Tiny Isaacson is retired and lives by himself in Totterdown in central Bristol. The 67-year-old has a heart condition which means he suffers from fatigue and breathlessness. His only income is the state pension. Buying fresh, nutritious food takes thought – and careful money management.
“Where I live it’s very hilly, so getting out is a problem,” Isaacson says. His options for food shopping are either to struggle up the hill to the bus stop, “which is exhausting – often I get to my front door and can’t face it”; fork out £10 on a round-trip taxi fare to the nearest supermarket; pay a significant proportion of his grocery bill to have it delivered; or rely on local shops half a mile away.
This is the type of fresh food dilemma that prevents many people on low incomes from being able to eat what they need to stay healthy. Supermarkets may not be the only answer to affordable fruit and veg, but many millions almost entirely depend on them. In certain areas of the UK’s major cities, getting to a supermarket is difficult.
Bristol, criss-crossed by major arterial roads and a river which makes for tricky access between localities, has 84 supermarkets, according to the city council’s recent mapping exercise. On some big estates, however, this might be just a Tesco Express stocking a limited range of fresh produce. In some areas, the grocery superstores have yet to venture: in deprived areas, this means nutritious, healthy food choices for those without a car or the cash for a bus fare are severely curtailed.
The health impacts resulting from poor nutrition are now causing enormous concern to the NHS and policymakers, says consultant interventional cardiologist Dr Ali Khavandi who writes the Cardiologist’s Kitchen food blog in an attempt to offer his patients easy ideas for healthy meals that don’t cost the earth.
In the UK, Khavandi observes: “Back to basics [foodstuffs], like sourdough have now become artisan and command high prices, and the foods that are cheap are the processed foods, which have become industrialised.” Unhealthy food habits die hard, he observes with some frustration. “There are a lot of perceived barriers [to healthy eating] which may not in reality be that huge. But if your normality has become ‘I can get really cheap and convenient food’, then a shift to buying fresh and cooking it which is a bit more hassle can become a big barrier.”
With diet-linked obesity and diabetes on the rise, the health implications of living in food deserts are becoming stark. Lack of access to healthy food – which many now substitute with sugar, salt, trans-fat and additive-packed takeaways – will lead to future health problems too. Dwindling confidence in how to cook food from scratch will affect the health of tomorrow’s families as today’s children grow up without the knowledge or practical skills to make nutritionally balanced meals.
People do know what they should be eating, “but they don’t have enough money to buy it”, says Kayleigh Garthwaite, research associate at Durham University, and author of Hunger Pains: Life inside food bank Britain. Clients she met while volunteering at a food bank were worried about wastage when they bought fresh produce, and while she says many made efforts “trawling the shops for hours for the cheapest food”, if you have physical problems, or young children, this becomes far harder to do.
Bristol city council, which has just been awarded a silver sustainable food city award, is keenly aware that there are pockets of the city where residents struggle to eat well. “In Avonmouth, a deprived part of north Bristol, you can get two eight-packs of Penguins for a pound, yet it costs 50p for an apple,” says Sally Hogg, public health consultant at Bristol city council. “Sixteen percent of households in Bristol suffer from some sort of income deprivation, and so are at risk of food poverty, leading to an inability to access food that would make up a healthy diet.”
To address this, Hogg cites a multiplicity of outreach and local food projects focused on disadvantaged areas that are happening across the city. These range from how to grow your own food, to cookery lessons, to selling off allotment gluts at low prices. Despite all this activity, there are still gaping health inequalities that are proving stubbornly hard to address at a fundamental, rather than a project-by-project level, observes Stewart North, food bank manager for the Trussell Trust’s north Bristol food bank. The various food festivals, micro food projects and learn to cook sessions are great in principle, he says, “but how long term and sustainable that is we will have to see. There needs to be a far more joined up approach to it locally.”
The stress of not knowing if you’ll be able to eat at all, let alone eat healthily, affects food bank clients’ mental health too, North points out. Isaacson has found his own solution to his fresh food problem. To get free delivery on his main grocery shop, he has to spend enough to buy three weeks’ worth at a time. Inevitably, he runs out of fruit and veg, as well as fresh meat and fish, after seven or eight days.
Recently however, he has taken advantage of the service offered by grocery company Fresh Range that launched in Bristol just last year. It sources fruit, veg, meat and fish from local producers and farmers, cutting out the middleman to offer lower prices: in order to make its food as accessible as possible to people on limited incomes, founder Rich Osborn has chosen to take the uncommercial step of charging a pound to make a doorstep drop on a minimum £20 spend. This means Isaacson can now buy fresher produce than much of what’s on offer elsewhere.
As someone who talks daily to patients about how to pursue a healthier lifestyle, Khavandi would prefer it if someone like Isaacson made the effort to walk up the hill to the bus stop en route to do his food shop in person, but knows this is difficult given the physical discomfort this can entail. Ensuring decent nutrition is at least a start to addressing individuals’ health issues. Without his doorstep delivery, Isaacson says, “I wouldn’t have any fresh food after that first week.”
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