOR, CENTER ON
CHILDREN AND FAMILIES, BROOKINGS INSTITUTION,
WASHINGTON, D.C.
Dr. Haskins. Chairwoman Walorski, Ranking Member McGovern,
Members of the Subcommittee, I am very pleased to testify----
The Chairwoman. Excuse me, can you turn your microphone on?
Dr. Haskins. I am sorry. I am very pleased to testify
today. I consider it a great privilege to be able to talk about
poverty and the solutions to poverty, that people can actually
do something about it.
I would like to do three things: Talk about the progress we
have made against poverty, or the lack of it, then I want to
talk about the causes, and then I want to focus on work because
it is something this Subcommittee could do something about.
So here are poverty rates for kids in female-headed
families, for the elderly, and for all children. For the
elderly, I think that is the pattern that we would all like to
see; that there is very substantial decline after the
declaration of the war on poverty, and it has continued to
decline slowly, and we have the lowest poverty rate of any
group and societies among elderly, and it is primarily because
of Social Security. A lot of the elderly have savings that take
them way above the poverty line, but Social Security hardly has
supplements enough to keep the elderly out of poverty.
The chart for single-parent families, the line graph for
single-parent families, is much more difficult. They have the
highest poverty rate, and they have the most rapidly growing
demographic group in the country because of our divorce rates
and especially our non-marital birthrates. So we are taking
kids out of the group, married couple families, who have a
poverty rate about \1/5\ of single-parent families, and putting
them into single-parent families. That contributes greatly to
poverty.
And then, of course, the second reason that we have such
high poverty rates is because of education. The gap in
education, even the low-income families and especially black
kids have increased their achievement over the years, somewhat,
not greatly, but somewhat. They still have suffered a greater
gap with middle-class families. So we haven't closed the gap.
And then the final cause, in addition to family composition
and education, is work. Let me devote the rest of my testimony
to work.
We have had one case in which work made a big difference,
and it occurred about the time of welfare reform. It was not
just welfare reform. I don't want to claim that. It was a very
good economy, we had very good programs, and I want to focus on
those programs. And I called them the work support programs.
Congress passed 20, 30 pieces of legislation to change these
programs so that they would be friendlier to work and address
the cliff problem, and so forth.
The Chairwoman. Pardon me, Dr. Haskins----
Dr. Haskins. Yes.
The Chairwoman.--for 1 second. I apologize. To the Members
that are here, you received his PowerPoint, it is right here,
that he is talking about. We are not seeing it on the screen,
but you do have it in front of you.
Thanks. Go ahead----
Dr. Haskins. Okay.
The Chairwoman.--Dr. Haskins.
Dr. Haskins. Do I get my 10 seconds back?
The Chairwoman. Absolutely.
Dr. Haskins. Good, thank you.
All right, so this chart shows other than Social Security
for the elderly, the best strategy that we have found to reduce
poverty. So what we did, if you look approximately at the
middle of the chart, roughly around the mid-1990s, is that we
dramatically reduced poverty among female-headed--kids in
female-headed families. And the reason we did that is in part
because of welfare reform. It required work and the mothers
went to work. It was about a 40 percent increase in the
percentage of mothers, especially never-married mothers, who
were the most disadvantaged, who got jobs. But then the second
part of the equation is that this work support system that I
have been talking about, and that Congress--and on several
occasion over the past 35, even 40 years, Earned Income Tax
Credit, Additional Child Tax Credit, and so forth, and you can
see by the subsequent lines that each of them, when you apply
them to the family, their poverty rate comes down and down and
down and down. It cuts it by more than 40 percent. So these
government programs really make a big difference. I do not
challenge the idea that food stamps are primarily for food, but
it also makes a great contribution to increase the incentive to
work in addition to serving its nutrition benefits.
So now let me say one thing about what this Committee could
do. The focus of welfare reform was not in education training,
it was in work. So states developed great skills, and people
who could do it, help people find jobs, do a resume, some
states even helped people dress better, they practiced
interviews and all that. And as I said, the mothers went to
work in droves, they got jobs, they made low wages, but with
additional benefits they were much better off, and their kids
were too. In fact, the poverty rate among black children who
are disproportionately female-headed families, and among all
kids in female-headed families, both reached their lowest rates
ever. And today, even after two Recessions, they are still
lower than they were during the early 1990s, so the system was
pretty successful.
So what this Committee could do. You have wisely, with the
Senate, created these ten demonstrations, because food stamps
do not have strong work requirements as welfare did in the so-
called TANF Program, Temporary Assistance for Needy Families. I
think they need to be changed. There are lots of issues about
how to change it, and you are going to learn a lot from these
demonstrations. There are ten states that are trying to figure
out how they can increase the work rate in food stamps. And
keep in mind, look at this chart, every mom who goes to work,
even in a low-wage job, it--has a great chance to get out of
poverty. If she works close to full-time and has two or fewer
kids, she will be out of poverty because of her work and
because of the work support benefits.
Now, I want to caution about something that happened in
welfare reform that is still the case today, and that is a
problem, and that is that there are a lot of single moms who
have a hard time both working and rearing their children. And
so as a result, we have a group at the bottom, most people call
it the disconnected mothers, who are probably worse-off now
than they were before. If they could go on welfare and stay in
welfare forever, they wouldn't be out of poverty but they would
be better off than if they didn't have income from either wages
or from cash.
So that is something to look out for. We want a system that
is tough, that requires work, that sends a message that people
have to work and then we subsidize their income, but we don't
want one that is so tough that mothers who cannot work
successfully and have depression or a number of other problems
we can talk about if you want to, wind up without either cash
income from the welfare program or in-kind, like food stamps,
or from earnings.
[The prepared statement of Dr. Haskins follows:]
Prepared Statement of Ron Haskins, Ph.D., Senior Fellow, Economic
Studies and Co-Director, Center on Children and Families, Brookings
Institution, Washington, D.C.
Chairman Walorski, Ranking Member McGovern, and Members of the
Subcommittee:
My name is Ron Haskins; I'm a Senior Fellow at Brookings and I co-
direct the Brookings Center on Children and Families. I am also a
Senior Consultant at the Annie E. Casey Foundation.
I have been invited to talk with you about what this Subcommittee
could do to reduce poverty and increase economic mobility. I begin with
a brief word about the problem; namely, how difficult it has been
reduce the poverty rate. This leads to an overview of one of the most
successful government reforms to reduce poverty, the welfare reform law
of 1996 and its impacts on work rates and poverty. I then turn to
review of what this Subcommittee could do to replicate the success of
welfare reform while avoiding its most important problem.
Are We Reducing Poverty and Increasing Economic Mobility?
Figure 1 shows the changes in poverty rates since 1959 for three
important groups--all children, children in female-headed families, and
the elderly. Trends in poverty among the elderly show something like
the progress everyone hopes we can make in reducing poverty among all
Americans. There was rapid progress in the early 1960s followed by a
slower rate of decline but very few years in which the poverty rate
increased. Poverty among the elderly today is ten percent, much lower
than the rate among children in the other two groups. The explanation
for this pattern can be found in two words--Social Security.\1\ Most of
the elderly receive a monthly cash payment from the Federal Government
that in most cases, including for the elderly who have few or no
additional sources of income, is adequate to keep them out of poverty.
---------------------------------------------------------------------------
\1\ Jonathan Gruber and Gary Engelhardt, ``Social Security and the
Evolution of Elderly Poverty,'' in Public Policy and the Income
Distribution, ed. Alan Auerback, David Card, and John Quigley (New
York: Russell Sage Foundation, 2006), 259-287.
---------------------------------------------------------------------------
Progress among the other two groups is far less impressive, with an
exception to be examined in more detail below. The poverty rate for all
children under the official measure shows rapid progress in the 1960s,
but little consistent progress since. The child poverty rate in 1960
was 14 percent. By 1980, it was over 21 percent. Worse, in no
subsequent year has the child poverty rate reached the 14 percent
achieved in 1969. The rate last year, the most recent available, was
well over 20 percent. Changes over time in the poverty rate of children
in female-headed families has been uneven, and has rarely been below 30
percent. But there was a major decline in the late 1990s that holds an
important clue about reducing poverty. I examine this decline in more
detail below.\2\
---------------------------------------------------------------------------
\2\ ``Income and Poverty in the United States: 2014'' (Washington:
United States Census Bureau, September 2015).
---------------------------------------------------------------------------
Figure 1
Official Poverty Rates for the Elderly, Female-Headed Households with
Children and All Children, 1959-2014
Source: Census Bureau, Poverty Division, CPS ASEC Tables 2
and 3.
Note: Data on elderly poverty rates unavailable for years
1960-1965.
Figure 2
Income Quintile of Children When They Grow Up Relative to Their
Parents' Income Quintile
Note: Numbers are adjusted for family size.
Source: Pew Charitable Trusts, ``Pursuing the American Dream:
Economic Mobility Across Generations'' (Washington: July 2012).
Figure 2 shows a standard measure of economic mobility; namely, the
economic position of children compared to the economic position of
their own parents based on data from the Panel Study of Income Dynamics
that started collecting data on 5,000 families in the 1960s.\3\ Then,
as the children of parents in the original sample grew up, they were
followed as well, yielding data on family income for both the parents
and their children. In Figure 2, the five bar graphs divide the parents
into five parts (called ``quintiles'') based on family income with an
equal number of parents in each bar graph. Thus, the 20 percent of
parents with the lowest income during their prime earning years are in
the bar graph on the left and the 20 percent with the highest income
are in the bar graph on the right; parents with income between these
two groups are displayed in the middle three bar graphs. Notice that
each bar graph is divided into five parts. Each of these five parts
represents the income quintile the children of parents in that income
quintile wound up in during their prime earning years.
---------------------------------------------------------------------------
\3\ Pew Charitable Trusts, ``Pursuing the American Dream: Economic
Mobility Across Generations'' (Washington: July 2012).
---------------------------------------------------------------------------
Figure 2 provides an informative way to look at economic mobility
across generations. If children wound up in an income quintile that was
not correlated in any way with their parents' income, each bar graph
would have five equal parts, each containing 20 percent of the children
of the parents represented in the bar graph. This pattern is close to
the one found in the middle bar graph which shows that children from
parents in the middle income quintile were almost equally likely to
wind up in each of the five income quintiles.
But the other quintiles, especially the bottom and the top
quintiles, show that where children wind up in the income distribution
in their generation is greatly influenced by their parents' income.
Consider the bottom quintile. Adult children from the bottom quintile
have a 43 percent chance of winding up in the bottom themselves and
only four percent of them wind up in the top quintile. Now consider the
top quintile. Here we see that adult children whose parents were in the
top 20 percent were more likely than adult children in the other
quintiles to wind up in or near the top. For example, whereas only four
percent of the adult children of parents in the bottom quintile made it
all the way to the top, 40 percent of adult children with parents in
top quintile made it to the top. Equality of opportunity this is not.
Several studies have shown that this pattern has not changed much over
the generations.\4\ We do not now have equality of economic opportunity
in America, nor have we ever, although there are and have been many
examples of individuals rising far above their parents' income--and
vice versa.
---------------------------------------------------------------------------
\4\ Raj Chetty, Nathaniel Hendren, Patrick Kline, Emmanuel Saez,
and Nick Turner, ``Is the United States Still a Land of Opportunity?
Recent Trends in Intergenerational Mobility,'' American Economic Review
Papers and Proceedings 104 (2014):141-147.
---------------------------------------------------------------------------
The conclusions are obvious, and almost everyone who studies
poverty and economic mobility agrees: progress against poverty has been
modest or nonexistent, depending on the group, and the nation has an
unequal distribution of income that persists across generations. We
have limited equality of educational and economic opportunity in
America.
Why Are We Having Trouble Fighting Poverty and Increasing Mobility?
Why has it been so difficult to reduce poverty and increase
economic mobility? We now spend around a trillion dollars a year on
programs for poor and low-income families and individuals.\5\ Until
recently, spending increased almost every year. But as spending
increased, the nation neither reduced poverty by much nor increased
economic mobility. Why, despite all this spending, have we made so
little progress?
---------------------------------------------------------------------------
\5\ ``CRS Report: Welfare Spending the Largest Item in the Federal
Budget,'' accessed October 23, 2015, http://www.budget.senate.gov/
republican/public/index.cfm/files/serve/?File_id=
34919307-6286-47ab-b114-
2fd5bcedfeb5&__hstc=15845384.42def987e2de1a7208006a251af15a
20.1363171173913.
1364813815069.1364846795312.22&__hssc=215845384.1.1364846795312.
---------------------------------------------------------------------------
Most analysts would agree that the dissolution of the two-parent
family, little progress in improving the educational achievement of the
poor relative to that of the more advantaged, and the decline of work
among men are major factors in accounting for our lack of progress.\6\
More specifically:
---------------------------------------------------------------------------
\6\ Ron Haskins and Isabel Sawhill, Creating an Opportunity Society
(Washington: Brookings Institution Press, 2009).
An ever rising share of American children live in female-
headed families, the family type in which children are five
times as likely to be poor as children in married-couple
families and in which their development is negatively
affected.\7\
---------------------------------------------------------------------------
\7\ David Ribar, ``Why Marriage Matters for Child well-being,''
Future of Children, Policy Brief, Fall 2015.
In addition, until recent years, more and more children were
born outside marriage, in most cases instantly creating the
family form in which children are likely to be poor.\8\
---------------------------------------------------------------------------
\8\ Ron Haskins, ``The Family is Here to Stay--Or Not,'' Future of
Children 25(2) (Fall 2015): 129-153.
Although education levels have improved modestly, the
education gap between kids from poor and rich families has
increased substantially, making it difficult for children from
poor families to close the income gap between themselves and
children from rich families.\9\
---------------------------------------------------------------------------
\9\ Sean Reardon, ``The Widening Academic Achievement Gap Between
the Rich and the Poor: New Evidence and Possible Explanations,'' in
Whither Opportunity? Rising Inequality, Schools, and Children's Life
Chances, edited by Greg Duncan and Richard Murnane (New York: Russell
Sage Foundation, 2011), p. 91-116.
Although work rates among women, especially low-income and
poorly educated women, have shown improvement, the work rate
for men has declined over the last 4 decades and wages for men
in the lower \1/2\ of the wage distribution have been
stagnant.\10\
---------------------------------------------------------------------------
\10\ Harry Holzer and Marek Hlavac, ``A Very Uneven Road: U.S.
Labor Markets Since 2000,'' US2010 series (New York: Russell Sage
Foundation, 2012) .
A comprehensive strategy to fight poverty and increase mobility
would attack these causes on three fronts by aiming to increase the
share of children growing up in married-couple families, in part by
delaying unplanned births; to increase the educational achievement and
years of schooling completed among children from poor families; and to
increase work rates among the poor. In this testimony, I confine my
attention to increasing work rates, an important determinant of poverty
and mobility that this Subcommittee could actually do something about.
I begin with the example of welfare reform.
What to Do: An Example
In 1996 Congress passed and President Clinton signed one of the
most sweeping pieces of welfare reform legislation ever passed by
Congress.\11\ A primarily goal of the legislation was to help,
encourage, and cajole mothers to work. The law did three things to try
to increase work rates: it ended the legal entitlement to welfare
payments, thereby clearing the way for cash benefits to be contingent
on working or preparing to work; it placed a 5 year time limit on
receipt of cash welfare for most mothers; and it required states to
place half their welfare caseload in programs designed to help
recipients find work or prepare for work. After the welfare reform law
was enacted, work rates among single mothers increased dramatically,
the welfare rolls fell more than ever before, and child poverty rates
declined to their lowest level ever among black children and among all
children in female-headed families. These effects cannot be attributed
exclusively to welfare reform. There is general agreement among
researchers who study welfare that the growing economy of the second
half of the 1990s and the maturing of a system of Federal and state
subsidies for low-income workers with children, which will be referred
to here as the ``work support system,'' also played important roles in
accounting for the dramatic increases in work and falling poverty
rates.\12\
---------------------------------------------------------------------------
\11\ Ron Haskins, Work over Welfare: The Inside Story of the 1996
Welfare Reform Law (Washington, D.C.: Brookings, 2006).
\12\ Carolyn J. Heinrich and John Karl Scholz, ed., Making the
Work-Based Safety Net Work Better: Forward-Looking Policies to Help
Low-Income Families (New York: Russell Sage, 2011).
---------------------------------------------------------------------------
Figure 3
Effect of Earnings, Transfers, and Taxes on the Poverty Rate among
Households Headed by Single Mothers, 1987-2013
Note: Abbreviations are as follows: Unemployment Insurance
(UI), Supplemental Security Income (SSI), Aid to Families with
Dependent Children (AFDC), Temporary Assistance for Needy
Families (TANF), General Assistance (GA), Supplemental
Nutrition Assistance (SNAP), Earned Income Tax Credit (EITC),
Additional Child Tax Credit (ACTC), and Federal Insurance
Contributions Act (FICA).
Source: Thomas Gabe, Congressional Research Service, Welfare,
Work, and Poverty Status of Female-Headed Families with
Children: 1987-2013.
Thus, it is the combination of the push of strong work requirements
and the pull of earnings supplements from the work support system that
provides the most complete explanation of how the nation can reduce
welfare rolls, increase work, and reduce child poverty. A recent report
from the Congressional Research Service shows how the new push and pull
system works. Figure 3 shows the trends in poverty rates from 1987 to
2013 based on a poverty measure that, unlike the official measure used
above, counts a wide-range of government benefits (including noncash
benefits like the Supplemental Nutrition Assistance Program, SNAP,
often referred to as food stamps, and cash benefits such as tax
credits) as income. The top line shows the poverty rate among female-
headed families when only earnings are counted as income. Lines below
the first line show the poverty rates when income from the various work
support benefits is added to earnings and taxes are subtracted in
stepwise fashion.\13\ The major finding from the figure is that
government work support benefits have greatly reduced poverty rates
among female-headed families (and low-income two-parent families as
well) in every year since 1987. In addition, the chart reveals a number
of important lessons for Members of this Subcommittee for fighting
poverty. Here is a summary of data from Figure 3 that provides the
information we need to understand these lessons:
---------------------------------------------------------------------------
\13\ Figures were adapted from Thomas Gabe, ``Welfare, Work, and
Poverty Status of Female-Headed Families with Children,'' R41917
(Washington: Congressional Research Service, November 21, 2014),
especially Figure 13, p. 33.
------------------------------------------------------------------------
Poverty Rate Based on:
-----------------------------------------------------
Years Earnings plus
Earnings Only Benefits Minus Difference
Taxes (Percent)
------------------------------------------------------------------------
1987-93 54.3 41.7 ^23.2
2000 40.8 26.8 ^34.0
2010 50.1 29.6 ^40.9
2013 47.6 29.2 ^38.7
------------------------------------------------------------------------
In the early period from 1987 to 1993, the poverty rate among
female-headed families with children based only on the mothers'
earnings was very high-well over 50 percent in every year and averaging
54.3 percent. Then the poverty rate based on earning plummeted for the
next 7 years, falling from 54.3 percent to 40.8 percent, the lowest it
had ever been for female-headed families. This precipitous decline in
poverty was caused mostly by much more work among single mothers,
attributable in large part to welfare reform.
Now consider how work support programs impacted the poverty rate
based on earnings only. Government transfer programs drove the poverty
rate down from 54.3 to 41.7 percent in 1987-93,\14\ a reduction of
about 23 percent. But when the work rate was much higher in 2000, the
poverty rate based exclusively on earnings was only 40.8 percent, 25
percent lower than the comparable rate in the 1987-1993 period. Even
better, after single mothers received the package of work-based
benefits, the 2000 poverty rate fell to 26.8 percent, a decline of 34
percent.\15\
---------------------------------------------------------------------------
\14\ Poverty rates in this section that take benefits into account
are not the official Federal poverty rate. They are based on the
official poverty threshold (the amount of income that divides the poor
and non-poor) but add benefits that are mostly not included in
calculating the official poverty rate.
\15\ The bottom line in Figure 9 includes payments from programs
enacted as part of the American Recovery and Reinvestment Act of 2009,
most (but not all) of which are now expired. Also included in the last
line is income the mother receives from other household members.
---------------------------------------------------------------------------
In 2010, work declined and poverty rose, due to the Great
Recession. Yet the combination of relatively high work rates in 2010
(relative to the 1987 to 1993 period) kept poverty lower than during
the earlier period and the impact of government programs in percentage
terms produced nearly twice as great a decline in poverty as in the
earlier period (a reduction of 40.9 percent vs. 23.2 percent).
Finally, the figures for 2013 show that female heads are now
increasing their earnings from work, and the work-based safety net
continues to reduce poverty a great deal (nearly 39 percent).
This analysis shows that the Federal work support system achieves
the goal of, as President Clinton put it so tersely, ``making work
pay.'' \16\ The most important element of the work support system was
the creation of the EITC program in 1975 and its expansion, almost
always on a bipartisan basis, on several occasions since. The EITC
provides working families that include children with nearly $60 billion
each year, mostly in one-time cash payments. The passage of the
Additional Child Tax Credit (ACTC) as part of the Bush 2001 tax
reforms, along with subsequent expansions of the ACTC, were also
important and now provide working families that include children with
around $30 billion each year. In addition, child care subsidies have
been expanded on numerous occasions, the Supplemental Nutrition
Assistance Program (SNAP) has been modified to make it easier for
working families to claim the benefit, the Medicaid program has been
modified and extended (in part by creating the Child Health Insurance
Program in 1997) to cover almost all children under 200 percent of
poverty, and a number of other improvements have been made in the work-
based safety net at both the Federal and state levels. This system is
available to all low-income working families with children and
virtually guarantees that if parents work close to full time, they and
their children can escape poverty.
---------------------------------------------------------------------------
\16\ The combination of work support benefits does have work
disincentives in the sense that some program benefits are reduced as
earnings rise. In most cases, however, the combination of earnings and
work support benefits yield higher total income than either earnings
alone or welfare benefits alone. According to the Congressional Budget
Office, the marginal tax rates on earnings for low-income working
families can be as high as 60 percent. See Congressional Budget Office,
``Effective Marginal Tax Rates for Low- and Moderate-Income Workers''
(Washington: CBO, November 2012).
---------------------------------------------------------------------------
What to Do: Two Ideas for the Nutrition Subcommittee
There are two actions this Subcommittee could take in the near
future that would have an excellent chance of reducing poverty. The
most important outcome of welfare reform was increased work rates by
single mothers. Not only did the work rate of single mothers increase
in the years after welfare reform, they have stayed higher than they
were in the early 1990s and previously despite two recessions and the
increased unemployment that comes with recessions. Given the importance
of benefits from the work support system in fighting poverty, work
becomes even more important because welfare recipients have to work to
get benefits from the work support system. So work opens up two sources
of income-earnings from the employment and benefits, especially tax
credits, that can only be obtained if mothers work.
The food stamp program currently has modest work requirements, but
they do not appear to be rigorously enforced. Last year Congress, at
the instigation of the House Agriculture Committee, wisely provided
$200 million over a period of years for the Department of Agriculture
to sponsor ten pilot demonstration programs by states that are willing
to explore innovative ways to encourage work among food stamp
recipients.\17\ An interesting parallel of this action is that the 1996
welfare reforms were preceded by more than 40 states conducting
demonstration programs aimed at testing ideas about how to promote
work, many of which were evaluated by high quality research designs.
These demonstrations generally showed that mothers on welfare could
work and that programs that helped them prepare for work and look for
jobs increased work rates and reduced the welfare rolls.\18\ By the
time of the welfare reform debate of 1995-96, most Members of Congress
on both sides of the aisle realized that many mothers on welfare were
capable of working and that good programs that helped them prepare for
and find jobs could substantially increase their work rate and reduce
the welfare rolls. It seems likely that the ongoing food stamp
demonstration programs will provide solid ideas about how states can
increase work rates among food stamp recipients, in this case both
women and men. These results can be expected to provide the
Subcommittee with ideas about how to write legislation that would
encourage work among food stamp recipients.
---------------------------------------------------------------------------
\17\ Department of Agriculture, ``2014 SNAP E&T Pilots,'' accessed
October 22, 2015, http://www.fns.usda.gov/2014-snap-e-t-pilots.
\18\ Judith M. Gueron and Howard Rolston, Fighting for Reliable
Evidence (New York: Russell Sage, 2013).
---------------------------------------------------------------------------
An outcome of welfare reform that should be emphasized is that most
mothers who found employment worked in low-wage, mostly unskilled jobs.
Thus, their earnings were generally quite low.\19\ Few states had
effective programs that attempted to upgrade the skills of mothers.
Even low-wage jobs provided a step toward self-sufficiency, but many
analysts think that with training (especially training for jobs
available in the local economy), these mothers could attain the skills
that would lead to better jobs, higher earnings, and even lower poverty
rates. There is now a large and growing literature on how skilled jobs
that require a certificate, a license, or a 2 year degree, often from a
community college, can help young people from poor and low-income
families qualify for good jobs with higher incomes.\20\ According to
the Department of Agriculture, the work demonstration pilots will test
``a range of job-driven strategies, including intensive sector-based
approaches and career pathways that prepare workers for specific
occupations.'' And because the pilots are being subjected to scientific
evaluations, we can be confident that the findings will be reliable.
These pilots, in other words, are very likely to provide the basis for
legislation that will encourage or require states to establish programs
that increase both work rates and earning among food stamp recipients.
---------------------------------------------------------------------------
\19\ Greg Acs and Pamela Loprest, ``TANF Caseload Composition and
Leavers Synthesis Report,'' (Washington, D.C.: Urban Institute, March
28, 2007).
\20\ Tamar Jacoby, ``The Certification Revolution,'' in Michael
Petrilli, ed., Education for Upward Mobility (New York: Rowman &
Littlefield, 2016); Sheila Maguire, et al., ``Tuning Into Local Labor
Markets: Findings from the Sectoral Employment Impact Study''
(Philadelphia: Public/Private Ventures, 2010).
---------------------------------------------------------------------------
A word of caution, based on the results of welfare reform, is in
order. The share of families in poverty receiving welfare cash payments
has declined as compared with the share receiving cash under Aid to
Families with Dependent Children (AFDC), the cash welfare program that
preceded the 1996 welfare reforms. In 1979, for every 100 families in
poverty, 82 families received AFDC. By contrast, in 2013, for every 100
families in poverty, only 26 families received Temporary Assistance for
Needy Families (TANF), the cash welfare program established by the
welfare reform law of 1996.\21\ Some observers have concluded that the
increases in work and reductions in poverty achieved by welfare reform
resulted from work requirements and time limits that forced too many
mothers off TANF without jobs. But there is little evidence that harsh
provisions are necessary to encourage able-bodied adults to work.
Reasonable requirements, strongly enforced, and accompanied by the
carrots for work provided by the work support system, may well be
enough to encourage adults to work. And in any case, the Subcommittee
will have the results from ten state food stamp pilot work programs to
provide ideas about how food stamp recipients can be encouraged to work
without resorting to harsh measures.
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\21\ LaDonna Pavetti, ``Testimony of LaDonna Pavetti, Ph.D., Vice
President, Family Income Support Policy, Before the House Ways and
Means Committee, Subcommittee on Human Resources'' (Washington: Center
on Budget and Policy Priorities, April 30, 2015), http://
waysandmeans.house.gov/wp-content/uploads/2015/06/LaDonna-Pavvetti-
Testimony-043015-HR3.pdf.
---------------------------------------------------------------------------
A second caution is that some people believe the goal of food stamp
work requirements should be to get as many people as possible off food
stamps. This goal, however, sharply conflicts with another goal of food
stamps as a vital part of the work support system; namely, to
supplement the earnings of low-wage workers and thereby both improve
their economic standing and provide a strong work incentive. Just as
many mothers who join the welfare rolls lack the skills and experience
to fill the requirements of high wage jobs, so many recipients of food
stamps are similarly qualified only for low-wage jobs. To both Congress
and society, the goal of luring people into work and helping them
improve their economic condition should be the most important goals.
Some of these people will work their way into jobs that pay enough that
they will no longer qualify for food stamps. But most people, including
parents, who are on food stamps will not have the skills to command
high wages. In these cases, food stamps will provide an incentive to
continue working and will allow workers to boost their income.
Conclusion
Over the last 4 decades, Congress has constructed a work support
system that not only makes work pay, but also provides substantial work
incentive. The food stamp program is a vital element of that system.
When the incentives of the work support system are combined with
effective programs that encourage work, help people acquire skills, and
help them find employment, many of the adults receiving food stamps
today and in the future will join the workforce, increase their self-
sufficiency, set an example for their children, and improve their
economic condition. Moreover, the state food stamp work demonstrations
now being implemented seem likely to serve as a beacon to help states
implement and sustain programs of this type.
The Chairwoman. Thank you, Dr. Haskins.
Dr. Haskins. Okay.
The Chairwoman. I appreciate it. And thanks to all of you
for your testimony.
We are going to move to the question period now. And I want
to just start out by saying, in my district, in South Bend,
Indiana, we just started recently with a three times a day
feeding program. We had breakfast, lunch in schools. Now we are
moving, in some areas in my district, to dinner as well. It is
being done year-round in some of the school districts. But as
we talked about today, we want to move beyond this issue of
just feeding kids and saying they are going to be successful.
And we want to see these kids succeed, we want to talk about
the community partnerships and those kind of things that are
available to make sure that kids actually have a chance to
reach their American dream. To do that, as you have heard
earlier, we are talking about holistic kind of approaches that
we have never done before, and we have made a real effort in
this Subcommittee to do that.
So I want to direct my question to Ms. Riley. Looking back
on your childhood and some of the experiences that you have
already shared in your testimony, can you just kind of
elaborate and tell us a little bit more about the support that
SNAP and school meals provided for you and your siblings, and
the whole concept of being a child raised in poverty, and
working your way out, but still looking back to your childhood,
what did it mean, how important was the nutrition assistance
you received?
Ms. Riley. Well, as a child, you are kind of oblivious a
little bit. I mean you realize that you are different than the
other kids. You have a means to get the nutrition in a
different way, whether it is the ticket that I used to get my
meals. But, as I talked to my mom, once I became a
spokesperson, I really started to understand the dynamic of our
family and her need at that time and how essential this was. So
my role as a spokesperson has been a sense of gratitude looking
backward and understanding how impactful these programs were to
my success, not realizing it maybe at the time, but now as an
adult, realizing that they were absolutely essential to me
being a healthy student and an athlete.
The Chairwoman. I appreciate it.
And, Dr. Haskins, we heard at previous hearings we needed
evidence-based understanding of how to address this issue
holistically. In your opinion, have we moved the needle at all
recently when it comes to poverty and economic mobility? Should
we keep doing the same things, or do you believe it is
worthwhile to actually reexamine the situation and say what
else can we do?
Dr. Haskins. Economic mobility is a much broader problem
and will require a much broader solution. And I am going to
leave that aside. Poverty, I think we have made progress, yes.
I have shown in the mid-1990s and even today, we have a lower
poverty rate among female-headed families. And the Committee
should know that we are not going to make progress against
poverty unless we address where it is most frequent, and that
is among female-headed families.
So this strategy of work and work support, something for
both sides of the aisle, is really a good strategy. We need to
expand it. We need more people on food stamps to have a job,
even if it is a low-wage job, and we would make even more
progress against poverty. I think the charts that I have shown
you show that that is the case.
The Chairwoman. I appreciate that as well.
And then, Ms. Riley, just briefly back to you. In the time
that you have been involved now as an advocate for the No Kid
Hungry campaign, do you see improvements in the lives of the
kids through the organization you are working for, do you see,
anything positive happening? And while there is a long way to
go, have you seen strides being taken that have been effective
in the area that you are focused on?
Ms. Riley. Yes, absolutely. And I have been a spokesperson
in all the cities that I have played in probably in the last
few years, and so I have been able to see a different
demographic aspect to that as well. But for kids to know that
there is a provision there, and to not have to worry about the
essential foundation of what they need, allows them to have
hope----
The Chairwoman. Yes.
Ms. Riley.--for a better future, allows them to just kind
of focus on what is before them, which is their school, which
is their ability just to be kids.
The Chairwoman. I appreciate it.
And then, Dr. Ratcliffe, one follow-up question quickly.
This issue of looking holistically at the issues low-income
people face, can you elaborate a bit more on that, this is
actually one of the issues the Committee is looking at in terms
of what else can we do.
Dr. Ratcliffe. Thank you. One of the issues, when we look
at children from birth and throughout their childhood, is that
parents' educational attainment is so important. So it is work
of the parents, but also we should look at education and
training programs, in coordination with childcare and other
work supports, to help people and parents provide better for
their families and move up the economic ladder.
The Chairwoman. Thank you, and I appreciate it.
And I want to recognize now Mr. McGovern for 5 minutes.
Mr. McGovern. Well, thank you very much, and I appreciate
all your testimony. And just for the record, Dr. Ochoa
mentioned the American Academy of Pediatrics policy statement,
which recommended that pediatricians screen all children for
food insecurity, noting the negative health that is associated
with child hunger. I think it is an important statement. I
would like to ask unanimous consent that we insert the AAP's
policy statement into the record.
Without objection? Okay, all right.
The Chairwoman. Yes.
[The information referred to is located on p. 439.]
Mr. McGovern. And----
The Chairwoman. I am nodding my head.
Mr. McGovern. Okay. I know we are talking about the whole
picture here, but we need to get all the little pieces correct
if we are going to solve the big picture, and that means we
need to make sure that SNAP works and provides a benefit that
is adequate to feed children and to feed families. I think it
is important to note that the SNAP benefit was more generous in
2013 than it is today. Food prices continue to go up, and more
and more families on SNAP end up at food banks. We have close
to 20 million children in this country who are hungry and food-
insecure. I think every single person in this Congress should
be ashamed of that fact. We are the richest country in the
history of the planet. We have close to 20 million children in
this country who don't have enough to eat, who end up at food
banks, who end up at food pantries at the end of the month. And
I think that is something we need to fix.
We want to get the nutrition part of this right, so we need
to make sure that the benefit is adequate.
And, Dr. Haskins, look, I appreciate your talking about the
importance of work, but let's understand one thing. Work
doesn't mean people get off of SNAP. To work, they need to be
able to work. Childhood development needs to come first because
that is the most important issue that we are talking about here
today. And we need to make work pay more. No one here mentioned
raising the minimum wage, but the fact of the matter is you
have people working and they are still on SNAP. Congress has
cut not only money for SNAP, Congress has cut money for job
training programs. And before we change anything, we ought to
see what the results of the SNAP work pilots are and then base
any changes on that.
Dr. Ochoa, in your testimony, you say you have data on what
a higher SNAP dose means for the health and well-being of
children in the form of the ARRA monies that boosted SNAP and
then ran out in November 2013. What does the evidence show,
because I want to make sure we get this right, and it is
important for people to understand that there are no quick
fixes. And a lot of the fixes we are talking about in terms of
job training, it is going to cost more resources. But I want to
make sure our kids right now are getting an adequate food
benefit. Maybe you could respond to that.
Dr. Ochoa. Yes, thank you, Mr. McGovern.
As you mentioned, the SNAP benefit was more robust in 2013,
and 2013 is when the Institute of Medicine issued its report
saying that the SNAP benefit needed to go up. And so what we
were able to see with our research in these five sites across
the country was that when our up-boost was in effect there were
much less hospitalizations and less developmental delay, better
health, better height to weight for the children that we
interviewed in our clinics and emergency rooms. And after the
rollbacks when we reexamined the data, we found that families
with young children were 23 percent more likely to be household
food-insecure, and 17 percent more likely to be child that was
food-insecure.
So in the face of having the better benefit and the better
outcomes, that reversed rather quickly. So it is a troubling
scenario, if you will, that under a more robust benefit as it
was, just a little change in that can really have disastrous
outcomes on child health.
Mr. McGovern. Yes. Well, I tell people all the time that
hunger is essentially a political condition because we know
what we need to do to solve it, but we, for whatever reason,
don't muster the political will to do it. I am not just talking
about Congress, I mean the White House as well needs to take
stronger leadership.
And I go back to where I began. I think we ought to have a
White House conference on food, nutrition, and hunger because I
do think that is the place where all these different ideas
which fall under the jurisdiction of multiple committees can
come together, and we can figure out a roadmap to move forward.
When you ask anybody, whether it is in the White House or here,
what is the plan to end hunger in America, there really isn't a
plan. We have programs to try to deal with hunger, but there is
no plan, and we do need a roadmap, and I am trying to find out
where the forum is that we can kind of connect all the dots and
pull these pieces together. I don't know if anyone has any
ideas, or if you want to endorse my idea of a White House
conference on food, nutrition, and hunger, that is perfectly
fine with me, but if we are serious about this, the White House
needs to be involved more directly on this matter.
I think I am out of time.
The Chairwoman. The chair now recognizes Mr. Crawford, for
5 minutes.
Mr. Crawford. Thank you, Madam Chair. And I want to thank
the witnesses for being here, and particularly I want to
welcome Dr. Ochoa from Arkansas Children's Hospital.
I am one of those families in Arkansas who has seen
personally, up close and personal, the benefits of Arkansas
Children's Hospital. It is a world-class institution and doing
great work there, and I thank you for that.
You mentioned some statistics in your testimony, Dr. Ochoa,
about Arkansas in particular being the second highest rate in
the United States in terms of food insecurity, and I find that
to be a little bit ironic considering we are one of the most
productive agricultural regions in the country, if not the
world. And so I say that to say this: we tend to look at these
problems a lot of times through the lens of our own district,
but with the statistics that we have in east Arkansas, which is
my district, and the Mississippi Delta, if we can get this
issue right there we can apply that anywhere, and create a
template to really effectively address this food insecurity
issue.
Let me ask what specifically the Arkansas Children's
Hospital is doing and the work you are doing in the region, how
are you tackling food insecurity in the Delta, and can you
expand on the role of public-private partnerships to help
assist in those challenges?
Dr. Ochoa. Yes, thank you very much, Mr. Crawford.
As I mentioned in my testimony, we issued a report in the
spring called Doctor's Orders, and I have some copies of these
reports here with me today, because what we specifically tried
to do at our institution was look at ways that we could help
hungry families that were coming to us for care. I mentioned
that we are the only pediatric hospital in the state, and so we
interview people in our emergency room from all parts of the
state, and we found that there were just as many people who
were coming to the emergency department who were food-insecure,
but interestingly enough, different from the other sites in our
research network, more of our families were educated and had
higher incomes. So even for people who had higher education and
income levels, the rates of food insecurity, and particularly
child food insecurity, were very high.
So we started looking at things that we could do at
Children's to help the situation, and we have gotten into
partnerships with both the State Health Department and the
State Department of Human Services, and private organizations
like the Arkansas Hunger Relief Alliance and the Arkansas Food
Bank. So we are doing a variety of things. One is that we are
training our people in the hospital who are financial
counselors to help people with their Medicaid and their SNAP
applications at the same time. DHS helped us a great deal with
that. Second, DHS helped us apply to be a site for the summer
meals program, and now we have extended that to all-year-round
meals. And since we started those meals a couple of years ago,
we have given away more than 40,000 free lunches to kids that
are on our campus. We ask no questions. They can have their
siblings get a lunch. So we give these lunches out every day of
the week. We also have partnered with the Health Department to
have a WIC office on our campus. So now for 1 day a week, we
have a WIC office on our campus that can do eligibility
determinations, and help people who are either getting
discharged from the hospital or leaving our clinics. And I am
sure a lot of those kids who are leaving from our hospital beds
are going back to your district feeling better that they have
gotten their WIC eligibility straightened out. And we have also
partnered with the emergency food networks to have food
available that we can give to families when they leave. So the
partnership with the local food pantry, our residents can ask
screening questions about food insecurity and provide those
bags of food to families.
I am going to open a clinic in about a year under the
Children's Hospital umbrella in southwest Little Rock where
Latino and African American children are predominantly living
in the city. And we are going to bake all this in, if you will,
to the way we design the clinic. To do the Hunger Vital Sign,
to ask about food insecurity, and to have things ready to
intervene when we find those.
Mr. Crawford. Thank you. I know there has been a lot of
mention about breaking the cycle of poverty. Madam Chair, you
mentioned that as a question you received in a meeting in your
district.
Dr. Ochoa, based on your experience in the Delta, what do
you think needs to be done to support children who want to
break the cycle of poverty, how do we do it?
Dr. Ochoa. Well, there are a lot of complex, interlocking
needs. Families don't just come with one issue. And when a
child is sick, we see that there are a lot of things that are
going on. It is not just about food, it is also about housing,
it is also about income. We are working with other advocates in
Arkansas to try to start a conversation about the EITC in
Arkansas which is very important. We have to think about other
things like childcare supports. I am glad that Dr. Ratcliffe
mentioned that because if you have more moms who are working at
low-wage jobs, if you don't have the childcare to help that
backstop, it is really not going to be very helpful for that
mom. So there are a lot of interlocking needs that we need to
address and think about the holistic view of the child, but
also know that hunger really marks the brains and the bodies of
our children.
Mr. Crawford. Thank you.
I yield back.
The Chairwoman. The chair recognizes Ms. Adams, for 5
minutes.
Ms. Adams. Thank you, Madam Chair, Ranking Member McGovern.
And thank you all for your testimony.
North Carolina is currently approved by USDA to receive a
waiver from work requirements for able-bodied adults in the
areas of the state that continue to experience high levels of
unemployment for Fiscal Year 2016. The waiver allows able-
bodied adults to receive SNAP benefits for more than 3 months
during a 3 year period if they cannot find a job during an
economic crisis.
Recently, the North Carolina General Assembly passed House
Bill 318, and it prohibits the state from ever applying for a
waiver for SNAP work requirements for able-bodied adults during
an economic crisis, and that any waivers currently requested
shall not extend past March of 2016.
The bill, in my opinion, is mean-spirited. It punishes
people in high unemployment areas. And in my district, we have
a 13.8 percent unemployment, and, of course, this limits the
state's ability to meet the needs of the unemployed. As has
been said here, SNAP is not a work program, it is a nutrition
program, to help those who are struggling to put food on the
table.
Last month, I sent a letter to our Governor asking that he
veto this bill. And we are still waiting, but I continue to
call on our Governor to do this, which he must do by the end of
this week to keep the bill from becoming law.
Dr. Haskins, if there are not enough jobs to go around for
every able-bodied adult without dependents in North Carolina,
what is the value of increasing work requirements for SNAP
recipients?
Dr. Haskins. Whether there are jobs available or not is a
complex question because even during a recession when
unemployment rates are high, people get jobs every day. There
is a lot of circulation in the economy so there are jobs
available even during a recession. That means that some people
are going to be out of work if there are no jobs available, so
they have to look in adjoining counties and so forth.
I think it is reasonable to have some adjustment during a
recession in Federal work requirements. I am not sure I would
suspend them, but I would give people a longer time to find a
job, for example, would be a reasonable approach. It is not
unreasonable to suspend them, but that defeats the policy in
the first place. There needs to be continuing pressure. People
getting public benefits need to know that they have to work as
much as possible, and the government will make exceptions when
it seems appropriate to do so, namely during recessions or
high----
Ms. Adams. Right.
Dr. Haskins.--unemployment rates like you are talking
about.
Ms. Adams. Thank you, sir. I think there are lots of things
that prohibit that. I mean transportation, gaps, in terms of
skills gaps and the jobs that are available.
Dr. Ochoa, how might SNAP be of particular benefit to young
children who also experience the stress of living in poverty?
Dr. Ochoa. Yes, thank you. That is an excellent question. I
think that benefit starts in the womb. So when moms are
pregnant and they are on SNAP, our research shows that the
children that are born to those moms do better. They do better
developmentally, they have better birth weights, they are in
the hospital less often. And so we not only see the benefit
from SNAP beginning prior to birth, but then we see the
benefits all through childhood.
A program like WIC is great, but WIC is part of the overall
fabric of food support that these families need in poverty. So
the SNAP benefit that impacts not just the child but the whole
household is really important. And as I mentioned earlier, it
lasts all through early childhood when brain formation is
really at its critical point, and continues all through school
and the workforce.
Ms. Adams. Thank you. How might the investment in SNAP save
money and healthcare costs in the long-run, just as other
vaccines do?
Dr. Ochoa. Well, our research shows that when children have
an appropriate SNAP benefit and they are not in child food-
insecure households, they do better. So we know there are less
hospitalizations, there is less developmental delay. The
developmental delays that I see in my clinics cost the system
money because we are trying to catch those kids back up. It
decreases the rate of pre-term births. There is just a whole
host of scientific evidence that shows that SNAP is really a
health benefit.
Ms. Adams. Thank you.
And, Madam Chair, I yield back.
The Chairwoman. The chair recognizes Mr. Yoho, for 5
minutes.
Mr. Yoho. Thank you, Madam Chair. Thank you all for being
here.
Ms. Riley, let me start with you. What led to your success?
I mean was it an internal desire to become great at what you
do, was it the physical attributes, was it mentors around you
that inspired you that led you into that, or was it a
government program?
Ms. Riley. All of the above.
Mr. Yoho. All of the above?
Ms. Riley. It was----
Mr. Yoho. I agree with that. You were going to say
something else?
Ms. Riley. Just that without any of the contributing
factors, my mom, mentors, teachers, the program, I couldn't
have been able to accomplish what I did.
Mr. Yoho. All right. Is there one that was greater than the
other? Loving, nurturing mother that gave you the can-do
attitude?
Ms. Riley. I think without food, it wouldn't have mattered
how great my mom was.
Mr. Yoho. Well, absolutely. None of us would be here
without it. There are a lot of us that have stories like you.
We have seen people throughout history have that. This
Committee has heard my story too many times to repeat it, other
than when my wife and I were married, we were picking up soda
bottles to get by because there were no jobs. It was during the
1970s.
The point is--and, Dr. Ochoa, you brought up hungry kids,
low performance, food insecurity, we know all these things. We
know about the prenatal vitamin supplements and all those
things that are necessary to have and birth a healthy child. We
know all those. We can do those studies over and over again.
Those are the facts. I mean that is just science. And it is
important to have those.
Dr. Haskins, you brought out that the single-parent
households have the highest level of poverty and the highest
level of food insecurity, and I agree. And these are all facts
that we know. To me, we are treating a symptom and not treating
the underlying problem. The underlying problem, to me, is
responsibility in a lot of this case. Not all these. Because if
we talk about the elderly or the disadvantaged, the people that
can't work, that is a whole different category, but for the
able-bodied person to raise children in the 21st century in
America and not be responsible for that child--and I am a
veterinarian by trade, and if we have somebody that doesn't
take care of an animal, the county steps in and they will
educate them, sometimes fine them, sometimes take that animal
away. And I said this in a meeting, actually with my priest,
and he said, so you want to treat children like people--or you
want to treat children like animals. I said no, but do we treat
our animals better than we do our children? And to go along Mr.
McGovern's case here, the plan to end hunger in America. I
think that is a noble cause, but we need to look at the
underlying cause, why are parents having children, multiple
children, if they can't have the responsibility to take care of
them? Is there any penalty for not taking care of a child? Does
anybody want to weigh-in on that?
Dr. Haskins. Yes, there certainly is. We have a very active
child protection system, and they intervene in families all the
time. We have thousands of children in foster care because
their parents are not providing adequate care. And sometimes we
completely terminate----
Mr. Yoho. Before that though.
Dr. Haskins.--their rights----
Mr. Yoho. I mean before----
Dr. Haskins.--and put them up for adoption.
Mr. Yoho.--that. With one child I can understand that, but
to have multiple children that fall into this. I know this is
at the risk of being very controversial, but it if we don't
treat the underlying problem, and I know it goes with
education, food, good jobs, and all of that, good-paying jobs,
we are missing the boat because we are winding up treating a
symptom that we are going to treat over and over and over again
unless we get into that. And it is noble that we get in there
and we feed the children, and we get them off to a good
educational start so that they can break that cycle, but we
should put more responsibility or more emphasis on the
responsibility. When that mother comes in, the single mother
comes into a health clinic and talk about the responsibility of
raising that child. And I just hope we are all doing that in a
manner that we get the results we want so that we can, as Mr.
McGovern said, work at ending hunger instead of just
perpetuating a situation over and over again. Any thoughts, Ms.
Ratcliffe--Dr. Ratcliffe----
Dr. Ratcliffe. Yes.
Mr. Yoho.--I am sorry.
Dr. Ratcliffe. Thank you. The fact is that we do have poor
children today, and so what my research shows is that focusing
on those children and making sure they get what they need is
going to help us into the future. And even if you have families
that are working full-time, full-year, at the minimum wage,
even above the minimum wage, that they are going to be eligible
for a program like SNAP. And when you talk to low-income
families, a lot of what they say is they would like one good-
paying job. So when we look at it, there are lots of complex
issues that families are dealing with.
Ms. Riley. If I could really quickly just say from my own
experience, my mom obviously didn't intend to be a single
parent. My father left. She wasn't raised in a household where
her parents encouraged her to get a skill-set and an education.
So these programs are essential to fill in the gap when she was
getting that education to provide for us. So you are looking at
a smaller subset there.
Mr. Yoho. Well, my house got repossessed when I was 15 and
there were six of us in the household. And, I understand that
plight, and it is, again, it was the opportunity that we took
advantage of and I never wanted to repeat that for my children.
I yield back.
The Chairwoman. The chair recognizes Ms. Plaskett, for 5
minutes.
Ms. Plaskett. Thank you very much. Thank you, Madam Chair,
and the Ranking Member. And thank you so much for your
testimony, for your thoughts and ideas in this.
I had so much to say, or questions that I had to ask, but I
was really taken by the last line of questioning, and the
discussion about symptoms and what the underlying symptoms are.
Recognizing in my own life that so many of the friends that I
grew up have not had the success that life has given me, and so
much of it had not to do with responsibility but just sheer
luck and being in the right place, because everybody wanted to
be responsible and everybody wanted to have those
opportunities, but they don't always come. They particularly
don't always come in the areas that this country has completely
forgotten about, or have neglected because they want to have
policies that satisfy their own personal needs but don't put
food in children's stomachs. And so the symptom is us, not the
irresponsibility of parents. But for those of us that have
excess food, and food being in abundance in this country, that
there are children who do not eat, who cares if their parents
are not working. If children don't eat, that is an indictment
on all of us.
So, Dr. Haskins, I wanted to ask you a question. You talked
about jobs and the responsibility, and that indeed it is very,
very important for people to have jobs, not only to receive the
funding, because having jobs makes people feel like fulfilled
individuals, and I think that most people want that feeling. I
agree there are some who do not, but as a general whole, most
Americans, most people throughout the world require that.
What do we do in the instances where we have a district or
an area that has a 31 percent child poverty rate, and in some
areas in that area there is an 18 percent unemployment rate,
how do you fulfill the need for people to have jobs in areas
like that?
Dr. Haskins. Well, there are several answers to that
question. Historically, Americans have moved to different
places if they can't find jobs----
Ms. Plaskett. And what if----
Dr. Haskins.--that is----
Ms. Plaskett.--they are so poor that they cannot get a
plane to get them off of the island where this place is?
Dr. Haskins. They have relatives, they have friends, there
are many people who take advantage of that, and the borrow
money, they are able to move if they are really determined to
move and especially if they have job experience.
Ms. Plaskett. So we just have a----
Dr. Haskins. Another----
Ms. Plaskett.--decimated place that no longer has the
people living there because there are no jobs there, and we
don't want them to be on food stamps or school lunch programs,
we would rather they borrow money from family and leave----
Dr. Haskins. No, I----
Ms. Plaskett.--than take care of the situation here?
Dr. Haskins. That is not what I am saying. I haven't said
anything about cutting food stamp benefits or anything like
that. In fact, I am arguing that food stamps are a crucial part
of what I call the work support system, and a lot of people
work because they can, not just with their own wages, which are
often low, but because they get these other benefits, up to
around $30,000 or so, they can make their family better off
because of food stamps, Medicaid, childcare, and so forth. So
the government programs that help them are essential. That is
the main point of my testimony.
Ms. Plaskett. Yes. And then aside from that, what are other
ways that they could be able to get food, I know that some
places have the waiver, but if the waiver is not available,
what do we do then? For those people who are going to be, for a
sustained period of time, on these programs.
Dr. Haskins. Okay, one idea that has been tried in the past
and has been, I would say, modestly successful is the
government hires people in jobs, some people call them make-
work jobs, but they don't have to be that way. They used--in
the old days they were called community work experience jobs.
In some places, they made a guarantee to people and say you are
going to get a job, you go out and look, we are going to give
you, say, 2 weeks or 3 weeks----
Ms. Plaskett. Yes.
Dr. Haskins.--if you can't find a job, we are going to give
you a job, and you get paid the minimum wage for that job so
there would be motivation to try to get out of the job.
Ms. Plaskett. Thank you.
Dr. Haskins. But once you have income----
Ms. Plaskett. Yes.
Dr. Haskins.--and earnings, then you can get these benefits
in the work support system and you would be much better off.
Ms. Plaskett. Thank you.
And, Dr. Ratcliffe, it is really important for us on this
Subcommittee and the Committee as a whole to have a detailed
reporting from you about the impediments that occur to families
and to those children who have these food issues, particularly
the economic, the long-term economic detriment to the
individuals. I was really encouraged and interested in seeing
the educational parameters and the impediments that happen to
those educationally. Are there other areas, even their own
relationships, the next generation, those things seem to me
very important? Thank you.
Dr. Ratcliffe. It goes back to some of what Dr. Ochoa was
saying. Some of the research that looks at outcomes and child
experience, we find that children who are poor in their
earliest years, between birth and age 2, that they are less
likely to graduate from high school, and that is controlling
for how long they are in poverty, parents' employment, other
measures of family well-being. So it is really in these early
years that can be particularly critical. And if we are looking
to identify children who are most at risk, those are children
who are born to poor parents and poor, less-educated parents,
those children are particularly likely to be persistently poor
and then have these worse academic outcomes.
Ms. Plaskett. Thank you.
The Chairwoman. The chair recognizes----
Ms. Plaskett. Thank you for your indulgence.
The Chairwoman. Not a problem. The chair recognizes Mr.
Aguilar, for 5 minutes.
Mr. Aguilar. Thank you, Madam Chair and Ranking Member
McGovern.
Dr. Ochoa, I appreciate your statement where you referenced
the fact that children who are living hungry may not experience
those signs of food insecurity in the home. Children with
asthma and allergies may demonstrate health-related issues and
may not show signs of food insecurity. The screening process
that you created to find children who are at risk of food
insecurity is a great tool, and I wanted to know if you could
expand on that for us, and do you believe that this is a model
that can be used in other states, either on demonstration
basis, or through your association? Can you walk us through a
little bit of that piece?
Dr. Ochoa. Yes, thank you, Mr. Aguilar.
The Hunger Vital Sign, as I mentioned, we distilled from
the 18 question USDA food insecurity screener and we validated
that in our Children's HealthWatch sites. And so we actually
are piloting it at our institution, at Arkansas Children's
Hospital, with our resident trainees and their pediatric
continuity clinics where they see the same panel of patients
over the course of their residency. And we have found in some
preliminary data analyses that they are detecting food
insecurity at a rate of about 23 percent, just like our
research in our emergency department shows. So by advocating
for the use of the Hunger Vital Sign, our academy, which
represents well over 70,000 pediatricians across the country,
and hundreds of thousands of pediatric trainees, is advocating
for its routine use. I do know that in the State of Oregon, the
Medicaid Program is looking at the Hunger Vital Sign as a
performance measure, and that would be great to replicate in
other State Medicaid Programs as a tool for how effectively we
are addressing the social determinants of health.
I wanted to mention also that the kids that I see in my
clinics are brought there by responsible parents who care for
them, and they are bringing them to us to help. It would be a
fantasy for me to try to treat some medical condition and
completely ignore a hungry child or hungry family. So that is
why the Hunger Vital Sign is so important because we are
looking for other ways that we can support those families so
that the health of their child is good, but the health of the
household is even better. And it is our responsibility as
pedestrians to figure that out.
Mr. Aguilar. And oftentimes the individuals that are coming
to you, they are going to have siblings who are going through
similar issues. Ms. Riley talked about her family and her
experiences. So if you could identify one child and screen them
and offer this type of service and awareness, you could be
helping multiple members of the family at the same time.
Can you talk about other examples? You mentioned Oregon.
How difficult would it be to take it to scale? Is the use
through Medicaid a best practice, is it the best way to go
about it, or what are other ways that we can look at it?
Dr. Ochoa. Well, it can absolutely be taken to scale. I
mean there are large health plans across the country like
Kaiser. Kaiser is looking at the Hunger Vital Sign as well. But
because Medicaid takes care of the majority of children in
Arkansas, from birth through age 18, and when we expanded
Medicaid for our adult population we also were able to have an
impact on how we address social determinants for the low-income
adult population. So I absolutely think that this can be taken
to scale, along with some of the other interventions that we
mention in our report, like the partnerships with the food
pantries and trying to help with the SNAP application process.
I think all those things working together can absolutely be
taken to scale. There are hospitals across the country that
have talked to us, from Louisiana to Ohio, about how we have
done this. And I will say that a lot of what we have done, we
have modeled after two large institutions in our network;
Boston Medical Center and Hennepin County Medical Center in
Minneapolis.
Mr. Aguilar. Dr. Ochoa, what is the reaction of individuals
and families after you bring information to their attention
about SNAP resources?
Dr. Ochoa. It is a huge relief. We have families that have
successfully navigated the SNAP application process, but for
those who don't, we help them out in our clinic. Even at some
point, we engage our medical legal partnership on our campus to
help them navigate the SNAP application process because we
think it is so important. And, there is nothing like the look
on the face of a family when you send them home with a bag of
food that can get them through the next 2 or 3 days until we
can reconnect them to another food provider in their county or
their city. It really takes that huge burden off the family,
even if it is for 2 or 3 days.
Mr. Aguilar. And if you are raising awareness through these
programs, you are offering them much more than something short-
term, you are offering them a path forward as a family.
Thank you so much. I will yield back.
Dr. Ochoa. Thank you, sir.
The Chairwoman. Well, I certainly want to say thank you to
the panel for coming and sharing your expertise, and giving us
information so we can continue to look at the challenges that
are faced by kids as they try to break the cycle of poverty.
And I would agree, based on the seven previous hearings that we
have had, that no program is perfect and we can always do
better. So I appreciate your contribution in making that happen
today.
Under the rules of the Committee, the record of today's
hearing will remain open for 10 calendar days to receive
additional material and supplementary written responses from
the witnesses to any question posed by a Member.
This hearing of the Subcommittee on Nutrition is adjourned.
[Whereupon, at 11:08 a.m., the Subcommittee was adjourned.]
[Material submitted for inclusion in the record follows:]
Submitted Report by Hon. James P. McGovern, a Representative in
Congress from Massachusetts
Promoting Food Security for All Children
Policy Statement Organizational Principles to Guide and Define the
Child HealthCare System and/or Improve the Health of all
Children
American Academy of Pediatrics
Council on Community Pediatrics, Committee on Nutrition
Pediatrics Volume 136, number 5, December 2015
This document is copyrighted and is property of the American
Academy of Pediatrics and its Board of Directors. All authors
have filed conflict of interest statements with the American
Academy of Pediatrics. Any conflicts have been resolved through
a process approved by the Board of Directors. The American
Academy of Pediatrics has neither solicited nor accepted any
commercial involvement in the development of the content of
this publication.
Policy statements from the American Academy of Pediatrics
benefit from expertise and resources of liaisons and internal
(AAP) and external reviewers. However, policy statements from
the American Academy of Pediatrics may not reflect the views of
the liaisons or the organizations or government agencies that
they represent.
The guidance in this statement does not indicate an exclusive
course of treatment or serve as a standard of medical care.
Variations, taking into account individual circumstances, may
be appropriate.
All policy statements from the American Academy of Pediatrics
automatically expire 5 years after publication unless
reaffirmed, revised, or retired at or before that time.
www.pediatrics.org/cgi/doi/10.1542/peds.2015-3301
DOI: 10.1542/peds.2015-3301
Pediatrics (ISSN Numbers: Print, 0031-4005; Online, 1098-
4275).
Copyright 2015 by the American Academy
of Pediatrics.
Financial Disclosure: The authors have indicated they have no
financial relationships relevant to this article to disclose.
Potential Conflict of Interest: The authors have indicated
they have no potential conflicts of interest to disclose.
Abstract
Sixteen million U.S. children (21%) live in households without
consistent access to adequate food. After multiple risk factors are
considered, children who live in households that are food-insecure,
even at the lowest levels, are likely to be sick more often, recover
from illness more slowly, and be hospitalized more frequently. Lack of
adequate healthy food can impair a child's ability to concentrate and
perform well in school and is linked to higher levels of behavioral and
emotional problems from preschool through adolescence. Food insecurity
can affect children in any community, not only traditionally under-
served ones. Pediatricians can play a central role in screening and
identifying children at risk for food insecurity and in connecting
families with needed community resources. Pediatricians should also
advocate for Federal and local policies that support access to adequate
healthy food for an active and healthy life for all children and their
families.
Introduction
In 2013, 17.5 million U.S. households, or 14.3% of all households
and 21% of all children, met the U.S. Department of Agriculture (USDA)
definition of a food-insecure household, one in which ``access to
adequate food is limited by a lack of money or other resources.''
\1\-\2\ Households with children are nearly twice as likely
to be food-insecure as households without children. In 2013, 7.5
million American families with children lacked consistent access to
adequate, nutritious food. The crisis becomes even more pressing for
families facing severe economic hardships. In 2013, almost 60% of all
food-insecure households had incomes below 185% of the Federal poverty
thresholds, the income eligibility cutoff for many child nutrition
programs. The Federal poverty threshold for an average family of four
people in 2013 was $23,834; 185% of this threshold amount is $44,093,
but the Federal poverty level is not a definition of economic hardship,
and the amount to provide basic needs for a family of four often far
exceeds this amount. Because 30% of food-insecure households have
incomes above this level, it is clear the problem is not related solely
to poverty.
The demographic of food-insecure Americans extends beyond the areas
of concentrated urban poverty and into suburbs and rural America, areas
often mistakenly thought to be immune to this problem.\3\ Like poverty,
food insecurity is a dynamic, intensely complex issue; the current
economic recovery has marginally diminished food insecurity, but levels
remain near historic highs.\4\ For many families, seemingly small
changes in income, expenses, or access to Federal or state assistance
programs may instantly reduce the ability to purchase healthy food and
result in increased vulnerability to food insecurity. Moreover,
families and children do not only feel the effects of hunger just as
missed or meager meals; food insecurity manifests itself in many other
biopsychosocial outcomes, including health, education, and economic
prosperity.\5\-\12\ In fact, more than 30% of families who
identified as food-insecure indicated that they had to choose between
paying for food and paying for medicine or medical care.\13\ Combined,
these negative effects can contribute to a less competitive workforce
for the nation and higher health care costs borne by the U.S.
Government and employers.
Food insecurity is associated with many factors in addition to
poverty. Unemployment and underemployment are also strongly associated
with food insecurity.\2\ Certain populations, such as children in
immigrant families \14\ and large families, families headed by single
women, families with less education, and families experiencing parental
separation or divorce are at greater risk.\2\-\3\ Families
who are food-insecure usually have at least one parent who is working
or has worked for at least 6 months of the previous year. Working poor
families and single-parent families are at particular risk of food
insecurity. In low-income households with children and food insecurity,
84% participated in at least one Federal food assistance program, such
as the Supplemental Nutrition Assistance Program (SNAP) or free or
reduced-price school meals in 2010 to 2011.\2\ Thus, 16% of low-income,
food-insecure households with children do not receive Federal supports.
Federal benefits can attenuate the severity of food insecurity but
might not eliminate it, particularly for children and in regions with
higher food costs.\15\-\16\
Effects of Food Insecurity on Child Health and Developmental Outcomes
The inability to consistently provide food creates stress in
families, contributing to depression, anxiety, and toxic stress, which
make optimal parenting difficult regardless of social
class.12, 17 Most parents strive to protect their children
as much as possible from the physiologic sensation of hunger and,
ultimately, nutritional deprivation. Studies on the effects of food
insecurity in households demonstrate low dietary quality in adults but
slightly better quality for the household's children,\18\ and
qualitative studies reveal how parents strategically limit their own
intake in an effort to spare their children.\13\
There are multiple adverse health outcomes strongly correlated with
food insecurity. Children 36 months old or younger who live in food-
insecure households have poorer overall health and more
hospitalizations than do children who live in food-secure
households.\7\ Children with food insecurity are more likely to be iron
deficient, as are adolescents with food insecurity.\8\-\9\
Food insecurity also is associated with lower bone density in
preadolescent boys.\19\
Poverty is associated closely with the development of obesity.
Although not a direct cause of obesity,\20\-\21\ food
insecurity disproportionately threatens certain populations at highest
risk of obesity, including those from racial and ethnic minority groups
and the poor.\22\ Children in food-insecure households generally have
limited access to high-quality food. Environmental realities in low-
income neighborhoods, including decreased presence of full-service
grocery stores and increased availability of fast-food restaurants and
energy-dense, nutrient-poor food,\22\ may create barriers for low-
income families trying to adopt healthy behaviors. Adequate food may be
available only intermittently, leading to unhealthy eating patterns and
increased stress that may make weight loss difficult and facilitate the
development of obesity.\20\ Households with smokers are more likely to
be food-insecure, perhaps because of the diversion of money to tobacco
in these households.\23\
Among children of all ages, food insecurity is linked with lower
cognitive indicators, dysregulated behavior, and emotional distress.
Children between 4 and 36 months of age who live in low-income, food-
insecure households are at higher risk of developmental problems, which
presage impaired school function, compared with children of the same
age living in low-income, food-secure households.\10\ Longitudinal
studies have shown that food insecurity in kindergarten students
predicts reduced academic achievement in math and reading over a 4 year
period.\11\
Young children in food-insecure households are more likely to have
behavior problems above and beyond those attributable to their mother's
depression and anxiety.\12\ Adolescents in food-insecure families are
more likely to experience dysthymia and suicidal ideation.\24\ These
observations may be attributable, in part, to neurotransmitter
perturbations from poor diet and the sensation of hunger and in part
from children's emotional reactions to food insecurity itself and its
social meaning.
School-aged children are aware of and distressed by food insecurity
in their household. They often try to help manage food resources in the
family, either by supporting the efforts of their parents or by
initiating their own strategies for reducing food intake (including
choosing to eat less than they want). Parents may be unaware of their
child's understanding of the family's plight and may believe their
child is unaware of the family's lack of food.\25\-\26\
Adolescents describe food insecurity in terms of quantity (eating less
than usual, eating more or faster when food is available), quality
(having only a few low-cost foods), affective states (worry, anxiety,
or sadness about the family's food, shame or fear of being labeled
``poor,'' feelings of having no choice or of adults trying to shield
them from food insecurity), and social dynamics (using social networks
to get food or being socially excluded).\27\
As with many pediatric conditions, the health effects of food
insecurity and associated malnutrition may persist beyond early life
into adulthood. A substantial body of literature also links early
childhood malnutrition to adult disease, including diabetes,
hyperlipidemia, and cardiovascular disease.\5\-\6\ Studies
of the outcomes of food insecurity in childhood suggest that it may be
an example of ecologic context modifying individual physiologic
function. Overall, the effects of food insecurity on the physical,
mental, and emotional health of children and families are additive to
the effects of low income alone.
Programs To Mitigate Food Insecurity
Given the high prevalence of food insecurity among U.S. families
with children and given its potential health effects, pediatricians
need to be aware of resources that can mitigate food insecurity and
know how to refer eligible families. These programs serve as critical
supports for the physical and mental health and academic competence of
children (Table 1).
Table 1--Websites With Nutritional Information on Programs to Mitigate
Food Insecurity
------------------------------------------------------------------------
Program Information Income Eligibility Website
------------------------------------------------------------------------
WIC WIC food packages 5185% of Federal http://
poverty level a www.fns.usda.
gov/wic/final-
rule-
revisions-wic-
food-packages
State agency WIC- http://
approved food www.fns.usda.
lists for food gov/wic/links-
packages state-agency-
wic-approved-
food-lists
SNAP Eligible food items <130% of Federal http://
poverty level a www.fns.usda.
gov/snap/
eligible-food-
items-
SNAP-Ed resources http://
snap.nal.usda
gov/
National School Nutritional Reduced-cost http://
Lunch and standards for meals: 5185% of www.fns.usda.
National school lunches and Federal poverty gov/school-
School breakfasts level; a free meals/
Breakfast meals: 5130% of nutrition-
Programs Federal poverty standards-
level a school-meals
Child and Adult Meal patterns for http://
Care Food infants, children, www.fns.usda.
Program and adults gov/cacfp/
meals-and-
snacks
Summer Food Finding summer meal http://
Service programs in the www.fns.usda.
Program community and meal gov/sfsp/
content summer-food-
service-
program-sfsp
------------------------------------------------------------------------
a Available at http://familiesusa.org/product/federal-poverty-
guidelines.
WIC
The Special Supplemental Nutrition Program for Women, Infants, and
Children (WIC), first established in the early 1970s, is a
discretionary Federal program for which Congress must appropriate
funding each year. Its mission is ``to safeguard the health of low-
income women, infants and children up to age 5 who are at nutritional
risk by providing nutritious foods to supplement diets, information on
healthy eating, and referrals to healthcare.'' WIC participants are
pregnant women, breastfeeding women (up to the child's first birthday),
non-breastfeeding postpartum women (up to 6 months postpartum), infants
(up to their first birthday), and children up to their fifth birthday.
Prenatal WIC participation has been consistently associated with
higher birth weight and longer gestation, particularly among mothers at
highest risk.\28\ Participation in WIC also is associated with more
iron-dense diets and increased food and vegetable intake in
preschoolers.\28\ WIC serves 53% of all infants younger than 1 year old
in the United States. Most states provide vouchers or electronic
benefits transfer cards for use in the purchase of eligible products
and for nutrition counseling and connection to health and social
services. In most states, WIC also has an associated program, the WIC
Farmer's Market Nutrition Program, which gives additional vouchers for
the purchase of fresh, locally grown produce at farmers' markets and
roadside stands.
WIC is an effective evidence-based intervention for improving the
health of low-income women and their children. WIC has a strong
commitment to increase breastfeeding among its participants, providing
counseling, peer support, enhanced food packages, and access to breast
pumps to support the initiation and continuation of breastfeeding. WIC
participation has been linked to better infant health and lower rates
of overweight and underweight status among infants.\29\
SNAP
SNAP is an entitlement program that provides nutrition assistance
to low-income families and individuals. SNAP, piloted as the Food Stamp
Program in 1961 and confirmed with the Food Stamp Act in 1964 (Pub. L.
No. 88-525), is the largest food and nutrition program of the USDA. It
serves 47 million Americans, 72% of whom are in families with children.
Like WIC, it is a Federal program, administered through state agencies.
Although SNAP application and eligibility rules can be complex, the
program has been shown to be effective in reducing food insecurity and
negative health and developmental outcomes among recipients.\30\ SNAP
provides monthly benefits (usually via electronic benefit transfer
cards) to purchase eligible food items at retailers participating in
the program. SNAP allotment is calculated as 30% of the net monthly
household income, capped by number of members of the household (e.g.,
the maximum monthly allotment for a family of four is currently $649,
or a maximum of $1.80 per person per meal).\31\ A pilot program to
increase monthly family SNAP allotments by $60 was successful in
reducing very low food security among children by 30%. A subsequent
pilot program found that a $30 per month allotment reduced very low
food security among children as well as the higher benefit but produced
smaller reductions in food insecurity among adults and the full
household.\32\
National School Lunch and National School Breakfast Programs
The National School Lunch Program was established in 1946, although
the USDA had provided funds and food to schools for many years before
that. More than 32 million children annually are provided with a
nutritionally balanced, low-cost or free lunch in over 100,000 public
and nonprofit private schools and residential child care institutions.
The School Breakfast Program was started as a pilot program in 1966 and
was made permanent in 1975. It provides 13 million children each year
with a free, nutritionally balanced breakfast in more than 89,000
schools. In 1998, Congress expanded the National School Lunch Program
to include coverage for snacks served to children in after-school
educational and enrichment programs. In 2010, the Healthy, Hunger-Free
Kids Act (Pub. L. No. 111-296) established the Community Eligibility
Provision, which allows schools in areas of high poverty to offer both
breakfast and lunch at no charge to all students while eliminating the
stigmatizing school meal application process, which burdens both
parents and school personnel. Notable savings in administrative costs
also have been attributed to the Community Eligibility Provision.\33\
The Healthy, Hunger-Free Kids Act required the USDA to update the
meal pattern and nutrition standards for school meals and foods sold in
schools during school hours based on the latest Dietary Guidelines for
Americans. Some of the recent positive changes to the meal patterns
included more whole grains offered, 0 grams of trans fat per portion,
appropriate calories by age, more fruit offered, and reduction of
sodium content. Although all meals must meet Federal meal requirements,
local food authorities make the decisions about which specific foods to
serve and how they are prepared. Implementation of these changes has
increased fruit consumption and decreased wasted food among students
participating in the National School Lunch Program.\34\
Child and Adult Care Food Program
The Child and Adult Care Food Program, administered by the USDA,
provides cash assistance to states to assist child and adult care
institutions and family or group child care homes in providing
nutritious foods that contribute to the wellness, healthy growth, and
development of children. In Fiscal Year 2013, the program served more
than three million children. In the Child and Adult Care Food Program,
the USDA establishes meal patterns with minimum food component and
quantity requirements; these requirements are currently under revision
to make them more consistent with the Dietary Guidelines for Americans.
Summer Food Service Program
The Summer Food Service Program (SFSP) began as a pilot program,
the Special Food Service Program, in 1968, serving children during the
summer and in child care. In 1975, the programs split and the SFSP came
to stand on its own. The SFSP ensures that low-income children continue
to receive nutritious meals when school is not in session and sustains
children's physical and social development, helping them return to
school ready to learn. Children 18 years old and younger can receive
free meals and snacks at approved community sites, which may include
health care institutions.
The SFSP serves approximately two million children each summer.
Despite its importance, participation in SFSP is far below the number
of children eligible for the program and also below the number
participating in school meals during the school year. In part, this
reflects the challenge of reaching some populations of children during
the summer, particularly children in rural areas, areas with dangerous
levels of summer heat, or very urban areas where transportation or
safety may be a challenge. Within communities, advocacy by
pediatricians is especially important during the summer, when school
nutrition programs may be insufficient or inaccessible for many
children and families.
Food Pantries and Soup Kitchens
Food pantries and soup kitchens are often available in local areas
and serve as another vital piece of the safety net for children and
families struggling with food insecurity. These resources usually are
funded by a combination of local philanthropic organizations, faith-
based communities, and government resources. Knowing what is available
in the community can help support improved nutrition and reduce food
insecurity among families served by pediatricians. However, many
charitable food providers are not consistently able to provide
healthful food in general, nutritional items appropriate for infants
and toddlers, or amounts adequate to protect families from food
insecurity for more than a few days. Realizing the limited capacity of
existing community resources is essential to tailoring referrals for
families facing food insecurity.
Screening Tools for Pediatricians
Pediatricians can better assess the stress of food insecurity in
individual families by incorporating a screening tool into their
practice. The USDA uses an 18 item measure to assess food insecurity
with the Household Food Security Scale,\1\ which is the standard tool
for research. A more practical in-office tool is the two item screen
designed by Hager, et al.\35\ (Table 2), which uses a subset of two
questions from the Household Food Security Scale. Affirmative answers
to either of these two questions identified food insecurity with a
sensitivity of 97% and a specificity of 83% (as compared with the full
18 item Household Food Security Scale). These screens are designed to
identify food insecurity in a family as a whole. In some cases, a
single child in a family may be more or less affected by food
insecurity that the others; this difference will not be detected by
these screens. Some resources to address food insecurity when
discovered at a clinic visit are listed in Table 3.
Table 2--Screening for Food Insecurity
-------------------------------------------------------------------------
1. Within the past 12 mo, we worried whether our food would run out
before we got money to buy more. (Yes or No)
2. Within the past 12 mo, the food we bought just didn't last and we
didn't have money to get more. (Yes or No)
------------------------------------------------------------------------
Adapted from Hager, et al.\35\ Although an affirmative response to both
questions increases the likelihood of food insecurity existing in the
household, an affirmative response to only one question is often an
indication of food insecurity and should prompt additional
questioning.
Table 3--Resources for Pediatricians Dealing With Food-Insecure Families
------------------------------------------------------------------------
Program Website Description
------------------------------------------------------------------------
2-1-1 211.org, then access by Access to information on
ZIP Code or city school lunch programs,
summer food programs
for children, and other
government-sponsored
programs (e.g., SNAP,
WIC) as well as soup
kitchens and community
gardens
Healthy Food Bank Healthyfoodbankhub.feedin Includes a food bank
Hub gamerica.org locator and other tools
and resources for food-
insecure households
MyPlate http:// Recipes and tip sheets
www.choosemyplate.gov/ for low-cost healthy
budget/downloads/ eating
MeetingYourMyPlateGoalsO
nABudget.pdf
------------------------------------------------------------------------
Advocacy and Education
At the Federal level, pediatricians have historically advocated in
support of expanded funding for and access to key nutritional
assistance programs such as WIC, SNAP, and the school nutrition
programs. It is critical to maintain strong, evidence-based nutrition
guidelines for all public programs that support childhood nutrition,
including school lunches. Because Congress is scheduled to reauthorize
many of the aforementioned child nutrition programs in the near future,
attempts to weaken nutrition standards in school meals and other
children's programs are anticipated. Advocacy by the American Academy
of Pediatrics is crucial to ensure that nutrition standards remain in
place and that access to effective assistance programs is expanded
rather than reduced.
Advocacy efforts at the Federal, state, and community levels must
incorporate both obesity prevention and expanded nutritional access at
the Federal, state, and local levels to promote children's health.
Engagement of community residents in understanding local context \36\
and establishment of interdisciplinary collaboration are key elements
of advocacy efforts that address food insecurity in communities.
Medical education offers a natural opportunity to teach students
and residents to screen for food insecurity regularly as a part of
pediatric care. National initiatives such as the Community Pediatrics
Training Initiative increasingly emphasize community- and population-
based objectives throughout residency training,\37\-\38\ and
evidence suggests that formal training in community health is
associated with community child health involvement among
pediatricians.\39\ The following approaches enhance training about food
insecurity within community pediatrics: engaging on-site social and
legal resources to emphasize screening and management of food
insecurity; \40\ using quality improvement methods to improve screening
and evaluate efforts,\41\ including obtaining data on the impact of
community-based initiatives such as farmers' markets and food pantries
on food insecurity; establishing curriculum-based community site visits
that expose medical students and residents to successful Federal
programs, such as WIC; \42\ and encouraging medical students and
residents to participate in local, regional, and Federal advocacy
efforts. More data are needed to elucidate how curriculum elements can
most effectively teach trainees to assess food insecurity and advocate
for programs that mitigate food insecurity.
Recommendations
The American Academy of Pediatrics recommends that pediatricians
engage in efforts to mitigate food insecurity at the practice level and
beyond. The following recommendations offer practice-level strategies
for pediatricians.
A two question validated screening tool (Table 2) is
recommended for pediatricians screening for food insecurity at
scheduled health maintenance visits or sooner, if indicated.
It is beneficial for pediatricians to familiarize themselves
with community resources so that when children screen
positively for food insecurity, referral mechanisms to WIC,
SNAP, school nutrition programs, local food pantries, summer
and child care feeding programs, and other relevant resources
are accessible and expedient. This information is particularly
important for new mothers. New mothers in food-insecure
households can be connected to WIC and other community
resources during pregnancy and early in the postpartum period
to encourage breastfeeding.
When advocating for programs targeted at families with food
insecurity, it is important that pediatricians be aware of the
nutritional content of food offered in supplemental programs
(Table 3).
In the office setting, pediatricians who are aware of the
factors that may increase vulnerability of food-insecure
populations to obesity and factors that disproportionately
burden food-insecure households may address these issues at
clinic visits. These factors include lack of access to healthy
and affordable foods, cost of healthy food (and the low cost of
many unhealthy foods), media messaging that promotes non-
nutritious foods and beverages, and the role of stress in
decisionmaking related to food.
At a system level, pediatricians can advocate for the needs of
children and families facing food insecurity.
Food insecurity, including screening tools and community-
specific resource guides, can be incorporated into education of
medical students and residents to prepare future generations of
physicians to universally screen for and address food
insecurity.
Pediatricians can advocate for protecting and increasing
access to and funding for SNAP, WIC, school nutrition programs,
and summer feeding programs at the local, state, and national
levels. Advocacy must also include keeping the food offered in
these programs high in nutrient quality and based on sound
nutritional science. Pediatricians can promote access to
nutritious foods in out-of-school settings, particularly in
child care, in preschool, and during the summer. Advocacy for
``express lane eligibility'' (adjunctive eligibility), which
permits a state to use findings from enrollment in one program
to enroll the family in other programs for which they qualify,
also will increase access to food and nutrition assistance
programs.
Pediatricians can strongly support interdisciplinary
research that elucidates the relationship between stress, food
insecurity, and adverse health consequences; the barriers to
breastfeeding for women under stress in food-insecure
households; and evidence-based strategies that optimize access
to high-quality, nutritious food for families facing food
insecurity.
Conclusions
Food insecurity is a complex issue that presents profound
challenges for children and families. Pediatricians play an essential
role in recognition of food insecurity, practice-level intervention,
and advocacy to mitigate food insecurity within our communities.
Lead Authors
Sarah Jane Schwarzenberg, M.D., F.A.A.P.
Alice A. Kuo, M.D., Ph.D., F.A.A.P.
Julie M. Linton, M.D., F.A.A.P.
Patricia Flanagan, M.D., F.A.A.P.
Council on Community Pediatrics Executive Committee, 2014-2015
Benjamin A. Gitterman, M.D., F.A.A.P., Chairperson.
Lance A. Chilton, M.D., F.A.A.P., Vice-Chairperson.
William H. Cotton, M.D., F.A.A.P.
James H. Duffee, M.D., M.P.H., F.A.A.P.
Patricia Flanagan, M.D., F.A.A.P.
Virginia A. Keane, M.D., F.A.A.P.
Scott D. Krugman, M.D., F.A.A.P.
Alice A. Kuo, M.D., Ph.D., F.A.A.P.
Julie M. Linton, M.D., F.A.A.P.
Carla D. McKelvey, M.D., F.A.A.P.
Gonzalo J. Paz-Soldan, M.D., F.A.A.P.
Liaisons
Ricky Y. Choi, M.D., F.A.A.P.--Chairperson, Immigrant Health
Special Interest Group.
Jacqueline Douge, M.D., M.P.H., F.A.A.P.--Chairperson, Prevention
and Public Health Special Interest Group.
Janna Gewirtz O'Brien, M.D.--Section on Medical Students,
Residents, and Fellowship Trainees.
Staff
Camille Watson, M.S.
Committee on Nutrition, 2014-2015
Stephen R. Daniels, M.D., Ph.D., F.A.A.P., Chairperson
Steven A. Abrams, M.D., F.A.A.P.
Mark R. Corkins, M.D., F.A.A.P.
Sarah D. de Ferranti, M.D., F.A.A.P.
Neville H. Golden, M.D., F.A.A.P.
Sheela N. Magge, M.D., M.S.C.E., F.A.A.P.
Sarah Jane Schwarzenberg, M.D., F.A.A.P.
Liaisons
Leila Beker, Ph.D., R.D.N.--Food and Drug Administration.
Jeff Critch, M.D., F.A.A.P.--Canadian Pediatric Society.
Rear Admiral Van S. Hubbard, M.D., Ph.D., F.A.A.P.--National
Institutes of Health.
Kelley Scanlon, Ph.D.--Centers for Disease Control and Prevention.
Valery Soto, M.S., R.D., L.D.--US Department of Agriculture.
Staff
Debra L. Burrowes, MHA
Acknowledgments
The authors thank Children's HealthWatch for its valuable review of
this policy statement.
Abbreviations
------------------------------------------------------------------------
-------------------------------------------------------------------------
SFSP: Summer Food Service Program
SNAP: Supplemental Nutrition Assistance Program
USDA: U.S. Department of Agriculture
WIC: Special Supplemental Nutrition Program for Women, Infants, and
Children
------------------------------------------------------------------------
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Promoting Food Security for All Children
Council on Community Pediatrics and Committee on Nutrition
Pediatrics; originally published online October 23, 2015; DOI: 10.1542/
peds.2015-3301
------------------------------------------------------------------------
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Pediatrics is the official journal of the American Academy of
Pediatrics. A monthly publication, it has been published
continuously since 1948. Pediatrics is owned, published, and
trademarked by the American Academy of Pediatrics, 141
Northwest Point Boulevard, Elk Grove Village, Illinois, 60007.
Copyright 2015 by the American Academy of Pediatrics. All
rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.
______
Submitted Report by Eduardo Ochoa, Jr., M.D., F.A.A.P., Little Rock,
AR; on Behalf of Children's HealthWatch
Series--Hunger: A New Vital Sign
Doctor's Orders_Promoting Healthy Child Development by Increasing Food
Security in Arkansas
``At Arkansas Children's Hospital, we recognize alarming and
disappointing rates of food insecurity among our vulnerable
patients. To improve the health of our patients, we have
implemented innovative programs to alleviate food insecurity.
We urge other doctors and hospitals to take similar steps to
ensure that young children are healthy and nutritiously fed.''
Patrick H. Casey, M.D.
April 2015
Children's HealthWatch
This brief was made possible by generous funding from
individual donors.
Executive Summary
Parents should be able to afford to meet basic needs, including
rent, utilities, medical bills, and prescriptions, and still have
enough each month to pay for adequate food for all family members.
Unfortunately, this is not a reality for many families in Arkansas,
especially those with young children. Even those with higher levels of
education and employment report an inability to make ends meet. When
bills, including rent and utilities, drain already tight household
budgets, families often cut the only flexible budget item: food. Both
mothers and children in families that lack enough money to provide food
for all members to lead active, healthy lives--a condition known as
food insecurity--face increased risk of health and development
concerns. Food-insecure families are also at increased risk of being
unstably housed and having inadequate home energy to keep warm in
winter or cool in summer.
Compared with Arkansas children from food-secure families, those
from food-insecure families were more likely to:
Have been hospitalized.
Have developmental delays.
Be in fair or poor health.
and their families were more likely to experience:
Fair or poor maternal health.
Housing insecurity.
Energy insecurity.
Foregoing needed health care for household members due to
cost.
Trade-offs between paying for other basic living expenses
such as food, rent, or housing in order to pay for health care.
Health providers around the state are in a unique position to both
screen for, and rapidly respond to, food insecurity in families. Many
health facilities in Arkansas--and across the country--are leading the
way by offering innovative health care-based approaches to reducing
food insecurity.
Options for connecting food-insecure families with assistance
include:
Sharing handouts or online listings of food assistance
programs and local resources.
Establishing or partnering with a food pantry and/or
farmer's market within the health facility to better connect
patients with healthy foods.
Sponsoring an on-site USDA Summer Food Service Program or
Child and Adult Care Food Program (CACFP)-funded meal to feed
children while they attend their appointment.
Training in-house financial counselors to serve as SNAP/WIC
application liaisons or establishing roles for SNAP/WIC
outreach
-------------------------------------------------------------------------
Household Food Insecurity: When households lack access to sufficient
food for all members to lead active, healthy lives because of
insufficient family resources. Child Food Insecurity: When children
experience reductions in the quality and/or quantity of meals because
caregivers can no longer buffer them from inadequate household food
resources (the most severe level of food insecurity).
Housing Insecurity: When households experience ANY of the following
in the past year: frequent moves (two or more times), crowded housing
situation, or doubling-up with another household for financial reasons.
Energy Insecurity: When households lack consistent access to enough of
the kinds of energy (e.g., electricity, natural gas and/or heating oil)
needed for a healthy and safe life.
Health-care Trade-offs: When a household is unable to pay for basic
living expenses, including rent, utilities, or food, due to payment of
medical expenses.
SNAP: The Supplemental Nutrition Assistance Program, formerly known
as food stamps, is the United States' largest child nutrition program
and is proven effective in reducing food insecurity.
WIC: The Special Supplemental Nutrition Program for Women, Infants,
and Children is a nutrition program specifically for low-income
pregnant, postpartum and breastfeeding women, and infants and children
under the age of 5.
------------------------------------------------------------------------
Hunger Hurts
The Impact of Food Insecurity on Children
Arkansas has the second-highest overall population rate of food
insecurity in the United States (19.7 percent or 570,000 people in
2013). The rate of food insecurity among Arkansas households with
children is substantially higher at 27.7 percent (affecting
approximately 196,950 children),\1\ which is, in turn, well above the
national average of 21.6 percent among households with children.\2\
Household and child food insecurity can harm every aspect of a
child's well-being--growth and development,\3\ psychosocial functioning
(e.g., ability to make friends, behavior, etc.),\4\ academic
performance, and physical health.\5\-\7\ In particular, the
first few years of life are critical because they are a significant
time of brain and body growth, and establish the foundation for future
physical and emotional health and school and workforce readiness.
Deprivation of any length during this period can have harmful
consequences that are remediable, but require much more effort and
investment than is needed to prevent such deprivation in the first
place.\8\
Parents do everything they can to protect their children from going
hungry, including going without food themselves.\9\ This can lead to
poor diets and negative physical and mental health outcomes for parents
8, 10-11 as well as diminished energy to work and/or care
for the child.\10\
In 2013, 22.7 percent of families with children under the age of 4
who received care at the Arkansas Children's Hospital Emergency
Department and participated in the Children's HealthWatch survey
reported food insecurity. Among those families surveyed, 8.3 percent
reported child food insecurity. In a sample of more than 8,800
interviewed between 2004 and 2014, families with a range of caregiver
educational attainment and level of employment reported food
insecurity. Some of the children in this sample had complex medical
needs; medical costs associated with such needs can make it even more
difficult for families to afford other basic necessities including
food, rent and utilities.\12\
Figure 1
Food-Insecure Families in Arkansas Are More Likely to Have Poor Child
and Maternal Health Outcomes
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Source: Children's HealthWatch Data, January 2004-June 2014.
All increases statistically significant at p < .05.
Figure 2
Food-Insecure Families in Arkansas Are More Likely To Experience
Additional Household Hardships
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Source: Children's HealthWatch Data, January 2004-June 2014.
All increases statistically significant at p < .05.
Compared with young children in food-secure families, young
children in food-insecure Arkansas families were:
19% more likely to be hospitalized, not including at birth.
45% more likely to be in fair or poor health.
31% more likely to be at risk of developmental delays.
Almost five times as likely to have foregone health care.
Compared with food-secure families, mothers in food-insecure
Arkansas families were:
Over twice as likely to be in fair or poor health.
Over three times as likely to report depressive symptoms.
Compared with food-secure families, food-insecure Arkansas families
were:
37% more likely to be housing insecure.
Four times as likely to be behind on their rent or mortgage
payments.
Almost four times as likely to be energy insecure.
Almost four times as likely to report making health care
trade-offs.
Three and a half times as likely to have foregone health
care.
``I am not hungry anymore, my stomach has shrunk so I [am]
used to it.''
Caregiver of patient at Arkansas Children's Hospital
``We can afford healthy food at the beginning of the month
when we receive SNAP. By the end of the month we are eating a
lot of noodles and carbs. Therefore, we are constantly losing
and gaining weight.''
Caregiver of patient at Arkansas Children's Hospital
Stranded in Arkansas' Food Deserts
Poor access to food is a concern in Arkansas. ``Accessibility'' of
food can refer to both affordability and physical proximity, and many
Arkansas residents struggle with a lack of both.\13\-\14\
Food deserts--areas where people have limited access to a variety of
healthy and affordable food--abound in Arkansas. Located far from
supermarkets and grocery stores (defined as more than 1 mile away in
urban areas and more than 10 miles away in rural areas),\15\ people
living in a `food desert' may have no food access or are served only by
fast food restaurants and convenience stores. All regions of Arkansas
have food deserts. The fact that many do not have reliable access to
transportation creates an additional barrier to food access and adds to
the cost of obtaining food.
The need for food assistance in Arkansas is large and growing.
Between 2010 and 2014, there was a 103.\7\ percent increase in food
distributed by the Arkansas Foodbank. Although food banks and pantries
are an essential part of an emergency response, they are not designed
to be a long-term solution and cannot match the rising tide of need.
``. . . food banking was started to provide people with
immediate and temporary food. We have taken on a wider role
because of need, and while we would love to provide for all
needs, we cannot.''
Rhonda Sanders, CEO Arkansas Foodbank
Food pantries are not able to meet the full need of families in
Arkansas. In 2014, 29 percent of Arkansas food pantries did not have
enough food to meet clients' needs, and 52 percent limited the number
of times a household could receive food in order to conserve
resources.\16\ When clients were able to get food from the pantries, 51
percent of them said they did not find fruits or vegetables at their
pantry, and 40 percent could not find dairy products.
Shoring up food pantries with more supplies is helpful, but food
pantries and banks report they do not have nearly enough resources to
bring about permanent food security. At the root of food insecurity is
an inability to access and afford food. Federal programs such as the
Special Supplemental Nutrition Program for Women, Infants and Children
(WIC) and the Supplemental Nutrition Assistance Program (SNAP) reduce
food insecurity by allowing families to purchase food appropriate to
their needs and at times that are convenient to them, while also
contributing to the local economy.
-------------------------------------------------------------------------
Spotlight on Arkansas Children's Hospital in collaboration with the
Arkansas Hunger Relief Alliance
Arkansas Children's Hospital (ACH) is the state's only pediatric
medical center. Its mission is: ``We champion children by making them
better today and healthier tomorrow.'' To achieve this mission, ACH has
implemented several innovative programs to address and alleviate food
insecurity among its patients and families. ACH currently:
Provides lunches to children visiting the hospital by acting
as a sponsor site for the USDA Summer Food Service Program and Child
and Adult Care Food Program.
Offers cooking and nutrition education resources to
caregivers in partnership with local organizations.
Employs financial counselors trained to assist families with
SNAP applications on-site when they apply for Medicaid.
Enrolls mothers and children in WIC through an on-site
office.
------------------------------------------------------------------------
Trendlines
Is the American Dream Still Alive in the 'Natural State'?
While food insecurity rates are traditionally high among very low-
income families, working families with higher education also struggle
with food insecurity. Employment and higher education are usually seen
as a solution to food insecurity, but when basic living expenses are
greater than wages, even families with a working adult with a technical
or college degree may face significant hardship.
The Great Recession and slow recovery affected families in Arkansas
from across the economic spectrum; many struggled to make ends meet,
experiencing food insecurity. Families with access to a wide range of
financial resources continue to be impacted. Unfortunately, sometimes
conditions are such that the traditional economic safeguards of
education and employment do not guarantee food security.
In a sample of 2,566 Arkansas families with an employed caregiver
who attended technical school, college, or higher, 13.4 percent
reported household food insecurity and five percent reported child food
insecurity.
Compared to young children in similar food-secure families, young
children in food-insecure families with an employed caregiver with
education beyond high school were:
Nearly 1\1/2\ times as likely to be in fair or poor health.
Compared to mothers in similar food-secure families, employed
mothers with education beyond high school in food-insecure families
were:
Over 2\1/2\ times as likely to be in fair or poor health.
Almost 3\1/2\ times as likely to report symptoms of
depression.
Compared to similar food-secure families, food-insecure families
with an employed caregiver with education beyond high school were:
1\1/2\ times as likely to be housing insecure.
Nearly five times as likely to be behind on rent or
mortgage.
Over four times as likely to be energy insecure.
Almost 4\1/2\ times as likely to have made health care
trade-offs.
Nearly five times as likely have foregone health care due to
inability to pay.
Mind the Gap--Ensuring Families Across the Entire Economic Spectrum
Receive the Help They Need
Health providers must be aware that even caregivers who are
employed and have education beyond high school may have a difficult
time providing enough food for their families. Screening all families
and ensuring that all have access to enough healthful food is crucial
for the health and well-being of Arkansas' children and families.
Figure 3
Food-Insecure, Working Families with Education Beyond High School Are
at Increased Risk of Poor Health Outcomes and Difficulty Paying
for Housing, Utilities and Health Care
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Source: Children's HealthWatch Data, January 2004-June 2014.
All increases statistically significant at p < .05.
Opportunities to Improve Access to Food at Health Facilities
Many clinics and hospitals around the country, recognizing the
difficulty of improving their patients' health if patients and their
families are food-insecure, have taken a preventive health approach by
actively screening for food insecurity and offering services to combat
it. A variety of healthcare-based approaches to addressing food
insecurity can be tailored for the needs of individual healthcare
settings.\17\-\18\ Many health providers in Arkansas
routinely work with their patients to solve and control acute and
chronic health problems, but typically may not consider assessing and
addressing food security as part of routine care. An Internal Revenue
Service (IRS) ruling may spur additional conversation and innovation
among nonprofit health facilities seeking ways to reduce patients' food
insecurity. Recognizing the importance of such efforts, the IRS now
allows nonprofit health facilities to claim an exemption on Federal tax
returns for services related to improving nutrition access.\19\
-------------------------------------------------------------------------
The Children's HealthWatch Hunger Vital SignTM
Children's HealthWatch validated the Hunger Vital SignTM, a two
question screening tool based on the U.S. Household Food Security
Survey Module and suitable for clinical or community outreach use. The
Hunger Vital SignTM identifies families with young children as at risk
for food insecurity if they answer that either or both of the following
two statements is `often true' or `sometimes true' (vs. `never true'):
``Within the past 12 months we worried whether our food would
run out before we got money to buy more.''
``Within the past 12 months the food we bought just didn't last
and we didn't have money to get more.''
------------------------------------------------------------------------
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Listed are various ways health facilities have improved their
patients' access to food. These options are grouped by level of effort
involved (Level 1 being the most easily achieved and Level 3 being more
involved) so any health facility, regardless of size or resources, will
be able to find a way to help connect vulnerable patients with food
resources.
Level 1: Preparing the Ground
Use the Children's HealthWatch Hunger Vital
SignTM 20 during intake to determine whether a
family is at risk of food insecurity.
If the caregiver responds affirmatively to either
question, clinic/hospital staff can direct them to food
assistance services.
For example:
provide a handout with information on how and where to
apply for SNAP
and/or WIC as well as where to find emergency food
assistance.
refer patients to a designated in-house outreach worker
or partner organi-
zation.
Provide information on hospital/clinic's website with links
to instructions and applications for SNAP/WIC.
Level 2: Planting Seeds
Include the Hunger Vital SignTM in the hospital/
clinic electronic medical record, simultaneously providing
health professionals with documentation of individual patient
needs and the ability to track the level of need across the
hospital/clinic population.
Partner with a trusted, local nonprofit organization for
electronic or faxed referrals for assistance. Once families are
identified as at risk for food insecurity, an electronic
`prescription' for outreach services can be sent to the partner
organization, which then follows up with the family.
Partner with, or establish on-site, a food pantry or
farmer's market.
Partner with the state's Department of Human Services or the
state Health Department to outstation a SNAP and/or WIC
enrollment worker at the health facility each week.
Level 3: Putting Down Roots
Sponsor an on-site Summer Food Service Program and/or Child
and Adult Care Food Program (CACFP)-funded meal to provide
nutritious meals to children while visiting the health
facility.
Raise philanthropic support to feed parents as well as
children during visits.
Train financial counselors or other relevant staff to act as
SNAP/WIC application liaisons and/or establish a role for SNAP/
WIC establish a role for SNAP/WIC in the healthcare facility.
Best Practices to Ensure Success
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Implementing tailored health care-based responses to hunger
requires planning to ensure all stakeholders will work toward success.
Below are proactive steps to take when implementing new programs or
changes to existing programs.
Talk with other health facilities that have undertaken
similar efforts to learn how they implemented their nutrition
access programs, garnered support from key stakeholders, and
effectively reached out to families.
Engage medical staff early and provide them with information
on the connections between food insecurity and health.
Reach out to hospital/clinic administrators to discuss
potential ways to assist patients at various levels of effort
and cost. Nonprofit health facilities can report on tax returns
some efforts to improve patient nutrition access.
Determine where nutrition access fits into the clinic/
hospital's organizational structure and who will be responsible
for implementation of new programs and future sustainability.
Engage Arkansas' DHS/DSS [1] and/or the local
health unit in efforts to train the health facility's financial
staff (who already assist families with state health insurance
applications) to assist caregivers through the SNAP and WIC
application processes.
---------------------------------------------------------------------------
\[1]\ The Arkansas Department of Human Services/Department of
Social Services (DHS/DSS) is the state department responsible for
administering benefits, including SNAP, to families.
Partner with Arkansas' DHS/DSS and/or the State Health
Department offices and solicit support from local stakeholders
to increase the likelihood of approval from the USDA for
---------------------------------------------------------------------------
implementing food assistance programs onsite.
Partner with local nonprofit agencies and individuals with
an interest in addressing food insecurity at the neighborhood,
county or state level.
About Children's HealthWatch
Children's HealthWatch is a nonpartisan network of pediatricians,
public health researchers, and children's health and policy experts.
Our network is committed to improving children's health in America. We
do that by first collecting data in urban hospitals across the country
on infants and toddlers from families facing economic hardship. We then
analyze and share our findings with academics, legislators, and the
public. These efforts help inform public policies and practices that
can give all children equal opportunities for healthy, successful
lives.
Authors: Lindsay Giesen, Policy Intern; Stephanie Ettinger de Cuba,
M.P.H., Research and Policy Director; Allison Bovell, M. Div, Boston
Site Coordinator; Patrick H. Casey, M.D., Principal Investigator;
Eduardo R. Ochoa, Jr., M.D., Principal Investigator; Kathy Barrett,
M.S.E., Little Rock Site Coordinator; and Sharon Coleman, M.S., M.P.H.,
Statistical Analyst.
Acknowledgements: Children's HealthWatch would like to thank Anna
Strong of Arkansas Children's Hospital, Rhonda Sanders of Arkansas
Foodbank, Kathy Webb, Patty Barker, and Nancy Conley of Arkansas Hunger
Relief Alliance, Jennifer Ferguson of Arkansas Advocates for Children,
William ``Buster'' Lackey of the Department of Human Services, and
Justin Pasquariello and Richard Sheward of Children's HealthWatch for
their thoughtful input and review of this work.
Printing made possible by funding from Buster Lackey,
Administrator, Arkansas Department of Human Services, Division of
Chilldcare and Early Childhood Education Health and Nutrition Unit.
For additional information, please contact:
Stephanie Ettinger de Cuba, MPH, Research and Policy Director
Tel. (617) 638-5850/E-mail: [email protected]
Follow us:@ChildrensHW Facebook.com/ChildrensHealthWatch
Endnotes
1. Feeding America. (2014). Map the Meal Gap. Retrieved from: http://
www.feedingamerica.org/hunger-in-america/our-research/map-the-meal-gap/
2. Coleman-Jensen, A., Nord, M., and Singh, A. (2013). Household
Food Security in the United States in 2012, Economic Research Report
no.155. U.S. Department of Agriculture, Economic Research Service.
Retrieved from: http://www.ers.usda.gov/publications/err-economic-
research-report/err155.aspx#.UuARENIo7Gg.
3. Casey, P.H., Szeto, K.L., Robbins, J.M., Stuff, J.E., Connell,
C., Gossett, J.M., and Simpson, P.M. (2005) Child Health-Related
Quality of Life and Household Food Security. JAMA Pediatrics, 159(1),51-
56.
4. Alaimo, K, Olson, C.M., Frongillo Jr, E.A. (2001) Food
Insufficiency and American School-Aged Children's Cognitive, Academic,
and Psychosocial Development. Pediatrics. 108(1),44-53.
5. Casey, P.H., Szeto, K., Lensing, S., Boogle, M., Weber, J. (2001)
Children in Food-Insufficient, Low-Income Families: Prevalence, Health,
and Nutrition Status. Archives of Pediatric and Adolescent Medicine,
155(4):508-14.
6. Alaimo K., Olson, C.M., Frongillo Jr, E.A. and Briefel, R.R.
(2001) Food Insufficiency, Family Income, and Health in U.S. Pre-School
and School-Aged Children. American Journal of Public Health, 91(5),781.
7. Cook, J.T., Black, M., Chilton, M., Cutts, D., Ettinger de Cuba,
S., Heeren, T.C., Rose-Jacobs, R., Sandel, S., Casey, P., Coleman, S.,
Weiss, I., Frank, DA. (2013) Are Food Insecurity's Health Impacts
Underestimated in the U.S. Population? Marginal Food Security Also
Predicts Adverse Health Outcomes in Young U.S. Children and Mothers.
Advances in Nutrition. 4(1), 51-61.
8. Shankoff J.P., Garner A.S., et al. (2012) The Lifelong Effects of
Early Childhood Adversity and Toxic Stress. Pediatrics. 129(1)e232-
e246.
9. Bickel, G., Nord, M., Price, C., Hamilton, W., Cook, J. (2000)
Guide to Measuring Household Food Security. United States Department of
Agriculture, Food Nutrition Service. Retrieved from: http://
www.fns.usda.gov/sites/default/files/FSGuide.pdf.
10. Cristofar, S.P. and Basiotis. (1992) Dietary Intakes and
Selected Characteristics of Women Ages 19-50 Years and Their Children
Ages 1-5 Years by Reported Perception of Food Sufficiency. Journal of
Nutrition Education. 24(2),53-58.
11. Cook, J. and Jeng, K. (2007) Child Food Insecurity: The Economic
Impact on our Nation. Feeding America and the ConAgra Foods Foundation.
Retrieved from: http://www.nokidhungry.org/sites/default/files/child-
economy-study.pdf.
12. Parish, S.L., Rose, R.A., Grinstein-Weiss, M., Richman, E.L.,
Andrews, M.E. (2008) Material hardship in U.S. families raising
children with disabilities. Exceptional Children, 75(1):71-92.
13. Krukowski, R., Smith West, D., Harvey Berino, J., and Prewitt,
T.E. (2010) Neighborhood Impact on Healthy Food Availability and
Pricing in Food Stores. J. Community Health. 35(3): 315-320.
14. Connell, C.L., Yadrick, M.K., Simpson, P., Gossett, J., McGee B.
B., Bogle, M.L. (2007) Food Supply Adequacy in the Lower Mississippi
Delta. Journal of Nutrition Education and Behavior. 39(2):77-83.
15. United States Department of Agriculture, Agricultural Markets
Service. Food Deserts. Retrieved from: http://apps.ams.usda.gov/
fooddeserts/fooddeserts.aspx.
16. Weinfield, N.S., Mills, G., Borger C., Gearing, M., Macaluso,
T., Montaquila, J., Zedlewiski, S. (2014) Hunger in America 2014.
Feeding America. Retrieved from: http://help.feedingamerica.org/
HungerInAmerica/hunger-in-america-2014-full
report.pdf?s_src=W151DIRCT&s_subsrc=http%3A%2F%2Fwww.feedingamerica.org
%2Fhunger-in-america%2Fourresearch%2Fthe-hunger-study%2F&_ga=1.2146484
71.1063929397.1409241861.
17. Project Bread and University of Massachusetts Memorial Health
Care. (2009). Hunger in the Community: Ways Hospitals Can Help.
Retrieved from: http://www.projectbread.org/reusable-components/
accordions/download-files/hospital-handbook.pdf.
18. Share Our Strength, No Kid Hungry. (2012) Fighting Hunger
Through Health Care: A Seamless Solution. Retrieved from: http://
bestpractices.nokidhungry.org/sites/default/files/resources/
Health%20Care%20Issue%20Brief.pdf.
19. The Hagstrom Report. (2015) IRS Nonprofit hospitals can claim
nutrition access aid to avoid taxes. 5(1). Retrieved from https://
madmimi.com/p/d6d0c5?fe=1&pact=27429225056.
20. Hager, E.R., Quigg, A.M., Black, M.M., Coleman, S.M., Heeren,
T., Rose-Jacobs, R., & Frank, D.A. (2010). Development and validity of
a 2-item screen to identify families at risk for food insecurity.
Pediatrics, 126(1), e26-e32.
______
Submitted Questions
Response from Ruth Riley, Former WNBA Athlete and Olympic Gold
Medalist; on Behalf of NBA Cares
Questions Submitted by Hon. Rodney Davis, a Representative in Congress
from Illinois
Question 1. Ms. Riley, as a Coach and father of two growing boys, I
understand the value of ensuring every child access to nutritious
meals. Without these meals, kids would not have the fuel they need to
put in all the hours of practice, training and conditioning that lead
to athletic success. But, from your personal experience, just how vital
is three meals a day towards achieving success in the classroom?
Answer. Growing up, I knew the expectation for me to excel set by
my mom was based on what I would learn from 8:00-3:00 rather than any
activity I pursued after school. While there is plenty of research that
highlights the correlation between hunger and children's capacity to
focus and learn, I have personally found my ability to concentrate on
any task is significantly hindered when I am hungry. From a purely
academic perspective, it is imperative for kids to have three meals a
day to not only focus while they are at school, but also to help them
concentrate on their homework at night.
Question 2. Was it your experience that government programs served
as a support, but were not the total solution? For example, in addition
to getting food stamps, were there also times that your family turned
to food pantries for help?
Answer. My family never saw the governmental assistance programs as
a singular answer to our problems. They were a complementary and
essential piece of a holistic solution. We received food stamps only
for a short period of time while my mother was obtaining the skill-set
she needed to provide for us. Off and on throughout my childhood, we
also were beneficiaries of the generosity of our family, friends,
churches, and strangers. Different individuals and organizations
collectively helped us when we needed it the most.
Question 3. How important were programs like school meals to
ensuring you received three meals a day?
Answer. School meals were incredibly important for our family
throughout my childhood. It not only provided two of our three meals
each school day, it also helped my mom make her monthly budget stretch
farther and ensured we would have enough food for dinner each night
when we got home.
SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM
(PAST, PRESENT, AND FUTURE OF SNAP: THE NATIONAL COMMISSION ON HUNGER)
----------
WEDNESDAY, NOVEMBER 18, 2015
House of Representatives,
Committee on Agriculture,
Washington, D.C.
The Committee met, pursuant to call, at 10:00 a.m., in Room
1300 of the Longworth House Office Building, Hon. K. Michael
Conaway [Chairman of the Committee] presiding.
Members present: Conaway, Austin Scott of Georgia, LaMalfa,
Davis, Yoho, Walorski, Allen, Bost, Abraham, Newhouse, Kelly,
Peterson, David Scott of Georgia, Walz, Fudge, McGovern,
DelBene, Lujan Grisham, Kuster, Nolan, Bustos, Kirkpatrick,
Aguilar, Plaskett, Adams, Graham, and Ashford.
Staff present: Anne DeCesaro, Haley Graves, Jadi Chapman,
Jessica Carter, Mollie Wilken, Lisa Shelton, Liz Friedlander,
Matthew MacKenzie, Nicole Scott, and Carly Reedholm.
OPENING STATEMENT OF HON. K. MICHAEL CONAWAY, A REPRESENTATIVE
IN CONGRESS FROM TEXAS
The Chairman. Good morning. I am going to call the hearing
to order. I will ask David Scott to open us with a prayer.
David?
Mr. David Scott of Georgia. Dear Heavenly Father, we come
before your throne of grace to, first of all, give thanks. We
thank you for the bountiful blessings that you give to each of
us every single day. Some we know not, some we asked not for,
but you intercede on our behalf and give us the blessings that
we need. And Heavenly Father, at this time we ask a special
blessing, that your arms of protection hover around those
families of those individuals of those 500 or more who were
assassinated and slaughtered and injured by those radical
Islamic terrorists in Paris. Now, dear Heavenly Father, we pray
that you give our nation, the United States, the will and the
backbone to stand up and lead. We ask, dear God, that you give
us all that power and strength. I pray that we, as NATO, would
give in to our Article V and help France the same way that,
when we were attacked, we asked for Article V of NATO. We must
do the same, and stand up and fight this evil, stand up with
France as they stood with us in our time of need. And our
President will lead and invoke Article V of NATO. This is my
prayer, dear God. And finally, give this nation the Isaiah
instinct. For when you said, ``Whom shall we send, and who will
go for us in that great time of need,'' Isaiah, without
hesitation, said, ``Here, my Lord, send me.'' Thank you, dear
God. This is what we pray for, the courage and the backbone. We
ask this prayer from our humble hearts, all of us, that we are
able to rid this evil. We pray for this earnestly, and we pray
for it in the name of your Son, Jesus Christ, and you, dear
God. Amen.
The Chairman. Amen. Thank you, David. Well, good morning,
this hearing on the past, present, and future of SNAP: the
National Commission on Hunger, will come to order. I want to
welcome our witnesses to today's hearing, and thank them for
taking time to share their experience as members of the
National Commission on Hunger. This hearing, like those before,
builds on the Committee's top to bottom review of the
Supplemental Nutrition Assistance Program, or SNAP. Throughout
this process we have had an eye towards strengthening SNAP so
that it doesn't become a trap, but rather a tool to help
individuals to move up the economic ladder.
As we have learned throughout this hearing series, SNAP
does not operate in a vacuum. It should not be expected to
carry the entire load and provide all the solutions for the
most vulnerable. That being said, it does serve an important
role in the lives of nearly 46 million Americans. For them, and
the integrity of our review, it is important that we continue
to invite for our consideration a range of perspectives and
recommendations for improving SNAP and the other nutrition
programs under our jurisdiction. Hearing from the National
Commission on Hunger is a continuation of that effort.
As you will hear, the Commission spent the last year
traveling the country to see and listen to those closest to
this issue, to better understand the challenges within these
programs, as well as learn about the successes. The Fiscal Year
2014 omnibus appropriations bill provided $1 million for a
national commission on the domestic hunger by including an
amendment from former Congressman Frank Wolf. The purpose of
the Commission, according to the bill, was to provide policy
recommendations to Congress and the Secretary of Agriculture on
how to more effectively use existing Department of Agriculture
programs, and their funds, to combat domestic hunger. They were
also instructed to develop innovative recommendations to
encourage public-private partnerships, faith-based sector
engagement, and community initiatives to reduce the need for
government nutrition assistance programs, while protecting the
safety net for the most vulnerable members of society.
The ten member Commission was made up of individuals
appointed by the Speaker, the Minority Leader of the House, the
Senate Majority Leader, and the Senate Minority Leader, the
result being five Republican and five Democratic selected
Commissioners with a range of backgrounds from a medical doctor
to a grocery store owner, to hunger advocates and community
leaders. Today, the Commission selected Co-Chairs are here to
share their year-long experience with a process that involved
field hearings and site visits, to nine different cities. Each
hearing began with invited witnesses, similar to our format,
but it would then open up for public input. I believe the
hearing in D.C., back in the spring, lasted more than 5 hours.
Now, that is pretty remarkable, considering each public witness
was limited to 5 minutes.
While their report is not yet final, I commend their
efforts to remain united as a Commission, especially given
their diverse backgrounds, in presenting their final
recommendations, and for staying within their charge to not
propose policies that increase costs or require additional
resources. I look forward to hearing from the Commission's Co-
Chairs about their process, the emergent themes from the
process, and a preview of what we can expect when their final
report is released in the coming weeks.
[The prepared statement of Mr. Conaway follows:]
Prepared Statement of Hon. K. Michael Conaway, a Representative in
Congress from Texas
I want to welcome our witnesses to today's hearing and thank them
for taking the time to share their experience as members of the
National Commission on Hunger.
This hearing, like those before, builds upon the Committee's top-
to-bottom review of the Supplemental Nutrition Assistance Program, or
SNAP.
Throughout this process, we have had an eye towards strengthening
SNAP so that it doesn't become a trap, but rather a tool to help
individuals move up the economic ladder.
As we have learned throughout this hearing series, SNAP does not
operate in a vacuum. It should not be expected to carry the entire load
and provide all solutions for the most vulnerable. That being said, it
does serve an important role in the lives of nearly 46 million
Americans.
For them and the integrity of our review, it is important that we
continue to invite for consideration a range of perspectives and
recommendations for improving SNAP and the other nutrition programs in
our jurisdiction.
Hearing from the National Commission on Hunger is a continuation of
that effort.
As you will hear, the Commission spent the last year traveling the
country to see and listen to those closest to this issue to better
understand the challenges within these programs, as well as learn about
the successes.
The Fiscal Year 2014 omnibus appropriations bill provided $1
million for a national commission on domestic hunger by including an
amendment from former Congressman Frank Wolf.
The purpose the Commission, according to the bill, was to provide
policy recommendations to Congress and the Agriculture Secretary on how
to more effectively use existing Agriculture Department programs and
funds to combat domestic hunger.
They were also instructed to develop ``innovative recommendations
to encourage public-private partnerships, faith-based sector
engagement, and community initiatives to reduce the need for government
nutrition assistance programs, while protecting the safety net for the
most vulnerable members of society.''
The ten member Commission was made up of individuals appointed by
the House Speaker, the House Minority leader, Senate Majority leader
and Senate Minority leader.
The result being five Republican and five Democratic selected
Commissioners with a range of backgrounds from a medical doctor and
grocery chain owner to hunger advocates and community leaders.
Today, the Commission-selected co-chairs are here to share their
year-long process that involved field hearings and site visits in nine
different cities.
Each hearing began with invited witnesses, similar to our format,
but then were opened up for public input. I believe the hearing here in
D.C., back in the spring, lasted more than 5 hours.
This is rather remarkable given each public witness was limited to
5 minutes.
While their report is not yet final, I commend their efforts to
remain united as a Commission, especially given their diverse
backgrounds, in presenting their final recommendations and for staying
within their charge to not propose policies that increase costs or
require additional resources.
I look forward to hearing from the Commission's co-chairs about
their process, emergent themes from that process, and a preview of what
we can expect when their final report is released in the coming weeks.
The Chairman. And with that, I turn to the Ranking Member
for any comments he would like to make.
OPENING STATEMENT OF HON. COLLIN C. PETERSON, A REPRESENTATIVE
IN CONGRESS FROM MINNESOTA
Mr. Peterson. Thank you, Mr. Chairman, and I would like to
yield our time to the Ranking Member of the Nutrition
Subcommittee, Mr. McGovern, from Massachusetts.
OPENING STATEMENT OF HON. JAMES P. McGOVERN, A REPRESENTATIVE
IN CONGRESS FROM MASSACHUSETTS
Mr. McGovern. I thank the Ranking Member for yielding me
the time. And let me also thank Dr. Chilton, and Mr. Doar, for
being with us today. And I want to thank you for your work in
Co-Chairing the National Commission on Hunger. This is a very
important subject. It is a big deal, and, quite frankly, the
issue of hunger ought to be a bigger deal in this Congress than
it is. I appreciate you being here.
I will say that this particular hearing is a little bit
premature, in the sense that we haven't seen the final report
yet. So, to me, it is difficult to see how we can get into the
details on anything we haven't seen on paper. That being said,
I appreciate your being here and giving us a preview of the
Commission's findings. You were given no easy task, to come up
with policy recommendations to solve hunger, and to put them
all in one report, and you were given very, very strict
parameters, to work within existing programs, and to carry out
your work on a very limited budget. The Chairman began by
saying that we want to strengthen SNAP, however, I have gotten
the feeling that, rather than strengthening SNAP, it is a
program that is constantly under attack in this Congress. And I
do think we need to re-focus our attention on how we strengthen
not only SNAP, but programs to make sure that people in this
country have enough to eat, have access to good nutritious
food, and don't go hungry.
I want to just take a moment to remind everyone about a few
fundamental facts about the SNAP program. First and foremost,
it is a food program, not a jobs program. Its purpose is to
provide food for people who are struggling. Second, about \2/3\
of those who receive SNAP are children, senior citizens, and
the disabled. They are not expected to work. So we can talk all
we want about work requirements, but the bottom line is those
won't apply to the majority of those who are receiving SNAP. Of
those who can work, the majority do work. Let me repeat that.
The majority of SNAP recipients, who are able to work, do work.
But the reality is they earn so little, either at full time
jobs or at multiple part time jobs, that they still qualify for
the benefit. And we do know, when people go back to work, they
begin to lose some of their benefits, and sometimes they find
themselves in this precarious predicament where, even though
they are working, hunger is a bigger issue, rather than a
smaller issue.
There is no doubt that a strong economy and a living wage
are the best pathways out of poverty, but compelling people to
work when there are no jobs, or there are precious few slots in
work training programs, or that they are not expected to work
to begin with, doesn't make a lot of sense to me. Cutting them
off from SNAP only makes hunger worse. SNAP is a food program,
and we shouldn't expect it to single-handedly solve the many
challenges of our country's poorest families. SNAP can't be
expected to solve broader economic challenges, or barriers
people have to work.
So as we begin today's hearing, I urge my colleagues to
remember that. What we really need is a national conversation
about how we can better tackle hunger in this country. For a
long time now I have been saying that the White House ought to
convene a White House conference on food, nutrition, and
hunger. Congress should work with the White House and the full
range of stakeholders to come up with a holistic plan to end
hunger in this country. We have programs to deal with this
challenge, but I don't know of anybody when asked the question,
what is our plan to end hunger, whether it is childhood hunger,
or hunger among senior citizens, or hunger in general, that can
actually articulate for me very specifically what their plan
is. At the heart of that plan would be strengthening SNAP, and
other anti-hunger programs, helping families put food on the
table.
Let me just finally say that, ultimately, hunger is a
political condition. We know we have the resources, we have the
intellectual capacity to solve this problem, we have the
infrastructure, but for some reason it hasn't been a priority,
and there is no sense of urgency to deal with this issue. And
too often when we have these debates they end up turning into a
session where people who are poor, and who are struggling, are
blamed, and we are not talking about developing a road map to
end hunger. So, I hope that this hearing is not just a hearing
to check the box, but I hope it is a hearing that will actually
begin to lay the groundwork for a wider discussion. We need
other agencies, other departments in the government to be
working together, not in a silo-like way. We need more public-
private partnerships. We have great examples of what works, and
I am sure you have seen some of them all across the country.
But we need to pull all this together, and work with the White
House to develop a comprehensive plan to end hunger once and
for all in this country. I thank you for being here, and look
forward to your testimony. I yield back.
The Chairman. I thank the gentleman. The chair requests
that other Members submit their opening statements for the
record so the witnesses may begin their testimony, and ensure
there is ample time for questions.
I would like to welcome our witnesses to the table today.
We have Mr. Robert Doar, Co-Chair of the National Commission on
Hunger, Morgridge Fellow in Poverty Studies, American
Enterprise Institute here in Washington, and Dr. Mariana
Chilton, Co-Chair of the National Commission on Hunger, and she
is the Director of the Center for Hunger-Free Communities at
Drexel University in Philadelphia. So, Mr. Doar, the microphone
is yours for 5 minutes.
STATEMENT OF ROBERT DOAR, CO-CHAIR, NATIONAL
COMMISSION ON HUNGER; MORGRIDGE FELLOW IN
POVERTY STUDIES, AMERICAN ENTERPRISE INSTITUTE, WASHINGTON,
D.C.
Mr. Doar. Thank you, Chairman Conaway, and Ranking Member
Peterson. I appreciate being invited today to testify about the
activities of the Congressionally appointed National Commission
on Hunger. My name is Robert Doar, and I am the Morgridge
Fellow in Poverty Studies at the American Enterprise Institute.
Prior to coming to AEI, I was the Commissioner of the New York
City Human Resources Administration, and prior to that, I was
the Commissioner of the New York State Office of Temporary and
Disability Assistance.
It has been an honor to serve on the Commission. As a
former State and City Administrator of Welfare Programs,
including the Supplemental Nutrition Assistance Program, I was
familiar with the challenges faced both by struggling
Americans, and by the government, and not-for-profit
organizations, which do so much to try to help poor Americans.
But the experience of the last 18 months, where we gathered
testimony and observed the difficulties facing low-income
communities across the country, has given me an even greater
understanding of the issue, and the ways in which we can
address it.
This morning I would like to highlight seven aspects of
what we learned during this process. First, we came to an
understanding of how to quantify the problem of hunger. We
decided early on to focus on very low food security at the
household level, an annual measure produced by the USDA, drawn
from a survey of Americans. To the members of the Commission,
reports of eating patterns being interrupted due to lack of
resources is a significant indication of difficulty within a
household, which requires attention. While we want to be clear
that the hunger seen in America is not equivalent to the
malnutrition seen in developing nations, we do believe that the
very low food security measure reflects the reality of hardship
in the United States. And by this measure, 5.6 percent of
households reported hunger in 2014, a rate that remains
elevated more than 5 years into the economic recovery.
Second, members of the Commission were cognizant of the
fact that our charge limited us to proposing changes which
stayed within existing resources. We are aware of the fiscal
challenges facing this country, and we are confident that more
progress can be made in reducing hunger without having to
significantly increase Federal spending. Third, members of the
Commission were unanimous in identifying a number of root
causes of hunger, many of which were beyond the traditional
scope of the food and nutrition programs of the Federal
Government. The root causes we identified included the still
struggling economy, which contributes to unemployment, the
growth in hunger rates are significantly higher for single
parent families than they are for married families--and the
need for personal responsibility from those with limited
resources. To the members of the Commission, it was important
to say to Congress that progress on reducing hunger will
require attention to these issues, which are not solely the
responsibility of the food and nutrition programs.
Fourth, we came away from our field visits and hearings
convinced that a key to solving hunger is helping more poor
Americans find full time employment. Rates of very low food
security are significantly higher in households with no adults
working than it is in households with a full time worker. Our
various social services programs, and our economy, must do a
better job bringing people into the workforce if we are to make
strides in reducing hunger.
Fifth, members of the Commission learned that a lot of the
best work being done on this issue is taking place in states,
and is often led by the not-for-profit community. And the
Commission feels that, to the extent possible, we should use
states and localities as places for experimentation with new
and different approaches, all to be rigorously evaluated before
making nationwide changes to the various programs. We don't
pretend to have all the answers to the problem of hunger, but
we are confident that if states are allowed to experiment with
pilot programs, better ideas will come to the fore. Sixth,
members of the Commission came to believe that addressing
hunger also means addressing nutrition. We can do a better job
helping Americans have access to, and to prepare and consume
more healthy foods, and in doing so we will make progress on
alleviating hunger.
Finally, Commission members came away from their experience
exploring this issue deeply proud of the extensive activity by
Federal, state, and local governments, corporations and not-
for-profits, individuals and faith-based institutions, which is
already directed at alleviating, and does alleviate, for many,
this difficult problem. Members were unanimous in wanting to
celebrate the great contribution our country already makes to
address this issue. And they also understood that knowledge of
what we already have accomplished should give us a foundation
to build on, and confidence that we can solve this problem. We
can end hunger in America. Thank you.
The Chairman. Thank you, Mr. Doar. Dr. Chilton, 5 minutes.
STATEMENT OF MARIANA M. CHILTON, Ph.D., M.P.H., CO-CHAIR,
NATIONAL COMMISSION ON HUNGER; ASSOCIATE PROFESSOR, DEPARTMENT
OF HEALTH MANAGEMENT AND POLICY, DORNSIFE SCHOOL OF PUBLIC
HEALTH, DREXEL UNIVERSITY; DIRECTOR, CENTER FOR HUNGER-FREE
COMMUNITIES, PHILADELPHIA, PA
Dr. Chilton. Again, thank you for the opportunity to
testify about the National Commission on Hunger. As a scientist
at the Dornsife School of Public Health at Drexel University in
Philadelphia, I bring over 15 years of experience designing and
carrying out research studies among families with young
children to investigate the causes, consequences, and
prevention of hunger. I have directly witnessed the physical,
social, emotional, and spiritual pain that hunger causes.
Our field hearings for the National Commission also helped
us to learn about the realities of hunger. The experience of
one particular person, Saleema Akbar, who lives right here in
Washington, D.C., made that hardship of hunger quite clear, and
these are her words. ``I have worked since I was 13 years old.
I am not a senior yet. I am only 57. I have fibromyalgia,
osteoarthritis, and diabetes. With the diabetes, they tell me
that I have to eat a lot of protein. I get food stamps, but I
don't have enough money to buy enough protein to make it
through the rest of the month. I am not a child, so I can't get
help from any programs, and I am not yet a senior, so I can't
get those, so I am stuck between a rock and a hard place. My
disability income goes to pay my rent. I get disability because
I am 100 percent disabled.'' She said, ``When you are talking
about hunger, it is right here, right here. I know you have to
feed the babies. I know you have to feed the seniors. But what
about the people in the middle?''
Ms. Akbar's testimony reveals to us two things. Number one,
like her, the vast majority of people who experience hunger are
already vulnerable. They are made vulnerable by their physical
and mental health, or perhaps by historical and social
circumstances, or perhaps they are incapable of coping with the
stress of poverty. Number two, while it is absolutely true that
we have very effective nutrition programs, and other support
for low-income families, there are still many people that are
missed, discounted, or uncounted that are poorly served through
our current program structures.
Hunger is an experience of poor nutrition that has major
health consequences. Our research shows that hunger has serious
consequences, especially in early childhood. Infants and
toddlers that are younger than age 3 are in the most important
years of human development, and any type of nutritional
deprivation in those early years has lifelong consequences, and
that is because hunger negatively affects children's physical,
social, emotional, and cognitive functioning. These
consequences stay with kids across their lifespan, and they can
be transferred to the next generation. This type of childhood
adversity is what neuroscientists call toxic stress. Other
types of toxic stress are homelessness, exposure to violence,
or having a parent in prison. Our report insists that families
with young children are quite vulnerable to hunger, and they
need special attention. Another group that needs our attention
is America's veterans. Among veterans of the Iraq and
Afghanistan wars, 12 percent reported hunger. This is twice the
rate of hunger in the general population. Given the serious
problems associated with Post-Traumatic Stress Disorder, we
understand that in addition to having nutrition support,
veterans may need specialized support to find jobs, and access
to safe, affordable housing.
SNAP, WIC, and other nutrition programs do a good job of
reducing hunger and promoting health, but they do not solve
hunger completely. Clearly we need to improve our current
programs, but we also need to address the root causes of
hunger, and ensure that we are counting and supporting the most
vulnerable citizens of America. Saleema Akbar experiences
hunger right here in D.C., and she can no longer be discounted.
So many people in communities across America need your
attention and leadership. One of our recommendations,
therefore, is quite simple. Congress, and the White House, must
insist on more effective cross-agency collaboration. Beyond the
Department of Agriculture, this includes the Department of
Health and Human Services, the Department of Education,
Department of Labor, Department of Housing and Urban
Development, and the Veterans' Administration. In concert with
leadership from the White House and Congress, these agencies
should make a coordinated national plan to end hunger in
America. Only with this type of leadership, driven by your
sense of social, moral, and personal responsibility to our
country, is ending hunger possible. Thank you.
[The joint prepared statement of Mr. Doar and Dr. Chilton
follows:]
Joint Prepared Statement of Robert Doar, Co-Chair, National Commission
on Hunger; Morgridge Fellow in Poverty Studies, American Enterprise
Institute, Washington, D.C.; and Mariana M. Chilton, Ph.D., M.P.H., Co-
Chair, National Commission on Hunger; Associate Professor, Department
of Health Management and Policy, Dornsife School of Public Health,
Drexel University; Director, Center for Hunger-Free Communities,
Philadelphia, PA *
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* The views expressed in this testimony are those of the authors on
behalf of the National Commission on Hunger. Institutional affiliations
are provided for identification purposes only and do not imply
institutional support or endorsement.
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Chairman Conaway, Ranking Member Peterson, and other distinguished
Members of the Committee, thank you for giving us the opportunity to
testify about the findings of the National Commission on Hunger.
This Commission was created by legislative mandate in the Omnibus
Appropriations Bill of 2014, with the following charge:
To provide policy recommendations to Congress and the USDA
Secretary to more effectively use existing programs and funds
of the Department of Agriculture to combat domestic hunger and
food insecurity; and to develop innovative recommendations to
encourage public-private partnerships, faith-based sector
engagement, and community initiatives to reduce the need for
government nutrition assistance programs, while protecting the
safety net for the most vulnerable members of society.
Congressional leaders from both parties appointed ten members to
the Commission: three each by the Speaker of the House and the Senate
Majority Leader (John Boehner, R-Ohio, and Harry Reid, D-Nevada,
respectively, at that time); and two each by the House and Senate
Minority Leaders (Nancy Pelosi, D-California, and Mitch McConnell, R-
Kentucky, respectively, at that time). The Commission members represent
government, industry, academia, and nonprofit organizations. The
biographies of each Commission member are included in the Appendix.
At the outset of our work together, the Commission selected two of
our members as co-chairs to guide our work: Mr. Robert Doar and Dr.
Mariana Chilton.
Between the two of us, we have over 35 years of experience in
addressing poverty and hunger. Robert Doar spent nearly 2 decades
administering many of our nation's major safety net programs in New
York City and New York State, and Dr. Mariana Chilton has dedicated
much of her academic career to studying hunger, its causes, and its
consequences for low-income Americans. We have been honored to serve as
co-chairs of this bipartisan Commission.
The Commission's goal is to develop recommendations to Congress and
the USDA that has the unanimous, bipartisan support of all our members.
We are close to completing our report, and are honored to share our
process with you.
Over the last year and a half, we traveled to nine cities and heard
testimony from 80 invited experts and 102 members of the public who
provided testimony and advice during hearings, briefings and site
visits. We also observed government and nonprofit programs designed to
alleviate hunger. We talked with struggling Americans trying to ensure
a better life for themselves and their children. We listened to state
officials describe the challenges they face in serving their
populations. Through this process, we gained insight into the root
causes of hunger in America, why it is such a significant problem, and
what improvements can be made.
As is to be expected from bipartisan commissions, sometimes we saw
the same things and reached different conclusions about solutions.
However, we are working together to put forward a report that gains the
unanimous endorsement from our members and presents a full picture of
hunger in America. We are confident that consensus will soon be reached
and hopeful that upon its release, the report will be considered
carefully by Congress.
Today, we will give an update on our findings and the themes at the
center of our forthcoming report. We lead with our outline:
I. Our definition of hunger and its consequences.
II. The root causes of hunger.
III. The populations that warrant specific concern.
IV. Our priorities in recommending solutions and improvements.
I. Our Definition of Hunger and its Consequences
Before we could reach any conclusions about hunger in America, we
first had to agree about how to define and quantify it. We chose a
measure of hunger called ``very low food security,'' defined as the
disruption of eating patterns and reduced food intake for at least one
household member because the household lacked money or other resources
for food. As a Commission, we are in agreement that hunger is an
important problem. We also want to be clear that the hunger seen in
America is not the equivalent of the famine and severe malnutrition
found in developing countries. In our judgment, the very low food
security measure of hunger appropriately reflects the reality of
serious hardship and focuses our attention on the U.S. households where
the problem is most severe. By this measure, 5.6 percent of households
(6.9 million households) reported hunger in 2014.\1\
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\1\ Coleman-Jensen A., Rabbitt M., Gregory C., Singh A. Household
food security in the United States in 2014. Washington, D.C.: Economic
Research Service, U.S. Department of Agriculture; September 2015.
Available at http://www.ers.usda.gov/publications/err-economic-
research-report/err194.aspx.
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This is a troubling statistic because the research shows hunger has
far-reaching effects on Americans of all ages. When children experience
hunger, their academic performance suffers.\2\ Adolescents in families
reporting hunger encounter more problems with mental health and
thoughts of suicide.\3\ Adults that report hunger are more likely to be
overweight and have other health problems.\4\ For seniors, hunger can
lead to depression and reduced capacity to perform day-to-day tasks.\5\
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\2\ Hickson M., de Cuba S.E., Weiss I., Donofrio G., Cook J. Too
hungry to learn: Food insecurity and school readiness, Part I of II.
Boston, MA: Children's HealthWatch, Boston Medical Center; 2013.
Available at http://www.childrenshealthwatch.org/wp-content/uploads/
toohungrytolearn_report.pdf.
\3\ Alaimo K., Olson C.M., Frongillo E.A. Family food
insufficiency, but not low family income, is positively associated with
dysthymia and suicide symptoms in adolescents. J. Nutr. 2002; 132(4):
719-725.
\4\ Lee J.S., Gundersen C., Cook J., Laraia B., Johnson M.A. Food
insecurity and health across the lifespan. Adv. Nutr. 2012; 3(5): 744-
745.
\5\ Ziliak J.P., Gundersen C., Haist M. The causes, consequences,
and future of senior hunger in America. Lexington, KY: University of
Kentucky; 2008. Available at http://www.ukcpr.org/Publications/
SeniorHungerStudy.pdf.
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We believe that addressing this problem is a question of values--no
one in a country as rich as ours should go hungry. And given these
concrete consequences, we argue that reducing hunger should be an
urgent priority of Congress.
II. The Root Causes of Hunger
After hearing over 180 testimonies and visiting multiple cities, it
is clear to the Commission that there are many factors leading to
hunger in America. A simple explanation focused only on low household
income or insufficient nutrition assistance ignores other critical
causes. For example, underemployment and unemployment are major
factors. Underemployment, which includes part time jobs with
unpredictable and fluctuating amounts of hours, seasonal work, or very
low wages, causes major income instability or sharp income
fluctuations, which are associated with increased odds of hunger.
Additionally, households without a working adult are disproportionately
likely to experience hunger.\6\ The 2007-2009 economic downturn led to
a more than doubling of unemployed workers, and hunger levels spiked
correspondingly.
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\6\ Coleman-Jensen A. Working for peanuts: nonstandard work and
food insecurity across household structure. Journal of Family and
Economic Issues. 2011; 32: 84-97.
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Six years after the official end of the recession, hunger rates
today remain at historically high levels. And the negative impact of
labor market forces on hunger is not just cyclical. Due to
globalization and automation, our economy has experienced structural
shifts over the last 60 years that have led to fewer well-paying job
opportunities for Americans without a college degree.\7\ Adverse labor
market conditions weaken the best defense against hunger: adequate
earnings from employment.
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\7\ Acemoglu D., Autor D., Dorn D., Hanson G.H., Price B. Import
competition and the great U.S. employment sag of the 2000s. August
2014. Available at http://economics.mit.edu/files/9811.
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Relatedly, we identified a strong relationship between hunger and
education that works in both directions. Children experiencing hunger
have lower graduation rates, while individuals without a high school
degree are more likely to experience hunger than their peers who
completed high school.8-9
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\8\ Alaimo K., Olsen C., Frongillo J. Food insufficiency and
American school-aged children's cognitive, academic and psycho-social
development. Pediatrics. 2001; 108(1): 44-53.
\9\ Coleman-Jensen A., McFall W., Nord M. Food insecurity in
households with children: prevalence, severity, and household
characteristics, 2010-11. Washington, D.C.: Economic Research Service,
U.S. Department of Agriculture; May 2013. Available at http://
www.ers.usda.gov/media/1120651/eib-113.pdf.
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A third critical factor is family structure. Marriage has a
significant impact on whether or not a household will experience
hunger: The hunger rate for households headed by married couples is
3.2%, yet for households headed by a single mother with children, the
rate is four times that at 12.8%. For households headed by single
fathers, the rate is more than two times that of married couples at
7%.\10\ Furthermore, children who grow up in single parent families are
less likely to do well in school or graduate high school.\11\ The fact
that 40% of children in the United States are now born to parents that
are not married is a key explanation for the continued existence of
hunger.\12\
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\10\ Coleman-Jensen A., Rabbitt M., Gregory C., Singh A. Household
food security in the United States in 2014. Washington, D.C.: Economic
Research Service, U.S. Department of Agriculture; September 2015.
Available at http://www.ers.usda.gov/publications/err-economic-
research-report/err194.aspx.
\11\ Pruett K. Father-need. New York, NY: Broadway Books; 2000.
\12\ The vast majority of pregnancies among couples that are not
married are unplanned.
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We also agreed that a full understanding of hunger requires
acknowledging the fact that the historical legacies of racism in
America and continued racial discrimination today affect access to
jobs, home ownership, education, and affordable healthy food. The
persistence of racial inequality contributes to hunger rates of 10.4%
and 6.9% for African American and Hispanic households, respectively,
compared to a 4.5% rate for white households.\13\ Additionally, there
is a clear link in the research between exposure to violence and
hunger.\14\
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\13\ Coleman-Jensen A., Rabbitt M., Gregory C., Singh A. Household
food security in the United States in 2014. Washington, D.C.: Economic
Research Service, U.S. Department of Agriculture; September 2015.
Available at http://www.ers.usda.gov/publications/err-economic-
research-report/err194.aspx.
\14\ Chilton M.M., Rabinowich J.R., Woolf N.H. Very low food
security in the USA is linked with exposure to violence. Public Health
Nutr. 2014; 17(1): 73-82.
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Finally, it is critical to acknowledge one other key ingredient--
the actions of individuals. We agree as a Commission that personal
agency, responsibility, and the importance of individuals making good
choices play a role in the extent to which Americans are hungry, and
any discussion of hunger that ignores the importance of personal
responsibility is incomplete.
III. Populations of Specific Concern
In our study of this issue, we have discovered that certain groups
in our country are particularly at risk of experiencing hunger. For
instance, the number of seniors will increase dramatically over the
next few decades, and it seems likely that the number of homebound
seniors will increase correspondingly. Because this growth will further
strain organizations on which many elderly Americans depend, such as
Meals on Wheels, seniors will be a group that warrants attention.
People with disabilities are also a population of specific concern as
38% of all households experiencing hunger include an adult with a
disability.\15\
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\15\ Coleman-Jensen A., Nord M. Food insecurity among households
with working-age adults with disabilities. Washington, D.C.: Economic
Research Service, U.S. Department of Agriculture; January 2013.
Available at http://www.ers.usda.gov/media/980690/err_144.pdf.
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A third population we want to focus on is America's veterans and
active duty military. A 2012 study of veterans of the Iraq and
Afghanistan wars found that 12% reported hunger, and approximately 1-2%
of active duty military members receive SNAP benefits.\16\ While there
is little data on the extent of hunger among active duty military and
veterans, we agree that this issue deserves careful research and
consideration.
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\16\ Windome R., Jensen A., Bangerter A. Food insecurity among
veterans of the U.S. wars in Iraq and Afghanistan. Public Health Nutr.
2015; 18(5): 844-848; and U.S. Department of Agriculture, Food and
Nutrition Service. Quick facts: SNAP participation among members of the
Armed Forces. Washington, D.C.: U.S. Department of Agriculture, Food
and Nutrition Service; February 2014. Available at http://mldc.whs.mil/
public/docs/report/qol/
SNAP_and_Military_Quick_Facts_Feb_2014_update_w_2010-2012_ACS.pdf.
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Our Commission is also particularly worried about the formerly
incarcerated, who have difficulty finding jobs, adequate housing and
opportunities to re-engage with their families and communities. As
previously indicated, single parent families with young children are
especially vulnerable to experiences of hunger. And immigrants and
American Indians face particular challenges in gaining access to enough
healthy food.
As Congress considers what interventions should be used to reduce
hunger, we recommend that these seven groups--seniors, single parent
families, people with disabilities, veterans and active duty military,
American Indians, immigrants, and the formerly incarcerated--be given
special consideration.
IV. Priorities in Recommending Solutions and Improvements
In our field visits and hearings, we saw and heard about public and
private food programs that were effective in reducing hunger. We
encountered research showing that the Federal Government's food
assistance programs--SNAP, WIC, and school meals among others--are
essential tools that effectively target those in need.\17\ However, the
latest ERS statistics show that hunger remains elevated despite a 171
percent increase in SNAP receipt since 2000. This illustrates clearly
that food assistance programs are addressing the problem, but not fully
solving the problem, and this Commission believes that, without a focus
on root causes and emphasis on work and nutrition, we will continue to
fail to end hunger. Our vital safety net programs provide a strong
foundation on which to build a more effective approach to fighting
hunger.
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\17\ Shafir E. Invited written testimony to the National Commission
on Hunger. Professor, Princeton University Woodrow Wilson School of
Public and International Affairs. Research Triangle Park, NC: National
Commission on Hunger; July 26 2015. Available at https://
hungercommission.rti.org/Portals/0/SiteHtml/Activities/
WrittenTestimony/InvitedWritten/
NCH_Invited_Written_Testimony_Eldar_Shafir.pdf; and Rachidi A. Invited
testimony before the National Commission on Hunger: Addressing very low
food security among American households. Albany, NY: Research Fellow in
Poverty Studies, American Enterprise Institute for Public Policy
Research; May 13 2015. Available at https://hungercommission.rti.org/
Portals/0/SiteHtml/Activities/PublicHearings/AlbanyNY/
AlbanyNY_Testimony_Angela_ Rachidi.pdf.
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While we are still working towards consensus on the final specific
recommendations, the Commission thinks reforms must speak to the
following themes: work, nutrition and well-being, experimentation, and
executive leadership. The primary goal of SNAP is to treat and prevent
hunger, but it can also serve as a support for families as they enter
the job market. We will put forward recommendations designed to help
benefit recipients find work, improve work incentives in assistance
programs, and encourage policymakers to evaluate the states'
performance in helping employable recipients go to work so they can
earn sufficient wages.
We also believe that nutrition programs should be viewed as an
opportunity to ensure healthy choices among recipients, and we will
endorse evidence-based strategies to encourage good nutrition, promote
health, and help recipients make positive choices for their families.
Our Commission will also prioritize finding ways to directly
improve the immediate well-being of vulnerable Americans. Our
recommendations will involve increasing access to and coordination of
essential safety nets, improving the support offered to military
families, and encouraging civic engagement efforts to provide help to
our neighbors in our own communities.
We don't pretend to have all of the answers to the problem of
hunger in America. Instead, we want policymakers at the Federal, state,
and local level to experiment with new ideas and to advance changes
that prove to be successful. We plan to recommend several pilot
programs and to encourage rigorous testing and evaluation of these
experiments.
Finally, while Congress can move forward on many of our
recommendations, addressing the root causes of hunger, and ensuring
that we protect the most vulnerable citizens of America will also take
very deliberate, cross-sector and cross-agency collaboration that is
encouraged by Congress and led by the Executive Branch. This will
ensure that the relevant agencies such as the Department of Health and
Human Services, the Department of Education, the Department of Labor,
the Department of Agriculture, and the Veterans Administration (to name
only a few) coalesce around the common cause of ending hunger in
America. This type of leadership, collaboration, and commitment will
demonstrate to all Americans that ending hunger is an achievable goal.
Thank you again for the opportunity to provide you with an overview
of our work. We hope that our findings and recommendations prove useful
in your efforts to help America become a stronger and healthier nation.
Appendix: Biographies of Members of the National Commission on Hunger
Mariana Chilton, Ph.D., M.P.H. is an Associate Professor at Drexel
University School of Public Health and Director of the Center for
Hunger-Free Communities. She directs multiple research studies on the
impact of public policy on food insecurity and health and well-being
among families with young children. (Reid appointee)
Spencer Coates is President of Houchens Industries, Inc. and serves
on its Board of Directors. He joined the Houchens family of companies
in October 2003, after retiring from BKD, LLP, a national public
accounting firm where he had spent 30 years serving in various
capacities. (McConnell appointee)
Robert Doar is the Morgridge Fellow in Poverty Studies at the
American Enterprise Institute, where he studies how improved Federal
policies and programs can reduce poverty and provide opportunities for
vulnerable Americans. Previously, he served as Commissioner of the New
York State Office of Temporary and Disability Assistance and
Commissioner of the New York City Human Resources Administration.
(Boehner appointee)
Jeremy Everett is the founding Director of the Texas Hunger
Initiative at Baylor University, a capacity building project that seeks
to develop and implement strategies to alleviate hunger through
research, policy analysis, education, and community organizing.
(Boehner appointee)
Susan Finn, Ph.D. is the CEO of the global consultancy Finn/Parks &
Associates and a recognized leader and a respected communicator in the
food, nutrition, and health arena. She is a leader in the Academy of
Nutrition and Dietetics and is committed to advancing nutrition
research and education. (Boehner appointee)
Deborah Frank, M.D. is a child health researcher and the inaugural
incumbent of a newly established Pediatric Professorship in Child
Health and Well Being at Boston University School of Medicine. She
began working at Boston City Hospital (now Boston Medical Center) in
1981. In 1984, she founded the Failure to Thrive Program, now called
the Grow Clinic for Children. (Pelosi appointee)
Cherie Jamason is President of the Food Bank of Northern Nevada, a
nationally recognized anti-hunger organization and recent Feeding
America Food Bank of the Year. She successfully implemented the Nevada
Child Nutrition Initiative providing summer food and after school meal
programs for low income children throughout Nevada. (Reid appointee)
Billy Shore is the founder and CEO of Share Our Strength, a
national nonprofit dedicated to ending childhood hunger in America
through its No Kid Hungry campaign. He is also the author of four
books, including The Cathedral Within, and chair of Community Wealth
Partners, which helps change agents solve social problems. (Pelosi
appointee)
Russell Sykes is an independent consultant working on multiple
Federal and state projects focusing on Job Search in Temporary
Assistance for Needy Families (TANF), Medicaid Reform, Social Security
Disability and workforce engagement. He was the former Deputy
Commissioner for New York State's Office of Temporary and Disability
Assistance where he was responsible for the administration of SNAP,
TANF, welfare-to-work and multiple other public benefit programs.
(McConnell appointee)
Note: Congressional leaders appointed ten people to the Commission,
but one, Ricki Barlow (Reid appointee), later resigned for personal
reasons and is not listed above. Institutional affiliations are
provided for identification purposes only and do not imply
institutional support or endorsement.
The Chairman. Thank you to our panel, our witnesses. The
chair would remind Members that they will be recognized for
questioning in order of seniority for Members who were here at
the start of the hearing. After that, Members will be
recognized in order of arrival. I appreciate Member's
understanding. I recognize myself for 5 minutes.
Again, I thank the witnesses for being here. We scheduled
this hearing in anticipation that the final report would be
done in October, and so that is why we are a little bit out of
sync, but I wanted to go ahead and bring the Co-Chairs in with
us this morning to visit.
Today is our tenth hearing on SNAP, which actually is more
than the last three Congresses combined, and calls attention to
an issue that is of great concern to all of us. We have made a
conscious effort to proceed without preconceived notions, and
with a desire to hear from a range of perspectives. We have
heard from policy experts, advocates, practitioners, agency
officials, and, most importantly, current and former SNAP
recipients, and it appears that the Commission made a similar
effort to cover a range of perspectives, and to open this
process to public witnesses. You are both well versed in the
topic of hunger, as are the other Commission members, and you
could easily have met and brought your ideas to form your
recommendations. Instead, you took a considerable effort to go
beyond your own knowledge base, which is important to do. So,
with that backdrop, what additional perspectives did you pull
in that we might not have been addressing here so far?
Mr. Doar. Well, Mr. Chairman, we definitely went around the
country. We went to the West Coast, we went to Maine, we went
to Texas, we went to Arkansas, and we saw a very comprehensive
picture of the extent to which many Americans are working hard
to address this issue, and we heard from people who were
struggling. I don't want to compare what perspectives we got to
what perspectives you get, because I presume you get all the
perspectives too. But we did a comprehensive job. I think we
talked to a lot of people, we learned a lot, we listened, and
our report will reflect their voices, both from the not-for-
profit, or government, or advocacy community, as well as the
recipient community.
The Chairman. What surprised you, or stood out, as a result
of your hearings? Dr. Chilton or Mr. Doar?
Mr. Doar. I would say one was the enormous amount of not-
for-profit involvement that we saw. That surprised me. I didn't
realize quite the extent of it. Second was that we did hear
from recipients of the Supplemental Nutrition Assistance
Program who were grateful for the assistance that they were
provided, but hoped that the social services programs broadly
would be more helpful in helping them get into full time
employment.
The Chairman. Dr. Chilton?
Dr. Chilton. It certainly wasn't a surprise to hear that--
--
The Chairman. Please talk into your microphone.
Dr. Chilton. Thank you. It certainly wasn't a surprise to
hear, across the country, from most of the people who are
recipients of SNAP and the other programs, that their primary
concern is finding access to well-paying jobs. When we were in
New Mexico, and in Maine, and in Texas, we heard a lot about
how the economy was still struggling, high unemployment rates
and it is still, very difficult to find full time employment so
that they could get off of SNAP. There was a strong desire to
be off of the nutrition programs, and the other programs, but
there was also a strong appreciation for how those programs
were helping families to get through the day.
I think some of the surprises were, I brought it up in my
testimony, the rates of hunger among veterans. And we heard a
little bit about active duty military, which were things that
were very concerning to us, which we are hoping to investigate
a little bit more. We were also hearing, especially in
Washington, D.C., about the relationship between disability and
food insecurity or hunger, and that was made to us very clear,
especially by Saleema Akbar and several others in Washington,
D.C. We heard many other things, but those were the things that
surprised me. Certainly the veterans, we need more assistance
from the Department of Defense and the Veterans'
Administration.
The Chairman. You mentioned Ms. Akbar. Were there other
memorable witnesses that stand out, besides her experience that
you can share with us?
Mr. Doar. Well, that is a hard question. We heard a lot.
This testimony that my Co-Chair refers to does reflect the kind
of gap in services between someone who is, due to a physical or
mental incapacity, is restrained to her home, and Medicaid and
Medicare, and other programs, aren't actually set up that well
to provide food assistance to them, or SNAP, while they are at
home and cannot get out. That was an issue that I thought was
striking to us.
Dr. Chilton. In Maine there was someone who testified who
has been a recipient of SNAP, and who has also been in and out
of the workforce, and was also very appreciative of the summer
feeding programs, but one of the comments that she made is that
we spend so much time and effort figuring out how to coordinate
summer feeding, or how to help people to not experience hunger,
but that we aren't doing enough to address the underlying
issues that are related to poverty. She wants more access to
skills, more training, more opportunities to get out of
poverty. And what was upsetting, and sad to hear, but also very
revealing, was that the access to emergency food, and to other
food programs, is good, but all that really does in the end is
keep her in line, waiting for the box of food.
Mr. Doar. Mr. Chairman, if I could just add one other, we
also saw effective summer feeding programs that were located in
schools, or libraries, where the children that came and
participated in them received the benefit both of the
additional nutrition, but also of the programmatic offerings
that that program would offer, that there was a benefit in
learning, and in growth, that went beyond just the provision of
food. And that was inspiring to us.
The Chairman. Okay. Thank you. My time has expired. Mr.
Scott, for 5 minutes.
Mr. David Scott of Georgia. Thank you, Mr. Chairman. I want
to talk about our veterans, because it is a very, very
particular disgrace and shame of this nation that disabled
veterans, disabled, not just veterans, those who lost their
limbs on the battlefield, those who suffer from PTSD from the
battlefield, are twice as likely to be a part of a food-
insecure household. And according to the Center on Budget and
Policy Priorities, between 2011 and 2013, 1.7 million veterans
live in households that need, and that use, food stamps. And
70,000 of those veterans, and disabled veterans, live in my
home State of Georgia. For veterans who are struggling to
overcome obstacles to feed their families, food stamps make a
crucial, crucial difference.
But now the question, Dr. Chilton, the question is, given
all of this, despite all this knowledge, we have people who
want to cut food stamps, who want to limit food stamps. When we
have our dear soldiers, who have given their all on the
battlefield, 1.7 million of them living in households where
they need and use food stamps. Why? What in God's name is
causing people to want to so drastically cut a program of food
stamps when our soldiers need it to exist? Can you answer that
for me?
Dr. Chilton. Thank you very much for your question. As a
Member of Congress, you might be better poised to answer the
question about why there is interest in cutting the programs.
From my perspective as a scientist, my sense is that many
legislators, and just the general public, do not understand
what the experience of hunger is like. They may have this
notion that hunger is a type of an eyeball diagnosis, that
somehow we can see it on a person's face, or see it very
easily. But hunger manifests in very invisible ways, but very
harmful ways. It manifests in poor mental health, poor physical
health, inability to get along with your peers, especially for
children. For adolescents who are experiencing food insecurity,
it is related to thinking about suicide. So it is hard to see
it, and there is a lack of understanding about what the true
issues really are.
Mr. David Scott of Georgia. Dr. Chilton, and you too, if
you have something----
Mr. Doar. Sure.
Mr. David Scott of Georgia.--to add to this----
Mr. Doar. Yes.
Mr. David Scott of Georgia.--because this is a very, very
burning issue. I work closely with veterans. I have jobs fairs
every year, health fairs, and I partner it with the VA in
Atlanta, Georgia, with Ms. Leslie Williams, who you may know is
Director of the VA program in Atlanta, and Al Bocchicchio, who
is the Regional Director for the whole region. The issue is,
and you put your finger on it, we in Congress sit here. Many of
those voices who want to cut this program come from Congress,
comes from us. And so what I want to ask is, what is it going
to take to finally get the issue of food stamps to be addressed
properly? And if we are not willing to do that for our
soldiers, I mean, how does that speak of our nation?
Mr. Doar. Congressman, one of the motivating factors behind
this discussion is the extent to which we have had, over the
last 7 or 8 years, a very significant increase in SNAP
expenditures and SNAP recipients. And yet, at the same time, we
have had a stubbornly high very low food security measure, at
about 5\1/2\ percent, which has not come down despite this--and
also big increase in school meals as well. All I would say is
that what we did hear was some frustration about that may not
be enough, you need to do other things as well to help people
escape hunger.
And that is what is happening when we have discussions
about SNAP not being sufficient, or doing enough, or being
effective enough. It is effective, but it is frustrating to
have, really, record high expenditures and number of
recipients, and also record high very low food security 5 years
after the end of the recession.
Mr. David Scott of Georgia. Well, just in conclusion, Dr.
Chilton, and I know you have passion for the veterans, and this
is what my passion is as well, and it is certainly the passion
of all of us in Congress, but whatever you can do to help get
this misguided vision of us here in Congress, and to lay out
and continue to stress the dire need of correcting this
terrible imbalance on food stamps, and use the examples of how
critically our veterans need it----
The Chairman. The gentleman's time has expired. Austin
Scott, 5 minutes.
Mr. Austin Scott of Georgia. Thank you, Mr. Chairman. Ma'am
and sir, thank you for being here today. And one of the things
that certainly I wrestle with is the balance between access of
the system for those who need it, and that it was designed for,
and the integrity of the system, where we have certainly some
abuses. I don't think it is a huge portion of the program, but
I do think that it is important for us to maintain the
integrity of any program that we have in Washington. The other
thing that I see is different policies that are put in place
that increase the cost of food. If the cost of food goes up 20
percent, then that is 20 percent less in calories, assuming
they were buying the same foods----
Dr. Chilton. Yes.
Mr. Austin Scott of Georgia.--that they would have that
they took home. Another issue that I see, quite honestly, is
abuse at the retail level, where many poor people in this
country end up paying significantly more for a gallon of milk
than my wife and I pay for it when we go to the local grocery
store and shop. I don't know that we can mandate fixes to all
of those things, but I do know that the only way out of poverty
is a job, and work. And the easier it is to create a job in
this country, the easier it is to own a business in this
country, the easier it is going to be for people to find that
work to hopefully work their way out of poverty. And the goal
would be to get them to the point where they no longer needed
to be on the program.
So one of my key questions--you do a nice job highlighting
the positive effects of work. I think that is a bipartisan
effort in the Commission.
Dr. Chilton. Yes.
Mr. Austin Scott of Georgia. Do you think that the current
structure of the SNAP program discourages work?
Dr. Chilton. I will start in on that. I am not really sure
I would use the word discourage, but there is an issue that our
Commission has really investigated, and that is it turns out
that very low food security is often reported by people who are
earning a little bit more than some people, and if they lose
their SNAP benefits because they find a better job, they may
have gotten a raise because they are doing well in the
workforce, it is possible that they are losing their food
stamps too soon, before they are able to adjust to the new
income.
And we have research with the Children's HealthWatch study,
I am a member of that study. I know my colleague, Dr. Eddie
Ochoa, was here a few weeks ago. It is a part of our research
that shows that when families earn a little bit more, and then
lose their food stamps, that they are more likely to report
child hunger, which is the most severe form of food insecurity.
It is a little bit counterintuitive, so something is going on
there in the SNAP program where our Commission thinks that we
could do a better job incentivizing people into the workforce.
And a part of that may be lengthening the amount of time that
we give families to stabilize themselves so that the income
fluctuations don't push a person off of the SNAP benefits, and
it makes them hungrier than they were before.
Mr. Austin Scott of Georgia. In other words, if I make $1
too much to qualify, I could lose hundreds of dollars worth
of----
Dr. Chilton. Yes. In a manner of speaking, yes.
Mr. Doar. And in addition, there was testimony, and the
Commission members came to believe that the programs that
provide assistance to low income Americans do not work well
together to help people who are on SNAP get into work. And we
will make recommendations concerning greater encouragement,
greater encouragement of collaboration, greater focus on that
minority of SNAP recipients who are adults, and could work, but
are not reporting earnings on their case.
Mr. Austin Scott of Georgia. I think this is an issue not
only with SNAP, but with other things as well, where if you
make $1 too much, then if you put in that extra effort, and you
work the overtime, it costs you more.
Mr. Doar. Absolutely. That came up, the disincentive, and
the marginal tax rate issue for people who are trying to
transition off of benefit programs. There was a feeling that we
don't have it quite right in this country in how we encourage
people to get to self-sufficiency, as opposed to remaining on
assistance, and maybe working less.
Mr. Austin Scott of Georgia. I am almost out of time, but
as you write the report, I would appreciate your opinion on
that balance between access and integrity, and how we hit those
areas of abuse. With that, Mr. Chairman, I yield the remainder
of my time.
The Chairman. The gentleman yields back. Ms. Fudge, 5
minutes.
Ms. Fudge. Thank you very much, Mr. Chairman, and I thank
you both for being here. Certainly I really very much
appreciate the discussion you were having about veterans, and
just want to bring to your attention that today at noon there
is going to be a briefing in Canon 340 about veteran food
insecurity. So if anyone sitting here today would like to
attend, certainly it is open to you.
Let me just say that I thank the witnesses for the work
they do. I thank you very much for how dedicated you are to
eradicating hunger. And please do understand that what I am
about to say does not have anything to do with you, is not
directed to you, or any other person who has testified about
SNAP or food insecurity. This is our tenth hearing on SNAP or
food insecurity. It has, in fact, become an exercise in
futility. It is a waste of our time if we are not going to do
something about it. We can talk, and talk, and talk. I have no
idea what the outcome is, or what we are even looking to do.
What I do know is that hunger is not a game. It is not
something that we play with. It is life and death for far too
many Americans.
We know the statistics. We have the data. We know the
problem. I don't know why we keep asking you. We know the
problem. We know about hungry veterans. We know about hungry
seniors and hungry kids. When are we going to stop talking and
do something? We can talk forever and never change one person's
life. So the next hearing I want to go to about SNAP is how we
are going to make it better. I don't want to hear any more of
this. Enough. Let us do what the American people sent us here
to do. We need to take care of our poor. We need to take care
of our children. We need to take care of our veterans. It is
time to stop talking. I yield back.
The Chairman. I thank the gentlelady for yielding back. Mr.
LaMalfa, 5 minutes.
Mr. LaMalfa. Thank you, Mr. Chairman. That is why we do
come here and talk, is to have a dialogue about how we improve
a system that is in place that is helping many, many children,
and people on the lower end of the income scale. We just want
to target that better, because we are all about having it be
effective, and having people's tax dollars be stewarded
carefully as well, too. There are both ends of that scale that
you hear. So I hope the hearings will produce a better
coordinated effort there, what your efforts have done with your
panels around the country, it looks like. So how many of those
have you convened around the country? I am aware of one you had
in Oakland, and----
Dr. Chilton. Seven. We were in Albany, New York, Oakland,
California. We had a roundtable discussion in Albuquerque, New
Mexico, and had a site visit in New Mexico. We were in Little
Rock, Arkansas, El Paso, Texas, Portland, Maine----
Mr. LaMalfa. Were they all similar----
Dr. Chilton.--Washington, D.C.
Mr. LaMalfa.--similar type hearings, with many witnesses,
or did----
Dr. Chilton. Yes. We started out with about eight to ten
invited witnesses, and then we opened it up for at least 2
hours for public testimony, where anyone could sign up, and we
had a variety of people. We had about 80 invited testimonies,
and 100 uninvited, or just public testimonies.
Mr. LaMalfa. Now, we were supposed to have a report in
October. What held that up from--I guess it is going to be
December now?
Mr. Doar. It is a hard thing, reaching a unanimous
conclusion, and it was important to us. We wanted to have this
diverse group come together unanimously and endorse something
that they all could stand behind. And that required some
intense discussions and meetings, and writing it, getting it
right. We had felt obligated to our customer, the Congress of
the United States, to produce a report that we could be proud
of. And, we didn't get it done, but we----
Mr. LaMalfa. All right. Well, I appreciate the effort.
Mr. Doar.--next month.
Mr. LaMalfa. I appreciate the effort. IRS demands I get
mine done on time. I am just kidding you a little bit there,
the thing you are talking about here with the gap, Mr. Scott
was talking about that it has puzzled me for a long time, even
before I have been here in this political world. You can have
the so-called welfare cliff, where they have a certain amount
of income from public assistance, and then if they get a job,
they find that they are lower than that.
I have always felt the need to find a better way of
tapering that to where a job, whether they have been able to
become employed, or a better position or whatever, that will be
a net plus to them to be employed, and if they are receiving
some sort of assistance, whether it is SNAP or others, that
they are better off, and that the incentive to advance is
better, if they are in a position without disability, or
retirement, whatever, that they can do that. So I hope the
efforts of this Commission will help us to shape that. It is
something that I am surprised we are not really aware of after
all this time. Ms. Fudge was frustrated we talked a lot. Well,
I guess I would be frustrated too that we don't know this
already, of how to----
Mr. Doar. Yes.
Mr. LaMalfa.--get there.
Mr. Doar. The issue is the coordination of the benefits
across programs. That is the hard part, as a former
Administrator of all these----
Mr. LaMalfa. That is the thing here; we don't talk enough
in this town of the cost of doing business. I am a farmer in my
real life, and the cost of producing food, whether it is me and
rice, or my colleagues and dairy, or----
Mr. Doar. Yes.
Mr. LaMalfa. There are so many costs that raise the cost of
delivering a product from the field, or the handling. You have
intervention, environmental regs, and you have the labor regs,
you have health regs, some of them very well intentioned, some
of them way off the mark. We are having food costs, or other,
like, Health Department issues, where people that want to
donate food, or they want to help people in certain ways, find
barriers to that. Stupid barriers, sometimes, because of a
bureaucrat somewhere saying, you can't do this, and people are
ready to help. Or you have somebody saying you can't do that
because it might cause a labor problem, something like that. I
hope we can really identify these cost of doing business
barriers that aren't necessary. Whether it is producing the
food--and we talked about jobs. Mr. McGovern, Mr. Scott also
mentioned that if we had more jobs available in this country.
We don't have a jobs economy lately. We have trillions of
dollars offshore that would like to be repatriated back to this
country. Probably not your bag here, but there are issues that
we need to do to have a jobs economy in this country, and raise
people up from that.
So the cliff, was this brought up a lot in the public
testimony on your various stops?
Dr. Chilton. Not only was it brought up in our testimonies,
but we also were reviewing the research. It is about 20 years
of food insecurity research that we were investigating, and
also talking to administrators about the experience of trying
to administrate staff, and helping people to find jobs. And so
it was not just in the testimonies that we heard it, but we
also see it in the research.
Mr. LaMalfa. I thank you. I will yield back, Mr. Chairman.
The Chairman. The gentleman's time has expired. Mr.
McGovern, 5 minutes.
Mr. McGovern. Thank you, Mr. Chairman. Again, let me thank
you for your testimony, and for the work that you have done.
This is big. This is a very important issue. We should all be
ashamed that there are so many people, of all ages, in our
country--the richest country in the history of the world--that
are hungry. And we also should be ashamed about the fact that
our response has not been particularly effective here in
Congress. And, in fact, those of us here have actually cut
SNAP. We cut it in the farm bill. We didn't renew the stimulus
monies, so some people saw actually a decrease in their
benefit. So, we have made people's lives more difficult because
of some of the things that we have done.
You mentioned the importance of cross-sector and cross-
agency collaboration, and more help from the Executive Branch.
I hope that you will help me, and be specific with the
Administration that they ought to do a White House conference
on food, nutrition, and hunger. We need White House leadership
to convene all the agencies and the departments together, as
this issue falls under various responsibilities from various
agencies and departments, as it does here in Congress. It is
not just the Agriculture Committee with oversight. There are a
number of other committees that do as well, so we need to work
together. And so, whatever your recommendation is, you have to
be specific, because people don't get it if you are vague. You
need to be specific, and say to the White House, you have to do
this. And, hopefully in a bipartisan way, we would support
that. So I appreciate your comment on that.
The other thing is: Mr. Doar, you talked about flexibility,
and I have to tell you, I get nervous when people say
flexibility. The way I look at flexibility, and the way some
people look at flexibility, we have two different definitions.
If flexibility means block granting this program and limiting
the amount of resources to go to help feed hungry people so
that it is not based on need, but based on a defined number. I
have a problem with that. I have no idea what the economy is
going to do. I hope it gets better, and better, and better, and
fewer people need it, but I do worry about that.
And the other thing is, as I understand it, under current
law, states already have quite a lot of flexibility in how they
administer their program, and how it interacts with other
social programs. There is even extra funding available for
states who want to expand employment and training, plus
matching money for administrative expenses, and farmers'
markets programs, among other things. And so, I am puzzled
about the continued call for more flexibility, when many states
don't take advantage of the flexibility that already exists. I
would like you to comment on that as well. Also, in your
hearings' testimony, did you bump into anybody who said cut the
program, cut SNAP more, cut nutrition programs more, or anybody
come out and say, block grant it, so that it is not based on
need, but based on just a defined number?
Mr. Doar. Well, we did get testimony on work requirements,
and we got testimony on the ineffectiveness of SNAP over these
past years to bring very low food security down, so there was
some testimony along those lines. On flexibility, I am a former
State Administrator from New York. We used flexibility to the
extent that we could to do a lot of good things. As someone who
had oversight from SNAP, Medicaid, cash welfare, and child
support enforcement, I would say that the SNAP one was the one
that I felt the most rigorous oversight and holding on us.
Although, through elaborate processes of applying for ability
to do waivers, you could get some flexibility.
I am kind of a state guy. I like giving states----
Mr. McGovern. I love states too. I love my state, but I am
just simply saying that states are given a lot of flexibility
right now, a lot of which they don't take advantage of. And I
am all for flexibility, as long as it is not code for cutting
the program, or eliminating the benefit.
Mr. Doar. Well, the Federal Government can put restrictions
on it, with regard to benefit levels or other, but I definitely
feel that there is innovation opportunities out there if states
were given greater ability to do more and different things,
especially around work. One of the E&T, you have to come up
with a local match in order to----
Mr. McGovern. Right.
Mr. Doar.--get most of the dollars. That puts a little bit
of pressure that makes them put money in the game, and I
understand why the Feds would want that, but it does make
states reluctant to do more on work and food stamps.
Mr. McGovern. And Dr. Chilton, do you want to comment? And
will you comment----
Dr. Chilton. Certainly.
Mr. McGovern.--on whether we should have a White House
conference so we can get the White House listening----
Dr. Chilton. Yes.
Mr. McGovern.--they will actually do something?
Dr. Chilton. I will----
Mr. McGovern. Yes.
Dr. Chilton. I will get to that in a second.
Mr. McGovern. Okay.
Dr. Chilton. Talking about flexibility first, actually, in
the employment and training programs, it turns out that, in the
states that are trying to administer those, and trying to
enhance those that the instructions are actually very
confusing, and it is very difficult for them to figure out how
to tap into subsidized employment. Also, we have heard from
state administrators that when families are on this, and when a
person isn't in an employment training program, and they get a
job, that they lose their SNAP benefits too quickly, they are
off the program. That also needs to be something that we look
at.
So there are some very positive ideas related to
flexibility that we could explore. One thing that is very
concerning, that we heard in New Mexico, however, is that the
Governor of New Mexico is now trying to institute a work
requirement, a work participating type of requirement, for 16
and 17 year old children to participate in unpaid work. This is
very concerning. It actually may not be allowable by Federal
Law. So there are some times when states may take things into
their own hands, and make matters worse.
On the issue of Executive leadership, we will make very
precise recommendations, as precise as we can make them, as a
non-Congressional type of a Commission. We are going to pitch
it all to you, and we hope that you can put it in statute to
make sure that the Executive Branch is actually taking some
leadership, and incentivize the cross-agency collaboration. It
has to be incentivized, and we have to actually think beyond a
conference. It needs to be ongoing leadership at the highest
levels of the White House.
Mr. McGovern. I appreciate it.
The Chairman. The gentleman's time has expired. Mr. Kelly,
5 minutes.
Mr. Kelly. Mr. Doar first, but follow up if you need to,
please, ma'am. Can you talk about the selection process, and
why you believe it was the appropriate cross-section of the
Commission? Mississippi, my state, is one of the highest food
insecurity states in the country. We have the highest poverty,
the highest obesity rates, which quite often go with hunger. We
have actually, a lot of the people who are in the poorest area
are actually in the areas where the food is grown, which are
the poorest, and have the least food, which does not make
sense. But you chose other food-insecure areas that are much
less insecure in food, like Albany, or Oakland, as opposed to
going to the Deep South, where some of the heart of the problem
is. Do you feel like the Commission maybe should have looked at
those areas?
Mr. Doar. I definitely feel that it would have been better
to go to more places, and it would have been nice to go to
Mississippi. We did go to Little Rock, and we did go down into
the Delta, and to----
Dr. Chilton. Pine Bluff.
Mr. Doar.--Pine Bluff, Arkansas. So we got a sense of that.
Arkansas also has very high food insecurity rates. I think the
highest in the country.
Dr. Chilton. Yes.
Mr. Doar. So we tried to do that. But, Congressman, you are
right to wish that we would been able to do more.
Dr. Chilton. What we did learn about in Pine Bluff in
Arkansas is that there is a major struggle. And in Pine Bluff
especially, their primary concern, again, was jobs, well-paying
jobs that had good safety measures for occupational hazards.
The major employers in that area, the fastest growing
employment opportunity is the Department of Corrections. That
was very concerning to us, and also very concerning to the
people in that area, who are losing their youth who are moving
to the city, looking for jobs, because there is nothing else
happening there. There are very high rates of hunger, and
Arkansas itself had the biggest increase in the previous years.
We should have gone to Mississippi. We had very little
time. It was a little bit difficult to get the money for us to
travel. But we do hope that you, sir, could potentially make
something happen to create an official visit to your state so
that you could really investigate, and hear from people who are
struggling, and then bring that back to Congress.
Mr. Kelly. Yes. And this is a comment, it is not a
question. But, people like to use us for the poster child of
all the last, and those things, or the 49th or the 48th. You
think you would start there, going to veterans, that is very
dear to me, okay? And when we talk about veterans, there are
two points that you made. Number one, that 12 percent of our
veterans are under-nutritioned, or hungry.
Dr. Chilton. Yes.
Mr. Kelly. The second part of that is, having served, and
being able to see those soldiers at the E1 through the E4
level, who, quite frankly, a lot of time are newlywed,
sometimes have children and those things, you said 12 percent
of veterans, and I am assuming that is folks who have served in
the past, but what percentage of our actually currently serving
E1s through E4s in the military service have children or
families who are undernourished?
Dr. Chilton. Sir, I am sorry, we don't have that specific
data, and one of our recommendations that we will be making is
that we need to do a better job of measuring food insecurity
and SNAP participation among our veterans and active duty
military. Right now it is very difficult for us to get that
information. It is not readily available. It is not formally
collected, and we think that should be collected. And what will
help us--this is the idea of being uncounted or discounted. We
need to make sure that we are counting those families that are
being missed by our samples nationally. And we can't do
anything about it, we think, if you can't measure it and see
some kind of a movement on it, try to find a way to intervene.
Mr. Kelly. And, again, I will just reiterate, I don't know
the numbers, but I have served with those guys----
Dr. Chilton. Yes.
Mr. Kelly.--so I know that they can't afford to feed their
families sometimes on what they are paid.
Dr. Chilton. Yes.
Mr. Kelly. And the hard part of that is that most of these
guys and girls, who cannot afford--the same gene that drives
them to serve this great country at a very low profit to them
also keeps them from asking or requesting assistance from a
government which they love so much they would die for. So,
again, I guess the whole point in my thing is let us look at
the areas where it is most prevalent, and that would be our E1s
through E4s, and the active duty military, and the poorest of
poor states, the Deep South, the Mississippis, so that our
recommendations reflect what best helps those who have the most
need. And with that I yield back, Mr. Chairman.
The Chairman. The gentleman yields back. Mr. Aguilar, for 5
minutes.
Mr. Aguilar. Thank you, Mr. Chairman. Thank you both for
being here as well. A couple of my colleagues have picked up on
the nine visits that you made, and I wanted to talk a little
bit about the--the number was 80 experts as well. So what
process did you use to reach out to pick experts at these site
visits to listen to? Was it coordination with the states and
coordination with other groups? How did that process come
about?
Dr. Chilton. First of all, we reviewed the research that
the staff created for us for the Research Triangle Institute,
RTI. We looked at the populations that were the most
vulnerable, and then we looked at the states that had the rates
of very low food security, in other words hunger, and where
there were major increases. Because of the limited amount of
funds that were allotted to our Commission, and the limited
amount of time, we worked through our networks to figure out
where we could go in a way that would be low cost. So it was
primarily through our own networks, and through navigating
where the highest rates of hunger were that allowed us to get
to Arkansas, Texas, New Mexico, et cetera. We also worked very
closely with the Southwest Regional Office at the United States
Department of Agriculture, and we collaborated with the USDA
throughout to try to help us with these hearings.
Mr. Doar. And we promoted our hearings, and made sure that
people were aware that they were taking place, and invited all
comers to come and participate. And we stayed for as long as
possible to hear all that could be offered.
Mr. Aguilar. Sure.
Dr. Chilton. Well, one last thing. In El Paso we also had
on site interpretation, live interpretation from English to
Spanish, Spanish to English, and that was available to everyone
as well----
Mr. Aguilar. Was that the----
Dr. Chilton.--in El Paso.
Mr. Aguilar. That was the only venue where----
Dr. Chilton. That was the only venue, unfortunately.
Mr. Aguilar. Okay. The public comment is admirable, I
appreciate that. I viewed this as kind of three buckets, so,
one, how did you pick the cities and the sites, how did you
pick the experts, and then public comment would be another. So
I kind of read it in that perspective.
I know this is a bipartisan Commission, Dr. Chilton, and I
appreciate that the Commission acknowledges that historical
racism and continued racial discrimination play a role in food
inequities and hunger. At the rate at which SNAP supports
minority families, do you believe it can help close the gap
between minorities and white communities? If not, what
recommendations do you suggest to close these racial
inequities?
Dr. Chilton. Thank you very much for the beautiful, and
extremely important question. Unfortunately, we have seen the
racial and ethnic inequities in food insecurity since we have
been measuring food insecurity in this country, and there has
been no change in those disparities. That is very problematic,
and I actually don't think that if we continue to administer
SNAP in the current way that we do that we will be able to have
an influence on reducing those racial and ethnic disparities.
Currently most of the agencies from the United States
actually have an Office of Minority Health, have a particular
incentive to reduce disparities. I don't think that, within the
United States Department of Agriculture, there is any type of
leadership on reducing disparities. There is no major office
that is looking at it. And, indeed, it turns out that with
American Indians, who have some of the highest rates of hunger,
the USDA does fund some very excellent programs, that we heard
some very positive things about, but the tribes are
continuously complaining that they don't have access to tribal
foods. The USDA is asking for studies on American Indian
hunger, but it doesn't feel as if they are doing enough to try
to reach out to American Indian communities to make sure that
they can reduce those rates.
We need a more coordinated effort within the USDA, and, of
course, across the agencies, more Executive leadership. The
people who are coming out of prison have extremely high rates
of food insecurity and hunger. I don't want to get into a
conversation about mass incarceration, but I do think that, as
we change the prison systems in the United States, that will
actually help us to reduce food insecurity and hunger, and
reduce some of the disparities. But we need a more
comprehensive look, and more leadership at the top.
Mr. Aguilar. Thank you so much. Mr. Doar, you mentioned the
summer feeding program. In response to a question just a little
bit ago, you talked about something that you learned within the
summer feeding program that includes what I interpreted was
kind of education and recreation, a more kind of inclusive view
of summer feeding programs. Could we see recommendations that
include that within the report?
Mr. Doar. Well, we are going to say that we are impressed
by it, and the aspect of summer feeding, and we are going to
talk a little bit about how summer feeding could be expanded.
But that is what I came away from, was that the dual benefit of
summer feeding, both the food and nutrition and the
programmatic aspect, was a two-fer. It made the program more
effective than if you were, for instance, doing home delivered
or EBT delivered food assistance. So that was my comment. I
think that the households that are struggling with food
insecurity or very low food security also have other issues,
and sometimes those other issues are addressed by coming to a
place in their community where they can get other kinds of
programmatic interventions.
Mr. Aguilar. Thank you. Thank you, Mr. Chairman.
The Chairman. The gentleman's time has expired. Mr. Yoho, 5
minutes.
Mr. Yoho. Thank you, Mr. Chairman. Thank you for being
here. A couple things come up. One is the root cause of hunger,
reading your reports here, and where it says the fact that 40
percent of the children in the United States are now born to
parents that are not married, and it is a key explanation for
the continued existence of hunger. Do you have any
recommendations on how we can structure the family--and I
believe in a traditional family, but I am not going to dictate
that to anybody else, nor should the Federal Government. But
what metrics can we look at to incentivize a family unit,
whatever that person defines it as, because I know there are
single mothers or single dads out there, and they have a family
unit, and it may be different than what I see.
What do you see that we can do differently to incentivize a
situation where that single family doesn't have this problem?
Because, with all the programs that I see, we are treating the
symptom. The the underlying cause it says here the root cause
is the single parent household. What have you guys come up
with, or recommendations, whether it is tax incentives--I know
we can have another program, and we can grow it, and we can
grow it, and we can grow it, but the problem doesn't go away.
And if we don't address the underlying problem, it is like
dealing with a metastatic lesion in a cancer, and we are just
treating that, not the underlying tumor.
Mr. Doar. Congressman, you will see in our final report
that we addressed issues that we thought were underlying
causes, like the growing prevalence of single parent families,
as being a contributing factor to higher rates of hunger in low
income families. But we also recognize the methods to address
them were beyond the charge of the Commission, which was to
focus mostly on food and nutrition programs. And so we
addressed them, and asked Congress to take a comprehensive look
at these issues, but it was beyond our charge. And for the
purposes of this testimony today, in other contexts, I talk
about this issue often, but as a member of the Commission, all
we could say was, this is an issue, it is a contributing
factor, it can't be ignored, it needs to be talked about, kids
need two parents. But we didn't come up with, for the purposes
of this Commission, solutions or answers. They exist, but that
was not what the Commission decided to tackle.
Dr. Chilton. That is our story, and we are sticking to it.
Mr. Yoho. All right. Well, then, you lead me into another
one, and you gave me the perfect segue, because I wasn't sure
how to ask this question. I wasn't sure how to ask this
question, but your conversation with my previous colleague was
perfect. You were talking about the ethnic disparity that you
see in different ethnic categories. And you were talking about
the hunger rates--or you weren't talking about that, but
reading in this report, the persistence of racial inequality
contributes to hunger rates of 10.4 percent, 6.9 percent for
African Americans and Hispanic households, respectively. What
is it in other minorities, like, say, the Chinese, or Iranians,
or the Cubans, Vietnamese, or Indian households? Are those
numbers large enough to do an analysis and a comparison, and
what are the results of those? What are you finding?
Dr. Chilton. Thank you so much for the question. It is
actually very difficult to drill down, in any kind of
meaningful way, for Asian populations, and Asian is a very,
very broad category. There are a number of studies that look at
people who are immigrants, but those studies are very small
studies, and very localized, so in certain areas of the country
we can pick up immigrants from Vietnam, et cetera. We can pick,
for instance, with Children's HealthWatch, we are picking up
the Somali population in Minneapolis, because that is where
they are tending the refugees----
Mr. Yoho. Right.
Dr. Chilton.--are locating. We don't have enough
comprehensive information nationally to make any kind of a
strong sense of what the estimates are. We can only talk about
necessarily immigrants, or people of a variety of ethnicities,
but we don't have enough information, the way that we are
measuring hunger right now, to be able to drill down. And that
is something that we are hoping we will be recommending in our
report, is to be able to drill down so we can figure out what
is happening in a more precise way.
Mr. Yoho. Well, that is interesting, because I have talked
to people from the islands, Jamaica, and some of the other
places, and I say, what do you view as poverty in your country?
And they say, we don't view it as poverty. That is just the way
it is, and we deal with it. And I don't know if we are, we
always talk about creating a dependent structure in this
country, and I don't know if we need to look at it differently
because you don't hear about the disparity in, say, some of the
other ethnic groups, and I want to know why. Is it a stronger
family unit, or these other things, that we can take that
information and utilize it here, and say, you know what, it
works here in this group, why don't we assess that, and
implement it here, and do a study on that? And so, with that, I
yield back, and I appreciate your time and your work. Thank
you.
Dr. Chilton. Thank you.
The Chairman. The gentleman yields back. Mr. Ashford, 5
minutes.
Mr. Ashford. Thank you. This is very interesting. I am
interested in your point about that it is really our job to
address these things, and maybe we haven't. Is it correct to
say that the last real comprehensive legislative approach to
poverty was the War on Poverty in Johnson's Administration? Has
there been any other real comprehensive big look at poverty?
Mr. Doar. Well, the welfare reform of 1996 was a----
Mr. Ashford. Okay.
Mr. Doar.--significant piece of legislation, and----
Mr. Ashford. Okay. And that was----
Mr. Doar. And led to reductions in poverty. And the farm
bill every year, Earned Income Tax Credit expansions--sometimes
I get a little frustrated with people thinking the last time we
looked at poverty was 1965. Back----
Mr. Ashford. I was just asking----
Mr. Doar.--Congress--President--on that for a long time,
and some progress was made, and some setbacks have occurred.
Mr. Ashford. So I guess the answer is that wasn't the last
time?
Mr. Doar. No.
Mr. Ashford. Okay.
Mr. Doar. It was not.
Mr. Ashford. No, but I----
Dr. Chilton. We have not had a comprehensive view that
involves multiple agencies----
Mr. Ashford. Right. And that is my point. I don't think
there has been a comprehensive look-see at this since the
1960s, and there had been efforts, and the farm bill is one,
obviously. There are other efforts like welfare reform. We were
involved in doing a welfare reform bill in Nebraska when I was
in the legislature, 1994. So, I am aware of those things, and
that bill dealt with poverty, it dealt with income disparity,
it dealt with incentives to work, and all those sorts of
things. But I don't think there has been a comprehensive
approach. This year it looks like we may have a comprehensive
approach on mental health in the Murphy bill that is going
through the Congress now. That has been decades where we
haven't had a comprehensive approach on mental health.
I served as Executive Director of a housing authority in
Omaha, Nebraska.
Dr. Chilton. Yes.
Mr. Ashford. It was a very challenging job, and all these
issues in that job. Clearly the issue of the cliff effect, when
someone gets a job, and then loses their public housing
immediately, which is exactly what happens. The idea of how
much do you spend on these programs in a static sense, how much
do you put into the budget for a program, is really not the way
to analyze these things. It would seem to me that the way to
analyze these efforts is what does it save over time? And so I
support and would love to see some ideas about ex-offenders,
with housing, and with veterans. Every hearing we have had this
year, and they have been great. I like these hearings. I think
we could have as many hearings as we can have, because we are
identifying the problem, and the solution is inter-agency
collaboration.
Mr. Doar. That is correct.
Dr. Chilton. Yes.
Mr. Ashford. You have already said it, so I guess you don't
need to say it again. I honestly don't know why we don't do it.
I mean, we need that same comprehensive approach we are doing
to mental health, with the Murphy bill and other things, to
really address this. It isn't just the farm bill, and the farm
bill can't----
Dr. Chilton. Yes.
Mr. Ashford.--possibly do this. I don't know if you have
any other comment on that.
Mr. Doar. Well, it takes Presidential leadership. I mean,
that would help. Someone would take a comprehensive look, and
make it a high priority. And that will be reflected in some of
what we say in our Commission report.
Mr. Ashford. Right. So the Commission report suggests that
a comprehensive approach, or an inter-agency approach is not
only a good idea, but it is essential, critical, can't be any
other way. Is that sort of----
Mr. Doar. Yes.
Dr. Chilton. Yes. I think we use those words exactly.
Thank you.
Mr. Ashford. That makes me feel better. Thank you, Mr.
Chairman. I yield back.
The Chairman. The gentleman yields back. Thanks, Brad. Mr.
Allen, 5 minutes.
Mr. Allen. Thank you, Mr. Chairman, and thank you for your
insight into this. I know we have had a lot of hearings on the
nutrition programs, as they relate to agriculture, and that
sort of thing. And I do somewhat agree with my colleague, we
kind of need to figure out why we are having these problems.
And your report is going to give us tremendous insight, and I
am looking forward to that report. But one of the things that
puzzles me as I am out in the district is that there are jobs
available, lots of jobs available, but at the same time we have
this disconnect in trying to get folks trained and on the job,
and off of these programs. And we have--I don't know, it seems
like there is a wall there. And I guess my question is are
programs like this discouraging folks from trying to get over
that wall, and get employed, and provide for their family, or
even have a family?
Mr. Doar. I think what we heard was that programs, and SNAP
would be the principal one that we heard the most about, was
that it just doesn't address work sufficiently, that it is a
transactional engagement between the case worker and the
applicant in which the caseworker says, in effect, ``Let me
find out what your income is, let me get you on assistance, and
everything else about your life, well, you go somewhere else
for that. We are just in charge of getting you food stamp
benefits.'' That is what we heard, and that is why we are going
to make a recommendation that there needs to be a more
holistic, comprehensive look at both the programs and how we
address the needs of people we serve.
Mr. Allen. My parents drilled into me every day that
choices have consequences. And, of course, back when I grew up
there were a lot less choices that you could get in serious
trouble on. And, it looks like to me that we have created, in
some of this--and it is not their fault. It is not the people
who are struggling in this cycle. Apparently we are not
educating them on, hey, there is a way out of this. Because,
what we are doing is we are increasing these programs, thinking
that that is going to solve the problem. But then again, we
have more single family households being created. We have more
people who are not looking for work anymore, and basically more
dependence on government. So, in your findings has there been
any suggestions on how do we get this thing turned around and
start making improvement? Or solving these problems, as my
colleague mentioned earlier.
Mr. Doar. Again, it was a bipartisan Commission----
Mr. Allen. Yes.
Mr. Doar.--so we had to come together unanimously, and I
think that these themes of leadership, comprehensive look,
coherent, working with multiple agencies, talking about work as
being essential, understanding that families matter, racial
discrimination matters, these other factors matter as well,
that is what we could do.
Mr. Allen. Yes.
Mr. Doar. We think it is a contribution, and it will
contribute to a fuller understanding. But, again, we definitely
saw witnesses who wanted to achieve self-sufficiency, and just
wanted help and how to get there. And I thought we felt that
our programs aren't doing enough about that.
Mr. Allen. There are also many pro-family organizations out
there. The State of Georgia has one, and they do a lot of
economic studies based on choices, like finishing high school,
and maybe not getting married until you finish high school, and
then after you get married, then you have children. And the
economic impact of that is enormous. And so how do we get that,
because I really believe, like I said, a lot of these folks
just don't know a way out. You might look at some of these
studies out there, as you put in this report--and, again, this
is a report, I guess, just on what your findings are.
Mr. Doar. Yes.
Mr. Allen. But as we go to solutions, it looks like that we
would look at, okay, this is the way out. This is the way to
get off, to feed your children, and to get a job. And is that
something you are going to look at, as far as your Commission
is concerned?
Mr. Doar. Again, we listed issues that are important to
resolving this problem----
Mr. Allen. Okay.
Mr. Doar.--and one of them was personal choices, or
personal agency, or personal responsibility. We felt that it
would be inappropriate to say that the entire solution resides
in what government can do for people. It also is related to
what people need to do for themselves. So we say that. Now, we
don't have many specifics on how to make that happen----
Mr. Allen. Okay.
Mr. Doar.--but we felt it was important to say.
Mr. Allen. So that would be the next step?
Mr. Doar. Yes.
Mr. Allen. This is how we make it happen? I yield back. I
am out of time.
The Chairman. The gentleman's time has----
Mr. Allen. Thank you.
The Chairman.--expired. Ms. Plaskett, 5 minutes.
Ms. Plaskett. Yes, thank you, Mr. Chairman, and thank you
all for your testimony, and for the information that you have
disseminated.
Dr. Chilton. Yes.
Ms. Plaskett. Despite some of the things that I hear, I am
going to just stick to what I originally thought I was going to
ask as questions. One of the factors that contributes to hunger
in the United States is related to food deserts. Can you talk
about that a little bit, and has the Commission looked at this
issue of food deserts, and how do you factor that in? And have
you, if you have looked at it, made recommendations as to how
to address it?
Dr. Chilton. Thank you very much for the question. We did
look at food deserts, but I don't think we looked at it
thoroughly enough. We heard a lot about lack of access to
nutritious food, especially in the State of New Mexico, where
the distances to the grocery store are very, very far. But,
again, turning back to the concerns of the people that we heard
from, the number one concern was being able to have enough
money to purchase food, enough money for travel. So we don't
make any recommendations in our report about food deserts. We
do acknowledge that it is a really important issue. It is
something that should be addressed. But the research on the
relationship between food deserts and food insecurity is not
very comprehensive, so we didn't feel confident enough to be
able to make recommendations on----
Ms. Plaskett. Did you look at--you talked about places like
New Mexico----
Dr. Chilton. Yes.
Ms. Plaskett.--where it is sheer distance. Did you look at
urban areas that are food deserts because people do not have
adequate transportation to not just purchase from the corner
store, that doesn't have fresh fruit and vegetables?
Dr. Chilton. We did not look at that thoroughly, no, we did
not.
Ms. Plaskett. Okay. And the other discussion----
Mr. Doar. Well, one thing----
Ms. Plaskett. One second. We are--do you have a----
Mr. Doar. We did discuss the extent to which--there were to
be some opportunities for USDA to use its authority approving
stores for participating in the SNAP program to encourage
greater availability of health fruits and vegetables, and
grains, and other----
Ms. Plaskett. Well, I mean, places in this city itself,
Washington, D.C., Chicago, all of those corner stores take food
stamps. But do they provide fruit and vegetables at a
reasonable price, or at all, to the people that are in those
communities----
Mr. Doar. That was an issue that we heard about, and was
something that we took seriously.
Ms. Plaskett. Did you have any thoughts, or do you have any
thoughts about how that can be addressed?
Dr. Chilton. We were talking among the Commission, we were
talking about extending the amount of shelf space for fruits
and vegetables and healthier foods at SNAP eligible stores,
that the USDA could make modifications to demand more of the
corner stores, and demand more of the bodegas to have----
Ms. Plaskett. Yes.
Dr. Chilton.--healthier choices. So we did look into it. We
don't know necessarily what that is going to do about reducing
food insecurity, but we did look into it. We make one minor
recommendation on that.
Ms. Plaskett. And will your report include information
related to the U.S. territories, Puerto Rico, Guam, the U.S.
Virgin Islands, which have enormous food issues, with having to
import a great amount of food, as well as high rates of
poverty?
Dr. Chilton. Thank you very much for the question. We did
not investigate in the territories what was happening. We did
get some encouragement to look into it, and, again, we did the
best that we could with the timeframe, and the amount of funds
that we did have, but we do encourage Congress to maybe make a
more comprehensive effort to look at what is happening in the
territories, and make a coordinated plan for that.
Ms. Plaskett. Okay. And because I am who I am, and I can't
help myself from asking in response to other questions I heard,
you talked some time ago about racial disparities. What are
some of those? You didn't go into specifics about what those
racial disparities are. What are the factors that cause greater
food insecurity in some communities, minority communities, as
opposed to other minority communities?
Dr. Chilton. Okay. So overall the hunger rates for African
American families are two to three times that of White
families, and for Latino families the same is true. There is--
--
Ms. Plaskett. The question----
Dr. Chilton. I just----
Ms. Plaskett.--why.
Dr. Chilton.--evidence--there is good evidence to
demonstrate that there is discrimination in access to safe and
affordable housing, and to access to jobs, et cetera, but we
did not get into it in any kind of a deep way. Again, we felt
like it was beyond our Commission's call to look at the
nutrition assistance programs, but we do acknowledge it as
something that is very important. So American Indians, who are
often isolated, who have a history of colonization, racial
discrimination, also have some major issues and major problems
with the nutrition assistance programs, access to housing, et
cetera. Housing and hunger go together.
Ms. Plaskett. Housing, and job opportunities, and
discrimination in jobs may lead to some of this, as opposed
to----
Dr. Chilton. Yes.
Ms. Plaskett.--people just don't want to have a job?
Dr. Chilton. This is true.
Ms. Plaskett. Thank you.
The Chairman. The gentlelady's time has expired. Mr. Davis,
5 minutes.
Mr. Davis. Thank you, Mr. Chairman, and thank you to both
witnesses for being here. My questions today are going to be
for Mr. Doar. Coming in late to the hearing, I notice that you
already addressed many of the issues that we wanted to bring
up. And I want to especially commend both of you for addressing
the issue about hunger, and a lack of access to food with our
veterans' population. I think it is a population that is self-
reliant, in many cases, sometimes not willing to ask for
assistance, and the Commission's recognition of this particular
group's issues, says a lot about some of the priorities that we
should have as policymakers, and also looking ahead.
But Mr. Doar, in your testimony you point out the
continuing cycle that is hunger and education. And children
experiencing hunger have lower graduation rates, and those
without a high school diploma are more likely to be hungry than
their peers that completed high school. In our last Nutrition
Subcommittee hearing, we started to address this relationship
between hunger and education when thinking about ways young
people can break the cycle of poverty. And from the stories and
the testimony that you have heard, just how vital is three
meals a day towards a child being able to focus and achieve
success in the classroom? So simply does the goal of three
meals a day get us closer to breaking the cycle?
Mr. Doar. I don't know that we made a recommendation about
the goal of three meals a day. I don't think we did. We
definitely heard testimony about the benefits, and aspects, and
results from school meals. We saw a breakfast in the school
program, in I believe Arkansas----
Mr. Davis. Yes.
Mr. Doar.--and we are aware of the role that school meals
play. So I would rank that activity as one of those things that
made us feel as if a lot of good work is being done in helping
people who struggle with hunger. And one place it is happening
is in schools, with school meals. But, specifically on this
sort of goal of three meals a day, or how government or school
meals would address it, I don't believe we got into that.
Mr. Davis. Well, do you have any additional comments
relating to the possibility of three meals a day that would be
relevant to our conversations that we have in this Committee
hearing room?
Mr. Doar. If you are talking about--no, I don't, because I
don't know exactly what it means. If it is discussing a
mandate, or a Federal requirement that all schools provide
three meals a day, I don't think I know enough about that
topic, and how that would work, and the cost-benefit of it, to
comment.
Mr. Davis. Okay. Well, Dr. Chilton, do you have any
thoughts on this issue?
Dr. Chilton. I do. We very deliberately chose the measure
of very low food security at the household level, which we are
referring to as hunger, which is an indication of reduced
nutrient intake, and also disordered eating patterns, skipping
meals, not eating for a whole day, and sometimes reporting
hunger because families don't have enough money for food. This
is a readily available measure that does indicate serious
nutrition hardship in our country, and so we wanted to work
with a measure that actually already exists, it is mandated
through the United States Department of Agriculture and the
Economic Research Service. So we feel like that is a very good
measure to be working with. It is also a very broad measure. It
picks up other kinds of issues about anxiety about having
enough money for food, and it picks up the issue about having
enough income for food, which is very, very important to the
underlying issues of food insecurity.
Mr. Davis. Well, thank you, and I do appreciate the work
that the Commission is doing. I represent a rural district that
has many metropolitan areas, and there are, I am glad that
there is starting to be a recognition of food deserts in rural
areas. And programs can work, but we have to get transportation
to those meal sites. So your willingness to continue this
discussion, and also intertwine it with a discussion on the
school lunch program, and how or why our kids may be still not
getting enough within those two meals that are being provided
at the school, and how that could impact that student's not
only learning, but also their physical abilities and
capabilities as we move into the rest of the day, whereas you
just mentioned, they may not get that third meal once they get
home.
So these are issues that are very important to me and my
district, and I know they are very important to Chairman
Conaway, and I look forward to working with you in the future.
I yield back.
The Chairman. The gentleman yields back. Ms. Adams, 5
minutes.
Ms. Adams. Thank you, Mr. Chairman, and thank you both for
being here. Next year, up to one million people in the U.S.
will lose SNAP benefits, and they will lose food assistance
because time limit waivers will expire for able-bodied adults
who work less than 20 hours a week, and do not have dependents.
In my home State of North Carolina, the Governor recently
signed a bill that would prohibit the state from asking for
waivers, even during economic downturns. Instead of helping
these people find jobs, North Carolina has decided to just cut
off their benefits. The North Carolina unemployment rate is
about the 11th highest in the nation, and in my district it is
about 13.8 percent. So a lot of people who want to work can't
find a job. And I am not opposed to encouraging people to look
for work, but sometimes the jobs just aren't there, and people
have significant barriers, as we have heard, to obtaining and
keeping a job.
Based on the conversations you have had during the hearings
that you held throughout the country, what do you think will be
the true impact of allowing these benefits to expire?
Mr. Doar. Well, Congresswoman, we do not make a
recommendation about waivers in our report. We could not come
to an agreement on that. As the Co-Chair, that is as far as, I
feel, for this testimony, I should go. That is a big issue, but
that is what the Commission has decided, to not make a
recommendation on that matter.
Dr. Chilton. What we--if--can I add here?
Ms. Adams. Yes, please.
Dr. Chilton. What we do think is really important is that
states make more of an effort to help people find employment
and training opportunities. As we heard in New Mexico, and in
Maine, both of those states are now doing work requirements,
and we heard in the testimonies that there is a lot of
difficulty in finding jobs, getting transportation to those
jobs, and getting access to child care. So as a Commission we
did work very hard to find out ways that we could help states,
or encourage, or potentially require states to offer assistance
in helping families to find jobs with sustainable, good wages,
and to be able to have the support that they need. Again, that
could be child care, transportation, et cetera.
So with the waivers now expiring, this is very concerning,
and we really hope that you can send a strong message to the
states to make sure that there are good supports in place to
help those families find gainful employment.
Mr. Doar. I should also say we did hear testimony from the
Commissioner of Social Services in Maine, who talked positively
about the benefits of the waiver ending, and helping people get
into work by being expected to get into work.
Ms. Adams. Okay. We notice also in our state we have a
skills gap as well, so the jobs that are available, people are
not qualified to take them. Of course, then education becomes
an issue there. But wouldn't the increase in hunger lead to
greater stress and more difficulty in job seeking?
Mr. Doar. I think that the premise of your question is that
there will be an increase of hunger because waivers are ending.
I do not accept that premise. I don't know that that will take
place.
Ms. Adams. Okay. Dr. Chilton?
Dr. Chilton. Although we do know, through our research, and
through the research of the United States Department of
Agriculture, that when families do lose their SNAP benefits,
and lose them too soon, they are more likely to report food
insecurity, or very low food security. So it is a concern that
families might be losing their--especially will be losing their
SNAP benefits. Again, if there are the proper supports in place
to help those individuals find and be able to keep jobs, then
we can prevent any type of potential increase in hunger. It is
a serious concern, and the issue about waivers is something
that is very important. And again, as you know, we did not
necessarily agree on that issue, and so we weren't able to pick
it up. But there are 27 states that have voluntary employment
and training programs, and they also need some support in
helping to help people find good available employment, and
opportunities for volunteering.
Ms. Adams. Thank you. How would fully funding the Child
Care Development block grant support working families with
children?
Dr. Chilton. Robert?
Mr. Doar. This is the Child Care block grant?
Ms. Adams. Right, yes.
Mr. Doar. Well, that, again, this is sort of outside the
scope of our Commission, representing the Commission, I don't
want to comment on it. But, in my other work, I will say that
child care assistance is something that is of concern to me,
and helping low income families stay in employment.
Ms. Adams. Thank you very much. I yield back, Mr. Chairman.
The Chairman. The gentlelady yields back. Well, thank you
very much. I appreciate both of you being here today. We are
all coming face to face with this difficulty of trying to
capture the essence of what we are talking about in 30 second
sound bites. Did you have a question?
Ms. Lujan Grisham. I do, sir. Nice to see you this morning.
The Chairman. Well, thank you. We started at 10:00. You are
recognized for 5 minutes.
Ms. Lujan Grisham.--the same thing.
The Chairman. I have you. But the Agriculture Committee is
alphabetically first, so the gentlelady from New Mexico is
recognized for 5 minutes.
Ms. Lujan Grisham. Thank you, Mr. Chairman, and I can't
really argue with the alphabet. So I really appreciate this
panel, and I am very grateful, sir, that I got here in the nick
of time. I spend a lot of time, really, talking about the
conditions in New Mexico, which, given your research, and some
of your--particularly, Dr. Chilton, some references that there
are concerns about states like New Mexico, who have had waivers
for the work requirements because our employment issues, and
our economic climate, is so severe. I learned public health by
the seat of my pants. I don't know what they did by appointing
a lawyer to run the Department of Health in New Mexico. I can't
really explain it. But I am very now clear about making policy
decisions, particularly in the area of public health, that are
evidence-based.
Work, and improved economic conditions, are absolutely
powerful tools in helping people achieve advances so that they
are not in poverty. But I also am clear about two facts. One,
that we have a working poor dilemma in this country that
doesn't really address being able to meet your basic needs, and
that two, New Mexico is in such a terrible set of circumstances
that there is no way that people can actually get the kind of
jobs that you would in states that make traditional investments
in helping folks navigate, and get the skills that they need to
meet the work requirement.
In fact, in a state that is so severely depressed
economically, it is my understanding that the state is thinking
about investing somewhere between $2\1/2\ million and $4
million without really what I would consider a tested evidence-
based plan on initiating a work requirement program without any
identification about real work, while at the same time ignoring
the fact that we still have one of the hungriest populations in
the country. Do you have data from New Mexico, and from states
in similar situations, that would indicate that when the
economic climate is this bad, that these investments, and the
way in which we make them, actually improve the hunger status
of the entire family, and particularly the children?
Dr. Chilton. How do you want to handle that one? I will go
first. Thank you very much for your comments, and also for
mentioning public health. We--in the world of public health, we
see public health in all policies. So even though some people
may think that food stamps, or SNAP, is a nutrition policy, it
is actually a public health policy----
Ms. Lujan Grisham. Yes.
Dr. Chilton.--as well as labor policies, et cetera. So I
appreciate you mentioning that. We did not specifically look at
any data to see whether an investment of having a work
requirement actually reduces hunger. I don't know if that data
really exists. We don't have data from New Mexico. Although I
do know that there are 23 counties in New Mexico that still
have very high rates of unemployment, that would still make New
Mexico eligible for the waiver to not require work, and that
there is a very deep concern. We heard that when we were in
Albuquerque, at our roundtable for the hearing, that imposing a
strong work requirement for almost the whole state, and also
for children and elders, or people who are over 50, was very
concerning. And it was especially concerning among the tribal
groups, who felt as if they had not been heard by the
Governor's Office, et cetera, even though they had been trying
to get meetings.
So we understand that there is very heightened concern,
very heightened worry, and that is a concern for us on the
Commission, but, again, we really strongly recommend that, as
states move people into the workforce, they actually provide
the support necessary. Again, transportation, child care, and
access to training opportunities.
Ms. Lujan Grisham. Go ahead. And then I am going to try to
have a couple seconds at the end.
Mr. Doar. We did not make a recommendation on waivers as a
Commission, and we heard concerns in testimony, but we did also
have two former SNAP directors of state food stamp programs who
did not take the waiver, and thought the waiver wasn't
necessary to help people get into employment.
Ms. Lujan Grisham. They don't have data that indicates that
what they were doing without the waiver made a difference. And
one of the----
Mr. Doar. Well----
Ms. Lujan Grisham.--individuals, I will tell you, said
things that are so highly inflammatory and discriminatory is no
longer working in the State of New Mexico. So, in claiming my
time, I just want to point that out, that we have to be clear,
and that is why I want the data. So it isn't politically
driven, it is data driven. It is evidence-based, so we make
decisions about reforming these programs that are in the best
interest, in a public health sense, of the population for whom
we are serving. Because I don't think that data exists, and,
Mr. Chairman, with all due respect, we should be demanding that
that data is available to us, and available in this Committee,
that leads the Congress on sound nutrition policy so that we
have an impact on stopping hunger in the richest country in the
world. Thank you both very much.
The Chairman. A bit of a conflict there, you said the data
doesn't exist, so----
Ms. Lujan Grisham. Much of the data about the work
requirement's impact on hunger does not exist, and----
The Chairman. Okay, then----
Ms. Lujan Grisham.--it certainly doesn't exist in New
Mexico.
The Chairman.--have it if it doesn't exist, okay. Mr.
Abraham, 5 minutes.
Mr. Abraham. Thank you, Mr. Chairman. I apologize for my
tardiness from another committee. I read your testimonies on
the root causes of hunger, and you lay out several critical
factors. One of them is work, which seems to be a theme
throughout the testimony. As you point out, we are 6 years from
the recession ending, yet hunger remains historically high. You
suggest digging a little deeper, beyond households being low
income. You talk about underemployment, which is a situation in
which a worker is employed, but his or her work and/or wages
have been reduced, other than at the worker's request. How is
that different from being low income? Because at the end of the
day, it is still not enough income to meet the needs of one's
family. Are there any particular policies currently in place
that promote underemployment? Say the 30 hour workweek
requirement under Obamacare.
Mr. Doar. As you will see in both our testimony, and in the
final report, there will be a reference to underemployment. So
we did hear from folks who indicated that the extent to which
they were not able to get full time work put them in a
situation that was precarious with regard to food. Now, we do
not, I believe, make any recommendations concerning Federal
policies that could incentivize, or regulate businesses that
make them more likely to cut people off at 30 hours, but it is
an issue that did come up among both our members, and in
testimony, that people wanted more hours, but, for whatever
reason, the employers were not offering them.
Dr. Chilton. In addition, the research bears out that
families that have jobs that have unpredictable work hours, or
that are seasonal workers, have major income fluctuations, and
those income fluctuations are not necessarily accommodated in
the SNAP program, so people may lose their SNAP benefits before
they have stabilized their income, and are more likely to
report hunger. So we are very interested in trying to figure
out how we can have a system within SNAP that doesn't cut
families off too soon, and helps to smooth out their incomes in
a way that can help to allay what is happening in terms of
reports of hunger.
Again, I want to reiterate what Co-Chair said, we do not
make any recommendations about what type of labor laws and
labor practices there should be, but we do recognize it as an
issue, and we heard about it in the field.
Mr. Abraham. Thank you, Mr. Chairman. That is the only
question I had.
The Chairman. Well, I thank the gentleman, he yields back
his time. One quick one. As you look at a community, where the
rubber meets the road, there is a vast array of resources. And
you talked a bit about the lack of coordination at the Federal
level, between all this nonsense, and I will talk to you in a
second about that, but can you talk to us a little bit about if
there are community examples where they have actually
integrated the not-for-profits, the churches, all those other
hunger resources and assets in with the state efforts and the
Federal efforts? Are you seeing a better job of coordinating
there with jobs, and all the other programs they have--about
case managers, and the importance they have? Did you see it
being done well somewhere?
Mr. Doar. We did see it being done well, in your home State
of Texas, under the leadership of one of the Commission
members, Jeremy Everett. The Texas Hunger Initiative does a lot
to coordinate both the----
The Chairman. A Baylor grad, by the way.
Mr. Doar. Yes. Well, I am not sure I heard you, Mr.
Chairman, but anyway, we also saw it in Indianapolis, where
another member of our Commission took us to see this really
robust interaction between the not-for-profit, the faith-based,
the corporate, and the government efforts to help people that
are struggling. And it will come through in our report, our
belief that that kind of thing is very much part of the
solution.
Dr. Chilton. And that it should also be incentivized. What
made those groups be able to coalesce together was they had
some incentive to work together. And also we recognized, when
we were in Texas, and seeing what the Texas Hunger Initiative
was doing, we recognized it really takes very strong leadership
in the local community. We saw a really extraordinary summer
feeding program in Anthony, Texas, where they were employing
teenagers, 70 teenagers, to help package the food, and help
distribute it out to members of their community. That was
extraordinary, and that was good public-private partnership.
That was a way of leveraging Federal funds, and using community
funds, to get really good nutritious food to families in the
summertime. It was very exciting to see that, and we hope that
Congress can find ways to incentivize that further.
The Chairman. Well, again, thank you both for being here.
The difficulty we all have is this is a broad issue with a lot
of aspects, and finding a 30 second sound bite to answer this,
about the attention span of many of us, is proving difficult.
We also spent a lot of time talking past each other. One side
uses an extreme of a 27 year old surfer, and the other side
uses the extreme of folks that no one would argue ought to come
off the benefits. Dr. Chilton, even you, when we were talking
you mentioned that it is hard for families to come off too
quickly, but you corrected yourself.
Dr. Chilton. Yes.
The Chairman. Even there we were talking about families, we
are--so we all use these--and in good faith. No one wants
anybody hungry. There is no one who would argue that we need
more hunger in this country, and we are all against it. I
appreciate the comments, at least in your testimony, about the
impact of families, and jobs, and education, and the personal
responsibility we have with respect to what we are all
struggling with as we move forward.
Again, thank you for what you have done. I am looking
forward to your recommendations, as you complete your report.
You are doing the Lord's work, so to speak, and I appreciate
your efforts, and also the efforts of trying to find a
consensus among yourselves. I sensed a bit of a struggle on
certain issues.
Mr. Doar. No.
Dr. Chilton. It is all very friendly.
The Chairman. Obviously, we do the same thing here. You
appear to have broken through those barriers in a way that
should be instructive to us, but none of us have all the
answers. I, for one, don't know everything I need to know about
it. Maybe there some folks on our Committee who know everything
they ever need to know about this issue. I don't, and so that
is the rationale behind this long look. We think it is an
appropriate look. You spent a year looking at it in a deeper
way than we can, and I appreciate getting your report in a
month or so, and being able to evaluate and analyze it. So,
again, thank you very much.
Under the rules of the Committee, today's record of the
hearing will remain open for 10 days to receive additional
material and supplemental written responses from the witnesses
to any questions posed by a Member. This hearing of the
Committee of Agriculture is adjourned. Thank you.
[Whereupon, at 11:46 a.m., the Committee was adjourned.]
[Material submitted for inclusion in the record follows:]
Submitted Report by National Commission on Hunger
Freedom from Hunger:
An Achievable Goal for the United States of America
Recommendations of the National Commission on Hunger to Congress and
the Secretary of the Department of Agriculture
2015
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Executive Summary
To identify solutions to hunger, Congress created the bipartisan
National Commission on Hunger ``to provide policy recommendations to
Congress and the USDA Secretary to more effectively use existing
programs and funds of the Department of Agriculture to combat domestic
hunger and food insecurity.''
This report is based on the Commission members' full agreement that
hunger cannot be solved by food alone, nor by government efforts alone.
The solutions to hunger require a stronger economy, robust community
engagement, corporate partnerships, and greater personal
responsibility, as well as strong government programs.
Our Process. The Commission held regular meetings; traveled to
eight cities across America to hold public hearings and visit
government, nonprofit, community, and faith-based programs working to
alleviate hunger; and heard testimony from 80 invited experts from
government, industry, universities, and nonprofits and from 102 members
of the public.
What Is Hunger? We chose a precise and readily available measure of
hunger called very low food security. For purposes of this report,
hunger means the lack of access to food when families do not have
enough money, causing them to cut the size, quality, or frequency of
their meals throughout the year. We wish to be very clear that hunger
in America is not the same as famine and the resulting malnutrition
seen in developing countries.
Why Is Hunger Significant? In 2014, 5.6% of households in America
experienced hunger in the past year, for an average of about 7
months.\1\ The percent of households facing hunger rose from 4.1% in
2007 to 5.4% in 2010, and has remained around 5.6% since, even as the
economic recovery enters its sixth year.
Root Causes. Many factors lead to hunger in America; focusing only
on household income or the availability of government assistance misses
major contributing factors such as low or underemployment, unstable
families, insufficient education, exposure to violence, a history of
racial or ethnic discrimination, personal choices, or a combination of
these. These factors can play a large role in hunger and cannot be
addressed solely through public nutrition assistance programs or
charitable giving.
Populations of Specific Concern. We focused on seven groups that
experience high rates of hunger: seniors, single parent families with
young children, people with disabilities, veterans and active duty
military, American Indians, people affected by high incarceration
rates, and immigrants.
Addressing Hunger. The U.S. Government, along with a host of
nonprofit organizations, corporations, and individuals, works daily to
reach millions of families, and they do so in comprehensive, effective,
and creative ways. In 2014, the U.S. Government spent an estimated
$103.6 billion on Federal food and nutrition assistance programs.\2\
Supplementing these are many community programs and private
initiatives.
Recommendations. We offer 20 specific recommendations in six areas
to reduce hunger:
I. Improvements to the Supplemental Nutrition Assistance Program
(SNAP) (10 recommendations)
II. Improvements to child nutrition programs (4 recommendations)
III. Improvements to nutrition assistance options for people who are
disabled or medically at risk (2 recommendations)
IV. Pilot programs to test the effectiveness of strategic
interventions to reduce and eliminate hunger (1
recommendation)
V. Incentives to expand roles for corporate, nonprofit, and public
partnerships in addressing hunger in civil society (1
recommendation)
VI. Creation of a White House Leadership Council to End Hunger (2
recommendations).
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Table of Contents
Introduction
The Commission's Work
Who We Are
Our Process
What Is Hunger and Why Is It a Significant Problem?
Root Causes of Hunger
Labor Market Forces and Job Availability
Family Structure
Education
Exposure to Violence
Historical Context
Personal Responsibility
Populations of Specific Concern
Seniors
Single Parent Families with Young Children
Veterans and Active Duty Military
People with Disabilities
American Indians
Those Affected by High Incarceration Rates
Immigrants
Addressing Hunger in America
Federal Programs
WIC
SNAP
School Meals
Summer and after school Food Programs
Community Programs
Public-Private Partnerships
Recommendations
Conclusion
References
Appendix A. Acknowledgments
Appendix B. U.S. Household Food Security
Survey Module
Glossary
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Introduction
[The] leading object [of our government] is . . . to lift
artificial weights from all shoulders; to clear the paths of
laudable pursuit for all; to afford all an unfettered start and
a fair chance in the race of life.
Abraham Lincoln, July 4, 1861
In America, we seek freedom and opportunity. But for almost seven
million households, the experience of hunger limits their freedom and
reduces their chances of success. Thus, hunger in the United States can
undermine our nation's full potential.
In spite of diverse viewpoints on the causes and consequences of
hunger, we as a Commission are in agreement that hunger is an important
problem and that we can do something about it.
Hunger in America is solvable. People in America are not hungry due
to war or famine or drought. Our country--with all its strength,
genius, creativity, and spirit of community--has the ability to be free
from hunger. America has no shortage of food, and no shortage of food
assistance programs. But those programs do not work as effectively,
cooperatively, and efficiently as they should.
To identify solutions to hunger, Congress created the ten member
National Commission on Hunger. The Commission members, appointed by the
House and Senate leadership, represent government, industry, academia,
and nonprofit organizations.
We believe that the problem of hunger in America is fundamentally a
problem of values--in a nation as rich as ours, no one should go
hungry. Our members are in full agreement that the problem of hunger
cannot be solved through government efforts alone. In addition to sound
public policy, the solution to hunger in America requires an economy
with broad opportunity for working age adults, robust community and
corporate partnerships, personal responsibility to make good, positive
choices for our families and communities, and our sincere commitment to
helping others in ways that strengthen the fabric of our society.
There are many root causes of hunger, including labor market forces
and job availability, family structure, education, exposure to
violence, historical context, and personal responsibility. By focusing
on the most vulnerable members of our society, such as seniors, single
parent families with young children, people with disabilities, and our
veterans, the United States can surely put an end to hunger.
In this report, we outline the pathway to achieve the goal of
ending hunger in the United States through 20 recommendations to
Congress, the U.S. Department of Agriculture (USDA), and other
Executive Branch agencies that can be acted upon in the immediate
future. What we outline here is achievable, practical, and forward
thinking. These solutions depend on bipartisan actions in Congress, and
commitment from the current and future President of the United States
and the Executive Branch, and they depend on each of us to make the
personal choice to get involved and act on our commitment to help
nourish our families and communities. By doing so, we will ``afford all
an unfettered start and a fair chance.''
This is our charge:
To provide policy recommendations to Congress and the USDA
Secretary to more effectively use existing programs and funds
of the Department of Agriculture to combat domestic hunger and
food insecurity; and to develop innovative recommendations to
encourage public-private partnerships, faith-based sector
engagement, and community initiatives to reduce the need for
government nutrition assistance programs, while protecting the
safety net for the most vulnerable members of society.
------------------------------------------------------------------------
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Defining Hunger:
Very Low Food Security
``Hunger'' is a complex concept to quantify. We wish to be very
clear that the situation we call hunger in America is not the
equivalent of famine and the resulting malnutrition seen in developing
countries.
Food insecurity (see glossary) is measured by the U.S. Household
Food Security Survey Module, which has been in widespread use for
nearly 20 years. It asks questions about respondents' reports of
uncertain, insufficient, or inadequate food access, availability, and
use because of limited financial resources, and about the compromised
eating patterns and consumption that might result. The USDA uses the
responses to classify households into four categories: high food
security, marginal food security, low food security, and very low food
security. Households with high or marginal food security are called
food-secure, and households with low or very low food security are
called food-insecure.
To define hunger for this report, we chose a precise and readily
available measure called very low food security, which occurs when
eating patterns are disrupted or food intake is reduced for at least
one household member because the household lacked money and other
resources for food. The use of this particular measure allowed us to
focus on households where the problem is most severe.
Thus, when we use the word ``hunger'' we mean households
experiencing very low food security. When statistics are not available
for this measure, we may report values for the broader measure of food
insecurity, which captures both low and very low food security.
------------------------------------------------------------------------
Volunteers at the D.C. Community Kitchen
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The Commission's Work
Who We Are
Congressional leaders from both parties appointed the Commission
members: three each by the Speaker of the House and the Senate Majority
Leader (John Boehner, R-Ohio, and Harry Reid, D-Nevada, respectively,
at that time); and two each by the House and Senate Minority Leaders
(Nancy Pelosi, D-California, and Mitch McConnell, R-Kentucky,
respectively, at that time). We then selected two of our members as co-
chairs to guide our work--Dr. Mariana Chilton and Mr. Robert Doar. Our
goal was to develop recommendations to Congress and the USDA that had
the unanimous, bipartisan support of all our members.
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Mariana Spencer Robert Doar Jeremy Susan Finn
Chilton Coates Everett
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Deborah Frank Cherie Jamason Billy Shore Russell Sykes
Note: Congressional leaders appointed ten people to the Commission, but
one, Ricki Barlow (Reid appointee), later resigned for personal
reasons and is not listed above.
Mariana Chilton, Ph.D., M.P.H., is an Associate Professor at Drexel
University School of Public Health and Director of the Center for
Hunger-Free Communities. She directs multiple research studies on the
impact of public policy on food insecurity and health and well-being
among families with young children. (Reid appointee)
Spencer Coates is President of Houchens Industries, Inc., and
serves on its Board of Directors. He joined the Houchens family of
companies in October 2003, after retiring from BKD, LLP, a national
public accounting firm where he had spent 30 years serving in various
capacities. (McConnell appointee)
Robert Doar is the Morgridge Fellow in Poverty Studies at the
American Enterprise Institute, where he studies how improved Federal
policies and programs can reduce poverty and provide opportunities for
vulnerable Americans. Previously, he served as Commissioner of the New
York State Office of Temporary and Disability Assistance and
Commissioner of the New York City Human Resources Administration.
(Boehner appointee)
Jeremy Everett is the founding Director of the Texas Hunger
Initiative (THI) at Baylor University, a capacity building project that
develops and implements strategies to alleviate hunger through
research, policy analysis, education, and community organizing. Prior
to THI, Mr. Everett worked for international and community development
organizations as a teacher, religious leader, community organizer, and
farmer. (Boehner appointee)
Susan Finn, Ph.D., is the CEO of the global consultancy Finn/Parks
& Associates and a recognized leader and respected communicator in the
food, nutrition, and health arena. She is a leader in the Academy of
Nutrition and Dietetics and is committed to advancing nutrition
research and education. (Boehner appointee)
Deborah A. Frank, M.D., is a child health researcher and the
inaugural incumbent of a newly established Pediatric Professorship in
Child Health and Well Being at Boston University School of Medicine.
She began working at Boston City Hospital (now Boston Medical Center)
in 1981. In 1984, she founded the Failure to Thrive Program, now called
the Grow Clinic for Children, where she still practices. (Pelosi
appointee)
Cherie Jamason is President and CEO of the Food Bank of Northern
Nevada, a nationally recognized anti-hunger organization and recent
Feeding America Food Bank of the Year. She established the Nevada Child
Nutrition Initiative implementing summer food and after school meal
programs for low income children throughout Nevada, and was
instrumental in crafting Nevada's first State Food Security Plan and
creating Bridges to a Thriving Nevada, which takes on poverty and
financial instability. (Reid appointee)
Billy Shore is the founder and CEO of Share Our Strength, a
national nonprofit dedicated to ending childhood hunger in America
through its No Kid Hungry campaign. He is also the author of four
books, including The Cathedral Within, and chair of Community Wealth
Partners, which helps change agents solve social problems. (Pelosi
appointee)
Russell Sykes is an independent consultant working on multiple
Federal and state projects focusing on job search in Temporary
Assistance for Needy Families, Medicaid reform, Social Security
Disability, and workforce engagement. He was the former Deputy
Commissioner for New York State's Office of Temporary and Disability
Assistance where he was responsible for the administration of SNAP,
Temporary Assistance for Needy Families, welfare-to-work, and multiple
other public benefit programs. (McConnell appointee)
Our Process
Since May 2014, we have met monthly in person or by phone to carry
out our work. In addition, we have held regular meetings with
representatives of the USDA.
We invited 83 experts from government, industry, universities, and
nonprofits to give us testimony, and received responses from 80 of
them. In 2015, we traveled to eight cities across America to visit
programs working to alleviate hunger, including government, nonprofit,
community, and faith-based programs. We held public hearings in seven
of those cities, where we heard from 102 members of the public.
Altogether, we received testimony from 182 people, including experts,
recipients of assistance, and members of the public.
Not surprisingly, we gained wisdom from people from all walks of
life. We listened to corporate executives who have forged public-
private partnerships to reduce dependence on government programs,
physicians who have treated children lacking adequate nutrition, state
officials tasked with implementing large Federal assistance programs
while also preventing fraud and abuse, and new Americans in search of a
safer and better life for their children. In schools and community
centers we witnessed breakfast-in-the-classroom programs, nutrition
education and cooking classes, summer meals programs, and emergency
food distribution.
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Public testimony from Coach Larry Clark of LifeSkills for
Youth, where they administer child nutrition programs In Little
Rock.
Used with permission. 2015 Jane Colclasure. All
rights reserved.
Sites Visited by the Commission
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Figure note: All hunger rates are state rate of very low food
security for 2012-2014, from USDA Economic Research Service
data. State rates range from 2.9% (North Dakota) to 8.1%
(Arkansas). U.S. average is 5.6%.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Community meeting at El Centro de Salud Familiar La Fe, El
Paso.
We visited Oakland, California, and Albany, New York, sizable
cities located in two of the country's largest states, and Portland,
Maine, in a northeastern state with high levels of hunger. We visited
Little Rock, Pine Bluff, and Altheimer in Arkansas, because Arkansas
has one of the highest rates of hunger in the country, and we wanted to
observe what local authorities and organizations were doing to address
it. We visited immigrant populations in El Paso, Texas, and American
Indian (Pueblo) communities participating in a Food Distribution
Program on Indian Reservations program near Albuquerque, New Mexico. In
Indianapolis, Indiana, we visited a public-private partnership that
works on multiple fronts to reduce hunger. In Washington, D.C., we
observed an example of a successful summer feeding program and learned
about nonprofit organizations offering job training and health services
along with food assistance.
Although these visits offered only a snapshot of people's
experiences, they provided insights into the available public and
private assistance programs, and revealed the need for continued
improvements on both fronts for programs to function more effectively.
We also learned firsthand about the root causes and consequences of
hunger. Many of the causes are associated with poverty and other
economic and social factors, and poverty itself has multiple causes.
Solutions to these larger issues are beyond the bounds of our mandate,
but we encourage Congress and the President to make them a greater
focus, as they lay the foundation for eliminating hunger across the
nation.
To support us in our efforts, the Secretary of Agriculture
selected, through a competitive bidding process, an independent,
nonprofit research organization, RTI International, to conduct a
current and prospective review of the literature on hunger, offer
independent recommendations for reducing hunger, and provide us with
ongoing research support and technical expertise. RTI prepared
research-based ``white papers'' on questions posed by Commissioners and
potential solutions to hunger.3-15 RTI also created a
Commission website, which houses our activities, minutes from our
meetings, and written testimonies and transcriptions and recordings of
the hearings. Commissioners also contributed relevant peer-reviewed
papers and other primary sources, some of which were posted on our
website.
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Charlotte Douglas, State Representative, R-75th District,
Arkansas, provided invited testimony In Little Rock.
Used with permission. 2015 Jane Colclasure. All
rights reserved.
Because our own backgrounds and disciplines are diverse, we often
saw and learned the same things but reached different conclusions. We
have sought to set those differences aside in favor of reporting on
what we did agree upon, and we have synthesized it to present an
overall picture of hunger in America today. At a time when our nation's
politics are so partisan and polarized, we hope the unanimity that we
demonstrate in this report will give its conclusions and
recommendations extra weight.
This report takes all of the information we collected through this
process and synthesizes it to present our collective view of hunger in
America today, and culminates in a set of recommendations to Congress,
the USDA, and others committed to decreasing hunger in America.
Eliminating hunger, as we define it, is possible, but doing so demands
leadership and strategic vision. In light of that challenge, we crafted
our recommendations to be targeted, meaningful, and realistic. We hope
that Congress, the USDA, and the rest of the Executive Branch respond
thoroughly, thoughtfully, and urgently.
What Is Hunger and Why Is It a Significant Problem?
In 2014, 6.9 million households, or 5.6% of households in America,
had at least one member experience hunger at some time in the past
year.\1\
Households reporting hunger (i.e., very low food security) in
2014 experienced it for an average of about 7 months of the
year.\1\ During the Great Recession, the percent of households
that experienced hunger increased from 4.1% in 2007 to 5.4% in
2010. The rate has remained at that level even as the economic
recovery enters its sixth year. In addition, too many people
who could work remain out of the labor market--labor force
participation by working age adults has been declining since
its peak in 2000.\16\
Hunger has far-reaching consequences, not just on
individuals, but also on the U.S. health care system, our
educational system, and the economy: hunger contributes to
nutritional deficits that can undermine people's health,
diminish human capital, and impede children's
development.17-34 These negative effects can
translate into greater health care expenditures, reduced worker
productivity, and greater rates of worker
absenteeism.21, 25
Decades of medical, economic, social science, and educational
research have shown that hunger affects people of all ages in
the United States. Impairment of childhood health and
development arising from hunger may result in poor health and
poor academic achievement, generating potentially preventable
costs for the health care and education
systems.20, 26-27 Adolescents in families reporting
hunger experience more problems with mental health and thoughts
of suicide.35-36 Adults that report hunger also
report poorer physical and mental health and higher rates of
being overweight or diabetic, and other related
problems.17, 24, 29, 30, 34 Among seniors, hunger
can lead to depression and reduced capacity to perform
activities of daily living.37-39
Given these serious consequences for individuals and for the
productivity and success of our country, it is urgent that we
do everything in our power to reduce and ultimately eliminate
hunger.
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Hunger Rates by Household Characteristics, 2014
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a Households with children in complex living
arrangements, e.g., children of other relatives or unrelated
roommate or boarder.
b Hispanics may be of any race.
c Metropolitan area residence is based on 2013
Office of Management and Budget delineation. Prevalence rates
by area of residence are not precisely comparable with those of
previous years.
d Households within incorporated areas of the
largest cities in each metropolitan area. Residence inside or
outside of principal cities is not identified for about 17
percent of households in metropolitan statistical areas.
Source: Calculated by ERS using data from the December 2014
Current Population Survey Food Security Supplement.
Root Causes of Hunger
Many factors lead to hunger in America. A simplistic explanation
focused only on household income or the availability of Federal
nutrition programs misses major contributing factors.
For example, the Supplemental Nutrition Assistance Program (SNAP,
formerly known as Food Stamps) has been shown to reduce hunger, but it
does not succeed in eliminating it altogether for every
participant.\40\ Furthermore, hunger occurs in 25.5% of households with
incomes below 130% of the poverty line that did apply for and receive
SNAP benefits for 12 months, but occurs in only 10% of households at
the same income level that did not receive SNAP benefits at all during
that period.\1\ Clearly, hunger has causes other than income alone, and
therefore, food assistance alone will not eliminate hunger.
U.S. households experience hunger because of limited income due to
a variety of factors, including low or underemployment, family
instability, low educational attainment, exposure to violence, a
history of racial or ethnic discrimination, personal choices, or a
combination of these. These factors can play a large role in hunger and
cannot be addressed solely through the public nutrition assistance
programs or through charitable giving. Understanding the root causes of
hunger is essential in order to eliminate hunger.
[People put] energy into collecting data and building
infrastructure to distribute food boxes and run soup kitchens,
creating ways to get kids to want to come eat some of the meals
in the parks and close by--that's a lot of work. It's a lot of
planning. It's a lot of organizing and it's great intelligence.
Yet, doing so does not assist anyone out of poverty, and/or
increase their accessibility to be part of mainstream
community. It keeps us in line waiting for the box.
Dee Clarke, Founder, Survivor Speak (Maine)
Labor Market Forces and Job Availability
The number of households experiencing hunger is sensitive to
economic forces.
------------------------------------------------------------------------
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Globalization: changes promoting the open flow of goods and services
among countries.
Offshoring: moving jobs from the United States to other countries
where labor is cheaper.
------------------------------------------------------------------------
The 2007-2009 economic downturn, the Great Recession, led to
significant unemployment, which in turn led to an increase in hunger.
The number of unemployed workers more than doubled, from 7.1 million in
2007 to 14.3 million in 2009.\41\ Hunger levels also jumped sharply
during that period. Six years after the official end of the recession,
hunger rates shamefully remain at historically high levels, with
particularly high rates among single parent households with young
children, households of persons with disabilities, and the households
of racial and ethnic minorities.1, 42-43
Our nation's economy has struggled with significant structural
shifts that have occurred over the last 60 years. Manufacturing jobs
have declined, partly due to deindustrialization and automation, while
the service sector is growing and producing more jobs. Globalization
has contributed to more widespread offshoring and outsourcing,
particularly of manufacturing jobs, but also of some types of service
jobs, such as those in call centers. These trends have contributed to
fewer well-paying job opportunities for those without a post-secondary
education.44-45
Workers with a high school education or below are more likely to
hold jobs that pay low wages, and are part-time, unstable, or seasonal.
Oftentimes these types of jobs offer few opportunities for career
advancement, and may not offer important supports such as sick leave or
family leave. Such jobs are also associated with major income
instability or sharp income fluctuations. These are the kinds of
conditions that can cause a household to experience hunger.\46\
We hear every day loud and clear from all areas of the state
that people can't support their families. They can't get food
because they can't find decent jobs. The forest industry, the
fishing industry, canning, textile, manufacturing are all in
distress. Giant Mills: Empty. A major naval air station:
Closed. Mill towns: have struggling economies. We hear about
the problem of people living isolated from job centers in a
state with virtually no public transportation, or the lack of
affordable housing (if people do move to the few job centers).
Donna Yellen, Chief Program Officer, Preble Street (Maine)
Family Structure
Marriage has a significant impact on whether or not a household
will experience hunger: Households with an unmarried head of household
are more likely to face hunger than other households in America.
The hunger rate for households headed by a single mother
(12.8%, or 1.3 million households) is four times the rate for
households headed by a married couple (3.2%, or 804,000
households). For households headed by a single father, the rate
(7.0%, or 228,000 households) is more than twice the rate of
households headed by people who are married.\1\
Today, 40% of children in the United States are born to
unmarried parents.\47\ These pregnancies are mostly unplanned:
69% of pregnancies among unmarried couples are unintended,
compared to 35% of pregnancies among married couples.\48\
Children growing up in single parent households are more likely
to miss out on fundamental opportunities for their social and
emotional development,\49\ and are less likely than children in
two parent families to do well in school or graduate high
school.\50\ Having children too early in life, struggling to
create a safe and stable household environment, and having
multiple children outside of marriage compounds this
problem.\51\ *
---------------------------------------------------------------------------
* It is important to note here that children can be raised in
single-parent households for reasons other than parents choosing not to
marry, such as divorce or death of a parent.
---------------------------------------------------------------------------
Households with one wage-earner typically have lower incomes.
In addition, women earned about 81% of the median earnings of
their male counterparts in 2012.\52\ Women with children under
18 also earned less than both women and men without children
and men with children.\53\ Understanding that many factors
affect the labor market and play a role in these data, these
wage disparities compound the problem facing single-earner
households, especially those headed by women. The poverty rate
among children in households headed by a married couple is 6.2%
(3.7 million households), compared to 15.7% of households
headed by a single father (970,000 households), and 30.6% of
households headed by single mother (4.8 million
households).\54\
Basically, what it comes down to, being food-insecure, you
have to go through a lot of resources. It is really aggravating
because basically I'm doing what I'm supposed to do as a
parent, right? But when there's no husband or boyfriend or any
other kind of support, everything falls on me.
Denise Speed, Marbury Plaza Resident, Anacostia (Washington, D.C.)
Education
U.S. high school graduation rates have improved, with the national
graduation rate exceeding 80% in 2012 for the first time in U.S.
history; however, economic, racial, cultural, and ethnic differences
remain.
The graduation rate for low-income students in 2014 was below
80% in 41 states.\55\ Some of the most important predictors of
high school graduation are reading level at third grade, family
poverty, family structure, and concentrated poverty at the
neighborhood level.
The relationship between hunger and high school graduation
operates in both directions: graduation rates are lower among
those experiencing hunger, and hunger, in turn, has been linked
to special education and grade repetition, both important
predictors of high school dropout rates.\56\ Hunger is also
related to lower educational attainment: in 46% of households
with hunger among children, the adults did not have an
education beyond high school.\57\ Hunger among children is
present in 2.9% of households in which the adults did not
complete high school, 1.3% of those with adults having only a
high school education or GED, and 0.4% of households having an
adult with a college degree or more.\57\
Exposure to Violence
Research over the last 10 years has found that victims of violence,
neglect, or abuse as a child or violence as an adult, are more likely
to report hunger.58-60
For example, hunger rates among women who, as children,
experienced physical, emotional, or sexual abuse or household
dysfunction (domestic violence, parent in jail) are 12 times as
high as rates among women who did not.\60\ Hunger is also more
frequently reported by women who recently experienced domestic
violence. In some studies, women who report experiencing post-
traumatic stress disorder are more likely to report household
food insecurity.61-63
Historical Context
There are significant racial, ethnic, and gender disparities
between households that report hunger and those that do not.
For example, the hunger rate among African American
households is 10.4% (1.6 million households); for Hispanic
households, it is 6.9% (1.1 million households); whereas for
white households, that rate is 4.5% (3.8 million
households).\1\ Among American Indians, data are not available
for hunger rates, but the broader food insecurity rate is
nearly twice that of the general U.S. population.\64\ These
racial and ethnic disparities have been consistent since the
USDA began measuring food insecurity in 1995. These disparities
may be attributable to a persistent combination of political,
social, and economic factors--including residual racial and
ethnic discrimination--that affect access to jobs,
opportunities for home ownership, high-quality education, and
affordable healthy food.
We must acknowledge this historical context if we are to
improve the nutrition, health, well-being, and security of all
Americans, regardless of race or ethnicity.
Hunger Rates Over Time by Race and Ethnicity
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
These disparities are wreaking havoc on our communities and
our country and we need a sort of holistic response to the
economic disparity and the food insecurity that you all are
focusing on. Dr. King said in a letter from the Birmingham
jail, ``We're caught in an inescapable network of mutuality
tied in a single garment of destiny. Whatever affects one
directly affects all indirectly.'' This problem isn't a problem
for people of color. This is everybody's problem.
George Jones, CEO, Bread for the City (Washington, D.C.)
Personal Responsibility
Although we feel that our nation would make progress in reducing
hunger if we made gains in each of the factors above, we also
acknowledge one other key ingredient--the actions of individuals.
Personal agency, personal responsibility, and individuals
making good choices play an important role in the extent to
which Americans are hungry, and any discussion of how to reduce
hunger that omits these factors is incomplete.
Individuals make many life choices that can affect financial
circumstances and hunger: choices about staying in or dropping
out of high school, choices about getting a job or not, and
choices about having or delaying children.
While it is true that enhancing the health and cognitive and
emotional well-being of Americans by reducing hunger would
produce greater opportunities for individuals, we must always
recognize the importance of individual decision-making. As Ron
Haskins, Senior Fellow at the Brookings Institution, contends,
``changes in personal behavior . . . would have an enormous
impact on poverty and opportunity.'' \65\
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Populations of Specific Concern
Taking into consideration the disparities in household
characteristics between those who experience hunger and those who do
not, we focused on seven specific groups that are especially vulnerable
to hunger: seniors, single parent families with young children,
veterans and active duty military, people with disabilities, American
Indians, people affected by high incarceration rates, and immigrants.
Seniors
The number of older adults will increase over the next few decades,
and if we do not change the way we assist seniors, the number of
seniors who experience hunger will increase significantly.\66\
In 2014, 3.2% of households with seniors aged 65 and older
(1.1 million households) and 3.8% (480,000 households) of
households with seniors living alone were hungry.\1\ Many
seniors who live alone depend on organizations such as Meals on
Wheels.
------------------------------------------------------------------------
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Multigenerational: a family headed by an adult householder aged 40
or older and with three generations (grandparent, parent, child) or
grandparent and grandchild with no adult parent (so-called skipped
generation).
------------------------------------------------------------------------
Among adults aged 40 and older, those living in
multigenerational households have higher rates of hunger (5.5%)
than those who do not (3.1%).\38\ Hunger rates among
multigenerational households have also increased substantially
over the past decade.
Compared to seniors who do not experience hunger, seniors
experiencing hunger are three times as likely to suffer from
depression, 50% more likely to have diabetes, and 60% more
likely to have congestive heart failure or a heart attack.\67\
In addition, 20% to 50% of patients admitted to the hospital
are malnourished and thus compromised in their ability to fight
illness and complications; these patients are predominately
low-income/Medicaid patients 65 and older.\68\ Readmissions
among this group costs the health care system approximately $25
billion annually, and 70% of this cost is for return trips that
might not have been necessary if patients had received proper
care, including proper nutrition.\69\ Programs such as Meals on
Wheels (both pre-admission and post-discharge), as well as
greater attention to early nutrition assessment and
intervention are critical to preventing complications and
lowering costs.\68\ These interventions in both health care
settings and the community are not meeting growing need: in
many communities, there is a waiting list for Meals on Wheels
and similar programs.70-71
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Gloria Gonzalez and Father Villegas, San Luis Rey Parish,
Chamberino, NM.
Single Parent Families with Young Children
Substantial research has found that a substantial percentage of
young children in food-insecure households experience negative social,
emotional, and cognitive outcomes.28, 31, 72-75
About 6% (4.4 million individuals) of individuals in
households with children under age 6 are in households that
report hunger; the rate is the same for households with
children under 18 (9.5 million individuals). These rates are
slightly higher than the percent of individuals in all
households that report hunger (5.5%, 17.2 million individuals).
But the problem is much worse in households with only one
adult. Among married couple families with children, the rate of
hunger among individuals is 3.5% (3.9 million individuals),
whereas for households headed by a single mother, the rate is
13.2% (4.7 million individuals), and for households headed by a
single father, the rate is 7.2% (0.8 million individuals).\76\
Although adult caregivers (including grandparents) often try
to mitigate the effects of hunger on their children by reducing
their own food intake, such reductions affect the caregivers'
health and capabilities, which in turn affects their ability to
juggle parenting, work, and self-care. We heard this reflected
in testimony from single parents during our field hearings.
Given the serious consequences of hunger for families with
young children and children in the sensitive period of brain
development, single parent families merit particular attention,
care, and support to lay the foundation for optimal child
development for school performance, good health, and
participation in the workforce.
The cycle of hunger has never left my family. My siblings and
I lived with my mom growing up, and we struggled with hunger.
When she died, we went to live with my dad. And we struggled
then. The stress of having no food affected him. He couldn't
deal. He was so overwhelmed he started drinking instead of
eating, and he sent us down South to our aunts, thinking we'd
be better off. But we still were hungry there. And on top of
that, we were missing our dad, and missing our mom. Hunger
destroys people. It destroys families.
Tangela Fedrick, Witnesses to Hunger (Washington, D.C.)
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Courtesy of Tangela Fedrick.
Veterans and Active Duty Military
America's veterans and active duty military have provided and
continue to provide our country with outstanding service to protect our
freedom and security.
However, there is evidence that both groups have experiences
with food insecurity and have inconsistent or inadequate access
to nutrition assistance. In a 2012 study of veterans of the
Iraq and Afghanistan wars, 12% reported hunger.80 Approximately
1-2% of active duty military members (more than 20,000) and 7%
of veterans (1.6 million veterans) receive SNAP benefits.\81\
Hunger tends to occur among the lower enlisted ranks,
especially those with multiple dependents.\81\
These issues are concerning, yet the Department of Defense,
the Veterans Administration, and the USDA provide little data
on the extent of hunger among active duty military and
veterans.
I ask that you consider our veteran population in your work,
and the only thing I have to say is that no veteran should go
hungry after serving honorably on behalf of this country. No
veteran should be left behind and that's what I ask of you is
to make sure that the veteran population is included in this
discussion about hunger in America. We're hungry, too.
Carlos Rivera, Veteran, U.S. Air Force, 1971 to 1975 (El Paso)
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People with Disabilities
Disability has been identified as ``one of the strongest known
factors that affect a household's food security.'' \77\
Thirty-eight percent of all households experiencing hunger
include an adult with a disability.\42\ Families with children
with disabilities are also at increased risk for hunger.\78\
Low employment rates and high health care costs constrain the
economic resources of people with disabilities, leading to
higher rates of hunger. Despite special SNAP provisions
regarding resource limits and medical deductions for adults
with disabilities, \1/3\ of chronically ill adults cannot
afford both food and medicine.\79\ In addition, their health
may be more fragile than those who do not have disabilities,
making them more vulnerable to the health consequences of
hunger. In Washington, D.C., we heard from Saleema Akbar, a 57
year old sufficiently disabled from arthritis and diabetes to
receive Supplemental Security Income and SNAP. She relies on a
manual wheelchair to go out, but she is too young to qualify
for programs that deliver meals to seniors. She said her SNAP
benefits are not sufficient to provide the high-protein diet
recommended for her diabetes, and in the previous year, she
lost more than 100 pounds from lack of sufficient protein.
American Indians
American Indians and Alaska Natives experience food insecurity at
rates more than twice those of non-Hispanic Whites (23% vs. 11%).\82\
The Navajo Nation has the highest reported rate of food
insecurity of any subpopulation in the United States, with
76.6% of households on their reservation experiencing food
insecurity.\83\ * This is more than three times the food
insecurity rate of American Indians as a whole.\84\
---------------------------------------------------------------------------
* Although figures for hunger specifically are not available, the
figures for the broader category of food insecurity highlight the
disparities in rates between American Indians and other populations.
---------------------------------------------------------------------------
For many American Indians living in their traditional
homelands or reservations, obtaining nutritious, affordable
food can mean traveling more than 30 miles. In one study of
Navajo members, 51% traveled off-reservation to get to a
grocery store. Among this sample, the shortest distance
traveled off-reservation was 155 miles round-trip.\83\ Lack of
access to healthy food is a daunting problem for American
Indians, who are two to three times more likely than the
general population to have diabetes, and are also more likely
to be obese.85-86
Those Affected by High Incarceration Rates
Incarceration affects not just those in prison, but also their
families and communities.
For a family, one member's incarceration can mean loss of
income and emotional support, disruption of family life, and
social stigma. Especially for children, the result can be
insufficient food and shelter, emotional trauma, difficulty in
school, and increased stress.\93\ Several studies have found
significant correlations between parental incarceration and
food insecurity.94-95
About 650,000 people are released from prison each year; most
are poor, unemployed, and homeless or living in marginal
housing.\96\ Returning to society after serving time, finding a
job, getting housing, and reconnecting with family and
community is often very difficult. Felons are ineligible to be
a principal lease-holder for subsidized housing, and in most
states, those convicted of a drug felony (but not other
felonies, including violent ones) are prohibited from receiving
SNAP. Currently, no nationally representative study assesses
the hunger rate of people recently released from prison across
the United States, but in a recent study, 90% of individuals
released from prison reported household food insecurity, and
37% reported not eating for an entire day because they had no
money.\97\ All of these difficulties affect not just the
released inmate, but also their families.
Meeting with Commissioners in Washington, D.C., two women
described their lives as ``broken'' after leaving prison, until
they began job training at D.C. Central Kitchen. Monitoring
hunger and providing assistance to people who have served their
time and are re-entering society with a willingness to become
productive and responsible members of society will not only
help reduce hunger, but may also help to keep people from
returning to prison and lessen the impact on their families.
Immigrants
Individuals and families immigrate to the United States for a
variety of reasons: economic opportunity, reunification with family, or
asylum from ethnic, religious, or political persecution.
Forty-one million immigrants--13.1% of our population--live
in the United States. Of those 41 million, about 27% (11.3
million) do not have legal documentation.\87\ Documented and
undocumented immigrants represent a sizeable portion of our
population, and their children account for a significant
proportion of our future workforce. Therefore, understanding
and monitoring hunger among immigrant families, including
undocumented persons, is an important part of preventing long-
term negative impacts.\87\
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Documented immigrants are those who are in the United States
legally.
Undocumented immigrants are those who are here illegally. These may
include asylum seekers (people who have entered illegally seeking
refugee status, which if granted, would regularize their presence and
make them legal) and those who entered the United States legally on a
temporary visa that has since expired, rendering their presence here
illegal.
Colonia: an unincorporated settlement of immigrant families, the
majority of whom are undocumented.
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Assessing hunger in documented and undocumented immigrant
populations is challenging for a variety of reasons. Immigrant
households may include citizen children and non-citizen
parents, who may or may not be documented. Extended family
members--documented and undocumented--may also live in such
households, either temporarily or permanently. In addition,
immigrants who are seasonal workers move frequently.
Undocumented persons may avoid participating in surveys and the
Census out of fear of deportation or incarceration. Therefore,
even though they are included in survey results, these factors
make it difficult to compare hunger rates between documented
and undocumented populations.\88\
Given these complexities, studies among immigrants tend to be
small, may include people of many different countries of
origin, or be limited to particular geographies or professions,
making it hard to compare hunger rates. We do know that
children in immigrant households are disproportionately
affected by hunger: children in households with immigrant
mothers are three times as likely to be hungry as children in
households with U.S.-born mothers \89\ (documentation status
not reported). Children in households headed by a recent
immigrant are also more likely to be hungry than children in
other households \90\ (documentation status not reported). One
small study compared documented and undocumented workers in
Georgia and found that undocumented workers were about three
times as likely to be food-insecure as documented workers.\91\
On our trip to El Paso, we visited Colonias in the Lower Rio
Grande Valley. Women and lay community health workers from
those communities told us that their communities lack basic
infrastructure for safety and security. A survey of women in
the Colonias found that 78% of households did not have enough
food, and 7% had no food at all. Approximately 18% had adults
who were unemployed (documentation status not reported).\92\
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A home to a family of nine in Sparks, a Colonia near El Paso,
Texas.
Photo courtesy of Socorro Ramirez Community Center, El Paso,
TX.
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Addressing Hunger in America
In our field visits, we observed many successful public and private
food programs with track records of effectiveness and bipartisan
support. These partnerships highlighted for us the synergy that can
occur between government entities, nonprofits, industry, and
individuals, not only producing a greater impact on hunger than any one
of these sectors could alone, but also strengthening the bonds of
communities across social classes and sectors. Through our review of
the research, we learned of many effective programs as well as
opportunities to enhance the work. The U.S. Government, along with many
nonprofit organizations, corporations, and individuals, works daily to
reach millions of families, and they do so in comprehensive, effective,
and creative ways.
Federal Programs
In 2014, the U.S. Government spent an estimated $103.6 billion on
Federal food and nutrition assistance programs,\2\ with one in four
people having participated in at least one of the government's 15 food
assistance programs at some point during the year.\98\ The five largest
programs accounted for 97% of these expenditures. Together these
programs form a nutritional safety net for millions of children and
low-income adults, providing them the additional nutrition assistance
they need to lead an active and healthy life. In his formal testimony
to the Commission, Dr. Eldar Shafir, the William Stewart Tod Professor
of Psychology and Public Affairs in the Woodrow Wilson School of Public
and International Affairs at Princeton University, wrote, ``The data
suggest that government safety nets are not luxuries, but can be
powerful tools to improve conditions precisely when things are
difficult.'' \99\
In her formal testimony to the Commission, Angela Rachidi, a
research fellow in poverty studies at American Enterprise Institute,
told Commissioners, ``Data suggest that our main food assistance
programs are appropriately targeting those with very low food
security.'' \100\
The largest food assistance programs are discussed below.
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Largest Federal Food Assistance Programs
SNAP: Supplemental Nutrition Assistance Program
WIC: Special Supplemental Nutrition Program for Women, Infants, and
Children
School Meals:
National School Lunch Program
School Breakfast Program
Summer and after school Programs
Summer Food Service Program
Child and Adult Care Food Program
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WIC: The Special Supplemental Nutrition Program for Women, Infants, and
Children
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The Special Supplemental Nutrition Program for Women, Infants, and
Children (WIC) provides Federal grants to states for specific healthy
foods, health care referrals, and nutrition education for low-income
pregnant or postpartum women, and to infants and children under 5 who
are at nutritional risk. In 2014, approximately 8.3 million women,
infants, and children under 5 received help through the WIC program in
an average month.\107\ More than \1/2\ of all newborn children in the
United States participated in the WIC program. As of Fiscal Year 2013,
23% of WIC participants were infants, about 54% were children from 1-4
years old, and 24% were women.\107\
WIC has been credited with a 68% reduction in hunger among families
with young children.\108\ Kate Breslin, President and CEO of the
Schuyler Center for Analysis and Advocacy, explained in her testimony
that WIC is associated with healthier births, more nutritious diets,
improved cognitive development, and stronger connections to preventive
health care, including an increased likelihood of children receiving
immunizations.\109\ Research supports Breslin's testimony: a
longitudinal study of WIC participation examined the association
between how long a household participated in WIC and food security
status. Among pregnant women who reported hunger, receiving WIC in the
first or second trimesters, as opposed to only the third trimester,
reduced the odds of food insecurity. Additionally, among children
living in food-insecure households, children who were on WIC longer had
lower odds of hunger at the final clinic visit.\110\
WIC, which involves participants in intensive nutrition education
and encourages linkages to health care services, exerts a positive
influence on health beyond reducing hunger. According to an analysis of
data from the Early Childhood Longitudinal Study of 10,700 children
born in 2001, WIC decreased the rate of low birth weight by at least
20%.\111\ Low birth weight is associated with increased risk of
impaired immune function, chronic disease, developmental delays, and
high perinatal and lifelong health and educational costs. Another study
of 26,950 WIC-eligible women and children from 2000 to 2010 found that
receiving WIC diminished the effects of multiple stressors, including
food insecurity and the depression often accompanying it.\112\
SNAP: The Supplemental Nutrition Assistance Program
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The Supplemental Nutrition Assistance Program (SNAP, formerly known
as Food Stamps) is the nation's largest program meant to address hunger
by improving access to food for low-income individuals and households
through additional income for groceries. According to program
operations data from the USDA Food and Nutrition Service, SNAP provided
assistance to 46.5 million people in an average month in Fiscal Year
2014, slightly fewer than the 47.6 million people served in an average
month in Fiscal Year 2013. Thomas Ptacek, a military veteran who had
experienced homelessness, spoke at the public hearing in Portland,
Maine. He said, ``It was not a quick and easy road back for me, and the
SNAP program was a big part of my success in returning to a more
fulfilling life. To me, the most beneficial aspect of the SNAP program
is that it allows for choice in the purchase of food that can be
prepared in the home . . . This extra piece, that I personally
benefited from greatly, is the sense of normalcy and stability that
comes from going to the grocery store and choosing your food.'' \101\
SNAP participation has decreased the percentage of households
experiencing hunger by 12-19%.\102\ In addition, people who participate
in SNAP for 2 years are 20-50% less likely to report hunger than those
who leave the program before 2 years.\103\
SNAP provides benefits that go beyond money for food. Compared to
low-income, non-SNAP households, mothers receiving SNAP are less likely
to experience maternal depression, although they are still more likely
to experience maternal depression than mothers in food-secure
households.\104\ In households participating in SNAP, children are 16%
less likely to be at risk of developmental delays and have lower rates
of failure to thrive and hospitalization compared to children in
similar households not participating in SNAP.\104\
The larger issues of economic growth, job creation, wages, and
family choices are the underpinnings of addressing the root causes of
hunger. SNAP is, by design, one of the most responsive programs to
economic downturns, diminished labor force participation, and recession
economies, doing exactly what it should do to mitigate hunger-
eligibility for participation increasing when incomes are decreasing.
In spite of SNAP's success, hunger remains a stubborn problem. SNAP
administrative data show that from 2000 to 2014, the number of SNAP
participants has increased 171%.105-106 However, hunger
rates, relatively steady between 3% and 4% until 2007, also increased
dramatically in 2008 (from 4.1% to 5.7%) and remained high in 2009 and
2010. But through 2014, both the increased participation levels and the
increased hunger rates have yet to decline significantly, even 6 years
into the recovery.
SNAP and National School Lunch Program (NSLP) Participation Compared to
Hunger Rates Over Time
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Our research has demonstrated the benefits of SNAP and WIC on
the health and developmental academic well-being of children.
We have come to think of these programs as prescriptions for
healthier children. We need research on the adequacy of SNAP
benefits in varying family contexts which relate to SNAP
benefit levels.
Patrick Casey, M.D., Harvey and Bernice Jones Professor of
Developmental Pediatrics, University of Arkansas for Medical Sciences
(Little Rock)
School Meals
The National School Lunch Program and School Breakfast Program
offered meals to more than 30 million students in Fiscal Year 2014. The
programs operate in more than 100,000 public and nonprofit private
schools and residential child care institutions. Because school
nutrition programs have such bipartisan support, many communities have
seen this as an excellent way to reduce hunger and improve the
nutritional status of our children.
Researchers found that children from food-insecure and marginally
food-secure households receive a larger proportion of their food and
nutrient intakes from school meals than do children from food-secure
households. This difference is partially explained by the higher
participation rates of the food-insecure and marginally food-secure in
school meal programs.\113\ While some studies have examined the
relationship between school meal programs and food security, they
cannot assess what the food security status of school meals
participants would have been in the absence of the program. However,
national nutrition survey data suggest that school meals are an
important source of healthy foods: all school lunch participants,
especially low-income participants, generally consume more healthful
food at lunch than non-participants.\114\
In similar fashion to SNAP and WIC, school nutrition programs have
an impact that goes beyond decreasing household hunger. Some studies
have examined the correlation between participation in the School
Breakfast Program and academic performance. Low-income school breakfast
participants are reported to have lower tardiness and absence rates and
a larger increase in test scores than low-income children who did not
participate.\115\ Similarly, studies have linked higher rates of school
breakfast participation with improved grades in math.116-117
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A school garden in Little Rock.
Despite the value of school breakfast, there remains a wide gap
between the number of children who receive school lunch and the number
who receive breakfast. In 2014, nearly 22 million school children
received a free or reduced price school lunch, but despite the same
eligibility, only about \1/2\ those children participated in school
breakfast.\118\ Implementing ``breakfast after the bell'' strategies
such as ``breakfast in the classroom'' or ``grab-and-go'' meals
(instead of serving breakfast in the cafeteria) is a promising approach
to improving child nutrition and academic achievement.
Under the National School Lunch and School Breakfast Programs, the
Community Eligibility Provision allows schools and local educational
agencies in communities with high poverty rates to provide breakfast
and lunch to all students without certification requirements, thus
decreasing the school's administrative costs and reducing stress and
stigma for parents who would normally have to apply on an individual
basis. The Community Eligibility Provision eliminates the burden of
collecting household applications to determine eligibility for school
meals, relying instead on information from other means-tested programs
such as SNAP and Temporary Assistance for Needy Families. Marian Wright
Edelman, President of the Children's Defense Fund, recommended in her
testimony to the Commission that use of the Community Eligibility
Provision be promoted, since it predominantly serves low-income
children and increases access to the school meal program while reducing
labor costs to schools.119
More than 14,000 high-poverty schools in 2,200 school districts
participated under the Community Eligibility Provision \120\ in the
first year of nationwide availability, and more than six million
children now attend schools participating in the program. In Illinois,
Kentucky, and Michigan, schools implementing the Community Eligibility
Provision in the 2011-2012 school year saw breakfast participation
increase from 44% in October 2010 to 56% in October 2012. Lunch
participation increased from 69% in October 2010 to 78% in October
2012.\121\ To our knowledge, no data are yet available linking the
implementation of the Community Eligibility Provision to food security.
Therefore, this is an important area for further research.
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Other Federal Nutrition Assistance Programs
The Federal Government operates a number of other smaller programs
targeted to specific populations to assist with reducing and preventing
food insecurity:
The Food Distribution Program on Indian Reservations provides
USDA foods to low-income households, including the elderly, living on
Indian reservations.\128\ For those living far from food stores, the
Food Distribution Program on Indian Reservations is seen as more
accessible than SNAP, although traditional food offerings are limited
and overall food choices are restricted. Those living near
supermarkets tend to choose SNAP for a better variety of foods.
The Emergency Food Assistance Program provides USDA foods to
emergency food providers and food banks to supplement the diets of
low-income Americans, including the elderly.\124\
The Commodity Supplemental Food Program provides seniors with
a food package containing good sources of nutrients.
The Fresh Fruit and Vegetable Program provides students with
no-cost fresh fruits and vegetables in school.
The Special Milk Program provides participants with no-cost
milk through their school, childcare center, or camp.
The WIC Farmers' Market Nutrition Program and Senior Farmers'
Market Nutrition Program provide coupons participants can use at
farmers' markets for fruits, vegetables, honey, and fresh herbs.
To our knowledge no recent research examines the effects of these
programs on hunger.
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Summer and Afterschool Food Programs
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A child receiving lunch in the summer at Acoma Pueblo
Community Center in New Mexico.
Millions of students participate in school lunch and breakfast
programs, but during the summer, many children face a period without
substantial healthy meals. In 2012, about 4% of households
participating in the National School Lunch Program reported ``sometimes
or often not having enough to eat'' from January to May, but this
figure increased to over 5% in June and July.\122\
In an effort to address this issue, the Summer Food Service Program
enables low-income children to receive meals when school is not in
session by going to a central location and eating in a supervised
setting. The program is delivered through public-private partnerships
with summer camps, summer school, parks and recreation programs,
churches, and other community organizations. Unfortunately, and for a
variety of reasons, participation is relatively low. In 2014,
approximately 14% of eligible children received meals in the
summer.\123\ More than 2.6 million children participated at almost
45,200 sites in the summer of 2014.\124\ While visiting Washington,
D.C., we observed the operation of the Summer Food Service Program at
Anacostia Public Library. Washington, D.C.'s summer food programs have
served over one million meals to children and youth in the District of
Columbia in the past three summers, and serve approximately 60% of the
D.C. children who are eligible.\125\ On a field visit in Texas, the
Anthony Independent School District reported that they increased summer
meal participation by almost 60,000 meals. This program helps to employ
over 70 high school students who get involved in distributing meals at
the baseball and t-ball fields, with a welcoming community atmosphere.
The Child and Adult Care Food Program is another program that
serves nutritious meals and snacks to eligible children and adults at
participating child care centers, day care homes, and adult day care
centers. The program also provides meals and snacks to children and
youth participating in after school programs or living in emergency
shelters. On an average day, 3.8 million children receive nutritious
meals and snacks through the Child and Adult Care Food Program in an
effort to reduce hunger.\126\ The program also provides meals and
snacks to 120,000 adults who receive care in nonresidential adult day
care centers.126-127 However, more empirical research
remains to be done to assess links between the Child and Adult Care
Food Program and reductions in hunger.
Community Programs
Across our country, individuals, nonprofit organizations, faith-
based organizations, and corporations are engaged in helping to
alleviate hunger in their communities. In 2013, 62.6 million people in
the United States contributed 7.7 billion volunteer hours, time
estimated to be worth $173 billion. Providing food to others was among
the most frequently reported activities, with 24% of volunteers saying
that they ``collected, distributed, prepared, or served food'' during
the year.\129\
We heard from many volunteers at our hearings, and they were very
proud of their organizations' accomplishments in providing food to low-
income people. While almost all experts point out that volunteers alone
cannot meet the overall needs of families, and that their efforts
cannot replace the effectiveness of Federal nutrition assistance
programs, volunteers can play an important role in supplementing and
leveraging those programs.
Through innovative school nutrition and summer feeding programming,
job training efforts, social services provision, community gardening,
farm-to-table programs, soup kitchens, food pantries, and advocacy
efforts, volunteers significantly contribute to the work of hunger
relief organizations across the country. We provide some examples
below.
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In Maine, Preble Street involves 5,000 volunteers in serving
500,000 meals yearly across eight local soup kitchens.\130\
The D.C. Central Kitchen relies on 14,000 volunteers each
year to help prepare meals, which are provided under government
contracts to D.C. public schools that don't have the equipment and
staff to do their own healthy ``scratch cooking,'' and to 80 partner
agencies, such as homeless shelters.
Feeding America, the largest umbrella organization for food
banks and food rescue organizations, has 200 members supporting
61,000 agencies that, as of 2010, distributed food to 37 million
Americans, including 14 million children.\131\ Feeding America
organizations benefit from 8 million hours of service per month from
two million volunteers; more than \1/2\ of these volunteers manage
entire agencies without full-time staff.\132\
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Public-Private Partnerships
People and businesses in America are generous and motivated to help
solve problems in their communities, and local organizations offer
opportunities for cross-sector collaboration to maximize the
effectiveness of publicly funded nutrition assistance programs. Public-
private partnerships create valuable relationships that draw on the
strengths of each organization to meet community
needs.133-134 Partnerships between public and private
entities have the potential to address hunger in ways that go beyond
the limitations of government entities, by taking advantage of the
ingenuity and creativity of private enterprise. For example, both the
public and private sectors bring knowledge about food production and
insights about pressing social issues.\133\
Public-private partnerships use a variety of strategies to reduce
hunger, and can be classified into five categories.135-136
SNAP partnerships offer outreach to increase SNAP
participation and train volunteers to help individuals apply
for SNAP and offer nutrition education. For example, the
Arkansas Hunger Relief Alliance brings together 47 food banks
and pantries and has increased access to SNAP applications
throughout the state. SNAP partnerships also involve efforts to
assist eligible participants in completing SNAP applications.
Another example is Making Dinner a SNAP, a collaborative effort
developed between the private nonprofit Ohio District 5 Area
Agency on Aging Inc., five grocery stores, the Department of
Job and Family Services in Richland County, and local nursing
homes. The program aims to increase senior SNAP participation
and teach seniors about cost-effective, nutritious recipes.
Child nutrition partnerships focus on increasing school meal
and summer meal participation and promoting farm-to-table
initiatives. For example, ConAgra Foods has funded grants to
Feeding America programs such as Kids Cafe, which provides free
meals or snacks in after school settings, and Child Hunger
Corps, which trains people in food banks nationwide to
implement outside-of-school meal programs for children. Public-
private partnerships also work together to implement child
nutrition assistance initiatives. For example, the Academy of
Nutrition and Dietetics and ConAgra work together to facilitate
community education delivered by registered dietitian
nutritionist educators. In addition, more than 80 private
partners and state agencies recruit meal sites and facilitate
the distribution of meals for summer breakfasts, lunches, and
food backpacks on the weekends.
Food distribution partnerships include food hubs that
coordinate the sale and transport of produce from farm to local
markets, stores, and emergency food providers. For example, in
Indianapolis, we visited a partnership between Elanco (a
division of Eli Lilly and Company), Kroger Country, Rose Acres
Farms, and two Indiana food banks to make eggs more accessible
to undernourished people of all ages.\137\ The Indianapolis
partnership also meets regularly to discuss and collaborate on
research projects and a variety of other anti-hunger efforts.
Healthy food access partnerships work to improve
availability of healthy foods. For example, the Boston Bounty
Bucks program promotes the purchase of fruits and vegetables.
The program, begun in 2008 as a partnership between The Food
Project nonprofit and the City of Boston, provides electronic
benefit transfer terminals at farmers' markets so SNAP
recipients can use benefits to buy produce. The program
promotes purchase of healthful food by providing a dollar-for-
dollar matching incentive for SNAP purchases up to $10. By the
2013-2014 season, $166,540 SNAP and Bounty Bucks dollars were
spent through the program at 20 farmers' markets in the Boston
area.\138\ The New York City Health Department and Human
Resources Administration works with Greenmarket Co. to
distribute $2 Health Buck coupons for every $5 that electronic
benefit transfer customers spend on fresh fruits and vegetables
at the farmer's market. Fifty-one Greenmarkets distributed over
$260,000 in Health Bucks in 2013.\139\ In addition, the Academy
of Nutrition and Dietetics, using funding from Feeding America,
General Mills, the ConAgra foundation, and the National Dairy
Council, provides community training tools and educational
grants for registered dietitian nutritionists to teach low-
income people how to cook for their families. In another
example, Share Our Strength's Cooking Matters Program works
with local organizations to educate and empower low-income
families to stretch their food budgets so their children get
healthy meals at home. Cooking Matters, which leverages SNAP
Nutrition Education funding in local markets, helps
participants learn to shop strategically, use nutrition
information to make healthy food choices, and cook affordable
meals.
Research and education partnerships create collaborations
among government agencies, businesses, nonprofits, and
community organizers to raise awareness and engage other
stakeholders in their efforts. For example, the USDA Hunger-
Free Communities Grants Awards program provided money to local
governments and nonprofits to help assess and reduce hunger. In
another example, Tyson Foods launched the KNOW Hunger
Initiative with the Food Research and Action Center to assess
people's views on hunger in the United States and raise
awareness of hunger among stakeholders to encourage people to
get involved in anti-hunger campaigns.140-141
Public-private partnerships can help address hunger and many
related issues (e.g., insufficient low-cost housing, lack of
employment, inadequate child care opportunities) that contribute to
food insecurity in communities where Federal assistance programs cannot
fulfill immediate needs. Open communication and clear guidelines may
help to increase the effectiveness of partnerships.\133\ Existing
partnerships may serve as examples for future initiatives and can
provide peer advice to other nonprofits, faith-based organizations, and
corporations that wish to similarly commit resources and staff to such
partnerships.
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``tQue Sabrosa Vida! (What a Delicious Life!)'' by Mauricio
Mora.
This painting hangs in the main lobby of El Centro de Salud
Familiar (Family Health Center) La Fe's Child and Adolescent
Wellness Center in South El Paso. It is meant to capture the
beauty of traditional and healthy Mexican-American foods.
Recommendations
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Defining Hunger:
Very Low Food Security
As noted in the box in the Introduction, when we use the word
``hunger'' we mean households experiencing very low food security.
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The latest USDA statistics, published in September 2015, show
levels of hunger that are still elevated from the pre-recession period.
This illustrates clearly that existing food assistance programs are not
solving the problem--nor are they likely to do so without progress on
the root causes of hunger. The Commission believes that we must
continue to improve existing food assistance programs to alleviate
hunger as effectively as possible, while also working to address the
root causes. Accordingly, we offer the following recommendations for
system changes, both statutory and administrative, across both the
public and private arenas, to reduce hunger. However, we want to
emphasize that although existing programs have not completely
eliminated hunger, the research and information we reviewed and the
testimony we heard support the conclusion that rates of hunger would be
higher without them. Thus, they provide both opportunities for
improvement and a strong foundation on which to build.
Mindful of our charge to ``provide recommendations to more
effectively use existing [USDA] programs and funds,'' our
recommendations will not require significant new resources, but may
lead to some future spending if further analysis or evaluations reveal
opportunities for improvement.
We urge Congress to act on these recommendations as soon as
possible, without waiting for bills (such as the farm bill) that are on
a particular timeline. The child nutrition program improvements can be
made through the upcoming Child Nutrition Act reauthorization process.
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We make recommendations in six areas to comprise a total of 20
specific recommendations to Congress and the USDA.
I. Make improvements to SNAP (10 recommendations in three categories:
work, nutrition, and well-being)
II. Make improvements to child nutrition programs (4 recommendations)
III. Improve nutrition assistance options for people who are disabled
or medically at risk (2 recommendations)
IV. Fund pilot programs to test the effectiveness of strategic
interventions to reduce and eliminate hunger (1 recommendation; 4
pilots)
V. Incentivize and expand corporate, nonprofit, and public
partnerships to address hunger in civil society (1 recommendation)
VI. Create a White House Leadership Council to End Hunger that
includes participation by a broad group of government and non-
government stakeholders (2 recommendations).
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With a little help, every non-disabled working-age adult has
the capacity to pull themselves out of poverty and experience
the life-changing, transcendent dignity that comes from gainful
employment.
Mary Mayhew, Commissioner, Maine Department of Health and Human
Services (Portland)
I Make Improvements to SNAP that Promote Work, Improve Nutrition, and
Enhance well-being
We identified ten areas for improvement in SNAP, which we have
placed in three categories: work, nutrition, and well-being.
Ensure that SNAP Promotes and Supports Work
While the primary goal of SNAP is to treat and prevent hunger, it
can also serve as a way to help support families as they enter or re-
enter the job market. The majority of people who receive SNAP benefits
are not expected to work: they are the elderly, children, or people who
are disabled. Another group of recipients includes adults who report
earnings when they apply for assistance. In these cases, SNAP is acting
to support work.
But a substantial number of working age, non-disabled adults who
receive SNAP benefits report no earnings on their case budgets, and
state SNAP administrators provide little help to these adult
participants in their search for employment. This needs to change.
1 Encourage a greater focus on job placement, job training, and
career development among SNAP recipients, and ensure
necessary supports and infrastructure to facilitate finding
work.
Rationale: Having sufficient earnings is the best defense
against hunger and reduces the need for nutrition assistance.
If SNAP, as the number one nutrition assistance program, did
more to help families move beyond the need for nutrition
assistance, not only would it be an investment in improving the
success, health, and productivity of low-income participants,
but also, in the long run, it would reduce government spending.
Action Items:
a. Congress and the USDA should require states to provide more
opportuni-
ties for adults participating in SNAP to attain the
skills they need and
find jobs with wages sufficient to enable them to leave
SNAP. All non-work-
ing, non-public assistance (Temporary Assistance for
Needy Families or
state cash assistance programs), non-disabled, non-
pregnant heads of
households (with or without young children) applying for
or participating
in SNAP should be strongly encouraged and supported in
their efforts to
seek employment or participate in work-related activities
realistically
designed to lead to available employment. SNAP
eligibility case workers
should, at all stages of the program (initial
application, during household
participation, and re-certification), assist all
employable heads of household
to secure employment by promoting the importance of
earnings both so-
cially and economically. For adult, non-senior recipients
who are not report-
ing earnings, not disabled, and not on Temporary
Assistance for Needy
Families, states must provide more case management and
employment
services at initial application and re-certification.
Further, they should offer
participants the ability to participate in existing SNAP
employment and
training programs or connect employable adults on SNAP to
other existing
job readiness, job development, and job placement
providers in the commu-
nity that offer case management, supervised job search,
resume prepara-
tion, transportation assistance, soft skill training, and
short-term career
training related to available jobs in the local
community. For households
with children, families should be connected to
subsidized, safe, accessible,
and affordable child care. Such requirements on states to
promote work
and connect employable adults to appropriate services
should be defined by
USDA's Food and Nutrition Service in regulations and
implemented by the
states.
b. Congress should ensure that the USDA collaborates with the
Department
of Labor, the Department of Health and Human Services,
and other rel-
evant agencies at the state and local level to facilitate
the administration
of programs that can support families applying for or
participating in SNAP
as they look for work and enter the workforce. Employers
and community
colleges should be integrally involved in designing
career-directed training
and skill development relevant to existing labor-market
job opportunities.
Specific services to ensure that families can find
employment are outlined
in (a) above.
c. Congress should direct USDA to monitor and report annually, on
a state-
by-state basis, the share of working age, able-bodied
adult SNAP recipients
who do not report earnings and who are not receiving
Temporary Assist-
ance for Needy Families. This may include adding new
tables to the ``Char-
acteristics of Supplemental Nutrition Assistance Program
Households'' re-
port or beginning a stand-alone, annual report on the
labor force participa-
tion and employment levels of SNAP recipients. In
documenting these labor
and SNAP participation dynamics, the USDA would provide
reliable
metrics to evaluate their performance in helping
employable recipients suc-
cessfully connect to the labor market.
d. The USDA should allow states greater flexibility within their
current
SNAP Employment and Training funding to test innovative
approaches
that encourage work. Currently, the USDA has rigid and
complex rules gov-
erning how SNAP Employment and Training funds can be
utilized, which
potentially stifle the creative and effective provision
of employment serv-
ices. For example, while other work support programs and
SNAP Employ-
ment and Training can be integrated to leverage funds
across programs,
more should be done to help states to utilize Employment
and Training
funds for programs such as subsidized employment,
substance abuse and
mental health treatment, and legal aid services that help
recent prisoners
reenter the workforce. While ten new SNAP Employment and
Training pi-
lots have been funded and will be evaluated for broader
replication, await-
ing their results should not be a reason to wait on
efforts to improve the
use of SNAP Employment and Training.
2 Ensure SNAP eligibility incentivizes work by improving
responsiveness to earned-income fluctuations.
Rationale: SNAP has a logical phase-down of benefits as
income increases. Still, there is evidence that when people
abruptly lose all SNAP benefits at the top end of income
eligibility, they may have less time to adapt to new income
realities and may report that they experience
hunger.46, 142, 143 Faced with this possibility,
some SNAP recipients may not seek out work or seize an
opportunity to increase their earnings.
Action Items:
a. Congress should allow states to offer all households leaving
SNAP for em-
ployment that pays sufficiently to end their program
eligibility an appro-
priate extension of their SNAP benefits at the pre-
existing level to help
them navigate pay lags and adjust household food
budgeting. The period of
extended benefits shall be determined by states. In
implementing these ad-
aptations, states should measure their effectiveness
through outcomes such
as household reports of hunger, amount of administrative
savings and cost
of benefits, and amount of churn (reapplications for
benefits within 3
months).
b. The USDA should encourage states to improve their
administration of
SNAP by mandating a more streamlined and effective
approach to re-cer-
tification for recipients who are working.
Ensure that SNAP Promotes Improved Nutrition
3 Encourage the use of financial incentives to SNAP recipients to
facilitate the purchase of fruits, vegetables, high-quality
proteins, whole grains, and other healthy foods.
Rationale: SNAP is not only an opportunity to help families
meet the costs of providing food for themselves and their
families, but can also play a crucial role in promoting healthy
choices and good nutrition.
Action Items:
a. Congress should encourage the USDA to continue to develop
mechanisms
for incentivizing purchases of healthier foods and to
promote cost-sharing
opportunities with states, nonprofits, and municipal
governments to
incentivize purchases of healthy foods.
b. The USDA should ensure mechanisms that provide broad,
understandable,
and culturally appropriate communication regarding these
healthy incen-
tives.
4 Exclude a carefully defined class of sugar-sweetened beverages
from the list of allowable purchases with SNAP benefits.
Rationale: SNAP benefits should help families meet their
nutritional needs, not contribute to negative health outcomes
through poor nutrition choices. Recent scientific evidence
suggests that the consumption of sugar-sweetened beverages,
which are unhealthy, can have profound and serious negative
effects on health, such as obesity and diabetes, especially
among children.144-148 Reducing the consumption of
sugar-sweetened beverages also follows the guidelines of
leading health agencies such as the World Health Organization,
the National Institutes of Health, the Centers for Disease
Control and Prevention, the Institute of Medicine, and the
Surgeon General of the United States. The technology to exclude
certain items already exists at the participating retail store
level. In light of the research and the recommendations of
numerous health agencies, sugar-sweetened beverages should be
added to the list of items excluded from the allowable purchase
with SNAP.
Action Items:
a. Congress should enact legislation to restrict the purchase of a
carefully de-
fined list of sugar-sweetened beverages developed in
consultation with
major health and nutrition organizations (e.g., the
organizations mentioned
above), nutritionists, and scientific experts.
b. The USDA should ensure mechanisms that provide broad,
understandable,
and culturally appropriate communication regarding this
new restriction.
5 Use evidence-based product placement strategies that encourage
purchase of healthy products with SNAP benefits, and tie it
to SNAP eligibility for stores.
Rationale: Participating SNAP retail stores receive
significant revenue from SNAP and should therefore promote the
purchase of healthy products. If the amount of shelf space
allocated to healthy foods is increased, and shelf space for
sugar-sweetened beverages and other unhealthy products is
reduced, consumers are more likely to purchase healthier foods.
Action Item:
The USDA should create new standards for SNAP vendor
eligibility to ensure that participating stores,
including not just grocery stores, but other outlets,
comply with improved health and nutrition standards.
For example, the USDA should require retail stores that
currently accept SNAP or apply to become a
participating retailer to provide enhanced and
immediately visible shelf space for healthy foods and
beverages.
6 Reform SNAP Nutrition Education (SNAP-Ed) to ensure that efforts
are likely to lead to measurable improvements in the health
of SNAP recipients.
Rationale: While there are other nutrition education programs
in the USDA system, SNAP Ed, which operates in all 50 states,
is the most comprehensive. The USDA spent about $400 million on
SNAP-Ed in Fiscal Year 2014.\149\ While there are many
evaluations of individual SNAP-Ed programs that demonstrate
their impact on nutrition, there is an opportunity to
standardize the data collection and evaluation across programs
to assess the effectiveness of SNAP-Ed on improving health and
hunger outcomes.
Action Item:
The USDA should continue to collaborate with the
Centers for Disease Control and Prevention and the
Department of Health and Human Services and other
agencies and experts to ensure that funds designated
for SNAP-Ed are supporting state-of-the-art nutrition
education that is effective, relevant, and meaningful
to SNAP participants. USDA can use multiple tools, such
as the Academy of Nutrition and Dietetics Guide for
Effective Nutrition Interventions and Education
(GENIE), to define best practices within SNAP-Ed,
develop or modify programs, and evaluate outcomes.\150\
We note that, currently, SNAP-Ed outcomes data tend to
focus on inclusion of fruits and vegetables in the
diets of recipients. Future studies, however, should
broaden that focus to include whole grains, low-fat
dairy products, and high-quality proteins (including
lean meat, fish, and eggs), in addition to fruits and
vegetables.
Maximize SNAP's Ability To Promote Well-Being
Overall, SNAP participation can improve health and well-being and
help steer participants to make healthy choices. SNAP is often only one
of the multiple services that a family or individual needs. For
instance, given the evidence that food insecurity is related to
increased risk of depression and poor mental health, or to unsafe
housing conditions, or to employment barriers, SNAP application and
administration provides an opportunity to assist families on a number
of fronts. Building on this, the Commission recommends the following:
7 Continue to promote and facilitate greater coordination of means-
tested programs across Federal and state agencies and
provide state incentives for establishing a ``no wrong
door'' approach between SNAP and non-nutrition family
support programs.
Rationale: Families that are eligible for SNAP are often
eligible for other programs, such as Medicaid and housing
assistance. Efforts are underway to find ways to serve families
more holistically. However, these programs still have their own
application mechanisms, facilities for application, and
distinct funding streams at the Federal level, which are
attached to differing rules and regulations for eligibility and
administration. This can create greater hardship for eligible
families and increase the administrative burden and costs for
states. In the case of Social Security/disability benefits,
such rules and regulations can sometimes act at cross-purposes.
Action Items:
a. Congress should intensify existing efforts to encourage
collaboration across
agencies to facilitate the coordination of programs and
to serve families
more holistically in terms of SNAP, housing, medical
care, education, child
care, and job training supports. Additionally, states
should be encouraged
to use the option for enhanced Federal systems match
funding to coordinate
Medicaid, SNAP, veteran's benefits, and Temporary
Assistance for Needy
Families more widely.
b. Congress should increase their efforts to identify additional
ways to link
funding streams between different agencies to ensure
greater collaboration
between SNAP and other means-tested programs to ensure
efficient and ef-
fective delivery of services, increased earnings, and
reduced hunger.
c. The USDA should find ways to ensure states are working to
collaborate
across agencies and should incentivize SNAP programming
that collabo-
rates with other state and Federal agencies.
8 The USDA should use its current flexibility to the greatest extent
possible to support state innovations that would help
clients to become more food-secure and more self-
sufficient, and should approve or disapprove these requests
within 90 days of submission.
Rationale: States have long been a valuable arena for trying
new ideas and evaluating them to see if they could work on the
national scale. In addition, not all states have the same
problems or conditions, labor markets, or caseload composition.
Therefore, it is important for the USDA to be receptive to
state innovation and experimentation, both by encouraging
demonstration projects and by reviewing proposed projects in a
timely manner. The USDA should create a process and offer staff
support to encourage such innovation, and maximize the
demonstration and waiver authority of the programs within its
purview, while adhering to the SNAP goal of treating and
preventing hunger, maintaining client protections, and keeping
program integrity safeguards intact.
Action Item:
Congress should require that the USDA allow greater
flexibility for states to apply for SNAP waivers and
demonstrations, and ensure that the USDA approves or
disapproves such requests within 90 days of submission,
including a thorough explanation of the final decision.
A common sense approach is needed [that would enable] states
to ensure welfare benefits are being used appropriately.
Being closer to recipients, state governments can more
effectively determine which program changes best fit their
populations. . . . [S]tates have made significant strides in
some areas to tackle fraud, waste and abuse in the system.
Jason Turner, Executive Director, [State Human Services] Secretaries'
Innovation Group (Maine)
9 Create mechanisms for improved training for front-line SNAP
caseworkers to maintain a customer service perspective that
facilitates best practices of case management.
Rationale: Although accessibility to participation in SNAP
has improved, the relationship between front-line caseworkers
and applicants could be more positive and effective. Front-line
caseworkers are often a client's first encounter with a system
meant to help them; therefore, they have the best opportunity
to provide effective and appropriate assistance.
Action Item:
The USDA should require states to provide
comprehensive training and modern infrastructure
support for front-line caseworkers that ensures strong
knowledge of SNAP eligibility; an emphasis on the
importance of positive client service that explores
potential other problems (such as violence exposure or
homelessness) faced by the applicant; cultural
competency; and the ability to thoughtfully convey the
benefits of full-time work and related work supports.
Periodic retraining is also recommended, as program
rules change often. Accountability mechanisms to
demonstrate high performance on client service and case
management standards should be built into caseworker
performance reviews. The USDA should also measure the
performance of states relative to customer service, in
addition to the current focus on error rates and
timeliness. Unless such new measurements and expanded
training are added, client service will likely not
improve. In many places, office hours extending beyond
9-5 and offsite access points for working families are
already available and should be encouraged.
I urge the Commission to focus on the horizontal integration
of these important programs, and not only linking these
resources, but [also] making the individual programs easy to
navigate. Because it is a social safety net, not a ropes
course.
Sarah Palmer, Policy Associate, California Association of Food Banks;
former CALFresh (SNAP) Recipient (Oakland)
10 Support the well-being of families that have members who serve or
have served in the U.S. Military.
Rationale: Families with an active duty service member should
have as much support as possible to stay healthy, well-
nourished, and financially stable while their family member
serves to protect our country. Likewise, veterans who have
served our country should not have to struggle to put food on
the table for themselves and their families.
There is a particular policy issue that restricts some SNAP-
eligible active duty military families from qualifying for SNAP
benefits. For families living off base or in privatized on-base
housing, the Basic Allowance for Housing is counted as income
in the determination of eligibility for SNAP and may prevent or
reduce eligibility for SNAP. However, the Basic Allowance for
Housing is currently excluded as income for calculating income
taxes and eligibility for other government programs, including
WIC. The Basic Allowance for Housing is also counted as income
in determining eligibility for the Family Subsistence
Supplemental Allowance, a program administered by the
Department of Defense that operates somewhat in parallel to
SNAP and was created to move military families off of SNAP.
Finally, data on food security and SNAP participation among
members of the military on active duty, veterans, and their
families are not readily available.
Action Items:
a. Congress should enact legislation to exclude the Basic
Allowance for Hous-
ing as income for the determination of SNAP eligibility
and benefit levels
for families who have an active duty service member.
b. Congress should direct the Department of Defense to undertake a
com-
prehensive review of the Family Subsistence Supplemental
Allowance pro-
gram and recommend reforms that are directed at improving
food security
in active duty military families.
c. In keeping with our country's priority of national security,
the USDA
should work jointly with the Department of Defense and
the Depart-
ment of Veterans Affairs to help with collecting data on
food security, its
causes and consequences, and SNAP participation among
active duty mili-
tary and veterans, and make this data available to
Congress, the President,
and to the public at regularly specified intervals.
II Make Targeted Improvements to Child Nutrition Programs
Nutrition programs that are especially targeted to children provide
much needed nutrition assistance in key periods of a child's
developmental growth, promoting their health and well-being and having
an impact on their ability to learn, grow, and develop to their full
potential. The WIC and school meal programs are widely available, show
significant effectiveness, and should be sustained and enhanced.
However, other programs, which seek to reach children outside of the
normal school hours and academic schedule, can be improved. Below we
make four specific recommendations.
11 Improve access to summer feeding programs and congregate meals by
reconsidering requirements for rural areas.
Rationale: Children living in rural areas may have limited
access to summer nutrition programs due to remote living
conditions and lack of transportation.
Action Item:
Congress should change the congregate feeding
requirements based on a community's stated need and
local context to allow them to substitute or supplement
with different, more accessible approaches. This
includes areas of high need in rural areas where
congregate feeding can be a barrier to feeding as many
children as possible.
12 Change area eligibility for reimbursement of summer feeding from
50% of children eligible for free or reduced price school
meals to 40% to help reach children in rural and suburban
areas.
Rationale: The summer feeding program uses an area
eligibility test to determine whether to provide reimbursements
for snacks and meals. This test defines a ``low-income area''
as one where more than 50% of children are eligible for free or
reduced-price school meals. It is particularly hard for rural
and suburban areas to meet this 50% requirement, because
poverty is less concentrated in these areas. That keeps many
communities with significant numbers of low-income children,
but not a high enough concentration of poverty, from
participating. In addition, the 50% test is inconsistent with
federally funded summer programs, such as the 21st Century
Community Learning Center programs and Title I Education
funding, which require only 40% school meal participation.
Action Item:
Congress should change the area eligibility criteria
for participation in summer feeding programs from 50%
to 40% of children participating in free or reduced
priced school meals.
13 Make the summer electronic benefit transfer option available by
creating a mechanism that allows communities to apply for
it if they can clearly demonstrate a barrier to congregate
feeding related to remoteness, climate, or safety.
Rationale: Despite a high prevalence of children at risk for
hunger in some communities, participation in summer feeding
programs can be very low. This may indicate that the need is
not as serious as thought in some areas, but in others, may
reflect chronic under-service due to transportation barriers
related to remote living conditions, severe weather patterns,
or parental concerns regarding community violence. These
barriers can occur in both rural and urban settings. USDA pilot
studies have shown that participation in an electronic benefit
transfer option can reduce hunger among families with children
by more than 30%.\151\ This is significant evidence of a
targeted child nutrition program improvement.
Action Items:
a. Congress should allow the USDA to offer summer electronic
benefit trans-
fer in communities that are especially at risk for hunger
among children
and where participation in summer feeding sites is
restricted or minimized
by remoteness, safety, or climate. The electronic benefit
transfer option
should be offered in areas (Census tracts or school
attendance zones) with-
out the consistent presence of summer meals sites in an
effort to minimize
the duplicate use of summer electronic benefit transfer
and congregate
sites.
b. The USDA should work with communities at risk to create an
administra-
tive mechanism through which funds can be provided
directly to families
with eligible at-risk children through an existing
electronic benefit transfer
mechanism.
At [our health center] we talk about Nuestro Bienestar, we
talk about our total wellness. We talk about the categorical,
dysfunctional system that we live in: where we talk about
health and nothing else; where we talk about education and
nothing else; where we talk about hunger and nothing else--as
if each one were to lead a separate life. We know that all of
them are intermingled. All of them are one.
Salvador Balcorta, CEO, El Centro de Salud Familiar de La Fe (El Paso)
14 Streamline and simplify administrative processes among the child
nutrition programs.
Rationale: Currently, the various child nutrition programs
have different application processes, even though the same
organizations and sponsors frequently administer these
programs. Having to complete separate applications and comply
with differing or conflicting regulations places undue
administrative burdens on the community-based programs that run
these programs. Currently, community-based organizations
operate the Child and Adult Care Food Program's At Risk after
school Meal Program and the Summer Food Service Program
separately, even though they are serving the same children,
often at the same sites, throughout the year. This approach not
only burdens community organizations, but also incurs
unnecessary USDA costs to review and respond to multiple
applications from the same providers under complex regulations.
Action Items:
a. Congress should allow the USDA to streamline and consolidate
the appli-
cation processes, funding mechanisms, and regulations for
the Summer
Food Service Program and the Child and Adult Care Food
Program's At-
Risk after school Meal Program into one program for
community-based
sponsors.
b. Congress should allow the USDA to permit school food
authorities, with a
single application, to provide and administer the School
Breakfast Program,
the National School Lunch Program, the Summer Food
Service Program,
and the Child and Adult Care Food Program's At Risk after
school Meal
Program under National School Lunch Program regulations.
It's very difficult on the SNAP and Medicaid side to have the
kind of effective streamlined eligibility access that leads to
that integrative perspective that we want to see, because they
are driven by different rules. That is something that is within
the hands of national policy makers to change--it's a
modernization. We know that if we can get services delivered
faster in earlier ways to families, and we're not caught by the
fact about whether someone qualifies for Medicaid or for SNAP
or vice versa, we're serving families better and ultimately
reducing taxpayer dollars because we're driving down the cost
of health.
Tracy Wareing Evans, Executive Director, American Public Human Services
Association
III Improve Nutrition Assistance Options for People Who Are Disabled
or Medically at Risk
People with disabilities or multiple, debilitating health
conditions are at increased risk for hunger and poor nutrition status.
Additionally, homebound seniors and others with disabilities with
limited ability in activities of daily living are also at nutritional
risk. Such problems can exacerbate illnesses, decrease functioning,
lower productivity, and increase health care costs. In our research, as
well as in our field visits and hearings, we heard from agency
administrators, people who are disabled and medically at risk, and
physicians about ways to improve programming for medically vulnerable
people. Below we make two recommendations that will improve conditions
for people who are frail or disabled.
15 Expand Medicare managed care plans to include coverage for meal
delivery for seniors with physician recommendation.
Rationale: Meals on Wheels programs meant to serve home-bound
elderly people have been found to be highly effective in
improving seniors' nutritional intake and reducing health care
costs.154 Access to this type of programming for under-served
seniors would be important, especially as the baby-boomers are
approaching their senior years, drastically increasing the
numbers who will need assistance and who will be looking to be
productive citizens in their own communities. This approach is
appropriately the responsibility of the health care financing
systems, because increased home-delivered meals could be an
important cost-effective approach to reduce costly hospital
admissions and readmissions. Currently, Medicare Advantage
plans under Medicare Part C that cover home-delivered meals in
certain circumstances are available in some areas. However,
since these areas can be small, the reach of existing plans is
difficult to determine.
Action Item:
Congress should work with the USDA and the Department
of Health and Human Services to leverage existing
efforts under Medicare Part C to create a national
mechanism to provide home-delivered meals to seniors as
a reimbursable cost through Medicare.
16 Expand Medicaid managed care plans to include coverage, with a
physician recommendation, for meal delivery for individuals
who are too young for Medicare, but who are at serious
medical risk or have a disability.
Rationale: Home-delivered meals for medically at-risk
patients can promote health and prevent readmission to the
hospital; as noted earlier, 20% to 50% of patients admitted to
the hospital are malnourished, and readmissions among this
group cost the health care system approximately $25 billion
annually. Programs such as Meals on Wheels, as well as greater
attention to early nutrition assessment and intervention, are
critical to preventing complications and lowering costs.
Additionally, some people who are too young to receive Medicare
have multiple debilitating health problems that affect their
functioning and activities of daily living. Such patients
should be afforded the same assistance as people over 65.
Currently, some states offer home-delivered meals via a
Medicaid Section 1915(c) Home and Community Based Services
waiver or a Section 1115 demonstration waiver. However, these
waivers cover a broader range of services than home meal
delivery, so reach is difficult to determine.
Action Item:
Congress should work with the USDA and the Department
of Health and Human Services to leverage existing
efforts under Medicaid waivers to create a national
mechanism through which to provide home-delivered meals
to people at risk and find a way for this to be a
reimbursable cost through Medicaid.
IV Fund Pilot Programs To Test the Effectiveness of Strategic
Interventions To Reduce and Eliminate Hunger
As with any endeavor, research and development is required to
consistently find ways to improve government programs and systematic
efforts designed to reduce and eliminate hunger. There are many valid
and empirically based ideas that suggest that USDA should make a strong
commitment to testing particular interventions. We recommend funding
the following demonstration projects. An evaluation component should be
part of each pilot, based on multi-year, rigorous, random assignment
protocols that include statistically valid sample sizes and a cost-
benefit analysis that pays special attention to documenting potential
savings in health and education spending. This list of projects is not
meant to be exhaustive; many additional approaches are worthy of
adequately funded research, but are beyond the time constraints of the
Commission to elucidate fully.
17 Congress should allot funds to the USDA to implement, evaluate,
and disseminate results of multiple pilot programs to
assess their effectiveness on reducing hunger.
Pilot A: Investigate the effect on hunger of changing the
SNAP benefit calculation from the Thrifty Food Plan to the Low
Cost Food Plan.
Rationale: While families are meant to supplement
their SNAP allotment with 30% of their own net income
after deductions, the combination of the Thrifty Food
Plan and additional family dollars may not be adequate
to provide enough healthful nutrition for their
families. Health and nutrition experts, including the
Institute of Medicine, contend that the Low Cost Food
Plan shows promise in reaching the appropriate
nutrition levels for low-income families and
individuals. Testing this theory will shed important
new light on this issue.
Pilot B: Test the effect on working families of three
different increases to the earnings disregard compared to the
current 20% (control).
Rationale: Providing a higher income disregard may
reduce the danger of losing benefits before families
are ready to transition to self-sufficiency. A higher
income disregard may provide families time enough to
stabilize their economic situations, and may also
promote entry into the workforce and job retention by
eliminating a potential disincentive to increase
earnings or to engage in work.
Pilot C: Test the impact on hunger of increasing the maximum
excess shelter deduction/allowance in SNAP. Focus test
demonstrations on the five markets with the highest housing
costs.
Rationale: Research has linked the lack of affordable
housing with hunger.152-153 If the shelter
allowance was raised to more realistically account for
the cost of housing, this change could reduce hunger.
Pilot D: Further assess the effectiveness of public and
private forms of nutrition education on purchasing habits,
nutrient intake, health, and food insecurity, and conduct meta-
analyses to better understand and build on collective evidence
across these domains.
Rationale: Multiple federally funded studies have
been conducted on the effectiveness of Federal
nutrition education programs at improving purchasing
habits, health, and nutrient intake, but the evidence
is mixed. Additionally, there is limited research on
how both public and private nutrition education
programs impact hunger. While there is a foundation of
studies analyzing the scope of nutrition education
programs, their barriers, and characteristics of
successful programs with programmatic recommendations,
the USDA should invest additional funds to test,
rebuild, and re-analyze these programs using standard
methodologies across a variety of domains and
demographic sectors.
V Incentivize and Expand Corporate, Nonprofit, and Public Partnerships
to Address Hunger in Civil Society
Federal Government programs are not and cannot be the only answer
to hunger--civil society plays a vital role as well. Many stakeholders
are already deeply involved in addressing the issues faced by
households that report hunger. For instance, corporations, faith-based
and community organizations, agriculture programs, and government
entities at all levels (e.g., local health departments) have a role to
play in providing fresh and nutritious foods for all people in the
United States by, for example, keeping food costs low or providing
strategic guidance and resources.
Community efforts should engage corporations in joint community
impact efforts. Additionally, it has been a long-standing tradition in
the United States for nonprofits, institutions of higher education, and
faith-based organizations to find creative and meaningful ways to help
people rise out of poverty through outreach to potentially eligible
households regarding existing public benefit programs and the strategic
provision of food, resources, technical assistance, education and
training, and behavioral health supports. Many times, government
programs cannot reach all eligible people in need, and sometimes the
added efforts of our community organizations, private philanthropy, and
corporations can not only help reach the most vulnerable, but also
provide strategic solutions to improve government programs. Therefore,
we make the following recommendation.
18 Incentivize and expand civic engagement efforts on reducing and
eliminating hunger.
Rationale: Addressing hunger should not be the responsibility
of individuals and government alone, but should be shared with
multiple stakeholders and a large volunteer base of committed
community leaders for widespread community impact. Much
ingenuity arises out of such community-based or corporate-led
efforts, and these efforts should be rewarded and encouraged,
as the strong desire to help our neighbors and to empower
others is part of our American values and social fabric.
Action Items:
a. Congress should designate existing funds to measures such as
tax incen-
tives, matching funding programs, and other similar
measures that provide
incentives to and catalyze the development of greater
private efforts to ad-
dress hunger and support existing partnerships with
government.
b. The USDA should provide incentives for creating and sustaining
public-pri-
vate partnerships (which should adhere to the same
standards of non-dis-
crimination that apply to fully public programs) while
also placing greater
emphasis on and providing funds for
i. Hunger-Free Communities collective impact efforts.
ii. Efforts that improve the quality of emergency food and
reduce food waste
by enabling grocers, restaurant owners, caterers and
other food service
providers, and food producers to donate extra food to
emergency food pro-
viders and others who serve low-income communities
(this requires im-
proved Good Samaritan laws).
ii. Programs that provide incentives for farmers to contribute
food to food
banks and other food providers.
iv. Social enterprise that supports job training and education,
and placement
strategies for high-risk groups.
VI Create a White House Leadership Council to End Hunger that Includes
Participation by a Broad Group of Government and Non-Government
Stakeholders
As stated above, the root causes of hunger are many and varied, and
many of the consequences of hunger are far beyond the reach and
effectiveness of nutrition assistance programs. For instance,
employment trends and labor market dynamics, housing costs, disability,
access to quality education, the rising prevalence of single parent
families, behavior, income dynamics, and access to medical care all
have an impact on hunger, but cannot be addressed effectively solely
through nutrition assistance programs. Therefore, just as hunger cannot
be solved by food alone, national efforts to alleviate hunger cannot be
carried out by the USDA alone. To improve the overall health and well-
being of people in the United States, the White House should mount a
thoughtful, coordinated, and focused effort to address hunger and its
root causes.
This strong commitment will demand
A willingness to review all programs meant to assist low-
income families for their effectiveness and to candidly discuss
economic dislocation, discrimination, and the family structure
and formation issues that contribute to hunger.
Cross-agency collaboration among, at minimum, the following
agencies: the Departments of Agriculture, Housing and Urban
Development, Health and Human Services, Labor, Energy, Defense,
Education, and Veterans Affairs; the National Institutes of
Health; the Centers for Disease Control and Prevention; and the
Center for Medicare and Medicaid Services.
Strong representation, participation, and commitment from
the corporate, nonprofit, university, and faith-based sectors.
More civic engagement in our communities, as well as
meaningful initiative and involvement from those experiencing
hunger.
Therefore, we make the following two recommendations.
19 Establish a mechanism for cross-agency collaboration to
facilitate improved public assistance programming and
evaluation through enhanced technology, data sharing, and
coordinated funding streams that protect effective programs
and encourage coordinated efforts to address larger issues
of poverty.
Rationale: Currently, mechanisms for funding streams,
eligibility and delivery systems, and accountability are
separate, resulting in a variety of disparate and uncoordinated
rules and regulations confusing to administrators and
recipients alike. Additionally, there is no single agency that
can improve hunger alone. A national, coordinated plan among
multiple government and private sector partners to address
hunger and its root causes should be developed. This plan must
build upon and improve current public and private programs and
have the mutual goals of improved outcomes and cost efficiency.
Action Items:
a. The President should establish a White House Leadership Council
to
End Hunger with representation from government,
corporations, non-
profits, faith-based organizations, community leaders,
program benefi-
ciaries, private foundations, and other stakeholders to
develop and imple-
ment a comprehensive plan to eliminate hunger, and should
ensure that
the Council has adequate resources and staff.
b. The President should establish, convene, and lead the White
House Lead-
ership Council to End Hunger through the office of the
Domestic Policy
Council. The White House Leadership Council to End Hunger
will be
charged with developing a coordinated plan for ending
hunger.
20 The White House Leadership Council to End Hunger and its members
should monitor hunger at the Federal and state level, with
a specific emphasis on the following at-risk populations:
(a) seniors,
(b) single parent households with young children,
(c) people with disabilities,
(d) veterans and active duty military,
(e) American Indians,
(f) those reentering society from prison,
(g) survivors of violence, abuse, and neglect, and
(h) immigrants (including documented and undocumented, asylum
seekers and
refugees).
Rationale: The groups listed above are particularly
vulnerable to hunger. Their individualized and unique issues
are often misunderstood and too often go unaddressed.
Action Item:
The White House Leadership Council to End Hunger
should oversee progress within the involved government
agencies and report annually to the Administration,
Congress, and the public regarding the status of hunger
nationwide among all families and individuals, as well
as those particularly vulnerable populations outlined
above. They should also report annually on the progress
being made to eradicate hunger. Further, as part of
their charter, they should regularly review program
efficiency and effectiveness and recommend to the
Administration and Congress any changes necessary to
accomplish their goals.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
High school students preparing food for a summer food program
at Anthony Independent School District in El Paso, Texas.
Conclusion
In this report, we have described our process, what we learned, and
what we think our nation should do to address hunger. We believe that
our best chance for success is to make progress on the contributing
factors and underlying root causes we have described. We also are
confident that the implementation of our recommendations will lead to a
significant reduction in hunger.
At various points in this report, we have said that personal
choices and individual responsibility are factors associated with
hunger in America. But there is another aspect of personal
responsibility at work: personal responsibility extends to all.
Everyone can take direct actions to reduce hunger. Each of us should
extend compassion for and help to our neighbors and get involved in
hunger relief efforts in our communities. We need more of that kind of
personal responsibility, too. With it, we will end hunger in the United
States.
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99. Shafir E. Invited written testimony to the National Commission
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100. Rachidi A. Invited testimony before the National Commission on
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119. Edelman M.W. Invited written testimony to the National
Commission on Hunger. President, Children's Defense Fund. Research
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120. Neuberger Z., Segal B., Nchako C., Masterson K. Take up of
community eligibility this school year: More than 6 million children
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123. U.S. Department of Agriculture. Summer Food Service Program
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124. U.S. Department of Agriculture (USDA), Food and Nutrition
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126. U.S. Department of Agriculture, Food and Nutrition Service
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127. Heflin C., Arteaga I., Gable S. The child and adult care food
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128. U.S. Department of Agriculture. Food Distribution Program on
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129. Corporation for National & Community Service. Volunteering and
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130. Preble Street. Soup kitchens. Available at http://
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131. Feeding America. How we work. Available at http://
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132. Donaldson A. Through the eyes of a volunteer. 2015. Available
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133. Institute of Medicine (IOM). Building public-private
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134. van der Meer K. Public-Private cooperation in agricultural
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135. Kane H., Sreenivasan P., Bronstein K., et al. Research to
support potential recommendations of the National Commission on Hunger
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136. Lawrence M. Bringing legislators to the table addressing hunger
through public-private partnerships. Washington, D.C.: National
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137. Elanco. Consumer purchases drive donations of HATCHT eggs in
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139. GrowNYC. Greenmarket farmers markets. Available at http://
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141. Nicholson E. Testimony to the National Commission on Hunger,
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142. Nord M., Coleman A.L. Food Insecurity After Leaving SNAP.
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143. Ettinger de Cuba S., Harker L., Weiss I., Scully K., Chilton
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146. Vartanian L.R., Schwartz M.B., Brownell K.D. Effects of soft
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147. Malik V.S., Hu F.B. Fructose and Cardiometabolic Health: What
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149. U.S. Department of Agriculture, Food and Nutrition Service.
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U.S. Department of Agriculture, Food and Nutrition Service; May 23
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150. Abram J.K., Hand R.K., Parrott J.S., Brown K., Ziegler P.J.,
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151. U.S. Department of Agriculture. Summer Electronic Benefits
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153. Meyers A., Cutts D., Frank D.A., et al. Subsidized housing and
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Appendix A. Acknowledgments
The Commission wishes to acknowledge all the organizations that
hosted us on our visits, as well as the community members who took the
time to talk to us in these informal settings. We found these site
visits and conversations enormously helpful--thank you!
Acoma Food Distribution Program, Pueblo of Acoma, NM.
Alameda County Board of Supervisors, Oakland, CA.
Anacostia Library Summer Meal Program, Washington, D.C.
Anthony Independent School District Summer Meals Program, El
Paso, TX.
Arkansas Children's Hospital Medical Nutrition and Feeding
Program, Little Rock, AR.
Arkansas Children's Hospital WIC Clinic, Little Rock, AR.
Arkansas Food Bank food distribution and Mayor Zola Hudson,
Altheimer, AR.
Arkansas Hunger Relief Alliance, Cooking Matters Class,
Little Rock, AR.
Bread for the City, Washington, D.C.
D.C. Central Kitchen, Washington, D.C.
East Side Baptist Church food pantry, Pine Bluff, AR.
ELANCO HATCH program, Indianapolis, IN.
First United Methodist Church, Cooking Matters Class, Little
Rock, AR.
Indian Pueblo Cultural Center, Albuquerque, NM.
Jericho Way Day Center, Little Rock, AR.
El Centro de Salud Familiar La Fe, El Paso, TX.
La Fe Culture and Technology Center, El Paso, TX.
Marbury Plaza, Washington, D.C.
Merrill Community Center, Pine Bluff, AR.
MLK Interdistrict Magnet Elementary School, School Breakfast
Program, Little Rock, AR.
Nelson A. Rockefeller Institute of Government, Albany, NY.
San Luis Rey Parish and Fr. Robert Villegas, C.S.C.,
Chamberino, NM.
Socorro Ramirez Community Center, El Paso, TX.
Statehouse Convention Center, Little Rock, AR.
TOPPS (Targeting Our People's Priorities with Service)
after-school snack program, Pine Bluff, AR.
University of Southern Maine, Lee Community Hall, Portland,
ME.
We are also grateful to all the people who testified at the public
hearings or provided written testimony, both invited and public. We
heard from a total of 182 people or organizations.
Summary of Testimony Received by Type and Category
----------------------------------------------------------------------------------------------------------------
University/
Type Nonprofit Government Research Industry Unaffiliated Total
----------------------------------------------------------------------------------------------------------------
Invited 53 11 12 4 -- 80
Public 64 7 5 -- 26 102
----------------------------------------------------------------------------------------
Total 117 18 17 4 26 182
----------------------------------------------------------------------------------------------------------------
Invited Testimonies
Justin Alfond, Maine State Senator, Portland, ME
Salvador Balcorta, M.S.S.W., Chief Executive Officer, El Centro De Salud
Familiar La Fe, El Paso, TX
Jessica Bartholow, M.P.S., Legislative Advocate, Western Center on Law
and Poverty, Oakland, CA
Joel Berg, Executive Director, New York City Coalition Against Hunger,
Albany, NY
Laurie Biscoe, Deputy Director, Texas Workforce Commission, El Paso, TX
Janet Bono, Workforce Services Program Administrator, Workforce
Solutions Borderplex, El Paso, TX
Linda Bopp, Executive Director, Hunger Solutions New York, Albany, NY
Lee Bowes, Ph.D., CEO, America Works, Albany, NY
Michael Brennan, Mayor, City of Portland, Portland, ME
Kate Breslin, M.P.H., M.R.P., President and CEO, Schuyler Center for
Analysis and Advocacy, Albany, NY
Patrick Casey, M.D., Harvey and Bernice Jones Professor of Developmental
Pediatrics, University of Arkansas for Medical Sciences, Little Rock,
AR
Dee Clarke, Founder, Survivor Speak, Portland, ME
Celia Cole, M.A., CEO, Feeding Texas, El Paso, TX
Faye Conte, MS, Advocacy and Education Director, Hunger Free Vermont,
Portland, ME
Christy Daggett, M.P.P.M., Policy Analyst, Maine Center for Economic
Policy, Portland, ME
Mitchell Davis, Director, Global Shared Value, ELANCO (written only)
Charlotte Douglas, Arkansas State House of Representatives, Little Rock,
AR
Clarissa Doutherd, Executive Director, Parent Voices Oakland, Oakland,
CA
Marian Wright Edelman, J.D., President, Children's Defense Fund (written
only)
Willy Elliot-McCrea, CEO, Second Harvest Food Bank Santa Cruz County,
Oakland, CA
Thomas Farley, M.D., CEO, Public Goods Project, Washington, DC
Linda Farr, R.D.N., L.N., F.A.N.D., Speaker-Elect of the House of
Delegates, Academy of Nutrition and Dietetics, El Paso, TX
Edward Frongillo, Ph.D., Professor and Chair, Department of Health
Promotion, Education, and Behavior, University of South Carolina,
Washington, DC
Veronica Garcia, Ed.D., Executive Director, New Mexico Voices for
Children, Albuquerque, NM
Karen Gruneisen, Associate Director, Episcopal Community Services in San
Francisco, Oakland, CA
Craig Gundersen, Ph.D., Endowed Professor, Department of Agricultural
and Consumer Economics, University of Illinois (written only)
Sandra Hassink, M.D., President, American Academy of Pediatrics (written
only)
John Hennessy, Interim Canon Missioner for Communication and Advocacy,
Episcopal Diocese of Maine, Portland, ME
Ellie Hollander, President and CEO, Meals on Wheels America, Washington,
D.C.
Mia Hubbard, M.A., Vice President of Programs, MAZON: A Jewish Response
to Hunger, Oakland, CA
George Jones, CEO, Bread for the City, Washington, D.C.
Paula Jones, Ph.D., Senior Health Planner, Office of Equity and Quality
Improvement, San Francisco Department of Public Health, Oakland, CA
Kathy Komoll, Executive Director, New Mexico Association of Food Banks,
El Paso, TX
Kathy Krey, Ph.D., Director of Research, Texas Hunger Initiative at
Baylor University, El Paso, TX
Jennifer Laurent, Executive Director, Randy Sams Outreach Shelter,
Little Rock, AR
Rich Livingston, State President, AARP, Portland, ME
Mary Mayhew, Commissioner, Maine Department of Health and Human
Services, Portland, ME
Kim McCoy Wade, J.D., Consultant, Alliance to Transform CalFresh,
Oakland, CA
Travis McKenzie, Executive Director, Grow the Future, Albuquerque, NM
Edmund McMahon, President, Empire Center for Public Policy, Albany, NY
Robyn Merrill, J.D., M.S.W., Executive Director, Maine Equal Justice
Partners, Portland, ME
Kristen Miale, M.B.A., President, Good Shepherd Food Bank, Portland, ME
Oscar Munoz, Dir., Texas A&M Colonias Program, Center for Housing and
Urban Development, El Paso, TX
Matt Newell-Ching, Public Affairs Director, Partners for a Hunger-Free
Oregon, Oakland, CA
Ed Nicholson, Senior Director, Community Relations and Customer Service;
Representative, Corporate Affairs, Tyson Foods, Inc., Little Rock, AR
Sarah Palmer, M.A., Policy Associate, California Association of Food
Banks, Oakland, CA
Kathleen Pickering, Ph.D., Professor of Anthropology, Colorado State
University; Dr. Pickering was joined in her testimony by Benjamin
McShane-Jewell, Community Garden Program Director, Community Crops;
Michael Brydge, Co-owner, Sweet Grass Consulting; Marcella Gilbert,
South Dakota State University Extension, Cheyenne River Tribal Office;
and Linda Black Elk, Secondary Science Education Instructor,
Ethnobotany, Sitting Bull College, Standing Rock Reservation (written
only)
Louise Pocock, J.D., Staff Attorney, New Mexico Center on Law and
Poverty, Albuquerque, NM
Janet Poppendieck, Ph.D., Policy Director, New York City Food Policy
Center at Hunter College and the CUNY School of Public Health, Albany,
NY
Anne Quaintance, Chief Program & Government Affairs Officer, Meals on
Wheels San Francisco, Oakland, CA
Mark Quandt, M.S.W., Executive Director, Regional Food Bank of
Northeastern New York, Albany, NY
Angela Rachidi, Ph.D., Research Fellow in Poverty Studies, American
Enterprise Institute for Public Policy Research, Albany, NY
Jennifer Ramo, Executive Director, New Mexico Appleseed, Albuquerque, NM
Robert Rector, M.P.S., Senior Research Fellow, The Heritage Foundation,
Washington, D.C.
Kori Reed, Vice President, Cause and Foundation, ConAgra Foods, El Paso,
TX
Heather Reynolds, President/CEO, Catholic Charities Fort Worth (written
only)
Audrey Rowe, Administrator for the Food & Nutrition Service, U.S.
Department of Agriculture, Washington, D.C.
Rhonda Sanders, M.P.H., CEO, Arkansas Foodbank, Little Rock, AR
Deborah Sanderson, Maine State Representative, Portland, ME
Eric Saunders, Ed.D., Assistant Commissioner for Fiscal and
Administrative Services, Arkansas Department of Education, Little Rock,
AR
John Selig, M.P.A., Director, Arkansas Department of Human Services,
Little Rock, AR
Cathy Senderling-McDonald, M.P.P.M., Deputy Director, County Welfare
Directors Association of California, Oakland, CA
Eldar Shafir, Ph.D., Professor, Princeton University Woodrow Wilson
School of Public and International Affairs (written only)
Joseph Sharkey, Ph.D., Professor, Texas A&M School of Public Health, El
Paso, TX
Tia Shimada, M.P.H., Managing Nutrition Policy Advocate, Food Policy
Advocates, Oakland, CA
Reagan Smetak, Bureau Chief, State of New Mexico Children, Youth &
Families Department, Albuquerque, NM
Andrew Souza, President and CEO, Community Food Bank, Oakland, CA
Valerie Tarasuk, Ph.D., Professor, Department of Nutritional Sciences,
University of Toronto (written only)
Charolette Tidwell, Director, Antioch Consolidated Association for Youth
and Family, Little Rock, AR
Jason Turner, Executive Director, Secretaries' Innovation Group,
Portland, ME
Kathy Underhill, Executive Director, Hunger Free Colorado, El Paso, TX
Emily Wang, M.D., Assistant Professor, Yale School of Medicine (written
only)
Tracy Wareing Evans, Executive Director, American Public Human Services
Association, Washington, D.C.
Kathy Webb, Executive Director, Arkansas Hunger Relief Alliance, Little
Rock, AR
Paul Winkeller, Independent Consultant (written)
Scott Winship, Ph.D., Walter B. Wriston Fellow, Manhattan Institute for
Policy Research, Washington, D.C.
Ian Yaffe, Executive Director, Mano en Mano, Portland, ME
Donna Yellen, M.S.W., Chief Program Officer, Preble Street, Portland, ME
James Ziliak, Ph.D., Founding Director, Center for Poverty Research,
University of Kentucky, Washington, D.C.
Kelly Zunie, Cabinet Secretary, Indian Affairs Department, Albuquerque,
NM
Public Testimonies
Many of the people who provided public testimony did not provide a
written copy, and we have only the sign-in sheet or audio transcripts
to document who they were. We apologize to anyone whose name we have
inadvertently misspelled as a result. We also had a few people present
public testimony who did not identify themselves at all, so we are
unable to thank them by name.
127 State and Local Hunger Organizations (See complete list of
organizations in Attachment 1; written only)
Saleema Akbar, Washington, D.C.
Alexandra Ashbook, J.D., L.L.M., Director, D.C. Hunger Solutions,
Washington, D.C.
James Audiffred (written only)
Ali Avery, Portland, ME
Patricia Baker, Senior Policy Analyst, Massachusetts Law Reform
Institute (MLRI), Portland, ME
Maria Elena Barron, Partner, El Pasoans Fighting Hunger, El Paso, TX
Lionel Battle, Washington, D.C.
Rev. David Beckmann, President, Bread for the World, Washington, D.C.
Jill Borak, Policy Manager, Jewish Council for Public Affairs,
Washington, D.C.
Rebecca Brislain, Florida Association of Foodbanks (written only)
Katharine Broton, Ph.D. Candidate, University of Wisconsin (written
only)
Elaine Bultena, Volunteer Coordinator, Food Ministry--First United
Methodist Church, Little Rock, AR
Rhonda Chafin, Executive Director, Second Harvest Food Bank of Northern
Tennessee (written only)
Leslie Clark, Veteran, St. Mary's Center, Oakland, CA
Bill Collins, Oakland, CA
Heather Cosson, M.S., Dir. of Communications, National Foundation to End
Senior Hunger, Washington, D.C.
Kay Cota (written only)
Evelyn County, Volunteer, Alameda County Community Food Bank, Oakland,
CA
Joanna Cruz, Witnesses to Hunger, Washington, D.C.
Mike Curtin, D.C. Central Kitchen, Washington, D.C.
Diana Davis (written only)
Lisa Davis, J.D., Senior Vice President of Government Relations, Feeding
America, Washington, D.C.
David DeVaughn, M.P.A., Manager, Policy and Government Relations, City
Harvest, Albany, NY
Allissa Eiser, R.D., School Food Service Director, Public School System
(written only)
Brooke Evans, Student and McNair Scholar, University of Wisconsin-
Madison (written only)
Tangela Fedrick, Witnesses to Hunger, Washington, D.C.
Susan Forte, Exec. Director, House About It Community and Economic
Development Agency, Little Rock, AR
Dana Frasz, Founder and Director, Food Shift, Oakland, CA
Abby Getman, The Food Bank of Western Massachusetts (written only)
Sara Goldrick-Rab, Ph.D. Candidate, University of Wisconsin (written
only)
Rev. Phillip Grigsby, Executive Director, Schenectady Inner City
Ministry, Albany, NY
Sarah Grow, Director of Advocacy and Development, The Open Door,
Portland, ME
Jonetta Hall, Oakland, CA
Scott Hamann, State Representative, Maine House of Representatives,
Portland, ME
James Hanna, Executive Director, Cumberland County Food Security
Council, Portland, ME
Helen Hanson, Portland, ME
Jim Hoffman, Friar, Franciscan Outreach Association (written only)
Ortencia Hopvi, Oakland, CA
Noel Hubler, Ray of Hope Food Pantry Inc., Little Rock, AR
Joan Ingram, SNAP-Ed Program Manager, University of New England,
Portland, ME
Jennifer Johnson, President, George J Mitchell School PTO, Portland, ME
Andrea Jones, Oakland, CA
Rev. Kasey Jones, National Baptist Memorial Church, Washington, D.C.
Monica Kamen, Advocacy Coordinator, DC Fair Budget Coalition,
Washington, D.C.
Erika Kelly, Meals on Wheels, Washington, DC
Courtney Kennedy, Nutrition Educator Manager, Good Shepherd Food Bank,
Portland, ME
Jeff Kleen, Public Policy Advocate, Oregon Food Bank (written only)
Jeremiah Lowery, Research and Policy Coordinator, Restaurant Opportunity
Center, Washington, D.C.
Cindy MacIntyre, Grace Episcopal Church Food Pantry, Washington, D.C.
Kate Maehr, M.P.P.A., Executive Director, Greater Chicago Food
Depository (written only)
Nahomi Martinez, El Paso, TX
Oscar Martinez, Coordinator, Social Justice Education Project, El Paso,
TX
Janese Massey (written only)
Kirk Mayes, Chief Executive Officer, Forgotten Harvest (written only)
Shannon McCabe, Portland, ME
Bruce Meraviglia, Bread for the Cities, Washington, D.C.
Joycene Moore, Washington, D.C.
Artrese Morrison, Executive Vice President, Strategic Initiatives,
Project Open Hand (written only)
Corina Marruto, El Paso, TX
National Association of Food Distribution Programs on Indian
Reservations (written only)
Gina Nunez, Ph.D., Interim Director of Women's Studies, The University
of Texas, El Paso, TX
Teri Olle, Director of Policy and Advocacy, San Francisco Marin Food
Bank, Oakland, CA
Marisa Parisi, M.S., Executive Director, Hunger Free Vermont, Portland,
ME
Mary Penet, Director of Senior Feeding Programs, FeedMore, Washington,
DC
Delene Perley, Food Pantry Coordinator, Project FEED, Portland, ME
Sr. Frances Mary Pierson, Dominican Sisters of MSJ (written only)
Shanti Prasad, Community Mobilization Coordinator, Alameda County
Community Food Bank, Oakland CA
Carla Price (written only)
Thomas Ptacek, Portland, ME
Paula Reichel, D.C. Regional Director, Capital Area Food Bank,
Washington, D.C.
Jeanne Reilly, Director of School Nutrition, Windham Raymond School
Nutrition Program, Portland, ME
Colleen Rivecca, Advocacy Coordinator, St. Anthony Foundation, Oakland,
CA
Carlos Rivera, President, Legacy of Valor, El Paso, TX
Wes Rivers, Policy Analyst, D.C. Fiscal Policy Institute, Washington,
D.C.
Connie Rizoli, Director of Public Policy, Project Bread (written only)
Rosemary Rodibaugh, Ph.D., University of Arkansas Cooperative Extension,
Little Rock, AR
Madonna Sactomah, Former Passamaquoddy Tribal Representative, Maine
State Legislature, Portland, ME
David Sanchez, Regional Evaluator, Aliviane, Inc. and Prevention
Resource Center 10, El Paso, TX
Ruben Sanchez, Regional Director, Texas Hunger Initiative, El Paso, TX
Anne Sheridan, M.S., Director, Maryland Governor's Office for Children,
Washington, D.C.
Janie Sinclair, Executive Director, El Pasoans Fighting Hunger Food
Bank, El Paso, TX
Ana Solis, Open Arms Catholic Charismatic Community, El Paso, TX
Denise Speed, Washington, D.C.
Triada Stampas, M.P.A., Vice Pres. for Research and Public Affairs, Food
Bank for New York City, Albany, NY
Kyle Stephan, Volunteer, Border Servant Corps-Kelly Memorial Food
Pantry, El Paso, TX
Andrew Stettner, M.P.P., Chief Program Officer, Single Stop (written
only)
Duke Storen, Sr. Director of Research, Advocacy, & National
Partnerships, Share Our Strength, Washington, D.C.
Nermin Tadros, Board Member, New York City Coalition Against Hunger Food
Action, Albany, NY
William Taft, Bread for the Cities, Washington, D.C.
Joel Thomas, Lead Culinary Educator, Martha's Table, Washington, D.C.
Daryl Twerdahl (written only)
Sr. Betsy Van Deusen, C.S.J., Catholic Charities of the Diocese of
Albany, Albany, NY
Gloria Williams, El Paso, TX
Michael Wilson, Director, Maryland Hunger Solutions, Washington, D.C.
Witnesses to Hunger, Washington, D.C.
Diane Woloshin, R.D., M.S., Director of Nutrition Services, Nutrition
Services of Alameda County, Oakland, CA
Jessica Wynter Martin, Restaurant Opportunity Center, Washington, D.C.
Esther Zapata, El Paso, TX
Ginger Zielinskie, M.B.A., President, Benefits Data Trust, Washington,
D.C.
Susan Zimet, Executive Director, Hunger Action Network of New York
State, Albany, NY
Attachment 1. List of Signers of Letter from 127 Organizations
AHEPA [American Food Bank of Alaska Ohio Association of
Hellenic Educational Food Bank of Central Foodbanks
Progressive New York Orange East Senior
Association] Center
Alabama Food Bank Food Bank of Contra Oxnard-Pathway to
Association Costa & Solano Educated Nutrition,
Arkansas Hunger Relief Food Bank of Delaware Inc.
Alliance
Arrowhead Senior Center Food Bank of the Golden Oregon Food Bank
Crescent
Association of Arizona FRAC Partners for a Hunger-
Food Banks Free Oregon
B.J. Jordan Child Care Franklin Grand Isle Pennsylvania Council
Programs Community Action of Churches
Baltimore Area Faces of GEDCO (Govans Point Roberts Food
Homelessness Speakers' Ecumenical Development Bank
Bureau Corporation) Poor Peoples United
Fund
Baltimore Outreach Great Plains Food Bank Preble Street Maine
Services, Inc. Greater Philadelphia Hunger Initiative
Bay Area Food Bank Coalition Against Public Policy Center
Bean's Cafe Hunger of Mississippi
Project Bread
Blue Valley Community Hardwick Area Food Redwood Empire Food
Action Partnership Pantry, Inc. Bank
CAFB (Capital Area Food Harvest Regional Food Regional Food Bank of
Bank) Bank Oklahoma
Cambridge Economic Hawaii Appleseed Center Rhode Island Community
Opportunity Committee, for Law & Economic Food Bank
Inc. Justice Roxbury Food Shelf
Capital Area Food Bank Hunger Advocacy Network San Francisco-Marin
of Austin Food Bank
CDA Hunger Free Colorado Schenectady Inner City
Center for Civil Hunger Free Vermont Ministry
Justice Hunger Solutions Second Harvest Food
CFPA (California Food Minnesota Bank of Middle
Policy Advocates) Tennessee
Champlain Islands Hunger Solutions New Single Stop
Foodshelf York
Child and Family Policy Hunger Task Force South Carolina
Center Idaho Hunger Relief Appleseed Legal
Child Care Food Program Task Force Justice Center
Roundtable
Children's Alliance Illinois Hunger South Plains Food Bank
Coalition
Citizens for Citizens, Imperial Valley Food St. J. Nutritional
Inc. Bank Center/Meals on
Wheels
Committee on Temporary Kenai Peninsula Food St. Mary's Food Bank
Shelter Bank Alliance
Community Action Kentucky Equal Justice Survivors, Inc.
Committee of Lehigh Center Tennessee Justice
Valley & Northeast Kingdom Community Center
Pennsylvania Services
Community Action Marin Loaves and Fishes Food The Food Depot
Pantry
Community Servings Long Island Care, Inc. The Greater Boston
Food Bank
D.C. Hunger Solutions Louisiana Food Bank The Open Door
Association
Day Care Connection Maryland Hunger The Food Bank of
Solutions Western Massachusetts
Duxbury Elf Food Shelf Mercy Medical Center-- Three Square Food Bank
El Paso Human Services, Mercy Supportive Toledo Northwestern
Inc. Housing Program Ohio Food Bank, Inc.
Empire Justice Center MLRI (Massachusetts Law Treasure Coast Food
End Hunger CT! Reform Institute) Bank
Turning Point
Enosburg Food Shelf Montana Food Security Umbrella, Inc.
Council
Facing Hunger Food Bank North Carolina United Ministries,
Association of Food Inc.
Banks
Fair Share National Health Care United Way of King
Faith in Action for the Homeless County
Northern Communities Council Virginia Poverty Law
Partnership New Hampshire Food Bank Center
Utahans against Hunger
Federation of Virginia Nebraska Appleseed Western Center on Law
Food Banks New Jersey Anti-Hunger and Poverty
Feeding Indian's Hungry Coalition Woodbury Calais Food
Shelf
Feeding Missouri New York City Coalition Woodstock Community
Feeding South Dakota Against Hunger Food Shelf
Feeding Texas Northeast Kingdom Worcester Food &
Neighbors Helping Active Living Policy
Neighbors/RuralEdge Council
Food Bank for New York Northwest Harvest Worcester State
City University
Florida Impact ....................... Wu Yee Children's
Services
Note: This letter was provided to us by FRAC (Food Research Action
Center). Some signers provided only an acronym. Where possible, we
have identified those and spelled them out in parentheses following
the acronym.
Appendix B. U.S. Household
Food Security Survey Model
In 2012, researchers at the USDA Economic Research Service compiled
and made available a current version of the U.S. Household Food
Security Survey Module to help other researchers achieve accuracy and
standardization in application of the measures in empirical research.
The U.S. Household Food Security Survey Module is available at the USDA
Economic Research Service website, Food Security in the United States,
(http://www.ers.usda.gov/topics/food-nutrition-assistance/food-
security-in-the-us.aspx#.U8HyuLFv_Ok) along with very helpful guidance
and recommendations for researchers' use of the module. In addition,
Economic Research Service researchers have been an ongoing accessible
and very helpful sources of advice, help, and guidance for public and
private researchers who wish to use the food security measures in their
own research. The support provided by the Economic Research Service has
been a key factor in the large number of high-quality research studies
that have been conducted on food security in the United States.
A household's raw score is the number of ``affirmative'' responses
(e.g., ``yes,'' ``often,'' ``sometimes,'' ``almost every month,''
``some months but not every month'') to the questions (listed below).
The raw score is translated into one of four food security levels
(high, marginal, low, very low) using ranges that depend on the subset
of questions used.
How is food security measured?
(Scores are adult-only households on left; households with children on
right)
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
U.S. Household Food Security Survey Module Questions
1. ``We worried whether our food would run out before we got money
to buy more.'' Was that often, sometimes, or never true for you in the
last 12 months?
2. ``The food that we bought just didn't last and we didn't have
money to get more.'' Was that often, sometimes, or never true for you
in the last 12 months?
3. ``We couldn't afford to eat balanced meals.'' Was that often,
sometimes, or never true for you in the last 12 months?
4. In the last 12 months, did you or other adults in the household
ever cut the size of your meals or skip meals because there wasn't
enough money for food? (Yes/No)
5. (If yes to question 4) How often did this happen--almost every
month, some months but not every month, or in only 1 or 2 months?
6. In the last 12 months, did you ever eat less than you felt you
should because there wasn't enough money for food? (Yes/No)
7. In the last 12 months, were you ever hungry, but didn't eat,
because there wasn't enough money for food? (Yes/No)
8. In the last 12 months, did you lose weight because there wasn't
enough money for food? (Yes/No)
9. In the last 12 months did you or other adults in your household
ever not eat for a whole day because there wasn't enough money for
food? (Yes/No)
10. (If yes to question 9) How often did this happen--almost every
month, some months but not every month, or in only 1 or 2 months?
(Questions 11-18 were asked only if the household included
children age 0-17)
11. ``We relied on only a few kinds of low-cost food to feed our
children because we were running out of money to buy food.'' Was that
often, sometimes, or never true for you in the last 12 months?
12. ``We couldn't feed our children a balanced meal, because we
couldn't afford that.'' Was that often, sometimes, or never true for
you in the last 12 months?
13. ``The children were not eating enough because we just couldn't
afford enough food.'' Was that often, sometimes, or never true for you
in the last 12 months?
14. In the last 12 months, did you ever cut the size of any of the
children's meals because there wasn't enough money for food? (Yes/No)
15. In the last 12 months, were the children ever hungry but you
just couldn't afford more food? (Yes/ No)
16. In the last 12 months, did any of the children ever skip a meal
because there wasn't enough money for food? (Yes/No)
17. (If yes to question 16) How often did this happen--almost every
month, some months but not every month, or in only 1 or 2 months?
18. In the last 12 months did any of the children ever not eat for
a whole day because there wasn't enough money for food? (Yes/No)
Glossary
Child and Adult Care Food Program: A Federal nutrition assistance
program that provides meals to children and adults in institutions and
day care centers. Generally subject to the congregate feeding
requirement.
Colonia: An unincorporated settlement of immigrant families, the
majority of whom are undocumented.
Congregate Feeding Requirement: A requirement of the Summer Food
Service Program and the Child and Adult Care Food Program to provide
meals at a public site (e.g., school, senior center).
Documented immigrant: A citizen of another country who is in the
United States legally.
Food-insecure: A household with low or very low food security, as
measured by the U.S. Household Food Security Survey Module.
Food insecurity: A household-level economic and social condition of
limited or uncertain availability of nutritionally adequate and safe
foods, or the limited or uncertain ability to acquire acceptable foods
in socially acceptable ways without resorting to emergency food
supplies, scavenging, stealing or other coping strategies.
Food-secure: A household with high or marginal food security, as
measured by the U.S. Household Food Security Survey Module.
Food security: Access by all people at all times to enough food for
an active, healthy life.
Globalization: Changes promoting the open flow of goods and
services among countries.
Hunger: Households experiencing very low food security.
Multigenerational household: A family headed by an adult
householder aged 40 or older and with three generations (grandparent,
parent, child) or grandparent and grandchild with no adult parent (so-
called skipped generation).
National School Lunch Program: A Federal nutrition assistance
program that provides school children with free or reduced price lunch.
Offshoring: Moving jobs from the United States to other countries
where labor is cheaper.
Public-private partnerships: Arrangements between public, private,
and nonprofit organizations to provide public services.
School Breakfast Program: A Federal nutrition assistance program
that provides school children with free or reduced price breakfast.
SNAP: Supplemental Nutrition Assistance Program, the largest
Federal nutrition assistance program. Formerly called Food Stamps.
Summer Food Service Program: A Federal nutrition assistance program
that provides children with food during the summer when they are not in
school. Generally subject to the congregate feeding requirement.
Undocumented immigrant: A citizen of another country who is in the
United States illegally. These may include asylum seekers (people who
have entered illegally seeking refugee status, which if granted, would
regularize their presence and make them legal) and those who entered
the U.S. legally on a temporary visa, such as a student or tourist
visa, that has since expired, rendering their presence here illegal.
U.S. Household Food Security Survey Module: A survey used to
classify households into four food security categories: high food
security, marginal food security, low food security, and very low food
security. See Appendix B.
Very low food security: The disruption of eating patterns and
reduced food intake for at least one household member because the
household lacked money and other resources for food.
WIC: Special Supplemental Nutrition Program for Women, Infants, and
Children; a Federal nutrition assistance program that provides
assistance to pregnant and postpartum women, infants, and children
under 5 to ensure they get adequate nutrition.