Understanding the determinants of inequities in healthy eating

Why we studied this topic

An unhealthy diet is one of the biggest risk factors for cardiovascular disease, type 2 diabetes, certain cancers, and osteoporosis. But little is understood about why people who experience greater social disadvantage have poorer diets.

Our study, known as the Healthy and Equitable Eating (HE²) study, was the first in Australia to use systems methods to explore the social distribution of poor diet. We wanted to move beyond the food system to address the social determinants of inequities in healthy eating. We engaged people across sectors and disciplines using collaborative conceptual modelling workshops with experts representing government, non-government health organisations and academia, and then produced a visual representation of HE² in the form of a causal loop diagram.

What this paper adds

This paper is the first attempt within Australia to explore the dynamic interactions occurring within a system spanning factors such as the price of food, food supply, access to cooking and food storage facilities, level of disposable income, working conditions, geographical location, access to affordable and appropriate transport, and level of health literacy. We found that these sub-systems were each important and were highly interconnected. For example, housing not only influences access to the food supply, but it is also related to transport, employment, and even the ability to store and prepare food for consumption.

Our paper establishes a new diagram that can help researchers and policy makers to understand the causal links between the many factors affecting the social distribution of healthy eating. It also identifies key leverage points for intervention. The diagram shows the complexity of the multiple and interacting determinants of inequities in healthy eating.

What was surprising?

The systems method we used broke down sectoral barriers in a fun and creative way. Keeping the focus on equity was sometimes challenging and we needed to continually remind ourselves to consider the factors affecting the social distribution of healthy eating rather than simply the factors affecting healthy eating.

What it means for policy

Our study findings suggest that all areas of government have a role to play in addressing healthy eating and its social distribution. We advocate that looking beyond the food system is essential to successfully tackling poor nutrition and chronic disease. “HE²” is not an issue that can be solved in health departments alone.