Dr Rupy: Why don't we start with the charity? Because I was just saying before we got started here, I hadn't come across the charity before. So do you want to give us a little intro into into the the background of the charity and then we can talk specifically about this wonderful study that you guys are are doing.
Jonathan Pauling: Thanks Rupy. Yeah, sure. I mean, I I quite often say to people we're we're like a charity startup, or be it one with 110 years of history and a royal patron. So the history goes back quite some time, but the work that we're doing currently is is brand new and we think really innovative. The history of the charity is it's actually a royal charity. It was connected to the royal family because it was founded by Queen Alexandra in 1912. And at the time it was set up to support access to healthcare for people in London, particularly before the NHS, actual access to healthcare was a real challenge for people living in poverty. And so they set up a fundraising drive to support access to better better medical attention and care. And the charity went along very successfully until 1948 when the NHS was developed, and then it turned its attention. It had this huge fundraising mechanism and it said decided that it would continue raising funds and distribute it to small charities across the UK. And that went on very well for for many, many years, and the charity used to have quite a high profile, especially in the 50s and 60s, but it sort of went into a slow and long decline, I would say, as the development of sort of single issue charities grew in the 80s and 90s. It it found it difficult to sort of really categorise what it what it was about and what it stood for. So in around about 2012, the charity decided to, you know, circle the wagons and go, do we either wind the charity up or do we look for a new mission? And they asked themselves, what's the equivalent dynamic to what was happening in 1912 that Queen Alexandra saw? What was the equivalent dynamic today? And they came to the conclusion that the sort of confluence, if you like, between diet related ill health and food insecurity or food poverty in the United Kingdom. And the fact that you can be in a situation where you're sometimes skipping meals just to make sure that your kids can eat, but at the same time, you might be suffering from diet related ill health, whereby it might be type two diabetes, it might be overweight or obesity, cardiovascular disease, all of these things associated with bad diet. But because when you're when you you don't have enough food quite often, but when you do have food, the kind of food that you have access to isn't necessarily great for your health and well-being. And so they said, well, what can we do in this space that's not being done currently? And we looked to the United States where there was some similar work going on where they'd come up with an idea of doubling the value of people's food stamps. And the food stamps is a huge part of the welfare system in the United States. Around about a third of families and and individuals are in receipt of food stamps, but they're not always being spent on the healthiest of food. So they said, how can we incentivise, you know, more consumption of fresh fruit and veg? What if we doubled the value of these vouchers, of these food stamps, and and but to incentivise it, we said you can spend it on fresh fruit and veg from local markets. And we thought that was a really great concept and we wondered if it could be brought here to the to the UK. And that's sort of where it all started. In around about 2014, the charity did its first pilot, a very small intervention in Hackney. And the only equivalent that we have to food stamps in the UK is a program called Healthy Start. So Healthy Start is a government program for pregnant women and families with children under the age of four, and it's all about prioritizing good nutrition within the first four years of a of a child's life because that's actually the most crucial point in their development. So we know, there's a huge evidence base that if you that the first 1,001 days of a child's life has a critical importance and critical impact on their future life chances. And that's from everything around socialization, education, but food and nutrition is really important. And we're already seeing that, you know, in the statistics out there, around about 20% of kids arriving at school in reception, either overweight and obese. So the problem has started within those that early years setting. And so we decided, why don't we see if we match the value of healthy start vouchers with our own voucher, which is all about access to fresh fruit and veg from local markets and independent retailers. So we did a pilot in Hackney, around about 45 families. We worked with Ridley Road market, which is a fantastic street market in the center of Hackney, and we partnered with local children's centres. These are places that are that were set up to to support early years development in areas where there's high levels of of of poverty. And so those centres engage the families who might be either at risk of food insecurity or have diet related health problems. They register them on the Rose voucher project and they distribute vouchers every week to those families who can take them down to the market and redeem them for the fresh fruit and veg that they want, that's culturally appropriate for them. It gives them choice, it gives them agency, but because we're only working with market traders, they can only redeem them for fresh fruit and veg. So it's it's it's really maximizing the amount of nutritious, healthy food that they can access. And at the same time, they through the association with the children's centres, they're getting that sort of wrap around lifestyle support. So that might be support for breastfeeding, weaning workshops, cook and eat sessions, advice and guidance on a range of sort of health and well-being issues that make sure that the voucher itself is a is one mechanism, but it's the sort of holistic approach to helping them develop a healthier lifestyle that really makes the impact. And the great thing about targeting it at early years is that when with all parents, it's the same whether you're rich or poor, when you become a parent, first thing is you don't really know what you're doing. So you're much more open to support and advice and guidance than you than you ever are really in your life. And you go out and seek it because you're like, my God, what am I doing here? I have no idea. And and those children's centres are just full of professionals who can provide you with all that advice and guidance. And when they engage you on the Rose vouchers for fruit and veg project, there's a sort of this moment of going, oh well, you know, my nutrition and my child's nutrition is important and here's the sort of the financial incentive to be able to do something about it. Because we know that one of the biggest barriers to accessing a healthier diet and and adopting a healthier lifestyle is the cost. Calories from unhealthy food are three times cheaper than calories from healthy food in the UK. So it's a rational economic decision when you've got very little money to spend that you spend it on calories that will easily and cheaply fill you up and give you the energy that you need, but they're possibly not giving you the nutritious and nutrients that you need to have a healthy lifestyle.
Dr Rupy: So I've just I've just rabbited on there, haven't I? So apologies for that. No, no, that's great. I'm just like sat here or standing here nodding my head along thinking, A, this is amazing. This is sick. And B, how on earth have I not heard of you guys before since you've been running in 20 in 2012. And I I've worked in Hackney as well. I I've been an ambassador for Made in Hackney, the um the the the the charity for for years now. And and done some sort of like, I'm sure you guys have probably worked together in the past.
Jonathan Pauling: We've we've worked with Made in Hackney on a number of occasions. Great, fantastic organization by the way, really great people to be involved with. So we're we're still kind of small. So we started with 45 families in Hackney. We probably support about 250, 300 now. It's a it's a it's a very targeted project. Um and uh and it's delivered through those partner children's centre organizations. So it's really about, you know, making sure that we engage the the the people who can benefit most from from the program. In saying that, I mean, we we started with that small pilot, then we started getting interest from other local authorities. So we rolled out into Lambeth uh in 2015 uh and then some sort of the interest sort of developed with national funders. And they sort of set us the challenge actually. They said, you know, that this is all well and good. It's a great project. It has excellent impact and improving um uh health and well-being in early years. It's increasing consumption of fresh fruit and veg, which is a key indicator of improved dietary quality. Uh but London is, you know, it's a special uh environment. Uh there's, you know, it's uh it has very diverse population, more open to fresh fruit and veg perhaps culturally than than um white working class communities in the UK who have the lowest consumption of fresh fruit and veg of any population in the UK. And they said, you know, how how would this work outside of the bubble of London? And I sort of said, well, look, if you give me some money, I will go and test that for you. And they were very obliging. And so we did an expression of interest in 2016 uh to see uh if there was interest outside of the out of outside of the London bubble. And uh we had 14 cities and towns from around the country apply from a far field as Belfast and Northern Ireland, Cardiff, Exeter, um uh Liverpool, Brighton, uh and so we we we went round and visited what we thought were the, you know, the top candidates and out of that we chose Barnsley in South Yorkshire and Liverpool. So that expansion started in 2016 outside of London. The project works really well um in both locations. Uh in Barnsley, they've got a fantastic um central marketplace. I think it's first deed of covenant from the king was something like 1256 or something like that. So it's been in situ in that location for over 800 years. It's unbelievable. It's a brilliant. And and quite often I I tell people who um who are interested that I I going to Barnsley market is like going to La Boqueria in um in Barcelona. Uh except instead of all the little stand-up espresso bars that you find um scattered throughout La Boqueria, um you've got uh a a cafes selling milky tea and a bacon butty instead. But the, you know, the range and diversity of produce is is fantastic and the vibrancy is amazing. Um and so that was a great uh partnership there. Uh but in Liverpool, the challenge was that there wasn't such a great market culture in Liverpool. Um there were a few markets, but they weren't near the populations of greatest need. Uh and and so what's been brilliant about the project in Liverpool is that they have um they have a fruit and veg bus. And it's a bus that has on on inside of it has a shop. You can walk into the bus and you can purchase your fresh fruit and veg. And that bus drives around to all the areas of Liverpool, some of which are, you know, like seriously are food deserts, right? So there are these are large swathes of of of housing, of of neighborhoods where it's physically very difficult to access fresh fruit and veg because there aren't shops, there's not supermarkets, and the nearest supermarket is across, you know, a very busy road. You either need a car to get there or you need to walk with your pram and your buggy a long way. So, uh so bringing fruit and veg into those communities has been is been a an amazing thing to be involved in. Um the bus itself is is fantastic. Um and without it, you know, these communities wouldn't have that accessibility. So, uh that happened in 2016, 17, and then more recently we've expanded in London burrows, so Southwark, Hammersmith and Fulham, Tower Hamlets, and uh and Glasgow was our last project during the pandemic. We opened up in Glasgow. So we support around about 2,800 families every week with vouchers. Uh that that um big um golden sign that you can see behind me uh is our 1 millionth voucher that we gave out on Hammersmith and Fulham market uh in September last year. Since September last year, we've done 600,000 vouchers. So you can sort of see that it has it took a long time to sort of really get going and really catch on. So it took us eight years to do a million and it's taken us another year to do 600,000. So the scale of it is developing quickly. Uh and and so we are we are just in this process of starting to put our head above the parapet and starting to talk more broadly about what we do. But most recently, the the development of a new two new pilots in our work, which is uh fruit and veg on prescription, working with local GPs and local community health practitioners. That gave us an opportunity to go out more widely to to the public and to the media to sort of to showcase um a new and innovative approach to improving access to to healthy food. So, I think that's probably what how you heard about us is the press release that we put out about that piece of work. That was developed in partnership with public health teams in Lambeth and in Tower Hamlets. And they both know about our work already because we do this children's centre model. But for for for many years, we've been aware that the voucher system that we work with early years could easily be transferable to many different groups outside of that age category. So there are many people who are struggling to access a healthy diet. That financial barrier is one of the key barriers and one of the the the things that's missing most from their diet is fruit and veg. And we knew for a long time that we've seen the success of this work overseas. So again, back in the United States, they've been piloting fruit and veg on prescription since around about 2014. Uh and uh there's some similar work in Australia as well on a small scale. We wanted to bring that to the UK. And I've been I've been sort of touting the idea around to various people. Uh and eventually someone took up the idea, both Tower Hamlets and and Lambeth public health teams commissioned us to set up two pilots, which we have done in the last sort of four or five months.
Dr Rupy: Yeah, that's that's epic. I I wanted to, I'm glad you brought up the US as an example because I I don't want to gloss over this. Did I did I hear this correctly? A third of people in the United States are utilizing food stamps? Is that correct?
Jonathan Pauling: Yes. So, um they don't call them food stamps anymore and I would need to give you the, you know, you'd need to research the the exact um name of it. Um there are it's a nutrition program. I think it's called Snap um is the acronym, but I can't remember what it stands for. But it's it's a nutrient nutritional um program in the US. This is, I mean, you you've got to remember the United States is a huge agricultural nation, much bigger agricultural nation than the UK. Uh it has one of the most subsidized food systems in the world. You know, they are all about free trade internationally, but when it comes to their food and farming sector, they are not free traders at in to any stretch of the imagination. They they subsidize their food system massively. Um but what had has been the case, I think since the end of the Second World War is that they've had these food stamps as a part of the welfare system. And I think that fits in really well with the sort of American mentality, which is, oh, we're not going to give you money, um but okay, well we'll give you some, we'll give you some uh uh some stamps, vouchers, stamps that you can that you can exchange for for food because the welfare, the safety net in the US is much isn't as uh as wide and supportive as it is in other Western countries. Uh and so it's always been tied to the farm bill in the US to some degree. Um so they know that these food stamps are mainly spent on um on US agricultural products because a huge amount of the production and consumption is is uh is homegrown in the US because their agricultural sector is so big. Um but what's exciting there is that they've seen the innovation in trying to incentivize healthier choices with these with this incentive program. And uh they uh have actually allocated around about 250 million US dollars to um to programs similar to ours where they are incentivizing fresh fruit and veg consumption specifically um from local distributors and local markets. So, uh I I think that's, you know, it's it's partly to do with this very unique American dynamic around food stamps, but also partly to do with the the people who are driving this sort of incentivization of fruit and veg over there have been very clever. They've lobbied central government and they said, well, look, if it's being spent on fresh fruit and veg, that means it's going back into the pockets of American farmers. So why don't you give us a chunk of that money and we will distribute it to the to the populations who need it most to address not only a income inequality, but also a health inequality. And that's the key here is that it's that, you know, in the past, they were giving food stamps to to alleviate income inequality, but those food stamps were exacerbating health inequality. So now they've reversed it and and they're trying to incentivize consumption of, you know, really good nutritious, healthy food.
Dr Rupy: Yeah, yeah. And I I think that that's super important because when I think about food stamps, I think about uh essentially food banks where they just have pretty much ultra processed food that's available for people to just pick up and stuff using their vouchers. Um just dialing into the actual vouchers that you've been piloting um since 2014 uh in in Hackney. What what does a rose voucher look like? How much is it for? And how do you work with the market vendors to um to to uh exchange them?
Jonathan Pauling: Well, they look a little bit like this. Actually, I've written on this because I was writing notes to myself about something I can't remember. So excuse the writing across this, but that's that's the rose voucher for fruit and veg. Um it's uh it's very colorful. Um you'll see you notice that it has a a barcode along the bottom there. So most traditional market traders in the UK are still cash-based economy. They um they they the some of them have card machines, but many, many um don't use card machines. And predominantly, you know, the the biggest users of cash in the UK are people in from low-income communities. Um and older communities as well. And so what when we set this up, we were really aware that we didn't want to create a mechanism that changed the way that traders exchange the exchange took place on a market. We wanted our families to feel confident in using their voucher and feel like they didn't stand out or they didn't delay transactions on the stand. So so we we designed this in in in consultation with um with families. Actually, our our trustees had some sort of much more corporate branded looking thing in their in their mind, but when we road tested it with the families, they were like, no, we want this, we want bright colors, we want it to look lovely. Um I quite often call this, you know, it's very quite simply, we've created the the a bank of Alexandra Rose charity. This is a uh a um it's a currency. Uh it's a conditional currency. You can only spend this currency on fresh fruit and veg, but it is a currency and you can redeem that currency at the Bank of Alexandra Rose charity. Um the uh the vouchers, you take your vouchers to the market trader, you pick the fruit and veg that you want. They're all one pound denomination, so you can you can shop around. You don't have to use it all at that one trader. You can go from trader to trader based on what they have best, you know, one one might specialize in fruit, one might specialize in South Asian veg, one might have African Caribbean produce. You know, you can just walk the market and choose where to spend it. But the trader takes it like cash, like any other trader, stuffs it into their uh into the front pocket of their um of their belt, their trader belt, um and the exchange is as smooth as if you were using cash. Then when the trader has a moment uh of quiet on his market stand, not normally, doesn't normally happen because they're very busy. So generally they take them home at the end of the day. They all have a mobile Bluetooth scanner. They can plug that into their phone, into their laptop or into their um tablet, and they just scan the barcode, goes into our um we've created a digital platform, a web application, all of the data goes into that and when they've um scanned all of their vouchers, they just press request payment and that sends a message to us. And the most important thing about that is it doesn't slow down the um the transition of cash through the business because they are very hand-to-mouth businesses on a on many occasions. Uh they um they take cash in the day, they go to the market that night and buy more produce and then they come back onto the stall the following day with that fresh produce. So we needed to make sure that the that the speed of cash flow through their business wasn't interrupted. And in saying that, what a lot of traders have told us and especially during COVID because markets were terribly disrupted during COVID, um that they've been so used to being a cash-based economy for a long time. They would take cash in the day, they would spend it that night, and then at the end of the week, what money they had left on them, they would distribute as wages to their staff and then and then spend and then spend the money themselves. Um what many of them find is that they sometimes they don't need to touch sometimes that money from the vouchers that goes into their bank account and then they turn around at the end of the month when there's been a lot of rain or snow and and trade has been slower, they look in their bank account and they've got this nice cushion of of um of income that they haven't touched and it allows them to sort of uh to ride out the vicissitudes of of what what trading in an open air environment is often like. Um it can be up and down depending on the weather, interrupted by things like COVID, interrupted by um by lots of different uh challenges that they face. So I always say that our theory, we have a theory of change in the charity. You know, we we want everyone to uh we want people families on low incomes to have better health and well-being um via access to um nutritious fruit and veg, right? So that's one very obvious uh end goal of our charity. The other end goal is that um we believe that everyone should have access to a healthy, diverse, sustainable food economy in their local community. And and until in the UK, until small business people can make money out of selling healthy food in low-income communities, we're we're we've I'm sorry, but we're not going to get out of this hole that we've dug ourselves into. You need to have a market economy that allows people to make money from selling healthy food. Uh and and that's fine if you go into a middle income area of the UK, you know, there's lots of grocery stores and and uh and supermarkets and green grocers and farmers markets and all all those types of things. But if you go to large swathes of of uh of the UK where where there's large populations on with low income, the accessibility to a healthy food economy is really challenging. And actually it's much easier to buy stuff that's ultra processed, packaged, high salt, saturated fats, sugars, all the things that we're told are bad for us, um and much more affordable, physically accessible than it is to buy good food, nutritious food. And we've got to change that dynamic. And so we want to see a healthy, diverse, vibrant food economy that's accessible to everyone.
Dr Rupy: Yeah, yeah. And it it it sounds like you're paving the way for that and to demonstrate the outcomes that I I want to dig into in in a second. How how much is distributed to to each family? Is it based on, is it means tested? Is it based on number of people in the household? Like how do I know as a family how much I'm going to get in terms of the value of the vouchers?
Jonathan Pauling: Every family on our on our early years program, so we have a different values between our fruit and veg on prescription and our early years program. But the early years program, uh each family uh gets four pounds of voucher um per child. Double if the child is under one year of age. And the reason for that is that we think it's really important to support the nutritional um uh the nutrition of the parents in that first year because that's a really tough year. Um so that focus on um supporting in the first six months because the child's not really eating any food in the first six months is to support the parents uh and then uh secondly to make sure that they have a a wide variety of fresh fruit and veg to wean their child off onto when when they start eating solid food from about six months onwards. Um uh we uh if you have more than one child, you'll get multiples of of four pounds of vouchers. Uh and uh in some areas, of course, these things um change because of the nature of our funding. So some funders uh in some areas our projects are have more funding than in other areas and the funders ask us to support in different ways. So we do in Glasgow and in Southwark and Lambeth, we support eligibility for vouchers to for children who are above five as well. So that increases the amount of vouchers the family gets. Uh uh but um that's only available in those areas sadly.
Dr Rupy: Okay. So so this is uh just to get my head around the scheme. This is more like a a top up of like your weekly shopping uh needs whereby these vouchers are specifically uh geared towards healthy uh fresh produce uh in addition to what you might spend in a supermarket, let's say.
Jonathan Pauling: And so what tends to happen is that lots of people who come onto the program weren't using the markets beforehand. Uh and so they take their fruit and veg vouchers down to the market. They find one, you know, fruit and veg markets in the UK are the most affordable place you can buy fresh fruit and veg. They're we did a a survey in Southwark with East Street market and the Morrison supermarket at the bottom of the street and um uh for on like for like items, um East Street market was 60% cheaper than Morrison's supermarket for those items. So families go, they start using the vouchers on the market stall, they realize the value for money that they get. They quite often dip their hands into their own pockets to top up their spending and we've got evidence from from economic impact surveys that we've done that the traders tell us that customers spend their own money and our Rose families tell us that they often spend their own money on top of the vouchers. But then they also realize that the local butcher on that um street market is much cheaper than the supermarket. They find that the clothes stall that they meet on that market is cheaper than where they've been buying them at Asda or or or at um New Look or wherever they might be shopping. Um and so they start using them their discretionary spend in the market instead of going back to the supermarket. So that's again, that's having that flow on effect for the economic benefit of the wider community. It's the vouchers aren't just going into the into the bellies of um, you know, it's making allowing families to access nutritious food to go into their bellies, it's um putting money back into local economies, which are in the poorest parts of the United Kingdom. So it's actually driving economic um vibrancy on of those communities at the same time, which in the end, because food poverty, right, is only a subset of poverty overall poverty. So so this project is also, um I mean, I'm not claiming that we're solving poverty, right? But it's actually it's putting money back into local economies, it's supporting, it's it's keeping small businesses, it's giving them extra income, which then flows on into their employees, the people that they pay. We also during the pandemic because markets um so the fruit and veg traders were allowed to keep trading because they were a essential food item, but all the rest of the market had to shut. So all of the incidental footfall that you would get from a fully operational market disappeared overnight. And we've had numerous traders tell us that if it hadn't been for the vouchers during that time, their business would have gone under. So we know that we've made sure that people's businesses have been stabilized. We've made sure that local jobs and employment has been has been um has been uh safeguarded. Uh and we hope as we scale that the economic impact of the project just becomes greater.
Dr Rupy: Yeah, that's that's epic. I I wanted to, I'm glad you brought up the US as an example because I I don't want to gloss over this. I interviewed um Professor Guy Standing uh a couple of years ago. He's a huge proponent of universal basic income and I proposed this idea of why I thought fresh food, uh healthy food should be free. Um he actually pushed back uh quite a bit. He said from his experience in doing these tests, these infield tests, it comes back to that idea that you mentioned earlier about the your locus of control, your feeling of control. And his idea was actually instead of giving uh vouchers that have a sort of mechanism around them, sort of limitations on where and what you can spend on, uh encourages more of that sort of feeling that gives people less stress, less anxiety in in conditions particularly of uh financial deprivation. I wonder how you would would sort of tackle that pushback if if maybe Guy said that to you about the the healthy food scheme and the voucher scheme that you have. What what what kind of ways in which do would you push back against that idea?
Jonathan Pauling: I mean, first of all, I you know, I just need to say I think universal basic income is a fantastic idea. I think the the the challenge that we have around um diet and nutrition, I think a lot of things would need to change within the food system to make universal basic income the the thing that would solve our our diet related ill health and uh uh uh problems that we're facing and the climate and nature emergency. At the moment, giving more people, giving people more money is really important and I I you know, I would encourage the government to, you know, I'm really glad that they're going to uplift benefits uh in line with inflation. Uh um uh I was very disappointed when they took the 20 pounds uh in uh uplift out of universal credit last year. I think people do need more money. It's really important. Um but at the moment we have a food system, like I said, where the the unhealthy food is three times cheaper than the healthy food. So even if you give people more money, there will always be people that will find themselves in financial difficulties or where money is squeezed. And the thing with food is that it's one of the very few um uh areas of your budget that has elasticity, right? So the rent, the rent has to be paid. The power company, the power company has to be paid. Food, you can you can skip a meal, you can you can trade down, you can go, well, I'll go for this cheaper stuff rather than the stuff that I really like. Um you there's so many ways of of elasticity within your within the budget for food. And so what would happen if we had universal basic income but still had the food system that we currently have is that people would continue to make a rational economic decision, which is to purchase the stuff that's cheap and easily available um to to to to fill themselves up, to make their kids happy and satiated. Um and uh and unless our food culture has changed, we would still have the same diet um related ill health problems. So I would argue that at the moment, these vouchers, these are all about incentivizing a change in our food culture where good food becomes the norm, where good food retail, where diverse retail economies become the norm. And once we've got that, sure, I Alexandra Rose charity, we can we can walk away and say job done and we can move on to our next program or disband, whatever it might be. I'd be really be wonderful to be in a place where we didn't didn't need um uh financial incentives for fruit and veg um to to to support communities. And and that's this amazing world. This is almost goes back to my, you know, my youthful university studies where we live in these in this utopian food culture, almost those blue zones. They always talk about those blue zones, don't they? Where, you know, where everyone eats lovely fruit and veg and fresh fish and but only small amounts of good quality protein. You know, when the UK does that, then of course, universal basic income will be the will be the thing that that stops poverty and um and it won't matter that there's there's not vouchers for fruit and veg because the food culture of the country will be a completely different one. But that ain't going to happen soon or quickly or easily. And what we need is a financial incentive to try and turn this oil tanker around of our food system to to financially incentivize it to go in a different way. Um and and I think I think that putting the money, I think what's great and you go back to your your your academic whose name I've forgotten, um but go back to him and say that um that this is going to be a great interim step for universal basic income because it is giving people more money. This is the Bank of Alexandra Rose charity going directly to people's pockets, but it's incentivizing a change in our food system that we definitely need to have happen in to uh so that when universal basic income finally comes, that it will that it will won't have any detrimental effect on um people's um uh diet. Or that that won't be the main effect on the diet. The food system and the food culture will still be having the impact on their diet.
Dr Rupy: Yeah, exactly, yeah. And I think that that idea of food elasticity is a really important concept that listeners should take take away because I think the way you frame that makes makes total sense. And I should have some round tables with people who are generally forward thinking and thinking in the same direction but might have nuances within their perspective. Uh when we start filming the pod again in in the studios, I'd love to invite you on and and uh get you to chat to Professor Guy Standing and a few other people from different perspectives actually because I think this this area is just so so interesting and discussion around it is um is really needed. I I want to bring our conversation to a close, although I feel like I could chat to you for ages about, you know, New Zealand and your and your background, your your your dissertations and stuff. It's it's fascinating. Um one of the with the with the current um study that's going on, do you I mean it might be quite early, but do you have any early sort of indications of what the outcomes are from uh giving these uh vouchers to how many look at eight locations and how many families are involved in this study?
Jonathan Pauling: So, so we have two programs. We have our early years program and we have our fruit and veg on prescription program. So the early years program operates in eight eight centres across the UK and fruit and veg on prescription is operating in two areas, um Lambeth and Tower Hamlets. So we're it's very small and early days. Um it's uh 120 uh um recipients to begin with, 60 in each area. We're working with the Bromley by Bow Centre in Tower Hamlets who are um I would say one of the most brilliant um medical um community health centres in the UK, have been trailblazing for 30 years. Uh and and they're also at the forefront of the social prescribing movement. Uh and social prescribing is really interesting because it's it's actually has, you know, a full-hearted support from central government and and Department of Health. Uh and it's all about recognizing that the that there are wider determinants to people's health and well-being than just what the doctor can prescribe. Uh and so social prescribers, the doctor might give you something for your ailment, but the doctor will say, you know, you could benefit because your ailment is related to your lifestyle, to your environment, to your situation, you might benefit from um engaging with our social prescribers who can help you with issues like housing, debt advice, income maximization, uh and now they can say access to healthy food. And so you can go along and get all of that support and get a a prescription for fruit and veg, one of our vouchers to take down to the local market. You'll also be able to access, you know, you might be referred to a a gardening club, a cooking workshop, um and and other sort of stuff, you'll have recipe cards and all of those things. And those sessions that you get with the social prescriber will be all about prompting and supporting you to make the changes that that you need. I suppose it's worth saying that the model is slightly different than early years. So we are we're doing we're testing at two levels and this is based on feedback from our local partners about what you could purchase at the market for the value of the voucher. So in Lambeth, we're basing it on 8 pounds per week for the for the recipient. If they have another member of of uh of their household, they get two extra vouchers for each member of household. So if they had uh if that was them and two others, they would get a a total of 12 vouchers. And in Tower Hamlets, it's starting point is six and two extra for every other member of the family. Um they are in in Lambeth, we're working with a fantastic um uh community health outreach program called the Beacon project. And the Beacon project was set up uh during COVID actually, they started they were set up before then, but they were focused on international health work and now they've started to look more in their community in South London and they realized that there are a huge swathe of that community that are a little bit um uh reluctant to go and see um medical establishment. They don't present, they don't go and see their GP very often. They don't they're a bit suspicious, they don't they're not inclined to engage with the medical profession until something is really wrong and then they're they're presenting with an emergency. So what they do is they take doctors and nurses out to the community rather than expecting the community to come into the GP practice. So they're they've got some fantastic outreach programs in Lambeth. One is in a church near Brixton market. There's one in a place called community shop in West Norwood and on Streatham High Street, they um they work out of a barber shop. So, you know, people come to the barber shop and they come to get their haircut and of course in South London, you come to chat, right? You come to sit around and have a good chinwag. And and then there's the doctor sitting there going, hey, do you want me to do your blood pressure? Should we have a chat about? And and so they they are terrific. They they just get out to where and they they just stop people in the streets. They'll stand outside and they'll stop people in the street and say, come in, let's do your blood pressure, let's have a chat about your health. So they're they're our other partners. Um so we're really excited because it's quite different approaches. Bromley by Bow, very traditional, very innovative, but very traditional medical practice, community health centre, and then the Beacon project getting out into communities, outreach work, um you know, location-based health practice, which is really cool. Uh and
Dr Rupy: That's amazing. That's like guerrilla healthcare. I love it.
Jonathan Pauling: It is, it is like guerrilla healthcare. They're really terrific and um yeah, when you see them in action, they just they have they are such they they've just got such a brilliant way of engaging people. They don't take no for an answer. They'll talk, you know, they'll they'll talk your ear off before they even say, by the way, I'm a doctor, would you like or I'm a nurse, would you like to come and get your your blood pressure done? And by that time you're already sucked in and you can't stop them.
Dr Rupy: Yeah, totally.
Jonathan Pauling: And so yeah, we're we're we're doing food frequency diaries, we're doing um uh you know, baseline surveys and and then we'll be reporting in six months. Of course, we're nearly three months in, we're already getting some anecdotal um feedback coming, you know, people are very happy with the project. We had one of my colleagues was uh at the distribution in West Norwood, people were hugging her, people were, you know, literally, you know, they were so grateful for for receiving this extra money really to be able to buy food because these are people who are who are very food insecure. And uh but it's it's allowing them, I was on Brixton market yesterday with one of the participants. We did a piece for BBC London News and I was talking to her and she just said, you know, it just allows me to experiment. You know, I don't know what some of this stuff is, but I would never buy it because I don't want to risk not liking it. I don't want to risk cooking it or not knowing how to cook it. But now I can experiment. I can ask the trader, what's that? How do I cook this? Let's give it a go because it's not my money at risk here. It's some money extra money that I got given. And that's the thing. I mean, we do that this comes back in our early years program. My daughter, she she's 10 now, but when she was little, she um she was very fussy eater. And um and you'd put something like broccoli on her plate and she'd grab it, fling it across the room and say, disgusting. And you know, I was always very proud at her wonderful vocabulary development at an early age. I was like, that's pretty good. But I was very disappointed with her with her um you know, her reluctance to try new things. Now, that's fine, you know, that's on the floor now, three second rule, I'll put it in my mouth or it goes in the bin, but I'm I I can risk that, right? I can take those risks. I can try a different type of veg. She turns out she loves cauliflower, hates broccoli, right? So I just plow, you know, put broccoli cauliflower on her plate all the time and she'll eat that. But if you don't have the financial um capacity to keep experimenting, to keep testing out. And there is, I don't I I I'll get the statistics wrong, but there is this there is this there is evidence base that says you have to try something new like six times before your your palette adjusts to a new taste or texture, before it becomes acceptable to you, right? So when you're a kid, you've got to be able to have, you know, and you all all well parents will have had this experience, like their kid will love something for ages and they'll just want it all the time and then they'll go off it and they'll never eat it for the rest of their life. They don't like it anymore. But they'll do the opposite. They'll like, I don't like that, I don't like that, I don't like that. And then one day they'll go, you know, they'll have it and they'll or they'll be at a friend's house, right? Because this is the thing. They don't eat it in front of you, but they go to a friend's house and somebody else gives it, puts it on their plate, they eat it. Then they come back and go, you know, dad, can I have some red pepper please? Because that when did you start liking red pepper? Oh, Ethan's mom gave me this lovely dish the other night, blah, blah, blah. And it's like, oh, okay, there you go. You need to there's a certain threshold point that they get to after being exposed to it for a certain amount of time. The vouchers give you the ability to keep experimenting with your kids, keep trying something new out. Because the sad thing is is that it probably doesn't take six times for you to bite into a chicken nugget and go, I like that, right? So you've done it once, you liked it, and the mum goes or the dad goes, you know what? I know they like it. I know they'll eat it all. There won't be any food waste. They'll turn around to me and say, dad, thanks, that was delicious. And as a parent, that's all you want, right? That's all you want. You want that reaction and you want your kids to be full, satiated and happy. And so that becomes the easy option and it's again, going back to what we've said so many times, it's pretty cheap and it's really available. Every shop I go into, I can buy chicken nuggets. Every shop without fail.
Dr Rupy: Yeah, yeah, totally, totally. Well, I mean, I'll be I'll be looking out for the results of um of this study in in in three or four months time. I'm fascinated by, you know, the pilot stuff that you've done already. Um you know, it's just find it interesting. There's a bunch of tech companies doing some, you know, weird and wonderful stuff, personalizing diets and doing all these tests and stuff. And then essentially recommending what is a healthy diet with increased fruit and vegetables, increased fiber. Um I don't think it needs to be as complicated as we want it to be. And almost similar outcomes to your pilots, you know, improved energy, improved bowel habit, improved consumption of a variety and diversity of of these ingredients. I I truly believe like the science is complicated around nutrition. The solution is simple, but the implementation, that's the hard bit. And I think, you know, what you're doing with the charity and with the vouchers, you're really dialing down to that implementation bit and I think that's where we need to focus a lot of our efforts. Um and you know, companies raising like hundreds of millions to do essentially what you're doing. I just really wish that money would just go straight to you guys. Uh and your fund expert. So I I really do hope this is a a stellar success and uh and we as GPs can start prescribing fruit and vegetables in the NHS. I think it's just it's got to happen. It's just it's so needed.
Jonathan Pauling: Well, if you ever come across any of those uh tech investors who are about to throw their money in that direction, please please do divert it our way. I'll be I'll be eternally grateful.
Dr Rupy: Perfect. Of course. Thank you so much, Jonathan. This has been a pleasure and I'm sure this won't be the last time. I'd love to to keep in contact and uh and see if I can help in any other way. And uh yeah, we'll have to do this again uh at the end and and go through the results.
Jonathan Pauling: Excellent. No, I'd I'd really welcome that. And yeah, I mean really nice talking to you. It's nice and easy and fun. So thanks very much, Rupy.
