Can food vouchers improve nutrition and reduce health inequalities in low-income mothers and young children: a multi-method evaluation of the experiences of beneficiaries and practitioners of the Healthy Start programme in England

Abstract

BackgroundGood nutrition is important during pregnancy, breastfeeding and early life to optimise the health of women and children. It is difficult for low-income families to prioritise spending on healthy food. Healthy Start is a targeted United Kingdom (UK) food subsidy programme that gives vouchers for fruit, vegetables, milk, and vitamins to low-income families. This paper reports an evaluation of Healthy Start from the perspectives of women and health practitioners.MethodsThe multi-method study conducted in England in 2011/2012 included focus group discussions with 49 health practitioners, an online consultation with 620 health and social care practitioners, service managers, commissioners, and user and advocacy groups, and qualitative participatory workshops with 85 low-income women. Additional focus group discussions and telephone interviews included the views of 25 women who did not speak English and three women from Traveller communities.ResultsWomen reported that Healthy Start vouchers increased the quantity and range of fruit and vegetables they used and improved the quality of family diets, and established good habits for the future. Barriers to registration included complex eligibility criteria, inappropriate targeting of information about the programme by health practitioners and a general low level of awareness among families. Access to the programme was particularly challenging for women who did not speak English, had low literacy levels, were in low paid work or had fluctuating incomes. The potential impact was undermined by the rising price of food relative to voucher value. Access to registered retailers was problematic in rural areas, and there was low registration among smaller shops and market stalls, especially those serving culturally diverse communities.ConclusionsOur evaluation of the Healthy Start programme in England suggests that a food subsidy programme can provide an important nutritional safety net and potentially improve nutrition for pregnant women and young children living on low incomes. Factors that could compromise this impact include erosion of voucher value relative to the rising cost of food, lack of access to registered retailers and barriers to registering for the programme. Addressing these issues could inform the design and implementation of food subsidy programmes in high income countries.

Has the UK Healthy Start voucher scheme been associated with an increased fruit and vegetable intake among target families? Analysis of Health Survey for England data, 2001–2014

“…Women who fed their babies using formula reported spending all or nearly all of their vouchers on formula 10 15 22. There may therefore be differential effects on diets of families purchasing infant formula compared with breastfeeding women, given that formula costs more than the value of vouchers 10. However, restricting the sample to exclude families with children aged under 1 did not change the overall findings: while F&V varied by eligibility and year, there was no significant interaction, indicating that there was not a significantly different rate of change for the HS-eligible group compared with the others.…”

“…A large qualitative study with HS stakeholders reported that HS is perceived to provide a nutritional safety net for low-income families 10. Our study sought to identify any association between the introduction of HS and F&V intake among eligible families compared with that of the control groups, using data from the HSE.…”

Food Banks in Glasgow and Ogoniland: A Cross‐country Comparison

“…The numbers of patients admitted to hospitals for malnutrition rose from 3000 in 2008 to 5500 during 2013(Channel 4 News, 8.12.2013. Families are at risk of malnutrition because they are unable to purchase healthy food items (Maslen, Raffle, Marriot, & Smith, 2013;McFadden et al, 2014;Wickham et al, 2016).…”

“…). Families are at risk of malnutrition because they are unable to purchase healthy food items (Maslen, Raffle, Marriot, & Smith, ; McFadden et al, ; Wickham et al, ).…”

Impact of two policy interventions on dietary diversity in Ecuador

“…In the case of the UK, no conclusive results were found. In some cases changes in consumption or purchasing behaviour were not observed (15) , while in other cases both quantity and variety of food were improved by interventions based on vouchers (16,17) . There are cases in which more than one intervention was tested, usually including nutritional training or advice and the use of vouchers.…”