The inequities of soda

There’s a double digit gap in life expectancy between the richest and poorest Americans. Chronic diseases, such as diabetes, stroke and heart disease are more common and start earlier in poor communities. One of the key drivers of this inequity is diet quality.

And one of the hallmarks of an unhealthy diet is sugary drinks, which are clearly linked with a whole host of chronic diseases and obesity.

The pandemic has focused our attention to our personal and collective health like never before. The CDC advises that to better cope with the pandemic, good nutrition is essential; “Getting the right amount of nutritious food like plenty of fruits and vegetables, lean protein, and whole grains is important for health.” Access to good nutrition, however, is unequal.

The income connection

A new study set out to look at the relationship between income and sugary drinks consumption. 

The study analyzed data from more than 24,000 adults in the US, looking at health, income, wealth, diet and attitudes, year after year. This study is unique in its attention not just to income, but also to wealth, which is the accumulation of resources. 

The study finds that the number of sugary drinks people drink a week declines as income rises. This is also true for wealth, and even more pronounced. It finds that people in the richest 10 percent of families drink about 2.5 fewer sugary drinks a week than those in the poorest 10 percent. The link between income and sugary drink consumption holds even after you control for education, race, gender, and interest in nutrition.

The researchers then tried to see if a change in income and wealth changes sugary drink consumption. They had data of just 4 years for this part of the study, and in these 4 years they didn't see changes in sweet drink consumption as people moved up the income or wealth ladder. 

It seems like soda habits, once formed, don’t change much, or at least not that quickly.

Health disparities and soda

The inverse relationship between socioeconomic status and sugary drink intake may help illustrate some of the health disparities we see, now more than ever, with Covid-19.

Healthy diet patterns depend on access, cost, as well as the ability to cook. Disparities in diet quality are driven by how cheap and easy it is to consume fast and highly processed foods, and how much harder it is to purchase and prepare meals from whole, fresh foods.

But when it comes to drinks, the least expensive and most accessible option is available to most of us. Sugary drinks are an unhealthy alternative to plain water -- they’re no more than an unexamined habit, instilled in us through clever marketing, wide accessibility and our innate fondness of sweet food. 

What makes it even more unfair is that soda marketing is specifically targeted towards people already suffering from higher risk of disease. Lower income neighborhoods have more outdoor ads such as billboards and bus shelter signs featuring soda and junk food, African American kids see more TV ads promoting sugary drinks, and disproportionate soda ad money is targeted at Spanish language media. 

The health disparities in nutrition and obesity correlate with the racial and ethnic disparities in Covid-19, according to a recent perspective in the New England Journal of Medicine. Improving access to better food is imperative, but isn’t easy; removing the drivers of the soda habit, especially in the most vulnerable communities, is just the decent thing to do.

Dr. Ayala