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CPSTF Recommends Healthy School Meals for All

The Community Preventive Services Task Force (CPSTF) recommends Healthy School Meals for All to increase participation in the U.S. National School Lunch Program and School Breakfast Program and reduce school absenteeism. Participation in these programs is associated with reduced food insecurity, improved nutritional quality of students’ diets, and improved academic outcomes.1-4 The recommendation is based on systematic review evidence from a published review5 and updated search.

Healthy School Meals for All is expected to advance health equity by making it easier for students from households with lower incomes to access to free and healthy foods.

What are Healthy School Meals for All Interventions?

Healthy School Meals for All offers free, nutritious meals to all students in qualifying schools, regardless of household income. It augments the traditional model of the U.S. National School Lunch Program and School Breakfast Program which uses household income to determine eligibility for free and reduced-price meals. Interventions aim to do the following:

  • Improve access to school meal programs by removing economic, administrative, language, and social barriers that may limit participation among students from households with lower incomes
  • Increase participation in the school meal programs to improve diet quality and promote health and well-being for all students

Healthy School Meals for All is implemented through policies at federal, state, and local levels. Congress authorizes federal policies administered by the U.S. Department of Agriculture.6-8 The Community Eligibility Provision, the most widely used federal policy, allows schools and school districts to offer Healthy School Meals for All if at least 40% of enrolled students are directly certified for free meals based on their participation in other means-tested programs, such as the Supplemental Assistance Program, Temporary Assistance for Needy Families, or Food Distribution Program on Indian Reservations.7,9,10

Why is this important?

Food and nutrition security is an established social determinant of health.11,12 Children experiencing food insecurity are at higher risk of poor physical and mental health, obesity, increased hospitalizations, poor academic performance, and behavioral problems.13-16 Families from historically disadvantaged racial and ethnic populations and populations with lower incomes often lack access to affordable nutritious foods17 and experience higher rates of food insecurity.18

For More Information:


1 County Health Rankings & Roadmaps. School breakfast programs. Published 2019. Accessed June 22, 2022. www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/school-breakfast-programs.

2 Fox MK, Gearan E. School nutrition and meal cost study: summary of findings. Published 2019. Accessed June 22, 2022. https://fns-prod.azureedge.us/sites/default/files/resource-files/SNMCS_Summary-Findings.pdf.

3 Liu J, Micha R, Li Y, et al. Trends in food sources and diet quality among US children and adults, 2003-2018. JAMA Netw Open 2021;4(4): e215262.

4 Ralston K, Treen K, Coleman-Jenson A, et al. Children’s food security and USDA child nutrition programs. U.S. Department of Agriculture Economic Research Service; 2017, EIB-174. Accessed June 22, 2022. www.ers.usda.gov/publications/pub-details/?pubid=84002.

5 Cohen JFW, Hecht AA, McLoughlin GM, et al. Universal school meals and associations with student participation, attendance, academic performance, diet quality, food security, and body mass index: a systematic review. Nutrients 2021;13:911.

6 USDA. National School Lunch Program: Provisions 1, 2, and 3. Published 2014. Accessed June 22, 2022. www.fns.usda.gov/cn/provisions-1-2-and-3.

7 USDA. Community Eligibility Provision. Published 2019. Accessed June 22, 2022. www.fns.usda.gov/cn/community-eligibility-provision.

8 USDA. Child Nutrition COVID-19 Waivers. Published 2022b. Accessed July 12, 2022. www.fns.usda.gov/fns-disaster-assistance/fns-responds-covid-19/child-nutrition-covid-19-waivers

9 Billings KC, Carter JA. Serving free school meals through the Community Eligibility Provision (CEP): background and participation. Congressional Research Service. Published 2020. Accessed June 22, 2022. https://crsreports.congress.gov/product/pdf/R/R46371.

10 National Archives. Code of Federal Regulations. Published 2022. Accessed July 12, 2022. www.ecfr.gov/current/title-7/subtitle-B/chapter-II/subchapter-A/part-245/section-245.9#p-245.9(f)(3)(i).

11 CDC, National Center for Chronic Disease Prevention and Health Promotion. Social determinants of health. Published 2022. Accessed June 22, 2022. www.cdc.gov/chronicdisease/programs-impact/sdoh.htm.

12 Serchen BA, Atiq O, Hilden D. Strengthening food and nutrition security to promote public health in the United States: a position paper from the American College of Physicians. Annals of Internal Medicine 2022 Jun 28; doi.org/10.7326/M22-0390.

13 Au LE, Zhu SM, Nhan LA, et al. Household food insecurity is associated with higher adiposity among US schoolchildren ages 10–15 Years: The Healthy Communities Study. Journal of Nutrition 2019;149(9):1642-50.

14 Cook JT, Frank DA, Levenson SM, et al. Child food insecurity increases risks posed by household food insecurity to young children's health. Journal of Nutrition 2006;136(4):1073–6.

15 McIntyre L, Williams JV, Lavorato DH, et al. Depression and suicide ideation in late adolescence and early adulthood are an outcome of child hunger. Journal of Affective Behaviors 2013;150(1):123-9.

16 Shankar P, Chung R, Frank DA. Association of food insecurity with children's behavioral, emotional, and academic outcomes: a systematic review. Journal of Developmental & Behavioral Pediatrics 2017;38(2): 135–50.

17 Centers for Disease Control and Prevention (CDC). Healthy food environments: improving access to healthier food. Published 2020. Accessed June 22, 2022. www.cdc.gov/nutrition/healthy-food-environments/improving-access-to-healthier-food.html.

18 Coleman-Jensen A, Rabbitt MP, Gregory CA, et al. Household food security in the United States in 2020. Published 2021. Accessed June 22, 2022. www.ers.usda.gov/publications/pub-details/?pubid=102075.