# Presentation: LBK2HLRL3MPK5ZMSITFINLTEQBFAROY2

## New Foods, New Messages, New Opportunities

- 	 **Linnea Sallack, MPH, RD**
**	****	****California WIC Program Director**

## Supplemental Nutrition Program

**A national nutrition program for low-income families with young children**
**Established in 1974 by amendment of the Child Nutrition Act of 1966 “To serve as an adjunct to good health care during critical times of growth and development to prevent the occurrence of health problems and improve health status”**
**A domestic, discretionary program with funding appropriated annually **
**Administered through the U.S. Department of Agriculture which establishes program rules, awards annual grants to states, and monitors state program performance **

## Supplemental Nutrition Program

**California WIC is administered by the Department of Public Health (CDPH)**
**100 percent federal funding**
**Service delivery provided through contracts between CDPH and local government and non-profit,          community based organizations**
**Available statewide in all counties**
**The largest WIC Program **
**	****in the nation**

## Supplemental Nutrition Program

**Services to 1.4 million women, infants and children each month**
**Over 950,000 California families are enrolled**
**60 percent of all infants born in the State**
**Nearly 80 percent of the estimated eligible population is enrolled in WIC**
**1 of every 6 WIC participants in the U.S. lives in California**
**Purchase $86 M of food per month; 6.6 M checks**

**California WIC Facts:**

## Supplemental Nutrition Program

**Eligibility:**
**Income up to 185 percent of poverty**
**Example - $3,184 per month for a family of 4 *****or***
**Enrolled in Food Stamp Program, CalWorks and/or Medi-Cal**
**Pregnant, breastfeeding and new mothers, infants and children up to the 5****th**** birthday**
**Nutritional risk determined through nutrition assessment**
**California resident**

## Program Services

**Provided by 82 local agencies **
**Half county and city health departments**
**Half community-based organizations**
**Available at 675 WIC centers statewide **
**Delivered by 3,600 professional, paraprofessional and support staff **
**“****Face-to-face” delivery of services at enrollment and throughout eligibility period **

## Program Services

**Nutrition Education and                 Breastfeeding Support**
**Individual and group**
**Referrals to Health and                    Social Services**
**92% of infants and children                       have health coverage**

## Program Services

**Food Assistance**
**Checks to purchase specific foods at any of 3,900 WIC authorized retail food stores statewide**
**Average value is $62 per month per participant**

## Program Services

**California WIC serves 1.4 million/month**

## Program Budget 

**Annual budget of $1.3 billion -****                  $982 M  Federal Grant and $311 M Food Rebates ****	**
** **

**Three-quarters for Food; One-quarter for Nutrition Services**

##  Other WIC Nutrition Programs

**WIC Farmer’s Market Nutrition Program **
**Annual budget of $3 million**
**Provides $20 in coupons to 140,000 WIC families per season (May – Sept) in 74 local programs**
**Includes 385 markets and 1,100 farmers**
**Breastfeeding Peer Counseling Program **
**Annual budget of $2.1 million**
**Average of 21,600 peer contacts with mothers each quarter at 16 local programs**

## What’s the Big News?

## Supplemental Foods

**Selected to provide nutrition known to be needed by, and lacking in diets of, pregnant and breastfeeding mothers, infants and children**
**Foods intended to supplement the diets of women, infants and children and to provide access to foods promoted through nutrition education **
**Current WIC foods established in 1974 with only one significant change in 1990’s **

##  Supplemental Foods

**It’s time for a change!**
**Since 1974 there have been many**
**Changes in the WIC program and population it serves**
**Changes in the food supply and food consumption**
**Changes in diet-related health risks**
**Changes in nutrition knowledge and dietary**
**	****guidance**

## USDA Initiates the Review - 2003

**In 2003, USDA established a contract with the Institute of Medicine (IOM) to conduct a review of WIC foods in two phases**
**Phase I: Evaluate the diets of the WIC population, and propose criteria for revising the food packages**
**Phase II: Using information from Phase I, recommend specific changes to the food packages**
**IOM Committee = nutrition, medical and program experts**

## The IOM Review - Parameters

**Recommendations were to be:**
**Cost-neutral**
**Efficient for nationwide distribution and vendor check-out **
**Non-burdensome to program operations**
**Culturally suitable**
**The committee was also to consider:**
**The supplemental nature of the WIC Program**
**Burdens/incentives for eligible families **
**The role of WIC Food Packages in reinforcing **
**nutrition education, **
**breastfeeding, and **
**chronic disease prevention.**

##  IOM Report – April 2005

**Overarching Recommendations**
**Encourage consumption of fruits and vegetables**
**Emphasize whole grains**
**Provide incentives for breastfeeding**
**Be consistent with current dietary guidance for infants and young children**
**Reduce saturated fat**
**Increase participant choice**

## IOM Recommendations

**To Achieve Cost Neutrality**
**Some of the current foods were reduced – milk, juice, eggs, cheese**
**So new foods could be added – fruits and vegetables, whole grain bread, baby food**
**Cost of some packages increased    **
**	****while cost of others decreased**
**Estimated cost per participant **
**	****stayed the same**

## IOM Recommendations

**Increase Participant Choices**
**Wide selection of fruits and vegetables, including processed options**
**Variety of whole grain choices**
**More substitutes allowed for milk**
**Canned as well as dried beans permitted**
**Expanded choice of low-mercury canned fish (salmon, tuna, sardines)**

## Proposed Rule Published: August 2006

**The proposed revisions largely reflected recommendations made by the IOM, with some modifications found necessary by USDA to ensure cost neutrality. **
**Over 46,000 comments received by November 2006**
**In general, the proposed changes received widespread support**

## Interim Rule: December 2007

**Modifications to the proposed rule were based on public comment and further review and determination by USDA**
**Timelines:**
**Rule went into effect on February 4, 2008**
**Rule must be implemented by October 1, 2009**
**USDA will accept comments until February 1, 2010**

## Implementing the Rule

**WIC Programs must:**
**Issue either current food package OR new food package**
**Implement new food package statewide**
**Implement breastfeeding mother/infant “dyads” concurrently**
**WIC Programs may:**
**Implement by category (e.g. children, pregnant women)**
**Phase in substitution options and other optional provisions**

## Food Package Rules

**CURRENT FOODS:**
**Formulas**
**Milk**
**Cereal (infant & adult)**
**Juice**
**Eggs**
**Cheese**
**Dried Beans or Peanut Butter**
**Tuna **
**Carrots**

**NEW/REVISED FOODS:**
**All current foods plus:**
**Fruits and Vegetables**
**Whole Wheat Bread or other Whole Grains**
**Soy-beverage & Tofu**
**Light Tuna, Salmon, Sardines, Mackerel**
**Canned Beans**
**Infant Foods**

## Food Package Rules

**Add Foods to Appeal to Diverse Populations**
**Tortillas**
**Brown rice and other whole grains**
**Soy beverage**
**Tofu**
**Wide choice of fruits and vegetables for ethnic variety**
**Canned salmon, sardines, mackerel**

## Food Package Rules

**Reinforce Nutrition Education Messages**
**“****Eat more fruits and vegetables”**
**“****Lower saturated fat”**
**“****Increase whole grains and fiber”**
**“****Drink less sweetened beverages and juice”**
**“****Babies are meant to be breastfed”**

**New WIC Foods**!

##  Food Package Rules

**Seven WIC Food Packages**
**Food Package I: Infants birth - 6 months *****Fully Breastfed, Partially Breastfed, Fully Formula Fed***
**Food Package II: Infants 6 - 12 months**
**Food Package III: Medically Fragile Women, Infants and Children**
**Food Package IV: Children 1- 4 years**
**Food Package V: Pregnant & Partially Breastfeeding**
**Food Package VI: Postpartum**
**Food Package VII: Fully Breastfeeding**

## Food Package Rules

**Revised Food Packages for Infants**
**Formula amounts tied to feeding    practice and age of infant**
**Complementary foods delayed                 to 6 months**
**Juice eliminated**
**Baby food fruits and vegetables              added for all infants **
**Baby food meat for fully breastfed babies**

## Food Package Rules

**New Food Packages for Partially Breastfeeding Infants**
**Compared to previous food packages, partially breastfed infants receive less infant formula to allow mothers to feed more breast milk to their infants.**
**No routine issuance of formula in first month to help mother maintain milk supply.**

## Food Package Rules

**Provide Breastfeeding Incentives and Support**
**New changes in the WIC food packages help WIC more actively promote and support breastfeeding**.
**Fully breastfeeding mothers receive most variety and largest quantity of food, including $10 cash-value voucher for fruits and vegetables.**
**Fully breastfeeding infants over 6 months receive larger quantities of baby food fruits and vegetables; also baby food meat.**

## Food Package Rules

**Add Fruits and Vegetables**
**Cash value-vouchers for fruits           and vegetables for:**
**Children - $6**
**Women - $8**
**Exclusively Breastfeeding - $10**
**Participants may choose from a wide variety of fruits and vegetables; only white potatoes excluded**
**Fresh required; frozen and canned allowed as substitutes for women and children and dried for women**

## Add Fruits and Vegetables

**Cash-value vouchers for fruits and vegetables**
**For use at authorized grocery stores.**
**WIC State agencies have the option to authorize farmers at farmers’ markets to accept the cash-value voucher.**
**WIC State agencies have the option to allow participants to pay difference if purchase of fruits and vegetables exceeds cash-value voucher.**

## Food Package Rules

**Reduce Juice Amounts for Children and Women**
**Reduces quantities of juice for           children and women by about half. **
**Amounts align with the 2005 Dietary Guidelines for Americans and recommendations of the American  Academy of Pediatrics.**

## Food Package Rules

**Increase Whole Grains**
**Adds whole wheat or whole grain bread for children and women.**
**Whole grain substitution options:**
**Brown Rice **
**Soft Corn and Whole Grain**
**	****Tortillas**
**Oatmeal**
**Bulgur**
**Barley**
**Requires whole grain cereals**
**At least half of the cereals on a State agency’s food list must be whole grain.**

## Food Package Rules

**Change Milk Amounts and Types**
**Reduces quantities of milk and cheese for children and women to align with 2005 Dietary Guidelines for Americans.**
**Only nonfat or low-fat milk is authorized for women and children over 2 years.**
**Maximum of one pound of cheese.**
**Add new milk substitution options:**
**Soy-based beverage**
**Tofu**

## Food Package Rules

**Reduce the Quantity of Eggs**
**Reduces quantity of eggs for children and women to align with 2005 Dietary Guidelines for Americans.**
**One dozen per                              month.                                            **

## Food Package Rules

**Provide Beans or Peanut Butter to all Women and Children**
**Substitution option – canned beans**

## Food Package Rules

**Add New Canned Fish Options for Fully Breastfeeding Women**
**Continues to allow canned light tuna and allows other canned fish identified as lower in mercury: **
**Salmon**
**Sardines**
**Mackerel**

## Food Package Rules

**Continue to Serve Medically Fragile Participants**
**Continues to provide exempt infant formula and medical foods.**
**Now authorizes medically fragile participants to receive other WIC supplemental foods in combination with formula or medical foods.**

## Impact on Participants

**More diverse and balanced food packages**
**Greater variety and choice including culturally appropriate foods**
**Offers choices consistent with Dietary Guidelines for Americans**
**Supports improved nutrient intakes**
**Addresses nutrition-related concerns (e.g. obesity, low breastfeeding rates)**
**Better Nutrition!**

## Impact on Local WIC Programs

**Opportunity to re-connect nutrition education to WIC foods**
**Enhances breastfeeding support activities**
**Greater flexibility to prescribe foods that are culturally appropriate or that better address health concerns of participants**
**Responsible for staff training on new foods and promotion of food packages to participants**

## Impact on Vendors 

**Under new rules, WIC vendors are required to:**
**Stock new WIC foods, including fruits and vegetables and whole grains**
**Redeem cash-value vouchers for fruit and vegetables **
**May experience change in sales of current and new foods**
**Responsible for training of store personnel and revisions to operations**

## Impact on Food Manufacturers

**New minimum nutrient requirements and specifications for WIC-eligible foods, i.e.**
**Soy beverage**
**Whole wheat and whole grain bread**
**Whole grain cereal**
**Fruits and vegetables**
**Infant foods**
**Canned fish**
**New opportunities for WIC customers**

## Impact on State WIC Programs

**Opportunity to focus nutrition education on WIC foods **
**More flexibility to authorize appropriate foods**
**Continue to have flexibility to select foods for the State food list within the Federal Rule:**
**Specific brands **
**Container/package sizes **
**Policies regarding organic, kosher, etc.**
**Lower cost options**
**Food substitution options**
**Responsible for planning and implementing the new Food Package Rule within existing resources**
**	****	****	**

## California’s Process – Part 1

**Understand the Food Package Rule**
**Gather Information:**
**Participant survey, Summer 2007 – 3,085 families representing all participants**
**WIC Staff survey, early 2008 – half of all staff**
**Breastfeeding survey – Summer 2008**
**Vendor forums – April through June, 2008**
**Food products – on-going from manufacturers and other states**

## California’s Process – Part 1

**Internal and external workgroups**
**State & Local Agency Food Package Committee**
**Western Region Food Policy Workgroup**
**Vendor Food Package Advisory Group**
**State Office Workgroups**
**Identify/expand partnerships within CDPH, other State Agencies, community**
**Food Package Summit on April 7, 2008**
**Collaborating with Nutrition Network **
**Possible First 5 and Child Nutrition Program**
**WIC local agency Vendor Liaison Project**

## California’s Process – Part 2

**Determine policies**
**Develop implementation plan with timelines **
**Systems and procedural changes**
**Training – WIC staff, vendors, participants**
**Communication **
**Communicate the plan **
**Work collaboratively with stakeholders         and partners to implement** **by October 1, 2009**
**Provide comments to USDA by              February 2010**

## Why are New Foods a Priority?

**Opportunity to:**
**Improve the nutrition and health of WIC families**
**Enhance WIC’s nutrition education **
**Better support breastfeeding**
**Increase access to healthy foods, especially in small stores**
**Strengthen partnerships with vendors and with other nutrition programs and services for WIC families**

## Families--and California--Grow Healthy with WIC

**Notes:**
Help families—and CA—grow healthy with WIC.

Thank you.