For a lesser God's children

A US health care programme ought to target poor mothers and children - those most likely to reap its benefits, says an expert report

Published: Sunday 30 June 1996

No more story telling: homeles (Credit: USIS)A NEW report from a committee of the Institute of Medicine in the us has put across some sane advice to a federally funded, state-run programme that provides food, nutrition, education, and health care for mothers and children. The programme could better address the unmet needs of poor children by targeting those most likely to benefit from improved nutrition, says the report.

The report recommends changes in the way mothers and children are selected for participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (wic). T he committee recommended that the system for determining eligibility and setting priorities be tailored to reach those actually in need of the benefits of the 20-year old, $3.8 billion programme - a fundamental shift from the past - which has been selecting individuals based solely on nutritional risk factors.

"The wic programme, in its present form, is very effective at identifying those at risk, but it could be made more effective by focussing greater attention to factors, such as homelessness, that make children vulnerable to nutrition problems," said committee chairperson Richard E Behrman of the Center for the Future of Children, David and Lucile Packard Foundation, Los Altos, California.

First established in 1974, wic now assists more than seven million low-income pregnant women and new mothers, infants and children at nutrition risk. This risk is defined as either having the physical signs of poor nutrition and health or other nutritionally related medical conditions, dietary deficiencies that impair or endanger health, or circumstances that may lead one to poor nutrition.

The report contains recommendations for changes in more than 80 individual criteria to help the Food and Consumer Service of the us department of agriculture guide states in determining eligibility for participation in the WIC programme. The committee said that because eligibility cut-off points in some criteria are too wide or poorly defined, many who are not actually at risk may be selected.

Anaemia is used frequently in the wic programme to establish eligibility. But because some states use very high cut-off points for anaemia, for example, an infant who is at little risk of the condition may receive wic benefits while a young homeless child who is actually at greater risk may not.

The report also recommends a reassessment of the priority system. Risk criteria for children that warrant inclusion in higher priority categories include nutrient deficiency diseases, malnutrition leading to a slow growth rate, serious metabolic problems from birth and gastro- intestinal disorders.

Criteria like high caffeine intake, and maternal age of more than 35 years should be eliminated because of a lack of evidence about nutrition risk and benefit. And lower priority should be given to conditions like mild nausea and vornitting during pregnancy, lack of pre-natal care, and the consumption of cigarettes, alcohol or illegal drugs, besides identifying additional risk criteria, a majority of the committee said. And with the needs of the population being constantly in a flux, the existing criteria should be evaluated every five -to 10 years, stresses the report.

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