Increasing food insecurity

Those who are most socioeconomically disadvantaged are most likely to experience food insecurity. The Office for National Statistics reported that 61 % of those living in the UK’s most deprived areas reported cutting down on food purchases compared with 44 % of those living in the least deprived areas^{(Reference Scott2)}. A poll from August 2022 found that 40 % of people living in the UK in receipt of Universal Credit, a benefit for those on a low income or out of work, reported skipping meals over the previous three months⁽³⁾.

In September 2022, 26 % of households in England with children reported experiencing food insecurity compared with 12·4 % in May 2020^{(Reference Goudie14)}. Households reporting experiences of food insecurity are much more likely to report that they are concerned about the impact of being unable to afford sufficient food on their children’s mental and physical health, as well as the wider impact of the cost-of-living crisis on their children’s friendships and social development. Teaching staff have reported an increase in children arriving at school hungry and with lunches brought from home with insufficient food^{(Reference Huseyinoglu15)}. Teaching staff also support extending eligibility for Free School Meals⁽¹⁶⁾. Data on secondary school pupil registration for FSM in Scotland indicates that this has increased from 14·2 % in 2016 to 18·6 % in 2022⁽¹⁷⁾.

To manage experiences of food insecurity, those affected often rely on emergency food aid. The number of emergency food aid parcels distributed has increased substantially in recent years. For example, the Trussell Trust network (the largest emergency food aid network in the UK) reports that the number of parcels they distributed from April-September 2022 rose by almost one third⁽¹⁸⁾. Similar percentage increases are reported for the numbers of parcels distributed for children (rising from 368 160 April-September 2021 to 483 677 April-September 2022). In Scotland during the same time period, 116 000 emergency food parcels were distributed, with 40 000 parcels for children⁽⁴⁾. Households with children are overrepresented in referrals to Trussell Trust food banks⁽¹⁹⁾, despite the Scottish Government’s introduction of a Scottish Child Payment. From February 2021, this provided low-income households with children under 6 years with an additional (at that time) £20 per week for each child. From November 2022 this increased to £25 for each child under 16 years for eligible families.

Insufficient income

A range of causes have been identified to explain increases in food insecurity across Scotland and the UK. The main overarching explanation is insufficient income^{(19,Reference Long, Stretesky and Graham25)} . This can arise from both wages and benefits being too low, particularly in the context of rising costs. In-work poverty has increased in the last 25 years. In 1996/7, 44 % of children and working-age adults living in poverty were living in families where at least one adult was working. By 2019/20 this had increased to 66 %⁽²⁶⁾. A main driver of insufficient income is a labour market in which wages have not risen in line with inflation^{(27,Reference Reeves, Loopstra and Stuckler28)} . This limits families’ spending power, making some of the most basic necessities, such as food and fuel, a challenge to purchase in sufficient quantities.

Families on low-incomes are at increased risk of experiencing food insecurity. After housing and energy, food spending is likely to take up the greatest proportion of these household’s outgoings^{(Reference Douglas, Ejebu and Garcia29,Reference Davis and Geiger30)} . Evidence indicates that amongst food bank users in the UK, low to no income is common^{(Reference Perry, Williams and Sefton21,Reference Pybus, Power and Pickett31)} . It is estimated that 94 % of people who use a food bank are living in destitution^{(Reference Bramley, Treanor and Sosenko23)}. Low-income households often consider food spending to be a flexible expense and will prioritise other spending ahead of food expenditure, such as housing^{(Reference Moffatt, Lawson and Patterson32)}. The impact of this is that families on low incomes need to spend a higher proportion of their income in order to eat a diet in line with dietary recommendations^{(Reference Scott, Sutherland and Taylor33)}.

Welfare reform

Families in receipt of benefits are also impacted by having insufficient income to meet their needs. Following the global financial crash in 2008, the Conservative-Liberal Democrat coalition government introduced a range of austerity policies, cutting public spending and freezing benefits. Additional changes were introduced through the Welfare Reform Act which reformed benefits in the following years including capping benefits for personal independence payments, limiting housing benefit payments when households had extra bedrooms, payments for child benefit being limited to only two children per household, increased conditionality and sanctions, and the move towards the Universal Credit system. Universal Credit has been identified as a key explanation for increases in food insecurity, particularly the introduction of a five-week wait for claimants to receive their first payments. This has increased the likelihood that claimants are indebted to the Department of Work and Pensions (DWP), putting further pressure on household budgets. Bennett-Clemmow et al. ^{(Reference Bennett-Clemmow, Oguntimehim and Steeden34)} identified that 47 % of people referred to a Trussell Trust food bank were indebted to the DWP. These policies and changes to the welfare system have been identified as key causes for increases in food insecurity^{(Reference Perry, Williams and Sefton21,Reference Garratt, Spencer and Ogden35–Reference Lambie-Mumford and Green38)} . For example, Loopstra et al. ^{(Reference Loopstra, Reeves and Taylor-Robinson39)} highlighted that as benefits reduce, higher rates of food parcel distribution are seen across local authorities in Scotland, Wales and England. In a later study, Loopstra et al. ^{(Reference Loopstra, Fledderjohann and Reeves40)}, found that sanctioning of benefit claimants was positively associated with increased food bank use. Despite significant media attention on such reforms, and various experiences of poverty^{(Reference Alston41)}, these issues remain.

Food prices

From mid-2021 food prices started to increase steeply in the UK, with inflation levels peaking at 19·2 % in March 2023⁽⁴²⁾. Of particular concern has been the above average increase for staple foods such as milk, cheese, eggs, pasta and oil^{(Reference Scott2)}. As would be expected, the increase in the cost of food is associated with an increase in the number of households reporting that they have experienced food insecurity. In August 2020, 6·9 % of UK households reported moderate or severe food insecurity compared with 18·4 % of households in September 2022⁽²⁴⁾. In 2021, 9 % of adults responding to the Scottish Health Survey reported that they had been worried that they would run out of food because of a lack of money or other resources in the last 12 months^{(Reference Birtwistle, Deakin and Whitford8)}. Food insecurity figures for Scotland have not yet been updated to take into account the highest levels of food inflation.

Geo-political events

Additional challenges are geo-political events. In January 2020, the UK left the European Union, leading to disruptions in food supply chains^{(Reference Bakker, Datta and De Lyon43)}. Issues have included temporary food shortages and higher food prices. Food and energy prices have also come under considerable pressure after Russia invaded Ukraine in February 2022. With export of goods restricted from Ukraine and Russia, prices of staples such as wheat and oils have increased, as have the food products that include these ingredients^{(Reference Scott2)}. The invasion has also impacted fuel supplies, coinciding with the Energy Price Cap increasing, and average household electricity and gas payments in the UK have almost doubled⁽⁴⁴⁾, making cooking even more challenging.

Target populations for policy

Schneider and Ingram^{(Reference Schneider and Ingram96)} created a conceptual scheme to group target populations for policies. Within this scheme, each target population can be placed in one of four categories based on whether that group is constructed either positively or negatively in relation to a policy problem, and as either weak or strong in relation to the power they hold in the policy arena. This results in four different types of target populations: (1) advantaged (positive and strong – elderly, business, scientists); (2) contenders (negative and strong – rich people, unions, cultural elite); (3) Dependents (positive and weak – children, mothers, disabled people); (4) Deviants (negative and weak – criminals, drug addicts). They argue that support for policies is likely to be higher among both the public and policymakers where the target population is constructed positively. In terms of food insecurity, the scheme generates hypotheses for why a greater number of policies appear targeted at children and families compared with others who are experiencing food insecurity, such as single men. Indeed, the majority of adults in the UK believe that Governments have a responsibility to support children, and support the extension of policies such as free school meals to achieve this^{(Reference Lasko-Skinner and Sweetland97–99)}.

Scottish child payment

In 2021, the Scottish Government introduced the Scottish Child Payment with the long-term aim of reducing child poverty. This was initially a payment of £10 per week for families receiving certain means-tested benefits for each child they were caring for under 6 years of age. The payment was introduced in November 2020 and was doubled to £20 in April 2021, during the Covid-19 pandemic. The payment has been increased to £25 per week per child under 16 years of age, and is in addition to Child Benefit Payments, which are also available to families living elsewhere in the UK. Families are paid 4-weekly and are able to spend the money in the ways they deem best. It is estimated that take-up of the benefit is only around 77 %⁽¹⁰⁰⁾. In a qualitative study, Scottish Child Payment recipients (n 39) from across Scotland reported using the money to buy food helped them avoid falling into debt, or prevented them from having rely on emergency food⁽¹⁰⁰⁾.

Food assistance

In England, Wales and Northern Ireland, these targeted policies include Healthy Start vouchers for women who are 10 weeks or more pregnant and families who have children under the age of four. These vouchers allow families to purchase vitamins, milk, fresh, frozen, and tinned fruit and vegetables, fresh, dried, and tinned pulses, and infant formula milk. Scotland runs a similar scheme called Best Start Foods where families are provided with pre-payment cards to purchase healthy foods including milk, infant formula milk, vegetables, pulses and eggs. Evaluation of these schemes is currently limited, but they have been identified as key areas for future evaluation^{(Reference Stewart, Brophy and Cookson101)}. The limited quantitative evaluations that have been carried out have not focused on food insecurity. The outcomes that evaluations have focused on have shown mixed results. For example, Parnham et al. ^{(Reference Parnham, Millett and Chang102)} analysed pooled Living Costs and Food Survey (LCFS) data from 2010–2017 and concluded that Healthy Start had not increased fruit and vegetable expenditure for participating families compared with non-participating eligible families. In contrast, using a longitudinal design with 296 households, Griffith et al. ^{(Reference Griffith, von Hinke and Smith103)} found that fruit and vegetable expenditure increased between December 2004 and November 2006 to December-November 2008, and that the nutritional quality of food purchases improved. Families describing the impact of Healthy Start have identified the scheme as helping to alleviate hunger^{(Reference Lucas, Jessiman and Cameron104)} and to help women buy healthy food during pregnancy^{(Reference Ohly, Crossland and Dykes105)}. Multiple explanations can be attributed to these differences including study design (pooled cross-sectional v. longitudinal) as well as the differing time periods and data sources (LCFS v. Kantar panel data). At this time, there have been no evaluations of Best Start Foods.

Beyond the UK, food assistance programmes, such as the Special Supplemental Nutrition Program for Women Infants and Children (WIC) and the Supplemental Nutrition Assistance Program (SNAP) in the USA, have been shown to prevent or mitigate household and child food insecurity, reduce the risk of caregiver and child poor health^{(Reference Ettinger de Cuba, Chilton and Bovell-Ammon106,Reference Schanzenbach and Thorn107)} . Evidence suggests that the health and economic benefits of SNAP are long lasting with children continuing to benefit into adulthood^{(Reference Hoynes and Schanzenbach108)}.

School meals

The other main policies which aim to mitigate food insecurity are free school meals (FSM). School meals have a long history in the UK, beginning in the 19th century with charitable organisations providing meals to children whose families were unable to feed them. Manchester was the first municipality to provide FSM to children requiring them. Following concerns around nutritional intakes and the physical condition of conscripts to the Boer War, the 1906 Education Act allowed for local authorities to provide free school meals to children during the school day, though very few did^{(Reference Keith109)}. Following World War 2, and the expansion of the welfare state, these duties became statutory and nutritional standards for school meals were set^{(Reference Chambers, Dundas and Torsney110)}. In the 1980s, compulsive competitive tendering and the abolition of nutritional standards saw a decline in the nutritional quality of school meals^{(Reference Chambers, Dundas and Torsney110)}. Eligibility criteria also changed during this time resulting in over 500 000 children from low-income households becoming ineligible to receive a free school meal^{(Reference Brown111)}.

With a focus on rising levels of obesity, and concerns around children’s nutritional intake, food and nutrient standards have been re-introduced across the devolved nations of the UK. In the early 2000s, the Scottish Government published the Hungry for Success⁽¹¹²⁾ guidance document, followed soon after by school food regulations in 2007⁽¹¹³⁾. These were subsequently updated in 2021 to further reduce levels of sugar, improve the nutritional quality of drinks, and reduce the frequency of red and processed meat⁽¹¹⁴⁾. In England, school food standards are in place and have been mandatory since 2008 for primary schools and in 2009 for middle and secondary schools, and updated standards were introduced in 2015^{(Reference Evans and Harper115,116)} . The introduction of these standards and regulations have been shown to have improved the nutritional quality of school meals in England^{(Reference Adamson, Spence and Reed117–Reference Wickramasinghe, Rayner and Goldacre120)}, but evidence is limited from Scotland.

Until 2014, FSMs were provided on a means-tested basis across the UK for families in receipt of certain benefits or who had a low annual income. With the Liberal Democrat-Conservative government elected in 2010, a universal FSM system for children in their first three years of primary school was introduced in 2014 in England and in 2015 in Scotland. This had been a Liberal Democrat manifesto commitment in 2010. Wales rolled out a universal free breakfast programme to all primary-school-aged children, whilst Northern Ireland retained the means-tested system, although with wider eligibility criteria. Some of the key policy aims of universal free school meals (UFSM) was to reduce the stigma associated with the means-tested system and to improve children’s health and wellbeing through the provision of healthy food. Interestingly, mitigating food insecurity was less likely to be discussed as a policy aim, though it was recognised as a likely outcome by some key stakeholders involved in delivering the policy^{(Reference Chambers, Boydell and Ford121)}. As outlined above, since the introduction of the policy, reported food insecurity and use of emergency food provision has increased massively. This has led for calls for UFSM to be introduced more widely to either all primary school children or all school children, including those in secondary schools. It has been estimated that 800 000 children living in poverty are not eligible to receive FSM under a means-tested system, and almost a quarter of children not receiving a FSM during Covid-19 restrictions were food insecure^{(99,Reference Yang, Power and Moss122)} . The Scottish Government pledged to widen universal provision to all primary school children within the 2021–2025 Scottish Parliament. By 2023, this had only been extended to children in the first five years of primary school, with the capital infrastructure needed for full implementation identified as a barrier by Scotland’s First Minister⁽¹²³⁾. Universal provision was implemented for children receiving free childcare places in early years settings in Scotland by 2021. The Welsh Government announced in 2023 that universal free school lunches would be available to all primary school pupils, having previously only had a universal service for breakfast. In February 2023, the Mayor of London announced that all primary school children in the capital would be eligible to receive a FSM for the 2023/24, with five boroughs already providing this offering. The main aim outlined for the policy was to provide emergency support to families during the cost-of-living crisis, and to reduce families’ food insecurity⁽¹²⁴⁾. There have been calls from third sector organisations working in the areas of poverty alleviation, family support and food to extend FSM eligibility to all children whose families are in receipt of Universal Credit and/or to move to universal provision at primary and secondary level^(98,99) .

Ahead of universal provision being introduced for the youngest primary school-aged children, pilots were carried out in Scotland and England. Evaluations of these pilots reported the perceived financial benefit of FSM for families and increases in attainment in England^{(Reference Kitchen, Tanner and Brown125–Reference Rahim, Kotecha and Callanan127)}. They also indicated that universal FSM had reduced barriers, including stigma, and increased uptake for children who were eligible to receive FSM under the means-tested system^{(Reference Holford128)}. The impact on food insecurity was not addressed in the pilots, or directly in the evaluations of the policies’ rollouts in both countries. Evaluations of the fully implemented policy in Scotland show that there has been no impact on attendance or behaviour^{(Reference Borbely, Gehrsitz and McIntyre129)}, however, parents perceived a financial benefit^{(Reference Ford, Eadie and Stead130)}. Positive outcomes observed in England include increased take-up in previously eligible FSM children, reduction in absence inequalities between children from higher and lower income backgrounds, reductions in obesity, financial benefits for families, and perceived improved readiness for learning^{(Reference Holford and Rabe131,Reference Sellen, Huda and Gibson132)} . Evidence suggests that the policies in both England and Scotland have lowered the consumption of crisps, total fat and sodium with the biggest impacts seen in children from families on low incomes^{(Reference Parnham, Chang and Millett133)}. These studies focus on relatively short-term outcomes given the recent implementation of these policies, however, a forecasting study examining the cost-benefits of universal provision for all children were such that for every £1 invested between 2025 and 2045, a return of £1·71 could be expected, with the potential for wider net benefits of £58 billion to the wider economy⁽¹³⁴⁾. There is some evidence from Wales that children at higher risk from food insecurity are more likely to take-up a breakfast offering and are less likely to skip breakfast under the universal scheme^{(Reference Moore, Murphy and Chaplin135)}. The findings of the evaluations of UFSM suggest that families facing food insecurity are likely to be benefitting from its implementation, however, it is challenging in the short term to assess whether they have reduced or mitigated food insecurity within the context of wider societal issues.

Beyond the UK, and as other areas, particularly within the United States, have introduced universal or have extended existing provision, more evidence of the impact on outcomes has been produced. These benefits include increased fruit and vegetable consumption, improvements in diet quality, improvements in educational difficulties and academic performance, financial benefits for families, reduced obesity risk, reduced health inequalities and reduced food insecurity risk^{(Reference Cohen, Hecht and McLoughlin136–Reference Vik, Van Lippevelde and Øverby140)}. Holley & Mason^{(Reference Holley and Mason137)} have flagged some of the limitations of these studies, including sample sizes being relatively small in experimental studies, along with incomplete outcome measures, lack of consistency across cohort studies in terms of addressing representativeness, and limited input from children in qualitative evaluations. An additional limitation is that measured outcomes are, as yet, relatively short term, and more time is needed to fully measure the impact of UFSM, particularly on improving health in childhood and beyond.

FSM provision has focused on children in early years or primary school rather than young people attending secondary education. Organisations such as the Scottish Trades Union Congress⁽¹⁴¹⁾ have campaigned for the Scottish Government to extend universal provision to secondary school pupils in light of the cost-of-living crisis and rising food insecurity. A study carried out by Chambers et al. ^{(Reference Chambers, Dundas and Torsney110)} found that where more young people were eating a school meal, take-up amongst those registered for a FSM was higher. In addition, where the proportion of young people registered for a FSM were higher, take-up was also higher among those young people. Interestingly this study indicated that levels of school modernisation did not seem to be associated with take-up, highlighting the importance of social connections for older children in relation to food consumption in schools. Pilots of UFSM at secondary level have run in some limited areas. In Hammersmith and Fulham, a London borough, two secondary schools offered universal FSM as a pilot in 2019. Key findings from evaluation are that uptake increased in young people previously eligible under the means-tested system, teachers reported improved behaviour and increased readiness to learn in the afternoon, and stakeholders perceived that food insecurity had been reduced^{(Reference Jessiman, Carlisle and Breheny142)}. The Food provision, culture and environment in secondary schools (FUEL) study, currently underway in England, led by the University of Birmingham and funded by the National Institute for Health Research (NIHR), is examining whether School Food Standards improve secondary school pupils’ dietary intake^{(Reference Murphy, Pallan and Lancashire143)}. Work more specifically aimed at answering questions around food insecurity is underway through the Free School Meals, Diet Quality and Food Insecurity in Secondary School Pupils Mixed Methods Study (CANTEEN) also funded by NIHR and led by Queen’s University Belfast. The study is examining the role of FSM in addressing food insecurity and diet quality in secondary school pupils (https://fundingawards.nihr.ac.uk/award/NIHR151295). The mixed methods study aims to evaluate the effectiveness and cost-effectiveness of FSM in UK secondary schools on nutritional quality and food insecurity. It will evaluate the association between school-level FSM uptake/individual level uptake on these key outcomes, with economic and process evaluations also undertaken. The findings of these studies will contribute to an up-to-date understanding of the effectiveness of FSM policy in addressing food insecurity and dietary quality.

Out of school food

With the introduction of austerity measures following the global financial crash, concerns were raised about the risk of food insecurity among children during school holidays. This was described as ‘Holiday Hunger’. An All-Party Parliamentary Inquiry into Hunger was chaired by Labour MP Frank Field, whose report highlighted that school holidays were putting 3 million children at risk of hunger⁽²⁷⁾. The issue was put under the spotlight even more by the school closures resulting from the Covid-19 pandemic. Provision of free school meals during this time came under substantial scrutiny as families shared photographs of woefully inadequate deliveries of food for children to eat over the week for lunch. Manchester United footballer Marcus Rashford galvanised a campaign to address inadequate food provision during this time, putting pressure on government to not only improve provision, but also to commit to providing food over the school holidays to families most in need^{(Reference Sinha, Lee and Bennett144)}. When the UK Government rolled out a voucher scheme for children in England in receipt of FSM, many families were unable to access the electronic system⁽⁹⁴⁾ or struggled with digital literacy^{(Reference Lalli145)}. It is estimated that almost half of eligible children did not receive any form of FSM during the Covid-19 lockdown^{(Reference Parnham, Laverty and Majeed146)}. The UK Government announced that the voucher scheme would stop during the school summer holidays of 2020. A legal challenge was mounted by the Non-Governmental Organisation, Sustain, and the Good Law Project to challenge this decision. The UK Government reneged and therefore never took the opportunity to clarify Government responsibility for food provision in court^{(Reference Parnham, Laverty and Majeed146)}.

The policy response to these concerns, and others around nutritional intake, physical inactivity, and social isolation, has been to introduce means through which families can access food, either through vouchers/direct payments or through holiday programmes that provide food. In England, the Holiday Activities and Food Programme rolled out from 2018 to 2025. Although annual evaluations of the programme have been carried out, the impact on food insecurity has not been measured, as this is considered a possible additional impact, and is not one of the main outcomes identified in the programme’s logic model^{(Reference Cox, Campbell-Jack and Blades147)}. Instead, the focus has been on nutrition, healthy behaviours and educational outcomes. This highlights that food insecurity among CYP’s has tended to be a secondary focus of programmes that might mitigate its impact.

Evaluations of the impact of food provision during holidays on food insecurity have been limited, but there is some evidence to suggest programmes can make a difference. These studies suggest positive impacts, but they have been small in scale. A pilot study^{(Reference Long, Stretesky and Graham25)} surveying parents found that 42 % of children participating in a holiday club in the UK were from insecure households, with 24 % reporting food insecurity with hunger. The results indicated that food insecure households reported benefiting most from the club in terms of it improving their ability to access food during school holidays. Holley & Mason^{(Reference Holley, Mason and Haycraft148)} report similar findings from research with both holiday programme staff and attendees. In a qualitative study, participants identified that the programme had provided not only social and financial benefits, but also had improved nutrition and attenuated hunger. Much more work is required to understand the extent to which holiday programmes can address food insecurity, or whether programmes that provide families with transfers of money are more effective.