Inequality: Food Follows Class-line

Class doesn't allow anyone and anything to get out of its clutch. Food and health are not class-neutral areas. These, rather, have to faithfully follow class-line. Inequality is one of its outcomes. It's a fact not only from one or two countries like the UK and the US , but from scores of advanced capitalist countries, and the fact has emerged over a period of decades.

It's not a single country-story

Inequality in food isn't a trend found only in a country. The pattern is wide. Nicole Darmon and Adam Drewnowski in their “Does social class predict diet quality?” ( The American Journal of Clinical Nutrition , vol. 87, no. 5, May 2008) find diet quality follows class stratification. The fact stands as: the poor have only the bad while the rich consume only the best.

Their study was based on a large body of epidemiologic data from scores of cross-sectional studies conducted in at least 15 countries in Europe, North America and Australia . The countries covered in the studies included Australia , Canada , Denmark , Finland , France , Germany , Greece , the Netherlands , New Zealand , Norway , Portugal , Spain , the UK , the US . In their study Darmon and Drewnowski covered about 200 studies published in medical journals during the period 1982-2007.

Citing 22 studies Darmon and Drewnowski write in the “Introduction” section of the study report:

“Morbidity and mortality rates in industrialized societies follow a socioeconomic gradient. The more disadvantaged groups suffer from higher rates of obesity, diabetes, cardiovascular disease, osteoporosis, dental caries, and some forms of cancer. All of these diseases have a direct link to nutrition and diet. It has been suggested, more than once, that dietary factors may help explain some of the observed social inequities in health. The more affluent population subgroups are not only healthier and thinner, but they also consume higher-quality diets than do the poor. Diet quality is affected not only by age and sex, but also by occupation, education, and income levels — the conventional indexes of socioeconomic status (SES) or social class.” As SES, they consider education, income, and/or occupation.

Their conclusion includes:

1. “[H]igher-quality diets are, in general, consumed by better educated and more affluent people. Conversely, lower quality diets tended to be consumed by groups of lower SES and more limited economic means.”

2. “Increases in food availability and ongoing marketing incentives to consume large quantities of low-cost energy-dense foods may be particularly damaging to the health of lower SES groups, for whom such foods represent a source of affordable calories.”

In the section “Evidence of a social gradient in diet quality” the researchers refer to scores of studies and write:

1. “Higher values of the Healthy Eating Index, Diet Quality Index, dietary variety and diversity scores, and other diet-quality measures have all been associated with higher SES. The same positive relation with SES was observed for dietary patterns.”

2. “[T]he consumption of whole grains was associated with higher SES, whereas the consumption of refined cereals (white bread), pasta, and rice was associated with lower SES.”

3. “Lower SES groups also consumed significantly more potatoes.”

4. “Higher SES groups were more likely to consume vegetables and fruit, particularly fresh, not only in higher quantities but also in greater variety.”

Citing a meta-analysis of studies from 7 European countries they write: “[F]ruit and vegetable consumption was consistently higher in the highest than in the lowest SES group …”

They add: “In Australia , a 3-fold difference was found between bottom and top quintiles of income for not consuming fruit on the previous day. In the Netherlands , women with a basic education level were almost 3 times as likely to be low consumers of fruit than were the most educated groups. In a recent Canadian analysis of food budget surveys, the strongest positive relation between income and the quantities of food purchased was found for fruit and vegetables. … Studies from the United Kingdom and the United States suggest that SES disparities in fruit and vegetables consumption have increased over time. … The consumption of lean meats, fish, and other seafood was associated with higher SES in a large number of studies. Lower SES groups tended to consume larger quantities of fatty meats instead of the recommended lean meat items. Fried, breaded, and canned fish were all consumed in greater quantities by lower SES groups, who also consumed more stews and fried foods. Diets of lower SES groups were also characterized by more added fats …”

Children are not spared

Children of workers and the poor are not spared by inequality.

Referring to a study in France Darmon and Drewnowski write: “[C]hildren of semiskilled and unskilled workers consumed significantly more sweets, bread, potatoes, cereals, and deli meats than did children from the upper SES group.”

In the US , the researchers write, “children and adolescents from low SES households consumed less fruit and vegetables and a more limited variety of produce. Children from families with lower education levels had the lowest fruit intakes and the highest consumption of sweetened beverages.”

Referring a number of European studies they add: “[L]ow fruit and vegetable intakes and a high frequency of soft drink consumption among low-SES children and adolescents.” On the opposite, the researchers write, “higher SES groups had consistently higher intakes of most vitamins and minerals and fiber than did lower SES groups.”

“Low-SES groups”, Darmon and Drewnowski write, “had the lowest consumption of vitamin C, ß-carotene, and folate, vitamin E, and plant-based polyphenols. Low iron intakes among low-SES populations were found in most studies and so were lower intakes of calcium and potassium.”

The rich can pay

Other evidences found by the researchers include:

1. “[H]ealthier foods are associated with increased monetary and time costs.”

2. “The observed SES gradient in diet quality may be mediated by food prices and diet costs. It follows from economic theory that food price is an important determinant of food choice. Not surprisingly, the lowest-cost diets are also the least healthy. In general, high-energy-density diets are associated with lower costs, whereas nutrient-dense diets are associated with higher costs per megajoule.”

3. “Diets composed of low-energy-density nutrient-rich foods are more expensive than are diets composed of refined grains, added sugars, and added fats.”

4. “Food costs are a barrier to the adoption of nutrient-dense diets, especially by the lower income groups.”

5. “One recent study, based on the US Department of Agriculture Thrifty Food Plan, reported that the cost of substituting healthier foods can cost up to 35–40% of an American low-income family's food budget.”

6. “Other studies have shown that food costs are an obstacle to reducing fat intakes or to increasing the consumption of fish, whole-grain products, or vegetables and fruit.”

7. “In a recent US study, women who considered food price very important were likely to live in low-income households and to have energy-dense diets.”

8. “Several studies have emphasized that food budgets of the poor are insufficient to obtain a balanced diet. Even when low-income groups develop efficient purchasing strategies, the food budget may not be adequate to procure the recommended diet.”

9. “Poverty may lead to the selection of low-cost diets that are both energy rich and shelf stable. … The emphasis on maximum calories and least waste and spoilage is another characteristic of poverty. Because trying a new food represents a risk of waste, diets of low-income households are often monotonous. Poverty is often accompanied by isolation, boredom, and depression — behaviors that may encourage snacking, simplifying or skipping meals, and sedentary behavior.”

The rich-poor inequality, as the references show, in the area of food is stark.

A lot and a nothing

The world system owns a lot for a few, and has nothing for many. An arrangement has thus been made. “Access to foods”, Darmon and Drewnowski said, “can also be a function of the physical environment. Whereas supermarkets and grocery stores may cluster in the more affluent neighborhoods, some lower-income neighborhoods have been characterized as ‘food deserts'.”

The areas the poor live bear signs of the poor and poverty. The researchers write: “Living in lower-income neighborhoods has been associated with lower consumption of fruit, vegetables, and fish. The quality of food choices was directly influenced by the ease of access to a supermarket as well as to the availability and variety of healthy foods in neighborhood stores. For example, foods recommended for the self management of diabetes are less likely to be stocked in East Harlem than on the Upper East Side .” It's not a New York-reality.

Dhaka is no exception: Jurain, Tallabag, Mugda, Basabo, Jatrabari, Madartek in the capital city are completely different from Gulshan and Baridhara in the same city. The shops with their appearance, the commodities sold in shops in the two groups of areas in the city, the names, type and quality of food the people purchase, and the cookies children in the two groups of areas in the city are happy with, the amount of money consumers spend in the shops, even the sound and noise, the smells and odors, are completely different: one, for the “unpolished” low-income persons, and the other, for the “sophisticated” well-off, and rich. Socioeconomic differences in dietary patterns are stark. In Luanda , Kolkata, Delhi , Mumbai and Manila , the same divide, the same line of demarcation dominate. It's, the line between the rich and the poor, difficult, but not impossible, to cross.

The poor can only afford low-cost foods that satisfy their hunger, and those “nice” foods are available in low-income areas. The rich don't even know names and tastes of those foods as foods of the poor are “nasty”. A slum dwelling woman in Dhaka , found a study, collects discarded rotten vegetables from a wholesale market. A portion of the collected rotten vegetables is consumed by the woman's family while the rest is sold to petty traders, and the traders sell those to the poor. (Farooque Chowdhury, “Urban poor: Neverending quest for energy”, People's Report 2002-2003, Bangladesh Environment ) In areas in the city of Dhaka , lower part of chicken legs, chicken intestines and chicken skin are sold. These are purchased in 250-300 grams by the low-income families. Sometimes, these are sold in smaller “shares”, pieces kept together. Smaller meat pieces from cattle heads are cheaper. These are purchased by the low-income families. The fish sold at around 10:00-11:00 PM at Malibag crossing, near Shantinagar Bazaar, Nandipara in the capital city are cheaper. These are purchased by the poor. These, most of the time, reach to the state of rotting down. But, these, the near-rotten fish, the chicken skin, are the only opportunity to taste “a better food” for large section of the society living at the lower strata. Darmon and Drewnowski add: “[F]or low-SES groups, the ability to adopt a healthier diet may have less to do with motivation than with economic means.” (op. cit.)

Travel to health & kitchen

None will question the connection between food, health and transportation. “Low-income families”, write Darmon and Drewnowski, “are less likely to own a car and may find it more difficult to reach out-of-town supermarkets, in urban as well as in rural areas. Deprived neighborhoods may limit not only food access but also opportunities for physical activity, because of the lack of facilities or because of security issues. Physical activity levels are lower among low-SES groups…” A visit to the Ramna Park in Dhaka in the morning will describe the same fact in a periphery-country. Sometimes, members of Dhaka-neo-elites drive to Mawa, kilometers away from the city, on the Padda, the lower part of the Ganga , to buy fresh Hilsha fish. The Dhaka-poor don't even have the time to dream it. The poor neither have the time and money required to travel there, nor the money to buy the fish while the rich have all.

Inequality is widespread. Darmon and Drewnowski write: “In very poor families, the lack of cooking equipment will in itself discourage cooking.” Kitchens, if those are considered kitchens, of the poor, of the low-income Dhaka families bear the same signs of inequality if compared with the kitchens the Dhaka rich use, the appliances they own.

It's not only lack of cooking equipment in advanced capitalist economy, but lack of kitchen in the periphery is also a problem the poor face in an unequal reality. In many Dhaka slums, one oven is shared by a number of slum-poor families. Even, many lower middle class families share a single oven. In many Dhaka slums, there are long single room with 5, 7, 10 ovens, each of which are used by a number of poor households. Sometimes, poor households rent in oven in a lower middle class household near to their place of residence. Doesn't the reality hurt food quality of the poor? It's an economy of the kitchen-poor, and an economy of inequality.

Economy determines access to food, nutrients, health. “A nutrient density standard for vegetables and fruits: nutrients per calorie and nutrients per unit cost” (Darmon N, Darmon M, Maillot M & Drewnowski A., J Am Diet Asso , 2005, 105) and “Nutrient-dense food groups have high energy costs: an econometric approach to nutrient profiling” (Maillot M, Darmon N, Darmon M, Lafay L, Drewnowski A, J Nutr , 2007, 137) discuss the issue. “Diet quality is influenced by socioeconomic position and may well be limited by financial access to nutrient-dense foods.” (Adam Drewnowski & Nicole Darmon, “The economics of obesity: dietary energy density and energy cost”, The Am J Cli Nutri , vol. 82, no. 1, July 2005) They mention the broader problem of increasing disparities in incomes and wealth, declining real wage, etc. while discussing obesity and its links to the low-income persons.

Another study said: “[T]he low-income group derived fewer financial and nutritional benefits than the medium-income group from both price manipulations.” (Nicole Darmon, Anne Lacroix, Laurent Muller & Bernard Ruffieux, “Food price policies improve diet quality while increasing socioeconomic inequalities in nutrition”, Int J Behavioral Nutri and Physi Activity , 2014, 11:66, doi:10.1186/1479-5868-11-66)

Citing “Widening socioeconomic inequalities in mortality in six Western European countries” (Mackenbach JP, Bos V, Andersen O, Cardano M, Costa G, Harding S, Reid A, Hemström Ö, Valkonen T, Kunst AE, Int J Epidemiol 2003, 32(5)) and “Socioeconomic inequalities in premature mortality in France: have they widened in recent decades?” (Leclerc A, Chastang J-F, Menvielle G, Luce D,Soc Sci Med , 2006, 62(8)) the researchers mentioned “the widening gap in socio-economic inequalities in health in Europe , including in France …” (op. cit.)

The link is being discussed for long although a group tries to deny the link. Nicole Darmon and Adam Drewnowski write: “The links between food, diets, and incomes have indeed been remarked on by a diversity of authors, ranging from Jean-Anthelme Brillat-Savarin in 1825 to John Boyd Orr in 1936.” (“Reply to RJ Karp”, Am J Clin Nutr , vol. 88, no. 4, October 2008)

They also cite Margaret Chan, the Director General of the WHO: “Food choices are highly sensitive to price. The first items to drop out of the diet are usually healthy foods — fruits, vegetables and high quality sources of protein….Nutrient-poor staples are often the cheapest way to fill hungry stomachs.” (WHO, Statement at the high-level Conference on World Food Security in Rome , June 3, 2008).

Referring to “Nutrient-dense food groups have high energy costs: an econometric approach to nutrient profiling” (op. cit.) they write in the “Reply to RJ Karp”: “Energy-dense foods that are nutrient-poor are the cheapest option for the low-income consumer.” Referring to “A cost constraint alone has adverse effects on food selection and nutrient density: an analysis of human diets by linear programming” (Darmon N, Ferguson EL, Briend A, J Nutr , 2002, 132) they write in the “Reply …” : “ Computer optimization programs, driven by cost constraints only, consistently create diets with compositions that resemble those that are consumed by disadvantaged groups. In contrast, higher-quality diets not only cost more but are more likely to be consumed by the more affluent.”

Referring to P Monsivais & A Drewnowski's “The rising cost of low-energy-density foods” ( J Am Diet Assoc , 2007, 107) Nicole Darmon, Adam Drewnowski write: “The recent rise in food prices that has begun to affect the middle class has helped put our earlier work in a new and much sharper perspective.” (“Reply to RJ Karp”, op. cit.)

The researchers add: “The dual burden of disease, undernutrition and overweight, now faced by developing nations is an economic issue that is directly linked to poverty and food costs. … The major policy and political challenge for global nutrition is to ensure a supply of affordable healthy foods to all.” (ibid. )

Existing glaring food inequalities, as evidenced above, raise a few “simple” questions: (1) Shall the world system eliminate the inequality? (2) Does the system posses the capacity? (3) Shall it feed all those failing to afford food? (4) What's the reason of the failure to arrange food, to get out of inequality? (5) Is there any reason/interest that stands as obstacle in formulating appropriate policies and effectively implementing those to ensure equality in accessing better food?