Guidelines Dietary - Eat For Health

A1Social distribution of diet-related health outcomesIn 2002–06 the death rate for people between 15 and 64 years was 70% higher in the lowest socioeconomicgroup than the highest socioeconomic group. 24 These rates reflect the higher prevalence of type 2 diabetes andcardiovascular disease among people living in the lowest socioeconomic group. 11,24Gradients in risk factor prevalence are also apparent across quintiles of social disadvantage as defined bysocioeconomic indexes for areas (SEIFA). The SEIFA assesses the relative social disadvantage of respondents bythe economic resources, education and occupation patterns of their area of residence. 24 Overweight and obesityrates are also highest among the lower socioeconomic areas, although there was not a clear gradation acrossSEIFA quintiles. 24 Some of the factors that contribute to the development of overweight are also related to equity,particularly the social, cultural and economic barriers and enablers to healthy food choices (see Chapter 1). There isalso a social gradient in physical activity levels; self-reported ‘sedentary’ behaviour rises from 25% of people inthe highest socioeconomic areas to 44% in the lowest socioeconomic areas. 24A2Social distribution of food intake and nutrition statusSocioeconomic factors have a large impact on food and nutrient intakes and food purchasing decisions andpatterns, 314 and there is clear evidence of a social gradient for the distribution of diet-related chronic disease.Yet evidence for a social gradient related to specific foods – rather than overall dietary patterns – is less clear.Two recent systematic reviews assessed the impact of dietary interventions relative to social disadvantage 980and determinants of healthy eating for those with low income. 981 They found that economic and cultural influencesaffect consumption of specific foods or food groups. Nutrition interventions can have greater impact in highersocioeconomic areas and non-ethnic groups. 980,981Those with the least disposable income are at the greatest risk of poor nutrition as households vulnerable topoverty spend less per person on food but a greater proportion of their total expenditure on food. 982 Analysis ofAustralian household food expenditure data suggests that a substantial proportion of the population is severelyrestricted in its capacity to make nutritious food choices and to achieve a healthy diet. 983Economics of food choiceThere is a growing body of research indicating that food groups with more favourable nutrient profiles are moreexpensive. The ‘economics of food choice’ theory states that people’s dietary decisions, when made withinthe context of sustained budgetary constraints, are driven by maximising energy value for money (dollars permegajoule [$/MJ]), resulting in energy-dense, nutrient-poor diets. 142,264 For example, meat, fruit and vegetablesfood groups have the highest nutritional quality however are usually associated with highest costs, while sweetsand salted snacks have the lowest nutritional quality but are an inexpensive source of dietary energy. 142,264,315,984Although high-quality nutrition is known to protect against chronic diseases, energy-dense, nutrient-poor foodscost considerably less than nutrient-rich foods. 140The costs of healthy (low energy density, high nutrient density) foods are reported to be increasing in Australiain comparison with higher energy density, lower nutrient density food. Between 2000 and 2006 the ConsumerPrice Index for food in Brisbane increased by 32.5% while the cost of a standard basket of healthy food increasedapproximately 50% across Queensland. 317A diet consistent with the Guidelines is expensive for welfare-dependent families. An Australian study found itcost around 40% of their disposable income compared with 20% for families on the average income. 316Food securityFood security refers to the ability to access safe nutritious, affordable foods and the capacity to obtain them. At anindividual or family level, food insecurity can be characterised by running out of food and being unable to afford tobuy more. About 5% of the Australian population suffer food insecurity in a year. 985-987 It is more common among:• people who are unemployed 987• Aboriginal and Torres Strait Islander peoples 988• people living in single parent households 987• people in the second lowest income quintile 987102EAT FOR HEALTH – australian dietary guidelinesNational Health and Medical Research Council