Intended for healthcare professionals

Rapid response to:

Feature The BMJ Appeal

How doctors can help end food insecurity

BMJ 2021; 372 doi: (Published 13 January 2021) Cite this as: BMJ 2021;372:n53

Rapid Response:

Food poverty should not be allowed to continue: government action is needed.

Dear Editor

We welcome the BMJ Appeal and think that it has the potential to have a significant and immediate impact on food insecurity and children’s health.(1) Early last year the Royal College of Paediatrics and Child Health’s report—State of Child Health 2020—painted a bleak picture of child health in the UK,(2,3) but since then the Covid-19 pandemic has intensified many difficulties that families face.(4-6)

An unhealthy diet is linked to chronic conditions such as obesity, cardiovascular disease and some cancers.(7) In addition, children who grow up in food-insecure homes are more likely to have poor health and a worse academic performance compared with children growing up in food-secure homes.(7,8) Children with high levels of wellbeing on average have higher levels of academic achievement and are more engaged in school now and in later years.(9)

Healthy eating is a multifaceted and complex public health area and there are interrelated structural issues that can negatively influence a family’s eating habits.(7,8,10) These include, insecure and low paid employment, insufficient social welfare provision, lack of cooking skills, and a socially unjust food distribution system. A fairly recent study supports this and found that those groups most at risk of food insecurity, that is people with low incomes, who are unemployed or who are living with disabilities, are also those groups already at risk of poor health.(11)

Over the past 10 months Marcus Rashford has undertaken significant work in this crucial public health area. His campaigning has made food insecurity a high-profile issue.(1) His appeals to the UK government have brought about some real positive changes.(12,13)

Doctors and nurses can make important contributions to reducing food poverty and promoting healthy eating.(7,10) At an individual level their roles are easier to understand in relation to providing good quality patient care. However, it is vital they are equipped with the skills, time and resources to support patients. They also have powerful voices that can advocate for change in different settings: healthy eating should become the norm in settings such as schools and hospitals.(7,10,14) In addition, they should make their voices heard at a national level.

One of the most immediate impacts of living in poverty for children and their families is that they are less likely to be able to access a nutritious and healthy diet. Fiscal measures are needed so that low income and unemployed families can afford food, electricity and other essentials. Fiscal measures could also be used to subsidise fruit and vegetables and tax less healthy foods.(15,16)

Foodbanks and free school meals are vital for supporting some families at the present time, but we urgently need a long-term national strategy so that these types of initiatives become redundant in the future. The UK is one of the world’s richest countries and the Institute of Health Promotion and Education strongly believes that food poverty should not be allowed to continue. Urgent and robust government action is needed immediately.

1) Feinmann J. THE BMJ APPEAL. How doctors can help end food insecurity. BMJ 2021;372:n53

2) Royal College of Paediatrics and Child Health. State of child health 2020. March 2020.

3) Watson M C and Lloyd J. UK infant mortality. Child health in the UK: we need to help children survive and thrive. BMJ 2020;369:m1412

4) The Food Foundation. Food insecurity and debt are the new reality under lockdown. May 2020.

5) The Food Foundation. 14% of UK families with children have experienced food insecurity in the past 6 months. September 2020.

6) Marmot M, Allen J, Goldblatt P, Herd E, Morrison J. Build Back Fairer: The COVID-19 Marmot Review. The Pandemic, Socioeconomic and Health Inequalities in England. December 2020. London: Institute of Health Equity.

7) BMA. Food for thought: promoting healthy diets among children and young people. 2015.

8) Marmot M, Allen J, Boyce T, Goldblatt P, Morrison J. Health equity in England: the Marmot review 10 years on. Feb 2020.

9) Childhood Wellbeing Research Centre. The impact of pupil behaviour and wellbeing on Educational Outcomes. DFE-RR253. London: Department for Education, 2012.

10) Watson MC, Lloyd J. Obesity epidemic: bold and decisive action needed. BMJ 2019;367:l6396

11) Loopstra R, Reeves A, Tarasuk V. The rise of hunger among low-income households: an analysis of the risks of food insecurity between 2004 and 2016 in a population-based study of UK adults. J Epidemiol Community Health. 2019 Jul;73(7):668-673. doi: 10.1136/jech-2018-211194. Epub 2019 Apr 29. PMID: 31036607.

12) Pride of Britain Awards. Special Recognition. Marcus Rashford

13) Plant M. Marcus Rashford’s Inspirational 2020. 31 December 2020.

14) Watson M and Lloyd J, 2013 It’s time to ban junk food on hospital premises. BMJ Rapid Response 1st July 2013.

15) Watson MC, Lloyd J. Taxing sugar should be just one element of a multifaceted campaign. BMJ 2015;351:h4388.

16) World Health Organization. Fiscal Policies for Diet and Prevention of Noncommunicable Diseases. Geneva: World Health Organization, 2016.

Competing interests: No competing interests

20 January 2021
Michael Craig Watson
Trustee, Institute of Health Promotion and Education.
Dr John Lloyd, Honorary Vice President, Institute of Health Promotion and Education.
Institute of Health Promotion and Education, PO Box 7409, Lichfield WS14 4LS, UK.