Unequal implementation of the “Escuela y Salud” regulations: A study of 3 middle-school cafeterias (in upper-, middle-, and low-income colonias) and community response in Sinaloa, Mexico

Background: Mexico ranks highest globally in incidence of childhood obesity. In Jan 2011 the Mexican government initiated new regulations to limit the sale of high-calorie snacks and drinks and promote healthier options in school canteens. Implementation of the new policies is limited by competing interests, including local organizational policies and practices. Purpose: This study examines the varied implementation of and reactions to the new regulations in 3 middle-school cafeterias in upper-, middle-, and low-income colonias in the Mazatlan metropolitan area. Methods: Site visits to the schools and interviews with cafeteria workers were conducted to study the various phases of reform (or lack thereof). Interviews were conducted with students, parents, local businesspeople, and authorities involved in implementation to examine facilitating and impeding influences. Conclusions/Discussion: The upper-income school has completed implementation of the reforms, the middle-income school is undergoing the first phases, and the lower-income school has not initiated any steps. Support from families and other stakeholders varies distinctly among the schools. The upper-income community strongly supports the changes; the low-income community is more ambivalent. The upper-income school relies less on the income generated by the school cafeteria and has fewer parties seeking a “cut” from its profits; in the other schools there are more parties seeking a portion of the income from cafeteria sales and thus resist changes that may reduce canteen profits. Policy Recommendations include initiatives requiring transparency in canteen financial accounting, incentives for completing and maintaining the reforms, and nutrition education programs that target students, parents and teachers.