1. Policy Options for School Nutrition Background Document Mary McKenna, PhD, RD Canada June 6, 2007

2. Overview School nutrition policy Policy options Stakeholder roles Evaluation Summary

3. 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

4. Purposes 1.Address health concerns 2.Support student learning 3.Provide a framework for action and accountability 4.Exemplify healthy public policy Equity Environments Comprehensiveness Coordination

5. 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

6. 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

7. Methodology Articles – PubMed articles (1995 onward) ‘Grey’ literature – Google searches WHO documents All countries Documents written in English

8. Policy Options

9. Legislation and regulation Financing Built environment Health services Advocacy Community mobilization

10. 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

11. Legislation and Regulation Policy components Comprehensive Targeted Stringency Directives versus guidelines Accountability

12. 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

13. Water Policy Option Ensure students have ready access to free and safe water EvidenceProvision of safe water can increase consumption and reduce disease Process Indicators -Availability and safety -Temperature -Classroom rules Output Indicators Water consumption

14. 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

15. 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

16. 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)

17. Local Foods Policy Options Contract with local food providers to supply schools EvidenceCase 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

18. Coordination of Food Availability Policy Option Designate authority to coordinate overall availability of food EvidenceFood 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

19. Health Services Counseling or other nutrition services in schools or school-community partnerships that address student health needs

20. Advocacy Identifying and reducing barriers to school nutrition policies at an individual or systemic level

21. 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

22. Stakeholder Roles

23. Stakeholders All levels of government Students Parents Health and Education personnel Non-governmental organizations Industry and media Academic community

24. Stakeholder Roles Attend to process Problem awareness through to evaluation Enlist support Anticipate and address obstacles

25. Evaluation

26. Purposes of Evaluation Document changes due to policy Enhance support for policy Allocate resources Provide accountability Inform decision-making Contribute to evidence base

27. Evaluation Data Surveillance data, policy document, policy-related communications, financial data Stakeholders Direct measures or self-report: food intakes and health outcomes

28. 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

29. 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

30. 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

31. Summary The need is now Policy options are promising Process is pivotal Evaluation is essential The children of the world are waiting

32. Mary McKenna E-mail: mmckenna@unb.cammckenna@unb.ca Tel: 1-506-451-6872