Hungry? Food Insecurity,Social Stigma and Embarrassment in the UK

Abstract

In the context of the economic recession and welfare reform in the UK there have been ongoing political debates regarding food insecurity. Food has an important role in defining people’s identities, yet the rapid growth in the number of food banks and food donation points in supermarkets and schools suggests a normalisation of food aid. Moreover, an estimated three million individuals are thought to be at risk of malnutrition in the UK. We examine: the discourse of food aid and the demonisation of those living in poverty, the scale of malnutrition, and the experiences of food bank users by drawing on survey data and case studies. Substantial numbers of people were constrained in their food choices, whilst food bank users had concerns about the social stigma of food aid. It is questionable whether the present policy approach is economically and politically efficient given the impact on people’s health and well-being.

Keywords

austerity budgeting food banks food insecurity hunger malnutrition stigma

Introduction

Food insecurity – when people do not have the economic, social and physical resources to shop, cook and eat in order to ensure a sufficient supply of nutritionally appropriate food – is a critical social policy issue in the UK. Research by the charity Church Action on Poverty has estimated that over 500,000 people in the UK are reliant on food aid (Cooper and Dumpleton, 2013) and leading health experts have warned of a potential public health emergency (Taylor-Robinson et al., 2013). The economic recession in the UK has had far-reaching impacts. It is estimated that one in five people (nearly 13 million people) live below the official relative poverty line, including many people living in households where someone is working (MacInnes et al., 2014).

Food insecurity can include issues of global food production and safety, identity, home and family life (Caplan, 1997; Devine et al., 2006; Dowler et al., 2011; Evans, 2011; Jackson, 2009; Murcott, 1997; Valentine, 1999; Warde, 1997; Warde and Hetherington, 1994).¹ Our focus is on food insecurity in terms of malnutrition and food poverty. Malnutrition, in terms of under-nutrition, is a deficiency in protein, energy or micronutrients. It can lead to poorer health outcomes, delays in recovery from illness as well as longer periods in hospital, and is associated with slower development and lower educational performance amongst children (Heismayr et al., 2009). Evidence from the National Nutrition Screening Survey suggests that more than three million individuals are estimated to be at risk of malnutrition in the UK. Indeed, 29% of adults have been identified as affected by malnutrition on admission to hospital, highlighting its community basis (Russell and Elia, 2014). It is estimated that £13 billion is spent on disease-related malnutrition each year in the UK (BAPEN, 2012).

Food poverty is a key aspect of food insecurity and is defined as being unable to afford or access a sufficient supply of adequate food for a healthy diet (Dowler, 2002). It is estimated that 4.7 million people in the UK live in food poverty, having no choice but to spend 10% or more of their household income on food (CEBR, 2013). The number of food banks has risen sharply in recent years and The Trussell Trust (a Christian social action charity that runs the UK’s largest food bank network) estimated that the number of food parcels their food banks had given out exceeded one million in 2014 (The Trussell Trust, 2015). Moreover, there are many independent food banks and informal sources of food aid that go undocumented, including food sharing and lunch clubs (Downing and Kennedy, 2014; Lambie-Mumford, 2013a, 2013b). In 2014, the UK Government convened an All-Party Inquiry into hunger and the causes of food poverty.

The causes of the increase in the number of food banks are disputed, including whether it is supply-led. The Trussell Trust (2015) reported that benefit delays and benefit changes accounted for 48% of their food bank referrals in 2014. Evidence from the Citizens Advice Bureau of over 600 food bank referrals across 29 of their advice offices during a one-month period found that the main reason for referral was a delay in benefit payments, accounting for 36% of all referrals (Citizens Advice Bureau, 2013). Loopstra et al. (2015) have highlighted the growth in the number of food banks in areas of high unemployment and which have had high levels of welfare cuts. It is also notable that the Department for Work and Pensions have reported that there is a backlog of over 700,000 disability benefit claims (DWP, 2014a). Miscampbell (2014) has also highlighted the high levels of errors in benefit sanction decisions. Garthwaite et al. (2015), Garratt (2015) and Lambie-Mumford et al. (2014) highlight that food banks were a last resort for many people and often the result of loss of employment, benefit changes and delays, as well as longer-term financial insecurity.

In this article, we examine the nature and extent of food insecurity in the UK. The key research questions are: What are the estimated levels of food insecurity in terms of malnutrition and food poverty? What concerns do food bank users have when visiting a food bank? How sustainable is a local voluntary-led food aid policy model?

Background

Malnutrition and Food Poverty

In the UK, malnutrition is most commonly measured using the body mass index (BMI), which is based on comparing a person’s height and weight. A BMI of 17–18.5 (kg/m²) is considered mild malnutrition. However, there are limitations to the BMI measure (Blackburn and Jacobs, 2014). The aetiology of malnutrition is complex but affordability, general health, food availability, food knowledge, preparation skills, equipment availability and social isolation are key factors (Dowler et al., 2001; Griffith et al., 2013). Health problems are thought to particularly affect the nutrition of older people, including in relation to eating and swallowing.

In recent years, the combination of falling incomes and rising costs presents risks for malnutrition and food poverty in the UK. Despite a recent fall in food prices in the UK, over the longer term food prices are rising in real terms and by more on average than other goods (Office for National Statistics, 2013). The costs of food are compounded by falling incomes (Alakeson and Cory, 2013; Dowler et al., 2011). Average incomes fell by 9% between 2007/08 and 2012/13 (MacInnes et al., 2014; Rowlingson and McKay, 2012). An increase in the number of zero-hours contracts, reductions to working-age benefits and rising costs, including housing rents and home energy, have exerted pressure on household budgets (Alakeson and Cory, 2013; Office for National Statistics, 2014; O’Hara, 2014; Resolution Foundation, 2014; Shildrick et al., 2013). In addition to a number of specific cuts to social security payments, working-age benefits and tax credits are being increased at a rate lower than inflation. In the financial year 2013/14 it was estimated that 1.75 million UK families experienced reductions in benefit entitlement due to welfare changes (Aldridge and MacInnes, 2014). Data from the British Social Attitudes Study (Park et al., 2014) have also indicated a large increase in people in working households reporting that they were struggling financially (36% in 2000 and 64% in 2013). Research on the public perceptions of minimum income standards suggests that many people are living without the resources to meet their minimum needs in the UK (Davis et al., 2013).

Analysis of food prices in the UK has shown that food costs increased between 2002 and 2012, and the increases were far greater for healthier food (Jones et al., 2014). On average, the nutritional quality of the food people have purchased has declined since 2005 (Griffith et al., 2013). Pensioners, households with young children and lone parent households have experienced the largest decline in the nutritional quality of the foods they have chosen to purchase. Evidence suggests that those on lower incomes have poorer diets and a lower awareness of healthy eating guidelines, and many people on lower incomes have concerns about the affordability of food (Dowler and Calvert, 1995; Nelson et al., 2007). In the UK, research by the consumer rights charity Which (2013) found that 29% of people surveyed said they were struggling to feed themselves or their family. Research by the Greater London Authority (GLA) found that 72% of teachers had experienced pupils coming into school with no lunch or no means to pay for one (GLA, 2012). A survey of 522 GPs, conducted by the medical practitioners’ magazine Pulse, found that 16% had been asked to refer patients to food banks (Matthews-King, 2014). Research by the Institute for Fiscal Studies (IFS) (2011) has highlighted that poorer households are choosing between either spending money on food or heating their homes during the winter months. Research in Canada has identified an association between income and food insecurity (Loopstra and Tarasuk, 2013).

The Discourse of Food Aid and the Labelling of Food Bank Users

It is revealing to explore the language surrounding the use of food aid in the UK. It has been argued that the growth in food bank use has been driven simply by the increase in the number of food banks. Lord Freud (2013) argued in the House of Lords’ debate on food banks that ‘food from a food bank – the supply – is a free good, and by definition there is an almost infinite demand’. The former Minister of State (Department for Work and Pensions) described the growth in the use of food banks as something ‘we would expect’ and a consequence of the economic recession and the shared responsibility to pay back the economic debt (McVey, 2013). We consider the reasons food bank users give for visiting a food bank below.

Constituting what can be seen as the demonisation of those living in poverty in the UK (Jones, 2012), political commentators have accused, or some might say attacked, food bank users of being unable to manage their budgets. The former Conservative Government Health Minister Edwina Currie seemed to blame food bank users, stating: ‘they never learn to cook … the moment they’ve got a bit of spare cash they’re off getting another tattoo’ (Currie, 2014). The social commentator Katie Hopkins compared food bank users to cancer patients: ‘Food bank users are like terminal cancer patients. There may not be a tomorrow so spend like hell today’ (Hopkins, 2014); while Rachel Johnson reportedly described food bank users as ‘living like animals’ (Buerk, 2014). Baroness Jenkin, who was part of the All-Party Inquiry into Hunger and Food Poverty, was reported as stating: ‘poor people can’t cook’ (Butler et al., 2014).

The language used to describe food bank users seems predominantly located in a discourse of blame. As Mooney and Neal (2010) highlight, the focus in many narratives of welfare is on the deserving and undeserving poor and what can be considered an anti-welfare message. It is notable that recent research by Wells and Caraher (2014), which examined the representation of food insecurity in the print media in the UK, found that the views of food bank users were rarely quoted in the media.

A challenge is that in the UK policies aimed at tackling poverty do not always recognise food and nutritional needs and the link to well-being (Dowler and O’Connor, 2012). Very little attention in the public and political debates has focused on the importance of food in terms of people’s nutrition and identity, including its importance in home and family life, and in relation to providing for dependents.

Methodology and Ethics

We first reviewed and analysed a range of UK Government surveys including the Family Resources Survey (FRS) and the English Longitudinal Study of Ageing (ELSA). We examined various indicators of malnutrition risk and food poverty. Small case numbers limited the statistical analysis possible and we reflect on this measurement issue in our discussion of evidence gaps.

Second, we conducted an assessment of the scale of food aid in one case study city in the UK using online and network searches and information from food bank organisers. This was designed to capture the scale of food aid in one urban area. Our approach has limitations and many food aid suppliers may not have an online listing of their contact details. Of course it is also important to consider the food insecurity challenges facing those people living in rural areas. However, the evidence produced is still of value in terms of adding to the existing understanding of the nature of food insecurity.

Third, we conducted four case studies of food banks in the north-west of England. The case study food banks were selected to reflect a range of organisation types, sizes and areas of operation. Each case study involved observation of the food bank and interviews with food bank users and organisers. Interviews with food bank users focused on the reasons for coming to the food bank, their household circumstances, the use of the food and budgeting. Interviews with the food bank organisers covered the number and profile of their users and the sources of their food supplies. Some of the food bank staff also collected anonymous comments from users in a visitors’ book and we also drew on these. The food bank users’ participation was voluntary. All the information collected was anonymised and a shopping voucher was given as acknowledgement of the interviewee’s time.

In total, 34 food bank users were interviewed. Of these, 23 were women, seven were men and there were two couples. Twenty-five of the food bank users had children and nine food bank users came to the food bank with their children. The average age of the food bank users we interviewed was 51 years old. Three of the food bank users were in employment. The remainder were in receipt of different welfare benefits, including Pension Credit, Job Seekers Allowance and Disability Living Allowance, or were waiting for their benefit application to be approved. Some of the food bank users were paying benefit sanctions.

All the case study food banks were being run by organisations affiliated to religious groups. Two of the food banks required users to be referred by social or welfare services and restricted the number of visits people could make. The other two food banks provided food parcels without asking for formal identification and had no limit on the number of visits. The case study food banks covered both urban and suburban areas, and areas that were predominantly white or ethnically diverse.

The food banks provided food parcels from food collected from donations, food purchased from the national charity FareShare (which sources food from within the food system and redistributes it), and two food banks bought food directly from supermarkets as needed. Each of the food banks was open for around two hours per week. On average, the food banks would have between 20 and 40 people visit each time they were open. In the previous 12 months, all four food banks had seen an increase in the numbers of people visiting.

Findings

Estimating Malnutrition and Food Insecurity Using UK Survey Data

Survey evidence allows us to examine the underlying patterns of food insecurity on a number of measures. Data from the Health Survey of England suggest that in 2012, 1.8% of adults (n=6969) in England had a BMI of less than 18.5 (kg/m²) and would be classified as suffering from malnutrition. Women (2.3%) were more likely than men (1.3%) to be malnourished. Data from ELSA, which surveys adults in England aged 50 years and over, indicated that 0.9% of respondents (n=7697) had a BMI of less than 18.5 (kg/m²) and women (1.2%) were also more likely than men (0.6%) to have a BMI of less than 18.5 (kg/m²). More than half (52.5%) of those at risk of suffering from malnutrition also had a limiting longstanding illness, suggesting a compounding of vulnerability in these individuals. It is important to note that, as described above, there are limitations to the use of BMI as a measure, and also we are reliant on small sample numbers so these estimates should be treated with caution.

We now focus on food sufficiency and, in particular, affordability, and examine people’s reported attitudes and behaviour across a number of government surveys. Table 1 highlights key evidence from a number of measures of food insecurity.

Table 1.

Measures of food use, affordability and meal skipping.

Question	Year	Survey	Population	%	n	Total n
1. Cannot afford to eat two meals a day	2012	Poverty and Social Exclusion (PSE) survey	All adults	1.8	139	7,789
1. Cannot afford to eat two meals a day	2012	Poverty and Social Exclusion (PSE) survey	Over-65s	0.7	15	2,150
2. Skipping meals or reducing size of meals	2012	Poverty and Social Exclusion (PSE) survey: In the last 12 months have you skimped on food so others in the household would have enough to eat (often or sometimes)	All adults	27.7	1,650	5,954
	2012		Over-65s	12.1	156	1,285
	2010	English Longitudinal Study of Ageing (ELSA): In the last 12 months did you (or anyone else in your household) ever cut the size of your meals or skip meals because there wasn’t enough money for food?	Over-50s	1.6	142	8,987
	2010		Over-65s	0.8	40	4,749
3. Not eating at least one filling meal every day	2011 / 12	Family Resources Survey (FRS)	Households containing over-65s	1.1	66	5,974
4. Affordability and socialising	2010	Understanding Society (US) survey: Cannot afford to host friends for a meal or drink every month	All households	7.9	1,779	22,525
4. Affordability and socialising	2010	Understanding Society (US) survey: Cannot afford for their children to have a friend round for tea or a snack every month	Households with children	4.9	291	5,958

The proportion of people (27.7%) (n=5954) in the Poverty and Social Exclusion (PSE) survey stating that they have cut down on food so that others have enough to eat is striking. In general, women were more likely than men to report difficulties with food sufficiency and affordability and, in particular, skipping meals. Of course, women may be more aware of problems with choice or affordability if they are responsible for managing the family budget and shopping (Jackson, 2009).

Data from ELSA in 2010 suggest that 6.9% of people aged 50 and over (n=8675) reported that: ‘Too little money stops them buying their first choice of food items’. The rate was slightly lower (4.9%) amongst those aged 65 and older. In terms of the specific issue of food choice, data from the 2009 British Household Panel Survey indicated that 1.7% of respondents (n=8556) ‘would like to eat meat, chicken or fish at least every second day but cannot afford it’. The 2012 PSE survey also captured evidence on spending on fruit and vegetables and 5.4% of respondents (n=7788) reported they could not afford to eat fresh fruit and vegetables every day. Whilst there is some variation in these estimates, it is clear that all surveys consistently find some evidence of food insecurity.

It is also important to examine the support aspect of food and eating, including the help people might need with preparing food. Data from ELSA in 2010 show that 1.1% of respondents aged 50 years and over (n=8987) said they ‘did not get the help they need to prepare and eat a hot meal’. We can also draw on evidence from the 2012 Adult Social Care survey. The specific population in this survey is adults receiving social care in their own homes and 4.3% (n=32,023) of respondents reported that ‘they don’t always get adequate or timely food’.

The social aspects of food include socialising and eating with friends. Data from the 2010 Understanding Society survey suggest that 7.9% of households (n=22,525) ‘could not afford to host friends for a meal or drink every month’. Similarly, 4.9% of households with children (n=5958) reported that ‘they could not afford for their children to have a friend round for tea or a snack every month’, while 93% of respondents to the 2011 FRS who were aged 65 years and over, who reported ‘not eating a filling meal every day’, lived alone.

We now consider these issues in more detail in relation to the scale of food aid provision and the circumstances and experiences of people using food banks.

Food Bank Case Studies – Understanding Need

Food Aid Provision Estimate in the Case Study Area.

In our food aid supply survey in one north-west city, we found that whilst there were seven Trussell Trust food banks and one being set up, there were 30 other food aid providers. Moreover, many informal food aid suppliers may not have an online presence or contact details. We have also not included informal food sharing between friends and families and through informal networks.

Clearly, further research is required to capture the scale of food aid provision nationally. However, it is clear that any estimate of food aid provision and use based on Trussell Trust data is likely to be an underestimate.

Food Bank Users and Volunteers.

We consider how people came to use a food bank and their approaches to balancing their household budgets.

The Costs of Coming to a Food Bank – Stigma and Embarrassment.

Whilst the food parcel from a food bank may be seen as ‘free’, there is evidence of some hidden ‘costs’ for the people involved. For some this involved a long journey, including one food bank user who regularly walked over two miles. More commonly the ‘cost’ was the perceived social stigma and shame. This included being reliant on others for their survival, as well as being seen by other people in their local area as lacking in the choice of food they could eat and not being able to provide for their families. There was a sense of being seen as ‘a failure’.

All the interviewees suggested that they had hesitated before coming to the food bank and most had felt a sense of embarrassment. A mother of two children commented: ‘I thought about coming but wasn’t sure and was embarrassed and didn’t want to ask friends … it was eating away at my pride’ (female, aged 46). For those with families, it was their children’s needs that led them to overcome their embarrassment. One interviewee commented: ‘It throws your pride out of the window … I am doing it for my kids, I am not going to make my kids suffer just because of my pride’ (female, aged 34). A father of two children commented on how uncomfortable he felt: ‘I was nervous coming here, I thought I had done something wrong … having to ask for food your ego takes a battering’ (male, aged 40). Another interviewee explained how she was coming to collect a food parcel for her daughter who was too embarrassed to come. She stated: ‘My daughter doesn’t want to be seen as a scrounger’ (female, aged 55). One Muslim interviewee stated: ‘I used to be a machinist … Not many Muslims come … I think they are too embarrassed’ (male, aged 56).

There was also a sense of being at risk in coming to use a food bank and the extent to which it might suggest that people were unable to care for their family and raising concerns of child welfare. Similarly, interviews with the food bank organisers revealed how two older food bank users were too embarrassed to collect a food parcel so the volunteer would take the parcel to them. We also found that some older people were unable to visit the food bank themselves and were having food parcels delivered by volunteers or other food bank users.

The food bank users described how they had been made to feel welcome and their sense of relief after coming to the food bank. There was a general sense that they felt less isolated and they valued meeting other people in a similar position to themselves. As one interviewee stated: ‘I come here for food as it’s so expensive to buy, but also to meet people … If I stayed at home I’d go doolally’ (female, aged 65). Many food bank users had become known by name to the volunteers who often tried to help them in other ways such as providing information on other services, as well as being someone to talk to. This welcoming approach compared positively with some food bank users’ experiences in their local benefits offices where they had witnessed arguments and shouting.

Many interviewees described a sense of desperation and need that led to them coming to the food bank. In particular, problems with benefits were common, with eight of the 34 food bank users stating that changes and delays in their benefits payments were the immediate reason for them coming. Other reasons included: lack of money resulting from benefit sanctions, reduced working hours and loss of employment. As one food bank visitor commented: ‘I don’t think I would survive without the food bank parcel. I feel like I am begging, whilst I’m waiting for my Pension Credit’ (female, aged 65). Another food bank user commented: ‘I was willing to turn to prostitution if I did not get help from the food bank’ (female, age unknown).

It is clear that many interviewees did not take the decision to use the food bank lightly and were in genuine need. It is of course possible that some users were being opportunistic regardless of the perceived stigma. This is very difficult to establish, but as one food bank volunteer commented: ‘We know some people can take advantage but that’s no matter, we have to help those in need’. Where the particular food banks have procedures in place for requiring a referral note and restricting the amount of user visits, any opportunism is likely to be minimised. We did notice that three food bank users we interviewed would also visit another of the case study food banks, which did not have any restrictions on visits or require a referral note.

The existence of food aid provided great reassurance to people. As one food bank user tellingly stated: ‘Knowing there is the food bank there is less of a sense of panic’ (female, aged 40). Another food bank user added: ‘I am constantly looking in my purse’ (female, aged 38). The food bank users we interviewed seemed to be constrained in terms of how they might improve their financial position in the longer term, with many aspects of their finances seemingly out of, or perceived to be out of, their control.

Household Budgets, Spending and Food Sacrificing.

There was a strong sense of budgeting and an awareness of the costs of food and other essential services such as heating and lighting amongst the food bank users. As one food bank visitor stated: ‘I’ve got a cooker at home but use the microwave as it uses less electricity. All my money goes on gas and electricity. There’s a café where the toast is free and tea is 20p. I had to stop work’ (female, aged 45). Another food bank user commented: ‘I buy the cheapest food in the supermarket … and make it last. I wait by the reduced section in the supermarket. I make the food bank food last all week’ (female, aged 63). One of the food bank users commented on how the staff at her local supermarket had got to know her and would often help her find the reduced price food.

It is notable that there was a sense of knowing what ‘cheap’ food was amongst some food bank users, often in the sense of describing its quality and that it was not the best food available. As one food bank user stated: ‘It’s sometimes all I can afford … to buy the cheap food in the supermarket’ (female, aged 55). Another interviewee commented: ‘Those food adverts are obscene, they make people who have bugger all feel worse … the families never row, they are all perfect’ (female, aged 65).

Many of the food bank users we interviewed were making difficult spending choices. As one interviewee stated:

You used to be able to buy lots of fruit but it’s so expensive … I just get it when I can afford it. My children love fruit … but we need to keep the house warm. I just had to buy some new school uniforms and that meant cutting down on something else. (Female, aged 52)

Another food bank user stated:

I buy the reduced bread in the supermarket and freeze it. It’s alright. I go to my daughter’s to get extra food. Most of my pension goes on fuel to keep warm … I’ve got to keep warm. I run out of money towards the end of the week. (Female, aged 65)

Another interviewee commented: ‘The two men who share the house don’t put any money in the meter … so if I don’t there’s nothing’ (female, aged 55). One female food bank user stated that as well as relying on food parcels: ‘My clothes usually come from friends or family’ (female, aged 66).

For many food bank users the impact of changes in benefits had created a personal and family crisis. This included the 2013 Spare Room Supplement or so-called bedroom tax, which limits the Housing Benefit payable according to the number of people in a household and the size of the accommodation (DWP, 2014b). As one mother, who did not feel she could move house, stated: ‘I can’t afford the bedroom tax. The room is the one my son died in’ (female, aged 52). Other food bank users highlighted how recent unemployment and a relationship breakdown had contributed to their financial difficulties. As one food bank user stated: ‘My husband left me and I had a real struggle. I am working but some weeks can’t afford food’ (female, aged 42). Moreover, there were some issues that were very much outside of people’s control. As one food bank user highlighted:

The weather changes and it sets me back because of my health. All my money goes on gas and electricity … I’ve got to eat regularly so I can still take my medication. I make the food stretch each week … it just sees me through. (Female, aged 55)

Some of the food bank users were in employment but were still struggling financially. As one food bank user stated: ‘Where are these better paid jobs? I can’t find them. I am working as hard as I can’ (female, aged 35).

A reliance on other informal sources of food as part of their food planning, including from family members, was common. As one interviewee stated: ‘My mum gives me and the children food, but she’s not really in a position to help’ (female, aged 33). There was evidence of food sacrificing by parents and also by grandparents. One mother stated: ‘I need to make sure my kids have full bellies’ (female, aged 40). One grandmother commented:

The Benefits Agency told me to ask my daughter for the extra money for the bedroom tax … I need the room when my grandchildren come to stay. I am too embarrassed to ask her so just save on other things and come here as well. (Female, aged 58)

Another food bank user stated: ‘When the grandchildren come they eat properly. I usually manage on some toast and eat at night’ (female, aged 55). Children receiving food aid were also aware of their parents’ sacrifices, as one child commented when we were interviewing her mother: ‘We say to my mum make sure you eat but she says she’s not hungry … she’s just making sure we eat first’ (child of food bank user, aged 10). Food insecurity was clearly having an impact on socialising and family life, although coping strategies were used. One mother of two described how her friend brought her children around for tea and had ‘brought the food to share with her’ as she could not afford to provide food for all of them (female, aged 33).

In terms of budgeting, despite the need for food, many of the interviewees had a mobile phone. This might be considered surprising to some people, but most of the food bank users’ phones were so they could be contacted, including by family members, employers and in case of emergency, and were pay as you go based contracts. Social isolation is an important issue here. As one mother of two grown-up children stated: ‘Without my phone my daughter couldn’t ring me to keep in touch … I try to speak to her every day as she’s not well’ (female, aged 63).

Discussion and Conclusions

Our research suggests that a considerable number of people in the UK are experiencing food insecurity. The national-level surveys we analysed consistently identify small proportions of people at risk of malnutrition. People are constrained in their food choices and are skipping meals in order to ensure there is enough food for their families. The case studies of food banks have highlighted the diverse range of people using food banks, including families, older people and people in employment. The small-scale survey of food aid suggests that, if measured in terms of food aid providers, food insecurity is more widespread than an estimate based on the numbers of people recorded as using Trussell Trust-supported food banks would suggest. Moreover, whilst our case study covered only one UK city, the existence of food banks across the entire UK – including in typically wealthy areas – suggests that experiences of food insecurity are not confined to deprived areas.

Food bank users were aware of the costs of food and their spending choices but many were struggling from week to week to make any changes. Supporting the findings by Lambie-Mumford et al. (2014), our research suggests that, for many people, food aid was a last resort. The food parcels were hugely valued and for many food bank users the food was only a temporary help. The decision to visit a food bank was only taken reluctantly and involved overcoming considerable embarrassment about being seen as not being able to provide for themselves and their family. This can be considered the hidden cost of food aid, and is somewhat at odds with the way in which some politicians and media commentators have sought to criticise food bank users. It is notable that recent research in the Netherlands has also highlighted how food bank users reported feelings of shame, fear and being blamed (Horst et al., 2014). Feelings of shame can of course lead to people detaching themselves from society and from potential sources of help (Chase and Walker, 2013; Lister, 2004). It is notable that the United Nations Special Rapporteur on the right to food has argued that food banks offer an insight into the extent of marginalisation in a society (De Schutter, 2013).

The importance of food goes beyond nutrition and is related to aspects of identity and can be a key part of family life and a sense of home. Visiting a food bank is likely to have a significant impact on a person’s sense of self-worth. At a food bank, people are taking what they are given and have little choice in the food they receive. This is a much-neglected aspect of the recent debates. Social isolation is also a factor in relation to eating and an issue for parents in terms of being able to afford to have friends and other children around for tea.

However, whilst some people using the food banks were in acute need, for others the food parcel was a top-up and used to balance their other spending as part of budgeting including, for example, having a mobile phone (often pay as you go) as a way of keeping in contact with family as well as with employers, benefit and advice agencies and, of course, for emergencies. The use of mobile phones also highlights how the burden of fixed costs, including bills and transport to work, may push people towards hunger, as food is not prioritised. Many food bank users were inventive in the way they made their resources stretch, but were perhaps not able to budget over the longer term given their limited finances. Whilst financially vulnerable people in these circumstances could be given information and support in managing budgets (credit unions are already playing a role in this), they would still need the resources to leverage the reduced costs of many goods and services available to people on more secure and higher incomes.

A key policy debate resulting from our research relates to the role of the state, the voluntary sector and commercial organisations in addressing malnutrition and food poverty in the UK and the part citizens can have in ensuring their own welfare. The UK Government has a commitment to the recognition of the right of citizens to adequate food under the International Covenant on Economic, Social and Cultural Rights, while the Child Poverty Act 2010 requires the eradication of child poverty in the UK by 2020. Yet, as Dowler and O’Connor (2012) have outlined, the rights and social justice aspect of food security, including the right to health, are not often discussed. The obligations of the state to ensure access to affordable food have not been fulfilled in the UK. A key policy emphasis in Government legislation, including the Welfare Reform Act 2012, is on conditionality and citizens’ responsibility for their own welfare. Our evidence suggests citizens were taking responsibility for their food security but there was a limit to their financial resilience and their ability to respond in a crisis, including factors that were outside their immediate control. As such, there is a question around the role of the state in protecting the food rights of already vulnerable populations. Moreover, nearly half of those living in poverty in the UK live in working households, many of whom have children who are not entitled to free school meals. This is still the case for older children, even following the introduction of universal infant free school meals in 2014.

Perhaps there is an inevitability about the scale of food insecurity in the UK given the impact of the economic recession and the ongoing welfare reforms. Arguably there has been a normalisation of food aid, with food banks on many high streets and food donation points in supermarkets. Whilst local authorities have provided some funding, food aid is predominantly reliant on volunteers, donations and the support of supermarkets and food manufacturers. For example, Kellogg’s (2014) is planning to deliver 16 million free breakfasts for school children in need in the UK by 2016. In this context it is important to consider how food waste and reuse is regulated and how the UK legislative framework compares with other countries. In the UK it is estimated that 15 million tonnes of food are wasted each year (WRAP, 2014). The limited role that the government is taking in ensuring access to adequate food (Lang et al., 2009) and the localisation of food welfare is a concern, as is the so-called demonisation of those living in poverty. Many of the food bank users we spoke to seemed to be surviving from week to week and some food banks were often running low on food supplies. Moreover, many people in need of food aid may not live near a food bank. It is clear the financial vulnerability of certain populations goes beyond the short-term fix of a food parcel.

In the UK, it can be questioned why the levels of food insecurity are so high and whether the present policy approach is economically and politically efficient given the impact on people’s health and well-being. Moreover, the full extent of food insecurity, including food poverty and malnutrition, may be going undocumented as some people remain too embarrassed or unable to visit a food bank and either go hungry or find other means of surviving. It is notable that the National Institute for Health and Care Excellence has identified better nutrition as one of the key cost-saving initiatives for the NHS (NICE, 2012).

Food banks are a very graphic representation of need, inequality and of the impact of the economic recession on often already vulnerable individuals in the UK. Food poverty and the need to visit a food bank can be a temporary problem; however, the issue of food insecurity is more complex than this and encompasses the wider problem of long-term financial vulnerability. The political and media language of blame used to describe people using food banks seems a long way from the day-to-day reality of food insecurity in the UK.

Footnotes

Acknowledgements

We would like to thank the interviewees for their time and for sharing their experiences with us. We are grateful to the UK Data Archive for the data cited in this article. We would also like to thank the anonymous reviewers for their time and feedback.

Funding

The research was supported by the University of Manchester Institute for Collaborative Research on Ageing, Manchester City Council, Food@Manchester and the HEIF Environmental Sustainability Knowledge Hub Project.

Notes

Kingsley Purdam is a lecturer in social research methods and statistics at the University of Manchester. He is an expert in rights and equality and in research with hard to reach groups. He has conducted challenging social research including on behalf of the Home Office and the Department for Communities and Local Government. His research has been published in a number of leading academic journals and has been cited in government, legal and media debates.

Elisabeth A Garratt is a researcher and PhD student in social statistics at the University of Manchester and at the Centre for Social Investigation, Nuffield College, Oxford. She is researching the impact of income on mental health in families with young children. She was formerly a research officer at the Oxford Institute for Social Policy. She has worked on high-profile research projects for the UK Government including the English Indices of Deprivation and research for the Department for Communities and Local Government.

Aneez Esmail is Professor of General Practice at the University of Manchester and works as a clinician, teacher and researcher. His high-profile research into inequality in the NHS has led to a number of important research breakthroughs including in relation to patient safety. His work has been the subject of numerous media articles and television documentaries.

References

Alakeson

Cory

(2013) Home Truths: How Affordable is Housing for Britain’s Ordinary Working Families? London: Resolution Foundation.

Aldridge

MacInnes

(2014) Multiple cuts for the poorest families. Oxford: Oxfam.

BAPEN (2012) Annual Report 2012. Redditch: British Association of Parenteral and Enteral Nutrition.

Blackburn

Jacobs

Jr (2014) Commentary: Origins and evolution of body mass index (BMI): Continuing saga. International Journal of Epidemiology 43(3): 665–669.

Buerk

(2014) Boris Johnson’s sister Rachel: I was so precious, so spoilt. Radio Times, 12 March 2014.

Butler

Wintour

Gentleman

(2014) Tory peer forced to eat her words after claiming poor people can’t cook. The Guardian, 8 December.

Caplan

(1997) Food, Health and Identity. London: Routledge.

CEBR (Centre for Economics and Business Research) (2013) Hard to Swallow: The Facts about Food Poverty. Manchester: Kelloggs.

Chase

Walker

(2013) The co-construction of shame in the context of poverty: Beyond a threat to the social bond. Sociology 47(4): 739–754.

10.

Citizens Advice Bureau (2013) Food Bank Survey. London: Citizens Advice Bureau.

11.

Cooper

Dumpleton

(2013) Walking the Breadline. The Scandal of Poverty in the 21st Century Britain. London: Church Action on Poverty and Oxfam.

12.

Currie

(2014) Foodbank users spend their money on tattoos and dog food says Edwina Currie speaking in North Staffordshire. The Sentinel, 18 January. Available at: www.stokesentinel.co.uk/Foodbank-users-spend-money-tattoos-dog-food-says/story-20453988-detail/story.html (accessed 3 January 2015).

13.

Davis

Hirsch

Padley

(2013) A Minimum Income Standard for the UK in 2014. York: Joseph Rowntree Foundation.

14.

De Schutter

(2013) Food banks can only plug the holes in social safety nets. Guardian, 27 February.

15.

Devine

Jastran

Jabs

. (2006) A lot of sacrifices: Work–family spillover and the food choice coping strategies of low-wage employed parents. Social Science and Medicine 63(10): 2591–2603.

16.

Dowler

(2002) Food and poverty in Britain: Rights and responsibilities. Social Policy & Administration 36(6): 698–717.

17.

Dowler

Calvert

(1995) Looking for ‘fresh’ food: Diet and lone parents. Proceedings of the Nutrition Society 54: 759–769.

18.

Dowler

O’Connor

(2012) Rights-based approaches to addressing food poverty and food insecurity in Ireland and UK. Social Science and Medicine 74: 44–51.

19.

Dowler

Kneafsey

Lambie-Mumford

. (2011) Thinking about ‘foodsecurity’: Engaging with UK consumers. Critical Public Health 21(4): 403–416.

20.

Dowler

Turner

Dobson

(2001) Poverty Bites: Food, Health and Poor Families. London: Child Poverty Action Group.

21.

Downing

Kennedy

(2014) Food Banks and Food Poverty. Standard Note. London: House of Commons Library.

22.

DWP (2014a) Work and Pensions Select Committee. London: House of Commons, 11 June 2014.

23.

DWP (2014b) Removal of the Spare Room Subsidy. London: Department for Work and Pensions. Research Report 882.

24.

Evans

(2011) Beyond the Throwaway Society: Ordinary domestic practice and a sociological approach to household food waste. Sociology 46(1): 41–56.

25.

FAO (2010) The State of Food Insecurity in the World: Addressing food insecurity in protracted crises. Rome: Food and Agriculture Organization of the United Nations.

26.

Garratt

(2015) Food insecurity and food bank use. Centre for Social Investigation Paper 13. Oxford: Nuffield College, University of Oxford.

27.

Garthwaite

Collins

Bambra

(2015) Food for thought: An ethnographic study of negotiating ill health and food insecurity in a UK food bank. Social Science and Medicine 132: 38–44.

28.

GLA (2012) A Zero Hunger City – Tackling food poverty in London. London: Greater London Authority.

29.

Griffith

O’Connell

Smith

(2013) Food Expenditure and Nutritional Quality Over the Great Recession. London: Institute for Fiscal Studies.

30.

Heismayr

Schindler

Pernicka

. and The Nutrition Day Audit Team (2009) Decreased food intake is a risk factor for mortality in hospitalised patients: The Nutrition Day Survey 2006. Clinical Nutrition 28: 484–491.

31.

Hopkins

(2014) The real reason food banks have trebled. Available at: http://www.huffingtonpost.co.uk/katie-hopkins/food-bank-real-reason-use-has-trebled_b_4121733.html (accessed 10 January 2015).

32.

Horst

Pascucci

Bol

(2014) The ‘dark side’ of food banks? Exploring emotional responses of food bank receivers in the Netherlands. British Food Journal 116(9): 1506–1520.

33.

IFS (2011) Is there a ‘heat or eat’ trade-off in the UK? London: Institute for Fiscal Studies.

34.

Jackson

(2009) Changing Families, Changing Food. Basingstoke: Palgrave Macmillan.

35.

Jones

NRV

Conklin

Suhrcke

. (2014) The growing price gap between more and less healthy foods: Analysis of a novel longitudinal UK dataset. PLoS ONE 9(10): e109343.

36.

Jones

(2012) Chavs – The Demonization of the Working Class. London: Verso.

37.

Kellogg’s (2014) Help Give a Child a Breakfast. Manchester: Kelloggs.

38.

Lambie-Mumford

(2013a) ‘Every Town Should Have One’: Emergency Food Banking in the UK. Journal of Social Policy 42(1): 73–89.

39.

Lambie-Mumford

(2013b) The Trussell Trust Food Bank Network. Exploring the Growth of Food Banks across the UK. Coventry: University of Coventry.

40.

Lambie-Mumford

Crossley

Jensen

. (2014) Household Food Security in the UK: A Review of Food Aid. Warwick: University of Warwick and London: Foods Ethics Council.

41.

Lang

Barling

Caraher

(2009) Food Policy: Integrating Health, Environment and Society. Oxford: Oxford University Press.

42.

Lister

(2004) Poverty: Key Concepts. Cambridge: Polity.

43.

Loopstra

Tarasuk

(2013) Severity of household food insecurity is sensitive to change in household income and employment status among low-income families. The Journal of Nutrition 143(8): 1316–1323.

44.

Loopstra

Reeves

Taylor-Robinson

. (2015) Austerity, sanctions, and the rise of food banks in the UK. British Medical Journal 350: h1775.

45.

Lord Freud (2013) Food: Food Banks. Question. House of Lords. 2 July, c1071. Available from: http://www.publications.parliament.uk/pa/ld201314/ldhansrd/text/130702-0001.htm (accessed 10 January 2015).

46.

MacInnes

Aldridge

Bushe

. (2014) Monitoring Poverty and Social Exclusion. York: Joseph Rowntree Foundation.

47.

McVey

(2013) Food Banks. House of Commons Debate. 18 December, c814. Available from: http://www.publications.parliament.uk/pa/cm201314/cmhansrd/cm131218/debtext/131218-0003.htm (accessed 3 January 2015).

48.

Matthews-King

(2014) One in six GPs asked to refer a patient to a food bank in the past year. Pulse, 18 February.

49.

Miscampbell

(2014) Smarter Sanctions. London: Policy Exchange.

50.

Mooney

Neal

(2010) ‘Welfare worries’: Mapping the directions of welfare futures in the contemporary UK. Research, Policy and Planning 27(3): 141–150.

51.

Murcott

(1997) Family meals – A thing of the past? In: Caplan

(ed) Food, Health and Identity. London: Routledge, 32–49.

52.

Nelson

Ehrens

Bates

. (2007) Low Income Diet and Nutrition Survey. London: Food Standards Agency, The Stationery Office.

53.

NICE (2012) NICE Support for Commissioners and Others Using the Quality Standard on Nutrition Support in Adults. London: National Institute for Health and Clinical Excellence.

54.

Office for National Statistics (2013) Changes in Real Earnings in the UK and London, 2002 to 2012. London: Office for National Statistics.

55.

Office for National Statistics (2014) People in Employment Reporting a Zero-Hours Contract, August 2014. London: Office for National Statistics.

56.

O’Hara

(2014) Austerity Bites. London: Policy Press.

57.

Park

Bryson

Curtice

(2014) British Social Attitudes: The 31st Report. London: NatCen Social Research.

58.

Resolution Foundation (2014) Looking Past the Headlines on Zero-Hours Contracts. London: Resolution Foundation.

59.

Rowlingson

McKay

(2012) Wealth and the Wealthy: Exploring and Tackling Inequalities between Rich and Poor. Bristol: Policy Press.

60.

Russell

Elia

(2014) Nutrition Screening Surveys In Hospitals In The UK, 2007–2011. Redditch: British Association of Parenteral and Enteral Nutrition.

61.

Shildrick

MacDonald

Webster

. (2013) Poverty and Insecurity: Life in Low-pay, No-pay Britain. London: Policy Press.

62.

Taylor-Robinson

Rougeaux

Harrison

. (2013) The rise of food poverty in the UK. British Medical Journal 347: 7157.

63.

The Trussell Trust (2015) Food Bank Stats. Salisbury: The Trussell Trust.

64.

Valentine

(1999) Eating in: Home, consumption and identity. Sociological Review 47(3): 491–524.

65.

Warde

(1997) Consumption, Food and Taste. London: Sage.

66.

Warde

Hetherington

(1994) English households and routine food practices: A research note. Sociological Review 42(4): 758–778.

67.

Wells

Caraher

(2014) UK print media coverage of the food bank phenomenon: From food welfare to food charity? British Food Journal 116(9): 1426–1445.

68.

Which (2013) Food Costs. London: Which.

69.

WRAP (2014) Estimates of waste in the food and drink supply chain: Final report. London: Waste and Resources Action Programme.