Geographies of Food: Global Visions of Healthy and Unhealthy Food (Springer Geography) 3031498720, 9783031498725

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Springer Geography

Harrison Esam Awuh Samuel Agyekum   Editors

Geographies of Food Global Visions of Healthy and Unhealthy Food

Springer Geography Advisory Editors Mitja Brilly, Faculty of Civil and Geodetic Engineering, University of Ljubljana, Ljubljana, Slovenia Richard A. Davis, Department of Geology, School of Geosciences, University of South Florida, Tampa, FL, USA Nancy Hoalst-Pullen, Department of Geography and Anthropology, Kennesaw State University, Kennesaw, GA, USA Michael Leitner, Department of Geography and Anthropology, Louisiana State University, Baton Rouge, LA, USA Mark W. Patterson, Department of Geography and Anthropology, Kennesaw State University, Kennesaw, GA, USA Márton Veress, Department of Physical Geography, University of West Hungary, Szombathely, Hungary

The Springer Geography series seeks to publish a broad portfolio of scientific books, aiming at researchers, students, and everyone interested in geographical research. The series includes peer-reviewed monographs, edited volumes, textbooks, and conference proceedings. It covers the major topics in geography and geographical sciences including, but not limited to; Economic Geography, Landscape and Urban Planning, Urban Geography, Physical Geography and Environmental Geography. Springer Geography—now indexed in Scopus

Harrison Esam Awuh · Samuel Agyekum Editors

Geographies of Food Global Visions of Healthy and Unhealthy Food

Editors Harrison Esam Awuh Faculty of Human Geography and Spatial Planning Utrecht University Utrecht, The Netherlands

Samuel Agyekum Institute of Geography, Political Urbanism and Sustainable Spatial Development University of Bern Bern, Switzerland

ISSN 2194-315X ISSN 2194-3168 (electronic) Springer Geography ISBN 978-3-031-49872-5 ISBN 978-3-031-49873-2 (eBook) https://doi.org/10.1007/978-3-031-49873-2 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Paper in this product is recyclable.

Foreword

Food is a fundamental requirement for all, not just for survival but for optimum growth, development, health and wellbeing through all the stages of life from conception to death. Food has multiple dimensions; beginning from the biological and physiological, it spans across the psychological, emotional, spiritual, societal, economic, environmental and political. Food impacts all these domains even at multiple levels, while all these domains interact with and impact food and food habits. This dynamic gives rise to food systems that determine the availability and accessibility of food to individuals and communities. Further, food and the nourishment derived from its components are key determinants of health and wellbeing of every person. Dietary diversity is now recognised to be essential for a healthy gut microbiome which in turn determines the person’s health and wellness. For this outcome, nutritious food of good or high quality and culturally preferred food should be available in sufficient amounts. In the mainstream Western perspective, healthy food has been largely linked to its nutrient composition, often ignoring the non-nutrient bioactives which have gained scientific attention in the recent decade. Across the world, urbanisation, globalisation, super-marketisation and the media-based food culture strongly influence food choices. The economics of food processing dictates use of one variety of a food type over others. Also, access to healthy food is a fundamental right which is often violated. This violation results in the high prevalence of hunger and malnutrition as proven in global statistics. The need to build a sustainable world in which everyone, everywhere has regular access to sufficient nutritious food that is culturally and personally acceptable is well recognised today. This is particularly urgent in current times with the climate change crisis, economic and political instability and food security, all of which contribute directly or indirectly to increasing food insecurity. Producing food and making it fit for consumption is a large human activity at the individual, community and industry levels with numerous stakeholders. These stakeholders include the following amongst others: the producer, the processor, the seller, the regulator, the government and above all the consumer. Power dynamics both within and between these groups strongly influence what, when and where food

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is available for every consumer. In many traditional societies, the woman/homemaker is a repository of knowledge of not only food and its culinary dimension, but also its contribution to health. Across cultures, women’s knowledge of spices, herbs and condiments were used to promote wellbeing, prevent disease and even treat it. But this dimension of food is not in the mainstream or structured knowledge domain. This highlights issues around inclusion and unequal power relations concerning knowledge about food. The vision to address these issues of power and inclusion in the domain of food for nourishment and health at the international, national, regional and local levels has seen multifaceted approaches. The editors of this book Dr. Harrison Esam Awuh and Samuel Agyekum and the other contributing authors have successfully set out to demonstrate an alternate perspective for a sustainable food future. They see the central role of the consumer, a key stakeholder in healthy food transformations as fundamental, rather than the dominant expert-driven food systems transformation knowledge. The necessity to address the problem of access and inclusiveness in food security, reflecting a range of social and environmental needs, is emphasised. A better understanding of the contextual factors—both independently and in interaction with each other—is required to make sense/sensemaking of healthy food, as well as visions of food. The book therefore aims at a more globally inclusive approach in producing meanings of food and future visions of food to strengthen food systems transformations. In an increasingly globalised world with explosion of information and opinion sharing on virtual platforms, the interplay between the physical experiences in specific time-space domains and those from outside may have different impacts on the way individuals and communities perceive and respond. The case studies from eight countries documented in the different chapters (The Netherlands, Cameroon, Ghana, Italy, Philippines, Canada, South Africa and India) reveal what the consumers/ societal groups see as healthy and unhealthy food for now and tomorrow in their respective spaces/places. The authors articulate inclusive meanings and visions of the present and future from these regions and thus, bring out both their common threads and unique perspectives. They have succeeded in synthesising meanings of healthy food from different regions by initiating a global discussion on the importance of consumers, cultures or social representations. They reiterate that this can facilitate adoption of policies towards the transformation of food systems that are sustainable socially, economically and ecologically. The unique and interesting perspective of the book will beneficially inform scientists, scholars, regulators and policy makers in the food, health and allied sectors. We share one world, and we seek health and wellness for all. In this inter-connected synergy, which is the large canvas, an understanding of the similarities and differences at the local and granular level is the key for sensible road maps to the goal. After all, as said, the Devil is in the Detail, and this book nudges all stakeholders to observe these details with an open mind to achieve the desired transformation. The empirical data sets collected and presented are compelling and provide the basis for such an approach by exploring different narratives on food and transformation.

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This book contributes to broader and more holistic understanding of what is viewed by consumers as healthy food and their vision of a healthier and more sustainable food future. It lends strength to the thesis that the pursuit of visions determined by all stakeholders irrespective of power can be effective in initiating the muchneeded change. It can fill the gap in the transition to a sustainable future in which food supports the health of the environment that sustains people. Prof. Usha Antony Dean, College of Fish Nutrition and Food Technology Tamil Nadu Dr. J. Jayalalithaa Fisheries University Chennai, India

Preface

Having an idea and turning it into a book is as hard as it sounds. The seed for this book was sown when I decided to take up a position as postdoctoral researcher in food system transformation at Aeres University of Applied Sciences in the Netherlands. My responsibility in this position was to study the needs, opportunities and effects of citizen engagement in urban food system transformation. This addresses the issue of how citizens can be engaged in the developments towards a more sustainable and healthier regional food system. Through collaboration within a multi-disciplinary team, I had to co-develop and expand a Citizen-Consumer-Lab that works for and by citizens. However, as the political ecologist I am, my first interest was to question what the concept of healthy or unhealthy is in the food domain. Who decides on what is healthy or unhealthy? When I raised concerns of a lack of inclusion in definitions of what is considered healthy or unhealthy with one of my colleagues (a nutritionist), the answer was blunt, ‘healthy food is what has been scientifically proven to be good for the body and that is the established fact’. This absolute claim put more doubts into my head about what sort of transformation I should be working towards in my postdoc position. This scientific stand on food health was in conflict with my own values of food health as a boy growing up in Cameroon in the nineties. I knew that concerning the food we used to eat, taste was just as important as what the food does to the body. No one I knew in my younger years in Cameroon enjoyed eating food that tastes horrible just for the health benefits. As my uncle James would often say, ‘You might as well eat medication from the pharmacy if all you think about is what the food does to your body’. I felt there was the need to understand what the ‘normal’ or unscientific consumers think about healthy or unhealthy food before I initiate a transformation pathway that consumers can see as a reflection of how they feel or what they think. Initially, I conducted research in the Netherlands (Flevoland) to understand consumers’ understandings of healthy food, unhealthy food and visions for a healthier food future. As expected, an overwhelming majority of consumers in the Netherlands described unhealthy/healthy food based on the nutritional disadvantages or advantages of certain foods. While a majority described healthy food based on nutritional advantages derived from foods, a significant number of people made reference to healthy ix

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food as ‘happy food’ (over 20%)—despite the fact that the government and formal institutions overwhelmingly promote a nutrition-based understanding of healthy food. Happy food was understood as food which might not necessarily offer any nutritional advantages, but its intake makes consumers feel happy—either through flavour or the general feel-good factor associated with the food. Looking closely at this sample, I noticed that a majority of the consumers (79%) in the Netherlands who presented healthy food as happy food (socially constructed meaning of healthy food) had migrant backgrounds. This generated an interest in understand global meanings of healthy and unhealthy food beyond the Netherlands. This initiative to understand global meanings of healthy and unhealthy food was also driven by the fact that a more globally inclusive approach in producing knowledge on meanings of food and future visions of food is a promising approach in food systems transformations. Consumers from all over the world have deeply engrained biological, psychological and cultural relationships to food which need to be recognised before we can successfully make the change to healthier and more sustainable food practices in future. This is how the idea of this book was conceived. Enjoy being immersed into the food environments of consumers from across the world as you read this book. The experience of writing this book has been both internally challenging and rewarding. However, this whole experience won’t have happened if it wasn’t or the dedication and assistance of a special group of people. Besides the chapter co-authors who have done a wonderful job, I wish to extend very special thanks to all the following selfless people who have been a part of making the dream of this book come true: Himanshu Sharma (India); Renu Sharma (India); Shachi Phadke (India); Nathan Simes (New Zealand); Juan Bautista Propato (Argentina); Monica Guasca Ricuarte (Colombia); Connie Fuentes Garido (Mexico); Christopher Permain (Mexico); Lee Pennington (United Kingdom); Patrick Coelho (New Zealand); Rebecca Simes (New Zealand); Kendra Parry (Peru); Tita Check Mbanwi (Cameroon); Mark Kwenoel Ndiformbie; Adrienne Troughton (New Zealand); Ainsley Simmonds (New Zealand); Emilia Vidaki (Romania); Mar Ortega (Spain); Anissa Sidhoum (France); Anne-Sophie Lotti (France); Jane Atesoh (Norway); Ian Fru (Norway); Amalie Hilde (Norway); Alice Douv (France); Elton Musita (Zimbabwe); Sally Chandra Hapsari (Indonesia); Floor Spijkers; and Mark Sandow. The world is a better place thanks to people like you who want to develop and share knowledge with others. People like you who share the gift of their time to contribute to producing knowledge for public good. Utrecht, The Netherlands May 2023

Dr. Harrison Esam Awuh

About This Book

In this book, the authors re-examine the role of place in global meanings and visions of healthy and unhealthy food through national case studies in nine countries across the globe. Here, place is conceptualised as a unique platform that mediates physical, social and economic processes and thus affects how such processes operate. This presents a more holistic view of places as the geographical context for meditating on physical, social and economic processes. But how can we understand these mediation processes? In this book, it will be captivating to see how and if place can still play a role in sensemaking about meanings and understandings of healthy and unhealthy food or not. This book uses a robust empirical perspective with case study chapters to fill this knowledge gap.

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Introduction to Understandings of Healthy and Unhealthy Food . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Harrison Esam Awuh

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Meanings and Visions of Healthy and Unhealthy Food in Flevoland, the Netherlands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Harrison Esam Awuh

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Cameroon: Land of Good Food, Agriculture, and Various Visions of Good and Bad Food . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ravenstein Nyugap Awuh

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Achieving Food System Transformation Through an Inclusive Understanding of Healthy and Unhealthy Food: The Case of Winneba, Ghana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Emmanuel Acheampong

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Perceptions of Healthy Diets and Food Futures in Veneto, Northern Italy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Antonio Pietropolli and Cristian Trujillo

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Exploration of the Diverse Meanings Ascribed to Food by Consumers in Eastern Visayas, Philippines . . . . . . . . . . . . . . . . . . . Gina A. Delima and Christopher Jr. R. Galgo

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Perceptions of Healthy and Unhealthy Food among People with Migrant Backgrounds in Canada: The Case of Toronto . . . . . . 123 Vincent Konadu and Harrison Esam Awuh

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From Heritage to Health: The Many Meanings of Food in South Africa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Johan Coetzer and Robin Breedeveld

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Exploring the Complexity of the Food Environment in India to Understand Healthy and Unhealthy Food . . . . . . . . . . . . . . . . . . . . . 163 Swapnil Tukaram Baste and Tanushree Sanjay Brahmankar

10 Contradictions and Consistencies in Understandings of Food in High and Low-Middle-Income Countries . . . . . . . . . . . . . . . . . . . . . . 183 Harrison Esam Awuh and Samuel Agyekum 11 The Entangled Islands: The Influence of Space–Place Relations in Global Meanings and Visions of Healthy Food . . . . . . . . 205 Samuel Agyekum and Luke Covill

Editors and Contributors

About the Editors Dr. Harrison Esam Awuh is a political ecologist and a human geographer by training. He is an assistant professor in climate change, food health and inequalities at the Department of Human Geography and Spatial Planning, Utrecht University, The Netherlands. Prior to this position, he served as a senior researcher at Aeres University of Applied Sciences and Flevo Campus (the Netherlands). Dr. Harrison Esam Awuh has conducted research and published several peer-reviewed papers on sustainability in the nature conservation sector in Africa (specifically Cameroon) and microfranchising in Africa (specifically Ghana). He also worked on a collaborative research project on sustainability in the frugal innovation sector. This was part of the Leiden University, Erasmus University Rotterdam and Delft University cooperation on frugal innovations. He has taught several courses on sustainability, urban political ecology and research methods to master’s and bachelor’s degree students at Leiden University, Katholieke Universiteit Leuven (KU Leuven, Belgium) and Aeres University of Applied Sciences (The Netherlands). Samuel Agyekum is an urban geographer with an orientation towards environmental planning. He is currently pursuing a Ph.D. in Urban Geography within the Institute of Geography—Political Urbanism and Sustainable Spatial Development group—at the University of Bern, Switzerland. Before, he studied M.Sc. Urban Environmental Management at Wageningen University and Research in the Netherlands. There, he started researching issues within the domains of urban food system and green cities, which are his specialties. Within these specialties, Samuel is currently exploring the question: how urban green commons could spur post-growth society within the Global North and the Global South. His research ambition is to enhance the discourse of critical sustainability science through interdisciplinary research, where inclusion is at the heart of creating sustainable futures.

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Contributors Emmanuel Acheampong University of Nebraska-Lincoln, Lincoln, USA Samuel Agyekum Institute of Geography, University of Bern, Bern, Switzerland Harrison Esam Awuh Aeres University of Applied Sciences/Flevo Campus, Almere, The Netherlands; Department of Human Geography and Spatial Planning, Utrecht University, Utrecht, Netherlands Ravenstein Nyugap Awuh University of Bamenda, Bambili, Cameroon Swapnil Tukaram Baste Van Hall Larenstein University of Applied Sciences, Arnhem, The Netherlands Tanushree Sanjay Brahmankar Van Hall Larenstein University of Applied Sciences, Arnhem, The Netherlands Robin Breedeveld University of Cape Town, Cape Town, South Africa Johan Coetzer Cape Town, South Africa Luke Covill Aeres University of Applied Sciences, Dronten, The Netherlands Gina A. Delima Institute for Strategic Research and Development Studies, Visayas State University, Baybay City, Leyte, Philippines Christopher Jr. R. Galgo Institute for Strategic Research and Development Studies, Visayas State University, Baybay City, Leyte, Philippines Vincent Konadu Brock University, Toronto, Canada Antonio Pietropolli Policy Analyst, Brussels, Belgium Cristian Trujillo Researcher at Resource Matters ASBL, Brussels, Belgium

Chapter 1

Introduction to Understandings of Healthy and Unhealthy Food Harrison Esam Awuh

Abstract The introductory chapter begins by making a strong case for the food system transformation based on the argument that food system transformation currently has a very limited focus on social sustainability. More importantly, there is a lack of sufficient recognition for the inclusion of consumers’ perspectives in pathways for food transformation. In addition, the chapter argues for explicit and diverse transition pathways regarding food systems. Drawing on the dearth of knowledge in connection with what (un)healthy food means in some contexts, the chapter argues for a more inclusive global vision of (un)healthy food as a pathway for achieving a diversified transformation but also pluralising the voices within the transition process. By raising six key questions, the chapter further explains the geographic notions of place and space as the conceptual basis for describing the study’s contexts. In conclusion, the chapter quizzed whether place or space has much influence in framing meanings of what is healthy or unhealthy. Without pre-empting the data gathered, the theory of sensemaking is also employed to explain plausible meanings of what is (un)healthy. Keywords Food meaning · Sensemaking · Place · Space · Consumers · Healthy · Inclusion

Introduction Concerns about global food security (or insecurity) gained increasing traction following the sharp price rises for agricultural and other commodities after the 2008 financial crisis. Following that, global hunger increased in 2016 after a prolonged decline (FAO 2018). More recently, the 2020 coronavirus crisis and the Russia– Ukraine war have again put food security (or insecurity) high on the policy agenda. This means that the world is currently confronted with significant decreases in food security and spreading public health challenges. In addition to guaranteeing food production, improved access to food has become an important component in thinking H. E. Awuh (B) Department of Human Geography and Spatial Planning, Utrecht University, Utrecht, Netherlands e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 H. Esam Awuh and S. Agyekum (eds.), Geographies of Food, Springer Geography, https://doi.org/10.1007/978-3-031-49873-2_1

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about food security. Furthermore, food and farming systems of the early twenty-first century overproduced cereals, oils and sugars and under-produced fruits and vegetables, thus, creating an imbalance between the optimum the world requires to benefit from a nutritious diet and what is produced (KC et al. 2016). Thus, the ‘Triple Burden of Malnutrition’ (i.e. under-nutrition, stunting and wasting), micronutrient deficiencies (iron, zinc, iodine and vitamin A) and over-nutrition (overweight and obesity) still pose major public health problems (Ebbeling et al. 2002; Global Nutrition Report 2017). Statistically, over two billion people are overweight or obese (Popkin 2017). Most countries face higher mortality from these nutrition-related non-communicable diseases (diseases that are not transmissible directly from one person to another) than under-nutrition which was the scourge of the past millennium. All these challenges add more urgency to how we think about food. As a result, food issues are currently at the centre of the public debate with issues such as the health and nutritive dimensions, the production process and the content of additives in the food products, the accessibility of fresh food and the origin of food products (Olsson 2018). Considering that food production is responsible for 20–30% of global environmental impact (Tukker and Jansen 2006; Onwezen et al. 2019), the daily food choices of consumers have a huge impact on the environment and public health. Therefore, consumers can improve both environmental impact and health by changing their diets. In addressing this, an increasing number of voices have highlighted the need to change the overarching structure of food-related policies, which they claim: address food safety issues, but not nutrition; lack regulations in connection with how food is consumed; and encourage food production systems with no link to sustainability (Global Nutrition Report 2017; Onwezen et al. 2019).

Consumers to Play a Central Role in Healthy Food Transformations However, transforming current food systems to support healthy and sustainable food system outcomes is a complex proposition. This is exemplified by the fact that consumer behaviour has not been sufficiently understood. It is often assumed that consumers will make rational choices with the right knowledge base (Chater et al. 2010). This suggests that people will refrain from unsustainable behaviour if they know they will receive punishment and engage in sustainable behaviour if a reward is permitted. This fits within the wider literature on command and control, ‘the incentive-based approach’ and the dominant paradigm of the ABC framework (attitude–behaviour–choice) of contemporary environmental policy (see Shove 2010). Although these rational approaches have led to a degree of favourable outcomes, the changes generated with these methods are often temporary or short term (Evans et al. 2012) or simply not significant enough. Therefore, there is a need to consider the roles of factors such as intrinsic motivations, moral convictions, social preferences, reciprocity and the impact of peer groups

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(Garforth 2015) in shaping the transition choices people make or could make. People do not only base decision-making on conscious deliberations. Research has shown that human behaviour is complex and influenced by a large range of internal and external factors (Onwezen et al. 2019). Food systems’ outcomes reflect complex causal processes that can involve interactions amongst various drivers (Ericksen 2008). This approach will provide a better understanding of why people stick to unsustainable choices despite more sustainable options or why people choose to switch to more sustainable food practices despite being surrounded by unsustainable choices. Understanding human preferences, visions and norms is the first step in the transformation towards more healthy and sustainable food choices.

The Problem of Insufficient Attention to Inclusion Nevertheless, one key stumbling block exists in understanding consumer behaviour concerning healthier and more sustainable food transformation. It is inclusion. Narratives about pathways to food system transformation are still either largely expertdriven (technocentric, technocratic) or based on ideas developed by a middle-class niche movement. Stakeholder participation has often been limited to involvement in agenda-setting, with little stakeholder involvement in knowledge creation, decisionmaking and (policy) evaluation (Dijkshoorn-Dekker et al. 2020). The monopolisation of power in the global food sector means that a few actors positioned along the food supply chain wield much influence on what, where, when and how food is grown, processed, distributed and consumed (Nature Food Editorial 2020). Focusing excessively on food systems or knowledge as a niche movement could enhance a resistance strategy instead of contributing to system-wide changes. Additionally, existing decision-support tools developed to inform policy-makers on the food system transition are mostly data-driven but hardly consider the activities and preferences of different stakeholders in the food system (Dijkshoorn-Dekker et al. 2020). The problem of access and inclusiveness in food security is receiving increasing attention in the literature (e.g. Sen 1982; Brons et al. 2020). This relates to problems of social inequalities, which are often linked to more broad-based structural urban inequalities and various forms of social, cultural, economic and spatial exclusion (Kolb 2015; Hochedez and Le Gall 2016). For deprived consumers and ethno-racial minorities, these inequalities combine with unequal capacity for participation in communication with public authorities and community-organised activities for the transformation of living conditions. This leads to increasing mistrust between groups and elevated risk of social unrest in more extreme cases, as revealed by Eriksson and colleagues (2017). This socio-economic exclusion also relates to exclusion in access to education (both formal and informal) as a resource in promoting better healthy food awareness. For instance, there has been an observable shift by middle-class consumers around the world towards diets that are better for overall health. In part, this has been stimulated by a global initiative to promote better food literacy (including cooking skills) amongst middle-class urban dwellers (KC et al. 2016). Enhancing

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consumer food education beyond the Western middle class to include vulnerable and disadvantaged groups could contribute to better overall diets globally. However, such transformations can generate inclusions and exclusions regarding who can partake and who benefits from them (Rose and Chilvers 2018; Rotz et al. 2019). When there is no space for diversity, some systems become hegemonic, generating inequalities and injustices which are non-desirable from a human welfare point of view or ecosystem integrity and sustainability standpoint (Rotz et al. 2019; Fraser 2020). As food systems become increasingly exclusive, serious attention must be given to addressing issues of power over the discourse of food systems—the democratisation of them. Food system transition is also inherently a political process with winners and losers, which involves choices, consensus and compromise about new directions and pathways. New voices in food discourse have much greater potential to act as disrupters of the system, and there is a need to use new entrants to create new products and/or value (Herrero et al. 2020).

Inclusive Perspectives as the Way Forward Food system transformations and the policies and strategies that support them should become more explicit about the diversity of transition pathways they contemplate. In order to be responsible, transformation pathways should evidently reflect a range of social and environmental needs. The inclusion of a range of actors in determining what the trajectory should be is crucial. More specifically, robust synthesis and assessment processes are needed to strengthen the legitimacy of scientific advice through transparency that encompasses the perspectives of low- and middle-income countries (Webb et al. 2020). There is a need to understand better which contextual factors— both independently and in interaction with each other—affect understandings of healthy and unhealthy food. A more globally inclusive approach to producing meanings and future visions of food is needed to strengthen food systems transformations. For example, there is a dearth of knowledge from the African continent about what people’s context-specific meanings and understandings of healthy and unhealthy food are. Or how they see the future of healthy food practices. This dearth of knowledge on what healthy or unhealthy food is in low- and-middle-income contexts precludes the establishment of a comprehensive context-specific theoretical and empirical knowledge of the participation processes in these regions. Consumers worldwide have deeply engrained biological, psychological and cultural relationships to food, which must be acknowledged. In a nutshell, there is a need for food system innovations to enable the transformation to a more sustainable and healthier food system on a global scale (Hoes et al. 2019) and with global meanings and visions of the future. One thing for sure is that pursuing visions determined by only a select group of people (policy-makers or other powerful actors) is unlikely to be fit for purpose (Klerkx and Rose 2020). Until we articulate inclusive meanings and visions of the present and future, it is difficult to start to anticipate the impacts of a food system transformation and how they can be

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made more responsible. This book attempts to investigate these global visions of the present and the future by asking and seeking answers to the following questions: 1. 2. 3. 4. 5.

What are the meanings of healthy food in different contexts? What are the meanings of unhealthy food in different contexts? How do people in different countries visualise healthier food futures? What can inhibit the realisation of these desired healthier food futures? What can facilitate the realisation of these desired healthier food futures?

Theoretical Framework: Place, Space and Sensemaking In order to guide the investigations needed to answer the aforestated questions from a global perspective, this book will use the geography concepts of place and space as a starting point. Space and place are now fundamental geographic notions, to the point that geography has even been defined as a science of place by the famous French geographer Paul Vidal de la Blache (2008) or as a spatial science (see Castree 2005). The conundrum of space and place in geographical knowledge concerns whether the question of ‘where?’ is sufficiently relevant in the way that ‘when?’ does in explaining ‘how?’ and ‘why?’ certain phenomena occur (Philo 1992). In the case of this book, when, how and why do certain meanings of food prevail? According to Agnew and Livingstone, the place refers to either a specific location somewhere (an address) or to the occupation of that location (living at the address) (Agnew and Livingstone 2011). In this sense, this book conceptualises place in two ways. Firstly, place is definable entirely in relation to a singular spatial metric (latitude and longitude, elevation, et cetera.) or other spatial grid defined by putatively nonspatial processes (core-periphery, city-hinterland, administrative regions, et cetera.). Secondly, place is also constituted by the impact that being somewhere has on the constitution of the processes in question. From this perspective, ‘place’ is a metaconcept that allows for the particular stories associated with specific places (Agnew and Livingstone 2011). Furthermore, Farinelli (2003: 11) states that amongst ancient Greeks, meanings of place can be clearly stated as, ‘a part of the terrestrial surface that is not equivalent to any other, that cannot be exchanged with any other without everything changing’. This means that place has its own special and unique qualities. However, increasingly, there has been a challenge to place as insignificant in the face of globalisation. The current challenge to place comes from the idea that the world itself is increasingly placeless with space-spanning connections and flows of information, things and people, undermining the rootedness of a wide range of processes situated anywhere in particular (Agnew and Livingstone 2011). In other words, space has consumed or absorbed place. From this perspective, new technologies are making ‘places’ obsolete. In this view, place is therefore nostalgic, regressive or even reactionary, and space is progressive and radical (Agnew and Livingstone 2011). To some scholars, globalisation has created networks that are placeless in any substantive, even perhaps locational, sense of the term (Marston et al. 2005). For instance, the term ‘place’ became associated with past geography, and space in itself

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was to be both the new object of study and the basis for a new and all-conquering contemporary geography. This was part of a spatial revolution in geography beginning in the 1960s with an increasing tendency to associate place negatively with the past and space positively with the future (Abler et al. 1971; Harvey 2000). Here, the focus was placed on modelling interaction over space, such as migration flows, diffusion of innovation, spacing of settlements as a function of distance to market, land uses specialisation and industrial location in terms of transportation costs, more than local/regional differences or place characteristics (see Berry 1967). This represents the transcending trend through which social relations and landscapes in place through mobility reflect the increased similarity of everyday life from place to place. In other words, what happens in Almere (The Netherlands) increasingly reflects Bamendas place (Cameroon) because both are exposed to the same spatial elements of globalisation. The distinction is not only an attempt to render place obsolete. It can also be viewed as an attempt to separate the physical place from the phenomenal space in which the place is located. In this case, place becomes a particular or lived space—place becomes a form of space. The consensus is based on a geometric conception of place as a mere part of space. In this sense, places are nodes in space which are reflective of the spatial imprint of universal physical, social or economic processes. Such contemporary conceptions of space and place depend on relatively complementary conceptions of what they mean—specifically the Newtonian and Leibnizian ones. In the Newtonian view, space is absolute. Space is an entity, independent of whatever objects and events occupy it, containing these objects and events and having separate powers from them (Slavov 2016). In the Leibnizian view, space is relational. This means that although it has no powers independent of objects and events, construed from the relations between them, space can be shaped by relations between objects and events therein (Bouquiaux 2008). The book weighs and absorbs the two views of space, but the Leibnizian approach is more relevant in analysing the meanings of healthy and unhealthy food. In the Leibnizian approach, space is only active because it comprises places where things are located within a force field at any particular moment (Feingold 2004; Antognazza 2008). Thus, drawing on the post-humanist actor-network theory of Latour (2007), but critical of its reluctance to engage with the ‘role of common ground’ or place in ‘how networks echo back and forth’, (Thrift 1999: 313), this book sees places as specific time–space configurations made up of the intersection of many encounters between ‘actants’ (people and things) that reflect ‘practical means of going on rather than something concerned with enabling us to see, contemplatively, the supposedly true nature of what something is’ (Thrift 1999, p. 304). This view reiterates that knowledge is always and everywhere geographically contextual and reflexive (Agnew and Livingstone 2011). Knowledge creation and circulation are invariably situated somewhere (Schatzki 1991). However, situating the view within the place vs space dialectic, it is still unclear if place (e.g. specific location in latitudes or longitudes) or space (systems of connections spanning connections and flows of information, things and people) is more influential in determining understandings of healthy or unhealthy food. Therefore, the study aims to address this knowledge gap. It digs

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deeper into the meanings of healthy food in different contexts by understanding why such meanings exist. Are peoples’ understandings of healthy or unhealthy food influenced by the specific locations or by the global networks to which they are connected, directly or indirectly? In order to understand how this place-space dialectic plays out in different contexts, this book draws on the Theory of Sensemaking to understand the acquisition of meanings of healthy and unhealthy food.

Sensemaking Karl Weick suggests that the term sensemaking refers to ‘the making of sense’ (Weick 1995: 4). Waterman (1990: 41) adds that it is the process of ‘structuring the unknown’ by ‘placing stimuli into some kind of framework’ that enables us ‘to comprehend, understand, explain, attribute, extrapolate, and predict’ (Starbuck and Milliken 1988, p. 51). Sensemaking is based on the principle that, occasionally, an attempt to explain the unknown is the only way to know how much you understand it. It can mean learning about the culture, politics and overall general structure of a problem. Ancona (2012) adds that sensemaking often involves moving from the simple to the complex and then back again to the simple. In other words, the simple is observing a phenomenon or phenomena. Then, the move to the complex occurs as new information is collected and new actions are taken to explain why the phenomenon is the way it is. Furthermore, as patterns are identified, and new socio-economic, cultural and ecological information is labelled and categorised to understand the phenomenon, the complex becomes simple once again (as the phenomena become easier to understand). According to Ancona (2012: 6), ‘there is no ‘right’ regarding sensemaking. Sensemaking is not about finding the ‘correct’ answer but creating an emerging picture that becomes more comprehensive through data collection, action, experience, and conversation’. Therefore, it is not about determining whose understanding of healthy or unhealthy is correct. Rather, it is about understanding why people think certain foods are healthy or unhealthy. In sensemaking, collecting data and observing trends in the data are only starting points. One then has to pay attention to environmental cues, incorporate new information and turn what may be incomprehensible data into useful data that can be used to transform practice. Sensemaking equals observing a phenomenon, looking for plausible meanings and understandings for the phenomenon and adapting the new meanings and understanding to understand better why the phenomenon is the way it is. Furthermore, sensemaking is not limited to understanding what we observe better. From an organisational and practical level, sensemaking can help understand why certain food habits are difficult to change, for example—why certain consumers could resist certain pathways of food system transformations. Also, sensemaking can help understand what is needed to make people overcome the threshold in transformation of the food system. So, in the domain of agency in food practices, sensemaking is a

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Fig. 1.1 Illustration of the concept of sensemaking as used to frame the theoretical base for this book

precursor to more effective action in changing how we eat. Based on acquired meanings and understandings, the chapters in this book would be able to reveal if places still play a significant role through their uniqueness in the acquisition of meaning through social relations. In other words, have places lost their unique capabilities to influence the acquisition of meanings based on social relations in the locales in an increasingly global world? Thus, understanding how places define meanings of social processes will need theoretical grounding based on the concept of sensemaking. After exploring the several chapters in this book and how the different authors try to ‘sensemake’ observable meanings, understandings and visions of healthy and unhealthy food, the concluding chapter will revisit the research question: are peoples’ understandings of healthy or unhealthy food influenced by the specific locations where they are or by the global networks to which they are connected either directly or indirectly? The conclusion will show how much this question can be answered based on the evidence in the chapters. See Fig. 1.1 below for an illustration of the theoretical guideline for this book.

Significance and Uniqueness of This Book The food system transformation discourse has attracted a lot of research interest, verified by the numerous publications (from students and teachers) searching for all-encompassing solutions to reaching a better food system transformation. Since

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consumers who are part of the food system are currently less discussed in the transition pathways, the book will show knowledge of how diverse consumers see healthy and unhealthy food to advance better the process of achieving more inclusive and just food system transformation pathways. This book will also be useful to policymakers who need knowledge of what consumers prefer to create robust policies to enhance sustainable food system transformation. The book has several illustrations with photographs and quotes that immerse the reader in the context within which the data were collected. The investigation of the same set of research questions in different contexts with sometimes different answers shows that there is no single truth or right way to see things. Also, the book presents the view of truth based on the way the respondents see it. It does not seek to impose a normative view of the truth on the way respondents perceive things in their contexts. In other words, it lets respondents determine what is good or bad in their contexts without any judgement. The following review presents how this book differs from some competing titles and how it makes a unique contribution to knowledge. Gaspar and colleagues (2020) use social representations of Brazilian, French and Spanish dietitians and young laywomen to define healthy food. In relation, this book does not object to the theoretical contributions of Gasper and colleagues (2020) regarding how the discourse on healthy food is constructed; the construction of the meaning of healthy food is framed by social, cultural and symbolic grounds linked to historical and sociocultural contexts. Nevertheless, this book widens the empirical base of the social representation of Sub-Saharan Africa and Asia, which are missing in the debates on the meaning of healthy food considering the growing food acculturation in these contexts due to the influx of Western diets. This has created unique (complex) societies with complex food cultures worth investigating. For example, this book extends the investigation of the social representation of food to Buea (Cameroon) and the Limpopo province (South Africa), where environmental heterogeneity and cultural diversity present a compelling case study in both cases for understanding social representations of healthy and unhealthy food. Mötteli et al. (2016) present a consumers’ perspective on the practical understanding of healthy food choices. Like this book, Mötteli and colleagues (2016) focus on consumers’ perceptions or meanings of healthy food. However, in their case, such consumer framings are expert-driven—unlike the case of this book, where the meanings are bottom-up. This is exemplified by the fact that in Mötteli and colleagues (2016), the question of what healthy food is has been limited to just food (disregarding food practices). Therefore, there is the selection of some foods by experts for people to make their choices. However, as shown in some of the chapters in this book, healthy food can be a socio-cultural practice, such as how food is prepared and the way it is eaten, which is not within the scope of Mötteli and colleagues’ study. Unsurprising, the study concludes that consumers (here referred to as laypeople) lack an understanding of the size and amount of nutrients. Culturally, these conclusions are unfair since they do not consider the competent knowledge system and practices that define what is healthy is other contexts beyond what was specifically selected for the study. In addressing the gap, this book argues for a more explicit and inclusive pathway to a healthy and sustainable food system transformation. Hence, this

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book seeks to pluralise the discourse on what healthy food means to achieve more inclusive, diverse and just sustainable food futures. Looking at consumer beliefs about healthy foods and diets, Lusk departs from the US Food and Drug Administration’s public process of redefining the use of the term healthy by companies on food packages. Lusk (2019) extended the discourse to consumers through his research. Following this, it can be deduced that the paper shares the rationality of consumer inclusion, which has been one of the main arguments of this book. Findings from the paper by Lusk (2019) showed that consumers’ perception of the term ‘healthy’ in food mainly alludes to the nutritional value, such as fat content and a certain degree, how much it aligns with guidelines of the food governing body. Besides, he reported that consumers believe the word ‘healthy’ is broader and nuanced simultaneously. This means that meanings ascribed to healthy cannot easily be defined and universalised to other contexts. The outcomes by Lusk (2019) support the argument that there could be different meanings in different contexts (place-based meanings of healthy food). Nonetheless, although this study by Lusk has highlighted diversity in meanings of healthy by consumers as advanced by this book, the study by Lusk fails to unravel what exactly these meanings are because it was the end result rather than the departure point of the study. Therefore, this book ‘Global visions of healthy and unhealthy food’ advances the literature by clarifying what these contextual definitions of healthy food could mean through the eight cases (see Fig. 1.2)—some oceans apart. Lastly, Boatemaa et al. (2018) study food beliefs and practices in poor urban communities in Accra, Ghana. This research by Boatemaa and colleagues (2018) revealed that the urban poor defined healthy food based on how it is prepared, the extent to which it reflects social food norms and affordability. Similar findings are presented in Ghana, Philippines and Cameroon in this book. Hence, it is fair to say

Fig. 1.2 Global distribution of case studies

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this book validates some studies that seek to enhance theory-building around the meanings of healthy and unhealthy food. Nonetheless, the comprehensive global outlook of this book gives a higher-level analysis (global) of the meanings of healthy food (compare and contrast) to foster the global transition of the current food system. Most importantly, this book offers a different theoretical frame (sensemaking) to enhance our understanding of what people mean by healthy food. In a nutshell, the aforementioned studies came close to the aim of this book. Nevertheless, all these sources fall short in one way or the other in providing the knowledge needed to make a truly inclusive transformation in the food system. On a general note, the current literature is yet to have a higher-level (global) discourse on what healthy or unhealthy food means in other places, cultures and traditions. Since the healthy and sustainable food transformation is a global vision that requires input from different people who now live on the margins of the decision-making process regarding the food supply chain, this makes the goal and the timing of this book evermore academically and societally relevant. The authors believe that by synthesising meanings of healthy from different contexts, a global discussion on the importance of consumers, cultures or social representation and, most importantly, what can be done from the consumer side of the spectrum can be kickstarted to enhance policies on sustainable food system transformation.

Chapter Layout Chapter 1: Introduction to Understandings of Healthy and Unhealthy Food Chapter 2: Meanings and Visions of Healthy and Unhealthy Food in Flevoland, The Netherlands Chapter 3: Cameroon: Land of Good Food, Agriculture and Various Visions of Good and Bad Food Chapter 4: Achieving Food System Transformation Through an Inclusive Understanding of Healthy and Unhealthy Food: The Case of Winneba, Ghana Chapter 5: Perceptions of Healthy Diets and Food Futures in Veneto, Northern Italy Chapter 6: Exploration of the Diverse Meanings Ascribed to Food by Different Social Groups in Eastern Visayas, Philippines Chapter 7: Perceptions of Healthy and Unhealthy Food Amongst People with Migrant Backgrounds in Canada: The case of Toronto Chapter 8: From Heritage to Health: The Many Meanings of Food in South Africa Chapter 9: Exploring the Complexity of the Food Environment in India to Understanding Healthy and Unhealthy Food Chapter 10: Contradictions and Consistencies in Understandings of Food in High and Low-Middle-Income Countries Chapter 11: Entangled Islands: Charting the Geographic Influence of Space-Place Relations in Global Meanings and Visions of Healthy Food

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Conclusion In this book, the authors re-examine the role of place in global meanings and visions of healthy and unhealthy food through national case studies in nine countries across the globe. Here, place is conceptualised as a unique platform that mediates physical, social and economic processes and thus affects how such processes operate. This presents a more holistic view of places as the geographical context for meditating on physical, social and economic processes. But how can we understand these mediation processes? In this book, it will be captivating to see how and if place can still play a role in sensemaking about meanings and understandings of healthy and unhealthy food or not. This book uses a robust empirical perspective with case study chapters to fill this knowledge gap.

References Abler R, Adams JS, Gould P (1971) Spatial organisation: the geographer’s view of the world. Prentice Hall, Englewood Cliffs NJ Agnew JA, Livingstone DN (2011) The Sage handbook of geographical knowledge. Sage Publications, London Ancona D (2012) Sensemaking: framing and acting into the unknown. In: Snook S, Khurana R, Nohria N (eds) The handbook for teaching leadership: knowing, doing, and being. Sage Publications Inc, USA Antognazza MR (2008) Leibniz: an intellectual biography. Cambridge University Press, Cambridge Berry BJL (1967) Geography of market centers and retail distribution. McGraw Hill, New York Boatemaa S, Badasu DM, de-Graft Aikins A (2018) Food beliefs and practices in urban poor communities in Accra: implications for health interventions. BMC Public Health 18(1):1–12 Bouquiaux L (2008) Leibniz against the unreasonable Newtonian physics. Leibniz: what kind of rationalist? Springer, Dordrecht, pp 99–110 Brons A, Oosterveer P, Wertheim-Heck S (2020) Feeding the melting pot: inclusive strategies for the multi-ethnic city. Agric Hum Values. https://doi.org/10.1007/s10460-020-10031-x Castree N (2005) Is geography a science. Questioning geography: fundamental debates, pp 57–79 Chater N, Huck S, Inderst R (2010) Consumer decision-making in retail investment services: a behavioural economics perspective. Report to the European Commission/SANCO Dijkshoorn-Dekker M, Linderhof V, Mattijssen TJ, Polman N (2020) Food secure metropolitan areas: the transition support system approach. Sustainability 12(13):5376 Ebbeling CB, Pawlak DB, Ludwig DS (2002) Childhood obesity: public-health crisis, common sense cure. The Lancet 360(9331):473–482 Ericksen PJ (2008) Conceptualising food systems for global environmental change research. Glob Environ Chang 18(1):234–245 Eriksson L, Isemo S, Abrahamsson H (2017) On justice, fairness and equity in Gothenburg (No. 2017). Mistra Urban Futures Working Papers, p 1 Evans D, McMeekin A, Southerton D (2012) Sustainable consumption, behaviour change policies and theories of practice. The habits of consumption, pp 113–129 FAO (2018) The state of food security and nutrition in the world. Retrieved from http://www.fao. org/3/I9553EN/I9553en.pdf Farinelli F (2003) Geografia: un’introduzione ai modelli del mondo. Giulio Einaudi editore, Rome Feingold M (2004) The Newtonian moment: Isaac Newton and the making of modern culture. Oxford University Press, New York

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Fraser A (2020) The digital revolution, data curation, and the new dynamics of food sovereignty construction. J Peasant Stud 47(1):208–226 Garforth C (2015) Livestock keepers’ reasons for doing and not doing things which governments, vets and scientists would like them to do. Zoonoses Public Health 62:29–38 Gaspar MCDMP, Garcia AM, Larrea-Killinger C (2020) How would you define healthy food? Social representations of Brazilian, French and Spanish dietitians and young laywomen. Appetite 153:104728 Global Nutrition Report (2017) Nourishing the SDGs. Retrieved from https://globalnutritionreport. org/reports/2017-global-nutrition-report/ Harvey D (2000) Spaces of hope. University of California Press, Berkeley Herrero M, Thornton PK, Mason-D’Croz D, Palmer J, Benton TG, Bodirsky BL et al (2020) Innovation can accelerate the transition towards a sustainable food system. Nature Food 1(5):266–272 Hochedez C, Le Gall J (2016) Food justice and agriculture: introduction. Retrieved from https:// hal.archives-ouvertes.fr/hal-01342989 Hoes AC, Jongeneel R, van Berkum S, Poppe K (2019) Towards sustainable food systems: a Dutch approach. Wageningen Economic Research KC KB, Fraser ED, Pascoal S, Dias G, Zundel T (2016) Pathways leading to a more sustainable and healthy global food system. Solution J 7:10–12 Klerkx L, Rose D (2020) Dealing with the game-changing technologies of agriculture 4.0: how do we manage diversity and responsibility in food system transition pathways? Global Food Secur 24:100347 Kolb V (2015) Analyse géographique des inégalités environnementales et écologiques en milieu littoral urbain [Geographical analysis of environmental and ecological inequalities in coastal urban territories]. University of La Rochelle, La Rochelle Latour B (2007) Reassembling the social: an introduction to actor-network-theory. Oup Oxford, Oxford Lusk JL (2019) Consumer beliefs about healthy foods and diets. PLoS One 14(10):e0223098 Marston SA, Jones JPIII, Woodward K (2005) Human geography without scale. Trans Inst Br Geogr 30:416–432 Mötteli S, Keller C, Siegrist M, Barbey J, Bucher T (2016) Consumers’ practical understanding of healthy food choices: a fake food experiment. Br J Nutr 116(3):559–566. https://doi.org/10. 1017/S0007114516002130 Nature Food Editorial (2020) Democratising food systems. Nature Food 1:383. https://doi.org/10. 1038/s43016-020-0126-6 Olsson GA (2018) Peri-urban food production as means towards urban food security and increased urban resilience. In: Zeunert J, Waterman T (eds) Routledge handbook of landscape and food. Routledge, London and New York, pp 197–212 Onwezen M, Hamon K, de Lauwere C, Reinhard S, Roefs M, Beekman G, Ruben R (2019) The relevance of behavioural insights in a transition towards a healthy and sustainable food system: closing the gap to create science-based insights with societal impact Wageningen Living Lab on Behaviour Change. Wageningen Economic Research Philo C (1992) Foucault’s geography. Environment and Planning d: Society and Space 10(2):137– 161 Popkin BM (2017) Relationship between shifts in food system dynamics and acceleration of the global nutrition transition. Nutr Rev 75(2):73–82 Rose DC, Chilvers J (2018) Agriculture 4.0: broadening responsible innovation in an era of smart farming. Front Sustain Food Syst 2:87 Rotz S, Duncan E, Small M, Botschner J, Dara R, Mosby I et al (2019) The politics of digital agricultural technologies: a preliminary review. Sociol Rural 59(2):203–229 Schatzki TR (1991) Spatial ontology and explanation. Ann Assoc Am Geogr 81(4):650–670 Sen A (1982) The food problem: theory and policy. Third World Quarterly 4(3):447–459

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Shove E (2010) Beyond the ABC: climate change policy and theories of social change. Environ Plan A 42(6):1273–1285 Slavov M (2016) Newtonian and non-Newtonian elements in Hume. J Scott Philos 14(3):275–296 Starbuck WH, Milliken FJ (1988) Challenger: fine-tuning the odds until something breaks. J Manage Stud 25(4):319–340 Thrift N (1999) Steps to an ecology of place. In: Massey D, Allen J, Sarre P (eds) Human geography today. Polity, Cambridge Tukker A, Jansen B (2006) Environmental impacts of products: a detailed review of studies. J Ind Ecol 10(3):159–182 Vidal de La Blache P (2008) Principes de géographie humaine. Principes de géographie humaine, pp 1–326 Waterman RH (1990) Adhocracy: the power to change (larger agenda series). Whittle Direct Books, Knoxville, TE Webb P, Benton TG, Beddington J, Flynn D, Kelly NM, Thomas SM (2020) The urgency of food system transformation is now irrefutable. Nature Food 1(10):584–585. https://doi.org/10.1038/ s43016-020-00161-0 Weick KE (1995) Sensemaking in organisations, vol 3. Sage, London

Chapter 2

Meanings and Visions of Healthy and Unhealthy Food in Flevoland, the Netherlands Harrison Esam Awuh

Abstract This chapter turns attention to the Netherlands, precisely the province of Flevoland, to show the meanings of healthy and unhealthy food. The choice of Flevoland was because the province is on an agricultural polder in the Netherlands at the forefront of agricultural transformations. By combining photovoice and online surveys, findings show that meanings of healthy food are predominantly nutrition-based. This is determined by the government recommendation (Disc of five) promoting a nutrition-based understanding of healthy and unhealthy food. This chapter highlights the overemphasis on nutrition in meanings of healthy and unhealthy food. The chapter argues that although the nutrition-based discourse on healthy and unhealthy food is dominant amongst Dutch consumers, there also exist socio-culturally informed meanings of un/healthy which include the pleasure derived from the acts of sharing food experiences that positively contribute to consumers’ overall pleasure and satisfaction with consumer’s food consumption. These socioculturally informed meanings of un/healthy food are equally important to consumers. Therefore, the author argues that the key to the future of healthy food is a middle ground where nutritionally rich food meets socially informed meanings of healthy food. Keywords Food meaning · Nutrition · Socio-cultural · Consumers · Netherlands

Introduction The Flevoland province is the youngest of all the provinces in the Netherlands. It was established as a province in 1986 and is located in the centre of the country at the site of the former Zuiderzee. The province was formed almost entirely through land reclamation. Between 790 and 1250, Lake Flevo became connected with the North Sea through heavy flooding. As a result, the sea swallowed a number of villages, and H. E. Awuh (B) Department of Human Geography and Spatial Planning, Utrecht University, Utrecht, Netherlands e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 H. Esam Awuh and S. Agyekum (eds.), Geographies of Food, Springer Geography, https://doi.org/10.1007/978-3-031-49873-2_2

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a new inland sea was created—formerly Almere Zee and later renamed Zuiderzee. After a flood in 1916, it was decided that the Zuiderzee (then an inland sea within the Netherlands) would be enclosed and reclaimed. Land reclamation work started in 1920 with the building of a dike (Afsluitdijk) that closed off the inland water basin, cutting the then Zuiderzee from the North Sea. Over the years, the Zuiderzee was drained in stages to create Flevoland. Work was effectively finished in the 1950s and 1960s with the creation of Flevo polders, the land combined by two polders (Noord Polder and Zuid Polder). The two polders are surrounded by dikes and kept dry by diesel and electric pumps. These pumps are located at intervals along the outer dikes surrounding the polders. The Zuiderzee was subsequently called IJsselmeer, meaning the lake at the river’s end. According to a study conducted by the Wageningen Economic Research and Statistics Netherlands (CBS) for the Ministry of Agriculture, Nature and Food Quality, the Dutch agriculture sector holds an enviable leading position in the global market. For example, according to this study, in 2019, the Netherlands exported up to 94.5 billion Euros worth of agricultural products—a sector which had grown by 8% from the preceding years—90.4 billion Euros in 2018 (according to CBS). This presents Flevoland as the heart of the Dutch agricultural sector. For instance, the province is the leader in organic agriculture in the Netherlands, with 13,564 ha or 18.4% of the organic agricultural land in the Netherlands (Dekking et al. 2020). On a provincial scale, 15% of the agricultural area in the Flevo Polder is taken up by organic farming (Dekking et al. 2020). However, despite being presented as being at the forefront in agricultural transformations, consumer understanding of healthy and unhealthy food in Flevoland is still not sufficiently understood. To fill this knowledge gap, this chapter seeks answers to the following questions; (1) What do citizens of Flevoland understand by healthy food? (2) What do citizens of Flevoland understand by unhealthy food? (3) How do citizens of Flevoland see a healthier food future? The choice of Flevoland was mainly because the lead institution for this research are based in the province.

The Context—Almere The data presented in the chapter were collected from citizens in Almere in Flevoland. The city of Almere (named after this the previous name of the lake which was drained) is the largest settlement in the province. Almere is a newly planned and rapidly growing suburb located 30 km east of Amsterdam (Jansma and Visser 2011). The city was founded about 45 years ago on the reclaimed land of the Southern Flevo Polder in the Ijsselmeer and constituted the Amsterdam metropolitan area (Jansma and Wertheim-Heck 2021). The city grew to 64,000 inhabitants between 1976 and 1989 (Constandse 1989). In 2019, the city had a population of about 208,000 inhabitants (Jansma and Wertheim-Heck 2021), and is expected to expand to 350,000 by 2030 (becoming the fifth largest city of the Netherlands). This rapid expansion in population is fuelled by the growing need for new housing in the Amsterdam metropolitan

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Fig. 2.1 The bi-weekly open food market in Almere where mostly locally produced food is sold

area and the absence of alternative locations for new housing construction (Jansma and Visser 2011). Its location (just 30 km from Amsterdam) offers an ideal suburban environment for commuting to Amsterdam (Dormans 2008). Although the city was originally designed to accommodate urban agriculture (Zalm and Oosterhoff 2010), this was never fully implemented. The only exception is the urban farming district of Oosterwold in the city’s Eastern fringe (Dekking et al. 2007). The Almere principles (Feddes 2008) for a sustainable future of the town consists of seven starting points for sustainable urban development. These include: cultivating diversity, connecting place and context, combining city and nature, anticipating change, continuing innovation, designing healthy systems, and empowering people to make the city more liveable (Feddes 2008). See Fig. 2.1 for a view of the bi-weekly food market in the city centre of Almere.

Material and Methods Photovoice In this study, citizens were asked to take photos of their daily life reflecting the following subjects: what do you consider healthy food? (2 photos); and what do you consider as unhealthy food? (2 photos). A total of 32 people (men, women, teenagers, elderly, and people with different ethnic backgrounds) participated in this exercise (Fig. 2.2). After the photographs were collected, one-on-one interviews were held with the participants (mostly over Zoom due to the limitations of holding face-to-face meetings during Covid-19 lockdowns). In these interviews, participants were asked to explain (with each photo): (1) what is visible in the photos; (2) what motivated them to take the photo; what is the meaning of the photo in line with the aforementioned subjects. At the end of the discussions, participants were asked to add any relevant information they found that the photograph could not cover. Participants were also asked to provide their general impression on the method itself.

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Woman, 22, Ethnic Dutch, research intern

Woman, teenager, Ethnic Dutch

Woman, 40, Ethnic Dutch, teacher

Man, teenager, ethnic Dutch

Woman, 66, Ethnic Dutch, retired

Man, teenager, Dutch/Moroccan

Woman, teenager ,Ethnic Dutch

Man, teenager,other European (Danish)

Woman, 28, Vietnamese, Marketing agent, grew up in Vietnam

Woman, teenager, Ethnic Dutch

Man, teenager, Ethnic Dutch

Woman, teenager, Mixed heritage (Dutch – Surinamese)

Man, teenager, Ethnic Dutch

Woman, 24, Latin American (Peruvian/Colombian) and one Scottish parent, Christian

Man, 33, Dutch Surinamese, fitness trainer

Woman, 22, African (Zimbabwean), Catering industry, Christian.

Woman, 70, Ethnic Dutch, Long-term medical condition which prevented employment.

Man, teenager, Ethnic Dutch

Woman, 22, Mixed heritage (Dutch/Inonesian), Research intern, Born and raised in the Netherlands, glutton allergy

Woman, 23, Ethnic Dutch,diabetic , Athlete

Woman, 32, British Indian, IT consultant

Woman, 24, Mixed heritage: Dutch/Tanzanian Univ. educ, Born and raised in Flevoland

Woman, 60, Ethnic Dutch, civil servant

Woman, teenager, Mixed heritage (Dutch – French)

Man, teenager, Ethnic Dutch

Man, 30 Pakistani, Businessman, Muslim

Man, 25, Ethnic Dutch, Engineer, vegan, lived in Eswatini while growing up.

Woman, teenager, Ethnic Dutch

Man, 29, Ethnic Dutch, hydraulic technician.

Man, 29, African (Ghanaian, researcher, Christian.

Woman, 35, Ethnic Dutch, Medical doctor

Woman, 24, Mixed heritage: German/African (Senegalese), Student

Fig. 2.2 Demographic details of photovoice participants

Online Surveys The study also utilised an online survey of 80 respondents. The essence of using quantitative surveys was to triangulate the data collected through photovoice. Methodological triangulation is a research approach using multiple methods to investigate similar or related research questions. It is useful in enhancing the validity and credibility of research findings and mitigating the presence of any research biases in findings. Therefore, in line with triangulation, the quantitative survey also asked participants the same questions as the aforementioned photovoice method. In this survey, participants were also asked to add from which sources they derived their knowledge on healthy or unhealthy food. The survey was launched on 9 May 2021 (week 18), for four weeks. The data were collected via Google Forms and analysed

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Fig. 2.3 Demographic background of participants in the online survey for societal context

through Microsoft Excel. Participants residents in Almere were recruited through social media (WhatsApp and Facebook). An overview of survey participants is shown in Fig. 2.3. The essence of presenting this demographic information is to show the degree of diversity in the sample selected. The data were analysed in Microsoft Excel to establish percentages presented through pie charts and graphs.

Findings Meanings of Healthy and Unhealthy Food in Flevoland Are Largely Nutrition-Based There was a predominantly nutrition-based understanding of the meanings of healthy food in Flevoland. The main reason for this overwhelmingly nutrition-based understanding of healthy food (especially as illustrated in Fig. 2.4) is government recommendations concerning what healthy food should be. The official source of information about what is healthy or unhealthy to eat in the Netherlands is the Voedingscentrum (The Alliance Nutrition for the Healthy Generation). The Voedingscentrum presents the disc of five (schijf van vijf ) as the most important definition of healthy and unhealthy food, and consumers should be advised to oblige to it. The disc of five is more focused on preventing chromonic diseases such as cardiovascular diseases (Feskens 2016). Therefore, the concept of the disc of five is based on the latest scientifical information regarding food products that are good and healthy for the human body. The disc is separated into five boxes as follows (Voedingscentrum 2021):

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H. E. Awuh Food which brings No snacking Less salt Healthy fats happiness Local 1% 1% 1% Vegan2% 1% Nutricious2% 3% Less carbohydrates 3% Vegetables Less fats 23% 3% Less sugar 3%

Less food quantities 1%

Vitamins 3% Protein 3%

Fruit 18%

Organic 4% Disc of 5 6%

Balanced diet 12%

Wholegrain food 8%

Fig. 2.4 Meanings of healthy food

1. The largest box consists of vegetables and fruit. These products decrease the chances of getting cardiovascular diseases, colon cancer, lung cancer, and type two diabetes. This is due to the large amounts of vitamins, minerals, and fibres in the products. 2. The second largest box includes bread and cereals. Again, the focus is on whole wheat products as they decrease the risks of colon cancer, type two diabetes and cardiovascular diseases. Besides, cereals supply energy and contain fibres, proteins, vitamin B, and iron. In addition, potatoes are also included in this box, not because they can be considered cereals but because they also contain the aforementioned important nutrients. 3. The third box is about beverages. This is an imported aspect as the loss of body moisture needs to be restocked. Green and black tea lowers blood pressure and reduces the risk of a stroke. 4. The fourth box contains many products: dairy, nuts, fish, legumes, meat, and eggs. Dairy is healthy because it contains calcium and vitamin B12 and protects against colon cancer. Nuts and legumes are included in this box as they lower the amount of LDL-cholesterol in the blood. In addition, fish reduces the chances of getting cardiovascular diseases, while meat and eggs provide the body with iron and vitamin B12. 5. The last box consists of spreads and cooking fats. For this box, replacing products containing saturated fat with unsaturated fat is important. This would prevent cardiovascular diseases. It also provides for vitamins A, D, and E.

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With the largest box on the disc of five consisting of fruit and vegetables as healthy food, it is unsurprising that these items constitute 18 and 23% of what is considered healthy food in Fig. 2.4. Likewise, several participants’ accounts through photovoice reference this nutrition-based understanding of what healthy food is. The following quotes from photovoice provide more insights into understandings of meanings of healthy food: I am diabetic. So, I have always been aware of what I am eating. So, I know from the Voedingscentrum that it is healthy to eat vegetables and carbohydrates and always something with protein. I think this photo shows something healthy because there are vegetables in the food. (Roos)

Fruits in general are quite healthy. Although they still contain a lot of sugar, eating them is still better than eating a cookie. So, I try to snack with fruits instead of cookies. I also think fruit is quite tasty. I eat at least two items of fruit a day. (Simon)

This is a healthy quinoa salad which I prepared. It contains a lot of fresh vegetables and also tuna. We have been told that grains such as quinoa contain nutrients which are good for the body. The fresh vegetables and tuna are also nutritious. (Karolien)

On the contrary, and in line with the nutrition-based understanding of healthy or unhealthy food, any food items that do not appear on the recommended five are considered unhealthy. For instance, products that contain added sugar and salt do not fit healthy food requirements as sugar increases the risk of getting obesity, and salt enhances blood pressure (Voedingscentrum 2021). Most food items specifically listed in Fig. 2.5 as unhealthy are prominently in Voedingscengtrum’s list of ‘not

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approved’. For instance, the Voedingscengtrum has fruit juices on the not approved list because the juices would contain too much added sugar. Products containing added sugar and salt fit the categorisation of unhealthy food as sugar increases the risk of obesity and salt enhances blood pressure. Therefore, these items are listed in the not approved section of Voedingscengtrum’s disc of five. Therefore, sugar, salt, and oil/fats represent up to 40% of the listings of meanings of unhealthy food in Fig. 2.5. Another recommendation of the Voedingscentrum that appears in people’s list of what they consider unhealthy food is foods that are low in fibre (4% in Fig. 2.5). The Voedingscentrum states that whole wheat products contain fibres, iron, and vitamin B, while white products do not or contain less. Therefore, white bread and biscuit are listed as unhealthy because they are low in fibre and contain high levels of saturated and trans fats. Trans fats are even worse for human health than saturated fat and increase cardiovascular disease risk (Bobroff 2017). In addition, trans fats are responsible for increasing the LDL-cholesterol and reducing the HDL-cholesterol (Bobroff 2017). The following quotes and photos from photovoice provide more insights into a predominantly nutrition-based understanding of the meanings of unhealthy food:

Lack of vareity 3% Food low in fibres 4% Eating alone Liquor consumption 3% 5%

Snacking or eating between meals 7%

Fatty,oily,sugary,salty 40%

Eating large portions 7% Unsustainable food (food chain) 7% Ready to eat packaged food 8% Fast food 16%

Fig. 2.5 Meanings of unhealthy food from an online survey

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This is fast food. Chips, burger, and ketchup. I think it shows an example of something I would like to eat but which I shouldn’t eat. To me this is an example of unhealthy food. It contains loads of fats and the ketchup often contains added sugars. (Respondent CF)

This is a candy shop. I think it shows the unhealthy side of food because there is so much sugar and it is also a lot. It is also all in plastic and I find that unsustainable and bad for the environment. (Respondent RB)

Beer. From my student days I started drinking a lot of beer. I know it is unhealthy because the alcohol damages your brain and your body and you can get a large belly from it. However, I still drink a lot of beer on a daily basis. So, yea I know it is unhealthy because I see the effects around me. I see how it affects a lot of people—weight gain in the wrong places (the more visible parts of the body). (Respondent FL)

Figure 2.6 shows that some respondents (6%) directly reference the disc of Five when discussing where they get their food information from. In addition, key actors who promote this nutrition-based meaning of healthy and unhealthy food, as on the disc of five, play an influential role in citizens’ sources of information about what healthy or unhealthy food is. As Fig. 2.6 shows, these include; the official government food website (17%), health professionals (5%), and scientific output (4%). Putting all these sources together, it is clear that a total of 26% of respondents to the survey question get most of their food information from sources promoting a nutrition-based understanding of what is healthy or unhealthy.

24 Fig. 2.6 Participants’ most important sources of information on food

H. E. Awuh food expert 1% food app 2% scientific research 4%

books 1%

health professional 5%

others 7%

family and friends 21%

food blogger/vlogger 8% social media mass media (TV, 20% newspapers, magazines) 14% food website (mainly the official government website voedingscentrum) 17%

A Desired Healthier Food Future for People in Flevoland is One with Less Consumption of Meat The most prominent vision of a desired healthier food future from the survey in this study is a recommendation to consume less meat (13% in Fig. 2.7). This is most likely driven by campaigns by government and non-governmental organisations which highlight the impact of meat production (especially beef) on the environment and the health risks of consuming too much meat. The rise of industrialised animal agriculture after World War II, the associated increased availability and decreased prices for meat, as well as industry marketing and advertising, all encouraging meateating (Kanerva 2019), resulted in meat eventually becoming a normal everyday food item for nearly all those living in the Global North, and increasingly also for many in the Global South. In response, in the race against climate change, many advocates in the West (including the Netherlands) have identified meat production as a major source of greenhouse gas emissions and say people worldwide must consume less meat or give up meat entirely. Thus, according to Professor Ian Scoones of the Institute of Development Studies, the livestock sector has become the ‘climate villain’ (see Vetter 2021). The most pressing issues linked to meat consumption include issues linked to various environmental impacts, issues linked more directly to human and animal welfare, and ethical impacts. The vast increases in the production and consumption of meat observed in the last half a century and the widely expected further increases for the future as incomes also rise in lower-income countries have been projected to worsen the aforementioned impacts of meat consumption. Thus, people in Flevoland are aware of the dangers posed by this high production and consumption of meat. The following quotes and photos from the photovoice

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Fig. 2.7 Visions of a desired food future

method support this vision of a healthier food future in which citizens of Flevoland will consume less meat: ‘Don’t worry, I won’t eat these sweet little chickens. However, there are a lot of people who still want to keep eating a lot of meat. I hope for the future that meat consumption will decrease, but also that the animals that are still being consumed can live a better life than they do now. We have chickens, turkeys, and geese at home that have a good life and are given a lot of space and food. The eggs they lay are eaten at home or sold to people from the village. This form of raising and consuming livestock is what would be good for the future’. (Jacolien) (continued)

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(continued) ‘In my ideal future, a no-animal day is not necessary. It should go without saying that you don’t eat meat every day. It shouldn’t have to be celebrated but it should be normal. This could be amplified if stores simply wouldn’t sell meat on some days. But people’s own will is still the biggest factor in this and therefore also the biggest obstacle’. (Maud, Almere)

‘Then there is this poster which shows that a lot of fast food chains are beginning to incorporate healthier options (plant-based options) as you see in the case of subway on this poster. It does show that there is a market for healthier and sustainable plant-based options and an increase in these options will make it easier for people to switch to healthier options. The first time I saw the poster I thought it was weird. But then the next day I thought about the photo assignment and it dawned on me that this kind of transformation of fast foods can actually enable healthy food transformation. I remember eating the vegan version of the McChicken at McDonalds and thought it was actually pretty delicious. So, fast food chains providing healthier food options will definitely make it easier to switch to healthier diets’. (Sameera)

A key obstacle to this desired healthier food future in Flevoland is the belief amongst some people that food which does not contain meat is bland. The following respondents (through photos and quotes) highlight this concern:

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Some people say healthy food like this shown on the photo is niet lekker (not delicious in Dutch). Although you can definitely make healthy food to taste as delicious as unhealthy food if you use the right ingredients, that becomes harder when all you hear is that healthy food is niet lekker. I think it is just a lack of information or people just believe what others are saying without being critical. (Respondent Jessy)

Vegetarian food here in the Netherlands is not attractive or tasty enough for me. This makes it harder for me to eat more vegetarian food. For example, in my country (Vietnam) when you go to a restaurant and eat vegetarian food you don’t really feel like you are eating vegetarian food because it is really delicious. (Nguyen, Almere resident of Vietnamese origin)

Another obstacle is the commercialisation of meat and other unhealthy food options in the mass media. The commercialisation of unhealthy food and the easy availability (through low costs) of unhealthy food options are major threats to a healthier future in Flevoland and the Netherlands. At the heart of these issues is the dominance of unhealthy food in mass media discourse. Some authors—such as Meersseman et al. (2021); Gupta et al. (2017)—argue that food-related advertisements have been found to lead to negative food consumption outcomes such as increased obesity in adolescents. Furthermore, they argue that advertisements affect food preferences and influence dietary habits. Gupta et al. (2017) also argued that TV is a major source of exposure to advertisements for fast food, high-sugar foods, and sugar-sweetened beverages that influence this vulnerable group’s choices (Gupta et al. 2017). Accounts from participants (as the following quotes illustrate) show that unhealthy food is very present in the mass media. You see a lot of hamburgers and meat commercials on TV. The more people see this, the more they crave them and in large quantities, as you can see in this photo. Large quantities of fatty food. (Jolien, woman from Almere)

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Supermarkets to do more in selling more healthy and less unhealthy food options A supportive food environmemnt

Insights and tips on what is healthy food

More healthy and delicious food recipes

Availability of cheaper healthier food options 0

2

4

6

8

10

12

14

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Fig. 2.8 Factors which can ease transformation towards a healthier food future in Flevoland

In order to overcome this obstacle and encourage people to be more receptive to vegan or vegetarian options, most participants recommended awareness of the negative health effects of eating too much meat or unhealthy food (see Fig. 2.8). For example, one respondent regarding nutrition-based recommendations said: ‘I read a scientific paper, and they confirmed that red meat is not good not only for your body but also for the environment’. Another said: I think education is definitely important in changing food habits because people need to know what is good and bad for them. On the other hand, you don’t really need anyone to educate you on the good or bad of what you are eating. For instance, if you eat only fast-food for one week, your body will let you know it’s bad for you through the weight you will gain. You will feel your body is light and fresh if you eat salads a lot. When you eat too much, you feel heavy too. So, just listen to the message from your body, and you can be able to tell if what you are eating is good for you or not. (Hoa, woman from Almere)

Based on this quote from Hoa, it can be emphasised that people’s bodies are key sources of discourse which require as much attention in research as the other sources of discourse. The body as a source of discourse is also closely linked to other sources of discourse. For example, changes in body weight or shape will be picked up by others, leading to either body shaming or body praising. Body praising can encourage people to stay on the path of healthier food practices. On the other hand, body shaming can either lead to people falling back to unhealthy eating practices or waking up and changing how they eat (transformation towards healthier eating). As a point of caution here, body weight and other factors such as beauty and attractiveness are cultural conventions that could be context-dependent. For example, while being overweight symbolises health and wealth within some non-Western cultures (see Zouaoui et al. 2020), in Western cultures, it signifies a low level of selfdiscipline, laziness, and lack of control which is often projected in poor diets and lifestyles. Besides, being overweight can also result from several genetic syndromes caused by mutation or chromosomal abnormalities, such as Prader–Willi and BardetBiedl syndromes (Farooqi and O’Rahilly 2006)—not always only unhealthy diets or lifestyles. According to Neagu (2015), the most prominent theoretical approach to the

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socio-cultural creation of body weight dissatisfaction or satisfaction and associated food pathology is tripartite of influence of the following factors: (1) family, peers, and mass media; (2) internalisation of societal appearance standards; and (3) social comparison processes regarding body appearance. These three factors can determine what sort of discourse people get from their bodies because they set the norm against which people can compare themselves. Awareness extends to people knowing more about healthier food options and how to prepare them. Awareness that there are several healthier food options cheaper to purchase than some unhealthier food options could go a long way in debunking the myth that healthy food is expensive. Also, awareness of how healthy food can be prepared quickly and with more ingredients to enhance taste could debunk the other myth that preparing healthy food is time-consuming and healthy food is not delicious (niet lekker in Dutch).

Discussion A key finding in this chapter is that Flevoland’s meanings of healthy and unhealthy food are predominantly nutrition-based. However, in general, the meanings of healthy food are either nutrition-based or socio-culturally informed. Nutrition-based meanings are related to food medicalisation, in which food and its practices are understood and experienced from a medical point of view based on scientific nutritional rationality (Viana et al. 2017). Here the definition of healthiness in foods is defined by the sensory pleasure that food brings to someone and the experience someone enjoys while eating (Ditlevsen et al. 2019). The reasoning behind this is that it is healthy to have a ‘happy’ body, experience pleasure, and enjoy food as part of a social community. This approach, sometimes called the ‘culinary order’, incorporates notions of gastronomy and commensality in understanding healthiness (Ditlevsen et al. 2019). In socio-culturally informed meanings, food-health associations are created in particular contexts by the social actors present in those given contexts, interacting with the values, representations, practices, and norms that organise social life (DíazMéndez and Gómez-Benito 2010). It involves assigning moral meanings to foods and is influenced by each social group’s cultural values (Gaspar et al. 2020). These socio-culturally informed meanings of healthy food include the pleasure derived from sharing food experiences that positively contributes to consumers’ overall pleasure and satisfaction with consumer’s food consumption (Mendini et al. 2019). In the previous section, a lack of consideration for this socio-culturally informed meaning of healthy food drives participants such as Nguyen and Jessy to have negative views on supposedly nutritionally healthier plant-based foods. Focusing on the socio-culturally informed side of healthy food will highlight the sensory element and ensure that, for example, plant-based food options are spiced enough to make them nutritious and delicious. This additional sensory element will ease the transition to a healthier food future with the consumption of less meat and more plant-based meals.

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Also, the association between a future with less meat consumption and the guidelines of the disc of five that promote a meat-free diet is unclear. People decide to eat less meat for reasons beyond personal health or the need to eat healthier. For example, some people could choose to eat less meat for animal welfare reasons or to combat global carbon emissions from the agricultural sector. Climate change, for example, has been largely framed as an issue that can be measured, understood and ultimately ‘solved’ by scientific and technological means (Demeritt 2006). This is the frame most commonly encountered in mainstream outlets such as; media accounts, government initiatives, activist campaigns, and even public engagement experiments. The narrative here is that humans are causing climate change by releasing greenhouse gases—mostly carbon dioxide—into the atmosphere, leading to the planet’s gradual heating (IPCC 2018). Therefore, it is assumed that we can reduce carbon emissions from the agricultural sector by changing our eating habits, and eating less meat.

Conclusion The findings from this study show the influence of official or institutional guidelines on what people consider healthy or unhealthy. Further evidence of this link can be found in the fact that many people, health professionals, and scientists get their healthy or unhealthy food information from the official government nutrition website. In turn, these understandings remotely influence people’s vision of a healthier food future with less meat consumption, in this case. However, focusing exclusively on the nutritional side of healthy or unhealthy food only addresses half the issue. This is because socially informed meanings of healthy or unhealthy food are equally important. Therefore, the key to a healthier food future for Flevoland and the Netherlands is finding a middle ground where nutritionally rich food meets socially informed meanings of healthy food. Lekker en Gezond, as they say in the Netherlands—means delicious (to make people happy) and healthy (to address food’s medicinal/nutritional value). This will lead to a healthier food future in the Flevoland and the Netherlands.

References Bobroff LB (2017) Nutrition for health and fitness: fat in your diet. EDIS 2017(2):8–8. Retrieved from http://edis.ifas.ufl.edu Constandse AK (1989) Almere: a new town in development: problems and perspectives. Neth J Housing Environ Res 235–255 Dekking A, Jansma JE, Visser AJ (2007) Urban agriculture guide; urban agriculture in the Netherlands under the magnifying glass. Wageningen University, Applied Plant Research, Lelystad, the Netherlands Dekking A, Jansma JE, Janssens B, Smit B (2020) Biologische landbouw in Flevoland: Omvang en productstromen (No. WPR-822). Stichting Wageningen Research (WR), business unit Wageningen Plant Research

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Demeritt D (2006) Science studies, climate change and the prospects for constructivist critique. Econ Soc 35(3):453-479 Díaz-Méndez C, Gómez-Benito C (2010) Nutrition and the Mediterranean diet. A historical and sociological analysis of the concept of a “healthy diet” in Spanish society. Food Policy 35(5):437–447 Ditlevsen K, Sandøe P, Lassen J (2019) Healthy food is nutritious, but organic food is healthy because it is pure: the negotiation of healthy food choices by Danish consumers of organic food. Food Qual Prefer 71:46–53. https://doi.org/10.1016/j.foodqual.2018.06.001 Dormans SEM (2008) Narrating the city. Urban tales from Tilburg and Almere. Doctoral dissertation. RU Radboud Universiteit Nijmegen, Nijmegen Farooqi IS, O’Rahilly S (2006) Genetics of obesity in humans. Endocr Rev 27(7):710–718 Feddes F (2008) The Almere principles; for an ecologically, socially and economically sustainable future of Almere 2030. Thoth Publishers, Bussum Feskens E (2016) Schijf van vijf 2016; een reactie van de wetenschap. Tijdschrift Voor Gezondheidswetenschappen 94(5):166–166. https://doi.org/10.1007/s12508-016-0063-9 Gaspar MCDMP, Garcia AM, Larrea-Killinger C (2020) How would you define healthy food? Social representations of Brazilian, French and Spanish dietitians and young laywomen. Appetite 153:104728 Gupta S, Kalra S, Kaushik JS, Gupta P (2017) Content of food advertising for young adolescents on television. Indian Journal of Community Medicine: Official Publication of Indian Association of Preventive & Social Medicine 42(1):43. https://doi.org/10.4103/0970-0218.199800 IPCC (2018) Global warming of 1.5 °C. An IPCC Special Report on the impacts of global warming of 1.5 °C above pre-industrial levels and related global greenhouse gas emission pathways, in the context of strengthening the global response to the threat of climate change, sustainable development, and efforts to eradicate poverty. In: Masson-Delmotte V, Zhai P, Pörtner HO, Roberts D, Skea J, Shukla PR, Pirani A, Moufouma-Okia W, Péan C, Pidcock R, Connors S, Matthews JBR, Chen Y, Zhou X, Gomis MI, Lonnoy E, Maycock T, Tignor M, Waterfield T (eds). Cambridge University Press, Cambridge Jansma JE, Visser AJ (2011) Agromere: integrating urban agriculture in the development of the city of Almere. Urban Agriculture Magazine 25(2011):28–31 Jansma JE, Wertheim-Heck SC (2021) Thoughts for urban food: a social practice perspective on urban planning for agriculture in Almere, the Netherlands. Landsc Urban Plan 206:103976 Kanerva MM (2019) The role of discourses in a transformation of social practices towards sustainability: the case of meat eating related practices. Doctoral dissertation, Universität Bremen Meersseman E, Vermeir I, Geuens M (2021) The effect of perspectives in food pictures on unhealthy food choices. Food Quality and Preference 89. https://doi.org/10.1016/j.foodqual.2020.104140 Mendini M, Pizzetti M, Peter PC (2019) Social food pleasure: when sharing offline, online and for society promotes pleasurable and healthy food experiences and well-being. J Cetacean Res Manag 22(4):544–556 Neagu A (2015) Body image: a theoretical framework. Proceedings of the Romanian Academy 17(1):29–38 Vetter D (2021) How the west’s climate campaign against meat could harm millions in developing world. Retrieved from https://www.forbes.com/sites/davidrvetter/2021/10/05/how-the-westsclimate-campaign-against-meat-could-harm-millions-in-developing-world/?sh=776b742451f5 Viana MR, Neves AS, Camargo Junior KR, Prado SD, Mendonça ALO (2017) A racionalidade nutricional e sua influência na medicalização da comida no Brasil. Cien Saude Colet 22:447–456 Voedingscentrum (2021) Wat is gezond eten met de Schijf van Vijf? Retrieved from https://www. voedingscentrum.nl/nl/gezond-eten-met-de-schijf-van-vijf/wat-is-gezond-eten-met-de-schijfvan-vijf-.aspx Zalm C, Oosterhoff W (2010) Het Almere landschap: dragger van polderstad Almere. Groen, Vakblad Voor Ruimte in Stad En Landschap 11(2010):8–13

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Zouaoui H, Smaoui F, W Belk R (2020) Beyond the westernised body: constructing the ideal curvy female body through paradoxical paradigms. ACR North American Advances. Retrieved from https://www.acrwebsite.org/volumes/v48/acr_vol48_2661299.pdf

Chapter 3

Cameroon: Land of Good Food, Agriculture, and Various Visions of Good and Bad Food Ravenstein Nyugap Awuh

Abstract Given that social representations are linked to environmental heterogeneity and cultural diversity and highlight the relationship that individuals have with a given social object (which in this case is food), this chapter explores social representations or understandings of meanings of healthy and unhealthy food as well as future visions of food in Cameroon. Since social representations are dynamic and susceptible to changes that occur in context (as is the case of Cameroon), there is a need to study social representations of food in Cameroon to enhance understanding of how narratives on what is (un)healthy are shaped by these factors that are unique to Cameroon or shaped by Cameroon’s relationship with the outside world. The chapter focussed on Buea (the capital of the southwest region of Cameroon), because its environmental heterogeneity and cultural diversity make it an attractive case study for exploring diverse food visions. From the 106 questionnaires administered, the findings showed that understanding of (un)healthy food in Cameroon and Buea specifically is predominantly clinically based. Also, the future of a healthier food system in Cameroon is organic food, and climate change is identified as a key threat to a food-secure future in Cameroon. Keywords Cameroon · Cultural diversity · Food meaning · Organic food · Climate change

Introduction Cameroon’s cuisine is one of the most diverse in all of Africa. This is due to the country’s ecological diversity, which includes savannah, desert, tropical forest, mountains and coast, and allows a great range of crops to be grown. Also, the wide ethnic and cultural diversity has resulted in many different regional dishes (Oliver 2014). Cameroon has over 250 ethnic groups, which are organised into four major ethnic R. N. Awuh (B) University of Bamenda, Bambili, Cameroon e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 H. Esam Awuh and S. Agyekum (eds.), Geographies of Food, Springer Geography, https://doi.org/10.1007/978-3-031-49873-2_3

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Fig. 3.1 Overview of the diversity of food in Cameroon

and cultural groups: Grassfields, Sudano-Sahelian, Fang-Beti, and Coastal. These groups can be distinguished from one another not only by their culture but also by their attachment to a geographical area, being associated respectively with the western mountainous region (Grassfields), the northern region (Sudano-Sahelian), the central, southern and eastern parts (Fang-Beti), and mainly the Atlantic seaboard (Coastal) (Etoundi et al. 2020). Each of these ethnic groups has its own food culture, and ethnic foods are often referred to as ‘contry chop’ in Pidgin English, which is the lingua franca for a significant proportion of the country. Figure 3.1 shows a partial illustration of the food diversity of Cameroon. The country also has a colonial legacy of German, French, and British cultures. These various colonial legacies have contributed to the diversity in the country’s current foodscape. For instance, cocoa was introduced to Cameroon by the German colonial administration in the western coastal areas, including around Mount Cameroon, in 1886 (Ardener 1996). During this colonial period, the Germans introduced a range of food and cash crops (tea, oil palm et cetera) from around the world into Cameroon through the Victoria (now Limbe) Botanic Garden at the foot of Mount Cameroon. The main staples consumed in the country include yams, cocoyam, rice, plantains, maize, millet, sorghum, and potatoes. The primary source of protein is fish, but a large portion of the protein the country consumes also comes from peanuts. Cameroon is a country rich in environmental heterogeneity and cultural diversity. Environmental heterogeneity is a concept most often applied to indicate differences in the abiotic factors of an environment (Shachak et al. 1991), such as landscape units or soil types. On the other hand, demographic diversity most often refers to a population, its ethnic or household diversity. Given that social representations are linked to environmental heterogeneity and cultural diversity and highlight the relationship that individuals have with a given social object (which, in this case, is

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food) (Etoundi et al. 2020), this chapter has chosen to explore social representations or understandings of meanings of healthy and unhealthy food as well as future visions of food in Cameroon. Social representations are defined as ‘forms of knowledge, socially elaborated and shared, with a practical aim and contributing to the construction of a reality common to a social group’ (Jodelet and Moscovici 1989, p. 53). Social representations can also be regarded as a grid for understanding how individuals and groups give meaning to their physical and social environment. Social representations are derived from the concept of collective representations (Emile Durkheim in Smith 2011). Moscovici (2001) added the term social to demonstrate that representations are dynamic, as they are contingent upon the changes that take place in societies. Moscovici (2001) demonstrated that representations lie at the interface between the collective and the individual, as they arise from interactions between individuals, just as they relate to social groups, through processes of objectification and anchoring. Furthermore, the social representation of an object, such as food, is a structured and organised set of beliefs, attitudes, knowledge, and information (Abric 1996). This chapter aims to contribute to a better understanding of these parameters in Cameroon. Given that the context exerts considerable influence on the structure of social representations (Bauer and Gaskell 1999), the rationale of this chapter is that studying social representations of food. In Cameroon would allow us to understand how this knowledge of what is healthy or unhealthy is shaped by factors that are either specific to Cameroon or a product of Cameroon’s relationship with the outside world.

Material and Methods Study Area The data for this chapter were collected from residents in the town of Buea. Buea is the capital of the South West region of Cameroon. It has a population of approximately 59,765 inhabitants (All-populations 2023). The town experiences a mean temperature range of 18–27 °C, relative humidity of 80% and rainfall of 4000 mm (Nkuo-Akenji et al. 2006). Common occupational activities in this area include subsistence agriculture, plantation agriculture, teaching in public and private educational institutions, civil servants, and business owners (Nlinwe 2014). It is situated on the slopes of Mount Cameroon (Fako in the local language), which at 4095 m above sea level, is the highest mountain in West Africa. At 9.1° E and 4.5° N, Mount Cameroon is the last active part of a range of volcanoes that extend from the island of Principe, around 100 km to the southwest, through the Island of Bioko (Equatorial Guinea) Adamawa Highlands in Cameroon and Obudu in Nigeria (Letouzey 1985). The Mount Cameroon area has two distinct seasons: a rainy season spanning from March to October, with maximum rainfall (2000–10,000 mm) in August and

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Fig. 3.2 Partial view of Buea on the slopes of Mount Cameroon (Mount Fako in the local language)

September. The dry season lasts four months (November–February) (Achidi et al. 2005). Furthermore, the demographic diversity of Buea also made the town an attractive choice for studying diverse food visions. The indigenous Bakweri people have a long history of interaction with external groups, including European traders, missionaries, and German and English colonial administrations. Also, there is a high composition of people from the grass fields region in Western Cameroon who add more diversity to the foodscape of Buea. Initially, workers on the surrounding plantations were drawn from other parts of Cameroon, particularly the Bamenda highlands and other parts of Southwest Province, during the colonial period (Ardener 1996). Following independence, migrants from different parts of Cameroon and Nigeria lived as settlers and farms or as university students in the region’s oldest English-speaking university, established in the early 90s. However, a more contemporary study indicated that the indigenous Bakweri people comprised less than a quarter of the roughly 250,000 people in the Mount Cameroon region (Schmidt-Soltau 2003). Lastly, the volcanic soil in Buea and the entire slopes of Mount Cameroon area offer fertile grounds for subsistence and cash crop farming. Volcanic soil, which belongs to a category of soils known as andosols, is derived from both volcanic lava and volcanic ash, both of which are rich in certain key nutrients, such as iron, calcium, magnesium, sodium, potassium, phosphorous, sulphur, silicon, and many other trace elements, a rich combination that can act as a stimulant for plant growth (Staughton 2022). When volcanic ash and lava fall in the same place, particularly if the region receives reasonable amounts of precipitation, as is the case with the slopes of Mount Cameroon on which Buea is situated, this is an ideal situation for rapid regrowth and abundance of plant growth. See Fig. 3.2 for a view of the town of Buea.

Data Collection One hundred sixty individuals were administered questionnaires in Buea town and its environs. They were interviewed from August to December 2021 using a mixture of printed questionnaires and Google forms. Online links to the Google forms were sent to several different WhatsApp chat groups, such as; ethnic associations of people

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Fig. 3.3 Demographic background of respondents

from certain groups, students of some institutions, players of some football clubs, associations of taxi drivers, church groups, and et cetera. This was done to increase the diversity of the sample. A research assistant administered the paper questionnaires, and this was done to ensure a demographic balance among respondents. For instance, after forwarding the link to the online forms to various respondents, the author noticed an over-representation of men in the sample. Therefore, the paper questionnaires were purposefully administered to more women to even the composition of the samples. Both the printed and the online versions of the questionnaires included questions about the respondents ‘socio-demographic information, education level, and household occupation, and these questions were set to provide the background needed to understand the respondents’ responses better. See Fig. 3.3 for a demographic overview of the sample. Besides these demographic questions, key questions addressing understanding the meanings of healthy and unhealthy food and future visions of food in Cameroon were asked. These included the following: 1. 2. 3. 4. 5.

What are the meanings of healthy food in Cameroon? What are the meanings of unhealthy food in Cameroon? How do people visualise healthier food futures in Cameroon? What can inhibit the realisation of Cameroon’s desired healthier food future? What can facilitate the realisation of Cameroon’s desired healthier food future?

Data Analysis Data from the questionnaires and Google forms were entered and analysed using thematic analysis. A key outcome of open-ended questions in quantitative inquiry is

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that it sometimes produces worded answers instead of numbers only. Such worded data is often more difficult to reduce and identify patterns than numbered data. Thematic analysis is a data analysis strategy that is a commonly used approach across all qualitative designs to convert these worded data to numbered data. Thematic analysis of open-ended responses from surveys or transcribed interviews can explore the context of research data at a level of depth that quantitative analysis lacks while allowing flexibility and interpretation when analysing the data (Castleberry and Nolen 2018). The coding activity involved systematically identifying interesting features of the data across the entire data set. Codes were attached to data units that could vary in size (in this case, words and phrases). Frequencies of similar answers (words and phrases) were identified and grouped. The outcomes were entered into Excel and presented as percentages, displayed in tables and graphics for easy visualisation. Quotes in response to open-ended questions were also extracted from the Google forms and questionnaires. The findings section presents these where appropriate to provide more context to the percentages, graphs, and pie charts.

Findings Understandings of Healthy and Unhealthy Food in Cameroon Are Predominantly Nutrition-Based Healthy eating was associated with idealised ways, often standards set by others, such as educational institutions, medical experts, governments, and non-governmental organisations (scientific advice). In their responses, participants positioned their understandings of healthy and unhealthy in relation to the authoritative recommendations. In referring to what people in Buea (Cameroon) understand as healthy food, most respondents referred to words that can be interpreted as clinical understandings of what is healthy or unhealthy. Concerning healthy food, words such as balanced diets, rich in nutrients, and organic and vegetables were used (see Fig. 3.4 for more details). The participants mentioned the consumption of vegetables, nutrientrich foods or organic food as fundamental for being healthy and one’s well-being. Concerning unhealthy food, words such as fatty food, unbalanced diets, and lack of food sanitation are all used as examples (see Fig. 3.5 for details). These descriptions of what is healthy or unhealthy. Healthy food is food containing all necessary nutrients needed by the body, i.e., essential vitamins, proteins, carbohydrates, and irons. (Henrietta, Woman, 30–39-year-old, GCE Advanced Level holder, Buea, Cameroon) Food to be considered has healthy food are food which provides the body with essential nutrition, fluid and adequate food energy… Unhealthy food are food which cannot provide the body with essential nutrition. (Namundo, Woman, 20–29-year-old, GCE Advanced Level holder, Buea, Cameroon)

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Low in fats 7%

Corn Fufu 2%

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Low in sugar 2% Balanced diet 28%

Hygienic (clean) 11%

Fruits 7%

Vegetables 9%

Organic 9%

Rich in nutrients 25%

Fig. 3.4 Social representations of healthy food in Cameroon

Food prepared in good hygienic condition and which contain all the elements needed for energy production, growth, and repairs of worn-out tissues. It should not contain elements that disrupts the smooth functioning of the body systems… Unhealthy food is food prepared in an unhygienic condition, lacks the essential elements needed for the system, e.g., unbalanced diet, contain too much of inorganic elements (chemicals) that may cause malfunctioning of the body’s system. (Bih, Woman, 20–29-year-old, Master’s degree holder, Buea, Cameroon) To me unhealthy food is junk food, canned foods, or foods containing higher proportions of some classes of nutrients and very low amounts of other classes of nutrients. (Charles, Male, 30–39-year-old, PhD degree holder, Buea, Cameroon)

Although the act of sitting together to eat as an opportunity to socialise, develop alliances, and foster understanding among the people is an integral part of eating in Cameroon and in much of Africa, the respondents did not perceive that the social aspect ‘food which is shared’ as something which can be associated with the concept of ‘healthy’. Eating stimulates and unfolds itself in the pleasure of interacting as it is an instrument of communication and aggregation which improves psychological well-being (a social meaning of healthy food). This is either the result of people normalising the habit of eating together and not finding anything outstanding about it, or it is the case of the dominance of clinical meanings of healthy food, which have been largely propagated in school, government, and non-governmental outreach programmes. It is worth noting here that the sample of respondents in Buea was relatively well-educated. Only about 5% of the sample had less than a secondary school education. Although this standard could be higher than the national level because Buea is an educational centre with several Universities and Institutes of higher education, it is fairly reflective of the literacy level of Cameroonians in general.

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R. N. Awuh Meat Canned food Starchy food Rice Meals without vegetables Salty food

Monotonous diets with no diversity Sugary food Non-organic Fast food Fatty food Nutritionally poor food Unbalanced diet Insanitary food 0

5

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15

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25

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Fig. 3.5 Social representations of unhealthy food in Cameroon

According to the World Population Review (2022), Cameroon had a literacy rate of 75%—on the high side compared to other African countries. This also explains why in Fig. 3.6, formal education was said to be most people’s source of information about healthy and unhealthy food. Growing up in Cameroon, the author recounts a subject known as domestic sciences being taught at primary and secondary schools in which pupils are already being educated on what is healthy and unhealthy to eat. Biology lessons in secondary schools also introduce students to the use of certain foods to the anatomy or the dangers certain foods pose to the anatomy. With this background information, it becomes clearer to understand why respondents in Buea attach clinical meanings to healthy and unhealthy food.

Cameroonians See Organic Food as the Future of a Healthier Food System Organic farming is defined by the Food and Agriculture Organisation (FAO/WHO Codex Alimentarius Commission 1999) as a holistic production management system which promotes and enhances agro-ecosystem health, including biodiversity, biological cycles, and soil biological activity. This definition emphasises the use of contextspecific management practices in preference to using off-farm inputs, considering that regional conditions require locally adapted systems. Where possible, agronomic, and

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TV/radio 5%

Friends and family Market members 2% 5%

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Farmers 2%

Healthcare sector 5%

Formal education 34%

Nutritionist 4%

The internet 20%

Personal experience 23%

Fig. 3.6 Sources from which Cameroonians derive information on healthy or unhealthy food1

biological materials are used in this farming practice. (FAO/WHO Codex Alimentarius Commission 1999). The valorisation of organic farming emerged in Cameroon as a response to the social and environmental impacts of the so-called green revolution implemented in Cameroon by late President Amadou Ahidjo’s government from 1973 onwards till 1986 under the regime of President Paul Biya to achieve national food self-sufficiency and be a primary source of food for neighbouring countries. Such agricultural intensification began to have a range of negative social and ecological perceptions for local people and their environments. Nevertheless, in part due to continued government and non-governmental support from NGOs, the organic agricultural sector has grown significantly in recent years. Also, with the economic crisis in the mid-80 s in Cameroon, farmers began to face multiple financial barriers to achieving a bountiful harvest. The costs of fertilisers, pesticides, seeds, equipment which they had been encouraged to use during the over ten years of the green revolution period, and transportation from farm to market began to reduce profits dramatically. Today, through formal2 and informal institutional support, Cameroonians have raised awareness that organic farming reduces the negative impacts of 1

Internet sources include material posted by local healthy food activists. An example is Farmer Tantoh, a Cameroonian environmentalist, who finds ways to ‘work with what he has’ to save the future for planet and people. Learn more about how he finds clean water for children and families, teaches organic gardening and sustainable farming, and inspires people young and old to go green in Cameroon. https://www.youtube.com/watch?v=sQ0vufr3Q08 2 Cameroonian government, in collaboration with the German Cooperation GIZ formalized organic farming in Cameroon in order to open up new avenues given the growing demand for this type of agriculture in Africa.

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agriculture on the environment and health since there is no chemical input in the production process. Although organic farms cover only 1.2 million hectares on the African continent, which represents barely 0.2% of its cultivated areas (Business in Cameroon 2022), the people in Cameroon generally see a healthier food future as one which represents a shift from artificial fertilisers towards more organic farming. This signifies a return to what agriculture used to be before the introduction of chemicals. The following quotes and Fig. 3.7 provide more context to this future organic vision of a healthier food future for Cameroon from participants (Fig. 3.8). The future of food in Cameroon is bleak because the use of fertiliser is increasingly becoming rampant. (Ambo, Male, 30–39-year-old, Master degree holder, Buea, Cameroon) Now based on our recent food processing industries and local farmers who grow food crops with too many chemicals turns to cause the population to eat food crops with too many chemicals, and as a result, this will cause so many illnesses in the population, and this may cause a failure in healthy food production. (Walter, Male, 40–49-year-old, GCE Advanced Level certificate holder, Buea, Cameroon) The high use of fertiliser. I am afraid the toxic nature of our food production will make the food we eat dangerous for the future. We need to encourage the production of more organic products or food stuff. Artificial fertiliser-free farming is the way forward for Cameroon. (Epolle, Woman, 30–39-year-old, Bachelor’s degree holder, Buea, Cameroon) Now based on our recent food processing industries and local farmers who grow food crop with too much chemicals turns to cause the population to eat food crops with too much chemicals, and as a result this will cause so many illnesses on the population and this may cause a failure in healthy food production. Growing our crops with natural manure such as animal dung will help grow our crops in a better condition and there by maintaining all the nutrient from the food. Which will help our future archive a healthier food production. (Kenneth, Man, 20–30-year-old, Secondary school certificate – GCE Ordinary level, Buea, Cameroon) In my opinion, we are moving backwards in the pathway towards healthier food for all because of the too much artificial fertilisers we currently use to grow our food. In the process of agriculture in the years of our forefathers, agriculture was based on natural things like domestic animal faeces and wood ash resulted in healthy natural yields. Today, we cultivate crops with extremely dangerous inputs we don’t even know where they come from, how they are produced or the effect they will have on our long-term health. (Manyi, Woman, 20–30-year-old, Bachelor’s degree holder, Buea, Cameroon)

Climate Change is Identified as a Critical Threat to Future Food Security in Cameroon Climate change is best defined by the IPCC (2018) as any change in the state of the climate that can be identified by changes in the mean and/or the variability of its properties and that persists for an extended period, typically decades or longer (IPCC 2018). According to the IPCC, these changes can be due to natural variability or human activity. A principal cause of climate change is the release of greenhouse gases, like carbon dioxide, methane, and nitrous oxide, into the atmosphere, partially trapping longwave radiation (which manifests as heat) that naturally emanates from

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Ban on GMOs Introduce and promote healthier fastfood Higher incomes More plant-based options More home cooking Food price control Smaller family sizes Discourage fast food Food hygiene Assistance to local farmers Education and awareness More value to organic farming 0

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30

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Fig. 3.7 Factors which could facilitate transformation to a healthier food future in Cameroon

Fig. 3.8 Examples of organic farming in Cameroon [free-range livestock rearing (left and centre) and traditional organic composting (‘ankara’ in local language) (right)]

Earth’s atmosphere. The system humans have created has maximised consumerism, and now, we are faced with the consequences, including climate change. Many developing countries like Cameroon have fought hard for their right to develop, including burning cheap fossil fuels and converting forests into agricultural fields. Unfortunately, as a result, carbon emissions are increasing sharply in developing countries as wealthy nations ‘offshore’ the energy and natural resourceintensive stages of production. Also, research and the systematic analysis of thousands of hydro-meteorological disasters over the past two decades leading up to 2007 show that the world’s poorest nations are least able to prepare for, handle, and recover from the effects of global climate change (Roberts and Parks 2007). Although less than 2.5% of fossil fuels burned since 1800 have been burned in Africa, and the continent is still the least urbanised region in the world, the IPCC predicts that the impacts of climate change on African communities will be disproportionately large (IPCC 2018). This is especially true of its fast-growing cities, where a change in climate patterns is threatening rapidly expanding populations and investment opportunities. Therefore, the rapidly expanding cities in Africa provide ideal spaces for engagement between and amongst policymakers and citizens where new

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climate-smart solutions can be shaped. However, Africa remains the continent most vulnerable to the impacts of climate change, even though it contributes the least to climate change—a situation aggravated by its low adaptive capacity. Africa’s rapidly expanding cities face huge threats from climate change over the next 30 years, which could bring knock-on effects such as higher crime rates, civil unrest, and hunger. The knock-on socio-economic marginalisation can provide a breeding ground for recruitment by terrorist groups as social values and moral authority evaporate. These current impacts of climate change are forecasted to amplify in the future (largely driven by rapid population growth), causing major setbacks to socio-economic development and food security. This puts Cameroon and Africa at the eye of the climate change storm and explains why as shown in Fig. 3.9, most respondents in Buea, Cameroon (29%), view climate change as the greatest threat to a healthier food future. Thanks to their high formal education rate, as shown in Fig. 3.3, the respondents in this study are too aware of the causes of climate change and the consequences it will have on the ability to grow food. In growing food, climate change poses two problems in Cameroon. These include either too little rain at certain times or too much rain at certain times. Concerning too much rain, increasing temperatures and elevated atmospheric temperature are projected to shift the frequency, intensity, duration, and timing of storms worldwide. Although much of Africa will have less precipitation, the intensity of storms is projected to increase. This means that extremely heavy rainfall that previously occurred once every 20 years will now occur once every few years (IPCC 2018). In nearby Douala (Cameroon), for instance (about 53 km from Buea), future scenarios show an increase in the frequency and intensity of severe rain events (Pauleit et al. 2015). In the case of too little rain, a deficiency of precipitation from expected or ‘normal’ amounts that, when extended over a season or longer, will be insufficient to meet demands for agriculture and other rain-dependent activities. As soon as 2020, increases in water stress due to climate change may affect between 90 and 220 million people across Africa (Wilson and Smith 2016).

Conclusion This research aimed to understand what Cameroonians understand by healthy and unhealthy food, as well as their visions about a healthier food future and what could inhibit or facilitate these visions. Firstly, the results revealed that in their social representations of unhealthy or healthy food, Cameroonians based their representations on clinical meanings of healthy or unhealthy—what the food does or does not do to the physical anatomy. These representations were attributed to the sample’s relatively high level of education and the fact that Cameroonians derived most of their food knowledge from formal educational institutions, which principally advocate a clinical meaning of what is healthy or unhealthy food. Secondly, the research in this chapter found out that most participants saw organic farming as the image of a healthier food future for Cameroon. This came against the backdrop of the increasing

3 Cameroon: Land of Good Food, Agriculture, and Various Visions … Large family sizes and rapid population growth 7%

Lack of adequate government regulatory policies 3%

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Time constraints 2%

Climate change 29% Fastfood 10%

Fertilisers and GMOs 15%

Poverty 17%

Lack of awareness on healthy and unhealthy 17%

Fig. 3.9 Social representations of what can inhibit a healthier food future for Cameroon

realisation of the socio-ecological effects of artificial fertilisers and the increasing costs of obtaining them. Hence, many respondents see a return to organic farming as a healthier food future. Lastly, the respondents identified climate change as a major threat to future food security in Cameroon. Although the case of climate change is global, people are pretty aware of its local consequences—too much rain or too little rain at some times. Considering that agriculture in Cameroon depends heavily on seasons, climate change-related unpredictability to weather patterns seems to threaten the agriculture and food security of the respondents. As a future research trajectory, although this chapter presents social representations about what is healthy or unhealthy in Cameroon, it is out of its scope to introduce a discussion about the gap between what people think is healthy and what they should be eating or what people think is unhealthy and they should not be eating. People may clearly understand the scientific advice related to healthy or unhealthy eating, but they may be unwilling or unable to follow through in their behaviours. Since this study did not investigate actual behaviours, it is hard to tell what the gap between understanding what is healthy and consuming what is healthy is. In other words, this gap is between what a person aspires to do and what they do, regardless of how the ideal behaviour matches scientific guidelines. Likewise, knowing what is healthy or unhealthy does not automatically translate to having access to what is healthy or staying away from what is healthy. Finally, focusing on a single region in Cameroon (no matter how diverse Buea is) means that the sample size might not truly represent Cameroon for this paper to make the conclusions. However, it indicates the sort of responses which can be expected

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from a more representative sample. Therefore, the conclusions made in this chapter should be seen as an indication of patterns of responses. A larger sample based on other regions of Cameroon could have generated more accurate results on a larger scale. Although that was not possible in this case, the findings of this chapter can serve as a point of reference for any further research on perceptions of the meanings of food in Cameroon. That is a major contribution this chapter makes to scholarship on food in Cameroon.

References Abric JC (1996) Specific processes of social representations. Papers on Social Representations 5:77–80 Achidi EA., Kuoh AJ, Minang JT, Ngum B, Achimbom BM, Motaze SC, Ahmadou MJ, TroyeBlomberg M (2005) Malaria infection in pregnancy and its effects on haemoglobin levels in women from a malaria endemic area of Fako Division, South West Province, Cameroon. Journal of Obstetrics and Gynaecology 25(3):235–240 All Populations (2023) Population of Earth. Retrieved from https://all-populations.com/en/cm/pop ulation-of-buea.html Ardener E (1996) Kingdom on Mount Cameroon: studies in the history of the Cameroon Coast, 1500–1970, vol 1. Berghahn Books Bauer MW, Gaskell G (1999) Towards a paradigm for research on social representations. J Theory Soc Behav 29(2):163–186 Business in Cameroon (2022) Cameroon fine-tunes a draft law on organic agriculture. Retrieved from https://www.businessincameroon.com/agriculture/1309-11872-cameroon-finetunes-a-draft-law-on-organic-agriculture Castleberry A, Nolen A (2018) Thematic analysis of qualitative research data: is it as easy as it sounds? Curr Pharm Teach Learn 10(6):807–815 Etoundi JC, Kay N, Gaymard S (2020) Social representations of risk in Cameroon: influence of sociopolitical and cultural context. J Soc Polit Psychol 8(2):642–661 FAO/WHO Codex Alimentarius Commission (1999) Organic agriculture. Item 8 of the provisional agenda, fifteenth session. Rome, 25–29 January 1999, Red Room. Retrieved from https://www. fao.org/3/X0075e/X0075e.htm IPCC (2018) Managing the risks of extreme events and disasters to advance climate change adaptation. In: Field CB et al (eds) A special report of working groups I and II of the intergovernmental panel on climate change. Cambridge University Press, Cambridge Jodelet D, Moscovici S (1989) Folies et représentations sociales. Presses universitaires de France, Paris Letouzey R (1985) Notice de la carte phytoge´ographique du Cameroun au 1: 500 000. IRA Yaounde´ et Inst. Cart. Intern. Ve´ge´tation, Tou- louse Moscovici S (2001) Social representations: essays in social psychology. NYU Press, New York Nkuo-Akenji TK, Chi PC, Cho JF, Ndamukong KK, Sumbele I (2006) Malaria and helminth coinfection in children living in a malaria endemic setting of mount Cameroon and predictors of anemia. J Parasitol 92(6):1191–1195 Nlinwe NO (2014) Effects of malaria on iron stores in the pregnant women of Buea and Tiko Health District, South West Region, Cameroon. J Metab Syndr 3:4–9 Oliver J (2014) Cameroon: tracing African food roots. In: Around the world, foodie world cup, grow your own. Retrieved from https://www.jamieoliver.com/features/cameroon-african-foodroots/

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Pauleit S, Coly A, Fohlmeister S, Gasparini P, Jorgensen G, Kabisch S, Kombe WJ, Lindley S, Simonis I, Yeshitela, K (2015) Urban vulnerability and climate change in Africa. Future City 4 Roberts TJ, Parks BC (2007) Fueling injustice: globalisation, ecologically unequal exchange and climate change. Globalisations 4(2):193–210 Schmidt-Soltau K (2003) Rural livelihoods and social infrastructure around Mt Cameroon: background information for the Mount Cameroon socio-economic geographical information system (MC-SE-GIS). Im Auftrag der Deutschen Gesellschaft fur Technische Zusammenarbeit (GmbH) Shachak M, Brand S, Gutterman Y (1991) Porcupine disturbances and vegetation pattern along a resource gradient in a desert. Oecologia 88(1):141–147 Smith TE (2011) Emile Durkheim: socialisation and education. Sourcebook of experiential education. Routledge, London, pp 164–170 Staughton J (2022) Why is volcanic soil so fertile? Retrieved from https://www.scienceabc.com/ nature/why-is-volcanic-soil-so-fertile.html Wilson RH, Smith TG (2016) Urban resilience to climate change challenges in Africa. In: Handbook of cities and the environment. Edward Elgar Publishing World Population Review. (2022) Literacy rate by country 2022. Retrieved from https://worldp opulationreview.com/country-rankings/literacy-rate-by-country#:~:text=The%20literacy%20r ate%20for%20all%20males%20and%20females,behind%20at%2082.7%25.%20However% 2C%20massive%20country-to-country%20differences%20exist

Chapter 4

Achieving Food System Transformation Through an Inclusive Understanding of Healthy and Unhealthy Food: The Case of Winneba, Ghana Emmanuel Acheampong

Abstract The quest for healthy food consumption has been of much interest to researchers. However, much attention has not been paid to the meanings of healthy and unhealthy food in different contexts. The purpose of this study is to examine the meanings of healthy and unhealthy food from the Ghanaian perspective and also to critically evaluate the future of healthier food practices in Ghana. This chapter will discuss how Ghanaians understand the meaning of healthy food, how healthier food practices in Ghana are perceived, and the factors that are contributing to or preventing the achievement of healthier and more sustainable food system transformation in Ghana. The data for this study were collected using the snowball method of sampling. Eighty-five participants from Winneba (a town in the South of Ghana) filled an online survey through Google Forms. The key findings of this study are that: (1) Healthy or unhealthy food is predominantly understood to be based on how balanced the diet is in terms of nutrition; (2) Healthy or unhealthy food meanings are linked to food hygiene; (3) Participants are pessimistic about a healthier food future due to the increase in the availability of highly processed food and rising food costs. The findings in this study should be used as a starting point to kick start the interest in including a citizens’ perspective in progress towards a healthier and more sustainable food future for Ghana. Keywords Ghana · Balanced diet · Food meaning · Food hygiene · Citizens’ perspective

E. Acheampong (B) University of Nebraska-Lincoln, Lincoln, USA e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 H. Esam Awuh and S. Agyekum (eds.), Geographies of Food, Springer Geography, https://doi.org/10.1007/978-3-031-49873-2_4

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Introduction There are countless conceptions of what constitutes healthy food, many of which share features and others which conflict throughout time. In order to carry out its everyday functions, the body requires the nutrients produced by the food we eat. If, however, we eat healthy foods, the body benefits greatly from this food consumption. The idea of classifying foods as healthy is challenging because a single dish may be good for one group of people, while being bad for another (Neufeld et al. undated). The World Health Organization (WHO) defines a balanced diet as one that provides all the necessary elements required for optimal health, growth, and development (WHO 2021). Various foods from the major dietary groups, such as fruits, vegetables, grains, foods high in protein, and dairy products are included in the right amounts to suit an individual’s energy requirements. Neufeld and colleagues pointed out that healthy food provides beneficial nutrients such as vitamins, minerals, essential amino acids, essential fatty acids, and dietary fibre and minimises potentially harmful elements—anti-nutrients, quantities of sodium, and saturated fats and sugars in the human body. Recently, the quest for healthy food consumption has been of much interest due to the high rate of urbanisation typically in the African continent. This high rate of urbanisation has brought about significant changes in food environments, leading to a changing diet towards food/beverage consumption, especially in socio-economically disadvantaged populations (Holdsworth et al. 2020). This has led to a rise in obesity and diet-related non-communicable diseases (DR-NCDs) (Ecker and Fang 2016; Holdsworth et al. 2020). Global changes like the dietary transition are being impacted by a convergence of factors, including urbanisation, poverty, industrialisation, globalisation, climate change, and the rise of a concentrated corporate food regime (Adjei et al. 2022). For example, the nutrition transition is underway in Ghana, which is also rapidly urbanising, witnessing an increase in overweight/obesity and suffering from linked NCDs. This comprises increasing the consumption of highly processed, caloriedense meals deficient in micronutrients and leading sedentary lives with little or no exercise. In response to the aforementioned challenges, the Government of Ghana (2013), in its National Nutrition Policy, pointed out that, as one of the first African countries to achieve the first Millennium Development Goal (that of eradicating extreme poverty and hunger), Ghana has been able to suppress household food insecurity, poverty, as well as undernutrition in the past three decades as the achievement of the Millennium Development Goal, and brought about a high level of economic growth. However, until recently, when the new National Health Policy was developed, Ghana’s health sector focused on curative rather than preventive care. The new National Health Policy now emphasises the importance of healthy eating, good nutrition, and more intensive and longer-term interventions such as growth promotion and health and nutrition education.

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Notwithstanding, intensive health and nutrition education with relevant inputs has not been delivered in Ghana on a scale large enough to bring desirable social or national results (Omari et al. 2017). This has made the future of healthy food practices in Ghana appear bleaker than desired. Despite the rapid economic growth and political stability for more than 20 years and emerging as one of the strongest economies in sub-Saharan Africa, Ghana has still been battling severe poverty and hunger, with the populace of the northern and central region mostly facing this challenge (Ali and Abizari 2018). Ali and Abizari further argue that these two regions now account for almost half of the country’s populace living under the poverty line and have a high prevalence of food insecurity, ranging from 11 to 34% being food insecure. Furthermore, there has not been an established set of understandings, procedures, and engagements at any given time that determines acceptable conduct within a particular practice (Evans et al. 2012). As a result, individuals are expected to be the autonomous architects of their actions—carriers of practice who routinely enact actions following shared understandings of normality and their subjective interpretation of the required forms of appropriate conduct necessary to perform any practice satisfactorily. Without policy and institutional support, people are driven to use their everyday practices to determine what is healthy or unhealthy for them concerning their food. Nonetheless, there is little or no knowledge about meanings or understandings of healthy and unhealthy food which could prevail or develop from these everyday practices in Ghana. This is a knowledge gap that this chapter seeks to address. Filling this gap is relevant to understand these meanings, which develop from everyday practice if a healthier and more sustainable food system transformation for Ghana is to be advanced. Furthermore, generally, although there has been recent concern about food security (or insecurity) around the globe, little attention has been paid to how people across different contexts understand what healthy or unhealthy food is. Likewise, there isn’t sufficient attention paid to drivers of meanings of what is healthy or unhealthy food. Furthermore, the future of healthier food practices from the perspective of consumers globally is also understudied. This chapter will look at healthy or unhealthy food consumption and, more importantly, try to fill the research gap by assessing the vision of healthier food practices from the Ghanaian perspective. As a result, this chapter seeks to delve into the Ghanaian setting to investigate the present and prospects of our eating habits by looking for answers to the following questions: (1) What is the meaning of healthy food? (2) What is the meaning of unhealthy food? (3) How do Ghanaians visualise healthier food futures? (4) What can inhibit the realisation of these desired healthier food futures? and (5) What can facilitate the realisation of these desired healthier food futures?

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Material and Methods Study Area This study was conducted in Winneba, one of the municipalities in the central region of Ghana (see Fig. 4.1). Winneba is a town and the capital of Efutu Municipal District in the Central Region of Southern Ghana and has a population of 60,331 inhabitants (Impraim and Swanzy 2015). Traditionally known as Simpa, Winneba is a historic fishing port in Southern Ghana, lying on the South Coast, 90 miles (140 km) east of Cape Coast. Efutu Municipal Area is one of the 170 districts in Ghana and one of the 17 districts in the Central Region. It was extracted from the then Awutu– Efutu–Senya–District Assembly in 2007 by L 11,860, and it covers a total area of about 64 km2 (Impraim and Swanzy 2015). Although Winneba is predominantly a fishing community, the town is well known for its Aboakyire (Dear hunt) festival and the University of Education Winneba (UEW), from which most online survey respondents of this research were reached. The inhabitants of Winneba celebrate Aboakyer (Deer Hunt) every year. It is one of the most well-known events in Ghana and is typically held in May. The festival of Aboakyer commemorates the movement of the Winneba people from Timbuktu, Mali, to their present location (Impraim and Swanzy 2015; Brown et al. 2005). According to legend, the war deity Penkye Otu escorted the ethnic group from Timbuktu to Simpa (modern-day Winneba), shielding them from all perils. The deity was consulted, and it was decided that they should sacrifice a member of the royal family, no less, as a token of their gratitude. The royal family continued this practice for a while until deciding it was undesirable and replacing it with a lion. But the lion was further changed to a deer because the animal had to be grabbed using just one’s bare hands and brought alive before being sacrificed to the God (Brown et al. 2005). Later, this ritual of animal sacrifice evolved into the Aboakyer (animal catch/ deer hunt) festival. The event is currently held on the first Saturday in May, drawing visitors to Winneba from around the country. Although the Winneba people are of the Guan ethnic group, the Akans (the largest ethnic group in Ghana) surround the Winneba community (Brown et al. 2005). The Winneba people speak Efutu as their native language, although they have also adopted and speak Fante, a well-known Akan dialect. Agyeman (2013) noted that only around twelve (located along the coast) of the approximately forty suburbs in Winneba speak Efutu, with the remainder (the inland part) speaking Fante.

Data Collection An online survey was conducted using Google Forms and shared with respondents using snowball sampling. The snowball sampling technique ensured that the sample was as diverse as feasible. Early May to mid-April 2022 was the time frame for

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Fig. 4.1 Map of Ghana showing Winneba and the Efutu municipality. Source Primary

data gathering. In this snowballing method of sampling, initial participants were selected based on the required criteria (limiting the follow-on contacts to two to ensure variety in the response). Though there was certain exceptional difficulty (like a huge number of the participants being students, hence the high level of educational attainment), the snowball method of sampling and limiting the follow-on contact to two was able to deal with this difficulty. The researcher used this method of sampling to obtain participants by first recruiting students, lecturers, parents, market men and women, food vendors, and non-teaching staff (cleaners, constructors, administrators, and security guards, among others) who represent the diversity of the survey seeks to achieve and they later recruit the additional respondents based on their common character traits.

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The first participants recommended second participants with similar demographic characteristics from their networks. The questionnaire was shared through social media platforms such as WhatsApp and email. The survey was initially sent to some respondents with varied demographic characteristics such as age, gender, ethnicity, income, and religious and educational background. After the initial respondents were contacted, they were urged to share the survey with at most two respondents with whom they share at least three of the demographic characteristics. In order to make the sample as diverse as possible, the number of follow-on contacts was limited to two. However, as noted, some initial participants recruited more than two responders, while others (such as the Provost, the chief farmer, and the MP of the Winneba Municipality) decided not to participate in the poll as a result of their hectic schedules. Some of the traits, such as the undergraduate students who make less than $750 per year, were made more prevalent due to this. The survey was in two folds, the first part collected the demographic information of participants and the second part included the main survey questions of healthy/unhealthy food as well as the healthier food future. A total of eighty-five (85) respondents took part in the survey. Age, sex, educational attainment, income, race/ethnicity, and geographical location are just a few demographic factors that may impact survey respondents’ opinions and responses. Therefore, researchers can more accurately analyse the data and ensure that their conclusions represent the group they are investigating by knowing the demographic trait of the survey respondents. This can aid in preventing biases and mistakes in the research and offer a more thorough understanding of the subject under investigation, hence the reason for knowing the demographic characteristics of the survey respondents of this research. Out of the 85 respondents to the online survey, 57.6% were men (see Fig. 4.2). It came out that most (40.6%) of the respondents who participated fell between the age range 20–29 years, and the respondents between the ages of 40–49 years recorded the lowest (9.1%) number of participants. The Akan ethnic group recorded the highest participation (80%) among respondents who participated in the survey (see Fig. 4.3). This is primarily because the central region (precisely Winneba) where most of the data were obtained is an Akan-speaking region, and it is the predominant ethnic group in Ghana as well. This ethnic representation in the survey sample is followed by the Ewes, Guans, Mole-Dagbani, Gurma, and finally, the Ga-Adangbes, who recorded the lowest of respondents, 6.7%. Concerning the income backgrounds of respondents, the annual range of income for almost half of the respondents (49.6%) was less than ₡6000 (less than $750) and 12.3% earned from ₡30,000 to ₡50,000 ($3750–$4900) annually. Concerning formal educational backgrounds, a majority of the respondents (63.5%) were bachelor’s degree holders, with 8.2% of the respondents having their secondary education ‘o level’ (see Fig. 4.4). Due to the University of Education Winneba, a significant portion of the participants were students, resulting in a high level of educational attainment, with most of the population possessing degrees. Concerning religious backgrounds, 57.3% of the participants were Christians, 32.9% were Muslims, and the remaining 9.8% of the respondents belonged to other religious denominations.

4 Achieving Food System Transformation Through an Inclusive … Fig. 4.2 Sex of survey participants

Fig. 4.3 Ethnicity of survey participants

Fig. 4.4 Educational level of survey participants

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Positionality of the Researcher The researcher is an ex-student of the University of Education Winneba (UEW) and has familiarised himself with the Winneba community for almost four years of his bachelor’s degree (2017–2021). As a result, he is well-versed in the consumption patterns of the student body and the people of Efutu municipality at large. Furthermore, data collection from participants from different backgrounds was easier by the researcher’s status as a student and the volume of interactions he had with other students, professors, and other teaching and non-teaching personnel at the University. Insider positionality describes the facets of an insider researcher’s identity or self that are shared or aligned with participants (Chavez 2008; Greene 2014). According to Robert (1972), cited by (Greene 2014), an insider has deep knowledge of the community and its members from the outset. I qualify as an insider researcher since I was a former student at the University of Education Winneba (Fig. 4.5), a school in the Winneba neighbourhood where the case study was conducted. My positionality has significantly impacted my technique for gathering and analysing data. As Unluer (2012) reported, there are many advantages to being an insider researcher like myself, including having a better understanding of the culture being studied, not interfering with social interactions unnaturally, and having a rapport that encourages both telling and judging the truth. Being an insider researcher with extensive knowledge of the Winneba community was really helpful and time-saving, because it would have taken much time for an outside researcher to understand how the Winneba community actually functions and, most importantly, how to approach participants in a way that would elicit sincere responses. In addition, as an insider, I could better comprehend participants’ psychological, emotional, and/or cognitive underpinning and have a deeper understanding of the historical and current events affecting the Winneba community (Chavez 2008; Greene 2014). This gave me much insight that aided in collecting, analysing, and presenting my data (Darwin Holmes 2020).

Findings This research found that although respondents had several diverse demographic characteristics, they had similar opinions and beliefs on the concept of healthy/unhealthy food and the vision of healthier food practices in Ghana. Based on this, the key findings of this study are that: (1) Healthy or unhealthy food is predominantly understood to be based on how balanced the diet is in terms of nutrition; (2) Healthy or unhealthy food meanings are linked to food hygiene. Food hygiene is an increasing concern in visions of a healthier food future; (3) Participants are pessimistic about the food future (increased availability of processed food and rising food costs).

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Fig. 4.5 University of Education Winneba. Source Primary

Healthy/Unhealthy Food is Predominantly Understood to Be Based on How Balanced the Diet is in Terms of Nutrition The respondents were asked to define healthy food from their point of view. The outcome was that a majority (54%) of the participants defined healthy food as any meal that contains a balanced diet. Precisely, any food that contains the required nutrients and is in its right proportion. The World Health Organization (WHO) defines a balanced diet as one that provides all the necessary elements for optimal health, growth, and development (WHO 2021). In addition, a balanced diet ought to offer bioactive phytochemicals like dietary fibre, antioxidants, and nutraceuticals that have positive health advantages. Furthermore, a balanced diet should offer around 60–70% of total calories from carbohydrates, 10–12% from proteins, and 20–25% from fat (Narayana Health Care n.d.). Despite these recommendations, research has shown that typical traditional Ghanaian diets largely comprise staple carbohydrates, with little protein and minimal vegetables (Omari et al. 2017). One of the reasons for this is that a healthy food item such as fruit is generally not considered as part of a meal in Ghana. When asked how frequently he consumes fruits, Agyemang, a survey respondent, replied: Approximately three to four times every week. Besides, food that will provide me the energy I need to do my daily tasks is more important than anything else, in my opinion. For instance, $1.25 worth of fruits can easily purchase a full meal alone, thus I always choose the more filing options over fruits. (Agyemang, security guard)

On page six of their study, Amuquandoh and Asafo-Adjei (2013) reported many local Ghanaian cuisines which are high in carbohydrates and low in certain essential micronutrients. Some of these include:

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• Waakye (boiled rice and black-eyed peas)—carbohydrates, protein, vitamins, and minerals • TZ (pounded corn paste with ayoyo leave soup)—carbohydrates, vitamins, and minerals with no oil • Gari and stew (fried cassava granules soaked in warm or cold water with stew or fish)—carbohydrates, protein, vitamins, and minerals • Emotuwo (rice paste balls with peanut soup or palm nut soup)—carbohydrates, protein, vitamins, and minerals • Cassava (boiled cassava with nkontonbra stew)—carbohydrates, protein, fibre, vitamins, and minerals • Koko (corn dough or millet porridge)—carbohydrates and fat with no vitamin or mineral • Akple (cassava dough past with okra soup)—carbohydrates, protein, and vitamins with no oil • Nkrandokono (corn and cassava dough paste boiled in corn husk)—carbohydrates • Plantain chips (thin slices of unripe plantain)—carbohydrates and oil with no protein or vitamins • Impotupotu (mashed cocoyam mixed with stew)—carbohydrates, protein, vitamins, and minerals. These foods justify what Omari et al. (2017) highlighted as a concern in Ghanaian diets—one that is heavily based on carbohydrates with no fruits. Participants in this study share the nutrition-based definition of what healthy food is. For instance, Aisha, one of the respondents, defined healthy food as, ‘any food that we eat to obtain all the essential nutrients in their right proportion required for the proper functioning of our body. We can summarise it as a balanced diet’. Aisha is a Level 300 Social Studies student. She is a Muslim, 23 years old, and is of the Mole-Dagbani ethnicity. Aisha makes less than $750 a year because she is still in school and not working full-time. Aisha says so because of concern that most traditional Ghanaian foods recorded as healthy food (balanced diet) lack the content of fruits which provide the body with essential vitamins that it needs to stay healthy. So, some participants follow mainstream nutrition-based understandings of a balanced diet very strictly, making them very critical of popular discourse, which has loosely labelled some traditional foods as healthy when in essence, they are not. This is evident from the foods displayed in Figs. 4.6 and 4.7 as examples of healthy food, for which none were served with some fruits, though both foods were prepared with some vegetables. As stated, most Ghanaians do not consider fruits part of a meal (Omari et al. 2017). The average Ghanaian meal is traditionally energy-dense (grain, cereal, legume, or tuber). Traditional Ghanaian food is often served with soup or stew, usually accompanied by fish, beef, or poultry (Laar and Aryeetey 2014; as cited in Evans et al. 2012), which is analogous to the cultural eating practices of many sub-Saharan African countries. Some participants know that eating any of these traditional Ghanaian meals served with some fruit will enhance nutrition and add more meaning to the concept of healthy food from a balanced diet perspective. This is evident in the fact that some participants claimed that they ate healthier food during the Covid19 pandemic since

4 Achieving Food System Transformation Through an Inclusive … Fig. 4.6 Fried plantain, beans, and egg

Fig. 4.7 Ampesi (boiled plantain) and garden egg stew with avocado and eggs

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they had more fruits and vegetables in their meals. When asked whether participants consumed more or less healthy food during the Covid19 pandemic, about 72% of them responded yes—indicating that they ate more healthy foods—and Lydia, a participant in the survey, stated that: During that time I did eat more healthful stuff. In contrast to working days when I was very involved in my work, I consumed adequate fruits and vegetables during the Covid19 pandemic period. (Lydia, a fashion designer)

This is because, as a result of working from home, people had more access to easily available fruit trees growing around their homes. At work or at school, people are more inclined to eat what is readily available around work or school premises and that usually doesn’t include fruit. In addition, unhealthy fast food is often easily available at work or school, as displayed by street food vendors (Micah et al. 2012). Correspondingly, concerning the meaning of unhealthy food, more than half (61%) of the respondents defined unhealthy food as any meal that is not a balanced diet. This refers to any meal that does not contain the food nutrients the body requires in its right proportions. The data shows that people are aware that an unbalanced diet is unhealthy. However, they still consume unbalanced diets not out of choice but out of financial constraints, which limit access to healthier diets. For instance, it has been argued that in times of economic hardship, low-income groups opt for cheaper energy-dense foods to maximise energy value for money—resulting in habitual energy-dense and nutrient-poor diets (Holdsworth et al. 2020). This is the sort of situation which is leading most Ghanaians to consume what they consider as unhealthy food.

Healthy or Unhealthy Food Meanings Are Linked to Food Hygiene A group of participants also looks at healthy or unhealthy food from the context of how hygienic or uncontaminated the food is. According to this group of respondents, food should be prepared and stored in a very hygienic environment to be classified as healthy. Regarding the unhygienic condition of food practices leading to the consumption of unhealthy food, references were made to street foods. Omari et al. (2017) mentioned that street food constituted more of young children’s (especially students’) meals in most Ghanaian communities like Winneba and Kumasi. Young people consume street food because they spend most of their time away from home and also due to the taste and availability. Street food is easy 2016; Popkin availability, low cost, and is regarded as delicious (Sezgin and Sanlıer ¸ 2017). Despite these advantages of street food, it is often fraught with sanitation issues that concern public health. Sezgin and Sanlıer ¸ (2016) noted that street sellers lacked knowledge of food hygiene. There is a death in knowledge about food safety, hygiene, and diseases originating from food sources among street food vendors (Sezgin and

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Fig. 4.8 Waakye seller and herring seller. Source Primary (Taking by Author)

Sanlıer ¸ 2016). Although consumption is increasing, the required and sufficient legislation regarding safety measures is not being effectively implemented. This exacerbates health risks relating to street food consumption and explains why respondents view street food as unhealthy food. A respondent (Stella) in relation to sanitation issues associated with street food, said: Looking at the poor hygienic condition of the environment where this food is sold (referring to Waakye seller on Figure 4.8). It is unhealthy to eat this food. However, due to its easy availability especially to students, there seems to be no other choice but to consume it. (Stella, school teacher)

People Are Pessimistic About Their Food Future More than half (about 54%) of the participants claim that the vision of healthier food practices is not promising. Several factors were cited as responsible for Ghana’s bleak vision of a food future. The most prominent of these factors were: the extensive usage of chemicals in food (production and procession) and increasing food prices. People see a bleak future for healthy food in Ghana because of the increased availability and popularity of processed food. The most significant factor, which accounted for over half of the responses (54%), was the extensive usage of chemicals in food—especially processed food. As the global population keeps increasing, an effort to feed everyone without harming our

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environment is increasingly a concern. Looking at how the modern food system is negatively affecting us, our planet is gaining more urgency (McClements 2020). Given this, food should be affordable, safe, convenient, nutritious, and sustainable. But in reality, that is not an easy task. Some scholars have argued that the current relative level of food security is because of advances in agro-technology (Lipton et al. 2020). Agro-technology involves the use of chemicals, which, although increased yields, also increase health risks for consumers. As a result, markets in Ghana are flooded with a range of tasty, affordable, and convenient processed foods which contain several potentially harmful chemicals. A significant issue in this regard is the abundance of ultra-processed (canned/ packaged) commodities on the shelves of our supermarkets and marketplaces. Foods in hermetically sealed containers (metal, glass, plastic, paper, etc.) that have undergone thermal processing to make them shelf-stable are known as canned foods (Doyle n.d.). The canning process comprises heating that occurs under pressure at a specified temperature for a specific amount of time, depending on the kind of food being canned (high-acid or low-acid, for example) (Zheng et al. 2021). Packaged food contamination can result from microbial, chemical, and physical factors. Metals, poisons, plastic-related compounds (PRCs), furans and alkylated furans, biogenic amines, and disinfection by-products have all been found in canned food or food packaged in cans with a variety of origins (Zheng et al. 2021). Although coatings limit metal contamination, some chemicals that are utilised in the manufacture of the polymers used in canning or that result from their deterioration over time may migrate into canned food. The impact of this dangerous chemical in canned foods is extremely destructive to human health, but these items are easily accessible in our stores, as seen in Fig. 4.9. Conventionally, Ghanaian families will grow their own food organically, including fresh vegetables, cereals, tubers, and livestock for meat. However, this trend is being increasingly replaced by the increasing popularity and availability of processed food. These foods contain high calories with sugar and fat but very little fibre, which are now common in our food joints and restaurants. An example is taken from one of the respondents (Nadia, a student nurse at Winneba Nursing Training) as she refers to Fig. 4.10 that taking in this kind of food is unhealthy due to the health risk associated with the processed spices that come with its packaging. I don’t like eating instant noodles such as Indomie. This is due to the information I have been getting from the internet concerning the chemical components used in its preservation and too much additives to the spices that comes with it. Though it is fast and easy to prepare, my health is more important. (Nadia-student nurse)

The concern here is not with the spices per se. It is rather with the chemicals needed to preserve them for this long or the possible risks associated with keeping spices on the shelves in the shops for long periods—perhaps with no indication of expiry dates. The severity of this problem with chemicals in preserved food is highlighted by Ghana’s recent Food and Drugs Authority’s (FDA) ban imposed on Indomie Instant Noodles (chicken flavour enhancer) in Ghana (Zurek 2022).

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Fig. 4.9 Canned foods in supermarket shelves Fig. 4.10 Spicy spaghetti with fried chicken

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Furthermore, concerning the consumption of sugar-sweetened beverages (SSB), Popkin (2017) reported that SSB consumption had increased remarkably in lowand middle-income countries (LMIC) like Ghana when compared with high-income countries. In Ghana, for instance, the SSBs are mostly consumed in the morning during breakfast (Holdsworth et al. 2020) and are recorded as either sweet tea or coffee. In the afternoons, their consumption often goes along with biscuits or pies, which also contain high sugar levels. The high sugar content in the SSBs makes them unhealthy because it poses several health risks, such as diabetes. Another concern for processed food is the increasing popularity of junk food in Ghana. Junk food can be defined in a variety of ways, such as any edible product that contains many calories but little in the way of nutritional value or unhealthy food that has many calories from sugar or fat but little in micronutrients such as vitamins and minerals (Taber et al. 2011). Junk food, according to Surya et al. (2020), is any food that has been pre-prepared or packaged and has little nutritional value. Junk food poses several health risks, such as diabetes, due to the high level of insulin it might contain (Torto and Brownell 2020). This is known to make consumers vulnerable to mental disorders such as depression (Torto and Brownell 2020). Additionally, highly processed foods contain too many preservatives such as excess salt, sugar, or fat, sometimes called ultra-processed foods (McClements 2020). The increase in certain chronic diseases such as obesity, stroke, diabetes, and several heart diseases has been traced to the consumption of such ultra-processed foods. Examples of this junk food which is increasing in popularity in Ghana and which respondents to the survey see as a threat to a healthy food future for Ghana, include: pizza, KFC fried chicken, Coca-Cola, and fried rice, among others. It is worth noting that many of these are global brands making inroads into the Ghanaian market—bringing processed food to the consumer.

People See a Bleak Future for Healthy Food in Ghana Because of Rising Food Costs Another factor responsible for the bleak outlook on the future of healthier eating in Ghana is the rising food costs. Over the years, the global economy has been battling several economic issues manifesting in rising food prices. In addition, rising food prices have been reported in other countries for several years. For example, Von Braun et al. (2008) reported that in Tanzania, 81% of the change in international maize prices between 2003 and 2008 had been reflected in local price changes. Similarly, in Ghana and the Philippines, local rice prices have increased accordingly in response to around 50% of changes in the price of rice in the world market (von Braun et al. 2008). These rises in food prices tend to directly impact inflation, adversely affecting the local cost of living in Ghana. Von Braun et al. (2008) further indicated that food inflation had increased significantly in Latin America, China, India, and several African countries—including Ghana.

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In the recent past, the world faced supply disruption due to the Covid19 pandemic, and not long after that, commodity prices skyrocketed due to constant geopolitical dangers such as the Russia-Ukraine war (Lagi et al. 2011; Sohag et al. 2022). The world was hit by the Russia-Ukraine conflict, which started on early hours of 24 February 2022. The war has affected global trade, production, and consumption patterns, keeping commodity prices high until 2024 and threatening global food security, which is a direct threat to the progress of Sustainable Development, Goals— especially SDG 1 (No Poverty), SDG 2 (Zero Hunger), and SDG 12 (Responsible Consumption and Production) (Ben Hassen and El Bilali 2022). The gravity of this war on food inflation and prices appears while experiencing the restriction on oil supply in European countries that rely strongly on Russian oil and Ukrainian foods, as well as the rest of the world that benefits from these two countries through trade (Ben Hassen and El Bilali 2022; Sohag et al. 2022) This ongoing global happening shows that not only on a national level (Ghana) but also on a global scale, the future of healthier food practices is certainly bleaker. The high cost of living directly impacts future visions of healthy food practices in Ghana. Many people in Ghana (especially those in the low and middle class) are struggling to keep pace with the rising inflation in the country. The Ghana Statistical Service’s figures (Avle and Susu 2022) noted that the continuous increase in food and transport prices across the country had pushed the national year-on-year inflation for April 2022 to 23.6%, which is reported to be the highest since August 2019. According to the most recent data from the Ghana Statistical Service (Avle and Susu 2022), food accounts for 50% of inflation in the last month. This is a critical issue because it directly affects the demand and affordability of healthy food. For instance, one of the participants of the survey stated that: I wish I could take in fufu1 with light soup (see Fig. 4.11) this afternoon but due to financial constraints as a result of how prices of foodstuff have increased, I decided to eat braised rice and smeared powdered pepper with an egg to sustain my hunger. I know it isn’t healthy enough but this is what I can afford. Indeed, eating healthier nowadays is costly in this country. (Annan, Winneba, Ghana)

Discussion There has been a great deal of lack of consensus about what people should consume. On one side are many who encourage only so-called ‘real food’, as expressed by Michael Pollan’s famous quotes: ‘Eat food, not too much, mostly plants’, and ‘Don’t eat anything your great grandmother wouldn’t recognise as food’ (Popkin 2017). On the other hand, the socio-economic development of every country is closely linked to the eating habit of its citizens. Undernutrition contributes to low intelligence and 1

Fufu is one of the most preferred and recommended local food among Ghanaians (especially the Akans), as an Akan person will say, ‘I haven’t eaten the whole day if I happen to not eat fufu in the day’.

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Fig. 4.11 Fufu (pounded boiled yam/plantain) and light soup with chicken. Source Primary (Taking by Author)

productivity, high risk of illness, higher rates of poverty, slow economic growth, and poor human development. Social norms, regarding types of foods, who should consume them, and knowledge about the right foods to consume and in what quantities are important determinants that affect nutritional status in any given economy (Torto and Brownell 2020). In Ghana, social norms regarding types of foods, who should consume them, and knowledge about what are the right foods to consume and in what quantities are also very important determinants that affect the nutritional status of the people, as Torto and Brownell (2020) stated. These go in association with other factors, including the individual’s economic status, level of education on healthy food, and government policies on food security and sustainability. These other factors also have an impact on what food is produced, processed, and consumed in a country. Information technology, especially social media, is an increasing factor driving social norms on what should be eaten in Ghana. Social media has significantly influenced food practices as some people decide what to consume based on what they have seen, heard, or read on the Internet, television, or radio stations. The government of Ghana, through the Ministry of Food and Agriculture (MOFA), food and drugs authority (FDA), social welfare, and other agencies, have strived to provide nutrition-based policies, e.g. The National Nutrition Policy for Ghana (Government of Ghana 2013). However, these measures have fallen short of sufficiently addressing food issues in Ghana. For instance, recent research confirms inadequate government action in enforcing the policies. Unhealthy foods are sold to Ghanaian children in school by private/independent vendors, and soft drinks are heavily advertised. MOFA, for instance, has sent several cautions to farmers to avoid using certain harmful chemicals for farming and resort to using organic chemicals

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(manure) for growing crops so that the nutrient content of the crop yields wouldn’t be affected by these harmful chemicals. However, such cautions have been largely ignored with minimal impact. That as well, has yielded a minimum outcome. Farmers have resorted to chemicals that force crops to yield before their natural rate, and harmful chemicals for fishing are rampant. A major reason for this shortfall in outcomes is that the policies are often developed and/or implemented based on single-sector mandates, priorities, and key functions, without clear coordination and national policy guidance. For instance, the Ghana FDA requires products to be registered and advertisement scripts approved before they can be advertised. The National Non-Communicable Diseases (NCD) Policy is only concerned with healthy diets for Ghana, including regulating the advertising of unhealthy foods and non-alcoholic beverages, particularly to children (Booth et al. 2021). Added to this is the lack of a citizen engagement plan which can lead these different agencies towards what Ghanaians think about healthy and unhealthy food. Any attempts to enhance healthy and sustainable food strategies in Ghana which do not use citizen knowledge and preferences as a starting point before the much-needed collaboration between governmental and non-governmental sectors are bound to fail. The findings in this chapter should be used as a starting point to kick-start interest in including a citizens’ perspective in progress towards a healthier and sustainable food future for Ghana.

Conclusion This chapter critically examines the meaning of healthy/unhealthy food from the Ghanaian setting and the factors that could account for the future success or failure of healthier food practices in Ghana. Based on the findings of this study, Ghanaians consider healthy food to be a balanced diet and unhealthy food to be an unbalanced diet. Also, Ghanaians view healthy or unhealthy food that goes beyond nutrition to include food hygiene. Furthermore, due to the increasing popularity and accessibility to processed foods and the rising food prices, Ghanaians are not optimistic about their food future. Although the findings are only based on opinions expressed by a handful of respondents in Winneba, they indicate what a much wider survey can produce. Encouraging healthy nutritional conditions among the Ghanaian populace will entail addressing a range of factors, including poor dietary practices and inappropriate choices that lead to malnutrition and nutrition-related disorders, as well as various governmental policies to that effect. In its National Nutrition Policy, the government of Ghana suggested that the state launch new health and nutrition programmes through the various ministries and review existing food policies that have grown ineffective in reducing food insecurity and malnutrition. This will help address the recurring nutritional problems which affect the future of healthier food practices among Ghanaians. Also, nutrition education and health programmes should be enhanced among various Ghanaian communities with clear-cut coordination of the factors that

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promote or discourage healthy food consumption and inculcate them into various policies and programmes that will help realise plausible eating habits in the future. However, this chapter argues that implementing this nutrition education and sensitisation alone may not yield the desired outcome. Therefore, the government and the various agencies ought to listen to what citizens understand by healthy or unhealthy food based on their everyday practices. This practice-based knowledge can then be used to support healthy eating policies and if possible, provide incentives for adopting healthier food practices. Hence, good and sustainable government policies on healthy food practices should be enacted with clear-cut coordination, involving various stakeholders (farmers, media, ministries, and the general populace) to yield a remarkable outcome towards a brighter future of healthier food practices in Ghana.

References Adjei AP, Amevinya GS, Quarpong W, Tandoh A, Aryeetey R, Holdsworth M, Agyemang C, Zotor F, Laar ME, Mensah K, Addo P (2022) Availability of healthy and unhealthy foods in modern retail outlets located in selected districts of the Greater Accra Region, Ghana. Front Pub Health 10:922447 Agyeman NA (2013) Language use in Winneba-some preliminary observations 1. In: SOAS working papers in linguistics, vol 16 Ali Z, Abizari AR (2018) Ramadan fasting alters food patterns, dietary diversity and body weight among Ghanaian adolescents. Nutr J 17(1):1–14. https://doi.org/10.1186/s12937-018-0386-2 Amuquandoh FE, Asafo-Adjei R (2013) Traditional food preferences of tourists in Ghana. Br Food J 115(7):987–1002. https://doi.org/10.1108/BFJ-11-2010-0197 Avle BK, Susu G (2022, May 16) Citi News Room. Retrieved from CitiNews.com. https://citine wsroom.com/2022/05/the-seven-factors-driving-high-cost-of-living-in-ghana Ben Hassen T, El Bilali H (2022) Impacts of the Russia-Ukraine war on global food security: towards more sustainable and resilient food systems? Foods 11(15). https://doi.org/10.3390/foo ds11152301 Booth A, Barnes A, Laar A, Akparibo R, Graham F, Bash K, Asiki G, Holdsworth M (2021) Policy action within urban African food systems to promote healthy food consumption: a realist synthesis in Ghana and Kenya. Int J Health Policy Manag 10(12):828–844. https://doi.org/10. 34172/ijhpm.2020.255 Brown KE, Cornelius S, Harnish D (2005) Social conflicts in contemporary Effutu festivals Chavez C (2008) Conceptualising from the inside: advantages, complications, and demands on insider positionality. In: The qualitative report, vol 13. http://www.nova.edu/ssss/QR/QR13-3/ chavez.pdf Darwin Holmes AG (2020) Researcher positionality—a consideration of its influence and place in qualitative research—a new researcher guide. Shanlax Int J Educ 8(4):1–10. https://doi.org/10. 34293/education.v8i4.3232 Doyle MP (n.d.) Food microbiology and food safety series editor. http://www.springer.com/series/ 7131 Ecker O, Fang P (2016) Economic development and nutrition transition in Ghana: taking stock of food consumption patterns and trends. In: Achieving a nutrition revolution for Africa: the road to healthier diets and optimal nutrition. pp 28–50. http://ebrary.ifpri.org/cdm/ref/collection/p15 738coll2/id/130760

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Evans D, Manchester AM, School B, Southerton D (2012) Sustainable consumption, behaviour change policies and theories of practice. Habits Consumption, Jackson 2005. https://helda.hel sinki.fi/bitstream/handle/10138/34226/12_07_evans-southerton-mcmeekin.pdf?sequence=1 Government of Ghana (2013) National nutrition policy for Ghana 2013–2017. Retrieved from https://leap.unep.org/countries/gh/national-legislation/national-nutrition-policy-ghana-20132017 Greene MJ (2014) On the inside looking. In: Methodological insights and challenges in conducting qualitative insider research, vol 19. http://www.nova.edu/ssss/QR/QR19/greene15.pdf Holdsworth M, Pradeilles R, Tandoh A, Green M, Wanjohi M, Zotor F, Asiki G, Klomegah S, AbdulHaq Z, Osei-Kwasi H, Akparibo R, Bricas N, Auma C, Griffiths P, Laar A (2020) Unhealthy eating practices of city-dwelling Africans in deprived neighbourhoods: evidence for policy action from Ghana and Kenya. Glob Food Sec 26(January):100452. https://doi.org/10.1016/j. gfs.2020.100452 Impraim E, Swanzy (2015) Recent discoveries in the Aboakyer festival of the Effutus-Ghana. Online 5(2):2225–2484 Lagi M, Bar-Yam Y, Bertrand KZ, Bar-Yam Y (2011) The food crises: a quantitative model of food prices including speculators and ethanol conversion. http://arxiv.org/abs/1109.4859 Lipton M, Sinha S, Blackman R (2020) Understanding the links between agriculture and health agricultural technology and health. www.ifpri.org McClements DJ (2020) Future foods: is it possible to design a healthier and more sustainable food supply? Nutr Bull 45(3):341–354. https://doi.org/10.1111/nbu.12457 Micah E, Colecraft E, Lartey A, Aryeetey R, Marquis G (2012) Street foods contribute to nutrient intakes among children from rural communities in Winneba and Techiman municipalities, Ghana. Afr J Food Agric Nutr Dev 12(49):5789–5801. https://doi.org/10.18697/ajfand.49. enam8 Narayana Health Care (n.d.) Narayana health. Retrieved 2022, from Narayana Health Web Site: https://www.narayanahealth.org/blog/how-to-maintain-a-balanced-diet Neufeld LM, Hendriks S, Hugas M (n.d.) Healthy diet: a definition for the United Nations Food systems summit 2021. https://sc-fss2021.org/ Omari R, Quorantsen KE, Omari PK (2017) Nutrition knowledge and food consumption practices and barriers in rural Ghana: the case of foods for preventing vitamin A and iron deficiencies. Afr J Food Agric Nutr Dev 17(1):11639–11656. https://doi.org/10.18697/ajfand.77.15815 Popkin BM (2017) Relationship between shifts in food system dynamics and acceleration of the global nutrition transition. Nutr Rev 75(2):73–82. https://doi.org/10.1093/nutrit/nuw064 Robbert MK (1972) Merton knowledge. Insiders Outsiders Chapter Sociol Knowl 78(1):1–40 Sezgin AC, Sanlıer ¸ N (2016) Street food consumption in terms of the food safety and health. J Hum Sci 13(3):4072. https://doi.org/10.14687/jhs.v13i3.3925 Sohag K, Islam MM, Tomas Žikovi´c I, Mansour H (2022) Food inflation and geopolitical risks: analysing European regions amid the Russia-Ukraine war. Br Food J. https://doi.org/10.1108/ BFJ-09-2022-0793 Surya V, Arul M, Arockiaraj A (2020) Junk food is the danger of future generation-review for a decade. Indian J Public Health Res Dev 11(6) Taber DR, Stevens J, Evenson KR, Ward DS, Poole C, Maciejewski ML, Murray DM, Brownson RC (2011) State policies targeting junk food in schools: racial/ethnic differences in the effect of policy change on soda consumption. Am J Public Health 101(9):1769–1775. https://doi.org/ 10.2105/AJPH.2011.300221 Torto NM, Brownell KD (2020) Role of food aid and assistance in addressing the double burden of malnutrition in Ghana: a qualitative policy analysis. BMJ Nutr Prev Health 3(2):196–204. https://doi.org/10.1136/bmjnph-2020-000136 Unluer S (2012) Being an insider researcher while conducting case study research. Qual Rep 17. http://www.nova.edu/ssss/QR/QR17/unluer.pdf von Braun J, Ahmed A, Asenso-Okyere K, Fan S, Gulati A, Hoddinott J, Pandya-Lorch R, Rosegrant M, Ruel MT, Teunis M, van Rheenen K, von Grebmer JW, Badiane O, Bouet A, Dimaranan B,

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Minot N, Msangi S, Orden D, Robles M, Zhu T (2008) Executive summary high food prices: the what, who, and how of proposed policy actions policy brief. International Food Policy Research Institute sustainable solutions for ending hunger and poverty. www.ifpri.org World Health Organization (WHO) (2021) Nutrition Zheng J, Tian L, Bayen S (2021) Chemical contaminants in canned food and can-packaged food: a review. In: Critical reviews in food science and nutrition. Taylor and Francis Ltd. https://doi. org/10.1080/10408398.2021.1980369 Zurek K (2022, May 11) Graphic online. Retrieved from Graphic.com.gh: http://www.graphic.com. gh/news/general-news/fda-issues-public-alert-on-indomie-after-recall-in-certain-countries.ht

Chapter 5

Perceptions of Healthy Diets and Food Futures in Veneto, Northern Italy Antonio Pietropolli and Cristian Trujillo

Abstract This chapter investigates consumers’ perceptions of healthy and unhealthy food in Italy, focusing on the Northern Italian region of Veneto. The study aims to contribute to the growing literature on the importance of social factors, such as cultural constructs and traditions, in shaping consumers’ perceptions of healthy food. The results show that consumers in Veneto hold diverse and multifaceted perceptions of healthy food, with a strong interest in organic food and the Mediterranean diet. Although the small sample size limits the amplitude of the results, the study provides relevant consumer perspectives for policymakers, companies, and other stakeholders, promoting sustainable lifestyles and organic food in northern Italy. The study supports the expansion of healthy food options in Italy, particularly organic food, the Mediterranean diet, and non-processed foods, especially among younger Italian women of middle income. There are differences based on income levels and age; younger adults associate organic food with healthy food, while older adults prefer non-processed and vegetarian food. These findings are consistent with other research showing that older consumers are less attracted to organic products and more likely to prepare their meals at home. Respondents with higher incomes tend to view fast food as unhealthier than those with lower incomes. Furthermore, the results also indicate a growing concern with food insecurity related to the materiality and social accessibility of food. Accordingly, the authors recommend integrating food justice into public policies to promote healthy food consumption, particularly rising concerns about food prices. Keywords Mediterranean diet · Healthy food · Food insecurity · Food justice · Italy

A. Pietropolli (B) Policy Analyst, Brussels, Belgium e-mail: [email protected] C. Trujillo Researcher at Resource Matters ASBL, Brussels, Belgium e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 H. Esam Awuh and S. Agyekum (eds.), Geographies of Food, Springer Geography, https://doi.org/10.1007/978-3-031-49873-2_5

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Introduction The research aims to investigate consumers’ perceptions of “healthy” and “unhealthy” food in Italy to understand better the social and cultural factors underpinning sustainable food choices. In line with the theoretical background outlined in the first chapter of this collection, this study aims to expand current research efforts on the role of subjective meanings of healthy food in shaping consumers’ propensity to adopt healthy diets. It also aims to provide relevant information for policymakers to design public health and food policies and for firms interested in understanding the demand for healthy foods. The analysis of the meanings of healthy food in Italy is an interesting case highlighting the relationship between place, globalisation, and food. Although food traditionally occupies a special place in forming Mediterranean cultures, over the last decades, meanings of healthy and unhealthy food in Italy—as elsewhere—have changed partly due to globalisation processes and the diffusion of “Westernised” diets such as fast food. In this context of changing dietary habits, different meanings of “healthiness” or “unhealthiness”, including “slow” food, “Made in Italy”, “local”, and organic food have emerged in the Veneto region. Subjective determinations of healthiness or unhealthiness are an integral component of what makes a particular food or product healthy or unhealthy, and they are often rooted in complex interactions between belief systems, taste, social identity, and cultural traditions. Furthermore, the analysis of consumer perspectives on healthy food is increasingly being linked to key policy objectives in the post-COVID global food economy, such as food security, sustainability, and public health (Eng et al. 2022; Kitz et al. 2022). Against this backdrop, this chapter investigates local perceptions of “healthy” and “unhealthy” food in Italy based on a survey of Italian consumers in the NorthEastern region of Veneto, Italy. In doing so, the chapter aims to contribute to the growing literature on the importance of social factors (choices, traditions, and cultural constructs) in consumers’ perceptions of healthy food. The study finds that consumers in Veneto hold diverse and multifaceted perceptions of healthy food across different socio-demographic groups. The study concludes by providing policy recommendations broadly supporting the expansion of healthy diets such as organic food and the Mediterranean diet in Italy. However, the survey results also give empirical weight to current debates about food justice and rising food insecurity in economic downturns. In the future, policymakers and managers should consider the impact of perceptions of food inequality in shaping consumers’ views on healthy food and more systematically integrate food justice in formulating and implementing public policies to promote healthy food consumption.

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Material and Methods Study Area The Veneto region is an interesting case study to understand the impact of culture, perceptions, and traditions on healthy food consumption. Situated in the northeast of Italy, bordered by the Adriatic Sea to the east and the Dolomite Mountains to the north (Fig. 5.1), Veneto hosts over 4.8 million inhabitants, the fourth-largest region in Italy. Since the 1950s, the region has experienced rapid industrialisation— described by some as Veneto’s “economic miracle”—driven by small, family-driven, but highly specialised and competitive businesses in fashion, retail, food, and wine (Becattini 2000; Tattara and Anastasia 2003). In addition, since the 1970s, the region has seen multiple associational and cooperative movements strongly emphasising locally sourced ingredients and seasonal produce, including the Slow Food movement (Leitch 2012). A comparison of key indicators between the Veneto region and the rest of Italy is presented in Table 5.1. These figures demonstrate the relative affluence of the Veneto region compared with the rest of Italy, as well as its focus on high-value industries such as food and beverage production. In addition to having a strong culinary history rooted in the Mediterranean diet, Veneto makes for an interesting case study as organic agricultural production is one of the region’s strongest nascent sectors (Rete Rurale Nazionale 2020). Although lacking in terms of land use compared with other Italian regions, in 2019 Veneto’s organic production was among the fastest growing in Italy, amounting to 2% of the national agricultural surface dedicated to organic production (Mozzato and Rossetto 2020). In addition, Veneto’s strong business ecosystem has produced some of Italy’s biggest organic food corporations, including NaturaSì and Rigoni di Asiago (Sistema d’Informazione Nazionale sull’Agricoltura Biologica 2021). In 2020, Veneto Agricoltura found that Veneto leads in Italy regarding organic food transformation and distribution (Veneto Agricoltura 2021).

Data Collection A survey of 62 Italian consumers based in the Northern Italian region of Veneto was conducted for this chapter. Following a snowball approach, the research took place online between May and June 2022, primarily through social media and word of mouth. The sample included a small group of Italians from Veneto. The choice of online data collection as a method was motivated by the COVID-19 pandemic and the lack of opportunities to travel and meet people face-to-face. In addition, the location of the study in Veneto was motivated by the author being originally from this region. Therefore, the author’s positionality as an Italian researcher from the Veneto region should be acknowledged as a factor in the sample’s composition. For methodological reasons and lack of time, this research did not address the meanings

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Fig. 5.1 Veneto. Source Wikimedia Table 5.1 Macroeconomic indicators, Veneto region and Italy Average income

(2020)1

Foreign-born residents (2023)2 Overweight index

(2020–21)3

Veneto region

Italy

35,536

32,812

494,079 (9.7%)

5,050,257

30.9%

32.5%

Obesity index (2020–21)4

11.1%

10.4%

Organic agricultural land (2018)5

45,999 (5.9%)

1,993,236

1

Istat, Average net income by region and type of municipality. Updated on 24 April 2023. Istat, Foreign residents as of January 1st. Updated on 24 April 2023. 3 Istituto Superiore di Sanità, Sorveglianza PASSI. Last accessed on 24 April 2023. 4 Ibid. 5 Mozzato and Rossetto (2020). 2

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of healthy food among non-Italian populations in Veneto, focusing instead on people identifying as Italian. The questionnaire includes 12 questions, divided into two parts. The first part of the questionnaire focuses on standard demographic information. For this study, five variables were accounted for: gender, age, ethnic background, education, and income. For the variable on ethnic background, respondents could identify as Italian-born or otherwise, including the four main nationalities in Italy, according to ISTAT.6 For the variable on education, the lowest possible educational title is “mandatory education”, which, according to the Italian system of educational qualifications, corresponds to at least ten years of education between 6 and 16 years old.7 The second part of the questionnaire analyses consumer perceptions of healthy and unhealthy food and perceptions of future food scenarios. In line with the qualitative nature of the study, the survey features open and voluntary questions. The first set of questions aims to test respondents’ ideas about healthy food, including the products considered healthy and the main reasons why they are healthy or unhealthy. Following these introductory questions, the survey includes three questions about consumers’ perceptions of food futures. These questions are meant to stimulate a reflection on the relationship between food, health, and sustainability. Concluding the survey, two questions investigate consumers’ information sources about healthy food and the impact of COVID-19 on healthy food consumption.

Data Analysis In this study, the authors employed qualitative surveys to gain insights into current perceptions of food in the Veneto region of northern Italy. First, the authors created ad hoc categories within each survey question to make sense of the information gathered, enabling them to distil the data and arrive at relevant conclusions. The next step was to analyse the data using Excel pivot tables, allowing for a quick and efficient summarisation of the results. Then, by cross-referencing answers from different survey questions, the authors were able to identify relationships between them and generate hypotheses to explain these patterns. Finally, the authors looked to the existing academic literature to further validate and nuance their findings, using it as a resource to contextualise their results. The resulting analysis and findings provide valuable insights into the evolving food culture of northern Italy, shedding light on how traditional perceptions of food are changing over time. Although the cluster analysis technique was used in several studies reviewed (Casini et al. 2013; Wongprawmas et al. 2021; Álvarez-Fernández et al. 2021), it was not used in this case as the number of questionnaires applied was not sufficient to obtain statistically significant results.

6 7

See: http://dati.istat.it/Index.aspx?QueryId=9441 See: https://www.miur.gov.it/sistema-educativo-di-istruzione-e-formazione

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The explorative analysis of the key socio-economic variables shows that the survey sample is predominantly composed of women (67.7%) mostly in the age group between 50 and 59 years (35.5%). In addition, 22.6% of respondents are between 60 and 69 years, making the sample overall skewed towards middle-aged people vis-à-vis younger age groups. This result is in line with the general demographic situation in Veneto.8 Regarding the level of education, more than 2/3 of respondents have a bachelor’s or master’s degree, and 11.3% hold a PhD. On the other hand, only one respondent possesses only the minimal education level required by Italian law. Furthermore, the analysis shows that 39.3% of respondents have an annual income between e20,000 and e29,000, followed by 19.7% who report an income between e30,000 and e39,000. At the extremes of the income distribution, two respondents have an annual income of more than e100,000, while three report less than e5000.

Findings Respondents Have Diverse and Fairly Equally Significant Understandings of Healthy Food The survey’s first set of questions was designed to probe perceptions of healthy and unhealthy food among Italian consumers. As shown by Fig. 5.2, the sample appears to have a remarkable familiarity with a wide range of information sources on healthy food, as the majority of participants (54.8%) declare to stay informed on healthy food through a mix of official publications, the Internet, and their social network. A minority of participants also claim to stay in touch regularly with their doctor about healthy diet and to consult scientific articles and their doctors directly. Based on this knowledge, Fig. 5.3 shows that respondents exhibit diverse views about what constitutes healthy food. For example, while most respondents identified “natural” or non-processed food as healthy food (18%), this study found that 16% of respondents identified organic food as a healthy food choice. In addition, about 6% of respondents responded that slow food, which is generally understood as food whose supply chain is transparent, traceable, and short (local): Food whose origin (not excessive distance, trusted producer), modalities of preservation, and of preparation, are known. (Woman, aged 50–59) Nutritive, the least transformed, and cooked or prepared in a “slow” fashion (Woman, aged 30–39 years)

A similar part of the sample identifies a balanced diet (16%) and a diet comprising pasta, vegetables, fruits, and low-fat meat, commonly associated with the Mediterranean diet (16%), as healthy food. References to the Mediterranean diet usually include a combination of fresh vegetables, fruits, fish, and cereals, but for some 8

See: https://www.tuttitalia.it/veneto/statistiche/popolazione-eta-sesso-stato-civile-2021/

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Fig. 5.2 Access to information about healthy food

Fig. 5.3 Perceptions of healthy food

respondents, the Mediterranean diet is associated to a style of cooking and preparing food: A simple food, natural, scarcely manipulated, cooked in a simple way (e.g., "arrosto" - roasted meat), and without adding too many ingredients (e.g., high-fat seasonings); in principle I consider as healthy the food associated with the Mediterranean diet. (Woman, aged 40–49)

A few respondents also indicate fresh food (3%) as healthy food, which is alternatively referred to as natural or fresh food. While no correlation between views on organic and fresh food can be proven in this study, it is worth noting that in recent

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Fig. 5.4 Perceptions of unhealthy food

years the fresh food sector (fruits, vegetables, eggs, and other non-cooked products) made up the most significant part of Italian consumers’ expenditures on organic food. In 2020 fruits, vegetables, and eggs were the most significant organic products pursued by Italian consumers, registering a growth of 2.1%, 7.2%, and 9.7%, respectively (SINAB 2020). Participants also report a positive impact of the COVID-19 pandemic on their food habits, with more than half of the sample claiming to eat healthier or somewhat healthier. Contrary to findings in other countries explored in this collection (see Chap. 3), genetically modified organisms (GMOs) do not appear to be of significant concern for Italian consumers, with only 2% of respondents identifying GMO-free food as healthy (see Fig. 5.3). This may be partly due to the strong regulatory environment surrounding GMOs in Italy and the EU compared with North America, where GMOs are generally more associated with “unhealthy” diets (Bruetschy 2019; Andreella et al. 2020). Likewise, a look at perceptions of unhealthy food across socio-demographic factors shows that the most common answers across both age groups were processed food (26%), highly caloric and sugary food (26%), and fast food (16%) (see Fig. 5.4).

Demography Plays an Important Role in Determining Venetian Understandings of Healthy and Unhealthy Although this study cannot prove any statistically significant correlation between socio-demographic traits and healthy food perceptions, the analysis still allows drawing some preliminary findings related to age, gender, and income. To state

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these demographic characteristics understood in a narrow sense—for example, age and sex9 as opposed to others, such as socio-economic (income, education level, and occupation), cultural (language, religion, and customs), or geographic (place of residence and migration patterns) characteristics—have a strong influence over the understandings of healthy or unhealthy food may be to state the obvious. This does not make it less true, however. In many articles consulted, these factors proved to be incisive when explaining food behaviours and perceptions. For instance, Civero et al. (2021) find that women with a university degree or postgraduate degree are more likely to purchase food safety products or that younger consumers are more likely to make food intake decisions based on social media than mass media. Casini et al. (2013) posit that women becoming more involved in the labour market has led to a bigger intake of ready-prepared foods. In the same vein, Pellegrini and Farinello (2009) conclude that younger consumers were more likely to consume organic products, perhaps due to a greater concern for environmental and health issues among younger generations.

Younger People Are Inclined Towards Biological Foods as Healthy Food; Older, Towards Non-processed Foods Similarly, in this study, age and gender are important determinants of food perceptions among the sample studied. In relation to age, one significant finding is that younger adults (identified as respondents between 19 and 40 years of age for convenience of explanation) associate organic food with healthy food more frequently than older age groups, which instead show a preference for non-processed and vegetarian food. This is in line with the literature findings referenced above. Conversely, the middle-age group’s (respondents between 40 and 70years) understanding of healthy food is significantly more associated with “Not processed/natural” (17% of the total respondents) and the similar category of “Vegetarian/fruits and vegetables” (13%) (see Table 5.2). This finding is consistent with conclusions by Pellegrini and Farinello (2009), who describe that older consumers are less attracted to consuming organic products, being more likely to consume them only when they have a higher income level. They also could be understood in tandem with insights from Casini et al. (2013) and De Magistris and Gracia (2008). When comparing the food habits of Generation X in the year 2000 with those of Generation Y in 2009, the authors observe that younger consumers are more inclined to consume food at bars, restaurants, and cafeterias and have more pre-prepared meals, while the older group is more likely to prepare their meals at home, which could be associated with a more important appreciation for “natural” products.

9

Ethnicity was not a factor widely considered in the literature covered.

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Table 5.2 Healthy food: categories by age group Categories

Young adults (19–40years)

Middle age (40–70years)

Total

Count

%

Count

%

Count

%

A balanced diet with correct energy intake

5

8.06

5

8.06

10

16.13

Biologic (organic)

7

11.29

4

6.45

11

17.74

0

1

1.61

1

1.61

0

1

1.61

1

1.61

8.06

5

8.06

10

16.13

0

1

1.61

1

1.61

Fresh food Low fat Mediterranean diet

5

No GMOs Not harmful to the body

0

3

4.84

3

4.84

Not processed/natural

1

1.61

11

17.74

12

19.35

Seasonal food

1

1.61

0

1

1.61

Slow food

2

3.23

1

1.61

3

4.84

Vegetarians/fruits and vegetables

1

1.61

8

12.90

9

14.52

Total

22

35.48

40

64.52

62

100

Gender as a Determinant of Understandings of Healthy and Unhealthy Food Just as age, gender remarkably influences perceptions of what is healthy and unhealthy food. For instance, women in our sample had an understanding of organic food significantly more associated with the Mediterranean diet and biological food, while men tended to relate healthy food more with non-processed food and a balanced diet; both genders had a similar proportion of respondents of the biologic food option (19 vs. 16%), although women outnumbered men in absolute terms (8 vs. 3) (Table 5.3). A gendered analysis reveals that the “Not processed/natural” option, highlighted in the previous section as divisive by age, is also divisive across this category. 21% of male respondents that reported this as healthy foods were of middle age, while a smaller 14% of women respondents had this understanding; instead, no woman and 5% of men replied with this option. In conclusion, while middle-aged respondents were likely to have an understanding of healthy food associated with “Not processed/natural” foods across genders, middle-aged men were significantly more likely to do so than middle-aged women. The “Balanced diet with correct energy intake” alternative had a similar behaviour: male respondents were more likely to have an understanding of healthy food in this vein than women (26% of men vs. 10% of women), especially in the middle-age bracket (16% of men vs. 5% of women). On the other hand, as noted above, women reported the “Mediterranean diet” substantially more than men (9 women or 21% of the total of them vs. one man or 5% of the total of them) across

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Table 5.3 Healthy food: categories by gender/of selected categories Categories

Female

Undisclosed

Total

Count

%

Count

%

Count

%

Count

%

A balanced diet with correct energy intake

4

9.52

5

26.32

1

100

10

16.13

Biologic

8

19.05

3

15.79

0

11

17.74

Fresh food

1

2.38

0

0

1

1.61

Low fat

1

2.38

0

0

1

1.61

Mediterranean diet

9

21.43

5.26

0

10

16.13

No GMOs

1

2.38

0

0

1

1.61

Not harmful for the body

2

4.76

1

5.26

0

3

4.84

Not processed/ natural

6

14.29

6

31.58

0

12

19.35

Seasonal food

1

2.38

0

0

1

1.61

Slow food

3

7.14

0

0

3

4.84

Vegetarians/ fruits and vegetables

6

14.29

3

15.79

0

9

14.52

42

100

19

100

62

100

Total Biologic

Male

1

Female

100

1

Male

Total

Count

% (of women)

Count

% (of men)

Count

% (of respondents)

Young adults (19–40 years)

5

12

2

11

7

11

Middle age (40–70 years)

3

7

1

5

4

6

Total

8

19

3

16

11

18

Not processed/ Female natural Count % (of women)

Male Count

% (of men)

Count

% (of respondents)

Young adults (19–40 years)

1

5

1

2

4

21

10

16

Middle age (40–70 years)

6

14

Total

(continued)

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A. Pietropolli and C. Trujillo

Table 5.3 (continued) Not processed/ Female natural Count % (of women)

Count

% (of men)

Count

% (of respondents)

Total

6

5

26

11

18

Balanced diet

Female

14

Male

Total

Male

Total

Count

% (of women)

Count

% (of men)

Count

% (of respondents)

Young adults (19–40 years)

2

5

2

11

5

8

Middle age (40–70 years)

2

5

3

16

5

8

Total

4

10

5

26

5

8

Mediterranean diet

Female Count

% (of women)

Count

% (of men)

Count

% (of respondents)

Young adults (19–40 years)

4

10

1

5

5

8

Middle age (40–70 years)

5

12

5

8

Total

9

21

10

16

Male

1

Total

5

age groups (four respondents from the young adults’ group and five from the middleage group) (see in Table 5.3, a closer look to the age and gender distribution for these answers). These results are grosso modo in coherence with those from Corallo et al. (2019). In their profiling of Italian food consumers according to their attitudes towards organic food, the authors discovered in their sample that “Individualist”, “Health enthusiast”, and “Environmentalist” profiles were more often female, while the cluster “Foodie” was more often male. The “Foodies” choose their food based on sensory factors such as superior taste, minimal use of preservatives, and appropriate price-to-quality ratio. These factors relate to answers mainly given by men in our sample: “Not processed/natural” and “Balanced diet with correct energy intake”. On the female side, the health enthusiast cluster consists of individuals who make food decisions by examining label contents, and health effects, according to current dietary philosophies such as low-calorie or Mediterranean diets. These reasonings align with the options from this study that were selected by women mainly: “Biological” and “Mediterranean diet”. Similarly, the environmentalists group makes their food choices based on concerns related to environmental sustainability, such as showing regard for nature during production, ensuring the integrity of the farmer, and considering the origin of the food, which are also linked to the “Biological” category, as well as others mainly voted by women, although with a lesser proportion to the ones mentioned above: “Slow food” and “Vegetarian/fruits and vegetables”. The substantial difference in the “Mediterranean diet” option favouring women also corresponds to findings in other studies. Biasini et al. (2021) observe in their

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study of adherence to the Mediterranean diet that women are statistically more likely to adhere to it. A similar result is found by Dinu et al. (2021). The authors warned, however, that with the information collected, it is impossible to conclude why this is the case and, more broadly, that there is no consensus about the significance of this relationship in the literature. While studies in Greece, Cyprus, and Spain showed no significant differences between sexes, studies in Italy produced conflicting results, with some reporting higher adherence in females and others reporting lower adherence. In any case, the authors found that differences in adherence to the Mediterranean diet among genders decrease with age and become insignificant for those in a relationship and that married or partnered males showed greater adherence to MD than unmarried or single males. Similarly, some noteworthy results exist when reading about unhealthy food perceptions focusing on gender. For example, in packaged food, the fourth most frequent answer (8 answers, 13%), the gender distribution (37.50% women vs. 62.50% men) is almost exactly inverse to that of the overall sample distribution (67.74% women, 30.65% men). Conversely, in the category of processed food (16 answers, 16% of the total), the proportion of women (81.25 vs. 18.75%) far exceeds the one found in the sample (see Table 5.4). This finding might highlight different understandings of unhealthy or industrial food across gender lines, consistent with other studies about the Italian population (Annunziata and Vecchio 2010). Higher-income people view fast food more as unhealthy food than lower-income people Not only demographic factors are relevant. As observed above, other elements, including socio-economic characteristics, nuanced findings concerning purely demographic definers. In other studies, establishing a statistical relationship between sociodemographic characteristics and perceptions of organic food has proven difficult, although some evidence exists regarding the significant impact of age, number of children, and income levels (Lamonaca et al. 2022). In this study, there is a preference for the Mediterranean diet and, to a lesser extent, for a balanced diet among people with lower income, even considering the bias related to the predominance of lower-income groups in the sample (see Table 5.5). This finding goes against what has been found by other analyses: Dinu et al. (2021) and Biasini et al. (2021) find that low income is negatively associated with adherence to the Mediterranean diet. It is far less straightforward to observe differences in meanings for higher income levels, as the number of respondents is too low to draw meaningful conclusions. Still, based on the available sample, some conclusions can still be drawn on perceptions of fast food. Elsewhere, the literature has found that at-risk populations with low incomes in lower occupational groups tend to follow the Mediterranean diet and that parents’ educational levels may also impact perceptions of healthiness (Álvarez-Fernández et al. 2021). In this study, Fig. 5.5 shows that respondents with a higher income tend to view fast food as unhealthier than those with a lower income (Table 5.6).

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Table 5.4 Unhealthy food: categories by gender Categories Fast food

Female

Undisclosed

Total

Count

%

Male Count

%

Count

%

Count

%

6

1

14.29

3

15.79

100

10

16.13

Food that 1 brings diseases

2.38

1

5.26

0

2

3.23

Food that harms the digestive system

2

4.76

0

0

2

3.23

Food using preservatives

2

4.76

0

0

2

3.23

GMOs

1

2.38

0

0

1

1.61

Highly caloric and sugary food

10

23.81

6

31.58

0

16

25.81

Packaged food 3

7.14

5

26.32

0

8

12.90

Processed food 13

30.95

3

15.79

0

16

25.81

Unbalanced diet

1

2.38

1

5.26

0

2

3.23

Unknown origin

3

7.14

0

0

3

4.84

Total

42

100

100

62

100

19

100

1

Participants Expressed Ambivalence in Their Visions of Food Futures The next part of the questionnaire was designed to observe perceptions of future food scenarios. The results indicate an ambivalence between positive and negative scenarios and diverse outcomes based on personal definitions and interpretations of healthy food (see Fig. 5.5). Overall, most respondents gave a positive assessment of the future of healthy food, citing greater availability of healthy food in the future (5%), the mainstreaming of sustainable diets such as vegetarian (6%) and organicbased (5%), and the greater availability of healthy food at the local level (10%). This “optimistic” consumer profile refers predominantly to a future where food systems are more natural, local and not processed, or reliant on GMOs, a clear echo of the common understanding of healthy food as “not processed” in question 1. Other interpretations point to behavioural changes and the diffusion of a culture of sustainability (8%). On the other hand, a “pessimistic” consumer profile can also be observed from answers pointing out food scarcity (5%) and the unequal distribution of healthy food (18%). It is worth noting that within the pessimistic profile, 64% of respondents identified the unavailability of food (either in the form of food scarcity or due to food

2.86

9

1

Mediterranean diet

No GMOs

17.14

6

1

3

3

35

Not processed/natural

Seasonal food

Slow food

Vegetarians/fruits and vegetables

Total

100

8.57

8.57

2.86

0

Not harmful for the body

2.86

25.71

0

1

14.29

Low fat

5

Biologic

17.14

Fresh food

6

20

4

5

2

1

1

4

3

Count

100

20

0

0

25

10

0

5

0

5

20

15

%

e30,000–e59,999

Count

%

0–e29,999

A balanced diet with correct energy intake

Categories

Table 5.5 Healthy food: categories by income levels

6

2

1

2

1

Count

100

33.33

0

0

0

16.67

0

0

0

0

33.33

16.67

%

e60,000–e100,000

1

1

Count

No answer

100

0

0

0

100

0

0

0

0

0

0

0

%

62

9

3

1

12

3

1

10

1

1

11

10

Count

Total

100

14.52

4.84

1.61

19.35

4.84

1.61

16.13

1.61

1.61

17.74

16.13

%

5 Perceptions of Healthy Diets and Food Futures in Veneto, Northern Italy 85

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Fig. 5.5 Future of healthy food

inequality) as the main reason to be negative. Frustrations with the costly nature of healthy food are evident in the following excerpt: I think people will be increasingly aware of the characteristics and health impact of the food they eat, also thanks to various apps. At the same time, the amount of time people invest in cooking will drop. Quick but unhealthy foods, as well as foods that are inherently healthy but require longer preparation, will remain inexpensive to some extent. On the other hand, fast but healthy foods will become more expensive and luxurious - that is, ready-made dishes treated in a certain quasi-scientific way to eliminate toxins and possible risks for the organism. (Male, aged 30–39 years)

Furthermore, optimistic views are found more frequently among younger groups (68%) than older respondents (37%), as given in Table 5.7. Younger participants to this survey responded in a higher proportion than their relative share in the sample in the following “optimistic” options: organic food (9.09% compared with 4.84%), growing awareness and personal responsibility (13.64% compared with 8.06), local (18.18% compared with 9.68%), and vegetarian (13.64% compared with 6.45%). Conversely, 45% of older respondents held negative views. At the same time, in some positive answers, older people were more represented, such as fresher food (2.5 vs. 1.61%), more healthy food (5 vs. 4.84%), more homemade and GMO-free food (2.5 vs. 1.61%), and positive future (12.5 vs. 11.9%). Finally, it is possible to observe that lower-income respondents are more frequently optimistic (Table 5.7). While the relative shares between lower- and middle-income groups are similar, there are differences in particular answers: middleincome “pessimists” more frequently view inequality as a negative factor. At the same time, lower-income optimists more commonly see local food as a positive factor (Tables 5.8 and 5.9).

5.71

2

1

9

4

9

2

1

35

Food using preservatives

GMOs

Highly caloric and sugary food

Packaged food

Processed food

Unbalanced diet

Unknown origin

Total

100

2.86

5.71

25.71

11.43

25.71

2.86

2.86

Food that harms the 1 digestive system

17.14

0

6

20

2

6

4

4

1

1

2

Count

100

10

0

30

20

20

0

0

5

5

10

%

e30,000–e59,999

Count

%

0–e29,999

Food that brings diseases

Fast food

Categories

Table 5.6 Unhealthy food: categories by income levels

6

3

1

2

Count

100

0

0

0

0

50

0

0

0

16.67

33.33

%

e60,000–e100,000

1

1

Count

No answer

100

0

0

100

0

0

0

0

0

0

0

%

62

3

2

16

8

16

1

2

2

2

10

Count

Total

100

4.84

3.23

25.81

12.90

25.81

1.61

3.23

3.23

3.23

16.13

%

5 Perceptions of Healthy Diets and Food Futures in Veneto, Northern Italy 87

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Table 5.7 Future food scenarios by age group Categories

Young adults (19–40)

Middle age (40–70)

Total

Count %

Count %

Count %

No answer

3

13.64 7

17.50 10

16.13

I don’t know

1

4.55

5

12.50 6

9.68

No answer

2

9.09

2

5

6.45

Optimistic

15

68.18 15

37.50 30

48.39

Biologic food

2

9.09

1

2.50

3

4.84

Fresher food

0

1

2.50

1

1.61

Growing awareness and personal responsibility 3

13.64 2

5

5

8.06

More healthy food

4.55

2

5

3

4.84

0

1

1

More homemade and free of GMOs

4

2.50

1

1.61

More local

4

18.18 2

5

6

9.68

Positive/promising future

2

9.09

12.50 7

11.29

Vegetarian

3

13.64 1

2.50

4

6.45

Pessimistic

4

18.18 18

45

22

35.48

Food scarcity

0

3

7.50

3

4.84

Negative/difficult future

0

6

15

6

9.68

No healthy food

0

2

5

2

3.23

5

Unequal access to food

4

18.18 7

17.50 11

17.74

Total

22

100

100

100

40

62

After probing respondents’ general ideas of healthy food futures, the questionnaire investigated perceived factors contributing to positive, healthy food futures. The key responses are summarised in Figs. 5.6 and 5.7. Most respondents (37.1%) identified educational solutions as the key factor contributing to healthy food futures. This answer was more preferred by older respondents (40.91%) than younger groups (27.27%). Respondents prioritised solutions such as including food education in primary school curricula, funding research on organic alternatives to pesticides and bioengineering, and promoting correct information in the media. Many participants (14.5%) also emphasised the importance of personal choices in achieving sustainable food futures, including buying local and seasonal food, cooking more at home, and learning about food ingredients. These responses align with what elsewhere has been described as the “citizen-consumer” model, highlighting the growing preference for ethical factors in formulating personal consumer choices (Grosglik 2017). The following answer provides some clues in this sense: A greater awareness of retailers and consumers regarding the origin of the ingredients used and the processing methods that can lead them to the development of a choice of products dictated not only by economic needs but also by ethical factors. (Male, aged 20–29 years)

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Table 5.8 Future food scenarios by gender Categories

Female

Male

Count

%

Count

%

No answer

4

9.52

6

31.58

I don’t know

4

100

2

33.33

0

4

66.67

No answer

Undisclosed

Total

Count

%

Count

%

0

10

16.13

6

60

4

40

Optimistic

22

52.38

7

36.84

100

30

48.39

Biologic food

2

9.09

1

14.29

0

3

10

Fresher food

1

4.55

0

0

1

3.33

Growing awareness and personal responsibility

4

18.18

1

14.29

0

5

16.67

More healthy food

1

4.55

2

28.57

0

3

10

More homemade and free of GMOs

1

4.55

0

0

1

3.33

More local

4

18.18

1

14.29

100

6

20

Positive/ promising future

5

22.73

2

28.57

0

7

23.33

Vegetarian

4

18.18

0

0

4

13.33

Pessimistic

16

38.10

31.58

0

22

35.48

Food scarcity

3

18.75

0

3

13.64

Negative/ difficult future

6

37.50

0

6

27.27

6

1

1

No healthy food 1

6.25

1

16.67

2

9.09

Unequal access to food

6

37.50

5

83.33

11

50

Total

42

100

19

100

62

100

1

100

At the same time, the study shows that, beyond moral concerns, collectivistic and altruistic behaviours may also shape perceptions of healthy food futures. Elsewhere, collectivism is an important cultural factor shaping decisions to consume environmentally sustainable and healthy diets, such as organic food (Roseira et al. 2022). In this study, several participants argued favouring an equal distribution of healthy food in disadvantaged areas, the recognition of farmers’ and local producers’ roles, and greater solidarity with local producers in the Global South.

1

5

5

2

9

2

5

More homemade and free of GMOs

More local

Positive/promising future

Vegetarian

Pessimistic

Food scarcity

Negative/difficult future

22.22

100

Unequal access to food 2

Total

35

0

No healthy food

55.56

22.22

25.71

10.53

26.32

26.32

5.26

5.26

1

More healthy food

10.53

15.79

2

Biologic food

54.29

28.57

0

19

Optimistic

3

2

No answer

71.43

20

Growing awareness and personal responsibility

5

Fresher food

7

I don’t know

20

7

2

1

10

2

2

1

1

1

1

8

2

2

Count

100

70

20

0

10

50

25

25

12.50

0

0

12.50

12.50

12.50

40

100

0

10

%

e30,000–e59,999

Count

%

0–e29,999

No answer

Categories

Table 5.9 Future food scenarios by income levels

6

1

1

2

2

1

3

1

1

Count

100

50

0

50

0

33.33

0

0

0

0

66.67

33.33

0

0

50

0

100

16.67

%

e60,000–e100,000

1

1

1

Count

No answer

100

100

0

0

0

100

0

0

%

62

11

2

6

3

22

4

7

6

1

3

5

1

3

30

4

6

10

Count

Total

100

50

9.09

27.27

13.64

35.48

13.33

23.33

20

3.33

10

16.67

3.33

10

48.39

40

60

16.13

%

90 A. Pietropolli and C. Trujillo

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Fig. 5.6 Factors contributing to healthy food scenarios

Fig. 5.7 Factors inhibiting healthy food scenarios

Discussion In recent years, choosing healthy food has become key for consumers worldwide. The motivation to consume healthy food is a significant dimension of consumer behaviours, albeit one still largely influenced by health factors and cultural ones, such as taste and environmental consciousness (Annunziata and Pascale 2009). As mentioned in the introduction to this collection (see Chap. 1), these cultural dimensions of eating healthy are essential to understand consumer behaviours oriented towards sustainability beyond neoclassical assumptions of rational choice. This study finds that Italian consumers in the Veneto region are highly preoccupied with eating healthy, with little variations across socio-demographic factors. A more thorough statistical analysis would permit the evaluation of the particular connections

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between factors such as gender, income, age, and healthy food. The analysis of ethnic factors is also limited in this study by the lack of diversity in the sample, which is mostly white and Italian. Further studies among populations with diverse origins and backgrounds are warranted to complement this study. A significant finding of this survey is that food systems with a reputation for being healthy, such as organic and locally sourced food and food associated with the Mediterranean diet are very relevant for Italian consumers. Regarding organic food,10 the study confirms a strong interest among Italian consumers across socio-demographic groups, but with particular resonance among younger female consumers. Although no statistical relationship between gender and organic-based diets can be proved elsewhere, the literature has found evidence of Italian women’s higher propensity for healthy food (Dinnella et al. 2020). More broadly, the growing importance of organic food and its status as a healthy food in Italy is likewise found elsewhere in the literature (Annunziata and Pascale 2009). It may also reflect the growing size of Italy’s—and Veneto’s—organic food market and the associated effects of marketing on consumer preferences.11 This study also finds that the Mediterranean diet remains an important choice for Italian consumers, especially women, which is also confirmed by the secondary data (Predieri et al. 2020). While adherence to the Mediterranean diet in Italy and elsewhere has fallen due to the impact of “Westernised” diets such as fast food, as well as the impacts of various economic crises since 2007 (Vilarnau et al. 2019), there is evidence pointing to an uptick in interest for this diet in recent years. The Mediterranean diet is increasingly seen as a sustainable lifestyle, especially after the COVID-19 pandemic (Lotti et al. 2022; Dernini and Berry 2015). This study shows that interest in the Mediterranean diet remains strong across socio-demographic groups, although different respondents may hold slightly different views about its definition. In addition, this study cannot prove whether socio-demographic variables such as income and occupational level influence the choice to eat foods associated with the Mediterranean diet. At the same time, this study finds that poorer respondents were more frequently in favour of a diet comprising pasta, fruits, vegetables, and non-red meats, which could be associated with certain accepted definitions of the Mediterranean diet. However, the reasons the Mediterranean diet is associated with 10

According to the European Commission, organic production is defined as an overall system of farm management and food production that combines best environment practices, a high level of biodiversity, the preservation of natural resources, and the application of high animal welfare standards. In practice, organic food production does not make use of synthetic pesticides or fertilizers, GMOs and cloning technologies, instead favouring traditional soil management techniques such as crop rotation and manure for pest and disease control (Rodman et al. 2014). 11 Italy is the third-largest market in the European Union in terms of overall production and organic land use, and the largest country in terms of number of organic producers (Research Institute of Organic Agriculture FIBL and Organics International IFOAM 2022). In 2021, 54% of Italian families consumed organic food daily as reported by Osservatorio Sana. Veneto is among the most important regions in Italy in terms of organic production, hosting 2% of the national organic farmland, 3.1% of the national organic cereals, and 6% organic wine. See: https://www.regione.ven eto.it/web/agricoltura-e-foreste/produzione-biologica.

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“healthy” living are hard to assess. It has been shown that the Mediterranean diet is a powerful vector of social identity and cultural belonging (Scepi and Petrillo 2015), and as such, adherence to it may reflect personal values more than health considerations. Further research on the cultural determinants behind adherence to the Mediterranean diet and its relationship with health, place, and social identity is thus warranted in the future. Furthermore, while this study finds that consumers generally hold positive views regarding the future of healthy food, there is evidence to suggest a preoccupation with rising food inequalities, food injustice, and food scarcity among the sampled Italian consumers. For example, responses such as the ones below reflect a preoccupation with the role of multinational corporations and profit-oriented in shaping food futures, which are seen as factors behind growing inequalities in accessing healthy food: A massive production more concerned with quantity than quality of food. (Woman, aged 40–49 years) Economic and industrial interests (meat, sweets, dairy industry etc.). Rising cost of living. Priority to increases in food production, and hence the use of production tools and modalities that decrease the quality of food. (Man, aged 30–39 years)

The future of healthy food will be accessible only to those that can afford it, highlighting inequalities (woman, aged 30–39 years). This may be attributed to rising food insecurity in Italy in the last two decades as an effect of the 2008 economic recession, the COVID-19 pandemic and, most recently, rising food prices following Russia’s invasion of Ukraine (Loopstra et al. 2016; Cavaliere et al. 2019; Dondi et al. 2021). Finally, there is evidence of significant concern with rising food prices and the impact this might have on the accessibility of healthy food. Elsewhere, the literature has found a relatively higher impact of the COVID-19 pandemic on healthy food prices, highlighting the implications of health risks during economic downturns (Lewis et al. 2023).

Limitations The small sample size primarily limits this study. The researchers could not travel to Italy during the data collection period, so the survey was distributed primarily through social media. In addition, the sample distribution does not fully represent Veneto’s demographic composition based on national statistical information. The sample distribution is relatively homogeneous regarding education levels, with over 2/3 of respondents being master’s holders, which further compounds the ability to extract general conclusions. Furthermore, this study does not account for the cultural diversity that has characterised Veneto’s population since at least the 1990s. Further research is needed to understand the relationship between ethnic background,

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immigration status, and perceptions of healthy food, especially in a region such as Veneto, where foreign-born residents contribute 10% of the regional GDP.12

Conclusion Although this study faces methodological barriers, most notably the relatively small size and lack of representativeness of the sample, the research has provided interesting findings which could be further explored in future studies. The survey results reveal a strong interest in healthy food consumption among Italian consumers in Veneto. The results also reflect a desire from participants to improve their diet and observe healthier diets. In this sense, this study broadly supports the expansion of healthy food options in Italy, most notably organic food, the Mediterranean diet and non-processed foods, especially among younger Italian women of middle income. Regarding organic food, this study finds that the preoccupation with eating healthy food (or food whose image is branded as healthy) may partly overcome price barriers, especially among younger consumers. Further, the high appeal of the Mediterranean diet confirms the cultural relevance of food as a conveyor of meaning well beyond its nutritive component in northern Italy. Thus, these results could provide relevant consumer perspectives for regulatory and marketing actors promoting sustainable lifestyles and organic food in northern Italy. At the same time, the results also indicate a growing concern with food insecurity related to the materiality and social accessibility of food (Ehlert and Faltmann 2019). This issue is especially relevant in times of rising food prices and economic uncertainty due to the combined effect of the COVID-19 pandemic and the Russian invasion of Ukraine. While further research would be needed to assess the relationship between inequality, food insecurity, and food scarcity in Italy, evidence supports public health and food policies integrating equity and sustainability considerations, especially during an economic downturn. In the absence of adequate welfare policies and careful policymaker attention to the impact of food prices on health risks, economic downturns can severely increase diet-related health inequities (Lewis et al. 2023). Theoretically, an approach incorporating food justice, primarily intended as equal access to food resources but also as the promotion of equitable work conditions in the food sector, has been the object of increasing analysis in recent years (Whyte 2015; Healy et al. 2020). Taking into account food justice may address Italy’s increasing problems with food insecurity and food poverty and ease perceived price barriers to consuming emerging healthy diets such as organic products, boosting demand for more sustainable lifestyles.

12

See: https://www.lazione.it/Attualita/VENETO-immigrati-in-Veneto-500-mila-residenti-produc ono-il-10-del-Pil

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Lewis M, Herron LM, Chatfield MD, Tan RC, Dale A, Nash S, Lee AJ (2023) Healthy food prices increased more than the prices of unhealthy options during the COVID-19 pandemic and concurrent challenges to the food system. Int J Environ Res Public Health 20(4):3146 Loopstra R, Reeves A, McKee M, Stuckler D (2016) Food insecurity and social protection in Europe: quasi-natural experiment of Europe’s great recessions 2004–2012. Prev Med 89:44–50 Lotti S, Dinu M, Pagliai G, Giangrandi I, Colombini B, Sofi F (2022) Adherence to the Mediterranean diet increased during the COVID-19 lockdown in Italy: results from the web-based Medi-Lite questionnaire. Int J Food Sci Nutr 73(5):650–656 Mozzato D, Rossetto L (2020) L’agricoltura biologica: la realtà italiana e le specificità venete [Organic agriculture: the Italian case and Veneto’s specificities]. University of Padua Pellegrini G, Farinello F (2009) Organic consumers and new lifestyles: an Italian country survey on consumption patterns. Br Food J Predieri S, Sinesio F, Monteleone E, Spinelli S, Cianciabella M, Daniele GM et al (2020) Gender, age, geographical area, food neophobia and their relationships with the adherence to the Mediterranean diet: new insights from a large population cross-sectional study. Nutrients 12(6):1778 Research Institute of Organic Agriculture (FIBL) and Organics International (IFOAM) (2021) The world of organic agriculture. Statistics and emerging trends 2021 Rete Rurale Nazionale [National Rural Network] (2020) Bioreport 2019: L’agricoltura biologica in Italia [Bioreport 2019: Organic agriculture in Italy] Rodman SO, Palmer AM, Zachary DA, Hopkins LC, & Surkan PJ (2014) They just say organic food is healthier: perceptions of healthy food among supermarket shoppers in southwest baltimore. Cult Agric Food and Environ 36(2):83–92 Roseira C, Teixeira S, Barbosa B, Macedo R (2022) How collectivism affects organic food purchase intention and behavior: a study with Norwegian and Portuguese young consumers. Sustainability 14(12):7361 Scepi G, Petrillo PL (2015) The cultural dimension of the Mediterranean diet as an intangible cultural heritage of humanity. In: Cultural heritage and value creation: towards new pathways. pp 171–188 Sistema d’Informazione Nazionale sull’Agricoltura Biologica [National Information System on Organic Agriculture] (2021) Bio in cifre 2020 Tattara G, Anastasia B (2003) How was that the Veneto region became so rich? Time and causes of a recent success. MPRA paper, 18458 Veneto Agricoltura (2021) Rapporto 2020 sulla congiuntura del settore agroalimentare Veneto. Vilarnau C, Stracker DM, Funtikov A, da Silva R, Estruch R, Bach-Faig A (2019) Worldwide adherence to Mediterranean diet between 1960 and 2011. Eur J Clin Nutr 72(Suppl 1):83–91 Whyte K (2015) Food justice and collective food relations. In: Barnhill A, Budolfson M, Doggett T (eds) Forthcoming in the ethics of food: an introductory textbook. Oxford University Press, p 24. Retrieved from SSRN: https://ssrn.com/abstract=2557925 Wongprawmas R, Mora C, Pellegrini N, Guiné RP, Carini E, Sogari G, Vittadini E (2021) Food choice determinants and perceptions of a healthy diet among Italian consumers. Foods 10(2):318

Chapter 6

Exploration of the Diverse Meanings Ascribed to Food by Consumers in Eastern Visayas, Philippines Gina A. Delima and Christopher Jr. R. Galgo

Abstract In the context surrounding the complex dynamics of food meanings and their implication towards healthier food transition, this study aims to comprehensively understand the perceptions, beliefs, and practices ascribed to food by consumers in Eastern Visayas, Philippines. Employing a mixed-methods approach using an online survey and photovoice methods, the study delved into the multifaceted meanings and visions of food among the local consumers. In total, 138 respondents participated in the online survey and photovoice method providing a rich sample of narratives and photos for data analysis using a qualitative thematic analysis and computational text analysis. Several prominent themes were identified in the analysis. Moreover, the analysis revealed the most frequently associated words ascribed to healthy, unhealthy foods, and the future of food. Notably, fruits and vegetables emerged as the most commonly identified sources of healthy food, with descriptors encompassing various aspects such as food type, quality, cooking methods, and frequency of consumption. This emphasis on fruits and vegetables can be attributed to the influence of early childhood education, community norms, and government interventions promoting healthier eating habits. Meanwhile, unhealthy foods are characterized as those foods that have undergone intensive processing as well as foods that are high in oil fats, sugar, flavour enhancers, and preservatives. Moreover, in transitioning to a healthier food future, the respondents emphasized the importance of individual and household-level initiatives. These findings shed light on the intricate and context-dependent nature of food meanings and visions in Eastern Visayas. Furthermore, this study underscores the significance of considering local perspectives and preferences in the development of public health and nutrition policies. By recognising and respecting the diverse meanings ascribed to food, policymakers and practitioners can formulate targeted interventions that align with the specific values and beliefs held by the local population. Such context-specific approaches are crucial for fostering improved food security and overall well-being, particularly in disaster-prone regions like Eastern Visayas. This study serves as a foundation for G. A. Delima (B) · C. Jr. R. Galgo Institute for Strategic Research and Development Studies, Visayas State University, Baybay City, Leyte, Philippines e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 H. Esam Awuh and S. Agyekum (eds.), Geographies of Food, Springer Geography, https://doi.org/10.1007/978-3-031-49873-2_6

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future endeavours in understanding the complex dynamics of food meanings and their implications for public health and nutrition in diverse socio-cultural contexts. Keywords Food meaning · Sociocultural · Consumers · Inclusion · Philippines

Introduction The Philippines is an archipelago of 109,035,343 (Philippines Statistics Authority 2020) people in Southeast Asia, consisting of 7641 islands (NAMRIA 2017), covering about 300,000 km2 in total land area. These islands are clustered into three major island groups that comprise the country, namely Luzon (northern part), Visayas (middle), and Mindanao (southern part). Due to the country’s archipelagic nature, the country is considered to be culturally rich and diverse. This chapter aims to explore one aspect of this diversity—the Filipino’s meanings and visions of food. The Philippines is rich in natural resources and a mega biodiversity country. However, its location and geographical context expose it to natural hazards, primarily tropical cyclones, storm surges, earthquakes, and volcanic hazards (European Commission 2005). These hazards have contributed to recurring disasters, which have had long-term implications on the country’s development, for one, its detrimental impact on food supply, especially in disaster risk-prone areas such as the Eastern Visayas region. This is one of the many reasons we have chosen to focus on this region as the study area. In this chapter, we emphasise diversity at the core of our analysis to explore meanings and visions ascribed on food by the local consumers in Eastern Visayas. By focusing on diversity, we aim to understand the variety of meanings attached to food by different people regardless of whether they are scientifically aligned. This chapter aims not to determine whose understanding of food is correct. It is mainly to understand what people think about food and why they think the way they do. To achieve this aim, this chapter uses a mixed-method approach. This chapter has four sections. First, we provide a brief overview of the study region. The second section discusses the methodology and adjustments made, given the applicability to the local context. The third section provides the results of our analysis based on the approaches employed. Finally, in the fourth section, we provide a discussion and draw conclusions based on the findings of this study.

Study Area: Eastern Visayas Eastern Visayas is one of the 17 regions of the Philippines situated on the eastern seaboard, directly facing the Pacific Ocean. It consists of six provinces: Biliran, Leyte, Southern Leyte, Samar, Eastern Samar, and Northern Samar. The region connects the islands of Luzon and Mindanao through the national Maharlika Highway Road. It has

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a total land area of 2.2 million hectares—of which 52% is classified as forest land, and 48% is considered alienable and disposable land (National Nutrition Council 2020). There are 4.5 million inhabitants based on the 2020 national census constituting 14% of the country’s population. The region’s population growth rate is declining, from 1.28% in 2010 to 0.5% in 2020. The three major languages are spoken in the region—Waray, Binisaya/Bisaya, and Cebuano (PSA 2000). The region has forest reserves contributing to the preservation of biodiversity. It also has metallic and non-metallic mineral deposits contributing to the local economy. These include chromite, uranium, gold, silver, manganese, magnesium, bronze, nickel, clay, coal, limestone, pyrite, and sand and gravel (Department of Trade and Industry n.d.). In addition, Eastern Visayas has abundant geothermal power reserves. For example, the Leyte Geothermal Power Field in Tongonan in Leyte Province is the world’s second-largest geothermal energy producer (PSA n.d.). The poverty incidence in Eastern Visayas is 28.9% in the first quarter of 2021, a 3% increase from the 2018 full-year estimate of only 24.0%. This indicates that the income of three in every ten families is insufficient to buy basic food and non-food needs. The recent increase in poverty is attributed to the impact of the pandemicrelated lockdowns, job losses, and closure of businesses (Keck 2022; Chua 2021). In the same survey period, the subsistence incidence among families in Eastern Visayas was estimated at 13.2%. This translates to 13 in every 100 families in the region having incomes insufficient to buy their basic food needs and satisfy the nutritional requirements set by the Food and Nutrition Research Institute (FNRI) to ensure that one remains economically and socially productive. The region is dominantly an agricultural area with rice, abaca, corn, coconut, root crops, sugarcane, and banana as the main crops (NNC 2020). About half of its total land area is devoted to agriculture. One-third of the population depends on agriculture for livelihood (PSA 2020b). This sector also is the main source of food in the region. Rice is the main staple food in the country, providing 1054.76 g of calories per day per person (PSA 2017). Concerning livestock, people in Eastern Visayas raise animals for meat and/or milk purposes. These animals include: swine, cattle, water buffalo (carabao), goats, and sheep. Poultry includes chicken, ducks, and turkey. Pork is the secondary source of protein for Filipinos, followed by chicken and beef (Angeles-Agdeppa et al. 2020). However, due to the outbreak of the African Swine Fever (ASF) disease that has affected many farms in the regions since 2019 (including Eastern Visayas), the production and consumption of pork have declined, and people are switching to chicken (Abao and Bedford 2021). In addition, this decline is fostered by the fact that chicken and egg are cheaper protein sources than pork and beef (Abao and Bedford 2021). The region produced 15,360 MT liveweight of chicken in the fourth quarter of 2020 accounting 3.2% of the total production of the country. Furthermore, PSA (2020a) recorded 29,870 MT live weight of swine production in 2020, contributing 3.4% of the country’s total swine production. In 2015–2016, it was estimated that in Eastern Visayas, the average per capita consumption of pork and meat was 6.90 kg of pork and 8.95 kg, respectively (PSA 2017).

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Apart from livestock and poultry, pisciculture is also practice in the region; fish is one of the primary protein sources. However, in 2021, the region could only contribute 2.93% or 124,276.73 MT to the country’s production (BFAR 2021). Meanwhile, the Philippines still ranked as the 8th producer of fish and fish products globally, producing 4.125 million metric tonnes (MT) of fish, shells, and aquatic plants (BFAR 2021). Nevertheless, fish consumption has steadily declined over the last few years (Sierra 2022; Abao and Bedford 2021). In 2019, the Central Bank of the Philippines pointed out that one of the major challenges in the country is its sluggish growth in agriculture, especially the fishery sector (BSP 2021). The region also grows vegetables and root crops. Vegetables grown include eggplant, squash, tomato, bitter gourd, pole beans, cabbage, and green leafy vegetables like moringa leaves (malunggay), Malabar spinach (alugbati), water spinach (kangkong), and pechay. Root crops such as sweet potato and taro/gabi cassava are produced in big volumes, making the region the country’s biggest producer. Cassava and yam are also significantly grown. In Leyte, the largest province of the region in terms of land area and population, eggplant is the most consumed vegetable, with 6.11 kg (kg) per capita annually, followed by squash, bitter gourd, onion, and tomato. Indigenous vegetables like moringa leaves, Malabar spinach, sweet potato leaves, and water spinach are also significant in the rice-fish-vegetable meal in Eastern Visayas. However, they are not represented in official statistical data because they are not included in the monitoring like the high-value crops group. Concerning accessibility, the relative easiness of growing and maintaining vegetables and root crops and the nutritional value of these indigenous vegetables make them important in food security, especially with the risks brought by climate change to highly climate-sensitive vegetables (Capuno et al. 2014). Grains, specifically rice, constitute the primary staple of the Filipino diet. In 2018, the Philippine Food and Nutrition Research Institute (FNRI) reported that the mean one-day household food intake in the Philippines consists of 39% cereals and cereal products (1198.2 g), 15% vegetables (454.1 g), 11% fish and products (338.1 g), 8% meat and products (236 g), 6% milk and milk products (198.5 g), 5% fruits (145.7 g), 4% poultry (131.5 g) and the remaining 12% are miscellaneous (i.e. ketchup, mayonnaise, etc.), egg, fats and oils, starchy roots and tubers, dried beans and seeds, and sugar and syrups. Instant noodles are also part of people’s usual meals, particularly bihon. In 2015–2016, a person in the region consumed an average of 2.10 kg of instant noodles annually, of which 1.27 is bihon, and the remaining include those that are prepared in just 5 min or less before eating (PSA 2017). FNRI also shows a difference in the meal components between families living in rural and urban areas and among families from different wealth groups. This translates into differential performance in meeting nutritional needs. The study concludes that one-day Filipino meal remains rice-vegetable-fish, inadequate in macro and micronutrients, and families still have not reached 100% energy adequacy.

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Material and Methods Sampling Technique Snowball and voluntary sampling techniques were used to recruit study respondents. The invitations to participate in the research, together with the Google Form survey, were sent to the personal and professional networks of the authors through e-mail and Facebook messaging services. When the research was conducted, the authors were affiliated with the Visayas State University located in the Eastern Visayas region. Those invited were informed that participation in the survey and the photovoice was voluntary. They were also encouraged to share the invitation with their networks. Snowball sampling is a non-probability sampling technique where participants are selected based on referrals from other participants (Babbie 2016). This process continues iteratively, with participants referring others, until the desired sample size is reached or no new participants are identified (Bryman 2016). Voluntary sampling occurs when participants can volunteer or choose to participate in a study without the researcher actively selecting them. In this type of sampling, individuals self-select into the sample (Bryman 2016; Creswell and Creswell 2018; Neuman 2014).

Data Collection A mixed method of online survey (quantitative) and photovoice with narratives (qualitative) was used in collecting data. These methods are the most accessible way of reaching respondents within the Eastern Visayas region, given the pandemicrelated restrictions on face-to-face interactions and mobility. The survey provides a general idea of the respondents’ ascribed meaning to healthy and healthy food. Meanwhile, the photovoice with narratives method was employed to gather in-depth data pertaining to food meanings. Photovoice is one of the non-conventional data collection tools used in social sciences, which is a fun and active exercise for participants (Simmonds et al. 2015) similar to serious games (Delima et al. 2021; Mertens et al. 2023). It is used primarily as a participatory approach in research aiming for inclusivity (Simmonds et al. 2015). Photos help respondents recall the moments when those photos were taken and articulate the meanings they attached to those photos. Independent of the photo narratives (such as photo captions or verbal explanations), the visual feature of photos can already convey ideas to their audience (Simmonds et al. 2015). The use of mixed methods provides data complementation and triangulation benefits.

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Online Survey The study developed a survey using a Google Form divided into two parts. The first part contained closed-ended basic socio-demographic questions such as sex, age, civil status, ethnic group, provincial and city/municipal address, family income, and educational background. The second part contained six open-ended questions: (1) What do you consider healthy food? (2) What do you consider unhealthy food? (3) How do you see the future of healthy food? (4) What can facilitate or contribute to a healthier food future? (4) What can inhibit or prevent a healthier food future? (5) Where do you get your information regarding what is and is not considered healthy food? (6) Would you say you consumed more or less healthy food during the COVID19 pandemic? Aside from the short narrative explanation, the respondents were also asked to upload photos of foods that visually represent their responses. The data collection ran from October 2021 to March 2022. A total of 158 responses were collected, but only 138 were analysed since 20 were from respondents not from the study areas. Figure 6.1 visualises the distribution of respondents in the study area, showing that most of the respondents come from Northern Samar, Leyte, Biliran, and Southern Leyte, respectively. Most of the survey participants were single female, and many were senior high school students or undergraduates (See Table 6.1). This means most of the sample belongs to the under-19 and 20–29 age groups. Positively, these characteristics (age distribution, sex, and educational attainment) are consistent or similar to the demographic characteristics of Region VIII, where the majority are either young dependents or belong to the working population (PSA 2020). Based on available 2015 PSA census data, the youth dependency ratio in the region is 57.19, and the median age is 22.67 years old. These characteristics also closely mirror that of the country, where the youth dependency ratio is 50.22, and the median age is 24.09 years old based on the same census data.

Photovoice The respondents of this study were requested to send photos of the food they consider as (a) healthy food and (b) unhealthy food. They were requested to send photos that they captured and provide a short explanation of why they consider them as either healthy or unhealthy. Some of those who did not send an explanation were interviewed.

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Fig. 6.1 Distribution of the respondents in the different municipalities in the Eastern Visayas Region

Data Analysis Data Cleaning The responses of those not from the study areas were excluded from the analysis. Those responses in the local languages, such as “Cebuano” and “Filipino” were translated into English prior to analysis. Most of these tasks were done in Google Sheets to facilitate collaboration among the authors in data preparation.

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Table 6.1 Socio-economic characteristics of the sample (n = 138) Variables

Description

Sample (%)

Age

Under 19

32.61

20–29

60.87

30–39

5.07

40–49

0.72

50–59 Sex

33.3

Female

64.49

Prefer not say Marital status

Educational attainment

Single

5.11

Common law or unmarried couple living together

0.73

Prefer not to say

0.73

Grade 7–10

1.97

Grade 11–12

63.16

Bachelor’s degree

27.63

Master’s degree

1.97

Doctorate degree

0.66 4.61

Below Php 10,957

57.25

Php 10,958 to 21,914

20.29

Php 21,915 to 43,828

13.77

Php 219, 140 and above

2.90

Php 43,828 to 76,669

4.35

Php 76,670 to 131,484 Province

2.17 93.43

Married

National Diploma and Advanced Certificates Monthly income

0.72

Male

1.45

Leyte

39.13

Northern Samar

43.48

Southern Leyte Biliran

2.17 13.04

Coding the Narrative Explanation of the Photos The narrative explanations for the photos provided by the participants were coded into different themes. There were 62 theme codes used, and many of them were suggested codes of Nvivo. There were several suggested codes that were not used due to the redundancy. The researchers also added extra codes, which include: • What do you consider healthy food? • What do you consider unhealthy food? • What food would you likely eat?

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• What do you believe can facilitate or contribute to a healthier food future? • What do you believe can inhibit or prevent a healthier food future? • And the following additional words and phrases: vegetables, fish, rice, chicken, meat (pork), chicken egg, who is involved, vision, taking care of the environment, profile, feeling, price of food, plant vegetables, food to eat regularly, discipline, cravings and taste buds, availability of healthy food, and challenges in the research participation. The codes were further examined to see patterns of similarities and to find common descriptors used by respondents in describing healthy and unhealthy foods and factors that facilitate and inhibit them in attaining a healthier food future. Following this, the descriptors were examined and guided by the Theory of Sensemaking (see Chap. 1 for a more elaborate discussion of the theory) to look into several plausible factors that influenced the respondents to arrive at those descriptors. The Theory of Sensemaking emphasises that knowledge is generated in a particular place. It also argues that despite the increasing similarities of different places due to globalisation, each one has unique characteristics that influence its inhabitants’ knowledge, such as food and nutrition. In the sensemaking process, the ecological model (informed by studies by Maneze et al. 2015; Ziegler et al. 2021) was adopted since it provides a more detailed basis for exploring the variables that influence the meanings the respondents ascribed to food. Such sensemaking variables include the local environment, socio-economic, culture, politics, and the influence of globalisation on knowledge production.

Computational Text Analysis A quantitative approach in exploring the narratives using computational text analysis was also done to provide a different approach to looking at the narratives provided by the respondents. This analysis was done in R version 3.5.1 (2018-07-02) using the steps and operations in computation text analysis as outlined by Welbers et al. (2017). These include importing survey responses, cleaning, preprocessing, creating a document term matrix (DTM), and filtering the DTM. A number of packages are available in R (tm, tidy text, etc.) for text analysis. However, the researchers opted to use the quanteda package for its performance and the flexibility of its DTM class relative to other packages (Welbers et al. 2017). For this, the open-ended survey questions were analysed to determine the most frequent words respondents have associated with answering the specific research questions. We only chose the top 20 most frequent words respondents ascribed to food for visualisation. Moreover, this type of analysis helped provide context on how respondents use these words to determine specific factors contributing to or inhibiting their visions. Using the result of computational text analysis as input, we tried to summarise and visualise these results using the ggplot2 package in RStudio. To provide more insight into this, we analysed and looked for themes where these words are used in context.

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Findings “Labeling foods as ‘healthy’ or ‘unhealthy’ raises multiple questions on the criteria used to define the terms and the implications of assigning an absolute healthiness value to an individual food in the context of complex diets” (Julia et al. 2022, p. 1). In this study, the authors neither intended to label or assign a healthiness value but to figure out how consumers understand the term and the process behind the construction of meanings by soliciting the most common words they associate with healthy or unhealthy.

Healthy Food is Fruits and Vegetables Fruits and vegetables were the most frequently used words by participants to describe what they consider healthy food (see Fig. 6.2). Descriptors were drawn out from these participant accounts, and four themes were identified, as summarised in Table 6.2. To enumerate, these are: (a) type of food, (b) food quality, (c) the way or manner of cooking food, and (d) frequency of eating certain types of food. This view on vegetables, fruits, fish, and moderate consumption of meat can be linked to early childhood education in the family and school about the benefits of eating healthy foods, especially vegetables. Parents, guardians, and educators may have also been influenced

Fig. 6.2 Top 20 words respondents associate with healthy food

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Table 6.2 Sensemaking of the descriptors used by the respondents in describing healthy foods Sensemaking variables

Themes of the healthy food descriptors Type of food: Fresh quality and vegetables, fruits, locally produced fish, meat food

The manner how Frequency of the food is food intake prepared or cooked

1. Universalist knowledge

Vegetables and fruits have vital nutritional value

Fresh foods are perceived as safe foods Fresh foods are recognised transnationally as healthy food (Cheung et al. 2021)

Respondents are aware that healthy foods contain less oil, salt, and sugar

Less meat, more vegetables, and fruits

2. Local environment (natural, policies and laws)

Vegetables, fish and seafood, fruits, and meat are available in the area

Fresh vegetables, fruits, fish, and meat are available in the region

3. Socioeconomic context (income, age, health conditions, personal taste preference)

• Families and schools educate children to eat vegetables and fruits • Government implements interventions to include vegetables and fruits in the diets (Zamora et al. 2013; Reeve et al. 2018; Capanzana and Aguila 2020) • Low-income households (HHs) have higher access to vegetables than other types of food • Vegetables have no or less adverse effects to people with illnesses

Fresh vegetables, fruits, fish, and meat are available in public wet markets where lowand middle-income buy foods

Simple preparations like fish and vegetable soup and grilled fish require fewer ingredients, thus, less expensive

Adults and elderly prefer to eat often and more vegetables

(continued)

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Table 6.2 (continued) Sensemaking variables

Themes of the healthy food descriptors

4. Culture

Vegetables and fish are an important part of the diet of Filipino families

5. Politics

Type of food: Fresh quality and vegetables, fruits, locally produced fish, meat food

The manner how Frequency of the food is food intake prepared or cooked

Traditional Filipino Vegetable and meals include fresh fish soups are ingredients common meals in Eastern Visayas

Vegetable and fish soups are common meals in Eastern Visayas

• Respondents are better informed of how the locally produced foods are grown, gathered, or caught • People can negotiate the price with local vendors • Ethnocentrism when it comes to fresh foods

by their community and government policies and interventions to promote healthy food consumption. In the country, the dissemination of the Nutritional Guidelines for Filipinos (Filipino: Mga Gabay sa Wasting Nutrisyon Para sa Pilipino) serves as an example of this intervention which was first published in 1990 (FAO 2022) and contains key nutrition messages for healthy living for all age groups from infants to adults, pregnant and lactating women, and the elderly (FNRI 2015). The healthy food plate for Filipinos (Pinggang Pinoy) is another example of a tool developed by the Food and Nutrition Research Institute of the Department of Science and Technology (FNRI-DOST), which is a visual tool that aims to guide Filipinos of all age groups in consuming the right amount of food in every meal. This tool by the FNRI-DOST shows the recommended proportion by food group for adults in every meal. Based on the findings, the food groups “Go”, “Grow”, and “Glow” (a popular food group concept promoted in schools in the Philippines) encapsulate the range of food in every meal, which guided the participants in defining their meaning of healthy food. Survey participants say a healthy meal must have all three food groups. Go foods give energy, such as grains and starch-rich foods. Grow foods help in muscle building, such as eggs, meat, and beans, while the glow food group includes vegetables and fruits rich in vitamins and minerals. Similarly, the ongoing campaigns for a healthy diet done by the government and media (TV, social media, and Internet) are also important and are influential in the respondents’ knowledge of the health benefits of vegetables, fruits, fish, and meat.

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Figure 6.3 shows where the respondents get information about healthy foods. The school (which may also include books) and the Internet are the primary source of knowledge on healthy foods, followed by the media and family, specifically the parents. The nutritional value of vegetables, fruits, and fish is the most commonly agreed justification of the respondents as to why they are healthy foods. As explained by one photovoice participant, “[…] is fish soup with malunggay leaves contains essential nutrients, such as omega-3 fatty acids and high-quality protein”. (Female, 20 years old, income above the poverty level). This universally accepted nutritional value of vegetables and fruits also transcends the local contexts of Eastern Visayas. Vegetables are a must for children, older people, and breastfeeding mothers. As explained by a participant, “Having a child and also breastfeeding, I need to be mindful of what I eat. I ensure that all the food that I consume is nutritious” (Female, 33, income below poverty level). Vegetables and fish can make the body feel light which is not the case when eating meat (Male, 45 years old, and income within the poverty level). See Fig. 6.4

Fig. 6.3 Respondents’ sources of information on healthy foods

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Fig. 6.4 Common fruits and vegetables sold in the public markets in Eastern Visayas

for examples of common fruits and vegetables sold in the local markets. Additionally, it should also be considered that the local environment of the region supplies fresh vegetables and fruits. As mentioned, backyard gardens are also key sources of fresh vegetables and fruits for most lower-income people. On the other hand, public markets are the most accessible new food suppliers to middle-income classes (Aban et al. 2009). Furthermore, there is also a health rationale behind regarding fruit and vegetables as healthy food. For instance, people suffering from diseases like diabetes and hypertension feel safe and more beneficial to eat vegetables and fruits regularly than eating meat.

Healthy Food is also Meat and Fish The meat here refers to chicken, pork, and beef. It should be noted that when it comes to meat, respondents tend to emphasise that moderate consumption should be observed. The local environment supplies fresh fish and meat. The abundance of these two food categories could explain why people regard them as healthy. For instance, the islands in Eastern Visayas have high access to marine and freshwater foods since they are surrounded by sea and rivers flowing in each island. A photovoice participant shared that their family “have close relatives who can get fresh fish when they have much catch. With this, I can provide them with healthier food” (Female, 39, income above poverty level). See Fig. 6.5 for some typical healthy Eastern Visayas fish food. The view of meat as healthy food is also culturally embedded in the Islands of Eastern Visayas. Meat from chicken, pork, and beef is important not only to the regular meals of Filipinos but also in traditional celebrations like religious festivities (for Catholics) and family gatherings. Fresh chicken, pork, and beef meat are supplied locally, but neighbouring regions also supply meat to Eastern Visayas. In addition, to save costs, low and lower middle-class households in rural areas raise their pigs in their backyards (Barroga et al. 2020) and slaughter them for the celebration. Fresh meat-based foods such as roasted pig (locally known as lechon) highlight these celebrations (Alejandro 2012; Lantrip 2017; Tomacruz 2017). It symbolises abundance and prestige and expresses gratitude for the blessings received (Valdez 2014).

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Fig. 6.5 Cooked dish of shellfish (left), fresh fish (middle), and fish, malunggay, and ginger (right)

Meanings of Healthy Food Consider How Food is Prepared The respondents emphasise the simplicity of preparing food. As observed in the pictures collected and from the survey result, soup dishes containing fish and vegetables are considered healthy. One of the reasons they are considered healthy is that they are easy to cook at home. Simple dishes such as fish soup, vegetable soup, and pickled fish (fish boiled in vinegar, salt, ginger, garlic, and black pepper) require within-the-reach ingredients and relatively cheaper spices. Soup, grilled, and pickled foods require minimal or no oil, salt, and sugar, thus, a healthier food preparation, according to the respondents. Lastly, simple food preparations do not require so much time to prepare. In Fig. 6.6, the leftmost photo is a soup with fish and pechay; the middle photo is a popular soup in Visayas called “Law-uy” made from mixed vegetables—pole beans, squash, eggplant, green leafy vegetables, okra, and mushroom; and the photo on the right is pickled fish—fish boiled in vinegar with spices. These vegetables are usually grown in the region. Another reason for choosing easy-to-prepare dishes as healthy could be economic. These easy-to-prepare dishes in Fig. 6.6 are less expensive than meat and more accessible to low-income households. Children and the elderly require nutrients that can be found in fruits and vegetables. As explained by a mother, “We always have tinola (fish or chicken soup with vegetables) every day. My kids have liked these

Fig. 6.6 Simple to cook dishes which are considered healthy

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foods, so I cook them for a healthy meal every day” (Female, 39, income above the poverty line).

People Are Aware that Certain Foods Are Unhealthy but Still Consume Them In the survey, the 20 most mentioned words describe what participants consider unhealthy foods. Again, junk foods top the list, followed by canned and processed foods and drinks. Figure 6.7 shows a complete outline of the most frequent words mentioned as unhealthy food. Also, Table 6.3 summarises the themes of descriptors used by the participants in describing unhealthy foods and the sensemaking variables that guide in providing meanings to the descriptions. Junk food is often fatty and contains added sugars, which can harm personal health. However, despite the awareness-raising done by the school, family, and the government, respondents still consumed them because of their palatability, lower prices, accessibility, and convenience in preparing. For instance, cooking food using a large amount of oil, as is often the case with junk food, is considered unhealthy. Therefore, respondents maintain that oil and fatty foods should be avoided or not consumed regularly. A participant explained this point in the following words:

Fig. 6.7 Top 20 words respondents associate with unhealthy food

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Table 6.3 Sensemaking of the descriptors used by the respondents in describing unhealthy foods Sensemaking variables

Themes of the unhealthy food descriptors Type of food: junk Foods high in oil, food, canned, and fats, sugar, and processed food salt (JCP foods)

The manner in how the food is prepared or cooked

Frequency of food intake

1. Universalist knowledge

Artificial flavour, preservatives, and ingredients that are present in JCP are perceived as harmful to bodies when consumed in large quantities or frequently

Food with high-fat contents, sugar, and salt causes diseases prevalent in many societies

The use of fatty ingredients in cooking, like oil, is not healthy

Unhealthy food should be avoided, but some people still eat those in moderation

2. Local environment

JCP foods are accessible. It can be found in the nearest stores Eastern Visayas is prone to disasters. Disaster situations pushed people to choose canned and preserved foods over fresh foods due to storage and price issues Donated relief goods after disasters usually consist of instant and canned foods

Fresh foods such as meat contain fats Canned goods are high in fats, salt, and sugar (for preserved fruits)

Canned and preserved food usually are cooked using cooking oil

Disasters that frequently affect the region disrupt the supply of fresh products There is seasonality in the supply, unlike fresh foods available throughout the year

Low-income households consume food high in salt, such as canned meat and salted and fermented fish, because it is appetising, easy to cook, and do not require sophisticated storage

Canned and preserved foods are usually cooked by frying using cooking oil

Due to the increasing prices of fresh foods, respondents are substituting meat and fruits with canned foods

3. Socio-economic • Fresh fruits and context meat are often more expensive than canned • Canned and preserved foods are easier to store

(continued)

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Table 6.3 (continued) Sensemaking variables

Themes of the unhealthy food descriptors Type of food: junk Foods high in oil, food, canned, and fats, sugar, and processed food salt (JCP foods)

The manner in how the food is prepared or cooked

4. Culture and tradition

Canned foods are becoming important substitutes for fresh products, especially meat products

Salt is traditionally used in households to preserve foods The region’s traditional snack foods are sweet since they contain sugar, coconut milk, and starchy ingredients like rice and root crops

Aside from soups, fried and saute (which uses oil) is a common way of cooking food in the region In traditional festivities and family gatherings, oily and fatty foods are commonly served

5. Politics between suppliers and consumers

Respondents feel that they have few food choices

No other cheaper substitute for oil, sugar, and salt

Frequency of food intake

As much as we enjoy having fried foods like chicken, meat, or fish, there are other better ways to cook foods without having to use too much oil. Frying it in oil is not a healthy way to cook fish, it’s much better to have it grilled or air fried.” (Female, 20 years old, family income above the poverty level).

Concerning processed or canned foods, people are also aware of the health risks of consuming these products but find it necessary to consume them or have them stocked in their homes. It is worth noting that Eastern Visayas is a disaster-prone region, particularly typhoons, floods, and landslides. People store food before the occurrence, usually consisting of rice, canned goods, instant noodles, and non-perishable food items. In the aftermath of disastrous typhoons, power and water systems are disrupted, which implicates difficulty in the storage of perishable food and in cooking. Disaster food reliefs mostly also contain canned goods. Instant food like instant noodles and food additives with artificial seasoning/flavour is cited by many as unhealthy food. As explained by a female respondent, “Instant noodles and this fried chicken which is coated by instant breading mix can damage our kidneys, liver and can cause cancer” (21-years-old female student). Another respondent with reference to the pork in Fig. 6.8, added: Liempo (fatty part of pork) is unhealthy because you can see it with thick fats which are really bad for your health. They are loaded with artery-clogging cholesterol and saturated fat which can lead to stroke or heart diseases (Female, 35 years old, income above the poverty level).

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Leftmost: Pork adobo; Middle: Fried pork; Locally term as 'paklay' which main ingredients are the internal organs of either pig, beef or carabao

Fig. 6.8 Unhealthy meat dishes

In addition, due to the increasing prices of fresh commodities like fish and meat, canned goods become the substitute or supplement. Moreover, the taste of junk foods, canned meat, and other preserved foods appeals to many people, especially children and adolescents. Similarly, as shown in Fig. 6.8, the internal organs of livestock are also pointed out to be unhealthy, although these are also consumed by many in the region, notwithstanding the recognition of the health risks therein. Therefore, to some extent, some respondents think that they have limited food choices given their socio-economic and environmental circumstances. As such, they are encouraged to buy and consume unhealthy foods out of circumstances—not choice. Traditional food preservation techniques in the region also use a large amount of salt, such as dried-salted fish and fermented fish. Similarly, the region has traditional snack foods and local delicacies that are added to sugar. In addition, sugar is added to sticky rice and starch-rich root crops in preparing snack foods. Hence, sugar is also part of the traditional Filipino diet, especially in the region, as it is commonly used in food coating (see Fig. 6.9). However, other healthier substitutes for cane sugar, like coconut and stevia, are more expensive. Cooking food using a large amount of oil is considered unhealthy. Respondents maintain that oil and fatty foods should be avoided or not consumed regularly. As explained by one participant,

From the left, first photo: cooked dried-salted fish with tomatoes; second photo: cake; third photo: locally known as 'Budbud", a local snack food made of sticky rice, cocoa, coconut milk and sugar wrapped in banana leaves; last photo: unwrapped "Budbud"

Fig. 6.9 Unhealthily coated food

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As much as we enjoy having fried foods like chicken, meat or fish, there are other better ways to cook foods without having to use too much oil. Frying it in oil is not a healthy way to cook fish, it’s much better to have it grilled or air fried.” (Female, 20, family income above poverty level).

However, apart from soup, frying and sauté (spices like garlic and onion are fried using oil) are common in the region’s cooking practices. Festivities are celebrated with food high in fats and oil, like pork and chicken. They are also commonly cooked using oils. Therefore, despite recognising that some foods or preservation techniques are bad for health, people persist with them either out of necessity or as a culture (way of life) that they are reluctant to change.

Enhancers of Transition in Food Practices Are More Bottom-Up Than Organisational or Institutional To facilitate a healthier food future, the respondents emphasise the importance of individual changes such as (a) self-discipline and self-motivation to buy, prepare and eat healthy foods and (b) initiative to grow their vegetables. Besides education and financial resources, differences in food choices are also defined by individual preferences and lived circumstances (Vanstone et al. 2013). As such, the respondents assert the importance of self-discipline and self-motivation as important facilitating factors. Respondents believe that to be healthy. Therefore, there is a need to individually learn to eat healthy foods, especially the children who like to eat meat and tasty food that are often unhealthy. As explained by a mother, “I have to train my kids to eat fish and vegetables and that she makes sure that every member of the family is eating nutritious food” (female, 39, and family income above poverty level). Even adults recognise that they need to learn to eat vegetables. Related to this, one respondent said: To tell you honestly [...] I don’t like eating vegetables. But as we grow older, we learn to see things differently. We are nearing old age so I need to be [mindful] on my food intake and learn to eat nutritious foods, follow the food pyramid.’ (Female, married, family income above poverty level)

The matter of education at home is highlighted. Respondents believe that education starts from home and the parents are responsible for educating their children about which foods are healthy or unhealthy. Training family members to eat healthy foods involves creativity; one mother shared her trick by saying: “There are also times that I trick them into thinking that I cooked corned beef but in fact, it was just fish, sliced and grounded and cooked as an omelet.” (Female, 39, income above poverty level).

Traditionally, food matters are responsibilities assigned to women in the household. However, some participants recognise that ensuring that the family has healthy meals is not just a choice and responsibility of one person. Participants described

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Fig. 6.10 Man buying fresh food ingredients at the public market in Baybay City, one of the five cities of the region

in their narratives how food choices and responsibilities are shared in their homes and men being equally responsible for household cooking duties is seen as a way to achieve a healthier food future (see Fig. 6.10). One participant said: My wife and I take turns to cook for our meals every day, we both take turns in buying the groceries too and she lets me choose what food I would like to eat for that week. (Male, 45, income above poverty level)

Furthermore, eating healthy food requires diligence, as explained by a female respondent. She said with reference to Fig. 6.11 that: Let us plant vegetable so we can eat healthy food, diligence is key.” and perseverance in growing their own vegetables, “It would be the perseverance of a person. If you want to attain a healthier food future [...] you can have a vegetable garden to have healthy food [...]. (Female, 33, income below poverty level)

Male participants also share similar thoughts. One said, “If we want healthy food, we should know how to plant and maintain vegetables” (Male, 33, income below poverty level). Another one reiterates diligence by saying: “Diligence. We need to diligently plant vegetables, even just malunggay, since we always eat that” (Male, 60, income below poverty level). Backyard gardens have been practised and encouraged in the Philippines (see Dorado et al. 2018; Honculada-Genove 2020; Madanguit-Mapayo 2020; Bagotlo 2021) for food security and economic and environmental reasons. This is not only confined to the regions but almost everywhere. Backyard gardens provide a fresh supply of vegetables. The local environment of the region (soil, climate, and water

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Fig. 6.11 Examples of backyard gardens and common vegetables grown in Eastern Visayas

availability), in general, is suitable for vegetable growing. Additionally, the residential areas in the dominantly rural areas of the region tend to have spaces for small gardens. It is also common in the region to see vegetable gardens in the backyards of houses. Gardening is taught in basic education schools. Adults are provided gardening support like free training and a free supply of vegetable seeds by the government, non-government organisations, and private companies but to a limited extent (DA Communication Group 2020). Apart from the government’s food security and nutrition programme, there are also national projects like the social protection programme, land distribution programmes, gender programmes, etc., that embed a component of food and nutrition (i.e. small individual gardens), and community gardens. Adult members of the families like to have fresh vegetables from their backyards. Gardening vegetables and ornamental plants are destressing activity and one of the coping activities during the pandemic lockdowns.

Conclusion In the context of diets, labelling food as “healthy” or “unhealthy” remains a complex and challenging issue that requires careful consideration of multiple factors, including the criteria and the process of defining these labels and their resulting implications. The study offers insights into this complexity by exploring how consumers understand and ascribe meaning to healthy and unhealthy food. The results of this study demonstrate that consumers’ sensemaking is influenced by their lived experiences, as influenced by socio-economic and environmental circumstances. Local community, culture, and government tools promoted through education and policies have also been highlighted in the results to shape the meanings of what is considered healthy and unhealthy. Additionally, these factors shape consumers’ sensemaking and impact and limit food choices, which have implications

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for building healthier dietary habits. In this regard, the results highlight how respondents see bottom-up practices, one that starts at home, for example, as promising. Furthermore, these findings can inform future research and policy reform, such as designing better labelling schemes to promote healthier dietary habits. Finally, the study underscores the critical role of nuanced and context-specific approaches as enablers towards healthier food transition rather than relying on simplistic and absolute labels.

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Chapter 7

Perceptions of Healthy and Unhealthy Food among People with Migrant Backgrounds in Canada: The Case of Toronto Vincent Konadu and Harrison Esam Awuh

Abstract The increasing global population has tremendously impacted food availability and distribution. This has necessitated maximising food production to satisfy the global population. This situation has caused scientific modification of plant and animal species to ensure that more food is produced in a shorter genetic cycle. This approach is criticised as a safety and ethical problem. Governments and other institutions worldwide have expressed concerns about and against what scientists consider healthy food. However, people’s perceptions, knowledge and attitudes towards what is regarded as healthy food in modern global cities have gained great attention in academia and the media. This study explored migrants’ perceptions of healthy or unhealthy food in the Greater Toronto Area (Canada). In this context, the multicultural trait of Toronto, with growing migration and cultural diversity, has influenced the discourse on what is considered healthy and unhealthy food. Most residents in the Greater Toronto Area contend that making genetic modifications to plants and animals makes them unnatural, hence unhealthy. Moreover, a more significant number of residents in Toronto affirm that healthy foods are natural and pure from excess chemical and scientific additives. These viewpoints are mainly due to residents’ religious and cultural backgrounds. In addition, residents in Toronto reveal that the availability of organic foods and markets, increased food affordability and awareness of balanced food would contribute to increased healthy foods in the future. This study recommends that governments, scientific institutions and stakeholders consider peoples’ cultural and religious heritage before defining and recommending healthy food. Keywords Healthy food · Migrants · Heritage · Affordability · Balanced diet · Canada V. Konadu (B) Brock University, Toronto, Canada e-mail: [email protected] H. E. Awuh Aeres University of Applied Sciences/Flevo Campus, Almere, The Netherlands © The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 H. Esam Awuh and S. Agyekum (eds.), Geographies of Food, Springer Geography, https://doi.org/10.1007/978-3-031-49873-2_7

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Introduction This research seeks to uncover meanings and visions of healthy and unhealthy food among people with migrant backgrounds in Canada. The focus has been specifically on Toronto in the Canadian province of Ontario. Toronto is the capital city of the Ontario province, with a recorded population of 2,794,356 in 2021 (Government of Canada 2022), ranking it as the most populous city in Canada and the fourth most populous city in North America. Immigration has contributed significantly to the population growth in the city in recent years, and immigrants (foreign-born) currently account for 47% of the city’s population (Statistics Canada 2021). The city has been reported to have the second-highest percentage of constant foreignborn population among world cities, after Miami, Florida. Interestingly, no single nationality or culture dominates Toronto’s immigrant population, placing it among the most multicultural cities in the world. For instance, in 2016, the three most reported ethnic origins overall were Chinese (332,830 or 12.5%), English (331,890 or 12.3%) and Canadian (323,175 or 12.0%) (Statistics Canada 2021). Furthermore, common regions of ethnic origin were European (47.9%), Asian (including MiddleEastern—40.1%), African (5.5%), Latin/Central/South American (4.2%) and North American Aboriginal (1.2%) (Statistics Canada 2021). This creates a rich ethnocultural diversity of the immigrant population in the city (with over 190 different ethnic origins represented), making it a suitable case to glean insights into immigrant experiences of food environments and food choices. In line with the main aim of this book, this chapter will seek to study how immigrant groups in Toronto understand healthy and unhealthy food and to try to explain these understandings (describing and explaining). Additionally, there is a paucity of research (especially in the context of Canada) on the food environment and its impact on the lifestyle of immigrants. Given the potential role of food practices in the decline of immigrants’ health status over time, understanding how immigrant groups in Canada understand healthy or unhealthy food and their visions for a healthier food future is an important area for exploration. The next section will present the methods used in collecting the data for this chapter.

Material and Methods This research is based on a semi-structured online survey of individuals residing in Toronto, Ontario (Canada). This project was undertaken as part of the book on ‘Geographies of Food’, which meant that the research questions were closely informed by general research questions used in the other country studies. These include: • What are the meanings of healthy food in different contexts? • What are the meanings of unhealthy food in different contexts? • How do people in different countries visualise healthier food futures?

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• What can inhibit the realisation of these desired healthier food futures? • What can facilitate the realisation of these desired healthier food futures? The choice of Ontario, Canada and specifically the Greater Toronto Area—besides the city’s cultural diversity—was based on the convenience of having a research assistant residing in the area as an international student. The positionality of the research assistant as a Ghanaian international student also influenced the sample being heavily skewed towards Africans and other immigrants in Canada. The choice of immigrants or people of migrant backgrounds in this study was based on the assumption that immigrants often have a unique worldview that might differ from non-immigrant groups. A growing body of research is focusing on the food practices and inequalities of immigrants. Some of these studies have shown that recent immigrants are two times more likely to be food insecure than the general population (Tarasuk and Dachner 2014) and are at risk of inadequate nutrition. Furthermore, their position between cultures brought over from their home countries and the new country’s culture gives them a unique perspective which might influence their meanings and understandings of healthy or unhealthy food. Immigrants currently account for just over 20% of the total population in Canada and are seen as a major contributor to population growth by 2030 (Rodriguez et al. 2016). The Covid-19 lockdowns influenced the choice of the online survey method. The data for this study were collected between September and December 2021 amid the Covid-19 inter-personal restrictions. The research assistant exploited contacts in his network to distribute links to the online survey. As a snowball, these contacts also forwarded the links to their contacts, and the chain continued. The state of the world during Covid-19 meant that many potential research participants were hard to find. As a result, conducting research became difficult, necessitating considering a snowball sample strategy to recruit participants. The online survey technique is suitable for descriptive, case–control, cohort and evaluation studies. Overall, the online survey technique is suitable for collecting information in a cross-sectional study where the researcher will contact the participant only once (Nayak and Narayan 2019)—an ideal scenario during Covid-19 when people were more hesitant about getting into contact with others. The data are analysed with M.S. Excel and presented in percentages and pie charts. Figures 7.1, 7.2 and 7.3 provide more demographic data on the sample used in this study.

Findings GMOs Are Significant in Data Concerning Food in Canada Genetically Modified (GMO) crops or Biotech crops production has brought an intense debate in many fields, mainly regarding advantages and disadvantages in health and the economy. The rapid increase of global GMO production is anticipated to accelerate by 2050. It will yield less expensive and more readily available crops

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Fig. 7.1 Age composition of the sample

Fig. 7.2 Ethnic identities of respondents

Fig. 7.3 Level of education of respondents

with the potential to increase the production and stability of staple food crops (Stanton et al. 2021). GMO crop production is known as exceptional because of its strength and, at the same time, the little opposition from society against this production model. According to Newel (2009), society embraced biotechnology because of its export potential and also, in the safe of the economic crisis, ‘the ideas of efficiency and modernisation were key components of dominant narratives’ (Caceres 2015, p. 126). GMO food production primarily seeks to generate superior plant species resistant to pests and capable of producing high-quality and large amounts in a short growth cycle (Bonny 2016). However, this argument for GMOs is increasingly criticised for being a model against food sovereignty and reinforces the marginalisation of some groups, mainly

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small farmers. According to the U.S. Food Sovereignty Alliance, food sovereignty is peoples’ right to healthy and culturally appropriate food produced through ecologically sound and sustainable methods and to define their own food and agriculture systems (2007). Criticism of the GMO model of food production can be explained in the words of Harvey (2004) as follows: Oligopolies largely based in the core capitalist regions, effectively control the production of seeds, fertilisers (…) Under these conditions, the creation of new market openings does not open up competition but merely creates opportunities to proliferate monopoly powers with all manner of social, ecological, economic and political consequences. (Harvey 2004: 71)

Furthermore, Martiniello (2015: 509) argues that ‘the capitalist transformation of agriculture has involved expanding mechanisation, criminalisation, land concentration, dependence on hydrocarbon farm inputs, expanded use of bio-technologies and commodification of seed production’. In this study, besides the more general understanding of healthy food as fruits and vegetables (35%) and balanced diet (29%), non-GMO food ranks as the third meaning of what is considered healthy food in the sample, with 14% of responses (see Fig. 7.4). Likewise, concerning meanings of unhealthy food, after fast food (21%), GMOs rank second (16%) along with unbalanced diets (16%) in what people in the sample understand as unhealthy food (See Figs. 7.5 and 7.6). Furthermore, 19% of responses from immigrants in Canada see cheaper GMO products as a threat to a healthier food future (See Fig. 7.5). Here, the food sovereignty issue focuses on the right to healthy food for all at the centre of food, agriculture, livestock and fisheries production—the GMO production system is not currently guaranteeing an issue (healthy) that they feel. These concerns are part of growing concerns locally in Canada and globally related to GMOs’ health, finance and environmental safety. Globally, studies have shown that many consumers have difficulties accepting GMOs (Bongoni 2016; Stanton et al. 2021). Although studies by entrepreneurs producing GMO crops and scientists have not shown significant negative effects of GMO crops or the direct link between GMOs consumption and human health problems (see Snell et al. 2012; National Academies of Sciences, Engineering, and Medicine 2016; Yang and Chen 2016), consumer confidence in GMOs is still relatively low. According to a New York Times article by Jane Brody: Although about 90 per cent of scientists believe GMOs are safe—a view endorsed by the American Medical Association, the National Academy of Sciences, the American Association for the Advancement of Science and the World Health Organization—only slightly more than a third of consumers share this belief. (Brody 2018).

These consumer concerns around GMOs stem from the scepticism surrounding the artificial combination of genetic elements derived from different organisms that cannot be crossed naturally (Holme et al. 2013). Concerning a desired healthier food future, one respondent referred to a wish to see less GMO food. He said, ‘I anticipate a decline in the availability of healthy food because of GMOs and increased availability of naturally grown food’ (Seth, Ghanaian immigrant based in Toronto).

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Fig. 7.4 Meanings of healthy food

People’s attitudes towards GMOs are a product of various influences, including socio-economic variables, scientific knowledge and background, religion and education (Hudson et al. 2015). A look at the demographic background of the respondents in this study can also explain the scepticism towards GMOs. Concerning education level and acceptance of GMOs, some studies (see Grimsrud et al. 2004; Ceccoli and Hixon 2012) have argued that both self-reported knowledge about biotechnology and higher levels of formal general education, increased acceptance of GMO food. However, like Schläpfer (2008) this chapter finds no evidence linking education background and positive attitudes to GMO crops. The sample is highly educated, as shown in Fig. 7.3, which shows that over 50% of the sample hold at least a university degree. However, there is still a relatively high degree of ambivalence towards GMOs. This shows that results on the impact of education and scientific knowledge on GMO acceptance are still quite inconclusive and disputed. Religion is perhaps the most critical demographic variable to explain concerns towards GMOs among the sample in this study. Research on the impact of religion on attitudes towards GMOs found religiosity to be significant in determining attitudes towards GMOs (see Costa-Font and Mossialos 2006; Scheufele et al. 2009). This is often based on the fact that religious people generally believe that crossing species is unnatural, as is often the case in GMO technology. For example, 50% of the

7 Perceptions of Healthy and Unhealthy Food among People with Migrant … Large portions of food 3% Excess salt 5%

Dairy Meat 2% 1%

Liquor 2%

Non-organic food 2%

Fast food 21%

Excess sugars 5% Excess carbohydrates 5%

Unbalanced diet 16%

GMO 16%

Processed food 8%

Fig. 7.5 Meanings of unhealthy food

Fig. 7.6 GMO foods in grocery stores

Excess fat/oil 14%

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sample used in Toronto self-identify as Black African. Among this group, 86% identify as Christians. This could explain why there is a relatively high level of concern towards GMO foods which some Christians could view as unnatural (not good because of that). This fits within the backdrop of the argument that people frequently rely on the natural-is-good heuristic (Rozin et al. 2012). One respondent said, ‘What I consider as healthy food is food which has not been changed from its natural state’ (Regina, 32-year-old woman living in Toronto)—suggesting GMOs are unhealthy because their natural states have been altered. Another respondent said with reference to a healthier food future that ‘the future of healthy food is not great since manufacturers are keen on profit, therefore, producing massively genetically altered products’ which compromise healthy food (Adamako, 34-yearold man, Toronto). These quotes suggest that naturalness may appeal to those who resent the intrusion of technology into basic traditions, and nothing provides that basic traditional background more than religious beliefs. This strengthens findings in other studies, such as Stanton et al. (2021), which said Muslims, Catholics and Orthodox Christians are significantly less approving of GMOs than others.

Socio-economic Exclusion is a Major Driver of Meanings and Visions of Healthy and Unhealthy Food Generally, there has been a marked increase in income inequality trends in Canada since the early 1980s (Picot and Hou 2019). More specifically, there has been a decline in the economic outcomes of immigrants since the 1980s and the associated rise in their poverty rate (Picot and Hou 2019)—a period which coincided with the exponential increases in immigration to Canada during the 1980s and 1990s. Picot and Hou (2003) state that in this period, while the low-income rate among the Canadian-born fell through the 1990s, it rose among immigrants, accounting for virtually all of the increase in the national low-income rate during that period (Picot and Hou 2003). Picot and Lu (2017) noticed this increase in the national low-income rate not only among recent immigrants in Canada (referring to those who had been in Canada for less than five years) but also among longer-term immigrants (those in Canada for 6–15 years). Furthermore, they observed that although the increase was evident across all education, age, and language groups, it was concentrated primarily among immigrants from Asia, Africa and southern and eastern Europe. This is even though between 2000 and 2010, the proportion of immigrants with a university degree increased from 31 to 42%. In addition, among those whose mother tongue was not English, the proportion of those who spoke English increased from 48 to 59% (Picot and Hou 2019). Therefore, language proficiency and education still didn’t significantly increase national low-income rates among immigrants. Such declines in family incomes among immigrants in Canada are expected to impact income inequality negatively. This study shows how it also affects immigrants’ visions of healthy and unhealthy food. This effect is more pronounced in

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large cities, where the immigrant population grew the most. Most respondents in the survey have recent migrant histories (ethnic minorities). Toronto (where our data were collected), Montreal and Vancouver remained the destinations for most recent immigrants since the 2000s. The marginalisation of such people with migrant backgrounds in Canadian society impacts the abilities of such groups to access healthier food. In turn, this affects their understanding and visions of what is healthy or unhealthy. The data collected show that visions of a healthier food future are either directly or indirectly linked to issues around socio-economic exclusion. For instance, issues around food affordability account for 18% of responses (See Fig. 7.7) concerning visions of a healthier food future. Affordability is linked to a key component of food security—access. In this study, there is a direct mention of another factor which influences affordability—socio-economic inclusion and exclusion. Figure 7.7 shows that 18% of respondents see a decrease in exclusion of migrants as a desired food future because it could increase access to healthier food (Figs. 7.8 and 7.9). The following quotes shed more light on issues around socio-economic exclusion, affordability and access to healthier food: I see a bleak healthy food future in which few privileged groups will make up the large majority of healthy individuals due to their access to healthier food whereas, other less privileged groups will have unhealthy life styles due to a lack of access to healthier food. This separation isn’t based on choice, but based on availability and access. This then feeds into issues of race, income, geography etc. which I don’t want to go into because a lot has

People are too busy with no time to cook healthy food Lack of sufficient 4% education on healthy/unhealthy food 8%

Reluctance to change eating habits 4%

Marginalisation of ethnic monorities which leads to less access to healthy food 2% Low disposable incomes 31%

Inflation 8%

Fragile agricultural sector characterised by farmers' strike actions 8%

Cheaper GMO 19%

Cheaper and more easily available fast food 16%

Fig. 7.7 Factors which can inhibit the attainment of a healthier food future

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Fig. 7.8 Visions of a healthier food future

Fig. 7.9 Street food in Toronto

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already been said about this – but not enough is done to address it (Emmanuel, 25-year-old man, Toronto, Canada) I see a healthier food future as one in which there is a decrease of fast-food chain restaurants and equal distribution of food markets/restaurants that supply healthier alternatives. I find that fast food is highly concentrated in racialised areas due to its low prices matching the affordability ratio of residents in such areas. You will also notice that restaurants like Pita Pit, grocery stores such as Freshco and farmers’ market which supply fresh and less produced foods are centralised in rich areas due to the affordability ratio of residents in such areas. These are factors that lead to health disparities because the distribution is uneven and based on faulty measure of deservingness (income). If food markets and healthy restaurants were accessible to all and at affordable prices, while reducing the presence of unhealthy restaurants/food chains our futures would be healthier (Shirley, 30-year-old woman, Toronto, Canada)

Conclusion This chapter has combined both a limited literature review and primary research findings to argue that ethnic exclusion is a significant factor in shaping meanings and visions of healthy and unhealthy food among immigrants in Canada. The findings of this chapter, in combination with secondary data, also reveal that demographic variables such as religion could have a major impact on underlying attitudes to perceived risks, social ethics and unnaturalness concerning GMOs. These underlying variables impact overall attitudes towards GMOs, enhancing perceptions of them as largely unhealthy—without any scientific basis. Surprisingly, the level of education did not seem to be a strong enough factor to overcome the influence of other factors, such as religion, in eliminating negative perceptions of GMOs. This chapter shows that despite being a relatively highly educated sample, people still base their ambivalence towards GMOs on unscientific grounds (feeling about naturalness being better)—Just a feeling. These findings are important from a policy perspective. For instance, if governments and policymakers believe that science is right and most GMOs present no risk to individuals or the environment, but they are prevented from being developed by consumer ambivalence, then something needs to be done to address the cause of this ambivalence. As religion has been identified as a key factor influencing beliefs around GMOs, a dialogue with religious leaders in immigrant communities may also help change opinions towards GMOs. Additionally, policymakers should endeavour to guarantee the dissemination of GMO-linked scientific knowledge to ensure a high level of objective knowledge among the population—a level high enough to counter-balance unscientific beliefs. Concerning socio-economic exclusion and the shaping of meanings of healthy and unhealthy food, more needs to be done in the integration of immigrants. This chapter shows that visions of a healthier food future are either directly or indirectly linked to issues around socio-economic exclusion. Addressing exclusion and marginalisation will enhance the affordability of food. This will increase access to healthier food, boosting food security.

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References Bongoni R (2016) East versus West: acceptance of G.M. foods by European and Asian consumers. Nutr Food Sci 46(5):628–636 Bonny S (2016) Genetically modified herbicide-tolerant crops, weeds, and herbicides: overview and impact. Environ Manag 57(1):31–48 Brody J (2018, April 23) Are GMO foods safe? New York Times. Retrieved from https://www.nyt imes.com/2018/04/23/well/eat/are-gmo-foods-safe.html Cáceres DM (2015) Accumulation by dispossession and socio-environmental conflicts caused by the expansion of agribusiness in a rgentina. J Agrar Chang 15(1):116–147 Ceccoli S, Hixon W (2012) Explaining attitudes toward genetically modified foods in the European Union. Int Polit Sci Rev 33(3):301–319 Costa-Font J, Mossialos E (2006) The public as a limit to technology transfer: the influence of knowledge and beliefs in attitudes towards biotechnology in the U.K. J Technol Transfer 31(6):629–645 Government of Canada, Statistics Canada (February 9, 2022) Census profile, 2021 census of population. Retrieved from www12.statcan.gc.ca Grimsrud KM, McCluskey JJ, Loureiro ML, Wahl TI (2004) Consumer attitudes to genetically modified food in Norway. J Agric Econ 55(1):75–90 Harvey D (2004) The ‘new’ imperialism: accumulation by dispossession. Socialist Reg 40:63–87 Holme IB, Wendt T, Holm PB (2013) Intragenesis and cisgenesis as alternatives to transgenic crop development. Plant Biotechnol J 11(4):395–407 Hudson J, Caplanova A, Novak M (2015) Public attitudes to G.M. foods. The balancing of risks and gains. Appetite 92:303–313 Martiniello G (2015) Food sovereignty as praxis: rethinking the food question in Uganda. Third World Quart 36(3):508–525 National Academies of Sciences, Engineering, and Medicine (2016) Genetically engineered crops: experiences and prospects. National Academies Press, Washington DC Nayak MSDP, Narayan KA (2019) Strengths and weaknesses of online surveys. Technology 6:7 Newel P (2009) Bio-hegemony: the political economy of agricultural biotechnology in Argentina. Cambridge University Press, Cambridge Picot WG, Hou F (2003) The rise in low-income rates among immigrants in Canada. Analytical Studies Branch, Statistics Canada, Ottawa Picot G, Hou F (2019) Immigration, poverty and income inequality in Canada. Institute for research on public policy. Retrieved from https://irpp.org/research-studies/immigration-poverty-and-inc ome-inequality-in-canada/ Picot WG, Lu Y (2017) Chronic low income among immigrants in Canada and its communities. Retrieved from https://epe.lac-bac.gc.ca/003/008/099/003008-disclaimer.html?orig=/100/201/ 301/weekly_acquisitions_list-ef/2017/17-39/publications.gc.ca/collections/collection_2017/ statcan/11f0019m/11f0019m2017397-eng.pdf Rodriguez PI, Dean J, Kirkpatrick S, Berbary L, Scott S (2016) Exploring experiences of the food environment among immigrants living in the Region of Waterloo, Ontario. Can J Public Health 107(1):eS53–eS59 Rozin P, Fischler C, Shields-Argelès C (2012) European and American perspectives on the meaning of natural. Appetite 59(2):448–455 Scheufele DA, Corley EA, Shih TJ, Dalrymple KE, Ho SS (2009) Religious beliefs and public attitudes toward nanotechnology in Europe and the United States. Nat Nanotechnol 4(2):91–94 Schläpfer F (2008) Determinants of voter support for a five-year ban on the cultivation of genetically modified crops in Switzerland. J Agric Econ 59(3):421–435 Snell C, Bernheim A, Bergé JB, Kuntz M, Pascal G, Paris A, Ricroch AE (2012) Assessment of the health impact of G.M. plant diets in long-term and multigenerational animal feeding trials: a literature review. Food Chem Toxicol 50(3–4):1134–1148

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Stanton J, Rezai G, Baglione S (2021) The effect of persuasive/possessing information regarding GMOs on consumer attitudes. Future Foods 4:100076 Statistics Canada (2021) Focus on geography series, 2016 census: Toronto, city (CSD)—Ontario: immigration and ethnocultural diversity. Retrieved from http://www12.statcan.ca/census-rec ensement/2016/as-sa/fogs-spg/Facts-CSD-eng.cfm?TOPIC=7&LANG=eng&GK=CSD&GC= 3520005 Tarasuk V, Dachner N (2014) Household food insecurity in Canada, 2012. Research to Identify Policy Options to Reduce Food Insecurity (PROOF), Toronto, ON. Retrieved from http://nutritionalsciences.lamp.utoronto.ca/wp-content/uploads/2014/05/Hou sehold_Food_Insecurity_in_Canada-2012_ENG.Pdf U.S. Food Sovereignty Alliance (2007) Food sovereignty|USFSA. Accessed 30 Aug 2020 from http://usfoodsovereigntyalliance.org/what-is-food-sovereignty/ Yang YT, Chen B (2016) Governing GMOs in the USA: science, law and public health. J Sci Food Agric 96(6):1851–1855

Chapter 8

From Heritage to Health: The Many Meanings of Food in South Africa Johan Coetzer and Robin Breedeveld

Abstract This chapter explores perceptions of healthy and unhealthy food in South Africa, considering factors such as ethnicity, income, education, and cultural background. The South African government developed common dietary guidelines for all healthy South Africans, but these guidelines are limited in their effectiveness due to the country’s diverse population and access to food. The study used a combination of online surveys, photovoice, and Twitter analysis to gather data and triangulate findings. Respondents considered vegetables, fruits, meat, and unprocessed or homemade meals healthy, while sugar, fat, and fast food were considered the unhealthiest options. The survey identified economic barriers, lack of education, convenience and accessibility to unhealthy food, environmental and societal factors, and cultural attitudes towards healthy eating as significant barriers to a healthier future. Respondents suggested changing perceptions of healthy food locally, promoting education and traditional farming methods, and adopting sustainable practices. The study also found that indigenous and traditional food crops were consumed by all South Africans, regardless of their income, and affordability was an important motivator for consuming healthy foods. Overall, the study emphasises the need for a multifaceted approach to address barriers to a healthier food future, including education, policy changes, and a focus on affordability, accessibility, and sustainability in the food industry. Keywords Food meaning · Indigenous food · Healthy food · Affordability · South Africa

J. Coetzer (B) C4 EcoSolutions, Cape Town, South Africa e-mail: [email protected] R. Breedeveld University of Cape Town, Cape Town, South Africa © The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 H. Esam Awuh and S. Agyekum (eds.), Geographies of Food, Springer Geography, https://doi.org/10.1007/978-3-031-49873-2_8

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Introduction South Africa has eleven official languages, eighteen unofficial languages, and a culturally and racially diverse population (Southall 2019). The South African government formally divides the country into five racial categories that include: Black South African (76%), White South African (9%), Coloured South African (9%), Indian South African (2.5%), and Other/Unspecified (0.5%) (Southall 2019). During the Apartheid rule in South Africa, which was implemented from 1948 to 1994, the white minority ruled over the black majority of the South African population. The Apartheid rule classified people into racial categories, and based on their racial category, they would either receive or be excluded from certain privileges. People of colour were denied many basic human rights. As such, they were forcibly evicted from their homes and ancestral lands and instead had to live in townships where they were heavily policed. Today, white South Africans still own most of the South African land and generational wealth due to its racial segregation and oppression history. South Africa is regarded as one of the most unequal countries in the world (Francis and Webster 2019). Regarding the South African diet, a wide variety of dietary preferences can be expected based on the diversity in demographic factors such as culture, race, language, socio-economic status, household income, and urban or rural lifestyles (Lewis et al. 2020). Based on the racial background of South Africa’s population, much can be said about the nation’s general dietary habits, whereas the white population follows a diet more similar to a ‘Western diet’, it being high in fat (over 30%) and sugar (over 10%) but relatively low in carbohydrates (under 55%). The Black African population of South Africa can be divided into two dietary groups: those that live in the rural areas, and those that live in the urban areas (Pretorius and Sliwa 2011). The rural Black population typically follows a low-fat diet (below 25%), low in sugar (below 10%), but high in carbohydrates (over 65%) due to ‘pap’ (made with corn starch) and occasionally cassava and sweet potato being the staple foods. On the other hand, the Black population living in the urban areas mostly eat Western diets, which are high in fat (over 25%) and low in carbs (under 60%). The final dietary group, Indian and coloured people, resort to a mix of traditional and Western diets (Pretorius and Sliwa 2011). Despite this diversity, the South African government’s Department of Health has developed 11 standard common dietary guidelines for all healthy South Africans above 6. These guidelines hardly consider the variety and diversity of the South African population’s dietary habits, traditions, and preferences. The guidelines advocate for ‘the importance of nutrition to combat the growing burden of chronic diseases and existing nutritional disorders associated with poverty and undernutrition’ (Department of Health, Republic of South Africa 2003, p. 1). The guidelines are listed as: 1. Enjoy a variety of foods. 2. Be active! 3. Make starchy foods part of most meals.

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4. 5. 6. 7. 8. 9. 10. 11.

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Eat plenty of vegetables and fruit every day. Eat dry beans, split peas, lentils, and soya regularly. Have milk, maas, or yoghurt every day. Fish, chicken, lean meat, or eggs can be eaten daily. Drink lots of clean, safe water. Use fats sparingly. Choose vegetable oils rather than hard fats. Use sugar and foods and drinks high in sugar sparingly. Use salt and food high in salt sparingly.

Like many other countries worldwide, South Africa is increasingly afflicted by chronic diseases due to poor nutrition habits. Malnutrition, type 2 diabetes, obesity, and cholesterol problems are the diseases that occur most frequently (Spires et al. 2016; Popkin 2006). The worsening health conditions of the South African population have caused the government to take action in a policy, an example being the development of the guidelines listed above. The guidelines advocate for healthy eating habits such as consuming sufficient amounts of fruits and vegetables, following a varied diet, staying hydrated by drinking enough water, and limiting sugar intake (Department of Health, Republic of South Africa 2003). However, while the guidelines can offer direction towards making healthy nutritional choices, their effectiveness as a policy may be debatable if they do not consider the country’s diverse cultural backgrounds and different food access levels. In this paper, we therefore seek to have a better or more inclusive understanding of the dietary habits of the South African population—an understanding which goes beyond the standard government assumptions on what is healthy or unhealthy for South Africans to consume. So far, we have painted a general idea of what the South African government considers healthy or unhealthy nutrition. However, we do not understand the South African general population’s perceptions of unhealthy and healthy food. In this chapter, we look into how perceptions of food might differ across ethnic groups in the country, their educational background and income. In order to answer these questions successfully, we need to first understand the context and factors that influence people’s perceptions, or changing perceptions, towards food. Dietary preferences and habits are not static: We have seen major changes in diet globally over the past few decades, and South Africa is no different. Although South African diets can sometimes be regarded as ‘traditionally African’, global dynamics and socio-economic changes have influenced the traditional diet. To better grasp this, we conduct a literature review below to illustrate the critical factors influencing perceptions towards food.

Literature Review In the first decade of this century, South Africa has been undergoing major changes in nutrition, referred to as the ‘nutrition transition’ (Stupar et al. 2012). Due to demographic and socio-economic shifts, diets have always been evolving. One of

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the most recent shifts in nutrition has been increased consumption of meat, fat, and sugar and lower consumption of fibre due to food processing (Popkin 2006), which a decrease in physical activity has accompanied. This shift is brought about by factors such as globalisation, urbanisation, GDP growth, and cultural factors. In general, big multinational corporations replace local food suppliers. Despite a worldwide trend towards these “Western” diets, there are notable variations both among and within countries. Bourne et al. (2002) define a “Western” diet as one in which less than half of the energy comes from carbohydrates and over 35% comes from fat, in contrast to a traditional diet where more than half of the energy comes from carbohydrates and less than 25% comes from fat. Additionally, diets are becoming less varied, with fewer vegetables and fruits being consumed. In South Africa, the nutrition transition towards a more ‘Western and modernised’ diet is accompanied by high rates of obesity (Popkin 2006). Interestingly, Popkin (2006) points out that globally, more people are overweight than underweight, including lower-income countries. South Africa has the highest obesity rates on the African continent, while at the same time, much of the population suffers from hunger and malnutrition (Kaltenbrun et al. 2020). According to Popkin (2006), there is a strong correlation between GDP growth, urbanisation, and caloric sweetener intake. These developments occur significantly in middle-income countries like South Africa (Brooks 2017; Popkin 2006; Bourne et al. 2002). Moreover, some studies examining South Africans’ perceptions towards healthy nutrition found a connection between post-apartheid South Africa and the increased preference towards fast foods such as KFC (Stupar et al. 2012). Traditionally farmed foods, generally high in fibre and vitamins, were sometimes associated with rural life or ‘being poor’, while fast foods are seen as ‘Western’ and thus belong to people with a higher socio-economic class. As a result, the healthy, traditional diet is increasingly being neglected as an unpopular food choice in South Africa (Bourne et al. 2002). Cloete and Idsardi (2013) point out that this is especially an issue in South Africa, while locally grown, indigenous food crops are much more valued and consumed in other African countries. In South Africa, these foods are often viewed as ‘poor people’s food’. Cloete and Idsardi (2013) argue that the connection between Indigenous and Traditional Food Crops (ITFCs) and a lower socio-economic status has been made because the crops were often cultivated for self-sufficient purposes in rural areas. Contrarily, the authors show in their results that despite this assumption, traditional South African foods are generally consumed by a wide variety of households with different income levels (Cloete and Idsardi 2013). In their analysis of South African’s perceptions of traditional and indigenous foods, they found that “culture and tradition are not important motivations for the consumption of ITFCs” (Cloete and Idsardi 2013, p. 909). Important motivations were rather that they are healthy and affordable, although unhealthy food such as takeaways and fried street food is also reasonably inexpensive. Affordability is also mentioned as an important motivator for the consumption of healthy foods in other studies. For example, Sturm and Hattori (2013) found that a reduction in the prices of healthy foods directly leads to an increase in the consumption of healthy foods and a decrease in the consumption of unhealthy foods.

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A study on healthy food for specifically young students in South Africa voiced several concerns regarding the nutrition transition (Stupar et al. 2012). First, they found that adolescents often do not eat breakfast but eat unhealthy, fatty, and sugary foods at the tuck shops near their school. They find that young students lack availability and access to adequate food within their households, schools, and community (Stupar et al. 2012). Stupar and colleagues (2012) also found that most people they interviewed knew what healthy food is and what is generally considered unhealthy. Nonetheless, primarily the unavailability of healthy food made the students eat unhealthily. Slightly contradicted the findings that Stupar et al. (2012) found, other scholars found that healthy food in rural areas is almost always available, yet more expensive. In their study on the availability and costs of healthy food in rural towns in the Western Cape, Temple et al. (2011) found that supermarkets offer healthy alternatives. Small food shops might offer a small variety of healthy food options. However, in sampled shops, they found that healthy foods are 10–60% more expensive than unhealthy foods when looking at rands spent per 100 g. When looking at the energy gained from the foods (kJs), the percentages are even higher: 30% to 110% more expensive. Putting those extra costs next to the average household incomes in South Africa, Temple et al. (2011) conclude that a healthier diet is unaffordable for most South African households. Linking this finding to the nutrition transition, Stupar et al. (2012) find that the availability and social value of ‘traditional’ foods have reduced, while fast food gains social acceptance or is even linked to belonging to a higher socio-economic class. This has led to traditional food cultures losing their prestige and status. This is reflected by the increasing numbers of obesity in South Africa. Obesity rates in South Africa are high among black women (Stupar et al. 2012; Phillips et al. 2020), with 31.8% of black South African women being obese and 26.7% being overweight (Bourne et al. 2002). According to South Africa’s National Department of Health (2019), the percentage of adults suffering from obesity has increased significantly over the past decades. The prevalence of obesity has increased from 6.4 to 28.3% from 1975 to 2016. Moreover, the prevalence of obesity among women was consistently higher than that among men over the years. Consequently, this has increased the number of non-communicable diseases, such as heart disease and type 2 diabetes, in the country (Bourne et al. 2002; Pretorius and Sliwa 2011). As a result, mostly black women suffer from these non-communicable diseases, indicating that nutrition is highly dependent on demographic factors. It is also important to note that the black population represents 77.4% of the South African population and is the most impoverished racial group. Related to this, Stupar et al. (2012) found that in townships, street sellers sell fatty foods for low prices. In these communities where parents are often at work (Stupar et al. 2012) and travel long distances to work (Bourne et al. 2002), it results in a lack of time to prepare healthy meals for their children, leading to poorer populations consuming more junk food from younger ages. Bourne et al. (2002) interestingly point out that an increase in socio-economic status does not always result in better nutrition. Instead, it is associated with a

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shift towards an unsuitable nutritional pattern that increases the risk of developing atherosclerosis. In the informal settlements of Cape Town, where most of the population is considered coloured or mixed, very few vitamins and minerals are consumed. These minerals and vitamins are more popular in formal settlements where the population has higher levels of education, access to resources and income. Despite the consumption of micronutrients in formal settlements, high cholesterol levels remain (Pretorius and Sliwa 2011). Physical health is likewise directly tied to individuals’ professions concerning their dietary choices. For example, lower-educated black women were found to have lower BMIs than higher-educated black women due to the nature of their jobs, where the less economically primarily privileged partake in physical labour (Pretorius and Sliwa 2011). Nonetheless, poverty remains an important factor in unhealthy diets among the black population (Bourne et al. 2002; Pretorius and Sliwa 2011). During the COVID-19 pandemic, food prices went up. In Naicker et al.’s (2021) survey, people living primarily in KwaZulu-Natal reported struggling to afford food. Since affordability, as previously mentioned, is an important motivator for people to buy healthy food, the lockdown may have led to a decrease in healthy food consumption, as people consumed more snacks than usual, with the addition of being less active. Almost 37% of Naicker et al.’s (2021) participants reported maintaining an unhealthier diet during the lockdown than before COVID-19. Interestingly, the authors also found that some of their participants started planting fruits and vegetables at home due to the increasing food prices. During the social distancing period, food suppliers played a critical role, as the increased availability of free time to most of the population has resulted in more time being allocated to meal planning. Free time for the majority of the population provided people with more time for meal planning. Governmental policies and food suppliers are increasingly catered towards the global and Westernised market. As a result, new initiatives to tackle food insecurity disregard traditional food’s crucial role in reducing the nation’s food insecurity (Cloete and Idsardi 2013). However, the government and the food suppliers are not the only ones that play an essential role in the nutrition transition. It is vital also to understand the consumers’ increasing demand for fast food or the decreasing social value of traditional crops. As Popkin (2006) writes: “consumer demand for processed and safer foods is on the rise in developing countries” (p. 294) as families need quick meals to provide food for their children while working a full-time job. Here, the supermarket saves the family much scarce time. At the same time, trade liberalisation has led to large supermarkets—which supply highly processed foods with higher sugar intake—competing with local shops that supply more healthy, fresh, locally sourced foods. The aforementioned example shows how the human rights principles of autonomy and participation can clash with the right to sufficient nutrition and good health (Stupar et al. 2012). This calls for an adequate understanding of consumer demand and South African’s perceptions of (un)healthy food. These perceptions, as discussed earlier, can vary greatly from socio-economic class, racial background, age, gender, and rural or urban lifestyle. While the literature discusses the nutritional issues South

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Africa faces, there is a lack of studies that qualitatively aim to understand the food perceptions of South Africans in general. Although some studies have conducted qualitative interviews, their participants were only school children or black women (Stupar et al. 2012; Philips 2017). This study connects sociological factors such as income, cultural background, age, and education with various perceptions of (un)healthy food in South Africa.

Material and Methods In order to answer our research question ‘How do perceptions of healthy and unhealthy food differ across South Africa?’, an online survey was conducted. This survey initially focused on the local population in and around Polokwane in the Limpopo province. However, since the survey was made available via a google forms link on various social media platforms, the survey managed to reach various areas in South Africa, including Cape Town. The literature study, methods applied, and results from these surveys will be systematically discussed in the following paragraphs. The methodological process included generating a questionnaire on Google Forms, conducting the surveys, using photovoice to add a visual element to the foods of South Africa and extracting Twitter tweets, including the words “healthy” and “food” from 2015 to 2020 posted in South Africa. It is important to note that the research for this study was conducted during the height of the COVID-19 pandemic when South Africa had strict restrictions on public gatherings and social distancing. This influenced the research methods chosen.

Generating the Questionnaire and Conducting the Surveys A questionnaire was generated in Google Forms with a shareable link. Initially, the link was intended to be shared with Facebook and WhatsApp groups in the northern Limpopo province of South Africa. However, since it was made freely available online, respondents to the survey were spread out throughout the country. The questionnaire had the following questions: • • • • •

What do you consider healthy food? What do you consider unhealthy food? How do you see the future of healthy food? What do you believe can facilitate or contribute to a healthier food future? What do you believe can inhibit or prevent a healthier food future?

The link to the survey was sent to several WhatsApp groups in the Limpopo area (Mountain Eco Watch, Haenertsburg; Polokwane Neighbourhood Watch; Limpopo Transport Opportunities; University of Limpopo Staff), as well as various Facebook groups in Limpopo (Haenertsburg town, Mankweng buy and sell, Tzaneen town,

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Polokwane town, Mokopane town). Since the link was freely accessible, it quickly reached respondents as far as Cape Town. The Limpopo province is located in the northern part of South Africa. The province has several ethnic groups, including the Pedi, VhaVenda, Afrikaans, and Tsonga people, each with their cultural practices and traditions. Limpopo is also home to a significant population of immigrant workers, many of whom come from Zimbabwe, Mozambique, and Malawi (South African History Online 2023). During apartheid, Limpopo was one of the most oppressed regions in South Africa, with many of its black residents forcibly relocated to segregated townships and homelands (South African History Online 2023). This includes the Mankweng township shown in Fig. 8.1. In the post-apartheid era, the province has made significant progress towards achieving greater social and economic equality, although challenges remain regarding poverty, unemployment, and access to basic services. Since much of South Africa’s population experiences varying poverty levels and limited access to electricity and network access, 17 surveys were conducted in person in the Mankweng township. These surveys were conducted in the town centre, opposite the busiest taxi rank, where respondents were randomly selected based on their willingness to participate. Their responses were entered into the Google Form Survey via the interviewer and then submitted. Individuals from around South Africa submitted a total of 49 surveys. Figure 8.2 shows the demographic profile of

Fig. 8.1 Map indicating the Limpopo region where surveys were initially conducted

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Fig. 8.2 Demographic profile of respondents

the respondents as it relates to gender, age, ethnicity, income, and education. Unfortunately, the racial makeup of the respondents only included black and white South Africans, as other racial groups are not that populous in the initial distribution area.

Photovoice This study used a photovoice approach to add visual data to the research. It furthermore broadens our perspective on South African dietary traditions and perspectives. Photovoice is a participatory research method that utilises photography to enable individuals to share their perspectives and experiences on issues that affect them (Wang 1999). Furthermore, it is a method that encourages dialogue and collaboration among participants and researchers to find solutions and highlight community problems (Brown 2014). Photovoice has been recognised as a more inclusive research method, allowing for the voices and experiences of those who have traditionally been left out of the research process to be heard. In addition, enabling participants to capture their images and share their experiences empowers them to express their thoughts and feelings

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in ways they might not be able to do through traditional research methods such as surveys or interviews (Wang and Burris 1997). In addition, photovoice is particularly effective in reaching out to traditionally hard-to-reach groups, such as individuals experiencing homelessness, people living with disabilities, and immigrant communities (Catalani and Minkler 2010). These groups may be more likely to participate in photovoice research because it offers a safe and supportive environment to share their experiences without fear of being judged or stigmatised (Wang 1999). One major limitation of the photovoice exercise was that the respondents had to have access to a smartphone and mobile data and had to have social media accounts. When the survey was conducted, the national lockdown limited social interaction, and responses depended on those willing to participate in the survey shared on social media groups. In this study, respondents were informed of the additional photovoice exercise, which they could have participated in should they be interested. If a respondent was interested in participating, they were instructed to send a picture of a meal with a description on whether they considered it a healthy or unhealthy meal. These photos were then sent via direct messages on WhatsApp and Facebook. Sixteen respondents agreed to participate in the photovoice, and 24 photos with descriptions were received via Facebook and WhatsApp.

Tweets from 2015 to 2020 In addition to the survey and photovoice, a search was conducted on all tweets posted from the start of 2015 (January 1st) to the end of 2020 (December 31st). This process used the methods described in the article “Air Pollution in the South African Twitterverse: Exploring User Awareness over the Past Decade” by Lindeque et al. (2021). Tweets have been used as a social research method because they provide researchers with a rich source of data that can be analysed to understand public opinion and behaviour on a range of social issues. Tweets are a form of user-generated content that can be accessed in real time, and hashtags and other metadata make it easy to identify and track specific topics or trends. The added value of using tweets for social research is that they offer a unique perspective on social phenomena, providing insights into public discourse, attitudes, and behaviours that traditional research methods may not capture. This data can inform policy and decision-making and develop interventions and communication strategies that are more responsive to public needs and preferences. In this study, data was mined using the following search terms and then grouped into themes accordingly: • food, health (general perspectives on food and health) • food, healthy (perspectives on healthy aspects of food) • food, unhealthy (perspectives on unhealthy aspects of food)

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All tweets in the dataset were then reviewed, and some were excluded if the search term context was irrelevant to our research questions. With our analysis, we included tweets that highlighted some of the perspectives found in our survey and photovoice study or any of the tweets that supported our study. The extracted data also included metadata from the Twitter users, including their username, twitter handle, location (if added to the post), and bio/description content. This made it possible to identify the occupation and location of some of the users. Although selective data was extracted, the personal information of the users will not be shared on this paper or elsewhere, and tweets will be quoted anonymously, for example: People who preach about healthy food get my attention until they mention broccoli and pumpkin. I can’t stand them both. That’s when they lose me. (Twitter user, Johannesburg).

Analysis The analysis used triangulation with the data collected from the survey, photovoice and tweets. In the extraction and selection of data, we focused on the questions asked in the survey. Triangulation was a useful research approach for this study as it involved using multiple data sources to provide a more comprehensive understanding of people’s perspectives on healthy food. Using multiple data sources allowed the validation of findings and provided a more nuanced understanding of the research problem. The combination of different types of data also provided a richer and more diverse set of perspectives, helping to ensure that the study’s findings were grounded in the experiences and perspectives of the study participants.

Findings This section discusses the main findings of the survey, photovoice and tweets, with links between them. The photos derived from the photovoice method will be used to illustrate some of the findings and descriptions of the photos received. This section is divided into multiple subsections that address the aforementioned research questions: • • • • •

What do you consider healthy food? What do you consider unhealthy food? How do you see the future of healthy food? What do you believe can facilitate or contribute to a healthier food future? What do you believe can inhibit or prevent a healthier food future?

For each open-ended survey question mentioned above, we adopted a method of coding. First, we tallied the frequency of particular words in the responses. Then, in certain instances, clustered words were put into a category. An example of this

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would be words such as chips, burgers, pizza, fast food, and junk food. These words are all clustered underneath the category of ‘fast food’.

A ‘Braaiing Nation’: Fruits, Vegetables, but Mostly Meat as Healthy Food In the survey, many respondents considered vegetables, fruits, meat, and unprocessed or homemade meals healthy. The racial background did not influence how many vegetables or fruits were mentioned in the answers. Fruits and vegetables were often mentioned together, as well as vegetables and meat. Black respondents only mentioned pap and spinach (both mentioned four times) as this is considered a traditional meal among black people in South Africa. Out of the black respondents, 33% mentioned meat as healthy food. Out of the white respondents, this was slightly less: 20%. Figure 8.3 shows the typical composition of foods you will find at a South African braai. Meat undoubtedly plays a major role in the culture of South Africa. The term “braai” and Afrikaans word for barbeque, is known throughout the country and practised by every demographic group of South Africa. For example, the photovoice respondent for Fig. 8.3 stated that “braai and meat are what makes South African dishes South African; we need meat, it gives us our strength”. However, concerning meat, the responses were more nuanced than Fig. 8.4 indicates. Some respondents specified that they consider white meat (or poultry) as healthy, with one respondent jokingly stating that chicken is their favourite vegetable. Some respondents noted that red meat is a healthy food and a dietary requirement, whereas another respondent specifically noted that meat is generally healthy, except for meat derived from pork. The exclusion of meat is most likely due to a religious connotation, as some religions, such as the Zion Christian Church (ZCC), which has Fig. 8.3 Typical Braai foods

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Fig. 8.4 What respondents considered as healthy food

their base in Moria outside of Mankweng, do not condone the consumption of pork. The ZCC Easter pilgrimage is also one of the largest social gatherings in the southern hemisphere. The often-occurring ‘unprocessed/homemade’ code also encompasses responses such as ‘raw foods’, ‘organic foods’, ‘fresh foods’, or ‘food from the garden’. This was mentioned by 24% of the white and 16% of the black respondents. This is interesting given that, as discussed in the literature review, Indigenous and Traditional Food Crops (ITFCs) are often seen as food consumed by people with a lower socioeconomic status. However, from the survey, ITFCs were seen as healthy and viewed more positively than processed foods. Therefore, if we regard ‘fruits and vegetables’ as ITFCs, the findings align with what Cloete and Idsardi (2013: 908) argue: the survey shows that these foods are consumed by all South Africans, regardless of their income. However, the wording ‘fresh, raw, unprocessed and homemade’ foods occurred more and more as the respondent’s income (and level of education) increased. This is displayed in Fig. 8.5. In general, the survey answers align with the dietary guidelines the South African government has developed. It is important to note that the three highest income categories—above R400,000— have significantly fewer respondents than the three categories below R400,000. For example, there are 30 respondents with an income level of R400,000, while only five respondents made more than R400,000 (* 14 participants preferred not to answer this question). This might lead to a skewing of the results. The distribution of the respondents among the income levels is displayed in Fig. 8.6, as well as their race. One of the photovoice respondents indicated that homemade fish and chips are a healthy dinner option. In addition, the respondent noted that “the fish and chips are

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Fig. 8.5 Percentage of participants responding to ‘fresh, unprocessed, raw, homemade food’, according to income level

Fig. 8.6 Distribution of respondents among income levels and racial makeup, where blue represents black respondents, and green represents white respondents

baked, not fried”. However, it is still evident that this meal (see Fig. 8.7), considered healthy by the respondent, has no vegetables on the plate.

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Fig. 8.7 Fish and chips as a healthy meal

A Coherent and Homogenous View of What Unhealthy Food is, but Such Unhealthy Food Remains Appealing Via the Twitter search, two quotes were highlighted. One from a student at the University of Johannesburg and another from a student from the University of Cape Town. These quotes illustrate an often-occurring opinion among South African students, which is that ‘unhealthy foods, such as junk food, are more attractive and appetising’: I’m sooo hungry, but the only thing available in my kitchen is healthy food which I genuinely have no interest in. (Johannesburg Student) I really don’t know how people who follow a strict diet with no fast food do it… (Cape Town Student)

Although these quotes specifically come from university students, we found in our survey that demographic characteristics barely influence South Africans’ opinions on unhealthy food. People across ages, income levels, and races answered fast food, including fries, burgers, and pizza and often specifically mentioned KFC as unhealthy. This does not mean that unhealthy foods are not consumed or not considered appetising. Figure 8.8 shows bobotie and rice, one of South Africa’s most beloved traditional meals. Initially introduced by Dutch colonists, the meal quickly became a homemade dish throughout the country. From region to region, the ingredients differ, but the main elements remain the same: minced meat cooked with fruit chutney, egg baked on top, and a side dish of yellow rice. The photovoice respondent who sent Fig. 8.8 described bobotie as one of South Africa’s most beloved and unhealthy dishes. This is because of the lack of vegetables and it being “served for dinner as opposed to breakfast or lunch”, which presumably relates to the high level of carbohydrates and proteins before bed.

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Fig. 8.8 Bobotie and rice

Unfortunately, the most accessible food and fastest to cook are not necessarily healthy, as made clear by the description provided by the respondent who sent Fig. 8.9 “I love frozen pizza: it’s cheap and easy to cook, especially if you buy from OK Foods”. Ready-to-eat meals and quick-to-cook meals are very common in South Africa and very popular. Primarily because these meals, such as the frozen pizza shown in Fig. 8.9, are not that expensive and do not take much time to cook. It would appear that cooking time plays a major role in the type of food people would consider purchasing. South Africa is a country of long distances where many people commute to work. They have to catch a taxi early in the morning and arrive late at home after work. Therefore, meals must be cooked fast and the content must be cheap. This is concerning, especially for children whose parents work many hours and take care of much unpaid housework. As a result, their parents do not have enough time to cook meals for the kids and instead provide them with pocket money, resulting in their children purchasing crisps, cookies, pies, and sugary sodas. Sugar, fat, and junk food, in general, were also mentioned in the surveys, and fast food ranked the highest in what respondents considered unhealthy food (Fig. 8.10). Interestingly, KFC is the only specific brand and franchise mentioned as unhealthy. The terms “KFC”, “Kentucky”, and “fried chicken” came up numerous times in the surveys. With other sorts of foods or characteristics of foods, no brand was mentioned. Other fast-food franchises such as McDonald’s, Steers, and Nando’s were not mentioned. Eat Healthy Food and Boost Your Immune System. Eat Junk Food and Deplete Your Immune System.—(Twitter user)

8 From Heritage to Health: The Many Meanings of Food in South Africa Fig. 8.9 Frozen pizza

Fig. 8.10 What respondents considered unhealthy food

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In questioning why KFC is specifically mentioned, we can speculate with the help of other studies that it is the most popular fast-food restaurant in South Africa and among the most affordable (Feeley et al. 2009). In South Africa, fast-food consumption is generally higher than in other countries. Lewis et al. (2020) also point out that fast-food companies like KFC and McDonald’s target especially children in lowand middle-income countries with their fast-food advertisements because they are easily influencing, and in those countries, there is less governmental regulation for what kind of advertising is allowed and what is not. Lastly, as already discussed in the literature review, fast food in South Africa is often perceived as a ‘modern’ food or a ‘treat’ that people see as a luxury if it can be afforded. To illustrate this, Chevalier (2015) quotes one of her interviewees who says: “We would go to KFC because my wife is paid on Friday” (p. 122). Similarly, Brooks writes: “Some people in Africa with money in their pockets are free to indulge in golden, crisp Kentucky Fried Chicken” (p. 1309). Interestingly, despite the popularity of KFC in South Africa, our survey shows that people know KFC is not a healthy food option. However, this does not imply that less of it is consumed.

Negative Views on the Future of Healthy Food Because of High Costs and Increasing Availability of Processed Foods The responses to the question ‘How do you see the future of healthy food?’ also used a coding methodology. Certain attitudes or perspectives were coded and grouped. For example, when a participant used words such as ‘good’ or ‘blooming’ in answering this question, the response would be noted as ‘optimistic’ towards the future of healthy food. On the other hand, negative responses such as ‘not that bright’ or ‘bad’ would be classified as a more ‘pessimistic’ attitude. Some of the respondents did not answer in a way in which the respondent’s attitude was optimistic or pessimistic. For example, they provided simple answers like ‘organic food’ or ‘fruits and vegetables’. With these answers, it is just coded as ‘organic’ and ‘plant-based’, respectively. When respondents answered that they see the future of healthy food as ‘expensive’, it was noted as both ‘pessimistic’ and ‘expensive’. The responses are shown in Fig. 8.11. In general, more people were pessimistic about the future of healthy food than optimistic. This was shared among the black and white respondents in our survey. A common reason for participants to be pessimistic was that healthy food is expensive, which was also a common finding in the Twitter analysis, as seen in some of the tweets extracted from South African Twitter users: This guy thinks healthy food prices doesn’t change ne? #umphakathi And it honestly doesn’t help that junk food is cheaper than healthy food. #Umphakathi Healthy food doesn’t come cheap. A healthy lifestyle also doesn’t come cheap. #Umphakathi If people don’t get HIV, the state can use the money spent on ARV’s for healthy food. #umphakathi

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Fig. 8.11 Perspectives on the future of healthy food

The Twitter platform allows individuals to raise their opinion on matters they find important, as these tweets and their content are often uncensored. Umphakathi, for example, is a social movement group in South Africa that aims to highlight the community’s issues. The word itself means “to tell the community”. This group has addressed many issues and brought them to the attention of the public eye, and in our study, we interestingly found that they also brought attention to the issues related to the cost of healthy living and the much cheaper cost of unhealthy living. One of the participants was generally optimistic, but on the prerequisite that healthy food would be more affordable. They answered: “If it’s not so expensive, good future”. Their concerns are valid when lining up with the available literature. It has previously been proved that healthy food is generally more expensive than unhealthy alternatives (Sturm and Hattori 2013; Stupar et al. 2012). Others were pessimistic because a lot of the food is highly processed or genetically modified; for example, one of the participants said: “We will never have healthy food since we eat modified, processed food”. A handful of respondents said that the future would depend on the awareness and knowledge of people about healthy food. Regarding the code ‘local, seasonal, organic’, as many as eight respondents think that people should produce their vegetables in their gardens and practise more self-reliance. This is interesting and unexpected because previous literature shows that planting your foods and farming is often associated with rural life and poverty (Cloete and Idsardi 2013).

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Both black and white respondents in our survey were pessimistic about the future of healthy food because of the high cost of healthy eating. As discussed in our introduction, South Africa is still economically unequal due to the legacy of Apartheid’s racial exclusion, oppression, and segregation. Therefore, poorer populations in South Africa are mostly black, whereas higher economic classes in South Africa tend to be white. Black South Africans are thus more heavily affected by increasing prices of healthy food. Interestingly, both Black South Africans and white South Africans are equally as pessimistic about the cost of healthy food. More research would need to be done to understand whether white, more wealthy South Africans also feel heavily affected by increasing food prices themselves and are therefore pessimistic, or if they are pessimistic about the future of healthy food out of consideration for other people in the country that may not be able to afford it. One of the white respondents in our survey who was pessimistic about the future of healthy food explained that: “Most people cannot afford to eat healthily”. Although we might expect the black population to be more pessimistic about the future of healthy food due to economic disadvantages, we found that the pessimism is shared among all respondents.

From Perception to Action: Sustainability, Gardens and Informed Choices When respondents were asked “What can facilitate or contribute to a healthy food future?”, several suggestions were revealed. The responses are reflected in Fig. 8.12 below. Changing perceptions on what constitutes healthy food is vital. These perspectives are also deeply rooted locally, mainly at the household level. Some respondents suggest that increasing awareness about the health and environmental benefits of eating local and less processed foods can be achieved by supporting local farmers and eating what’s available in season instead of eating food that needs to be imported. Another suggestion is to make healthy food more affordable and readily available. The respondents deem this possible by promoting and encouraging backyard gardens, buying locally produced foods and building a network in the community based on a barter trade system. Some respondents also mentioned education as playing a key role in what is considered healthy food and producing one’s own food at your household garden. The price of healthy food is still an issue, and better delivery of reasonably priced healthy food compared to cheaper unhealthy food is needed. Addressing the cost issue includes reducing prices and advocating for healthy eating that supports local markets. One respondent suggested introducing school education programmes that include lessons on healthy eating and traditional farming methods that do not use pesticides and excessive fertilisers. She stressed that in this way, education can help promote healthy food choices from a young age. At the very least, this will improve the future of healthy food by improving the mindset of younger generations today.

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Fig. 8.12 Factors that can facilitate or contribute to a healthy food future

The current food system needs to be addressed to facilitate a healthy food future. The adoption of sustainable practices and changing our current lifestyle are critical. For example, the dependence that has developed on takeaway places that use fats and oils desperately needs to change. On a more national and international level, the large-scale agricultural practices we have become accustomed to need to be altered. It is a well-known fact that our monoculture and feedlot dependency impact our health and the environment. For farmers, practising organic farming is suggested, which includes rotational grazing, permaculture, and no-till farming. The core of the healthy food future depends on the actions and perspectives of individuals. We can contribute to a healthy food future by setting personal goals, opting for sustainably produced foods and cultivating our vegetables where possible, which will help lower the cost of fresh produce and indicate that individuals can make informed decisions about their food choices. An interesting description of one of the photos obtained via the photovoice study was that we need to consider other protein sources. In Fig. 8.13, a respondent provided a picture of mopani worms with pap (maize meal), stating that it is a good source of protein that does not require as much production input as cattle, sheep, and goats. Mopani worms are found in the northern provinces of South Africa. Each year millions of them hatch and can be found in the Mopani forests that stretch from Mpumalanga, Limpopo to Mozambique, Zimbabwe, and Rwanda. The suggestions provided by respondents highlight the need for a significant shift towards healthy food choices. This shift requires changes in perceptions, increased education, more vegetable farms and gardens, reduced hormonal products, and the adoption of sustainable practices. Additionally, making healthy food affordable and accessible is vital, and individuals can contribute by setting goals, cultivating their gardens, and making informed decisions about what they eat. By implementing these suggestions, a healthy food future can be achieved.

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Fig. 8.13 Mopani worms and pap

Breaking Barriers to Healthier Food by Overcoming Socio-cultural and Economic Barriers When asked, “What do you believe can inhibit or prevent a healthier food future?”, five themes became apparent from the responses. These include overcoming economic barriers, the importance of education, convenience and accessibility, environmental and societal factors, and cultural factors reflected in Fig. 8.14. The price of food, poverty, unemployment, and general lack of income were considered the main economic factors that inhibit a healthy food future. Mass-produced foods derived from monocultures and feedlots are often cheaper than locally produced foods, usually because local producers do not have access to the equipment and capital that mass producers have. This results in the price of healthy foods prohibiting those with a limited budget. Job losses, high unemployment rates, and a lack of income can also make it difficult for people to afford healthy food options and limits their overall options in food sources. Education and knowledge were also prominent themes in the response to this question. This can lead to negative attitudes towards healthy foods, resulting in a consumer demand that opts for unhealthy foods. In such circumstances, the market will provide what the consumers demand, highlighting the importance of individual perceptions and understanding of healthy food and a healthy diet. This lack of knowledge can also extend to farming and agriculture, where people may lack the skills and space to grow their food. Convenience and accessibility to unhealthy food options are significant barriers to healthy food choices. As a respondent indicated, it “is much easier to get a takeaway meal than to cook at home and have to do dishes”. Fast-food options are much more convenient and readily available than healthier options, and the increase in fast-food chains and the high number of food delivery options make it even easier to access these unhealthy choices without leaving your house or office. Two of the respondents

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Fig. 8.14 List of factors which can inhibit a healthier food future

highlighted the importance of environmental and societal factors, which include climate change, environmental degradation, overpopulation, and our dependence on the mass production of crops. Using genetically modified organisms (GMOs), hormones, pesticides, and chemical fertilisers impacts our food’s nutritional value and healthiness. High food prices and an exponential increase in demand for food can lead to reliance on mass production and food shortage, which can negatively impact the health of our ecosystems and social structures. There is also a need to address cultural attitudes towards healthy eating. South Africans’ dependence on meat is so deeply ingrained in the overall culture that the exclusion of red meat from a meal is almost insulting. Some people also believe healthy food is bland and unappetising compared to fast-food options. This relates to education and exposure to healthy food from a young age. Healthy food does not need to be bland and tasteless, with the proper preparation. But the lack of a healthy eating routine can contribute to poor food choices that soon become habits. Addressing the aforementioned barriers will require a multifaceted approach that includes education, policy changes, and a focus on affordability, accessibility, and sustainability in the food industry.

Conclusion The desire for organic, unmodified, unprocessed, and local food is growing while, unfortunately, the increasing power of transnational food companies and their marketing systems are doing the opposite. It is important to address the multifaceted barriers that inhibit a healthier food future, primarily caused by affordability and

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convenience. The survey results indicated that vegetables, fruits, meat, and unprocessed or homemade meals are considered healthy foods, with affordability being a crucial issue in South Africa. However, the role of culture and tradition, particularly the popularity of meat and braai culture, cannot be ignored. Sugar, fat, and junk food were mainly identified as unhealthy options, even though they are favoured for their accessibility, affordability, and convenience and are positively associated with a higher social status. Individual self-discipline is required to overcome these barriers on the consumer’s side so that the consumer demand for unhealthy foods will stop further fuelling the market provision thereof. On the supply side, to achieve a healthier food future, education, policy changes, and a focus on affordability, accessibility, and sustainability in the food industry are critical. This requires a collaborative effort between the food industries, consumers and the food industry to ensure that healthy options are accessible and affordable. The study highlighted the need for a more inclusive approach to understanding the dietary habits of the South African population. By embracing inclusivity and examining the complexities of cultural, socio-economic, and environmental factors, we can pave the way towards a more equitable and healthier future for all. In due course, a healthier food future is possible and will likely happen, but it will require a determined effort from all stakeholders to create a food system that prioritises health and sustainability.

References Bourne LT, Lambert EV, Steyn K (2002) Where does the black population of South Africa stand on the nutrition transition? Public Health Nutr 5(1a):157–162 Brooks A (2017) What class is the African middle class? In: Melber H (ed) The rise of Africa’s middle class: myths, realities and critical engagements. Zed Books, London, p 232 Brown CA (2014) Photovoice: A methodological guide. Photogr Cult 7(2):169–185 Catalani C, Minkler M (2010) Photovoice: a review of the literature in health and public health. Health Educ Behav 37(3):424–451 Chevalier S (2015) Food, malls and the politics of consumption: South Africa’s new middle class. Dev South Afr 32(1):118–129 Cloete PC, Idsardi EF (2013) Consumption of indigenous and traditional food crops: perceptions and realities from South Africa. Agroecol Sustain Food Syst 37(8):902–914 Department of Health, Republic of South Africa (2003) Food-based dietary guidelines for healthy South Africans older than 6 years. Available at: https://www.kznhealth.gov.za/fbdg. pdf. Accessed Feb 2022 Feeley A, Pettifor JM, Norris SA (2009) Fast-food consumption among 17-year-olds in the birth to twenty cohort. S Afr J Clin Nutr 22(3) Francis D, Webster E (2019) Poverty and inequality in South Africa: critical reflections. Dev South Afr 36(6):788–802 Kaltenbrun TA, Du Plessis LM, Drimie S (2020) A qualitative analysis of perceptions of various stakeholders on nutrition-sensitive agricultural interventions, including the taxation on sugarsweetened beverages (SSBs), to improve overall health and nutrition in South Africa. BMC Public Health 20:1–12 Lewis D, Bhoola S, Mafofoi L (2020) Corporate fast-food advertising targeting children in South Africa. S Afr Child Gauge 62

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Lindeque LF, Klopper D, Botha I, Burger RP, Piketh SJ (2021) Air pollution on the South African twitterverse: exploring user awareness over the past decade. In: Conference of the National Association for clean air, 6–8 Oct 2021, Held Online. ISBN: 978-0-620-95266-8 National Department of Health (NDoH), Statistics South Africa (Stats SA), South African Medical Research Council (SAMRC), and ICF (2019) South Africa demographic and health survey 2016. Pretoria, South Africa Naicker A, Palmer K, Makanjana O, Nzama PF (2021) The impact of the COVID-19 pandemic on food consumption habits, food purchasing behaviours, and food security status among South Africans. Afr J Inter/Multidiscip Stud 3(1):131–143 Philips L, Visser J, Nel D, Blaauw R (2017) The association between tuberculosis and the development of insulin resistance in adults with pulmonary tuberculosis in the Western sub-district of the Cape Metropole region, South Africa: a combined cross-sectional, cohort study. BMC Infect Dis 17(1):1–12 Phillips R, Dagadu H, Motley D, Shawahin L, Janusek LW, Klonowski S, Saban KL (2020) Qualitative evidence for resilience, stress, and ethnicity (RiSE): a program to address race-based stress among Black women at risk for cardiovascular disease. Complement Ther Med 48:102277 Popkin BM (2006) Technology, transport, globalisation and the nutrition transition food policy. Food Policy 31(6):554–569 Pretorius S, Sliwa K (2011) Perspectives and perceptions on the consumption of a healthy diet in Soweto, an urban African community in South Africa: a healthy diet in Soweto. SA Heart 8(3):178–183 South African History Online (2023) About Limpopo [online] Available at: https://www.sahistory. org.za/place/limpopo. Accessed May 2022 Southall R (2019) Polarisation in South Africa: toward democratic deepening or democratic decay? Ann Am Acad Pol Soc Sci 681(1):194–208 Spires M, Delobelle P, Sanders D, Puoane T, Hoelzel P, Swart R (2016) Diet-related noncommunicable diseases in South Africa: determinants and policy responses. S Afr Health Rev 2016(1):35–42 Stupar D, Eide WB, Bourne L, Hendricks M, Iversen PO, Wandel M (2012) The nutrition transition and the human right to adequate food for adolescents in the Cape Town metropolitan area: implications for nutrition policy. Food Policy 37(3):199–206 Sturm R, Hattori A (2013) Morbid obesity rates continue to rise rapidly in the United States. Int J Obes 37(6):889–891 Temple NJ, Steyn NP, Fourie J, De Villiers A (2011) Price and availability of healthy food: a study in rural South Africa. Nutrition 27(1):55–58 Wang CC (1999) Photovoice: a participatory action research strategy applied to women’s health. J Womens Health 8(2):185–192 Wang C, Burris MA (1997) Photovoice: concept, methodology, and use for participatory needs assessment. Health Educ Behav 24(3):369–438

Chapter 9

Exploring the Complexity of the Food Environment in India to Understand Healthy and Unhealthy Food Swapnil Tukaram Baste and Tanushree Sanjay Brahmankar

Abstract The chapter tries to study the perception of Indian people about food. The aim was to investigate what people consider as healthy and unhealthy food, how people visualise a healthier future, and what challenges must be overcome. The research methodology used to carry out the study was a multi-method qualitative approach that used photovoice and in-depth interviews to collect the data. Two Indian metro cities were chosen for this Jaipur (North) and Mumbai (West). The study identified four major factors influencing eating habits in India. The first factor is weather conditions which are an important determinant of the choices made by Indian people regarding what they consider healthy or unhealthy depending on the season, temperature, time of the day and place. The second factor is the misrepresentation of India as a vegetarian nation due to the association of religion with dietary habits, which is not true. The third factor is that Indian people prioritise taste before health despite their awareness of the health issues that spicy, sweet, and oily food consumption can cause. The fourth factor is that as Indians become wealthy, they can afford unhealthy food, which leads to obesity and health-related problems. Looking at the future and growing population, India will face challenges of food security and a rise in the number of food-related health issues; therefore Indian government should implement various policies and programmes that are targeted towards tackling these issues and building a healthier India. Keywords Food meaning · Taste · Healthy food · Food security · India

Introduction India is the seventh-largest country in the world, with an area of 3.288 million square kilometres. It has a long coastline of over 7500 km (about 4660.28 miles) (Food and Agriculture Organization 2018). The Indian economy is primarily agricultural, with S. T. Baste (B) · T. S. Brahmankar Van Hall Larenstein University of Applied Sciences, Arnhem, The Netherlands e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 H. Esam Awuh and S. Agyekum (eds.), Geographies of Food, Springer Geography, https://doi.org/10.1007/978-3-031-49873-2_9

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about 70% of the population dependent on agriculture and allied activities. India is the world’s largest producer of milk, pulses, and jute and ranks second-largest producer of rice, wheat, sugarcane, groundnut, vegetables, fruits, and cotton. It is also one of the leading producers of spices, fish, poultry, livestock, and plantation crops (Food and Agriculture Organization 2018). India has 29 states and eight union territories. Each state has its cuisines greatly influenced by climatic conditions and dietary habits. The cuisines also reflect the socio-economic status of the regions and the availability of several ingredients native to the specific regions (Taufique and Hoque 2019). India has several unique communities due to various socio-cultural and environmental factors. Concerning religious diversity, an overwhelming proportion of Indians are Hindus, with some 83% of the population. Muslims are India’s largest religious minority, accounting for 11% of the population. Among other religious groups, the Sikhs, concentrated in the northern state of Punjab, number less than 2% of India’s population. Christians, Buddhists, Jains, Parsees, and Jews enrich India’s religious diversity (Singh 2019). Besides religion, the caste system also adds another level of diversity in India. The caste system divides society in India into mutually exclusive, hereditary groups ranked by ritual status. Traditionally, Indians believe that a person’s social capacities are known from the caste into which they are born, and a person’s caste prescribes the occupations they could enter. The most distinctive features of caste ideology are the distinction between lowest-ranked castes, formerly untouchables, and the strict exclusiveness of the so-called clean higher-ranked upper castes (Hoff 2016). There is virtually no mobility of individuals across caste groups. Concerning ethnicity, India’s population is a conglomeration of people belonging to different racial groups with different ethnic backgrounds whose ancestors entered India from different parts of the world at different periods (Jadhav et al. 2022). Therefore, India has been a meeting point for different ethnic groups over thousands of years, thus, creating a varied population and diversified ethnic composition. The culinary diversity derives from the demographic diversity contributing to Indian food being famous for its spicy flavours. The diets keep changing from South to North or East to West of the country. According to a study by Alae-Carew and colleagues (2019), the main difference between dietary habits is that some are based on rice consumption and others on wheat. Diets based on wheat are more prevalent in the Northern states, whereas the people in the Southern states prefer rice in their meals (Alae-Carew et al. 2019). People prefer to consume fruits and vegetables grown in a particular season as they consider them healthier and fresher. For example, the consumption of mangoes in summer and root vegetables during the winter season. Despite the uniqueness of Indian food culture, global changes in dietary and lifestyle patterns are harming nutrition. This is particularly more critical in low- and middle-income countries (Popkin 2015) like India. Indian food culture is quickly changing and becoming more Westernised. Pre-processed products and packaged foods are more popular nowadays than traditional foods. Many Indian snacks are known to be high in trans fatty acids (less than or equal to 2% of total fatty acids), according to Agarwal et al. (2008). Such dietary concerns adversely affect blood

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lipoprotein profiles and increase coronary heart disease risks (Gupta et al. 2016). According to the National Sample Survey Organization report, the urban population is spending more on junk foods than healthier food alternatives like fruits and vegetables. Globalisation has led to a rapid increase in the number of fast-food restaurants across India like McDonald’s, KFC, and PIZZA HUT, which are increasingly preferred as the fast-food nature of these business models saves much time spent in cooking. The fast food is also known to be cheap and tasty. Also, the increase in disposable incomes in India is changing lifestyles and food preferences (Bharat Express English 2023)—the rise in the number of obese people in India. For instance, over 10% of Indians are currently overweight or obese, with most of such people being residents in urban areas. It is also projected that by 2025, India will be home to an estimated 65 million obese people, including seventeen million obese children. These challenges are further aggravated by the fact that India is still a middle-income nation and cannot meet the requirements of its low-income population. Like many other low- and middle-income countries, India faces the dual challenge of undernutrition and obesity. The incidence of poverty is now pegged at nearly 30%. In India, almost 1/3 of people can’t afford a healthy diet, according to a UN Food and Agriculture Organization report. According to the Global Hunger Index (2022), India ranks 94 out of 107 countries. Gupta and colleagues (2016) note that in India, households in both urban and rural areas frequently experience undernutrition and diet-related noncommunicable diseases, particularly heart disease and diabetes. Furthermore, the diets of urban slum dwellers in India are often deficient in key healthy nutrients. Slum dwellers consume high amounts of trans fatty acids from hydrogenated oils (Misra et al. 2001). In response to such negative effects which poor nutrition has on public health, formal institutions such as the government of India and schools are often regarded as fundamental units of the food environment that shape eating behaviours (Larson and Story 2009) through defined interpretations of food health based on the element of nutrition. For example, the Indian government passed an act in 2013—National Food Security Act (NFSA 2013)—to ensure the availability and affordability of enough food for its population. Also, India’s public distribution system is the world’s largest, covering more than 800 million people (Gulati et al. 2023). In addition, the public distribution system provides food to people experiencing poverty under various welfare programmes. Furthermore, to improve nutrition among school-going children, the government started a Mid-day meal programme, a school lunch programme with the double objectives of increasing school attendance and providing nutritional food for the children. Lastly, the Government of India has taken steps to limit the amount of trans fatty acids (TFA) in foods by publishing regulation guidelines which set an upper limit of 5% TFA in partially hydrogenated vegetable oils and obliging producers and distributors to clearly label amounts of TFA on packaged foods (Food Safety and Standards Authority of India 2014). However, despite the nutrition-related concerns and government responses to these concerns with nutrition guidelines, as seen in the previous paragraph, it has been observed that nutrition knowledge transmitted through formal institutions such as schools and government agencies alone might not be sufficient to influence peoples’

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eating practices in India (Rathi et al. 2017). This is because formal institutions paternalistically control discourse around what constitutes healthy or unhealthy food and could lack the support of citizens who might have alternative understandings and visions based on the everyday realities of the local contexts in which they live. As Travert and colleagues (2019) argue, there is a critical need to unpack the complex network of interactions that link various dimensions and the frequent, multifaceted, situational, dynamic, and complex ways in which people acquire, prepare, and consume foods as part of daily life). One of these complexities is understanding healthy and unhealthy food in different contexts. If the meanings of health from a consumer perspective are misunderstood, it is inconceivable that we can design transformation pathways in food systems that everyone can relate to. Therefore, this chapter’s objective is to see what kinds of knowledge ‘common’ citizens in India hold concerning what is healthy or unhealthy food and visions which could be derived from such understandings. Findings from this chapter seek to improve knowledge and understanding about how people perceive and experience drivers of food acquisition and consumption as part of daily life. This is to inform policies designed to enhance the healthiness of food environments and diets.

Material and Methods Research Design and Study Areas This study utilised a multi-method qualitative approach that included photovoice and in-depth interviews. Such an approach is grounded in socio-ecological theory and its recognition of multi-scalar perspectives as determinants of health-related behaviours. Data were collected from participants in Mumbai and Jaipur. These two cities were purposively selected because of the geographical and demographic characteristics differences between them and the research assistant’s personal contacts in these cities. Although capturing the full scope of the diversity in understandings of healthy or unhealthy food is practically impossible in a country like India with over a billion inhabitants, these two cases of Jaipur in the north of the country and Mumbai to the south are intended to indicate the regional differences between places in India.

Sampling Participant recruitment was conducted by snowballing in sequential order from the contacts of the research assistant. One person (often a spouse) for each household was contacted and asked if they would be willing to participate, with other eligible household members invited to participate in cases where the index person or their spouse were not willing or able to participate. Care was taken to ensure that there

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was only one representative per household. Additional people were recruited based on recommendations from the index persons in each case. In addition, index person was allowed to recommend only one other contact or potentially interested persons to prevent an in-group of only like-minded people from participating in the exercise. This was done to enhance the diversity and representativeness of the sample. In Jaipur, 10 participants participated in the research, and in Mumbai, there were 12 participants. In the total sample, there were nine men and thirteen women. The slight over-representation of women was because the research assistants were women. Therefore, reaching out to other women in the sampling process was easier than men.

Data Collection Since the data were collected during the Covid-19 period (October 2021 to March 2022), follow-up in-depth interviews with participants were mostly conducted over WhatsApp as face-to-face meetings were restricted. In-depth interviews were conducted with participants (n = 22) based on the photos they provided in the photovoice exercise. These interviews provided answers to the following questions, which are key questions in this book: 1. 2. 3. 4. 5.

What do you understand by healthy food? What do you understand by unhealthy food? How do you see a healthier food future for India? What can inhibit the realisation of this desired healthier food future? What can facilitate the realisation of this desired healthier food future?

Participants were asked to take two photographs of images linked to their responses to the above questions. Then, they were asked to address each photo separately. Initially, participants were asked to explain what could be seen in the photo. The follow-up question required them to describe how the photo relates to the question it sought to answer. Since interviews were predominantly on WhatsApp, interview audio was recorded using a separate recording device. In-depth interviews lasted between 30 and 40 min and were predominantly in English.

Data Analysis Thematic analysis was used to identify key themes in accordance with qualitative analysis guidelines for health research. Thematic analysis can be a useful analytical tool for examining the perspectives of a diverse group of research participants (Turner et al. 2022), as was the case in this study. This analytical approach highlights similarities and differences, generating unanticipated insights that other analytical approaches could miss. Thematic analysis is also useful for summarising key

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features of a large data set, such as extensive audio recordings, because it enables the researcher to take a well-structured approach to handle data. Thus, helping to produce a clear and organised final report. Interview transcripts were analysed, and recurrent themes were derived from deductive and inductive techniques in an iterative process. Deductive techniques were used in the initial stages of analysis to code the data in line with the prior external and personal factors. Inductive techniques were utilised as the analytical process developed, drawing from elements of grounded theory such as constant comparison to generate emergent themes and investigate deviant cases. The convergence of key themes and lack of new themes were interpreted as achieved thematic saturation—when the probability of identifying new themes is diminished. This process led to identifying the following findings based on the recurrence of themes in the data sets: (1) Weather conditions are important determinants of healthy/unhealthy food in India; (2) There is a misrepresentation of India as a vegetarian nation; (3) The deliciousness of Indian food is a blessing and a curse for food system transition; and (4) As Indians get richer, they eat more unhealthy food. These findings will be presented in more depth in the following section.

Findings Weather Conditions Are Important Determinants of Healthy/ Unhealthy Food in India Weather conditions have been known to determine what people consider as healthy or unhealthy food. Contemporarily, the weather has often influenced food production and access to food. For instance, global warming can disrupt food availability, reduce access to food, and affect food quality. Projected increases in temperatures, changes in precipitation patterns, sudden or extreme weather patterns, droughts, and floods may all result in reduced agricultural productivity. Weather variations are expected to directly impact agricultural productivity and income as higher temperatures and changing rainfall patterns are likely to modify the hydrological cycle. These will ultimately affect crop yields. Specifically, an increase or decrease in maximum and minimum temperatures and/or an increase or decrease in precipitation intensity can lead to floods or droughts. These changes, especially when sudden and prolonged, can severely affect the agricultural sector. It has been widely suggested that climatic extremes will produce negative impacts on agriculture that will be most felt in lowand middle-income countries than high-income countries. In mitigating weather variability’s effects on crop output and consumption, households may adopt ex-ante and ex-post coping strategies. For instance, on the production side, in a bid to respond proactively to weather shocks, rural households might choose crops that are less sensitive to weather variations. Weather patterns are likely to influence not only food production but also food consumption depending on the nature of the food to be consumed and the degree

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of temperature in the specific areas. Consumption smoothing or ex-post coping comprises borrowing and saving, selling or buying non-financial assets, modifying labour supply, and making use of formal/informal insurance mechanisms. Nevertheless, there are also other ways in which people across the world have learned to cope with the weather in their consumption habits. One of these can be merely adjusting the food they eat to the temperature at a specific time and place. Such coping strategies shape their understanding of what is healthy or unhealthy. According to Zellner and Durlach, these coping strategies and understandings could be based on direct experience with the taste, socially spread information about the taste, or general ideas about the foods’ temperature appropriateness. In relation to these coping strategies suggested by Zellner and Durlach, findings of the research presented in this chapter show how across a vast sub-continent as India, people consume light food and cold food when temperatures are high. On the other hand, it also shows how people in certain parts of India consider warm or spicy foods healthy in low temperatures. In Jaipur (Rajasthan, India), at the time of writing this chapter (April 2023), it was about 30 degrees Celsius at sunrise. While this might be considered very hot in some countries, it is a relatively cooler temperature for consuming warmer food in India. This rapidly increases to about 47 °C by lunchtime—making light food more desirable and healthier at that time. This high temperature stays uniform into the evening, which explains why the ideal healthy evening meal, according to participant Ramesh, is still warm. In India it is often said that you should have your breakfast like a king, your lunch like a prince and your dinner like a beggar. This is linked to the weather here. You need a heavy breakfast like the meal you see on the photo because it is the start of your day and at that time the sun is not up yet—meaning a warm or heavy dish is ideal and you need all the energy. Then you eat lunch which is a bit less heavy because by lunch time it is usually hotter than the morning and you need something light when it’s warm. Your dinner should be light and easy to digest. Typical lunch in this part of India will be what you see on the attached photo. A small bowl of rice pudding and Indian bread made of wheat flour. Relatively light food in the context of India (Ramesh, Jaipur, India)

At the seasonal level, people are believed to eat cooler foods in summer and warmer foods in winter. This reasoning angle is confirmed in this chapter’s findings as illustrated by the following quotes and photos, which refer to how people in Jaipur prefer to shape their understandings of what they consider healthy or unhealthy based on the temperatures of the specific seasons.

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I grew up in Rajasthan state in India. In Rajasthan the food is usually spicy, very oily and made with refined butter called ghee which you can see on the photo. In the winter we eat a lot of food with red chili pepper and black pepper because these spices help in keeping us warm. So, if you eat these foods with much pepper in the summer, then it doesn’t serve the purpose of warming the body up anymore. Therefore, in the winter, very very spicy food can be considered unhealthy (Umesh, 40-year-old man from Jaipur, India)

This food you see on the photo is not necessarily healthy in a nutrition sense as it is deep fried. However, I consider it healthy because of the feeling it gives when you eat it. This is often eaten during winter time in Northern India as brunch or breakfast food. So, it is a little bit heavy food to keep you warm and going during the cold winters. To me, that is healthy food in the winter (Gita, 39-year-old woman from Jaipur, India)

This is a bowl of rice pudding. We eat it in two ways. We can keep it in the fridge to cool and eat it in the hot summers in order to keep the body cool. In the cold winters, the rice pudding stores heat. So, it can be eaten warm and that helps in keeping the body warm too. It is healthy because it has rice, contains milk and keeps the body warm or cool depending on which form it is eaten according to season. Dry fruits are not essential, but sugar and cardamom are. We also put saffron in it to make it pretty. The only problem from a health perspective is that it contains sugar. Nevertheless, you can reduce the amount of sugar in it to make it healthier (Renu, woman from Jaipur, India)

There is a Misrepresentation of India as a Vegetarian Nation Because of Hinduism Religion is a set of organised beliefs, practices, and systems that most often relate to the belief and worship of a controlling force, such as a personal god or another supernatural being (Khalsa et al. 2020). While this is a basic definition, there are

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many different understandings of what religion is and not all religions are centred on a belief in a god, gods, or supernatural forces. Religion is also commonly regarded as how people deal with ultimate concerns about their lives and fate after death. One such concern about peoples’ lives is food. Religion has shaped what people in different civilisations eat for centuries. It has also shaped what people consider good or healthy food and what they consider bad or unhealthy food. It creates a special bond between people and certain foods. In many religions, food is one of the crucial components of non-secular ceremonies. Therefore, the position of food in non-secular tradition is a crucial part of displaying affinity with religion. Followers of religion often obey the commandments about food. In this case, what followers of a religion consume, how they collect the food, and how they prepare and eat it all have a religious basis. One such religion which provides a guideline on nutrition is Hinduism. Hinduism is a religion with a significant influence on food choices. Although the term ‘vegetarian’ was coined relatively recently in 1847 by the founders of the Vegetarian Society of Great Britain, vegetarianism as a practice has been around for ages. Some of the world’s oldest civilisations have long advocated a vegetarian diet for religious purposes. This is more the case in India, where millions of Hindus are vegetarians because of their religious beliefs. Hinduism is a polytheistic religion that promotes the virtue of not eating meat. Although this has never been an absolute requirement for all followers of Hinduism, Hindu scriptures have long supported the spiritual benefits of a vegetarian diet. Therefore, although not all Hindus are vegetarian, vegetarianism is integral to the Hindu religion based on the ethical ideals of non-violence towards animals (Ahimsa). Among the passages in Hindu scriptures which promote the virtues of vegetarianism are the following: The sins generated by violence curtail the life of the perpetrator. Therefore, even those anxious about their welfare should abstain from eating meat. (Mahabharata, Anushasana Parva 115.33) How can he practice true compassion? Who eats the flesh of an animal to fatten his flesh? (Tirukural 251) Those noble souls who practice meditation and other yogic ways, who are ever careful about all beings, who protect all animals, are the ones who are serious about spiritual practices. (Atharva Veda 19.48.5)

This explains why to Hindu respondents such as Ratan and Renu (see the following quotes), healthy food is vegetarian because it symbolises spiritual health and purity.

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This is a photo of a dish we call sabudana khichadi. I think it is healthy because of how it helps us Hindus spiritually. We often eat this when we are fasting. We eat it with curd. On the days we are fasting, we are not allowed to eat any grain. So, during lunchtime on the days we fast, we eat this because it does not contain any meat. It is made of the roots of a plant and follows a very complex preparation procedure. This makes it a healthy and popular food option during days of fasting (Kamala, woman from Jaipur, India)

Religion can facilitate a healthier eating lifestyle. In India we have different religions. Different religions have different food habits. I am a Hindu and in Hinduism there are sub-categories. We are Brahmins and our ancestors used to be priests in the temple and our responsibility was spiritual—worshipping God. Because of that, we do not traditionally eat meat, chicken or any eggs. We are pure vegetarians. My wife and mother cannot even look at meat—the sight of meat just makes them sick. However, not all Hindus are vegetarian. There is a sub-category called Rajput who are traditionally allowed to eat chicken or goat only—no beef because the cow is sacred in our religion (Ratan, man from Jaipur, India)

Therefore, in India, a significant part of the population can be considered vegetarian because Hinduism, the most followed religion (the main religion for about 80% of the population), promotes vegetarianism. However, it is incorrect to assume that all Hindus follow dietary guidelines based on religious norms and beliefs. For example, in the case of India, the Hindu religion promotes Ahimsa (non-violence against animals). Also, there are certain religious days during which most Hindus (including meat-eaters) avoid eating meat on these days because the practice is considered sinful and disrespectful to God on such days. However, many Hindus eat meat and consider it an important part of their diet to meet their nutritional needs. The last two sentences of the quote from Ratan clearly show this distinction between meat-eaters and vegetarians among Hindus. Ratan’s

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quote shows that in presenting Hinduism as a religion which promotes vegetarianism, there is the need to avoid misconceptions which have often accompanied generalisations about the characteristics of food and religion in India. Some Hindus still choose to eat meat because they consider it necessary to meet the nutritional requirements, and such a practice is often promoted through educational and awareness programmes carried out by government agencies. Additionally, doctors advise patients to eat meat and eggs to overcome protein deficiencies. Furthermore, India has an immense variety of food habits across scale, space, group, class, and gender. Additionally, it is argued that considerable intra-group variation in almost every social group (caste, religious) makes essentialised group identities based on food practices deeply problematic or difficult. Natrajan and Jacobs (2018) found that the extent of overall vegetarianism is much less—and the extent of overall beef-eating much more—than suggested by common claims and stereotypes. In some cases, it has also been reported that some younger people use meat eating as a protest against the caste system. Sonali from Mumbai said: I know several Hindus from the upper class who eat meat as a show of solidarity with lower-class Hindus. Meat eating is considered impure and only reserved for lower class ‘untouchables.’ So, it is good to see younger generations of supposedly ’pure’ upper-class Hindus using meat eating to bring down the caste system. (Sonali, a 25-year-old woman from Mumbai)

Taste Before Health: The Deliciousness of Indian Food is a Blessing and a Curse The reputed deliciousness of Indian cuisine poses a challenge for healthier food futures. At the base of this richness in Indian food flavour is a wide array of spices. Historically, India has upheld a reputation as the spice capital of the world. In 1497– 98, a Portuguese fleet commanded by Vasco da Gama made one of the greatest global breakthroughs by successfully sailing from Western Europe to India via the Cape of Good Hope in present-day South Africa (Disney 2010). This voyage was largely driven by the desire of Europeans to get to the lucrative spice trade in the Indian sub-continent (Holland 2017). Indian food still has a reputation for being rich in flavours. However, not all that is tasty is good. For instance, evidence from some studies has suggested that a higher level of spicy food intake may be associated with an increased cancer incidence. Evidence of such health risks from extremely spicy food is explained in the following quotes and photos from some participants: The food is always served very spicy at Indian weddings and celebrations. So, that’s a problem. When my father-in-law was admitted to the hospital, the doctor asked him, “What is the first thing you eat when you go to marriage?”.1 So, that shows how many functions 1

Implying that the ailment was caused or aggravated by excessive consumption of spicy food at weddings and other festivals.

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like marriages are often characterised by so many irresistible unhealthy foods. (Amit, a man from Jaipur) There is too much spice in our food I would say. Some people prefer taste over health. Some people who are more health-aware cook with less spices, less ghee and less oil. However, people who prefer taste will put a lot of spices, ghee and oil in their food. With ghee, it is healthy to use only one spoon per meal. But if you eat more than one spoon then it becomes unhealthy. Too much spices can increase acidity in the body or lead to indigestion, gastric and so on. If you eat this a lot, you will have problems. This has happened in my family. There are some of my relatives who used to eat a lot of spicy food. My father-in-law underwent open heart surgery last year and the doctor specifically asked him, ‘what do you like to eat?’ He said, ‘I like spicy food’. Then the doctor said, ‘you need to stop eating spicy food. You have to change your food habits’. Now, he can only look at spicy food and he won’t allow anyone to eat spicy food around him because he is not allowed to (Himanshu, man from Jaipur, India)

Another element behind the deliciousness of Indian cuisine is the amount of sugar used in some dishes. Sugar and India have a long history of association. According to Gulati and Misra (2014), the word sugar is derived from Sarkara, meaning gravel in Sanskrit.2 Sugar became known to the Western world when the army of Alexander the Great went to India in 327 BC (Gulati and Misra 2014). According to these accounts, Alexander the Great’s army was surprised to see another alternative to honey which could be used to sweeten food. They described it as a ‘reed that gives honey without bees’—about the sugarcane plant (Gulati and Misra 2014, p. 5956). Thus, it is no surprise that India is one of the biggest sugar consumers in the world (Shahbandeh 2022). In 2021, it was projected by OECD/FAO that India would experience the largest increase in the level of sugar consumption based on population growth and the expansion of the food and beverage industry. Traditionally, any occasion in India is celebrated with the intake of sweets. Gulati and Misra (2014) note that: It is customary to “sweeten the mouth” after every meal, joyous occasion, religious festival, social gathering, etc. It is considered mandatory to offer sweets to the gods on every religious occasion (e.g., it is believed Lord Ganesha, who is worshipped first on all religious occasions, is fond of ladoos (made by frying a batter of gram flour and ghee in small pearl-size drops and then mixing with sugar syrup, this mixture is given a round shape). (Gulati and Misra 2014: 5956)

Increased palatability and sometimes attractive presentation make this sugary food irresistible to the average Indian consumer. However, this comes at a high cost in poor 2

An important language of India from which many smaller northern Indian (Indic) languages are derived.

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health. There is a strong relationship between calorie intake and obesity. In India, the prevalence of obesity and type 2 diabetes mellitus (T2DM) is increasing rapidly due to increased energy intake due to increased consumption of sugary food. The severity of these concerns about excessive sugar consumption and their challenges to healthier food transformations are evident in the following quotes from some of the participants: The sugar content in Indian sweets is very high making them unhealthy. Here people often prefer taste over health and so for most people it is the sweeter the sweets are, the better. We usually drink tea with very sweet biscuits. Concerning meals, a dish which I consider too sweet for example is jalebi. They make a batter like pancake and then they roll it up and deep fry it in the ghee. And after deep frying it, they immerse it completely in sugar syrup—directly [Smiles]. You are basically eating sugar syrup [Smiles]. (Renu, woman from Jaipur)

The festival food you see on the photo is very unhealthy. It is almost all deep fried and/or sugary. Although you will only eat these in large quantities during festivals (not every day), I still think it is very unhealthy (Preity, 37-year-old woman from Mumbai)

The reputed deliciousness of Indian food poses significant obstacles to the transition to healthier options. In the views of some participants, some Indian food that can be considered nutritionally unhealthy is too good to cease consumption. This is especially true with older people who have built long-lasting associations with certain flavours over time. This corroborates research which has revealed that younger people are more open-minded and curious than older people about food. As a result, they are more likely to try new flavours and would be less likely to shun healthier options. On the other hand, despite being more vulnerable to health risks, older people are more likely than younger people to resist measures requiring more drastic transformation in the way they eat. For example, as the quote from Deena illustrates (see below), the transition challenge posed by difficulties in changing food habits is much stronger among older Indians than younger Indians. She said:

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There is a generation problem here in India. Younger people tend to care more about eating healthier food than older people. Older people feel like they don’t have much time left to be in this world. So, they prefer to spend their remaining years enjoying the blessings of good food rather than worrying about how healthy the food is. Personallly, I would rather die eating unhealthy food than live eating healthy but disgusting food. My view does not apply to everyone of my age but there are quite a good number of people like myself who think the same. We prefer tasty, sugary and spicy unhealthy food over plain bland healthier bowl of lentil soup as shown on the photo (Deena, 65 year-old woman from Mumbai, India)

The view of a longstanding association with certain tasty flavours, which have become harder to change habits, as expressed by Deena, is also supported by Vijay in the quote below describing the delicious but creamy nutritionally unhealthy food in the photo below. He says: Changing habits is difficult. When I think about the food here, I won’t want a healthier version. I am used to the taste the way it is. Therefore, introducing any healthier version will require me to change what I am used to and I cannot do that. It is difficult to change how you are and how you grew up. I grew up with spicy, oily curries as you see on the photo and I won’t want anything else. The issue is that there is a recipe used in cooking every dish and when you change anything about these recipes, people will complain and resist. You will hear things like, ‘this is not how we cook’, ‘you are not adding enough oil or enough spices’, ‘it’s disgusting’, ‘Don’t do that’, ‘Are you sick?’ (Vijay, 57-year-old man from Mumbai, India)

As Indians Get Richer, They Eat More Unhealthy Food The cost of food and the financial resources to procure it are key economic determinants of food choice. Food security is the physical, social, and economic access to a stable and safe food supply, in sufficient quantity and quality to meet dietary

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needs and food preferences, within an environment that supports a healthy and active lifestyle. Affordability, availability, and accessibility are probably one of the most well-known aspects of food security. As with the first two, food affordability is not a static characteristic of food or food sources. It is best understood in relation to the characteristics of people, households, and communities. In general, food prices are rising steadily worldwide, especially sharply in recent decades. In developing countries, these increasing food prices and price volatility are linked to heightened food insecurity. There is consensus that healthy foods are becoming increasingly expensive, and low-income families face financial struggles to buy healthy foods. Low-income families often face poverty when considering the cost of food. Housing, utilities, healthcare, and transportation have some fixed costs. However, food prices often fluctuate for a variety of reasons. Foods are cost-flexible and often characterised by options such as healthy or cheap foods, which allow lowincome families to choose and reduce costs. According to a PEW study, low-income families spend far more on basic needs such as housing, transportation, and food than high-income families. As of 2014, lower-third households spent 40% of their income on housing, and one-third of these tenants spent almost half of their income on housing. Low-income households spent significantly less on luxurious choices such as eating out and entertainment than middle- and high-income households. Core spending absorbed a large portion of their income. However, accounts from participants in this study show that the link between money and healthy food is not viewed the same as some people in India. Here, as Indians get richer, they tend to consume unhealthier food because they can afford more. In this case, unhealthy, often expensive foods become more affordable to wealthier Indians. As incomes continue to rise in India, diets are projected to diversify nutritionally and include excess dietary energy, particularly from oils, meat, dairy, and sugar (Kearney 2010; Muhammad et al. 2017). Broadly, it has been reported that such changes in food affordability may increase the number of obese individuals from 1.33 billion in 2005 to 3.28 billion by 2030. Asia is leading both the economic growth and growth in obesity (Alexsandrowicz et al. 2019). Therefore, economic growth does not necessarily improve nutrition. This is a point of view which is corroborated by a participant in this research with the photo and quote below:

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There is the issue of incomes here. The more money people have, the unhealthier they eat. The well-to-do can afford a lot of tasty but unhealthy foods. Those who are less well-to-do, do not have that luxury and tend to eat more basic food which tends to be healthier. So, if you go to a village in India and see what a farmer is eating, you will realise that rural people often eat more nutritionally healthy food. They eat curries with less spices, eat less vegetables and they burn a lot of calories with the manual labour they engage in. Richer people who often live in urban areas eat more luxurious food items which often contain high calories. This is aggravated by the fact that the richer people often do not exercise enough. They often have white collar jobs which are less physically demanding. Rich people’s foods are often tastier because they contain costly but unhealthier ingredients such as butter. Poorer people cannot afford such luxuries eat more natural or basic food (Jenani, 35-year-old woman from Mumbai, India)

The quote from Jenani highlights the effect of a common phenomenon—globalisation. Globalisation allows countries to benefit from capital flows, technology transfer, cheaper imports, and larger export markets in the long term. Globalisation has three dimensions. Firstly, it enhances the multiplication and intensification of worldwide economic, political, social, and cultural linkages. Secondly, globalisation promotes the universal application of standard economic, institutional, legal, political, and cultural practices. Thirdly, and most importantly, concerning this finding, globalisation leads to significant spillovers from the behaviour of individuals and societies from high-income countries to the rest of the world. As a result of the interactions of the various dimensions, the way of life in one country (especially when perceived by others as superior) is bound to affect other countries. For example, with globalisation comes access to heavily subsidised, mass-produced food items to low-income countries from high-income countries. Globalisation also brings cheap, unhealthy eating habits from high-income countries, which become expensive and sometimes prestigious habits in lower- and middle-income countries such as India, this case, which only the rich can afford.

Discussion In the findings, the temperature element explains different understandings of healthy or unhealthy food. For example, in cold weather or low temperatures, there is a tendency for people to view hot food and drinks as healthy. Here, the common belief

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is that the heat from foods and drinks served warm or hot enhances the flavour—the reason why some people prefer hot spicy food flavour. But, more importantly, people consume warm or hot food because they believe it warms the body’s core when it’s cold weather outside. In this case, if someone prefers hot food or drinks to cold ones, they generally feel cold and want to be warmed up. Furthermore, research has long established that food intake creates heat, and a complete meal increases body temperature by about one degree Celsius. Therefore, consuming high-calorie food and drinks could raise an individual’s skin temperature on average by about two degree Celsius approximately 60 min after the meal. This implies that food preferences and, by default, understandings of what is healthy or unhealthy seem to be related to environmental temperature and the individual’s metabolism by increasing or decreasing body temperature. When it comes to understandings of healthy and unhealthy food, time and place matter. People strive to maintain bodily balance over time and place. Different times of day and different seasons require different foods. The place, the time of the day, or the time of the year (season) organises bodily practices, household chores, and eating schedules. These factors eventually determine what people consider healthy or unhealthy at a particular time or place. Although Indian food has a reputation for being rich in flavours and is considered incomplete without spices and sugar, there is a risk with such eating habits. The participants seem aware that consuming food rich in spices and sugar can cause many health-related diseases and, in some cases, be life-threatening. Nevertheless, although this ‘educated’ sample of the people selected are aware of these health consequences, they still prefer to eat these kinds of food because they have developed a palate for tasty food from early childhood, which they are reluctant to modify. This reluctance to change habits, even among those aware of the need to change them, is a major challenge for institutional interventions seeking to enhance food system transformation from a consumption perspective in India. However, there is hope that this cycle of addiction to tasty but unhealthy food could be reversed by the younger generation, who are growing up with more food health consciousness. The main limitations of this study are methodological. Firstly, although photovoice and in-depth interviews are good tools needed to conduct a qualitative study, in a highly populated and diverse country like India, the sample can be skewed and give an incomplete overview of the situation. For instance, India comprises 29 states, each with unique eating habits. Despite this, in the current research, the sample was limited in that it only had participants from two Indian cities, Mumbai and Jaipur, from the states of Maharashtra and Rajasthan, respectively. Nonetheless, the sample size is less important since this was not a quantitative study. A more quantitative study will be needed to provide wider coverage of how different regions and demographic groups in India perceive food healthy and unhealthy. The second methodological limitation of this study was selection bias. Although care was taken to ensure that the sample of participants could be as diverse as possible, the snowballing sampling method still led to a group of participants who were largely described as middle class (with a university education). As a result, the research assistant (a master’s degree holder herself) tended to have other university-educated participants within

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her network during her initial contact with participants. The impact of this bias is seen in the last finding, in which the participants describe having more money as a problem with healthier eating. This group of participants is probably in a good financial position, which allows them to have the privilege position to look beyond barely having something to eat (no matter how unhealthy) to eating healthier food. The results would probably have been different if the sample was composed of poor slum dwellers, with the need to survive being a priority over food health. Another research will be needed to assess food choices made by people in lower-income categories and what this means for the vision of food health in India.

Conclusion The purpose of this chapter was to investigate the opinion of Indians regarding food, what they consider healthy or unhealthy, and what they consider a healthier future for the country would be like. The chapter also examines the possible challenges in achieving this healthier food future and what can facilitate the progress towards food health in India. As a result of this investigation, there were four key observations from the responses in the data collected. These include the following: Weather conditions are important determinants of healthy/unhealthy food in India; there is a misrepresentation of India as a vegetarian nation; the deliciousness of Indian food is seen as an obstacle to healthier food system transformation; and, as Indians get richer, they eat unhealthier food. As India looks towards 2030 and beyond, its food system faces many challenges ranging from increasing pressure on natural resources due to rapid population growth, climate change, fragmenting of land holdings, increasing urbanisation, and high malnutrition rates. Increasingly, the challenge to sustainably feed India’s growing population will only get harder. Despite India’s economic progress over the past two decades, regional inequality and malnutrition problems persist. Simultaneously, trends in overweight and obesity, along with micronutrient deficiency, are an emerging public health challenge. Therefore, there is greater urgency for people in India to change their eating practices to adapt to their changing world. This begins with understanding what different groups in India perceive of food health or unhealth and how they see the food future of India. This chapter makes a small but important contribution in that domain, but more needs to be done.

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Chapter 10

Contradictions and Consistencies in Understandings of Food in High and Low-Middle-Income Countries Harrison Esam Awuh and Samuel Agyekum

Abstract The existence of different food cultures across the world and their link to health or well-being raise the questions of how health or unhealth in food is perceived in these different food cultures?; What characterises them?; and What similarities and differences exist between them? Although speculatively, studies around these questions suggest that there might be heterogeneity not only in terms of different regions within a country or continent but also with regard to different global regions; there is currently insufficient comprehensive international comparison of different food cultures in a single study. To fill this gap in the literature, this chapter used Photovoice to engage 90 participants across 18 countries selected from the World Banks’ 2023 financial year categorisation of High-Income Countries (HICs) and Low- and MiddleIncome Countries (LMICs). While the two worlds—HICs and LMICs—are similar in terms of vegetable consumption and snacking, there are significant differences on how these manifest in these blocks. Results revealed five key areas of difference between LMICs and HICs concerning similar categories—rising cost of food, vegetable consumption, fruit consumption, perceptions of fast food and meat eating. This knowledge could promote a better understanding of food cultures that go beyond nutrition which has been the dominant frame for defining healthy and unhealthy food. Varied knowledge bases must be considered when promoting healthy eating habits and addressing food insecurity in different parts of the world. Keywords Food meaning · Contradictions · High-income · Low- and middle-income · Fast food · Meat

H. E. Awuh Aeres University of Applied Sciences/Flevo Campus, Almere, The Netherlands H. E. Awuh (B) Department of Human Geography and Spatial Planning, Utrecht University, Utrecht, Netherlands e-mail: [email protected] S. Agyekum Institute of Geography, University of Bern, Bern, Switzerland © The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 H. Esam Awuh and S. Agyekum (eds.), Geographies of Food, Springer Geography, https://doi.org/10.1007/978-3-031-49873-2_10

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Introduction Food culture is best defined as a culinary order whose traits are prevalent among a certain population (Askegaard and Madsen 1998, p. 550). The most basic distinction in the culinary order is the categorisation of what is edible and what is not from a social point of view. Other distinctions within food cultures include: taste, the relationship between certain food items and certain consumption situations, the timing of meals and eating situations, the associations pertaining to food products and the values attached to food (Fischler 1990; Heisley 1990; Lyman 2012). The interpretations of and relations between food cultures vary by geography and scale, as well as by the conceptual and theoretical differences within the discourses themselves (Jarosz 2014). Furthermore, food culture discourses are tied to distinctive political and economic histories, ecologies, and identities at the local, regional, national, international and continental levels. This means food cultures may be distinguished from the micro-level (family) to the macro-level (countries, regions, social classes, etc.). Thus, food cultures vary worldwide, and these cultures are shaped by factors such as resources in specific contexts, ethnicity and technology (Wahlqvist 2007). Also, food cultures can play a role in promoting well-being and health (Loring and Gerlach 2009) in various ways. In the context of Europe, it is unsurprising that Askegaard and Madsen (1998) and Minkov and Hofstede (2014) found that nation and language boundaries strongly impacted European food cultures. They discovered that common food cultures exist between people sharing the same cultural values. This means that heterogeneity in food cultures exists within regions in a country and within countries in a continent or sub-region. Looking beyond Europe, the USA is marked by a plurality of ethnic groups, displaying many different eating traditions (Kittler et al. 2016). There have only been mere speculations and anecdotes that similarities and differences between food cultures exist between countries. For instance, concerning similarities, Sproesser et al. (2022) speculate that modern elements of different food cultures could be more similar to each other than the traditional elements. Specifically, it is assumed that food cultures tend to homogenise when moving from traditional behaviours to modern behaviours through the forces of globalisation—what Hawkes (2006) refers to as “coca-colonisation” or “McDonaldization”. Concerning differences, Sproesser and colleagues (2019) note that food cultures might differ both in what and how people traditionally eat. For instance, while the consumption of dairy products is seen as part of traditional eating in the Turkish food culture (Akpinar-Bayizit et al. 2009), it is rather part of contemporary eating or emerging food habit transformation in other countries such as Japan (Grant 2014), Ghana (Agble et al. 2009) and China (Morgan 2021). Likewise, while meals traditionally end with a sweet dessert in some countries, such as Turkey (Akpinar-Bayizit et al. 2009), sweet desserts are less traditional in other countries, such as China (Li et al. 2010). Although these differences suggest that there might be heterogeneity in terms of different regions within a country or continent and regarding different global regions,

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there is currently insufficient comprehensive international comparison of different food cultures in a single study. Little is known about which facets are similar and different between country regions. Until now, there has been little attention to whether regional distinctions such as Global North or South, High-income or Low-middleincome countries also unite or separate food cultures at a macro scale. Existing studies have largely focused on comparing food cultures between countries only within the Global North—predominantly high-income (see Reid et al. 2001; Laufer et al. 2015; Mancini et al. 2019; Ribeiro et al. 2022) or only within the Global South— predominantly lower-income (see Vallianatos and Raine 2008; Garnweidner et al. 2012; David and Kofahl 2017). The existence of different food cultures worldwide and their link to health or well-being raise questions of “How healthy or unhealthy food is perceived in these different food cultures?”; “What characterises them?”; and “What similarities and differences exist between them?” There is the necessity to understand the geographies of the relational overlap and continual difference through an aspect of food culture, such as perceptions of healthy and unhealthy food. For example, in low- and middle-income countries (LMICs), dietary energy intake can be limited by food shortages—creating more of a food problem in general and not only a healthy food problem. This is based on measures of food insecurity which typically focus on the number of hungry or undernourished people. These estimates and projections are based on average calorie consumption data, measures of the distribution of consumption and an estimate of the minimum nutritional requirement for each country (Temple and Steyn 2011). Overall, studies have shown that consumers in higher-income countries (HICs), on average, purchase slightly more healthy foods than lower-income shoppers (Volpe and Okrent 2012). Therefore, not having enough money can be seen as a severe limitation to the ability to access healthier food options, and this could influence the way such consumers perceive health or unhealth in food (an aspect of a food culture). Furthermore, socio-cultural factors account for differences and similarities in perceptions of healthy and unhealthy between consumers in LMICs and HICs. This chapter examines similarities and differences in perceptions of food health and unhealth between these two worlds in a single study. This chapter acknowledges that conducting a macro study as such could be controversial because countries and macro-regions such as LMICs and HICs are not culturally homogeneous. However, a study by Minkov and Hofstede (2012) found that African, Asian, Latin American and Anglo in-country regions tended to form homogeneous and distinct national clusters on World Values Survey (WVS) items. The following section will present how data were collected in this study.

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Fig. 10.1 An illustration of the global distribution of selected countries

Material and Methods Design For the 2023 financial year, the World Bank (World Population Review 2023) placed 81 countries in the high-income category. Although some countries have consistently ranked as high-income countries since the 1980s, others have moved in or out. From the latest classification by the World Bank, high-income countries are countries with a gross national income (GNI) per capita of $13,206 or more. Seven of these highincome countries were included in this research, and they include: South Korea, Spain, The United Kingdom, New Zealand, Norway, Romania and France. On the other hand, for the financial year 2023, the World Bank classified low- and middleincome countries as those with a GNI per capita of less than $13,206. From this list of low- and middle-income countries, this study selected the following: Mexico, Colombia, Peru, Argentina, Indonesia, Israel, Zambia, Zimbabwe, Senegal, Pakistan and Vietnam. These countries were selected based on the author’s networks (see Fig. 10.1).

Photovoice The photovoice method is based on the understanding that images teach what participants perceive as significant to define their concerns and priorities (Hergenrather et al. 2009). In each of the selected countries, five people (n = 5 × 18 = 90 participants) were chosen from the network of the initial person of contact to provide photographs

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which answer the following questions. (1) What do you consider healthy food? (2) What do you consider unhealthy food? The only criterion for selection was that no two persons could belong to the same household. Although the authors understand that this might not be the most objective or representative sample of the country’s population, the idea was just to give a sneak peek of what could be roughly expected from a country, construing rough cross-country or global-regional comparisons. The photographs were sent to the research by participants via WhatsApp or email. Besides the photographs, participants were requested to provide text about the photographs based on an adaptation of the acknowledged methodological guideline. It is the development of Wallerstein (1987) and refers to asking and answering the following question of the presentation of photographs: What do we see here in the photo? What’s really happening in the image? How does this relate to the research question? Why does this issue we see in the photo exist? What can we do about this? Although some participants from Latin America sent their responses in Spanish, most participants sent their texts in English. The data derived from the photos and accompanying texts were analysed like other qualitative data through codifying data, exploring, formulating and interpreting themes. The researcher developed the themes based on the frequency of their recurrence in the discussions.

Findings HICs and LMICs Vegetable Consumption Preferences Differ Vegetables have long been presented as important components of a healthy diet, and sufficient daily consumption can help prevent most non-communicable chronic diseases (World Health Organization 2003). Thus, the case for consuming vegetables is built on the nutritional value of consuming these foods. Under-consumption of fruits and vegetables could expose people to chronic disease risks such as cardiovascular-related diseases (van Breda and de Kok 2018). Increased fruit and vegetable consumption and physical activity have been reported to have a positive effect against several negative health outcomes besides heart diseases, stroke and cancers. Several varieties of vegetables exist, each with potentially hundreds of different plant compounds that benefit health. Since no single fruit or vegetable provides all the nutrients needed to be healthy, it is widely recommended that people should consume a variety of vegetables to give the body the mix of nutrients it needs. Therefore, it is not only in the Western World that people recognise the health value of vegetables. The following quotes and photos across the world reveal how fruits and vegetables are the most universally acceptable examples of what healthy food is: Healthy food to me is vegetables because they are full of vitamins, fibres and all the nutrients needed by the body. (Emilia, 48, Bucharest, Romania)

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Healthy food is fresh vegetables. You hear everywhere consistently that they are one of the top foods for health. Also, I feel good afterwards when I’ve eaten vegetables. So, that suggests my body runs well on them. (Rebecca, Wellington, New Zealand)

To me, healthy food is vegetables like the sweet potato leaves you see on the photo provided. Vegetables provide many nutrients which are good for the body. I am a footballer and I need to eat more vegetables in order to stay fit and maintain my body weight. (Mark, Lusaka, Zambia)

Healthy food is the coca plant. It is a very popular vegetable here in Peru and helps our people to eat healthier. It is also consumed as tea as you can see on the photo. It is true that it becomes a problem when drug cartels process it into cocaine. However, as a vegetable, the coca plant is medicinal and its consumption as a vegetable has been helping people high up in the Andes survive in high altitudes for thousands of years. (Manuel, 46 years-old, Cusco, Peru)

I think healthy food is food originating from local farming—fresh like what you will find at the market on the photo attached. I imagine a diet with more vegetables would be healthier. It means a healthier food future should be more vegetables, more vegetables, more vegetables. (Hoa, 30-year-old woman, Saigon, Vietnam)

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Despite the global popularity of vegetables as healthy food, it is worth mentioning that people in different parts of the world consume vegetables in different ways and forms. For example, people in low- and middle-income countries (LMICs) consume cooked vegetables as opposed to raw vegetables. Consuming raw vegetables is widely promoted as healthy living. This is largely because of the belief that eating raw means you are getting more nutrients or that cooking vegetables kills the natural enzymes in plants, as well as the vitamins and minerals. It can also be argued that cooked foods are easier on digestion, are healthier in terms of sanitation, and may taste better. Concerning taste, there are five flavours that we taste in foods. These are: sweet, salty, savoury (umami), sour and bitter. Of these flavours, the sweet and salty flavours are the most likeable. Right next to these is savoury which also has a positive connotation. In contrast, bitter and sour are the more disliked flavours. Some sources (Healthy Options 2019) have suggested that perhaps our natural dislike for bitter and sour comes from a natural response in us as humans which perceives sour and bitter flavours as foods that might be toxic or harmful to us. Vegetables, although very healthy, sometimes have a hint of bitterness. This could be from a low level of toxins the plant creates to avoid being eaten or a kind of bitterness camouflage to make an animal think the plant is toxic. This could suggest why in many LMICs, people prefer to consume cooked vegetables. Cooking vegetables introduces two processes which enhance the flavours of these dishes and make them the delicious vegetable dishes they are now. These processes of cooking are spicing and ‘camouflaging’ in a stew. Spicing could overcome the bitterness in some vegetables. Concerning ‘camouflaging’ in a stew, a delicious stew is immensely helpful in creating an irresistible vegetable dish. Immersing vegetables in stew could make the difference between being forced down to being gobbled up with an irresistible flavour. The aforementioned reasons could explain why cooked vegetables are more popular in some LMICs than raw vegetables. Another reason people in LMICs consume more cooked vegetables than raw vegetables is food hygiene. Concerning sanitation, global inequalities in hygiene standards influence how vegetables are eaten. Access to sufficient amounts of safe and healthy food is key to sustaining life and promoting good health. However, unsafe food containing harmful bacteria, viruses, parasites or chemicals can increase morbidity and mortality. According to the World Health Organisation (WHO, undated), approximately 600 million people (almost 1 in 10 people in the world) fall ill after eating contaminated food, and 420,000 die every year, resulting in the loss of 33 million healthy life years (WHO n.d.). According to WHO, children under five years of age are at particular risk, accounting for 125,000 deaths yearly from food poisoning. Fruits and vegetables contaminated with faeces and other toxic materials are listed as one of the causes of these deaths and poisonings. In the following quote, Bethari from Indonesia highlights the hygiene factor in food safety. She says: Raw ingredients used in salads should normally be fresh. However, when you buy or eat salad outside your home, it is hard to know whether the ingredients used in it are clean and fresh or not. So, homemade salad can be good, but salad out of the home is not healthy to me because of hygiene risks. (Bethari, 37-year-old woman from Surabaya, Indonesia)

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Given that food is a common medium for disease transmission and unsafe food practices directly contribute to high morbidity and mortality rates in many LMICs, food hygiene is an important theme that should be highlighted across sectors. For example, some respondents, like Carlos from Cali in Colombia, try to prevent food contamination by only eating cooked vegetables. This practice of cooking vegetables is seen as a response to high risks of disease transmission through unhygienic food conditions. Carlos said: Healthy food is cooked vegetables like what you see on the photo attached. I say so because here in Colombia you can never trust the sanitation of uncooked food. Who knows if it has been washed properly (ha ha ha). That’s probably why cooked vegetables are very popular here in Colombia. That’s why I don’t eat salads when I eat out because I am not sure the vegetables used have been properly washed. However, if they are cooked, I won’t mind so much. (Carlos, Cali, Colombia)

Snacking Habits Differ Between Consumers in HICs and LMICs Snacking fruit is quite common in low- and middle-income countries (LMICs). One of the authors remembers from his personal experience growing up in Cameroon that they were never actively encouraged to eat more fruit. Eating fruit was just part of everyday feeding habits. It was what they would eat between meals. This could mean passing by a neighbour’s yard or hedge and plucking a few guavas, oranges, mangoes, pawpaw fruits or being in the bushes and realising the only edible thing around was a wild guava tree. Therefore, people in the context of Cameroon and much of sub-Saharan Africa, there isn’t a habit of just planting trees for the aesthetic benefit of having trees. People often plant fruit trees instead of just trees because, besides the aesthetic and environmental value of trees, they also want to see the trees producing fruit. Therefore, a hedge with guava trees will be of more value than a hedge with cypress trees. Snacking with fruit is the norm for such people, especially as unhealthier snacks such as biscuits and chocolate bars are dearer than fruit. For instance, the author remembers an experience growing up in Cameroon of a large freshly picked mango costing about 25 FCFA, while a chocolate bar used to cost about 150 FCFA. In season, fruits can be cheap, making it easier for people to access healthy snacks in some LMICs than in HICs, where fruit prices are uniformly high

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all year-round. This value of fruit as snacks is evident in the data collected from Colombia. In their accounts, Monica from Bogota and Francisco from Medellin highlight how fruits as healthy snacks in Colombia are cheap (see the first quote and photos) and accessible at every street corner (see the second quote and photos). Here are photos of farmer markets here in Colombia. We have a lot of farmer markets even here in the city of Bogota in which they sell fresh fruits and relatively cheap too. I think this encourages people to eat healthier. (Monica, Bogota, Colombia)

(continued)

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(continued) Street fruit snacking with mango, papaya, pineapple is healthy… In Colombian cities we tend to have healthy fast food. Every two or three blocks or at every street corner you can find someone selling fruits which are often consumed as fast food here. Yes, there is always the competition with hot dog and burger places but at least these fruit stands provide an alternative which reduces dependence on greasy fast food. These fruits sold at street corners are often very cheap and for every budget. A couple of mangoes do not cost much. (Francisco, Medellin, Colombia)

In contrast to the aforementioned cases in LMICs where fruit can be cheap and accessible snacks, there is the case of a wealthy country like New Zealand where most consumers consider fruits (and vegetables) unaffordable. This view of fruits in HICs as expensive contributes to why people in these countries view healthy food as expensive. Suppose people view fruits and vegetables as flagships of healthy diets, and these same components are deemed expensive. In that case, it is easy to see where stereotypes of healthy food being expensive in HICs originate. For example, Matthew from Wellington (New Zealand), the screenshot from his phone as seen below, states how healthy fruits (and vegetables) are expensive in the following quote:

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It is harder to eat healthy when healthy food is so expensive. Food prices are going up a lot. Fruits and vegetables are pricey here and this makes a healthy diet out of some people’s reach. This is exactly the reason why some people would prefer to snack with chips instead of fruit. Chips are cheaper than fruit. (Matthew, Wellington, New Zealand)

In New Zealand, some participants highlight a key reason why fruits and vegetables are expensive—GST on fruits and vegetables. GST is a tax on goods and services. It is usually charged at 15%. Prices shown in shops and online include GST unless they say otherwise—the GST component of a paid product is usually displayed on receipts. In 2009, according to Statistics New Zealand, its annual GST on all fruits and vegetables sold in New Zealand households was NZ$167 million. In fact, an analysis collated for a Sunday paper in January 2009 showed that the Government earned just under NZ$51 million in GST revenue on fruits and vegetables in the year to June (New Zealand Parliament 2010). This meant that, as Rahui Katene (Member of Parliament for the M¯aori Party—Te Tai Tonga) suggested, some retailers have been charging 500 per cent more GST to customers than they are paying in GST to the growers (New Zealand Parliament 2010). Therefore, cancelling GST on fruits and vegetables, including other healthy food products, has improved nutrition, especially among low-income New Zealanders. The World Health Organization reported that New Zealand has the third-highest rate of obesity worldwide. This statistic highlighted the urgency of reducing GST to increase access and affordability to fruits and vegetables for lower-income Kiwis. However, despite flirting with these ideas about reducing or eliminating GST on fruits and vegetables, 12 years later, in 2022, Kiwis still pay 15% GST on every purchase of fruits and vegetables. GST on fruits and vegetables in New Zealand is still a key obstacle to healthier diets. Patrick, from Wellington (New Zealand), highlights this problem by saying in the following quote:

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This is a banner supporting removal of GST (goods and services tax) on fruits and vegetables in New Zealand to reduce child obesity. A healthier food future will be more realistic if there is the removal of GST on fruits and vegetables sold at supermarkets/dairies. (Patrick, Wellington, New Zealand)

Meat is Perceived Differently in HICs and LMICs Pre-1950s, eating meat was considered a luxury for most people globally, rather than the everyday practice today, particularly in the Western context (Aiking 2011). In this period, people who did not eat meat in the Western world usually did so because they had no choice. For example, many people did not have access to meat due to hardship, but when given a chance, they often did not resist eating meat (Kanerva 2019). However, the rise of industrial meat production after the 1950s became a game-changer. The rise of industrialised animal agriculture after World War II and the associated increased availability and decreased prices for meat all encouraged meat eating. Kanerva argues that industrial meat production also led to the psychological distancing of animals from their flesh by separating industrial meat production far away from most people (Kanerva 2019). This resulted in meat becoming an everyday food item for nearly everyone in the Global North. According to economic theory, the lower the price of a desired item, the more people will buy and consume it (Westhoek et al. 2011), and this is the case with meat as well. Furthermore, what aggravates the situation is that decreased meat prices have been matched by rising GDPs globally in the last 40 years. Although a rising GDP (gross domestic product) per capita—as an indicator of standard of living—may not be claimed to directly cause rising meat consumption levels, a positive association between GDP and meat consumption exists (FAO 2011). As a result, one of the critical issues in food consumption is the excessively high ratio of industrially produced meat in the Western diet. Next to health issues associated with consumption, such production systems heavily burden the environment due to increased nutrient and energy demands, greenhouse gas emissions, and other pollutants (Jurgilevich et al. 2016). For instance, the embodied phosphorus of meat products is estimated to be three times higher than that of vegetable products (White et al. 2010). Therefore, meat (particularly beef) is considered a high-cost food source. It requires more energy, water and land to produce meat than other food sources. Also, meat production has been linked to greenhouse gas emissions and plays a major role in climate change.

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Although a more organic production process should be primarily chosen to produce meat, there is also an urgent need to change the dietary habits of most people, at least in Western countries, and very especially to reduce meat consumption. This approach is part of a ‘strong’ sustainable meat consumption approach, and it involves radical changes to the system, substantial reductions in, or the elimination of, intensive meat production, and radical behavioural, dietary change, at a global level wherever this is achievable (Kanerva 2019). Therefore, it would ideally lead to faster and more relevant changes, bringing about large-scale and significant reductions in meat production and consumption and the related adverse impacts. Subsequently, this pathway would also result in large positive impacts, e.g. in terms of human health, significantly reduced carbon emissions and air and water pollution, and terms of rewilding of landscapes (Kanerva 2019). Furthermore, research has shown that adopting the ‘strong’ sustainable meat consumption approach can significantly reduce carbon emissions. For example, Westhoek et al. (2011) state that a 50% reduction in all meat, dairy and egg (production and) consumption in the European Union alone could reduce carbon emissions from the agricultural sector in the European Union by up to 42%. Such research contributes to a push towards vegetarianism and veganism, especially in the Western context, to reduce meat consumption to a healthy level for human and planetary health. The ideal outcome of this ‘strong’ approach is a world in which everyone is vegan or vegetarian. From Paris to Bergen in Norway and beyond in the HICs, there is the urge to view a meat-free diet as healthy food and to see a meat-free diet as the future of healthy food. This can be seen in the following quotes from some participants: I believe a healthier food future will have to involve more large-scale social and environmental issues. It will have to tend towards vegetarianism. I am biased on the topic since I am a vegetarian, but eating less meat, (and more locally sourced meat, if any) will be beneficial to ensure all humans have enough food to sustain themselves without causing damage to the environment. (Anissa, Paris, France) I think healthier food would be the need to promote vegetarian and vegan options. These are still very rare here and not really integrated to the habits of people and restaurant menus. If you go to restaurants here in the South of France, you can still struggle to find vegan and vegetarian options. Even when you see them, they aren’t as diverse in terms of range of options as the non-vegetarian options. (Alice, 23-year-old, Toulouse, France) Healthy here is less or no meat. In Norway I think people in general need to eat less meat and more vegetarian dishes with items like tofu or fish. I eat very little meat myself. (Amalie, 28-year-old, Bergen, Norway)

Looking beyond the HICs, reducing meat consumption globally is a difficult proposition. Food consumption patterns, in general, are usually linked with people’s value orientations, emotions, personal and collective identity, traditions, and food culture (Jurgilevich et al. 2016). These aspects vary from country to country and from region to region. The consumption of meat is, for example, in some places bound to particular framings of masculinity and ethnicity (Schösler et al. 2012). Although the choice to eat meat is sometimes considered in some Western circles as a lack of awareness of the negative impact of meat consumption on the planet (see

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González et al. 2020), this is not the case in most LMICs included in this study. So too many people, particularly those from low- and middle-income countries, healthy food is more than just nutritional benefits or global environmental sustainability gains. That explains why the participants quoted below refer to healthy food as meat. This is because they find meat delicious, and their choice doesn’t imply that they do not care about the environment or disregard the possible adverse effects of eating meat on personal health. They simply think meat is healthy because it is delicious (socio-culturally based understanding of healthy food). Healthy food is Picada Colombiana. This is a traditional Colombian dish in which a variety of grilled or fried meat and vegetables are served on a large platter. In Colombia, it is considered healthy to eat meat. Meat here refers to fish, red meat, chicken. When I cut down on the amount of meat I eat, my parents became worried. My parents eat meat every day and sometimes twice a day, and that’s quite normal in Colombia and also considered healthy. It is normal to have a big piece of meat for lunch and dinner. I would say here in Colombia, a meal without meat is considered unhealthy [Smiles]. To a lot of people, it is still meat, meat, meat as healthy food. (Eva, woman from Bogota, Colombia)

Healthy food is definitely meat. In Argentina meat is red meat. We eat a lot of meat every day. Anything else like chicken, pork or fish is not meat. To me, parilla (pronounced pa-REE-sha in Argentina) or asado is always associated with healthy food. Asado is a style of cooking a whole animal on a spit or cross over an open wood fire. But with parrilla cooking, a metal grate is always involved. In parilla, a metal grill grate is often placed over a firebox filled with wood. These are typical Argentinean barbecues. (Juan, Buenos Aires, Argentina)

To some other participants like Bethari from Indonesia, healthy meat goes beyond how the animal was raised. Her idea of meat as healthy meat is based on how the meat is prepared (disregarding how the animal was raised). Bethari said:

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Healthy meat is homecooked meat or the meat that we process by ourselves. Since we choose the materials, the herbs and spices from raw stage. We take control from the very beginning. An example is the homemade fried chicken you see on the photo. Although we can buy it, it is healthier when we make it because we change the frying oil regularly. (Bethari, 37-year-old woman from Surabaya, Indonesia)

According to Kemper (2020), only about 5% of the global population consider themselves vegetarian, while many people (between 14 and 60%) define themselves as flexitarian. Flexitarian refers to the reduction but not the complete elimination of meat from diets. Also, this does not mean the vast majority of people worldwide who eat meat are ignorant or lack awareness concerning the scientific facts against meat consumption. Furthermore, Leahy et al. (2010) stated that 22%, or around 1.5 billion people worldwide, were vegetarians, primarily out of necessity—hardship-driven necessity. Furthermore, they estimated that out-of-choice vegetarians would number only around 1% of the global population at that time (Leahy et al. 2010). In the drive to promote less or no meat eating globally, there is the tendency to downplay the fact that the consumption of meat and meat products has also scientifically been proven to benefit human health (Ahmad and Khan 2020). This is through being a source of nutrients—proteins, iron and vitamins, among others—to the human diet. Grass-fed cows have been suggested as a solution to the contribution of meat production to high-carbon emissions (by the argument that grazing locks away soil carbon). However, this line of thinking has been disputed (Godfray et al. 2018), and the argument persists that well-placed grazing cows may be relatively harmless to climate change (Röös et al. 2016; Garnett et al. 2018). As part of this ‘weak’ sustainable meat consumption through consuming only meat products that are less burdening to the environment by being more sustainably produced, Marina from Rosario in Argentina makes mention of the free-range production of meat in Argentina on the extensive pampas (grassland). Exploiting the pampas for cattle rearing without altering the vegetal cover significantly is seen as a relatively more sustainable meat production process than deforestation of the Amazon in Brazil, for example, to establish grazing land for meat production. Marina supports Argentinean beef as healthy food along the lines of a more sustainable process of animal husbandry. She said: Argentina is a big country which is relatively underpopulated with a lot of land for animals to graze. The grass is good with no hill in La Pampa (500 kilometres flat extensive grassland). So, the cows live a good life outdoors and with the relatively good weather, the cows are never locked up inside. So, Argentinean meat is very organic and with good cattle welfare, I consider healthy. To me, as long as the animals are well looked after, I have no problem with eating meat. (Marina, Rosario, Argentina)

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The aforementioned quote by Marina also addresses one of the reasons people choose to eat less or no meat—animal welfare. Animal welfare concerns regarding factory farming can run counter to the trends of meat consumption, with some potential to reduce meat eating or to reduce some environmental or health impacts from eating meat. The emerging literature on the psychology of meat consumption suggests that appeals to animal welfare might provide distinct and powerful psychological pathways towards reduced meat consumption (Rothgerber 2020). However, looking beyond the animal welfare reasoning, Marina argues that even if individuals consider the animal origins of the meat and are informed about conditions on factory farms, animals are by default raised to be eaten.

Fast-Food Chains from HICs Hold an Element of Prestige in Some LMICs Fast food commonly refers to takeaway or take-out foods or out-of-home foods. Fast food is often associated with national/multinational chains (such as McDonald’s, Domino’s Pizza, Subway, Burger King, Pizza Hut, Kentucky Fried Chicken and Taco Bell). Fast foods have become increasingly popular over the past few decades and are thought to be among the key proponents driving increasing numbers of overweight and obese individuals (Lachat et al. 2012). Although the causes of obesity are complex and cannot be easily deduced to a single factor, it is increasingly evident that the overconsumption of often oily/fatty and sometimes sugar-sweetened fast foods, along with their often-increased portion sizes, are undoubtedly strong determinants of obesity (Janssen et al. 2018). Thus, many respondents identify fast food as an example of unhealthy food, as shown by the responses below with specific references to particular high-street fast-food brands: Unhealthy food is fast food you get from McDonalds with fries and hamburgers as examples. The food you get from these places is unhealthy because of how it is prepared. It is often deep fried with enormous amounts of unhealthy ingredients. (Marius, 28, Bucharest, Romania)

Unhealthy food is fast food like KFCs and Dominos pizzas. Food has been changing in our lifetime and a lot has been done to make food faster and unhealthier. The businesses make a lot of money from it and they really don’t care what they put in the food and its effect on public health. I think fast food is just getting worse to be honest with you. We eat all this bad stuff in fast food and later on down the line we develop problems—if we aren’t already having them right now. (Lee, Liverpool, United Kingdom)

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Research has conventionally shown increasing trends in the frequency of out-ofhome food consumption, predominately in Europe, the USA and Australia (Janssen et al. 2018). This has been matched by emerging research from LMICs which show similar trends in increasing frequency of out-of-home food consumption. However, in some LMICs where Western brands only recently made in-routes, global food chains have shaped food identities differently. Food identity refers to individuals choosing or feeling pressured to eat in a manner influenced by others; to project a social or political statement within certain groups (Janssen et al. 2018). In such countries, global fast-food chains are a key aspect of a youth or fashion identity. They are seen as a way of expressing a more classy or fashionable self and lifestyle image, whereas healthier and more local food has been shown to conflict with the image of being fashionable and sophisticated. The following quote from Colombia illustrates this problem: In Colombia, we have more and more fast-food chains. We have double burger stations, takeaway pizzas, and the fast-food culture is becoming more widespread, and that could be a problem. Greasy fast food is actually more expensive that fresh fruit sold around the corner. A lot of people consider fast food more delicious than fruits and, in some case, it is even trendy to eat greasy fast foods like double burgers and stuff like that. The hamburger places here are marketed as posh and fancy, and that increases people’s desire to eat at places like these. (Carlos, Bogota, Colombia) I like eating at the KFC. Although they say KFC fast food is addictive, I also just like the environment in their restaurants – classier than some of the other restaurants. Nothing they say about fast food like KFC will prevent me from eating at a KFC. Unless something will kill me today in terms of danger to my health in the present, I will not listen to any warnings about KFC fast food. Unless they say KFC is serving human flesh, I will not stop going there because I also like to be seen eating there. (Anne, a woman from Harare, Zimbabwe)

The Cost-of-Living Crisis is Seen Everywhere as a Threat to a Healthier Food Future The cost of food and the perceived financial resources to procure it can be key economic determinants of food choice and, by association, food culture. Affordability, availability and accessibility are probably one of the most well-known aspects of food security. Food security is the physical, social and economic access to a stable and safe food supply, in sufficient quantity and quality to meet dietary needs and food preferences, within an environment that supports a healthy and active lifestyle (Love et al. 2018). Affordability of food is not a static characteristic of food or food sources but is best understood concerning the characteristics of people, households and communities. In particular, food affordability could not only refer to the cost of food but also consider the requirements for household income, excluding food and the availability of nutritional support to cover these costs. As a global problem, the cost-of-living crisis has transmitted into the cost-of-food crisis. In general, food prices are rising steadily worldwide, especially sharply in recent decades. These rising food prices and price volatility are linked to heightened

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food insecurity globally and not only in LMICs. Even in HICs, where the strongest definition of healthy food is nutrition-oriented, there are still concerns that eating healthy (organic) foods expensive. This view is reflected in the following responses from consumers in HICs who identify money as the principal barrier to a healthier diet: Money. Unhealthy food is relatively cheap and healthy food is more expensive. Junk food is cheaper so sometimes harder to choose healthy foods. (Jane, Drammen, Norway)

Money is the problem with ability to eat healthily. organic products are harder to find at the market. Even when you find them, they are usually quite expensive. (Marius, 28, Bucharest, Romania)

This is an economic issue because the food that is cheap is the stuff that is often least healthy. Eating well requires money! So, to be clear, it is easier to eat healthily if prices are manageable. (Adrienne, Wellington, New Zealand)

Although the aforementioned quotes were made before the Russia-Ukraine crisis (a crisis which started in February 2022), it is not an exaggeration to mention that the reverberations of the war—massive disruption of global food supply chains— have worsened the cost of living and consequent affordability of food (Dyson et al. 2023) across cases investigated. In LMICs, although the desire to eat healthy meals is present, the rising cost of living and the concomitant weaker financial position

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of people in these countries in relation to higher-income countries pose challenges for people to afford healthy food. Consequently, people would just wish to eat food and not necessarily healthy food. Therefore, people stick to whatever they can find at affordable prices. As Cretney and Nissen (2022) point out, the ontology of emergencies differs across space and time. In this sense, an emergency means different things to people in different places and times. It could be well argued (based on the optimism for a healthy food future) that the ontology of emergency in HICs reflects threats to a healthier food system. However, for people in LMICs, the ontology of emergency reflects threats to a food future in general—not necessarily a healthier one. In LMICs, it is difficult to avoid attention to questions of poverty (a social emergency) as a key concern. Thus, people in LMICs might see the need to take care of their urgent needs of providing just food—not necessarily healthy food for their people. The following quote from someone based in an LMIC clearly illustrates this problem: In line with the assignment for this project, I tried to take a photo of a garbage heap with someone scavenging for food. Poverty can make it very difficult for people to even eat anything at all - before we consider eating what is healthy. The person I saw scavenging was probably a homeless person. Besides the fact that I will have had to seek permission from the person before taking a photo, it was risky anyway. There was always the risk of being attacked by this person. They say a hungry person is an angry person you know. Do you think that person scavenging for food cares about which food is healthy or not? (Identity or country of the participant withheld upon request from the participant)

Conclusion Comparing food cultures regarding understanding healthy and unhealthy food across 18 countries, including data from 90 participants, revealed that despite connections between regions because of globalisation, some regions, such as LMICs, still hold on to unique understandings of healthy or unhealthy foods—insights in LMICs which contrast with dominant frames from HICs. Globalisation has allowed HICs and LMICs to benefit from capital flows, technology transfer, cheaper imports and larger export markets. It has also amplified the intensity of connections between regions in socio-ecological and economic. However, regarding food cultures and specific understandings of healthy and unhealthy food in the context of this chapter, the spillovers from the behaviour of individuals and societies in HICs have not been successful in completely overriding place-specific understandings in LMICs. Results revealed five key areas of difference between LMICs and HICs concerning similar categories—the rising cost of food, vegetable consumption, fruit consumption and perceptions of fast food and meat eating. Altogether, these results provide rich information about the similarities, differences and characteristics of food cultures from different parts of the world about understanding what is healthy or unhealthy. This knowledge could promote a better understanding of food cultures that go beyond nutrition which has been the dominant frame for healthy and unhealthy food. This must be considered

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when promoting healthy eating habits and addressing food insecurity in different parts of the world.

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Jarosz L (2014) Comparing food security and food sovereignty discourses. Dialogues Hum Geogr 4(2):168–181 Jurgilevich A, Birge T, Kentala-Lehtonen J, Korhonen-Kurki K, Pietikäinen J, Saikku L, Schösler H (2016) Transition towards circular economy in the food system. Sustainability 8(1):69 Kanerva MM (2019) The role of discourses in a transformation of social practices towards sustainability: the case of meat-eating related practices (Doctoral dissertation, Universität Bremen) Kemper JA (2020) Motivations, barriers, and strategies for meat reduction at different family lifecycle stages. Appetite 150:104644 Kittler PG, Sucher KP, Nelms M (2016) Food and culture. Cengage Learning, London Lachat C, Nago E, Verstraeten R et al (2012) Eating out of home and its association with dietary intake: a systematic review of the evidence. Obes Rev 13:329–346 Laufer P, Wagner C, Flöck F, Strohmaier M (2015) Mining cross-cultural relations from Wikipedia: a study of 31 European food cultures. In: Proceedings of the ACM web science conference, pp 1–10 Leahy E, Lyonsa S, Tol RSJ (2010) An estimate of the number of vegetarians in the world. ESRI Working Paper No. 340. Economic and Social Research Institute, Dublin, Ireland Li M, Dibley MJ, Sibbritt DW, Yan H (2010) Dietary habits and overweight/obesity in adolescents in Xi’an City, China. Asia Pac J Clin Nutr 19(1):76–82 Loring PA, Gerlach SC (2009) Food, culture, and human health in Alaska: an integrative health approach to food security. Environ Sci Policy 12(4):466–478 Love P, Whelan J, Bell C, Grainger F, Russell C, Lewis M, Lee A (2018) Healthy diets in rural Victoria—cheaper than unhealthy alternatives, yet unaffordable. Int J Environ Res Public Health 15(11):2469 Lyman B (2012) A psychology of food: more than a matter of taste. Springer Science & Business Media Mancini S, Moruzzo R, Riccioli F, Paci G (2019) European consumers’ readiness to adopt insects as food. A review. Food Res Int 122:661–678 Minkov M, Hofstede G (2012) Is national culture a meaningful concept? Cultural values delineate homogeneous national clusters of in-country regions. Cross-Cult Res 46(2):133–159 Minkov M, Hofstede G (2014) Clustering of 316 European regions on measures of values: do Europe’s countries have national cultures? Cross-Cult Res 48(2):144–176 Morgan N (2021) Introduction: dairy development in Asia. In Morgan N (eds) Smallholder dairy development: lessons learned in Asia. Food and Agriculture Organization of the United Nations. Retrieved from http://www.fao.org3i0588eI0588E02 New Zealand Parliament (2010) Goods and services tax (exemption of healthy food) amendment bill—first reading. Retrieved from https://www.parliament.nz/en/pb/hansard-debates/ rhr/document/49HansD_20100908_00001000/goods-and-services-tax-exemption-of-healthyfood-amendment#:~:text=Analysis%20of%20the%20Statistics%20New%20Zealand%20hous ehold%20economic,sold%20in%20New%20Zealand%20households%20was%20%24167% 20million Reid M, Li E, Bruwer J, Grunert K (2001) Food-related lifestyles in a cross-cultural context: comparing Australia with Singapore, Britain, France and Denmark. J Food Prod Market 7(4):57– 75 Ribeiro JC, Gonçalves ATS, Moura AP, Varela P, Cunha LM (2022) Insects as food and feed in Portugal and Norway–cross-cultural comparison of determinants of acceptance. Food Qual Prefer 102:104650 Röös E, Patel M, Spångberg J, Carlsson G, Rydhmer L (2016) Limiting livestock production to pasture and by-products in a search for sustainable diets. Food Policy 58:1–13 Rothgerber H (2020) Meat-related cognitive dissonance: a conceptual framework for understanding how meat eaters reduce negative arousal from eating animals. Appetite 146:104511 Schösler H, De Boer J, Boersema JJ (2012) Can we cut out the meat of the dish? Constructing consumer-oriented pathways towards meat substitution. Appetite 58(1):39–47

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Sproesser G, Ruby MB, Arbit N, Akotia CS, Alvarenga MDS, Bhangaokar R et al (2019) Understanding traditional and modern eating: the TEP10 framework. BMC Public Health 19(1):1–14 Sproesser G, Ruby MB, Arbit N, Akotia CS, dos Santos Alvarenga M, Bhangaokar R, Renner B et al (2022) Similar or different? Comparing food cultures with regard to traditional and modern eating across ten countries. Food Res Int 157:111106 Temple NJ, Steyn NP (2011) The cost of a healthy diet: a South African perspective. Nutrition 27(5):505–508 Vallianatos H, Raine K (2008) Consuming food and constructing identities among Arabic and South Asian immigrant women. Food Culture Soc 11(3):355–373 van Breda SG, de Kok TM (2018) Smart combinations of bioactive compounds in fruits and vegetables may guide new strategies for personalised prevention of chronic diseases. Mol Nutr Food Res 62(1):1700597 Volpe R, Okrent A (2012) Assessing the healthfulness of consumers’ grocery purchases (No. 14762017-3895) Wahlqvist ML (2007) Regional food culture and development. Asia Pac J Clin Nutr 16:2 Wallerstein I (1987) The construction of peoplehood: racism, nationalism, ethnicity. In: Sociological forum. Eastern Sociological Society, pp 373–388 Westhoek H, Rood T, van den Berg M, Janse J, Nijdam D, Reudink M, Stehfest E (2011) The protein puzzle: the consumption and production of meat, dairy and fish in the European Union. PBL Netherlands Environ Assess Agency, The Hague White S, Cordell DJ, Moore DD (2010) Securing a sustainable phosphorus future for Australia: implications of global phosphorus scarcity and possible solutions World Health Organization, WHO (2003) Fruit and vegetable promotion initiative. A meeting report 25-270803. Geneva, Switzerland World Health Organization, WHO (Undated), Food safety in the Western Pacific. Retrieved from https://www.who.int/westernpacific/health-topics/food-safety World Population Review (2023) High-income countries 2023. Retrieved from https://worldpopu lationreview.com/country-rankings/high-income-countries

Chapter 11

The Entangled Islands: The Influence of Space–Place Relations in Global Meanings and Visions of Healthy Food Samuel Agyekum and Luke Covill

Abstract This chapter summarises the diverse country-based contributions in the book. In what will follow, we discuss various perspectives on what constitutes healthy and unhealthy, as well as visions for a more sustainable food future from a diverse standpoint. By exploring different narratives on food and transformation, this contribution strengthens the argument that the pursuit of food visions determined solely by a select group of individuals, such as policy-makers or other powerful actors, is unlikely to effectively initiate change. Therefore, we contend that, until inclusive visions of the present and future are articulated, anticipating the impacts of sustainable food transition and enhancing their responsibility remains challenging. In this regard, we highlight lessons learned from comparing visions of healthier food in different contexts—rural and urban cases. At the core of this chapter is a rethinking of the significance of space-place relations in determining the meanings of healthy and unhealthy food and visions for a healthier and more sustainable food future. Consequently, this contribution makes a contribution to the space-place dialectic and its relationship to food system transformation. Keywords Place · Space · Inclusion · Rural–urban · Food meaning · Global

Introduction Central to the climate emergency debate is the imperative of healthy and sustainable food transformation. Taking responsibility for our eating practices holds an immeasurably significant value in resolving the emission problems being faced by our planet. This is because our food systems are responsible for a third of current

S. Agyekum (B) Institute of Geography, University of Bern, Bern, Switzerland e-mail: [email protected] L. Covill Aeres University of Applied Sciences, Dronten, The Netherlands © The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 H. Esam Awuh and S. Agyekum (eds.), Geographies of Food, Springer Geography, https://doi.org/10.1007/978-3-031-49873-2_11

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sources of greenhouse gas emissions (Crippa et al. 2021). While it sounds theoretically appealing to target one of the highest emitters (food production and consumption), the contribution of the agricultural sector to global emissions has been blurry, to some extent due to the hyper-diversity in social, cultural, political, and environmental spheres of life. In the midst of these varied factors, globalisation—through its elements of interconnectedness and interdependence—has created a bond among geographies. It does so by transforming localities oceans apart into proximate areas such that happenings in a locality might be to a greater or lesser extent influenced by events that emerge from places oceans apart and vice versa (Giddens 1990; Veltmeyer 2005). Despite the seemingly homogenising role of globalisation in our lives, the great hyper-diversity across the globe (and the consequent varied definition of healthy food) challenges the approach of merely generalising food choices as the effect of a global transfer of food cultures from the North to South. To put this more clearly, we refer to Robbins who drew on the work of Uhoff to problematise the socalled ‘superior environmental knowledge’—a proxy to contemporary imposition of solutions from the North to the South. He stated that: The general more assertion that superior environmental knowledge originates in the global north for transfer to the global south is in itself problematic, reproducing as it does paternalistic colonial knowledge relations and a priori discounting the environmental practices of indigenous and local communities. (Robbins 2012, p. 19)

His argument stresses the importance of co-producing knowledge with the people within the context not for a sole reason of best solutions but most importantly for recognition justice. Attempts to authoritatively recommend practices have not resulted in outcomes hoped for. This is exemplified by the long-standing struggle between proponents of ‘going vegan’ and cultures where the utility (consumption) of meat-based diet does not serve just the purpose of food-for-fill but also an integral part of tradition (during religious celebrations, festivals, and ceremonies). This is suggestive that superimposition of ubiquitous meanings of healthy food will continue to bind us to the binary conflict between the two blocks. For example, the struggle between vegans and meat-essentials. Such struggles shroud our ability to calibrate our thinking about attaining an inclusive healthier food future. The specific mention of vegan and meat debate should not be misunderstood as an attempt on our part to reduce the complex dietary choices across the world to the binary between meat and non-meat. This example, however, is considered due to its increased emergence in the food transformation debate. While we may be well aware of the evidence that the events happening elsewhere will ever shape practices in other contexts and vice versa, we must tread cautiously to not interpret this through the lens of superimposition when visioning our healthier food futures. Perhaps, and as may be deduced from the contradictions, we remain a long way from reaching congruent solutions because we fail to understand the meaning and visions of healthier food across geographies (space and place). This chapter broaches the need to clearly understand what influences the meaning of healthy and unhealthy food in diverse contexts. We build on the conviction that

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pushing the knowledge borders this far (as done by the case studies in this book) is imperative because if we fail to ask the right questions, we lose sight of alternatives that could enhance our views and understandings of how to foster a global healthy and sustainable food transformation. To potentially overcome the dilemma, this book framed the eight case studies within the place–space dialectic by making sense of what healthy food means now and what could be the future of healthy food in respective countries. In doing so through the empirical cases, the book makes a conceptual contribution to the space–place dialectic and how it could enhance our efforts towards identify pathways to healthier and more sustainable food system transformation. The rest of this chapter is organised as follow: (1) We present a rethinking of the significance of place-space dialectic in determining meanings of healthy and unhealthy food; (2) following that, we compare the understanding of meanings of healthy and unhealthy food between rural and urban areas; (3) then, we conclude with the significance of this book.

Rethinking Space-Place relations in Understandings of Health and Unhealth in Food Terms ‘Space’ as used in this chapter alludes to the diffusion of technological innovation and spatial processes of communication that come with globalisation. ‘Place’ is the context specific social, cultural, and environmental conditions that shapes lives (see Fig. 11.1). By using these concepts in this book, specific reference is made to meanings and visions of healthy and unhealthy food. What we see in this book is that although the diffusion of technological innovation and globalisation through spatial processes of communication, migration, etc., has likely led to some general understandings of healthy and unhealthy food that go beyond specificities of place, and some meanings are still very much influenced by the specific places (as in longitudinal and latitudinal locations) in which people find themselves. There is the need to see place in terms of meaning for human agents—focussing on the mediating role of place in both social relations and the acquisition of meaning. This book shows that although there is evidence of progressive overcoming of local places by global spaces through mobility, communication, and general aspects of globalisation, specific place-based factors still play an important role in how people understand healthy and unhealthy food. Basically, the argument of this diagram on Fig. 11.1 is that it takes a combination of place-specific and spatial processes to produce understandings of healthy and unhealthy food. Sometimes, place is more significant, and sometimes, spatial processes override the uniqueness of place. For example, we can see how understandings of healthy food based on nutrition values (fruits and vegetables) are based on formal institutional promotion of these meanings through formal education and international organisations. While we do not discount the fact that specific places might

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Fig. 11.1 Illustration of findings in relation to theoretical framework and central question

also independently promote fruit and vegetables as healthy food, these nutritionbased meanings cannot be disentangled from global discourse which promote the nutrition element in healthy food over the socio-cultural meanings (for example, feel good or happiness derived from eating delicious food). Empirically, several cases in this book show that the understandings of healthy food and the vision of a healthier food future are dependent on the spatial processes such as education, government policies, and technological diffusion that are products of globalisation. In Ghana (Chap. 4), people define healthy food as a balanced diet with precise definitions of a meal that consists of all the food nutrients in their right proportion. These meanings are generally acquired through mainstream education platforms such as schools and the government policy. Emergent government policies have resulted to these effects since the Ministry of Health and the Ghana Health Service (partnering agency) devises health policies rooted in the UN WHO guidelines by virtue of Ghana’s membership. In the Philippines (Chap. 6), food and vegetables were predominantly referred to as what should constitute healthy food. As noted in the case of Ghana, these general understandings of healthy food in the Philippines are also acquired through spatial processes such as early childhood education in homes, schools, and the media. The case of the Netherlands (Chap. 2) represents a twist of how spatial processes contribute to meaning acquired about healthy food. In this sense, the increasing

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migrant populations transfer their localities oceans apart to the food culture of the country. In so doing, meanings of healthy food are constantly being reimagined from purely nutrition-based classification of the government (Schijf van Vijf) to also accommodate the socio-culturally informed definitions. In this case, the sociocultural definitions are not tied to the Dutch culture but rather the migrant culture. These socio-culturally informed meanings of un/healthy include the pleasure derived from the acts of sharing food experiences that positively contributes to consumers’ overall pleasure and satisfaction with consumer’s food consumption. This interesting observation in the Netherlands broaches the need for geographers to be reflexive of the term ‘local’ in food because of its evolving nature in correspondence to changing demographic character of a place. The influence of global networks on the meanings of healthy food was also evident in the cases investigated in Cameroon (Chap. 3) and South Africa (Chap. 8). In Cameroon, evidence of the role of spatial processes in people’s acquisition of meanings of healthy food—clinically-based and interpreted based on effects on physical anatomy of the human body—was glaring. This understanding of healthy food is acquired through the recommendations by educational institutions, medical experts, and scientific advice of Non-Governmental Organisations. This substantiates the fact that peoples’ understandings of healthy or unhealthy food are also influenced by the global networks to which they are connected either directly or indirectly. Conversely, the meanings people acquired about healthy or unhealthy food are not monolithically defined by spatial processes. Certain kinds of understandings of healthy food are more informed by place-specific characteristics. These placespecific factors (geography and human–nature interaction) are the basis of practicebased meanings ascribed to food in some cases in this book. People form certain meanings as a result of their interactions with unique place-specific socio-ecological interactions. The findings from the Eastern Visayas Philippines (Chap. 6) showed a more place-based understanding of healthy food. This is evident in two major scenarios. On the one hand, the geography—proximity to the sea and abundance rivers—of the region makes access to marine and freshwater foods relatively easier. To this end, people or the cultural context in entirety have built specialised skills in collecting and preparing marine-derived foods in a healthy manner. Ability to get plentiful catch overtime makes fish a staple. Considering the fact that fish is what the geography of Eastern Visayas has blessed its inhabitants with, they have understood that eating a lot of fish does not pose a threat to one’s health. According to them, using the fish for simple dishes such as fish soup and pickled fish requires local spices that are cheap and easily accessible. These foods mentioned require less or no oil, sugar, and salt. As a result, healthy food, to the people of Eastern Visayas, is everything about the manner the fish is prepared and not necessarily only the fish per se. Also, in Chap. 5, the location of Venice in the Mediterranean Sea region makes Mediterranean diets popular in the area. This geography and the long-enduring interaction with nature sculpts a food practice that is considered healthy. In the same vein, urban dwellers in Ghana define healthy, in part, on the manner in which food is prepared and the time in which it is consumed (Boatemaa et al. 2018). These are characteristics which are determined by specific cultures of food preparation and the

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particular time in which it is culturally appropriate to eat certain foods in Ghana. The same aspect of time of the day and temperature of the day or season in relation to what is considered healthy or unhealthy food was observed in India (see Chap. 9). Despite these place-specific factors which play a key role in shaping people’s understandings of healthy food as highlighted in the cases of the Philippines, Ghana, and Cameroon, people are very aware and careful of the risk of excessive consumption of nutritionally unhealthy foods. In the aforementioned cases, social meanings of healthy food do not preclude foods from being positioned along the lines of the nutrition value. Generally, people are still cautious about what food does or does not do to the physical anatomy of the human body. For example, although the sociocultural meanings of healthy food are implicit in the Cameroon culture (Chap. 3), the influence of social media, educational institutions, and government recommendations has made it almost invisible. Although eating together and the resulting pleasure—healthy state of mind—it brings (a socio-cultural meaning of healthy food) is an everyday practice, it was not mentioned as an understanding of healthy food in Cameroon. This could mean that those meanings are not important to people (especially, the formally educated people who constitute the sample in Cameroon). This is a case of the spatial processes overcoming the place-specific processes. It could also mean that these socio-cultural value of eating together as a healthy food practice in Cameroon is normal. Thus, not warranting attention enough to be mentioned as a healthy food practice—‘nothing special’. Additionally, in the Netherlands where the dominant understanding is nutritionbased, the spatial process—migration—is redefining meanings of healthy food along the lines of social norm (pleasure of eating together) rooted in food cultures oceans apart. Here, although the way healthy food is viewed is largely determined by placespecific nutritional knowledge, spatial processes such as migration have introduced the need for socially informed meanings of healthy food. Thus, there is hardly ever a geographical area where meanings of healthy or unhealthy food are monolithically influenced by just spatial processes or place-based factors. This complementarity in dialectic relationship as observed in the acquisition of meanings of healthy/unhealthy food is perfectly summarised by Robbins’s who argued that: Dialectical stories … rarely focus on how individual things or variables cause outcomes or explain other things in a straightforward way, but instead how things and relations change by becoming entangled with one another. (Robbins 2012, p. 94)

From what has been observed within the space–place dialectics in shaping meanings of healthy/unhealthy food, it is needless to mention that the mechanisms through which meanings are acquired, and the kind of meanings ascribed to a healthy food are a tangle of dialectical relationship of space–place in which things comes to explain one another. The prominence of both space and place in shaping lives in present times is a position held by famous scholars on justice. For example, Fainstein (2011) mentioned that globalisation essentially does not easily supplant cultural identities as Marx would have expected through the dissolution of national and sectorial loyalties. She asserted that there are natural tendencies for people to be essentially defensive against any cultural imperialism that seeks to melt away their

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original religious and cultural identities. This is a defensive trait inherent in human condition. Fainstein (2011: 43) noted in contrast to liberal and Marxist theorists’ expectation that, ‘contrarily, globalisation intensifies particularistic commitments as a consequence of reactions to alleged cultural imperialism’. Thus, globalisation through its awareness creation ultimately strengthens religious, cultural, and social identities which in turn establish stronger place-based meanings of healthy food. In other words, people could instead take seriously the need to preserve their place-based meanings of healthy food enmeshed in the culture (Italy for Mediterranean diets), religion (Philippines for the consumption of meat for Catholic religious practices), and society in general when feeling threatened by global trends. For this reason, viewing the world through a dialectic lens of place and space invites a more processual and complex picture of the nature of things. While this suggests that pathways to a healthy food future are complex, this should not be seen as a message of panic, despair or any sort of pessimism. Rather, we must celebrate the fact that it levitates us to see the tremendous role inclusion plays in shaping a healthier and more sustainable food system transformation. Therefore, priority should not be placed either on just space or place but both in search of pathways that can transform the global food system into a healthier and more sustainable one.

Comparing Understandings of Health and Unhealth Between Rural and Urban Considering the rural–urban dialectics in the case studies of this book, it is worth noting that the only rural region was the Eastern Visayas region of the Philippines. As a result, we cannot cite many rural cases to use in an extensive comparison with the urban region regarding meanings of healthy/unhealthy food. Notwithstanding, the meanings of healthy food in the rural region of Eastern Visayas exhibited patterns that are typical of rural areas. This varied substantially from our observation in the urban areas in the other cases. For instance, responding to the question of, ‘what is the future of healthy food?’, people of Eastern Visayas mentioned growing their own food more often than in the other cases. Being aware of the abundance of canned and junked food, they believe that growing their own food is the best way to escape the unhealthy reality of canned foods. Thus, the growing of own food and vegetables as a suggested recommendation is facilitated by the abundance of vast land available for planting food crops—land which is often in short supply in urban areas. Also, the understanding of meat as healthy is much stronger in the Philippines than in the other cases where meat is mentioned as healthy food. In contemporary times, the urban region depends very much on the rural for food. This is the case of the Eastern Visayas region where lower-middle-households in the rural areas have been the backbone of abundant pork supply which sustains celebrations. Some participants in the Philippines recount that they receive pork for celebrations from their families

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in the areas who raise their own pigs. These rural populations manage to supply pork in abundance because of relatively easier access to space (even in their backyards) needed to raise their own pigs. It can be inferred that without the rural areas—by their advantage to so much space, access to abundance of meat for their celebrations could have been challenging. By virtue of their access to space to raise animals for celebrations, it can be inferred that cultural traditions which prioritise meat-eating are much stronger in rural areas than in urban areas. This important use of meat for celebration in rural Philippines signifies one’s gratitude for the blessings received (Valdez 2014) and would probably not be as significant in urban environments. Therefore, the vision of healthy food varies along the lines of rural–urban dialectics. For the rural population, growing own food gives them the leverage over organic food because of the relatively large access to land for food production. However, the limited space in urban areas for food production could possibly make urbanites to resort to less healthy food practices. These differences could also be linked to the relatively less mention of money as a key barrier to a healthier food future in the Philippines. While people in other more urban cases see financial resources as key to obtaining food, people in the rural areas of the Philippines see growing own food as key to a healthier food future. They might not have financial resources, but they have land. In this rural setting, all that could be needed is the will to farm and not money to buy food. The urban–rural dialectics shows that a major difference exists between the rural and urban regions—the ability to buy healthy food by improved access to money (urban) and growing own food because of their access to space. Nonetheless, although significant differences have been observed between the case of the Philippines and the other urban cases, the more rural case of the Eastern Visayas (Philippines) alone is not sufficient to draw major conclusions about the rural–urban dialectic in understandings of healthy and unhealthy food. The observed differences are not exhaustive of all the possible relationships between the rural and urban regions and meanings people hold about understandings of healthy food and visions. Therefore, it will be beneficial for further research to include more case studies in rural settings in order to significantly compare rural and urban areas.

Conclusion Looking beyond simply recognising the diversity in meanings of healthy and unhealthy food, the findings of this book also seek to foster inclusion. Inclusion, in turn, promotes social sustainability. Diversity and inclusion are key concepts within current debates on sustainability. Sustainable development, defined in 1987 by the Brundtland Report as development that meets the needs of the present without compromising the ability of future generations to meet their own needs, is now more important than ever (Brundtland Report 1987). The widespread and generally agreed understanding of sustainable development contains three dimensions which include: the ecological, the social, and the economic. These components are consistent with the notion of the triple bottom line of sustainability: people, planet, and profit (Pava

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2007). Although the sustainable development paradigm has been put forward in the last 30 years or more as a panacea for the socio-ecological crisis the world is facing, the ‘people part or the social’ is often the most downplayed component in talk about sustainability. At the same time, however, there is broad agreement that the global economy needs more inclusive growth (Scholz and Brandi 2020). To put this more vividly, we turn to Raworth’s (2017) doughnut economics. In ‘Doughnut Economics; Seven Ways to Think Like a 21st -Century Economist’ (Raworth 2017), the model represents the state of humanity in a single image (Raworth 2017, p. 51). The hole at the Doughnut’s centre reveals the proportion of people worldwide falling short on life’s essentials, such as food, water, health care, and political freedom of expression—and according to Raworth, a big part of humanity’s challenge is to get everyone out of that hole. At the same time, Raworth argues that we cannot afford to be overshooting the Doughnut’s outer crust if we are to safeguard Earth’s life-giving systems, such as a stable climate, healthy oceans, and a protective ozone layer, on which all our well-being fundamentally depends. According to Raworth, humanity’s twenty-first century biggest goal and challenge are to get into the Doughnut’s safe and just space between these social and planetary boundaries. In Raworth’s doughnut, inclusion is seen as the key to preventing a shortfall into the middle of the doughnut. It ensures that everyone has a fair access to social equity, energy, water, food, health, education, and above all, representation in all domains of public life—including the foodscape. I see this book through a recognition and celebration of the diversity in the global visions of healthy and unhealthy food as a step towards drawing people away from the middle of the doughnut as suggested by Raworth (2017) to the safe centre—inclusion for sustainability. Notwithstanding, how can we link recognising diversity in meanings and understandings of what is healthy and unhealthy to inclusion in social sustainability? The answer to this question lies in an often underestimated or undervalued concept— recognition justice. Recognition justice is about recognising that different people need, want, value, or expect different things at different times and for different purposes (Douglas 2020). When we recognise others and their different views and values, we facilitate social interactions and this helps in holding society together. Here, there is the need to view difference in a positive light. In other words, the key to social justice is finding how we as a society can maximise positive recognition and minimise negative recognition. Despite laudable progress which has been made in the domain of social inclusion globally, marginalisation and exclusion continue to happen. One approach that has not gathered sufficient attention in academic and policy circles especially is to understand acts of injustice or exclusion in terms of recognition. According to this approach, exclusion is fear and ignorance, but mostly it is a misrecognition of another human that denies that person is worthy of ethical consideration. Scholars such as Hegel (2014), Habermas (2018), and Honneth (1992) have written about the role of recognition in social relations and politics. Honneth in particular has written extensively about the human need to be accepted and valued by others (despite differences in values) and that being recognised by others is essential for all persons to develop a positive relation to themselves and others. This is inclusion and recognition

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should be seen as the first step to inclusion. In order to build an inclusive society, we need to first recognise that people are different and have different values. This recognition of difference should be seen in a positive light because negative recognition can be counter-productive—leading to prejudice and exclusion instead. Positive social recognition norms are the foundation to a socially just and inclusive society. Social inclusion requires equal participation in social institutions like education and government but also, and importantly, in the social conversation about our values. According to Douglas (2020), what and who we value and who we include in and exclude from the rights and privileges of our society define social justice. Therefore, framing social issues in the context of recognition can humanise complex issues that too often are considered only in the abstract or as political conflicts. To recognise that we think differently as people concerning a core issue such as food, is an essential ingredient of a just society. In this book, one key lesson that can be learned is that recognising and celebrating diversity in global visions of what is healthy and unhealthy food can enable us to confront and deal with some of the unconscious biases we harbour about what or how the rest of the world is eating. In other words, the implicit biases created by seeing the world only from our own world view, as well as the perpetuation of negative stereotypes about eating habits of people from other countries, can become explicit. Furthermore, while in the global West, people commonly think that healthy food is expensive and you need to be rich in order to be able to eat healthy food, in some lower-income countries, being rich drives people into eating more unhealthily. In Chap. 9, this book shows how being rich in India (and perhaps the same in other low-middle-income countries) can be a curse because it exposes people to usually unaffordable unhealthy foods. The moral of this book from these experiences is that one rule does not fit all and the terms healthy or unhealthy in the domain of food can be very relative depending on all the reasons that the chapters in this book have been able to present. This comes out especially in the contradictions surrounding what is unhealthy and unhealthy food from place to place and across space.

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