“Here is public health’s bind,” wrote science journalist Ed Yong recently in The Atlantic: “Though it is so fundamental that it can’t (and arguably shouldn’t) be tied to any one type of emergency, emergencies are the one force that can provide enough urgency to strengthen a system that, under normal circumstances, is allowed to rot.” Building on the work of Elizabeth Fee and Ted Brown, Yong rightly laments that this panic-neglect cycle has resulted in a disastrous response to the COVID-19 pandemic and left US public health infrastructure fragmented and chronically underfunded.
But it is also a mistake to equate public health with disease prevention and control. Earlier this year, California and Maine became the first US states to authorize free meals for all public school students since the National School Lunch Program began 75 years ago. Other states are considering similar bills, and national legislation may now be within reach. There are few public health interventions as impactful as providing up to two meals and a snack to every child attending a non-profit educational institution, and research indicates that such interventions reduce food insecurity and improve students’ diets, academic performance, and even their future earnings.
Recent success obtaining permanent funding for universal free school meals was due in part to emergency measures taken to address the impact of COVID-19 on communities, which begs the question: Why have public health nutrition programs not suffered from the same “rot” as infectious disease control? Why have emergencies led instead to more robust, sustained program development?
There are many factors involved, including the medicalization (and thus individualization) of infectious disease prevention and control, but perhaps the most important is the extent to which emergencies have mobilized powerful reform movements. Major epidemics in recent history (including COVID-19, Ebola, and SARS) have generated significant emergency responses, but those have not typically been translated into sustained activism for broader preparedness. Emergencies have been much more successfully leveraged to mobilize support for public health nutrition programs such as school meals, especially around issues of access and equity.
Part of the issue is also that nutrition problems, such as hunger and malnourishment, are generally endemic, and they become more visible (or perhaps less ignorable) during times of crisis. In his work on the history of cholera, Louis Chevalier argued that epidemics do not cause extreme situations so much as they reveal existing imbalances in health and welfare. Those imbalances amplify vulnerability and thus the asymmetric effects of crises on different groups, what Paul Farmer termed the “biological reflections of social fault lines.” Sometimes the crises arrive suddenly, in the form of an epidemic or natural disaster, but the same applies to what is often termed slow crises, which may become suddenly visible but reflect long-term underlying processes.
It was a slow crisis that spurred the first sustained development of school meal programs in the United States beginning at the turn of the twentieth century. The emergence and rapid expansion of school medical inspection in the 1890s, and medical inspection of men enlisting for service during World War I, revealed shockingly high levels of ill health among young people. Much of the ill health documented by medical inspectors was preventable, and a significant portion was attributed to chronic undernourishment and lack of basic medical care.
In addition to making visible a crisis of child health, the findings of medical inspectors mobilized a broad coalition of reformers—home economists, club women, physicians, nurses, and philanthropists—to organize meal services and establish public-private partnerships with schools to feed children, and especially poor children. This required private, charitable financing, as schools were not typically authorized to provide food for students. As late as the 1920s, only Wisconsin and Vermont explicitly authorized public schools to provide meals to poor students at less than cost—that is, to subsidize those meals using public funds. In Wisconsin, the means testing was left to boards of education, so long as “the conditions under which, and the pupils to whom, such food is furnished at less than cost, shall not be disclosed to any other pupils.” This was a common refrain in programs across the country, which sought to provide nutritional support for poor children without calling attention to their poverty. Without federal legislation, school meal programs were subject to state law.
Although the federal government traditionally had no role in education and little involvement in public health, the economic crisis of the Great Depression enabled reformers to obtain emergency federal support for school meals. Beginning in 1933, the federal government provided food to schools, first by distributing surplus agricultural commodities and then by providing cash reimbursements for local food purchases. After 1935, the federal government also provided labor through the Works Progress Administration; nearly 20% of the agency’s labor force worked in school meal programs.
Reformers were able to leverage the tremendous popularity of the emergency federal meal programs, which continued during the war, to obtain permanent legislation. The passage of the National School Lunch Act in 1946 entitled states to matching federal funds for school meals, making it possible for schools in any state to offer free or reduced-cost meals to children “determined by local school authorities to be unable to pay the full cost of the lunch,” with a proscription against stigmatization. But the legislation represented a significantly watered down version of the school meal program that reformers wanted, prioritizing agricultural surplus disposal over children’s health (to appease the farm bloc) and ceding considerable operational power to state and local authorities (to appease Southern Democrats).
The National School Lunch Act’s empowerment of local authorities to set eligibility criteria and lack of significant federal oversight left minoritized and structurally marginalized students at the mercy of bureaucratic machines designed to exclude them. In 1968, two decades after the National School Lunch Program began, two-thirds of schools were participating but fewer than 10% of children living in the impoverished urban neighborhoods had access to lunches, and schools in remote rural areas had very low rates of participation. Racial discrimination was even worse than economic discrimination, with Black, Native American, and Latine students almost completely excluded, and humiliation was rampant—recipients of free meals often stood in separate lines, ate separate meals, and at times even worked for their food.
Against the backdrop of the civil rights movement and President Johnson’s War on Poverty—and specifically, the (re)discovery of hunger and poverty in the land of plenty, a perennial but cyclical crisis—the Right to Lunch movement emerged in the late 1960s, driven by a coalition of organizations as disparate as the Catholic Church, national women’s councils, and the Black Panther Party. Grassroots groups mobilized nationwide under the idea that nourishing meals at school were a basic human right, and they successfully lobbied to increase funding for free and reduced price meals and to establish federal eligibility standards and uniform reimbursement rates. Despite increasing participation rates, driven largely by increased provision of free and reduced-price meals, widespread economic and racial discrimination persisted for decades, abetted by federal apathy to enforcement of program requirements and chronic underfunding. Even decades later, numerous cities that received federal money to provide free and reduced-price meals were providing inexpensive cold lunches to poor students while providing warm meals in more affluent districts. And poor and minoritized students were much more likely to have unhygienic lunchrooms and kitchen facilities. Parents in the Bronx, for example, advocated for plastic utensils and disposable plates because schools lacked dishwashers, and staff often had to buy soap themselves.
It took another crisis, this time the Great Recession of 2008, to provide the activation energy needed to address continued inequities. When President Obama signed the Healthy, Hunger-Free Kids Act into law in 2010, its signature feature was the Community Eligibility Program: the act authorizes schools to provide free meals to all students in a school if at least 40 percent of attending students would qualify for free meals individually. This was a major advance in the struggle for access and equity, but it was also a bureaucratic compromise: more children would receive free meals, and the costs would be offset in part by the significant reduction in effort required to means test individuals and certify eligibility, not to mention the elimination of debt collection and lunch shaming.
Perhaps even more importantly, the Community Eligibility Program empowered many cities to enact universal free meals for all schools, even those that may not qualify under the federal criterion. That is, the program made universal meals permissible in a way that they hadn’t been previously.
When the COVID-19 pandemic caused the number of food insecure children to more than double—from 5 million to 12 million—the U.S. Department of Agriculture, which administers school meal programs, authorized every school to provide free meals to all children through a series of waivers on program requirements and increased reimbursement rates, which were recently extended through June of 2022. The popularity of these measures has led to legislation making them permanent in two states.
Despite the panic-neglect cycle that has characterized the United States’ response to epidemics and subsequent infectious disease preparedness, other elements of the country’s public health infrastructure have been less prone to “rot.” In the case of school meals, reformers and activists have used emergencies, including epidemics, to mobilize the support needed for incremental but critical progress, often by pursuing incremental if suboptimal gains. But this has been possible due to persistent and sustained mobilization of both national leaders and local communities around a clear and compelling issue: that all children have the right to be fed.
- Elizabeth Fee and Theodore M. Brown, “The Unfulfilled Promise of Public Health: Déjà Vu All over Again,” Health Affairs 21, no. 6 (2002): 31–43. ↑
- HIV-AIDS is perhaps an exception to this pattern in that it did generate significant mobilization and activism, but as Fee and Brown suggest, that had limited impact on infectious disease prevention and control more broadly. ↑
- Louis Chevalier, Le Choléra: La Première Epidémie du XIXe Siècle (Impr. Centrale de l’Ouest, 1958). ↑
- Paul Farmer, Infections and Inequalities: The Modern Plagues (University of California Press, 1999), 5. ↑
- This is, essentially, what my book on the origin of school meals explores: A. R. Ruis, Eating to Learn, Learning to Eat: The Origins of School Lunch in the United States (Rutgers University Press, 2017). ↑
- A third state, Massachusetts, assigned this power to local governments beginning in 1915: William R. Hood, Stephen B. Weeks, and A. Sidney Ford, Digest of Laws Relating to Public Education in Force January 1, 1915 (US Department of the Interior, Bureau of Education, 1916), 594. ↑
- C. P. Cary, School Law Supplement Giving the Amendments and New School Laws as Enacted by the Legislature of 1917 (Democrat Printing, 1917), ch. 427 § 486t. ↑
- Final Report on the WPA Program, 1935–43 (US Government Printing Office, 1946), 36. ↑
- National School Lunch Act, Pub. L. 396 (4 June 1946), § 9. ↑
- Susan Levine, School Lunch Politics: The Surprising History of America’s Favorite Welfare Program (Princeton University Press, 2008), 128, 136 ff. ↑
- Annelise Orleck, Storming Caesars Palace: How Black Mothers Fought Their Own War on Poverty (Beacon Press, 2005). ↑
- Lana Dee Povitz, Stirrings: How Activist New Yorkers Ignited a Movement for Food Justice (UNC Press, 2019). ↑
- Healthy, Hunger-Free Kids Act, Pub. L. 111–296, (13 December 2010), §§ 204, 208. ↑