WIC’s New Food Choices: Helping to Change the Neighborhood

1. WIC’s New Food Choices: Helping to Change the Neighborhood Michele Y. van Eyken, MPH, RD Assistant Director Nutrition and Program Services California WIC Program

2. While You Enjoy Your Meal….. • A Bit about WIC • WIC Foods– Changing for Health • Working with WIC Vendors • WIC-authorized vendor facts • Local Vendor Liaison Initiative • Collaboration with WIC and CX3 • CX3 survey additions to assist WIC • WIC LVL survey information • Future possibilities

3. Supplemental Nutrition Program Eligibility: • Category: Pregnant, breastfeeding and new mothers, infants and children up to the 5th birthday • 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 • Nutritional risk: Determined with a nutrition assessment • Residency: California

4. Supplemental Nutrition Program California WIC Facts: • Services to 1.4 million women, infants and children each month– one million families • 60 percent of all infants born in the State • Nearly 80 percent of the estimated eligible population is enrolled • 1 of every 6 WIC participants in the U.S. lives in California • Purchasing power: $86 M of food per month; 6.6 M checks • No State General funds

5. Supplemental Nutrition Program In California, the Department of Public Health (CDPH) administers: • Provided by 82 local agencies • Half local health departments • Half community-based organizations • Available at 675 WIC centers • Delivered by 3,600 professional, paraprofessional and support staff • “Face-to-face” service delivery at enrollment and throughout eligibility period

6. Program Services • Nutrition Education and Breastfeeding Support • Individual and group • Newest adult learning methods • Referrals to Health and Social Services • 92% of infants and children have health coverage

7. Program Services • Food Instruments (“checks” for healthy foods) • Checks to purchase specific foods at any of 3,900 WIC authorized retail food stores statewide • Average value is $62 per month per participant

8. Current Food Package

9. What’s the Big News?

10. 30 Years–It’s Time for a Change! Since 1974 there have been • 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– but… • NO significant changes in the foods WIC provides

11. The IOM Review In 2003, USDA commissioned a scientific panel of experts through 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 foods • Phase II: Using information from Phase I to recommend specific changes to the foods

12. The IOM Review • Recommendations must be • cost-neutral, i.e., some current foods were reduced or eliminated so new foods could be added and the total cost of all packages is the same • workable for nationwide distribution and store check-out, • not a burden to administer, and • culturally suitable.

13. IOM Recommendations, 2005 • Overarching Themes: • 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

14. 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, 2007

15. Food Package Rules– Infants • Revised Food Packages for Formula-fed Infants • Formula amounts tied to feeding practice and age of infant: Half current amount starting at 6 months. • Infant cereal and baby food fruits and vegetables starting at 6 months • Juice eliminated until first birthday

16. Food Package Rule– Breastfeeding Dyads • Partially breastfed infants receive less formula to encourage mothers to breast feed more; • Fully breastfeeding mothers receive most variety and largest quantity of food; • Fully breastfeeding infants over 6 months receive larger quantities of baby food fruits and vegetables; also baby food meat. • Provide Breastfeeding Incentives and Support

17. Food Package Rules–Women and Children • Half the juice for children and women • Adds whole grain breads and other cultural options, such as tortillas, brown rice, bulgur • Adds fish choices for breast feeding mothers • Half the milk and must be low-fat (except for children under two) • Half the eggs and cheese

18. Food Package Rules–Women and Children • 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

19. Impact on Participants • Provides more diverse and balanced food packages • Provides greater variety and choice • Offers choices consistent with Dietary Guidelines for Americans • Includes more culturally appropriate foods • Supports improved nutrient intakes • Addresses nutrition-related concerns (e.g. obesity, low breastfeeding rates) Better Nutrition!

20. 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

21. 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

22. CA WIC-Authorized Vendors

23. CA WIC-Authorized Vendors • 3,900 retail grocery outlets statewide • 40 corporate chains with 2,050 stores • 300 independent grocery stores (2-6 stores) • 1050 neighborhood stores (owner-operated) • 560 “Above 50 Percent” stores-- > half of food income is derived from WIC Checks

24. State Vendor Activities • Enter into “contracts” with vendors as WIC-authorized vendors • Provide training on WIC rules • Monitor for compliance with stocking and other requirements • Disqualify and conduct appeal hearings • Very limited technical assistance

25. Collaboration with CX3 • Expertise in “store detailing”, “point-of-sale” nutrition education, marketing • Survey tool to assess the neighborhood environment for healthy food • Fall 2007: Added additional questions to CX3 survey to help assess store readiness to implement new WIC foods;

26. New WIC Vendor Partnership • Initiated in February 2008 • Funding for “Local Vendor Liaison” • All 82 local WIC agencies • Starting with Neighborhood stores– one store, one owner • Eventually will reach all 3,900 stores

27. New Vendor Partnership • Phase One: “Getting to Know You” • Meet and greet, provide WIC materials, listen • NEW! Survey store for readiness for new foods • Phase Two: Prepare for WIC Food Changes • Provide materials • PROBLEM! WIC staff cannot provide business consulting due to perceived conflict of interest • WIC staff cannot promote stores to apply to be WIC-authorized • Opportunity for CX3 partnership • Phase Three: Continue partnership

28. Survey Tool– Sample Questions

29. Survey Tool– Sample Questions

30. Survey Tool– Sample Questions

31. Survey Tool– Sample Questions

32. Survey Tool– Results to Date • In the first two weeks, 17 visits • Introduced most to the up-coming food changes • Most have fruits and vegetables, at least 2 types of each • About 2/3 have a “good selection” (not defined) of fruits and vegetables • Most have baby food F, V and meats • Fewer have low-fat/ skim milk • This was a very small sample

33. WICI-CX3 Partnerships? • Identify overlap– and gaps– between Food Stamp-eligible stores in low-income census tracts and WIC-authorized vendors? • Full CX3 survey for all WIC vendors? • LVL- Network Retail Coordinator collaboration? • Regional meetings on vendor-retail visiting, TA, issues, education, policy? Healthy foods in low-income neighborhoods!

34. California’s Process • Understand the Food Package Rule (2007) • Gather Information from stakeholders (6/2007- 8/2008) • Participants • WIC Staff • WIC-authorized Vendors • Food manufacturers • Other forums and meetings– like this one • Make policy decisions (7-9/2008)

35. California’s Process • Develop implementation plan(7-9/2008) • Systems and procedural changes • Training and Technical Assistance– WIC staff, vendors, participants • Communicate policy decisions and plan with stakeholders (10-12/2008) • Work with stakeholders and partners • Implementby October 1, 2009 • Provide comments to USDA by 2/2010

36. New WIC Food Package