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Background Partnerships between charitable food systems and healthcare systems have been forming across the country to support individuals and families experiencing food insecurity, yet little research has focused on these partnerships, particularly from a food bank perspective. The objective of this exploratory pilot study was to identify implementation challenges and facilitators of charitable food system and healthcare partnerships from the food bank perspective. Method Texas food banks with existing food bank/healthcare partnerships were identify through website review and support from Feeding Texas. Interview questions were tailored to each interview, but all focused on identify program components of the food bank/healthcare partnership and implementation barriers/facilitators of the partnership. In total, six interviews were conducted with food bank/healthcare partnership leaders (n = 4) and charitable food system experts (n = 2) about their experiences of working with food bank/healthcare partnerships. All interviews were completed via Zoom and took between 30 and 60 min to completed. Detailed notes were taking during each interview, and immediately discussed with the complete research time to formulate broad implementation themes. Results Interviews suggest unique implementation challenges exist at all levels of food bank/healthcare partnerships including the partnership, program, and system levels. Partnership-level implementation challenges focused on issues of partnership scale and data collection, sharing, and analysis. Program-level implementation challenges focused on food and produce expectations. Structural-level implementation challenges included issues of food safety, subsidized food regulations, and patient privacy. Implementation facilitators included leadership support, mission compatibility/organizational readiness, food insecurity training, and identify of partnership champions. Conclusions This study adds to the growing interest in food bank/healthcare partnership as it highlights unique implementation challenges and facilitators for cross-sector partnerships between healthcare systems and community-based charitable food systems. Ultimately, we believe that collaborative discussion among leaders of charitable food systems and healthcare systems is needed to overcome outlined implementation challenges to better facilitate sustainable, equitable implementation of food bank/healthcare partnerships.

The issue of food insecurity has moved to the forefront of social policy debates, with inadequate diets affecting one in three people globally (IFPRI, 2016) and with low income persons carrying the largest burden. The impacts of food insecurity on health are extensive and resonate throughout a lifetime which positions issues of food insecurity as a central social justice concern. An increasingly normalized response to food insecurity, more commonly referred to as food poverty in Ireland, is the redistribution of surplus food. In the decade following the economic crisis of 2008-10 Ireland has witnessed a rapid expansion of charitable food services and the establishment of what would become Ireland’s first national system of surplus food redistribution. This growth was also facilitated by multiple co-existing factors and circumstances. These include the historical precedence and primacy afforded to charitable responses, the withdrawal of significant third sector funding post economic crash, Ireland’s persistently high rates of poverty, and a protracted homelessness crisis. An additional critical factor in this trajectory has been the deepening neoliberal ideology promoting novel, business led solutions and Corporate Social Responsibility responses to issues of social inequality. These features of Irish society combined with an increasing awareness of the problem of food waste positioned surplus food as a legitimate and distinguished approach to tackling poverty more generally. This thesis focusses on the contemporary charitable food system in Ireland and is set against the backdrop of increasing diet-related poor health, rising inequality, wider food system trends, and the experiences of charitable food assistance in other high-income countries. Using critical realism as a metatheory and Cork city as an embedded case study, several aspects of Ireland’s contemporary charitable food system are explored. This includes the organisations providing charitable food assistance, the surplus food flowing through it, the circumstances and level of food insecurity and ill-health experienced by its users, and the representation of food poverty at the national level. The overarching goal is to identify the factors influencing food governance within the charitable food system and its impact at the local level. The findings suggest that several dominant ideas and practices influence the governance of food within the charitable food system and work to indirectly support, and legitimize, the use of any surplus food as a response to poverty. This includes the conceptualisation of food poverty and nutritional poverty as separate issues which in turn supports the idea that health concerns are outside the remit and responsibility the organisations responding to food poverty. The local impacts of surplus food redistribution include redistribution beyond demand, in some instances the replacement of food vouchers with surplus and the loss of charity-based support for local food businesses. The findings highlight that the growing role of the charitable sector as a key food waste reduction strategy means that surplus food redistribution is influencing the diets, the health, and food cultures of low income populations using these services. Aligning these concerns with surplus food redistribution would prevent further deepening Ireland’s inequalities. A practical first step in this regard would be the introduction of a healthy food policy across the charitable food. Overall, this thesis demonstrates that the ideological framing surrounding food poverty have changed little since the early 20th Century where the focus was on the ‘personal’ rather than ‘economic or social reform’ (Miller, 2014), on providing food rather than addressing the causes of food poverty and with the local community as duty bearer. This thesis ultimately argues that a more critical reflection on food charity in Ireland is required with questions of social justice and the human right to good food in a socially accepted manner, taking centre stage.