This chapter examines work on inequalities in food and nutrition in the UK since the late 1990s, looking at how problems have been constructed and measured, responses by government and civil society, and future challenges. It begins by summarising data on social inequalities in food and nutritional intakes and outcomes, focusing largely on income and occupationally based inequalities, and outlines why these outcomes are thought to occur. The relationship with health, and particularly health inequalities, is briefly discussed. The location of the Acheson Inquiry within the food and nutrition policy context of the time, and developments since, are discussed in terms of their potential effectiveness and relevance to reducing inequalities. The chapter concludes with an outline of contemporary anxieties and activities in relation to inequalities in food and nutrition.

Inequalities in food and nutrition

It has long been recognised that food patterns, nutrient intakes and physical outcomes of growth and attained body size vary by indicators of social and economic conditions. People who are better off are more likely to eat more healthily than those who are poorer, although the size of differences between classes varies by country (Roos et al, 1999; Dowler, 2001; Drewnowski and Specter, 2004) and may be attenuating over time (Crotty and Germov, 2004).

In the UK, differentials in household or individual dietary patterns, nutrient intake and blood levels by various socioeconomic indicators have been observed in the annual national surveys of household intakes (published by the Ministry for Agriculture, Fisheries and Food until 2000, now by Defra, the Department for Environment, Food and Rural Affairs), and in regular national surveys of individual intakes (Gregory et al, 1995; Finch, 1998; Gregory, 2000; Hoare et al, 2004). Intakes of vitamins, minerals and dietary fibre, and consumption of vegetables and (especially) fruit, are much lower (and for nutrients, further below Reference Nutrient Intakes) and consumption of white bread, processed meats and sugar are higher in households whose members are poorer than in those whose members are more affluent (Dowler et al, 2001a). (The further a group's nutrient intake is from the reference level, the more likely it is that some members of the group have inadequate intakes that contribute to poor functioning and ill health.) The differentials are true for all age groups and geographical regions, and, in contrast with other rich industrialised countries, worsened during the 1980s and 1990s.