Healthy food voucher programs: Global evidence on structure, implementation, and nutrition-related outcomes

Healthy food voucher programs (HFVPs) provide lower-income participants with benefits to purchase healthy, nutrient-dense foods and are a promising strategy for improving dietary and nutritional outcomes. HFVPs can complement policies aimed at reducing unhealthy food consumption, contributing to improved food security, dietary outcomes, and reducing nutritional disparities. Understanding the structural factors that make these programs acceptable and effective in improving dietary patterns is essential for designing impactful HFVPs. However, updated evidence on these components is limited. This narrative review focuses on incentive programs that provide voucher benefits for healthy foods, synthesizing global evidence on program structure components (i.e., participant eligibility and enrollment, benefit delivery and timing, eligible products, benefit value, program duration, retail venues, and inclusion of nutrition education) that may influence program impact. It also summarizes diet and nutrition-related outcomes by country's income level, when possible. Key determinants of program acceptability included positive interactions with program and retail staff, available multilingual information, electronic benefits over physical ones, a variety of eligible healthy foods, and including local markets as participating venues. Additionally, offering remote enrollment options, using mail delivery or electronic benefits to avoid transportation costs, adjusting benefits for inflation and household size, allowing redemption in various retail venues, and coupling benefits with engaging nutrition education activities were factors influencing program effectiveness. Most evidence indicates that HFVPs increase the purchase and consumption of healthy foods, improve food security, and enhance nutrition knowledge. However, mixed results were found regarding diet quality indicators, physical health outcomes, and mental health. Factors such as insufficient benefit size, inflation, and rising food prices, as well as short intervention lengths, contributed to null results. Our findings underscore the potential of HFVPs to improve diets and reduce nutritional disparities; however, addressing identified barriers during program design and implementation is essential to ensure that these programs achieve their goals.