Background Food bank use has been rising in the EU, raising concern about food hardship and associated health consequences. While attributed to economic downturn or rising costs of living, no studies have systematically examined food hardship in the EU or investigated explanatory factors. Here we examine within-country trends in food hardship over 2004 to 2012, and test the hypotheses that economic downturn and rising costs of living are associated with rising food hardship, but that effects are mitigated by social protection spending.

Methods Data on GDP, unemployment, food price inflation, housing cost inflation, average wages, and social protection spending per capita were compiled for 21 EU countries with available data from Eurostat and OECD databases for 2004 to 2012. We constructed indices for costs of living relative to wages from data on food inflation and housing inflation relative to wage inflation. Fixed effect multiple regression models were used to examine how GDP, unemployment, wages and costs of living indices related to food hardship, as indicated by reported inability to afford meat or equivalent.

Results After a steady decline in food hardship from 2004 to 2009, this trend reversed, with food hardship rising from an average prevalence of 7.72% (SD = 7.06) to 9.10% (SD = 7.86) from 2009 to 2012. There was marked variation however, where food hardship continued to decline in some countries over this period, but rose by over 5 percentage points in others. We observed that for every 1 percentage point rise in unemployment, there was a 0.45 percentage point increase in food hardship (95% CI: 0.039 to 0.86%), and for every $100 increase in average wages, food hardship declined by 0.34 percentage points (95% CI: –0.53 to –0.15%). Food price and housing cost inflation were not directly related to food hardship, but there was a significant interaction between food price inflation and wage inflation, which indicated that a combination of rising food prices and falling wages compounded to increase food hardship more than either factor alone. Social protection had significant modifying effects on associations of food hardship with unemployment and the index of food price inflation relative to wages. Where there was high social protection, associations were not detectable.

Conclusion Food hardship has been rising across countries in the EU in association with unemployment, falling wages, and rising food prices relative to wages, but social protection spending mitigated these associations.