California

Healthy Kids Meals: How Local Action Can Spur Policy Change Across the Nation

“Without this policy, the beverage industry, through its relationships with fast-food chains, decided what kids were going to be given with their meals. This gave parents the right to decide.”
HAROLD GOLDSTEIN
EXECUTIVE DIRECTOR, PUBLIC HEALTH ADVOCATES

In 2015, the city of Davis, California, enacted a landmark ordinance that replaced sugary beverages with water or milk as the default beverage for kids meals sold by restaurants.

Building on the Davis victory and equipped with a new model policy from ChangeLab Solutions, other localities in the state quickly passed their own ordinances. And in 2018, California became the first state to pass a law that made water or milk the drink automatically offered by restaurants for all kids combo meals that include a beverage.

For more than 20 years, public health advocates have pursued policy changes to reduce sugary drink consumption. Yet despite the alarming rise of both obesity and diabetes nationwide, especially among children, these efforts have faced powerful — and often insurmountable — opposition from the beverage industry.

Not so with the healthy kids meals movement.

California’s Healthy by Default Kids Meal Beverages Act, which took effect January 1, 2019, was a rare takedown of Big Soda. And it happened with virtually no opposition.

The optics for the beverage industry were not good.

“It was a true success story,” said Julie Gallelo, who was a member of First 5 Yolo when it led the Davis healthy kids meals campaign. First 5 Yolo, as Yolo County’s children and families commission, works to improve the health and lives of children in their first 5 years of life.

How did healthy kids meals prevail so consistently where other initiatives — like a proposed sugary beverage tax and a sugary drink warning label — did not?

First, there were the optics. For the beverage industry, they were not good. Instead of turning out in opposition, industry remained silently neutral.

“It would have been tough to lobby for 3-year-olds being able to get only sweetened beverages with their kids meals,” said Bill Monning, the state senator who sponsored the kids meals bill in the state legislature, as well as other measures aimed at reducing sugary drink consumption.

“The path of protecting children’s health proved to be particularly salient,” he added.

Second, a change in kids meals was easy to explain, easy to understand, and easy to accept.

“This wasn’t about dictating anything,” said Harold Goldstein, executive director of Public Health Advocates (PHA), which, after the Davis victory, led the statewide campaign to enact local and state kids meal policies. “It wasn’t about raising the price of anything. It wasn’t about changing whether sugary beverages were available in restaurants. The policy simply makes sure that kids get a healthy beverage with their meal unless parents ask for something different.”

Third, the timing was right. Many fast-food restaurant chains — including McDonald’s, Wendy’s, Burger King, Subway, and Dairy Queen — had already changed the default drinks in their kids combo meals to healthy beverages on their own.

Fourth, supporters framed healthy kids meals as an expansion of parental choice. “Without this policy, the beverage industry, through its relationships with fast-food chains and other restaurants, decided what kids were going to be given with their meals,” Goldstein said. “This gave parents the right to decide.”

And finally, the Davis campaign built a solid foundation for other municipalities to follow.

It started in Davis, California

First 5 Yolo wanted at least one city in Yolo County to adopt an ordinance requiring restaurants to make healthy beverages the default for all kids combo meals. Supported by funding from The California Endowment, the group chose to focus on Davis.

Gallelo and her colleagues approached Mayor Brett Lee to discuss how best to introduce the idea to the city council. They developed educational materials and met individually with council members and key city government staff to explain the proposal and answer questions.

Everyone was on board with the proposal, but they had one concern: Council members did not want to be seen as telling parents what to do. They didn’t want to be accused of promoting a “nanny state.”

Accordingly, the Davis ordinance stipulated that while milk and water would be the default drink offerings for all kids meals, parents could always opt for soda instead. But they had to ask for it specifically.

According to Sabrina Adler, senior attorney and program director at ChangeLab Solutions, that simple provision made a big difference. She noted that ChangeLab Solutions’ original model ordinance for healthy kids meals made parents pay separately for sugary drinks. Using a nudge instead of a push made the Davis ordinance more politically palatable. ChangeLab Solutions subsequently tweaked its model policy on healthy children’s meals to include the approach taken by the Davis ordinance.

First 5 Yolo advocates also reached out repeatedly to restaurants in the community that offered combo meals for kids, requesting their feedback on the proposed ordinance. They barely got a peep.

Six months after First 5 Yolo’s initial meeting with Mayor Lee, the Davis city council unanimously approved the healthy kids meals ordinance.

With funding from the American Heart Association, PHA expanded on the Davis victory by asking other municipalities to consider a healthy kids meals ordinance of their own and rallying the support of local community advocacy groups. A string of successes in California followed: Stockton, Perris, Santa Clara County, Berkeley, Cathedral City, Long Beach, and Daly City.

Going statewide

The healthy kids meals movement had reached a critical point: It was ready to go statewide. A coalition of health and children’s advocacy groups — including the California Black Health Network, the Latino Coalition for a Healthy California, MomsRising, and the California State Alliance of YMCAs — all came out in support of a state law on healthy kids meals.

“The kids meal bill seemed like a really sensible thing for us to support because it focused on children and families and recognized the reality that many families these days eat out more often than they dine in,” said Kris Lev-Twombly, executive director of the California State Alliance of YMCAs. “It seemed like the right thing to do.”

In addition, Adler noted that healthy kids meals promote health equity, because kids combo meals are offered primarily by fast-food restaurants, which disproportionately market to children in communities of color.

Similar to what happened at the local level, the state proposal attracted virtually no opposition. The bill passed the California legislature by a wide margin, with bipartisan support.

"The more the public learns about the health risks, the more open they are to new solutions."

Since then, momentum for the healthy kids meals movement has grown beyond California. Laws for healthy kids meals have passed in the cities of New York; Baltimore, MD; Wilmington, DE; Louisville, KY; and Philadelphia, PA. The states of Hawaii and Delaware have laws for healthy kids meals on the books, and the District of Columbia, Vermont, New Hampshire, and Rhode Island have explored similar proposals.

Will the success of laws for healthy kids meals in California help pave the way for other efforts to push back against the beverage industry, like a statewide sugary drink tax?

Monning said it’s too soon to tell: “Just as we’re trying to create habits of reduced soda consumption, the soda industry is trying to create habits of consumption.” He added that continued public education will be critical not only to passing future legislation but also to changing social norms and individual behaviors.

Flojaune Cofer, PHA’s senior director of policy, who helped lead the state campaign, expressed optimism that eventually concerns for public health will prevail. “The more the public has learned about the health risks of developing obesity and diabetes, the more open people’s minds are to new solutions,” she said. See ChangeLab Solutions’ model policies on healthy children’s meals, or contact us to learn more.

10/21/19