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Archive for April, 2014

  • by Martin Caraher
  • Professor of Food and Health Policy/Thinker in Residence Deakin University, Melbourne (February 2013)
  • Centre for Food Policy, Department of Sociology, School of Arts and Social Sciences, City University London

There has been recent concern in public heath circles with the media reporting that the UK has opted out of the new EU Social Welfare Fund scheme, which began in January 2014. This replaced the ‘Food Aid Programme to the Most Deprived Persons in the Community’, commonly known as the MDP programme ran from 1987 to December 2013. The reporting has focussed on the issue that by opting out of the new scheme that food banks in the UK cannot access food or funds from the new scheme for those in need. While this is true and a consequence of the opting out (Hansard 2012), there are deeper – and maybe hidden – issues to be addressed.

These relate to the role of food banks in our society and the right to food for citizens as well as questioning why such a need exists? While food banks have captured the public imagination and grown from one in 2000 to over 400 today their emergence raises questions over the roll back of the state around food welfare and the role of charity as a replacement. Focusing on the supply of food to food banks while it may be important does not address the fundamental question of the place and role of food banks in a welfare society.

In the UK the methods of operation and funding of food banks varies. However, they generally rely on donations from retailers and to a lesser extent the general public. In the UK Food bank provision is broadly provided by two schemes currently in operation. The key provider of food banks in the UK is the Trussell Trust, a Christian charity which franchises its model to local groups allowing them access to food supply sources and the use of publicity materials. In the three months to the end of September 2013, 356,000 people received three days of free food from one of the 400 + food banks in the Trussell Trust network.

The second major operator is FareShare which collects surplus food from supermarkets and shops and distributes it through 720 charities and organisations to needy families and individuals feeding one million people every month. It itself does not operate outlets but distributes to those who do, some of which might be food banks but others could be homeless charities, shelters or soup kitchens. Aside from this there two schemes there are many other food banks operating on their own either as independent charities or part of existing community groups, see Milestone London for an example of a group setting up a food bank for the Muslim community.

So we are seeing increases in the number of food banks and also a divergence in delivery to specific groups. Such initiatives might be welcomed under the Big Society banner; the PM has praised the work of food bank volunteers, although the Work and Pensions Secretary of State Iain Duncan Smith is on record as accusing the Trussell Trust of expanding by nefarious means when he said:

I understand that a feature of your business model must require you to continuously achieve publicity, but I’m concerned that you are now seeking to do this by making your political opposition to welfare reform overtly clear.

Many contend that the rise in the numbers using food banks is indicative of household food poverty, while the official government line is that there is no evidence that the welfare reforms are contributing to the rise in numbers using food banks. There remain unanswered questions as to the abilities and appropriateness of food banks to tackle food poverty in the long-term and as to their ability to provide healthy food, even in the short term. Underfed people are also likely to be badly fed, leading to long-term health problems. This problem of supply is because of the reliance on donations and surplus/waste food stocks.

There is a body of work examining the mechanics and efficiency of operation of food banks and their contribution to nutrient health outcomes but few, UK focussed, questioning their social relevance. Dowler and colleagues (2001) argued that such schemes perpetuate food poverty by enabling the problems in rich societies to remain marginalised.

Looking to the situation in Canada which has a long history of food banks, Riches, (2002) asserts that those seeking assistance do so repeatedly and become dependent on food aid; as what starts as an emergency response risks becoming entrenched in civic society, a la Big Society model.

Such depoliticisation of food poverty and normalisation of food bank usage can have profound consequences not just for the users of food banks but for society as a whole -‘[T]his is precisely what government wishes to hear and it helps them promote their argument that it is only in partnership with the community that the hunger problem can be solved.’ (Riches 1997)

So while decrying the opting put of the new European Social Welfare Fund it needs to be understood that the UK decision was based on issues of subsidiarity and the right of the UK to determine its own solutions. The principle has much wider implications for the UK in terms of the part it plays in European policy formation.

The debate reported in Hansard (2012) concerning the social fund is nothing more than political mud slinging with MPs, across the political divide, accusing each other of being responsible for the increase in the number of food banks but no discussion on the determinants of food poverty.

In fact, the new The Social Welfare Fund is a cohesion policy justified by Article 174 of the Amsterdam Treaty which allows the Union to promote overall harmonious development by pursuing economic, social and territorial cohesion. It is not exclusively focused on food aid. It might be important to note that the Labour government never partook in the MDP programme or other EU initiatives such as the fruit and vegetable to schools scheme.

Additional supplies of food to food banks in the short-term may help but the long-term issues of ensuring a right to appropriate and nutritious food and needs to be addressed. Key to this is how people access food and without having to resort to emergency food provision through food banks. Food banks were set up to meet failings in the welfare state and to provide emergency assistance not to be the long-term providers of food to those in need.

The elephant in the room is not the food banks but the reasons why people are turning to food banks for help.

This is a combination of welfare reforms, increasing pressure on household budgets as income remains static while food and other prices such as fuel increase. The food banks themselves are beginning to be overwhelmed by the needs and the numbers being referred. The UN Special Rapporteur on the Right to Food, commenting on the UK said the solution was for the government to define social benefits in terms of rights  (Justfair 2013).

Thus we need to see food banks as the failure of government to deliver on the right to food. Winne (2009) in his book on the US food system says: “we must seriously examine the role of food banking, which requires that we no longer praise its growth as a sign of our generosity and charity, but instead recognize it as a symbol of our society’s failure to hold government accountable for hunger, food insecurity and poverty” (p.184).

In exercising the principle of subsidiarity and non participation in the new EU Social Welfare Fund the UK government may have limited access to additional food and resources for food banks in the UK; however this should not stop the public health movement from questioning and debating the role and place of food banks in society and looking to government for solutions to food poverty. Food banks are ‘band aid’ and needed to help people in emergency situations. As to what part they play in the longer term remains to be debated.

References
Dowler, E., Turner, S., with Dobson, B., (2001) Poverty Bites, Food, Health and poor families, London, CPAG.

Hansard. (2012), Fund for European Aid to the Most Deprived [Relevant document: Twenty-second Report from the European Scrutiny Committee, HC 86-xxii.] 18 Dec 2012: Column 806, (Accessed 28th October, 2103).

Justfair (2013) Freedom from Hunger: Realising the right to Food in the UK. Doughty Street Chambers, London

Riches, G., (2002) Food Banks and Food Security: Welfare Reform, Human Rights and Social Policy. Lessons from Canada? Social Policy and Administration. Vol. 36, No. 6, pp.648-663.

Riches, G., (1997c) Hunger, food security and welfare policies: issues and debates in First World societies, Proceedings of the Nutrition Society, 56: 63-74.

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by Professor Frank Kelly and Dr Julia Kelly
King’s College London

When the UK passed the Clean Air Act in 1956 to reduce smoke and sulphur dioxide, it led the world in cleaning up air. In recent years air quality improvements have miserably stalled. We have been breaching European Union (EU) limit values every year since 2005 for the modern day pollutants nitrogen dioxide (NO2) and particulate matter (PM). Currently there is no prospect of achieving compliance for NO2 in some areas until 2025.

More worryingly, evidence to support the detrimental short and long-term effects on health has increased substantially over the same period of time. Data for 2008 estimate that air pollution contributes to at least 29,000 premature deaths in the UK each year.

In 2012, the International Agency for Research on Cancer classified particulates in diesel fumes as a known carcinogen. In 2013, a WHO report concluded that the health effects of PM and NO2 can occur at concentrations lower than the their health-based Guideline values which of note, are lower than the EU limits we fail to adhere to.

In addition, other than the well-documented risks to cardiopulmonary heath, increasing evidence exists that air pollution exerts a wider threat, negatively influencing reproductive outcomes and neurological health.

The lack of progress in improving air quality isn’t due to lack of attention by professionals in the field or lack awareness by Government. I and other expert witnesses have given evidence to the Commons Environmental Audit Committee in 2010 and again in 2011 – the ensuing reports were blatant in their conclusions, calling in 2010 for ‘political will’ and ‘committed resources to meet air quality targets.

The 2011 report concluded that ‘the Government has failed to get to grips with the issue’ and ‘must not continue to put the health of the nation at risk’. In February 2014 the European Commission launched legal proceedings against the UK for excessive emissions of NO2. This is the first case by the EU against a member state for breaching limits. One can only hope that this may have the clout to shake political indifference to air quality in this country.

Unlike the powers that be, up until the beginning of last week, it is probably fair to say that the majority of the public was relatively unaware of day-to-day air pollution, the sources and the dangers associated with current concentrations. This is partly because PM can’t be seen by the naked eye and NO2 is invisible and probably owing to a poor understanding of what is undisputedly a complex science.

However on Sunday 30 March 2014 light southeasterly winds began to blow Saharan dust plus polluted air from Europe over the UK. This mingled with our domestic emissions from cars and industry resulting in high levels of rather unusual mix of pollution. Owing to the persistence of easterly winds and dry weather, poor air quality remained with us until the end of the week.

Light easterly winds taking pollutants from continental Europe to the UK where are own fresh emissions are added is not unusual – even dust flows from the Sahara are not uncommon. Instead, what really grabbed the attention of the nation – other than the visible hazy smog – was the prolific reporting of the events in every conceivable form of media.

This was because on the 1 April 2014 the Met Office, our national weather service provider, took over responsibility for forecasting air pollution on behalf of Defra. With that came greater publicity. In comparison, previous episodes have attracted insignificant coverage. Other than registered users of proactive air pollution alert services, you would have been hard pressed to hear about the even worse poor air quality affecting parts of England three weeks ago. This particular event culminated in London recording the greatest concentration of PM10 in 2 years.

The highly charged media coverage did not stop even when air quality improved. This was the result of a change in wind direction to southwesterly, coming in from the cleaner Atlantic, combined with wet weather washing the pollutants out of the air. Sunday’s press covered emerging evidence that traffic-related air pollution may target neurodevelopment and cognitive function as well as holding diesel fumes to account.

British drivers respond to the marketing of diesel cars as the “green” option – on the basis of reduced CO2 emissions and lower fuel costs – such that approximately one half of all new private car registrations in 2012 were diesel. Added to this, in most cities diesel engines power the majority of our buses and taxis. The image however is now tarnished.

Diesel engines emit especially harmful particulate pollution and owing to lenient European testing regimens, NO2 emissions have risen steadily of the past 10-15 years. It was reassuring that this information reached the front pages of the Sunday broadsheets.

This pollution episode has certainly raised the profile of what, to many, has previously been an invisible problem. However the chronic effects of air pollution, owing to year-round exposure, are much more worrisome than the short-term, often transient outcomes. We cannot afford to just focus on distinct episodes. As succinctly put in one online blog earlier this week: ‘We need to reduce air pollution when it isn’t making the headlines as well as when it is.’ Traffic must be reduced and we must ensure a cleaner and greener element to what remains on the road.

This can be achieved through a number of strategies: an expansion of low emission zones, investment in clean and affordable public transport, a move back from diesel to petrol or at least a ban on all diesel vehicles not fitted with a particulate filter and a lowering of speed limits. Focused education and continued evolution of sophisticated information systems can also achieve a durable change in public attitude and in turn behaviour.

But engagement must be blatant and put in the context of other public health risks such as passive smoking and utilise compelling messages such as premature death. There will be costs – but these should be balanced against the economic cost from the impacts of air pollution in the UK that are estimated at £9-£19 billion every year.

Cracking our air pollution problem is a huge challenge. It is highly unlikely that our major cities will ever be able to boast ‘pure air’ especially if strategies focus on small areas of an overall road network – as I have been quoted before: ‘air pollution does not respect any boundaries’. With bold, realistic and moral leadership however, enormous potential exists to reduce air pollution so that it no longer poses a damaging and costly toll on public health.

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by Tara Zolnikov

PhD Candidate, Developmental Science, North Dakota State University; Environmental Health, Harvard School of Public Health

Western Kenya is significantly affected by HIV/AIDs, with rates up to 15%. Many variables, including the environment and transient populations, contribute to the high percentage of HIV in the region.  The sister cities, Busia, Kenya and Busia, Uganda, are the busiest border crossings between Kenya and Uganda. Heavy commercial traffic travels from Kenyan ports to landlocked countries in Sub-Saharan Africa.

The mid-way location offers drivers a night’s stay and a profitable market for transactional sex.  Other contributing factors of the spread of HIV in Western Kenya are attributed to culture.   Cultural factors may include the unspoken acceptance of polygamy, disco matangas, and wife or sister inheritance.

While working with the Kenya Red Cross, I experienced a ‘disco matanga’, also known as a disco funeral.  Because of the low socioeconomic conditions of the province, this event takes place to help raise money for a deceased individual’s funeral.  This event also includes wife or sister inheritance, or the transfer of a widow to the former husband’s brother or family member.  The disco matanga has a select group of people who are invited, generally of the same tribal affiliation (e.g. Luo, Luhya).

The party, with music and dancing, starts around 10 to 11 pm and can last for days, but typically goes throughout the night until the morning hours.  Men are generally drink a “home brew” and smoke marijuana or chew miraa. An MC makes attendees pay if they want to remain sitting or go out and dance to avoid paying.

Men also pay for girls who they want for their dance partners.  This dance is also used to decide on later transactional sex; if unwilling, girls are frequently raped as a consequence.  To date, a solution regarding this cultural practice does not exist.  There are many reasons why risky sexual behaviour has not been addressed at disco matangas:

•    The high mortality rates resulting from AIDS contributes to a larger percentage of orphans in the province.  Orphanhood is also associated with risky sexual behaviour.  At disco matangas, orphans are also largely unsupervised.  This situation contributes to an increased risk of sex and resulting adverse health effects (HIV transmission, sexually transmitted infections, and pregnancies).

•    The environmental context of disco matangas contributes to risky sexual behaviours.  The location is frequently undisclosed until the last minute and located deep in the woods which would make any intervention within the event difficult to target.

•    There is not a lot of available entertainment in this region.  Adolescents look forward to attending disco matangas for entertainment.  How would any teenager feel if their parents told them they could not attend a school dance or prom? To eliminate this need for entertainment, an additional setting needs to be provided for adolescents.  A youth center is one viable option; however, it also needs to be free of charge and available at all hours.

•    Because communities are rural, it is difficult to disseminate information to every person that may be affected. How does one disseminate knowledge, education, or an intervention to a population inclusive of many ages, occupations, and located sparsely throughout the region?

•    The consumption of alcohol, miraa, marijuana, and “home brew” contribute to risky behaviours. Unfortunately, the female population is at an increased risk because men are more likely to consume these substances and display sexually aggressive behaviour without the consent of the female.

•    Because this province has the highest rates of HIV in Kenya, there is a surplus of public health messages being disseminated.  Personally, I think there has been a message shift from “don’t have sex” to “let’s put everyone on ARVs.”   I believe the shift of information is difficult for people to understand and digest.  ‘If we are all taking ARVs, doesn’t that mean we can’t contract HIV?’  We need to collaborate, combine, and coordinate our HIV education efforts in the region.

Public health interventions should consider cultural influences.  There are many times that we, as scientist, humanitarians, and public health advocates, forget that other individuals do not have the same knowledge base that we do.  Therefore, my initial instinct would be to design a phenomenological qualitative study to understand current knowledge and perceptions.

I would approach the population and ask if they are aware of the consequences of risky sexual behaviour and that disco matangas presents a scenario that may put them at risk for HIV transmission or pregnancies? If they are aware of this information, why do they continue to go?  The majority of the population has mobile phones, so is there a number that they would want to call if they were in danger?  I would further probe and ask for their solutions to the problem.

Researchers from the Western world come from such a different, individualistic perspective, but Western Kenya is a collectivist society and we should integrate these societal perspectives into our interventions.  Is there someone that could disseminate the message better than us – as researchers or as an outside influence?

My initial instincts are to design an intervention for disco matangas to introduce education on risky sexual behaviour to adolescents and their parents. Unfortunately, this may not be effective.  The better approach for involvement would be to include grandparents, because grandparents often live with and spend more time with the children who are attending these events.

The stories that I have listened to about the rapes that occur at disco matangas are gut-wrenching and as an advocate for gender rights, it is very worrisome.

Proposed solutions have been to include community health workers be on watch and attend the events, but because of the location and small exclusive invitees, this is difficult.  We have also thought about emergency phone numbers for adolescent girls to call, but again, who will be able to help them when they are one hour away from the nearest town?

Do we send a community health worker out in the middle of the woods at night to help a girl and risk the chance of getting raped herself?  Should we focus on eliminating the alcohol, the setting, or the night time setting?  Could we promote positive youth development and provide a social setting in a community centre?  Would adolescents located in remote villages have access to this?

There are many angles that we could consider from a public health programme implementation perspective, but what would be the most effective?  My instinct is to focus on girls and eliminate them from the disco matanga scenario.  If girls are attending disco matangas solely to interact with boys, peers, and friends, one possible solution would be to provide other sources of entertainment and ways for adolescents to socially interact in a safe setting.  Additional perspectives need to be garnered for further insight, resource feasibility, and sustainabilityto further explore this option.

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  • Andy Graham – specialty registrar in Public Health, County Durham

A couple of years ago I found myself in need of a dissertation topic for an MSc in Public Health – ‘make sure it’s something you are interested in’ was the advice. Simple I thought, I just need to weave football and beer into a research project! All joking aside though, I have become interested in the relationship between the two over the years.

As a public health professional and former A&E nurse, I am well aware of the potential harms of excessive alcohol consumption. Also, as a fan who both attends matches and watches on TV, I have become increasingly aware at how visible this relationship has become. Of course, football and beer have long been associated, ever since Victorian landlords would set up teams, use the land out back for a pitch and, in the amateur days, employ the team as barmen in lieu of pay.

But at the risk of sounding like my dad, when I ‘was a lad’, you either went to the match, where as a young working class man it was normal to have a pint with the lads, or you waited for Saturday night’s Match of the Day for your football fix. The pubs were open sporadically, had no TVs, and the football was rarely broadcast anyway.

Fast forward a few years and we have football on satellite TV almost every night of the week and all day at weekends, most top flight football clubs sponsored at some level by an alcohol brand, marketing of alcohol, beer in particular, is rife and the norm appears to be drink beer and watch football with the lads in the pub. Opportunities to do both are far more common than when ‘I was a lad’, and not just within pubs, but within living rooms, where the cheaper alcohol deals of the supermarkets are very popular. As a dad myself I was disturbed by these developments, but hadn’t been able to quantify them.

I decided my dissertation would try to measure the amount of alcohol marketing that football TV viewers were exposed to. With the help of Jean Adams at Newcastle University, I planned the research. I chose six live broadcasts representing over 18 hours of footage, developed coding frameworks and watched 40 hours plus of coding footage to consider all the verbal and visual references.

The results shocked me:

• Over 2,000 visual images, 111 per hour on average, or around 2 per minute.

• 32 verbal references.

• 17 traditional advertisements, accounting for 1% broadcast time.

• Over 1,100 visual images in one alcohol sponsored Cup competition alone

The issue of traditional advertising commercials is interesting because the ‘voluntary’ codes of practice in place to regulate how alcohol is portrayed (should not appeal to youth, should not suggest social success, etc.) are most relevant to this type of advertising. Given that we know that quantity of alcohol marketing is more important than content, then the apparently unchecked stream of visual references in this research may be even more important, and we could argue that the current controls are completely inadequate because they are focused on content, rather than quantity.

I can’t help but feel that we have taken our eye off the ball – the globalisation of sports such as premier league football as a product, the satellite age, the endless thirst for profit and market share within corporations, the ‘self’ regulation that fails to control the exposure reported above, the relaxed licensing laws in this country, and the increase in type, availability, and affordability of alcohol. All of these things create a perfect storm in which alcohol and sporting idols become normalised as one and the same, and the brand becomes a member of the team. It feels as though the relationship between sport and alcohol has evolved towards its perfect and logical form.

I am disturbed to be one of a generation of football fans that has been manipulated in this way and that my children are also targets. And meanwhile, the alcohol industry has a seat at the policy making table through the Public Health Responsibility Deal. So we must ask the question: are we sleepwalking into a situation where drinking alcohol is so closely associated with the sporting heroes that children see on TV, that they are being actively normalised to become drinkers? No one seems to question this, but it is time someone did, and through public health advocacy it may just be up to us.

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