EAT FOR HEALTH – AusTRALiAn diETARy guidELinEs
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A1 Social distribution of diet-related health outcomes
In 2002–06 the death rate for people between 15 and 64 years was 70% higher in the lowest socioeconomic
group than the highest socioeconomic group.^24 These rates reflect the higher prevalence of type 2 diabetes and
cardiovascular disease among people living in the lowest socioeconomic group.11,24
Gradients in risk factor prevalence are also apparent across quintiles of social disadvantage as defined by
socioeconomic indexes for areas (SEIFA). The SEIFA assesses the relative social disadvantage of respondents by
the economic resources, education and occupation patterns of their area of residence.^24 Overweight and obesity
rates are also highest among the lower socioeconomic areas, although there was not a clear gradation across
SEIFA 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 is
also a social gradient in physical activity levels; self-reported ‘sedentary’ behaviour rises from 25% of people in
the highest socioeconomic areas to 44% in the lowest socioeconomic areas.^24
A2 Social distribution of food intake and nutrition status
Socioeconomic factors have a large impact on food and nutrient intakes and food purchasing decisions and
patterns,^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^980
and determinants of healthy eating for those with low income.^981 They found that economic and cultural influences
affect consumption of specific foods or food groups. Nutrition interventions can have greater impact in higher
socioeconomic areas and non-ethnic groups.980,981
Those with the least disposable income are at the greatest risk of poor nutrition as households vulnerable to
poverty spend less per person on food but a greater proportion of their total expenditure on food.^982 Analysis of
Australian household food expenditure data suggests that a substantial proportion of the population is severely
restricted in its capacity to make nutritious food choices and to achieve a healthy diet.^983
Economics of food choice
There is a growing body of research indicating that food groups with more favourable nutrient profiles are more
expensive. The ‘economics of food choice’ theory states that people’s dietary decisions, when made within
the context of sustained budgetary constraints, are driven by maximising energy value for money (dollars per
megajoule [$/MJ]), resulting in energy-dense, nutrient-poor diets.142,264 For example, meat, fruit and vegetables
food groups have the highest nutritional quality however are usually associated with highest costs, while sweets
and salted snacks have the lowest nutritional quality but are an inexpensive source of dietary energy.142,264,315,984
Although high-quality nutrition is known to protect against chronic diseases, energy-dense, nutrient-poor foods
cost considerably less than nutrient-rich foods.^140
The costs of healthy (low energy density, high nutrient density) foods are reported to be increasing in Australia
in comparison with higher energy density, lower nutrient density food. Between 2000 and 2006 the Consumer
Price Index for food in Brisbane increased by 32.5% while the cost of a standard basket of healthy food increased
approximately 50% across Queensland.^317
A diet consistent with the Guidelines is expensive for welfare-dependent families. An Australian study found it
cost around 40% of their disposable income compared with 20% for families on the average income.^316
Food security
Food security refers to the ability to access safe nutritious, affordable foods and the capacity to obtain them. At an
individual or family level, food insecurity can be characterised by running out of food and being unable to afford to
buy 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^987