STRATEGIES FOR INTEGRATING FOOD AND NUTRITION IN THE PRIMARY SCHOOL CURRICULUM

Introduction

Every child has a right to food, nutrition, health, and education. However, millions of children around the world are suffering from malnutrition, diseases, and poor education. Based on the Education for all - Global monitoring report, around 58 million children are out of school globally and around 100 million children do not complete primary education (UNESCO, 2015). UNESCO has identified barriers to inclusive education categorized as follows: child (homelessness and the need to work, illness and hunger, birth registration, violence, pregnancy), family (poverty, conflict, inadequate caregiving, HIV/AIDS); community (gender discrimination, cultural differences and local tradition, negative attitudes); and school (costs, location, scheduling, facilities, preparedness, class sizes, resources, and teachers’ workload).

Malnutrition continues to affect millions of children globally (FAO et al., 2017) and in the Association of Southeast Asian Nations (ASEAN) countries (ASEAN/UNICEF/WHO, 2016). However, the nutrition situation of school- children is not as well measured as that of pre-school children. In Asia and the Pacific, there is a dearth of information on the nutritional status of schoolchildren (SEAMEO INNOTECH, 2016). Understanding malnutrition is important as it affects populations throughout the life cycle, from conception through childhood into adolescence, adulthood, and older age (IFPRI, 2016). Among schoolchildren, under-nutrition has been linked with poor school achievement and performance, reduced school attendance, and diminished income-earning capacity in adulthood (ASEAN/UNICEF/WHO, 2016).

The school has been recognized as a setting for advancing nutrition in a large group of young people, school staff, families, and community members

(Perez-Rodrigo and Aranceta, 2003; FAO, 2005). Nutrition education is identified as one of the key interventions addressing malnutrition and in promoting lifelong healthy eating and exercise behaviours (Center for Disease Control and Prevention, 1996; McNulty, 2013). According to Perez-Rodrigo and Aranceta (2003), school-based nutrition education should (a) address the needs and interests of the students, teachers, and school; (b) be relevant to programme goals; (c) take into account what children already know and can do; (d) be culturally appropriate; and (e) be delivered in a way children can understand and teach the skills and knowledge required to improve or strengthen healthy eating habits.

Methodology

This chapter aims to review current strategies on how food and nutrition education is integrated in the primary school curriculum focussed on countries in Southeast Asia. The interventions were identified using Elton B. Stephens Co. (EBSCO) research database, information searches on Google Scholar, and targeted internet searching of key organization websites. The search keywords used were “food and nutrition education” AND “integrated” AND “school curriculum” AND English language; and “food and nutrition education” AND “school feeding program” AND English language. Additional search was done using the keyword “school gardens”, “school meals”, and “school feeding”. Search results were refined to include full text copies of peer-reviewed journals published from 2005 onwards.

Main Findings

Health and nutrition problems among schoolchildren

Nutrition and health problems affect many schoolchildren in Southeast Asian countries though there are some variations from country to country. Based on the study of SEAMEO INNOTECH (2016), the most common school health and nutrition problems in the countries are underweight and dental problems, followed by overweight, and then EENT (eyes, ears, nose, and throat) problems and water- and sanitation-related illnesses (see Table 3.1). In terms of diet, SEAMEO RECFON (2018) has documented the nutritional practices of schoolchildren, including not eating breakfast regularly; not bringing food from home; poor consumption of fruits and vegetables; and high consumption of sweet drinks and processed food high in sugar, salt, and oil or fat. Said practices were reported to be a reflection of situations in countries in the region which contribute to nourishment-related problems among schoolchildren such as stunting, being underweight or overweight, anaemia, and obesity.

SO Maria Theresa M. Talavera and Aileen R. de |uras

TABLE 3.1 Most common SHCN problems by country

Source: SEAMEO INNOTECH (2016).

Strategies in nutrition education

The governments ofSoutheast Asian countries have formulated and implemented policies and programmes addressing the problems identified among schoolchildren. Nutrition education is one of the interventions implemented to protect and promote the health and well-being of schoolchildren. Recently, there are several initiatives that have been implemented such as training of trainers on integrating nutrition in primary education curriculum by FAO in 2016 (FAO-RAP, 2016), development of comprehensive documents on school food and nutrition education by FAO that started in 2017 (FAO and United Arab Emirates University, 2019), and SEAMEO-RECFON has introduced the Nutrition Goes to School (NGTS) programme first in Indonesia and then to be expanded to other ASEAN countries (SEAMEO RECFON, 2018). This programme aims to produce active, well-nourished, and smart (AWESOME) schoolchildren using three approaches: 1) active (students perform physical activities); 2) well- nourished (students have a body mass index (BMI) that falls within the normal range; and 3) smart (students reduce their number of absences due to sickness and show improved academic performance).

While there are efforts to step up school-based food and nutrition education, several strategies have been implemented in nutrition education for school- children: namely, (1) integration of nutrition in primary school curriculum, (2) school gardening, (3) technology/web-based, (4) parental involvement, and (5) school feeding programmes. In this chapter, the curriculum approach is defined as nutrition education programmes delivered by teachers or specialists and cross-curricular when nutrition education programmes are delivered across two or more traditional primary school subjects. The technology/web-based approach is defined as students interacting with website(s) via the internet to enhance their knowledge of healthy eating or internet-based resources or feedback mechanisms that could be accessed by students at home or school. Parental involvement is defined as parents playing a role in the delivery of messages in the classroom and/or reinforcement of messages at home or programmes requiring active participation or assistance from a parent within or outside the school environment. School feeding programmes are defined as providing meals to schoolchildren. According to FAO (2019), integrating food and nutrition education with school meal helps establish meal times as learning opportunities and, at the same time, enhances effects on food practices.

Curriculum approach

Primary schools have been identified as a suitable place for nutrition education because of its systematic environment. They reach a large proportion of children and can influence schoolchildren at a critical stage when eating habits and attitudes are being established (FAO, 2005). One of the interventions to incorporate nutrition education in the school curriculum is through activities and/or lessons in a specific subject or programme related to healthy eating. With the narrow strategy currently employed in Southeast Asian countries, a ‘tripartite curriculum’ on school-based nutrition education developed by the FAO is put forward wherein the classroom curriculum is linked with the family, community, and school environment.

Integration is an act of bringing together small components (subjects) into a single system (a particular grade curriculum) that functions as one (specific knowledge domain + nutrition education). The goal is to develop a curriculum that can help learners to recognize the links between food, health and the environment and the causes and consequences of hunger, malnutrition and food insecurity, and (where possible) to act on this understanding. The expected output is a seamless integration of learning knowledge, skills/behaviour domains as specified in the school curricula and proper nutrition. The question has been why integrate concepts of nutrition in primary education. The answer is basically because it offers a unique venue for inculcating proper nutrition behaviour and healthy lifestyles at an important stage in a person’s lifelong learning and total development and can provide the important multiplier effect when families and communities are engaged.

When integrating food and nutrition concepts, several factors have to be considered such as country context (food and nutrition issues in the country and focus on the most urgent), content (select curriculum content that will contribute to the objectives of nutrition education, i.e. healthy eating and nutrition literacy), development (structure learning so that it is age group appropriate and develops systematically though the school years), relevance (learning is relevant to local practices, beliefs, and attitudes, and makes direct connections to children’s daily lives), and framework (spread nutrition education and school gardening through the primary school curriculum while at the same time maintaining its coherence and impact).

In deciding the level of integration, several questions have to be answered such as how much nutrition is already taught, what subjects are already taught and how are they grouped, which subjects are examinable, how much time is available, how much competition for time exists, whether the current system favours cross cutting subjects, and whether schools are used to project work, team teaching. There are several ways by which nutrition can be integrated, namely, nutrition education as a separate subject (considered as most ideal, raises profile of nutrition, and easier to develop appropriate teaching materials), infusion into subjects such as science, social sciences, literature and math, themes and projects with a nutrition focus such as Nutrition Month in the Philippines, World Food Day, and a combination of the strategies. The types of learning needed include food-based knowledge rather than information on basic nutrition science and nutrient-based; procedural knowledge, with emphasis on developing self- efficacy, skills and practices (food preparation/cooking, label reading, the habit of breakfast, food gardening); application of learning to the food environment (school, home, community, and the food system) and involving families.

If you take a look at the topics included in the curriculum, the most common ones are nutrients, functions, and/or nutritional value of foods; food safety, hygiene, and/or sanitation; and relationship between diet and health and disease. On the other hand, the least common topics are producing and growing diversified and nutritious foods, procuring/shopping for good food value, planning and preparing healthy meals, and trying out new foods or new food practices. New topics have to be included in the context of changing food systems, such as increasing dependence on mass-produced convenience and fast foods; the fact that it is not only women who need to understand and practice healthy eating and lifestyles; climate change; food culture; right to food; and household practices: for example, who does what in the home and why, and how long it takes.

Results of the literature search revealed that Cambodia, Indonesia, the Lao People’s Democratic Republic (the Lao PDR), Malaysia, Myanmar, Philippines, Singapore, and Thailand integrate food and nutrition education by using the curriculum and cross-curricular approaches. Nutrition knowledge and principles are covered in Science, Health Education, and Home Economics subjects. Topics discussed are food groups, nutrients, eating a variety of foods, meal preparation, and proper hygiene. Moreover, the curriculum in some countries was designed using developmentally appropriate and learner-centred approaches.

Within the Asian countries, there is an integration process taking place where different educational levels are being revisited and improved. This is because of the recognition of the need to integrate nutrition and use of school gardens as a platform for acquiring lifelong skills and positive nutrition behaviours. In 2016, a FAO Regional Training of Trainers on Integrating Nutrition in Primary Education Curriculum was conducted. Representatives from countries of Bangladesh, the Lao PDR, Myanmar, Timor Leste, Nepal, Cambodia, and Thailand were represented (FAO-RAP, 2016). The aims were to develop regional capacity and national capacity on how to integrate nutrition and related key concepts on nutrition in the curriculum and promote the use of school garden-based learning as a more sustainable strategy for promoting and acquiring lifelong skills and positive nutrition behaviours that translate to improved food and nutrition security. The experiences among the said countries revealed that primary or elementary curriculum varies among countries. In addition, primary education has incorporated nutrition mostly in science, health, physical education, and life skills subjects. The quality of teaching nutrition needs to be addressed due to lack of knowledge of schoolteachers and lack of teaching materials. Many of the countries have also implemented school garden learning but it is not widely promoted (Myanmar, the Lao PDR, Bangladesh, and Timor Leste) and linking school gardens with nutrition and with curriculum are not well established.