Access to nutritious food, socioeconomic individualism and public health ethics in the USA: a common good approach

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Abstract

Good nutrition plays an important role in the optimal growth, development, health and well-being of individuals in all stages of life. Healthy eating can reduce the risk of chronic diseases, such as heart disease, stroke, diabetes and some types of cancer. However, the capitalist mindset that shapes the food environment has led to the commoditization of food. Food is not just a marketable commodity like any other commodity. Food is different from other commodities on the market in that it is explicitly and intrinsically linked to our human existence. While possessing another commodity allows for social benefits, food ensures survival. Millions of people in United States of America are either malnourished or food insecure. The purpose of this paper is to present a critique of the current food system using four meanings of the common good--as a framework, rhetorical device, ethical concept and practical tool for social justice. The first section of this paper provides a general overview of the notion of the common good. The second section outlines how each of the four meanings of the common good helps us understand public practices, social policies and market values that shape the distal causal factors of nutritious food inaccessibility. We then outline policy and empowerment initiatives for nutritious food access.

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Neighborhood of residence and incidence of coronary heart disease.

A. V. Diez Roux, S Merkin, D Arnett … (2001)

Where a person lives is not usually thought of as an independent predictor of his or her health, although physical and social features of places of residence may affect health and health-related behavior. Using data from the Atherosclerosis Risk in Communities Study, we examined the relation between characteristics of neighborhoods and the incidence of coronary heart disease. Participants were 45 to 64 years of age at base line and were sampled from four study sites in the United States: Forsyth County, North Carolina; Jackson, Mississippi; the northwestern suburbs of Minneapolis; and Washington County, Maryland. As proxies for neighborhoods, we used block groups containing an average of 1000 people, as defined by the U.S. Census. We constructed a summary score for the socioeconomic environment of each neighborhood that included information about wealth and income, education, and occupation. During a median of 9.1 years of follow-up, 615 coronary events occurred in 13,009 participants. Residents of disadvantaged neighborhoods (those with lower summary scores) had a higher risk of disease than residents of advantaged neighborhoods, even after we controlled for personal income, education, and occupation. Hazard ratios for coronary events in the most disadvantaged group of neighborhoods as compared with the most advantaged group--adjusted for age, study site, and personal socioeconomic indicators--were 1.7 among whites (95 percent confidence interval, 1.3 to 2.3) and 1.4 among blacks (95 percent confidence interval, 0.9 to 2.0). Neighborhood and personal socioeconomic indicators contributed independently to the risk of disease. Hazard ratios for coronary heart disease among low-income persons living in the most disadvantaged neighborhoods, as compared with high-income persons in the most advantaged neighborhoods were 3.1 among whites (95 percent confidence interval, 2.1 to 4.8) and 2.5 among blacks (95 percent confidence interval, 1.4 to 4.5). These associations remained unchanged after adjustment for established risk factors for coronary heart disease. Even after controlling for personal income, education, and occupation, we found that living in a disadvantaged neighborhood is associated with an increased incidence of coronary heart disease.

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Obesity and the food environment: dietary energy density and diet costs.

Adam Drewnowski (2004)

The highest rates of obesity in the United States occur among population groups with the highest poverty rates and the least education. The impact of socioeconomic variables on obesity may be mediated, in part, by the low cost of energy-dense foods. The observed inverse relationship between energy density of foods, defined as available energy per unit weight (kilocalories per gram or megajoules per kilogram), and energy cost (dollars per kilocalorie or dollars per megajoule) means that diets based on refined grains, added sugars, and added fats are more affordable than the recommended diets based on lean meats, fish, fresh vegetables, and fruit. Taste and convenience of added sugars and added fats can also skew food choices in the direction of prepared and prepackaged foods. Paradoxically, attempting to reduce diet costs may lead to the selection of energy-dense foods, increased energy intakes, and overweight. The present energy-cost framework provides an economic explanation for the observed links between obesity and the food environment, with diet cost as the principal intervening variable. If higher food costs represent both a real and perceived barrier to dietary change, especially for lower-income families, then the ability to adopt healthier diets may have less to do with psychosocial factors, self-efficacy, or readiness to change than with household economic resources and the food environment. Continuing to recommend costly diets to low-income families as a public health measure can only generate frustration and culpability among the poor and less-well educated. Obesity in America is, to a large extent, an economic issue.

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Neighborhood characteristics and availability of healthy foods in Baltimore.

Manuel Franco, Ana V. Diez Roux, Thomas A. Glass … (2008)

Differential access to healthy foods may contribute to racial and economic health disparities. The availability of healthy foods has rarely been directly measured in a systematic fashion. This study examines the associations among the availability of healthy foods and racial and income neighborhood composition. A cross-sectional study was conducted in 2006 to determine differences in the availability of healthy foods across 159 contiguous neighborhoods (census tracts) in Baltimore City and Baltimore County and in the 226 food stores within them. A healthy food availability index (HFAI) was determined for each store, using a validated instrument ranging from 0 points to 27 points. Neighborhood healthy food availability was summarized by the mean HFAI for the stores within the neighborhood. Descriptive analyses and multilevel models were used to examine associations of store type and neighborhood characteristics with healthy food availability. Forty-three percent of predominantly black neighborhoods and 46% of lower-income neighborhoods were in the lowest tertile of healthy food availability versus 4% and 13%, respectively, in predominantly white and higher-income neighborhoods (p<0.001). Mean differences in HFAI comparing predominantly black neighborhoods to white ones, and lower-income neighborhoods to higher-income neighborhoods, were -7.6 and -8.1, respectively. Supermarkets in predominantly black and lower-income neighborhoods had lower HFAI scores than supermarkets in predominantly white and higher-income neighborhoods (mean differences -3.7 and -4.9, respectively). Regression analyses showed that both store type and neighborhood characteristics were independently associated with the HFAI score. Predominantly black and lower-income neighborhoods have a lower availability of healthy foods than white and higher-income neighborhoods due to the differential placement of types of stores as well as differential offerings of healthy foods within similar stores. These differences may contribute to racial and economic health disparities.

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Author and article information

Contributors

Jacquineau Azétsop

Tisha R Joy

Journal

Journal ID (nlm-ta): Philos Ethics Humanit Med

Journal ID (iso-abbrev): Philos Ethics Humanit Med

Title: Philosophy, Ethics, and Humanities in Medicine : PEHM

Publisher: BioMed Central

ISSN (Electronic): 1747-5341

Publication date Collection: 2013

Publication date (Electronic): 29 October 2013

Volume: 8

Page: 16

Affiliations

[1 ]Département de Santé Publique, Faculté des Sciences de la Santé de l’Université de N’djaména, Avenue Mobutu, B.P. 1117 N’djaména, Tchad

[2 ]Department of Medicine, Western Ontario University, B5-107, 268 Grosvenor Street, London, Ontario N6A 4V2, Canada

Article

Publisher ID: 1747-5341-8-16

DOI: 10.1186/1747-5341-8-16

PMC ID: 4231366

PubMed ID: 24165577

SO-VID: 699d8267-a7da-4699-94f6-a71c7a5cc69b

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Access to nutritious food, socioeconomic individualism and public health ethics in the USA: a common good approach

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Most cited references 30

Neighborhood of residence and incidence of coronary heart disease.

Obesity and the food environment: dietary energy density and diet costs.

Neighborhood characteristics and availability of healthy foods in Baltimore.

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