Measuring the existence and extent of food poverty

Aim / Research question Food poverty, defined as the inability to afford or access a healthy diet (Radimer et al., 1990), is becoming recognised as a public health emergency (Furey, 2019; Taylor-Robinson et al, 2013). In January 2019, the Environmental Audit Committee published its latest report on the Sustainable Development Goals in the UK, highlighting the need to ensure Government cross-departmental understanding and action on hunger and implement strategies for improvement and monitor progress. However, with no agreed indicator, the Government has not measured the prevalence of food poverty over time to identify those who are unable to afford sufficient food. In the absence of an agreed indicator, Ulster University Business School (UUBS) researchers investigated the internal and inter-reliability of three food poverty indicators (EU Survey on Income and Living Conditions; Food Insecurity Experience Scale; and Household Food Security Survey Module) to inform evidence-based policy making for ultimate inclusion in the government-endorsed Health Survey or Family Resources Survey that may be used/adapted by all UK regions to effectively implement interventions and strategies with the purpose of alleviating food poverty and to support national efforts for food poverty measurement. Design/methodology/approach UUBS researchers, in commonality with the global call to re-orient research and teaching in Business Schools in order to address core societal principles, sought to apply research to solve societal problems under Ulster University’s 5&50 strategic theme of Healthy Communities. Ulster University in conjunction with Institute of Technology Sligo, disseminated an online survey between September and November 2018. Ethical approval was sought and granted from Ulster University’s Research Ethics Filter Committee. A monetary incentive (the opportunity to win one of four £25 high street vouchers) was offered to encourage respondents to complete the online survey. The research was undertaken within the University’s research governance framework and in accordance with data protection. All respondents were made aware that contributions to the research were voluntary and their right to withdraw at any stage was respected. Anonymity and confidentiality were assured. Formal request practices were used to secure respondents’ informed consent. The collection of data, and its storage and security met acceptable ethical standards. Data were analysed with the use of Statistical Package for Social Science (SPSS) software package (Version 24) for Windows (Inc., IBM). Findings In total, 944 respondents completed the survey. The majority (78.7%) was employed full/part time or self-employed; the remainder comprised retired (8.1%); unemployed (4.9%)’; students (3.2%) and homemakers (3.2%). One in twelve (8%) had a total household income (salary and benefits) of less than £10,000 and more than half (52.9%) had a household income of less than £39,999 each year. One in 14 (7.4%) of the total sample self-evaluated their health status as poor. Two in five respondents (41.9%) had children aged under 18 years living in their households. EU-Survey on Income and Living Conditions (four food deprivation measures): • No (0) positive responses to food deprivation measures: 65.6% • 1 positive response to food deprivation measures: 10.1% • 2 positive responses to food deprivation measures: 10.1% • 3 positive responses to food deprivation measures: 7% • All (4) positive responses to food deprivation measures: 7.3% • One in three (34.4%) experienced at least one measure of food deprivation (ie) couldn’t afford to eat meat, fish, poultry or vegetarian equivalent every second day; had a day in the last fortnight when they didn’t have a substantial meal due to lack of money; would like to have, but couldn’t afford, a roast joint (or its equivalent) once a week and/or would like to, but can’t afford to have family/friends around once a month for food/drinks. Food Insecurity Experience Survey (8-item scale): • Food secure / Mild food insecurity (0-3 measures): 84.1% • Moderate food insecurity (4-6 measures): 8.9% • Severe food insecurity (7-8 measures): 7.1% • One in three (35.7%) reported experiencing at least one food poverty measure concerned with eating less healthy foods or skipping meals etc. Household Food Security Scale Module (10-item adult measure; 8-item child measure): • Food secure / Mild food insecurity (0-1 measures): 88.1% • Moderate food insecurity (2-5 measures): 7% • Severe food insecurity (6-10 measures): 4.9% • One in five (21.2%) reported experiencing at least one food poverty measure concerned with worry about running out of food or not eating enough. Even more worryingly, 79 households with children confirmed experiencing at least one food poverty measure. To reduce the quantity of food they serve to their child(ren) is an indication of the extent of the food poverty experience in these households. Overall, there was good ‘agreement’ between the measures with each scale identifying (generally) the same people as experiencing ‘mild’, ‘moderate’ or ‘severe’ food poverty. The qualitative accounts of the lived experience presented the human stories behind the statistics and uncovered how: 1. Food poverty is a reality in terms of unaffordability dictating the nutritional quality and variety of food: “I know my budget: sometimes 'food' is biscuits.” 2. The coexistence of hunger and food poverty in a dual working household: “Based on the last fortnight I have been able to afford meals but, as a working single parent, I worried about feeding my son over the summer and as a result couldn't afford meals for myself. Food is fast becoming an issue for me and it is embarrassing to have to admit that despite working there are still times when you have to go hungry to support your child. You feel entirely responsible.” “Embarrassed at not having money for basics, with both of us working.” 3. Alternative coping strategies deployed to provision the household: “Food bank Friday.” 4. The precariousness of the food situation in households: “Because although money is tight in our house we budget so we make sure we always have enough money for food which may mean sacrificing other things, like treats, but feeding our children and ourselves is a priority.” “ … at present our financial situation is uncomplicated. I fear for the future though.” 5. The disbelief that such a phenomenon exists in the fifth richest world economy: “It makes me feel terrible to think that some people living in this, one of the wealthiest countries in the world, may not have enough money to have a large meal, or to give gifts of food to their friends and extended family. It makes me feel sick to think about that.” Research limitations/implications This research is limited by its focus on Northern Ireland respondents and fact that not every respondent answered every question. While there was good variation across the responses, sample size differed with more limited engagement with open-ended questions regarding the comprehension and complexity, or otherwise, of the food poverty scales. Practical implications Food poverty requires a long-term, sustainable solution that addresses the policy issues under focus: low income, under/unemployment, rising food prices and Welfare Reform, informed by routine, Government-supported monitoring and reporting of the extent of food poverty among our citizens. The recent development that the UK/NI Government(s) will monitor food insecurity with results available from March 2021 will enable annual monitoring, allowing for more focused strategies and targeted interventions to tackle diet-related health inequalities in society. Social implications In unison with End Hunger UK, Church Action on Poverty, Independent Food Aid Network, Food Foundation and others, we sought to have a collective voice on so substantive an issue as food poverty to form the critical mass to lend additional authority, credibility and reach to the results and recommendations. Our data have been shared with the Office of National Statistics re: planning to measure household and child food insecurity for the UK. Originality/value The research benefited from a valuable opportunity to work with the public and third sectors to arrive at experiential results to inform pragmatic solutions to improve our most vulnerable citizens’ lives. It served as a vital conduit between academia and the public sector with dividends in terms of achieving policy makers’ buy-in to the research results and evidence-informed recommendations to address the structural causes of food poverty such as income adequacy, welfare, access to shops and regional planning. This research will inform more focused strategies and targeted interventions to tackle diet-related health inequalities in society and deliver (in)direct public health benefits and savings in terms of healthier diets, reduced prevalence of dietary-related diseases attributable to malnutrition and associated health care, and reduce productivity costs. References Environmental Audit Committee. (2019) Sustainable Development Goals in the UK follow-up: Hunger, malnutrition and food insecurity in the UK. London: House of Commons. Available from: https://www.parliament.uk/business/committees/committees-a-z/commons-select/environmental-audit-committee/inquiries/parliament-2017/sustainable-development-goals-follow-up-17-19/ Furey, S. (2019) UK food poverty now a public health emergency. London: End Hunger UK. Available from http://endhungeruk.org/uk-food-poverty-now-public-health-emergency/#more-555 Radimer, K.L.; Olson, C.M.; Campbell, C.C. (1990) Development of indicators to assess hunger. Journal of Nutrition 120, 1544–1548. Taylor-Robinson, D., Rougeaux, E., Harrison, D., Whitehead, M., Barr, B., and Pearce, A. (2013) Letters: malnutrition and economic crisis - The rise of food poverty in the UK. British Medical Journal, 347:f7157. doi: 10.1136/bmj.f7157.