## Northampton Borough Council Overview And Scrutiny Scrutiny Panel 1 - Food Poverty Core Questions  - Expert Advisors Director Of Public Health, Northamptonshire County Council

The Scrutiny Panel is currently undertaking a review:


To examine the extent to which individuals and families are experiencing food poverty, the range of contributing factors and the changes that have been made to the way the Council and partners support residents during hardship.  

To review the impact and concentration of food poverty across the Borough of Northampton
The required outcomes are:


To make informed recommendations to all relevant parties on the most appropriate approaches to take to mitigate the impact of food poverty in Northampton.

To make recommendations on how the specific issues in relation to food poverty are dealt with from now until the new Unitary Authority.  
   

## Core Questions:

A series of key questions have been put together to inform the evidence base of the Scrutiny Panel: 

## 1. In Your Opinion, What Are The Main Impacts Of Food Poverty?

It's important to define what we mean by "food poverty" so that we can properly understand what the impacts of this might be and to accurately measure how widespread this problem is. Food poverty according to the Department of Health is "the inability to afford, or to have access to, food to make up a healthy diet"1. It is closely related to household food insecurity which is the inability to be able to secure social and economic access to sufficient, safe and nutritious food which meets dietary needs and food preferences for an active and healthy life2.

Hunger as a term to describe the physical feeling of insufficient food is used by a number of organisations working with people unable to afford food as a means of communicating messages to the wider public, including the Trussell Trust, FareShare, Magic Breakfast, and Church Action on Poverty. Hunger is one consequence of food insecurity but not an inevitability. A clear direct impact of not having access to a healthy diet is malnutrition. As illustrated in **Figure 1** below, the malnutrition that arises as a result of food insecurity can manifest as undernutrition, **hunger and underweight** but may also come in the form of nutrient deficiencies with healthy weights or **overweight/obesity**. The poor health and wellbeing and risk of chronic ill-health related to food poverty are not only due to the direct dietary risks but also due to associated social and psychological impacts e.g. chronic stress related to food poverty and poverty more generally, poor school performance due to acute hunger, It is also important to consider the differences between acute hunger and chronic food insecurity. Poverty has been further defined in terms of the way that it effectively excludes individuals from participation in what might be regarded as the customary life of society (Levitas, 2006).3
Source: FAO The State of Food Insecurity4

## 2. How Widespread Do You Understand Food Poverty In The Borough To Be?

Food poverty or food insecurity are challenging conditions to measure and there is a lack of robust or systematic measures in the UK. Other measures, however, can be useful in estimating the size of the problem.

Food poverty is clearly linked to poverty more generally and poverty can be measured in a number of ways. One useful metric is "income deprivation" which measures the number of people who are in receipt of various means tested benefits. In 2015 the total number of people affected by income deprivation in Northampton was 27,2795  of whom 7,8066 were children and 6,1937  older people.

Use of emergency food aid (i.e. food banks) can give an indication of the levels of need around acute food poverty. It should be noted that while the existence of emergency food aid provision reflects the growth of both episodic and chronic severe food poverty it measures just one aspect of this and so doesn't capture those who manage food insecurity in different ways 8.

Re;Store coordinate food parcels across 6 churches in Northampton Borough and in 
2018 distributed 4500 parcels (website reference)9.There are  other emergency food aid providers (including those who provide meals to the homeless and rough sleepers) that are not included in this figure. Nationally, the Trussell Trust saw a 20% increase between 2017-2018 in the number of food parcels given out in the summer holidays10.

## 3. In Your Opinion Does Food Poverty Differ Across The Borough Of Northampton And What Are The Reasons For This?

Food poverty is closely related to income deprivation and so patterns of food poverty across the borough are likely to mirror pattern of deprivation across the borough. Map 1 below illustrates the proportion of children across the county affected by income deprivation. The 2019 update to Index of Multiple Deprivation (IMD) identifies the top 20 most deprived small areas (lower super output areas - LSOAs) in the proposed West Northamptonshire [see Appendix 1]. It shows that 19 of the 20 areas are in Northampton Borough and that one small area in the borough is within the 1% most deprived LSOAs in England (Bellinge Ward: Fieldmill Road area, Billing Aquadrome). Another important factor to consider is accessibility of food, and in particular fresh fruit and vegetables. 'Food Deserts' describe areas where there are no shops selling affordable healthy food. This is particularly an issue for those with mobility issues or lack of access to transport. 

## Map 1. Income Deprivation Affecting Children Index (Idaci) Northamptonshire 2019

The University of Southampton has developed a methodology11 to estimate risk of food poverty across local communities and it was last updated in September 2019. The map below shows the food poverty estimates at MSOA level across the borough of Northampton.  Other presentations of the data are available here. 

## Map 2. Proportion Of Households At High Risk Of Food Poverty In Northampton Borough 2019 4. What Strategic Approaches Are You Aware Of To Tackle Food Poverty?

In order to understand approaches to tackle food poverty it's important to understand the root causes of food poverty. An analysis by the House of Commons' Environmental Audit Committee "Sustainable Development Goals in the UK follow up: Hunger, malnutrition and food insecurity in the UK" identified three themes relating to the causes of hunger, food insecurity and malnutrition:

1. Low incomes and rising living costs: 2. Universal Credit and the benefits system; and 3. Cuts to funding for local social care services.
Further to this, Sustain, in their guide to developing Food Poverty Action Plans suggest three broad approaches to tackle food poverty that complement the three key themes identified by the Environmental Audit Committee, namely;

1.  Taking a preventative approach
a. Improving access to financial and debt advice as well as maximising 
access to welfare and discretionary funds inc. fuel poverty funds.
b. Improving access to healthy start vouchers, breastfeeding support and 
free school meal provision and access to affordable locally grown produce.
c. Promoting fair incomes and the Living Wage
2. Shaping crisis provision (or more immediate provision)
a. Improving access to food aid by developing signposting tools for 
frontline staff and ensure this is delivered in a non-stigmatising way.
b. Improving nutritional value of food aid. c. Promoting greater coordination and networking of assistance providers.
3. Taking a wider approach
a. Measuring and monitoring food poverty at a local level b. Using planning and business rate relief systems to shape local areas 
and support social supermarkets and community food growing
c. Provide stable and affordable housing as well as access to energy 
efficiency measures
d. Make reducing food inequalities a priority across a range of strategies 
and plans and/or integrate food poverty actions within a wider food plan
It is also worth noting that innovative digital approaches can be employed as part of actions to address food poverty across these themes.In partnership with CAST (Centre for the Acceleration of Social Technology), Oxfam is exploring how digital technology can challenge and address the causes of food poverty in the UK.

## 5. What Approaches Are In Existence To *Reduce* People'S Dependency On Food Aid, Such As Food Banks?

A review by the Child Poverty Action Group (CPAG), Church of England, Oxfam GB and The Trussell Trust "Emergency Use Only: Understanding and reducing the use of food banks in the UK"12 gives the following recommendations for preventing need for food banks:


Improve access to short-term benefit advances: increase awareness, simplify the claim process and improve data collection to identify support needs.

Reform sanctions policy and practice: increase access to hardship payments, clarify communications about sanctions, mitigate the impact whilst a sanction is being reconsidered and address issues for Housing Benefit.

Improve the ESA regime: ensure claimants are not left without income whilst challenging a decision made because of missing medical certificates or missed appointments.

Sustain and improve access to emergency financial support through Local Welfare Assistance Schemes.

Ensure Jobcentres provide an efficient and supportive service for all clients.

Improve Jobcentre Plus Advisers' awareness of, and ability to respond to, mental health problems.

Improve access to appropriate advice and support.
Crisp et al 201613 explores the value of community led approaches to reducing poverty in neighbourhoods, including:


Approaches impacting on the 'material' forms of poverty, reducing housing or fuel costs or creating employment opportunities

Approaches impacting on the 'non-material' aspects by enhancing health and wellbeing, improving quality of housing, the condition of the physical environment and increasing levels of social participation.
Approaches are neighbourhood based; need adequate funding and are reliant on skills and leadership and a strong voluntary and community sector. Approaches include:


Voluntary action

Food banks

Community organising and social action

Neighbourhood enterprise

Community-based credit unions 

Developing physical assets

Community-led housing
This conceptual distinction between material and non-material forms of poverty provides a useful framework for understanding the broad range of poverty-related outcomes that community-led approaches may have. This is summarised in Table 1 below. The framework enables distinctions to be drawn between interventions that might not prevent 'material' poverty but could mitigate some of the 'non-material' impacts of poverty' that are part of the experience of poverty. 

## 13 Cresr, 2016 Community-Led Approaches To Reducing Poverty In Neighbourhoods: A Review Of Evidence And Practice

Activities may impact on 'material' poverty where they generate outcomes around: 
Activities may impact on 'nonmaterial' poverty where they generate outcomes around: 

 Jobs  Employment  Worklessness  Enterprise  Local economic growth  Living costs (e.g. food, fuel or housing) 
 Education  Health  Housing (availability, quality or security)  Community safety  Physical environment  Social interaction  Community cohesion  Community empowerment 

## 6. How Do You Understand Food Poverty Is Being Addressed?

Nationally, the Government has recognised the need to understand better and measure the impact of food poverty. A national index of food insecurity is to be incorporated into an established UK-wide annual survey run by the Department for Work and Pensions (DWP) that monitors household incomes and living standards. More widely, parliament, via the Environmental Audit Committee published a report in 2019 recommending greater action to reduce food poverty across the UK. There are also a number of voluntary sector organisations who campaign around Food Poverty. Schemes such as 'The Sustainable Food Cities Award' incorporates a strand on tackling food poverty, diet related ill-health and access to affordable healthy food as part of the criteria for award. Locally, alongside emergency food aid provision to address acute poverty there have been partnership efforts in recent years to address the root causes of food poverty. Northamptonshire Community Foundation currently host the Northamptonshire Food Poverty Network who are active in promoting issues of food poverty across the Some of the NCC Public Health Team's activities to address food poverty are listed below: As part of the support for the Borough and Districts Health and Wellbeing Fora, a Public Health Healthy Town grant was made available in 2018-19 for them to apply for projects that support the health and wellbeing of local residents.  Out of the 17 projects supported 5 projects are food related. Breastfeeding - Health Visitors commissioned by the public health team provide infant feeding support including breastfeeding drop-ins as one of the key areas to reduce impacts of food poverty. The Healthy Start Scheme is a statutory UK-wide government scheme that provides a 'nutritional safety net' for pregnant women and families on qualifying benefits and tax credits. Women who are at least 10 weeks pregnant and families with children under 4 qualify if the families received the relevant benefits. Pregnant women under 18 are also eligible, regardless of whether they receive benefits. The scheme includes food vouchers and vitamin supplements.. The uptake of Healthy Start vouchers in Northampton borough in August 2019 was 56%. Nationally the uptake in this period was 52%. A recent recruitment to a public health role has the function to develop a coordinated plan of existing work to tackle obesity across the County and identify key gaps that can be collectively worked on through a whole systems approach. There are also projects around fuel poverty and healthy schools that seek to improve people's uptake of means tested support e.g. support to reduce fuel poverty and to provide free school meals.

## 7. How Can The Borough Council, Together With Its Partners, Can Collectively Respond To Food Poverty?

Food poverty is an issue affecting the whole county and while there will be geographical and demographic variation the core issues, principles, actions and goals will be similar across all the boroughs and districts. With the move to the two unitary authorities a way forward could be to use this issue to come together across the County and consider the following actions for local authorities recommended by Sustain:

Developing a **food action plan** to tackle food poverty Improving the uptake of Healthy Start vouchers Promoting breastfeeding via the Baby Friendly Initiative Harnessing the value of children's centres Ensuring low-income families have adequate access to childcare Ensuring children's access to food 365 days a year Becoming a Living Wage employer and promoting the Living Wage Ensuring all residents have physical access to good food Supporting and enhancing meals on wheels provision Supporting financial advice services and providing crisis support

## 8. In Your Opinion What Are The Specific Issues Relating To Food Poverty?

Food poverty is a complex issue and so has multiple and overlapping causal factors and impacts on health and wellbeing. As noted by the Trussell Trust there are a widening group of people affected by food poverty, destitution and hunger14. Those vulnerable to food poverty are likely to be disadvantaged in other ways that have a negative impact on health and wellbeing. Some specific associations with higher risk of food banks use include those who have a disability or health condition, lone parents and families with 3 or more children, those who have experienced adverse life events such as bereavement or loss of a job plays a role in food bank usage.

## 9. Are You Aware Of The Existence Of "Holiday Hunger" And What Is Its Impact?

A national survey conducted by the NEU indicates teachers concerned over pupils missing meals during the school holidays15 and describe how the impacts of lack of school meals during the holidays and how these are compounded by:


Increased pressure on family food budget

Increased costs in Child care

Increased Fuel bills (even cooking food has a cost)

Social contact is diminished

School readiness and learning decline

Family Stress elevated
There is national evidence of adults skipping meals to save money so that their children can eat.  For example in London in 2018 33% skipped meals16
One project funded by the NCC Public Health Grant - Food with Dignity - was set up to address the issue of holiday hunger.  As part of its application it recorded:

## Kcu (Kettering Community Unit) Food Bank Statistics And Local Feedback:

Between October 2017 and September 2018, 1,495 adults and 1,032 children were fed through the food bank.  Since the start of rollout of Universal Credit (October 2018), there has already been over a 30% increase on the figures in food parcel requirements.  In areas where full rollout has been going for 1 year, the average increase in food bank usage is 52%.

Researchers at Thomas Coram speaking with children on the impacts on their 
lives.17  

Children in low income families are going hungry and missing out on healthy food and social activities that their peers take for granted.  Lack of money and food cause children physical pain, feelings of guilt and shame and a sense of social exclusion;Children in lone parents families are at greater risk of food poverty than others, reflecting broad poverty trends.  Since most lone parents are mothers, the health implications of parental sacrifice are gendered;

Free school meals are sometimes delivered in a discriminatory and stigmatising way and often don't buy enough to fill someone up.
They recommended:


Healthy free school meals should be available to all children at school. Solutions to food poverty must address the root causes of low and irregular wages, inadequate benefits and the high cost oif essentials that leave parents struggling to make ends meet.

## 10.Please Supply Details Of The Support That Your Organisation Or Group Offers?

Northamptonshire County Council supports disadvantaged groups who are vulnerable to food insecurity through a number of its statutory services as well as non-statutory offers. The Adult Learning Service provides a "healthy cooking on a budget" course to provide communities with skills to prepare healthy meals with fruits and vegetables while As noted above the Public Health within NCC provides support around reducing the burden of food poverty in the following ways:


Intelligence - 
o
The public health team have a responsibility to produce Joint Strategic Needs Assessments that identify local health and wellbeing priorities.

Commissioning - 
o
Through our commissioned services (primarily the Public Health Nursing Service) we:

Work with health visitors to improve uptake of Healthy Start scheme

Maintain level 3 accreditation for the Baby Friendly Initiative as part of the public health nursing contract.

Work with health visitors to promote breastfeeding as part of infant feeding offer

Partnership and project workingo
Our work also includes areas that have an impact on the determinants of food poverty including:

Projects working with schools to improve uptake of free school meals. 

Projects to reduce fuel poverty and address other wider determinants including access to training and employment will contribute to reducing food poverty.

Obesity prevention activities including promoting cooking on a budget skills and shaping food environments to reduce accessibility of fast food.

## 11. Please Supply Details Of Your Thoughts On Suggested Solutions Regarding Food Poverty.

1. Bringing together local leaders
Identify a strategic group to come together and map the need, current provision and develop a way forward across:

2. Tackling the underlying causes of food poverty
This includes working on local economic development, access to training and good quality jobs as well as a living wage and improving access to benefits.

3. Improving access to existing support for those at risk of food poverty
This includes improving uptake of free school meals, healthy start vouchers and other related support for prevention of acute food poverty.
4. Working at local community level to address food poverty
This includes improving access to affordable healthy foods through working on local community growing schemes and working with local businesses.
12.Are you aware of the number of people who are registered for pupil 
premium?  Please supply details. 
Pupil premium for deprivation is provided to schools on the basis of the number of pupils on the school roll that have ever eligible for FSM, (including those not currently eligible for FSM). Pupil Premium is also awarded on the basis of other elements of need e.g. children who have previously been "looked after children" and children of those previously in service in the armed forces. Nationally, data on pupil premium values is reported according to the upper tier authority or parliamentary constituency that the school is located in and not lower tier authorities. FSM eligibility, conversely, is available at borough level and is presented below:

|                  | Table 2.    | -        | Free School Meals Eligibility - January School Census 2019   |
|------------------|-------------|----------|--------------------------------------------------------------|
| District         | % Eligible  | Eligible | Total on Roll                                                |
| Northamptonshire | 10.4%       | 12300    | 118504                                                       |
| Corby            | 12.5%       | 1598     | 12831                                                        |
| Daventry         | 9.3%        | 1009     | 10897                                                        |
| East Northants   | 8.6%        | 1022     | 11920                                                        |
| Kettering        | 10.2%       | 1688     | 16517                                                        |
| Northampton      | 11.7%       | 3934     | 33642                                                        |
| South Northants  | 4.5%        | 812      | 18097                                                        |
| Wellingborough   | 12.3%       | 1543     | 12513                                                        |
| PRU              | 47.5%       | 96       | 202                                                          |
| Special          | 31.7%       | 598      | 1885                                                         |

13.Do you have further information or comments regarding food poverty 
which you would like to inform the Scrutiny Panel?
We would like to promote the development of a food poverty strategy and note that the process of developing a food poverty strategy can of itself have wider impacts such as:


Raising the profile of food poverty, especially with local decision-makers

Developing a shared positive vision

Creating a sense of empowerment for experts by experience

Empowering diverse groups to raise their voices to call for food justice

Ensuring the local council and other partners take ownership of agreed actions

Sharing of good practice across local authority boundaries to support specific 
projects18