PUBLIC HEALTH AND COMMUNITY STUDIES

Introduction

Research methodology is the science of organised investigation of the methods used in the study (Clough and Nutbrown 2012). The methodologies aim to explain the use of the right approaches at finding credible answers to the research questions (Creswell and Creswell 2018). The research approaches are the quantitative, qualitative and mixed method research approach.

2.1a Quantitative

Quantitative research is a systematic approach that investigates objective theories using numerical data in examining the relationship of variables (Bell and Waters 2018). The goal of this approach is to find out the truth in a scientific method as it associates with postpositivist paradigm (Wisker 2019). Postpositivist regards the ontological assumption of ‘naïve realism’ which means that there is only one reality or truth that is measurable and known (Creswell and Creswell 2018). The epistemological assumption underpinning

quantitative research is that truth can be measured through scientific technique using reliable and effective method (Creswell and Creswell 2018).

Approaches used in quantitative research are experimental, quasi experimental and non experimental designs such as surveys (Creswell and Creswell 2018). Predetermined and instrument based questions are utilised as well as closed ended questions and numeric data (Greetham 2014). Data is collected statistically and gathered mainly through questionnaires, observations, tests and experiments (Davies and Hughes 2014). Sampling is done using either probability or nonprobability sampling. Probability sampling types are stratified, systematic, cluster, or simple random sampling which are generalisable, contrary to nonprobability sampling which can be bias (Greetham 2014). The sample size is large to ensure that the population is well represented which increase the chance of obtaining a statistically substantial conclusion (Greetham 2014). However, large scale research can be limited by time or inadequate resource (Greetham 2014). Statistical analysis is used in analysing the quantitative data (Creswell and Creswell 2018). Data is analysed through descriptive statistics where central variables are described by statistical measures such as median, mean, standard deviation and variance (Creswell and Creswell 2018). It can also be analysed through inferential statistics where the relationship of two variables are tested (Creswell and Creswell 2018).

Quantitative research is reliable and generalisable as data is collected rigorously and results are replicable when research is repeated by another researcher under the same situation (Wisker 2019). Although findings of quantitative approach are more objective and generalised to a large scale population, it is argued that it is dependent on chosen methods and does not take into consideration human feelings and thoughts (Creswell and Creswell 2018).

2.1b Qualitative

Qualitative research approach explores and understands insights of individuals such as opinion, feelings and behavioural patterns (McMillan and Weyers 2011). It is generally exploratory in nature and aims to understand the complex reason for human behaviour (Creswell and Creswell 2018). The paradigm of qualitative research is mostly constructivism (Kawulich 2012). Contradictory to postpositivism, constructivism postulates the ontological assumption of numerous socially constructed realities (Creswell and Creswell 2018). Constructivist epistemological assumption suggests that knowledge is subjective, and that reality depends on human experiences (Creswell and Creswell 2018).

Five main approaches in qualitative research are ethnography, grounded theory, phenomenology, narrative inquiry and case study (Bell and Waters 2018). It is descriptive in design and uses open ended questions through emerging method (Bell and Waters 2018). However, questions that lead or restrict the answer should be avoided as it can influence on the integrity of research (McMillan and Weyers 2011). Data is collected by interviews, focus groups, observations and documents. The data analysis is coded and thematic such as text and image analysis (Creswell and Creswell 2018). Qualitative research uses a small scale sample in contradictory to quantitative research (Bell and Waters 2018). Types of sampling method are theoretical, convenience and purposive sampling (Creswell and Creswell 2018). Samples are carefully selected and do not necessarily have to represent the whole population because the value of the research derives from authentic and case specific details that it can encompass (McMillan and Weyers 2011). Data analysis is inductive, that checks between themes and databases, and deductive where it looks back at data from the theme to gather more evidence for the theme (Mason 2018). It is interpreted through themes and patterns (Creswell and Creswell 2018).

One of the strong points of qualitative research is that it can be used to analyse information  that  is  hard  to  quantify such  as  identifying  how people  define

concepts like ‘anxiety’ (McMillan and Weyers 2011). It can also allow researchers to reflect on own experience as part of the process (McMillan and Weyers 2011). Furthermore, it can provide a distinctive understanding of the viewpoints and needs of participants (Greetham 2014). On the other hand, a major criticism of qualitative research is that it may lead to unexpected results or results that are opposite the hypothesis (Greetham 2014). It can also be time consuming and there is a greater risk of the researcher to influence the result (Creswell and Creswell 2018).

2.1 c Mixed Method

Mixed method is the combination of quantitative and qualitative research where methods in data collection, analysis and interpretation of results are integrated (Teddlie and Tashakkori 2009). It follows pragmatism and transformative paradigm (Creswell and Creswell 2018). Pragmatists believe in the ontological assumption that the truth can be explained either objectively or subjectively or combination of both (Creswell and Creswell 2018). The emphasis of this paradigm is on the problem and uses the best method suitable for answering the research question (Creswell and Creswell 2018). Pragmatists underpin the epistemological assumption of finding out the explanation to reality using the most appropriate method irrespective of the viewpoint that method follows (Creswell and Creswell 2018). On the other hand, the transformative paradigm underpins the ontological assumption of multiple realities (Kawulich 2012). It suggests that social reality is constantly changing and is influenced by values of different cultures, society, politics, gender, race, ethnicity and disability (Kawulich 2012). This paradigm’s epistemological assumption emphases empowerment which is particularly focused on underrepresented group and its goal is to advocate change (Creswell and Creswell 2018).

The approaches used in mixed method are convergent, exploratory sequential, explanatory sequential and transformative (Creswell and Creswell 2018). This research uses predetermined and emerging open ended, closed ended and instrumental based questions  (Teddlie and Tashakkori 2009). Data collection

in mixed method depends on the type of approach used as data are collected using both qualitative and quantitative data collection (Teddlie and Tashakkori 2009). The two forms of data collected can be independent of each other when gathered concurrently and can be linked together when gathered sequentially (Aveyard 2019). This balances the weaknesses of one method of data collection with the strength of the other (Aveyard 2019). Sampling method can use both purposive and random sampling depending on the purpose of the research and design used (Creswell and Creswell 2018). Sample size also depends on the purpose and design used in the research (Creswell and Creswell 2018). The quantitative data collection will use a larger sample than qualitative data collection (Greetham 2014). Data is analysed by using all forms of both quantitative and qualitative procedures depending on the purpose of research and design used (Teddlie and Tashakkori 2009). It is interpreted through triangulation where data sets are merged to explain discrepancies or for comparison (Creswell and Creswell 2018).

Mixed method research produces stronger results than using quantitative and qualitative method independently (Creswell and Creswell 2018). It provides a further understanding of study as well as a complete and thorough picture of the research (Teddlie and Tashakkori 2009). Furthermore, it allows researchers to be flexible in elaborating or extending on their findings when one type of research is not enough (Teddlie and Tashakkori 2009). However, it is argued that mixed method research is more time consuming as it needs to go through two different strands of research designs (Creswell and Creswell 2018).

METHODS

This research is based on secondary literature review using a systematic approach (Aveyard 2019). A systematic search and analysis of high quality literature were done to obtain new insights into the research study (Aveyard 2019). Methods for this research is outlined using a modified PRISMA (Preferred Reporting Items for Systematic Reviews and Meta Analyses) to aid on the reporting of the systematic review (Liberati et al. 2009).

2.2 a Eligibility Criteria Inclusion

Literature search was mainly focused on peer reviewed empirical research with dates from 2009 onwards. Discussions began around welfare reform, although links were not yet made in relation to the increase in the usage of food bank which started shortly afterwards. Primary research conducted by main food bank organisations was included as it produces up to date rich data. However, organisation bias can be a limitation. Study population was focused within the United Kingdom as research is specific to this demographic. Participants in the study contain those with food bank users, food bank staff/volunteers, food bank providers and food bank members. Mixture of participants in terms of gender, ethnicity, age, parental and immigration status are also included.

Exclusion

Literature search excludes secondary research and documents. Specific gender, ethnicity, age, parental and immigration status are excluded as research does not focus on a narrow sample group. Study population outside the UK was excluded as the focus of study is specific to UK demographic. Exposure of interest outside food bank, food insecurity, social welfare reform, benefit sanctions are excluded as it does not reflect the context of the research.

Information Sources

Digital sources such as electronic journals were used for literature search. The databases used covered a range of disciplines that conducted research on increased food bank usage and social welfare system reform in the UK. The databases searched included the following:

1. Academic Search Complete AMED Allied and complimentary medicine databases
2. EBSCOhost
3. Family Health Database
4. Health and Medical Collection
5. Health Management Database
6. Locate
7. Medicine
8. ProQuest Nursing and Allied Health Resources
9. PsycINFO
10. PubMed
11. SAGE Premier
12. ScienceDirect
13. Social Care Online

Search Strategy

A thorough search was carried out for peer reviewed, primary, current literature surrounding the topic of the study to ensure that the literature review emphasis do not reproduce any previous work. The term ‘food bank’, ‘food aid’, ‘food parcels’, ‘food insecurity’, ‘food poverty’, ‘poverty’, ‘socioeconomic status’, ‘diet’, ‘nutrition’, ‘nutrition guidelines’, ‘health inequalities’, ‘health outcomes’, health consequence’, social determinants of health’, ‘government policy’, ‘policy’, ‘social support’, ‘benefits’, ‘benefit sanction’, ‘sanction’, ’welfare reform’, ‘social welfare reform’, ‘austerity’, ‘health inequalities’, ‘poverty’ ‘vulnerable’, ‘public health issues’,  and ‘UK’ were entered into databases as part of search

focus. The original search provided supplementary articles relevant to the emphasis of the study.

Synthesis of Results

Purposive sampling was done in selection of ten high quality literature to help in answering the research question. Data were collected from peer reviewed primary research and primary research done by an organisation (Trussell Trust Foodbank Network). A thematic analysis was conducted in synthesis of results. Contents were analysed to provide detailed understanding and identify the strengths and limitations. Themes were then identified from main findings and results of each literature and relevant data was assigned to this. Themes were compared to identify similarities, differences and relationships. Irrelevant themes were reassessed to help answer the research study (Aveyard 2019).

Limitations to Study

A primary limitation in this study is the use of some primary research done by organisation which can influence the result due to organisation bias. Second, the time available to study the research problem and is constrained given that this is an academic research with a deadline for submission. Third, the small number of primary literatures used for secondary research limits the study as it might not reflect the wider picture of the research and it can also affect the exact estimate of food bank usage in UK, therefore the severity of the problem is not fully reflected. Different locations in the UK also have different needs and severity of poverty and some are more affluent than others. Fourth, most data gathered from primary research were generated from one food bank provider (The Trussell Trust). Again, this can influence the extensiveness of the problem and does not include the cases of hidden hunger.

Ethics

Ethics approval for the research study was obtained from Coventry University Research Ethics Committee in compliance to the requirements for the dissertation component of the degree. Please see appendix 1 for the ethics certificate awarded.

  CHAPTER 3  –  LITERATURE REVIEW                                                

This chapter will explore and discuss the key published materials relating to the relationship of current increase in food banks and social welfare reform and the consequences it conveys to the health and wellbeing of individuals. Section 3.1 will show the findings using a table of data summary. Section 3.2 will evaluate the themes which is divided into three categories that will help investigate and identify the gaps within the problem through comparison of findings. Section 3.3 will discuss and analyse the themes and issues found in literature.

 FINDINGS

Data generated were organised into a summary matrix table to acquire logical and statistical results from gathered values. Please see appendix 2 for the attached data summary matrix.

 THEMES

3.2A Correlation of Social Welfare Reform and Current Increased Demand in Food Banks.

More and more individuals rely on food banks as food insecurity has become a public health problem in the UK in recent years. This has been linked to the social welfare reform and sanctions applied by government as a wider approach to austerity (Lambie Mumford 2013, Perry et al 2014, Garrat 2017 and Loopstra et al 2018). Several researchers have investigated on the relationship between the current increase in food bank demand and social welfare reform (Lambie Mumford 2013, Perry et al 2014, Garrat 2017 and Loopstra et al 2018). Studies have shown food bank usage have risen in different places where sanctions were applied to mainstream population (Lambie Mumford 2013, Perry et al 2014, Garrat 2017 and Loopstra et al 2018). It also showed the variations of individuals relying on food bank and how sanctioning affected their situation.

a.   Trends in Food Bank Use

Since 2010, there have been reports of increasing food bank usage in different parts of the UK (Lambie Mumford 2013 and Loopstra et al 2018). Lambie Mumford (2013) reported that the number of foodbanks has increased from 54 in 2010 to 201 after significant spending cuts and reform of social welfare have taken place in 2012. In addition to this, Garratt (2017) described a 29% increase in the number of food bank beneficiaries between 2013 and 2015 from a study conducted using data referrals in West Chesire Foodbank in northwest England. The Trussell Trust Foodbank Network have provided robust statistics on the increase in number of operating food banks as well as the number of beneficiaries since 2004 and trends have shown that the rate of individuals fed by food banks have continually increased in recent years (Loopstra et al 2018). A qualitative study conducted by Loopstra et al (2018) showed that between the first quarter or year 2012 to 2013 and the last quarter of year 2015 to 2016, there was an increase of 254 operating sites of Trussell Trust food banks to 259 more local authorities from the original 114 local authorities. From 18,855 adult users per 100,000 over the period of April to June 2012, the average rate of feeding across local authorities with food banks increased to 52,468 per 100,000 adult users over the period January to March 2014 (Loopstra et al 2018). However, Loopstra et al (2018) posits that although the curvature in the growth of food bank demand continually rose since it was launched and showed evidence of growth in demand of supply of food bank between 2013 to 2014, the demand started to decline in 2015. Nevertheless, it is evident that referrals from Trussell Trust Foodbank Network does not comprise the totality of food bank users all over UK as there are other private food aid providers and charities that provides emergency food (Garratt 2017). Therefore, the number of individuals using food banks is not clearly estimated (Loopstra et al 2018).

b.   Individuals Using Food Banks

The profile of individuals using food banks vary according to age, gender, marital status, social status, and education (Lambie Mumford 2013, Perry et al

2014, Garthwaite et al 2015 and Loopstra et al 2018). Several studies conducted on the rise of food banks in the UK have interviewed and observed lived experiences of diverse set of participants representing the food bank users (Lambi Mumford 2013, Patrick (2014), Perry et al 2014, Garthwaite et al 2015, Garratt 2017, Loopstra and Lalor 2017 and Loopstra et al 2018). Perry et al (2014), Garthwaite et al (2015) and Garratt (2017) performed different research in different locations in the UK where participants shared the same characteristics of men and women of working age, living alone or with extended family or children, and mostly unemployed. The research performed by Garratt (2017) pointed out that individuals from working age and one person household were recorded to have increased number of visits compared to households referred secondary to domestic abuse and unemployment.

Further studies conducted by Patrick (2014), and Loopstra and Lalor (2017) presented participants of the same characteristics as above but included groups of disabled individuals and migrants. Although the research of Loopstra and Lalor (2017) and Loopstra et al (2018) categorised food bank users according to household type where results showed that majority of household category supported by food banks are single men living on their own. This is followed by women who are either single, married or in partnership and are most likely living with household members such as children (Loopstra and Lalor 2017). Moreover, the category of individuals living with household members, showed majority are parents and children in single parent household (Loopstra et al 2018). Households with three or more children dominate the category of children using food banks (Loopstra and Lalor 2017). On the other hand, Loopstra and Lalor (2017) also indicated that adults with low levels of education and adults seeking asylum dominate the overall population of food bank users.

c.   Linkage Between Sanctions and Food Bank Use

Sanctions to unemployment and other issues on social welfare reform is strongly linked to the raging demand for food banks (Lambie Mumford 2013). Immediate financial crisis was related to cuts on disability benefits, changes to

entitlements, reduction in household income and long wait for benefit payments, which have driven a lot of individuals to rely on food banks in order to address their financial situation (Lambie Mumford 2013, Perry et al 2014, Patrick 2014 and Loopstra et al 2018). A study by Perry et al (2014) concluded that critical predicaments that challenged these individuals were driven by unexpected financial loss or variation in family situation such as death in family or homelessness. Nevertheless, more than half of participants in the study expressed that immediate financial crisis was related to tax credit payments or problems with benefit system procedures such as waiting for payments, sanctions or cuts on disability benefits (Perry et al 2014). Perry et al (2014) also explicated that individuals turn to food banks as last option when all coping techniques are used and not successful, as feelings of embarrassment, shame and peculiarity on deciding to rely on food banks were expressed. Moreover, the study concluded that there is very little emergency support for individuals experiencing crisis and a lot of individuals are unknowledgeable of emergency payments available in different situations and only a few receive them (Perry et al 2014). This is supported by a study performed by Patrick (2014) which indicated a large proportion of food bank users on jobseeker’s allowance, incapacity benefit, income support and employment and support allowance who are strongly determined to secure full time job but are unsuccessful due to setbacks and challenges experienced.

A more recent study conducted by Loopstra et al (2018) which tested the acute dynamic relationship of quarterly numbers of individuals who accessed food banks linking to the amount of sanctions applied in different areas in the UK suggests that there is an increased food bank usage in localities where higher rate of sanctioning is applied. This indicated a projection of 10 additional food bank users when sanctions increased by 20 per 100,000 in local authorities with five distribution sites (Loopstra et al 2018). Furthermore, the study also suggested the likelihood of hidden hunger which is not fully reflected in food bank usage (Loopstra et al 2018). The samples used on the study of Perry et al (2014) and Loopstra et al (2018) were obtained from Trussell Trust Foodbank Network which are up to date rich information; however, data collected from only  one  source  can  be  influenced  by  uncontrollable  factors  such  as

organisation bias. This also bounds the sanction data and the approximation of the influence of sanctions on food bank usage could have been misjudged (Loopstra et al 2018).

3.2B Impact of Social Welfare Reform on Individuals.

Social welfare reform immensely affects diverse groups of individual. As previously stated, individuals with pre existing disability or health conditions, individuals who are unemployed, households with dependent children such as single parents and large families, and other disadvantaged individuals such as the homeless are some who are significantly affected (Lambie Mumford 2013, Patrick 2014, Perry et al 2014, Garthwaite et al 2015, Garratt 2017, Loopstra and Lalor 2017 and Loopstra et al 2018). Reforms are being experienced by these individuals in number of ways Patrick (2014). A qualitative longitudinal study conducted by Patrick (2014) on the lived experiences of individuals on benefits showed that there is a strong sense of ‘shame and stigmatisation’ linked to poverty and reliance on benefits. The notion of reliance on benefits being a ‘lifestyle of choice’ was challenged by most participants in the study as most of them were strongly determined and are trying to secure a full time job (Patrick 2014). Although, most participants also brought up the issue of ‘othering and stigmatisation’ towards migrants and drug users who they strongly believe to be underserving of claiming benefits (Patrick 2014, Garthwaite 2016). Furthermore, social welfare reform has also taught these individuals on how to be resourceful as most participants in the study state that they are only ‘getting by’ with the benefits they receive (Patrick 2014). Individuals must prioritise spending their money on rent, electric and water and end up disregarding healthy diet and proper nutrition (Patrick 2014 and Garthwaite et al 2015). Though, the study conducted by Patrick (2014) was based on a small sample which cannot claim to be representative of the whole food bank users in the UK, it was eventually supported by another research. Purdam et al (2016) conducted a research which showed households curtailing on significant needs such as heating, clothing and food, as well as restricting themselves from

socialising with friends, having a holiday and family activities. Further studies show that benefit claimants are inclined to increasing amount of debts on loans, rents, heating, water and other miscellaneous utility bills where they become heavily indebted and bankrupt (Garthwaite 2015 and Thompson et al 2018). These predicaments brought about by social welfare reform impact on individuals’ health and wellbeing (Garthwaite 2015 and Thompson et al 2018). It weakens their resilience and diminishes their sense of agency (Thompson et al 2018). Pre existing health and social problems do not get better but rather get worse (Thompson et al 2018). Studies also show evidence of benefit cuts putting tension on relationship between family as well as in the community (Patrick 2014 and Garthwaite 2016). However, Lambie Mumford (2013) cited a positive impact of welfare reform on community and individuals as it brought about a sense of community and voluntary action. This is supported by the study of Patrick (2014) where some participants expressed their satisfaction in volunteer work to communities, such as the homeless hostel, to gain experience in securing a permanent job.

 C Impact of Current Increase Demand in Food Bank on the Health and Wellbeing of

There are several reasons to be concerned about the rapid rise in number of individuals needing support from food banks in the UK (Thompson et al 2018). Individuals using food banks reflect groups who have been identified as most vulnerable to deep poverty, such as lone parents and their children, people with disabilities, people out of work and the homeless (Lambie Mumford 2013, Patrick 2014, Perry et al 2014, Garthwaite et al 2015, Garratt 2017, Loopstra and Lalor 2017 and Loopstra et al 2018). These groups have seen their benefit entitlements reduced in recent years, in connection with reductions in spending on local services by the government (Loopstra and Lalor 2017). Increased demand in food bank have direct and indirect impact on the health and wellbeing of individuals (Thompson et al 2018).

a.   Direct Impact

A study by Lambie Mumford (2013) indicated that the food bank system provides an enormous support to the disadvantaged individuals by bridging the gap not only through provision of food but also through sign posting food bank users to other organisations for more needed support. According to Garthwaite et al (2015), it also gives a sense of community to food bank users as staff in food banks are very welcoming and accommodating. Food bank users appreciate the sense of belonging and that they have someone to talk to which helps in alleviating the negative effects of being reliant on food banks such as stigma and embarrassment (Garthwaite et al 2015). However, there are evidence that suggests direct negative effect of food bank reliance on the health of individuals (Purdam et al 2016 and Thompson et al 2018). Findings on the study conducted by Purdam et al (2016) showed that a significant proportion of adults in England are classed as suffering from malnutrition, where women are affected more than men. More than 50% of these individuals have limiting longstanding illness (Purdam et al 2016). The study also showed that women are more likely to cut down on food than men and are more likely to have food insufficiency and low food affordability (Purdam et al 2016). It also highlighted that women with children would rather starve or skip meal to make sure their children have enough to eat (Purdam et al 2016). Thompson et al (2018) conducted a study focusing on the challenges of food banking system to health and wellbeing which showed that families with children are the ones who are greatly affected. It suggested that food poverty hinders the provision of proper nutrition needed for physical and mental development of young children and infants (Thompson et al 2018). Both studies of Purdam et al (2016) and Thompson et al (2018) also highlighted that adequate dietary allowance and proper nutrition is not met by the food distributed from food banks and that food bank is not a long term solution to the problems that associate food bank users to poverty. Evidence from research also suggests that as nutritional inadequacies is a high probability in this vulnerable group, many individuals go without enough nourishment on a chronic basis (Loopstra & Lalor 2017).

b.   Indirect Impact

Increasing demand in food bank also has indirect impact on the individuals relying on it (Thompson et al 2018). Even though food banks help in meeting immediate need of hunger for free, it constitutes some hidden costs to the users (Purdam et al 2016). Evidence show that the pre existing health conditions of some food bank users get worse due to various problems related to accessing food banks (Purdam et al (2016). For example, some individuals with conditions such as COPD must walk a long trip to get to the site and double the burden going back home carrying the heavy bags filled with food causing them to experience stress, anxiety and more difficulty breathing (Purdam et al 2016 and Thompson et al 2018). It also aggravates the condition of users with mental health problems or cause mental health problems due to the experience of stigma, fear and embarrassment which is worsened by the way media represent food bank users on national television and new papers (Garthwaite 2016). Food bank users also perceive themselves as ‘failure’ which lowers their self esteem and affects their sense of agency (Purdam et al 2016).

 DISCUSSION

The findings presented have shown relationship between poverty, food bank provision and social welfare reform in the UK. It also highlighted the impact of social reform and increase in the demand for food banks to the health and wellbeing being of the individuals. Studies performed in different localities in the UK suggest that the increasing demand for food banks is a problem that is escalating and affecting the lives of numerous vulnerable individuals (Lambie Mumford 2013, Patrick 2014, Garthwaite et al 2015 and Loopstra et al 2018). Trends have shown that food bank demand started to increase in 2010 and has continuously risen to the present (Loopstra et al 2018 and Lambie Mumford 2019). This is being linked to austerity and modifications in social welfare provision (Lambie Mumford 2013, Patrick 2014, Garrat 2017and Loopstra et al 2018). However, most of the researches conducted regarding the trend in food bank usage that links to social welfare reform were gathered mostly from

Trussell Trust Foodbank Network which can cause organisation bias and the count of the whole population that rely on food banks is not well determined upon reliance to only one source (Loopstra 2018). Nevertheless, Trussell Trust is the biggest food charity in the UK that has 1200 food distribution sites that uses up to date rich information (Loopstra 2018). Studies also suggest that individuals experiencing food poverty in the UK express feelings of embarrassment and shame receiving food from charity, and therefore would avoid using food bank not unless they are desperate and have no other choice (Perry et al 2014, Garthwaite 2016 and Purdam et al 2016). Loopstra and Tasaruk (2015) conducted a study on food banks in Canada, where it showed only 20% of the number of individuals experiencing food insecurity are using food banks despite its wide availability and this suggests an extensive difference to the data in UK (Loopstra and Tasaruk 2015). The study also captured that food bank usage only show those who are able and determined to use food banks due to desperate need which is not a good indicator of household food insecurity (Loopstra and Tasaruk 2015). Lyall (2014) reported food bank use in Germany is higher compared to UK considering Germany have better benefit system and higher level of pay. Nevertheless, the worsening trend in food bank usage whether it be in UK, Canada or Germany suggests that there is a high number of individuals identified to be most vulnerable to deep poverty and health inequality and this is an alarming issue to public health (Loopstra 2018).

Poverty and health inequality are two of the many circumstances influenced by social determinants (Naidoo and Wills 2016). Some of the social determinants such as food, housing, education, employment, as well as social policies are factors that influence health and wellbeing of individuals who rely on food banks (Naidoo and Wills 2016). These social determinants are interrelated to each other that a change to one factor can affect other determinants which then results to vulnerability of individuals and can also result to social exclusion and stigma (Naidoo and Wills 2016). Marmot (2003) points out that better health outcomes are associated with the circumstances and conditions that support individuals to have greater control over different aspects of their lives. Poverty and reliance on food bank affects individuals’ self esteem and agency which

could result to poor health outcomes (Marmot 2003). The Marmot Review recommended different measures to address social determinants of health, reduce social gradient and create and develop communities to empower vulnerable groups in changing their lives and have a better outcome in life (Marmot 2010). This sets out a framework for policy objectives to tackle social injustice and health inequalities (Marmot 2010).

The government has set out different policies that address social inequalities such as disability and care service, housing benefit, council tax support and social security (Spicker 2019). However, amendments targeting to cut deficits, particularly emphasising welfare costs was proclaimed by the government in 2010 in accordance to the government’s wider agenda on austerity (Farnsworth and Irving 2015). The Big Society was also launched as a measurement in countering poverty and hunger by encouraging the community to be involved and be responsible for their own communities (Spicker 2019). This has promoted volunteering and charitable acts, empowering people and communities that catalysed social mobility (Ashton 2010). T the narratives of individuals using food banks have reflected a sense of belonging in the community (Power et al 2017). Albeit, many argue that the Big Society approach was used to guise the cutbacks on spending (Ashton 2010). Nevertheless, the concurrent rise in food banks and the cutbacks on welfare still poses a threat to the health and wellbeing of the vulnerable groups (Dowler et al 2011, Loopstra 2018)

Linking to public health perspective, the increased demand in food bank use is a critical issue (Loopstra 2018). Individuals who rely on food bank such as single parents, children, individuals with disability and the unemployed are identified to be susceptible to profound destitution and health inequality (Garthwaite et al 2015 and Loopstra et al 2018). Social welfare is a policy that helps bridge the gap of social and health inequality (Alcock et al 2016). However, sanctions in benefits and the long waiting time for pay is detrimental to these vulnerable individuals. Food banks are free and available as a temporary solution to the symptoms of hunger (Thompson et al 2018). Nevertheless, the quality of food does not provide enough nutrition and the

hidden cost such as stigma and embarrassment can be detrimental to the physical and mental health (Garthwaite et al 2015 and Thompson et al 2018). Tackling the root cause of increasing demand for food bank is an ambitious challenge (Lambie Mumford 2019).

CHAPTER 4  –  CONCLUSION AND RECOMMENDATION                       

In conclusion, research have shown that there is a correlation between the increased demand in food bank and the reform of social welfare in the UK. Evidences have demonstrated the failure of social welfare reform and how it has affected vulnerable to a certain degree where it impacts their health and wellbeing. The trend in food bank use have worsened since amendments in social welfare have taken place as a measure in tackling austerity. A similar occurrence to other countries such as Canada and Germany. Increase demand for food bank is an evidence of social injustice as many people are at risk and experiencing food insecurity is against the basic human rights. The impact of food poverty and reliance on food charity on individuals such as shame, stigma and peculiarity pose a threat to the health and wellbeing. This could result to low self esteem, lost sense of agency and low resilience. Malnutrition is also a major issue in food bank reliance as it does not only weaken the health of individuals, but it also affects the physical and mental development of children and infants. Government policies and initiatives are in place to counter the issue such as the Big Society approach that empowers individuals and communities; however, the root of cause of the problem is challenging to tackle.

Therefore, it is recommended to have an immediate action plan to counter the issue on increasing food bank demand to protect the population from the impacts of food poverty and food poverty itself. A better identification and earlier intervention of the problem should be considered by policy makers as well as local authorities. A thorough recognition of the complex nature of the social determinants of health can be used to create a more extensive range of public policy action to promote good health. Creation of more community initiatives using Asset Based Community Development approach can make a beneficial result not only to specific vulnerable groups but to the whole community. This will empower individuals in the community and create a sense of belonging for everyone. This will also promote multi agency working that will create more opportunities and development of skills. Further research to fill the gaps is

suggested in order to fully identify the number of individuals living in food insecurity, more specifically hidden hunger.

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