The governments of both the United States (US) and the United Kingdom (UK) fund programs with similar objectives to support healthy diets among low-income women and young children. The US has the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) that was established over 40 years ago. The UK has a relatively new model implemented in 2006 called Healthy Start. Both programs provide access to fruit and vegetables through cash value vouchers (CVV). In WIC the CVV can only be used to purchase F&V and is given in addition to other benefits allowing the purchase of prescribed healthy foods that meet the participants’ nutritional needs. In Healthy Start the CVV is the sole source of nutritious supplemental food – the participant chooses whether to spend the CVV on milk, infant formula and/or fruit and vegetables.

A comparison of WIC and Healthy Start was conducted by drawing on evaluation, program and academic literature. The aim of this paper is to consider lessons from WIC, an established program, for the relatively new, Healthy Start. With regard to F&V consumption, the comparison found that nutrition education and dedicated funds for F&V are areas of WIC policy which the UK could explore to strengthen Healthy Start. It is of course important to recognize that WIC and Healthy Start have unique foundations, goals, and social and political contexts that have influenced administrative structures and program delivery. However, the similar objectives to supplement the diets of low-income women, infants and children indicate that there is value in comparing both policies to explore opportunities for learning.

Nutrition education

WIC clients receive group and tailored individual nutrition counseling based on their individual nutrition needs. A nutrition risk assessment is conducted in the WIC clinic. WIC agencies are required to invest in nutrition education for participants and report on the education provided. There is a growing body of literature demonstrating the impact of WIC nutritional education on behavior change.

In Healthy Start, health professionals are encouraged to provide details on how to participate in the program. There is no requirement to provide nutrition education to Healthy Start participants. A recent evaluation of Healthy Start suggests that there is little evidence that health professionals actually provide information or guidance on how to use Healthy Start vouchers to meet the nutritional needs of the individual¹. Qualitative research indicates that this is in part because there is not adequate time to do so and Healthy Start is often delivered as health promotion, as opposed to an intervention with any focus on behavior change.

Dedicated funds for F&V

In WIC, the dedicated CVV specifically for F&V ensures participants always have financial access to F&V. WIC demonstrates how increasing access to fresh and local F&V is a priority – there is the WIC Farmers’ Market Nutrition Program (FMNP) and some Farmers’ Markets will double the value of WIC CVV. This concept is being explored with Healthy Start, but as Healthy Start vouchers are not dedicated funds specifically for F&V, it means a family must choose whether to use their CVV to purchase F&V, milk or infant formula. The most recent UK Infant Feeding Survey found that most families use their Healthy Start vouchers to purchase infant formula².

Impact

The WIC model successfully combines nutrition education with benefits to improve nutritional status and influence health behaviors. Whereas, Healthy Start is challenged by the fact success hinges on individual choice without an individual education component embedded in the program.

Due to the amount of data available through routine monitoring and evaluation, WIC is a highly researched program. There is evidence that demonstrates how WIC successfully supports low-income families to eat more fruit and vegetables, influence positive behavior change and improve nutritional status. Additionally, the data and research on WIC, enables the program to consider how best to meet the needs of the population it serves. Healthy Start is largely under-researched. There is a lack of routine data, therefore making it challenging to accurately access the program’s impact and inform program development.

Conclusion

Both WIC and Healthy Start are valuable programs that should be promoted and protected. Without nutrition education or ring fenced funds specifically for F&V, it can be challenging for families to get the most out of Healthy Start. Healthy Start may benefit by considering concepts from WIC, such as considering how to incorporate nutrition education into policy, dedicate funds specifically for fruit and vegetables and enhance data collection.