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Category: Nutrition

House FY24 Agriculture Appropriations Bill will Stall Progress, Decrease Access for Families in Need

1,000 Days is dismayed by the House Appropriations Committee’s fiscal year 2024 Agriculture Appropriations bill released today. This bill under delivers in providing nutrition assistance to those in need and rolls back successful program improvements implemented during the pandemic. Of concern, the bill would reduce funding levels for WIC below current levels, with proposed funding $800 million below the FY24 President’s Budget request. This would result in fewer women and children being served, and possible waitlists for those that qualify for the program. The proposed House Agriculture Appropriations bill ends the increased fruit and vegetable benefits that have been provided to families since April 2021, further reducing nutrition benefits provided to WIC participants. These benefits have had multiple benefits, especially for young children, including increased fruit and vegetable consumption in WIC toddlers and a broader variety of fruit and vegetable purchases by parents. The bill also undermines the science-based review process for the WIC food package, preventing USDA from updating the foods provided to include more fruits, vegetables, seafood, and whole grains.

The proposed bill is short-sighted, cutting benefits to pregnant women, infants and children when investment in the 1,000 days between pregnancy and a child’s 2nd birthday sets the foundation for all the days that follow. How well or how poorly mothers and children are nourished and cared for during the 1,000-day window has a profound impact on a child’s ability to grow, learn and thrive. Research has proven that WIC saves lives. WIC reduces fetal deaths and infant mortality; reduces low birthweight rates and increases the duration of pregnancy; and it improves the growth of nutritionally at-risk infants and children. We call on Congress to fund WIC at $6.35 billion in fiscal year 2024, providing essential nutrition services during this critical timeframe.

Lifting Up the Powerful Role of Nutrition for Policymakers and Advocates

Good nutrition before, during, and after pregnancy has a profound impact on the health of both a mother and child. This National Nutrition Month (NNM), and as part of our global #March4Nutrition campaign, 1,000 Days is highlighting some of the nutrition-related regulations and legislation that we support to ensure every child can grow, learn, and thrive. Much of this legislation also shapes the future for mothers, pregnant, birthing and postpartum people. This Spring, we are focused on advocating for regulatory updates, legislation that supports nutrition for families here in the U.S. and around the world, and additional funding to support all these programs. This year’s NNM theme of “Fuel for the Future” highlights the importance of ensuring families are well nourished to support healthy futures.

Updated Regulations for Maternal & Child Nutrition

WIC Food Package Updates

The United States Department of Agriculture (USDA) has proposed several regulatory changes to strengthen nutrition programs and improve maternal and child nutrition. The agency is currently updating the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food packages, that would impact over 6 million WIC participants which include moms, babies, and young children. The updates, which are science-based and align with the most recent Dietary Guidelines for Americans and the 2017 National Academies (NASEM) report, increase fruit and vegetable vouchers, promote greater flexibility to accommodate cultural food preferences and dietary needs, strengthen support for breastfeeding, and increase access to under-consumed, nutritious foods, like seafood with lower levels of methylmercury.

Child Nutrition Program Updates

USDA also proposed updated nutrition standards to school meals that would more closely align the standards recommended in the Dietary Guidelines for Americans to provide children with nutritious and delicious meals. The proposed updates do include some changes to the Child and Adult Care Food Program (CACFP), which serves young children, including those in their 1,000-day window, at childcare. Changes in the CACFP program would support more nutritious meals and snacks by reducing added sugar content and allowing more plant-based meat/meat alternate options.

Dietary Guidelines for Americans

While not specific legislation or regulations, the Dietary Guidelines for Americans (DGA) form the basis of nutrition policy in the U.S. and are a critical component of improving maternal and child nutrition. Co-developed every five years by USDA and the Department of Health & Human Services (HHS), the basis of the guidelines is a science-based report developed by the Dietary Guidelines for Americans Advisory Committee (DGAC) which includes nutrition researchers, physicians, and Registered Dietitians. The DGAs have a broad impact ranging from WIC food packages and child nutrition programs to food labeling and nutrition education programs. The guidelines include dietary recommendations for pregnant and lactating people and birth to age 2, which were included for the first time in the 2020-2025 DGA. The next iteration of the guidelines is currently underway as the DGAC is reviewing evidence and drafting conclusion statements which will ultimately lead to dietary recommendations and guidelines for Americans, including mothers, babies, and young children.

2023 Farm Bill

Every five years, Congress reauthorizes the Farm Bill which is a robust, multiyear law that authorizes food and agricultural programs. Although the name may imply that most of the bill is focused on farming and agriculture, nutrition spending makes up an overwhelming majority of the legislation. In 2018, the nutrition title (Title IV) made up about 76% of total Farm Bill spending, and for the 2023 Farm Bill, it is projected to be as much as 85%. The Supplemental Nutrition Assistance Program (SNAP), formerly known as “food stamps,” is authorized in the Farm Bill which is the reason for the large amount of spending for nutrition in the bill. When children have access to SNAP, from birth through early childhood, their risk of developing high blood pressure, heart disease, diabetes, and other poor health outcomes later in life greatly decreases. Children on SNAP can immediately experience a reduction in food insecurity. As Congress works to reauthorize the 2023 Farm Bill, it is imperative that they ensure families have access to the food and nutrition assistance they need through SNAP benefits as nearly half of all people who participate in SNAP are children.

In addition to domestic nutrition programs, the Farm Bill also reauthorizes international food aid programs in Title III. These programs include Food for Peace Title II, the McGovern-Dole Food for Education Program, Food for Progress, and the Bill Emerson Humanitarian Trust. These programs are primarily focused on improving food security. As Congress works to reauthorize the 2023 Farm Bill, we urge them to further consider how the programs can incorporate nutrition interventions to address both food and nutrition insecurity and prevent malnutrition. Robust funding will be needed to address the current malnutrition crisis and to build resilience in communities globally.

Implementation of the Global Malnutrition Prevention & Treatment Act

In October 2022, the Global Malnutrition Prevention & Treatment Act (GMPTA) was signed into law to bolster the federal government’s efforts to address global malnutrition and build resilience. It authorizes the United States Agency for International Development (USAID) to advance targeted interventions to prevent and treat malnutrition around the world while requiring a robust monitoring of interventions to ensure effective use of funding. As USAID works to draft the implementation plan and coordinate efforts, we look forward to working alongside them to ensure all activities address the nutritional needs of families in their first 1,000 days.

Fiscal Year 2024 Appropriations

Addressing nutrition security in the U.S. remains a critical need. 1,000 Days joins the National WIC Association and the broader maternal and child health community in urging funding of $6.35 billion for WIC in FY 2024. This amount will ensure adequate funding to support WIC’s growing caseload and address rising food costs in WIC food categories. We also support increased funding to strengthen FDA’s food safety and nutrition capacity, especially for infants and young children.

While reductions in global mortality rates for women and children are two of the biggest success stories in international development, progress has slowed over the past 12 years. There remain significant gaps that additional investments can help close. In 2021, 5 million children under age five died from mainly preventable and treatable diseases, with malnutrition as the underlying cause of roughly half of these deaths. Additionally, 300,000 women die annually of preventable causes related to pregnancy and childbirth. 

As Congress determines funding levels for FY2024, it is critical that funding meets the moment to address the malnutrition crisis. 1,000 Days as part of the 1,000 Days Advocacy Working Group (AWG) and the Maternal, Newborn, Child Health Roundtable (MNCH RT), is requesting $300 million for the nutrition account and $1.15 billion for the maternal and child health (MCH) account within USAID. Malnutrition costs the world $3.5 trillion in lost productivity and healthcare costs each year. The current global food crisis, fueled by conflict, climate shocks and the threat of a global recession, continues to threaten the lives of women and children globally. Full funding of the nutrition account is critical for saving lives and reaching USAID’s goal of ending preventable child and maternal deaths.

President’s FY2024 Budget Meets the Moment for U.S. Families, Misses the Mark for Foreign Investments in Nutrition

The Biden Administration’s FY 2024 budget proposal includes significant funding for several of 1,000 Days’ domestic key policy priorities. The proposal reflects priorities of the 2022 White House Conference on Hunger, Nutrition, and Health and opportunities identified in the American Journal of Public Health series to unlock the untapped potential of this critical time by closing data gaps, enhancing promising programs, strengthening policies and uniting around this powerful window of growth. It includes:

  • $6.3 billion to fully fund the 6.5 million individuals expected to participate in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
  • $325 million to establish a national, comprehensive paid family and medical leave program plus $10 million to help states expand access to paid leave benefits, including creation of a Technical Assistance Hub to share best practices among states.
  • $471 million to support implementation of the White House Blueprint for Addressing the Maternal Health Crisis to strengthen maternal health initiatives. Additionally, the budget requires all states to provide continuous Medicaid coverage for 12 months postpartum, eliminating gaps in health insurance at a critical time.
  • Increased funding for early care and education programs to increase childcare options for more than 16 million young children and lower costs so that parents can afford to send their children to high-quality child care.

While we celebrate increases across domestic nutrition programs, the proposals for global programs missed the mark. We welcome the topline increases for the State Department and USAID, but the Administration’s proposal to provide no increases to current investments in global nutrition and maternal & child health fall short in addressing growing the need. This past week, a report released from UNICEF shed light on how dire the malnutrition crisis is, particularly among adolescent girls and women. The number of pregnant and breastfeeding mothers suffering from acute malnutrition has soared from 5.5 million to 6.9 million – or 25 percent – since 2020 in 12 countries hardest hit by the global food and nutrition crisis. Ensuring children have access to good nutrition when it matters most is one of the most powerful and cost-effective ways to create brighter, healthier futures.

As rates of hunger and malnutrition continue to climb around the globe, it was disappointing to see that Global Health accounts within the United States Agency for International Development’s (USAID) budget for the Nutrition and Maternal & Child Health (MCH) did not receive funding increases in the President’s Fiscal Year 2024 budget. Within the proposal, the nutrition account is flat funded at $160 million and the MCH account is flat funded at $910 million. The NGO community has called for no less than $300 million for the nutrition account and $1.15 billion for the MCH account. The released budget is world’s apart from these needs-based community asks to address the ongoing health and nutrition crisis.

Ultimately, these funding levels will be decided by Congress and we urge Congress to fund State and Foreign Operations accounts at a level that meets the moment, including $300 million for the Global Health Nutrition account, $1.15 billion for the Maternal and Child Health account.

Our favorite time of year: #March4Nutrition

Our favorite time of year: #March4Nutrition

We’re thrilled to celebrate the 50th anniversary of National Nutrition Month in March 2023. Developed by our friends and colleagues at the Academy of Nutrition and Dietetics, every March we work especially to amplify the importance of nutrition for families in the first 1,000 days: the time between pregnancy and a baby’s second birthday.

Throughout pregnancy, infancy and beyond, families need good nutrition, breastfeeding support, and nurturing care in order to thrive. Backed by decades of research and most recently the American Journal of Public Health’s special nutrition series, we know nutrition plays a foundational role in a child’s development and her country’s ability to prosper.

We invite you to follow #March4Nutrition on Facebook, Instagram, and Twitter all month long and join the conversation. Every week in March, we’ll dive deep into a new theme and explore how nutrition lays the foundation for brighter, healthier futures.

Week 1 March 1-10: Women’s nutrition – Access to proper nutrition can help women grow their power.

Week 2 March 13-17: Benefits of breastfeeding – Breastfeeding has critical benefits for both moms and babies.

Week 3 March 20-24: Healthy foods and drinks for babies and toddlers – Growing babies need good nutrition to flourish.

Week 4 March 27-31: Raise your voices – Help us spark action to change the world for moms, babies and families, 1,000 days at a time.

At 1,000 Days, we believe that every family, everywhere deserves the opportunity to have a healthy 1,000-day window and beyond – and that starts with access to good nutrition.

Join us this month as we #March4Nutrition for moms and babies!

New Series in the American Journal of Public Health Identifies 1,000-Day Window as Untapped Potential to Improve Health of Families

Opportunities, Challenges Identified for Pregnant People and Babies 0-2

(WASHINGTON D.C.) Over the last two decades, science has shown that the 1,000-day window, the time between a pregnancy and the baby’s second birthday, is most critical for brain development and when good nutrition has the greatest influence on future health. Today, on the heels of the first White House Conference on Hunger, Nutrition, and Health in more than 50 years, The American Journal of Public Health released a special series that identifies opportunities to unlock the untapped potential of this critical time by closing data gaps, enhancing promising programs, strengthening policies and uniting around this powerful window of growth.

“Prioritizing the health of babies, younger children, and mothers will reap significant returns on investment, setting the foundation for the health of our nation,” said Ambassador Susan Rice, White House Domestic Policy Advisor, in one of the editorials in the series. “Everyone has a role to play—the private sector; state, local, tribal, and territory governments; civil society; academia; philanthropy; and other partners.”

The 70-page series with more than 15 authors outlines the role of Early Childcare and Education (ECE) settings to strengthen overall support systems for low-income families and influence the healthy growth and development of children; how to improve breastfeeding outcomes without leaving anyone behind; new analysis on COVID’s impact for people who gave birth during the height of the pandemic; investments needed to achieve nutrition security; and new opportunities for pediatricians to better support families in their care with nutrition advice and access.

“This special issue sets the stage for what we know about nutrition in the first 1,000 days in the U.S. and what is needed to move forward. Unfortunately, nutritious foods are not uniformly and equally available to all. This has unique relevance to the first 1,000 days as inequities in childhood growth and development due to poor nutrition can have long-term effects on cognitive development and health throughout that child’s life,” said Dr. Ruth Petersen, MD, MPH, Director of the Division of Nutrition, Physical Activity and Obesity at the Centers for Disease Control and Prevention (CDC), guest editor of the series and an author (R. Petersen).  The series identifies:

  • Gaps in data of nutrition status and eating behaviors through pregnancy, infancy and toddlerhood (H. Hamner), including micronutrient deficiencies such as iron status, which leaves women vulnerable to poor maternal outcomes (M.E. Jefferds).
  • Steps to improve nutrition of pregnant people, including how to realize the potential benefits of breastfeeding so no one is left behind (R. Perez-Escamilla).
  • Impacts of early disparities from historically underserved communities, especially racial disparities that stem from systemic racism in food access, education, housing, health care and employment that have been exacerbated by the COVID-19 pandemic (S. Bleich).
  • Efforts to counter repeated exposure of marketing of unhealthy foods and drinks (J. Harris),  and address overconsumption of ultra-processed food through government policies (J. Krieger).
  •  Opportunities to leverage federal and state programs and policies, such as ECE funding streams, state licensing regulations, state quality improvement programs, and accrediting organizations to strengthen nutrition security in childcare settings. (C. Dooyema).
  • Actions key sectors can take immediately, including childcare, healthcare and the philanthropic sector, as well as policy recommendations for the U.S. government (B. Thomas).  

“What happens in the first 1,000 days sets the foundation for every day that follows. How well or how poorly mothers and children are nourished and cared for during this time has a profound impact on a child’s ability to grow, learn and thrive,” said Blythe Thomas, initiative director of 1,000 Days, an initiative of FHI Solutions. “Achieving nutrition security during the first 1,000 days will ultimately require multisector collaboration, advocacy, and action to fully support families where they live, learn, work, play, and gather. We invite all to join us in prioritizing and realizing the opportunity presented by this AJPH supplement.”

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Celebrating Progress Towards Leaving No One Behind on World Food Day

Low and middle-income countries are still grappling with the ongoing COVID-19 pandemic, conflict, and weather shocks which continue to impact global food and nutrition security. The World Food Programme estimates that 50 million people in 45 countries are on the edge of famine. On World Food Day 2022, we take stock of the hard-fought progress that has been made to strengthen nutrition during the first 1,000 days, and we renew our commitment to continue the fight. Though work still needs to be done to truly leave no one behind, we applaud the following actions that have been taken by the US government to address food and nutrition insecurity in low and middle-income countries.

United Nations General Assembly Food Security Announcements

US Government Global Food Security Commitments

Multiple events were held at the United Nations General Assembly (UNGA) in New York related to food and nutrition security efforts. President Biden announced $2.9 billion in additional funding to strengthen food security, which included funding for humanitarian assistance and global development assistance. As part of UNGA, the Global Food Security Summit, which was held one year after the UN Food Systems Summit, took place on September 20th and included remarks from Secretary of State Antony Blinken. Secretary Blinken highlighted current actions to address food insecurity, including progress made on the Roadmap for Global Food Security, and called for  more countries to respond to the food insecurity crisis. He mentioned commitments made by the US government, which include $6.1 billion in humanitarian assistance and $2.3 billion in development assistance, and the expansion of Feed the Future. Much of the funding provided by the US government addresses the negative impact on food insecurity throughout the world due to the war in Ukraine.

Commitments to Prevent and Treat Severe Malnutrition

On September 21st, USAID, UNICEF, the Government of Senegal, and the Children’s Investment Fund Foundation co-hosted “The Child Malnutrition Crisis: Pledging to Save Lives.” The event followed the call to action and announcement from United States Agency for International Development (USAID) Administrator Samantha Power in July when the US committed $200 million to scale up access to wasting treatment, including Ready-to-Use-Therapeutic Food (RUTF). During the September event at UNGA, $280 million was announced which included new funding from donors around the world to address severe malnutrition and wasting. Between these events, over $530 million has been committed through public and private sector funds which has the potential to reach the majority of children suffering from wasting with treatment.

Passing the Global Malnutrition Prevention and Treatment Act

In September, the Senate passed the Global Malnutrition Prevention and Treatment Act and it is awaiting President Biden’s signature. The legislation was led by USAID and non-governmental organizations (NGOs) like 1,000 Days of FHI Solutions dedicated to preventing and treating malnutrition. It makes nutrition an even higher priority within the US government by establishing a five-year strategy to institute precise and targeted reforms in U.S. global nutrition programs. It prioritizes investments in high-impact nutrition programs and allows USAID administrators to scale up the prevention and treatment of global malnutrition and coordinate with relevant public and private partners on these efforts. A Nutrition Leadership Council will be established with representatives from relevant inter- and intra-agency offices to coordinate USAID’s efforts and ensure effective use of taxpayer dollars. 1,000 days is proud to have supported this lifesaving bill!

Advancing the Global Food Security Reauthorization Act of 2022

The House of Representatives passed the Global Food Security Reauthorization Act of 2022 on September 29, 2022. This legislation reauthorizes the Global Food Security Act (GFSA) through 2028 and continues to build upon and strengthen the Feed the Future initiative. It supports agriculture-led economic growth, bolsters small-holder and women-owned farms, and improves maternal and child nutrition, including during the 1,000-day window. GFSA will strengthen local and regional economies and promote resiliency in some of the world’s lowest income countries. This legislation aims to not only improve food and nutrition security, but also national security, and meets the moment to address rates of increased hunger and malnutrition globally.

Moving Progress Forward

Further progress on a global scale is still needed to address the food and nutrition insecurity crises. While we recognize and celebrate the commitments made by donors, the US government, other country governments, and the NGO community, we will continue to advocate for efforts to improve nutrition, particularly during the 1,000-day window. We know the critical role that nutrition plays in a child’s development, and the investments during this time allow communities to prosper. 1,000 Days looks forward to continuing to be a part of efforts to advocate for strong food and nutrition security programs and investments, including evidence-based nutrition interventions.

A Much-Needed Win for Moms and Babies: the Global Malnutrition Prevention and Treatment Act

Photo Credit: USAID

Nutrition plays a foundational role in a child’s development and her country’s ability to prosper. It is why several of the world’s leading economists have called for greater investments in the nutrition and well-being of mothers, babies, and toddlers as a way to create brighter and more prosperous futures for us all.

On September 20, 2022, the Senate passed the Global Malnutrition Prevention and Treatment Act (H.R. 4693) a lifesaving bill that will positively impact tens of millions of women and young children especially in their 1,000-day window, the time between pregnancy and the baby’s second birthday. This is the precious window of opportunity that enables all children to reach their full potential. When children are well nourished, cared for, and protected from disease, violence and toxic stress, they have the best chance at a thriving future. And when children get a strong start, we all benefit.

About the bill

The legislation will support countries in their efforts to prevent the current 2.6 million childhood malnutrition-related deaths worldwide, approximately 150 million children with stunted development, and the 13.6 million children globally under the age of 5 experiencing wasting because they do not have adequate nutrition.

The Global Malnutrition Prevention and Treatment Act, led by the U.S. Agency for International Development (USAID) and non-governmental organizations (NGOs) like 1,000 Days dedicated to preventing and treating malnutrition, makes nutrition an even higher priority by establishing a five-year strategy to institute precise and targeted reforms in U.S. global nutrition programs. It prioritizes investments in high-impact nutrition programs, such as prenatal vitamins, fortifying foods with essential nutrients (like Vitamin D, iron, and iodine), providing young children with vitamin A supplementation, supporting new mothers to breastfeed, and lifesaving treatment for severely malnourished children.

With this bill, the USAID administrators will be able to scale up the prevention and treatment of global malnutrition and coordinate with relevant public and private partners on these efforts. A Nutrition Leadership Council will be established with representatives from relevant inter- and intra-agency offices to coordinate USAID’s efforts and ensure effective use of taxpayer dollars. The USAID administrators will select priority countries to receive prioritized nutrition assistance and develop clear goals for increasing coverage of high-impact, evidence-based nutrition programs. USAID will be required to submit an annual report to Congress on the progress made toward preventing and treating global malnutrition.

“With the passing of this legislation, we believe the effectiveness of these nutrition programs can be significantly increased with greater strategic vision, accountability, integration, and coordination,” said Blythe Thomas, 1,000 Days of FHI Solutions Initiative Director.

The power to change lives

For example, large-scale vitamin A supplementation has played a major role in decreasing Senegal’s under-five mortality rate from 59 to 37 per 1,000 live births in 5 years. In Nepal through the Suaahara II program, USAID increased the rate of exclusive breastfeeding in supported communities from 45% to 71% in 5 years.

This Global Malnutrition Prevention and Treatment Act is an investment in the future of many lives and aims to address malnutrition at the core so that our most vulnerable populations have access to proper nutrition for continued health throughout the lifespan. As Congresswoman Chrissy Houlahan (D-PA) stated “investing in global nutrition translates to lives saved.”

With both the House and Senate passage, we enthusiastically await the legislation being signed into law by President Biden.

1,000 days is proud to have supported this lifesaving bill and will continually engage with USAID and our partners as the act is implemented.

New Peer-Reviewed Series Reinforces Powerful 1,000-Day Window in U.S.

The “1,000-day window” as an organizing agenda is a new and relatively unknown concept in the United States despite its established role in global health. But, there is opportunity to unite public health communities through the relevant, compelling framework.

We believe further focus on creating the best conditions for families in their 1,000-day window can change the trajectory of the path we’re on. We seek to present a comprehensive picture of the state of the science, research needs, and a policy agenda for optimal maternal and child health in the United States through a dedicated series in the American Journal of Public Health (AJPH).

Three papers were released at 4 p.m. ET September 19, 2022 (and can be found below once published). The full series will be released October 26, 2022 on the AJPH website.

RESEARCH NEWS STORY – The First 1,000 Days: A Window of Opportunity for a Brighter Future for Children

September 20, 2022

The First 1,000 Days: A Window of Opportunity for a Brighter Future for Children

Optimizing federal programs and policies can significantly improve nutritional outcomes in the 1,000-day window—a vital period of development for children

Optimal nutrition between pregnancy and a child’s 2nd birthday (i.e., the first 1,000 days) is critical for the development and long-term health of the child. The 1,000 Days initiative of FHI Solutions aims to improve the health of pregnant people and babies by giving them a healthy start. The 1,000 Days initiative sponsored a new series in the American Journal of Public Health, to publish October 26, 2022, with a pre-release of three papers today.

How can we help create a healthier and more equitable future for all pregnant people and their children? The infant and maternal mortality rates in the US are among the highest of any wealthy country, with glaring racial and ethnic disparities. There is significant room to develop a unifying plan for the right policies and systems to improve nutritional security and well-being for vulnerable families.

A new essay published in the American Journal of Public Health by Dr. Heather Hamner—a health scientist at the Centers for Disease Control and Prevention—reveals numerous gaps between the dietary intake of pregnant people, infants, and toddlers and the US Department of Agriculture and the Department of Health and Human Services’ Dietary Guidelines for Americans, 2020–2025, with race and ethnicity disparities persisting across the spectrum. The average consumption of sugars, saturated fat, and sodium are higher than the recommendations of the Dietary Guidelines. The article also reveals that nearly 75% of infants are not exclusively fed human milk for the first 6 months of their lives and 1 in 3 of them are started on complementary foods (other than human milk or infant formula) before the recommended age. Most children between 12 and 23 months do not consume the recommended amounts of vegetables, dairy, and fruits.

How do we set about addressing these nutritional deficits? The essay states “Advancing efforts related to research and surveillance, programs and communication, and dissemination could help positively, and equitably, influence the health and well-being of mothers and children.” It also outlines a framework by which current federal policies and programs can be strengthened and how access to and participation in programs can be improved.

Another paper in the collection, authored by Blythe Thomas, Initiative Director of 1,000 Days, an initiative of FHI Solutions, points out that a clear plan that unifies maternal and early childhood nutrition policy and systems has eluded implementation in the US. The paper emphasized four sectors where immediate actions can be taken, and where long-term investment can make a significant impact on maternal and child health: early childhood development, health care, philanthropy, and US government relations. “Achieving nutrition security during the first 1000 days will ultimately require multisector collaboration, advocacy, and action to fully support families where they live, learn, work, play, and gather,” says Thomas, in her editorial.

A third paper in the collection—authored by Dr. Kofi Essel, community pediatrician, Children’s’ National Hospital, discusses the limited focus on nutrition-related medical education as a significant constraint on the ability of pediatricians to deliver sound feeding and nutritional guidance during the first 1,000 days. Using examples from the author’s own experience during his pediatric residency, the editorial explains that a paradigm shift on the importance of nutrition and nutrition guidance is important to enhance clinical care. According to Dr. Essel, “This shift requires a collective effort that activates pediatricians to work in cross-sector collaboratives to influence change alongside industry, researchers, and even early childhood educators. It requires pediatricians to use their voices to support local policy that shifts the food landscape, supports national policy that enhances nutrition security for our families, and transforms medical education for current and future providers.”

These three papers are part of a special series, sponsored by 1,000 Days of FHI Solutions, that will appear in AJPH on October 26, 2022. The full series will present the state of science, research needs, and a policy agenda for optimal maternal and child nutrition in the United States. Never before has a journal series brought together papers on these topics during pregnancy, birth, the postpartum period, and early childhood for the US population.

Reference

  Authors                   Titles of original papers                 Journal   Heather C. Hamner, PhD, MS, MPH, Jennifer M. Nelson, MD, MPH, Andrea J. Sharma, PhD, MPH, Maria Elena D. Jefferds, PhD, Carrie Dooyema, MPH, MSN, RN, Rafael Flores-Ayala, DrPH, MApStat, Andrew A. Bremer, MD, PhD, Ashley J. Vargas, PhD, MPH, RDN, Kellie O. Casavale, PhD, RD, Janet M. de Jesus, MS, RD, Eve E. Stoody, PhD, Kelley S. Scanlon, PhD, RD, and Cria G. Perrine, PhDKofi Essel, MD, MPHBlythe Thomas, BS   Improving Nutrition in the First 1000 Days in the United States: A Federal Perspective   The First 1000 Days—A Missed Opportunity for Pediatricians   From Evidence to Action: Uniting Around Nutrition in the 1000-Day Window     American Journal of Public Health
   
DOI         10.2105/AJPH.2022.30706310.2105/AJPH.2022.307028NA
10.2105/AJPH.2022.307028
NA

 

 

Q&A with Dr. Kofi Essel: AJPH Special Series on Nutrition in the 1,000-Day Window

An interview with Dr. Kofi Essel, Community Pediatrician, Children’s National Hospital

What inspired you to become a pediatrician?

I always found the field of pediatrics to be a very fertile ground.  Families are interested in the wellbeing of their children, doing whatever it takes to improve the health of the next generation.  This made my clinical experiences very positively reinforcing as we engaged in effective, shared decision-making.  In addition, my mentors in my early training were all pediatricians and huge community advocates.  I knew I wanted my career to expand beyond the clinical examination room, and I found the opportunity to advocate for marginalized young children and families to be meaningful and necessary.

Your recently published a paper entitled, “The first 1,000 days: A Missed Opportunity for Pediatricians.” Why are the first 1,000 days important?

The first 1,000 days are a critical stage for young children.  Unfortunately, healthcare is often very reactionary and prioritizes management and treatment of disease.  However, the opportunity to engage young children and families in prevention and take advantage of these early years to optimize brain development and maturation, eating patterns, and healthy family relationships is critical.  We know that children are incredibly vulnerable during these first 1,000 days and small insults to their brain and environment can cause permanent challenges down the line.  Helping families and creating systems that protect and support the most vulnerable is essential for our nation.

Why is this a missed opportunity for pediatricians?

This article gave me a chance to highlight the gaps in nutrition education for future and practicing providers, but also magnify the importance of pediatricians like myself to take the mantle to support our young children and families.  Systemic change is crucial and necessary, but the need for strong counseling and advocacy is always going to be an important piece of the puzzle.  The gap in nutrition education is a disservice to our patients, so I call on our training programs to recognize the essential nature of equipping our current and future pediatricians with the knowledge, tools, and skill to work alongside our patients and through shared decision-making support their desire to optimize the health of their children.  We also must remember that the 21st century clinician must engage using modern tools of integration.  We must seamlessly integrate our clinical work with population health to provide more voices to advocate for the changes needed that our families share with us each and every day.

How does your awareness of nutrition in the 1,000-day window influence who you are as a pediatrician and what you prioritize?

I truly believe nutrition is a powerful tool that I use in my clinical arsenal, and it deserves more attention.  Food is medicine, and I use this medicine with confidence in the same way I have developed confidence in the tried-and-true inhalers, pills, and liquid solutions that my prescriptions help my families acquire.  Unfortunately, as a pediatrician I realize that the access to the medicine of food is often limited for many populations and this inequity leads to worsening disease with its origins beginning in the womb.  As a pediatrician with an awareness of the power of nutrition I am compelled to advocate for programs, tools, and interventions that support equitable access to nutritious foods so that all my families can have a chance from the start.

What needs to happen to support pediatricians with this opportunity?

In order to support pediatricians to use food and nutrition as medicine to impact the first 1,000 days of young children, it is important to keep a few things in mind: 

  1. Incorporate required, high-quality, substantial and practical nutrition education in medical schools and residency training, so that future providers become aware of its necessity.
  2. Ensure curricula that inform current and future providers engage with the tangible social needs that are ubiquitous throughout the country, such as food and nutrition security.  If not integrated into training, we set the stage for worsening inequities by only promoting a message that appears unreachable for many. 
  3. We often focus on the challenges within communities, but we need to recognize their strengths and assets. Pediatricians need support to screen families for food insecurity and must have in place strong, community, clinical-collaborative referral programs to seamlessly connect families from clinics and health systems to meaningful, nutrition-based, local and federal programs as needed and beneficial (i.e. food as medicine, local pantries, community cooking classes, WIC, SNAP, etc).
  4. Systems change requires systemic solutions.  To redirect the health system will require more than a few pediatric advocates on the ground, but rather larger licensing bodies and federal policy to turn the tide, such as the recent bipartisan resolution authored by Congressman McGovern & Burgess in May of 2022 calling for “substantial training in nutrition” for physicians.