Feature

Bread and real life

Peta Cottee explains why healthy eating on a low income doesn’t always make sense

Published nearly three years ago, The Health of the Nation was a landmark in health policy. For the first time, health promotion was given the same importance as healthcare. Clear targets were set in several areas, including nutrition, emphasising, at last, the impact diet has on our overall health.

It was recognised that if these nutrition targets were to be met, priorities had to be established, which has been the job of the Nutrition Task Force. Eat Well! An action plan from the Nutrition Task Force, published in March 1994, identified priorities but acknowledged that some groups would have specific problems meeting targets. One such group is people living on a low income and a special project team has been established to, among other things, ‘collate and disseminate examples of good practice and of local initiatives to help encourage those on low incomes to eat a healthy diet’.

The National Food Alliance (NFA) has long been interested in the effect of low income on diet, and the access low income groups have to healthy food. The Department of Health funded publication of an NFA pack entitled Food and Low Income: a practical guide for advisors and supporters working with families and young people on low incomes. Since its launch in December 1994, almost a thousand packs have been sold, demonstrating the enormous level of interest and concern there is around this issue. As a result, the Health Education Authority recently supported the NFA in running a series of regional conferences in London, Newcastle and Birmingham.

Their purpose was to provide those working with low income groups and those responsible for policy development a forum to discuss how materials from the NFA food and low income pack might be incorporated into their work; gather suggestions for future research and/or new editions of the NFA pack; and encourage the development of networks of professionals tackling food and low income issues.

Reaction to the seminars, as with the pack itself, has been overwhelming. It is now widely accepted that the health of low income groups is significantly and adversely affected by the poorer diet they eat. The question is, why is this happening?

At the seminars, participants argued powerfully that the idea of ‘choice’ to those without adequate income is meaningless. For people on a low income, choices, and particularly those relating to food, are highly constricted. Choosing healthy foods is not a priority when there are other less flexible items such as rent, heating and clothing that need to be paid for.

In any event, education is not an issue. The healthy eating messages of cutting down on fat and eating more fresh fruit, vegetables and cereals is well understood across all socio-economic groups. So why do low income groups apparently ‘waste’ their limited money on high fat and/or high sugar foods such as pies, chips and biscuits, particularly when healthy food such as carrots, potatoes, cereals and pulses seem cheaper?

We know from the National Food Survey that lower socio-economic groups already eat more potatoes and cereals than any other groups, because they are cheap and filling. But fresh fruit, vegetables and other healthier, lower fat foods are largely neither cheap nor filling. Custard cream biscuits cost only 2p per 100 calories, frozen chips 4p per 100 calories, full-fat milk 7p per 100 calories and pork sausages 10p per 100 calories. Carrots cost 20p per 100 calories, tomatoes 80p per 100 calories, broccoli 74p per 100 calories, oranges 30p per 100 calories and skimmed milk 13p per 100 calories. In these terms, low income groups are efficient shoppers. They may not necessarily know the figures, but they know what is most effective at filling up their family.

In addition, fatty and sugary foods are comforting and filling. Pies, sausages, cake and biscuits are easy to cook or need no cooking at all, which is important when cooking facilities are limited or you have to economise on fuel. It is also better to provide food that will be eaten than risk waste.

Food projects are springing up all over the country which help increase access to good food for people on low incomes. Groups of people are organising themselves into co-ops to buy food in bulk direct from wholesalers.

Empowering low income groups to make healthy changes to their diet is not going to be achieved solely by setting up local food projects. But it is a start, and a step in the right direction. Grassroots action can make a real difference to people’s lives and that is what the NFA pack aims to do. The next step, to which the NFA is committed, is to keep all those involved in touch with each other and help them learn from and support each other.

With the government’s commitment to low income groups through The Health of the Nation, the work of the NFA and those working with low income groups we hope to push this issue up the political agenda so that grassroots action is supported by stronger government policy.

The Food and Low Income Pack. From: National Food Alliance, 5-11 Worship Street, London EC2A 2BH. 0171-628 2442. Price: £9.95 incl. p&p