Making the Case for Nutrition Interventions through Schools

By Janice Hunt,2014-05-20 10:32
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Good health and nutrition are needed to achieve one's full educational potential because nutrition affects intellectual development and learning ability.

FRESH Tools for Effective School Health First Edition 2004

     Making the Case for Nutrition Interventions through Schools

     Description of the tool: This tool puts forward a number of arguments that can be used to convince people of the importance of healthy nutrition during childhood and adolescence. Each argument gives reasons why communities and schools both need and will benefit from nutrition interventions and related health promotion activities.

The information in this tool was adapted by UNESCO from the following publication:

     WHO/FAO/Education International 1998. WHO Information Series on School Health Document 4: Healthy Nutrition: An Essential Element of a Health-Promoting School.

    Geneva: WHO.

    The full text of this document is available on WHO’s website at the following address:

Description of the document:

    This document provides information that will assist individuals and groups to make a

    strong case for increased support and attention to healthy nutrition in schools. It also

    provides information about the nature of a Health-Promoting School and how efforts to

    promote health and healthy nutrition might be planned, implemented and evaluated as

    part of the development of a Health-Promoting School. In addition, the document

    describes how each of the four components of FRESH can be used to improve dietary


     FRESH offers a strategic framework within which to develop an effective school health

    programme. Planning and evaluation are

    essential processes that enable the

    framework to be adapted to local

    resources and needs. Careful planning

    and documentation of outcomes enhances

    the success and sustainability of school

    health programme activities.

FRESH Tools for Effective School Health First Edition 2004

     1Making the Case for Nutrition Interventions through Schools

I. Healthy nutrition among school-age youth is important!

The following arguments can be used to convince others of the importance of healthy

    nutrition during childhood and adolescence. They give reasons why communities and

    schools both need and will benefit from nutrition interventions and related health promotion


Argument: Good nutrition improves the learning potential and well-being of


Good health and nutrition are needed to achieve one's full educational potential because

    nutrition affects intellectual development and learning ability. Many studies report significant

    links between nutritional status and cognitive test scores or school performance. Children

    with more adequate diets score higher on tests of factual knowledge than those with

    less adequate nutrition. For instance, studies in Honduras, Kenya and the Philippines

    show that the academic performance and mental ability of pupils with good nutritional status

    are significantly higher than those of pupils with poor nutritional status, independent of

    family income, school quality and teacher ability.

Argument: Good nutrition in early life lays the foundation for healthy

    adulthood and ageing

Among well nourished people, acute disease and illness tend to be less frequent, less

    severe and of shorter duration. Good nutrition also fosters mental, social and physical well-being throughout life by, for instance, strengthening a positive body image and

    increasing a sense of personal worth. Healthy nutrition can also contribute to a more

    comfortable life by helping young people to develop healthy teeth and gums. Thus, good

    nutrition during childhood helps to lay the foundation for a healthy adulthood.

A healthy diet can also contribute to more mobility in old age. For instance, it is during

    youth that the strongest possible bones can be acquired that will decrease the risk of

    osteoporosis in old age. Diets rich in calcium can help build stronger bones; diets rich in

    protein and salt increase the chances of losing bone density later in life. It is important that

    children acquire the knowledge, skills and attitudes that will enable them to maintain their

    own health and the health of those they care for. It is beneficial to everyone to teach them to

    adopt healthy eating patterns whilst they are young because eating patterns are established

    early in life and are difficult to change later.

Argument: Girls in particular will benefit from nutrition interventions

Many problems during childbirth, such as haemorrhage, infection and obstructed labour, can

    be reduced by adequate nutrition earlier in life. For instance, small stature, which may be

    related to undernutrition, is a well-known risk factor in obstructed labour. Anaemia, which

    can result from inadequate intake of iron-rich foods, lack of iron supplements or parasite

    infection, causes about one-fifth of maternal deaths during pregnancy and childbirth.


FRESH Tools for Effective School Health First Edition 2004

    In areas where women are primarily responsible for preparing food for their families,

    increasing their nutritional knowledge helps ensure better preparation, preservation, handling

    and distribution of foods. Thus, effective nutrition interventions in schools are important and effective means of improving not only the nutrition and health of girls and women,

    but also of families as a whole.

Argument: Healthy nutrition contributes to decreasing the risks of today's

    leading health problems

Studies show that early indicators of chronic disease begin in youth. For instance, avoiding

    obesity in childhood and youth is important because obesity tends to continue in adulthood,

    contributing to chronic diseases. Furthermore, hardening of the arteries and high blood

    cholesterol levels, which are a major contributor to coronary heart disease, are influenced by

    nutrition and lifestyle. Proper nutrition and physical activity are likely to have long-term health

    benefits in reducing the growing number of diet-related diseases.

    ? Obesity in infants, children and adults is a major problem worldwide. The prevalence of

    obesity in adults is 10% to 25% in most Western European countries, 20% to 25% in

    some countries in the Americas, up to 40% in some countries in Eastern Europe, and

    more than 50% in some countries in the Western Pacific. Obesity rates, which are

    doubling every 5-10 years in many parts of the world, are placing significant additional

    financial burdens on health systems, which must deal with the resulting problems.

    Obesity eventually leads to chronic disorders such as diabetes, high blood pressure,

    high cholesterol levels, hardening of the arteries and some forms of cancer. Obesity

    also leads to acute consequences of chronic disorders including strokes and heart

    attacks. Reducing caloric intake and increasing physical activity decreases the risk of


    ? Cardiovascular Diseases include coronary heart disease, which is a major cause of

    adult death. The risk of cardiovascular disease can be decreased by healthy eating,

    especially a low fat diet.

    ? Cancer accounts for 25% of all deaths in developed countries. It has been suggested

    that practicable dietary means could reduce cancer deaths by as much as 35%. A diet

    that contains plenty of fruit and vegetables can significantly reduce the risk of cancer.

    ? Eating Disorders present serious threats to adolescents' health and can lead to death.

    Psychological counselling, medical treatment and dietary advice can help to prevent

    and treat eating disorders.

Nutrition education has been shown to have a significant effect in fostering healthy eating

    habits. Schools can contribute to reducing nutrition-related problems by integrating nutrition

    interventions into a comprehensive approach to school health.

Argument: Education and good nutrition strengthen the economy

Adequate nutrition is necessary if children are to become fit and productive adults, able to

    fulfil their responsibilities in life. People who are well-nourished and educated are more

    productive and improve their own income as well as their contribution to the national

    economy. For instance, improvements in health and well-being of women and their families

    through better nutrition contribute to reducing their financial burdens and time constraints.

    Extra time and resources can be used for income-generating and productive activities or to

    participate in educational, health or social actions from which women and their families can



FRESH Tools for Effective School Health First Edition 2004

    Furthermore, it has been estimated that by implementing essential public health

    programmes, including nutrition and health education and micronutrient supplementation, a

    considerable amount of the disease burden in low- and middle-income countries has been

    reduced. For example, the benefits of investing in school feeding will far exceed the costs

    even though this is one of the most expensive possible nutrition interventions. Nutrition

    interventions help to reduce health care costs for nutrition-related chronic diseases and for

    productivity losses due to nutrition-related health problems.

Argument: Malnutrition weakens the learning potential and well-being of


Malnutrition is holding back the education of millions of children throughout the

    world. Malnutrition in early childhood can affect school aptitudes, school enrolment,

    concentration and attentiveness. Children with a history of severe malnutrition perform less

    well on IQ and general knowledge tests than children in matched comparison groups.

    Undernourishment also impairs the ability to concentrate, learn and attend school regularly.

    Good nutrition will strengthen the learning potential of children, enable them to learn

    effectively and thus maximize investments in education.

Argument: Malnutrition causes death and impairs the growth and

    development of millions of children

Malnutrition is a major factor in 54% of deaths to children under the age of 5 in the

    developing world. Moreover, 83% of these deaths are attributable to mild to moderate, rather than severe, malnutrition. Malnutrition disrupts growth and weakens the mental

    development of children, producing less healthy and less productive adults.

For example:

    ? Protein-energy malnutrition (PEM) affects about 200 million children worldwide under

    the age of 5. The number of protein-energy malnourished children has recently risen in

    Africa and South-East Asia. Protein-deficient children do not grow at their genetic

    potential. They also run the risk of experiencing more severe consequences from

    common childhood infections. Current and prior protein-energy malnutrition has been

    shown to result in poor retention of facts, poor school attendance and poor school


    ? Iron deficiency affects approximately 2 000 million people in developed and developing

    countries. Iron deficiency anaemia in infants and children can retard physical

    growth and delay cognitive development as well as increase vulnerability to

    infection. Furthermore, it impairs the reproductive function of women, which puts the

    lives of both women and their babies at risk.

    ? Vitamin A deficiency puts over 250 million children worldwide at risk of blindness.

    Every year up to half a million children become partially or totally blind. Two-thirds of

    them die within a few months of going blind. Even moderate levels of deficiency can

    lead to stunted growth, increased susceptibility to and severity of infections and higher

    death rates. Vitamin A deficiency is the single greatest preventable cause of

    blindness in children. ? Iodine deficiency is estimated to affect over 800 million people worldwide. Over 40

    million people are affected by some degree of iodine deficiency-related brain damage.

    In later infancy and childhood, iodine deficiency causes mental retardation, delayed

    motor development, stunted growth, speech and hearing defects. Iodine deficiency is

    the single most common preventable cause of mental retardation and brain

    damage in children.


FRESH Tools for Effective School Health First Edition 2004

All these consequences of malnutrition compromise children's attendance and performance

    at school. They can be reduced by school-based interventions. Educating parents, parents-

    to-be and other family and community members, as well as providing resources to correct

    deficiencies, will help decrease the risk of developing these conditions.

II. Nutrition interventions in schools really work!

The following arguments can be used to convince others of the effectiveness of nutrition

    interventions to promote health through schools. They can also help to justify decisions to

    increase support for such efforts.

Argument: Nutrition interventions improve children's health, learning

    potential and school attendance

Good health and nutrition are needed for concentration, regular school attendance and

    optimum class performance. Existing research makes a convincing case in respect of

    nutrition and health interventions improving school performance. For instance, studies

    in several countries indicate that the academic performance and mental ability of pupils with

    good nutrition are significantly higher than those of pupils with poor nutrition. This and other

    evidence of the positive impact of good nutrition has been so convincing that the United

    Nations Sub-Committee on Nutrition recommends health and nutrition programmes be

    included in efforts to increase school enrolment and learning.

Argument: Schools are important settings within which to promote good

    nutrition and provide nutrition interventions

Schools offer more effective, efficient and equal opportunities than any other setting to

    promote health and healthy eating. They are in contact with young people at a critical age of

    their development during which lifestyles, including eating patterns, are developed, tested

    and adapted through social interactions within families, and with peers, teachers and other

    adults. Classes for younger pupils provide excellent opportunities because eating habits are

    formed early in life. In addition, schools have the potential not only to reach students, but

    also school staff, teachers, parents and community members, including out-of-school youth.

Schools are an ideal setting within which to promote health and healthy nutrition for several


? Schools reach a high proportion of children and adolescents.

? Schools provide opportunities to practice healthy eating and food safety.

? Schools can teach students how to resist unhealthy social pressures since eating is a

    socially learned behaviour that is influenced by social pressures.

? Skilled personnel are available to provide follow-up and guidance ? after appropriate

    training of students, teachers and other staff.

? Evaluations show that school-based nutrition education can improve young peoples’

    eating habits.


FRESH Tools for Effective School Health First Edition 2004

    Argument: We know how to improve health and well-being through school

    nutrition interventions

For many years now, evidence has maintained that well-managed nutrition education

    programmes can, at relatively low cost, bring about behaviour changes that

    contribute to improved nutritional well-being. Studies in the United States indicate that

    carefully designed and implemented comprehensive health education curricula can prevent

    certain undesirable health habits, including dietary patterns that cause disease, taking hold.

    Students in behaviourally based health and nutrition education programmes have shown

    significant improvements in levels of blood cholesterol, blood pressure and body fat.

Moreover, school feeding programmes increase food availability to schoolchildren who need

    it, whilst at the same time promoting long-term development through education. Numerous

    evaluations of school feeding programmes report significant increases in height and/or

    weight for participating children or in attendance and achievement levels. School feeding

    programmes decrease short-term hunger, thus enabling children to concentrate on their


Argument: Schools can provide interventions to improve nutrition in highly

    cost-effective ways

Cost-effective interventions in schools can prevent or greatly reduce the negative

    consequences of malnutrition and foster the positive effects of healthy nutrition. Compared

    with other public health approaches, research shows that school health programmes

    providing safe and low-cost health service interventions, such as screening and

    health education, are one of the most cost-effective investments a nation can make to

    improve the health of its citizens. Among the most cost-effective investments are programmes that include micronutrient supplementation and increased knowledge about

    nutrition. For example, a nutrition education programme in Indonesia based on behavioural

    change showed a considerably greater impact at much lower cost than other types of

    interventions to which it was compared.

Argument: Education and healthy nutrition for girls has a positive impact on

    family health

Improving and expanding educational opportunities for girls is one of the best health and

    social investments. In the long term, an improvement in girls' health results in better health

    for their children and families because women generally have more responsibility for caring

    for others within the household, including household management, food preparation,

    cleaning, health care, education and supervision of children, all of which can have a

    significant impact on health. Furthermore, educated girls are healthier than girls with little or

    no education. Educated girls and women seek appropriate prenatal care, give birth to

    healthier babies and bring them home to healthier environments. Research has shown that

    the single most important factor in determining a child's health and nutritional status

    is its mother's level of education. Malnourished mothers tend to deliver low birth weight babies, thus perpetuating the problem of malnutrition and ill health from one generation to

    the next. And, there is now evidence that a child's aptitude for formal education may be in

    jeopardy even prior to school enrolment if the mother suffered from maternal iodine

    deficiency during pregnancy. Thus, educating young mothers and mothers-to-be is one of

    the best ways of ensuring the health of the next generation. In addition, the school may be

    useful in supplementing the diet of girls before puberty to ensure that their growth potential is

    fully achieved during this critical stage of their development.


FRESH Tools for Effective School Health First Edition 2004

Argument: Nutrition interventions in schools benefit the entire community

School health education about good nutrition also serves as a means to inform families and

    other community members about ways to promote well-being and prevent malnutrition. For

    instance, educating children about good eating habits has the potential to enhance the

    nutrition and health status of their siblings and other family members who learn along with

    their children. Additionally, involving parents in nutrition interventions at the

    elementary school level has been shown to improve the eating behaviour of both

    pupils and their parents.

Research also shows that school health education interventions can be considerably

    strengthened by complementary community-wide strategies. Schools can be the centre for

    community projects that include programmes to improve the health and nutrition of the

    community. They also provide a setting within which to introduce new health information

    and technologies to the community. For instance, the establishment of school canteens

    offering healthy food choices and practising good food safety is one way of demonstrating

    how to improve facilities within the wider community. Furthermore, partnerships between

    schools, organizations and businesses can benefit both the school and the community, if the

    partnership is mutually beneficial.

     1 Adapted from: WHO/FAO/Education International 1998. WHO Information Series on School Health

    Document 4: Healthy Nutrition: An Essential Element of a Health-Promoting School. Geneva: WHO. (


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