Promoting Healthy Eating to Children

A Look at Successful Canadian Programs

by Doris E. Gillis, M.Sc., M.Ad.Ed., P.Dt., Nutrition Consultant

Youth under 19 years of age make up about 28% of the Canadian population.¹ Limited access to foods for people living in poverty; increased responsibility for food selection among "latch-key" kids; and a rising prevalence of obesity, coupled with an obsessive concern about weight and dieting, are some of their main nutritional challenges.¹

How can such challenges be met? Some innovative community-based strategies across the country suggest important clues for success.

Position healthy eating in the broader context of healthy living.
Involve children and their parents in identifying their needs and determining ways to meet them.
Capture children's interest and nurture their self-esteem by using innovative methods to develop personal skills and by recognizing their achievements.
Address the needs of vulnerable children through food programs and development of food choice skills.
Respect the cultural diversity of children and youth.
Create supportive environments through school food policy.
Capitalize on multisectoral collaboration.

Understanding the Challenges

More than 1.2 million Canadian children live in poverty, including one in five under the age of 7.¹ Poor children are more likely to have chronic health problems and difficulties at school, and less likely to feel good about themselves.
Almost 40% of the Aboriginal population is under the age of 15;¹ they are more likely to face food shortages, and their social and economic conditions are significant barriers to healthy eating and positive self-esteem.
One fifth of school children spend some time alone at home, and tend to make many decisions about what and when to eat. Almost 30% of these "latch-key" kids are between 6 and 9 years of age.
Obesity appears to be increasingly prevalent among Canadian children, largely attributed to limited physical activity.³
Many young people, especially girls, are concerned about their appearance, weight and dieting. Many also report low self-esteem, increasing their risk of eating disorders. By Grade 9, only 26% of girls reported high self-esteem compared to 40% of boys.⁴
About 13% of Canadians speak a language other than English or French at home,¹ a cultural diversity reflected in eating patterns.

Making It Happen

Key health educators across the country have shared examples of innovative initiatives in their communities, many of which involve partnerships.

Involving Children
Through Simcoe County Health Challenge, Ontario students have been challenged to identify and address issues that concern them. The program was initiated in 1991 by school boards, the public health unit and the local Canadian Mental Health Association chapter. Many of the projects focus on nutrition. A priority identified by one school, "Eating a nutritious, litter-free lunch which will promote good health with a cleaner environment", resulted in an environmentally friendly, healthy food program with parents and grandparents serving lunch to about 50 students a day. Student accomplishments have been recognized through media coverage, participation certificates and a compendium of the projects circulated to other schools in the county. Students report that the program has helped them build self-esteem and confidence.

The adaptation of this program by Calgary signals its success. SNIP: School Nutrition Incentive Program, involves boards of education, health services, the Dairy Nutrition Council and the Boys and Girls Club.

Reaching Vulnerable Children
Most school-based feeding programs to reach vulnerable children are community-driven,² offered mainly at school, but also through churches and community centres. They rely heavily on short-term funding, donations and volunteers.

Since 1992, the Breakfast for Learning program of the Canadian Living Foundation for Families has helped more than 1,000 community groups in all provinces set up and maintain breakfast programs. Not only are children provided with nourishing food, but they also learn about healthy eating, buying and preparing food, and develop social skills and cultural sensitivity.

In Ontario, the Hamilton-Wentworth Regional Health and Social Services Committee initiated a School Child Nourishment Task Force to assess the need for nourishment programs. Through a community forum, focus groups and questionnaires, more than 2,200 people contributed to the 1994 Task Force report. The principles and practical tools which emerged for starting such programs have been widely distributed. They not only reflect important elements in building food security, but also highlight the importance of nourishment programs in promoting healthy eating skills and practices. School food policies have also been influenced: the Roman Catholic School Board is now developing its own food policy and the Hamilton School Board is putting higher priority on its existing policy.

Organizers of the Newfoundland and Labrador School Milk Program overcame significant barriers, such as supplying refrigeration and serving small schools in remote areas, to provide more than 108,000 students (95%) with affordable milk. This required a 50% reduction in its wholesale price, through financial support primarily from dairy producers and processors and the provincial government. Classroom activities, a video and promotional incentives encourage children to consume milk as part of healthy eating.

Better Beginnings, Better Futures is a major longitudinal project in a number of low-income Ontario communities which aims to promote optimum child health through community-based strategies.

Involving Parents
In Vancouver, the School and Community Action on Nutrition (SCAN) Project puts high priority on parental involvement. Two schools overcame the barrier of parents speaking five different languages. Through translators, teams of students, parents, teachers and community resource people have outlined their concerns and are planning action strategies. These include setting up nourishment programs, enhancing the nutrition education curriculum, developing school food policy and providing after-school programs. Cooking classes have been suggested as a way for children to share their cultural food practices.

A school board in the Northwest Territories has developed two curricula which focus on Native culture. Parents and elders teach children about traditional food practices, from hunting, fishing and gathering food, to preparing it and enjoying the social aspects. Food guides portray local foods to illustrate healthy eating.

Partners from Industry and Voluntary Organizations
The B.C. Dairy Foundation and the Dairy Farmers of Ontario (formerly Ontario Milk Marketing Board) are on the cutting edge of nutrition education for children and youth with innovative materials and workshops for educators. Posters developed by the Canadian Egg Marketing Agency reinforce the food guide messages in a creative way that is age-appropriate and meaningful to children.

For the last 4 years, Kellogg Canada Inc. and the Quebec Ministry of Health and Social Services have orchestrated a back-to-school awareness campaign called A Good Breakfast Makes Good Sense! Last fall's campaign reached some 100,000 Quebec school children. A range of communication channels was used. In addition to the information kits for schools and public health professionals, two commercials were aired, one aimed at adults and one at children, and an insert featuring a quiz, healthy breakfast ideas, and cereal coupons were distributed to 500,000 households.

Voluntary health organizations are also launching exciting campaigns. The Fitzin Program of the Heart and Stroke Foundation of Manitoba promotes the selection of a variety of tasty, nutritious foods in high school cafeterias. It includes in-service training for school food service managers, as well as recipes and promotional materials.

Reaching Impressionable Pre-teens
Getting There is Half the Fun is part of a campaign targeted to 10- to 12-year-olds. Developed by the Hamilton-Wentworth public health department for use throughout Ontario, the program encourages families, the school and the community to work together to create a supportive environment for promoting healthy lifestyles. Market research techniques were used to identify pre-teens' concepts of health, healthy eating, activity and self-esteem.

In Vancouver, Girls in the 90's helps pre-teen girls to talk about issues important to them. The health department, Boundary Health Unit and Delta Youth Services teamed up to produce a facilitator's manual which outlines a format for meeting with groups of pre-teens; gives background on gender socialization and development, the challenges of adolescence, eating disorders and the preoccupation with food and weight; and suggests learning activities.

The Boundary Health Unit uses drama to help students make decisions about healthy eating, physical activity and smoking. School StreetHearts: A Dramatic Approach to Healthy Living, developed with the ministry of health, includes a teacher resource kit with ideas on reinforcing parts of the curricula and activities that use simple drama techniques.

Using the Media
Kidzone, a B.C. Knowledge Network program, reflects the reality pre-teens face in school and helps them make smart choices. A segment on healthy eating was produced through collaboration with the B.C. Ministry of Health, the Heart and Stroke Foundation, the B.C. Dairy Foundation and the Dairy Bureau of Canada. Kidzone won the "best children's programming in Canada" award in 1993 and 1994, and the segment on healthy eating won an award for excellence in motivational programming. Other components include newspaper inserts, teacher resources and an on-line computer network for B.C. schools.

National Support
National goals on child health, a comprehensive school health program and a resource for using Canada's food guide with young children are some national efforts that provide a broad context for developing effective strategies at the community level.

After wide consultation, national child health goals are being developed⁵ that will give direction and priority to efforts to eliminate disparities, to prevent health problems and to promote optimal well-being.

The Comprehensive School Health Program⁶ provides a framework for integrating teacher instruction with services and programs to create a healthy school and community environment. It is a collaboration between Health Canada, the Canadian Association for School Health and representatives of national health, education and social welfare organizations.

Canada's Food Guide to Healthy Eating: Focus on Preschoolers, reflecting an update in nutrition recommendations,⁷ assists educators in using the food guide with children 2 to 5 years of age. Resources are also being produced to help promote healthy eating among school-age children and adolescents.

Future Directions
Focusing efforts, evaluating initiatives and sharing experiences will be key to ensuring that all children and youth have access to nutritious foods, that they have opportunities to develop skills for making food choices as a base for life-long healthy eating, and that they live in environments that support healthy eating practices.

We have only begun to understand how children view healthy eating and to apply Canada's food guide in designing appropriate messages. Efforts will have to become more focused, including more formalized nutrition education curricula and media campaigns targeted to specific age groups. Evaluation will be crucial to define the extent to which these initiatives are effective in improving child health. Moreover, research and monitoring efforts should be increased to identify nutritional concerns of children, and to set priorities for relevant strategies. Finally, better ways of networking, through computers and otherwise, are needed to share valuable lessons.

Adapted from a presentation at the Child Health 2000 World Congress and Exposition on Child Health, Vancouver, BC, June 1995.

The program inventory, Promoting Healthy Eating to School-aged Children and Youth: Examples of Innovative Strategies, 1995, which includes contacts, is available from Nutrition Programs Unit, Health Canada, Jeanne Mance Building, 5th Floor, Ottawa, ON K1A 1B4.

REFERENCES

Canadian Institute of Child Health: The Health of Canada's Children: A CICH Profile, 2nd Edition, Ottawa, 1994
McIntyre L, Dayle JB: Exploratory analysis of children's nutrition programs in Canada. Soc Sci Med 1992; 35(9): 1123-1129
King AJC, Coles B: The Health of Canada's Youth: Views and Behaviours of 11, 12 and 15 Year Olds from 11 Countries, Health and Welfare Canada, Ottawa, 1992
The McCreary Centre Society: Adolescent Health Survey: Province of British Columbia, Vancouver, 1993
Health Canada: A Vision of Health for Children and Youth in Canada: Discussion Paper, Health Promotion Directorate, Ottawa, April 1993
Canadian Association for School Health, Health Canada: Making the Connections: Comprehensive School Health. A Guide for Presenters and Facilitators, Minister of Supply and Services Canada, Ottawa, 1993
Joint Working Group of the Canadian Paediatric Society and Health Canada: Nutrition Recommendations Update...Dietary Fat and Children, Health Canada, Ottawa, 1993

This article first appeared in RAPPORT, Volume 10, No.l 4, Fall 1995, published by the National Institute of Nutrition.

Posted by: National Institute of Nutrition, September 1996.