We can’t hope to end poverty and health inequality without understanding why people make the choices they do

I was chatting to the Prevention Lead at Diabetes UK the other week. I asked how tackling health inequality works, as it seems to me it’s mostly been about reaching poorer people to tell them where they’re going wrong. No one is telling them they’re wrong just for being poor but maybe different choices could help them live longer.

We discussed a different theory of change. What is Quids In‘s role in the fight against health inequality if our main goal is to help people lift themselves out of poverty? “Simple,” I was told. “You give people the means to make those positive choices.”

It’s easy enough to bemoan the dangers of diets based too heavily on ultra-processed foods. (See our special report.) As the additives and food production is designed to help mass produce it and for it to last longer, however, it is undoubtedly driving down cost. Public health bodies and disease-prevention charities can bang the drum for fresh produce and home-cooked meals all they like but if the cash isn’t there, or could be used in other ways to increase people’s perceived quality of life in the short term, the easy option is the cheapest.

Brow-beating consumers about the quality of what they choose to eat will quickly backfire

Sweeteners and flavourings add to the appeal. Whether or not they’re designed to be in any way addictive, they’re certainly trying to sell as much as possible. Kids love burgers costing less than a quid no less than pricey ones, so why wouldn’t hard-pressed parents line up these ‘treats’. The long-term harm is invisible but it stores up a health inequality punch as we programme young tastebuds to associate nutrition-light meals with tasty rewards and sound budgeting.

Quids in! has a role to play in freeing up cash to make healthier options viable but it’s still a culture battle. We are generations down the line since McDonald’s became the takeaway of choice for millions of cash-strapped families. Brow-beating consumers about the quality of what they choose to eat will quickly backfire as condescending lecturing. Providing the means to make informed decisions and leaving the consumer in control will always do better. Counter-intuitively, it’s not health professionals people want to hear from. We’d be better off hiring influencers on TikTok to take the ‘Supersize Me’ challenge, (under supervision), as filmmaker Morgan Spurlock did back in 2004.

It comes as a surprise to policy-makers when we point out how many don’t have a cooker, fridge or freezer

It’s different with smoking, even though ASH (Action on Smoking and Health) describes it as “the leading cause of health inequalities in the UK [that] accounts for half the difference in life expectancy between the richest and poorest in society”. Quids In’s budget calculator, though, doesn’t list fags as luxuries or make any value judgement on people’s choices. Instead, tobacco sits under the section ‘Makes Life Easier’ alongside takeways and alcohol. We neither condone nor condemn these things, people get by however they can. But if we could have a conversation with anyone who wants to quit about what they’d do with the money they’d save, we could help incentivise quitting through making savings. With food, it’s not that straightforward.

So the best thing we can do is help people lift themselves out of poverty. They may or may not make healthier lifestyle choices but one of the barriers will have been lowered, if not removed altogether. We can address some other barriers at the same time too. I know there are increasing numbers of cookery classes to help fill this skills gap, (also now often inter-generational), but it comes as a surprise to policy-makers when we point out how many don’t have a cooker, fridge or freezer. That why the Quids in! guide to Food includes as much on accessing grants and free white goods to help get on top of food costs. It’s also why we talk about batch cooking, to save the cost of turning on the oven twice. Poor diets are not just about cheap ingredients.

So, who to blame for poverty? If only it were that easy. There’s sure as hell not enough being done to combat it. It’s as if policy-makers shrug it off as too big and too inevitable. That’s true for relative measures of hardship but it is a total cop-out to abandon those on course to die early because the unintended consequences of the system we live in will chew up and spit out a big part of our community. To understand and end absolute poverty is to engage with the issues. There’s a clear case to bring in health commissioners on this fight. As I always say during presentations on the work we do, it’s important to understand the ‘why’ we do it. People die.

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