306 Diet and Health
by major pathogens cost up to $35 billion each year in medical costs and lost pro-
ductivity.^122 Policy makers must be concerned about both foodborne illness and
degenerative diseases, the latter of which do not as yet receive sufficient political
attention.
Food Poverty in the Western World
Most public health concern about food poverty rightly centres on the developing
world, but it is also important to recognize that the impact of food poverty is sig-
nificant in the developed world. The new era of globalization has unleashed a
reconfiguration of social divisions both between and within countries; these social
divisions are particularly marked in societies such as the UK and the US which
have pursued neoliberal economic policies. Indeed, one review of EU food and
health policies estimated that food poverty was far higher in the UK than any other
EU country,^123 where inequalities in income and health widened under the Con-
servative government of 1979–1997. The proportion of people earning less than
half the average income grew^124 and the bottom tenth of society experienced a real,
not just relative, decline in income and an increase in social health distinctions.
This was the converse of the post-World War II years of Keynesian social demo-
cratic policies during which inequalities narrowed: lower UK socioeconomic
groups now experience a greater incidence of premature and low birthweight
babies, and of heart disease, stroke and some cancers in adults. Risk factors such as
bottle-feeding, smoking, physical inactivity, obesity, hypertension, and poor diet
were clustered in the lower socioeconomic groups^125 whose diet traditionally
derives from cheap energy forms such as meat products, full-cream milk, fats, sug-
ars, preserves, potatoes and cereals with little reliance on vegetables, fruit and
wholemeal bread. Essential nutrients such as calcium, iron, magnesium, folate and
vitamin C are more likely to be ingested by the higher socioeconomic groups:126,127
their greater purchasing power creates a market for healthier foods such as skimmed
milk, wholemeal bread, fruit and other low-fat options. Similarly, in the US, hun-
ger has been a persistent cause of concern for decades and rising during the 1990s
when the Census Bureau calculated that 11 million Americans lived in households
which were ‘food insecure’ with a further 23 million living in households which
were ‘food insecure without hunger’ (in other words at risk of hunger).^128 Other
US surveys of the time estimated that at least 4 million children aged under 12
were hungry and an additional 9.6 million were at risk of hunger during at least
one month of the year. Despite political criticisms of these surveys, further research
suggested that even self-reported hunger, at least by adults, is a valid indication of
low intakes of required nutrients. It should be noted that, ironically, the US spent
over US$25 billion on federal and state programmes to provide extra food for its
25 million citizens in need of nutritional support.^129