Challenging Dogma


...Using social sciences to improve the practice of public health

Thursday, April 26, 2007

“School Wellness Programs” Ineffective at best - Thea Ivester

Childhood obesity is an enormous and growing problem for our nation. According to the National Center for Health Statistics, in 2003-04, 17.1% of children and adolescents between the ages of two and nineteen, which amounts to over 12 and a half million youth, were overweight, and 32.2% of adults (over 66 million) were obese, with almost 5% of adults being extremely obese. (1) In Massachusetts alone, 29% of children and 55% of adults are overweight or obese. Rates of obesity among children have more than doubled in the past two decades. (2) Overweight children are at a higher risk of developing diabetes, asthma, heart disease, depression and low self-esteem. From an educational standpoint, poor nutrition reduces children’s ability to comprehend and learn. On the Federal and State level a number of programs are being enacted in order to address this critical issue.

On June 23rd 2004 Congress enacted the ‘The School Wellness Programs’ Bill which calls “for each local education agency that participates in the school lunch or breakfast program to ‘establish a local school wellness policy’ not later than the first day of the school year beginning after June 30, 2006.”(3) Each state will receive 4 million dollars for local grants and to provide “technical assistance”. Technical assistance being a vague term that is unspecified in the language of the bill is assumed to be for program development. The funding provided by the School Wellness Programs bill is intended to help each school to create and adopt the following policies: goals for nutrition education, physical activity, and other school-based activities, nutrition guidelines selected by a local educational agency for all foods available on each school campus. These program guidelines are meant to be acceptable by the Agriculture Department, school educational agencies, and no less restrictive than the regulations issued by the Agriculture Department, and ways of measuring how well the school wellness policy is being implemented (3).

The School Wellness Programs bill will be ineffective for a number of reasons including the adverse effects of having a flat disbursement of 4 million dollars to each state, the lack of national nutrition guidelines to drive the creation of policies, and the lack of guidelines to insure quality assurance, implementation of policy, the failure to designate a national oversight agency other than a local educational agency to which each school will report its activities.

Problem with Funding- Local Grants and Technical Assistance The problem with the distribution of a flat 4 million dollars per state is that the money unevenly distributes itself in the distribution of dollars per school per pupil. States with larger populations and larger numbers of school age children are not receiving the same amount of money per student as states with smaller populations of school age children. This money should be distributed by the Federal government on a population or per pupil basis to provide for adequate financial assistance for each local educational agency. In the end each school is still fighting for the same amount of grant money, regardless of school and jurisdiction size. As a result of the unequal distribution of grant funding per dollar, per jurisdiction due to population size differences some larger pupil population schools will suffer. I predict a lower number of programs will be created in schools with larger populations. Due to the lack of necessary funding to implement these integral programs, less comprehensive programs will be developed due to the limited dollars available for each particular program. Which in turn will lead to further education disparities in urban and highly populated school settings. Also, if schools and or local educational agencies do not have proper funding, the likelihood of hiring an employee specifically trained, skilled or qualified to implement a school program will lessen. More specifically the probability of schools to designate a teacher or another type of employee from within their current payroll will greatly increase, meaning the students will not receive the proper educational training from a teacher who specializes in that particular form of study.

“Technical Assistance” is also an extraordinarily vague term when used in conjunction with the distribution of funding through local grants. From the bill: “States will be expected to create ‘team nutrition networks’ to provide technical assistance to local agencies and to identify effective programs.” (3) This very unspecified and undefined term is supposed to determine who creates a schools wellness policy. Who is to say that these individuals are even qualified to create policies for the children to follow? Because there are no specific guidelines to enacting the policy from within local, state and regional levels there can be no National standard. From which we can determine that all States will not be held by the same standards of wellness.

No National Guidelines on Physical Activity and Nutrition

The School Wellness Programs policy was not created to mandate guidelines for physical activity, but each local educational agency may determine what they feel is an adequate amount of time for physical fitness, whether it be 45 minutes a day for a physical education class, an after school sport, or 10 minutes of unstructured activity. Because schools are removing recess, this indeterminate amount of time and level of strenuous activity some children are receiving reinforced messages from their schools that promote a sedentary lifestyle. This would be particularly relevant now, at a time when schools are cutting out physical education altogether due lack of space and schoolyard safety issues. It is shown that the majority of our nations young are increasingly inactive, unfit, and increasingly overweight. In the long run, this physical inactivity will increase death rates from cardiovascular diseases. Healthy People 2010, indicates physical activity as one of our nation’s leading health indicators. Without properly regulated school physical activity our nation stands to reverse all “…the decades-long progress we have made in reducing death from cardiovascular diseases and to devastate our national health care budget.” (4) Which negates the efforts of the bill to promote student wellness.

The School Wellness Programs policy also does not address what is considered proper nutrition. The only stipulation mandated by the bill is “Assurances that guidelines for reimbursable school meals are not less restrictive than the regulations issued by the Agriculture Department.”(3) There are no guidelines to specifically address what is considered ‘junk food’ as a whole.

Food and eating styles vary from region to region in the United States, so what a warm California community may deem acceptable for their children to eat at school may not necessarily be the same as what a parent or another adult in a colder Wisconsin community will find suitable for their children. As a result of regional differences in dietary habits some areas of the country will become healthier due to their wellness plans and some will not. Without proper implementation across the entire United States, regions will utilize their standards of ‘good cooking’, which may not be as healthy as what the Federal government would allow for nationally.

Where are School Wellness Programs to draw the line in the removal soda and junk food? The lack of specificity in the guidelines leaves the introduction of unhealthy food to what the local ‘team nutrition network’ deems unhealthy. Without a national guideline for school wellness policies, schools are left to their own devises to implement what they believe is nutritious from their local educational agency. The lack of focus to guide the states in the quality of this bill leaves room for much variance between local educational agencies and what are attainable goals for the whole nation to achieve.

The lack of a national evaluation team leaves school wellness food plans very unregulated. There will be no overall increase in childhood health without national guidelines. It is as arbitrary as saying one community finds all vegan meals satisfactory while other communities find dairy products exclusively nutritious. Regional eating trends may be part of the larger obesity problem, so addressing the district’s needs before developing the policy may return a lopsided result. Thus, requiring the resulting problem to ultimately return to the issue of what the requirements of the policy development team are to be.

Implementation and Evaluation

With respect to the implementing of a policy development team, “Anyone can initiate a process to create a new policy or adopt an existing policy. The law requires (1) parents, (2) students, (3) representatives of the school food authority, (4) the school board, (5) school administrators, and (6) the public to be involved in the process. Make sure you involve everyone that will be affected by the policy.” (5) Dietician and nutritionists are not mandated to work with each ‘team nutrition network’, because policy development teams are not effectively created with education and prior experience in a health field as a mandate, there are no guarantees that schools and education agencies will receive a trained implementer for the required position. Which in turn will result in the hiring of a current school or local educational agency employee to (as I stated before in who is not necessarily qualified) develop and run the policy development or renewal of a local School Wellness Program. Schools are generally operating under strict budgets, and placing and developing additional positions on the payroll will generally be denied as a frivolous expenditure.

Conclusion

Unfortunately, the School Wellness Programs Policy, while a significant and wonderful idea in theory, will not work as it is currently outlined. The policy is ineffectively planned and lacking significant structure and policy implementation to reduce national rates of obesity and to stop the future devastation of our health care budget. Certain areas of the policy must be restructured to provide adequate funding per pupil per state to ensure comprehensive program development. The School Wellness Policy has no nutrition and physical activity guidelines, is not nationally regulated, and is inconsistent not only between states but between cities and towns within the states. The power that is being given to each local educational agency is narrow and pigeonholed in thought, because it has not been clearly defined and regulated to provide equal assistance nationwide. Changes must come from the Federal government in the form of direct policing and regulation of this bill in order to develop suitable continuity between local educational agencies. The largest problem that I find with the School Wellness Programs is the lack of quality assurance. The implementation of a national team to verify that policies have been developed would greatly benefit the entire program and provide the national standard that is so greatly needed. Childhood obesity is an enormous and growing problem for our nation, and policy alone will not correct the problem.

References:

1. National Center for Health Statistics. Obesity Still a Major Problem. Friday April 14, 2006. Available at: http://www.cdc.gov/nchs/pressroom/06facts/obesity03_04.htm

2. Massachusetts Public Health Association. Promote Our Children’s Health Fact Sheet. Available at: http://www.mphaweb.org/documents/SchoolNutritionfactsheet3.28.pdf

3. Health and Health Care in Schools. Congress Gives Schools Two Years to Improve Nutrition/Wellness. July 2004,Vol. 5 No. 5. Available at:

http://www.healthinschools.org/ejournal/2004/july1.htm

4. Healthy You! Promoting Better Health for Young People through Physical Activity and Sports: A Report to the President. Available at: http://www.cdc.gov/healthyyouth/physicalactivity/promoting_health/

5. United States Department of Agriculture. The Local Process: How to Create and Implement a Local Wellness Policy. Available at:

http://www.fns.usda.gov/tn/Healthy/wellnesspolicy_steps.html#step2

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