Health Impact Assessment: National Nutrition Standards for Snack and a la Carte Foods and Beverages Sold in Schools

1.1 Introduction

In December 2010, the U.S. Congress passed and the President signed into law the Healthy, Hunger-Free Kids Act, setting the stage for a range of improvements in school meals and the school nutrition environment. One change outlined in Section 208 of the Act directs USDA to regulate all foods and beverages sold on the school campus throughout the school day. Foods sold outside of the school meal programs include venues such as vending machines, school stores, and a la carte lines, and what is sold varies greatly in schools across the country. A set of national nutrition standards for these foods could have a significant impact on the health of students and the financial health of schools across the United States.

Background on the Issue

USDA defines competitive foods as items sold at school outside of the school meal, including all reimbursable school meal programs—school lunch, school breakfast, and afterschool snack programs.¹³ These foods and beverages include a la carte sales during mealtimes and items sold throughout the school day in vending machines, food carts, school stores, and snack bars, or through fund-raisers. They are technically called competitive foods because these options compete with items offered in school meal programs for inclusion in a child’s daily diet. Whenever possible, this report avoids using this term as it has been found difficult to understand by the general public; rather, such items are referred to as “snack and a la carte foods and beverages.”

HIA Background

An HIA is a prospective research tool that is used to inform decision makers regarding the possible health impacts of proposals. HIAs recommend actions to minimize adverse consequences and optimize beneficial effects.¹⁴ The World Bank, International Finance Corporation, and a growing number of private companies voluntarily use HIAs as part of international lending standards and project planning studies because there is a strong business case for proactively identifying and addressing health effects in major investment decisions. The use of HIAs in the United States is increasing rapidly, driven in part by a growing body of data linking decisions made outside the health sector—in transportation, housing, and urban planning, for example—to rates of many diseases. A number of HIAs have addressed nutrition and school-related proposals, such as a farmers’ market,¹⁵ a physical education policy in California,¹⁶ Baltimore’s recent land use plan,¹⁷ Hawaii County’s agriculture plan,¹⁸ and the 2002 federal Farm Bill.¹⁹

This HIA explores the potential health and financial effects USDA’s updated snack and a la carte food and beverage regulations could have on children and their schools. The Kids’ Safe and Healthful Foods Project and the Health Impact Project—both collaborations of The Pew Charitable Trusts and the Robert Wood Johnson Foundation—contracted Upstream Public Health, a nonprofit health policy advocacy organization experienced in HIA and nutrition policy, to conduct this HIA in anticipation of USDA releasing its proposed regulation in spring 2012.

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