Outside/inside: social determinants of mental health.

Individuals' mental health and wellbeing are dependent on many social factors including housing, employment, education and adequate nutrition among others. These factors can influence at personal, family and community levels. The interlinked and cumulative impact of these social determinants needs to be ascertained to aid appropriate patient management, as well as to establish prevention and health education programmes. Some of these determinants also have to be recognised at policy level. It is crucial for clinicians to understand the role social determinants play in the genesis and perpetuation of mental and physical illnesses, so that appropriate social interventions can be set in place. Clinicians have a role to play in their clinical practice, as well as advocates for their patients and policy leaders. In order to ensure that health is joined up with other sectors, such as education, employment, judiciary and housing, policy-makers must avoid silos. Every policy must have an impact assessment on physical health and mental health. Policy-makers need to understand scientific evidence and must work with researchers, clinicians, communities and patients to help develop and implement rights-based policies.

Investigating the prevalence and predictors of food insecurity: a comparison of HFSSM and EU-SILC indicators

Purpose>Data from the Northern Ireland (NI) Health Survey 2014/15 (n = 2,231) were statistically analysed to examine the prevalence of food insecurity according to both indicators. Pearson's X2 test for association and logistic regressions were used to examine associations between food security status and predictor variables.Design/methodology/approach>Household food insecurity has been identified as a significant societal issue in both developed and developing nations, but there exists no universal indicator to approximate its prevalence. In NI, two indicators (United States Household Food Security Survey Module [HFSSM] and the European Union Statistics on Income and Living Conditions [EU-SILC] food deprivation questions) have been used. This study examines how both indicators differ in their classification of food insecurity prevalence in a population sample and also examines the relationship between various demographic and household factors and food security status.Findings>According to the EU-SILC food deprivation questions, 8.3% (n = 185) were indicated to be food insecure, while according to the HFSSM, 6.5% (n = 146) were indicated to be food insecure. The HFSSM and EU-SILC regression models differed in the underlying variables they identified as significant predictors of food insecurity. Significant variables common to both modules were tenure, employment status, health status, anxiety/depression and receipt of benefits.Originality/value>Findings can inform policy action with regards to targeting the key contributors and can inform policy decisions in NI and elsewhere with regards to choosing the most appropriate food insecurity indicator.

The Economic Perspective of Food Poverty and (In)security: An Analytical Approach to Measuring and Estimation in Italy.

The UN Sustainable Development Goals have set clear targets on global poverty, hunger and malnutrition to be achieved by 2030, which have prompted academics and policymakers to identify useful strategies and drivers. Moreover, the COVID19 pandemic has exacerbated inequalities at national and sub-national levels thus hampering the achievement of these goals. On considering the multifaceted nature of poverty, a recent research strand focuses on food poverty and insecurity issues in terms of economic access to food and healthy diet consumption, with moderate and extreme food insecurity affecting almost 9% of the population in Europe and North America. This paper aims to analyse food poverty and insecurity at regional level in Italy. Using micro-data from the Italian Household Budget Survey carried out by ISTAT, an analytical approach was proposed to define and measure the different degree of food poverty and insecurity. Moreover, to obtain insights into whether food poverty and insecurity can afford population healthy nutrition, inequality of the distributions of food expenditure categories are estimated. The results provided us with information on other important aspects of the poverty. Indeed, in Italy individuals who are at-risk-of-food-poverty or food insecure amount to 22.3% of the entire population. Furthermore, the at-risk-of-food-poverty-rate varies at regional level from 14.6% (Umbria) to 29.6% (Abruzzo), with high levels of food consumption inequalities observed above all for vegetables, meat and fish. All these issues could help policy makers to define economic intervention policies aimed at reducing social exclusion and achieving more equitable and sustainable living conditions for the entire population.

"The reality is that on Universal Credit I cannot provide the recommended amount of fresh fruit and vegetables per day for my children": Moving from a behavioural to a systemic understanding of food practices [version 1; peer review: 2 approved].

Background: Evidence suggests that people living in poverty often experience inadequate nutrition with short and long-term health consequences. Whilst the diets of low-income households have been subject to scrutiny, there is limited evidence in the UK on the diet quality and food practices of households reporting food insecurity and food bank use. We explore lived experiences of food insecurity and underlying drivers of diet quality among low-income families, drawing upon two years of participatory research with families of primary school age children. Methods: We report on a mixed-methods study of the relationship between low income, food bank use, food practices and consumption from a survey of 612 participants, including 136 free text responses and four focus groups with 22 participants. The research followed a parallel mixed-methods design: qualitative and quantitative data were collected separately, although both were informed by participatory work. Quantitative data were analysed using binary and multinomial logistic regression modelling; qualitative data were analysed thematically. Results: Lower income households and those living with food insecurity struggle to afford a level of fruit and vegetable consumption that approaches public health guidance for maintaining a healthy diet, despite high awareness of the constituents of a healthy diet. Participants used multiple strategies to ensure as much fruit, vegetable and protein consumption as possible within financial constraints. The quantitative data suggested a relationship between higher processed food consumption and having used a food bank, independent of income and food security status. Conclusions: The findings suggest that individualised, behavioural accounts of food practices on a low-income misrepresent the reality for people living with poverty. Behavioural or educational interventions are therefore likely to be less effective in tackling food insecurity and poor nutrition among people on a low income; policies focusing on structural drivers, including poverty and geographical access to food, are needed.

COVID-19 pandemic and food poverty conversations: Social network analysis of Twitter data.

This novel and mixed-method study investigated food poverty conversations at the beginning of the COVID-19 pandemic and the subsequent national lockdown on the social media platform Twitter. NodeXL Pro software was used to collect tweets using the terms 'food' and 'poverty' in any order somewhere in a tweet sent on selected days between April 5 and May 23, 2020. The data obtained from NodeXL Pro were cleaned. Social network analysis tools were used to analyse and visualise our data. Using this method, sentiment-related words (positive or negative words), the top (the most mentioned) 10 hashtags, top words and top word pairs were identified. The patterns of word pairs communicated in our network were visualised based on each word pair's frequency. This also enabled us to carry out a content analysis to create coding of the word pairs' data. A total of 81 249 tweets were identified that contained the terms 'food' and 'poverty'. Our findings revealed that individuals' tweets overwhelmingly contained views about the increase in hunger, food poverty and food insecurity due to the COVID-19 pandemic. Twitter users perceived that when the pandemic measures began, many food-secure families were pushed into food insecurity due to a rapid rise in unemployment and rising poverty due to the quarantine and stay-at-home instructions in place at the time. They also addressed the sharp rise in food poverty being driven by panic buying, food shortages, food affordability and disruptions in food supply and food systems. Our analysis of this data suggests that to mitigate food poverty or to prevent a 'hunger pandemic' for future pandemic emergencies, comprehensive and longer term policy responses and economic supports are needed to strengthen the resilience of food systems. However, the highlighted limitations of this study must be considered.

What Family Circumstances, During COVID-19, Impact on Parental Mental Health in an Inner City Community in London?

The introduction of lockdown due to a public health emergency in March 2020 marked the beginning of substantial changes to daily life for all families with young children. Here we report the experience of families from London Borough of Tower Hamlets with high rates of poverty and ethnic and linguistic diversity. This inner city community, like communities worldwide, has experienced a reduction or closure in access to education, support services, and in some cases, a change in or loss of income, job, and food security. Using quantitative survey items (N = 992), we examined what differences in family circumstances, for mothers and fathers of young children aged 0-5 living in Tower Hamlets, during March 2020 to November 2020, were associated with their mental health status. We measure parental mental health using symptoms of depression (self-report: Patient Health Questionnaire depression scale: PHQ-8), symptoms of anxiety levels (self-report: General Anxiety Disorder: GAD-7), and perceptions of direct loneliness. We find parental mental health difficulties are associated with low material assets (financial security, food security, and children having access to outside space), familial assets (parents time for themselves and parent status: lone vs. cohabiting), and community assets (receiving support from friends and family outside the household). South Asian parents and fathers across ethnicities were significantly more likely to experience mental health difficulties, once all other predictors were accounted for. These contributing factors should be considered for future pandemics, where restrictions on people's lives are put in place, and speak to the importance of reducing financial insecurity and food insecurity as a means of improving the mental health of parents.

Assessing Food Poverty, Vulnerability and Food Consumption Inequality in the Context of COVID-19: A Case of Bangladesh.

There is no denying the fact that, for a developing country like Bangladesh, the economic consequences of lockdown for containing COVID-19 pandemic can be far reaching affecting livelihoods of millions of households. Given that the share of food consumption expenditure to total expenditure is higher in the lower income groups of Bangladesh, this shock is expected to directly affect affordability of consumption of basic food items of these households. Using nationally representative household survey data of Bangladesh, and while following the Feasible Generalized Least Square method, this paper attempts to examine food poverty, food consumption inequality along with vulnerability to food poverty of households and explores the importance of different socio-demographic and environmental factors in this connection. Our estimation reflects that, greater percentage of households with young children or with elderly people are found to suffer high food vulnerability. In addition, households in environmentally endangered regions e.g. drought prone areas or river erosion affected places are more food vulnerable than those in other parts of the country. Certain occupation groups e.g. day labourer and self-employed are found to be highly vulnerable to food poverty while according to our decomposition analysis of food consumption inequality, area of residence (urban vs. rural) is expected to cause sizable inequality in food consumption. This study can therefore, help in identifying food vulnerable households for government's social protection programs and COVID-19 incentive packages, and thereby can contribute towards designing effective poverty reduction strategies.

Feeding the food insecure in Britain: learning from the 2020 COVID-19 crisis.

The lockdown in Britain has rendered a large proportion of the population economically vulnerable and has at least quadrupled demand for emergency food relief. This paper looks critically at response to the crisis from the government and the voluntary sector with respect to provision of emergency food. In doing so, it has exposed gaps in understanding of the vagaries of the food supply for certain population groups and systemic weaknesses in the current system of emergency food aid. We make recommendations for healthier governmental capacity to react to a food security crisis, better relationships between the government and the voluntary sector, and further research into the dietary constraints of the precariate. Importantly, the social system needs to be responsive to short-term changes in people's income if people are not to fall into food insecurity.