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Abstract
Rising attention to the ‘social determinants of health’ puts questions of gender and class squarely on the public health agenda. Most health outcomes and health risk factors are inversely correlated with social class: people with better education, better jobs and higher incomes typically enjoy better health. By comparison, gender differences in health are quite variable, depending on the health outcome or risk of interest. Furthermore, the distribution of any given risk factor tends to vary from society to society, from time to time, and between specific sub-populations. Public health research rarely considers class and gender together. In this paper we summarise and problematise the interplay between gender and class in empirical research on the ‘problem’ of obesity. We suggest that some of the difficulties in explaining research findings arise from limitations in the evidence base used to measure obesity, conceptual ‘slippage’ between key terms like gender and sex, and an erasure of social class from academic language. It is via an examination of these issues that underpin current obesity research that we offer more innovative and effective ways to approach the underlying theoretical and health promotion problems. Nevertheless, we acknowledge the considerable practical and intellectual challenges of analysing and reporting social determinants like gender and class in an environment that demands certain kinds of scientific evidence.
Notes
The authors thank the Life Course & Intergenerational Health Research Group (LIGHt), Discipline of Obstetrics and Gynaecology, and the Robinson Institute, University of Adelaide for their generous financial support at AWGSA. We also acknowledge the participation of Dr Michelle Jones in the AWGSA key note panel. Finally, we express our appreciation to an anonymous AFS reviewer and to the Editor of this Special Issue, Professor Margie Ripper, for thoughtful feedback on an earlier draft.
1. Parallel discourses were also evident in which fatness was discredited (Monaghan and Hardey Citation2009).
2. Similar shifts appeared in the distribution of cigarette smoking over the twentieth century. Adopted first by men and later by women, smoking was initially a habit for elites which was gradually democratised when mass production and rising demand lowered tobacco prices. As the health hazards became more widely documented, more educated people quit first, and the gradient—initially direct—reversed and now the majority of smokers, like people who are obese, are of lower SES (Broom Citation2008).
3. Rates are almost twice as high amongst Indigenous Australians as among non-Indigenous people (AIHW 2003b).
4. Weight in kilograms (kg) divided by height in meters (m) squared; the criterion for obesity is BMI > 30.
5. For children, a different internationally recognised method of measurement is used to measure BMI, one that takes account for changes to growing bodies and is age and gender specific (Cole et al. Citation2000, Citation2007).
6. In a more recent paper Evans et al. (2011) suggest that the animated figures and accompanying Department of Health documents used in the Change4Life social marketing campaign are part of a much broader public health discourse which aims to refigure ‘familial relations to fit an ideal classed and gendered model’ (2011, 332). This discourse they argue, serves to mask the ideological blaming for obesity directed at working-class mothers and ethnic minority families.
7. Race and ethnicity (including birthplace, religion and culture) are additional dimensions on which health is often systematically patterned, with social minority status a common correlate of elevated health risk. An exception to this generalisation is the ‘healthy migrant effect’ in which some foreign-born people enjoy an initial health advantage from their country of origin. (This does not apply to refugee populations or survivors of torture and trauma, whose health disadvantages are likely to arrive with them.)
8. Historical research suggests early concern about the potential obesogenic effects of becoming an ‘organisation man’ (Berrett Citation1997).
9. A recent Canadian study by Simen-Kapeu and Veugelers (Citation2010) reports that boys were more physically active than the girls, and their diets were higher in fats. These authors conclude that public health interventions aimed at childhood overweight and obesity should be gender focused.