Debating poverty and malnutrition
I took part in a radio debate with food blogger Jennifer Parker, who later blogged about the debate. This is my response to her blog post.
I took part in a lively debate on the Stephen Nolan Show on BBC 5 Live on Friday night with Jennifer Parker, aka Food Girl, on the issue of food poverty. It followed reports in the media of a ‘19 per cent rise’ in hospitalisations for malnutrition in the UK in the past year, along with increasing cases of diseases like rickets. BBC News quoted the vice president of the Faculty of Public Health, John Middleton, who said food-related ill health was getting worse ‘through extreme poverty and the use of food banks… It’s getting worse because people can’t afford good quality food. It’s getting worse where malnutrition, rickets and other manifestations of extreme poor diet are becoming apparent.’ There were also claims about increases in shoplifting due to food poverty.
Actually, it’s worth quoting the source of that main statistic, the Health and Social Care Information Centre: ‘Today’s report also shows that overall admissions where malnutrition was a primary diagnosis decreased from 683 in 2012-13 to 612 in 2013-14. However, during the same period there was an increase in overall admissions where malnutrition was a primary or secondary diagnosis, from 5,590 to 6,690. Over the last five years there was a 71 per cent increase in hospital admissions where malnutrition was a primary or secondary diagnosis, from 3,900 admissions in 2009-10 to 6,690 admissions in 2013-14.’
In other words, straightforward cases of malnutrition actually fell in the past year, although the numbers are absolutely tiny in any event. Even cases where malnutrition was a secondary factor are still tiny - very roughly one in every 10,000 people. And these are almost certainly where people are actually incapable of feeding themselves (the very ill or the elderly, for example) or unwilling to (those suffering from eating disorders). The implication that this terrible state of affairs is due to food poverty seems questionable. As for the return of rickets, our main source of vitamin D (the absence of which causes rickets) is sunshine, not diet. People may not be getting enough sun for a variety of reasons, from religion to skin cancer panics, but it is far from a simple issue of inadequate diet.
Nonetheless, a wider discussion of food poverty is worthwhile. After all, if food banks are dishing out around a million emergency parcels per year, is it now the case that many people simply cannot afford to eat? If so, why?
The notion of ‘food poverty’ demands some critical examination. It suggests that it is different from - indeed, worse than - regular ol’ fashioned poverty, that people are so broke that they can’t even afford to feed themselves. However, the food campaign Sustain draws the term so widely as to mean something rather different: ‘Food poverty can be defined as the inability to obtain healthy affordable food. This may be because people lack shops in their area or have trouble reaching them. Other factors influencing food access are the availability of a range of healthy goods in local shops, income, transport, fear of crime, knowledge about what constitutes a healthy diet, and the skills to create healthy meals.’ The loaded term here is ‘healthy’, since it is not merely what is required to keep body and soul together but includes things like access to a fairly wide range of fruit and vegetables in order to achieve that now hackneyed goal of ‘five a day’.
A related idea is that of ‘food deserts’. This doesn’t mean vast areas of the country without access to food at all, however. According to research by Hillary Shaw reported in the Independent in 2007, a food desert is an urban area where there is no shop within 500 metres that sells at least 10 items of fresh produce. This is a fairly restrictive definition, both in range and in food content. Even a fairly meagre corner shop can supply an adequate diet. According to Shaw, even market towns like Shrewsbury and Winchester contain such food deserts. In fact, Shrewsbury alone has 10 branches of major supermarkets, never mind whatever other medium and small suppliers are there - it’s just that their positioning may leave some people with a little further to travel than Shaw’s rather measly cut-off distance. As Jennifer Parker notes: ‘Supermarkets and other food retailers are interested in making profits and are responsible to shareholders for these profits, however, they cannot make money in areas struck by poverty and thus chose (as any sound business would) not to open in these areas.’
But thanks to the big supermarkets, along with cars, fridges and freezers, shopping can be a once-a-week chore. How many people are really unable to eat well simply because there isn’t a supermarket - which offer much bigger ranges than small towns would have had in the past - within walking distance? Between public transport, taxis and home delivery, the options for obtaining food in bulk and at low cost are greater than ever before. Parker continues: ‘We forget that some people are in tough financial situations such as single parents, working 2-3 jobs, unable to hunt around the sales and good food deals, they are lacking transportation to do so, the time, the cooking skills, or worse yet, the resources to afford even cooking utilities such as a working stove top or as simple as adequate pots and pans – and for even some, electricity.’ Yes, that’s just called ‘poverty’. It’s a bad thing, too. Adding ‘food’ at the start doesn’t really tell us much more. We need jobs and economic development. Supermarkets and fast-food chains are not responsible for the lack of those things.
Yet in her blog post about the debate, Parker goes on to offer up some rather conspiratorial ideas about supermarkets that are sadly typical of food campaigners; ‘what we want is dictated to us’. Supermarkets, it is true, are trying to flog things to us, just as surely as a market trader with a good patter will try to do the same thing. To say that we, as consumers, are just mugs for whatever rubbish the supermarkets sell is rather demeaning. Parker says ‘the rise in what we call non-communicable diseases is undeniable. These are conditions that are diet related such as diabetes, heart disease and a variety of cancers.’ But heart disease mortality - and it would appear, the incidence of heart disease - has been declining for decades. And we are most certainly living both longer and with more years of good health than ever before. Even the most modest chainstore branch will provide the means of any diet you wish to pursue - the choice really is ours. As for diabetes, reported cases are certainly on the rise - they’ve increased by 50 per cent in the past few years. It is hard to believe that changing diets alone could be responsible for such a surge. Greater screening and changing definitions of what constitutes ‘diabetes’ are clearly a factor, too.
Parker suggests that, according to the World Health Organisation, 60 per cent of deaths are due to diet-related diseases. But this factsheet from the WHO, for example, suggests that all non-communicable diseases combined are responsible for 36million deaths. Of these, six million are thought to be due to smoking, 3.2million to lack of exercise, 1.7million from inadequate intake of fruit and vegetables, and over one million from alcohol. And we all know clean-living people who have succumbed to these diseases despite doing all the ‘right’ things. Even these figures are dubious, no doubt based on extrapolations from epidemiological studies of doubtful worth, but poor diet does not cause 60 per cent of deaths - at least, not the kind of diets available in the UK. Chronic lack of food in some parts of the developing world is certainly a problem, but the problems of diet in the UK are nothing like those in poorer countries. The rise of non-communicable disease is as much to do with the decline of infectious disease and longer lifespans as anything to do with our lifestyle choices.
Parker laughed at my comment that takeaway food was ‘perfectly nutritious’. I stand by that statement. By the basic yardsticks of nutrition - energy, protein, fat, vitamins and minerals - it is certainly adequate, particularly if there is a reasonable quantity of animal-sourced foods like meat and dairy in it. I wouldn’t eat it every day - it would be downright boring if nothing else - but the idea that it should only be eaten rarely seems nonsense to me and more revealing of food prejudices than a sensible assessment of nutrition. Cheap takeaway food is too often built upon starchy stodge, because it is cheap, but that’s a far cry from saying that it is not nutritious at all.
At this point, Parker’s blog post really falls off the cliff of eco-foodie prejudice. The world is undoubtedly better fed than ever before. Just a quick glance at the massive decline in the proportion of the world that is malnourished should be evidence of that. And that is a direct product of farming on a large scale, using machinery, artificial fertilisers, pesticides and all the rest, and then trading across a global marketplace.
And now I’m going to stop. Despite her accusations to the contrary, Parker has out-ranted me.