policy options for school nutrition background document mary mckenna, phd, rd canada june 6, 2007
TRANSCRIPT
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
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
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
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