Jane McCredie: Don't ignore the bleeding obvious

IN the past few weeks there has been a lot of news about socioeconomic disadvantage being linked to poorer health outcomes. We tend to shrug and say, nothing new there.

But is that really an adequate response?

Yes, we’ve known for a long time that people of lower socioeconomic status have higher rates of obesity, and a raft of medical conditions including diabetes and, as the MJA reported recently, stroke.

When we hear this kind of message over and over, it’s easy to start accepting it as a given and stop thinking about what we might be able to do to change it. Comments posted on an MJA InSight article about the MJA research showed some readers thought the research stated the “bleeding obvious”.

Yet, as MJA editor Dr Annette Katelaris wrote in an editorial accompanying the stroke research, the fact that lower income people die younger and have poorer health along the way is not just a medical issue. It is also a social justice one.

Clearly, there isn’t going to be a quick fix, given the complex and multifactorial nature of health disadvantage.

And whenever we start talking about interventions to reduce smoking, or improve diet and exercise, allegations of attempts to impose a “nanny state” don’t take long to rear their ugly head.

Few of us would probably go as far as the American researchers who recently reported an unsurprising link between low-income people’s consumption of fast food and its availability.

Their conclusion? We should consider imposing zoning restrictions on fast-food restaurants within three kilometres of low-income residents. I can’t see either commercial operators or their customers taking that one lying down.

But, alongside education and other programs, there could be less draconian ways to use market forces to influence people’s health choices.

Evolutionary biologist Professor Rob Brooks, from the University of NSW, has spent considerable time investigating the links between socioeconomic factors and obesity.

He writes, in his recently published book, that “our ancient evolved tastes often fool us into wanting foods that are crammed full of sugar, starch, fat and salt”. Consumption patterns that helped protect our distant ancestors from periods of famine may be driving our contemporary obesity epidemic, he believes.

Brooks discusses studies in primates and humans that suggest we are programmed to keep eating until we have ingested enough protein for our needs, regardless of kilojoule intake.

And that’s where the market forces come in. In our industrialised societies, high-energy, low-protein foods are priced lower per kilojoule than more nutritious foods such as fruit, vegetables and lean meats.

The relative cheapness of processed carbohydrates — sugar in particular — is partly due to government subsidies and other support for the agricultural sector that may actually be distorting the market.

Of course, this is not the only factor behind the higher rates of obesity in less wealthy members of our society but, given the scale of the problem we are facing, should we consider dropping all government subsidies for sugar production or, even, as Brooks suggests, imposing a tax on the sweet stuff?

Jane McCredie is a Sydney-based science and medicine writer.

Disclosure: The book by Professor Rob Brooks — Sex, genes & rock ’n’ roll: how evolution has shaped the modern world — is published by NewSouth Books where Ms McCredie is employed as a publisher.

Posted 18 July 2011