1. Morrow, Cynthia B. MD, MPH

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Almost 50 years ago, the federal government began a pilot project to try to reduce the risk of malnutrition in pregnant women, infants, and young children living in poverty by providing supplemental food. In 1974, 2 years after the pilot project began, the program, now known as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), was made permanent.1 Today, WIC is known for its impactful provision of "supplemental food, nutrition education (including breastfeeding promotion and support), and referrals to health care and other social services to low-income, nutritionally at-risk women, infants, and children up to 5 years of age."1 There is a large body of literature that demonstrates positive health outcomes associated with participation in WIC including but not limited to lower rates of low birth weight, preterm births, infant mortality, anemia, and obesity, as well as higher rates of food security and breastfeeding. As we celebrate the 25th anniversary of the Journal of Public Health Management and Practice (JPHMP), it is an opportune time to reflect on how the journal has provided a platform to disseminate important new research about WIC and share management and practice tips to optimize its impact on the communities we serve.


Over the past 25 years, JPHMP has published almost 20 articles that have highlighted the WIC program and many more articles that relied on crucial data from WIC in the analysis of important public health topics. In keeping with its tradition of evidence-based public health practice and research, JPHMP has not only published a wide array of WIC topics from spatial evaluations of healthy food access to considering customer-focused strategies to improve participation in the program but also provided focused attention on essential elements of WIC. As one example, several articles in JPHMP have documented the evolution of WIC's role in linking participants to health care. In 1996, Birkhead and colleagues2 identified that children participating in WIC programs had low immunization rates and recommended that WIC clinics were ideal sites to implement strategies to improve immunization rates for its participants. In 1999, Shefer and Massoudi3 reaffirmed this finding and shared successful strategies to identify and refer WIC participants who were at high risk for low immunization rates. By 2002, strategies to improve immunization rates among WIC participants were well established, yet Shefer and colleagues4 were able to demonstrate how a more intensive strategy including assessment, referral, monthly voucher pickups, outreach, and tracking had the potential to not only improve immunization rates but also improve utilization of other clinical preventive services such as well-child visits and lead screening. In addition to advancing the science behind utilizing WIC sites to improve health in at-risk children, JPHMP has advanced WIC management and practice strategies through a series of published reports on successful quality improvement projects to optimize the delivery of WIC services and breastfeeding education and promotion.5-8


The most recent examples of JPHMP's continued dedication to furthering evidence of WIC program utilization and impact include Laura Smock's work in this area. While the benefits of WIC participation have been well documented and while more than 50% of children through the age of 4 years are eligible to participate in WIC, we have not yet achieved optimal WIC coverage for all those who are eligible. In 2019, Smock and colleagues9 provided a research report detailing refugee children's participation in WIC over a 12-year period in Massachusetts. The authors identified that fully one-third of eligible refugee children were not participating in the program. In this issue of JPHMP, Smock and colleagues10 share a compelling study demonstrating that for refugee children who were identified with growth abnormalities and anemia upon arrival in the United States and who were enrolled in WIC, the number of WIC visits was associated with recovery from stunting, wasting, low weight-for-age, and anemia. This study provides further evidence for the ongoing need to continue to develop strategies to engage and retain families in WIC services.


Recent trends in immigration policy in the United States threaten the health of many vulnerable populations. In August 2019, the Department of Homeland Security (DHS) issued new guidance on the "Inadmissibility on Public Charge Grounds."11 There has been a public charge policy in place since 1882 to deny individuals permanent residency if they are determined likely to become dependent on government assistance; however, the new language authorizes DHS to now consider many more benefits, including Medicaid and the Supplemental Nutrition Assistance Program (SNAP), in its determination of eligibility for permanent residency or citizenship. The new language does not apply to refugees, nor does it include WIC benefits; furthermore, DHS clearly states that it "will not consider public benefits received by children." Despite these protections, there is significant concern that misinformation, mistrust, and fear about the public charge policy changes will have a chilling effect on enrollment in critical public health programs including WIC. In fact, a recent Kaiser Family Foundation report provides evidence that changes in the public charge policy already appear to be resulting in decreases in participation in public programs, specifically noting that across several states, WIC agencies have seen drops in enrollment numbers attributed, in part, to fears about public charge.12


Decades after its initial enactment, WIC continues to provide opportunities to decrease the risk of malnutrition in vulnerable populations. This month's article, "Recovery From Malnutrition Among Refugee Children Following Participation in the Special Supplemental Nutrition for Women, Infants, and Children (WIC) Program in Massachusetts, 1998-2010," illustrates how now, more than ever, JPHMP has both the privilege and responsibility to provide a voice for public health leaders and researchers across the country to share their experiences, insight, and research to programs that improve the public's health.




1. United States Department of Agriculture. About WIC. Accessed September 18, 2019. [Context Link]


2. Birkhead GS, Cicirello HG, Talarico J. The impact of WIC and AFDC in screening and delivering childhood immunizations. J Public Health Manag Pract. 1996;2(1):26-33. [Context Link]


3. Shefer A, Massoudi MS. Missed opportunities to improve immunization status among high-risk children in the WIC program. J Public Health Manag Pract. 1999;5(5):82-85. [Context Link]


4. Shefer A, Fritchley J, Stevenson J, et al Linking WIC and immunization services to improve preventive health care among low-income children in WIC. J Public Health Manag Pract. 2002;8(2):56-65. [Context Link]


5. Green CG, Harrison M, Henderson K, Lenihan A. Total quality management in the delivery of public health services: a focus on North Carolina WIC programs. J Public Health Manag Pract. 1998;4(5):72-81. [Context Link]


6. Wright SS, Lea CS, Holloman R, Cornett A, Harrison LM, Randolph GD. Using quality improvement to promote breast-feeding in a local health department. J Public Health Manag Pract. 2012;18(1):36-42. [Context Link]


7. Chen LW, Wilson FA, Gregg A, Gupta N, Bekmuratova S, Palm D. Measuring the cost and value of quality improvement initiatives for local health departments. J Public Health Manag Pract. 2018;24(2):164-171. [Context Link]


8. Cain KL, Collins RP. Using quality improvement to improve internal and external coordination and referrals. J Public Health Manag Pract. 2018;24(suppl 3):S69-S71. [Context Link]


9. Smock L, Nguyen T, Metallinos-Katsaras E, Magge H, Cochran J, Geltman PL. Refugee children's participation in the Women, Infants, and Children Supplemental Nutrition (WIC) program in Massachusetts, 1998-2010. J Public Health Manag Pract. 2019;25(1):69-77. [Context Link]


10. Smock L, Martelon M, Metallinos-Katsaras E, Nguyen T, Cochran J, Geltman PL. Recovery from malnutrition among refugee children following participation in the Special Supplemental Nutrition for Women, Infants, and Children (WIC) program in Massachusetts, 1998-2010. J Public Health Manag Pract. 2019. doi:10.1097/PHH.0000000000000995. [Context Link]


11. Department of Homeland Security. US citizenship and immigration services. Final rule on public charge ground of inadmissibility. Accessed September 22, 2019. [Context Link]


12. Kaiser Family Foundation. Changes to "public charge" inadmissibility rule: implications for health and health coverage. Published August 2019. Accessed October 1, 2019. [Context Link]