Low-income are families more likely to be obese and at the same time malnourished than the more affluent in society – and the EU must act to bridge the divide – says Dorota Sienkiewicz

Every day hundreds of thousands of children living in Europe are going to school hungry. According to the United Nations Children’s Fund only every second child in countries like Romania, Slovenia, Greece, Hungary, Austria and Slovakia gets to eat breakfast each morning. Yet, startlingly, some 24 per cent of six to nine year-olds in Europe are overweight or obese. The figure for adults is equality telling – more than 50 per cent.

At first glance, it is puzzling to see the co-existence of such phenomena? But this data speaks volumes about the double burden of malnutrition – not having enough to eat in quantitative terms or having too much of the wrong stuff in qualitative terms. Both leads to varying levels of nutritional insufficiency ranging from hunger to obesity and everything in-between.

Malnutrition in all forms increases the risk of disease and early death. Furthermore, it is estimated that the cost to the global economy as a result of lost productivity and direct health care costs amounts to as much as 5 per cent of worldwide gross domestic product – or $3.5 trillion per year. Being overweight and obesity are leading risk factors for many diseases and generated costs estimated to be about $1.4 trillion in 2010 alone.
Let us zoom in to underlying cause. Both forms of malnutrition have something in common: poverty.

The lower socio-economic status a person belongs to, the poorer the social determinants of that person’s health are – including access to, quantity and quality of food and diets. In 2009 – after the early impact of the economic crisis – some 43 million people in the European Union were estimated to suffer from food poverty. Low income groups eat less well, pay more for what they get in relative terms and have worse access to healthy options – such as fresh fruit and vegetables; and therefore chose cheaper but unhealthy products that are high in saturated and trans-fats, sugar and salt.

It leads to such absurd situations as a jar of processed apple sauce could costing less than a single apple. A new phenomenon has sprung up – an obesity paradox. Low-income are families more likely to be overweight or obese – a sign of their undernutrition status – than their richer peers. Food poverty and nutritional insecurity are on the rise across Europe. In 2011 in the United Kingdom, for example, the numbers of people turning to food banks tripled in one year. This in the 7th richest nation in the world.

Current unemployment and poverty levels, as well as cuts in social provision across the continent have led to situations in which many families are unable to meet their basic nutritional needs. Parents have to choose between feeding their children or themselves, or sending their kids hungry to school hoping teachers will solve the problem for them.

Food environments are increasingly characterised by higher prices for fresh fruit and vegetables, low prices for processed foods and easy access to fast-food shops – and the so-called convenience shops. This is not conducive to healthier eating habits and often promotes less healthy – obesogenic – diets. Healthier food environments play a crucial role in changing behaviour by making the healthy choice the handy one.

We need to realise that purchases are strongly influenced by three factors: what, and at what price, is available; past experiences; and marketing messages. But let us say more than that. We are on a brink of losing our ability to produce real food having given it away to highly specialised manufacturers, advertisers and retailers. Food has become a politicised commodity, highly susceptible to price fluctuations, a playground for content reformulation.

This dire nutritional landscape can be turned around by introducing the right measures. First and foremost, effective reform of the Common Agricultural Policy is needed. The current plan does not deliver on better health outcomes. There are several cost-effective public policy interventions that would go a long way to prevent and reduce diet-related non-communicable diseases and nutritional inequalities – along with fixing our ‘broken’ food system. Quantity and quality of diets largely depend on how health and nutrition-sensitive food systems are.

Improving diets by increasing fresh fruit and vegetable consumption is one of such cost-effective strategies – recognised by and co-funded by the European Commission’s School Fruit Scheme. Currently, less than half of EU member states reach the World Health Organisation-recommended daily consumption of fruit and vegetables. In 2006, it was estimated that the number of lives potentially saved annually if fruit and vegetables intake were increased slightly reached 892,000 and 423,000 in the EU-15 and the EU-10 respectively.

To address many of the flaws in the way that our societies and economic systems approach food production and consumption, we will need to place nutrition at the centre of our agriculture and food systems. We have to strengthen the role of the horticulture market, look to shorten supply chains and pursue locally-source food – ‘farm-to-fork’ or community-supported agriculture – while empowering the EU school fruit scheme. We must also launch similar programmes in other institutional settings like hospitals and expand the principles of the fruit and vegetable scheme into other vulnerable population groups – such as pregnant and breastfeeding women, and users of food banks.

Dorota Sienkiewicz is health equity and policy coherence coordinator at the European Public Health Alliance network of non-governmental organisations