A/HRC/26/31 tend to lack the time or facilities for cooking, making ultraprocessed, ready-to-eat foods more attractive than healthy foods even if they are not necessarily less expensive. 44. Low-income persons may also be more likely to live in “food deserts”, where healthy fresh food options are lacking, or in “food swamps”, where there is significantly greater presence of unhealthy foods and unhealthy food marketing. Healthy foods are frequently less available, of lower quality and attractiveness, or more expensive in lowincome areas.67 Conversely, lower-income areas can have up to two and a half times as many fast food stores as higher-income areas.68 These problems are likely to be compounded by geographical barriers for remote rural communities, poorly served urban slums or where transport between lower-income and higher-income areas is poor. 45. Poor diets tend to have greater consequences for low-income persons than for other groups. Undernutrition early in life may lead to a greater probability of obesity later in life due to a “feast or famine” response that causes the body to hoard fat when it is available.69 This combination of lack of food security or hunger with the ready availability of caloriedense junk foods places many low-income communities at particular risk of NCDs, compared to higher-income groups. Psychosocial factors such as stress, higher incidences of other NCD risk factors and less access to preventive care can also increase risks of dietrelated diseases such as diabetes, heart disease and hypertension among low-income groups.70 46. In combating NCDs, States should therefore ensure that they comprehensively address socioeconomic disparities. They should ensure that food security or poverty reduction plans adequately address the need for healthier food options. They could do so, for example, by increasing availability of fruits and vegetables under food security schemes, incentivizing food retailers to stock healthy foods in low-income neighbourhoods or improving public transport to areas where healthy foods are available. In particular, social programmes aimed at ensuring food and nutritional security can be a useful tool for improving health, if they are sufficiently funded to allow for the purchase of healthy options and are combined with appropriate measures to provide nutrition education and make healthy foods available and accessible to those receiving benefits.71 Finally, States should work to eliminate inequities in access to primary and preventive care, to lessen the disproportionate effects of unhealthy foods on low-income communities. VII. Participation 47. The right to health framework requires the participation of the population, especially affected populations, in health-related decision-making at all levels – community, regional and national. States should ensure the participation of affected communities and vulnerable groups in developing food policy and in decision-making regarding food availability and 67 68 69 70 71 16 Policy Link and The Food Trust, The Grocery Gap: Who has Access to Healthy Food and Why it Matters (2010). DD Reidpath et al., “An ecological study of the relationship between social and environmental determinants of obesity”, Health Place, vol. 8, No. 2 (2002), pp. 141–145. Gian-Paolo Ravelli et al., “Obesity in young men after famine exposure in utero and early infancy”, New England Journal of Medicine, vol. 295, No. 7 (1976), pp. 349–353. Food Research and Action Center, “Food insecurity and obesity: understanding the connections”, spring 2011, available from http://frac.org/pdf/frac_brief_understanding_the_connections.pdf. Food Research and Action Center, “How improving federal nutrition program access and quality work together to reduce hunger and promote healthy eating”, February 2010, available from http://www.frac.org/pdf/CNR01_qualityandaccess.pdf.