Food security is at a crisis point

Pressures on global food supplies have resulted in inflation and decreased living standards across many countries worldwide, with growing concern over food insecurity⁽¹⁾. This coincides with two other areas of concern. Globally, there is a trend for increasing consumption of ultra-processed foods (UPF), which are increasingly displacing minimally processed, whole foods in the diet^{(Reference Monteiro, Moubarac and Cannon2)}. Additionally, the worldwide prevalence of obesity has also been increasing, for a range of complex reasons including but not limited to diet. Furthermore, food insecurity, UPF consumption and weight gain are inextricably linked, whereby food insecurity is associated with increased UPF consumption^{(Reference Hutchinson and Tarasuk3)}, which in turn is associated with weight gain^{(Reference Chang, Khandpur and Neri4)}. This confluence of factors will likely contribute to further widening of health inequalities and exacerbate multiple areas of concern for health. All groups in society have been negatively impacted by these changes; however, households with low incomes or young children are most at risk of food insecurity^{(Reference Yau, White and Hammond5)}. Experiencing food insecurity, poor nutrition and obesity in early childhood is known to have negative physical, mental and social consequences^{(Reference Aceves-Martins, Cruickshank and Fraser6)}. Consequently, it is imperative that children, especially those from disadvantaged backgrounds, are shielded from food insecurity.

While these issues will affect many countries, they are of particular concern in the UK. Across Europe, children in the UK consume the highest levels of UPF^{(Reference Monteiro, Moubarac and Levy7)}, have the eighth highest levels of obesity among 10- to 19-year-olds⁽⁸⁾ and in 2018 had the highest levels of food insecurity⁽⁹⁾. Furthermore, food price inflation is just one of the current stresses to the food system which include Brexit, stagnant wages and labour shortages^{(Reference Mozaffarian, Angell and Lang10,Reference Seferidi, Laverty and Pearson-Stuttard11)} . As such, food insecurity was already on the rise in the UK and is due to increase further. The use of food banks has increased by 81 % since 2016–2017⁽¹²⁾, and food insecurity is estimated to have doubled from 7·6 % before March 2020 to 15·5 % in April 2022⁽¹³⁾, reflecting changes associated with the COVID-19 pandemic. Food insecurity is heading to a crisis point, with invariably serious consequences for the diet and health of the nation.

Are school meal programmes an effective policy for improving diets and reducing food insecurity?

There is a well-established view that schools are a potentially effective area for equitably intervening in children’s diets^{(Reference Micha, Karageorgou and Bakogianni14)}. They have a wide population reach, and children spend about 40 % of their time and consume 30 % of their diets at school^{(Reference Harrison, Jennings and Jones15,Reference Woodside, Adamson and Spence16)} . Furthermore, from a policy perspective, school food is easier to regulate than food that children bring from home (packed lunches). Indeed, evidence has shown that school meals can improve children’s diets^{(Reference Micha, Karageorgou and Bakogianni14)}. Research from the past 10–15 years has shown that the introduction of the School Food Standards improved dietary quality^{(Reference Haroun, Harper and Wood17)} and that school meals are consistently preferable compared with packed lunches^{(Reference Stevens and Nelson18,Reference Pearce, Wood and Nelson19)} . Furthermore, evaluations of the universal free school meal scheme showed that a large uptake of school meals did impact children’s dietary intake, reduce inequalities and improve children’s weight^{(Reference Holford and Rabe20,Reference Parnham, Chang and Millett21)} . School meals also have benefits for behaviour, attention and educational attainment at school^{(Reference Kitchen, Tanner and Brown22)}. Consequently, this evidence demonstrates that there is potential for the school meals programme to substantially improve children’s diets and address inequalities.

Indeed, providing food at school is the UK Government’s main nutrition assistance for school-aged children in the UK. The Education Act 1944 stipulated that Local Authorities must provide school meals to children who want them^{(Reference Long23)}. However, as this is now a devolved policy, there is variation in who pays for school meals. For most schools across the UK, a means-tested system is in place whereby school meals are free for children whose families access benefits (< £7400/year) and sold low cost to the remainder (about £2·40/meal in 2022^{(Reference Jeffreys and George24)}). However, in 2014, a universal scheme was introduced in England and Scotland, providing school meals to all young children (4–7 years) regardless of income. This has now been expanded in Scotland and introduced in Wales^(25,26) . The universal scheme aimed to save families money, improve learning and improve children’s diets^{(Reference Sellen, Huda and Gibson27)}. However, critics of the universal scheme state that a targeted policy for a wider age range of low-income children would be a better use of finite public finances^{(Reference Ferguson28)}. The content of school meals is governed by mandatory School Food Standards, set by each nation, yet monitoring of compliance across the UK ranges and is not monitored in England^{(Reference Woodside, Adamson and Spence16,Reference Long23)} .

An updated picture of school meals in the UK

It is increasingly evident that the school meals programme is failing to meet its potential and protect children from poor nutrition.

First, the means-tested eligibility criteria for a free school meal is very low, meaning one in three children who live in poverty, and over 25 % of children with very low food security are not eligible for a free school meal^{(29,Reference Dimbleby30)} . Low-income children who are ineligible for the means-tested scheme and too old for the universal scheme are more likely to take a packed lunch, as the cost of paying for school meals is too high^{(Reference Hart31)}.

Second, research has revealed that the content of school meals is often substandard. A report by the Food Foundation highlights that only 25 % of schools in England were estimated to be committed to meeting the School Food Standards^{(Reference Goudie and Hughes32)}, data on the remaining 75 % of schools is lacking. Indeed, recent evidence has for the first time described the level of UPF in school food in the UK^{(Reference Parnham, Chang and Rauber33)}. In a nationally representative sample of UK schoolchildren, it was found that 64 % of the calories consumed in school meals were UPF. Furthermore, a proportion of school meals were estimated to not be meeting recommendations on food groups such as ‘Sweet Snacks’ (38 %) and nutrients such as Fe (93 %) and Ca (72 %)^{(Reference Haney, Parnham and Chang34)}.

Third, there are inequalities in the quality of school meals between low- and high-income children. Socio-economic inequalities were observed in children’s dietary intake at secondary schools, with the lowest income children most likely to consume the highest levels of UPF at school^{(Reference Parnham, Chang and Rauber33)}. This suggests that currently, the school food system is not protecting the most vulnerable from food insecurity and dietary inequalities.

Challenges to the school food system

There are many challenges facing the school food system in the UK, which may explain why it is currently deficient.

First, the funding for free school meals has not kept in line with inflation, rising 5 % between 2014 and 2022⁽³⁵⁾, an issue that is further exacerbated by higher inflation and Brexit^{(36,Reference Weale37)} . As a consequence, schools are increasingly required to cover the deficit from their wider educational budgets^{(Reference Sellen, Huda and Gibson27)}. As healthy food costs more than less healthy food^{(Reference Jones, Conklin and Suhrcke38)}, it will become increasingly unaffordable for schools to offer healthy meals. Indeed, school caterers have expressed concern over supplying healthy food within their current contracts^{(Reference Weale37)}.

Second, the combined effect of the pandemic, rising inflation and a recession have caused increased childhood poverty. Therefore, the cost of providing free school meals to low-income children is increasing^{(Reference Dimbleby39)}.

Third, across the UK the monitoring of school food quality varies, with no systematic monitoring in England^{(Reference Woodside, Adamson and Spence16,Reference Long23)} . Therefore, schools may not be incentivised to abide by the food standards in this challenging fiscal environment.

Fourth, the quality of school food varies greatly across the UK^{(Reference Kenton-Lake, Heger and Tobi40)}. While there are examples of schools serving healthy and appealing foods, there are likewise examples of the converse⁽⁴¹⁾. This is in part due to the complex delivery system, which is a mix of in-house, local authority and outsourced private caterers^{(Reference Dimbleby and Vincent42)}. A postcode lottery is created whereby the quality of a school’s food can be more dependent on factors such as the school’s leadership than central governance.

Optimising the school food system

There is a need for urgent and profound changes to address the challenges that face the school food system. Several policy options have been proposed.