Feeding the Poor

By Peter H. Rossi

Over the past three decades, federal food assistance programs have grown rapidly. By 1996, the five largest—the Food Stamp Program; the Special Supplemental Nutrition Program for Women, Infants, and Children; the National School Lunch Program; the School Breakfast Program; and the Child and Adult Care Food Program—had a combined federal cost of $36 billion with additional state expenditures of $2 billion. Although those programs are all directed toward improving nutrition, they differ in ways that influence the effectiveness and efficiency of each. This volume uses the findings of empirical research into each program to trace the effects of those differences on how each program functions. It describes each program’s historical origins, goals, and operations and then uses the best available research to assess its effectiveness and importance.

Peter H. Rossi is S. A. Rice Professor Emeritus of Sociology and director emeritus of the Social and Demographic Research Institute at the University of Massachusetts at Amherst. He is a faculty research associate at the Chapin Hall Center for Children.

Overview

Federal food assistance programs were first introduced during the depression in the 1930s but did not become a major element of the federal government’s battle against poverty until the 1960s and 1970s. The largest of the current programs are the Food Stamp Program (FSP); the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); the National School Lunch Program (NSLP); the School Breakfast Program (SBP); and the Child Care Food Program (CCFP). In 1996, the total cost of those five programs was $38 billion, and approximately one in six Americans, or 45 million people, received benefits from one or more of them.

By any measure, food programs are a fundamental part of the social safety net. In 1996, for example, these efforts were larger than the nation’s basic welfare program, Aid to Families with Dependent Children, which had a combined federal and state cost of $23.7 billion and served 12.6 million people. And yet, compared with AFDC, federal food programs received much less attention from policymakers, researchers, and the public. This volume is meant to bring food programs into broader scholarly and public view.

The Food Stamp Program

The Food Stamp Program is the largest of the federal nutrition programs. In fiscal year 1996, it cost more than $26 billion and provided benefits to an average of 26 million persons a month. Its purpose is to help low-income households obtain adequate and nutritious diets by providing food coupons, which can be used only to purchase food. The program is based on the assumption that without food stamps, low-income households skimp on purchasing foods necessary for a nutritious diet so that they can obtain other necessities. To be eligible for the FSP, a household must have a gross monthly income at or below 130 percent of the poverty level. In 1996, the maximum food stamp benefit was $397 a month for a household of four.

Each food stamp dollar increases average household food expenditures by an estimated thirty cents. In contrast, increases in cash income lead to about ten cents in additional food expenditures per dollar.

The major studies of FSP effects on food expenditures are based on the National Food Consumption Survey, a national household sample undertaken in the late 1970s to obtain data on food consumption and expenditures. Analysts examined food expenditures of FSP households against "comparable" households not receiving food stamp benefits. The studies estimated that each additional food stamp dollar increased food expenditures by seventeen to forty-seven cents.

Although food stamps increase food expenditures somewhat, their impact on nutrition is hard to assess because it is difficult to measure actual food consumption, to estimate nutrient levels in food consumed, and to define a nutritionally adequate diet. Some studies show that food stamp participation does increase the availability of nutrients, such as calcium, vitamin C, and protein. The research evidence on the nutritional effects of the FSP does not, however, lead to the firm conclusion that the program improves the nutritional status of recipient households.

Because households use most food stamp benefits to support nonfood expenditures, the program may be regarded as income maintenance. It is the major social welfare program in which benefits are almost entirely conditioned by income. In some states with low AFDC benefit levels, food stamp dollars exceeded welfare payments. Furthermore, food stamps are available to eligible persons of all ages and to households of any size or composition.

The WIC Program

Started in 1972, the Special Supplemental Nutrition Program for Women, Infants, and Children has grown rapidly. In fiscal year 1996, the program cost $3.7 billion and had an average monthly caseload of 7.2 million participants. WIC was established to lower the high incidence of prematurity, fetal deaths, and low birthweights of children born to poor mothers and to counter nutritional deficiencies found among young children in low-income families. The goals of the program are to reduce the incidence and prevalence of nutrition-related disorders of childbirth, infancy, and early childhood, as well as associated medical costs.

WIC attempts to reduce these conditions by providing specific groups with food supplements, as well as nutritional education and referral to health services. Those groups are pregnant, postpartum, and breastfeeding women, infants, and children up to age five who have family incomes at or below 185 percent of the poverty level and are found to be at nutritional risk.

Studies have shown that WIC has a positive effect on pregnancy outcomes. In particular, participation of pregnant women in the program appears to increase birthweights and to reduce infant mortality. Research on WIC is undermined somewhat, however, by weaknesses in the evaluation designs used. Comparison groups, no matter how well matched, differ from WIC participant groups in ways that may be related to nutritional status or food expenditures.

The research evidence on the effectiveness of WIC supplements for infants and children is not strong, although the program appears to have been successful in reducing iron-deficiency anemia among poor children. Evidence also shows that participating children consume greater amounts of such critical nutritional ingredients as iron and zinc. No evidence exists, however, on the health consequences of that increased consumption.

The School Meals Programs

Because the National School Lunch Program and the School Breakfast Program share similar goals and target populations and operate in closely parallel ways, they are reviewed together. Both programs aim to provide access to proper nutrition for elementary and secondary school children and to subsidize lunch and breakfast costs for students from low-income families. The programs are based on the assumption that students from poor families may not be eating breakfasts or lunches of either adequate amounts or proper nutritional value. In fiscal year 1996, the federal component of the NSLP and SBP cost was $5.4 billion and $1.1 billion, respectively.

Both programs function essentially the same way. In participating schools, lunches and breakfasts are provided without charge to students whose family incomes are 130 percent of the poverty level or below. Meals are provided at a reduced price if the family incomes are 131-185 percent of the poverty level. The meal subsidies paid to participating schools amount to about $65 per month for each student who qualifies for a full subsidy and eats lunch and breakfast every day ($42 for students who eat only lunch).

Almost all elementary and secondary schools (92 percent) participate in NSLP. Only about 70 percent of schools, however, participate in SBP. The participation rates for NSLP have not changed much since 1977, while SBP has more than doubled in size and cost in the same period.

A majority of eligible students receive fully or partially subsidized lunches. Of those students qualifying for a fully subsidized lunch, 79 percent participate. Not all eligible students, however, take steps to become qualified. Slightly more than half the eligible students eat subsidized lunches. Qualitative studies indicate that eligible nonparticipants cite poor food quality and participation stigma as major reasons for not eating school meals.

Although widely perceived as a good program, the National School Lunch Program does not appear to improve the nutrient intake of children significantly. The success of NSLP in reaching so large a proportion of America’s schools stands in the way of determi ning the extent to which the program improves dietary status since virtually no nonparticipating schools are available to serve as comparisons.

As for the School Breakfast Program, a minority of eligible students receives fully or partially subsidized breakfasts. Only 40 percent of those qualifying for a fully subsidized breakfast eat breakfast at school. Most children, poor and otherwise, eat home breakfasts.

Because about 30 percent of schools do not participate in the SBP, studies regarding its impact on whether students eat breakfast are possible. Research comparing the eating patterns of children in schools with the program with those without it, with student socioeconomic characteristics held constant, shows that the percentage of students who do not eat breakfast on an average school day is the same for both categories: 12 percent. The presence of SBP apparently does not decrease the number of students who skip breakfast.

Another issue is the quality of the food served. In this regard, both programs are roughly similar. Typically, school lunches do not significantly exceed the NSLP requirements for caloric intake and specific nutrients. Those requirements indicate that any school lunch should provide one-third of the daily total nutrients and breakfasts, one-quarter. Unfortunately, school lunches do tend to exceed the U.S. Department of Agriculture dietary guidelines regarding saturated fats and sodium. That is not necessarily a program flaw: at the time of the study, NSLP regulations did not provide recommendations on fat content. Similarly, SBP provided more than the required 25 percent of nutrients and came close to meeting the dietary guidelines’ recommended limits on fat and sodium content. In short, both NSLP and SBP meals once conformed to current USDA nutritional content regulations but do not conform to new standards in the USDA guidelines.

The Child Care Food Program

CCFP is similar in structure to the school meals programs: subsidies are provided to day care providers for meals served to children who come from low-income families. In fiscal year 1995, the program cost $1.5 billion and served 2.3 million children. CCFP recognizes two types of child day care: family home day care (provided in private homes) and child care provided in organized child care centers.

Eligibility requirements vary depending on whether the child is in a family day care home or in a child care center. As with the school meals programs, children in child care centers receive a full subsidy if the family’s income is 130 percent or less than the poverty level and only a partial subsidy if it is 130-185 percent of the poverty level. In contrast, until July 1997, children in family day care homes received a full subsidy regardless of family income, though children of the child care provider were not subsidized unless family incomes were at or below 185 percent of the poverty level.

The major studies of CCFP have concentrated on targeting issues and have found that, historically, the family home day care portion of the Child Care Food Program has been poorly targeted. The major targeting goal is to cover children in child care facilities who come from households with incomes below 185 percent of the poverty level. In the family care portion of CCFP, however, 78 percent are above 185 percent of the poverty level threshold: most subsidies support meals for children who would not qualify for subsidies if they had been enrolled in child care centers. In contrast, in day care centers, subsidies are given primarily for meals served t o children from families with incomes 185 percent or less of the poverty level. Clearly, the family home day care portion of CCFP was poorly targeted.

The mode of subsidy payments to family home care providers was changed in the Personal Responsibility and Work Opportunity Reconcil-iation Act of 1996. Because all research reviewed here was conducted before the changes went into effect in July 1997, the findings are focused on what CCFP was like before that date.

The Child Care Food Program does not have clearly articulated nutritional goals. CCFP meals provide slightly fewer calories than required in the school meals programs, although the shortfall is far from a serious deficiency. Judged by USDA dietary guidelines, CCFP meals derive too many calories from fats and contain more sodium than deemed desirable according to current standards.

Conclusions

In a comparison of the five programs, several conclusions emerge. First, all five major federal nutrition programs are as much income support as nutrition programs. The Food Stamp Program and WIC provide income support directly to participating households, whereas the two school meals programs and the Child Care Food Program provide income support primarily to the participating school systems and day care facilities and secondarily to low-income families.

Second, the programs vary in the extent to which they are based on strong evidence concerning nutritional problems and appropriate remedies for them. Significantly, the most effective program, the WIC subprogram for pregnant women, achieves its success as a nutrition program because it rests more completely on a base of solid scientific knowledge. This base clearly identifies a target population and provides benefits closely related to identified nutritional problems. In contrast, FSP is uncertain about the nutritional problems it addresses, provides diffuse benefits to a widely defined target population, and is more important as an income support than as a nutrition program. The WIC children’s program, NSLP, SBP, and CCFP are poorly matched to identified nutritional problems in their target populations, and consequently their benefits are also diffuse.

A third conclusion concerns the importance of program-targeting strategies. Without a clear understanding of the nutritional problem to which a program is supposed to be directed, program targeting tends to broaden to include families and individuals who are not clearly at nutritional risk. The volume discusses how targeting strategies affect program costs and effectiveness and suggests that the effectiveness of the WIC program for pregnant women is bolstered by its relatively more precise targeting.

The fourth conclusion concerns the importance of the decades-long USDA program of evaluation research on the five nutrition programs. That so much is known about these programs clearly results from this exemplary effort. Nevertheless, improvements are possible. The volume suggests how the USDA evaluation research program can be improved by closer attention to the way the programs affect critical subgroups of beneficiaries, particularly the extremely poor and other disadvantaged groups.