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