Exclusive Commentary

Evidence-Free Policy Decisions: Driving an Epidemic

Dr. Deborah A. Frank, Grow Clinic for Children at the Boston Medical Center, Children’s HealthWatch, and Boston University School of Medicine - Posted June 25, 2012


Spotlight on Poverty and Opportunity will be running a series of commentaries in the summer of 2012 on the fight to end childhood hunger in America.

This commentary is the fifth installment in the series, which is entitled “Ending Childhood Hunger in America.”

As pediatric healthcare providers, we are held to high standards. We strive to assure that our diagnoses and our interventions are “evidence based,” not reflections of personal prejudice or anecdotal experience. We know that striving to implement our decisions based on evidence gives our young patients the best chance of avoiding illness, disability, even death.

Given this framework, we are alarmed that so many of the proposed changes in public policies - many of which will impact the lives of our young patients as surely as any epidemic - are not evidence based.

Nowhere is this problem clearer than in the proposed changes to the anti-hunger programs that support millions of American children, such as the Supplemental Nutrition Assistance Program (SNAP). The House of Representatives, in an effort to meet their budget-cutting goals, proposed cutting $36 billion from SNAP. Members of the Senate have proposed cutting the same program by $4.5 billion. While significantly lower, this number comes entirely from benefits and still takes meals off the tables of families with hungry children.

While these numbers alone are startling, the apparent choice to ignore evidence from administrative and medical analyses in these debates is even more disturbing. For example, some elected officials sought to discredit SNAP by claiming that the program is plagued by rampant fraud. In reality, less than one percent of program dollars are expended because of fraudulent claims, whether from retailers or participants. Including this one percent, SNAP’s error rate is only about four percent overall. Opponents also claimed SNAP encourages dependency among people who could be working. Today, however, nearly half of the SNAP households with children have working adults.

Politicians also ignored several decades of medical evidence that SNAP participation is associated with positive outcomes for children. Studies have shown that children receiving SNAP have healthier birth weights and school-age girls receiving SNAP have better reading and math scores. Moreover, there is less obesity in school-age children whose families gain SNAP benefits compared to families who lose SNAP.

The effects in the often invisible period between birth and school age are even more striking. The most recent evidence comes from a Children’s HealthWatch report, The SNAP Vaccine: Boosting Children’s Health. Our analysis shows that, compared to young children in families who are likely eligible but not enrolled in SNAP, young children in families receiving SNAP are less likely to be underweight and less likely to be at risk for developmental delay. This, as we say in medicine, is “biologically plausible,” since families who receive SNAP, compared to likely eligible families who do not, are less likely to report having difficulty providing an adequate diet for all household members to enjoy an active and healthy life. They are also more likely to be able to afford essential healthcare and other expenditures while meeting their families’ nutritional needs.

As is true with so many medical interventions, the SNAP effect is dose-related. After the American Recovery and Reinvestment Act (ARRA) boost in SNAP benefits, young children in participating families are more likely to be in good health, not hospitalized, developing normally, and neither overweight nor underweight than children in similar families not participating. The ARRA boost is now scheduled to terminate prematurely, meaning the average family of four will lose about $51 - or 31 meals - a month.

SNAP is not alone in facing drastic cuts contrary to best evidence and best practice. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is also at risk. Extensive pediatric research shows that WIC has a substantial effect on babies even before birth, reducing low birth weight and preterm delivery—two major causes of infant mortality. After birth, WIC has also been shown to promote breastfeeding, decrease anemia, and enhance the cognitive development of toddlers and preschoolers. Despite these data, WIC is subject to sequestration, which will deprive hundreds of thousands of pregnant women, nursing and postpartum mothers, and young children under the age of five of nutritional prescriptions tailored to protect the health and learning abilities of our youngest children.

As researchers and clinicians, we anticipate the impact of these unscientific policy proposals with the dread usually reserved for an impending epidemic. We cannot comprehend how the nation’s leaders can ignore not only medical evidence, but also the impact of their evidence-free decisions on the brains and bodies of America’s children.

As clinicians, we do not have that luxury. We know that these policies are as real a threat to children’s health and future school success as a viral meningitis epidemic. Unlike such an epidemic, these anticipated nutrition epidemics are manifestations of our lack of political will. Our leaders could make an evidence based choice today to protect the nutrition programs that will preserve and enhance the health and learning of our children. The future prosperity of our country depends on their decision.

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Deborah A. Frank, MD is the director of the Grow Clinic for Children at Boston Medical Center, professor of child health and well being at Boston University School of Medicine, and principal investigator of Children’s HealthWatch.


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