If you spend a day in a malnutrition clinic, you will see a dismal parade of babies and toddlers who look much younger than they are. Underweight and developmentally delayed, they cannot perform normally for their ages. Some are so weak that when you hold them in a standing position, their knees buckle. When they lie on their stomachs, they cannot push themselves up. Long after they should be able to roll over, they can only flop around listlessly.
Doctors describe these conditions as "failure to thrive." If President Bush's budget is enacted, there will be many more children in America who fail to thrive.
The most direct reason is his proposed cut in food stamps. But there is another cause of hunger, less obvious and no less damaging: his budget's diminished housing subsidies, which will leave more families exposed to escalating rents.
It may seem odd to think of housing causing hunger, but the link becomes clear when you talk with parents who bring their children into a malnutrition clinic. They usually lack government protection against the private market's steeply rising housing costs. They can't get into public housing; they are languishing on a long waiting list for vouchers that would help pay for private apartments. Or they are immigrants ineligible for government programs. As a result, some find that rent alone soaks up 50 to 75 percent of their earnings.
They have no choice. They have to pay the rent. They have to pay the relentless electricity and telephone bills. In most of the country, they need automobiles to get to work, which means car loans and auto insurance. None of these can be squeezed very much. The main part of the budget that can be squeezed is for food. What happens then is documented by a soon-to-be-published study in which nearly 12,000 low-income households in six cities were surveyed. It found an increased incidence of underweight children in families without housing subsidies.
There has been a lot of talk since Sept. 11, 2001, about the need to "connect the dots" to share intelligence and combat terrorism. It's about time that the country did the same to fight poverty. The factors that retard children's futures are interrelated; connecting the dots is the clearest way to see the lines of cause and effect.
Housing costs contribute to malnutrition, and malnutrition affects school performance and cognitive capacity. It weakens immune systems and makes children susceptible to illness, which diminishes appetites and thereby increases vulnerability to the next infection. The downward spiral can lead to frequent absences from school and expensive hospitalization.
Even when hungry children are able to go to school, they don't do well. "Learning is discretionary, after you're well-fed, warm, secure," says Deborah Frank, a pediatrician who heads the Grow Clinic at Boston Medical Center. She treats infants who look like wizened old men, and older children who are bony and listless.
What is not visible may be more serious. Inadequate nutrition is a stealthy threat, because its hidden effects on the brain occur long before the outward symptoms of retarded growth. Several decades of neuroscience have documented the impact of iron deficiency, for example, on the size of the brain and the creation and maturation of neurons and other key components. If the deficiencies occur during the last trimester of pregnancy or the first two or three years of life, the results may last a lifetime.
Long after malnutrition ends, such children have lower IQs. In adolescence, they score worse than their peers on arithmetic, writing, spatial memory and other cognitive tests. Parents and teachers see in them "more anxiety or depression, social problems, and attention problems," according to a volume of studies compiled in 2000 by the National Research Council and the Institute of Medicine.
Practically every factor that contributes to malnutrition is worsened by a lack of cash. A child's food allergies are harder to address if a family can't afford to offer an array of choices, buy high-nutrition baby formula or live in a neighborhood with stores that stock fresh fruits and vegetables. Eating problems are compounded when working mothers have to pass their children among multiple caregivers who don't provide healthy diets. Malnutrition is also exacerbated by welfare caps and time limits, Frank and other pediatricians observe.
Youngsters who cannot succeed in school usually drop out and go on to fail in other ways. So the Bush budget exchanges a short-term gain for a long-term loss, overlooking the simple fact that the less we invest in children now, the more we will have to invest in prisons later. Connect the dots.
David K. Shipler won a Pulitzer Prize in 1987. His most recent book is "The Working Poor: Invisible in America."