Speakers: Secretary Tom Vilsack, U.S. Department of Agriculture; Dr. Sandra Hassink, M.D., FAAP, President, American Academy of Pediatrics; and Jessica Donze Black, Director of Child Nutrition, Pew Charitable Trusts
Moderated by Anthony E. Gallo, Newsmaker Committee, National Press Club
Tuesday, September 8, 2015
MR. GALLO: Ladies and gentlemen, welcome to the National Press Club, the world's largest and oldest organization for professional journalists and communicators. The subject today is child nutrition, and we have three people to whom this subject is very important: the U.S. Secretary of Agriculture, the president of the national pediatric association, and the director of nutrition research at the Pew Charitable Trusts. I am going to briefly introduce all three of them.
Tom Vilsack is the 30th Secretary of Agriculture. As a native Pittsburgher and alumnus of the Agriculture Department, I am very proud to introduce Pittsburgh's first-born, native-born Secretary of Agriculture. I believe that's correct. He is a graduate of Hamilton College, which I believe has its first Secretary of Agriculture, and Shady Side Academy, which surely has its first Secretary of Agriculture. Mr. Vilsack is quite distinct. He is the longest-serving member of the Obama administration. That's quite a feat. And during his Administration, we have seen a record increase in agricultural exports. He's instituted very top food safety regulations. He has enrolled the highest number of acres in the National Conservation Program, and he has worked at revitalizing the U.S. economy. Before being the Secretary of Agriculture, he was the accomplished governor of the great farm state of Iowa, and he even ran for president once upon a time.
Dr. Sandy Hassink-she prefers to be called "Sandy"-is the president of the American Academy of Pediatrics. So, therefore, she is very interested in children's health. She is with the DuPont Children's Hospital in Wilmington, Delaware.
Jessica Donze Black is head of research and nutrition research at the Pew Charitable Trust.
With that, I have spoken long enough, and we will begin with our speakers. We will have 30 minutes or so for questions and answers. So, with that, shall we begin with you, Jessica, and then you-with Sandy, Jessica, and then Secretary Vilsack.
[Applause.]
DR. HASSINK: Well, good afternoon, everyone. We could have begun with Jessica. Jessica and I actually go back, way back. When I was first starting my clinical practice, Jessica was my nutritionist in clinic with me, so we go way far back in our interest in child nutrition, so thank you, Tony, and thank you, Secretary, for inviting me to join you all today in talking about an interest very close to my heart, which is child health and child health and nutrition. And there could be nothing more important that we could be talking about today than child health.
And I began my clinic 27 years ago at Nemours Children's Hospital for children with obesity long before obesity was on anybody's radar screen and long before we realized that we couldn't afford to take child nutrition for granted and its impact on child health for granted. We used to take it for granted. We used to just assume nutrition-children would be well nourished and they'd come to the physician, and I would try to take care of their health. And what's happening today is children are not well nourished. They're coming to physicians and pediatricians like me and my 64,000 colleagues, overweight with obesity, with food insecurity, not well nourished, and it makes our job so much harder in trying to help them achieve their optimal health.
And we've been very focused this year on thinking about what is optimal health for all our children and what are the foundations of health that every child in this country needs, and we start that foundation with sound and optimal nutrition. And every child needs that to succeed. Every child needs stable, nurturing, loving relationships in their family, early child care education in school to succeed, and every child needs a safe and healthy environment and community to live in to succeed and achieve their optimal health and well-being.
So meeting these foundational needs is fundamental to child health, and pediatricians have been stepping beyond the walls of their clinic to engage in the community and their state and like me in federal policy to ensure those foundations for child health. And these foundational elements are often intertwined, and when we fail to meet them, we shortchange our children, and we shortchange them in terms of their ability to contribute to our communities and our society in their full optimal health and potential.
And the earlier we start addressing these fundamental needs, the better we are, and so research has shown that the nutrition beginning before pregnancy and during pregnancy and during childhood and optimal nutrition really results in support of the rapid physical, cognitive, and social development that children undergo in those early years. And so children who are well nourished early in life have healthier brain development. They have higher IQs. They have stronger immune systems. They have better educational attainment than those who are not well nourished.
And children-and I almost hate to say these words-children who are malnourished, who have food insecurity-and we have those children in this country-during this critical time period have health problems, and also food insecurity itself is a stressor on a family and a child, and that toxic stress can compromise their physical, mental, and social health and well-being into adulthood.
In the coming weeks, Congress will have the opportunity to build a strong foundation and continue to build that foundation of sound nutrition for every child as it prepares to reauthorize several child nutrition programs. As pediatricians, we are here, and I am here, to remind our federal leaders of the importance of these programs and the importance they play in keeping our children and families healthy.
And in order to set this stage for a lifetime of good health and success, we must ensure that our youngest children and their mothers have access to nutritious foods, and this is not a trivial problem. And it's integrally related to their good health. So the special supplemental nutrition program for Women, Infants, and Children, known as WIC, does just that. WIC provides nutritious foods, nutrition education, breastfeeding support, and referrals to health care and social services for millions of low-income women and children and infants and young children who are determined to be nutritionally at risk. And we can't overemphasize the importance of this.
WIC has received strong bipartisan support for the past 40 years, and rightly so, and has demonstrated positive health effects. Children who participate in WIC have improved birth outcomes, increased rates of immunizations, better access to health care through medical homes, and they even have reduced rates of childhood obesity. Who does not want that, and who does not want that contribution to the health of our population? And this link to breastfeeding counseling and its link with Medicaid, a health insurance program, is so important and ensures that millions of moms and babies have access to nutritious foods and health support.
But the importance of sound nutrition doesn't end with infancy or at age 5. Important nutrition throughout life is essential to maintaining health, and we are now in the midst of a nutritional epidemic characterized by high rates of overweight and obesity, food insecurity, and hunger. And nearly one in three school-age children and adolescents has overweight or obesity. That has its roots in nutrition, and only half of all children age 2 to 17 meet federal dietary quality standards. This is not really acceptable for us as a community, us as a society.
I see children with obesity-and have for 27 years-who have the health profiles of sick middle-aged adults. They have high cholesterol. They have liver disease. They have sleep apnea. They have orthopedic problems. They have type 2 diabetes. The youngest child we had in clinic with type 2 diabetes was age 8. We have 4-year-olds with liver disease based on their obesity. This is a nutritional problem that reaches down into our youngest children, and since children typically consume up to half their calories in school, we really have an obligation to ensure that those school meals are as healthy as possible. Just like we vaccinate to prevent illness, we can also vaccinate against chronic disease by providing children with nutritious foods in schools and make our schools role models of good nutrition.
Five years ago, Congress made great strides in addressing the nutritional needs of children through the Healthy, Hunger-Free Kids Act, and I stood there at the press conference when that law was initiated. These science-based nutritional updates ensure that all children who eat school meals have access to fruits, vegetables, whole grains, and the appropriate amount of sodium.
The impact of these changes will not be realized overnight, but we know schools are doing well. Over 95 percent of schools are meeting these requirements, and 9 out of 10 people in our country support these requirements. Parents are counting on schools to be good role models and provide nutritious and healthy foods, and in the past four years, there's been a significant increase in the schools that serve fruits and vegetables and whole grains, and our schools are healthier than ever. And we need to build upon the success that we've had and make sure that our children continue to have access to healthy meals throughout the day.
It's important to remember as we say this that one in five children in our country live in households where food is scarce. One in five children in our country live in households where food is scarce. We have children that were going to school hungry; that in the snow days that we had in the Northeast, children were hungry those days because they didn't have access to school programs. These children who are hungry have difficulty in learning and are more likely to experience education, health, and behavior problems as a result of this.
And we know that there are also high rates of obesity found in our lowest income populations, and the challenge for our low-income families today in this modern food environment is access to healthy food and having dependable access to high-quality healthy food. We have a double burden in this country, and the double burden is that of obesity, overweight, and food insecurity affecting nearly 50 percent of our children. We can fix this, and we are fixing this.
We can't forget about after-school meals and summer feeding programs and the child and adult care food programs that help children have access to nutrition and good nutrition any time of day and any season of the year.
We still have work to do when it comes to meeting our children's needs for sound nutrition, and an upcoming child nutrition reauthorization is an opportunity for our country to take another step in the right direction.
We know our leaders in Congress are working hard on a bipartisan basis to keep our child nutrition program strong and build upon these strong foundations. The AAP hopes these efforts continue and that we move one step closer to reauthorizing these important programs for children.
I want to thank Secretary Vilsack again for inviting me to speak about a topic that couldn't be more important, and it's the health of our children in this country. Thank you very much.
[Applause.]
MS. BLACK: Well, thank you, Dr. Hassink, for that impassioned speech, and it's really an honor to be with you here today. Thank you, Secretary Vilsack, for having this event and for inviting us to join you, and thank you, Tony, for being here with us today to talk about something that couldn't be more important, which is the health of our kids.
It's the day after Labor Day, and as many happy parents will tell you, that means that nearly every school-age child is back in school as of today, and the great story in that is that virtually all those students are walking into schools that are healthier than they might have been several years ago. That goes for pre-kindergarteners up through high school students, for the 30 million young people who are getting a school meal today, and for their classmates who are packing lunches but may be buying food from the a la carte line or from vending machines and observing what kids are eating throughout the school. All across the campus and especially in the biggest of classrooms, the cafeteria, every child is being greeted by nutritious choices and consistent messages that support healthy bodies, minds, and habits, habits that will hopefully help them avoid the pitfalls of previous generations where now nearly 70 percent of adults are either overweight or obese.
Due to both updated school nutrition standards issued by the United States Department of Agriculture and the hard work of thousands of professionals working at the local level, school meals are healthier than ever. One of the best examples is the focus on fruits and vegetables. The National Health and Nutrition Examination Survey data demonstrates that 60 percent of children do not get adequate servings of fruit, and 93 percent do not get adequate servings of vegetables. Yet before the updated nutrition standards, fruits and vegetables were not necessarily included in every lunch or breakfast, and up to 40 percent of schools didn't necessarily have fresh fruits and vegetables available on a daily basis. Today, every school breakfast and lunch includes a serving of fruits and vegetables. Most schools have increased their variety of fruit and vegetables offerings, and nearly a third of schools even have self-serve salad bars. The result of this progress is that students in nearly every school, not just exceptional schools, have healthier options every day.
According to research from Bridging the Gap, before the updated school meal standards, teenagers at larger high schools were more than three times as likely than their peers in smaller schools to have both fruit and vegetable options available. Similarly, middle school students, middle schools with predominantly white enrollments, were more than twice as likely as racially and ethnically diverse schools to have fruits, vegetables, and whole grains available each day. Today, smaller and more diverse schools have increased their offering of these nutritious foods, enough to close those gaps, but this isn't just about serving healthier foods. Multiple studies have also shown that children's eating habits are changing for the better too.
For instance, research by the Rudd Center, published in March, measured what middle school students chose and ate before updated lunch standards and after updated lunch standards. The results showed that with healthier meals, more students were choosing fruit and vegetables. They consumed more of their entrees in vegetables and overall increased their nutrient intake without increasing plate waste. Given these benefits, it's little surprise that voters with children in public schools want to preserve the policies driving the progress.
More than 7 in 10 of parents support the current nutrition standards according to the national poll released jointly by the Pew Charitable Trusts, the Robert Wood Johnson Foundation, and the American Heart Association in 2014. And given the tremendous progress already made and the effort already invested, the road forward should focus on maintaining healthier food standards already implemented by nearly all schools, while providing effective assistance to those districts that are encountering obstacles.
Continuing to provide children with healthy food is not without its challenges, as many school nutrition directors are essentially running the largest restaurant in their communities and having to impress the same customers and not the easiest of customers with healthy meals prepared on a limited budget every single day, but these challenges can be overcome, as thousands of school nutrition professionals are demonstrating, and they are worth overcoming.
For instance, when the updated meal standards took effect in 2012, Pew surveyed school meal program administrators nationwide and found that 88 percent of districts said they needed at least one piece of new kitchen equipment to serve healthier meals such as baked rather than fried chicken and potatoes, with greater variety of fruits and vegetables. Likewise, almost two-thirds of districts reported staff training needs, but only 37 percent said they had adequate budgets to provide that training. Many districts have been able to address some of these needs, thanks to Congress' dedication of funds for equipment grants in annual appropriations bills over the last few years, and USDA and many state agencies have worked to address the training needs via programs such as Team Up and other innovative strategies within the states.
Looking forward, a bipartisan group of House and Senate leaders have introduced legislation that would accelerate this momentum by giving schools easier access to the tools and workforce training they need to run healthy, successful meal programs. Their bill, the School Food Modernization Act, would allow schools to better plan and make investments in food service equipment and professional development for nutrition staff.
Child nutrition reauthorization provides a tremendous opportunity for Congress to continue to build on the recent progress and ensure that every child has access to the healthy food they need to learn and succeed. The nation's $16 billion annual investment in school meals is a crucial catalyst to help the next generation thrive and succeed while establishing healthy habits for a lifetime. Spending these taxpayer dollars on nutritious meals remains a wise investment in the future of our children and in that of our nation.
[Applause.]
SECRETARY VILSACK: Jessica, thank you very much, and certainly thanks to the Pew Charitable Trusts for their extraordinary commitment to child nutrition and to the work of our efforts to improve child nutrition. We could not be where we are without its commitment. And, Doctor, I want to thank you and pediatricians all across the United States for lending your voice and your energy to this effort. You have been a tireless champion for youngsters throughout the last couple of years, and certainly have appreciated the role that pediatricians are playing in making sure that people around the country understand and appreciate how important this issue is to the children of this country. Tony, thanks very much to the Press Club for giving us this forum.
The two previous speakers did such a great job of explaining why this is important and talking a little bit about the acceptance of these new standards, that it's a little difficult to follow them. But what I thought I would do is, first of all, reiterate the importance of this and then perhaps respond to some of the concerns that have been expressed over the last couple of years about the program so that folks understand that now is not the time to roll back these standards. Now is the time to commit for a continued forward movement with reference to these standards.
Dr. Hassink did a terrific job of explaining the health care consequences of obesity and food insecurity, but I would suggest to you that in addition to the health care consequences, there is also the issue of economic competitiveness. Our country is now facing a global competition for economic opportunity. In order for us to achieve success in that global competition, we're going to need every person in this country working and producing at their God-given ability. The reality is that if you are food insecure, if you're hungry, if you're concerned about your self-image in schools, you're not going to be the learner and the student you intended to be. You won't be as productive in school. You won't achieve as much in school, and the result is that you may very well not be as productive as you could be as a citizen for this country in the future. So I think our economic competitiveness in part is dependent on our ability to stay the course with reference to school nutrition and the child nutrition programs.
If there were admirals and generals here from the military, I'm sure they would say that they are deeply concerned about the condition of our military and its readiness to meet the challenges globally from a national security perspective. Why would they express that concern, and why are admirals and generals who are retired from mission readiness now making that case? Because they know how few young people today are physically fit for military service. Around 25 percent of youngsters 19 to 24 years of age are fit for military service. A principal reason for that low percentage is the fact that the other 75 percent are not physically fit to do the hard work, the manual labor that is associated with defending this country. So it's not just economic security. It's not just health care. It's not just student achievement. It's also national security and the ability of this country to continue to have a pool of dedicated young people who are fit for military service. So this is an important discussion we are having here today. It's an important discussion that Congress will continue to have as it gets back to work today and, as Jessica indicated, as youngsters get back to school, their work today.
Now, I've heard a lot of reasons why it's necessary for us to slow down, to take a step back, to roll back some of these standards, and I want to address several of them today. One of the concerns I heard is that participation is down. Participation is down, and therefore-therefore, there must be a reason for us to roll back, to reduce the standards, to make it a little bit easier for folks. Well, the reality is that school breakfast participation is actually up, which is a positive sign. We're seeing literally now 13 million school breakfast meals served a day, and we know how important that first meal of the day can be.
Secondly, free and reduced lunch student participation is actually up over the last several years. What's down is paid lunch, and that actually didn't start with the imposition of the new standards. That actually occurred several years before the standards were enacted in large part, I suspect, because of the economic realities that we faced. The reality is that we are looking at USDA trying to make it easier for students to participate in this program with community eligibility, which was part of the Healthy, Hunger-Free Kids Act. In those school districts where there are significantly high members of the student body that are free and reduced lunch, then we're making it a little bit easier from an administrative standpoint for schools to participate in the program, but for students to be able to all participate. We think that that will increase numbers.
We know that some of the school districts that dropped out of the program initially are now returning because they realize that, indeed, it wasn't as simple as they thought leaving the program, and we're also simplifying the application process to make it a little bit easier for that third grader to get the information to mom and dad and get it back to the school so that folks can participate.
So there are many reasons why I'm not convinced that participation rates down in the fully paid meal category are a reaction to the school standards and the meal standards, especially given the fact that we see breakfast numbers up and free and reduced numbers up significantly.
Then there's the issue of money. I hear from folks that, "Well, this is just too expensive. It's too difficult for us to do." Well, the fact is that 95 percent of school districts across the country have embraced these standards and are certified as being in compliance, and as a result, they received the six cents additional reimbursement rate that the law allowed.
In addition, we provided $90 million at the beginning of this effort several years ago in implementation resources to states. The sad reality is that still, today, 28 million of those dollars have been unspent by states, so if, indeed, there is an issue with money, then we'd strongly encourage those school districts in the states that have not fully utilized that implementation money to ask for assistance and help from their governor and their state legislature. The reality is 450 million additional dollars is going into the system today. We have also provided school districts the ability to readjust the paid meal rate because the reality was that many schools were subsidizing that paid meal rate at the expense of the rest of the program, and of course, we would encourage schools not to necessarily dip into the school nutrition budget to pay for other aspects of the school budget needs. The reality is that is happening in many school districts across the United States.
So this isn't an issue of money, and in fact, today, we are going to provide additional resources. Jessica mentioned the importance of standards and training and assistance in adopting new strategies. Today, we announced an additional $8 million as part of the Team Up program to 19 different state agencies in states. $2.6 million is going to be provided to assist those states in upgrading the professional standards of the folks who are working in those kitchens and in those cafeterias. That is an extraordinarily important component. We want to partner with schools to make sure that we have the highest level of professionalism in those cafeterias, and we know how important that is to school nutrition personnel. We are also providing 5.6 million additional dollars for our Smarter Lunchroom strategy effort, up to $350,000 going to states to assist them in providing resources, to embrace research-based ideas as to how you might encourage more participation in more fruit and vegetable consumption, for example. There are a lot of interesting strategies that can be used in the cafeteria, and this resource will provide folks the opportunity to access those strategies. So it can't be money. It can't be participation rate.
There's a lot of food waste. There was a recent study from Vermont that suggested that food waste was significant as a result of new school standards. Well, this is counter to a number of other studies, including the one at the University of Connecticut, the Rudd study which Jessica mentioned. The University of California at Berkeley had a study. The Harvard Public Health School had a study. CDC also recently had a study that suggested more fruits and vegetables were being consumed, more entrees are being consumed, and indeed plate waste is not any greater than it was before.
Now, plate waste is an issue around the entire United States, but it's not increased as a result of these school meals. And the Vermont study, let's put it in context. It was two schools out of over 99,000 schools and child care facilities that participate in the school lunch and school breakfast program, two schools out of 99,000.
There's been acceptance by schools at the 95 percent rate. Jessica mentioned a survey of parents showing strong support for this effort and in fact surveys that the kids also reflect an acceptance of these meal standards. So the reality is that that can't be the reason why we're having this conversation about rolling back or taking a step back.
Well, it's that it's really hard to do this. It's hard to get the sodium down. It's hard to get the fat content out. It's hard to reduce the sugar. We just can't reformulate, and in some cases, that's a legitimate argument, which is why we have provided flexibility, provided additional time to be able to allow the food processing companies to adjust to these new standards. And the good news is they are in fact doing that. We have provided flexibility, but the industry is stepping up. They have a can-do attitude, and we want to encourage that. We don't want to discourage it.
I spent an interesting time recently at the McCormick facility, the research facility in Baltimore. Now, this is a company obviously that's in the business of providing spices, but I had one of the best meals I have ever eaten, which was within the calorie content limit of the nutrition standards that met the sodium levels, that met the sugar levels, that met the whole grain levels, and it was deliciously prepared. And the reality is I think what these new standards provide is an extraordinary opportunity for creativity, and indeed, we need to provide the tools for that creativity, which is why we have supported the school equipment grant program, continuing to ask Congress to increase its commitment to that program. $185 million has already been granted. We obviously look for additional increases to meet the needs that we know are out there and know that if we meet those equipment needs, then we are freeing up folks at the local level to be creative.
We have invited chefs to schools. We have created menu contests, all of which design to provide help and assistance, and the reality is that we recognize that some school districts indeed do have a difficult time. It is a small, small, small percentage of school districts, but nevertheless an important component of this, which is why we established the Team Up for Success Program. It was designed to establish a relationship between struggling schools and succeeding schools similarly situated. If you're a rural school and you're having a hard time because your student numbers, your population numbers are down, your state aid may not be as great as it once was, you're struggling with that budget overall, and that cafeteria is having a hard time, we want to pair you up with a similarly situated rural school that has figured out how to do this, giving you the best procurement options, giving you a way of understanding what may be produced and available from a local and regional food system perspective, from our Farm to School program. We want to provide you with technical assistance. We want to provide you a mentoring relationship that will allow you to pick up the phone and call a colleague across the country who is similarly situated and ask how did you handle this particular circumstance and situation. And we know from the initial reaction to our efforts with Team Up for Success that it is indeed working. We have seen a great acceptance of this, and we have now expanded this beyond our initial effort in the Deep South to include every region of the country, and with the help of Mississippi State and their Nutrition Center, the work that Cornell is doing in their Nutrition Center, we are providing up-to-date information so that, indeed, every school district has a pathway to success. That's the answer.
The answer is not creating an opportunity, an excuse for us to move back off of these standards. The answer is not rolling back the standards. The answer is not saying to the food processing industry, "You can't do this." The answer is having the confidence and faith in the industry to be able to do it. Why? Because it's so important. It's so important.
Now, there may be folks out there who don't like the idea that the Federal Government is establishing nutrition standards, but the reality is 9 out of 10 members of the public in this country believe it's appropriate for the Federal Government to establish standards. Why? Because our kids are important. Our kids' future is important. It is tied directly to our country's future.
I understand and appreciate how serious this issue is when the doctor talks about food insecurity and talks about obesity, and I suspect that everyone in this audience and everyone who may be listening to this or seeing this may also have a circumstance out of their own life that they could allude to. But, in my case, it was a circumstance and situation of being overweight. I was adopted into a family where my mom struggled with alcohol and prescription drug abuse, and my reaction to that stress was to eat. And my parents were so concerned about my weight that they put a cartoon of a grossly overweight young person with a little beanie cap, and his stomach was extending beyond his belt. His belt buckle was exploding, and his pants were falling off because he was so overweight. And they put that on the refrigerator to remind me not to go into that refrigerator to eat.
It's tough when you're faced with that kind of situation at home, and you're faced with the bullying and being made fun of at school. It's tough to expect that student to sit down and be an A or B or C student, to want to go to school, to feel accepted at school, to understand the significance and importance of the education to their future and their country's future. It's mighty tough.
So, to the extent that we can help parents, to the extent that we can help grandparents, to the extent that we can help foster parents do what they want to be able to do for their child, to be able to provide them advice and direction and assistance and help at school where nearly a third to a half calories are consumed, to ensure that there's a summer feeding program there for those days when school is not in session, to work with a backpack program for weekends, to understand the significance and importance of the WIC program for very, very young children and young parents who are trying to do the right thing by starting their child on the proper nutrition path, that's what this law is about. That's what this discussion is about. That's how important this is, which is why it's important for Congress to find a way to provide for reauthorization without taking a step back, for Congress to continue the commitment that it made in 2010 to a brighter and better future for our children, and I'm confident that if they are able to do that, if they are able to find a way to reauthorize, to provide additional resources, to do the right thing by this law, it will do the right thing by our children. And, in turn, we'll have a generation of healthier and happier kids who will grow up. Many of them will want to serve their country bravely and heroically around the world. Others will contribute to a growing economy, and most will not be faced with chronic diseases that will cripple their ability to be productive.
That's what this debate is about. That's why it's important. That's why pediatricians support it, and that's why charitable organizations are behind it. And that's why we at USDA will continue to press forward on the important changes that were made with the Healthy, Hunger-Free Kids Act and continue to urge Congress to do the right thing for our kids.