Introduction

The nutritional intake of the homeless and other marginalised groups, including those surviving on limited income, is inadequate. This chapter gives an overview of key nutritional issues and contemporary advances in human nutrition in marginalised groups and provides insight from primary research into the nutritional needs of vulnerable groups. There is evidence to suggest that the dietary choices of communities on low income, including the homeless and families residing in temporary accommodation, are compromised. This chapter will examine the potential benefit and community responses to dietary intervention, food banks and voucher systems, within the context of complex nutritional needs, food insecurity and marginalised housing scenarios. UK policies and guidelines, including the National Institute of Clinical Excellence (NICE) and specialist groups, will also be discussed. It is concluded that further research is required to develop effective nutritional strategies to address the complex nutritional and physical requirements of disadvantaged groups on low income.

Homelessness is associated with increased physical and mental health needs. The absence of a nutritionally adequate diet, in combination with a marginalised housing situation, is likely to exacerbate this further (Luder et al, 1989). The average age of death for homeless adults is 47 years (CRISIS, 2011); thereafter, cardiovascular disease (CVD) is the leading cause of mortality (aged 45–65 years) (Hwang et al, 1997). With up to 80% of chronic diseases such as CVD attributed to poor dietary and lifestyle choices (eg smoking) (Alwan et al, 2011), there is a clear role for adequate nutritional intake in enhancing health.

Determinants of food choice include sociological, psychological and physiological factors, with food availability being a key issue in the homeless community. In a review of health promotion needs, Big Issue vendors rated ‘nutritional deficiencies’ as the third most common health concern for vulnerably housed individuals, following ‘drug and alcohol use’ and ‘the effects of the cold weather’ (Power and Hunter, 2001). In children, health, hunger and dietary intake were primary concerns; inadequacies in these areas have been associated with developmental delays (speech delay and impaired cognitive ability) (Rafferty and Shinn, 1991).

This chapter considers the evidence for the nutritional requirements, dietary intake and associated health and lifestyle factors in homeless individuals.