Recent success obtaining permanent funding for universal free school meals was due in part to emergency measures taken to address the impact of COVID-19 on communities, which begs the question: Why have public health nutrition programs not suffered from the same “rot” as infectious disease control? Why have emergencies led instead to more robust, sustained program development?
There are many factors involved, including the medicalization (and thus individualization) of infectious disease prevention and control, but perhaps the most important is the extent to which emergencies have mobilized powerful reform movements. Major epidemics in recent history (including COVID-19, Ebola, and SARS) have generated significant emergency responses, but those have not typically been translated into sustained activism for broader preparedness.[2] Emergencies have been much more successfully leveraged to mobilize support for public health nutrition programs such as school meals, especially around issues of access and equity.
Part of the issue is also that nutrition problems, such as hunger and malnourishment, are generally endemic, and they become more visible (or perhaps less ignorable) during times of crisis. In his work on the history of cholera, Louis Chevalier argued that epidemics do not cause extreme situations so much as they reveal existing imbalances in health and welfare.[3] Those imbalances amplify vulnerability and thus the asymmetric effects of crises on different groups, what Paul Farmer termed the “biological reflections of social fault lines.”[4] Sometimes the crises arrive suddenly, in the form of an epidemic or natural disaster, but the same applies to what is often termed slow crises, which may become suddenly visible but reflect long-term underlying processes.
It was a slow crisis that spurred the first sustained development of school meal programs in the United States beginning at the turn of the twentieth century. The emergence and rapid expansion of school medical inspection in the 1890s, and medical inspection of men enlisting for service during World War I, revealed shockingly high levels of ill health among young people. Much of the ill health documented by medical inspectors was preventable, and a significant portion was attributed to chronic undernourishment and lack of basic medical care.