There's no free lunch: a public health crisis and re-imagining the school cafeteria

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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