The Health Equity Blog’s mission is to contribute to the discussion of health policy using evidence and research, to explore the opportunities for health equity through policy change, to raise awareness about health disparities, and to increase public advocacy for health equality.

According to the CDC, “Health equity is achieved when every person has the opportunity to ‘attain his or her full health potential’ and no one is ‘disadvantaged from achieving this potential because of social position or other socially determined circumstances.’”

Achievement of full health potential is necessary in all aspects of life – from running errands to relationships with loved ones. Some people are born into environments that limit their ability to achieve their full health potential. We believe that because society created many health inequalities, society can also fix them.

Monday, December 9, 2013

School Lunches - an opportunity to improve health

What is the National School Lunch Program?
The National School Lunch Program (NSLP) feeds millions of children in schools every day. In 2012, 19.6 million children received free and reduced-price lunch, a qualification that is based on family income.

Children with families at or below 130% of the Federal Poverty Level (FPL) qualify for free lunches (an annual income of $30,615 for a family of four).
Schools that chose to participate in the NSLP receive cash subsidies from the U.S. Department of Agriculture (USDA). For the 2013-2014 school year the reimbursement rates are:
  • $2.93 for Free Lunches (each child’s lunch who is under 130% of FPL)
  • $2.53 for Reduced Price Lunches (each child’s lunch who is under 185% of FPL)
  • $.28 for Paid Lunches (each child’s lunch who is over 185% of FPL)

The National School Lunch Program Nutrition Standards
In January 2012, the Federal government issued updated NSLP nutrition standards. In part, the updated nutrition standards were in response to the rapid increase of obesity in children, particularly low-income children. Among low-income children, obesity rates increased 23% between 2003-2007, compared to a 10% increase among all U.S. children. Rates of severe obesity are roughly 1.5 times higher among poor children. For many of the children who receive free lunches, it is the only guaranteed meal they receive that day.Schools provide a great opportunity to impact childhood obesity. Not only are children required to attend school by law, but they also consume at least one meal five days a week at school.   The updated nutrition standards:
  • Increase fruit and vegetables served
  • Emphasize whole grains
  • Allow only lower fat and nonfat milk
  • Limit calories
  • Reduce saturated fat and sodium

Providing healthier items at lunch will at least provide many children one healthier meal everyday and that is a step in the right direction. However, I think the message and food environment in schools is more important than the actual nutrition quality. Kids learn by example and schools are a learning an environment. What are we telling our kids when they learn about the benefits of fruits and vegetables but in the lunchroom there is only pizza?

The Barriers to Providing Healthy School Lunches
As soon as the updated NSLP nutrition standards were released, many school districts nationwide expressed concerns. In September 2013, The Robert Wood Johnson Foundation and The Pew Charitable Trusts conducted an extensive survey of schools and the barriers faced while implementing the new nutrition guidelines. The barriers include:
  1. Higher costs. It is too early in the new USDA school lunch guidelines to have data related to cost of school meals. Researchers disagree on the cost of fresh food compared to easy to re-heated, processed food. New research shows that a diet rich in fruits, vegetables, nuts, and fish costs about $1.50 more per person per day. If that increase in cost is applied to schools, it is substantial. However, there are innovative school lunch programs (listed below) that have proven it is possible to serve healthy meals on a budget. Another cost to consider is the increase in staff needed to cut, chop, and cook foods. If a school staff previously only reheated pizza, it is a large annual cost to hire more people in the kitchen. Schools are already cash-deprived.
  1. Need to remodel or upgrade school kitchens. Many schools do not have full kitchens, but instead operate out of a district-wide central kitchen and deliver the foods to schools. This makes the preparation and storage of fresh foods difficult. For example nearly half of New York City schools lack cooking and fire-suppression equipment to cook on a stove and Seattle prepares all foods at district headquarters before being shipped out to schools. The USDA has strict rules for food storage for good reason, and, currently, many school districts do not have suitable kitchens.

Neat things schools are doing
Like I stated above, some innovative school have pushed past the barriers and are serving healthy lunches. Here are three examples.
  1. Minneapolis Public Schools. In full disclosure, I am a product of the Minneapolis Public Schools (MPS) district, which is probably why I’ve been following their school lunch improvements. Many Minneapolis schools don’t have full kitchens so most of the food prep happens at a central nutrition center.  However, in 2012 the district hired Bertrand Weber who declared he was bringing real foods back to the schools. Since then Weber has banned irradiated meats, converted all high schools to cooking from scratch, set-up salad bars with seasonal ingredients, and focused on staff development. The menu for December looks great and certainly different from the meals I remember. Check it out here. Spoiler: the menu includes free-range turkey, arroz con pollo with brown rice, and thai red curry.
  2. Baltimore School District. The Baltimore schools system was the first to implement meatless mondays back in 2009. Since then 18 school districts have followed Baltimore in instituting meatless mondays. The district also partners with local farmers and has a Great Kids Farm to teach kids about locally produced foods.
  3. Farm to School Programs nationwide. According to the National Farm to School Network, there are 38,629 United States schools that have a farm to school program. Some schools have more extensive farm to school programs than others - from a day dedicated to farmers to school gardens. Earlier this year, Oregon awarded $1.2 million for Farm to School and School Garden Programs. A majority of the money will go to purchase locally grown foods to feed students with the remaining funds for education and gardens. Massachusetts is another example of a state with a vibrant Farm to School program. In the 2011-2012 school year, 231 schools and 114 farmers participated in the program.

The list above is short and there are endless examples of awesome things schools do everyday to provide healthy free lunches for students. Some people are convinced that kids aren’t going to eat healthier foods. Most kids like fruits and vegetables if they are prepared well and are the norm in their environment. School lunches are a huge opportunity to introduce new foods to children and unlike previous generations, the new foods should be healthy. Looking at the rates of obesity in this country, we have to provide healthier lunches, we have to teach kids what a normal lunch should be, and we have to provide the financial support to all school districts to do so.

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