#022 Food: A Manifesto (Part 2, zooming out)

What we eat can depend on our economic circumstances, where we live, and the food policy settings we have in place.

So how did we get here? (if you are not sure what ‘here’ I am referring to, go back to Part 1 of this post and read that first!).

There is so much information out there about food. Eat this, not that. Do this and be healthy. Exercise more and you can eat what you want.

How much choice do we have in the matter?

What we eat can depend on our economic circumstances, where we live, and the food policy settings we have in place. As noted in Part 1 of this series, our poor state of health isn’t simply because we don’t have the willpower to eat better, our food systems have a huge impact on what we put on our plate.

Economic

In Australia, the way we eat is one clear marker of inequality. In wealthy countries like the United States, the United Kingdom, and Australia, childhood obesity often occurs together with poverty. Most food deserts are located in low-income areas. People living in these regions often have to rely on fast or heavily processed foods that are high in calories but low in nutrients. 

What is a food desert?

It’s is an area where it is difficult to access fresh, healthy food at affordable prices.

Food deserts are becoming more and more common in Australia. A UNSW study found that nearly two-thirds of suburbs in one major part of Sydney have no food stores at all. And in those that do, unhealthy food outlets outnumber healthy ones by more than 6 to one.

In regional and remote areas of Australia, it is even harder to access healthy food, and sometimes impossible to access fresh food.

In 2022, the average household in Australia spent up to a third of their total income to purchase a healthy diet. Those living in regional and remote areas spent 40 per cent of their income.

In the Northern Territory, food in supermarkets is 56 per cent more expensive in remote communities than in regional supermarkets due to long supply chains and poor quality roads (2021 data). You might remember reading this ABC article that showed residents in a remote NT community paying $74.25 for 1kg of Nescafe Instant Coffee.

Australia’s Food Environment Dashboard is a great resource that highlights food access and affordability issues.

It shows that the cost of a healthy diet per fortnight for a family of four in high socioeconomic urban areas of Queensland is $628. In remote areas of Queensland, the same diet costs $813. In very remote communities it can cost $868-$1023, or almost 63 per cent higher than in urban areas.

Food deserts and the lack of access to healthy food is a multi-generational problem for low-income communities. It’s not just the adults who are suffering, but children have no control over the communities in which they are raised. When children don’t have access to nutritious food it can stunt their physical and developmental growth. They might struggle in school, develop illnesses, and have shortened lifespans.

In Henry Dimbleby’s book Ravenous, he writes that the children in the poorest areas of England are both fatter and significantly shorter than those in the richest areas at age 10-11. Because food insecurity is so pervasive, the average 5-year-old in the UK is shorter than their peers in nearly all other high-income countries.

With the cost of living crisis not going away anytime soon, food inequality and food insecurity is on the rise. The 2023 Foodbank Hunger Report found that food insecurity was reported by 3.7 million households in Australia over the past year, representing over a third of the population. If we count the people on the brink, who are anxious about putting food on the table, then it is half the population!!

Access to healthy food is no longer a marginal issue affecting the unemployed and homeless, it probably affects someone you know, or someone who sits next to your child at school.

Policy

Dimbleby argues that “we are fat and ill because we live in a world full of food that makes us fat and ill.’

Why do we live in a world full of food that makes us fat and ill?

To quote Bill Clinton ‘It’s the economy, stupid’ (and, I would argue, the food lobby).

Economics 101 introduces us to the concepts of supply and demand. To decrease the amount of unhealthy, processed food we eat, we can either decrease consumer demand for these products or decrease supply.

How do we do that?

One of the easiest* ways is through price.

We eat highly processed food because it is (a) cheap (remember that fat, sugar and salt are some of the cheapest food inputs), (b) it is convenient, and (c) we are hooked on it.

Over the decades, the salt and sugar in processed foods has retrained our palates, so we now expect an abundance of both ingredients in everything we eat.

FSANZ estimates that Australians aged 2 years and older eat an average of 2,150 mg of sodium per day from an average of 5,500 mg of salt (5.5 g). About 80 per cent of this is from processed foods and 20 per cent from salt used at the table or in home cooking. For adults, the World Health Organization (WHO) recommends less than 2000 mg/day of sodium (equivalent to less than 5 g/day salt (just under a teaspoon).

According to the latest National Nutrition Survey, our average sugar intake is 14 teaspoons or 60g of free sugars daily (also noting that this is pretty old data, and given our ultra-processed food intake has increased, so has our sugar consumption).

These14 teaspoons are more than two times the WHO recommended daily sugar intake of 25g (6 teaspoons) of free sugar. The majority of our free sugar intake comes from added sugars (from processed foods) with an average of 52g (12 teaspoons), with the remaining free sugars coming from honey and fruit juice.

The typical Australian currently gets about 42 per cent of their calories from foods that are high in salt, sugar, and saturated fats, and low in fibre, vitamins, minerals and water, such as sugary drinks, processed meats, muffins, cakes, muesli bars, burgers, pizzas, and alcohol.

So, should we just tax sugary and salty food?

Maybe?

Taxes work to change consumption.

Cigarettes are a great example. Smoking rates have fallen as prices have risen. According to data collected by the Cancer Council of Victoria, the cost of a pack of 25 or 30 cigarettes has increased from a few dollars in the early 1990s to well over $40. The rate of daily smokers aged over 15 in Australia has dropped from over 24% in 1991 to just over 11% in 2019.

In the UK, the Soft Drinks Industry Levy was introduced in 2018. The makers of sugary drinks reformulated their products, reducing sugar content by 35.4 per cent across the market, rather than increasing their prices. The sale of low and high-levy drinks fell by 79.1 per cent and 54.8 per cent respectively.

In Australia, the Australian Medical Association is campaigning for a tax on sugary drinks and argues:

A tax of 40 cents on every 100g of sugar added to soft drinks would raise the cost of a 375 ml can of soft drink by just 16 cents, which is a small price signal that shows us that these drinks are bad for us, and that we should instead be choosing water — the free and healthy alternative.

Our analysis projects this tax would reduce consumption by 31 per cent by 2025–26, and is estimated to result in 16,000 fewer cases of type 2 diabetes, 4,400 fewer cases of heart disease, and 1,100 fewer cases of stroke. It is a simple but effective way to improve the lives of Australians.

[*easiest, I mean hardest. Tax reform is (politically) hard. In Australia, our last major tax reform was 24 years ago with the introduction of the GST!!]

Or, rather than making unhealthy food more expensive, should we make healthy food cheaper?

One UK study using mathematical modelling has shown that subsidies (a 10 per cent discount) on healthy foods (fresh fruit and vegetables, fish and lean meats) was the most effective policy, reducing the percentage of overweight people from 57 per cent to about 13 per cent.

The researchers found that introducing this subsidy would cost the UK government around £991 million. However, when accounting for the saving to the NHS (UK Medicare equivalent) of not having to treat as many overweight-related conditions, the net benefit of the policy equated to £6 billion in the long run. Governments are often reluctant to introduce some subsidies because there is a long lag between implementing the subsidy and seeing results – it might take years or even decades to show that a healthy food subsidy works (which is also why preventative healthcare funding is miniscule when compared to curative healthcare).

So, as we can see diet-related choices are not just an outcome of personal preferences. The availability of food outlets, and the range of foods they sell, can influence those choices, as well as the taxes and subsidies available on certain foods. And in turn, this can influence our nutrition and health.

And a quick word on Big Food. There is a tonne of research out there that shows how Big Food, aka food lobbyists, influence what we eat. From influencing scientific research and dietary guidelines, to shaping how nutrition education is presented to adults and children (remember, those Got Milk? ads in the late 90s, early 2000s?).

Source: Food Unfolded

An investigation into industry-funded science looked at 206 studies, 54 per cent of which received industry funding (for example, this might be a study into why eating eggs is good for your health, funded by an industry body, like the Egg Farmers of Australia). It identified that industry funded studies were 400-800 per cent more likely to find a favourable outcome in support of the funding company’s product compared to non-industry funded research. Of the 206 studies, not a single industry-funded study published unfavourable results. So next time you reach for a glass of milk because you want stronger bones or think that eating bacon isn’t that bad for you, think again – who funded the research?

If this is leaving you confused (and a touch angry), I don’t blame you. What on earth are we supposed to eat then?

Stay tuned! Zooming in, Part 3 of Food: A Manifesto will be about what we, as individuals, can do to improve our own health through food, and how we might advocate to others to help us!

Be well,

Alicia