Social Determinants of Health: Healthy School Meals for All, Updated 2026

Details

• Alternative Title:
  Social Determinants of Health: Healthy School Meals for All: Community Preventive Services Task Force Finding and Rationale Statement Ratified July 2022; Updated 2026
• Corporate Authors:
  Community Preventive Services Task Force (CPSTF)
• Description:
  Context: Food and nutrition security is an established social determinant of health (CDC 2022, Serchen et al. 2022). It exists when people have consistent physical, social, and economic access to affordable foods and beverages that promote health and prevent adverse health outcomes (CDC 2022, Mozaffarian et al. 2021). Families from historically disadvantaged racial and ethnic populations and populations with lower incomes often lack access to affordable nutritious foods (CDC 2020). In 2020, 14.8% of households with children in the United States experienced food insecurity, and rates were even higher for those below 185% of the federal poverty level (33.7%) and Black or African American (27.3%) and Hispanic or Latino (21.8%) households (Coleman-Jensen et al. 2021). Children experiencing food insecurity are at higher risk of poor physical and mental health, obesity, increased hospitalizations, poor academic performance, and behavioral problems (Au et al. 2019, Cook et al. 2006, McIntyre et al. 2013, Shankar et al. 2017). ; The National School Lunch Program (NSLP) and the School Breakfast Program (SBP) - two key U.S. Department of Agriculture (USDA) meal programs - operate in public and non-profit private schools, and residential child-care centers (USDA 2021, 2022a). Studies have shown these programs reduce food insecurity (Ralston et al. 2017). Children from households experiencing food insecurity receive significantly more of their daily energy from school meals than children from households that are not experiencing food insecurity (Forrestal et al. 2021). Studies have also shown that school meals provide the best diet quality of major U.S. food sources among children and improve the nutritional quality of students' diets (Fox et al. 2019, Liu et al. 2021). School meals are not linked with increases in obesity and have been associated with decreases in obesity among children from households with lower incomes (Kenney et al. 2020). Studies have also shown a favorable association between SBP and school attendance and academic performance (County Health Rankings & Roadmaps 2019). ; NSLP and SBP have the potential to benefit millions of students in the United States, many of them from households with lower incomes (National Center for Education Statistics 2021, 2022). Estimates indicate more than half of students in U.S. public schools are eligible for free or reduced-price lunches (NCES 2021). In schools that offer NSLP and SBP, however, it is estimated that only 79% of students from households experiencing food insecurity participate in NSLP and only 38% participate in SBP (Forrestal et al. 2021). ; The traditional payment model under which NSLP and SBP operate requires students to apply and meet certain income-based eligibility requirements to receive free or reduced-price meals (). Students who do not apply or meet these requirements must pay full price for their meals (USDA 2021, 2022a). This system presents economic, administrative, and language barriers that may make it more difficult for students from households with lower incomes to participate. Families with low to moderate monthly incomes undergo income fluctuations that cross the eligibility threshold for reduced-price lunches an average of five times a year (Newman 2006). The certification process for free or reduced-price meals also presents barriers, as errors on applications or in administrative procedures may lead to eligible students being denied benefits (Milfort et al. 2021). In the 2017-18 school year, an estimated 34 percent of students who were denied free or reduced-price meals were actually eligible to receive them (Milfort et al. 2021). Another issue is families with limited English proficiency may be unaware of the availability of free or reduced-price meals and may have difficulties with the application process if there are not translation services or forms available in their primary language (USDA 2016a, 2016b). ; The traditional payment model also presents social barriers to participation. Students who are unable to pay for school meals may be denied nutritious meals and face stigmatization due to what is commonly referred to as "lunch shaming" practices. In some schools, students who have unpaid meal debt are identified with a wristband or hand stamp and receive an alternate meal of minimal nutritional value or no meal at all (Fleischhacker et al. 2020). ; The Community Preventive Services Task Force (CPSTF) findings and recommendations for "Social Determinants of Health: Healthy School Meals for All" are based on systematic reviews of evidence of effectiveness and economic impact. All CPSTF findings and recommendations were originally published in The Community Guide. ; The 2022 Findings and Rationale Statement was updated in July 2026. This update include the addition of these supporting document appendices: Appendix A: Analytic Framework (Effectiveness Review); Appendix B: Search Strategy (Effectiveness Review); Appendix C: Included Studies (Effectiveness Review); Appendix D: Summary Evidence Table (Effectiveness Review).
• Content Notes:
  Publication date supplied by CPSTF
• Subjects:
  • Adolescent
  • Breakfast
  • Child
  • Food Security
  • Health Inequities
  • Lunch
  • Nutritional Status
  • Population Characteristics
  • Social Determinants of Health
  • Schools
  More +
• Keywords:
  • Child Care Center
  • School
  • Children
  • Early Childhood Education
  • Lunch Shaming
  • Social Determinants of Health
  • School meals
• Series:
  CPSTF Finding and Rationale Statement
• Subseries:
  Social Determinants of Health
• DOI:
  https://doi.org/10.15620/cdc/168659
• Document Type:
  Text
• Corporate as Subject:
  National School Lunch Program (NSLP) ; School Breakfast Program (SBP)
• Genre:
  Report
• Place as Subject:
  United States
• Rights:
  Public Domain
• CIO:
  Office of Science (OS)
• Topic:
  Diseases and Conditions
• Location:
  North America
• Pages in Document:
  32 pdf pages
• Citation:
  The Community Preventive Service Task Force (CPSTF). Social Determinants of Health: Healthy School Meals for All, Updated 2026. The Community Guide www.thecommunityguide.org. The Community Preventive Service Task Force, Atlanta, Georgia, 2026. https://doi.org/10.15620/cdc/168659
• Download URL:
  https://stacks.cdc.gov/view/cdc/168659/cdc_168659_DS1.pdf
• File Type:
  [PDF - 1.30 MB]
• Collection(s):
  The Community Guide
• Main Document Checksum:
  urn:sha-512:26a1aa6a62d0a5e12c8e7caa4b20553469f725394ef86adb6205679d50f8b8486361f746cbf3c76f44789635ee86ddf9a79c873b81baf0e731e01b584700114b