Healthy food is everywhere, so why we don't eat healthy?

The lack of fresh food and produce is certainly not something we can complain about in Malaysia (although the prices are another matter altogether), with our supermarkets, hypermarkets, wet markets, pasar malam (night market), pasar tani (farmer's market), and even, food trucks selling fresh meat.

So, the concept of the "food desert" might be a bit foreign to us.

University of Cambridge, United Kingdom, Centre for Diet and Physical Activity Research (Cedar) Social, Economic and Neighbourhood Determinants of Diet programme lead Dr Pablo Monsivais explains: "There was some research in the '90s in the UK that said that lack of access to fresh, healthy, affordable food was partly to blame for the unhealthy eating habits in Britain, and they got this idea going about food deserts.

"That idea was born in England, then it spread, and is now a global phenomenon."

This concept is particularly popular in the United States, where it really caught on about 10 years ago.

The underpinning assumption behind this concept is that people typically shop for groceries within their own neighbourhoods.

However, Dr Monsivais notes: "The connection between neighbourhoods and our behaviour isn't actually that strong.

"Because most of the things that are related to how we eat and our health are measurable at a personal level."

Based on his research, he says that he can tell a lot about what a person eats just from their age, gender, ethnicity, relationship or family status, income and education level.

"If I know what neighbourhood you live in, I can add a little bit more information to that story, but it's a very small part, and that makes sense because our individual characteristics are so important in dominating how we behave, including how we eat," he adds.

No desert here

Cedar Dietary Behaviours and Public Health Interventions lead Prof Dr Martin White agrees, saying that his own research has shown that food deserts, which are commonly associated with poorer areas, are a fallacy in the UK.

"So, we were able to show that this was absolutely, categorically not true.

"We showed, in fact, quite the opposite in Newcastle, which is a fairly typical British city; that in the poorer areas, there were more supermarkets and more smaller shops selling fresh fruit and vegetables," he says.

Another finding for the survey Prof White led for the UK Food Standards Agency (FSA) beginning in 2000, was that most people generally did not shop in their local neighbourhood.

"Most people (64 per cent) got into their car and went to their chosen supermarket to do their shopping about once a week.

"And they tended to do that when they were doing other things.

"So, if they had gone to take their kids to school or collect the kids from school, they go to the supermarket on the way - after all, why would you want to make an extra trip?

"If you were going to work or coming back from work, you would tend go to a supermarket on the way for the same reason.

"So, this pattern emerged that people did shopping to fit in their life, and so, the supermarket might be five miles (eight kilometres) from their home, but that made sense because they work seven miles (11km) from home and that was on the way," he says.

In the final report to the FSA in 2004, the researchers wrote: "Our findings suggest that the key predictors of healthy eating are primarily dietary knowledge, relative affluence and a 'healthy' lifestyle, so we must question whether those people whose diet is 'less healthy' than desirable would eat more healthily if supplied with improved retail provision."

Nevertheless, Dr Monsivais explains: "But the reason we care about it is because, in public health, we try to focus on factors that shape our health that are also modifiable.

"We can change the neighbourhood, but I can't go and change your gender, your age, or for that matter, your family composition.

"So, we want to focus on things that are changeable, and also, that affect everybody - neighbourhoods affect all of us, some more than others.

"And they are subject to intervention - we can shape how our neighbourhoods look and what they offer."

Money matters

As many Malaysians can testify to, especially in recent times, prices are certainly an important factor when it comes to choosing food.

Dr Monsivais observes that in general, diets that are richer in nutrition - i.e. containing fresh fruits and vegetables, fresh seafood, lean meats and dairy products, among others - can be up to 20 per cent to 60 per cent more expensive than less healthy diets in developed countries like the UK, US and France.

"We know that price is a big motivation for everybody, but it's a particularly big motivation for people of low socioeconomic status," he says.

"As a result, due to their financial situation, the price of food becomes the dominant influence on food choice.

"And when people try to economise on their food choices, what almost inevitably happens is that they are relegated to high-calorie foods that are quite cheap, and actually, pretty tasty, and oftentimes, very convenient as they don't require much in way of preparation."

Dr Monsivais explains that with industrialisation, we have created a food supply that is quite cheap overall, but is primarily based on a combination of grain, fat, sugar, and to a certain extent, animal protein.

"Of course, lean high-quality meat is not cheap, but you can get very cheap - for example - processed meat like sausages that are absolutely so cheap, and they become available to everybody," he says.

"Unfortunately, they are high in fat, high in salt and high in other unhealthy ingredients."

Avoiding conflict

An additional factor is the desire by women from lower socioeconomic groups - often the one solely responsible for feeding the family - to take the path of least resistance.

Says Dr Monsivais: "There was some fantastic work done 10-20 years ago trying to understand the motivations of low-income, really economically-constrained shoppers.

"And what they've found is that there's very little tolerance for risk, in the sense of buying any food that might not get eaten or that might be rejected by the children or the man of the house.

"Oftentimes, these women were working at least one job, plus caring for the family, doing the cleaning and cooking; and they didn't want to have to struggle.

"So they wanted to buy things that the kids would just eat and not put up a fuss about; they didn't want to have a fight about eating broccoli or anything that might be healthy, but the kids didn't want.

"They were basically avoiding any confrontation."

He notes that being persistent in presenting healthy foods that might get rejected initially is easier both financially and emotionally for parents who can afford to waste some food and who are not so exhausted by constantly struggling in life due to their better socioeconomic status.

"Low-income mothers can't afford to do that. They can't afford to buy food that their families won't eat and they don't want these struggles because they've got enough struggles.

"That's going to cause them to gravitate towards a lot of snack foods, a lot of ready meals, things that are cheap and easy, and nobody's going to fight about, and you won't throw anything away.

"So, even if a ready meal, in theory, is not as economical as making a big cauldron of lentil soup and eating that for a week - number one, who's going to make the soup, and number two, are the kids going to eat that soup?

"No they're not," he says.

Dr Monsivais notes that this is where a lot of theories about economy and thrift fall down, as there is the assumption that low-income people will tend to buy cheaper raw groceries than more expensive ready-meals.

"You've basically imposed lots of impositions on that family," he says.

No time to cook

Time is also another factor that is often neglected in research about access to healthy food.

"We've done some research in the US that has looked at timing," says Dr Monsivais.

"People know, for example, that if you can cook family, home-cooked meals, that that's correlated with a healthy diet."

In his study published in the September 2014 issue of the American Journal of Preventive Medicine, Dr Monsivais and his colleagues found that survey respondents who spent the most time (more than two hours a day) preparing food at home, ate more fruits, salads, vegetables and fruit juices than those who spent the least time (less than an hour a day) doing so.

The latter group was also 1.8 times more likely to visit fast-food outlets than the former.

He observes that time is something we seem to have less and less of.

"Even as we have more and more devices that are suppose to make our lives more efficient, we are kind of still strapped for time.

"And even for people who know better, who have money, who are motivated, often aren't necessarily making healthy choices because they don't have time.

"So, time is another factor that I think should be added to the discussion of why we, as a society, have gotten away from healthy eating."

Tan Shiow Chin was a 2015 Khazanah-Wolfson Press Fellow at Wolfson College, University of Cambridge. This article is part of a series from her fellowship project on the subconscious cues that influence us to eat more and unhealthily. Her next article will be on food in the wider context.