Elizabeth Dowler

Inequalities in diet and physical activity in Europe.

The contribution of food, nutrition and physical activity to inequalities in health across Europe is largely unexplored. This paper summarizes cross sectional survey data on food patterns and nutrient intakes, and briefer data on physical activity, by various indicators of socio-economic status for countries across Europe. Factors are examined which underlie the outcome data seen. These include structural and material conditions and circumstances which contribute to excluding socio-demographic groups from participating in mainstream patterns of living. Trends in social and economic conditions, and their implications for nutritional and physical wellbeing are briefly outlined.

The impact of a community-based food skills intervention on cooking confidence, food preparation methods and dietary choices – an exploratory trial

OBJECTIVE To evaluate the feasibility of undertaking a food skills intervention study in areas of social deprivation aimed at altering cooking confidence, food preparation methods and dietary choices. DESIGN A standardised skills programme was implemented in community-based settings. Pre- (T1) and post-intervention (T2) and 6-month follow-up (T3) measures (7-day diaries and self-administered questionnaires) were undertaken in intervention and comparison groups. SETTING Eight urban communities in Scotland. SUBJECTS One hundred and thirteen adults living in areas of social deprivation. RESULTS It was clear that many subjects led fragmented lives and found commitment to intervention classes problematic. Sixty-three subjects completed the final (T3) assessments. The response to each component varied due to inability to attend sessions, illness, study requirements, employment, moving out of the area, change in circumstances, loss of interest and loss of postal questionnaires. At baseline, reported consumption of fruit and vegetables was low (mean frequency 8.1 +/- 4.78 times per week). Fruit intake increased significantly (P < 0.05) between T1 and T2 in the intervention group (1.7 +/- 2.36 to 2.7 +/- 3.28 times per week) only. Between T1 and T3, there was a significant increase (P < 0.05) in intervention subjects who reported confidence in following a recipe (67-90%,). CONCLUSIONS This exploratory trial shows that a food skills intervention is likely to have a small but positive effect on food choice and confidence in food preparation. A full-scale randomised controlled trial in this hard-to-reach group would require a range of flexible approaches rather than a fully defined intervention, and presents challenges for trial design.

A minimum income for healthy living

BACKGROUND Half a century of research has provided consensual evidence of major personal requisites of adult health in nutrition, physical activity and psychosocial relations. Their minimal money costs, together with those of a home and other basic necessities, indicate disposable income that is now essential for health. METHODS In a first application we identified such representative minimal costs for healthy, single, working men aged 18–30, in the UK. Costs were derived from ad hoc survey, relevant figures in the national Family Expenditure Survey, and by pragmatic decision for the few minor items where survey data were not available. RESULTS Minimum costs were assessed at £131.86 per week (UK April 1999 prices). Component costs, especially those of housing (which represents around 40% of this total), depend on region and on several assumptions. By varying these a range of totals from £106.47 to £163.86 per week was detailed. These figures compare, 1999, with the new UK national minimum wage, after statutory deductions, of £105.84 at 18–21 years and £121.12 at 22+ years for a 38 hour working week. Corresponding basic social security rates are £40.70–£51.40 per week. INTERPRETATION Accumulating science means that absolute standards of living, “poverty”, minimal official incomes and the like, can now be assessed by objective measurement of the personal capacity to meet the costs of major requisites of healthy living. A realistic assessment of these costs is presented as an impetus to public discussion. It is a historical role of public health as social medicine to lead in public advocacy of such a national agenda.

Rights-based approaches to addressing food poverty and food insecurity in Ireland and UK

Food poverty is an important contributing factor to health inequalities in industrialised countries; it refers to the inability to acquire or eat an adequate quality or sufficient quantity of food in socially acceptable ways (or the uncertainty of being able to do so). Synonymous with household food insecurity, the issue needs to be located within a social justice framework. Recognising the clear interdependence between the right to food and the right to health, this paper explores how international human rights obligations could inform approaches to addressing food poverty and insecurity with specific reference to Ireland and the UK. Little attention has been paid to how countries should meet their obligations to respect, protect and fulfil the right to food in developed countries. The paper contributes by examining the social and policy circumstances which inhibit poor households from obtaining sufficient food to eat healthily, along with strategies and interventions from State and civil society actors in the two countries. In practice, problems and potential solutions have largely been directed towards the individual rather than at social determinants, particularly as research on environmental factors such as distance to shops has produced equivocal results. Other key structural aspects such as income sufficiency for food are broadly ignored by the State, and anti-poverty strategies are often implemented without monitoring for effects on food outcomes. Thus scant evidence exists for either Ireland or the UK meeting its rights to food obligations to date, in terms of roles and responsibilities in ensuring access to affordable, available and appropriate food for all.

Mapping access to food at a local level

Access to food is currently on the political agenda. This paper presents a quantitative method for local level use to help identify the geographic location of areas with inadequate access to food. A census of retail outlets selling food of any kind was carried out in a deprived area within a 2km radius from a central point between two estates. Information on the price and availability of “healthy” food lists, acceptable to each of the four major ethnic groups in the area, was collected. The food lists were not mutually exclusive. Food shops were mapped in terms of food availability and price indices using Geographical Information System (GIS) software. Maps show, progressively: roads within/outside 500m of a postcode with any outlet selling food; any outlet selling more than 50 per cent of the food list, below the area mean price, acceptable to a Gujarati Hindu; the latter in relation to population density. Within the area analysed there appears to be reasonable walking access to the more reasonably priced shops within the area, however the cost of a healthy diet would still require more than 50 per cent of the income of someone in receipt of income support.

Budgeting for food on a low income in the UK: the case of lone-parent families

Abstract In the UK, long-parent households are often low income households: a summary account is given of the reasons. Methods for investigating budgeting strategies for food are reviewed, with results of recent studies in the UK. The negative nutritional consequences, as measured by nutrient intakes and dietary variety, of budgeting strategies currently adopted by poorer lone-parent households are discussed.

Rising use of “food aid” in the United Kingdom

Purpose – The purpose of this paper is to present the findings from two recent reviews on food aid use in the UK and discuss their implications and the challenges they posed for researchers, policy makers and the voluntary and community sector. Design/methodology/approach – The paper draws on two research reviews conducted in 2013 and 2014. Findings – Whilst it is possible to draw important insights into key drivers of food aid use, how food aid is draw on by recipients and some of the perceived outcomes of the provision from the research that is available, ultimately the reviews highlight the emergent and largely unsystematic nature of the UK evidence base. The lack of agreed definitions and measures of food insecurity/food poverty further limits the knowledge base. Even where such evidence may be forthcoming, in terms of implementing effective solutions to the need for food aid, UK researchers, policy makers, NGOs and others face considerable challenges in terms of identifying responsibilities for addre...

Priority research questions for the UK food system

The rise of food security up international political, societal and academic agendas has led to increasing interest in novel means of improving primary food production and reducing waste. There are however, also many ‘post-farm gate’ activities that are critical to food security, including processing, packaging, distributing, retailing, cooking and consuming. These activities all affect a range of important food security elements, notably availability, affordability and other aspects of access, nutrition and safety. Addressing the challenge of universal food security, in the context of a number of other policy goals (e.g. social, economic and environmental sustainability), is of keen interest to a range of UK stakeholders but requires an up-to-date evidence base and continuous innovation. An exercise was therefore conducted, under the auspices of the UK Global Food Security Programme, to identify priority research questions with a focus on the UK food system (though the outcomes may be broadly applicable to other developed nations). Emphasis was placed on incorporating a wide range of perspectives (‘world views’) from different stakeholder groups: policy, private sector, non-governmental organisations, advocacy groups and academia. A total of 456 individuals submitted 820 questions from which 100 were selected by a process of online voting and a three-stage workshop voting exercise. These 100 final questions were sorted into 10 themes and the ‘top’ question for each theme identified by a further voting exercise. This step also allowed four different stakeholder groups to select the top 7–8 questions from their perspectives. Results of these voting exercises are presented. It is clear from the wide range of questions prioritised in this exercise that the different stakeholder groups identified specific research needs on a range of post-farm gate activities and food security outcomes. Evidence needs related to food affordability, nutrition and food safety (all key elements of food security) featured highly in the exercise. While there were some questions relating to climate impacts on production, other important topics for food security (e.g. trade, transport, preference and cultural needs) were not viewed as strongly by the participants.

Food and Poverty in Britain: Rights and Responsibilities

Social policy and food/nutrition are both to some extent contested disciplines and areas for intervention. The role of food in poverty definition and measurement by experts and within the lived experience by those defined poor, has been a neglected component of disciplinary study and focused policy response in Britain in the latter half of the twentieth century. This paper explores the historical and contemporary complementarities and challenges, and examines some of the consequences poor people face because society has ignored the social aspects of nutritional needs, and the nutritional contributions to poverty definition and interventions. Current policy initiatives in the health, food and social sectors in Britain are briefly reviewed and their potential shortcomings discussed.

Effectiveness of a social support intervention on infant feeding practices: randomised controlled trial

Background: To assess whether monthly home visits from trained volunteers could improve infant feeding practices at age 12 months, a randomised controlled trial was carried out in two disadvantaged inner city London boroughs. Methods: Women attending baby clinics with their infants (312) were randomised to receive monthly home visits from trained volunteers over a 9-month period (intervention group) or standard professional care only (control group). The primary outcome was vitamin C intakes from fruit. Secondary outcomes included selected macro and micro-nutrients, infant feeding habits, supine length and weight. Data were collected at baseline when infants were aged approximately 10 weeks, and subsequently when the child was 12 and 18 months old. Results: Two-hundred and twelve women (68%) completed the trial. At both follow-up points no significant differences were found between the groups for vitamin C intakes from fruit or other nutrients. At first follow-up, however, infants in the intervention group were significantly less likely to be given goats’ or soya milks, and were more likely to have three solid meals per day. At the second follow-up, intervention group children were significantly less likely to be still using a bottle. At both follow-up points, intervention group children also consumed significantly more specific fruit and vegetables. Conclusions: Home visits from trained volunteers had no significant effect on nutrient intakes but did promote some other recommended infant feeding practices. Trial registration: Current Controlled Trials ISRCTN55500035