Madeleine Power

All in it Together? Community Food Aid in a Multi-Ethnic Context

This paper derives from a study of community food aid in a multi-ethnic, multi-faith city in the North of England. The paper begins to make sense of the diversity of types of food insecurity assistance, examines the potential exclusion of certain groups from receipt of food aid, and explores the relationship between food aid providers and the state. Faith-based food aid is common in the case study area, particularly among food bank provision to the most ‘destitute’ clients. While food aid is adopting service responsibilities previously borne by the state, this does not imply an extension of the ‘shadow state’. Rather, it appears reflective of a pre-welfare state system of food distribution, supported by religious institutions and individual/business philanthropy, but adapted to be consistent with elements of the ‘Big Society’ narrative. Most faith-based providers are Christian. There is little Muslim provision of (or utilisation of) food aid, despite the local demographic context. This raises concerns as to the unintentional exclusion of ethnic and religious groups, which we discuss in the concluding sections.

Food insecurity and socio-demographic characteristics in two UK ethnic groups: an analysis of women in the Born in Bradford cohort

Background The use of foodbanks has risen sharply in the UK; however, the epidemiology of UK food insecurity is undeveloped. This study contributes to the field by analysing socio-demographic risk factors for food insecurity in a female, ethnically diverse population. Methods Data from the Born in Bradford (BiB) cohort were matched with data on food insecurity from the nested BiB1000 study (N = 1280). Logistic regression was used to model food insecurity in relation to ethnicity and socio-demographic factors. Results Food insecurity, reported by 13.98% of the sample, was more likely among White British than Pakistani women (crude Odds Ratio (OR) 1.94, 95% CI: 1.37; 2.74, adjusted OR 2.37, 95% CI: 1.57; 3.59). In fully adjusted analyses, food insecurity was associated with a range of socio-economic measures, particularly the receipt of mean-tested benefits (adjusted OR 2.11, 95% CI: 1.41; 3.15) and perception of financial insecurity (adjusted OR 8.91, 95% CI: 4.14; 19.16 for finding it difficult/very difficult compared to living comfortably). Conclusions The finding that food insecurity prevalence may be higher than previously thought and that food insecurity is highly associated with socio-economic status, notably benefit receipt, is a cause for concern necessitating an urgent policy response.

Food insecurity and mental health: an analysis of routine primary care data of pregnant women in the Born in Bradford cohort

Background Since 2008, use of food banks has risen sharply in the UK; however, evidence on the epidemiology of UK food insecurity is sparse. The aim of this study was to describe the trajectory of common mental disorder across the pre-pregnancy, pregnancy and postnatal period for food secure compared with food insecure women. Methods Data from the Born in Bradford (BiB) cohort, the nested BiB1000 study and primary care records were linked based on National Health Service (NHS) numbers. Data linkage was completed for 1297, and primary care records were available from 18 months prior to 40 months after birth of the cohort child. Incidence rates of common mental disorders per 1000 patient years at risk were compared between food secure and insecure women, and for Pakistani compared with white British women, in 10 6-month periods around pregnancy. Poisson regression was used to calculate incidence rate ratios, adjusted for ethnicity and exposure. Results Food insecurity was significantly associated with an increased risk of common mental disorder before and during pregnancy (incidence rate ratio 1.9, 95% confidence interval 1.3 to 2.8, p=0.001) and after giving birth (incidence rate ratio 1.3, 95% confidence interval 1.0 to 1.7, p=0.029). Conclusions Our study shows that food insecure women have worse mental health than food secure women, and that this difference is most pronounced for white British pregnant women. These findings provide evidence for concerns expressed by public health experts that food insecurity may become the next public health emergency.

Income Inequality and Crime: A Review and Explanation of the Time- series Evidence

This review analyses the time–series evidence of the effects of changing income inequality on crime for a number of countries and types of crime. 17 papers analysing this relationship using time–series evidence were found via a systematic search. The papers’ findings on the relationship between inequality and crime were classified as providing evidence of Significant Positive Associations, No Significant Associations, or Significant Negative Associations. The analysis indicated that property crime increases with rising income inequality and specific measures of violent crime, such as homicide and robbery, also display sensitivity to income inequality over time. Aggregated non-specific measures of violent crime, however, do not display such sensitivity, which is most likely to be due to differences in crime reporting. The majority of the differences in the findings can be explained by the choice of covariates, and the estimators and measures used in the paper. The paper concludes with a unified interpretation of the time–series evidence.

“Bringing heaven down to earth”: the purpose and place of religion in UK food aid

Purpose This paper uses data from a city with a multi-ethnic, multi-faith population to better understand faith-based food aid. The paper aims to understand what constitutes faith-based responses to food insecurity, compare the prevalence and nature of faith-based food aid across different religions and explore how community food aid meets the needs of a multi-ethnic, multi-faith population. Design/methodology/approach The study involved two phases of primary research. In Phase 1, desk-based research and dialogue with stakeholders in local food security programmes were used to identify faith-based responses to food insecurity. Phase 2 consisted of 18 semi-structured interviews involving faith-based and secular charitable food aid organizations. Findings The paper illustrates the internal heterogeneity of faith-based food aid. Faith-based food aid is highly prevalent and the vast majority is Christian. Doctrine is a key motivation among Christian organizations for their provision of food. The fact that the clients at faith-based, particularly Christian, food aid did not reflect the local religious demographic is a cause for concern in light of the entry-barriers identified. This concern is heightened by the co-option of faith-based organizations by the state as part of the “Big Society” agenda. Originality/value This is the first academic study in the UK to look at the faith-based arrangements of Christian and Muslim food aid providers, to set out what it means to provide faith-based food aid in the UK and to explore how faith-based food aid interacts with people of other religions and no religion.

Is food insecurity associated with maternal health among UK ethnic groups? An exploration of women in the BiB cohort

Food insecurity is a determinant of maternal health; however, research on the health impact of food insecurity among mothers of varying ethnicities is under-developed. We assessed the association of food insecurity and health among white British and Pakistani mothers. Data from the Born in Bradford cohort were matched with data on food insecurity and self-reported health from the nested BiB1000 study (N = 1280). Food insecurity was associated with elevated odds of fair/poor health among white British mothers but not Pakistani mothers. Adjusting for financial security, the association between food insecurity and poor health was not significant among either white British or Pakistani mothers.

Development and validation of a search filter to identify equity-focused studies: reducing the number needed to screen

BackgroundHealth inequalities, worse health associated with social and economic disadvantage, are reported by a minority of research articles. Locating these studies when conducting an equity-focused systematic review is challenging due to a deficit in standardised terminology, indexing, and lack of validated search filters. Current reporting guidelines recommend not applying filters, meaning that increased resources are needed at the screening stage.MethodsWe aimed to design and test search filters to locate studies that reported outcomes by a social determinant of health. We developed and expanded a ‘specific terms strategy’ using keywords and subject headings compiled from recent systematic reviews that applied an equity filter. A ‘non-specific strategy’ was compiled from phrases used to describe equity analyses that were reported in titles and abstracts, and related subject headings. Gold standard evaluation and validation sets were compiled. The filters were developed in MEDLINE, adapted for Embase and tested in both. We set a target of 0.90 sensitivity (95% CI; 0.84, 0.94) in retrieving 150 gold standard validation papers. We noted the reduction in the number needed to screen in a proposed equity-focused systematic review and the proportion of equity-focused reviews we assessed in the project that applied an equity filter to their search strategy.ResultsThe specific terms strategy filtered out 93-95% of all records, and retrieved a validation set of articles with a sensitivity of 0.84 in MEDLINE (0.77, 0.89), and 0.87 (0.81, 0.92) in Embase. When combined (Boolean ‘OR’) with the non-specific strategy sensitivity was 0.92 (0.86, 0.96) in MEDLINE (Embase 0.94; 0.89, 0.97). The number needed to screen was reduced by 77% by applying the specific terms strategy, and by 59.7% (MEDLINE) and 63.5% (Embase) by applying the combined strategy. Eighty-one per cent of systematic reviews filtered studies by equity.ConclusionsA combined approach of using specific and non-specific terms is recommended if systematic reviewers wish to filter studies for reporting outcomes by social determinants. Future research should concentrate on the indexing standardisation for equity studies and further development and testing of both specific and non-specific terms for accurate study retrieval.

All in it Together? Community Food Aid in a Multi-Ethnic Context – CORRIGENDUM

The following acknowledgement was omitted from the original publication: The authors would like to acknowledge the support of the BBSRC (The Biotechnology and Biosciences Research Council) for the funding of IKnowFood at York which is 4-year research programme being funded through the Global Food Security-Food System Resilience programme with contributions from BBSRC, ESRC, NERC, and the Scottish Government. The authors apologise for this oversight.

What do participants of the Crohn's and Colitis UK (CCUK) Annual York Walk think of their inflammatory bowel disease care? A short report on a survey

There has been a growing interest in a patient-centered model of care in inflammatory bowel disease; however, no relevant study using a mixed methodology has been conducted to date. Thus, our multidisciplinary group aimed to explore the issue of patient involvement in care among the inflammatory bowel disease community. A mixed-methods anonymous survey was conducted during the Crohns and Colitis UK annual event. Summary statistics were used to describe the sample, and a simple thematic analysis identified key themes in qualitative responses. There were 64 survey respondents, representing 73% of the total family/friend groups participating (N = 87). Overall, 75% of respondents answered that they had the opportunity to discuss their care with their inflammatory bowel disease practitioner and 81% felt their opinions were taken on board and valued. A clear majority (84%) had at some point been treated by a gastroenterologist. In contrast, less than half (44%) had the opportunity for a dietician consultation and only 28% had the opportunity for a psychologist/counselor consultation. Although satisfaction with inflammatory bowel disease care was high, access to specialty services was concerning. Efforts should be made to provide access to mental health practitioners for those with clinically significant anxiety and/or depression.