20020416-Nutrition screening in rural areas — Testimony to HHS Regional Hearing, Pittsburgh, PA, April 16, 2002

Nutrition screening in rural areas — Testimony to HHS Regional Hearing, Pittsburgh, PA, April 16, 2002

Pittsburgh, PA
April 16, 2002

It is my pleasure to discuss nutrition and its importance for citizens in rural America. As a member of American Dietetic Association (ADA), I am speaking on behalf of our nation's largest organization of food and nutrition professionals with nearly 70,000 members. We are dedicated to serving the public through the promotion of optimal nutritional health and well being. Our work is based on information drawn from peer-reviewed nutrition research and resources representing significant scientific consensus.

All Americans require adequate nutrition to maintain health, prevent chronic disease related to diet, and treat existing disease. However, rural America offers some unique challenges due to distance, topography, and limited availability of the wide array of health care options that are present in more urban settings. Isolated individuals frequently are more susceptible to poor control of chronic diet-related disease states due to difficulty in accessing available medical and/or nutritional care.

Nutrition screening can identify people at increased risk for poor nutritional status and facilitate intervention to improve health.

A good example of the importance of nutrition screening comes from a Nevada Division of Aging Services pilot program started in January 2001. The program provides 120 at-risk seniors with nutrition screening and intervention that includes medical nutrition therapy, additional meals and dietary supplements. In one instance, a homebound older gentleman was screened after spending two weeks in the hospital to treat a sore on his foot. The healing process was impaired by poorly controlled diabetes. The gentleman’s physician was concerned that if the wound did not heal, amputation might be necessary. Medical nutrition therapy provided by a registered dietitian along with home delivered meals through the Meals on Wheels program helped this man to control his diabetes, resulting in the rapid healing of his foot wound. He also was able to lose ten pounds. This was accomplished with Medical Nutrition Therapy that included nutrition counseling related to meal planning, food preparation, and diet enhancement using protein and vitamin supplements. The total cost of this nutrition intervention was $350 -- far less than the cost of even one day in the hospital, not to mention the additional costs in health care and support services had the man’s foot been amputated.

Although this hearing is not directly about the Older Americans Act, this example is appropriate since a large percentage of our elderly population live in rural areas. The meals programs and other nutrition-related services offered through the Administration on Aging are vital in maintaining their nutritional health and well being. These programs do a play a significant role! Between 80 and 90 percent of participants have incomes below 200 percent of the DHHS poverty level, which is twice the rate for the overall elderly population in the United States. Approximately two-thirds of participants are either over- or underweight placing them at increased risk for nutrition and health problems. Those receiving home-delivered meals have more than twice as many physical impairment compared to the general elderly population. To underscore how these programs fill a need, nine percent of congregate and 41 percent of home-delivered meals programs have waiting lists greater than two months in duration with an average of 52 to 85 people on the list at any given time. Only 22 percent of other programs (for example homemaker, transportation and home health aid service) have waiting lists, which average two months in duration.

People all over the country must be able to access dietitian/physician teams who can determine what will best meet their needs and who can teach them how to apply that knowledge in their daily lives. Unfortunately, citizens in rural areas often have limited access to qualified health professionals capable of providing information and guidance needed to make proper nutrition a priority. Programs like the National Health Service Corps, which encourages health professionals to practice in under-served rural areas, could help bridge the gap between need and access. Unfortunately, this program no longer includes dietetics professionals in its list of eligible participants. ADA believes that dietetics professionals should again be included in this program. ADA also is interested in community health systems and urges that people qualified to promote health and nutrition be placed to address some of the nation's most significant health concerns which often link to diet and nutrition.

Recognition of telemedicine technology as a vehicle for nutrition services delivery also could facilitate access to dietitians when none are available in the immediate area.

Many rural populations would benefit directly if they could reach dietitians and others to help them focus on healthy eating and exercise patterns. In selected rural populations, diabetes, kidney and cardiovascular disease and obesity are reaching epidemic proportions, making it imperative that federal and state programs include nutrition education and counseling by professionals who have demonstrated records of success in helping individuals sometimes prevent but generally manage chronic conditions.

Finally, rural America has a significant challenge in addressing poverty and alleviating the pain it causes for individuals. More than one-fifth of rural America has persistently high poverty rates (above 20 percent) in each of the past four decades. These chronically poor areas are concentrated in the South, Appalachia, the Ozarks, Mississippi Delta, Rio Grande Valley and on Native American reservations in the Southwest and Northern Plains. Rural development is an appropriate long-term strategy, but in the interim, many rural residents need access to nutrition assistance programs such as food stamps, WIC, school breakfast and lunch programs. ADA supports these programs and recommends the approach included in the Senate version of the farm bill as the basis for future program delivery. Legal immigrants and their families who often live and work in rural areas on farms and in agriculture-related businesses have a huge stake in the final decision on these farm bill provisions.

People living in rural areas often face unique and difficult challenges -- not the least of which is accessing nutritious meals each day and in developing the knowledge and skills to adopt and maintain healthful long-term eating and exercise patterns.

Thank you for the opportunity to discuss some of the nutrition programs and services that can make such a huge difference. I’d be pleased to respond to any questions the committee might have.