- Author: Mike Hsu
Researchers contribute recommendations for national strategy on hunger, nutrition, health
At the first White House Conference on Hunger, Nutrition and Health convened since 1969, President Biden announced on Sept. 28 a national strategy “to end hunger in America and increase healthy eating and physical activity by 2030 so fewer Americans experience diet-related diseases.” Much of the foundational research undergirding the strategy has been informed in part by the Nutrition Policy Institute, a program of UC Agriculture and Natural Resources.
“Science is the work of many – and no one study answers all the questions – but we have a tremendous body of work that has contributed to this conference, building from all the programs and changes that were made from the last conference,” said NPI director Lorrene Ritchie.
The original Nixon-era conference produced about 1,800 recommendations – and 1,600 were eventually implemented in the subsequent years, according to Stacy Dean, U.S. Department of Agriculture Deputy Under Secretary for Food, Nutrition and Consumer Services.
A litany of far-reaching programs grew from or were propelled by the 1969 conference: the School Breakfast Program, WIC (the Special Supplemental Nutrition Program for Women, Infants and Children), SNAP (the Supplemental Nutrition Assistance Program)-Ed and CalFresh Healthy Living UC, the Expanded Food and Nutrition Education Program, and more.
This history illustrates the potential for sweeping change from this 2022 conference – which gathered about 500 experts and advocates (with 1,000 more participating online) – and from the national strategy that represents the Biden-Harris administration's “playbook.”
“Does that document have everything in it that we would like? No – but, oh my goodness, if we could accomplish all the things that they've laid out, what a transformational impact it would have,” said Ritchie, adding that she was thrilled that the highest levels of government are prioritizing hunger and nutrition-related chronic disease.
Including beverages in the conversation
In the course of gathering ideas and input from across the country, conference organizers asked Christina Hecht, NPI senior policy advisor, to author and submit NPI recommendations on encouraging the public to choose water instead of sugary drinks. Those suggestions – which range from including water in the “MyPlate” dietary guideline graphic to ensuring that every public school has a water bottle-filling station – crystallized extensive, rigorous scholarship by a broad community.
“NPI's recommendations were built on lots of work by many water researchers and advocates over the years; they're based on many years of thinking by many people,” Hecht said.
Christina and Ken Hecht, NPI policy director, also submitted recommendations as part of the Sugar-Sweetened Beverage Reduction Workgroup, which brings together experts from national, state and local organizations. Several of their key proposals, such as targeting the marketing of sugary drinks and clarifying front-of-package nutrition labels, appear as recommended steps in the national strategy document.
Other nutrition policy changes compiled by Christina Hecht – like updating the Federal Food Service Guidelines used on federal properties and in federal programs – are also reflected in the national strategy, albeit without specifically mentioning sugary drinks. Nonetheless, Hecht believes doors have been opened for future discussions that could incorporate and promote healthy beverages.
“What those doors require are continuing to develop the evidence base, continuing to translate and share the evidence base, and continuing the advocacy to bring that evidence base to the attention of decision makers,” she said.
University of California setting an example
Suzanna Martinez, an NPI-affiliated researcher who attended the White House conference, said she hopes the convening generates momentum for two bills before Congress that would help alleviate food insecurity in higher education: one that provides funding for campuses to address students' basic needs, and another that reduces barriers to SNAP (Supplemental Nutrition Assistance Program, formerly known as food stamps). The national strategy document explicitly acknowledges that “SNAP's college student eligibility restrictions are out of date given the current population who seek higher education credentials.”
Martinez, an associate professor in the Department of Epidemiology and Biostatistics at University of California San Francisco, was invited to the conference because she's part of a group driving the UC's effort to halve the number of students facing food insecurity across the system by 2030. That commitment, and UC Berkeley's work on basic needs, were highlighted by Second Gentleman Douglas Emhoff during the closing plenary session.
“The work that we're doing here in California tends to set the stage for what happens in other states,” said Martinez, who also cited California's pioneering effort to provide meals for all public school students.
NPI's ongoing work evaluating universal school meals in California and other states is just one example of how its academics and staff are refining innovative programs so they can be adopted more effectively and broadly (perhaps nationally). In fact, the White House identified “healthy school meals for all” as the top strategy for improving food access and affordability, and Ritchie applauds the administration's consistent emphasis on early interventions for healthier outcomes.
“The earlier you can create healthy habits – meaning in utero all the way through childhood – the more likely you are going to have adults who don't end up with nutrition-related chronic diseases,” she explained. “The last thing you want to do is to wait until people are really sick before they start to change their habits.”
Another overarching theme that excites Ritchie is the national strategy's “whole of government” approach to addressing a host of nutrition and hunger issues. One example is how the strategy calls for agencies not traditionally associated with food to contribute to reducing waste, such as the Department of the Treasury clarifying tax benefits for businesses that donate food.
“Throughout the document, over and over again, there are countless examples of creating synergies across government agencies and with local and state governments that can help move the needle,” Ritchie said. “It's just this kind of bold call to action that we really need.”
- Author: Mike Hsu
Partnering for California
As the gravity of the COVID-19 pandemic hit communities across the U.S. in mid-March 2020, the policy team at UC Agriculture and Natural Resources' Nutrition Policy Institute received an urgent email from a longtime partner in the San Joaquin Valley.
“It was simply entitled ‘help' in the subject line – with multiple exclamation points,” said Christina Hecht, NPI senior policy advisor.
The colleague was writing on behalf of community groups concerned that pandemic-related school closures would jeopardize school meal programs – a nutritional lifeline for children in a predominantly agricultural region with many low-income households.
Hecht immediately contacted a frequent collaborator, Dr. Anisha Patel, an associate professor of pediatrics at Stanford University. To help school districts continue those essential meals during the fast-approaching spring holiday, they quickly produced a fact sheet, “Kids' Hunger Doesn't Take a Spring Break,” sharing tips and resources for the districts.
Then, as the pandemic evolved throughout 2020, the U.S. Department of Agriculture and California Department of Education continued to issue a flurry of waivers and guidance updates. To keep pace, the authors produced three more fact sheets to help districts digest the information and adapt and sustain their school meal programs.
“We tried to make a really user-friendly resource that would help districts sort through everything they needed to do, and easily discover resources for best practices,” Hecht said.
Their efforts attracted the attention of the School Nutrition Association, a prominent nonprofit representing more than 50,000 members who provide meals to students across the country. The organization co-branded general versions of the fact sheets and distributed them widely through its website.
Gathering community perspectives on school meals
Those resources represent just one way that lessons from the San Joaquin Valley experience are shaping the national conversation on school nutrition programs. Cultiva La Salud and Dolores Huerta Foundation – health equity and social justice organizations based in Fresno and Bakersfield, respectively – approached the researchers to study ways to boost participation in school meal programs and address food insecurity in their largely Latino communities.
“Working alongside Stanford and NPI is crucial in expanding our capacity and ability to use data and research as a tool to empower parents to advocate for improved health and wellness policies and practices,” said Cecilia Castro, deputy director of Dolores Huerta Foundation, which works in Kern, Fresno and Tulare counties, as well as Antelope Valley in Los Angeles County.
To better understand the “barriers and facilitators” to meal program participation, Hecht, Patel and their collaborators – including student trainees who were eager to learn about community-based participatory research and wanted to help their local communities – sought the perspectives of school district administrators and staff, community groups and parents.
Through the relationships nurtured by Cultiva La Salud and Dolores Huerta Foundation, the researchers convened focus groups of parents with children in six school districts across the San Joaquin Valley.
“We needed to understand better what helped and hindered families from getting the school meals,” Hecht said.
According to Castro, parents have leveraged their feedback to advocate for increased access to school meals, through the use of buses for meal delivery and changes to meal pickup times and locations.
“This engagement has validated the lived experience of our communities,” Castro said. “It has provided an additional strategy for parent leaders to use in efforts to engage decision-makers about ways to improve quality and access to school meals.”
Another key takeaway from these conversations is that the parents are deeply concerned about the content and nutritive value of the meals served to their children.
“We learned that although school meals meet nutrition standards, parents are not aware of this,” Patel said. “Parents also worry about the healthfulness of school meals, noting heavy processing and added sugar. Most compelling was that parents want to provide feedback to improve school meal appeal and healthfulness but have no way to act.”
San Joaquin Valley voices reverberate
The Nutrition Policy Institute played a crucial role in bringing the parents' perspectives to legislative staffs at the state and federal levels, through the production of four policy briefs that center the voices of San Joaquin Valley residents. In the first, “School Meals: Kids Are Sweeter with Less Sugar,” one parent says: “Children cannot sustain themselves on treats that give pure sugar…They give with the best intentions, but less food would be better, but better quality and healthier.”
“One of the most rewarding parts of all this work has been seeing how meaningful it has been for the parents in the San Joaquin Valley to see their voices getting carried all the way to Washington, D.C. by these policy briefs,” said Hecht. “And it was so meaningful for them that Cultiva La Salud had the briefs translated into Spanish so that the parents could actually read their own words.”
Their voices joined a chorus comprising over 200 organizations who called for universal school meals across California. In June, the state became the first in the nation to adopt a policy, starting in the 2022-2023 school year, to provide free meals for all K through 12 public school students, regardless of family income. Momentum continues to build on the national scale.
The next step for the team is to explore ways to make school meals even more appealing to potential program participants in the Latino communities of San Joaquin Valley. Patel said they will draw on the expertise of Szu-chi Huang, associate professor of marketing in Stanford's Graduate School of Business.
“Using a participatory approach, we will work with parents and school officials to design an intervention focused on communicating the benefits of school meals, and test strategies to improve the appeal of school meals,” Patel explained. “Then we will examine how that intervention affects parents' satisfaction with school meals, students' participation in meals and food insecurity.”
Those insights will be another valuable result of a unique partnership – spurred by a call for help and galvanized by the ongoing health crisis – that continues to benefit families across California.
“Our partnership has been very unusual and very fruitful because we had policy experts, we had research experts and trainees, and then we had the organizations actually working in the community,” Hecht said. “And as we look back on it, it's hard to imagine working that successfully without that kind of partnership.”
- Author: Jeannette E. Warnert
The first study of California law that requires schools to test tap water for lead found that the majority completed the testing on time, and only 3% reported any tested taps with lead in the water higher than the state's 15 parts per billion (ppb) limit. About 30% of the 240 randomly selected public schools in the study didn't report their results within three months of the deadline.
The study, Water Safety in California Public Schools Following Implementation of School Drinking Water Policies, was published in the January issue of Preventing Chronic Disease, a Centers for Disease Control and Prevention online publication.
Christina Hecht of the UC Nutrition Policy Institute, one of the study's co-authors, said she was heartened by the results, and acknowledged there is more work to do.
“Because we strongly encourage people to drink water rather than sugary beverages, we need to have confidence that tap water is safe,” she said. “But this is a complex issue with shared responsibility among public water systems, school administrators and regulating agencies.”
Access to safe drinking water in schools is essential to help avoid the developmental and health consequences for children associated with consuming contaminated water, under hydration or excessive intake of sugary beverages.
Schools that get water from public utilities can expect the water they receive to meet federal and state water quality standards. However, 16% of study schools received water from a utility that violated health-based standards, such as elevated levels of contaminants or failure to adhere to disinfectant protocols. When water flows into buildings through pipes that contain lead – such as those made entirely of lead, or galvanized iron or leaded brass, or connected with lead solder – and especially when water sits stagnant in lead-containing plumbing, lead may leach into the water before it flows from the tap.
In October 2017, California passed Assembly Bill 746, which mandated that public water utilities sample and test for lead in tap water of public schools that were built before 2010. The law is designed to identify and mitigate sources of lead in water. Funds to upgrade school drinking-water plumbing were also earmarked in the state budget. Working with their local water suppliers, the schools selected taps for sampling. The number of taps that released water with lead was very low, and even those sources are not necessarily unhealthy for drinking, Hecht said.
“When we test tap water, we're not talking about every drop of water that comes from the tap,” she said. “We test the first water that comes out of the tap after it has been stagnant in the pipes. Once the taps are in use and water is flowing, the lead level should drop dramatically.”
Although few schools (3%) had even one tap in violation of California state standards for lead, violations increased to 16% when the federal Food and Drug Administration standard for bottled water was applied. The FDA requires that bottled water not exceed 5 ppb of lead.
The 174 schools in the study collectively tested 1,238 independent water sources – such as playground, hallway and gym drinking fountains, classroom faucets, food service areas and restroom taps in 2019. Some of the tests took place in locations that serve staff, such as teachers' lounges, nurses' stations, distribution sources and maintenance areas. Without detailed guidelines to follow, some schools tested only 1 tap; others tested as many as 76.
“Testing only a subset of taps in a facility prevents full identification of which schools need to undertake lead remediation actions,” Hecht said.
Hecht and her co-authors – Isioma Umunna, Anisha Patel and Lauren Blacker of Stanford University, Marc Edwards of Virginia Tech, and Emily Altman of UC Berkeley – conclude that, in the future, states should require schools to test to nondetectable levels of lead for maximum data collection and require that at least one water source in food service areas be tested.
The information and recommendations from the study are already informing California legislation designed to protect children from lead exposure from water. A new law, Assembly Bill 2370, will require all licensed childcare centers to test taps for lead by 2021 and every 5 years thereafter. The inconsistencies experienced in AB 746 compliance revealed the need for detailed guidelines on the number of taps facilities should test, the required locations for testing, clear naming conventions to identify taps and reporting procedures.
