After fierce debate: WIC still works

The Fall 2005 issue of the Journal of Policy Analysis and Management has a great debate over WIC.

Ted Joyce, Diane Gibson, and Silvie Colman argue provocatively that previous research exaggerated the effectiveness of the Special Supplemental Nutrition Program for Women, Infants, and Children. They have great data, from 800,000 births to women on Medicaid in New York City, over many years. But their interpretation is unusual. They find -- as most studies do -- that the children born to women on WIC appear heavier and less likely to be underweight than children born to seemingly comparable women not on WIC. Nevertheless, they tie themselves into knots trying to cast doubt on what is at least one leading explanation for this finding -- that WIC makes for healthier new babies.

Their doubt stems from their belief -- really, an assumption -- that WIC could not possibly affect the length of the pregnancy and the chance that the mother carries the baby to full term. Under their assumption, it makes sense to control for gestational age in seeking to assess the effect of the WIC program. Their regression analyses that do control for gestational age fail to find that WIC is effective. Hence, they doubt that WIC is effective.

In a rebuttal in the same issue, Janet Currie and Marianne Bitler (whose previous work on WIC we reviewed here), argue that Joyce and his colleagues were wrong to reject the possibility that WIC influences the length of the pregnancy. The data certainly seem to indicate that WIC does have such an effect, and moreover, this effect seems plausible based on the array of services that WIC provides.

I know this question about whether to control for gestational age may seem arcane. Think of it this way. If Joyce and colleagues are right, it makes sense to investigate whether WIC women who give birth at 38 weeks have heavier babies than non-WIC women who give birth at 38 weeks. On the other hand, if Currie and Bitler are right, one might find that WIC women tend to have pregnancies 40 weeks long and heavier babies, while non-WIC women tend to have pregnancies 38 weeks long and lighter babies. If WIC may in principle affect the length of the pregnancy, as seems reasonable, then Currie and Bitler seem to have the stronger case.

The debate is so heated that the journal took the unusual step of inviting a third, neutral commentary by two competent social scientists who are not WIC experts, Jens Ludwig and Matthew Miller. As writers, these two are more more polite and less frank than Currie and Bitler. But they agree with Currie and Bitler: "Our reading of the medical literature suggests that there is no conceptual or theoretical reason why the bundle of services provided by WIC could not affect preterm birth rates."

As far as I could tell, none of the three papers sufficiently acknowledged that this debate has all been hashed out previously, as well. In a 1998 book, Feeding the Poor, noted program evaluation expert Peter Rossi rather criticized WIC on much the same grounds as Joyce and colleagues. But, generously, Rossi gave space to Robert Greenstein of the Center on Budget and Policy Priorities for his characteristically lucid response: "Rossi accords too much significance to the fact that findings of WIC's effects in improving birthweight appear to be lessened when one controls for gestational age. The problem here is that controlling for gestational age necessarily understates WIC's effects on birth outcomes."

It is in many ways too bad that the federal government has not supported the clearest type of (ethical!) random-assignment research on WIC. Still, the solid conclusion of all these debates over the non-experimental evidence on birth outcomes is, as always, that WIC works.

Two postscripts. First, related to the question of ethical random-assignment studies, see the interesting discussion in the same issue of the Journal of Policy Analysis and Management -- a very tough ethical critique of current practice by Jan Blustein, and rebuttals by Peter Schochet at Mathematica Policy Research, Inc., and others. My own conclusion is that researchers should read Blustein attentively, and then instead of giving up, seek to use ethical random-assignment research designs whenever possible.

Second, let me boast a bit about my department's history on WIC. At President Nixon's White House Conference on Nutrition in 1969, the chair (and later Tufts University president) Jean Mayer and a colleague Stanley Gershoff (later the first dean of the Friedman School when Mayer was university president) were involved in the discussions that led to the formation of the WIC program in the early 1970s. Current dean Eileen Kennedy also did substantial research on WIC. In the 1980s, David Rush (now emeritus at the Friedman School at Tufts) led the major National WIC Evaluation -- including overseeing the private publication of the unedited conclusions in a special supplement to the American Journal of Clinical Nutrition in 1988 after the Reagan administration edited and censored the original favorable conclusions about the effectiveness of WIC.

Local food for Thanksgiving

Dan Barber's op-ed today for the New York Times lays out the interesting case for supporting mid-sized American farms, in preference to large corporate farms (of course) and small farms (surprisingly). With a Thanksgiving turkey hook:

THIS Thanksgiving there's something to be really thankful for: more and more Americans - at least 250,000 of them in New York alone this week - are shopping for their turkeys and sweet potatoes at local farmers' markets.

They're doing so because the food is fresher, less processed and generally tastes better than what you'd find in a supermarket. But there are also political and social considerations: supporting small farmers, these shoppers believe, will preserve farmland, reduce the number of industrial farms and help us move away from an agricultural economy that encourages the production of commodities like corn, soy and sugar at the expense of just about everything else.

Thanks to Jack from Fork & Bottle for the link.

In our home, I am looking forward to cooking the turkey, stuffing, and gravy for the whole extended family tomorrow, while my wife runs in Somerville's 4 mile "Gobble, gobble, gobble" race -- perhaps in the snow! Happy Thanksgiving to you.

McDonald's nutrition labels

McDonald's Corporation announced in October that it would begin printing nutrition facts information on food packages (see Associated Press). Facing a number of legal challenges, and long a focus of public interest group attention, the leading fast food company now does better than any of its major competitors in sharing detailed information about its products with consumers.

Some public interest groups are still pressing the company to put calorie information on its menu boards. Michele Simon, who publishes the Informed Eating newsletter, recently noted in an AlterNet column that the labels on food packages will not be read until after purchase -- which one might think is too late.

Upon closer inspection, the move is a thinly veiled attempt at deflecting government intervention that could have even greater impact. How effective is seeing the calories on the wrapper of a cheeseburger you've already purchased?

Still, most McDonald's patrons are repeat customers, and by choosing an accessible format for the key nutrition information, the company has really taken a fascinating step forward. Far from criticizing, I'm saving my ammunition for a post on the (likely but not certain) forthcoming occasion of the removal of this information.

Much of the information has already been available at somewhat greater distance from the point of sale. CalorieLab, for example, provides an accessible summary of the restaurant chain's nutrition facts. The publishers of the Fast Food Facts weblog also link to nutrition information for McDonald's and other companies that make these facts public.

AAEA president Per Pinstrup-Andersen shouts for justice from a high podium

In his presidential address at the annual meeting of the American Agricultural Economics Association (AAEA) in Providence last July, Cornell professor Per Pinstrup-Andersen began with almost half an hour of scholarly discourse on the role of ethics in economic analysis. Bentham. Aristotle. The first law of welfare economics. Stigler. Comparing utility across people. And so on.

He never increased the cadence or raised the volume of his gently accented European voice.

I laugh to imagine a poor audience member, whose mind wandered in this early discussion, returning to focus on his quiet voice some time later, realizing with a shock that the words themselves were by this time shouting and yelling.

The point of the early discussion was to shake a large ballroom full of economists out of their complacency about the moral inadequacy of their usual discourse. Slowly and methodically, Pinstrup-Andersen knocked one leg after another out from under the table holding the usual banquet of apologies and excuses for government inaction against the world's greatest injustices.

By the time his words started pushing a little harder, Pinstrup-Andersen, who for many years led the International Food Policy Research Institute in Washington, DC, was quoting statistics about child hunger around the world:

6 million of the 10 million child deaths could be avoided by known interventions in each of 42 countries at a recurrent annual cost of ... $1.23 per person in these countries. Could the richest 10% of the populations of these countries afford to pay $12.30 annually without sacrificing anything of comparable moral or material significance? Of course. Do they? No.

By the time his words really got shouting, Pinstrup-Andersen was asking whether there is any moral difference between killing 6 million children and standing by idly while 6 million children die.

Is it genocide when millions of children die because of neglect by the state? Is failure by governments to take action as promised on various occasions, a crime against humanity? Not according to the United Nations and the International Criminal Court. The terms "genocide" and "crime against humanity" apply only when certain acts are committed. Failure to act to save lives is not covered, even when states have the means to act (United Nations 1948, and International Criminal Court).

A reasonable person may doubt that we are all quite so directly culpable for children's deaths around the world as Pinstrup-Andersen implies. For we Americans in particular, there are wise reasons, including the preservation of peace, to better remember that not every injustice around the world is our problem to solve. But this post is not a critical review. This post is all praise. I can't recall a previous occasion in which the speaker from the plenary session podium at the AAEA annual meetings quoted Nelson Mandela.

Like slavery and apartheid, poverty is not natural. It is manmade and it can be overcome and eradicated by the action of human beings. And overcoming poverty is not a gesture of charity. It is an act of justice. It is the protection of a fundamental human right, the right to dignity and a decent life. While poverty persists, there is no true freedom.

The presidential address was published this month in the American Journal of Agricultural Economics.

GAO exposes fraud in federal crop insurance program

The Government Accountability Office has shined brightly in reports from the press and some sectors of the blogosphere this month. GAO labeled the Food and Drug Administration's decision on the Plan-B morning after pill as "very unusual." For a federal government agency in the legislative branch, which is nonpartisan but which answers to a Republican Congress, that is pretty loud criticism.

With similar understated conviction, the GAO recently reported (.pdf) on serious fraud in the federal crop insurance program. USDA's Risk Management Agency (RMA) administers the insurance program in cooperation with private insurance companies. GAO reported:

RMA does not effectively use all the tools it has available. Specifically:

• Inspections during the growing season are not being used to maximum effect. Between 2001 and 2004, FSA [the Farm Service Agency] conducted only 64 percent of the inspections RMA had requested. Without inspections, producers may falsely claim crop losses.

• RMA’s data analysis of the largest farming operations is incomplete. According to GAO’s analysis, in 2003, about 21,000 of the largest farming operations in the program did not report individuals or entities with an ownership interest in these operations. As a result, USDA should be able to recover up to $74 million in claims payments. FSA did not give RMA access to the data needed to identify such individuals or entities.

• RMA is not effectively overseeing insurance companies’ quality assurance programs. GAO’s review of 120 cases showed that companies completed only 75 percent of the required reviews and those that were conducted were largely paper exercises.

• RMA has infrequently used its new sanction authority to address program abuses. RMA has not issued regulations to implement its new sanction authority under ARPA. RMA imposed only 114 sanctions from 2001 through 2004. Annually, RMA identifies about 3,000 questionable claims, not all of which are necessarily sanctionable.

For more colorful detail on how the fraud works, see National Public Radio's reporting. The report has a nice interview with one cotton farmer who was caught (and later got to see a new slice of life playing cards in prison with a table full of drug dealers -- where his nickname was "Cotton"). He explains that the fraud becomes tempting if the potential insurance payments become high enough relative to what one would get selling a crop. In such situations, a farmer finds ways to make sure the crop doesn't come up -- "either planting substandard seed, plowing too deep, planting too shallow. I mean, if you don't want it to come up, you can pretty well make it to where it won't come up." The thrust of the GAO report is that neither insurance companies nor "captured" federal agencies had sufficient interest in protecting the taxpayer from such schemes.

This issue is significant for U.S. farm policy more broadly. From an economic perspective, it is sometimes tempting to support insurance arrangements to reduce the exceptional earnings risk of farming, relative to other occupations. Some might defend such insurance plans, even while criticizing chronic subsidization. The GAO takes one plank out of this platform. If farmers and the financial industries that service them abuse such insurance arrangements, it will push reasonable people toward an even more severe stance on farm programs.

U.S. Food Policy housekeeping

First, a warm round of applause for everybody who has been commenting at this site. You turn this work into a memorable conversation.

Second, please let me humbly apologize for the disappearance of the comments to date. Now that Google's Blogger service has implemented backlinks, I have resigned from the HaloScan service I was using in order to consolidate my site management tasks in one place. By switching services, I seem to have omitted existing comments.

Third, I know my posting schedule has been light during the mid-semester crunch. Junior faculty around the country who are also webloggers have been careful with their blogging time, following the denial of tenure to a couple much-admired webloggers, such as Daniel Drezner at the University of Chicago. I should add, though, that I have less cause to fear Dan's particular adventures than some faculty webloggers have. Following his rather distressed post in early October ("So, Friday was a pretty bad day"), I thought to myself that perhaps some universities were less oriented toward dusty journals and more oriented toward the civic engagement and passion for real world communication that Drezner exemplifies. A month later, I was delighted and truly not much surprised when he was offered a position as associate professor at Tufts University, at the Fletcher School of Law and Diplomacy ("So Friday was a pretty good day"). Fletcher has a tenure system, but the Friedman School at Tufts does not. Dan and I have already agreed to go out for a coffee or beer when he gets here. Way to go, Tufts.

Opposition to food stamp cuts delays House budget reconciliation bill

Opposition by moderate Republicans has derailed efforts to cut food stamps for some 300,000 participants as part of the budget reconciliation bill on the House floor. Under this bill, House Republican leaders had hoped to cut more than $800 million from the Food Stamp Program over five years.

Charles Abbott of Reuters reports:

Some moderate Republicans have said they may not vote for a bill that cuts welfare programs. Meanwhile, conservatives complain the bill does not go far enough on energy issues, such as opening the Arctic National Wildlife Refuge to oil and gas drilling.

Republicans control the House by a narrow majority and cannot afford to have many party members vote against the bill.

Two anti-hunger groups said they hoped Republicans would abandon the plan to cut food stamps, used by some 25.8 million poor Americans each month to help buy food, according to government data.

The $844 million in proposed cuts would affect 300,000 food stamp recipients and, in a ripple effect, make 40,000 children ineligible for free school lunches.

The Senate's version of a budget-cutting bill would reduce $35 billion in federal spending, but does not touch food stamps or health care to the poor and elderly.

"I'm sure they (House Republicans) are looking at a lot of things," said Minnesota Rep. Collin Peterson (news, bio, voting record), the Democratic leader on the House Agriculture Committee. "They're in a real box."

House staff workers said modification or deletion of the food stamp cuts appeared to be a prime topic in efforts by Republican leaders to amass the 218 votes needed to pass the budget bill. One staff worker said some sort of reduction seemed the most likely outcome.

Defenders say this summer's hurricanes showed the value of federal food aid to struggling citizens. Blunt said cuts would "reform the system so you get better results" by sharpening the focus of the program "for the people you intended to help instead of just adding on to the edges."

Meanwhile, the Center on Budget and Policy Priorities has a nice analysis showing that the "SUPPOSED EASING OF HOUSE FOOD STAMP IMMIGRANT CUT TURNS OUT TO BE LARGELY COSMETIC."

The House Rules Committee change would make two modest exemptions to this rule that would apply to limited number of current food stamp recipients. These exemptions, however, would simply result in a phasing-in of this cut over a two-year period. After that period, the full cut would be in effect.

The Rules Committee would exempt from the cut those legal immigrants who both are participating in the Food Stamp Program at the time of enactment and either are age 60 or older or have applied to naturalize for citizenship.[1] Contrary to what some Members of Congress seem mistakenly to believe, the Rules Committee change does not exempt those poor non-elderly legal immigrants with serious disabilities whom the Agriculture Committee provision would disqualify. These people would be terminated immediately.

The Rules Committee change reduces the overall savings from this cut from $275 million over five years to $255 million over five years — a reduction of 7 percent. Thus, some 93 percent of the food stamp immigrant cut remains. This change would reduce the bill’s total food stamp cuts from $844 million over five years to $824 million, a reduction of just two percent.

Detective work uncovers restaurant nutrition secrets

Many restaurant chains hide their nutrition information from the public. Perhaps, with a little detective work, we can offer the nanny-free market-based solution to this information failure. All we need to do is to shine a flashlight in the restaurant industry's darkest cave.

According to this post from CalorieLab Counter, food reporter Rebekah Denn was frustrated that Claim Jumper restaurants would not disclose the nutrition information for their products. So, she bagged a typical meal and shipped it off to a lab for analysis.

Ms. Denn skipped the extras and the monster dishes and simply ordered what looked to her to be an average Claim Jumper entree: the fried chicken dinner, which includes a biscuit and mashed potatoes.

Portland-based Food Products Laboratory reported back the results: 2,032.5 calories, 105.4 grams of fat, and 3,713 milligrams of sodium. The U.S. government daily reference values used in the Nutrition Facts labels on packaged food suggest no more than 2,000 calories, 65 grams of fat, and 2,400 milligrams of sodium for an entire day (these requirements vary by person).

Would anybody like to pitch in and begin a project to continue these investigations? I will be the first contributor.

To be polite -- and to be a good steward of the laboratory expenses -- the project should begin each campaign with a letter to the restaurant chain asking for voluntary disclosure. (We would only do this for major chains with standardized products; nobody wants to bully small restaurant owners). If the information is disclosed, we would file it on a public internet site. Perhaps CalorieLab would volunteer to host. If the information is not disclosed, we would send the food to a laboratory, and then post the information to the same public internet site, along with some graphic icon indicating the special shame of being a restaurant that "hides its nutrition facts from its customers."

A good place to start would be the nutrition information for the Quiznos Steakhouse Beef Dip sandwiches that the federal government supported through a beef checkoff promotion. Then, we could move on to the 3-cheese stuffed crust pizza that the federal government supported through a dairy checkoff promotion in collaboration with Pizza Hut (no, wait, we already reported the nutrition information for that one here).

High-calorie fast food monstrosities promoted by the government are a good place to begin, because there is no laissez-faire argument to suggest that these sponsorships simply respond to consumer demand. But, even moving on to the chain restaurant sector more generally, there is an excellent pro-market case to be made that more consumer information would be better.

Did you know you eat that stuff in nails?

Yeah, real metal carpentry nails. Here is a nice weblog post from Gary King at Harvard, emphasizing the importance of having a control group in social science inference. He says his classroom demonstration works well with students ranging in age from kindergarten kids to graduate students.

To start, I hold up some nails and ask "does everyone likes to eat nails?" The kindergarten kids scream, "Nooooooo." The graduate students say "No," trying to look cool. I say I'm going to convince them otherwise.

I hand out a little magnet to everyone. I ask the class to figure out what it sticks to and what it doesn't stick to. After a few minutes running around the classroom, the kindergardners figure out that magnets stick to stuff with iron in it, and anything without iron in it doesn't stick. The graduate students sit there looking cool.

From behind the table, I pull out a box of Total Cereal (teaching is just like doing magic tricks, except that you get paid more as a magician). I show them the list of ingredients; "iron, 100 percent" is on the list. I ask by a show of hands whether this is the same iron as in the nails. 3 of 23 kindergarten kids say "yes"; 5 of 44 Harvard graduate students say "yes" (almost the same percent in both classes!).

I show the students that the box is sealed (and I have nothing up my sleeves), Then, I open the box, spill some cereal on a cutting board, and smash it up into tiny pieces with a rolling pin. I take the pile of cereal around the room and let the kids put their magnet next to it and see whether the cereal sticks to the magnet. To everyone's amazement, it sticks!

The students are all delighted and now believe that the iron in the food is sticking to the magnet. But, like a good mystery, the story still has two more twists and turns.

King points out that perhaps the cereal is simply sticky, like gum or tape. The graduate students clap their palms to their foreheads and think they have been duped. This gives King the chance to explain the importance of having a control group -- in this case a box of cereal without the iron fortification.

But, in the final twist, the control group cereal fails to stick to the magnet. It really is the iron in the fortified cereal that makes it stick to magnets.

King's moral:

Everyone gets to take home a cool fact (they love to eat the stuff in nails), I get to convey the point of the lesson in a way they won't forget (the central role of control groups in causal inference), and everyone gets a free magnet.

Thanks to the excellent economics weblog Marginal Revolution for the link.

Food Safety and Nutrition Section of the AAEA

The American Agricultural Economics Association (AAEA) has sections -- somewhat like subsidiaries -- on several topics, including a Food Safety and Nutrition Section. This is one of several professional organizations whose work in the borderlands between the main disciplines of economics and nutrition I find most interesting. I will be the chair-elect of this small hard-working group of scholars in the coming year. In this role, I am helping to plan the section's "track" sessions at the AAEA's annual meeting in Long Beach next July. If you have any ideas for symposia or brief scholarly papers on topics related to the economics of food safety or nutrition, please see the call for input on the section website.

Upcoming research on food stamps, food spending, and household food security

USDA's Economic Research Service (ERS) recently announced its food assistance research grants for fiscal year 2005. These eight projects will study many topics in food and nutrition assistance, including: the Commodity Supplemental Food Program (Kenneth Finegold at the Urban Institute), recertification policies and Food Stamp Program participation dynamics using administrative data from South Carolina (David Ribar at the George Washington University), the effective tax rates on cash income induced by Food Stamp Program regulations (Jim Ziliak at the University of Kentucky), and a study of how food stamps affect food spending in grocery stores and restaurants, and how food spending in turn affects household food security (Parke Wilde at the Friedman School at Tufts University -- hooooray!). I'll give you an update in several months.

Eric Bost hears recommendations from New England public

Speakers from throughout New England delivered their suggestions for improving food assistance programs in person to USDA Under Secretary Eric Bost, at the Farm Bill Forum in Boston on Friday. Friedman School graduate student Kelly Horton has this report:

There were many common themes between the speakers at the forum, many of which pertained to the Food Stamp Program (FSP).

Several speakers asked that the minimum benefit be raised from $10 – some organizations suggested raising the minimum to $25 while others recommended as much as $50 for the minimum monthly benefit. One speaker suggested that benefit be calculated using the USDA moderate cost meal rather than the Thrifty Food Plan to calculate the benefits. Another speaker suggested that the benefit amount be attached to inflation.

There were many suggestions made for regarding the Food Stamp Program among them included:

• Simplify the application process, i.e. extend the SSI combined application;
• Advertise the option for a face-to-face interview waiver;
• Implement mandatory elimination of face-to-face interviews;
• Increase FSP office hours to increase accessibility and convenience;
• Design a web-based best practices guide;
• Enable beneficiaries to establish their EBT pin codes remotely;
• Expand the farmer’s market FSP;
• Increase the asset limit – some speakers suggested to set the limit at $5,000, while others suggested a $10, 000 limit;
• Increase the housing cap;
• Remove the work requirement;
• Restore immigrant and permanent resident eligibility;
• Develop a system of reciprocity between FSP and the Fuel Assistance Program;
• Preserve categorical eligibility; and
• Rename the program to “Eat Better Today” (based on the EBT card usage).

The food stamp program was not the only program of interest. To provide further support of making changes to the National School Lunch and Breakfast programs, a representative from Mantrose-Haeuser Co., Inc., located in Westport, Conn., spoke about the value of NatureSeal. NatureSeal is a product that was developed in partnership with USDA to help preserve the freshness of sliced apples provided in schools. Several other speakers emphasized the success in providing children with sliced as opposed to whole fruit in school – that children will eat the sliced fruit but will most often discard whole apples and oranges.

Helen Mont-Ferguson, Director Food and Nutrition Services of the Boston Public Schools stated that USDA fails to realize that not all schools are the same – some schools have full kitchens while others receive foods from elsewhere. She went on to say that when fruit was cut up children will eat it but will more that likely not eat it when it is whole. She encouraged USDA to create packaging that is appealing to children, such as providing packages of dried fruits, because children will take them.

A representative from Sunkist Growers spoke on behalf of fruit producers to also encourage USDA to implement program policy changes that would help schools provide healthier meals based on the dietary guidelines, e.g. changing the school menus to reflect an increase in the amount of fruit and vegetables provided in each school meal

The USDA will continue to reviews comments submitted via its website by December 30, 2005.