Section 4: Impacts of food and financial insecurity

Marmot (Institute of Health Equity (Feb 2020). Health Equity in England: The Marmot Review 10 Years On) states

"If everyone followed Public Health England's eating advice, people in the bottom decile of household income would spend 74 % of their income on food. So, there's not much point telling them follow the healthy eating advice they can't afford."

We need to create the right conditions and recognise the social determinants of health, to allow people to be able to take responsibility for feeding their families healthy food.

Harsh austerity measures including slashed welfare payments and dwindling public services have caused the rapid spread of food banks across Britain, new academic research suggests.

The research (Austerity, sanctions, and the rise of food banks in the UK), "Austerity, sanctions, and the rise of food banks in the UK," noted that increasing numbers of doctors in Britain are witnessing their patients turn to food banks to survive and concluded that the UK government's argument that this trend is the result of supply rather than demand is false.

The study highlighted a concrete link between demand for food parcels and the government's austerity measures. It found demand for emergency food aid is highest in areas where poverty occurs in tandem with reductions in social welfare payments. It also revealed that emergency food assistance is particularly common in regions where high levels of unemployment exist.

In 2010, the Trussell Trust food banks were active in 29 local council areas in Britain. By 2013/14 this number had risen to 251. Over the same period, the Trussell Trust's rate of emergency food aid distribution had tripled, the Oxford University study said.

While soup kitchens have long been present in the UK, the rapid spread of food banks is a recent phenomenon. This new trend has been sharply criticized by the UK's Faculty of Public Health, which warned Prime Minister David Cameron in 2014 that Britain's welfare system was "increasingly failing to provide a robust last line of defence against hunger."

In 2019 over 7,800 people accessed foodbanks in Gateshead (including over 2,500 children), that is an increase of over 20% in demand since 2017. 

In Gateshead, our approach to food and financial insecurity is developing, we know that food insecurity experienced during childhood, harms health at the time and throughout the rest of life.

In 2018/19 the Gateshead Poverty Board worked with partners to develop the Gateshead Community Food Network. The idea came from feedback provided at the first Gateshead Poverty Conference in 2018 where the attendees from all sectors of Gateshead, agreed that food poverty should be a key priority in order to tackle poverty in Gateshead.

The Community Food Network now has a detailed interactive map and understanding of exactly where in Gateshead certain types of food support is available and how it can be accessed by partners and families.

This includes foodbanks, food co-ops, FareShare sites, supermarket donations, Breakfast Clubs, Free Meals, low cost meals and pay as you feel cafes. By working better together, the network members can maintain a dialogue with each other, this means far greater opportunity to operate in cohesion rather than isolation. When there are overstocks of food items, network members are able to notify the other members of what's available, resulting in partners sharing food and not wasting anything.

This has also allowed the network to share resource, such as volunteers, transport, collections and so on. Before the network existed, many partners were unaware of what other food support was available, even those operating in the same area as them which has increased collaboration between partners. 

For families of low income in Gateshead, the holidays, particularly the summer holidays, can be a very difficult time; causing stress, isolation, poor health and food insecurity. Poverty can be a real problem for families who normally receive free school meals.

There is evidence both locally and nationally that food banks experience a peak in demand during school holidays. As part of a DfE National Programme, Voluntary organisations and community groups participating in the 'Fill the Holiday Gap' scheme try to address these challenges by delivering a range of stimulating activities or experiences for children, providing children with a nutritious meal, a place for parents and children to socialise and providing parents with support. In 2019 holiday clubs with lunches benefited 2,020 children across 39 projects.

In 2019 Gateshead Council successfully bid for Department of Education Funding and received £204K to provide holiday clubs with a meal, targeting disadvantaged children and those eligible for free school meals.

In 2019 local holiday clubs served 2,000 different children over 8,000 meals. Holiday hunger projects continue to be supported in Gateshead, targeting those families most in need.  

The Marmot Review powerfully illustrated, inequalities in health arise because of inequalities in society - the conditions in which people are grown, born, live, work and age. Children who live in more deprived areas are more likely to suffer from obesity just as they are likelier to have a lower life expectancy.

In Gateshead we acknowledge that no single intervention or policy approach can be implemented to deal with inequalities alone. To tackle this complex problem, a number of approaches have been implemented in Gateshead and although progress has been made, unfortunately this is not at the speed we would want or that is required.

In the context of tackling obesity, we understand as a Council that we are in an influential position to help lead transformational change. A whole system approach to obesity provides the process and methods to do this and demonstrates a genuine 'health and wellbeing in all policies' approach. Gateshead Council has committed to working with stakeholders and communities to develop an ambition for a healthy weight generation in Gateshead. Progress has been made working with a wide range of stakeholders through workshops and consultations to ensure a co-ordinated approach to healthy weight.

In 2019, Gateshead was one of the first areas regionally to sign up to the Healthy Weight Declaration, in partnership with Food Active. The declaration is focused on population level interventions which take steps to address a number of factors that affect people's ability to change their behaviour. 

Growing healthy 0 to 19

Gateshead (health visitors and school nursing services) provided by Harrogate NHS, now has a dedicated infant feeding and nutrition lead. This is a key post as it provides a priority focus for breastfeeding, weaning and nutrition for the crucial early years period and also support the healthy weight agenda for school children.

The daily mile-Gateshead

is supporting the regional 'daily mile' programme, which is a targeted approach which contributes greatly to achieving the required 30 minutes of school-time activity recommended by the Chief Medical Officers report. Approximately 30% of Gateshead schools are engaged with the programme and this has been closely aligned in a partnership approach with the school sport partnership and their health and wellbeing offer to schools.

The Gateshead Schools Health and Wellbeing Service

was developed in 2019 by the Gateshead School Sports Partnership. The service has already established a local network of 40 primary schools and Health and Wellbeing co-ordinators, all with the aim of improving the health and wellbeing of children and young people. The service provides a range of tangible services to schools, providing effective support across the four key themes of;

• Emotional health and wellbeing
• Healthy eating
• PSE
• Physical activity

Our food environment / food consumption

is an innovative approach between Gateshead Young People's Assembly and Gateshead Health NHS Foundation Trust, who have focused on the lived experiences of young people and the impact of the food environment.

The young people have captured images of the food environment in and around Gateshead and highlighted the impacts of the food environment upon young people's personal food choices. The images captured and stories by the young people highlighted the vast availability of food choices and the impact of food advertising and promotion in our communities. The young people described a clear distinction between food available in different areas of the borough and this support the link between more fast food takeaways in areas of deprivation. 

During 2019 Gateshead Youth Assembly members started an informal conversation with Emma Gibson from Public Health and Dr Ann Dale from the QE hospital about food choices. The conversation wound its way to focusing on the frustrations of the availability of fast food and often poor quality food (we never said that all fast food was poor quality though, we do like our pizza and burgers in moderation).

As we were about to start our summer programme, we talked about doing a bit of a research project about the kinds of foods available in the parts of Gateshead we regularly access and how our food environment can influence what we eat.

This wasn't qualitative data collection; it was more 'off the cuff' snapshots of the areas young people spend time. We have a bus day every summer, where we buy all day tickets and see where we get to, this enables some of our members to get used to using public transport (in the days of parents dropping us off everywhere) ... and we spend a little bit of time looking around the places we visit, so this year, we decided to take photos of the food shops available in the vicinity of the bus stops and surrounding areas in Gateshead.

The results, when we really looked at them were shocking for the young people In areas which are in wards of high deprivation in Gateshead, we saw options, of maybe a corner shop and a chippy, in 'posher' areas, there are still chippies and corner shops but there are also restaurants, bakeries, butchers, greengrocers, just really more access to fresh foods. How can we expect people to make good choices, when the options most available to them are all fairly poor?

Our plan was never to criticise the takeaways, like we say, we love a takeaway now and again as a treat. But, we all need local access to decent fresh food.

The young people expressed their views:

Sophie "I'm not surprised by the results of our project, but I am shocked, and disappointed at what we found in Gateshead. There was a huge difference in what was available, depending on where you live'

Freya "How can we expect people to buy good food if they have to get buses to find it, if you are on benefits, the bus fares are huge!"

Benjamin "We found it easier to get a bag of chips and a can of pop, than an apple. That can't be right!" 

Gateshead led the way nationally in 2015 with their Supplementary Planning Document (SPD), supported by an integrated public health policy. Many areas are now seeking to develop their own SPD's.

The SPD has been used successfully to control the number of hot food takeaways in areas with high levels of child obesity and areas of deprivation. Since the SPD was adopted in Gateshead, no new planning applications for hot food takeaways have been approved and the number of applications has also dropped, which is a huge success for the area. As we recognise the complexity and societal influences on food choices we are supporting a PHD student, who is researching access to food in Gateshead. 

I am exploring people's inability to access and have the choice of an affordable, acceptable and healthy diet in Gateshead and the social determinants of food insecurity; to understand how this affects health and wellbeing, contributing to wider health and social inequalities.

The focus of this research is on women, mothers and the early years of life (recognised as an important period of development for a child's health, then and into adulthood). Early research in Gateshead has identified different models of service provision offering food to women and mothers who are struggling to access or afford adequate nutritious food.

In the coming year I will be talking to women and mothers who access these services. The aim is to listen and to understand the situations that lead them to use of these services; to learn from their experiences about what extra support is needed, if any, to have access to an affordable, healthy balanced diet in Gateshead. This will help us to understand if and how we can improve available services and resources.

I will also be listening to frontline workers experiences and perspectives of responding to the health and wellbeing challenges posed by lack of access to and affordability of a healthy diet in Gateshead.

Section 5: How the Gateshead MECC Approach Has Challenged Inequalities