The Food Journal and Food, Nutrition & Science

An alliance between The Lempert Report and The Center for Food Integrity

Small Town Health Policy Disparities

Small Town Health Policy Disparities

Health and Wellness

August 27, 2013

Small towns may not be getting enough of the policies they need to support healthy eating in school food environments, according to a recent study from the University of Minnesota. The study looked at the distribution of food and nutrition policies from 28 U.S. states and 6,732 secondary schools (6th to 12th grade), finding the greatest disparities in small towns and rural schools.

Researchers have made evaluating the effectiveness of The Child Nutrition and Wic Reauthorization Act of 2004 (CNRA 2004) a top priority since its implementation at the start of the 2006-2007 school year – especially since there is evidence that school food environments contribute to excess energy in children’s diets. And with obesity disproportionately affecting minorities and children from low socio-economic groups, it continues to be important to evaluate and monitor the distribution of policies like CNRA 2004 across all economic and geographical spectrums with a focus on minority enrollment and free/reduced-price school meal enrollment.

"I think it's also important to point out that 15% or about 46.2 million live in rural areas – spread out over 72% of the land in the U.S.," says study author Dr. Susie Nanney. "It seems that geography may be the challenge to accessing healthy food.Students in rural schools are already more likely to attend small schools, live in poverty, be food insecure, be eligible for free or reduced lunch, and come to school unprepared to learn. These startling figures make finding real solutions for small town/rural schools to provide and promote healthy eating options for their students all the more important."

University of Minnestoa researchers learned that small town schools were less likely to serve fruits and vegetables at school celebrations, have fruits and vegetables available in vending or school stores, and were less likely to limit serving-size packages. Schools with low free/reduced lunch eligibility were more likely to have all 10 of the less healthy items available to them. The most commonly available less healthy items were sports drinks, 2% or whole milk, soda, cookies and salty snacks.

Schools with a higher percentage of low income students in small towns fared even worse when it came to fruit and vegetable policies, but they did have better vending machine food policies. That may be because high minority and high free/reduced lunch eligibility schools are targeted with programs which give them additional supports to meet standards, says Nanney. (For example, the USDA fruit and vegetable program initially targeted elementary schools in high needs areas). Interestingly, schools with low rates of free/reduced lunch are much more likely to have vending machines or school stores with less healthy snacks available for purchase. 

The marketing of unhealthy items like candy, soda and fast foods was least likely to be prohibited in towns and rural schools. Suburban schools with high minority enrollment and low free/reduced lunch were most likely to limit package size of foods and drinks (87.5%); town/rural schools with low minority, low free/reduced lunch were least likely to limit package size of foods and drinks (54%).

Researchers point out that many small town schools are simply at a disadvantage because of their size, as smaller schools have fewer resources, and with a lower product volume, the chances for an abundance of fruit and vegetables seriously decrease. High quality produce in particular is so expensive that a smaller school operation may not be able to afford it.

Even though suburban and city schools seem to offer better food environments, overall scores are lower than they should be across the board. There is room for improvement in all areas with a particularly strong need for small town and rural focused policy support.

"Don't forget that these are middle, and junior/senior high schools. Previous efforts and therefore gains have been seen in elementary schools. The CNRA 2004 (to be implemented school year 2006-07) really started the ball rolling to improve school nutrition (and activity environments) for all schools. The Healthy Hunger Free Kids Act of 2010 expands upon those efforts. We'll see rolling implementation of additional improvements to the school food environments starting this school year. The extent that a 'one size fits all' policy effort speaks to small town/rural communities remains to be seen. I believe that the small town/rural communities have unique strengths and needs that will require different supports to realize healthier school and community environments," adds Nanney.