Class and Social Gradient: Income, Food, and Health

Adam Sheingate, KSAS

Lindsay Thompson, CBS

Sara Bleich, BSPH

Sources: www.cdc.gov/obesity/data/trends.html#County www.ers.usda.gov/publications/ap/ap036 labs.slate.com/articles/food-deserts-in-america

Counties in the top and bottom two quintiles for both diabetes and obesity

Low Income Areas of the United States

40% Below 200 FPL

Income, Health, and Food Access in the United States

Income and Food Access in Baltimore

Source: http://foodsystemmap.cgis.us/

“Six Miles – 20 Years”

0

5

10

15

20

25

30

35

40

Less than $15,000

$15,000- 24,999

$25,000- 34,999

$35,000- 49,999

$50,000+

Perc

ent

Obesity and Food Insecurity by Household Income

Obese

Food Insecure

Source: Behavioral Risk Factor Surveillance System and Current Population Survey

Political Participation by Income Quintile

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

Voted in primary

Attended meeting

Gave Money Voted '08

lowest

second

third

fourth

fifth

Source: 2008 National Election Study

Voting Participation among Beneficiaries of Government Programs

0

10

20

30

40

50

60

70

Social Security Unemployment AFDC Food Stamps

1982

1990

Source: Suzanne Mettler, “The Transformed Welfare State and the Redistribution of Political Voice.”

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Lindsay Thompson, Ph.D.

Carey Business School

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THE

LIVA

BLE

CITY

MAT

RIX Human

Capabilities Sustainability

Social Environmental Economic

Som

atic

• Life • Bodily Health • Bodily Integrity • Sense

Noe

tic

• Senses • Imagination • Thought • Emotions • Practical Reason

Rela

tion

al

• Affiliation • Other Species

Age

ncy

• Play

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Albemarle Square HOPE VI PUD Mixed income community replacing Flaghouse Courts 153 Market Rate Homes 124 Low Income Rental Units

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EXETER GARDENS

Re-growing ethnic food cultures in historic Jonestown Village

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Jonestown Village challenges and assets

Challenges • 40+% Section VIII renters,

transients • High proportion of poor,

elderly, very young • 50+ vacant, abandoned,

derelict properties • Minimal green space and

tree canopy • Severe rat infestation • Negligent, indifferent

property management

Assets • Nucleus of community

leaders • Low crime / violence • Influx of engaged, affluent

homeowners • Proximity to high value

neighborhoods, employment, anchor institutions

• Affordable, convenient public transit

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l Exeter Gardens includes all WHO

intervention strategies to influence social determinants of health

• Improve daily living conditions

• Tackle the inequitable distribution of power, money, and resources

• Measure and understand the problem to assess the impact of action

WHO Commission on Social Determinants of Health Report (2008)

© 2008, Johns Hopkins University. All rights reserved.

Sara Bleich, Ph.D. Health Policy and Management, Bloomberg School of Public Health

© 2008, Johns Hopkins University. All rights reserved.

Why do we care about the food environment • Physical and financial access greatly shapes

our choices and obesity risk • Local food environments differ considerably by

the racial and economic composition of a community

• Differences in the food environment may contribute to inequities in obesity risk and risk from obesity-related conditions

• Indirect costs (money and time) of preparing healthy foods are additional barriers to good nutrition for low-income groups

© 2008, Johns Hopkins University. All rights reserved.

All food environments are not equal

© 2008, Johns Hopkins University. All rights reserved.

National data may not be ideal for understanding disparities in obesity National data show a persistent racial

disparity in obesity among women National data do not account for race

differences in health risks resulting from racial segregation → different environmental exposures

National data do not account for the correlation between race and socioeconomic status → minorities more likely to be poor

© 2008, Johns Hopkins University. All rights reserved.

Exploring Health Disparities in Integrated Communities (EHDIC) EHDIC is a multi-site study designed to

assess the nature of health disparities where African Americans and Whites live under similar and environmental conditions

Nation-wide assessment of census tracts 35% African Americans AND 35% white b/w median income ratio 0.85-1.15 b/w percent high school grad 0.85-1.15

Of 66438, 425 census tracts met the criteria

© 2008, Johns Hopkins University. All rights reserved.

Black-White disparity in obesity among women, social context matters

Significant differences in obesity disappear among low-income women living in the same social context

18.3*

33.4 35.0 39.5

*p<0.05

Bleich SN, Thorpe RJ, Sharif-Harris H, Fesahazion R, LaVeist TA (2010) "Social context explains race disparities in obesity among women." Journal of Epidemiology and Community Health. 64(5):465-9.

© 2008, Johns Hopkins University. All rights reserved.

Important caveat In the EHDIC data, race disparities among

black and white women were eliminated because of higher prevalence of obesity among white women as a result of challenging social conditions

Policies are needed that will help obesity decline among both white and black women

© 2008, Johns Hopkins University. All rights reserved.

Who does the public blame for obesity?

Public Attitudes on Responsibility for Obesity (in percent) Great deal Good

amount Just some Hardly any

Individual Americans in their choice of diet and lack of exercise

67 20 7 4

Fast-food restaurants 43 21 19 13 Schools that allow high-calorie snacks

and sweets 40 24 20 12

Manufacturers of high-calorie packaged and processed foods

36 25 22 12

Marketers and advertisers of high-calorie packaged and processed foods

35 25 24 12

Government policies and laws on food content and marketing

20 21 28 24

Note: "Don't know" responses not shown. Sources: ABC News/Time Poll (Storrs, Conn.: Roper Center for Public Opinion Research, May 10-16, 2004). Questions: Whatever the causes of obesity, I'd like to ask you about groups that may or may not be responsible for creating the problem. For each, please tell me if you think it bears a great deal of responsibility for the nation's obesity problem, a good amount, just some or hardly any.

Bleich SN, Blendon RJ, "Public opinion and obesity," in Robert J. Blendon, Drew E. Altman, Mollyann Brodie, and John M. Benson eds., American Public Opinion and Health Care Policy (Washington: CQ Press, September 2010), Chapter 17.

© 2008, Johns Hopkins University. All rights reserved.

How to move the agenda forward • Improve public awareness of the food

environment

• Identify ways to reducing disparities by eliminating challenging social conditions

• Develop synergies between public health and industry, government and communities

• Appropriately align incentives to “nudge” people in the right direction and encourage community investment in increased access to healthy foods