AS A YOUNG CHILD I REMEMBER THE FEELING OF HUNGER. I NEVER APPROACHED MY PARENTS WITH MY FEELINGS. I WOULD JUST TRY AND SOLVE THE PROBLEM MYSELF. I REMEMBER AFTER HAVING A MEAL GOING IN THE REFRIGERATOR AND TRYING TO FIND SOMETHING ELSE TO EAT THAT WOULD NOT REQUIRE COOKING. LOTS OF TIMES I EXPERMENTED WITH BREAD & KETCHUP, BREAD & JELLY AND BUTTER SANDWICHES. ALTHOUGH, I CAN HONESTLY SAY I NEVER FELT LIKE I NEEDED MORE TO EAT WHEN I WENT TO SCHOOL. THE CHILDREN IN MY CLASSROOM OFTEN COME TO SCHOOL ALMOST EVERY DAY WANTING MORE TO EAT. THEY WILL GRAB FOOD FROM OTHER STUDENTS, THEY WILL EVEN GRAB FOOD FROM SOMEONE WALKING DOWN THE HALLWAY. IT'S EASLY DONE BECAUSE THEY KNOW THE PEOPLE THAT DON'T KNOW THEM VERY WELL IS NOT EXPECTING THAT TYPE OF BEHAVIOR FROM THEM. AS A TEACHER I DO MY BEST TO HAVE FAST EATING FOODS THAT I CAN GIVE THEM WHEN THIS HAPPENS. I WILL SAY SOME OF MY STUDENTS COULD EAT FORVER. THIS IS JUST NOT POSSIBLE WHEN IT IS INSTRUCTIONAL TIME. TEACHERS BECOME VERY CREATED WITH SNACKS VS. INSTUCTION. I WAS CURIOUS TO SEE WHAT GOES ON IN THE LIFE OF SCHOOL AGE CHILDREN IN CANADA. BELOW WILL EXPLAIN SOME OF THE THINGS GOING ON WITH CHILDREN IN CANADA.

Perception | Volume 23, #4 (Spring 2000)

School Food Programs: A good choice for children?

by David I. Hay

Introduction

Food security is not assured for all Canadians. For a number of reasons, many families are unable to adequately meet their food needs. School food programs have been one response to this problem. But have school food programs been a sound response? What do we know about the delivery and outcomes of school food programs?
Health Canada recently completed a three-phase review of school-based nutrition and feeding programs*. In Phase I, interviews were conducted with provincial government officials about existing programs within their jurisdictions. During Phase II, an analytic literature review was commissioned on the role of breakfast programs in contributing to children's mood, behaviour and ability to learn.
This article is a condensed version of the work commissioned for Phase III of the project. The objective of this phase was to analyze whether school food programs are an appropriate social policy choice for children. Two questions guided the research:
1. Are school-based food programs a sound social policy response for children?
2. What role, if any, should the federal government assume in supporting these programs?
Interviews with key informants and a review of relevant research literature were the two methods used. The research was conducted between November 1998 and February 1999.

What are sound school food programs, and why are they needed?

Generally, sound social programs are those with the following characteristics:

developed in response to clearly defined needs
designed to meet clearly articulated goals and objectives
managed efficiently and effectively
evaluated in terms of clear, direct and relevant program outcomes.

Unfortunately, most school food programs lack one or more of these elements, making proper assessments difficult. In particular, the need for school food programs has not been adequately determined or demonstrated.
School food programs have tended to be implemented in response to a fairly informal, and sometimes anecdotal, assessment of a school's or community's social and economic situation. Most school food programs began as a response to perceptions of hunger and inadequate nutrition among low-income children. Although the program goals are not always explicit, the implementation of school food programs is meant to reduce hunger and enhance nutrition among the particular population of children who are considered to be at risk of poor outcomes. Explicit goal statements of school food programs, however, usually refer to the delivery of the programs and not to enhancing health.
One example of such a program is in British Columbia, where the government operates a school meal program throughout the province. This program was initiated in 1992 because the BC government recognized that hunger was a potential consequence of child and family poverty, and that hunger hindered child development. The overall purpose of the program "is to provide meals to students who come to school hungry." The objectives of the program are to "provide ... meals to children in need, promote a healthy school environment ... [and] promote nutrition education."
The program criteria, purpose and objectives contain no statements about reducing hunger or enhancing nutrition. Because evaluations of programs usually assess outcomes in relation to program objectives, an examination of the contribution of school food programs to hunger reduction and nutrition enhancement may be inadvertently overlooked. Yet there is a real need to evaluate programs to assess their effectiveness in reducing hunger or enhancing nutrition.
As school food programs have developed, their goals have shifted. Programs that were begun simply to feed children now try to address multiple goals such as nutritional adequacy for all children, nutritional education, positive socialization, school attendance, family time-stress, community mobilization, partnerships and social supports. One reason for this shift is that programs have been unable to demonstrate reductions in hunger and enhancements in nutrition.

Hunger

Hunger has been defined narrowly as physiological discomfort as a result of a lack of food, and it is defined more broadly as "the inability to obtain sufficient, nutritious, personally acceptable food through normal food channels or the uncertainty that one will be able to do so." If "the availability of nutritionally adequate and safe foods or the ability to acquire acceptable foods in socially acceptable ways is limited or uncertain," then a condition called food insecurity exists.
Hunger and food insecurity in Canada are primarily the result of family income insecurity. Family income insecurity puts children and adults at risk of a large number of negative outcomes, including ill health, stress, family violence, and illiteracy.
From this review of school food programs, it would seem that they are an inadequate or inappropriate response to hunger in children for a number of reasons, including the following:

Programs can only address a symptom - hunger - of one or more underlying problems.
Typically, hungry children and their families use other means to alleviate hunger - such as food banks, relatives, neighbours - before using school food programs.
Lack of data makes it very difficult to know, other than through anecdotes, what percentage of hungry children in any given school area participate in programs.
The nutritional value of programs and of the food that is served may be inadequate. A lack of documentation means that there is insufficient evidence to measure the nutritional value.
From a developmental perspective, hunger and undernourishment can have the most severe effects on preschool-aged children, rather than on school-aged children. Children not yet in school should probably be the priority recipients of food programs.
Most programs are elementary-school based, thus disregarding youth.
Most programs are based in schools rather than in other community facilities, so the food is available for only about half the year.

All informants stated that they believed the government's number one priority should be to strengthen the ability of families to provide for their own children. This capacity building for families requires many elements, including job and income supports, work and time-stress supports (most importantly, adequate child care), nutrition education, affordable and accessible nutritious food, and neighbourhood and community services (such as pregnancy support and outreach, home visiting, early childhood education, and the like). Within these responses, school food programs could be one element in an overall strategy to alleviate hunger. They could be particularly useful as interventions with high-risk, poor children and communities.
Many informants for this review feel strongly that hunger - and to some extent, nutritional adequacy - can be addressed only with additional monies for low-income families with children, at a cost of approximately $5,000 per hungry family. Increased employment opportunities and higher minimum wages could contribute to families' increased incomes but in some cases, for example when parents or children are ill or the family is led by one parent, increases in income support programs would also be required.

Nutrition

Some informants believe that there is a current or emerging "crisis" in nutrition (and therefore, a crisis in health) for a variety of reasons, including poverty, low education, lack of appropriate food choices, food insecurity, a lack of time, and gender issues (such as body image). Although research is lacking on the prevalence of hunger and inadequate nutrition, some informants see school food programs as part of an appropriate response to these conditions. They note that the fast food industry can create problems for families who have little time to shop and cook, and the choices available do not usually offer a balanced and nutritious diet. School food programs can allow families to bypass the fast food market.
After the family, schools are considered to be the location of choice for delivering a food program because many of the social conditions that children face elsewhere are minimized or equalized in schools. Schools can provide a positive environment in which children can learn about appropriate nutrition and eat a nutritious meal. In addition to alleviating hunger, school food programs can introduce children to foods that they might otherwise never eat, and the programs can provide the children with a general education about food security and their place in the food system. Again, we do not have adequate information from evaluations or from other research in order to determine how, or even if, these outcomes are achieved.

Dependency / Institutionalization / Professionalization

The literature indicates that some school food programs appear to have created various forms of dependency. In some cases, programs have become an institutionalized response to a lack of money, time and, to a lesser extent, knowledge among families about how to prepare and deliver nutritious meals. This institutionalization of food delivery can also serve to depoliticize responses to community food issues, for example by encouraging people to concentrate on continuing a food program rather than tackling the underlying issues of food and income production and distribution. Some of the research on school food programs has argued that the professionalization of school food programs - evident in the hiring of staff, increased management and administrative activities, and fundraising - may indicate that a program is focussing more on its continued existence and less on program objectives like hunger reduction or nutrition enhancement. These researchers have concluded that, over time, program delivery objectives gain prominence over hunger reduction and nutrition-enhancement objectives. As mentioned earlier, it may be erroneous to equate the continued existence of a program with success, without examining the program outcomes.

Sustainability

Most school food programs depend on voluntary support for their existence. Because of this, programs vary widely, particularly in regard to food quality and safety. To ensure sustainability, program operators request more money or they concentrate some of their time on fundraising. An adequate and assured funding base, along with plans for the maintenance and succession of staff or volunteers, are central to a program's sustainability.

Charity

Charitable groups believe that they are contributing to community capacity by delivering programs to meet community needs. For a number of reasons, however, many informants said they are uncomfortable with charitable responses to social problems. Primarily, they view charitable responses as a sign that government priorities have shifted away from serving the broad public interest through the delivery of a basic necessity of life. As well, charitable programs tend to view vulnerable populations as being unable to help themselves. As a result, some informants suggest that charities contribute to the promotion of values that are the antithesis of equity, perpetuating a social system that fails to make more systemic, structural changes that would equalize opportunities for all citizens.
Other informants feel that the time, energy, and resources generated by private charities should not be dismissed. These informants are concerned that in an era of decreased public sector initiatives and a focus by governments on sectoral partnerships, charities have filled a void in services by providing vital support. These informants believe that there can be dynamic and creative roles for charities as long as appropriate criteria are in place to guide their actions. Two criteria most frequently mentioned are transparency and accountability.
There is also evidence that charities are unable to respond adequately to food insecurity, with the result being that Canadians are still going hungry.

Food security / Food policy

According to some commentators, ad hoc, band-aid attempts to alleviate hunger and enhance nutrition have been insufficient because they have been based on a food charity system that "does not have the capacity to address any of the deeper, structural issues that have created the conditions of poverty and hunger."
In some jurisdictions, community/government partnerships are addressing broader issues of food security and food policy. Many informants feel that dialogue and action at this level would greatly benefit family and community health and that this is the most appropriate forum in which to assess the need for school food programs.

Potential roles for the federal government

A few of the informants interviewed for this study, particularly the provincial government representatives, gave a one-word answer when asked what role the federal government should have in the area of school food programs: none. Provincial officials recommended that the federal government restore federal transfer payments delivered under the CHST to their pre-1995 or earlier levels. They did not feel that designating any part of the CHST funding for food programs was workable, given the ongoing social union discussions and other federal/provincial/territorial initiatives.
On the other hand, community and local or regional government representatives would like stronger federal involvement in this area. They believe that federal dollars are more readily available - at least currently - and potentially more sustainable than provincial government funding sources. These informants also believe that the federal government should take on the role of providing national leadership by setting standards for healthy child development, family food security, and school food programs, and by promoting ongoing collaboration with the provinces. Some informants would support the direct delivery of a broad-based food or nutrition program by Health Canada.

Recommendations

1. Are school-based nutrition programs a sound social policy response for children?
There doesn't seem to be a clear answer to this question, although the short answer is "No." Overall, the available evidence does not clearly demonstrate that school-based nutrition programs are a sound social policy response for children. More evidence is required to adequately assess the contribution these programs can make to alleviate hunger, enhance nutrition, and contribute to healthy child development, without creating any adverse consequences such as dependency or stigmatization.
2. What role, if any, should the federal government assume in supporting these programs?
As a response to social program funding cuts, communities across Canada are examining school food programs as a potential solution to issues of hunger and inadequate nutrition. However, without adequate evidence, the federal government should not support further development of school food programs.
The federal government should share conclusions from the three phases of research on school food programs commissioned by Health Canada with other provincial and community stakeholders. This could contribute to the development of additional research, with the following goals:

Creating outcome targets and key indicators to better assess levels of hunger, nutrition, and food security among Canadians generally, and among children in particular.
Building appropriate evaluation frameworks - including outcome targets and key indicators - to evaluate and assess current programs.
Identifying, documenting and disseminating innovative approaches to food security.

More broadly, the federal government can make a number of contributions to reduce hunger and enhance nutrition for Canadians within five existing elements of its mandate: Population Health; Healthy Child Development; Income Security; Food Security; and Social Policy Leadership. Population health and healthy child development provide the context and basis for priority policy directions in income security and food security. Social policy leadership is important to demonstrate federal commitment to these policy directions

Measuring Up - A Health Surveillance Update on Canadian Children and Youth

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Infant Mortality

With the exception of Japan, Canada has had the most dramatic decline in infant mortality rates in the past 35 years.

Infant mortality rate is often used as an indicator of a country's state of health development. Infant mortality refers to the death of a live born infant within the first year of life. Rates of infant mortality are usually based on the number of infant deaths per 1,000 live births in any given year, but are sometimes based on the number of infant deaths per 1,000 population less than one year old. Two related terms used to describe infant mortality are neonatal death - the death of an infant under 28 days of age - and post-neonatal death - the death of an infant between 28 days and 1 year of age.
In 1996, 2,051 infants in Canada died before their first birthday.⁽¹⁾ Of these deaths, 1,441 (70%) occurred in the neonatal period and 610 (30%) in the post-neonatal period. The two leading causes of neonatal death were conditions originating in the perinatal period and congenital anomalies. Conditions originating in the perinatal period, which include respiratory distress syndrome, short gestation and low birth weight, accounted for 62% of neonatal deaths. Congenital anomalies accounted for 30% of neonatal deaths. The two leading causes of post-neonatal death were sudden infant death syndrome (SIDS) and congenital anomalies, accounting for 26% and 23% of post-neonatal deaths respectively.
With the exception of Japan, Canada has had the most dramatic decline in infant mortality rates in the past 35 years. In 1996, the infant mortality rate in Canada was 5.6 per 1,000 live births compared with a rate of 27.3 per 1,000 live births in 1960; it has decreased steadily since the early 1960s, tapering off somewhat in the mid-1980s. Figure 1 depicts the Canadian infant mortality rate from 1960 until 1996.
Figure 1: Infant Mortality Rates, Canada, 1960-1996

Figure 1: Infant Mortality Rates, Canada, 1960-1996

Source: Bureau of Reproductive and Child Health, LCDC, based on Statistics Canada data⁽¹⁾
Low birth weight is correlated with higher rates of mortality and morbidity among infants. Regional and temporal variations in the classification of live births weighing less than 1,500 g have been reported in the medical literature.^(2,3,4) Analyses of Canadian data have demonstrated that including live births weighing less than 500 g changes the infant mortality rates.^(4,5) From 1992 to 1993, the infant mortality rate, including all live births, increased from 6.1 to 6.3 per 1,000 live births. However, the exclusion of live births weighing less than 500 g resulted in a decreasing rate, from 5.6 to 5.4 per 1,000 live births. An increasing rate of live births weighing less than 500 g during this period, from 5.1 to 8.5 per 1,000 live births, explains this variation and highlights the importance of accounting for these extremely low birth weight infants in infant mortality analysis.
In comparison with infant mortality rates in other Organization for Economic Cooperation and Development (OECD) countries, Canada's rate of 5.6 per 1,000 live births is somewhat high.⁽⁶⁾ As depicted in Figure 2, in 1996, Japan, Finland and Sweden reported the lowest infant mortality rates at 3.8, 4.0 and 4.0 per 1,000 live births respectively; New Zealand and the United States reported the highest rates at 7.4 and 7.8 per 1,000 live births respectively.
Figure 2: Infant Mortality Rates, selected countries, 1996

Figure 2: Infant Mortality Rates, selected countries, 1996

Source: OECD Data, 1998, except Canada: Bureau of Reproductive and Child Health, LCDC^(1,6)
Data limitationsInternational differences in infant mortality rates must be interpreted with caution as there are significant international variations in clinical practice and in the way live births are classified.^(2,3) Furthermore, even in Canada, there is a lack of consistency in handling live births weighing less than 500 g for infant mortality calculations.
SummarySince the early 1960s, reductions in infant mortality rates in Canada have been dramatic and encouraging. However, there is still room for improvement, as other OECD countries have lower infant mortality rates.

Unless referenced otherwise, infant mortality statistics are the product of the Bureau of Reproductive and Child Health, LCDC.⁽¹⁾

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This topic is meaningful to me because my husband had a lot of client's who babies died and was diagnosis with Sudden infant death syndrome (SIDS). He is a Funeral Director and Embalmer. It has been very interesting trying to understand why so many deaths occured. I read in Chapter five that infants to 12 months of age should not sleep with their parents are in a soft bed. This was very interesting to read. Now it has me wondering how may of the young women allowed their babies to sleep with them on soft beds? And the time of year the infants die? I included information above about deaths in the country of Canada. I was wondering if living some where colder made a difference. I believe the information can impact my future work by educating young mothers of my students about topic such as Sudden infant death syndrome. (SIDS) I think it would be good to have a news letter to inform mothers about diseases as well as how to help the progress of the infants development. I believe just by reading information from their child's school may give them food for thought or even help them help someone else.

five of seven

Saturday, March 26, 2011

HUNGER IN SCHOOL AGE CHILDREN