Journal Issue: Children and Poverty Volume 7 Number 2 Summer/Fall 1997
The six programs reviewed in this article constitute most of the federally funded in-kind public assistance safety net for low-income children and their families. These programs are intended to mitigate the negative effects of poverty on the ability to meet such basic human needs as food, housing, education, and health care.
In general, the three food and nutrition programs are considered successful at providing food assistance to low-income children, starting with pregnancy and continuing through the critical growth and development periods of infancy, preschool ages, and school years. Currently, in the United States there is little evidence of energy and protein deficiencies caused by not having enough food. Iron-deficiency anemia in infants and children, once a very common public health problem with long-lasting effects on children's cognitive growth and development, has declined significantly since the 1970s. The FSP is central to the food assistance safety net for low-income children. It provides food assistance nationwide to all households solely on the basis of financial need, without regard to age, sex, marital status, or family composition. The improved dietary status of FSP participants is consistent with empirical evidence concerning the low prevalence of energy and protein deficiencies in the United States. Moreover, the FSP appears to benefit poor children proportionately more than other population subgroups. The participation rate among eligible children is quite high, more than 90%, and the dietary impacts of FSP participation are strongest for children.
The WIC program is widely considered to have played a strong role in reducing the prevalence of iron-deficiency anemia in infants and children and in increasing intakes of certain targeted nutrients for program participants. These effects have resulted from the provision of iron-fortified foods to WIC infants and children and, potentially, by altering the content of infant and child cereals for all children. WIC may also improve birth outcomes. The school nutrition programs provide free or low-cost meals to most school-age children. These programs also are credited with providing foods that satisfy the dietary goals of breakfasts and lunches.
Despite these positive effects of the food assistance safety net, several questions and concerns remain. Recent concerns about diets focus more on diet quality than on food quantity, and only lately have the food and nutrition programs begun to address diet quality. The school nutrition programs, in particular, have levels of fat and saturated fat that exceed recommended dietary guidelines. In addition, most of the empirical evidence regarding the effects of the FSP and the school nutrition programs focuses on a limited set of dietary outcomes, and the long-term health and developmental effects on children have rarely been examined.
The Medicaid program has been successful at extending health care coverage and benefits to millions of low-income children. However, between 8.7 and 11.1 million children remained uninsured in 1993. Probably about one quarter of these uninsured children were eligible for Medicaid but were not enrolled. In addition, children enrolled in Medicaid do not have the same access to medical care as privately insured children, and little is known about the effects of Medicaid on children's health status.
For Head Start, evidence accumulated from many different studies supports the conclusion that children who experience at least one year of the program show significant short-term benefits in their cognitive, social, and physical development and in receipt of health services. Enhanced cognitive development is seen in academic achievement, intelligence, and school readiness. Improved social development includes achievement motivation and social behavior. In the area of health and physical development, Head Start children demonstrate lowered incidence of pediatric problems, higher immunization rates, more nutritious diets, and improved motor coordination and development as compared with nonparticipants. Studies of the longer-term effects of Head Start, however, are inconclusive, largely because of methodological limitations.
Housing assistance is successful at improving housing quality and reducing the burden of housing costs for recipients. However, because of limited budgets, the goal to provide "a decent and suitable living environment for every American family" is far from being realized. There is a large unmet need for decent, affordable housing; only 26% of eligible very-low-income households received rental housing assistance in 1993. Because the effects of housing assistance programs on child well-being have not been well researched, it is difficult to comment on the specific benefits to children from expanding housing programs.
Overall, then, the in-kind programs covered in this article are successful at achieving some basic program goals. Nonetheless, as also highlighted herein, there are significant areas for improvement in most of these programs. And there is a need for more focused research on a wider array of potential benefits from these programs for children. This research should look beyond the provision of goods and services and attempt to quantify the effects of these programs on children's health status, development, and general well-being.
Finally, it should be noted that an important benefit of most of the programs reviewed is that they substantially augment the household budgets of poor families, not only by increasing their access to specifically designated necessities but also by reducing the squeeze on poverty-level household budgets by allowing the diversion of cash from the purchase of the program-targeted items to the purchase of other goods. The value of this indirect effect of these programs, although little studied, could be important for poor children, particularly in the current changing policy environment that, through recent welfare reform legislation and other efforts, may affect not only these specific programs but also the total amount of resources available to poor families with children.