Food as a Lever for Change
Vicky Sullivan reflect on her experience of collaborating with Think Through Nutrition in prisons.
“Poor nutrition is strongly associated with poor health outcomes”
— Vicky Sullivan, Registered Health Promotion Practitioner | Researcher | Health Coach
About Vicky
Vicky Sullivan is a Registered Health Promotion Practitioner, researcher and health coach with an MSc in Nutrition, Physical Activity and Public Health.
Why are you passionate about nutrition?
I find nutrition a fascinating topic. It is multi-dimensional and plays a huge role in our social and cultural lives. What we eat has a profound effect on our physical and mental health and the way we feel, and access to good food is key for sustaining our health. We know that poor nutrition is strongly associated with poor health outcomes, and there is a pressing need to address planetary health and biodiversity through the decisions we make regarding the food we eat, how it is produced and how we use the land. Ethically, we need to address nutrition inequalities, and confront the exploitative nature of modern food production globally in terms of labour practices and animal cruelty.
What’s your favourite meal?
Five bean chilli & wholegrain basmati rice with a green salad.
What made you want to work in prisons?
People in the prison setting experience health inequalities at a higher rate than in the community, and I welcome any opportunity to support people to better health and wellbeing. It’s an interesting setting in which to work, and the types of prison programmes I co-deliver aim to equip people with knowledge, skills and confidence to manage their health successfully in a challenging environment.
How did you get involved in nutrition in prisons?
My first prison project was delivering a Wellbeing Champions programme to a group of staff and residents in two women’s prisons, with the aim of improving various aspects of wellbeing including nutrition. I co-delivered this project with a GP colleague who I have worked with in both primary care and community settings. The experience of being a Wellbeing Champion was later explored for my MSc thesis.
The Participants & the Environment
“The quality of the food available to people in prison and the food regime can have a positive or negative effect on residents’ physical and mental health”
How important is food to people in prison?
Hugely important. The quality of the food available to people in prison and the food regime can have a positive or negative effect on residents’ physical and mental health through a variety of processes. Quite often, particularly for women, there is an unwelcome increase in weight whilst in prison which is a risk factor for a range of health conditions including type 2 diabetes and cardiovascular disease. There is also recognition that diet quality is linked to mental health, brain health and behaviour. Throughout our life course our nutritional requirements also change which is not well reflected in prison food generally. There is also the sociology of food in prison to consider. The sharing and trading of food is commonplace and can bring people together. However, food which is poorly prepared and presented, of poor quality, or of insufficient quantity, can lead to tensions and frustration.
The Project
“This was an ambitious project and I was delighted to be a project partner.”
What made you want to undertake this project?
This project was a great opportunity to bring together a range of partners who are committed to improving access to nutritious food in this setting. By taking a ‘whole prison’ approach not only was the project team working to make changes within the prison itself, but to also inform prison policies regarding catering and improve the nutritional quality of their meals. This was an ambitious project and I was delighted to be a project partner.
What was the hardest part?
Working to the rhythm of the prison. We had a limited amount of time in which to run workshops, and on occasion, some of the participants were required to be elsewhere. It can also take a long time to get through security and the prison gates, and onwards to where you need to be, so allow plenty of time!
What was the best part?
Delivering the practical workshops with the women. We had taster sessions where we brough in great ingredients such as sauerkraut, home-made seeded loaves, natural yogurt, tinned fruit, and bags of salad to create tasty snacks which they absolutely loved. We also looked at sugar content on a range of drinks, explored shopping on a budget, and cooked and ate meals together, such as Bolognese sauce, pitta pizzas, and vegetable curry. It was amazing to see these women grow in confidence and identify and overcome some of their own barriers to healthy eating.
Another great aspect was close working with the prison catering team and involving the women in the design of the new menus. Everyone working together was key for a successful programme.
What were the outcomes?
A range of benefits of participating in the programme were described by the women including: improved digestive health; increased energy; weight loss (wanted); understanding how certain foods affect the way they feel; feeling more sociable; improvements in nutritional knowledge and skills around food; choosing healthier options; feeling more adventurous with food; and wanting to share learning with family upon release. In addition, the women valued the work that had been put in by the prison staff and delivery team. This increased feelings of self-worth for some participants.
Has this informed your work subsequently?
Yes. Working in the prison setting illustrates very well the wider determinants of health and how these impact people’s ability to make healthy choices. I make sure these aspects are considered when I am supporting people to make behaviour changes in their lives which support their health and wellbeing. I also take more of an interest in interventions which modify people’s environments to improve health, and health policy.
Vicky’s Perspective
“Create menus which support the nutritional needs of prison populations across the life course”
From your perspective, what’s the value of investing in the right nutrition?
People who spend time in prison are often disadvantaged when it comes to health. Addressing their nutritional needs on arrival can improve their physical and mental health while in prison and promote better overall health in the future. Providing a healthy prison setting with access to nutritious food creates an enabling environment, and this can help people to make healthy food choices. Involving people in initiatives which develop their food literacy and build their confidence in this area not only prepares them for a healthier life in prison, but it also equips them with knowledge and skills for life and future employment opportunities.
What would be your message to anyone considering commissioning or taking on a piece of work like this?
Working in this area is hugely rewarding. For these types of projects to be a success I would give some thought to the following:
Involve the people who you hope will benefit from improved nutrition from the beginning, as it is crucial to understand their experiences and perspective; encourage their ideas.
Be clear about your scope. Is your focus on improving decision making regarding healthy food choices? Are you planning to help increase people’s knowledge and skills for preparing their own food? Is improving the food environment in one prison your primary outcome? Are you seeking to influence food policy across the prison estate?
Work with the catering team to explore their capacity to make changes and involve them in project decisions from the start.
Seek to involve wider prison staff who are interested in the project and who can support the participants in-between workshops.
Share project outcomes and findings with HMPPS and the wider prison estate to build the knowledge base in this area and inform policy.
What do you believe is needed to improve nutritional intake for prisoners at a large scale/systems level?
Nutrition can be improved by approaching this from several angles. My suggestions include the following:
An increase in the food budget nationally would undoubtedly give prison catering teams more room for manoeuvre. It is woefully low, at just over £2.00 per person, on average.
Changes to procurement, nationally. There needs to be more flexibility so catering managers can broaden the range of ingredients they buy, choose healthier alternatives, and source more ingredients themselves.
Create menus which support the nutritional needs of prison populations across the life course. Whilst efforts are made to support women’s nutritional needs during pregnancy for example, women experiencing the menopause and older people have specific nutritional needs which are not always addressed.
Provide additional training for staff catering teams regarding the nutritional requirements of people in prison who are often already nutritionally compromised.
Improve the quality and affordability of canteen items available for people in prison to purchase. There is a lack of healthy food options, and many are over-priced. This impacts the degree of choice and control people have over the food they buy and prepare for themselves.
Increase opportunities for people in prison to prepare their own meals with access to kitchen facilities and equipment in their living areas.
Include nutrition and cooking skills programmes as part of the prison education programme which focus on improving people’s nutrition literacy.
Develop opportunities for all prisons to grow some of their food and bake their own bread. This works well at some prisons which have the land for gardens and polytunnels and can bolster existing food budgets.