From The Field M A Y 1 9 , 2 0 1 5 Kids and Drinking Water: A Glass Half Full or Half Empty? ELLEN BRAFF-GUAJARDO KENNETH HECHT Program Officer, W.K. Kellogg Foundation Director of Policy, Nutrition Policy Institute, University of California W e know this to be true: increasing kids’ consump- OBSTACLES IN SCHOOLS tion of drinking water supports their health and In 2010 the Healthy, Hunger-Free Kids Act imposed a new learning. Yet most children do not drink enough requirement on schools participating in the National School water. Between 2005 and 2010, 28 percent of U.S. children Lunch Program: to make free drinking water available where aged 4 to 13 did not have a drink of plain water on two meals are served. But having this law is only a start. It is consecutive days (Drewnowski et al. 2013). A key challenge is that many children do not have ready going to take robust implementation to guarantee ready access access to drinking water in childcare settings, at school, or in and successfully promote water as the “cool” beverage of choice. aftercare programs, where they spend much of their day. The While schools may have drinking fountains, they are often problem is exacerbated for low-income kids and children of inadequate to serve hundreds of students during a short lunch color, who disproportionately live and go to school in places period. Kids often wait in long lines, simply to get a few sips with dilapidated plumbing or high levels of environmental of water. In many schools, water fountains do not function contaminants. properly or fail to consistently meet safe drinking water The W.K. Kellogg Foundation and University of California’s standards. For example, in California nearly 15 percent of Nutrition Policy Institute believe that it is high time to invest in public schools received or were associated with at least one accessible, safe drinking water for all children. It is simply com- maximum contaminant level violation (Community Water mon sense and supports children’s optimal development. We Center and EJCW, forthcoming report). In other schools, bot- need a movement making free, safe drinking water first for thirst. tled water is more readily available or appealing than the drinking fountain; however, it is typically locked up in vend- THE SCIENCE IS COMPELLING ing machines and its cost excludes low-income kids from this basic necessity. Every system of our body needs water to survive. Leading health For many schools faced with competing demands and organizations like the Institute of Medicine, Centers for Disease insufficient resources, improving water access may seem a low Control and Prevention, and American Heart Association priority. Installing water bottle filling stations, rehabilitating emphasize the importance of water consumption in preventing broken fountains and plumbing, and ensuring water safety can chronic disease. When fluoridated, drinking water promotes seem daunting and expensive. And bringing water to students oral health. Research also shows that cognitive function is is only half the solution. Kids also need to learn why they improved through water consumption. The American Academy should drink water and be encouraged to embrace the notion of Pediatrics and groups like Partnership for a Healthier that water really is the “go to” beverage. America and First Lady Michelle Obama’s Let’s Move! identify water as the best source of hydration for young people. DRINKING WATER CHALLENGES IN Water also is essential in combating our nation’s childhood COMMUNITIES obesity epidemic. About one-third of U.S. children are obese or overweight, which increases their risk for chronic diseases, Water accessibility issues go beyond schools. Consider the including diabetes and heart disease (Fryar et al. 2014; May et plight of children and families who live, play, and go to school al. 2012; Go et al. 2014; Gregg et al. 2014). Because sugar- in areas where the drinking water is not potable due to lead, sweetened beverages (SSBs) are the largest contributor of nitrates, arsenic, bacteria, or other contaminants. For instance, added sugar in kids’ diets—and the third largest source of in 2011, more than one million Californians lived in calories—substituting zero-calorie water for SSBs is a promis- communities where the drinking water was unhealthy ing obesity prevention strategy (CDC 2010; USDA and HHS (CDPH 2012). Such situations exist in rural, industrial, 2010). In recognition of this, soda has been removed from and marginalized areas throughout the United States. schools, but it has not necessarily been replaced by accessible Another challenge is the misperception that public water sources of safe, free drinking water (USDA and HHS 2010). may be unsafe, even when it is not. This is particularly true for readily reach for it to quench their thirst. We can engage For much of our history, water was the beverage that children relied on… current and future parents, other Water should be the default thirst quencher again. caregivers, teachers, health providers, and policymakers so they understand and play a role newcomers to the United States, whose water may have been in encouraging water consumption. We can engage water unsafe in their countries of origin. Even where safe to drink, utility companies and public health departments to be the water may be warm, discolored, have an unpleasant odor, valuable allies in promoting drinking water. or be available only through unsanitary or faulty fountains or • Fund data collection and research. We need more data on faucets. children’s access to drinking water in childcare settings, schools, and public places, as well as on children’s THE POLICY FRAMEWORK consumption of water. We also need continued research Some states and communities are leading the way by enacting and the curation of best practices for improving access and policies to improve drinking water accessibility. Before promotion. This data and research can help inform strategic passage of the Healthy, Hunger-Free Kids Act, a statewide action agendas at the local, state, and federal levels. survey in California found that in nearly half of the • Promote multisectoral partnerships. We must build responding schools, their students could not get free water in far-reaching public support for increased access to and their cafeterias (Agron 2010). In response, Governor Arnold consumption of free, safe drinking water. Creative Schwarzenegger sponsored—and then signed—a law (Cal. partnerships involving public health, oral health, education, Ed. Code section 38086) requiring every California school to economic development, philanthropy, and community can make free drinking water available wherever school meals are bring together the right resources and build momentum served and consumed. toward positive changes. California, and later, the federal government also passed laws to ensure the availability of drinking water in childcare • Advocate for supportive policies. We need stronger, fuller facilities. In California, availability of drinking water is a water policies, and we need to make them consistent across condition of licensure for all childcare facilities, while federal all federal, state, regional, and local water safety, health, and policy requires drinking water to be available in childcare nutrition programs. We also need to ensure that the current facilities participating in the Child and Adult Care Food standards are implemented and that supplemental policies Program. are created to fill gaps and address inequities in access to this Much more needs be done to ensure that these standards essential element of life. are effectively implemented and policy holes are filled. Existing federal regulations should be expanded to explicitly For much of our history, water was the beverage that children cover breakfast in the classroom and afterschool meals and relied on, after they were weaned from breast milk. Water snacks—and to provide targeted reimbursement for replace- should be the default thirst quencher again. The national ment water in schools where the tap water is unsafe. Other policy is partially in place, the technology is ready, and federal child nutrition programs—like Women, Infants, and advocates and researchers are eager to lend expertise. What Children (WIC) and summer meals—should have drinking is needed are the resources—funding, alliances, and water requirements. Free, safe water should be available in support—that grantmakers can contribute to help fuel the parks and other public facilities. movement. HOW CAN FUNDERS HELP? The W.K. Kellogg Foundation supported a strategy convening Health funders have an indispensable role to play in hosted by the Nutrition Policy Institute on April 29, 2015, increasing kids’ access to and consumption of free, safe in Oakland, California, that marked the beginning of a drinking water. Opportunities include: national alliance. We invite other funders to join this effort. • Improve access. Schools and childcare facilities need the For more information, contact Ellen Braff-Guajardo at right equipment to bring healthy, free water to kids. There ellen.braff-guajardo@wkkf.org or Kenneth Hecht at is no one correct way to accomplish this. Depending on kenhecht@berkeley.edu. circumstances, the best solution could be water stations, fountains, jets, large refillable containers, pitchers with cups, or other options. Free water also should be available and promoted in other public places where kids gather— like parks, playgrounds, libraries, and clinics. • Prioritize education. Kids need opportunities to learn about the benefits of water, develop a preference for it, and SOURCES Agron, P. California Department of Public Health. Telephone call, 2010. California Department of Public Health (CDPH), Division of Drinking Water and Environmental Management. 2012 Annual Compliance Report. 2012. http://www.waterboards.ca.gov/ drinking_water/certlic/drinkingwater/documents/dwdocuments/2012/2012acr.pdf. Centers for Disease Control and Prevention (CDC). The CDC Guide to Strategies for Reducing the Consumption of Sugar-Sweetened Beverages. March 2010. http://www.cdph.ca.gov/ SiteCollectionDocuments/StratstoReduce_Sugar_Sweetened_Bevs.pdf. Community Water Center and Environmental Justice Coalition for Water (EJCW). An Analysis of California Schools Impacted by Unsafe Drinking Water at the Tap. Sacramento, CA: forthcoming report. Drewnowski, A., C.D. Rehm, and F. Constant. “Water and Beverage Consumption among Children Age 4-13y in the United States: Analyses of 2005-2010 NHANES Data.” Nutrition Journal. 12, no. 1 (2013): 1-9. Go, A.S., D. Mozaffarian, et al. “AHA Statistical Update. Heart Disease and Stroke Statistics— 2013 Update.” Circulation 127 (2013): e6-e245. http://circ.ahajournals.org/content/ 129/3/e28.full#sec-25. Gregg, E.W., X. Zhuo, Y.J., Cheng, A.L., Albright, K.M.V. Narayan, T.J. Thompson. “Trends in Lifetime Risk and Years of Life Lost Due to Diabetes in the USA, 1985-2011: A Modeling Study.” Lancet Diabetes Endocrinology. 2014. doi:10.1016/S2213-8587(14)70161-5. May, A.L., E.V. Kuklina, and P.W. Yoon. “Prevalence of Cardiovascular Disease Risk Factors among U.S. Adolescents, 1999-2008. Pediatrics 129, no. 6 (2012):1035-1041. U.S. Department of Agriculture (USDA) and U.S. Department of Health and Human Services (HHS). “Table 2-2. Top 25 sources of calories among Americans ages 2 years and older, NHANES 2005–2006.” Dietary Guidelines for Americans. Seventh edition. Washington, DC, 2010. Views from the Field is offered by GIH as a forum for health grantmakers to share insights and experiences. If you are interested in participating, please contact Osula Rushing at 202.452.8331 or orushing@gih.org.