Abstract

Abstract There were 272,339 primary age students in Wales in April 2021, of whom 63,614 (23%) were entitled to free school meals. Free school meals (FSMs) are currently means tested in Wales. Estimates suggest around 40,000 children in primary education may be currently living in poverty but are not eligible for a free school meal .Free school meals have been available to all children in Reception, Year 1 and Year 2 in England since 2014. Wales does not currently have universal provision to children in any school year. However, Welsh Government committed to this for 2023/4. Steered by a Task and Finish Group, a comprehensive mixed-method HIA was conducted over a six month period in 2022-23. A comprehensive database search of peer-reviewed and grey literature published in the ten years to 2021 identified evidence relating to the impacts on health, educational attainment and household socioeconomic outcomes of making school meals free to all primary age children compared with no or means-tested provision. Routine data sources and school census data were analysed to contextualise evidence in relation to Wales. This evidence was supplemented with interviews and data provided by cross sector stakeholders. The HIA identified significant potential impacts across the determinants of health, including impacts across population groups such as children in working families on low incomes, mental well-being and food behaviours. School food policy and provision, length of lunchtimes and implementation were identified as key pathways for health impacts. For example, a strong theme was that current provision is often experienced as stressful, with requirements for rapid turnaround limiting opportunities to socialise and enjoy meals and wider opportunities to play during lunch hours constricted. The report was used to inform the Health and Education ministers who approved the extension and the implementation of the offer. The unique HIA has transferrable learning for others. Key messages • This work has demonstrated the value of evidence based HIA on government policy and has enhanced implementation plans. • Free school meals for children can promote better health and educational and mental wellbeing outcomes.

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