Doctors need to take the lead on poverty’s effects on health

For the first time in more than 17 years, child poverty in the United Kingdom increased in absolute terms in 2011-12.1 This follows a long term reduction in child poverty from among the highest rates in Europe. These were hard won gains resulting from policies to improve the life chances of children in the UK. Now we see worrying signs that these achievements are being undone.

Poverty leading to inadequate nutrition is one of the oldest and most serious global health problems. Although it is assumed not to be a serious issue in rich countries such as the UK, we have highlighted a nearly twofold increase in hospital admissions linked to malnutrition in England—from 3000 cases in 2008-9 to 5500 in 2012-13.2 People’s food purchasing behaviours have changed since the recession. The poorest households have reduced their consumption of fresh fruit, vegetables, and fish, with evidence of substitution by unhealthier foods, especially in families with young children.2 3 More children are turning up to school hungry in the UK, with teachers reporting that hunger is influencing children’s ability to concentrate and learn.4 Frail elderly people are also at risk of food poverty, with the combination of inadequate heating and nutritional intake over the winter being particularly dangerous.

Christmas is a time for giving. Many people across the country will be gladly donating to food banks, to support the estimated 60 000 people turning to emergency food aid over the festive period.5 The use of food banks in England has risen dramatically—from 26 000 referrals in 2008-09 to around a third of a million in 2012-13—with many of the recipients being families with children.2 Furthermore, the public seems to be increasingly worried about the growing social injustice exemplified by food poverty. A recent opinion survey showed that one in six of the British public is worried about poverty and inequality, the highest figure the polling company MORI has ever recorded.6

What has caused this increasing reliance on food aid? We know that incomes have fallen considerably during the economic downturn and have continued to fall as other economic indicators improve,1 and this has occurred alongside a rise in the cost of living. For instance, the prices of fish, fruit, vegetables, bread, and meat have all risen by more than 30% since 2007.3

But the policy response to the recession is also to blame. The most common reasons cited for food bank referrals are benefit delays, low income, and benefit changes.7 Changes to the tax and benefit system are leading to a reduction in the adequacy, eligibility, and access to benefits, especially for some of the poorest families with children.1 Cuts to the public sector are hitting services on which poor families with children rely, with the largest spending cuts to local authority budgets occurring in the most deprived areas.8 As a result, cuts are affecting vital children’s services such as Sure Start centres, 580 of which have closed since 2010.9 10 The erosion of these safety nets in the UK is of grave concern, because those European countries that have more adequate social protection experience better health outcomes (see figure on bmj.com).11

In the short term, a priority must be to get food to those who need it most over winter. The Trussell Trust, Oxfam, and the Red Cross, in collaboration with supermarkets, are leading these efforts. Local government needs to step up to the mark.12 Local authorities and health services can help to develop joined-up local strategies, to collect better data, and to provide staff and facilities.

But food banks cannot be seen as a viable long term solution. In the context of globally rising food prices and stagnating wages, this problem is not going to go away. Although the charity of people giving food to those who are struggling is commendable, as a basis for a social protection system it is neither sustainable nor appropriate. The rise of food banks is a powerful symbol of failure in our national systems. But being at the receiving end of charity can be stigmatising and disempowering, and food banks do not deal with the root causes of food poverty. Case studies highlight the shame that some people feel when they are forced to resort to emergency food aid. As Nick Saul director of a Toronto based food bank said recently “Most people who have to visit food banks say it is a slow, painful death of the soul.”13

What can be done? As a start, we call on the royal colleges to take up the challenge of leading doctors against poverty. There is a clear need for better data, improved monitoring, and an increased awareness of the health impacts of poverty that are all too evident at the sharp end of healthcare. The medical profession also has an important role in assessing the adequacy of welfare benefits for supporting health and for maintaining the principles of equity in the NHS. Furthermore, public health professions have a key role in influencing local authority decision making on where the cuts fall in local services. We all need to advocate for more equitable welfare reforms, with the test that they must protect the most vulnerable, particularly children.