Then and now

The study of the ‘social’ in the nutrition sciences is not a new phenomenon; it could be argued that nutrition as a discipline in modernity emerged from nutrition as a social issue. Wilbur Atwater, credited with leading the nutrition movement in the USA in the late 19th century, linked nutrition with the labour unrest of the time and argued that ‘optimal nutrition would increase productivity’ while at the same time ‘the application of sound nutrition principles would reduce worker expenditures for food, thereby increasing the buying power of existing wages’⁽Reference Aronson²⁴⁾ (p. 478). The emergence of the discipline of nutrition, however, has more to do with the linking of nutrition to a social issue in order to access resources than to a genuine concern for addressing the issue. Aronson makes the claim that, once established, nutrition scientists distanced themselves from the social issues, and that new disciplines ‘emerging under conditions of marginal institutional support, to establish themselves “turn” the definition of political issues of class conflict into problems of deviance or moral order’⁽Reference Aronson²⁴⁾ (p. 484). It comes as little surprise then that from the beginning of the 20th century a significant and intentional effort was made to dissociate the nutrition sciences from social issues and reconfigure them as biomedical⁽Reference Aronson²⁴⁾.

Various attempts have been made to recover and rehabilitate the contribution that the ‘social’ can make to the discipline. Only three decades ago, ‘Social Nutrition’ was distinguished as an emerging sub-discipline that embraced ‘the study of social, psychological and economic factors that determine food habits and of the means by which future choice may be influenced in the interests of better nutrition’⁽Reference McKenzie²⁾. In this same decade, Eide⁽Reference Eide³⁾ was also writing about the requirements for engaging with a social orientation in studying food access, and Rozin⁽Reference Rozin²⁵⁾ was calling for a better balance between scientific–technical concerns and the realities of everyday life through a more active engagement with social science research paradigms.

Australian social nutritionist Crotty's⁽Reference Crotty¹²⁾ observation that the act of swallowing divides nutrition into the post-swallowing domains of biology, physiology, biochemistry and pathology and the pre-swallowing domains of behaviour, experience, culture and society was (and remains today) important in characterising two necessary parts of the nutrition sciences. In 1993 she expressed concern that, despite the growing focus on PHN, there continued to be a dominance of the influence of the post-swallowing domains in nutrition policy making. Notably her concerns lay with gaps in social nutrition knowledge and methods of community engagement. Her interests included the social context of food behaviour and, in particular, aspects of domestic life, insiders’ perspectives on food provisioning, and developing critical insights into dietitian–nutritionists’/policy makers’ roles, interests and actions. Within the Australian context, the research needed to fill these gaps is not carried out as part of any integrated research strategy, and the challenge to integrate the two spheres of knowledge remains.

These pioneers of social nutrition were all writing at a time when having an understanding of ‘social’ context was seen as having relevance quite specific to the nutrition educator and particularly to action at the community level⁽Reference McKenzie^2–Reference Crotty^4, Reference Rozin²⁵⁾. Today, the significant expansion of the PHN workforce, alongside an expanded and multi-strategy agenda, means that having quality social science research to inform policy remains critical.

If the authors of the Giessen Declaration have not given the status quo within the nutrition sciences a glowing endorsement, this NNSP-led critical self-reflection has been amplified by recent Australian sociological analyses. Critics of biotechnical hegemony in the traditional nutrition sciences have variously argued that its dominant paradigm privileges nutritionism ⁽Reference Scrinis²⁶⁾, where a nutritionally reductive approach to food has come to obfuscate other ways of engaging with food, and that rapidly evolving (and potentially profitable) biotechnologies, nutrigenomics and other biotechnical responses to nutrition problems have grown in significance, to the detriment of the promotion of a more socio-ecological model⁽Reference Scrinis^27–Reference Dixon, Hinde and Banwell²⁹⁾.

Much, however, is changing in the nutrition sciences. In contrast to the ‘social’, the most recent decade has seen the ‘environmental’ dimension of the NNSP capture the attention of consumers, practitioners, researchers and increasingly policy makers. The imperative behind the NNSP has been that ‘planet Earth is on the brink of major climate change, with its implications for food production, and of massive shortages of sustainable energy and safe water’⁽Reference Wahlqvist¹⁹⁾ (p. 766). Intensification of agricultural and animal-rearing practices and the concomitant risks associated with changing climatic patterns, industrialisation of food processing to meet consumer demand, global distribution of plant and animal varieties, and the reduction in food crop and livestock biodiversity will all impact on the ability of communities to grow and consume particular food types⁽Reference Lang^20, Reference Lang^30, Reference Johns and Eyzaguirre³¹⁾. For those trained in the biological sciences, the integration of nutritional and environmental concerns represents a relatively safe ground for expansion in a number of ways: the shared research quest for knowledge and the ‘truth’ (epistemologies), the integration of environmental considerations into an expanded set of dietary guidelines, and a number of common or overlapping grassroots applications. Research in the fields of the environment, agriculture, climate change and biotechnology all have positivist science frameworks that can be applied at regional, local and household levels. There are clear levels of enquiry, hypotheses to be formed and researched, outcomes to be measured and funding available. The implications of major climate change on food production and on the sustainability of that production has resulted in the direct link with nutrition⁽Reference Wahlqvist¹⁹⁾. Internationally, dietary guidelines for sustainability were developed 25 years ago and more recently this has captured the imagination of consumers through the local food and Slow Food movements⁽Reference Rose, Serrano and Hosig^32–Reference DeLind³⁶⁾. Concerted efforts in this arena have now placed the environment, the protection of natural resources and sustainability of the food supply on the agenda for the next iteration of the Australian Dietary Guidelines⁽³⁷⁾ and on the national food policy agenda⁽³⁸⁾.

Interpreting the social

Today, the word ‘social’ gets used by nutrition scientists, and especially those engaged in PHN, with relative ease – we look for the social determinants, aim to integrate the social with the biological and environmental dimensions, and engage with the socio-cultural or socio-economic in order to influence environments and food choice for better health outcomes. Yet, the appreciation of what the ‘social’ encompasses is not clearly articulated.

What needs to be clearly delineated here is a more sociological way of thinking about the social dimensions of nutrition. Sociologists typically think about human behaviour in terms of the influence of structure and agency. In this context human ‘agency’ refers to the capacity of individuals to act independently and to make their own judgements and decisions in social life. In this sense the individual is seen to have control over his/her food choices. Germov and Williams explain social structure as referring to ‘recurring patterns of social interactions by which people are related to each other through social institutions and social groups’⁽Reference Germov and Williams¹⁶⁾ (p. 10). If we were to accept structural forces as being a dominant factor in shaping our food choices, then we would support the idea that we are very much products of our society.

The position taken by many modern social theorists is to attempt to argue not solely for an explanatory role of agency or structure, but to attempt to find a point of balance between the two. Structure and agency are seen as complementary forces – structure influences human behaviour, and humans are capable of changing the social structures they inhabit. These views are now represented in contemporary literature in the sociology of consumption⁽Reference Schor, Slater and Zukin^39–Reference Warde⁴¹⁾ and the sociology of health⁽Reference Williams⁴²⁾.

While structural perspectives, and their associated analytical approaches, seek to explain social, political, economic and environmental structures and institutions and their shaping of population dietary practices, the agentic perspective takes as its starting point that human behaviour is based on individuals’ interpretation of a situation and the meaning given to it. The latter tells us how, in a given social context, communities, households and individuals respond to the conditions in which they find themselves.

Concerns about the inability of research methodologies in the nutrition sciences to capture the dimensions of understandings required around ‘pre-swallowing nutrition’ have not gone unnoticed. Pelto and Freake⁽Reference Pelto and Freake⁵⁾ provide a broad overview of social science contributions to the nutrition sciences, and a recent paper by Delormier et al.⁽Reference Delormier, Frohlich and Potvin⁴³⁾ has further advanced the theoretical argument regarding the perception of eating as a social practice rather than simply a behaviour. Notably, Delormier et al. highlight the misleading tendency of behaviour-oriented methodologies used to study food choice to ‘exaggerate the extent to which rational choice drives what people choose to eat, and underestimates the extent to which eating is embedded in the flow of day-to-day life’⁽Reference Delormier, Frohlich and Potvin⁴³⁾ (p. 217). Yet by and large this is the dominant way in which the nutrition literature presents investigations of food choice. Some attention has been paid to research methodologies that explore approaches that move beyond positivism and postpositivism by adopting alternative epistemological perspectives (e.g. constructivism, critical realism, feminism, symbolic interactionism) more amenable to investigation of the agential perspective⁽Reference Landman^8, Reference Fade^11, Reference Fade⁴⁴⁾.

Research that explores structural concerns has grabbed the imagination of public health and sociology of nutrition and food policy scholars, particularly in the last decade⁽Reference Lang^20, Reference Lang, Barling and Caraher⁴⁵⁾. As a result, terms like food miles, $/kJ analysis, food system analysis, food marketing environment and obesogenic environment are used widely by nutritionists, something unheard of two decades ago. There is also a substantial body of research that measures the role of socio-economic disadvantage in nutritional inequalities. These advances in knowledge, while critical in building a framework for understanding of the multiple social structures, do not provide, in themselves, a complete picture. These perspectives tell us about the conditions that shape food choice, but illustrate neither the experience of living under these conditions nor how different individuals and households respond differently to similar conditions. The risk involved here is that in research and policy making there is a shift to a position where concerns with structure overshadow and override agency-oriented perspectives. This can lead to the mistaken belief of the ‘social’ in ‘social nutrition’ as a unidirectional process involving only structural forces. Nutritional scientists trained in the dominant biomedical paradigm⁽Reference Dean⁴⁶⁾ and enmeshed with deterministic research approaches have turned the ‘social’ into branches of behavioural epidemiology and quantitative nutritional sociology that adopt what Murcott⁽Reference Murcott⁴⁷⁾ has referred to as political arithmetic, where links are made between social characteristics and nutritional deficits, with a view to ‘proving’ who or what should be the target of interventions. The ongoing research interest in the association between working mothers and forms of malnutrition (i.e. both undernutrition and obesity) in children⁽Reference Phipps, Lethbridge and Burton^48–Reference Anderson, Butcher and Levine⁵⁰⁾ is one example of such treatment. This approach to diet that reduces it to the primary causal factor for nutritional disease contrasts with a ‘social’ approach that recognises the narratives behind diets and constructs them as an outcome of a complex set of processes, leading to potentially more effective interventions. The social approach would also complement the ‘food-based’ approach providing local context for the translation of food and nutrition policy into communities and households⁽Reference Wahlqvist⁵¹⁾.

Structural research is significantly removed from the human level (the agential perspective) where nutritionists interact with real people and their dietary practices. SENS start at this point and propose a research agenda that serves first the needs of households and communities (in all their diversity) as well as the practitioners and policy makers who work with them. Research and practice at the agential level also allows understanding of, for example, local contexts and variation, the experience of populations living on the margin, of ethnically diverse and migrating communities, and of those living in diverse household forms.

There will always be a need for local context research methods, whether carried out by researchers, nutritionists or other community health workers equipped to undertake this work as part of their role. Socially engaged research makes it possible to tailor existing programmes, or devise original programmes to meet local conditions and communities via a range of critical methodologies⁽Reference Travers^52–Reference Cook⁵⁵⁾. Research that investigates either the structural or agential dimension, as well as research that investigates the interplay between these dimensions, can be paradigm shifting by contributing theoretical insights, and by generating new theory.

A proposal

In outlining the proposal for socially engaged nutrition sciences it is necessary to emphasise that there is no singular ‘nutrition science’ with roots in natural (biological) sciences, with a range of derivative sub-disciplinary fields, but rather the ‘nutrition sciences’ (pl.). It is also important to highlight that ‘social nutrition’ has played a significant role in the history of nutrition, but the time has come to revisit its definition, scope, and future requirements for its development and relevance to all nutrition endeavours. SENS would require an active engagement with the social sciences in training of nutrition professionals, in nutrition curriculum, and in research activities concerned with the study of human nutrition and in nutrition professionals’ practices.

We have adopted the descriptor socially engaged for two reasons. First, we wish to highlight the desirability of a discipline that explicitly engages in its research agenda and scope, policy and practice with issues relevant to society, and in a way that reflects the values and ethical standards of the broader society, not just those of an academic community. Similar ideals have led movements of social engagement within disciplines (architecture and art), institutions (universities) and religious communities (Buddhism and Islam), where terms such as ‘socially responsible’, ‘participation and collaboration’ and ‘engaged practice’ reflect the move towards recognising the potential to contribute to social transformation and development. In more socially engaged nutrition sciences, the full spectrum from biological and chemical scientific perspectives to social scientific research that explores food consumption practices of real people living in society are given due weighting. For food and nutrition policy makers to move towards this, there is a need to recognise the centrality of the ‘social’ and that matters concerned with nutritional health and well-being of individuals, households, communities and populations in a life course perspective are mediated via the social roles and relationships, meanings, activities and organisations that tie food and people together.

Second, in order to understand this perspective a dedicated research agenda that privileges approaches that are sympathetic to the provision of in-depth understanding of this social reality is needed. This would encompass the strategic engagement with more theoretically informed, qualitatively driven social science research that explores, and contributes to our understanding of, the myriad social dimensions of feeding and eating that play a role in human health in contemporary settings. While the nutrition sciences are lagging in their appreciation of the ‘social’, food- and nutrition-related research is being carried out by socially engaged scientists. This work rarely appears in nutrition journals, but interest is such that papers, special editions and dedicated conferences can be now seen in the fields of sociology, cultural studies and human geography. Some illustrative examples of agent-focused socially engaged research on the topics of overweight and obesity, feeding families, breast-feeding and food security are shown in Table 1. Additionally, research that contributes to a life course perspective to nutrition (as described by Wethington⁽Reference Wethington⁵⁶⁾) for children⁽Reference James, Kjørholt and Tingstad⁵⁷⁾ and in family households⁽Reference Jackson⁵⁸⁾ demonstrates the potential of socially engaged research to enhance the nutrition sciences as a disciplinary field of research and to inform professional practice. The socially engaged in socially engaged nutrition sciences is, therefore, both about processes (of engagement) and outcomes.

Table 1 Examples of agent-focused socially engaged food and nutrition research

Implicit in SENS is the necessity for a multiplicity of perspectives and multidisciplinary social science research to underpin theoretically informed⁽Reference Dean⁵⁹⁾ and evidence-based⁽Reference Perez-Escamilla and King⁶⁰⁾ nutrition policy and practice. In this way SENS could substantially enhance the potential of the nutrition sciences to improve population health. The remainder of the paper will address this proposal, and briefly discuss some of the policy and practice implications of embracing a social engagement approach to nutrition.

Policy makers or practitioners need to view their analyses of nutrition issues and problems through both structural and agential perspectives in order to deliver actions/programmes/policies which deliver outcomes that work, given the social realities. Impregnation of the analytic lenses with research findings from both perspectives is necessary to achieve this.

A social engagement approach to nutrition includes attention to those aspects of the social, cultural, economic, geographic and political environment that have a direct bearing on human nutrition, seeks to understand the role of structure and agency, and fosters research at these macro and micro levels. All these dimensions are important, but further critical attention needs to be paid to the understanding and interpretation of ‘social, ‘cultural’, ‘economic’, ‘geographic’ and ‘political’ in the context of nutrition studies. Disciplines like cultural sociology, human geography, social anthropology, political science and health economics provide expertise that is currently underutilised in the nutrition sciences. While we acknowledge distinct sub-fields that now exist dedicated to the study of nutrition and food, particularly in sociology and anthropology, we believe that further diversity in social science perspectives and methodologies is necessary, and that, to date, the dominance of positivist approaches within the nutrition sciences has constrained the breadth of social science enquiry. Epistemologically, SENS research sets out to pioneer qualitatively driven, multidimensional approaches to social explanation that are pursued strategically in the service of research questions that encompass the range of food and nutrition issues in human populations where they present as social problems.

If the nutritional sciences were to more readily embrace an understanding of the field as suggested here, and if a SENS research agenda were used to inform PHN practice and policy, this would support a move towards a profession and discipline of human nutrition that holds values of social, economic and ecological sustainability at its core, understands dietary practices as socially constructed practices, and supports interventions, strategies and policies that are in tune with agential as well as structural impediments to good health outcomes.

Currently NS dedicates limited attention to these areas of investigation. We believe that this is partly due to an undervaluing of the ‘social’ and a lack a clarity regarding what the ‘social’ encompasses. This imbalance needs to be addressed. Increasing the appreciation of the ‘social’ can only be realised when it is fully integrated into curriculum design for degree programmes that have a nutrition focus, and when it becomes the norm for social scientists with an interest in food and health to be appointed in university schools of nutrition sciences. The failure of nutritionists’ education to provide comprehensive access to and critical analysis of a more socially engaged approach will continue to limit the extension and expansion of nutrition.