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"...public opinion deserves to be respected as well as despised" G.W.F. Hegel, 'Philosophy of Right'

health inequalities « Previous | |Next »
July 21, 2011

In Australia overweight and obesity have become increasingly more prevalent among socially disadvantaged groups, particularly in urban areas. Like most other risk factors for ill-health, excess body weight tends to be more prevalent among people further down the social and economic scale.

MIll St
Gary Sauer-Thompson, Mill St, Adelaide, 2011

Encouraging healthy eating habits is difficult given the extensive array of convenience and pre-packaged foods high in fat, sugar and salt (so called junk foods) which are increasingly available across the world, often promoted in large or multiple serving sizes.

This has made eating healthily a challenge—for individuals personally, and for policymakers indirectly; and the challenge has been compounded by a bombardment of marketing and advertising that surreptitiously and adversely influences people’s food preferences and consumption patterns.

In Overfed, overgrazed and difficult to overcome in the Sydney Morning Herald Elizabeth Farrelly refers to Sydney's diabetes map. This:

map reveals a clear doughnut pattern with dark, congealed patches around the west and exurban fringes (Mt Druitt, Wollongong, Toongabbie) and pale bits in the old centre (north shore, city, Coogee). It's the direct inverse of how a rickets or tuberculosis map would have looked a century ago.It's not just fat. Maps of obesity, heart disease, renal failure, smoking, TV-watching and hypertension - diabesity, if you'll excuse the coinage - would show similar patterns...What's interesting is that this stuff is class-related. Diabesity is a poverty indicator.

The data provokes the question not only why the poorest of the poor and the most vulnerable and marginalised groups have bad health but why is there a socially graded relation between social position and health?

The Marmot Review highlights that there is a social gradient in health – the lower a person’s social position, the worse his or her health. Health inequalities result from social inequalities. Consequently, reducing health inequalities is a matter of fairness and social justice. Health equity then becomes a marker of successful development.

So why the social gradient in health? Farrelly says that (relatively) poor Australians, despite decades of education campaigns, still see conspicuous consumption - of land, leisure, energy, alcohol, food - as a norm, not a mortal danger. It's overconsumption that is driving obesity and diabetes.

The problem with Farrelly's argument is that obesity and diabetes doesn't come from overconsumption per se (the middle class also over consume as Farrelly acknowledges); it comes from overconsumption of cheap junk food. What, and how much, people eat, drink and smoke and how they expend energy are responses to their socio-political, socio-economic, socio-environmental and socio- cultural environments.

From another perspective that a significant proportion of the Australia population now eats large volumes of energy-dense nutrient-poor foods--junk food --- does not expend enough energy, smokes and consumes harmful quantities of alcohol is a sign of success –the commercial success of the corporate food industry. It's a lucrative business. Hence the intensive advertising.

| Posted by Gary Sauer-Thompson at 9:32 AM | | Comments (13)


"Education" is the key.

I air quoted it because 'education' comes in various forms.

The most visible and pervasive form is TV radio, print etc advertising.
Mass media in other words.
Where people are constantly exhorted cajoled persuaded etc to consume buy spend now, as in immediately.
Including processed and junk foods, foods known to have low levels of nutrition and high levels of salt and sugar despite the de-emphasis of such and the silence and even handwaving in other directions in the advertising. Where sugar is disguised as an 'energy source' and any attempt to regulate such, tut tut, is seen as an attack on personal and individual liberty, the rights and duties of the parent, the forcing of unacceptable 'nanny statism' on a public that would be deprived if such antidemocratic [or is that anti corporate, same thing] care was allowed to be exercised.
So instead we have a brief [usually] series of advertisements, to the joy of the advertising and media companies, extolling the virtues of 2 fruit and 3 veg which is drowned in volume and quantity by a whole barrage of ads from the supermarkets, chef programs, junk food companies who assure us that if it comes processed in a pack its really good stuff.

Far more powerful than what is generally termed 'education' programs.

BTW Gary, I do appreciate you giving us the insights you do and the opportunity to engage in a rant or two.

" I do appreciate you giving us the opportunity to engage in a rant or two. "

No problems. Go for it.

Public health approaches to modern day health challenges have given primary emphasis to the role of individuals, their behaviours and health services. Individual factors such as functional differences, personal skills and socio-cultural beliefs can indeed facilitate (or constrain) behaviour change.

However, choosing to eat healthy food, being physically active, limiting alcohol consumption and not smoking – among all social groups - requires that people are empowered to make these choices.

The reason we have failed re obesity and diabetes is that obesity and diabetes are not primarily biomedical disorders, but rather are rooted in socio-economic, political, environmental and cultural determinants. The latter is not in the traditional purview of medicine or pediatrics.

There is certainly lots of good advertising to lure people to takeaway joints and grog shops but only limited to induce healthy lifestyles.
The Norm campaign a few years back was an excellent one. Perhaps it should be rejigged and put out there again.

Its not only lifestyle health that is related to poverty and class.
Once upon a time the Social Atlas showed the correlation between lower socio-economic suburbs and the incidence of pollution, air/water/soils, [toxic] industrial wastes and the like and related diseases.
A classic being that of lead pollution and associated diseases and conditions.
Not just correlataion but causation as well.

Yes and now it seems that the poo'er will have such a large internet cost every month with NBN they will have less money to eat. Well at least they will be able to go onto youtube and watch other people eat.
Internode! soumds like something I once had removed from my anus.

are you referring to this --Internode’s NBN pricing?

The basic entry (bronze) plan is pretty much the same as its current ADSL2+ voice and data bundle. The real world speeds on even the bronze plans in the NBN will be quicker than most ADSL2 customers can get today, unless they are next door to the Telstra exchange.

You increasingly pay more for the higher speeds and the bigger data unloads. I cannot see those on lower incomes needing or requiring a platinum service plan. Can you?

The food industry appears incapable of marketing healthier foods.Their reason for existence is not public health but profit, so they’ll continue to sell the health-damaging food that’s most profitable, until the market or another force skews things otherwise.

Mark Bittman in the New York Times says:

That “other force” should be the federal government, fulfilling its role as an agent of the public good and establishing a bold national fix. Rather than subsidizing the production of unhealthful foods, we should turn the tables and tax things like soda, French fries, doughnuts and hyperprocessed snacks. The resulting income should be earmarked for a program that encourages a sound diet for Americans by making healthy food more affordable and widely available.

Simply put: taxes would reduce consumption of unhealthful foods and generate billions of dollars annually. That money could be used to subsidize the purchase of staple foods like seasonal greens, vegetables, whole grains, dried legumes and fruit.

Whilst I agree that the food industry is not a charity, it can only make money by people choosing to buy their products. That the customers prefer greasy/salty/sugary food to excess is not a push from the "industry" but a direction dictated by the purchaser. And milked accordingly.

Australian processed food is much higher in calories than processed food available in other countries.

Traditionally Australians eat a sandwich and piece of fruit for lunch. In Singapore you might chose Nasi Padang which is rice and 2 veg dishes.

Lean Cuisine in Australia is 350g of rice, pasta or potato and 30g of protein in gravy. Isabella in Spain is tuna, vegtables and about 20% pasta preserved in oil.

Then we can talk about soft drink, chips, and twisties etc

To be fair the inhabitants of lower socio-economic suburbs of European cities are as large as their Australian counterparts

The bottom line is profit not health. eg., Campbells. Campbell’s soup just announced yesterday that can’t sell low-sodium soups and so they’re adding salt back.

And part of the reason they can’t sell it is that if you’re on a high-salt diet, food that isn’t salty tastes terrible to you. And if you’re on a low-salt diet it takes three to six weeks to get accustomed to being on a low-salt diet and then everything you eat tastes salty. And so the more salt in the food supply the more salt people need to bring the flavor you associate with salt.

Public concerns about obesity put food companies in a difficult position. Even if companies want to produce healthier products and stop marketing to kids, they can’t. If they do, they lose sales.

It is common for those on the political right to say that the best way to prevent obesity to personal responsibility (eat healthy food), to downplay the soft drinks and junk food, and to advocate niform voluntary national nutrition and marketing standards for food and beverage products marketed to children.