How a Public Health Goal Became a National Law

Abstract

This case study provides insights into policy strategy and advocacy best practices that resulted in passage of the Healthy, Hunger-Free Kids Act of 2010, a public health law that resulted in improvements to school foods and beverages across the country. Congress reauthorizes child nutrition programs such as the National School Lunch Program and School Breakfast Program every 5 years. The Healthy, Hunger-Free Kids Act of 2010 is the legislation that reauthorized the child nutrition programs through September 30, 2015, and continues in effect today. We conducted stakeholder interviews and reviewed the legislative and regulatory history of the Healthy, Hunger-Free Kids Act of 2010 and advocates’ files. We formed an external advisory committee which helped to develop the interview questions and list of interviewees and reviewed the content of the case study. This case study focuses on the provisions that address the nutritional quality of school meals, snacks, and beverages and covers the period from 2004 to 2016. Overall, the case study demonstrates a number of key lessons to help inform other nutrition and public health policy initiatives, as well as continued implementation and defense of school nutrition. For instance, how advocates used research to develop and advocate for policy change, compromises that were needed to advance the policies, changes in attitudes about school food policy over time, framing and messaging, the role of state and local policy that contributed to national change, and how challenges were resolved between stakeholders.

Impact Of The Healthy, Hunger-Free Kids Act On Obesity Trends

“…Partly in an effort to help address the growing epidemic of childhood obesity, and after years of public health advocacy and research into optimal nutrition standards, 10 the HHFKA changed the guidance for all meals and snacks provided through the National School Lunch Program and School Breakfast Program, aligning these programs—which had not been updated in over fifteen years 10 —with science-based recommendations from the National Academy of Medicine. 11 Specifically, the meal patterns for breakfast and lunch changed to increase the amounts of fruit and vegetables served and limit starchy vegetables; create age-specific recommended serving sizes in recognition of differing calorie needs by age; serve only lowfat or fat-free milk; and serve more whole grains for grain products (only whole grains at lunch; half whole grains at breakfast).…”

“…Despite these public health gains and implementation success, there has been substantial industry and political pushback to the HHFKA, with some organizations claiming that its nutrition standards for school meals and snacks must be weakened in order to reduce supposed food waste and compliance burdens. 10 Within the past several years, whole-grain standards have been relaxed, although this rule change was recently vacated by a federal judge at the US District Court for the District of Maryland. 19 Additional roll-backs, besides the whole-grain standards, have been proposed.…”

Lunch on School Days in Canada: Examining Contributions to Nutrient and Food Group Intake and Differences across Eating Locations

“…65,67 In both Canada 40 and Australia, 63 the majority of children bring a home-packed lunch to school. In contrast, most US schools offer school meals at a low price or at no cost, 68 and school meals offered through the NSLP are required to offer both vegetables and fruit as well as low-fat or fat-free fluid milk daily for lunch. 69 As a result, national-level analyses from US samples suggest that the lunch meal appears to provide relatively higher contributions of vitamins A and D, calcium, and magnesium 27,58 compared with Canadian lunchtime contributions for these nutrients.…”

Changes in association between school foods and child and adolescent dietary quality during implementation of the Healthy, Hunger-Free Kids Act of 2010

“…This limitation is inherent in conducting a national observational study without detailed geographic information; however, the alignment of HHFKA passage and implementation with NHANES cycles gives us confidence that improvements in school foods observed in this study are from the policy of interest. The positive association between school foods and dietary quality in the pre-passage period may be at least partially due to many stateand district-level policies implemented in the decade before HHFKA passage, and earlier advocacy, which together made the HHFKA politically possible (10,44).…”

“…The Healthy, Hunger-Free Kids Act of 2010 (HHFKA) 9 was signed into law on December 13, 2010, directing the United States Department of Agriculture (USDA) to reform national standards for all foods served in schools, 10 better aligning school foods and meal patterns to new dietary guidelines. 11 Hereafter we will refer to “HHFKA implementation” as the period in which new rules were in effect.…”