Institute Insights: April 2017

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Photo by Joe Molieri / Bread for the World

From the Director

It’s spring — traditionally a hopeful time of year. 2017 is the second spring of the 2030 Agenda, in which 193 countries are working to achieve ambitious but feasible human development goals, including ending hunger and all forms of malnutrition. It’s profoundly hopeful to have a vision of moving the world forward by strengthening human capabilities and establishing the governance structures needed to protect and sustain progress. The 2030 principles of “leaving no one behind” and “reaching those furthest behind first” offer hope to many who may not have had much reason for it in the past. Bread for the World works to end hunger and malnutrition, conditions that crush hope and threaten humanity and its future. 

But the “skinny” (i.e., offering fewer specifics) budget the administration sent to Congress this spring reflects a different world view. It is not hopeful. It seems to define threats not as long-standing global problems such as hunger and new global problems such as climate change, but as military action from hostile countries and attacks from terrorist individuals. Therefore, it proposes to rely on military spending and “circling the wagons” (including a literal wall) to protect us. 

It doesn’t acknowledge the progress that the United States has made in recovering from the Great Recession and propose ways of continuing to solve our economic and social problems. Nor does it reflect the progress the world has made against hunger or the hopeful spirit that led to the adoption of the 2030 Agenda.

We are alarmed and deeply disappointed by the budget proposals and rhetoric. This short-sighted budget would cut the programs that are solving problems and responding to needs in favor of military spending. Ironically, it would exacerbate many of the current threats to our security: growing inequalities at home, not only in income and wealth but in access to education and health care, and instability, conflict, and climate change overseas. Fragile Environments, Resilient Communities, our 2017 Hunger Report, looks at how the United States can take the next steps against these threats.

In this issue of Institute Insights, we discuss the devastating impact that this budget would have on people in the United States, particularly members of female-headed households and people of color. We also describe the impacts on people in developing countries — some of whom are lifting themselves out of poverty with the help of U.S. development assistance, and far too many others of whom face famine or near-famine conditions. 

Asma Lateef is director of Bread for the World Institute

Asma Lateef is director of Bread for the World Institute.

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Measuring a child’s upper arm circumference helps gauge her nutritional status. Photo: Joe Molieri / Bread for the World

Skinny Budgets Versus Hungry Babies

Photo: Measuring a child’s upper arm circumference helps gauge her nutritional status. Photo: Joe Molieri / Bread for the World

By Jordan Teague

The world is on the verge of dealing with four simultaneous famines.

Let me repeat that. Four famines. At the same time. Twenty million people facing starvation in the next six months because of conflicts and drought in South Sudan, Somalia, Yemen, and Nigeria. And that’s on top of the existing global humanitarian needs — already at record highs, with tens of millions of people displaced from their homes due to war or natural disasters. A crisis of this magnitude has not been seen in several decades. It is a test of the humanitarian relief system, and of all who contribute to it: will the global community be able to prevent hundreds of thousands of deaths?

We are already behind, because by the time a famine is declared, as it has been in parts of South Sudan, the population is already in grave danger. By definition, more than 30 percent of the population is acutely malnourished and the death rate has increased. People have already died of starvation.

Young children are more vulnerable to malnutrition than older children and adults. Even without famines or other hunger emergencies, about 3 million children younger than 5 die due to malnutrition each year. The number for 2017 is very likely to be much higher given the crises several countries are facing. Millions of children and their families are in need of emergency assistance for treatment of acute malnutrition and food assistance.

Now is not the time to turn our backs on our fellow humans in desperate need of help.

On March 16, the president released his “skinny budget,” which proposes significant cuts to the budget of the State Department, including the U.S. Agency for International Development (USAID). By significant, I mean nearly a third (28 percent). In any year, this would be a dangerous proposal that would have real human consequences. This year, any such cuts would without a doubt abandon starving people to their fates.

U.S. assistance for global maternal and child nutrition goes largely to treating acute malnutrition. It also supports efforts to prevent anemia and stunting (lifelong, irreversible damage to a child’s growth and development), promote lifesaving breastfeeding, and meet other urgent health and nutrition needs.

For fiscal year 2017, as part of foreign assistance funding, the administration budgeted approximately $256 million for maternal and child nutrition. Bread for the World often makes the point that the foreign affairs budget is less than 1 percent of the total federal government budget — you’ve likely read or heard that. The maternal and child nutrition funding is less than 1 percent of the foreign affairs budget. Doing the math tells us that less than 1 cent of every $100 in the federal budget goes to prevent and treat malnutrition among pregnant women and young children.

A 28 percent cut to this funding would be a loss of nearly $72 million. According to cost estimates by the World Bank, a decrease of $72 million in U.S. government funding for maternal and child nutrition would cause nearly 4,000 additional deaths from malnutrition each year, and nearly 68,000 more cases of stunting. U.S. government nutrition funding both provides treatment in emergencies for people with severe acute malnutrition and prevents stunting and other forms of malnutrition. Our assistance helps children survive and thrive.

Especially in the face of famine, we can’t step back.

The U.S. government is one of the leading donors of food and nutrition assistance to people in need. In 2015, the United States spent 3.6 times more on food aid than the second-highest donor. The United States is also consistently one of the top donors to maternal and child nutrition programs. That’s why a significant reduction in the U.S. contribution to these lifesaving efforts will mean a significant reduction overall in the world’s ability to respond to the needs of women, children, and families at risk of hunger and malnutrition.

In defending funding for development and diplomacy on the Senate floor recently, Sen. Marco Rubio noted that Scripture teaches us that “to whom much is given, much is expected” (Luke 12:48). Our government’s history of leadership means that any change of heart would be particularly costly.  

This is not a time to be pinching pennies (remember, less than one penny per $100) from some of the poorest people in the world. We must not only join, but continue to lead, the world in responding to these historic levels of famine, hunger emergencies, and malnutrition crises. We must support countries that have communities on the verge of starvation in their efforts to reach people in need — particularly the babies, toddlers, and preschoolers who are being hit hardest.

Jordan Teague is international policy analyst at Bread for the World Institute. 

Less than 1 cent of every $100 in the federal budget goes to treat malnutrition among pregnant women and children.

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Esther of Mexio. Photo by Ivan Muñoz/Oxfam

Cutting Foreign Assistance Would Derail Decades of Progress

By Faustine Wabwire

There are forces that make the world less safe for everyone, regardless of where we live. They include conflict in countries with weak institutions; the repression of public calls for social change so that it becomes explosive, and the combination of demographic pressures and climate change.

As Congress debates the next fiscal year’s budget, I cannot emphasize enough the need for stronger commitment to U.S. foreign assistance. Currently, U.S. foreign assistance accounts for less than 1 percent of the federal budget. This small amount of money makes a huge difference in the lives of the world’s approximately 800 million hungry people.

Assistance to help people caught in hunger emergencies is even more urgent today: the world is facing the most serious food crisis since World War II. 20 million people in four countries — northeastern Nigeria, South Sudan, Somalia, and Yemen — are facing famine or are on the verge of famine. There is much we can do to save millions of lives, but the window of opportunity to do so is extremely limited.

According to the United Nations, humanitarian agencies urgently need $4.4 billion to respond to and avert famine. So far, only $429 million of this amount has been received. The most immediate needs include improving access to food and treating malnutrition. For more on the famine situation, see “Skinny Budget Versus Hungry Babies” in this issue of Institute Insights.

It is also critical not to abandon these areas once the crisis begins to abate. Support to foster peace and stability, enable people to earn a living, and rebuild public institutions will help ensure that the threat of famine doesn’t simply recur next year or the year after. That is why the administration’s proposed cuts to international development assistance are particularly disturbing.

In this budget environment, it’s worth remembering that U.S. development and humanitarian assistance has inspired other donors to make significant contributions of their own.  For example, the World Bank Group is significantly scaling up its response in some countries with hunger emergencies, providing both short-term support for immediate needs and long-term support to reduce the risk of crisis in the future.

While responding to food emergencies is vital, we also know that investing in governance institutions and building agricultural and economic systems that are sustainable in the long run not only saves incalculable human lives and suffering, but is a much more cost-effective approach.

Over the past 15 years, U.S. foreign assistance has paid greater attention to long-term investments in women and children and in country-led initiatives that lay the foundations for sustainable agriculture and livelihood strategies.

A good example is Feed the Future, a U.S. foreign assistance program that complements funding from partner countries themselves and works with American businesses across sectors to improve livelihoods through agriculture value chains. Other efforts, such as the McGovern-Dole Food for Education program, bolsters food security while also supporting local farmers and encouraging girls’ attendance at school.  

Cutting funding for these programs will not significantly reduce the deficit — but it will undermine the progress already made and ultimately raise the human and financial costs. 

Faustine Wabwire is senior foreign assistance policy analyst at Bread for the World Institute. 

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Children enjoy a snack at an after-school program in Washington, DC. Photo by Mark Fenton / Bread for the World

Twice As Likely to Be Hungry

By Marlysa D. Gamblin

In 2015, the United States and 192 other countries adopted the 2030 Agenda, which includes goals of ending hunger, malnutrition, and extreme poverty by 2030. We know from the progress that has been made in the recent past that while these are ambitious goals, they can be met.

As Bread for the World frequently points out, however, whether this in fact happens comes down to political will, more simply known as “whether we want to do it.” The FY2018 budget proposals and recent rhetoric of the administration and some members of Congress do not uphold the 2030 agreement’s two most important principles, “leave no one behind” and “reach the furthest behind first.”

Most of us would agree that people who are at least twice as likely to face hunger or poverty as people in the average U.S. household could be considered furthest behind. All of the following people fall into this group: people in households headed by single women, African Americans, Latinos, Native Americans, people returning from prison or jail, and undocumented immigrants.  

Safety-net programs that help people put food on the table when they fall on hard times are especially important for people who, at the best of times, are at higher risk of hunger, because it is more difficult for them to save enough to meet emergency needs.

All of this is to say that the United States should certainly not be contemplating a budget that would not only not reduce hunger, food insecurity, and poverty, but would actually increase it.

  • Plans to reduce funding for the Supplemental Nutrition Assistance Program (SNAP, formerly known as food stamps) will hurt families with one of the most immediate needs of all: putting food on the table. All SNAP participants have incomes at or below 130 percent of the federal poverty level. For a family of four, this works out to about $31,000 a year. Women and people of color are more likely to work in low-income jobs, and they often face gender and racial discrimination in the workforce and other areas. It is not surprising, therefore, that they are more likely to qualify for programs such as SNAP.

    Studies have shown that SNAP benefits improve household nutritional status among households that would otherwise have been food insecure. Still, SNAP benefits are not enough to enable families to afford nutritious food for the whole month, and many SNAP families are still struggling to meet their other basic needs. In addition, SNAP does not reach everyone who qualifies — in fact, about 40 percent of food insecure households are not receiving nutrition assistance such as SNAP. Still other families need SNAP, but earn slightly too much to qualify.

    We know that SNAP is reducing food insecurity in our country, that the program needs more resources to adequately support current participants, and that millions of families need and qualify for SNAP benefits, but do not receive them. In this situation, it simply makes no sense to reduce SNAP funding.

    Moreover, the most vulnerable people will be the ones hardest hit. Every dollar of nutrition assistance matters more to the families that earn the least — generally households led by single women of color. As the end of the month draws closer, mothers typically begin reducing their portion sizes and skipping meals, in hopes of sparing their children. Even if they manage to provide three meals a day for children, though, food insecurity affects the quality and quantity of food available to everyone, as well as the household’s overall health and functioning. Cutting SNAP would push our country in the wrong direction on hunger and food insecurity.

  • Plans to block grant Medicaid, by giving states a fixed amount of funding to provide health insurance coverage, would force states to limit the medical care provided, the number of people who can enroll, or both. Medicaid would no longer be able to respond to all who meet the eligibility criteria. Lack of sufficient health insurance will also increase food insecurity and, in a vicious cycle, would lead to the additional healthcare costs associated with food insecurity. Bread for the World’s 2016 Hunger Report, The Nourishing Effect, explores how hunger and food insecurity lead to additional healthcare costs — unnecessary costs of at least $160 billion a year.

    Communities of color would be disproportionately affected by changes in Medicaid’s structure. Almost 50 percent of Medicaid participants are people of color. Communities of color have a health gap because they have less access to health care — and because of racial disparities in health conditions. For decades, researchers have found that African Americans and Latinos are more likely to contract chronic diseases. If it weren’t for Medicaid, 25 million people of color would be uninsured and those with chronic diseases would be underserved.

    Today, 21 percent of Latinos, 21 percent of Native Americans, and 13 percent of African Americans are uninsured. This number would increase if Medicaid were block granted to states — widening the health gap for communities of color and their vulnerability to food insecurity.

Marlysa D. Gamblin is domestic advisor for policy and programs for specific populations at Bread for the World Institute.

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Because SNAP was available to all who needed it, people could eat healthier during the Great Recession. Photo by Mark Fenton / Bread for the World

What’s in a Name? Block Grants vs. Entitlements

Photo: Because SNAP was available to all who needed it, people could eat healthier during the Great Recession. Photo by Mark Fenton / Bread for the World

By Michele Learner

Some members of Congress and the administration are strong supporters of “letting the states decide.” State and local governments, they argue, know their own populations and understand the local context better. Officials who are closer than Washington, DC, can more easily respond to people’s priorities and needs.  

This sounds reasonable. Who would oppose leaving decisions to the people who seem to be in the best position to understand the situation?

Well, sometimes, Bread for the World Institute and other anti-hunger advocates. Why? As we explained recently, phrases like “leaving it to the states” are often a reference to block grants. These are set amounts of funding that the federal government makes available to states for a program, often a safety-net program, and that the states then implement.

This might not sound so bad in theory either. But in practice, block grants have serious drawbacks. Once a program has been block-granted, there is generally less funding available for it, because the federal government reduces its contribution. In some cases, states are granted too much discretion. Some block grant structures even allow states to redirect funding to completely unrelated programs or expenses, and in the worst cases, the people in need who are the intended beneficiaries never get access to the funding. 

Two recent examples illustrate some of these pitfalls. Although the national debate over health insurance has been raging for months now, one issue we hear about less often is the implications of states’ being able, under the Affordable Care Act, to choose whether to take advantage of federal funds made available to them to extend their Medicaid coverage. Not surprisingly, the states that chose to add more low-income people with the available funding now have higher rates of insurance coverage than those that did not.

States as different as California, New Jersey, and Arkansas expanded their Medicaid programs and saw sharp decreases in their uninsured rates. Fewer previously uninsured people were able to obtain coverage in states that did not expand Medicaid, such as Texas, Virginia, and Florida. The average uninsured rate in the former has dropped to 9.3 percent, the lowest in U.S. history, while the average is 15.4 percent in the latter group.

“Letting the states decide” has produced mixed results at best in the Temporary Assistance for Needy Families (TANF) program. Since its inception as “welfare reform” in 1996, TANF has had a block grant structure. The amount of funding is set in advance, and states have wide scope to administer the program. Benefits are modest in every state — not enough to bring anyone above the poverty level.

The goal of welfare reform, for many federal policymakers, was simply to reduce the number of participants. Last year, which marked 20 years of TANF, we heard a great deal of praise for it as an unequivocal success — using this as the only criteria for success.  And, in fact, fewer people receive TANF than its predecessor, Aid to Families with Dependent Children. But what about TANF’s effectiveness in reducing hunger and poverty among the families it serves?  

At the outset, TANF was said to be a way for low-income female heads of household to get a foothold in the job market. In TANF’s early years, some women who were “on welfare” were able to find and keep jobs, and some of those jobs paid a livable wage. It turned out, though, that these successes were largely to the credit of the national economic boom of the early and mid-2000s. When the Great Recession hit in 2007, TANF was far less able to help low-income women transition to paid work. The national unemployment rate climbed to 10 percent, and even experienced workers were being laid off.

The strict lifetime limit on receiving TANF benefits, meanwhile, pushed women, along with their children, out of the program whether they had a secure job or not. There has been little follow-up to determine what happened to those who left welfare but did not transition to work. Perhaps some got jobs later as the economy began its slow recovery. Perhaps some are among the growing number of Americans who live in deep poverty. The lack of data means that we don’t know to what extent TANF has succeeded in anything but reducing its own size.

Words matter in public policy as in other arenas. A common term for federal safety-net programs that are not block granted is “entitlement.” This used to be a more neutral word, but it has gradually acquired mostly negative connotations — for example, spoiled and ungrateful children are said to have a “sense of entitlement.” In government vocabulary, it is still a factual term, meaning simply that everyone who meets the eligibility criteria can participate. But many people think of “entitlement” as a pejorative term.

SNAP (the Supplemental Nutrition Assistance Program, formerly food stamps) is an entitlement program. The graphic below shows what happened to participation in both SNAP and TANF during a time of crisis: the Great Recession.

SNAP worked as intended. As poverty increased, more people became eligible for SNAP benefits and more enrolled in the program. But participation in TANF did not increase. SNAP is a primary reason that hunger rates did not climb more steeply than they did during the Great Recession. TANF, however, had a fixed amount of funding, and thus could not expand its assistance even though more people were in need.

Michele Learner is associate editor at Bread for the World Institute.

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Infographic: SNAP Responded when Poverty Rose. TANF did not.

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