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Dear Editor
We are grateful to Goodwin for clearly describing the worsening food insecurity crisis and the brutal paradox that food bank teams are caught in as poverty levels continue to rise.(1) Even before the recent pandemic the UKs food insecurity crisis was growing and more recently there has been unprecedented demand with some food banks struggling to cope.(1,2)
The public health implications of food insecurity are considerable, particularly as food insecurity has a higher prevalence among certain population groups. Children living in food-insecure homes are more likely to have poor health and worse educational outcomes compared with children growing up in homes that are food-secure.(3,4). However, Article 24 of the United Nations Convention on the Rights of the Child is unequivocable in stating that:
“Every child has the right to the best possible health. Governments must provide good quality health care, clean water, nutritious food, and a clean environment and education on health and well-being so that children can stay healthy”(5)
Food insecurity can have damaging effects on physical and mental health.(6) Some adults will feel stigmatised and isolated and the immediate impacts may be stress, depression and anxiety. In the long-term it could contribute to inequalities in cancer, coronary heart disease and diabetes.(4)
A classic public health parable “the upstream-downstream story” can help to guide us out of this crisis.(7) We should not just “keep pulling people out of the river”, we need to go upstream and ask “why do so many people keep falling in?” We should stop our preoccupation with this short-term work and begin focusing our attention upstream, where the real problems lie. Foodbanks and free school meals are currently vital and help to meet individuals and families’ immediate needs but they are unable to ameliorate long-term food insecurity.
The main reasons for increased use of food banks, food pantries, food clubs, soup kitchens and other essential supports are the impact of low wages and low benefits and the deepening cost of living crisis.(4,6) Food banks are seeing increasing numbers of people who are in work but cannot afford essentials. A considerable number of families are struggling to meet basic living costs and so eating healthily is unaffordable.
Free school meals can be offered in different ways and may be part of a future solution. Unfortunately, when they are linked to family incomes they can generate stigma and a sense of segregation.(8,9) However, when food is served as a universal free school meal, they can help to improve the quality of children’s diets, general health, and well-being.(9-11) Universal free school meals may also encourage children and young people to make healthy food choices in an environment where healthy food and drink are available as part of a school food policy.(12)
The UK is one of the world’s richest countries and individuals and families should have enough resources to buy and prepare nutritious food. National interventions are needed so that unemployed and low-income families can afford food and heating. In addition support could be provided by subsidising fruit and vegetables and taxing less healthy foods.(13,14)
The Institute of Health Promotion and Education strongly believes that food insecurity should be made a priority by the Government.(15,16) Fiscal measures are urgently needed that improve the adequacy and stability of household incomes. In addition, a longer-term strategy should be developed so that foodbanks can be phased out.
8) Yu B, Lim H, Kelly S. Does receiving a school free lunch lead to a stigma effect? Evidence from a longitudinal analysis in South Korea. Soc Psychol Educ 2019; 22(2): 291–319. doi: 10.1007/ s11218-019-09485-7 https://link.springer.com/article/10.1007/s11218-019-09485-7
9) Taylor J, Garnett B, Horton MA, Farineau G. Univer¬sal free school meal programs in Vermont show multi-do¬main benefits. J Hunger Environ Nutr 2020; 15(6): 1–14. doi: 10.1080/19320248.2020.1727807 https://www.tandfonline.com/doi/abs/10.1080/19320248.2020.1727807
10) Vik, F.N., Van Lippevelde, W. & Øverby, N.C. Free school meals as an approach to reduce health inequalities among 10–12- year-old Norwegian children. BMC Public Health 19, 951 (2019). https://doi.org/10.1186/s12889-019-7286-z
11) Illøkken KE, Johannessen B, Barker ME, Hardy-Johnson P, Øverby NC, Vik FN. Free school meals as an opportunity to target social equality, healthy eating, and school functioning: experiences from students and teachers in Norway. Food Nutr Res. 2021 Jul 9;65. doi: 10.29219/fnr.v65.7702. PMID: 34349612; PMCID: PMC8287658. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8287658/
12) Lloyd J. Compassion through development of physical and mental health and well-being. In, Towards the Compassionate School. Ed. Maurice Irfan Coles. London: Trentham Books/IOE Press, 2015.
15) Watson M C, Lloyd J. Food poverty should not be allowed to continue—government action is needed BMJ 2021; 372 :n343 doi:10.1136/bmj.n343 https://www.bmj.com/content/372/bmj.n343
Food banks should be phased out: fiscal measures are needed.
Dear Editor
We are grateful to Goodwin for clearly describing the worsening food insecurity crisis and the brutal paradox that food bank teams are caught in as poverty levels continue to rise.(1) Even before the recent pandemic the UKs food insecurity crisis was growing and more recently there has been unprecedented demand with some food banks struggling to cope.(1,2)
The public health implications of food insecurity are considerable, particularly as food insecurity has a higher prevalence among certain population groups. Children living in food-insecure homes are more likely to have poor health and worse educational outcomes compared with children growing up in homes that are food-secure.(3,4). However, Article 24 of the United Nations Convention on the Rights of the Child is unequivocable in stating that:
“Every child has the right to the best possible health. Governments must provide good quality health care, clean water, nutritious food, and a clean environment and education on health and well-being so that children can stay healthy”(5)
Food insecurity can have damaging effects on physical and mental health.(6) Some adults will feel stigmatised and isolated and the immediate impacts may be stress, depression and anxiety. In the long-term it could contribute to inequalities in cancer, coronary heart disease and diabetes.(4)
A classic public health parable “the upstream-downstream story” can help to guide us out of this crisis.(7) We should not just “keep pulling people out of the river”, we need to go upstream and ask “why do so many people keep falling in?” We should stop our preoccupation with this short-term work and begin focusing our attention upstream, where the real problems lie. Foodbanks and free school meals are currently vital and help to meet individuals and families’ immediate needs but they are unable to ameliorate long-term food insecurity.
The main reasons for increased use of food banks, food pantries, food clubs, soup kitchens and other essential supports are the impact of low wages and low benefits and the deepening cost of living crisis.(4,6) Food banks are seeing increasing numbers of people who are in work but cannot afford essentials. A considerable number of families are struggling to meet basic living costs and so eating healthily is unaffordable.
Free school meals can be offered in different ways and may be part of a future solution. Unfortunately, when they are linked to family incomes they can generate stigma and a sense of segregation.(8,9) However, when food is served as a universal free school meal, they can help to improve the quality of children’s diets, general health, and well-being.(9-11) Universal free school meals may also encourage children and young people to make healthy food choices in an environment where healthy food and drink are available as part of a school food policy.(12)
The UK is one of the world’s richest countries and individuals and families should have enough resources to buy and prepare nutritious food. National interventions are needed so that unemployed and low-income families can afford food and heating. In addition support could be provided by subsidising fruit and vegetables and taxing less healthy foods.(13,14)
The Institute of Health Promotion and Education strongly believes that food insecurity should be made a priority by the Government.(15,16) Fiscal measures are urgently needed that improve the adequacy and stability of household incomes. In addition, a longer-term strategy should be developed so that foodbanks can be phased out.
References
1) Goodwin S. Ending the food bank paradox BMJ 2022; 379 :o2919 doi:10.1136/bmj.o2919
https://www.bmj.com/content/379/bmj.o2919
2) Independent Food Aid Network. IFAN Survey November 2022. London: IFAN, 2022.
https://www.foodaidnetwork.org.uk/data
3) BMA. Food for thought: promoting healthy diets among children and young people. 2015. https://www.bma.org.uk/collective-voice/policy-and-research/public-and-p...
4) Marmot M, Allen J, Boyce T, Goldblatt P, Morrison J. Health equity in England: the Marmot review 10 years on. Feb 2020. https://www.health.org.uk/publications/reports/the-marmot-review-10-year...
5) UNICEF. A summary of the UN Convention on the Rights of the Child.
(Accessed 10/12/2022)
https://www.unicef.org.uk/wp-content/uploads/2019/10/UNCRC_summary-1_1.pdf
6) Sosenko F, Littlewood M, Bramley G. State of Hunger. A study of poverty and food insecurity in the UK. The Trussel Trust, 2019.
https://www.trusselltrust.org/wp-content/uploads/sites/2/2019/06/SoH-Int...
7) McKinlay JB. A case for refocusing upstream: the political economy of illness. Applying behavioral science to cardiovascular risk: proceedings of a conference. American Heart Assoc 1975;7-17
https://iaphs.org/wp-content/uploads/2019/11/IAPHS-McKinlay-Article.pdf
8) Yu B, Lim H, Kelly S. Does receiving a school free lunch lead to a stigma effect? Evidence from a longitudinal analysis in South Korea. Soc Psychol Educ 2019; 22(2): 291–319. doi: 10.1007/ s11218-019-09485-7
https://link.springer.com/article/10.1007/s11218-019-09485-7
9) Taylor J, Garnett B, Horton MA, Farineau G. Univer¬sal free school meal programs in Vermont show multi-do¬main benefits. J Hunger Environ Nutr 2020; 15(6): 1–14. doi: 10.1080/19320248.2020.1727807
https://www.tandfonline.com/doi/abs/10.1080/19320248.2020.1727807
10) Vik, F.N., Van Lippevelde, W. & Øverby, N.C. Free school meals as an approach to reduce health inequalities among 10–12- year-old Norwegian children. BMC Public Health 19, 951 (2019).
https://doi.org/10.1186/s12889-019-7286-z
11) Illøkken KE, Johannessen B, Barker ME, Hardy-Johnson P, Øverby NC, Vik FN. Free school meals as an opportunity to target social equality, healthy eating, and school functioning: experiences from students and teachers in Norway. Food Nutr Res. 2021 Jul 9;65. doi: 10.29219/fnr.v65.7702. PMID: 34349612; PMCID: PMC8287658.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8287658/
12) Lloyd J. Compassion through development of physical and mental health and well-being. In, Towards the Compassionate School. Ed. Maurice Irfan Coles. London: Trentham Books/IOE Press, 2015.
13) Watson MC, Lloyd J. Taxing sugar should be just one element of a multifaceted campaign. BMJ 2015;351:h4388.
https://www.bmj.com/content/351/bmj.h4388
14) World Health Organization. Fiscal Policies for Diet and Prevention of Noncommunicable Diseases. Geneva: World Health Organization, 2016.
https://www.who.int/dietphysicalactivity/publications/fiscal-policies-di...
15) Watson M C, Lloyd J. Food poverty should not be allowed to continue—government action is needed BMJ 2021; 372 :n343 doi:10.1136/bmj.n343
https://www.bmj.com/content/372/bmj.n343
16) Watson M C, Tilford S, Neil K E (2022) IHPE Position Statement: Ethics and Health Promotion. Altrincham: Institute of Health Promotion and Education.
https://ihpe.org.uk/wp-content/uploads/2022/11/IHPE-Position-Statement-E...
Competing interests: No competing interests