Poverty on the plate

Malnutrition on a large scale usually conjures images of the third world. But one ANU researcher says food poverty is causing major problems much closer to home.

Nearly two centuries later, some might think the luck of the Irish has improved. The rapid growth of the Irish economy during the last decade led to it being christened the Celtic Tiger, whose roar was the envy of Europe. there is another, less desirable way in which Ireland is leading its European neighbours.

While that famous son of Eire, Sir Bob Geldof, is rallying rock stars to help end deprivation in the developing world, it is estimated 20 per cent of the Irish population live in risk of poverty. On top of this, the mortality rate of Ireland’s poorest people is three times higher that of its wealthier citizens. One nutritional epidemiologist believes a major link between these two startling statistics is to be found between knife and fork on dinner plates around the nation – food.

For the last 13 years, Dr Sharon Friel has been studying the overlap between poverty, nutrition and population health at the Centre for Health Promotion Studies, part of the National University of Ireland in Galway. She plans to continue the work as a research fellow at the ANU National Centre for Epidemiology and Population Health. Her work for various European government and private agencies has helped bring the problem of food poverty to the attention of policy makers, who even now still tend to regard poverty as an economic problem and nutrition as a health problem. Dr Friel says the issues are inextricably linked.

“The situation for many people in the Republic of Ireland is grim. We know that poor nutrition leads to all sorts of health problems, including cardiovascular disease, diabetes, cancers and obesity. It also affects birth weights, bone density and increases dental risk.

“Often the government response to nutritional problems revolves around health education: ‘Let’s tell people what they should be eating, and by telling people what they should be eating it will change their behaviour’. This in and of itself just doesn’t work. It’s fundamentally flawed to have a society or a government that talks about health education on this level like it’s the answer to changing dietary choice.

“Besides, there is generally a good level of knowledge about what constitutes healthy food among all levels of Irish society. It’s the many other factors at play that are affecting what kinds of food people eat.”

In a report called Food Poverty and Policy (2004) co-authored by Dr Friel for the Combat Poverty Agency (CPA) in Ireland, food poverty is defined as the inability to afford and access a nutritionally adequate diet, and the relative impacts on health, culture and social participation. Dr Friel says addressing these three key areas – affordability, access and social norms – will determine whether food poverty remains a major problem in Ireland and around the world.

“In recent years, studies have shown that most people in Ireland are spending a smaller amount of their average income on food. It remains however, that as a proportion of total weekly household expenditure it is the socially disadvantaged groups who continue to spend more on food.”

Dr Friel says one reason for this is poorer people tend to shop in stores that are part of smaller but national chains, whose appeal lies in their physical proximity and national ties. But on the whole, the food in these group stores tend to be more expensive than the big supermarkets and less varied than independent retailers.

“Low income families are on such a tight budget. They just don’t have that amount of money to allocate for food. Mothers end up being the bad person because they can’t allow children to have friends around to play as they often can’t afford offer any food. That’s a very common story.

“I remember one case in particular, involving a family of asylum seekers from sub-Saharan Africa. The only food consumed by the mother each day would be a cup of tea. She used the same tea bag each day to make repeated cups. The little money she had went on food for the children. That, compounded by the fact she knew nobody, she wasn’t part of the community, added to her poverty of connection. It’s very harrowing to see this unfold.”

Dr Friel says the availability of certain foods is also a contributing factor to food poverty. She says research shows many of the stores most frequented by socially disadvantaged people stock a high proportion of processed foods, which are high in salts, sugars and fats. But she says there is an added incentive for some consumers who are trying to keep a tight budget to purchase these low-nutrition products.

“One of the things to remember in nutritional terms is that a packet of biscuits has a high energy intake. So it’s actually very smart budgeting as there’s a very good energy return. A cheap packet of biscuits will give the children the energy they need to keep running around for hours, whereas a healthier option like a wholemeal salad sandwich is a much more expensive for the same energy return.”

But Dr Friel says the area most often neglected by policy makers surrounds the social determinants on diet and the social consequences that arise from food poverty. One example of this is the growing asylum seeker population in Ireland, which finds its cultural and linguistic isolation compounded by the inability to access traditional food. Another example can be found among Irish nationals for whom the memory of the Great Famine might determine whether or not fish appears on the menu.

“During the famine, eating fish was a sign that you lived in the poorest, most remote parts of the country, along the coast. As a consequence, a stigma grew up around eating fish. Today, you might be an affluent Irish person whose family went through the famine and you know the stigma of the fish, but your social position is one that fish is now a fashionable thing to eat.

“Whereas for more socially disadvantaged groups, anything to do with fish still has that whole stigma attached, because it’s to do with poverty, and says, ‘Here we are, living in poverty, and we don’t want to be seen living in poverty, so therefore we’re not going to eat the fish’.

Now the Scottish expert is turning her attention to Antipodean diets, with her shift to ANU this year after a five-month period at the University last year. Dr Friel is taking part in an NCEPH project called the ACT Obesity Sentinel Site that will study health and healthy weight in the ACT. One focus of this project is on the factors contributing to childhood obesity, and how the tenets of food poverty could be at play.

“Given the review of the policies that we did in the Republic of Ireland, the basic principles of what we found in relation to access and availability are likely to be no different to any other developed country in that respect, including Australia. Food poverty isn’t often being explicitly talked about, because it has always been associated with developing countries.

“Retail arrangements in Australia are different, as is the whole trade situation, but you still end up with the situation that you’ve got socially disadvantaged groups and we need to find out more about what foods are available to them and how affordable is it. This could help us to understand and address the factors influencing their health choices.

“This work is important, because it’s ultimately about improving the standards of living for more people in developed countries. We can say we live in a democratic society, but how just is it when some people are more at risk than others?”

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