The most frequently-heard, populist answer is to explain it in terms of self-destructive behaviour for which people from poorer communities are deemed personally responsible. Being supposedly less concerned about their own state of health, they eat to excess and lead inactive lives. It is claimed that the economically disadvantaged lack will-power, which also neatly explains their reduced economic success in the first place.
But it is unclear why such personal irresponsibility should be concentrated in those with lower incomes. Nor does this explain why levels of poverty – and its distribution between different groups – changes so markedly over time in response to current economic and social policies.
"Energy-dense, fatty foods tend to be cheaper and therefore attractive to those who are struggling to make ends meet"
This ‘personal responsibility’ argument also views people out of context, in isolation from the social factors that so strongly influence us all. In recent years considerable attention has been paid to the ‘obesogenic’ environment: all the influences that encourage people to eat excessively and lead inactive lives. There is good reason to think that these factorsbear more heavily on people with low incomes, accounting for their higher level of obesity.
People on low incomes tend to find themselves in a vicious circle of unhealthy eating. Energy-dense, fatty foods tend to be cheaper and therefore attractive to those who are struggling to make ends meet. They are heavily advertised by the food industry, and often linked to a ‘modern’ lifestyle. And they are also likely to be more available in the shops that poorer people use. Without a car, a low-income person’s choice of food suppliers will be restricted even further.
Meanwhile today’s jobs require much less energy than in the past, as do contemporary leisure activities. Poorer people are less likely to live in areas with good access to green spaces – where exercise is enjoyable – and the green space they can access may not feel safe. Limited private transport and the cost of fares discourage poorer people from travelling to make ‘healthier lifestyle choices’. And facilities like gyms and active forms of transport like cycling are currently more utilised by middle-class people, creating a strong sense of feeling that healthy living is inappropriate for ‘poorer people like us’.
Those on lower incomes tend also to have less predictable lives that might create a stronger basis for investing in a longer term future. Their work is more likely to be insecure and with variable hours, while benefits are increasingly subject to administrative changes and pressures imposed by the state. Those who feel they are ‘ getting by’ or ‘living from day to day’ are inevitably less able to plan ahead, and are thus more concerned with more immediate satisfactions.
"On average poorer people are more likely to suffer from a wide range of health problems, and this can only be addressed by strong government action"
They may therefore find unhealthy ‘treats’ more attractive, and prefer food that feels satisfying and makes up for difficult and stressful days – or enables them to face the next one with confidence. It is much harder to feel that it’s worth postponing gratifications into the future when that future seems unpredictable and hard. This does not mean poorer people are less concerned with their health; more that they have a different understanding of what this involves compared to experts.
Should policies to reduce obesity take closer account of its link to economic and social position? As with many other forms of ill-health in contemporary society, there is a strong social gradient here. On average poorer people are more likely to suffer from a wide range of health problems, and this can only be addressed by strong government action. Reducing levels of economic insecurity, low pay, and minimal benefits will be important, but also quite specific changes in food policy.
Making a healthy diet more affordable and attractive is vital. This means better regulation of food production, but also of advertising, especially in relation to children and young people, and more informative food labelling. Because even if you are well educated, have a good job and are motivated to eat healthily it is currently hard to assess just how nutritionally valuable to food we buy in shops, cafes and takeaways really is.