S. Pettigrew, PhD, Professor of Marketing
Outcomes of the West Australian school healthy food and drink policy
Article first published online: 28 FEB 2012
© 2012 The Authors. Nutrition & Dietetics © 2012 Dietitians Association of Australia
Nutrition & Dietetics
Volume 69, Issue 1, pages 20–25, March 2012
How to Cite
PETTIGREW, S., PESCUD, M. and DONOVAN, R. J. (2012), Outcomes of the West Australian school healthy food and drink policy. Nutrition & Dietetics, 69: 20–25. doi: 10.1111/j.1747-0080.2011.01564.x
M. Pescud, BSc (Hons), Research Associate
R.J. Donovan, PhD, Professor of Social Marketing
Author contributions: SP and RJD participated in the design of the study. SP conducted the interviews and carried out the thematic analysis of the transcripts. MP carried out the statistical analyses. All authors assisted in drafting the manuscript and read and approved the final manuscript.
- Issue published online: 28 FEB 2012
- Article first published online: 28 FEB 2012
- Accepted June 2011
- traffic light;
- upstream intervention
Aim: The introduction of the Healthy Food and Drink Policy in Western Australian government schools caused controversy. Of particular concern were anticipated financial difficulties associated with replacing high-margin processed foods with healthier foods that may be more labour intensive and expensive. The present study investigated the outcomes for school canteens to assess whether these concerns were realised.
Methods: A multi-method approach was used to obtain data from school principals. Ten principals participated in individual interviews and 310 (44% response rate) responded to an online survey.
Results: A majority of the study participants reported a favourable attitude to the Policy, both prior to and after its introduction. Most participants perceived improvements in the healthiness and quality of canteen menu items as a result of the Policy. There was a significant increase in the number of school canteens reporting break-even (19% to 28%), a non-significant decrease in the number being in profit (57% to 48%), and a non-significant increase in the number of canteens reporting a loss (10% to 16%). These results appear to be largely the result of higher-than-CPI (consumer price index) increases in food prices and a reluctance to pass these increases on to canteen users.
Conclusions: The results are encouraging in the light of the new National Healthy School Canteen Guidelines. Efforts to improve children's food environments may attract criticism from a vocal minority, but are likely to receive support from key stakeholders.
Current high levels of child overweight and obesity are of concern due to adverse health implications in both the short and long term.1 Governments wishing to implement policies designed to make children's environments less obesogenic may be constrained by a lack of evaluation data to guide such upstream interventions.2,3 Also of concern is the likely response of key stakeholders to policies that affect children's diets. Given the economic implications, as well as the emotional and cultural significance of food,4 policies that impact children's diets are likely to be contentious.
In 2007, the Western Australian Department of Education and Training (DET) introduced their Healthy Food and Drink Policy5 in an effort to improve the food environment within government schools. The main element of the Policy is the traffic light categorisation that designates fruit, vegetables, wholegrain foods, lean meats and low-fat dairy products as ‘green’; foods high in fat, sugar and/or salt (HFSS) as ‘red’; and all other products as ‘amber’. Western Australian Government schools are no longer permitted to provide ‘red’ foods in the canteen, and a minimum of 60% of the menu items have to be ‘green’. The Policy is similar to that implemented in other states, but more stringent as ‘red’ foods are permitted to be sold in school canteens twice per term elsewhere but are disallowed entirely in Western Australia.6 An evaluation of the Policy commenced around 18 months after its introduction and included qualitative and quantitative components. This article reports school principals' comparisons of canteen outcomes between 2006 and 2008 (i.e. before and after the Policy was introduced) to assess the impact of the Policy on their canteens' operations.
School canteens fulfil several roles within schools. First, the snacks and meals provided can constitute a substantial source of children's daily nutrition.7 Canteens are thus important in ensuring children receive adequate nutrients and energy, both for general development and for academic performance.8,9 Canteens can also be a source of excessive energy intake if unhealthy foods dominate the menu, thereby increasing the likelihood of child obesity.7,10,11
Second, canteens are a source of information for children and parents about appropriate diets,12 and they can reinforce education about healthy eating in the school curriculum.13,14 It has been suggested that the provision of unhealthy foods in canteens leads children to believe that these products are appropriate for daily consumption.10,15 Where food provision is aligned with healthy eating principles taught in class, a consistent message is delivered to children about the foods that are most appropriate for them to consume.16,17
Third, canteens are revenue sources for schools, sometimes providing much needed income to fund educational materials or physical activity equipment.13 It is typically easier to maximise canteen profits through the provision of high-margin processed foods that are high in sugar and saturated fat.7 Finally, some parents consider canteens as appropriate sources of treat foods to reward or express affection to children.13,15
Some of these roles are in potential conflict. Where a school considers the primary function of a canteen to be profit generation, other objectives relating to healthy eating can be forsaken. In such instances, children's innate preferences for sweet and fatty energy-dense foods18 are likely to result in suboptimal purchase decisions. This has led to recommendations to reduce the quantity of ‘competitive foods’ that act as deterrents to healthy eating in schools.9,13,15 Such a strategy is supported by evidence that children are more likely to make poor food choices when facing menus with a large number of choice alternatives.19,20
Attempts to improve the food supply within schools can attract criticism from those who perceive such efforts as reducing choice by adopting a ‘nanny state’ approach.21 When the WA Healthy Food and Drink Policy was first introduced, around 2000 complaints were received by the DET and the Western Australian School Canteen Association (WASCA; S. Milbourne, DET, personal communication, 22 November 2010). These complaints largely originated from parents, canteen workers and school staff, and they focused on concerns about the removal of some of children's favourite foods from the menu, the cost implications of replacing high-margin processed foods with more labour-intensive healthy options and the implications of these two factors for the viability of school canteens. In this context, it was important to evaluate the Policy to assess whether the concerns expressed in the immediate post-implementation period were well founded and to identify any implications for future policy development.
Ethics approval was obtained from the University of Western Australia Ethics Committee prior to the commencement of the evaluation study. School principals were selected as the sample group because they could provide insight into the effects of the Policy at an operational level within schools and they constitute the primary interface between parents and the DET. A mixed method approach22 was used to obtain principals' views on various Policy outcomes. In the first instance, individual interviews were conducted with principals from 10 schools across WA. This number of schools was adequate to provide a purposive sample22 of schools of varying school type (primary and secondary), school size, school location (metropolitan and regional) and socioeconomic status (as determined by the SEIFA (Socio-Economic Indexes for Areas) index). The selected schools also had varying canteen operating hours, ranging from one to five days per week. All principals who were approached to participate in the qualitative phase of the study agreed to be interviewed. Table 1 provides a description of the schools included in the qualitative phase.
|School||Type||Location||SES||Student population||Canteen operating days|
The interviews were semistructured in format to allow coverage of specific issues while allowing principals to introduce any other topics they felt were relevant.23 During the interviews, the principals were asked to recount their schools' experiences throughout the implementation phase; their personal feelings towards the Policy; their perceptions of the attitudes of school staff, parents and students; the financial consequences of the Policy; and any changes that were observed in canteen usage patterns and foods brought to school from home.
All interviews were audio recorded and subsequently transcribed verbatim. The transcripts were imported into NVivo8 (QSR International, Doncaster, Victoria, Australia) for analysis. Line-by-line coding and key word searches were used to code the text and identify the dominant themes in the data. On the basis of the interview findings, an online questionnaire was developed and forwarded to all principals in WA government schools via the DET's regular email memorandum system. The survey items included questions relating to the characteristics of the school (e.g. number of students, age range of students) and canteen operating procedures. Frequency and cross-tabulation analyses and chi-squared tests were performed using SPSS 18 (SPSS Inc., Chicago, IL, USA).
Interview findings: The interviewed principals reported being in regular contact with their canteen managers and were generally well informed of the operational status of their schools' canteens. The primary themes evident in the data related to the principals' perceptions of the policy implementation process, the facilitators that assisted implementation and the issues that required resolution in some schools. Each of these themes is discussed below.
Almost all of the interviewees reported that the implementation of the Policy in their schools had been smooth and relatively uncontentious. In their view, the Policy was positively received by most parents and school staff:
“It actually went unbelievably smoothly. There were some questions earlier on, in terms of the staff more than the kids, on how the whole process was going to happen and what needed to be put in place, but it actually has gone quite smoothly. I haven't had any complaints from kids in terms of the Policy and I think that's probably the best measure in terms of how smoothly it's gone (secondary school, medium socioeconomic status (SES), regional).”
In terms of factors that facilitated implementation, most of the interviewees commented that there was a general awareness of the problem of childhood obesity and an appreciation among parents for efforts within the school to enhance children's health. Several principals noted that they had wanted to introduce the kinds of changes required by the Policy for some time but had believed that it was not possible due to an expected backlash from parents, students and canteen managers. They felt that the Policy gave them the legitimacy and authority to make important changes that would otherwise have been too difficult to instigate at school level.
“We suddenly could cling to this and say, ‘Hey, we have to do it anyway’. So from my point of view we liked that, and I was glad the Policy came out (primary school, high SES, metropolitan).”
The smooth transition process was also often attributed to a range of communications strategies that ensured key stakeholders were informed throughout the Policy implementation process. In particular, information materials provided by the DET were reported to be helpful in explaining the Policy to school staff, canteen managers and parents. Examples of these materials were colourful brochures sent to families to explain the Policy and its implications in user-friendly terms. In addition, some schools had been proactive in engaging with the community, such as by placing notices in newsletters and the local community paper to announce the school's new menu and explain the reason for the change. Such initiatives were more common among the larger schools, possibly because their size ensured that the parent body was a significant proportion of the larger community.
The issues that required resolution included complaints from some parents and children, a reluctance to engage with the Policy by a small number of canteen staff and increasing food costs. Where they occurred, complaints were described as originating from a small number of parents and/or children, and were quickly resolved once it became clear to the complainants that the Policy was permanent and non-negotiable. In one of the secondary schools, it had been necessary to change canteen staff to find replacement employees who were amenable to working to the requirements of the Policy. In most cases, however, the training provided by WASCA for canteen staff was reported to have been effective in advising how appropriate menus could be developed and delivered within the infrastructure and staffing limitations of school canteens. These issues were described as being important by interviewees because of the increased space and time needed to prepare foods designated as green and amber. The training also alleviated concerns relating to the extent of operational change required by the Policy:
“The canteen manager was a little bit more resistant to it in that she felt that she was already doing a great job and that kids should be able to get all of those snack type foods that they enjoy. When she went to the training and had a look at what we were already doing compared to what was required by the Policy, it wasn't that difficult for her (primary school, low SES, metropolitan).”
Most of the interviewed principals acknowledged that the canteen should be primarily a resource for ensuring children had access to appropriate foods to sustain them during the school day rather than a source of revenue for the school. As such, break-even was the financial target in almost all cases. However, it was noted that break-even was more difficult to achieve in 2008 relative to 2006, although this was attributed to several factors and not perceived to be specifically related to the new Policy. Increases in food costs were frequently cited as reasons for a reduction in profitability in recent years. There was a general reluctance to raise prices in line with increasing costs due to a desire to keep the menu items affordable for students and their parents. It was generally acknowledged that initial fears of bankruptcy resulting from the new Policy were misplaced and that their canteens were functioning as normal:
“It definitely operates at a profit . . . it doesn't cost the school money (primary school, medium SES, metropolitan).”
Survey results: In total, 310 principals completed the survey, representing a response rate of 44%. Seventy-five per cent of the respondents were based in primary schools and 60% were from schools located in the Perth metropolitan area. Approximate student numbers in schools ranged from seven to 3000, with an average of 351 in 2006 and 349 in 2008. The proportion of schools reporting an operational canteen was 61% in 2006 and 64% in 2008. The average number of days the canteens were open was 3.8 in 2006 and 3.6 in 2008. In both years, the main services provided were provision of food for morning recess and lunch. A small number of schools were also open for sales before school and at afternoon recess. There were no significant changes in opening days or service provision among the sampled schools since the introduction of the Policy.
Respondents were asked to indicate their reactions to the Policy when it was first introduced and at the time of the survey in 2009. Around two-thirds of respondents answering this question (n = 236) reported that they had positive feelings and around a quarter had mixed feelings at both points in time. The remainder reported either neutral or negative feelings. There were no significant differences in reported reactions before and after the introduction of the Policy (χ2 = 2.397, P = 0.792), indicating that the principals' largely positive expectations had been realised.
Table 2 shows the profitability results for those responding to the two questions relating to this issue. There was a significant increase in the number of canteens achieving break-even, but no significant changes in reports of profit or loss. The large proportion of respondents failing to answer this question (35%) may reflect staff turnover over the relevant period and/or a failure to retain data relating to canteen profitability over time.
|n = 199(a)(%)||n = 195(a)(%)|
|Profit||114 (57.3)||94 (48.2)*|
|Break-even||38 (19.1)||55 (28.2)**|
|Loss||20 (10.1)||31 (15.9)*|
|Unsure||27 (13.5)||15 (7.7)*|
Table 3 shows the respondents' perceptions of the Policy across several outcome categories. A majority reported that the healthiness and quality of the canteen menu items had improved, the proportion of students using the canteen had remained constant, the healthiness of food items brought from home was the same, and the amount of food purchased from nearby stores by students on their way to school had remained constant. Around half felt that the cost of the menu items and children's satisfaction with the menu had remained unchanged.
|Better (%)||Same (%)||Worse (%)|
|The healthiness of the menu||77.8||21.4||0.8|
|Quality of the menu items||57.5||38.1||4.4|
|The range of items offered||26.6||45.2||28.2|
|Healthiness of snacks/meals brought from home||17.1||67.5||15.5|
|Children's satisfaction with the menu||15.5||57.9||26.6|
|Proportion of students using the canteen||9.5||68.3||22.2|
|Quantity of snacks/meals bought at stores on the way to school||7.9||69.4||22.6|
|The cost of menu items||4.0||56.3||39.7|
The study limitations include the sample size and reliance on principals' knowledge and memory of changes to their schools' canteen operations over recent years. A higher response rate in the quantitative phase of the study would have increased the representativeness of the results. However, the 44% of principals responding to the survey is not dissimilar to the 55% response rate of a previous canteen survey conducted by the DET.24 It is to be expected that participation rates would be higher for studies conducted by the DET compared to studies performed by external researchers. The lower response rates to specific questions relating to profitability are likely to reflect turnover in staff and the recall difficulties associated with retrospectively reporting the situations pre- and post-implementation of the Policy. The strengths of the present study include the mixed method approach, the coverage across school types and assessment in changes to related phenomena such as out-of-school food purchases and food brought from home.
The study results support previous Australian research that found a wide base of community support for initiatives to improve children's diets.25 This bodes well for governments seeking to introduce similar policies in the future, such as the Department of Health and Ageing's recently published National Healthy School Canteen Guidelines.26 Given the central role of food in social and cultural norms and the implications of menu changes for canteen profitability, such policies may cause angst among some groups in the community. Individuals may be vocal in their criticism of new policies, but may be unrepresentative of broader community sentiment on the issue. This ‘squeaky wheel’ phenomenon27 can be anticipated and managed where possible to reduce its effects. Policy makers can assess the views of different stakeholders to identify those groups who are most likely to be unhappy with a proposed policy and develop appropriate communications to alleviate the core concerns of this group. Taking a proactive stance may reduce negative reactions, or at least minimise their transference to other groups.
In combination, the qualitative and quantitative data suggest that principals had largely positive reactions to the DET's Healthy Food and Drink Policy. Most of the study participants viewed the menu items to be healthier and of higher quality since the introduction of the Policy. The training and resources provided by the DET and WASCA appear to have largely ameliorated concerns that healthy menu items would be too labour intensive and time consuming. While there was a small but non-significant increase in the number of canteens reporting a loss, this appears to be primarily the consequence of increases in food costs over the period. The Australian Bureau of Statistics reported a 5.6% increase in food prices from December 2007 to December 2008 compared to an overall CPI increase of 3.7%.28 Given the statements made by interviewees relating to keeping prices as low as possible and that more than half of the survey respondents reported that the cost of menu items had remained the same, a reluctance to pass price increases on to canteen users is likely to have contributed to the changes in profitability that were reported.
As governments continue to grapple with the causes and consequences of child obesity, more upstream interventions designed to improve children's diets are likely to be implemented in an attempt to create environments that are conducive to healthy eating. The lack of evaluation data for such interventions may limit their ability to inform future policy efforts. The present study provides evidence of the potential for government policies to favourably influence school food environments by specifying the range of foods that can be sold or distributed on school grounds. The results suggest that well-designed policies that include appropriate information materials and staff training can make meaningful changes to the food supply in schools without incurring onerous implementation costs.
The present study was funded by Healthway WA and the West Australian Department of Education and Training. The authors thank Siobhain Milbourne from the Department of Education and Training for her assistance.
- 1World Health Organization. Obesity: Preventing and Managing the Global Epidemic. WHO Technical Report Series 894. Geneva: WHO, 2000.
- 3An Australian childhood obesity summit: the role of data and evidence in ‘public’ policy making. Aust New Zealand Health Policy 2005; 2: 1–10., , , .
- 4The World of Goods: Towards an Anthropology of Consumption. London: Allen Lane, 1979., .
- 5Department of Education and Training. Healthy Food and Drink Policy. Perth: Government of Western Australia, 2008.
- 6Department of Health. Healthy Options WA: Food and Nutrition Policy. Perth: Government of Western Australia, 2009. (Available from: http://www.healthyoptions.health.wa.gov.au/links/index.cfm, accessed 17 April 2011).
- 8Psychological effects of snacks and altered meal frequency. Br J Nutr 1997; 77: 105–20..
- 12A need for healthy canteens in secondary schools in Mauritius. Nutr Food Sci 2003; 33 (5): 208–12., , .
- 13What are grade 5 and 6 children buying from school canteens and what do parents and teachers think about it? Nutr Diet 2004; 61 (3): 145–50., , .
- 24Department of Education and Training. 2006 Review of the Nutritional Value of Food Sold in School Canteens: Survey Report. Perth: Government of Western Australia, 2006.
- 26Department of Health and Ageing. Guidelines for Healthy Foods and Drinks Supplied in School Canteens. Canberra: Australian Capital Territory, 2010.
- 28Australian Bureau of Statistics. Consumer Price Index: December Quarter 2008. Cat. No. 6401.0. Canberra: ABS, 2009.