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We welcome the BMJ Appeal  to support independent food banks; as Watson & Lloyd point out , it has the potential to have significant and immediate benefits for food insecurity and children’s health. Perhaps more important for longer term change, is the powerful voice of doctors and nurses in advocating for the ability for all citizens to be able to access a healthy diet for physical and mental health and wellbeing.
The immediate and direct effects of the national coronavirus pandemic response strategies on food security and nutrition are well documented in Baraniuk’s exposition . Food banks report an enormous uplift in demand for emergency food aid (Trussell Trust: 47% increase in first six months of the crisis compared to the same period in 2019; IFAN: 110% rise February to November 2020 compared to 2019 ).
However, the end of the Brexit transition period on 31 December 2020 now adds to this already uncertain landscape, with the prospect of reduced levels of employment, general downward pressure on wages and perturbations in food supply. In speaking of this disruption, Lang et al  state the “The jury is out as to whether these are mere ‘teething problems’ or permanent features of the new normal”.
In an initial expert elicitation in 2019 , we asked the question ‘what will be the “new normal” in terms of food prices after Brexit and what are the implications for health?’ When the deadline for the completio...
In an initial expert elicitation in 2019 , we asked the question ‘what will be the “new normal” in terms of food prices after Brexit and what are the implications for health?’ When the deadline for the completion of UK’s exit from the EU was extended to December 2020, we ran a fresh analysis to estimate prices in April 2022, i.e. 15 months after Brexit date to allow for any initial disruption to subside . In this second elicitation, we considered three different trade deal scenarios: A: full WTO terms; B: a moderately disruptive trade agreement (better than WTO); C: a minimally disruptive trade agreement. We elicited prices for 10 categories of foods used for CPI under these scenarios. We calculated the weekly cost of a healthy diet of basic foodstuffs for a family of four and for a single pensioner, and how these would vary under the three scenarios. Later, in July 2020, as a follow-up we asked the same food industry experts to indicate how likely each scenario would be the actual outcome (or close to it) in January 2021.
Now the UK-EU trade deal has been published, it remains unclear - and debatable - which of these scenarios can be considered closest to the actual trade deal that was negotiated. As a consequence, we went back to our experts in January 2021 and asked them to reconsider the probabilities they had ascribed to the three scenarios in the light of their understanding of the agreement. Pooling their revised judgements suggests the following relative weights:
July 2020: A:24%; B 41%; C34%
January 2021 A:70%; B16%; C13%
In short, in July 2020 our expert panel regarded Scenario A (full WTO terms) as the least likely analogue for what the final agreement would entail for food supplies, but in January 2021, the most likely.
Adjusting our food price projections to these January 2021 scenario weights results in a likely weekly food bill increase, by April 2022, a family of four of +£17.83, from a baseline cost £95.41 (see ) to £113.24, i.e. a rise of more than £927 per annum. There is, of course, uncertainty on this estimate and our analysis also provides the one-in-20 lower plausible and higher plausible price change; these extremes are much less likely than the median price increase, but cannot be said to be far-fetched. For this ‘family of four’ weekly food basket, the lower plausible price increase is +£7.08, giving a weekly bill of £102.49 (an increase of more than £368 per annum). The higher plausible weekly increase is +£30.86 per week, giving a weekly bill of £126.27 (an increase of £1604 or more per annum).
Similar analysis for a single pensioner gives a likely weekly food bill increase of +£6.36 per week from £35.92 (see ) to £42.28, an increase of more than £330 per annum. The lower plausible increase is +£2.41 per week (more than £125 per annum) and the higher plausible increase is +£11.22 per week (more than £583 per annum).
These potential price rises represent significant incursions into household budgets and a likely driver towards lower nutrient diets with consequent health consequent implications for heath and wellbeing and demand on health and social care services. With a fixed income, pensioners are particularly vulnerable to large rises in the costs of essentials. The effects of Brexit on fruit and vegetable prices are particularly severe (see ), raising the spectre that the fall in fruit and vegetable consumption during lockdown, especially among poorer households, would persist long term. Food bank growth is possible only because of slack in the food system – which may not endure.
As the details of the Brexit agreement - parts incomplete, parts untested and parts unconstrued - and its effects emerge, this analysis would be amenable to revising and updating. If the economic effects of coronavirus lockdown or the impacts of Brexit on employment are more than transitory, then we are likely to see the double pressure of falling incomes and rising prices leading to increases in financial exclusion and child poverty with consequent impacts on diet-related ill health.
1. Feinmann, J., How doctors can help end food insecurity. BMJ, 2021. 372: p. n53.
2. Watson, M.C. and J. Lloyd, Rapid Response: Food poverty should not be allowed to continue: government action is needed. BMJ, 2021. 372.
3. Baraniuk, C., Fears grow of nutritional crisis in lockdown UK. BMJ, 2020. 370: p. m3193.
4. The Trussell Trust. 2,600 food parcels provided for children every day in first six months of the pandemic. 2020 [cited 2021 09/02/2021]; Available from: https://www.trusselltrust.org/2020/11/12/2600-food-parcels-provided-for-...
5. IFAN. Independent food banks and increased need for emergency food parcels since the outbreak of COVID-19. 2020; Available from: https://www.foodaidnetwork.org.uk/ifan-data-since-covid-19
6. Ranta, R. and H. Mulrooney, Pandemics, food (in)security, and leaving the EU: What does the Covid-19 pandemic tell us about food insecurity and Brexit. Social Sciences & Humanities Open, 2021. 3(1).
7. Lang, T., E. Millstone, and T. Marsden, An Open Letter on the Food Emergency to the Prime Minister and Government. 2021.
8. Barons, M.J. and W. Aspinall, Anticipated impacts of Brexit scenarios on UK food prices and implications for policies on poverty and health: a structured expert judgement approach. BMJ Open, 2020. 10(3): p. e032376.
9. Barons, M.J. and W. Aspinall, Anticipated impacts of Brexit scenarios on UK food prices and implications for policies on poverty and health: a structured expert judgement update. 2020: arXiv.
The workshops [8,9] were funded by the Warwick Global Research Priority for Food. The study is part of work undertaken for EPSRC grant number EP/K007580/1.
The views expressed here are ours alone and do not necessarily reflect the views of our employers.