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Access to healthy food: Are schools the solution?

In 2012-13, according to data from the NC Department of Public Instruction, 56 percent of the student population in schools across North Carolina qualified for free or reduced price lunch. In 95 of 115 school districts, more than 50 percent of the students qualified for free and reduced price lunch. In Halifax County Schools, 93.45 percent of the students qualified for free and reduced price lunch. Statewide, in 193 schools, 100 percent of the students qualified for free or reduced price lunch.

Children whose families are at 130 percent of the federal poverty level or below get free lunch, and those between 130 and 185 percent get reduced price lunch. Between July 1, 2013 and June 30, 2014, 130 percent of the poverty level was $30,615 for a family of four; 185 percent was $43,568.

“You cannot teach hungry kids.”

This is an educational problem, according to Dr. Maureen Berner, a professor of public administration and government at the University of North Carolina School of Government. “It also potentially has significant educational gains attached to it,” she said. “You cannot teach hungry kids. Everybody understands that logic.”

The state’s schools are on the front line of a battle being waged across the nation. A battle exacerbated by the 2008 recession and one that state legislatures like our own are trying to tackle. It extends outside schools and school districts to the surrounding communities, and it has serious implications for the health of our children and our state. The battle is for access to healthy food.

Food deserts 

The children who qualify for free and reduced price lunch often come from areas labeled food deserts. The federal government defines it this way:

“USDA, Treasury and HHS have defined a food desert as a census tract with a substantial share of residents who live in low-income areas that have low levels of access to a grocery store or healthy, affordable food retail outlet.”

That’s the simple definition, but Berner says it is far more complicated.

“It’s developed to be a place where folks have difficulty accessing food,” she said. “But accessing food not only deals with is there food available to purchase or get in some way, but can the consumers, can people in the community actually get that food.”

Transportation, mobility, and economics all play a role in this equation. Jill Staton Bullard, co-founder and CEO of the Triangle-based Inter-Faith Food Shuttle, explains that one can be in the midst of a food desert even when, to outside eyes, there is food everywhere.

In 2013, the NC General Assembly put together a bipartisan legislative committee on food desert zones to look at the problem. They found, using USDA data, that North Carolina has at least 349 food deserts in 80 counties. More than 1.5 million residents live in these areas. The committee explored many aspects of the issue and possible solutions already at work in the community. They concluded that fixing the problem wasn’t as simple as building more grocery stores.

“Studies have shown that simply opening supermarkets in food desert zones is not enough to solve the problems of food insecurity and unhealthy eating,” the report stated.

Many of the potential solutions to the issue discussed by the committee involve our schools.

Free breakfast

The federal government subsidizes meals for low-income children who qualify. That includes free and reduced price lunch, but also free breakfast. However, the number of children actually taking advantage of that is a fraction of what it could be.

In 2011, about 48 percent of the students who could get free breakfast were actually getting it. That’s according to Lou Anne Crumpler, state director for No Kid Hungry NC, which strives to increase access to free breakfast and summer meal programs for qualified North Carolina children.

“96% of North Carolina schools offer breakfast in the school cafeteria, but only 30% of students eat breakfast at school…”

The legislative committee found similarly disappointing numbers.

“96% of North Carolina schools offer breakfast in the school cafeteria, but only 30% of students eat breakfast at school, due to a combination of factors including ‘breakfast before the bell’ policies, late bus arrivals, and the stigma that ‘only poor children eat school breakfast,’” the committee report found.

Since 2011, through the efforts of No Kid Hungry, the State Department of Public Instruction, and other agencies and organizations, the number of qualified children taking advantage of free breakfast has inched up to about 58 percent.

But according to Berner, it could be so much better.

“This seems to me really low hanging fruit — sorry for the pun — that we can take advantage of,” she said. 

The problems referenced by the report are ones of access. Schools often require students to eat before school starts. However, not everybody gets there early enough. And other school requirements prohibit the ability of students to get that breakfast.

“Schools have to be very pristine in their structure, so if the rule is you may not go to the cafeteria for breakfast if your bus arrives late, automatically, for that day or that week, that child has been denied access,” said Dr. Lynn Harvey, chief of school nutrition services for the Department of Public Instruction.

And then there is the stigma referenced in the report – “only poor children eat school breakfast.”

Schools in North Carolina are already taking steps to combat these problems.

“There are some very innovative models that the data show are successful in creating significant increases quickly,” Crumpler said.

These are programs such as breakfast in the classroom, grab-and-go breakfast, and “second chance” breakfast.

They are simple. Breakfast in the classroom makes breakfast a part of the instructional day. Students can eat while learning. Grab-and-go breakfast allows students to grab a bag of food on the way to class rather than going to the cafeteria to eat. And “second chance” breakfast is for middle school and high school students who might not get hungry until later in the morning.

“Teens need the same level of sleep as toddlers so they might not be hungry early in the day,” Crumpler said. “Second chance allows breakfast to be served through second period.”

Out of about 2,500 public schools in the state, 699 are now using these innovative models, Crumpler said. Before 2011, when No Kid Hungry began, Crumpler said the number was probably closer to 50.

And school breakfast isn’t just about hungry students. It’s about better learners. 

The financial consulting firm, Deloitte, did a study in 2013 of the impacts of breakfast on the achievement levels of students. It found that if participation in breakfast reached just 70 percent of participation in lunch, the gains would be remarkable: almost 85,000 fewer absences, more than 56,000 students with better math test scores, and more than 14,000 more high school graduates.

The demonstrated educational gains raise an interesting question: why not extend free breakfast to everybody? While those who qualify for these programs surely need them, Berner says that poor children who don’t qualify, and even middle income families, could benefit as well, especially since the recession in 2008.

If everybody had free meals … nobody would feel like they were being singled out.

“Folks are having to do the same amount or more in the face of higher prices —food prices in particular — but with less income,” she said.

And she said there are federal programs that are pushing for both universal (free) breakfast and lunch.

“When we talk about expanding the program, I think most folks involved are not talking about any new state money or any new programs, but simply taking advantage of programs that already exist but are underutilized,” she said.

Rep. Yvonne Holley
Rep. Yvonne Holley (Photo Credit: NCGA)

Democrat Rep. Yvonne Holley, a member of the legislative committee from last session, agrees that expanding these programs is a good idea. If everybody had free meals, she said nobody would feel like they were being singled out.

“It allows the kid to have access with dignity, without that stigma being attached,” she said.

Republican Rep. James Langdon was also a member of the committee. He said that while it seems like a good idea, it’s probably not realistic.

“I think that has some positive things…but I don’t think that’s going to happen,” he said.

Summer feeding programs 

The legislative committee also looked at the ability of summer feeding programs to address the needs of students. For Berner, this is a program with huge potential, but thus far, not enough impact. She said that all those kids who qualify for free breakfast or free and reduced price lunch during the school year, also qualify for free meals in the summer. But because of logistical difficulties, the state is able to reach far fewer students — only 16 to 17 percent of those who qualify. 

… about $2 million in federal funding is not utilized each day when qualified children aren’t fed.

“That’s money left on the table that if a really enterprising group or organization or business could sort of figure out how to make it work logistically, there is financing available to get that going,” she said.

And when she says “money left on the table,” she means a lot of money. She says more than $2 million in federal funding is not accessed each day when qualified children aren’t fed.

Tamara Baker, program manager and communications director for No Kid Hungry NC, said that in 2011, when her organization came on board, only 11 percent of those qualified children were being fed. It’s a vastly different challenge than feeding kids during the school year. 

“We know where the kids are during the school year,” she said. “And in the summer, everything is all up in the air.”

Without the schools open, organizations and officials have to find a way to either get the kids to the food or the food to the kids. Baker said that happens in a variety of ways: serving food at community centers, local YMCAs, on a blanket beside a tree, via bus, or even on a dirt road.

Almost everybody agrees that this isn’t an issue that the General Assembly can necessarily legislate. Rather it takes partnerships between school systems, local business, organizations, and families to make it work.

But there are other missed opportunities. Baker said one notable opportunity was the Read to Achieve legislation from last session. It required 3rd grade students who were not reading at grade level by the end of the year to get special help, including Reading Camps over the summer. That was an opportunity for schools to provide meals, but Baker said that many of the schools did not offer nutrition that would have helped the kids learn.

“It’s amazing how many of them ended at 11:45 so they didn’t have to serve lunch,” she said.

Baker said they had many options. In areas where more than 50 percent of the population is high need, meal sites can be opened where any child 18 or younger can eat for free whether or not they qualify, she said. No identification or registration is needed in these “open” sites. School districts could have opened schools in high poverty areas for reading camps and made them open to the public for kids throughout the community to get free nutrition.

“They could have done that because they were having to turn the lights on anyway,” she said.

“You’re not trying to force them to do something, but you’re trying to make sure they understand what that issue is.”

One of the big issues, and one that many experts think the legislature can help with, is getting the word out to localities about these programs and encouraging them to take part.

“I think the folks are elected to the legislature to be leaders. And they are leaders,” Berner said. “And they do have that ability in their leadership to either take direct action or to serve as a bully pulpit.”

Langdon agrees.

“What you find out is in order for things to happen, we have to trigger a response,” he said. “You’re not trying to force them to do something, but you’re trying to make sure they understand what that issue is.”

Rep. James Langdon
Rep. James Langdon (Photo Credit: NCGA)

With officials like Langdon and others calling attention to the issue and the possible solutions, Berner, Baker and others think the state can do better to make summer feeding programs work.

Other solutions 

Other programs mentioned in the legislative committee report include farm to table and school gardens, both of which come with their own benefits and drawbacks.

The farm to table program is a simple one where schools work with farms to get healthy food from local farms to provide to school cafeterias. Berner said it is available everywhere, but she thinks it’s underutilized.

The reason for this comes down to logistics in some cases and a lack of information and interest on the parts of schools and/or farmers. But a bigger problem is cafeteria kitchen capacity. Federal funds help with transportation, but if a cafeteria can’t hold or cook the food received, then the program isn’t much good.

Federal funds help with transportation, but if a cafeteria can’t hold or cook the food received, then the program isn’t much good.

“If those kitchens don’t actually have the capacity to cook that food, if they only have warming ovens to warm up chicken nuggets…there’s nothing they can do,” Berner said.

And the Feds are not much help there. State or local funds would be needed to make sure all cafeterias could take advantage of this program.

The issue of school gardens is also complicated. While school gardens are good educational tools, because of Good Agricultural Practices (GAP) certification, most schools can’t actually feed kids the produce they grow. GAP certification is a regulation that limits what kinds of foods can be served to children. Basically, it’s there to ensure that food is safe to eat. Some, like Bullard from the Inter-Faith Food Shuttle, think those requirements need to be made less onerous. But others, like Harvey, think that’s a bad idea. 

Harvey said that everything served in a school cafeteria must come from an approved source, and that’s as it should be.

“The population in a public school is incredibly vulnerable,” she said.

Langdon said he would be willing to look at that law, but it would be a hard one to change.

“It is food safety and that is a difficult issue because it’s so complicated,” he said.

Note: Next week, EdNC will provide an in-depth report on school gardens.

An added wrinkle

Many of the solutions discussed here rely on the support, coordination, and oversight of school nutrition staff, but they aren’t supported by state funds.

Two of the main avenues of funding for these programs come from the federal government and the sale of a-la-carte items in school cafeterias. 

However, the passage of the federal Healthy Hunger-Free Kids Act in 2010 set new standards for healthy eating in schools that Harvey said is affecting a-la-carte sales.

“It’s very difficult to achieve those standards and find foods that are appealing to students,” she said.

“The federal partners cannot continue to be solely responsible for funding the school nutrition program.”

She explains that some districts are losing anywhere from $5,000 to $10,000 a day as a result of the law, and it’s not a sustainable.

The State Board of Education regularly requests funds from the General Assembly to fund school nutrition, but they are just as regularly denied. Up until now, the programs could still function, but that might change.

“The federal partners cannot continue to be solely responsible for funding the school nutrition program,” Harvey said. “Eventually that’s probably going to mean some [state] funding for the program.”

Health

It’s one thing to provide food to children, and it’s another to ensure that it’s good for you. Langdon said that is an issue when it comes to addressing the health of kids, particularly among the low-income population.

“One of the disadvantages that we find in our poorer population is lack of knowledge,” he said. “They’re eating the wrong foods because they don’t know better.”

SNAP-Ed is one avenue through which this education happens. It is a program that tries to teach those eligible for “food stamp” programs about nutritional eating. But that only reaches a portion of the population, and it is not only the poor population of the United States that is in need of education.

In North Carolina in 2012, 14.9 percent of children two through four years of age were overweight and 14.5 percent were obese. Overall, one in three children is overweight, according to Duke Children’s Hospital. And the Centers for Disease Control and Prevention says that overweight children are more likely to become overweight adults. 

To address this issue, schools and communities have tried nutrition education programs before with little success, but a relatively new program called MATCH offers hope of a possible solution.

MATCH stands for Motivating Adolescents with Technology to CHOOSE Health™, and it was designed by Tim Hardison — a former middle school science teacher — for 7th graders. It’s relatively simple, but is different in how it’s implemented. Instead of being taught as a chapter in health class, it takes an interdisciplinary approach. The curriculum, which is aligned with standard curriculum and the Common Core, can be used in math, science, English, or basically any type of class, and it incorporates health education with normal classroom curriculum.

Instead of being taught as a chapter in health class, it takes an interdisciplinary approach. The curriculum …can be used in math, science, English, or basically any type of class, and it incorporates health education with normal classroom curriculum.

For instance, in science class, the MATCH curriculum might involve a discussion of diabetes. Or in math class, the teacher may teach ratios by having the students calculate their body mass index. The goal is to have healthy information be a constant presence in all subjects for the duration of the MATCH program.

Two studies published in Childhood Obesity found strong results for children who went through the MATCH curriculum.

“The main finding is that a child’s BMI…overall is lower at the end of MATCH than the beginning,” said Dr. Suzanne Lazorick, an Associate Professor of Pediatrics and Public Health at the East Carolina University Pediatric Healthy Weight Research and Treatment center. She works closely with Hardison, and she said that the improvements last over time.

A group of students who went through MATCH were measured again at the end of 8th grade. They were less overweight than they were at the start of the program. Two groups of children were also measured after 11th grade, and they, too, had managed to keep the weight off. Overall, new cases of obesity between 7th and 11th grade were 17 percent for MATCH kids compared to 39 percent for those who didn’t go through MATCH.

“There’s no reason it couldn’t be taught in every school,” Lazorick said. “There really are no limits, other than you need to have teachers who are willing to do it.” 

And money. Right now, through grants, MATCH has managed to make its way into 17 schools, but Lazorick and Hardison have bigger ambitions. They would like to see it taught throughout North Carolina.

They said given MATCH success rates, NC Medicaid savings — $18.1 million annually as computed by an RTI International economist — and compounded savings over time, the program could be implemented statewide at a fraction of the savings.

Who will lead the way this session? 

The 2015 session of the NC General Assembly is underway, and there’s no way to tell just yet what’s going to happen.

For his part, Langdon thinks both parties can work together on the issue of food deserts.

“Democrats nor Republicans want people, young people especially, to go hungry… so I think there’s common ground we can find there,” he said.

He admitted, however, that if it comes to spending state money, there are bound to be divisions, but that doesn’t necessarily mean there isn’t room for compromise.

“Sometimes we’re willing to actually go further to spend money, particular when we’re trying to help kids,” he said.

“Democrats nor Republicans want people, young people especially, to go hungry… so I think there’s common ground we can find there.”

Holley said she wants to look at programs that are already working in the state and see if lawmakers can find ways to expand them. She would also love to see one central agency serve as a repository of information that communities can use to find out what programs are out there to help them.

But she says a long term solution may require businesses to find a way to set up programs that can support themselves.

“Whatever we do needs to be sustainable. There will always be hungry people. There will always be organizations that help feed hungry people. But we don’t want to rely on organizations,” she said.

Berner agrees.

“I personally don’t think you can do this without including business folks,” she said.

But she adds that it is localities that will ultimately figure out how to address this problem.

“I think looking at the issue at the local level is key because local folks can figure out how things work in their community,” she said.

Alex Granados

Alex Granados was the senior reporter for EducationNC from December 2014-March 2023.