Hunger and Obesity Understanding a Food Insecurity Paradigm: Workshop Summary (2011) / Chapter Skim
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3 Socioeconomic Disparities: Food Insecurity and Obesity
3 Socioeconomic Disparities: Food Insecurity and Obesity
Pages 33-50
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Studies of food insecurity often draw connections to measures of socioeconomic status (SES) , noted Adam Drewnowski, professor of epidemiology and director of the Center for Public Health and Nutrition at the University 33
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Furthermore, SES measures typically do not reflect economic insecurity, which is a measure of desperate need. New and different measures to better understand economic security are important in understanding the relationship between food insecurity and obesity, said Drewnowski.
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. The overall obesity prevalence among children ages 6 to 17 increased threefold during the same time.
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50 Income Below 100% FPL 42.3 45 40.1 Income 100-199% FPL 39.9 38.7 Income 200-299% FPL 37.4 40 34.9 34.1 Income 300-399% FPL 33.3 32.5 32.6 32.4 31.2 31.2 Income 400-499% FPL 35 30.9 30.7 Percentage 28.1 Income 500+% FPL 26.6 30 22.8 22.5 22.2 25 21.1 21.1 20.4 18.8 18.5 18.3 17.4 20 15 10.3 10.0 8.1 10 5 0 Children 6-11 Adolescents 12-17 Adults 18-44 Adults 45-64 Adults 65+ FIGURE 3-3 Socioeconomic disparities in obesity prevalence, in percentage, compared with federal poverty level, fig 3-3 redraw.eps data from the 2003-2008 across the life course, National Health and Nutrition Examination Survey (NHANES)
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The same pattern is seen when looking at obesity and overweight prevalence by income or poverty status. Neighborhood socioeconomic characteristics, measured by indicators such as safety, housing quality, and vandalism, are correlated with childhood obesity risk (Figure 3-5)
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Unfavorable Neighborhood Social Conditions FIGURE 3-5 Excess obesity risk, in percentage of higher prevalence, among children ages 10-17 in unfavorable neighborhood social conditions, 2007. fig 3-5 redraw.eps SOURCE: Singh et al., 2010b.
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. NHANES provides heights and weights measured by a trained interviewer.
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Education is often used as a proxy for income, which is more sensitive to measure. Researchers typically say that they have controlled for SES through the use of income or education, but most studies fail to consider explicitly and fully the potential causal role that these or other closely linked socioeconomic factors may have played, either as a mediator or as a moderator1 of effects on the outcomes of interest.
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Across all five of the datasets Braveman considered, the Spearman correlation coefficients ranged, with a few minor exceptions, between 0.42 and 0.50. To further assess the importance of selecting appropriate SES measures, Braveman showed data from analyses in which a model was constructed that looked at racial/ethnic disparities in health outcomes and asked whether the conclusions about disparities (the size, direction, and statistical significance of odds ratios)
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health studies, but it can be very important for health, noted Braveman. Wealth could buffer the effects of temporarily low income, and it is more likely to reflect socioeconomic circumstances in childhood.
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Other Factors Other factors that are rarely measured but may have important associations with health include quality of education, occupational ranking, socioeconomic features of a neighborhood such as the concentration of poverty in it and related physical and social features, subjective social status, or past socioeconomic experiences, said Braveman. The evidence regarding the magnitude of the health consequences of each of these SES factors is not definitive and is sometimes controversial.
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Yet paralysis is not the inevitable consequence, as long as researchers consider and acknowledge the limitations of SES measures and what effect those limitations could have on conclusions. Better SES data are needed, but researchers also could make much better use of the data they have, she said, by thinking critically about the potential role of a range of socioeconomic factors in causal pathways leading to health or disease.
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. This minimum income standard forms the basis of the campaigns for a "living wage" -- which is above the national statutory minimum wage -- a campaign that has met with some success.2 The income standard meshes with the idea of household food security -- that people should have access to sufficient, safe, affordable, and healthful food appropriate for their needs and culture.
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Recent policy documents in Europe, such as Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health (Commission on Social Determinants of Health, 2008) and Fair Society, Healthy Lives: A Strategic Review of Health Inequalities in England (Marmot et al., 2010)
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"It is failing to provide true food security and a food system that is sustainable environmentally and socially, and this is despite huge technological innovations." New ways of thinking about food and food systems are being developed by public health advocates, policy makers, social scientists, food producers, and many others. "These different ways of growing, processing, retailing, sharing, preparing, and eating foods not only reconnect producers and consumers to one another and to the natural world, but [represent]
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Singh responded to the same question by saying that the health surveys he uses do not contain a range of measures that could capture wealth and assets. One possible way to make up for this lack is to use data from the decennial census or the American Community Survey to look at area-based income and wealth indicators.
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2005. Socioeconomic status in health research: One size does not fit all.
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2011. Dramatic increases in obesity and overweight prevalence and body mass index among ethnic-immigrant and social class groups in the United States, 1976-2008.
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