The hunger

In the hour that this Red Cross food pantry has been open, 96 people have signed in at the security desk downstairs -- listing their destinations simply as "FOOD" -- and proceeded to the second floor to pick up enough emergency groceries to last their families three days. Most of them will be back next month.

Last year, this pantry gave out 22,000 bags of food, all between 9 a.m. and noon on Wednesdays and Saturdays. And it's just one of hundreds of food pantries and soup kitchens in Massachusetts, one of thousands across America. Right now, more than 21 million people use emergency feeding programs in this country. Five percent of households with children experience some hunger each month, and an additional 12 percent live with regular worry over where the next meal will come from. In Massachusetts, more than half a million residents live in households where parents go without food so that kids can eat, where everyone's meal portions are shrunk so the food can go further, or where both kids and parents go to bed hungry because there simply isn't any food in the house.

In these buoyant times, more and more families -- most of them with working parents -- are having trouble staying afloat. Project Bread, a nonprofit community organization, funds and supports 350 Massachusetts food pantries and soup kitchens, which provided 17 milion emergency meals last year. Sixty-two percent of those agencies report increased caseloads over the previous year. This past December, the US Conference of Mayors reported that, in 23 major cities, the number of requests for emergency food had increased by 16 percent over 1996, and that 40 percent of those requests came from people who were employed.

And it's about to get much worse. By 2002, the federal government will have cut back food-stamp benefits by $27.7 billion. Many people will lose all welfare benefits, and those who still qualify will see their food-stamp allocations shrink by about 20 percent. The federal government has already cut off food stamps for immigrants. Mothers subject to the two-year time limit on Aid to Families with Dependent Children (AFDC), which begins to kick in December 1, 1998, will also lose these benefits. (See "Who gets food stamps?", below right.) Charities and nonprofits are preparing to pick up the slack, but they're worried that welfare reform will put demands on their services that they just won't be able to meet. This Sunday, May 3, is Project Bread's annual Walk for Hunger, which raised $3 million in 1997. Organizers say they're going to have to raise more money than that this year.

Right now, the Grow Clinic treats 400 undernourished children -- children who are chronically underweight, whose brain growth is already slowed, who need serious medical intervention to get the nutrition most folks' kids take for granted. And hunger affects more than just those children. Its costs bleed into the health-care system, the education system, and the juvenile-justice system: kids who can't count on good meals every day are more likely to develop illnesses, learning difficulties, and behavioral problems. Short-term savings in food stamps will bring a much higher price for everyone later on. Frank expects her caseload to jump into the thousands when welfare reform kicks in, and she can't handle thousands.

"I see this as a public-health disaster," she says.

About a quarter of the children who come to the Grow Clinic wear their hunger all over their little bodies. Their hipbones and kneecaps press up through their skin, which is dry and scaly and pale. Their hair is thin and clumpy, and often, their teeth are rotten. But these are the worst cases. Most malnourished kids' problems are less obvious than that.

Our image of hunger is fed by those gut-wrenching TV pictures of children with distended stomachs in war-tattered or drought-ravaged African countries. In the developing world, hunger kills children, and does so quickly, because kids go with no food at all for so long. (It takes an adult three months without food to die of starvation. It takes a baby just three weeks.)

In America, hunger usually has another shape. "Here, it's a gradual catastrophe," says Deborah Frank. Here, hunger is more of a chronic disease: kids miss a meal a day, or a few meals a week, or what they're eating doesn't come close to meeting their dietary needs. The tangible signs are similarly subtle. Malnourished four-year-olds could be mistaken for healthy two-year-olds, for example. Here, hunger is less likely to make ribs stick out than to make kids prone to frequent illnesses, or to make them slow, or sullen, or just small.

"Long before it causes changes in physical growth, hunger impairs cognitive skills," says Frank. "The body tries to hold onto heat and size, so the kids become less active before the malnutrition shows up in their height."

"Most children, at least to the eye, get enough calories to maintain their weight and growth," says Doctor Ron Kleinman, head of the pediatric gastroenterology and nutrition unit at Mass General. "You see the effects of hunger by looking more closely into their nutritional profiles."

Many malnourished kids look more like Maria*, a shy three-and-a-half-year-old with long, curly hair. She stands up straight and proud against a wall in the Grow Clinic to have her height measured, her little gold-braceleted hands clasped before her. She was always small for her age. Between birth and age one, babies are supposed to gain between a half-ounce and an ounce a day, and their heights should increase by a foot overall. But Maria seemed stuck: as a baby she grew so slowly that her pediatrician recorded a change only on every third visit. When she was first referred to the clinic at the age of two and a half, in January 1997, Maria was the size of an average 15-month-old.

Her mother, Suzanne, who has been on welfare since she had Maria at 15, knew something was wrong, but she wasn't sure how to fix it. Maria's problem wasn't just how much she was eating -- although her food intake was alarmingly low -- but also what she was eating. "My mother raised me like, if you get full, you're eating good," says Suzanne. But she and Maria were getting full on "soda and junk."

"Maria, can I take a look at you?" asks Frank, a small, short-haired woman with a lot of energy. She's wearing thick glasses and a friendly shirt with teddy bears all over it. "I'm not the hurting kind of doctor. Have you been sick since the last time?" Suzanne answers no for Maria. "Good," says Frank. "Hurrah, hurrah, hurrah."

Suzanne gets food stamps, but they don't provide enough for Maria's special needs, so she also gets food from the clinic's pantry, as well as dietary supplements to accelerate Maria's growth. After regular visits and vigilant encouragement from Frank, a social worker, and a nutritionist, Maria's mother finally has her daughter eating the right things, and regularly -- although breakfast, a crucial meal, is still a battle.

Now, Maria is on her way into the normal weight range for her age: in two and a half months, she's gained two whole pounds. She'll be counted among the success stories. Other kids take almost two years to get to where Maria is. Grow Clinic staffers have also taught Suzanne how to make sure her daughter's progress continues after her welfare benefits and food stamps run out next January.

By catching her malnutrition relatively early and treating it so intensively, doctors have saved Maria from a legion of problems later on.

Hunger can hurt a child even before she is born. Pregnant women who don't get enough of the right kinds of food give birth to underweight babies, and underweight babies have much more difficult childhoods than do other children, especially if deficiencies in their diets continue after birth.

The months between conception and age two are the most crucial of a baby's life: the brain grows to two-thirds of its adult size during that time. If children are malnourished in those years, their brain size and learning capacity can be permanently affected, hobbling them years before they enter their first schoolroom.

And if hunger continues, the problems multiply. According to the Massachusetts Community Childhood Hunger Identification Project (CCHIP), hungry kids from low-income families fall way behind non-hungry kids from low-income families. They are nine times more likely to lose weight and five times more likely to experience fatigue, and they are far more susceptible to colds and lead poisoning. They are four times more likely to have difficulty concentrating and four times more likely to be absent from school. Children who are frequently hungry are twice as likely as non-hungry children from the same background to need special education, or to repeat a grade.

And those physical and mental consequences are matched by behavioral ones. A study published in the journal Pediatrics in January found that the prevalence of fighting was seven times higher in families that reported repeated experiences of hunger than in families that reported none. The prevalence of stealing was 12 times higher.

In the end, hunger can cost everyone a lot of money. A baby born with a low birth weight can cost between $20,000 and $50,000 in postnatal care, and for welfare recipients, Medicaid picks up that tab. The CCHIP estimates that America spends $700 million a year on special education for kids whose limitations are primarily a result of low birth weight. And every year a kid is held back adds thousands of dollars to the cost of his education.

Since Franklin D. Roosevelt was president, the government has viewed the poor as its responsi-bility, recognizing the need to spend money on citizens in trouble -- especially when they're children -- to help them become productive later on. Social Security, AFDC, free and subsidized school lunches, supplemental food programs for pregnant women and infants -- all of these are in place to prevent poor folks from getting hungry.

But Roosevelt's New Deal was a product of the Great Depression. It was built on images of bread lines, of the Dust-Bowl poor loading beat-up trucks with rickety furniture as they set out in search of work. Now, the public consensus is that the system of safety nets Roosevelt initiated has gotten out of hand. President Clinton himself sold welfare reform on promises of making it "a second chance, not a way of life." Now, the rhetoric goes, folks who have relied on the state for too long need to come out into the working world and get jobs. What poverty activists fear is that this will bring a great deal more hunger out, too.

Hunger is an invisible problem in America because its physical effects usually aren't immediately obvious. But it's also invisible because the parents of hungry children want to keep it that way. The people who work in the food pantries and soup kitchens and even the schools see things that families go to great lengths to hide from the rest of the world. "It's a shadow Massachusetts," says Ellen Parker, executive director of Project Bread. "In the light, it seems like everybody's doing well. But even with all that money around, there are kids who go to school hungry all over Massachusetts every day."

Parker knows of a mother who lives in a paid-off house in Andover and whose husband stopped paying her alimony. She went all the way to Lawrence for emergency supplies, even though they were available in Andover, because she knew no one would see here there.

Shame can also make kids themselves reluctant to take advantage of services that can help them, especially as they get older. When a kid is 10 or 12, he'd rather die than have the other kids know he qualifies for a reduced-price or free school lunch, so he'll go without, effectively choosing to wear the physical, mental, and emotional consequences of hunger instead.

Many clients of the emergency food services Project Bread supports are working and do not live below the poverty line ($16,056 for a family of four). But the dearth is in the details -- a parent gets sick, or a kid loses a coat, or an apartment building catches fire. Or winter comes: a Boston City Hospital study showed that poor kids' growth actually slows in winter, when money that would otherwise be spent on food goes to heating bills. So parents end up going to nonprofits for help. And hating it.

"People who can't afford food get the same messages we do [about the economy]," Parker says. "They hear that everything's wonderful, so they think, `What's the matter with me that I can't feed my family?' "

For many families, the coming winter will be much harder than the last. Starting December 1, families with kids older than four who have been on welfare for 24 months will be cut off from all benefits. Of the federal government's $27.7 billion in food-stamp savings between now and 2002, $528 million will be absorbed by Massachusetts. Project Bread estimates that half of those cuts will hit families with incomes below the poverty line, and that families with children will absorb two-thirds of total reductions.

Those who remain on welfare will be subject to work requirements, and many parents will work in full-time, low-paying jobs. (The annual salary of a full-time worker making minimum wage is just $10,920 a year.) "What are the implications for the already overworked mother?" asks Project Bread's Parker. "Who's going to be there to feed the kids, especially if she needs to travel a long way to work?"

"We need to be really concerned about institutionalizing emergency food," says Parker. "An emergency is not something that is supposed to happen every week." Parker remembers the early '70s, when a homelessness crisis spurred governments to put money into emergency shelter beds rather than good low-income housing. She doesn't want the same thing to happen with food. "We need to be thinking about how to get good, reliable, dependable, government food programs," she says. Or more realistic welfare reform.

Ron Kleinman is convinced that even something as simple as providing every schoolchild with a free breakfast would make an enormous difference. "There's a simple way to ensure that a kid has the optimal opportunity to learn in school," he says. "Give them a breakfast that costs less than a buck." He's been testifying before several state legislatures that universal free breakfasts for kids would vastly improve their ability to learn, saving everyone money down the line. The response has been mixed, at best. Some legislators like the idea. Many balk at the prospect of "another handout."

"I tell them they're being unbelievably shortsighted and mean-spirited," Kleinman says. "If they looked at it from the child's perspective, they could see that they could get very big returns from a very small investment."

If we don't do something about hunger now, say Kleinman and fellow advocates, then when? The Dow Jones is over 9000, yet still more families -- working families -- are turning up at food-pantry doors. "It's tragic that at a time when we can afford to help these people, we're not doing it," says Kleinman.

When Deborah Frank looks ahead, she sees a grim picture. "The way some people survive in other countries where they have no income is to prostitute themselves," she says. "The numbers of kids in prostitution here will jump. People will have to eat.

"We're in the developed world. I don't know why our goal is to be like Brazil."

Yvonne Abraham can be reached at yabraham[a]phx.com.