Tuesday, December 12, 2006

The Public Health Approach to Reduce the Risk of Cancer by Promoting an Organic Diet Risks Increasing Disparities in Health - Elizabeth Kenny

Encouraging an organic diet is one of the hot campaigns in public health’s nutrition sector. California Department of Health Services’ Harvest of the Month campaign along with it’s support of a University of California Davis program educating local high schools on the benefits associated with eating natural whole foods are all promoting an organic diet. One major player in the organic food diet initiative is called Campaign for Better Health, an organization established to prevent poor health through promoting a natural diet. However, by affecting higher income individuals, Campaign for Better Health’s campaign efforts to increase people’s organic food intake neglects addressing how it is contributing to the established separation in health status between economic groups in the U.S. Higher income or education increased the likelihood of being in good health while people with lower income and education suffer a higher prevalence in poor health and report unmet health care needs (CDC’s National Center for Health Services).

Campaign for Better Health’s approach is reaching only those in a higher economic level population and increasing the existing state of socioeconomic disparities in U.S. health as it only applies to those who can afford it financially. The organization is marketing its campaign to change people’s behavior to adopt an all-organic diet by promising better overall health and a reduction in cancer risk. From McDonalds to Whole Foods Market, consumers are pressured to spend more on high price organic food items to assure better health. The majority of the public, however, is at a disadvantage for they simply do not have the means to adopt the campaigned lifestyle change.

The prominent health disparity between higher and lower socioeconomic groups continues to grow. Studies reflect a drastic difference between socioeconomic levels and mortality and morbidity rates. Evidence suggests that people belonging to lower socioeconomic groups (below the poverty level) face lower survival rates for chronic disease and experience an increase in heart disease and obesity compared to those in the higher economic groups (Haan, Kaplan & Camacho 1987). In fact, because the divide is so evident and an obvious problem in the public health community, Healthy People 2010 includes “eliminating health disparities” among on of two overarching goals, the other being to “increase quality and years of healthy life” (Healthy People 2010, 2006). So why would CBH neglect to address the exact target population prone to heart disease, a disease directly correlated to diet?

One of the key factors in the campaign’s contribution to increasing the gap is its lacking communication strategy. The Campaign for Better Health is guilty of limiting its exposure and promoting a diet that calls for food advertised in such obscure outlets, consequently reaching only a subset of the population. CBH and organic food is primarily advertised in high price magazines such as Natural Health, Organic Living, and Yoga. One of CBH’s founders and primary advertising source is one such magazine, Total Health Magazine. Using this mass communication outlet to promote the benefits of eating organic already jeopardizes reaching the vast majority of the public by inhibiting overall exposure to the ads. Most lower income individuals do not have the opportunity to purchase the magazines since they are mostly located in natural food markets, alternative medicine care facilities, co-ops and bookstores, found in few if not any lower class neighborhoods. If the magazines were sold in convenient stores, Wal-Mart or markets located in lower income neighborhoods where this population shops, more people would be aware of the health campaign and learn the advantages of incorporating natural food in their diet.

However, lower income individuals do not have the luxury of shopping at Whole Foods Market, Wild Oats Market, or natural food co-ops. Nor do the poor customarily spend out-of-pocket medical costs to visit chiropractors and alternative medicine doctors, where such advertisements are located, which presents a second problem in the campaign. Limited access to organic food markets is a huge obstacle for lower income shoppers to cross. Finding time to shop bestows a large enough burden on a single working mom for example, therefore finding the time and means of transportation to shop at an organic food market outside the neighborhood poses an even greater challenge. She not only has to find time to travel there, but also spend more money on transportation costs.

An additional aspect of an organic diet the campaign neglects to recognize as a challenge for lower income individuals is the actual shelf life of organic produce. It is much shorter compared to non-organic fruits and vegetables. Because the produce is not sprayed with chemicals to prolong its life, organic produce last for only a few short days. Thus, shoppers must purchase the produce more frequently. If lower income individuals are already facing time constraints to shop on occasion, how can they be expected to allocate the time and money to visit organic food markets more frequently? The costs and available access associated with non-organic food is taxing enough for low-income individuals who are attempting to follow a healthier lifestyle.

For this population to even consider following the now infamous 5 A Day Program, which is a proven failure (Siegal, 2006), is ludicrous. The campaign attempts to ameliorate US Americans heart disease health crisis by promoting to incorporate a minimum of five fruits and vegetables a day in one’s diet. However, results show weak associations between awareness of the 5 A Day Program and fruit and vegetable intake. Also, program evaluation recommendations include “rethink its channel –use strategy, with particular focus on new media, tailored communications, and now media channels may be used as part of a collective approach to reaching lower socioeconomic groups and the disadvantaged,” (National Cancer Institute). If the 5 A Day Program fails for reasons related to awareness, high cost and limited access to fruits and vegetables in lower class neighborhoods, it is hard to imagine that a campaign promoting “5 Organic A Day,” both more expensive with even less accessibility, will be successful.

This is of course assuming the general population is even prepared to make such a change in behavior. Incorporating the transtheoretical model to support how the organic food campaign increases socioeconomic disparities in health, it is demonstrated that lower income individuals are at a disadvantage when considering changing diet behaviors. The model is based on the stages of change individuals move through to make a change in behavior. “The core constructs, around which the other dimensions are organized, are the stages of change. They represent ordered categories along a continuum of motivation readiness to change a problem behavior” (CPRC, 2006). The five stages are precontemplation, contemplation, preparation, action and maintenance. If an individual is not ready to advance to the next change, they are restricted from changing his/her behavior. The model also incorporates a series of intervening variables that include physiological, environmental, cultural, physiological variables and socioeconomic factors.

The socioeconomic intervening variable is the primary barrier restricting lower income individuals from advancing out of the first stage, precontemplation. Individuals in this group, compared to higher socioeconomic groups, do not share similar experiences which influence change- CBH messages, 5 A Day Program information, access to purchase organic produce, etc.

Precontemplation is when there is no intention to change a behavior in the near future for the simple reason that the individual is unaware of the problem. People must at least have access to organic food or be informed of its benefits to consider making behavior changes. Lower income populations are not even aware of the benefits encompassed in the diet change let alone the financial means to support it. When public health approaches limit access to their intended message, only those receiving the messages are in the position to contemplate altering eating behaviors. In this particular issue, lower income populations will not even consider the change, preventing them from advancing out of the transtheoretical model’s first stage.

Campaign for Better Health’s mission is to change people’s diet to include more organic, which means individuals must reach the fifth stage, maintenance, in order to benefit from the changed behavior. Eating an organic food based diet is believed to reduce the risk of cancer by eliminating cancer-causing agents found in non-organic food. Therefore, the campaign’s effort to promote this change fails because not all socioeconomic groups are given the opportunity to reach maintenance.

Campaign for Better Health is irresponsible and an unsuccessful public health approach for it excludes a portion of the population in which it is intended to aid. Thus, the organic food campaign for better health increases racial disparities in health and must re-evaluate its method of campaigning. A simple suggestion is to either financially support organic farming to reduce market price making organic produce an affordable option for all, or refrain from pushing an organic diet until the organic food industry develops further. Reduced shelf life is still a chief constraint prohibiting lower economic class people from choosing organic produce, calling for better natural preservative farming strategies. Public health approaches for better health must first reconsider modifying the US population’s overall traditional (non-organic) diet before attempting to add costs on top of change, a strenuous enough task on its own.


Haan, M., Kaplan, George, & Camacho, T. Poverty and Health. American Journal of Epidemiology, 125, 989-998.
Siegal, M. (2006) Session 7-Socioeconomic Disparities in Health. Social and Behavioral Sciences for Public Heath class. Boston University School of Public Health.
CDC’s National Center for Health Services ttp://www.cdc.gov/nchs/pressroom/98news/huspr98.htm
National Cancer Institute http://cancercontrol.cancer.gov/5ad_exec.html


Blogger Michael Siegel said...

This is an important paper because it shows how public health approaches intended to address one public health goal (promoting healthier diets) may actually undermine other goals (reducing health disparities). Public health practitioners need to think about the implications of their interventions for either reducing or enhancing health disparities. I hope this critique is seen by many public health practitioners and that it stimulates more consideration of this important issue.

5:16 PM  
Anonymous Anonymous said...

Right on! For two years I was a nanny in Newton and had to drive 20 minutes to get to a non-designer food market, though I had 3 Whole Foods within a mile radius of me. I loved the nutritional stuuf, but I could not afford to buy my fruits and vegetables toxin-free. It sucked. -Heidi

9:18 AM  

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