In this issue’s column, the British Dietetic Association explore the role of dietitians in reducing the impact of food poverty and health inequalities in Northern Ireland.

An estimated 292,000 people in Northern Ireland were living in poverty in 2017 / 2018 – that’s 16 per cent of the Northern Ireland population. (1) This likely significantly under-represents the true extent of poverty in Northern Ireland as many groups who are considered at ‘high risk of poverty’ were not included in this survey e.g. those who are homeless, living in a hostel, institution or retirement home, asylum seekers, students, nomadic Irish travellers. Why have these groups been excluded? The sample group for the survey only included those who live at a ‘private household’. (2)

It’s perhaps unsurprising that living in poverty contributes to health inequalities; most strikingly highlighted in the existence of a life-expectancy gap of 6.6 years for men and 4.5 years for women between the most and least deprived areas. (3) Simply meaning your wealth can, to some extent, determine your health.

Food poverty is a complex issue which is difficult to define. One commonly-used definition is the ‘inability to access a nutritionally-adequate diet and the related impacts on health, culture and social participation’. (4) Reflecting that, food poverty does not only affect dietary intake, but has implications for health status, lifestyle and social interaction. (5) Consider the integral role that food plays in gathering with friends and family, celebrating and bringing people together – in addition to being a bare necessity for life.

Households experiencing food poverty typically consume less nutritionally-balanced diets, resulting in higher rates of diet-related chronic diseases such as diet-related cancers, heart diseases and obesity. (5)

Presently there is no official measure of the rate of food poverty in the UK or Northern Ireland, however, in 2009 a reported 14.8 per cent of Northern Ireland households were at risk of food poverty. (6)      

Food bank use is a useful indicator of the extent of food poverty. Food banks provide emergency food and support to people experiencing crisis. The government does not directly collect this data (7), therefore we rely on Trussell Trust’s statistics, which research suggests accounts for around two-thirds of all food aid provisions. (8) The number of food parcels provided each year has more than doubled over the past four years. (9)

For many experiencing poverty, accessing a food bank is a last resort. Walking through the doors of a food bank holds a huge hidden cost to the service-user, including emotional distress, embarrassment, shame, a sense of personal failure and for many it can be a traumatic event. (10) Therefore, these figures are likely just the tip of the iceberg for food poverty.

Reducing health inequalities and achieving better health and wellbeing for all people is one of the top priority areas within the Making Life Better Strategic Framework for Public Health 2013 – 2023 (DoH 2014). (11)

So, What Role do Dietitians Play in Promoting Health and Wellbeing for all People and Reducing the Impact of Food Poverty?

Public health / health improvement dietitians work within each of the Health & Social Care Trusts in Northern Ireland. Their aims and objectives are directed by the Public Health Agency, with a key priority being to reduce health inequalities.   

Dietitians, alongside registered nutritionists, dietetic support workers and health improvement specialists, aim to support community, voluntary and statutory groups and organisations, to promote and encourage healthy nutrition, primarily within areas of deprivation. Some examples of specific ways in which dietitians work towards reducing health inequalities include:

Nutrition Education Programmes

Free training and support are provided for a number of nutrition programmes, all of which have a focus on eating well on a budget. Group leaders are equipped with the information and skills to run these programmes within their own communities. Two examples of these are:

Cook it! – A fun and interactive healthy eating programme focusing on the eatwell guide and cooking healthy meals with budget in mind. I Can Cook it! is a version of Cook it! designed specifically for those with learning disabilities

Food Values – A food budgeting programme aiming to help participants make best value nutrition choices. Food budgeting skills, such as meal planning, writing a shopping list and keeping a store cupboard, are explored in a fun and interactive way – as well as cooking healthy meals together

Supporting Food Banks

Links have been built with food banks over the years, with advice, support and programme training or direct delivery of nutrition programmes being provided across the region.

A recipe book entitled ‘Get Cooking… Making the Most of your Food Parcel’ has been developed with the aim that it would empower food bank clients to utilise their food parcels to produce more enjoyable and balanced meals. It provides a range of simple recipes, with ingredients based on typical food parcel contents, in addition to helpful information such as basic cooking skills, food budgeting and fuel saving tips. Currently this is being distributed to clients accessing food banks throughout the region.         

Dietitians are uniquely qualified to not only assess nutritional problems, but to look at the ‘bigger picture’ of an individual or communities’ life and identify contributory factors. They have the skills and expertise to partner with groups and individuals to work towards realistic and innovative ways to bring about dietary change or improvement. Dietitians will continue their commitment to supporting those living in food poverty and reducing health inequalities.

References

1. Department for Communities. Poverty Bulletin: Northern Ireland 2017/18 [cited 6 October 2019] Available from:  https://www.communities-ni.gov.uk/system/files/publications/communities/ni-poverty-bulletin-201718.pdf

2. Department for Communities.  Family Resources Survey Northern Ireland.  Background, quality, methodology report 2017/18 [cited 16 October 2019] Available from: https://www.communities-ni.gov.uk/system/files/publications/communities/frs-201718-quality-methodology-report.pdf

3. Joseph Roundtree Foundation Poverty in Northern Ireland 2018 [Internet]. 2018 p. 2. [cited 16 October 2019] Available from: https://www.jrf.org.uk/report/poverty-northern-ireland-20182.   

4. Combat Poverty Agency. Food Poverty and Policy [Internet]. 2004 p. 120. [cited 16 October 2019] Available from: http://www.combatpoverty.ie/publications/FoodPovertyAndPolicy_2004.pdf.  Public

5. Health Alliance. Food Poverty: Fact of Fiction? [Internet]. 2007[cited 16 October 2019] p. 8. Available from: http://www.safefood.eu/SafeFood/media/SafeFoodLibrary/Documents/Professional/Food%20Poverty/PHA2007_FoodPovertyFactorFiction.pdf4.

6. Food Standards Agency Northern Ireland. Understanding Food in the Context of Poverty, Economic Insecurity and Social Exclusion [Internet]. 2015 p. 14, 43. [cited 16 October 2019] Available from: https://www.food.gov.uk/sites/default/files/media/document/FS307008%20-%20Food%20Poverty%20Final%20Report.pdf

7. House of Commons Library. Food Banks and Food Poverty. 2014 p. 1.

8. Mapping the UK’s Independent Food Banks [Internet]. Independent Food Aid Network UK. 2018 [cited 16 October 2019]. Available from: http://www.foodaidnetwork.org.uk/mapping

9. The Trussell Trust – End of Year Stats [Internet]. The Trussell Trust. 2019 [cited 17 October 2019]. Available from: https://www.trusselltrust.org/news-and-blog/latest-stats/end-year-stats/#fy-2018-2019

10. Garthwaite, K. (2016) ‘Stigma, shame and `people like us’ : an ethnographic study of foodbank use in the UK.’, Journal of poverty and social justice., 24 (3). p. 277-289.

11. Department of Health, Social Services and Public Safety. Making Life Better: A whole system strategic framework for public health 2013-2023. [cited 17 October 2019] Available from: https://www.health-ni.gov.uk/sites/default/files/publications/dhssps/making-life-better-strategic-framework-2013-2023_0.pdf