National Public Health Week is April 4th to April 10th. To learn more about how to get engaged with National Public Health Week, follow @NPHW on #NPHW on twitter! Graphic: NPHW
The American Public Health Association has focused its advocacy attention and this year’s National Public Health Week on making the United States the healthiest nation in one generation, by 2030. I have to admit I was skeptical when I first heard this announcement. I mean, it’s hard not to be when Bloomberg Business recently ranked the United States the 33rd healthiest country, based on World Health Organization, United Nations and World Bank data which included risk factors like infant birth mortality, obesity prevalence, and percent of population physically inactive. This low ranking is not surprising considering that more than one third of U.S. adults are obese, nearly one third of children (ages 2 to 19) are overweight or obese and that 16 percent of U.S. medical expenditures ($210 billion in 2008 dollars) are linked to obesity.
In order to rise to the top, we will have to find a way to overtake nations with universal healthcare coverage and healthier diets. But, hey, if modern ingenuity can get cars to drive on their own by 2030, we must be resourceful enough to ensure that today’s children grow up to be healthier than my generation, in spite of the inauspicious status quo. Crazier things have been done, right?
The President and First Lady’s (and no I don’t mean this celebrity DC duo) focus on childhood obesity has helped to achieve much-needed changes to the school lunch program and to advance the most recent Dietary Guidelines for Americans which for the first time recommended a concrete limit on added sugar intake for children and adults over two years of age. But let’s consider the underserved populations who need additional support to meet the federal nutrition guidelines and determine how we can best give these individuals access to healthier foods that will ultimately lead to better diets and improved lives.
WIC: Safeguarding the health of low-income women, infants, and children
Last week, I attended a National Academy of Sciences Institute of Medicine workshop for the Food and Nutrition Board members who are writing a recommendation report to the USDA on potential changes to the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) food packages in light of the most recent Dietary Guidelines release. It is only fitting to talk about WIC during National Public Health Week since this program, established in the 1970s, is one of the nation’s premier public health programs. It provides supplemental nutrition and health education for over 9 million low-income women, infants and children up to age 4 across the nation. According to the USDA, participation in the program has been correlated with improved fetal development, reduced premature births and incidence of low infant birth weight, and improved diets for children and pregnant and postpartum women.
During the IOM workshop, USDA representatives identified the retention of children in the program as a significant challenge. While this program has been hugely successful for pregnant and postpartum women and infants, there is much lower participation among eligible children ages one through four. While the cause for the drop-off is complex and not quite understood, there are a variety of reasons why a mom might not stick with WIC after her child turns one including the stigma of being a part of a government assistance program or lack of time or transportation options to get to WIC clinics. Another possibility is that moms are not completely satisfied with the flexibility of food options and the general value, in dollar form, that WIC provides.
Most Americans are not meeting the recommended intake of fruits and vegetables set by the U.S. Department of Health and Human Services and the United States Department of Agriculture. This is troubling because the Dietary Guidelines Advisory Committee found in its 2015 report that there was strong evidence that dietary patterns higher in fruits, vegetables and whole grains and lower in sugar-sweetened foods and beverages were associated with lower risk of cardiovascular disease and moderate evidence that it was associated with healthy body weight and lower obesity risk and type 2 diabetes. Graphic: HHS
The drop-off rate is concerning because the prevalence of obesity among children aged two to four is higher among low-income households (In 2010, the percentage of obese children aged two to four was 14.4 percent compared with 12.1 percent of all U.S. children aged two to five). Fortunately, there are ways that WIC can help. One recommendation that rang loud and clear from the WIC community was for an increase in the cash value voucher (CVV) for purchasing fruits and vegetables and the option to substitute items like juice and pureed baby food with fresh, frozen or canned fruits and vegetables. Currently, women and infants may receive up to $10 of CVV per month, while children ages one to four only receive $6 per month.
When five panelists from various state WIC agencies were asked which food items could be cut from the food program while still meeting the needs of participants, they were unanimous in their support for removing juice and jarred baby foods, backed up by data of low redemption of these items in their states (Check out minutes 12 to 22 of this video). One WIC health educator emphasized that individuals she hears from are calling for the option to purchase more fruits and vegetables instead of more processed items. The California WIC Association Executive Director urged Board members to listen to the request for more fruits and vegetables and to take advantage of a time when there is such a large focus on the prevention of chronic diseases.
Of course these comments were equally balanced by statements from the juice industry on Day 2 defending the role that 100% juice plays in children’s diets and downplaying moms’ interest in fresh fruits and vegetables.
Note that the American Academy of Pediatrics recommends that juice not be given to infants under 6 months and be given in limited amounts to young children, acknowledging that whole fruit offers the advantages of fiber and nutrients that are lacking in fruit juice. A single serving of juice for a one year old child may contain 13 to 15 grams (roughly 3 to 4 teaspoons) of sugar. This means that one juice drink for a two year old makes up more than half of the child’s recommended 25g of daily total sugar, without providing fiber to slow absorption. Graphic: AAP
Using science to improve children’s health
The Institute of Medicine will be finalizing their recommendations report later this year, and if they rely on the scientific evidence associating whole fruit and vegetable consumption with more positive health outcomes for women and children, their recommendations and hopefully USDA’s revisions, in turn, will help to give all participants the choices they deserve for healthy food. More access to fruits and vegetables in WIC will certainly be a step in the right direction for healthier children and a healthier America by 2030. Driverless cars or not.