One of the perks of getting older is the constant sense of déjà vu when listening to political debates.
So, here we go again, #freeschoolmeals are under attack.
It was 1995 and I was living in the United States when the Republicans tried to cut the school lunch programme, at that time subsidising the meals of 25 million eligible children, and also tried to scrap the “uniform national nutrition standards” to be implemented in these lunches — basically, their minimum quality standards in terms of nutritients.
It wasn’t the first time, and it would not be last.
In 1981, in the famous “ketchup as a vegetable” controversy, the Reagan administration attempted to deal with the cuts in the federal budget for school lunches by listing ketchup and pickle relish as vegetables, thus offering cheaper alternatives to previous ‘true’ vegetable options.
And perhaps this went lost among the myriads of other recent news stories from the Trump administration, but just a few months ago the American Agricultural Department tried to reduce the amount of vegetables and fruits provided by the school lunch programme, and instead offer kids more pizza, burgers and fries.
All of these attempts were rejected by public opinion — and yet we are hearing the same debate again today, following the refusal by the British Government to extend the free school meals scheme.
And again, this is also not the first time in the UK: in 1979, under Margaret Thatcher, an Education bill proposed ending entitlement to free meals for thousands of children, as part of a plan to save £220 million from the educational budget.
I do not want to even try to argue the moral imperative of feeding a hungry child — or a hungry person, for that matter. The generous response of people and businesses alike to support free school meals since the Parliament vote is a testimony that such an argument is not needed.
And also I do not want to dwell on the well-described paradoxes of this political decision, like the fact that the costs of the free school meals are lower than the costs of the “eat out to help out” scheme, or the recent news that an Indian charity now offers free school meals in England.
As a scientist and a clinician, however, I do want to emphasise the enormous long-term costs of such short-sighted decisions: the creation of a generation of malnourished children who will grow to become adults with mental, physical and social problems.
Even mild forms of child undernutrition — both in terms of reduced quality intake and reduced quality of nutrients — is responsible for increased morbidity and mortality. Economic studies quantify the costs of these long-term consequences at around 1–2% of the gross domestic product and rising. Longitudinal studies (where we observe something over time) have shown that some of these consequences can last two or three generations.
The list of these consequences is long and wide, as they affect all areas of health and wellbeing.
Undernourished children tend to have a stunted growth and fewer years of schooling, and, as adults, they have reduced economic productivity, and, for women, lower offspring birthweight.
Other studies indicate an association with high sugar and fats in the blood, high blood pressure, and, above all, obesity.
Because the problem of cutting free school meals is not only that it makes children hungry — although this is a big problem; it is also that those hungry children, especially if from families with limited or no financial possibilities, will end up eating cheaper, more unhealthy foods, which then increase their risk of becoming overweight or obese.
In fact, undernutrition and overweight are no longer considered two distinct problems but, quite the opposite, they are now understood as the “double burden of malnutrition”: the simultaneous manifestation of both undernutrition and being overweight.
Let me state this again: the benefits of programmes such as free school meals are not just that they feed children — although this is important. It is also that these programmes often provide the only healthy and nutritional food intake for these children.
And the evidence linking a nutritional deficiency to mental health is striking.
An “unhealthy diet”, such as lots of fast foods or take-aways, and foods containing high fat and sugar levels, increases the risk of depression and poor mental health in children and adolescents, while lots of fruit and vegetables are protective for mental health, including depression and attention-deficit hyperactivity disorder (ADHD).
Indeed, studies over the years have shown that higher intake of fish, vegetables and fruits are associated with a smaller risk of developing depression, both in adults and children.
And we have also shown that children with ADHD have evidence of dietary deficit of omega-3 fatty acids, present in fish. Indeed, we have extensively discussed the importance of a healthy diet for our mental health, including for depression and ADHD, in previous blogs.
Of note, the amount of good quality food required to have this effect is not negligible. For example, studies in adults show that at least 50 grams of fish per day, or three normal portions of 100–120 grams a week, are required to protect us from depression, which is more than the amount that the UK government currently recommends (that is, one portion of fish twice a week, and few of us eat that). Why would any governments recommend a specific amount of fish intake with one hand, and then take it away from children with the other hand, is obviously, and sadly, an unanswerable rhetorical question.
Interestingly, a recent study assessed the economic benefits of school feeding programmes on undernutrition and obesity.
The evidence shows that these programmes have truly beneficial effects, quantifiable as an increase in children’s growth and a reduction in children’s body mass index, an index of being overweight or obese.
Most importantly, undernourished children can gain years of education from improved nutrition, as well as reduce their risk of premature adult death and disability due to being overweight.
The conclusion was that providing school meals with improved quality of diet would lead to
“substantial benefits that outweigh the costs of implementation, with return on investment”.
So, if it makes moral and economic sense, why do some governments want to cut these programmes?
Ultimately, it is, unfortunately, down to political views.
Newspapers have reported how some politicians have expressed their views in crude ways, but, basically, it is down to two simple, contrasting views.
Some people think that only parents should take responsibility for their children. And that children’s hunger is only their parents’ problem to solve. And that the only thing that the government should do is to help parents through welfare systems or support into work. This view has been emphasised with some MP’s justifying their vote by explaining that other welfare schemes, such as Universal Credit, were increased in response to the pandemic to support families meeting all welfare needs, including food.
And some people, like me, think that we, as a society, are responsible for all children. And that we can and must step up and step in if parents — for whatever reasons: poverty, disability, ill health, and yes, even lack of parental abilities — cannot feed them. This too has been highlighted with much public upset, protests and of course, the generous response of people and businesses that I mentioned earlier.
Only in this way we can break the vicious cycles of poverty leading to illness, and illness leading to poverty, from childhood to adulthood, from one generation to the next.
People have understood this already.
When will our governments understand?