STUDY: Cost-Effectiveness of Water Promotion Strategies in Schools

A new study from the CHOICES Project at the Harvard T. H. Chan School of Public Health found that installing chilled water dispensers on school lunch lines could be a relatively low-cost strategy to help children drink more water and prevent future cases of childhood obesity.

Increasing access to and promotion of drinking water in schools could help improve child health in a number of ways, including better hydration, improved cognition, and healthier teeth, if the water is fluoridated. However, there is limited evidence on how promoting water in schools could reduce childhood obesity and the costs of strategies that could facilitate such promotion.

The authors of this study sought to estimate the cost-effectiveness of installing chilled water dispensers (known as “water jets”) on school lunch lines and how it could impact childhood obesity. In addition, they compared key findings about water jets with three other national water promotion strategies to understand the costs of different approaches and their impacts on water consumption. The team selected the three other strategies because of existing evidence linking them to increased water intake.

To facilitate this study, the team used the CHOICES microsimulation model to estimate over a ten-year time frame the impact of each of the four strategies on children in kindergarten through eighth grade attending schools that participate in the National School Lunch Program (NSLP). The team analyzed all four strategies – Grab a Cup, Fill it Up, portable water dispensers, bottle-less water coolers, and water jets – to assess their cost-effectiveness and impact on water intake. They also estimated how water jets could impact the number of cases of childhood obesity in 2025.

Key findings from the study included:

  • Water jets would cost $4.25 per child in the first year
  • Water jets could prevent nearly 180,000 cases of childhood obesity in the year 2025
  • Over ten years, water jets could save nearly $390 million in health care costs nationally
  • In the first year, children reached by water jets would increase their water intake by 1.43 ounces per day
  • While Grab a Cup, Fill it Up was the least costly – totaling about $122 million in costs over 10 years – it also had the lowest impact on water intake

Making water jets available for students on school lunch lines could save almost half of the money required to install these dispensers, and could positively impact child health. Interventions that promote drinking water are lower-cost solutions to consider adding to the toolkit of public health school-based strategies to reduce obesity risk.

Kenney EL, Cradock AL, Long MW, Barrett JL, Giles CM, Ward ZJ, Gortmaker SL. Cost-effectiveness of water promotion strategies in schools for preventing childhood obesity and increasing water intake. Obesity. 2019;27(12):2037-2045. doi:10.1002/oby.22615.

Address correspondence to Erica Kenney, ScD, MPH at