Good Food 4 All. Kensington and Chelsea access to food project. Public Health Nutrition Team. December Contact details

Transcription

1 Good Food 4 All Kensington and Chelsea access to food project Public Health Nutrition Team December 2013 Contact details Ali Ginn and Ginny Eastwood Goodfood.4all@clch.nhs.uk 1

2 CONTENTS 1. Background..PAGE 3 2. What we did.. PAGE 4 3. Threeat risk groups. PAGE 5 4. What the community said..... PAGE The cost of healthy food.... PAGE 8 6. Key messages from the healthy food basket PAGE Other issues with accessing a healthy diet.. PAGE Recommendations for action. PAGE 13 Acknowledgements: The Public Health Nutrition team would like to thank those who generously contributed their wealth of knowledge, skills and experience to the project and who spoke passionately about seeing change for those in food poverty. Members of the K&C community who answered surveys and gave their time in focus groups and interviews Martin Caraher, City University methodology and advice from previous Studies The Trussell Trust and The Dalgarno Trust food bank staff and volunteers Claire Palermo, Monash University methodology advice Abigail Davis, Loughborough University minimum income standards, methodology advice Anne Majumdar, London Metropolitan University focus group methodology and analysis Rufus Fearnley, CLCH survey design and collection templates and assistance with HFB tool Dominic Baker, RBKC mapping of the food outlets Sandra Cuningham, Citizens advice bureau survey assistance Stela Chervenkova and Niamh O Sullivan piloting the HFB and collection tool Charlotte Foster, Rachael Luffman, Sarah Awatli, Toni Russell collection and analysis of the HFB Age UK, Open Age, 240 Project, Westway Development Trust assistance with recruiting to focus groups and providing venues. 2

3 BACKGROUND The goal of the Kensington and Chelsea Good Food 4 All project was to measure access to healthy food in the target catchment area of North Kensington and understand barriers faced by vulnerable communities. The public health nutrition team at CLCH works with the community to promote good food and nutrition habits to prevent health problems or complications. We address the social, personal and environmental issues that surround food choice. We undertook the good food 4 all project as part of a service review to ensure our programmes contain the most relevant and helpful messages for our community and that our voluntary sector partnership projects are as effective as they can be. Food poverty can be defined as the inability to afford, or to have access to, foods which make up a healthy diet. Those experiencing food poverty may have limited money for food after paying for other household expenses; live in areas where food choice is restricted by local availability and lack of transport to large supermarkets; or be lacking in the knowledge, skills or cooking equipment necessary to prepare healthy meals. Food poverty occurs after a breakdown somewhere in a complex web of social and environmental problems. This may include poverty, ability to adapt to change, health and mobility, education and the environment (transport, number and type of shops, density of housing). Food poverty in turn can lead to a number of health problems including depression and anxiety, poor oral health, malnutrition (obesity and under nutrition or an imbalance of nutrients), diabetes, cardiovascular diseases and some cancers. Food poverty is not an isolated issue and should not be treated as such. Instead, to reduce the rates of food poverty the factors that cause food poverty, as seen in the list below, must be addressed. poverty and unmanageable debt food poverty. access shop type, transport, assistance, computer skills capacity transparency food prices, access to entitlements, services prevention and early intervention social and health services Outcomes will be - better children s nutrition (leading to school attainment) - less malnutrition and isolation in the elderly - better maternal nutrition - less obesity, better oral health and better long term condition management 3

4 WHAT WE DID Asked our partners: We conducted one to one interviews with our voluntary sector and health service partners to identify key issues with food access and affordability for service users and clients and where interventions should focus. Asked the Community: 102 community members answered paper based surveys on their food and shopping experiences and preferences. 41 community members representing a cross section of the population attended focus groups to discuss their food preferences, budgeting techniques and issues with accessing food. Mapped food availability: we worked with RBKC to map the availability of food across the borough and identify who may have less access to food. Investigated food prices: we collected a healthy food basket which included enough food to meet nutrient requirements for 7 days for 6 case study RBKC households. Price, availability and quality were all assessed. A final minimum cost as well as recommendations of how to shop was found. 4

5 3 KEY AT RISK GROUPS Key characteristics How they are likely to present Suggested intervention Short term change Long term low incomes Inability to access food Recent change in circumstances food poverty eg job loss, new household member, change in housing, benefits sanctions / delays, sudden illness / injury. Unable to adapt usual food habits in response to the situation At citizens advice or food bank for emergency assistance. High risk of short term hunger. Provide emergency relief and deal with the underlying problem. Once resolved refer to nutrition intervention service chronic low income (often do not expect this to change). Excellent at budgeting and know how to go without. Typically older people. Many single person households Eat an inadequate diet in order to pay the rent and bills Housing or benefits centres, chronic health issues, malnutrition, obesity, tooth decay Increase access to free social activities which include a nutritious meal. Community based nutrition and budgeting programmes (emphasis: improve nutrition on a low budget not how to budget ) Illness, injury or disability and social isolation. Difficultly with public transport. High density of take away food Difficulty leaving the house eg inadequate equipment / support to take children out, physical ability and fatigue, mental health disability. Food access issues are independent of financial situation At health and social services for non food related issues: health visiting and midwifery, disability services, older people services, health centres, GP s Support internet access and IT skills Community transport to facilitate access to markets Identify food access issues in home visit assessments Food access advice and service sign posting within existing programmes and activities 5

6 WHAT THE COMMUNITY SAID Household weekly spend on food Respondents reported weekly household spend on food by weekly household income. (N = 94) 100% Percentage of each income group 80% 60% 40% 20% 0% Less than More than weekly household income % of responding households spend over 70 per week on food. This is likely to reduce means to buy other essentials and indicates a need for food budgeting advice. Equally concerning, is that many low income households spend less than 30 per week on food and are unlikely to meet a nutritionally adequate diet on this budget. Increased reliance on Food banks In the past 12 months the Trussell Trust food bank in RBKC has seen 515 people (398 adults, 117 children). In May November 2013 the Dalgarno food bank has seen 196 people. Both food banks had similar clientele and referral reasons: Main reason for attendance was benefit delays followed by benefit changes Increasing numbers of working adults needing help. Benefit sanctions are a major issue and are becoming more frequent More than Less than 30 Both food banks refer clients to other services to treat underlying issues Few reports of people skipping meals (food bank conversations focus on underlying problems and solutions, not symptoms.) Trussell Trust currently has good supply of food. Dalgarno has adequate fresh food supply to meet current demand. Need for funding for storage. Fruit and vegetable consumption in low income households Frequency of households eating fruit and vegetables every week in all households (outer circle) and households earning < 100 per week (inner circle) (n=102). 19% 32% 68% 81% Eating Fruit and Vegetables Not Eating Fruit and Vegetables 81% of respondents ate fruit and vegetables every week. When broken down by income only 68% of respondents with a household income of less than 100 per week (low income households) reported eating fruit and vegetables every week. RBKC Food bank key workers case studies relating to sanctions Man presents to food bank: Had no money for bus so had to walk to and from hospital for outpatient appointment and was one hour late to job centre appointment. Outcome: Sanctioned 4 months Mother presents to food bank: Child was ill and had to be picked up from school. There was no one else to pick her up, so mother phoned to cancel job centre appointment. Outcome: sanctioned 2 weeks Man presents to food bank: Missed a job centre appointment to attend a friend s funeral. He phoned job centre after the funeral Outcome: Sanctioned 2-5 weeks 6

7 How price influences food choice The cost of food is seen as a combination of: The price of the product The price. And also the quality and how long it lasts. The quality Participant 1 Focus Group 5 The shelf life. Of the 102 survey respondents 49% indicated they do not have enough money to buy a range of foods each week 70% reported that healthy foods are expensive Most respondents (82%) reported that they really care what they eat. I think if it wasn t there, I go to the next shop because they ve got it Participant 7 Focus Group 3 These survey answers were also reflected in focus group discussions. Skills required for comparing the prices are essential It was highlighted in several focus groups that there are some essential skills needed by shoppers to identify the best value product Metric and imperial conversion Since I moved here it s been about 8-9months. [ ] As I m trying to figure out 1: the difference in the type of foods, and the variety and the labels. And then 2: to calculate in kilos or pounds. Pounds per kilo whereas it s dollars per pound. So you see the whole thing, shopping for meat I don t even know how much to ask them for. I m like, I want half a pound they re thinking half a pound is money. Not half a pound in weight. Participant 5 Focus Group 5 Converting to price per unit I think that s one of the hard things. For me it s doing the calculation in my head as to what s a good deal. I struggle sometimes. Participant 4 Focus Group 5 Comparing final price When I m doing shopping on the market I m putting in my fruit and I m always surprised at the end how much is the price. Yeah like I bought a few apples like normally 1 s worth and they re telling me 3! I m like where are you getting this from? Participant 4 Focus Group 5 We read all these statistics, but the fact still remains that it s not what people are eating, it s what they can actually afford to actually buy. Participant 2 Focus Group 5 And mainly if I m feeling a bit peckish, I don t eat it all the time, probably McDonalds or Burger King if they have special offers or sometimes you can find special offers in the newspaper. Participant 1 Focus Group 5 You go into a shop and pay half the price more just for convenience. Though I can t afford it, but yeah. Participant 2 Focus group 5 Food purchases are unplanned There was a general (although not universal) lack of planning food purchases expressed by focus group participants and survey respondents. Most people do food shopping every one or two days When asked about planning many people referred to what they feel like Focus group participants often referred to what they had for that day, how they would decide on the next meal and did not communicate any planning to save so they could invest in healthier options. Shopping around is seen as time consuming and physically tiring This is likely to lead to: Impulse purchasing Buying bulk deals and not using them Unplanned meals which are likely to cost more Reliance on convenience stores which generally stock less variety 7

8 THE COST OF HEALTHY FOOD The healthy food basket survey was conducted in North Kensington and involved checking quality, price and availability of foods in: 22 local speciality stores 6 small supermarkets 5 large supermarkets 3 local markets (Portobello Road, North End Road, Shepherds Bush) The healthy food basket included enough food for 7 days for each of six case study families, living in a variety of areas in North Kensington. Food selection was based on food eaten by focus group participants, and adjusted to make a nutritionally adequate diet. The total cost to each household was calculated and their disposable income after food was estimated. Results are summarised below The cost of a 7 day healthy food basket for case study families living in RBKC Household type Cost of cheapest basket in walkable neighbourhood Single parent white British family (Golborne) Case study household income Single parent Moroccan family (Golborne) Case study household income Couple with 2 children, white British family (Coleville) Case study household income Pension couple, white British (St Charles) Case study household income Single male pension, Caribbean (St Charles) Case study household income Single male pension, white British (Norland) Case study household income Cost of cheapest basket in closest large supermarket Online Cost of cheapest basket if household has ability to travel Groceries online Fruit & Vegetables Market Meat & Fish supermarket TOTAL Note: Halal meat unavailable in this area. Substituted for price non Halal item Groceries online Fruit & Vegetables Market Meat & Fish supermarket TOTAL Groceries online Fruit & Vegetables Market Meat & Fish supermarket TOTAL Note: Not all fruit and veg available, substituted for alternative Note: Not all fruit and veg available, substituted for alternative Note: Most meat unavailable so price from Shepherds Bush area included Groceries online Fruit & Vegetables Market Meat & Fish supermarket TOTAL Groceries online Fruit & Vegetables Markets 9.32 Meat & Fish supermarket 8.24 TOTAL Groceries Online Fruit & Vegetables Markets 6.13 Meat & Fish supermarket 6.03 TOTAL Disposable Income after food

9 KEY MESSAGES FROM THE HEALTHY FOOD BASKET The healthy food basket survey revealed some trends in availability and pricing across store types and areas. These trends were used to form key messages and tips for food budgeting, which will be incorporated into future training, food budgeting support and food budgeting resources. Shop Local for fruit and vegetables Fruit and vegetable prices in markets and local green grocers were often half that of the same product in a supermarket. Prices were variable and there was no one store or store type that was cheapest for every fruit and vegetable item. The quality at all store types was generally found to be good. How to save - Try fruit and vegetable shopping at the local markets - Try all markets. Various households will see better savings at different markets depending on main fruit and vegetable purchases - For vegetables; herbs and spices, garlic, carrots, onion and salad vegetables varied most in price. Shop around for these products. - For fruit; grapes, bananas, and apples saw a 5 to 11 fold difference in price. Shop around for these products. - Use canned and frozen fruit and vegetables in cooking canned and frozen fruit and vegetables contain fibre and vitamins and minerals and are much cheaper than fresh. - Consider shopping with neighbours or friends many deals at the market become even cheaper when purchased in larger amounts. Stock up on store cupboard essentials It was found that long life, refrigerated and frozen grocery items were generally cheapest online when purchased all in one go. However, there were some bargains seen at discount stores and in some large supermarkets for specific items or larger purchases. How to save - Plan in advance!! - Starchy foods are cheapest; include more pasta, couscous, rice, flour, bread, pita bread. - Rice, pasta and couscous are cheaper than potato, sweet potato, cassava, yam try to include these more often. *note: speak to a dietitian for tailored advice about budget foods for managing special diets when concerned about weight, diabetes or other medical conditions. - Have store cupboard and freezer well stocked with cheap foods and check the expiry before purchasing - Consider online shopping for long life products every two weeks or once a month, to reach minimum spend to waive delivery charge. - Factor in delivery charge each online store has a unique pricing index for delivery. Try my to find best deal for household. - Pool with neighbours or friends to reduce delivery charges. - Try discount stores (one pound shops, budget shops, whole sale speciality food stores) for store cupboard items. But check the packet size it is often different to mainstream supermarkets. - Long life products are the best items to buy in bulk or on offer. Avoid upsizing or offers for perishables unless pre-planned to be used within a short time. 9

10 Limit meat and fish and choose alternatives Meat and fish were most expensive items in the basket. When purchased all in one store they were cheapest in a large supermarket (note; other large supermarkets were the most expensive). Individual items were sometimes cheaper at market fish mongers, local halal butchers and other butchers. Households that have the ability to travel are encouraged to shop around. How to save - Plan meals and try to vegetarian alternatives every week eg egg, lentils, chickpeas, cheese, tofu, falafel. - Have smaller portions of meat - Try the deli counter at the supermarket or local butcher to get the exact amount needed - Try cheaper types of fish and frozen fish (check for frozen 100% fish) - Check the halal section of the supermarket or try a halal butcher for cheaper meats. General tips from the healthy food basket - Plan meals in advance - Keep your receipts and review them to help with budgeting - Shop around when possible - Talk to neighbours and friends about best deals - Try and shop on the way to and from other activities to save on bus fares or fuel - Convenience foods generally cost more - Tinned and frozen alternatives will help reduce the budget - Think twice before buying a special offer 10

11 OTHER ISSUES WITH ACCESSING A HEALTHY DIET Availability and affordability of less nutritious foods In many cases the unprocessed foods were found to be cheaper than foods that were processed and had added salt, sugar and fat. However, when compared with fruit, many sugary or salty snacks were cheaper. The table below indicates how many of each snack item could be purchased for 1. More chocolate bars or crisps could be purchased than could oranges. 1 worth of six foods collected in the healthy food basket Loose orange 2 finger kit kat(in an 8 pack) 25g crisps (in a 6 pack) 36p each 13p each 22p each 2.8 for for for 1 Difficult price labelling Per unit pricing was not found to be standard. Comparing the price between a large and small supermarkets is very difficult as is comparing prices at the markets. The table below demonstrates the many different prices for vegetables at one market (other markets also had difficult pricing). Some items were not priced at all and customers had to ask the stall holder. Convenience and discount stores generally had better pricing labels. Examples of variations in pricing at one market place. 1 bowls 50p / lb and 3 lb / / kg ( 1 / lb) 1.20 each 11

12 The local environment Some neighbourhoods surveyed in the healthy food basket had a wide variety of stores and access to transport. The healthy food basket was cheaper in these areas and it was found there was more choice and alternatives available on the rare occasions when quality was inferior. Depending on the type of large supermarket available in a local area the total price of the healthy food basket fluctuated greatly. It is recommended that residents in these areas think about travelling further to save money, as even after factoring in the cost of travel there are significant savings at shops within a 30 minute journey. The two areas with highest expense and lowest availability of the full healthy food basket were: Personal ability to access food There are also personal circumstances which impact on a person s ability to shop, including mobility, knowledge of the area and mental wellbeing. Focus group participants had strategies for overcoming barriers to accessing a range of shops and having a range of foods to eat. It is acknowledged however, that those most at risk of food access issues, are unlikely to attend a focus group. Community malnutrition risk assessments for older people should consider their access to food and ability to prepare food and incorporate it into the planned a care pathway. Co-operatives and pooling of resources or sharing shopping may help some at risk people to access a better diet. Dalgarno, in St Charles St James, in Norland This is important as both of these areas have a relatively high number of older residents. Improved public transport, more local stores and community assistance to access stores further away and online shopping would assist people in these areas to save money 12

13 RECOMMENDATIONS FOR ACTION Work with local markets and shop owners to improve transparency of pricing Use technology to help shoppers compare prices investigate development of a price comparison smart phone app Community transport should encourage community members to use the markets and consider collaborating to shop online Include food budgeting messages within community based assistance programmes Develop and deliver volunteer training to become food champions to communicate food budgeting messages within their usual voluntary roles Voluntary sector and statutory sectors to improve communication of services available to help people out of food poverty Promote use of healthy start vouchers for eligible families and work with market trading to accept vouchers at markets Communicate to relevant departments the impact sanctions and benefits delays are having on people at risk of food poverty and work collaboratively to review sanctions and delays 13