There’s No Free Lunch: Public Health Crisis and Re-Imagining the School Cafeteria

The problem of unhealthy cafeteria food in public schools, how it contributes to obesity in America, and measures we can take to stop it.

What’s the problem with lunch?
School just started again and my kids set off again for their public schools. My daughter goes to an elementary school that is a pilot site for a health and wellness program. School breakfasts and lunches are made on-site, and students learn about the benefits of cooking with natural and local ingredients, and eating healthfully. My son’s middle school, part of the regular school lunch program, models fast-food culture: chicken nuggets served in individual boxes branded King Deluxe, and pre-packaged burgers and sloppy Joes in branded foil wrappers. The contrast is dramatic.

Kids from my daughter’s school come home talking about things you can make with kale, what is in season, and how squash actually tastes good on pizza (yes, made with whole grain crust). My son never talks about the food at his school except to demand that we pack his lunch. This would only be of personal interest, except for the fact that opting out of school lunch is not an option for many kids: About 57 percent of kids in the US rely on free and reduced-price school lunches for their main meal of the day. The nutritional impacts of what is served at school, and the expectations and habits these food choices create about eating have both lifelong implications for kids and public health, and equity implications for us all.

Every day we hear about the growing crisis of obesity-related disease and the ticking time bomb that childhood obesity represents for the US. Approximately 17 percent, or 12.5 million US children and adolescents (ages 2-19), are obese. This does not even include kids who are overweight. The human and economic costs are significant. Diet-related diseases are among the top causes of death and cost more than $1 trillion annually. And while what students eat at school is just one of many contributing factors, the combination of direct nutritional impact with the social reinforcement of eating habits created by school lunches offers a clear opportunity to address a key social issue.

So, what is getting in the way of seizing this opportunity?
Cash-strapped school districts are primarily responsible for school lunch programs. Support from the National School Lunch Program (administered by the US Department of Agriculture) in the form of cash and surplus food serves as a primary revenue source for schools—and thus, it comes with regulations. Meanwhile, state and county public health agencies develop and implement obesity prevention programs and educational outreach to encourage healthy eating habits and prevent dietary causes of disease. Responsibility, funding, and expertise are divided, making a systems approach to the issue challenging. The current economic model funds health treatment, not prevention. It provides money for prescription drugs, inpatient services, and emergency room visits, but not for healthy food or health education.

The excellent examples of farm-to-school, healthy school kitchen, and school garden programs generally have a key, non-replicable aspect in common. They require entrepreneurial and resourceful advocates who are willing and able to seek waivers; garner exceptions to rules; establish site-specific partnerships with farmers, cooks, and health educators; and raise grant and other money—none of which is sustainable or scalable. These are all common factors to piloting new models, but the scale of the public health need and the economic costs of childhood obesity require that we rethink the divide between school nutrition services, public health, and health care.

But, what can we do?
We must shift from seeing the improvement of children’s access to healthy food at school as a cost we cannot afford to a savings we cannot afford to miss. And this scale of change can only happen if voices from many sectors demand innovation and provide the political and social capital necessary to counter the territorial and economic incentives to maintaining the status quo.

• What would the food expectations of the 30 million kids served by the National School Lunch Program be if we drove the design and funding of the program from a health and wellness perspective?
• What would the funding system look like if we established monthly funding of better school lunches as a prevention benefit (a monthly payment similar to a prescription drug benefit) that contributes funding for the preventative benefits of healthy food?
• What if we put in place a market-based solution to fund better school lunches - increase the quality and health of school lunches, increase demand and, if needed, increase the cost per day for families that can afford it, creating a sliding scale that improves life for all kids?
• What if we used the millions of acres of surplus public land in transportation right-of-ways, and the millions of hours of mandated community service and corrections labor to grow food for our schools?
• What if we passed public health opportunity bonds that funded preventative approaches to health and wellness, including healthy school lunches, and paid back the bonds with future public health savings?
• What if we established soda and high-fat snack taxes that funded healthy school lunches?
• What if education, public health, economic equity, and childhood development advocates placed as much priority on impacting the farm bill as commodities and agribusiness advocates do?

We must imagine and act on possibility because there is a generation in the balance. The trend lines of obesity, diet-related disease, and its treatment costs keep going up. But prevention that can reverse this trend line is in our control—if we put in place equitable access, education, and the supports that establish lifelong habits of healthy eating. And what better place to start than with our kids?

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  • BY Scott M Taylor

    ON September 23, 2011 06:26 PM

    If you have never heard of Jamie Oliver you should check him out. He’s done a lot of work in making school lunches in the UK healthier and has fairly recently been here in the US trying to do the same thing.

  • Also check out the Healthy Schools Program at The Alliance for a Healthier Generation for a free program to help make your son’s school healthier.

  • BY Dave Soleil, Leadership for a Healthier World

    ON September 23, 2011 07:54 PM

    I believe what Mr. Friedenwald-Fishman sees as a primary problem, non-replicable solutions, is actually a primary strength that is indicative of the field of health and must be harnessed.  The crisis of obesity and diet-related disease is very much a product of systems and replication from how the food is made and processed to how it is distributed.  There has been a complete loss of control in communities over what foods and physical environment surround those communities.  So, reclaiming the individuality of our communities will take individual leadership, as Mr. Friedenwald-Fishman notes, and as a result, the community-driven solutions will seem unique and non-replicable. 

    As well they should be unique and non-replicable.  That is the very essence of reclaiming control and individuality of any community.  These solutions greatly complicate the landscape and will confuse anyone looking for replicable solutions in the outcomes.  So, let’s take a step back.  Mr. Friedenwald-Fishman says that entrepreneurial leadership is effective.  I believe that to be true.  In this context, we should not look to replicate solutions, we should look to replicate leadership training in communities.

    The solutions will be unique and individual.  The solutions will maximize impact by being “of the community, by the community and for the community.”  A crisis caused by systemization and homogenization will be undone by uniqueness and diversification.  It is the health leadership training that is replicable and sustainable.  Do not focus on the solutions.  Focus on the people who will create the solutions most appropriate for their community.

    Mr. Friedenwald-Fishman said that we need to shift our thinking from healthy food being “a cost we cannot afford to a savings we cannot afford to miss.”  The question is HOW does this happen?  From an economic perspective, people make decisions based upon perceived costs and perceived benefits.  These costs and benefits are based upon the knowledge we currently have and our values upon which we base our decisions.  Values are the language of leadership.  Teach leaders to organize people around shared values and you have strengthened those values.  Teach them about health and you have strengthened their knowledge.  When you strengthen values and knowledge, you can tip the scales of perceived benefits and perceived costs.  Tip those scales and you will see behavior change… replicable, sustainable behavior change because you have systematized the health leadership training and empowerment rather than the unique outcomes and solutions.

    This is the fundamental work of my organization, Leadership for a Healthier World.  Thanks for a thought-provoking article.

  • BY Eric Friedenwald-Fishman

    ON September 27, 2011 11:48 AM

    Eric here - While I agree with Dave Soleil’s points that leadership is critical to drive change and that local approaches and dispersed solutions are an effective means to meet the needs in different places, I strongly believe that scale matters. All communities and individual schools cannot muster the independent resources to drive the needed change and systems (funding streams, farm partnerships, links between public health and education providers, etc) are a critical underpinning of addressing wide-spread issues and normative expectations like childhood obesity. A key point is that it does not need to be a zero sum game. One problem with systems solutions is they try to apply the scale solution down to the application details.  A place where Dave Soleil and I possibly agree is to address the shared expectations and major enabling systems issues (a baseline expectation, funding streams and removal of program silos to establish healthy food as the school lunch norm) with flexible local leadership on how it is implemented to work in local context. Thanks for adding the element of leadership to the conversation.

  • BY Erin Kilburn, Metropolitan Group

    ON September 28, 2011 12:08 PM

    If you enjoyed this post, you may appreciate these articles that our friends at The Trust for Public Land and APHA shared with us.

    From Fitness Zones to the Medical Mile (TPL)

    Understanding Hunger and Obesity and the Role for Center for School-Based Health Care (APHA)

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