Poverty and Health

[lavendersparkle]

I keep on getting confused with some of the rhetoric I hear about the place about poverty and healthy life style. So, first of all, I'll explain some ways in which poverty obviously does impact upon one's ability to have a healthy lifestyle. Firstly, access to healthcare. In the US healthcare actually costs money. In the UK healthcare is free at the point of demand for most services but there are still costs to obtaining healthcare, such as travel expenses and topping up NHS care from the private sector. Housing is another big thing. Housing which is cold or damp or contaminated with toxins is cheaper and likely to cause health problems. There's also the problem of work hazards, as if you are poorer you have less opportunity to avoid dangerous work environments or demand appropriate health and safety practice.

With that on board, I want to talk more specifically about areas of health which are usually closely related in public dialogue: diet and fitness. Poverty is associated poor diet, or at least this is what I have heard from t'internets. There are some possible good reasons for this. The first is accommodation. If you are living in very poor quality accommodation you may not have any cooking facilities. You may not have a fridge or a freezer. This makes it very difficult to eat anything which requires cooking or cool storage. Crisps, biscuits, take-aways can be eaten in these circumstances. This leads to another of the 'can't afford to be poor' situations, because these types of food are more expensive than home cooked food, so buying some cooking equipment would work out cheaper in the long run, but if there's nothing left of the pay cheque each week there's no way you can make that investment.

Another issue, which I suspect is more of an issue in the US, is time poverty. I get the impression that because of differences in the tax and benefit system, single parents working three jobs to make ends meet is more common in the US. If you're time poor and get home exhausted, it's much harder to cook. Similarly, if one has not been taught to cook before leaving home, the risk of experimenting with an unfamiliar recipe to gain the skills and confidence to cook, is too much if you will have to go without dinner if the cooking goes wrong.

Access to shops is something I've heard a lot about. Mainstream supermarkets aren't so keen to open in council estates and even when they do they tend to open smaller shops with higher prices and more restricted range. I get that. The thing that confuses me is that in the past when I've talked about eating more vegetables and wholemeal bread I've heard people say that they'd like to but they don't have an organic store near them or the organic store is so expensive. There definitely seems to be a big meme, at least of LJ, that eating healthy food requires access to an organic shop. This completely flummoxes me. I eat a pretty healthy diet, and it is almost entirely bought from Tesco. Do US supermarkets not sell vegetables or wholemeal bread? Does the US allow such noxious chemicals to be sprayed on their crops that it's really better to eat ready meals than non-organic veg? Please explain because every time I ask I'm told that I'm an evil privileged middle-class vegan who should STFU.

On a related not, what's the deal with the whole "I can't exercise because I can't afford to join a gym" meme. I can see the advantages of belonging to a gym for some people. If you want to build particular muscles or train for a particular activity then the gym can provide expert advise and machinery. If, on the other hand, you just want to improve your general level of fitness, you can get most of the benefits of the gym for free. You could turn on the radio and dance around your apartment for half an hour. You could run up and down the stairs, if you have stairs. You could even just make small lifestyle changes to be a bit more active: walk rather than drive on short errands, take the stairs, get off the subway a stop early and walk the rest. These things aren't going to get you ready to run a marathon but they will get you a bit fitter and healthier. Of course, as with preparing food, time poverty will put a big spanner in the works.

A thing I've noticed in common between both diet and exercise is that in both these cases unnecessary purchases have become necessary in the mind of the public. I'm increasingly coming to think that this is a central feature of consumerist capitalism. Activities which don't require much stuff, such as sex, or are initially carved out as a space separate from consumerism, are very quickly colonised with consumer goods, the purchase of which we are convinced is essential to the activity. A healthy lifestyle is relatively cheap and easy if one is not impeded by the issues I've mentioned above: less salt, sugar, fat, alcohol, caffeine, nicotine; more vegetables, fruit, complex carbohydrates, movement, water. However there is a multi billion dollar industry trying to sell us the 'secret' to all this. At its best it's just a waste of money and resources to, for example, drive to a gym, walk on a tread mill, and drive home. At its worst, the effort to make profit from those who can afford it requires convincing those who can't that they therefore can't afford to participate in activities which shouldn't cost anything.

Comments

[naath.livejournal.com]

The Budgens in Arbury Court sells the crapest veg I have ever bought! Basically gone-off before you even buy it. The other Arbury/King's Hedges shopping place are the organic food co-op place that is pricey and open short hours, the mini Tesco and the One Stop (also Tesco) which are both lacking in decent fresh produce. To get a better shop I have to go further - and that means transport and time. Not *much* time, this is Cambridge, but I can imagine that in a larger city that a decent shop might be much further away from the areas that poor people can afford to live in.

Poor areas of cities are (unfortunately) likely to be less safe to go out and jog around the block in. That's not really true here (we even have a nice park area near the house), but it is (apparently) in larger cities. Which is unfortunate. A small flat isn't going to be great for working out in either - you run a high risk of annoying the neighbours if you do any aerobic work out (especially the downstairs neighbours).

That said, I think a lot of people do whine about the cost of Organic food and Expensive Gyms when they could very well afford to buy fresh food that's not Organic or to jog 'round the streets where they live. Driving to the gym seems pretty insane to me, silly people; although I do think gyms are useful, largely because there's bog all chance of me affording a swimming pool in the back yard of the house I can't afford...

[oedipamaas49.livejournal.com]

When I'm skint my diet tends to revert to pasta, rice and potatoes -- an all-carb diet may not be healthy, but it is cheap and easy and stops you feeling hungry. My income has a pretty clear impact on how healthy I feel (although that could be more perception than fact). Even in the supermarket many vegetables, and particularly fruit, tends to be pretty expensive. Cabbages, potatoes, etc are OK, but apples or tomatoes cost a lot (esp. out of season. maybe not knowing what time of the year to buy things is a factor?).

[feanelwa.livejournal.com]

In the parts of the US I have visited I fear the answer to the food question is yes - you can buy very expensive pedigree organic vegetables and dried fruit, or things in jars, but I never found a walkable shop that sold normal vegetables.

[feanelwa.livejournal.com]

Oh other thing - chronic minor depression. When you come home from a job where members of the public and bastard supervisors treat you like dirt all day, and you have spent all day dehydrated with a headache because you're not allowed to drink water on duty and no bastard will bring you some because you can't give them a promotion, you don't want to cook a healthy meal or do exercise, you want to either kill somebody or lie down, talk to nobody and eat sugary fatty shit that makes you feel good until you fall asleep. You realise that you never make any progress toward anything because of choosing the easy route, but after being treated like crap for enough days you convince yourself you can't do anything anyway so there's no point eating healthily or doing exercise because nobody will notice or care, and however good you feel at 8:45am, by 9:00 you will be exactly as subhuman as the day before, whatever you ate or did last night and at the weekend, so you may as well take the easy choice every time because everybody else makes all your other choices for you and pushes you into the hard ones every time.

[rav-hadassah.livejournal.com]

Thank you for this insightful post.

I think there are many factors at work here: both access to real capital and to cultural capital and factors of (dis)empowerment and personal responsibility.

I've been quite poor for many years. Poor in the sense that I have to make economic choices about what I spend my money on: an extra bit of food or the one-off ticket to the cinema/book/item of clothing. I've been in situations where I didn't know when I would have money, where I had to scrounge around the house looking for coins to buy a loaf of bread. Thank G'd I had a guarantee of the basics most of the time (but not always): health insurance, housing and education and a fall-back scenario of being able to live with my family if anything.

Yet, because I come from a middleclass/educated background, my poverty has never crippled my health/food choices. The health insurance needs to be paid before the 'fun stuff', fresh veg and good, homemade cooking before the chocolate and cookies and chips etc. I've been able to make these disciplined choices because I have cultural capital: as frustrating as my financial insecurity may be, I know if will only be temporary; I have been educated about health and responsible lifestyle and am not too defeatist/disempowered to just 'let it all go'. I am not from a family of poverty, nor trapped in a cycle of poverty. Those circumstances, I think, produce a different mindset. Many of the people you discuss ARE in that very situation.

(cont. below).

[rav-hadassah.livejournal.com]

Living in the US has really opened my eyes even more to the brutalities of a class system. Fruit and veg are prohibitively expensive in the US and almost ALL of my disposable income goes straight to (healthy choices in) the supermarket. It's actually financially painful to choose healthy food (I am not talking about organic food here; just normal veg) and yet I insist I'd do it.

Also, don't forget that food in the US is laced with all kinds of crap. High Fructose Corn Syrup is the biggie and boy, is it crap. Furthermore, you're constantly bombarded with bad food choices as being 'fun', 'tasty' and 'easy'. I've never seen so many fast-food ads on tv as I have in the US. Again, junk food, cookies, crisps, soda, take-out meals etc are all cheaper than homecooked, healthy food. Unless you're very disciplined and conscious, it's very easy to make Bad Food Choices. There's an evil industry at the root of all this; even food that we in Europe wouldn't consider healthy is marketed as 'healthy' in the US because it's made with regular sugar rather than HFCS!

Then, there's the lifestyle aspects. This is an intensely car-based society (here in California): nothing gets done without a car. Forget public transport. Forget walking. There's a real culture of aversity towards walking/public transport. You only take the bus if you're dirtpoor or crazy and I'd wager to say it's even dangerous to ride the bus. People do not get exercise.

But finally there's the issue we just can't ignore. As cruel and crippling as all these circumstances are, there is still the issue of personal responsibility. There's a very hypocritical culture here that on the one had punishes/criticises and on the other hand rewards/accepts obesity. Obesity here is almost seen as a (legitimate) lifestyle rather than as a disorder. At the same time, Hollywood markets Size 0 enthusiastically. Being constantly pulled between these two polarities is confusing, frustrating and fatal for one's self-esteem.

Yet, I've never seen a more indulgent food/lifestyle culture as here in the US. Enough simply ain't enough. People eat and eat and eat, and don't move. When I noticed that the Grad School Lifestyle was piling on a couple of pounds, I immediately took measures and my weight has stabilized. I already had a pretty healthy diet but turned it up a notch. I cut out sodas at home, greatly reduced the intake of sodas out of the home. I only eat chocolate on Shabbat. I replaced sodas with sparkling water, tea (with far less sugar than before) and natural fruit juice in some mornings. I almost only buy fresh veg, as much organic as I can. I always cook at home if at home. If I have one carb-laden meal during the day, I'll have something very light/vegan as the other meal, etc. But it takes strength to make these food choices. At the beginning it felt ridiculous and offensive: here I was, a slender girl on a diet?!? But that's what you have to do in the US: be on a constant diet, otherwise you WILL get fat. I will start an exercise routine in the Fall.

Yes, circumstances are bad, but I also do hold people accountable for their choices. Gaining some over the years is something entirely different from being (morbidly) obese and continually living with that obesity. I've never seen so many obese people in my life as here. Americans and even more so the American poor, really look to (bad) food as a cheap and easy source of comfort.

The government has to step in and change things, I think. People have to wake up and smell the coffee and demand very real changes in their lives and food industry. But ultimately, it also really depends on the individual.

[hatam-soferet.livejournal.com]

You can get wholemeal bread in my supermarket, but the other one, the one that just closed, you couldn't. They also had appallingly expensive veg, and the remaining supermarket isn't much better. Crap like high-fructose corn syrup is govt subsidised and doesn't spoil, so it's very much cheaper to eat a meal of crap than a meal of real food, even if you do cook the real food at home, unless you are very organised indeed and have lots of time to make lots of food and freeze it.

The gym thing. Speaking for myself, no-one I know can turn on the radio and dance around the apartment, because the person living below you will give you hell for it. And in some areas it genuinely isn't safe to get off a stop early and walk, etc, especially (surprise) poorer areas. In principle I agree that one shouldn't need a gym in order to have increased activity, stairs and the like, and I think it's the time poverty aspect that swings it for me. On a treadmill you can chat with your friend next to you even though she's going twice as fast as you are, or you can let your brain unwind by watching the TV whilst jogging instead of having to watch out for holes in the pavement. Also in my mind at least "gym" is shorthand for "any enjoyable physical activity," most of which seem to require some kind of financial investment, even if it's just proper running shoes so you don't fuck up your feet, but that's me talking so take it with a pinch of salt.

And I didn't mean driving to the gym, either, I meant the kind where you walk to it or get off a few subway stops later than usual and it's there :) but I live in a city.

And relating to feanelwa's point about chronic minor depression - Orwell talks about healthy vs unhealthy diets in The Road to Wigan Pier - a cup of sugary tea isn't nearly as good for you as a brisk walk and a carrot, or whatever comparison he uses (my copy's gone walkies), but if you basically have a pretty crap life, you're going to take the sugary tea every time.

[frankthebarmaid.livejournal.com]

There's also a correlation/causation counfound here. If you are poor you are statistically:

- More likely to smoke
- Less likely to have been taught to cook by your parents
- More likely to have a worse education, which reduces your ability to make informed health choices
- More likely to have been brought up by a similarly poorly-educated mother, and this has been shown to impact on child health
- More likely to be, or be the child of, a young mother

Another causational one I can see is stress - being poor is stressful, and I'm sure that if you live on some grim council estate somewhere, sugary and fatty food might be an easily available stress relief or comfort.

There's also the reverse causation: being out of work due to ill health (mental or physical) can make you poor and the chaotic lifestyle many people with mental health or substance misuse problems is certainly not conducive to a healthly lifestyle.

So yes, I suppose it is possible to be poor but still have a good diet and get exercise but only if:

1. You have been taught how to cook
2. You have the educational level required to listen to the 5-a-day campaign but ignore Gillian McKeith (whole nutha post there...main argument why she should be silenced rather than ignored is that she makes something very simple - 'eat more fruit and veg' - into something opaque and complex)
3. You do not have a preexisting health problem