In this excerpt from our new report Why End UK Hunger?, Dr Rachel Loopstra and Claire Greszczuk explain why food security is fundamental to health.
In high-income countries, where food is abundant and available in supermarkets year-round yet not affordable to those in poverty, food insecurity has devastating and widespread effects on diets and health. Food insecurity manifests in a range of experiences, from anxiety about running out of food, compromised dietary quality and reliance on low-cost foods, to not having enough food and going without. It not only impacts on what people eat, but how they feel and participate in society. It is unsurprising then that food insecurity is linked to numerous health outcomes:
Food insecurity is associated with poor dietary quality.
Though many cookbooks, blogs and public health programmes suggest it is possible to cook healthily for not much money, an abundance of evidence shows that healthier food options cost more and those experiencing food insecurity have lower intakes of vegetables, fruit, and dairy products.
(See ‘Food insecurity and dietary quality in US adults and children: a systematic review’ by KL Hanson and LM Connor, and ‘Do healthier foods and diet patterns cost more than less healthy options? A systematic review and meta-analysis’ by M Rao, A Afshin, G Singh et al.)
The healthiest and most diverse diets in the UK are the most expensive, and to meet the Eatwell Guide dietary advice, households with incomes in the lowest two income deciles in the UK would have to spend 42% of their after-housing disposable income on food.
Food insecurity is associated with diet-related long-term health conditions.
As a critical determinant of dietary intakes, food insecurity has been linked to many diet-related long-term health conditions including type 2 diabetes, heart disease, and for some, overweight and obesity. However, beyond a link to these conditions through diet, food insecurity also associates with other risk factors for these conditions, such as poor sleep patterns. Thus, there are multiple ways that experiences of food insecurity can lead to higher risk of these health conditions.
Food insecurity compromises the ability of adults living with long-term health conditions to manage their conditions.
Many long-term health conditions require patients to follow prescribed diets, eat at regular intervals, and take medication with foods. This is not possible when people are experiencing food insecurity. For example, research indicates that managing diabetes is compromised by food insecurity. Food insecurity is associated with higher risk of mortality among people with long-term health conditions, and it is likely that poor disease management and being unable to follow dietary advice may underlie this association.
(See ‘Relationship between Food Insecurity and Mortality among HIV-Positive Injection Drug Users Receiving Antiretroviral Therapy in British Columbia, Canada’ by A Anema, K Chan, Y Chen, S Weiser, JSG Montaner and RS Hogg, and ‘Food insecurity status and mortality among adults in Ontario, Canada’ by C Gundersen, V Tarasuk, J Cheng, C de Oliveira and P Kurdyak.)
Food insecurity has a profound link with poor mental health.
Highlighting how food insecurity is much more than a risk to nutritional health, numerous studies have documented its strong link with poor mental health. Those experiencing food insecurity are more likely to report depression and anxiety. Food insecurity damages the mental health of children as well, and early life experiences of hunger have scarring effects many years later, with child hunger associated with suicide ideation and poor mental health in teenage years.
Health consequences of food insecurity have numerous downstream costs.
A growing body of evidence has shown food insecurity is associated with higher healthcare expenditure and utilisation. In one Canadian study, adults who experienced severe food insecurity cost the healthcare system 121% more than those who did not report any experiences of food insecurity.
Addressing hunger and food insecurity is imperative for protecting and improving the health of the population and reducing costs to the NHS.
More people are developing diet-related long-term health conditions and mental health conditions in the UK than ever before. Growing vulnerability to food insecurity in the low-income population will undoubtedly increase this burden and widen health inequalities. In addition to the other cases laid out in this report, action to end hunger is needed because of its profound effects on health and costs to the healthcare system.
Dr Rachel Loopstra, Department of Nutritional Sciences, King’s College London
Why hunger must be addressed: the public health perspective
Estimates suggest one in ten adults and one in five children in the UK experience food insecurity, to the detriment of their dignity, wellbeing and long-term health. A varied, nutritious diet, and enough of it, is essential for good health. People experiencing food insecurity go hungry or resort to an unhealthy diet, which puts their health at risk in a multitude of ways. For example, only one in 25 children from the poorest households eats the recommended amount of fruit and vegetables, fibre and oily fish – the building blocks of healthy growth and development. Hunger is debilitating. It not only causes physical and psychological harm, but has far-reaching consequences, such as damaging children’s school attendance and attainment. The experience of food insecurity in itself damages people’s health. Studies have shown adults experiencing food insecurity are at greater risk of stress, which can manifest in both physical and mental health harm. These impacts can last a lifetime and span generations.
Food insecurity affects those who are most economically disadvantaged: an embodiment of health inequity. And poverty, the root cause of food insecurity, causes profound, wide-ranging health, social and economic harm. Poverty leads to health problems through limiting what people can materially afford, shaping people’s life experiences and opportunities, and causing psychological stress that can result in physical and mental illness. Poverty and inequality damage communities, introducing stress and breaking down cohesion and connectedness between people. And poverty costs the public purse, including through NHS, education and policing costs.
People’s health is one of the nation’s greatest assets. Giving everyone the opportunity for a healthy life, such as through tackling food insecurity, will not only improve the health of the millions affected – everyone will benefit from a more equal society.
Claire Greszczuk, The Health Foundation