Dr. Anisha Patel is an Assistant Professor in the Division of General Pediatrics at UCSF. She provides primary and acute care to pediatric patients at the UCSF Benioff Children’s Hospital.
Dr. Patel’s main research interests are childhood obesity prevention and access to clean drinking water in schools and child care settings. Her publications are widely recognized and have influenced state and federal legislation that require schools to offer free drinking water to students in places where meals are served and/or eaten.
Dr. Patel made a powerful presentation at our 2016 SSEW Symposium: Interventions to curb obesity in children. In our Q & A below, we asked her questions on the importance of clean water accessibility for children and its link to childhood obesity.
SSEW: The issue of water accessibility for children has been gaining a lot of attention. Why do you think it is now more important than ever to work towards clean water accessibility in schools? Does this question tie in to the fight against childhood obesity?
Dr. Patel: For over a decade, policies have restricted students’ access to sugary drinks in schools. While these policies have helped to curb students’ consumption of sugary drinks, effects have been limited. Students can still bring in sugary drinks from home or from corner markets they visit on the way to school. And when students want to make a healthier choice, safe and appealing drinking water may not be available in schools. A limited set of studies in school settings, including our own, suggests that increasing access to appealing, free, and safe drinking water may hold promise in reducing SSB [soda and sugary beverages] intake and obesity.
SSEW: What do you see as some of the current, most important gaps in school programs in terms of water accessibility?
Dr. Patel: In 2010, the U.S. Healthy Hunger-Free Kids Act required schools participating in federal meal programs to offer free water where meals are served. Although this was a great action toward ensuring that students have water to drink with meals, the law has not sufficiently increased the intake of water in schools. Currently, most schools comply by providing a single fountain for hundreds of students and, in our studies, only 2-11% of students drink from traditional fountains in schools. Concerns about the safety and palatability of water from fountains are inhibiting factors, along with poor maintenance and inadequate access. Providing more appealing water sources, along with cups and reusable water bottles -- not only in the cafeteria but in other key locations of the school -- may help to increase water intake.
SSEW: In your presentation at the last SSEW Symposium, you mentioned that groups with the lowest tap water intake are Latinos and African Americans. Why do you think this disparity exists? What can be done to change that disparity?
Dr. Patel: Latino and African American populations have one-third the odds of drinking tap water compared to other racial/ethnic groups. This is important because these populations are using resources to pay for bottled water which often does lack fluoride that helps protect teeth from cavities. Recent revelations about lead in the tap water in Flint, Michigan highlighted disparities in access to safe tap water in America. Although tap water is free of regulated contaminants when it leaves the treatment plant, lead can enter water on its path from the plant to older buildings through lead-laced plumbing, fixtures, or solder. In some communities, nitrate, arsenic or hexavalent chromium in tap water are also concerns. And even when tap water is safe, low-income minority residents may not trust tap water supplies because they disproportionately bear the burden of contaminants in their water. In order to reduce racial/ethnic disparities in tap water intake, it is not only important to improve community-wide access to safe and appealing tap water but to also promote its consumption. For water promotion to be effective it must not only address the benefits of drinking water but also emphasize the reasons why minorities avoid tap water, including lack of access, perceived inconvenience, and concerns about contaminants.
SSEW: The State Water Resources Control Board recently announced voluntary, free lead testing of drinking water in schools until November 2019. Apart from this great initiative, what do you think schools with small budgets could do to promote clean water intake?
Dr. Patel: The State Water Board announcement is a great step toward ensuring that students and staff have access to safe water in school settings. Through California Senate Bill 828, the State Water Board will make 9.5 million dollars in grants to schools to improve access to high quality drinking water in public schools. Funds can be used to offset costs of water bottle filling stations and filtration for schools that have drinking water with contaminants. http://www.waterboards.ca.gov/water_issues/programs/grants_loans/schools/
Even if schools are ineligible for these opportunities, providing safe drinking water programs in schools is not costly. In our previous studies, we were able to provide safe water dispensers and cups in school cafeterias at a cost of 4 cents per student per day. For more information about starting water programs at local schools in your community check out the Parents Making Waves toolkit. It’s available in Spanish and English. http://waterinschools.org/parents-making-waves/.
SSEW: How do you think the soda tax that is being implemented on sugary beverage distributors starting January 1, 2018 in San Francisco will affect schools?
Dr. Patel: Policies have restricted students’ access to SSBs in schools with mixed effects on at-school SSB intake and no reduction in overall consumption. The limited impact of these policies may be due in part to students’ consumption of sugary drinks that are brought from home or purchased on the way to school. Local soda taxes could help augment school-based policies by limiting students’ consumption of sugary drinks they bring from home or purchase from corner stores near schools.
SSEW: Moving forward, what kind of measures would you like to see in schools and in the city in an effort to fight child obesity?
Dr. Patel: While there are numerous programs and policies to promote nutrition and physical activity among children in schools, it is important to expand these efforts to include all of the settings where children learn, play, and live (such as child care, parks, afterschool programs, and homes).