Running head: COMMUNITY HEALTH EVALUATION PRESENTATION 1

Community Health Evaluation Presentation

Elaine Dean

Jacksonville University

April 3, 2017
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Community Health Evaluation Presentation

Introduction/Overview of Program

The national school lunch program (NSLP) is a federally funded meal program that

operates in approximately 100,000 thousand public and not-for-profit private schools throughout

the United States. The program provides free or reduced nutritionally balanced meals to more

than thirty-one million children K-12 (NSLP, 2013). Children participating in aftercare and

enrichment programs are also provided snacks as a part of the program. At the federal level, the

program is administered by the United States Food and Nutrition Service. In each state, the

program is administered by the education agency. School districts that participate in the NSLP

receive cash subsidies and entitlement foods from the United States Department of Agriculture

(USDA) for each meal served. In return, the school must serve meals that meet nutritional

standards based on the latest dietary guidelines, develop strategies to contain competitive foods,

and establish realistic wellness policies (NSLP, 2013). The Healthy Hunger-Free Kids Act which

was signed into law on December 13, 2010, initiated the most significant investment and change

in the nutritional quality of the school meal program in over three decades (Wootan, 2012)

thereby challenging a change in the nutritional landscape in promoting health, wellness, and

disease prevention.

Assessment and Extent of the Severity of the Problem

The health of our nation’s children has been an area of concern for some time. A casual

observation at any school playground reveals a high percentage of overweight children. The

physical education period shows young kids easily fatigued while running around the

playground, then reach for an equally non-nutritional food or snack. Obviously, these children

are at a disadvantage and their health is compromised. Since 1980 the number of overweight and
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obese children have tripled. Between 2011-2012 16.9% of children and adolescents aged two to

nineteen were obese and 31.8% were either overweight or obese (Peek, 2016). These children are

at significant risk for disease processes such as cardiovascular disease, diabetes, fatty liver, high

cholesterol, hypertension, insulin resistance, and sleep apnea. However, childhood obesity also

extends beyond just physical health. Studies have made a connection between obesity and mental

issues, poor academic performance, and poor psychological performance. It also showed that

these children are prone to have a higher number of absentee school days in comparison to their

normal weight counterpart (Peek, 2016).

Monitoring Program Outcome

The NSLP provide increase access to healthy nutritious foods that promote health and

wellness to all students at risk for obesity and chronic disease, students of low-income families,

and all other eligible students. Supported by HHFKA and other community efforts it is aimed at

curbing hunger in school, improve nutrition, and help to combat the national epidemic of

childhood obesity. The NSLP follow the established guidelines for all foods sold in schools. The

program mandates certification and training of all food services personnel to ensure compliance

and the integrity of established food safety standards, nutrition, and health. The United States

Department of Agriculture participates by supplying entitlement foods including fruits and

vegetable and uses evidence-based nutritional data to set standards for competitive foods which

are energy dense and of poor nutritional value

Determine if Program Resulted in Desired Change

In January of 2011, the USDA issued new nutrition standards for the NSLP based on

recommendations from the Institute of Medicine and the dietary guidelines for Americans. This

was superior compared to meals served prior to this initiative. The current meals consist of
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double the amount of fruits and vegetables, decrease sodium content, limited saturated and trans

fat, adequate caloric values to address both hunger and obesity, and the inclusion of low fat or no

fat milk with meals (Wootan, 2012). Nutritional standards were also placed on competitive foods

such as sodas, cakes, chips, sports drink and candy which undermine healthy diets and compete

with the school meal program. The proposal on competitive foods was crafted as it was seen as a

barrier to participation in healthy food choices and stigmatization of low-income student who

cannot afford them.

Documented Outcome for Program Sustainability

School-aged children consume 35% to 47% of their daily dietary intake in the school

environment (Mobley et al). The availability of foods with low or no nutritional value influences

unhealthy dietary behaviors which are associated with increased chronic disease processes such

as diabetes, obesity, and hypertension. The medical community concurred with policy makers

recommending population-based approaches to prevent these diseases by improving the quality

of foods in the school system. In 2010 the White House reported that it costs more than 150

billion per year to treat obesity-related conditions (Environmental Nutrition, 2010). A task force

was subsequently created to focus on empowering parents, provide healthy foods in schools,

improved access to affordable healthy foods and increased physical activity. Additional

documentation found showed a primary care based obesity intervention program cost an average

of $65,643 per year per child (Wright, 2014). These facts prove that the cost of prevention in

providing health quality foods in schools far outweigh the consequences and treatment of obesity

and its related disease. The NSLP also provide reduces food insecurities that can hinder

development, growth, and learning.

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Accountability in Resources (funding)

The cost of the National school lunch program for the fiscal year 2012 was 11.6 billion

compared to 6.1 billion in 2000 (NSLP, 2013). The additional improvements made after the

signing of the HHFKA was estimated to cost an additional 6.8 billion over 5 years (Wootan,

2012). The USDA provides cash reimbursement to the schools for meals served. For the 2014-

2015 school year, the reimbursement rates were $2.93 for free lunches and $2.53 for reduced

lunches. Children of families below 135% of the poverty level receive free lunches. Children of

families below 185% of the poverty level receive reduced lunches. The students usually pay no

more than 40 cents for reduced lunches (NSLP, 2013)

Revising program Interventions

The NSLP serves 100% fruit juice limited to one serving per day. However, evidence-

based studies show that fruit juice consumption is problematic. For example, 4oz of 100% apple

juice has 13 grams of sugar, 60 calories and 0 fiber whereas ½ cup of apple slices contain 30

calories, 1.5 grams of fiber, and 5.5 grams of sugar. The detail of the scientific evidence is that

sucrose without the fiber component predisposes to metabolic syndrome, fatty liver, and obesity.

The recommended revision is to eliminate fruit juices and provide whole fruits instead. The

elementary school that was evaluated did not have adequate water stations for children to have

water readily available. The milk option was also not encouraged creating a dietary deficiency in

the recommended intake of milk.

Providing information

School meals contribute significantly to the overall dietary intake of school-aged

children. The promotion of balanced nutrition in the school environment provides the student

with the opportunity to make healthy food choices such as increase fruit and vegetable
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consumption in their diet. Stakeholders at all levels are encouraged to continue the effort Policies

and strategies designed to promote and strengthen the school meal program should continue to be

supported (Fernandes, 2013). The provisions under the HHKFA have impacted the food quality

and improve opportunity for health promotion and disease prevention. With this momentum,

there needs to be a program designed for continued adherence to healthy nutrition outside of

active school days to sustain the advances made within the schools.

Reporting of Unintended Effects of the Program

Practices such as not paying for lunches in the lunch line identify low-income students

receiving free or reduced lunches under the NSLP. This result is stigmatization of the student.

Children may also perceive the program as been for poor kids only rather than quality nutrition

for all students.

Meeting Accreditation Requirements

There are no required accreditation requirements for the school lunch program. However,

the Food and Nutrition Services (FNS) is legislatively mandated to monitor program

administration and the operation of its food services (NSLP, 2016). This on-site review provides

a basis to gather data for assessment of the program and to plan for future objectives.
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References

Bhatia, R., Jones, P., & Reicker, Z. (2011). Competitive foods, discrimination, and participation

in the national school lunch program. Government, Politics, and Law, 101(8).

Cooper, C. C. (2016). The child and adult care food program: Nutrition for both ends of the life

cycle. Today’s Dietitian.

Environmental Nutrition (2010). The white house takes on childhood obesity. Nutrition

Newsletter, 33(8).

Fernandes, M. M. (2013). A national evaluation of the impact of state policies on competitive

foods in schools. Journal of School Health, 83(4).

Mobley, C. C., Stadler, D. D., Staten, M. A., Ghormli, L. E., Gillis, B., Hartstein, J., ... Virus, A.

(2012). Effect of nutrition changes on foods selection by students in a middle school-

based diabetes prevention intervention program: The healthy experience. Journal of

School Health, 82(2).

National school lunch program. (2013). Retrieved from http://www.fns.usda.gov/office-

type/child-nutrition-programs

Peek, L. A. (2016). Interventions in childhood obesity. The Clinical Advisor.

Robinson-O’brien, R., Burgess-Champoux, T., Haines, J., Hannan, P. J., & Neumark-Sztainer,

D. (2010). Associations between school meals offered through the national school lunch

program and fruit and vegetable intake among ethnically diverse, low-income children.

Journal of School Health, 80(10).

Wojcicki, J. M., & Heyman, M. B. (2012). Reducing childhood obesity by eliminating 100%

fruit juice. American Journal of Public Health, 102(9).

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Wootan, M. G. (2012). The healthy, hunger-free kids act: One year later. Government Affairs.

http://dx.doi.org/10.1177/194260X11429827

Wright, D. R. (2014). The cost of a primary care based childhood obesity intervention. BCM

Health Services.