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Food welfare for low-income women and children in the UK: a policy analysis of the Healthy Start scheme

Machell, G. (2014). Food welfare for low-income women and children in the UK: a policy analysis of the Healthy Start scheme. (Unpublished Doctoral thesis, City university London)


Food welfare for low-income women and children in the UK is an unexplored area of food policy. The current food welfare scheme for low-income women and children in the UK is called Healthy Start, and this replaced the previous Welfare Food Scheme in 2006. The main changes were that Healthy Start was intended to be more health focussed and aimed to influence behaviour change by providing a voucher that could be spent on fresh (and later frozen) fruits and vegetables, milk or infant formula. The previous scheme only provided milk and infant formula. In addition it was intended that there would be more interaction with health professionals as part of the scheme. Little is known about why the Welfare Food Scheme changed to Healthy Start and what influenced the initiation, formation and implementation of Healthy Start. Nor is there substantial information on how Healthy Start operates in practice. The objectives of this thesis were to consider what influenced the development of Healthy Start and to consider how Healthy Start as a policy relates to Healthy Start in practice.

After mapping how Healthy Start was developed, what is known about the scheme, undertaking a literature review on subject specific literature, research questions were developed to direct the line of inquiry. A theoretical literature review explored methods of policy analysis that could inform the overarching methodology. Models of policy analysis and literature on the policy process were developed to better understand the policy process that informed Healthy Start.

To address the research questions, three phases of research were undertaken. The first was a policy analysis of publically available policy documents using Kingdon’s concept of policy streams to make sense of the process; the second was a series of semi-structured interviews with policy participants to add detail to the first phase. A recurring issue was the role of the Health Professional in delivering Healthy Start, and a case study with health professionals who deliver Healthy Start in one Borough of London was developed to further explore this issue.

The findings indicate that the shift from the Welfare Food Scheme to Healthy Start was largely influenced by political factors, with inadequate consideration of public health objectives and practical components of behaviour change. A lack of training and support for health professionals who are gatekeepers of the scheme was apparent at all points of the policy process. By tracking the development of the Healthy Start scheme and its place within food welfare this research highlights the need for more thorough consultation and thoughtful development if complex schemes crossing welfare and food policy are to be successful.

Publication Type: Thesis (Doctoral)
Subjects: H Social Sciences > HQ The family. Marriage. Woman
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Departments: Doctoral Theses
School of Health & Psychological Sciences > School of Health & Psychological Sciences Doctoral Theses
School of Health & Psychological Sciences > Healthcare Services Research & Management
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