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Enhancing Food Security and Physical Activity for Māori, Pacific and Low-income Peoplesfood in 18 countries. 16 The review identifies a large variation in practices betweencountries. Food provided ranges from pre-packed sandwiches and soup to full meals.The meals are provided free or at a reduced price in most countries to families whoqualify, based on socio-economic circumstances, with the exception of Sweden andFinland where meals are provided free to all students. Provision of school fruit and13 16 17breakfast clubs are also increasing in several countries.The majority of literature accessed comes from the UK and US, where both breakfastsand lunches are subsidised by the government, with free meals available to childrenfrom low socio-economic households. In the US it is estimated that some form ofsubsidised lunch is available to 92 percent of students, and that 56 percent ofstudents participate, with 47 percent of the lunches provided under the programmebeing free. 18 In the UK the take-up of school meals varies by region, with Rees et alreporting rates between 28 and 57 percent. 19 Results from a nationally representativeUK survey in 1997, showed that between 23 percent (secondary school girls) and72 percent (primary school boys) took up free meals when eligible. 11School Food Provision and Child OutcomesThe majority of the literature related to school food provision describes links tonutritional and academic outcomes. In the UK there have been several studiesexamining the nutrient content, and impact on students’ diets, of school meals. In ananalysis of a nationally representative survey conducted in 1997, Nelson et al 11conclude that ‘if anything, school meals are making matters worse rather than better’(p 660). This is due mainly to the number of foods high in fat and sugar, and therelatively few vegetable and fruit options. There is an exception to this conclusion.For those from the poorest households, who were shown to have the worst diets ingeneral; the school meal provided a benefit. The authors suggest that for thesegroups school meals offer a ‘safety net’. Reports of poor quality food available inschools led to the UK government introducing new standards for school meals in2006. 19Prior to the new UK school food standards being compulsory, Hull City Councilintroduced free school meals to all children, with those meals guided by the new mealstandards. A comparison of one Hull City school with a neighbouring local authorityarea school, 12 showed that students’ average intake of nutrients was inadequate,compared with the standards, for both schools in 11 of the 17 nutrients assessed.Rees et al, 19 in another small study of four schools, showed that the packed luncheschildren were bringing to school provided double the amount of fat and sugarcompared with school meals, yet more calcium, iron and fruit. These studies suggestthat unless school meals are meeting nutritional standards, their ability to offsetinadequate diets at home will be limited. The quality of free lunches may also impacton student take-up. Wojcicki and Heyman 20 report increased uptake of free schoollunches in the San Francisco school district after nutritional regulations wereintroduced for both the federal school meal programme, and other foods available forsale within the school.Dunifon and Kawaleski-Jones 18 report an analysis of a nationally representativesurvey in the US, where children who participated in the school lunch programmewere found to be more likely to come from food insecure households. They concludethat there is little to suggest participation in the school lunch programme is associatedwith improved child cognitive, behavioural or health outcomes. They suggest anumber of mechanisms to explain this finding, including: the level of additionalnutrients gained from the lunches being inadequate for improvements to be recorded;that families may use the lunch programme to replace food they would have otherwiseprovided; or that children may already be receiving adequate nutrients, and therefore53
Enhancing Food Security and Physical Activity for Māori, Pacific and Low-income Peoplesthe additional nutrients do not lead to improvements. This study does not examine indetail the impact of school lunches on children from food insecure households. Cooket al, 21 in a US cross-sectional study, found associations between children from foodinsecure households and adverse health outcomes, and that health outcomes wereworse again if the child themselves was considered food insecure. The associationbetween food security and adverse health outcomes was reduced with participation inthe Food Stamp Programme. These studies suggest that providing benefits to thehousehold, rather than to the child directly, may have more of an impact on childhealth outcomes. However, these studies are relatively small, and do not examine allassociations that could more fully explore these scenarios.A number of studies have examined the impacts of school breakfast and fruit schemeson child outcomes. These studies are largely cross-sectional and not designed tomeasure effect on food security. Given this, the picture appears to be mixed.Breakfast provided at school has been associated with increased school attendanceand performance; however, a review of studies notes caution in generalising fromthese studies due to size and methods. 14 A study of 22 primary schools in deprivedareas of London (13 with and 9 without breakfast clubs), showed a significant increasein academic test scores for schools with breakfast clubs, comparing the year beforethe clubs were introduced with the year after. These improvements were sustained insubsequent years. 22 There was no change in test scores for schools without breakfastclubs. Principals from schools with breakfast clubs reported several benefits forchildren, including: improved social skills; improved punctuality; improvedconcentration levels; and promoting links between schools and parents. 22Effect on EquityIn the UK and US, not all children in a school will be eligible for free school meals, andseveral studies report concerns over stigma as a reason for children not taking up freemeals. 14 In the US income and parental education are negatively associated with freeschool meal take-up. 18 Low levels of take-up are likely to mean that those childrenmost at risk of food insecurity are not receiving the benefit of free food. There is someindication from breakfast clubs and fruit schemes that universal eligibility within aschool increases take-up. 6 17Sustainability and Acceptability to StakeholdersStudies that include qualitative components with teachers and school staff generallyreport positive attitudes from students, 20 school staff, 22 and parents. 23 This suggestsgeneral acceptability to stakeholders if the organisation of the food provision is easy to14 22 23access and meets their needs.Cost Benefit of School Food ProvisionThere appear to have been few studies that examine the costs and benefits of schoolfood provision. A review of breakfast and fruit programmes suggests that benefits arelikely to be larger where the food is designed as additional, rather than a substitute forhome provision, such as fruit schemes. 14 A study by Currie, 24 while drawing onlytentative conclusions, suggests that direct in-kind provision to children, such as schoolfood programmes, are likely to have a bigger positive impact on children’s wellbeingthan cash transfers to the home.54
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