Child food insecurity in the UK: evidence on its extent, nature and effects and what can be done to address it. A rapid review

Food insecurity is a social and economic problem that involves difficulties in accessing sufficient, safe, and nutritious food necessary to meet individuals' dietary requirements and preferences for a healthy life.1 This is a multifaceted phenomenon, where each stage is typi?ed by conditions and experiences of food insuf?ciency and behavioural responses.2 Food insecurity may be experienced when there is i) uncertainty about future food availability and access, ii) insuf?ciency in the amount and kind of food required for an optimal and healthy nutrition status, or iii) the need to use socially unacceptable ways to acquire food.3 There are various indicators of food insecurity, such as quality, variety and desirability of diet as well as total intake, but not all are measured consistently.4 Measuring food insecurity is challenging, especially in children, and there is currently no gold standard to assess this issue in an effective, efficient and feasible way among young people.5 Food insecurity in children may jeopardise their health and development. A key indicator for food insecurity is low income.6 Poverty and food insecurity during childhood has immediate-, short- and long-term consequences for physical health, mental and emotional health, cognitive development, educational achievement and future employment and earnings prospects.7, 8 Poverty in children in the UK is on the increase. Around 30% of children in the UK are currently living in poverty, representing a notable reversal in the trend of decreasing poverty levels evident over the past 20 years.9 Furthermore, it is estimated that around 4 million children (three in 10) live in poverty in the UK after housing costs are taken into account (2.7 million or one in five before housing costs).3 According to recent Scottish data, 10% of children live in relative poverty (including variations in household size and composition net income for one year of less than 60% of median), 5% live in absolute poverty (variations in household size and composition net income of less than 60% of the a financial year; involves taking account of changes in the value of money since the financial year), 5% live in a combination of low income and material deprivation (variations in household size and composition net income of less than 70% of median net household income for the year and experiences material deprivation in the year), and 5% live in persistent poverty (variations in household size and composition net income of less than 60% in at least 3 of the survey years).10 It is always challenging to estimate how many children who live in poverty are hungry or food insecure, but recent evidence shows that signs of childhood hunger have become more visible to health workers and school staff, especially on Monday mornings or the first day back from school holidays.11 Projections indicate that the number of children living in poverty in the UK, hence at higher risk of food insecurity, may rise to as many as 5 million by the end of this decade. 12, 13 Food insecurity is not only a matter of sufficient (in quantity and quality) nutritious food, but is also a matter of social justice.14 Considering the high number of children at risk of food insecurity, and the associated health consequences, more efforts to adequately measure and tackle food insecurity are needed. Therefore, it is important to improve our understanding of the links between child food insecurity, health and developmental consequences, as well as any recent attempts to address it. Main objective To determine the nature, extent, and consequences of food insecurity affecting children (< 16 years old) in the UK. General methods This rapid review will focus on five main aspects of child food insecurity: 1.The nature and determinants of child food insecurity. 2.Estimations of the incidence, prevalence, and costs of child food insecurity in the UK, including recent trends. 3.The impact of child food insecurity on health in terms of physical, mental and social well-being. 4.Evaluated interventions to eliminate, reduce or mitigate food insecurity and its effects on children. 5.The cost-effectiveness of interventions designed to tackle child food insecurity including long term modelling economic impacts. For each of these aspects, specific research questions will be formulated and relevant methods described. However, a number of elements are common across each research question, namely: Literature searches Participants/population Methods for selecting evidence (data screening, selection and synthesis).