Jane Dixon

The Health Equity Dimensions of Urban Food Systems

There is increasing recognition that the nutrition transition sweeping the world’s cities is multifaceted. Urban food and nutrition systems are beginning to share similar features, including an increase in dietary diversity, a convergence toward “Western-style” diets rich in fat and refined carbohydrate and within-country bifurcation of food supplies and dietary conventions. Unequal access to the available dietary diversity, calories, and gastronomically satisfying eating experience leads to nutritional inequalities and diet-related health inequities in rich and poor cities alike. Understanding the determinants of inequalities in food security and nutritional quality is a precondition for developing preventive policy responses. Finding common solutions to under- and overnutrition is required, the first step of which is poverty eradication through creating livelihood strategies. In many cities, thousands of positions of paid employment could be created through the establishment of sustainable and self-sufficient local food systems, including urban agriculture and food processing initiatives, food distribution centers, healthy food market services, and urban planning that provides for multiple modes of transport to food outlets. Greater engagement with the food supply may dispel many of the food anxieties affluent consumers are experiencing.

Urban Environmental Health Hazards and Health Equity

This paper outlines briefly how the living environment can affect health. It explains the links between social and environmental determinants of health in urban settings. Interventions to improve health equity through the environment include actions and policies that deal with proximal risk factors in deprived urban areas, such as safe drinking water supply, reduced air pollution from household cooking and heating as well as from vehicles and industry, reduced traffic injury hazards and noise, improved working environment, and reduced heat stress because of global climate change. The urban environment involves health hazards with an inequitable distribution of exposures and vulnerabilities, but it also involves opportunities for implementing interventions for health equity. The high population density in many poor urban areas means that interventions at a small scale level can assist many people, and existing infrastructure can sometimes be upgraded to meet health demands. Interventions at higher policy levels that will create more sustainable and equitable living conditions and environments include improved city planning and policies that take health aspects into account in every sector. Health equity also implies policies and actions that improve the global living environment, for instance, limiting greenhouse gas emissions. In a global equity perspective, improving the living environment and health of the poor in developing country cities requires actions to be taken in the most affluent urban areas of the world. This includes making financial and technical resources available from high-income countries to be applied in low-income countries for urgent interventions for health equity. This is an abbreviated version of a paper on “Improving the living environment” prepared for the World Health Organization Commission on Social Determinants of Health, Knowledge Network on Urban Settings.

A cultural economy model for studying food systems

In 1984, William Friedland proposed a Commodity Systems Analysis framework for describing the stages through which a commodity is transformed and how it acquires value. He challenged us to think of commodities as entities with a social as well as a physical presence. Friedlands argument enriched the concept of commodity production, but it remains essentially a supply side perspective.Since then, many commentators have argued that power is shifting from producers to consumers. Furthermore, some are claiming that, contrary to much traditional Marxist thinking about how individuals find meaning through their productive capacities, it is now through consumption that individuals are identifying themselves. Given the significance of this view, it seems timely to extend Friedlands framework to incorporate the consumption perspective.In light of other claims that the distance between production and consumption is increasing, it is equally important to acknowledge the processes that structure the relationship between the two spheres. This entails using new retail geographical and cultural studies to explore further what takes place in distribution and exchange.This article describes a new model for understanding power in commodity systems, one that acknowledges the input and interests of a range of actors beyond the agricultural sector. The proposed cultural economy model also emphasizes a range of value adding processes that are wider than those that apply to commodity production.

Body mass index and health-related behaviours in a national cohort of 87 134 Thai open university students

Background: Thailand is undergoing a health-risk transition with overweight and obesity emerging as an important population health problem. This paper reports on a study of the transition, focusing on “lifestyle” factors such as diet (fried foods, soft drinks, Western-style fast foods) and physical activity (mild, moderate, strenuous exercise, housework/gardening and screen time). Methods: A baseline survey was administered to 87 134 adult students from all regions of Thailand attending an open university. Results: 54% of the cohort was female. Participants’ median age was 29 years. By self-reported Asian standards, 16% of the sample was obese (body mass index (BMI)⩾25) and 15% overweight at risk (BMI⩾23–24.9). Men were twice as likely as women to be overweight (21% vs 9%) or obese (23% vs 10%). Obesity was associated with urban residence and doing little housework or gardening and with spending more than 4 hours a day watching television or using computers. The latter occurred among 30% of the cohort, with a population attributable fraction (PAF) suggesting that it accounts for 11% of the current problem. Daily consumption of fried food was associated with obesity, and eating fried foods every second day or daily had a PAF of nearly 20%. Conclusions: These health-related behaviours underpinning the Thai health transition are associated with increasing obesity. They are modifiable through policies addressing structural issues and with targeted health promotion activities to prevent future obesity gains. Insights into future trends in the Thai health transition can be gained as this student cohort ages.

Heading the table: parenting and the junior consumer

From the 1970s onwards, studies of the dynamics involved in family food provisioning in Britain and the USA have provided consistent evidence of the centrality of husbands and male breadwinners to food decisions. Recent studies are beginning to show the significance of children or the “junior consumer” to household food decisions. This paper reports on focus groups conducted in Australia in the mid‐1990s that support the argument that children exert considerable influence over family diets. One obvious reason for this trend lies in the activities of food retailers and advertisers/marketers, who target their goods, services and messages to children. These marketplace actors are encouraging children to identify as consumers. A less obvious explanation, and the one explored in this paper, concerns changing parenting practices. Despite the double workload of many family food providers, childrens demands are being responded to in unprecedented ways. Metaphorically, children are displacing male adults at the head of the table. The paper comments on the consequences of childrens dominance over dietary practices.

Functional foods and urban agriculture: two responses to climate change-related food insecurity

Affluent diets have negative effects on the health of the population and the environment. Moreover, the ability of industrialised agricultural ecosystems to continue to supply these diets is threatened by the anticipated consequences of climate change. By challenging the ongoing supply the diets of affluent countries, climate change provides a population and environmental health opportunity. This paper contrasts two strategies for dealing with climate change-related food insecurity. Functional foods are being positioned as one response because they are considered a hyper-efficient mechanism for supplying essential micronutrients. An alternative response is civic and urban agriculture. Rather than emphasising increased economic or nutritional efficiencies, civic agriculture presents a holistic approach to food security that is more directly connected to the economic, environmental and social factors that affect diet and health.

Human Health and Climate Change: Leverage Points for Adaptation in Urban Environments

The design of adaptation strategies that promote urban health and well-being in the face of climate change requires an understanding of the feedback interactions that take place between the dynamical state of a city, the health of its people, and the state of the planet. Complexity, contingency and uncertainty combine to impede the growth of such systemic understandings. In this paper we suggest that the collaborative development of conceptual models can help a group to identify potential leverage points for effective adaptation. We describe a three-step procedure that leads from the development of a high-level system template, through the selection of a problem space that contains one or more of the group’s adaptive challenges, to a specific conceptual model of a sub-system of importance to the group. This procedure is illustrated by a case study of urban dwellers’ maladaptive dependence on private motor vehicles. We conclude that a system dynamics approach, revolving around the collaborative construction of a set of conceptual models, can help communities to improve their adaptive capacity, and so better meet the challenge of maintaining, and even improving, urban health in the face of climate change.

Climate Change Adaptation at the Intersection of Food and Health

Nutritious, safe, affordable, and enjoyable food is a fundamental prerequisite for health. As a nation, Australia is currently classified as food secure with the domestic production exceeding domestic consumption of most major food groups. The domestic system is almost self-sufficient in terms of nutritious plant foods, although these foods have seen steady higher price increases relative to other foods, with nutrition equity implications. However, the viability of Australia’s food security sits counter to the continued presence of a stable and supportive climate. This article reviews the current state of science concerning the interface between climate change, food systems, and human health to reveal the key issues that must be addressed if Australia is to advance human health and sustainable food systems under a changing climate.

Obesity, convenience and “phood”

Purpose – With rising levels of obesity, public health attention has turned to the “obesogenic environment”, which includes the ready availability of convenience foods. We seek to provide an historical account of the popularity of convenience foods, alongside an elaboration of how international and Australian experts believe convenience food has contributed to rising rates of obesity. In this context, the paper aims to speculate about the likely success of functional foods, or “phoods”, and draw conclusions about potential implications for the obesity epidemic.Design/methodology/approach – An “expanded” Delphi survey was utilised to identify key trends underpinning the rise in obesity and experts hypotheses about how these trends have operated to promote obesity. Elaborating on these data, an historical perspective of the emergence and consolidation of convenience foods in Australian diets, with particular attention paid to foods that offer “healthy convenience”, is provided.Findings – Australian researc...

Urbanisation and human health in China: spatial features and a systemic perspective

Background, aims and scopeCurrent studies have paid little attention to the dynamism in urban spatial expansion and its possible environmental and health effects or to the health effects of rapid urban environmental change at different points along the urbanisation gradient. This study adopts a public health ecology approach to systematically understand the relationship between urbanisation, urban environmental change and human health in China.MethodRemote sensing image analysis, based on night light data at five different time periods in recent decades, was used to determine changes to the overall urban area. Through a review of the evidence on the relationships between environmental health, urbanisation and health, we advance a pathway framework for explaining urban human health ecology. The Spearman rank correlation coefficient was used to measure the correlation between disease prevalence and urbanisation level, adding a further dimension to a systemic understanding of urban health.Results and conclusionsUrban areas have been increasing spatially, but unevenly, in recent decades, with medium and small cities also expanding rapidly in the past decade. Urbanisation and urban expansion result in changes to land use/coverage change, the urban environment and the residents’ lifestyle, which result in human health problems. Regions with the highest urbanisation level were more inclined to have a high prevalence of chronic disease in recent decades. An ecological public health approach provides insights into the multiple types of data which need to be routinely collected if human disease is not to become a barrier to social and economic development.