Austerity

The politics of austerity have been deleterious to the many, and the most vulnerable young people in society inevitably find themselves in the most hostile of environments. Local authority funding for children and young people’s services fell by £3 billion between 2010/2011 and 2017/2018; this represents a 29% reduction, with the most deprived areas experiencing the greatest cuts. Regional variations are stark, with the North East showing the steepest decline and the South East the smallest (34% vs 22%).1

Despite free childcare funding for children aged 3–4 years old being introduced, any positive gain is likely to have been negated by the extensive closure of Sure Start children’s centres, with well over 500 of these being shut down. England now spends only 0.8% of gross domestic product on childcare.1 Children’s services have been disproportionately targeted by the austerity agenda. A function of Sure Start children’s centres was to provide nutritional advice to parents and promote physical activity in the young. It is not difficult to imagine that their closure may be implicated in rising obesity in the poorest children, although more research is needed to explore this further. Principally, they helped in reducing the wider economic disparities associated with obesity. Protecting investment in early years services was a key recommendation of the Marmot Report aimed at reducing health inequalities, but largely ignored by the government.1

Austerity has a damaging effect on families. This is highlighted by the issue of in-work poverty. While more people are in employment presently, compared with 2010, wages are only £5 a week higher presently than they were in 2010. This is against a background of generally low wages, diminishing levels of benefits with the roll-out of universal credit and the increasing cost of living. Work is no longer a route towards adequate subsistence, and even in two-parent families where only one of the parents is not working or is only working part time, there are 1.6 million children living in poverty.1 It is likely that the COVID-19 crisis will lead to an unprecedented rise in unemployment in the coming months, further exacerbating the current levels of inequality and wealth disparity.

The obesogenic environment

The infrastructure and urban layout of deprived neighbourhoods are recognised as being more obesogenic compared with affluent neighbourhoods. Fast-food outlets proliferate in poorer areas, with convenience and peer influence as well as taste being major factors for fast-food consumption in school-aged children.1 4 Exercise is clearly implicated in obesity, with higher energy expenditure reducing caloric surplus relative to activity and therefore preventing adiposity. A lack of playgrounds and suitable greenspaces in deprived areas to encourage physical activity is further associated with childhood obesity.4

Conversely, for children from wealthier, more affluent areas there is evidence that they benefit from an environment that promotes physical activity. A less aesthetic environment (lack of open spaces, presence of littering and graffiti) prompts parents to perceive the neighbourhood as less safe and therefore place restrictions on outdoor physical activity.5 Increased indoor time as a consequence is often sedentary in nature. This is further driven by housing factors, with smaller, more densely packed houses lacking in gardens.5 During national ‘lockdowns’ to control the spread of coronavirus, it is likely that increased indoor sedentary time and reduction in outdoor physical activity will disproportionately apply to deprived children.

Emerging food exclusivity

The WHO identifies energy-dense, nutrient-poor foods that are high in fat, sugar and salt as contributing to the risk of chronic diseases.6 Dietary patterns and food choices are drivers of obesity in childhood. The problem is largely the unavailability of choice rather than making innately unhealthy choices. Healthier food choices are less available to the poorer within society. Between 2002 and 2012, the cost of 1000 calories’ worth of healthy foods rose from £5.65 to £7.49, while in contrast unhealthy foods with the same energy value cost only £2.50.6 Economic constraints on food choices derive from lower wages, unemployment and increasing housing costs.1 6 The European Union’s common agricultural policy intervenes in food markets to subsidise grains, dairy products, oils and sugar, a measure that has undermined public health initiatives.6 The reduced spending power of parents on healthy foods is not only deleterious to the health of children from poor families but exacerbates the risk of obesity.6 In the UK, a constrained family budget is associated with higher intake of high-energy, low-nutrient food.2 While eating behaviour is a complex phenomenon influenced by biophysiological, psychosocial and socioeconomic factors, it appears that economic constraint is dominant in governing unhealthy food choice in families.2

Tackling obesity, reducing poverty: policy agenda

To talk of ‘British society’ wrongly implies the existence of a homogenous entity and is inconsistent with the wide variation in socioeconomic status.1 Children from the most deprived backgrounds navigate a very different world, compared with their more affluent peers. Treating the disease of poverty should be a paramount public health priority. The government must be prepared to invest in tackling gross inequalities if it is to both alleviate the obesity crisis and ease the mounting pressure on the National Health Service from its consequences. An evidence-based ‘whole system’ policy agenda needs to be established (table 1) if promises of ‘levelling up’ are to be given substance.