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L-R: James Ziliak, director of the Center for Poverty Research at the University of Kentucky, during his presentation regarding food assistance programs and child health at a conference hosted by Children's of Alabama hospital on Thur., July 9, 2015; attendees at the conference, including academics, child advocates, health practitioners and others. (Jesse Chambers/jchambers@al.com)

Children in Alabama do not fare very well in some statistical health measures compared to the rest of the country, according to a leading researcher who spoke in Birmingham on Thursday afternoon.

Infant mortality is high in the state, even among whites, and rates of child obesity are higher than in the United States as a whole, according to Nancy Reichman, a professor of pediatrics at the Robert Wood Johnson Medical School at Rutgers University.

Not all of the indicators for the state were negative, said Reichman, who spoke at a conference on children's health and nutrition hosted by Children's of Alabama hospital and attended by about 300 academics, child advocates, health practitioners and others.

The rate of cognitive, behavioral and developmental disorders in the state is about the same as the rest of the nation, she said. "That seems to be on par with the rest of the U.S.," she said. "It doesn't seem to be higher or lower."

Alabama is one of the leaders in one key area, according to Reichman. "Interestingly enough, rates of insurance coverage and regular dental care (for children) are higher in Alabama than the U.S.," she said.

However, she said this may indicate that simply having coverage may not be enough to ensure that a child is properly cared for. "Just because you have insurance, you may not have access to a doctor," she said. "You may not have transportation. You may not have access to quality care."

Reichman, who is also a visiting professor in economics at Princeton University, made these observations during her conference-opening presentation, "How Healthy Are Our Children?"

The event at Children's marked the publication of the latest issue of a journal, The Future of Children, which is a collaboration between Princeton University and the Brookings Institution, a non-profit public policy organization based in Washington, D.C.

Poor kids are hit harder

Reichman's presentation - she referred to it as a "broad overview" of the health of American children and the role of government investments - was drawn from a chapter in the new journal written by two other researchers. She also used some of her own data.

By some important measures, the health of American children has improved dramatically over the last century - for example, infant mortality has dropped from 127.6 deaths per 1,000 live births in 1920 to 6 per 1,000 in 2011, Reichman said.

"But new child health concerns have come to the fore," she said, citing such growing problems as asthma, cognitive and developmental disorders, and obesity, which she said has quadrupled in the United States since the 1960s.

And some groups in society are hit even harder, according to Reichman. "Child health status is strongly associated with socioeconomic and minority status in this county," she said, meaning that poor and minority children typically face the greatest health risks.

Be it diabetes, obesity, hypertension or high cholesterol, Reichman said, "The lower the income, the higher the prevalence of the condition."

In dealing with these problems, the "fragmented nature" of responsibility for child health between different agencies and governmental entities has produced a chronic lack of coordination, according to Reichmann.

What works? What doesn't?

There needs to be more effective evaluation of what works and doesn't in improving child health, according to Reichmann. "We don't have enough information to compare all the programs that have been tried," she said. "We can't answer that most basic question, 'What are the most cost-effective ways to promote child health?'"

There are some things that seem to work, though, according to Reichmann. In improving health at birth and in early childhood, the federal Women, Infants, and Children (WIC) food assistance program seems to be effective, she said. In addition, she said that "there is a lot of research to support" the effectiveness of some early childhood care and education programs, such as Head Start.

Investments in child health have the potential to repay current expenditures many times over, according to Reichmann. "This allows children to grow up to be productive citizens," she said. However, she urged policy-makers to not expect instant results. "The dividend won't be paid next year," she said. "Any investment strategy is a long-term strategy."

'Food insecurity'

Hunger is a persistent problem in the United States, especially given the nation's recent economic turmoil, according to James Ziliak, who is the founding director of the Center for Poverty Research at the University of Kentucky.

Ziliak, who presented information from the new journal concerning food assistance programs and child health, discussed the important concept of "food insecurity," which he said is defined by the U.S. Department of Agriculture as the "household-level economic and social condition of limited access to food."

There was a big jump in food insecurity - about 30 percent - during the recent Great Recession, and about 47 million Americans are food insecure, according to Ziliak. "It leaves no area of the nation untouched," he said.

Children have been hit hard, according to Ziliak, who said that one in five children in America lives in a household that is food insecure.

It is also "distressing" that more than five years after the official end of the recession, there had not been more progress in reducing child poverty, he said. "Normally, this far into a recovery, one would have seen an improvement, but the numbers are stable, and in this case, stable is not good."

Income is an important, but not the only, risk factor for food insecurity, according to Ziliak. Other factors include the mother's mental health, disabilities among care-giving parents, single-parent families, inconsistent or non-existent child support and housing instability.

'Thinking about the whole person'

Food insecurity can lead to a variety of health problems, according to Ziliak, including anemia, cognitive problems and poorer general and oral health. "The health system needs to move beyond just thinking about health and thinking about the whole person," he said. "Issues like food insecurity feed into so many health issues."

As far as solutions, he said that "the best research suggests" that some government food programs, including the federal Supplemental Nutrition Assistance Program (SNAP) and the National School Lunch Program, are effective in reducing childhood food insecurity.

The 'dollars and cents' of hunger

The conference ended with a panel of several experts, including four from Alabama, discussing child nutrition programs that are working to improve child health.

Stephanie Cihon of ProMedica, a non-profit health care system headquartered in Toledo, Ohio, said that it has become clear to ProMedica staff that -- in the communities they serve in Ohio and Michigan -- hungry people are more prone to all sorts of health problems.

She said the health-care industry must deal with the economic impact of hunger, which she said amounts to about $167 billion each year in the United States. "Even from a dollars and cents standpoint, we have to get a handle on this issue," she said.

ProMedica now does food-insecurity screenings of patents and recently opened a "food pharmacy" where patients are "prescribed" healthy food related to their diagnosis, such as diabetes or high blood pressure.

'More than passing out food'

Dave Reaney, executive director at Bay Area Food Bank in Mobile, said that his organization has a large network of donors, including 166 grocery stores in the Mobile area, which allows them to distribute lots of food in Alabama, Florida and Mississippi.

However, there is more to the group's mission than that, according to Reaney. "There is more to it than just pass out food," he said.

"We also want to improve nutrition," he said, citing several programs the food bank has, including nutrition and cooking classes. These cooking classes teach "food-stamp recipients and people who pick up food at food banks to do better cooking for themselves and their children," he said.

Far too many children in Alabama - 26.7 percent - are considered food insecure, meaning that about one in four children in the state struggle with hunger, according to Reaney.

One bright spot is the help the group gets from officials in Montgomery. "State government works with us really well," he said. "State government has a good support system."

'A vision and a plan'

Margaret Morton, executive director of the Sylacauga Alliance for Family Enhancement, said that Talladega County is a "poor, rural, under-resourced county," but that a growing number of officials and advocates in the county have "a vision and plan" to wipe out childhood hunger.

She said the multi-agency "Get Healthy Talladega County" initiative eliminates "silos" and brings together as many people as possible - elected officials, agencies, churches, educators, mental and public health professionals - to tackle the problem and provide more effective food and nutrition assistance.

Citing such initiatives as community gardens operated by faith-based groups and others, she said, "We want to strengthen a culture of active, healthy living" in the county.

Hope on the farm

Grant Brigham, executive director of the Jones Valley Teaching Farm in Birmingham, presented what she called "a story of hope" about the efforts of the JVTF to bring children and teenagers from Birmingham City Schools to their urban farm downtown - seen as a hands-on classroom - to learn more about good food and good nutrition.

Through its Good School Food program, about two years old, the organization partners with four middle and elementary schools in the city and will soon add Woodlawn High School, where another urban farm is planned, according to Brigham.

Harriet Giles, managing director of the Hunger Solutions Institute at Auburn University, also took part in the panel.

The first joint Future of Children journal was published by Brookings and Princeton in 2005. Each covers a single issue relating to children. The journal is aimed at translating the best social science research about children and youth into useful information.