A Hungry Child's First Thousand Days

 

By David K. Shipler 

                Dr. Megan Sandel, a pediatrician, experiences a troubling revelation whenever she sees a patient in the Boston Medical Center’s Grow Clinic. The clinic seems like a normal health-care facility in an advanced country, she notes: a waiting room, a medical assistant taking a child to be weighed and measured and then into an examining room.

“But that’s where, in some ways, the picture changes,” said Dr. Sandel, the clinic’s co-director, “because when you walk into the room you see this really cute, what you think is a twelve-month old, but it turns out it’s a two-year old. It’s a two-year old who hasn’t outgrown their twelve-month-old clothes yet.” [Listen to Sandel here.]

Even more serious than what you see is what you do not see: the brain of the child during a critical window of cognitive development. And in that largely invisible universe of neurons and synapses, of myelin sheaths and the neurological connections that are supposed to be generating the abundant future of every small person, lifelong damage is being done. The medical diagnoses are “stunting” and “failure to thrive.”

 That is malnutrition in America, which is chronic among the poor and has soared during the pandemic. Its long-term harm will be one of the most severe legacies of Covid-19.

 The usual incidence of what the government calls “food insecurity” ranges from 13 to 21 percent of American households with children, varying with the state of the economy. Most of them are white, although Black and Hispanic families suffer at higher rates. As school meals ended and vulnerable parents lost jobs during the Covid-19 outbreak, the Grow Clinic’s caseload jumped 40 percent. Nationwide, the rate of food insecurity in families with children rose to 29.3 percent last spring and summer from 13.6 percent in 2019, before the pandemic. With the return of some jobs and bursts of government assistance, the level has gradually declined to 17.8 percent, according to a large sample of adults with children in their households, surveyed by the Census Bureau in April. Seven out of ten who reported that they “sometimes” or “often” did not have enough to eat said they simply couldn’t afford to buy more food.

The recent $1.9-trillion American Rescue Plan will help, but not sufficiently or indefinitely. It raises grants by what used to be called food stamps--the Supplemental Nutrition Assistance Program (SNAP)—by up to $100 a month per family. More significantly, the plan’s $3000 to $3600-per-child stipend for one year would re-conceptualize governmental aid if made permanent, evading bureaucratic red tape by providing direct cash payments. Medical professionals say that getting money into parents’ pockets is the best way to treat children’s malnutrition.

Without broader policy overhauls, though, food insecurity seems likely to remain both a result and a cause of hardship, a key link in the middle of a complex chain reaction. For poor families without government housing subsidies, for example, rent on the private market can soak up 40 to 60 percent of income. Paying rent is not optional. The bills for electricity, water, heat, phone, and car loans cannot be ignored. The part of the budget that can be squeezed is the part for food. And that’s what happens.

MACA: Make America Competent Again

 

By David K. Shipler 

The first in an occasional series 

                Perhaps the word “again” should be put in quotes or parentheses or followed by a question mark, because while the United States has done a lot of things very well through its history, incompetence has also plagued governmental behavior in areas ranging from foreign affairs to poverty. A frequent hallmark of failure has been the unwillingness to apply what we know to what we do. Expertise does not get translated into policy.

                The most obvious recent example is the Covid-19 pandemic, where the Trump administration’s floundering cost lives and worsened economic hardship. But the gap between knowledge and practice inhibits problem-solving in many fields. If you add up all of society’s accumulated understanding about the causes of poverty, for example, or about the sources of conflict in one or another region of the world, and then compare that knowledge with the actions being taken, it looks as if knowledge gets filtered out through a fine sieve before it gets to the policy level.

The Vietnam War was such a case. The US government saw North Vietnam as a Chinese and Soviet proxy in the vanguard of communism, and therefore a threat to American security. But historians knew that Vietnam had resisted China for centuries. And so could any American soldier or diplomat in Saigon who bothered to notice how many streets were named for Vietnamese heroes in the long campaigns against Chinese occupation. It should have been no mystery to American policymakers that the war, for Hanoi, was the continuation of a long anti-colonialist struggle, not one fought to spread global communism.

The dilution of expertise in making policy can be seen in the Middle East, Russia, China, and other parts of the world. The same is true at home. Much is known about how to treat prisoners to reduce recidivism rates, how to prevent police from extracting false confessions, how to provide good defense attorneys for indigent defendants, how to curtail global warming, how to clean up air and water, how to make workplaces safer, how to reduce suicides (gun control), how to treat mental illness, and on and on.

Accumulated knowledge about poverty is not put to good use. We know how to alleviate housing problems in America; it’s a matter of money. We know how to eliminate malnutrition—also a matter of money. We know how to raise workers’ skills and make work pay enough to sustain a family. We know how to provide decent medical care. We know how to improve education. True, some of our abilities diminish along the more difficult part of the spectrum—we are confounded by child abuse, drug abuse, gang violence, racism, white supremacy, and harmful parenting. But we know how to ease many other hardships.