Wednesday, May 17, 2017

Malnutrition in England: not a suitable topic for a General Election

The media-led "debate" in this current general election studiously avoids any topic that might reflect badly on the Tories. There will therefore not be any discussion of  climate change, or of things like malnutrition in England, which is a scandalous problem. The Green Party would bring up these topics, but will not be granted time and space to do so.  

Here is a short review of malnutrition in our country:



The central purpose of government is to protect its citizens. Recent British governments have been failing to do this because there is a significant and growing incidence of malnutrition affecting all age groups. This is especially shameful when we remember that Britain is the sixth largest economy in the world. This paper looks at the size of the problem in the UK, its trends in recent years, and suggests a few measures that might help to reduce the problem.

How big is the problem?

Accurate figures on malnutrition are difficult to find.
It is well known that food bank usage has been expanding in recent years but the statistics of food bank usage cannot by themselves be taken to reflect actual hunger, as the reasons that people go to food banks are not simple, apart from the fact that benefit sanctions is an important driver of food bank use. The Tories can and do obfuscate the food bank issue, so it is not a good discussion point.++
What is undeniable is that food prices are rising faster than wages.

Here are the trends for food price inflation:
Food price inflation between 2010 and 2013 varies between 2-6%.

Incidentally, food price inflation in the UK is part of a tendency for food prices to increase worldwide.

Wage growth over the same time period rarely exceeds 2.5%:

Consumer Price Index inflation exceeds wage growth nearly all the time in these graphs. Food price inflation is if anything at the top of CPI. It is to be expected therefore that those on lowest income will find it increasingly difficult to buy adequate food - especially those affected by the Conservatives' savage benefit cuts.

The British Association for Parenteral and Enteral Nutrition report that in the year 2011-12 the cost to the State presented by malnutrition in England alone (not the UK as a whole) was £19.6 billion, around 15% of health and social spending. Most of this cost fell on hospital care, as malnourished people take longer to recover from illness.
Of this £19.6 billion, 52% was for older adults, 42% was for younger adults, and 6% was for children. NHS expenditure on a malnourished individual is more than 3 times greater than on a well nourished individual.

Malnutrition of children costs us £1.176 billion a year. Malnutrition of children is of especial concern, since it has an impact on health throughout subsequent life. Malnourished children are prone to infections, are smaller, lack energy, suffer problems associated with brain development and motor control. 48% of teachers report that some of their children are under-fed, and many teachers state that they bring food into school to help hungry kids to concentrate.

Apart from the human suffering caused by malnutrition, there is a point to be made that there are significant financial savings to be made if we have an effective response to malnutrition.
Addressing the problem of child poverty is an excellent long-term investment.

The problem of obesity attracts attention at present. It should not be seen as the opposite of malnutrition, but as a form of malnutrition.

A growing problem?

The problem of malnutrition seems to be growing.

Here is a graph of statistics from NHS Digital :

The best source on malnutrition incidence is hospital admission data. Hospital Episode Statistics show that there was a 34% increase in malnutrition cases between 2011 and 2014.

Rickets cases were on a rising trend until 2011, which is pretty shocking considering that rickets is considered a problem of the Victorian era:

These graphs suggest a trend, but must be interpreted with caution. The tendency for children not to play outdoors in recent years is a factor, as well as poor diet.
Whatever the cause, vigorous identification and treatment (vitamin D supplements and assistance with diet and lifestyle) of rickets is needed.

Malnutrition in the UK is under-studied and under-recognised. NICE has guidelines about managing obesity, but none on malnutrition, and no guidelines are planned at present.

What needs to be done?

  1. Recognise that we as a nation do have a major problem
  2. Alert GPs, Health Visitors and schools to the problem so that cases are found earlier
  3. Stop and reverse the downward pressure on benefits
  4. Educate those on benefits on how to obtain and cook cheap yet nutritious meals, while avoiding expensive sugary drinks and food.
  5. Consider a well-designed food voucher system for those at risk (controversial: but objectors should be asked to provide an effective alternative)
  6. Put an end to food waste in supermarkets
  7. Ban advertising of processed foods on TV programmes targeted on children
  8. Encourage children to play outside more - to prevent rickets
  9. Encourage production of food in gardens and promote the “Incredible Edible Todmorden” model

Richard Lawson


No comments: