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Public Health Nutrition: 16(6), 1006–1011 doi:10.1017/S136898001200420X
School food cost–benefits: England
Michael Nelson*
School Food Trust, 8 Wakley Street, London EC1V 7QE, UK
Submitted 30 March 2012: Final revision received 7 June 2012: Accepted 1 August 2012: First published online 25 September 2012
Abstract
Objective: To estimate the costs per relevant unit (pupils and meals) associated
with improvements to school food and the potential economic and health gains
that may result.
Design: Calculation of costs per relevant unit (pupils and meals) based on
(i) Department for Education expenditure to support improvements in school
food, 2005–2011 and (ii) measures of the changes in the number of pupils taking
school lunch and the number of meals served over the same time period; plus
examples of the use of linked data to predict longer-term economic and health
outcomes of healthier eating at school.
Setting: England.
Subjects: Local authorities, government departments and non-departmental
public bodies.
Results: Analysis of investment over a 6-year period indicates that costs of setting
up and maintaining a change organization such as the School Food Trust were
low in relation to short-term benefits in nutrition and behaviour. Models that
predict long-terms gains to the exchequer and to quality-adjusted life years need
further elaboration.
Conclusions: Modest levels of government investment in the delivery and promo-
tion of healthier school food is likely to yield both short-term and long-term
benefits in relation to nutrition, learning, economics and health.
Keywords
School food
England
Economics
Schools in England provide school lunches on site for
46 % of primary-school pupils and 40 % of secondary-
school pupils
(1)
. The majority of the remaining pupils
bring a packed lunch, although in some secondary-
schools pupils are allowed off-site at lunchtime. School
caterers are required to provide food in accordance with
compulsory school food standards
(2,3)
, except in aca-
demies which are exempt from the legislation. Catering
services are provided through local authorities, private
catering companies and in-school provision. Almost all
secondary schools have a dedicated kitchen in which
school food can be prepared from scratch; the majority of
primary schools have either a dedicated kitchen or a mini
or regeneration kitchen in which food can be plated
or reheated, with limited facilities for basic preparation.
A minority of primary schools (18 %) have hot food
transported in from elsewhere or serve cold food only.
The economic analysis of the impact of better school
food in England has been undertaken in several ways.
These include:
>implementation costs;
>income gains; and
>quality-adjusted life years.
These three approaches overlap, and none is conclusive.
They all suggest, however, that investment in school food
presents good value for money and has demonstrable
benefits in the both the short and long term.
Table 1 lists the potential benefits in terms of health,
attainment and income in the short, medium and long
term. The evidence base for each of them is strongest
for short-term (proximal) outcomes and less good for
medium- and long-term (distal) outcomes. One of the
reasons for this is the cost of and foresight needed to set
up robust longitudinal surveys. Relevant measures must
be included at baseline so that meaningful outcomes can
be assessed. For example, if the aim is to understand the
impact of healthier eating at school on adult risks of
diabetes, birth data (length and weight), weight gain in
the first year, family history of diabetes, school food
consumption and total diet in childhood all need to be
assessed. Intervening changes in eating habits and
changes in body weight over time throughout adulthood
also need to be collected. How to model this effectively is
a challenge. From the point of view of disease prevention,
it is as important to understand the lifetime progression to
a state of ill-health as it is to understand the proximal
circumstances immediately preceding that state.
Attempts to evaluate the impact of healthier eating
in childhood typically suffer from this lack of longer-
term evidence and reflect instead the stronger evidence
from more proximal interventions relating to outcomes.
*Corresponding author: Email Michael.Nelson@childrensfoodtrust.org.uk rThe Authors 2012
For example, the impact of cholesterol-lowering pro-
grammes in middle-aged men on risk of heart disease
appears to favour late intervention
(4)
. This conclusion,
based largely on randomized controlled trials, is reached in
part because there is no comparable longitudinal evidence
which evaluates the long-term impact on heart disease of
eating healthily from childhood and the impact of school
food policy on health-related outcomes in adulthood.
Were such evidence available with the same level of
robustness as the evidence from randomized controlled
trails, the cost–benefit analysis could yield very different
conclusions. Thus, the limitations of research approaches
and a robust evidence base dictate policy and imple-
mentation decisions that are skewed toward proximal
circumstances and interventions, ignore the cumulative
impact of life-course events and may not be the most
effective basis for improving public health. A further
limitation is the lack of evidence for outcomes other
than CVD morbidity and mortality. Long-term evidence
relating school feeding to non-fatal outcomes (e.g. risk of
diabetes), for example, is virtually non-existent. Equally,
there is very limited evidence of the impact of school
standards and feeding policies on total diet in the short
term or over time. In consequence, there is a strong
likelihood that the influence of school feeding pro-
grammes on adult health is substantially underestimated.
In the absence of such evidence, it is important to con-
sider the cost of implementing school food policies on the
understanding that even if the long-term risks cannot
be modelled appropriately or determined directly, there
are changes in nutrition that can be brought about that
are deemed desirable and accord with current govern-
ment healthy eating policy. This is the subject of the first
element of the current paper: a description of the unit
costs of implementing and supporting change in school
food, based on absolute costs relevant to policy outcomes
(e.g. increases in take up of school lunches).
An effective, alternative strategy is to link together
successive pieces of evidence collected at different life
stages. This can help to overcome the limitations of
longitudinal studies by making the data collections more
timely and relevant to outcomes. This is particularly the
case when policy interventions supersede baseline data.
(For example, the ALSPAC (Avon Longitudinal Study
of Parents and Children) study
(5)
, begun in the early
1990s, cannot provide evidence in relation to children’s
eating habits relevant to the introduction of school lunch
legislation between 2006 and 2009
(2,3)
.) Timely, robust
and coherent evidence on the impact of school food
policy on adult outcomes relating to morbidity, mortality,
economic and social well-being, etc. is therefore likely to
require an alternative approach to classical randomized
controlled trials or even community intervention trials
with evaluation of only relatively short-term outcomes.
The remainder of the paper summarizes briefly two
examples of ways in which successive longitudinal data
drawn from a variety of sources can be used to illustrate
longer-term gains in economics and health.
Implementation costs
School Food Trust spend per new school lunch
pupil, per pupil eating more healthily at
lunchtime and per meal provided
The School Food Trust (SFT) was set up to foster change
towards healthier school food provision. Specifically, its
role as a change agent was to increase school lunch take
up, encourage and facilitate adherence to the school
food standards, and to play supporting roles relating to
specific stakeholder groups: clarifying the standards
for caterers and parents; developing menus for school
caterers; advising on monitoring and compliance; devel-
oping software for caterers to use to promote their
services and menus, etc. to get across messages. The role
was specifically to work with schools, caterers, local
authorities, pupils, parents and other stakeholders about
the way in which school food had changed and why
(6)
.
Table 1 Benefits of school food over time*
Time scale Health Attainment Income
Now Better nutrition Better behaviour –
Healthy growth Better attendance –
Better grades –
Later Better nutrition Better qualifications Higher income
Healthy weight Better employment More taxes paid
Normal cholesterol
Normal blood pressure
Much later Less diabetes More satisfying work Higher income
Less hypertension Better social networks More taxes paid
Less heart disease Better emotional well-being Higher pension
Less stroke
Less cancer
More quality-adjusted life years
–, Not relevant at school age.
*This list is not comprehensive, but indicative of major outcomes.
School food cost–benefits: England 1007
The SFT received £38 million in total over 6 years
to support these activities. In addition, over this same
period, government provided £480 million ring-fenced
specifically to subsidize the cost of ingredients and in the
second three years to allow the money to be spent on
software for analysis in relation to the standards, for
professional support and for small pieces of equipment.
Food quality was an important component in making
sure that the changed school meals were acceptable to
pupils and parents, but the money was used as a subsidy
for food and not specifically to promote higher take up.
Other basic subsidies for school food from local autho-
rities over this period did not change. The following
calculations assess the approximate costs of providing
this support.
Over a period of 6 years, from 2005 to 2011, the
Department for Education (in its various incarnations)
provided programme grants of £15?4 million (2005–2008) 1
£22?6 million (2008–2011), a total of £38 million to set up
and run the SFT.During this same period, approximately
270 000 more pupils began taking school meals. Although
there was an initial decline in take up following broad-
casts in 2005 by Jamie Oliver about the poor quality of
some school food, national take up increased between
2008–2009 and 2010–2011 by about 5 % in primary schools
and about 2?5 % in secondary schools
(1)
. This represents
an increase by 2010–2011 of approximately 270 000 more
pupils taking a school lunch than in 2007–2008. This
includes both paid-for and free school meals. In relation
to the direct funding for the SFT, therefore, it has
cost approximately £38 million/270 000 5£141 for each
pupil new to taking a school lunch. While the long-term
impact of taking a school lunch is not fully known, from a
public health perspective, £141 represents a small cost in
relation to a change in eating habits in keeping with
government guidelines and with the potential to affect
lifetime eating habits (and concomitant improvements in
health) that may accrue from an introduction to healthier
eating in school.
In 2010–2011, there were approximately 3 million
school meals served each day in England. This has varied
slightly over time according to take up and the numbers
of pupils on roll. Evidence from a national study of school
food provision, choice and consumption in primary
schools in England suggests that the balance of con-
sumption has become more healthy (lower levels of fat
(22 %), saturated fat (16 %) and non-milk extrinsic sugars
(12 %), salt (32 %) and energy (8 %); and higher levels of
vitamin A, folate, dietary fibre and calcium (between 3 %
and 23 %))
(7,8)
. Similar improvements have been demon-
strated in the secondary sector
(9)
, and there is persistent
evidence over many years that school lunches are more
nutritionally sound than packed lunches
(10–12)
. For the
purposes of the present analysis, therefore, it can reason-
ably be argued that the average school lunch consumed
in both the primary and secondary sectors is more
nutritionally healthy than prior to the introduction of
school food standards in England. The cost per child per
year to have access to and consume a healthier school
lunch (in relation to the costs of setting up and running
the SFT over 6 years) would therefore be £38 million
divided by 3 million meals per day divided by 6 years 5
£38 million/(3 million 36 years) 5£2?11. This approach
takes into account the actual number of school meals
served, as not every child has a school meal every day, so
£2?11 represents the cost per child-equivalent across the
entire year.
Finally, the SFT spend can be expressed in terms of the
number of meals served over the period in which the SFT
has been running. If the spend per child-equivalent per
year is approximately £2?11 and there are roughly 190
trading days per school year, then the SFT spend per
school lunch 5£2?11/190 d 51?1p/lunch. A penny per
meal signifies how tiny has been the level of investment
needed to finance a change management organization
that has had a demonstrable impact on the pace and
extent of change in school food services over a 6-year
period and on children’s eating habits nationally. A recent
evaluation of the impact of the standards on total diet
suggests that the healthier eating gains evident within
school carry over to the total diet, i.e. the improved
profile of eating in school is not compensated for by
worse dietary habits outside school
(13)
.
Central government grants for school
catering services
Many caterers were concerned that there would be direct
costs relating to food, equipment, and kitchen and dining
facilities in schools if the transition towards healthier
eating following the introduction of the standards was
to be successful. Government therefore provided a direct,
ring-fenced grant to local authorities to support catering
services in this transition. Between 2005 and 2008,
government provided £240 million as a direct subsidy
to support the costs of ingredients. This was equivalent
to £240 million/(3 million meals served per day 3
3 years 3190 trading days) 514p/meal. A further ring-
fenced grant of £240 million was provided between 2008
and 2011. After representation from the school catering
industry, the scope for expenditure from this second
grant was expanded to cover not only subsidies on food,
but also to purchase software for nutrient analysis relating
to the menu development and the monitoring of com-
pliance in relation to the standards; professional support
to achieve and monitor compliance with the standards;
and small pieces of equipment (but not major kitchen
refurbishments). When non-food expenditure was taken
into account
(14)
, this was equivalent to a subsidy on food
of approximately 11p per meal. A further £80 million was
provided by the Department for Education for 2011–2012,
but this was not ring-fenced. This money was spent
similarly to spending in 2008–2011
(1)
.
1008 M Nelson
Income
Economic impact of healthy eating
The SFT commissioned an analysis of the economic gains
that may accrue if healthier eating is associated with
better attainment at school
(15)
. This would be mediated
through higher educational qualifications, employment
prospects, and lifetime earnings and taxes payable. The
question is whether the net gain to the exchequer in tax
revenues over the employment life of an individual pays
for the implementation of healthier eating in schools.
This analysis does not include the potential savings to the
National Health Service from lower morbidity, nor higher
productivity relating to better health. The model outlined
below (elaborated fully in the publication on the SFT
website
(15)
) is illustrative of the approach that shows
how evidence from stages of progression through child-
hood and adulthood can be linked to generate useful
conclusions.
A small study of the impact of the introduction of
breakfast clubs on attainment in primary schools in poor
areas of London provided the starting point
(16)
. Average
changes in Key Stage 2 in the year following the intro-
duction of breakfast clubs in thirteen schools was 0?72
points, significantly greater than the change (0?27) in nine
comparable schools over equivalent time periods in
which a breakfast club had not been introduced in the
school. In each of several scenarios, the economic gain
relating to the observed changes in attainment stood at
between £1330 and £1692 over the life course (expressed
in monetary value in 2008). Adopting the most con-
servative outcome, the findings suggest that the economic
impact of the introduction of breakfast clubs was £1330
per pupil in the treatment group compared with control
group. The number of children in the year groups parti-
cipating in this initiative was approximately 675. Using
the model described in the paper, the total economic
benefit of the initiative was approximately £897 000.
There was no accurate information on the costs asso-
ciated with the implementation and delivery of the
initiative (some of it being supported by volunteers,
some through corporate or charitable sponsorship, and
some through subsidies from both schools and parents).
A least-favourable cost of implementation, based on the
highest reported value, was about £8?00 per week per
pupil attending the breakfast club. If it were assumed
that 100 % of pupils in the school attended the club
(again, a least-favourable assumption for the purposes of
modelling), the total annual cost associated with the
provision of these services (assuming 190 school catering
days per annum) would be in the region of £205 000. This
implies that the ratio of benefits to costs was approxi-
mately 4?38 (£897 000/£205 000). In reality the ratio of
benefits to costs may be significantly higher, as the gain in
average Key Stage 2 results was based on far lower levels
of participation.
Quality of life years added
Public Health Research Consortium
The Public Health Research Consortium (PHRC) carried
out research to evaluate the impact of the introduction
of school food standards on changes in provision and
consumption (in relation to school food and total diet)
(13)
and to assess the cost–benefits over time
(17)
. Their find-
ings suggest that the cost of implementing the standards is
small in relation to the likely gains in quality-adjusted life
years that will accrue following the implementation of the
standards to support healthier eating at school.
The PHRC analysis took into account the direct costs in
relation to food, catering staff, etc. It did not, however,
include the subsidy from central government to support
the transition to healthier food in school catering, nor the
cost of setting up and running a change management
organization (the SFT).
Discussion
The evidence summarized in the current paper supports
two conclusions in relation to the costs and benefits
of introducing school food standards. First, the costs of
promoting and implementing healthier eating over a child’s
school career are low. At just over a penny a meal, the
short- and long-term benefits of instituting and maintaining
a change support organization (the SFT) are immediately
evident in terms of nutritional outcomes
(7,9)
, and highly
likely in relation to longer-term economic
(15)
and health
(17)
outcomes. While it could be argued that the introduction of
compulsory standards together with direct financial support
for catering services might have achieved the same ends,
the overwhelming experience of the SFT in overcoming
resistance to change suggests otherwise. In every sector
(catering, schools, parents), it was necessary to address
anxieties about change and to do so in a way which was
coordinated across sectors
(6)
. Without the presence of an
organization dedicated to supporting the transition in
school catering, it seems unlikely that the immediate
nutritional or longer-term hypothecated economic and
health benefits would have been achieved to the same
extent, if at all. Thus, the benefits appear far to outweigh
the costs of implementation.
Of course, these changes did not occur in isolation.
The banking crisis which began in 2008 had complex
effects on family incomes (remaining virtually static),
spending patterns (reduced consumer spending) and
food costs (food inflation varied between 2 % and 6 % per
year over this period)
(18)
. While some families became
newly qualified for free school meals, there were thus
pressures against spending on school food in families on
low incomes that did not qualify for free school meals:
packed lunches are cheaper to provide (if less healthy)
and are consistently viewed as the cheaper alternative
School food cost–benefits: England 1009
to school lunches when budgets are tight. Over this
same period, three local authorities in deprived areas in
England participated in a pilot study to provide universal
free school meals in primary schools
(19)
, and one or two
other local authorities instituted their own free school
meal schemes in the primary sector. The changes thus
represent the product of a number of competing trends.
Given the initial widespread resistance to change, as
evidenced by the initial rapid drop in school lunch take
up following Jamie Oliver’s revelations about the poor
quality of food in some schools, it seems reasonable to
assume that intervention by the SFT was at least in part
responsible for the turnaround in this decline.
These costs are in line with other published findings
relating to school-based food and health programmes,
whether in low-income
(20)
or high-income countries
(21)
.
They also confirm the notion that healthier diets are likely
to cost more
(22)
(although improvements can be achieved
with very modest increases
(23)
) and that investment in
both social change and ingredients are necessary to
achieve desired outcomes. They suggest that appro-
priately focused, modest investment through schools to
improve food quality and nutrition, intended to reach the
child population and their families, represents good value
for money when assessed against the broadest criteria
(24)
.
The investment value thus accords with other studies
internationally.
Second, understanding the likely longer-term impact of
improvements in school food on educational and health
outcomes is complex. Modelling of the economic and
health benefits is likely to be achieved only through
concatenation of existing sets of evidence, appropriately
selected in relation to the starting and end point of
each analysis. Conlon’s economic paper
(15)
, for example,
required concatenation across four sets of data (primary
school breakfast clubs – academic attainment at Key
Stage 2; probabilities of progression through academic
levels, including GCSE, A levels and higher and further
education; educational outcomes and employment pros-
pects; links between employment and lifetime earnings).
Each of these medium-term longitudinal data sets
requires appropriate starting and end points to facilitate
linkage across life stages. Similar links are required in
relation to the analysis of likely health outcomes. This
assumes that the appropriate starting and end points can
be matched, which is not a given.
Ultimately, the findings presented and summarized here
suggest that improvements in school food are cost-effective,
both in terms of economic gains by the exchequer relating
to employment, productivity and taxation, and in terms of
health outcomes. The economic modelling
(15)
referenced in
the current paper is probably conservative, while the
modelling relating to health gains
(17)
needs to take into
account the costs relating to the setting up and running of
the SFT and the subsidies for school food and catering
support provided by government directly to catering
services. Further analyses of changes in growth and edu-
cational attainment in relation to changes in school lunch
take up are currently being undertaken, and will contribute
further to the evidence base for the cost-effectiveness
of implementing and supporting school food standards
in England.
Acknowledgements
This research received no specific grant from any funding
agency in the public, commercial or not-for-profit sector.
There are no conflicts of interest. The workshop in which
the paper was presented was supported by the School
Food Trust and the WHO Regional Office for Europe.
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