Individual studies have demonstrated socioeconomic differences in the consumption of fruit and vegetables

Previous studies have shown socioeconomic differences in the consumption of Fruit and Vegetables (F&V): those in lower socioeconomic groups use less F&V. The studies have predominantly covered only one country or region, whereas international comparisons on the patterns and magnitude of the differences are few. However, some systematic reviews based on existing published studies have suggested that in the southern part of Europe the educational differences are not as systematic as they are in the northern Europe. Very little is known about the background of the varying educational patterns.

Are socioeconomic differences similar everywhere in Europe?

We examined the relationship of socio-economic position and vegetable consumption in nine European countries. The first aim was to analyse whether the pattern of socio-economic variation in regard to vegetable consumption was similar in all the studied countries. A second aim was to explore whether education had an independent effect on vegetable consumption when the other determinants of socioeconomic status, that is, occupation and place of residence had been taken into account. And finally, we analysed socio-economic variation within the countries in relation to the availability or affordability of vegetables in that specific country. “Availability” referred to the supply of foods as measured by food balance sheets, the consumption statistics. “Affordability” referred to the relative the price of vegetables.

In connection of the Eurothine–project (coordinated by Prof. Johan Mackenbach from the Erasmus University of Rotterdam, the Netherlands), we had a possibility to analyze data obtained from nationally representative surveys on health behaviors and health. Altogether, nine countries had sent to the Eurothine data center comparable survey data on the consumption of vegetables and, on the other hand, on educational level, occupational status and place of residence of the survey participants. Individual level data on vegetable consumption was obtained from national surveys conducted in Finland, Denmark, Germany, Estonia, Latvia, Lithuania, France, Italy, and Spain in 1998 or later. These surveys included comparable data on the frequency of consumption of vegetables. A detailed description of the study has been published earlier (Prättälä & al. 2009).

Availability and affordability of vegetables in nine European countries

According to FAO’s Food Balance Sheets from 1993 to 2003, the Southern European countries, France, Italy and Spain, showed high availability of vegetables. In Finland, Denmark, Germany and the Baltic countries, the availability was lower but increased from 1993 to 2003 more than in the South.

Data on vegetable prices in the nine studied countries were obtained from EU-statistics. To be able to compare the affordability figures between the countries, we focused on relative prices and used Price Level Index divided by Gross Domestic Product. The relative prices were lowest in the Mediterranean countries and Germany and highest in the Baltic countries.

Socioeconomic differences were not similar in every country

The pattern of socio-economic variation in relation to vegetable consumption differed by country. The Figure presents the relative inequality indices of education, that is, the relative difference in vegetable consumption between educational groups in the studied countries. If the index is 1, there are no educational differences in vegetable consumption in that country. If the index is above 1, the higher educational groups in that country consume vegetables significantly more often. If the index is below 1, then the lower educational groups consume vegetables more often. The index figure presents the educational differences when the place of residence and the occupational status have been taken into account. Thus, it shows the independent effect of education on the use of vegetables.

The most obvious difference in educational patterns was observed between the Mediterranean and the Northern European countries. In France, Spain and Italy, educational level had only a weak effect on the use of vegetables. After adjusting this level for place of residence and occupation, those having a higher educational level were found to consume slightly less vegetables than those with a lower educational level. In the Nordic and Baltic countries, the educational differences were greater and their direction was different. Those with a higher educational level were more often daily users of vegetables. In Germany no significant educational differences were observed.

Both education and geography make the difference

Our results support the assumption that a positive association between educational level and vegetable consumption is related to the availability and affordability of vegetables. The positive association was observed in countries with a low availability and high prices, as compared to countries where the availability and affordability were higher.

Availability and affordability cannot be the only explanations for the varying educational patterns observed in regard to vegetable consumption. Cultural factors expressed in dietary traditions can also have an impact. In the Mediterranean countries, local production of vegetables has a long history. Local products were available throughout the year and therefore even the lower socio-economic groups could use them as an essential part of Everyday cooking. In Northern Europe, vegetables were available only during summer, while in spring and winter imported products would occasionally be available, but at a high price. Therefore, Northern Europeans have not developed a tradition of using vegetables on a daily basis. When more vegetables entered the market, the higher socio-economic groups were the first to buy them.

Both education and geography make the difference in vegetable consumption. In order to increase the use of vegetables among the lower socio-economic groups multiple measures reaching from price policies to nutrition education are needed.