6.1. The main purpose of this evidence review was to examine whether and how the Healthy Start Scheme meets its aims and how effective it is in meeting needs of low-income families. To achieve this, a significant number of medical and social literature databases were searched and relevant evidence was identified and evaluated. Yet, rather scarce literature on the Healthy Start scheme that has been produced mostly in England, serves only to limit our knowledge and understanding of its role in improving health outcomes, diets and nutrition of low-income mothers and young children in Scotland.
6.2. On the one hand, undeniably the Healthy Start scheme at least to some extent works as a nutritional and financial safety net for some low income families. On the other, it is argued that the Healthy Start scheme itself, even when combined with a range of public health policies and initiatives, remains "insufficient to outweigh the negative effects of poverty on nutrition" or to provide adequate support for low-income mothers and young children in achieving healthy diets (Attree, 2006:75). Certainly, however this evidence review supports the claim that the initiatives such as the Healthy Start Scheme are useful and needed as they provide low-income families with some level of nutrition and food security (Lucas et al., 2015). Nevertheless, in order to work more effectively and to meet its strategic aims and its users' needs, a number of barriers and limitations to awareness of, availability of and access to the scheme should be addressed and overcome.
6.3. In particular, the Healthy Start Vitamins remain rather a 'missed opportunity' due to a very low uptake of the vitamin supplements and consequently - an increased risk of birth defects and negative health outcomes associated with certain vitamin-insufficiency before and during pregnancy and early years (McFadden et al., 2015). Universal provision of the Healthy Start vitamins to all women planning pregnancy, pregnant and breastfeeding women and young children, fortifying foods with vitamin D and folic acid, national and local-level activities promoting the importance of supplements serve as examples of actions that can be taken by Department of Health, local authorities and a range of public and third sector organizations (NICE, 2014; McFadden et al., 2013; Scottish Government, 2015b). Further research is needed whether, and how, it would be possible to implement the universal provision of vitamins, especially in relation to costs of such provision, types of distribution routes that may be adopted and how to successfully target women planning pregnancy (NICE, 2015).
6.4. Finally, this review offers a broader perspective on the role of the state on how to more effectively support low-income families in making healthier dietary choices as well as to reduce barriers to making such choices. In particular, it argues that poor diets, nutrition and dietary choices are adversely linked with high levels of poverty and deprivation (Attree, 2006; Khanom et al., 2015). For this reason, interventions that recognize negative impact of broader structural inequalities and environmental factors at nutrition, diets and dietary patterns should be considered to be implemented at both - local/community and national levels, alongside the Welfare Foods policy in Scotland (Attree, 2006; Khanom et al., 2015).
Email: Odette Burgess