Thursday, 15 October 2015

Obesity: How neoliberalism made us fat

Posted by Ted Schrecker, Fuse Associate Member and Clare Bambra, Fuse Associate Director

A 2010 editorial in the Journal of the American Medical Association warned: “If left unchecked, overweight and obesity have the potential to rival smoking as a public health problem, potentially reversing the net benefit that declining smoking rates have had on the US population over the last 50 years”. Obesity increases the risk of developing cardiovascular disease (CVD), certain types of cancer, Type 2 diabetes, and orthopaedic problems. At the end of the 1970s it was estimated that 15% of US adults were obese. By 2012, this had more than doubled, to 35%. Among adolescents the increase is even more striking – from 5% at the end of the 1970s to 20% in 2012. In the UK, it is estimated that obesity nearly tripled between 1980 and 2002, from 6% amongst men and 8% amongst women to 23 percent and 25 percent women respectively. Amongst children in England, obesity has increased from 11% among boys and 12% among girls in 1995 to around 20% today.

In our book Neoliberal Epidemics: How Politics Makes Us Sick we argue that obesity in high–income countries is partly the result of political and economic choices made since the 1980s. Since the early 1980s, neoliberalism or “market fundamentalism” has dominated politics and economics across much of the globe, perhaps nowhere more conspicuously than in the post-Thatcher UK. Obesity is a neoliberal epidemic – one of four, along with austerity, stress, and inequality. They are neoliberal because they are associated with or exacerbated by the rise of neoliberal politics. They are epidemics because they are on such an international scale and have been transmitted so quickly across time and space that if they were a biological contagion they would be seen as of epidemic proportions.
North American contrasts between rich and poor urban areas, less than a mile from one another
Photo: T. Schrecker
Other high-income countries have also experienced increases in obesity. Obesity has no single cause; the many influences include changes in the food environment (including advertising, marketing, accessibility and affordability); the growth of sedentary work occupations and leisure time activity, such as television viewing; changing settlement patterns, notably the rise of a privatised approach to planning organised around driving rather than walking or the provision of public transportation; and changes in the built environment that reduce the safety and attractiveness of physical activity, especially for those who do not live in leafy places. However, countries that have gone farthest down the neoliberal road, the UK and the US in particular, have experienced greater increases in obesity – suggesting that neoliberalism has magnified and accelerated trends that are present to some extent throughout the high-income world.

Obesity is a neoliberal epidemic for several reasons. These include: (1) economic and social policies that have meant fewer people can afford a healthy and balanced diet; (2) increasing time poverty, as when the demands of work (often on unpredictable schedules), transportation, and (especially for women) child care within ‘flexible’ labour markets are combined, there is not much time or energy left for eating a healthy diet and the attraction of a quick stop at the shopping park’s fast food outlet are strong; (3) the role of aggressive corporate marketing of unhealthy, energy-dense foods, notably as multi-national supermarkets, manufacturers of ultra-processed food and fast food chains expand into developing economies with the lowering of barriers to foreign investment. This helps to explain why overweight and obesity are now also rising rapidly in many middle- and some low-income countries, with prevalence in Mexican adults comparable to levels in the United States.
Corporate food systems and time poverty interact at the shopping park.
Photo: T. Schrecker
A fourth connection was addressed at a groundbreaking workshop at the University of Oxford in 2009: political structures such as welfare state regimes. More specifically, higher levels of economic insecurity – associated with neoliberal policies like the rollback of welfare state protections and opening up labour markets to the “creative destruction” that Joseph Schumpeter extolled as a defining virtue of capitalism – are causally linked with a higher prevalence of obesity through both biological (stress-related) and psychosocial (comfort eating) mechanisms, in addition to the more direct effects on time and food budgets.

Public health researchers, who agree on little else, recognize that reducing overweight and obesity is a formidable challenge. A first step is to avoid the lifestyle trap. A recent literature review on policy interventions to tackle what has been called the obesogenic environment produced by the Scottish Collaboration for Public Health Research and Policy provides some useful directions. Its authors do not shrink from arguing the need for large-scale interventions that may be expensive or challenging to vested interests, noting (for example) that the transport mode split in urban areas is 84% by car versus 9 percent walking in the United States, while it’s 36% by car versus 39% walking in Sweden. “Suffice it to say, it has been a concerted combination of infrastructure provision, integrated transport planning and disincentives for private cars which has helped to bring about the higher active travel rates.” We have no easy solutions, but emphasise that neoliberalism and the associated political choices have exacerbated the obesity crisis. Obesity is an example of how politics makes us sick.

Links: Schrecker, T. and Bambra, C. (2015) Neoliberal Epidemics: How Politics Makes Us Sick, Palgrave Macmillan, available at:

Professors Schrecker and Bambra will be discussing their new book 'How Politics Makes Us Sick' at an event at Durham University on 15 October 2015. For more details click here.

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About the authors

In June 2013, Ted Schrecker moved from Canada to take up a position as Professor of Global Health Policy, Centre for Public Policy and Health, Durham University (UK). Since 2002, most of his research has focused on the implications of globalization for health; he also has long-standing interest in issues at the interface of science, ethics, law and public policy. A political scientist by background, Ted worked as a legislative researcher and consultant for many years before coming to the academic world, and co-edits the Journal of Public Health. Among his publications, he is editor of the Ashgate Research Companion to the Globalization of Health (2012) and co-editor of a four-volume collection of key sources in Global Health for the Sage Library of Health and Social Welfare (2011). Ted is also an Associate Member of Fuse. Ted can be followed on Twitter @ProfGlobHealth.

As well as being an Associate Director of Fuse, Clare Bambra PhD is Professor of Public Health Geography and Director of the Centre for Health and Inequalities Research, Durham University (UK). Her research focuses on the health effects of labour markets, health and welfare systems, as well as the role of public policies to reduce health inequalities. She has published extensively in the field of health inequalities including a book on Work, Worklessness and the Political Economy of Health (Oxford University Press, 2011). She contributed to the Marmot Reviews of Health Inequalities in England (2010) and Europe (2013); the US National Research Council Report on US Health in International Perspective (2013); a UK Parliamentary Labour Party Inquiry into international health systems (2013), as well as the Public Health England commissioned report on the health equity in the North of England: Due North (2014). She is a member of the British Labour Party and can be followed on Twitter @ProfBambra.

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