The American Academy of Pediatrics issued a policy statement on children and food security some months ago. Took me awhile to get to it, but better late than never, I think, because the statement is important for several reasons — and still timely, also for several reasons.
Voice of Authority
First off and most obvious, the AAP has unusual credibility — and in some quarters, influence — as a voice for children’s well-being. It’s the professional association for some 64,000 doctors who provide primary care and specialized services to children and young adults.
It’s nonpartisan, of course, and apparently free from the conflicts of interest that can shape research and policy, including support from corporations who’ll profit more — or less — from nutrition policies, guidelines and the like. (You who’ve been following the debate over school meal nutrition standards know why I mention them.)
Big Picture From Research
The policy statement pulls together findings from reliable research on how food insecurity affects children. Some are familiar to anyone who follows anti-hunger campaigns, even casually — poorer overall health, more hospital stays, high risks of obesity, learning problems, etc.
Others are perhaps less so. For example, the shame kids feel when they see their parents eating less so they can have enough. Also the fear they’ll be labeled “poor” and shunned by their peers.
Feelings like these probably stem from the all-too-common view that poverty reflects a failure of personal responsibility. Perhaps doctors — highly respected folks who’ve surely demonstrated personal responsibility — could lend their weight to a culture shift.
Call to Action
The AAP enjoins pediatricians to advocate for federal and local policies that help ensure food security for all children and their families. It notes specifically sufficient funding for SNAP (the food stamp program) and the Child Nutrition Act programs.
It also calls for advocacy to keep foods offered in these programs “high in nutrient quality,” according to “sound nutrition science.” Respected voices needed here.
Congress has already enabled schools to get temporary waivers from two school meal nutrition requirements — a switch to use of only whole-grain food products and a gradual reduction in the total amount of sodium in the breakfasts and lunches they serve.
Now the Senate Agriculture Committee has completed a revised CNA — one of those bipartisan compromises that gives schools some flexibility on the whole grains and sodium, but not a free pass.
But we may see further compromises in the “high nutrient quality” of the meals schools serve. A bill introduced by one of the Republican members of the House subcommittee responsible for the CNA would go further toward “reducing federal mandates,” as its title proclaims. No caps at all on calories or grains, for example.
So the call is especially timely. But it’s also forward-looking because USDA will presumably review the nutrition standards and related meal plans for daycare facilities, as well as school meals now that we have new Dietary Guidelines for Americans.
At the local level, pediatricians have several advocacy opportunities. They obviously could — and should — discourage schools districts from relaxing their efforts to serve meals as healthful as the current standards require.
They could also encourage more school districts to opt for community eligibility. Schools with relatively high percents of poor and near-poor students could then serve free meals to all, regardless of their family’s income.
This, among other things, has increased the number of students served two full, well-balanced meals a day — probably in part by removing fear of the free-meal stigma.
Broader Approach to Children’s Healthcare
The AAP statement reaches furthest, I think, in its recommendations for incorporating food insecurity into pediatrics training and practices. Children’s doctors would then not only understand how it affects their patients’ health, but actually do something about it.
The AAP recommends a routine screening, using a pared-down version of the survey used for USDA’s annual food security reports.
Pediatricians, like other doctors, need the information in part to understand what the source of their patients’ problems might be — anemia, for example, chronic anxiety, both overweight and underweight.
They also need it to make sure parents can follow instructions. Pills should be taken three times a day with food. Well, will there be food in the house?
Beyond this, however, the AAP wants pediatricians to become familiar with food assistance sources in the community so they can make referrals. It envisions the screening and readiness to link families in need as a regular part of medical education.
And beyond this, it alludes to specialized training that has led to partnerships between pediatrics clinics and both social workers and pro bono attorneys.
Attorneys supplied by law firms and legal aid societies have helped parents resolve diverse problems that directly and indirectly affect their children’s health, e.g., loss of benefits they’re entitled too, substandard housing, unmet needs for special education.
This broader approach to children’s health recalls the nonprofit I’ve blogged on that partners with hospitals and clinics to secure and fill “prescriptions” for more healthful and secure living conditions.
The AAP’s recommendation could, in the best of worlds, expand the project model to a major sector of our healthcare system, shifting its focus from care to health, as the project’s founder intends.
There’d be ripple effects beyond the immediate health of children. Better health and better economic prospects for them as adults. Better health for their parents too.
Still not the be-all and end-all. The food insecurity pediatricians would identify, the further needs social workers would surface and make referrals for, the problems attorneys would tackle are all rooted in poverty — the “causes of causes,” as we’re told epidemiologists refer to it.
We’re not going to cure poverty by ensuring that malnourished children have enough of the right kinds of things to eat and a warm, mold-free place to live. But having many thousands more widely respected, vocal champions could make a difference.