Abstract
Background: Healthy Start is a food assistance programme in the United Kingdom (UK) which aims to provide a nutritional safety-net and enable low-income families on welfare benefits to access a healthier diet through the provision of food vouchers. Healthy Start was launched in 2006 but remains under-evaluated. This study aims to determine whether participation in the Healthy Start scheme is associated with differences in food expenditure in a nationally representative sample of households in the UK. Methods: Cross-sectional analyses of the Living Costs and Food Survey dataset (2010–2017). All households with a child (0–3 years) or pregnant woman were included in the analysis (n = 4869). Multivariable quantile regression compared the expenditure and quantity of fruit and vegetables (FV), infant formula and total food purchases. Four exposure groups were defined based on eligibility, participation and income (Healthy Start Participating, Eligible Non-participating, Nearly Eligible low-income and Ineligible high-income households). Results: Of 876 eligible households, 54% participated in Healthy Start. No statistically significant differences were found in FV or total food purchases between participating and eligible non-participating households, but infant formula purchases were lower in Healthy Start participating households. Ineligible higher-income households had higher purchases of FV. Conclusion: This study did not find evidence of an association between Healthy Start participation and FV expenditure. Moreover, inequalities in FV purchasing persist in the UK. Higher participation and increased voucher value may help to improve programme performance and counteract the harmful effects of poverty on diet.
| Original language | English |
|---|---|
| Article number | 2220 |
| Journal | BMC Public Health |
| Volume | 21 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 17 Dec 2021 |
Bibliographical note
Funding Information:This study was novel in its ability to characterise Healthy Start Participants compared to Eligible Non-participants. We found that households with pregnant women were less likely to participate in the Healthy Start scheme. This is supported by qualitative research reporting poor awareness of the scheme amongst pregnant women []. A reliance on health professionals to promote the scheme has meant eligible pregnant women frequently learnt of the programme after birth. There have been no national-level campaigns to improve awareness, with local efforts targeting the eligible population. Improving universal awareness of the scheme has been suggested as a way of increasing uptake []. Moreover, the requirement for a health professional’s signature was removed in April 2020 and the scheme is being digitised throughout 2021, which may help to improve future uptake of the scheme.
Funding Information:
The NIHR School for Public Health Research is a partnership between the Universities of Sheffield; Bristol; Cambridge; Imperial College London; and University College London; The London School for Hygiene and Tropical Medicine (LSHTM); LiLaC ? a collaboration between the Universities of Liverpool and Lancaster; and Fuse - The Centre for Translational Research in Public Health a collaboration between Newcastle, Durham, Northumbria, Sunderland and Teesside Universities.
Publisher Copyright:
© 2021, The Author(s).