Hunger alleviation, tackling food poverty or challenging the determinants of poverty: What can Public Health do? Tony Cooke Head of Health Improvement Kirklees Public Health

Food poverty is… “the inability to afford or to have access to food to make up a healthy diet” (Department of Health) “Food poverty is worse diet, worse access, worse health, higher percentage of income on food, and less choice from a restricted range of foods.” (Tim Lang, Professor of Food Policy at City University, London)

Lower consumption of fruit and veg and a higher intake of fats, sugars + salt. Problems with overweight and underweight Space for preparing and eating as a family Lack of cooking in the home. Families rarely sit down together to eat a meal Access to affordable healthy food Less opportunity for physical activity and large number of takeaways in deprived areas. Food poverty and diet of people on low incomes Low income and less healthy eating behaviours Food budget will often be reduced before other household outgoings Lack of cooking skills & confidence Food behaviour linked to other health behaviours: physical activity,alcohol, smoking Lack of exposure to sunlight = Vit D deficiency Irregular meal times Lack of cooking utensils Shift work and irregular hours Psycho-social stress and stigma

Population wide people are eating less nutritious food Starker inequalities in income, stark inequalities in diets and food skills In Kirklees lower income groups less confident at cooking from scratch ‘Bad’ food can cost less per calorie It is also more accessible/profitable Increased numbers accessing food banks Increased under nutrition Increase in numbers overweight and obese Perfect storm

Child Poverty Working age Poverty Pensioner Poverty 20,840 42,800 22,040 Poverty in Kirklees

Cost of living increases % Work related benefits uprating 25% Minimum Income basket 2.2% Disabled people and pensioners uprating 2.2% Universal uprating 18% Food 27% Energy Annual benefits uprating Annual benefits uprating 2013 onwards

average loss per affected household/individual £3,480 average loss per affected household/individual £810 The biggest losers Some households and individuals, notably sickness and disability claimants, will be hit by several different elements of the reforms.

Discussions in Kirklees… All people in poverty are at risk of food poverty but individual circumstances are different Some people are more resilient Some have stronger communities/social capital Some grow their own food or have an allotment Benefit sanctions are an exception Most people on benefits do not attend food banks but most people sanctioned do Increasing numbers are sanctioned

The Kirklees response: Proportionate universalism Narrative for change: the food charter and strategy A population level approach where possible Food for Life Partnership in schools to improve quality and uptake of meals Silver catering award provider supplies food to all but one Kirklees school Projects to increase food growing across Kirklees National Child Measurement Programme Healthy Choice Award targets take-aways and restaurants Recycling and food waste projects Better procurement promotes more local jobs Targeted services where necessary 40 growing sites in areas of multiple deprivation, focus on social housing, disabilities, LTCs Settings based approach to target hospitals, early years and care settings, using FFLP and development of similar standards to support sustainable food Food banks+ i.e. skills training, cook and eat sessions and (planned) growing sites

Questions for consideration Do we need to make a clear distinction between hunger, food poverty and poverty? Should we focus on alleviation of hunger, improvements to diet/nutrition or both? How to engage with public health teams to address food poverty? How can public health engage other partners to address food poverty? What are the consequences of food poverty? Which areas can public health address? Focus on low / medium input, high impact Can local authorities develop systematic strategies to address health inequalities including food poverty and poverty more generally How can they join wider lobbying efforts around poverty and its impact What action can you commit to taking forward when you get back to your City/town?

What’s happened is that the level of income inequality has been increasing. And by that we mean that the very rich have been getting more and more money, and people lower down, have been getting less. Michael Marmot, 2013