Austerity, sanctions, and the rise of food banks in the UKBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1775 (Published 08 April 2015) Cite this as: BMJ 2015;350:h1775
All rapid responses
Loopstra et al’s paper is an important analysis of the unacceptable phenomenon of acute hunger in modern Britain. 1 Emergency food aid is an extreme manifestation of food poverty. The rise in food prices, the rise in energy costs and the fall in real wages until last year has meant that perhaps 13 million people cannot afford a healthy nutritious diet. This is a much greater proportion of the UK population than before. For the poorest in our society, up to 35% of disposable income will now be needed for food, compared to less than 9% for the more wealthy. This will increase reliance on cheap, highly processed, high fat, high sugar, high salt, and calorie dense, unhealthy foods. 2 Re-emerging problems of poor public health nutrition such as rickets and malnutrition in the elderly are also causes for concern.3
The authors are also correct in saying that other factors such as food and energy price, levels of food poverty relative to real wages need to be look at it in the complex of factors leading to extreme food poverty and acute hunger. A national living wage policy is also urgently needed, or a minimum wage which reflects the real needs of people to benefit from a healthy diet, as we suggest in the Faculty’s manifesto, Start well, live better.4
We also agree with the authors that a national surveillance system for emergency food aid is needed. Furthermore, we believe that public health nutrition has been a neglected area for far too long. A much greater emphasis should be placed on surveillance of public health nutritional deficiencies and populations at risk of food poverty. A national food policy is needed. This should place a greater emphasis on healthy nutrition, restrict marketing of processed foods to children, and provide stronger regulatory and fiscal policies to discourage consumption of junk food and sugary drinks.
The work of Boyd-Orr 5 and Dugald Baird 6 showed how national food policy in the World Wars powerfully contributed to better public health outcomes, particularly for pregnant women and young children. It is time for us to relearn the lessons of history and not tolerate the presence of hunger and poor nutrition in British society.
John Ashton President UK Faculty of Public Health
John Middleton Vice President, UK Faculty of Public Health
Simon Capewell, Vice President elect, UK Faculty of Public Health
1. Loopstra R Reeves A, Taylor-Robinson D, Barr B, McKee M, Stuckler D. Austerity, sanctions, and the rise of food banks in the UK. BMJ 2015; 350:h1775
2. Ashton JR, Middleton J, Lang T. Open letter to Prime Minister David Cameron on food poverty in the UK. Lancet 2014; 383:1631
3. Middleton J why we should be concerned about Victorian diseases. Guardian healthcare online network, august 8th 2014. http://www.theguardian.com/healthcare-network/2014/aug/08/return-victori... (accessed April 17th 2015)
4. Stewart L, Skinner L, Weiss M, Middleton J. Start well, live better a manifesto for the public’s health. J Public Health 2015; 37 no.1: 3-5. http://jpubhealth.oxfordjournals.org/content/37/1/3.full.pdf?keytype=ref... (accessed April 17th 2015)
5. Horton R. Economic austerity, food poverty, and health. Lancet 2014;383:1609.
DOI: http://dx.doi.org/10.1016/S0140-6736(14)60771-6 (accessed April 17th 2015)
6. Baird D. Social and economic factors affecting the mother and child.
Am J Public Health 1952; 42: 516-520.
Competing interests: No competing interests
Can you please explain why there are no food banks in the NE of England?
Competing interests: No competing interests
The article is certainly timely given the current political debates but doesn't seem to answer its own question of whether increased use is related to increased supply or increased demand. By their nature, food banks are operated by groups of people who have a social conscience, may feel a religious duty to serve the poor and themselves have sufficient resources to allow them to do so. This is not necessarily an evidence base for establishing a food bank.
My own church established a food bank last year, although not as a direct response to being asked for food. We also run a branch of Christians Against Poverty, not a political campaign but a budgeting advice service for people in money difficulties, a service often recommended by the national press.
Many years ago when working in England I was asked by a young mother if I could give her a prescription for vitamins as she couldn't afford food for herself and husband; their small child was catered for with baby food jars. We had a discussion and it turned out she meant they didn't have enough money to buy sufficiently filling ready-meals for the two adults. She and I debated how much cheaper cooking from scratch might be, although the first efforts might not be a total success. Mum wasn't entirely convinced, so to keep the relationship open she left with a prescription. A few weeks later, she returned and having started to cook from scratch, she realised that yes it was cheaper and more filling; also now the toddler was taking the same food thus further reducing costs. I could have reacted differently to the original request, advised approaching a charity, writing to an MP or newspaper about her situation or decided there was an unmet need and founded a food-bank.
Now I work what is still one of the most deprived areas of the UK, although slowly improving. To date no-one has asked for access to a food-bank, one person has complained that having left an area of town where cheap vegetables were easily available their diet had deteriorated, also becoming more expensive and many people admit to eating ready meals or take aways most of the time, although that choice isn't restricted to lower income families.
I wonder whether food poverty is at least a little about lack of knowledge and attitudes to food and cooking that prevent people from taking advantage of cheap foods? The perception of what constitutes 'food' have changed dramatically in the UK in the last 30 years, not least due to the activities of the food industry. As the Jack Monroe blog (1) shows, food can be cheap with a little effort and some planning.
Not addressed in the article is fuel poverty, which might detrimentally affect the ability to cook. Money may be in short supply but possession of the skills to use it efficiently can also help to alleviate poverty. As was once said, give a man a fish and feed him for a day, teach him how to fish and you feed hm for a lifetime.
1 A girl called Jack, blog.
Competing interests: I donate to the Food bank and CAP.
The article reflects what we see in Derbyshire. To my knowledge, Derbyshire County (not including Derby City) now has 22 food banks, some with additional branch operations, compared with one in 2009.
The key point I should like to make is that of the 22 food banks in Derbyshire only five are affiliated with the Trussell Trust. The remainder are independent, usually initiated by Christian Churches and occasionally by community groups. So the data cited in this article is certainly an underestimate.
From April 2014 we have asked food banks in Derbyshire to share with us some of the routine data they collect. These data generally reflect Trussell Trust data. We learned that the second most frequent referral agency (JobCentre+ being the first) was our children's centres. This causes us great concern as it suggests that many families with children in Derbyshire are going hungry and need emergency food parcles.
We would welcome a more systematic approach to surveillance of food insecurity and use of food banks and an end to 'the causes of their causes'.
Competing interests: Derbyshire County Council has given small grants to local food banks for the last two years totalling just under £126,000.
Austerity, sanctions and asylum: some asylum seekers’ diet comparable to pre-Welfare State conditions
We welcome the publication of this important and timely study highlighting the link between austerity, unemployment, sanctioning and food insecurity. We support unreservedly the authors’ call for effective measures of food insecurity and steps to tackle its root social and economic causes. We note the correlation of unemployment and welfare cuts with increased food bank usage, and would like to take this opportunity to share with the authors and BMJ readers the results of an as yet unpublished exploratory study we conducted which highlights the particular plight of asylum seekers. Our findings suggest that there may be a cohort in the UK for whom absolute poverty1 at pre-Welfare State levels, at least in dietary terms,2 is a daily reality.
Primary data for our study was collected using a combination of semi-structured in-depth interviews, a questionnaire to capture demographic and lifestyle information and diet sheets. Our sample was comprised of seven British nationals living on state benefit as their primary income source (three of whom had used a food bank in the weeks prior to interview), six asylum seekers (five of whom used food banks or relied partly on gifts of food) and five European Union migrant temporary agency workers. While all the participants in our study were on a low income, even within our small sample there were marked differences in the nature and severity of hardship experienced, with the asylum seekers experiencing particular difficulty. Being legally unable to work and receiving no benefits, five of the six asylum seekers depended on informal social and financial support. Three were surviving on cash gifts from friends, religious organisations or refugee charities, as much as £15 if they were fortunate, sometimes just £5 a week. At times, nothing. Their diets consisted of low cost carbohydrates like baked beans, rice with chicken, bread and microwave chips. They would have liked to eat fruit and vegetables but were unable to afford them very often. Seldom would they eat more than one meal per day.
Various sources on the diet and health of working-class people in the late nineteenth century show that the diets of labourers, workhouse and prison inmates - known as ‘energy producing diets’3 - were monotonous, starchy fare comprised mainly of carbohydrates, proteins and fats. Fruit and vegetables were limited; the priority was food that would provide sustained energy for physical labour, the ‘diet of toil’ reproduced today by some of our participants and an unknown number of others who have fallen through the safety net of the state, surviving hand-to-mouth.
The scale of this is very difficult to quantify, not least because of the challenge defining poverty4 and destitution.5 In their report "What is meant by poverty?",6 the Joseph Rowntree Foundation wrote: "when we talk about poverty in the UK today we rarely mean malnutrition or the levels of squalor of previous centuries, or even the hardships of the 1930s before the advent of the Welfare State”. Poverty is a relative concept, the report goes on to say, where ‘poor’ people are those whose standards of living are out of sync with “the majority of the population in one of the most affluent countries in the world”. However, our findings, which view poverty through a conceptual lens provided by that most basic of human needs - food - suggest that there may be a cohort in the UK who face a daily struggle to survive, living lives comparable to pre-Welfare State deprivation.
Add to the difficulties faced by asylum seekers the bleak picture painted by reports of harshly applied benefit sanctions,7 which we know from this study to have a significant effect on food insecurity, as well as the possibility that migrant workers operating in increasingly insecure labour markets8 may lose their safety net at any time.9 In this letter, therefore, we would like to add our voices to those of these authors, calling for research to explore more closely the intersectional impact of asylum, welfare, and labour market policies on the diet and health of some of the most vulnerable people in the UK.
Funded by the Crucible Programme of the Universities of Bristol, Bath and West of England. The study obtained ethics approval from the Universities of Bath and West of England; informed consent was secured from all study participants.
1 United Nations.The Copenhagen Declaration and Programme of Action: World Summit for Social Development 6-12 March 1995. New York: United Nations Department of Publications; 1995.
2 Oliver, T. The Diet of Toil. Lancet 1895; 145(3748): 1629–35 http://dx.doi.org/10.1016/S0140-6736(00)79808-4 (accessed 27 June 2014).
3 Amos, D. M. Working-Class Diet and Health in Nottingham, 1850–1939. PhD thesis; University of Nottingham; 2000.
4 Gordon, D. The concept and measurement of poverty. In Pantazis, C, Gordon, D, Levitas, R (eds.) Poverty and social exclusion in Britain: The millennium survey, Bristol: The Policy Press; 2006. p29–70.
5 Fitzpatrick, S, Bramley, G, Blenkinsopp, J, et al. Destitution in the UK: An interim report. JRF Programme Paper. March 2015. http://www.jrf.org.uk/sites/files/jrf/destitution.pdf (accessed 29 March 2015).
6 Joseph Rowntree Foundation. What is meant by ‘poverty’? http://www.jrf.org.uk/sites/files/jrf/poverty-definitions.pdf (accessed March 19 2015)
7 Manchester Citizens Advice Bureau Service. Punishing Poverty? A review of benefits sanctions and their impact on clients and claimants. October 2013. https://onedrive.live.com/view.aspx?resid=CB5ED957FE0B849F!350&app=WordP... (accessed 19 March 2015).
8 Maroukis, T. Temporary Agency Work in the UK today: precarity intensifies despite protective legislation. IPR Policy Brief. Bath: University of Bath Institute for Policy Research (IPR); forthcoming May 2015. http://www.bath.ac.uk/ipr/.
9 Wintour, P, Travis, A. Cameron to tell EU: cut all tax credits to migrants. The Guardian. November 28 2014. http://www.theguardian.com/politics/2014/nov/27/david-cameron-european-u... (accessed 19 March 2015).
Competing interests: No competing interests