1. SCHOOL FOOD (IN) SWEDEN Emma Patterson, PhD, BSc Hum. Nutr. Project manager ”SkolmatSverige”/”School Food Sweden” - Center for Epidemiology och Community Medicine, Stockholm County Council - Karolinska Institutet

2. Sweden vs Canada

3. Important background/context ◊9 year compulsory school system (ages 6-15) ◊National law, national curriculum ◊Completely free – incl. books, school meals ◊Funded predominantly by local government taxes ◊Some (16%) are “private” but must follow the same law ◊290 municipalities (3-150 schools) ◊Many have dietary managers ◊Welfare state ◊Plus a general tendency to trust/obey authorities!

4. History of the Swedish school lunch ◊Late 1800s – targeted at very impoverished children ◊1940s – more widespread ◊1970s – almost all schools ◊1997 – enshrined in Education Act – “free school meals” * ◊2011 – updated – “free and nutritious school meals”

5. 1970s

6. What is the Swedish school lunch like today? ◊National guidelines from the National Food Agency – A hot lunch (half of schools offer a choice of main dishes) – A salad buffet (usually with 5+ components) – Milk and water – Bread and spread

7. A few pictures to illustrate:

8. A few pictures to illustrate

9. A few pictures to illustrate:

11. A few pictures to illustrate

12. What sets it apart? ◊No competitive foods ◊No packets, no cartons, no tinned vegetables ◊Self-served, proper plates, cutlery ◊No soft drinks or desserts ◊No “combinations” required ◊No strict standards?

13. How much do school meals cost? ◊On average, 10 SEK per day ($1.50 CAD) – Ingredients & personnel (not rent) – Large variation between municipalities

14. History of www.SkolmatSverige.se ◊In 2010 we had – A new law with demanding requirements coming in 2011 – No national data (but reports of varying quality) – No plans for monitoring or for the evaluation of new law – A risk of too much focus on nutrition at the expense of “the bigger picture”

15. Aims ◊Web-based instrument ◊Free, easy to use, available to all schools ◊Instant tailored feedback ◊No commercial interest ◊Database for research

16. Choices Accompaniments Other meals Dishes Choice of products Serving frequency Amounts Routines Training Dietary requirements Nutrition Safe food Level 1 Lunch provision Level 1 Food-based nutritional criteria for vitamin D, iron, fat quality and fiber

17. Scheduling Service & milieu Pedagogic lunch Student involvement Integration Wastage Product choice (e.g. meat, fish) Organic products Nutrition Safe food Lunch Level 1 Environment Service & pedagogy Level 2

18. Organisation Level 3 Goals and guidelines Responsibilities Training and resources Attendence and consumption Level 1 Level 2 Nutrition Safe food Lunch Environment Service & pedagogy Level 3

19. Organisation Level 3 Level 1 Level 2 Nutrition Safe food Lunch Environment Service & pedagogy + Staff questionnaire + Student questionnaire + Guests Is the food tasty? Do you have enough time? Is the ambience pleasant? Do you throw away food? Guests’ opinion

20. Automatic results

21. Is it being used? 31 % of all schools, in 85 % of municipalities ”Finally a tool to use that is easy to explain and use and which takes into account the entire school meal!” - Municipal dietary manager

22. Has the new law had an effect? ◊Between 2011 and 2013: – Yes, but modest ◊Since 2013, bigger improvements have been seen

23. Has SkolmatSverige had an effect? ◊Preliminary analysis suggests it has! – Nutritional quality Improvement over time AND between frequent users cf. one-time users – Service and pedagogy Between frequent users cf. one-time users ◊Analysis ongoing

24. Future challenges ◊Star chefs vs processed foods ◊Nutritional quality still not optimal ◊Meal environment/lack of time ◊Incomplete/unbalanced meals We plan ◊Study of instrument’s effects ◊Study of meal quality and socioeconomic deprivation ◊Study of meal quality and school performance ◊Adaption to other areas (food provision for the elderly)?

25. Thank you! ◊www.skolmatsverige.sewww.skolmatsverige.se ◊emma.patterson@ki.se

26. Förbättringar 2011-2013 20112013P1P1 % Råd om utbud En alternativ rätt dagligen 50 1.000 En vegetarisk rätt dagligen (till alla) 18  34 0.001 En saladsbuffet dagligen med minst 5 komponenter 76  83 0.307 Råd om val av livsmedel Salt ej tillgänglig för elever 23  27 0.556 Sötade drycker mindre än 1 gg/månad 90  96 0.070 Bakverk mindre än 1 gg/månad 95  99 0.125 Fisk 4 ggr/4 v 71  85 0.049 Fet fisk 2 ggr/4 v 18  23 0.458 Korv max 3 ggr/4 v 86  89 0.549 Lättmjölk erbjuds dagligen 57  66 0.035 Nyckelhålsmärkt smörgåsfett erbjuds dagligen 44 42 0.874 Blodpudding minst 1 gg/4 v 40  49 0.280 Några signifikanta skillnader (<0.05)

27. Utbud ◊Alternativ huvudrätt: – finns i 55 % av skolorna ◊En vegetarisk rätt: – erbjuds till alla elever 4-5 dagar i veckan i 45 % ◊Söta drycker och bakverk: – förekommer nästan aldrig till lunch ◊Ett bra salladsbord med minst fem sorters grönsaker: – finns dagligen i 88 %

28. Säker mat ◊Resultat generellt bra! ◊Tydliga rutiner finns hos det mesta, med undantag för – hur eleverna ska tvätta händerna innan lunch – hur eventuella tillbudsrapporteringar ska följas upp

29. Service och pedagogik ◊Vad eleverna själva tycker om skolmaten – 40 % gör minst varje läsår en undersökning för att ta reda på detta ◊Servering: – På 77 % har majoriteten av eleverna minst 25 min schemalagd lunchtid

30. Service och pedagogik (fort.) ◊Skolrestaurangens miljö: – Ljud och buller upplevs som ett problem på 41 % ◊Vuxennärvaro: – På 65 % där pedagogiska luncher förekommer finns det skriftliga riktlinjer för vad det innebär

31. Miljöpåverkan ◊Skolorna källsorterar avfall och material ◊Matsvinn i produktionen mäts i 15 % av köken (under minst en vecka per termin) ◊En vegetarisk rätt erbjuds så gott som dagligen till alla elever i nästan hälften av skolorna (45 %) ◊Mjölk är livsmedlet som skolor oftast väljer ekologiskt

32. Organisation och styrning ◊I 75 % av kommunala och 50 % av fristående skolor är kökschefen en kvinna* ◊Utbildning: – I 50 % har kökschefer utbildning inom ledarskap – I 63 % har samtlig kökspersonal utbildning inom matlagning i storkök ◊78 % av skolorna har tillgång till någon form av kostkompetens utanför köket*

33. Organisation och styrning ◊Påverkan – Nöjda med hur de kunde påverka matsedelns utformning (79 %) – Nöjda med hur de kunde påverka inköp av livsmedel (51 %)* ◊Hälften av skolorna (55 %) har en kostpolicy.