oversight

Adequacy of Nutrition Programs on Indian Reservations

Published by the Government Accountability Office on 1990-02-20.

Below is a raw (and likely hideous) rendition of the original report. (PDF)

                    United States General Accounting        Ofllce    /f   o Ls
                    Testimony


                                                                              Ill1110
                                                                                   ll
                                                                                  140656

For Release         Ackquacy of Nutrition        Programs on Indian
Delivery
Ekpectedat          Reservations
9:00 a.m. EST
Tuesday
February 20, 1990




                    Statementof
                    Flora H. Milans, Associate Director
                    Resources, -unity,      andEconomic
                       Development Division

                    Before the
                    Cutxnittee on Agriculture,       Nutrition
                    and Forestry and Select        mttee       on
                      IndianAffairs
                    United States Senate
Messrs.              Chairmen              and Members                     of     the         Committees:


           We appreciate                         this         opportunity                     to    discuss            our     findings             on the
U.S.       Department                 of         Agriculture's                     (USDA)               food      assistance             programs
on Indian                  reservations.                           This work was done at your                                    request            as well
as several                   other    members                      of the Senate.  Our testimony                                        today          is,    in
part,          based          on our             September                 1989         report,1               which         addresses           the
availability      of                  food assistance     and                              the nutritional                        adequacy  of the
Food Distribution                        Program  on Indian                                Reservations:                     (Indian    commodity
program)              and      the         Food         Stamp             Program.                 In    addition,             we will           discuss
our      ongoing              follow-on                 work         in     which             Indian           recipients          of         these
programs,               and        community                  representatives,                            including            social          service
providers,                 health           care             professionals,                        program          officials,                and
leaders              within          the         reservations,                     told            us their            views      on how hunger
and nutritional                   concerns were being   addressed     by federal                                                              food
assistance.                    Our work was confined  to four     reservations:                                                                 Fort
Berthold              in      North         Dakota;                  Pine Ridge                in South Dakota:  White                              Earth
in      Minnesota:              and         Navajo                 in Arizona,                 New Mexico and Utah.


SUMMARY OF FINDINGS


          The         Food         Stamp           Program            along         with            commodity            foods          have
contributed                   to     the         improved             diet         of      Indian              households          on the
reservations.                        However,              there            are    indications                      that    some hunger--
more      common among food                               stamp            participants        and                  nonparticipants       in
both      federal programs--                              exists            on all             four           reservations              we visited.
According               to     recipients                     and     community                    representatives,                     the     major
causes          of      hunger             are      (1)         obstacles                in        applying            and qualifying                   for
food      stamps,              (2)         the      h eavy           reliance             on the               federal         programs             that
are      not         intended              to      provide            a full             diet           for     most     households,                   (3)
procedural                  requirements                      of     the        Food      Stamp Program that    influence
the      size         and delivery                      of     benefits,                 and (4) high  food prices      that
erode          the      purchasing                  power            of     food         stamp           benefits.


lFood          Assistance                  Programs:           Nutritional                        Adequacy of Primary Food
Prcjrams   on Four                         Indi-        n Reservations                         (GAO/RCED-89-177,  September
24, 1989).
       Of greater                         concern   to those we spoke to                                            on each of                 these
reservations      is                      the prevalence    of diet-related                                           problems,                  such           as
obesity,              diabetes,                 heart            disease,               and         hypertension,                  and how federal
food       assistance                     and      the         lack      of     adequate                  nutrition              education                  may
have       an impact                 on those                  diseases.       In particular,                                while  the limited
variety           and poor                  quality              of     some commodity     foods                            are concerns    for
even       healthy              individuals,                        these       foods               can     present             serious              problems
for      participants                      with          diseases             that            require          special             diets.                  Based
on a consensus                       of      people              that        we talked                to,      it      appears            that
providing              better               access             to     food     assistance,                     an adequate                     and
nutritious                  diet,   and             proper  education      that                              addresses     the
nutritional                   needs of              the general    reservation                                 population,                          as well          as
those          with         diet-related                       diseases,                could          improve           the       quality                 of
life.


BACKGROUND


          Our         September                 1989           report         identifies                    various             federal              and
nonfederal                  food       assistance                     programs            and         nutrition                education
available              on the               four         reservations                    and         addresses             the      adequacy                    of
the      nutritional            design                    of the Food Stamp Program                                       and Indian
commodity              program.       It                  also presents  program and                                      tribal   officials'
views   on whether     these                              programs             are        meeting              the       nutritional                       needs
of Indian   participants.


          Our         follow-on                 work        builds            on our            earlier              report.              It        provides,
for      the      first             time,          the         recipient             perspective                     on how well                     the
programs              are      meeting              their             needs        and whether                      nutrition             education                  is
adequate.                 We obtained                     this          perspective                   through            the      use          of     focus
groups8           which             are      small             homogeneous                groups             assembled              to candidly
discuss           a topic              under             the        guidance             of     a moderator.                        We also
discussed              the          nutritional                     impact         of     the         Food          Stamp        Program              and
Indiah          commodity                 program               with         panels            of     health           care       and          social


                                                                               2
service            providers,                  and      program                    officials                 from      the        reservation
communities.

          We focused                   on the           two         primary                    programs--the                 Food          Stamp
Program            and     the         Indian           commodity                        program--that                  provide             food
assistance                to     recipients                  on the                     four         reservations.             The Food                     Stamp
Program            increases               the        food         purchasing                         power      of     low-income
households,                enabling              them             to     buy             a more           nutritious               diet.         It is
funded        by USDA and                     administered                          through               a cooperative                    federal-state
effort.             Benefits              are         provided                     to        eligible           households                 in        the    form
of     food        coupons             that      are         exchanged                         for      food     at     participating
stores.           The dollar value  of the food stamps that  a family    receives
varies,          based on an assessment   of household size and countable
income,2            and is intended                          to provide    a nutritionally        adequate,                                                   low-
cost      diet       when combined                          with a portion     (about      30 percent)    of                                                the
recipient's                income.               If         a household                         has      no countable                 income,               food
stamps        provide              for        their          total                 monthly              diet.


          1JSDA's          Food          Distribution                         Program                 on Indian          Reservations                       was
created          primarily                to     help             meet         the             nutritional              needs         of        Indian
households               located              on or          near             Indian                 reservations.                  The         Indian
commodity            program              provides                 participants                          with       a monthly               food           package
comprised            of        a variety               of         surplus                 and         purchased          commodities.                         The
package     is           intended              to be consistent                                      with  national            dietary
guidelines,                and the             size of the food                                      package    does          not vary                 with
income.             USDA considers                          the         Indian                 commodity            program           to        be a
supplemental                    food      program,                 which                is      not      intended            to     be the             sole
source        of     food         for         recipient                  households                      for     the     complete                 month.
Reservation                households                  that             are         eligible               to    participate                    in     both        the
Indian        commodity                  program             and         the            Food          Stamp      Program            may choose                 to
participate                in     either              but         not         in        both          programs         simultaneously.



2Not "all of a household's                                        income is actually    counted.                                           Some
exclusions    and deductions                                      are allowed  .when determining                                            its        food
stamp benefits.
                                                                                    3
HUNGER IDENTIFIED   AS A PROBLEM PRIMARILY FOR
NONPARTICIPANTS   AND FOOD STAMP HOUSEHOLDS

        Federal               food programs                   have             helped   to            alleviate    hunger                           on the
reservations                  by providing                  Indian              households                the opportunity                            to
obtain a more adequate                                diet.  However,    at all                                  four    reservations,
some of the food stamp                                and commodity   recipients                                    told    us that                       they
often        did      not      have       enough            food          to     eat         and had             to    borrow                food         or
skip        meals       to     make       it         through          the        month.              Health                and    social                 service
providers              from      these          communities                     had      also        witnessed                   hunger--among
families             who      needed           food        assistance                  but      could            not        get        it:         among
children,             for whom the one meal of                                       the day was the school   lunch:
among the             elderly who gave some of                                       their  food to other needy family
members:             and      finally,           among             food         stamp         participants                       who ran             out         of
benefits             before        the         end     of      the     month            or      who had               to     wait            weeks         for
their        food       stamps.


           Recipients              and         community              representatives                            identified                   various
factors   to help explain   the causes of hunger  on the reservations.
Some factors,    such as the Food Stamp Program's   lengthy  application
process         and stringent  eligibility        criteria,                                             illiteracy,                          language
barriers,         and poor physical        accesq   t,s food                                          stamp offices,                            are
perceived             as obstacles                    to    participation                       in     federal               food            assistance.
Other        factors           relate           to     high         unemployment                     that         leaves            households
that       participate               in    the         programs                with       little            resources                   beyond             their
food      assistance               with         which         to      buy        food,          and        the        procedural                    or
administrative                   requirements                   of     the           Food       Stamp            Program.


          The        lengthy         application                     form,           which         combines                application                     to
several         assistance                programs,                 and        the      need         for         receipts,                   pay     stubs,
and     other         documentary                evidence                 to     verify            statements                    on the
application              form        deter         some households                           from applying                        to         the
program,             according          to       either  recipients                            or community
representatives                   at      all  locations.                            Further,              according                to        one        Food
Bank      ifficial            , the       time   it takes                      some households                         to        meet         the
verification                 requirements                   could          delay          receipt            of        food         stamps               by up
                                                                           4
to 3 or            4 weeks.    While                        the Food Stamp Program     can expedite
benefits            for applicants                          with little  income,  this    official  did                                                          not
indicate               whether              households                  that            were          experiencing               delays           were
eligible               for       expedited                benefits.                       It         should         be noted,            however,                 in
an earlier                   study3           of     other             states'                 practices,             we found             indications
that    eligible                   households                were             not         always           offered             expedited
benefits.


            In     addition,                  illiteracy,                     language                 barriers,            and     poor          physical
access            to     the       food         stamp        office                 further              hinder         participation                       for
many        Indian            households.                        For         example,                 participants               may have               to
travel  anywhere                           from 30 to 165 miles                                  one way to get to the                               main
food stamp office                             on the Pine Ridge                                 and Navajo Reservations,                               which
can       limit          their             ability          to     comply                 in
                                                                                        a timely    manner with   the
procedural                   requirements                   of         the     program.      According    to both
recipients                   and      community              representatives,                                 the     limited         number                of
offices            serving             remote          areas             of         the         reservations                and     the         absence                 of
reliable               transportation                       make         the            program            inaccessible                  for      many.


            Food         stamp         offices              at         some of                 the     reservations               offer
alternative                    services              where         applicants                        can      be     interviewed                at      a
satellite                location               in    lieu         of         the        main          office.            However,              operation
of    these            satellite                offices            may be limited                             to     1 to      4 days           a month,
and for a limited     number                                 of     hours  each day.                                 Furthermore,                 the        lack
of adequate  transportation                                        can make even the                                 satellite            offices
inaccessible.                         According              to         community                    representatives                 at         some
reservations,                      many         households                   must          rely          on neighbors               or         others             for
transportation                        to      the     food         stamp                office.


            At     all         four         reservations,                      recipients                     and     community
representatives                        agreed          that             a principal                      obstacle           to    participation
in    the         Food        Stamp           Program             is     the            asset          limitation              as applied                   to


3Fooi  Stamp Proqram:      Administrative                                                         Hindrances              to     Participation
(GAO/RCED-89-4,    October   21, 1988).
                                                                                    5
automobiles.                     Recause           only          $4,500             of      a vehicle's                         value--an                  amount
set in 1978--                  is excluded               from consideration                                when                 applying     the
$2,000           asset         limitation              for eligibility,                                families                  with    cars that
are      less          than      3 years           old,          in     all         likelihood,                     will           not          qualify             for
benefits.                Some commodity                     recipients                      at        three         reservations                           told        us
that      they          could       not      qualify              for         food          stamps            because                   they       had        cars
that      exceeded               Food      Stamp           Program                limits,              while          others               indicated
that   they             had      sold      their           cars         in        order          to     qualify                   for      the        program.
Furthermore,                   community            representatives                              told         us that                   households                  do
not understand   the eligibility                                            and administrative       differences
between   the two food assistance                                            programs    and wrongly      assume                                            that
ineligibility                    for one program                        automatically                         disqualifies                         them           from
participation                    in the other.


          Recipients                and      community                  representatives                             told           us that              they
also      had      concerns               about       the         monthly                reporting                  requirement                       of      the
Food      Stamp          Program           and      the      administrative                             burden               it         places          upon
recipients.                    Households            with             earned             income           that           are            subject             to      this
requirement               must          report        income,                 expenses,                 and         other               information
that      determines               benefit            levels                and      to      provide                supporting
documentation.                      Failure           to     submit                a complete                      and      timely               monthly
report           can     delay          benefits            or        cause          participants                          to      be terminated
from      the      program.


          In      an earlier               report4           that             looked             at     the         reasons                for        food
stamp       participants                   being          temporarily                     terminated                       from          the      program,
we found           that          states          may adopt                  a monthly                  reinstatement                           option.
This      option              permits       states           to         accept            a monthly                  report                in     the        month
after       it     is     due       and provides                      the         recipient,                  if     still               eligible,                 a
full       month's             benefits,    rather     than reduced                                       benefits                  prorated                  from
the      time the              report    was correctly      submitted.                                             We noted                    that         13
states           had     not      adopted           this          option,                including                  Minnesota,                    which


4Fooud Stamp Program:     Participants     Temporarily                                                               Terminated                       for
Procedural  Noncompliance      (GAO/RCED-89-81,      June                                                            22, 1989).
                                                                              6
contains               the White  Earth    Reservation:                                       North   Dakota,  which    contains
the Fort               Berthold  Reservation:      and                                     New Mexico   and Utah,    which
contain           portions              of      the            Navajo           Reservation.


          Recipients                 that        we talked                      to      at       the          Fort        Berthold              and        Navajo
reservations                  have        had             their          benefits                terminated                  for         untimely
reporting               and have             had           to      reapply                for      benefits.                      Others            at     Fort
Berthold,               Navajo,           and             Pine         Ridge         have          experienced                     delays            of
anywhere               from      10 days                  to      1 month            in         receiving                 benefits              because             they
did   not         complete              or      made errors                        in      their          monthly                 reports.


          Because               information                       from      the         monthly                reports             is         used        to
establish               benefit           levels                  in     subsequent                 months,                the          food        stamps
received           may not            be sufficient                             to      meet        current                food          needs.
Although           the        program                is        designed              to         provide              a means             of     obtaining
minimum           food        requirements                         through              a combination                        of      food           stamps         and
income,           in     practice               this              does      not         happen            when            recipients                 have
fluctuating      incomes and expenses.       For                                                    example,                 a household's                        prior
month's     income could  be high,   resulting                                                           in      a small             benefit,                  when
the   household                  may need                  a larger              benefit                 in     the        current              month           due       to
a loss       of         income        or        higher                 shelter             costs.               According                 to        some
recipients               at      three          of         the         reservations,                      this            type      of        mismatch
creates          hardships                for         many.


          High         reservation                    food             prices           and        costs             to    travel             off        the
reservation                to     buy        lower-priced                         food           contribute                  to hunger  among
food stamp participants,                                        according                  to      recipients.                  They pointed                           out
that   because    the food                            stamp              benefit           is based                   on the            cost of
purchasing     the Thrifty                              Food             Plan5          at current                    average            national                 food
prices,     it           does       not         take              into      account                the        high         food         costs            on the
reservations.



5USDA's lowest     cost diet     plan                                       that     specifies                        quantities                    and        types
of foods providing      a nutritious                                           diet.

                                                                                 7
           Additionally,                          recipients               at some reservations                                told us that
since          food            stamps           are issued               to everyone   on the                               same day of the
month,          grocers                can       and do             increase        food              prices     during    the week of
issuance.                      Although               food      stamp         regulations                  allow    states    to stagger
issuance              of        stamps,           we noted   that                    only the                  states    serving                  the
Navajo          Reservation                      use a staggered                       issuance                  schedule.


           Recipients                     also         told         us that          to        get      better          value             from      their
food       stamps,                they       had         to     travel          50 to            75 miles             off      the         reservation
to      purchase                food       at         lower         prices.            Recipients                    we talked               to    who did
not      have         cars         or      whose             cars      were         unreliable                  had      to    incur          the
expense              of        finding           alternative                  ways         to        travel.


NUTRITIONAL                     CONCERNS


       At            all   four reservations                                 the most prevalent   diet-related
concerns               are obesity,    diabetes                              --which  is near epidemic      proportions
at      Fort         Berthold              and Pine                 Ridge--heart                  disease,              and hypertension.
According           to health                     care providers,       diets    low in fat and salt         and
high    in       nutritional                      variety   can prevent       or minimize      these   diet-
related          diseases     at                  the four   reservations.          Recipients     and
community                 representatives                           we talked             to      believe             that          the      Indian
commodity                 program            cannot            accommodate                  the         special             diets          required              to
treat          these  problems                         unless   changes  are made to the food                                                 package.
Also,          many recipients                          we talked    to had limited resources                                                 beyond
their          food         assistance,                   particularly                     at     Fort         Berthold,              and         had       to
rely       on the               commodity               foods          for      most        or        all       of    their          diet.


           Recipients                    and      community                  representatives                         told      us that             the
commodity    package    lacks   the nutritional                                                    variety   needed                        for a
healthy   diet   because    many commodities                                                    are consistently                           unavailable,
servings              of        vegetables                and        fruits          are
                                                                                      inadequate,                             and some other
foods          are         inedible              and      cannot             be used.    At three                           reservations,
approkimately                      half          of     the         60 plus          items            offered           in     the         program    are
available                 at     any       given          time         for      recipient                   selection.                    As a result

                                                                                8
of the poor variety,      some recipients told   us that  they often    eat
the same foods   throughout    the month and often    for many months at a
time.  For example,     often  the only meat is luncheon     meat,  the only
vegetable                is        canned             green         beans,            and        the      only          fruit          is     canned
pineapple.


           While             we did             not      examine            the        reasons               for        the      lack         of     variety
in      the     program,                 we were              told         that        many            factors           affect              the
availability                       of        commodities.                   According                   to      USDA, market
conditions,                   tribal              food        preferences                   and         ordering                practices,                price
fluctuations,                       and         storage             limitations                   at      the      state           and        reservation
level          limit          the            variety          of     food          available                 at    specific                  reservations
for       specific                 months.


              Community                 representatives                       noted              that        the    package,                  as presently
designed,               does            not      provide             adequate               servings               of         fruits          and
vegetables                   for        healthy           individuals.                       According                   to      USDA,         the
commodity               package                 provides             only          73 percent                 of    the          servings             of     fruit
and      28 percent                     of      the      servings             of       vegetables                  recommended                     by the
American               Red Cross                 and      USDA.             Because               diabetics                need         more         of    these
items          than          do healthy                  individuals,                   according                  to      Indian             Health
Service           officials,                     the      commodity                   package            can       significantly
aggravate             this              problem.


        Recipients     in each                                of     the focus groups  told                                     us that     the            poor
quality     and inedibility                                   of     some of the commodity                                      foods   further
limited           variety.                      Spoiled            milk,          moldy           cheese,           flour              infested            with
bugs,          and      canned                foods       with         foreign              objects            could   not be eaten by
these          households                     and had          to      be discarded.                          Although    the program
provides               for         replacement                 of      damaqed              or      inedible               foods,             recipients
at      some reservations                              told        us that             program               officials                 did     not        replace
inedible               items            or      that      recipients                could               not afford   to drive  back                                  to
the      warehouse                  to        return          items.              To help               overcome   some of these
problems,               recipients                     suggested              that          USDA place                   expiration                 dates         on
all      commodities.

                                                                                  9
       In             1985, USDA reviewed                            the nutrient                     profile               of the commodity
package               and concluded   that                         the package                     provided                a nutritionally
adequate,                supplemental               diet            for healthy                       individuals                and made
further               improvements                in the            program   to                    reduce     the            fat and salt                     in
the      package.                However,            USDA's               conclusion                         assumed         that      the     maximum
variety           of      foods        is     consistently                       available                     to     recipients,              which
recipients'                 experiences                 indicate                 may be unrealistic.                                   Some
recipients             and health  care providers                                            at all             four reservations
believe           that    some commodities   still                                          contain             too much fat and                          salt
and      that          additional             changes               to     the         package                 are     needed.

           In     December             1989,         USDA proposed                           further                changes           to     the
commodity               package             to make           it     more             consistent                    with      dietary
guidelines                and     to    be more               responsive                     to         the     special             needs      of        its
participants.                     These           changes            would             increase                 the        quantity           of        fruits
and      vegetables               and        further               reduce             the         fat         and     salt      content            of      the
package.


NUTRITION               EDUCATION


          Since          many of            the      health               problems                 on the             four     reservations
appear           to     be diet-related,                           community                 representatives                         told      us that
providing                proper  education                  through   the                          federal   food                   assistance
programs               is necessary     to               the prevention                             and treatment                      of these
problems.                Commodity             participants,                           in     particular,                     could         benefit
from      nutrition               education              as they              may not                    get        an adequate               variety               of
foods       or        be able          to     control               the      fat     and salt                       content    of           their
diets.            According             to        recipients,                    some nutrition                         education              is
available               on the         four        reservations,                        but  efforts    by the                             commodity
program           are      limited,               and    little,                 if     any, assistance      is                            provided              to
food      stamp          participants.


          'Nutrition              education              is         a component                         of    both the Food                  Stamp
Program           and      the      Indian           commodity                program.                        The Secretary                  of

                                                                            10
Agriculture                    has      discretion                   in     setting                the        form     and content                        of
nutrition               education                  programs               for         food         stamp        participants                        and         the
state        agencies                 administering                       the         Indian             commodity              program
determine               the          form,         content,               and         amount          of       program               funds          allocated
to      nutrition               education                  activities.


           We found                  that       nutrition                 education                 activities                  of         local          food
stamp        offices                 serving            the       four          reservations                    consisted                   primarily                   of
having          nutrition                   brochures              and          other          literature                  available                 for          food
stamp        recipients.                        However,              because                most         recipients                  receive                  food
stamps          at      their           residence,                 they          are         not      exposed              to     this         literature
except          when        applying                  or      reapplying                 for        benefits.                   Food stamp
recipients                we interviewed                        at        the         four         reservations                  were neither
aware        of      nor        had         they        received                any      nutrition                literature                       from         their
local        food          stamp            office.


           We also              found          that         nutrition                  education                provided               by the
commodity               program               was       limited            and         varied            by     reservation.                         The
Navajo          commodity                   program            provided                the      most          nutrition                education
activities                of     all          four         reservations,                       although              not        all         recipients
participated                    in      the        educational                   program.


           At     the      White              Earth,           Fort        Berthold,                 and        Pine        Ridge            reservations
we found             that   other     federal                         agencies   or programs                                were providing
nutrition              education--primarily                               the Indian   Health                               Service,   USDA's
Special           Supplemental                        Food      Program                for      Women,           Infants,                   and      Children,
and USDA's                home extension                        service.                     Commodity               recipients                    we talked
to    were        aware          of         some of            these         efforts,                but        told        us that                 these
activities               may not               be available                      to      all        food        assistance                   participants
because           they          require               an agency              referral.


          Health           care providers                         at all  four reservations                                           told  us that
for      nutrition            education   to                      have the greatest      impact                                       it should   be
provided             along            with         federal            food        assistance.                        Also,            to     guarantee                   a
certain           level          of         activity,             Navajo               representatives                          recommended                      that

                                                                                11
the Food           Stamp Program     and                       commodity   program                       earmark    funds                    for
nutrition           education   instead                         of leaving    it to                      the discretion                        of
local         administrators                   of    the        programs.


           Community            representatives                        from       the       Navajo            and       Fort         Berthold
reservations               also         suggested               that        the        federal           health,           welfare,                 and
food       assistance             programs                be     allowed          to     consolidate                    program              funds
to     sponsor       mass         media         campaigns                and      education                programs              that         would
promote         understanding   of good health   and nutrition       and to allow                                                                         the
agencies         to use outside    experts to effectively      design   these
programs.


         Community              representatives                        noted         that         nutrition              education
provided           through  the federal    programs                                   needs to be tailored                               to the
behavior           and knowledge   of recipients                                     and that one-on-one                              counseling
with       a nutritionist                 is        the        most      effective                way.        White            Earth,           Fort
Berthold,           and,Navajo             representatives                           also         thought           that         nutrition
education           should         address                cultural           foods          and      their          effects             on health
as well         as different               ways to                prepare            commodities                   in    times          of
limited         nutritional               variety.


         In     addition           to     providing                  nutrition              education               through             the         food
programs,           community             representatives                         at     all       four       reservations
thought    that   more              nutrition                   information                should            be provided   through
the public      school              curricula                   to address               dietary             habits   at an early
age.        They     believe            there             is    a need         for       extra           training              for      teachers,
particularly               in     elementary                   schools,           and       for      parents             so that
learning           can be reinforced                           outside         the       classroom              as well               as inside.


GAO OBSERVATIONS


         Many       factors         affect            the         nutritional                  status         of        Indians:             the
availability            of an adequate                          food supply,  accessibility          to food,
undeistanding             how to select                         and prepare  nutritious       foods,      and
individual           health         problems,                   which may impair      a person's       access                                        to

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an adequate    diet.                          Based        on a consensus    of people   that  we talked
to, many of these                           factors         cannot  be fully   addressed    by existing
federal  programs.                            However,              improving            the          adequacy           and         availability
of      food      assistance                  and proper                  education          may allow                 broader
participation                    in     the      federal             food         programs             and help            reservation
households               attain          better            nutrition.


           Based         on our          current             and past              work,6             the application                   process
and      asset       limitations                    can      be obstacles                   to        participation                   in the food
stamp          program.               Illiteracy,               language               barriers,                poor      physical
access,           and      a lack           of      understanding                    about        program              eligibility                  and
benefits           are      additional                  factors             that       can       make        the       administrative
requirements                obstacles                for      Indian              applicants.


           Some of          these           obstacles                can be minimized                        through            better
implementation                of existing                     services               authorized                 by food              stamp
legislation                and regulations.                           For         example,             funding           for         outreach
services,           which             has     been         reinstated                by the            Hunger          Prevention                  Act     of
1988,       is     available                to      states           to     promote          informational                      activities
regarding           program              eligibility,                     benefits,              and      the      application
process.            Further,                current           program              regulations                  require              states         to
provide   assistance     to applicants                                       who have difficulty        in                            obtaining
the required     documentary    evidence                                      to support    information                                on their
application.                 This service  could  make the application                                                          process             less
burdensome               for those households    who are experiencing                                                          problems.


           People         that         we talked              to      told         us that             one      change          that          could
make the           Food      Stamp            Program           more         accessible                 to      Indian          households
involves           the      $4,500            automobile                   exclusion             in     applying               the      $2,000
asset       limitation.                     They      believe               the      $4,500            exclusion,               which          has       not
been       updated          since           1978,          limits           participation                    in    the         program,             can
deny      rural          participants                  the      reliable              transportation                      needed              to


6Fool; Stamp Program:      Administrative                                             Hindrances                  to     Participation
(GAO/RCED-89-4,    October   21, 1988).
                                                                           13
comply           with         procedural                  requirements                     of   the        program,           and does              not
account           for         inflation.


            Additionally,                     recognition                    of     how some               food     stamp           procedural
requirements                    and      administrative                        practices              can         impact           food     stamp
benefits               is     important              to     addressing                 hunger              on the        four
reservations.                      Delays          or           interruptions                   in     food        stamp        benefits
resulting               from       noncompliance                        with        monthly           reporting               requirements,
as we previously                         reported,7                 can be partially                          addressed              by
adopting               the      reinstatement                      option that    allow                       states    to           accept
reports            up to         one month                 late         with        no interruption                      in     benefits.                  It
should           also be noted that    the Hunger Prevention     Act                                                          of     1988        makes
monthly           reporting  an option    of the state agencies.


            In     addition,                 recipients                 and        community               representatives                   believe
that        staggering                 the      issuance                of     stamps           throughout              the        month,
instead           of         issuing          them         to     all        participants                   concurrently,                   might
help      discourage                   grocers             from         raising             their       prices          when         food        stamps
are    issued.

          Reducing               the      prevalence                    of     obesity,              diabetes,             heart          disease,
and hypertension                        depends             on Indians                 having           food        available               that      is
low    in        fat         and on changing                      certain            aspects           of      their          lifestyles,
such as choosing    food low in fat and salt,    preparing                                                                      these        foods              in
a nutritious   manner,  and increasing exercise.


          Since             many       Indian         households                    rely        heavily            on food           assistance
for    their            diet,          providing                quality             food        and proper              education
through           the         federal           programs                is     important              to     the       prevention              and
treatment               of      these         diet-related                     diseases.               Ensuring               that        adequate
nutritional                    variety  is            consistently                   available,        the                 fat and           salt
content           of         the package              are within                   moderate     levels,                    expiration


7Fooi Stamp Proqram:     Participants    Temporarily                                                              Terminated               For
Procedural Noncompliance      (GAO/RCED-89-81,     June                                                           22, 1989).
                                                                              14
dates    are placed   on commodities,                         and inedible     commodities   are
replaced     can improve  the quality                         of diet   provided   commodity
recipients.


          Improving         the     quality     of    diet       for     food     stamp       and      commodity
households            depends       on proper        nutrition           education           to   convince        the
Indian        population           with   diet-related            health        problems          to     adopt     the
food preparation                  and consumption   patterns      that    will    benefit                        them.
Proper  nutrition                 education  can better     assure     that    program
recipients            are   getting       the   maximum          value     from      their        food
assistance            benefits.




         This        concludes        my prepared         statement.             We will          be pleased             to
respond         to    any   questions.




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