In a wealthy country like Germany, can everyone get enough healthy food? It’s not that simple. Income, education and employment are closely linked to health.
The concept of “food poverty” refers to the structural relationships between socioeconomic status, diet and health. Regular surveys on this topic are lacking in Germany, as access to food is regarded as relatively secure. The supply of food has never been greater, food prices have never been lower, and expenditure on food as a proportion of total consumption by private households has never been smaller.
The constitutionally guaranteed basic security system is supposed to enable everyone to participate in society. Under these circumstances, if someone eats poorly, this must be the result of a lack of information, ability or other priorities. At least, that is the usual assumption in public discussion.
But social epidemiological research points at the major influence that structural and material conditions can have on behaviour related to nutrition and health. Factors such as the amount of income that the household has at its disposal, the relative price of food, and housing, work and living conditions have a big influence on people’s nutrition and health behaviour – and that is especially true for households with little money at their disposal. The Robert Koch Institute, the government organization responsible for disease prevention and control, calculates that a woman in the highest income bracket can expect to live 8.4 years longer than one in the lowest bracket. For men, the figure is 10.8 years.
Poverty is a health risk. Someone is regarded as at risk of poverty if their income is less than 60 percent of the national median. In March 2020, 6.48 million people in Germany lived off unemployment or Hartz-IV social security benefits, including 1.87 million children and young people. For adults living alone, the basic monthly benefit in 2020 was 432 euros. That included a food allowance of 150 euros a month, or about 5 euros a day. To make ends meet, poor households tend to buy less food, or food of low quality.
The relationship between food prices and their energy density or nutritional value is little studied in Germany. But research in other wealthy countries show that energy-rich foods high in starch or sugar are relatively cheap compared to healthier fare such as fruits and vegetables, fish or lean meat. Soft drinks, bread, pasta and pizza contain a lot of calories per euro, while fruit and vegetables are relatively expensive. In terms of calorie content, only fats and sugar are cheaper than starchy staples in affluent countries.
Research shows that poor households have a significantly smaller variety of foodstuffs than wealthier households, and that they prefer cheap, filling foods over fruit and vegetables. A total of 11 percent of German households in the lowest income groups say that they cannot afford a full meal every other day.
Qualitative studies of nutrition behaviour of poor households, such as one undertaken in the central German city of Giessen, point to financial bottlenecks – mainly at the end of the month – when there is not enough money to pay for a healthy diet. At such times, people have to stretch their budgets or tighten their belts, so they end up with very monotonous meals. Some talk about having to go hungry.
These findings are in line with the first studies of clients of the food banks that are becoming increasingly common in Germany. The food banks distribute unsellable, donated food to needy people in return for a small contribution towards their expenses. In 2019, 1.65 million people took advantage of such services. Most were people who were living off basic social security, followed by pensioners and asylum seekers.
In a single year from 2018 to 2019, the number of food-bank clients rose by 10 percent. Half of the 1,033 clients who were questioned in one study said that they could not afford a healthy, nutritious diet. Around 60 percent mentioned they had an unhealthy diet, and around 10 percent reported that they had gone without any food at all at least once in the previous 12 months because they did not have enough money.
Nutrition is important not just for a person’s health. It also has social and cultural functions. Living in poverty can limit people’s ability to participate in everyday routines such as visiting restaurants or canteens or sharing a family meal. This may restrict their involvement in social networks. Children and young people especially suffer from the psychological impacts, such as low self-esteem and limited appreciation of others.