Reflections and learning on poverty, food and nutrition
By Elaine Lane
BDA Public Health Specialist Group member
Elaine Lane visted the House of Commons in 2015 to attend the conference Stomach This. Here’s her take on what she learned
A lack of wellbeing has an impact on both physical and mental health. It is also known that inequalities in health are strongly associated with deprivation and with those on low incomes suffering significantly more ill health and earlier death than those better off.
Deprivation and low income are related to unhealthy lifestyles, but patterns are complex, with health of the homeless recognised to be extremely poor.1, 2 It is also clear that the effects of poverty on nutritional status are more far-reaching than simply limiting the amount of choice of food bought and this is an issue that dietitians can help to address.
During the conference, we were all handed a small parcel of sugar to our bemusement. The conference facilitators then revealed that their personal inspiration for the event had been ‘watching a child eat sugar for her school lunch’. This led us to truly recognise that, as dietitians, we need to support and contribute to the ‘nutritional aspects’ around food poverty - its causes and effects. Exploring the challenges together enables us to find practical nutritional solutions which improve health wellbeing and quality of life.
Defining food poverty
The idea that we live in the world’s seventh wealthiest country, yet millions of people find it hard to afford food essentials came through strongly throughout the conference as was identified in the UK Low Income Diet and Nutrition Survey of 2477 households between 2003-2005.3 In this survey, 39% of respondents sometimes worried about running out of food because of money, 22% reported skipping meals and 5% reported sometimes not eating for the whole day because of money. This of course leads to severe nutritional issues.
During the conference there was recognition that 'food poverty' is a symptom of 'poverty'. The Faculty of Public Health4 recognises there are no established definitions of ‘food poverty’ but common themes are:
- food poverty is a worse diet, with worse access, worse health, higher percentage of income on food, and less choice from a restricted range of foods
- an individual or household is not able to obtain healthy, nutritious food – they have to eat what they can afford, not what they choose to
- the inability to consume an adequate quality or sufficient quantity of food for health, in socially acceptable ways, or the uncertainty that one will be able to do so.
Factors identified as influencing food access include: a lack of shops in local areas; individuals’ inability to reach shops; poor range of healthy goods in-store; income; transport; fear of crime; knowledge about what constitutes a healthy diet; and limited skills to create healthy meals. Due to this complex mix of factors, people on low incomes have the lowest intakes of fruit and vegetables and are far more likely to suffer from diet-related diseases such as cancer, diabetes, obesity and coronary heart disease. Food poverty can also be about an overabundance of ‘junk’ food as well as a lack of healthy food.
The conference also included profile speaker presentation from a variety of industry backgrounds and organisations such as FareShare and Magic Breakfast, all presenting initiatives to combat food poverty. (Further background reading into the challenges and practical experiences of hunger, poverty and food aid provisions can be found in ‘An Evidence Review for the All-Party Parliamentary Inquiry Hunger in the United Kingdom5.)
So what is the way forward?
One way forward is to improve the nutrition care of those in food poverty and develop clearer definitions of hunger, food poverty and malnutrition. Dietitians need to be engaged with this agenda and to raise awareness of the professions role as a source of practical food and nutritional solutions.
In addition, it is important to maintain sufferers’ dignity whilst making improvements to their health and quality of life. Addressing the underlying causes of food poverty clearly requires sensitivity and the underlying causes for each person will be different. For example, some individuals may benefit from assistance with budgeting or cooking to address their problem. In other scenarios, people may be forced to face tough choices, such as to ‘heat or to eat’.- Our current models of working may need reassessing in order to engage within this important preventive agenda, led and coordinated by dietitians. For example, dietitians could deliver training on the recognition of poverty, food and nutrition needs as well as practical guidance for fulfilling nutrition requirements on a budget.
Through the conference I learnt that no one organisation can alleviate poverty directly, but by means of sensitive and appropriate advice, we can work together to help improve nutrition. This could be through training those individuals who are involved with these food programmes. In addition, as dietitians, we have a responsibility to highlight the challenges which result from low income lifestyles to the policy makers and the planners, something which many of these charities do very well.
Each local area requires a clear coordinated pathway for emergency food aid and longer term support plans with a range of ‘packages’ to include free social activities linked to food, alongside debts, benefits and housing advice. It is also important that we address these challenges together in this time of tight budgets and increasing diet-related ill health costs to the NHS.
- Dept of Health (2010) Tackling inequalities in life expectancy in areas with the worst health and deprivation. London, National Audit Office.
- Buck, D. (2014) How healthy are we? A high-level guide. Available from: <www.kingsfund.org.uk/sites/files/kf/how-healthy-are-we-oct-2014.pdf> [Accessed 20.06.15].
- Nelson, M., Erens, B., Bates, B. Et al. (2007) Low income diet and nutrition survey: Summary of key findings. London, Food Standards Agency. p43.
- Faculty of Public Health (2014) Response to the All Party Parliamentary Inquiry into Hunger and Food Poverty in Britian. [Internet]. Available from < www.fph.org.uk> [Accessed 23.06.15].
- Forsey, A. (2014) An Evidence Review for the All Party Parliamentary Inquiry into Hunger in the United Kingdom. Available from: <https://foodpovertyinquiry.files.wordpress.com/2014/12/food-poverty-appg-evidence-review-final.pdf> [Accessed 20.06.15].
Elaine Lane, Freelance Dietitian (Partnership in Nutrition)