Austerity and old-age mortality in England: a longitudinal cross-local area analysis, 2007-2013

Objective: There has been significant concern that austerity measures have negatively impacted health in the UK. We examined whether budgetary reductions in Pension Credit and social care have been associated with recent rises in mortality rates among pensioners aged 85 years and over. Design: Cross-local authority longitudinal study. Setting: Three hundred and twenty-four lower tier local authorities in England. Main outcome measure: Annual percentage changes in mortality rates among pensioners aged 85 years or over. Results: Between 2007 and 2013, each 1% decline in Pension Credit spending (support for low income pensioners) per beneficiary was associated with an increase in 0.68% in old-age mortality (95% CI: 0.41 to 0.95). Each reduction in the number of beneficiaries per 1000 pensioners was associated with an increase in 0.20% (95% CI: 0.15 to 0.24). Each 1% decline in social care spending was associated with a significant rise in old-age mortality (0.08%, 95% CI: 0.0006–0.12) but not after adjusting for Pension Credit spending. Similar patterns were seen in both men and women. Weaker associations observed for those aged 75 to 84 years, and none among those 65 to 74 years. Categories of service expenditure not expected to affect old-age mortality, such as transportation, showed no association. Conclusions: Rising mortality rates among pensioners aged 85 years and over were linked to reductions in spending on income support for poor pensioners and social care. Findings suggest austerity measures in England have affected vulnerable old-age adults

The impact of benefit sanctioning on food insecurity : a dynamic cross-area study of food bank usage in the UK

Household food security, which may be compromised by short-term income shocks, is a key determinant of health. Since 2012, the UK witnessed marked increases in the rate of ‘sanctions’ applied to unemployment insurance claimants, which stop payments to claimants for a minimum of four weeks. In 2013, over 1 million sanctions were applied, potentially leaving people facing economic hardship and driving them to use food banks. Here we test this hypothesis by linking data from the Trussell Trust Foodbank Network with records on sanctioning rates across 259 local authorities in the UK. After accounting for local authority differences and time trends, as the rate of sanctioning increased by 10 per 100,000 adults, the rate of adults fed by foodbanks by an additional 3.36 adults per 100,000 (95% CI: 1.71 to 5.01). The availability of food distribution sites affected how tightly sanctioning and food bank usage were associated (p<0.001 for interaction term), such that in areas with few distribution sites, rising sanctions led to smaller increases in Trussell Trust food bank usage. Sanctioning appears to be closely linked with rising need for emergency food assistance, but the impact of sanctioning on food insecurity is likely not fully reflected in available data. There is a need to monitor household food insecurity in the UK to fully understand the impact of government policies on this outcome

'Set up to Fail'? How Welfare Conditionality Undermines Citizenship for Vulnerable Groups

Underpinned by the assumption that unemployed persons are passive recipients of social security, recent welfare reforms have increased benefit conditionality in the UK and introduced harsher penalties for failure to meet these conditions. Yet, conditionality may result in vulnerable groups disproportionately experiencing disentitlement from benefits, one of the rights of social citizenship, because they are, in some cases, less able to meet these conditions. Rising sanctions, then, may be the product of a disconnection between welfare conditionality and the capabilities of vulnerable claimants. To test this hypothesis, we evaluate whether sanctions are higher in areas where there are more vulnerable Jobseeker's Allowance claimants, namely, lone parents, ethnic minorities and those with disabilities. We find that sanction rates are higher in local authorities where more claimants are lone parents or live with a disability, and that this relationship has strengthened since the welfare reforms were introduced under the Conservative-led coalition. Failure to meet conditions of benefit receipt may disproportionately affect vulnerable groups

The continuing effects of welfare reform on food bank use in the UK: the roll-out of Universal Credit

In this paper we explore whether the recent rise in food bank usage in the UK has been induced by the roll-out of Universal Credit. We bring together official statistics on the introduction of Universal Credit with data on food bank usage from the UK’s largest food bank network. We test the relationship between Universal Credit and food parcel distribution using a range of causal identification strategies (such as fixed-effects model, Granger causality tests, and matching designs) and consistently find that an increase in the prevalence of Universal Credit is associated with more food parcel distribution. We also find that the relationship between Universal Credit and food parcel distribution is stronger in areas where food banks are active, suggesting food insecurity arising from Universal Credit may be hidden in places where food banks are largely unavailable. Though it is challenging to implement any large-scale change to social security, our analysis suggests systemic and persistent problems with this new system. Whilst the logic of Universal Credit is intuitively appealing, it has also proven to be unforgiving, leaving many struggling to make ends meet

The rise of hunger among low-income households: an analysis of the risks of food insecurity between 2004 and 2016 in a population-based study of UK adults

Background: Rising food bank use in the past decade in the UK raises questions about whether food insecurity has increased. Using the 2016 Food and You survey, we describe the magnitude and severity of the problem, examine characteristics associated with severity of food insecurity, and examine how vulnerability has changed among low-income households by comparing 2016 data to the 2004 Low Income Diet and Nutrition Survey. Methods: The Food and You survey is a representative survey of adults living in England, Wales, and Northern Ireland (n=3118). Generalised ordered logistic regression models were used to examine how socioeconomic characteristics related to severity of food insecurity. Coarsened exact matching was used to match respondents to respondents in the 2004 survey. Logistic regression models were used to examine if food insecurity rose between survey years. Results: 20.7% (95% CI 18.7% to 22.8%) of adults experienced food insecurity in 2016, and 2.72% (95% CI 2.07% to 3.58%) were severely food insecure. Younger age, non-white ethnicity, low education, disability, unemployment, and low income were all associated with food insecurity, but only the latter three characteristics were associated with severe food insecurity. Controlling for socioeconomic variables, the probability of low-income adults being food insecure rose from 27.7% (95% CI 24.8% to 30.6 %) in 2004 to 45.8% (95% CI 41.6% to 49.9%) in 2016. The rise was most pronounced for people with disabilities. Conclusions: Food insecurity affects economically deprived groups in the UK, but unemployment, disability and low income are characteristics specifically associated with severe food insecurity. Vulnerability to food insecurity has worsened among low-income adults since 2004, particularly among those with disabilities

Liberal trade policy and food insecurity across the income distribution: an observational analysis in 132 countries, 2014–17

Background: Eradicating food insecurity is necessary for achieving global health goals. Liberal trade policies might increase food supplies but how these policies influence individual-level food insecurity remains uncertain. We aimed to assess the association between liberal trade policies and food insecurity at the individual level, and whether this association varies across country-income and household-income groups. Methods: For this observational analysis, we combined individual-level data from the Food and Agricultural Organization of the UN with a country-level trade policy index from the Konjunkturforschungsstelle Swiss Economic Institute. We examined the association between a country's trade policy score and the probability of individuals reporting moderate-severe or severe food insecurity using regression models and algorithmic weighting procedures. We controlled for multiple covariates, including gross domestic product, democratisation level, and population size. Additionally, we examined heterogeneity by country and household income. Results: Our sample comprised 460 102 individuals in 132 countries for the period of 2014–17. Liberal trade policy was not significantly associated with moderate-severe or severe food insecurity after covariate adjustment. However, among households in high-income countries with incomes higher than US$25 430 per person per year (adjusted for purchasing power parity), a unit increase in the trade policy index (more liberal) corresponded to a 0·07$450 per person per year) in low-income countries, a unit increase in the trade policy index was associated with a 0·35% (0·06 to 0·60) increase in the predicted probability of reporting moderate-severe food insecurity. Interpretation: The relationship between liberal trade policy and food insecurity varied across countries and households. Liberal trade policy was predominantly associated with lower food insecurity in high-income countries but corresponded to increased food insecurity among the world's poorest households in low-income countries. Funding: Joseph Rowntree Foundation, Economic and Social Research Council

The Relationship Between Food Banks and Food Insecurity:Insights from Canada

Food banks have become the first line of response to problems of hunger and food insecurity in affluent nations. Although originating in the USA, food banks are now well established in Canada, Australia, and some Nordic countries, and they have rapidly expanded in the UK and other parts of Europe in the past two decades. Defined by the mobilization of food donations and volunteer labor within communities to provide food to those in need, food banks are undeniably a response to food insecurity, but their relevance to this problem is rarely assessed. We drew on data from the 2008 Canadian Household Panel Survey Pilot to assess the relationship between food bank use and household food insecurity over the prior 12 months and examine the interrelation between food-insecure households’ use of other resource augmentation strategies and their use of food banks. We found that most food-insecure households delayed bill payments and sought financial help from friends and family, but only 21.1% used food banks. Food bank users appeared to be more desperate: They had substantially lower incomes than food-insecure households who did not use food banks and were more likely to seek help from relatives and friends and other community agencies. Our findings challenge the current emphasis on food charity as a response to household food insecurity. Measures are needed to address the underlying causes of household food insecurity.</p

Is trade liberalisation a vector for the spread of sugar-sweetened beverages? A cross-national longitudinal analysis of 44 low- and middle-income countries

Does trade and investment liberalisation increase the growth in sales of sugar-sweetened beverages (SSBs)? Here, for the first time to our knowledge, we test this hypothesis using a unique data source on SSB-specific trade flows. We test whether lower tariffs effectively increase imports of SSBs, and whether a higher level of imports increase sales of SSBs. Cross-national fixed effects models were used to evaluate the association between SSBs sales and trade liberalisation. SSBs per capita sales data were taken from EuroMonitor, covering 44 low- and middle-income countries from 2001 to 2014, SSBs import data were from TradeMap, Foreign Direct Investment data were from EuroMonitor, and data on applied tariffs on SSB from the World Trade Organisation tariffs database, all 2015 editions. The results show that higher tariffs on SSBs significantly decreased per capita SSB imports. Each one percent increase in tariffs was associated with a 2.9% (95% CI: 0.9%–5%) decrease in imports of SSBs. In turn, increased imports of SSBs were significantly associated with greater sales of SSBs per capita, with each 10 percent increase in imports (in US$) associated with a rise in sales of 0.36 L per person (95% CI: 0.08–0.68). Between 2001 and 2014, this amounted to 9.1 L greater sales per capita, about 40% of the overall rise seen in this period in LMICs. We observed that tariffs were inversely but not significantly associated with sales of SSBs. In conclusion, lower tariffs substantially increased imports of SSBs in LMICs, which translated into greater sales. These findings suggest that trade policies which lower tariff barriers to SSB imports can be expected to lead to increased imports and then increased sales of SSBs in LMICs, with adverse consequences for obesity and the diseases that result from it

Food banks: Understanding their role in the food insecure population in the UK.

This paper reviews the growing body of literature on food insecurity and food bank use in the UK. It provides an overview of food insecurity in this context, followed by a description of the emergence of food banks, highlighting how any role that food banks play in the food insecure population is limited. Data on food insecurity and food bank use suggest many people experiencing food insecurity do not receive help from food banks. To better understand the factors influencing the relationship between food insecurity and food bank use, a conceptual framework is outlined, suggesting the relationship is far from straightforward and contingent on many factors. The nature and availability of food banks and other local support services and individual-level factors influence the likelihood of food banks being used in the context of food insecurity. Then, the extent to which food banks can impact on food insecurity is also dependent on the quantity and quality of food distributed, as well as other support services offered from food banks. Closing reflections highlight rising living costs and food banks reporting that they do not have capacity to cope with increasing demand, underscoring the need for policy interventions. Reliance on food banks to respond to food insecurity may ultimately impede formulation of effective policy interventions to reduce food insecurity, giving the illusion of widespread available support, while food insecurity persists among those receiving help from food banks and those who experience food insecurity but do not use food banks