Journal of the American College of Nutrition, Vol. 18, No. 2, 100-101 (1999)
Published by the American College of Nutrition
Head Start, Nutrition, and Problems of Poverty in Childhood
Robert J. Karp, M.D.
Professor of Pediatrics
Children’s Medical Center
SUNY - Downstate,
Brooklyn, NY
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INTRODUCTION
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Head Start is one of the most effective ways of addressing the multiple interrelated problems of poor families with children—specifically, to make sure that they get enough nourishing food. Reviewing the paper by Dr. Bollella and her colleagues at the American Health Foundation [1] reminded me of advice given by my father who lived through the great Depression of the 1930s. "If times get tough, take a job in a restaurant, you can eat two big meals and several snacks. You won’t starve." Head Start seems to fill that role.
The data presented show that preschool-age children attending "all-day" Head Start actually consume 1/3 of the daily energy and most nutrient requirements expected by the government in funding school feeding programs [2]. Half-day students do not meet this goal as they do not have enough "eating time." For some nutrients, specifically iron (44%) and Vitamin A (63%), all-day children have a ratio of percentage of daily intake of nutrients as compared to calories substantially greater than one. These high percentages for the most expensive nutrients, calculated on a cost-per-100 calories basis, raises concern for the effects of poverty in these families [3,4].
Admittedly, advocacy in science, such as I am presenting here, is a risky business and has no place in the presentation of research data. The eugenics movement serves as a model of evil consequences, usually unintended, resulting from advocacy [5–7]. Nevertheless, malnutrition is a common phenomenon among poor children in the United States [4]. The data provided by Dr. Bollella and colleagues point to a solution. Had this same paper derived from a query "could diet advice affect the likelihood of lung cancer in smoking families of Head Start children," authors from the American Health Foundation would certainly put smoking as a "first cause" for lung cancer and address not smoking as a recommended outcome. Similarly, the role of poverty in producing a need for food supplemental in programs providing nutrition, freeing money for food and other expenses deserves comment.
School feeding programs have a "double origin." The first was to keep farm families and the agricultural economy working. The second, from the McGovern, Committee’s work of 30 years ago, was to keep our nation’s children well-fed and healthy [2]. Moreover, as David Rush noted in his introduction to the National Evaluation of School Nutrition Programs, there is great advantage to be gained when poor families and communities are able to appreciate concern, rather than neglect, from society at large [8].
Food supplementation programs are extremely effective in preventing malnutrition in both developing countries and among the poor in the United States [4,9,10]. Rebecca Blank, in her recently published "It takes a nation: A new agenda for poverty," notes that food support, along with direct income supplements and progressive tax structures, has effectively removed the elderly in the United States from poverty while their absence has lead to rising rates for poverty for families with children [10]. As noted in a prior commentary published in the Journal [11], in the United States, families with children at the tenth percentile for income have one-sixth the income of affluent (90th percentile) families with children [12]. For no other industrial democracy is the ratio lower than one-to-four.
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How malnutrition follows poverty
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Hunger and malnutrition, following a rise in food costs [13], spending on other necesssities [14,15], and just plain poverty [16], illustrate the "Engels phenomenon" where food selection narrows to those items which provide the most energy at lowest cost [3,4,17]. If this continues for sufficient time essential nutrients—those at highest cost for energy—disappear from the diet and malnutrition ensues. The cost to society from this phenomenon is to have a population of undernourished children who then evidence various health and learning problems [4].
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Why food supplement programs are effective
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Widespread malnutrition will be prevented by food supplement programs [9]. Moreover, they are extremely effective in reversing the consequences of the Engels phenomenon [3,4,17]. In the United States, provision of food stamps, school lunches and breakfasts and the special program for Women, Infants and Children (WIC) do a good job of offering foods with a high nutrient density affecting the most important nutritional deficiency impacting on children in the United States, that of iron [18]. Money left over can be used to purchase the remaining caloric requirements in foods of high nutrient density. Hence, these food programs have a "double effect." As a result, nutrient intake is equal to that of middle income families, and the Engels phenomenon is reversed [3,4,17]. Still, these supports are often referred to as "welfare dependence," implying that there is an unearned benefit to the recipient. Actually, the benefit of these programs is to children and to society by creating a healthy population able to learn, work and earn [3,9,19]. They do not create "welfare dependence" since supplemental programs provide essential food to working families and their children [4,9,10,18,20].* Contemporary food programs have never been shown to be a detriment to work. Rather, they are an alternative to the bread lines and soup kitchens of a post-Victorian era [21].
The study of Bollella and colleagues [1] provides evidence of the effectiveness of Head Start as a school-based food supplementation program for children. It is an example of our doing something right in the United States. Would that it be so more often!
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FOOTNOTES
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* Note that one well known nutritionist-physician, George Graham, has attacked the concept of nutrition support programs as promoting obesity and a "welfare mentality" [20]. 
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REFERENCES
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- Bollella MC, Boccia LA, Nicklas TA, Pittman BP, Spark A, Williams CL: Sources of nutrient intake in diets of Head Start children.
J Am Coll Nutr
18:
108–114,
1999.[Abstract/Free Full Text]
- Radzikowski J, Gale S: Requirements for the National Evaluation of school nutrition programs.
Am J Clin Nutrition
383–391,
1984.
- Immink MDC: Purchasing power and food consumption behavior: how poverty level is defined. In Sanjur D (ed)
" Social and Cultural Perspectives in Nutrition." Prentice-Hall Inc. Englewood Cliffs, NJ, pp
91–122,
1982.
- Karp RJ: Malnutrition among children in the United States. The impact of poverty. In Shils ME, JA Olson, M Shike, and AC Ross (eds),
"Modern Nutrition in Health and Disease." 9th edition. In press Wiliams and Wilkins, Baltimore, MD.
- Kevles DJ:
"In the Name of Eugenics: Genetics and the Uses of Human Heredity." New York, NY: Alfred A Knopf, Inc,
1985.
- Gould SJ:
"The Mismeasure of Man." New York, NY: WW Norton & Co Inc,
1981.
- Kuehl S:
"The Nazi Connection: Eugenics, American Racism and German National Socialism." New York, NY: Oxford University Press,
1994.
- Rush D: Introduction: National Evaluation of School Nutrition Programs.
Am J Clin Nutrition
40(supp):
363–364,
1984.
- Sen A: "
"Poverty and Famine." New York, NY: Oxford University Press,
1981.
- Blank RM:
"It Takes a Nation: A New Agenda for Fighting Poverty." Princeton, NJ: Princeton University Press,
1997.
- Karp RJ: Poverty and malnutrition in two countries.
J Am Coll Nutr
14:
561–562,
1995.[Medline]
- Rainwater L, Smeeding T:
"A Comparative Study of Children’s Wealth." Luxembourg Income Study (LIS) Working Paper No. 127, Syracuse University,
1995.
- Karp RJ, Fairorth J, Kanofsky P, Matthews W, Nelson M, Solimano G: Effects of rise in food costs on hemoglobin concentrations of early school-age children, 1972–1975.
Public Health Reports
93:
456–459,
1978.[Medline]
- Frank DA, Roos N, Meyers AM, Napoleone M, Peterson K, Cather A, Cupples LA: Seasonal variation in weight for age in a pediatric emergency room.
Pub Health Rep
111:
366–371,
1996.[Medline]
- Meyers A, Frank D, Roos N, Peterson KE, Casey VA, Cupples LA, Levenson SM: Housing subsidies and pediatric undernutrition.
Arch Ped Adoles Med
149:
1079–1084,
1995.
- Cutts DD, Pheley AM, Geppert JS: Hunger in mid-western inner-city young children.
Arch Pediatr Adolesc Med
152:
489–493,
1998.[Abstract/Free Full Text]
- Karp RJ, Greene GW: The effect of rising food costs on the occurrence of malnutrition among the poor in the United States: The Engels phenomenon in 1983.
Bull NY Acad Med
59:
721–727,
1983.[Medline]
- Zee P, DeLeon M, Robertson P, Chen CH: Nutritional improvement of poor urban preschool children. A 1983–1977 comparison.
JAMA
253:
1269–1272,
1985.
- Murphy JM, Pagano ME, Nachmani J, Sperling P, Kane S, Kleinman RE: The relationship of school breakfast to psychosocial and academic functioning: Cross-sectional and longitudinal obstructions in an inner-city school sample.
Pediatr Adolesc Med.
152:
899–907,
1998.
- Graham GG: Poverty, hunger, malnutrition, prematurity, and infant mortality in the United States.
Pediatrics
75:
1117–1125,
1985.
- Rosen D: Paralyses of response to poverty. In Karp RJ (ed)
"Malnourished Children in the United States: Caught in the Cycle of Poverty." Springer Publishing Co, p
250–52.
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INTRODUCTION
How malnutrition follows poverty
