Between September 2015 and August 2016 I completed my MSc in Public Health Research at the University of Aberdeen (now the Master of Public Health).
The first few months involved classes, course work and exams – I learnt a lot and it has provided me with a really solid grounding for a career in research – but where the fun really began was in the 6 month project phase.
I chose a primary data study (where the researcher collects the data for their study rather than use existing data) which looked at health professionals’ experiences of and perspectives on food insecurity and long term conditions. I was supervised by Dr Flora Douglas and Professor Vikki Entwistle. I’ll do another blog post about the positives/negatives, from my point of view, about my choice but for now I’ll talk about food insecurity and our findings.
For those of you with less time/shorter attention spans/hatred of rambling. Or if you want to read some quotes gathered in the study please feel free to read my study summary available here: health-professionals-and-food-insecurity-summary
What is food insecurity?
You might have heard of food poverty rather than food insecurity. They’re quite similar but basically food insecurity focuses on the range of experiences that people can have rather than focusing exclusively on the manifestation of hunger.
A commonly used UK definition of food insecurity was coined by Elizabeth Dowler and colleagues in 2001 and is the one which we used in this study:
“The inability to acquire or consume an adequate quality or sufficient quantity of food in socially acceptable ways, or the uncertainty that one will be able to do so”
We don’t currently measure food insecurity in the UK so at the moment food banks are often used as a proxy. This isn’t ideal as not everyone who is food insecure will access a food bank; based on a Canadian study only around a 5th of all those who are food insecure access a food bank. However it’s enough to indicate that food insecurity has been increasing sharply in the last few years.
So now you know a bit about the background on food insecurity I’ll briefly discuss long term conditions.
What are long term conditions?
In this study we used the Scottish Government’s definition of a long term condition:
“a condition that lasts a year or longer, impacts on a person’s life, and may require ongoing care and support.”
In Scotland alone over 2 million people live with at least one long term condition. International evidence (again I’ll mention that we don’t routinely collect data on food insecurity so we’re reliant on international evidence to inform us) suggests that households living with a long term condition are more vulnerable to experiencing food insecurity than those without (Tarasuk et al, 2013; Seligman et al, 2010). In addition to this children from food insecure households are more likely to go on to develop chronic mental health and respiratory diseases such as depression and asthma (Kirkpatrick et al, 2010; McIntyre et al, 2013). Those who do experience food insecurity and have a long term condition such as diabetes or heart disease have been found to be less able to manage any such condition.(Department of Health, 2012; Gucciardi et al 2014; Seligman et al, 2014; Vorozis & Tarasuk, 2013) This lack of ability to manage long term conditions as a result of being food insecure, independent of other social determinants of health (ie. even when you take into account other factors like employment status), has been found to lead to increased health care utilisation and costs in a universal health care system in Canada. (Tarasuk et al, 2015).
So back to the UK… we can infer that food insecurity is increasing from the food back statistics, we can also see that those with long term conditions might have more difficulty managing their conditions if they are experiencing food insecurity as well as be more likely to experience food insecurity – where do the health professionals come in?
Well, firstly health professionals are likely to engage with those living with long term conditions with around 80% of the GP consultations occurring annually in Scotland being related to long term conditions(Audit Scotland, 2007). However, it is not only GPs who work with individuals with long term conditions. The range of services provided by the NHS means a number of health professionals are likely have contact with individuals with long term conditions for example, clinicians, nurses and Allied Health Professionals.
Secondly, the limited evidence there is available suggests that health and social care professionals increasingly act, or are expected to act, as informal referring agents to food banks in Scotland and elsewhere in the UK (Douglas et a, 2015b; Sosenko et al 2013).
Given that Health Professionals are working with people who have long term conditions AND they are potentially being asked to make referrals to food banks we wanted to explore: (a) what they understood about household food insecurity in general terms, (the extent to which they knew about it, or understood about it to be a problem in Scotland); and (b) their experiences of supporting people who were affected by one or more long term conditions and (possibly) food insecure.
What did we find out?
We spoke with 20 primary and secondary care health professionals in a combination of interviews and discussion groups between April and July 2016. We found that:
- Most were aware that some of their patients were, or could be affected by food insecurity, but they lacked confidence that they could always recognise it in particular patients and were unsure how to raise the issue to find out.
- Some knew some patients who definitely had difficulty managing their health condition(s) due to food insecurity and considered more likely to have poorer health outcomes as a result. The particular implications of food insecurity could depend on the conditions. For example, health professionals working with people with diabetes were concerned about diet quality whilst those supporting patients with respiratory conditions such as COPD were more concerned with dietary quantity.
- All thought they had a role to play in relation to food insecurity. Typically this involved needing to be aware of food insecurity as a potential problem and signposting people to potential sources of help.
- Health professionals seemed to have varying degrees of uncertainty about what they could and should be doing in relation to food insecure patients given their clinical roles, priorities, and time constraints.
- Some believed it was necessary to modify standard dietary advice to make it realistic for people they believed to be food insecure. However, this created tension and uncertainty about deviating from evidence based clinical guidelines for condition management.
From these findings we concluded that our study provided a preliminary insight into questions about the impact of food insecurity on long term condition management in Scotland. Without denying the need to address the root causes of food insecurity, the study suggests we need to get a better and broader (national) picture of how it affects and is addressed in clinical health care practice. Work is also needed to identify how best to support health professionals work effectively and appropriately with people whose ability to manage their long term conditions is impaired by food insecurity. Finally, we need generate a much better picture and understanding of the impact of food poverty on chronic condition management from the perspective of people who are directly affected by both chronic and acute food poverty health in Scotland.
So that’s quick run down of some of the background to, and the findings of, my MSc project.If you have any questions/comments please feel free to direct them to me here or on twitter.
Audit Scotland (2007) Managing Long Term Conditions. Available from: http://www.audit-scotland.gov.uk/docs/health/2007/nr_070816_managing_long_term.pdf
Department of Health (2012) Chronic disease management. A compendium of information Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216528/dh_134486.pdf
Dowler E, Turner S, with Dobson B. (2001) Poverty bites: food, health and poor families. London: Child Poverty Action Group.
Douglas F, Sapko J, Kiezebrink K and Kyle J (2015a) Resourcefulness, Desperation, Shame, Gratitude and Powerlessness: Common Themes Emerging from A Study of Foodbank Use in Northeast Scotland. Public Health 2(3): 297-317
Douglas F, Ejebu O-Z, Garcia A, MacKenzie F, Whybrow S, McKenzie L, Ludbrook A and Dowler E. The Nature and Extent of Food Poverty (2015b) Available from: http://www.healthscotland.com/uploads/documents/25717-The%20nature%20and%20extent%20of%20food%20poverty%20insecurity%20in%20Scotland.pdf
FAO (2013) Food and Agriculture Organization of the United Nations The Food Insecurity Experience Scale. Available from: http://www.fao.org/3/a-as583e.pdf
Gucciardi, E., Vahabi, M., Cockwell, D., Norris, N., Del Monte, JP. (2014),Farnum, C. The Intersection Between Food Insecurity and Diabetes: A Review. Curr Nutr Rep 3: 324.
Kirkpatrick SI, McIntyre L, Potestio M. Child hunger and longterm adverse consequences for health. Arch Pediatr Adolesc Med 2010;164:754-62. 8.
Loopstra R and Tarasuk V (2015) Food Bank Usage Is a Poor Indicator of Food Insecurity: Insights from Canada. Social Policy and Society 2015 Jul:443-455
McIntyre L, Williams J, Lavorato D, et al. (2013) Depression and suicide ideation in late adolescence and early adulthood are an outcome of child hunger. J Affect Disord 2013;150:123-9
Seligman HK, Laraia BA, Kushel MB (2010) Food insecurity is associated with chronic disease among low-income NHANES participants. J Nutr 2010;140:304-310.
Seligman HK, Bolger AF, Guzman D, Lopez A, Bibbins-Domingo K. (2014) Exhaustion of food budgets at month’s end and hospital admissions for hypoglycemia. Health Affairs. 2014 Jan 1;33(1):116–123.
Tarasuk, V., Mitchell, A., McLaren L., and McIntyre L (2013) Chronic physical and mental health conditions among adults may increase vulnerability to household food insecurity. J Nutr. 2013 Nov;143(11):1785-93
Tarasuk V, Cheng J, deOliveira C, Dachner N, Gundersen C, Kurdyak P (2015) Association between household food insecurity and annual health care costs CMAJ 187/14/E429
Vorozis NT & Tarasuk VS (2013) Household food insufficiency is associated with poorer health. J Nutr. 2013 Jan;133(1):120-126
(PS. referencing this just brought back horrible flashbacks to desperate 5am referencing the day of hand in after dreaming about ones I’d missed…You better appreciate them!)