What can be learned from others about policies for healthier school food?  What can be learned from others about policies for healthier school food? 

Background

In 2016, Chile became the first country to combine three WHO-recommended healthy food policies into a single comprehensive law: front-of-package warning labels, marketing restrictions and school food regulations. This created mutually reinforcing measures rather than isolated interventions. The school food regulations banned the sale, marketing and advertising of foods and beverages with warning labels inside schools, restricted free giveaways to children under 14 and required schools to incorporate healthy eating activities into their curriculum.

How the Policies Work Together

The policies reinforce each other through multiple pathways:

• Warning labels identify unhealthy products ➔ Marketing restrictions prevent companies from marketing them to children ➔ School bans of these products create protected environments
• Schools promote healthy eating and create environments free of unhealthy products ➔ Children influence parents’ purchasing decisions at home (mothers reported children “acting as change agents, asking for healthier snacks”), extending impact beyond schools
• All three policies use the same nutrient thresholds, creating a consistent regulatory environment

Timeline

2006-2012: Legislative Development

• The Global Strategy Against Obesity plan introduced front-of-package labeling concept, sparking debate
• Senator Guido Girardi, a medical doctor, led bill development through intense legislative, academic and social debate
• School provisions were part of the original drafting: public health experts on the bill’s committee, including Dr. Ricardo Uauy, argued for restricting sales near and inside schools, explicitly drawing on Chile’s tobacco control precedent

July 2012: Law of Food Labeling and Advertising Enacted

• The law was approved, but without the school-proximity buffer, establishing a one-year deadline for implementing regulations

2012-2015: Regulation Development

• The first regulation attempt (2013) was deemed insufficient, with the new government administration restarting the process with two expert committees to help generate a stronger regulation
• The Ministry of Health organized national and international consultations on the final draft of the regulation, with participatory dialogues nationwide with families, parents, teachers and school communities
• Chile lacked strong civil society coordination, requiring the Ministry of Health to actively lead community engagement—delaying implementation but strengthening public support

2015-2019: Phased Implementation

• The food and beverage industry exerted significant pressure, resulting in a final regulation with phased implementation with progressively stricter nutrient thresholds: Phase 1 (June 2016), Phase 2 (June 2018), Phase 3 (June 2019)

Impact on schoolchildren

• Sales of unhealthy foods at school kiosks in Santiago dropped from 90% to 15% within six months of the law’s introduction.
• At school, children reduced consumption of total sugars (4.5-11.8 percentage points), saturated fats (1.1 percentage points) and sodium (10.3 mg/100 kcal); adolescents reduced total sugars (5.3 percentage points) and saturated fats (1.5 percentage points). However, researchers found increased consumption of nutrients of concern at other locations (e.g., restaurants, stores), emphasizing the need to extend regulations to environments near schools.
• A national study of more than 300,000 Chilean schoolchildren aged 4-6 found Phase 1 of the policy was associated with a lower probability of excess weight, with effects growing over time: 1.91% lower among girls and 2.24% among boys after 6 months, rising to 2.85% and 2.40% after 18 months.

Key Success Factors

• All three policies based on the same nutrient profiling system, with warning labels serving as the trigger for marketing restrictions and school bans
• Nationwide participatory engagement built stronger public acceptance
• Strong government leadership that actively engaged academia compensated for weaker civil society coordination
• Schools served as conduits for healthy eating advocacy, with children learning about nutrition at school and acting as change agents at home

Remaining Gaps

• Chile’s nutrient thresholds are not as stringent as other models, such as WHO regional nutrient profile models
• Nonsugar sweeteners are not included, meaning companies can circumvent regulations by replacing sugars with alternative sweeteners
• The policy does not cover areas around schools, which are important sources of food and marketing exposure for children
• The policy defines children as under 14 years of age, which falls short of the international standard under the UN Convention on the Rights of the Child as under 18 years of age

Background

In 2022, Barbados became the first Caribbean country to adopt a comprehensive National School Nutrition Policy—a significant achievement driven by coordinated civil society advocacy and proactive planning for implementation. The policy includes nutrition standards for all foods and beverages available in schools, marketing restrictions, physical activity requirements and health literacy from preschool through tertiary education.

Timeline

2015: Original Guidelines

• The National Nutrition Centre developed voluntary guidelines lacking legal mandate and enforcement; school implementation remained low

2018: Building the Movement and Evidence Base

• Prime Minister Mottley committed to childhood obesity prevention policies including health-promoting schools at CARICOM Summit
• The Heart and Stroke Foundation of Barbados (HSFB) collected foundational data on noncommunicable diseases and school food environments
• HSFB launched the first major campaign on banning the promotion and sale of sweetened and unhealthy foods in schools
• Barbados Childhood Obesity Prevention Coalition was formed at national workshop where Caribbean stakeholders convened to share school nutrition policy experiences

The Pivot: HSFB expanded its advocacy from just removing sweetened beverages to also demanding a comprehensive National School Nutrition Policy prohibiting sale and promotion of ultra-processed products, aligning with WHO/PAHO recommendations.

2019-2021: Proactive Implementation Planning

• HSFB designed a Model School Project, signing a ceremonial MOU with six schools across Barbados to pilot a ban on sweetened drinks and promote healthier school environments. The project included training and sensitization sessions for key stakeholder groups—including vendors and canteen concessionaires, principals, teachers, parents and students
• HSFB marked World Health Day with a Youth Day of Advocacy Action, tagging decision-makers in activities online; prompting a Ministry of Health meeting to discuss policy development
• HSFB engaged technocrats from the ministries of Health and Wellness, and Education, who became policy champions, becoming a go-to information source for the media and public
• PAHO/WHO hosted three consultations to develop a multi-sectoral policy with the Ministry of Health, Ministry of Education, Child Care Board, civil society and other stakeholders

2022: Cabinet Approval (One Year Delay)

• May 2022: Cabinet approved the National School Nutrition Policy

2023: Official Launch

• February 2023: The policy was officially launched, with an action plan for phased implementation from April 2023
• HSFB facilitated a two-day session of the Barbados School Nutrition Policy Implementation Committee to design a four-year Implementation Plan

Key Success Factors

• Strategic scaling in advocacy from a focus on sweetened beverages to comprehensive policy addressing all ultra-processed products
• Proactive implementation through model schools demonstrated feasibility, while vendor training addressed livelihood concerns
• Youth engagement and digital activism that proved effective with government
• International coordination, with PAHO/WHO playing a key role in facilitating the multi-stakeholder process and providing technical expertise

Background

The Brazil National Feeding Program (PNAE) is one of the largest school meal programs in the world, feeding more than 40 million children each year. Initially established in the 1950s to meet students’ nutritional needs, the program has evolved to integrate emerging scientific evidence, restrict ultra-processed products and support local farmers, serving as a model for countries worldwide.

Timeline

1950s: Program Established

• PNAE launched to meet students’ nutritional needs during school hours

2009: Law Mandates Buying from Local Farmers

The School Feeding Law (Lei da Alimentação Escolar):

• Guaranteed all primary students healthy, varied school meals that respect local food culture, plus nutrition education in the classroom
• Required that at least 30% of federal PNAE resources be spent buying food directly from family farmers—with priority given to land reform communities, Indigenous communities, quilombola (Afro-Brazilian descendants of escaped enslaved people) communities and women’s groups. This made Brazil the first country to require this kind of local farmer procurement for school meals
• Established monitoring and accountability mechanisms

2020: Restrictions on Ultra-Processed Products

• A new resolution aligned procurement with the Brazilian Dietary Guidelines using the Nova food classification system to cut down on processed foods and avoid ultra-processed products
• At least 75% of funds now had to go to fresh or minimally-processed foods; processed and ultra-processed food purchases were capped at 20% of the budget (with an additional 5% cap for processed culinary ingredients)

2023-2026: Tightening the Rules Further

• A resolution increased per capita PNAE funding to 28–39% in 2023
• A 2023 decree set out a broader framework for healthy school eating: Nutrition education, rules on what can be sold or donated in schools (prioritizing minimally processed foods) and limits on marketing ultra-processed foods to children
• The cap on processed and ultra-processed food purchases dropped from 20% to 15% in 2025, and will fall further to 10% in 2026
• In February 2026, the government approved a 21.8% budget increase—its biggest in years—restoring purchasing power lost to food inflation

Impact on schoolchildren

• Health outcomes: Adolescents who frequently consumed school meals had 11% less prevalence of overweight and 24% less prevalence of obesity, compared to those consuming fewer school meals High consumption of school meals was also associated with better overall diet quality scores.
• Economic impact: Family farming procurement stimulated GDP growth (R$15 million/US$5 million net increase), boosted family farmer income (R$39 million/US$12 million) and created 24,000 jobs nationally
• Global influence: Brazil’s institutional procurement experience inspired the Purchase from Africans for Africa (PAA Africa) initiative, which uses school feeding as one of its main channels for connecting smallholder farmers to markets in Ethiopia, Malawi, Mozambique, Niger and Senegal