In today’s post Hillary Shaw and Julia Shaw consider the links between poverty, poor diet and ill health. In the UK, escalating food, fuel and housing costs, stagnating incomes and poor employment prospects have realised a fateful and catastrophic convergence of problems, which all serve to compound and amplify each other. Increasing social inequalities have, in turn, evidenced the rising incidence of obesity and diabetes, fuelled by nutritional poverty. In the broader context of austerity and welfare reforms, it is suggested that the urban food question – specifically in relation to accessing foods essential to a healthy diet – becomes a priority on the political agenda. The authors describe the particular challenges this poses, and argue that more comprehensive policy solutions that go beyond focussing on individual behaviour, to include regulating industry as well as creating positive food environments, are necessary.
When Margaret Thatcher, British Prime Minister 1979-1990, advocated a return to ‘Victorian values’; she probably did not mean the return of ‘Victorian’ diseases we are now seeing, such as gout and rickets which are closely linked to diet. Gout is caused by excess consumption of fatty food and alcohol; rickets is caused by lack of vitamin D which we get from sunlight and from oily foods, eggs and fortified breakfast cereals. Today, children in deprived areas are going to school without having had breakfast; some even return home to no supper. They may even arrive at school with lunchboxes containing cold chicken nuggets, stale toast, or last night’s leftover chips, so that in deprived areas (e.g., Lanarkshire, Scotland) there is a need for programmes such as ‘Food-365’, an initiative to provide school lunches all year round to alleviate ‘holiday hunger’ amongst the most vulnerable. The ‘health premium’ – the excess cost of eating well either in terms of money, time or knowledge acquisition – has never gone away, and rising inequality in the early 21st century has brought back the old 19th century diseases of dietary poverty. However hunger, poverty and poor diet are now commonly associated with carrying excess weight rather than being underweight.
Once the poor and malnourished were thinner than the rich; yet in modern times, uniquely, they are heavier and more likely to be obese. At age 11, the poorest British children are, on average, 2 kg heavier than those of the wealthiest families, which is the exact opposite of the figures in 1946. At the extremes of obesity the gap is even larger, with the most obese 10% from the poor weighing 4.6 kg more, on average, than the 10% most obese from the wealthy. The same reversal has occurred in developing countries. In Brazil low-income women in 1997 were 40% more likely to be obese than underweight, whereas in 1975 they were four times more likely to be underweight than obese. Once, you had to be wealthy to afford to be obese; now we have an abundance of sugary junk foods and cheap fatty meat, and you increasingly need to be wealthy to be slim.
In Victorian Britain, poor people did die of starvation. At best, undernourished children would suffer physical stunting and mental retardation. So, has the situation improved now the poor are over-consuming calories rather than under-consuming them? Perhaps not, for four reasons. Firstly, obesity stigmatises the poor whereas the sight of a starving person, especially a child, excites sympathy, provokes action and public philanthropy. Our mental attitude has not caught up with our modern socio-economic food situation, and we tend to associate obesity with self-indulgence and laziness. Secondly, obesity is harder to reverse than emaciation; our calorie-hoarding biology, inherited from prehistoric days when food could be scarce for long periods, means we are very efficient at gaining weight and strongly biologically resistant to losing it. Thirdly, obesity creates long-term health problems which cascade on from one another. Excess weight precipitates cardiovascular problems and arthritis; fat can promote cancer, and above all, type 2 diabetes is a major cause of blindness and amputations. These are all chronic and expensive conditions, and may lead to the poor being accused of consuming excess health resources and money, as if they wanted to be obese and ill, and it is their fault they are not eating healthily. Naturally the concept of the health premium is seldom mentioned here. Fourthly, obesity keeps poor people poor. Obese adults are “less likely to be hired, are lower paid, have fewer opportunities and are often outright bullied in the workplace”. This especially applies to women, who already suffer the consequences of the gender pay gap, and who also have higher expectations of ‘appearance’ placed upon them by society. Accordingly, this adds multiple reinforcing layers of prejudice and discrimination to the poverty and obesity issue.
The ‘obesity prejudice’ begins early in life, with overweight children being bullied and achieving less at school; again this may mean they attain lower qualifications and, as adults, earn less and remain poor. In turn, the cycle of poverty means they tend to produce poor children who similarly eat unhealthily and gain excess weight. This is one crucial way in which poverty can transmit itself down the generations. Obesity also propagates poverty through sleep apnoea, causing daytime exhaustion and lower productivity. Obese schoolchildren often miss lessons as they take time off for associated medical conditions such as intensive dental treatment, and obese adults miss work days for a range of illnesses associated with poor nutrition, as noted above.
Society tends to put the burden of reversing obesity largely back on the individual; exercise more, get fitness apps, learn cooking skills, read the food labels. There is no current policy initiative aimed at stopping supermarkets from selling unhealthy foods. A sugar tax has been recently imposed, which raises costs to the consumer, but the government is not using this tax revenue to reduce the costs of healthy foods; for example, a negative VAT rate on fresh produce. Schools have restarted cookery lessons, but there is no educational provision for adults with advice on easy, cheap and healthy eating at the places where they can be easily accessed, for instance, jobcentres, food banks, citizens’ advice bureaux, housing associations or GP surgeries in deprived areas. There is also a tendency to promote a revolutionary rather than evolutionary approach to diet, as typified by Jamie Oliver’s initiative in Rotherham, straight from ‘Turkey Twizzlers’ to gourmet vegetables. This may be interesting, and even informative, for more affluent families who can afford to experiment, waste food, spend time on learning new cooking techniques, and drive to shops which sell these novel foods.
For less wealthy families, and certainly the poorest, a gradualist approach may be preferable; by, for example, introducing leafy green vegetables into ready meals, making healthier sandwiches, adding fresh fruit to processed puddings, and replacing fizzy drinks with fruit juices. A major problem is that truly breaking the vicious circle of obesity, ill-health and deprivation takes far longer than the customary five-year lifetime of a government. A climate of austerity and squeezing the already poor creates financial returns much faster. Although entrenched vicious circles such as the seemingly never-ending cycle of poverty are hard to break, and even though social returns often only materialise –as Ivan Illich almost said – ‘at the speed of a bicycle’, nevertheless social returns bring true longer-lasting benefits for all.
Julia J.A. Shaw is Professor of Social Justice and Interdisciplinary Legal Studies, as well as a member of CURA at De Montfort University.
Hillary J. Shaw is the author of many journal articles, book chapters and commissioned reports in the general areas of economics, geography, politics and the sociology of food consumption and obesity – particularly in relation to the dynamics and evolution of the food desert phenomenon within the wider context of austerity. His book The Consuming Geographies of Food: Diet, Food Deserts and Obesity (Routledge, 2014) explicates the development of the current global food system and explores how sustainable and accessible political and economic structures for feeding the future global population of ten billion can be achieved. He is currently completing a further monograph, Corporate Social Responsibility and the Global Food Chain (Routledge, forthcoming 2019) which explores corporate social responsibility in relation to government policy and the food retailing industry.