Written Evidence Submitted by Professor Charlotte Hardman at University of Liverpool (FWM0097)
Food and Weight Management Inquiry – August 2025
Submission from the SCHOUSE project team
We are delighted to have this opportunity to submit evidence in relation to our new research project, SCHOUSE (Supporting Communities in social Housing and Optimising Urban food System interventions for Equity). SCHOUSE is a 3-year research project led by the University of Liverpool, in collaboration with the University of Cambridge. It is funded by UK Research and Innovation (UKRI) as part of UKRI’s work to create opportunities and improve outcomes.
SCHOUSE will investigate the factors that limit access to fresh healthy foods for people living in social housing in Liverpool (defined here as subsidised housing owned by local government or social organisations and provided to people on low income). The project will then co-design and evaluate two interventions in Liverpool to improve access to affordable fresh produce - (i) a mobile greengrocer van, known as the “Queen of Greens” plus (ii) provision of “Alexandra Rose” vouchers for purchasing fresh fruit and vegetables at the Queen of Greens. Towards the end of the project, we will use public health modelling to predict the health and equity impacts of these interventions if they were implemented more widely.
In this evidence submission we set out the need for this work and how the SCHOUSE project will deliver critical new evidence and robust data to address the following Inquiry questions:
People living with socio-economic disadvantage and food insecurity experience multiple barriers to healthy eating that predominantly relate to the food environment and wider contextual factors (Briazu et al., 2024; Stone et al., 2025). However, most government obesity policies in England have placed high demands on individual agency and behaviour change rather than targeting external influences and upstream drivers (Theis & White, 2021). Such policies are therefore less likely to be effective and will likely further exacerbate dietary inequalities. Engagement with communities and stakeholders is needed to design and tailor interventions that respond to population- and context-specific needs.
The food environment can be conceptualised as a complex adaptive system, comprising interacting factors which together determine the availability, accessibility, acceptability and affordability of a healthy diet (Sawyer et al., 2022). Interventions which aim to improve accessibility and affordability of healthy foods need to take account of factors beyond the physical provision and cost of food, as other issues are likely to limit – or increase - the effectiveness of an intervention within or across population groups. For example, the effect of an intervention which increases physical access to food could be limited if individuals are less likely to purchase foods that are unfamiliar, not culturally appropriate, require specific storage facilities (such as freezer space) or sold in volumes that risk food waste. Similarly, if individuals are using specific strategies to manage tight financial budgets, interventions increasing the affordability of healthy food need to consider how pricing, promotions and payment options correspond to these strategies (Sawyer et al., 2022).
Our SCHOUSE project will directly address these complexities through its use of systems science and co-design methods to draw on the experiences and expertise of residents and food system partners and tailor interventions to specific contexts and populations. We anticipate that working closely with the people delivering and receiving our interventions will enhance intervention effectiveness. Furthermore, adopting a systems approach will mean we take a holistic view of the intervention and its potential intended and unintended consequences; this will inform the design, implementation and evaluation of the intervention.
To effectively reduce ethnic and social disparities in obesity, we first need to understand the drivers of poor nutrition and the experiences of different communities in terms of their access to affordable healthier foods. Residents of social housing experience multiple disadvantages (e.g., poor employment prospects, mental health issues, stigmatisation, inadequate housing) and stark nutrition-related health inequalities (higher rates of diabetes, obesity and food insecurity) relative to households in privately-rented or owned/mortgaged accommodation. As a large demographic group, representing over four million people in England (17% of households), improving the dietary outcomes of residents of social housing could have a significant impact on overall population health and meaningfully narrow social inequalities.
However, there is very little UK-based research characterising the food and diet-related needs of people living in social housing and that explores reasons for diet-related disparities in this population and the role of the wider food environment (e.g. distance to supermarkets, access to online deliveries, other food retailers). As a result, there is a lack of understanding about how to intervene and what can work to effectively reduce dietary inequalities. Residents of social housing are diverse and comprise multiple population groups in which poorer diet-related outcomes tend to be observed (e.g. social renting households have a higher percentage of ethnic minority household reference persons and over half of households have a member with long-term illness of disability (English Housing Survey, 2023)). These demographic characteristics intersect with experienced disadvantages, for example, in social rented households, overcrowding is higher in ethnic minority households than white households (English Housing Survey, 2023). Although the most powerful determinants of diet may differ between sub-groups, in SCHOUSE we are seizing an excellent opportunity to take a place-based approach to addressing disparities reported across many of the sub-groups. Taking a flexible, nuanced approach, through the adoption of co-design methods and mixed-methods to explore the drivers of nutrition will enable us to deliver and evaluate a complex intervention that addresses shared determinants of diet in this population.
The government needs to invest in and implement interventions and policy actions that ensure equitable access to affordable nutritious foods.
In SCHOUSE, we will generate novel robust evidence on drivers of poor nutrition in social housing communities and the effectiveness of two interventions that directly address the issues of affordability and accessibility of healthy foods. Liverpool currently has a mobile greengrocer (known as the Queen of Greens) which successfully provides fresh fruit and vegetable to lower-income areas in Liverpool. For the first time, our SCHOUSE research project is enabling this intervention to be implemented in social housing settings in order to reduce geographic barriers by bringing fruit and vegetables directly to residents. The addition of fruit and vegetable vouchers in one arm of our randomised controlled trial is expected to promote purchasing, where fruit and vegetables are often not the economical choice for low-income households. Furthermore, our use of system science co-design methods to tailor the intervention to the specific population and context will enable us to anticipate and overcome potential barriers to implementation and effectiveness. It is essential to robustly evaluate interventions, including modelling longer-term health and economic benefits, if we are to generate the evidence needed to support local and national policy actions. To achieve this, we will employ gold-standard randomised controlled trial methodology which will involve cluster randomisation of output areas (areas of usually 110 to 139 households) to the intervention conditions (Queen of Greens alone and Queen of Greens + Vouchers) compared to the control condition (usual food security/nutrition programmes in Housing Associations).
SCHOUSE has three inter-linked workpackages (WP) which are summarised below:
In WP1, we will investigate the factors that explain why people in social housing have poorer diets. This will involve looking at how a range of issues affect people and the places they live in by interviewing people in social housing about their lived experiences. We will supplement this by quantitatively mapping the features of places relating to food access and diet in Liverpool into an interactive mapping tool that can help us better target our interventions (and other interventions that may be implemented in the future).
In WP2, we will deliver, test and evaluate two interventions in Liverpool aimed at helping residents of social housing to access affordable healthy foods: (i) Use of the Queen of Greens mobile greengrocer van which provides access to fresh fruit and vegetables, and (ii) Provision of Alexandra Rose vouchers for purchasing fruit and vegetables. To do this, we will conduct a cluster randomised controlled trial in partnership with the three major social Housing Associations in Liverpool, local social enterprise Alchemic Kitchen, and charities Alexandra Rose and Health Equalities Group. The primary outcome measure will be fruit and vegetable consumption. Secondary outcomes will include household food insecurity, mental well-being and other diet quality indicators. We will work closely with local residents and delivery partners to co-design the intervention and understand how it can best be delivered so that it is acceptable and feasible for end-users. At the end of the intervention, we will conduct interviews/focus groups with intervention recipients and delivery partner representatives to understand how interventions worked in practice, perceived impacts, and barriers and facilitators. We will also collect data on intervention costs (i.e. staff time, costs of interventions, overheads) to understand the cost-effectiveness of offering these different interventions for wider rollout.
In WP3, we will forecast the short- and long-term health impacts of these interventions. We will use a well-established computer model (IMPACTNCD) to predict the number of cases of diseases and deaths that could be averted by expanding the interventions to the whole of Liverpool and England. We will also explore how these future trends will vary across different communities and social groups, as well as whether it would be cost-effective or not compared to other strategies. The IMPACTNCD model has been validated in multiple contexts (including Liverpool, England and United States), and the SCHOUSE project is a novel application of this methodology within social housing settings.
SCHOUSE brings together a diverse academic team comprising expertise in psychology, public health, nutrition, epidemiology, health geography, health economics, modelling, systems science, and statistics. We are working closely with our project partners (including Liverpool City Council and NHS Cheshire and Merseyside) to co-produce and deliver the research, and widely share our findings at local, regional and national scale across different sectors.
SCHOUSE will produce new evidence on how we can support healthier diets among people living in social housing in a scalable way that can be deployed in other areas to improve local food environments and population health. We will welcome the opportunity to share our findings and learnings with policy makers as the project progresses.
Professor Charlotte Hardman, University of Liverpool, charlotte.hardman@liverpool.ac.uk
Dr Alexia Sawyer, University of Cambridge, Alexia.Sawyer@mrc-epid.cam.ac.uk
On behalf of the SCHOUSE project team.