Washington. I THOUGHT it would be interesting to talk to someone who thinks about hunger, not in terms of statistics, but in terms of what effect it will have on the inside and outside of an infant's skull. So I came up to Baltimore and spent most of a sunny Wednesday morning with David Paige, one of America's leading experts on nutrition.
Dr. Paige is Professor of Maternal and Child Health. He is also an attending pediatrician at Johns Hopkins Hospital, and he is chairman of the Maryland State Advisory Council on Nutrition. He runs five WIC clinics (Women, Infants and Children) in Baltimore. Twenty-two years ago he chose a job at Johns Hopkins over a position at Harvard. He's been there ever since, not counting a few stints with Native Americans in Arizona and with starving children in Peru.
For 90 minutes Dr. Paige spoke to me about amino acids, fat storage, metabolic rates, glucose, the Ponderal index, the Krebs cycle and other mysterious terms that help explain the pathology of hunger. Dr. Paige has spent his entire professional life studying and treating the medical conditions of people with nutrient deficiencies due to hunger.
He is compassionate, but not at all sentimental. His focus is on what happens to a single cell when iron stores run low and fail to deliver sufficient oxygen. And what happens to an organ when cells don't grow on time or at the pace they should. And what happens to the body when such organ growth is static.
The body's organs don't all grow at the same time. Each organ undergoes its own specific period for growth. If a nutrition deficiency, or what doctors call a "nutritional insult," occurs during a time when a certain organ needs to be growing, the damage can be incalculable and irreversible. This is because an organ grows in two ways: when its cells divide, and when its
cells increase in size. "Static" organs and tissues, like neurons, at some point permanently lose their capacity to divide, sometimes at a very early stage.
Some organs are classified as "renewing" or "expanding" which means that they can make up growth at a later stage. The kidneys and liver are examples of this. So are hair, skin and bone marrow. Others, like the brain, or the nervous system, are "static."
At birth the brain is approximately 60 percent developed. At six months it has grown to 90 percent of its full size. The remaining growth takes place between 6 and 18 months. After that the brain is fully grown. If it is not, well, too bad. There is nothing that can be done after 18 months to cause brain tissue cells to further divide to make up for lost brain growth. The cells that are already there will expand and grow, but there will never be more of them, never as many as in the brain of a child whose minimal nutritional requirements were satisfied.
The worst of the classical nutritional diseases -- scurvy, pellagra, beri-beri and xerophthalmia -- are now rare in the U.S. though still prevalent in other parts of the world. But the task here at home is still far from complete. The most common nutritional problem seen in the United States today in anemia due to iron depletion. This is particularly common in late infancy and early childhood.
Iron sits at the center of a red blood cell. It is what the oxygen attaches itself to. Less iron means less oxygen circulating to the body's organ. I've never thought of hunger as suffocating, but in this way it is. Anemic children weigh less and are shorter, as you might expect. They also have shorter attention spans, less ability to concentrate, less curiosity, etc. They are susceptible to infectious disease. There are communities within urban areas of the U.S. where nearly the entire population is anemic by medical standard. Infant mortality rates in the U.S. are higher than in 19 other nations.
Dr. Paige has also had considerable experience with rural hunger and poverty. One Thursday each month he travels to a small town in Maryland called Perryville, where he treats patients at a public pediatric clinic. Perryville is about an hour north of Baltimore, just a few minutes off of Interstate 95. "I'm surprised that after 22 years in medicine I'm still an innocent," he told me, "that I can still see things that will shock me. The poverty of Perryville is as bad as anything I ever saw on the Navajo reservation, in rural Mississippi, even in Peru."
Robert Coles, a Pulitzer Prize-winning child psychiatrist, wrote "Still Hungry in America" more than 20 years ago, and began it with these words: "Before a child is born he has already lived a life." This is literally quite true.
If policy makers knew what physicians and scientists know about the importance of adequate nutrition during those early VTC fragile days -- as a fetus, then as an infant -- our country would have a nutrition policy as different from current practice as night from day. The vast bulk of public and private resources are invested at the wrong end of the life cycle. Nothing is more cost-effective than early intervention. As a society we spend decades paying for programs designed to compensate for a few months of neglect.
Some of the problems that face American society today are complex, chronic and seemingly insoluble. Hunger is not one of them. We know precisely what must be done to guarantee the nutrition necessary for the body and mind of a young child to grow properly. We simply haven't been willing to do it.
This is an area where government can be effective. Full funding of the WIC program, universal childhood immunization, guaranteed access to prenatal and pediatric health care, and government efforts to discourage smoking, drinking and drug use among pregnant women could wipe out malnutrition and its consequences once and for all.
If we do so, we won't only be improving our nation's statistics about hunger. We'll be saving and strengthening the cells and organs and young bodies that Dr. Paige has studied so closely these past 20 years.
Mr. Shore, chief of staff to Sen. Bob Kerrey, D-Neb., is the founder of Share Our Strength, a hunger-relief organization.