Navigating household food insecurity and environmental sustainability on a low income: An exploration of Sheffield mothers

In 2023, 25% of adults in England, Wales and Northern Ireland experienced food insecurity. The concentration of food insecurity in both socioeconomically disadvantaged groups and households containing children raises concerns about its uneven nutritional and health impacts across different groups. In parallel with rising food insecurity over the past decade, concerns about the environmental consequences of human diets are intensifying, where urgent changes are needed to people's diets to avoid irreversible environmental damage. It is generally assumed that cost has a significant impact on people's ability to adopt more environmentally sustainable food practices. This UK Research Council-funded project seeks to gain insights into the ways in which low-income mothers (are able to) engage with environmentally sustainable food practices. RQ1 will examine the day-to-day food practices that mothers undertake for their families to offer insights into everyday food insecurity and the relevance of environmentally sustainable food practices. RQ2 will explore biographical experiences to highlight how mothers' life histories influence their familial food practices, including their current household food security and engagement with environmentally sustainable food practices. Finally, RQ3 will explore mothers' upcoming prospects of food insecurity and environmentally sustainable food practices. These research questions will be explored through a qualitative longitudinal, feminist study of 15 low-income mothers in Sheffield, UK, combining in-depth interviews with ethnographic elements. Gaining improved knowledge of mothers' food practices on a low income will be valuable to influence realistic, effective and meaningful philosophies, policies and practical action that prioritises equity, good nutrition and environmentally sustainable food practices.

Food insecurity in adults with severe mental illness living in Northern England: Peer research interview findings

Food insecurity means that a person does not have access to sufficient nutritious food for normal growth and health. Food insecurity can lead to many health problems such as obesity, heart disease, diabetes, and other long term health conditions. People living with a severe mental illness are more likely to experience food insecurity than people without mental illness. Peer-led in-depth interviews were conducted with adults with severe mental illness from Northern England, during which their experiences of food insecurity and strategies to tackle food insecurity were discussed. Interviews took place between March and December 2022, with interviews being transcribed and analysed using deductive and inductive thematic analysis. Thirteen interviews were conducted, finding that food insecurity in adults with severe mental illness was often a long-standing issue. Unemployment, the cost-of-living crisis and fuel poverty impacted on experiences of food insecurity. Difficulties accessing food banks such as transport, stigma, and the limited selection of available food was also discussed. Strategies to tackle food insecurity centred on making food banks more accessible and improving the quality of available food. Future research should aim to eradicate food insecurity for adults with severe mental illness, as limited research and action focuses on this population group over and above 'mental illness' or 'poor mental health'. Removing barriers to accessing food such as lack of transport, and providing food which is of adequate nutritional quality, should be prioritised, as well as tackling the stigma and accessibility issues surrounding food banks use.

The Nutritional Quality of Food Donated to a Western Australian Food Bank

Food banks provide an indispensable service to people experiencing severe food insecurity. Food banks source donations from across the food system; however, the food redistributed to clients across the developed world is nutritionally poor. This, together with the increasing prevalence of diet-related diseases and food insecurity, has prompted a focus on nutritional quality. Despite more food being distributed via food banks in Australia, the nutritional quality of donated food remains unreported. This study analyzed all food (84,996 kg (1216 products)) donated to Foodbank WA over a 5-day period using diet-, food-, and nutrient-based nutrition classification schemes (NCSs). A total of 42% (27% of total weight) of donated food products were deemed 'unsuitable' and 19% (23% by weight) were 'suitable' according to all NCSs. There was no agreement on 39% of products (50% by weight). Overall, NOVA and the Healthy Eating Research Nutrition Guidelines (HERNG) (κ = 0.521) had the highest level of agreement and the ADGs and HERNGs the lowest (κ = 0.329). The findings confirm the poor nutritional quality of food donated to food banks and the need to work with donors to improve the food they donate. Fit-for-purpose nutrition guidelines are urgently needed for Australian food banks to support them in providing nutritious food to their vulnerable clients.

Food security definition, measures and advocacy priorities in high-income countries: a Delphi consensus study

OBJECTIVE

To establish an international consensus on the definition of food security, measures and advocacy priorities in high-income countries.

DESIGN

A two-round online Delphi survey with closing in March 2020 and December 2021. Consensus was set a priori at 75 %. Qualitative data were synthesised and priorities were ranked.

SETTING

High-income countries.

PARTICIPANTS

Household food security experts in academia, government and non-government organisations who had published in the last 5 years.

RESULTS

Up to thirty-two participants from fourteen high-income countries responded to the Delphi with a 25 % response rate in Round 1 and a 38 % response rate in Round 2. Consensus was reached on the technical food security definition and its dimensions. Consensus was not reached on a definition suitable for the general public. All participants agreed that food security monitoring systems provide valuable data for in-country decision-making. Favoured interventions were those that focused on upstream social policy influencing income. Respondents agreed that both national and local community level strategies were required to ameliorate food insecurity, reinforcing the complexity of the problem.

CONCLUSIONS

This study furthers the conceptual understanding of the commonly used definition of food security and its constituent dimensions. Strong advocacy is needed to ensure food security monitoring, policy and mitigation strategies are implemented. The consensus on the importance of prioritising actions that address the underlying determinants of household food security by experts in the field from across wealthy nations provides evidence to focus advocacy efforts and generate public debate.

A UK-wide survey of healthcare professionals' awareness, knowledge and skills of the impact of food insecurity on eating disorder treatment

OBJECTIVE

Food insecurity (FI) is associated with significant adverse effects on health and well-being and increasingly recognised as a global problem. The current study explored the impact of FI on eating disorder (ED) clinical practice in the UK, aiming to assess healthcare professionals' (HCPs) knowledge, skills and views on the topic of FI in their patients.

DESIGN

This study was an exploratory, mixed-methods, descriptive analysis of online survey data collected from ED HCPs in the UK between September and October 2022.

MEASURES

A 15-item survey with rating and open-ended questions was circulated to ED professional organisations in the UK. Descriptive statistics were used to summarise quantitative data, including perceived prevalence of FI in ED clinical practice and confidence in knowledge on the topic. Descriptive content analyses provided insight into perspectives on FI screening and aspects to be included in guidance and resources.

RESULTS

93 ED HCPs completed the survey (40.9 % psychologists). Findings demonstrated healthcare providers' limited knowledge on FI and its relation to EDs, while they increasingly perceive it in their patients, as well as a general lack of available resources on how to address FI in ED treatment. HCPs stressed the need for practical guidance and formal training for dealing with FI in their patients, as well as implementing routine screening.

CONCLUSION

These findings provide both important directions for future research and clinical applications related to screening, assessment, treatment and support of food-insecure patients with EDs.

The nutritional quality of food parcels provided by food banks and the effectiveness of food banks at reducing food insecurity in developed countries: a mixed-method systematic review

BACKGROUND

Research indicates that food parcels provided by food banks are nutritionally poor. Food insecurity and the use of food banks are both rising, with detrimental effects on the dietary intake and health of users. This mixed-method systematic review aims to investigate the current nutritional adequacy of pre-packaged food parcels and whether using food banks reduces the food insecurity and improves the dietary intake of their users.

METHODS

A mixed-method systematic literature review, restricted to articles published from 2015, was conducted using eight electronic databases, four grey literature databases and eight relevant websites. Quantitative findings, investigating the nutritional quality of food parcels and/or their impact on dietary intake or food insecurity, were presented narratively. Qualitative findings reporting the views of food bank users regarding food from food banks underwent thematic synthesis. These independent syntheses were integrated using configurative analysis and presented narratively.

RESULTS

Of 2189 articles, 11 quantitative and 10 qualitative were included. Food parcels were inconsistent at meeting nutritional requirements and often failed to meet individual needs, including cultural and health preferences. Using food banks improved food security and dietary quality of users, allowing otherwise unachievable access to food. However, food insecurity remained, and is explained by limited food variety, quality and choice. The mixed-method findings support interventions to ensure consistent, adequate nutrition at food banks, including catering for individual needs.

CONCLUSIONS

Food banks are a lifeline for those severely food insecure. However when used alone, food banks struggle to eliminate the heightened food insecurity of their users. Efforts to improve the nutritional quality of food parcels could improve the experiences and diet-related outcomes of those requiring food banks.

Understanding the post-2010 increase in food bank use in England: new quasi-experimental analysis of the role of welfare policy

Background

The number of food banks (charitable outlets of emergency food parcels) and the volume of food distributed by them increased multi-fold in the United Kingdom (UK) since 2010. The overwhelming majority of users of food banks are severely food insecure. Since food insecurity implies a nutritionally inadequate diet, and poor dietary intake has been linked to a number of diseases and chronic conditions, the rise in the number of people using food banks is a phenomenon of significant importance for public health. However, there is a shortage of robust, causal statistical analyses of drivers of food bank use, hindering social and political action on alleviating severe food insecurity.

Methods

A panel dataset of 325 local authorities in England was constructed, spanning 9 years (2011/12–2019/20). The dataset included information about the volume of parcels and the number of food banks in the Trussell Trust network, as well as economy-related, welfare system-related and housing-related variables. A quasi-experimental approach was employed in the form of a ‘first differencing’ ecological model, predicting the number of food parcels distributed by food banks in the Trussell Trust network. This neutralised bias from omitting time-constant unobserved confounders.

Results

Seven predictors in the model were statistically significant, including four related to the welfare system: the value of the main out-of-work benefit; the roll-out of Universal Credit; benefit sanctions; and the ‘bedroom tax’ in social housing. Of the remaining three significant predictors, one regarded the ‘supply’ side (the number of food banks in the area) and two regarded the ‘demand’ side (the proportion of working age population on out-of-work benefits; the proportion of working age population who were unemployed).

Conclusion

The structure of the welfare system has been partly responsible for driving food bank use in the UK since 2011. Severe food insecurity could be alleviated by reforming aspects of the benefit system that have been evidenced to be implicated in the rise in food bank use. More broadly, the findings provide support for ‘Health and Health Equity in All Policies’ approach to policymaking.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13738-0.

Chronic pain and depressive symptoms are related to food insecurity among urban food bank users

BACKGROUND

Food bank users suffer high food insecurity. Food insecurity increases risk for chronic health conditions. However, chronic pain and its relation to food insecurity among food bank users is unknown. Knowledge about populations with chronic pain is important to direct appropriate public health nutritional strategies.

METHODS

Participants completed a survey including sleep, pain, depressive symptoms and food insecurity measures. Descriptive statistics characterized the burden of chronic pain among the sample, and a series of chi-square and t-tests assessed for demographic differences between food bank users who reported pain compared to those who did not. Logistic regression tested for variables predicting food insecurity.

RESULTS

Within the sample (N = 207), 53% reported a chronic pain diagnosis. Adults with pain were more likely to receive food stamps and to have a mental health condition than those without pain. Regression analyses revealed that depressive symptoms and chronic pain significantly predicted food insecurity when controlling for age and gender.

CONCLUSIONS

Exploring the link between depression, pain and nutritional resources may enhance understanding of causal relationships driving food insecurity. Public health officials should address nutritional needs of adults including those with chronic pain who use food bank services.

Prevalence of food security in the UK measured by the Food Insecurity Experience Scale

Background

Measurement of UK food insecurity has historically been inconsistent, making it difficult to understand trends. This study contributes by reporting and analysing data from a national survey conducted in line with UN Food and Agriculture Organization (FAO) recommendations and standard methods, providing an internationally comparable pre-coronavirus disease 2019 (COVID-19) snapshot of food insecurity.

Methods

Data came from a nationally representative 2019 UK sample (N = 2000) surveyed by Ipsos-Mori. Prevalence of food insecurity was assessed using the UN FAO Food Insecurity Experience Scale. Logistic regression was used to model food insecurity in relation to geographic and socio-demographic variables.

Results

Severe food insecurity was reported by 3% of the sample, an increase of 66.7% over the last directly comparable UK analysis (Gallup World Poll data from 2016 to 2018). Indication of some degree of food insecurity was reported by 14.2% of the sample and tended to be higher amongst younger age groups, those on lower incomes, and home renters (as opposed to owners). No geographic variables were significantly associated with food insecurity prevalence.

Conclusions

The finding that prevalence of severe food insecurity was already increasing before the COVID-19 pandemic, across all areas of the UK, is cause for concern. Our results provide an important benchmark for assessing the impact of COVID-19 on food insecurity.

Barriers and Facilitators to Healthy Eating among Adult Food Bank Users

Healthy eating relates to improved health, yet adult food bank users report difficulty accessing healthy foods. Registered nurses can promote healthy eating for food bank recipients by understanding perceived obstacles and facilitators. Urban food bank users completed a survey, and qualitative content analysis was used to analyze four open-ended questions regarding perceptions of healthy eating. In total, 196 adults were included in analysis. Two main categories were identified as perceived facilitators and barriers to healthy eating. Themes from the facilitator category included internal resources and external resources. Themes from the barrier category were personal challenges and environmental issues. Healthy eating is a complex behavior that requires personal motivation, skills, and social/environmental supports to be successfully executed among food bank recipients. Nurses should advocate to leverage food bank resources for healthier eating by offering nurtition counseling at events, optimizing access to fresh fruits and vegetables, and decreasing unhealthy food options.

The prevalence, severity and experience of food insecurity in Australia: An investigation of food aid use

High costs of living and low wage growth in Australia have resulted in an increase in the number of people experiencing food insecurity, and a corresponding increase in the number of people accessing food aid. This research employs qualitative methods alongside standard methods to explore food security to investigate these issues in food aid settings in Victoria, Australia. The two aims of this study were, 1) to explore the profile of people who access food aid and 2) to explore the experiences of people accessing food aid. A convenience sample of people was recruited from organisations that distribute food aid from across the state. People in need of food aid typically self-refer to charities, who then apply varied and localised criteria to manage access to the charitable service. Interviews were conducted with 78 participants between June 2018 and January 2019. Participants had been accessing food aid for 4 years on average (SD 5.7, range 1 month-40 years), most participants were female (n = 57, 73.1%), with an average age of 52.6 years (SD 15.9), and over half were born in Australia (n = 44, 56.4%). Most participants were in receipt of a government welfare payment (n = 75, 96.2%), and over 40% were living in private rental accommodation. Around two thirds of participants reported low or very low food security (n = 54, 67.5%). Participants reported a range of both positive and negative experiences accessing food aid. This study adds to the body of literature exploring food insecurity in high-income settings and its persistence despite significant national economic prosperity. Current economic and political conditions in Australia mean that the reliance on food aid by welfare recipients is unlikely to decrease.

Health professionals' experiences and perspectives on food insecurity and long-term conditions: A qualitative investigation

Estimates suggest that over 10% of the UK population are affected by food insecurity. International evidence indicates that food insecurity is a risk factor for many long-term health conditions, and can adversely affect people's ability to manage existing conditions. Food insecurity is thus not only a serious social concern but also a healthcare issue requiring the attention of UK health professionals. An exploratory qualitative study was undertaken to investigate the experiences and views of health professionals in north east Scotland, with a particular focus on support for people with long-term conditions whom they believed were affected by food insecurity. Two focus groups and nine semi-structured interviews were undertaken with a total of 20 health professionals between March and July 2016. Thematic analysis generated three main themes. The health professionals had (a) diverse levels of understanding and experience of food insecurity, but between them identified a range of (b) negative impacts of food insecurity on condition-management, especially for diet dependent conditions or medication regimes, and for mental health. Even for those health professionals more familiar with food insecurity, there were various (c) practical and ethical uncertainties about identifying and working with food insecure patients (it could be difficult to judge, for example, whether and how to raise the issue with people, to tailor dietary advice to reflect food insecurity, and to engage with other agencies working to address food insecurity). This study indicates that health professionals working with food insecure patients have learning and support needs that warrant further investigation. Debates about health professionals' responsibilities, and interventions to guide and support health professionals, including tools that might be used to screen for food insecurity, must also reflect the diverse lived needs and values of people who experience food insecurity.

Edible City Solutions—One Step Further to Foster Social Resilience through Enhanced Socio-Cultural Ecosystem Services in Cities

Nature-based solutions have not been able to actively involve citizens and to address successfully food security, poverty alleviation, and inequality in urban areas. The Edible City approach promises a strategic step towards the development of sustainable, livable, and healthy cities. We introduce the conceptional framework of Edible City Solutions (ECS), including different forms of urban farming combined with closed loop systems for sustainable water, nutrient, and waste management. We review scientific evidence on ECS benefits for urban regeneration and describe the status quo of ECS in Rotterdam, Andernach, Oslo, Heidelberg, and Havana as case studies. We provide an analysis of strengths, weaknesses, opportunities, and threats (SWOT) to explore the capacity of ECS to enhance multifunctionality of urban landscapes with special focus on social cohesion and quality of life. Based on this we identify and discuss strategies for fostering socially relevant implementations for the case study cities and beyond.

A Qualitative Study to Understand the Potential Efficacy of an Information-Based Sugar Reduction Intervention among Low Socioeconomic Individuals in the UK

Sugar consumption in the UK consistently exceeds recommendations, despite the association it has with poor health outcomes. Low socioeconomic groups are most likely to over-consume sugar, which could exacerbate existing health disparities. Various interventions attempt to reduce the amount of sugar consumed, but their effectiveness is still unclear. This study qualitatively explored the sugar consumption behaviours of individuals experiencing food poverty, and examined how an information-based sugar reduction intervention might influence these behaviours. Eight clients and six volunteers from a food bank in Bristol (UK) completed semi-structured, one-to-one interviews that were thematically analysed. Food bank clients appeared to heavily consume sugar, with little understanding of the associated health effects and limited awareness of the intervention. Consumption behaviours were particularly influenced by personal and psychological factors, such as mental health; in addition to social factors, like familial behaviours and food access issues. It emerged that food bank clients' often-challenging personal circumstances were likely to promote their sugar consumption. Making intervention materials visually appealing and easily comprehendible were found to be important for improving an intervention's reception. Recommendations were developed to improve the efficacy of similar information-based sugar reduction interventions among socioeconomically deprived groups.

Food banking and emergency food aid: expanding the definition of local food environments and systems

If current trends in food insecurity continue then the diets of low-income people may become characterised by the inclusion of significant amounts of donated and surplus food accessed via the third-sector. These developments have yet to be integrated into macro models and concepts of the food environment. Addressing this caveat is necessary in order to both help build an evidence base to challenge policies that exacerbate the drivers of food insecurity and to inform interventions aimed at improving the diets of disadvantaged populations.

"A Lot of People Are Struggling Privately. They Don't Know Where to Go or They're Not Sure of What to Do": Frontline Service Provider Perspectives of the Nature of Household Food Insecurity in Scotland

This qualitative study explored frontline service providers' perceptions of the nature of food insecurity in Scotland in 2015 to inform national policy and the provision of locally-based support for 'at risk' groups. A country-wide in-depth interview study was undertaken with informants from 25 health, social care, and third sector organisations. The study investigated informants' perspectives associated with how food insecurity was manifesting itself locally, and what was happening at the local level in response to the existence of food insecurity. Data analysis revealed three key themes. First, the multiple faces and factors of food insecurity involving not only increased concern for previously recognised 'at risk of food insecurity' groups, but also similar concern held about newly food insecure groups including working families, young people and women. Secondly, respondents witnessed stoicism and struggle, but also resistance amongst some food insecure individuals to external offers of help. The final theme identified community participation yet pessimism associated with addressing current and future needs of food insecure groups. These findings have important implications for the design and delivery of health and social policy in Scotland and other countries facing similar challenges.

Examining Patterns of Food Bank Use Over Twenty-Five Years in Vancouver, Canada

Food banks have grown substantially in Canada since the 1980s but little is known about patterns or predictors of engagement including frequency or duration of service use. This study examined food bank program data from a large food bank organization in Vancouver, Canada, finding that between January 1992 and June 2017, at least 116,963 individuals made over 2 million food bank visits. The majority of members were engaged for a short time and came for relatively few visits, but 9% of members engaged in longer-term episodic or ongoing usage over several years, accounting for 65% of all visits. Results from cluster and regression analyses found that documented health and mobility challenges, larger household size, primary income source, and older age were predictors of higher frequency and duration of service usage. Findings add to growing critical examinations of the "emergency food system" highlighting the need for better understanding of the broader social policies influencing food bank use.