Food, Poverty, Health and the Environment:
Evidence from Exeter Foodbank
Introduction: Exeter Food Bank (EFB) opened in 2008 to provide emergency food to people in Exeter and the surrounding area. Affiliated to the national Trussell Trust network, EFB operates on a referral basis in partnership with around 150 frontline agencies across the city, including Exeter City Council, Citizen’s Advice, schools, health services, social workers and local charities. EFB clients, who come from a wide range of backgrounds, are those identified by referring agencies as ‘having little or no food, and little or no money with which to buy food’. This breadth of referral sources makes the foodbank well placed to note general trends in food insecurity over time, albeit with a focus on acute food poverty and crisis intervention.
1) What are the key causes of food insecurity in the UK? Can you outline any significant trends in food insecurity? To what extent (and why) have these challenges persisted over a number of years?
Trends in UK food insecurity
1.1 Significant increase in numbers of people experiencing food insecurity: The number of emergency food parcels provided by EFB has risen continually each year, and has increased by 138% since 2012/13. In 2018/19, the foodbank provided three days’ worth of emergency food to 6,878 people, of which 2,158 were children. (These figures include repeat clients; the significant increase in overall demand can be attributed both to an increase in the number of individuals served and an increase in repeat visits to the foodbank, as explored below). These patterns are broadly in line with national trends across the Trussell Trust network1.
1.2 Increase in ‘chronic’ food insecurity & prolonged or cyclical food crises: The initial rationale of EFB, like the majority of Trussell Trust Foodbanks, was to operate as a short-term ‘crisis’ service. The primary focus of the service is on relieving the immediate physical and psychological distress and other pressures caused by food poverty, whilst other agencies ensure that more long term support is put in place. Historically, EFB has therefore advised referral agencies that clients should be issued with up to three vouchers (each of which enables the recipient to receive up to 3 days’ worth of food) per crisis without contacting the foodbank; further support is available by arrangement. In recent years, however, EFB has seen a marked increase in the duration of some clients’ crises. Similarly, growing numbers have also encountered recurring crises and had to use EFB services intermittently over the course of many months or even years.
This rising trend of prolonged or repeated food insecurity seems to be reflected across the country. A national study of people accessing Trussell Trust foodbanks found that 78% of respondents stated that ‘severe food insecurity’ (in which they had cut back on food intake or gone without eating) was a ‘chronic’ experience (experienced at least once a month or almost every month in the past year)2. Many foodbanks, including EFB, are currently reviewing their internal processes in order to accommodate the increasing number of people affected by chronic food insecurity. However, this departure from foodbanks’ initial rationale as a crisis service is a cause of great concern; these trends suggest that food insecurity is becoming an increasingly permanent and accepted component of the political landscape.
Key causes of acute food insecurity:
1.3 Welfare reform is undoubtedly the single largest factor contributing to the increase in food insecurity observed by EFB, although specific causes within this process have changed with time. The table below (figure 2) sets out the primary cause of referral to EFB in 2018/19, as indicated on foodbank referral vouchers. However, this data does not give a comprehensive view of the circumstances of those accessing EFB, and the often complex, multiple underlying factors contributing to food insecurity. To aid insight into this area, we present a series of thematic stories reflecting EFB client experience below.
Primary cause of food crisis
% of food parcels provided by EFB in 2018/19
Child holiday meals
No recourse to public funds
1.4 Low income: ‘Low income’ has increased steadily as the primary cause of referral to EFB; it accounted for just 13% of referrals to EFB in 2012/13 and 39% in 2018/19. National research commissioned by the Trussell Trust found that the average monthly income of households referred to a foodbank was only £3202.
Low rate of benefits in relation to cost of living: The majority of people accessing EFB are not currently in full-time work and find that income from benefits is simply insufficient to meet rising costs of living. The failure of Local Housing Allowance rates to keep pace with local rental prices, cuts to entitlements for Universal Credit claimants in the Limited Capacity for Work Group, significant benefit deductions or repayments, and loss of other disability assessments, have had a severe, cumulative and enduring impact on people’s ability to purchase adequate food.
Low or unstable income from work: EFB has seen a significant increase in levels of in-work poverty, with single-parent families, and/or larger numbers of children particularly adversely affected.
Lack of financial resilience: Individuals and families managing long term on very low incomes tend to live on a ‘hand to mouth’ basis, with no additional financial capacity to set aside savings. Any increased expenditure (eg – unexpected bills, breakdown of essential household appliances or car) or reduction in earnings (eg – through job insecurity, benefit errors, ill-health, relationship breakdown or other crises) can easily tip people into financial crisis and result in foodbank referral. Purchasing sufficient nutritious food is considered a lower priority for many people than maintaining rent / accommodation and other urgent costs. EFB also frequently serves parents who have deprived themselves of food for sustained periods in order to provide for their children.
1.5 Benefit delays:
Universal Credit: Trussell Trust research shows a 52% average increase in foodbank use in areas that have had Universal Credit (UC) for at least 12 months3. Since UC was introduced locally in September 2018, EFB has seen an increase in new referrals for people who have previously managed their finances well, but simply do not have the financial resilience to cope with the 5 week wait between making a UC claim and receiving first payment. Sadly, a high proportion of these new referrals go on to experience chronic food insecurity and repeated foodbank referrals due to arrears, debts and deductions incurred during the initial waiting period.
Delays in medical assessments: EFB serves many people experiencing prolonged delays for Personal Independence Payment (PIP) assessments or appeals; waiting times for tribunals can stretch to a year or more. Delays in Work Capability Assessments for other benefits can also be substantial. Suspension of disability benefits, or awards at reduced rates, places additional, chronic financial pressures on claimants’, many of whom have already additional expenditure due to their health needs.
1.6 Benefit changes:
Eligibility for sickness / disability benefits and sanctions: Many foodbank clients have previously received sickness benefits such as Employment & Support Allowance (ESA) but find themselves considered ‘fit for work’ when re-assessed. EFB clients often report that they have received little support in adapting to new work conditionality requirements; they subsequently incur benefit sanctions in addition to an initial drop in income. This is particularly true of those with mental health issues and those who have been out of work for some time.
In this context, it is worth noting that ill-health is often an indicator of increased vulnerability to food insecurity, as well as a consequence of it. National research commissioned by the Trussell Trust found that over 50% of households accessing foodbanks included a disabled person; 75% experienced ill health in their household, with mental health issues the most common condition cited2. Sadly, many people served by EFB become trapped in cyclically-reinforcing patterns. Initial ill-health is exacerbated by prolonged inadequate or unbalanced food intake, the stressors of acute poverty and welfare uncertainties; in turn, this makes addressing underlying causes of food insecurity more challenging. Cuts to statutory adult & social care services, inadequate mental healthcare facilities, and loss of specialist support agencies in recent years have also had a cumulative effect on vulnerable people’s capacity to navigate out of these traps.
1.7 Child holiday meals: EFB experiences an increase in referrals from schools each summer due to the additional pressures caused by school holidays. Loss of free school meals during the holidays deprive children of what, for some, may be their most substantial, nutritionally balanced (and/or only cooked) meal of the day; larger families in particular may face significant additional expense in providing alternatives. For parents in employment, both enrolling children in childcare, or choosing to reduce working hours over the summer to provide childcare themselves, can result in loss of income and exacerbate food insecurity further, albeit usually on a short-term scale.
1.8 Lack of job security or unexpected redundancy: In this current economic climate, EFB has helped many clients who have been made redundant and struggled to find new employment. Many of the jobs available locally are temporary posts, involve ‘zero hour’ contracts or agency work; maintaining a consistent, adequate income is very hard. Those who are self-employed, or have worked in low-paid manual jobs for many years until experiencing a debilitating health condition, seem particularly vulnerable to food insecurity, and often struggle the most to access support. The largest demographic of people accessing EFB are single men, many of whom have experienced severe food insecurity for prolonged periods and reached crisis point before seeking help.
1.9 No recourse to public funds: Although numerically fewer in the local area than in larger UK cities, EFB’s experience suggests that asylum-seekers, refugees, and others affected by recent changes to habitual residency legislation, are at high risk of prolonged food insecurity – both due to the extreme levels of destitution experienced by some, and the extremely lengthy processes involved in resolving many residency issues. Language barriers, religious or cultural dietary restrictions, and cultural unfamiliarity may also limit uptake to food sources where available.
2) What are some of the key ways in which diet (including food insecurity) impacts on public health?
Please see Dr Rebecca Sandover’s evidence for further information about the health impact of food insecurity experienced by interviewees from Exeter Foodbank.
3) How accessible is healthy food? What factors affect people’s ability to consume a healthy diet?
3.1 Most foodbank clients, by definition, are experiencing financial crisis and simply have inadequate income to purchase the most basic of essential supplies, let alone consider their long-term health impact. However, financial challenges often interplay with complex, overlapping social factors and often negatively reinforce each other.
3.2 Contents of a foodbank parcel: Foodbank parcels are carefully designed to provide nutritionally balanced meals for 3 days according to a prescribed list of pre-dominantly non-perishable foods. However, at Exeter Foodbank’s distribution sessions, food parcels are packed with the client’s input; some choice is offered where possible, particularly with ‘miscellaneous’ donated items that do not fall within the list’s parameters. Parcels are also supplemented with fresh fruit and vegetables, and bread, supplied by a partner charity (Exeter Food Action) which redistributes surplus produce from manufacturers.
3.3 Food choices made by foodbank clients: Clear cultural discrepancies are evident at EFB between the types of food which are frequently given by foodbank donors and those popular with recipients. Donors often prioritise perceived nutritional benefit, production quality and long-term economic value; items such as lentils, tinned pulses, wholegrain pasta and rice, couscous, flour and nuts are frequently given. However, these items are unpopular with many recipients; they are often rejected in favour of sweet, processed or instant foods. Many overlapping social factors seem to contribute to these choices, as explored below.
3.4 Lack of cooking facilities, equipment and energy: Many clients accessing EFB are in temporary or emergency accommodation (including B&B provision), are in shared housing, and lack access to basic cooking facilities; others are rough sleeping. Many people we see only possess a microwave (or in some cases, a kettle) and do not have access to a hob or oven; clearly, this severely restricts their ability to prepare meals with fresh ingredients. Absence or very limited refrigeration, or concerns about using shared facilities, similarly reduces the appeal of fresh produce and encourages use of often-less nutritious, processed foods and ‘ready meals’, which can be high in salt and fat.
Concerns about high energy costs similarly contributes to a preference for food requiring minimal or no preparation over fresh or wholegrain items with longer cooking times. We frequently see people, particularly those on energy meters, whose gas/electricity supply has been cut off entirely. However, long term dependence on pre-packaged meals can often prove expensive and contribute to further financial insecurity.
3.5 Limited cooking skills or experience: Some people experiencing chronic food insecurity at EFB have never had the opportunity or capacity to acquire the skills needed to plan, budget for, shop for, cook and implement a healthy diet. Many have complex support needs, experienced family breakdown at an early age, suffer from chronic mental ill-health, learning difficulties, substance misuse issues or had repeated contact with the criminal justice system. Lack of confidence in cooking ability increases dependence on instant, processed food, and causes some EFB clients to make repetitive food choices with very limited variety. However, our experience suggests that this barrier is not simply a lack of knowledge (to be addressed merely by tuition); it needs to be considered in context alongside other social stress factors.
3.6 ‘Social stress factors’ & limited emotional/mental resources: Accessing and preparing a healthy diet requires thought, planning and time. Many clients accessing EFB are in crises (including relationship breakdown, redundancy, insecure accommodation, acute financial need or chronic ill-health) which place their emotional and mental resources under strain. Under such stressful conditions, many lack sufficient capacity to acquire new skills or consider making long-term lifestyle changes; all available energies centre on addressing much more urgent, survival issues at hand. Eating can become low priority - a mere necessity for survival - to be completed with as minimal mental input as possible. Again, these factors increase the appeal of familiar, ready-prepared and nutritionally limited food items. Whilst, for some, such crises are short-term, for others (eg – single parents juggling childcare and work) they can become a way of life.
3.7 Mental health issues and social isolation: Around 62% of people accessing Exeter Foodbank are single adults; relationship breakdown is a common theme, particularly among older men. Many clients live alone, are not currently in work and are socially isolated, which can exacerbate mental ill-health. These factors can significantly reduce motivation to invest time and effort in preparing nutritious meals.
3.8 Food as a source of familiarity and comfort in crisis: Food can provide an emotional connection with earlier social contexts and family memories for lonely people; it can also be a deep-seated source of comfort and pleasure in the midst of challenging circumstances. This dynamic can become particularly pronounced for some clients in crisis. However, it can also heighten people’s tendencies to choose familiar foods within a narrow range and deter experimentation with healthier alternatives. It can also enhance tendencies to prioritise instant, powerful taste-gratification over long-term health benefits and contribute to a preference for very sweet or processed foods.
3.9 Stigma attached to asking for help: The value of being able to provide food for one’s family is deeply embedded in our culture; for many, the inability to do so remains (often unfairly) a source of deep personal shame. EFB frequently sees people who are embarrassed to receive donated food, and are apologetic about their presence at foodbank sessions. This reaction is particularly common amongst the older generation, and amongst parents distressed by the possibility of seeing their children go hungry. Sadly, the stigma attached to an inability to provide can exacerbate long-term food security by deterring people from seeking early-intervention support. It also means that much food insecurity remains hidden within society, often within communities where it is little expected.
4) What role can local authorities play in promoting healthy eating in their local populations, especially among children and young people, and those on lower incomes?
4.1 Exeter’s LA has recently worked hard to promote the national NHS Healthy Start scheme, which enables families on low incomes with children aged 4 and under, and pregnant women, to receive free weekly vouchers for purchase of milk, fruit, vegetables and vitamin supplements. New training for midwives and healthcare staff, plus increased publicity amongst local support agencies and charities, has helped raise awareness of this under-utilised resource. Eligible families attending Exeter Foodbank are now signposted to the Healthy Start scheme, and can complete the application form on-site.
Please see also Dr Rebecca Sandover’s evidence from the University of Exeter regarding local collaborative efforts in Exeter.
5) What can be learnt from food banks and other charitable responses to hunger? What role should they play?
5.1 Foodbanks and similar charitable organisations are hugely valuable in mobilising community support to meet local need. Flexible and tailored to specific local issues ‘on the ground’, they are often more accessible and viewed as more approachable than statutory agencies. This makes them particularly effective in identifying and responding to ‘hidden hunger’ through organic development of relationships. Perceived barriers between aid givers and recipients can be less pronounced in volunteer-led, more informal environments; this also aids charities’ abilities to effectively address people’s more holistic social needs alongside hunger through the trust established.
5.2 Trained sign-posters are present at Exeter Foodbank sessions to talk to clients over a cup of tea, help people access specialist partner agencies, supply information leaflets/application forms and make direct referrals to a local debt-relief charity as required. Meeting these additional needs in a relaxed, welcoming and non-judgmental environment is an important part of EFB’s stated aim to ‘revive dignity and restore hope’. Given the significant role of social isolation and emotional factors in determining food choices, this in itself can play an important role in addressing food insecurity.
5.3 However, significant increase in demand for foodbank services, coupled with the new challenges of addressing chronic food insecurity (as described at 1.2 above), is hugely problematic on several levels:
a) Operational capacity: Exeter Foodbank, like most similar organisations, is volunteer-led and employs just three part-time members of staff. It does not receive statutory funding, does not own premises, and is almost entirely reliant on donations of food and finance from the local community in order to operate. The huge challenges of seeking to meet rapidly escalating demand – and effectively to operate as a quasi-statutory service following repeated cuts to statutory provision – have placed every element of the organisation under strain.
b) Long-term nutritional value: The contents of foodbank parcels, although carefully determined by a nutritionist to provide balanced meals for three days, consist primarily of non-perishable, easily accessible foods. Intended as a crisis resource, their contents is inevitably limited in variety and not designed for long-term, continuous use. Whilst EFB has sought to adapt contents (eg – through supplementing them with fresh items from food waste schemes), this in itself is highly logistical complex. There is a risk that sustained use may inadvertently reinforce people’s tendencies to make restricted food choices, with a preference for processed, instant items. Limited resources, continually rising client numbers and the underlying design of the foodbank system make it difficult for them to play an effective new role in supporting development of healthy eating habits. However, partnerships with other local charities can be beneficial. (See also Dr Rebecca Sandover’s evidence from the University of Exeter for further details of the benefits and challenges of local partnership working).
c) Ethical: Increasing pressures to respond to chronic food insecurity and fill gaps in statutory services are deeply at odds with EFB’s long-term aim to create a world where foodbanks are no longer needed. The foodbank is highly conscious of the risks of creating a ‘sticker plaster’ effect (rather than addressing the issues that leave people unable to afford healthy food) and of ‘normalising’ food insecurity within society. For this reason, EFB (via national organisations such as the Trussell Trust) considers raising awareness of key causes of food poverty, and campaigning for long-term change, an important part of its role in addressing UK hunger.
11) How effective are any current measures operated or assisted by Government, local authorities, or others to minimise food waste? What further action is required?
11.1 The rapid development of schemes to re-distribute surplus food from manufacturers, producers, supermarkets and retailers in recent years has hugely benefitted vulnerable local people. Exeter Foodbank receives supplies of bread, fresh fruit and vegetables several times a week for immediate distribution. These enhance the nutritional quality of food parcels and are hugely appreciated by clients.
11.2 Logistical complications: The scale of logistical demands, storage challenges and time commitment required by such schemes should not be underestimated. Supermarkets often require volunteers to collect surplus food at short-notice, or at anti-social hours. Quantities and types of food received often cannot be effectively predicted in advance, creating significant transportation and safe storage challenges, particularly for refrigerated or frozen items. By definition, many items have very short shelf-lives and require rapid redistribution and use, yet the types and quantities of foods do not always match the operational requirements of local charities. For example, as most individual EFB clients transport food on foot, heavy items or those designed for bulk catering are inappropriate.
In Exeter, organisations such as EFB are only able to surmount these challenges through the partnership work of local charity and Exeter Food Action and Fareshare. These volunteer-led organisations exist solely to collect surplus, provide appropriate large-scale storage and co-ordinate redistribution to a wide range of frontline local charities.
11.3 Secondary waste within food redistribution schemes: Unavoidable and often substantial food waste occurs even within redistribution schemes due to the significant challenges of timely redistribution, and of matching demand with unpredictable supply.
Exeter Food Action receives significant daily quantities of surplus fresh bakery items from supermarkets, who often overstock in-store shelves for aesthetic reasons. These items are then frozen by Exeter Food Action to extend their shelf-life and are received by Exeter Foodbank whilst defrosting. However, this can significantly affect the quality, utility and secondary shelf-life of some fresh bread/pastry items. Supply of such items also often still exceeds demand; surplus and poor quality items frequently have to be discarded.
Conversely, Exeter Food Action often receives insufficient supplies of popular fruit and vegetables to reliably meet the needs of foodbank clients. Although certain core items are in high demand amongst EFB’s client group, more exotic or unfamiliar produce tends to be rejected due to its unfamiliarity, limited kitchen resources and uncertainty about the cooking required. Moreover, fresh produce is sometimes received in poor condition and has to be discarded by volunteers. This unseen necessary disposal means that food redistribution schemes can be significantly less efficient in reducing food wastage than they are often perceived to be.
11.4 Although valuable, care therefore needs to be taken to ensure that redistribution schemes do not become a long-term substitute for efforts to reduce food waste at source in production and retail processes. Similarly, such schemes should not become a long-term substitute for addressing root causes of food poverty, and seeking to ensure that everyone has access to a choice of quality, nutritious and dignifying food without reliance on foodbanks. Indeed, it could be argued that reducing food waste is not a viable ethical solution to reducing food poverty; it can legitimise consumption of sub-optimal unwanted items by vulnerable people. The twin challenges of addressing food insecurity and reducing food wastage are sometimes best addressed separately.
1 End of Year Statistics 2018/19. The Trussell Trust: https://www.trusselltrust.org/news-and-blog/latest-stats/end-year-stats/
2Financial insecurity, food insecurity, and disability: the profile of people receiving emergency food assistance from The Trussell Trust Foodbank Network in Britain. Rachel Loopstra & Doireann Lalor, (2017): https://trusselltrust.org/wp-content/uploads/sites/2/2017/06/OU_Report_final_01_08_online.pdf
3 Five weeks too long. The Trussell Trust (2018): https://www.trusselltrust.org/five-weeks-too-long/#1537788899622-f44560cb-2db8
Submitted by Laura McIvor from Exeter Foodbank Management Team on behalf of Exeter Foodbank.
12 September 2019