FOOD ENVIRONMENTS
Based on Mexico’s experience and a review of literature on the topic, we believe a few key considerations should be taken into account when developing school food policy in similar contexts. Policy to improve school food environments should:
Acknowledge the interdependence of human rights to achieve the Right to Adequate Food and Nutrition To advance the Right to Adequate Food and the Right to Health, related human rights must also be upheld, for example, the Right to Education, the Right to Water and the Rights of the Child.
The Right to Education and the Rights of the Child:
Educators and educational authorities often find themselves overwhelmed by the scope and demands of their various roles and responsibilities. When a health- or nutrition-related policy is imposed on a school, it is often difficult to find educators willing and able to dedicate the time and resources needed to implement it. This is not only due to their already heavy workload, but the fact that they do not necessarily see the link between healthy school food and educational success, so view the policy as being beyond their remit. It is important to work with educational authorities to foster the widespread understanding that a school food environment that promotes health and nutrition is one that promotes education and optimal human development. The link between the Right to Adequate Food and the Right to Education must be acknowledged in policy development and practice.
Guaranteeing the Right to Water is essential to achieving the Right to Adequate Food and Nutrition: Many schools do not have access to potable or running water, as is the case in Mexico. Ensuring that potable water is freely available in schools is critical to reducing the reliance on sugary drinks and promoting the consumption of water. Thus, guaranteeing access to potable water within schools is critical to ensuring the Right to Adequate Food and Nutrition. Countries may consider fiscal policies, such as a tax on sugary beverages, to help finance the installation of drinking fountains in schools. In Mexico, the civil-society advocates and academics behind the national sweetened-beverage tax also called for a portion of the resulting tax revenues to be utilized to install water fountains in schools. Although it was not possible to directly earmark the revenue, a law was approved soon afterwards requiring schools to provide drinking fountains.
A National Drinking Fountain Programme was developed for this purpose, although few fountains have been installed to date and there is a general lack of transparency over the utilization of the tax revenues in question.
Address the financial and structural realities facing schools The Mexican study demonstrates that many schools rely on food sales to fund school maintenance costs and this is also the case in many other Latin American countries (Dárdano and Álvarez, n.d.). Many vendors and school principals believe that changing the school food offering will lead to a reduction in profit from food sales, thereby jeopardizing the functioning of the school. This has two implications for policy development that should be considered. First, policy to improve the school food environment must be accompanied by efforts to ensure funding for public schools, as this will reduce the need for principals to rely on food sales to generate income for school maintenance. Finding ways to finance schools and increase the educational budget is critical as a parallel policy goal, to ease pressure on school principals and allow school communities to focus on maximizing the quality and nutrition of the foods on sale on school grounds, rather than on generating income.
Second, it is important to engage with school administrators and vendors to identify how the sale of healthy food can prove economically sustainable, especially where schools continue to rely on food sales for maintenance. There are studies from the USA and Latin America that illustrate how the transition to selling healthier food in schools actually resulted in increased revenue and that concerns over losses were overestimated, in part because when unhealthy snack options disappeared from the environment, more money was
spent on purchasing prepared foods (Center for Weight and Health, University of California, Berkeley, 2007; Wharton, Long and Schwartz, 2008). Policy implementation must identify techniques for transitioning to healthier foods in ways that are economically sustainable in the specific country context.
Economic subsidies for healthier and more sustainably produced foods must be considered as an important option (Mozaffarian, Rogoff and Ludwig, 2014).
Acknowledge the impact of ultra-processed products on the food environment
Research has demonstrated the clear links between ultra-processed food consumption, obesity and diet-related chronic diseases: the replacement of minimally processed or unprocessed food with heavily marketed, ultra-processed products has had a negative outcome on nutritional health, the food system, the environment and cultural practices. It has been suggested that efforts to reverse this dietary shift should be a central goal of the UN Decade of Action on Nutrition and the UN Sustainable Goals (Monteiro et al., 2017). Because of the significance of ultra-processed foods in shaping the state of global nutrition, close attention should be paid to identifying and reducing the presence of ultra-processed foods in the school environment. This objective should be an important guiding principle of school food policy.
The NOVA food classification system (Monteiro et al, 2012, 2017), which categorizes the extent and nature of food and beverage processing, could be useful in designing school food policy. The simplicity of the NOVA system could enable quick identification of the foods permitted and prohibited for sale, especially in resource-poor settings, where monitoring processes are limited.
Engage civil-society and public-sector actors in implementation, monitoring and evaluation
Policy implementation, including training, monitoring and evaluation, cannot be an afterthought to policy design.
Rather, policy development must put these processes at its core, or it will struggle to be effective. School food policy typically involves multiple actors, spanning the education, nutrition/health and agricultural sectors. The roles and responsibilities of these actors, as well as how they will cooperate to jointly implement a policy, must be clear. Government agencies responsible for policy implementation should, therefore, be consulted during policy design so that potential barriers to implementation are prevented or can be addressed early on.
It is critical to involve the school community and civil society in every stage of school food policymaking, from formation to evaluation. Communicating new or existing policies to the public (parents, teachers and children) is an essential part of the process and key to increasing understanding of the importance of a healthy school food environment, as well as to impart knowledge about healthy and unhealthy foods. It will also increase the accountability of school principals and authorities in implementing the policy. One recommendation for improving knowledge of Mexico’s school food regulation is the development of posters or banners for the front of each school to inform the community about the regulation and its details, in addition to other informational material and talks, aimed in particular at school principals, vendors and teachers.
Civil society should participate in the monitoring and evaluation of a school food policy to foster accountability and to provide insight on the differential impacts of the policy on children and schools. Monitoring how the policy is experienced “on the ground” is key to creating a feedback loop for policy improvement.
Safeguard against conflicts of interest and industry interference
The food and beverage industry has an interest in ensuring that packaged foods and beverages, and the marketing thereof, are present in schools. Consequently, school food policy tends to attract interest from the ultra-processed food industry, which is concerned about the impact any policy changes may have
El Poder del Consumidor launched the campaign “Schools 100% free of junk food” in May 2019, as part of the “My Healthy School” initiative, to inform the school community of the Mexican school food regulation and to advocate for its full implementation.
Figure 3.
CAMPAIGN EFFORTS TO BAN JUNK FOOD IN SCHOOLSon its profits. The design, implementation and evaluation of school food policy must be safeguarded from potential conflicts of interest to ensure that the policy has public health and children’s rights as its primary objectives. The food and beverage industry should be kept informed on policy to ensure that prohibited products (and their marketing) do not enter schools and to enhance reformulation efforts.
Importantly, nutritional information and educational workshops within the school should also be free from conflicts of interest.
Such information should be evidence based and not be aimed at promoting industry arguments or justifying the consumption of any particular food or beverage brand.
In terms of school food provision, efforts should be made to enable direct collaborations between small-scale farmers and producers selling unprocessed and minimally processed foods. In countries with strong school food policies seeking to prohibit ultra-processed foods, it will be easier to allocate a large part of food provisioning to local producers and producer organizations rather than the ultra-processed food and beverage industry. These collaborations should also be transparent and any possible conflicts of interest managed.
Look beyond the school grounds
It is important to consider aspects beyond the school grounds when developing school food policy. Effective policy may also require regulating the sale and marketing of unhealthy or ultra-processed foods outside the school grounds, so that school food sales are not affected by competition from these products. The impact of the sale of unhealthy foods outside the school is particularly strong where children have access to these foods at lunchtime (i.e. if they can leave the school grounds to make purchases, or purchase the foods through the schoolyard fence). School food policy must take this into account and include ways to reduce the marketing and availability of unhealthy foods and beverages on the school periphery (Center for Weight and Health, University of California, Berkeley, 2007; Poppendieck, 2010; Barquera et al., 2018).
Promote sustainable food systems and culinary knowledge School food regulations should not have the sole focus of improving the nutritional quality of the child’s diet, but also promote healthy and sustainable food systems and the diversity of culinary cultures and techniques. It is, therefore, imperative that school food policy be developed in such a way that promotes the sale of unprocessed or minimally processed foods from small-scale producers and supports a shift from foods produced via the agro-industrial complex towards more sustainable production that promotes agro-ecology and local and territorial markets. School food policy should consider procurement policies to support such food-system transitions.
In addition to supporting sustainable food systems, school food policies should promote the richness and diversity of culinary knowledge and techniques. It should encourage the consumption not only of unprocessed fresh fruits and vegetables, but also of freshly prepared culinary dishes, when possible, using regional vegetable, fruit and grain varieties. There has been a shift away from selling freshly
As part of its campaign “Schools 100% free of junk food”, El Poder del Consumidor developed this banner for installation in primary schools. The banner illustrates which foods are permitted and prohibited for sale, according to the Mexican school food regulation. The “My Healthy School” initiative is inviting school authorities to install this banner in primary schools nationwide.
Figure 4.
BANNERS ATTEMPT TO EDUCATE PARENTS AND CHILDRENprepared culinary dishes in Mexico towards the sale of ready-to-eat snacks in schools. Proponents argue that it is easier to guarantee the hygiene and safety of packaged foods, especially when kitchen facilities are not present in schools. Nevertheless, it is critical that policies recommend and support the sale of freshly prepared dishes, while following hygiene and food-safety protocols, because such dishes are generally healthier than packaged snack foods and simultaneously help to promote the maintenance of cultural and culinary practices. The Mexican case study showed that children often preferred prepared dishes because they were satiating, particularly when children came to school on an empty stomach. Thus, increasing the availability of such dishes could be an effective element of school food policy.
Ensure policy coherence
Lastly, school food policy should be coherent with related nutritional policies, such as food labelling, regulations governing food marketing to children and fiscal measures, as well as policies that promote the sale of healthy food around schools.
In this sense, setting harmonized nutritional criteria is key. For example, the nutritional profile used in a country’s front-of-pack labelling and to determine which products are banned from being marketed to children should be consistent with the profile used to determine whether a product should be permitted inside schools. Under Chile’s food labelling and advertising law, for example, front-of-pack labelling, marketing and school food policy are harmonized so that a product that is barred from advertising cannot be sold in schools. Policy coherence would also ensure that a country’s marketing regulations outlawed school food marketing and that school events or activities could not be sponsored by the food and beverage industry.
Furthermore, agriculture and trade policy and physical-activity programming must be consistent with school food policy and, thus, with the Right to Adequate Food and Nutrition.
CONCLUSION
Primary schools in Mexico are currently characterized by unhealthy food environments and a series of barriers to implementing the country’s school food regulation, which are impeding the promotion of healthy and sustainable diets, as well as the prevention of malnutrition, including overweight and obesity. Recommendations for shaping effective policy for healthy school food environments include the need for a rights-based approach and policy design that is comprehensive, coherent and informed by the structural, social and economic barriers that condition the school food environment. School food policy should promote civil-society involvement, reduce the presence of ultra-processed foods in the environment, contribute to a more sustainable food system and guard against conflicts of interest.
FUNDING
This work was carried out with the aid of grants from the International Development Research Centre, Ottawa, Canada, and Bloomberg Philanthropies of the United States. The views expressed herein do not necessarily represent those of IDRC or its Board of Governors, nor those of Bloomberg Philanthropies.