Issue 3 • 2022
© 2022 The Royal Australasian College of Physicians
lunchbox with healthy vegetables and sandwiches

Food for thought: The effect of school canteen food on children’s health

To be healthy, children need nutritious food and schools are big contributors towards their development. In addition to teaching about the value of nutrition in the classroom, schools are responsible for providing nutritious food in the canteen.
Many schools across Australia and Aotearoa New Zealand appreciate the value of healthier, more engaged students and have implemented healthy food and drink policies. However, there are still schools that don’t appear to understand the importance of nutrition education or the benefit of serving quality and healthy food in their canteens.
Professor Boyd Swinburn, RACP Fellow and Chair of Health Coalition Aotearoa (HCA) says, “The New Zealand government’s Ka Ora, Ka Ako program provides free healthy lunches to a quarter of primary and secondary school students. But a 2016 national survey conducted to evaluate the healthiness of New Zealand school food environments revealed that nutritional policies are weak, and canteen food is generally unhealthy. Two-thirds of primary schools are already ‘water and milk’ only schools. That’s the good news. The bad news is that most school tuckshops, lunch order systems, and fundraising activities are far less healthy.”
Exploring the bigger picture What children eat affects not only their physical health but also their mental development, mood and learning capabilities. And habits that are built at a young age become a lifestyle well into adulthood.
To meet their nutrient requirements, children need to eat a range of foods daily in the recommended amounts from each of the five food groups – vegetables, fruit, cereals, lean meat and milk products. However, according to the 2015 NSW School Physical Activity and Nutrition Survey (SPANS), only 5 per cent of Australian children consumed the recommended amount of vegetables and approximately 39 per cent of total daily energy was derived from carbohydrate-heavy, nutrient-poor items and junk food, such as chips, soda, doughnuts, etc. The report also highlighted other undesirable eating behaviours among children and adolescents, especially snacking on unhealthy foods and skipping breakfast.
Many studies show that, in young children and adolescents, unhealthy food habits lead to an increased risk of obesity, heart conditions, mood disorders and depression, among other health issues. “Sugary, fatty, salty and processed foods seem to give a short lift in mood followed by a longer depressed mood – similar to the pattern of short highs and long lows associated with addictions,” explains Professor Swinburn.
Such food products are part of school canteen menus. The items differ from school to school across different Australian states and territories, but very little is being done to enforce strict regulations.
Sharing the responsibility Children are growing up in an environment where food and drink with high added sugar, salt and saturated fat are heavily promoted and easily available at a low cost. The onus is on parents, educators, government regulators and policymakers, as well as the food industry, to collectively protect the health of children.
Understanding of healthy eating begins at home. Parents have a tremendous responsibility in setting the right examples, providing healthy food at home, and building a routine that enforces healthy eating habits. But children spend a large part of the day at school when they are most active, learning from their educators, engaging with their peers, and consuming food that is available to them. So, it’s the duty of schools to reinforce the value of nutrition at every step while ensuring their nutritional requirements are met while at school.
Parents should take care to pack a balanced diet in their children’s lunches. Schools should ensure that canteen menus provide more greens and protein-rich food, along with milk, water and fresh juices, which are healthier alternatives to sugary and carbonated drinks, such as artificial juices and sodas. Vending machines on school premises and external food trucks should stock healthier foods.
Allergy awareness is just as important. Schools should be aware of the National Allergy Strategy and best practice guidelines. Canteen staff should be trained, have up-to-date information and access to resources to prevent anaphylaxis, and provide children with the necessary care.
Gearing school canteens toward compliance The Australian dietary guidelines provide up-to-date advice about the amount and kinds of foods that children need for good health and wellbeing.
In New South Wales (NSW), all school canteens are required to implement the NSW Healthy School Canteens Strategy and adhere to the norms regarding permitted foods and drinks, allergy management and hygienic food service compliance. These guidelines have been developed in line with the NSW Department of Education’s efforts to reduce obesity rates in children by 5 per cent over 10 years to 2025. NSW categorises school cafeteria food as ‘Everyday Foods’ and ‘Occasional Foods’. Everyday foods are based on the essential five food groups and should comprise 75 per cent of the canteen menu. Occasional foods and drinks are high-energy snacks, that are easily available, but they should be only 25 per cent of the menu.
In Victoria (VIC), Queensland (QLD), Australian Capital Territory (ACT), Northern Territory (NT), Western Australia (WA) and South Australia (SA), school canteens use a traffic light system to categorise foods sold at school canteens into green, amber or red foods according to their nutritional value. Green foods have the most nutrients and are strongly encouraged. Amber foods are provided in moderation and red foods, being energy-dense and low in nutrients, are served rarely. Some red foods are not permitted in canteens, catering at school events, or at fundraising activities.
In Victoria, the School Canteens and Other School Food Services Policy applies to all school food services, including canteens, vending machines, external lunch order services from milk bars or breakfast clubs etc. In the ACT, all school canteens need to follow the National Healthy School Canteen Guidelines and have a food safety supervisor who oversees canteen hygiene. Canteen staff are required to undergo nationally recognised training.
Several state-based organisations partner with schools to promote healthy eating measures for children. They outline strategies aligned with government policies, conduct programs tailored to schools and educate parents through workshops so they can have the know-how and confidence to keep children healthy at home and at school.
Enforcing stronger policy and regulation Australian states and territories have their own set of nutrition policies and guidelines that outline specific criteria and determine what products can be sold in the school canteen. While government schools are mandated to implement these criteria, many independent and Catholic schools are only “strongly encouraged”.
In Aotearoa New Zealand, many children live in low-income households and in communities facing greater socio-economic barriers, and parents often run out of food. The Aotearoa New Zealand government’s Ka Ora, Ka Ako program aims to reduce food insecurity by providing access to a nutritious lunch every day, so children can be healthy and focus on learning at school.
Professor Swinburn says, “The Ministry of Education is converting its food and drinks guidelines into regulations to take effect next year and the Government had an excellent opportunity [to] ensure they aligned with its Child and Adolescent Wellbeing strategy, Healthy Eating Guidelines, healthy food criteria for Ka Ora, Ka Ako, and the new Pae Ora health system which is supposed to prioritise prevention.”
However, the Minster of Education, Chris Hipkins, opted for the weakest possible regulations, creating a massive policy incoherence. Schools will now have mandates to promote healthy food and drinks, but when it comes to the provision of food and drinks, such as in canteens or for fundraising, there is no mandate for them to be healthy.
“This is not enough,” adds Professor Swinburn, who believes that stronger, clearer, equitable and action-oriented government policy is the need of the hour. “The kids are taught about healthy eating in the classroom but fed junk in the tuckshops. This doesn’t make sense because actions speak louder than words.”
Closing the gap, raising the bar There is legislation across Australia and Aotearoa New Zealand to prioritise children’s health in schools, but there are several drawbacks in the system as well. These need to be addressed so as to close the gap and represent children from all communities, age groups and demographics.
“The biggest gap for healthy food and drinks policies is in secondary schools”, highlights Professor Swinburn. According to the 2020/2021 NZ Health Survey, adolescents are more frequent consumers of unhealthy drinks – 17 percent of 10–14-year-olds compared to 8 per cent of 5–9-year-olds consume fizzy drinks at least three times a week. Due to unhealthy food habits, they are more prone to mental health issues and depression. Therefore, national policies should create more holistic and healthier school food environments with a real focus on secondary school students.
He adds that the government also has an obligation to implement Te Tiriti o Waitangi. It is currently failing in its obligations to ensure that Māori children have the same rights and protection as other New Zealander school children. Long-standing structural and historic inequities in New Zealand society have disadvantaged particular groups.
Moreover, COVID lockdowns have had serious consequences for children’s health across all communities. Parents, schools and the government have to work together extra hard to support children through the post-pandemic period. “There have been huge spikes in obesity levels, mental health problems and disengagement from learning,” stresses Professor Swinburn. “It’s crucial for the government to get a Child Wellbeing Recovery Package underway.”
Professor Swinburn teaches Population Nutrition and Global Health in the School of Population Health, University of Auckland. As the Chair of HCA, he aims to provide a collective voice and expert support for effective policies and actions to reduce harm, through a focus on the determinants of health. HCA promotes the health of all New Zealanders, especially children, and endorses healthy food and drink policies in all schools and early learning services.