Michele Y. van Eyken, MPH, RD Assistant Director Nutrition and Program Services California WIC Program

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 CX 3 CX 3 survey additions to assist WIC WIC LVL survey information Future possibilities

Supplemental Nutrition Program Eligibility: Category: Pregnant, breastfeeding and new mothers, infants and children up to the 5 th 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

Supplemental Nutrition Program 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 California WIC Facts:

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

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

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

Current Food Package

What’s the Big News?

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

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

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.

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

Food Package Rules, 2007 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– 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

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

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

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

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!

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

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

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

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

Collaboration with CX 3 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 CX 3 survey to help assess store readiness to implement new WIC foods;

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

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 CX 3 partnership Phase Three: Continue partnership

Survey Tool– Sample Questions

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

WICI-CX 3 Partnerships? Identify overlap– and gaps– between Food Stamp-eligible stores in low-income census tracts and WIC-authorized vendors? Full CX 3 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!

California’s Process 1. Understand the Food Package Rule (2007) 2. Gather Information from stakeholders (6/ /2008) Participants WIC Staff WIC-authorized Vendors Food manufacturers Other forums and meetings– like this one 3. Make policy decisions (7-9/2008)

California’s Process 4. Develop implementation plan (7-9/2008) Systems and procedural changes Training and Technical Assistance– WIC staff, vendors, participants 5. Communicate policy decisions and plan with stakeholders (10-12/2008) 6. Work with stakeholders and partners 7. Implement by October 1, Provide comments to USDA by 2/2010

New WIC Food Package