With the UK government’s publication of a new obesity strategy last week, Gill Reeve suggests that a more urgent need is a broader strategy to address the underlying causes of poverty and inequality. With a cabinet minister inviting us to take personal responsibility for our weight, the new strategy should not be used to deflect attention from the government’s own responsibility to address inequality.
In his interview with the BBC on 24th July, Boris Johnson highlighted the problem of obesity. There is undoubtedly a serious health issue related to obesity in the UK, which also increases the risks of COVID-19, but is it really as simple as thinking a little more about lifestyles and taking personal responsibility, as Dominic Raab suggested in an interview? The causes of obesity are complex, but significant among them are the deep-seated inequalities that persist in the UK. In highlighting obesity without setting it in its broader context, there is a danger that the government side-steps their own responsibility for rising socio-economic inequality.
A recent government briefing paper on poverty in June 2020 highlights that poverty rates for children and working age adults are higher than they were fifty years ago, and that an estimated 24% of children are now in households of relative low income after housing costs (AHC). Research has long recognised that the health outcomes for deprived communities are much lower in multiple ways, and that people living in deprived areas are much more likely to live with multiple morbidities. The impacts of this are laid bare in a Public Health England report on health equity (2017), that showed people living in the least deprived areas live around twenty years longer in good health than those in the most deprived areas. Obesity is part of a much bigger health crisis that is significantly correlated to poverty.
An independent report on poverty by the Institute for Fiscal Studies in 2017 suggested 4.2 million children were living in relative poverty, with the prediction (pre-COVID-19) for this to rise to 5.2 million by 2022. The Children’s Commissioner supports these findings and the forecast that about 37% of children will live in poverty by 2022. The impacts of COVID-19 on poverty are not yet known, but a recent article by the Institute for Public Policy Research (IPPR) suggested that COVID-19 has already placed an extra 200,000 children in poverty.
The Public Health England report on heath equity (2017) reveals ‘stark inequalities in the prevalence of obesity’ in children aged 10-11 years old, with a 17.5% gap in prevalence between the least deprived and most deprived areas of England. A report by the Royal College of Paediatricians and Child Health (RCPCH) brings insights from doctors on the front line, who report that ‘poor nutrition as a result of the inability to afford enough healthy food is associated with both poor growth of deprived babies and children on the one hand, and rising child obesity on the other’. When obesity is considered within the wider context of poverty, the reports shows that central issues include: the inability of people to afford healthy food options, the struggle to afford essential items such as toothpaste, and widespread food poverty. Added to that, the RCPCH report points to other social factors that negatively impact health, including the lack of access to a garden and to safe green spaces in local neighbourhoods.
Poverty leads to multiple morbidities, food poverty, obesity and much more, and it disproportionately affects particular ethnic groups. The Public Health England report on health equity (2017) provides evidence that there is ‘a clear gradient’ between increased poverty and increased obesity, with the most deprived areas of England having the highest proportion of overweight and obese children. And the statistics are startling in the connections made between poverty, ethnicity and childhood obesity. The Government briefing paper on poverty (2020) shows that in households where the head of the household is from a Black ethnic group, relative poverty rates are 42% (AHC) with 47% of children experiencing child poverty (AHC). Comparative data for a Bangladeshi ethnic household is 53% and 67%, and for a white ethnic household it is 19% and 26%. The Public Health England report on health equity shows the link to child obesity rates, which is the highest in Black ethnic communities at about 43%.
There is plenty of statistical evidence that welfare changes over the past ten years have put many more children into poverty, and a report in June 2020 by the Social Mobility Commission calls for a common strategy across government to tackle inequality, coordinated and driven forward by a single unit at the centre of government. It is this coordinated strategy that is needed in order to review complex issues that are deeply interrelated and to embed changes across policy, decision-making and implementation.
Addressing the key area of child poverty would have multiple benefits, not just to obesity but to the health and wellbeing of whole families. The IPPR report suggests targeted changes that would immediately decrease child poverty: removing the two-child limit and the benefit cap—imposed in 2015 as part of the government’s austerity measures–and increasing Child Benefit by £5 per week per child. The RCPCH report suggests restoring national targets to reduce child poverty and the adoption of a ‘child health in all policies’ approach to decision-making and policy development. In addition, there needs to be a reversal of the public health cuts that have decimated early years services, which are vital support services for families.
COVID-19 has exposed wide inequalities in the UK that are racially, socially and geographically aligned. Tackling COVID-19 is also an opportunity for the government to take responsibility and to strategically address poverty and the profound inequalities that negatively affect so many people’s lives.
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