SODA BANS, FARM-TO-SCHOOL, AND FAST FOOD IN HOSPITALS: 
AN AGENDA FOR ACTION

THE OBESITY CRISIS: CHALLENGING THE FAST FOOD CULTURE
AMERICAN PUBLIC HEALTH ASSOCIATION ANNUAL MEETING  
Philadelphia - November 13, 2002

ROBERT GOTTLIEB  
and Amanda Shaffer
Henry R. Luce Professor of Urban and Environmental Policy,
Director, Urban & Environmental Policy Institute
Occidental College

 

Slide 1

In the last year, the focus on fast food and the obesity crisis has generated a series of government and industry responses that underline the impact of the research by Marion Nestle, Eric Schlosser, and others about the role of the food industry in contributing to negative health outcomes.  This research has also been complemented by action – organizing at the community, school district, regional and state-wide level to change policies, introduce innovative programs, and ultimately challenge a fast food culture that has been aggressively shaped and promoted by food industry interests.

Slide 2

I’d like to discuss three action strategies – two that have been successfully launched and one that is in the process of being developed. These are: first, school food programs, including the groundbreaking farmers’ market salad bar program in the Santa Monica, California school-district that recently had its fifth anniversary; second, the fight against sodas and other low or zero nutritional quality “competitive foods” in school vending machines, including the recently approved Los Angeles Unified School District soda ban and some pilot programs here in Philadelphia; and third, the expansion of fast food and junk food in hospitals and the development of strategies to offer instead healthy and local food options.

Slide 3

School food programs, including farm-to-school initiatives, represent some of the most exciting and innovative approaches countering the overwhelming presence of fast food in our daily lives. These programs include making available fresh, local foods in school cafeterias, developing school gardens, and pursuing new approaches to nutrition education based on learning by doing and student empowerment approaches. Just last month, more than 260 parents, school food service directors, farmers, students, and other farm-to-school advocates participated in a “Farm-to-School” conference in Seattle, sharing wonderful stories and insights about how they have been able to get tasty, fresh, and appealing food to be part of the school lunch. Nearly every place where this has happened, kids have responded, particularly when they have been able to connect the food with their own experience or when they have been able to make a choice or be part of the process of making change inside or outside the cafeteria.

Slide 4

One of the first of these farm-to-school initiatives was the farmers’ market salad bar launched in Santa Monica, California in 1997. At first, a very skeptical food service director, who had previously worked for Sodexho-Marriott, didn’t believe that the students at a low-income elementary school where the salad bar was to be piloted would prefer the salad bar to the pizza, fried calzone, greasy cheeseburger or other similar school lunch items.  

Slide 5

Food Service directors, after all, are under a lot of pressure to generate income or at least be revenue neutral. The food service operation is divorced from the rest of the school day, the amount of time the kids have for lunch has been reduced, and school kitchens have been eliminated for cost savings. At the same time, food service directors are increasingly besieged by fast food competitors who see school children, including those as young as five and six, as a market of opportunity, where the school cafeteria and the vending machines can be places where lifetime loyalties are established.  

Slide 6

It was clearly a challenge to make the program work in Santa Monica and otherwise convince the food service director that this was a viable approach. But work it did. The idea of the program was simple. Farm fresh produce was purchased directly from farmers’ through the farmers’ market for a salad bar option where the kids had their choice of what to eat as long as they had their required portions of protein, milk, grain, and vegetable. The salad bar was also linked to a school garden where harvested items could be displayed. Farm tours, farmer visits, and farmers’ market coupons also provided ways the kids could understand and relate to where the food came from. 

Slide 7

Once in place, and thanks in part to a young Latina organizer hired by our Center who systematically did outreach among the predominantly Latino students and parents, the pilot project succeeded well beyond expectations. Kids were not only eating salads but taking some ownership of the program. This success also began to make a believer of the Food Service Director and his staff.   

Slide 8

It’s now five years since the program was launched and a farmers’ market salad bar is available at each of the 15 schools in the District, including the two high schools. As you can see from these figures the level of participation for the salad bar meal has been maintained or increased for the salad bar meal as well as overall participation in the school lunch program, an additional economic benefit for food service.  

Slide 9

Not all farm-to-school programs provide a full salad bar meal during the entire school year, given what’s available on a seasonal basis.

Slide 10

 However, a variety of innovative programs involving farm fresh items in the school cafeteria have been developed in sixty eight school districts around the country serving more than a half a million students and it has caught the attention of policymakers and food service directors alike.  

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no text (Cornell Farm-to School Program)

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The participation issue – that is, if you provide healthy and tasty food, the kids will respond -- is important because even if most school lunches don’t offer much from a health or nutrition or taste standpoint, it’s far worse when it comes to the vended items, like the sodas and other junk foods that have become increasingly available in school districts throughout the country. These “competitive foods” include the candy, chips, and soda that are ubiquitous wherever vending machines have been installed on school grounds. These junk food items are not so much the cause of poor nutrition habits as the occasion to continually reinforce the ways in which fast food and junk food dominate teen – and adult – diets.

Slide 17

To challenge fast food and junk food like sodas requires a powerful message about health outcomes as well as an organizing strategy that engages students, parents, and teachers, as well as school board members and public officials. We need the kind of research and arguments that Marion Nestle and others have provided but we also need to graphically demonstrate what’s at stake, much as the anti-tobacco messages have been able to do. In fact, one of the most effective tactics used by those who mobilized three months ago for a soda ban in the Los Angeles Unified School District was to present school board members a large mason jar of sugar, representing the average amount of sugar consumed from soft drinks each week by a single teenager. The message was clear: soda was a sugar fix.   

Slide 18

This tactic was especially effective when combined with an organizing campaign that involved low-income Latino and African-American parents and community members and not just white middle class “health food” advocates. The health messages were quite powerful, underlined by comments made at the board meeting by the School Superintendent and a member of the L.A. County Board of Supervisors that they had both been recently diagnosed with diabetes.  

Slide 19

The health message and the organizing proved to be a compelling combination and ultimately led to a wonderful victory – a soda ban – that became in turn a quite extraordinary media story around the country.

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But there are clearly major challenges ahead even with or perhaps especially with this victory. There was limited but still insufficient organizing among high school and middle school students in Los Angeles that was suggestive of the power of student organizing when it did happen but cautionary insofar as it also suggested that the absence of a student role could create problems in implementation. If students are not engaged in the process, either in getting the junk food out and especially in helping define what new products should become available, there is a risk that students will simply see this move as the powers that be telling them what to eat and drink rather than their deciding why and how they should turn against junk food and fast food.  

The Los Angeles District now has until January 2004 when the ban goes into effect to explore alternatives to the sugar/fast food fix and it is imperative that the soda ban movement also become a student as well as community movement. 

Slide 23

In Philadelphia, pilot programs at several schools through the efforts of the School Nutrition Policy Task Force have demonstrated that a wide variety of healthier and more appealing alternatives are available and that students, once engaged, can help make that shift.

Slide 24

And, as a preliminary study by the Philadelphia Food Trust indicates, sales of these items at vending machines can be greater than the revenues from the previous sugar fix sales of Pepsi, Coke, and the like.  

Slide 25

It’s not just schools that have become an institutional market of opportunity for the fast food industry and junk food providers. If you read the trade publication Food Service Director you know that hospitals and health centers rank high as a fast food target and that they are succeeding in penetrating this market. Preliminary studies, including our own in Los Angeles, indicate that junk food laden vending machines are the predominant source of food for staff and visitors and that fast food outlets are also beginning to be located in hospitals either in addition to, or as substitutes for hospital cafeteria food.

Slide 26

McDonald’s, for example, proudly displays its golden arches at a number of children’s hospitals throughout the country, including in Los Angeles and one here at the Children’s Hospital of Philadelphia. 

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 In fact, we surveyed forty seven children’s hospitals around the country – thirteen had McDonald’s or other fast food outlets (e.g. Pizza Hut, Dunkin' Doughnuts, Wendy's, etc.) within the hospital or more than 25%.

Slide 30

And, similar to fast food’s defenders in K-12 schools who covet the revenues and poo-pooh the nutritional issues involved, some hospital staff have even argued that “fast food can be part of healthy eating,” and that “sometimes junk food is just going to make you happy,” as one food service director at St. Joseph Medical Center in Maryland argued. Further underlining that point, all residents at Children’s Hospital in Los Angeles receive as a bonus $25 in McDonald’s dollars each month that they are on call, since the McDonald’s  at Children’s Hospital is open 5AM to midnight Monday through Saturday and 6AM to midnight on Sunday; hours more convenient than the main hospital cafeteria. And at one Children’s hospital at Vanderbilt University Medical Center in Nashville it will be not just an option for staff and visitors; patients at this hospital will be able to order their Big Macs and French fries directly from their rooms.

          Is cafeteria food in hospitals, like the school lunchroom, so bad that fast food gets to be presented as a treat? And what’s the message that’s being sent, from two institutions that presumably care about the health and well-being of children, patients, and staff?

Slide 31

 Fortunately, there is also a budding healthy food and farm-to-hospital movement that has begun to emerge. Our Center for Food and Justice at Occidental College is in the process of establishing a pilot farm-to-hospital program at Cedars-Sinai in Los Angeles that will feature certain produce items for their patients provided that day by local farmers. 

Slide 32

At Duke University Medical Center a farmers’ market takes place once a week located between Duke Hospital and Duke Clinic. In Burlington, Vermont, Green City Farm, which originated as a hospital garden producing one acre of organic vegetables, established what is known as a Community Supported Agriculture arrangement or CSA where the farm provides organic kale, spinach, lettuce, tomatoes, carrots, and cherry tomatoes in exchange for 12 monthly installment payments from the hospital. In Iowa, the Leopold Center for Sustainable Agriculture has also helped facilitate a farm-to-hospital arrangement with Allen Memorial hospital where upwards of 30% of food purchases now come from local farms. And hospital vending machines have also become a target. In San Antonio, several hospitals have committed to join the “Fit City” vending machine movement, with the machines to be stocked mainly with low fat foods and milk, water and juices.  

Slide 33

  What’s critical in each of these cases – the school lunch room, the school vending machines, and hospitals – is the need for action and for innovation; to challenge the assumption that school food and hospital food are simply part of the problem of an unhealthy society and that the fast food and sugar pushers can waltz in and proclaim that Pepsi or McDonalds’ the one. What our school kids and our hospital patients and visitors and staff eat should no longer be a market opportunity but instead become essential to an agenda for change.