According to the WHO, world hunger is on the rise again due to conflict and climate change, after falling for the previous decade. In a report published September 2017, it estimated that 815 million people were suffering from hunger, more than one in every ten people globally, 98% of whom are found in developing countries.

However, while hunger is a prevalent form of malnutrition in developing countries, malnourishment can also be found far closer to home, here in the UK, where its impact is significant and increasing. NHS England calls malnutrition a “common problem”, affecting millions of people in the UK. It is largely a concern for those with long-term health issues that affect appetite, people who are socially isolated and with limited mobility, and most commonly, the elderly. Following a study undertaken by the Office of National Statistics, which showed that 391 people died in the UK from malnutrition in 2015, former Lib Dem leader Tim Farron called it a, “national scandal that anyone is being admitted to hospital from malnutrition.” So, what is really is to blame for such high rates of the condition, in one of the world’s richest nations?

‘Malnutrition’ means, literally, ‘poor nutrition’ and technically it can refer to over-nutrition – getting more nutrients than you need, as well as under-nutrition – not getting enough nutrients or an inadequate balance of nutrients. In the UK the available statistics for malnutrition relate only to under-nutrition, hence our focus on this issue in the Sustainable Food Trust’s recently published report, The Hidden Cost of UK Food.

Drawing on published research, the report calculated that malnutrition costs the country approximately £17 billion annually. This includes the cost of treating malnourished people in hospitals and long-term care facilities, GP visits and outpatient appointments. In general, rates of malnutrition are not due to a shortage of food per se, but to a range of complex issues which include increased consumption of processed foods and reduced preparation of meals from fresh primary ingredients, part of which relates to low incomes and part of which relates to poor nutritional education and/or the lack of adequate food preparation facilities.

Worldwide, around 2 billion people suffer from malnutrition, costing the global economy $3.5 trillion per year. Within that figure, undernutrition and micro-nutrient deficiencies cost up to $2.1 trillion per year. In the UK, a study by BAPEN estimated in 2005 that more than £7.3 billion was spent on treating malnutrition annually. According to the study, this was made up of £3.8 billion for treating malnourished patients in hospitals and a further £2.6 billion for similar treatment in long-term care facilities. These figures make up part of the £17 billion annual sum, as outlined in the Hidden Cost report, which notes that the level of malnutrition in the UK increased from 15% in 2005 to 17% more recently, and includes other costs associated with malnutrition, as well as accounting for inflation.

The report shows that malnutrition is just one of the hidden costs of our current food system. What the report exposes, more broadly, is that for each £1 spent on food in the shops, consumers incur hidden costs of £1 from externalities of the food system. This means that in addition to the £120 billion spent annually on food by consumers, the UK food system generates further costs of £120 billion, nearly 30 times higher than composite estimates have indicated.

Approximately half of this total is made up by the damaging impacts of intensive production methods, including environmental pollution, soil degradation, biodiversity loss and health impacts from things like pesticides and antibiotics. Food-related healthcare costs, linked to poor diets, account for a total of 37p of these hidden costs. The report explains that these costs are not paid for by the food businesses that make unhealthy foods, nor are they included within the retail price of food more generally. Instead they are passed on to consumers in a variety of hidden ways, including through both state and local taxation, water charges, additional healthcare costs and insurance, and lost personal income caused by time away from work when sick. In effect, UK consumers are paying twice for their food – once at the checkout, and again through these extra charges.

Studies show that the number of hospital beds in England taken up by patients being treated for malnutrition has almost trebled in the last 10 years, due to what some charities have described as the “genuinely shocking” extent of hunger and poor diet. This upward trend is often said to be a result of rising poverty, deep cutbacks in recent years to ‘meals-on-wheels’ services for the elderly and inadequate social care support.

Factors cited as the cause of the increase in poor diet are often political and socio-economic in nature, particularly with reference to the increase in levels of child malnutrition, which is now believed to be more than simply the consequence of inadequate health and food education. Recent figures suggest that amongst hospitalised children in the UK, 16% were severely stunted, 14% wasted and 20% at risk of severe malnutrition. Additionally, the National Child Measurement Programme determined that 11,317 children in the United Kingdom were underweight in 2010. The lasting effects of malnutrition on children include long term issues such as increased incidence of illness due to poor nutrition, and gastrointestinal infections, which compound and make it harder to fully absorb nutrients. As such, malnutrition combined with infection can undermine a child’s growth, and in the long term, can also undermine brain development, causing delays in motor and cognitive functions.

As well as its prevalence amongst children, malnutrition affecting the elderly was commented upon by Stephen Dalton, the chief executive of the NHS Confederation, in a recent Guardian article. He said: “Our members take malnutrition seriously. Good nutrition is a fundamental human right our citizens can expect, and vulnerable, particularly older, people are most at risk of serious consequences if denied basic compassionate care.”

Alongside issues of health care and social support mechanisms, or lack thereof, there is another, less well understood reason as to why malnutrition is so prevalent within our society: the fact that we have a failed food-pricing system which provides perverse incentives that reward farmers, land owners and food businesses for intensifying their farm systems at the cost of the environment, whilst discouraging those who want to conserve and enhance natural capital, biodiversity, non-renewable resources and health. The knock-on effect of this hugely inhibits access to fairly priced, sustainable produce – which is often much higher in price than its intensively produced counterpart, where many of the production costs are passed to individuals and to society in hidden ways.

For the first time in more than 40 years, the UK will be setting its own unique food and farming policy over the next year or two. While there are some encouraging signs that a more enlightened approach is being contemplated, it’s up every one of us to make sure that politicians and policymakers take account of the true cost of issues like malnutrition in the UK, and in future encourage the production and consumption of genuinely wholesome and sustainably-produced food.

The Government has now released it’s command paper on post-Brexit agriculture policy and is seeking views on the proposals for agriculture policy in England.

Photograph: Elvert Barnes

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