City Research Online

From Food Welfare to Healthy Start: A Social and Economic Perspective

Egger, Laurie (2021). From Food Welfare to Healthy Start: A Social and Economic Perspective. (Unpublished Doctoral thesis, City, University of London)


Healthy Start is a well-regarded food voucher scheme for young children and pregnant women. Despite its popularity with government and charitable organizations, it only reaches half of those eligible, and food insecurity and health inequalities have worsened since its implementation. The significant and steady decline in uptake has focused civil society and the government on increasing uptake and considering modifications to delivery but not on questioning whether the scheme is the best tool to address poor nutrition in young children.

The social and economic impacts of Healthy Start are under-researched and the focus of this dissertation. This research relies on qualitative interviews with parents of young children, health professionals and regional managers of the scheme, as well as on an economic model that was developed to evaluate the scheme’s cost effectiveness and financial impact.

The findings indicate that the shortcomings of Healthy Start will not be resolved with minor adjustments or more promotion. The policy is based on an inaccurate assessment of the underlying cause for poor nutrition in low-income families. Parents (usually mothers) at all income levels take seriously their responsibility for their family’s nutrition, value healthy food prepared at home, and have a good understanding of the importance of fruit and vegetable consumption. Rather than a lack of knowledge or desire to feed their children healthfully, mothers describe the challenges of limited budgets, the relatively high cost of fruit and vegetables, and the preferences of family members as obstacles to their food provisioning. The restrictions imposed by the Healthy Start voucher reflect and perpetuate the widely accepted perception, among both those that receive benefits and those that do not, that low-income parents lack the knowledge and/or desire to feed their children healthfully. This message reduces participation in Healthy Start as health professionals are less likely to promote the scheme for fear of offending patients and potential recipients are less likely to apply. The vouchers compound the stigma of needs-based welfare undermining personal resilience and contributing to social division.

The findings of this research illuminate the benefits of making the scheme universal for all pregnant women and children under 4 years old, of changing the restrictions on purchasable items, and of increasing the voucher amount. All three changes, or a combination thereof, result in positive economic returns. There is also a significant opportunity to align the policy with other policies and objectives and support local economies, food security, UK farming, and environmental sustainability.

Publication Type: Thesis (Doctoral)
Subjects: H Social Sciences > HM Sociology
Departments: Doctoral Theses
School of Health & Psychological Sciences > School of Health & Psychological Sciences Doctoral Theses
School of Health & Psychological Sciences
Text - Accepted Version
Download (4MB) | Preview



Downloads per month over past year

View more statistics

Actions (login required)

Admin Login Admin Login