The development of a public health economics model to evaluate UK school-based feeding interventions: conceptual modelling of household food insecurity and child health

In the UK, household food insecurity (HFI) is disproportionately prevalent in families with children and can have detrimental effects for child health. Thus, a strong case exists for considering HFI as a public health concern. School-based feeding interventions may be introduced as public health interventions that mitigate the harmful impacts of HFI on child health. The objective of this thesis was to develop a conceptual framework of HFI and child health as an early step for developing a future public health economics model, that will be used to evaluate school-based feeding interventions for their impacts on health.

A rapid literature review (Chapter 2) summarised the mechanisms by which HFI is related to poor child health and a second rapid literature review (Chapter 3) summarised the effectiveness and cost-effectiveness of UK school-based feeding interventions for impacts on HFI-related child health. HFI was related to a plethora of child health outcomes via two key pathways (diet and mental health), with parent mental health playing a mediatory role. School-based feeding interventions had the potential to improve HFI, child diet, behaviour and relieve parents’ financial pressures. A problem-based conceptual model of HFI and child health was informed by consolidating the results of these reviews, stakeholder expert opinion and further pragmatic reviews (Chapter 4). Based on this problem-based conceptual model a design-based conceptual model (encompassing child diet, behaviour and parent mental health) was developed and Born in Bradford data identified to quantify the relationships within this model structure (Chapter 5). HFI was not associated with child diet quality (Chapter 6) and was indirectly associated with child behavioural difficulties via parent mental health (Chapter 7). Results of this thesis encourage further investigations in this research for the interest of designing a health economics model of HFI and child health and suggest improvements in methodologies (Chapter 8).