EAT FOR HEALTH Australian Dietary Guidelines

APPENDICES

101

Appendices

A Equity and the social determinants of health and nutrition status Appendices

nutrition status

The World Declaration on Nutrition (1992) states that ‘access to nutritionally adequate and safe food is a basic

individual right’.^960 Australia is fortunate to have an abundant and safe food supply. life expectancy and health

status are relatively high.11,24,45 Australians are generally literate and have good access to health and nutrition

information and sufficient education to make informed food choices.^961

However, there are differences in health and wellbeing between groups of Australians. People in lower

socioeconomic 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 in

other countries, there is a socioeconomic gradient whereby health status generally improves the higher a

person is up the socioeconomic ladder.^24

The 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.25,26

The relationship between these factors and health status is complex and it is often difficult to determine the

nature and direction of causal relationships.25,26 For example, those on higher incomes tend to have greater

opportunity to attain higher levels of education and afford housing in higher socioeconomic areas with better

access to goods and services (e.g. health services, transport, shops including food outlets) that support

healthy lifestyles. lower levels of education and/or an individual’s poor health status can limit opportunities for

employment and therefore income and access to other goods and services, including nutritious food.25,26

While higher education can improve health literacy, just because a person can understand healthy lifestyle and

nutrition information does not mean they can or will act on it. For example, one Australian study of people

16 years and older found that, although 80% and 35% of people knew the recommended daily intake of fruit

and vegetables respectively, only 56% and under 10% met these respective recommendations.^24

The economic, social and cultural factors that influence health inequities also influence the ability of an individual

to choose nutritious foods consistent with dietary guidelines.^33 The ability of parents and carers to make nutritious

food choices is likely to affect their family’s nutrition status too.

Factors associated with complying with dietary guidelines include being female, older age, higher socioeconomic

status, with higher education and having nutrition knowledge.44,314,316,963-979

Conversely, lower socioeconomic status and lower educational attainment are barriers to complying with dietary

guidelines, and lower socioeconomic groups perceive cost as a barrier to healthy food purchase.44,314,316,963-979

In a Melbourne study it was found that areas of greater socioeconomic advantage had closer access to

supermarkets, whereas areas of less socioeconomic advantage had closer access to fast food outlets.^355

A 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-related

disease. It was essential that the social determinants of health and nutrition status were considered in the

Guidelines to reduce the risk of adding to health inequities, for example by promoting consumption of expensive

or hard to access foods.