This is the third instalment of our series on health inequalities, where we explore the unfair and avoidable differences in cancer incidence and outcomes across society. Our last post looked at inequalities in smoking, and what needs to change to reduce smoking-related cancers.
In this piece, we investigate diet inequality and its root causes with Dr Amy Yau, Research Fellow at the London School of Hygiene and Tropical Medicine. We also explore why governments need to go much further and much faster to tackle diet inequality and to support people to maintain a healthy weight.
Food, health and wealth
There’s no shortage of information and advice about diet. From online food bloggers to conversations with family members, everyone seems to have an opinion about what we should be eating. And it’s not surprising, with food playing such a key role in our health.
A healthy, balanced diet can help us keep a healthy weight, reducing our risk of 13 different types of cancer. And what you eat can also have an effect on your risk of cancer. Eating too much processed meat increases the risk of bowel cancer. Whereas a diet low in red meat and high in fibre from wholegrain foods may reduce the risk.
But a healthy diet is not always easy to achieve, and people from lower income groups face substantial challenges when it comes to accessing healthy food.
Inequalities in diet and eating are extremely complex – the healthy option is not always the easy option, or an option at all. But there are still things that can be done to tackle the differences between groups in access to healthy balanced diets.
We spoke to Dr Amy Yau about the drivers of this issue and what can be done to tackle three of the biggest threats to our health: diet inequality, food poverty and obesity.
What do we mean by diet inequality?
Diet inequalities are differences between groups in how difficult it is to eat healthily in the long-term.
“Food is such an important part of people’s lives, culture and identity. There isn’t just one diet that’s the perfect diet that we want everyone to have – it’s about giving people the ability and the option to have a healthy balanced diet that is tasty to them, but also easily achievable,” says Yau.
This means that it doesn’t really matter if you have curry or cauliflower cheese for tea tonight. We all have a right to have a healthy diet overall – one that’s made up of plenty of fruit, vegetables, wholegrains and healthy proteins, and is light on processed and red meat, as well as foods high in fat, salt and sugar.
But in reality, we’re not all getting an equal shot at making healthy food choices, which in turn contributes to health and cancer inequalities.
So, what is it that puts a healthy balanced diet out of reach for some of us?
Barriers to healthy eating
“A lot of things feed into peoples’ different dietary habits and their ability to purchase and maintain a healthy balanced diet,” Yau explains.
“It’s really down to the resources that people have, be that personal resources – the time and effort that has to go into choosing, buying and cooking food. Or whether it’s actual material things – money to buy food, housing with kitchen facilities, a big enough fridge and freezer to store things in and so on.”
A lack of cooking facilities in homes might seem like an extreme example, but data collected by charity Turn2US suggests that 1.9 million of us are living without a cooker, and 2.8 million without a freezer.
And what’s more, worrying anecdotal reports of people turning off fridges and freezers, or disconnecting from gas and electricity in response to increasing energy costs, mean that appliance poverty could be affecting more people now than it has previously.
Even if access to cooking facilities isn’t a problem, being short on other resources might be. Lack of time, money or energy can also make buying and preparing healthy food a difficult prospect. Examples include a lack of travel options to supermarkets making the weekly shop long and costly, or not having enough time to prepare lunches for school or work.
Lack of resources take healthier options off the table for some. And the proliferation of fast-food outlets in more deprived areas provide a quick, easy, and often less nutritious alternative.
Food gives us energy (measured in calories) and the nutrients we need to keep our bodies fuelled up and ticking over. And when faced with these limited resources, high-calorie meals are often the easiest and cheapest option available. Products that are higher in fat, salt and sugar often have more calories, are cheaper, and are more likely to be advertised and part of price promotions such as 2-for-1 deals.
“If someone is struggling to make ends meet, then they are more likely to be buying these products to get enough calories. And it’s not just the cost of products, but the cost of products relative to others that is really important.” Yau adds.
It’s clear that a healthy balanced diet, as recommended by the NHS, demands time, energy, and money. And although motivation, cooking skills and knowledge are also important, we must recognise that often ‘the healthy option’ simply isn’t an option for many in the UK.
With costs of food and other household bills rising faster than income, more people are facing the prospect of food poverty or food insecurity . Yau defines this not only as “the inability to consume enough quality food”, but also “the worry that you won’t be able to do so”.
Yau also explained that it’s difficult to track food poverty, and data is often incomplete or insufficient, but that data from foodbanks can help us understand trends in food poverty across the UK.
“Not everyone who is food insecure will go to a foodbank, but we’ve seen foodbank use really rising. It’s been going up ever since the global financial crisis in 2007/2008, and we saw the highest recorded use in the first year of the pandemic.”
Foodbanks in the UK do an incredible job helping families get enough to eat. But they are only a partial solution. “Solutions need to be upstream,” explains Yau.
Upstream solutions address the causes of a problem, rather than just tackling the symptoms.
“Just providing food is not a long-term solution. We need to address the drivers – people not being able to afford to live in general because of the high cost of living and low incomes. Solutions have to start there – looking at minimum wage, national living wages, zero hours contracts, and income stability.”
Limited diets and obesity
Overweight and obesity in the UK is amongst the highest in Europe, with more deprived groups affected the most. If current overweight and obesity trends continue, the number of UK adults who are overweight or obese could reach around 7 in 10 people, or 42 million people, by 2040.
It can seem counter-intuitive, but many people experiencing food poverty are also affected by obesity. In England, obesity rates are more than a third higher in the most versus least deprived men, and around three-quarters higher in the most versus least deprived women.
When a healthy balanced diet and regular meals aren’t an option, the alternative is high-calorie, highly processed, less nutritious food that makes it much harder to keep a healthy weight.
What we can do as individuals
Just knowing what makes a healthy diet can help with our day-to-day food choices. That could be as simple as choosing beans or fresh chicken over processed and red meat next time you’re eating out, or making swaps to increase the amount of wholegrain foods in your diet.
However, relying on education and awareness alone won’t narrow existing health inequalities.
“If you’re only asking people to change their behaviour, you’re losing people at each step. It’s the people that have the most resources, and maybe more knowledge that are most able to make these changes.” Yau says.
“Education is important for people to have the knowledge and confidence to make good decisions and prepare healthy meals. But just equipping people with knowledge and skills won’t fix the problem if the environment isn’t also supportive.”
Making the healthy choice the easy choice
Take advertising. What we’re exposed to on our mobile phones, tv screens and high streets plays a big part in what we end up eating.
Recent research by CRUK found young people recalled seeing advertising of unhealthy foods at high levels and offered tangible examples of how this influenced their food choices and purchases. And the number of places young people are exposed to this advertising is growing, with the rapid rise of new digital platforms.
“Most of the advertising we see is for high fat, salt and sugar products, so by removing some of those, we’re really giving people more choice to be able to choose from a variety of options. It’s about rebalancing what we’re exposed to,” Yau explains.
And it’s important to remember that multi-buy offers on junk food aren’t just bad for our diets – they don’t help us save us money either – but they do hoodwink shoppers into spending more on less nutritious food.
Despite significant potential to change the food environment, the UK Government has delayed its commitment to implement restrictions on junk food advertising, and on multi-buy price promotions for less healthy food and drink in England. Wales is currently consulting on implementing such promotions restrictions; and Scotland has pledged to implement similar measures, but has not yet introduced legislation to make this happen.
Not taking action to reduce obesity rates now has a direct effect on cancer risk. We need governments to recognise the urgency of this issue. Delay means that more people will be at higher risk of cancers like breast, bowel and pancreatic cancer in the future. And it means that people from deprived areas will bear the brunt of this.
What’s more, we know that most of the UK’s biggest food brands could quite easily switch to marketing healthier options right now if they were made to. Supermarkets are also ready to make this change. Both Tesco and Sainsbury’s have confirmed that they will go ahead with the original October 2022 deadline to see an end to multi-buy deals on junk food. But other retailers have not yet volunteered to follow suit.
When it comes to UK health, we need timely government action to bring about wider change to our environment; making it plausible for families in all areas to eat well and have a lower risk of serious diseases, like cancer.
Rachel Orritt is Inequalities Programme Lead at Cancer Research UK