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As the parent of a newborn and a 4-year-old, I want to believe that my daughters will have healthy environments at home and at school. But as a pediatrician and a researcher for the University of California, San Francisco, I know that many U.S. children may face unhealthy nutrition environments in child-care facilities and schools, and may even lack an essential nutrient that most of us take for granted – water that is safe to drink.

Studies suggest that children do not drink enough plain water and instead drink sugar-sweetened beverages that can lead to serious and costly health issues including obesity, tooth decay, and even decreased cognitive function.

As a parent I can take steps to make sure my daughters get enough clean water to drink at home. But when they enter child care and kindergarten, will I and millions of other parents across the United States know if they are getting enough free clean water to drink in these out-of-home settings?

In a paper just published in the American Journal of Public Health, my colleague Karla Hampton, J.D., an attorney at Public Health Law & Policy in Oakland, Calif., and I have identified serious and costly barriers that schools face in providing children plenty of clean, good-tasting water.

That report, which was funded in part by the Robert Wood Johnson Foundation through its Healthy Eating Research program, also outlines a series of action steps that schools, child-care facilities, and even parents can take to increase access to clean drinking water in public schools and child-care centers.

According to a 2010 study, most young people in the United States drink far less water than recommended for optimal health. Among teenagers, plain drinking water accounted for only 33 percent of total water consumption, and the remaining intake consisted of sugary drinks, such as sodas, sports drinks or juice-blends.

The U.S. Congress, as part of the Healthy, Hunger-Free Kids Act of 2010, decided to address inadequate water consumption—at least during the school day. The law requires schools that participate in federal meal programs to provide children with plenty of clean water during meal time—at no cost to students. The law also states that child-care facilities should make water available to children throughout the day, including at mealtimes.

Even mild dehydration can lead to fatigue, headaches and poor performance in school. And kids who drink too much soda and other sugar-sweetened beverages may be more likely to suffer from unhealthy weight gain, obesity and a raft of serious health problems that go along with excess weight gain like early-onset diabetes.

But the study we just published suggests many schools in the United States will face great expense or have difficulty complying with the law.

For example, nearly three-quarters of all schools in the United States were built before 1969, and many have costly infrastructure problems, like deteriorating pipes or plumbing fixtures. In many cases, old pipes allow the toxic metal lead to leach into the water. And often, schools with budget problems cannot afford the plumbing repairs to simply turn on the taps to provide children with clean water.

Other barriers to providing children with enough clean water during the day include:

  • Drinking fountains in poor repair that dispense bad-tasting, foul-smelling or unsafe water.
  • Vending machines or school lunch lines that provide sugar-sweetened beverages that compete with plain water; schools fear they may lose revenues if they ban sodas from vending machines.
  • School policies that restrict access to drinking fountains or other sources of clean water during the day.

What can be done? The paper also offers some solutions for schools faced with these common challenges.

For example, schools can improve the quality of tap water by first testing the water for contaminants. If high levels of lead or other toxins are found, schools must pay for repairs that would fix the problem and then provide students with access to the chilled, clean water.

Many schools cannot afford expensive plumbing repairs or the testing to find out if the water is safe. However the research revealed a number of lower-cost solutions for schools struggling with budget problems.

For example, schools in Utah partnered with a company to provide filters that cleaned the water dispensed by drinking fountains. The company keeps the filters in good repair and the school allows children better access to the clean water during the day.

For schools that lack resources to install new drinking water infrastructure, a temporary solution could be to provide students with free bottled water. Some schools may find that this alternative is less costly than testing water quality and making corrections.

One cheap solution for schools that have long lines at the drinking fountains: They put out large dispensers in the cafeteria filled with clean, chilled water and provide the cups so students can drink their fill.

Some schools, like a school district in Mississippi, have lifted policies that restrict access to water in the classroom, allowing students to drink water throughout the day.

Parents also have gotten into the action. In Oakland, Calif., parents raised funds so that the schools could improve access to drinking water at school.

But the truth is that schools, and parents, must start taking action today or many children in the United States will continue to go through the school day without getting enough clean water to stay healthy.

That is an outcome that we simply cannot afford—as a nation or as individual parents.

Anisha Patel, M.D., M.S.P.H., M.S.H.S., is with the Department of Pediatrics, University of California, San Francisco and the Philip R. Lee Institute for Health Policy Studies in San Francisco.

Karla Hampton, J.D., is an attorney with Public Health Law Policy in Oakland, Calif.

Healthy Eating Research is a national program of the Robert Wood Johnson Foundation. The program supports research on environmental and policy strategies to promote healthier eating among children to prevent childhood obesity, especially among lower-income and racial and ethnic populations at highest risk for obesity. For more information,


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