Global gender disparities in science

brought together to support each other to better manage their conditions. Since 2009, we have been involved in the Southampton Initiative for Health, which uses an empowering, problem-solving approach to improve the diets and physical activity levels of Southampton’s most disadvantaged young women and their children. The programme has involved training the staff of the city’s Sure Start Children’s Centres — providers of services such as baby clinics, breastfeeding and weaning support, dentistry, parenting and cookery classes — in having conversations that encourage women to identify problems and generate solutions to change behaviour. Although the data suggest that attending centres staffed by workers using this approach enhances women’s sense of empowerment, to improve their nutritional status we need both to help women to feel more in control of their food choices and to make it easier for them to make better choices. On a small scale, such a multilevel approach has proved effective. Trials in Canada, Australia and the United States demonstrate that the diets of small-town residents can be improved when efforts to enhance people’s sense of empowerment in relation to healthy eating are pursued alongside local media campaigns to promote the benefits of eating well, together with programmes that help people to gain better access to fruits and vegetables and skills in food preparation. The challenge is to scale up such efforts to the wider public-health arena, because this means engaging political and commercial interests, including those of powerful food companies. We believe that the methods used by people working in public health to engage politicians and food companies need to undergo a similar transformation to those being used to engage individuals. So far, public-health advocates have called for regulation and legislation as a means to improve diets — an increased tax on fatty and sugary foods, for instance. Yet this is unlikely to happen because raising the tax on soft drinks, say, is not in the interests of industry, or of politicians, who are sensitive to industry pressures and to a public desire for cheap soft drinks. Instead of wagging fingers, we need to generate consensus. Empowering consumers to call for better access to better food will put pressure on politicians to respond to voters, and on the food industry to please their customers. More than 20 years ago, one of us (D.B.) wrote in this journal that “if more was known about the processes by which the environment in early life influences adult health ... the rise in incidence of ‘Western’ disease [might be] minimized.” Today, we have the knowledge to readily prevent chronic diseases, had we but the will to do so. ■