Developing an area (street) based cash transfer scheme to promote healthy eating communities in areas of high deprivation (the FRESH Street Project)

Throughout our lives, what and how we eat affects our bodies, our health, our relationships with others, as well as our communities and our environment.

Many communities in the UK are in food poverty, i.e. "the inability to afford, or have access to, food to make up a healthy diet", with diets high in processed foods and low in fresh fruit and vegetables. Those on low incomes are more likely to have higher consumption of sugar and saturated fatty acids, and lower fruit and vegetable intake than is recommended.

We do know that it is acceptable to offer fresh fruit and vegetable vouchers to families in receipt of income support (Healthy Start), and that this helps families eat more fruit and vegetables. We also know that it is possible to give vouchers for fresh fruit and vegetables supplied by local market stalls and box schemes to vulnerable families in receipt of the government's 'Healthy Start' vouchers.

However, the decisions that people (individuals and families) make about food are not made in isolation. These decisions are very influenced by what is easily available and by how others are buying, preparing and eating their food.

What we do NOT know is what would happen if we offered everyone in one area (i.e. streets) fresh fruit and vegetable vouchers supplied by local markets and box schemes. Nor do we know this voucher scheme would look like, e.g. how much would the vouchers be worth? where would they be exchangeable? and how would the voucher scheme link with all the many groups and organisations interested in, or affected by how and what people eat?

The purpose of this project is to develop a community based fresh fruit and vegetable voucher scheme. The scheme will help people eat more fresh fruit and vegetable from local suppliers, increase how often people prepare and eat food together in the home, and reduce the amount of processed food they eat.

If the voucher scheme is successful then it will help improve the quantity and range of fruit and vegetables in family diets, encourage new patterns in how food is purchased, prepared and eaten. In the longer term the scheme has the potential to reduce food poverty and improve the health of individuals, communities and make stronger and more sustainable local food systems.

The setting for this early phase study is Dearne in Barnsley in South Yorkshire, an ex-mining area in the north of England with high levels of deprivation, poor health and poor dietary practice. Barnsley Metropolitan Borough Council have identified low fresh fruit and vegetable intake as a key risk factor contributing to deaths in Barnsley.

The researcher team (based at the University of Sheffield) will work with people in the local area and the project partners 1) Barnsley Metropolitan Borough Council and 2) the Alexander Rose Charity. Together we will develop (and then test) a fresh fruit and vegetable scheme for Dearne.

This project will begin by interviewing local people in order to understand how the scheme will link to local organisations and groups. The research team will work with key community stakeholders to co-design the scheme - how much the vouchers are for, how people will access the fresh fruit and vegetables, whether the vouchers should be conditional (or not) on healthy eating social behaviours (preparing and eating food together in the home), etc. When the scheme is developed, it will then have a short test in 2 - 4 streets in North and South Dearne in order to assess how people respond to the scheme. The researchers will then discuss the results with key people living and/or working in the local community, and decide whether the scheme should be tested further.

The results of the project will then be shared with local people, and all those interested in food poverty, and ill health that is related to diet (charities, third sector organisations, local authorities and national government and the media).

This project addresses an issue of major strategic public health importance - how to create sustainable and healthy diets, eating behaviours and food systems in areas of high deprivation.
Many communities in the UK are in food poverty "the inability to afford, or have access to, food to make up a healthy diet" (DH 2005), with diets high in processed foods and low in fresh fruit and vegetables. Moreover, social eating patterns have changed with food often consumed in a rush, alone and while multi-tasking. The combination of what we eat and how we eat often leads to poor long term health including type 2 diabetes and obesity.

The intervention to be developed in this project takes into account the fact that decisions about food are complex and not made in social isolation. The intervention (and the project) engages with this complexity, and as such is seeking to change social practices of eating and diet by helping alter the contexts and recognise the constraints on decision making. This public health intervention is seeking to achieve positive long term change at multiple levels of the socio-ecological model (Whitehead & Dahlgren, 1991).

This public health intervention is a health behaviour change financial incentive voucher scheme for specific areas with high deprivation levels and low fruit and vegetable and high processed food consumption.
The voucher scheme to be developed will be product specific (fresh fruit and vegetable) and supplier specific (local fresh fruit and vegetable market stalls and shops and fruit and vegetable delivery schemes e.g. box schemes), and delivered to all children and adults in the target communities (streets). In order to be sustainable in the long term the voucher scheme will need to be embedded within local communities, and multiple various organisations and infrastructures which provide services relating to the food system and healthy eating (education, production, preparation, consumption, waste management.)

This research has the potential to impact local communities (target streets) and those associated with services to these communities (key stakeholders will be invited to join the project steering group at the start of the project).

The research will enable charities, third sector organisations, local authority public health and social exclusion teams as well as national government to acquire greater understanding of the ways to address poverty associated issues of diet related public health.

The research will have an impact in healthcare disciplines, public health nutrition, healthy eating programmes, health related behaviour change, healthy food systems and sustainable food economies. Beyond these, the research speaks to current debates in food poverty related research being studied by sociologists, anthropologists, economists, political scientists, psychologists, urban planners and geographers.

Academic publication of findings will target the following journals: Journal of Public Health, Social Science and Medicine, Food Culture and Society. We will also use research blog posts and outlets such as The Conversation and the Discovery Society blog and the Food Research Collaboration website which all reach wide audiences.

We anticipate media interest at a local and national level due to the innovative nature of the intervention. We will also produce a briefing to be disseminated through local authority public health networks, the DH Healthy Start policy leads in England, Scotland Wales and N Ireland and the UK Behavioural Insights team.