by Rebekah Graham, February 2019
Addressing the social injustices that underpin health issues
One in five children in Aotearoa (New Zealand) live in households without access to sufficient food for health and well-being. Government hardship grants for food remain at an all-time high, indicating that for many families, providing sufficient food is an ongoing struggle. These families are experiencing food insecurity. Food insecurity refers to the absence of sufficient, nutritionally adequate, safe foods, as well as the inability to acquire such foods in socially acceptable ways.
The main driver of food insecurity in Aotearoa is poverty. Low-income earners are frequently left without adequate resources to purchase enough to eat for the household.
Alongside food insecurity, poverty creates sickness. Professor Innes Asher’s work clearly shows that poverty is a key cause for acute and chronic ill health in children; over the past 30 years, the rate of hospitalisations among children with potentially preventable illnesses has increased by 50%.
What happens in already-struggling households when a child is admitted to hospital? Things get worse. Paediatric wards in public hospitals in New Zealand provide three meals a day for admitted children. However, parents are not routinely provided with meals and those who cannot afford to purchase food from the hospital cafeteria go hungry. Frequently, such parents have to rely on busy nursing staff noticing a parent is going without food and supplying a packed lunch on the sly or organising an exemption.
Participants in my recent hospital-based study (article forthcoming) shared stories of going without food for several days, surviving on cheap, readily available items such as the ubiquitous “pie and drink” from the local dairy (corner shop), and of desperately hoping their child wouldn’t eat all their dinner so that they could at least have something to eat. “Pureed stuff is what he was getting so I was eating that,” one parent told me. The hospital café is simply too expensive for parents already on a tight budget.
Even where parents did have a few extra dollars for food, some found it difficult to leave their children, who require personal care, feeding, and much-needed comfort and emotional support during a distressing time. As one participant notes, the local dairy was a long way away from the paediatrics ward:
I was starving … I didn’t have any means of getting stuff. I was told there are shops you can go down and use the laundromat and things like that, but I couldn’t walk all the way down there in between her doses of medication.
Parents were loathe to leave their child alone without someone to look after them, making their already difficult experience even more stressful:
It would be really good if the hospital could feed the parents as well, because I would have to wait until baby was asleep and then run down the road or run to the café or whatever and try and get back before he woke up. That is just another added pressure. It would be good if the hospital could take that pressure off … the café is too expensive so I have to go to the shop across the road from the hospital, and I worried about that when I went over there, if he wakes up are they going to know that he is up, are they going to hear him crying because they are so busy.
For families on highly constrained incomes, the extra expenses associated with a hospital stay, such as reduced work hours, taking (unpaid) time off work, parking and transport costs, and the need to purchase additional food or personal care items, places them under significant financial strain.
Reduced income and increased expenses left some families particularly stretched during a child’s hospital stay. One family in my study required a food grant to make ends meet, while another rationed food and went without:
These couple of weeks [since being in hospital] have been our
mostpoorest weeks and my kids come home [saying], “we’re hungry, we’re hungry”. They don’t understand the concept of we have to ration what food we have and there is not enough money to buy anything else. They don’t understand.
The costs associated with a child’s hospitalisation (both financial and other) exacerbates food-related insecurities, leaving families with even less than before. This strain is exacerbated for families from rural areas who do not have family locally to provide support (e.g., caring for the rest of the family). Mothers, in particular, are left isolated and without meals while in hospital caring for their unwell child.
Pinching pennies by avoiding the provision of meals for family members of hospitalised children may seem fiscally responsible to (wealthy, food secure) Board Members and CEOs of District Health Boards, but it is a false economy. In actuality, such short-sighted savings contribute to the root causes of the problem. As Prof Innes Asher notes, poverty and food insecurity contributes to increased hospitalisations of children. Failing to provide meals for parents of children in hospital, particularly mothers, who are meeting the essential care needs of their sick child, perpetuates the cycle of poverty, food insecurity, and preventable illness. Instead, as my research shows, health boards need to take a wider view and, importantly, to listen to people living in financial hardship, who experience difficulties that those with secure incomes often do not even anticipate.
Dr Rebekah Graham works as a researcher in the area of social determinants of health, with a particular focus on food-related practice and the impact of food insecurity on people’s well-being. Rebekah lives in Hamilton with her husband, four children and a very large orange cat. She tweets from @bexgraham and you read more of her work on food insecurity here and here.