This case study forms part of Shaping Places for Healthier Lives, a grant programme funding five council-led partnerships across England to build places that support good health for all. The programme is funded by the Health Foundation, delivered in partnership with the Local Government Association, and supported in delivery and learning by the Design Council and Cordis Bright/PPL.
Newham Council and its partners are using their SPHL project to explore the issue of food insecurity for young people aged 11 to 19. Food insecurity is a key driver of poor health outcomes. Newham’s ambition is to create a system shift in how the borough’s food insecurity interventions are framed and delivered.
Newham’s population is the youngest in England, according to the 2011 census, and very ethnically diverse. Approximately 40,700 young people aged 11-19 live in the borough. Almost half (49 per cent) of Newham’s children and young people were living in poverty in 2020/21, in households with an income of less than 60 per cent of the UK median after housing costs have been subtracted (Trust for London).
The ‘We are food secure 11-19’ team chose to focus on this age group because it is such an important life stage in terms of nutrition. Adolescence represents the second-fastest growth period after the first two years of life, and good nutrition is critical as a basis for adult health. There is little research on how food insecurity is experienced by teenagers or the impact on their health and wellbeing.
The project involves the council’s public health team, the Association for Young People’s Health (AYPH), and academics from the London School of Hygiene and Tropical Medicine (LSHTM). They are seeking to understand and address:
- What can be done to help 11-19 year olds get good nutrition in the face of challenges such as the cost of living crisis?
- How are their experiences different from other age groups?
- Can any new levers for action be identified that will improve things for this age group?
The team began by exploring young people’s experience of food insecurity. In the first 18 months, they delivered three rounds of engagement with young people, a review of the evidence and two sets of stakeholder engagement.
Work to understand and map out the complex system of determinants and impacts of food insecurity for young people in Newham has been led by Natalie Savona, Honorary Assistant Professor at the LSHTM, a system mapping expert specialising in responsibility for healthy eating in the food system and influences on people’s food choices.
This mapping work focused on the complex interaction between the settings where young people live, learn, socialise and play, and food security. The influences including poverty, developmental stage, the commercial food environment and social norms.
It revealed two main places where there is room for specific interventions for this age group: at secondary school and at out-of-school provision after school and at weekends.
Natalie Savona is also working with Newham Council on another system mapping project on healthy weight, and the combined effect is beginning to encourage public health colleagues to think in a wider, more systems-focused way.
Ann Hagell, AYPH Research Lead and a member of the Newham team, said:
This was one of the main aims in our original bid, to embed systems thinking in the way the public health department goes about its work – thinking about what some of the levers and drivers might be. What we are now planning, in terms of interventions on the ground, have arisen out of conversations that we facilitated because of the system map.”
Complex system mapping for age groups
The project is demonstrating the value of complex system mapping in relation to a specific life stage. Ann said: “Don’t just assume that what you are doing for 0-5 year olds, or older adults, is what you should be doing for teenagers. They live in a different world and think in a different way.”
Newham recognises that a complex systems approach will bring together a broad range of stakeholders including children, young people and families; various teams within Newham Council; the voluntary, community and faith sector; pan-London stakeholders; and food service and retail operators.
Listen to your target group
The best way to learn about people’s lived experience of food insecurity is to ask them. So far, three groups of young people have been involved in engagement work within Newham schools. A workshop with young people at the outset informed how the project was planned. Work is also underway to engage with young people using out-of-school provision.
The Association for Young People’s Health does a lot of engagement work with teenagers. Ann said:
The main messages are always ‘see me, I’m a person, not just an exam result. Think about my life in the round, treat me with respect and communicate in ways I can understand’.”
For example, people in Newham said the following things about food in school:
“A lot of people don’t bother eating at school, saving money for later or to eat/cook at home.”
“The price should be affordable for families who struggle.”
“Spaces to eat food are really important as well as food.”
“I would like the council to know how food shortages affect young hungry people.”
“They build music rooms [using] so much money but no space to eat properly.”
Valuing food in schools
The project has shown that food is often under-valued in the secondary school setting. At best it is seen as an opportunity to refuel quickly and with minimal disruption; at worst it is seen as an inconvenience and a burden for staff and budgets. They have found that while schools cannot be expected to solve every social problem for young people, food does seem to be under-considered within secondary education.
Taking a systems approach to this complex issue involves looking at it from a teenager’s point of view. The team has considered challenges such as the timing of the school day; some teenagers finding it difficult to eat early in the morning; their natural tendency to ‘graze’; and the temptation of unhealthy food at lunchtime/after school when feeling hungry.
They have identified a number of barriers to change – from food not being considered important by those managing or governing schools, to the challenges of ensuring that contracted caterers can make the necessary profit while providing young people with access to healthy choices.
Time to talk
The project partners bring different and complementary strengths. They value the opportunity to meet for an hour every fortnight to discuss these issues and consider ideas. Putting time aside in this way is not always possible within a busy public health team, and is something that has been enabled by the SPHL funding.
Both the issue of food security for young people and the idea of complex system mapping have strong political and senior management buy-in at Newham Council. The elected mayor strongly supports the children and young people’s agenda and this commitment runs through all of the council’s work.
One of the challenges has been to keep the focus on food insecurity and not on nutrition, as the two things are intrinsically linked.
Newham’s complex systems approach aims to build on and expand existing strategies and interventions but also allow more creativity and new connections, identifying new levers for action.
Newham Council is one of only a handful in England that provide free school meals for all primary-age pupils, from Reception to Year 6. ‘Eat for Free’ costs around £6 million a year and is highly valued by the community. During the second half of the SPHL project, the team plans to build on this by trialling something similar in two secondary schools, perhaps with a particular year group.
They will work with these schools to explore the idea of developing a whole-school approach to food. Each school will have a small budget to spend and the opportunity to think about how to use it.
The team will also work with two or three voluntary sector organisations and after-school facilities to explore whether the 3 to 6pm period could provide another opportunity to address food insecurity through clubs and after-school settings.
Sharing our thinking and learning with other people will be a very important output from this project. We are doing some of the thinking and groundwork on what the issues and levers are, in terms of this age group and food insecurity, and we are very keen to share that in a range of different ways.”