Policy makers don’t read tabloid newspapers. They read more
serious broadsheets from the London Times to Figaro to the Washington Post. And
these broadsheets often perpetuate the beliefs that make the upper social echelons
happy or indeed smug. And among these beliefs is that which argues that the
present epidemic in obesity is primarily a problem of the lower socio-economic
groups. One cannot argue against the line that obesity rates are higher among
the socially disadvantaged. Neither can one argue against comparably higher
rates of suicide, homicide, drug abuse, violent crimes, indebtedness, heart
disease, cancer and anything you care to mention but which you’d rather do
without, thank you very much.
The fact that obesity, like suicide and homicide, is higher
in those who are socially disadvantaged doesn’t mean it is absent in the
socially advantaged. The differences in obesity rates are in high fractions
such as 0.8 or thereabouts such that for every 5 obese persons who are socially
disadvantaged, there are 4 obese persons among the economic elite. Think of the
Clintons, Hilary in recent times and Bill, a while back. However, as I’ve
already said, obesity is higher among the socially deprived. The question is
why so and what to do about it.
A recent paper in the American Journal of Public Health[1]
looked at residence mobility in relation to social status and the economic
deprivation of the areas of residency in the city of Dallas. The study was part
of an on-going study on heart disease and followed subjects (about 1,800) over
the period 2000 to 2009. Weight was monitored at baseline, at various intervals and at follow up. Half the subjects moved from one neighbourhood to another and of these, 600 subjects moved
to a neighbourhood with a higher ‘Neighbourhood Disadvantage Index’ (NDI: ~
perceived neighbourhood violence, poor physical environment, and low social cohesion).
Compared to those who moved to a neighbourhood with a lower NDI or who remained
where they originally resided, those moving to a higher ranked NDI suburb
gained significantly more weight and the longer the residence in the higher NDI
suburb, the greater the weight gain.
Well of course, the answer is simple. These people moved to “food
deserts”, the trendy middle class quasi left wing term to describe regions
which are so poor, its not worth anyone’s time and money in building them a
supermarket. Consequently, the creed goes, they cannot get access to affordable
and varied food supplies but are forced to shop in local stores that don’t sell
fruit and vegetables at a reasonable price and which prefer to stock their
shelves with cheap and, of course, high fat, high sugar and high salt foods
(Credo in unum dieta!). Enter a governmental initiative that subsidised the
building of a brand new supermarket in the suburb of Morrisania in the New York
borough of the Bronx with a ‘control’ suburb of Highbridge where no such
investment was made. A research paper just published[2]
examined food choice 5 weeks and 52 weeks after the supermarket was opened. The
authors concluded as follows: “The
introduction of a government-subsidized supermarket into an
underserved neighbourhood in the Bronx did not result in significant changes in
household food availability or children’s
dietary intake. Given the lack of healthful food options in underserved
neighbourhoods and need for programmes that promote access,
further research is needed to determine whether healthy food retail
expansion, alone or with other strategies, can improve food choices of children
and their families”. So, access to healthy food options is not the issue.
It is most likely lifestyle choice arising from a particular educational
stance.
Now enter the ultimate holy grail of the urban middle class
food priests, the Farmers Market. What can be more morally upright than buying
wholesome food directly from the farmer who toiled the land to produce such
heavenly fare? Well, a recent study[3],
also in the Bronx, paints a different picture. Following a comprehensive study
of farmers markets (FMs) in this region, they conclude as follows: (1) FMs operate overwhelming fewer months, days,
and hours than nearby stores, (2) FMs carry less-varied, less-common,
more-expensive produce than nearby stores. (3) FMs offer many items not optimal
for good health (e.g., jams, pies, juice drinks) and OMG, (4) FMs might provide
little net benefit to food environments in urban communities.
Social inequality lies at the heart of many patterns of
chronic disease. Tackling it is outside my expertise but I’ll vote for it
