More than Just Food: Food Insecurity and Resilient Place Making through Community Self-Organising

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: A systematic review with meta-analysis

INTRODUCTION

Food insecurity in adults living with Severe Mental Illness (SMI) is an underresearched area worldwide.

AIM

This systematic review and meta-analysis aimed to identify and collate evidence on food insecurity in adults with SMI, in high- and upper-middle income countries.

METHOD

A comprehensive electronic search was completed up to August 2022. Random effects meta-analysis was undertaken to determine the prevalence and the odds ratio for food insecurity in adults with SMI. Narrative synthesis explored the data further.

RESULTS

Sixteen publications were included (13 in the meta-analysis). The prevalence estimate of food insecurity in adults with SMI was 41% (95% CI: 29% to 53%, I2  = 99.9%, n = 13). Adults with SMI were 3.31 (95% CI: 2.03 to 5.41) times more likely to experience food insecurity than comparators without SMI (z = 6.29, p < .001, I2  = 98.9%, n = 6). Food insecurity appears to be a risk factor for developing SMI.

DISCUSSION

This review suggests adults with SMI living in high- or upper-middle income countries are more likely to experience food insecurity than the general population and that this relationship may be inverse.

IMPLICATIONS FOR PRACTICE

Mental health practitioners should be aware of food insecurity and support individuals with SMI to access sufficient food.

Food insecurity and the dental team: a pilot study to explore opinions

PURPOSE

In total, 17% of UK households with children experience food insecurity, with evidence to suggest a direct correlation with the prevalence of oral disease. This study explores current perceptions of the dental team, when recognising and supporting families who may experience food insecurity.

MATERIALS AND METHODS

An online, anonymous cross-sectional survey was designed and sent to members of the British Society of Paediatric Dentistry (BSPD) in June 2023, examining confidence and understanding surrounding food insecurity and dental health. Quantitative data is presented descriptively and qualitative data using a thematic analysis.

RESULTS

The response rate was 9.6% (n = 76). A significant number recognise the link between poor oral health and food insecurity, 80.3% (n = 61). Although practitioners are confident in oral health counselling, 80.3% (n = 61) a smaller proportion are not as confident when approaching food insecurity 32.9% (n = 25). Dental team members recognise the need to improve identification of affected patients and that they have a professional duty to support. Intervention strategies, such as additional training to support team development and signposting of patients are indicated.

CONCLUSION

This study suggests that whilst dental professionals understand the link between food insecurity and oral health, and their responsibilities to those affected; they lack confidence in identifying such patients and providing support. Additional conversations and training are fundamental to better understand their role, which must reflect the needs of the population that they serve.

Food insecurity in adults with severe mental illness living in Northern England: A co-produced cross-sectional study

AIM

This study aimed to explore food insecurity prevalence and experiences of adults with severe mental illness living in Northern England.

METHODS

This mixed-methods cross-sectional study took place between March and October 2022. Participants were adults with self-reported severe mental illness living in Northern England. The survey included demographic, health, and financial questions. Food insecurity was measured using the US Department of Agriculture Adult Food Security measure. Quantitative data were analysed using descriptive statistics and binary logistic regression; and qualitative data using content analysis.

RESULTS

In total, 135 participants completed the survey, with a mean age of 44.7 years (SD: 14.1, range: 18-75 years). Participants were predominantly male (53.3%), white (88%) and from Yorkshire (50.4%). The food insecurity prevalence was 50.4% (n = 68). There was statistical significance in food insecurity status by region (p = 0.001); impacts of severe mental illness on activities of daily living (p = 0.02); and the Covid pandemic on food access (p < 0.001). The North West had the highest prevalence of food insecurity (73.3%); followed by the Humber and North East regions (66.7%); and Yorkshire (33.8%). In multivariable binary logistic regression, severe mental illness' impact on daily living was the only predictive variable for food insecurity (odds ratio = 4.618, 95% confidence interval: 1.071-19.924, p = 0.04).

CONCLUSION

The prevalence of food insecurity in this study is higher than is reported in similar studies (41%). Mental health practitioners should routinely assess and monitor food insecurity in people living with severe mental illness. Further research should focus on food insecurity interventions in this population.

Engaging with 'less affluent' communities for food system transformation: a community food researcher model (FoodSEqual project)

The UK food system is distorted by inequalities in access, failing the people most in need, yet it should provide access to safe, nutritious affordable food for all citizens. Dietary patterns are associated with socio-demographic characteristics, with high levels of diet-related disease mortality attributed to poor dietary habits. Disadvantaged UK communities face urgent public health challenges, yet are often treated as powerless recipients of dietary and health initiatives. The need for food system transformation has been illustrated within recent UK government policy drivers and research funding. The Food Systems Equality project is a research consortium that aims to 'co-produce healthy and sustainable food systems for disadvantaged communities'. The project focusses on innovating food products, supply chains and policies, placing communities at the centre of the change. Tackling the above issues requires new ways of working. Creative approaches in food research are known to empower a wider range of individuals to share their 'lived food experience' narratives, building relationships and corroborating co-production philosophies, thus promoting social justice, and challenging more traditional positivist/reductionist 'biomedical' approaches for nutrition and food studies. This review paper critiques the use of community-centric approaches for food system transformation, focusing on one, a community food researcher model() as an exemplar, to highlight their utility in advocating with rather than for less affluent communities. The potential for creative methods to lead to more equitable and lasting solutions for food system transformation is appraised, consolidating the need for community-driven systemic change to foster more progressive and inclusive approaches to strengthen social capital. The paper closes with practice insights and critical considerations offering recommendations for readers, researchers, and practitioners, enabling them to better understand and apply similar approaches.

A critical exploration of the diets of UK disadvantaged communities to inform food systems transformation: a scoping review of qualitative literature using a social practice theory lens

The UK food system affects social, economic and natural environments and features escalating risk of food insecurity. Yet it should provide access to safe, nutritious, affordable food for all citizens. Disadvantaged UK communities [individuals and families at risk of food and housing insecurity, often culturally diverse] have often been conceptualised in terms of individual behaviour which may lead to findings and conclusions based on the need for individual change. Such communities face public health challenges and are often treated as powerless recipients of dietary and health initiatives or as 'choiceless' consumers within food supply chains. As transforming the UK food system has become a national priority, it is important a diverse range of evidence is used to support understanding of the diets of disadvantaged communities to inform food systems transformation research.A scoping review of UK peer reviewed qualitative literature published in MEDLINE, CINAHL Plus with Full Text, EMBASE, PsycINFO and Web of Science between January 2010 and May 2021 in English. Eligibility criteria were applied, a data extraction table summarised data from included studies, and synthesis using social practice theory was undertaken.Forty-five qualitative studies were reviewed, which included the views of 2,434 community members aged between 5 and 83. Studies used different measures to define disadvantage. Synthesis using social practice theory identified themes of food and dietary practices shaped by interactions between 'material factors' (e.g. transport, housing and money), 'meanings' (e.g. autonomy and independence), and 'competencies' (e.g. strategies to maximise food intake). These concepts are analysed and critiqued in the context of the wider literature to inform food systems transformation research.This review suggests to date, qualitative research into diets of UK disadvantaged communities provides diverse findings that mainly conceptualise disadvantage at an individual level. Whilst several studies provide excellent characterisations of individual experience, links to 'macro' processes such as supply chains are largely missing. Recommendations are made for future research to embrace transdisciplinary perspectives and utilise new tools (e.g., creative methods and good practice guides), and theories (e.g., assemblage) to better facilitate food systems transformation for disadvantaged communities.

Opportunities to improve population health: possibilities for healthier food environments

The recent Covid-19 pandemic highlighted stark social inequalities, notably around access to food, nutrition and to green or blue space (i.e. outdoor spaces with vegetation and water). Consequently, obesity is socio-economically patterned by this inequality; and while the environmental drivers of obesity are widely acknowledged, there is currently little upstream intervention. We know that living with obesity contributes to increasing health inequalities, and places healthcare systems under huge strain. Our environment could broadly be described obesogenic, in the sense of supporting unhealthful eating patterns and sedentary behaviour. Evidence points to the existence of nearly 700 UK obesity policies, all of which have had little success. Obesity prevention and treatment has focused on educational and behavioural interventions targeted at individual consumers. A more sustainable approach would be to try and change the environments that promote less healthy eating and high energy intake as well as sedentary behaviour. Approaches which modify the environment have the potential to assist in the prevention of this complex condition. This review paper focuses on the role of wider food environments or foodscapes. While there is an imperfect evidence base relating to the role of the foodscape in terms of the obesity crisis, policy, practice, civic society and industry must work together and take action now, in areas where current evidence suggests change is required. Despite the current cost-of-living crisis, shaping the foodscape to better support healthful eating decisions has the potential to be a key aspect of a successful obesity prevention intervention.

Understanding the Experiences of Food Insecurity in Older Adult Households

Food insecurity is a pressing multidimensional problem that negatively impacts the health and well-being of a significant number of the older population. Finding ways to better address nutritional issues among this vulnerable population is vital to their well-being. Using a mixed-methods approach, we conducted semi-structured phone interviews with a representative sample of 434 low-income older adult households in Tennessee. The aim of this study is to assess the prevalence of food insecurity, examine ongoing barriers, and, using qualitative data, to explore the diverse daily experiences older adults face when confronted with a food insecure lifestyle. Based on the USDA Adult 10-Item Household Screening Module, we found that 30% in our sample were designated as marginally, low or very low food secure. Many of those most vulnerable (older women, widowed or divorced, poor health and below the poverty line) constantly struggled with food insecurity. Being food insecure was attributed to limited financial resources, lack of transportation, health limitations, and a poor psychological state. Utilizing food stretching practicing, governmental agencies offering food supplements, family/friends, religious groups and personal resilience were common coping strategies. Implications and recommendations for service providers are offered.

The Role of Food Literacy in Managing Nutritional Precarity in the Migrant Experience: Dietary Lifestyles of Cambodia Migrants in Thailand

The paper explores the dietary lifestyles of young Cambodian migrants in Thailand to illuminate the role of food literacy in determining nutritional outcomes and well-being, including during crises, such as the COVID-19 pandemic. In this context, food literacy is defined as food skills and abilities to plan, select, and prepare to achieve adequate consumption under new or adverse social and culinary contexts of the migrant experience. In this paper, we consider both how nutritional precarity arises in the migrant experience, and to what extent food literacy can mitigate it under various conditions. The research approach involves a combination of qualitative and quantitative approaches that were adjusted to address the limited mobility for social science research during the COVID-19 pandemic in Thailand. Data collection was conducted through hybrid (online and in-person) ethnography, focus group discussions, food literacy questionnaires, and key informant interviews, often facilitated through internet messaging clients. The findings indicate that, while generally high food literacy may facilitate the transition to the foreign food systems found in migration destinations, optimizing nutrition and well-being requires reinforcement by context-specific food literacy, such as openness to foreign flavors and recipes. Contextual food literacy most directly leads to positive social and health outcomes while simultaneously expanding universal food literacy in the long-term.

Household food insecurity risk indices for English neighbourhoods: Measures to support local policy decisions

BACKGROUND

In England, the responsibility to address food insecurity lies with local government, yet the prevalence of this social inequality is unknown in small subnational areas. In 2018 an index of small-area household food insecurity risk was developed and utilised by public and third sector organisations to target interventions; this measure needed updating to better support decisions in different settings, such as urban and rural areas where pressures on food security differ.

METHODS

We held interviews with stakeholders (n = 14) and completed a scoping review to identify appropriate variables to create an updated risk measure. We then sourced a range of open access secondary data to develop an indices of food insecurity risk in English neighbourhoods. Following a process of data transformation and normalisation, we tested combinations of variables and identified the most appropriate data to reflect household food insecurity risk in urban and rural areas.

RESULTS

Eight variables, reflecting both household circumstances and local service availability, were separated into two domains with equal weighting for a new index, the Complex Index, and a subset of these to make up the Simple Index. Within the Complex Index, the Compositional Domain includes population characteristics while the Structural Domain reflects small area access to resources such as grocery stores. The Compositional Domain correlated well with free school meal eligibility (rs = 0.705) and prevalence of childhood obesity (rs = 0.641). This domain was the preferred measure for use in most areas when shared with stakeholders, and when assessed alongside other configurations of the variables. Areas of highest risk were most often located in the North of England.

CONCLUSION

We recommend the use of the Compositional Domain for all areas, with inclusion of the Structural Domain in rural areas where locational disadvantage makes it more difficult to access resources. These measures can aid local policy makers and planners when allocating resources and interventions to support households who may experience food insecurity.

Food insecurity and severe mental illness: understanding the hidden problem and how to ask about food access during routine healthcare

Food insecurity occurs when an individual lacks the financial resources to ensure reliable access to sufficient food to meet their dietary, nutritional and social needs. Adults living with mental ill health, particularly severe mental illness, are more likely to experience food insecurity than the general adult population. Despite this, most interventions and policy reforms in recent years have been aimed at children and families, with little regard for other vulnerable groups. Initiating a conversation about access to food can be tricky and assessing for food insecurity does not happen in mental health settings. This article provides an overview of food insecurity and how it relates to mental ill health. With reference to research evidence, the reader will gain an understanding of food insecurity, how it can be assessed and how food-insecure individuals with severe mental illness can be supported. Finally, we make policy recommendations to truly address this driver of health inequality.

Exploring the Geographic Variation in Fruit and Vegetable Purchasing Behaviour Using Supermarket Transaction Data

The existence of dietary inequalities is well-known. Dietary behaviours are impacted by the food environment and are thus likely to follow a spatial pattern. Using 12 months of transaction records for around 50,000 ‘primary’ supermarket loyalty card holders, this study explores fruit and vegetable purchasing at the neighbourhood level across the city of Leeds, England. Determinants of small-area-level fruit and vegetable purchasing were identified using multiple linear regression. Results show that fruit and vegetable purchasing is spatially clustered. Areas purchasing fewer fruit and vegetable portions typically had younger residents, were less affluent, and spent less per month with the retailer.

Social eating initiatives and the practices of commensality

Social eating initiatives are a mode of food provisioning and eating that have become increasingly popular in the UK. These organisations provide a menu of low-cost meals prepared using food surpluses and deliberately serve food communally to improve social inclusion. Although these community initiatives have grown rapidly in popularity, research into their value from the perspective of participants is currently limited. This article presents data from a concurrent multi-method study conducted across multiple sites of the Nottingham Social Eating Network to explain the emergence of these novel social configurations. The results show this form of commensality, or group eating practice, is not simply a consequence of reducing food waste or food insecurity. Instead these initiatives are enacted through a series of intersecting social practices, which include: the restructuration of the shared mealtime; alimentary contribution; and performances of care. The findings provide important insights into the values expressed in these emergent initiatives and are therefore useful for framing social eating in public policy.

Fresh street: the development and feasibility of a place-based, subsidy for fresh fruit and vegetables

Background

Many UK communities experience food insecurity, and consume diets high in energy-dense, nutrient poor, processed foods and low in fruit and vegetables (FV). We explored a novel area-based approach to promote FV consumption and healthy eating in one such community.

Methods

We developed a weekly subsidy scheme for fresh FV with key local stakeholders in an area of socioeconomic deprivation in Northern England. The scheme (Fresh Street) offered five £1 vouchers to every household, regardless of income or household type. Vouchers were redeemable with local suppliers of fresh FV (not supermarkets). The feasibility of the scheme was assessed in four streets using rapid ethnographic assessment and voucher redemption information.

Results

Local councillors and public health teams were supportive of the scheme. Most eligible households joined the scheme (n = 80/97, 83%), and 89.3% (17 849/19 982) of vouchers issued were redeemed. Householders reported that the scheme made them think about what they were eating, and prompted them to buy and eat more FV.

Conclusions

This feasibility study reported high levels of acceptance for a place-based, household-level weekly FV subsidy scheme. Further research is required to evaluate the effectiveness of this approach to creating healthy diets, eating behaviours and food systems.

Pathways to Scaling Agroecology in the City Region: Scaling out, Scaling up and Scaling deep through Community-Led Trade

Scaling agroecology has the potential to support more sustainable and just food futures. This article investigates a case of community-led trade operating in the city region of London. Drawing upon interviews with stakeholders and practice-based ethnographic fieldwork, challenges and opportunities for agroecology are examined. Three dimensions of scaling agroecology are identified as pathways to sustainable and just food futures in the city region: scaling out, scaling up and scaling deep. Findings suggest scaling out agroecology requires access to secure, affordable land and infrastructure for agroecological communities of practice, alongside investment in capacity building for agroecological communities of practice via learning platforms (such as training programmes) and knowledge exchange (such as farmer-to-farmer and trader-to-trader learning). Second, scaling up agroecology requires transformations in policy, planning and legislation that value and invest in agroecological practices and divest in unsustainable and unjust food systems, supported via translocal networks for exchange of good practice. Third, scaling deep agroecology requires investment both in transformative learning opportunities and networks that support agroecological communities of practices, including those with lived experience of food injustice. Findings have implications for the question regarding scaling agroecology in the city region.

Foodscape: A scoping review and a research agenda for food security-related studies

Since 1995, the term ‘foodscape’, a contraction of food and landscape, has been used in various research addressing social and spatial disparities in public health and food systems. This article presents a scoping review of the literature examining how this term is employed and framed. We searched publications using the term foodscape in the Web of Science Core Collection, MEDLINE, and Scopus databases. Analyzing 140 publications, we highlight four approaches to the foodscape: (i) Spatial approaches use statistics and spatial analysis to characterize the diversity of urban foodscapes and their impacts on diet and health, at city or neighborhood scales. (ii) Social and cultural approaches at the same scales show that foodscapes are socially shaped and highlight structural inequalities by combining qualitative case studies and quantitative surveys of food procurement practices. (iii) Behavioral approaches generally focus on indoor micro-scales, showing how consumer perceptions of foodscapes explain and determine food behaviors and food education. (iv) Systemic approaches contest the global corporate food regime and promote local, ethical, and sustainable food networks. Thus, although spatial analysis was the first approach to foodscapes, sociocultural, behavioral and systemic approaches are becoming more common. In the spatial approach, the term ‘foodscape’ is synonymous with ‘food environment’. In the three other approaches, ‘foodscape’ and ‘food environment’ are not synonymous. Scholars consider that the foodscape is not an environment external to individuals but a landscape including, perceived, and socially shaped by individuals and policies. They share a systemic way of thinking, considering culture and experience of food as key to improving our understanding of how food systems affect people. Foodscape studies principally address three issues: public health, social justice, and sustainability. The review concludes with a research agenda, arguing that people-based and place-based approaches need to be combined to tackle the complexity of the food-people-territory nexus.

Participatory Food Cities: Scholar Activism and the Co-Production of Food Knowledge

UK food policy assemblages link a broad range of actors in place-based contexts, working to address increasingly distanciated food supply chains, issues of food justice and more. Academic interest in social movements, such as Sustainable Food Cities, has in recent years taken a participatory turn, with academics seeking to foreground the voices of community-based actors and to work alongside them as part of the movement. Bringing together literatures on multiscalar food governance and participatory methods, this paper investigates the intersection of food policy networks via a place-based case study focused on the co-convening of a community acting to co-produce knowledge of household food insecurity in a UK city. By taking a scholar activist approach, this paper sets out how a place-based cross-sectoral food community mobilised collective knowledge and brought together a community of practice to tackle urgent issues of food justice. Drawing from Borras 2016, it will explore how scholar activism requires the blurring of boundaries between thinking and doing in order to both act with, and reflect on, the food movement. The issues of actively driving forward a food network, along with the tensions and challenges that arise, are investigated, whilst also foregrounding the role academics have in linking food policy and praxis via place-based food communities.