Australia: the healthiest country by 2020
National Preventative Health Strategy – the roadmap for action

Key action area 8: Support low-income communities to improve their levels of physical activity and healthy eating

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Social determinants of inequalities in obesity

'The proposed approach (as described in the October 2009 Taskforce discussion paper) addresses the need for specific initiatives for disadvantaged groups, recognises the value of health workforce development and the value of building the evidence base' (Quote from submission)

Any serious effort to promote wellbeing, prevent ill health and reduce health inequities must address the social determinants that shape the way people grow, live, work and age, which ultimately affect their health.[187] Social determinants are the combination of structural factors and daily living conditions that ultimately determine health and health equity.[187] An unequal distribution of factors supporting the opportunity to be a healthy weight underlies the unequal distribution of obesity observed in developed countries.[81]

The effect of social structure on inequalities in the distribution of weight is suggested by epidemiological trends and patterns of obesity, illustrated in Figure 2.3 below.[81]

Figure 2.3.
Conceptual framework of the social determinants of inequalities in obesity


Larger version of Figure 2.3 Conceptual framework of the social determinants of inequalities in obesity

Interventions directly aimed at encouraging people to improve their eating behaviours and increase their physical activity levels will not address underlying social determinants.[81] There is a need to acknowledge the role of the complex global social system that is driving the obesity epidemic and determines the social gradient of obesity rates. Obesity prevention can only be achieved through addressing inequities in the social system, providing:

• A sufficient, nutritious food supply
• Local urban planning and design that provide access to healthier choices for all, especially low-income earners
• Sufficient, equal material and psychosocial resources to support healthy living options for individuals and communities across all social groups

'The global obesity epidemic is unequally distributed within and between countries. It is being fuelled by economic and psychosocial factors as well as the increased availability of energy-dense food and reduced physical activity. Tackling it requires concerted action at national and international levels to promote a more equal distribution of affordable nutritious food, and improved, more equitable living and working conditions.'[81]
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The increased prevalence of obesity is associated with significantly decreased energy expenditure, as well as dietary changes that have been occurring around the world since the mid-20th century, involving a greater intake of more refined foods, meat and dairy products containing high levels of saturated fats. Significant changes in food systems and behaviours have meant that dietary energy is increasingly available and readily accessible, with factors including: trade liberalisation exposing more countries to international markets; food subsidies contributing to a food supply that favours unhealthier food products; a global market in which EDNP foods cost little to produce; buying in bulk, convenience foods and supersized serves being promoted through the displacement of small stores and stalls by supermarkets and chains.[81]

Barriers to healthy living among low-income Australians

Prices influence behaviour and choices, particularly among those on lower incomes, pensioners and the unemployed. Low income should not be a barrier to participation in physical activity or access to healthy food options.[49]

Poorer families, the elderly and Indigenous people are more likely to live in the outer suburbs, and more likely to live in depressed rural communities with poor or ageing physical activity infrastructure. Poorer members of the community are further disadvantaged by:[49]

• Transport policy and urban planning that is dominated by the car (rather than public transport, walking and cycling)
• Urban planning that fails to provide for accessible physical activity, sport, recreation, walking and cycling
• The high cost of physical activity, recreation and sport

Action 8.1
Fund, implement and promote effective and relevant strategies and programs to address specific issues experienced by people in low-income communities, such as lack of access to affordable, high-quality fresh food.

Action 8.2
Fund, implement and promote multi-component community-based programs in low SES communities.

Action 8.3
Provide resources for brief interventions from the primary healthcare setting.











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