5 12 May 21, 1986 HOLDING HANDS AGAINST HUNGER HOW AMERICANS ARE BEING CONNED INTRODUCTION Americans will join hands across th e continent this weekend to draw attention to what the sponsors of the event refer to as the problem of llmillionsvl going hungry in this country. It has been suggested that there may be as many as 20 million "hungryll Americans.

The organizers of Hands A cross America have even claimed on network television that "there is widespread hunger and famine in America.Il There are no facts to substantiate this assertion To the contrary, in the late 1970s scientific studies reported that hunger and malnutrition b ecause of lack of income were not a problem in the U.S.; only isolated cases of it remained. Since then, federal spending on food programs has gone up, not down of the poverty population is receiving food stamps today than ever before.

Supplementary privat e-sector food assistance also is expanding rapidly. And food costs comprise a smaller proportipn of personal income than five years ago, while per capita caloric consumption is UP A greater proportion Indeed, one in ten Americans is a food stamp recipient So what would explain rising hunger? Nothing. The truth is that there is no reason to believe the problem is any worse now than it was in the late 19708, and the likelihood is that it has improved.

Moreover, the degree of hunger in the U.S. is comparative ly tiny, and persistent hunger is related more to dietary ignorance than to lack of federal assistance. The perception of widespread hunger is rooted in subjective, anecdotal impression, based on isolated and unrepresentative cases.

The methodologies of t he much publicized studies that purported to IlfindlI 20 million hungry Americans and to identify 150 "Hunger Countiesll have been soundly discredited. Other studies, also given significant publicity, are based on equally questionable assumptions and shak y methodologies is worsening, for example, was based on 1976-1980 nutritional data.

Political reports, such as that of the Conference of Mayors frequently draw conclusions that the ambiguous and incomplete data presented cannot justify Field work" frequent ly consists of going to people's homes and looking in their refrigerators. When refrigerators are empty or near empty, individuals are deemed hungry even when they themselves deny it and there is no physical evidence of malnutrition. And even though it is clear that many of the poor really do have too little food, studies also show that many food stamp recipients do not spend all their incremental income solely on food.

There is absolutely no credible evidence that hunger in America is either widespread or on the rise One claim that the plight of the rural poor At the same time, there is no question that intractable pockets of poverty do remain It is equally true that for many millions, the problem of providing adequate nutrition for their families is a da i ly concern. These problems should be addressed by the community and all levels of government. For Washington's part, there are several steps that could be taken to improve federal efforts to alleviate the misery of those who find themselves unable to acqu i re sufficient food one thing, Washington should improve the collection and dissemination of relevant nutritional data so that the nutritional status of the general population, including the poor, is not a matter of wild speculation. For another, Congress s hould continue to reform food assistance programs to ensure better targeting and use of available resources. And lawmakers should step up educational efforts on proper nutrition by coordinating the efforts of the relevant public and private health and edu cational organizations For THE MEANING OF HUNGER IN AMERICA Huncrer or Malnutrition?

Malnutrition is a clinical state easily measured by physicians.

Hunger, on the other hand is a subjective impression, which can be measured only by the person actually experiencing it. While this may seem patently obvious, the distinction is important, because different people understand different things by the word l l hunger.Il This complicates policy making on the issue feeling of hunger itself that is the proper focus of policy, because that feeling is experienced voluntarily by millions of dieting Americans every day. It is the association of hunger and poverty or t h e involuntary experience of prolonged hunger leading to malnutrition that should be of concern It is obviously not the This means that the strictly relevant policy questions are: What is the extent of malnutrition and health-threatening involuntary 2hunge r in the U.S.? To what degree is such insufficient nutrition a function of income? What is the government doing to alleviate such hunger and what more could it be doing? And what are the limits of government intervention in terms of improving the nutrition of the poor?

Nutrition and Income A 1977 federal report on the status of children noted that II adequacy of nutrition in the United States is not primarily a problem of low income: true malnutrition is virtually nonexistent in this country. However, poor nutrition and poor nutritional habits are found in all income groups, and, over the years, have become perhaps typical for most segments of our society.18 The report concluded by noting that ll...good nutrition and dtet are ultimately a family matter," de pendent on family choice.

This conclusion is consistent with the independent analysis of data from the federal Ten State Nutrition Survey conducted in 1968-1970 before the massive federal involvement in food programs.

Economists Dov Chernichovsky and Doug las Coate looked specifically at the effect of diet on children's growth in.low-income households, and came to the conclusion that, whatever else such families might have sacrificed, they generally provided adequate amounts of protein and calories for the ir children, based on indicators of physical growth.

Moreover, they found no significant statistical. relationship between income and food intake. Chernichovsky and Coate noted that known inadequacies in iron, vitamin A,'and vitamin C in low-income childre n might bf the result more of lack of nutritional information than of income. In fact, low-income households generally provided far more than the recommended levels of protein to their children, even though it is a relatively high-priced nutrient.

The U.S. Department of Agriculture (USDA) has conducted dietary I surveys for decades, known as the Household Food Consumption Survey.

These surveys show that poor people are more 1ikely.to have poor diets than'are higher income groups, but that poor nutrition i s not.simply a function of income and most of the poor manage to feed'themselves adequately I 1. U.S. Department of Health, Education, and Welfare, Administration for Children, Youth and Families, The Status of Children, 1977, 1978, pp. 89-91 2. Dov Chern i chovsky and Douglas Coate The choice of diet for young children and its relation to children's growth," Journal of Human Resources 15, Spring 1980, pp. 255-263 3USDA maintains that "diets of individuals are as good or better nutritionally now than in 1977 . ll' Ind$ed, in some respects there are indications that diets are improving. For instance, a comparison of the nutritional status of preschool children in an urban poverty area showed nutritional improvement over the period 197701983, in spite of the fact that family incomes declined over the same period.

DEVELOPING THE MYTH OF INCREASING HUNGER Despite the data, hunger--together with homelessness--has been attracting attention, mainly because of the efforts of such groups as the self-appointed Physician Task Force on Hunaer in America.

Despite annual federal expenditures of 18.6 billion on food programs alone, this group claims that hunger is directly "the result of federal government policies 116 Such statements, however, do not rest on serious studies a dhering to scientific standards, but on analyses with flawed methodology and conclusions not supported by the data published in 1985 by the Harvard University School of Public Health which concluded that there are at least 20 million hungry Americans--ind i viduals who do not have sufficient income to buy an adequate diet. Understandably, this shocking statistic was reported by the press around the world. The trouble is that the statistic bears no relation to fact surveys available to any analyst, which find that the majority of the poor have perfectly adequate diets, and that many nonpoor have inadequate ones.

The clear implication in the study was that the hunger I1findingsl1 were based on the field work of the physicians on the task force, many of whom had participated in a similar field study in the late 1970s Typical is the Physician Task Force's Hunaer in America The study simply ignored the dietary 3. USDA, Office of the Assistant Secretary, Food and Consumer Services, Memorandum "USDA Monitors Dietary Status of Americans 1986 4 bid 5. Paul Zee, M.D., Ph.D., Marina DeLeon, MD Paula Roberson, Ph.D., Chen-Hsin Chen Ph.D Nutritional Improvement of Poor Urban Preschool Children, A 1983-1 977 Comparison,"

Journal of the American Medical Association, June 14, 1985, Vol. 253, No. 22, pp 3269-3272 6. Hunaer in America. The Growing EDidexniG Harvard University, School of Public Health 1985, pp. xiii and 5 4- .I But field work had nothing to do with number of supposedly hungry Americans. Dr. Larry Brown, the repo r t's principal author, simply subtracted food stamp recipients from the total poverty population in 1983 and added to that an arbitrary number of food stamp recipients deemed to have an insufficient diet was done on the dubious and unproved assumption that anyone below the official poverty line, but not on food stamps, must go hungry and that the food stamp allotment itself is inadequate for many he method used to derive the This That is shoddy scholarship, and it is dishonest. Using exactly the same method o logy in 1979, for example, would7result in the findingI8 that 18 million were hungry that year. Yet the report contrasts the early 1980s with the late 1970s, noting that the 1977 field team '#had reason to believe that the hunger problem had virtually bee n eliminated; they took professional pleasure in our nation's having eradicated this dreadful pr~blern It would seem that the physicians might have noticed 18 million "hungry" people then, if 20 million are so evident now.

In short, Huncrer in America is a tract that rails against inhumane bureaucracies, analyzes trends in unemployment and poverty draws analogies between today's economic conditions and the Great Depression, and makes frequent references to the "mean-spirited political climate created by th e Reagan Administration. But it fails to establish any cause-and-effect relationships between present economic policies and trends and the Task Force's suppose-d subject of study-hunger and malnutrition.

T he Task Force's most recent effort, Hunaer Counties 1986 is similarly flawed purporting to determine where in America hunger is most prevalent. Once again, medical diagnosis was derived not from on-the-spot investigations and field studies but from econom ic data.

The economic data, moreover, were not even relevant. When reporters travelled to the counties identified by the report as America's hungriest, they by and large found no evidence of hunger. More significant, a review by the nonpartisan General Acc punting Office of the report's's methodology concluded that 'Ithe study's overall methodological limitations are such as to cast general doubt on the I I 9 7. See S. Anna Kondratas, "Is There a Hunger Epidemic?" The Washinvton Times April 17 1985 8..Hun~e r in America, p. 1 9. Physician Task Force on Hunger in America, HunPer Counties 19

86. The Distribution of America's Hiph-Risk Arexi, Harvard University School of Public Health, January, 1986 5-study's results these methodological issues severely damage t he credibility of the results of Hunaer Counties 1986 do Other studies purportedly documenting hunger in America today suffer from similar limitations. For instance, a year-long study culminating in a 146-page report on the nutrihional status of the rural poor, Risina Povertv. Declinina Health, claims to have found Inongoing deterioration of the nutritional status of the rural poor as well as growing gaps between their status and that of the rest of the nation.t1 Moreover, says the study, "federal aid to r u ral Americans is shrinking. The result is a state of severely compromised nutritional status in rural America that grows worse While the analysts use poverty data from 1983, they misleadingly combine it with 1976-1980 nutritional data from the Second Nati o nal Health and Nutrition Examination Survey ANES 11), conducted by the National Center for Health Statistics. Moreover, they confuse tlrural,ll urban II llnonmetropolitan,:ll and llmetropolitanll categories to .draw completely invalid conclusions about po v erty rates bases are mismatched throughout the study conclusions can be supported by the data presented Many other data Few of the report's The United States Conference of Mayors report, "The Status of Hunger in Cities" (April 1985), is similarly flawed. Its conclusions are based on surveys of their own urban food program directors. Even if those surveyed could put self-interest entirely aside, the survey provides useless data, which do not support its sweeping conclusions.

Example: the report presumes tha t an increase in the number of emergency food assistance facilities means that hunger is rising it could mean just the opposite--that there is less hunger previously hungry people have access to food they did not formerly have, hunger then is falling. Nor can hunger be calculated from so-called turnaway data, the number of those seeking food who were turned awayt1 from food distribution outlets. If a turnaway, for example, goes to another pantry or soup kitchen and gets food, his need is not llunmet.ll Yet he is, in effect, double-counted in gauging demand in the manner that the mayors measured it.

Sometimes the self-interest of local officials and groups pleading on behalf of Inthe hungry" is transparent A New York Times story described how one group assai led New York City school officials for Ildiscouragingll students from participating in school meal programs by placing in their way llobstacles such as limited access to lunchrooms and a lack of publicity about the programs But If Complained 10. U.S. Gene r al Accounting Office, Hunaer Counties. Methodolopical Review of a ReDort bv the Phvsician Task Force on Hunger, March 1986, GAO/PEMD-86-7BR 11. Jeffrey Shotland, Rising Povertv. Declining Health: the Nutritional Status of the Rural Poor, a report by Publi c Voice for Food and Health Policy, Washington, D.C February 1986 12. Ibid, pp. 111 and 1 6the author of the group's report: "That $50 hillion [in potential federal reimbursements if all eligible students participated translates into food that is not bough t locally and jobs that are not there for local residents As such, it is a loss to the city's economy Ills In other words, the students' nutritional needs were not the crucial factor. For the report's author, the purpose of federal food programs is to prop up an ailing city's economy.

There are dozens of such studies. And since officials lawmakers, and the press rarely have either the background or the time to distinguish between serious work and flawed advocacy projects, the myth of worsening hunger flouri shes. These studies, tragically, may discredit sincere and honest advocates of the poor, making the real problems of the poor more difficult to solve IS WASHINGTON TO BLAME?

The numbers game is only one part of the hunger myth part asserts that changes in federal food policy since the late 1970s are largely responsible for the alleged but undocumented increase in hunger The second An examination of the facts refutes this.

In fiscal 1981, the last budget year of the Carter administration, federal spending on food programs tgtaled $15;6 billion. By 1984, this had risen to $18.6 billion This year over 19 billion will be spent.on federal nutrition programs of food stamp recipients, meanwhile, has climbed from 14.4 million in 1978 to 20.6 million in 1981 to ap proximately 21 million last year.

There is little indication that recent policy changes have significantly affected the hunger picture A comprehensive two-volume study by scholars at the Urban Institute, The Effects of Leaislative Chancres in 1981 and 1982 on the Food Stamx, Procrram which studied month-by-month caseloads and benefit levels over a 13-year period, and adjusted the figures for economic conditions and demographic characteristics, concluded that "the legislation of 1981-82 did not The number 1 3 . Larry Rohter Students Spurn Meal Programs, Group Asserts," The New York Times March 7, 1986 14. Congressional Research Service, Cash and Noncash Benefits for Persons with Limited Income: Eliaibilitv Rules. ReciDient and ExDenditure Data, 1984 and 1985 e d itions, Vee Burke, compiler 15. Volumes I and 11, Final ReDort to Conpress, Prepared by The Urban Institute, 2100 M Street, N.W., Washington D.C. 20037, For the Office of Analysis and Evaluation, Food and Nutrition Service, U.S. Department of Agriculture, May 1985 7-have as large an impact on recipients'as previously th~ught Caseload reductions because of eligibility changes amounted to 250,000 to 500,000 at most, rather than the I8mill.ionst1 previously projected budget savings thus were also much lower t han anticipated).

Further, "the composition of the caseload did not change as a result of the legislation,Il and "the average incomes of food stamp recipients were virtually unchanged over the period during which the legislation was implemented.I1 Economic analyst Warren Brookes points out that the Urban Institute study Ilalso confirmed the fact that since 1978, constant dollar benefits per household had risen 18 percent, while the actual percentage of the poverty population receiving food stamps had risen from 49 percent to 59 percent, because of greater targetting wiFp 95 percent now going to poverty-level, up from 83 percent in 1978 So if it is assumed, as it should be, that those below the poverty line are needier than those above it, the Reagan Adminis t rationls policies actually seem to be doing more to alleviate hunger than previous efforts. Indeed, in the medical study of poor urban preschool children cited earlier, which found nutritiona.1 improvement even as family incomes declined from 1977-83,"the authors attributed the improvement to federal food assistance. This study also provides evidence, as noted in a Journal of the American Medical Association editorial, that simply providing food does not prevent malnutrition, that personal nutrition practi c es are critical, and that Veduction of chronic hunger is not the sole responsibility of the federal government. Ill8 ARE PRESENT EFFORTS ADEQUATE Advocates of expanded federal food programs not only overestimate But even this the amount of income-related h unger but also insist that anyone eligible for food aid must surely be hungry without it is refuted by dietary surveys showing that there are many poor people with perfectly adequate diets. It is one thing if hungry people are denied food program benefits , but quite another if people choose not to participate because of their own evaluation of their needs 16. Ibid, Vol. 1, pp. 2-3 and 15 17. Warren T. Brookes Urban Institute Study Debunks Harvard's 'Hunger-Hype Heritage Features Syndicate, February 6, 1986 18. Editorial .comment by Effie

0. Ellis, M.D., Journal of the American Medical Association, June 14, 1985, p. 3299 8- There is considerable evidence that many food stamp participants do not spend all their incremental income on food in any case. In this sense, federal food programs simply increase the income of welfare recipients and replace food that people would have bought for themselves. For example, a Congressional Budget Office study found that a dollar's worth of food stamps only increased food p u rchases by 57 cents. An Agriculture Department study of Supplemental Security Income recipients found each dollar 06 food stamp payments only increased food purchases by 14 cents. The Chernichovsky and Coate study cited earlier also found indications "tha t the increase in real income resulting from food stamps is devoted to consumption of other goods rather than food I2 These studies raise the question of whether simple expansion of eligibility and benefits in current food programs will actually improve th e diets of low-income Americans. The only way to guarantee everyone an adequate diet would be to provide the actual foodstuffs and then force recipients to eat them. This is obviously not a realistic policy choice.

Accusations also appear from time to time that the food stamp allotment itself is unrealistically low, set to enable only the wisest and most frugal shoppers to buy the necessary balanced diet inaccurate. If adequate nutrition were the only consideration, it would be possible to devise far lower budgets than the so-called Thrifty Food Plan, on which the food s& allotment is based, and still provide all necessary nutrients. In fact, the plan is based on the actual consumption patterns of food-stamp eligible households so as to be 'Ileast disrup t ivell to actual food practices This is The plan is only modified to the extent that higher than necessary consumption of high-priced items, such as meat, is reduced in favor of less expensive acceptable substitutes including grain products and dry beans c o nsiderations. Thus, the 1983 revision purposefully limits the intake of fat, cholesterol, caloric sweeteners, and sodium. The Thrifty Food Plan provides not only an adequate diet but a healthier diet than the average American seems to prefer reflecting pr ices in stores where food stamp recipients actually It is also modified for nutritional The plan is also costed out on the basis of consumption patterns 19. Cited in James Bovard Feeding Everybody: How Federal Food Programs Grew and Grew,"

Policv Review, F all 1983, pp. 42-51 20. OD. cit.. p.260 21. U.S. Department of Agriculture, Human Nutrition Information Service, Consumer Nutrition Division The Thrifty Food Plan, 1983," Hyattsville, MD, August, 1983, p. 13 9shop. The USDA organizes "field shopping trips 1 ! in various cities from time to time to make sure that the proper foods can be bought within the budget framework. Allowances are even made for the discarding of edible food. The fact that most food stamp recipients exceed the food stamp budget because o f personal preferences does not mean allotments are inadequate. The purpose of food programs is to alleviate hunger and provide sufficient income for an adequate diet not to guarantee the poor the frequently unwise food choices of the middle class.

POLICY RECOMMENDATIONS Despite the mythology and exaggerations surrounding the hunger issue, policy makers should not be complacent about the plight of the poor, the hungry, the homeless, or any less fortunate American. To ensure sound policy, the federal government should fund annual health and nutrition surveys to produce reliable and current estimates of the nutritional status of all Americans as well as of the poor would help identify the scope of the problem and at-risk groups, as well as changes over time. There is currently no methodology to estimate the degree of hunger and malnutrition in the U.S. Both health and welfare policy makers would benefit from such information. The Food and Nutrition Board of the National Research Council is currently eva luating the possibility of developing such methodologies and studying ways to improve the major food consumption and pertinent health surveys This These efforts should be given high priority.

Washington also should continue seeking ways to be more effectiv e in allocating benefits to those most in need and to those needy who are not. now eligible. For example, in their January 1984 report, the President's Task Force on Food Assistance suggested raising asset limits for food stamp eligibility on the grounds t hat the assets of many newly unemployed and needy households are not readily marketable or that selling them off may constitute an insupportable drain on the household's resources. The Task Force also suggested a nutrition block grant to states to give th e m more discretion in distributing funds among the different federal nutrition programs based on each statels particular needs and economic conditions. In the absence of consensus on the direction of a fundamental reform of the welfare system, these increm e ntal changes in nutrition 'programs to improve local and state flexibility and reach neglected at-risk groups would be a step in the right direction play, a fundamental role in food assistance to the needy a sign of deficiency in the governmental safety n e t, as some have suggested, but a sign of the strength of the American voluntary sector. The federal government should evaluate and continue to help these delivery networks The private sector has also been playing, and should continue to This is not 10 - T h e problem of hunger in America has been vastly exaggerated in recent years its exact extent, the evidence suggests strongly that there is no mass hunger in America and that there has been no major change in the nutritional status of Americans in recent ye ars while there is no credible methodology for determining S. Anna Kondratas Schultz Senior Policy Analyst 11