Note: Presentation moved to gender and family session on friday

Background Food insecurity is negatively associated with health. Therefore, local food aid provision is crucial to helping protect the health and wellbeing of vulnerable groups. At present, the politics and logistics of this provision are only partially understood and under-theorised. In London, one of the most expensive and equal cities in the world, food insecurity is intensifying. Long-term provision of food aid presents challenges for health maintenance and promotion that are frequently overshadowed by more immediate problems at the local level. This qualitative study examines how London healthcare professionals encounter and seek to address these challenges.

Methods A snowball approach was used to recruit 38 healthcare professionals and food aid coordinators through contacts with participating London food aid organisations. Semi-structured interviews were conducted with all participants. Additionally, observations at a variety of food aid distribution events and stakeholder strategy meetings were used to explore narratives around organisation and health. A critical grounded theory approach to analysis served to identify and situate both the material (physical and mental health) and social (structural inequalities and precarity) issues.

Results Health and wellbeing challenges occur at both the frontline and organisational levels. Participants explained that the mechanisms of addressing (dietary) health via food aid referral are not straightforward. Household interaction with food aid typically occurs during episodes of crisis, which prompt them to turn to healthcare professionals. Food insecurity is rarely the ‘presenting problem’ and is embedded within a suite of stressors. Frontline healthcare professionals have to deconstruct complex accounts of poverty and find ways to intervene. Offering food aid referral is just one way of doing this. At the organisational level, a culture of precarity makes it extremely difficult to provide consistently nutritious food aid that caters to a reasonable range of medical and religious dietary restrictions. Fluctuating sources of funding, food donation and staffing are obstacles to the implementation of dietary guidelines and the monitoring of nutritional content.

Conclusion Community food aid is undermined by precarity and a lack of structural support, making health and wellbeing concerns difficult to prioritise. Healthcare professionals and food aid coordinators are responding to this in imaginative ways, such as pooling resources, sharing expertise and best practice, and strategizing across sectors and communities.