Social Disparities. Institute of Medicine Workshop Food Insecurity and Obesity. Elizabeth Dowler

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1 Social Disparities Institute of Medicine Workshop Food Insecurity and Obesity Elizabeth Dowler Reg. Public Health Nutritionist Professor of Food & Social Policy Department of Sociology University of Warwick, UK

2 SES complexities both papers have immense richness of data show gradients rather than binary associations relationship SES indicators & obesity/health indicators depend on age/stage lifecourse/race importance place and space income now (and who controls is in household) vs accumulated wealth, status, control depth and severity poverty and deprivation

3 complexities of poverty Spicker, 1999, Definition of poverty: eleven clusters of meaning in: Gordon & Spicker (eds) International glossary on poverty, London: Zed Books material deprivation: physical needs, ill health, bad housing, fuel poverty and patterns of multiple deprivation economic circumstances: economic inequality, occupational status, employment, structure of opportunities social relationships: social exclusion, marginality, dependency, powerlessness, inability to participate

4 Family resemblances different concepts of poverty Spicker, 2007, The idea of Poverty, Bristol: Policy Press

5 conceptual challenges Dowler, 2008, Proc. Nutr. Soc., 67, ? low income (absolute) or lowest deciles? aim to differentials or improve those worst off? (household) income or area factors? target specific groups or whole population? is problem poverty + deprivation or class + cultural capital

6 UK Minimum Income Standards consensually defined budget standards checked/negotiated by experts costed at reasonable, low prices produced for different household sizes and compositions uprated regularly used for comparison with legal Minimum Wage and state benefits

7 food security and entitlement people should have access to food: grow, obtain, buy food enough money; reach shops stocking foods needed for health at affordable prices enjoy the choice safe food, necessary, appropriate for health and own culture be free from anxiety about whether they can eat properly

8 food security realities? do people have enough money to buy healthy food? can people get to shops selling the range of food needed at reasonably prices? ( food deserts ) is food more expensive in the shops poorer people use (because of loans, feeling accepted etc)? quality of food where poorer people live? institutions schools, workplaces usage do people have skills, confidence, equipment to cook? time? tables? can people eat socially? share food?

9 MIS food budget Oldfield & Burr,

10 MIS vs actual expenditure on food Oldfield & Burr,

11 UK Foresight report on obesity an attempt to capture complexity

12 UK Foresight report obesity: systems map

13 sustainable food security sustainable ways of obtaining food through purchase, production, gifting, earning sustainable ways and means of producing and distributing food; grounded in and governed by just, equitable, moral, ethical social values food should be obtained in ways that uphold human dignity solutions to problems are joined up

14 reconnecting through food shorter supply chains, known provenance buying ethical food values for money supporting smaller scale, sometimes local, initiatives/ businesses/ community food may be economically inefficient, hi/lo-tech aim is better planet, better welfare/ health photos: L Davis, L Venn

15 Food Justice: report of the Food & Fairness Inquiry Food Ethics Council to remedy relative neglect social justice in public debate about food and farming 14 members; call for evidence (100 submissions); 3 sessions with expert witnesses; deliberative process ethical framework: fair shares - equality of outcomes distributions of wellbeing fair play equality of opportunity access to the means to bring about outcomes fair say autonomy and voice freedom to lead the life I value; process is critical applied to food security, sustainability, public health