Policy Options for School Nutrition Background Document

Mary McKenna, PhD, RDCanada

June 6, 2007

Overview

School nutrition policy Policy options Stakeholder roles Evaluation Summary

School Nutrition Policy Framework to guide school planning,

implementation, and evaluation pertaining to student nutrition and health Promote norms Reflect national dietary guidance Consider cultural and dietary practices

Target: (sub) national governments

Purposes

1.Address health concerns2.Support student learning3.Provide a framework for action and

accountability4.Exemplify healthy public policy

EquityEnvironmentsComprehensivenessCoordination

The Mandate

School policies and programmes should support the adoption of healthy diets and physical activity. Adopt policies that support healthy

diets at school and limit the availability of products high in salt, sugar and fats

Support contracts for locally grown foods

WHO Global Strategy on Diet, Physical Activity and Health, 2004

Basis for Action NEED!

Current knowledge warrants urgent public health action (WHO)

Best available evidence Randomised controlled trials Epidemiologic observations Practice-based evidence Parallel evidence Theory and informed opinion

Methodology

Articles – PubMed articles (1995 onward)

‘Grey’ literature – Google searches WHO documents All countries Documents written in English

Policy Options

Policy Options

Legislation and regulation Financing Built environment Health services Advocacy Community mobilization

Legislation and Regulation Direct policies that address all foods Direct policies that address some

but not all foods Standards for school meals but not for

other foods Indirect policies that address the

quality of all foods Clauses that allow or mandate sub-

national or local action

Legislation and Regulation

Policy components Comprehensive Targeted

Stringency Directives versus guidelines

Accountability

Financing The use of money or food to shape

food consumption School food programs

Access to food to meet nutrition needs Water

Ready access to safe and free drinking water

Food pricing Higher priced less healthy food;

subsidized healthy food

Water

Policy Option

Ensure students have ready access to free and safe water

Evidence Provision of safe water can increase consumption and reduce disease

Process Indicators

-Availability and safety-Temperature-Classroom rules

Output Indicators

Water consumption

Built Environment

Types of foods and food services in the school and immediate vicinity and food marketing

The built environment can reinforce consistency throughout the school

Built Environment Nutrition standards Local foods Food preparation Student access to fruits and vegetables Use of food Coordination of food availability Food availability near schools Sustainable food practices Food marketing Food and beverage contracts

Nutrition Standards Availability of food items that reflect

dietary guidelines Ensure access to healthy foods Prohibit or reduce access to unhealthy foods Specify nutrient/food availability

Portion size/calorie specifications Location (where available) Timing (when available) Age of student (e.g. standards for all or

some students)

Local Foods

Policy Options

Contract with local food providers to supply schools

Evidence Case studies—increases in school meal participation, fruit and vegetable consumption, farmers’ revenue

Process Indicators

Contracts for foods that meet nutrition standards with local farmers

Output Indicators

Types and amount of local food available and amount consumed by students in school

Coordination of Food Availability

PolicyOption

Designate authority to coordinate overall availability of food

Evidence Food availability widespread; no evidence of impact of coordination

Process Indicators

-Coordinator/stakeholders designated-Role defined and communicated-Written coordination plan

Output Indicators

Overall availability of food

Health Services

Counseling or other nutrition services in schools or school-community partnerships that address student health needs

Advocacy

Identifying and reducing barriers to school nutrition policies at an individual or systemic level

Community Mobilization

Education and infrastructure required for school nutrition policies Nutrition education Staff qualifications and training Nutrition and health infrastructure

Advisory councils Student, parent, community involvement Whole school approach

Stakeholder Roles

Stakeholders

All levels of government Students Parents Health and Education personnel Non-governmental organizations Industry and media Academic community

Stakeholder Roles

Attend to process Problem awareness through to

evaluation

Enlist support

Anticipate and address obstacles

Evaluation

Purposes of Evaluation

Document changes due to policy Enhance support for policy Allocate resources Provide accountability Inform decision-making Contribute to evidence base

Evaluation Data

Surveillance data, policy document, policy-related communications, financial data

Stakeholders Direct measures or self-report:

food intakes and health outcomes

Process Indicators: Legislation Formation and composition of policy team Completion of needs assessment to

identify policy options Completion of written policy and plans for

implementation and evaluation Communications pertaining to policy Adoption of policy Factors influencing implementation Allocation of resources to the policy

process

Output Indicators: Legislation

Breadth and stringency of legislation

Progress toward policy implementation

Ability of policy to address areas of greatest need

Evaluation results fed back into policy process

Outcome Indicators Food, nutrient, energy intake, and

meal patterns in and out of school Adiposity Health outcomes (e.g., blood

pressure, blood glucose, blood cholesterol)

Unintended consequences Academic/school outcomes Cost/benefit analysis

Summary The need is now Policy options are

promising Process is pivotal Evaluation is

essential The children of the

world are waiting

Mary McKenna

E-mail: mmckenna@unb.caTel: 1-506-451-6872