The Ethical Basis for Promoting Nutritional Health in Public Schools in the United States

Public schools have an obligation to question and refute policies that do not benefit their students and their communities and a corresponding responsibility to protect students, for whom school attendance is mandated, from harm. However, implementation of change in school procedures and policies presents challenges and requires an ethical justification for the change and feasible methods for accomplishing it. The mission of schools is broader than simply teaching academic skills. Schools have long accepted responsibility for supporting the health of their students, for example, by requiring immunizations, providing health screenings, and by offering meal programs that support their students’ nutritional health. Nutritional health is associated with academic performance (1), and well-nourished students are better able to learn and less likely to miss school for health reasons (2). Research shows that children from lowincome families who participate in school breakfast programs score higher on standardized tests and have better school attendance than similar students who do not participate (3). Breakfast programs also improve classroom behavior and attentiveness (4). In 1904, Robert Hunter wrote, “It is utter folly, from the point of view of learning, to have a compulsory school law which compels children, in that weak physical and mental state . . . to sit at their desks, day in and day out for several years, learning little or nothing . . . because hungry stomachs and languid bodies and thin blood are not able to feed the brain” (5). Focusing on nutritional health promotion in schools can support the common good by reducing the impact, including substantial financial costs, of future diet-related disease associated with the childhood obesity epidemic. Furthermore, optimizing nutrition in childhood is critical to learning and future productivity. We must consider whether schools have an ethical obligation to serve the common good in this area, even if the actions they take appear to conflict with the autonomy or freedom of choice of children, parents, and school staff, or the interests of food and beverage companies. The purpose of this article is to present a bioethics framework for justifying stricter regulation of school food, specifically, to determine whether this type of health promotion in schools is ethically justified (6). To determine whether current s