Long-Term Food Insecurity, Hunger and Risky Food Acquisition Practices: A Cross-Sectional Study of Food Charity Recipients in an Australian Capital City.

Inadequate social protection, stagnant wages, unemployment, and homelessness are associated with Australian household food insecurity. Little is known about the recipients of food charity and whether their needs are being met. This cross-sectional study of 101 food charity recipients in Perth, Western Australia, measured food security, weight status, sociodemographic characteristics and food acquisition practices. Seventy-nine percent were male, aged 21-79 years, 90% were unemployed, 87% received social assistance payments, and 38% were homeless. Ninety-one percent were food insecure, 80% with hunger, and 56% had gone a day or more without eating in the previous week. Fifty-seven percent had used food charity for ≥1 year, and, of those, 7.5 years was the mode. Charitable services were the main food source in the previous week, however 76% used multiple sources. Begging for money for food (36%), begging for food (32%), stealing food or beverages (34%), and taking food from bins (28%) was commonplace. The omnipresence and chronicity of food insecurity, reliance on social security payments, and risky food acquisition suggest that both the social protection and charitable food systems are failing. Urgent reforms are needed to address the determinants of food insecurity (e.g., increased social assistance payments, employment and housing support) and the adequacy, appropriateness and effectiveness of food charity.

Using Cross-Sectional Data to Identify and Quantify the Relative Importance of Factors Associated with and Leading to Food Insecurity.

Australian governments routinely monitor population household food insecurity (FI) using a single measure-'running out of food at least once in the previous year'. To better inform public health planning, a synthesis of the determinants and how they influence and modify each other in relation to FI was conducted. The analysis used data from the Health & Wellbeing Surveillance System cross-sectional dataset. Weighted means and multivariable weighted logistic regression described and modelled factors involved in FI. The analysis showed the direction and strength of the factors and a path diagram was constructed to illustrate these. The results showed that perceived income, independent of actual income was a strong mediator on the path to FI as were obesity, smoking and other indicators of health status. Eating out three or more times a week and eating no vegetables more strongly followed FI than preceded it. The analysis identified a range of factors and demonstrated the complex and interactive nature of them. Further analysis using propensity score weighted methods to control for covariates identified hypothetical causal links for investigation. These results can be used as a proof of concept to assist public health planning.

Gratitude, resignation and the desire for dignity: lived experience of food charity recipients and their recommendations for improvement, Perth, Western Australia.

OBJECTIVE: The present study explored recipients' perceptions of food charity and their suggested improvements in inner-city Perth, Western Australia. DESIGN: In-depth interviews were conducted with charitable food service (CFS) recipients. Transcripts were thematically analysed using a phenomenological approach. SETTING: Interviews were conducted at two CFS in inner-city Perth. SUBJECTS: Fourteen adults. RESULTS: The recipients' journeys to a reliance on CFS were varied and multifactorial, with poverty, medical issues and homelessness common. The length of time recipients had relied on food charity ranged from 8 months to over 40 years. Most were 'grateful yet resigned', appreciative of any food and resigned to the poor quality, monotony and their unmet individual preferences. They wanted healthier food, more variety and better quality. Accessing services was described as a 'full-time job' fraught with unreliable information and transport difficulties. They called for improved information and assistance with transport. 'Eroded dignity' resulted from being fed without any choice and queuing for food in public places, often in a volatile environment. 'Food memories and inclusion' reflected a desire for commensality. Recipients suggested services offer choice and promote independence, focusing on their needs both physical and social. CONCLUSIONS: Although grateful, long-term CFS recipients described what constitutes a voluntary failure. Their service improvement recommendations can help meet their nutritional and social needs. A successful CFS provides a food service that prioritises nutritious, good-quality food and individual need, while promoting dignity and social inclusion, challenging in the current Australian context.

Charitable Food Systems' Capacity to Address Food Insecurity: An Australian Capital City Audit.

Australian efforts to address food insecurity are delivered by a charitable food system (CFS) which fails to meet demand. The scope and nature of the CFS is unknown. This study audits the organisational capacity of the CFS within the 10.9 square kilometres of inner-city Perth, Western Australia. A desktop analysis of services and 12 face-to-face interviews with representatives from CFS organisations was conducted. All CFS organisations were not-for⁻profit and guided by humanitarian or faith-based values. The CFS comprised three indirect services (IS) sourcing, banking and/or distributing food to 15 direct services (DS) providing food to recipients. DS offered 30 different food services at 34 locations feeding over 5670 people/week via 16 models including mobile and seated meals, food parcels, supermarket vouchers, and food pantries. Volunteer to paid staff ratios were 33:1 (DS) and 19:1 (IS). System-wide, food was mainly donated and most funding was philanthropic. Only three organisations received government funds. No organisation had a nutrition policy. The organisational capacity of the CFS was precarious due to unreliable, insufficient and inappropriate financial, human and food resources and structures. System-wide reforms are needed to ensure adequate and appropriate food relief for Australians experiencing food insecurity.

Guest Commentary: Fat and other taxes, lessons for the implementation of preventive policies.

Fat, sugar or sweetened beverage taxes are part of an overall public health nutrition approach to healthy eating. They are not approaches that on their own are likely to bring about change. Policy evidence from existing food tax implementation suggest that taxes need to be paralleled by subsidies and other interventions to encourage healthy eating. Such dual methods help not only contribute to nutrition outcomes but also ensure political support for food taxes. Politicians and policy makers are suspicious of taxes, using subsidies and revenue monies from taxes to support healthy eating is more likely to encourage both political and public support. Building support for policies is never just a matter of academic evidence. Public health advocates need to show more ambition by developing skills in implementing pricing policies to support healthy eating. Key opponents to taxes are the food industry who use a range of arguments to prevent taxation being implemented. Public health advocates are weak in tackling the issues of corporate power and providing evidence to maintain policy and political support. The public health movement needs to continue to develop the political will among politicians and the public for taxes on food. A new way of looking at policy formation is required and this includes addressing the power of corporate interests and the role of professionals in shaping or combating these influences.

The European Union Food Distribution programme for the Most Deprived Persons of the community, 1987-2013: From agricultural policy to social inclusion policy?

The European Union Food Distribution programme for the Most Deprived Persons (MDP) of the community ran from 1987 until 2013. It was funded from Common Agricultural Policy budgets. The programme initially made use of surplus foods from the food mountains resulting from intervention stocks. This food was then distributed through aid agencies within member states, coordinated at a national government level. Reform of the CAP and global rises in food prices resulted in an increase in budget from €300 to €500 million Euros in 2010 with the added power to buy food on the open market. This led to a formal challenge to the scheme on the basis that buying goods on the open market shifted the emphasis from an agricultural/financial basis to a social one. A court ruling found that because the program was no longer used for removing surpluses the link to agriculture policy has become tenuous and therefore had no basis in community law. As a result of this legal challenge a number of policy compromises ensured the MDP would continue until the end of 2013 with a reduced budget. The scheme has been superseded by a new scheme in March 2014 called the Fund for European Aid to the Most Deprived (FEAD). This is seen as a social programme. The way that policy and politics developed and changed the MDP programme are set out. The article tracks its move from being an agricultural policy to a social welfare one. The key policy players and actors in this move are set out as are the changing context and policy frameworks. The replacement of the MDP by FEAD is discussed as is how intensive lobbying in 2012/13 resulted in the development of a new Fund for European Aid to the Most Deprived (FEAD).

The Public Health Responsibility Deal: brokering a deal for public health, but on whose terms?

UNLABELLED: Coalitions of multinational food and drink businesses have pledged to reformulate their products and to market them responsibly. Largely business-led and self-regulated, the integrity of these voluntary initiatives has been questioned. The Public Health Responsibility Deal in England is an example of a voluntary initiative that is government-led. Does this approach provide evidence that with public leadership there is potential for voluntary actions to deliver meaningful results for public health? METHODS: The subject of the research is the calorie reduction initiative of the Responsibility Deal. Source material was obtained primarily through a series of UK Freedom of Information requests and comprises previously unpublished Department of Health documentation relating to relevant meetings held during 2011 and 2012. RESULTS: The Responsibility Deal approach to calorie reduction deliberately involves the food industry in the specification of the measures it is to implement (reformulation and portion control). Finding the common ground between private and public interests has resulted in the deflection of public health objectives and the preclusion of adequate monitoring and evaluation. CONCLUSIONS: The Responsibility Deal approach is fundamentally flawed in its expectation that industry will take voluntary actions that prioritise public health interests above its own. Being government-led counts for little in the absence of sanctions to drive compliance. Instead the initiative affords private interests the opportunity to influence in their favour the public health policies and strategies that affect their products.

Systematic reviews of the evidence on the nature, extent and effects of food marketing to children. A retrospective summary.

A 2009 systematic review of the international evidence on food and beverage marketing to children is the most recent internationally comprehensive review of the evidence base. Its findings are consistent with other independent, rigorous reviews conducted during the period 2003-2012. Food promotions have a direct effect on children's nutrition knowledge, preferences, purchase behaviour, consumption patterns and diet-related health. Current marketing practice predominantly promotes low nutrition foods and beverages. Rebalancing the food marketing landscape' is a recurring policy aim of interventions aimed at constraining food and beverage promotions to children. The collective review evidence on marketing practice indicates little progress towards policy aims has been achieved during the period 2003-2012. There is a gap in the evidence base on how substantive policy implementation can be achieved. We recommend a priority for future policy relevant research is a greater emphasis on translational research. A global framework for co-ordinated intervention to constrain unhealthy food marketing which has received high level support provides valuable insight on some aspects of immediate implementation research priorities.

When chefs adopt a school? An evaluation of a cooking intervention in English primary schools.

This article sets out the findings from research on the impact of a, UK based, chefs in schools teaching programme on food, health, nutrition and cookery. Professional chefs link with local schools, where they deliver up to three sessions to one class over a year. The research measured the impact of a standardised intervention package and changes in food preparation and consumption as well as measuring cooking confidence. The target group was 9-11year olds in four schools. The main data collection method was a questionnaire delivered 2weeks before the intervention and 2weeks afterwards. There was a group of four matched control schools. Those taking part in the intervention were enthused and engaged by the sessions and the impact measures indicated an intention to change. There were gains in skills and confidence to prepare and ask for the ingredients to be purchased for use in the home. Following the session with the chef, the average reported cooking confidence score increased from 3.09 to 3.35 (by 0.26 points) in the intervention group - a statistically significant improvement. In the control group this change was not statistically significant. Children's average reported vegetable consumption increased after the session with the chef, with the consumption score increasing from 2.24 to 2.46 points (0.22 points) again, a statistically significant increase with no significant changes in the control group. The research highlights the need to incorporate evaluation into school cooking initiatives as the findings can provide valuable information necessary to fine-tune interventions and to ensure consistency of the healthy eating messages.

Television advertising and children: lessons from policy development.

AIM: To conduct a policy review of the regulations related to food advertising on television aimed at children. DESIGN: The study consisted of documentary analysis of relevant legislation and policy documents related to children's advertising from both industry and non-governmental organisations at a global level and in 20 countries. This was supported with semi-structured telephone interviews with individuals from 11 countries. RESULTS: The initial findings resulted in a listing of regulatory impacts from which we developed a taxonomy of regulatory schemes. There was a tension between the development of legislation to cover this area and the use of voluntary agreements and codes. This tension represents a food industry/civic society split. The food and advertising industries are still engaged in a process of denying the impact of advertising on food choice and children as well as commissioning their own research. Outright bans are unusual, with most countries addressing the situation through voluntary agreements and self-regulation. We found a deep division over the way forward and the role and place of legislation. Policy-makers expressed concerns that national legislation was increasingly less relevant in dealing with broadcast media transmitted from outside national boundaries and therefore not subject to the receiving countries' laws but to the laws of the country from which they were transmitted. CONCLUSIONS: The options for the regulation of advertising targeted at children range from (1) a complete ban on advertising as in the case of Sweden, through (2) partial restrictions on advertising by type of food, target group or limits on the amount of advertisements or times shown, to (3) continuation of self-regulation by the advertising and food industries. There is a global dimension to regulation that needs to be built in, as national frontiers are no barriers to broadcast media and public health nutrition needs to ensure that its concerns are heard and addressed.

Taxing food: implications for public health nutrition.

AIM: To set out a policy analysis of food taxes as a way of influencing food consumption and behaviour. DESIGN: The study draws on examples of food taxes from the developed world imposed at national and local levels. Studies were identified from a systemised search in six databases with criteria designed to identity articles of policy relevance. RESULTS: The dominant approach identified from the literature was the imposition of food taxes on food to raise general revenue, such as Value Added Tax in the European Union. Food taxes can be applied in various ways, ranging from attempts to directly influence behaviour to those which collect taxes for identified campaigns on healthy eating through to those applied within closed settings such as schools. There is a case for combining taxes of unhealthy foods with subsidies of healthy foods. The evidence from the literature concerning the use and impact of food taxes on food behaviour is not clear and those cases identified are mainly retrospective descriptions of the process. Many food taxes have been withdrawn after short periods of time due to industry lobbying. CONCLUSIONS FOR POLICY: Small taxes with the clear purpose of promoting the health of key groups, e.g. children, are more likely to receive public support. The focus of many tax initiatives is unclear; although they are generally aimed at consumers, another focus could be food manufacturers, using taxes and subsidies to encourage the production of healthier foods, which could have an effect at a population level. Further consideration needs to be given to this aspect of food taxes. Taxing food (and subsidies) can influence food behaviour within closed systems such as schools and the workplace.

Public health nutrition and food policy.

Food in its many manifestations allows us to explore the global control of health and to examine the ways in which food choice is moulded by many interests. The global food market is controlled by a small number of companies who operate a system that delivers 'cheap' food to the countries of the developed world. This 'cheap' food comes at a price, which externalises costs to the nation state in terms of health consequences (diabetes, coronary heart disease and other food-related diseases) and to the environment in terms of pollution and the associated clean-up strategies. Food policy has not to any great extent dealt with these issues, opting instead for an approach based on nutrition, food choice and biomedical health. Ignoring wider elements of the food system including issues of ecology and sustainability constrains a broader understanding within public health nutrition. Here we argue that public health nutrition, through the medium of health promotion, needs to address these wider issues of who controls the food supply, and thus the influences on the food chain and the food choices of the individual and communities. Such an upstream approach to food policy (one that has been learned from work on tobacco) is necessary if we are seriously to influence food choice.

Intersectoral food and nutrition policy development: a manual for decision-makers

The dynamic world food system makes it hard for governments to keep pace with the changes and at the same time protect public health. Recent food scares such as the BSE crisis in the United Kingdom, the Asian flu crisis with chickens in Hong Kong and China and the breakdown of the food supply system in the Former Soviet Union highlight the importance of global surveillance and response. The changes in public health systems and health protection legislation that is needed can be difficult to introduce both at international and national levels. Consistent food and nutrition policies are important from international, national through to the local level. The need for managing human and financial resources cannot be underestimated when trying to initiate institutional change. Enlightened administrators and policy-makers play a key role in enabling these changes. After high-level decision-makers are sensitized to the need for a food and nutrition policy to ensure public health, decision-makers are more likely to support an intersectoral approach. This workshop is multidisciplinary and intended for policy-makers, and their advisers, working in the sectors connected with food. It is not intended to convey new technical information but focuses on using their current information to develop national action plans. The participants can come from a range of backgrounds: health, agriculture, environment, education, social welfare, finance, academia, the food industry, and the nongovernmental or voluntary sector. A successful food and nutrition policy will be developed by involving all the relevant sectors and key players. It is imperative that the participants attending this workshop represent as many sectors as possible. Participants who complete the workshop will be equipped with some of the skills necessary to develop a food and nutrition policy at a national or local level.