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Food insecurity – health impacts and mitigation

Contents

This call was first advertised in 2020. The programme was disappointed that it was not able to fund any of the submitted applications. The Programme acknowledges that this is a broad and complex issue and therefore is launching the call again with enhanced support and guidance offered to all potential applicants applying to this call.

As well as ensuring that the supporting information for applicants is carefully reviewed, applicants should pay particular attention to the following aspects of their application and ensure that these are clearly defined within the application:

  • How the work packages link to each other and the methodologies that will be used within each work package.
  • The expertise of individual members of the study team and how they will contribute to the proposed elements of the study.
  • Sample sizes and associated assumptions.
  • Public involvement.
  • Health economic assessment and analysis.

Additional support is available through the Public Health Research Applications and Design Advice (PHRADA) scheme and all applicants are urged to make use of this support. Contact PHRADA: phrada@nihr.ac.uk

Research Question(s)

  • What is the effectiveness and cost effectiveness of interventions aimed at preventing and reducing the health harms caused by food insecurity?

Poor diet is responsible for a substantial share of the 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 people from disadvantaged socio-economic backgrounds 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, 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. Data from a YouGov survey commissioned by the Food Foundation, suggest that a large number of households fell into food insecurity at the start of the Covid-19 pandemic. More than three million people (6%) in the UK went hungry in the first 3 weeks of the first lockdown, with households reporting that a member had been unable to eat, despite being hungry, because they did not have enough food. A new report on insights from surveys commissioned by the Food Foundation up to January 2021 shows that food insecurity remains consistently higher than pre Covid-19 levels. Permanent or temporary unemployment appears to underlie lack of resources.

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 have included: (i) the Children’s Future Food Inquiry, which published its final report in April 2019; (ii) the House of Lords Select Committee on Food, Poverty, Health and the Environment report Hungry for change: fixing the failures in food, published in 2020 (iii) the Department of Work and Pensions announcement that from 2021, it will publish food security data in the annual Family Resources Survey (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 (v) the Environment, Food and Rural Affairs Committee report on Covid-19 and the issues of security in food supply published in March 2021.

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. The Public Health Research Programme is also 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.

Research areas of interest may include (but are not limited to):

  • 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.
  • 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.

A range of study designs and outcome measures could be used. Researchers will need to clearly 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 quality, 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.

For further information on submitting an application to the PHR Programme, please refer to the supporting information for applicants submitting stage 1 and stage 2 applications which can be found here.