Health advice says we should exercise, sleep more and eat better. But it’s not an option for all of us
Every day we’re bombarded with stories telling us how to live our healthiest lives. We’re told we should sleep seven to nine hours each night, eat plenty of fruit and vegetables, exercise regularly, drink lots of water and avoid alcohol.
It’s a lot to take in. And even though it might be based on the best possible science and medical advice, for some Australians, the guidance can actually be unhelpful — or just plain unrealistic.
If you’re a shift worker, or if you work multiple jobs, getting a solid eight hours of sleep every night isn’t just something you can choose to do.
If you struggle to fit in time to exercise between work and family commitments, and a gym membership is too expensive, working out can be really hard to do.
And if you aren’t able to afford or access quality fruit and vegetables for your meals, it can be deflating and isolating to read advice that assumes you can.
Often well-meaning advice from doctors and experts can miss the mark, because it assumes we all have the option to just get more sleep, exercise more and eat healthier food.
“When you experience severe hardship, the last thing you are thinking about is health. Your primary concern is survival. It sounds counterintuitive but survival and leading a healthy life are almost opposing things,” says Liz Allen, a demographer at ANU.
It’s not just about choices
Dr Allen speaks from experience. Her childhood was marked by trauma and abuse, and it became too difficult to live at home. She was homeless at 16, and had her first child at 17.
Over many years, and with great difficulty, she carved out a new life for herself through education.
The experience of hardship, she says, is like dealing with a “constant panic attack”.The lessons of overcoming disadvantageI’ve overcome extreme trauma, poverty and disadvantage. For Australia to ever be truly equal, we need to learn from stories like mine.Read more
You are constantly worrying about how you are going to pay for your rent, heat your house or keep your child in clean clothes at school without a washing machine, she says.
You aren’t even entertaining the idea of going for a jog, and if you are, it might not be safe to run on the streets of your neighbourhood. You sleep if — and when — you can get it.
Your food choices are determined by what you can afford, not what you want, or what’s best for you.
“A lot of people will say, it’s about choices: that people in poorer situations make poorer choices. That’s not the case,” Dr Allen says.
“They have fewer and more constrained opportunities by sheer fact of the resources that are available to them.”
What disadvantage does to your health
Data from the Australian Bureau of Statistics’ (ABS) National Health Survey shows that those who live in the most disadvantaged areas of Australia are more likely to be overweight, more likely to smoke, less likely to get exercise, more likely to have cancer and more likely to report high levels of psychological distress.
Over a lifetime, the consequence is stark: disadvantaged people simply die younger. One study found the life expectancy of the most socioeconomically disadvantaged men in New South Wales was 3.8 years less than that of the most advantaged.Australia’s ‘food deserts’Public health experts begin mapping Australia’s so-called “food deserts” and find the consequences for the people who live in them are extremely serious.Read more
For Indigenous Australians, the gap is even bigger.
Data from the ABS shows Indigenous men have a life expectancy at birth 10.6 years less than non-Indigenous men. For women, the gap is 9.5 years.
One factor is access to healthy food. Many Australians live in “food deserts”: areas where it is unreasonably expensive — or simply impossible — to buy fresh and healthy food.
“Access to food and resources are compromised by the sheer fact of where we live and that idea of the tyranny of distance,” Dr Allen says.
“Lettuces are frozen and taken to some communities in the Northern Territory. Imagine eating a frozen or a thawed lettuce? It’s disgusting, and you pay $30 for that opportunity.”
When it comes to inequality in health, it’s not just about the gaps between the haves and have-nots.
There’s a “social gradient” that affects our outcomes: those in the middle will be a little bit better off than those below them, and a little bit worse off than those above them, says Sharon Friel, professor of health equity at the Australian National University.
“The health of people in lower-income households over time has improved, as it has in higher income households,” she says.
“Yes, all the boats rise, but not all boats rise equally.”
Why it’s harder to stay healthy as a shift worker
Even if you are financially comfortable, there can be other barriers to health.
In 2015, almost 2 million Australians worked shifts, according to the ABS, which has been linked to increased risk of diabetes, heart problems and stroke.
Rose Gaumann, 29, loves her job managing a bar in Melbourne’s inner suburbs. But, like many shift workers, she finds getting a good night’s sleep difficult.
“You’re in a constant state of trying to play catch up,” she says.
“I find I’ll go through stages where I’m only sleeping five hours at night, and then I’ll attempt to sleep for 12 hours on a day off, but then you end up overtired.”Surviving shift workThe world doesn’t stop, so neither does the work. Here are some tips to try to help you survive and maybe thrive in the world of shift work.Read more
It’s also harder to eat well when you’re out of sync with the rest of the world.
“I would come home and eat at 4:00am in the morning. It’s hard to manage weight fluctuation and … you also end up eating a lot of really shitty food,” Rose says.
“In terms of the mainstream health advice — getting up early, eating breakfast, and doing some exercise each day — you just can’t look at it, because it’s not applicable.
“All you can do is try to find a routine and stick to it.”
Towards more inclusive health advice
The issue isn’t that people don’t know about the benefits of healthy living. It’s more that, with everything else going on in their lives it falls by the wayside, says Professor Friel.
“We’ve done a whole lot of work with lower socioeconomic households around healthy eating. Of course, they know they should be eating healthily and feeding their family healthy food, but they’re operating in this cacophony of environments that just make it very difficult to do that,” she says.
“I think that needs to be addressed if we don’t want to do harm to people. They’ve got conflicting things coming at them: there’s the advice to do all of this stuff that’s important for health, and then their everyday life is being shaped by structures that make it really problematic to follow that advice.”Inside the class divideDepending on who you ask, class is a major barrier to social mobility — or it scarcely exists.Read more
When health advice isn’t inclusive, it risks reinforcing inequality rather than reducing it, Dr Allen says.
“It’s almost as if the way that society is built is to service those on the higher rungs, while keeping those on the lower rungs down,” she says.
“We’re told to be healthy, to lead a healthy life, not now but also into the future, you should sleep an adequate amount, exercise an adequate amount and eat the right foods … but there are all these barriers that are faced by people who experience hardship.
“[What] if you’re working multiple jobs and you’re up at night worrying about how you’re going to pay the $5 for your child’s school excursion?
“Or how you’re going to feed your family for the next fortnight until you get paid?
“You’re not going to sleep eight hours.”