Schools as Platforms to Deliver Integrated Nutrition: Review of Relevant Literatures

Nearly a billion people experienced hunger in 2010 (FAO/WFP 2010). Another billion are thought to suffer from “hidden hunger” in which important micronutrients are missing. Under nutrition remains one of the world’s most serious but least addressed socio-economic and health problem (FAO/WFP 2012; SUN 2010).

Maternal and child under-nutrition is the underlying cause of 3.5 million deaths each year and 35% of the disease burden in children younger than 5 years. For all developing countries, nearly a third of 178 million children younger than 5 years are stunted (low height for weight). There are 55 million acutely malnourished children globally (10%) and 19 million children severely acutely malnourished (3.5%).[1]

The recent Second International Conference on Nutrition (ICN2) brought UN member states together to bring much needed global attention to the billions of people around the world who suffer from all forms of malnutrition – undernutrition, overnutrition, and micronutrient deficiencies. There is now  a growing  global consensus that all forms of malnutrition are unacceptable, preventable, and more must be done to saves millions of lives from the devastating effects of malnutrition.( http://globalnutritionreport.org)

Though agriculture has already a strong impact on poverty and malnutrition (mainly the result of successful expansion of food staples such as cereals), the question needs to be asked if the nutritional impact of lower staple food prices is overcome by higher prices of vegetables, fruits and animal products over the past 25 years. These foods are particularly rich in micronutrients and other substances that are crucial to good health and human development. Agriculture practices need to be studied to see if agriculture can have a larger role in reducing micronutrient deficiencies and malnutrition.[2] The impacts of food price rises  in 2007-2008 have brought consideration attention to the impacts of  how food instability in Asia.

Climate change modeling studies suggest, that at the global level, climate change will reduce crop yields and land suitable for agriculture with the greatest impacts in tropical latitudes. Climate change could increase  the numbers of malnourished children ,especially in the least developed countries. Evidence supports the idea that the impacts of climate change on food security will spread unevenly, affecting the population that are currently most at risk. Several quantitative assessments also suggest that food prices will increase as a result of climate change, thereby affecting the ability of poor farmers to purchase food. Ultimately how strongly the impacts of climate change will be felt will depend on the ability to adapt to these changes.[3] Climate change is expected to result in further food price rises affecting the poor likely to eat more carbohydrate sources and less of the nutrient dense food sources.

This  increasing concerns about nutrition is bringing the global community together to  recognize the role of nutrition in development. The biggest recent step forward for the nutrition sector was the  establishment of the Scaling Up Nutrition (SUN) movement in 2010. World leaders came together again in June 2013 to endorse a global compact on nutrition for growth that will prevent at least 20 million children from being stunted and save at least 1.7 million lives by 2020. As of 2014, 47 countries joined the SUN movement”.[4]The Philippines has only very recently  joined the SUN movement

As result of this resurfacing  of the importance of  nutrition , the agriculture sector is also increasingly under pressure to better deliver on the nutrition objectives. A small part of that debate on  nutrition-sensitive agriculture mentions the role of bio-fortification which involves breeding new varieties of crops. Others promote diversification of agriculture and the need to ensure that nutrition outcomes accrue in all agriculture programs through the deliberate inclusion of nutrition outcomes in the impact pathways and value chains for  agriculture. It is believed that new ways of approaching agriculture, including bio diverse and agro ecological approaches to gardening, small holder diversification and agro forestry can provide the level of dietary diversity needed to reduce child stunting, by promoting a more diverse range of crops, tree species and protein (livestock, legumes) options. School gardens have proven to be an excellent mechanism to promote nutrition sensitive agriculture especially if agro ecological are used ensuring safe  food free of residues

School feeding programs  receive considerably more attention as mechanisms to address childhood level malnutrition. Recent analysis by the World Bank (WB), World Food Program (WFP) and the Partnership for Child Development identified ,that today, most countries are seeking to provide food, in some way and some scale to its school children (Bundy, et al., 2009). The coverage (however) is most complete in the rich and middle income countries. Countries do not seek to exit from continuing to provide food to their school children but rather tend to transit from externally supported projects to nationally owned programs.[5] These programs procure commodities locally and are referred to as Home Grown feeding (i.e. ingredients are promoted locally so as to stimulate local trade).

The 2013 Global Child Nutrition Forum meeting in Salvador in Bahla Broul recommended the “School Feed Program” be considered a key national investment that complements early child interventions to promote full child development. It also recommended that the integration of school feeding programs with effective complimentary interventions including sanitation, health, deworming, micronutrient supplementation or fortification and nutrition education. (Over forty countries were present. The Philippines was not one of them.)

Meanwhile, there have been changes in SHN programming over the past decade with  increasing recognition since 2000, in middle and low income countries. SHN programs, as it is now known  offer important benefits to education and can sometimes serve as a productive social safety net. The evidence for  these benefits of SHN  is growing and usually  uncontested . This recognition has resulted in a movement away from the traditional perception of SHN programs as primarily a health-promotion tool implemented by the health sector to a vision of programs that aim to improve educational outcomes. Such programs are largely implemented by the education sector and designed to reach the poorest segments of the populations.[6] As many as 368 million children receive school meals with up to US$ 75 billion invested each year.[7]

Research with teachers has shown that they use school gardens to enhance the learning of their students, promote experimental learning, and teach environmental education (De Marco 1999, Skelly and Bradley 2000). Studies have also found that using school gardens to support teaching also does in fact improve student learning (Sheffield 1992) and environmental disposition (Alexander et al.).[8] Studies in industrialized countries have shown that “students who are actively engaged in garden projects tend to enjoy learning and show improved attitudes towards education. …third, fourth and fifth grade students who participated in school gardening activities scored significantly higher on science achievement tests than students who did not experience any garden-based learning activities” (Klemmer, Waliczek and Zajicek 2005).[9]

A literature review conducted by Nikki Norman and her colleagues concluded that there is “meaningful evidence that environmentally related education using the best educational practices can increase academic achievement across curriculum subjects”. Studies of natural environments , it concluded ,can be a significant factor in academic achievement gains. Certain teaching practices and teaching support in environmental education appear to strengthen academic outcomes (Norman, K. et. Al., 2006).[10] The potential for gardening as an environmental subject especially in the context of climate change and the growing nutritional awareness has not been maximized in the developing world. Gardens in schools can serve as a powerful mechanism to educate students, teachers and parents alike.

Other studies have stressed the role of gardens in influencing the food habits of children. “Children who grow their own food are more likely to eat fruits and vegetables and to show higher levels of knowledge about nutrition. They are more likely to continue eating healthy habits through their lives. Eating fruits and vegetables in childhood has been shown to be an important predictor of higher fruit and vegetable consumption in adulthood which can prevent or delay  chronic disease conditions over lifetime (Blair2009).[11]

The school system provides a platform for delivering nutrition interventions which can include not just gardens and school feeding but also for environmental and nutrition education. Rather surprisingly, in the literature for Asia and Africa, there is only scant reference to efforts that link school gardens to school feeding programs. The school is a perfect venue for demonstrating the potential for linking garden with school feeding, an area that has surprisingly not been adequately addressed except in few cases as in the IDRC-supported school gardening program with the Department of Education and the Food and Nutrition Research Institute in the Philippines (discussed elsewhere in this document). The local school board, the PTA and other government organizations and NGOs are, in effect, in a best position to ensure effective implementation of school health and nutrition programs.

[1] Black, R.E., Allen, Lit., Bhulta, Z.A., Caulfield, L.E. de Onis, M. Ezzati., Mathers, C.Rivera, J. (2008). Maternal and Child Undernutrition:Global and Regional Exposures and Health Consequence. Lancet 37 (9608) 243-260.

[2] Arne Oshaug and Lawrence Haddad in Nutrition:  A foundation for Development, Geneva ACC/SCN 2002.

[3] Climate impacts on food and nutrition: a review of existing knowledge. Mel Office Hadley Centre and WFP office for Climate Change.UNWFP. 2010.

[4] Nutrition Sensitivity: How agriculture can improve school nutrition, Save the Children (2014).

[5] Bundy, D.C. Burbano ,M. Grosh A. , Gelli M. Jukes and Drake 2009. Rethinking School Feeding, World Bank Washington D.C.

[6] What Matter Most for School Health and School Feeding: A Framework Paper, The World Bank Saber Working Paper Series Number 3, June 2012. (http://issuu.com/world.bank.publications/docs/9780821379073)

[7]State of School Feeding Worldwide Overview 2013, WFP.

[8] Quoted in the growing phenomenon of school garden: measuring their variation and their effect on students’ sense of responsibility and attitudes towards science and the environment by Sonja, M., Skelly Cornell Plantations and Department of Horticulture, Cornell Univesity, Ithaca NY USA.

[9] Klemmer, Waliczek and Zajicek, 2005. Growing Minds: The effect of school gardening program on the science achievement of elementary students. Horticulture Technology 15(3) 448-452).

[10] Nomann, N., Jennings, A., Wahi. L. (2006). The Impacts of environmentally related education on academic achievement . A literature survey. Community resources for Science. www.crscience.org.

[11] Blair, Dorothy (2009). The Child in the Garden: An Evaluative Review of the Benefits of School Gardening. The Journal of Environmental Education, Vol. 40, No. 2, Winter 2009.

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