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Food, health and homelessness Alison McKay

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1 Food, health and homelessness Alison McKay

2 Homelessness in Hampshire Climate of increasing homelessness across UK and in Hampshire. Lacking accurate definitions and counts statutory vs single homeless/rough sleepers/hidden homeless Vulnerable and marginalised group

3 Maslows Hierarchy of Needs

4 What is Public Health Nutrition (PHN) The promotion of good health through the primary prevention of diet-related illness in the population What people eat Nutritional needs through the lifespan Dietary recommendations Nutritional surveillance Achieving change Food supply, food safety and policy

5 Is PHN relevant for the homeless?

6 Food related homeless services Homeless services: Types: Day centres, hostels and supported accommodation Churches and voluntary groups Food provision: Food or cooking facilities Resources are limited – financial, human Often depend on donations of food and/or money Examples of good practice; Edinburgh Cyrenians St Mungos

7 Why is food important for homeless people? A nutritious and healthy diet is important: In restoring and safeguarding health In improving quality of life In helping people make a sustainable recovery from homelessness.


9 Short term consequences of a poor diet Low energy, tiredness Irritability and lack of concentration Increased susceptibility to infection

10 Poor diet and longer term health Often a tri-morbidity of: physical illness, mental health problems substance abuse Common health problems: Dental caries and gum disease Liver disease Exacerbation of pre-existing health conditions Increased risk of premature mortality Role of diet and lifestyle ???

11 Food and health project Aim: To understand the eating habits and food acquisition practices of the users of Southampton's homeless services Key activities: Interviews with service providers Service users survey 4 homeless services in Southampton: 1 Day centre 1 Hostel with full board 1 Hostel with self catering facilities 1 Supported accommodation project 79 single homeless participants Those who agreed to participate out of 111 individuals approached

12 Homeless peoples food patterns 63% of participants ate at least 2 meals daily 14% ate only one small meal daily 2 individuals ate no regular meals Rough sleepers and those not engaged with homeless services most at risk of poor nutrition.

13 Where do homeless people eat? Food sources 4-7 days weekly Hostels were a regular food source for nearly half of the survey participants. n =79

14 Alternative food sources Begging for money for food, stealing, raiding bins and selling property were commonly used

15 Barriers to homeless people eating well Service provider: Food availability Variety of food Cost Nutritional quality Service user: Lack of nutritional knowledge and skills Addictive behaviours of clients Poor physical and/or mental health Lack of interest

16 Factors influencing food related health and wellbeing

17 What next for food and health? Food, nutrition and homelessness policy Multi-sector approach Using food as centre of community and skills building Cooking, shopping, budgeting skills Local needs assessments Screening for nutritional needs

18 Summary Good food and nutrition are vital for health Homeless people have worse health outcomes than the general population Little guidance or financial help for food- related homeless services There are numerous barriers to eating well To improve nutritional health and wellbeing a multi-sector, practical and educational approach is needed.

19 References 1. Fitzpatrick S Pawson H Bramley G Wilcox S. The Homelessness Monitor: Great Britain 2012. London: Heriot Watt University, University of York Crisis, 2012. 2. Maslow A. Motivation and Personality. New York: Harper; 1954. 3. Department of Health. The Eatwell Plate Resources. DoH. London: TSO; 2011. 4. Saeland M Haugen M Eriksen F Wandel M Smehaugen A Bohmer T and Oshauger A. High sugar consumption and poor nutrient intake among drug addicts in Oslo, Norway. Br J Nutr. 2011;105:618-24. 5. Royal College of Physicians of the United Kingdom. Food poverty and health: Briefing statement. London: Faculty of Public Health, 2005. 6. St Mungo's. Homelessness: It makes you sick. London: St Mungo's, 2008Homeless Link. The Health and Wellbeing of People who are Homeless. London: Homeless Link, 2010. 7. Homeless Link. The Health and Wellbeing of People who are Homeless. London: Homeless Link, 2010. 8. Crisis. Homelessness: A silent killer - a research briefing on mortality amongst homeless people. London: University of Sheffield, 2011.

20 Thank-you!

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