BFJ101,8

590

British Food Journal,Vol. 101 No. 8, 1999, pp. 590-609.# MCB University Press, 0007-070X

The state of cooking inEngland: the relationship ofcooking skills to food choice

Martin CaraherThames Valley University, London, UK

Paul DixonUniversity of York, York, UK

Tim LangThames Valley University, London, UK, and

Roy Carr-HillUniversity of York, York, UK

Keywords Food, Cooking

Abstract This article uses data from the 1993 Health and Lifestyles Survey of England topresent findings on how, why and when people use cooking skills; where and from whom peoplelearn these skills. The implications for policy are explored. The survey data suggests that socio-economic status and education are associated with the sources of people's knowledge aboutcooking. The first or prime source of learning about cooking skills was reported to be mothers;cooking classes in school were cited as the next most important by the majority of correspondents,with some class and educational variations. The importance of mothers as sources of informationon cooking skills is observed in all social classes. What emerges is a population unsure of specificcooking techniques and lacking in confidence to apply techniques and cook certain foods. Womenstill bear the burden of cooking for the household, with four out of every five women respondentscooking on most or every day, compared with one in five men. This may be related to the largenumber of men who claim to have no cooking skills (one in five).

IntroductionIn recent years, there have been important attempts to explore the variousperspectives of eating and preparation of food and to ascertain if coherenceexists between the findings from academic disciplines (see Murcott, 1998a). Inparticular there has been interest in the public policy and social implications ofapparent trends in cooking skills and behaviour. One of the issues exploredhere is whether differences in cooking skills might be a factor in healthdifferences and whether these differences can be construed as an inequality.Differences in individual behaviour and consumption do not of themselvesconstitute an inequity as they may be related to individual choices, rather thanbeing structurally influenced (Whitehead, 1991). Research has reported oncontinued differential sharing of household roles and tasks (Murcott, 1998b),with women taking or being forced to take the greater responsibility forhousehold tasks including that of cooking. Whether these differences arelocated within gender roles or because men do not possess cooking skills havenot been satisfactorily answered. This article sets out to address some of these

The current issue and full text archive of this journal is available athttp://www.emerald-library.com

Cooking inEngland

591

issues, drawing upon the Health Education Authority's (HEA) 1993 Health andLifestyles Survey (HLS), it explores whether the population in general and menin particular do not possess the skills or the confidence to cook. It draws onquantitative data from a large sample of the English population, to explore howoften people cook and the extent of their confidence and application of specificcooking techniques. The impact of cooking skills and cooking facilities asbarriers to food choice are explored and finally the level of reported support forthe teaching of cooking skills are reported.

This paper explores the impact of income, social class, gender and age ondifferences in domestic cooking skills, an area which until recently has hadremarkably little attention from a health and social policy perspective.Although cooking skills and their application tend to have been viewed as amatter of individual behavioural or lifestyle choice, the acquiring of such skillsin fact relies on structural factors such as cultural norms and educationalpolicy. As Stronks et al. (1996) point out, behavioural factors are influenced by`living conditions' but also the relationship works in the other direction withbehavioural factors contributing to socio-economic inequalities in health.Cooking skills may work in both these directions, with their absencecontributing to an increased feeling of relative poverty and the inability toprepare and consume a healthy diet and their presence as an additionalpassport to health. Conversely having to cook rather than access ready madeexpensive food or be able to afford take-aways might be perceived as anindicator of poverty.

The role of cooking and its relationship to health is today debated butunclear. There is some evidence that cooking classes or training programmeswhich are multifaceted in their approach, in the short term achieve behaviourchange (see Bostock, 1993; Demas, 1995; Kennedy and Ling, 1997; Caraher andLang, 1998a). Arguments for the importance of cooking skills range from theirrelationship to healthy eating (Department of Health, 1998), through their usefor those on low incomes to achieve healthy diets (Leith 1998) to their role as anessential lifeskill and fun in their own right (Royal Society for theencouragement of Arts, Manufacturers and Commerce (RSA), 1997). Whilethese debates unfold, the absence of empirical data hinders the development ofa coherent theory.

MethodsThe findings presented here are a secondary analysis of the 1993 Health andLifestyle Survey (HLS). The survey was conducted by MORI on behalf of theHealth Education Authority (HEA) and is a rich and detailed source ofinformation, especially on access to food supplies, eating, cooking andshopping.

In 1993, the Health Education Authority conducted one of a series of largesurveys into aspects of health and lifestyles, the Health and Lifestyles Survey.A significant number of questions were included about foods consumed, how

BFJ101,8

592

they were purchased and the circumstances of cooking. These had not beenincluded in previous surveys and the present study looks at one of these ±cooking ± to see whether it could be a factor explaining variations in health.The relevance of the findings for policy provision is also explored. It alsoprovides a baseline for future surveys. The present study was undertakenbecause the Health and Lifestyles Survey with its larger sample, could beexplored to generate a more complex picture than previous small scalequalitative studies.

The present paper concentrates on the HLS questions which refer to,cooking, and health. The authors have analysed further topics from the surveyin a report to the HEA. The report contains additional material on cookingskills, nutrition knowledge, food consumption in the home and sources ofnutrition knowledge.

The 1993 Health and Lifestyle Survey consisted of 5,553 interviews with 16-74 year olds at a random sample of addresses in England, stratified by NHSregion. People were interviewed in their own houses where possible, interviewstook on average an hour and a half to complete. Despite the use of a boostersample of 16-24 year-olds the sample is biased in several ways and it isnecessary to weight these data to make the results more representative. Thereare three main sources of bias due to: stratification by region, under-representation of certain age groups, and the policy of only interviewing oneperson per household, regardless of household size. Cases are weighted in twoways to compensate for these effects. Firstly, each case is weighted by thenumber of eligible adults (16-74 year olds) in each household. Secondly, thecases have been weighted to match the 1991 census age and genderdistributions for all 16-74 year olds in England. The cases could not beweighted to match the age and gender distributions for the eight English NHSRegions because of the lack of geographical identifiers in the released data.

The variable definitions used in the article should be familiar to the reader;for example, the Registrar General's 6-group classification of social class(OPCS, 1990). However, the definition of income used for the current analysis isan estimate of per capita disposable income calculated by a linear equivalencescale of a type that is widely used in reporting variations in wealth andpurchasing behaviour. The gross household income is divided by a weightedsum of the number of people in the household: the first adult counting as 1,subsequent adults counting as 0.7 and any under 16 year olds counting as 0.5.The scale is recommended by the OECD Social Indicators Programme (OECD,1982) and was selected for its compatibility with the relatively crude age codingof the data in the survey. It gives similar, but not identical, results to the moredetailed scale more widely used in the UK (McClements, 1987). The differencesbetween the scales are too small to affect the statistical significance of theresults in this paper.

Cooking inEngland

593

The resultsThe findings are presented under the headings of cooking as a lifeskill, howoften people cook, the application of cooking techniques and the cooking ofspecific foods, cooking and cooking facilities as barriers to food choices.

Cooking skills as a lifeskill?The sample was taken in 1993 before cooking was excluded from the newEnglish National Curriculum. It remains to be seen what impact this policychange will have. Most respondents said that they learned to cook from theirmothers ± 76 per cent of women and 58 per cent of men (Table I). Earlyinfluences on cooking varied with age. Variations in early influences oncooking were less related to age for women, but reports of learning frommothers, fathers, grandmothers and school classes were all highest amongstyounger women. A much smaller proportion of women than men learnedcooking from a spouse or partner, and the percentage citing this influence didnot vary with age. In the case of men, the most striking finding is that nearlyhalf of 16-19 year olds mentioned cooking classes at school, compared withonly 2.4 per cent of 55-74 year olds. Younger men were also more likely to havelearned from mothers, fathers and friends. Learning to cook from wives and

Table I.`̀ When you first startedlearning to cook, whichif any of these did you

learn from?'' (Resultsby gender)

Percentagelearning fromthose sources

w2 test fordifference

between gendersSource Women Men X2 Sig.

Mother 76.1 58.3 199 ***Father 5.9 10.5 39 ***Grandmother 13.1 6.4 70 ***Wife/husband/partner 2.8 17.6 337 ***Other relatives 7.3 5.4 8.4 ***Friends 7.0 8.3 3.7 *Childminder 0.4 0.1 7.2 ***Cookery classes at school 48.6 15.0 718 ***Other cookery classes 3.4 2.1 9.4 ***Cookery books 25.0 14.9 88 ***Cookery programmes on media 4.5 4.8 0.4 nsSpecialist cookery 2.4 1.0 17.3 ***Magazine articles 5.5 2.3 37 ***Booklets from supermarkets 1.8 1.4 1.5 nsBooklets from food producers 1.3 1.5 0.04 nsHealth centre/doctor 0.2 0.3 1.3 nsNone of these 1.1 5.0 ± ±Haven't learned to cook 0.5 8.1 199 ***Don't know/own response 0.4 1.4 ± ±Number of respondents 2,826 2,727 ± ±

Notes: significance levels reported in all tables ***<1 per cent; **1-5 per cent;*5-10 per cent

BFJ101,8

594

partners was the only influence that was more frequently reported by the oldermen. Overall, men were slightly more likely to have first learned cooking fromtheir wives or partners than from school or books, indicating that for somemen, they did not learn cooking skills at an early age.

The survey suggests that class and education are associated with the waysin which people learn how to cook. Cookery books are more important for thehigher social classes, whilst cookery classes at school were more important forlower social classes (see Table II), whereas the importance of mothers seems tobe above both class and educational differences (Tables II and III), 63.8 per centof social class I and 66.4 per cent of those in social class V identifying mothersas important source of first learning. Predictably, learning from cookery booksis strongly associated with education (Table III) and this relationship remainssignificant after controlling for age. Those respondents with morequalifications were also those who were most likely to have learned cookingfrom friends as well as from family.

Later in life, respondents cited cookery books as the most cited source inlearning more about cooking, although this had a social class and educationalbias. This is a source biased against the lower social classes, presumably forreasons of cost of purchase and culture, thus making the loss of `̀ hands on''

Table II.`̀ When you first startedlearning to cook, whichif any of these did youlearn from?'' (Resultsby social class)

Percentage in this class group learningfrom these sources

F test forlinearity

Source I II IIIN IIIM IV V F Sig.

Mother 63.8 65.4 71.9 60.4 68.8 66.4 0.0 NSCookery classesat school 11.1 25.4 42.4 21.6 37.9 35.2 24.8 ***Cookery books 23.8 26.4 24.2 12.0 17.0 14.3 62.7 ***

Notes: Significance levels reported in all tables ***<1 per cent; **1-5 per cent;*5-10 per centThe F test is a measure of the proportion of the variation explained by any linear trendbetween groups

Table III.`̀ When you first startedlearning to cook, whichif any, of these did youlearn from?'' (Results ±by education)

Respondents aged 20 or over with these qualifications F test forO/GH Lower Higher linearity

Source No qual. CSE tech. A level tech. Degree F Sig.

Mother 61.6 68.3 65.4 69.3 71.9 70.9 26.3 ***Cookery classesat school 29.1 38.6 32.4 33.2 28.1 22.3 16.9 ***Cookery books 13.4 22.4 20.7 31.3 21.2 27.5 60.2 ***Number ofrespondents 1,573 961 659 270 654 759 ± ±

Notes: Significance levels reported in all tables ***<1 per cent; **1-5 per cent;*5-10 per cent

Cooking inEngland

595

cookery classes from the English curriculum (but not the Scottish) all the morepoignant. On many of these potential sources of learning, later in life, therewere clear differences between the sexes, and some less marked differences insocial class. For instance, 55.7 per cent of females cited cookery books, and only29.4 per cent of males. Cookery books were cited by 49 per cent of social classesl and ll, and by 41 per cent of class V. It is not clear from how the question wasphrased what sort of learning people do from cookery books or indeed whattype of cookery books. Caraher and Lang (1998b) noted that working classwomen reported less reliance on cookery books than the middle classes andtalked in interviews about the availability of cookery books from commercialsources such as the `̀ milkman''.

How often do people cook?How often people cook gives an indication of the practical usage of skills whichpeople may possess. When asked how often they cooked a meal, (i.e. any meal),less than half said they did every day. This apparently low figure may beaccounted for by the fact that many people do not cook as there is someone elsein their household who does. In households where the respondent was the onlyperson aged 16 or over, 74 per cent of respondents reported cooking on most ornearly every day, whereas the comparable figure for respondents in householdswith three over-16 year olds is 43 per cent, decreasing to 39 per cent where thehousehold includes four over-16 year olds. This could also be because of someplasticity in what is meant by `̀ cooking''. Also what is the meaning of a readyprepared meal? Is cooking a transformation of raw ingredients? Is the key taskan assembly process? A matter of energy? Or defined as the act of re-heating? Ifwe cook today, but re-heat half tomorrow, is that cooking? This is a conceptualmatter which can be glossed over in everyday speech. It may be that answersreflect responsibility for getting a meal together, this issue of responsibility isimportant. The HLS question was not sensitive enough to determine thesedifferences and meanings ascribed to it by respondents but took meanings atface value. In future this ought to be refined but nonetheless answers to thequestion provide clues as to the use of cooking skills, no matter how defined.

There was a huge gender difference in the frequency of cooking meals. Atotal of 68 per cent of women said they cooked every day, compared to only 18per cent of men. The majority of people reported eating at least seven mainmeals at home per week, and just over three-quarters of these meals weredescribed as not ready-prepared or take-aways, implying some degree ofcooking skills or assembly utilisation. Cooking skills in themselves do notguarantee the preparation of meals from basic ingredients. Many people lackthe ideas, knowledge and menu-planning skills necessary to organise a meal.Cooking skills are only one component of bringing together a meal (Bosely,1999). There was a clear social class and income effect on how likely arespondent was to have purchased a main meal within the previous week. Asixth (17.4 per cent) of the least affluent had purchased ready-prepared mainmeal within the last week, compared to a quarter (28.5 per cent) of the most

BFJ101,8

596

affluent. A quarter of social class 1 had purchased and eaten at least one ready-prepared meal in the last week, compared with just under a fifth of socialclasses V and Vl. It is clear that the poor do not simply pop around the cornerfor a take-away while the more affluent prepare meals from basics.

Marked variations within the sample begin to appear once questions turn tothe preparation of meals. When asked how often they cook a meal, income andsocial class produced few variations but gender did (see Table IV). A total of79.8 per cent of women reported cooking on most or everyday, compared with25.4 per cent of men. On average, women respondents cooked on 5.8 days perweek, men on only 2.5 days.

Application of cooking skillsThere has been a dearth of extensive hard evidence over changes in cookingand the manner in which food is prepared and consumed (Murcott, 1997a;1997b). Generally, people said they were confident of their ability to cook, butthere were gender differences, with 94 per cent of women and 80 per cent ofmen saying they were very or fairly confident in their abilities. This rosypicture is marred by the finding that nearly a quarter of males (24.4 per cent)either do not cook or do not feel confident to cook from basic ingredients,compared to 7 per cent of females. When people were asked about specifictechniques and the application of these techniques to real foods, the picturebecame even more uneven. It is at this point ± the practical display of skills onfoods in everyday life ± that the relevance of cooking skills for healthpromotion could be significant. The Balance of Good Health (HEA, 1996), forexample, commended by the Department of Health's Nutrition Taskforce,promotes food such as pasta, rice, green vegetables and oily fish withoutaddressing who can cook them.

Confidence in applying techniquesThe HLS asked how confident people felt about cooking in general, as well asparticular techniques and foods. The most marked feature was the difference

Table IV.`̀ How often do youcook a meal?'' (Resultsby gender)

Percentage cooking this oftenHow often do you cook a meal? Women Men

Every day 67.9 18.4Most days (5-6) 11.9 7.0Some days (3-4) 7.7 11.9One or two days 6.0 19.4Less than once per week 2.6 16.2Only for special occasions 1.0 4.3Never 2.6 22.4Don't know/no response 0.3 0.4Number of respondents 2,826 2,727

Note: w2 = 1,810***

Cooking inEngland

597

between the sexes in their level of general confidence. For example, 94.3 percent of females, compared to 80.3 per cent of males, felt either fairly or veryconfident about being able to cook from basic ingredients. Thus 24.4 per cent ofmales either do not cook or don't feel confident to cook from basic ingredients,compared to 7 per cent of females. Although it could be argued that generalconfidence was fairly high, as we shall see in the next section, it is lower whenquestions are asked about particular cooking techniques or the cooking ofparticular foods.

If confidence about cooking is gender-related, so too is confidence overcooking techniques and foods. A total of 67.8 per cent of females, for instance,compared to 40.5 per cent of males, were confident about using steaming.Females were more confident about almost all techniques but especially aboutstewing, braising and casseroling.

For both men and women, confidence with some of these techniques isstrongly related to age. For women, three techniques in particular, steaming,poaching and stewing/braising now seem out of fashion and are not methodswith which younger women feel familiar. Generally, older women reportedmore confidence in using a wider range of techniques. The one exception wasmicrowaving.

The same associations apply to men ± again, steaming, poaching andstewing/braising are techniques with which older men feel more confident,whereas microwaving is more familiar to younger men. However, theseassociations are weaker for men than for women.

Confidence in general is quite high for most techniques except for steaming,microwaving, poaching and stir-frying (Table V). In all other eight techniques,reported confidence increases with income, and even stronger associations withsocial class were found. For all but one of the techniques, confidence is highestin the professional and managerial classes ± the exception is deep frying, withwhich respondents in social classes IV are most confident. There are similar,but weaker, associations with educational attainment. In most cases,confidence with cooking techniques is greatest in groups with the highesteducational qualifications ± and the trend is particularly strong for stir-fryingand microwaving. Again, deep frying is the only technique for which the trendis reversed.

Confidence with groups of foodsKnowing about cooking techniques in principle is one thing, applying them isanother. The application of general skills to particular foods or dishes appearsto be uneven. When explored from the perspective of social class and gender itbecomes more complex.

There are gender, social class and income variations in these applied skills.Even in cooking fresh green vegetables, there is a gender divide, with 78.4 percent of males confident and 94.9 per cent of females (Table VI). Especiallyamongst women, confidence in cooking most foods increases with age and thetrend is particularly strong for cooking red meat, chicken, white fish, oily fish

BFJ101,8

598

and pulses. For men, the increase in confidence in cooking certain foods isstrongest for white fish. Pasta is the only food type where the general trend isreversed and both younger men and women, though not necessarily theyoungest groups, show more confidence in cooking pasta than older people.

Table VI.Confidence in cookingparticular foods (bygender)

Percentage who areconfident cooking

these foods

w2 test fordifference between

gendersFood/food type Women Men w2 Sig.

Red meat 85.3 70.8 171 ***Chicken 91.8 74.5 299 ***White fish 81.0 62.0 247 ***Oily fish 58.1 39.1 200 ***Pulses 61.7 46.4 131 ***Pasta 81.0 59.2 314 ***Rice (not rice pudding) 87.3 68.3 292 ***Potatoes (not chips) 96.6 86.2 195 ***Fresh green vegetables 94.9 78.4 327 ***Root vegetables 91.9 76.0 261 ***None of these 0.8 6.2 119 ***Don't know/no answer 0.2 0.7 ± ±Number of respondents 2,826 2,727 ± ±

Notes: Significance levels reported in al tables ***<1 per cent; **1-5 per cent;*5-10 per cent

Table V.Confidence in usingcooking techniques ±by gender (sample ofresponses)

Respondentswho are

confident theycan use this

technique

Percentageof those

confidentwith thesemethods

w2 testfor

differencebetweengenders

Cooking technique N Percentage Women Men w2 Sig.

Boiling 5,018 90.0 95.1 85.4 150 ***Steaming 3,019 54.4 67.8 40.5 417 ***Shallow frying 4,186 75.4 80.4 70.2 78 ***Deep frying 3,579 64.5 70.4 58.3 88 ***Grilling 5,022 90.4 93.8 86.9 75 ***Poaching 3,466 62.4 70.5 54.0 160 ***Oven-baking or roasting 4,495 80.9 92.9 68.6 532 ***Stewing/braising/casseroling 3,744 67.4 82.6 51.7 601 ***Microwaving 3,472 62.5 62.8 62.2 0.2 nsStir frying 3,071 55.3 62.1 48.3 107 ***None of these 113 2.0 0.5 3.6 67 ***Don't know/no answer 20 0.4 0.2 0.6 6 **Total number of respondents 5,553 2,826 2,727

Notes: Significance levels reported in all tables ***<1 per cent; **1-5 per cent;*5-10 per cent

Cooking inEngland

599

Not surprisingly, age is a factor in people's confidence to cook specific foods.For men, the increase in confidence with age in cooking certain foods isstrongest for white and oily fish. Younger men report feeling more confident tocook pasta. For health promotion purposes, it is important to note that youngwomen start from a higher level of confidence in key foods such as greenvegetables. A total of 50 per cent of men aged 16-19 years were confident tocook green vegetables, compared to 81 per cent of young women. Across theages, men appear never to catch up this early start.

Confidence in cooking these foods is less clearly related to educationalqualifications except for four food types: oily fish, pulses, pasta and rice, whereconfidence is highest amongst those with most qualifications. Table VIIsuggests that confidence in cooking all these types of foods increases withincome.

Cooking as a barrier to food choiceThe survey explored whether people felt their food choices were in generalrestricted. Most respondents said that they were not. Concerns about foodgoing off, difficulties in storing the food and carrying from the shops weredeemed more important than cooking skills, but this was gender related. Atotal of 12.7 per cent of men compared to 5.4 per cent of women cited notknowing how to cook a food as a factor limiting choice.

When people were presented with a list of factors that might have a majorimpact on the types of food they could purchase, about half said that nothinglimited their choice. Only one or two per cent of the total sample said that theirchoice was restricted by having limited cooking facilities. And nearly a tenthcited not knowing how to cook as a factor. Taken together, these were smaller

Table VII.Confidence in cooking

particular foods, byannual per capita

income (all respondentssupplying details of

income)

Percentage in each income group whoare confident they can cook this food F test for

£3000 £3,001- £7,001- £14,001 linearityFood/food type or less 7,000 14,000 and over F Sig.

Red meat 67.7 81.6 82.8 84.6 85.7 ***Chicken 74.8 87.0 86.2 88.6 61.1 ***White fish 60.2 75.9 75.2 77.8 69.6 ***Oily fish 33.6 51.0 53.6 56.7 107.9 ***Pulses 45.0 55.8 56.3 63.0 47.4 ***Pasta 66.1 68.4 75.6 81.2 49.6 ***Rice (not pudding) 73.1 76.5 84.2 88.2 70.0 ***Potatoes (not chips) 87.5 92.8 94.1 94.8 38.2 ***Fresh green vegetables 78.4 89.2 90.9 92.6 91.9 ***Root vegetables 74.7 87.4 88.3 90.6 92.8 ***None of these 4.0 3.1 2.6 1.3 8.4 ***Number of respondents 1,214 1,518 1,231 407

Notes: Significance levels reported in all tables ***<1 per cent; **1-5 per cent;*5-10 per cent

BFJ101,8

600

than the proportion of people who cited transport problems or food going offbefore being eaten. So, cooking skills should not be over-emphasised aboveother factors influencing food choice.

Other studies have suggested that geographical factors, such as proximity tofood shops and access to cars, are significant material factors affecting choiceand the range of foods (Lewis, 1985; Piachaud and Webb, 1996; Leather, 1996;Caraher et al. 1998), but nevertheless that approximately one-tenth of a sampledid cite it should equally be taken of interest.

FacilitiesIn the late nineteenth-century and early twentieth-century, social reformerswere concerned about the poor lacking cooking facilities (e.g. Spring-Rice,1981). Access to facilities as an issue for people on low incomes was raised oncemore in the 1980s (Conway et al., 1988). Yet generally today, people of allincome and social class groups have equipment their predecessors could onlyhave dreamed of. The present survey found 98.6 per cent of people who cookedreported that they had fairly, or very, easy access to cooking facilities.

The main variations by social class and income related to the possession ofmicrowaves, non-stick pans or woks, steamers, food processors, liquidisers,chip and deep fat fryers and slow cookers. Higher income groups weresignificantly more likely to have all but one of these items. The exception is thechip pan or deep fat fryer, which are the only pieces of equipment which aremore often owned by lower income groups ± 66.8 per cent of respondents inhouseholds with per capita income of £3,000 or less had one of these, comparedwith 40.5 per cent of respondents in the highest income households.

Views on cooking skillsAs in previous surveys (MORI, 1993; OPCS, 1995), this survey found nearunanimity on the importance of teaching children to cook. A total of 98.5 percent of women thought it fairly or very important to teach boys to cook and 99.2per cent to teach girls to cook. A total of 95.3 per cent of men thought it fairly orvery important that boys be taught to cook and 97.6 per cent were similarly infavour of teaching girls to cook.

Views on the importance of teaching cooking to girls and boys varied withthe age of the informant. In general, older people attached most importance tothis type of teaching, especially for girls.

There were also some links between these views and the respondents'education. Two trends were notable: that women with higher academicqualifications were most likely to value the teaching of cooking to boys; andthat men with the least qualifications were most likely to value this teaching forgirls. Both results remain significant at less than one per cent, after controllingfor the respondent's age.

Cooking inEngland

601

DiscussionHealth and FoodThe relevance of food as a factor in, and on occasions determinant of, health isbeyond question (James et al., 1997). The epidemiological evidence on thecontemporary diet has become increasingly clear. Food is a factor in variationsin health and is implicated in the West's main causes of premature death: heartdisease and some cancers (breast, colon) (WHO, 1990). There is near unanimityin the scientific literature about the connection between diet and health(Cannon, 1992) and on the need of the UK population to reduce its overall fatintake.

Since the Second World War, the British have altered what they eat to aremarkable degree. A previously unimaginable range of foods and ingredients,from pizzas to samosas, from yoghurts to muesli, are now mass market items.The restructuring of the food economy has been exemplified by the emergenceof high value-added foods, the rapid up-take of microwave foods and by trendstowards what marketing specialists have called `̀ grazing'' of foods. Thesechanges have coincided with, or helped create, a revision of culinary skills. Onthe one hand, there has never been more interest in food and cooking, asevidenced by the popularity of cooking shows on television (there were nearly30 in a week at the start of 1997) and the sales of cooking magazines and books.There is a strong suggestion that cooking is becoming part of the leisureindustry for some. The Henley Centre estimates that over 36 per cent of Britishadults now cook at least once a week for pleasure (Henley Centre, 1994),implying that most cooking is still perceived as a duty. Yet on the other hand,as this survey has shown, the English are by no means wholly confident orfluent in practising cooking and utilising culinary skills. They may bewatching and reading about them, but are they applying them?

Cooking appears to be a microcosm of wider social and cultural relations.Cooking culture is divided, in particular by gender. The present study echoesprevious work highlighting the central role of women and mothers in affectingwhat is purchased, cooked and consumed (Charles and Kerr, 1984; Brannen etal., 1994; Murcott, 1995; Charles, 1995). These studies have tended to underlinethe role of cooking as a domestic role borne by women, having considerableideological significance, particularly with regard to the family. In terms ofcooking, women bear the greater burden with four fifths of women cooking onmost or everyday, compared with a quarter of men. On average, women cookon 5.8 days per week, men on only 2.5 days, the only technique with whichwomen are not significantly more confident than men is microwaving.

Those concerned with cooking may need to review the teaching of cookingskills to update them in line with changes in the type and preparedness of thefood purchases and changes in assembly of meals and the techniques used tocook them.

The use of general skills among the population is evenly spread among thesocial classes, but the gap occurs in the use of specific techniques such aspoaching and stir frying. This gap also became apparent when applied to

BFJ101,8

602

specific foods. Confidence in cooking specific foods is less clearly related toeducational qualifications, except for four food types: oily fish, pulses, pastaand rice, where confidence is highest amongst those with most qualifications.Confidence in cooking all these types of foods increases with income and thereare significant tendencies for confidence to increase with social class, except foran inverse but weaker social class effect on confidence in using a deep-fat fryer.Whether this gap in skills acquisition is important in terms of basic skills, ormerely a reflection of the different social class interests in terms of cookinghaving a leisure focus is hard to ascertain from the current findings. It may alsoreflect both a familiarity with and an acceptance of healthy eating guidelinesby higher income groups. The low levels of skills and confidence among menraises issues concerning the future relationship to health, demographic trendssuggest that the growth of men as single family units is set to grow. How thesemen can cater for themselves without adequate knowledge or skills remainsopen to conjecture. At some point cooking skills appear to empower people notonly with skills to prepare food but also with knowledge concerning thepreparation of ready-prepared foods, thus adding them in their food purchasingdecisions. The link between cooking skills and health may have more to dowith acquiring knowledge of how food is prepared, empowering consumerswith knowledge necessary in their purchasing of ready-prepared and ready toeat meals.

Other research has looked at the constraints on diet and domestic foodculture of particular social groups such as single women and mothers (Dowlerand Rushton, 1994; Kempson, 1996). This tradition of research has highlightedthe extraordinarily complex process of juggling cost, skills, taste andavailability that women perform daily. Brannen et al.'s (1994) work, forexample, has shown how food can be the locus for intergenerational conflictand how women perform a role as negotiators and mediators in domestic foodculture. Such findings connect with more anthropological studies showing thesymbolic significance of cooking within culture (e.g. Douglas, 1972; Douglasand Isherwood, 1978; Mintz, 1996). Arguments such as that put forward byLeith (1998) in arguing a place for cooking in the lifestyles of the poor asimportant in helping them choose and cook a better diet are open to question.Cooking from basics often neglects the hidden costs such as those of fuel andcooking costs. The current research shows that the poor manage well onrestricted income and their choice of food is based on value for money andmanagement of family preferences to ensure maximum uptake of food. Whilecooking skills can empower in many ways, they cannot compensate for theabsence of adequate resources. The present study underlines the need to givehigher priority to gender in understanding household dietary variations. TheLow Income Project Team (LIPT) of the Nutrition Taskforce has called formore food clubs and skills opportunities for all young people, not just females,both at school and in the community (LIPT, 1996). Here it is important tountangle work allocation and power. It is often assumed because women do the

Cooking inEngland

603

majority of the cooking that they have the power to decide on the family diet.This neglects the power that partners and children exercise in the process, fromfood choice to methods of preparation (Dobson et al., 1994).

Changes in cooking culture might undermine efforts to improve dietaryintake. It is not known whether cooking skills are a factor in variations in theintake of any of these nutrients, but the capacity of the informed consumer tocontrol his or her intake and to meet health advice may be weakened if theycannot choose to cook and they simply have to purchase pre-prepared foods.Knowledge of cooking enhances understanding of food ingredients (Demas,1995). Conversely, an absence of cooking skills means the consumer is solelyreliant upon abstract knowledge and upon information on packets. Food labelsshould be the last line of defence in public health policy, not the only line ofdefence (Lang, 1995; Lang, 1997). The Pennington Report (1997) on outbreaksof E-coli food poisoning highlights the importance of teaching food hygienefrom an early age in schools. Locating food hygiene and cooking skills as partof a wider cultural agenda appear to be important in ensuring their place insociety.

The convergence theory voiced by MAFF (1991) has tended to encourageattention to focus more on individual processes, rather than wider cultural oreconomic changes and as Murcott (1994) points out, eating is heavily embeddedin culture. Yet the food economy in recent decades has witnessed considerablechange, both in supply, distribution and consumption (Hughes, 1994). This hashad tremendous impact on the amount of cooking that occurs in the home, theamount of time given to cooking and to the level of skills used (Gershuny, 1989;Raven and Lang, 1995), but there has been very little attention onto whetherthis restructuring of skills has any health implications. The importance ofpossessing cooking skills to deal with new foods and the necessity of learningnew skills for new technology, such as microwaves, are demonstrated in thefindings where there are age differences in being able to cook foods such aspasta, and gender and age differences in the ability to use microwaves. Menand children seem happy and confident to use the new technology. Skills arealso heavily embedded in cultural mores, which are hard to shift and are notdirectly related to health concerns.

While all the indications are that the family (the mother) are the prime sourceof teaching cooking skills, it is not clear if this is achieved in a pedagogicalmanner by formal teaching, or by example and absorption of the principles bychildren. Whichever manner, it is clear that this remains the primary source oftrans-generational passing on of skills. It is also clear from other research thatthis route is under pressure from the increasing demands placed on mothers(Murcott, 1998a; Oakley, 1974/1990).

With the introduction of the new national curriculum in England and Wales,traditional home economics, which was the prime non-domestic source ofteaching cooking skills, was replaced by a new focus on technology. Concernswere expressed about the long-term impact of the curriculum change on health(NFA, 1993) and throughout the country, cooking skills classes have

BFJ101,8

604

mushroomed under the auspices of health promotion and the NGO food sector.Many schools have started cooking skills classes, either out-of-hours or woveninto the curriculum under different guises. The findings from this survey, thata significant proportion of young men for example found cookery classes inschool useful sources for first learning about cooking skills, is an interestingfinding, given that the provision of such classes before their removal from thecurriculum was not evenly spread. Also, as demographic trends indicate, thegrowth in single young men setting up homes, so the importance of aknowledge of cooking skills becomes more important. In the past there hasbeen an assumption that if women possessed such skills they would look afterpartners or spouses and they may not require these skills.

Traditionally, health promotion has focused upon changing knowledge,attitudes and behaviour. Cooking skills are a very practical illustration of theintersection of all three. There is little point in exhorting the public to change itsdietary behaviour if it lacks the practical cooking skills needed to be able toexecute the change (NFA, 1993; Caraher and Lang, 1995). A gradual erosion ofcooking skills has been noted in other cultures (e.g. Demas, 1995; Steven, 1985).In this respect there are disturbing indications from the survey that there aregender (not unsurprisingly), social class and educational variations in skills'acquisition and ability. Without skills, there can be no empowerment thatmodern health educators seek to promote. Indeed, as cooking skills change,reliance upon pre-prepared foods could mean an unwitting intake of the verynutrients that health educators are most concerned about, such as fats andsugars. As Fieldhouse has argued `̀ if prepared food is so easily accessible, whybother to learn to cook? If you haven't acquired cooking skills, then fast foodsare the most efficient answer'' (Fieldhouse, 1995). This could have profoundimplications for health education, a connection recognised by many healtheducators who are showing interest in the possibility of using cooking skillsclasses as `̀ soft'' vehicles for health promotion (Caraher and Lang, 1995).Empowerment in this light needs to be viewed from two perspectives: first, thatof practical empowerment, the ability to cook from basics, and second, theability to be informed that comes from understanding how to cook from basics.

This review suggests that there are variations between the sexes, agegroups, income and social classes in their approaches to cooking. The greatestvariation appears to be on gender lines, perhaps unsurprisingly. The findingssuggest that it is time to re-evaluate the significance of cooking incontemporary food culture and its significance for health and health promotion.The direction of influence is unclear, the current data suggest that theacquisition of cooking skills is structurally determined, primarily along genderlines but also by social class and income. It is also possible that the absence ofcooking skills may contribute to structural differences in health status,although we would caution against assuming this link to be the prime influenceon eating habits, this primarily being the direct influence of poverty. Thesurvey presents evidence of a lack of skills among men and certain age groups

Cooking inEngland

605

in relation to their ability to cook foods promoted as healthy by national bodiessuch as the HEA (1994) and the National Food Alliance. Cooking skills are onespoke in a complicated web of events, but nonetheless important.

ConclusionDoes it matter if people do not know how to cook? Cooking skills, like allmatters of food choice and health, can be addressed from an individualist (e.g.Rogers and Blundell, 1990; Sparks et al., 1992; Sparks, 1993) or structuralperspective (e.g. Wilkinson, 1992a; 1992b; Wilkinson, 1994; Blane et al., 1996).Health promotion can fit into both models and is often torn between the two(McKinlay, 1993). Cooking classes have often been taken up as a method forhealth promotion, targeting at-risk groups, particularly those on low incomes,but they can be used for general community use (Demas, 1995; Caraher andLang, 1995). If cooking classes are targeted only at certain populations, thisruns the risk of `̀ ghettoising'' the issue. The present study suggests that allsocial groups could benefit from cooking skills education and also reinforcesthe case that health promotion, if it is to be successful, should not rely solely onan individualist model of human behaviour, or on a rational connectionbetween knowledge and action. The conclusion draws out these implications.

The relevance of cooking for health inequalities should not be overstated. Nodirect relationship between cooking skills and health status can be drawn fromthe present data. At the same time, there does seem to be something ofimportance in the social divisions in cooking, skills and confidence. Poorcooking skills could be a barrier to widening food choice, if they reduce thechance of eating healthily. The study reported here does support the suggestionthat skills, and particularly confidence to use them, could be a psycho-socialfactor in people's general health outlook and behaviour. There are somepointers for further enquiry. The state of cooking skills in contemporary Britishfood culture is a challenge for health education and policy. A number ofimplications can be drawn.

The data reviewed suggest that there are considerable variations inknowledge about cooking, its application, role in domestic life and relevance tohealth. Various aspects of cooking are related to gender, age, income and socialclass. Given that this is the case, health professionals need to accept that thesesources of variation, which have received less than their due attention in recentyears (Wilkinson, 1996), should be at the heart of health promotion strategywith regard to food. Health promotion could place more emphasis on trying toinfluence the determinants of health, and beware an undue emphasis ontargeting at-risk groups and risk behaviours. Issues related to cooking skillsmay not be as amenable to health promotion approaches as cultural ones.Making cooking an accepted part of everyday life and culture as opposed tojust being an issue for already marginalised groups may offer moreopportunities for health promotion practice (Benson and Finlay, 1999). Cookingskills are only one part of a complicated food-web, with possible impacts onhealth status. The question, as Dowler (1999) points out, should be do the poor

BFJ101,8

606

have enough money to buy food? Affluent groups may choose not to cook frombasics yet still maintain healthy eating habits, as they can afford to. Lowincome-groups even those who possess cooking skills, may not be able to afforda healthy diet. Health promotion should locate cooking skills within these widereconomic and cultural factors.

The public needs long-term, reliable sources of education which would helpit to translate intention into action. Local health promotion workers need toinclude cooking skills into their frame of reference (Benson and Finlay, 1999).There is little point in purveying nutrition advice and tips on healthy eating ifpeople lack the skills to implement them. Policy provision on cooking skillsneeds to be tackled across various government departments and voluntary andprofessional groups. This ranges from education through MAFF to health andfrom teachers of home economics to health visitors.

Cooking skills classes should not be targeted solely at low-income groups.Some more affluent groups have lower skills, but probably have greaterresources with which to compensate. Cooking skills education could play auseful part in generating a common food culture rather than reflecting adivided food culture.

At the national level and international level, there are grounds for changes inpublic policy (Stitt et al., 1997). Cooking classes or some practical element of`̀ hands on'' skills should feature in a young person's curriculum at some stageat school. The situation where interested individuals and NGOs are keepinginterest in cooking skills alive should be supported by the introduction of anational policy supporting the development of skills such as cooking and notfocus solely on high technology skills such as computer skills. The acquisitionof cooking skills promotes not only the development of young people's healthbut also their social and emotional development.

In line with the health promotion indicators outlined by Hanaboro andBridgwood (1997), targets could be set for increases in the proportion of peopleand groups using and applying cooking skills. There is certainly a need tomonitor changes in cooking skills and behaviour.

References

Benson, K. and Finlay, R. (1999), Get Cooking and Beyond: Brighton, Hove and Lewes Food andLow Income Project (1995-1998), Environmental Department, Brighton and Hove Council.

Blane, D., Brunner, E. and Wilkinson, R. (1996), `̀ The evolution of public health policy'', in Blane,D., Brunner, E. and Wilkinson, R. (Eds), Health and Social Organisation, Routledge,London.

Bosely, S. (1999), `̀ Equal portions'', Guardian, Society, 17 March, pp. 3-4.

Bostock, D. (1993), `̀ Nutrition communication ± the community view: General Practitioners'', inButtriss, J. (Ed), Getting the Message Across: Proceedings of a National Dairy CouncilConference: Getting the Message Across, NDC, London.

Brannen, J., Dodd, K., Oakley, A. and Storey, P. (1994), Young People, Health and Family Life,Open University Press, Buckingham.

Cannon, G. (1992), Food and Health: The Experts Agree, Consumers Association, London.

Cooking inEngland

607

Caraher, M. and Lang, T. (1995), Evaluating Cooking Skills Classes: a Report to Health PromotionWales, Health Promotion Wales, Cardiff.

Caraher, M. and Lang, T. (1998a), `̀ Can't cook, won't cook: a review of cooking skills and theirrelevance to health promotion'', International Journal of Health Education, forthcoming.

Caraher, M. and Lang, T. (1998b), `̀ Cookery writers and presenters as agents of change: healthpromotion conundrums and paradoxes'', paper presented at ASFS-AFHVS Conference,California, 4-7 June.

Caraher, M., Dixon, P., Lang, T. and Carr-Hill, R. (1998), `̀ Barriers to accessing healthy foods:differentials by gender, social class, income and mode of transport'', Health EducationJournal, Vol. 57 No. 3, pp. 191-201.

Caraher, M., Lang, T., Dixon, P. and Carr-Hill, R. (1996), Buying, Eating and Cooking Food: aReview of a National Data Set on Food Attitudes, Skills and Behavioural Change, (a reportto the Health Education Authority on variations in health: implications for healthpromotion policy), Health Education Authority, London.

Charles, N. and Kerr, M. (1984), Attitudes Towards the Feeding and Nutrition of Young Children,Health Education Council, London.

Charles, N. (1995), `̀ Food and family ideology'', in Jackson, S. and Moores, S. (Eds), The Politics ofDomestic Consumption, Prentice-Hall/Harvester Wheatsheaf, Hemel Hempstead.

Conway, J. et al. (1988), Prescription for Poor Health ± the Crisis for Homeless Families, LondonFood Commission, Maternity Alliance, SHAC and Shelter, London.

Demas, A. (1995), `̀ Food education in the elementary classroom as a means of gaining acceptanceof diverse, low-fat foods in the school lunch program'', PhD thesis, Cornell University,Ithaca, NY.

Department of Health (1998), Our Healthier Nation: a Contract for Health, Cm 3852, HMSO,London.

Dobson, B., Beardsworth, A., Keil, T. and Walker, R. (1994), Diet, Choice and Poverty: SocialCultural and Nutritional Aspects of Food Consumption among Low Income Families,Family policy Studies Centre, Joseph Rowntree Foundation, York.

Douglas, M. (1972), `̀ Deciphering a meal'', Daedalus, Vol. 101, pp. 61-82.

Douglas, M. and Isherwood, B. (1978), The World of Goods, Allen Lane, London.

Dowler, E. (1999), `̀ Food and poverty: the present challenge'', Benefits, No. 24, pp. 3-6.

Dowler, E. and Rushton, C. (1994), Diet and Poverty in the UK: Contemporary Research Methodsand Current Experience: a Review, Department of Public Health and Policy Publication No.11, London School of Hygiene and Tropical Medicine, University of London, London.

Fieldhouse, P. (1995), Food and Nutrition: Customs and Culture, Chapman and Hall, London.

Gershuny, J. (1989), `̀ Technical change and the work-leisure balance'', in Silberston, A. (Ed.),Technology and Economic Progress, Macmillan, London.

Hanaboro, J. and Bridgwood, A. (1997), Health in England 1996: What People Know, What PeopleThink, What People Do, Office for National Statistics, Health Education Authority,London.

Health Education Authority (1996), The Balance of Good Health, Health Education Authority,London.

Henley Centre (1994), Leisure Futures, Henley Centre, London.

Hughes, D. (Ed.), (1994), Breaking with Tradition, Wye College Press, Ashford.

James, W.P.T., Nelson, M., Ralph, A. and Leather, S. (1997), `̀ The contribution of nutrition toinequalities in health'', BMJ, Vol. 314, pp. 1,545-9.

Kempson, E. (1996), Life on a Low Income, Joseph Rowntree Foundation, York.

BFJ101,8

608

Kennedy, L. and Ling, M. (1997), `̀ Nutrition education for low-income groups ± is there a role?'', InKoÈhler, B.M., Feichtinger, E., BarloÈsius, E. and Dowler, E. (Eds), Poverty and Food InWelfare Societies, WZB, Berlin, pp. 349-62.

Lang, T. (1995), `̀ The contradictions of food labelling policy'', Information Design Journal, Vol. 8,No. 1, pp. 3-16.

Lang, T. (1997), Food Policy for the 21st Century: Can it be Both Radical and Reasonable?Discussion Paper 4, Centre for Food Policy, Thames Valley University, London.

Leather, S. (1996), The Making of Modern Malnutrition: An Overview of Food Poverty in the UK,Caroline Walker Trust, London.

Leith, P. (1998), `̀ Cooking with kids'', in Griffiths, S. and Wallace, J. (Eds), Consuming Passions:Food in the Age of Anxiety, Mandolin Press, Manchester, pp. 58-65.

Lewis, J. (1985), Food Retailing in London, Food Commission and CES Ltd, London.

LIPT (1996), Report of the Nutrition Taskforce Low Income Project Team, Department of Health,London.

McClements, L. (1987), The Economics of Social Welfare, Heinneman, London.

McKinlay, J.B. (1993), `̀ The promotion of health through planned sociopolitical change:challenges for research and policy'', Social Science and Medicine, Vol. 36 No. 2, pp. 109-17.

MAFF (1991), Household Food Consumption and Expenditure 1990 with a Study of Trends overthe Period 1940-1990. Annual Report of the Food Survey Committee, HMSO, London.

Mintz, S. (1996), Tasting Food, Tasting Freedom: Excursions into Eating, Culture and the Past,Beacon Press, Boston, MA.

MORI (1993), Survey for Get Cooking!, National Food Alliance, London.

Murcott, A. (1994), `̀ Food and nutrition in post-war Britain'', in Caterall, P. and Obelkevietch, J.(Eds), Understanding Post-War British Society, Routledge, London. pp. 155-64.

Murcott, A. (1995), `̀`It's such a pleasure to cook for him': food, mealtimes and gender in someSouth Wales households'', in Jackson, S. and Moores, S. (Eds), The Politics of DomesticConsumption, Prentice Hall/Harvester Wheatsheaf, Hemel Hempstead.

Murcott, A. (1997a), `̀ The lost supper'', Times Higher Education Supplement, 31 January, p. 15.

Murcott, A. (1997b), Family meals ± a thing of the past?'', in Caplan, P. (Ed.), Food, Health andIdentity, Routledge, London, pp. 32-49.

Murcott, A. (1998a) The Nation's Diet. The Social Science of Food Choice, Longman, Harlow.

Murcott, A. (1998b), `̀ The nation's diet'', in Griffiths, S. and Wallace, J. (Eds), ConsumingPassions: Food in the Age of Anxiety, Mandolin Press, Manchester. pp 110-8.

NFA (1993), Get Cooking!, National Food Alliance, London, Department of Health and BBC GoodFood, London.

Oakley, A. (1974/1990), Housewife, Penguin, Harmondsworth.

Office of Population and Census Surveys (OPCS) (1995), Cooking: Attitudes and Behaviour, Officeof Population Census and Surveys, London.

Office of Population and Census Surveys (OPCS) (1990), Standard Occupational Classification,Vols I, II and III, HMSO, London.

Organisation for Economic Co-operation and Development (1982), List of Social Indicators,OECD, Paris.

Pennington, T.H. (1997), The Pennington Group Report on the Circumstances Leading to the 1996Outbreak of Infection with E-coli 0157 in Central Scotland, the Implications for Food Safetyand the Lessons to be Learned, Stationery Office, Scotland.

Piachaud, D. and Webb, J. (1996), The Price of Food: Missing out on Mass Consumption,STICERD, London School of Economics, London.

Cooking inEngland

609

Raven, H. and Lang, T. (1995), Off our Trolleys?, Institute for Public Policy Research, London.

Rogers, P.J. and Blundell, J.E. (1990), `̀ Psychobiological bases of food choice'', BNF NutritionBulletin, Vol 15, suppl. 1, pp. 31-40.

Royal Society for the Encouragement of Arts, Manufacturers and Commerce (RSA) (1997), Focuson Food: The Production and Social Importance of Food. A Campaign to Promote, Developand Sustain the Place of Food in Education, RSA, Dean Clough.

Sparks, P., Hedderley, D. and Shepherd, D. (1992), `̀ An investigation into the relationshipbetween perceived control, attitude variability and the consumption of two commonfoods'', European Journal of Social Psychology, Vol. 22, pp. 55-71.

Sparks, P. (1993), `̀ Explaining choice and choosing explanations'', Appetite, Vol. 20, pp. 217-8.

Spring-Rice, M. (1981 (1939)), Working Class Wives, Virago, London.

Steven, M. (1985), The Good Scots Diet: What Happened To It?, Aberdeen University Press,Aberdeen.

Stitt, S., Jepson, M., Paulson-Box, E. and Prisk, E. (1997), `̀ Schooling for capitalism: cooking andthe national Ccurriculum'', in KoÈhler, B.M., Feichtinger, E., BarloÈsius, E. and Dowler, E.(Eds), Poverty and Food In Welfare Societies, WZB, Berlin.

Stronks, K., van de Mheen, D., Casper, H., Looman, W.N. and Mackenbach, J.P. (1996),`̀ Behavioural and structural factors in the explanation of socio-economic inequalities inhealth: an empirical analysis'', Sociology of Health and Illness, Vol. 18 No. 5, pp. 653-74.

Whitehead, M. (1991), `̀ The concepts and principles of equity and health'', Health PromotionInternational, Vol. 6 No. 3, pp. 217-28.

Wilkinson, R. (1992a), `̀ National mortality rates: the impact of inequality?'', American Journal ofPublic Health, August, Vol. 82 No. 8, pp. 1,082-4

Wilkinson, R. (1992b), `̀ Income distribution and life expectancy'', British Medical Journal,Vol. 304, pp. 165-8.

Wilkinson, R. (1994), Unfair Shares, Barnado's, London.

Wilkinson, R. (1996), Unhealthy Societies, Routledge, London.

World Health Organisation (1990), Diet, Nutrition and the Prevention of Chronic Disease,Technical Series, No. 797, World Health Organisation, Geneva.