Poverty, food insecurity and social prescribing — branching viva

Viva — Branching structured oral

Stem. A four-year-old girl is brought to your clinic for routine immunisation. Her mother has recently lost her job, the family is behind on rent, and the child's weight has fallen across centiles. The mother asks quietly whether you know anywhere that gives food. [2]

Branch 1 — Classification and framing of material hardship

Examiner: How do you classify this family's hardship, and why frame it as material hardship rather than income poverty alone? [2]

Model answer. I classify hardship by domain and severity. Income poverty measures whether household income falls below a threshold, but the lived experience that becomes biology is material hardship — going without food, stable housing, heating or health care because the household cannot afford them. This family faces food insecurity (the mother's disclosure), housing instability (behind on rent) and, likely, income poverty. Food insecurity is graded marginal, low or very low; this child's faltering growth suggests at least low food security. Framing it as material hardship matters because each domain has a screening tool and a specific intervention, and because income poverty alone misses families whose income sits above the line but who still cannot meet basic needs. [2]

Examiner follow-up: Why is housing instability a separate screening domain? [2]

Model answer. Housing instability — crowding, multiple moves, falling behind on rent, eviction and homelessness — adds a distinct mechanism of harm beyond income. Each move severs routines, sleep, schooling and relationships, and the resulting allostatic load tracks into measurable health and developmental deficit. Eviction in families with very young children is associated with increased hardship, food insecurity and health problems, so housing is a clinical vital sign that I screen for explicitly rather than waiting for it to surface. [2]