On 15 September, 2021 POST held a closed briefing on Food insecurity and children’s health. As this was a closed event for Parliamentarians and parliamentary staff, questions and comments during the discussion have not been attributed.
The Food and Agriculture Organization of the United Nations defines food insecurity as a “lack of secure access to sufficient amounts of safe and nutritious food for normal growth and development and an active and healthy life”. According to the UK latest estimates, around 4.7 million adults and 2.5 million children live in households that have experienced food insecurity in the past year. Food insecurity has effects on children’s physical and mental health and negative consequences for children’s educational attainment.
The aim of this event was to inform Members and Peers about the latest data on food insecurity in children and young people (CYP, young people up to age 18) in the UK; physical and mental health consequences of food insecurity in children; and potential interventions to support access to healthy food.
Baroness Boycott chaired the panel. Speakers included:
Lady Boycott welcomed attendees to the meeting and began by highlighting that childhood food poverty has become a very serious issue in the last year. Food poverty can have many shapes and forms. For instance, it could mean skipping a meal, not getting enough vegetables, taking a packet of crisps to school rather than having lunch or not having breakfast. Not having enough food around becomes a worry and a health liability, something that every child in this country deserves not to experience.
Anna introduced her presentation focusing on six key themes: recent trends in food insecurity; what experiencing food insecurity means for children; safety nets in place to protect children; recent Government interventions; immediate and future policy priorities and how much they will cost.
The Food Foundation has been tracking levels of food insecurity during the pandemic using a survey, which has been run eight times to capture any trends. The survey gathers data on moderate and severe food insecurity. The survey focuses on these more severe measures, which refer to people’s experiences of skipping meals, not being able to eat although they are hungry, or going without food, within a fixed time period.
The latest statistics from the survey were published on 5th September 2021. 15% of households with children reported food insecurity between January–July 2021, compared with 12% pre-pandemic. Pre-pandemic data comes from the Food Standards Agency. Overall, this means that food insecurity affects 2.5m children in the UK. The levels were already high before the pandemic, an increase was observed during the first phase of the pandemic, which then declined. Most recently food insecurity in household with children has increased to the highest level since the pandemic began. This trend is something that the Food Foundation thought might not appear until later in 2021, linked to the termination of the financial support for families from the Government’s furlough programme (Coronavirus Job Retention Scheme) and the removal of the Universal Credit £20 uplift.
Anna went on to say that it is very important to think about the effects of food insecurity in their entirety. The physical effects are well described in research, covered by Professor Charlotte Wright’s presentation. It is particularly important to think about that if you are a child living in a food-insecure household, levels of stress and anxiety are likely to be very high, and whilst parents will do their utmost to protect children, they will pick up on the fact that their parents will say ‘I’m not hungry’, or ‘I’ll eat later on’. They are alert to the fact that there is anxiety in the family about when food will run out and they may experience it themselves. Therefore, there are significant knock-on effects on children’s wellbeing. Other aspects are stigma and social isolation; children quickly pick up on the fact that food insecurity is not something to talk about. Parental anxieties reflect concerns that there may be consequences of being open about food insecurity in their household. For example, a fear that this might lead to contact with social services. Food insecurity is something that is happening behind closed doors. Children are suffering in silence and not asking for help because they do not feel able to talk to their friends or to school staff about this issue.
There is good evidence from international studies, mostly from the US and Canada, which use similar measures of food insecurity. This research shows that people in food insecure households depend more heavily on health services. Therefore, the equivalent costs to the NHS, as people with physical and mental problems need help, are likely to be higher.
This has been a live debate over the last 12-18 months, with discussion as to whether feeding children well is a parental or governmental responsibility. Some debates set these against each other. It is important to note that many households which have experience of food insecurity have one adult in employment, so this is not something that is unique to families where adults are not working. When we talk with the public in a more nuanced way about parental responsibility, we see that the main view is that while feeding children well is a parental responsibility, when they are not able to do that, there is a clear role for the State to provide a safety guarantee so that every growing child’s health and wellbeing is protected. The two main programmes in UK that meet this are the Healthy Start scheme (for pre-school children from low-income families) which provides vouchers for purchasing milk and fruit and vegetables, and the Free School Meal programme which in England is provided for children from families whose earnings (not including benefits) are less than £7,400 pa. The provision of such schemes varies across the UK nations, with differences in earnings thresholds. In Northern Ireland the earnings threshold is £14,000 pa. Scotland will be moving to providing universal free school meals for all primary-aged school children. In summary, when comparing the level of provision, children in England are worse off when compared with their peers in Northern Ireland and Scotland.
In November 2020, the Government increased the value of the Healthy Start vouchers from £3.10 to £4.25. The Government also extended the Holiday Activities and Food (HAF) Programme which was being piloted prior to the pandemic. This scheme was extended to cover all children eligible for Free School Meals, so that they can access enriching activities and good food during school holidays. The University of York is working in partnership with the Food Foundation on work to review the impact of the programme. These programmes represent significant and valuable investments, which were part of the Government’s last spending review.
Anna highlighted three important elements:
Anna noted that extending the Healthy Start programme, the HAF scheme and Free School Meal programme would cost an estimated £1.1bn per year, while offering significant benefits to children both for their physical and mental health, as well as improving their educational attainment.
Charlotte gave her talk as in her private capacity as an academic, not as a representative of the UK Government’s Scientific Advisory Committee for Nutrition (SACN). She noted that children are most at risk of food insecurity, since they are growing fast and they are the most in need of food.
While food poverty tends to be associated with undernutrition, the relationship is more complex. Nutritional stunting (lower than average height for a child’s age) and wasting (low weight-for-height) are still very common worldwide, but much less in the UK.
In the UK, undernutrition still occurs in around one in 20 babies under 2 years old, because this group is the most vulnerable to undernutrition. However, a clear-cut association with poverty for this cannot be found. Until the 1990s, it was very clear that poorer children were growing less well than the more affluent, but this trend cannot be observed in more recent cohorts. The effect has largely disappeared because food in the UK today is probably cheaper and more widely available than it has ever been in the past. Cases of short and stunted children can still be observed, but this is now much more likely to be due to genetic factors or underlying illnesses rather than undernutrition.
Obesity, not undernutrition, is an issue in the UK, affecting all ages and classes. Obesity is much more common in adults than it is in children, but children living in poverty are more likely to be obese and much more likely to be severely obese – the type of overweight that tends to persist into adulthood.
While it may seem counterintuitive that shortage of money leads to overconsumption of food, this is explained by the fact that that we now live in an obesogenic environment, where high-energy food is widely available and affordable, while diverse diets are still much more expensive per calorie consumed. If you’re running out of money, what will you buy for a hungry child? For the same price (£1), a pack of biscuits supplies 20 times as many calories as three sweet peppers.
Low-income working families are time-poor and the most vulnerable families tend to lack cooking and food storage facilities. This, combined with the obesogenic environment, will inevitably lead to overconsumption of cheap, high energy, highly processed foods.
There are three main health effects of food poverty in children:
Charlotte noted there is something intrinsically inappropriate about the idea of handing food out to poor families, when what they need is money and the opportunity to buy, cook and prepare their own food. Handing out treats to children or even giving food parcels to families are not solutions to food poverty. Charlotte stressed that, even though food banks are doing a great job in responding to immediate food poverty, the food provided is usually by necessity, tinned or dried, as food banks are limited by what food they can get and store. In practice this means that food content tends to be high on energy-density and low on nutrients.
Appropriate solutions involve:
Louis introduced the theme of her presentation, based on her research on how our experience of access to food and what we eat influences our psychological health.
Louise began by describing results of data from surveys carried out in two different geographic regions of the UK. These are robust surveys which use well characterised measures. These data are currently being written up for publication in a scientific journal.
Louise then went on to discuss the importance of breakfast for children’s health and wellbeing and explained the research describing the influence of this meal on educational attainment. It was noted that the School Breakfast Bill (a Private Member’s Bill sponsored by Emma Lewell-Buck MP) is going through Parliament at present. The Bill is due for its Second Reading in the House of Commons but the date for this has not yet been announced.
Research has examined how regularly eating breakfast can impact on behaviour and academic performance, with breakfast consumption associated with better academic outcomes. Data shows that attainment in mathematics is improved, and further research in the UK demonstrated an association with overall performance in GCSE examinations, with children eating a regular breakfast achieving on average, 2 grades higher than children who rarely ate breakfast.
The availability of school-based breakfast programmes is also a factor linked to encouraging children to attend school. Survey data from a breakfast boost intervention (a two-week, universally free, return-to-school breakfast intervention in Shropshire following the COVID-19 lockdown school closures) suggested that the free breakfast had a range of positive effects on hunger, energy levels, mood and concentration. Students also noted that the free breakfast was important for those who usually skipped breakfast or couldn’t afford it.
Louise concluded her presentation highlighting that ‘poverty accelerates the sense of what is possible in the world’. Children in poverty are aware of barriers from a very early age and that limits their aspirations, because their concern is ‘where is my next meal coming from?’ and not ‘how do I do well at school?’ or ‘how do I achieve longer term attainment?’
Clara presented two programmes delivered by the Mayor’s Fund for London, an independent social mobility charity supporting young Londoners to obtain a successful education and move into a meaningful career. Clara highlighted how poor nutrition and isolation not only affect a child’s physical well-being, but also their long-term educational attainment and employment prospects, thereby perpetuating the cycle of poverty.
Kitchen Social was established in 2017 to develop, test and scale holiday meals in community settings across London. It funds community organisations with existing programmes of activity to offer free nutritious meals. Kitchen Social provides a wide range of wraparound support and coordinates the growing network of providers in London.
The Mayor’s Fund for London also campaigned for the Department of Education’s Holiday Activities and Food (HAF) Programme, and delivered one of the HAF pilot programmes in 2020, providing 336,485 meals that met school food standards to children across London.
The Mayor’s Fund for London is producing a review of the policy and implementation of the HAF Programme. They are particularly concerned about the programme’s eligibility criteria and coverage:
However, HAF provides an opportunity to invest in grassroots organisations in areas of high deprivation to provide high quality meals and food education. During the two lockdowns, thirty Kitchen Social hubs provided emergency responses to offer nutritious meals for families with children.
The Mayor’s Fund for London’s evaluation produced alongside the Healthy Living Lab at Northumbria University, shows that holiday provision has a range of benefits for children and their families, including:
The Mayor’s Fund for London believe that the programme benefits should be extended to those young people vulnerable to a wide range of risks outside of the school terms including social isolation, and family isolation, educational attainment loss, safeguarding issues, mental health issues and obesity. These factors are contributors to and signals of poverty and therefore high-quality holiday provision, funded by the Department of Education, should be extended to families in receipt of any form of means tested benefits.
Take & Make Recipe Boxes provide a fun, practical cookery activity to support children to increase their knowledge of food and cookery, and to feel more confident preparing nutritious meals.
Consuming home-cooked meals is associated with lower rates of obesity and better diet quality in both adults and children. Research shows that helping with home meal preparation is a modifiable youth behaviour and may substantially influence overall dietary quality. Clara’s research suggests that children in low-income households are not frequently encouraged to participate in food preparation for time and budget constraints, and for food wastage and financial loss risks.
To date, the Mayor’s Fund for London has provided 95,635 recipe boxes to families across London, equating to the same number of hours of practical cooking experience and 382,540 meals.
Take & Make is the provision of branded recipe boxes which include four portions of nutritious, vegetarian food, with high-quality ingredients needed to cook a meal from scratch. Every box contains step by step instructions plus online video tutorials. Each meal meets school food standards and it is culturally appropriate, taking consideration of the fact that ethnic groups (including black and mixed heritage groups) have a higher percentage of children living in low-income households than the national average.
The boxes are marketed to families as a food activity for children with recipes that are easy enough to repeat. Each box teaches a different recipe, including a wide range of cooking skills, to young people and are designed to get children learning to cook in their homes, with their family.
Take & Make was originally designed as a contingency programme prior to summer 2020 as part of HAF Pilot. It meets the intended of HAF outcomes of supporting children to have a greater knowledge of health and nutrition, and ensuring that families develop their understanding of nutrition and food budgeting.
An evaluation of Take & Make has been limited by the COVID-19 pandemic. However, the Mayor’s Fund for London’s family survey found that:
The Q&A session started by discussing the international literature on impact of breakfast on children’s cognitive performance, wellbeing and educational attainment. Data on breakfast and academic outcomes mostly comes from the developed world, including UK, the US, and Australia. When reviewed systematically, these data show short term benefits of consuming breakfast on children’s cognitive performance (i.e., memory, learning abilities) on that day in school. The longer-term benefits are less well established and rely on association studies (so cause and effect cannot be established).
Research in undernourished children from countries such as the Peruvian Andes, Jamaica etc., shows that if nutrient deficiencies are corrected there is a positive impact on child health, child cognitive performance and educational performance.
The panel discussed how breakfast is not part of the Free School Meal provision. Programmes such as Magic Breakfast (which with Family Action is part of the National School Breakfast program) have been providing breakfast to about 200,000 children each day across the UK. The Department for Education has awarded a new contract to supply breakfasts to at least 2,500 schools in England between September 2021 and July 2023 to Family Action but the long-term commitment is uncertain.
There are also schemes run by companies like Greggs or Kellogg’s that have certain eligibility requirements. However, corporate social responsibility schemes usually tend to set up a breakfast club and schools then take over responsibility for ongoing provision, which often requires parents to pay. The parents who sign-up to these tend to be those who are at work and need childcare early in the morning rather those who have children experiencing food poverty for whom costs may be too high.
The panel discussed the complexity of the risks associated with childhood obesity. The greatest risk for obese children is becoming obese as teenagers and adults rather than being obese as a child.
There is limited research suggesting that children do not have concerns about obesity itself and do not consider it stigmatising. For children who have grown up in food poverty, obesity is normal and standardised. Their fear of hunger is much greater than their fear of being overweight, which is instead regarded as being healthy. This is common in a lot of poorer societies, where overweight is a very desirable outcome because it is a sign of nutritional security.
However, if a child is obese in adolescence, there’s a very high probability that they will remain obese throughout life. This increases their risk of type 2 diabetes, a disease used to be called ‘an old man’s disease’ that is now occurring in teenagers. Type 2 diabetes in midlife is associated with higher risk of vascular dementia in later life. This can have very serious implications for our aging population.
It was noted that there are two sides of the body positivity movement: one very healthy, focused on self-acceptance, and another one somehow minimising how harmful it is to be obese. Speakers discussed the need of changing the language about obesity, that is currently based on shame and disgust. This is despite overweight now being the new ‘norm’, with two thirds of adults being overweight and one in four obese. People talk about obesity as a problem of poverty and ignorance. But it is a very widespread problem, that is not confined to the poorest families. It is just that for the poorest families it is the hardest to address.
Auto-enrolment to the Free School Meals was discussed as a potential way to ensure that all children eligible for Free School Meals get registered. However, it was noted that it requires the technology able to deal with data sharing between different departments, which is not without its challenges.
It was highlighted how HAF programmes have been invaluable in communities across England, but they were heavily dependent on the charity sector, and there was no systemisation across the country. In 2020, the Government committed funding towards the HAF programme until the end of this calendar year, but there is no longer-term funding as yet, and no funding for the extension of Free School Meals and Healthy Start. There is a hope that this will be addressed in the comprehensive spending review due later in October. The National Food Strategy (NFS) recommended increased funding to these programmes and recommended a sugar and salt reformulation tax that would lower the economic incentives around junk food alongside creating revenue which can be used to ensure lowest income families can access healthier food.
Speakers stressed the importance of the upcoming spending review in securing funding to measures tackling children’s food insecurity, as well as the role of the upcoming White Paper in response to the National Food Strategy, which is led by Defra. They hope that it will include other departments as well, such as Department for Education and the Department of Health and Social Care, to ensure a substantial consideration of the NFS recommendations and a set of actions to tackle both food insecurity and dietary inequalities across the UK.
It was also noted how there is a robust evidence base showing that School Breakfast Provision, Free School Meals and HAF programmes have real benefits to children. Creating a What Works Centre for Food might be a solution to help bring policymakers closer to the evidence base.
Starting from an observation that research in Sheffield shows that food insecurity is also linked to the mental and physical capacity to cook (i.e., how to cook with ingredients given through food parcels; being able to stand at the cooker, etc.), the role of food knowledge in food insecurity and the importance of expanding programmes like Take & Make was then discussed.
It was noted that the Take & Make scheme is open to all councils in London, while outside London there are some similar successful schemes. The strength of Take & Make lies in supporting children in their own home, creating habits within the household, confidence and relationships with parents and with family members (rather than just a transference of skills). It was also noted that children feel that better food knowledge would be useful for them and that they are disappointed in the level of education they are receiving at school , which does not cover how to prepare full nutritious meals, for example. Speakers discussed the need to educate children about food in multiple and holistic ways, including gardening clubs, cooking workshops, schools, and schemes like Take and Make that enable young people to engage in those activities in their home.
It was highlighted that including cooking on the national curriculum as a way to address lack of food knowledge had already been proposed a few years ago by Henry Dimbleby, but there is a mixed picture with regards to the extent in which the curriculum is currently implemented in each school. This is the subject of one of the other recommendations in the NFS, which also recommends that schools supply ingredients for the whole class, to help children from low-income families who might struggle to provide ingredients.
It was also noted that food education and cookery are seen as an extra component of education, rather than a vital part of it. Speakers stressed that cooking skills are not particularly patterned socio-economically as there are people with very poor skills in the richest households as well as in the poorest households. However, the effects of poor cooking skills are much greater for people from very low-income households, because they then buy the very cheapest calories, while people from high-income households without cooking skills buy healthier alternatives.
Speakers felt that lifting the £20 Universal Credit will have a significant negative impact on food-insecure children, increasing their stress and anxiety levels. Research discussed in the presentations showed that simply worrying about not having enough food was enough to make children significantly different from their food-secure peers. It was noted that increasing the number of children into that position will negatively impact their mental health.
Speakers stressed the importance of financial security and how a lot of existing interventions represent a ‘cheap sticking plaster’ approach. It was highlighted how there is a tendency to believe that the right interventions involve educating the poor and giving them the right foods to eat as opposed to just giving them enough money to live on. Ensuring financial security, not handing out food, has made the most difference historically.
Speakers noted that community gardening and projects that include growing are incredibly useful for community cohesiveness and generation of social capital. While they do not believe it could impact food insecurity directly (i.e., providing enough food to eat), they are important as they create environments where healthy food is visible.
Others noted that community growing and gardens are excellent strategies, with a positive impact on wellbeing as well as providing some valuable sources of food, but soil quality is an important consideration. Members of the audience discussed how some U.S. cities have used commercial urban agriculture as a strategy to contribute to food access goals. For example, 28 urban farms have a key role in the city of Atlanta’s goal of having 85% of people to live within half a mile of fresh and healthy food by 2022. These farms also sell at half price to people using food stamp support.
The panel shared their view on which actions Parliamentarians can take to tackle the issue discussed in the session. These included:
Photo by Aaron Burden on Unsplash
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