Professor Louise Dye, University of Leeds, Cross Faculty Food Theme – Written evidence (FPO0058)
- One of the major causes of food insecurity has undoubtedly been the roll out of Universal Credit. This has impacted on families increasing their food insecurity.
- Please see this extract taken from the Free School Meals (FSM) toolkit which provides the information on change in numbers now eligible for FSM. This is sobering.
- “In April 2018, the Government announced a Transitional Protection (TP) scheme, by which all children and young people who had an existing written FSM award in place on 1st April 2018, or who later came into FSM entitlement, would keep that award until the roll out of Universal Credit has been completed in March 2023. This protection continues regardless of whether parental incomes rise above the means-tested FSM qualifying threshold, and, since, the protection follows the child, it stays with them even if they move to live with a different carer who may themselves not meet the FSM qualifying criteria.
- In the first 10 months of existence, the TP scheme had an extremely positive impact if looked at purely on the extra number of FSM Awards now in place. The total live FSM caseload in Leeds stood at 17,321 in January 2018. Following the advent of TP, less than a year later, at the time of the recent January 2019 school census, it had already reached 22,500.”
- Qualitative evidence of the impact of food insecurity can be found on Twitter. One good example is AnotherMumUsingFoodBanks @foodbankmum who eloquently shares her lived experience of food poverty, foodbank use, and the impact on her mental health as a direct outcome of being moved onto UC.
- The potential decrease in food availability and of price rises following Brexit are likely to compound food insecurity in the UK, particularly in the less affluent areas e.g. the North.
- Insecure access to food can be considered a universal stressor. This stress will likely be compounded by the living and environmental conditions associated with living in poverty. The combination of this stress and the intake of a poor quality diet will have profound short and long-term health consequences for individuals. Chronic psychosocial stress drives physiological dysregulation that has been associated with multiple and profound negative effects on human health and well-being. The synergistic relationship between psychosocial and metabolic stress (chronically elevated blood glucose and lipids) and negative health outcomes is gaining increasing recognition.
- The neuroendocrine end-products of stress (glucocorticoids and catecholamines) are key affectors of energy homeostasis. Indeed, chronic stress prospectively predicts obesity, diabetes mellitus, and metabolic syndrome. Stress also promotes irregular eating patterns and physical inactivity, poor health behaviour (e.g. smoking, poor diet, alcohol abuse), can bias food preferences towards high calorie dense food, and promote abdominal adiposity which is most closely linked to T2DM and metabolic syndrome. Metabolic stress has grave long term consequences for health.
- Conditions characterised by metabolic oversupply (e.g., obesity and diabetes mellitus) are associated with increased oxidative stress, systemic inflammation, altered gene expression e.g. shortening of telomeres and impaired cognitive performance; ultimately affecting quality and longevity of life. Therefore, individuals facing food insecurity and associated poverty can be expected to suffer considerable detriments to personal health and well-being which will be accompanied by considerable social and health care costs.
- We would also suggest that the Select Committee consider the following evidence on the impact of breakfast interventions on cognitive function, academic performance, in-class behaviour in schoolchildren.
The positive effects of breakfast consumption on cognitive function in children and adolescents ages 2-19 years.
- In 2009, our research group conducted the first systematic review of all of the evidence examining the effect of breakfast on cognitive function in children and adolescents aged 2-19 years, by gathering all of the evidence that had been published in this field (Hoyland, Dye, & Lawton, 2009). There was consistent evidence that breakfast consumption relative to fasting had a short-term (same morning) positive, domain specific, effect on cognitive function measured within 4 hours post-ingestion. Tasks requiring attention, executive function, and memory were facilitated more reliably by breakfast consumption relative to fasting, with effects more apparent in undernourished children (children who were below height- or weight-for-age). Our research group updated this review in 2016 to capture any new evidence that had been published since 2009 (Adolphus, Lawton, Champ, & Dye, 2016). The findings were consistent with our previous review. We also found more evidence to support that breakfast consumption has a transient beneficial effect on cognitive function measured within 4 hours post-ingestion compared with breakfast omission, suggesting that this finding is reliable.
The positive effects of breakfast on academic performance and in-class behaviour.
- Along with cognitive function, our research group has also examined the effect of breakfast on academic performance or in-class behaviour. In 2013, we conducted the first systematic review on the effect of breakfast on behaviour in the classroom and academic performance in children and adolescents by gathering all of the evidence in this field that had been published to date (Adolphus, Lawton, & Dye, 2013).
- The evidence indicated a mainly positive effect of breakfast on on-task behaviour in the classroom. There was evidence that habitual breakfast (frequency and quality) and SBPs have a positive effect on children's academic performance with clearest effects on mathematic and arithmetic grades in undernourished children. Increased frequency of habitual breakfast was consistently positively associated with academic performance. Some evidence suggested that quality of habitual breakfast, in terms of providing a greater variety of food groups and adequate energy, was positively related to school performance.
- To follow this review, we conducted the first study to examine the relationship between habitual school-day breakfast consumption and GCSE attainment in British adolescents, which unlike cognitive performance tests, have a functional relevance to the pupil (Adolphus, Lawton, & Dye, In press). GCSE attainment was assessed by three composite measures using the Department for Education GCSE point score system and by grades achieved in Mathematics and English. These outcomes were chosen to reflect typical performance indicators used within the education system. Attainment in Mathematics and English were considered separately as these represent compulsory subjects are often included as part of entry requirements for further education. Adolescents who rarely consumed breakfast on school days had a significantly lower capped GCSE point scores and mean GCSE point scores compared with frequent breakfast consumers. Low/middle socio-economic status (SES) adolescents who rarely consumed breakfast were significantly less likely to achieve higher Mathematics grades compared to low/middle SES adolescents who frequently consumed breakfast. This study has been accepted for publication in Frontiers in Public Health, so will be published imminently.
Adolphus, K., Lawton, C., & Dye, L. (In press). Associations between habitual school-day breakfast consumption frequency and academic performance in British adolescents: A cross-sectional study. Frontiers in Public Health.
Adolphus, K., Lawton, C. L., Champ, C. L., & Dye, L. (2016). The Effects of Breakfast and Breakfast Composition on Cognition in Children and Adolescents: A Systematic Review. Advances in nutrition (Bethesda, Md.), 7(3).
Adolphus, K., Lawton, C. L., & Dye, L. (2013). The effects of breakfast on behaviour and academic performance in children and adolescents. Frontiers in Human Neuroscience, 7. doi:10.3389/fnhum.2013.00425
Hoyland, A., Dye, L., & Lawton, C. L. (2009). A systematic review of the effect of breakfast on the cognitive performance of children and adolescents. Nutrition Research Reviews, 22(02), 220-243. doi:doi:10.1017/S0954422409990175
- Healthy food is not universally accessible and requires education and financial resource to access. There are differences in access to healthy food in rural and urban areas but these are also affected by finances. The planning of supermarkets on out of town developments can make access difficult for those without transport e.g. the elderly who if malnourished will have 3 times longer hospital stays when ill. Access to healthy food is also difficult in some housing estates where the only provision is a corner shop or in inner city areas when fast food outlets dominate the available food provision (see also response to Q4 below).
- There is a continued focus upon dealing with the downstream effects of poverty which is both ineffective and costly. Attempts to promote healthy lifestyles in lower income populations ignore all the environmental and social barriers that are preventing uptake. Providing information on healthy eating to populations living in food deserts and on limited budgets is likely to be ineffective. A lot has been made of the cost of a bag of carrots or frozen peas being well within the budget of those on low income. Almost no recognition is given to the stress and hardship of living on such low income.
- Under such circumstances, individuals do not make the best choices even when they are in a position to do so. Parents living on low income talk about giving their children rewarding foods is often the only nice thing they can do for their children. It is also the case that cheap calorie dense foods are the best way to fill their children up and reduce hunger. It brings considerable shame on this country that we are talking about initiatives to address holiday hunger whilst ignoring the fact we live in a system that allows the children of the most vulnerable sectors of our nation to face holiday hunger in the first place. Leeds has run a successful Healthy Holiday program funded via the Leeds Community Foundation.
- In summer 2018 they funded 39 projects and reaching over 4,000 young people. The project was run in partnership with Fareshare Yorkshire, Fuel for Schools and Street Games. The Leeds summer 2018 scheme ran the highest number of projects of any area in England (reflecting the need in this area) and the program for 2019 has been much bigger, reaching into new communities- although statistics are not yet available – suggesting that this problem is growing.
- Addressing poverty at its root is the only way to ensure these initiatives, that are either costly or rely on the goodwill of the community, are no longer required.
- There is another section of the population we would suggest that the Select Committee consider in its inquiry – namely disabled and elderly people who are in need of social care and support. Luke Clements in “Community Care and the Law” (7th ed. Legal Action Group 2019) para 8.96, notes that there appears to be a significant correlation between the recent fall in the number of people receiving meals on wheels from English social services authorities and the rise in the number of hospital beds taken up by people with malnutrition. Between 2010 and 2014 there was a 63 per cent fall in the number of people receiving meals on wheels in England. Between 2011 and 2015 the number of hospital beds taken up by people with malnutrition rose by 61 per cent.
 Rowena Mason, ‘Meals on wheels for elderly in 63% decline under coalition’, Guardian, 3 January 2015, concerning a freedom of information requests submitted by the then shadow care Minister Liz Kendall: the figures being 296,000 in 2009/10 and 109,000 in 2014/15.
 Parliamentary Written Question ‘Malnutrition 53159’ Jonathan Ashworth (15 November 2016) Answer, Department of Health Nicola Blackwood (18 November 2016) the figures being 128,361 in 2010/11 and 184,528 2015/16.
- The existence of food banks creates a conundrum. Food bank provision has ensured an unacceptable number of families in the UK have access to food in dire circumstances; for this they are essential. However, even the food banks emphasise that they should not need to exist. It is a moral and human imperative that the need for food banks are eradicated in the modern UK rather than becoming a normalised part of the food system. The food bank model in the US clearly demonstrates the wholesale adoption and industrialisation of charitable/waste redistribution of food to meet food shortages of food insecure individuals’ compounds and maintains food insecurity, poverty and reliance on the state.
- Mapping of the food environment - the types of food related retail premises in a geographical area – clearly show a predominance of fast food shops, off-licences and small food outlets (which often offer limited choice of healthy, fresh foods) concentrated in low SES areas. How can we expect individuals to follow the guidelines on healthy eating and lifestyle whilst living in retail environments so utterly incompatible with the conditions required to meet these guidelines. Food deserts are a real issue for low SES areas in the UK and will only compound the tertiary disease risks associated with poor diet. This is an unacceptable burden both for the individual and the health care system.
- Leeds City Council Public Health have been running a vending machine trial with Leeds Teaching Hospitals and evidence has shown that providing healthier choices in line with Government Buying Standards does not negatively affect the income stream. The Council are in the process of renewing their vending machine contracts in line with this evidence. A conference on the food environment is planned for spring 2020 in partnership with Leeds Food Partnership. Attendance by representatives of the Select Committee is welcome.
- Legislation to reduce sugar, salt and saturated fats in processed foods is a needed. Existing legislation on sugar reduction can be effective and will result in the food industry changing the way in which they operate. Attempts to change the dietary habits of the population have proven largely ineffectual. The drive to eat rewarding foods high in sugar and fat is so powerful that action is needed above and beyond trying to change dietary behaviour. In this instance the change has to come at the source if any lasting and efficacious change in dietary health of the nation is to be achieved
- There is a heavy reliance on imported fruit and vegetables in the UK. More could be done to promote the production and use of UK grown fruit and vegetables with particular attention given to seasonality. We will have to accept certain fruit and vegetables will not be available year round if we are serious about environmental sustainability. This will require education/public campaigns. Utilisation of urban spaces and community spaces to grow fruit and vegetables could be utilised at the community level to ensure affordable locally produced fruit and vegetables are available. Such projects would increase community spirit and reduce reliance on transport of foods over large distances. Local cooperative food hubs could also be supported and legislation adopted to permit cooperatives of local producers to be able to compete with large food suppliers in contracts for local public services. This will boost local economies and reduce emissions during transport of food supplies.
- In chapter 7 of the UK Climate Change Risk Assessment 2017, the authors note that "the main overall gap in relation to food is the lack of strategic co-ordination to build systemic resilience of the food system. There is currently no overarching strategy to tackle systemic vulnerability in the food system and to assess and measure the effectiveness of single actions (e.g. those promoting sustainability of agriculture or reducing waste) in tackling systemic vulnerabilities.... The House of Commons EFRA committee on food security has recommended that Defra appoint a Food Security Coordinator in order to bring about greater coherence across government on food security.”
- The authors cite the lack of a unified system or process to understand and manage UK food security in a global context as the main reason for the risks identified in the report not being addressed. The authors further note that "a Food Security Coordinator would therefore need to be cross-departmental (or independent) and multidisciplinary. This could be, for example, a strategic committee tasked with assessing evidence and improving management of knowledge and data in order to tackle systemic vulnerability of the food system."
Further research is required to provide a robust analysis of the links between poverty, food insecurity, health inequalities and the sustainability of food production. The links outlined above related to the stress of food insecurity on health outcomes have not been examined. Many politicians seem to make decision based on n=1 i.e their personal experience which is remote from that of the general public and quite distant from those suffering from food insecurity. Government could make better use of the research conducted in its universities to inform decision making in this area.
29. In British Columbia, Canada there is the following scheme: The BC Farmers Market Nutrition Coupon Program. Low income families, pregnant women and seniors are entitled to $21 a week in coupons to spend on fresh produce, meat, fish and eggs at farmers markets. The program ensures both people in need and farmers are supported. Stalls at farmers markets display signs saying they accept the coupons and paying with them is widespread. The public perception is that in general it works really well for both parties. Other provinces are considering it too e.g. https://bcfarmersmarket.org/coupon-program/how-it-works/
30. In the UK, the only thing we have remotely like this is the Alexandra Rose Voucher scheme that works with market traders rather than farmers markets, so no direct benefit to local farmers and limited to 6 locations only. https://www.alexandrarose.org.uk/pages/category/rose-vouchers
31. The Healthy Start Voucher scheme also does not benefit farmers – only specific retailers.
32. Consistent support of community kitchens and cooperative projects that offer nutritious and affordable/free/pay as you feel food for local communities. There are numerous existing grassroots community developed projects that are trying to deal with local food insecurity in an equitable manner without the stigma associated with charitable food bank use.
Professor Louise Dye on behalf of the University of Leeds, Cross Faculty Food Theme.
12 September 2019