A minimum income for healthy living

There is overwhelming evidence of the role of food and nutrition in the maintenance and promotion of good health, from the avoidance of classic deficiency diseases to the role of antioxidants in the prevention of coronary heart disease and cancer. Hopefully, the man will be active and enjoy a lot of walking, in comfortable shoes and away from traffic. Such exercise is rewarding in mental refreshment, in sociality, and weight regulation with its multiple short and long-term metabolic benefits. Society, including social welfare, has been slow in coming to terms with the new health knowledge.

A minimum income for healthy living.

BACKGROUND: Half a century of research has provided consensual evidence of major personal requisites of adult health in nutrition, physical activity and psychosocial relations. Their minimal money costs, together with those of a home and other basic necessities, indicate disposable income that is now essential for health. METHODS: In a first application we identified such representative minimal costs for healthy, single, working men aged 18-30, in the UK. Costs were derived from ad hoc survey, relevant figures in the national Family Expenditure Survey, and by pragmatic decision for the few minor items where survey data were not available. RESULTS: Minimum costs were assessed at 131.86 pound sterling per week (UK April 1999 prices). Component costs, especially those of housing (which represents around 40% of this total), depend on region and on several assumptions. By varying these a range of totals from 106.47 pound sterling to 163.86 pound sterling per week was detailed. These figures compare, 1999, with the new UK national minimum wage, after statutory deductions, of pound 105.84 at 18-21 years and 121.12 pound sterling at 22+ years for a 38 hour working week. Corresponding basic social security rates are 40.70 pound sterling to 51.40 pound sterling per week. INTERPRETATION: Accumulating science means that absolute standards of living, "poverty", minimal official incomes and the like, can now be assessed by objective measurement of the personal capacity to meet the costs of major requisites of healthy living. A realistic assessment of these costs is presented as an impetus to public discussion. It is a historical role of public health as social medicine to lead in public advocacy of such a national agenda.

Mapping access to food in a deprived area: the development of price and availability indices.

OBJECTIVE: To develop and map indices to illustrate variation in the cost and availability of healthy food. DESIGN: Two contiguous wards in London were selected by virtue of their high Carstairs deprivation scores. A 2-km area was defined around a randomly chosen central point. All retail outlets selling food within the area were visited and their location recorded. A list of foods, acceptable to the local ethnically diverse population, which met current dietary guidelines, was devised. Data on the availability and price of 71 food items were collected. Indices were developed using SPSS and mapped using Geographic Information System (GIS) software. RESULTS: Information on availability and prices were collected from 199 outlets. The mean price index shows how expensive a shop is relative to other shops in the area. The least cost index shows the relative expense of a shop using the cheapest ways of buying their range of foods. Shorthand indices were tested, using data on 19 of the 71 prices. Availability indices are also discussed, including a green availability index and a fresh green availability index. Illustrative maps of the shop locations and the mean price index and fresh green availability index are shown. CONCLUSIONS: Data can be collected and indices developed which indicate geographic variation in shop 'expensiveness', and in the price and availability of healthy food. GIS software can be used to map these indices, to identify areas with high food prices or low availability.

Gender and living alone as determinants of fruit and vegetable consumption among the elderly living at home in urban Nottingham.

Consumption of fruits and vegetables by a sample of 369 elderly people living in Nottingham, England, was analysed in relation to whether or not they were eating five portions a day. Living status was only of significance to men who, if single, consumed 2.66 portions of fruits and vegetables per day compared with an overall mean of 4.1. The salient question is therefore not "Are you living alone?" but " s there a woman in the household?". Those respondents who were older and less educated ate less vegetables and those respondents who had a lower income or social grade ate less fruit. Men were less likely to be able to cook a range of meals, to have had a job that involved cooking or to watch cookery programmes on television. Single men were more likely than single women to say that eating food that was easy to cook and prepare was an important influence on their food choice. Single women on the other hand were more influenced by body image. Finding foods that were the right portion size and easy to open, prepare and cook was more important to single men than married men, as was the amount of money left after paying the bills.

Food safety knowledge and practice among elderly people living at home.

OBJECTIVE: To assess the food storage knowledge and practice of elderly people living at home. METHODS: Three phase survey data collection: face to face interviews; dietary diaries with a food frequency questionnaire; and follow up interviews. SETTING: Urban Nottingham. PARTICIPANTS: 809 elderly people (aged 65+) randomly selected from general practitioner lists. MAIN OUTCOME MEASURES: Respondent's refrigerator temperature; knowledge of freezer star rating; understanding of "use by" and "sell by" dates; reported ability to read food product safety labels. RESULTS: From a weighted total of 645 refrigerators measured, 451 (70%) were too warm for the safe storage of food (> or = 6 degrees Celsius). Only 41% of respondents (n = 279) knew the star rating of their freezer. Within a smaller sub-sample knowledge of the "use by" and "sell by" dates was good, but 45% of these respondents reported difficulty reading food labels. The storage of foods at inappropriate temperatures was not independent of socioeconomic or demographic status, and tended to be more likely among the poorer and those not living alone. CONCLUSIONS: Food storage practices among the majority of elderly people interviewed in this study do not meet recommended safety standards to minimise the risk of food poisoning.

Fruit and vegetable consumption in later life.

OBJECTIVE: to assess levels of fruit and vegetable consumption in elderly people, and to examine the socio-economic, physical and psychological factors which influence this consumption. METHODS: a three-phase survey: face to face interviews; self-completed dietary diaries with a food frequency questionnaire; and follow-up face-to-face interviews. PARTICIPANTS: 445 elderly people (aged 65+) randomly selected from general practitioner lists in urban Nottingham and rural Nottinghamshire, Lincolnshire and Leicestershire. RESULTS: the recommended target of five portions of fruit and vegetables a day was achieved by less than half the respondents: 37% of those living in the urban area and 51% of those living in the rural area. Low fruit and vegetable consumption was particularly associated with being male, smoking and having low levels of social engagement. CONCLUSIONS: most elderly people consume less than the recommended levels of fruit and vegetables. Health programmes promoting fruit and vegetable consumption may not be successfully reaching elderly people and need to target those particularly at risk of low consumption.

The interaction of physical, psychological, socioeconomic and sociodemographic variables on the Body Mass Index (MINDEX) of the community-dwelling elderly.

Two cohorts of older people 65-74, and 75 or more years of age living at home in Nottingham or in a nearby rural area in the UK were interviewed and anthropometric measurements were taken (n=1037). Bivariate analyses showed significant relationships between mindex and variables previously associated with food choice. Those with a mindex above the 95th percentile were more likely to live in a rural area, and were less likely to smoke than those between the 5th and 95th percentiles. Those with a low mindex, below the 5th percentile, were more likely to smoke than those between the 5th and 95th percentiles (45% compared to 17%), and were also more likely to live in an urban area, to have difficulty carrying shopping bags, not to use a car for shopping, to have a poorer appetite, and to live alone. Those overweight and underweight had lower levels of social engagement and were more likely to be of a lower social class. In multivariate analysis, socioeconomic variables and psychosocial variables were not significantly associated with mindex, when controlling for physical and sociodemographic variables. Advancing age, female gender, smoking and decreased appetite were significantly associated with decreased mindex (Adjusted R2 = .168).