Denmark: Working with the education sector for children’s health

The cases highlight the role of providing school meals in improving the health of young people and its potential to reduce social inequalities in health and learning outcomes. It uses two different national approaches to school food service in Denmark and Sweden. The idea that schools should contribute to protecting children’s health by promoting healthy diets and physical activity is not new. The idea that school food service can contribute not only to improving childhood health outcomes but also to equalizing these outcomes and reduce health inequities has been introduced in a several food policies and programmes at the local, regional and national levels.

The cases show that initiatives at school require a high degree of intersectoral cooperation. Food, nutrition and health are not core issues at school and need to be handled in the broad framework of stakeholders that the school constitutes, including teachers, canteen staff, school management, school board members, students and parents. The involvement of municipal actors responsible for both health and education is another important dimension in the intersectoral collaboration.

The case studies suggest that publicly provided food service at school may contribute to improving health among young people. There are also some indications of the potential that such provision has in contributing to reducing social inequalities in health. The cases suggest two distinct and different approaches to school food provision. The consumer approach is characterized by a variety of voluntary and local solutions and financed primarily by parents as pay-per-meal, as illustrated in the case of the City of Copenhagen and Municipality of Gladsaxe. It is also characterized by exploratory and sometimes experimental bottom-up approaches often involving children in the operation of the systems. The citizenship approach is characterized by compulsory state-regulated solutions and financed by the municipality through taxes. It is also characterized by very similar and bottom-up approaches, and its operations are based on a professional workforce with limited involvement of the children.

In addition, the cases identify two possible mechanisms in which food provision at school can be assumed to promote good diet and positive health outcomes in a way that contributes to reducing the gap in health across socioeconomic groups. The first pathway is related to the ability of the publicly organized school meal system to guarantee the availability and accessibility of the healthy lunch or breakfast options that students would not otherwise get. By making sure that all students have access to one or more healthy meal options during their school day, health can be assumed to be promoted evenly across socioeconomic borders.

The second pathway is related to how school food might be able to improve health in a longer time perspective. This pathway is using the collective practice of students cooking, learning and eating at school as a mediator to strengthen social cohesion among students. It can be assumed that the life skills provided this way might help students from all social backgrounds in adopting a healthy lifestyle and good eating patterns in their later life course.
Several recommendations can be made on the design of future school food initiatives.

  • Make food available for all students regardless of socioeconomic background and adopt the necessary payment options and entitlement schemes.
  • Adopt the necessary policies at the national level that can support local and bottom-up approaches to school food.
  • Make the school foodscape a protected environment by developing, adopting and maintaining a food and nutrition policy.
  • Support interdisciplinary cooperation between teachers, food-service staff and management involved in designing school foodscapes.
  • Involve children and adolescents in developing and, if necessary, in operating the school food service.
  • Make the school foodscape an environment for learning about food biodiversity and support such diversity through menu planning procedures.
  • Create a sense of coherence between food service practice and classroom activities by integrating food and nutrition issues in the curriculum by using the whole-school approach.
  • Take advantage of the learning opportunities created by the local food environment by providing insight into local food and farming and food chains.
  • Take advantage of the learning and social cohesion opportunities created by using preparation, cooking and eating at school as a mediator.