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Guest Blog: Cash First approaches to addressing food insecurity: What is the role of health visitors, midwives and family nurses?

In this guest post, Dr Flora Douglas (Reader in Nursing at Robert Gordon University) discusses her recent research:

In late 2019 I was commissioned to undertake a short, focused piece of work to develop a better understanding of lived experiences of parenting on a low income in Aberdeen City, by NHS Grampian’s Child Health Commissioner. In addition to establishing how parents were managing on a low income, the study was also keen to find out how parents with young children were engaging with midwives and early years nursing services (health visitors and family nurses) in relation to disclosing financial challenges, with the aim of helping them maximise their household income through onward referral to financial advice services. This so-called Financial Inclusion Pathway has become integral to Grampian’s Child Poverty Action Plans and is in line with a Cash First approach to addressing food insecurity.

As a member of Aberdeen’s Sustainable Food City Steering Group, I had been aware that a significant amount of work had gone into trying to improve local access to high quality, but low cost food for low income families, through the development and introduction of a number of food pantries in the city in previous years. Existing evidence has told us that families with young children, particularly female-headed households, were most at risk from food insecurity, but were notably absent from foodbanks’ statistics in the UK. Feedback from food pantry staff had indicated that women with young families were engaging with food pantries (and their linked services) much more readily than foodbanks. So, we thought the city’s food pantries would be an ideal place to engage with families for this research study too.

So, in collaboration with colleagues at Community Food Initiatives North East (CFINE), we recruited ten parents (all women) to our study in late summer of 2020. Our initial plans to speak to parents earlier in the year were stymied by the first wave of the COVID pandemic, so because of this, participants not only shared their pre-COVID parenting experiences but also related their experiences of parenting, food access and their engagement with health professionals during that first lockdown. It is important to note that all our participants had a child under five and were living on very low incomes. A few participants worked part-time, but those who didn’t work couldn’t do so because of childcare commitments and the lack of local jobs that paid enough money that would cover their household and childcare costs.

We completed our report in January this year, and we welcome readers’ comments or observations on it. But there are four main findings that I want to spotlight in this piece that stood out for me in this work.

Firstly, I was really struck by the extent to which the £20.00/ week COVID 19 pandemic Universal Credit uplift had made to some of the parents we spoke to. It may seem like such a small amount of money to some people, but it clearly represented a significant change to the household budget for those families, particularly in relation to being able to buy food that parents and their children wished to eat, compared to pre-pandemic times. I think it’s important that we try to find out about the broader impact that this policy change has had on parent’s and children’s health and wellbeing throughout Scotland, and that we learn more from this national ‘natural experiment’, particularly given the disproportionate socio-economic impact the COVID pandemic has had on women in the UK.

Secondly, this study reinforced for me (again) how skilled and conscientious people who are food insecure are with their food resources. Shopping knowledgably and carefully, maximising food bought or received, and trying not waste food, along with batch cooking and ‘cooking from scratch’, emerged very strongly as key coping strategies in our conversations. This is something that I’ve picked up in previous research and have read in other’s research with low income groups. This evidence is at odds with some public and policy maker perceptions’ that assert that people living in poverty often lack knowledge and understanding about food preparation skills, and, planning and budgeting, and that they could do with some education to address those perceived deficiencies. Quite frankly, I was deeply humbled to hear our participants’ experiences and perspectives, as it seemed to me that our participants had much to teach many of us about how to save money – and the planet too, I suspect.

Thirdly, in relation to talking to health professionals about financial challenges, it was sad and disturbing to hear some participants express fear that if they did so, it could or would raise child protection concerns with the authorities. They believed this was a significant barrier to some parents disclosing they had financial problems, even if asked. At the same time, they viewed health visitors as health professionals that could really help first time parents, young parents and low-income families navigate the social security system to access more money for their families.

And fourthly, when we asked parents about what they thought would help with discussions about financial challenges with health professionals, they recommended that they (health professionals) should proactively raise and frame discussions about claiming additional benefits or seeking to increase their family’s income with benefits, as a positive thing to do, and not a negative thing or a sign of their being deficient parents.

Given numbers of people who have fallen into poverty because of the pandemic, and the projections of the numbers who will fall into poverty (the newly poor), or will be affected by very low income in the post-COVID world, this study suggests there is scope for health professionals (and community-based health professionals in particular) to play a key role in linking families with young children with help to increase their household income, and thereby reducing their need to rely on charity and food banks to eat, and avoid the nutritional and mental health challenges that this brings. However, this study indicates that there are some understandable barriers and challenges to realising the full potential of the Financial Inclusion Pathway. So, now we are currently undertaking a study investigating health visitors’, midwives’ and family nurses’ experiences of supporting low income parents with financial challenges, as well as conducting some more parent interviews where we hope to include more rural and ethnically diverse views too. We anticipate reporting on both studies towards the end of this year.

‘A qualitative investigation of the perspectives and experiences women and families living on low income in Aberdeen City associated with the introduction of the Financial Inclusion Pathway in 2019/2020’  is available here.

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