On the 21^st July 2016, the United States Department of Agriculture (USDA), under the Obama Administration, announced four final policies to make the school environment and meals healthier.¹ These four policies (Smart Snacks in School, Local School Wellness Policy, Community Eligibility Provision (CEP), and Administrative Review) have been put in place to essentially remove junk food and snacks, whilst promoting more fruits, vegetables, and whole-grains. Any food or beverage marketed on school campuses during the school day must meet the Smart Snacks standard.

These policies will also empower parents and community members to take an active role in establishing school environments that support healthy eating and physical activity. They will also allow schools and local educational agencies with high poverty rates to provide free breakfast and lunch to all students; promoting access to healthy food. There will be an update to the administrative review process, which is used by state agencies to monitor federal funded school meal programs. Under these new policies, States will have the flexibility to allow limited exemptions to school-sponsored fundraisers during the school day, and develop a policy that works best for them. In addition, to better assist schools to meet these requirements, USDA have implemented mentor-based training for school nutrition professionals.

Although these initiatives represent a way forward in educating children and parents about eating healthier, I personally believe that the standards set by the USDA are still modest, and schools are at risk of more "copycat" products being marketed and served at canteens without being correctly labelled - which will impede any attempts to direct kids toward whole foods that would better serve their long-term health. Nevertheless, it is an important step forward that the USDA have announced these progressive policies as school meals are the best way to educate children and parents on healthy and sustainable food and help them make healthy choices for their future.

Along with schools, another major public sector, the healthcare sector (primarily hospitals), has a role to play in providing lessons about healthy diet. There are some existing regulations in the US regarding healthy meals in hospitals. In 2011 the Department of Health and Human Services (HHS) and the US General Services Administration (GSA) released guidelines specifying healthy food and sustainable procurement practices for all federal food service concessions and vending machines. In addition in 2014 the Center for Disease Control and Prevention (CDC) produced guidelines² to promote and support healthy food, beverage, and physical activity options in hospitals. These guidelines are not as explicit as the ones being implemented in schools; therefore, further efforts should be required.

In Europe, many countries (such as Finland, France, Italy or Sweden, etc) have policies to help schools provide nutritionally balanced meals, which also reflects the different national eating cultures we have in Europe. Some of these school meals are fully funded by governments and promote nutrient-rich foods (fruits, vegetables, and dairy products), while limiting food high in salt, sugars, and fat. School lunches across Europe provide children with an opportunity to learn healthy habits and improve academic performance, and at the same time, improve social interaction. Parents and communities are also encouraged to be involved in school meal policies. In hospitals, some initiatives have been launched by the National Health Service (NHS) in England³ to improve the quality of food provided in hospitals, and inform staff about the "protected" mealtime system under which they operate to provide safe nutritional care (e.g. opening packages, ensuring adequate fluid intake) and not interrupt patients while they are eating their meals. These initiatives and sustainable food programmes already implemented in some European hospitals (see my previous blog post⁴), should be considered as a starting point to update European nutritional standards (from evidence-based research). These standards are applicable to administrations (local/municipal, regional, and national), private operators, schools and hospital board/food service teams. In order to tackle malnutrition and other nutritional-related diseases (i.e. obesity, diabetes, etc.), the marketing of unhealthy food (particularly through vending machines) needs to be addressed, food procurement contracts and cooking methods need to be improved, and an increased choice/diversity of produce and meals (considering cultural preferences and needs) need to be provided. These standards and guidelines should set health promotion and educational goals in order to benefit the wider community,

At the EU level, Directive 2014/24/EU on public procurement⁵ is the only legislative tool that plays a  role to promote green and ethical procurement policies in public administrations, that procure for sectors such as schools and hospitals. Food procurement is not specifically addressed, but the rules set out by this directive cover a wide range of sectors including food services.  In addition, the Joint Research Centre's Institute for Prospective Technological Studies (JRC-IPTS) recently began  developing new Green Public Procurement (GPP) criteria for "Food and Catering Services" for the European Commission's Directorate General for the Environment, which will be adopted in 2017.⁶ These criteria are voluntary but they will set progress in procuring healthy and sustainable food in schools, hospitals, and other public facilities (e.g. national and local government staff canteens).    

Quite a few hospitals are already implementing sustainable procurement policies, which make an important contribution to sustainable consumption and production in the European healthcare sector.

• The Nottingham University Hospital NHS Trust (UK) The hospital, which serves around 1,94 million meals per year, has regular contact with local producers and organise monitoring visits yearly to ensure perfect traceability. The main focus of the hospital’s sustainable food programme is to provide fresh and locally produced food. In fact, 77% of its raw ingredients are locally sourced, and 95% of meat served comes from a local processor in the East Midlands.  This contributes to the socio-economic growth of the region and reducing food waste, thus freshness and seasonality have been seen as contributing factors to increase patient’s satisfaction.

• The Lozano Blesa University Hospital Clinic in Zaragoza (Spain) prepared around 338,000 meals annually in their own kitchen. They provide healthy and sustainable menus with fresh, local and organic products, while avoiding processed food, even though the procurement contract doesn’t have any specification about local suppliers who do not use chemicals, pesticides or industrial processes. They have not seen neither any significant change in costs by shifting to these kinds of local and fresh products.

• ­The Centre Hospitalier Regional (CHR) de la Citadelle in Liège (Belgium), where 955,000 meals a year are served to staff, visitors, and patients. The hospital, following the public market rules of competition for food providers, have established their own food procurement criteria by using a price-quality ratio and purchasing fresh, seasonal and locally grown food from farmers in the region, which have not been proven to be more expensive. They are also keen in introducing organic products. In fact, they have established a working group of catering employees and medical staff that evaluate how organic food could be introduced in the hospital menus taking into consideration the price, availability and traceability of organic products.

European hospitals have the purchasing power to create opportunities for sustainable procurement and explain the important role of healthy food in our daily diet. Many hospitals have already made the link between eating healthy food and having a good health. But procuring healthy food means also procuring food that is environmentally sustainable. When this is understood, the healthcare sector will actively contribute to having healthy people on a healthy planet.

- Paola Hernández, Sustainable and Healthy Food Programme Assistant

^{Preview image: Miia Sample, via Flickr cc}