20/48 Food insecurity – health impacts and mitigation
Deadline for submission: 17 November 2020, 1pm
The RDS representative supporting this commissioning brief is Louise Hayes; firstname.lastname@example.org.
- What is the effectiveness and cost effectiveness of interventions aimed at preventing
and reducing the health harms caused by food insecurity?
Unhealthy diet is responsible for a substantial share of excess burden of non-communicable diseases globally and in the UK, comparable to smoking. Poor diets are associated with a range of adverse outcomes, such as obesity and related metabolic outcomes including type 2 diabetes and cardiovascular diseases, as well as a range of cancers and liver disease.
Food insecurity (sometimes referred to as food poverty) describes the situation in which an individual or household has difficulties accessing sufficient, safe, culturally appropriate and nutritious food to meet dietary requirements and preferences for a healthy life due to lack of money or other resources.
The effects of poor access to resources on diet and health are represented by a spectrum of severity. Where an individual or household has limited resources this limits access to a healthy diet (e.g. as represented by the Eatwell plate). Access may be limited due to the immediate food environment and due to the affordability of healthier foods within that environment. For example, more disadvantaged areas tend to have an excess of fast food takeaways selling
unhealthy foods and poorer people are exposed to more advertisements for unhealthy foods in a range of environments. In such circumstances, diets become more limited with an excess of cheap, low nutrient but energy dense foods with an excess of calories, which can contribute to increasing levels of obesity.
With more severe restriction of resources, a nutritionally poor diet becomes more limited in quantity, leading to a reduction in energy intake. Household members often skip meals or limit intake to ensure there is enough food to go around, resulting in hunger. In this way, a ‘double burden of malnutrition’ can exist in a community, with both obesity and hunger co-existing in different or even the same households.
UK data from the 2017 International Food Policy Study (IFPS) suggests that around 24% of adults live in food insecure households. Analysis of the 2018 IFPS data suggests a very similar prevalence. Recent data from a YouGov survey commissioned by the Food Foundation, suggest that a large number of households have fallen into food insecurity since the advent of the Covid-19 pandemic. More than three million people (6%) in the UK went hungry in the first 3 weeks of ‘lockdown’, with households reporting that a member had been unable to eat, despite being hungry, because they did not have enough food. Permanent or temporary unemployment appears to underlie lack of resources, with claims for Universal Credit approximately doubling since mid-March 2020.
Food insecurity affects physical and mental health, and social and emotional wellbeing. For children experiencing food insecurity, there are potentially negative developmental consequences. The link between food insecurity and poverty is clear and research has found that it mainly affects unemployed people and people in the lowest income quartile. Research has also identified certain population groups as especially vulnerable to food insecurity for example, disabled people, people living in a household affected by ill health and households headed by a lone parent. The complex systems in which individuals live their lives, their connections to their families and intra-household relationships, their social and environmental experiences and influences, and certain political and economic drivers are all important in the understanding of food insecurity and the effectiveness of interventions to prevent and reduce the health harms which is not well evidenced in the UK context. ‘Effectiveness’ in this context relates not only to the size of the effect, but it also takes into account any harmful or negative side effects, including inequitable outcomes.
Recent policy developments in response to the Covid-19 pandemic include the Food Charities Grant Fund managed by the Department for Environment, Food & Rural Affairs (DEFRA).
Other recent pre-Covid-19 policy interest has come from: (i) the Children’s Future Food Inquiry, which published its final report in April 2019; (ii) a House of Lords Committee, which will consider food poverty and its impact on public health and the environment and will produce its final report in mid-2020; (iii) the Department of Work and Pensions, which has announced that from 2021 it will publish food security data in the annual Family Resources Survey; and (iv) the House of Commons Environmental Audit Committee report on sustainable development goals in the UK follow up: Hunger, malnutrition and food insecurity in the UK.
For this call, the Public Health Research Programme is particularly interested in evaluating the health outcomes of interventions that aim to decrease food insecurity in the longer term rather than on an emergency basis. Research areas of interest may include (but are not limited to):
- Analysis of existing data sets to examine correlations between food insecurity, food aid/assistance, diet, nutrition and health.
- Assessments of social and environmental influences on food insecurity and the impact on food choices, dietary intake, nutrition and health and health risks by different population groups affected.
- Evaluations of local and regional food programmes in terms of accessibility and inclusivity with an emphasis on long term, sustainable impacts on food insecurity.
- Evaluations of policy interventions that provide free or subsidised meals, free or subsidised fruit and vegetables or food vouchers on a non-emergency, longer term basis.
- Evaluations of the impact of the availability of free school meals on food security, the impact on the household of the child receiving this support and evaluations of the impact of holiday hunger.
- Evaluations of the long term impact on population health of emergency food aid.
- Modelling of the impact of policy changes on food (in)security, for example, the impact of policy measures to increase income security, income maximisation, or provide affordable credit. Modelling work should form part of a study that tests the model or a wider programme of work
- Evaluations of social interventions that aim to improve inclusion, reduce inequalities and alleviate poverty at a societal level and the impact they might have on food insecurity.
- Evaluations of interventions that might have an indirect impact on food (in)security.
For example, evaluations of interventions that relate to local transport or housing quality.
- Evaluations of anti-poverty strategies implemented at population or community level that aim to increase the income of people living in poverty and the impact these strategies might have on food insecurity.
- Research that is focused on population groups identified as vulnerable for example: people living in rural areas, women from minority ethnic groups, households with a single parent, disabled people, people living with a long term illness, people living in sheltered accommodation or social care, adults and children who have no recourse to public funds, people who do not access food security support programmes, children in junior and secondary education who do not qualify for free school meal programmes.
For this call, the Public Health Research Programme is particularly interested in receiving applications for evaluations of upstream interventions that seek to influence factors that operate at national, regional or civic, community, or institutional levels to prevent and reduce food insecurity. Researchers should specify and justify their choice and the relevance to the population being studied.
A range of study designs and outcome measures could be used. Researchers will need to identify and justify the most suitable methodological approach(es). Researchers will also need to specify key outcome measures and specify how these will be measured in short, medium and long term. Outcomes to be researched could include, for example, diet and nutrition, mental or physical health. Applicants are normally required to have a health outcome as their primary
research outcome. For this call, the Public Health Research Programme accepts that there are established links between food security and health and will therefore accept proxy measures for health outcomes. Researchers will need to clearly justify the link between food security, health and their chosen outcome.
Researchers may wish to consider evaluating natural experiments comparing the effects of different approaches and different settings in design and delivery of programmes to prevent and reduce food insecurity.
Researchers should demonstrate the relevance of their proposed research to evidence users. Inclusion of evidence users as funded members of research teams is encouraged. Researchers might want to consider how they will share their findings with relevant decision makers. They will be expected to be aware of other studies in this area and ensure their proposed research is complementary.
Studies should generate evidence to inform the development or implementation of single or multi-component interventions. Studies may include evidence syntheses, studies evaluating interventions, including trials, quasi- and natural experimental evaluations, and feasibility and pilot studies for these. We welcome applications for linked studies (e.g. pilot + main evaluation, evidence syntheses + modelling). Secondary analyses of existing epidemiological data and/or impact modelling studies may also be funded. We encourage the adoption of a systems perspective where appropriate to the study context. In all cases a strong justification for the chosen design and methods must be made.
The primary outcome measure of the research, if not necessarily the intervention itself, must be health-related. The positive or negative impacts of the intervention, including inequitable outcomes should be considered. Researchers are asked to indicate how long-term impacts will be assessed. All applications should identify underlying theory and include a logic model (or equivalent) to help explain underlying context, theory and mechanisms. Proposals should ensure adequate public involvement in the research.
The impacts of public health interventions are often complex and wide-reaching. Studies should acknowledge this by adopting a broad perspective, taking account of costs and benefits to all relevant sectors of society. An appropriate health economic analysis to inform cost effectiveness, affordability or return on investment should be included where appropriate. Sustainability - health, economic and environmental - is also of interest.
For all proposals, applicants should clearly state the public health utility of the outcomes and the mechanisms by which they will inform future public health policy and practice. Details about the potential pathway to impact and scalability of interventions, if shown to have an effect, should be provided, including an indication of which organisation(s) might fund the relevant intervention(s) if widely implemented.
Remit of call
All proposals submitted under this call must fall within the remit of the NIHR Public Health Research (PHR) programme. Please go to the Public Health Research Programme webpage for details. For the evaluation of time sensitive, policy driven, interventions applicants may wish to consider the fast-track work stream - further details on the PHR webpage.
The PHR Programme funds research to generate evidence to inform the delivery of non-NHS interventions intended to improve the health of the public and reduce inequalities in health. Our scope is multi-disciplinary and broad, covering a wide range of interventions that improve public health.
The primary aim of the programme is the evaluation of practical interventions. We will fund both primary research (mainly evaluative, but also some preparatory research) and secondary research (evidence synthesis); precise methods will need to be appropriate to the question being asked and the feasibility of the research.
Our research serves a variety of key stakeholders including: decision-makers in local government; primary care organisations and other local public services; third sector organisations; relevant national agencies (e.g. NICE) concerned with improving public health and reducing health inequalities; researchers; public health practitioners and the public.
Applicants should consider how their findings will impact upon decision making in public health practice, whether results are generalisable to other populations and affordable, setting out a clear pathway to impact. The NIHR PHR programme recognises that there is a need for an evidence base for disinvestment and that the removal of an intervention from a population can be worthy of evaluation.
The affordability of the intervention, and at least an indication of the stakeholder(s) willing to fund the intervention, should be referenced within the stage 1 application. At the stage 2 application point, statements of support confirming stakeholder commitments to funding will be required. Applicants should be aware that the NIHR PHR programme is unable to fund intervention costs.
The NIHR PHR programme is open to the joint funding of research projects with other organisations such as those in the third sector. If you would like to explore the potential for joint funding, please contact us at email@example.com with details of your proposal and the other funder prior to submission.
All of our funded projects are eligible for publication in the NIHR Journals Library. This open access resource is freely available online, and provides a full and permanent record of NIHR-funded research.
Notes to applicants
The NIHR PHR programme is funded by the NIHR, with contributions from the CSO in Scotland, Health and Care Research Wales, and HSC R&D, Public Health Agency, Northern Ireland. Researchers in England, Scotland, Wales and Northern Ireland are eligible to apply for funding under this programme.
Applicants are recommended to seek advice from suitable methodological support services, at an early stage in the development of their research idea and application. The NIHR Research Design Service can advise on appropriate NIHR programme choice, and developing and designing high quality research grant applications.
The NIHR Clinical Research Network
(CRN) supports health and social care research taking place in NHS and non-NHS settings. The CRN provides expert advice and support to plan, set up and deliver research efficiently.
Clinical Trials Units are regarded as an important component of many trial applications however, they are not essential for all types of studies to the PHR programme. The CTUs can advise and participate throughout the process from initial idea development through to project delivery and reporting. NIHR CTU Support Funding provides information on units receiving funding from the NIHR to collaborate on research applications to NIHR programmes and funded projects. In addition, the UKCRC CTU Network provides a searchable information resource on all registered units in the UK, and lists key interest areas and contact information.
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