Good morning everybody and it's good we've got two or three screens full of folks I'd like to you know just welcome all of you to the committee and the subject matter of food security and in that area we're going to be spending quite a lot of time on and trying to make it easier and and better for people to be sure that we've got adequate supplies of food and to ensure people that they aren't going to go hungry so and you folks all work in that field and and we need to get your expertise and how how to proceed and if we need to change rules regulations laws to make it better for for our people and easier to get the food uh material out to them um I'd like to start off by having the committee introduce themselves and I think we'll start with Chris you want to lead off sure good morning everybody thank you mr chair uh Chris Pearson from Chittenden district great to be with everybody have everybody here and look forward to the discussion welcome i'm anthony polina i represent washington county and this has certainly been an important it will be an important issue important work the next couple of weeks appreciate y'all being involved ryan call them or representing the ruttland district and what chris and anthony both right and uh i'm quarry parent i represent franklin county in alberg yeah uh thank you uh senators and his uh you folks that are on can see we have people who are senators on the committee from uh around the state and uh so we were covered pretty well geographically and and we have committee members that are also like um chris piercings in in finance and senator call them or as in government operations along with anthony polina did and quarry did they assign you to a committee or are you a floater i float where i want to be because i'm here and um and i'm on a appropriations because we all serve on uh two committees um i don't know if um quite i guess we'll start off we have a list of witnesses and uh we'll try to stick with the list and we'll uh introduce you and and you can and you can take over from there meredith niles is the first witness uh on our list and you're an assistant professor at the department of nutrition and food sciences uh sciences at the at ubm excuse me bobby uh samantha samantha levy is the first person on the list i'm sorry it was up there oh well and she has to leave a little early yeah well i guess we'll go to samantha then great thank you so much senator uh hopefully you all can hear me um thank you for having me here at your um committee meeting my name is samantha levy and i'm new york new york policy manager for american farmland trust so my work is mostly in new york but i actually happened to be in vermont's the second home for me all throughout my life i'm in windham county right now um so um i like i said i'm new york policy manager for american farmland trust and for farm to institution new york state and uh we work to help farmers um protect their land promote sound farming practices on farms and then we also coordinate the farm to institution new york state initiative uh that works to empower institutions like schools and other public institutions to commit to spending at least a quarter of their food dollars on food from within the state um so i thank you for um graciously allowing me to go first given my time constraints i really appreciate that i'm probably a strange one to start off with but i think i was invited here to talk about our farm to school program in new york state um so i'm happy to go through that i have quite a lot of information in my testimony um but i can give you the highlights verbally as well so um great so so uh just so you know a little bit about me i lead the new york grown food for in your kids coalition which advocated for the incentive in new york our reimbursement incentive for schools um and i have also conducted research on the implementation of that incentive for the last two years so i've got a wealth of information um that hopefully can help other states in designing their own incentives um so in new york related to food security you know of course we think of this program as a food security program um and child food and security is rising as a result of the pandemic probably why you've called this hearing today we've also found in our research that half of a child's daily calories on average come from school meals when they're in school and so increasing access to healthy local food at schools really effective way to improve healthy food access for all children no matter their socioeconomic status um while also of course helping farmers and strengthening local food systems it's a win win win um and in new york when schools well across the country when schools serve so much milk and cheese and yogurt and apples and other locally grown products of which you also grow in vermont and raise um we we just think it makes very little sense for them to be spending public dollars to buy them from outside of state when they could very easily support local farmers so um this is why we advocated for this program in new york and in new york we've got two programs that work hand in hand to enable schools to purchase more farm fresh healthy food so we've got the farm to school incentive which you may be familiar with uh this is a program in new york that quadruples the school's lunch meal reimbursement from the state that gives them four times what they would have gotten so long as they spend 30 percent of their lunch food costs on new york grown food i can talk about definitions if you're curious about that um and then we also have a farm to school grants program which invests in training and uh staff and equipment and transportation to enable schools to reach 30 percent supportive program and the with these two programs working hand in hand in york we found that we can achieve a lot so go ahead senator please and use uh how what is your budget over there for your farm to school uh program good question so for our incentive program uh we have a it's it's an entitlement program so any school that meets it it will pay them so we have a budgetary placeholder new york is considerably larger with new york city so we've got 10 million dollars as a budgetary placeholder in there for the incentive and one and a half million dollars for the farm to school grants program has been appropriated for the past several years yeah thank you you're welcome so within two years with this incentive the number of schools that have successfully reached 30 percent has grown this is a successful program um in year one we had seven schools apply in year two we had 57 that was this past year um and those 57 schools combined spent five over five million dollars on food from new york farms to feed 90 000 students and the average percentage was actually well above 30 percent it was 39 percent and there was one school that even hit 63 percent spending on local food so the commitment is high um and beyond those that successfully reached 30 percent plenty of other schools are purchasing new york products so it's not just five million dollars spent by schools on the local economy and we found big increases of fruit and veg and then also in processed products that use new york farm products in there um senator pierson smitha thank you um i don't want to divert too much into definitions but it's interesting we have about 90 000 students in vermont um and so i'm trying to wrap my head around the scale um and what you're saying one school got over 60 percent do you have a lot of processing and is that you know that's not something i think we'd be able to replicate so just help us understand uh some of what we're talking about there's only so many apples kids can eat um so can you just help me understand like how much is it processed versus raw produce or whatever sure um so in those percentages i don't have the exact breakdown of how much schools are serving raw versus processed though um something that could be helpful is uh so the governor started the new york grown and certified program in new york and their definitions were borrowed for this program so um anything that is a new york food product qualifies and that can be um raw fresh or minimally processed produce um it can be fish it can be dairy so if it's a processed product the components that make up that processed product need to be at least 50.1 percent coming from raw agricultural ingredients in new york states so it still does create that market um and in addition the decision was made that processing could take place within or outside of new york states it's you know it's very common for these products to cross borders to process and then come back and be sold in new york and on that topic we saw an enormous increase in the amount of processed products new york food products available to schools to buy and that's not just for schools but other institutions too and things from local businesses and small businesses in new york that are processing there like the new york grape juice company but also from you know multinational corporations like moths or macaens that are making new york applesauce or new york french fries to meet this new market demand and they're creating that market for new york farmers for their products good yeah and then just a couple of other points to share uh looking ahead in spite of the pandemic we found in our research and i put a link to my report in my testimony that 75 percent of schools um felt confident that they would reach 30 percent by 2025 with the right support from the state of course um and this would increase the amount schools spend at new york farms to 250 million dollars feeding over 900 000 kids in new york state and that would be a return on investment of three dollars and 50 cents for every taxpayer dollar spent so we also found enormous growth opportunities for dairy here um in new york so that's that's an important point to make particularly in the context of vermont and just a few things that we learned and i put a couple of things to keep in mind in my well it was a list of five or six i think in my testimony you certainly need a well-designed incentive the threshold should be challenging but not too high and the financial um reimbursement should be enough fairly enough to cover the costs in order to spur action um schools also need a support system so the farm to school grants program is really important um we found that positions like farm to school coordinators which in new york are housed within extension or at nonprofits or at the schools themselves that actually connect the school with farmers or help them design menus to incorporate local products or prepare bids are really important since at least in new york our school administrators are pretty strapped for time to try and troubleshoot how to procure local food and serve it to kids successfully um also to help with tracking for this program and then we also need capacity at the state level to do it well you need folks who have expertise in um supply chains and guidance released while in advance to school so they can prepare needs to be achievable not to administratively burden some and there needs to be integrity and tracking and documentation required to prove that schools hit the percentage um so the benefit does go to farmers and kids who do get that access to local food have have you uh this is uh senator star do you have you had any conversation uh about uh the uh i know as you talked about dairy uh have you had any conversation in regards to moving to uh school lunches uh whole milk instead of two percent milk as has that been an issue over in new york yeah we haven't really talked about that at the state level since those decisions are made more at the federal level um at least the requirements are but we we did find that there are many schools not all but many schools that are able to buy new york dairy um no matter the fat percentage in the in the milk yeah and uh what about your distribution in new york how do you how do you set that up uh so you're talking about the supply chain side yes great question so um so that sort of sets itself up naturally and this is where procurement comes in and you know as a legislative body something that we often talk about in new york is looking at new york states procurement laws um and how they interact with the federal regulations that schools need to follow to buy food that's something i i highly recommend taking a look at to make sure because schools um put up bids and they're required to award their bids if it's above a certain amount to the least cost most responsive bitter so that's important to keep in mind um and in addition so your question about distribution in the supply chain certainly there are gaps in our supply chain in new york that need to be recognized and addressed and invested in but the idea behind this incentive was if the demand is there then the market will respond and we have seen that when it comes to process products um you know i think that we are going to need to recognize areas of gaps like i said and help move things along in processing and aggregation um but you know when you when you have the the number one barrier that schools say they face in procuring local food is cost so when you have a financial incentive that frees them up to be able to ask for in their procurement's local food following the regulations at the federal level at the state level um and then the market is able to respond to that demand yep thank you um uh senator parent yeah thanks for that could you elaborate a little more and if not get us information on how your school districts are getting around the fat content and milked by local i'm just interested in more about that um you know i'm really not sure uh but i could follow up with you if you'd like to my email is in my testimony if you want to send me an email i can uh put out some feelers to a few schools and ask them yep i'll follow up thank you very much sure yep any other questions for samantha from the committee if if not uh thank you very much for your your time and and we're glad to have you on with us this morning yeah thank you so much for having me and apologies for needing to jump but best of luck with the rest of your uh your agenda here this is at least this is one advantage of being on zoom we can get people like you from long distances to be on with us absolutely and at any point if anybody has any questions please just reach out yep thank you for the offer so we'll move on to uh meredith uh niles uh from ubm good morning senators thank you for having me i'm gonna go ahead and share my screen i have a brief presentation to share yep i'm assuming you look good can you see the full slides or do you see the preview version we see them both yeah is that better yeah okay great well thank you so much for having me i'm an assistant professor in the department of nutrition and food sciences and the food systems program at the university of vermont um i've been at uvm for over five years now and uh some of my research focus is on food insecurity and since covid-19 i have worked with my two colleagues at uvm emily bellarmino and feral bertman both in my department to document and understand the impact of covid-19 on food systems in vermont and also across the country so what i'm going to present today is just a brief overview of some of our most important findings to help give you some data about how vermonters have been affected by covid-19 and i'll just share that i shared with linda we have eight separate policy briefs that we've released um from all of our work so there's a lot more depth behind what i'll present here today if you're interested to dig into a topic a little bit further so the data that we have to inform our decisions here are from three rounds of surveys that we've done with vermonters since march we did a survey of vermonters right at the beginning of the covid-19 pandemic end of march and early april with 3200 vermonters we did another survey in june with 1200 vermonters and then we did a survey in september with another 600 vermonters so we have nearly 4 000 vermont perspectives on how they've been affected by covid-19 to share what we found um in early part of the pandemic was a 33 increase in food and security as compared to before covid-19 and to share a little bit about what that looks like over time with our surveys i have a graphic here to document that what we have found is that since covid-19 nearly 30 of vermont households have faced food insecurity and with our data we've also found that about one third of those are newly food insecure households so people who were not facing food insecurity prior to covid-19 so you can see the rates of food insecurity that we found across the different surveys i should add that these numbers are retrospective to march so for example when we asked this question in september we asked it at any point since covid-19 began having faced food insecurities and in that most recent survey we found that 29 percent of our respondents had faced food insecurity when we look at who is most likely to be food insecure what we have found across all of our studies is that households with children are significantly more likely to be food insecure so this is data from our september survey showing that 41 percent the orange bars are food insecure 40 nearly 42 percent of households with children were classified as food insecure as compared to only about 24 percent where there are no children in the household we've also found that households earning less than $50,000 and respondents without a college education were more likely to be food insecure across all of our surveys and finally households with a job disruption were significantly more likely to be food insecure across all of the surveys that we did around 40 percent of respondents had faced some type of job disruption since covid-19 in their household so whether that's a loss of hours being furloughed or losing their job we see about 40 percent of households have that and in this bottom graphic here you can see the breakdown in food insecurity by whether or not someone had a job disruption or did not so 39 percent of households with a job disruption classified as food insecure in our most recent survey we've also found some diet quality impacts so food security is not just about having enough food but also about having high quality food in order for people to be healthy and have the nutrients that they need and in our most recent survey we've also documented a change in diet quality especially among food insecure remonters so what we found here was that over 50 percent of food insecure households told us they're eating less fruits and vegetables since covid-19 as compared to before the pandemic so there could be other impacts on reduced diet quality in terms of health outcomes that aren't just about having enough food but also having good quality food we've also documented how consumers have shifted where they've purchased food since covid-19 so this graphic is showing in red a decline in reported respondents food sources and then in blue where we've seen gains in those and I think there's some really interesting important impacts here across the entire vermont food system so our consumers and respondents told us that they're going to farmers markets less specialty stores and restaurants especially we also documented in our most recent survey a six percent decline in people telling us they sometimes are often choose local vermont products as compared to before covid-19 but what we do see are some potential new opportunities where we've seen gains in people using grocery delivery restaurant delivery and on farm websites or e-commerce as compared to before covid-19 we've also documented an increase in the use of food assistance programs in vermont among respondents to our surveys so overall we found that one third of our respondents used some type of food assistance program since covid-19 and we've also documented an increase in use in those food assistance programs I know you'll hear from some different people in those programs later on who can talk more about that we also found in our work that the use of those food assistance programs is more common among food insecure households households with children and those households with job disruption so here you can see we asked about in our most recent survey six different types of food assistance programs ranging from snap and three squares vermont food pantry use the national guard marines drop-off school meals program the women infants and children program and meals on wheels which serves older vermonters and you can see here the breakdown and you have these slides as well for future reference what kinds of breakdown and who's using those programs before covid since covid or at all since covid-19 they have just a couple more slides to share so we did want to share with you some of the results about what vermonters told us would be helpful I think there's three key messages here first of all as we asked about people's concern for food security and food access over time from the beginning of the pandemic until our most recent survey in march or in september excuse me we did find in general people actually had fewer concerns you know they're the grocery store shelves were no longer empty they could buy their toilet paper again for example but there was one major two major areas where we saw increasing concerns despite covid-19 in some ways at that point in time becoming less of a challenge the first was increasing concerns from vermonters about losing access to food assistance programs so we saw as more people use those programs there's increasing concern that people may lose access to them or lose access to the extended benefits that have been possible with covid-19 relief the second area where we have a strong interest and documented evidence from our respondents is increasing safety people are still concerned about the safety of going to stores to obtain food and the safety of the supply chain and that is regardless of whether or not someone is food insecure and then the final thing is is cost and financial help so in our in our surveys we found about one in three vermonters really do want and need additional financial assistance the numbers that we've documented is about 149 dollars a week for food insecure households and about 130 dollars a week for food secure households we also saw increasing concerns about food costs between our surveys so a growing concern about the increasing cost of food and here's a quote from one of our respondents that I think sums that up as I wrap up my slides here food prices have gone up and so I'm much less likely to use the food pantry because of the increased number of people who need help I try to find other ways to cut down but mostly have just increased my debt and maxed out credit and I think that's sort of a silent financial impact that we may not even be seeing the full effect of yet people who may be maxing out their credit cards or going into debt to afford food so just to wrap up and then I'm happy to take any questions I did want to share we are continuing this research we have two future rounds of surveys planned to continue to document and understand the impact of this issue across Vermont we've also been working with the Vermont Agency of Agriculture Food and Markets especially Abby Willard who will be testifying next we've done a survey of farmers and food businesses across Vermont and we have a forthcoming report coming out looking at the business impacts on the food system and then as I mentioned and I've shared with Linda we have put out eight briefs summarizing all three of these surveys that give much more detail for you if you're interested and finally I just wanted to note that you know our team is very interested in conducting any additional analysis that might be useful for you or if there's any other questions that we could help provide data to inform your decisions we're really happy to do that so thank you so much for the opportunity to be here today and I'm happy to take any questions we may have and Senator Starr you're so muted you're muted Mr. Chair why don't we go to Senator Collamore I think we're going to Senator Collamore thank you Mr. Chair and Mr. Vice Chair Meredith I'm wondering because we've heard different definitions of insecurity can you tell us exactly what that means and I'm also curious with all the surveys that you did how how did you reach people was it an online survey was it a paper one did you call people I guess those are my two questions yep yep happy to answer those okay so on the first one great question you know there's a lot of definitions and terms you hear hunger you hear food insecurity it's important to clarify those things the way that we measure that in our survey is through using a valid set of questions from the US Department of Agriculture so the USDA measures food insecurity consistently over time and we used their six set of questions that we asked at all three of our surveys over time so there's six questions I'm happy to share those with the committee they range from whether or not someone is worried about happy enough to eat whether they have enough money to purchase all the way through to actually cutting meals in order to save money for example or because they simply didn't have enough to eat so that is how we measure it if you answer affirmatively to two or more of those questions out of six that classifies you as food insecure that allows us to be able to compare our numbers to other numbers that the USDA has had over time using that same survey methodology on your second question about our distribution you know unfortunately with COVID-19 and with the University of Vermont restrictions we are not really able to do that work with people in person and so we have deployed all of these surveys online and we recognize that that may mean that some people unfortunately are not able to participate and we fully recognize that but it's been necessary to do it that way just because of COVID-19 at this point the most recent survey was deployed using a professional survey company I should mention that all of the surveys were representative to the Vermont population on race income and age yeah so this was a call out survey I'm sorry say that again center yes this was a call out survey that was done by the group that you hired in other words how would people know to go on the website that there was a survey sure so the first two rounds that we did we established a collaboration with a broad suite of state across Vermont including our state agencies the Vermont Food Bank hunger free Vermont a number of other groups and organizations we also did targeted social media ads directing people to the survey we also did a press release from UVM and did media interviews on Vermont public radio and many tv stations and radio stations as well and so we had a multi-pronged approach to get the survey out and then finally we had paid ads in a front porch forum which reaches two-thirds of Vermont households and so the targeted media social media ads we did were targeted towards populations we knew were not likely to be on front porch forum especially men and lower income households so we had a very diverse strategy for those first two surveys and then hired a professional company for the third thank you Mary senator Pearson my questions were similar about the survey so would we consider it as good as can be these days basically a poll I mean a sampling of Vermonters did you allow for geography as well zip codes um so we can tell you about the distribution I can tell you that we've had respondents and all of us are all of our surveys across all counties um I I do not feel comfortable uh taking all of the data down to the county level to say it's representative um it's representative of Vermont and we have had representation across the state um but we can't predict food insecurity outcomes in some smaller counties because there's been obviously not as many people there so we've tried to keep the numbers um largely sort of at the state level although in some cases where we've had enough respondents like in Chinden County we could do that kind of analysis but yes it's broadly representative geographically as well and are we tracking the country as a whole are we worse off what we're how do we compare we uh it's a great question I've also I'm also running a national effort um the national uh COVID um research team food systems and food security research team and so we have actually implemented the survey in 15 states across the U.S. and so we have very comparative data actually Vermont is on the lower end of impacts as compared to some of the other states that we're working in um but nevertheless consistent trends across all the states and nationally the food insecurity rate has gone up it is consistently higher for households with children is consistently higher for uh BIPOC and Hispanic respondents and it is consistently higher for people who have had a job disruption across all of our surveys. So um Anthony, yeah Sharon de Polina. Yeah just an observation I was a little surprised to see that you found that uh participation in CSAs was down a little bit and farmers markets participation was down a little bit it's just that it's contrary to what we hear anecdotally where farmers have said are that um demand for their CSA has gone up so it's just I don't know what it's if it's a question I just thought it was interesting to see that those who had gone down as opposed to going up which I thought they would have gone up I with farmers markets is a little different because people may not want to go and I understand that but it's just the CSA thing was just very different than what we've heard from other people anecdotally so it's just a thought I don't know if it's a question. Yeah I appreciate that I mean one of the things we're trying to do in our work with um with abbey is to triangulate some of this so we have this farmer and food business survey we've done we have these consumer surveys that we've done and so trying to understand like who are the people who have been unable to maintain their CSAs certainly there's been a growth with some populations but others um you know may not be able to do that so we're certainly trying to look at all this data together moving forward to have a better understanding of that. Thanks. Yeah I'm crash yeah sorry Senator Polina it makes me think his question the that slide about where people are getting the food was that among people that identified as food insecure or that was across the broader population? Across the whole population um and it was uh you know it was self reported so where they said they had food or they obtained food prior to COVID-19 since COVID-19 I'm certainly happy to dig into that CSA result to see who is it who are the kinds of people who maybe started CSAs and who are the kinds of people who uh stop CSAs because we did see in some earlier research that food insecure populations um were possibly more affected by not being able to utilize the local food system in different ways. Well I would guess the agency has some of that information but thank you. Yeah um any other questions from the committee members? If not uh thank you very much Meredith uh you folks have done a lot of work there and um and I'm sure we'll use some of your numbers and figures uh when we get to presenting um the bill or whatever we do to move forward in a positive way uh so thanks. Thank you. Our next uh witness is Abby Willard from the Ag Agency and good morning Abby it's good to see you and welcome. Good morning good morning senators um I am happy to visit with you this morning on a few topics I'll say every time I hear Meredith speak about the data and the survey uh collection that they did this year I'm really appreciative of having such a strong research team at the university and focused uh here in Vermont looking at looking at food procurement and um additionally on the farm and food business side so I might recommend that there's a variety of different follow-up testimonies when the committee has time um to talk further about some of the farm and food business survey results. Um so good morning um Abby Willard I'm the director of the Ag Development Division at the Vermont Agency of Agriculture Food and Markets uh a few pieces that I wanted to share this morning also really cognizant of the long list of testimonies that you have on your docket for the morning so I might recommend um if there's interest for further testimony um this session to talk about the agency's Farm to School grant program in greater detail additionally um I'm going to give a few highlights about some pivots that happened in our Farm to School program our plans for 2021 and then a little bit about the COVID Ag Assistance Program that benefited Farm to School. We also hope to be able to visit with this committee again selectively on our um what we call V-CAPS over my COVID-19 Ag Assistance Program impacts and outcomes in the coming weeks so um I'll do my best to be brief so you can you can move along on your list um I also was inspired by Sam Anthos testimony from New York happy to talk additionally about the new local definition that was passed by you and others last session and how that might apply in any future Farm to School incentive programs as well as share how that connects to a U.S. Department of Agriculture Farm to School grant that the agency received to help schools look at tracking local so lots of topics for us to engage on so really quickly though from the food insecurity side wanting to think about two sides both the activities that have happened in schools and then a little bit on the ag production side sort of thinking about where is our food coming from how did our ag businesses fair from a food production side so in 2020 the Vermont Farm to School grant programs which I believe Betsy Rosenblith will talk in further detail about um we had grantees that we gave a lot of flexibility to in April recognizing that they really had some primary focus on keeping kids safe healthy and well fed and so there were a variety of grantees that really needed to take a break on their farm to school activities and focus on more of those immediate needs so we were able to offer the opportunity for extensions if our Farm to School grantees needed such support because these were two-year grants we haven't had a school take us up on that offer and hipstead felt like they have an additional year to do the work and also really important to acknowledge that the TA providers again a population that you'll hear from in this testimony and again have been very flexible and have offered a lot of support to our schools in their farm to school program both development and implementation so our plan for 2021 briefly we have just over two hundred and twelve thousand dollars to support the program the annual general fund appropriation of a hundred and seventy one thousand eight hundred and seventy five is coupled with some philanthropic investments that we receive each have received for recent years and we've elected to make some changes to the program that we'll just again briefly highlight here and then happy to talk about in greater detail and might even make sense to bring in Trevor Lowell who's our farm to school program manager to talk in greater detail with the committee so the one of the first changes is that we're delaying the launch of our grant program so historically they've straddled two different school years so awards have been granted in the fall they get started and then summer break comes and then they re-pick up their programs again the following school year so we are delaying the program so that again they'll sort of generally encompass one entire school year and we're going to limit the grants to one year so with a holistic level of technical assistance and coaching that will continue we're adding a new component to the program this year which really sort of focuses a bit on the piece that Meredith shared around the reduction of fruit and vegetable consumption and creating a CSA or a community supported agriculture program that's really focused on early child care funding that's offering real nutritious feeding opportunities at centers and schools with a real attention to that direct procurement from local farms so the concept would be that a child care center or school would purchase a CSA share from directly from afar and the farm to school grant program funds would support up to 80 percent of the costs for that share no more than a thousand dollars so centers could purchase multiple shares for multiple centers but the idea is to really make a direct connection between local food and the feeding programs for our youth the additional program piece is really around a farm to school vision program so wanting to create some real opportunities for schools to work with the really talented nonprofit community in Vermont around farm to school to do something new and different so they could really look at the impact of a particular project or the sustainability of their meal program address food security talk about diversity equity inclusion through a particular project so looking to create some more flexibility in the farm to school program for some of these unique partnerships so again that's all I plan to sort of share sort of a high level intro with if there's questions or more interest happy to discuss it additionally so then I wanted to just talk quickly about the again the VCAT farm to school grants that went out and so there is a one-pager here that I'll try to do a quick screen share you also have access to this I shared it with Linda so can you see this one pager yeah yes okay so this is sort of an overview of the farm to school coronavirus relief grants that were invested based on your efforts on wanting to allocate a hundred thousand dollars of the coronavirus relief funds in act 154 which became or h969 focused on schools and childcare centers so you'll have an opportunity to look at this in in your own time in greater detail so this was importantly a collaboration with the agency of education and the agency of agriculture so there was an opportunity for us to have one application for schools and two different funding opportunities captured in that same application so a wonderful efficiency in state government on our side for there to be one application that the agency of education managed and ran and a real ease in application for the schools so they could apply through one application and access various funding sources so it meant that up front we had to do some important partnership but we also avoided any redundancy by creating the application together doing the promotion collaboratively through the network and the variety of partners as well as from the agencies of education and agriculture so really in the true spirit and Genesis of what our farm to school efforts are in Vermont and I would say give credit to to you all in your vision of allocating a hundred thousand dollars for this program both the concept but also the amount it was pretty close to perfect we received a hundred and eighteen thousand dollars in requests and we were able to award a hundred thousand dollars of those grants Abby any idea why five of the applicants didn't receive a grant because I see there was 27 submitted 22 that were awarded a grant yeah so my understanding is that four of those 27 applications that were submitted were deemed ineligible based on the legislative authorizing language and then 22 were awarded and that was again up to a hundred thousand dollars which was the appropriation that was available yeah and again acknowledging that that Rosie Krueger can probably speak to either today or another time sort of the complementary infrastructure grant support that existed with the agency of education which had far greater impact and more resources to allocate so what I wanted to share and at least on this one pager was both the total funds that were requested the dollars that went out the door and then examples of a few of the projects so they were really focused on creating a safe learning environment for kids in school during the pandemic so classrooms set up outdoor spaces they created sort of outdoor learning environment so one example at brahman academy was a fire ring and campfire cook sites at school some were able to address some of their food security issues and offering homemade snacks in the school by having a freezer and refrigerator installed creating picnic tables and tented areas outside of the school so the classrooms could have more isolated and safe outdoor learning environments so really great projects really creative partnerships and important work that happened at a time when you know schools were really struggling just to meet the basic needs of of their of their responsibility as educators and caregivers during the day so let me stop sharing here if I can I'm not sure that I I've lost the functionality in my zoom here sorry for that you guys are still seeing my screen or two. The agency of education is the state agency that's responsible for implementing all of the federal child nutrition programs so the national school lunch program the summer food service program the child and adult care food program and then we also administer the t-fat program which is food that the federal government purchases for the Vermont food bank so we're quite involved in this all of these federal programs have lots of federal regulations and so usually when you have me come talk to you you want to know why can't we do this why can't we do that with these programs and the answer is usually the feds say we can't do that it's federal money we put a very small amount of state money towards kind of supplementing and supporting these programs but mostly it's federal money and if we want the federal money we have to follow the federal rules and I know that's not an answer you like to hear but but that's sort of the way it is with these programs and that's there was a mention earlier of fat content in milk and unfortunately that's the case there that's a rule set by the feds if we want the federal money for these meals we have to follow their rules about low fat milk so but covid has been a really interesting situation with with regard to federal rules so fairly quickly when school school started closing in march we realized that the federal rules were not written for this circumstance and so we immediately started beginning to apply for waivers of the federal regulations and since march we have applied for 38 waivers at the agency of education in addition we've received a bunch of nationwide waivers so first it was states filing individual state waivers and eventually usda kind of caught up to it and realized that you know this shouldn't just be done on a statewide basis that nationally they needed to issue waivers and congress gave them authority to do that so the programs that we are running now look very very very different than what they would look like in a normal year we have waivers that allow us to serve all children 18 and under they don't need to be a student we can operate open meal sites where any child 18 and under can can receive a meal we can offer multiple days worth of meals at a time we can have parents pick up meals on behalf of children children don't need to eat meals in a congregate setting all together they can take the meals off site we have some flexibility with a meal pattern there's just a whole host of regulations that used to be just really strict and set in stone that we've been able to get waived and so we're doing a lot with that and programs have used that flexibility to continue providing meals to kids during the spring a lot of folks were actually delivering meals on school buses to households since the spring we've moved more towards pickup models where households have to go to a location to pick up the meals but we are able to offer multiple days worth of meals at a time and more recently we have some programs that have started some really innovative meal kit boxes that are basically the ingredients for a week's worth of meals rather than individually packaged meals and that's really being well received where that's happening across the state and we're really encouraging that model since September we've had the challenge of not only trying to provide meals to kids in their homes the remote learners but also trying to provide meals to kids in school and still keep everybody COVID safe and so and it's often the same food service program is having to do both things they're having to produce meals for the remote learners and produce meals for kids in their classrooms so these programs have again shown just enormous creativity and willingness to figure it out and they're doing it but they're they're getting pretty tired and that's something that's always a concern to me we've really asked our school food service staff statewide to really keep working and keep pushing on a really high level since March normally these folks would have had some time off over the summer but we asked them to keep providing meals over the summer normally they would have some breaks around the holidays but we asked them to keep providing meal kits and meal boxes over the holidays and they've done that these folks really are dedicated and really want to ensure that children have access to meals but that's definitely something that I'm thinking about as we come up to this summer and we're not sure yet what the summer is going to look like because USDA currently hasn't extended these waivers past the end of June although Congress has given them the authority to do so so as the new administration comes in we're going to be paying attention and advocating for potentially some extensions of the waivers to allow folks to continue meal service through the summer but assuming we get some flexibility there the other piece that we need to be aware of is you know how do we staff that how do we keep these programs operating we've asked a lot of our programs and we don't want to break them so that's something that's definitely a concern for me and the same is kind of of true for my staff you know we have nine child nutrition program staff members at the agency and all of us have been working on COVID kind of non-stop and working on writing these waivers providing technical assistance we've done individual technical assistance calls with every single school food authority in the state and we did a round of those in the fall and we're about to start a round of those in the spring and we're doing that rather than our intensive monitoring that we normally do because we want to give everybody the assistance to be able to serve meals safely and well during this time so the the the team at AOE has really been working hard as well and I'm also concerned about how do we keep that going and I think my my big ask for you today is really to keep it simple for us this year we are are working like crazy and I haven't even touched on all the different things that we're doing I did provide some written testimony to you that talks about everything that we're doing and you know if you're thinking about any any new programs any you know the purchasing incentive I would just ask to give us some time for implementation to keep it as simple as possible if you want to provide additional funding I've given some advice in the past and I'm happy to do that again about the simplest ways to just inject a little bit of funding into the programs without adding a lot of administrative burden for us or the schools and to just keep that in mind this year would would really be my ask today so have you ever have you ever seen us do anything simple we have we have too many lawyers working for Rosie to keep it simple but anyways I'm sorry to interrupt you if I did no I provided you some some written testimony about everything so I'm really happy at this point to just kind of answer whatever questions you all have I can I'm happy to talk more about any of those those pieces of work that we're doing that I mentioned in the written testimony but I know you've got a lot of other speakers today and I would really love for you to be able to hear from them yes and and also you know when we get our simple piece of legislation put started put together we'll have you in to help us with are there questions from the Chris you have a question yes thanks mr chair our thinking is always as simple as the federal rules that oversee the work you do Rosie you know this is where the complication starts start surfacing but I've been thinking of you a lot because as you know I've elementary school kids and every time we get an email from the school you know schools dismissed early school we're having a holiday but food pickup is available or double the pickup will be available Thursday because Friday's off it's really impressive and and I have thought of you often knowing that you're well behind the scenes driving a lot of this we've talked about in the past how messed up it is the way that districts basically pay food staff it's different in a lot of schools it's not part of the base budget blah blah blah you mentioned that you asked staff to work over the holidays to you know this this burden that the the people doing the work have felt and I'm curious are you aware of maybe I should know this but in it has a state in any capacity added money for these people who are working more or is all that burden fought on the districts or is that one of the places that we've used cares money to help school budgets can you just help us understand that picture yeah so under the the waivers that we've got I mentioned all these meals are free to all all children and that's because the federal government is paying for the meals so each meal is reimbursed at the free reimbursement rate which is around four dollars per meal for for a lunch around two dollars per meal for breakfast and that's separate from cares money is that right yeah yeah so that's just the normal like child nutrition funding we we've basically taken it's kind of wonky and I didn't really want to dive too far into it but basically the feds are allowing us to operate the summer food service program year round and that allows us to feed any child 18 and under instead of operating the national school lunch program which would just be limited to children at school and so when we're asking folks to you know continue working over the summer continue working over vacations it's to produce meals and they get reimbursed by the feds for each of those meals I should be clear you know we haven't mandated that anybody were do meals over the summer or over vacations it's just a strong ask and that was one of the things this summer you know we asked you to help us provide some some assistance in terms of equipment so that folks felt more able to provide meals over the summer and by the time that money got out the door I think it was a little bit late so it didn't have as much of an impact as we had hoped but certainly it was still helpful so so there isn't additional state money going to pay for staffing specifically but we there is funding coming in assuming that that extra work equates to more meals served thank you any other brian thank you mr chair so rosie I think our phrase maybe for this session should be do no harm hopefully we can live up to that and I'm trying to just understand I thought I heard you say that I think the bill number was s273 last year which had the pricing incentives for buying more food locally in it were you saying that you would prefer that we not take that up during this session I think if you were to take it up I would prefer a delayed implementation of it I really can't see us getting ready to start working on that July 1st that's just not something we have the brain space to work on and frankly the folks at the school level who would be most involved in that are the business managers and these are the folks who are having to deal with all that different federal funding they're going to be dealing with trying to to manage all that and the audits and everything and I just don't think that they have capacity to deal with it right now either so I would certainly ask you to delay any implementation of it I did provide some pretty extensive testimony on that last year and I found I do still have the written testimony and I'm happy to provide that for senator parent because you all you all heard from me on that and it's I think we have some significant concerns at the agency that it's far more complicated than it needs to be the way that it ended up written last year and I know you had made some changes since then and I haven't had a chance to really delve into that further but based on the way the bill was written last year it felt fairly complicated you know I'm never going to say no to more child nutrition funding but I felt like there were much more efficient ways that you could have spent that in order to get a good outcome and so that I think we're not against it but it's it's a there might be some some simpler or better ways to accomplish your your goals all right thank you Rosie and probably your plate is pretty full yes I haven't got much room to add any more yeah any other questions for Rosie if if not thanks a lot Rosie for your time and we'll certainly be talking with you as time goes forward I will also mention senator that you all had asked in a previous farm to school bill for a report every year on local food spending and that report is due at the end of January and we are preparing to send that over so you will see that in the next few days from us and that hopefully will help you provide you some good information on what's currently happening with local food spending yeah very good thanks so we'll move on to Meg from the agency on aging welcome back and and good morning thank you very much for the opportunity to testify and Meg Burmeister I'm the executive director at the northeast kingdom council on aging there are five area agencies on aging overseen by dale and those provide home delivered meals program to residents 60 and older through the older americans act and then somewhat in conjunction with people who are disabled through VCIL the five agencies are age well the central vermont council on aging northeast kingdom council on aging senior solutions and the southwestern vermont council on aging so as you can see we are cover the entire state these meals provide a third of the recommended daily intake as prescribed by usda um menus are reviewed by a registered dietitian was oversight by the area agency on aging and the older americans act long ago placed value on the grassroots approach to ensuring the community need was represented on a local level and many of you see that there are varied models of how meals programs relate to their geographic region in the state of vermont and several of the more populated models in the state do so through larger vendors and other systems use smaller non-profit meal providers when the pandemic began to hold the home delivered meals system nimbly adapted to a rules suspension by the administration on community living which oversees the program at a federal level and the rule was suspended stated that people who were over 60 um had to meet criteria to be homebound and have difficulty or need assistance with activities of daily living or physical or mental conditions um making them unable to prepare food with that rule suspension that really opened the door to anyone who needed home delivered meals contacting us and being able to receive them one of the complications with home delivered meals is that most of our drivers are volunteers and they in many cases are over the age of 60 themselves and though we saw people decide to end their volunteerism others stepped up to the plate and the programs continued without a pause increased demand and increased numbers of meals per week quickly impacted the programs and the surge has not subsided congregate meals moved to take out meals for many sites and home delivered meals increased since march we've seen between 25 and 40 increase and those that range represents the diversity throughout the state and that has not really reduced dramatically of course we all thought in march that we would be seeing an end in sight and the realities of our world now are very different than what we anticipated we were able to receive funding through the older americans act through the families first and cares act was a generous allocation and the funds came with the provision that they could be expended through the fiscal year 2021 um this allowed us to meet the demand and as I just mentioned we all thought at that time that we would see an end in sight so we really funded the that increase in volume using those funds those funds are also supported by two legislative actions that provided cares funding through the state of vermont this past fall that increase the amount we were paying per meal to the meals providers and currently we're working with dale to arrange and develop a comprehensive plan for managing demand because the funding is not at a sustainable level the funds that we have received from the federal government through the older americans act by and large are being expended or have already been expended in some agencies because of the demand for meals and the volume of numbers of meals being produced so if you have any questions i'd be happy to answer them yeah um the federal older americans act that money it's being i mean they didn't allow you or give you enough to cover the cost of these meals uh or that 25 to 40 increase in signups has driven that away or use that money out yeah the the contracts that we have with our meal providers um you know sets forth a budgeted amount per year we certainly increase that thinking that we would be nearing the end of the pandemic at some point in this journey and that did not occur so the um you know what we see is that there's increased demand every time that there's a surge in an area that people are still very frightened to leave their homes to go grocery shopping um and some people really have self isolated just in an attempt because they're high risk in nature by virtue of their age yeah uh other questions from the committee if if not uh one more quick one uh you have made uh your request to dale uh and and i'm wondering uh we're we're going to have them in in the near future in in appropriations to present their budget how how is your portion of that budget uh being dealt with uh by the commissioner uh part of that is the expectation that we come up with a plan to handle um both looking at the funds that were expended looking at the demand and then coming up with a plan on how to respond to that um and on a national level what we've seen is that um many states are now moving to wait lists or reduced numbers of meals per week to be able to contain costs because there has not been additional federal funding in the amount needed to support an ongoing sustained high level of meals yeah well um thank you for that and we'll keep an eye out for it um any other questions from the members if not thank you uh mag and uh next on our list is john style the styles from the food bank welcome john and uh good to see you and be glad to hear from you welcome mr chairman thank you i i was wondering if it's okay mr chairman i i would like to defer um my testimony um oh did carol just pop off oh there she is i can't oh you you've turned your video on so that we can keep the school stuff closer together and make it uh flow a little more would that be okay sure and um yeah that that would be great thank you john you're welcome so kale thank you my name is carol kent and i'm president of the school nutrition association of vermont um we're affiliate of the national um school nutrition association i'm also director of school nutrition at the moille north supervisory union um i just want to i'm really grateful for this opportunity to talk to you all and share with you what's actually going on in the schools and how we are affecting families and our communities i want to give a big shout out to the aoe child nutrition team who have been working with us um since the moment this dropped on us back in march um weekly calls with school nutrition professionals across the state um and helping us navigate all the waivers that have come our way um i don't have to tell you that back in march when this first happened um you've heard the stories of how school nutrition teams sprung into action how we came to the call delivering meals on buses curbside pickups um it was monumental and we barely stopped um there has really as as rosie said there's hardly been a vacation break for anybody and our teams are our cooks they're they're happy to do it um they are essential and the work we're doing is just what motivates us because these are our neighbors these are our kids um when we started back well let me back up the waiver to serve meals for free to all kids 18 and under was a godsend and it really kind of set a precedent of what communities and what schools need to do to care for their children when we started back to school in the fall um those waivers had ended and we were really afraid and as school foods service directors weren't afraid of the virus and we were not afraid of all the revenue we were probably going to be losing we were really afraid that kids who are on free and reduced meals were really going to be overtly identified in the classroom because with meals going back to um being free reduced or full priced it was probably mostly free and reduced kids that were going to be eating meals in the classroom and it would be known to everybody who was low income that was our greatest fear and how were we going to deal with that so when the waiver came back to do the summer food service program and meals were free again it was just a huge weight off the shoulders of everybody and if I could take just a moment to read you a statement from one of my teachers it kind of sums it up and she said I have 10th graders in our high poverty school when I told them on the first day that school lunches would be free I saw the relief on many faces they didn't have to think about hunting through the fridge and cabinets at home trying to scrounge up something to bring for lunch and some of them laughed out loud telling me that this was great news because they hadn't brought anything in for lunch and they were just going to go without every other week or so one of the students would check in with me again on this our school lunch is still free there was a fear that the program had ended and that they wouldn't know and if it was wind up with a bill they couldn't afford and as winter break approached in the end of 2020 I fielded that question again and again as students wanted reassurance the program would continue through the new year so these free lunches were more than just fuel more than nutrition they wrote that our reassurance that they wouldn't go hungry that adults would take care of them that their school was a safe place and that the pandemic wouldn't win that it was all going to be okay those free lunches meant family and community and hope and the reason I share that is because we're beginning to become fearful again of what happens when the free meals stop and how do we tell these kids that we can't feed them lunch our big ask is for universal school meals and it's a really big ask and we understand that at the state level that's going to take a lot of innovation reinvention a lot of work we would like that to come down from the federal level but if it doesn't we're really asking Vermont to step up and try to find a way to continue feeding all kids for free it has eliminated the stigma in schools it's eliminated shame it's eliminated kids being hungry kids hiding food teachers paying for school meals all those things that you see in the data from hunger free vermont has worn out it happens um our kids are more attentive I have pages and pages of statements from teachers and principals um and from parents kids attention level is focused and they're learning better they're prepared throughout their day and um and that's because they don't have to worry about their parents getting a big bill um and where the next meal's coming from secondly I'd like to thank you all for the equipment grants that was a huge help at a time when we really needed it in the farm to school grants were also just really really important to us um we would like to I'd like to also share that we got cut up in the beginning of school year with the supply chain issues of getting the produce that we needed um as they did across the country and we were able to turn to our local farms for produce and vegetables we needed um what made it possible to do that was the extra reimbursement that we received from the summer food service program that little bit of extra money made it possible for us to make more purchases locally and to support our local farms up here in lamoille we've been purchasing from west farm green mountain farm direct kingdom creamery and and so on so that's been extra money going right into our communities and they've acknowledged what a big help that's been for them so we'd like to speak in support of the vermont food for vermont kids program the local person purchasing initiative when we can make that happen it'll be a great benefit to all of our schools and all of our farmers parents have shared with us that the food they're getting in the meal kits because many of us are doing bulk meal kits to send home they're getting a lot of local produce that they've never tried before fresh fruit and vegetables that they typically can't afford to purchase and that kids are eating more healthfully at home than they have before they're cooking together as families they're learning how to cook kale and how to cook leeks and other root vegetables so it's been a win-win the pandemic has opened up so many opportunities for us to respond locally and healthfully and just bring our our families so much support yeah well thank you for your testimony and thoughts and yeah it has been great having the universal meals programs since last march it's worked out very well of course our committee supports that very much the big issue was of course trying to find the money to pay for it and but anyhow it's been a good a good run trying universal meals out and and we've had certainly good participation so are there any other questions from the committee we've we've got to wrap this up but like in by 1040 so we got eight or ten minutes left and then we got a switch over but what and for those I don't know who wants to go next if John you want to be up next and and but we're gonna get the rest of you back in it probably will be just early next week so now John and of course if you if you need to you can come back next week too if you have time thank you mr chairman I think I can get everything in in just a few minutes and thank you committee members for holding this hearing today and all the other all the other testimony I mean it's obviously it's we don't have to say that this is something in Vermont that we can do something about and we are particular thanks to professor Niles for all the research they've done which is really helpful and kind of letting us understand the extent of the of the issue here and to show what we can do also I want to say that my testimony is on the site along with some supporting documentation and that that under Fay max name there is an overview of all the asks and I'm gonna have a couple of asks here so I just want to let you know what the food bank's been doing we're really grateful for the support of the state particularly since March when uh and you know everything hit the fan and uh the the National Guard and the state seo c and the agency of human services and the legislature with cares act funding it's just been an outpouring of support and allowed the food bank to respond in the way that we really wanted to and we continue to um this hunger crisis is not going away and uh you know what we were at one in ten people food insecure now we're at one in three maybe one in four um it's going to take a long time I know there was some testimony about people maxing out their credit cards to to buy food and it takes a long time for people to recover from that so so we'll be here for the long run the food bank to address that increased need has doubled our distribution since March for for fresh food or excuse me local food um fresh local food it's up 63 percent from last year and our our fiscal year ends in in in September and this first quarter of the new year our fresh food distribution is up 77 percent so we're out there because of the cares act funding and other food bank support um we spent in the last fiscal year 975 thousand dollars on local food from Vermont growers and producers um and hope to continue um a really high level of of partnership with our Vermont growers um we also have been providing many grants to food shelves and meal sites in all of your communities and those are grants of you know between the thousand dollars and maybe up to ten thousand dollars where the local food shelf or meal site can then purchase directly from a small farmer um some of the farms are are really a little too small for the food banks logistical um nightmare um and so it's it's it makes a lot more sense for for the parent child center or the food shelf or the meal site in that community to to get a csa or local deliveries there are i'll get right to the asks because i know we're really short on time there are three ways that the state can continue to help the food bank and support our neighbors here in vermont one is the food bank is right now conducting our own we're calling it the vermont farmers to families program where we're doing 500 food boxes a day for eight weeks at locations all over the state working with the abbey group and those boxes include at least 50 percent vermont product that's a $1.5 million program and our request that we've talked to the administration about also is to get some funding to support that through the budget adjustment act or perhaps if there's any additional cares act funding or from additional federal funding that comes in again we were at the legislature last year and we'll be there again this year as the food bank asking for a $500 000 annual appropriation for vermonters feeding vermonters and every dollar of that money will go directly to purchasing food from vermont growers and producers that would then be distributed within the food bank system finally if more federal funding does become available the food bank has a a budget to keep us producing and getting food out at at these pandemic levels and that will be about $7 million that includes that $1.5 million for the vermonters vermont farmers to families program and what do we do we have 20 monthly and twice a month distributions for our veggie van go program we partner with 215 food shelves and meal sites all across the state in each of your communities we supply food to 42 sash housing sites around the state and there's a program that provides 55 csa shares of culturally responsive food to new american communities in the berlington area and and a lot more but we don't have time to talk about that i'll just leave it at that thank you mr chairman yeah well thank you john and and thank you for all the work you've been doing with our food shelves and around the state since last spring and i think i think we should be proud we as vermonters are proud of taking care of our own citizens and making sure that that no one goes hungry the i'm wondering if helen and betsey and fey and any of the rest of you could come back another day like i i'm sorry that we i guess we should have started earlier or gone longer and and moved things but it's uh it's a very trying time and in our time but we're going to be spending way as a committee a lot of time on food security and and we're going to be working of course with all of you folks and and other partners to get make sure we get this as right as possible um i don't know chris did you have a question yeah sorry just a quick question for john um thank you for all the vital work you're doing i'd heard from a constituent who's got celiac i think is how you say it's uh a little like crones and finds it and is got low income and dependent on food food bank and says it can be quite hard to find appropriate food could you just comment on that is there any plan you know i'm sure he's not alone it's obviously hard you're juggling a lot of competing pressures but just wondered if you had any thoughts and any plan to help somebody like him out yeah um you know uh celiac uh are people who don't or cannot tolerate gluten and as we know and when it comes to um processed foods of any kind there's generally gluten in them and so um it's very very challenging for us to have separate enough of of food that is certified gluten free and they get available to all of our partners in a way that's that's equitable um i would actually if you would if you would refer the the the um the person to to me i'd be happy to work with them and figure out where in their areas the best place um to get more of the the kinds of foods that they can that they can tolerate um this is this is not just a problem in vermont with food banks and the charitable food system it's a problem across the country um and just a really challenging one it's it's hard for people who have plenty of income and have celiac disease um and i just it's just you know really really challenging when you have really limited limited means i'll try to connect him with you by email thanks ronnie anything else uh from the committee if not i want to thank all all of you folks for being with us this morning and we'll be sending out invitations um for our meeting next week when we work on um foods so thanks again and sorry that we couldn't get everybody through this morning but it certainly shows that this is a very um serious you know subject matter and that we're trying to take it serious and and working with all you we can i know we can build a better system of food supplies for our people so thanks again for being with us um committee members i don't would you like to take a couple of minute break and and uh then we have the um vermont dairy producers alliance with us and i see amanda's already on and and so we'll be hopefully getting going by 1045 or or shortly uh thereafter so if you'd like to just stop for a minute to catch your breath we'll uh we'll take a little break


The study found that emergency laparoscopic cholecystectomy, LCE, can be safely used for patients with high operational risk, such as those with advanced age, grade 3 to 4 obesity, or a history of abdominal surgeries. However, it also showed that some patients may require more complex procedures due to technical difficulties during the procedure. Despite these challenges, the overall success rate of LCE was comparable to traditional cholecystectomy. This article was authored by F. I. Makhmadov, D. Murbygiev, P. S. H. Karamov, and others.


Go to David McDowell John Layfield and Melissa Armell on all of this most anything with you begin with you What do you look for? Late Sunday night when you're looking at Asia or you're looking at how our futures are trading Well, what do you pick apart and want to discern for maybe signs of stability or norm returning? Whatever that is I actually only focus on where the market's gapping So that's pre-market or post-market activity So Sunday night really just have the futures in the morning when you get up in the morning Monday It'll be really interesting to see where we gap. I know we rallied into the close on Friday But I think we were weak we were weak all last week and that's what made people panic was the first bearish week You could really say we've had in 14 and a half months since Trump was elected. I think we could still be lower I think we have to gap up huge on Monday morning in order to recover from this immediately Which we might but I don't think that we will we'll have to say so I look at the gap The poll how the gap between what the gap between the close of four o'clock We'll be closed and the open on Monday morning. Where are we gonna open? Where's our institution's gonna come in in the pre-market and buy or they're gonna dump more shares That's interesting, you know taking that's the one thing you always look for every time. There's a downdraft Who's buying we're told about Mark Cuban buying, you know an index We told you about some of the big names though has not yet come forward They might in the days ahead like they did in 87 Peter Lynch buying stocks in a downdraft IBM then GE buying their own shares back in the middle of that in that slide We've seen precious little of that so far it could be going on but they would usually announce it But what do you make of that? I think that Tracy mentioned this. Where is the money going when it goes out of stocks? Well money gets destroyed It doesn't have to go anywhere Excellent point. So it but what I am most concerned about is We are facing you mentioned interest rates We had an unprecedented era of cheap and easy money not just in the United States from the Federal Reserve But around the globe and we don't really know how this ends We don't really know how high interest rates can go in the short run So I think that yours this you know who didn't benefit from all that cheap and easy money actually regular folks They're finally seeing their wages grow at almost three percent tax reform a big part of that I'm not worried about them as much as I'm worried about a collapse in the stock market Maybe 20% a collapse in junk bonds Bitcoin Obviously a bubble there So I think that you're beginning to see just in the start of an unwind and all of this free money And you know what it's never free repercussions. No, you're quite right about that John late So one of the things that has been said of this market is it doesn't know what it doesn't know and it doesn't know How far interest rates could back up nor does it appreciate that you don't have to back up to levels like maybe you and I can Remember and the late 80s or 90s to get people scared that when you don't have sort of like a sense of how high is high People sell first and ask questions later. I understand that but are they overdoing it? Is it your sense now because it's been a volatile six trading days. We've it's the fastest correction on record But are we overdoing it? My opinion is yes, and what you don't know, I think it's the most important thing out there You did have an exotic instrument that was on margin at your previous guest said this these instruments should not be on margin It blew up a bunch of margin calls But it calls what you don't know out there to really come to the forefront and you had a lot of programs selling that was going on People were just taking off risk because they didn't know what was going to happen next and simply this week You had more sailors than buyers. It was a very simple market dynamic that was going on Nothing fundamentally has changed in the global economy They have global synchronized growth for the first time in many years. You still have a low unemployment in the United States You have a low unemployment the eurozone to a 10-year low going on over there and global growth We do have some inflation coming up It doesn't look like it's gonna be 6 to 18 months out before it manifests itself if it does but that's nothing new Nothing has changed. We just have right now I think selling going on because people don't know what they don't know it's not the inflation Inflation as John said isn't that much of a worry? But it's a mistake and fears of inflation where you have policy makers at central banks like the Federal Reserve new chief Jay Jay Powell just taken the job last week. You have Investors overreacting and starting to dump longer term treasuries. That's your real fear It's not the actual inflation, but somebody who makes a mistake in the face You know what revolving credit is at a record high that is credit card debt in this country is north of a trillion dollars I call people about adding additional credit if you think rates are gonna go significantly higher by the way the 10-year yield in 81 it was about 15 percent. Remember that Paul Volcker trying to kill inflation. I do and after 87 I know it got as high as 10 percent the last time so Melissa very very quickly What are you telling clients to do right now? I would say wait and hold if you're a long-term investor all signs are still green for the market We're still very very bullish tax reform has just started I think that corporate earnings this year are gonna really turn out to be great and as far as interest rates go I mean I used to do two mortgages 10 years ago. We were giving rates at 6% people were loving 6% That's the point the higher rates go cheaper the home prices need to be to make that's make sense for people Alright guys. Thank you very very much. Meanwhile adding to this angst this is additional 400 billion dollars in spending as part of that two-year Budget Accord that Republicans and Democrats agreed on


International governmental organisations like the World Bank and International Monetary Fund are major producers of aggregate data. With their global reach and representation in many countries they are well placed to collect and aggregate social and economic data. We'll look at a few of these organisations and types of data they produce. The World Bank collects time series data on all aspects of human development worldwide and is designed for international comparability. The World Development Indicators is a good database to start. It covers topics such as economic policy, health, education, poverty, trade, social protection and labour. The coverage is excellent meaning thorough data for most countries for most topics. Here you can see the proportion of seats held by women in national parliaments during 2016. The countries in green have the higher proportion and the countries in red the lower proportions. Here you can see a chart of the 10 countries with the highest proportions. These data come from the World Development Indicators. The OECD is an organisation dedicated to economic development. It currently has 35 member countries which includes many of the world's most advanced countries but also emerging countries like Mexico, Chile and Turkey. The datasets cover a vast amount of topics such as economics, health, environment, migration, employment, tax, social and welfare. Most of the data are country level but there are some data at smaller country regional level. Here you can see deaths due to transport accidents for several countries. You can see these have been falling over the years but notice the huge smack due to the Estonian very disaster in 1994. This map shows Indian immigrants. The map shows you where these people are resident. It mainly covers OECD countries. The International Monetary Fund published data on national accounts, trade, balance of payments, government spending for most countries. Collectively they provide a global picture of economic development and international trade. Here you can see the price of gold from 1965 onwards and these data came from the International Financial Statistics. The International Energy Agency covers detailed data concerning energy prices and taxis, CO2 emissions, energy statistics and balances covering electricity, coal, natural gas, oil and renewables. There are of course other international data providers. We have just concentrated on some of the most well known. Take a look at the international macro data that we have in ukds.stats at stats.ukdataservice.ac.uk.