Opinions

Long term conditions management + food insecurity. How does that work?

Written by: Flora Douglas, Robert Gordon University

Published: 18/03/2020

Those living with health conditions should be able to eat the best diet possible to help their bodies deal with their condition(s).

People affected by ill health, including long term conditions, should be able to eat the best diet possible to help their bodies deal with their condition(s), and their associated clinical treatment and self-management regimes. The UK Government’s Eatwell Guide provides daily recommended nutrient intakes needed for optimal health. 

However, it may (or may not) surprise you to know that a recent analysis by the Food Foundation (this link will take you away from our website) found that 30% of UK households would need to spend more than 25% of their disposable income after housing costs, to meet the Eatwell Guide costs.  In low income households with two or more children, this rises to almost 43% of household income that would need to be spent on foods that meet the Eatwell Guide recommendations.

In Scotland we have just recently started to gather information about people’s own experiences or assessments of their household’s food security status in the annual Scottish Health Survey (this link will take you away from our website). It has found that over 18% of people with some form of ill health, were also affected by food insecurity.

International evidence (this link will take you away from our website) shows that living with food insecurity makes managing health conditions more difficult; for some, much more difficult (this link will take you away from our website). While little attention has been paid to this issue in the UK, we do know that far too many people with health conditions are reverting to or being directed toward food banks to help them cope (this link will take you away from our website). Studies of the food distributed by food banks in the UK are lacking, but research (this link will take you away from our website) in other high-income countries highlights concern (this link will take you away from our website) about the quantity and quality of food available in this system. Food bank staff in Scotland have expressed concern (this link will take you away from our website) about not always being able to give some of their clients the sorts of foods they needed to manage their health condition. 

Our recent research study (this link will take you away from our website) involving Aberdeen-based Community Foods North East (a local social enterprise working with economically deprived communities) and Robert Gordon University took place because of similar anxiety about how food insecure people with one or more health conditions were managing. From our interviews with people so affected, we found evidence of individuals with multiple conditions and caring responsibilities surviving on very little food, with most reporting eating one meal a day as a regular way of life.

Some were not eating a proper meal for days at a time as a way of stretching out what little food they had. We talked to people living with diabetes who said they not managing to get access to foods they knew they should be eating to control their blood sugar. We found some people with bowel conditions having limited or no choices about the types of foods they ate, who were regularly risking exacerbations of their conditions and symptoms by eating what was on offer from the food bank, or, were buying cheaper alternative foods to stretch out their food budget.

We also found evidence of people taking less of their oral medication than they should to avoid unpleasant side effects due to a lack of a regular supply of food.  Living with limited access to (what was described by most) a very limited and unappetising food supply was also described as affecting our study participants mental health quite profoundly.

As an indication of how serious this problem is, it is important to be aware that food banks are no longer just an emergency source of food (as most were intended when set up) but have become a regular way of coping for individuals and households experiencing severe food insecurity. People are much better able to manage their diet and health condition(s) when they have the money in their pockets to buy food they need and want and are also free of fear (this link will take you away from our website) that they might run out of money for food for themselves and their loved ones at the end of the week or month. The sad fact is that many people living on low incomes, including those with health problems, have seen a real decline in the value of their incomes (this link will take you away from our website) at the same time as we have seen a rise in household costs, including the prices of basic food stuffs. Making food banks work ‘better’ will not solve this problem either, as international evidence has shown (this link will take you away from our website). Making sure people have enough money to live on (this link will take you away from our website), to able to live well, is the more effective response (this link will take you away from our website). It’s the right thing to do not only on moral grounds from a social justice point of view, but it’s also the right thing to do on practical grounds, given the untold and unnecessary, individual suffering (this link will take you away from our website), and, health care use and costs arising from the interaction between food insecurity and chronic health problems.

In meantime, the health care professions, policy makers and researchers must start to pay more attention to the impact that living with food insecurity is having on the self-care endeavours of people living chronic health conditions; whether using a food bank, or not. Its an elephant in the consulting room that few, as yet, seem prepared to talk about, or consider in their research studies.

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