The Influence of Socioeconomic and Environmental Determinants on Health and Obesity: A West Virginia Case Study

Abstract

A recursive system of ordered self assessed health together with BRFSS data were used to investigate health and obesity in the Appalachian state of West Virginia. Implications of unobserved heterogeneity and endogeneity of lifestyle outcomes on health were investigated. Obesity was found to be an endogenous lifestyle outcome associated with impaired health status. Risk of obesity is found to increase at a decreasing rate with per capita income and age. Intervention measures which stimulate human capital development, diet-disease knowledge and careful land use planning may improve health and obesity outcomes in Appalachia in particular and rural America in general.

Individual, Social, Economic, and Environmental Model: A Paradigm Shift for Obesity Prevention

“…Obesity could also be a result of market failure [28,60]. Like environmental pollution, it imposes an external cost to society so that public intervention to control obesity is justified.…”

“…Like environmental pollution, it imposes an external cost to society so that public intervention to control obesity is justified. In order to reduce the consumption of unhealthy foods, it has been suggested that foods high in calories, fat, or sugar be taxed and that healthy foods such as fruits and vegetables be subsidized [28,61]. A steep tax would probably reduce consumption of taxed foods and could be used to generate funding to subsidize healthful foods; although it was found that fruit and vegetable subsidies were more likely to increase sales, there were mixed opinions on the feasibility and desirability of a steep "junk food" tax [62].…”

“…On the other hand, low-income consumers within rich nations consume lower-quality diets than higherincome consumers [26]. Evidence shows that the highest rates of obesity are among population groups with the highest poverty rates and the least education [28]. Moreover, an inverse relationship was observed between the energy density, mega joule per kilogram (MJ/kg), and energy cost ($/MJ), such that energy-dense foods composed of refined grains, added sugars, or fats become a low-cost option for the consumer [26].…”

“…Therefore, the selection of energy dense foods by food insecure, low-income consumers may represent a deliberate strategy to save money. Also, poverty and food insecurity are associated with lower food expenditures, low fruit and vegetable consumption, and lower-quality diets [26,28]. Food insecurity, which is defined as limited or uncertain availability of nutritionally acceptable safe foods, appears to be linked with obesity, with women and young girls who received food stamp benefits are also more likely to be obese [29].…”

“…These developments are important, because transportation, which is a key factor of everyday life, could also be a decisive factor of changes in physical activity as small shifts in travel modes noticeably alter energy expenditure. While time spent on transportation has increased, suburbanization, street design, and land use patterns can reduce the amount of physical activity that can be achieved through transportation [28,37,44]. The influence of transportation on energy expenditure is mainly affected through the built environment in which the cities and transportation corridors are planned and developed [47].…”