.LES E................. ****UGH LESVE TANTS · HR 3698 is sponsored by Rep C(liff Stearns (, Fla) and has 17 cosponsors. According to Stearns, this bill would guarantee unli- versal coverage and establish "a minimum policy covering basic health services such as physician services; inpatient, outpatient, and emergency services; and prescription drugs and [would setl limits on deductibles and out-of-pocket expenses." The bill fea- tures "medical savings accounts" and tax credits. The bill would also "permit the formation of purchasing groups, such as unions, business associations, and churches, as an added cost control incentive." In support of his bill, Stearns noted, "Federal employ- ees can choose between more than 35 plans, all of which offer a menu of coverage choices at competitive premiums. That's the kind of choice and purchasing power we want all Americans to have." Similar legislation was introduced in the Senate as S 1743. Senate Bills for Health Care Reform . S 1579, The Managed Competition Act of 1993, is sponsored by Sen John Breaux (D, La) and Sen Dave Durenberger (R, Minn) and has three cosponsors. Similar legislation was introduced in the House as HR 3222 (see summary under House bills). S 1743 is sponsored by Sen Don Nickles (R, Okla) and has 24 cosponsors. Similar legislation was introduced in the House as HR 3698 (see summary under House bills). a S 491, The American Health Security Act, is sponsored by Sen Paul Wellstone (D, Minn) and has four cosponsors. This legisla- tion was also introduced in the House as HR 1200 (see summary under House bills). · S 1770, The Health Equity and Access Reform Today Act of 1993, is sponsored by Sen John Chafee (R, RI) and has 19 cosponsors. This bill, which was drafted primarily by the Senate Republican Health Care Task Force, has the support of moderate Republicans, including Sen Robert Dole (R, Kan). S 1770 would establish a National Benefits Conunission that would set a stan- dard benefits package. Similar legislation was introduced in the House as HR 3704. Sen Phil (ramm (R, Tex) is also expected to introduce a bill later this winter. Provisions of Gramrn's proposal include "reward- ing preventive medicine and healthy lifestyles, reforrring Medic- aid, and expanding choices in Medicare." GRASSROOTS EFFORTS ARE CRUCIAL The American Dietetic Association (ADA) is encouraged that nutrition is recognized in the legislative language of Clinton's Health Security Act and hopeful that continuing discussion of all the legislative proposals for health care reform will provide opportunities to promote inclusion of medical nutrition therapies in the final legislation. The grassroots lobbying efforts of all members of the Associa- tion will be crucial during the coming months. ADA plans to contact every member of Congress to explain the importance of including medical nutrition therapies as a covered basic benefit in any health care plan that comes up for a vote. Contact your state legislative network coordinator to ask how you ( an participate. Members who would like to purchase a copy of the Health Security Act (publication no. S/N 040-00(-0(1634-6) can order the 1,336-page document by calling the Superintendent of Docu- ments at 202/783-3238. Telephone orders require Visa or MasterCard payment. Cost is $45. ADA Srecomeuds that school feeding real s fellow te US Dietary 6lee: TbIy bfere the UDA he National School Lunch Act of 1946 (PL 396) is the cornerstone of today's school feeding programs. Section 2 of the Act declares that it is "a measure of national security to safeguard the health and well-being of the nation's children and to encourage... consumption of nutritious agricultural commodities and other food." In recent years, however, the UJS Department of Agriculture (USDA) (which administers the government's school feeding programs) has come under fire from health and consumer groups that charged that school meals often provide too much fat and sodium and too few fruits and vegetables. Under the direction of Secretary of Agriculture Mike Espy, USDA is gradually refocusing attention and resources on promot- ing nutrition. In recent remarks about the importance of the school feeding programs, Espy said, "A good lunch or break- fast...is just as important as a good schoolbook. You can't under- stand what is in a book.. unless you energize the brain." This fall, USDA invited recommendations for improving the nutritional quality of school meals. Public hearings were held at four locations across the United States. Yvonne Bronner, ScD, RD, presented both oral and written testimony on behalf of The American Dietetic Association (ADA) at the December 7, 1993, hearing in Washington, DC. Bronner is an assistant professor in the Department of Maternal and Child Health at The Johns Hopkins School of Hygiene and Public Health in Baltimore, Md. ADA's recommendations for improving the nutritional quality of school feeding prograns were developed through the collaborative efforts of ADA members with expertise in school nutrition services, pediatrics, public health, research, and hunger and malnutrition. Following are edited excerpts of ADA's testinmorny before Ellen Haas, assistant secretary for food and consumer services at USDA. ADA is here today for one reason. We care about children and( their future. A good education is essential for the fture of our children, and healthful food choices are critical to learning and intellectual performance. ADA applauds the leadership shown by you and Secretary Espy in making nutrition a priority at, USDA. We thank you for helping 26 / JANUARY 1994 VOLUME 94 NUMBER 1
Transcript
.LES E................. ****UGHLESVE TANTS
· HR 3698 is sponsored by Rep C(liff Stearns (, Fla) and has 17cosponsors. According to Stearns, this bill would guarantee unli-versal coverage and establish "a minimum policy covering basichealth services such as physician services; inpatient, outpatient,and emergency services; and prescription drugs and [would setllimits on deductibles and out-of-pocket expenses." The bill fea-tures "medical savings accounts" and tax credits. The bill wouldalso "permit the formation of purchasing groups, such as unions,business associations, and churches, as an added cost controlincentive." In support of his bill, Stearns noted, "Federal employ-ees can choose between more than 35 plans, all of which offer amenu of coverage choices at competitive premiums. That's thekind of choice and purchasing power we want all Americans tohave." Similar legislation was introduced in the Senate as S 1743.
Senate Bills for Health Care Reform. S 1579, The Managed Competition Act of 1993, is sponsored bySen John Breaux (D, La) and Sen Dave Durenberger (R, Minn)and has three cosponsors. Similar legislation was introduced inthe House as HR 3222 (see summary under House bills).
S 1743 is sponsored by Sen Don Nickles (R, Okla) and has 24cosponsors. Similar legislation was introduced in the House as HR3698 (see summary under House bills).a S 491, The American Health Security Act, is sponsored by SenPaul Wellstone (D, Minn) and has four cosponsors. This legisla-tion was also introduced in the House as HR 1200 (see summaryunder House bills).· S 1770, The Health Equity and Access Reform Today Act of1993, is sponsored by Sen John Chafee (R, RI) and has 19
cosponsors. This bill, which was drafted primarily by the SenateRepublican Health Care Task Force, has the support of moderateRepublicans, including Sen Robert Dole (R, Kan). S 1770 wouldestablish a National Benefits Conunission that would set a stan-dard benefits package. Similar legislation was introduced in theHouse as HR 3704.
Sen Phil (ramm (R, Tex) is also expected to introduce a billlater this winter. Provisions of Gramrn's proposal include "reward-ing preventive medicine and healthy lifestyles, reforrring Medic-aid, and expanding choices in Medicare."
GRASSROOTS EFFORTS ARE CRUCIALThe American Dietetic Association (ADA) is encouraged thatnutrition is recognized in the legislative language of Clinton'sHealth Security Act and hopeful that continuing discussion of allthe legislative proposals for health care reform will provideopportunities to promote inclusion of medical nutrition therapiesin the final legislation.
The grassroots lobbying efforts of all members of the Associa-tion will be crucial during the coming months. ADA plans tocontact every member of Congress to explain the importance ofincluding medical nutrition therapies as a covered basic benefit inany health care plan that comes up for a vote. Contact your statelegislative network coordinator to ask how you ( an participate.
Members who would like to purchase a copy of the HealthSecurity Act (publication no. S/N 040-00(-0(1634-6) can order the1,336-page document by calling the Superintendent of Docu-ments at 202/783-3238. Telephone orders require Visa orMasterCard payment. Cost is $45.
ADA Srecomeuds that school feeding real s fellowte US Dietary 6lee: TbIy bfere the UDA
he National School Lunch Act of 1946 (PL 396) is thecornerstone of today's school feeding programs. Section 2 ofthe Act declares that it is "a measure of national security to
safeguard the health and well-being of the nation's children and toencourage... consumption of nutritious agricultural commoditiesand other food." In recent years, however, the UJS Department ofAgriculture (USDA) (which administers the government's schoolfeeding programs) has come under fire from health and consumergroups that charged that school meals often provide too much fatand sodium and too few fruits and vegetables.
Under the direction of Secretary of Agriculture Mike Espy,USDA is gradually refocusing attention and resources on promot-ing nutrition. In recent remarks about the importance of theschool feeding programs, Espy said, "A good lunch or break-fast...is just as important as a good schoolbook. You can't under-stand what is in a book.. unless you energize the brain."
This fall, USDA invited recommendations for improving thenutritional quality of school meals. Public hearings were held atfour locations across the United States.
Yvonne Bronner, ScD, RD, presented both oral and writtentestimony on behalf of The American Dietetic Association (ADA)at the December 7, 1993, hearing in Washington, DC. Bronner isan assistant professor in the Department of Maternal and ChildHealth at The Johns Hopkins School of Hygiene and Public Healthin Baltimore, Md. ADA's recommendations for improving thenutritional quality of school feeding prograns were developedthrough the collaborative efforts of ADA members with expertisein school nutrition services, pediatrics, public health, research,and hunger and malnutrition.
Following are edited excerpts of ADA's testinmorny before EllenHaas, assistant secretary for food and consumer services at USDA.
ADA is here today for one reason. We care about children and(their future. A good education is essential for the fture of ourchildren, and healthful food choices are critical to learning andintellectual performance.
ADA applauds the leadership shown by you and Secretary Espyin making nutrition a priority at, USDA. We thank you for helping
26 / JANUARY 1994 VOLUME 94 NUMBER 1
focus public attention on the importance of good child nutritionin schools and its link to intellectual performance and futurehealth.
School meals offer an incredible opportunity to improve thenutrition of the nation's schoolchildren. Not only can nutritiousfoods be fun to eat, but nutrition education must start with veryyoung children and be consistently reinforced through highschool in a creative, entertaining curriculum that links learning inclassrooms to application in school cafeterias.
ADA endorses applying the US Dietary Guidelines to schoolfeeding programs. We supported the US Dietary Guidelines whenthey were released and recently granted one of our Association'shighest honors to USDA's educational tool, the Food GuidePyramid.
The link between diet and disease is becoming clearer as themedical science of nutrition advances. Unfortunately, little basicresearch on the direct link between diet and development ofdisease in later life has been conducted among children. Evenwhat we know about the link between one major adult disease -osteoporosis - and child nutrition was the outcome of researchinitiated on adults. Current research indicates that this diseaseshould not concern only women; osteoporosis is now beginning toshow increasing frequency among men. School meals and prac-tices can play a major role in preventing osteoporosis. Becausebasic bone mass and density are built during childhood andadolescence, it is essential that school meals provide a balanceddiet with adequate amounts of energy, protein, and calcium.
Offering meals that are lower in fat and sodium and that featuremore fresh vegetables and fruits is an important first step towardmeasurable improvements in school meals. But to improve thenutritional quality of children's diets, children must want to eatthe healthful food that is provided. This is the greatest challengefacing us. If meals reflecting the US Dietary Guidelines areunpalatable, children won't eat them.
EXPAND NUTRITION EDUCATIONTo bring about measurable changes in children's diets, ADA urgesUSDA to establish a high-profile and exciting national nutritioneducation initiative. Food consumption choices are usually shapedearly in life, and schools should be learning laboratories fornutrition from kindergarten onwards. Innovative school nutritioneducation programs that are already in place have demonstratedthat students will increase consumption of school meals whennutrition taught in the classroom is coordinated with what isserved in the lunchroom.
For nutrition education to be truly successful, school adminis-trators and teachers must work with nutrition professionals toimplement classroom-lunchroomprogramsjointly. Teachers mustrecognize that children who eat a nutritious breakfast and lunchare more receptive to learning, make fewer mistakes, are morecreative, and have more energy.
Model nutrition education curricula must be developed, pro-moted, and accredited nationwide to make nutrition outreacheasy and accessible for teachers. ADA urges USDA to work inpartnership with the Department of Education to make nutritioneducation a priority and to integrate nutrition into the nation'seducational curriculum. Teachers should also be granted continu-ing education credits for taking courses in nutrition that aredeveloped in conjunction with the national nutrition educationinitiative.
ADA is concerned that many teachers do not currently viewnutrition education as a priority, given the substantial pressuresthey face preparing children to meet rigorous testing standards innonnutrition subjects. This perception must be overcome byproviding good nutrition education using current technology suchas videos and computers. Funds are also needed to develop and
provide fun, colorful, and interactive teaching supplies to accom-pany model curricula so that the message of good nutritionreaches the children.
EXPAND ACCESS TO FOOD SOURCESSchools must have access to food products of reliable quality thatare consistent with recommendations outlined in the US DietaryGuidelines. At present, when schools find an appropriate UJSDA-donated food that they like using, such as USDA's low-fat harm-burger, they often cannot consistently obtain it. Schools fre-quently do not know which USDA-donated conmmodities will beavailable at the time food is delivered, which makes menu plan-ning difficult.
ADA recognizes that USDA's commodity donation programplays an important role in providing many healthful, appropriatefoods used in school feeding, such as flour, raisins, and oil (usedin moderate amounts). Nevertheless, many commnunodity-donatedfoods are inconsistent with recommendations in the US DietaryGuidelines. For example, the french fries provided often have ahigher fat content than the french fries available at fast-foodrestaurants; the chicken comes with the skin on the meat; and thechicken nuggets are high in fat and sodium. Schools should not berequired to offer specific USDA-donated commodities in theirmeal programs; instead, they should be required to meet efinednutritional standards for the meals they offer.
Cash vs Commodity DonationsAnother way to improve the nutritional quality of school meals isto offer more quality fresh fruits and vegetables through IJSDA'scommodity donation program. If fresh fruits and vegetablescannot be delivered effectively, a program that would expandeligibility for cash in lieu of commodities should be adopted toenable schools to purchase fresh fruits and vegetables. Schools inextremely rural areas, where fresh fruits and vegetables are veryexpensive, should certainly be eligible for targeted funding thatwould help them offer more of these commodities. If n ore schoolswere eligible for programs that provide cash in lieu of commodi-ties, they would have the flexibility they need to tailor schoolmenus toward the US Dietary Guidelines.
Low-Fat Recipes and Prepared FoodsThere is tremendous need for recipes and prepared foods that arelower in fat and sodium than those currently used by schoolfeeding programs. USDA can be a catalyst for organizing anddisseminating new tested recipes from the variety of innovativenutrition programs that already exist, such as the L UNCHPOWER!Program. ADA urges food manufacturers and distributors that sellprepared foods to schools to modify their vendor products andother foods to meet the goals of the US Dietary Guidelines.Aggressive education and outreach to the food industry will helpincrease their awareness of their role in improving the nutritionalquality of school feeding programs.
At present, even prepared foods that are labeled "CN" (ie,"child nutrition"), which means the food is designated for schoolfeeding programs, are not necessarily nutritious meal choices.The current CN label designation indicates only that a food meetsthe requirements for one of the meal-pattern components. Forexample, a pizza slice may meet one bread, one meat, and part ofa vegetable from the meal pattern. Rather than always represent-ing a highly nutritious food, a CN-labeled food can be the cheapestfood of its type and be high in fat and sodium
EXPAND NUTRITION TRAININGBoth teachers and school foodservice staff need greater knowl-edge of sound principles of nutrition. Many school foodservicepersonnel (who typically are not trained in nut rition or dietetics)
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purchase high-fat, high-sodium, CN-labeled foods thinking thatthese foods are appropriate for school meals. But who can blamean assistant principal who is responsible for a school's menuplanning and food purchasing for making such a decision? He orshe follows the CN label but lacks the proper training to makeeducated choices that are critical to improving the nutritionalquality of school meals. As another example, a cook, who is well-meaning but has little or no nutrition training, may respond to thefinancial pressures facing schools today by buying the cheapestfoods, which also tend to be high in fat and sodium.
For this reason, ADA strongly recommends that creative andqualified nutrition professionals play an essential role in helpingschool feeding programs meet the US Dietary Guidelines. Nutri-tion science is complicated and technical. School foodservicestaff should work with dietetics professionals to purchase nutri-tious foods for use in school meals, design appropriate menus,and learn techniques for preparing low-fat, low-sodiurn meals.
CONTROL THE SALE OF COMPETITIVE FOODSThe sale of individual food items in snack bars, school stores, andvending machines (called "competitive foods") competes withschool meals for students' appetites, time, and money.
Current federal regulations prohibit the sale of carbonatedbeverages, chewing gum, water ices, and most hard candies inthe foodservice area when school meals are being served. Theregulations do not restrict the sale of chips, noncarbonateddrinks, and most candy bars in the foodservice area or the sale ofany food in other areas of the school building or campus at anytime.
Competitive foods are sold in schools for several reasons. Thesale of these foods can generate revenue for the student body orfor a special project. Sometimes their sale raises revenue for basicsupplies such as paint and toilet paper. In fact, several schoolsystems (such as one of the largest school systems in Little Rock,Ark) have left the USDA school feeding programs at the second-ary level so that they can sell competitive foods and earn money.Supporters of the sale of competitive foods say that financiallysound upper-level schools help support the school foodservice ofprimary schools that participate in USDA feeding programs.
In view of the financial problems facing many school districts,ADA urges state legislatures and local boards of education torecognize that the availability of competitive foods poses threemajor problems. First, it diverts income essential to the financialwell-being of the school meal program. Second, it encouragesconsumption of partial meals. Finally, it fosters the erroneousidea that school meals are for needy children only.
ADA would welcome the opportunity to work with USDA andother allied organizations to resolve the issue of competitivefoods.
REDUCE ADMINISTRATIVE PAPERWORKThe current documentation required for school feeding pro-grams encourages "perfect paperwork" rather than "perfectmeals." Frequently, the school foodservice director is too busyreviewing applications for accuracy, collecting data for docu-mentation, or conducting required audits to focus on providinggood nutrition for children. ADA believes that the time andefforts of school foodservice staff would be better spent learningabout and implementing the US Dietary Guidelines in menuplans and food preparation techniques. Federally-mandatedpaperwork could be reduced with the advent of "universal"school meals for children. A universal meals program would helpfocus attention on nutrition and on developing good eating habitsin children.
SIX STEPS FOR IMPROVING NUTRITION IN SCHOOLADA recommends that six issues be addressed to enable schoolfeeding programs to meet the UIS Dietary Guidelines.* Schools should be allowed more flexibility in the types of foodsoffered. ADA recommends that use of nutrient-based menuplanning, which focuses on the nutritional content of foods, beexpanded. Schools should also be allowed to serve foods that theybelieve are appropriate to meet the US Dietary Guidelines.* Schools must have access to reliable sources of food productsthat are consistent with the I JS Dietary Guidelines. Comrnoditydonations are often high in fat and sodium, and delivery times areunpredictable. More fresh fruits and vegetables should be madeavailable, either through the donation program or by expandingprograms that provide cash in lieu of commodities.* USDA should help identify and disseminat e new tested recipesand prepared foods that are lower in fat and sodium than thosecurrently used. ADA urges food manufacturers and distributorswho supply foods to schools to modify their vendor products antdother foods to meet the goals of the IJS Dietary guidelines .· Expanded nutrition training of teacher s anid school foodsericestaff is needed to promote understanding of sound nutrition. ADArecommends that qualified nutrition professionals including registered dietitians, play an essential role in helping school feedingprograms meet the US Dietary Guidelines.* The sale of inappropriate competitive foods in schools should becontrolled. These foods, which are often high in fat, sodium, an(lsugar, compete with nutritious school meals for students' appe-tites, time, anld money.* USDA should reduce the costly and t.ile-(conlsuming adminis-trative paperwork required of schools participating in federalfeeding programs. School foodservice staff could spend more timecreating healthful menus if federally-mandated administrativeburdens were reduce:l.
SUPPORT LOCAL SCHOOL DISTRICTSAs USDA considers how to improve the nutritional quality of thenation's school feeding programs, ADA asks that you and otherkey decision makers realize that school foodservice is a businessand cannot operate at a loss unless federal subsidies are substan-tially increased. Many local school districts are facing seriousfiscal constraints.
For school foodservice to meet, the IS l)ietarv Guidelines,children and adolescents must now be willing to purchase themeals offered or the fiscal viability of the school district, will bethreatened. Every school needs students to pay for their meals if'the school is to continue offering reduced-price or free schoolmeals. If the paying students buy fewer school meals, the nutri-tional meals offered free or at reduced price will be in jeopardy.
We urge I SDA to press forward awith an aggressive, nationwidenutrition education program to teach children that nutritiousfoods are fun and good for them. ADA stands ready to work withyou as USDA develops proposals o illprove the nutritionalquality of the nation's school feeding programs.
Thank you for the opportunity to testify here oday. ·
The allowing persons sen eid oon the advtliso)yj comr ittleethat prepared ADA's testimony regarding national schoolfeeding programs: Linda Crisp, Ellen Fineli, Sae Greig,Nancy Kennon, Janet R. Hunt, Minkie Medora, andPatricia Snyder.
