Life on the margins: the inequality of food and nutrition security RESPONSE AND MANAGEMENT: FOOD AID AND ASSISTANCE

1. Life on the margins: the inequality of food and nutrition securityRESPONSE AND MANAGEMENT:FOOD AID AND ASSISTANCE PowerPoint presentation by Médecins Sans Frontières / Doctors Without Borders (MSF) UK Schools Team: Mary Doherty and Severa von Wentzel January 2014

2. Response and Management: Food AID and ASSISTANCE

3. Management of food security and supply • Management of food security and supply, an age-old topic, became very topical in the 2000s because of • Economic concerns following food price shocks of 2006-2008 • Environmental concerns such as climate change, soil degradation and water • Health, particularly growing malnutrition including obesity epidemic and related non-communicable diseases • Concerns with resilience of food supply; for instance, in the UK after the lorry strike that brought the country to 5 days from shortages • Most current policy responses focus on supply side (producing more), but given global numbers of hungry this is not working on its own. Consumerism and markets need to be accompanied by policies that help rebalance power. Source: “Food Security and Sustainability: One Can’t Make an Omelette Without Cracking Some Eggs” http://vimeo.com/24914046

4. Challenges • To sustain global commitment • To boost country-level commitment • To translate commitment into action • To boost improvements in nutritional status and livelihoods Source: http://download.thelancet.com/flatcontentassets/pdfs/nutrition_5.pdf

5. International consensus The focus is still largely on addressing undernutrition, not the double burden of malnutrition. International management is increasingly needed to ensure food supply and security. Initiatives such the UN REACH and the Millennium Development Goals have been followed by the L’Aquila initiative and New Alliance for Food Security and Nutrition and US Feed the Future, "1,000 days" campaign and “Scaling Up Nutrition” (SUN). These are developed by government, academic, research institution, civil society, private company, development agency, UN organisations and the World Bank specialistsand bring together countries suffering high levels of malnutrition with major international food donors. There is a growing scientific and political consensus on the need to focus on children under two. Source: MSF “Food Aid System continues to fail malnourished children” http://www.msf.org/article/food-aid-system-continues-fail-malnourished-children

6. Millennium Development Goals In Sub-Saharan African countries levels of malnutrition are declining very slowly, remain very high or are growing, while there are have been large declines across Asia, Latin America and the Caribbean. FirstMillennium Development Goal: reduce by half the proportion of people who suffer from hunger between 1990 and 2015. (ftp://ftp.fao.org/docrep/fao/012/i0876e/i0876e02.pdf). Based on the latest FAO undernourishment estimates, this can be met if appropriate actions are taken to reverse the slow down since 2007/2008. Further info: Save the children, Ending poverty in our generation. https://www.securenutritionplatform.org/Pages/DisplayResources.aspx?RID=143 MDG, Food and Agriculture: http://www.mdg-review.org/index.php/sections/38-food-a agriculture/56-mdg-food-and-agriculture Source: http://beijingcircles.files.wordpress.com/2010/09/mdgs-large.jpg

7. MDGs: sustainability and gender Environmental sustainability and gender equality are key to meeting Millennium Development Goals. “We have learned from the experience of the MDGs. There have been huge successes, but also gaps. I believe the new goals need specific targets on hunger and nutrition. I believe we need a strong emphasis on agriculture, and in particular climate-sensitive agriculture. I believe we need a stronger, more specific approach on the rights of women and girls.” - Irish Minister for Foreign Affairs and Trade Eamon Gilmore “Conserving the agricultural resource base and livelihood security of the poor can be mutually supportive in three ways. First, secure resources and adequate livelihoods lead to good husbandry and sustainable management. Second, they ease rural-to-urban migration, stimulate agricultural production from resources that otherwise would be underused, and reduce the need for food to be produced elsewhere. Third, by combating poverty, they help to slow population growth.” (UN Documents, Our Common Future - http://www.un-documents.net/ocf-05.htm) Image MDGs: http://www.unscn.org/files/Publications/RWNS6/report/SCN_report.pdf; Source: http://www.irishtimes.com/news/world/fight-against-hunger-at-heart-of-irish-foreign-policy-says-eamon-gilmore-1.1362325

8. Rome principles The Rome principles call on donors to draw up and implement development plans that respond to the needs of developing countries and ensure that all actors are cooperate in their work to achieve sustainable outcomes: Rome principle 1: Country Ownership Rome principle 2: Strategic coordination Rome principle 3: Comprehensive approach Rome principle 4: Multilateral support and improvement Rome principle 5: sustained financial commitment Other core commitments: gender, environmental sustainability, transparency Action for students: Watch and make notes in your folder on the clip outlining the Rome principles, a blueprint for investment in food security: http://www.youtube.com/watch?v=jZdP3wZkcQY Source: http://www.one.org/c/international/hottopic/3930/

9. Global initiativesL’Aquila The G-8 group of powerful nations made a L’Aquila commitment signed by over 20 countries in 2009 in Italy to "take urgent action to eradicate hunger from the world." It set out to invest $22 billion in agriculture over three years based on the Rome Principles. This reversed two decades of aid policies that neglected developing country agriculture to invest in country-led programmes. Instead of renewing the L’Aquila 2009, which was up in May 2012, the New Alliance for Food Security and Nutrition and US Feed the Future and was rolled out. • Video and article on food security policy and trade: http://www.iatp.org/blog/201302/food-crisis-update-main-drivers-of-price-volatility-still-not-addressed (16:45 min) • International Food Policy research Institute (IFPRI) Global Food policy Report 2012 https://www.securenutritionplatform.org/Pages/DisplayResources.aspx?RID=179

10. L’Aquila pledges According to the ONE organisation report on accountability of donors to the l’Aquila pledges, only 22% have been met. And most are not on track to meet them within their pledge period. Source: http://www.one.org/c/international/hottopic/3929/

11. New Alliance for Food Security and Nutrition • “At the G-8 Summit hosted by President Obama at Camp David, African heads of state, corporate leaders and G-8 members pledged to partner through the New Alliance and, working with the African Union and Grow Africa, lift 50 million people out of poverty in sub-Saharan Africa by 2022.”(http://feedthefuture.gov/article/fact-sheet-new-alliance-food-security-and-nutrition) • The New Alliance for Food Security and Nutrition private-sector-led affords a lot more power to partnerships with the private sector, multinationals like Monsanto and Yara. • Conditions imposed by donors give foreign firms greater access to Africa's markets. Source: http://www.aljazeera.com/indepth/opinion/2013/01/201312915630857878.html; Image: www.usaid.gov http://www.aljazeera.com/indepth/opinion/2013/01/201312915630857878.html

13. Supporting global impact Together, countries and supporting stakeholders are collectively working to reach the global targets set out by the World Health Assembly 2012 Resolution: • 40% reduction of the global number of children under 5 who are stunted Target 1: • 50% reduction of anemia in women of reproductive age Target 2: Further info: Slideshow on SUN Framework. http://scalingupnutrition.org/resources-archive Target 3: • 30% reduction of low birth weight • Increase exclusive breastfeeding rates in the first 6 months up to at least 50% Target 4: Target 5: • No increase in childhood overweight Target 6: • Reducing and maintaining childhood wasting to less than 5%

14. Nutrition-sensitive strategies increase the impact of specific actions for nutrition Specific Actions for Nutrition Nutrition-Sensitive Strategies Agriculture: Making nutritious food more accessible to everyone, and supporting small farms as a source of income for women and families Clean Water & Sanitation: Improving access to reduce infection and disease Education & Employment: Making sure children have the nutrition needed to learn and earn a decent income as adults Health Care: Access to services that enable women & children to be healthy Support for Resilience: Establishing a stronger, healthier population and sustained prosperity to better endure emergencies and conflicts Feeding Practices & Behaviors: Encouraging exclusive breastfeeding up to 6 months of age and continued breastfeeding together with appropriate and nutritious food up to 2 years of age and beyond Fortification of foods: Enabling access to nutrients through incorporating them into foods Micronutrient supplementation: Direct provision of extra nutrients Treatment of acute malnutrition: Enabling persons with moderate and severe malnutrition to access effective treatment

15. Types of Aid and Actors

16. Multi-sectoralapproach “Malnutrition is often misunderstood by policymakers as simply a ‘lack of food’ problem. It is not. Rather, it is a complex multidimensional and intergenerational problem and needs a multi-sectoral as well as direct and specific interventions.”(http://www.financialexpress.com/news/tackling-undernutrition-challenges/1154970/0 ) • As malnutrition and its causes are complex, a multi-stake holder and multi-sectoral approach underpinned with better governance is required. Such an approach can meet multiple objectives such as nutrition, gender equality and sustainability. • A multi-sectoral approach includes interventions in food systems, public health and education and needs to create an enabling environment. • It includes broader interventions and direct nutrition-specific ones. Action is urgent for both types of interventions. • It should be based on the “Three Ones”: “one agreed ... framework that provides the basis for co-ordinating the work of all partners; one national coordinating authority, with a broad multi-sectoral mandate; and one agreed national monitoring and evaluation system. Source: http://scalingupnutrition.org/wp-content/uploads/pdf/SUN_Framework.pdf

17. Governance:coordination and coherence In an effective, timely and comprehensive mechanism for governing and coordinating food and nutrition security and sustainability, including food aid, key stakeholders could: • Address complex and interrelated issues and deeper underlying determinants such as the quality of governance and institutions as well as issues relating to peace and security. Fragile states have special needs. • Garner high-level support and political partnerships as a foundation for an “whole of society” approach with “ownership” led by the governments, but including civil society, parliaments and the private sector. Country-owned strategies may not be possible in fragile states, so other actors must assume a more activist role based on interim strategies. • Build a mechanism for “policy coherence”, timely policy co-ordination through government-wide attention to unintended negative consequences on nutrition of donor and recipient countries’ policies and interventions; for example, subsidies for biofuels and food exports. Source: http://scalingupnutrition.org/wp-content/uploads/pdf/SUN_Framework.pdf; http://download.thelancet.com/flatcontentassets/pdfs/nutrition_5.pdf

18. Actors and their rolein sustaining life on the margins

19. International agencies Action for students: Discuss in a group of four, elaborating on your answers: • Why is it necessary for international agencies to be increasingly involved in ensuring food security? • What makes an approach purely evidence-based as opposed to practice- or opinion-based. What evidence matters (e.g., best evidence such as RCT* versus best available evidence)? How do you get it? Why is there a classic policy problem of gap between evidence and policy? 3. What makes an approach sustainable? Are there situations that call for an approach that is not sustaianable? • Why does cost-effectiveness matter? * Randomised-control trial: specific type of experiment that is the gold standard for a clinical trial

20. Types of aid Emergency aid: Given in a country suffering from natural disaster or man-made disaster, which may include food, water, tents, clothing or rescue and medical teams. Development aid: Given to benefit the people and economy of a country, money is given to a wide range or programmes and projects such as infrastructure and education. Tied aid: Money that comes with strings – a requirement to spend it a certain way or to follow a particular policy. SAPs (Structural adjustment programmes) Implemented by the IMF, aid or loans given if a country followed SAPs. Aimed at boosting development and reducing corruption, they were criticised for benefiting rich countries and corporations. Untied aid: No spending or policy proviso attached to money given. Multilateral aid: Given by multiple donors to a specific country, it may be collected by an UN organisation or an NGO Bilateral aid: Given by one country directly to another. Source: http://www.geographybase.co.uk/IB%20Geography%20HL%20Disparities%20in%20Wealth%20and%20Development%20Revision%20Notes%20FINAL.pdf

21. Source: http://www.aidinfo.org/wp-content/uploads/2010/10/kharas-aid-architecture-diagram.png

22. Advantages anddisadvantages of aid Source: http://www.geographybase.co.uk/IB%20Geography%20HL%20Disparities%20in%20Wealth%20and%20Development%20Revision%20Notes%20FINAL.pdf

23. Aid strategies Short-term views prevail over long-term policies as most political attention is short-term. The wide spectrum of strategies includes: • Fairer trade • Reduced debt servicing • Reduced subsidies to richer economies • Less tied aid • More community involvement • Appropriate technology • Infrastructure building Action for students: • Discuss in pairs and make notes in your folder about what each of the different strategies above entails refer to concrete examples and highlight the desired outcomes. • Identify the strategies which are long term, short term • Watch the Fairfood international clip “A Fair Future for food chain workers: http://www.fairfood.org/videos/a-fair-future-for-food-chain-workers/

24. Aid actors Aid actors include: • Donors and international institutions • UN institutions such as World Food Program • NGOs (non-governmental organisation) actors are independent of national governments. • World bank Formed at Bretton Woods in 1944,its remit is to support developing countries. • IMF Formed at Bretton Woods in 1944, it is in charge of stabilising currencies and supporting weak economies Further InfoCritical view on the actors, politics and economics of Food Aid: http://www.globalissues.org/article/748/food-aid Greeley et al Effect of mass supplementation http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0044549 URBAN SETTING RESPONSE http://www.cmamforum.org/Pool/Resources/Humanitarian-resp-in-urban-settings-Disasters-Lucchi-2012.pdf

25. FOOD AID and Assistance

26. Food aid versusFood Assistance An emergency response is not designed to be sustainable, but rather to keep people alive. Food aid and assistance help build the basis for long-term food security. Both are particularly important in countries in protracted crisis. “Food Assistance Programmes any intervention to address hunger and under nutrition (e.g., food stamps, WIC, food subsidies, food price stabilization, etc.). Food Aid: International concessional flows in the form of food or of cash to purchase food in support of food assistance programmes. It constituted over 20% of global aid flows in the 1960s, but is now less than 5%. It started off in the 1950s with the US and together with Canada accounted for over 90% of global food aid until the 1970s when the United Nations World Food Programme (WFP) became a major player” Further info: • Humanitarian Policy Group Food aid and food assistance in emergency and transitional contexts: a review of current thinking – shift to food assistance and trends http://www.odi.org.uk/sites/odi.org.uk/files/odi-assets/publications-opinion-files/6038.pdf • Slideshow on emergency response: http://www.unicef.org/nutrition/training/2.6/31.html • Case study success stories Nutrition report 2013. UN childhood nutrition report on 11 countries with success in their childhood feeding programmes http://www.unicef.org/media/files/nutrition_report_2013.pdf Source: http://www.globalissues.org/article/748/food-aid

27. Problems with food aid • “It is a donor-driven system • It promotes domestic interests of donor countries • It is a foreign policy tool • International institutions are driven by exporters • Development is not necessarily the objective” (http://www.globalissues.org/article/748/food-aid#Themajorplayersinthefoodaidgame)

28. The future of food aid In the last decade there have been: • Many new response options and more flexible donor resources, specifically a shift from food aid to cash and voucher assistance for a more effective food aid system. “People need different kinds of aid in different situations. If food is not available in a flooded area, actual food supplies are the answer. In the case of chronic shortages, experts suggest cash or vouchers, integrated into a broader social protection system, might be the answer.” http://www.irinnews.org/report/97576/getting-food-aid-right • Major efforts to improve food security analysis, early warning, response analysis However, there “remains little in the way of an evidence base about what works best under what circumstances.” and little on recipient preference http://www.irinnews.org/report/97576/getting-food-aid-right • Much broader livelihood responses • Greater focus on nutrition programming. Further info: On the cluster approach, new global food security mechanism: “Aid policy: New mechanism to boost food security” http://www.irinnews.org/report/92846/aid-policy-new-mechanism-to-boost-food-security On “The future of food aid” http://www.irinnews.org/report/98469/analysis-the-future-of-food-aid Source: Levine and Chastre et al “Missing the Point” http://www.odi.org.uk/sites/odi.org.uk/files/odi-assets/events-presentations/1422.pdf

29. Ways of minimising negative effects of food aid • “Depression of food prices in local markets, affecting local livelihoods: Buy food for distribution from local markets. • Intercommunity conflict when food aid is targeted; friction between the agency and the community: Involve communities in the selection of targeting methods and other aspects of food distribution. • Hijacking of food for political purposes (e.g. feeding armies): Use a food commodity that only the most needy will find desirable. • Households outside the immediate area leave their homes in order to be close to sources of aid: Spread information about targeting criteria before aid distribution starts. • Change of attitudes and creation of unrealistic expectations; hindrance of traditional coping strategies: Limit to the absolute minimum the time that free food aid is distributed, and replace it with other forms of aid if necessary. • Friction between refugees or IDPs and local populations: Make sure that local leaders are informed at all stages about the aid, and include the most vulnerable of the host population in assistance interventions. • The market becomes flooded with food aid commodities, prices tumble and the food loses its economic value: Target food aid as much as possible. • Reduced demand for local farmers' produce: Choose commodities that will not compete directly with local production, or else purchase commodities in local markets.” (Source: http://www.fao.org/docrep/008/y5815e/y5815e0a.htm)

30. Nutritional emergencies

31. Nexus of strategiesand scales There are no one-size fit all scaling up nutrition programmes. First, the risks and vulnerabilities need to be assessed in order to devise policies and implement interventions. Successful ones addressing the particular vulnerabilities and needs have secured: • Political commitment, • Evidence-based national policies and programmes • Trained and skilled community workers cooperating with communities • Effective communication and advocacy • Integrated service delivery across multiple sectors The combination of interventions needs to be put in place in a number of scales (international to local): • Long- and short-term strategies • Supply and demand-side strategies • International (Millennium Development Goals and their replacements after 2015; SUN; AGRA)

32. What works in nutritional emergencies • “Proven solutions exist that can end the preventable child deaths and damage caused by malnutrition. Investing in improved nutrition during the critical 1,000 day window can: • Save more than 1 million lives each year; • Boost a country’s GDP by as much as 11% annually; • Build self-sufficiency--well-nourished children are more likely to continue their education, have higher IQs, and earn up to 46% more over their lifetimes; • Significantly reduce the human and economic burden of infectious diseases such as malaria and HIV/AIDS, and chronic diseases such as diabetes; and • Help end hunger and break the cycle of poverty.” • Source: 1000 days.org “Nutrition – An Investment in Growth” http://thousanddays.org/wp-content/uploads/2012/05/1000-Days-June-2013-Investment-in-Growth-Policy-Brief.pdf

33. Afar, Ethiopia – Nutritional intervention “When I see this child I feel very happy because the grandmother and the rest of the community thought she was going to die, but we saved her life and she is still alive,” says NabiyuAyalew, MSF’s outreach nurse. Further info: http://www.msf.org.uk/article/ethiopia-isolated-and-malnourished-msf-treats-malnutrition-rural-afar

34. Nutrition interventionsare cost-effective “Evidence shows that nutrition interventions are some of the most cost effective of any development intervention, saving lives and investing in the future potential of children. Scaling up coverage of a minimum package of direct nutrition interventions, identified by the Lancet medical journal in 2008, could prevent a quarter of child deaths and lower the prevalence of stunting —a condition limiting physical and cognitive development caused by chronic malnutrition—by a third.” Enough Food If Campaign “G8 Summit Briefing” http://www.bond.org.uk/data/files/G8-summit-briefing.pdf Action for students: Watch “MSF Campaign for Effective Treatment” on therapeutic foods and their use in Niger, Sahel http://www.youtube.com/watch?v=e-XMu1YzLsU

35. Food aid in crisis situations Source: http://www.fao.org/docrep/008/y5815e/y5815e0a.htm

36. Proven interventions (Lancet)to reduce child mortality, improve nutrition outcomes and protect human capital Source: Nutrition programmes as an investment and Source on Lancet study: http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Resources/Peer-Reviewed-Publications/ScalingUpNutrition.pdf

37. Core interventions for pregnant women Source: 1000 days.org Preventing maternal and child malnutrition http://thousanddays.org/wp-content/uploads/2013/03/BEST_START_FA101011Infographic2.pdf

38. Core interventions forchildren under two Source: 1000 days.org Preventing maternal and child malnutrition http://thousanddays.org/wp-content/uploads/2013/03/BEST_START_FA101011Infographic2.pdf

39. Timeline Pregnancy and first 6 months From 6 to 24 months Source: 1000 days.org Preventing maternal and child malnutrition http://thousanddays.org/wp-content/uploads/2013/03/BEST_START_FA101011Infographic2.pdf

40. Prevention is much better than treatment– not to get sick in the first place. Preventative measures such as cash transfers and supplementary feeding are far more cost efficient than treating a malnourished child and the loss inherent in its curtailed future. Yet, current spending focuses on treatment. http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Resources/Peer-Reviewed-Publications/ScalingUpNutrition.pdf

41. m Types of feeding programmes: General food distribution “General food distribution (GFD) When food insecurity is prevalent, sustainable economic and health development programs are often appropriate, targeting the most vulnerable populations. This is not a blanket coverage, and is most likely not used in large-scale emergencies. GFD is used almost exclusively in large-scale emergencies, where there is an acute food shortage and / or food prices increase sharply (the two often go together). GFD is usually not targeted. Examples: • GFD in Haiti after the earthquake in 2010 • GFD in typhoon affected areas in the Phillippines 2013. In such an acute onset emergency, high energy biscuits are used. General food distributions can become part of a country’s anti-poverty programme in which case they are targeted to the poorest segments of the population. Examples of ‘targeted’ GFD: • US SNAP programme • Brazil’s FomeZero

42. Blanket feeding Blanket feeding This is deployed normally during a severe food crisis and also targets specific populations, normally extending non-discriminatory feeding programmes for pregnant mothers, under-5 children, elderly, and the sick, whether they are facing malnourishment or not. Often in conjunction with general food distribution, blanket feeding can also exist independently. It targets the members of a population who are at the highest risk of malnutrition (pregnant and breast feeding women, children under 5, elderly, chronically ill) with foods that are designed to meet their specific nutritional needs. PlumpyDoz is used for blanket feeding. Further Info: Alertnet “Milk in the Sahel; making a real impact on malnutrition” http://www.trust.org/item/20140109120020-yg42e/?source=hpeditorial

43. Supplementary feeding programme Supplementary feeding program (SFP) When malnutrition rates extend over 15 percent and populations still need assistance to fill gaps and in treating specific target groups, NGOs will provide SFPs during the day to provide warm meals, appropriate nutrients, and special foods for various parts of the affected population. It provides supplemental foods to members of the population who exhibit moderate levels of malnutrition (defined by low middle arm circumference or low weight for height) and are at risk for developing severe malnutrition. Most SFP target pregnant and lactating women and children under 5 with energy dense fortified foods. PlumpySup is used for SFP.

44. Therapeutic feedingprogramme Therapeutic feeding program (TFP) TFPs are established to treat severely malnourished people, and to provide immediate relief to those of an emergency-affected population in danger of dying because of lack of food. Ideally, TFPs are 24-hour stations. In emergency settings, though, staff and supply limitations will often prevent 24-hour operation.” (http://www.cdham.org/wp-content/uploads/2011/11/Chapter-12.-NGOs-and-Food-and-Nutrition.pdf) The vast majority of TFPs are run in regions where food availability is not the predominant concern (e.g., Niger, Burkina Faso, Ethiopia, Democratic Republic of Congo). TFPs are established in in out-patient clinics and in-patient hospitals areas where childhood malnutrition is endemic due to a high burden of infectious disease combined with poor diets that fail to meet young children’s specific nutritional needs. TFPs may also be set up in emergency-affected populations where there is a background level of endemic malnutrition that will get worse or where there is reason to believe that the number of severely malnourished children will increase. Ready to use foods (RUTF) are used in TFPs.

45. The nutritional status of a child is checked by using the MUAC (Middle-Upper-Arm Circumference) bracelet at an MSF therapeutic feeding centre. The indicator gives rough estimates of protein (muscle) and energy (subcutaneous fat stores) that correlate with changes in body weight in malnourished children

46. Nutritional interventionUK AND US

47. ‘Food stamps’ in the UK Food stamps were last issued during the Second World War to address food insecurity. Right: a woman is handed food stamps in office in Elephant and Castle in south London in 1944 Top right corner: a shopkeeper cuts out a coupon in a shop in 1940 Images: AP Photo http://news.uk.msn.com/uk/food-stamps-in-the-uk-613888 • Action for students: What are some of the issues raised against moving to payment cards? What are the issues with Foodbanks? • Read the BBC article “Numbers relying on food banks triple in a year ” http://www.bbc.co.uk/news/business-24536817 • Watch the clip on UK Foodbanks and explain how these help address food insecurity. http://www.trusselltrust.org/foodbank-projects

48. Foodbanks in the UK

49. UK vouchers: HealthyStart • Programmes such as Healthystart (UK) or WIC (USA) address the problem of nutrition security by providing a limited number of highly nutritious foods, dairy, fruits, vegetables, fish, fortified foods for children. • They intend to target the population subgroups most at risk of malnutrition such as pregnant and breast feeding women and young children. • Risk of malnutrition has increased with the economic downturn and the rise in food prices in the UK. Action for students: Read about Healthystart vouchers http://www.healthystart.nhs.uk/ the Guardian’s “Food vouchers to provide emergency help but prevent spending on alcohol” http://www.theguardian.com/politics/2013/mar/26/payment-cards-emergency-assistance-food-stamps 2. MSN News 'Food stamps' to be issued in the UK: Q&A http://news.uk.msn.com/uk/food-stamps-in-the-uk-613888 Source: http://www.trusselltrust.org/foodbank-projects

50. Double standard: Nutrient-dense at Home and Substandard abroad