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Towards a National Nutrition Policy: Nutrition andGovernment.Congress of the U.S., Washington, D. C. Senate SelectCommittee on Nutrition and Human Needs.May 7570p.Superintendent of Documents, U.S. Government PrintingOffice, Washington, D.C. 20402 ($0.85)

EDRS PRICE MF-$0.76 HC-$3.32 PLUS POSTAGEDESCRIPTORS Administrative Policy; Delivery Systems; *Federal

Government; Federal Legislation; Federal Programs;Food Service; Food Standards; *GovernmentalStructure; Health Needs; Health Services; *Nutrition;*Organizatimal Change; Program Planning; *PublicPolicy; Social Planning

ABSTRACTExperts testifying at the National Nutrition Policy

study hearings on June 19-21, 1974 in Washington, at the invitationof the Senate Select Committee on Nutrition and Human Needs,recommended several steps which the committee staff feel merit aprompt Congressional response. This report prepared by staffincorporates those recommendations, focusing on the need for: (1)

creation of a Federal Food and Nutrition Office; (2) formalizingnutrition policy making into a written National Nutrition Plan; and(3) implementation of a better system of National NutritionSurveillance. Members of the Nutrition Committee submittedlegislation for improved nutrition education during the ninety-thirdCongress, and those recommendations are therefore only treatedbriefly in this report. A comprehensive National Nutrition Policy isnecessary to coordinate and monitor the varied nutrition-relatedprograms and activities now dispersed throughout the government. Thepresent global food situation threatens millions overseas withstarvation and requires immediate concerted action. The present lackof policy coordination derives from the multidimensional character ofnutrition. Agricultural policy, tax policy, and even foreign policyall have nutritional implications. The flow of information todecision makers in a form they can use must be coordinated.(Author /JR)

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94th Congr 11st Session I COMMITTEE PRINT

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TOWARDS A NATIONAL NUTRITIONPOLICY

NUTRITION AND GOVERNMENT

PREPARED BY THE STAFF OF THE

SELECT COMMITTEE ON NUTRITIONAND HUMAN NEEDS

UNITED STATES SENATE

(75/F1)

MAY 1975

2Printed for the tye of the Select Commit tee on Nutrition

and Human Needs

Us GOVERNM EN T PRINTING OFFICESI-570 () WASHINGTON

For sale by the stipenatenderli of l)octinants. ('.5. (;overnittent l'rinting (MiceWashington. C 21)102 Pneo 85 cents

SELECT COMMITTEE ON NUTRITION AND HUMAN NEEDSGEORGE McGOV E RN. South Dakota, Chairman

HERMAN E. TALMADGE. GeorgiaMILD- A HART, MichiganWALTER F. MONDALE. MinnesotaEDWARD M. KENNEDY, MassachusettsGAYLORD NELSON. WisconAnALAN CRANSTON. CalitorniflUBERT H. HUMPHREY, Minnesota

CHARLES II. PERCY, IllinoisROBERT DOLE, KansasHENRY BELLMON, OklahomaRICHARD S. SCHWEIKE R. PennsylvtnlaROBERT TAFT. JR., OhioMARK 0 11.4.TFIELD, Oregon

KENNETH S.CIILOSSA ERG, Staff DirectorGER LLD S. J CASSIDY, General Counsel

NELSOV S. HALLMARK, Consultant

NATIONAL NUTRITION POLICY STUDY HEARINGS.Part 1Famine and the World Situation. June 14. 1974.Part 2Nutrition and the International Situation, June 19. 1974.Part 2A Appendix to Nutrition and the International Situation.Part 3Nutrition and Special Groups. lune 19. 1974Part 3AAppendix to Nutrition and Special GroupsPart 4 Nutrition and Food Availability. June 20, 1974.Part 4A Appendix to Nutrition and FoodPart 5Nutrition and the Consumer. June 20, 1974.Part SAAppendix to Nutrition and the ConsumerPart 6Nutrition and Health. June 21, 1974.l'art OSAAppendix to Nutrition and HealthPart 7Nutrition and Government. June 21. 1974Part 7AAppendix to Nutrition and Government.

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CONTENTS

PagePreface_ vSummary

1

Introduction.A. Background 9B. The National Nutrition Policy Study :3C. Focus of the Panel on Nutrition and Government 13I) Profile of the Panelist; 14

Chapter INational Nutritional Planning'A. Background 19B. A National Nutntion Plan 20

Chapter IIOrganizing the Federal Effort:A. Need for Institutionalization 27B. Organizational Recommendations of 1969 White House

Conference 27C. The View in 1974 29I). The Cage for a Federal Nutrition Office :12E. A National Nutrition Center 35F. A Presidential Assi:.tant for Nutrition 37G Food and Nutrition Policy Board 38II. Other Organizational Proposals 39

Chapter IIIImproving Programs and Activities:A. Nutritional Surveillance 43B. Nutntion Education 48C. Nutrition Research 51

Bibliography 55National Nutrition Consortium, Inc.:

Preface 59Foreword 61

I. Need for a stated National Nutrition Policy 62II. Goae; of a National Nutrition Policy 62

III. Measure.: to attain goals 63IV. Programs needed io meet objectives 63V. Requirement: to establish and effectively implement 66

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PREFACE

We still need a Federal Food and Nutrition Office. TheWhite House Conference on Food, Nutrition and Health recom-mended such an office more than 5 years ago. Subsequent eventshave strongly reaffirmed the importance of assigning responsi-bility to a single Federal agency:

(1). Global food consumption has outstripped productionin each of the last 5 years; some regions of theworld are already suffering famine.

(2). Rising food prices and even shortages are adverselyaffecting the American family; our national dietis undergoing possible permanent changes withnutritional consequences we cannot yet foresee withany precision.

(3). In addition to problems caused by the scarcity orthe cost of food there are also serious healthproblems which appear related to excessive foodconsumption. In the United States these includeheart disease, cancer, diabetes,osteoporosisand others.

(4). It is becoming increasingly clear that nutritionpolicy is inextricably linked to the agriculturalmarketplace_ the energy crisis, foreign policyand international economics, as well as domesticpolicy conflicts thich existing interdepartmentalcoordinating mechanisms may be institutionallyunsuited to resolve.

(5). These problems are likely to get worse before theyget better, and there is evidence they may persistfor the foreseeable future.

We cannot continue to operate on the assviption that theincreasingly complex threads affecting nutrition policy willautomatically weave themselves together into a coherent plan.There is no invisible seamstress repairing the rents in oursocial fabric caused by rising food pi-Ices, or patching holesin our national economy caused by commodity shortages. To be-lieve such a fantasy is just another way of rationalizing ir-responsible government.

We are no longer a nation of subsistance farmers. We relyon the orderly workings of the nation's largest industry--thefood industry--in order to eat. Only a comprehensive government

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policy can guarantee that this system operates effectively. Weexpect government, through its agricultural policies, to assurethe availability of an adequate food supply. We have the rightto demand that the food we purchase be clean, nutritious, ac-curately weighed and labeled as well as wholeseve. Only co-ordination of interdepartmental regulatory and investigativeactivities can assure that this is so.

Recommendations of Panel on Nutrition and Government

The following is a report by the staff of the Senate SelectCommittee or Nutrition and Human Needs based primarily on testi-mony presented to the Panel on Nutrition and Government during3 days of hearings on National Nutrition Policy before the SenateSelect Committee on Nutrition and Hunan Needs during June 1974.Witness after witness told the same story: Present policy lacksfocus and direction; change in organization of Federal programsis necessary to alleviate serious defects in nutrition policyplanning. The panel, as early conferences had done, endorsedthe concept of a Federal Food and Nutrition Office.

Many witnesses at the hearings asserted that administrationpolicy is dangerously myopic. Nutrition is treated as a ne-glected stepchild of income maintenance programs which themselvesare woefully inadequate. This narrow concept virtually deniesthe nutrition dimension in comprehensive health care, or eventhat nutrition is a health issue. This parochial view ignoresdisturbing questions about misleading food advertising and otherissues totally unrelated to income inequality. It fails tograpple with the reality that even wealthy Americans are oftennutritionally illiterate, ah3 net arteriosclerosis and otherdiseases associated with the acing process affect more than thepoor. These and other issue. germane to the health and well-being of the American people go far beyong the perils ofpoverty, and require a much broader Federal concept of the na-tion's nhtritional policy requirements.

Federal Programs

It is regrettable that we are no closer to a comprehensivenutrition policy today than we were S years ago, we cannot dis-count the progress made in the interim.

The Food Stamp Program is no longer an experiment. It works.Whereas only 3 million people were receiving this assistance in1969, more than 18 million people are now beneficiaries.-an in.crease of SOO percent in S years.

The reduced-price and free components of the National SchoolLunch Program is also a singular success. These lunches nowassure 9 million children at least one balanced meal per day.In 1969 the figure was only half as large.

We also have programs which did not even exist in 1969.The most vital is known as WICfor pregnant women, infants andsmall children, whose diet it supplements. As of 19"4, 89,000were utilizing the program in any given month, with 144,000

VII

infants and nearly 200,000 small children also receiving dietaryassistance. The program thus measurably reduces the possibilityof brain darAge during the vital growth period from conceptionthrough the ge of 4 for many Americans hitherto vulnerable topermanent hurls.

Agenda for Action

Much remains to be done. Many Americans suffer from in-adequate diets because they do not realize that there are pro-grams to help them. Others, often with as great a need, arenot eligible for existing programs. Furthermore, none of ourpresent efforts deal comprehensively with the global foodemergency.

The present lack of policy coordination exacerbates in-ternal conflicts within the administration over priorities.This year's debate over whether the United States should sup-port a World Crain Reserve is an example. Gne can understandhow the Secretary of State might disagree with the Secretaryof Agriculture.on such an important matter. But it is diffi-cult to 'relieve that such differences could not be subordinatedto a single national policy by the President.

Clearly we must bring the separate strands of nutritionpolicy together in an independent office with direct access tothe President. The new office would advise the President asto the nutritional state of the union on a regular basis, for-mulate a unified interdepartmental National Nutrition Plan andcoordinate existing nutrition-related programs throughout theGovernment in terms of this unified policy.

This concept represents a major departure from conventionalattempts to institutionalize programs or policies. It focuseson the real problem--coordination of the flow of informationto decisionaakers in a form they caa use--rather than on theillusion that creating a new Federal agency will automaticallysolve complex, tangled issues. This proposal will not insurean effective National Nutrition Policy--it will only facilitateone. There is no legislative substitute for concern or commit-ment on the part of the Executive Branch of government.

This new Federal Food and Nutrition Office would not cen-tralize program administration. Existing programs would continueas pact of line agencies. But the new office would insure thatactivities of various departments administering programs wereconsistent with the National Nutrition Plan.

Finally, I would like to take this opportunity to commendthe National Nutrition Consortium, Tnc., whose report "Guide-lines for a National Nutrition Policy" was instrumental in de-veloping our concept of a National Nutrition Office and NationalNutrition Policy and Planning as presented in this report.

George McGovern, ChairmanMay 1, 1975

SUMMARY

It's time for a comprehensive National Nutrition Policy.Such a policy is necessary to coordinate and monitor the variednutrition-related programs and activities now dispersed tlrough-out the government. The present global food situation threatensmillions overseas with starvation, and requires immediate con-certed actio.

The present lack of policy coordination derives from themultidimensional character of nutrition. Agricultural policy,tax policy and even foreign policy all have nutritional impli-cations. Cabinet officers can be excused for giving primacyto their own concerns, but without some centralized responsibleagency coordinating the nutritional implicatiohs of governmentalactivities, the present lack of coordination is certain topersist.

Experts testifying at the National Nutrition Policy Studyhearings on June 19-21, 1974, in Washington, at the invitationof the Senate Select Committee on Nutrition and Human Needs,recommended several steps which the Committee staff feel merita prompt Congressional response. This report prepared by thestaff incorporates those recommendations, focusing on the needfor: (1) creation of a Federal Food and Nutrition Office; (2)formalizing nutrition policy-making into a written NationalNutrition Plan; and, (3) implementation of a better system ofNational Nutritional Surveillance. Members of the NutritionCommittee subllitted legislation for improved nutrition educationduring the 93rd Congress and those recommendations are thereforeonly treated briefly in this report.

National Nutritional Planing

Present national nutrition planning is parochial and dis-torted. Untii now the federal effort has consisted of piecemealprograms generally tied to the interests of the food industry,corporate farming, grain traders, or other special interests.This parochial focus, of course, was episodically interrupted bytemporary concern with overseas famine or domestic hunger.

Nutrition research for example, has suffered from thispolicy. Federally funded nutrition program priorities haveshifted in recent decades away from basic research in humanmetabolism or the identification of unknown nutrients towardsincome maintenance which now dominates national nutrition policyat the federal level. Research now plays a relatively minor rolein national policy compared to such direct feeding efforts asthe National School Lunch Program, or income maintenance viaFood Stamps.

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This is not to denigrate the crucial role of income main-tenance programs in any national nutrition plan. But in thepresent budget all nutrition policy goals are classified underthis single heading. The health dimension of nutrition appearsto have been left out of present planning, while nutritioneducation has been relegated to the status of a secondary con-cern. Without disparaging existing programs, this approachclearly leaves large gaps.

In the view of the Committee staff, the remedy for thispiecemeal approach is development of a comprehensive NationalNutrition Plan (N.N.P.). To insure accountability th7-15Iiiishould be a written document. To insure review this documentshould be submitted to the Legislative Branch at the beginningof each Congress. The N.N.P. should include a formal assessmentof the "nutritional state of the union" in terms of the bestavailable current indices of national nutritional status

The National Nutrition Plan should be articulated interms of specific goals. These goals should address thefollowing concerns:

Maintenance and improvement of the health of theAmerican people;

Insuring adtquate food production for domesticneeds and global commitments;

Maintenance of food quality;

Guaranteeing accessibility to food supplies; and

Maintaining freedom of choice as an essentialfeature of U.S. food distribution and allocation.

The N.N.P. must be framed in a manner compatible witheffective program evaluation. This means, at a minimum,that specific implementing objectives are required for eachgeneral goal of the Plan. Provision should also be made tomonitor implementation.

The staff believes that establishing a National NutritionPlan compatible with continued local efforts by the States,or municipalities. Provision should be made in the nationalplan for rapid dissemination of data collected by the FederalGovernment to the States and for facilitating cooperationamong the States.

The proposed National Nutrition Plan would not representthe views of the proposed Federal Nutrition Office as to whatthe N.N.P. !not to be, but rather what it is already, in termsof planned government activities. In this sense, there alreadyis a national nutrition plan, but it is not integrated intoone document so that it can be reviewed for consistency, balanceand reasonableness.

Integrating the plan into a single document will likelyhave the effect of improving it, since it will be a readilyreviewable standard to measure the effort of any particularadministration. This process should be a progressive

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evolutionary one that leads to the best possible nationalnutrition plan.

The basic concept is to have each agency submit nutrition-related budgetary and legislative proposals as well as contin-uing program plans for nutrition activities to the Federal Foodand Nutrition Office as part of the regular planning andbudgetary process. As an agency develops its proposals tosubmit to the Office of Management and Bndget for incorporationinto the President's annual budget ressige those objectives oractivities with nutritional implicatiols w 11 be "tagged" andcompared with nutrition-related objectives of other federalagencies. This totality of-objectives, placed in a singledocument, is the National ..utrition Plan.

This formal process of integration of related objectivesinto a single document is designed to icilitate developmentof an integrated, mutually reinforcing national nutritionpolicy. The Federal Food and Nutrition Office, by puttingtogether this document will be forcing agencies and departmentsto confront conflicts in goals which have an adverse nutritionalimpact.

The agency is not intended as a new department, or evena first step towards a new department. The sole power of theagency, except possibly a limited ability to delay implementa-tion of proposed regulations having an adverse nutritionalimpact, is control over information. The Federal NutritionOffice will not tell agencies how to run their programs. Itwill simply remind them--and the Congress-- whenever theirprograms have an adverse nutritional impact.

Organization of the Federal Effort

To implement the National Nutrition Plan a Federal Foodand Nutrition Office F.F.N.O. should be established. Suchan o ice was first recommene A yte '.' " ite ouse Confer-ence on Food, Nutrition and Health. The National NutritionConsortium reiterated this recommendation in 1974, and the.anel on Nutrition and Government endorsed the recommendationat the National Nutrition Policy Study hearings in June 1974.

In the view of the Committee staff, a formal NationalNutrition Plan will remain an empty commitment unless a speci-fic federal office assumes responsibility for implementing it.If this is to happen, organizational changes are necessary,and the concept of a single Federal Food and Nutrition Officeappears to be the best vehicle for insuring visibility,accountability and access.

The new office would not administer nutrition-related pro-grams. It would be responsible for coordination rather thanday-to-day supervision. The F.F.N.O. would, however, monitornutrition programs throughout the government in terms of N.N.P.goals and objectives. The new agency would also have directresponsibility for providing the President and the Congresswith definitive interpretation of data collected as part of thenational nutrition surveillance effort.

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The issue of advance approval by the new Federal NutritionOffice for any major changes in program guiuelines or regula-

tions by action agencies has been carefully reviewed by the

Committee staff. We believe that advance. clearance by the newoffice should not be required, as this would hog the new agercy

down in the details d. direct administration as well as diluteresponsibility for program supervision. The staff does recom-mend that the F.F.N.O. have the power to delay implementationof any proposed zhanges in nutrition programs published in the

Federal R,gister 'or up to 45 days and that 1' be required toissue a Nutr/tiot Policy Impact Statement if administrativechanges proposed by agencies are inconsistent "ith the National

Nutrition Plan. The F.F.N.O. should also be consulted bydepartments when major decisions having nutritional implications

are under consideration.

National Nutrition Center

Creation of a Federal Food and Nutrition Office to coordi-

nate nutrition policy government-wide, still leaves a majorneed for institutionalizing nutrition policy at an administrative

level within DHEW. The Committee staff shares the view ofSenator Kennedy that a national nutrition center be established

within the Department orgeaTiV, Education and Welfare to directlyadminister expanded nutrition programs urged by the panelists.

The propose center would be directly subordinate to the

Assistant Secretary for Health, and would have the following

responsibilities:

1. Administration of nutrition education programs;

2. Coordination and monitoring of all federallyfunded nutrition research;

3. Administration of nutrition manpower programs.

Relationship Between the Federal Food and NutritionOffice and the National Nutrition Center

The F.F.N.O. would operate at the Cabinet level in terms

of policy formation and coordination. The National NutritionCenter would operate at the sub-cabinet level within the

Department of Health, Education and Welfare. The NationalNutrition Center within PHEW would have no extramural nutrition

policy or program responsibilities. The National NutritionCenter would, of course, formulate departmental inputs to the

National Nutrition Plan prepared under F.F.N.O. supervision.

If this organizational approach, separating responsibility for

program monitoring and planning from day-to-day supervision isadopted, the two new agencies are expected to work closely

together, but the F.F.N.O. would provide overall guidance for

government-wide policy.

The Director of the National Nutrition Center would report

to the Assistant Secretary of Health, and through him, and theSecretary of DHEW, to the Cabinet, rather than to the F.F.N.O.

The Director of the Federal Food and Nutrition Office, on the

other hand, would be the highest national nutrition policyofficial and would have Cabinet status. He or she would be

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expected to participate in Cabinet meetings dealing with nutri-tion policy issues, or meetings of the Nat,nna, Security Counciland the Domestic Policy Council when nutrition and food-relatedmatters were on the agenda.

Other Organizational Proposals

A Presidential Assistant for Nutrition would be a valuableaddition to the federal nutrition establishment only if he orshe had the ear of the President. In the view of the Committeestaff this proposal should not he considered a substitute forinstitutionalization of nutrition policy responsibilities in aFederal Food and Nutrition Office. The staff concedes, how-ever, that should the new federal office be located within DHEWas some have proposed, rather than the indepen2ent office dis-cussed in this report, that designation of a special Presiden-tial assistant might facilitate institutionalization merely byenhancing visibility.

A National Nutrition Polic Board as discussed at theNationargaiition7WM57 btu y earings in June 1974 seemssomewhat unwieldy to the Committee staff. Advisory bodies, asa general rule, facilitate the sense of participation or policy-making but not both. Participation means a large membership,while decision-making requires a smaller govp. But such aBoard could perform an invaluable role us a national forum fordiscussing nutrition policy matters. Since most groups who areinterested in participation already testify frequently beforethe Congress, however, the Committee staff does not see this asan urgent matter.

Improving Nutrition Surveillance

At the heart of a revitalized effort to establish anational nutrition policy is better information on the nutri-tional status of Cle American people. Existing data collectionis fragmentary. bietary intake is analyzed once per decade- -the last survey was published in 1965. The preliminary findingsof the Health and Nutrition Examination Survey (H.A.N.E.S.)begun at Congressional request in 1968 will not be completeduntil 1976. While the H.A.N.E.S. data will be a significantimprovement in methodology, it is not a substitute for a contin-uous program of national nutritional monitoring and surveillance,

The Committee staff believes that a National NutritionSurveillance Plan is the key element of any National Nutritionrfan ana shoUrrge the major tool of the Federal Food andNutrition Office. The surveillance plan should clearly defineinformation collection priorities and should seriously considerthe possible role of hegional Nutrition Centers in collectionof such data.

The National Nutrition Surveillance Plan must take intoaccount the changing dietary pattern of the American people,especially the emergence of new kinds of food such as texturedsoy protein. The surveillance effort should also encompass:

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Food Consumption Surveys;

A National Consumer Panel;

Composition of Food (including nutrient content);

Monitoring of Food Additives; and

Evaluation of Nutritional Status.

This last category must take into account regional varia-tions in diet, the impact of demographic variables and otherfactors which can distort survey results. Measurement tech-niques should be employed which will track the impact of rapidfood price changes on the nutritional status of the poor andthe elderly.

Improving Nutrition Education

The recommendations of the panel on the need to improvefederal assistance for nutrition education have already resultedin legislative initiatives. The Nutrition Education Act (S.3864)was submitted on July 31, 1974, by Senators McGovern, Abourezk,Case, Cranston, Hart, Kennedy, Mondale, Percy and Schweikhr, indirect response to panel recommendations. If enacted, thepronosal would:

1. Establish a 3-year pilot effort in nutrition education.Under this provision federal funds would (with asmall matching State grant) be used to introducecomprehensive nutrition education programs into thenation's schools.

2. Provide for increasel technical ;.s3i-t..ice to theStates, as hell as bot1 in-service and undergraduateteacher training.

3. Be administcred by State e,lue t ..n c f-cies,strf.' g teacher plannic, an.. c, g, ion as wellas curric11 d.s'elopment.

4. Provide Jr . Nil : 1 '' ' . :.! rdinator ineach State to .ievflop -d L . .4:: a State planfor nutri'tion educatio.

S. Establish a State Advisory rov.lcil for NutritionEducation, including parent, teachers, schoolofficials, school fuod servce personnel and othersto advise the State coordinator.

6. Provid,.: for coordinating and directing each Stateplan by a single State Nutrition Education Office,with each plan weaving nutrition education into allappropriate aspects of the curriculum.

7. Provide for creation of a national Nutrition EducationCenter to crlpile materials, develop curriculum,and evaluate existing programs in nutrition education.

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The Center would utilize and expand existingcapabilities in this area within the Depart-ment of Agricul-.ure and DHEW.

The funding level authorized for the first year would beapproximately $75 million. States would contribute 2S percentof the total moneys received under this Act but teacher trainingand pilot programs would br 100-percent federally funded.

This proposal on nutrition education is an excellent exam-ple of the kind of comprehensive approach the Committee staffbelieves essential for the National Nutrition Plan to work.The bill was dratted in consultation with the Society forNutrition Education, the American School Food Service Associa-tion, the National Dairy Council and representatives of variousfederal agencies and departments of education among the States.

Panelists also discussed other needs in the area ofnutrition education, including the need for refresher training,improved training for medical professionals, and the generalpublic.

Special interest was voiced by several speakers in utilizingexisting food distribution programs like the National SchoolLunch or Food Stamp Program as a vehicle for nutrition education..lients receiving such assistance prove a natural audience fornutritional information.

Nutrition Research

Our scientific knowledge of nutrition is still limited.We have yet to identify the actual requirements of many nutrientsessential to man. Our lack of information is especially seriouswith respect to the special dietary needs of preschool children,teenagers and the elderly. Basic research on nutrient-nutrientInteraction, nutrient-additive interaction and long-term accumula-tion of minerals in the body is also important, if significantprogress is ever to be made on diseases associated with the agingprocess.

We also need more information about the effects of mal-nutrition on mental as well as physical development. Thisinformation would be useful to economic development strategiesfor developing countries as well as health policies in theUnited States.

Further research is also required in the area of agricul-tural practice, use of processed food and changing lifestyles.We still know very little about food consumption habits or thelong-term effects of food additives, pesticides, and otheraspects of food quality and safety.

But more than any of these areas for research, despitetheir intrinsic importance, is the need for better methods ofnutritional surveillance. In the view of the Committee staff,high priority research into better methods of nutritional sur-veillance, especially the development of nutritional indicatorswhich are sensitive: reliable and inexpensive to collect andevaluate are essential to aTE0Yre national nutrition policy.

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Without such indicators neither a national planning document

nor a new Federal office will be able to implement nutrition policygoals with any assurance of success..

Panelists at the hearings also detailed some additional areas

fur federally supported research worth noting:

Present methods of exchanging information among

research groups is inadequate. Panelists urged theNational Science Foundation to play a more active

role in nutrition research.

Nutrient fortification proposals should require field

testing as should intervention or novel use of

nutrients on human subjects. Measurement of the

impact of field tests should be a focus of national

nutritional surveillance.

Support for the training of nutrition researchspecialists should be stepped up. Somepanelists foresaw shortages in some disciplinesunless prompt action is taken.

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INTRODUCTION

A. Background

World Food Crisis

The growing world food crisis is already seriously af-fecting the U.S. economy. Eventually it will permanentlyalter our national eating habits and affect the budgets ofeven middle-income Americans. The spectre of famine in SouthAsia or the human tragedy of children dying of malnutritionin the Sahel region of Central Africa may be remote to mostAmericans. But last year's catastrophic food-price increases,following the 22 percent leap in the costs of food at home (1)in 1973 is very real to the average American family.

Domestic Impact

Even well-to-do Americans have had to tighten their beltsas worldwide competition for scarce food supplies drove priceshigher and higher. Upper-income families, for example, havetraditionally consumed 42 percent more meat per capita than poorfamilies. Yet 1973'!. 7 percent decline in meat consumption percapita was most dramstic among upper income families accordingto market research firms, (2) Continued high prices, therefore,seriously threaten to plunge cattle-producing regions of thenation into a stark depression.

Businessmen throughout the economy continue to reel underthe double blows of rising costs and falling consumer demand ashard-pressed families divert money from other purchases to main-tain food consumption. In 1973 Americans spent a higher fractionof their income for a smaller portion of food for the familytable. (3)

The price of continued inaction is nearly as bad on the do-mestic front as it is overseas. We appear to be moving towardsan historic and unnecessary dilemma: Watching our cwn peoplesuffer, or standing by while countless !.umbers of human beingsslowly die of hunger overseas. Unless 'lard decisions are madesoon, this ailemma will end in tragedy (o..: us all. In a worldin vhIch even unstable governments may have access to nuclearweapons, every responsible step nust be taken to ensure thatthere is enough to eat at prices people can afford to pay.

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Food and Fuel

The interdependence of nutrition and other issues is no-where more clear than in the case of the energy crisis. U.S.food production depends on fossil fuel and this dependence isincreasing:

The agricultural complex--fertilizer makers, farmers,food processors, and others--account for nearly 30percent of annual fuel consumption in the U.S. (4)

Energy use by the food industry has been increasing inrecent years at a p'pnnmenal rate. According to a study revposted by the National Academy of Sciences in April 1974,energy use in food production has increased 422 percent sinceITTO: (5) Other energy uses by the industry are up by com-parable amounts in the last 34 years

Energy use in food processing has risen 294 percent;

Food transportation use of energy has risen 497 percent;

Overall increase for all stages from farm to table is316 percent. (6)

This is an average annual rate of increase of 11 percentper year.

The impact of the oil embargo was especially severe forfood costs. The farmer uses fertilizer, pesticide, herbicide,tractors, drying agents and other fueldependent items to growfood. The expected long-term impact of skyrocketing fuel costsover the next few years could increase food costs as much as84 percent to consumers once the impact is fully passed on atthe retail level. (7)

It is regrettable that a world crisis was necessary beforeplanners could begin to focus on the multiple dimensions offood and nutrition policy. The growing public realization thatfood prices, nutrition, Middle-east politics, oil prices, andthe weather are intimately connected with the need for foodstamps, subsidized school lunches, and the prime interest ratewas long coming.

Changing Concept of Nutrition

Only a few years ago the term "nutrition policy" createdthe immediate image in the minds of most people of making surethat people had orange juice for breakfast, and were cautiousabout the amount of candy and soda pop they fed children. Thepresent comprehensive view is part of a long-term shift in theway we view the subject.

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Nutrition and Government Panelist, Dr. Grace A. Goldsmith,de'cribed this evolution in a speech before the American Societyfor Clinical Nutrition at their annual meeting in April 1973.In the 192C's and early 30's 'nutrition policy' focused onnutritional dificiencies, with research aimed primarily at dis-covering new vitamins and understanding basic metabolism. (8)

During World War II emphasis shifted to efficient use offood supplies and maximizing production. The United States wasthe 'breadbasket' of democracy and our ability to feed ourselveswhile supplying our Allies with ample foodstuffs was viewed asa significant military asset. During the war, with food rationed,public nut7itional awareness was also a major policy focus.Families =-_e urged to use government supplied charts in mealplanning, and many Americans who grew up during the war still re-member the JSDA-supplied charts on the 'eight basic foods' postedin their family kitchens. Some nutritionists have argued thatthe average kmerican ate a more wholesome diet under rationingthan under free r.uoice. (10) British experience with their National Consum..r ,oanel after the end of wurtime rationing appearsto boa- cat tits hypothesis, at least with respect to theRrit % population. (11)

After the end of the war, nutrition policy came to beassociated with feeding the hungry overseas. First in war...evastated Europe and China, but gradually coming to extendto all developing countries as well. The chronic surplusesproduced by American farmers matched the needs of the hungryoverseas, and resulted in such programs as PL 480 (Food forPeace; during the following decade.

Preoccupation with hunger overseas persisted until themid-60's. While hunger has always been a problem for low-income Americans, it was the civil rights movement which fi-nally roused public attention. A major share of the credit,according to Dr. Jean Mayer who was general coordinator of theNutrition Policy Study hearings, goes to Dr. Martin Luther Kingand the Southern Christian Leadership Conference.

By dedicating themselves to bettering the lives ofpoor blacks, Dr. King and his followers createda new climate of concern about many of our urbanand educational problems, and, above all, about theplight of the poor throughout America. (12)

Dr. Mayer attributes part of the earlier lack of realizationof the extent of hunger in America to the failure of health pro-fessionals to keep track of what was happening. He points outthat it was not professionals but:

A small heterogenous group of interested lay individualswho took the first stops towards eliminating hunger amongblack agricultural workers in the deep Souti. (13)

Dr. Mayer also presented his own stork indictment of cal-loused regional economic policies underlying hunger in America:

...the growing demand for manmade fibers left

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the owners of the great cotton plantations with fewoptions--either they replaced their cotton withcorn crops that required little manpower, or theycommitted their fields to the soil bank in exchangefor a subsidy. In the wake of this turnover, noprovision was made for poor blacks and their familieswho were wholly dependent on the plantations fortheir livelihood. Hunger and malnutrition and, at times,actual starvation were to be their fate. (14)

Our new national awareness about hunger in American reallydid not occur until the Spring of 1967 when investigations bythe Senate Poverty Subcommittee were conducted at the MississippiDelta. Sponsored by a grant from the Field Foundatica, doctorsformed a Citizens Board of Inquiry. The board was responsiblefor the publication of "Hunger U.S.A." and helped lead to thepowerful CBS film documentary of the same title.

Not everyone accepted the findings of these panels at facevalue. Public concern led to Senate passage in June 1967 of alaw requiring the Secretary of Health, Education, and Welfareto conduct a comprehensive survey of the incidence and locationof serious hunger and malnutrition. Later, in 1968, the Senateappointed a Select Committee on Nutrition and Human Needs, whichheld its first hearing!. in December of that year.

Despite the original 6-month deadline written into the 1967law, the nation still awaits a definitive assessment of the ex-tent and location of domestic hunger. The 10-State NutritionSurvey carried out between 1968 and 1970 was not published until1972. A study by the General Accounting Office concluded thatthe report "failet to comply with the intent of the Congress".(15) The GAO indicated that the 10-State survey failed to gatherincome-related data in a form which would permit meaningful exam-ination of the relationship between hunger and poverty exceptin the crudest terms.

A more recent study, known as the "Health and Nutrition Ex-amination Survey" (H.A.N.E.S.) was published in a preliminaryform by DHEW only this year. But definitive interpretation ofresults may take another year.

The major event in nutrition policy during the past 5 yearswas the 1969 White House Conference on Food, Nutrition and Health.This wide-ranging meeting remains, in the words of ConferenceChairman Dr. Jean Mayer of Harvard "a watershed in American socialhistory". (16) But Mayer goes on to point out that little hasbeen done to implement the recommendations of that conference.Panelist Dr. Grace Goldsmith suggests that despite some ,uccessesin the area of food stamps and the National School Lunch Program,failure to act on the 1969 call for creation of a Federal Nu-trition Office remains a major sore-point among those whoseexpectations were whetted in 1969. (17)

It was the Congress, not the Executive Branch which finallydrew attention to the unfinished agenda in nutrition policy.Continuing its mandate the Senate Select Committee on Nutritionand Human Needs solicited testimony from a wide range of experts,both in and out of government, on the current status and prospectsfor a national nutrition policy as of 1974.

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Hearings before the Committee were the basis for the presentseries of reports, and have already led to the drafting of ap-propriate legislation to implement some of the more urgent sug-gestions.

The background of this report is,therefore, one of dis-appointment at the failure to move on a national nutritionpolicy since the 1969 Conference.

B. The National Nutrition Policy_Study

This report is part of a continuing series beginning withpanel presentations at the National Nutrition Policy Studyhearings held from June 19, through Zl, 1974, in Washington, D.C.under auspices of the Senate Select Committee on Nutrition andHuman Needs, under its continuing mandate and Resolution 260of the United States Senate.

Each report in the series is designed to summarize panelviews, discuss issues raised by witnesses, and elaborate onproposals or concepts suggested by panelists. This report onnutition and government deals wit:i material presented to thePanel on Nutrition and Government chaired by Dr. D. Mark Hegstedof Harvard in4vPrlity and William B. Carey, Vice-President ofArthur D. Littic, Inc.

As Dr. Hegsted suggested in his up.ring reaarkS :t thehearings, issues raised by this pule' car of be considered inisolation from substantive topics re:; in to government policydiscussed before other panels. Conclutdons presented here,therefore, represent the interim assts..ment of the Nutrition Com-mittee Staff, rather than the panelist themselves.

C. Focus of the Panel on vutrition and Government

The panel was asked to address three broad issues relatedto the role of government in nutrition policy:

1. What should be the role of the Federal governmentin nutrition policy-making?

2. How should the Federal effort be organized?

3. What are the specific requirements for Federalsupport for national nutritional surveillance,nutrition research, and nutrition education?

This report follows this focus, and is organized into threechapters: I. National Nutrition Planing; II. Organizingthe Federal Effort; and III. Improving Nutrition Programs andActivities. Chapter III is subdivided into sections on sur-veillance, research and education.

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D. Profile of the Panelists

Co-Chairmen:

Dr. D. Mark Hegsted

Professor of nutrition, Harvard University School ofPublic Health.

Dr. Hegsted is a member of the National Academy ofSciences, and winner of the Osborne and Mendel Award of theAmerican Institute of Nutrition (1965). He has served as pasteditor of Nutrition Reviews, President of the American Insti-tute of Nutrition, Chairman of the Food and Nutrition Board,President of the National Nutrition Consortium, Inc., Chair-man of the National Nutrition Sciences Training Committee ofthe National Institutes of Health, and as Co-chairman of theArteriosclerosis Research Center Advisory Committee of theNational Heart and Lung Institute.

Dr. Hegsted is presently serving on the Commission onNomenclature, Procedures and Standards of the InternationalUnion of Nutrition Sciences. Dr. Hegsted also served as apanel co-chairman at the 1969 White House Conference on Food,Nutrition and Health.

William D. Carey

Vice-President, Arthur D. Little, Inc.

Mr. Carey served as a member of the Bureau of the Budgetfor 26 years, and as Assistant Director of the Bureau from1966-1969. He isa member of the Technical Advisory Board of theU.S. Chamber of Commerce, and on the Committee on Publi. En-gineering Policy of the National Academy of Engineering.Mr. Carey is also a member of the Institute of Medicine of theNational Academy of Science, and serves as Chairman of the U.S.Panel on R&D Management of the Joint U.S.- U.S.S.R. Joint Com-mission on Science Policy.

Mr. Carey also served as a panelist at the 1969 White HouseConference.

Panelists

Dr. Aaron M. Altschul

Professor of Community Medicine and International Health,Georgetown University School of Medicine.

Dr. Altschul is an internationally recognized expert on pro-tein and nutrition. He was appointed Special Assistant for Inter-national Nutrition Improvement within the Agricultural DevelopmentService of USDA, and as a special consultant to the Secretary ofAgriculture in 1967.

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In July 1969, Dr. Altschul was named Special Asnistant tothe Secretary of Agriculture for Nutrition Improvcnent, thusbroadening his assignment to cover domestic as well as inter-national nutrition problems. Dr. Altschul, who holds 11 patents,has specialized in developing new strategies for increasing theprotein value of foods. he also has served as a consultant tothe United Nations and several foreign governments. Dr. Altschulwas named "distinguished food scientist of the year" by theNew York chapter of the Institute of Food Technologists in 1971.

Dr. William J. Darby, M.D.

President, the Nutrition Foundation, Inc.

Dr. Darby also serves as Profeisor of Medicine in Nu-trition at the Vanderbilt University School of Medicine,where he has taught since 1944.

Dr. Darby is presently serving as President of theCitizen's Commission on Science, Law and tl.e Food Supply andas a member of he Board of Cummissioners or the Navajo HealthAuthority.

Dr. Darby is also presently serving ss a member of theTask Force on World Hunger of the Presbyterian Church of theUnited States, the Commission on Aging of the State ofTennflsee, the Expert Panel on Food Safety and Nutrition ofthe Institute of Food Technologists, the Council on Foodsand Nutrition of the American Medical Association, the Ex-pert Advisory Panel on Nutrition of the World Health Organi-zation, Evezi as co-chairman of the Hazardous Materials Ad-visory Committee of the Environmental Protection Agency.

Dr. Donald H. Ford

Dean, College of Human Development, Pennsylvania StateUniversity (1967).

Dr. Ford, a licensed psychologist, has taught psychologysince 1955. He is an expert on the effect of nutrition onhuman behavior. Dr. Ford is a member of the PennsylvaniaState Citizen's Advisory Committee on Corrections, and a memberof the Executive Committee and Board of Directors of CommunityServices of Pennsylvania.

Dr. Grace Goldsmith, M.D.

Director, Graduate Program in Nutrition, Tulane UniversitySchool of Public Health and Tropical Medicine.

Dr. Goldsmith, winner of the Osborne-Mendel Award of theAmerican Institute of Nutrition (1959) for her research on theinter-relationship between tryptophan and niacin in human nu-trition and for work on protein malnutrition is presentlyserving as Chairman of the Board of Nutrition Today.

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Dr. Goldsmith has served as past President of theAmerican Society for Clinical Nutrition and as Chairman ofthe Iron Committee, Food and Nutrition Board, National Academyof Sciences National Research Council.

She has also served as President of tne American Insti-tute of Nutrition (1963-64), and Chairman of the Committee onDietary Allowances of the Food and Nutrition Board, NationalAcademy of Sciences National Research Council, among otherassignments.

Dr. Doris E. Hanson

Executive Director, American Home Economics Association.

Prior to accepting her present post, Dr. Hanson servedas Assistant Dean of the School of Home Economics, PurdueUniveristy.

Dr. Hanson's background include? establishment of a newcurriculum in home economics for the New York State publicschools, as well as assisting the Republic of Pakistan inestablishing a College of While Economics under a FordFoundation grant (1959).

Dr. Hanson represents the American Home Economics Asso-ciation on the President's Committee on Employment of theHandicapped. She has also served on the Metric AdvisoryPanel of the U.S. Chamber of Commerce.

Dr. Irvin J. Lewis

Professor of Public Policy and Community Health, AlbertEinstein College of Medicine (1970).

Prior to his appointment, Dr. Lewis has served the FederalGovernment since 1942 in a variety of posts. His last position,prior to retirement from Federal Service in 1970, was asDeputy Administrator of the Health Services,and Mental HealthAdministration, DHEW.

Earlier assignments included service with the Bureauof the Budget, the Federal Aviation Agency, Department of Stateand the Office of Price Administration.

Dr. Lewis is an expert in government health care programs,and has written extensively on health care planning. He isa member of the Institute of Nutrition, National Academy ofSciences, the American Public Health Association, the AmericanSociety for Public Administration, the Association of AmericanMedical Colleges, and the American Political Science Associa-tion,

Dr. Arnold E. Shaefer

Director of the Swanson Center for Nutrition, Inc.

Prior to his present position, Dr. Shaefer served asChief of the Nutrition Program, National Center for DiseaseControl, Health Services and Mental Health Administration,

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DHEW, He also has served as head of the Nutrition Section,Office of International Research, N.I.H., and as ExecutiveDirector Interdepartmental Committee on Nutrition for NationalDefense.

Dr. Shaefer is a consultant to the Pan American HealthOrganization of W.H.O. , and past President of the Federationof American Societies for Experimental Biology of the AmericanInstitute of Nutrition.

Dr. George A. Silver, M.D.

Professor of Public Health (international health),Department of Epidemiology and Public Health, Yale UniversitySchool of Medicine (1969).

Dr. Silver is an internationally recognized expert infamily health care, and a member of the World Health Or-ganization. Dr. Silver has also served as Executive Associ-ate for Health Affairs of the Urban Coalition (1968-70) andas Deputy Secrets:), of Health for Scientific Affairs, DHEW.Dr. Silver serves as Chief of the Division of Social Medi-cine at Montefiore Hospital, New York City, N.Y. from 1951to 1965.

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CHAPTER I--NATIONAL NUTRITION PLANNING

A. Background

The National Nutrition Study hearings were held in 1974.The Guidelines for the hearings, iss;..ed in May 1974, by theNational Nutrition Consortium put it this way:

A stated National Nutrition Policy is needed toinsure that food will be available to provide anadequate diet at a reasonable cost to every personwithin the United States. (1)

Dr. D. Mark Uegsted, co-chairman of the Panel on Nutriticnand Government affirmed this view when he observed:

Practically all nutritionists and many others agreethat the United States should have a nationalnutrition policy. Nutritional considerationsshould be an integral part of the development ofa sound food and agricultural policy. (2)

But nutritional planning is so inextricably intertwinedwith other policies and programs that it is difficult to treatin i elation from other government policies. Growing knowledgeof nutrition considerations colors perception of export policy,national economic planning, energy policy, and the InterstateCommerce Commission's rate structure to highway freight.

Nutrition, like the environment, is a web of many strands.

Environmental policy, in fact, provides an appropriateanalogue for nutrition policy needs. The ecological perspectivebrought home to many Americans, for the first time, the idea ofa complex interactive system.

The systems approach makes it easier to grasp that foodprices in America are related to droughts in Africa or to anoil embargo in the Middle East. We can see how high petroleumprices affect the price of fertilizer, driving up the costof food production.

We ought, therefore, to have little difficulty in graspingthat the nation needs an equally integrated, comprehensivepolicy for nutrition. Every time a new dam is proposed, theecologists are quick to demand an environmental impact state-ment.. We should have a national nutrition policy equally sensi-tive to the implications of candy machines in the schools ormassive television advertising.

(19)

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Nonetheless, it has '..aken global food crisis to raisepublic consciousness of food and nutrition issues to presentlevels of awareness:

Rising food costs during the past year may providethe best opportunity and stimulus for a nationalnutrition policy....Regardless of w'nether anindividual's income is marginal, rising costs offood does emphasize the problem for everycne,as it is such more tangible than the less wellunderstood concepts of nutritional quality.

Developments of the past year re-emphasize theneed for a national nutrition policy. For thefirst time in our lifetime the qv stion is beingasked: Can the United States prouuce enoughfood? Rising food costs and inflation haveobviously diminished the food budgets of manypeople and have emphasized for many the need fornew or changed programs. (3)

Despite the difficulties of formulation, there ,.as notbeen a better time for developing a National Nutrition Plan.

B. A National Nutrition Plan

1. Identifying Nutriticnal Problems

In some ways history itself is the history of nutritionaladvances. Dr. Hamish Munio argues that "nutrition is thecentral fact in the evolutionary history of animals," assertingthat early forms of animal life d'veloped muscles and nervesto facilitate fond acquisition. (4) Man's brain can even beconsidered "part of his ancestor's equipment for regulatingmovement in the search for food." (5) Anthropologists alsoclassify human history in nutritional terms, calling earlyhuman cultures "hunter-gatherer" and later forms "agricultural."This classification scheme is essentially nutritional incharacter.

Civilization still is advancing through nutritionalknowl-edge. The discovery of vitamin D permitted elimination ofrickets--a disease which formerly afflicted children even inwealthy nations--only in recent times. The discovery of vitaminB12 permitted treatment of pernicious anewia, iodized salthelped reduce the incidence of goiter--all within recent memory.Continuing discoveries belie the notion that we already knowwhat is necessary for the human diet.

Yet, we are all operating under the concept tat there isan "ideal diet" in which everyone has just the right amount ofevery nutrient withott defining what we meal.

Like anything else, dietary "suf'iciency" nePAs to bespelled out if real problems are to be addressed: .ufficientfor what? Man after all, is subject to the laws of thermo-dynamics. In order to expend energy in work (digging a ditch,writing a paragraph) a person must obtain that energy fromfood. So the assumption that there is a single "ideal" cannot

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be severed from what people do, any more than it can besevered from their health status.

So nutritional adequacy needs to be defined in operationalterms. A diet adequate to sustain life is inadequate to permitheavy manual labor on a continuing basis. John Gage of Hoffmann-LaRoche addressed Nutrition and Government panelists directlyon this point:

I think that the lack of a scientific baseline fornutritional adequacy is one of the most formidablebarriers we face in creating a National NutritionPolicy. We talk about adequate nutrition educationand adequate nutritional levels. We have no standardto aim for. (6)

Clearly what is required is to define some fairly preciselimits as to what constitutes a nutritional problem. Gagesuggest that:

Rather than wait for a haricore data base, quantitativeanalysis or compelling evidence that shows what theadequate standard should be, I would hope that theCommittee /SEnate Select Committee on Nutrition andHuman Need? or the panel /Panel on Nutrition andGovAramenfT would recommendthe establishment of aminimal nutritional level such as employed b,r theHousehold Food Consumption Survey. I would hopealso that those expressions be as grams of protein,milligrams of iron, units of vitamin A, and so forth.I think this is important that this be established asquickly as possible sc that we have an appropriatetarget to aim for. Our success must be S.sed on theachievement of a target, and if we don't have atarget to shoot for it would seem to me that allefforts would be aimed at a mythical objective. (7)

Gage has a point. Every era has its organizing myth.Ours believe in the myth of quantification. We want numbers,graphs, statistics and charts to document nutritional problemsin order to measure government performance in solving thoseproblems. But we cannot procrastinate while awaiting a perfectstate of technical expertise which may never occur. We alreadyknow enough to begin.

The problem of measurement has not chanted -ignificantlysince 1969 when thn Panel on Standards cf Dietary and Nutri-tional Evaluation of the White House Conference observed that:

Many of the methods currently being employed areinsufficiently sensitive, cumbersoue, tediousand expensive. Micro and automate! methods areneeded. Methods and standards for he evaluationof nutritional status with regard tc somenutrients which may well be of public healthimportance in the U.S. population are simplyinadequate. These include nutrients such asvitamin B6 and folic acid for which we haveinconclusive evidence of the extent or seriousness

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of the deficiencies in the United States.Finally, there are other nutrients such assome of the trace minerals, which are thoughtby some to be of health significance in theUnited States for which data are so fragmentarythat no real evaluation can be made. (8)

The 1969 Panel recommended additional research to endthis inadequacy. But such a response to the problem assumesthat this is essentially a technical issue for which researchis the remedy, rather than TairifINFTEFairlying need forany kind of quantitative index, however inaccurate, so longas it points in the right policy direction.

The monthly unemployment statistics and the Consumer PriceIndex may have done more for social policy than any othersingle thing the government has done in the past 40 years. Thisrealization led the Johnson Administration under DHEW SecretaryWilbur Cohen to experiment with the idea of regular socialindicators, quantifying such things as "alienation," healthstatus and educational progress. The regular reporting of suchindicators were to give impetus to the Great Society's socialprograms.

If a monthly Nutritional Index could be developed whichinlicated in simple, stark terms, how the nation was doing innutrition, national nutrition policy could be formulated on astraightforward "stimulus response" basis. When the indexwent down, it would be time to step up efforts, when it wentup, program managers could take kudos.

We do not need to have data more precise than the programswe have for dealing with the problems we are measuring--atleast not in the short run. We do not need to ;Snow the inter-action of proteins with enzymes to decide that children withbloated bellies crying for food may be hungry. We need a simplestandard sensitive to policy changes. A monthly opinion pollon food prices might be all that is necessary to remind thegovernment that something should be done. Lack of a standardhas led to quite capricious methods for measuring performancewhich have little or nothing to do with human nutritional needs.Agencies presently defend their progra. s in terms of how muchthey are spending, how many people are being reached by theirprogram, or how many on-site service locations they have inoperation.

Such standards are silly. "More" money for P.L. 480 in1975 will mean "less" food unless inflation is compensated for;"more" food stamps issued may simply mean the economy is deteri-orating. The increasing number of counties with Food Stampprograms coincides with the winding down of Commodity Distribu-tion. It does not recessarily mean more food for anyone.Simple measures could remedy these defective indices withoutdeveloping new data. Program expenditures could be reportedin constant dollars. But developing indices first requiresdefining policy objectives more precisely. We need to knowwhat should be monitored in order to measure program effective-ness.

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2. Setting Policy Goals

The National Nutrition Consortium suggested five broadgoals for a national nutrition policy:

1. Assuring an adequate, wholesome food supply ata reasonable cost to meet the needs of all segmentsof the population. This objective was to takepresent lifestyles into account, not merely set anabsolute standard involving a wholly unrealisticpattern of dietary intake.

2. Maintaining food resources sufficent to meetemergency needs; and to fulfill a responsible roleas a nation in meeting world food needs.

3. Developing a level of sound public knowledgeand responsible understanding of nutrition andfoods that will promote maximal nutritional health.

4. Maintaining a system of quality and safetycontrol that justifies public confidence in itsfood supply.

S. Supporting research and education in foods andnutrition with adequate resources and reasonedpriorities to solve important current problems andpermit exploratory basic research. (9)

Stated in general terms, such goals appear ambiguous.Goals must be translated into some behaviorally measurable param-eter:, if budgets are to be allocated in terms of priorities.Supplying food "at a reasonable cost" might be specified assupplying existing kinds of food at a cost of less than 30% ofany person's real income. Once such a standard is specified,it becomes possible to see where we are, and identify thosepopulations needing immediate assistance in order to meet thestandard.

Specification need not require a scientifically defensiblejustification. We can simply decide, as a society, how muchwe want to spend for food, in terms of the cost of other goodsand services. "Meeting the needs of all segments of the popula-tion" could be measured by asking people if they get enough toeat, or it could involve expensive clinical testing of thephysiological status of a sample population.

Once national nutritional goals are translated intobehaviorally measurable parameters, it is necessary to rankthese goals in order of importance. Given a choice between" wholesomeness" and "adequacy" of the food supply, which ismore important? It is not enough to simply say "both areequally important." In many American cities food storesroutinely turn over spoiled but edible items (or simply foodwith expired shelf-life stickers; to soup kitchens for consump-tion by derelicts or the elderly. This practice, while usuallyillegal, is often sanctioned unofficially by city governmentshard pressed by rising welfare budgets, who simply look theother way. Which is more important, wholesomeness or adequacy?vie need to make up our mind if we are to have a policy.

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This approach to decision-making, specification in behavi-orally measurable terms permits making choices in "cost-effective" terms. Cost-effectiveness, properly understood,should not be considered a pejorative term, implying lack ofhuman feeling. Government, after all, is spending money onsocial programs, including nutrition, and money is quantifiable.Do we want programs which help people a little, when the samefunds could help the same people a lot? "Cost-effectiveness"properly understood, can also translate as "the greatest goodfor the greatest number."

3. Evaluating Policy Alternatives

The real virtue of this method of planning is to assistin choosing among alternative policies. Once goals arespecified, strategies can be evaluated in experimentallyverifiable ways, rather than on intuition. In more advancedsystems, this can involve using such tools at "relevancetrees", "decision theory" or other paraphernalia of thecomputer age. Planners can discuss alternatives in terms ofthe likelihood of achievement of the desir,,:d policy goals,not merely as abstractions.

The importance of ranking nutritional policy goals in termsof importance is obvious. If policy A is best for meeting onegoal, but B is more suited to meeting another, it is vital toknow which goal is most important.

At this stage of planning a nutrition policy, experimentscan be conducted to test alternatives on a pilot basis.

4. Preparing the Plat.

Once alternatives have been evaluated and the best approachselected, formal preparation of a written National NutritionPlan can begin. The advantage of a written plan is that it canbe reviewed, evaluated, debated and revised. The present setof informal, loose ideas about nutrition, or pious statementsby public officials about the need for better nutrition arenot easily reviewed--it's like punching jell-o.

A formal National Nutrition Plan can be a guidepost forpublic policy. We will, at long last, be in a position toaccurately measure progress or the lack of it. This concep-tion, it should be emphasized, is inherently apolitical. Ifthe nation wishes a conservative approach, with high relianceon individual responsibility or local initiative, this can bewritten into the Flan. It may be that the majority of theAmerican people do not wish the government to act as thesupplier of last resort for the rejects of our social system.If that is the case, the National Nutrition Plan should reflectthat value decision.

It is irresponsible to obscure the real motives of policyunder the guise of ignorance, or to deliberately downplay thelikely consequences of a chosen policy.

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In the long run, such an approach helps feed the worst sortof paranoia about the system, and only serves as fel forsocial discontent. If it is our choice to permit `:anger in thename of some other social value, then let's at least talkstraight with America's hungry. Our system evades responsibilityby pretending that some last bit of technical evidence showingclinical symptoms of hunger is required before government facesthe reality of how the poor live.

A real nutrition policy will always include significantlevels of uncertainty, regardless of the state of research.We can never be sure that a decision to ban an additive whichcould stimulate food production is the "right" decision. Thereality is one in which responsible public officials do whatthey can, based on the best evidence at hand at the time.

Open acceptance of responsibility by government for havinga nutrition policy coherent enough to facilitate debate is atthe heart of the concerns which brought people from many disci-plines together for the National Nutrition Policy Study hearings.It's time to have a visible policy, even if it imperfect,because a visible policy can be changed. The inv.Jible nutri-tion policy of this government must be brought out into the lightto see if this is really what we choose to be doing.

S. Nutrition and Other Priorities

A formal National Nutrition Plan will have to compete forpersonnel and money with all other activities of the govern-ment of a diverse nation with many interests. The NationalNutrition Plan will conflict with the goals of agriculturalpolicy, among other programs. Maintenance of farm income some-times means pricing food out of reach of low-income consumers.Reducing spoilage, while it reduces unit costs, requirespremature harvztsttng of vegetables and fruits, with loss infood value and appeal. Maximizing production means toleranceof medical problems caused by use of herbicides, pesticidesor other additives. Each of these illustrations representsa choice situation. Articulating the real choices is theessence of responsible decision-making.

A National Nutrition Plan may conflict sharply with foreignpolicy goals. Tolerating an Arab oil embargo during delicateMiddle East negotiations to maintain leverage over participantsmeans higher fertilizer prices and food costs. Selling wheatto the Russians on preferential terms to bolster saggingprogress in bilateral arms control negotiations may conflictwith alternative humanitarian uses of the same grain in SouthAsia.

But all of these conflicts can usefully be aired withoutemoarrassment once the commitment to responsible choice hasbeen made by government. Restoration of public confidence innational decision-making at a minimum will require an end tothe empty rhetoric which claims that money alone is the limitof our power to influencer events. A National Nutrition Planmay finally force public acceptance of the real limits to ourpowers. We may not be able to free mankind from the threat offamine. Rather than being another step towards overburdening

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government, a National Nutrition Plan could be a step on theroad to limited government which is responsible, and acceptsthe responsibility for its real choices.

It is the belief of the Committee staff that it is betterto make promises we can keep than it is to pretend we do nothave problems in feeding our people. It is better to startwith articulated goals, specified in terms of concrete mile-stones amenable to measurement, than it is to piously promisethat no American need go hungry.

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CHAPTER II-- ORGANIZING THE FEDERAL EFFORT

A. Need for Institutionalization

A formal National Nutrition Plan will remain an emptycommitment unless a specific federal office is assigned re-sponsibility to implement it. As Dr. Irvin Lewis, Professorof Community Medicine at the Albert Einstein College of Medi-cine suggested to the panel at the hearings last June:

Any major need of society, once it has been identifiedabsolutely requires a focus or leadership and effortin government if that need is to be adequately financedby government. (1)

Institutionalization should not be perceived as an endin itself; nutritionists and concerned health professionalshave no desire to expand the government bureaucracy for itsown sake: Instead, as Dr. Lewis emphasized:

Government organization isn't static, but it has toreflect in a dynamic way: (a) the importance thatsociety attaches to a particular field; (b) thesubstantive policy approach of government; and (c)the administrative or operational relationshipsamong government programs in any field. (2)

The case for institutionalizing, as Dr. Lewis viewsit, is not just for "bookkeeping" or "efficiency," butrepresents a realistic assessment of wnat is necessary toget a program which is well organized, and adequately financedunder present conditions. Institutionalization permits de-velopment of career-orientated staff support at the agencylevel, and facilitates the interpersonal connections--thehuman web of policy--that is necessary if a long-term com-mitment to a national nutrition policy is to be forthcoming. (3)

B. Organizational Recommendations of 1969METTeRouse Conference

The 1969 White House Conference on Food, Nutrition andHealth concluded that:

Balkanization of responsibilities and authorityconstitutes a serious barrier to a concertedattack on hunger and malnutrition. (4)

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From the 1969 perspective it seem:. the rapid growthof programs, proliferating as they were r differentagencies throughout the government, was .ag rather thanpromoting a concerted attack on nutrition Jblems:

As the Federal government is now organizedfor roles and missions affecting food, nutritionand health, these problems are everybody'sbusiness and therefore nobody's. We recognizethat this profusion of interests arises from therealization that nutritional fitness intersectswith the government's objectives in promotinghealth, and education, job opportunity, familysecurity, maternal and infant care, earlychildhood development, income maintenmi e, foodand agricultural programs and a wide range ofefforts to enhance economic opportunity. (5)

An example often cited of such profusion of jurisdictionis the overlapping responsibilities shared by the Food andDrug Administration and the Department of Agriculture with re-spect to regulation of meat in food products. FDA regulatesfoods containing less than 2 percent meat, while USDA regu-lates foods containing more than 2 percent meat. This meansthat some soups fall under FDA regulations, while others areUSDA's responsibility. (6)

The 1969 Conference made four major organizational recom-mendations:

1. Creation of a Federal Nutrition Office.

2. Designation of a Presidential Assistant for NutritionPolicy.

3. Assigning the Secretary of Health, Education andWelfare Executive Order responsibilities for govern-ment-wide nutrition policy coordination.

4. Creation of Area Nutrition Centers to supplementefforts of State and local public health agencies. (7)

In calling for a Federal Nutrition Office, the 1969 panelistsargued that

The Department of Health, Education and Welfare hasat its disposal, a remarkably diversified array of programsthat have high relevance to nutrition and health. At thesame time, the Department is an extremely complexorganization. The task is to create a mechanism forsynthesizing and coordinating research and appliedcommunity and indiv'dual services. (8)

The 1P69 Conference clearly conceived of the NutritionOffice as having the function of formulating and carryingthrough policies within DHEW, rather than government-wide.They recommended that the new c7fice be subordinate to theAssistant Secretary for Health and Medical Affairs within theDepartment. (9) Government-wide coordination was presumablyto be a function of the separate recommendation for a special

34

)9

Presidential Assistant for Nutrition. (10)

The belief of the 1969 White House Conference participantsthat DHEW was the best existing vehicle for institutionalizationof nutrition policy was reflected in their call for delegationof Presidential powers to the DHEW Secretary for formulatiLlExecutive Orders relatinato nutrition policy, ana their requestthat the Food Stamp and Commodity Distribution programs betransfered to DREW from USDA.

On balance, the 1969 Conference urged:

Greater centralization of program responsibility withinDHEW.

Enhancing visibility for nutrition concerns by designationof a Special Presidential Assistant for Nutrition.

A fair assessment of the tone of the 1969 Conference wasthat a hope that something was about to happen had been generated.Regrettably, these high expectations and hope gave way to frus-tration.

C. The View in 1974

The Panel on Nutrition and Government at the NationalNutrition Policy Study hearings concluded that, as of June 1974,nothing had been done to implemont any of the 1969 Recommendationsexcept a move by the administration to consolidate the FoodStamp Program with other income-maintenance efforts in DHEW.Even this action appears not to be what the panelists had in mindin 1969: They wanted centralization of programs as part of acomprehensive policy. The Administration proposal, on the otherhand, appears as an effort to make the Food Stamp Program competefor already scarce welfare dollars; this is viewed by many as afirs, step towards elimination of the program entirely.

The basic position of the Administration is thatfamilies should make their own spending decisionsby receiving income assistance in cash, rather thanin kind. Thus, the transfer of food stamps andrelated 'nutrition programs' is perceived as a steptowards welfare reform, not nutrition reform...This may be a reasonable policy, but it preemptsa national policy for nutrition as a health goal.Nutrition would be assoL_rtted with the "W" in HEWrather than the "H". (11)

As panelists observed in subsequent discussion at the Junehearings:

What is to be gained by urging the transferto HEW if nutrition programs are to be buriedunder income-maintenance programs? Will thetransfer be more of a setback to nutrition thana gain? (12)

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11WAIIFIMOMII

30

Concern that government was abandoning its commitromt wasnot alleviated by a review of the Office of Management and Budget's144 Presidentially approved Federal objectives in 1974. Only twoobjectives related to nutrition

"develop a more cost-effective child nutrition program"

and

"rationalize eligibility requirements for food stamps"

Both of these objectives were submitted by the Departmentof Agriculture. (13) Concern among participants at the 1974hearings about the income-maintenance obsession of the adminis-tration ran deep:

The failure of the federal government to designand implement a national nutrition policy andorganization is largely due to a policy viewpointwhich associates nutrition with "income maintenancerather than health policies." (14)

In denouncing this parochial viewpoint, Panel Co-ChairmanDr. D. Mark Hegsted of Harvard observed that:

The first and primary responsibility of the Foodand Nutrition Policy must be the maintenance andimprovement of health. The major responsibilitymust fall on the health system --that is, physicians,nurses, dietitians, nutritionists, dentists, healthauxiliaries of all kinds. And in this system, thephysician must play a primary role. (15)

The panel felt administration myopia went even deeper thannarrowness of conception:

The Executive Branch senses no urgency to createpolicy planning, coordinating or surveillancearrangements..fit7will take a great deal ofconvincing before it recognizes a priority fornutrition policies, and nothing is in sight which islikely to be convincing. (16)

The panel connected this philosophy of inaction with thepresent emphasis of government managers on

compelling evidence /Without whicE7 theclaims of nutrition advocates receive politeconsideration and short shift. (17)

Panelists believed that

absent any scientifically-based and authenticatedstandards of nutritional adequacy, and absentanv ongoing surveillance system linked to suchstandards, the policymakers will not assignserious priority or resources to the improvementof nutrition and health. (18)

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Yet whose responsibility is it to obtain such information?

The absence of a scientific baseline (discussed more fullyin Chapter 111)is presently being used as a screen to avoidcommitment but it is the same government which refuses to collectthe information it claims is necessary.

Members of the panel therefore emphasized that:

The perceived lack of scientific baseline datais the most formiaable barrier to the creationof a national policy focus,

and

Nothing is being done at the top policy levels toaccelerlte the formulation of the baseline. (19)

With this depressing assessment of the status of administra-tion interest in nutrition policy, it is not surprising that, asof 1974, experts in nutrition policy who were calling for cen-tralization of programs in DHEW oily 5 years ago, nnw helieve:

Decision-making in the federal government ispluralistic. It is shared, negotiated, andbargained. But the strategic directions and majorpolicy choices are focused in the hands of a few:the White House, the OMB, and the DomesticCouncil. Policy goals, organizational changes,objectives, funding, new legislation--thesedecisions are settled at the highest levels. TheDepartments and agencies may propose, but thepower centers dispose. (20)

And how do the experts size up the quality of decision-making at these "power centers"? The panel concluded that:

1. Nobody in the Executive Office of the President is incharge of the nutrition policy question.

2. No single focus exists anywhere in the executive branchof the government to assess and advocate nutrition poli-cies.

3. No overall co-ordinating machinery exists at eitherthe executive office level or the interdepartmentallevel for nutrition planning, program management orR&D. (21)

It seems fair to observe, in summary, that views have shifte6significantly since 1969. If a-v single quotation could crystal-lize this change, it might souna like the following observationlast June:

The recommendations of the White House Conferencefor government organization may not have been themost appropriate. Political and financial realitiesmust be considered in the development of any systemwhich will be effective. (22)

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Despite this growing cynicism, the Panel on Nutritionand Government like the White House Conference before it, stillrecommended creating a Federal Nutrition Office. (23) But,in 1974, interest has shifted towards creation of an indepen-dent office with direct access to recalcitrant policy-makers,rather than buried in DHEW.

D. The Case for a Federal Nutrition Office

The proposed formalized National Nutrition Plan outlinedin Chapter I can never be written, much less implemented, un-less the mresent federal effort in nutrition is substantiallyrevamped.

This means either creating a new office, or giving anexisting office additional functions The staff of the SenateSelect Committee on Nutrition and Human Needs believes thatthe case for a new office is stronger than the argument forexpanding an existing department.

To begin with, which department can eitclusively claimjurisdiction over this field? As we have seen, nutritioncuts acrost, issues affecting many departments. Nutrition poli-cy affects agriculture, commerce, exports, fdreign relations,health and even national defense. As Senator McGovern hassuggested:,

It is a subject whose jurisdiction cuts acrossa dozen federal agencies. I think that is partof our problem. Great progress has beesmade, but these is a de Aerate need fordirection and coordination of these activitiesAlD, cut across so manriines of Pede.-il------responsibility. (24)

Furthermore, assignment of the nutritim policy functionto any single existing agency could permaneitly cast nutritionpolicy into a restrictive mold. If assignee to agriculture,nutrition policy might merely he a method of expanding demandfor farm products. After all, this is the way the food stampand school lunch program' are often defended by USDA officialseven now.

Placing policy solely within DHEW, as recommended in 1969,while possibly preferable on a number of grounds, also has draw-backs. It still does not reconcile the educational, healthand welfare dimensions of a comprehensive nutrition policy.

The current global food crisis suggests that it is no longerfeasible to have a purely domestic nutrition policy--if thatever was the case--/et assigning the new office to a "domestic"cabinet department would inevitably have such an effect. Theinternati -nal dirension of nutrition policy might continue, asin recent years '- t.e suhordinated to the dictates of foreignnolicy rather than humanitarian goals.

It seems clear that the multi-dimensional character of"nutritioras a policy focus leaves only one alternative:

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an independent office, outside any existing department.

Creation of an independent office avoids not only thejurisdictional squabble which otherwise might occur among thedepartments, but neatly sidesteps the comparable dispute amongthe technical disciplines as well. Real differences existamong doctors, nutritionists, public health officials, and othersas to which discipline should dominate the field. lhis year'sexpressed concern from the medical profession that administra-tion policy has neglected the health component of nutritioncould easily become next year's assertion by agronomists thatthe technology of food production was not being integrated intonutrition policy-making.

If anything seems clear, it is that nutrition policymust not be the province of any single perspective.

Another virtue of creating an independent office is visi-bility. It is a lot harder to hide the existence of any agencywith its own letterhead and national director. An agency with-in a larger department, however, is easier to suppress. Thefate of the Office of Comprehensive Health Planning is instruc-tive. During the mid-sixties the Congress directed the estab-lishment of a system designed to encourage comprehensive healthplanning at the State and local level. Each state was to createa single agency to integrate health planning within its boundariesinto a single comprehensive plan. The plan was to be based ona consensus developed among both consumers and providers ofhealth services.

But CHP, including its ambitious program for trainingmulti - disciplinary professionals at the graduate level,floundered because of lack of visibility at the nationallevel. State and local officials were never able to lookto Washington for direction. The Office of ComprehensiveHealth Planning was buried alive in DHEW,where it remains to thisday. We still are no nearer to comprehensive health planning.

Independence, of course, is no guarantee of visibility.There can never be an organizational substitute for Presidentialinterest. But a Federal Food and Nutrition Office whose direc-tor has access to the President can never disappear entirely.Furthermore, visibility facilitates integrity. If a highlyvisible public official is removed, it almost always ensuresventilation of a major policy issue.

Functions of the Federal Food and Nutrition Office

As Senator McGovern outlined to the members of the Panel onNutrition and Government, an independent office would be re-sponsible for setting forth national policy and priorities inthis vital area: The director of such an office would have in-dependent access to the President in addition to maintainingcloseliaison with other federal agencies.

The McGovern plan, in brief, would create an independentoffice of cabinet status in terms of visibility and access, butnot a large new bureaucracy. The purpose of the office wouldbe planning and coordination, not program administration As

we have already seen, it is not possible to separate out the

39

nutrition dimension from other aspects of policy. The goal isnot to subordinate agricultural export policy to nutrition policy,but to insure that the nutritional implications of exports aretaken into account during decision-making at the executive level.

The new office would be analogous to the Federal EnergyAgency during it early months. The Federal Food and NutritionOffice would initially, like FEO, operate as a clearinghousefor ideas and suggestions for national nutritional goals.

But, once in operation, the major task of the FFNO wouldhe to prepare a draft National Nutrition Plan, as outli.ed inChapter ', for suomission to the President.

In preparing this plan, the FFNO would be req.ired to consi-der the views of all agencies and department havinj jurisdictionover nutrition-related programs and activities. The Committeestaff believes this task would be facilitated by having the FFNOmake the final determination as to whether a program was nutri-tion-related.

Since the FFNO is not an administrative agency--it has noprograms--it does not displace the "chair of command" frlmProgram to agency to departmental secretary, or to the President.But no agency would be able to have its nutrition- related pro-grams escape policy review and comment by the FFNO.

The purpose of this broad scope for the new agency is notto subordinate existing programs to judicial review bynutritionists, but rather to guarantee that the nutritionalispications oflijor policies will be recognized at the timether_are foriliifeoc. RespoTilIle government often involvesEird-Oloices. niiie will be many occasions in which nutri-tional considerations must be subordinated to larger economicor political factors. But these choices need to be identi-fied, and the nutritional costs known.

By funneling nutrition policy issues through a singleoffice, the possibility of a consistent and comprehensivepolicy will be increased. At a minimum, this argroach willrouse national concern whenever outright contradictionsin policy goals are confronted in a particular issue.

The National Nutrition Plan will provide the FFNOwith a working document to chart the nation's progresstonards implementing the nutrition-related goals ofspecific action programs of the various departments andagencies. The FFNO could also become a focus to presentingadministration views on nutrition policy issues before theCongress.

A specific function of the -,ew agency would be toissue Nutrition Impac. Statem"zs whenever significantdecisions affecting the objectiv,s contained in theNational Nutrition Plan occurred.

40

Under Vas conception, the F.F.N.O. would serve as a kitaof ombuds sr within government for highlighting the secondarynutritiona implications of major policy decisions. TheF.F.N.O. would not have veto power over decisions, but wouldbe a voice of concern strategically placed where it might heheard by those with the power to do something.

The F.F.N.O. would also be responsible for followingthrough on the commitments made by agencies during formula-tion of the National Nutrition Plan. Though agencies wouldadminister their programs, the F.F.N.O., not the agencies,would evaluate performance in meeting milestones specifiedduring the planning process.

The F.F.N.O. would have a major voice in developing theNational Nutrition Surveillance System (discussed in ChapterIII) though it would not operate the system. Data would becollected by line agencies, who might even interpret theresults, in a preliminary manner, for its own internal use.But definitive interpretation of all nutrition programperformant7idita would be an F.F.N.O. mandated responsibility.The need for a definitive interpretation by an agency otherthan the .^.,ne administering a nutrition-related program isa major advantage of having an independent office withoutprogram responsibilities.

The power to issue an adverse Nutrition Impact State-ment falls short of supervision or veto over line agenciespe'rf'orming their responsibilities as they see them. Agenciescould choose to ignore the statement and implement theirpolicies despite the adverse nutritional implications. TheCommittee staff believes the F.F.N.O. should have the powerto delay final implementation of any administrative decisionseen as nutritionally unsound. The delay would allow timefor Congressional review and alert the public to the signi-ficance of the pr^posed change in policy. Such a delay powerwould still fall short of administrative control, but wouldact as a "trip-wire" escalating the significance of thenutriti::1:1 component of an agency's policies.

This proposal for a Federal Food and tsatrition Officeoffers a realistic way of implementing the kinds of concernsexpressed by members of the Panel on Nutrition and Government.An independent agency, with access to the President, respon-sible for formulating a National Nutrition Plan as well asmonitoring progress in achieving the goals of the plan pro-vides the Congress with an unambiguous method of implementingCongressionally-mandated objectives in food, nutrition andhealth,

E. A NaLional Nutrition Center

The propased Federal Food and Nutrition Office wouldbring focus and dirc-tion to national nutrition policy. Inorder to provide the interdepartmental frame of reference,the F. N.O. concept outlined here excludes program admini-stration functions--otherwise it would be a Department ofNutrition, forfeiting its role as "ombudsman" for nutritionprograms,whatever agency administered them.

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36

But, in addition to the clear need for such a planning andmonitoring activity at the Cabinet-level, the proliferation ofprograms at the departmental level also leaves something tobe desired. At the June 21st session of the Nutrition PolicyStudy Panel on Health, Senator Edward M. Kennedy of Massachusettsoutlined a plan (25) for clarifying the administration of on-going nutrition programs which the Panel on Nutrition andGovernment believes has great merit.

The Kennedy proposal would group four program areaswithin the Department of Health, Fducation and Welfare undera single National Nutrition Center subordinate to the AssistantSecretary for Health in DHEW. (26)

The Center would coordinate and monitor DHEW nutritionprograms in education monitorin &, research and mannower. (27)The Center'sMition within DHEw would facilitate monitoringof other departmental nutrition activities as well.

In Senator Kennedy's view, "foremost under the nationalnutrition center should be the establishment of nutritioneducation programs." (28) Such programs would emphasizepublic nutritional awareness, improving nutrition educationof physicians, and ocher specialized target populations. (29)

The Senator's second area of concern was nutritionalmonitoring:

...periodic reviews of our national eating habitscan provide the basis for ensuring that the publicis eating the proper food. (30)

The third concern was research. Senator Kennedy arguedthat nutrition research not only includes information aboutnutrition problems, but also the role of nutrition in pre-ventive health programs. He also stressed research on theeffects of preservatives, additives and pesticides on humanhealth. (31)

The final area the Senator proposed for the Center wasmanpower. He argued that:

Programs to provide additional manpower as para-professionals and health nutritionists who candeliver these services must be initiated toguarantee the success of the other...basic aspectsof a national nutrition policy. (32)

Relationship Between Proposed Federal Foodana Nutrition Office and the National Nutrition Center

The Federal Food and Nutrition Office would operate atthe Cabinet level in terms of policy formulation and coordi-nation. The National Nutrition Center would operate as asub-Cabinet activity subordinate to the Assistant Secretaryfor Health of the Department of Health, Education andWelfare.

The Center would actually admini.ter line programs relatedto nutrition within DHEW. Innuts by the Center to National

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37

Nutrition Policy would be through departmental channels.

The F.F.N.O. would not administer any programs. F.F.N.O.influence over line programs would be restricted to itsimpact on the budgetary planning process during the formula-tion of the National Nutrition Plan and by issuance of adverseNutrition Impact Statements.

If this organizational approach is adopted, the two newagencies could have a close working relationship on a day-to-day basis. DHEW and the National Nutrition Center would beintimately involved in the process of evaluating data collectedthrough survey instruments and other collection efforts. Suchinformation would be the basis of policy decisions formulatedby the F.F.N.O. or the cause for most Nutrition Impact State-ments issued over the course of time.

The Director of the National Nutrition Center wouldreport to the Assistant Secretary of Health, and through himto the Secretary, the Cabinet and the President.

The Director of the Federal Food and Nutrition Office,on the other hand, would be the highest ranking nutrition policyofficial in the nation, and would have Cabinet status. He orshe would normally attend Cabinet meetings dealing with nutritionpolicy issues, or meetings of the National Security Councilor the Domestic Policy Council when nutrition or food-relatedmatters were on the agenda.

F. A Presidential Assistant for Nutrition

While less desirable than creation of a Federal Food andNutrition Office, designation of a special PresidentialAssistant for Nutrition, as proposed by the 1969 White HouseConference is clearly an idea with some merit. Such an official,especially if he or she were not only qualified in terms ofexperience, but also a person of some national recognition,could quickly become a useful focal point for enhancing nutritionawareness both in and out of government.

Unfortunatel, the sad state of visibility of nutritionpolicy does not make finding such an individual an easy task.The national leaders in the field, while widely known in profes-sional and academic circles, are not household words.

The Committee staff concludes that the goals of NationalNutrition Policy Study hearing panelists could be articulatedwith greater effect from the vantage point of a White Housestaff position if voiced by an individual already prominent inthe eyes of the public, rather than by selecting the mostqualified expert in nutrition.

This realization underscores our concept of the limita-tions of a White House Special Assistant. In ouz view, thisall too often is a route for co-opting an important cause- -such as the need for a national nutrition policy--with theappearance of a response rather than a real response. Thehistory of the White House Assistant for Consumer Affairs isa case not to emulate.

C. 43

3S

The staff further believes that designation of such anofficial in addition to creation of a Federal Nutrition Officewould be redundant, unless the F.N.O. Director was also the

Special Presidential Assistant. The staff therefore prefersthat this proposal be tabled in deference to the F.F.N.O.

concept.

G. Food and Nutrition Policy Board

Concern of panelists at the 1974 Nutrition Policy Study

hearings as well as frustration extending back to the 1969

White House Conference has revived interest in the creation

of a National Nutrition Policy Board. Such a body--called aNutrition Advisory Council by some--appears to attempt toinstitutionalize some sort of national forum for interested

groups to issue periodic statements on nutrition policy in a

context designed to guarantee some hearing for their views.

The Committee staff is sympathetic to this concel.u. The

long struggle to get a national nutrition policy with somekind of integrity has been a grueling and disappointing seriesof frustrations for countless numbers of concerned Americans

in many disciplines,

As articulated by the National Nutrition Consortium inGuidelines for a National Nutrition Policy such a board would

consist of:

...representatives of various organizations withspecial competence in dealing with food andnutrition issues...(33)

The Board would:

...advise the Office of Nutrition in planning andevaluating a National Nutrition Program. (34)

It is the opinion of the staff, however, that concerned

groups as well as nongovernment experts would be well advised

to keep clear of the institutionalization of nutrition policy-

making per se, in order to retain their full freedom to criti-

cize and review government behavior from a non-administration

frame of reference.

We believe that participation of such groups and experts

In the process of legislative hearings before the Congress andthrough periodic national conferences can allow full articula-tion of viewpoints without another layer of quasi-governmental

organization. It may be more important in the long run toinstitutionalize concern for nutrition within existing agencies

and activities than to create new ones. A greater concern fornutrition by the National Academy of Sciences and the NationalInstitutes of Health might do more for institutionalizationthan another policy board.

It has been the experience of those intimately acquainted

with the legislative process that partial institutionalizationof interest groups in the form of a Policy Review Board all too

often merely provides a convenient stage for divisive terri-

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torial disputes--much to the satisfaction of institutionalopponents of change--rather than clear-cut articulation ofissues.

It is also clear that such bodies cannot simultaneouslyserve the function of full participation of all interestgroups and still serve the function of policy review. Thesetwo goals are inherently antagonistic. One needs a largegroup to insure full participation and a small group tomake a decision.

On balance, the Committee staff does not support creationof a Nutrition Policy Review Board at the present time, onthe grounds that this is more likely to become a forum forverbal maneuver among those long denied a chance to articulatetheir well-placed concerns than a policy-making body.

H. Other Organizational Proposals

As Dr. Hegsted pointed out in his opening remarks tothe Panel on Nutrition and Government at the hearings, thehaphazard way in which nutrition issues are now treated madeit difficult ever to organize a coherent discussion. (3S)It proved impossible to focus all government-related nutritionissues in a single panel, and several other panels inevitablychose to recommend specific governmental responses of anorganizational character. These other proposals growing outof the study hearings are discussed briefly below. Moreextensive analysis of these proposals will be made in futureCommittee reports.

Panel oi. Nutrition and the Consumer

The panel had two basic proposals: (I) creation of astanding Committee on Food Policy in both the Senate and theHouse of Representatives; (2) Central administration of allExecutive Branch nutrition programs by a single department.

(1) Standing Committee on Food Policy

This proposal would create an additional standing committeein both Houses of Congress to deal with these issues. (36)The new Senate Food Policy Committee would, presumably, sharejurisdiction over relevant legislation with the Committees onAgriculture, Labor and Public Welfare, Commerce, Treasury andother committees with an interest in issues impinging on food,nutrition or health.

Stated in this way, it is clear that the nopes of paneliststhat all issues impinging on nutrition could be dealt with ina single committee is unrealistic. The Nutrition Committeestaff believes this proposal reflects the clear need for amore comprehensive and integrated approach to nutrition bycreating an additional committee in each House of Congress.

But the Committee staff believes that this proposal shouldbe tabled at least until it becomes clear how the Budget ReformAct will affect Committee operations during the next session.Under the Budget Reform Act a number of measures have beentaken to attempt to improve the treatment of related issues

;it 45

40

by the Committee system. We believe the new approach shoulu

be given a fair test before additional reorganization is

attempted.

(2) Centralization of Food Policy Programs

Under this proposal all food policy programs, including

those dealing with production, standards, safety, and nutritioneducation would ae transferred to a single agency within the

Executive Branch. The new centralized agency would be given

four additional functions:

1. Admini!AratioL of a National Consumer Library,2. Creation of a Bureau of National Economics,3. Creation of a Nutrition Research Administration.4. Designation of a consumer "ombudsman" for

nutrition and health, independent of theExecutive Branch.

While the Committee staff shares the concerns which moti-

vated these proposals, it does not endorse them at this time.

Most proposals to create agencies or officials independent ofthe Executive Branch can be viewed as a sign of continuingdistrust of the motives of public officials. Such distrust

may or may not be based on solid grounds, but the Committeestaff believes then that there is no technical or administra-

tive solution which can effectively compensate for unconcerned

or incompetent public officials.

In our view, it would be better to directly confront the

concerns which led to this proposal than to hope that anotherindependent agency would be a cure-all remedy. We do not yet

need a Special Prosecutor for Nutrition on tne public payroll.

The thrust of these propos :un against the major themedeveloped in this report: Nutri.ion programs are inherently

interdepartmental and interdisciplinary, requiring coordination

and goal-setting rather than centralized administration.

The Committee staff therefore cannot endorse the idea of

what would appear to be a Department of Food Policy at the

-abinet level. The new department, if it truly centralized all

tie programs related to production, standards, safety, andnutrition education would combine half of the government in

one agency. The Departments of State, Agriculture, Treasury,

Commerce, Labor, HEW, and Defense would be replaced by a single

agency--or, alternatively, the Department of Agriculture wouldbe divested of crop production, Commerce of export policy, and

State of foreign assistance.

Sub-panel on Popular Nutrition Education

This panel recommended establishment of an AdvisoryCommission on Nutrition, (37) using the present Advisory Commis-

sion on Intergovernmental Relations as a model. The Commission

would include representatives of federal and State governments,encompassing spokesmen for USDA, State Commissioners of Agricul-

ture, DHEW, State, Commerce, and the Office of Management and

Budget. Representatives of scientific nutrition societies would

also be included.

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The Commission wc,uld be jointly funded by the federal andState governments. Its functions would include holding publichearings. All proceedings would be a matter of public record.

The Committee f,Laff bel;eres that such a body, while pro-viding a public forum, would not lead to greater participationby interested parties in the formulation of a national nutritionpolicy. The nroposal has the same weaknesses as the Food andNutrition Pcl.cy Foard already discussed.

The Committee staff, therefore, does not endorse thisrecommendation at the present time.

Sub-panel on Nutrition and Disease

This sub-panel recommended creation of a national boardto review all food advertising

directed at adults in the UnitedStates. (38) The board would also advise the press as to themerits (or lack of merit) of claims of diet faddists. Theboard would collect, evaluate end disseminate information onhealthful nutrition practices to the public.

The Committee staff believes that the issue of foodadvertising and the related questions of food labelling andnutrition education deserve further investigation. Experts inthe field of food marketing

appear increasingly to believe thatthe long-term trend is away from brand-name marketing throughnational media campaigns towards

point-of-sale advertising infood stores, or price competitive advertising in local markets.

A recent speculative forecast in Advertising Age evensuggested that brand-name advertising for food products maybe a thing of the past by 1980. Such a review board, therefore,may not be necessary.

Creation of such a board also raising constitutionalissues of prior restraint and censorship. We believe that evenif advertising restraints are advisable, consideration shouldbe given to using existing

institutional vehicles (FDA, FTC)rather than creating a new agency.

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CHAPTER III-IMPROVING PROGRAMS AND ACTIVITIES

A. Nutritional Surveillance

Nutritional surveillance, as pointed out in Chapter I,is at the heart of a revitalized national nutrition policy.We need information in order to know what nutrition problemswe have, and how existing programs and plans are impactingon these problems.

The major health problems of the United States includeheart disease, cancer, diabetes, osteoporosis, and otherconditions which, to the best of present knowledge, are atleast partially exacerbated by what people ingest in theirdiet.

Major social and educational issues turn on nutrition-relate/. concerns as well. Inflationary food prices placepressure on the social security recipient, which in turncreates pressure for increases in benefit levels. Lack ofan adequate breakfast for a school-age child, for whateverreason, may lead to less then optimum learning conditions.

Dr. Aaron Altschul of the Georgetown University Schoolof Medicine believes:

A policy of surveillance and monitoring may well bethe cornerstone of a National Nutrition Policy, andeight well be the structure upon which to build acoordinated nutrition policy. (1)

The Panel on Nutrition and Government states the issueas follows:

A primary deficiency in the development of both policyand programs is the lack of information--the kind ofinformation which would be supplied by a surveillanceand monitoring system...we have scattered bits ofinformation but these do not tell us what we needto know. (2)

An evaluation of the impact of food price changes on nutri-tional status conducted by the Committee staff in January oflast year concluded:.

Rapidly rising food prices in 1973 had an adverseimpact on the diet of the average American family,but the full extent that impact had--especially onthe poor, elderly, and low incomeis obscured andmay never be known. Government information

(43)

48

gathering in this vital area is severelydeficient. (3)

That study went on to point out:

Neither the special Ten-State nutrition survey conductedby HEW between 1968 and 1970, nor the National Healthand Nutrition Examination Survey (H.A.N.E.S.) linkmonth-by-month or even year-to-year changes in foodprices to either food consumption or actual nutrientintake. (4)

The Department of Health, Education and Welfare concedes,with resp,:ct to the H.A.N.E.S., data:

These preliminary data permit only limited generalconclusions concerning the nutritional status ofthe U.S. population. (5)

Dr. John E. Kinsella of Cornell University argued, inaddressing the Panel on Nutrition and Government that, regard-less of the effect of food pri_e changes, there is a continuingneed to monitor whit people are eating:

There are many justifications and needs for establishingregularly recurring or continuing food consumptionsurvey!, Frequent surveys are needed...as supplyalters and as economic status of consumers change. (6)

Dr. Kinsella also suggested other needs, including therelationship of eating habits to health, especially arterio-sclerosis and heart disease, as well as to facilitate usefuldesign of educational programs. (7)

Another major theme raised in recent years has been thechanging nature of food itself. Dr. L. M. Henderson of theUniversity of Minnesota, in a paper presented to the AmericanPublic Health Association's ninety-ninth annual meeting,observed:

To begin with, future patteAs of food consumptionare not at all clear and if they were, the nutritionalimplications would not be easily predict:ine. (8)

In discussing these trends, the panel suggested that:

This change takes place mostly for reasons thathave nothing to do with nutrition. It may be theavailability of food; it may be money to buy food;the availability of convenient forms of food; foodhabits have changed or been encouraged to changeby the cultural influences. (9)

These changes include the total amount of food consumed,excessive intake of some nutrients; or reduction of certainfoods in favor of others. Above all, some changes are forthe better, while some are for the worse. The first prioritythen is to find out what is happening.

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For these reasons the 1969 White House Conference madenational nutritional surveillance a major point within itsrecommendations. Panelists unanimously agreed that bothmonitoring and surveillance programs were necessary, andurged that these programs:

Gather data that will serve as the basis of appliednutrition programs aimed at the improvement of thenutritional status of the American population withemphasis on the poor. (10)

The Panel on Nutrition and Government expanded theserecommendations to include suggestions that any new surveil-lance system include:

1. Food consumption surveys;2. Composition of food;3. Monitoring of food additives; and4. Evaluation of nutritional status.

The Committee staff therefore recommends that a NationalNutritional Surveillance System be an integral part of theNational Nutrition Plan. Such a system, which should bedeveloped under the auspices of the proposed Federal FoodNutrition Office would include a broad cross section of datacollection instruments. The system would work only if itwere "sensitive" to the impact of changes in policy. Sensi-tivity in this technical sense (borrowed from systems theory)means that an increase in Food Stamp allotment levels duringone month ought to show up in terms of increased food consump-tion among program participants in subsequent months, if theprogram is working as intended.

Nutritional Surveillance System

The kind of nutritional surveillance required by the nationis too urgent to permit further delay while researchers attemptto develop some perfect national nutritional index which iseasy to collect and tabulate. The struggle for better methodsof measurement must take place simultaneously with ongoingcollection of the best available indicators we already have ontap.

A nutritional surveillance system ideally would be developedin four phases:

1. Identification of the strategic goals of nationalnutrition policy.

2. Listing of those kinds of data which are essentialto achieving these goals. If we want to reducethe level of salt in the average diet, we must knowhow much salt people are consuming over a period oftime.

3. We must translate these essential elements of infor-mation into a set of possible indicators which couldhelp answer the basic question at hand. We mightlist, using the above example, annual commercial

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sales of salt for human consumption, the currentestimated population of the United States, andincidence rate of hypertension as possible indi-cators of where the nation stood on salt consump-tion.

4. Once a list of indicators is developed, a planto collect such information is needed. The p anwould specify which indicators would be utilized,who would collect the data,and provide for dissem-ination of the information to appropriate agenciesand activities.

Each step in this process is essential. Information shouldnot be collected merely because it is "nice to know" or someresearcher would like to have it. Business and governmentagencies at the action level are currently being inundated withforms and documents to fill out concerning all kinds of ,ata.The nutrition surveillance effort of this country should be tiedat the outset to policy goals.

Once we know our goals, we need to specify what kinds ofInformation are essential to achieving these goals. This step,development of essential elements of information, is the heartof any future system of nutritional surveillance.

The next phase, development of some behaviorally definableparameters which might constitute evidence, one way or another,as to some essential element of information (e.g. the incidenceof malnutrition in the United States) is equally essential.Malnutrition is a state of being which must be inferred at theclinical or the societal level by observation of somethingmeasurable.

Finally, all these things need to be related to an ongoingplanning process.

The Committee staff believes that any viable nutrition sur-veillance plan must be worked out by experts and does not wishto second -guess what a Federal Food and Nutrition Office staffmight propose as an effective method to implement su h a plan.As outlined above, the national nutrition policy goals willhave to be articulated in some detail before the kind of dataessential to implementing such a plan can be specified oralternative measures assessed. In developing such a plan theF.F.N.O. would clearly have to take into account the cost ofcollecting data as welt as its level of accuracy.

Nonetheless, the panel made four specific suggestionswhich ought to be considered as appropriate kinds of methods for

getting a clearer picture of where the nation stands, nutrition-ally speaking:,

1. Evaluation of Food Purchase and Consumption

Short-term methods could be used to monitor the effects offood price changes and supplies. The panel recommendedthat

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A series of sites should be identified and a systemdeveloped which will continuously monitor changesin purchasing patterns. With modern computertechnology it should be possible to record thechanges on a month-to-month basis. (11)

The Committee staff oelieves consideration should also begiven to use of a National Consumer Panel to obtain such infor-mation. Such a system .as worked effectively in Great Britainand has even been utilized by commercial firms in the U.S. forseveral decades.

Congress might even consider purchase of proprietary datasuch as that collected by the Market Research Corporation ofAmerica's National Menu Census or data available from theNational Purchase Diary. Both have month-to-month data onfood consumption (and preparation) patterns going back fornearly 30 years in some cases.

The existing government collection effort--the decennialsurvey of Food Consumption done by the Department of Agricul-ture--while a valuable aid in understanding trends is largelyof only historical value. The most recent data, for example,was collected in 1965.

The Committee believes that once published, the Healthand Nutrition Examination Survey (intended to be repeatedevery 5 years) may alleviate some of the information gaps,but urges that a stepped-up pace of collection (perhaps onceeach 4 years for a complete cycle of observation) be adopted.If such a cycle coincided with the Presidential elections,administrations might even be held accountable for theirnutrition policies.

2. Nutrient Cor ,sition of Food

Analysis of dietary patterns will not provide much insightunless the nutrient contents of foods are also monitored.Recent revelations that a major chain store in New York Statehad been diluting milk with water for several years highlightsthe need for ongoing surveillance.

, The national food supply is changing rapidly, and new food;of uncertain composition are entering the market at a rapidrate. Even familiar foods ci.Inge in quality with time--soilleaching denudes products of essential vitamins formerly foundin ample quantities.

The panelists suggested monitoring the nutrient contentsof food on a random sampling basis, with data indexed andencoded ono a computerized record accessible anywhere in thenation.

3. Food Safety

All foods should be monitored for the presence of poten-tially hazardous chemical agents, food additives, or inadver-tent contaminants, or for other such potentially dangerousmaterials as may occur naturally in foods--according topanelists.

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This information could be part of a consolidated nationalrecord, which would include provision for storage of samplesso that retrospective evaluation can be made as new problemsor inte.ests arise. (12)

4. Evaluation of Nutritional Status

Panelists were interested not only in the H.A.N.E.S.survey being conducted by HEW but also in developing specialsurveys for use in local areas fauing specific nutritionalproblems.

While the national survey ought to reveal the kind andextent of nutritional problems of a national nature--such asobesity and other medically related conditions caused byexcessive food consuaption a. well as deficiency conditions--local surveys could emphasize measurement of the impact ofnutrition education in a local program or evaluation ofdietary habits unique to a particular population.

The panelists also noted that a great deal of data isalready collected by primary care practitioners from theirpatients. Doctors, clinics, school health programs, andother local activities routinely obtain data of value in moni-toring national nutritional status. If methods of insuringconfidentiality could be developed, existing medical recordscould be an invaluable addition to the national data bank onnutrition.

B. Nutrition Education

The vital nead for improvement of nutrition education hasbeen recognised for some time. It was the first item on theagenda for Nutrition Committee members after the NationalNutrition Policy Study hearings ended last June. A bill--the National Nutrition Education Act of 1974 (S.3864)wasintroduced last July 31st.

Since the White House Conference on Food, Nutrition andHealth in 1969 there have been two major additional conferencesand at least one major comprehensive study on nutrition education.

The Conference at Williamsburg, Virginia, in 1972, broughttogether experts from the Council on Food and Nutrition ofthe American Medical Association, the Nutrition Foundation,the Azzrican Heart Association, and the U.S. Public HealthService, among others.

The other large scale conference, involving 44 dentalschools, was held at M:I.T. under Nutrition Foundation sponsor-ship. (13) In addition to these two conferences, Dr. WilliamDarby, President of the Nutrition Foundation, also remindedpanelists about a year-long study by the American DieteticAssociation projecting training needs for dietitians for thelong-term future. (14)

Dr. Darby expressed his grave disappointment to the Committeethat despite this ample documentation of the need for greatersupport of nutrition education, "...there has not yet beenmade available to medical and dental schools, funds specifi-

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tally for this purpose." (15) Dr. Daroy's concern was thecrucial link between education and the world food crisis:

I submit that in the field of food science andtechnology--an integral portion of which isnutrition--there is a great opportunity forincreasing, enhancing, the food supply and thenutritional level of the countries that, at thepresent time, we consider to be the so-calleddeveloping world. It is crucially important,therefore, that we integrate nutrition into theteaching in our departs. cs, universities--ourinstitutions that develop food scientists andtechnologists. (16)

Unfulfilled Needs in Professional Education for Health Services

The panel concluded that:

The development of a national food and nutritiohpolicy will require increased numbers of profes-sionally trained people. The numbers and kindswill depend upon the nature of the policy even-tually developed. We would insist, however, thatthe primary aim of such a policy must I..5 themaintenance and improvement of health--thehealth of all people, affluent as well as thedisadvantaged. (17)

and

The major responsibility must therefore fall uponthe health system--physicians, nurses, dietitians,nutritionists, health auxiliaries, etc. Thecurrent system transmits precious little nutritionalinformation to physicians who um inevitablyoccupy a leading role...(18)

Ruby P. Puckett, Director of the Food and NutritionServices at the J. Hillis Miller Health Center of theUniversity of Florida, pointed out, however, that eventhough:

Ne all agree that physicians should be educated innutrition; but with t)e move to reduce the numberof years that one attends school to become aphysician, it seems more important that theclinical dietitian be the knowledgeable one of thetotal team in nutrition and '-od. (19)

Constance McCarthy, Chief of ... _ Public Health NutritionService of the Rhode Island School of Public Health arguedsimilarly on behalf of public health nutritionists:

I an very concerned about the dilution of thescope of public health nutrition services at thefederal level....We are finding a drastic decreasein the number of program areas that are beingcovered by professional nutritionists. (20)

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Without taking sides on which profession is "more impoz-tant'i-they are all important--it is clear that there is aconsensus on the need for stepped-up nutrition education for abroad range of health professionals.

The panel recommendation expressed this consensus:

To provide support for training of all health professionals

as called for by the Williamsburg Conference. (21)

Unfulfilled Needs of Land-Grant Institutions

The panel concluded:

The crucial importance of integrating nutrition intcfood science and technology is evident in view ofthe increasing industrialization of food productionand distribution in all Western countries butespecially within the United States and the depend-

ence upon industrial developments in concert withimproved practices for meeting world food needs. (22)

But the panel found the present institutions ill-equippedto meet these growing demands. As they put it, the "virtualdearth of well-trained personnel...makes it difficult tomet this challenge and the educational need within theseinstitutions". (23)

They therefore recommended:

That support continue to be provided for nutritionand health programs in the land-grant institutionswith a special emphasis on the development ofpersonnel and programs of "1890" schools. (24)

Unfulfilled Needs for Teacher Education

For health professionals, food specialists and agricul-tural scientists to improve the quality of their knowledgeof nutrition is only half the problem. Public nutritioneducation is also needad if new knowledge is to benefit theaverage citizen.

If the public is to be reached, the educational systemis clearly a major institutional vehicle. But, as the panelobserved: "The level of understanding of nutrition by amajority of America's teachers is low." (25) The panelattributes this lack of knowledge to

Current nutrition education and teaching programsdurinZ the formal learning experiences from kinder-garten through college are largely ineffective ornonexistent. Frequently what is taught is misleadingor unsound. (26)

W Black land grant institutions recently elevated to equalitywith other land grant institutions by Public Law 89-106

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and

The lack of sound, well-prepared, challenging educa-tional materials and failure to commit school timeto nutrition education have limited the healthbenefits derivable from our abundant wholesome foodsupply. (27)

The panel recommended:

1. An intensive national effort to provide nutritioneducation to teachers in colleges and universities.

2. Support for in-service and continuing educationafter graduation.

3. Support for a series of summer institutes innutrition and food modeled on the National ScienceFoundation programs of science teaching institutes.

4. Utilization of modern multi-media materials andtechniques to instruct teachers without priorexperience in these fields. (28)

The panel also went on record as favoring Resource andDevelopment Training Centers at selected universities andcolleges.

National Nutrition Education Act

The response by the Committee to these suggestions wasthe National Nutrition Education Bill of 1974. In introducingthis legislation, Committee Chairman George ":Govern (D-SouthDakota) observed:

This bill represents the first legislative actiontaken directly from the recommendations of theNational Nutrition Policy hearings held this Juneby the Nutrition Committee. (29)

In his floor remarks, Senator McGovern observed:

At the present time there is no comprehensive legis-lation which allows for the teaching of nutritioneducation in the nation's schools. We feed 2Smillion children a day in the School Lunch Program,but we do not take advantage of that opportunityby educating them at the same time as to foodchoices, dietary habits and nutrient content...(30)

C. Nutrition Research

In terms of government policy, the highest priority innutrition research ought to be develoyment of better, cheaperand more reliable methods for measuring .utritional status.The National Nutrition Surveillance Systeo proposed in thisreport would necessitate development of su6, instruments ifthe concept is ever to become operational.

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Our present weaknesses in this area should not, howeier,be used as a rationalization for delay of comprehensive andrealistic policies which can be instituted now, withoutfurther research.

We must simultaneously act on the best informatior wehave while acquiring better techniques of assessment forthe future.

The panel also suggested other important researchpriorities:

Increased understanding of nutritional requirements;

Better information on the effects of malnutrition;

Research into the impact of changing patterns offood consumption;

Better understanding of the relationship ofeconomic and social problems on nutritionproblems; and

Better understanding of basic metabolism. (31)

The panel argued that such research could only comethrough support of training programs for research per.,onnel,and significant increases in research funding. (32)

The Department of Agriculture prepared a special reportfor use by the panel and the Nutrition Committee outliningsome of the major arguments for substantial nutritionresearch efforts:

First, major health problems are diet-related.USDA observed that "most of the health problemsunderlying the leading causes of death in theUnited States could be modified by improvementsin the diet." (32)

Second, the real potential from improved dietis preventive. While data supplied to the Committeeprecludes quantifying the potential benefits,virtually all clinicians and nutritionists con-sulted were convinced that improved diet coulddefer or modify the severity of many diseaseconditions. But these same experts observed thatpresent research has emphasized the food needs ofnormal persons, suggesting that a major change inthrust eght be appropriate if the full benefitsof this knowledge were to be obtained. (33)

Third, everybody would benefit from suchresearch. Not everyone gets cancer or heartaIFIFITiTT But everyone eats. Basic research intodiet, nutrient requirements and other basic knowledgewould benefit people of all ages, regions of thecountry and economic status. To the extent thatresearch helps the homemaker cut costs withoutcutting out essentials, such research could evensave people money.

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Fourth, the benefits are long range. ,We donot yet fully understand the relationship of dietto health. It is likely that minor changes in foodhabits instituted at an early age might well avoidserious changes later on in life. One intriguingindication of the possible ecology of food andsociety is the following:

1he highest death rate areas generally correspondto those where agriculturalists have recognizedthe soil as being depleted for several years.This suggests a possible relationship betweensubmarginal diets and the health of succeedinggenerations. (34)

In addition to these four major arguments for nutritionresearch, panelists at the hearings expressed two otherconcerns:

1. Present research lacks coordination.

2. Food fortification concepts should receivemore field testing.

The panel also appeared to resent the present lack ofemphasis given to nutrition concerns in National ScienceFoundation sponsored programs. Panelists believed theNSF could perform a much more aggressive coordinating rolein facilitating a comprehensive program of research for thenation in the area of nutrition.

The staff shares the view of the panel about the needfor new priorities, but concludes that greater federalfinancial support is more urgent than organizationalrestructuring at the present time.

There is an important relationship, nonetheless, betweenthe need for more research and the proposals contained inthis report. Essentially, the development of a NationalNutrition Plan, with its requirement of goals and objectiveswhich are ranked according to importance will provide theDepartment of Health, Education and Welfare, as well asthe Department of Agriculture, a better basis for evaluatinggrant proposals.

Under our proposed National Nutrition Plan it will bepossible to integrate the entire federal nutrition researcheffort into a single coherent focus. The time, intelligenceand resources of the scientific community will be harnessedto promote the health of the American people through improvedunderstanding of nutrition.

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BIBLIOGRAPHY

Introduction

(1) of A "National Fooditiary'7.,asi-ported in: "Food

Price Changes and Nutritional Status", Volume I, SenateSelect Committee on Nutrition and Human Needs, February 1974.

(2) "Food Price Changes and Nutritional Status", Volume II,Senate Select Committee on Nutrition and Human Needs,April 1974.

(3) United States Department of Agriculture, Op. Cit.(4) Science, Volume 184, April 1974, pp. 413.(5) MU:7pp. 414.(6) Ibid., pp. 414.(7) Ecology, Volume 216, No. 6, Spring 1973.(8) Goldsmith, Dr. Grace A. "A National Nutritional Policy and

Program", American Journal of Clinical Nutrition, Vol. 26,pp. 901 -905, September 1973.

(9) Peters, Sir Rudolph Albert, "The Neglect of Nutrition andits Perils", American Journal of Clinical Nutrition, Vol.26, pp. 750-777751FITFeibiT1773.

(10) Ibid., pp. 750.(11) Mayer, Dr. Jean, "Towards a National Nutrition Policy",

Science, Vol. 176, pp. 237-241, April 21, 1973.(12) MU:7pp. 439.(13) Ibid., pp. 439.(14) Ibid., pp. 440.(15) Senate Select Committee, Op. Cit.(16) Mayer, Dr. Jean, testimony before Senate Select Committee

on June 21, 1974, reported in "National Nutrition PolicyStudy Hearings", Vol. 7-A, Senate Select Committee oaNutrition and Human Needs, 1974.

(17) Goldsmith, Dr. Grace A., testimony before Senate SelectCommittee on June 21, 1974, reported in "National NutritionPolicy Study Hearings" Vol. 7-A, Senate Select Committeeon Nutrition and Human Needs, 1974.

Chapter I

(1) National Nutrition Consortium, Inc., "Guidelines fot aNational Nutrition Policy", Senate Select Committee onNutrition and Human Needs, May 1974

C2) Hegsted, D. Mark, opening statement "National NutritionPolicy Study Hearings", Vol. 7 -A, Senate Select Committeeon Nutrition and Human Needs, November 1974

(3) Hegsted, Op. Cit.

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(4) Munro, Hamish N., "Impact of Nutritional Research on HumanHealth and Survival", Federation Proceedin s, Vol. 30,No., 4, pp. 1403-1407, July-August

(5) Munro, Op. Cit.(6) Gage, John, statement, "National Nutrition Policy Study

Hearings", Vol. 7-A, Senate Select Committee on Nutrition andHuman Needs, November 1974.

(7) Gage, Op. Cit.(8) White House Conference on Food, Nutrition and Health, Com-

prehensive Report, December 1970.(9) National Nutrition Consortium, Op. Cit.

Chapter II

(1) Lewis, Dr. Irving, testimony before Senate Select Committeeon June 21, 1974, reported in "National Nutrition PolicyStudy Hearings', Vol. 7-A, Senate Select Committee onNutrition and Human Needs, November 1974.

(2) Lewis, Op. Cit.(3) Lewis, Op. Cit.(4) White House Conference on Food, Nutrition and Health, Op. Cit.(5) Ibid.(6) Ibid.,

(7) Ibid.(8) Ibid.(9) Ibid.

(10) ibid.(11) "National Nutrition Policy Study Hearings", Vol. 7-A,

Senate Select Committee on Nutrition and Human Needs,June 21, 1974.

(12) Op. Cit.(1:) Op. Cit,(14) Op. Cit.(15) Hegsted, Dr. D. Mark, testimony cited "National Nutrition

Policy Study Hearings", Vol, 7-A, Senate Select Committeeon Nutrition and Human Needs, June 21, 1974.

(16) Panel on Nutrition and Government, cited "NationalNutrition Policy Study Hearings', Vol. 7-A, Senate SelectCommittee on Nutrition and Human Needs, June 21, 1974.

(17) Ibid.(18) Ibis'

(19) 'bit..

(20) Ibid.(21) Ibid.(22) Ibid.(23) Ibi.(24) McGovern, Senator George, cited "National Nutrition

Policy Study Hearings", Vol. 7-A, Scnate Select Committeeon Nutrition and Haman Needs, June 21, 1974.

(25) Kennedy, Senator Edward M., cited in: "National NutritionPolicy Study Hearings Report of the Panel on Nutrition andHealth", Senate Select Committee on Nutrition and HumanNeeds", 1974.

(26) Ibid.(27) Ibid.(28) Ibid.(29) Ibid.(30) Ibid.(31) Ibid.

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(32) Ibid.(33) National Nutrition Consortium, Inc., Op. Cit.(34) rbio.(35) Report of the Panel on Nutrition and the Consumer, National

Nutrition Policy Study Hearings, Senate Select Committee onNutrition and Human Needs, 1974.

(36) Op. Cit.(37) Report of the Subpanel on Popular Nutrition Education,

National Nutrition Policy Study Hearings, Senate SelectCommittee on Nutrition and Human Needs, 1974.

(38) Report of the Subpanel on Nutrition and Disease, NationalNutrition Policy Study Hearings, Senate Select Committee onNutrition and Human Needs, 1974.

Chapter III

(1) Altschul, Dr. Aaron, testimony cited in: National NutritionPolicy Study Hearings, Vol. 7-A, Senate Select Committee onNutrition and Human Needs, June 21, 1974.

(2) Report of the Panel on Nutrition and Government. NationalNutrition Policy Study Hearings, Senate Select Committeeon Nutrition and Human Needs, June 21, 1974.

(3) "Food Price Changes and National Nutritional Status", Vol. I,

Senate Select Committee on Nutrition and Human Needs,February 1974.

(4) Ibid.(5) "Preliminary Findings of the First Health and Nutrition

Examination Survey, U.S., 1971-72, "National Center forHealth Statistics, January 1974.

(6) Kinsella, Dr. John E., statement cited in "National NutritionPolicy Study Hearings", Vol. 7-A, Senate Select Committeeon Nutrition and Human Needs, June 21, 1974.

(7) Henderson, L.M., "Nutritional Problems Growing Out of NewPatterns of Food Consumption", American Journal of PublicHealth, Vol, 62, No. 9, September 1972.

(8) Report of the Panel on Nutrition and Government, Op. Cit.(9) Ibid.

(10) White House Conference, Op. Cit.(11) Report of the Panel on Nutrition and Government, Op. Cit.(12) Ibid.(13) Mayer, Dr, Jean, Op. Cit.14) uarby, Dr. William, testimony cited in "National Nutrition

Policy Study Hearings", Vol, 7-A, Senate Select Committeeon Nutrition and Human Needs, June 21, 1974,

(15) Ibid,(16) Ibid,(17) Panel on Nutrition and Government, Op. Cit,(18) Ibid.(19) Puckett, Ruby M., testimony cited in "National Nutrition Policy

Study Hearings" Vol. 7-A, Senate Select Committee on Nutritionand Human Needs, June 21, i974.

(20) Ibid., Testimony of Constance McCarthy.(21) Panel on Nutrition and Goveinment, Op. Cit.(22) Ibid,(23) Ibid.(24) Ibid.(25) Ibid.(26) Ibid.(27) Ibid,(28) Ibid.

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(29) McGovern, Senator George, "National Nutrition IducationAct: First Step Towards a National Nutritional Policy",news release, July 31, 1974.

(30) Ibid.(31) Report of the Panel on Nutrition and Government, Op. Cit.(32) Ibid.(33) United States Department of Agriculture, "Current Programs

of Human Nutrition Research in the USDA", June 1974.(34) Ibid.

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PREFACENational Nutrition Consortium, Inc.9650 Rockville Plke, Bethesda, Maryland 20014 Telephone (301) 530-7050

Toward a National Nutrition Policy

The past year may represent a turning point in history. Numerousdevelopments including the energy crisis, inflation, rising food costsand depletion of our food reserves have convinced many knowledgablepeople that we are now entering an era which will be characterized by ashortage of resources including food. The high energy cost of producingfood makes it clear that food and the energy supply are inextricablylinked. For the first time, the capacity of the United States to feeditself and meet its world food commitments is being seriously questioned.A world food crisis exists at this time, and this will have seriousrepercussions in this country.

The first requirement of a food supply is that it provide a nutritionallyadequate diet for the population. We must first supply what we need evenif we cannot supply what we want.

New attitudes, priorities, and a restructuring of responsible

governmental agencies and their programs will be required if we areto deal effectively with food and nutrition problems that we face nowand in the future. We must create the social and political climatewhich will make this possible and this will be a complex process.This statement on a national nutrition policy by the National NutritionConsottium indicates the essential components of such a policy and weurge that action be taken now to initiate its development.

April 1974

D. Mark HegstedChairman, Board of Directors

(59)

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FOREWORD

Governments are established in order that man, through his collec-tive efforts, may fulfill his needs for survival and security: and, withincreasing affluence, enjoy the benefits and comforts that arise fromshared abundance. To accomplish this, high priority must be givento protection of the individual by assuring him the best opportunityof procuring and utilizing food to fulfill his basic needs.

The costs of meeting these needs and the level of abundance atwhich they are fulfilled vary with the socioeconomic, cultural, andtechnologic level of a particular society. Indeed, these features areeverchanging as a society evolves from its early primitive structure--concerned primarily with survival and security-- to the complex,technologically developed, affluent organization as currently existsin North American and European countries. In these latter societies,,the majority of the population is concerned with maintaining thestandards of health, comfort, convenience and enjoyment that areunattainable b less developed societies. Government, of the highlydeveloped societies have recognized new responsibilities of food supply,quality assurance and health protection that arise with developingtechnology.

Large-scale technological production of foodstuffs has createdunique circumstance, that require new sstems of regulations andI onitoring; and new understanding by the public in order to attainmaximum benefit, with minimal risks.

From the founding of this Government, in 1776 to the present,the United State, has grown from a population of 3 million to over 200million. The high standard of living aml level of health of the Nationare result,; of technologic development. The technolog,n. applicationof science in agriculture makes it possible for less than 4 percent ofthe population to prodin the abundant agricultural supply of thisNation --in ,triking contrast to the earlier situation, and that per-taining today in developing, :ountrie, here GO percent to SO percentof the population are engaged in avieniture with l'Ating and healthstandards in markod contrast to those of the United stftte-;.

According'', ..encise -latetnent of a National Ntitri ion Pono istimely and de..,irabh,. The Naf 1Int! Notrition (consortiumrepre-senting four maj'u ,chntifit ar,d profe,:onai sm.it tips,' the ,nember-,'Iio, Of which haw, e,ponilitie, for developin(z, ;hroazh research,'nio' knowledge in nutrit p and food ,cicuce in Iolation to inan'sneeds for health---has addressed to 1,r;,;aratifq. gid( lines ror

Thr itorricu, ln,lit it< t Nt trit for Clinicalt.; and The of Te.-1)-

.1140v, Thc 'ngat117,:,t1i111.11.'.% cotilloili.,tioeinl.wr-ilip iippr \itilao.1\ 40,000-41ilitificallr trained profe.Nionak

(61) 64

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a National Nutrition Policy. TJese are presented'nt order to identifythe many considerations to be brought into focus in effective long-range governmental planning and implementation of programs forfoods and nutrition in relation 'to the Nation's health and othernational responsibilities,

I. NEED FOR A STATED NATIONAt. NUTiirriON P01,1111;

A stated National, Nutrition Policy is needed to ensure that foodwill be available to provide an adequate diet at ,a reasonable cost toevery person within the United States. Food to provide good nutritionis a fundamental need of every, member of ,society.. In order that hemay utilize food to greatest benefit, the individual must have somebasic understanding of food and nutrition in relation to requirementsfor healthincluding informa#ion con crning the products which hepurchases.

Nutrient requirements of the population should be defined andtranslated into terms of food in developing plans' for food productionat the agricultural and manufacturing level. The nutritional con-tribution of foods as well as their.econornic importance must receiveconsideration. Agricultural and nutritional policies should be coor-dinated. The production of suffieicnt food to fulfill the needs of allsegment, of the population must be accompanied by an adequatedistribution system. The .piality and safety of the food supply mustbe assured by quality control of production and by regulatory controlsand surveillance.

A National Nutrition Policy is needed to fulfill our commitments asa Nationin cooperation with other nations and internationalorganizationsin planning and devising measures for provision ofadequate food for the expanding world population. This includes themaintenance of adequate world reserves of food, provision of technicalassistance to developing nations, pa. Licipa ion in world trade andassistance in provision of fc'ds in emergency situations are importantaspects of international nutrition responsibilities.

Go.ms or A NATIONAL, NUTRITIoN Poney

The goals of a National Nutrition Policy should be to:1. Assure an adequate wholesome food .pply at reasonable

cost to meet the needs of all segments of the population. Thissupply to be available at a level consistent with the affordablelifestyle of the era.

2. Maintain food resonrees- sufficient to meet emergency needs;and to fulfill a responsible role as a Nation in meeting world foodneeds.

3. Develop a level of sound public knowled, a and responsibleunderstanding of nutrition and foods that will promote maximalnutritional health.

4. Maintain a system of quality and safety control thatjustifies public confidence in its food supply.

5. Support research an' education in foods and nutrition withadequate resorces and reasoned priorities to solve importantcurrent problem t and to permit c: ploratory basic research.

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III. MEAsurtEs TO ATTA I N GOALS

To attain these goals, it is essential to:L Maintain surveillance of the nutritional status of the

population and deterrne the nature of nutrition 1 problemsobserved.

2. Develop programs within the health care system that willprevent and rectify nutritional problems.

3. Assist the health professions in coordinated efforts toimprove the nutritional status of the population through thelife cycle.

4. Develop programs for nutrition education for both healthprofessionals and the general public.

5. Identify areas in which nutrition knowledge is inadequate,and foster research to provide this knowledge.

6. Assemble information on the food supplyincluding foodproduction and distributi:)aand provide a nutritional input inthe regulation of foreign agricultural trade.

7. Determine the nutrient composition of foods and promote,and monitor food quality and safety.

8. Cooperate with other nations and international agencies indeveloping measures for solving the world's food and nutritionproblems.

IV. PROORAMs NEEDED To NIEET OBJECTI V ES

Seven major phases are needed; they are:1. The nutritional status of all segments of the United States

population should be monitored continuously with periodicnational reporting of:

a. the prevalence of specific nutritional problems;b. the effects of various preventive and remedial pro-

grams or. nutritional status and on prevalence of nutritionalproblems; and,

c. food consumption of various population groups.2. Nutrition programs should be established and expanded in

the Health Care system, giving consideration to the followingpoints:

a. Maintenance of good nutrition in all segments of thepopulation should be promoted through Health CareCentersclinics, hospitals, neighborhood centerswhichshould be responsible for nutritional diagnesis and coun-selling. Good nutritional practices should be an integralpart of services in nursing homes, day care centers, orphan-ages, prisons and other institutions.

b. Alleviation of malnutrition in disadvantaged groups isof high priority. These groups include the poor, those athigh risk, infants, pregnant women, the elderly, migrantworkers and other minority groups. Programs may includefood stamps,, commodity distribution, food supplements,and school feeding programs.

r. The prevention and therapy of nutritional problems is itcontinuing public health responsibility. Current problemsinclude anemia, obesity, delayed growth and development of

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children, mild' or potential vitamin' deficiencies, and nutri-tional problems related to' a wide variety of 'disease statessuch as coronary artery disease, malabsorption syndromesand other gastrointestinal disorders, inborn errors of metabo-lism, diabetes, allergic conditions andrenal disease.

d. Programs should include provision of a nutrition compo-nent in all Health Care Centers in all geographic areas.Nutrition services should be under the directionat 'somelevelof a professional with competence in nutrition ordietetics.

Provision of nutrition services should be included ni plansfor benefits provided by National Health Insurance.

e. Nutrition centers of excellence for diagnosis, treatment,research and training should be established in various partsof this country.

3. Nutrition information should be incorporated into all !owlsof formal education.

a. In schools: Nutrition should be a basic curriculumrequirement in all elementary schools and high schools.

The School Lunch Program should used to assist innutrition education through correlation with teaching inthe classroom.

All teachers should receive training in nutrition.Courses in nutrition should be available in colleges and

universitiesb. Training of nutrition professionals and paraprofessionals,

physicians, dietitians, public health nutritionists, dentists,nurses, veterinarians, social workers, physical educationteachers and health educators should have high priority.Both undergraduate and postgraduate training is needed, aswell as continuing education.

Medical schools should be encouraged to establish facultyand resources for teaching nutrition in clinical as well aspreclinical departments; and nutrition training and servicesshould be promoted in hospitals and clinics.

The Land Grant Universities should continue and expandtraining in the areas of food and nutrition.

c. Scrum' nutrition information for the general publicshould be carried out through all components of the com-munications mediaincluding Federal, State and local de-partments of education, cooperative State Exte.lision Services,colleges and universities, community agencies, industry andthe mass media.

Food labeling and food advertising can contribute sig-nificantly to nutrition knowledge. Labeling am; advertisingregulations should require presentation of truthful nutritioninformation in all instances where nutritional claims aremade.

Nutrition education can be incorporated in such programsas the Food Stamp Program and in supplementary feedingprograms.

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4. Nutrition research should be supported at all levels. Basicand applied research in nutrition are both essential for solvingcurrent and future problems.

Research should be supported in colleges and universities, innutrition centers of excellence, in health care facilities, in specialinstitutes, in industry and in the Federal agencies. Support fortraining of nutrition scientists to conduct such research shouldhave high priority.

Among the agencies with responsibilities for nutrition-relatedresearch are the Food and Drug Administration, the NationalInstitutes of Health, the Department of Agriculture, the De-1 -ia,.4- ,tent, of Defense, the Veterans' Administration, the Depart-ment of Conunerce and the Environmental Protection Agency.

Researci. support should be provided for all areas of roodproduction, process,ng and use.

The exi:iment stations in the 50 States have responsibilitiesfor research in both food science and experimental nutrition.Food science and human nutrition deserve especially highpriori ties.

Coordination of nutrition research activities among all depart-ment.; and divisions of the government is highly desirable.

5. Food production and distribution in the United States andin other parts of the world should be considered from the stand-point of nutritional policy.

Increased agricultural production should be encouraged, in-cluding greater yields, and development of new genetic types offood %Ott' improved nutrient content.

More beneficial distribution of foods should be plannel.Food reserves should be established and maintained.Priorities in international trade in agricultural commodities

should be planned to make the best use of supplies to meet theneeds in the United States and in developing countries of theworld.

6. Nutrient composition, quality and safety of foods deservecontinuous study and assessment.

The development of wholesome new foods such as formulated,fabricated and convenience foods, as %yell as the fortification offoods should be encouraged.

Informative food labeling can aid in educating the consumerin nutrition, and can assist him in his choice of foods, so that agood diet can be obtained.

Research in food scie, e and technology has an important rolein the total nutrition program and is a responsibility of Govern-ment, as well as of industry and academic institutions.

Regulation of food quality and safety is an essential aspect ofa National Nutrition Program. Periodic review of regulatorycontrols permits changes as needed.

Research in all aspects of the quality and safety of foods shouldreceive high priority.

7. Programs to fulfill the responsibilities of the United Statesas a Nation to other countries, in cooperation u ith nftt:onal andinternational agencies, should be a permanent part of the Na-tion's policy.

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In view of the high ,prevalence of malnutrition throughout thedeveloping countries, of the world and the rapidly, expandingpopulation, the critical areas are:

population control and family Planning; ,

food production;food science and technology;economic development ; ,

knowledge of nutritional science and applied,nutrition;social and cultural changes; and,education.

These areas require financial support and technical assistance bythis country, other developed nations and international groups,industry, foundations, philanthropic organizations and privatecitizens.

V. REQUIREMENTS TO ESTABLISH AND EFFECTIVELY IMPLEMENT

An effective plan for establishing and implementing a NationalNutrition Policy should provide for the following:

1. Formation of a food and nutrition policy board at a high levelin the Government.

2. Establishment of an Office of Nutrition or a National Nutri-tion Center to develop plans and programs for implementation ofa National Nutrition Policy.

An Advisory Nutrition 'Council or Board composed of repre-sentatives of various organizations will special competence indealing with food and nutrition problems should be formed toadvise the Office of Nutrition (National Nutrition Center) inplanning and evaluating a National Nutrition Program.

Responsibilities and activities of the Office of Nutrition (Na-tional Nutrition Center) should include:

a. Identification and coordination of food and nutritionprogram.; in various governmental agencies.

b. Provision for continuing food and nutrition surveillance.This should include: (1) monitoring of the food suprIv;

(2) continuing general surveys of the nutritional status of thepopulation; (3) in-depth studies of specific public health prob-lems related to nutrition; and, (4) continuing accumulationof information relative to food consumption and food com-position.

Some or all of these activities could be assigned to appro-priate organizations or agencies.

The surveillance system should be designed to utilize notonly survey sources but also centers of health services andeducation, monitoring efforts of Federal and State govern-men agencies,, health insurance programs and similar sourcesof reliable information.

c. Establishment of a itrition information service.Nutrition resources and programs for information gather-

ing at State and local levels should be supported andstrengthened. State and local nutrition offices should beincorporated into a nationally coordinated nutrition infor-mation service.

d. Periodic evaluation of nutrition policy and program.

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3. Development of centers of excellence for food and nutritionresearch and for the diagnosis and treatment of nutritional healthproblems.

4. Establishment of programs for the support of extramuralresearch and education in universities, research institutes andsimilar organizationsincluding special support for centers ofexcellence in research and education in human nutrition.

5. Development of programs and resources to encourage,nationwide, the incorporation of sound information concerningfoods and nutrition into public school education at all levels frompreschool through high school, college and university curricula,and into materials used by the communications media.

Broad support should be provided for teaching nutrition inhealth professional schoolsmedical, dental, public health andallied health professionsand in colleges of teacher education.

6 Coordination of international aspects of the NationalNutrition Program with the Agency for International Develop-ment, international programs of other branches of the FederalGovernment, also with international agencies such as the WorldHealth Organization, the Food and Agriculture Organizationand others.

Finally, the National Nutrition Consortium urges responsible offi-cials and Members of the Congress to consider such policy as a whole,and give appropriate priorities to necessary legislation and funding.

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