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.
Shropshire is one of England’s most rural and sparsely populated counties. Research on the topic of food insecurity often has a focus on urban areas, so Shropshire’s SPHL project is looking at food insecurity in south-west Shropshire – a very rural part of this rural county. The project involves Shropshire Council, Healthwatch Shropshire, the Shropshire Food Poverty Alliance and Citizens Advice Shropshire as key partners.
Living in a rural area brings specific challenges for people on low incomes, and this has been exacerbated by the cost of living crisis. Many rural jobs are low paid. Transport costs are higher as people have to travel further to access work, training and essential services. It is more difficult for rural residents to access affordable healthy food: shops that serve these communities tend to be more expensive and public transport options can be very limited. These extra costs add up for rural families.
Mapping the food landscape
Shropshire’s SPHL partners are exploring how a systems approach to food insecurity can impact on health inequalities, and how supporting the community can lead to sustainable change. The long-term vision is that statutory and voluntary services will work with communities to ensure that everyone in Shropshire has access to the help and support they need to prevent food insecurity.
During the first 18 months of this three-year programme of work, the partners set out to understand the complexity of the local food landscape, the extent to which a healthy diet is unaffordable for some, and how access to healthy food is constrained by rurality. This involved:
- Mapping access to affordable healthy food for communities within south-west Shropshire.
- Identifying challenges/barriers affecting access to, or consumption of, healthy food.
- Identifying local assets, opportunities and levers for change to improve the local food environment.
The project team led a series of engagement activities with stakeholders and people with lived experience of food poverty. This helped them to understand the particular challenges faced by people living on low incomes in rural areas. They also reviewed the existing data and intelligence.
All this information was combined to develop a complex systems map of food insecurity in south-west Shropshire, which identified four levers for change:
- Strengthen the system: creating a learning and feedback structure which brings partners together from across the system.
- Economic: enabling individuals to maximise their income.
- Social: reframing food insecurity as a public health issue.
- Community: build on local assets to develop sustainable community-led solutions
Strong partnership working has driven the Shropshire project since its inception. Complex system change must involve a broad range of agencies and organisations, so the project’s reach is far wider than the four key partners.
SPHL funding is providing new opportunities for all stakeholders to work together and learn from each other. The project team is connecting and driving this work. They are working to understand the system-level changes that different actions are having, including to inform further development of the project. Some examples of the learning so far are outlined below.
Food is more expensive for rural communities
Early on in the project, a ‘basket research’ exercise saw volunteers from Healthwatch visit food shops across south-west Shropshire to compare the price of 20 essential items. This was plotted on a map, which revealed that the price of food was much higher in rural towns and villages – in some places the cost almost doubled.
This exercise was repeated in November 2022 to explore how inflation had impacted on the price of food in rural areas. Developing the food basket research has proved to be a useful tool to engage local stakeholders and open conversations about these issues.
Linking primary care and food banks
Valuable links are being formed between primary care and food banks. Primary care outreach within food banks has created new opportunities for people to access the physical and mental health support they need.
This began with primary care networks in Shropshire wanting to do more to address health inequalities. In one food bank, a trainee GP helped to introduce a mental health triage service. The food bank team was given an electronic tablet on which clients can complete a questionnaire about how they are feeling. The GP practice can then triage them to the right support.
In another food bank, connections were made with primary care to offer basic health checks such as blood pressure testing. That soon progressed, and now a primary care practitioner visits the food bank twice a week. There is a private consultation space where people can discuss their physical or mental health concerns.
The SPHL team found that many food bank clients were not registered with a GP practice or did not feel comfortable going there. Val Cross, Health and Wellbeing Strategic Manager at Shropshire Council, said:
Bringing health services into food banks is a great example of the difference that partnership can make. It is a really effective way of reaching people not registered with a GP practice, one of the groups we really want to reach.”
Food banks can provide access to wider support
Food banks play a critical role in the local food landscape. The Shropshire partners are working to reduce the stigma associated with visiting food banks, and to build on their role in signposting and helping people to access to wider support – with the aim of preventing food poverty and reducing health inequalities.
In research with Shropshire food bank users, most (more than 85 per cent) said they needed additional help with issues such as household finance or housing. The partners are piloting Citizens Advice ‘advice first aider’ training in food banks in south-west Shropshire. Volunteers will be empowered to support clients to access self-help – and trained to make referrals where appropriate.
Kate Slater, Community Project Coordinator for Citizens Advice Shropshire, said: “In our initial discussions with these organisations we realised that they don’t always know where to signpost people to. It might be a case of providing laptops so that volunteers can sit with customers and guide them through the various websites to find out some answers. It would be a first port of call, and if that person needs a referral they would still get one.”
This could take some of the pressure off local advice services, which are overwhelmed.
It’s about enhancing those existing community assets – not creating more work for them but hopefully making it easier for everyone by giving them more tools.”
Supporting those who support
The voluntary and community sector (VCS) is under immense pressure, and this is affecting the mental health of frontline workers and volunteers. Shropshire’s SPHL partners are exploring how to support those people who provide support to others.
The partners worked with the Samaritans to put on a session for food bank volunteers on the importance of debriefing, to ensure they don’t take home all the difficult things they hear during the day. Further mental health training sessions for VCS organisations are planned.
Cathy Levy, Public Health Development Officer at Shropshire Council, said: “It is so important to support those on the frontline who spend their days managing everything for other people – particularly as they may be impacted themselves by the rising cost of living.”
This is just some of the work underway in Shropshire to explore the challenges of food insecurity in a rural population. The immediate focus is on community assets – how the partners can work alongside organisations such as food banks and the VCS, exploring new ideas and partnerships. Some funding has been put aside for grants to community projects to take this forward.
Emily Fay, Shropshire SPHL Programme Manager, said:
Thinking about complex systems change and the levers that we have to create change, we realised that most of the drivers of food insecurity are not local. Much of it comes down to funding and policies at a national level. That restricts what we can actually do to change the situation, so we are working to influence and improve what we can at a local level.”