Healthy Food for All
69 One of the conditions for the school to join with this Project is that the whole
school (or at least most of the children) is participating, because the strength of SchoolGruiten is eating the fruits and vegetables altogether.
The SchoolGruiten Project started with a pilot phase in February 2003, in which the intervention was tested in a controlled design to study further improvement and implementation needed in order to grow into a successful nationwide campaign. The focus of the Project was primarily to provide free fruits and vegetables to schools in deprived areas.
The pilot took place in seven different cities in the Netherlands; Deventer, Leiden, the Hague, Almelo, Zwolle, Dordrecht and Breda. It thus focused on communities with a low socio-economic status and was providing free fruits and vegetables for a full year. The pilot was financed by the Ministry of Health, Welfare and the Environment.
Based on the pilot, three ‘Gruitmodels’ were developed for schools to join the initiative, distinguished from each other by the way the portions of fruits and vegetables are reaching the schools (however, so far no school has ever chooses model number two).
Model 1: delivery by a subcontractor (delivery service)
Model 2: the school goes to a subcontractor to get the products their self Model 3: Parents or child carers give fruits and vegetables to their children to
bring to school
When a school decides to cooperate with a subcontractor, one of the conditions is that a participation of at least 100 children is required. Furthermore, at least three quarters of the participating classes should exist of children who are participants of the Project. When a school exists of less than 100 pupils, participation with a high percentage of children is required.
Schools can either select a subcontractor from a list that is provided by the initiative, or it can get in contact with a new delivery service in the neighbourhood of the school. Participation of the program is extended every year automatically.
The basic selection of the fruits and vegetables consists of apples, pears, mandarins, mini cucumbers, small tomatoes, bananas, kiwis and carrots. These fruits and vegetables have been proven to be liked the most by children. When a subcontractor provides kiwis, it needs to provide spoons as well. These spoons need to be kept and recycled by the schools the next time the delivery contains kiwis.
The concept of the Project is that during 40 school weeks, portions of fruits and vegetables are delivered twice a week. Model one is calculating € 0.20 per portion (including taxes), and will thus comes down to a total amount of € 16 euro’s a child per year. Model two will cost the parent a bit less, € 0.1625 per portion, and thus a total amount of € 13 euro’s per child per year is required. When a school decides to leave it up to the parents to give their kids fruits and vegetables to bring to school twice a week, it is very important that the school constantly reminds and stimulates the parents to really do so, and to vary in the products they give to their child(ren). As an encouragement and stimulus, Gruitboxes are provided when a school decides to choose Model three. These boxes are having such a shape, that besides a sandwich, a apple fits in as well. Schools that are structurally and actively participating with the SchoolGruiten Project can request for a SchoolGruiten hallmark. This will distinguish them from other schools that are not participating with the Project.
At the moment 450 schools are registered and are thus participating in the SchoolGruiten Project. However, it is likely that more schools have established a similar scheme, but since they prefer to follow their own rules or did not wanted to bind their selves to SchoolGruiten as there is no registration duty.
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Aim: The SchoolGruiten project, the largest-scale free fruits and vegetables
scheme for Dutch primary-school children, aims to improve accessibility of fruits and vegetables at school by providing a serving of fruit or vegetable to all children twice weekly.
Support: SchoolGruiten is a joint initiative of the Dutch Ministry of Health,
Welfare and Sport (VWS), Horticulture manufactures, Holland Produce Promotion and the Dutch Nutrition Centre. It collaborates with the Dutch Ministry of Agriculture, Nature and Food Quality (LNV) and the Dutch Ministry of Education, Culture and Science (OCW).
The Project can be financed in three different ways 1. By the school itself
2. By the parents
3. By a third party (like a health insurance, municipalities etc.)
If the parents finance the costs of their child(ren), they will receive a authorization form for a one time collection a year. The school will provide and receive those forms. When the school or a third party will finance the project, the money can directly be transferred to the subcontractor.
In order to facilitate the finances and to reduce the administrative work for a subcontractor, the GIS logistic system was developed. Schools can import the data of participating children and the financial details of the parents into this system, which the subcontractor can access and then send to the bank.
Every region in Holland has its own arrangements concerning the financial compensation of the products delivered. Some schools ask for a full coverage from the parents, other schools (for instance in the South of the province Limburg) offer 10 weeks of free fruits and vegetables and after the parents are ask to pay. However, the municipality of Amsterdam decided to fully cover all expenses needed for the Project, and schools are thus providing free fruits and vegetables.
Trigger: Most children in the Netherlands do not comply with recommendations
for fruit and vegetable intake (150 grams of vegetables and 2 pieces of fruit a day. For children of 12 years and older, the recommended amount of vegetables is 200 grams a day). Since 1987, the intake in grams has dropped by 16% (fruits) and 17% (vegetables) (Tak et al. 2008).
Targeted Communities: The programme was set up for all primary schools in the
Netherlands who are interested in participating.
Evaluation: SchoolGruiten has already been proven to be effective. From an
extensive study at around 300 primary schools with in total around 75.000 children and 7.000 teachers involved in seven different cities, turns out that indeed the children at the Gruitschools are eating more vegetables: From 1.1 portions a day to 1.6 portions a day. Teachers criticize the project as very positive (grade: 8.5/10) and children enjoy eating together in the classroom. By providing them with the possibility of eating together, they dare to try new fruits and vegetables faster as before.
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Norway
(Extra information was provided by the faculty of Medicine of the University of Oslo)
National Strategy:
The strategy document: ‘A healthy diet for good health’ [42], commissioned by the Norwegian Directorate for Health and Social Affairs, was drawn up by the Norwegian National Council for Nutrition and handed over to the Ministry of Health and Care Services in June 2005. Eleven ministries were involved in the development of the document, including the Ministries of Health, Agriculture, Fisheries, Children and Equality, Finance, Industry and Trade, and Education and Research [23].One of the primary objectives of the work in the areas of nutrition is to reduce social disparities in health. To this end, the National Council for Nutrition has designated the following five high-priority areas.
1. Healthy choices (lowering the prices of fruit and vegetables, raising the prices of energy dense, nutrient-poor foods, and preventing the marketing of unhealthy foods to children and adolescents).
2. Educational institutions (providing free fruit and vegetables in day-care centres and schools, and ensuring basic health literacy, basic cooking skills and good teaching skills).
3. Health and social services (intensifying nutrition-related work in prenatal health services, children’s health clinics, school health services, nursing and care services and primary and specialist health services, and enhancing nutritional knowledge among health care personnel).
4. Research and monitoring (focusing on health-promotion and disease prevention measures that address public health challenges; conducting regular studies of eating habits and diet-related health and disease indicators in the population; and monitoring height, weight, blood pressure and various blood parameters).
5. Communication (placing more emphasis on communication to enhance the public’s knowledge about food, diet and health)
The Norwegian Action Planon Nutrition (2007-2011) ‘Recipe for a Healthier Diet’ was developed by twelve ministries and serves as a tool for decisionmakers, professionals, experts and others in the public and private sectors and NGOs that play a role in the population’s diet [43]. One of the two main goals of this Action Plan is to reduce social inequalities in diet.
The Action plan for physical activity 2005–2009: ‘Working together for physical activity’ [44] was adopted by the Parliament in 2005. The result of the joint effort of eight ministries, it contains 108 measures spread across diverse areas of the community, such as kindergartens, schools, workplaces, transport and urban planning, and leisure activities. A communication strategy for 2005–2009 was also developed to increase knowledge about physical activity and health and to motivate people to adopt an active lifestyle. A coordinating group, including representatives from all eight ministries, meets regularly to implement the different initiatives of the plan. The Directorate for Health and Social Affairs will coordinate the follow-up of the plan [23]. The Action Plan acknowledges the fact that the number of physically active persons increases according to the level of socio-economic status, and it foresees the challenge is has, to promote physical activity within these groups.
National Programmes:
Information about running campaigns can be found in the WHO report and on the website of the government of Norway: http://www.regjeringen.no. At the moment none of these programmes are focusing on the communities from deprived areas in Norway specifically.72
Portugal
(Extra information was provided by the Ministerio da saude; da Plataforma Contra a Obesidade)
National Strategy:
The National programme against obesity[45] is integrated in the National health plan 2004 – 2010[46], together with other programmes such as the National Programme on Integrated intervention of Health Determinants Related to Lifestyles, the National Programme on Diabetes Control, the National Programme on Prevention and Control of Cardiovascular Diseases and the National Programme against Rheumatic Diseases.The National programme against obesity aims to contribute to weight loss in the obese and those affected by Type 2 diabetes and cardiovascular diseases, and to combat habits leading to overweight. In general terms, it aims to contribute to the development of a culture that promotes healthy weight in the Portuguese population through intersectoral cooperation. The objective of the programme is, in this way, to reverse the increase in the prevalence of pre-obesity and obesity in Portugal [2, 23]. More information about this national programme can be found in the documents published by EuroHealthNet and the WHO.
National Support:
The National Platform against Obesity (Plataforma Contra a Obesidade - http://www.plataformacontraaobesidade.dgs.pt) has a special focus on the understanding of the socio-economic determinants of obesity. For example, the Platform has a Local Governments based project, which is trying to identify children with increased needs in this area.National Programmes:
One of the running programmes of the NationalPlatform against Obesity is the POZ project.
The main purpose of the “Projecto Obesidade Zero” (Zero Obesity Project) is to develop a healthy cooking programme and a nutritional guidance programme targeted at low income families with overweight children. This action will be available and articulated with healthcare centres and town halls. Protocols will be established, according to which the healthcare centres and the town hall health offices will direct people to this service.
This project will last one year with the following development stages:
Planning, defining the calendar and establishing agreements with the different partners.
Constitution of regional teams for the cooking workshops and of guidance teams for individual and group counselling.
Field work – organising cooking workshops, therapeutic groups, individual and group counselling.
Assessment, with regular monitoring of the work done.
The expected results are: 1) Development of competences, within the families, in healthier food selection and preparation, especially in those families with obese children, and 2) Making nutritional guidance available to families with obese children, in a comprehensive and motivational process based on the work of the healthcare centres.
For more information, please contact:
João Breda, General Health Directorate +35 191 7547 955