Rachel Loopstra

Austerity, sanctions, and the rise of food banks in the UK

Doctors are witnessing increasing numbers of patients seeking referrals to food banks in the United Kingdom. Rachel Loopstra and colleagues ask, is this due to supply or demand?

The Relationship between Food Banks and Household Food Insecurity among Low-Income Toronto Families

Étant donné l’absence de politiques publiques précises face au problème de l’insécurité alimentaire des ménages au Canada, les banques alimentaires restent la solution la plus courante, malgré les questions qui se posent au sujet de leur efficacité. En effet, parmi 371 familles à faible revenu de Toronto que nous avons interviewées dans le cadre de cette étude, 75 % avaient vécu de l’insécurité alimentaire, mais seulement 23 % avaient eu recours à une banque alimentaire ; et, pour la plupart des utilisateurs de banque alimentaire, l’insécurité alimentaire était un problème chronique grave. Parmi les raisons qui font que les familles vivant de l’insécurité alimentaire n’ont pas recours à une banque alimentaire, notons une certaine réticence à demander la charité, mais aussi un accès difficile à ces banques pour diverses raisons. Ces résultats remettent en question le rôle que les gouvernements fédéral, provinciaux et territoriaux semblent donner aux organismes caritatifs comme moyens de réduire l’insécurité alimentaire, et soulignent la nécessité de politiques publiques claires en cette matière.

Food banks, welfare, and food insecurity in Canada

Purpose – Similar to the recent emergence of food banks in other affluent nations, the genesis and ultimate entrenchment of food banks in Canada has been tightly intertwined with the dismantling of the welfare state. Through an examination of Canadian data, the authors elucidate the implications of entrenching voluntary, extra-governmental, charitable food assistance programs as an adjunct to publicly funded social assistance programs. The paper aims to discuss these issues. Design/methodology/approach – Publicly available food bank reports, population health survey data, and the results of a study of low-income families in Toronto are reviewed to examine the food security status of social assistance recipients and their use of food banks. Findings – In 2012, 70 percent of households in Canada who were reliant on social assistance were food insecure. Social assistance recipients comprise at least half of food bank clientele and have done so for as long as this information has been tracked, but the assista...

‘First, do no harm’: are disability assessments associated with adverse trends in mental health? A longitudinal ecological study

Background In England between 2010 and 2013, just over one million recipients of the main out-of-work disability benefit had their eligibility reassessed using a new functional checklist—the Work Capability Assessment. Doctors and disability rights organisations have raised concerns that this has had an adverse effect on the mental health of claimants, but there are no population level studies exploring the health effects of this or similar policies. Method We used multivariable regression to investigate whether variation in the trend in reassessments in each of 149 local authorities in England was associated with differences in local trends in suicides, self-reported mental health problems and antidepressant prescribing rates, while adjusting for baseline conditions and trends in other factors known to influence mental ill-health. Results Each additional 10 000 people reassessed in each area was associated with an additional 6 suicides (95% CI 2 to 9), 2700 cases of reported mental health problems (95% CI 548 to 4840), and the prescribing of an additional 7020 antidepressant items (95% CI 3930 to 10100). The reassessment process was associated with the greatest increases in these adverse mental health outcomes in the most deprived areas of the country, widening health inequalities. Conclusions The programme of reassessing people on disability benefits using the Work Capability Assessment was independently associated with an increase in suicides, self-reported mental health problems and antidepressant prescribing. This policy may have had serious adverse consequences for mental health in England, which could outweigh any benefits that arise from moving people off disability benefits.

Austerity and old-age mortality in England: a longitudinal cross-local area analysis, 2007-2013.

Objective There has been significant concern that austerity measures have negatively impacted health in the UK. We examined whether budgetary reductions in Pension Credit and social care have been associated with recent rises in mortality rates among pensioners aged 85 years and over. Design Cross-local authority longitudinal study. Setting Three hundred and twenty-four lower tier local authorities in England. Main outcome measure Annual percentage changes in mortality rates among pensioners aged 85 years or over. Results Between 2007 and 2013, each 1% decline in Pension Credit spending (support for low income pensioners) per beneficiary was associated with an increase in 0.68% in old-age mortality (95% CI: 0.41 to 0.95). Each reduction in the number of beneficiaries per 1000 pensioners was associated with an increase in 0.20% (95% CI: 0.15 to 0.24). Each 1% decline in social care spending was associated with a significant rise in old-age mortality (0.08%, 95% CI: 0.0006–0.12) but not after adjusting for Pension Credit spending. Similar patterns were seen in both men and women. Weaker associations observed for those aged 75 to 84 years, and none among those 65 to 74 years. Categories of service expenditure not expected to affect old-age mortality, such as transportation, showed no association. Conclusions Rising mortality rates among pensioners aged 85 years and over were linked to reductions in spending on income support for poor pensioners and social care. Findings suggest austerity measures in England have affected vulnerable old-age adults.

Rising food insecurity in Europe

People queueing for food aid is an image reminiscent of the Great Depression in the 1930s, but one that has come to characterise many European nations in the grip of austerity today. In 2013–14, the UK’s Trussell Trust, a national network of food banks, provided emergency food aid to more than 900 000 adults and children, a 163% increase from the previous year. Greek, Spanish, and French charities have also reported marked rises in the number of people seeking emergency food support. Alongside clinical evidence of rising nutritional defi ciencies, these reports suggest that a problem is emerging, but to what extent is food insecurity rising across Europe? We have searched the EuroStat database for the prevalence of households that are unable to aff ord meat (or a vegetarian equivalent) every second day—an amount generally recommended in European dietary guidelines. This is a common measure of household food insecurity, which is defined as uncertain and insufficient food availability and access arising from resource constraints. Between 2005 and 2010, the proportion of people reporting an inability to aff ord meat or equivalent decreased by about 0·5% points each year (fi gure). In 2010, this trend reversed, rising from 8·7% in 2009, to 10·9% in 2012, and remaining elevated thereafter. Since 2010, the prevalence of food insecurity was about 2·71% points (95% CI 0·56–4·85%) greater than would have been expected on the basis of previous trends ( appendix) and corresponds to an excess of about 13·5 million people (95% CI 2·8 million–24·2 million) living with food insecurity. What is driving food insecurity is a crucial question. The recent recession in Europe led to unemployment, debt, and housing arrears—all of which could make food less affordable for households. Yet not all countries facing such hardship had these problems. For example, both Ireland and Portugal were strongly aff ected by the fi nancial crisis, yet between 2009 and 2012, food insecurity rose by 1·8% points in Ireland but actually dropped in Portugal, according to EuroStat data. Rising food insecurity is an urgent health problem. It is strongly associated not just with malnutrition, but with sustained deterioration of mental health, inability to manage chronic disease, and worse child health. While wealth is becoming increasingly concentrated among the richest 1% of the population and trillions of Euros have been spent on bailing out European banks, surely there is enough to secure adequate access to food for all?

Food Bank Usage Is a Poor Indicator of Food Insecurity: Insights from Canada

This article reflects on the insights afforded by the regular measurement and monitoring of household food insecurity in Canada juxtaposed against information on food bank usage in the population. We show that the number and characteristics of people using food banks suggest that this population is a non-representative subset of the food insecure population. We also highlight how the number of people using food banks is insensitive to the level of household food insecurity in the population. Who goes to food banks is a function of the nature of food bank operations and the severity of food insecurity. Representative data on household food insecurity should be regularly collected and utilised to make policy recommendations for interventions to address the problem of insecure food access.

The impact of economic downturns and budget cuts on homelessness claim rates across 323 local authorities in England, 2004–12

Background It is unclear why rates of homelessness claims in England have risen since 2010. We used variations in rates across local authorities to test the impact of economic downturns and budget cuts. Methods Using cross-area fixed effects models of data from 323 UK local authorities between 2004 and 2012, we evaluated associations of changes in statutory homelessness rates with economic activity (Gross Value Added per capita), unemployment, and local and central government expenditure. Results Each 10% fall in economic activity was associated with an increase of 0.45 homelessness claims per 1000 households (95% CI: 0.10–0.80). Increasing rates of homelessness were also strongly linked with government reductions in welfare spending. Disaggregating types of welfare expenditure, we found that strongest associations with reduced homelessness claims were spending on social care, housing services, discretionary housing payments and income support for older persons. Conclusions Recession and austerity measures are associated with significant increases in rates of homelessness assistance. These findings likely understate the full burden of homelessness as they only capture those who seek aid. Future research is needed to investigate what is happening to vulnerable groups who may not obtain assistance, including those with mental health problems and rough sleepers.

Austerity and health: the impact in the UK and Europe

Abstract Austerity measures—reducing social spending and increasing taxation—hurts deprived groups the most. Less is known about the impact on health. In this short review, we evaluate the evidence of austerity’s impact on health, through two main mechanisms: a ‘social risk effect’ of increasing unemployment, poverty, homelessness and other socio-economic risk factors (indirect), and a ‘healthcare effect’ through cuts to healthcare services, as well as reductions in health coverage and restricting access to care (direct). We distinguish those impacts of economic crises from those of austerity as a response to it. Where possible, data from across Europe will be drawn upon, as well as more extensive analysis of the UK’s austerity measures performed by the authors of this review.

Fit-for-work or fit-for-unemployment? Does the reassessment of disability benefit claimants using a tougher work capability assessment help people into work?

Background Many governments have introduced tougher eligibility assessments for out-of-work disability benefits, to reduce rising benefit caseloads. The UK government initiated a programme in 2010 to reassess all existing disability benefit claimants using a new functional checklist. We investigated whether this policy led to more people out-of-work with long-standing health problems entering employment. Method We use longitudinal data from the Labour Force Survey linked to data indicating the proportion of the population experiencing a reassessment in each of 149 upper tier local authorities in England between 2010 and 2013. Regression models were used to investigate whether the proportion of the population undergoing reassessment in each area was independently associated with the chances that people out-of-work with a long-standing health problem entered employment and transitions between inactivity and unemployment. We analysed whether any effects differed between people whose main health problem was mental rather than physical. Results There was no significant association between the reassessment process and the chances that people out-of-work with a long-standing illness entered employment. The process was significantly associated with an increase in the chances that people with mental illnesses moved from inactivity into unemployment (HR=1.22, 95% CI 1.03 to 1.45). Conclusions The reassessment policy appears to have shifted people with mental health problems from inactivity into unemployment, but there was no evidence that it had increased their chances of employment. There is an urgent need for services that can support the increasing number of people with mental health problems on unemployment benefits.