The government roll-out of emergency food parcels to those who are unable to access groceries highlights cracks in our food system and raises questions about what we need from it in the future, argue Geraldine McNeill, Liz Dowler and Kirsteen Shields. In March 2020, across the UK an estimated 1.5 million people were instructed to ‘shield’ themselves indoors for 12 weeks due to being at extremely high clinical risk of COVID-19 infection. As a result many of these were at risk of not being able to obtain enough food as supermarket home delivery slots quickly filled up and, despite assurances to the contrary from the supermarkets and the UK government, several weeks into lockdown many households were still struggling to get hold of food and basic supplies. In an initiative heralded as ‘a scheme of an operation …. not seen since the Second World War,’1 the governments of the UK and devolved nations of Scotland, Wales and N Ireland began rolling out food box delivery schemes and facilitating supermarket deliveries to shielding households. These interventions deserve closer examination as they raise questions about what we need from our food system in times of crisis and in the future – nutritionally and beyond. Image Fig 1: Contents of one emergency food parcel. While some of the first food parcels reportedly contained only sugary foods and drinks2,3 most parcels are based on a generic food list compiled by the UK Government Department for Environment, Food and Rural Affairs in consultation with nutritionists, and are delivered in a large box left on the doorstep by wholesale food companies on behalf of local government authorities. Each parcel is designed to feed one adult for a week and contains mostly tinned, dried and long-life foods such as pasta, rice, long-life milk and tinned meat and vegetables, along with some a loaf of sliced bread and some fruit and vegetables which can be kept at room temperature such as potatoes, carrots, apples and oranges. Without other items from pre-existing kitchen stores the foods in the parcel can only be used to make a limited number of meals and snacks, as illustrated in Table 1. Table 1: Menu based on one emergency food parcel. Meal Possible items in food parcel Any Apple or orange, biscuits, tea or coffee, milk Breakfast Bread Light meal Tomato soup or baked beans Bread Main meal Pasta, rice or potatoes Tinned pork, meatballs or tuna Carrots, tomato sauce, tinned tomatoes or peas Custard Image Fig. 2: Protein, vitamin and mineral content of the emergency food parcel in comparison with reference nutrient intake for a woman aged 50-64y. Analysis of the nutrient content shows that the parcels meet the nutritional needs of most adults (see Appendix 1 for full food list and nutrient analysis). The calorie content of 7.95 MJ (1900 kcal) per day would be enough to meet the average energy needs for women though would be below those for men, particularly those who are young and/or physically active.4 The fibre content of 26 g per day, while a little below the recommended 30g per day, is still a considerable improvement on the average UK diet pre-lockdown.5 The protein, vitamin and mineral content of the foods, shown in fig. 2, would exceed nutritional needs of most adults apart from that for vitamin D, for which guidance was issued to the effect that people should consider taking supplements of vitamin D during the lockdown period if they have to stay indoors.6 Image Fig. 3: Fat, sugar and salt content of the emergency food parcel compared with UK diet surveys. The standard food parcel also measures up favourably in relation to components of the diet which are harmful for health if consumed in excess. Fig. 3 shows that the amount of fat, saturated fat, free sugars and salt in the foods is below the recommended upper limits, notably for free sugars and salt which exceeded the recommended upper limits in pre-lockdown surveys.5,7 It is important to recognise, however, that food provides not only essential nutrients but also sensory interest, comfort, and a sense of cultural identity, all of which may be particularly important during a period of social isolation. Choice and variety have been recognised as an important factor in ensuring dignity in food provision by food charities,8 and an emergency food parcel can come at a cost to recipients’ humanity and dignity.9 Food is also a vehicle of cultural identity, solidarity and social cohesion. Most of the foods in the box would be familiar to most people but not necessarily part of their regular diet. Canned meats would be avoided by vegetarians and have caused offence to members of some religious groups10 while the limited variety of foods might mean that some items would not be eaten, leading to reduced nutrient intake and possible food waste. There is no provision for recipient choice or for adding other items such as savoury spreads for bread or condiments to add more flavour to the meals, though subsequent guidance in Scotland highlighted the potential for incorporating a wider range of foods to accommodate recipients’ food habits, bearing in mind the availability of refrigeration and cooking equipment.11 As part of the food distribution scheme local authorities also provided major supermarkets with lists of those who they have told to shield so that they can book a grocery delivery slot. Delays occurred as the initial lists provided by health boards did not contain everyone who is clinically vulnerable, and telephone and email enquiries were not always answered quickly. There was also confusion about whether the entitlement to food parcels and priority for grocery deliveries extends to others advised to take extra precautions during the pandemic such as those over 70y and pregnant women.12 Comments on government websites in the early weeks of operation of the scheme show that many people have appreciated the parcels but lack of clarity about who was entitled to them, how to be included on the lists and delays in receiving the parcels have caused hardship.13,14 Some recipients did not actually want or feel they needed the parcels but were afraid to cancel them for fear of losing priority for online supermarket deliveries.15 During the pandemic several restaurant chains and chefs turned to cooking hot meals for health care workers and those in need16,17 and in some places local community groups organised the provision of cooked meals using ingredients donated from restaurants and wholesalers.18 All the while charitable food banks, a last resort for those short of food, suffered from a reduction in donations and shortages of volunteer staff due to illness and self-isolation.19 The fact that these programmes have struggled to cope is perhaps not surprising given the sudden nature of the lockdown and that the collaboration needed between health practitioners, social care partnerships and food retailers is different in nature and scale to anything which has been implemented before. This is unfortunate as food and nutrition security problems in the UK are not new: even before the lockdown foodbank use was rising as a result to changes in the state benefit system20 and in 2018 national surveys found that around 10% of households had worried about running out of food for financial reasons,21,22 with younger adults, single parents and those with health conditions being at higher risk.23 A survey early in the lockdown period found a sharp rise in food insecurity, partly due to concerns about food shortages24 while a more recent survey found that the level of food insecurity was still around twice that of pre-lockdown times, with minority ethnic groups and those with a pre-existing medical condition or disability again at particularly high risk.25 The economic downturn caused by the pandemic will probably lead to more people unable to afford to eat well, which may be compounded by higher prices of food and vegetables as a result of food supply problems when the transition period for the UK leaving the European Union comes to an end at the end of 2020.26 Changes in the availability of and access to fresh foods and an increase in the consumption of processed and low-cost foods, especially those which are high in fat, sugar and salt would reduce the nutritional quality of the diet, compromising nutrition even if calorie intake is maintained. What is the experience of other nations in feeding their citizens during the pandemic? An international report on the impact of COVID-19 on food systems highlights the need for longer-term reform of already fragile supply systems for nutrient-rich foods, but stresses that the first priority must be to protect the most vulnerable.27 In most countries charitable organisations, volunteers and local governments have stepped up to provide or deliver food but a more rapid response has been possible in a few countries which had pre-existing food distribution schemes. The largest of these is the Public Distribution System in India which since the 1940s has used ration cards to provide reduced price commodities such as staple grains, sugar and cooking oil for many households, with greater entitlements for those below the poverty line. During the COVID-19 pandemic this infrastructure has been used to provide extra cereals and pulses and sometimes other foods, often at no cost, and in some states to extend the scheme to everyone in need. Although there have been problems such as access for migrant labourers and safety fears from the use of fingerprint ID, the system has been credited with preventing serious hunger for many people.28 In the USA the Supplemental Nutrition Assistance Programme has been in operation nationally since 1964 and enables purchases of groceries by the approximately 1 in 10 households below the poverty line, originally through food stamps but more recently via a debit-style card which can be loaded with credit centrally. During the pandemic the scheme has been used to provide an automatic ‘pandemic electronic bank transfer’ supplement for households with children who would otherwise have received free school meals: in some states additional credit has been provided and grocery purchases have been possible through Amazon as well as grocery stores to enable home delivery.29 These examples show that existing systems can pivot rapidly in crises but still need tailoring to the nature of each emergency, the local situation and the challenges of reaching each target population. Beyond nutrition, food distribution services may aim to address acute social needs by helping to tackle loneliness at a time of increased anxiety, and to enhance commensality and sharing. This recognition that food is more than calories and nutrition is embedded in the UN definition of the Right to Food as ‘the right to have regular, permanent and unrestricted access, either directly or by means of financial purchases, to quantitatively and qualitatively adequate and sufficient food corresponding to the cultural traditions of the people to which the consumer belongs, and which ensure a physical and mental, individual and collective, fulfilling and dignified life free of fear’.30 It is explicitly stated in UN General Comment on the Right to Food that the right to food shall not be interpreted in a narrow or restrictive sense which equates it with a minimum package of calories, proteins and other specific nutrients.31 Food systems can do so much more than provide calories – they can be engines of sustainable development and social cohesion, but to do so there is a need to move beyond a focus on food supply.32 At the institutional level more creativity, respect for food choice and recognition of the role that food plays in individual and community well-being is needed to transform food systems in the longer term. This requires a re-structuring of our cultural value systems to prioritise the rights of the vulnerable and a synergy of polices at local and global levels. Document Appendix 1: Average daily energy and nutrient intake provided by an emergency food parcel in the UK. (780.92 KB / ) Authors: Geraldine McNeill, Visiting Professor of Global Nutrition and Health, The Global Academy of Agriculture and Food Security Elizabeth Dowler, Emeritus Professor, Dept. of Sociology, The University of Warwick Kirsteen Shields, Lecturer in International Law and Food Security, The Global Academy of Agriculture and Food Security References Gov.UK. First food parcels delivered to clinically vulnerable people. 29 March 2020. https://www.gov.uk/government/news/first-food-parcels-delivered-to-clinically-vulnerable-people Manchester Evening News. Crunchies and Dairy Milk bars: this is what the government is including in emergency food parcels being delivered to the most vulnerable. 30 March 2020. https://www.manchestereveningnews.co.uk/news/greater-manchester-news/crunchies-dairy-milk-bars-what-18010098 Butler P, Lawrence F, Proctor K 2020. Doubts over take-up of government emergency food parcels. https://www.theguardian.com/world/2020/apr/01/doubts-over-take-up-of-government-coronavirus-emergency-food-parcels Public Health England 2016. Government dietary recommendations. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/618167/government_dietary_recommendations.pdf Food Standards Agency and Public Health England. NDNS: results from years 7-8 combined. 2018. https://www.gov.uk/government/statistics/ndns-results-from-years-7-and-8-combined NHS UK. Vitamin D. 2017. https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/ Public Health England. Assessment of salt intake in adults in England 2018 to 2019. 30 March 2020. https://www.gov.uk/government/statistics/ndns-assessment-of-salt-intake-in-adults-england-2018-to-2019 Nourish Scotland and The Poverty Truth Commission. Dignity in Practice: Learning tools and guidance for community food providers. March 2018. http://www.nourishscotland.org/wp-content/uploads/2018/03/Dignity-in-Practice-Full-Report-March-2018.pdf lDe Schutter O. Food banks are no solution to poverty. Guardian. 24 March 2020. https://www.theguardian.com/world/2020/jun/18/shielding-muslims-receiving-pork-items-in-england-food-packages https://www.foodstandards.gov.scot/publications-and-research/publications/food-package-provision-during-covid Walsh H. Which? calls for urgent government action to help vulnerable households access food. Which? 5 May 2020. https://www.which.co.uk/news/2020/05/which-calls-for-urgent-government-action-to-help-vulnerable-households-access-food/ - Which? Gov.UK. First food parcels delivered to clinically vulnerable people. 29 March 2020. https://deframedia.blog.gov.uk/2020/03/29/first-food-parcels-delivered-to-clinically-vulnerable-people/ Gov.UK. Nutritional content of the government food parcels. 2 April 2020. https://deframedia.blog.gov.uk/2020/04/02/nutritional-content-of-the-government-food-parcels/ https://forums.moneysavingexpert.com/discussion/6132135/cancelling-food-parcels-for-the-vulnerable Butler S. Leon sets up initiative to deliver free meals to NHS critical care staff. Guardian. 27 March 2020. https://www.theguardian.com/business/2020/mar/27/leon-sets-up-initiative-to-deliver-free-hot-meals-to-nhs-staff-coronavirus BBC. Coronavirus: Chef cooks 1,200 free meals a week in lockdown. 22 May 2020. https://www.bbc.co.uk/news/uk-england-bristol-52756668?intlink_from_url=&link_location=live-reporting-story https://www.bridgendfarmhouse.org.uk/covid-19.html Power M, Doherty B, Pybus K et al 2020 How COVID-19 has exposed inequalities in the UK food system: The case of UK food and poverty. Emerald Open Research 2:11. https://emeraldopenresearch.s3.amazonaws.com/manuscripts/14610/f1531648-66c8-4d3a-912f-72c512b0e105_13539_-_bob_doherty.pdf Loopstra R, Reeves A, Taylor-Robinson D et al. 2015. Austerity, sanctions and the rise of food banks in the UK. BMJ 350:h1775. https://doi.org/10.1136/bmj.h1775 Government Statistical Service 2019. The Food and You Survey: wave 5. London, Food Standards Agency and National Centre for Social Research. https://www.food.gov.uk/sites/default/files/media/document/food-and-you-wave5-combined-report-web-revised.pdf Scottish Government 2020. The Scottish Health Survey 2018. https://www.gov.scot/publications/scottish-health-survey-2018-volume-1-main-report/pages/46/ Sosenko F, Littlewood M, Bramley G et al 2020. State of Hunger. Heriott Watt University and the Trussell Trust, 2020. https://www.stateofhunger.org/wp-content/uploads/2019/11/State-of-Hunger-Report-November2019-Digital.pdf Loopstra R 2020. Vulnerability to food insecurity since the COVID-19 lockdown. Enuf, Kings College London and the Food Foundation. https://foodfoundation.org.uk/wp-content/uploads/2020/04/Report_COVID19FoodInsecurity-final.pdf Food Foundation 2020. New Food Foundation Data: Food insecurity and debt are the new reality under lockdown. https://foodfoundation.org.uk/new-food-foundation-data-food-insecurity-and-debt-are-the-new-reality-under-lockdown/ Lang T 2019. No-deal food planning in UK Brexit. Lancet 394; 814-5. https://www.thelancet.com/action/showPdf?pii=S0140-6736%2819%2931769-6 IPES-Food 2020. COVID-19 and the crisis in food systems: Symptoms, causes and potential solutions. http://www.ipes-food.org/_img/upload/files/COVID-19_CommuniqueEN%282%29. Rao J, Tiwari P 2020. Securing India’s food supply during COVID-19. https://pursuit.unimelb.edu.au/articles/securing-india-s-food-supply-during-covid-19 US Dept. of Agriculture Food and Nutrition Service. FNS Actions to Respond to Covid-19. 2020. https://www.fns.usda.gov/disaster/pandemic/covid-19 UN Committee on Economic, Social and Cultural Rights 1999. General Comment No 12 on the right to adequate food. E/C.12/1999/5. UNFAO 2002. The Right to Adequate Food in Emergencies: FAO Legislative Study 77. 2002. Caron P, Ferrero y de Loma-Osorio G, Nabarro D et al 2018. Food systems for sustainable development: proposals for a profound four-part transformation. Agronomy for Sustainable Development 38: 41.
