Guidelines Dietary - Eat For Health

AppendicesAppendix AEquity and the social determinants of health andnutrition statusThe World Declaration on Nutrition (1992) states that ‘access to nutritionally adequate and safe food is a basicindividual right’. 960 Australia is fortunate to have an abundant and safe food supply. Life expectancy and healthstatus are relatively high. 11,24,45 Australians are generally literate and have good access to health and nutritioninformation and sufficient education to make informed food choices. 961However, there are differences in health and wellbeing between groups of Australians. People in lowersocioeconomic groups have shorter life spans and poorer health. They have higher rates of death and disease,are more likely to be hospitalised and are less likely to use specialist and preventive health services. 962 As inother countries, there is a socioeconomic gradient whereby health status generally improves the higher aperson is up the socioeconomic ladder. 24The determinants of health inequities are largely outside the health system and reflect the distribution of social,economic and cultural resources and opportunities. 25,26,960,962 Employment, income, education, cultural influences,lifestyle, language, sex and other genetic differences, geographic, social or cultural isolation, age and disability,the security and standard of accommodation, and the availability of facilities and services, all influence diet,health and nutritional status. 25,26The relationship between these factors and health status is complex and it is often difficult to determine thenature and direction of causal relationships. 25,26 For example, those on higher incomes tend to have greateropportunity to attain higher levels of education and afford housing in higher socioeconomic areas with betteraccess to goods and services (e.g. health services, transport, shops including food outlets) that supporthealthy lifestyles. Lower levels of education and/or an individual’s poor health status can limit opportunities foremployment and therefore income and access to other goods and services, including nutritious food. 25,26While higher education can improve health literacy, just because a person can understand healthy lifestyle andnutrition information does not mean they can or will act on it. For example, one Australian study of people16 years and older found that, although 80% and 35% of people knew the recommended daily intake of fruitand vegetables respectively, only 56% and under 10% met these respective recommendations. 24The economic, social and cultural factors that influence health inequities also influence the ability of an individualto choose nutritious foods consistent with dietary guidelines. 33 The ability of parents and carers to make nutritiousfood choices is likely to affect their family’s nutrition status too.Factors associated with complying with dietary guidelines include being female, older age, higher socioeconomicstatus, with higher education and having nutrition knowledge. 44,314,316,963-979Conversely, lower socioeconomic status and lower educational attainment are barriers to complying with dietaryguidelines, and lower socioeconomic groups perceive cost as a barrier to healthy food purchase. 44,314,316,963-979In a Melbourne study it was found that areas of greater socioeconomic advantage had closer access tosupermarkets, whereas areas of less socioeconomic advantage had closer access to fast food outlets. 355A greater understanding of the barriers to consuming a nutritious diet will help ensure that appropriate messages,education and public health strategies are developed for groups who experience a greater burden of diet-relateddisease. It was essential that the social determinants of health and nutrition status were considered in theGuidelines to reduce the risk of adding to health inequities, for example by promoting consumption of expensiveor hard to access foods.AppendicesNational Health and Medical Research Council101