Description and assessment of main policies and programmes in place in the member states and recommendations for improvements

• Author: Hunt, Paula Frederica
• Pages: 29-50

Target Group Discussion Paper Children with disabilities

29

Description and assessment of main policies and

programmes in place in the Member States and

recommendations for improvements

For the remainder of this section, and as needed for context, an overview of policies that

cover all children will be provided (mainstream poli cies), to underpin or highlight the lack

of policies ai med at children with disabilities. While this report is meant to be focused on

children with disabilities, it is important to note that, in many cases, the argument for

better policies for children with disabilities cannot be made without maki ng the argument

for better policies for all children (twin-track).

4.1 Description and assessment of main policies to ensure adequate

nutrition and recommendations for improvements

While a l ot of i nformation exists (globally and in the EU specifically) about adequate

nutrition for the general population including children, few pieces of legisl ation could be

found. The detailed review of the Country Reports shows that most countries indicate a

lack of adequate policies related to children, and even fewer related to the TGs. In some

cases, policies exist that have not been evaluated for impact.

According to Country Reports, there are a variety of policies which potentially have an

impact on children’s nutrition. As detailed in Bradshaw & R ees (2019), these are policies

that:

1) refer to the extent to which families with children have sufficient means to ensure

health nutrition for children;

2) mitigate inadequate income and prevent child mal nutrition (health checks, school

meals, etc.);

3) encourage breastfeeding;

4) promote healthy eating; and

5) ensure the dietary needs of children with disabilities are met.

Overall, Country Reports were mostly silent on mainstream policies related to

breastfeeding and healthy eating (see 3 and 4 above), 2 Country Reports indicated a policy

to ensure sufficient means for health nutrition for children (1 above), while the bulk of the

existing policies address nutrition (including nutrition for specific populations) through

school programmes (2 above).

Policies on nutrition for the mainstream popul ation of children, with the potential to affect

nutrition of children with disabilities, could be found in some Country Reports, as follows:

To ensure sufficient means to ensure health nutrition for children (1 above).

• In Germany, children with special and costly nutritional requirements (due

to illness or disability) can apply for additional benefits, if the household income

is not sufficient to cover the cost and if they receive minimum income benefits.

These require a recommendation by a doctor , and the percentage increase in the

benefit is not defin ed by law but merely recommended (between 10 and 20%,

depending on the condition) (Deutscher Verei n (für öffentliche und private

Fürsorge), 2014).

• In the Czech Republic, supplementary allowances up to the subsistence level are

provided to people who follow a special diet (which may or may not be related

to a disability) based on the recommendation of a doctor (Sirovátka, 2019 ).

To mitigate inadequate income and to prevent child malnutrition (see 2 above).

• In Belgium, primary schools and schools for special secondary education can receive

a subsidy for providing fruit, vegetables and/or milk to their students under the

project ‘Oog Voor Lekkers’ (an eye for a tasteful snack). This project aims to address

all children, but schools with a certain percentage of vulnerable pupils and

special education schools have priority in the selection for participation and

receive the subsidy for an extended period (Oog Voor Lekkers, n.d.).

Target Group Discussion Paper Children with disabilities

30

• In Finland, in ECEC/pre-school settings three meals are provided for free, free meals

are available in basic schools, and highly subsidised ‘student meals’ are available in

the second and third grade, with special dietary needs taken i nto

consideration at all levels.

• In the Netherlands, the current Nati onal Prevention Agreement (2018-2040)

includes, as a specific key activity, the development of a dedicated school

intervention programme for children with special ed ucation needs, to

promote a healthier lifestyle. The Healthy School programme prioritises, in its

funding, seconda ry schools for children with special education needs (van

Waveren, De Vaan, Krop et al., 2018).

• In Slovenia, a free snack and lunch are offered to students w ith special needs

in primary school, and a sna ck in upper secondary school (Zakon o uveljavljanju

pravic iz javnih sredstev, 2010). School meals are subsidised. They are free only

for children from families with a per capita income below a certain income threshold.

• In Sweden schools are obliged to provide a special diet to students with allergies,

celiac disease or other hypersensitivities. Pupils in need of a special diet due to

other conditions may have i ndividually adapted dietary advice from the healthcare

sector, and schools need to engage in dialogue with the caregivers/parents on how

to best accommodate such advice. All school meals are provided for free. Chi ldren

up to age 16 are entitled to receive certain milk, and gluten/soy-free specialty

products on prescription (€12 is charged per prescription) (Nelson, Palme, &

Eneroth, 2019).

To ensure the dietary needs of children with disabilities’ are met (5 above).

• In Bulgaria, policy covers only educational establishments and institutional care –

where children with disabilities’ nutrition is regulated by the Healthy Nutrition

Regulations of the Ministry of Health, but seldom followed (Bogdano v, 2019).

• In Romania, children with ‘special education al requirements’ receive a daily

food allowance up to the age of 26 (if attending any f orm of education). Howev er,

none of the income support is explicitly and transparently bas ed on a nutritional

requirement (Pop, 2019).

• In Slovakia, children with disabilities can apply for an ‘allowance f or

compensation of increased expenditure for special diet’, depending on the heal th

issue (Gerbery, 2019), although the Country Report also recognises that cash

measures do not necessarily indicate policy compliance.

• In Portugal, children with disabilities are entitled to a fully funded lunch at their

school canteen (Perista, 2019).

There are no specific policies regarding the nutrition of children with disabilities in the

remaining Country Reports, and no litigation related to nutrition could be found with

regards to children with disabilities in the EU.

As reported by Bradsha w and Rees (2019), in most cases the de scribed benefit systems

do not address the additional costs associated with providing adequate nutrition to children

with disabilities with dietary ne eds whi ch, as mentioned, ‘was identified as an additional

risk factor for household poverty’ (p.15) in some countries. In addition, ‘there was a l ack

of broader adaptation of systems and services for disabled children with specific nutritional

needs. This included availability of qual ity food; information and trai ning for professionals

and parents; and lack of recognition of sp ecific needs of this group of children in national

nutritional policies and guidelines.’ (p.15).

In addition, the analysis indicates that mainstream instruments related to nutrition

do not sufficiently address the specific needs of children in general, or the needs of

children with disabilities in particular. First, despi te ample research on the positive impact

of breastfeeding on child development and the need to promote healthy eating, no Country

Report indicates this to be considered at the policy level. Second, following up on the

obvious links between disability and poverty made in this and other reports, it is concerning