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The solution is clear: local food for local children creating local markets for local farmers.
(Conway, 2012)

Nurturing Healthy Food Choices School Feeding

July 2012

Note: nutrition impacts citizens at all stages in life, but especially at early-life stages; obesity, Type-2 diabetes, hypertension and high cholesterol are serious public health issues affecting children, linked to poor nutrition; government school feeding (SFP) is a key strategy to influence and nurture healthy food choices and earlylife health.

Understanding the Concept

School feeding (WFP) - provision of meals or snacks at school to reduce the hunger of children during the school day; - the provision of in-school meals only; - sometimes classified in terms of objective, i.e.,: (a) take-home food rations provided as economic incentives to families (or foster families, or other child care institutions) in return for a childs regular attendance at school, (b) food provided to adults or youth who attend literacy or vocational training programs, (c) food for pre-school activities with an educational component, (d) any one or more of the following at-school meals: breakfast, mid-morning snack, lunch, or dinner

Improved nutrition contributes to healthy citizens, the base of productive activities and economic development. Early-life health (i.e., infants and children) is the base for human capital formation. Governments are recognizing SFPs as a strategic building block for both social welfare and human capital development.

Contents:

1 Understanding the Concept. 2 Should Government get involved in SFPs school feeding programmes? 3 SFPs can influence healthy food choices! 4 Policy Intervention Critical Control Points. 5 Bottom line!
6 Recommended

Students in Aranaputa (the Guyanas interior), snacking on home-made peanut butter and cassava biscuits, provided under the national school feeding programme. (Photo: Ravena Gildharie)

Many outstanding sons of the soil owe their sustenance to the Barbados School Meals Program piloted in 1963 with six primary schools. (Posted by David Jan 25, 2010, http://bajan.wordpress.com

reading

School feeding programmes which seek to reach and feed all children already exist; however in places where they are most needed they are often too small, unsustainable and unable to offer nutritious food. In the same communities, small-holder farmers, often unable to reach a market, struggle to make a living selling their food (Conway, 2012).

As a safety net, school feeding offers an incentive for households to send children to school, providing them with an education, while also reducing shortterm hunger and improving nutrition and health through quality fortified food. School feeding is also a platform for several other developmental outcomes. (WFP 2009)

Should Government get involved in school feeding programmes (SFP)?

The answer is not a simple yes or no; nor should it be a vague maybe! Why? For the simple reason that once a decision is made to intervene in school feeding, it must be backed by firm policy and institutional structures that support and enhance the efficacy and efficiency of the intervention. In a 2009 report, the World Bank strongly advised governments to be very clear as to the objectives and results expected from SFPs in the context of their countrys specific development goals, national policies and socio-economic situation. Although several Caribbean governments have made some inroads in improving standards of living and their human development indicators, the pervasive challenges of rising poverty, increasing proportion of working poor and under-nutrition still exist. Children are amongst the most vulnerable group. By intervening in school feeding programmes alone, Governments are provided the opportunity to simultaneously positively impact 3 of the 8 Millennium Development Goals (MDGs); namely: Goal 1 ending poverty and hunger; Goal 4 Child health, through access to nutritious food and education to attain higher-earning jobs; and Goal 2 Universal education by encouraging school attendance by poor/vulnerable families.

The Regional Food and Nutrition Security Policy (RFNSP, 2010) recognised that Early
Childhood Learning Centres, primary and secondary schools provide an entry point for interventions to prevent/control some of the identified nutrition conditions and influence food tastes and preferences. It was clear about the need to include training on good nutrition practices (particularly breastfeeding and Young Child Feeding) in teacher training colleges and pre-school, primary and secondary level curricula. Among key actions proposed include developing policy and guidelines on:- school health and nutrition to guide school meal preparation and foods allowed to be sold in schools; relative proportion of local food content; school gardening and promotional campaigns to encourage healthy and nutritional food choices, to ensure that children receive adequate levels of micro-nutrients.

Nursery children benefiting from Government's school feeding programme.

Source: http://www.gina.gov.gy/archive/daily/b110813.html

There is need for product development and transformation to meet consumer requirements for safe, nutritious and convenient foods is essential. This relates especially to options for marketing healthy foods to children and (in particular) their parents.
(Helen Constance Robertson, Director of School Feeding Programme, Ministry of Education, Jamaica (ART 2011))

SFPs can influence healthy food choices!

Experiences in the Caribbean with early SFPs indicated that food choices among children were shifting towards a food culture different from traditional eating patterns and in some cases, these SFPs inadvertently contributed to the evolution of poor nutrition choices and eating patterns. This was because these programmes were very dependent on the generosity of international donors, with the school meal consisting of mainly white flour bread, cheese or butter and skimmed milk. According to one Caribbean advocate, these early SFPs were founded more on the belly full than a healthy fed philosophy. Despite the relative costs and driven by concerns over rising prices of imported foods, practitioners are increasingly exploring options for increasing the local content of school meals and regulating foods that are sold in schools. E.g., in Grenada, there is a concerted effort to ensure that children are fed a balanced meal from the six food groups, including use of available local foods. While in Trinidad, more than 50% of the meat is imported, vegetables used in school meals are 100% local. If guidelines are well established, if meals are prepared through innovative and creative uses of local foods, and with the support from parents and complementary nutrition and health policies, over time, SFPs will influence food choices towards a healthy and balance option of local and imported foods.

Policy Intervention Critical Control Points (PICCP): building blocks.

The HACCP concept (Hazard Analysis Critical Control Point) can be applied to define the building blocks for using SFPs as a tool to influence healthy food choices among children. The Hazard: Feeding local Minister of Agriculture and Fisheries, Hon. Roger Clarke, said the Ministry will be working with farmers to get more local produce into the National School Feeding Programme to reduce cost and improve the nutrition of students. Our farmers are going to be asked to work in clusters to provide some of the nutrition for our school children. We (are) going (to) stop them from drinking bag juice and eating cheese trix. We want to give them some real Jamaican foods, Jamaican fruits
Agriculture Ministry to get more local produce into schools June 8, 2012 by Chris Patterson, JIS Reporter. www.jis.gov.jm/news/list/30875

The emergence of CNCDs in children and youth populations in the Caribbean is alarming and is a risk to development! As we move into a global knowledge economy, human capital development represents one of the most lucrative avenues for development. For small developing states, with few natural resources, human capital will come to represent a major resource for sustaining development. Being unhealthy limits the ability to work productively and/or the ability and incentives to invest in human capital. Hunger and ill-health compromise the capacity of children to learn! An uneducated and unskilled youth population is unproductive and will compromises development! The Analysis:

A 2010 survey of Body Mass Index (BMI), conducted by the Caribbean Food and Nutrition Institute (CFNI)/PAHO), revealed that childhood obesity is on the rise in Trinidad and Tobago. Approximately a quarter of primary and secondary school age children, (24.6%), in Trinidad and Tobago are overweight or obese. The school based Diabetes Screening project being conducted by Prof. S. Teelucksingh further revealed the existence of Type II Diabetes, often referred to as adult onset Diabetes, in school aged children. Overweight and obesity are risk factors for Type II Diabetes. These are indicators that the current chronic disease epidemic is only going to worsen if critical preventive and health promoting action is not taken urgently. (www.news.gov.tt)

The RFNSP confirmed that many Caribbean countries are experiencing a shift in nutrition patterns that has resulted in increasing rates of obesity, which in turn has contributed to an increase in nutrition-related CNCDs including diabetes and hypertension. In the last decade, CNCDs, described as a major public health enemy have become major causes of illness and death in the Caribbean. These diseases are reported to consume the largest percentage of financial and human resources allocated to the health sector. It is estimated that by 2020, deaths from CNCDs in the Caribbean could double, affecting particularly, the poor, disadvantaged and vulnerable, including children. CFNI reported that in various Caribbean countries fat and obese children account for as much as 15% of their population group. Research has linked rising obesity rates to related increases in consumption of fatty foods, snacks, soft drinks, high-energy foods and drinks. Sugar and fat are strongly implicated in this worrying trend. Prof. Teelucksingh advised that with the chronic disease we have to move away from the medical model. It applies to acute illnesses; we need to change from the medical model to a sociological model.1 School feeding is a critical element of this sociological model and response. This is well recognised in the Caribbean, where SFPs emerged out of efforts of both public and private, including religious, groups and organizations, to assist in the cognitive development of children, especially the under privileged.

Targeted Regional Response to Public Health Enemy Number One - CNCDs by Lisa Bayley; Caribbeannewsnow.com; Last Update: Oct 25, 2010. http://www.islandjournal.net
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We have million children in schools; almost 900 schools; about 15,000 teachers. We provide meals to schools via 97,173 lunches and 56,000 breakfasts every day. School kitchens and cafeterias are also being examined, including if soft drinks should be sold in schools since there are about 450 calories/ soft drink. If we start the education right here in schools, we can impact almost million of our population with the right education. This is then spread to the wider society since interventions at the school-aged stage will result in life-long lessons being learnt.
(The Hon. Dr Tim Goopeesingh, Minister of Education, Trinidad and Tobago. August 30, 2011. www.news.gov.tt) Teach a child to farm, and he will feed himself. (Photo: Raynard Burnside, The Bahamas)

Some Critical Control Points:

8 Standards for Quality and Sustainable SFPs Standard 1: Sustainability Standard 2: Sound alignment with the national policy framework; Standard 3: Stable funding and budgeting; Standard 4: Needs-based, cost-effective quality programme design; Standard 5: Strong institutional arrangements for implementation, monitoring and accountability; Standard 6: Strategy for local production and sourcing; Standard 7: Strong partnerships and inter-sector coordination; Standard 8: Strong community participation and ownership (Source: WFP 2009)

Know the Basics! A critical starting point must be a determination of the nutrition needs of children, an assessment of whether such needs are adequately provided in the homes. Based on these results, then an identification of the most vulnerable and the definition of a mix of options and tools to alleviate hunger and under/malnutrition among children. School-feeding, if done right, is one to directly address the problem. The World Food Programme (WFP) offers 8 Standards as guides for building quality and sustainable SFPs. The WFP advises that these standards are also relevant for governments and NGO partners in the design and implementation of high-quality, sustainable and relevant SFPs. It is important that the transition to sustainable, nationally owned programmes requires that school feeding be mainstreamed in national policies, strategies, programmes, financing mechanisms and administrative structures. The United Nations Educational, Scientific and Cultural Organization (UNESCO), also provides a Toolkit that sets out seven step-by-step guidelines that will enable teachers and administrators to enhance the impact of SFPs on education. The guidelines include sections on a rationale for addressing nutrition and health issues for schoolchildren, the potential benefits of SFPs for education, and recommendations for building up effective SFPs as an integral part of a package of nutrition and health interventions for schoolage children.

Involve Parents! Moving from the medical to a sociological model begins with parents, particularly mothers and continues with the school system. Parents play an essential role in helping shape children's eating habits. However, as recognised by Eleanore Lambert of the Dominica Food and Nutrition Council (DFNC) there are different varieties of parents. This is simple and yet profound in its meanings and implications for policy. Partnering with parents us key and must recognise the need to also re-educate and enable access to healthy food choices for the parents and by extension, the family. Some simple parenting tips to help children eat well and learn to enjoy nutritious foods include accentuating the positives, i.e., focus on eating nutrient-rich foods instead of what not to eat and using Use positive messages that let children know that all foods fit into a healthful diet; there are no "good" or "bad" foods. The key is moderation. 2 This reinforces the call by Lisa Hunt, Nutritionist, Ministry of Health, Saint Lucia that in promoting foods for healthy choices, people need to understand WHY; dont give them half the story! For any long-term nutrition security solution, cultivating good eating habits in the home was a good and essential place to start and build from.

The health of the region is the wealth of the region

Achieving such health can only be built and sustained by nurturing healthy food choices in children. Parents: know your child's changing nutrient needs for their early life health. Basic nutritional needs should be met both at home and school. Parents should: Offer 5 servings of fruits and vegetables a day Choose healthy sources of protein (e.g. lean meat, nuts and eggs) Serve whole-grain breads and cereals because they are high in fibre Broil, grill or steam foods instead of frying them Limit fast food and junk food Offer water and milk instead of sugary fruit drinks/sodas

Start young! It is virtually a universally accepted conclusion that children are truly ground zero where nurturing a culture of healthy eating are concerned. What is not yet universally accepted is the notion that children should be fed by schools (through government intervention), as opposed to in schools and in homes (provided for by families). However, evidence from around the world and in the Caribbean provides a strong enough case for government-led school feeding programmes. There is also strong recognition that good health, starts with good feeding at the early life stage from the womb through to the formative years - at least in the twenties! As more and more young children are being afflicted with lifestyle diseases previously thought to affect only adults, the need to intervene from young have become absolutely critical. There are no short-cuts or substitutes! School feeding programmes are therefore an important tool/vehicle to tackle child health and by extension, nurture a culture of healthy food choices for lifelong health benefits. The immediate need for SFPs is to feed hungry children and get poor/vulnerable children into the schools, to provide them with education and as a place to get them fed, as well!

More tips can be found in U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary Guidelines for Americans, 2005. 6th Edition, Washington, DC: U.S. Government Printing Office, January 2005, http://school.fueluptoplay60.com/tools/nutritioneducation/view.php?id=23945657
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The right to food is universal!

ALL families should be afforded

the resources and capacity to exercise this right!
Build Bridges! Nutrition is the bridge between agriculture and health.3 SFPs provide an enviable opportunity to teach and enhance understanding of the concept of nutrition and its importance to good health and to instil, reinforce and nurture a culture of healthy food choices from young. Therefore, enhancing understanding of the nexus between agriculture food production and health via nutrition is also critical. For Caribbean countries, food production policies have generally not been informed by nutrition policy. In fact, nutrition policy itself has been weak, within the context of an overall health and wellness policy. The former Caribbean Food and Nutrition Institute (CFNI) has promoted the food group approach to a healthy diet, built on balancing intake of foods categorised into six groups.

Maroon child in Asigron, an agriculture community in the Suriname interior (Photo: Maureen Silos)

Importantly, these six groups emphasised foods that have traditionally been produced in the region. Despite these efforts, the bridge between agriculture food production - and health nutrition- continues to be incomplete in some areas, and disconnected in others. For example, while the region produces a diversity of fruits at affordable prices, consumption of fruits is way below the recommended daily intake. Also although the region is no longer a large producer of oils and fats (90% of these products are built on imports of soya bean and other imported oils), consumption of fats has been measured to be excessive. And while a few countries are major producers of sugar (an important export industry), sugar is nowhere listed as a major food group, yet consumption is also excessive! Excessive consumption of the latter two foods is strongly associated with the rise of CNCDs. Understandably, there is the desire to also use school feeding programmes as a vehicle for stimulating sales and growth in local food production. While important, the experiences of several Caribbean countries indicate that making the SFP-local agriculture link is fraught with challenges. This is partly because in todays globalised world, the healthy food choice can no longer be constrained by, or conditioned on only what is produced locally. This is especially because healthy locally produced food choices either continue to be offered in a manner that does not inspire consumer acceptability, or priced out of the income bracket of a large segment of the population, or they are either just not available on a consistent enough basis to build consumer loyalty. Despite these challenges, there is great value in building bridges between agriculture and health by firmly integrating nutrition imperatives into SFPs and by investing in production, distribution, promotion and marketing of foods within the six food groups that can be supplied by the region.

European food and nutrition policies in action / edited by Nancy Milio and Elisabet Helsing, European Series, No. 73; ISBN 92 890 1337 0. http://www.euro.who.int
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Nurturing Healthy Food Choices School Feeding

Bottom Line

Children eat with their eyes!! Healthy food choices must be nurtured, from young, starting in the homes and continuing at pre-schools, primary and secondary schools. All families are not equal. There are several under-privileged children living in Caribbean communities with limited access to food and unable to make healthy food choices. Some form of Government intervention is both expected and necessary. In most countries, a direct intervention is school feeding (SFP) a vehicle to both feed hungry bellies and fuel healthy bodies. SFP is a strategy to directly impact at least 3 socio-economic development goals starting at ground zero under-privileged and vulnerable children: (1) alleviating their hunger and malnutrition; (2) improving child health and well-being and (3) providing them with access to education. Good parenting, which nurtures and provides healthy choices, is the best first option.

Recommended Readings:
:

Bleakley, H. 2010. Health, Human Capital and Development; Annual Review of Economics. <http://popcenter.uchicago.edu/pdf/arec18.pdf> Buhl, A. 2011. Meeting Nutritional Needs Through School Feeding: A Snapshot of Four African Nations. www.gcnf.org/library/Meeting-Nutritional-Needs-ThroughSchool-Feeding.pdf Fan, S. and Brzeska, J. 2011.The Nexus between Agriculture and Nutrition: Do Growth Patterns and Conditional Factors Matter? 2020 Conference: Leveraging Agriculture for Improving Nutrition and Health. www.ifpri.org Hawkes. C. A. and Ruel, M.E. 2011. Value Chains for Nutrition - 2020 Conference: Leveraging Agriculture for Improving Nutrition and Health, February 10-12, 2011; New Delhi, India. Conway. Sir Gordon, 2012, Investing for the Future with Home-Grown School Feeding, Huffington Post, February 7, 2012; World Bank, 2009, Rethinking School Feeding - Social Safety Nets, Child Development and the Education Sector, by Donald Bundy, Carmen Burbano, Margaret Grosh, Aulo Gelli, Matthew Jukes, and Lesley Drake- ISBN: 9780821379745, World Food Programme, 2009, Feed Minds, Change Lives -School Feeding: Highlights and New Directions http://documents.wfp.org/stellent/groups/public/documents/newsroom/wfp204 709.pdf United Nations Educational, Scientific and Cultural Organization (UNESCO), 2004, Guidelines to Develop and Implement School Feeding Programmes that Improve Education FRESH Tools for Effective School Health First Edition 2004. http://www.unesco.org/education/fresh

Research/ Content: Editor:

Brent Theophille Jeanelle Clarke Diana Francis

The views and opinions expressed herein, errors and omissions are those of the author and not necessarily those of Inter-American Institute for Cooperation on Agriculture (IICA), the Technical Centre for Agriculture and Rural Cooperation (CTA) or the Caribbean Regional Agricultural Policy Network (CaRAPN) an IICA-CTA initiative in the Caribbean.

E-copy available on: www.pn4ad.org