Food projects in London: Lessons for policy and practice - A hidden sector and the need for 'more unhealthy puddings ... sometimes'

Background and Objective: Successive governments have promoted local action to address food components of public health. This article presents findings from research commissioned by the (then) London NHS Office, scoping the range of food projects in the London area, and the potential challenges to public health practice. Methods: Research followed four overlapping phases with a London focus: (1) a systemized review of the literature, (2) analysis of health authority Health Improvement Plans (HImPs) and Coronary Heart Disease (CHD) local implementation plans and Health Action Zone reports, (3) a scoping exercise of`food projects' and community-based participatory projects with a food focus using food databases and directories, and (4) 29 in-depth interviews with individuals responsible for commissioning and running projects. Results: There were, in 2001/2, a variety of food projects in the London area, ranging from small-scale social enterprises to those whose turnover marked them out as small businesses. There was a significant human resource cost in maintaining and setting up such projects both from NHS staff and in terms of volunteer and paid labour. The lack of an overall or area-based approach to food policy development in London was apparent, and little thought seemed to have been given to creating a supportive policy environment. Food projects often existed as isolated entities in a borough or health authority area, with short-term funding and little systemic long-term support. The majority employed what might best be called health education approaches. This is now partially addressed by the draft London Food Strategy. Conclusions: Food projects run by local professionals and/or volunteers operated within an isolated policy and suffered from a lack of support both from financial and human resources perspectives. The potential for long-term delivery of improved health was unrealized, as was their potential contribution to a London-wide food economy and to London food policy

A tale of two localities: Healthy Eating on a restricted income

Objective: To determine the availability and affordability of a healthy food basket and to model how those on low-incomes might manage. Design and methodology: After determining access and availability of key items from shops in two localities, called Deepdale and Ingol, a healthy food basket was developed. From this a week’s healthy menu was devised for a mother and two children, then availability of the ingredients was checked using data collected from the shops and costed. The baskets represented the cultural preferences of White British and South Asian families informed by participatory work with both these groups. We chose the income level for a family entitled to income support and child allowance. Results: Analysis of the availability of some healthy options such as brown bread, wholemeal pasta, and brown rice showed they were not widely available within shops in the two areas. The price of the ‘White British’ basket in the area of Ingol was £70.61 (lowest price). For comparable goods in the area of Deepdale, using the most expensive shopping basket, the price for the same basket was £42.47. A South Asian family shopping at a major supermarket outlet in Deepdale would pay £47.05. Using local shops they could pay between £38.59 and £44.28 by seeking out the best bargains in five shops (including some top-up items from a national supermarket). At the time of the research a mother with two children entitled to income support and child allowance would have to spend 28–32 per cent of her income in local shops and 34 per cent in a supermarket to buy a basket of healthy goods. This compared to the national average of 10–12 per cent of income being spent on food purchases. Conclusions: Prices varied enormously between the two areas. Local shops in one area offered a comparable price to shopping in the supermarkets. The Ingol area, with a large white working class population, was particularly poorly served for those on low incomes and the range of choices restricted. The percentages spent on food to meet the requirements of our healthy baskets and menus show that more than the national average – in both absolute and relative terms – would have to be spent to eat healthily. For the vulnerable and price dependent poor in Preston this will mean having to spend more on food and possibly more on travel to access basics, a healthy diet will cost more, while proportionally an unhealthy diet, as can be found in fast food outlets, may not be as expensive when other costs such as cooking are taken into account. An overall rise in food prices of 5 per cent will reduce living standards among high-income consumers by approximately 3 per cent; for low-income consumers this reduction in an already poor diet could be as high as 20 per cent. What we have demonstrated is the usefulness of local studies to highlight micro-differences in relatively small areas (Preston city) and the different experiences of groups in accessing healthy foods, and thus the need to refine interventions at a local level

Effectiveness of a social support intervention on infant feeding practices : randomised controlled trial

Background: To assess whether monthly home visits from trained volunteers could improve infant feeding practices at age 12 months, a randomised controlled trial was carried out in two disadvantaged inner city London boroughs. Methods: Women attending baby clinics with their infants (312) were randomised to receive monthly home visits from trained volunteers over a 9-month period (intervention group) or standard professional care only (control group). The primary outcome was vitamin C intakes from fruit. Secondary outcomes included selected macro and micro-nutrients, infant feeding habits, supine length and weight. Data were collected at baseline when infants were aged approximately 10 weeks, and subsequently when the child was 12 and 18 months old. Results: Two-hundred and twelve women (68%) completed the trial. At both follow-up points no significant differences were found between the groups for vitamin C intakes from fruit or other nutrients. At first follow-up, however, infants in the intervention group were significantly less likely to be given goats’ or soya milks, and were more likely to have three solid meals per day. At the second follow-up, intervention group children were significantly less likely to be still using a bottle. At both follow-up points, intervention group children also consumed significantly more specific fruit and vegetables. Conclusions: Home visits from trained volunteers had no significant effect on nutrient intakes but did promote some other recommended infant feeding practices

Greater than the sum of the parts? unpacking ethics of care within a community supported agriculture scheme

Book synopsis: Reconnecting so-called alternative food geographies back to the mainstream food system - especially in light of the discursive and material 'transgressions' currently happening between alternative and conventional food networks, this volume critically interrogates and evaluates what stands for 'food politics' in these spaces of transgression now and in the near future and addresses questions such as: What constitutes 'alternative' food politics specifically and food politics more generally when organic and other 'quality' foods have become mainstreamed? What has been the contribution so far of an 'alternative food movement' and its potential to leverage further progressive change and/or make further inroads into conventional systems? What are the empirical and theoretical bases for understanding the established and growing 'transgressions' between conventional and alternative food networks? Offering a better understanding of the evolving position of the corporate food system vis a vis alternative food networks, this book considers the prospects for economic, social, cultural and material transformations led by an increasingly powerful and legitimated alternative food network

Access to shops: The views of low-income shoppers

Concern is mounting as the retail stranglehold upon access to food grows. Research on the implications of restructuring retailing and health inequality has failed to involve low-income consumers in this debate. This paper reports on an exercise conducted for the UK Government's, Social Exclusion Unit's Policy Action Team on Access to Shops. The survey provides a useful baseline of the views of low-income groups in England. The choices that people on low income can make were found to be dominated by certain factors such as income and, most importantly, transport. Consumers reported varying levels of satisfaction with retail provision. The findings suggest gaps between what people have, what they want and what the planning process does and does not offer them. Better policy and processes are needed to include and represent the interests of low-income groups