Are they ‘Vulnerable’? Older Adults and the Targeting Dilemma in Food & Energy Insecurity Policy

Introduction

Debates on multidimensional poverty and health raise questions about how ‘vulnerability’ is determined in policy. In Scotland, older adults face heightened health risks from food and energy insecurity (FEI) (outcome vulnerability) yet are not necessarily the groups with highest prevalence (exposure vulnerability), especially for food insecurity. This creates a potential policy targeting dilemma between epidemiological efficiency and severity of need.

Methods

We conducted 30 key-informant interviews with stakeholders across FEI prevention in Scotland (2023), alongside five lived-experience in-depth interviews with older adults in Northern Scotland (2023-2024). Data were analysed abductively adapting Schröder-Butterfill and Marianti’s Framework of Vulnerability, with triangulation across sources to examine how elements of vulnerability were conceptualised and operationalised.

Results

Our analysis yielded two second-order additions to the framework: susceptibility (individual characteristics that interact with broader systems to impact exposure FEI) and constrained coping (actions that avert immediate crisis but can intensify another risk). Exposures to FEI were environmentally, socially and politically structural (i.e., rurality, stigma, political invisibility), whereas susceptibility were embodied and practical (i.e., health status and living alone). Threats were both individual and institutional (i.e., bereavement and digitalisation of FEI support). Coping strategies include formal assistance schemes and individual household management, whereas constrained coping was extreme household management that aggravated health (i.e., self-rationing or lowered expectations).

Discussion

The largely mutually reinforcing FEI accounts suggest that constrained coping may worsen health and suppress the visible markers of need on which targeting often relies. FEI policy design should therefore be vulnerability-informed and stigma-aware.

Key messages

• Older adults may report lower food and energy insecurity yet face greater health harms. Policy should distinguish exposure from susceptibility rather than use age as a uniform proxy for vulnerability.

• Constrained coping, such as under-heating, eating less or lowering expectations, can protect short-term autonomy while worsening health and concealing need from services and policy measures.