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Enhancing Food Security and Physical Activity for Māori, Pacific and Low-income PeoplesKey components for effectivenessGreenhalgh et al 25 report the findings of a realist review of 18 school food programmestudies. The interventions included in these studies ranged from milksupplementation to full lunch meals, from the 1920s until early 2000s, and acrossdeveloped and developing nations. They draw conclusions of process factors thatseemed to increase the efficacy of the programmes, which include:• clear nutritional deficiencies being targeted• well organised school and food distribution chain• locally designed interventions• pilots of interventions are used to assess acceptability of the food to children• processes increase the likelihood that the food is consumed, such assupervision, and• inclusion of social aspects of the meal in the intervention.Literature scan: National ContextUse of school food programmes in New ZealandSince the end of the school milk programme in the 1960s, there was no governmentfundedschool food provision in New Zealand 9 , until the introduction of the Fruit inSchools scheme in 2005. There have, however, been a number of individual schoolsand non-government organisations providing locally organised breakfast or lunchfoods to schools. 9There is little evidence in New Zealand of the impacts of food provision in schools onchildren, and even less on children from food insecure households. A processevaluation of the Fruit in Schools scheme, completed after one year of operating,reported significant increases in the number of students reporting eating vegetablesand fruit every day, as well as the amount of vegetables and fruit being consumed. 26This result is from a relatively small sample of 591 students. Staff and students weresupportive of the scheme. Further evaluation results with more child outcomeinformation should be available in 2009.The positive results from the Fruit in Schools evaluation are supported by the findingsof Ashfield-Watt et al, 13 in a pilot study of a free fruit in primary school scheme.Across ten matched intervention and control schools in Auckland, schools where apiece of fruit was provided daily increased average fruit intakes by 0.39 pieces perschool day per student, compared with no increase in control schools. There was areduction of almost 50 percent in students who ate no fruit in intervention schools.The increased fruit intake was not sustained six weeks post intervention, and theauthors suggest the intervention period of one school term was not long enough toestablish new habits independently of the intervention. Other studies internationallyhave shown sustained effects following longer intervention periods. 17A study in the Waikato as part of project Energize, 27 trialled the provision of vitamin Dfortified low fat milk to all students in eleven low decile primary schools. The studyfound that compared with control schools, students receiving the milk had higherserum vitamin D levels, even though both groups’ vitamin D remained low. Thestudents who received the milk also had a significantly better cardio-protective lipidprofile compared with students from control schools.The Red Cross Breakfast in Schools programme was launched nationally in 2007, 28with 29 schools involved as at March 2008. An evaluation survey was conductedincluding eight months of operation. A majority of teachers considered that bothbehaviour and students’ learning capacity had been improved by the breakfast55
Enhancing Food Security and Physical Activity for Māori, Pacific and Low-income Peoplesprogramme. No information was collected on food security of the children before andafter introduction of the programme. Delivery of the programme relied on volunteersand sustainability of the volunteer workforce was cited as a potential risk for theprogramme.Acceptability to stakeholdersWhile it appears that the Fruit in Schools scheme is highly acceptable tostakeholders, 26 less is known about other school food programme types. In a study offood insecurity amongst primary school children, Gerritson 9 surveyed 115 primaryschools in the Wellington region. School principal respondents estimated that3.3 percent of students were regularly hungry throughout the survey period of May2004. The research also found that the majority of schools between decile 1 and 6 inWellington provided free food to a small number of students on a regular basis.Principals from decile 1 and 2 schools were largely in agreement with statements thatparents found it difficult to always provide breakfast and lunch for children. Principalsfrom higher decile schools (decile 7-10) agreed with these statements less. Therewas full agreement amongst principals that it is the responsibility of parents to providetheir children with lunch every day, although a third of principals also acknowledgedthat schools had a responsibility for ensuring children had lunch.Key informant interviewsThe following section presents results relating to food security and school foodprogrammes from 15 policymaker interviews as part of the project Promoting healthychildhood nutrition through primary schools.Responsibility for children’s food at schoolMost participants stated that parents have primary responsibility for the food thatchildren eat during the day at school. A few participants noted that the responsibilityrests with parents because that is how the schooling system has developed in NewZealand, and acknowledged that internationally there is a wide variety of practice.There was also recognition that when children are faced with food insecurity theschool may be required to take some responsibility for feeding children at school.Who should provide food in schools?As highlighted by Gerritsen, 9 some schools currently provide some food to childrenwho present as hungry at school. This provision of food is usually paid for by theschool, or donations are used. Participants were asked about the type of support thatshould be available for schools to address hunger in students. There was a range ofopinions. Three participants stated that lower decile schools, with an assumption thatthis is where the burden of hungry children is located, already receive more money inoperational grants from government than higher decile schools. They suggested thatsome of this operations money should be used to purchase food if this is a need forthe school.Other participants suggested that the number of children presenting as hungry is likelyto vary between schools and communities. They suggested that the best place tolocate solutions therefore was to use community resources to support schools (e.g.,local suppliers providing food at cost, or the wider whānau). Some participants notedthat existing welfare agencies, such as the Red Cross, were providers of food inschools, and saw this as a positive alternative to individual schools funding foodprovision. Two participants raised concerns about community- based solutions andcharitable models, questioning the “sustainability in the long term”, particularly if the56
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