Is School Milk Dietary Racism?
Is School Milk Dietary Racism?
Because 65% of the world can't digest lactose like Northern Europeans can.
In August, a group of 28 civil rights, animal rights, and health care organizations announced they had sent a letter1 to the USDA Equity Commission, asking the commission members to consider an injustice inherent to the National School Lunch Program: making cow’s milk the default beverage with school meals2, when a disproportionate number of children of color are lactose intolerant. The letter calls this requirement "dietary racism."
When I heard about this, I suddenly had a memory of the day I learned that an estimated 70 to 80 percent of African Americans, Native Americans, and Mexican Americans, and over 90 percent of people of Southeast Asian descent are lactose intolerant.3 In contrast, just five percent of people descended from Northern Europeans have problems digesting lactose. We covered it in my "cultural foods" class, and the statistics were printed in the textbook. I stared at it and raised my hand. "Why do we recommend that everyone drink milk if so many people are lactose intolerant?" I asked.
I should point out I was not an explicitly antiracist dietitian at this point; I wasn't trying to stir up trouble. I was just your normal, average person wondering why the USDA had created the image of a nutritionally ideal plate that included a glass of milk alongside it, when said milk could cause diarrhea, gas, nausea, pain, and other after effects in 70 to 90 percent of people of color who consumed it.
I also asked it as a person whose Thai-Chinese father was lactose intolerant and whose white, American mother had grown up in Thailand, where no one drank milk, and instead got their calcium from leafy greens, legumes and tofu, fish, and other non-dairy sources. I knew that milk wasn't the only option.
"It's the least expensive way for people to get their calcium," was my professor's answer.
It is true—dairy foods like milk, yogurt, and cheese are high in calcium, and thanks to government support of the dairy industry, relatively affordable. But if the goal is to make sure people consume enough calcium, and the problem is that non-dairy sources of calcium are too expensive, shouldn't the approach be: Let's work to make non-dairy sources of calcium more available, affordable, and understood by the public? Instead the strategy for decades has been to double down on dairy, and just tell lactose intolerant people to take a Lactaid and deal with it.
Whiteness as the Default
If a dietary condition affects only a small number of people in a population (say, five percent), it makes sense to organize the system around the needs of the vast majority of people, and make it the responsibility of those with the condition to request the accommodations they need. From the perspective of those of Northern European descent, the current school milk system makes perfect sense: students who are lactose intolerant can bring in a note from a doctor, and then they are allowed to take a nutritionally equivalent substitute like soy milk in place of cow's milk.
But the ability to digest lactose past infancy is not actually normal; as in, the majority of people worldwide do not have this genetic mutation. In the National School Lunch Program, where Black and brown students are overrepresented, the majority of kids likely do not have this genetic mutation. If we started with the reality of BIPOC students as the default, it would make more sense to offer an equivalent lactose-free drink, and allow students who have the desire and ability to drink cow's milk to opt in to milk.
But instead we begin with the reality of white students as the default, and it is left to the families of lactose intolerant students to have accessible and affordable healthcare, an understanding of the milk exemption policy, and a job that will allow them to take time off during the day to take their child to the doctor for a diagnosis and a note, barriers which disproportionately burden families of color.
The Power of Industry
Schools require milk because the USDA recommends children consume 2½ to 3 cups of dairy daily. In contrast, Harvard's Healthy Eating Plate features a glass of water and says to limit milk and dairy. Why the difference? "The Healthy Eating Plate is based exclusively on the best available science and was not subjected to political or commercial pressures from food industry lobbyists." Damn, shots fired by Harvard School of Public Health!
But it's true the dairy industry has incredible influence over nutrition policy in this country, and works to spread its message on a number of fronts. There are consumer-facing campaigns, such as the large number of billboards I've been seeing around Denver from the "Gonna Need Milk" campaign, promising that milk will help you recover faster, hydrate better, build more muscle, etc., and featuring mostly BIPOC models, which is undoubtedly intentional.
There are efforts targeting dietitians and other professionals who influence food recommendations. Immediately upon joining the Academy of Nutrition and Dietetics, I started receiving promotional mailings from food companies and industry interest groups like the National Dairy Council, offering coupons, free materials for my clients, and free "educational" materials, including webinars and sponsored conference sessions that would earn me continuing education credits (CEUs). The free CEUs are especially appealing to health professionals like dietitians, who need to accumulate them in order to maintain their credentials, and often approved CEUs are expensive. I sat through an "educational" session on chocolate milk for sports recovery at a conference once—and it was reasonably convincing, like a Cutco knife demonstration carried out by an enthusiastic salesperson. But also terrifying, because it didn't seem like many other dietitians in the room saw it for the sales pitch it was.
The dairy industry players also seek public validation through scientific research, which helps bolster their other efforts because they can say "but science!" if anyone questions their claims. As I was researching this topic, I saw some articles in peer-reviewed journals that argued for the need for dairy in order to overcome health disparities, so I decided to investigate further. The one from 2002 was fairly clear in its position; clicking on more information about the author told me they were representing the National Dairy Council. Cool, cool. Seems like they are coming from an unbiased place.
The other, from 2015, is more savvy. The author, a registered dietitian, is listed as a "Nutrition Consultant," but a little Googling reveals that she is also a "Dairy Advocate" for the American Dairy Association Northeast, was a Dannon “Nutrition Advisor,” and has published a number of academic papers and other articles framing the consumption of dairy as an issue of health equity—as in, including more dairy in the diets of Black Americans will help close health equity gaps, because even if one cannot digest lactose, there is always yogurt. What the what? Sure, give me your industry-funded argument about why people of color should drink more milk, but don't tell me it's to help achieve health equity.
There is also a trend in these industry-funded articles to say BIPOC individuals’ "perceived lactose intolerance" (italics mine), subtly but persistently calling into question the legitimacy of their gastric experiences. NOPE, NOT TODAY, DAIRY INDUSTRY.
I'm not trying to call out this individual dietitian, because this is not an individual problem. It is a problem with a system that is working so hard to preserve the interests of an industry in which production is becoming ever more concentrated in the hands of a small number of large, powerful operations, in which most of the labor is done by Latinx immigrants with few, if any, labor protections, and we haven't even had time to get into the animal rights and sustainability impacts of school milk.
I also want to note that this is not meant to be a wholesale indictment of dairy. Giving up dairy because wellness culture has convinced you it is the healthy thing to do, not because it actually makes you sick, is just as silly as thinking that getting people to eat more Dannon yogurt is going to eradicate health disparities. (Okay, fine. I actually think the yogurt thing is sillier.)4
But again, this is about systems, not individuals, and a lot of the nutrition systems and policies in the U.S. were built in a different time, with different goals. Creating a policy that gives every child milk with their meals made a lot of sense when the National School Lunch Program was created in the 1940s. The student population was whiter (and more lactose-tolerant), undernutrition in children was a serious health concern, and small dairy farmers around the country needed the financial support of the federal government.
That's not where we are anymore. That's not who we are anymore. I'll be interested to see if and how the USDA Equity Commission responds to the letter. But given that this person is on the commission, I'm not holding my breath.
The National School Lunch Program provides free or reduced-price lunches to students whose household income is below a certain level. In order for the school to be reimbursed for a NSLP meal, the student needs to take a carton of milk or a medically-authorized substitute.
There is a range of estimates around the prevalence of lactose intolerance in different racial and ethnic groups. Worldwide, approximately 65 percent of adults cannot digest lactose.
For the record, thanks to my mother's genetic mutation, I am not lactose intolerant, and neither are my quarter-Asian kids, and we all consume dairy.
The level of conflict of interest in American Dietetics is off the charts and, as you say, no one seems to bat an eyelid. It's so deeply unethical and yet totally accepted. The milk thing has always seemed totally wild to me too, for all the reasons you give. I've also read that white dietitians played a really enormous role in terms of performing 'experiments' on indigenous children in residential schools to prove that those kiddos 'needed' milk. It's all so vile. Side note: I always thought lactose intolerance in BIPOC folks was due to downregulation? Assuming they were able to digest lactose in breast milk and then lose the ability because they have no dietary exposure. I may be wrong though, and either way your point still stands!
Yessss, I was thinking about this exact same issue in relation to WIC. The monthly allowance for a household of 3 (which can also be 2 + unborn child) is 4.75 gallons -- yes, gallons! -- of milk, with no option for a non-dairy alternative. Initially I only considered my own Ashkenazi gut, and then was like, wait a second -- how many/what proportion of people on WIC can't digest dairy? This makes no sense to anyone except the dairy industry, and is at least a micro-aggression if not full-on racism.