September 12th, 2007

Is this the worst policy announcement ever?

There seems to be a plan to give pregnant women £200 and training in nutrition – it will be a ‘Health in Pregnancy Grant’ [Pregnant women to get healthy food grant – Telegraph] [BBC]. Despite the recently announced end of spin, this was spun in the media several days before its real announcement, in a speech by the Health Secretary. By the time of the speech, the payment was less precise – it would be “substantial” and “sufficient to help every mother eat healthily during her pregnancy“. Perhaps some sums have been done…

I don’t doubt that it would be good to improve diet and nutrition – and we should be worried about the rise of the tubby tots see chart [data from Dept Health]. There are also marked social class differences in child nutrition and prevalence of low-birthweight babies – see ONS The Health of Children and Young People Surveychapter 3 on nutrition.

But it is one thing to recognise a problem but quite another to find a policy that will actually address it. And I think this announcement is just about the worst policy I can think of.

Let’s set out some of the doubts one might have…

1. Untargeted – there is a huge ‘dead-weight loss’ as payments are made to all women, including many that don’t need the advice or don’t need the money. Who are the target group? Why aren’t they targeted? If there is less than 100% uptake, will those not taking it be disproportionately part of the target group?

2. Wasteful – a high likelihood the £200 will be spent on anything but the intended outcome thus wasting money – there is no evidence that apples, broccoli and oat bran are the marginal purchase for poor families. Frankly, if I was a pregnant women I’d be taking a well-earned lunch at Quirinale. Why do they think the money will have the desired effect?

3. Expensive – I’ll guess about £130m assuming England and Wales (based on about 640,000 births per year) for the payments and provision of ‘nutritional advice’. God knows how much for administrating it, preventing fraud etc. Even for the NHS, that’s a substantial sum. About half the additional funding the government is making available for new flood protection by 2010-11 (£200m).

4. No evidence – I couldn’t see anything links the intervention with the hoped-for outcome … and to be honest it seems unlikely and hangs on the value of the nutritional advice. What’s the evidence that nutritional advice interventions change diets? How intensive does the intervention need to be? Does it make a difference if the person opts in voluntarily or attends under semi-coercive conditions to receive a payment?

5. Untried – there’s no sign that a pilot has been run – if there had it would have been part of the announcement. I’ve the evidence of my own eyes in seeing ‘Healthy Start‘ vouchers exchanged for sweets and Coke in my local shop. Welcome to the graveyard of good intentions. Why can’t they just try it and learn some lesson before they waste taxpayers’ money?

6. Uncontested – There’s no obvious consideration of opportunity costs or alternatives – what about strengthening supply side by improving the services available? Is pregnancy the best time for the intervention? Would a community-based intervention work better – eg. running an aerobics class with a wider focus on healthy living etc etc…

7. Unfocussed – What about bigger interventions aimed at fewer people? There’s no recognition of the benefits of concentration – if, say, one-third are in the target group(the chav mums?), wouldn’t a targeted £600 intervention work better that a £200 general intervention?

8. Implausible – I’ve yet to see what the training would amount to, but I’ll be surprised if a lecture works – I suspect the problem is a skills deficit and confidence in cooking fresh food – linked with time poverty. Also, assuming one person can run 300 training session per year and there is a single training session per woman, that would require a workforce of about 2,000. Where are they?

9. Prudence – the old girl has had a quite torrid experience with this one. Where is the control and checks an balances on such poor policy-making? What is this government in a ‘tight fiscal situation’ doing? I hope the NAO and select committees are all over this.

Apart from that, it’s a great idea. Nominations please, for a worse policy? Poll tax excepted.

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