Commodity supplemental food program survey

MISSING IMAGE

Material Information

Title:
Commodity supplemental food program survey
Physical Description:
iv, 122 p. : ; 24 cm.
Language:
English
Creator:
United States -- Congress. -- Senate. -- Select Committee on Nutrition and Human Needs
Publisher:
U.S. Govt. Print. Off.
Place of Publication:
Washington
Publication Date:

Subjects

Subjects / Keywords:
Food relief -- United States   ( lcsh )
Child welfare -- United States   ( lcsh )
Genre:
federal government publication   ( marcgt )
non-fiction   ( marcgt )

Notes

Statement of Responsibility:
prepared by the staff of the Select Committee on Nutrition and Human Needs, United States Senate.
General Note:
At head of title: 94th Congress, 2d session. Committee print.

Record Information

Source Institution:
University of Florida
Rights Management:
All applicable rights reserved by the source institution and holding location.
Resource Identifier:
aleph - 025989149
oclc - 144698402
lccn - 76601685
Classification:
lcc - HV696.F6 U6144 1976
ddc - 362.8/2
System ID:
AA00024867:00001

Full Text



94th Congress COMMITTEE PRINT
2d Session I








COMMODITY SUPPLEMENTAL


FOOD PROGRAM


SURVEY


PREPARED BY THE STAFF OF THE

SELECT COMMITTEE ON NUTRITION

AND HUMAN NEEDS


UNITED


STATES


SENATE


,FL,
pfif""o





41L*


APRIL 1976


* 40


U


Printed for the use of the Sebect Committee on Nutrnition
and Human Needs


U.S. GOVERNMENT PRINTING OFFICE


WASHINGTON : 1'76


68-151











































SELECT COMMITTEE ON NUTRITION AND HUMAN NEEDS

GEO(RO E MciGOVF RN, 5ruth Dakodia, Cliqir,,,a,


iIERlIAN F. TALMADG E. 1;..
PIU ILIP A. HART, :.l:, .i
WALTER F. MONDALIE. Miimiidi,i
El WARD M. KL -1NEDY, M.,-- .c'!ts
(iAYL' RID NIA')N, \\-,.'ii~m
.Al-A \ C RANSTON. ('alifurnh
1i l'iERT H! I II .",I'll iEY, .Mini., -ota


-~
,~ .5
S


-

~


I


'09
. If V.,
*. Sv.^


(IA L.S H. PERCY, Illinois
R{OBERT DOLE, Kansas
HVENY B13 LLMON. i.i1;nin
ICUIIA11;!) -.- 4C1I\VKIKFR. IPcnnsylvanlia
ROBE R"I TAFT, li( Ohio
MARK 0. lIATFIE li)L, Qv,'it.n


IZOBERT M. 5?i'r.m \, S/ifrzDirector
ALAN GTI.NL Get ral Counsel


'S ~


I


(II


1*
Sr
S ,
~) -~
*1


-%'% ,,It .














CONTENTS


Page
Introduction ------------------------------------------------------ 1
Staff analysis----------------------------------------------------
Appendix A:
Letter from Senator McGoverni to suppllemental program directors._ 9
Questionnaire for commodity programs--------------------------- 11
Appendix B: Responses to questionnaire:
Arkan.-.a:
Benton--------------------------------------------------- 15
Fayetteville ------------------------------------------------17
Jas)per----------------------------------------------------- 19
Pine Bluff------------------------------------------------ 20
California:
Sacramento------------------------------------------------ 21
San Francisco---------------------------------------------- 22
Colorado:
Grand Junction ------------------------------------------- 24
Greele------------------------------------------------ 25
Monte Vista ---------- --- ------------ ----------- 27
District of Columbia-------------------------------------------- 27
Illinois: Chicigo- -------------------------------------------- 30
IowI:
Emmetsburg---------------------------------------------- 34
Marshalltown- ----------------------------------------------
Polk County----------------------------------------------- 36
Loiii-.ianiia: Baton Rouge ------------------------------------ 38
Michigan: Detroit---------------------------------------------- 39
Missouri: St. Louis --------------------------------------------- 55
North Carolina: Burlington ------------------------------------- 57
Tennessee:
Dresden-------------------------------------------------- 59
Memphis------------------------------------------------- 60, 02
Nashville -------------------------------------------------- 603
Union Citi------------------------------------------------ 65
Utah:
Moab---------------------------------------------------- 66
Ogden---------------------------------------------------- G7
Salt Lake City--------------------------------------------- 68
Provo----------------------------------------------------- 71
Appendix C: Background materials:
S. 2905-Commodity Supplemental Food Program Act of 1976-_.--_-- 75
Starved brains-reprint from Psychology Today, September 1975_--_- 78
Scientists estimate 1 million children have stunted brains-reprint
from the Community Nutrition Institute Weekly Report, Novem-
ber 6, 1975-------------------------------------------------- 82
Two million children risk underfed brains------------------------- 83
Title 7-Agriculture:
Chapter II-Food and Nutrition Survice, U.S. Department of
Agriculture---------------------------------------------- 86
Section 250.14-Supplemental food program-------------- 86
Section 250.15-Operating expense funds for distributing
agencies--------------------------------------------- 88
Authorities for commodity distribution:
Section 32-Act of August 24, 1935-------------------------- 91
Section 4-Agriculture and Consumer Protection Act of 1973---- 92
Section 41G-Agricultural Act of 1949------------------------ 93
(inI)








A~pp 'I' ('\C: 1-iirkLrmi*niil iii.itri.-il- ('mitimurd Page
.'uieii i!ik-IILl fU t prir gntin- Siirni i:irv t f cy, rAtio0[-, hV nrnt1 1- -- __!)
6,:;1: .'. iiI 3tai fomi rItl zr:, i : Q 'l .iit'-t ;.1d 4-1 iiinaI trtii vi t r,,, )niiji Ii~' f, r tti:-t ib titii n p'wr per,-iti per int -w h .- - -- - - '--S
ip i^ -iti1fn 'cld prt>^r:01i -u inu i~iory __- - ._ -. . _ --------S
:Su p;'Ifin-itail f<">'i pr.,-r.in 11d. tt:t :i i -- f N )\v v nil I, -r I T.! 5- -- -- -- - - -IS
F:IIi i '0 f:Lct Ti iM iii*it ty cut h.imck -rfiprint frui i tIw ( )iiiimnunit y
N itri i.i-i lit-uIui.- Wrfklv IL-p)(irt. April 121. 1973;-- --- -.-------- 103
I. ( ri-. m ~t ri knS-iii- iiif:iit f'oding dc'iri d-ii-rvrintt fri illthe
0 >ii.;i>;ity N'utriti.-ii Tit-tituite Vw'cvklY l6-lpcirt, M aiy '24, 11)73_--_- 104
Me~nFv*r! i'il Li~li-1 to pr-r-rre d(Itnmitq(d Ciii fiit'dilit-.- reprint frmni
fli C ii~nuiiv. Nut ri Iit n Inlit itutL fkvI','~~t JLLIIII;r\ 24
7-1 -.--- - -- - ---- 105
USD )A ii miv revteal-. -trat i'y for ridingi 'C (iii in 1' dil t - reprint frtim
iII' (Xr1II'!llitv Nutrition 1n-tiL.it' W\\eklv r 1974-------- -----------Ll-O------S-------------- --- 10S
Ni i rili-n'>al vTiwn tfi fr'iii Fedeiril fond :in- L-. --t-inr''_ ---- _._- 112
L]'etir fri m lUirh.i;rd L. F-'!t( rr, A^-i-tant Secret :Lry, Marketing and
CO'mi-uicr Srrvico-, USI)A, to Senat, r Mc( <->\rii-- ----------------122












INTRODUCTION


The Commodity Supplemental Food Program was established in
1968 by the Department of Agriculture in order to provide iron and
protein rich food to low-income pregnant women, nursing or po.t-
partum mothers, and children under six. Although primarily the
responsibility of USDA, the program operates in conjunction with
Federal, State, and local health clinics which issue "food prescrip-
tions," and with various administrative agencies which handle
transportation, warehousing, outreach, and distribution. Mothers
receive surplus poultry and meat, peanut butter, farina, fruit, egg
mix, dry milk, vegetables, juice, evaporated milk and corn syrup at
an average per-person value of between $9 and $12.50 per month.
This cest has remained constant over a period of many years.
Prior to 1971, the program operated as a subprogram under the
same statutory authority as the Commodity Distribution Program
(see Section 612c of the Agricultural Adjustment Act of August 24,
1935, 40 Stat. 750, 774, 7 USC 612.) In 1971, the legal basis of the
Supplemental Food Program was altered in that the amended Food
Stamp Act provided for simultaneous operation of the Food Stamp
and Direct Distribution to Needy Persons Programs in the same area
under certain conditions. Also, Public Law 92-32 provided explicitly
for USDA payment of administrative expenses of the program during
fiscal year 1972. Regulations for the program are found in Title 7,
Section 250.14 of the Code of Federal Regulations.
The Supplemental Food Program as developed under the Com-
modity Program is not specifically authorized under any law, except
for funding legislation. This means that changes in the program can
be made by regulation and need not go through the congre -ional
process.
Fiscally, the program is a patchwork. USDA pays for the food and
for its transportation to the State warehouse but not for local operating
expenses. USDA has declined to provide any funds for storage, dis-
tribution of foods, outreach, clerical costs, or any other administrative
costs-nor would HEW provide the funds. All administrative costs
have been placed on the already overburdened county and local
governments.
In many of the supplemental programs in operation in 1976, the
Community Food and Nutrition Program of the Community Services
Administrative covered those administration costs. In other locales,
other sources of funds both private and public, have been found.
The actual operation of the Commodity Supplemental Food Pro-
gram allows for variance depending on the local situation. A comnbina-
tion of county health departments, hospitals, clinics, and county and
local commodity program personnel, are usually involved.
(1)







Vie potential recipient nui-t ihave a certificate or note of medical
noeed from a doctor or a doctor's authorized medical representative.
The1 income status of the mother iV; 1u11.ally certified by the local wel-
fare agoricy. If the women meet,; the-e tets., she then receives either
dorunlents entitling her to pick up the supplemental food package at
the distribution place, or the actual food package if it is kept near the
p11i
A BRIEF CHRONOLOGY OF SUPPLEMENTAL FOOD PROGRAM
1907-196S-Series of meetings between USDA and HEW which
resiilted in a recognition of pregnant and nursing women, and
children under 6 as a high ris-k group.
19GS-Board of Inquiry into hunger and malnutrition in the United
States recommends supplementation of the diets of infants and
pregnant women.
May 190S-Secretary Orville Freeman bow-; to pressure from the
Poor People's Campaign and established Supplemental Food
Program.
March 1969-Food and Nutrition Council of President's Urban
Affairs Council recommends rapid expansion of Supplemental
Food Program and the development of a voucher system.
Ad ministration rejects both recommendations.
April 1969-Directive to Supplemental Food Programs that partici-
pation estimates should be established. These become quotas.
May 1969-President Nixon endorses Supplemental Food Program
at White House. Conference. Conference makes maternal and
infant feeding a top priority.
April 1970-USDA prohibits new programs in Food Stamp Program
areas, excludes children over 1 year old in new programs in
commodities areas, and reduces food allotments.
May 1971-USDA requires termination of supplemental programs
in all those areas transferring from commodities to food stamps,
except Indian reservations. Peanut butter and egg mix are
removed, and juice allotment is reduced.
June 1971-Public Law 92-32 passes. Section 6 provides $20 million
for fiscal year 1972, part of which could be usmed for administrative
expenses.
August 1971-Deputy Assistant Secretary Philip Ollson freezes
supplemental funding level, excluding 820 million in Public Law
92-32.
December 1971-Due to political pressure, peanut butter, egg mix,
;ind juice are restored to program nationwide. Detroit supple-
mental is allowed to increase its quota four fold.
Fall-Winter 1972-OEO's Emergency Food and Medical Services
budget is cut-numerous supplemental program nis face shutdown.







March 1973-USDA institutes an absolute ban on new Supple-
mental Food Programs pending an evaluation of WIC. Shortages
of vegetables, dried milk, and evaporated milk become more
severe.
January 1974-USDA memo recommends sharp reductions and
"hopefully a phaseout of all Supplemental Food Programs."
June 1974-Public Law 93-347 passes. Supplemental Food Programs
funding authorization is to continue until June 30, 1977.
January 1976-Senator Hart of Michigan and Senator McGovern
introduce legislation to make Supplemental Food Programs
permanent.
January 1976-USDA issues regulations on WIC expansion giving
priority to Supplemental Food Program over areas with neither
program.
March 1976-USDA agrees that it always had authority to add
infant formula to the food package but has arbitrarily chosen
not to do so.



















Digitized by the Internet Archive
in 2013













http://archive.org/detaiIs/commilem00unit












STAFF ANALYSIS


Almost since its inception, the U.S. Department of Agriculture has
acted in a manner designed to destroy the effectiveness of the Com-
modity Supplemental Food Program.
In spite of USDA's efforts to close the Program, it has been one of
the most cost-effective federally mandated child nutrition programs
ever implemented. This is a result of the economies of scale effected
by USDA, combined with the expertise of USDA purchasers. These
two factors have kept the cost of providing a month's food to each
recipient at a relatively constant and low level for the life of the
Program. In addition, it should be added here that local administra-
tive costs for the Program range from a low of 50 cents per person per
month to a national average of $1.55 per person per month based on
the Committee's Questionnaire. The responses represent 112,702
recipients out of approximately 140,000 recipients or about 80 percent
of the recipients of the Program nationally.
USDA, as part of its ongoing efforts to diminish Commodity Sup-
plemental Food Programs, is once again urging Commodity Programs
to join with the WIC Program.
The proposed WIC regulations (7 CFR 246) give priority for new
WIC slots to existing Commodity Supplemental Food Programs,
ignoring those areas which have no special feeding program for low-
income nutritionally-at-risk mothers, infants and children.
The only reason for this nonsensical decision by USDA must be the
desire to limit the total number of persons on supplemental feeding
programs. This policy guarantees that there will be no relationship
between the need for supplemental feeding programs and the actual
participation in those programs.
In addition, USDA's policy for those Commodity Supplemental
Food Programs which have had to switch to WIC for a variety of
reasons, including inadequate administrative funding, is to limit those
Supplemental Food Program change-overs to current participation
levels once they join WIC. In other words, a program with 500 cur-
rently participating recipients is limited to 500 recipients once they
change to WIC, even though their original Supplemental Food
Program caseload may have been authorized for 1,000. Money saved
in this manner will not be made available for WIC, nor will any new
Commodity Supplemental Food Programs be allowed to start up
under current USDA policy.
USDA could not possibly absorb both the 140,000 Commodity
Supplemental Food Program recipients and the over 850,000 new
WIC applicants in the near future.
Program expansion funds for WIC have been set by USDA at $25
million nationally. It would make more sense to take this money
(5)







andl spend it in areas- where neither supplemental feeding program
exi"t N. This '. "25 million iomild we available for WIC ( 'Xpaisioil and.
not as- a .-1 rgaiin tool to tve to keep Sippleenilt ail Food Progranmi
And IVIC a(pplicalts oipetinig for fiinds- iwtween i tiemsniselves-. TIim
deci-ion l) I'SDA to ( i pievt deferral for S6 million in WIC fund,
de(lloil-t1l tIe thleir lack of desire to iimnplement any kind of sippli-
imncit.a feeding: pro(rnamii, eithlier Suippleime n t a!l Food Prourain or WI- .
TIhe 1.151rt to clo-e thie commodityty Sipple ntal Food Programi-
io iifv. SiIne 1970, USDA liai-s miadle a naiumllber of administrative
deci-iois wlieijli lavec flIhnlicapped tlie Comminoditv Siipplevmental Food.
Pro1rra V, i prevented it from blinc; truly effective. ther the yCar-,
tlim two mo-t de-t'uicli\" y thilngs USD.DA lias 0done are (1) reflsn to
provide administrative fundm, for the prozram-i, and (2) not muakimio
commli )oditfiep- available In 1a timiely fa.hiion.
Coinmod ity Siippleimental Food Progrmans have closed in many
locations- sipyiq)]N becaus-e local .spon-or- could not afford to run thiemi
any longer. (oimtv and State money lias leen limited, when avail-
able. and money for the Commnioditv Supplemental Food Programn
ha, been soiiudit by and needed by other agencies in many localitie-.
After a period of time, local -ponsors hayve. decideil to, amid, in -*:0oiuJ
casle, been forced to change to WIC so a- not lose the ability to feed
neeld.vy inothers, infants, and children.
In other cai-.e, local sponsor-; have blOn so concerned about the
availability of coimnodities that they have changed to the WNIC
Pro,-riamn in an attempt to guaranitee some stability to their supple-
mental feeding effort. USDA, while never actually closingm down a Sup-
plement.al Food Program, intimidated many program--fearing tlie
end of their commodities, they have come to believe that WIC should
be accepted in place of Commodity Supplemental Food Programs.
When the Commodity Supplemental Food Program began, USDA
reque-ted caseload needs from the spon-ors of the Programs. These
figures were to be e-timates of the need for the Program in the area to
be seIrved. Once the-e figure-, were in, USDA decided that. the figure7-
would repre-ent caseload authorizations or maxirnum allowable case'-
loads rather than estimate^ of need.
Two developments have re',ulted from USDA's administrative
deci-.ion to arbitrarily limit caseloads on the Commodity Supple-
mental Food Program.
Fi-t, no Program may go beyond its authorized ca-eload despite
the obvious need for the Commodity Supplemental Food Prograni
in the local area. Second, no Program may allow another Program to
accept or utilize caseload which is unhmsed. Commodity Supplemental
Food Programs are sharply limited in their attempts to expand to
meet local needs by these USDA imposed policies.
The original authorized caseload for the Commodity Supplemental
Food Progmamn wais about 275,000 low-income mothers., infant", and
children. With the recent approval of ain additional 20,000 people
for the Detroit program Commodity Supplemental Food Program
has an original authorized caseload of 295,000 per-ons. However,
only 138,000 persons are now being served. The authorized caseload
for the Commodity Supplemental Food Program combined with the
current caseload of about 830,000 for the WIC Program w%-ould at
least be a substantial Federal commitment toward ending malnutrition







-among approximately five million low-income nutritionally-at-risk
mothers, infants and children.
Over a period of years, even with problems outlined above, it has
still been possible to document the improvements that have been made
in the nutritional health of Commodity Supplemental Food Program
recipients. The study by Drs. Anthony G. Kafatos and Paul Zee,
"Nutritional Benefits from Federal Food Assistance," covers a three-
year period involving 4,000 preschool black children from South
Memphis in the Commodity Supplemental Food Program.
Their study concluded that: "In the absence of other recognizable
intervening factors, we conclude that Federal food assistance programs
were primarily responsible for the observed nutritional improve-
ments." The children on the program showed "significant improve-
ments in height and weight" over the three-year period. Anemia
decreased "significantly" as well. This kind of result from a low-cost
Federal program is nothing new. For many years, a correlation has
been proven to exist between inadequate diets among low-income
persons and anemia, low-birth weight, stunted growth, low serum
iron values and other indicia of abnormal growth.
The policy at USDA must be changed. Hungry mothers, infants,
and children must be fed now at a low cost so that society does not
have greater costs to bear for the care of these individuals later on.
It seems apparent that society will have some costs to bear at some
point for low-income nutritionally-at-risk mothers, infants, and
children. It only seems logical that the least expensive cost would be
preferred. The low cost of the Commodity Supplemental Food Pro-
gram should be preferred to a policy which can only lead to geo-
metrically higher costs later.













APPENDIX A


U.S. SENATE,
SELECT COMMI TF.E ON NUTRITION AND HUMAN NEEDS,
WaUshinton', D.C.
DEAR SUPPLEMENTAL FOOD PROGRAM DIRECTOR: Sin 9, the
Cominmodi ty Supplemental Food Program has provided Ccom !Iditifels
for thousands of low income pregnant women, nursing and po-rtpj'tm
m-lothers, infants, and children under six years of age.
The United States Departnient of Agricuhture, which adui niters
this program, has taken the position tihat this p!C.' ami -hui il be
eliminated. As a. result, the number of Drograms LaUS d1oppAd from a
Ii.yh of 310 (37 States) in 1971, to a present level of 100 (5
Tile number of participants has also been dr:stially reducedf.
However, the Senate Select Committee on Nutrition and tiuman
Needs has, over the years, received very positive esio with
regard to the Commodity Supplemental Food Program. Asa result,
we would like to pre--. ve and improve this program. B>1ore( sh-
mitting new 1egisIlation to Congres.s, the Conimnlit wI ic to
certain that you, as program aL tr;:to7 have to opportiiity to
IImke those recommendations anu criticm~nis you think are relevan.
Therefore, your prompt response to the followingr questions will be
greatly appreciated. We realize that in some c;. es o1lJ- an elrcie
guess can be provided.
Thank you for your attention to this matter.
Sincerely,
GEORGE MCGOVERN, COa'krr,\an.
(9)












QUESTIONNAIRE FOR COMMODITY PROGRAMS
1. (a) How many recipients are you serving?
(b) Do you have a ceiling on your caseload?
(c) If you have not reached your authorized caseload, what have
been the reasons?
What is your total requested caseload?
2. What is your actual current budget? How does this break down
into food costs and administrative costs?
3. (a) Who administers the commodity program in your county?
(b) How many staff persons are budgeted for in your contract?
(c) Who is your contracting agency?
4. Are the people most in need of the commodity program being
reached in your project area? If not, what needs to be done to
reach them?
5. (a) Who pays administrative costs for your program?
(b) For the most recent month with available data, what were
the actual administrative costs of your program?
(c) How much, if anything, was paid by USDA?
6. What constitutes administrative costs for your program? Could
you pay for outreach, operating costs, nutrition education
indirect administrative costs, and the costs of administering
the local office if twenty percent of the projected total yearly
budget were made available for these purposes? Less than
20 percent? More?
7. (a) Which food delivery system do you use?
(b) Are you satisfied that your system works well?
(c) Can you estimate the cost, per participant, of your food
delivery system?
S. (a) What percent of your present budget would be required to
run an adequate nutrition education program?
(b) How important do you feel nutrition education would be to
the Supplemental Program?
(c) Does your Program currently have a nutrition education
component? If so, how much has it cost and what percent,
if any, of the money comes from your proginmm's admini-
stria-tive budget? What percent comes from in-kind
contributions?
9. Have you found that any of the foods in the Supplemental food
package are being rejected, for whatever reasons.
10. (a) Are you satisfied with the nutritional value of the Supple-
mental foods?
(b) If not, what recommendations would you make to change the
food package?
(c) What recommendations would you make to change the
manner of delivery of the food package?
11. Do you know of any unfunded project applications in your area?
How Yi:tIn persons and how much money do these applications
rep)re ent
(ID1







12. Assuming adequate monies were available to remch all persons in
Vour area eligible under current Snupplementail Program guide-
line^, what would your total calseload be? What would your
total budcret be?
13. If there hua been any medical evaluation of the Sl-upplemental
Pr(oigram, plen-e at tach the result-. At this point, call vou
a cribe to It he Supplementail Prograi any V im ve1 d eoc nt
counts. d*ocrezi-ed infant mortality rates, etc.?
14. What are oui ui-ingr for initial eligribility criteria for participation
in the Supplemental Prgranmi?
15. II a the Supplemewn t il Pro-i vin afTected partici nation in other
rehited a lidt4 or welfare prolxrrmnin- for low-income recipient -?
16. Phea-ze li.st yvour priority recommend ion< for change in tlie
commodityty Supplemental Food Progrim legi.l nation, kee1)ipg
in Dind the import inmce of olth d nimii'-trukive efficiency and
meaningrful heaidh care for thii-s vulilibl)!e group. Feel free to
sumLge~t le&~i-l ~itive iii iigua e.





























RESPONSES TO QUESTIONNAIRE


68-151-76---2















APPENDIX B


CENTRAL ARKANSAS DEVELOPMENT COUNCIL, INC.,
Benton, Ark., Deceinber 1, 1975.
Hon. GEORGE MCGOVERN,
0w frinan, Select Committee on Nutrition and Hluman N(eds, U.S.
Senate, Washington, D.C.
DEAR SENATOR MCGOVERN: I was very pleased to get your ques-
tionnaire on the commodity supplemental food program. We have
been administering this program for a number of years in the two
counties in Central Arkansas. I feel that this program has made a
significant impact on the nutritional well-being of the children in-
volved in our program. Enclosed you will find our response to the
questions you provided. I hope this information will be of value to you
in your efforts to continue the supplemental food program.
Sincerely,
CHARLES F. CUNNINGHAMA
Executive Director.
Enclosure.

RESPONSE TO QUESTIONNAIRE FOR COMMODITY
PROGRAMS
1. (a) 725.
(b) Yes, we do have a ceiling on our caseload.
(c) We have reached our authorized caseload and we have
requested a total caseload of at least 900.
2. Our actual current budget is approximately $181,000 per year.
Our administrative costs are approximately $8,500 per year
and the value of the food which we distributed last year was
approximately $173,000.
3. (a) The CADC administers the commodity program in both
Saline and Hot Spring Counties.
(b) One staff person handles this program. Our agency works
directly with the state office of the U.S. Department of
Agriculture for commodity distribution.
4. We feel that we are reaching people who really need the service
in our area. Since individuals have to pick up their own food,
we feel we are mis-in' some people who lack transportation.
5. (a) Administrative costs are paid from our basic administrative
grant from the Community Services Administration.
(b) Our actual administrative costs for the last month were $6S5.
(c) None of this was paid by USDA.
6. Administrative costs include salary of the individual who
distributes food, transportation cost and some contr a ct labor
help in transporting the food. We also include some duplicating
costs for material distributed to participants.
(15)





16


6 a Food is4 (distributed once each month to participants. We
order food itemsH and pick theim up once each month at
U SDA coinmiodity food offices in Littie Rock. Participants
can come in on one day of the week during the entire month.
(h) Our syVtem ('i works reaIonalbly 1 well.
(c) O(ir (-*1iM at es :re that )1u deliVery syVtemi which in effect
merani- our adminisrii'tr'ative co-ts run alout 870 per person
pIll.! TIl'ult Ii.
S* (a) We would '1e ,approximat ely 10 pewrcnt would be necesssary
for -oi adequate nutriition education program.
N We feol that nutrition education is vital y important to the
supplement ;i1 piroL:!';ini.
(c) Durinullr tfh0 pa-t yeair we have had a nutrition education com-
jmnont for our pr(.
We li;kd a VI STA worm4king witli the pnro ni who was very effec-
tive. Our costNv were only tho~e -upp(rtive cc"ts flece-vY for
tn'iMns-portzation ;ind f lBt eri.nlIs. No ini-kind monitribiition" wevei
l110(d in thii educa,!ional efl' i t. Our nutritioniit i^ now gone
andl we feel that ti s i.-; a r[eAt lo]<- to our proyra1.
9. O(ur experience ha- been tli:it if recipients are provided with
peci .1 recipes and are enconILraed to try new ways to prepare
the foods, I1o0t foods a[re u-ied. We do find that F1arina
is not ;is attractive to them as some of the other items
they vet.
10. (a) ye,- we are relatively :atisfied with the nutritional value of
the -sIupplemnental foods.
11. Yes. we would like to establish such a progiatmiii in Clark County
which we feel we could administer for very little additional
cost. Our efforts in the past, to establish such a progriiin have
met with no succes-. We feel that 400 pregnant women, nursiinc
mother-l, infants and young children could benefit in juA. t fliat
one county. We feel that we could admninister the program for
an additional $3,000 to $4,000 and that serving 400 persons
would mean apiproximnately $S5,000 worth of food a year.
12. We fore.ee. the need for a caseload of around 1,500 in the three
county area. An adequate administrative budget. for such a
program which would also p)iovide nutrition education would
be around $20,000 per year. Since we pick up food and only
do estimates of its value, this cost, we can estimate at $360,1000
per year.
13. There have been no medical evaluations of our supplemental
program.
14. Eligibility criteria are that either the mother or children are
suffering to some degree from malnutrition. Eliribilitv it;
establii-hed in local health departments by public health nurses.
After the per-ons are certified we then add them to our caseload.
15. We provide information to supplemental prognim plirticipaints
on other programs available to them. We have not done an
ais-e~-ment of how frequently these persons take advantage of
those other proL-rams.
16. One of our priority recommenldations for change in the program
is that a nutrition education component be included. WAe have
surveyed participants during the last quarter and are now







analyzing the results of our surveys. When that information
is available, we will be glad to provide it to you. We found
that the respondents reported using the food provided and
also benefited from the educational information provided to
them.

ECONOMIC OPPORTUNITY AGENCY
OF WASHINGTON COUNTY, INC.,
Fayetteville, Ark., December 22, 1975.
GEORGE MCGOVERN,
Chairman, Senate Select Committee on Nutrition, and Human Needs,
U.S. Senate, Washington, D.C.
DEAR SENATOR McGOVERN: I would like to respond to your ques-
tionnaire for Commodity Programs mailed to our agency Novem-
ber 20, 1975.
The Economic Opportunity Agency is responsible only for the
distribution of commodities in our one-county service area. The local
health department determines eligibility of applicants. I have con-
sulted with the county health department and state social services
personnel regarding the commodity program, and I feel the informa-
tion to follow is accurate.
I do hope this information will be helpful to your committee in
its deliberations.
Sincerely
JEANIE WYANT,
Administratire Aide.
Enclosure.

RESPONSE TO QUESTIONNAIRE FOR COMMODITY
PROGRAMS
1. (a) Between 70 and 100 recipients.
(b) Caseload ceiling of 200.
(c) The local health department, as is their right, chose to certify
only pregnant women and children under one when they
negotiated their new agreement. In the past, children under
six were eligible. The health department still requests a
caseload of 200.
2. The State Health Department is responsible for the administration
of the supplemental, food programs in the state. Neither the
county health unit nor EOA receives direct funds to operate the
program. I do not know the State's budget nor its breakdown
into food and administrative costs.
3. (a) County health unit public health nurses certify eligible par-
ticipants, and the EOA (local community action agency)
distributes the commodities.
(b) No staff are budgeted in the health department's authoriza-
tion agreement nor in the EOA's distribution agreement
with the State.
(c) Arkansas Social Services Food Distribution Unit.
4. Probably not. Local health unit has cut back on persons they will
certify (children under six). There is no coordinated outreach or
public information effort conducted by the health department.





is


5. (a) The state bears the health department' ad ministrat itivv- costAs.
EOA pays one part-time person for 61 time spent distribl)utig
food plus 4mileage e''xpens oi the job.
(1b) EOA paid S40 in Novemibeir to the part-time dit ribultion
sup1ervisor.
(c) EGA a 211( Health Deparll'miient receive Io direct funds from-i
USDA.
6. See Section 5a. Not applicable as stat recei mione1 Y f1( )i1
USDA.
7. (a) Food is di-4ribuited att two sites in the count onco a weilhk
and once eveiyv two wNeek-.
(1)) Thj systemn work.s well.
(c) Minimial, next to nothlingr.
S. (a) I believe EGA could admuinistver thle oi lire supplemental food
prograli ini tII is coutyIl b hiring two full-time people to
(certifV, dli-tribute anid plan nutrition eIdu(lcationl.
(b) Nutrition e(Iiucation is a very imnportanit- part of the program.
Basic, information on nutrition aI well a;s specific training
on how to iise cominoditites is necessadL rv.
(c) The only nutrition education is done informally 1b public
Ilmilth nurses- whvii ceitilying applicants. On 0i o(-.ion, a
participalnlt will comment on celtain food(s, uIId thI ('1eaulth
1111nres e-sIpond. The EGA distr-ibution s1ipervi-(Or makes
available paniphlets for participants. Budi get que-tion1, iiot
applicable.
9. Our distribution supervisor s:s vegetarians ne.'( suibstituttes for
meat items. She also has had unfavorable comim-ientfst d)(jut the
farina stemming from what -;ie believes. is lark of knowledge
on how to prepare it. Health mirses have had complaints alout
powdered eggs also due, they believe, to no kiowie.ledge of how
to use them.
10. (a) Yes.
(14 No comment.
(c) No recommendations.
11. No, but the applications would be made to the State Ilt-alth
Department or Social Services Divi-ion.
12. The caseload would be at least 200 and pos-ibly twice tilat
(estimate).
13. There has been no formal medical evaluation of the sup)plemnent al
food program mi. Public health nurses have rerords on babies
attending well baby clinics, but, again, no conclusions, as to
relationships, if any, between health and supplemental food use.
14. Public health nurses certify pregnant and lactatiig mother-; and
children four mniiths to onev yvar if they meet current poverty
guidelines (Community Services Adminim-tration).
15. No information except that soime participate nts find out about
other lil('lth department services available to them.
16. I am not familiar with the current Commodit V Supplemental Flo(o
Program legislation. Also, I do not know if Arkansiia.' adwiniiiis-
tration of the food program is typical.
The only siuggestions I would make would be to alh.w some fuminding
for a(dministration to go directly to tile local program. Again, I
do not know if this Inappens in other states.







OZARK OPPORTUNITIES, INC., P.O. Box 217, JASPER, ARK.
RESPONSE TO QUESTIONNAIRE FOR COMMODITY
PROGRAMS
1. (a) 300.
(b) Yes.
(c) Contracting agency rules and guidelines.
2. We do not operate on a monetary budget per se.
(a) Food cost determined by contractor, not known to us.
(b) Administrative cost borne by Ozark Opportunities, Inc. A
Community Services Administration funded program.
3. (a) Same as 2b.
(b) 1 full time, 2 part time.
(c) Arkansas Department of Social and Rehabilitative Services
Food Services Division, P.O. Box 5071, North Little Rock,
Arkansas 72119.
4. (a) Not completely.
(b) Guidelines of contracting agency apparently eliminates some
needy families.
5. (a) Same as 2b and 3a.
(b) $650-rent, wages, and truck charge-..
(c) None.
6. (a) Same as 5a.
(b) Yes (20 percent).
7. (a) 001 transports food from Little Rock (150 miles) recipient
gets food from store house in Jasper.
(b) Yes.
(c) Approximately $2.20 per person per month.
8. (a) Cannot be approximated because cost of food unknown to
administrative agency.
(b) A good nutrition education program would increase value of
Supplemental Food Program.
(c) No.
9. Some items of food are rejected by a few people for various reasons.
(A nutritional education program would overcome most of the
rejections.)
10. (a) Yes.
(b)
(c) USDA to transport food from Little Rock to Jasper.
11. None known at this time.
12. If guidelines were adjusted to include needy families who do not
receive assistance under other programs the case load would
double and also the budget.
13. (a) No medical evaluation has been done in area but for some
reason (possibly supplemental food) the hemocrit of Head
Start children has increased in the past few years.
(b) Screening activity affords an opportunity for County Health
Nurse to detect orthopedic, vision, hemoglobin, etc.
problems.
14. County Health Department screens participants, initial eligibility
criteria for participation is that the family receive some type
of assistance from Department of Social and Rehabilitative
Services.





20

15. No.
16. (J) Include emergency clauQe for unforseen circumstances.
(b) Use a4 guidelines something other than requirement of
participation in Social and Rehabilitative Services.
(c) Raise age limit for special rases i.e. children with physical
defects that could be attributed to malnutrition.


PINE BLUFF JEFFERSON COUNTY ECONOMIC OPPORTUNITIES
COMMISSION, INC., PINE BLUFF, ARK.
RESPONSE TO QUESTIONNAIRE FOR COMMODITY
PROGRAMS
1. (a) Average number of recipients served each month-1,410.
(b) The ctiseload ceiling is 1,500 recipients.
(c) We have at different times reached our authorized caseload
ceiling. We have requested that the caseload ceiling be
increased to 2,000.
2. None.
3. (a) Pine Bluff Jefferson County Economic Opportunities Commis-
sion, Inc. (Community Action Agency).
(b) None.
(c) None.
4. No. To reach all people that are in need of the program it would
require funds to employ a staff of approximately fifteen.
5. (a) The administration cost or operation cost is absorbed by this
agency.
(b) The monthly operation cost is approximately $1,900.
(c) None of the cost is paid by USDA.
6. (a) The salary for two (2) intake clerks and approximately 10
percent of the salary for the director of General Services under
which the program is administered.
(b) The county provides the transportation for transporting the
food to a central location for distribution.
(c) The manpower required in handling the food is provided by
this agency and the CETA program.
7. (a) The food is transported by county trucks from the central
warehouse in Little Rock, Ark. to Pine Bluff, Ark. distribu-
tion center. The recipients then pick the food up at the
center.
(b) Yes.
(c) No.
8. (a) The nutrition education program is being conducted by the
local county extension office nutrition program.
(b) Very important as part of the over-all program.
(c) No.
9. (a) There has not been any rejection of any of the supplemental
food packets.
10. (a) Yes.
(b) It is recommended that more varieties of food be used in the
program.
(c) None.





21

11. There are no known unfunded project- application in this area.
12. If adequate monies were available the caseload would be approxi-
mately 2,000 per month with a total budget of approxi,.uitely
$2,900 a month.
13. No medical evaluation can be made by this agency.
14. The criteria for participation in the program is determined by the
health department.
15. The supplemental food progrn-m has affected participation in
related health and welfare programs.
16. (a) That fund be appropriate for supplemental food programs.


COUNTY OF SACRAMENTO,
HEALTH AGENCY,
Sacramento, Calif, Decemibn r 30, 1,975.
Hon. GEORGE MCGOVERN,
Chairirman, Select Committee on Nutrition and Human Xce-!s,
Wa.shington, D.C.
DEAR SENATOR McGOVERN: Enclosed is our response to your
Committee's request for input regarding the Commodity Supple-
mental Food Program.
We hope that our experience with this pro--:inn v-ill aid your com-
mittee in its attempts to strengthen and improve it.
Very truly yours,
TED GRADY, Assistant Director.
Enclosure.

RESPONSE TO QUESTIONNAIRE FOR COMMODITY
PROG RAMS
1. (a) About 2,000.
(b) Yes-2,000.
(c) Not applicable.
(d) 2,000.
2. Food cost------------------------------------- 1 $24, 000
Warehousing and delivery------------------------- 32,000
Outreach, eligibility and follow-up------------------ 23, 000

Total------------------------------------- 79,000
2 Retail value of coiuinodities is estimated at $?50il0.000.
3. (a) Sacramento County Department of Community Health.
(b) Two stock clerks.
(c) Program run jointly by Departments of Community Health
and Personal Health.
4. Yes, there is good representation of low income, nutritionally
needy families. The program is well known to the Welfare
Department and other social agencies that refer candidates.
5. (a) Sacramento County.
(b) Approximately $6,600.
(c) Nothing.
6. (a) Warehouse rental, delivery costs, salaries for warehouse,
delivery and field personnel.
(b) Not with the present method of valuing the food. However,
if for purposes of determining an administrative allowance,





22


the food wore valued at retail, twenty percent would be
adequate to cover present. administrative costs and to
improve the nutrition education component.
7. (;) 50 percent of food is delivered by county, 50 percent is picked
up by recipients.
(b) Ye-.
(c) S0.75/3participant'month.
S. (a) Approximately 20 percent.
(b) Very important on a selected recipient basiS.
(c) Yes, on an as needed and as available basis. We have not
CO.-ted out the nutrition education element of our service.
Dependingr upon the specific need of thl recipient, nutrition
education may be provided by a Community Health Nurse,
Public Health Aide or through ,omie other community
resource. Our experience lias been that nutrition education
is- most effective on a one-to-one basis. Also, some recipients
need intensive help for fairly long periods initially. However,
on-going routine education has not seemed profitable.
9. No.
10. (a) No.
(b) Need more protein and staple foods, less vegetables. Would
suggest pinto beans, rice or wheat flour.
(c) None.
11. No.
12. We do not have sufficient data to answer this question.
13. There has been no medical evaluation and so no statistics are
available.
14. Low income and nutritional need.
15. The program is an excellent referral source for other health
programs such as well child care, family planning, immuniza-
tions and medical care follow-up. Many referrals are made to
the food stamp program from our recipients.
16. The future of the program would be more assured if the fiscal
impact of administrative cost on local government could be
reduced or eliminated through an adequate administrative cost
allowance.

CITY AND COUNTY OF SA x FRANCISCO,
BUREAU OF MATERNAL AND CHILD HEALTH,
DEPARTMENT OF PUBLIC HEALTH,
San Francisco, Calif., January 5, 1976.
Senator GEORGE MCGOVERN,
Cha 'r+an, Select Conitizittee on Nutrition and Human Needs, U.S.
Senate, Wa.hington, D.C.
(Attention: Senator Philip A. Hart)
We have attempted to answer your questions to the best of our
ability and arc hereby listing our answers in the same sequence as
the questions.
Sincerely yours,
ISOLDE E. LOEWINGER, M.D.,
Director,
Bureau of Afaternal and Child Health.
Enclos ures.





23


RESPONSE TO QUESTIONNAIRE FOR COMMODITY
PROGRAMS
1. (a) In August 1975-8,964. In September 1975-8,404. In
October 1975-7,966.
(b) 11,883.
(c) The mobility of the population, the uncertainty of the future
of the program, the drop in the birthrate, and shortages
of certain commodities discourage some clients.
(d) Same as 1 (b).
2. There is no budget available for the Supplemental Food Program.
Food is furnished by USDA. The Economic Opportunity
Council pays $50.00 per boxcar or $1.00 per case handling
charge for transportation. All other administrative costs are
furnished bv EOC or through volunteer agencies.
3. (a) There is a contract between the State Department of Educa-
tion and the San Franci-co Department of Public Health.
The San Francisco Department of Public Health sub-
contracts with EOC.
(b) None.
(c) State Department of Education.
4. We do not think we are reaching all in need and we plan to have
more outreach.
5. (a) Economic Opportunity Council.
(b) Approximately $16,000.
(c) None.
6. Rental of warehouse, utilities at warehouse, transportation,
supplies (i.e. packing boxes), rental of forklift, salaries of ware-
house staff (including fringe benefits), boxcar charge of $50.00
each, security system at warehouse and miscellaneous smaller
expenses. Yes-20% or possibly less would suffice.
7. (a) There are 10 distribution centers located throughout the
City. They receive the food by truck from the Central
Warehouse and the participants pick up the food monthly
from the distribution centers.
(b) Yes.
(c) Approximately $1.80 per package.
8. (a) 2Y percent or about $40,000.
(b) Very important.
(c) Yes-it is all in-kind contribution and can be valued at
9. No. approximately $20,000 per annum.
10. (a) Yes.
(b) None.
(c) None.
NOTE.-If corn syrup could be packaged in tins instead of
glass bottles it would eliminate the possibility of breakage
and damage to other commodities.
11. No.
12. To the best of our estimate, this program in this City could
serve close to 20,000 eligible recipients.
13. Not available.






24


14. El:igiliht aticordincr to USDA reguiiatio011s "iii(l policiet'-Title
VI I-Co(mniodity Diktribution, Subchapter 11, Section 250.14 -
4B, da2ted Janujary" 15, 1969.
15. Ye'---tlie SupplFoiontal od Program hIas; brought eligiblvh into
other proogrnais, Mi as food A.11 st11p and health services.
16. None.

COLORADO WIE-VT CONMNIIMTY ACTION PROGRAMS,
2.22 MAIN STREET, GEAT GI) JUNCTION, CoLO.
RESPONSE TO QUESTIONNATRE FOR COMMODITY
PROGRAMS
1. (a) We are serving ta total of approxinintely five hundred-twenty
(520) personI1 per month.
(b) Our ceiling is 1,000 per-sons.
(c) Our reason for not rcacliing our caseload is because we Li(.k
funds with whi(-ich to operate a suitable program.
2. Our budget was about $15,000.00 per year for the AdmniniztrationL
of the Program. The foods are of no co-t to us since they are
donated foods from the Department of Agriculture.
3. (a) We are the Administrator' of the Program-Colorado Weszt
Comminiunity Action Programs,.
(b) We have no budget contract.
(c) Colorado Ve-;t Community Action Programs.
4. What is needed to reach more people in our area is to have
adequate personnel, to outreach, and to deliver foods to tlio-e
for whom lack of transportation is a problem to pick up com-
modit ies.
5. (a) 70 percent from Community Service. Administration, 20
percent from County Commissioners and the rest cone:
from asking for charity in the Community.
(b) $-1,000.00 average per month.
(c) Nothing.
6. Admini-tration of the Program constitutes a total operation of
the Proirram: ordeiing, transporting, unloading, packaging,
and distributing of foods; also includes filling all types of forms,
making reports, and keeping active and inactive file system;
also includes storage and distribution facility, etc. I do not
know what the projected total yearly budget is, so therefore,
I cannot give my opinion.
7. (a) Because of the lack of funds, we distribute foods four (4)
times per month at the Distribution Center, and we make
horne deliveries on a very limited ba4is.
(b) No, but we can only work with what we have.
(c) Under this limited system, we estimate the cost per participant
in the Supplemental Foods Program at $30.00 per year.
8. (a) 100 percent.
(b) Nutrition education is a must for this Program.
(c) We do not have a direct component. We have a good working
relationship with the CSU Extension Service and they
provide nutritional education.
9. We have not.





25

10. (a) No.
(b) We recommend an increase of some of the foods, and that
other food items be included.
(c) None.
11. No applications have been submitted because the Department
of Agriculture does not want to start new programs in other
counties. This information was related to us by the Depart-
ment of Social Services of Colorado.
12. Our caz-eload could be almost to maximum (1,000 persons per
month) in Mesa County. Our total budget would be excluding
nutrition education $40,000.00 per year.
13. No.
14. National poverty income guidelines.
15. No. (Question unclear.)
16. The priority recommendation that we are making is: Adminis-
trative monies must be included in the legislation.


WELD COUNTY DEPARTMENT OF HUxMAN RESOURCES,
Greeley, Colo., February 18, 1976.
Hon. GEORGE MCGOVERN, and HON. PHILLIP A. HART,
jU.S. Senate, Select Commrnittee on Nutrition and Human Needs,
IlWashington, D.C.
DEAR SENATOR MCGOVERN AND SENATOR HART: Enclosed are our
responses to the Questionnaire for Commodity Programs.
It is our understanding that the questionnaire is geared toward
the new legislation that you have proposed (S. 2905). In review of
S. 2905, it is my opinion that it will improve the Supplemental Foods
Program in Weld County, Colorado. I am in full support of the bill.
Unless we can receive additional funds for the expansion of the pro-
grain and funds for administrative costs, the quality and effectiveness
of the program will be affected. The program has made a substantial
impact on the community and its continued growth is of great
importance.
Upon passage of the bill, Weld County would appreciate fair con-
sideration for funding.
If we can be of any further assistance through additional support
materials, please contact me at 351-6100 or Weld County Division
of Human Resources, P.O. Box 1805, Greeley, Colorado, 80631.
Sincerely,
WALTER J. SPECKMAN,
Executive Director.
Enclosure.

RESPONSE TO QUESTIONNAIRE FOR COMMODITY
PROGRAMS
1. (a) We serve from 700 to 800 families a month or 1,400 to 1,600
individuals.
(b) No.
(c) The Program serves as many families and individuals as
possible.






26


2. Current budget:
SainLrios. -----.-.---------------------------.--------------- -l4- S'
Fringe bciw fit'l -4 ---------- ---------- ---------- ---------- 1 7'."
Audit ------------------------------- ------- -- ---- 200
Rvent----------------------------------------- --- ---- 1, 020
Utilitie,- ---------------------------------------- -- - *2V.)
Phone ----------------------------------h---- -. :00
Otficc .41uppli --------- ------- ---------------- --- --- ----- 200
Total --.-----_--- ------------- - ------. --- 1 (;17
1*stiniaitld food co-ts 'I ----- ----------- ---- ---- -2 00, 00)
Donated fod ------------------------------------------ .'O0
1 All food is r'co'i\ id from USDA at no cost to the 1irngrnm.

3. (a) Weld County Division of Muman Resource-.
(b) 3 person-.
(c) Weld County
4. The Promrin se1v1C 1 many people that are niost in need. Tb'i-o'uzl
the effective use of additional sits and i mobile sites in the
County, the Proagram can- '-upply seiviceeS for I he people we are
unable to reahli, a'1d continue a quality progruain.
5. (a) Weld Count v Divi-i(on of Human Resource .-.
jb) Sl,400.00
(c) Nothing was paid by USDA.
6. Salairies, fringe benefits, rent, utilities. phone, supplies, and audit
costs. Yes, the twenty per(Pnt of the projecte(d total yearly
budget for administrative co-ts would help pay for ouitremch,
opera timng co -ts, nutrition e(ducation, in(Iirect adlmini-.tAntive
costs, and the co-ks of aidministering the local office.
7. (a) All potential participants must be certified for participation
by the Weld County Health Department. Upon certifica-
tion, food is distributed out of the Grecley office.
(b) No, the Program must be expanded to reach people we are
now unable to serve.
(c) 1,500 participants per month-18,000 per year. Est irna ted
yearly cost $S1,647.00-$1.03 per client, excluding food
costs.
8. (a) 25 percent of present Administrative Budget (4,662/,yr.-1
person).
(b) The nutrition education effort will provide a very important
service to the pal'ticipafnt. The participant can learn to
utilize the food more efUectively for increas-ed nutritional
value in their diet.
(c) No, the budget precludes this effort.
9. No.
10. (a) Yes.
(b) Increased portions and/or packages.
(c) No recommendations.
11. A few counties have expressed interest in the Program.
12. Total caseload-2,000 families per month. Total budget-$50,000
to $75,000.
13.
14.
15. No.
16. No recommendations at t('us time.








BAPTIST HEALTH CENTER, 408 LINCOLN, MONTE VISTA, COLO. 81144

RESPONSE TO QUESTIONNAIRE FOR COMMODITY
PROGRAMS
1. (a) 325.
(b) Yes.
(c) 325.
2. $1,000 freight, $700 administrative.
3. (a) Baptist Health Center.
(b) None.
(c) None.
4. Yes. Our caseload should be increased to 400.
5. (a) I do.
(b) $120.
(c) None.
6. Distribution and records. I have no budget.
7. (a) A trucking company.
(b) Yes.
(c) $33 per year per recipient.
S. (a) Can't answer.
(b) Very vital.
(c) No.
9. Dry milk-some recipients don't care for it and arc indifferent to
the work involved in mixing it.
10. (a) Yes.
(b) None.
(c) None.
11. Sagauche County, Colorado. 300 possible recipients.
12. We serve a county of 12,000 persons. A level caseload of 400
would meet our need. I should be using a budget of $3,000 per
year.
13. The doctor of this clinic and nurse report positive benefits.
Certainly a drop in emergency hospital cases.
14. The current national poverty income table.
15. The Supplemental program is administered with and through
the Baptist Health Center which is an out patient maternal
and child care center.
16. No recommendations. I am very satisfied with the purpose and
results of this program. At the present most of the administra-
tive work is done by volunteers. Bee-i use of no funds it has- been
impossible to make an accurate medical evaluation of the re-
sults of this program. This is very nece--ary because guesswork
is most unsatisfactory.

DEPARTMENT OF HUMAN RESOURCES, WASHINGTON, D.C.

RESPONSE TO QUESTIONNAIRE FOR COMMODITY
PROGRAMS
1. (a) Fourteen to fifteen thousand clients two times per month.
(b) Ceiling on caseload is 30,000 two tim'e> per month.
(c) Caseload not reached due to:
Lack of administrative funds or lack of outreach staff.





2S


2. (iurrlht budget i-. -$2,S500O. Current food L-ost retail store value
^*2.25 ).126.
3. (n) State atvy,-ncy (D.(i) Idrninister-; the program for city within
thlo Dp);t rtni'cnt of Huizinn Re-ources' Cornmunitv 1lealth11
?md Ho 'pit "is Ad linisit ration.
') Tiijri y--i'vn il st.dr pr-.oiin sho(ild be bud get od in the program;
t0i6r' v-t 'vo 1in(b m ruvoly bti1.b_,t(-(d for Fi-wcl Year 1976.
(e) "11m Di-ti ct of Colum1i 's Dlp: r-tient, of Hilirnin R'-so'irce-z.
4. Y'l-, 0 dIy lov-milcorni, p1r-oIv on Nl\dicaid, food stamps; or Public
A*4-i I11C( %I' C (onvidered ehi-ible according to the( GAO defini-
ti(n of Neody. M ore client4 Moild b, reaehlid if funds were
iv2iilaIle to fill varant po.ition- and to print the necessary
dith:11 iofl al iniwteidals to bh' ii-~ed in outreach.
5. (n) D.C. Government pniys for the nd rniniiusrative costs.
(b) Admuinist native co-t for one month i- $4,047.
(c) USDA provides food and costs of delivery to the rail company
sidinII.
6. Adinini-,trative cost includes:
t Opcratin< cost
(b) Nutrition education
6c) Outreach (printing and staff)
N) .Ionitorinc of pro.rraii
(e) Other indire(:t co-A>s, '.uch as supplies, travel and telephones.
TIhie proyraun would be greatly improved if 20 percent were made
avaiLable. The total yearly budget should reflect food cost in
calculating the 20 percent figure. More than 20 percent is
I actually needed.
7. (a) Food is pre-packaged and distributed from public health
centers and from a mobile unit.
(b) Our system works well, mobile unit is a great asset to the
needy community due to the 18-25 pound bag weights.
(c) Cost per client for food delivery is unknown at this time.
S. (a) An adequate nutrition education program would require at
minimum 25 percent of our present budget or $125,000.
Nutrition education should include: Qualified nutritionists,
motivated outreach staff, funds for supplies (food demon-
strations), printing, and travel.
(b) Based upon a continued 6.5 years of experience it is known
that nutrition education is a most vital part of the Supple-
mental Food Programs. The beauty of the Commodity Sup-
plemental Food Program is that it is a health program. The
client, through nutrition education, receives:
1. Information for prenatal care early in her pregnancy.
2. Supplemental Food is provided on site after proper
diet counselling (some clients don't have adequate
food to carry out diet instructions) (protein
diets or increased Vitamin C and A food intake).
By going home with the supplemental food, the
client can immediately partake of not only food,
but is actually beginning to carry out the pre-
scribed instructions which were designed to change
client's food habits to improve client and unborn
infant's health status.








(c) 1. The District of Columbia, had prior to budget cuts a very
strong( nultrition education prograin.
2. Cost was never over 25 percent of the Program's total
budget. Currently, all of the nutrition education cost
comes from the Progia m's administrative buid(get. There
is a sizable amount, 40 percent, of in-kind contribution
from nutritionists in other health programs. These
nutritionists give much support in nutrition education
because of improving the health status of the client and
also because of the availability of the community foods
that can be used to visually award, motivate or stimulate
the patient in nutrition edu(lcation.
9. There are no foods rejected in the Supplemental Food package.
Efforts should be made to further demonstrate the use of egg
mix and instant dry milk in the client's diet. Food that is re-
jected by a client could be credited to lack of nutrition educa-
tion, few foods are rejected due to allergies.
10. (a) The District of Columbia's Department of Human Resources
health team is very satisfied with the nutritional value of
the commodity food program. Tile extra iron, protein and
Vitamins A and C are especially needed by many of inner-
city clients to improve and maintain good health. A choice
of iron-fortified formula, in addition to the evaporated milk
issued for infant formula, is offered.
(b) Due to a recent FDA regulation, USDA is not purchasing
iron-fortified Farina. It should be recommended that either
Farina or another iron-fortified cereal, preferably rice cereal
which is more frequently reqiiested by pediatricians, be
substituted. Canned seafood and dried bemns are requests
that were made by community people.
(c) Our experience of pre-packaged foods distributed to clients
from both permanent distribution centers and from a mobile
unit have been successful. It is recommended that for
additional service to the community that an additional
mobile unit be used on a rotating basis throughout the city.
This mobile unit could be used for food demonstrations
and nutrition education.
11. To my knowledge there are no unfunded project applications.
The District has had two requests rejected by USDA:
(a) For a supply of iron-fortified formula to be issued by physi-
cians' request.
(b) For approval of an agreement with Howard University
Hospital to issue Supplemental Food coupons to needy
clients. This type of an agreement was approved ea rlier in
thie 1970s for Walter Reed and Children's Hospitals' needy
clients.
12. The total caseload as approved by USDA is 30,000 clients per
month. The total budg-et need would be $S50 000.
13. There were positive findings of improved hemoc(rit counts and
decreased infant and mrat ernkal mortality ra-es.
14. Initially, in 1969, the eligibility criteria for participation in the
Supplement al Food Prograul. was for:
(a) D.C. r-,idents attending public health clinics and found to
be at nutritional ris-k.
68-151-76---3





30


(b) Pregnant or one year po-tpartiim women.
(c) Infants or children under acge six.
In 1972, GAO and USDA deemed the lerm "needy" to mean not.
only at nutritional ri-k. but should include a means test.
Currently and since 1972, low-income or needy recipients
mean clients who are pregnant, one year postpartum or infants
and preschool children under age six who are also eligible
for food stamps, Medicaid or Public A-sistance.
15. Yes. the Supplemental Food Progri'amn encourages and depends
upon other related health and welfare programs-communit
summer hires and school volunteers recruited by the Suipple-
mental Food Programin to give outreach programs in the Food
Staiimp and other welfare office-:.
16. Priority ies recommiiendations for change in the Commodity Sup-
plemnental Food Program legislation would be li-ted as:
(a) A-ssuranices that recipients of the Suppleniental Food Program
be provided with adequate exposure to basic nutrition
education which includes consuimier information, major
FDA regunlations and nutrition labelling.
(b) Provisions for 25 percent administrative funds to admini-ster
the Commodity Supplemental Food Program. That reim-
bursement be provided for nutritionists' services, plus
clinic costs.
(c) Aksuranc6 that iron-fortified formula and evaporated milk
be provided in the Program.


COMMUNITY AND ECONOMIC DEVELOPMENT
ASSOCIATION OF COOK COUNTY, INC.,
Chicago, III., December 1, 1975.
Hon. GEORGE MCGOVERN,
Hon. PHILIP A. HART,
U.S. Senate, Select Committee on Nutrition and Human Needs,
Washington, D.C.
DEAR SENATORS McGOVERN AND HART: Enclosed is this Agency's
response to the questions -sent to us on November 20, 1975. We
appreciate the opportunity to provide the attached information
prior to your submitting new legislation.
Although no questions referred to participants view of the Program,
we can indeed verify their positive feeling that the Program fills
nutritional and dietary needs, even if sometimes only partially. We
would also stress the economic value of this Program which results
in a cost saving to low-income families food budget severely strained
by inflationary food prices.
On behalf of those low-income persons, we appreciate your advocacy
of this Program which is a most worthwhile one.
Sincerely yours, CHARLES D. HUGHES, Jr.,

Executive Director.
Enclosures.






31


RESPONSE TO QUESTIONNAIRE FOR COMMODITY
PROGRAMS
1. (a) The Community and Economic Development Association of
Cook County, Inc. (CEDA), serves 6,275 persons each
month in suburban Cook County, outside the City of
Chicago in its Supplemental Food Distribution Program
under the U.S. Department of Agriculture (USDA), sup-
ported by a Community Services Administration (CSA)
grant.
(b) There is no ceiling on the Program caseload. The number
served is limited only by the Agency's outreach capacity
and available funds for administrative overhead support,
both of which are provided by a CSA Community Nutrition
Program grant.
(c) See (b).
2. Our actual budget is as follows: Administrative costs annualized,
$66,645 CSA Funds. 64,850 Projected Revenue Sharing Funds
from municipalities and townships. Total $131,315. Food costs
(quoted from USDA estimates): $15 per participant X6,275
=$94,125 per month. Annualized food costs: $94,125 per month
X 12 months=$1,129,500.
3. (a) The Community and Economic Development Association of
Cook County, Inc. administers the Commodity Food
Program in Suburban Cook County outside the City of
Chicago.
(b) Fifteen (15) staff persons are budgeted in the grant award
from CSA, plus eighteen (18) workers funded through the
Comprehensive Employment and Training Act (CETA),
Manpower Assistance to Underutilized and Retired
Employees (MATURE) Program. CEDA's Contract with
USDA provides only for food commodities and not staff
or administrative costs.
(c) Community Services Administration (CSA) is the funding
agency, which supplies administration, outreach and the
operational funds to distribute the supplemental food
commodities received under a separate contract with USDA.
4. All of the current participants served are under the Federally
established guidelines for food stamp eligibility, but is only
34.8 percent of those in suburban Cook County who are poten-
tially eligible. In order to reach all those persons who are
potentially eligible, an increase in the Community Nutrition
Program grant from CSA and/or an inci;m-te in local support
funds, and/or administrat- ive funds from USDA wx.ould be
required.
5. (a) The Administrative costs are paid for by the grant from CSA
and what financial support the Agency can develop through
local municipalities and townships.
(b) Average monthly administrative budget is $8,050.
(c) The U.S. Department of Agriculture (USDA) supplies no
funding for administrative costs. Their sole contribution is
the food commodities.








6'. Adhimiii-lr~tive, 1 1-.; ;is c-cfnbrdi ill ti,- ALT-IIC'olc pro;r im o -i-t,
of iill 1`1111k 1'rf'iiirr'lt" I d i-t rilmic lk Ow su1ppli'mentafil fon)d
I I I 0di 1 ~, 1 -M1111imtI ir n Ii I )i r l de v c (ur .11c -ev 1iees,
\;('el i ii& ) '-nI I I ,'f i': i I, sfoiL.-.re of fo)Id)I ;nd tr iii-portlition of
foq d to Io' -.- d Ist it I on1 11 ( er(. eI "1(1-.
V ci I Ie toI:il co-I (if tle i ll, incl1ding both

WIo11(1d 1 ;i "i "1q''a1tely ovmer, lo t only currI nt I >pera !io'i. hiuItwo l
dilow ;in (xp.!sioI of the 1umbe1i11'r of h'_ille er-ojii)s to be
-erve(I t I lore clo ,l- rf'irl I I lie innher (li"ile.
~Ii, a r ir11 h' M,' Ih I,~ .I I')r w Isrq ;* I (uj/ ,. .N i cjiC1('i (111F to
Ji ihn ii pnpbil f' 11 f/ .t'In 1'hi i 1, ;sff/if 1'0 ('1.7^ )s p c flu ..# I; fil S( 1r'iC sA ilimbi/*0 i;."/00? 0 ( h GS'. I) rICE If (lfe Im'J11C( /1 f t
Mau f/i i Y wr;17 b( iwri (I.a'igS dic rt /i fi )f dt *s aI /it/cy prif af~ i iN
UY7Ii l*if I.~ N/ i frIrie a pr,.' p< Sq f"''/ (S/ .'mw.
(ln uall' to p'er s.5!) p/ i'/uf f'iOt aiw'l557. fnafly), a wt

7. (;1) Tlie suppleiiientil fo'dl- ;I ie shippi'd into'a coflitdnllhOihC
by mill w"Here they are receive ii id storedl. E;]li of the locil
d1-i-liblitionl center-: 1us-e truck-- ;ill dlonnlde~ by Ilu1, vai-ious-.
n'llilcipi litie-, to pick uIp tile coiiimoditiv' for (1istriution
in local celiters to the cli 'zible Pei-ons Il "pre-cription" lot-.
The Cook County Department of Public Headt i andi other
loc'il health facilitie- (rt ify 'pre-(ciption" lot- for program
participants. O(it vi'ch workers- in ;iddition to lo(ca(1t ini: aldll
enlisting r poteniiat ly eli--ible palrticip)ant-, are re'-pon-.i1)le
for the ;ictua~l distribution, usuiya-i-ted by commniiiiity
voluntteer-.
(b) Trhis AXencvy's --tein lisN been lIiiId' v s-ati-sfactor\ andl iin
receenit evaluations bv IUSDA ]ias- beYlo coimmilenflded aw an
excellent svytem. Problems generally have been due to a
Ishiortace of staff and other neces--ary supports to the
program.
(c) The staff of this Agency's program are re-pon-ible for central
allinii-t iation'warehouzngn and food 4i-tribution, out-
rcach, providing or referring to supportive -ocial services
(i.e., nutrition education, referrals to other health an(]
welfare agencies, etc.), and promoting andl operating food
buying cluib-, which further -4 retches flhe foodI buying
dol-1;r of the T)articipa-nts. Tins latter activity involves an
additional 1P7 low-in come famiileZ, mo-4t of wlhom are aI'o
participaint in the -uippieimental food program.
It is e-tiliiated that 45 percent of the adinii-rative funds
froimi C SA and local contributions are expended for activ-
ities other t0han actwial1 food (delivery.
The co-t per participant of tli- Agency's food(i delivery is as
follow-: Thle IV(-r(ige value of food1 ditributed per part-ici-
pant per rnon1 h is, S15. The two1;l adiiiii-tat ire co-t to
opelitc th eC proufLira ii-: Anniiiuiniz'(l (',SA funl-4 $66,465.
Per miionthi: s3 Doiinal ed lwail funds .$64,s.50. Per mon lii:
$S.5,4(4. Tot ;il 131,315. Per mono Ii: S10,942. Co-!t per parti(-
ipanlt per moinuthi all actS $10,942 divided by 4;6,275
s S.75; per month11. Co-t per pirt icipa n t per month
food deliverv ;iid (li-ti ijbution on]\ (55 perceilt of $1.75)
ediuals .0%





33


8. (a) An additional $15,000, per year, or 11 percent of our preo-ent
administrative budo'et, is required to operate an adequate
nutrition education program.
(b) Next to actual provision of the food commodities to partici-
pants, nutrition education has one of the higlhest priorities
among supportive social services needed by the participant.
This has added s-,ignificance when eduicating the participant
in better uses of the donated commodities.
(c) Due to cutbacks in CSA funding to this Progriam, no a~dmin-
istrative funds are committed to nutrition education at
the present time. However, an attempt to maintain a
nutrition education prograiii continues by utilizing nutri-
tion components in other programs operated by this Agency
as welt as volunteer dietitians and nutritionists.
9. Although no foods have been rejected, participants have registered
complaints as to the lack of variety in fruit juices' and vegetables.
rThey have also stated a desire for rice cereal which was removed
from the package. They also would like to see canned fruits in
the package.
10. (a) The foods seem to be low in iron unless the farina is fortified.
(b) Infants-0-6 months: Low in vitamin C. Could increase the
juice to 3-46 oz cans and preferably orange, grapefruit or
tomato juice. Orange is the best tolerated juice at that age.
Diet is also low in iron; however, infants have a store to
compensate for loss for approximately 6 months.
Infant8-7-12 months: Diet is low in iron. Perhaps the ad-
ministration of larger quantities of eggs could help increase
this level; or if the farina was fortified. Some cereal could be
used with higher levels of iron, such as Quick Cream-of-
Wheat cereal or Pablum baby cereals which are iron for-
tified. The diet would also be low in vitamin C unless the
juice was citrus and \vas increased to 3 cans per month.
Children-I3 to 24 months and 2-5 years: May be low in iron
and vitamin C depending upon the juices. Vegetables should
be high in iron. Citrus juices should be sent monthly;
either orange or grapefruit juice.
Pregnant and post-partuim inaiorn: Low in iron should add
vegetables which are high in iron and cereal which is for-
tified. Foods are low in vitamin C and perhaps juice should
be 6 cans rather than 3 cans to pregnant and post-pa irtum
women. This evaluation is only an approximation, in order
to do a complete nutritional evaluation, it would be neces-
sary to calculte the nutritional content of each product and
compare it to the U.S. RDA of 1974. This is very time
consuming and was not done for this report.
(c) The instant mashed potatoes are in a container which is
easily damaged, and a stronger box or reusable can would
be desiretable.
11. We are unaware of any unfunded supplemental food program
applications in Cook County or the counties adjacent to Cook
County. This Agency's al)plications to secure additional funds
under the WIC Program for an additional 1,000 participants
have been approved by the State but rejected by USDA.
12. Assuming adequate monies were available our total caseload would
reach from 13,000 to 14,000 persons monthly and the budget





34


would be S2.50,000 in Admini-trative funds and $2,520,000 for
food, totaling 3.,770,500.
13. There has been no medical evaluation of this Agency's Supple-
mental Food Program, but we are in the process of beginning
-n examination of infant mortality rates over the five years the
program has been in operation. It is our current assumption that
an improvement in this area will be due to both improved
nutritional diets and the fact that participants are. entering
into other health and welfare programs, eg., well baby clinics,
food stamps program, etc.
14. Participants in the program are referred by local and County
Public Health Offices, by other health and welfare agencies and
by the Agency's outreach efforts. The food stamp program
criteria of income is 'used for economic eligibility while physi-
cians and nur-es certify medical eligibility. A "means test" is
prohibited, only a "self declaration of need" is attested to by
the participant.. The other criteria nre those of the Supplemental
Food Programn guidelines, i.e., children under 6 years of age,
pr'egmnat and post partmn women, etc.
15. Program recipients, if not already participating, are referred to
prena1til and well baby clinics, operated by the Public Health
Department and to agencies providing other health and welfare
services they require. Program staff have been trained in as-
sisting participants in applying for the food stamp program.
16. This Arrency's recommendations for change in the Program are
as follows:
1. That administrative funds be provided by USDA, at a
minimum of 20 percent of the food costs, preferably 30
percent.
2. That USDA strive to give a more varied supply of vegetables,
i.e., peas, corn, tomatoes and green bean and fruit juice;
i.e., orange, grapefruit and tomato juice.


OFFICE OP ECONOMIC OPPORTUNITY,
UPPER DES MOINES OPPORTUNITY, INC.,
Emmetsburg, Iowa, Not-ember 25, 1975.
Hon. GEORGE MCGOVERN,
Cltairman, Senate Select Committee on Nutrition and Human Needs,
U.S. Senate, Washington, D.C.
DmP SENATOR MCGOVERN: I am coordinator for North Kossuth
Community Action Program and we do have the Supplemental Action
Program in our county. It is part of a 7-County Area administered by
the Upper Des Moines Opportunity, Inc.
They will be filling out the questionnaire and returning it to you.
If, however, you need client reactions or comments, I can secure those
for you. If I can help in any way to further the continuation of this
program, please let me know. I feel it is a very helpful program and
appreciated very much by our clients.
Sincerely,
DOROTHY SHEIRBON,
Bancroft, Iowa.
P.S. At present I am serving 27 families, with total participants at
138. This is for the north half of Kossuth County.







RESPONSE TO QUESTIONNAIRE FOR COMMODITY
PROGRAMS
1. (a) 700.
(b) No.
(c) 1,200.
2. 10,700 all administrative.
3. (a) C.A.A.
(b) 2.
(c) Iowa Social Service. Des Moines, Iowa.,
4. Most needy are being reached.
5. (a) Community Services Administration.
(b) $1,300.
(c) None.
6. Personnel, warehouse, and delivery. Need more than 20 percent.
7. (a) Pre-packaging.
(b) Yes.
(c) $1.50 per month per recipient.
8. (a) 200 percent.
(b) Most important.
(c) We do not have a nutrition component (education):'
9. Yes. Many low income mothers do not know how to use the food
stuffs.
10. (a) Yes.
(b)
(c) Separate warehouse facilities in each of the 7 counties instead
of one central warehouse.
11.
12. Caseload 1,500-budget $60,000.
13. None.
14. Financial eligibility and nutritional need.
15. Public health nurses see each family every six months.
16. 1. Stronger finding.
2. A required nutritional education component.


MID-IOWA COMMUNITY ACTION, INC.
102 East State Street
Marshalltown, Iowa 50158
RESPONSE TO QUESTIONNAIRE FOR COMMODITY
PROGRAMS
1. (a) 329.
(b) No.
(c) Not available.
2. No formal budget. Board of Supervisors pay for the food the
administrative cost is approximately $10,000.
3. (a) Coordinator, Outreach, Warehouseman.
(b) None.
(c) Social Services, Des Moines.
4. Yes.
5. (a) County, CSA salaries, transportation.
(b)
(c) None.





36


('.\ l; .tniaii-po nti"ioi, hevat,1'.:hi~ t,. renit, frinl Ee.
7. (; ) ir tru1k from .Iht- M n i ) Io I)\- Pick-uip to

h1) Y,-.
(c)

(t') Xe-. .No cost. lot ;il iii-kind.
9. Y<..

(b) liLar. variety of vvc-etva bl-. anid jAice".
(c ) \oi1.
11. No.
12. C;-cl(.atd one-quarte'tr mole.
13. No.
14. NXutritiowil need. EPooinic clioibilit y.
15. YX:.
16. 1. Increa.;e income gruidelines for low-income nut on welfare or



POLK COI-NTY DEPARTMENT OF HUMAN RESOU-RCE.:S, POLK COUNTY,
IOWA

RESPONSE TO QUESTIONNAIRE FOR COMMODITY
PROGRAMS
1. (a) 2,700 a month.
(b) No.
2. Not available.
3, (a) State Social Service.; is the purchaser. Polk County Social
Services is the delegate agency.
(b) 6/2.
Coordinator----------------------- Velma Flisher
Clerk Typist---------------------- Betty Lyman
Registered Certifier II-------------- Thressa Lamar
Registered Certifier I--------------- Betty Martin
Registered Certifier I--------------- Lillian Beamran
Truck Driver and Warehouseian---- Mike Butler
Part-time Man-------------------- Mike Lyman
(c) State Social Services.
4. The people who are reached by our program are the ones in real
eeld.
5. (a) Polk County Pauper Fund
(b)
(c) Food donate(l.
6. We do not hav'e outreach at the pre--ent. 90 percent of all our
referral, come from Public Health Nuirsing Association. They
are the nurses delegated by the physician as- his Designees,
to sign the pre-wription forms.
7. (a) By truck to other three (3) counties. (Jasper, Marion and
Warren) other than Polk County. Recipients pick up at
designated areas:






37


Jasper County: U.A.W. Union Hall, Newton, Iowa; 1st
Monday of each month. Hours: 9:00 A.M. til 12:00 Noon
and 1:00 P.M. til 3:00 P.M.
Marion County: O.E.O. Opportunity Center, Knoxville,
Iowa; first Tuesday of each month. Hours: 9:00 A.M. til
12:00 Noon.
Warren County: O.E.O. Opportunity Center, Indianola,
Iowa; first Wednesday of each month. Hours: 9:00 A.M.
til 12:00 Noon.
In Jasper County the Public Health Nurses and union officials
cooperate with us 100 percent. In Warren and Marion
County I'm sorry we do not have that kind of cooperation.
As we do not have any outreach whatsoever, only by word
of mouth I feel we do fairly well.
(b) Yes definitely with the exception of no outreach, and lack
of staff.
(c) $3.90.
8. (a) 10 percent.
(b) I feel nutrition plays a big part in having a successful program.
(c) No. Only thru the Polk County Extension Service. The
extension people work with our recipients on a one to one
basis as well as in groups. (It is nothing out of our budget.)
9. Once in a while people do reject different products. Some times
they still have siome left on hand. Example, Farina in the hot
months especially they do not use as much. But thaanks to
our extension people, they are being educated in many different
ways how to use their food supplements. However our recipients
are advised that they need not take any item they do not want.
They also know that we cannot substitute one item for another.
10. (a) I am completely satisfied with the nutritional value in the
food that we are receiving now.
(b) I would like to see more items added.
11. No.
12. 10,000 roughly per month. I really cannot project a budget.
This would include larger warehouse space, more staff in-
cluding outreach.
13. No.
14.
15. No, unless of course General Relief.
16. As I said, more items. I would also like to see the prograia ex-
panded to include all low income persons. I do not feel the
Food Stamp prog!',;i is do-ijgned for the poor people. I would
very much like to see a person or family be able to pick up
commodities one month and food stamnps the next. 1 am not
talking supplemental food now I am talking Commodities.
Something like they have in Bend, Oregon. (Deschutes- Countv)
"ABUNDANT FOODS."
That wav more youngsters mav hzive a chance for a better healthier
life if a nutrition program was included.
We need to reach all people who have an inadequate diet for what
ever reasons.
"PEOPLE TEND TO LET FOOD GO."
"LAND LORDS WILL THROW YOU OUT."
"LIGHTS, GAS AND WATER WILL BE TURNED OFF."





38


"LOAN COMPANIES WILL REPOSSESS THAT BEAUTIFUL
LONGED FOR TELEVISION."
"NO ONE DOES ANYTHING ABOUT IT IF YOU DON'T
EAT."
BUT MALNUTRITION BEGINS.
M ln\v sickne-sses and handiCApps areT Visablle, malnutrition is not
readily viable. BUT IT IS A KILLER.


STATE OF Lot'ISIANA,
CONrI!uN rTY SERVICES ADMINISTRATION,
Baton Ron ge, La., December 5, 1075.
Hon. GEORGE MC GOVERN,
Chairman, Scicet Comnmuific on Atfrit'ion and Human Needs, U.S.
Seiate, Washington, D.C.
DEAR SE\-ATOR McGovERN: In reply to your letter of November 20,
1975 regarding btatu-, of the Supp)lemental Food Program in the State
of Louisiana, attached is a completed questionnaire on this subject-
along with other correspondence which should prove helpful in our
quest for continuance of tli-s mo[t valuable program.
It is the hope of the state of Louiiiana, and our office particularly,
that the Supplemental Food Program (which is one of a kind) will
continue to serve the people in need for many years to come. Since
196S, wlien this program first. surfaced, the state of Louiiana has
benefited substantially from this program and has received many
accolades from its recipients. We like to think tliat wve have the fineAt
Supplemental Food Program in the United States. It should be
preserved.
If you should desire more information on the Supplemental Food
Program operations in this state please feel free to contact us. Thank
you for your assistance.
Sincerely,
DAVID B. SELF, Jr.,
LCSA Director.
Enclosures.
RESPONSE TO QUESTIONNAIRE FOR COMMODITY
PROGRAMS
1. (a) 15,523 (October 75).
(b) Yes
(c) Need more food distribution centers. Orleans Parish-25,000.
Weblter Parish-2,000.
2. Annual cost of USDA food-- i. ocimated at $1.5 million. Louii.ziana
State provides $180,000 for storage, etc.
3. (a) Loui-iarmi Communit y Servics Admini.t ra ion.
(b) 4.
(c) Archdioeese of New Orlnotm, Family Planning, New Orleans
City HIealth & Choril-v Hospital, Webster P-IrJj.h IHeailtjh &
Community Action Association arp contracted with Louiisi-
ana Community Services Adnministration. Louisiana State
Community Services Administration has contract with
USDA-Food and Nutrition Service.






39


4. Yes. However, transportation is nece-_KPry to get elicibles to food
distribution centers.
5. (a) Louisiana State C(onimunity Services Adinin-i ition.
(b) $15,000.
(c) Costs of food and rail trarsportation.
6. No. No Federal dollars are expanded for this purpo-0-only
state funds.
7. (a) Trucks from win ehouse-.
(b) Yes.
(c)
8. (a) USDA may advise.
(b) IMuch. Food demonstrations now in existence.
(c) Mo.tly done by Family Planning Offices; in New Oi-e;.. and
Webster Parishes at their expense.
9. No.
10. (a) Y e.
(b)
(c) None.
11. Do not know of anV.
12. In the two parishes where pilot program is in effect all qualified
pe-sons are b -ui served to the bI.-t extent possible.
13. City Health De-r;:,-. im'; rq1wotld have -ihis-.
14. State followl- the instructions rcci'ved by USDA-FooU ,ind
Nutrition Service, Dallas, Texas.
15. Not known.
16. We are satisfif I thait we have a most succe-eIf.l Supple'*ent ii
Food Piro :'_-z. If we could continue with the food pc0age
that we li:-ve, we believe that the people tuht we serve would
continue to be sati-fied! with the food reeeivd (\-.at i-; if USDA
sends all the food that we order) aLd that the pogramn woVid be
well r-ceived by all -,]to partiipae-possibly witb the excep-
tion of USDA wxo seem conteni to phae this program, out for
a, lesse1 pro2-&:nm (WIC serves chiir- n UD to 4 vears obd where
we serve childrv n up to 6 years old). We are confident i1.,1 our
high protein SuppiemeIntal Food Progr-nY (;"W;Po be suu;i;ed
by\ an-thino, now b,-~ offeredJ b' the U.SDA and! 11iohlyv
recommend it; continuance.


Focus: LOPE,
FOOD PRESCRIPTION PROGRAM,
Detroit, A'ch., January 12, 1976.
Hon. GEORGE MCkGOVERN,
Hon. PHILIP A. HART,
U.S. Senate,
Select Committee on Xittrition and Huriian Needs,
Washington, D.C.
DEAR SENATORS: Enclosed is our response to your recent que-tion-
naire on the commodity supple mental food program.
I am happy to acknowledge that our report and recommendations
were prepared with the a--i.,tance of Ann NM. Byrne, Chief of Nutrition
Services for the Wayne County Department of Health, DMIC-
PRESCAD Project. Ms. Byrne is one of the original founders of the






40


supplement al food program in IDetroit and lia-% provided nutritional
con0u Iltatiou to Fhocu-': HOPE on nhI1umerouis OccaUions.
With Be.-t W-Ihie.,
C1RLESNI M. GRE:NV.II.LE,
Director.

RESPONSE TO QUESTIONNATRE FOR COMMODITY
PROGRAMS
1. (a) Yumher of reciptb.: 25.20S (October 1975).
(b) Oise bJaf I ii clig: 35,000.
(c) Jfl acitnli fMe /i wri-t dI ca(si lrud-fufal req((Ji(.I'dl Ca(stOcu(l.
The ca-elowid ceiling i of 3,;.00 is an im-iean-r from the previous
level of 15,000, aut hlorize('d by the L1SDA in March 1975. Tie piograim
h1i- b)(een steadily gr)Vowingr 1i1(1" then. ;iId .11il be expected to reac10
its alut o1l.iZed ca -elomid in 1app)0o\i1ately one y -,i I.
'The number of pcr-ons in the city who need inid quiiaify for snup-
plelncntal food is oiliCiallv es-tiiansled bY the Detroit I lealthi De-
parltini iit at 105,000. About 9,0o) of these aie cuniently beimyi served
1luronigri the WIW progrinin, with an anticip(( ted growth, to 12,000
in hlie Co0inllno year. '1'he cobi1)iied -ervice of the Food Prem-cnption
atnd WIC Aroarlm :t their full authorized ct-elomid level.., thus
still fndl- Aiort of the city''^ c-tiniated it need by itmore tihan 50 percent.
Sehrvinjg tlii- entire lievd will certainly require, as it ha- in previous
iTnstancr-'. of attetimptedl program gI'owth, overcoIii. two ploblemf
the USDA practice of finll (lleloa( fclitiZs anld the limited amount
of (Imimu-t rbtile funding aailale from the C'SA. For the moment,
attaiiiniuii even the ciirrrtt authorized ca --el(od level m av reqi yire tle
re-olution of two iuiter-rliited problem) whiicIh ca1i only loom larger
the myiore the prui ra1m grows. These have to do with out reach and thlie
aivailability of certification re-omn e. It t-vms appropriate to identify
a111d di-cu'-- them he're, becaiu-v in our opinion they aire -iruictural
to the supplcmenital food piogranu it-elf, and tend to act a- inherent
limitations-- on rgrmbie
(1) O(Iriach
Outreach, a function not funded tinder the Food Prev-cription
Progroi iii's pre-entt adiiii i-trative grant, is needed d for Iv.-o rea'-ons.
First, in or der to revich tlio-e mox! in need. Secondly, in order to reach
all those in need. The two objectives evm clo-vey related, ill that.
tho-ir "milost in need" may be the last reahiiied-i.e. ei*"'led nily
when all are.
Tlie importlicnee of outreach is related to i program's capability of
servin(gy the entire need- of a comminuiniity. Up to a certfiin point, tho'e
Who aNe aitware anld pnicticed in sing51l -v.-ii liable -ervi(-. tenl to be
ea Hl av 11td stCd y paPri Wticipants. Fhe* v miiay all be described aI, in need,
and umany of tIhem I- perTsons 'nm'-4 in needI' Ifiwiva-iiig lv, however,
tho-e (-till 11ot pa;lrI ticipating a11*e the InaWaie, d(epif"(ed, apatlietic
.n1d unmotivaitoi|, with a higher proportion of per-on- 'mo-t in need.,
1o motivate tlie latter, am effective outreach campaign becomes a
mor1 critical pri ogram activity.
Peihaips everyone in ne0d will JIeverP be reached. Ne\vetheless, the
Food(1 Pr-PCription Program -'eems to be appmoucliniumg the tine when
11 should go beyond reliance oil media CoveI'age, I tlie cooperation of





41


other agencies, and word of mouth to increase comnumity awareness
and participation.
(2) Certification resources
The integration of food prescription with other services offered by
the health professional is a highly attractive quality of the program
and wise social policy. But it also repre-ents an inherent limitation
on program size. For in the final analysis, given unlimited food avail-
ability and administrative funding, dedicated health personnel and a
simple certification process, only that number would still be able to
participate as the available agencies and health professionals are
capable of serving. In a city such as Detroit, this essential limit will
have to be faced long before the Food Prescription Program reaches
105,000 persons, and is becoming a problem even in the attempt to
reach 35,000.
There are several obvious answers to the problem. The first is to
insure that all possible certification resources in the community are
being used. The second is to increase the number of health profes-
sionals serving the poor. The third is to augment the service of health
professionals with trained paraprofessionals and volunteers. We are
already at work on all three of these approaches.
To reach all those in need the certification or food prescription serv-
ice should be as universally available as possible. This means including
as certification resources not only the publicly-funded agencies, but
all the private physicians and groups with a large Medicaid practice.
Up to the level of about 20,000 participants, the Food Prescription
Program relied principally on publicly-funded agencies, all of which
provide certifications. Growth beyond that point has been increasingly
dependent on enlisting the participation of the private sector, and we
have been adding about 5 physicians or groups per month. Their
thousands of Medicaid patients are the largest group of low-income
persons still unreached.
The Wayne County Medical Society and the Osteopathic Associa-
tion have assisted by publishing newsletter articles urging their mem-
ber physicians to provide food prescriptions. A significant number of
these, however, seem not particularly sensitive to the nutritional needs
of their low-income patient, not accustomed to rendering a service
for which no fee can be attached, and willing to participate in the
Food Prescription Program only with some reluctance and as mini-
mally as possible.
Over the long term, more nutritional education in the training of
doctors and nurses would probably be helpful. But in the short term,
the Food Prescription Program's approach has been to stimulate
patient demand for the service in individual caies, and then to assist.
the physician to supply it. Within the next few months, however, we
will attempt a more direct approach to doctors through various pro-
fessional organizations and individual letters or visits.
A much more effective solution would probably be to make nutri-
tional assessment and food prescription a reimbursable service under
Medicaid. The Detroit Task Force on Hunger and Malnutrition re-
cently attempted to convince the State to make this a service under
the Michigan HMO Plan (which has a large Medicaid contract) but
were told that federal provisions in this matter were not clear enough.






42


The prov-ision of nutritional services under Nredicaid would prob-
nblv ii iani -()file increa-e in thI e profe-'-ionial Mal- 11 or V a ilOfViILs 'Medicaid
2111d IN10 groip: --thiervby helpi hg to off.et the actual decline in the
number of health jrofe>ionzld- working in publicly-ftirided health
aecieuUIth over the pzi t year. Budgetary short ages harpe led to per-
sOn tinl c(lit lack-Z. hiding firezes- :anid a reduction of services in these
aIleTC1Eci di uinz a iinne of iiicivzi g need. Aind] thii-s has immeant a rela-
ti\v( 'Icclinie in the capacity of these nanreicies to provide food

To resolve the problemslI of outreach and certificat ion, a proposal
wos jointly pi pared by Focus: hOPE, Ithe Detroit Maternity and
In faint Care-P KSECA1 projo'ct. and the Dttroit, Department of
Htealthi in Septemibc~'r 1974, aid >u!)init~te(d by the latter to the State of
1i(;!wali. The- propo.oal asked the State to fund twVenty Nutrition
Able po-ition- in Detroit, along: witli a mode-t training budget and
fllnds& to develop ouitreachl t(' ifll*. "t(he tolt l aimouint requested was
s2277,1:3, amid this fiiiire was more than Tina Wled by anticipated in-
kind contributions. A copy of the propo-,al i: appended as Attachment
#1 *
Our bac concc'pt was to train paraprofessionals in the eligibility
and certification procedures of all feeding programs, and particularly
to qualify tfitun a-, coriiliers for the Food Pre-.cription and WIC pro-
ramsI. Alternating their work in the clinics and the community, these
persons would bf1 expected to certify for the supplemental feeding
progrramin and/or to aIdvise on the eligibility and method of applying
for other programs, especially food stanips. A small amount of out-
reach funds were to be ii~ed to develop information materials which
could be given widespread publication by newspapers, radio and
televi-ion.
Plie proposal wa.s made to the Governor's office, which replied that a
legi.Ilative appro-1priiation would be needed. Some months later it was
submitted to the Committee on Public Health of the State House of
Repn-eentatives, and little lias been heard of it since. In the interval
Focus: HOPE has begun to recruit Volunteers to asist in the clinic
on a limited basis.
Tho-e concerned with supplemental feeding in Detroit, however,
still consider the approach suggested in this proposal a necessary and
viable one, and amnouc our top priorities. Tri; position is reflected mi
our commenits on nutrition education. (See 8.(b).)
Without some sort of increase in the number of health professionals
or omiie exten-ion of their capabilities through paraprofessional
n-si<'taIce, it really seems doubtful whether any supplemental feeding
program could reach the vast number of people in need in our large
urban poplilations.
2. Current bniyet: $6,693,000. Food cost.: $6,200,000,1 administration:
$493,000.2
*Sfi p. 47.
Yf s ''iss can only IVI- Fi-ql ipn delivery. The present figi.rn is bai d on tie rf fail in ices of the same or r.niiparable iineds. averaged between
a pw.i rra chain store ard smai i ii( .Ic nllri.t in lii'1y, 7T5.' and p re 1, d .ipniii nntf n bilcr d part vi-
pll.tin driintr the 1'..")-7 pri raw yar. In IItii ;-urvi y, we iri;nd 'he reiil vnl% u'e (if tihe various find packages
Io :P :1. f;1ii>ws: $1 .n'5. 0-3 nirjii'h.. 1-5.71, I. L m iiiLhs:; 2t *-.UL. 1-2 2'-5 ;: NI -5 \(ars; Wti.17, mother.
2 Adiistrative cost are rei d urdrr a grariil frr-ni hih' C"A fonIituijy ] 'r( d nnd Nul rition Services.
The tota! Vr:oit for P'7:, 7t',is14A'!3,11 1. i.'di i( ( jr-osi d (it $32.1100 in ili fo in ol a newgrant from Ihe Chicago
1. : n' ii n S if i *. i ii l'.'7--.' carry over hinds. and $C'.,P'0(i from discreiionary funds of the CSA
1)nrir'cior. Thi.s amount is sillicienti for the service of 35,000 partcipranis.





43


3. (a) Commodity program administration
To our knowledge, all commodities in Michigan are administered
by the Food and Nutrition Services division of the Department of
Education, State of Micliiran. There is no administrative apparatus
for commodities at the level of county government.
(b) NJumber of stoff persons
* All 33 staff persons directly engaged in Food Prescription Program
activities are budgeted under the CSA administrative grant. Other
Focus: HOPE personnel contribute substantially to the success of the
Food Prescription Program, but without cost to the program budget.
(c) Contracts
At least two contracts exist. One is bet ween the State of Michigan
(Department of Education) and the City of Detroit in regard to the
handling of commodities and observance of USDA supplemental
food regulations. The other, regarding the CSA administrative
grant, is between the City of Detroit and Focus: HOPE. The former
is the actual, legal rvipient of CSA funds. Focus: HOPE administers
the Food Pre-cription Program as the City's delegate agency, under
provisions of the contract. Focus: HOPE is, however, recognized by
name in CSA grant papers as the ultimate recipient of the grant.
4. People "most in need" : See above, 1.(a) (1), (2).
5. (a) Who pays adramu isitrati Fe costs
Administa tive costs are covered exclusively under a grant from
the CSA, Community Food and Nutrition Services. This is supple-
mented to a great extent, however, with services and materials
contributed by volunteers, local oiganiz.-tions, and other agencies.
(b) Actual co-0.4for a rec-nt month: $39,955 (October 1975).
(c) USDA shaie of ad'istoion.srative costs: 0.
6. What cosTi.Ftutes ad.miniiisirative costs-cost of other services
Admini-trative costs are the following: Personnel (salaries, wages,
benefits); Consultant and Contract Services (required annual audit by
independent CPA firm); Travel; Space Costs and Rental (rental of
food storage/distribution facilities, utilities, maintenance); Con-
sumable Supplies (record forms, printing, office supplies, cleaning and
warehouse supplies, grocery bags, etc.); Equipment Lease and Rental
(warehouse and office equipment); Other Direct Costs (Insurance
policies, telephone and telegraph, rodent control service, railroad
demurrage, etc.).
If the adminibtrat ive funding were extended to cover outreach,
nutrition education, etc., I am inclined to believe that 20 percent of
the total yearly budget would be sufficient.
7. (a) Food delivery system
Our system is to unload supplemental food directly from railroad
trains into two large storage-(listribution facilities. The facilities are
located on railroad sidings, are clean and attractive in appearance,
have adequate parking, proximity to major thoroughfares and to
low-income residential areas.
For distribution, the food is simply unpacked and placed on shelves
as in a supermarket. Participants, using an individualized family list
of maximum amounts to be taken, shop for the foods, exercising op-
tions of rejection and selection (when more than one kind of product
is available). The actual supplement taken is recorded at a check-out
counter, packaged, and carried out to vehicles. Inventory control is
achieved by comparing check-out totals with physical inventories.





44


Participants obtain the entire supplement once each month, and
may co('e1 on any day Monday-Frid ay, 11:00 a.m.-7:00 p.m. Those
without any other means are provided free transportation by volun-
teer' (about 500 trip- per monthh.
(b) Araliatiin of .s/ in
III M1r opinioll, thi- SVstemi lias proven itself economical, efficient,
falnd effective. ihe direct unloading from trains into the facility and
the shopping procedure eliminiazte two handI4llinig steps which would
otherwi-e increase co"ts. The coit ribution of volunteer drivers deals
effectively with the transportation problem which is intrinsic to all
comnmiodity supplemental food progranis.
There is one major inmprovenehnt, which should be made to further
reduce costs and improve the system. That would be for the USDA
to follow the now normal practice of the food industry by contracting
to have its food shipped on pallets. (At present, all foods arrive in
cartons stacked tightly inside the trains and must be handled one by
one.) The result would be a saving in labor costs-three/men, using
automated lift equipment could unload the train in about two hours,
rather than the present effort of six men over eight hours-and a
dramatic, substantial saving in. the amount supplemental food pro-
grams must pay in railroad demurrage charges.
(c) CoQt per particIpaint
Taking October, 1975 as an example, the monthly cost per partici-
pant was $1.59 ($39,955 administrative expenses divided by 25,208
participants). The most important aspect in considering cost per
participant, however, is that supplemental food programs tend to
have largely fixed costs.
Consequently, the more persons participating, the lower the cost
per participant. For example, projecting a month in which Food
Prescription Program participation rises to 35,000 persons, adminis-
trative costs will still be about $42,000. The result would be a $1.20
cost per participant. In 1974-75, the average cost per participant in
the Food Prescription Program was $1.29. The monthly cost per
participant in 1975-76 should average about $1.45-$1.40 for the year.
8. (a) NAtrition education costs
1 percent of $6.7 million, or $67,000 would enable us to supplement
nutrition education personnel in the participating clinics. A much
more adequate program, combining outreach, certification, and
education would require about 6 percent of $6.7 million, or $402,000.
(b) Importance of nutrition education
In the setting of the supplemental food program, nutrition education
takes its value in ass-ociation with actual food assistance. In our
opinion, an adequate nutrition education program would combine
nutrition assessment to detect problems with a treatment plan includ-
ing nutrition information and food assistance. Supplementing this
focused effort would be general nutrition education proograms presented
through participating health agencies and local media..
(c) Prexoid n trition education
The Food Pre-cription Program does not have a nutrition education
component as such.
Nutrition education and counseling are provide(] through virtually
all of the publicly-funded participating health agencies, but are
notably absent in the case of Medicaid and IIMO groups. One of the





45


publicly-funded agencies, the DMIC-PRESCAD Project, which
certifies approximately one-third of Food Prescription Program
participants, offers nutrition education at nine cliicms, repreo onting an
estiinated $50,000 in in-kind services to those of their patients using
the program.
Nutrition education dealing with the usage of supplemental foods
is, however, a feature of the Food Prescription Program. This. service,
in the form of demonstration cooking, with distribution of samples
and copies of recipes, is provided free of charge by the Home Services
Division of the Neighborhood Services Department (City of Detroit)
and by the Expanded Nutrition Program (Wayne County Extension
Services). Similarly, supplemental food demonstration luncheons and
a current supplemental food recipe contest for participants have been
sponsored by the Michigan Consolidated Gas Company.
9. Rejection of products
About 4 percent of the scrambled egg mix which could be distributed
according to USDA rates and about 2 percent of the farina is rejected
each month. In our opinion, this has to do with the difficulty of using
these foods, and a lack of either cooking skills or motivation, especially
among younger participating mothers.
Farina poses an additional problem. Nutritionists caution mothers
not to use farina as a food for infants under five months of age, because
of wheat allergies. A non-wheat, infant cereal should be provided
instead. The baby picture should be removed from the farina box.
10. (a) Nutritional value of supplemental foods
(1) The protein value of the present supplement is much
too low.
(2) The variety of foods offered is too limited.
(b) Changes in the food package
We would suggest the following changes:
(1) Make infant formula and special formulas available.
(2) Increase the meat supplement to three cans per person
monthly.
(3) Distribute peanut butter monthly.
(4) Add cheese, beans, and tuna as products for monthly
distribution.
(5) Insure a variety of choices in products such as meat,
vegetables, fruit juices, and cereal.
(c) Okanges in delivery
A certain amount of flexibility on the method of delivery should
be allowed to each locality. A supplement of the quality and variety
desired might be economically feasible if the option were allowed
for direct wholesale buying at the local level combined with the
distribution system now being used by the Food Prescription Program.
11. Unfunded project applications
During the past few years, we have been contacted by health and
human service agencies and by interested leaders throughout the
United States inquiring about how to apply for the commodity supple-
mental food program. And these inquiries have continued even since
the WIC program became available. We have had to advise these
persons that an application for a new commodity supplemental food
project was probably futile, and that an application for WIC was
more likely to succeed.
68-151-76---1






46


12. Total casel,.za1 and bl'ijet. 10.5,000 monthly participants;
S2S.6 million annual budget.
13. 1fi':Hcai eraliuaton
V' V limited evaluation wa!s coniduicted at the DMIC-PRESCAD
clini- ait Critttnton Hospitzal in 1972. T'fie re-siflts are appended as
A 1/ad'?; ri~t #2.,* Tit auencv expects to have more reliable evaluation
data in the comhifng year.
It, is difficult, and not strictly valid to nscribe improved health
directly to the supplemental food program. here are, however, some
indications that comlbined health care and food assistance are having
-in cfl''elt. The DM1II-PRESCAD project, who;e nine clinics have
plirticipn1ted in the Food Prescription Program since its beginning in
1969, r,'port an anemia incidence of 10 percent among their patients,
contiv-tte I with a national incidence among like populations of 30
perc- ii. The infant death rate in Detroit ha- been reduced from 27.4
per 1.000 live births in 1969 to 25.8 per 1,000 in 1974.
14. Ec'']'itq crteria.
(1) Elipilit msniiit be determined by a health professional, i.e. a
doctor, niir-e, nutritionis4, medically trained health official, or person
dpe-iLri;ted by the proceeding as competent to evaluate nutritional
risk.
(2) "Inadl equate income" for purposes of the Food Prescription
Progeai mean; "medical indicrency". Anyone participating in
maternJl and child health programs, public assistance programs,
the Food Stamp Program, or receiving "free or substantially free
health care provided by OEO Neighborhood Health Centers, or by
the state, county, or local public health services" automatically
meet income eligibility standards for the program. Likewise, anyone
found to be medically indigent "on the basis of a statement by the
patient that she is unable to afford private medical care for herself
or her infant" has met income eligibility standards. Only "in case of
any que-tionable misrepresentation", must "an evaluation of the
patient's re-ources" be made.
(3) "Nutritional risk" (vulnerability to malnutrition) may be
mea-ured by interview, examination, or clinical testing, according to
generally acceptable standards and the judgment of the health pro-
fe;sional. Nutritional risk is assumed and defined as a dietary intake
which meets less than two-thirds of the Recommended Dietary
Allowances established by the National Research Council.
15. Affect on participation in. other programs
The common opinion of participating agencies is that the supple-
mental food program has substantially increased the utilization of
health services and attracted many low-income persons who would not
otherwise have sought or received adequate health care.
16. Priority recommendations
(1) Improve the protein content of the food supplement.
(2) Provide dependable administrative funding which is adequate to
cover administration, outreach, certification and nutrition education.
* Se. p. 53.












ATTACHMENT I


CITY OF DETROIT,
DRiroit, Mich., September 16, 1974.

COMMUNITY OUTREACH FOR NUTRITION PROGRAMS
Because of a continuing concern and persistent attention to the
nutrition problem of many citizens, especially women, infants and
children, the State of Michigan and the City of Det i oit have gradually
become a leading force in the nation to improve the response of the
federal government to this critical need. With the leadership of
Governor Milliken and others recognizing the importance of this
nutritional crisis, national support has been gradually developed
through letter writing, personal calls, appearances before congres-ional
committees, etc. generating an increu sing pres-,ure on the United
States Department of Agriculture to forthrightly initiate improve-
ments in their efforts to help the nutritionally disadvantaged.
The present impact on the Detroit area of these efforts is reflected
in two impending actions:
Food Prescription Program which has been operating at a level of
18,000 enrollees has been granted the administrative budget to expand
their effort to 35,000 if USDA approval to provide food for that
increase is received.
The Detroit proposal for a WIC project is being approved by the
USDA on a nine-month grant to reach a maximum of 12,000 eligible
clients.
If we assume both of these actions take place in the near future, a
major breakthrough will have occurred and the succ-essful implementa-
tion of these two efforts can provide the firm foundation for reaching
the important future objectives we share in this area. Realistically
we must be aware of the constraints and obstacles that must be faced.
A major one is the difficulty in motivating hard to reach people,
especially with both programs having some less than desirulble required
characteristics. As we move closer to implementation of these actions,
the need for more concentrated community outreach to ensure partici-
pation in both of these programs has become apparent.

AVAILABLE RESOURCES
The available or potentially available re-ourcez to concentrate on
reaching out into the community to get people to participate in these
two programs include:
The Detroit WIC project proposal contains approximately $100,000
to be used for clerical support and health examinations at the clinics
which is required by the USDA, so they will not function in the field.
In addition, several community service workers are provided by the
grant whose primary responsibility will be to monitor services pro-
(47)







vidd fom he lient, "I'o ad (rantIt administration viewpoint
Peronal common Uity o wtrenlich i- not -sIipported.
Thlie FoodI Pie-(cription admiinisitrative budget for Focus Hope iA
funded tIhroulgli 0E()O. A copy is \-;aiiil)le wliici describes the present
and potentially iicreav'ed budget for tlie var'ious- aspVcts of the pro-
gram. Fund,% are not provided to acco.0i ph-li certification or oultreach
at the pre'-ent time 1a1ndl either volunther or health center personnel
are depended on to respond to the-( neeid.
PerJoinel of official health centters in Detroit have extended them-
selea. ,ii far as possible in tlieir support of the Food Prescription
Progzrami in ccrtifv ; at the level of 18,000 and there is no chance of
additional help from that direction if the expansion is approved
to 35,000.
Trle State of Michigan's extension service program through MSU
has approximately 15 nutrition aides presently functioning in the
Detroit area and their present respon-ibilities do not include con-
centrated attention to the community outreach needed for these two
projects.
Volunteer services are an important current resource and should be
expanded and used to the greatest extent possible both for professional
and lay person participation. However, thils must be considered as
supplementary to a basic organizational effort of community out-
reach and not depended upon to fulfill this role solely.
These present resources do not have the potential of supporting an
outreach effort needed to successfully reach our objectives.

OBJECTIVES
Having identified at least a level of 105,000 women, infants and
children in Detroit as nutritionally disadvantaged, the short-term
objective is to successfully implement the WIC and the Food Pre-
scription Program to reach 47,000 by July 1, 1975. The importance of
reaching this short-term objective is emphasized by the knowledge of
how the USDA will utilize a documentation of our failure to reach
this objective in their overall campaign to minimize nutritional efforts
in urban centers.
The long-term objective is to integrate these two programs into one
service for needy women, infants and children which would include
the desirable characteristics of each program and be funded to respond
to all the eligible nutritionally disadvantaged in this area. Success in
reaching the short-term objective will greatly enhance the potential
of achieving this long-term objective.

PROPOSAL
To succeed in the short-term objective of implementing the Food
Prescription Program and the WIC project to the maximum level of
47,000 by next July 1st, resources are requested from the state for
support starting this fall.
The appendix attached describes the proposed budget, the in-kind
contributions, the financial value of the food assistance programs, and
the locations where they would function.
It is estimated that 50 percent of the aide's time will be spent in
the field contacting and helping to motivate participation in the two.






49


women, infants and children feeding programs. In addition, they will
provide information and/or referral to the Food Stamp and Senior
Citizen programs as well as serving as a contact referral to the social
HP worker involved for other individual social problems.
It is also essential that a similar response to the need identified in
this material be considered for inclusion in the state budget for the
fiscal year 1975-76.
Enclosure.
POSSIBLE POINTS IN OUR RATIONALE
1. Malnutrition and hunger, due largely to economic deprivation,
unemployment, soaring food prices, and high mark-up in, central city
stores (characteristically small and medium independents), is an
extremely widespread problem in Detroit.
2. Virtually none of the exi-ting food assi-tance programs serve all
of those who need and are eligible for the ptograums and for whom
they are intended.
3. Some food assi-4ance programs do not reach all of thos-e eligible
because of budgetary restraints. For example, the Food and Friend-
ship Programin is only able to seirve about 1600 eldt-1 Detroiters when
it is known that 50,000 Detroit Senior Citizens have incomes below
the poverty line.
4. The major food a-sistance prorzln, Food Stamps, serves only
about one-half of those eligle in Wayne County. An important
reason for this is the lack of adeqtiate outreach resouces. 1e lo-ss to
Wayne County in potential federal food stamp bonus payments is
estimated at more than S2 million per month.
5. Lack of decent outreach and nutritional education efforts g-
gravate problems of malnutrition- and hunger, leave man\ nee((y
per,-ons ignorant of the services available to them or confus-ed about
how to obtain food assist ance.
6. 'Malnutrition and lungoer is an identifiable major factor con-
tributing to a host of health and social problems.
7. From a health standpoint, and in terms of its future costs to
society, malnutrition ilmong pregnant ti- hicta tig women, infants
and pre-chool children mak he-" the "niost vulnerable group" and
the priority focus for our efforts.
8. It is estimated that 105,000 Detroit women, infants and children
qualify to take part in existing federal supplemiental food programs.
9. At the present time, 18,000 women, infants and children are
receiving monthly dietary suipplemen-.ts through the Fcs PE: HOPE
Food Prescription Prograin. The selected USDA commodities dis.-
tributed through this prograin have an estimated annual retail value
of $3.2 million.
10. In the coming year, however, Detroit wil- have a unique oppor-
tunity to mount a massive and intensive attack upon maternal and
-child hunger:
The Detroit Health Department has received a S-..6 million grant
to operate a Women, Infant, and Children (WIC) supplemental,
food program for 12,000 participants, beginning October 1, 1974.
Beginning September 1, 1974, Focuis: HOPE's annual administra-
tive budget (OEO-EFMS) was more than doubled to 8425,000. Tliils
grant is intended to enable the Focus; HOPE Food Prce-cription Pro-





50


grain to serve 35,000 monthly participants. USDA agreement to
provide tlie additional supplemental food is expected shortly. At
this level. tle annual value of tlie program will be approximately
SO6%J 7nfldlwh.M
It is therefore apparent that in the coinig year -upplemental food
assi-4tance, wortli more than S')J i'Ilion can be extended to 47,000
persouns throw' lrgh tile two programs.
11. Unlike other food assistance programs, however, supplemental
food programs are designed as health programs. Tlie dietary supple-
iment provided is considered part, of preventive health care in colinec-
tion with pregnancy, birth and early childhood development. By law,
d('trmhitil.iioni of need and eligibility for both the WIC and Food
Prescription Piogramis must be made by a health professional (Doctor,
Nurse, Nutritionii4) or by soincone designated as competent to per-
form tWe niecesa.-,iry nutritional asses-;iuent.
12. For neit'hier program, liowever, does the U.S. Department of
Agriculture provide adequate (in the case of WIC) or any (in the case
of Food Pce -cription) fiiia-,cial assistance to the public health authori-
ties upon whom the responsibility for certification falls.
13. It is therefore apparent that the usefulness and success of either
program in any given community depends ultimlately on tile public
heale r -(,ourceC.- available.
14. While enjoying the unprecedented possibility of assisting 47,000
undernouri-he'i motiers, infants, and c iildren and providing them
with more than $9 million worth of urgently needed food in the coming
year, all Detroit public health facilities combined do not nearly pos-
sess enough personnel to perform the necessary nutritional assessment
and certification for so many persons.
15. It is apparent therefore that both the WIC and Food Prescrip-
tion Programs will be underused and fall far short of our goals, unless
additional certification personnel can be placed in various, key
public health facilities.
16. We itre therefore turnina to the State of Michigan for a giant
of $227,133, the "little exi a" needed to take full advantage not onl-
of the imlti-million dollar supplemental food programs av% ailfible,
but also tho-e other programs, especially the Food Stamp Progiran,
which fall Jshort due to lack of adequate outreach.
17. Our basic plan is to train and employ twenty "Nutrition Aide,"
under the direction and ongoing supervi-sion of a professional Nutri-
tionist. They will be placed at various public health facilities through-
out the City of Detroit, and through primary and regular in-service
training, will be enabled and asniged to perform the following

Provide the nutritional assessment and certi flea tion necessary for
participation in the WIC and Focu.N: HOPE Food Prescription
Programins.
Provide nutritional co(:0 nscllig and educa-tion in regard both to
good (at iny- habits :nd good buying) practices.
Provide direct, fa.iia, and detailed guidance on how to apply for
and iie all other food a-dtnce programs, particularly the Food
Stamp Program.
Provide informMtion on other consumer, home economic, and social
services available to assist with food-related problems.






51

Finally, the Nutrition Aides will be assisted by one full-time Social
Worker. Our experience has confirmed that serious food problems n re
almost inevitably conjoined in reality with other severe socio-economic
problems. Though one Social Worker is hardly adequate to deal with
these, it is expected that this person will be able to accept referrals
from the Nutrition Aides reg-,t ding pmarticuhlrly serious or mnusual
problems, and provide the guidance, intervention, or direct asbistance
needed.


Ant icipated budget
I. Personnel:
(a) Twenty (20) nutrition aides at $8,000 plus 15 percent
benefits ($9,200)------------------------------------
(b) One (1) coordinator/supervisor (profe-zsional nutritionist) at
$12,500 annual salary for 13 months, plus 15 percent
benefits ------------------------------------------
(c) One (1) social worker at $12,000 plus 15 pe-rv-.nrt bcnefitf,___
Personnel subtotal -------------------------------
II. Training:
(a) 70 cla-s.sroom hours at $15 per classroom hour------------
(b) Materials for twe-nty traine-. at $25 per trainee----------
Training subtotal --------------------------------
III. Outreach expenses:
(a) Paper, printing, duplicating of outreach materials---------
(b) Office supplies and postig -----------------------------
(c) Production of six (6) TV-radio (package) public e': ice
spots at $700 per package-------------------------
Outreach expenses subtotal---------------------


S S4, 000

15. S:
13 800
$2>;. 383

1, 050
500
1, 550

6,000
2,000
1. 200
12, 200


Total anticipated budget: (annual)----------------- 227, 133

Anticipated in kind ci'intrib 'dirov- to OWreach effort
I. Space and equipment (estimate)------------------------------ S12,000
II. Media assistance:
(a) Radio public service spots ($70 per spot, estimated at five
stations, four times daily, 300 days per year------------- 420. 000
(b) Television public service spots ($70 per spot, estimated at
three stations, twice weekly, 50 weeks per year)--------- 21. 000
(c) Newspaper assistance (printing of full-page food pro.rain
descriptions at $3,000 per page for five programs; 10,000
copies (reprints) of each full-page program description for
five programs at 2 cents per reprint-------------------- 16, 000
Total ------------------------------------------- 457 000
III. Other volunteer efforts:
(a) Volunteer Outreach a-zittnnce estimatedd 300-500 volun-
teers) ---------------------------------------------- N.C.
(b) Supplemental food cooking demonstrations of the expanded
nutrition program and Michigan Consolidated Gas Co---- N.C.
(c) Volunteer speakers time (e-tini,;ted 10-15 presentations to
churches, civic groups, block clubs, and other community
organizations per month)----------------------------- N.C.
Annual financial value of food assistance programs which this Outreach effort will
serve


I. Certification for WIC and food prc-scription program:
(a) WIC
(b) Food prescritpion program (present worth: $3,200,000)
anticipated 1974/75 value------------------
(c) Food Stamp program ----------------------------
(d) Food and friendship------------------------ -
Total----------------------------- -------


1 Estimated annual value of Wayne County current Food Stamp bonuses only.


$2.600. 000


6,500.
1 29, 000,
845,
3S. 945.


000
000
000
000






52


ANTICIPATEi ASSIGNMENTS OF TWENTY NUTRITION AIDES 1


Two each (-/):
Grace Ro's.
Gratiot.
One f(lch (I6G):
('1 [ASS.
B i ce-li)oii gi a
Nortlivilst.
J11(&rim Kiifer.
I lutii l.
Mt. C(arinel.
Crit tenton.
Det roit Niciniorial.
Mom & Tots.
(Gloria Biigliin PRESCAD.
Frauiklin Settlenient PIES( AD.
Downriver PRES(.'AD.
St. Jo-epli Mercy Honpit a Clinic.
(hilVdrenl 's o-pit i-JaI (Jozens
Two 'MCHRD) Clinics.


Memorial


I Aides will be !is-zignd to centers for clinic sessions .'mil will also funi-tion in the field in
e.stimati.' 50 pjrcrrut of their time. Reaso.igiiuit s inay be imidl as dettriiiined by need.


Clinic.












ATTACHMENT 2


SUPPLEMENTAL FOOD PROGRAM EVALUATION DETROIT MATERNITY
AND INFANT CARE PROJECT-CRITTENTON HOSPITAL, JANUARY
1972
In February, 1969, the Detroit Maternity and Infant Care Project's
clinic at Crittenton Hospital became the first certification center for
supplemental foods in the city. The Supplemental Food Programn in
Detroit has overcome many barriers to its existence. It has progressed
from a token program serving 500 participants per month in 1969
with donated distribution services from the Salvation Army, through
a decentralized program serving 3,500 in 1970-71, operated by the
Salvation Army and funded by the local Office of Economic Oppor-
tunity, to its present status of a centralized program with the capacity
to serve 15,000 which is administered by Focus: Hope and funded by
O.E.O. at double the previous level.
Crittenton has continued to certify pregnant women and their
children throughout the metamorphosis of the food program. Sixty-
four (64) families who were certified at Crittenton in 1969 are still
participating in the program. Descriptive data has been collected on
thirty-six (36) mothers from these families who were enrolled in the
Supplemental Food Program at sometime during their pregnancies.

PRENATAL DATA
1. Sample size-36 patients whose length of enrollment in the
Supplemental Food Program prior to delivery varies from one to
nine months.
2. Age of mothers-Range is 15-37 years. Mean age is 22.8 years.
7 patients are 17 years or under.
3. Parity-4 primiparas (first pregnancy); 18 multiparas (two or
more pregnancies); 13 grand multiparas (four or more pregnancies).
4. Hemoglobin at delivery-Mean is 11.5 grams. Percent anemic,
(10 grams or below) is 19%.
5. Infant birth weigLit-Mean is 7 pounds 5 ounces. Percent low
birth weight (below 5 lbs. 8 oz.) is 8%. Percent low birth weight in
17-and-under group is 0%. (17 and under is high-risk for low birth
weight infants). Mean cord hemoglobin is 19.1 grams.
6. Obstetric course-38 live births, 2 sets of twins, 1 neonatal
death for a perinatal mortality rate of 26.3 per 1,000 live birthsp.
The percentage of low birth weight infants for the corn plete Critten-
ton program is 14%. The perinatal mortality rate for the Crittenton
program is 35.2 per 1,000 live births.
Infants whose mothers have delivered at Crittenton are eligible
for pediatric care in the Crittenton Infant Clinic for one year after
birth. Thirty out of the 37 infants in this sample were seen at least
(53)





54


once at the Crittenton Infant Clinic. Eighteen of these infants
continued to receive care through six months of age and five of the
18 remnined in the program until their first birthday.
All Detroit Maternity and Infant Care Project clinics are now
certifying patients for the food program. An effort is being made at
each clinic to collect data such as the above. A larger sample size
should lend greater validity to the data collected. From the small
.,ample reported here, it would seem that prenatal participants in the
Supplemental Food Program have a lower percentage of low birth
weight infants and a lower perinatal mortality rate than the Crit-
tenton average.
ANN MARIE BYRNE.
Chief Project Nutritionist,
Detroit Alaternity & Infant Care Project.
W. LOUISE LEE,
Autritionist,
Crittenton Prenatal Clinic.
CARRIE NELMS,
Nutrition i'st,
Critteiiom Infant Clinic.











HUMAN DEVELOPMENT CORPORATION
OF METROPOLITAN ST. Louis,
St. Louis, Mo., December 10, 1975.
Hon. GEORGE McGOVERN, Cliairman,
Hon. PHILIP A. HART,
U.S. Senate, Select Committee on Nutrition and Himnan Needs, Wash-
ington, D.C.
DEAR SENATORS McGOVERN AND HART: The Human Development
Corporation of Metropolitan St. Louis began operating a Commodity
Supplemental Feeding Program in September of 1969. At that time,
it was estimated that approximately 15,000 pregnant and post-
partum mothers and children under the age of six (6) years were at
risk due to insufficient nutritional and medical services.
For the past six (6) years, we have operated this extremely popular
and beneficial program in the City of St. Louis and in St. Louis
County, with food provided by USDA and funds from the Com-
munity Services Administration (formerly the Office of Economic
Opportunity).
We are most encouraged that the Select Committee is considering
legislation which would preserve and improve this vital program,
and hope the attached answers to the questionnaire will provide
useful information to you.
We are most eager to assist the Select Committee in any way and
hope you will feel free to call upon us if any additional information
is needed.
Sincerely,
HAROLD ANTOINE,
General Manager.
Attachment,"

RESPONSE TO QUESTIONNAIRE FOR COMMODITY
PROGRAMS
1. (a) During the past six (6) years, between 7,000 and 13,000
recipients took part in the Supplemental Food Program each month.
(b) Our original case load ceiling was 15,000 per month.
(c) We continue to reach additional new clients each month and
feel that a very high percentage of the potential clients in our area
are being served.
2. Our current actual budget provides for administration only. This
includes handling of the food, packing it, the distribution, nutri-
tional education, and documentation. We estimate the retail value of
the food distributed last year at $1.75 million, but have no way of
knowing what it actually costs the USDA.
3. (a) Our Community Action Agency administers the Commodity
Supplemental Food Program for St. Louis City and County.
(b) The program staff consists of 13 permanent full-time employees
and numerous temporary and part-time employees.
(55)





56

() All 't 'IfT are paiid f4o1 und1(er ouir trrait f roml tilt Co"()II I IIIIIIty
4. Tlii-. prt:aiiw i fte-'rirno' -pervifif-,dlv to re i lo the e v nee iest
of cli'filt -. It (a d cv p)'d -0 tlI.it lo)w ijn10 ome cli t'iit.- be ut erlifiedI
-It :ivui one of );1 p ,if. and pri nie 1 i I lt a(1t I I.-c alih ;ic receiC(
their co; Ilodil it'I at aly lt ;III (1 d *1ist)ri11 tionl cenit erh.. alt the tites
1m10-t coniveifenIt lo )the Clienlts;. Red lape" for 1we clients lia- been
reduIC0ed to a 1iniii6mum1. (hitimeach i" (* codiluctel in tli-oct areai where
the very pnr live ;'ITd Imo-t of tile -ocial :nirtncie-, in St. LoUis act
a"' r fl~-1 al2 so i1'C0--l1 I () Ill PjW'-o 1rain.
5. () Te CommuI1111nsity Si vicic" Adlliiiinitration pay-, tlie admiinis-5
tra.tlve cos-ts of tIII J~,, ;^~ll
(0) I -.; niontli tflIitt co t-t amount ed to appro\inately $17,000.
(ci USDA provide- the food only.
6. 'Flte ;ti 1111 11-traItive c(o-ts of the pro rl-l alla include' co)-t of the
PrownratmI Dinc 1tor, AdIn ii .-in t tive A--s-ist t Nutritional Ed cation),
cle'rical andl b okkowping s..t aff, \\'arerh(u i-eiiime, food i)Ie-paicker-,
trick dri'iV(e's, 1e011t1al of two (2) truck-. wazi'ehom i-e rental, andc su applies.
We feel that the ;t1(ve p)ll< additional needed vi ucationt a Ii.--i~tance
mnd omitreach could 1)0( hadlled coifortablv wi 20 percent of tlme
total pIrogram cts.
-0 (a) e a -paCkn12ed s of elivey. Th Fliat is, the com-
modities- arrive in St. Lomi- in carloadl lots. T (e delivered commnlodlities'
are than pre-pauokaged in b6xio- suitable for ijiluanmce. The prepacked
boxes are then delivered to the 17 distribution centers where they
a r'e is,-iied to clients.
(b) We feel that for the qunmtity of food distribute(l and our
re,ources available thlat it i-s a very 00ood system. It allows for inaxi-
mimi control of food and records.
(c) Our food distribution costs run from a $1 .50 to $2.00 per issuance.
8. (a) It is difficult to judge wliat percent (re of our budget would
be required to run an adequate nutritional education program.
(b) We feel that nutritional education is very important.
(c) Our Supplemental Food Progaimi currently has a nutritional
education component. One staff member conducts and coordinates
the nutritional education component. Each of the 31 cooperating
health ugencie- provide nutritional education to ,ome degree to tlie
patients at their hmfalth facilities. In addition, the University of
Missouri Extension Service provides period 1ic edluca tonal sessions in
which they demonstrate the iie of Supplemental Foods.
9. With the current state of the economy it is rare when any of
the food^-. issued in this program are rejected.
10. (a) Ba-ed on wimat we have leaniedl from USDA, it appears
the Suppleinmiental Foods are quite nutritious.
(b) The najor recommendation for c(awige wolld be to add more
foods to the package. Additional peanut butter, meats, i(nd more-
varied v of vegetables would enhiance the nutritional value of the
pack ag[e.
(c) An ideal --tem of (di-tribution would be to deliver the food
packagef- to the program participant's home. This would require a
much larger budget.
11. We are not aware of any unfunded project applicationss in our
area.






57


12. Assuming the foods were available, we would be able to reach
approximately a case load of 15,000. Our budget in addit ion to the
cost of the food would be between $250,000 and $300,000.
13. After the first two (2) years of operation in St. Louis (_it t and
County, we saw a statistical redtiiholl ill tile infant i 'o4aIilv rate of
those census tracts in the inner cit \ served bl) tilhis proori-amt (idop fIromi
35 per thousand to 2S per thiousanlid. WAe feel that the SlIpplemjellntal
Food Program played a major role in this improved rate.
* 14. We have three (3) eligibility cr'iteri a for participation. rJTe are:
(1) Pregnant women, mothers post-partoun li)p to one (1) year, and
children up to age six (6).
(2) The client must be eligible to receive free or sibstantially free
medical treatment from the Pediatric and OB/GYN services of the
health agencies writing the prescription.
(3) There will be a medical( determination made that nutrition is
needed for the health of the individual.
Eligibilitv is determined by the health agency. Potentially eligible
clients are referred to the health agencies by our CAA outreach staff
and other sources.
15. Many clients who participate in the Supplemental Food Pro-
gran also learn of and make use of other IIDC' services suIc -as, E duica-
tional Services, Housing, Head Start, General Social Services,
j Vocational Training, etc. A good number of clients who have been
referred to and are now participating in the Food Stamp Program
learned about food stamps through thisi program.
16. We strongly urge that USDA provide administrative funds for
the operation of the Supplemental Food Program.


ALAMANCE COUNTY HEALTH DEPARTMENT,
COOPERATING WITH N.C. STATE BOARD OF HEALTH,
Burlington, N.C., December 2, 1075.
* Senator GEORGE McGOVERN,
Cha'irmani, Senate Select Committee on NuYtrition and Human Needs
U.S. Senate, Washington, D.C.
DEAR SENATOR McGOVERN: Enclosed is the Questionnaire for
Commodity Programs. We appreciate the interest you and your
committee have taken in the Supplemental Food Program and your
efforts to provide legislation to continue and improve the program.
If we can be of further assistance, please contact us.
Sincerely,
(MIiss) GEORGIA WALTER,
N1tr iton ist.
A. H. (JNI) SCOTT,
Sanitarian.

RESPONSE TO QUESTIONNAIRE FOR COMMODITY
PROGRAMS
1. (a) At present wce have about 1,100 on the pro'rrain with about
950 to 975 actually receiving food each i month.
(b) Ceiling: 1,000.
(c) Several months ago we requested( an increase in caseload to
2,000 participants, but this was denied.





58


2. Monthly budget S.56S.64-total administrative, none food.
3. (a) The Health Director, Dr. William Norville, has ultimate
administrative responsibility, however, it is supervised by
A. 11. Scott. Sanitarian.
(,h) The contract does not budget for specific positions.
(c) North Carolina Department of Agriculture is the contracting
agency.
4. To the best of our knowledge, the. people most in need are being
reached. We receive referrals from the Department of Social
Services, as well as our own Health Department patients.
5. (a) The county pays the co-t. and is partially reimbursed by
North Carolina Department of Agriculture 240/part.icipant/
1mo011th.
(b) The administrmitive coAt for November was: Bookkeeper,
,$259; 1 worker-64 hours at $2.20, $140.80; 1 sanitarian-
32 hours at $5.12, $163.S4; Nutrition education, $5. Total
S568.64.
(c) USDA pays nothing directly to the county.
6. Administrative cost includees the items listed in question 5(b) as
well as in kind contributions from the Public Health Nurses
who certify the participa-nts and 24 hours month at $6.20/hr.
from a state employed nutritionist working in the county.
(However, the county will be picking up this position July 1,
1976, so at that time this will become part of their administration
cost.)
7. (a) The food is delivered to us by NCDA in Raleigh. The par-
ticipants pick up their food at the Health Department once
each month (on one of 4 distribution days).
(b) We are satisfied with our system.
(c) Unknown.
8. (a) At present, the county gives the Nutritionist $60/year for
nutrition education for the Supplemental Food Program.
This (or more) could certainly be used gratefully.
(b) Because of lack of knowledge of how to most effectively use
several of the food items (farina, powdered eggs, etc) we
feel nutrition education is very important.
(c) Our current education program costs the county $60/year.
The nutritionist provides 24 hours in kind contribution a
month at $6.20/hr.
9. Rejection problems are found mostly with:
Dried eggs-"because they taste flat" and aren't properly
prepared.
Farina-because they "don't like it."
Dried milk-(to a certain extent) because "it doesn't taste like
whole milk."
These three. products have been the main target of our nutrition
education prog;a1m.
10. (a) No, I'm not entirely satisfied with the food package.
(b) I would like to see cheese (American pasteurized process
added. Also, an infant prepared formula (similar to Similac
with Iron or Enfamil with Iron) rather than the evaporated
milk would be nice, but not essential.
(c) No recommendations for change in delivery.





59


11.
12.
13.
14.


15.
16.


NORTHWEST

RESPONSE


1. (a)
(b)
(c)


250.
No.


TENNESSEE, EcoNoMic DEVELOPMENT COUNCIL,
Box 2, DRESDEN, TENN. 38225


TO QUESTIONNAIRE
PROGRAMS


P.O.


FOR COMMODITY


1


1


3. (a) Cooperation between County Health Department
Northwest Tennessee Economic Development Council.
(b)
(c)
4. Yes.
5. (a) No cost to our County.
(b)
(c)
6.
7. (a) Participants pick up food at Distribution Center.
(b) Yes.
(c)
8. (a)
(b)
(c)
9. No.
0. (a) Yes.
(b)
(c)
1. No.


and


12.
13.
14. Poverty income guidelines.
15. No. This program has gotten mothers and children to Health
Department that othenrise could not.
16. These children and mothers go to the Henalth Department to be
certified for supplemental food-thus mothers and children aire
checked for all health purpose. -family planning recommended
to mothers and children receive immunization shots.


I know of no unfunded projects.
Ideal caseload: 2,000. Ideal budget: $725'/month.
No medical evaluation has been done.
(a) Women pregnant, post partum to 1 year. Children up to 6
years of age.
(b) They must attend one or more clinics in the Health Depart-
ment.
The program has increased our clinic participation.
(a) Funds for nutrition education.
(b) Addition of cheese and if possible, infant formula.





60


Mr-v: t'1 kRE AuE.\ PIM.1 rCT-S -iuir. T\'r.,
-1 lo iti p *, p'( hi li., Jail I/ar? 2-s', 1D)76G
SlIon. C;i'.ti; L MN( (IMu IAS.
< El iY, v,1 ( ..s f ,I'1/1 Se 10 Cf ( '11n/it '/ o w, A *h'if m id aHn( fl ninrn

DI.AH SI:VATyiH M<( iMi--i-x I: l:i-e fidcl eTflnli-d repOnses to tile
(ies ifniile f .Ir'dcd to 11-, f oin tl tI w 'Sclect )1111 i tivii e mn XUt 'ition
A I'
We lIwo, the eIcIu)lo..d inf)ra f(inui I illn \\-I-~ orII aA ii~iflittee i1ll
dra tiiL'" IKv\ cri-III)Io v.-itlh reg.,11'd to the1 (o i n d t iD l IIIcit
SIcr 1 n^T.ini
Sinc I('ly
JIS-I'ii MIULlIN,
Di'/rtchr.

RES-POXSE TO QUESrIONNAIRE FOR COMMODITY
PROG RAM S
1. (a) There Ir'1 2,777 recipients --orviced each month.
fh No.
(c) 1liere Wia neve*r 1ui aiuthorize(d <-eloaid. Ou11 c1- are confilined
1to the nine (9) cenisusw tir-ct. Aklyone who is (ligiible under
the USL.DA ui( ielini(- m;iv receive tlhe coinmoditie<.
2. Our current budget i< -_,52,000.00, t1i- is almini-trative only.
3. (a) IMeinplii- and Shelby County Healdth Depa rtmient.
(b) Sveii (7) per-ons are budgeted for in our current budget.
(c) Coiii'iiiitv Action Ageiic.
4. Y(,-.
5. (a) The admiirivtrative cost is payed for out of "MAP-South's
XWarehou-e Budgt through or contiucting agency (Coinniu-
nitv Action Acxencv).
(b)
(c) None.
6. Personinel co.t; fringe benefits, non-personnel cost; travel, space
:1nd rental, conii1iumible -upplies, other cost.
No. Our budget is limited to a staff of ,even (7). However the
outreach work is done by St. Jude Iea-ilth Aide- and MAP-South
Aide. who are under the Social Service component.
7. (a) Truick, for the medically confined ca~e( and hard-.lip case
only. All other revipient.s pick up their coimimodities at the
Warehouse.
(b) No. Lack of sufficient Mman)power.
8. (a) Per-onnel, MAP-South is a pnigra;ii de(-,igtrned for the distribu-
tion of 1S)DA Coymmodities to low-income families; in the
nine (9) census Iract of the MAP-South :i (l Iiimiited to tile
personnel. Our budget 1has no fund-s for thie expans;iIon of any
co1n)poiiefit other than Soiail Serviee. The nutritional
educa ition component has been an in-kind coitn1tribution from
ftle St. Jude C(h1ildren's Re-ca rch lo-bpital.
(b) Due to the lack of knowledge in preparing the food and realizing
the importance of proper diet, we feel that the proper
)repai ration of food should be available to all recipient" in
tlie SIpplemental 'ooil Prozr.in111.
(c) No.





61

9. Yes. For the lack of knowing how to prepare the USDA food.
10. (a) We are not satisfied with the food package.
(b) The food package should be adapted to the nutritional
deficiencies that occtir iii the target population.
Evaporated milk should be replaced by a (proprietary)
infant formula containing the recommended allowance
of vitamins and minerals, especially iron, and should be
simple to prepare. Some form of enriched milk should be
available for all age groups in view of the fact that we
continue to d(emonstrate vitamin A and riboflavin de-
ficiency. A soy-protein preparation should be considered
as ail alternative, as black children become, intolerant
to cow's milk with increasing agiZe. Food stuffs should not
be removed from the allotments without a convincing
nutritional reason, i.e. the discontinuation of evaporated
milk this fall. It decreases participation and defeats the
purpose of the program.
(c) A delivery system e.g. a van aind a driver, should be available
because the food package is too heavy to be carried and
too cumbersome to be taken on a bus. Cabs and "friendly
neighbors with a car" have become prohibitive expensive
this vear.
13. A 1974 nutritional survey of 300 children randomly taken from
the rolls of the Map South warehouse showed:
mean hemoglobin 11.3 -1.0 gin percent.
hematocrit 33.0 2.7 vol percent.
Incidence of: anemia (Hgb below 10 gm percent) 9.7 percent.
(Hct below 30 percent) 11.1 percent.
unacceptable viluamin A levels (below 20 mcg percent) 26
percent.
unacceptable vitamin C levels (below 0.2 mg percent) 2 percent.
unacceptable vitamin B2 activity IS percent.
Effect on vital statistics in the 9 census area in which the
program operates:

Average,
19o6 -C8 1969 1970 1971 1973 1974

Total number of births------------------------- 1,111.0 1,007.0 1,014.0 901.0 708.0 718.0
infant mortality (per 1,000 births)----------------- 37.4 34.7 20.7 23.3 32.5 32.0
Prematurity (per 100 births)---------------------- 17.9 16.0 16.5 17.6 16.4 15.8
Stillbirths (per 1,000 births)---------------------- 24.5 35.7 17.7 21.0 25.4 19.5
14. We use only USDA criteria for eligibility, no others are added.

15. We feel that the program has improved the nutritional status of
the preschool population.
16. Recommendations:
1. See 10(b).
2. Dietary counseling should be provided to improve the effec-
tiveness of the program. This should include recipes to
improve the palatebility of the comnmodiities and the
emphasis of good food habits in children.
6 ,l,-7 0- 5






62


MEMTPHI-AI SAHNLU.1v COUNTY,

Afe'rn pit TUn i/., .Ja iiiuary I9, 1!i7 U.

( ''<~rn(]i, ff 'f(*1,iffmt ttr~f i>n NXutr1*t:n anr Ii H mai -Yrcd-s,
U.S. Suf1 afri II (7S11;fu1/1t.C
DEAR NIOR iMcGoviR: In to yo recent Ictter re-
Lrjj'iug the Commordity v uppleI!eutiil 'ood lProwrrIm, attached nre
ou1 :I I-n\%Or- to the qile--Ztior \which you -8skwd. WVe have given this
qu!-lioiii:ire, ti cb-fid(erbl)' ;imoiiint of timi' in order to give you an
;tccurnte -ppraii-al of our program.
We at th1e Memphis nrid Shelby Counv Health Departen01t en-
CouMIMU'g you to continue your effort in lwl itlf of thils essential program.
If we cain be of further a.-i~tsuuWC to you or your c')mlilittee, plea-ze
.id visec.
Sincerely,
HAROLD D. CARVEi-Fity

Aktt awfin lent.

RESPONSE TO QUESTIONNAIRE FOR COMMODITY
PROGRAMS
1. (a) 71 ,S33 in 1975 Supplemental Food.
(b) Ye-, letter dated March 26, 11)73-10,000 families.
(c) Eligibility requirerits, decrease in evapor-ted milk d1istribu-
tion ad1 hick of tran-portatjon by recipe -.
(d) 10,000 fiilie^-authorized cas-;eload.
2.(-0 $130,5'sl.59.
iIb) A(dministrative cost only 75-76 budget. Food costs not avail-
able locally. Available through Tenness.-Cee Department of
Agricuilture.
3. (;i) Memphii- and Shelby County Health Departenit.
(b) 16 per-ons,.
(c) TrineA,*Ib Departrent of Agrjcultuiire.
4. Y. throiuzhL free health services provi-Wed by Mempluii and Sihelhy
Coiiity Health Depa:'tment.
5. (a) Shelbvy Count v government.
$b)10,882.00 (approximate).
(e) \one. USDA pays shipment cw-t of comimodities only.
6. (a) (Cnmplete and total operation of Supplemental Food Program.
(b) No, it would be above 20 percent.
(a.) Direct warehous-e plickjp and city, county truck stop delivery
in outlying areas.
(b) Ys--with direct warehouse pickup and truck delivery to
outlying areas most people in need of coimmodity program are
reached.
(c) $1.81 per recipient.
8. (a) 10 percent.
(b) Extreminely important.
(c~) Yes.
$)>,000.00
Nonle.
None.






63

9. To my knowledge none of the Sulpplemient;al Food is or hlas been
rejected for any reason.
10. (a) Yes. Present Supplemental Food package would appetar to
contain a well-balanced nutriti-nal value.
(b) None.
(c) At present time, I see no need in change of delivery of food
package.
11. None to my knowledge.
12. (a) Due to present economic and] unemployment coniditioins, as-
suming adequate money was available to ro1ich all persons
eligible under current Supplemental Prognr;-i guidelines, 1
believe our total c.iseload would be approximately 15,000
families.
(b) $326,400.00 (est imrated).
Cfr,'PARISON OF ANEMIA IN NOrNWHITE CHILDREN, LESS THAN 4 YEARS OF AGE, TESTED IN SHELBY COUNTY
WITH A SUPPLEMENTAL FOOD PROGtAM (SFP) AND HAMILTON COUNTY WITHOUT A SFP

Hematocrit data Shelby 1 Hamilton

? 1969 No. tested------------------- ------------------ -------------- 8,025 222
Substandard ----- ----------- ------------- ------------ 1,364(17) 78(35)
1970 No. tested------------------------------- 3,442 309
Substandard- --- ------- -------------------------------- --- ---- - ------ 1,097(13) 102(33)
1971 No. tested---------------------------- -------- 9,733 7 2
Substandard -- -------- -- ------------------------------------- 1, 168(12) 227(1,)
1972 No. tested------------------ ------------------------------ 10,899 946
Substandard---------------------- 839(7.7) 166(17.6)
1973 No. tested ------ ------------------------------------------ 9,334 1,2i -
Substandard -------------- ----------------------------- ---------------- 457(4.9) 161(13.4)
1974 No. tested-------------------------------------------------------- 10,692 1,234
Substandard-------------------------------- ----- 657(6. 1) 134(14.9)
Total tested.---- --------------------------------------- 51, ?55 4,788
Total substandard ------------------------------------------- ------ 5,209(10.1) 918(19. 1)
5 Shelby County was approved for a SFP in July 1969.

14. The initial eligibility criteria for participation in the Supple-
mental Food Program is medical ev aluation through I( .th
Department Clinics and public health nurses with access, to
known background of the family, as to diet, income and social
conditions within the family.
1-5. It has hel;&'d to itcie i.;.e the (unu ber of children boing- seen and
immunized within the I I eal th Departmnent.
16. None at present time based on original guidelines.


METROPOLITAN GOVERN ENT O0F NA SHVILLE AN[)
)DAVUISON COUNTY,
Nas hiv1e, Tevn., il c'beJ 9, 1975.
Senator GEORG-E :dcGoVERN,
CL a ;)?ma a, U. Senate Select ("ommdilee on Nutritin and 'HuIa Aee((1
Washington, ). C.
DEAR SENATOR XI1CGOVERN: Enclosed is our r:-ponse to your
questionnaire regarding Supplemental Food Pr'ograii ms. We cert. mainly
hope that legislation will allow for a continuation of the Commodity
Supplemental Food Prognoiis.








<':tn it. the, t p ii-c HH, Ou ~~ j v riie t.( r dleparm entivi
I 4'' *-, thn fm'd frum the k e Tvilic-*c I)Wmi 1t mclit of Agricult1re' aund
all filt l Shir otigc, ili-t ribult)in 1iiild tCILit id (c -t a4nc borne by the

1u" ;i a lick (if ;itleq iitl i ftuiljiig, i i- ] ()i ';niin I1S nievv r lHI(-(I
;ildle Ito I 1ii ;ll (;I4 tiw i \'ll(t dljill ; ill ln e:1 of th iiV "upPulUt. Ti(c Govcrn-
rieiit of X:i-ilvillt' ailtid DnvidI-(Hi C(oliitV h1:- clwi(ol> nt, great vxpvii.e,
It ;iiako til-l l)wotzi2ini ovailll)Itd to the cointillflit v buiit 1hs- nlevelr
1>r<-n ;ll' I to cit h r duld qii.itely 1 t;iff ti'e pri)IT'Lriiii o M" P t fllt, tio.-e
jnlir-ull i m- \\-lio re iveo, the( f t)i't Id i-,k r('CCLNve Odiicatioial. ilirorin11,tiol
i('I;i;"ii h!tti prthe j)F()iii;tio1i of the fooil.
We vory much1( -11'pp o)lt Your clfovt-% to mitiut.' this valuable

Sin ('"rlyour-,
Jo,- N. RIGGINS.
ii I l i r o.

REsLK( )NSE TO QL U'TI()NNAIRE FOR CONINMODITY
PROG RAMS
1. (:6) 8,000.
(h) Yes-16,000.
(c) Thiere is a lack of funds for adequate personnel, and also due
to the lack of funds there is itadequiate publicity to make
the community aware of thie program.
2. Current budg(et-S'5,8S3. AdImini4trative cost -rent $15,S40.
Sn iarie..-$20,043.
3. (a) Metropolitain Health Departiment of Na-hville and Davidson
Count v.
(b)
(c) Tenne>^ee Department of Agriculture.
4. Yes, but people in borderline areas of need and( income are not
fi('1ifl reached.
5. (a) Metropolitan Hiealth Department of Nashville and David-oon
County (.Metropolitan Government).
(b) S4,660.25.
(c)
6. (6) Rent and salaries.
0b) Yes, we could pay for some outreach, operating costs, nutri-
tional education, ;nd indirect adimini-trat ive costs for
approximately 20 percent of the projected yearly budget.
It is. po-,ible that a figure slightly more than 20 percent
mirrht actually be niec-carvy.
7. (a) Direct distribution of food at a .-incle warehoiu-e.
(b) Yc-.. except additional di-,tributioin points would be more
affective.
(c) $2.26 per person.
S. (-i) We have 110) progi0L:1111 l)lu1dget. Al adequate nu tritional educa-
tion pj)oI(1im woWld pIobablv co-(4 from S6(0,000 to $70,000

(1) We feel thait it i- very miwprtant. rany of the recipients; or
Iiv slupplemeIntal fro~id (do not know how to potperly prepare
Vie food andii tilt'riel'o wa-te a CoH-id<'rbii(le -mloiuilt of it.
(c') N(.








9. Yes, farina, egg mix, dry milk. Tie reasons for rejection are tie
fact that the recipients do not know how to prepare the
food (no recipes) and complain of the poor taste. If these
foods were used to prepare combination foods it is pos -ible
that these objections could be eliminated.
10. (a) Yes.
(b) Not applicable.
(c) None (however, our program is very limited by the amnouint1
of time allotted for imload(ing boxcars when delivered to
our program. We would recommend an extension of tile
time allowed so that staff would not have to be increiaed).
11. None.
12. 26,000 to 32,000, $:250,000.
13. Not applicable.
14. (a) Substantial participation in health proga Ins for low-incol lie
recipients.
(b) Recipient of welfare or SSL
(c) Proven medical or nutritional need.
15. Yes.
16. (a) Continuation of the Supplemental Food Progras .ii
(b) Adequate funding for operation of Supplemental Food Pro-
girams (provisions for administrative costs).
(c) Adequate funding for nmitritional e(Iucation.


NORTHWEST TENNESSEE ECONOMIC DEVELOPMENT COUNCIL-, ROUTE
3 c/o EVERETT-STEWART AIRPORT/UNION CITY, TENN., DECEMBER
3, 1975.

RESPONSE TO QUESTION NAI RE F( )R COMM ODI T Y
PROGRAMS
1. (a) 24,700-25,000.
(b) No.
(c) Transportation and knowledge of program.
2. None. Not available.
3. (a) CSA.
(b) None.
(c) USDA.
4. No-more.
5. (a) CSA.
(b) Not available.
(c) None.
6. Not available. Yes.
7. (a) Family pick-up commodities.
(b) Yes.
(c) Yes.
8. (a) 1 percent.
(b) Very important.
(c) No.
9. None.
10. (a) Yes.
(b) None.
(c) None.






G(


11. \K'ne.
1 7..,'f ^->

15. 2Ye7.5
16. irir .id inil'l rntitm' .11"(] operating cfots Nvith1 ('S^A f


GRANI) 'Cor'TY Pnui-ric II i-:.u/ru, \IOAB, IITAur
h IK~KN) TO QUESTI1ONNAIRE FOR COMMODITY

1. (a) Aver e of -0.
()) No.
(c) It v;ire^-.
2. Our couity p1ii is almit 1200 a y\ir, -.1itc (**nivrbiit e S1G6 a ytar,
to t i11iHj ;I bdt of al360 out of the Poor :ti d mIdirent find.
3. 0t) Public )1 lelth Xe!zi r.
,(b)iOn,.
(c) Grand Countv .
4. Y --.
5. (;0 Crmind Count *v.
('1b) About I":M).
(C)
6.
7. (a)
(b)
(c) Almout ,I per faijlyv.
8. (a)
(b) Beneficial.
(C) No.
9. Yc-. At one time \vw found 1lii~t powdermd milk wai (lumped
at Moab City dump and a farmer took it to feed his hogs!
Some people do not know h(ow to use the powderedI grgs.
10. (a)
(b)
(c)
1 1.
12. Probably the same.
13.)
14. Yomur sa;.1e provided with iilfnst r ions.
15. No.
16. Thi- pri gni is budgeted under the Poor hnnd Indigent, fund. As
Public ellalth Niisne, I aflIU'(dy am on the payroll. One person
is hilL-d to taike ( olinIty provide-i storae. Often we (di-tribute to Iransients who
ae job l hunting with yoitig fnrv-iiie^. Tllme arC ilually for oily
on(e or two ir;ntb-.-until they gKet n' paycheck, or leave. I
s1y'.o-T t tha't ;.1)plic(111 fill out .1 1 si-n au form" application.
My belief is; 6l, t >mle p1-op)l i0e. ahout th'/ir salarie arid
M re ii insance--. A form ih Iev have to i n might hel to prevenit
r Iiid. A;.,o, it might b] wvell for recipietlis 1t say teticy will
u1-e ;I11-or give I-P-ra the oppoArtunity to reject items they





67


would not uCe. Most State fie:t i Detartments hire t Nutri-
tionist, and I feel sure that arrangements could b,1 made for a
2 or 3 hour lesson with recipes fnd demousi rttions withoH t
inein HIPa bud-lget. I believe in using people already emi-
ploved to set up programs, and not create more position;.


WE, BER COUNTY, OGDEN, UTAH, DECEMBER 1, 1975

RESPONSE TO QUESTIONNAIRE FOR COMMODITY
PROGRAMS
1. (a) Approximately 1,100 a month.
(b) No.
(c)
2. We have no specific budget for this program. We are reimbursed
at the rate of 30 per person served per month. The food is
provided by the Federal Government, space is provided by the
County Health Department and the personnel are paid with
the amount received from the 300 per person allowance with the
County picking up any amount not covered.
3. (a) Web-r County.
(b) None.
(c) Utah State Mental Health Agency.
4. Yes.
5. (a) Weber County pays everything not covered by the 300 per
month via the Manpower Programs and general County
funds.
(b)
(c) None.
6. Salaries for two people to operate the program (one full-time and
one part-time).
7. (a) Direct dispensing to rccipient.
(b) Yes.
(c) Yes.
S. (a) As we have no present budget, it would be impossible to
answer this question. However, a nutritional education
program is now being offered in the County through our
public health nurses and our U.S.U. Extension Service.
(b) Very important.
(c) Yes, we have a nutritional education component as explained
in 8(a). None of the program cost has comie from the
administrative budget as we hli:ve none. It could all be
labeled in-kind con. rib-utions.
9. No.
10. (a) Yes.
(b)
(c)
11. No.
12.
13. To my knowledge, there has been no direct evaluation done as to
the medical benefits of the food supplement program in Weber






68


Co nty. I l;in -n rv Ih r ;iv :,re nlut rition'i! benellit bec'.iisc* of thle
\% ()IvhoIe-omen- -s 4o)f t I I( foodI i--ue. tt
There ha ve iween 11any s-e dar medicaIl bieiefit-s fromi t(he fool
sujpplement programs fom in-e. cIvt- reinde Cred(I by thI e public

(a) I1u1nm ///I l/ fii.is done by the health (departmiiient to tlil childreni
oni the food sipplemient The public hezdit h niur~-e evabla tes :Ill
childreIi aszI to theii helth reedItol s. 1 The alth d tIc rt inel it tIi i
p.( vovide- 1 1 UoIrI I I IT. for t II )-v.
(1) hinnhf d fi, tli/ iflf/ St *;un-<'s i\ro\\'g}\ tlie pu ~l)ic lieilth ldcjiirt iit,
Referrnia ire' mnid(e from thie public heilth nurse.
(c) hWel ( h';/hil .l'.xissu'u ni. Many of the chill(ren -*en for food
-upplemnuiit aic referredl for 1e(1:11th ;1e-.-ei iiit hroiio-I i Ille
public. lihealth department child heiaith clinic-. Wlien ijImedical
eeds aire t1i-rovered I, referrals 1Ire niade for definitivee c a re.
14. The Public Ilc'It1 Nurie- -creei the al)pliciut, for food NMIl1)j)le-
rment and giiideline-l defined in the program are followed a- to
eligij)ility a nd foods issued.
15. Ye-- --- as entionied uinder- qiuestion 1:3, multiple health benefiivts-
are reccive(I through the food sluppleimien t program li as a;ii
initial contact afndl referral service.
16. The Weber County program is working very nati-fartorilv at low
administ ra tive costs. In some in-tance-, a wider vnrietv of
formula (when medically needed) would iinprove tlhe program.
If you need arny additional information oni this que-tionnairt', please
feel free to cont act miie.
Sincerelyv,
DOUGLAS 11. DIELU,
A 1i o/m/ in i.^rci .'- Ass istaij 1h orfi
1tber County Cofwii/hs;v/K/*1.


COMNI UNITY ORGANIZATION OPERATIONS PROGRAM, T-c.,
Salt Lake C/7'/, Utah, Dt ciintber 23, V)715.
lion. Sna-tors GEORGE McGOVERN and PHILIP A. 11 \BT,
S nate Sdr-Io C0i lhi;tttt on NtriAtioni and HUman Needs,
U.S. Senate, 1T (zs/i'n~qton, D.C.
GENTLEIEN, Enclo-sed is the informiaition you requested on oir
Commodit Supplemental Food Prorramin. The program C0 )-OP
operai es is the one designed to benefit families with pre-school children
(through age 5 years). COI-OP operate- tiihs program only in Salt
Lake County, Utah and it is a relatively small one. Still, I hope this
information will be of value to vou; I feel that this pro gram ni 1" ex-
tremelv valuable to those receiving it and, in fact, l)'belte Ihlain the
WVIC prorigram which is being proposed to replace it. For your informa-
tion in tii line, -Ial alo 9lo7in 3;a copy of a1 comparative evacuation
we did of the two programs in 1973; 1 hope that it, too, catn be of
some value to vou.
Respectfully,
FREDERIC E. PEN\J NA,
As!.4aft i)t r ic for.
IEnclo-iire-.





69


RESPONSE TO QUESTIONNAIRE FOR COMMODITY
PROGRAMS
1. (a) Average Monthly Participation-1975: 3,450 recipients.
Projected Total Participation-1975: 41,400 recipients.
(b) No.
(c) We et4iimate that we are serving one-third to one-half of those
eligible. Outreach work is being (lone to the extent our
limited resources will allow but participation seems to
remain at about this level.
2. We have figured the market value of the USDA cominodities
distributed by us in Salt Lake County at about $560,000. Our
total administrative budget, for all programsis $40,000. If we
combine these costs, we have $600,000 operating budget though
the majority of this is in donated foods; the cost split 14:1 between
food and administrative cost. All administrative cost come from
local government sources (County and State).
3. (a) Community Organization Operations Program, Inc. (a non-
profit community service organization) in conjunction with
Salt Lake City-County Health Department which acts
solely as the authorizing agent in signing-up recipients.
(b) Six staff personnel though the salary costs of two of tliese is
divided between this program and other programs being
conducted by CO-OP, Inc.
(c) We contract with the Salt Lake County Social Services
Department.
4. Yes, to the best of our knowledge.
5. (a) Salt Lake County with participation by the Utah State De-
partment of Social Services.
(b) $3,550 approximately.
(c) None.
6. Our administrative costs consist of staff salaries, employee benefits,
space rental, office costs (supplies in postage, phone, etc.), and
accounting services. Outreach is done through associated agencies
e.g. local CAP's, division of family services, NAACP, etc.
Nutrition education on a limited scale, is provided gratuitously
by Utah State University Extension Division and the Salt Lake
City Board of Education-Division of Adult Education. We
definitely could do the services named with a budget of 20 percent
and probably with somewhat less.
7. (a) Food is delivered to us from the central distribution point
in Utah. We have a central warehouse where food is
stored and broken down into individual food orders.
The recipients come to this warehouse to pick-up their
monthly order. We also have three satellite warehouses in
outlying areas of the county which are operated by CAP
agency on a limited time basis for the convenience of re-
cipients living in their areas-they serve approximately
8 percent of our recipients.
(b) Yes, the only drawback with this system is that home de-
liveries to recipients with transportation problem is not
possible within our budget lirnitaticns-this segment
represents 10 to 15 percent of those eligible and authorized.
(c) $1.07 per recipient.





70


S. 0II i Or pre-vilft s'eni of v.-in otler ;iVaile resonrces, i.e.
Itinth St ate Universitv Exten-ion Divi-i m uinl Salts Lake
(iy Sc huiml, AIult Ediat ion Po 'i ;i, is work iun well
wit h1 very lit tie money needed froil ()II oI nI budget to
fnmneeCI it. XWe -110ou1ld 1e able to conitilnue utilization of
the01h resoiresL in the fut.ire.
kb) I feel nutrition edutication i-; a very important factor in
providing our recipients with a somll(d diet; malnutrition
re-ilts .s much from lack of knowledge about good food's,
Ib)alnce(d Te1n('a Hs;, .11nd proper food preparation a-^ it (oche
from not having an nlevqlnte supplv of food.
(c) Our program lmas 1)en working with other community
resource>- as nam.'d alove, to provide this-; vital service.
T'the co-t of the prilgraim i' delivered entiirely in in kind
contrfibutions from tho.-e a1e0ie-, -o We have no set
percentage of our admHiist rative budget allocated for
thii- puiipo:e.
9. No.
10. (a11) YeV<.
(b) iNore other than ;iurmp that the periodic short agc3; of
some items thit have plagued the programi in the la -t two
ye ar happen lv-s-- frequently.
(c) M n; ;e proviion for (eliverv of the cormLuriodit v
package to 10 to 15 percent of Ilie recipienits wlio have
problem yettiig trani'-portation to and froim the central
wII-1rlehoust).
11. No.
12. Top achievable c:i-eload is projec ted at about 5,000 recipients
monthly ("k0),000 tnuiuallyv), 1thi:., would still not reach evcrv
eligible per-on in the Couni v though. The budget for this
CU-eCl1tI(l would be apprv ximatelly $900,000-,sS30,o0 in
donated commodities; $70,000 in administrative costs.
1.3. W\e have no such m clicnl ev. imuation nor can we make any sub-
stantiat cd I objective claims about the effect- the program -.i
baviii 2 on thb health of the recipients.
14 rliei ehjribilitv criteria for ouitr prcgrvniii are:
(1) Income-the -amne family income guideline- that are u-41
to (eteriine eligibilitY for Communi tv Services Ad mini-
Ira tion progyramI is ;8C ii-e I 1. (2) Age of chili I-en in tie family.
(3) Special faiiilv cir'inistancis of either a health-
r Lated 'or financi;il iwtm;1 iire takcn in'io acIoiut on at
indIividiual family basis.
15. Ye-,1to sloe Netf--nt, this proia lk b;-iV.(s the ecipiernt into contact
with eit her program ipersomiel or program information from
other related agencies e.g. Salt Lake Comuntv Health Depart-
ment, Food Starmps, Utah GOoup Health Plan, CAP service
agLrencie,4, etc.
16. (a) Provi-ion for inclusion of home delivery service for needy
families in 0111 bdlge.t.
Wb) Guaoant of fundlinig for the entire eelvlds of the administian-
tive budget--tlie prmvesent comityjstate funding does not
(10 th I.
(c) Addition of a jedicil component to the commodity program.







CITY AND COUNTY HEAL'iT DEPARTMENT,
P~ro';o, Ul 1(h Th Dumbr 27, 19~7J.
Hon. GEORGE MCGOVERN,
Chairman, Select Coit;'ua tee on Nutrition and Humana Needs, U.S.
Senate, Washington, D.C.
DEAR CTAIRARMAN McGovERN: 1, also, concur with your feeling
that the Commodity Suppletnen tal Fo0( Program should be preserved
and improved.
As a Program Administrator, I appreciate the opportunity of
submitting the following recommendations:
Sincerely,
Lois NASON-
Program Director.

RESPONSE TO QUESTIONNAIRE FOR COMMODITY
PROGRAMS
1. 350-500.
2. $2,600. Nothing for food costs. This money pays for one half-time
staff member and office mate ials.
3. (a) The County Commissioners are the cont0 acting agency and
they administer the program.
(b) One half-time staff memrb": is bu(dgete(d for in our contact.
4. Yes, the needy are being con' *Ited in our area. WVe c (Iud us e
more outreach help, as this is done by public he.Ith nursc*- now.
5. (a) The County pays administrative costs.
(b) Actual administrative costs last month were $300.
(c) Nothing was paid by USDA.
6. (a) Our only administi.ttive costs are pay for ene staff p(e--on
plus additional help on fch''1 (lays.
(b) We could pay above melnitoned costs with a 20 percent
increase.
7. USDA delivers our food items to us from Provo, Utah, warehouse.
We, in turn, use county trucks 8nd p'Tsonnel to deliver food
stuf.; within the county. I c1nVot 0- Hate the cost per partici-
pant; however, it is very small. Our system works very well.
8. Nutrition education would be very helpful to the program ;
however, I do not know thie p(rieutago (f our current budget
required to run an adequuate educ:n ion 1)1piratit. Utalih State
University has a nut: itiou program, but they need more people.
No money comes from our budget for t1is purpose.
9. Yes, Farina, powdert*I milk and ii imx are occasionally rejected ;
usually, by Mexican-Amierica it fiilit Thley (do iot take the
time to prepare them ; or, they (to not underst and how to use
them. Some f".illies do not take tlie time to prepare the-c items
properly. Here nutrition educz ion vould help.
10. (a) I am satisfied with the nutritional value of the foods; however,
a larger variety or frequent change \'oull be most welcome.
(b) My only recommendation to change the delivery of tlie food
package is confined to my particular situation. We have no
permanent quarters, which nak, stornoge and d(leliver\y aa
bit complicated to say the least. This situation means
handling and rejandling the food pac-ige- and makes for
duplication of effort and increased costs.





72

11. I l.11i Iof~ In( iInfundedC~ p~roject Uj)1)i(itiunl-; ini lmy area.
1270(0 people. Withl onIIV 11 smidl ilcrva-'e ill Ole to(;d1 budgIet.
I W e 1i:i1e i ediuiicij (evlauNa-iin .pra; therefore, I lhaivI, no
III(dica rt(.i.l(- to oii1inii 1 imIproved hi'1Iloc(it colilits or
1i'611'd infant inrt litN ratIes. But, I know, from seeing tlie
f.iiiiilie. p)rt iripat ii l1v in the pic zrlriiii from iii oitli to Inoitli,
Hin:lt Ilivir licdalti is lIctiit ely improved nI, i amult of better

1 .Ilfmii< ;1(1 ived l.
15. -\I). 0)6l1 ei 1oW-iucoiiie familikiv a.re eligible for more tlhan one
tv N of al;-i' liu'e.
l6. Al I ilii'1'a-cd biid ct w(oli 1 be ii [lfiioity aed f1 I t pvrliiip- ,
:dditiond food itcilh-. ciuld 1b(e iclluide(I ill tin' package. WVe
liave ;1m. iiiriiniilwr of r'qiioe-ts for food help from elderly
p)ople (low income and retire(l) inl our area ; could they be
hel'ped 0Y a sin'iilal pnro~gIMri or be inchlded in this program
by Hew le".i.hlation?
We have 1)eeii able to help a larLwe number of families. Often
ftiniilie, c(011 into the pro1grnIii wl'hen they a-v out of work arld
Liter drop out when their work situation improves. We al-o
a-"nV ;i irait agricultiral-worker population during the
springz aind "Nuininer months. Often we are the only agency able
to lielp an applicant get foodl quickly during times of crises,
d(ue to our more flexible paperwork .-3stemns.
Smirbllv, other a!eaTs have their own ethnic groups who have certain
fo,4dI requirements, or taste.:-. Our group is1 predominantly
Mlexivan-Amierican and they prefer tomatoes and fruits to
green beaiis and other vegetable-. We have chicken and green
1)'; its in abundance and often have the."e items for a prolonged
perio(I. A more frequent change and perhaps cheese, dried
beaus, peas, lentils, fi~h, and a variet v of cereals could be
;idhded. Peanut butter is a favorite with everyone a. is canned
miilk and syrup. Dried fruits such as raiuis, dates, prunes, etc.
adm nuts have been mentioned.
eio: XXWhen more supplemental food form are printed.
(t."( include numbers for amlounts.

























BACKGROUND MATERIALS















APPENDIX C


S. 2905-COMMODITY SUPPLEMENTAL FOOD PROGRAM
ACT OF 1976


SE CTIoN--BY-SECTION ANALYSIS

Section 1. Provides that the Spcretairy of Agriculture will pay up to
20 percent of food costs for all administrative expeiie-; for commodity
programs. The Secretary must, under this e-ection, match each local
program's current funding level at a minimum. Lack of administrative
money is the single greatest problem facing current programs. This
section should solve that problem.
Section 2. Within six months of the passage of this bill, e;tch local
program sponsor must submit a plan for nutrition education in its
service area. Program funds could not be withheld by the Secretary if
this information does not come within the six month period.
Section 3. (a) This section provides that as part of administrative
costs the Secretary, during the first three months of any progiara, will
pay expenses adequate to insure start-up of the program; (b) Cultural
eating patterns are to be taken into account where necessary to
provide an adequate diet; (c) Equivalent substitutions shall be niade
by the Secretary where shortages occur; (d) (1) Administrative expenses
are defined; (d) (2) The commodities available under the Program are
listed and special formula for infants is made available where nece-arv
(e) This section allows dual operation of the SFP with the WIC
Program and makes it the rteponsibility of the local program to prevent
dual participation by an individual or household on WIC and the
commodity program; (f) All programs where children under the age of
six were removed must now reinstate these children in their programs,
where they qualify.
[From the Congressional Record, Jan. ';o, 1976]
By Mr. PHILIP A. HART (for himself and Mr. McGOVERN) :
S. 2905. A bill to extend and revise the commodity supplemental
food program. Referred_ to the Committee on A'.rriculture and Forestry.
Mr. PHILIP A. HART. Mr. President, I would like to introduce for
Senator McGovern and myf-.I f legislation which would authorize
Federal payment of administrative costs to improve a Federal pro-
gram which provide- iron- and protein-rich foods to low-income
women who are pregnant and to children under 6 years of age.
This important piece of legislation is being introduced at a time
when, as shown in the recently published 1977 budget, the administra-
tion seek-; to end the supplemental feeding progrinn. The logic of the
administration must be que-tioned when it asks for still more money
(75)






76

for weapons- ( apabi of killing the Riiiii-. 10 timeisc over but uzil -h finds for feediiu prograiis.
The child \vlioc braille is dziizlgI' or wlos growth is stiinted be-
CWaIs-e of a poor d'iet faces a life of d evpvndncN aid povrty. If theI
liio1'tl c((sidilerations;t of taikingt e\r pe tep to prevent such
(1a11H1.ii are Wot comil pel lig eliy gi, then co--1t t ters sIolld "it least
coider t c-ost to fitture genentiolls in terms of lo(st earning caipaci-
t i'-s~ and, peirhaps, 1113 public asistance.
There are presently boutt 140 s11pple] (e(it ill feeding pro"11granis
.ervii alo ut 140,0 N( women atid childrihi, flie largest being Focli-s
IHlope in Detro)it-. The Depart iiient of AkricutltIr provides about $21
million wortli of food a year for tlie program-l but no fund-. to pay
,Idminist I a I tive, very, storage, or public informal ion cost. lii-
lhas leaIillt tllit pjr()ga I-.jniors have been forced to s-eek moiiey for
tho-e activities' from Iot al and State agrhetciehs or other Federal depart-
ineiit-r. A-, a re:>iilt, at tiniie- -orne of the program-us have ]lad food avail-
able but no way to .'et the coiimimlodities to tlie people they ^eek to help.
Tis legi-lation would require the Agriculture Department to pro-
vide additional funds of up to 20 percent of each local program's
budget to pay adiiiii4iitrative and other nonfood costs. Based on an
annual food budget totaling $21 million, the proposal would cost no
more than $4.2 million in additional funds per year.
The bill would al-so require the Agriculture Department to:
Provide nutritional food recognizing the cultural patterns of tlie
recipients;
Provide equivalent substitutions if a shortage of a particular item
occurs;
Give a clear mandate for the program to operate in areas where
food stamps are available;
Provide specific types of food which are to be made available,
including any special formulas for babies or pregnant women declared
necessary by qualified medical personnel.
Perhaps it is going too far to suggest that these children who are
permanently damaged by diet deficiencies are victims of a. war not
yet fought. But when billions of U.S. dollars are budgeted for cruise
misiiles while nothing is budgeted for supplemental feeding programs,
a human dimension is added to the sterile rhetoric about nisplaced
spendinfl priorities.
Mr. Pre-sident, I ask unanimous consent that a list of the supple-
mental feeding programs in operation in August, three articles about
the effect of malnutrition on children and the text of the bill be printed
in the Record.
There being no objection, the bill and material were ordered to
be printed in the RECORD, as follows:
S. 2905
Be it ricacled b6/ At-- Senate awl HOIusc (f Rfprcsei'lihih'CR of the Un itod Staf.s vif
Am rica in Co',/r<.' ,, .a..,nlicdi, Tliat t1ii" Act may be cited as the "Ciniuiodity
SiippiTlcient al F,'fd Progr~iin ANt of 1976".
Si:(C. 2. The Child Nutrition Act of 1.9G6, a-', amended, is awendcd by rrmdsiginat-
irg -ection 18 as -1 f-tir.n 19 and addiiig a iiw rvction IS to read a, faillows:
'S^ .r. 18. (a) (1) In ca*;rryiin out tlic suip;lr iir--~il f'cdiii pr<' ra irs (he i after
in thn- -ictiin called tlic cimrimiodity supplfeiilntia ft'.'d prograpil) reftrrt'd to in
sfde ion 4(a)(1) of th' Avrjcilture ii;d Coti-uiier Pr' section Act of 1973, the
Siert tary shaNll ay to cacli Siai%- or lcAil :ij *idiiiini-.tcriiig an'i s;h prulhriili
b1l admini *t ral iv( c, -'t- in an Thv yIar nu't in exci .- of mn amiiunt equal to
20 per c' tuni of tin' tot al amount 1ade available to such State or (:' g'-zcy for









such programil in such fiscal year. In no ca-e shall any State or local a'-.ncv receive
le-s for administrative expenses in any fiscal year than it received in the iiAejl
year in which this -ection was enacted.
"(2) Within six months after the date of enactment of this section, each State (or
local agency participating in the commodity supplemental foAd p .1; ii >liall
submit to the Secret~iry a report describing the manner ini which nutrition eduica-
tion ser\ ices are being provided to the recipients of food under such prograin. The
payment of administri:'tive expeiinss by the S t ary under paragraph (i) shiall
not in any respect be conditioned upon the subiiii-i-an of such report by any
State or local agency.
"(3) Notwithstanding the limitations prescribed in pairagraph (1) o( this'
subsection, during the first 90 days after the date of enactment of this section o(
until the commodity supplemental food prograiii 1h;is- reached its pro ejectedd case-
load level, whichever first occurs, the Secretary shall piy the total expen-ses
necessary to successful operation of such program.
"(b) The Secretary shall take into account medical and nutritional objectives
and cultural eating patterns to the extent n'c-'-ary to provide a nutritionally
adequate diet for recipients under the Commodity Supplemental Food Prograiml.
"(c) The Secretary shall make appropriate provision for equivalent suhstiitu-
tions of commodities where shortages occur in the Commodity Supplermental
Food Program.
"(d) (1) Administrative costs shall include but not be limited to expenses for:
information and referral, medical certifievi tion, operation, monitoring, nutrition
education, and general administration, including staff, warehouse and transporta-
tion personnel, insurance, and administration of the State or locall office.
"(2) The same types and varieties of commodities in the same proportional
amounts as is currently available or as were available in the fiscal year ending'-,
June 30, 1974, whichever is greater, shall be maintained. In carrying out the Com-
modity Supplemental Food Program, the Secretary shall require by regulation or
otherwise that the food made available to any recipient under such program
shall include, but shall not be limited to: dried egg mix, c::nned fruits, canned
fruit juice, canied vegetables, farina, canned meat and canned poultry, evaporated
milk, instant fortified nonfat dry milk, peanut butter, instant potatoes, and corn
syrup. In addition, such food shall contain commercially formulated preparatit ns
specifically designed for women or infants in those cases where it is the opini n
of qualified medical personnel that such formulations are necessary to meet the
medical and nutritional needs of the individual program recipient involved.
"(e) The Commodity Supplemental Food Progi-,nii may be carried out in the
same geographic area in which a food stamp prorjiii or other food distribution
programil is in operation if the State or local agency responsible for carrying out
such Commodity Supplemental Food Program establishes safeguards to prevent
participation by households and individuals in both the Commodity Supplemental
Food Program and one or more of the other types of food assistance program ins.
"(f) No State or local agency shall prohibit children under six years of age from
receiving benefits under the Commodity Supplemental Food Progr.iiii if they are
otherwise eligible to redc i\ v such benefits."
AUGUST 1975

Number
State of ric.-irms Amount Participation

Arkansas------------------------------------ ------------------- 10 $93634 8,874
Cal iorna ------------------------------------------------------- 3 113, 730 10,6 2C
Colorado -------------------------------------------------------- 7 109. -' 11. 184
District of Cclunbia----------------------------------------------- 1 118.118 11.927
Illinois-------------------------------- -------------------------- 1 57,551 5,255
Iowa--------------------------------------------------------- 31 67,976 6.1318
Louisiana---------------------- --------------------------------- 2 170, 127 15,756
Michigan--------------------------------------------------------- 1 253,099 22 431
Minnesota------------------------------------------------------ 1 6,363 835
Missouri ------------------------------- ----------------------- 47 123.854 11,546
Nebraska------------------------------- 1 328, 3.319
New Jersey----------------------------------------------------- 1 33?2
New York. ----------------------------------------------------- 1 378 153
North Carolina------------------------------------------- 6 25,614 2.4b8
North Dakota--- --------- -------------------------- 4 2. :' 321
South Dakota---------------------------------------------------- 3 15.S44 2.038
Tennessee-------------------------------------------------- 9 387,01K 17,939
Utah--------------------------------------------------------- 10 17,269 6,9-:2
~ ~ ~~~~~ ~ T-a-- ------ - -- - -. -_ -3 - ------------ .------ ----
Tct ------------------------------------------------------ 139 -- --
68O-151-76---






7S


!'Ir0 !' P-.% li i. g '1I01,1 S1 'IIt,-nii I l!'7,'1]5
T. TAV 1.U B RAINS
fliyioer Iew in)
An inf.'int (dPriveil of nutrition oir st invl;iti,,n will nvii rr develop to full
in, iit.il o:ipvreiiY. Then 's no second chainec. Toda:i, 70 lpetrcent of the world's
p. 11 iil;! ill -Ti( 1i'.lY riski prrn ii. nrni dama11ge9.)
W'e knOw t11i pie; lire wtellI: Owr Wlo:LtEd ';lli, stick-thinl :irliis, And sad listless
e ",-v I !I. i iI rk I M\ r I in IlItrit 1 i)"1. Cut iIIIII He,- iII d by cin I Iir food shortages
r Itrownii iiito det,-);iir by suidii dIi tv: I L, ii 19 f;aI i Ii riiiii and ar have burned
thiiI' !iii:iL~C- intoI our ei~ii-cice. But ,e-s drastic, ;ind theirefore more insidious,
:1 tie ,Iiw i of liii-trr iiiunderiutrition, which liii''i than :300 million children
'tlrr-tly -;iIter.
AI!hough iihr-r ''lrtldri H 1II.I (*sc: ii Ihe %,(ir.t ri4irs of st arV:Ltion, there is
i l'l, b11'ift ilLi ;iI I if -. :ii ttill Ivjdeiic tli:t their iiitbllc(,tiIil develrpinent
,iiqr'r hl:Ioi1:ir- frnn w\iichl t hre is noii (liaini of compLi-ti, rer'lvcry.
The -ii:ni ifiilly ,rin)pli-x trchitectrtire if the hiuiia:n 1rain follows an innate
lbiii irlint, but f.ictir- in tlit, ([iviri'iimneiit (f the growing infant p:irtly influence
iiB final foirni. riud therefiire its !in~il performance. One- major factor during the
r:irlY 4I' of brain (lItrbipr'nlnt, We now ri':li 7, is an ;adeqiiate supply of food.
Wit:hiit the n'#*ee-4iry flow of nutri(*nts I he liraiin simply cannot, create the
reitiin -t he cclI-. lhe wiring, and the complex circuits-that fuse to form
llr fuiie ii ilitnig liii man itiiid.
I mei rcIiT rs in H uropt -. Afric:i n nd South Az kitrica -I re als'o learning of a delicate
l)ut crucizil iTiti-rplay vIwi'w'en a d-riu tte diet ;and enviniiiririi tal stiniulation in
11i b first two years if life. l)iinr.i this critic:il period t lie brain's potential has to
1 r'- hed. or it iz tI'o l1it:. There is no seemed chance. An infant deprived of
nutritiGn or AtiiiIIIl:t itin will niver d' velo ip to full nient al capacity. The iinplica-
tion-l of this .sit unitioi are fright'min,4: cycles if poor nutrition arid environmental
ip iver? v erli.hice n ach other, Ia:idinng to personal suffering and chronic social
ii el j-e. Tod:iy 70 ptre' iit of the Nourld's population seriously risks permanent.
bruiin d.miinazc.
The critic:il period of dt veli ipnent of the human brain results from its peculiar
p:itterin of aromwth. At birth an infLat's braini has alre:idy reached 25 percent of its
.iuhilt weight, and by six months it is half way to the final target. In comparison
to!:il hi ( ody weight at birth is a mere five percent of its adult maximum, and reaches
ile 50 percent mark wily at ;ige 10.
Until rei-entyv we had no clear picture of the stages and timing of human brain
gro 'with. Now, John Dobbing and Jean 'Sand, of tlie University of IManchester,
.Hgfand, havi X:nniined the c mnpo! ition of alrmoist 150 hum1111an brains ranging in
:i!4 f1111 10 wi-ks (if gf(*'tttion to se-ven years. What they found helps us under-
-1:11n1 the effects of naln:lrition in children.

PROGRESS OF TH E BRAIN
R~i-i(:ily, th0 hmr.in grows in two stages. Fir~t, between weeks 10 and IS of
pro'-i.inei*iy, the adunlt numni r of nerve cells develop- ..Secnd, beginning about.
w<-'k 20, the brain's pn;cking cevl-l (the oligodeIndrogli:i) luegin to :nip)ar, followed
by the production o'f the in.';linting irnitmril (mveli'il that coinits the long filw'rs
longg which the niwrve cells end their mes.a;i(s. This -ec ioind stage continues
for :.t .*;t two years after birth; m%-clin;iatio n progressit- at a lower rate until
the :>L;' of four ve;r-. The v-c'ind tnage, known a;s the 1brin-gro'wth spurt, repre-
I'lit- thl" most vulnerable period of bruin developinint. It is the critic:il period
whliii ii.-id'qu-iie nutrition and lick of stimulation inflict Before Dobbing and S;ands laid out (lef-irly the timing of tei hinian brain's
growth sp)urt, w% :>-1siired 1ihat mot of the brain's inipoinrtnnt develo)prment took
p1;irac pirinrit:>ly and w.-1, mom, or le-s compli-t by birth. Nit their demonstration
that about, five -iths of the growth spurt com unes after birth forced an awareness
of the 1i r/:n-ds of prolonged inalnutritiion in th' cirlv years of life.
Tfi-re are sivernil wavy of expioiring wh:it h;ippens to an infant nurtured in an
irpovei-li'd )womb :mi liirini into i world where lie or she is deprived of food.
One ezin:m :-t udy what physi'-illy happen- to thli brain or one can examine the
phy-ieal :mid lweaimviormil coini-rquenees of nialnutrition in animals. Or one may
ot -erve children bo'rn unf!'Ti (pri ved circinstances aind determine the effect of
environment :tl facti~rs in impro v ing or w(ir-sening their condition.






79

One thing that is more or less safe fr. nin nutritional insult in the growing human
br.;ii is the number of nerve cells it coB:'i B'c:-.use this number is established
virv early in pregnancy, at a time when outside nutritional factors fail to impinge
on the d. veloping fetus, the brain's basic nerve coll complements e-i'-iped
There is, however, a major exception. The cerebellum, a wrinkled
,trictiire at the back of the brain that coordinates movement of the arms and legs,
is vulnerable to nutritional deprivation because its nerve-cell generation and
growth spurt Cr.- delayed. A starving brain risks delyved eration of the oligoden-
droglia and the later mvelination of the nerve fihb r-.
Pin4-nortem exjminimations of human bein-_- can't answer questions about the-f-
early developmental phases, so we have to rely on animal (\p''ri!-bnts. This
approach is justified, because although the timning of the growth spurt in human
and other animal brains differs, the stages are id'-itical. Dobbing and his colle-ihues
find th-it rats with malnutrition have significantly smaller brains than healthy
r;;ts, with the cell deficit concentrated in the oligodendroglia. Starvtd r,!-, also
show reduced myelination, and some (enigmatic enzvme imbalances too. The
crrebellum, comipartd with the r'-t of the brain, suffers more: it wri~h- less and
doesn't have the arl;ilt complement of nerve cells, due to its delayed growth
spurt. The particular vulnerability of the en iMbellum is important becaw.-e damage
to this structure goes a long way toward explaining the reported cluhn-ir-w-s and
reduced manu1il skills of malnourished childr'In.

MALNOURISHED NATIONS
One thing thait brain researchers readily admit is that they have measured
what is easiest to 1'-a-ir,. The f-:-ture of brain development that is probably
most difficult to quantify, but is almost certainly the most important, is the
lacework of connections between the nerve cells (neurons). Reliable reports show
th:Ut the major part of the nerve fiber-, the axons, shrink in diameter in mal-
nourished ani!n!1l-. But the really crucial area of interneuron communication
center-: on the end of the axon, where it b:-. nches into literally thousands of tiny
fign r-; that make contact with the neighboring neurons. B. G. Cragg from Mona-h
Univer-ity, Australia, has had a crack at this problem, and what he finds is most
disturbing.
Cragg did some microscopic investigations of the cerebral cortex in rat-; mal-
nourished early in life. In what must have been a crushingly tedious experiment,
he counted the number of minute nerve endings (the synapses) in the cortex of
undernourished animals. He found a 40 percent reduction, compared to normal
rats. Cragg suspects too that some of the synarpzes may have been unable to
function because of molecular breaks. The creation of the interneural network is
one of the brain's major construction projects during the first two years of life, so
Cragg's result is crucial and needs to be confirmed. If the undernourished cerebral
cortex really lacks almost half of its interconnections (or even a 10th), the con-
sequenc- for brain function are frightening. The planet may be raising a ."nera-
tion of clumsy, feeble-minded millions.
A crucial point about all these experiments is that moderate di'~r.-t. of mal-
nutrition-of the sort that 300 million children experience daily-can produce
the-4e physical side effects and deficiencies. More important, we cannot repair
these physical deficiencies by normal feeding once the brain growth spurt ha;
pa--cd.
The typical undernourished child is shorter and lighter than his counterpart in
affiu'-,nt countries. He is about 70 percent of his c 'rrect weight, and the brain
weight and head diameter are marginally smaller as wfli. The next step we've
taken is to find out what this means for intellectual and social activity.
In the attempt to find the consequences of chronic undernutrition, most re-
search groups have used the longitudinal study, observing the prngre-< of a
group of children over a period of years. For example, Joaquin Cravioto and Elsa
DeLicardie studied a group of infants born in 1966 in a small rural village in
southwest Mexico. They have been observing the children ever since. The village
has a "normal" background of undernutrition, but the researchers concentrated
on 22 children who at times had had almost no food and thui- had been -,verely
malnourished.
FOOD AND LANGUAGE
Cravioto and DeLicardie studied nutrition and mental development against the
background of social and economic factors. Their outstanding discovery was the
effect of malnutrition on language development and verbal-ci'ncept formation.






so

X- I ; I Ir I I, the -. -1 i* v l n:ilnoiiri-lhed liihilnr-i 1,-rg nl I-, lhti, ehiand in i; ii]. i ...f
;iliiit -i\ Il-ai1t1i1. At tlir age <-f onle (e.ir the Il matelitdi cont rol gro-iiip l-d
l.ii'i[i(' d 1evelopeilt equivalent to) 33 divs, co )pare(d with 2-'S) d&\ys fur the
huigcr griiicp. H1 thd-rC Ve:Lr- the gip \'ai 917 d:Ly-s to t657.
1tVC;Ill-e, \ri~ii l C pI'its are ;a bai-ic area of himiiiaii initehlihzenice, the, re-eazrchers
iL;IVe ch1Ireni ti-ls 1,me-lr tho-ir iindur't.indmii 4f 23~ p~tir- (If tippisiti-s (isuch
1 bin-litt1e, Wlo'-.hoi-t. in-oIut). -At 31 imoimitli-4 of Lge the control groiup (if norniail
unde '(n ;~in :i\vrr:iL' of 5.LA c('oiicR)t-, ei)rn*L;Lrtn(d with .1.91*2 for illn- iiilnioirished
tliilirr-i: by *liG N\-.-.L! hlirir c.irc. \M-rt- 16.92 ;iid 12. 16; mid it ) weeks ifle con-
1r'l- k-\iisw 20 t of I lit- i-io'n ])it -. th '*c ahlieid of tlh ie nIuilmiori-hcd group. Evin -ifter
*li iiirithei flite Ihildrcii \O t io 1id iffcred iiiJ malnitrition in ifif:iiicY w%'r(, bihiiind
fliw ct't nli-l cliinlr-Ri in l1tiLi'4tizw (*vrluhpi iit :mid toivept fiii-riation. Althoi)Ulgi
Ilit N r-t ph~ -ictl -yi ,i x loi)i- (if th'ir inilinitritioii WITr( g' iti, .i0d althoimh thcv
did fliiiLe up) soIliv of l i'e lo-t grioind, tlhy didn't citeli up with their htalthier
]'liviii:it> t;. Tl1-i Inijit line simm'st- they never will.
Bri *fi-w tl I, ,, i r(I flizit pr( id iir wrvere imi itnutritii In :n11-o prodtices dprived
enivironIi nirnt., ( 'rt';i '-it to i>f ld Drlcardiv co -it:irt(d tlIc Ii itri hives of the children.
TIh I u-V d the (1:iid'%% h1 Inventory oiif Homie Sti iiuilhit itill ti,) i-:I-ure f;.ctors Stich
.I, fre(liiiwicy and -t:tTility of adult co 'ntWrt -. th'' nii nil wr of voices the child lwar-,
;Iv:lii dllilt (If toys and gnii -, whitther lite child's iieed, are in'et, and how many
rr-trivti n-i Ili r ;i-re on tlie child's activity-. TIll(e rei-.ireliitrs found that the
nalni iiri.lwid ilnfant- r:tn- firmn hmi'-- thlt. iwere TSil..riifir:Lltly iipijovcri-dhil ill
.ictivitY that hrini- the h'iuinin inind alive.
Altlioiil!h Iliii. poor ilnviriiiiieiit of the iniinirhed children contribute- to
thf ir 4m'lwed int eli ctual dvel\iepnwieit, ('rinvioto clai iii-; liht it is not thi' iilt
1A1:LTpanailm. Thi4 ctonclii- iiin k suppor-ted by St1phiii Richie rdsoin and hIk col-
Ile IH' whoii tiidi-d a cmmiiunity of child i' ill J~Iani;ica : ind fouid t hat mal-
nutrition i, :Ia dni Rama:Ling t- an inipovenri.-lc(ld focinl life. IRichardi-'oin ninea ri"red the
phvio'. l 1 and i nifli lectital status ;i f I group of boy)-, aged seven to 11 years, who
had duriiing tho fir-4t tw y? venrs of their lives suffered severe malnutrition. These
children were snmaller in statu-re, lighter in weishit and liad smaller heid& thain
normal lijdren. Behaviirallv, they were dikad\;'iit aged too: they did le"q well
in foirnual telt; of readini writing and aritlimetic; teacher,. found their s-chuol
perfoiriannce to be poorer, with more spe cial probhlenl-C in claz-sw irk
Further, the previously nialnouii-ihed children were less4 popular among their
-chooilfmte". When Hichardo-in asked all the children to pick the three peers in
their clai,-s with whom they most preferred to -zpend their time, they named the
mailnoiuiri-hed childr'-ii much less frequently. Thi i- a tricky result to uintanglI.,
but the cau-e may have somine parallel-s with the observation that nialnourished
animilals are -ocia:lly di-tuzrbcd and more irritable. Perhaps the children were too.

TEACHER'S OVERALL EVALUATION

Malnourished
children Comparison

Ouilstanding'above average ------------------------------------------------------ 11 27
eBelw) a~eraqe. ---------- ----- ----------- ----------------- 18 20
Poor or severely retarded------------------------------------------------------ 32 18
Special problems in classwork:
Yes--------------------------------------------------------------- 50 40
No -------------------------------------------------------------- 12 25

POOH NUTRITION V.S. POOR ENVIHONMNKXT
Thli rmeIriin1r- il-o m i-ured the children's home enviromnent-iV -ind this time
founiid that not :ill of the mi1i:inoui-i-hed children c:itle frioni imipov(erished homes.
So they wire a)le(, to copiinire four groip-4: maui' 'un-led children from rich
envirlnmelt- iualmiiiri-lied ehildreni fromn deprived envirioinent-. healtyliv
children fr,,'Ii rich envionmiients, ;id lheilItliy children from deprived
ci-vir. 'RiRRRI1 '.
Thlle nd-ullio\\i I clc:irly how a home 1li:J: i- poor in ntifm.l;iiIon and oppor-
tunity fr t child will imp1);ir hi-4 or I1 r intillecziii:il devel p'ent, r-L.irdles iof-
!1ie e\ti nit Of ici:iliiul riflion. Aiiiolw lie:i!thy cliildren, t-p froii -.timiuliting
en1in' ilinit: avieriied 71.4 o1 ;ill ellini enic( e 1e while tliti-e from deprived
eiivirt 'Till 1(6.--` :ihverio ied(60.5. Ml:lnoni-lieid oliildit(n frioim enriched hoimies. score-d
62.7. Biult Ili oi-iiii.in;tiomi of iiiiliitrilion and a poolri tenvt'ionment proadhiced the
df1;!dhie-t dilfiit in lei:riiinyi of ill, ax\ r;'g- Of 11lv N2.'- .









One report that seemed to counter the evidence for the prolonged effects of
malnutrition comes from the Columbia University School of Public Health and
Ad-iik trative Medicine, which detailed the intellectual performance of 19-year-
old Dutch youths entering the armny. These men had either been born or were
young infants during the famine the Nazis imposed on their country dinrii-,
World War II. These young men showed normal intelligence, which si'gge-ted
that malnutrition has no lasting effect on mental development. The crucial
fallacy in such a conclusion is that the Dutch famine was very short, only six
months, and before and immediately after the famine there was no svere food
shortigu-. Any brain-growth deficit inflicted by this brief famine would th'-r fore
be made up for by enhanced development within the two and one quarter year
brain-growth period. The Dutch infants, who went hungry for a brief period but
oth, iwi-se were well-nourished in infancy and childhood, are thus not comparable
to the Me.i'u and Jamaican children, who live in a state of chronic malnutrition.

CURING DEPRIVED CHILDREN
-Now researchers are beginning to ask what can be done to help children who
do not get adequate food and environmental enrichment. Leonardo Sinisterra
and his colleagues in Cali, Colombia, are giving malnourished children food and
supplemental schooling from the age of three and a half on. Compared with their
fellows, the children in his program have a marvelously rich environment indeed.
They build with wooden blocks and even make large--cale structures with poles
and planks; they paint pictures of their environment, make up stories, and even
act out adult situations; and they get an expanded view of the world by going on
trips into the country, all of which are outside the experience of most of the poor
children of Cali. These children are now five years old, and have made remarkable
strides toward catching up with the intellectual ability of more affluent children,
both in verbal reasoning and general intelligence.
Sinisterra gave a second group of formerly malnourished children one part of
the treatment but not the other: they got good food, but no extra schooling.
So far, it looks as though they are doing no better than malnourished children
who have had no supplem-entary program. The reason seems to be that the
children did not get the additional food until they were three and a half, well
after the critical brain-growth period had passed.
One aspect of intellectual performance remains resistant to repair in mal-
nourished children, regardless of whether or not they get additional food and
special schooling--hort-term memory. So far no program has been able to help
deprived children gain a normal ability to remember what they just learned.
Another compensation study is underway in a poor agricultural village in
Mexico, Tezonteopan. Few families in Tezonteopan show signs of severe and
clinical malnutrition, but almost all are chronically underfed, barely mana.ning
to survive. Passive children and tired mothers barely communicate, rarely play.
H Adolfo Chavez is studying the longterm effects of supplementary food on both
parents and children. He began his food supplements with pregnant women and
continued them throughout the brain growth spurt, i.e. until the children
were over two years old.
For a start, the supplemented mothers produced babies that were roughly eight
percent heavier than normal in the village, and this weight advantage continued
and expanded. But behavioral differenet-; appeared rapidly too. The test childreii
showed superior language development within the first year, and in simple physic~il
Saci`ivify they far outshone their underfed fellows. On a meC-Z--1r of movement,
they were three times as active by age one year, and four times as active by ;'g'
two.
* Further, the well-fed children spent less time in their cots, walked at a younger
age, were more vigorous in play, and were more likely to take the lead in play, and
were generally much more independent. And because of their great activity and
exploratory behavior, their parents and siblings took a greater interest in them,
which in turn, was strengthened by the infants' tendency to smile more. The
whole family dynamics gained a higher level.
* Some Tezonteopan fathers even took an active part in child care, something
they almost never do. They were enthused by having a vigorous, alert child.
Several were so imprl*--Ced with their "special" children that they declared to
Chavez. "This child will not be a farmer like me."
Chavez's work reea l the tragedy and the promise. Millions of people today ac-
cept d'i-p, grinding hunger and poverty as normal and inevitable, and pay the
price with lowered intellect and activity. We know that if the brain is not well






82


fl*d dilrih.! it.- critirail p1i ''d Of gr'wtHi. it wvill iw v r (letlI.'Ii Ow the full mnd rich
pi\\ il'i) ii-..iv dp-c.-, of goid dict, fun
:111d gauze-. tvachiiniz :ildl ?'iimuilntion (.iii hilp i'1' tipi iircti the intelligence Igip
ih.it iii mlnutrition Ic.tvf. in it-. w:ikv.
[hiiniily, thu Ot''rt- I'n iuntalngle tlne effvictz of iinIlniltritiimn and :L poor
Ill% iri\lillitt Inav iiia iAke little' di(itri-m-l inl thli re:itl world, where the twio uxist in a
\ivir-ii- circle. Poverty intlicut ;i double in.-tilt it. viutimi L'c''ud nrd to a dearth
i-f food aInd ;t -(rl'- 0ri'\ ir''uinzzinil. The eiuni ini:iti. I k i-. at wIirk daiily, eroding thc
I:!' izt.il C p11I. itYv If .O)(hiiil]ni''i children.


I Frwo tI C?1P,(om n:'it y Nutrition Ti.?:i'iit. W, r'':.1y I., E ir. Nov.; 6, i'C..l
1 NTI-T.-S IY T1N \TI. ( )NE1: MILLION C(il i. vt H AV I ST INTri1) 1 % lNS
Ii i virT-i^ V'f (C:i1if(',rni.i rr (l:irchvr-; estim.9te llimt Yntrv than oine milli(ifn VS.
inff.iil .01( i yiiing childi-m li.i\vt citlihr suffered -tIuri ing of braiin growtI or are
;t ri-!: (of such d~miioii. liw'ati-c (f ni.mtnutriti'.n.
The iTidiuz ', 1ir-4t rc'porl Id lni-t weekend by thli Noew Yo rk Times, are based on
n ;>n ilv-i f nil iin; il niutrili fedir.-:dJi -'vernimelt, including their HEWV Depairtment's Ten-State Survey and a
i-udv f lit- nutrili, nmil .-t:iu-z f'f pre---<'Iiil children perf' 'nui'd by Ohio Slat-,
Unix( rn-ilN :rid thu inivi r-it of (c' h1i1lit-. inC' me fi(% plhv-ic;t1 chln r:ic1cristi-~ 'izch a!- 1iody -i<.-, wciglit j rid develop-
nrent ;i- weil :i: evidence (If biouh Thi C(>l'forni.i ri- c:irc'1fr- in:' tmlitd nutrititon ind inim i ric da:t from thr siirvrc-;
with heiAd eircun.ft r.1-n'TO Tni-vtiircment-z thait give cluc- to iintp;iired b)rzlin dcvelop-
ililit. 1li t-y [ji~;!tu(! :11' .xvt F::;;e de-ficit in br:iin \Wi(ilit iinng. severeiv n;il-
n' IIli-ll- (inildr ii n at I 2 gn1iI-. A), ;i li t 9 wrcr(''itt of t lit 1,4f00 gr;rn li i of .1
norm. 0 I in-' ini in a f Itr-vv;t r-- .1( ch ild. Th(-' est il.t c Corrl ia t e wit li the findina-
'f P.il'i-; 7re :nd othlieir ob-'T r' of ni.iln'i r:-zhlk inffant.s and children Jt thu
N. Judt.`I o-]it:il clinic in Memrnlii-. they said.
MN;tnv in'l.iv id'I..lI liviiiit ;i K iw 1l)\ e lov11t, level :-Triw\(.d scriois lio-
Ci1.qiiC. I ~ifir.. ''iir-. the ITri- sl'>w( 4. vurt l:rrnior. the Ti]--.1luli '0i.-.i'd infunt-.
and vti'zn'ii child.-' ;i had hi";i'd ej! z1f^r. i 'e-n so far below the )ic iormai ran'?e f<'r
their a f- a to s-i-',( t I miria' n i lIr.;'.i d'-' oi}m ivrit, I ii-,i' sc* tn ist" d. ('n (If
thlie -e.rn~Vt tid Iil- Ti no- that the d( ^ree "f d, flrit in the T iiln imri-hPd children
.i'p -red to be ,' r" It A hat he I -tiil'..Li d the L I. dda ;t 1' -1 h1.l.u one in a million
li:it it could r .. -i!t nniii r::!:l \-,;tri.LtioR.
Usin- 7!970) Ccns i- dat:i, the C-ilif.,rr;i r cj z-i(nti-tS -K'in'.oted flaIt the toitat
n`1i ri, of prT r I.AlMIt Wo011'-1 in the U.-S. -uffi ring nIalnutriti'in fi 'e enoi]" iti
r ilii-ir 1:'.11' 1Vas rii ',i00i 0 then ;( nfl is nr i ) rec'.tt r
now. Thvy i::.['d the numi'ev of infants and childreii. in thI jeopi.rdized grk-up
ali'r'' d o'rn at m, it, f1 tii 1.1 million.
"I-'iiii.z 'iv1d. m-, ILA.t a stibsaJ.iaia pro4 'rfi*:i ''f the p jii'Ail;.thon tof n afflun('nt
CeitI1r\y like1- Ih,- Inited Stzii-. i- i, jireopirdv for li'a;u,'rol' Ii arid d('\it l'plimeiit
( ~ ~ ~ 1 .."!r- i-a ** to u tIll.. in is~ -:.y in ;n rirh. iiijw*) rt. "'it 'ii[)lif-
That a (.i: ~ r: i'i pro," j.ljiql (f 4i 1: .- fm ul i i .I.lJr !i\ j'i r i.' i -chool
:11d L`(0 r in i'- i ca"-'r !'xl. '. it 1 due to mid1- rnutriti,.ii :*T'ectitio-

*r')ious wvay wvili the c ua:Ii1 i~f t1U' in ljve- .111( p1:LifiniL ;rl ;'PIiai~-.1i(i\- but.
prl'>I '2iy -ingnficfLi..t 1 Wi on 1 he r> if 'Unit'.d St ate'- :-'C'-".) V.

NO 1'!Pf1OVVMi.N T SEEN
]) i,; II. Cri1!ow:i r, a L'nivcr-y III'f r7iiforiii (r:erk-l-) n'lt ni lni-t who'
pa~iip-irdin tInl -111dNy, 0&1CN '.rd Ecprrt f1i:t nt iin^ r-v happened
in r. ( -nt ':r- to l-t.' impr\('en~ent ini tle -ititi'init w'itlinied in her tzrouip s
.~r'ip!-;-. ''Tlf foi d ici' aind csiini.mdity pro-r:wi>a- cr'- iii efT- :Lt Owh tir.e-
i' l'V 8 Wa \.r^ L;;1 r *I, ski' ii' !rd. ".miid the jwi-t iti1 i miz:rl I iarrirr- 1o good ?-t;amp
iartieia.0i ri in ruiiiIt fli1w lire-w iii tiin. Th.- \\"IC ( riin, i'lf. nt, 1t1ii childrfei)
pIIr .o;.ii li:z- iot 11 f 1" .m eV):Ilu'atued, but it- iunpa: hac t i fair y limiled up
to now. There ar"11,1, re-1r~', P c i)'I-t (.f pI'verty ann i itrit jn"
I lubrt, B. Living 2.'!' n, ai 'Univrr-itv of r:it1'forni-L ( ;:r 1 irjn) nr' oeien1 Vt
h '''ld (^I I,. proer f I ri : dit io nI to (I -. way, ?liwn re-e:irnlur incli''d d John .
Mac z*' or in :r\- J. r--,her and A. Baiird ia-tinL-, :,!1 4f ';.n I1i'gQ. A rep)urt






83

of their work has been written for a volume on brain growth and development to
be published this fall by Raven Press, New York, for the Internationrm. Biain
Research Organization.

Two MILLION CHILDREN RISK UNDI.WFED BRAINS

(By Robert B. Livingston)
(Dr. Livingston is a neuroscientist at the Univer.-it y of California, San Diego,
School of Medicine, which published this article as a ne'.vs release. For further
background, see CNI Vol. V:44A)
We have developed strong statistical evidence that, in the United States, there
are approximately two million pregnant women, infants, and young children
who are in serious jeopardy for the growth of the developing brain.
This serious development problem is attributable to insufficient nourishment,
which in turn is associated with low family income. Testimony concerning low
nutrition intake within this population is corroborated by the fact that many
individuals living below and close to the poverty level of income show low and
deficient blood and urine levels for substances that are diminished by chronic
undernutrition.
Furthermore, infants and children living below the poverty level of income have,
in the aggregate, unexpectedly small head circumferences. This is strong presump-
tive evidence for diminished brain volumes. Indeed, the head circumferenmv-*- In
this population are so small that the likelihood of their constituting a norrmnal
population is less than one in a million. The average deficit in brain volume
bet.we-eii this socioeconomically deprived population and an average population
of children comes out to be approximately 125 grams, a conspicuous brain deficit.
Infants and children from succr'-4ively higher family income levels move progres-
sively nearer to normal head circumferences suggesting that low socioeconomic
conditions or factors associated with low socioeconomic conditions are operative.
This study was initiated by the Institute for Information Systems and the
Neiiro-;ciences Department at the University of California, San Diego, as a result
of student initiative, and with special assistance from Professor Doris H. Colloway,
of the Department of Nutritional Sciences at tha University of California, Berke-
ley. The study involves statistical analyses applied to existing information on
human nutritional, medical, laboratory, and physical measurements ob42uird from
The Ten State Nutrition Survey (TSNS), conducted by the IA'jlth Services and
Mental Health Administration of the Center for Disease Control, HELW, and A
Study of Nutritional Status of Pr-uchool Children in the United States (PNS),
carried out collaboratively by Ohio State University and the University of Georgia.
These two surveys were designed and conducted independently during the period
1968 to 1970. They rep.--ment the first comprehensive investigation of ini'.ti ion
and health status applied to large sectors of the U.S. population and constitute
the best available pertinent information. The pr-ctnt study reveals \}t these tvw'o
surveys strongly corroborate one another' in relation to this problem. We were
privileged to have access to the statistical working tapes from both of
surveys. We utilize these two data sourei.-'; to secure inforrpi;'.ion especially rele-
vant to brain development.
JEOPARDY CRITERIA
Independently of the nutrition -urveys, we established levels of nutrition intake
below which we had reason to believe there would be serious jeopardy to brain
development affecting the unborn, the infant, and the young child. We elcted
levels below which 97.5 percent of all normally healthy individuals are known to
be delete riously affected, as manifested by growth retardation in children and
by weight loss below normal levels in adults. According to these critei *a, people
would be in jeopardy for brain development if' they were in,;ediing less than two
standard deviations below their minimum daily requirements for either energy or
protein. Thus, all but 2.5 percent of individuals ingesting below 70 percent of
their Recommended Daily Allowance (RDA) for energy and less than 40 percent
of their RDA for protein, would be in such jeopardy. Thc-c pirt stages are at
levels two standard deviations below average requirements for these nutrients as
determined by the Food and Nutrition Board of the National Academy of Scienct -
National Research Council. Jeopary criteria relating to RDA levels can be readily
applied to the nutrition intake of any individual according to age x. weight, oc-
cupation, and the special requirements of pregnancy and lactation.






S4

vli' i riri:i f-r iiit viii''ii jI:'!ke. '- c,- t-iv foir serii'ii- jii' inrdniv t brain de-
vi l",i!oi I t, wIrI t1N I it in tliti d frr ;iialv-i-. of data fr. inI t\%i' nati''tial jinitritiolin
ill' [--']:i h t ji I i t I i t1W V% illtlio-i t lit' hadl ,.it h'wrt rc~i wetliIIL-, (i ck otinonlicip
Si I'V rV Oi I- f:l iillt ti Ili it 11'\ k I ir Ill' h a or: 11 tl At i (I II LI I r I I' I C Ill l'iei i* i' ( -a ir m oiliic
IL',' ii'iiib'i.- *it" iildividrI:ils 1hrlr4I.1I0hit the liuitt-d Stati-.
I t :r fI 'huil I li:it ui:'rly (* (G pi-reilt (5-') pifircciit) if prvL.i:illt w i rii living in
I10% rt V w\% :L- (If 1'17, ill -"'iiIll- j(op.-irdY for hi liai-;iin ( 14- o t ltpinvnt in their
i1;!horni eliirC!'rii (111- to t.'L ir tmuw toi;tl vierryv intake (-( L- Ydble I). S'lil 25 percent
oif I 1r 1 ,iriiit %\- 1111 li\ ii,!- in p I\ rtl N wc c r ri-iniiiiiiiz Ir-, tIl:ili 10 percent, t if their
liin' rL It )DA. tli:it is. I,-- l ]]:Il 1. if lith jei 1r1''i lit .f prr1i:Iint oi 'illi ill p 'VcrtV N veru Nve- ill iul i% joijip:,rdv for booth
<1ii'-rr Y ;,id pr 'tern. III'l' po\ rty lr\vel if inc''ieru i- ii-'t ;i niia ir thlvir lidocl, hc('iu -v
10i.:'i 1iirrit uf pr'm;nit Wv'!iien livin'_- at 1 to 2X pu-vir;y (47 prrcit)
1.t1i 2 to' :A.\ i (4-4 pei-crn' lt) Wvcrn in -iiniitiir jrrp.i rdy for ciiwrgy iut.Lke.
a ;i *ln-er pi rr i1:!;~i are jm l'jclted in r<1;1i1'i to tlie 11' 1'i1lw)r- of preiginint
W i ri! H at ,l' -1: i! ie(l1i'1 le\r1- in Ilien Ubnited Si;ati- (n'-. c'tiim:itfrl froin data: in tlie
U>. S. 70 Pl ii-io), we' fimI tliit nc.irly a quarter if ai miilli'n prcgilrint Notuiunt'e
livinL- inl po\\ el V24.'),9.,)l) :iidl r' iitdlily n third of a million of thein living at 1 to
2X pix (.ii. 1)921 and at 2 to ;X 3 po)\ilyiv (:10.712) ire ing-''tiuig bvlow the
lr.iir i*i'q.:rdy criliri;' for (-wni-r The oviri:l1 tot:nl (of prniiaiit w\ l '* siiier ,iWie iv\cl- .wi *..rc.iter than 900,000 9-45)555).

HEAD CII'UMlNI-Iil NCE

Infants :ind c(liil(rtii. tccordina to tihk analv-i-, are distinctliry I-t Icr nonri-,ihed
tinii !ll. I ])ini mit wmiine. The incidence 4of nutrition int ;ike lwlow criterion for
'*ii TL!., in Hie TSNS, for 1)oth infaunl n&dir onie ve*ar of ;'c aind children under
four living in pi ixerty, wa- 18 ptnrcunt niiid for children aged ,ti'' to four years, in
PNS, in the -alne iiic'nie e:i 1e~orv, \i N 24 ijrcelt. For children living at 1 to 2X
*1nd 2 to 3)X 1 )vrtv, in l)11th !-iirv\, tlui- rate driip.s to Ie(- than half the incidence
in the 1Oelow port'Nty inleff'ile pi piulation. The I total niiuiber of infaints and children
1I1 1, hlii*ir f'w'irth birthlday in jeopardy with re-pect to energy int ake, projected
for the whi Iit U.S., i. li, ire thali one million (1,176, 569 for infants and children in
the TSNS, and 1,011,,53C, inly including children aged I to 4 years, in the PNS).
By flie- er;t ria, tlie total of preiglant women, infants and young children
livingr a1t xe.lv and near-poverty levels of income is more th:in two million
(2,122,124 projected from the TSNS alone, and imtire than 2.3 million if evidence
fnmi b'>th .-iirvct\ ar;e con-olidated,).
A> noted abi'Ve, the evidelncie concerning low nutrition inmtae within p)ovcrty
:inod in a r-p' vcrl income level popular ti' ns is co rrobo'hirated by the fact. that.
111anV of 1lw-i individual, shotw l)w and deficient b1oid and urine levels for
z il- .iincts that :ire dniinki-eid by chronic undernutrition, s.such as hemoiglobini,
cluii:it<.eri<, so ruin albhimin, red cell folacin, vitamin A, and urinary riboflavin
l!iiin *-tlwr.-. Thi-< evidence was pre-ented in detail at the Society for Neuro-
.- Clirin.'e Annual Meeting.
Prrhjip- the most co0pen(ll. evidence for br:iin jeopardy due to undernutrition,
;i- r#t Ot rd in 1 Il'- TSNS aimd I-NS surxey-, relate ( to head circumference nmeas-
ureimients. Ta1i!.w II show:- that an unexpectedly large niiumber of infants and chil-
dren with -iai:ill head circiuimferences was found among lowN ine'ine failies.
The data in Talve II, which was derived from the two independent surrveys
(TSNS and PNS), are very cli-ely ,iznilair. The probability that the impoverished
popul.-ili 'as repr--ented hr le.-r tw\o -irveys co.it-tuite a normnil pop]ulationi
with ri -pect to lie:id circumiference .-taindnirds is le:-s than one in a million. Since
hiAd circumiifi rence corrv1;itris with brain volume, the smaller head circumferences
r flefet bm:ullir lr:ain dimeii-iniia. Thii olbserv-ation in)plies coinfirnintioii of the
prcd iction frou nutr ition intake data Ilhat there are likely to be a large number
of inf at-z a;n(] children whNii-e brain develop pimlent was I thwarted by undernuitrition.
It -hu iild li- iioted tli:it Ilie-e mea-uirerivnts were miiadie simply by placing a
S:ijw around each he-ad and that they are completely independent (if the methods
fi'r iia-uirii1L; nuitriti~i'i intake ;i- wel as indepeniclent of he brain jeoipardy criteria.
Thi- woirk \va- vminducted by Robert B. Livin,-ton, M .D., J,111h S. M ac(reg 'r,
(arv .J. 1 i-hr, and A. Baird Ilast iu. Ph. 1)., at thlie Univer-ity of California,
:M Div.,.) Sehool of Medicine; and Doris H. CAlIinwy, Ph. D., at the University
o4 ( ilif 'niia. Berkeley.







S5


TABLE .-ESTIMATES OF BRAIN JEOPARDY

Percent below
70 percent of Projected
Number energy RDA U.S. totals

TSNS pregnant women:'
Below poverty -- -------------------------------- ------ ---- 151 59 243,951
1-2X poverty----------------------------------------------- 102 47 300,892
2-3X poverty----------------------------------------------- 61 44 340, 712
TSNS infants: 2
Below poverty------------------------------------------- 201 18 99,235
1-2X poverty----------------------------------------------- 172 13 133,095
2-3X poverty------------------------------------------------ 34 15 154,869
TSNS children: 3
Below poverty ------------------------------------------- 556 13 297, 110
1-2X poverty----------------------------------------------- 280 9 275,876
2-3X poverty---------------------------------------------- 132 7 216,384
PNS children: 4
Below poverty------------------------------------------------ 246 24 396, 146
1-2X poverty--------------------------------------------- 570 11 337, 182
2-3X poverty------------------------------------------- 398 9 278,208

1 Total pregnant women in jeopardy, 945,555.
2 Total infants in jeopardy, 337,199.
3 Total children (TSNS) in jeopardy, 789,370.
4 Total children (PNS) in jeopardy, 1,011,536.

TABLE II.-HEAD CIRCUMFERENCE COMPARISONS

Percent below 3d 10th 25th 50th 75th 90th 97th

Expectations for a standard population-- 3.0 10.0 25.0 50.0 75.0 90.0 97.0
Below poverty:
TSNS (N =1382)------------------ 17.3 33.7 51.6 73.2 86.7 94.5 97.4
PNS (N=249)------------------ 14.9 28.1 44.6 72.7 89.6 97.2 99.6
1-2X poverty:
TSNS (N=714)----------------- 10.8 21.3 43.7 69.2 84.6 92.3 97.3
PNS(N=584)----------------- 11.6 23.0 42.1 64.2 84.4 96.1 99.7
2-3X poverty:
TSNS (N=269)------------------ 6.7 20.1 39.8 68.0 85.9 94.4 97.4
PNS (N=404)------------------- 9.4 20.5 35.2 61.6 86.6 95.1 93.3

Legend: Head circumferences for poverty and near poverty populations are compared with Boston standards for head
circumference. In a population meeting the Boston standards for normal growth 3 percent of all individuals would be
found below the 3d percentile, 25 percent below the 25th percentile etc. Note that when the infants and children from
the TSNS are compared with the standards 17.3 percent are found below the 3d percentile, an excess of 14.3 percent.









'l1i ri.E: 7-Ar1it;


CHAPTER Il-FOOD AND NUTRITION SERVICE, U.S.
DEPARTMENT OF AGRICULTURE
SV i~c i1 IKH B--G]:\H I {\L i{GULATIONS A--) POLICIES-FOOD
DliT[RIi!'UTION
PART 250-DONATIOrN OF Fooi)D ivot vs-; x i.\ UNITED STATES, ITS
TlvRITOHIE-, AND POS.>iLSSIOS A NID AREAS UNI)DER ITS JURIS-
DIcTION,
Section 2.')0.11-Supplemental Food Program
(:0I)0fu f For the p1rpoe-es of Ihis section:
(1) *'( TPDO" nitan: the Food and Nutrition Service Regional
OIlice, FNS.
(2) "Health facility" mean,- any public or nonprofit private center
or :uenew which provide.: free or sub-lstanti lly free health services to
low-ueincome persons1__.
(3) "Supplemental food" means, commodities specifically made
available by the Department for persons in low-income groups vulner-
able to malnutrition.
(4) "Low-income groups, vulnerable to malnutrition" means (i)
infants anld preschool children and (ii) women during and 12 months
after pr-egnancv.
(b) Eligi;blity for stppilemental food. Persons in low-income groups
vulnerable to malnutrition who have, after consideration of agre and
income (location and income of parents, in the case of a minor), been
found eligible for benefits under existing Federal, State or local food,
health or welfare programs for low-income persons, shall be eligible
to receive supplemental food donated under section 461, section 32
or other applicable authority through authorizations issued by pro-
f-,ional or supervisory personnel of a health facility, or by other
personnel the health facility may de:,ianiate, or by physicians serving
money-payment recipients tinder public welfare programs, in ac-
(o4rdance with the provisions of thils section. The food benefits pro-
vided in thli-% section are available to any area without regard to
whether there is a Food Stamp Progra 'im in such area aid may be
made to eli'rible pens whether or not they are participating in the
Food Stamp Prozram or a1e otherwise receivig commnoditie; under
this pairft, provided that distribution is made in the immediate vicinity
of their place of permanent resicleiice in areas in which the Food
Stnnmp Prorrain is in effect.
(c) Allthor;2znaf~ui for -ip)1<-imrental food. Health facilities al)l)roved
undeir1 tliH section or physicians seiwiig money-paYinvent recipients
under Public Welfare Programs, maty issue to eligiblee personis in
low-income gyrou ps, vulnerable to nalnutirition, vi -o are determined
(I >)





87


by a physician or other staff member of such health facility, or his
1-ee, bY serving ra
de-in, by such phv.-icians serving money-payment re-inients
to be in need of the nutrients in the supplemental food, authorizations
for the supplemental food for home consumption in specified amounts
and varieties> judged necessary for their health. The supplemental
foods shall be distributed to such persons by health facilitiv-, by
recipient agencies, or by the Deopartmiient.
(d) Appl'c-0onm by health facilities. Health facilities desiring to
participate in the Supplemental Food Program under this section
sholl negotiate a plan of operation with distributing agencies. If the
distributing agency is other than an agency of the De'partnment, the
plan of operation shall be approved by the Department. Stit dis-
tributing agencies may design and submit, for approval by the De-
partment, a plan of operation in behalf of several or all health facilities
in a geographic area or State. As a minimum, each plan of operation
shall contain the following:
(1) The name and location of the health facility(ies) and the title
of the officials) in charge.
(2) Such information regarding the nature of services provided, the
criteria of eligibility for such services, the professional and supervisory
personnel, and the source of financial support of the health facility
as will assist the distributing agency to determine eligibility to par-
ticipate in the Supplemental Food Prognrm.
(3) The estimated number of persons from low-income groups,
vulnerable to malnutrition, who would be eligible for the program
based on the following categories: (i) Infants through 3 months,
(ii) infants 4 months through 12 months, (iii) pre-chiool children 1
year through 5 years, and (iv) women during and for 12 months after
pregmm ncy.
(4) The method of identifying persons eligible for authorizations,
the methods of controlling the issuance of authorizations, and the
manner in which distribution will be made to include (i) the identities
of the agencies and units that will store and distribute foods on
presentation of authorizations, (ii) the records to be maintained,
(iii) reports to be made, and (iv) the method of financing distribution.
Reports will, as a minimum, show the number of persons in each
category that are benefited, and the variety and quantities of foods
distributed to each.
(5) The identity of the public health agency and personnel in the
unit who will issue authorizations for food with an assurance that no
authorizations for supplemental food will be issued except by a
physician, or other staff members of the health facility, or hii-s designee,
and that issuance; will be made only to persons in low-income groups,
vulnerable to malnutrition, who are determined to be in n!ted of the
nutrients contained in the -iipplemental food.
(6) Provision for periodic review to ascertain the continuing
eligibility of persons to whom authorizations are issued.
(7) Provision for identifying y ;iv person who has been dc-:igrnated
to reecive supplemental food.
(8) A -'.iiu nes that the supplemental food program will not be
r^ed as a means for furthering the political interest of any individual
or party, and that there will be no diLcrimination in the i--uance
of authorizations for supplemental food because of race, creed, color,
or national origin.






ss


(9) A1iiee hi p rois i o -inlfomel 11() wlln t be
reqpuired to: ma1ke ally payme Nt 1cin mone11011Y, nui1tvrinils or Iservices for
the s'11pplt'ient al foods. andol llii( they will not be solicited il (oI-
nectioin witit fihe Sulppflcmeiital F ood Pruonmiln for voluntary cah1
c( *o t Iib tioi. for ; i IMpIu ose.
W,10) Tlie ii7ine of d ile Ipvj~ervisin!r agzenlcy Mid the in:mnner by wliinci
it will s-Ilpervise aIind coordinaiHte 111 'Slie Sppleient ail F1oo(l Procrtatun
(if it is ultiz01neIW.0 iature). To tfei( (\teint posw-'il-ble, o1perationls
shall cover; anll entire political s1)division.
(e A)ir minnfs ,ri// .i (P 11)wlicrc ii! *i a tfeilvnc of' the D"pitit tlielitibutj. ;ZL(V.
Taial eni-ter ilto iirhne11ts with icii lth fLiilili<- which are XiPprovvI1 to
pI1! ticipate ill the ippleicutal Fo (iro(i nt. Such ,1LrreeineiA! .I lH
I(e in, writing 'In;d i;S1 i( con1laii. -n1ch terms I111d condl(itions s til% (Ii-
tihtii!(c, or *F1(1 Pills11(w-.^i vv to a-ire tlhat (i is ince
of 1) [h-I 1r options for sdilppleniental food is iin a ccor(Iad;;ce wit 1 iii -e'c-
I ion ; (ii) health fticilities a-re rvspoipnsible to tlie d(-isribiti tiiU zigecy (wr
('FPDO for any distribution ronltn^ from irl)Ioper or negli(e'it i-
suaince by tblicn of prevcription,-, for s;ippleimental food.
(2) n situntioiv in wlicli health facilities N will thcveslvec-s d i-4riit ('
the s.I)I)plelmPntal food, the w~ht'itt with the health facilities- shall
also cont. tli ell, provisions which are required with respect to recipiiet
ageneiC. ndller 250.6(b).
(3) E;-ch L ,-_rreonwnt with a h,;ltI faIcility sli tll provi(le tlill the
1health facility sAiall maintain accurate and complete records witdh
e'spect to its; activities under the Supplemental Food Pro.raiui, and
s-ill retain such records for a period of I) ve;irs from the close of t he
Federal fiscal year to which they pertain.
[34 F.R. 807, Jan. 18, 19691
Section 230.15-Operating expense funds for distributing agencies
(a) Pm-pose,. Te Department will make payments to (listribuitiniL-
iIWi(1Lh-. other than private ;aeicie, to a-.i-t them in meting oper-
atiniig expee iurred in administering food distributionn projrnii'n -
for needy poi--ons in households.
(b) I [st offui hi/f. Distributing agencie-; ,ml1 make every reasoinable
effort to iiislure the availability of a food distribution program for
needy per-ons in hoi iusholds rei(d-Clinfg within the are;la served by ihe
distribution agelicy but outside an area where the Food Stamp Pro-
g-'rain is in operation and shall assigl priority, in the ii-e of any fund-
received under this section, to accomplishing that objective. Ally re-
m11lining- fund,,, ..hall be 1s ed to expand a-nd( imipr)ove distributiti) to
1oI-ci iolI(1.-. Such funds may be used fori aIN costs which are allowable
under Burenui of the Budget Circtular A-s7 (a copy of which nmay be
obt .alined from FNS) and which ar in( iil(I( in (istrI'il)butingr donate4d
foods to households, including determining eligibilityv of recipievnt-,
except for the purchas-e cost of land and buildings. Ill no event shIanll
such funds be used to pa any portion of any expeni-; if rCimh bur-e-
ment or payment therefore is claimed or made available from any oiler
Federal source.
(c) Apportionment of funds. From the funds available for the purpose
of this section for any fiscal year, the Departiiient shall first reserve
funds in an amount sufficient to meet the requirements of siibpara-






89


graph (3) of tbis paragraph and then shall apportion the remaining
funds, as follows:
(1) Twelve and one-half percent of the remaining available funds
shall be apportioned among the distributing agencies for Guam,
Puerto Rico, the Virgin Is lands, American Samoa, the Trust Territory
of the Pacific Islands, and the governing bodies of Indian reservations
which are also distributing agencies. The proportion of funds appor-
tioned to each of these distributing agencies shall be such amount as
FNS determines is necessary to effectuate the purpose of this section.
(2) The remainder of the funds shall be apportioned among the
other State distributing agencies which are, or may be, responsible
for food distribution programs to households. The amount of the funds
apportioned to each shall be established by dividing 10 percent of such
remaining funds equally among such distributing agencies and dividing'
the remainder among them on the basis of two factors: (i) Per capital
income within the State as related to the national per capital income,
and (ii) the number of poor in such State, as determined by FNS, who
(1o not reside in areas where a Food Stamp Program operates or is
approved for operation by the Secretary, or in areas where distribution
is made by the Department or is financially assisted with funds made
available under Part 251 of this chapter, as related to the total number
of poor in the United States who do not reside in such areas.
(3) If any program of financial assistance conducted under Part 251
of this chapter or any food distribution program operated by the
Department is terminated and the Food Stamp Program will not be
administered within the same area in which such terminated program
was conducted, there shall be added to the amount of funds available
to the distributing agency under subparagraph (2) of this paragraph
all amounts which would have been paid to a distributing agency or
recipient agency or which would have been expended by the Depart-
ment with respect to such terminated program.
(4) The apportionment of funds under this paragraph shall not be
regarded as conveying to any distributing ag>-ncy a vested right to
any fixed amount of funds.
(d) Notification of availability. As soon as practicable after funds
for the purpose of this section are made available, written notification
of the amount of funds apportioned and the period for which they are
available shall be given to the distributing agency for which such funds
are available.
(e) Payment of funds. Upon receiving notification of the amount of
funds available to it, each distributing agency shall advise FNS of
the amount e-timated to be required for the fiscal year. FNS shall,
if it concurs, issue a Letter of Credit to the appropriate Federal Reserve
Bank in favor of the distributing agency. The distributing agency shall
obtain funds needed through pro -entation by ofefgI ; ated ocialls of a
Payment Voucher on Letter of Credit to a local coinmercial bank for
train-ini-ion to the appropriate Fedei il Reserve Bank, in accordance
with pr ocedures pi;-cribed by FSN and approved by the U.S. Treasury
Department. The distribution aencv shall draw only such funds as are
needed to pay claims certified for payment and shall ii-, such r
without delay to play the claims.
(f) Agi f'ments. Each distributing ?i'(cy which desires to receive
funds under this section shall execute and submit to FNSO (a letter






90

t'i ;1111 11 Wzm i O'rli'm OW: ( 1) Expend "AlI fI III(] rvccf %-d -ocluly frm iIli-
lrepm-a 1ndhr ihi- part; 2-d (1)
.*.rnc1,d the exi- r l : 'i'tfu(Mqt betWt'e1 n tie t i-tiibutina 1reVicN 011d Oiiile
l) rli.int )III I I!Vt-., ichlidii..1 1,e 1ii l^4i Opportunity cLini-v ts iclion 2112
of >' SII.i-i'tl 1v -i ( 'o t r;. 3~27-:2)) ;iI~d tII W vL Cm-(ontric't Act of 196,5 (41 U.S.C. 351-257).

j1 il I I c!l1.ii foi 3 froti 11ic clo~- of the Fechi ;l fi.'ciI yvci to whicll
tlI..,v i'rl rl 11, r. !ik ) lc te i:'.d ri1:I-;Ittc record(-. of til ;IIo ioiio it -< rc1ccived
.111d di !wr w' 'o ii d Yr ibi-. -cction. (2) k' i') uc'li nt w cm1 tiil(d record,
i;:iy hi. liic<;--.hi' to e(ilulc ISX to wifcrmine Wictiler hlicre hia-
1"'.iI (*oii~iplsii'c ". ithli ii-, sectio!. :1:d (3) pi'iiiit r)(eplseIn'tlit iv(es of
the DI'T"iOi'tmpnt 1i1d (If thP (i'viirtiid Acco)Ioltir O1W llice of the United
S I i I Ito Ii-I)t't. alditt, iid copy such d i eod al IT)d ;'cou7nlt ast a i
F ~S o(w om i 'l NS o (10 cmic(nin2ir the obliAat io: *XpCricliturei and
st(td- ol fudis eCeived tunier til- S-0e jion. In :(ddihionl, distihu)tinI1
*Iu': IlCie-~ U'CICOI P A.111, hfilid' iiiilr this- ...A.(1l~ ~-11211 :-IlbluIlt u11lv other
rrwports ;I -lich form as may be Ivyfuii'd froml time to i11e by tlie
Dep1w i H mNct.
[Aii.'t. 14, :1),1, F.R. l-Di~sf;) Jully 37 1971]
NOTE: 1"iW r "ip 'rtiiU u-,d,',r rrcvird!cepin rcquir' *ments crnt :iied heroin
ha\ic' lo )n oppri)vwe bv llie (I)vf ii O 'if 4 Minnaenici gnit midi Budpct in aCCmrdancc with
the l\drikIl It Piarlt-. Act of P1.42.













AUTHORITIES FOR COMMODITY DISTRIBUTION



SECTION 32-ACT OF AUGUST 21, 1935

(PUBLIC LAW 74-320) 1

SEC. 32. There is hereby appropriated for each fiscal year beginning
with the fiscal year ending June 30, 1936, an amount equal to 30 per
centum of the gross receipts from dutie- collected under the customs
laws during the period January 1 to December 31, both inclusive,
preceding the beginning of each such fiscal year.2 Such sums shall
be maintained in a separate fund and shall be used by the Secretalry
of Agriculture only to (1) encourage the exportation of agriculturalt
commodities and products thereof by the payment of benefits in
connection with the exportation thereof or of indemnitiks for los-j>
incurred in connection with such exportation or by payments to pro-
ducers in connection with the production of that part of any agricl-i-
tural commodity required for domestic conslumlJption; (2) encou *e
the domestic consumption of such commodities or products by divert-
ing them, by the payment of benefits of indemnities or by other iLteans,
from the normal channels of trade and commerce or bv incasin thcir
utilization through benefits, indemnities, donations or bv oter means,
among persons in low-income groups as det minedd by the t`.-retary
of Agriculture; and (3) reestablish farmers' purchasihg powrr by
making payments in connection with the inornal production of anyi
agricultural commodity for domestic co' -umption. Det erminations
by the Secretary as to what con-tltuth diver-ioi anld what constitutes
normal channels of trade and commerce and what constitutes normal
production for domestic consumption slall bo final.
The sums appropriated under this section shall be expended for
such one or more of the above-specified purposes, and at such times>
in such manner, and in such amounts as the Secretary of Agriculture
finds will effectuate substantial accomplishment of .>v one or more
of the purposes of tVis section.' Notwithstanding any1 oti er provisioIn
I The Act of Auzu-t 24, i.", 49,F 'r. 735, 744. A l ;'!. this section has been amended a number of tire'.
Thepurii- s of section 32-'l L1'L t : is or indenities i to .: P e ('&'a, and V U r-ri
consumption of acT i:Hural commodities and i: 1 'ls and to reestablish fanners' Duni'. power Ii.
connection with the normal ijr Dirtion of ;.:ii* ural ommoditie-rmiains ia h same since
February Ui. 1 '. Authority to encourage con-u. r ;1 x <~f .ural cnmo i: 1' n i r di it 'h ir
ui ilizaIifn zm'.riL persons iin low-income groups wav .' .dd by a o- a in 1
975). Later amendments are noted.
Surplus a-zriuul;iri1l commodities purchased undpr clause -may be donated for ree purp s ? nd fo-r
use in nonprofit summer camps for children urndr the Act orf Je- e 1 37. and ayi. do1ated to J'hools
and service institutions under sections 9 and 13 of the Nauional !chool Lunchi At, as am-nde and secn
8 of the Child Nutrition Act of 1 m-.
2 Section -ii5 of the Acrii.ultudil Act of 1 *' autl jrized the ai r a : i eah r.ear.
'with the fiscal y:ar erdiriz June 30, 1. 57, '..' ''.u';'i to en LI rtary of Ayri uitre
carry out the provisions of section 32, t'1'j' ii to all provisions of law r, ic to the o xpnture f fu:
appropriatt-ol by such section, except that up to .51' percent of the $:'''i... a b1 oevoid 2 any
scalel year to an': one agricultural commodity or the products thereof.
, Forthe adminiirriiil i.ri if >eon 32, not to exceed 4 percent of the total amount available for such section
in any fiscal year may be used for that purpose under the limitation contained in section ^'2'b of the A2'
cultural Act of 1938, as aimnended.
(91l)








Of t0n' Vc-ti(11, the il iinmic ht I m1 A be dvtd ui';ayt~lva
1i'lr (J.ue ;1ii. li',, I to aLIN one tgricultual ommimodit v or the p)rodIIcts
tiei.* ini -lh fi-. 1i1 year, sdliall not excel 2D pe-r ceit mi1 of the funids
avil~ale undetllri thI is-ee 'cion for Ili lcdya.Tesmapopi
ctd In e iItIthI- s I e tio)i -,]Iall In h e vo.(ted( principally to perish'able 1101-
1 ,1-ic agriculitural comilmodities, oo llher 11ha1 tho),. -1curciving pri-1C e
silupport uider title It of tile AzritciltIuiral Act (r 1949)' aind[ their
oucts/'lit hite smiis appropriate under tihii ceioU -hliall, iotwith-
st:i dii! f1r tlIt puirp-Im't of tIlii" xctioii until expciided ; l)it anv excess (df tile
:illouiilt riA1inini1Lr lnexpeflid at tlie cud of aIl fi\- al y Ma A over
.00.M() (l shiTall. in t lit z:e mainner s t hioii:h it had been uppro-
p) [1 I "1or, t1 1 W'Ovice of -I Icli fi-cal y r be >11j)c to 11 provisions
of scitoin;90O of the Hevijedl Statvt( (l.>.C., title 31, -eC. 712), and
rctioti 5 of thie Act entitled "An Act makiintr appropriations for the
l t'I i-ive, executive, and judicial expenVes of t Ile (GovernmIieWt for the
year eli'iiii' *Irie ll1irticti, eigltee -td ad siventv-five anid for
otl

SECTION 4-AGRICULTURE AND CONSUMER
PROTECTION ACT OF 1973
(PuBIic L.w 93-347)
SEC. 4.i (a1) (1) Notwithstamdiin'g any oiler pro\'ision of law, tile
SeceFtarIyl* of Agricult 'ilre shall until July 1, 1975, (i) us-e fulls avail-
able under provisions of section 32 of Public Law- :320, Seventy-foiirth
Conjrre--, as anended (7 U.S.C. 612c), and not otherwi-e expenlded or
I Iee-.ary for such purpo-e- to purcha-e, without regard to the provi-
sions of cxi-4ing law governincr the expenditure of public funds, agri-
ciultiial comimoditiet- and their products of the type- customarily pur-
cba-'tl under sections 32 (which may include seafood commodities and
their prodiuctst) to maintain the traditional level of asn-i4tance for food
4' it tance p)oanmsi as are authorizedI by law, including but not limited
to dis--tribution to needy families pending the tan-si4tion to the food
stamip pr(onram, i n-titutions, supplement alfeeding pro-.ramus wherever
locft t ed, diia-ter relief, simimer camps for childrh en. and the family
Com1ill1odity di-tribution pro11-ra mi on Indian re1urva tio1- not requesting
a foo(1d -t(.mp program, and (ii) if stock. of the C( oiimodity Credit
(Corporation are not available, ui-e the funds of the (orporation to
pilrch a -C' aIgrliculltu1 iral comlmiodities anlid their piomlimuts of thie types
cti-o0i1 I :rilv available tinder certion 416 of the Agnricult ural Act of
1949 to Iniet sc1!Cli requiireiments.

4 '1 .. l wnith Nhe 1 i0.,-!- .- ss s snhstitut'd ffr "othfr than those d1j ini.'.''l1 t. 11 of tile
A- vIIiTIraIl Art If i' 1,\ s -. i on 5 of 1he Art of .Jan. 311. Cl' -'i. i, 4.
i ~ s e 't ~w~is d .4 hv sc ion 411 of tho A hural A1t. o' 1 If C'.6 it?
1 *1 1 hv ti Act of .1ui1 'V, I'l 3 -..LC. '17.3{ U 1' C. l !'i. iil hr Act ',i July 2Y.) 1%6. 70 Slat.
i.,' as.ri* .1 I i .1 **r r ..-'.(. TO1- Ti-.
( '1 r, < t< > w H4 s addedi 1l' s jton :ii o, f tI Av. Io1ii. i r il Act of al, Ii:''. ;. l2l 1. I'2 7lal 1257. Si'e
sst i41 .4': b of A 1 A- i n inii; Adjustni ut Act of 1--3-,. as ;ii it 1-I. for on administrative
"p ** 4414 .*:**io) 5 ( ) 4 hasI w 'M'ih l0 tltd bh Iublic La 3 3 17", i) -i i1 .




93


(2) Notwithstanding any other provision of law, the Secretary of
Agriculture shall, during each of the two fiscal years beginning July 1,
1975, and ending June 30, 1977, purchase agricultural commodities
and otherwise carry out the provisions of this subsection with funds
appropriated from the general fund of the Treasury. There are hereby
authorized to be appropriated such funds as may be necessary to carry
out the provisions of this paragraph. Authority provided in this para-
graph shall be carried out only with such funds as are appropriated
from the general fund of the Treasury for that specific purpose, and in
no event shall it be carried out with funds derived from permanent
appropriations.
(b) The Secretary is prohibited from furnishing cQmmodities to
summer camps as authorized under section 416 of the Agricultural
Act of 1949, section 32 of Public Law 74-320, and section 709 of the
Food and Agriculture Act of 1965 if the number of adults participating
in the activities of such camp is in excess of one for each five children
under 18 years of age participating in such activities.
(c) No individual who receives supplemental security income bene-
fits under title XVI of the Social Security Act shall be considered to
be a member of a household for any purpose of the Food Distribution
Program for families under section 32 of Public Law 74-320, section
416 of the Agricultural Act of 1949, or other law for any month if
such person receives for such month, as part of his supplemental
security income benefits or payments described in section 1616(a) of
the Social Security Act (if any), an amount equal to the bonus value
of food stamps (according to the Food Stamp Schedule effective for
July 1973) in addition to the amount of assistance such individual
would be entitled to receive for such month under the provisions of
the plan of the State approved under title I, X, XIV, or XVI, as
appropriate, in effect for December 1973, assuming such plan were in
effect for such month and such individual were aged, blind, or disabled,
as the case may be, under the provisions of such State plan or under
public Law 92-603 as amended. The Secretary of Health, Education,
and Welfare shall issue regulations for the implementation of the
foregoing sentence after consultation with the Secretary of Agriculture.


SECTION 416-AGRICULTURAL ACT OF 1949

(PUBLIC LAW 81-439)

DISPOSITION OF COMMODITIES TO PREVENT WASTE
SEC. 416.10 In order to prevent the waste of commodities whether in
private stocks or acquired through price-support operations by the
'Commodity Credit Corporation before they can be disposed of in nor-
mal domestic channels without impairment of the price-support pro-
10 The provisions of this section were substituted for the previous provisions by section 302 of the Agri-
cultural Trade Development and Assistance Act of 1954, 68 Stat. 458, See section 9 of the Act of September 6,
1958, 72 Stat. 1792 (on p. 244) providing for distribution of commodities under section 416 to overseas areas
under the jurisdiction or administration of the United States.
The Food for Peace Act of 1966, Public Law 89-808,80 Stat. 1538, approved November 11, 1966, deleted all
references to foreign donations from section 416. Such deletions are effective January 1, 1967.
11 The words "whether in private stocks or" were added by the Act of July 24,1959,73 Stat. 250.


68-151-76---7






94


1U1,1 oP -,old abroad tt uomiipetitive world prices, the CommoditV
Credit Corpora ltion is aI thoiized, on !iic term-s and uinder such regula-
tioii a-s the Secretary mayiv deemi iil the public interest: (1) upon
a1p)plicat ion, to minake sluich commnoIdit ies available to any Federal agency
for ise in miiaking paymieiit for commi11(odities not produced in thle United
Statve; (2) to 1art or ex(lhanlge sc1111i comimiodities for strategic or
otlier m1zaterialV as authorized by law; (3) inl the case of food cominodi-
ti&" to doiiaite -unih cmOinofliti-' to the Bureau of Indian Affairs and to
-nIich State, Fvederail, or private agency or agencies as iay be' deg-
.n0ted bIy the proper State or Fedfral authority and approved by the
Secrt arv, for ii-e in tile United St rates i in nonprofit nichool-lunch pro-
iranm,1^' iin nonprofit siiwiiivrer caiiips for children,"3 in the fl i--ltnce of
need0 lper)-on. and in chiaritable institutions-, inclu(ling ho-pitazls, to
the extent t1hat neeId phr'-ons arie served. In the cate of (3) tlie Secre-
tarylv -hall obtain am -ch a-I'lrl IWCce 21 he deeims necessary that the recipi-
ents thereof will not diinillihl1 their normiial expenditures for food by
rea-,on of tiich donation. In order to facilitate the appropriate (li-posal
of such comimlodities, the Secret ar- may from time to tuie e-htimiiate
;nd ainiounce the quantity of such commodities wich he anticipates
will be1comne available for ditAiibution under (3). The Commodity
Credit Corporation inn1y pay, with re-pect to comimiodities di-posed of
under tlii-s -wvftion, reproces-inag. packagmig, trail-porting, handling,
.1iMd other c(1a rzes-U accruing up to the time of their delivery to a Federal
i-e1icy o01 to the de-ignziated State or private agency. In addition, i the
case of food commodities di-qpo)ed of under this -ection, the Commod-
itv Credit Corporition 111,y pay the coAt of proces.-ing s-juchi comniodi-
ties into a form -.uaitnble for home or in-stitutiomil use, such processing
to be accomplished through private trade facilities to the greatest ex-
tent pos-zible.14 For the plirpose of this section the terms '"State" and
"United State-" include the District of Columbia and any Territory or
po,-e--ion of the United St rates. Dairy products acquired by the Com-
modity Credit Corporation through price support operations may, in-
-ofar as they can be used in the United States in nonprofit scliool lunch
and other nonprofit child feeding programs. in the assistance of needy
persons, and in charitable institutions, including hospitals, to tile ex-
tent that need(I persons are served, be donated for any such ue prior to
any other use or dispo-ition.15 (7 U.S.C. 1431.)
12 S 'e Act of zr-it nibcr 13, 19(, 74 Stat. 899(p. 243) authorizing the use of surplus foods for training home
eeonomirs students.
Is The words "in nunpr''fit summer caps for children," were added by the Act of July 2, I958, 72 Slat.
86.
14 This sentence was added by the Apwliculiural Act of 19I5A. 70 Stat. '203.
is Tbia last sentnce was add..d by Public Law,.'1-2-33, 84 Stat. 199, approved April17, 1970.












95


(U






07
I-






















.0


'o
0 E


















L2 cc







C*-
z



























-00.
(U a
























C4-
0
o c
CO0






o o*

































LO .,
02








0











V5-
0c


0on













I I-







"o .o





0C








60


(U








-S










0


-'0D0(too0oro=
(0U? C0 w0 rp00 0


cLOnr-% D = Ot








4-.1mmoioo) M
I 41 -1 iC C C


4
(0 4-i





40

0IZ


4 4 4
1 4 I
* I 4


4 4 I
4 I 4
4 I
4 4 I
I I


00 00 -rCj m




'3CMOOOOOr-C~r-



CYi O- --0 4=r m

Cn C" U-)(. 00 to U-)~ 0
csif-00a,.oo

aj to^ (D 0 P 00

4 00 r 4 n



C14 I tr 00 00




U")(D00W4mOOD -
r-. C%.J 4= 00 url r (D "%


CY) r o00 a en
~*-< O-^





-Z


') -n CDO )Lo= 00
r C MC,4 C)00M00
4D 4






00 (Lr C14 00 m r01

C o) o -j 4= (Y c
*' -0 C oo 0 r
4 14 M CMC
0^Cj co~ Lo 00 P


CM "I ra w )

OiOCrer.J(0( OCT
Ln C~rf- 4g : 0 v




-00r-csr-0c'4'o


4 I 4 "C. ~


I '0 001. (0
o 00io r-- r. to CM






Wt 00 r., to
I C'* Uj cn ,grL
P0 r~ cn 0 CD
I *~C~C'C)J
I -
*4 CY(0CWM






-4


OIC0tC0i,-.l0I0OOOCM
(DJ c' ( -) Cl U) 00- (= w -
M rCD or'- = M W-4Mtno
mr-. CD( r- 0*0 CD U-) w0 w C)

co~-- n M X;C14 Or me).0 0



m, 14: -R -c 0 O to4 ('4 w, m, m)


00() U') W, -1 CIJU) U~") M .00 C0

m) n r~ C) 00 -,r(.0 U,(0
o---- o- Co4 "o4 -4 NJ



C)~~~ 0)-40)) r- ('4 M a)
T- UI l C14 N 00 LC) CDcNJ (00) Jl "r
SCD-; (.0 -4 (0 r. a) 0)- to
O1)- 0 a)OiC0 -Pm -0M a")
r- .cMiCMO)ien iocCY o"T L) C) a _



m) to00 CD e m, m0 (N 0)0 fU,
cn ^" m3 mo Mo I=- Lo CTmr -tr =" a)


)CQmtono 0o(oM r oo0C)m
CD(% Lo) e0)0 C> rm0 U, C) -(0)
e.r 00 (= l CV) D Icr ) -C 00~


vt00 0 (0 l o D18- 0 mmt
m (000 C~ CIJ M0 =l C() -(
P U- ) (4mY (0 l C) j U)U,0)


~00 C!N (D00 m MI Lo(0-t
rn UCM01)toMo 4 r MCi 'Cn

0'0 co' -D C4'4 o MM W-0 Mr- 0d'




"~ 0)i I' 1) (D00mU) to) m, (.0 -= U
m C14 U-) "cm0O0c o




to 00 (.000 0)M0) U, 0'4 CI
im en q (00 t-o 00-W r(' -01 (D




(NJ tzil m, (00 a4) a, (0Y) toCD alr -

LO mmjw oi C4 = O o i-* C) mc


M~N (7) r- CD) M U-) 000

U-)C (D ( 0 r.. -04 = A


(0 -0(00 toCDM, mc)I 0l)0 00 ro -4
DCMC r) (00 C al m a) P "00





pcM.-i.-ncM 00ooinmrm t00m mo




U, 0) r (fl C*4 0) M- CV ') M, M


M, UD -40 OL)1, 0- U o
0)000(0(0 -IItt UL)) l) LO0Y -cr






C)('4 Cn) c00-~ C. D- IY 0)- W-. -0 ( 00'
m'(00 m q ) -T Lo ) LOw 00 CY) CY)


U, t t0 -r LnP,( l l0 00400 L0~
---ci r)-, LO (NJ(N CY) CY it ) ()t
4 -40 U U4-4 1.00- *4 (J (0C-4 "
=0 M C)) 00C0 CO M 0 CM 00 wr









CY)( 00 U)4 0) -4 (I) U 4 U, 4
0.4(0 U It 'm U, t00 -r' en00 m en


















4 ('4 14 ('4 "N C4 r U, r- CY) 4=








C4 CM CM CM CO M CVO C> CV )















O 0 4 I 4 I I 4


17S q3 -0 0 CD 0
0 c .L Ao M<
'Z e~~-o~inooou
(U o4= i0 O~c iiisi'
O .0o~vrv~t'o


=~~o-n'ii'reoc
CMM(oU-rri-''^(
V l i -rl-rl l-C C C r



a, sr.e o^ o 1c 1iio











96


-6!!
8.2






S0.
E










o
'3
. 'S



I-.








Co0
o0a.


q.2 cocz Z O TI -'O ^-T -

Of-OmOoeo---..-.

N bomo LM o-. 00Q



m IC)J. C= JCd0 ~cJ*




hn 00q CD C~l M00 m- M00 MD
. r. . . . .




M LO ("00 C p- ('si LO m CDJ ('.500


Lnr V i00 0 F- m w C:) k

00 ". Go 00%' C%J ('1 M LZ
00 P- r0 r- 00c r- 00c000000





', 0- 0 "n "T =% M% 6n. 100 10
-W' 1" en 0" j UO- I= r0 6T 0 m"f









M r-a"C-4 00COh-(- CMC-l.00
C0'D 4m 0 CD m T-00 r- -0C) U



rl- O M o-7 -0 M4D r-.j -00
-riiNOC%;6 -zr 06nId C%;




rQ RT ln (Nn %n 0.0 IA( Z; W 'D
CQ 01 "o C" q* r(I n %cMoo

- --------- -



C.D 0O C4 ; C %MCJ
0LoP0-100W 2 f.0 (v CD

0000 q00 >r o<0r~jrlc

000 ("I (; 0-0_00V r-z 4 C; 00 C



CD m r4. "~' 00: 0 m 0 r- mrCiC-


- --- --- C'4 - "'



c' 1- cfj = 0M -? 000 0000e
00 M 1f r- 0D m r- IN 0D q
IO ) ul =~ r.0 F^ oo Mo or Co cIn en






C(N.v = 40- at 0 00000" rii
In 0 ) r*4 CMj 41 o f 0- M o if 00
t010'sCN M 0 "M3'iCr? 1-
- (N r-4 #'s -* 0-4 I 0 o"




C'.s 0C" Y-. I CD r- cc0' CD a% LO %
cD Wn so r- 0 0's - C(n (N 4
(N05(jcif's-r0.LnU--.00







QI 00 US M O cr- W 0' 0's -
m Kr --W-- -l- -0 mast
tMS Cr MMr MCSICr <*l*lM 6ffC<





















0. =N 0 0 a, W m VsU
^*ctoi~ooooo
CSJA COl COSf CO t- 0000000 ?.^ P ^



0000000000000o0o0o000o000















*" S 5r tI S mS 9 05 5
** <( OZ0 5 9 E * I S S I
I S P *5I
* 5 5 5 9


S'Sl



(N I


It





P^I1
-: !


















I 'I
S II



i '9

I -





I'








I -


(*7
00







00



rni
S00




















C-
I-.



C-





















00
V4













co
^--
-4





00 I




as"


0011
(N
00i


'n 'n Co-i -
i C 00 -O M e'


no -a =. -n co00V7-

rd n' '-,0 1- M. UM Wl 000 0%~ -W


Wf. O0 In (N w U' .a 00 90 00
's"-J9O r.: 0 .-;






-0 0 0M 0-0. 0 m^ - M%

U4- 00 '-000 Cod CI ;_q r
W -0--W m m m00



0000 CD- Z. M r- 10d C. r. 00 cosa'


Qi 0's 'D G,- C-4 M0 S 6n 0N 'n
tr-1; a; ri t 7 (c; t -W -.; >n rsi 6ri oo









La 10n kn 0r0Mc Q 0 0" C en0C0





Cc w o 0s L 00 Lo (N^ Q1
-t 00 r -N 0 r, C--
OOOOPlr fr mi co~r-4 OO C"








U'-00 00% e 00 U .) m. 10('1
-, c C4 U-; C- ------. C ~ia
= c^LnT-CDt".0I nr- ^p- M LC go





L-uNs00 sDoI C oirCo n
rs 000 V-Q if' 0n 0 W N f 0" ho CM
r-.'-- "Jioc 00 00 'itncM0O>










Co'. r.- 0 ) L: n' r. 5-. 00 LA
0%o 0 cc %D -0 to 10" 0000o
0rn 00-0000000000 r

co- r .D;^i~pN!o-^00r\r'













Ct .-. -.0 9Z D 6' 0 %5..CJ MN C39
C 's oJ r, r D COq




(. %00 'rsn. O 00tMP.T





-, ~ 'C.7 UZ 0 0 0
0ri 00 m CDs m In- m- 0D mO








m.Q0 (1 00 M5 IN U,!
-T C0 n- r-= ln - ( NiCDmCDm
M a) MIMM l a esknr r -a f q^ 'C

P. relI- 00&
nrsi oo CM or. if' 10 --- ^ oo 0



U' oo" c'i 100- C's oo" r 0 o"CMO ?T0r>












00o r'j C0o 0 .'d d CIn
090'so 0' 090' CM 0M Dr." ra> 00" ^ 0


-~r~ (Sr _i^o -r



C0'sC's 'siT0000 i- ~ 0000r^
00- (N) (. o(N (N (N (N dN (N *' (N (N o












r P- F-- ri T- P4% f0' - LM -0 -M
0- 0..p... 5. P.- 0.s n (N 1009.0




















A 9 4 1
*. I it I I 5 5 M 5 5M





I = W = W 5 9 9 I
ci*


VP<
S i s I
S I 9 5 9 Q ~i S 9 5
.59 ISS 4
(J *~.S. 9 9 I 5 9 S 5
C-S 9 55) 94 a. > S S 3


U*<^ Z~2S S
I-
*LZ


1-4

01

C-,
(4


00




CIS
iii




5.0'


em
10




rsi





C"
O'iI1









Ln
a's Ii










00i
rU'
in i

0101

(001
0's-I




co
0)01

00







(N
00 *


CL

















0
9-




















.~0 E





40





06
LA-
*3E
0.














5 *













oa