Welcome to the Wiring Wick Symposium. We're going to be talking about technology innovations to strengthen the special supplemental nutrition program for women, infants, and children. And I want to thank my collaborators from the Harvard T Chan School of Public Health, the Department of Nutrition, Dr. Walter Willett, and the MIT Media Lab, Dr. David Newman, who we'll be hearing from later. Next slide. We have an incredible group of speakers today and experts from policy makers to foundation leaders, people doing the research in the field. You'll be hearing from them all during this program. Next. Over the course of this symposium, we're going to be talking about what is Wick. We're going to talk about the recommendations of the Wiring Wick Health and Technology Summit. We're going to talk about some of the challenges and changes to Wick that were made with the COVID-19 pandemic and what's happening with the infant formula shortage today. And then we're going to have a wonderful panel discussion of experts talking about progress that's been made in implementing technology into Wick as well as future directions. Next. We're here today because hunger is a major public health crisis in America. In last year, 45 million people, including 15 million children, experienced food insecurity in our country. And the rates have gone up significantly during the COVID pandemic. Research shows that poverty and adversary during a child's early years can have a lifelong impact on their physical, mental, and economic health and well-being. Next. Food insecurity and obesity are now converging in our country and particularly impacts low-income communities. 10.5% of households are food insecure. And 31% of our nation's children are overweight or obese, 73% of adults. This could be the first generation of children that are not as healthy or live as long as their parents. Next. And that's where Wick comes in. For nearly five decades, Wick has served as a vital safety net program, providing nutritious foods to supplement diets, nutrition education, breastfeeding counseling, and health care referrals for low-income pregnant and postpartum women, infants and children up to age five who are deemed medically or nutritionally at risk. It's administered by the Food and Nutrition Service at USDA and locally administered by 89 state agencies. Next. In 2020, 6.2 million people received Wick benefits. And as you can see, Wick serves diverse population groups. Next. Critically, and did you know that 50% of all infants born in the United States are enrolled in Wick today? Next. And this is why Wick is the largest buyer of infant formula in the United States, making up more than half of annual formula sales. And so the shortage and the recall that has occurred is particularly impacting our nation's low-income families enrolled in Wick. Next. We'll hear more about this later in our program. Despite serving as a critical source of nutrition, only 57.4% of eligible people are enrolled in Wick, including just 53% of eligible pregnant women. And there's a significant attrition rate from the program, while almost 99% of infants are enrolled in the program. By the time the child ages out at five, only 25% are enrolled in the program. Why is this? Well, there are a number of participation barriers for Wick, including transportation challenges, stigma, figuring out what foods are eligible. The participant's regular store doesn't participate in Wick or carry the right selection or sizes with foods. There can be long waiting times for clinic appointments and before the pandemic in person only appointments and language barriers as well. And many of these problems could be solved in part by modernization of Wick with technology. Next. Why does Wick matter? Because children in Wick have better learning out and it returns every dollar spent on Wick more than doubles its return. Wick is not just about providing food and nourishment, it's about empowering mothers. And parents should view Wick as a valuable and relevant source of support during one of the busiest times of their lives, not as a program with barriers, stigma, and navigation difficulties. Next. So we asked, what if the delivery of Wick benefits and services could be modernized with technology and social media to help boost enrollment and decrease attrition? Next. And that's what the Wiring Wick, the health and technology initiative is all about. In 2017, we held a summit to highlight opportunities for technology, to strengthen Wick, we built a website WiringWick.org as a hub for information about Wick, and today we're releasing a report and executive summary of our findings. Next. The culture of health in America requires that everyone has access to the resources they need to flourish in their communities. And this initiative supported the belief that technology can fundamentally help modernize in combination with in-person services. The initiative's goal was to identify ways to integrate cutting-edge technology so that the program could more effectively, equitably, and efficiently deliver benefits and services now and in the years ahead. Next. So in 2017, we held a summit. It was held at the MIT Media Lab with multidisciplinary experts from tech, from public health and design, along with Wick agency directors and participants to engage in out-of-the-box thinking and imagine what was possible for Wick in the digital age. We held this meeting in anticipation of the transition from the delivery of food benefits from paper vouchers, which had been from the beginning of the program to EBT cards for distribution. And at the summit, we workshopped and we proposed technology solutions that could enhance Wick's services and increase the impact of the program in anticipation of the EBT transition that was going to occur three years later. And we fostered cross-sectoral collaboration, partnerships and networks to leverage the power of technology and social media to strengthen the program. Next. Next. And here are our project recommendations. Next. First, the bottom line is that technology should be integrated into Wick to create a human-centered, a culturally sensitive, efficient, equitable and more successful program for participants. There should be a hybrid program that includes both technology enhanced services and in-person services. And the COVID-19 pandemic has accelerated the implementation of our recommendations, some of which were going on before the conference and many now are being implemented. Next. We looked across a mother's journey through Wick to see where technology could make a difference. Next. Firstly, how do we inform eligible mothers about Wick? Well, the first recommendation was that we need to conduct Wick outreach through other federal assistance programs. About 80% of current Wick participants are enrolled in one or more federal assistance programs like TANF or Medicaid. And so we need to create more digital outreach and using texting to inform mothers and projects are underway that have found this to be extremely effective. But people should be able to be seamlessly cross-enrolled if they're in Medicaid, for example, into Wick without having to upload all of their other documents and making it really easy for people to get into the program. Next. We also want to use social media to conduct Wick outreach and recruitment. And again, since the conference was convened, social media is being used more and more by USDA, by the National Wick Association and other organizations that should continuously develop resources and tools to help Wick's local agency across America identify and enroll eligible people. Next. We need to update the application and certification process with digital portals and interactive customized mobile and web-based apps that simplify and facilitate the Wick application process and creating a digital wallet to streamline cross-enrollment. Next. And modernizing the clinic and education experience is also critical. So again, this hybrid in-person virtual Wick experience, again, apps and web-based technologies including telehealth services which were approved with a pandemic with waivers to create a more personalized nutrition education experience and provide breastfeeding support virtually as well. Again, that remote service provision by permanently waiving physical presence requirements in the program. And again, reducing clinic waiting times by offering appointment scheduling through web-based and text messaging. Next. We need to explore digital innovations to improve the shopping experience. Already many state local agencies are using Wick shopping apps to create an easier and more innovative shopping experience. But we also need to allow online ordering and mobile pay, in-store curbside pickup and home delivery for Wick participants so that they can shop like other retail experiences like other people in America and expanding partnerships with online vendors for ease of food benefit redemption. Next. We need to reduce Wick attrition rates with engaging user-friendly apps, texting, teleconferencing and other digital services. So creating Wick online ordering platforms forming social network groups as virtual co-ops for mothers to share with participation experiences, breastfeeding support parenting tips and childcare information. Next. And then we have some priority policy recommendations that we wanna discuss with all of you today. First, we need to leverage partnerships to enhance the participant's experience and improve program administration. We need to foster partnerships between the government, experts in tech, policy design, public health, EBT vendors, app developers and researchers. And we need to work to promote mobile-based transactions at farmer's markets to enable greater access to fresh produce. And then also working with venues such as museums and public transportation to recognize with EBT as passes for low-cost access to various venues. Next. We also believe that a National Wick Technology Assistance Center for Research and Program Improvements should be created to design a cross-agency data warehouse for routine uploads of de-identified administrative health outcomes and EWIC data and develop technical guidelines and protocols so that there can be compatibility across Wick management systems. Next. Conduct regular evaluations of technology tools on Wick's impact by technical assistance to all Wick agencies and conduct research to demonstrate how local agencies can use existing Wick data to boost retention and decrease retention and increase research on the use of cutting-edge technologies. This is very important to see how these technologies are impacting enrollment and retention in the program. Next. We need to involve participants and staff in Wick program modernization. We need to wire Wick's program culture and ensure equity in the program. So clearly the end user needs to be a part of this process to design technology innovations and conducting research, ensuring inclusivity and improving service delivery and education. We also need to provide staff training to build proficiency with these new digital tools to help create a cultural shift that supports the use of technology innovations in combination with in-person services, developing online and mobile app surveys for Wick participants to identify and implement technology enhancements and ensure equity in access to digital tools and services that are modernizing Wick. Next sign. The COVID pandemic has revealed the shameful health disparities that have existed for all too long in our society, having a disproportionate toll on Black, Hispanic, Indigenous Americans and low-income communities. As we emerge from this health and economic crisis, equity must be central to every solution proposed in our society, including in Wick, whose mission is to provide a just and healthy start for the most vulnerable in America. Next. And while technology can be a force for connecting people, information and services, it can also perpetuate inequities. So digital skills and access has now become a key social determinant of health as these resources are increasingly moving online. So we know that access to devices and broadband is problematic in some communities, including for minority populations and rural areas of our country, creating a digital divide. So we need to really ensure that low-cost broadband access is expanded and that Wick really needs to be addressing the equity impact of the program to ensure that tech and other interventions are culturally sensitive and responsive. Next. Need to focus on participant-centered technology at the USDA with special task force. One has already been created on online ordering and permanently allow with local agencies to use approved telehealth technology and other digital services. Next. Need to focus on conducting annual surveys and mapping of the spectrum of technology tools being used, developing tutorials and guidance and templates to assist local Wick agencies and clinics and design a section of USDA's website to serve as a technology resource hub with guidance on how to use acts and social media for outreach to Wick participants. Next. Need to dedicate funding on modernizing with technology infrastructure and innovations. That means increasing congressional appropriation so that all 89 agencies can use and benefit from these advances and designing a universal open-source digital ecosystem with USDA developed standards, guidelines and protocols so that agencies and vendors can facilitate system integration across technology providers. And again, increasing support for digital pilot programs such as online ordering, delivery services and mobile pay. Next. And lastly, designing a national online education resource hub and toolkit for education for parents and families across America about nutrition to ensure a healthy start in life for their children. Next. Many of the changes and these recommendations that we've talked about have been accelerated by the COVID pandemic. Some were underway already before the conference went in place. But the Families First Coronavirus Response Act through the Food and Nutrition Service of USDA approved over 800 WIC waivers and importantly waived the physical presence requirement that had been required for enrollment certification, nutrition education and issuing of food benefits. Next. Additionally, the American Rescue Plan of 2021 has included $390 million of funding to support WIC outreach, innovation and program modernization efforts. We're hopefully giving flexibility to many of the barriers that have been in the program keeping the waivers in place will help to modernize this program moving forward. And importantly in the Infrastructure Investment Jobs Act of 2021, $65 billion was included for expanding broadband access. 14.8 million people don't have it, particularly in our minority communities and this could help reduce disparities in access to digital services and resources in WIC and other federal and state assistance programs. Next. From the EBT transition in 2020 and the COVID pandemic has come opportunities to modernize WIC. Most of today's new parents are millennial or Gen Z who are highly connected to tech and keen on using social media. These parents need to view WIC as a valuable and easy access to a source of food and nutrition services to help them raise healthy children. While WIC has significantly increased the use of technology since the program was established including the EBT implementation and waivers as a result of the pandemic, the program's continued success will depend on its ability to serve new generations of beneficiaries to digital innovations, platforms and services that allow high quality WIC services to be delivered remotely as well as in person. Next. So we believe that creating a technology enhanced WIC can provide more ways to reach participants and meet their diverse needs, helping to boost participation and retention in the program. We believe that WIC rules should be prospective and look to be inclusive of next gen technologies and new regulations and system changes must include these anticipations of innovations that will be occurring in the future. Next. The need to alleviate food insecurity, reduce obesity and enhance the health of Americans is so pressing that every effort must be made to strengthen, modernize and wire with as a critical safety net program for millions of Americans, including nearly 50% of all infants in the United States and essential part of our nation's future. Next. Thank you so much for listening. And if you want more information and a copy of our report, please check out wwwwiringwIC.org and you can also press a button on the screen to get a copy of the report. Well, it's now my great pleasure to introduce to you Dr. Walter Willett, Professor of Epidemiology and Nutrition at the Harvard T.H. Chan School of Public Health who served as an collaborator and leader on the Wiring WIC Health and Technology Initiative. When you Google the word nutrition, up pops Dr. Willett's picture as the most cited nutritionist globally. Dr. Willett has focused much of his career over the past 40 years on the development and evaluation of methods to study the effects of diet on the risk and protective factors for chronic diseases. He's published more than 2,000 scientific articles, authored several books and received numerous awards for his landmark contributions to advancing nutrition and health in America and around the world. Dr. Willett. Good. Thank you, Dr. Blumenthal. And it's a great pleasure to be with you today. And it's also been a great pleasure for me and my fellow department members at the Harvard Chan School of Public Health and Nutrition to be part of this program, starting it with our symposium in 2017 and right up to issuing this important report. Most of my work as an adult has been related to my training as a physician in internal medicine and more recently as a nutritional epidemiologist. So mostly I've been looking at adult issues in health and nutrition. And what we see is a very concerning problem. But again, it connects directly with what is going on during pregnancy, infancy and early childhood. Probably the most obvious and conspicuous issue has been the obesity epidemic and we hardly need statistics to appreciate that. We've often seen this picture showing from about year 2000 where obesity affected approximately 30% of adult Americans and by 2018 up to 42%. But actually if we go back in time, further to when I started working on this project, only about 10% of American adults will be. So there's been about a fourfold increase over this period of time and it's still going up unrelentingly. And in children, there's also been a fourfold or greater increase in obesity over this time period. Next slide, please. And if we take the trajectories of actual weight gain in children, one of my colleagues here at Harvard has also done an analysis looking at the predicted prevalence of obesity among the children who are today two years of age and the projected prevalence of obesity by the time they're 35 is actually over 50%. And we know that at 35 people are still gaining weights steadily. So by the time they reach 50 or 60, the prevalence is going to be way over 50% for just obesity, not even counting overweight. Next slide, please. And as sure as night follows day, diabetes follows obesity. And here we see even by the time someone gets or a group of people get up to be overweight even before they're obese, the rate of obesity is about 10 to 20 fold increase higher than it would be for people who are lean. And then again, at risk goes up steadily being about 60 fold higher for people with moderate levels of obesity compared to people without overweight or obesity. Next slide, please. And as sure as day follows night after diabetes comes increasing risk of heart disease. And this has been going down for decades. We had about an 80% decline in heart disease mortality up to about 2010 and then it started plateauing. And in fact, there's been some increase in coronary heart disease mortality since about 2014. Next slide, please. And it's not just heart disease, obesity related cancers which had been coming down. Colorectal cancer are now going back up in more recent generations. Next slide. And of course, this all plays out into life expectancy. And even before the pandemic, life expectancy had been going down in about four years prior to the COVID pandemic. Some of this is related to opioids but a long-term driver is excess rates of obesity and overweight. And of course, as Dr. Blumenthal mentioned, the averages don't tell the full story because this has impacted different parts of our population very differently. White Americans lost about one year of life expectancy.  So huge reversals due to, of course, many factors not just nutrition, but work sites and excessive exposure due to high-risk occupations. Next slide, please. But there is a very clear risk, a very clear association between overweight and obesity and actual severe COVID. The issue isn't whether someone gets infected or not but the severity of COVID that obesity and diabetes together contribute somewhere around 30 to 50% of hospitalizations for, for due to COVID. And overall risk factors related to nutrition potentially contributed about 60% of the excess high-risk cases of COVID. So having a good dial will protect you from getting infections, but it can protect you to some degree from getting severe and fatal infections. Next slide, please. Of course, immunizations are number one. To put this somewhat bluntly, we've entered a dive, a death spiral in this country. As weight gain goes up, we have more cardiovascular disease, diabetes, cancer, arthritis. All of those cause reductions in physical activity that leads to more television watching and we see that's directly related to more consumption of junk food and all through the cycle. There's aggressive marketing of unhealthy food to children who can't really make the distinction between healthy food and unhealthy food. And that all leads to more weight gain and then we're spinning around here to premature death. And unless we break this cycle strongly in the multiple places, it's pretty clear we are going to see mortality to go up and life expectancy to go down. Next slide, please. This is not totally surprising that we're seeing this. We several years ago did an analysis using and hence data looking at the foods that people at less than 130% of the federal poverty line were consuming and it paints a stark picture. Whole grains, this is servings per day, less than half a serving a day. Refined grains, 4.6 servings a day, less than one serving a day of fruit, vegetables and potatoes almost equal to non-starchy vegetables. And certainly generous amounts of red meat processed meats and almost three servings a day of sugar sweetened beverages. So from all of our research, we see that this diet is actually the fuel for overweight obesity and diabetes. So it's no big surprise that what we see happening in terms of disease and life expectancy is actually happening. Next slide, please. The good news here is that standards and policy can make really important differences. This was strikingly apparent for the effects of implementing new standards for foods and schools on a scale of zero to 100. In 2010, the quality of food served in schools was about 58%. And after the implementation of new standards and there were some unhappiness and pushback about raising the standards, but this really made a difference. This went up to 81 out of 100 just in that very short period of time. And so what we're talking today about WIC is really important. WIC is a wonderful program, really important, but it's equally important that all kids who are eligible be enrolled and that we have high retention of those that are enrolled. We know that this can really make an important difference to long-term health and wellbeing and help close the tremendous gaps across some groups of our population. So again, thank you. And I hope this effort will be beneficial to be helpful to those running the WIC program to our agriculture and especially helpful to participants. Thank you. Thanks so much, Dr. Willett, for really setting the stage of the importance of nutrition to health and for your leadership. Well, it's been terrific to collaborate on this project with the Harvard School of Public Health and also with the MIT Media Lab, which is an oasis of multidisciplinary work and a hub of innovation where our summit was convened. So it's my great pleasure to introduce to you a gifted scientist who is the embodiment of innovation and new frontiers of exploration, the director of the MIT Media Lab, Dr. Deva Newman. She also serves as the Apollo Program Professor of Astronautics at the Massachusetts Institute of Technology and she's a Harvard MIT Health Sciences and Technology faculty member. Prior to these positions, Dr. Newman served as NASA Deputy Administrator from 2015 to 2017. She was the first female engineer in this role and she was awarded the NASA Distinguished Service Medal for her outstanding leadership and contributions. Welcome, Dr. Newman. Hello, thank you, Dr. Boulouville. So wonderful to be here. Hello, everyone. So this isn't rocket science, this isn't rocket science, right? Maybe it's harder. We just really are here today to celebrate the start, right, to celebrate an amazing report, the recommendations. We were so glad to convene everyone here together with our colleagues at Harvard School of Public Health, of course with New America and the recommendations in this report are so important, so important to mothers and infants and children and that means all of us should be human right to have great medical care, to have great food, to have wonderful food, to have a chance, to have a chance for all those little folks to dream and attain, you know, get to the moon and Mars, which is what my dream for them is, but it starts with nutrition, it starts with being healthy and where we come in, again, being the technologist or innovators are so happy to just be part of this discussion is when you highlighted all those recommendations, we really wanna accelerate positive change. And let me give you some examples of the digitization. It's so important. We already have the technologies today. We have the technologies today. We've made those innovations so that literally everyone should be able to, every mother, hold that in the palm of your hand to have that digital record, that digital application that you're talking about, making it very easy. So not too cumbersome, not too bureaucratic to make sure that everyone has access. You show the numbers, not everyone has access to even having the internet, let alone high bandwidth on the internet. We need to change that. We need to give everyone equal access, as you mentioned, it's all about equity, it's about really empowering folks, about saving lives at the end of the day. It's about empowering everyone. Everyone definitely needs to have equal access to the technologies, to the information, to beautiful, healthy food that is going to overcome. I remain the eternal octaves, overcome so many of the challenges that Dr. Willett put before us in terms of obesity and the diabetes. I hadn't seen that spiral that was pretty powerful to take a look at that circular downward spiral. When we think about technologies, think about the ease of telehealth, telemedicine. How can we empower people? How can we get people right out of that spiral just again to go about their daily great work healthy? But so this doesn't take people down that so it empowers them with the tools, the digital tools, the modernization, the innovations that necessarily we all need to work on together. They are for everyone who has mentioned equity. Everyone should have equal access, equal opportunity to all of the technologies, tools, all the digitization, and I would add maybe personalization of health, of health for the mothers, of health for the infants and children so that we can get everyone to a very healthy, equitable state.  They're gonna help us all solving the challenges we have and just kind of go full circle to also saying the research elements that you mentioned. That's exactly what we do at the MIT Media Lab where a lot of data scientists, we use artificial intelligence, machine learning. That's because we're kind of curating the data because we can look at that data, we can visualize that data and we can hopefully almost in real time understand the data and then maybe help people make positive changes. Maybe help people take the appropriate action so that they can live well, be healthy. Of course, that's what everyone wants, but hopefully some of the digitization, the tools and my dream is that everyone could just have the information right here in the palm of their hand. That would be the most convenient, easy, most accessible way that this, I say going forward very optimistically and trying to make the most impact for society and most equity that's possible. Thank you so much, Dr. Newman. You are the Apollo Professor of Astronautics. And today, as you pointed out, we have the power of the computer that was on the Apollo mission in our pockets. Let's make sure that it works for everyone. And it was so exciting working with the MIT Media Lab and really bringing the tech innovation public home of hunger. Thank you for your collaboration. It's now my pleasure to introduce a very important and influential national leader on nutrition and other issues related to health, Senator Roy Blunt. He serves as the chairman of the Senate Republican Policy Committee and as the ranking member of the Senate Rules Committee. He is also the ranking member of the US Senate Appropriations Subcommittee on Labor, Health and Human Services and Education. Senator Blunt has been a leader for improving the health and nutrition of children in the United States. And last year, he introduced the Hunger-Free Summer for Kids Act that would add flexibility to USDA Summer Food Service Program, providing children free lunch and snacks during the summer months. So thank you so much for joining us today, Senator Blunt and adding your powerful voice to this discussion. Well, thank you, Dr. Blunt. It's great to be with you. Matter of fact, I was able to get in listen to the discussion a little bit earlier. So I heard what you were saying and Dr. Willis and Dr. Newman and certainly helpful to be thinking about that. Obviously, Dr. Willis' comments about long-term health challenges starting with habits that start early makes the WIC program and nutrition programs even more important than they would otherwise be. When you begin to develop the right kind of habits early, it makes a big difference. And WIC in its best does that. And the other thing I wanna talk about before we're done would be the whole concept, Dr. Newman's concept of data. We heard more about data, at least I did, the last two years and the shortcomings of data often and what we could have if we had better data. And as Dr. Newman mentioned, if we have almost in real-time data, you're not just talking about a historic impact of data or what happened in some later period of time. But you also have some immediate predictability that might allow adjustments in either programs or how you encourage things within those programs. We've all heard a lot, certainly every member of the House and Senate has heard a lot in the last two weeks about the baby formula shortage, which is a huge part of the WIC program. I think 50% of newborns and young children are in the WIC program. And prior to COVID, every state had the capacity to negotiate a specific company that they became the provider for baby formula in that state. We suspended that during COVID, it was suspended during the shortage. So that's not one of the problems for the shortage. But just a few days ago, the Congress last week suspended that permanently that baby formula of your choice, as long as there wasn't some WIC non-compliance issue, would be the baby formula that you could have. You know, I would like to say on the current shortage, like so many things in a complicated society, this is something looking backwards. It looks like it would have been pretty easy to predict and maybe even prevent. And I'm sure there'll be a lot of people wondering about why in October of last year when FDA was beginning to look at the potential problem. And between October and February, when one of the Abbott labs, a principal provider of a baby formula was closed, that there wouldn't be an anticipation that if something else didn't happen differently, there would be a big shortage by May, which is what happened. And probably some of the things we've done right now, if we'd have done them a little earlier, suspending some tariffs, being sure that at least from the nine FDA approved facilities in Europe, that we would be able to have formula coming back into this country from those facilities, just like we're doing now. Fly formula, I think is what they're calling that response. But looking a little further down the line, that's where data again becomes important. And certainly the 10-year effort now to get states on a electronic benefit card that lets you see what's happening in real time and wonder what kind of adjustments need to be made. The other thing I mentioned about WIC versus the SNAP program, the food benefit, the other food benefit program is that WIC is much more responsive to immediate cost increases. And obviously we're gonna see that right now. And your WIC card, unlike your SNAP card that just has a benefit amount on it, your WIC card is very much impacted, or at least the pain for what you get on WIC is very much impacted by price increases. And right now at the grocery store, they're significant price increases.  I believe that'll almost all be absorbed if I understand the program the right way by the government as opposed to people using the WIC card. But there are times when the government has to be really thinking about, okay, what's going on in this program? Is it properly funded for the circumstances we're in now? 10 or 11 years ago when I came to the Senate, I was the top Republican on the AG FDA committee. Herb Cole was the chairman. And there was a milk shortage. And we actually had to have a supplemental appropriations passed to provide more money to WIC because of that milk shortage. And it was big enough that the WIC funding wasn't gonna cover the current cost of milk and maybe other dairy products. And we had to do that. But looking at what you all are talking about today, I think really important to understand that most parents today are very technically capable and having that card available to them or the availability of even being able to order products that WIC pays for directly should make a big difference. And look forward to reading this report to looking at what we can do with more nutritional possibilities for WIC. I do remember another appropriating story, Susan Collins from Maine on the Appropriations Committee in fresh fruits and vegetables, potatoes were left off. And so Susan Collins being the loyal Maine senator, she has had a major and really causes to have a major discussion about the value of the potato. And I think she did that with a bag of potatoes sitting right there at the hearing table with her. And potatoes weren't involved at the time were not part of what counted for fresh fruits and vegetables, but have been since. And so there actually is merit to reaching out to your representatives and senators. If you think there are things in the WIC program that you can make an argument why they either should be there or shouldn't be there. And I'm looking forward as I said to seeing your report, seeing how far along we are with the transition and maybe just as importantly, seeing what other information we're gaining about the transition that tells us about what's happening with nutrition, what's happening with infants and children. Thank you so much, Senator Blunt for adding your important perspectives to our discussion and for underscoring the importance of data and technology, how they can be integrated into ensuring that this program maximizes its potential for a healthy start in life for children. I'm now delighted to introduce a leader who I greatly admire, Senator Debbie Stabenow, the first woman from Michigan elected to the United States Senate. Senator Stabenow serves as chairwoman of the powerful Senate Agriculture, Nutrition and Forestry Committee that authorizes WIC and other federal food assistance programs. She's also a senior member of the Senate Finance Committee Budget Committee and the Environment and Public Works Committee. Senator Stabenow has been a national leader and champion in promoting the importance of WIC and other federal nutrition assistance programs to reduce food insecurity and obesity in the United States and promote a healthier future for all Americans. Senator Stabenow. Hi and thank you to Harvard's T.H. Chan School of Public Health, the MIT Media Lab and New America for the chance to join you today for this important discussion. I have to tell you that I just left the floor of the United States Senate and I know you're not getting this message for another week but we just passed a really important bill to make sure WIC moms and babies are able to get the formula they need in the middle of this crisis. There's so much to do. I appreciate Secretary Vilsack moving as quickly as possible to create some flexibilities in terms of purchasing brands and sizes and other things that are necessary. This bill also makes clear that if you have a WIC contract as a company, then you're gonna have to put in place the plans for what you do if there is a recall, a shutdown, something happens in the future so we're better protecting moms and babies but I have to say that I think this has moved faster than I've ever seen as we put this together. We wrote it in two days when it became clear what was happening and jointly put it in the House and Senate bipartisan, passed it on Wednesday in the house and then the next day now Thursday we pass it in the Senate and it'll go to the president. This certainly isn't everything that needs to be done but it's really important that we do everything we can to protect our moms and babies on WIC and that's certainly my job as chair of the Agriculture Nutrition and Forestry Committee and so I'm really glad that we've been able to put in place something that's gonna ensure that our parents can feed their babies and equip USDA to better manage future formula disruptions. When we want to, we can move and I would love to see more of that happening in the United States Senate. You know, continued innovation like this is essential to make sure WIC can easily and effectively provide healthy nutritious food to the people it serves powered by the groundbreaking teams at Harvard and MIT and supported by New America. Your discussions today will bring valuable new ideas to the table to help us get there. As the pandemic and the recent baby formula shortage have shown us, we have to constantly reinvent how people can access the help they need through critical programs like WIC. In my work on the Agriculture Committee, I've fought for funding and resources for this kind of modernization as well as more funding for WIC food packages so moms can get more healthy fruits and vegetables for their kids. The $390 million in modernization funding in the American Rescue Plan will help WIC providers better serve participants through telehealth, WIC online and EWIC. Through the Consolidated Appropriations Act, I've helped establish a task force to study how we can move WIC benefits online. And the pandemic has demonstrated the value of additional outreach and streamlined enrollment. And we're not done. As we consider reauthorization of our child nutrition programs like WIC, we're looking to do even more to modernize how folks can get the help they need. You are the brightest minds and biggest innovators in this space. Your ideas will help us use the tools and technologies of today to serve people in need tomorrow and into the future. I'm so proud to be your partner in this work. I now wanna introduce to you Dr. Rajiv Shah who serves as the president of the Rockefeller Foundation an extraordinary charitable organization that has as its mission promoting the wellbeing of humanity around the world. The Rockefeller Foundation provided support for this wiring WIC initiative. And we're very appreciative to them for that leadership. Dr. Shah has had a number of important positions including serving as the administrator of USAID. And before that he was the undersecretary for research, education and economics as well as the chief scientist at the US Department of Agriculture. So he's been particularly impactful on critical issues of nutrition and health. Hello everyone.  I wanna thank Dr. Susan Blumenthal for inviting me to be part of this important event and for her important leadership. Last month, the Atlantic published an article on efforts to relieve what is called the time tax the administrative burdens families face when applying for public assistance. The piece opens by describing what a mother in Louisiana must have to complete a 26 page application for benefits from the Supplemental Nutrition Assistance Program or SNAP. That mother must provide paperwork or data in up to 13 categories including baptism certificates. She must detail income from 24 possible sources and she must document 14 different household related expenses. These are just a few of the required inputs. If that Louisiana mother doesn't complete every one of them and complete them correctly, her application may be rejected and her children may not have enough food to eat that month. When you hear stories like that one, it's easy to understand why billions of dollars of federal assistance are left on the table every year while too many families experience hunger or difficulty with their financial position. And that's why we must all work together to automate and digitize these processes and bring them into the 21st century, especially because COVID-19 exposed both how important access to the social safety net is and how tenuous that access can be. Federally funded aid was so effective that it actually lowered the poverty rate in 2020. But millions of people got help too late or not at all as government offices closed and websites failed under the weight of unprecedented demand. The Rockefeller Foundation has been proud to work with New America and other partners across the country to address these challenges. Before and during the pandemic, we've been supporting initiatives like this one working to expand access to the social safety net using data, technology and design. The goal is to replace rigid, impersonal and confusing processes. Instead, we wanna see active processes that reach out to offer assistance when it is needed, provide multiple ways for people to get help and respond to individual needs. Our grantees are already making progress in each of these areas. In 2020, they help more than 100,000 people across at least 36 states secure more than $200 million in benefits. Efforts like these are so important and so are events like this one. Because we know that by working together we can harness the power of science, data and technology to help people become healthier and more economically stable. We can expand and strengthen America's social safety net and we can finally make opportunity universal and sustainable for all. I look forward to continuing to work with all of you to do just that. Thank you for your important efforts. Thank you so much, Dr. Shaw. And again, thank you for your support of this initiative and for the work that the foundation is doing to really use technology and data to improve health in our country and around the world. Well, it's now my pleasure to introduce to you Stacey Dean. She is USDA's Deputy Undersecretary for Food, Nutrition and Consumer Services and we're so delighted that she could join us today. Stacey Dean works tirelessly to advance President Biden's agenda on increasing nutrition assistance for struggling families and individuals as well as tackling systemic racism and barriers to opportunity that have denied so many people the chance to get ahead. Prior to joining USDA, Stacey served as the Vice President for Food Assistance Policy at the Center on Budget and Policy Priorities where she made important contributions to strengthening federal food assistance programs including WIC. This afternoon, Stacey will share with us new developments in the use of technology in WIC as well as what is being done to address the infant formula shortage in the United States. And after her remarks, we're gonna open the floor to your questions. I really wanna acknowledge the incredibly deep challenge the WIC program and the whole country is facing right now with the infant formula recall and the associated supply shortfall. So if you'll indulge me, I'm gonna just spend a few minutes updating folks on that. It goes without saying that this is an incredibly stressful time, one that no parents should have to experience. And President Biden knows that families across the country are worried about finding enough infant formula to feed their babies. And that's why he has directed the administration to do everything possible in a whole of government approach to ensure that there is enough safe formula in the country for families that need it. USDA has been working over time to answer that call in partnership with other federal agencies and our state, local, private and nonprofit partners. The good news is that infant formula manufacturers produced more formula in April and then in the month preceding the recall. And I know it may not seem like that given the pictures of what you see on the shelves. So we have some work to do on distribution but the production side is definitely answering the call. And at USDA, we're extending broad flexibilities to quickly increase access for families. We're working hand in hand with states and local WIC agencies along the way, putting the health and safety of all Americans first and foremost. This makes it easier for WIC families to buy whatever product is available on the shelves. And many of you may have heard about that or seen some of yesterday. Secretary Vilsack was in the news when he met a DOD flight in Indianapolis carrying more than a 70,000 pounds worth of specialty formula. Yesterday's shipment, a collaboration across DOD, HHS and USDA will help provide relief from specialty infant formula supply shortages. And this will not be the last of this operation or our efforts to resolve the shortage. We're focusing our immediate attention on formulas that are currently the hardest to get. Specialty formulas like this expedited shipment of the amino acid-based alpha-mino formula, which are designed for infants with medical conditions to meet their special dietary needs. The administration is using every available tool to expedite the increase of supply. And in the long run, and I heard Senator Blunt talk about this and Senator Stabenow, we also must continue to take steps to short the resiliency of our food supply and ensure this never happens again. In WIC specifically, since the recall was announced in February, USDA has issued more than 200 regulatory waivers to give states maximum flexibility in their programs to respond to the recall. And we did more than a hundred of these within the first three days of the recall announcement. Thanks to the bipartisan action in Congress last week, which we heard Senator Stabenow talk about her vote on that bill. These waiver authorities are now permanent and we've gotten somewhat expanded authority, which will strengthen our ability to address disruptions. In the case of future recalls or emergencies, which of course we hope to never see again, and we'll need to take action on those fronts as well. And we're gonna continue to work with the private sector, including manufacturers, retailers and health providers, as well as our government partners to pull every lever to address this shortage and get infants and families the care and nutrition that they need and deserve. So while we're addressing, well, sorry, while addressing formula shortages is our top priority, it is without a doubt, singularly what we are focused on at FNS right now, this gathering here today is focused on improving work for the longer term. And so the recall has underscored the vital role that WIC serves as a nutritional lifeline to millions of moms, caregivers and children. And of course this builds upon the similar critical lessons learned throughout COVID that also some of your speakers have talked about. It's really one of the many reasons we're looking to strengthen WIC as a part of a wider effort to promote nutrition security, which we consider to be the consistent and equitable access to healthy, safe and affordable food. But WIC yields more dividends than just good nutrition. The program provides a healthy foundation to help kids unlock their full potential. And the evidence really speaks for itself that WIC participation correlates with fewer infant deaths and premature births, increased birth weights and even better academic results. The program has an amazing peer breastfeeding counselor program. And if it's not the largest in the country, it's certainly among the largest breastfeeding programs offered in the country and it's increased breastfeeding rates amongst participants. And on top of that WIC serves as one of the most powerful public health interventions to reduce stark racial disparities in maternal and child health outcomes. But I, and we heard this again from other speakers, so I'm sorry to be repeating, but the bear's repeating. I would wager that WIC is probably the best, most positive, powerful program we have that just simply not enough people know about, particularly eligible families and their healthcare providers. And the healthcare providers may know about but may not really know about in enough rich detail. So we have a lot of work to do to share that news and we absolutely want to make sure that you all can help us connect to eligible families. But before we seek to connect with eligible families, we've got to make sure they're experienced when they reach out to learn about WIC, when they reach out to enroll in WIC and when they seek to use their benefits in WIC, that that's a positive experience because that will of course be critical validation that reaching out for help of this program is well worth the effort. So at USDA, we're working to expand the impact of WIC on three fronts, increasing enrollment, keeping participants enrolled for as long as they are eligible and ensuring equitable access so that all eligible families reap its benefits. And across all of these goals, technology plays a crucial role and we see that from wiring WIC. WIC must serve participants in ways that work for families and that means we've got some serious adaptation to do. Recognizing family's needs in today's world, the administration has extended significant new funding for outreach, innovation and modernization as WIC in WIC. The majority of these funds will leverage technology to enable states to update their business practices and boost service delivery. And as a part of this investment, FNS and the US Digital Service are conducting research to pinpoint challenges that can be resolved through technical innovation. So let's go through an increasing enrollment. First, as I said, we want more eligible families to enroll in WIC. So to do so, we need to improve people's interaction with government services. For example, reducing the time it takes to enroll in or access services. To streamline these processes, we can provide simple, more convenient online forms available on a mobile phone. Or even better, we can use the federal data in programs we already have to eliminate the form altogether. And so the prior speaker spoke to the long snap form in Louisiana. That should certainly mean that no one in WIC should have to fill out an eligibility form if they've gone through that trouble already. And we also can do much more to ensure that we're data matching across WIC and Medicaid to identify people eligible for the program. In terms of retention, once we've got families enrolled, we want to keep them as participants for as long as they're eligible. And the research shows that WIC has the biggest impact on health outcomes if a child participates for the full five years. So that's really important to us. Unfortunately, retention remains challenging. Participation is relatively high amongst infants, but falls off considerably as children get older. So there's some friction there that we have to address. One pain point we hear is how transportation barriers and work hours make it difficult for participants to get into a WIC clinic in person. And as part of the pandemic response, WIC offices have experimented with using technology and virtual services to lessen these burdens. So we can move when we can move swiftly, as Senator Stavino said. And let me give you an example. Mary Center operates several WIC clinics in DC. They have an app for WIC participants that provides breastfeeding support and helps them learn about their WIC benefits and how to use them. So clients don't have to go into the office for those services. Additionally, many state WIC staff find that texting participants often generates better responses than phone calls. So we're gonna be providing grant opportunities for states to invest in more communications tools. I don't know if they're advanced, but they are a diverse set of communication tools, including platforms that allow WIC staff to text with participants right from their desks. Another pain point we hear from WIC participants surrounds the stigma of shopping in the store with the benefits. And over the last few years, technologies helped to address this issue as most states have transitioned from paper-based coupons or vouchers to debit cards or EBT cards. But we're also seeing a lot of positive reactions to WIC shopping apps that let participants scan barcodes to confirm whether a food is WIC eligible, right? To eliminate a friction and embarrassment or a stigma at the checkout line. And this individual can, this can actually really particularly help individuals with limited English proficiency, where they might be concerned about asking. We're also actively engaged in promoting pilots that allow vendors to offer online shopping, an innovation we know we need to make soon, very soon. Which will help promote equity by affording families in WIC the same conveniences as other American consumers. So, I don't know if you know this, Dr. Blumenthal, but I am a former advocate. And so I have a rule as an advocate that you never leave the room without making an ask. So I wanna check in with all of you. We have an ambitious plan within the administration for WIC, but I wanna make sure I leave you all with ideas for how you can help. As we constantly strive for improvement in WIC, we wanna absolutely deliberately emphasize equity and collaboration. And our efforts here are really no exception. Technology, ingenuity and modernization can help WIC reach families in a more equitable way. But we do need your help. Fundamental changes on the horizon and we're not gonna get there alone. Moms, babies and young children deserve the best, the most nutritious start. And so that we can help ensure great things await them in their futures. And technology is really a key component to realizing these goals. It's not an end of itself. We have to modernize WIC, but remember the goal is to serve people better. And I do believe the work that you all are doing is just deeply rooted in that goal, which is what do our customers want? What do you participants want? What will most meet their needs? Oh my goodness, I am truly having some trouble here today. So, and I do think your research, you all will be able to move faster, pivot perhaps than we will and your expertise is just so crucial to this goal. So we value your partnership. We want you to keep sharing your research, your ideas, your perspective. And also we wanna hear from you on how we're doing, right? You will be an important, your perspective in addition, fundamentally the WIC participants will be a key proof point. So mother, infants and young children across America are counting on us. So let's forward to head together. Appreciate being the opportunity to be here. And I understand you may wanna ask some questions, but I also don't know how you're doing on time. Well, thank you so much, Stacy, for sharing what USDA is doing to meet the moment and to work on modernizing WIC with technology to make this a hybrid program as we've talked about within person services as well. But everyone on this call, hundreds of people on this call wanna be your partners to ensure the success and the strength of this program in this new century. We are going to take some questions. Thank you for addressing the infant formula shortage as well. So let's open the floor, Angela. Do you have some questions for us? Yes, we have time for about two questions. The first is for Stacy. Can Stacy speak to immediate actions USDA has taken to address formula shortage and what areas of the country women use WIC benefits for this the most? Sure, so first off, I would say it is a whole of government approach. This isn't an issue that just affects WIC participants, right? So there's a shortage issues regardless of whether you're on WIC or not. So we're working with FDA, HHS, Department of Transportation, DOD. So there are a couple of things going on. One is trying to expedite formula from overseas that was already planned to come in. Let's say, and this happened this weekend, Gerber or Nestle has an overseas factory who's planned to come in. We used USDA Department of Defense carriers to get it here faster. And that was medical formula. HHS is working with Nestle and Federal Express to distribute that across the country to get it to babies with the particular medical needs because that's where we were seeing the most acute shortage. And then I guess I would say more, so the big top line answer is we are working to increase supply dramatically. That's the best first solution and then to target really high needs supply to those places that need it first. So let me just stop there and see if that's helpful. Yes, thank you. Next question we have, what are specific strategies on increasing awareness to WIC? And that's to both of you. Dr. Blumenthal, do you wanna go first? Sure, I mean, I think one of the things is to really use, as we talked about digital outreach campaigns from other federal assistance programs as well as using community organizations, community health clinics, parents organizations, children's organizations to raise awareness about WIC's impact and services. I think that's really important. Text messaging, I think as you mentioned, as Stacy has been found to be a very effective tool to alert people to WIC. And I think we need to explore other innovations that would work as well. Yeah, I totally agree with that, but let me underscore one or two aspects of it. So the idea of in reach, for example, identifying pregnant women, infants or toddlers, say in Medicaid and letting them know about WIC, I think is important. But I also think that setting performance metrics, expectations and then assessing how you're doing is important. So every governor can ask their department of health or human services, how many families who are WIC eligible, do we have on Medicaid? And how many of them are enrolled in WIC? I'd like a report on that every month. I think advocates and public health professionals can do the same. You can set the expectation of your local government that they're doing everything they can to support infants and toddlers with the critical nutrition benefits of WIC. My guess is that they may not have been asked about this before, right? I think these are incredibly powerful programs. They're widely understood to be beneficial, but they may just not appreciate that there's an incredibly large, there's a large share of eligible on Medicaid or SNAP who aren't enrolled in WIC. So that to me is very motivating and we need to set the expectation that there should be no gap there. And then you set the strategies around how to identify and find them. And of course we wanna make the product even better, right? We wanna make the experience better. We wanna make it more responsive to today's moms and what they need and what we learned during COVID. And of course, connecting to individuals through their community and people they trust. So I'm on board with all of this. Stacey, I wanted to ask you, the waivers really helped to accelerate some of the recommendations that we've pointed out. What are your expectations about making these waivers permanent and also online ordering? That's sort of the holy grail in terms of letting WIC parents shop like other people do. Any thoughts about that? Yeah, I think a lot of the waivers that, and I think what you're there, you're talking about are the COVID waivers that's where we eased up on some of the in-person requirements, for example. We're very interested in sorting out which of those we can keep and carry forward. And in some cases that will be, we have the ability to do that with these innovation funds and we're gonna need to talk to Congress about carrying that flexibility forward. But then also with respect to online shopping, we should end on that note. We 100% agree that that option needs to be available for WIC participants. We want all of the shopping benefits that any shopper has to be extended to our WIC families. So that's top of mind for us and you'll be hearing more on that up from us very soon. Great. Well, I wanna thank you so much, Stacey, for joining us, for sharing your perspectives. Our thanks also to Secretary Vilsack for his commitment. And just to let the audience know that in September, the White House will be convening the first conference on hunger, nutrition and health in 50 years. And we know that child nutrition will be an important piece of the discussions at that meeting. Thank you for your leadership and thank you for joining us today. Thank you so much. Well, we're now going to move to our panel discussion where we've brought together diverse experts to talk about the progress that's been made in terms of implementing some of the technology innovations we've been discussing, as well as future directions for this field. And to moderate our discussion, I'm very proud to introduce to you an incredibly innovative scientist. I think he's a Renaissance man, Dr. David Kahn, who is a synthetic biologist, a community organizer, a musician and a photographer who currently serves as the director of the MIT Media Labs Community Biotechnology Initiative. David is also a leader in the global community bio movement, which aims to democratize biotechnologies and enable diverse communities around the world to learn about and innovate with the life sciences. David is going to moderate our panel and discuss the progress and promise of technology innovations in WIC. David. Susan, thank you so, so much for the kind introduction. It's a tremendous honor to be here with you all. Again, my name is David Sun Kong. I direct the Community Biotechnology Initiative at the Media Lab at MIT. As we've been hearing already over the past hour plus, I personally am so impressed to learn so much about the power and impact of the WIC program. And obviously there's some really significant challenges, both in the awareness of the program, how do we increase enrollment? How do we increase retention? And so obviously technology and innovations are a really key factor in how we can address each of these different areas. And so we're really, really excited to be joined by a number of expert panelists and speakers who are each gonna share some opening remarks and then we'll go into a larger discussion together as a group. And so again, we'd really love to, before we start, thank Dr. Susan Blumenthal, Numerica, the MIT Media Lab and the Harvard Department of Nutrition at the Harvard TH Chan Public School of Health and also to the Rockefeller-Edna Foundation for all of their support. And so again, as we've been discussing throughout today, there was also a summit that was convened in 2017, the 50% summit. And so we'll hear a little bit from one of our panelists about that event as well. And so today we're incredibly honored to be joined by a number of wonderful experts. So we have with us, Ahildreth Englund who is a colleague of mine, a former colleague of mine at the MIT Media Lab. Ahildreth is a social designer working across scale sectors and industries to build more inclusive equitable systems by design. And she led the communication strategy and research on inclusive design at the MIT Media Lab. Ahildreth is going to share some thoughts about the co-design efforts that were involved in the 50% summit. We also have joining us, Rachel Coltramiro who serves as the director of the nutrition division of the Massachusetts Department of Health. And Rachel has tremendous expertise and insight in the WIC program in Massachusetts. So really excited, Rachel, to hear from you. Up next, we also have Jennifer Loyo who's the co-founder and principal consultant of Lime Tree Research which is a dynamic women and minority owned public health research and evaluation consulting firm based in Austin, Texas. She and her co-founder drew inspiration from their work on research projects for the Texas WIC program in her graduate school experience. So Jennifer, welcome. And we're so excited to hear you talk about WIC in this context of your work in Texas. Up next, we have Amanda Renteria who is the chief executive officer for Code for America. And again, Amanda has a real tremendous resume. She previously was the chief of operations at the California Department of Justice served as the national political director for Secretary Clinton during the 2016 presidential campaign. And was also the first Latina chief of staff in the history of the United States Senate. So Amanda, it's a true honor to have you here as well. We're very excited to hear about your reflections about WIC from your role as CEO of Code for America. And finally, we have joining us, Harry Zhang who's a professor of community environmental health at Old Dominion University. Harry received his PhD in economics in the University of Alabama in 2001 and most recently won the Gene W. Hirschfeld Faculty Excellence Award and also does specializes and does research in WIC and we'll speak about some of what's happened with the program so far and also its future directions. So to each of our panelists, we're so thrilled and honored to have you. Each of you has got a very short set of remarks to give first. So I'll introduce you individually to give your remarks and then we'll switch over into the discussion. So to kick things off, I'm Heldruth. I'm gonna turn it over to you for three minutes to talk about your experiences with the 50% conference. Thanks, David. It's great to see you. Thanks for having me here, Dr. B. I have to tell you that it was a little bit more than five years ago. I was sitting in my office and I got this text telling me to come to the director's office of the Media Lab immediately to join a phone call and I had no idea what the phone call was about. But after a few minutes, I was listening to this kind, passionate informed voice on the line advocating for a more modern WIC and I got really excited. And I got excited because I knew WIC really well first as a dietitian. I used to work for WIC as a dietitian and then I was an engagement specialist for Texas WIC. So I was developing mobile apps and websites and materials in classes for WIC moms and their families. And then I got a little starstruck because I got introduced to Dr. B. for the first time at Dr. Willett and as a community nutrition dietitian, I think of Dr. B. and Walt Willett as the Mick Jagger and the Debbie Harry of the public health nutrition world. So I stay excited because over the course of many months through 2016, 2017 and then into the future, I got to bring lots of disciplines together, my own and then also others at the Media Lab, human centered design and nutrition and technology for a program about which I've long been passionate and had lots of experience. And so it was through the extraordinary efforts of Dr. B. and Dr. Willett and IDEO and this whole team, we got to put together the 50% conference in 2017 and that conference was ahead of its time for so many reasons because we not only wrangled the faculty at the Media Lab and Media Lab students and Walmart and Amazon, Facebook, BPs and designers and nonprofit leaders, but also, and this is really important, we went to great lengths to make it possible but not only possible, probable that WIC families and WIC local staff and WIC state staff could participate meaningfully in that conference. And so this inclusive experience design was intentional and the co-design, participatory design aspect of it was also innovative. We knew we needed WIC families and staffs lived experience on this explore of the Media Lab in addition to the multi-sector, multi-disciplinary, multi-scaled event, this expertise that we were bringing into the room to talk about WIC's modern future. So that 2017 conference kickstarted a whole bunch of things, not least of which is the symposium. I got to build out a small research project focusing on bringing this inclusive spirit into the Media Lab. And today I'm really excited that this excitement, my own personal excitement, but the excitement for this project continues and that it's continuing in this inclusive forward-thinking way. This symposium is important for lots of reasons, but I'm so glad that it's bringing this progress and promise of the WIC program out to so many people, but also bringing so many people into it. So I think it's important to just acknowledge that. It was a super exciting time and it's living on and I'm so excited to be here. Hildreth, wonderful. Thank you so much for your remarks. And again, I think this notion of community engagement and how we can all work together collaboratively to both develop and implement solutions, I think it's probably a really core value that this community really appreciates very much. So thank you. And up next, I'd like to introduce again, Rachael Kulture-Miro, who again serves as the Director of the Nutrition Division of the Massachusetts Department of Health to share a little bit about her perspective on WIC in the state of Massachusetts. So Rachael, the floor is yours. Thank you, David. Thanks to Dr. Blumenthal and everyone for inviting me and including me in this event. It's very exciting. I know I have just a few minutes and I just wanted to share a little bit about what we're doing in technology, but I know it's not just Massachusetts. States across the country have been working on technology advancement and innovation for years in partnership with USDA and the National WIC Association. But I can share what we're doing here locally and then provide you some resources at the end to learn more through the National WIC Association about what other states might be doing and recommendations for the future. Next. So just a little bit about Massachusetts. We're serving quite a few folks and in the 2021 nearly 183,000 unique individuals accessed WIC in Massachusetts. And we're serving about 42% of all the babies in this state. We do utilize online EBT and we have since 2014 and we have almost 850 retailers that can transact WIC benefits. Next. So we have a lot of technology and we use it all the time and the pandemic has definitely provided impetus to use it even more in different ways. We have a web-based information system that we can access from the clinic and from home for staff that are working remotely. We do have online staff access to Medicaid eligibility and immunization registry portals which allow us to determine eligibility remotely and also to ensure that we are providing good immunization, education and referral information. We have online EBT, we utilize the WIC Shopper app including a real-time benefit balance feature that is super helpful for families and we also communicate through it widely all the time and it also houses lots of nutrition education information and referral information. We use an online nutrition education system called WICSmart. We use teletask to implement statewide texting and local program texting and one-on-one participant staff communication all the time. It also reminds folks of reminders about appointments and we use an online pre-application which collects information from folks and brings it right into EOS which is our management information system for easy application processes. Next. We do do lots of digital marketing campaigns through Facebook, geofencing and other media placements and we drive all of that traffic right to our online pre-application so folks can apply really easily and get in contact with the local program that serves their zip code. And we do have extensive data sharing agreements both with Medicaid, we call it Mass Health in Massachusetts and SNAP to identify folks who are likely eligible but not participating and we reach out to them after matching them against our database text messages that provide information about the benefits of WIC and link them right to our online pre-application. Next. This is an example of when we do our quarterly data matching campaigns both for SNAP and Mass Health and every peak that you see in our online applications is directly related to a text messaging campaign that began that week. Next. We added some more technology strategies during the pandemic that I wanted to highlight briefly. We greatly increased utilization of our WIC shop or app for participant communication, nutrition education and WIC program information including required forms and releases that were available to participants through the app. We enhanced utilization of tele-task friendly reports to be able to identify specific families that we needed to reach out to and be able to communicate with them easily through text. We obviously increased our remote service delivery and tele-health options. We authorized self-checkout lanes at a variety of our retailers. They participated in the hand approach to go curbside pickup online ordering platform and we enhanced our interpreter services options to allow for scheduling of different and hard to find interpreter services and for video appointment tele-health interpreter services as well. Next. We learned a lot of lessons during the pandemic but we have seen that the ease of access has led to significant improvements in child retention. We are continuing to focus on supporting families with the WIC shopping process. We've noticed that we need with our remote service delivery more options for third party interpretation services. We need more solutions for video tele-health services that are easily embraced by staff and participants and we do need more solutions for enhanced data sharing and a collaboration with healthcare providers to allow for timely nutrition assessment and require data collection for follow-up in WIC. Next. Just want to tell you where we're going next. We are one of the three awardees in partnership with Washington State for the WIC online ordering project that is funded by USDA and managed through the Gresham Swanson Center for Nutrition in collaboration with Washington Walmart and CDPFIS, CBT processors. We are working on some digital documents storage upload capacity through our WIC Shopper app and through scanning at the WIC office to allow for electronic maintenance that require documents for eligibility. We are in thinking about how to enhance our MIS system to directly link to our mass health eligibility portal to the Massachusetts Immunization Registry and to our WICS more online education system and we are planning to work with our partners at the Massachusetts Department of Agriculture to explore these solutions for a WIC Farmers Market Nutrition Program. Next. And just to follow up for more information, I strongly recommend visiting the National WIC Association's WIC Association's webpage and the hub, thewikhub.org which allows you to see what other states are doing and to learn about recommendations of the association and for more information about the online ordering project the Gresham Swanson Center for Nutrition page is there as well as our WIC page from Massachusetts WIC. Thank you so much for the opportunity. Rachel, that was like a perfectly timed five minutes that was amazing. Thank you for keeping us on time and up next to bring us some perspectives from the state of Texas, really, really pleased to be joined by Jennifer Loya. So Jennifer, I'll turn it over to you. Thank you. And first of all, I wanna thank y'all for inviting me to participate in this panel. I'm very honored to be here. And I wanna talk a little bit about not only the technology use that is happening in Texas, but I've also had the opportunity to work with other programs across the nation. And I did reach out to them to find out what they were doing and what were their immediate needs. And I wanna talk about those as well. Next slide, please. So first of all, I wanted to start off by saying that WIC helps address equity by providing nutritious foods to low-income families, by providing nutrition-related illness and enhancing health outcomes. And that is super, super important. WIC is also culturally, ethnically and racially diverse and serves participants for the wide range of traditional food preferences. And they actually changed their food packages back in about 10 years ago now to allow for more foods and to address these culturally and ethnically and racially diverse foods that people were eating. Also the programs are incorporating many of the mainstream technologies that we use every day to increase and maintain program participation as we saw with what Massachusetts is doing. Next slide, please. Okay, current technology use includes like the telehealth, telewik, texting participants, not only program information, but also advice. And they've also have found unique ways to use texting to increase participation for participants ages 18 months or while actually they enroll them at 12 months. And we have a project here in Texas that's doing that that's enrolling participants from 12 months to 36 months. This project right now is in a pilot and we're noticing that we are having a very little drop off and participants are really enjoying that. We also have interfaces with other programs such as Medicaid and SNAP that is used to meet the eligibility requirements such as Massachusetts was talking about. They are also, some programs are also are now having or being able to do some document uploads through the tele task. They text participants the documents that they need and the participant could text back the document. The only problem with tele tasks though is that the staff person has to go in the backend to pull out that document and then connect it to the MIS. They also have, we have two types of, we have online and offline states that were the benefits for the EBT cards. This means that in an offline state, the benefit is stored on the card, that information is stored on the card whereas in the online states, it's stored in the network system. So the online states have the capacity to issue WIC benefits remotely, which was very useful during the pandemic with the use of the physical presence waiver. They were one of our programs that I talked to, told me that they were able to even to do batch, batches of, to deliver those benefits, which was very useful. The other programs are starting to use live online nutrition education sessions. Texas has some live online classes. And then they also have a WIC shopping app for locating the correct foods at the store and checking WIC benefits online and through the app before they would have to ask at the store and that was kind of cumbersome. Next slide, please. Also now Texas is part of a state that is testing another app and they're starting to design, test and implement more sophisticated apps that allow participants to enroll online. They can upload documents directly on this app. They can answer their health history questionnaires. They can make an appointment, cancel it and reschedule it. And right now they're trying and testing new features that are being developed and tested right now as we speak. One of those, which is fairly important for the formula would be to be able to do a formula exchange right through the app. This is just currently now, like I said, it's just in a testing phase. They're also testing online remote, there are some programs as Massachusetts mentioned that are testing online remote shopping using EWIC. And then we also have social media presence including Facebook, Instagram and YouTube. They're also using the new technology that these apps have such as real life sessions. There's a wonderful sessions called Coffee with a Dietitian that where they can ask dietitians different questions that they have regarding feeding their children. And there are also these program managers are doing food and cooking demos for their clients. And Texas has some innovation centers where these programs are actually testing these technologies and innovations. Next slide, please. Now what technology needs would these programs want? They're speaking about this online shopping use using the WIC-EBT card. They also want an integrated medical record or WIC record that is like the standard EMR such as Epic that would allow for file exchange directly from the healthcare provider. Some programs already have the interfaces with other programs such as Medicaid and SNAP used to meet eligibility requirements but not all of them, especially the tribal organizations. They're not really part of the state. So this requires some extra steps in order to get that to happen. Programs are also having to use multiple technologies such as DocuSign, TeleTask, WICSmart, online pre-application systems to get the job done. They would like to have a way to integrate those technologies with their MIS and just have one. Next slide, please. They would also like secure ways to upload documents, chat and telehealth visits. Use technology to obtain healthcare provider authorizations for different formulas and even provide general issuance of a formula. So for example, if I have a premature baby that I don't have to have the exact brand of a premature formula such as like NeaShore, I could have both NeaShore and EMPHA care which is one is a simulac brand and the other is the EMPHA mill brand or maybe just a general issuance of just a premature formula. So we don't have to go back to the healthcare provider to obtain that authorization. And they would also like to support supporting the continued development of these apps to facilitate enrollment and program logistics for current participants, including the possibility of lying for the document upload, the formula exchange that I talked about and the chat between the participant and the EWIC staff. This last piece I heard from testing of the Texas WIC app where participants would love to be able to chat when they have an issue with one of the WIC staff members. Next slide, please. Jennifer, I'm so sorry, but if you don't mind, I'm just wrapping up your remarks shortly. Thank you so much. Yes, really quick. I just wanna really quickly talk about this formula recall and supply change uses programs that were allowing participants to purchase alternative brand formulas, which was really helpful. They changed the UPC codes on the back end. Online states were able to do it at the store whereas the offline states, the participants had to come in the clinic. One of the things that one of the states was doing was using Tableau to find where the recently purchased formulas were so that they could use this information to find where the formulas were being processed. Next slide, please. Purchase, sorry. And what could have helped in this instance would have been a national formula inventory where renders could share basically what formulas they had. We could relay this information to participants so they could be more successful in finding formula for their infants and then having an easier and more efficient way to get the health provider organization for the infant, especially for those that are impacted by the recall and supply chain. And then finally changing the issuance like I already talked about. And I know now that they do drop ship some of the formulas, especially the specialized products, but I think it would be great if we could start drop shipping any formula to participants. And that is all. Thank you very much. Jennifer, thank you so much for sharing your perspective. And again, we'll come back and talk about the formula shortage. And I think both your and Rachel's specific insights from your respective states, I think has been really valuable. So thank you for sharing. And up next, it's a real honor and pleasure to introduce Amanda Renteria, who is the CEO for Code for America. So Amanda, the floor is yours. Thank you. And Yemeni Los Atolos, welcome everyone. It is wonderful to be here with you. From a personal level, I grew up in one of the lowest income congressional districts in the country. And the meaning of this kind of work is real for communities all across America. And so from a personal level, thank you very much. From a perspective of policy and politics and where we are in this country, I also wanna thank you because so much of the work that when I was on the hill for nine years fighting for policies or when I was in politics trying to win hearts and minds, this is the kind of work that makes a real difference. And now I Code for America, I get a chance to actually work on the systems themselves. And to give you a sense of the perspective that Code for America brings, we have been in this work for 11 years. Most notably, we were actually at the first WIC conference and has really given us a foundation for how we think about human-centered government all across the country and all kinds of different programs. Our most notable work that's really adjacent to this is we were the first mobile app in Spanish and English for the child tax credit. We launched with the White House and the Treasury and we were able to bring a lot of these ideas and things that discussed here on this call to the forefront in order to reach people who had never been reached before by the tax system or frankly from any benefits programs. But that has been our most recent work. Our work that we've been in for 11 years is really around the safety net. Everything from food assistance to WIC to integrated benefits. Our most recent integrated benefits project was in Minnesota where we not only cut down the time from I think it was like 48 hours or something like that when you go through it to 12 minutes where you can apply for nine different safety net benefits and for the first time ever, Minnesota was able to coordinate with all its sovereign tribal nations in order to have a seamless smooth process. And so the work we're most excited about and this really leads me to why this kind of conversation is so important is we really are at that window now where we can start to have real systems change not just in a crisis, but really foundationally. And so we were excited just two weeks ago to launch an announcement of $100 million to transform the safety net across the country. And the idea around that is really focused on how do we make sure SNAP, WIC, integrated benefits are able to really work for the kind of communities we have today, thinking humans and our design at the beginning, being able to reach folks where they are when they are in the languages they speak and really make a difference so that we are ready for a more uncertain world as we think about what we're going into in the future. And I think not only the pandemic was a window into that but also the infant, the formula crisis that we're handling now, more and more if we can build those resilient systems that not just matters for our country and our resiliency but for those communities who have felt far too long that they've been left out, finally there are ways that technology can help to finally connect them at a time when they are in crisis but also at a time where our country really needs everyone to be able to manage through these uncertain times. So again, I just wanna end with saying thank you for having us on this call. We really appreciate the partnership we have with Stacey Deans, Chairwoman Stabenow, my former boss, Secretary Vilsack. This is the kind of work that gets us up every day at Code for America and we can't tell you how excited we are to actually be a part of these kinds of discussions to move things forward. Amanda, that was amazing. Thank you so, so much. And again, we're really looking forward to hearing more about your thoughts regarding systems change, infrastructure, both social and technological and also some of your thoughts on co-design and community engagement. So thank you so much. And up next again, to close out our presentation round we're so thrilled to have joining us, Harry Zhang who's the Professor of Community Environmental Health at Old Dominion University. And Harry, I think we want to thank you in particular for your special and dedicated leadership to the WIC team. I know you've been a really critical member of the team pulling all of this together. So thank you so much for your leadership and I'll turn it over to you for 10 minutes of remarks. Thank you so much. It's a great honor to be invited to share some of my thoughts about why we want to develop a human-centered technology for WIC. Next slide. Okay, so I just wanna give you the limit of time I wanna share like two stories. The first one called bounded rationality. The second one causing the chasm. If you're not familiar with the term, totally fine. That's a purpose why we wanna come here and learn from each other. But next, okay, so the bounded rationality it's a kind of scientific concept say individuals has a limited rationality because we are not God. We cannot make optimal decision every minute anywhere. Okay, this is something we have to live with next but why this is related to WIC technology? Well, one quick key question. For example, we talk about like the WIC app like right, you talk about the WIC Shopper app but can the WIC Shopper really improve the food benefit redemption rates? So we look at, we're using the West Virginia WIC EBD data in 2019 and we look at the 18 food benefits across the basket and we just calculate the absolute difference in the redemption rate between app users and non-app users. Because even it's the best technology some people will never use it. So like in our group, we have like around like a two thirds using the WIC Shopper app but the one third not using the WIC Shopper app. So we just look at the absolute difference between their redemption rates but also kind of we can calculate the relative difference. See, compared to the non-app users what the redemption rates can be improved or change for the app users. Next slide. Wow, I mean, we have like 18 benefits, okay? And not surprisingly, and although these benefits are free some benefits are very popular, like infant formula but some benefits are not, for example infant meat. I still remember when I was a young daddy 20 years ago I personally tasted the infant meats. So frankly it's not a good experience, okay? So and then you can see the redemption rates are different. So we just rank the redemption rates on average from the lowest like infant meat to the highest infant formula, okay? And the too easier like to make it easier for you to recognize these benefits we just divide this 18 benefiting to three groups. The bottom six I marked at a red is like a low redemption rate. The middle group six benefits we call it like a medium redemption rate and then the highest redemption rate group highlighted with green parts. So this is a very, very arbitrary simple like a kind of a grouping. Next. So then we just look at the absolute difference in redemption rates, okay? And the good news is the absolute difference in redemption rates are all positive. What does that mean? That means on average the app users redemption rates are higher than the redemption rates of non-app users, right? So this is a good news. But for each benefit they're different, okay?  And for the fish, the absolute difference is like a 14.3 percentage point which means, you know, have a larger like an increase. But if you look at the color, okay? You know, forget about the numbers. Just look at the color. Oh, we don't see like a clear pattern. It's like a more like a shuffle, right? Now the magic moment comes. Go to next. So look at the relative difference, okay? If you look at the bars, it's amazingly, you know all the red bars goes to the right which means, you know, what the low redemption rates actually have a higher, you know kind of relative increase regards redemption rates, okay? But what did that mean? You know, we see, we see some pattern but what did that mean? Let's go to the next slide, okay? So we know participants make decisions with bound to the rationality. What did that mean? Okay, so I just, I know there are so many sorry people in the audience and some of you are like a geniuses, okay? And I just have a quick quiz for you. How many people can recall the 18 benefits? I just showed in the previous three slides. And how many people can remember the redemption rates? So the numbers are associated with these benefits. So raise your hand, okay? But think about the work participants, okay? They have an infant to feed. They have a child to take care of. They may have two part-time jobs to do and they have like a pandemic to fight with but now we require them, hey, you know what? This is an EBD card, okay? Your benefits is on the card. You cannot see the balance. You cannot see the transaction record.  That's what we require them to do. So they can do what? Acceptable but not optimal. Oh, you know what? Aim for the formula. This is a benefit I really want to get. I will make sure to redeem it. Aim for the means, yeah, if I remember I will redeem it but if I forgot, that's totally fine. So that's called acceptable but not optimal. How are we going to nudge with technology? So with the Wixop app, if you check the balance, it's oh, you know what? I have the balance to check.  There's another benefit called the infant of meat. Why not just redeem at once? So this technology, the cool product about the technology in that is what? Reduce the cognitive load for the participants. So they can easily remember, easily, oh, you know what? And there's a benefit called infant meat just redeem it. So this is the first story, tell us. Go next. Next called the crossing the chasm. What did that mean? Okay, go back, go to next slide. Okay, Wix Online Ordering is mentioned several times. All right, and we look at a pilot program in Oklahoma Wix Online Stores called the Primetime Nutrition. And this is kind of like a pilot program. It's called online ordering but like in-store pickup. So participants can order Wix Foods on the store app and pick them up in store with the EBD card. So this is not a totally like online ordering, you know, kind of, it's like a pilot version. Go next. So this is the trends in new Wix Online Ordering. So they implemented the Wix Online Ordering in July, 2020. And then we look at the first six months of the new Wix Online Ordering, okay, the new customers. And originally we thought is what everybody remember the chaotic time, you know, the end of the 2020, the COVID-19 numbers, skyrocketing, you know, supposedly we should be scared of the going out. We should using more of the Wix Online Ordering, right? No. The number to show the new online ordering is steadily worth going down. Why? It's against our expectation. We're so passionate about the technology innovation, but we look at the data, only 5.4% of the customers in the stores actually adopt or try Wix Online Ordering. So this is very against our intuition. We did like a thorough interview, we're ordering of, oh, let's just blame the store staff. We did interview with the staff, did interview with the management team, the technology director, they did a wonderful job. They did all the job they can to promote, to make the system working. But why only 5% were customers using the Wix Online Ordering? Okay, goes next slide. So we dig into the literature and we find that there's an interesting theory called the crossing the chasm. So this is a marketing theory just say, hey, you know what, for all the technology innovation, we face different consumers. There's some people like in the consumer, we call the techies or visionaries, like a folks from MIT. They may just using whatever the technology come up, they say, oh, you know, let's try it. But the majority of the market in the consumer basis were, they're conservative, they are skeptics, they will using the technology innovation until most people say, oh, you know, it's great, let's try it out. If you don't believe it, look at your phone. How many apps you downloaded, tried a few times and then you never use the key. Just stay quiet on the phone. So this is like a theory called the crossing the chasm regarding the technology innovation. Next. So this is a complicated model. So we developed for the Wix Online Ordering, okay? And then we did the interview with the participants, we look at the data using the, you know, kind of the statistical analysis to ensure we understand the problem. Okay, originally, if we have the technology, it easily transit to the, like a major market, everybody will accept it, but no. Okay, there are so many factors in the system that can potentially prevent that diffusion, okay? The lack of awareness, okay? Lack of interpersonal communication, lack of the resource supported from the different agencies, all these things create a big chasm. So our goal is our, not only develop the technology innovation, is to crossing the chasm together. Next. So this is what we call the human center, the Wix. Okay, we are looking to the future. Whenever we build a developer technology, we really need to put the participant, put the people in the center. Okay, because the technology is there, but how are we gonna develop a technology adopted by these people, by the participants serve them? This is a significant question for researchers, for the agency, for all the stakeholders. It's not easy, okay? When we design it, when we evaluate, we have to definitely make sure we keep the mindset is not the technology is the center, but the people is the center. And when we develop this kind of, like a technology in Wix, especially we have to understand, they may have a very different life experience, maybe different like a bandwidth, like us. Now we can sit comfortably in a conference room and talk something very high tech, but they are living maybe in low income neighborhood, facing the street crimes, have to risk their lives to do multiple jobs, okay? But this is a very, very important mindset we have to adopt when we develop a design or evaluate this kind of technology innovations in Wix. Next, okay, easy said then done, right? And I still remember like 10 years, I was at the base camp of Mount Everest, okay? I never ever thought to think I am gonna reach that level, but I know how far even you kind of stay at the base camp. It's 17,000 feet, it's pretty kind of a crazy level. But after like a few years working with, I realized I encountered more like a failure than success. And I realized this is a tough job. This is not something one person or one team can do it together. I really appreciate I have the opportunity to work with so many one-for-people from multiple state agency, from like a active out of JPMA, from the store owners, primetime nutrition, my team at the ODU, and also my funding agencies from Duke. The HGR program is wonderful to support this innovative, sometimes we call high risk like a project, okay? But today I feel very excited because I heard so many stakeholders are willing to stand up and form a united front line to conquer the technology innovation in WIC, you know? It's not easy to do, but sometimes say, because it's hard, because it's challenging, we wanna come together to make a better WIC program with modernized technology for women, infants and children because they are the future of our nation. Thank you. Wonderful, Harry. Thank you so, so much for your remarks and for all of your comments and your presentations. I have the unfortunate role of trying to fit as many questions as we can in probably in the 15 minutes. So I hope it's all ready for everybody. We go about 10 minutes after the hour. And again, I apologize. We'll have to keep your questions, your responses brief if you can. But again, I'm really looking forward to this discussion. So I'd like to start first with Rachel and Jennifer. Again, thank you both for sharing your perspectives from Massachusetts and Texas. One big theme we've heard all day throughout the day has been around data, right? And I think, you know, one question that I have for both of you is in both of your presentations, you shared a lot of different types of interventions that you're working on in both of your states. Could you talk a little bit about how data plays a role and are you able to kind of, you know, pick one key intervention that you feel like has the data shown to be particularly successful in your states? That's the first question. And then secondly, you know, if you sort of had a magic wick wand and could create, you know, a technology that you think would be really, really impactful of what you think that might be. So Rachel, I'll start with you and then we'll go to Jennifer. Goodness. We use data all the time, especially in the EBT space that having our data available to us through our CVP processor is just amazing. It's been super helpful during this formula shortage and it was helpful in evaluating our cash value benefit increase. We used data initially when we talked about our data exchanges with Mass Health to see if text messaging would improve folks' online application process. And it did and that's why we went forward with it and also continued on to have that partnership with SNAP. So data is super important. We have an epidemiologist assigned to us and we use it all the time. We have a needs assessment where we match against births and look to see who's accessing WIC and who doesn't and what are the characteristics of populations that aren't signing up. But if I had a WIC magic wand, oh man, I don't know. We're really excited about the online shopping experience but it is a challenging process. The WIC transaction is not simple and I think that that's hard to grasp if you're not familiar with the program. And so I think making it through that, demonstrating how we can make that work in different types of retailers across this project with Gretchen Swanson will be super exciting and open up a lot of opportunity for families. So I think that's my magic wand. Thank you, Rachel. Wonderful. Jennifer, back to you. Yes. So we do a lot of mixed methods of qualitative and quantitative research for Texas WIC specifically and we've done it also for other programs. And I think that that work helps really to with the implementation of projects. So they're doing like, that's part of our work with innovation centers is going out and speaking to participants and seeing how those innovations are being perceived and accepted. Same thing goes with the Texas WIC, the app they're developing with other states. So I think that we talk about more about that lived experience and how participants are being able to interact with that technology. And then for the magic wand, I guess I have to agree with Rachel. I think the online shopping is probably one of the priorities for the participants and the program. So... That's great. And one other follow-up. Amanda, I'm gonna hop to you in a second but I'm one other follow-up for both of you. One thing that struck me throughout the day but also in both of your remarks as well, it just feels like there's so much that the states could be doing to learn from each other and not be reinventing the wheel. And so I'm wondering if you both could comment a little bit about, you know, either prospects for collaboration or ways that we can better share these insights across all of these different programs that are being developed. I'm happy to start like from my perspective. So we have lots of opportunities to do that. We all work within our regions very collaboratively, all the more so since the pandemic. And so we share innovation all the time. We work with various states to have the same contractors, processors, WIC app vendors, and we work together to like share best practices. And then the National WIC Association brings together a lot of folks to work together through conferences or special task forces. And so there is a lot of opportunity. I feel like we all are constantly learning from each other and not necessarily recreating the wheel. That's great. Jennifer, do you have anything quick you wanna add to that? I just have to agree with Rachel. I think what she said was perfect. Okay, great. And Amanda, I know you wanted to chime in on this thread as well. I've got a separate question for you too, but why don't you go ahead first of thought to pick you up on this thread? Yeah, just two things. The cohort modeling is exactly right. We were involved with the pandemic EBT with about 10 different states. And the conversation that happened around the table was absolutely critical. Everything from just how data worked across things to even understanding the legality of what was legal and what wasn't legal was incredibly useful. And then when we actually did the after debrief the biggest chance for flexibility were those states that had data interactions already and data cleanliness already. And so that was our number one barrier when we started to work with 10 states across the country to go clean this up first and then let's identify the legalities of this and then let's build best practices. And so it's absolutely critical for states as we think through this going forward. Fabulous. And Amanda, I wanted to just follow up again on some of your remarks. You made a pretty, I thought a really statement that woke me up a lot thinking about systems. I was wondering if you could expand a little bit about what you meant by kind of systems change and infrastructure. Like is there a particular type of system that you're talking about? And then what are the ways that you might try to address those changes within that system? Yeah. A lot of our conversation that we have with Code for America is we can see this gap whether it's WIC or it's SNAP or it's automatic record clearance or else on that work or tax benefits. And we basically say, all right, what right now let's take just what exists now not changing the policy, not changing anything about it. And how do we actually bring down a barrier? And there are kind of three things that we've started to surface. Number one is actually just trust. How does a system actually grab you? Is it asking, are you a criminal when you walk into the room and some of our benefits actually in fact do that?  The second is what kind of language are you using? So it's not just about being welcoming but then you get to the next step, which is are you simple? And are you using the kind of language that your end users understand that the people you're really trying to reach understand? That's a second piece that pretty much every system can benefit on and it will evolve over time. And then the third is meeting folks where they are. So it is absolutely true when we talk about mobile first it matters not just that you're taking a paper form to a website to make that easier but actually starting mobile first makes a real difference particularly for the folks that we are trying to reach. And then lastly is as we make these changes how do we make sure that these systems changes are also impacting the way public servants themselves are able to better and more smoothly reach the clients they serve because remember on the backend when it comes in, you have public servants who some of these cases are piling up, right? And if we can make it a little bit smoother where now we can understand the barriers or why things get stuck where you need a human or a public servant to actually reach it out and work it out if we can actually reduce that pile we're all better for it. And so that's sort of the methodical way we talk through or think through program by program. That's really, really inspiring. Thank you so much, Amanda. Harry, I wanna go with you I return to you for two questions. The first question again going back on the steam on data I really appreciated in your presentation the various ways in which you sorted the different data and how that really revealed what was effective and not effective for the various programs you're working on. I was wondering if you could comment a little bit about data innovations. And earlier Senator Blunt was talking as well about this idea of real-time data and could that actually influence policy more quickly? I was wondering if you had any quick reflections about that, Dr. Zhang. Yeah, I think though one thing we need to remember the WEK is kind of regulated the program, right? Everybody wants the data sharing but still I'm learning I deal with like a multiple state agency and they get kind of help them with the data. But one thing I learned that we definitely need to how to know dancing with the shackles on. Okay, so you want the data but you may get the data very differently across different states. Some people will give a group or some will give individual transactions. So this is a data accessibility. The second one is, I don't think it's a data issue. I think it's a talents issue. So the data is sitting there but whether we can have talents to interpret data, these kind of data scientists that are the real person who can interpret a good story that's a totally different dimension. So I think like Senator Blunt comments when the FDA shut down these facilities if you have the data you should have a very simple projection you will predict there's a shortage of crisis coming, right? But there's no like alarming signals from these agencies. So I think that the data is important. The data is wonderful but we require tremendous like many talents researchers stakeholders work together to let the data to tell a good story. So that's my comment. Wonderful. And just to follow up again and we only got about five, six minutes left. I want to spend a little time on this theme of human-centered design and community engagement which has come up a number of times. And again, I really appreciate the comment as earlier as well about trust which is I think is also very much connected to this notion of human design and a community engagement. Harry, I'll start with you first.  Can you share a little bit more about sort of innovations that we can create in human-centered design and how we can better apply those frameworks for WIC. I think, you know, well, not for WIC per se but the industry is a very, very smart. For example, we are doing like a a systematic review on the online marketing strategies. In the marketing industry they have already built a very, very smart technology to predict your shopping behaviors. The famous case is the target, the sand, what? The formula to a teenager girl even their parents don't know that the teenager is pregnant, right? This is kind of the human-centered technology. We have to be very careful, what does that mean? But we have the technology, we have the algorithm but we need to be very careful to using the right technology for the right people. So this is kind of say even we talk about the human-centered but we have to using the right framework for the human-centered, we want to serve them. We want to make them better but we don't want to take advantage of this human being. So this is so crucial in the design. And so Heldreth, I'll turn it over to you to share a little bit more as well. I know you played obviously a critical role in the human and community-centered design aspects of the 50% conference. I was wondering if you could share a little bit more about how you believe that this type of a framework could be used going forward in the future. I think it's interesting because human-centered design leaves out some of the humanness of being inclusive and being participatory in events like the 50% conference or in any development or design process where you're asking people to come to the table and help you think through how a technology can serve them. For example, putting people at the center of the design process is human-centered. But I think what was interesting at the 50% conference was that there were many solutions that came out of that conversation or those discussions that didn't involve technology at all. And that's what I mean by referring to the humanness of the technology. And Amanda spoke to this earlier. It's as simple as, is your language simple enough? Are you translating what's happening? If it's mobile first, are you making sure that your visually impaired clients are able to access the same information? This is where I think focusing more on the humane aspect of what technology does for all humans which is connect us to each other. Storytelling has come up. I think that's an area where WIC can also really thrive. The storytelling is what this emotional impact that design can bring to technology is a really important key player, key factor. So I'd be curious to see how to think through the technology design process and the products, putting people not only center but making sure that you're including people at the very beginning of any discussion about what a technology is doing for them. Perfect, thank you. And Amanda, I don't know if there's anything you wanted to add on this thread as well because I know I can tell you got a lot to say. On this thread, please go ahead. Yeah, I mean, so part of what is really exciting about really thinking about this as building trust is we have all kinds of fantastic community-based organizations who are out there, right? And we learned this in real time during the pandemic where we didn't have time to build long-term trust. So we had to find where are the people that are already trusted? Where are the community groups? Can we build toolkits so that Code for America isn't necessarily bringing people through the process but we're already using community-based organizations to try and help them through. And I think as a long-term strategy for reaching people where they are, that is bringing the community along on an ongoing basis. So I was really excited to say that because we keep learning this lesson which is there are some fantastic people and that's all about lived experience and what we're hearing from Hildreth about bringing them in, not just at a moment of research but ongoing over time too. That's great. And again, I imagine there's also some really wonderful technical solutions that can help with fostering that community engagement and trust as well. We're almost out of time. I've got one question actually from Dr. Blumenthal that I'll ask to close it out but I wanted to take that. This is a very rare opportunity for all of us to be here. Do any of you have any questions for each other that you wanna ask before we ask one final question from Susan? Put you all a little bit on the spot there. If you think of it, let me know. We've got about two minutes left. I'm gonna ask- One that we could answer in two minutes. Yeah, okay. Well, I'm gonna ask a closing question from Susan. So she asks, what can be done for the states that don't have the resources or tech proficiency? It's a patchwork system. There may be convenings going on but what is needed for the implementation process? Should the USD play a greater role? So I'll open that up if anybody wants to raise their hands and offer some remarks to this one. Susan always asks the tough questions. Rachel, yeah, go for it. I think the USDA does play a role and when funds are awarded for tech projects, USDA plays a very strong role in implementation and that was certainly evident in EBT. So it's true in our project for online ordering. I think there's some thinking about how to do this more with the funding that was mentioned, the 390 fund. And so I think that there is a process for USDA to support but also we do need more flexibilities. We need updated child nutrition authorization. We need policy to allow us to explore these things. And so I think it's a combined effort but resources are good and support technical assistance is very important. Fabulous. And Amanda, go ahead.  And so to the extent that we measure where the biggest gaps are. And if those are states that don't have enough funding or we can figure out different ways of tackling that problem. I think if we centered around that kind of conversation and build policy around it, then you can see the gaps and you can figure out whether it's tech talent you need or resources you need. But we haven't had that kind of discussion enough to be able to identify how do we close these gaps and how do we close them in the biggest places across the country. So everyone, unfortunately, we're gonna have to wrap up there again throughout this whole day. I know I've learned so much throughout the past couple of hours about how can we increase awareness? How do we increase enrollment retention and address all these stigmas and other barriers and challenges. I'll end with just reflection on Harry's remarks about kind of climbing Mount Everest together. And I think I personally am so inspired that there are so many great efforts happening and that if we do band together and work with our grassroots communities and work with each other, we really can make a difference here. So with that, thank you so much to each and every one of you for participating in this panel. And I'm gonna turn it over to our fearless leader, Dr. Susan Blumenthal, to offer some closing remarks. So thanks so much to everybody and Susan. Thank you so much for all of your leadership and incredible work. Well, thank you so much to David Kong for being a fantastic moderator and to all of our terrific panelists for sharing their perspectives on the progress that's being made and also the promise for integrating technology but making sure that it is human-centered design. I wanna thank everybody who joined us today in this wiring with virtual symposium and our collaborators at the Harvard T. Chan School of Public Health, the Department of Nutrition, Dr. Willett and for Dr. David Newman from the MIT Media Lab. We're very grateful that this was really a cross-disciplinary endeavor and really a journey to be inclusive and to really reimagine what could be Wix's future in this decade and beyond. Next slide. Thanks to all of the speakers. They were fantastic, diverse perspectives and to all of the attendees on this virtual symposium. We are so grateful for the work that you're doing and for your support of Wix and for the ideas that you have about how we can strengthen it for the future. Next slide. We've heard today that some of the challenges and the pandemic really has provided an opportunity to waive some of the barriers to participation in the program but we still have only 57% of people who are eligible for Wix are participating and there is a very dramatic attrition rate with 98% of infants that are enrolled but only 25% of four-year-olds. So what can be done to enhance that? And that's what this wiring Wix symposium was all about. That's what your work is all about. Creating a technologically enhanced Wix can provide more ways to reach participants and meet their diverse needs helping to boost participation and retention in the program. Next slide. Our concluding message today is that modernizing Wix is an opportunity to improve the nutrition, health and economic security of millions of people in the United States providing a healthy start in life for children reducing medical cost link with hunger and obesity and as a result strengthening America's future now and in the years ahead. Next slide. Thank you all for joining us today. If you would like a copy of the Wiring Wix report please visit wiringwix.org. There's also a button at the bottom of the screen to get the PDF of it. And again, thank you all for your work. Let's keep working together to strengthen Wix now and in the future. Have a great afternoon.