Food and Health: Actor Strategies in Information and Communication 9781786302625, 1361391391, 1786302624

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Food and Health

Health Information Set coordinated by Céline Paganelli and Viviane Clavier

Volume 2

Food and Health Actor Strategies in Information and Communication

Edited by

Viviane Clavier Jean-Philippe De Oliveira

First published 2019 in Great Britain and the United States by ISTE Ltd and John Wiley & Sons, Inc.

Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may only be reproduced, stored or transmitted, in any form or by any means, with the prior permission in writing of the publishers, or in the case of reprographic reproduction in accordance with the terms and licenses issued by the CLA. Enquiries concerning reproduction outside these terms should be sent to the publishers at the undermentioned address: ISTE Ltd 27–37 St George’s Road London SW19 4EU UK

John Wiley & Sons, Inc. 111 River Street Hoboken, NJ 07030 USA

www.iste.co.uk

www.wiley.com

© ISTE Ltd 2019 The rights of Viviane Clavier and Jean-Philippe De Oliveira to be identified as the authors of this work have been asserted by them in accordance with the Copyright, Designs and Patents Act 1988. Library of Congress Control Number: 2019936605 British Library Cataloguing-in-Publication Data A CIP record for this book is available from the British Library ISBN 978-1-78630-262-5

Contents

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

xi

Viviane CLAVIER and Jean-Philippe DE OLIVEIRA Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

xiii

Viviane CLAVIER and Jean-Philippe DE OLIVEIRA Part 1. Public Space and Communication and Legitimization Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1

Chapter 1. Food as a Public Health Problem: Convergences and Divergences of Public and Private Actor Games . . . . . . . . . . . . .

3

Sylvie BARDOU-BOISNIER and Jean-Philippe DE OLIVEIRA 1.1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.2. The “crisis of confidence” in the agri-food industries . . 1.2.1. Food and fear . . . . . . . . . . . . . . . . . . . . . . . 1.2.2. A generalized crisis of agri-food companies and their communication policies . . . . . . . . . . . . . . . . . . 1.2.3. An evolution in consumer food practices . . . . . . . 1.3. Food as a public health issue. . . . . . . . . . . . . . . . . 1.3.1. Organizations and the emergence of a societal issue 1.3.2. Constituted audiences and opinion leaders . . . . . . 1.4. The PNNS: communication and actors’ logic . . . . . . . 1.4.1. A consensus on the need for regulation . . . . . . . . 1.4.2. The PNNS as a framework for the State: better production for better communication? . . . . . . . . . . . . 1.5. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.6. References . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Chapter 2. From Controversy to Media Controversy: Analysis of Communication Strategies Concerning the Health Risk of Growing Limousin Apples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

29

Christelle DE OLIVEIRA and Audrey MOUTAT 2.1. Introduction . . . . . . . . . . . . . . . . . . . . . . . 2.2. The Limousin apple at the heart of a controversy 2.3. Unbalanced communication strategies . . . . . . . 2.4. From controversy to media controversy . . . . . . 2.5. Conclusion . . . . . . . . . . . . . . . . . . . . . . . 2.6. References . . . . . . . . . . . . . . . . . . . . . . .

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Chapter 3. Naming “Antibiotic-Free” Meat: American Agri-Food Industry Communication between Commitment and Guaranteeing Food Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Estera BADAU 3.1. Globalization of the antimicrobial resistance problem and diversification of action programs . . . . . . . . . . . . . . . . 3.2. A variety of formulas to name “antibiotic-free” meat in the United States . . . . . . . . . . . . . . . . . . . . . . . . 3.3. Problematization, hypothesis and methodology . . . . . . . . 3.4. Stages of progressive communication . . . . . . . . . . . . . . 3.4.1. The voluntary approach . . . . . . . . . . . . . . . . . . . . 3.4.2. First naming attempts . . . . . . . . . . . . . . . . . . . . . 3.4.3. Commitment through action . . . . . . . . . . . . . . . . . 3.5. Emergence and use of the no antibiotics ever and no/without medically important antibiotics formulas . . . . . . . . . . . . . . . 3.5.1. Private industry’s claim and takeover of an institutional formula . . . . . . . . . . . . . . . . . . . . . . . . 3.5.2. Brand commitment and guarantee of food safety . . . . . 3.6. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.7. Appendix. Methodological aspects: corpus building . . . . . 3.7.1. The press corpus compiled for our thesis work . . . . . . 3.7.2. Constitution of the corpus for this chapter . . . . . . . . . 3.8. References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Chapter 4. From Health Responsibility to Ethical Responsibility: The Legitimization of New Vegetable Experts in France . . . . . . . .

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Clémentine HUGOL-GENTIAL, Sarah BASTIEN, Hélène BURZALA and Audrey NOACCO 4.1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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4.2. Expert nutritionists and the gradual erasure of the traditional expert figure . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.3. Dissemination of the socio-ecological discourse on vegetables: the dissolution of journalistic discourse in favor of “ethical” value . 4.4. Chefs and culinary experts: from the acceleration of public authorities’ health discourse to an integrative discourse on ethics . . 4.5. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.6. References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Contents

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Part 2. Education and Prevention: A Critical Approach to Discourses and Dispositives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Chapter 5. Food at School: Between Science and Norm . . . . . . . .

99

Simona DE IULIO, Susan KOVACS, Christian ORANGE, Denise ORANGE-RAVACHOL and Davide BORRELLI 5.1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.2. Using scientific expertise to achieve public policy . . . . . . . . 5.2.1. Public policy on food education: strategic use of studies and statistics on obesity and overweight . . . . . . 5.2.2. The “Food Education” page of the Éduscol web portal: rewriting technocratic science . . . . . . . . . . . . . . . . . 5.3. Food pedagogy and the challenge of school interdisciplinarity 5.3.1. Promoting interdisciplinarity across school subjects . . . . 5.3.2. Interdisciplinarity in teachers’ discourse . . . . . . . . . . . 5.4. Food pedagogy and food communication dispositives: applied or normative science? . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.4.1. In praise of applied science: food in school textbooks . . . 5.4.2. Playful science as a means to promote eating behaviors . . 5.4.3. When students take on the role of statisticians: relaying technocratic science . . . . . . . . . . . . . . 5.5. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.6. References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Chapter 6. Info-educational Dispositives to Educate Children about Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

129

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Marie BERTHOUD 6.1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . 6.2. Educating about the nutritional model . . . . . . . . . 6.3. Designing info-pedagogical dispositives to educate about nutrition in schools . . . . . . . . . . . . . . . . . . . 6.3.1. The association of multiple professionals . . . . .

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6.3.2. A homogeneous production . . . . . . . . . . . . . . . . . . 6.4. Adapted national dispositives . . . . . . . . . . . . . . . . . . . 6.4.1. “Léo and Léa”: info-educational dispositives for schools 6.4.2. A tool belonging to national public institutions . . . . . . 6.4.3. A tool to mobilize children . . . . . . . . . . . . . . . . . . 6.5. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.6. References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Chapter 7. Communication and Nutrition: The Clinician’s Point of View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

151

Anne-Laure BOREL 7.1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.2. The physiology of eating behavior and its dysfunction in terms of obesity . . . . . . . . . . . . . . . . . . . . . . . . . . 7.3. The “confusiogenic” effect of communication on nutrition among obese people . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.4. The danger of increasing the stigmatization of obese people through communication on nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.5. The danger of increased eating disorders through nutrition communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.6. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.7. References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Part 3. Information, Food and Health: Consumers’ and Patients’ Points of View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

161

Chapter 8. Information Resources and Information Practices in the Context of the Medicalization of Food . . . . . . . . . . . . . . . . . . . . . 163 Viviane CLAVIER 8.1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.2. Taking context into account in the study of information practices and information resources . . . . . . . . . . . . . . . 8.2.1. The medicalization of food . . . . . . . . . . . . . . . 8.2.2. From nutritional information to the nutritionalization of knowledge . . . . . . . . . . . . . . . . 8.2.3. Three social logics in the health sector . . . . . . . . 8.3. More diversified information practices than in the health field . . . . . . . . . . . . . . . . . . . . . . . 8.3.1. Targeted and intentional practices . . . . . . . . . . . 8.3.2. Floating and unintentional practices . . . . . . . . . .

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171 172 174

Contents

8.4. Sources of information and forms of medicalization of knowledge . . . . . . . . . . 8.4.1. Nutrition professionals as resources . 8.4.2. Food in health discussion forums . . 8.5. Conclusion . . . . . . . . . . . . . . . . . . 8.6. References . . . . . . . . . . . . . . . . . .

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Chapter 9. Labeling for Sustainable Food: The Consumer’s Point of View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

189

Anne LACROIX, Laurent MULLER and Bernard RUFFIEUX 9.1. The potential role of labeling in a sustainable food perspective . 9.2. Data collection techniques . . . . . . . . . . . . . . . . . . . . . . . 9.2.1. Observing information behaviors when purchasing . . . . . . 9.2.2. Defining priorities for information . . . . . . . . . . . . . . . . 9.2.3. Identifying opinions and beliefs . . . . . . . . . . . . . . . . . 9.2.4. Assessing expectations. . . . . . . . . . . . . . . . . . . . . . . 9.3. Limited use of information when purchasing . . . . . . . . . . . . 9.3.1. Consultation of a small part of the available information . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.3.2. Price and origin: major benchmarks . . . . . . . . . . . . . . . 9.3.3. Influence of education and income levels on the use of information . . . . . . . . . . . . . . . . . . . . . 9.3.4. Diversified benchmarks for sustainable food. . . . . . . . . . 9.4. A widely shared desire for more information . . . . . . . . . . . . 9.4.1. A significant demand for information from less well-off consumers . . . . . . . . . . . . . . . . . . . . . . . . . . 9.4.2. Packaging: a favored material . . . . . . . . . . . . . . . . . . 9.4.3. Priorities for clarification information on packaging . . . . . 9.5. Opinions expressing beliefs and mistrust . . . . . . . . . . . . . . 9.5.1. Origin, a vector of beliefs on sustainable food . . . . . . . . . 9.5.2. Mistrust towards all actors in the food chain . . . . . . . . . . 9.5.3. Simpler and more practical labeling . . . . . . . . . . . . . . . 9.5.4. A plea for comprehensive information . . . . . . . . . . . . . 9.6. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.6.1. From desired information to the information used . . . . . . 9.6.2. Sustainable food from a consumer point of view . . . . . . . 9.7. Implications for stakeholders . . . . . . . . . . . . . . . . . . . . . 9.8. Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.8.1. Appendix 1. Screenshot of the online experiment . . . . . . . 9.8.2. Appendix 2. Screenshot of the face-to-face survey . . . . . . 9.9. References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Chapter 10. Social Appropriation of “Diet and Health” Information: From Public Health Campaigns to Digital Tools . . . . . . . . . . . . . .

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Faustine RÉGNIER 10.1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . 10.2. Dissemination and appropriation of “diet and health” information in public health campaigns . . . . . . . . . . . . . 10.2.1. Dissemination of general information . . . . . . . . 10.2.2. General information: socially unequal reception . . 10.3. “Diet and health” information and personalized digital tools: issues and shifts . . . . . . . . . . . . . . . . . . . 10.3.1. Customization tools: are they effective media? . . 10.3.2. First lessons: plural shifts and appropriations of information via digital technology . . . . 10.4. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . 10.5. References . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Postface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

239

David DOUYÈRE List of Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Preface

This book is the second volume in a series entitled “Health Information”, edited by Céline Paganelli and Viviane Clavier. This series is part of the “Health Engineering and Society” collection proposed by Bruno Salgues. Each book is the subject of a specific editorial project, designed in close collaboration with the book editors1. This book focuses on the link between food and health, and proposes 10 contributions that address the info-communication practices, issues and strategies of actors related to food as a public health problem. It is the result of a call for contributions. The published chapters were evaluated twice blindly, first as a summary and then as full chapters. We would like to thank the members of the reading committee: – Sylvie BARDOU-BOISNIER, Lecturer in Information Communication Sciences, Gresec, Université Clermont Auvergne;

and

– Fausto COLOMBO, Professor of Communication and Media at the Faculty of Political and Social Science, Università Cattolica del Sacro Cuore, Milan (Italy); – Alexandre COUTANT, Professor of Communication in the Department of Social and Political Communication, Université du Québec à Montréal (UQAM); – Laurent MORILLON, HDR Lecturer in Information and Communication Sciences, Lerass, Université de Toulouse;

1 We also wish to thank Laure Sterchele for her editorial assistance.

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– Stéphane OLIVESI, Professor of Information and Communication Sciences, CHCSC, Université de Versailles Saint-Quentin-en-Yvelines; – Caroline OLLIVIER-YANNIV, Professor of Information and Communication Sciences, Ceditec, Université Paris-Est Créteil (UPEC); – Roxana OLOGEANU-TADDEI, HDR Lecturer in Information and Communication Sciences, Montpellier Recherche en Management (MRM), Université de Montpellier; – Céline PAGANELLI, HDR Lecturer in Information and Communication Sciences, Lerass-Céric, Université de Montpellier 3; – Isabelle PAILLIART, Professor of Information and Communication Sciences, Gresec, Université Grenoble Alpes; – Jocelyn RAUDE, HDR Lecturer in Sociology, École des hautes études en santé publique (EHESP); – Adrian STAII, Professor of Information and Communication Sciences, Université Jean Moulin Lyon 3. Viviane CLAVIER Jean-Philippe DE OLIVEIRA March 2019

Introduction

This collective work brings together contributions to present theoretical reflection, case studies or feedback on food and health, from an informational and communicational perspective. Food and health are closely linked, identified since antiquity, and are still the subject of active research in several disciplines (medicine, history, sociology and anthropology, management, marketing, etc.). Concerning information and communication, many publications on the subject have aimed to analyze the impact of information and communication media on food-related norms and practices, limiting their analysis to a particular dispositive without taking into account the social logics in which they are embedded and the multifactorial, sometimes contradictory and often “cacophonic” decisive features that participate in the reception of nutritional messages. Research work thus approaches info-communication dispositives according to an operational and instrumental approach, and is based on the premise that they necessarily induce effects, both in terms of norms of thought and behavior. The book aims to shift the questioning and looks at the relationship between food and health at different levels. Thus, rather than questioning the “how to do” for preventive communication to be effective or to provide reliable and transparent information to consumers1, we suggest a more global approach by: – identifying and locating the mobilized actors in relation to food and health issues; Introduction written by Viviane CLAVIER and Jean-Philippe DE OLIVEIRA. 1 Although legitimate, these expectations are based more on the analyses of communication professionals than on researchers in information and communication sciences.

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– considering their discourses in relation to their actions, strategies and practices; – characterizing published and unpublished content using clear typologies of information produced and disseminated. Our contribution lies in the analysis of the conditions of producing health-related information and considers the discourses and actors’ strategies as a positioning that corresponds to that of other actors. It is impossible to understand, for example, the journalistic approach to the subject of food without linking it to the activism of scientific “whistleblowers”, to the activity of public institutions concerned with food or to that of consumer and environmental associations. Without this insight, the analysis would risk reducing the importance of the actors involved in the political and social framing of the subject for the benefit of journalists, who, it is true, by the way they treat the subject, give it a new legibility. These more general considerations make it possible to understand that the messages produced respond to diverse and sometimes contradictory information and communication issues. The aim of this book is to provide a broader and global vision of info-communication practices, issues and actors’ strategies related to food as a public health problem. The book’s contributions focus on current topics on nutrition that raise health issues: specific food categories (e.g. vegetables, apples, dietary supplements), specific diet-related conditions (e.g. obesity), diet or dietary risk (e.g. antibiotics in meat or fish, pesticides in fruits and vegetables). All the following chapters also make it possible to identify the “experts” who contribute to outlining and defining the challenges of “healthy food”. In this respect, expertise is more than ever “polyphonic”, to borrow an expression by sociologist Francis Chateaureynaud. The hierarchy of the knowledge of researchers, professionals or community activists is difficult to establish for the public (consumers, patients, eaters). This had led to a sense of disorientation in terms of information, especially since at the individual level, expertise can come from relatives. At the level of collective audiences (whether or not they are targeted by the discourses produced), expert figures are legitimized by representatives such as the media, manufacturers, public authorities (through, in particular, the mandated expertise of researchers who guide successive national nutrition and health programs), or opinion leaders such as high-profile chefs. Beyond expert figures, it is also the translation of informative statements that can be questioned, particularly in the field of

Introduction

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education. Thus, some contributions focus on the forms of organization of research for the dissemination of scientific information on nutrition and the diversity of media that are mobilized upstream, thus showing how food discourses are constructed and circulated. In this perspective, this book raises a number of questions. To which issues and social constructs do communication messages respond, driven by the many food actors who consider food as a health factor? How do information sources for the public (general or specialized press, documentation for education, public health information portals, etc.) reflect the diversity of enunciative sources and pragmatic aims? What are the informational strategies used by consumers to evaluate the information available and on what criteria do they base their confidence? More broadly, how do individuals learn about nutrition and how does the health factor influence this practice? In order to structure the answers provided by 10 original contributions, the book has been organized into three parts. The first part brings together contributions that analyze different configurations structuring the power relations between actors in the food sector: agri-food industries, researchers, consumers and activist associations, public institutions and the media. Sylvie Bardou-Boisnier and Jean-Philippe De Oliveira address the issue of food from the perspective of creating a public problem. The study highlights both the actors and contextual elements that have contributed to its emergence and politicization, as well as the communication strategies implemented by actors to position themselves in relation to the problem. Christelle De Oliveira and Audrey Moutat are interested in the media coverage of the claims by local residents’ associations regarding pesticides used locally in apple production. Through this case, the contradictory strategies of the actors involved locally and nationally are analyzed, as well as the biases introduced by the media when processing the conflict. Clémentine Hugol-Gential, Sarah Bastien, Hélène Burzala and Audrey Noacco propose an analysis of the journalistic treatment of “vegetable” food in the media and the expert figures convened, which direct information towards a set of values gravitating around health (well-being, pleasure, territory, gastronomy), which ultimately contribute to the framing of “food” in the media, in general. Finally, Estera Badau, using the case of meat without antibiotics, highlights how the agri-food industry in the United States is adapting its communication strategies to the trends of

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consumers concerned about a healthy diet and the Health Agency’s injunctions. It thus offers a point of view on the subject across the Atlantic and highlights similarities between the United States and France. The second part focuses on structures identified as key places for communicating information on food and nutrition: schools and hospitals. This contribution, written by Simona De Iulio, Susan Kovacs, Christian Orange, Denise Orange-Ravachol and Davide Borrelli, by studying the case of primary schools in three European countries – Belgium, France and Italy – observes the way science is mobilized in food education programs. The chapter proposed by Marie Berthoud also deals with nutrition education in schools and focuses more specifically on the “Léo and Léa” teaching booklets, developed by the French National Institute for Prevention and Health Education (INPES, Institut national de prevention et d’éducation à la sante) and a committee composed of doctors, nutritionists and teachers. This second part ends with the feedback of Anne-Laure Borel, a university professor and hospital practitioner, endocrinologist, diabetologist and specialist in nutrition at the université Grenoble Alpes and the centre hospitalier universitaire Grenoble Alpes. Through her experience as a clinician, the author of this testimony shows the difficulties encountered by patients suffering from eating disorders and identifies forms of stigmatization related to nutritional communication for obese people. Finally, the third part focuses on the expectations, practices and conditions of individual resources – whether consumers or patients – in terms of information on healthy eating. Viviane Clavier identifies the specific features of information resources and information practices in a context of strong medicalization of food, and presents the common points and differences with health information seeking. Anne Lacroix, Laurent Muller and Bernard Ruffieux, all three researchers at the laboratoire d’économie appliquée de Grenoble (GAEL), offer an overview of the results of a large-scale survey conducted on the most appropriate labeling methods for food products. This survey was in relation to consumers’ expectations and purchasing practices. This contribution attaches importance to the lowest incomes and the most disadvantaged populations, considered less receptive to information. Finally, Faustine Régnier looks at the digital devices set up by Santé publique France, as part of the French National Nutrition and Health program (PNNS), and analyzes the limits of such a strategy in relation to the stated objective of reaching less well-off population groups, and thus reducing health inequalities.

Introduction

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The link between food and health is, as Annie Hubert points out, an “ancestral” issue, and it is not so much on this evidence uncovered by food historians and sociologists that we wish to insist on, but on the way in which information and communication are convened. Whatever the subjects we are studying, the contributions in this book identify the common points, the breaking points or, more generally, the structuring elements of food and health that can be revealed through information and communication.

PART 1

Public Space and Communication and Legitimization Strategies

Food and Health: Actor Strategies in Information and Communication, First Edition. Edited by Viviane Clavier and Jean-Philippe De Oliveira. © ISTE Ltd 2019. Published by ISTE Ltd and John Wiley & Sons, Inc.

1 Food as a Public Health Problem: Convergences and Divergences of Public and Private Actor Games

1.1. Introduction “The mad cow crisis is a revealing one.” These remarks by sociologist Jean-Pierre Poulain [POU 02, p. 37], referring to the population’s sensitivity to the conditions under which animals are raised for food purposes – including slaughter methods – show the links between food, health and the public: the mad cow “issue”, like many others subsequently, has indeed crystallized and highlighted an apparently pre-existing mistrust towards manufacturers. If, today, both industrial and public actors spontaneously and unanimously refer to a “crisis of confidence”, it should be recalled that food has always been a concern of the “Homnivores” that we are and an object of power over the centuries [POU 02]. Many scientific contributions dealing with the relationship between marketing and nutritional norms are oriented towards an analysis of the impact of agri-food industry communications on food practices. These analyses are often based on the premise that marketing creates need, ignoring debates that question the scientific validity of such an influential advertising power on behavior [MAR 04, SAN 06]. Others establish a causal link between state communication via measures promoted by the French National Nutrition and Health Program (PNNS, Programme national nutrition santé) and the norm that guides the eating habits of consumer Chapter written by Sylvie BARDOU-BOISNIER and Jean-Philippe DE OLIVEIRA.

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citizens. However, the sociology of food or health has produced work that makes it possible to analyze communication as supports for objectification, taking into account at least two major trends: – the social question of the link between diet and health has emerged in a context of “medicalization” of society. Presented by Didier Fassin as a social construction, the medicalization of society “consists of conferring a medical nature to representations and practices that were not previously socially understood in these terms. It is above all the redefinition of an existing problem in a medical language” [FAS 98]; – based on Jean-Daniel Reynaud’s work on the norm, Jean-Pierre Poulain points out that the food sector is subject to “anomie”, that is, the loss of legitimacy for consumers of normative dispositives that lay down rules and procedures to be followed, which, in addition, refers to an “inflation of contradictory injunctions” [POU 02, p. 53; POU 02, p. 71] and to practices that contradict internalized values [POU 02, p. 65; POU 02, p. 89]. These contributions raise two major questions. If medicalization “becomes a social phenomenon, when the recognition of the problem as pathological is coupled with its inclusion in the collective space [and] takes on a political dimension” [FAS 98, p. 07], what are the elements that have allowed the emergence and development of the question of food as a public health problem? The second question refers to the one raised by Jean-Pierre Poulain: starting from the observation that the discourses broadcast in response to citizens’ concerns about the quality of their food accentuate their concerns, he points out that “this situation leads manufacturers and political leaders to question sociologists on ‘how can we make consumers understand all the efforts we make?’” [POU 02, p. 79]. Our contribution does not aim to answer this type of operational question but information and communication sciences can nevertheless opportunely transform this request addressed to sociology by questioning the forms of governability underlying public communication related to food, as well as the interests of actors in the agri-food industry to proclaim themselves as “partners”. This new question leads to an approach that analyzes communication not as a “tool” aimed at inducing behavior, but as a revealing measure of actors’ “games” and the evolution of their positioning in relation to food. This question also leads to the observation that the media, on the one hand, and political actors, on the other hand, have raised consumers’ awareness of “food and health” (linked to the development of obesity, and also to

Food as a Public Health Problem

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cardiovascular diseases, among others), that they have only structured a problem already perceived by consumers (loss of “confidence”). In any case, “whistleblower” scientists, like the media, have received favorable reception from consumers in regard to the construction of food as a public health problem. Consumer practices thus appear to be an essential lever for the acceptance by agri-food manufacturers of government intervention in their sector. This point leads us to explore what the French National Association of Food Industries (ANIA, Association nationale des industries alimentaires) considers to be part of the “self-regulation” of agri-food industries: “The first filter refers to the manufacturers: they have their own rules of conduct, so they must discipline themselves” (interview with ANIA, February 23, 2017)1. After having presented in the first part the crisis that manufacturers have had to face and changes in consumption practices, we will see how they have contributed to the emergence of food as a public health problem and how they have structured decisions in terms of communication strategies aiming at restoring a relationship of trust between consumers and manufacturers. 1.2. The “crisis of confidence” in the agri-food industries Humanity’s fundamental anxiety about diet is as much motivated by a fear of being poisoned as by a fear of lacking something [POU 02]. The overwhelming supply of food offered by food manufacturers on the French market has erased most consumers’ fear of lacking something, but has given way to growing mistrust of food products due to recurrent scandals and health crises. The proliferation of television and radio broadcasts, press articles or published books dealing with the link between food and health

1 The data presented are based on semi-directive interviews conducted as part of a “young researcher” research project, funded by the University of Grenoble-Alpes in 2016 with nutrition and communication experts from the ANIA, the French National Food Council (CNA – Conseil national de l’alimentation) team, an expert from the French National Agency for Food, Environment and Work Safety (ANSES, Agence nationale de sécurité sanitaire de l’alimentation, de l’environnement et du travail) an expert from the “nutrition and physical activity” unit of Santé publique France, two communication agency directors specialized in health and nutrition (to whom we refer as Agency 1 and Agency 2) and a journalist who has specialized in nutrition for 20 years.

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convey anxiety-provoking messages2 to which better informed consumers are particularly sensitive. This situation may seem paradoxical, since monitoring the process of industrialization of the food chain by public authorities, as well as the consultation of agri-food industry actors, has been considerably strengthened since the early 2000s (interview with ANIA, February 23, 2017). 1.2.1. Food and fear During the 1980s and 1990s, various food scandals (hormone-doped calves in 1980, mad cow in 1996, dioxin-contaminated chickens in 1999) and health crises (diabetes, obesity) created anxiety among consumers about their diet. From the 1990s onwards, Hélène Romeyer noted that the themes covered by the media were “risk, the precautionary principle and scandal” [ROM 15, p. 45]. The health and nutrition theme is then overexposed on the media stage. The close link between diet and health is long-standing. However, fear of harmful food is relatively recent when we refer to the work of food historians [FER 02, FLA 97] who reported examples of collective fears related to famine or food consumption, as was the case for rye bread. This particular example – when infested by a fungus – triggered the ergot of rye, which had the specific feature of causing gangrene in the unfortunate consumer. The disease, after having been present for nearly 800 years without the cause being known, finally had its origin identified by the botanist Candolle during the 19th Century [FER 02, p. 185]. According to Gérard Pascal, a former INRA researcher and food safety specialist, a “good food” must have four functions: health, safety, satisfaction and service [PAS 02]. Each culture has favored over time one of the four functions. Currently, health and safety functions are a priority for consumers, as the fear of ingesting a toxic product is very much on their minds. Fear is not always based on reality or a level of risk, but rather on the subjective perception of a potential threat [ZAW 04, p. 279]. The increase in the population’s education level has enabled the consumer to move from being a simple eater to being an “informed, demanding and convinced consumer” [FER 02, p. 9]. However, food risks existed well before the 20th Century, so 2 Example of the special edition title of the “Aliments toxiques” series of the magazine 60 millions de consommateurs published in May–June 2018: “Ces aliments qui nous empoisonnent”.

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Jean-Pierre Poulain wished to emphasize the “invariant” nature of food anxiety in our relationship with food [POU 02, p. 83] and warns against a “short reading of history”, which triggered the food crisis with the mad cow affair: While this event is indeed a decisive moment when risk takes on a new form, both in its symbolic and real dimensions, historical analysis is full of stories of poisoning and food crises, the objective scope of which extends far beyond what we are experiencing. [POU 02, p. 78] According to historian Madeleine Ferrières, awareness of these risks also included “silent fears” [FER 02]. Major scientific advances in the field of hygiene and health have made it possible to show more clearly the role that diet plays in balanced health: During the 20th Century – following Claude Bernard’s discoveries on the role of the liver in the assimilation of sugars, and Louis Pasteur’s discoveries on microbes – doctors, biochemists, microbiologists and toxicologists joined forces to define the foundations of a diet that protects our health, to identify the dangers that await us on our plates and to minimize the risks of poisoning caused by tainted and contaminated food. [FEI 07, p. 13] The ingestion of food that was originally unclear due to the accelerated development of industrial food production in the mid-20th Century, stemmed by growing consumer anxiety [FIS 90]. The questions now being asked seem legitimate: where does food come from? What manufacturing processes took place before the food reached our plates? Should we adopt an alternative diet to meet our vital needs without putting ourselves in danger? A symposium organized in 20163 under the direction of Jean-Pierre Poulain, socio-anthropologist of food in charge of Food Studies at the University of Toulouse, addressed this theme: “Food: how can we restore consumer confidence?” During this conference, the main consumer concerns were identified: the lack of control of food safety by public authorities, 3 See Brigitte Bégue’s comments in Sciences et Avenir, available www.sciencesetavenir.fr/nutrition/alimentation-comment-restaurer-la-confiance-desconsommateurs_108343 (accessed May 8, 2018).

at:

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Food and Health

agricultural production models (pesticides, heavy metals), GMOs, the living conditions and slaughter of animals and basic products used by the industry (such as palm oil). The origin of the fears identified always refers to the same sources: repeated health crises since the 1990s, the media coverage of the so-called crisis, crisis detection tools (the health monitoring system), the dissemination of scientific information establishing a link between a product and a disease, the loss of credibility of expertise, the dissemination of documents by a whistleblower but largely ignored by the general public and daily investigations that reveal the truth about the backstage of the agri-food sector4. Paradoxically, better access to sources of information on food and dietetics (websites, blogs, TV programs and reports) and the increase of public health discourses (by public authorities, journalists), instead of reassuring consumers, create doubts and anxiety about a “food cacophony” [FIS 90]. However, if the relationship of trust between food manufacturers and consumers is deteriorating, it is not so much due to the increased media coverage of health scandals, but because of the reappearance of anguish linked to the complexity between food and health, which “is rooted in the fact that food is a source of energy, vitality, health, and at the same time, a vector of intoxication, a potential cause of disease and disorders” [POU 02, p. 85; POU 02, p. 89]. The media coverage of food crises is thus received by consumers according to ancient anthropological traits. In this regard, Olivier Brunel, Céline Gallen and Dominique Roux [BRU 13] describe the different appropriation tools that contribute to the implementation of the food consumption experience, depending on the degree of product development. Thus, they show that products increasingly close to the state of immediate consumption proposed by agri-food manufacturers cause the social function of food to disappear, in the sense that domestic tasks (peeling, cutting, cooking food) have been transferred to manufacturers. Thus, the consumer is deprived of the act of preparing food products that are ready to be consumed, but whose main processing steps are ignored. Claude Fischler already spoke in 1990 of “unidentified edible objects” [FIS 90]. Food products are more and more abundant and varied in France, but less and less successfully identified by consumers despite all the efforts made, particularly on product labeling. It is this anxiety-provoking aspect of food that communication 4 Cash Investigation broadcast on September 13, 2016 on France 2: “Le nitrite dans la charcuterie suspectée de favoriser le cancer”; Complément d’enquête broadcast March 13, 2014, on France 2: “La peur au ventre”.

Food as a Public Health Problem

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professionals use to promote the merits of certain foods (organic, food supplements, gluten-free foods, etc.) by adopting a serious discourse based on studies, research results, scientific discourses and evidence that the food produces the health effects sought by the consumer: The messages […] work very well on frail people such as those with weight problems, people with long periods of illness, malnourished elderly people, etc. These are niche markets, very good markets… We exploit a market of weakened consumers and companies are ready to do anything to attract these consumers […]. (Interview with Agency 2, October 10, 2016) Some communication consulting agencies partially erase anxiety (at the request of agri-food actors) by including reassuring elements in their messages (image of the food that they process, its naturalness, etc.) and a scientific discourse demonstrating all the virtues of the product and its various components: “We follow the iceberg strategy: we provide a lot of science and solid justifications while saying little” (interview with Agence 2, October 10, 2016). Products offered to consumers are controlled, validated and/or monitored by European5 and national public institutions. For example, in France, these are the Directorate-General for Competition, Consumer Affairs and Fraud Control (DGCCRF, Direction générale de la concurrence, de la consommation et de la répression des fraudes), for the verification of the quality of the product placed on the French market, or the French National Agency for Food, Environment and Work Safety (ANSES, Agence nationale de sécurité sanitaire de l’alimentation, de l’environnement et du travail) for the monitoring of label compliance. The validation of the product by public institutions gives it a certain level of credibility without recreating a relationship of trust with the consumer. More recent and multiple scandals have rather reinforced this attitude of mistrust (e.g. horse meat in lasagna distributed by Findus and produced by its subcontractor Comigel in 2013 or salmonella in infant milk manufactured by Lactalis in 2017), which has been accompanied by a more general crisis of confidence towards the industry and its communication policy. 5 The European Regulation No. 1169/2011 on consumer information on foodstuffs (INCO) entered into force on December 13, 2014. The INCO regulation updates, simplifies and clarifies labeling.

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1.2.2. A generalized crisis of agri-food companies and their communication policies It is necessary to deconstruct the idea that the media coverage of health crises and food scandals is the starting point for a public policy aimed at regulating and monitoring food purchasing, consumption and manufacturing practices. It has certainly been an accelerator for strengthening public action (the French Food Safety Agency, AFSSA, was created by the law of July 1, 1998) [NOL 15, p. 22], but other factors explain the significant position that food has now taken in France’s health policy. The multiplication of actors with sometimes converging or opposing issues and strategies has led to greater media exposure of this subject and to the urgent need to respond to public health problems. Madeleine Ferrières notes that a new food system began to emerge at the beginning of the 20th Century with the adoption of food laws in various Western countries, such as the United States, Switzerland and France [FER 02, p. 431]. There are two opposing approaches to food management: a minimalist approach that emphasizes individual responsibility in which the government has only an informant role towards the consumer and an interventionist approach that requires the government to control information and product quality. Food remains a private matter, and it is partly for this reason that the French government initially chose, before the establishment of the first national nutrition and health program (PNNS) in 2001, to let the market carry out its own work by adopting the first approach. On many occasions, food crises have given the State the opportunity to strengthen its position as an arbitrator and watchdog over agri-food companies, through framework tools or public monitoring bodies. However, it can be observed that a consensus in the interests of food processing companies – or working with them – is often sought to the detriment of consumer health. The excessive consumption of sugar in France is an illustration of this. The 2006–2007 national individual food consumption study (INCA 2)6 found that more than 4 in 10 French people exceeded the World Health Organization’s (WHO) sugar consumption threshold, while sugar is considered a food additive that can trigger serious diseases such as type 2 diabetes, obesity or cardiovascular disease. Both legislators and food manufacturers have recently taken this problem into account and have taken 6 Agence française de sécurité sanitaire des aliments (AFSSA), “Étude individuelle nationale des consommations alimentaires 2 (INCA 2)”, 2009.

Food as a Public Health Problem

11

action to reduce the sugar content of certain processed foods and beverages. For example, an increase in the soda tax was voted on in October 20177, to apply it to drinks containing too much added sugar. Similarly, manufacturers have strived to place on the market processed products with a much lower sugar content8. These efforts, although real and convergent, are not enough, because marketing arguments on the packaging of certain products which mention “no added sugar” can mislead the consumer as to the actual content of the product. Sugar levels are not hidden, as manufacturers must comply with state-imposed nutritional information requirements, but reading the label remains difficult for consumers, as neurobiologist Serge Ahmed points out (see note 9). Despite the many reports published on the health risks linked to sugar, the obligations on nutritional information and the efforts of some manufacturers regarding the level of sugar added to processed products remain very high in relation to the real needs of consumers. This is partly due to the very strong opposition of sugar lobbyists in Europe to adopt laws imposing sugar limits on food and to simplified labeling, which is supposed to help consumers choose food according to its fat, salt and sugar content. The persuasive power of lobbyists can be decisive if we refer to the decisions taken in 2010 by the European Food Safety Authority (EFSA), which had issued a report9, based on studies published by the agri-food industry. This report had considered that there was insufficient scientific evidence to set a reference threshold for sugar consumption. The freedom of action by the public authorities in this context has been very limited in the face of a financial strike force of lobbyists, who defend a product that is essential to the sustainability of their activities. Food is therefore a private matter, as well as a public and commercial one [DEI 15], as it is highly dependent on health policies developed by public authorities and the development strategies of agri-food professionals. The latter understood that their growth could only be based on a modification of their qualitative offers. Thus, in the early 2000s, advertising and promotion were at the heart of the food sales system, and the nutritional argument took precedence over “all others to ensure the promotion of food industry products” 7 An increase in the soda tax, which came into force in France on January 1, 2012, was voted on October 27, 2017, as part of the draft social security budget. 8 “Sucre, l’ennemi public”, 60 Millions de consommateurs, special issue no. 125S, p. 20, May/June 2018. 9 “Scientific Opinion on Dietary Reference Values for carbohydrates and dietary fibres”, European Food Safety Authority (EFSA), vol. 8, no. 3, p. 1462, 2010.

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[FEI 07, p. 198]. According to Pierre Feillet, former deputy president of the Institut national de recherche agronomique (INRA), the sums invested by agri-food companies in promotional campaigns were so large that messages pushing for the consumption of profitable products made it ridiculous for governments to promote nutritional education, which protects health. “Each sector finds its feet on the ground and appoints eminent nutritionists to promote the merits of the foods it sells. It is through some nutrients in food, […] that food is promoted” [FEI 07]. This very critical position regarding the influential power of marketing tools and communication campaigns deployed by food manufacturers, however, does not take into account the regulation of the food market imposed by French public authorities for more than 20 years. Since the 1990s, several studies have highlighted an image crisis of large agri-food companies, their communication and the “bankruptcy” of marketing models, which are increasingly being countered by consumer associations: So there are consumer groups and there are associations like 60 millions de consommateurs […]. On the doctors’ side, there is the act of “prescribing”; they are almost above their targets of getting people back on the right track. I think these are extremely important safeguards. This forces the industry to be more attentive, beyond the fact that there is significant legislation. But it also allows us to benefit from a better quality diet. (Interview with Agency 1, May 18, 2016) Communication professionals (advertising agencies, consulting agencies) have themselves questioned the content of messages promoting the benefits of agri-food products. Tensions between the objectives of food manufacturers and the practices of communication professionals have arisen. Professionals are also confronted with ethical principles and must reconcile the customer’s demands (advertiser in the agri-food sector) and their personal ethics: We are working on different projects with the Danone Institute, Elior, etc. And I sometimes find myself at odds with the demands that the manufacturer can make… For example, I was approached by a laboratory that sells food supplements, […] which would allow us to give “chocolate bars” to certain

Food as a Public Health Problem

13

gentlemen and to us, the women, to lose weight while sleeping. They consulted me because I work a lot with nutrition paediatricians and they wanted to offer a dietary supplement to prevent childhood obesity. I told them, “Where do you get your evidence from to say that?” and we stopped there. (Interview with Agency 1, May 18, 2016) We note that this lack of ethics is also noted by Agency 1, which is both a communication consulting agency and a research and development company at the service of manufacturers: Some agri-food companies do not have an ethical principle about the products they distribute. Rather, they have a short-term vision. When some of our advisors return to ethics in their dealings, particularly with regard to allegations accompanying the sale of a product on the market, some companies refuse to follow our advice and decide to change agencies to the detriment of legislation… So, even if some agencies agree to go along with the manufacturers, it can backfire on them and on the manufacturers themselves. The ARPP10 must constantly monitor the market and the advertisements broadcast, and it is therefore up to the agency to properly carry out its role as an advisor to avoid this type of inconvenience. (Interview with Agency 2, October 10, 2016) The crisis of consumer confidence is becoming widespread, as it is public actors and agri-food manufacturers as well as scientific nutritional experts who are criticized for the links and complicity established between them. The nutrition journalist interviewed agrees with this analysis: Studies have always been funded by manufacturers, just like drugs. They (manufacturers) put aside those that do not suit them and value others […]. That is why we do not believe in official discourse: it is dated, it is just general discourse. (Interview with a nutrition journalist, November 14, 2016) Marketing professionals are also highly criticized for the way they work with consumers to promote products known to be harmful. Today, we speak 10 ARPP: Autorité de régulation professionnelle de la publicité (French professional advertising regulatory authority).

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of an “industrial epidemic”, because of the close link established between certain diseases (cancer, diabetes, cardiovascular diseases) and marketing techniques [HAS 17], techniques that no longer seem to work on a category of consumers who are better informed and more attentive to the content of products offered by the agri-food industries. 1.2.3. An evolution in consumer food practices Food practices are complex and decisive features that food manufacturers must take into account. The paradox of a diet is that it causes health problems – because it can cause illness – and it also has multiple virtues for treating the body. The anxious nature of consumers towards a food considered harmful leads more and more people to adopt an alternative diet, also called in the United States, “food counter-culture” [FER 02], which seems safer because it is better controlled. Some consumers have therefore changed their dietary practices by adopting so-called alternative consumption patterns, which the food sociologist Claude Fischler calls “special diets” (e.g. meat free, gluten free, vegan diet, etc.) [FIS 90]. The individual does not consume this form of food to keep up with others, but rather to be happy and in good health. These changes in practices are taken into account by communication and R&D agencies, and also by companies in the agri-food sector, which offer products that best meet the market, as highlighted by Agency 1: We innovate […], which creates a new source of value, inventing new markets, increasing our profit opportunities. […] We work in a very limited niche market (natural products, products for children, such as Vitabio or Vita infantile, etc.). We are increasingly orienting our products towards being natural, towards unmodified products. So the products we offer to manufacturers offer a communication that is based less on health-related principles than on naturalness. (Interview with Agency 1, October 10, 2016) Food practices have therefore evolved according to repeated health scandals, and also according to other factors such as lifestyle changes and the multiplication of available communication media (information sites, the specialized press, etc.), which consumers consult from time to time to obtain information on raw or processed food products from manufacturers. Health

Food as a Public Health Problem

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and food journalists subject to information prioritization constraints also adapt to what reader-consumers expect, as mentioned by the nutrition journalist: Eating well is still a concern today that, for many people, seems to be becoming more and more complicated… The notion of healthy eating is relatively recent, however. […] A fundamental trend in the subjects covered is to be noted: organic is a “trend”. […] Ten years ago, we didn’t write articles on organic farming. Nor were there any articles on the ecological impact of meat or palm oil. […] There are now consumers who use the Internet… Before, all this information was found in magazines that were slightly specialized. (Interview with a nutrition journalist, November 14, 2016) The evolution of consumer practices for the purchase of food and their information practices, linked to a reactivation of food fears, is pushing manufacturers to reposition themselves both in terms of product offerings and the display of social values related to public health. Public authorities have also chosen not to remain inactive in the face of the societal issue of the proven link between food and health by setting up a national system to support good agri-food practices. 1.3. Food as a public health issue The PNNS, established in 2001, represents a benchmark and is often mentioned as a milestone in the construction of the food issue as a public health problem. The increase of state intervention in the field of food practices to the private sphere has been largely legitimized by scientific research, of which Serge Hercberg is the most emblematic figure as a whistleblower. He has helped to demonstrate and objectify the links between food and health as a social issue. The notions of demonstration and objectification are understood here in the sense that Peter Berger and Thomas Luckman [BER 14] give them about making a problem visible and, in a second step, making it a societal issue. While other subjects, such as antibiotic resistance [ARQ 16], remain confined to a technical-administrative sphere – for lack of “constituted audiences” [DEW 27] – the issue of nutrition has reached a more advanced stage of institutionalization, in which the State is now actively involved. What are the audiences (individuals or

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social groups) that have reinforced this demonstration by scientists of a request for State regulation on the issue of food and its objectification in the public debate? Has the visibility of the issue of food as a public health issue created a “foundation” for public authorities to use their actions and legitimize their intervention? 1.3.1. Organizations and the emergence of a societal issue First of all, it should be stressed that food has always been a political “object”, requiring arbitration and regulation – for example, to contain famines or epidemics. Moreover, in our so-called “advanced Western” societies, the 1970s were marked by a general crisis of public confidence in their representatives, experts and manufacturers. A “biopolitical” dimension of power is then strengthened, marked by the expansion of both the intervention of the State on subjects previously covered by the private sphere and the instruments mobilized, in order to renew the link with citizens (public communication, so-called “participatory” or consultation mechanisms) [LAF 12]. With regard to the question of food, two organizations, created almost 20 years apart, are representative of this evolution in the management of societal problems: the CNA and the ANIA. In May 1968, companies in the agri-food sector set up a union that brought together the various sectoral federations. The interests of sugar, chocolate and fat manufacturers were no longer defended only by their respective unions, but also by the ANIA; 18 federations were members through 23 regional associations. The objective presented by ANIA was to “maintain expert relations with administrations and elected officials, because [they] need to have a favored interlocutor who represents everyone”. They defined themselves as “one actor among others in the debate”, whose subjects were dealt with by five commissions structured around the themes of food and health, sustainable development, relationships with supermarkets, social relations, and R&D (interview with the CNA, February 23, 2017). Their main targets remain manufacturers and public authorities. In 1985, the French National Food Council (CNA, Conseil national de l’alimentation) was created, chaired and directed by an inter-ministerial secretariat. When it was created, the CNA’s mission was not to organize public debates on the subject (this was a new mission assigned in

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September 2017), but it was already included in the composition of the associations and the representatives of consumer associations. Representatives of civil society, including patients, food aid and environmental associations, were integrated into a separate association from 2016, alongside agricultural producers, processors, distributors, restaurateurs, employee unions in the agri-food industry, qualified persons and full members, such as the CNRS and INRA. The CNA’s employees define its role as “informing public decision-makers by formalizing opinions” which, after self-referral to an association (and approval by 2/3 of the members) or referral to one of the supervisory bodies, are drawn up in a three-step process: hearing experts, drafting, discussion and voting in plenary session with all the association. As the ANIA is an advisory body, its opinions – like those of the ANSES – do not engage the public authorities, but reflect a certain form of consensus between different actors on a subject related to food11. Other public authorities completed this configuration of actors involved in the food issue before the implementation of the PNNS. In addition to regulators related to free competition, claims and advertising, the State has a body at the national and regional level, via the Regional Health Agencies (ARS, Agences regionals de santé), responsible for implementing prevention and health education programs in various fields, in particular by managing communication campaigns. Created in the early 1970s as an association, the French Committee for Health Education (CFES, Comité français d’éducation à la santé), which became the French National Institute for Prevention and Health Education (INPES, Institut national de prévention et d’éducation pour la santé) in 2002 and has been integrated into the French Public Health Service (SPF, Santé publique France) since 2016, does not act as a mere operational actor, but also as an agency of expertise assuming an “advocacy” role aimed at persuading the relevant ministries to choose certain orientations related to health, education in general or the environment. Less independent than an agency such as the ANSES, this committee is nevertheless a key player in mediation, in the sense given by Paul Beaud, because it is composed of employees involved in the orientation, dissemination and implementation of a new social norm [BEA 85]. In this respect, it represents one of the “constituted audiences” particularly sensitive

11 In the event that the opinion could not be reached by consensus, the divergent opinions of the majority are presented in the appendix.

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to issues related to food and health12. The existence of these institutions, well before the widespread “crisis of confidence” in the 1990s and the development of the PNNS, served as a support for public constitution on the subject. 1.3.2. Constituted audiences and opinion leaders The researchers thus had important representatives at their disposal to support the demonstration and objectification of a problem that was still poorly or badly identified as a public health issue. These intermediaries within public institutions or consumer associations composed of employees, which Paul Beaud analyzed as “intermediary intellectuals” [BEA 85], benefit from an additional legitimacy through the concern of “consumer-citizens” regarding food-related issues. As we have seen, food purchasing practices are changing at the expense of “traditional” agri-food industries and are moving towards consumption that is more favorable to health (and to a certain extent also more favorable to the environment). The search for information is therefore more important and is accompanied by a requirement for transparency and reliability, in a context where manufacturers’ discourses are discredited (sometimes to the benefit of equally questionable sources). However, this development only concerns a certain category of the population, which is why a large number of the communication objectives set by the PNNS involve raising awareness among the less well-off populations, with inconclusive results (see Chapter 10). However, the categories of the population that face difficulties when changing their eating habits or developing informational practices remain in need of maximum information, so that experts (scientists and consumer associations in some cases) can use it to carry out warnings, as shown by the GAEL study on consumer expectations in regard to labeling (see Chapter 9). Thus, the audiences that remain removed from the “alternative” food consumption trends are nevertheless the audiences identified by food-related issues, even though they delegate their treatment to expert and militant actors.

12 Moreover, depending on the field, INPES works in collaboration with “focus groups”, with volunteers from associations, for the development of its campaigns, as well as for the prevention of AIDS. However, this is not the case for campaigns related to the PNNS.

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Researchers have also benefited from another factor that favored the visibility of their expertise and claims. For example, the succession of health scandals related to the exploitation, production and distribution of food, discussed in the first part of the chapter, and consumers’ concerns about their food were accompanied by an increasing media interest in the links between food and health. The words of a journalist specialized in nutrition are revealing of this evolution over the last 20 years: There are subjects like that… It only takes one study for it to trigger [a wave]. First you see an article passing by from time to time, and then two and then finally it’s three, five and then there’s the media snowball effect. And then, when the audience follows and it raises questions […]. Like we’re following some kind of thing and at some point [it hits]. It’s a bunch of little things [studies, scandals], which end up generating a little inferno, and then it happens or it doesn’t happen. […] On food, right now everything is happening! (Interview with a nutrition journalist, November 14, 2016) Questions related to “food and health” thus refer to a context of pressure from researchers and consumer associations and increasing media coverage. The comments collected from ANIA experts and a communication agency specializing in nutrition communication illustrate this: At the end of the 1990s, there were significant events, even traumatic ones for the consumer. There was the mad cow episode. So there have been a lot of regulations and legislation, particularly to manage this safety issue. (Interview with ANIA, February 23, 2017) The first tools used by the public authorities were regulations that imposed new conduct through coercion and threatening companies with sanctions in the event of non-compliance. However, the State has also set up consultation measures to encourage the adoption of new non-regulatory norms within the agri-food industries. Does the participation of their representatives in these schemes reflect their true involvement in the development of a healthier diet? Or the need for them to renew their customer-oriented strategies in order not to lose market share? Field data show that the two methods are firmly intertwined and that they give the State

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legitimacy to regulate the sector, confining debates on food to politically controlled areas. 1.4. The PNNS: communication and actors’ logic The analysis of our interviews revealed three trends that have contributed to legitimizing state action, in particular via the PNNS aimed at regulating industrial practices in the agri-food sector: a trend relating to the evolution of consumer expectations and a trend relating to the media coverage on “food” itself (influenced by researchers – both converging towards a trend towards objectifying the link between food and health). These three trends have led us to analyze the PNNS as a framework for new state practices based on the converging logic between various actors, and not as a measure to promote these practices. The State has thus taken on board a societal issue, which was already in the process of evolution, thus building “consensus” on the need to change manufacturers’ practices and to offer them the opportunity to integrate themselves into a dynamic that would enhance their image. 1.4.1. A consensus on the need for regulation According to ANIA experts, the consumer of the 1960s–1990s, who had “a desire for diversity, accessibility and variety,” was replaced by a consumer concerned above all with “what they had on their plate [in terms of composition].” CNA employees translate this new request in these terms: There is […] this need on the part of the consumer for naturalness, for example, with products without palm oil, without processed sugars, with the least possible additives, the least amount of coloring agents. (Interview with the CNA, February 23, 2017) An observation, which is shared by a consulting agency specializing in innovation and food marketing, is shared below: We realized that consumer expectations had changed and companies felt this desire from customers to consume differently, in a smarter and more thoughtful way, a desire and an opportunity for consumers to better inform themselves about

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the products purchased, particularly to improve their health. (Interview with Agency 2, October 10, 2016) In this regard, Agency 1 has noted a significant change in the balance of power between its agency and its agri-food industry clients: So sometimes they say, “Wait, I’m not asking you for your opinion: you do what I tell you,” but it happens much less than before. That was the case at one time; it is much less so today, because they are now aware of the importance… that they must not be caught [talking nonsense]. So our role will be much more interesting, because they are listening to us more. (Interview with Agency 1, May 18, 2016) These comments should be put into perspective with those of the nutrition journalist on consumer expectations and the evolution of journalists’ framing of the “food” subject in the media and the articulation between the two, with consumers being also those whom the media must “seduce” with subjects that interest them: There came a time when people seriously questioned what our food really was. The various scandals have nevertheless intensified the situation. Eating well is still a concern today that, for many people, seems to be becoming more and more complicated. Before, there was no “food” section, instead we gave recipes. Today, we really mix the two. It is true that there was less knowledge as well, there was probably much less understanding of the influence of agri-food. There was a whole period when we let the manufacturers do absolutely what they wanted. A little while later, we said “ouch ouch ouch ouch”; we saw the link between diet and health. […] The notion of healthy eating is relatively recent, however. (Interview with a nutrition journalist, November 14, 2016) The observation of “laissez-faire” is shared by an expert from Santé publique France, stating that “for a while, we were, I think, more on their side… Generally speaking, we let them do quite a lot”. The analysis of the interviews conducted also shows a result of the objectification between diet

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and health, and the need to rethink nutrition in terms of health benefits. For example, the journalist interviewed insists on a change in the food issue, which has gradually integrated the “health” dimension. They also discuss the fact that “everything burns” on this subject: Because today we are still facing an explosion, not only of obesity, but also of associated diseases. One in two French people is very stressed, one in two or three takes statins… Cardiovascular diseases have exploded. We are now talking about non-alcoholic hepatic cirrhosis. Diabetes has increased. And cancer… There is now a proven link between cancer and diet: today it is estimated that 30% of cancers are associated with diet or dietary effects. And these are still validated studies. (Interview with nutrition journalist, November 14, 2016) The objectification of the link between food and health has thus also been accompanied by a change in consumer expectations and the media’s framing of the subject related to food, caught up in an ever more global trend of the “medicalization of society” (see Chapter 8); accentuating the demands of citizens of a “biopolitical” state [DEO 17] managing food-related risks. These developments have led manufacturers to rethink their strategies to maintain their market positions. While they are now “listening more to their consulting agency”, they have also been keen to participate in the consultation measures set up within the framework of the PNNS. 1.4.2. The PNNS as a framework for the State: better production for better communication? In addition to regulatory aspects and messages to the general public (such as mangerbouger.fr or “eat 5 fruits and vegetables per day”), the PNNS represents a broader measure, in particular with the help of the steering committee and the monitoring committee, responsible for guiding operational implementation and ensuring the monitoring of actions involving the various actors. The ANIA was not part of the first program but has been participating since 2006, while the second program encouraged manufacturers to sign a “commitment charter” aimed at guaranteeing better quality production. However, based on voluntary action, the signing of this

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charter required closer involvement of industrial actors in the PNNS, as recalled by the two ANIA experts: The challenge was to demonstrate the interest in public authorities, including the agri-food industry sitting around the table, because they expected a lot from us. But we were not part of the discussions, so it’s more complicated, since we were implementing voluntary measures on our side. When you find yourself as a player rather than a discussant to address the constraints that exist, the possible margins of manoeuvre become apparent: it’s complicated. So that was the whole point of the discussions we had at the time, and it’s been 10 years. (Interview with ANIA, February 23, 2017) These remarks confirm the analysis of a convergence of logics between agri-food manufacturers and public authorities, driven by the pressure of constituted audiences and the objectification of the link between food and health. Indeed, on the one hand, the State is “summoned” to intervene to regulate the sector; on the other hand, manufacturers must face a “crisis”, which pushes them to act – not only in the interest of the “consumer and public health”, as declared by the ANIA, but especially in the interest of the market, as mentioned by Agency 2: A company’s action must generate value over the long term, so messages must be delivered that give credit to a company that is positioned in the market as a serious company. The market is volatile, and if the public remembers that a company has lied or watered down commercials about scientific claims, it can turn against them and stock market shares can tumble. (Interview with Agency 2, October 10, 2016) This changes the configuration of power relationships. Although those that exist between industry and public authorities, they are not limited to formal and visible measures. However, in the face of the State that is politically investing in the food problem, there are manufacturers who are becoming aware of the need to review their strategies. Manufacturers can thus advertise themselves as partners of the State for the “good of the consumer and public health”, by signing, for example, the commitment

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charter, and thus give credibility to their communication on “producing better”. In this respect, the CNA has already published their opinion on the “ethical” rules related to advertising (opinion no. 76), relayed by ANIA experts to its members, through a charter signed with five ministries (Health, Food, Economy, overseas French departments and Sport): There are 4 different filters. The first filter is the manufacturer: they have their rules of conduct, so they must implement self-discipline […]. Then there is the role of the ARPP to give its opinion. The third filter is the TV channels, which will actually give their opinion and say if it works. And the fourth filter is the CSA, which annually checks whether the codes have been respected. (Interview with ANIA, February 23, 2017) However, these recommendations are mainly undertaken as part of a reflection on advertising to children. Another tool, published by the ANSES and INRA, the “Observatoire de la qualité de l’alimentation” (Oqali)13, produces studies accessible to the public, aimed at obtaining information on the evolution of the quality of products sold: the names of the brands are not mentioned, but their documents allow manufacturers to know where they stand in terms of quality on the market. Analysis of the interviews also reveals the motivation of various actors to restore trust with consumers by generalizing the opening of manufacturing plants, not for the sake of “transparency” but for the sake of “sincerity”. Doesn’t a “sincere” communication operation for manufacturers above all conceal more “hidden” communication issues on the part of public authorities? Because by relying on these consultation measures, do they not seek to suggest that they themselves have promoted this evolution through effective action, the PNNS? The two dynamics lead to a “win-win” relationship, as summarized by ANIA experts: “We must feel that we are partners in a voluntary way based on win-win actions” (interview with ANIA, February 23, 2017). It is not possible for us to determine whether manufacturers would have oriented their strategies towards “better production” without government action (consumer choice could have been sufficient to achieve this). In any case, “producing better” meets another purpose, that of better communication.

13 Available at: www.oqali.fr (accessed May 24, 2018).

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1.5. Conclusion In this chapter, we have identified the factors that have contributed to the emergence of the food issue as a public problem and to the structuring of decisions taken by public authorities to regulate the market. Consumer food practices and their increased vigilance, via consumer associations, as well as the work of nutrition researchers and epidemiologists, relayed in a crisis of “confidence” context identified by manufacturers (in terms of market share), exploited by the media, taken into account by communication agencies, have also contributed. It is therefore a set of actors that has made it possible to strengthen the demonstration of a demand for regulation (through its strong visibility) and the objectification of food as a public health problem (through its legitimacy in debates). In addition to the basic rules, it is through public communication that the State has participated in the supervision and dissemination of new norms, which only make sense to those whose food practices and economy were already in harmony with them. Hence, the communication presented by the various actors was analyzed as being revealing of actors’ “games” and their position in relation to the food problem in the public sphere and not as a tool aimed at inducing new behaviors. The communication and consultation measures set up by public actors are indeed more revealing of the interactions between actors than efficient measures intended to influence agri-food manufacturers’ development strategies. The State has chosen in a timely manner to highlight its action plans through public communication campaigns – such as the one accompanying the PNNS – by positioning itself as an actor (the CNA organizing public debates; the ANSES sets out the values that make it possible to protect health), as an evaluator (the PNNS integrates indicators of effectiveness and evaluates processes) and as a prescriber (the PNNS promotes the growth of health protection factors), in order to gain legitimacy. More specifically, with regard to the agri-food industry, we note that the State has imposed new conduct norms more often by choosing the path of consultation over that of coercion. In return, manufacturers have been able to position themselves as partners of the State on the food issue for the benefit of the consumer. The State has therefore taken up a societal issue – that of food – as a public health issue, to create consensus on the need to change the agri-food manufacturers’ practices, as well as to enhance, in terms of governability, its ability to act on the market.

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1.6. References [ARQ 16] ARQUEMBOURG J., “L’antibiorésistance en France, du risque à la menace pour la santé publique. Analyse d’un processus inachevé de constitution d’un problème public”, Questions de communication, vol. 29, pp. 29–47, 2016. [BEA 85] BEAUD P., Médias, médiations et médiateurs dans la société industrielle, PhD thesis, Université de Grenoble, 1985. [BER 14] BERGERON H., CASTEL P., Sociologie politique de la santé, PUF, Paris, 2014. [BRU 13] BRUNEL O., GALLEN C., ROUX D., “Identification des mécanismes d’appropriation d’un produit alimentaire en fonction de son degré d’élaboration”, Le marketing dans le secteur agro-alimentaire, Revue Management et Avenir, vol. 64, no. 3, pp. 121–142, 2013. [DEI 15] DE IULIO S., BARDOU-BOISNIER S., PAILLIART I., “Penser les enjeux publics de l’alimentation”, in DE IULIO S., BARDOU-BOISNIER S., PAILLIART I. (eds), “L’alimentation, une affaire publique?”, Questions de communication, vol. 27, pp. 7–19, 2015. [DEO 17] DE OLIVEIRA J.-P., “La communication publique comme support de légitimation et d’institutionnalisation des normes sociales. Le cas de la prévention du sida”, Études de communication, vol. 48, pp. 71–90, 2017. [DEW 27] DEWEY J., Le public et ses problèmes, Folio, Paris, 1927. [FAS 98] FASSIN D., “Avant-propos. Les politiques de la médicalisation”, in DELANOË D., AÏCH P. (eds), L’ère de la médicalisation. Ecce Homo Sanitas, Economica, Paris, 1998. [FEI 07] FEILLET P., La nourriture des Français. De la maîtrise du feu… aux années 2030, Éditions Quae, Versailles, 2007. [FER 02] FERRIERES M., Histoire des peurs alimentaires. Du Moyen Âge à l’aube du XXe siècle, Le Seuil, Paris, 2002. [FIS 90] FISCHLER C., L’Homnivore, Odile Jacob, Paris, 1990. [FLA 97] FLANDRIN J.-L., MONTANARI M. (eds), Histoire de l’alimentation, Fayard, Paris, 1997. [HAS 17] HASTINGS G., “Pouvoir du marketing et réponses nécessaires en matière de santé publique”, in Inserm, Agir sur les comportements nutritionnels. Réglementation, marketing et influence des communications de santé, pp. 73–93, Éditions EDP Sciences, Montrouge, 2017.

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[LAF 12] LAFON B., DE OLIVEIRA J.-P., “Le cancer et la maladie d’Alzheimer, des chantiers présidentiels. De la gestion moderne des maladies aux stratégies communicationnelles des présidents Chirac et Sarkozy”, Communication [online], vol. 30, no. 1, 2012. [MAR 04] MARION G., Idéologie Marketing, Eyrolles, Paris, 2004. [NOL 15] NOLLET J., “L’emprise du journalisme sur les catégories d’action publique. Le cadrage médiatique de la crise de la vache folle et ses usages dans le champ bureaucratique”, in DE IULIO S., BARDOU-BOISNIER S., PAILLIART I. (eds), “L’alimentation, une affaire publique?”, Questions de communication, vol. 27, pp. 21–39, 2015. [PAS 02] PASCAL G., “L’alimentation de demain”, in Michaud Y. (ed.), La nature et les risques, Odile Jacob, Paris, 2002. [POU 02] POULAIN J.-P., Sociologies de l’alimentation, PUF, Paris, 2002. [ROM 15] ROMEYER H., “Le bien-être en normes : les programmes nationaux nutrition santé”, in DE IULIO S., BARDOU-BOISNIER S., PAILLIART I. (eds), “L’alimentation, une affaire publique?”, Questions de communication, vol. 27, pp. 41–61, 2015. [SAN 06] SANSALONI R., Le non-consommateur. Comment le consommateur reprend le pouvoir, Dunod, Paris, 2006. [ZAW 04] ZAWIEJA P., “Les peurs alimentaires et leurs justifications”, in SYLVESTRE J.-L., CHAPELOT D. (eds), Les comportements alimentaires, Lavoisier, Paris, 2004.

2 From Controversy to Media Controversy: Analysis of Communication Strategies Concerning the Health Risk of Growing Limousin Apples

2.1. Introduction In 2006, the Allassac ONGF association, made up of local residents concerned that orchards were encroaching on where they lived, denounced the intensive use of pesticides for growing Limousin apples. Indeed, according to an INRA study [BUT 10], a non-organic orchard undergoes an average of 36 chemical treatments per harvest. Thus, supported by extensive media coverage and numerous legal actions against apple growers, this association has contributed to a collective awareness of the dangers of pesticide use on health and the environment. Faced with such a problem, the French state implemented the Écophyto plan in 2008, the objective of which was to reduce the use of phytosanitary products by 50% over a 10-year period. A vast communication plan was launched with growers to communicate the dangers of pesticides. At the same time, protesters’ discourses (local residents and ecological associations) were developing on a large scale, while apple growers were hiding in silence. On the one hand, opponents of pesticides were leading a real campaign to demonize apple consumption. Effective and highly

Chapter written by Christelle DE OLIVEIRA and Audrey MOUTAT.

Food and Health: Actor Strategies in Information and Communication, First Edition. Edited by Viviane Clavier and Jean-Philippe De Oliveira. © ISTE Ltd 2019. Published by ISTE Ltd and John Wiley & Sons, Inc.

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organized in terms of information dissemination, they used the “mass” media in order to target public opinion. On the other hand, growers communicated mainly locally, in order to reassure consumers by distributing leaflets and through a website promoting good pesticide use practices. As for the State, its role did not seem clearly defined. It intended to act as a mediator between local growers and the general public, but it did not perform this function. Indeed, although the Écophyto plan has been the subject of a major communication investment, its existence remains unknown to the general public. It seems that the program mainly focused on farmers by imposing new production methods on them. Thus, the only way for the general public to have access to information was through the media, which, under the guise of investigation and investigation, dealt with this issue from their own point of view and, hiding behind the silence of apple growers, only intensified a climate of fear. In this context, this chapter of the book proposes to study a corpus of television reports broadcast on the television channel France 2: “Peut-on encore manger des pommes?” (Can we still eat apples?), a summary of the program Envoyé Spécial from March 05, 2015, and Cash Investigation from February 3, 2016, on the theme “Chemicals: our children at risk” – in which local residents’ associations expressed their feelings; three communication brochures from the Écophyto plan produced in 2012 for farmers; as well as two general public brochures distributed locally in 2012 and 2014 by apple growers. The aim will be to determine the contradictory communication strategies implemented by these different actors around a collective health issue related to pesticide use. In particular, we will try to highlight the argumentative methods implemented by each of them in what is first and foremost a controversy on the health risk caused by the use of pesticides in the cultivation of Limousin apples. We will see that, as soon as it is dealt with by the media, controversy becomes an argument that aims to guide public opinion. This is how the problem of the links between mass media and the public sphere arises, and more particularly the role played by the former in the construction of representations. Following the methodologies offered by Christine Servais [SER 13] and Patrick Charaudeau [CHA 10], the aim will

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be to uncover how the media produce biased information in the public sphere. By placing their study at the enunciation level, these authors have proposed models for analyzing journalistic mediation such as the communication contract [CHA 10], the principles of structuring the public sphere through journalistic enunciation and the ways in which representations of the world are constructed [SER 13]. Using this work, we will focus our attention on the methods of media sense production in order to highlight the different relationships established between the media and the general public; the former has access to the “raw interpreted event”, while the latter is a “constructed event” thanks to the filtering of the media production authority. There are difficulties in studying such a subject. Indeed, as Thierry Libaert and François Allard-Huver point out [LIB 14, p. 82]: Sensitive communication then deals with a subject that places the researcher in an uncomfortable position between denouncing methods and the methodological expertise of complex communication practices that can be included in a purely pragmatic vision. The nature of these practices, as well as the subjects covered, therefore call for methodological and ethical caution. It is in this desire for scientific and ethical rigor that we conducted our study, in order to objectively determine the communication strategies implemented by the various stakeholders involved in the problem of pesticide use in the cultivation of Limousin apples. 2.2. The Limousin apple at the heart of a controversy For Gilles Sénécal [SEN 02], environmental controversies are based on a population’s fear of losing their quality of life and that of the environment: They [are] the product of a struggle to maintain or preserve a state of quality that is now threatened. They thus become the expression of a demand for quality or conservation of the environment, the sign of stress or fear, founded or unfounded, of a loss of quality or more simply of weariness in the face of a situation of continuing discomfort.

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Usually, these controversies involve several actors: [They] reveal the nature of local issues by confronting the three emblematic figures of the urban scene: the planner/decision making partner (including community partners), the user (employee, subcontractor, etc.) and the inhabitant (resident, resident, father or mother of a family, etc.) who interact and put themselves in stressful situations. However, in the controversy which arose related to the health risk caused by the use of pesticides in Limousin apple cultivation, the operating principle was somewhat different insofar as the government body was disengaged from this dynamic. Indeed, this controversy was not realized as a true triad, but rather as a dual relationship, one triadic and the other dyadic, taking place in distinct modes. The first was direct and pitted local resident associations against apple growers through the mediation of a third party, the local public, forced into a judging role. Local residents’ associations denounced the practices of “Golden culture” to this public, using local media, print and radio, citizen forums and community meetings. Apple growers, for their part, were trying to reassure consumers by distributing informational brochures on apple production methods and orchard cultivation. The second level of the controversy highlights an indirect relationship between residents’ associations and the authority of the State. It was indirect in the sense that these associations challenged the State using direct controversy, the objective being to influence political decisions. Therefore, if the associations did not communicate with the State, the latter did not address them either, but directly addressed apple growers and the general public on good agricultural practices using the Écophyto plan. However, we will see that resident associations were not content with local action, but took the controversy to national level by investing in the mass media. It was then that, acting as a relay for these associations, some programs, such as Envoyé Spécial or Cash Investigation, initiated a transformation of local controversy into media controversy.

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But before discussing these considerations, let us look back at how the controversy itself worked. Cyril Lemieux’s triadic conception of this situation was expressed in a dispute between two parties staged before an audience, “a third party placed in the position of judge” [LEM 07, p. 195]. The composition of this audience was selective by mobilizing peers: It is always a question of creating the conditions to take testimonies, or even to constitute as a resource, the public in a debate. This audience can be virtual, or it can represent posterity or universality: the presupposition of its existence opens the space for the manifestation of truth. [FAB 07, p. 50]

Indirect controversy Resident associations

Apple growers Écophyto plan

Direct controversy

Local media,/citizen forums/meetings

State authority

Information leaflets

Local public

Media controversy Mass media

General public

Relationship between actors Means of communication used

Figure 2.1. From controversy to controversial

This is one of the reasons why controversies are presented as real struggles, nevertheless marked by public politeness. Indeed, in front of third parties, participants keep their composure, accepting their opponent’s dignity.

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To the extent that each controversy is a singular discursive event, it requires a study in context. The controversy over pesticides in the cultivation of the Golden du Limousin apples thus originated in a closed environment, away from the general public, in other words within a relatively autonomous social or institutional space, but with distinctive judging skills (unlike the lay public). It then developed by soliciting the State or other non-initiated actors: Tactical relevance [consists] of resorting at some point to public authority to authoritatively settle the dispute [between resident associations and apple growers], or in seeking support from lay people, at the risk in both cases of undermining institutional autonomy, and therefore the specific authority of judgment, from which they benefited […] Most often, in fact, they go beyond their circle of peers and enroll with them social forces and individuals located beyond the institutional perimeter where they originated (itself a very difficult perimeter to define generally). [LEM 07, p. 197] At this stage of the study, this includes understanding how participants in the environmental controversy were addressing the institutional crisis. Our approach consists of studying the media actions then undertaken, such as disclosure or simplification, to achieve this. This evolutionary process from controversy to institutional crisis is based here on a call by local residents’ associations for the judgment of their peers and an active search for external support, particularly through media resources. At the heart of this controversy is the question of risk, or more precisely, the absence of risk. In today’s society, while the desire to maintain good health is increasingly at the center of consumers’ concerns, they are nevertheless confronted with a paradox. On the one hand, we have advances in medicine and knowledge that suggest great opportunities for improvement and, on the other hand, a very strong sense of vulnerability due to the media coverage of the agri-food industry’s sliding on production methods [DAB 13]. There is thus a high social expectation regarding the control of health risks in relation to the use of pesticides

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in fruit and vegetable cultivation and the establishment of rigorous state control over these practices: Any defect in these dispositives creates an outrage all the more so because these violations are due to environmental factors that cannot be detected and controlled at the individual level. If it is not possible to protect oneself, then the public authorities are expected to organise health protection. [DAB 13, pp. 14–15] The absence of risk is undeniable. However, the perception of its potential dangerousness is mainly related to the magnitude of the risk and its uncertain outlook. The risk appears to be unevenly distributed, because the actors who suffer it are not the ones who benefit from it. At that point, is it possible for the consumer to consider an acceptable risk threshold for pesticide use? This is a threshold below which it could accept this use in apple growing, without knowing the extent of their real impact on health. This is what the State and apple growers would like to see accepted through the Écophyto plan and the appellations d’origine contrôlée1. The notion of risk is thus linked to the possibility of having healthy and abundant fruits and vegetables. It is associated with consequences that we wish to minimize on a health level (the use of pesticides), and for which there are possibilities for action (Écophyto plan). The core of the debate between consumer activists and the State – apple growers and the challenge of communication was precisely the use of this notion of risk, because, for some, the mere possibility of damage to health or the quality of the environment was sufficient to define the risk, while for others, there was no risk unless the danger was truly and scientifically demonstrated. Thus, it was not the intensity of the risk that mattered to public opinion, but the way it was discussed. Therefore, health risk management is fundamentally based on a principle of trust. This contract of trust between consumers and the State (which is supposed to regulate the use of pesticides in agriculture) is fiduciary in nature; that is, it requires persuasive action from the recipient and, in return, the recipient’s support [GRE 93, p. 146]. It therefore implies mutual trust, implicit or explicit, between the exchange partners. Thus, the question of truth about these practices lay in the strategies of “making it appear true”, 1 This is a French certification granted to certain French regional foods and wines.

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where the persuasive (making it believable) nature of different protagonists’ discursive strategies corresponds to the interpretative nature (believing it to be true) of consumer strategies [FON 99]. The highlighting of the real conditions of pesticide use led to feelings of mistrust among the general public based on suspicion. In response to this mistrust, a fiduciary counter-strategy immediately emerged in the form of a discursive strategy, which aimed to make information on the use of pesticides in Limousin apple cultivation “transparent”, both in the local press and in the leaflets distributed by the State and apple growers. This effort at transparency (real or oriented) attempted, despite suspicion, to restore this confidence in the information provided on pesticide use. If the suspicion did not disappear, this counter-strategy of transparency still raised hopes of a return to “good practices” in terms of the use of pesticides. This environmental controversy between the State, pesticide users and whistleblowers had two dimensions: – strategic, where each party had to reverse the balance of power with the other; and – argumentative, the actors used different communication methods. Our main axis of analysis therefore involves uncovering the way in which this controversy was deployed at the argumentative level. In this respect, it can be seen that the latter is not determined by public argumentative constraints, which led to a distortion of the public spheres in which it was deployed. Indeed, it can be seen that the balance of power between local residents’ associations and farmers limited the argumentative potential of the latter who refused to express themselves publicly. Thus, our approach is in line with Cyril Lemieux’s proposals [LEM 07, p. 203]: This approach amounts to precisely describing the methods of public speaking in a given social environment or institution, depending on whether they allow actors to satisfy, at more or less high levels, the equality of rights clause between opponents or whether, on the contrary, they upset it, thus making arguments of authority, intimidation or even methods of judgment external to those preferred by their peers.

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We therefore propose to study the position-taking methods adopted by apple growers, the State and local residents’ associations. 2.3. Unbalanced communication strategies In their leaflet “La pomme du Limousin AOP2, fruit de l’agriculture durable” (AOP Limousin apple, the fruit of sustainable agriculture), local growers considered risk as a potential [FON 99, p. 179]. While recognizing the use of pesticides (“the use of pesticides is only made when necessary, and always after an observation period. Nevertheless, when the need is imperative, arborists are called upon to intervene punctually in orchards with products that comply with regulations – increasingly targeted at pests – in order to disturb local flora and fauna only when necessary”), they explained to the general public what they were actually doing to reduce their use and make the products of their crops healthier, both for the health of the consumer and for the environment: “In order to moderate phytosanitary interventions, ‘soft’ agricultural techniques are used: introduction of natural predators of orchard pests (mites, chickadees, etc.), sexual confusion for butterflies, etc.” In the brochure, it was written in bold: “Today, we want to combine the best of organic and conventional farming practices by working every day on the new techniques of progress introduced in France.” Bad practices were therefore not mentioned; the emphasis was instead placed on the improvements made and on the notion of control aimed at reducing the impression of risk by promoting the AOP designation: The Limousin apple is the only apple in France to benefit from this designation since 2005. It is an official recognition of the Limousin exception guaranteed by a demanding set of specifications and controlled by an independent body. [FON 99] Apple growers focused their communication on the risk that was present in the past, but has almost completely disappeared now. The graphic chart used the yellow color code symbolizing the Golden du Limousin, brown and green, symbols of fall and nature. Fall is the apple harvest season, and apple 2 The French acronym AOP designates a product where all its production stages have taken place according to recognized expertise in the same geographical area, thereby giving the product particular characteristics. AOP is also recognized by the European Union and protects the product throughout this particular area. For more information, see [INA 13].

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growers used the photographic endorsement to bring these scenes of good growing and harvesting practices into our field of importance. Attention was focused on the seasonal cycle and the link was made with the various actions carried out, presented in a clear and understandable way, to show that the work of apple growers is carried out with respect for nature, which is further accentuated by the description of the moon’s action on the product’s taste quality: In Limousin, the fall days preceding the harvest are hot and sunny, while the nights remain cool. This typical Limousin alternation, combined with the action of the moon, allows apples to perfect their flavors and develop this subtle balance of acidic sugar and inimitable crunch. [FON 99] To further explain this respect for nature’s cycle, illustrative photographs emphasized characteristic technical gestures. These were the result of professional practice and are not known to the general public. To show them concretely by means of a photograph transformed them into from a themthen-elsewhere into an I-here-now [BEY 09]. The role of this staging was to establish an ethical relationship between growers and the subjects in the form of a didactic truth. Instead of focusing on the effects and guiding the observer through actual roles and values, photography can formulate a didactic metadiscourse on the event to aid their understanding. [BEY 09, p. 44] Footnotes completed the syntagmatic chain and illustrated the passage of the apple from the cooperative where they are packaged, through the act of purchase to the product placed on the consumer’s plate. Here we find the discursive strategy of transparency, designed to regain the latter’s trust. We show the individual, while explaining to them, all the stages of apple production, from the replenishment of the orchard to their plate, insisting on respect for nature and the seasonal cycle, so that the story we tell them becomes that of each apple in the Limousin that they will eat. For its part, the State recognized the use of pesticides for crops. It was part of a dynamic of change brought about by the Écophyto plan, and thus unveiled a remediation in the process of deployment. The leaflet for farmers made extensive use of the color green, a symbol of nature, echoing several

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paragraphs of the text: “These new pesticide-friendly practices help to better respect soil structure and promote biodiversity”. Like apple growers, the State used photography to bring these good practices into our field of importance. It was nevertheless distinguished by a focus on a green nature and different actors in the agricultural world in a professional situation. For example, the latter do not wear any special clothing protection, which suggests that they do not use dangerous products. The State thus adopted a viewpoint that clearly recognized past abuses in the use of pesticides (“dependence of farms on pesticides”). The word “dependence” used in the first part of the leaflet referred to the systematic use of these products in the past for all types of crops. The leaflet insisted on the need for change, particularly in relation to the consumer: “while meeting the needs of consumers who expect quality products”, “consumers are also concerned!” Agricultural professionals were committed to ensuring food quality and the government took action. However, the State’s discourse did not suggest the elimination of these products and, unlike apple growers, it did not call into question their dangerousness (“Phytosanitary products, otherwise known as pesticides, make it possible to protect agricultural production against harmful insects, fungi or weeds that harm the proper development of plants and the food we eat”), but recognized the massive use made of them out of ignorance and intended to act on this fact. The dangerousness of these products was also minimized by the use of the term “phytopharmaceuticals”. Indeed, in the collective imagination, “phyto” refers to the vocabulary of botany and therefore, by extension, of nature, while “pharmaceutical” refers to that of drugs; it would therefore be perceived as a product intended to treat. To this end, the discourse focused on two main areas. The first area was the establishment of training and information systems for farmers, enabling them to better understand pesticides and therefore to use them better in the future: “by disseminating pesticide saving practices as widely as possible to farmers”, “by improving real-time information for farmers on the presence of crop pests to better target treatments. [...] These bulletins, available free of charge on the websites of the French regional directorates of food, agriculture and forestry (DRAAF), allow farmers to measure pesticides more accurately according to the health status of the crops”.

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The second area insisted on the need for accountability and commitment of all actors in the sector with regard to the use of these products: “reducing the use of pesticides and making them safe to use implies real training, accountability and certification of all actors in the sector, […] by guaranteeing the competence of all actors in the chain (distributors, advisors and pesticide users). [...] The Écophyto plan involves the entire supply chain: firms, traders, cooperatives, agricultural advisors, farmers, as well as all other stakeholders, such as environmental or consumer associations.” By sharing responsibility for the use of pesticides with other actors in the sector, the State reduced its level of responsibility in these practices. Indeed, when deciding to take action, the State may try to anticipate the consequences of the action and provide a course of action that would allow it to be carried out successfully. In other words, it authorizes the use of pesticides to produce beautiful-looking fruits in large quantities to meet the needs of the population. However, once this authorization has been granted, the resulting consequences are not necessarily those initially foreseen by the health authorities: dangers to consumer health may indeed arise. At that point, the government’s planned course of action (allowing the massive use of pesticides) no longer makes sense in terms of the goal to be achieved (producing beautiful fruit in abundance). It can even have disastrous consequences if it continues to not take into account the changes that have occurred in the course of this action. In the event of proven health hazards, apple growers’ responsibility is disengaged because their agricultural practices comply with state-imposed legislation. In this way, it is impossible to know who made the error, as responsibility for the error can be attributed to everyone as well as to no one in particular. In order to appear irreproachable, the State positioned itself as a guarantor of good practices, because through this leaflet, it clearly insisted on the fact that these have already succeeded in making things happen: “Every day more farmers are committing themselves, more sustainably, more effectively, by adopting agricultural practices that are economical in pesticide use. […] Visit agriculture.gouv.fr to discover testimonies from French farmers who have already successfully reduced pesticide use as part of the Écophyto plan.” This implies that bad practices were not the responsibility of the State, but of farmers.

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For local residents’ associations, the health risk of pesticides was very real, as Jérôme Lafitte pointed out [LAF 15]: The words and arguments of citizen-users concerned by a situation of environmental controversy are often denigrated in the public and media arenas, and reduced to irrational, emotional and unjustified attitudes, signs of a lack of information or a lack of openness. It must be noted that the actions taken by these “citizen-users” were heard at the local level (citizen marches, forums, publications and interviews in the local media). We are thus witnessing an axiological reversal where passionate attitudes are erased in favor of a public legitimization of the protest actions of local residents’ associations. Farmers, for their part, refused to express themselves through the media, so it was not their knowledge about pesticides that was judged on the media scene, but their attitude. “The controversy is based on a social practice of discussing a problem that requires the confrontation of a diversity of knowledge leading to the construction of updated knowledge” [LAF 15]. In this case, this updated knowledge was based on a confrontation between knowledge related to legislation and knowledge reconstructed from the experiences of local residents who were victims of pesticide treatments. Each of the two parties took refuge behind an authoritative body; legislation for farmers, and scientists and doctors for local residents’ associations. This instrumentalization of the experts' voices was also the spearhead of the mass media, which selected information for the benefit of local residents’ associations. This was the case with the Envoyé Spécial who, by extracting scientific reports or analyzing hair strands, was part of this misinformation practice. Indeed, in order to provide a scientific guarantee for her argument, a journalist from Envoyé Spécial took a strand of hair from a resident near the local apple orchard and a worker who had worked for 13 years in an orchard. These samples were sent to a private laboratory, specialized in the sale of home testing kits and whose legitimacy was also criticized in an article in the journal Agriculture et environnement [AGR 13]. In the absence of a toxicologist or biologist present in the laboratory, the journalist called upon a scientific guarantor, Dr Alvarez (pharmacology and toxicology department of the Université Versailles Saint-Quentin-en-Yvelines), to read

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the results of these samples. However, what the arrangement did not show was that it is possible to find – if only in infinitesimal doses – any substance in the hair, including those that are now banned, but which persist in nature. Moreover, detecting a substance in hair does not necessarily mean a risk of disease, but only indicates that the subject is in contact with the substance, as no hazard threshold value can be determined in hair samples [AFI 15]. Another example: when a general practitioner from Limousin was called upon to testify about the dangers of pesticides, she invoked an increase in prostate cancer in the region without specifying that such an increase had also been observed at the national level, during the same period [AFI 15]. Extracts “from the policed framework of their scientific sphere” create awareness of “clashes in the public sphere by the mediatization of controversy” [ALL 15, p. 34]. While the journalist’s primary mission was to inform the public, we found that they were a stakeholder here by intentionally changing the meaning. This modification was not based on a simple transformation or juxtaposition of positions within the discourse, as is usually the case in journalistic practice, but consisted of a discursive medium that is sometimes sensational3. We can see that it is from the moment when the controversy left the local sphere and was taken up by the mass media, the representatives of local residents’ associations that it became a media controversy. 2.4. From controversy to media controversy This transition from local controversy to media controversy was achieved through the manipulation and transformation of “pre-texts” into “meta-texts” [ALL 15], so that the elements to be interpreted were no longer scientific articles, but journalistic texts. These were constantly being refined, with the use of media constantly reshaping the problem. An absent statistic or an extrapolation was then enough to make the controversy swell and call the actors’ voices into question. This is what Yves Jeanneret [JEA 10] calls the phenomenon of “polychrisy”, which is no longer based on the original text, but on the interpretations of its media consequences: it is in this sense that 3 In this respect, we can cite the example of Envoyé Spécial, who compared a “plain” apple with one treated with SmartFresh® using morphing, which, on the principle of hypotyposis, put before the viewer’s eyes what they usually cannot see: the normal aging of an untreated apple.

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“communicating always means acting in several directions at once” [JEA 98, p. 20]. Controversy is used to manipulate a third party against the attacked person, or to constitute propaganda from the speaker’s point of view. [YAN 03] Without the skills to debate on their own, the public established as judges relied on modes of legitimization and beliefs. The outcome of the controversy, in other words the judgment, was not so much to decide between the parties as to believe one party and denigrate the other. Thus, programs such as Envoyé Spécial or Cash Investigation derogated from the deontology of the press, which, according to Sophie Moirand, is usually “a meeting place for discourses on science and these events, […] an intertext composed of several voices” [MOI 07, p. 64]. Journalists usually have a duty to report the facts accurately and neutrally; their credibility is based on an absence of bias, partisanship or a desire to influence their audience. However, since this objective is futile – the discourse can be neither really didactic, nor really demonstrative, nor even strictly persuasive – these programs force the line to paroxysm and lead to what Patrick Charaudeau [CHA 10] calls a “shift and misinformation of the media machine.” Indeed, these programs are not part of ordinary journalism, but offer a form of opinion journalism, which is nevertheless not asserted as such, and whose argumentation, under the guise of investigation, is part of a controversial process. In other words, the journalistic project is not informational, but rooted in a dramatization of the facts. The informational aim is indeed obscured by the staging, which is more or less spectacular because of the challenge of capturing audiences. Hence, the question of the role and responsibilities of journalists as mediators between actors in the public sphere. This “dissident” journalism reflects a profound imbalance within the dual logic of the media sphere. As Patrick Charaudeau points out [CHA 10], the latter is articulated through the double dimension. The first is symbolic: To be part of a democratic purpose by serving – ideally – public opinion and citizenship by informing about events in the public sphere and by contributing to the social and political debate by staging a confrontation of ideas.

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The second is pragmatic. It must attract the public by implementing a seduction strategy in order to be competitive in the information market. This internal tension in media discourse is at the heart of its paradox and implies a “communication contract” and specific discursive constraints. According to Patrick Charaudeau [CHA 05, p. 94], the act of communication is therefore a process of discourse that does not target the discourse itself, but seeks to grasp its effects. “Communication contract” “Raw and interpreted event”

“New” constructed event

Media production

Transformation process

Media reception

“Interpreted event”

Interpretation process

Transaction process Figure 2.2. The communication contract

The transformation process questions the discourse of information used by journalists. The first appearance of the event – “the raw and interpreted event” – results from a reaction to a presence that gives rise to media coverage. It then authorizes a process of cutting, describing or structuring the world. Journalistic writing is subject to a double challenge. At the same time, it must capture the reader’s attention and transmit the information in the most credible way possible. The journalist’s position is therefore between these constraints and their personal project of describing and organizing the facts. In other words, they must take into account the forms that constitute the communication situation, but at the same time they have the possibility of arranging and presenting them in the way they wish. They thus use a strategy based on the credibility and appropriation challenges they set for themselves. To do this, they proceed with what Patrick Charaudeau [CHA 05, p. 106] calls “the construction of the ‘new’”, in other words, they process information with certain discursive modes according to the dispositives through which it passes. Depending on the enunciation

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situation, inscribed in the communication situation, this construction proceeds from a staging of the information and defines in this way a journalistic enunciation contract. Thus, the issue of Envoyé Spécial devoted to pesticide use in apple growing, and more particularly the Golden du Limousin apple, presents the real risk and danger associated with their use in the sensitive and perceptible world. Invested in relaying information, news reporters make an ontological promise of authenticity to their viewers, bringing them new and proven facts. The viewer validates the presence of this regime of informativeness [JOS 05, pp. 63–69], when they judge that the appearance of the event, which is presented to them, is organized in a recognizable and identifiable form, conducive to the events constituting real-life experiences. For example, when shown an accident, the viewer will assess the severity of the accident by comparing it with other accidents they have stored in their memory. Thus, the viewer’s interpretive journey in relation to a new event is constantly informed by their memory and experience. It is in this regime of informative beliefs that the viewer is positioned to interpret events related to the use of pesticides in the cultivation of Limousin apples. The report thus showed them in concrete terms people whose health had been affected by the use of phytosanitary products: the local resident, whose land borders the apple trees in question; the farm worker made seriously ill by the handling of pesticides, etc. Factual elements are thus borrowed from the real world and different “assumptions” regarding pesticide use are immediately stated. In this regard, the Envoyé Spécial journalist is making a major dramatization which, according to Patrick Charaudeau [CHA 10], consists of staging a good story about the victim/aggressor/savior triad. The show thus featured singular victims of pesticides (residents, farm workers), in order to invite the spectator to share their suffering – their word being indisputable. As for apple growers, they did not appear as absolute villains, but as ambiguous characters. They aroused curiosity by their silence and provoked rejection through the discourse reported by the victims. The figure of the savior was embodied by associations such as Allassac ONGF, which – in response to victims – initiated legal proceedings and actions to spread information on the harmful effects of pesticides and seek compensation.

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Thus, we observe an overstatement of emphatic and hyperbolic terms: the apple is “lightly watered” and undergoes “shock treatment”. SmartFresh® is described as a “powerful preservative gas”, an “amazing treatment” and a “super-powerful preservative”. The Envoyé Spécial journalist went so far as to use the adjective “shock”, which appeals to the imagination and viewers’ consciousness: the words “chemistry” and “hormone treatment” were then deliberately used. The speaker relied on passionate states linked to the fear that everyone can feel in the face of danger, when she showed in a catastrophist way the treatment of an apple orchard with pesticides. An event selection process was also used. The journalist selected those with a strong dramatic propensity. The narrative played on the effects of coincidence and was strongly marked, even conditioned by the words related to the use of pesticides and by an overwhelming and fatalistic vision: “As soon as we arrive in the region, we come across an ongoing spray. Toxic cloud, chemicals, shock treatment…”. This pesticide treatment thus became the symbol of the implementation of a didactic belief system that appeared inevitable. The report aimed to disseminate knowledge validated by a chain of institutional and social guarantees condemning the use of pesticides. In addition, the discursive methods used by the journalist in her piece used war rhetoric: “residents who went to war against pesticides”, “at the head of the protest”, “triangle of death”, “orchards are gaining ground”, “residents feel surrounded”, “harassment”, “small village of irreducible people”. Designations were also called for, characterizing as depreciative or highly emotional, playing on the complementary rhetoric of transgression and denaturalization: “Changing the appearance of France’s favorite fruit”; “flashy apple”; “invented by an agricultural engineer”; “it is the clothing that makes the fruit today” – or even profit: “In a hurry”; “crazy project”; “juicy”; “reigns over a domain”; “crunching its share of the market”; “so that it is worth it”; “profitability”, thus giving the image of an apple grower/alchemist who transgresses the laws of nature to grow new apples in order to increase profit. The denunciatory questioning was carried out in a subtle way. Indeed, the repeated use of the conditional invites the viewer to agree with the journalist’s comments, by arousing immediate suspicion: by telling them that the apple “would be a healthy fruit, or even more, a fruit that does good”, it

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seeks to guide the viewer’s thinking, namely that “the apple would not be a fruit as healthy as we think it is”. Summoned throughout the report, this mode of discourse constantly reassessed the comments of apple growers and thus questioned their responsibility in the health crisis caused by the use of pesticides. Consequently, the enunciator/journalist established a relationship of complicity with the viewer, suggesting that they accept this challenge. Finally, it should be noted that the selection of witnesses and experts is not transparent, since most of them are affiliated with the Allassac ONGF association, without this being specified in the report. Indeed, the latter relies on the testimonies of militant scientists affiliated with this ecological association on numerous occasions. Consequently, their activist role took precedence over their scientific status, which they nevertheless claimed in order to support their arguments. Only material elements favorable to their personal opinion were retained, and decontextualized in order to construct a focused discourse. At no time does the report leave room for a contradictory debate allowing the viewer to become aware of the full extent of the phenomenon. We can see that the report creates confusion between experts, scientists and ecological activists; confusion that can also be observed during the journalist’s experiments and whose expertise is relative. This is the case for the above-mentioned analysis of hair strands, and also for the analysis of apples from different orchards. Once again, the report prepared by a Belgian laboratory specializing in fruit analysis is commented on, not by one of its employees, but by an ecological activist, spokesperson for Génération futures, but considered by the journalist as a scientific guarantee. 2.5. Conclusion This plurality of discourses on the use of pesticides leads to confusion in society’s consumption practices, thus compromising the existence of living together. In practice, the control and rational use of phytosanitary products are now proving ineffective and allow multiple, out-of-sync and independent events to take hold. The Écophyto plan, which aimed to reduce the use of pesticides within 10 years, has not achieved its objectives [GUI 17].

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The result is a desynchronization between the course of events and the solutions provided, whose temporality seems suspended and disconnected from real events. Indeed, time continues to elapse, and health problems persist, while the question of the use of pesticides is at a standstill, the Écophyto plan having failed [GUI 17]. Thus, we are faced with two temporal disruptions embedded in each other. The first disruption is related to the solutions provided and was theorized by François Ost [OST 99, p. 34], then taken up by Jacques Fontanille [FON 15, p. 181]. It is “irreversible time”, a time of existence that takes place alone, enclosed within itself, given the ineffectiveness of these solutions. The second disruption, including the first, is called “dispersive desynchronization” [FON 15, pp. 182–183], because it plays into the natural tendencies of social dispersion (anger and panic), when a failure of the State threatening living together is observed. It promotes a relaxation of temporal synchronization, considered as a principle of unity of life in society, between the course of the process of events and the solutions implemented. To counter this trend, the government and apple growers are seeking to introduce a “time of promise” [FON 15, p. 184–185], which takes the form of commitments to implement the economic and financial means necessary to reduce the use of pesticides. The promise, at the time of the Écophyto plan, is materialized, as we have seen, in the farmers’ leaflet by the performative statement of the results of pesticide use presented as virtuous. It promises to anticipate the improvement of the future state of agriculture and encourages confidence in the solutions put in place. “Fermes DEPHY” is a pilot network of farmers, who have committed using fewer pesticides on their farms. It experiments with pesticide-friendly crop systems, shares good practices and supports each other. “We are in the ‘time of promise’ and in the ‘time of memory’” [FON 15, p. 184]. This allows us to put the past into perspective, to reconfigure it by transforming it into a present experience so that the past and the future can be confronted with it. Memory is therefore a necessary condition for judging the fulfillment of the promise, as both notions maintain a relationship of involvement. The highlighting of the massive use of pesticides and its direct consequences on the environment and health by local residents’ associations and the mass media has generated a real awareness among consumers.

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The suspicion is such that INRA researchers [MAR 12] reveal that the presence of the AB logo is no longer sufficient to reassure consumers who are seeking to know more about apple production methods, particularly in terms of pesticide use. Thus, it would be relevant to complete our present study with an analysis of the reception of these media discourses, in order to measure consumers’ perceptions of pesticide use and their regulatory expectations. This complementary study will allow us to verify if and how the Écophyto plan creates a strong tension between the “time of promise” and the “time of memory”, and generates a passionate effect of catastrophism. 2.6. References [AFI 15] AFIS, 2015. Available at: www.pseudo-sciences-13.org/smartfresh -pommes.html (accessed May 24, 2018). [AGR 13] AGRICULTURE & ENVIRONNEMENT, 2013. Available at: www.agriculture -environnement.fr/2013/03/12/generations-futures-assure-la-com-de-kudzu -science (accessed May 24, 2018). [ALL 15] ALLARD-HUVER F., “La transparence, de pierre angulaire à pierre d’achoppement des controverses médiatiques”, in CATELLANI A., CRUCIFIX A., HAMBURSIN C. et al. (eds), La communication transparente. L’impératif de la transparence dans le discours des organisations, pp. 31–48, PUL, Louvain, 2015. [BEY 09] BEYAERT-GESLIN A., L’image préoccupée, Hermes-Lavoisier, Paris, 2009. [BUT 10] BUTAULT J.P., DEDRYVER C.A., GARY C., et al., Écophyto R&D. Quelles voies pour réduire l’usage des pesticides ?, 2010. Available at: www6.paris.inra.fr/depe/content/.../3496/.../EcophytoRD-8pages-VFweb3.pdf (accessed May 24, 2018). [CHA 05] CHARAUDEAU P., Les médias et l’information : l’impossible transparence du discours, De Boeck, Brussels, 2005. [CHA 10] CHARAUDEAU P., “Une éthique du discours médiatique est-elle possible ?”, Communication, vol. 27, no. 2, pp. 51–75, 2010. Available at: journals.openedition.org/communication/3066 (accessed May 24, 2018). [DAB 13] DAB W., SALOMON D., Agir face aux risques sanitaires : pour un pacte de confiance, PUF, Paris, 2013.

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[FAB 07] FABIANI J.L., “Disputes, polémiques et controverses dans les mondes intellectuels. Vers une sociologie historique des formes de débat agonistique”, Comment on se dispute. Les formes de la controverse, revue Mil neuf cent. Revue d’histoire intellectuelle, vol. 25, pp. 45–60, 2007. Available at: www.cairn.info/revue-mil-neuf-cent-2007-1-page-45.htm (accessed May 24, 2018). [FON 99] FONTANILLE J., Sémiotique du discours, Pulim, Limoges, 1999. [FON 15] FONTANILLE J., Formes de vie, PUL, Liège, 2015. [GRE 93] GREIMAS A.J., COURTES J., Sémiotique, dictionnaire raisonné de la théorie du langage, Hachette, Paris, 1993. [GUI 17] GUICHARD L., DEDIEU F., JEUFFROY M.-H. et al., “Le plan Ecophyto de réduction d’usage des pesticides en France : décryptage d’un échec et raisons d’espérer”, Cahiers Agricultures, vol. 26, p. 14002, 2017. [INA 13] INAO, Regulation (EU) No. 1308/2013 of December 17th, 2013. Available at: https://www.inao.gouv.fr/eng/Official-signs-identifying-quality -and-origin/PDO-AOC. [JEA 98] JEANNERET Y., “L’affaire Sokal : comprendre Communication & Langages, no. 118, pp. 13–26, 1998.

la

trivialité”,

[JEA 10] JEANNERET Y., “Une volonté de savoir au crible d’une querelle médiatique”, Communication & Langages, no. 166, pp. 75–99, 2010. [JOS 05] JOST F., Comprendre la télévision, Armand Colin, Paris, 2005. [LAF 15] LAFITTE J., “Les controverses environnementales : entre conflit et consensus”, Éducation relative à l’environnement, vol. 12, 2015. Available at: journals.openedition.org/ere/453 (accessed May 24, 2018). [LEM 07] LEMIEUX C., “À quoi sert l’analyse des controverses”, Comment on se dispute. Les formes de la controverse, Mil neuf cent. Revue d’histoire intellectuelle, no. 25, pp. 191–212, 2007. Available at: www.cairn.info/revuemil-neuf-cent-2007-1-page-191.htm (accessed May 24, 2018). [LIB 14] LIBAERT T., ALLARD-HUVER F., “La communication sur les sujets sensibles au prisme des sciences de l’information et de la communication”, Communiquer, no. 11, pp. 81–100, 2014. Available at: journals.openedition.org /communiquer/574 (accessed May 24, 2018). [MAR 12] MARETTE S., MESSÉAN A., MILLET G., “Consumers’ willingness to pay for eco-friendly apples under different labels : evidences from a lab experiment”, Food Policy, vol. 37, p. 151, 2012. [MOI 07] MOIRAND S., Les discours de la presse quotidienne, PUF, Paris, 2017.

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[OST 99] OST F., Le temps du droit, Odile Jacob, Paris, 1999. [SEN 02] SENECAL G., “Controverses en environnement et développement durable urbain : la formation d’un nouvel espace public”, VertigO, vol. 3, no. 2, 2002. Available at: journals.openedition.org/vertigo/3762 (accessed May 24, 2018). [SER 13] SERVAIS C., “Énonciation journalistique et espace public”, Communication, vol. 32, no. 2, 2013. available at: journals.openedition.org /communication/5058 (accessed May 24, 2018). [YAN 03] YANOSHEVSKY G., “De la polémique à la polémique journalistique”, Recherches en communication, no. 20, 2003. available at: sites.uclouvain.be/rec /index.php/rec/article/viewFile/4501/4231 (accessed May 24, 2018).

3 Naming “Antibiotic-Free” Meat: American Agri-Food Industry Communication between Commitment and Guaranteeing Food Safety

3.1. Globalization of the antimicrobial resistance problem and diversification of action programs Antimicrobial resistance appears to be a global health problem. The problem itself refers to the ability of bacteria to adapt and become immune to the effects of an antibiotic when used repeatedly [LEV 99]. In recent years, it has been the subject of increased awareness and has involved a plurality of actors from various sectors: health bodies, public authorities, private actors in the agri-food field and the pharmaceutical industry, non-governmental organizations and consumer associations. In this regard, 2016 was a year of several significant international events: in January of that year, at the World Economic Forum in Davos, a group of 80 international pharmaceutical industry representatives called upon governments to participate in the fight against antibiotic resistance [IFP 17]. In May, the British group “Review on antimicrobial resistance”, which was set up at the request of the British Prime Minister and led by economist Jim O’Neil, published its final report. This report presents prospective quantitative estimates of the human and economic costs of antimicrobial resistance: 10 million deaths annually and $100 trillion loss in global production Chapter written by Estera BADAU.

Food and Health: Actor Strategies in Information and Communication, First Edition. Edited by Viviane Clavier and Jean-Philippe De Oliveira. © ISTE Ltd 2019. Published by ISTE Ltd and John Wiley & Sons, Inc.

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by 2050 [ONE 16]. The report led as well to the problem being placed on the political agenda of the G7 and G20 summits, where political leaders acknowledged the urgency of international action and affirmed their commitment to combat antibiotic resistance. In September 2016, for the first time, the issue was put on the agenda of the 71st UN General Assembly. Based on Joseph Gusfield’s [GUS 81] and Jean Widmer’s [WID 10] proposals, we see that this problem is the subject of various action programs implementing several types of solutions. For example, while the pharmaceutical industry calls on governments to fund research into new antibiotics, agri-food industry actors participate in the development of the “antibiotic-free” concept, which appears in their discourses under a plurality of “formulas”1 [PLA 09, p. 9]. 3.2. A variety of formulas to name “antibiotic-free” meat in the United States In the United States, the public awareness of the antimicrobial resistance problem has seen a very particular evolution. One of the factors behind this development is the regulation of antibiotic use in intensive livestock production. While in Europe, the use of antibiotics as growth promoters in raising food-animals has been banned since 2006 [EUR 18], such a measure has only been applied by the United States authorities since January 1, 2017 [FOO 17]. In fact, the use of antibiotics in intensive livestock farming (as growth promoters, as a preventive and curative measure, in a metaphysical2 way) and the need for regulation have been the subject of a long debate. It pits the scientific community’s “whistleblowers” [CHA 99], who have been joined over the years by non-governmental organizations, consumer associations and administration representatives, against representatives of producers and the pharmaceutical industry. The movement against the widespread use of antibiotics was launched by the researcher Stuart Levy with the founding of the NGO Alliance for the Prudent Use of Antibiotics, the first alliance dedicated to the prudent use of antibiotics, in 1981 [APU 17]. Three years later, the movement was joined by the NGO Natural 1 We borrow this term from Alice Krieg-Planque, defining it as “a set of formulations which, because of their uses at a given time and in a given public space, crystallize political and social issues, which these formulations contribute at the same time to construct.” 2 Administration of antibiotics in feed to the entire herd or share of animals.

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Resource Defense Council, and since 1999, several NGOs and associations have joined this movement3. Thus, the American Administration has spent nearly half a century implementing a policy to regulate the use of antibiotics in livestock farming. Moreover, under increasing consumer pressure, the agri-food industry has in recent years taken hold of a new “health allegation”4 [OUI 06, p. 113], which claims either a decrease or the absence of antibiotics in the production of food animals and implicitly in food products derived from livestock. Whether it regards meat producers, restoration or distribution chains, the argument in favor of “antibiotic-free” meat circulates under a plurality of formulas. According to a study published by Pew Charitable Trusts in 2016, which examined the policies adopted by actors in the agri-food chain regarding the use of antibiotics in animal farming, producers such as Foster Farms or Tyson Foods raise chicken with the judicious use of antibiotics, while their competitor, Perdue Farms, possesses the label no antibiotics ever. The communication of fast food chains uses formulas such as “raised without antibiotics” (Subway food chain), or also “without the use of antibiotics classified as being important to human health use by the WHO” (no medically important antibiotics5, McDonald’s) [PEW 16]. The multiplicity of these formulas results from the debate between scientists, health actors, private actors (agri-food and pharmaceutical industry) and consumer associations regarding the use of antibiotics in livestock farming, and the risks that this practice poses to both health and food, at two levels: the first being the loss of antibiotic effectiveness and the second the transmission of resistant bacteria through the food chain. While the meanings of these formulas vary, the implicit link between them is that they do not imply an actual presence of antibiotics in food products, but that they refer to risks of product contamination with resistant bacteria. The use itself of the “antibiotic-free” label is prohibited by the administrative agency in charge of food and drug safety [FOO 18], due to existing regulations on the timing of the treatment of animals with drugs before slaughter. Indeed, 3 For example: Center for Science in the Public Interest, Union of Concerned Scientists, Food Animal Concerns Trust, Environmental Defense Fund, Pew Charitable Trusts, Consumers Union. 4 We borrow this term from Christian Ouillet who gave the following definition: “Indication or advertisement establishing, or suggesting, a link between a product and health” [OUI 06, p. 113]. 5 “Without medically important antibiotics”, according to the WHO list.

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any food product is not supposed to contain antibiotic residues surpassing the accepted residue levels, and therefore, the use of a label based on the absence of antibiotics is prohibited, because authorizing it would imply that other products may contain them. In addition, the emergence of these claims is in line with the claims “hormone-free” or “pesticide-free”, which appeared following health crises related to the industrialization of agriculture and intensive livestock farming and their impact on health, food and the environment. The agri-food industry’s interest in the antimicrobial resistance issue is reflected in the production of meat “without antibiotics” and in “making it known”. The meanings of the formulas for naming this meat reveal communication strategies specific to this sector. 3.3. Problematization, hypothesis and methodology This study is based on analyzing two types of documents: articles published in the national daily press and documents released by agri-food actors. The study of the actors’ discourses, reported by the national press, testifies as well as participates in debates and exchanges on the subject of antibiotics. It is a privileged research field within communication studies for three main reasons: it facilitates the understanding of the context of how these formulas appear, their meanings with their evolutions, as well as observation of their circulation. The study of documents produced by actors in the food chain makes it possible to analyze their uses in terms of methods and communication strategies of the agri-food industry. The study corpus was compiled in two stages: first, we collected articles published in two reference titles of the national press between 1980 and 2016 (334 articles for the New York Times and 194 articles for the Washington Post – see the appendix for the methodology and the 44 titles selected for this analysis). In a second step, the corpus was completed by 12 documents, published by agro-industrial actors specialized in the meat sector. The analysis is based on two specific examples: the Perdue Farms communication (the 4th largest chicken producer in the United States) and McDonald’s. The quantitative analysis of the corpus studied in this work reveals a media coverage of the subject of meat without antibiotics (see Figure 3.1) – which has increased in recent years – with a peak between 2014 and 2015, which is explained both by the emergence of the no antibiotics ever formula and by political events related to the subject (see Figure 3.2).

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Figure 3.1. Histogram of the subject of meat “without antibiotics” (between 2002 and 2016)

Figure 3.2. Histogram of the subject of antibiotic use in livestock in The New York Times and The Washington Post between 1980 and 2016.

The second graph, on the media coverage of the debate on the agricultural uses of antibiotics between 1980 and 2016 and the subject of meat without antibiotics, highlights the increased awareness of the impact of antibiotic

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resistance on food, with the emergence of the subject of meat without antibiotics since 2002. These corpora meet the twofold objective of our study: first, to observe the names and the process of setting formulas such as no antibiotics ever and no/without medically important antibiotics; second, to analyze the involvement of agri-food actors and their communication strategies. Methodologically, the tools and concepts on which our approach is based resulted from a cross-perspective of the pragmatic approach of public problems by using the terminology developed by Joseph Gusfield6 [GUS 81, p. 9], with a semantic-pragmatic discourse analysis perspective based on the terminology developed by Jean Widmer7 [WID 10]. The analysis of discourse follows as well the pragmatic approach of nomination, as developed by Paul Siblot [SIB 01]. According to Joseph Gusfield [GUS 81], public problems are processes that are defined by three categories: ownership (designating the actors who claim the legitimacy to define and name the problem), causal responsibility (establishing the causal factors of the problem) and political responsibility (representing the actors designated as responsible for providing solutions)8. According to Jean Widmer [WID 10], the social operativity of discursive practices lies in the organization of social and cognitive activities through categorization processes in adjacent pairs. Adjacent pairs are made up of intrinsically linked segments: the first calls and conditions the meaning of the second. The configuration of action programs is based on adjacent pairs, resulting from categorization processes, which organize the orientation of practices and implicitly the constitution of the meaning of phenomena. In other words, during the process of public problem establishment, various actors take over the legitimacy to define these categories (ownership, causal responsibility and political responsibility), participating in the publicization of various social, economic or political issues linked to the problem itself, and contributing to the emergence of action programs that

6 American sociologist. This author has highlighted three categories that describe the public problem structure. 7 Jean Widmer, also a sociologist, integrating discourse analysis, highlighted the processes of setting up action programs. 8 See also [BAD 18] for an interpretation of the work of [GUS 81].

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link these categories to solutions. At the same time, the solutions that emerge depend on the definitions assigned to these categories9. Within the pragmatic approach, nomination is defined as the activity whose purpose is both “to semiotize fragments of reality according to the social experience of the speakers and to disambiguate the polysemy that characterizes the word or the reference, thanks to the relationships that are established between the word and the other terms of the context” [BRA 07]. In addition, Paul Siblot stressed the importance of the context in which the naming takes place. It is conceived as a contextual and interdiscursive modality of meaning, and it also emphasizes the importance of the role of the person who performs the act of naming, a fact that suggests the existence of a plurality of possible nominations. According to him: As I cannot name the object “in itself and for itself”, I name it as it appears to me and concerns me, as I perceive it, as I use it and as from there I can conceive it. So when I think I name the object itself, it is my relationship with it that I actually name. [SIB 01, p. 203] With this in mind, the purpose of our study was to test two hypotheses. The first hypothesis was to study the process by which the no antibiotics ever and no/without medically important antibiotics formulas were part of the “antibiotic-free” meat naming process. We wondered whether the meaning of the “antibiotic-free” segment was constituted through the use of other formulas in the discourses of agri-food industry actors, as a result of these actors’ appropriation of the antibiotic resistance issue in the debate in which antibiotic resistance was defined, with an emphasis on agricultural uses of antibiotics. The second hypothesis of our study aimed to verify whether the two formulas in favor of “antibiotic-free” meat work in agri-food actors’ communication as tools that contribute both to the consolidation of brand

9 We rely on this reasoning, which links the process of creating public problems to the emergence of action programs, as a result of a collaboration with Jocelyne Arquembourg (CIM of the Sorbonne Nouvelle University – Paris 3) and Nicolas Fortané (CNRS of the INRA Paris-Dauphine).

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identity [AUR 16] and to the guarantee of food safety. Considering these two formulas as updates of the “antibiotic-free” segment, we were interested in setting the meaning of these formulas, which the media and agri-food actors’ discourses show. According to Alice Krieg-Planque, one of the characteristics of the “formula” concept [KRI 10] is the fact that each “formula” has a social referent that means the same thing for everyone. Our study therefore questioned the factors that contribute to the setting of the meaning of the formulas studied and to the construction of a referent shared by the actors involved in the problem. 3.4. Stages of progressive communication The analysis of daily national press discourses indicates three stages of media coverage. The first began in 2002, which is characterized by the announced willingness of chicken producers to reduce antibiotic use. The second, which took place around 2007–2008, is characterized by the first attempts to name meat products as being “without antibiotics”. It regards the launch of the raised without antibiotics label by producer Tyson Foods and the controversy emerging over this formula. Finally, the third stage, from 2014 onwards, highlights a chain reaction of other agri-food actors whose discourses are based on commitments (and re-commitments) with quantified objectives. Indeed, the evolution of communication of agri-food actors during these three stages is part of sector-specific communication strategies addressing food risks: in particular persuasive communication and commitment through actions [GIR 15]. 3.4.1. The voluntary approach In the first stage, which also represents the first public engagement discourses by agri-food actors on the subject, the three major national chicken producers (Tyson Foods, Foster Farms and Perdue Farms) claimed to have voluntarily reduced certain antibiotic uses. Thus, according to Tyson Foods’ discourse, the use of antibiotics similar to those used in human health has been reduced – the only two antibiotics of this type being used only as a preventive measure and no longer as growth promoters. On the other hand, Foster Farms claimed to use antibiotics only for curative and preventive purposes. Perdue Farms, for their part, insisted that they only use antibiotics

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that are not used in human health, to ensure that their practices do not contribute to the emergence of resistance in human health. One of the specific features of the media coverage of this first voluntary approach is that it places the commitments of agri-food actors in the context of the debate on agricultural uses of antibiotics, as a response to requests from public health groups10 and consumers, through the words of Marian Burros, a journalist contributing to the newspaper and a specialist in food journalism: The poultry industry has quietly begun to bow to the demands of public health and consumer groups by greatly reducing the antibiotics that are fed to healthy chickens. Long a mainstay of poultry farming, antibiotics have been justified as a means of preventing infection in chickens as well as enhancing growth. Opponents have bitterly criticized the industry for a strategy that they say contributes to a much larger public health problem: the growing resistance to antibiotics of diseasecausing bacteria in humans. Now it appears that with little fanfare, the industry has begun to acquiesce. Three companies – Tyson Foods, Perdue Farms and Foster Farms, which produce a third of the chicken consumed by Americans each year – say they have voluntarily taken most or all of the antibiotics out of what they feed healthy chickens.11 We quote this extract exhaustively because it highlights and explains the context in which the subject of our research emerges (the development of chicken meat production with reduced or no use at all of antibiotics, as a result of consumer demand). It also represents the time limit at the beginning of our analysis corpus. The voluntary approach continues with McDonald’s request to its suppliers to stop using antibiotics as growth promoters and reduce their use as a preventive measure.

10 That is, the coalition of the NGO KAW: Keep Antibiotics Working (CSPI, UCS, CU, FACT, NRDC). 11 The New York Times, October 2, 2002.

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3.4.2. First naming attempts During the second media coverage phase, between 2007 and 2008, the controversy surrounding the naming of “antibiotic-free” products emerged with the launch by Tyson Foods of the raised without antibiotics formula. However, due to the use of ionophores12 for the prevention of intestinal diseases, the U.S. Food and Drug Administration withdrew its approval a few months after the launch of the formula. The producer transformed its formula into chicken raised without antibiotics that impact resistance in humans, but the denunciations of their competitors Sanderson Farms and Perdue Farms regarding the use of antibiotic molecules in eggs, and the legal proceedings initiated by the administrative agency, forced them to withdraw their label in 2008. The importance of media coverage of the “affair” lies in the emergence of a referential link between naming products made from so-called “antibiotic-free” meat and the antibiotic-free formula, through reformulation processes and inclusion in the titles under which the news were published by the two newspapers studied in our corpus. Reformulated free of antibiotics13 by the Associated Press news agency, the name was replaced by antibiotic free14 in the articles by Andrew Martin and Annis Shyn, then taken over by the Reuters agency15. 3.4.3. Commitment through action Between 2008 and 2014, a variety of nominations in favor of “antibiotic-free” meat emerged, as evidenced by the study published in 2015 by several NGOs evaluating antibiotic reduction policies by producers, restaurateurs and distributors16. 12 Substances considered as a class of antibiotics in the United States, but not in Europe. 13 “Tyson to sell chicken free of antibiotics”, Associated Press, June 20, 2007. 14 “U.S. Withdraws approval for Tyson’s antibiotic-free label”, The New York Times, November 20, 2007; Tyson Finds a Label for Its Antibiotic-Free (Well, Almost) Chicken”, The Washington Post, December 21, 2007; “Court Orders Tyson to Suspend Ads For Antibiotic-Free Chicken”, The Washington Post, May 2, 2008. 15 “Tyson to stop calling chicken antibiotic-free”, Reuters, June 3, 2008. 16 “Chain reaction: how top restaurants rate on reducing use of antibiotics in their meat supply”, NRDC, KAW, FACT, CU, 2015. Available at: www.nrdc.org/resources/chain -reaction-how-top-restaurants-rate-reducing-antibiotics-their-meat-supply.

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During this last stage of mediatization, which is characterized by strategies of engagement through actions, two types of communication emerge: – on the one hand, Perdue Farms communicates on the results obtained following the elimination of antibiotics at different stages of breeding; – on the other hand, companies such as Tyson Foods or McDonald’s communicate their commitments to eliminate different classes of antibiotics with quantified targets. Perdue Farms’ statement in 2014 that it would eliminate antibiotics in hatcheries, the last stage of breeding, was followed by a press release in 2015, which announced the approval by the administrative agency in charge of food and drug safety of the no antibiotics ever label, for the chicken line of the Perdue Simply Mart brand. In 2016, the company announced that its chicken production under the no antibiotics ever program reached 67% of their total chicken production. Also in 2015, McDonald’s published an official position paper on the use of antibiotics in the breeding of animals whose meat is purchased by the company. This declaration concerned Preserving antimicrobial effectiveness in the future through ethical practices today. Based on the World Health Organization’s antibiotic classification list, the company affirmed the removal of medically important17 antibiotic uses as growth promoters in the production of purchased meat. 3.5. Emergence and use of the no antibiotics ever and no/without medically important antibiotics formulas 3.5.1. Private industry’s claim and takeover of an institutional formula If these two formulas naming “antibiotic-free” meat, no antibiotics ever (as claimed by chicken producers) and no/without medically important – antibiotics (a formula taken from the World Health Organization’s

17 The WHO’s classification includes three categories of antibiotics, based on the resistance rate of bacteria: important, highly important and critically important microbials.

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discourse) succeed in taking precedence over the plurality of formulas existing on the market, the appropriation of the problem by agri-food actors is also indebted to a restructuring of chicken production system according to animal husbandry programs. According to estimates by the National Chicken Council, announced in early 2017 [OKE 17], the production of broiler chicken under the no antibiotics ever program increased from 3% in 2014 to 12% in 2015 and 33% in 2016; production under the no medically important antibiotics program, according to the World Health Organization’s antibiotic classification list, increased from 29% in 2014 to 36% in 2015. A particular characteristic of these formulas is the nomination process. On the one hand, the formula no antibiotics ever is a claim by Perdue Farms in cooperation with the public authorities. In a press release, the producer emphasized the validation of the program and the label granted by administrative authorities such as the USDA Process Verified Program: “Perdue launched the PERDUE HARVESTLAND®, brand of NO ANTIBIOTICS EVER™, chicken, with the first-ever USDA Process Verified Program, assuring that no antibiotics of any kind were used at any point. Within a few years, PERDUE HARVESTLAND® reached national distribution, becoming the leading brand of NO ANTIBIOTICS EVER™ chicken in the U.S.” [PER 16a] On the other hand, the no/without medically important antibiotics formula is a takeover of the institutional discourse, concerning the antibiotic classification lists carried out by health actors (the World Health Organization and the Food and Drug Administration). Implicitly, the takeover and the uses of this formula by the actors in the agri-food industry reveal their positions on the problem. While McDonald’s engagement relies on the World Health Organization’s “classifications” and takes over the formula under the form of an authoritative argument, the Perdue Farms initiative reveals a private claim leading towards innovation. 3.5.2. Brand commitment and guarantee of food safety Perdue Farms’ commitment to the no antibiotics ever program – as one of the first major chicken companies to propose solutions to the antibiotic resistance issue – has enabled it to position itself as a leader on the subject, compared to its competitors who joined the program in 2016 and 2017.

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Being the first major producer promoting products under this name has allowed it to distinguish itself in the context of a multiplicity of claims and formulas, through argumentation using various processes, such as descriptive argumentation by analogy (“At Perdue, we believe in taking extra steps. It’s how we stay one step ahead. And it’s how we raise healthy chickens with No Antibiotics Ever”), argumentation by illustration (video explaining the implementation of alternative solutions – essential oils – to replace antibiotics), or argumentation by exclusion: Perdue Farms announced that it completed the final step away from the routine use of any antibiotics in its chicken production by eliminating all use of animal-only antibiotics. This comes two years after Perdue became the first major poultry company to stop routinely giving its chickens antibiotics also used in human medicine. Through more than a decade of advancements in animal husbandry and the acquisitions of Coleman Natural Foods and Niman Ranch, we found we can consistently raise healthy animals without relying on the routine use of any antibiotics, and with no compromise in food safety. [PER 16b] The previous extract emphasizes the possibility, as well as the brand’s choice, of producing healthy chickens without systematically using antibiotics and using natural alternatives (the takeover of Coleman Natural Foods and Niman Ranch, groups of farmers known for their natural approach). While safety is one of the two dimensions of food products and is highlighted in communication strategies [AUR 16, p. 34] (the other being nutritional quality), the claim of absence of antibiotics is accompanied by phrases referring to the health of farmed animals, or the safety of products (healthy chickens; healthy animals; food safety). Phrases referring to animal health or food safety are also recurrent in McDonald’s discourse, the first global fast food chain to have adopted a policy of commitment to antibiotic use, claiming responsible use of antibiotics: McDonald’s USA will only source chicken raised without antibiotics important to human medicine. Farmers who supply chicken for our menu will continue to responsibly use

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ionophores, a type of antibiotic which helps keep chickens healthy but is not beneficial for humans. McDonald’s is committed to ensuring wholesome and safe food for our customers. Safe food is McDonald’s number one priority and its central to all company operations. (Paragraph extracted from the company’s commitment policy) McDonald’s statements clearly show their position in the debate on the agricultural use of antibiotics. Using World Health Organization guides, whose reference functions as an authoritative argument, their communication uses phrases that highlight the responsible use of antibiotics in the rearing of healthy chickens to ensure product safety. As the researcher Roselyne Koren points out: “If naming is categorizing, but also evaluating or judging, legitimizing or disqualifying” [KOR 16], then brand commitment in regard to the subject, through private claims or takeovers of institutional discourse, as well as the call for authoritative arguments in their communication, shows legitimate strategies to position themselves as leaders in a new market sector, guaranteeing, at the same time, product safety. 3.6. Conclusion The crossover perspective between Joseph Gusfield’s work on the process of constituting public problems, Paul Siblot’s work on the naming process and Jean Widmer’s research on the role of language in configuring action programs have allowed us to observe in detail two particular scenes publicizing solutions to the antibiotic resistance problem. The first refers to the media scene and the second to the discourses of meat producers, with both focusing on raising awareness of the impact of antibiotic resistance on food and its management in the United States by agri-food industry actors. Our approach has thus enabled us to analyze the role of the agri-food industry in the process of publicizing the antibiotic resistance problem and the emergence of solutions, namely the production of so-called “antibiotic-free” meat. The process of constituting a public problem is also a process of publicization, which shows a progressive emergence of various aspects of the problem. In the case of antibiotic resistance, we can mention nosocomial infections, the challenges of regulating antibiotic use in

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livestock, the need for research into new molecules, the production of meat with reduced use of antibiotics or even the cessation of the use of antibiotics. These aspects have emerged gradually in the public sphere, as a result of the different appropriations of the problem by actors from several fields. The debate on agricultural uses of antibiotics emerged very early in the United States, and since the 1980s, non-governmental organizations and consumer groups have come together to work on the subject. However, the publication of the concept of “antibiotic-free”, under the different formulas, remains relatively recent. It is now used following the agri-food industry’s investment in the antibiotic resistance problem and shows strategies for replicating institutional discourse, or the use of formulations by the agri-food industry – strategies that have enabled brands to position themselves as leaders in a new market sector. As our study shows, in the communication strategies of these brands, the formulas studied function as arguments supposed to guarantee product safety. Our research, based on discourse analysis of action program constitution and their segments functioning in the communication strategies deployed by the agri-food industry, has therefore enabled us to provide some answers to the hypotheses formulated. If the daily press coverage and the agri-food actors’ communication publicize the problem of antibiotic resistance and make it possible to analyze the emergence of formulas replacing the “antibiotic-free” concept, the study has also made it possible to highlight two important aspects. The first aspect shows that the emergence of the “antibiotic-free” segment as a solution to the antibiotic resistance problem has been referred to in several ways between 2002 and 2016. The meaning attributed to these designations has been different according to the actors appropriating the subject (Perdue Farms: no antibiotics ever; McDonald’s: no/without medically important antibiotics). In other words, the process of constructing the antibiotic resistance problem and the emergence of its “antibiotic-free” segment is a complex process that evolves according to the investment of actors who appropriate the problem and define the solutions to be provided. Nonetheless, this process takes place following the impact of various issues specific to each sector of actors involved. The second aspect shows that the appropriation of the concept by the two players (Perdue Farms and McDonald’s) under the two formulas (no antibiotics ever and no/without medically important antibiotics), used as arguments guaranteeing food

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safety, has contributed to the development of the “antibiotic free” concept, by allowing the two brands to position themselves as leaders in a new market sector. 3.7. Appendix. Methodological aspects: corpus building 3.7.1. The press corpus compiled for our thesis work For our thesis, the corpus was constituted by articles published in two reference titles of the American national press (The New York Times and The Washington Post) between 1980 and 2016. The articles were retrieved from the Factiva database, based on several searches based on keywords used in conjunction and expressions: antibiotic resistance, antimicrobial resistance, antibiotic free/antibiotic-free, antibiotics and food, antibiotics and farming, antibiotics and resistant, antibiotics and salmonella, salmonella and resistant, salmonella and outbreak, antibiotics and campylobacter and resistant, antibiotics and routine, antibiotics and routinely, antibiotics and one health. After the removal of duplicates, the deviation of articles dealing only with human health, or mentioning search words in contexts not related to the subject, the corpus consisted of 334 articles published in the Times and 194 in the Post respectively. 3.7.2. Constitution of the corpus for this chapter 3.7.2.1. National press The corpus analyzed in the study is based on articles published in two daily newspapers between 2002 and 2016. The keywords used in the search for the articles were: “Perdue” AND “antibiotics”, “Perdue Farms” AND “antibiotics”, “McDonald’s” AND “antibiotics”, “Tyson” AND “antibiotics”, “Tyson Foods” AND “antibiotics”, “Foster Farms” AND “antibiotics”. Titles of articles selected in the New York Times: – February 10, 2002, Marian Burros: Poultry industry quietly cuts back on antibiotic use; – February 13, 2002, Editorial desk: Antibiotics in the poultry industry;

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– February 15, 2002, Letter Tamar Barlam MD, Center for Science in the Public Interest: A food supply without antibiotics; – February 17, 2002, Marian Burros: Healthier chicken; – June 20, 2003, David Barboza, Sherri Day: McDonald’s seeking cut in antibiotics in its meat; – June 22, 2003, Editorial desk: Fast food, not fast antibiotics; – June 25, 2003, David Barboza: Animal Welfare’s unexpected allies; – August 14, 2003, Denise Grady: W.H.O. finds use of antibiotics in animal feed can be reduced; – January 12, 2005, Marian Burros: McDonald’s takes steps on its antibiotics promise; – June 20, 2007, Associated Press: Tyson to sell chicken free of antibiotics; – November 20, 2007, Andrew Martin: U.S. withdraws approval for Tyson’s antibiotic-free label; – December 21, 2007, Andrew Martin: Tyson finds a label for Its antibiotic-free (well, almost) chicken; – April 23, 2008, Stephanie Clifford: Tyson told to end an antibiotic claim; – June 3, 2008, Reuters: Tyson to stop calling chicken antibiotic-free; – June 14, 2008, Reuters: Tyson Foods sues U.S.D.A. over antibiotic rules; – September 4, 2014, Stephanie Strom: Antibiotics eliminated in hatchery, Perdue says; – March 5, 2015, Stephanie Strom: McDonald’s Moving to limit antibiotic use in chickens; – March 8, 2015, Stephanie Strom: McDonald’s seeks its fast-food soul; – April 8, 2015, Mark Bittman: McDonald’s turns “progressive” (contributing op-ed writer); – April 29, 2015, Stephanie Strom: Tyson Foods says it plans to eliminate use of human antibiotics in chickens;

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– May 5, 2015, Stephanie Strom: Panera Joins the rush to simplicity in food; – May 23, 2015, Stephanie Strom: Walmart pushes for improved animal welfare; – June 2, 2015, Stephanie Strom: Foster Farms ending use of human antibiotics; – August 1, 2015, Stephanie Strom: Poultry’s cage match; – September 9, 2015, Stephanie Strom: Perdue expands in specialty meat business. Titles of articles selected in the Washington Post: – June 19, 2003, Marc Kaufman: McDonald’s will tell meat suppliers to cut antibiotics use; policy reflects concerns on drug-resistant germs; – June 13, 2003, Marc Kaufman: WHO urges end to use of antibiotics for animal growth; – June 16, 2003, Dana Hedgpeth: Hog producers dispute WHO on antibiotics; – May 2, 2008, Annys Shin: Court Orders Tyson to Suspend Ads For Antibiotic-Free Chicken; – June 3, 2008, Food: Tyson drops no-antibiotics labels; – September 19, 2014, Amy Ellis Nutt: White House addresses antibiotics; – March 5, 2015, Sarah Halzack, Lenny Bernstein: McDonalds cuts out key antibiotics; – March 7, 2015, A-section: In case you missed it; – March 7, 2015, Editorial board: McDonald’s healthy choice; – March 10, 2015, Editorial-Opinion: McDonald’s warmed-over changes; – April 29, 2015, Ana Swanson: Tyson to curb human antibiotic use; – May 2, 2015, Editorial board: Hold the drugs; – May 5, 2015, Editorial-opinion, NRDC member: The FDA’s halfmeasures;

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– September 10, 2015, Roberto A Ferdman: McDonald’s moves toward making cage-free Egg McMuffins; – October 26, 2015, Editorial board: Progress on antibiotics; – December 20, 2015, Michael Mitchell Nick Weiger: The case for eating at chain restaurants; – June 29, 2016, Rachel Premack: U.S. poultry company’s animal-care plan lauded by activists; – July 26, 2016, Karin Brulliard: The movement toward cage-free eggs gains some global momentum; – August 3, 2016, Tamar Haspel: Hens’ happiness matters, but recognizing it is hard. 3.7.2.2. Titles of documents published by McDonald’s and Perdue Farms – March 2, 2015, McDonald’s: McDonald’s Global Vision for Antimicrobial Stewardship in Food Animals; – April 3, 2015, McDonald’s: Evolving our menu to meet customers’ expectations; – September 1, 2014, Perdue Farms: “Antibiotics Position Statement” (accessed on August 7, 2017 at: www.perduefarms.com/news/statements /antibiotics-position-statement); – September 3, 2014, Perdue Farms, PR: Perdue Foods reaches milestone in reducing antibiotic use, sets standard for responsible use (accessed July 19, 2017, at: www.perduefarms.com/news/press-releases/perdue-foodsreaches-milestone-in-reducing-antibiotic-use-sets-standard-for-responsibleuse); – October 15, 2014, Perdue Farms, PR: PERDUE® SIMPLY SMART® breaded products now USDA Process Verified for no antibiotics ever (accessed August 7, 2017, at: www.perduefarms.com/news/pressreleases/perdue-simply-smart-breaded-products-now-usda-process-verifiedfor-no-antibiotics-ever); – August 7, 2015, Perdue Farms, PR: After Eliminating Human Antibiotics in Chicken Production in 2014, Perdue Continues Its Leadership Role to Reduce All Antibiotic Use – Human And Animal (accessed December 15, 2017, at: www.perduefarms.com/news/press-

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releases/after-eliminating-human-antibiotics-in-chicken-production-in-2014perdue-continues-its-leadership-role-to-reduce-all-antibiotic-use-human-andanimal); – February 26, 2016, Perdue Farms: No antibiotics ever factsheet, (accessed August 7, 2017, at www.perduefarms.com/news/pressreleases/perdue-no-antibiotics-ever-fact-sheet); – February 26, 2016, Perdue Farms, PR: Perdue expands NO ANTIBIOTICS EVER poultry into mainstream grocery foodservice (accessed August 7, 2017, at www.perduefarms.com/news/pressreleases/perdue-expands-no-antibiotics-ever-poultry-into-mainstreamgrocery-foodservice); – February 26, 2016, Perdue Farms, PR: A History of Leadership: Perdue’s Journey Away From Antibiotics (accessed August 8, 2017, at: www.perduefarms.com/news/press-releases/perdues-journey-away-fromantibiotics); – October 7, 2016, Perdue Farms, PR: First major poultry company to eliminate routine use of all antibiotics (accessed August 8, 2017, at: www.perduefarms.com/news/press-releases/first-major-poultry-company-toeliminate-routine-use-of-all-antibiotics); – 2016, Reuters: Perdue Way No Antibiotics (accessed December 15, 2017, at: www.perdue.com/perdue-way/no-antibiotics); – 2016, Perdue Farms: Company’s Stewardship Report. 3.8. References [APU 17] APUA, “The alliance for the prudent use of antibiotics”, available at: apua.org/ourhistory (accessed December 12, 2017). [ARQ 16] ARQUEMBOURG J., “L’antibiorésistance en France, du risque à la menace pour la santé publique. Analyse d’un processus inachevé de constitution d’un problème public”, Questions de communication, vol. 29, no. 1, pp. 29–47, 2016. [AUR 16] AURIER P., SIRIEIX L., Marketing de l’agroalimentaire : environnement, stratégies et plans d’action, Dunod, Paris, 2016. [BAD 18] BADAU E., ARQUEMBOURG J., FORTANÉ N., “Les appropriations de l’antibiorésistance en France : la carrière d’un problème public au sein de la presse vétérinaire (2006–2014)”, in BERNARDIN S. (ed.), Croisades privées et problèmes publics. L’héritage sociologique de Joseph Gusfield, PUR, Rennes, 2018.

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[BRA 07] BRANCA-ROSSOF S., “Approche discursive de la nomination/dénomination”, in CISLARU G., GUERIN O., MORIM K., et al. (eds), L’acte de nommer. Une dynamique entre langue et discours, Presses Sorbonne Nouvelle, Paris, 2007. [CHA 99] CHATEAURAYNAUD F., TORNY D., Les sombres précurseurs, une sociologie pragmatique de l’alerte et du risque, Éditions de l’École des Hautes Études en Sciences Sociales, Paris, 1999. [EUR 03] EUROPEAN PARLIAMENT AND COUNCIL OF THE EUROPEAN UNION, Official Journal of the European Union, Regulation No 1831/2003 of the European Parliament and of the Council of September 22, 2003 on additives for use in animal nutrition, L268 of October 18, 2003, pp. 29–43. Available at: eurlex.europa.eu/legalcontent/FR/TXT/PDF/?uri=CELEX:32003R1831&from=en (accessed April 18, 2018). [FOO 17] Food and Drug Administration, “Veterinary feed directive”. Available at: www.federalregister.gov/documents/2015/06/03/2015-13393/veterinary-feeddirective (accessed December 15, 2017). [FOO 18] Food and Drug Administration, “Notice”, available at: www.fda.gov/ohrms/dockets/dockets/06p0394/06p-0394-cp00001-08-Tab-06EN-Notice-2002-vol1.pdf (accessed April 29, 2018). [GIR 15] GIRANDOLA F., “Communication engageante et risques alimentaires”, CONSEIL NATIONAL DE L’ALIMENTATION, Communication et alimentation : comment reprendre confiance ?, Éditions François Bourin, Paris, 2015. [GUS 81] GUSFIELD J., The Culture of Public Problems. Drinking – Driving and the Symbolic Order, University of Chicago Press, Chicago, 1981. [IFP 17] IFPMA, “Declaration by the pharmaceutical, biotechnology and diagnostics industries on combating antimicrobial resistance”. Available at: www.ifpma.org /resource-centre/declaration-by-the-pharmaceutical-biotechnology-and-diagnostics -industries-on-combating-antimicrobial-resistance (accessed December 15, 2017). [KOR 16] KOREN R., “Introduction. La nomination et ses enjeux socio-politiques”, Argumentation et Analyse du Discours, no. 17, 2016. [KRI 09] KRIEG-PLANQUE A., La notion de formule en analyse du discours. Cadre théorique et méthodologique, PUFC, Besançon, 2009. [KRI 10] KRIEG-PLANQUE A., “La formule ‘développement durable’ : un opérateur de neutralisation de la conflictualité”, Langage et société, vol. 134, no. 4, pp. 5–29, 2010. [LEV 99] LEVY S., Le Paradoxe des antibiotiques. Comment le miracle tue le miracle, Éditions Belin, Paris, 1999.

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[OKE 17] OKEEFE T., “One-third of US broilers raised antibiotic free”, WattAgNet, published on March 14, 2017. Available at: www.wattagnet.com/articles/30116one-third-of-us-broilers-raised-antibiotic-free (accessed 15 December 2017). [ONE 16] O’NEIL, J., “Tackling drug resistant infections globally: final report and recommendations”, The Review on Antimicrobial Resistance. Available at: amrreview.org/Publications.html (accessed 15 December 2017). [OUI 06] OUILLET C., Marketing, aliments et santé, conception et application au service d’une stratégie, Éditions RIA, Paris, 2006. [PER 16a] PERDUE FARMS, “A history of leadership: Perdue’s journey away from antibiotics”, February 26, 2016. Available at: http://www.perduefarms.com/news /press-releases/perdues-journey-away-from-antibiotics (accessed August 8, 2017). [PER 16b] PERDUE FARMS, “First major poultry company to eliminate routine use of all antibiotics”, October 7, 2016. Available at: http://www.perduefarms .com/news/press-releases/first-major-poultry-company-to-eliminate-routine-use-ofall-antibiotics (accessed August 8, 2017). [PEW 16] PEW CHARITABLE TRUSTS, “Major food companies committed to reducing antibiotic use”, July 2017. Available at: www.pew trusts.org/en/multimedia/data-visualizations/2016/major-food-companiescommitted-to-reducing-antibiotic-use (accessed 13 December 2018). [SIB 01] SIBLOT P., “De la dénomination à la nomination. Les dynamiques de la signifiance nominale et le propre du nom”, Cahiers de praxématique, vol. 36, pp. 189–214, 2001. [WID 10] WIDMER J., Discours et cognition sociale. Une approche sociologique, Éditions des archives contemporaines, Paris, 2010.

4 From Health Responsibility to Ethical Responsibility: The Legitimization of New Vegetable Experts in France

4.1. Introduction Since the introduction of the first version of the French National Nutrition and Health Program (PNNS, Programme national nutrition santé) in 2001, food discourse has changed. Indeed, this public health policy launched by the French Ministry of Health has strongly promoted the nutritional dimension of food [ROM 15]. Information and education campaigns, designed by public authorities and doctors, are conducted to make eaters aware of the close link between their diet and their health, but also of their individual responsibility in this area, taken up by the “relay transmitters” [REN 07, p. 111], which are the media. In addition, the notion of committed consumption experienced an unprecedented boom during the 20th Century [DUB 09], giving rise to new supply methods, such as the short circuit [BEA 14], the development of fair trade and, more generally, the promotion and enhancement of ecology and ethics in many food discourses [HUG 16]. Thus, the messages concerning food practices emanating from different sources (experts, manufacturers, media, consumers, institutions) are of different natures (advertising, preventive, agri-food, health, etc.) and highlight different values: health, well-being, pleasure, local, French food.

Chapter written by Clémentine HUGOL-GENTIAL, Sarah BASTIEN, Hélène BURZALA and Audrey NOACCO.

Food and Health: Actor Strategies in Information and Communication, First Edition. Edited by Viviane Clavier and Jean-Philippe De Oliveira. © ISTE Ltd 2019. Published by ISTE Ltd and John Wiley & Sons, Inc.

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Many contemporary food sociologists (Claude Fischler, Jean-Pierre Poulain, etc.) have highlighted the shift towards the medicalization of our food, health becoming a value and medicine a culture [LUP 95]. This medicalization of food practices leads to a “nutritionalization” of practices and discourses with the dissemination of nutritional knowledge through the press, television and health education campaigns, transforming the structure of meaning given to the food act. Nevertheless, the nutritionalization of food [DOD 17] has led to the rise of a contradictory discourse [HEB 12] reconfiguring pleasure, conviviality and taste, which regain a certain legitimacy [DUP 13]. The coexistence of these different discourses on food, accentuated by the increasing media coverage of food crises [HAN 03] and the dichotomy between pleasure and health give rise to the presence of different types of experts in the media field: doctors/researchers, nutritionists, as well as chefs who become spokespersons for food truth and feed a form of “cacophony” described in the 1990s by sociologist Claude Fischler [FIS 95]. Food practices, governed by all kinds of representations (cognitive, social and symbolic), are constructed by several factors, including current discourses [BOU 07], to which consumers have access. Gastronomic/ culinary/food communication is being renewed and disseminated on digital networks and in the media. It covers the role of the “chef”, cooking and the food itself. The actors of this communication are varied, from chefs to agrifood industrialists, via the media, but also the State and local authorities, actors in the tourism sector, or even in the health sector mobilizing different types of discourse. These are now relayed by many media experts, who are particularly active in the field of nutrition, since there is “media interest for most nutrition specialists” [ROM 15, p. 56], but also in other fields such as ecology, ethics and sustainability. It is then necessary to focus on the coalition of these different discourses, their divergences, complementarities and similarities, as well as on the various media experts who relay them. The major themes and discourses that are aggregated around food practices question the legitimacy of experts in the current media environment, the forms of discourse and the values they mobilize. Thus, the analysis of the corpus now raises questions about food experts in the current media field and how they legitimize themselves. The emergence of these different figures raises questions about the social and societal challenges that result from them, with a shift from ethical responsibility to health responsibility.

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In this perspective, it is particularly interesting to analyze the discourses on the “star” food of the PNNS, vegetables, which are valued daily by eaters through all possible communication channels1. Long “despised” [MIC 03], vegetables now seem to benefit from the image of healthy, light and seasonal food currently promoted by food prescribers under the prism of health and ecology. The aim here is therefore to understand the stakes of symbolic vegetable production, put into circulation by the various media institutions and featuring different experts. To access these varied and disseminated discourses, by numerous and diverse producers, a corpus of 181 articles has been compiled, from an exclusive source, the Google News search engine, over a three-month period, from October 2015 to December 2015. This “aggregator” [REB 06] of information is particularly relevant here since it allows access, by the same means of communication, to several levels of dissemination of current information, not created but put into circulation via the Internet. The aim is to focus on a contemporary corpus by taking into account the information available and accessible to consumers from online sources that are widely used in the search for food information [STO 13]. Overall, the 181 articles collected show that the discourse on food and vegetables is the responsibility of generalist media, which “exclude a minimum number of categories of readers” [MAI 98], listeners or spectators, as well as specific media, “who construct their audience by exclusion” [MAI 98]. In this sense, in addition to magazines specializing in nutrition, health or gastronomy, which regularly talk about vegetables, we can see, for example, in the written press today, an increase in articles and pages on this subject, whether in the magazine press, with some special issues2 or in the regional or national daily press3. This plethora of information indicates that the evolution of vegetable media coverage can be correlated with the evolution of food and attention to vegetables, in the context of food overload and growing dietary and ethical concerns. 1 The “5 fruits et légumes par jour” (five fruit and vegetables a day) became a real slogan when PNNS 2 was implemented in 2006 – the initial target of 10 portions of fruit and vegetables per day seemed unrealistic. 2 “Manger bien, manger sain. Pour votre santé et pour la planète”, Une de L’Express, no. 3351, 23–29 September 2015; “Que peut-on encore manger?”, Une du Point, no. 2252, November 5, 2015. 3 In the corpus, 12% of the articles come from the national daily press, 42% from the regional daily press, 11% from magazines and weeklies, and 35% from websites and blogs.

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The massive dissemination of the discourse offered by nutrition experts has led to the emergence of new values, particularly visible ones about vegetables, which are articulated around the axiological core of health: transmission, well-being and food ethics [BUR 17]. Today, food ethics is becoming more and more significant in discourses, and defends the idea of good food: tasty, good for the environment, health, etc. Thus, food ethics seems to link health and pleasure by also taking into account socio-environmental dimensions. These themes are now being taken up by opinion leaders of international stature, showing a shift in the traditional shape of an expert: food discourses are no longer only driven by nutritionists, researchers and public authorities, chefs are now strong voices in the various discourses circulating around our food. In this perspective, the corpus has been expanded with the integration of 25 additional articles4 for the period 2015–2017. Thus, this corpus reflects an increasing number of chefs’ comments and media coverage on the food model [BAR 17] and in particular on vegetables, whether in the national or regional daily press, but also in magazines or on websites. The corpus has been integrated into the existing one and analyzed, in order to show how the theme of ethics, highlighted in the discourses of these gastronomy experts, allows them today to extend their food expertise. Finally, it is a question of analyzing the discourse on vegetables in order to raise the specificities and challenges of the various experts involved and to isolate the characteristic determinants of the food and health experts. 4.2. Expert nutritionists and the gradual erasure of the traditional expert figure Among all the discourses on food, that of the French Ministry of Health promotes a more balanced diet with its nine benchmarks, including the “5 fruits and vegetables per day” [MAN 19] and by popularizing nutritional information from scientific research. “Thus, the PNNS are playing a part in the nutritionalization of society [POU 13], i.e. a process of massive dissemination of nutritional knowledge through the media, and the multiplication of health education campaigns” [ROM 08, p. 47]. These new

4 In this new corpus, 52% of the articles come from the national daily press, 20% from the regional daily press, 16% from magazines and weeklies, and 12% from websites.

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norms, set by scientific experts in nutrition5, are legitimized by the presence of the State. A first rapid analysis of the corpus aimed to better understand this nutritionalization and the media presence of nutritionists. This analysis was carried out using the Iramuteq text data processing software [RAT], based on the Reinert classification method [REI 83, pp. 187–198], comparable to Alceste6. It is particularly relevant in the analysis of social representations7 and makes it possible here to identify, by selecting the 20 most frequent nouns and adjectives in the entire corpus, six types of discourse. The health discourse, organized around four themes8, with, in order of importance, the nutritional qualities of vegetables, the need to eat them every day, dietary balance, and disease prevention, highlights the disenchanted aspect of contemporary food. The socio-ecological discourse that evokes vegetables through ethics, in the citizen’s vision of food that is currently emerging: anti-waste, environmentally friendly, promoting new production techniques and the return to short supply chains, in a more social and solidarity-based economy. The “local” discourse is organized around four themes: product quality (freshness, label), rare and ancient vegetables, their local origin (linked to their quality), and the ideal nature of good vegetables from the garden “as in the past”, with an emphasis on respecting seasonality. Focused on the themes of taste, recipes, the beauty of vegetables and their possible appeal to children, the “cooking and gastronomy” discourse gives a much more hedonic image of vegetables, presented as gourmet and mouthwatering products. Finally, the last two types of discourse are the playful discourse, oriented towards local, cultural and artistic events around vegetables, and the socio-economic discourse related to the figures and news from the sector. These discourses are distributed as follows: 5 Professor Serge Hecberg, Dr. Michel Chauliac, etc. 6 “Iramuteq, lexical statistical software based on the ALCESTE method” [TOU 12, pp. 77–78]. 7 “Alceste software (Co Lexem Analysis – occurrences in a set of text segments [REI 86] – belongs to the field of text data analysis and is often used in work that is part of social representation theory” [GEK 10, pp. 111–135]. 8 Defined by a lexical analysis taking into account the signifiers themselves, based on the occurrence of the retained semantic units (lexical fields), as well as their context of use through syntax (mode and tense of verbs present in articles, for example).

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7%

Health discourse 12%

21% Territory discourse

15%

18% 27%

Socio-ecological discourse Cooking and gastronomy discourse

Figure 4.1. Typology of media discourses on vegetables. For a color version of the figure, see www.iste.co.uk/clavier/health.zip

At first glance, the hypothesis that vegetables – in the current context of nutritionalization of food discourses – would first be presented and perceived as utilitarian foods with health value, is not verified. Health discourse, from a quantitative point of view, although it represents 21% of articles, remains a minority. An analysis of these 36 articles also shows the relative importance given by journalists to scientific and medical expertise in relaying information to the general public.

Figure 4.2. Nutritional discourses on vegetables

Eleven articles are based on a scientific study, on the PNNS or on the advice of medical nutritionists or dietitians. For the remaining 25 articles, journalists themselves use the nutritional arguments and language elements from the official discourse, both in content and form (see Figure 4.2).

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Thus, a detailed qualitative thematic analysis of the articles in the corpus coupled with the use of Iramuteq reveals that the health discourse (see Figure 4.3) emphasizes the “medicalized” side of food.

Figure 4.3. Elements of the health discourse on vegetables

From this utilitarian perspective, vegetables are presented primarily for their nutritional benefits, with the frequent use of terms such as “vitamins”, “virtue”, “intake” or having their intrinsic qualities for health and well-being: “antioxidant”, “fiber”, “potassium”, “magnesium”, etc. In addition, verb analysis highlights their injunctive tone, with titles such as “10 protein-rich vegetables to eat regularly”9, “butternut, squash, pumpkin, but also avocado, chestnut, quince and carrot must appear on your shopping list!”10 or “Choosing the right vegetables to recover from Christmas dinner”11. The underlying idea is that there is a “good” way to eat and eat vegetables. But the other 25 articles, if they do not mention these nutrition experts explicitly, do so implicitly. This extract is particularly representative: Rich in protein, but also in fiber, antioxidants and minerals, broccoli has it all. Easy to cook, it is delicious steamed with 9 voici.fr, accessed October 5, 2015. 10 consoglobe.com, accessed November 16, 2015. 11 metronews.fr, accessed December 25, 2015.

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lemon juice and perfect for salads. According to some scientific studies, broccoli may reduce the risk of cancer.12 The first two sentences, which begin with a nutritional presentation of broccoli, try to seduce the eater with terms that evoke delicacy (“delicious”, “cooking”). Conversely, the latter brings the reader back to their condition as a consumer responsible for their health and the role of food in preventing disease. To convince the reader of this, the journalist relies on a reference that aims to legitimize broccoli consumption by “objective” evidence, despite the imprecision of the reference and the use of the conditional tense. Thus, in recent years, “nutritionists” have multiplied their interventions in the press, on television or on radio, contributing to the “moralization” of the French diet. However, the nutritionist “title” can be self-proclaimed. The “dietitian” title is only granted after obtaining a state diploma, a DUT or a BTS13 in France, and only diabetologists or endocrinologists are doctors specialized in nutrition: The women’s press, among others, has popularized the term “nutritionist” in response to expert advice. In reality, it is an abuse of language […] The term “nutritionist” is only an adjective: we speak of “nutritionist doctor” or “nutritionist dietician”. [PUJ 10, p. 8] The terms nutrition expert or nutritionist, which are often used by the media, therefore imply scientific expertise and objectivity that are far from always being verified. Indeed, in this context of the nutritionalization of food discourses, the figure of a nutrition expert now extends to more or less qualified people, who derive their legitimacy from their practice and their media aura more than from their title. Thus, well-known media figures proclaim themselves as experts against the advice of qualified experts. This is the case, for example, of Gilles Lartigot, an illustrious stranger who succeeded in 2015 in ranking his book, “Eat”, first in Amazon’s sales in the nutrition section [LAR 15]. Outside the field, it is through his own experience, practice and intimate convictions that he now claims a form of expert status, and that he uses its vocabulary, tone and posture:

12 beautistas.com, accessed October 5, 2015. 13 A DUT is a technology degree in France, and a BTS is an advanced technician’s certificate.

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I met people who came to give me their testimony, people who were treated outside the traditional chemo-radiotherapy protocol, who had stopped everything, who started on cures, fasting, juice, etc. I see them every day! [C8 17] As a result, alongside the experts considered legitimate and convincing, namely researchers, doctors and dietitians, there are those who could be called “self-proclaimed” experts, who in most cases rely on the development of their experiential knowledge, thus freeing themselves from an institutional discourse. The recognized nutritional expertise of doctors or dietitians is no longer exclusive. Today, through the circularity of nutritional discourses in the media space, journalists themselves often proclaim themselves to be food advisers by adopting a prescriptive tone on nutrition with the use of imperative forms or the massive resumption of public health discourses, as shown in the following diagram (see Figure 4.4):

Figure 4.4. Characteristics of injunctive discourse in French food discourses, from official discourse to media discourse. For a color version of the figure, see www.iste.co.uk/clavier/health.zip

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4.3. Dissemination of the socio-ecological discourse on vegetables: the dissolution of journalistic discourse in favor of “ethical” value It is the tones of injunction and prescription – directly resulting from public nutrition policies – which, more than the health theme itself, have spread to all other types of discourse, particularly the “socio-ecological” discourse on vegetables, which is proportionally the most important in the corpus (see Figure 4.5). This socio-ecological discourse is characterized, in particular, by an ethics of “responsibility” described by the observatoire des éthiques alimentaires (2017), which emphasizes that consumers are turning towards the social and environmental responsibility of the products purchased [HLP 17]. The French Ministry of Agriculture in its definition of sustainable food also emphasizes the importance of ethics: “the rise of social, ecological and ethical concerns over the past several decades has led consumers to seek more sustainable food and to turn in particular to sustainable food products”14. Vegetables are mentioned in the citizen’s vision of food that is currently emerging [THO 15]. But although the interrogative and the conditional are more present, reflecting a more global questioning on the vegetable food chain, the articles concerned appeal to the recipients’ sense of responsibility rather than the pleasure of tasting: “Where can we buy organic vegetables?”15 one newspaper had as a headline; “Just register”16 to get your vegetables directly from the farm, explains another article; “consume locally and support farmers”17. From being formative and functional, the discourse becomes implicitly moralizing and prescriptive. Consuming vegetables therefore does not have the same meaning in this type of discourse; the values symbolized by their consumption are related to macro-social issues of concern for the environment or the return to short chains in the country’s socio-economic interest. But the status of vegetable consumption here remains more utilitarian than hedonic: it is an individual responsibility and a rational choice on the part of a reflective eater on their practices. 14 agriculture.gouv.fr/16-fiches-pour-pieux-apprehender-les-behaviorements-alimentaires-de2025 (accessed December 13, 2017). 15 nouvellecaledonie.la1ere.fr, accessed October 2, 2015. 16 letelegramme.fr, accessed 17 December, 2015. 17 ouest-france.fr, accessed October 9, 2015.

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Figure 4.5. Elements of the socio-ecological discourse on vegetables

Figure 4.6. The elements of the “local” discourse on vegetables

Even the “local” discourse (see Figure 4.6) includes a significant number of articles, in which the eater’s individual responsibility, or the nutritional and health benefits of vegetables, are mentioned at least once. This type of discourse is not free of nostalgia and appeals to the idealized imagination of a return to “nature”, like the local cuisine movement [ASC 05, BOU 05].

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However, although the local discourse claims a return to taste, quality, and pleasure of tasting in accordance with the expectations and needs of many eaters, it does not escape an often empowering tone, visible in the frequent use of the infinitive reflecting a claimed conative dimension. However, the line that separates it from guilt is never far away: “Eat better”18, the title of an article emphasizing that the French do not eat well enough; “Salsify, low in calories: this vegetable can be eaten raw or cooked. It is rich in potassium and fiber. A word of advice: choose it for its firmness and lack of blemishes”19 says a journalist in an article praising forgotten vegetables and taking up the arguments of the health discourse. Thus, all these media discourses claim to have expert status on vegetables, whether on the form, with much advice and injunctions, or on the substance. Indeed, the ethics of responsibility, present in a transversal way, circulates throughout the corpus and makes it possible to bring out values that are linked together in a health perspective: quality (organic, short circuits, labels, etc.), concern for the environment, and naturalness. In this sense, nutritionists broaden the spectrum of their skills and, at the same time, expertise in food can no longer be limited to that of nutritionists. In all the articles dealing specifically with socio-ecological issues, no nutrition expert is mobilized, only journalists take the floor and write, thus showing a paradigmatic change. This partly explains the current deployment of the discourse of new experts who, through experience, are appropriating the themes of nutrition and a food ethic based on individual responsibility. It is in this logic that chefs make their voices heard and position themselves within a new form of food expertise. 4.4. Chefs and culinary experts: from the acceleration of public authorities’ health discourse to an integrative discourse on ethics In this complex context between health and socio-ecological discourse, chefs20, in line with their culinary expertise, seek to enhance the pleasure of eating while meeting new norms of balanced nutrition. Cooking (according to newspapers, social networks and cooking shows) is fashionable. Digital content and attention to food are certainly reasons for the expansion of 18 lesechos.fr, accessed November 3, 2015. 19 letelegramme.fr, accessed November 2, 2015. 20 lemonde.fr, accessed February 25, 2017.

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culinary content, and are attracting increasing interest [BOU 10]. However, it is no longer just a question of cooking, but also of health. With 640 titles published in 2016, “healthy and light” cuisine is experiencing an undeniable development, with chefs taking up the same healthy discourse from the public authorities. Vegetables are mobilized in several ways by chefs, and four types of discourses are highlighted within this specific corpus of 25 articles: a discourse related to the sublimation of a dish and the associated technicality (four articles); another related to taste and delicacy in line with the values of the French food model (five articles); a third with an assumed health dimension (four articles are concerned) and lastly, the most mobilized, on the ethics of responsibility underlined by organic, local and seasonality (12 articles). French gastronomy is traditionally associated with gourmet delicacies and gustatory pleasure. Chefs are known for their expertise, creativity and innovation. This perspective remains present in the corpus through the discourses “taste/love of good food” and “sublimation/technicality”. Chefs’ tips are numerous and combine taste and pleasure to offer innovative recipes: “A selection of gourmet recipes, illustrated and accompanied by a zest of tips and a pinch of tricks”21; “Chef’s tip: cooking a gourmet vegetable cake”22; “Six star chefs’ tips to give taste to your vegetables”23. Culinary tips and techniques aspire to reform traditions, as one of the titles of Cyril Lignac’s challenges in Le Meilleur Pâtissier underlines: “The revisited classic”; “Revisiting the traditional strawberry cream cake”24. Novelty also appears through the discovery of new products, as shown by the words of reported chefs: “Kimchi brings the spice and bitterness of cabbage. Everything is balanced and constitutes a new flavor”. But this creativity combines relevant originality, since it satisfies the “balance” of a “new flavor”25. The “sublimation/technicality” discourse is very present in the “taste/love of good food” discourse. Taste is always a highly mediatized value, but revisited to bring a touch of creativity, balanced in terms of flavors.

21 letelegramme.fr, accessed November 18, 2015. 22 lemonde.fr, accessed November 27, 2015. 23 rtbf.be, accessed August 23, 2017. 24 francebleu.fr, accessed November 4, 2015. 25 lefigaro.fr, accessed January 17, 2015.

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The notion of balance is also present with a shift from protein to vegetable, now finding a central place in the meal. In this logic, we find an article entitled “It’s time to force vegetables”26. The use of the verb “force” implies the notion of constraint in choosing vegetables, requiring effort. In this editorial approach, the journalist introduces their article as follows: “In this period of respite between the Christmas and New Year’s Eve dinners when proteins have been abused and green beans dropped, it is time to put vegetables back on the menu.” To this end, the journalist promotes Tommy Myllymäki’s book “Légumivore.” Another example concerns a chef’s recipe proposal, here “Tofu cocoa, crispy with parsnip and chocolate sauce”27, completed by a nutritional information note: “This delicately sweetened tuber is well endowed with carbohydrates, especially inulin (such as artichoke stock), but also vitamins (A, C…) and potassium.” The injunctive tone is also present: “We can never repeat it enough: you have to eat vegetables.” The circularity of discourses between chefs, journalists and public authorities is therefore visible, but the notion of pleasure does not disappear. Indeed, in a 2016 interview for the Femme Actuelle newspaper, Alain Ducasse emphasizes: “more pleasure and more health!” Thus, by integrating health and nutrition norms into their discourses and cooking practices, chefs are positioning themselves as experts in food and health. While public authorities provide information on the products to be consumed and limited, chefs translate these nutritional recommendations into dishes, gourmet recipes that are pleasant and balanced, thus contributing to consumers’ power to act. Indeed, the media coverage of the chef allows them to transmit to consumers and everyday cooks; Dominique Pagès stresses that “the multiplication of the dispositives in which they [the chef] is involved reduces the distance between the one who knows and the one who does not know” [PAG 17]. Finally, in the chefs’ discourses, the notion of balance is articulated around an ethics of responsibility, which penetrates the discourses of “taste-love of food”, “sublimation-technicity” and “health”. Chefs associate the environment with cooking and broaden their field of expertise. They no longer only guarantee a healthy, tasty diet, but they also promote an environmentally friendly diet. Several headlines demonstrate this: “Chefs embark on climate-friendly cooking”28; “Great chefs who grow their own 26 leparisien.fr, accessed December 27, 2015. 27 ladepeche.fr, accessed October 20, 2015. 28 20minutes.fr, accessed June 8, 2016.

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vegetables”29; “Chefs, pioneers of short circuits”30. Ethics is also promoted by Alain Ducasse, promoting seasonality and respect for the earth’s cycle. He gives his vision of it, through the example of strawberries: “If we persist in eating strawberries in December, we make a triple mistake: these strawberries will have no taste, no dietary virtue, and their cultivation will have been disastrous for the planet”31. This discourse thus combines elements on taste, health and environment. “If we persist” suggests that a choice is possible, endorsed by other cooks, as these examples illustrate: “Honestly, in city, I didn’t expect to get vegetables of such maturity”32 and “Pontoise cabbage […] breathes the authenticity of a region once covered with cultures”33. Ethics seems rare and precious as shown by the use of terms related to high intensity: “A maximum of colors and flavors”34 (about the vegetables of an organic market gardener), “Flavors so exceptional” and “A micro-production of an exceptional quality”35. Chef Arnaud Arnal of La Chassagnette in Arles adds the notion of the present moment: “This ‘evil’ garden forced me to accept the moment. And yet, what it promises me is never really kept from one season to another, from one harvest to another; the garden changes: never the same, nor quite another. That’s also why, from now on, the moment dominates in my kitchen. Because it’s the only thing that really belongs to me”36. Thus, the ethics of responsibility is correlated with a new temporality, such as renewal, adaptation and respect for the conditions imposed by nature. From this perspective, chefs preserve their essence by combining ethics with the vocabulary of taste and technicality: “The further we go in haute cuisine, the more technical we become, and the further we move away from the taste of vegetables. Creating this small vegetable garden is a way of getting closer to our raw material, of understanding it”37. Ethics is considered here in the link with local producers, the fight against food waste and the maturity of vegetables, ensuring a tasty and healthy product in a “natural cuisine”.

29 lefigaro.fr, accessed June 8, 2016. 30 humanite.fr, accessed July 27, 2016. 31 femmeactuelle.fr, accessed April 11, 2016. 32 lefigaro.fr, accessed May 3, 2017. 33 leparisien.fr, accessed January 5, 2016. 34 francesoir.fr, accessed December 14, 2015. 35 telerama.fr, accessed July 17, 2016. 36 lefigaro.fr, accessed June 8, 2016. 37 lefigaro.fr, accessed May 3, 2017.

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The chefs thus load the vegetables with different values, around different polarities: “taste-love of food”, “sublimation-technicity”, “health” and “ethics”. The PNNS public health discourse is thus reflected in the chefs’ discourse on healthy and balanced recipes. However, the statements are not only focused on nutrition, since, at the same time, we see a focus on consumer and global health to build a virtuous circle of food. Consequently, the discourse is articulated around the ethics of responsibility, a transversal and emerging notion, of taste and health. If the chef is not a nutrition expert, they build on their own expertise and legitimize themselves through other forms of discourse in which taste, culinary technique and ethics are the pillars. Thus, chefs’ discourse is based on a sensory triangle (see Figure 4.7) with esthesics (taste), esthetics (technique) and ethics (individual responsibility) [BOU 07].

Figure 4.7. The triangle of chefs’ sensory discourses (source: [BOU 07])

4.5. Conclusion Media discourses on vegetables, while containing diversified, even contradictory values (healthy, light, “natural”, local, good, “comfort” food), do not escape, in the end, a utilitarian vision of food. However, a new modality is emerging, the ethics of responsibility, which is present in a transversal way in most types of discourse (health, socio-ecological, local, cuisine and gastronomy). Rich in meaning, this notion makes it possible to

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make the link between different types of discourse, and to reduce the dichotomy between pleasure and health. Thus, several interrelated values emerge from a health perspective: quality (organic, short circuits, labels, etc.), concern for the environment, all encompassed in the new health vision promoted by the WHO, that of well-being and no longer just the absence of disease. The shift from health to ethics as the fundamental value of a new “life form” [BOU 16] proposed to eaters is changing not only consumers’ responsibilities, but also nutritional expertise, which is no longer the exclusive responsibility of legitimate and convincing nutritionists. In the media space, medically recognized experts are therefore in competition with experts who lack clear qualifications: self-proclaimed specialists in the environment, health, well-being or even beauty. These self-proclaimed experts are not legitimized by scientific knowledge, but by experience. At the same time, chefs, who until now had benefited from expertise based on their technical and experiential knowledge of taste and gastronomy, have extended their expertise to health and ethics. The observation of a perceptible craze for testimonies on the subject, both in the traditional media analyzed here and on social media, opens up interesting research perspectives on the new status of the experiential in nutritional expertise. Indeed, the experience lived and shared by nutritional, food and gastronomic experts, as well as, more and more, by the eaters themselves, tends to shake up the decisive factors of expertise. The expert is no longer the one who relies on scientific knowledge, since we note, in particular, the increasingly frequent consultation of so-called “nonconventional” sources [COH 11], in the sense that they are not recognized by academic authorities and are not based on so-called conclusive studies [MAR 99]. The expert is no longer only the one who holds academic and scientific knowledge, but also the one who has acquired experiential knowledge based on their practices and experience. Thus, the chef, who was first and foremost an expert in culinary practices, is now able to deploy their discourse “from pitchfork to dinner fork” in the domestic sphere and invite consumers to “eat better” [PAG 17, ROU 12], but also to reflect on their diet from an ethical perspective. Without heralding the disappearance of traditional nutrition experts with a scientific basis in the media, this assertion still raises questions about their

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future status. What if the new legitimate experts were none other than – through lifestyle blogs, discussion forums or tutorials, which are multiplying on YouTube in particular – the consumers themselves? The ethical value of food, bringing together health, pleasure, naturalness and taste, could then lead to a paradigmatic shift from “eating well” to “good to eat” [HUG 16]: good for oneself, good for health, good for pleasure, good for the planet and good for taste. Focused on the individual and taken in hand by the same, the “good to eat” paradigm would thus allow the eater to find a coherent meaning and identity in the face of the nutritional and food uncertainty in our contemporary society, caught up in a cacophony of food discourses. 4.6. References [ASC 05] ASCHER F., Le mangeur hypermoderne, Odile Jacob, Paris, 2005. [BAR 13] BARDIN L., L’analyse de contenu, PUF, Paris, 2013. [BAR 17] BARNES C., “Mediating good food and moments of possibility with Jamie Oliver: Problematising celebrity chefs as talking labels”, Geoforum, vol. 84, pp. 169–178, 2017. [BEA 14] BEAUDOUIN V., Le comportement du consommateur à l’égard des circuits courts alimentaires : une étude anthropologique du mouvement amapien, PhD Thesis, Université de Rennes, 2014. [BOU 05] BOUTAUD J.-J., Le sens gourmand. De la commensalité – du goût – des aliments, Jean-Paul Rocher, Paris, 2005. [BOU 07] BOUTAUD J.-J., VERON M., Sémiotique ouverte. Itinéraires sémiotiques en communication, Hermes-Lavoisier, Paris, 2007 [BOU 10] BOUTAUD J.-J., MADELON V., “La médiatisation du culinaire”, Communication & Langage, vol. 164, pp. 33–40, 2010. [BOU 16] BOUTAUD J.-J., HUGOL-GENTIAL C., DUFOUR S., La gastronomie au cœur de la Cité, Éditions universitaires de Dijon, 2016. [BUR 17] BURZALA-ORY H., HUGOL-GENTIAL C., BOUTAUD J.-J., “L’image des légumes”, Anthropology of Food, [Online], 2017. Available at: http://journals. openedition.org/aof/8172. [C8 17] “Salut les terriens”, [Television program], C8, 2017. Available at: www.c8.fr/ c8-divertissementt/ms-salut-les-terriens/pid8608-invites.html? vid=1420483 (accessed November 20, 2017).

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[COH 11] COHEN P., LEGRAND E., “Alimentation et cancers. Personnes atteintes et autorités alternatives”, Anthropologie & Santé, vol. 2, 2011. [DOD 17] DODDS A., CHAMBERLAIN K., “The problematic messages of nutritional discourse: A case-based critical media analysis”, Appetite, vol. 108, pp. 42–50, 2017. [DUB 09] DUBUISSON-QUELLIER S., La consommation engagée, Presses de Sciences Po, Paris, 2009. [DUP 13] DUPUY A., Plaisirs alimentaires. La socialisation des enfants et des adolescents, PUR, Rennes, 2013. [FIS 95] FISCHLER C., “La cacophonie diététique. Ce que manger veut dire”, L’école des parents, vol. 5, 2015. [GEK 10] GEKA M., DARGENTAS M., “L’apport du logiciel Alceste à l’analyse des représentations sociales : l’exemple de deux études diachroniques”, Les Cahiers Internationaux de Psychologie Sociale, vol. 85, pp. 111–135, 2010. [HAN 03] HANSEN J., HOLM L., FREWER L. et al., “Beyond the knowledge deficit: recent research into lay and expert attitudes to food risks”, Appetite, vol. 41, pp. 111–121, 2003. [HEB 12] HEBEL P., PILORIN T., “Comment les discours nutritionnels influencent-ils les représentations de l’alimentation ?”, Cahiers de Nutrition et de Diététique, vol. 41, no. 1, pp. 42–49, 2012. [HLP 17] HLPE REPORT – Nutrition et systèmes alimentaires. L’observatoire des éthiques alimentaires- explorer les nouveaux moteurs de transformation du rapport à l’alimentation, 2017. Available at: www.lobsoco.com (accessed December 13, 2017). [HUG 16] HUGOL-GENTIAL C., PARISOT A., SICARD M. et al., “Pratiques, discours et représentation autour du café en France et en Allemagne”, in PARISOT A., STENGEL K. (eds), Écrits et discours culinaires : quand les mots se mettent à table, L’Harmattan, Paris, 2016. [HUG 16] HUGOL-GENTIAL C., Se nourrir ou manger ? Les enjeux du repas en établissement de santé, L’Harmattan, Paris, 2016. [LAR 15] LARTIGOT G., Eat, Winterfields, Montreal, 2015. [LUP 95] LUPTON D., The Imperative of Health: Public Health and The Regulated Body, SAGE Publications, London, 1995.

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[MAI 98] MAIGUENEAU D., Analyser les textes de communication, Dunod, Paris, 1998. [MAN 19] MANGERBOUGER, Les fruits & légumes : au moins 5 par jour, par exemple 3 portions de légumes et 2 fruits [Online], Santé publique France, 2019. Available at: http://www.mangerbouger.fr/Les-9-reperes/Les-9-reperes-a-laloupe/Fruits-et-Legumes (accessed March 4, 2019). [MAR 99] MARKS H., La médecine des preuves – Histoire et anthropologie des essais cliniques (1900–1990), Synthélabo, Paris, 1999. [MIC 03] MICHEL D., “Au fil des siècles, légumes méprisés, légumes anoblis”, Champ psychosomatique, vol. 29, pp. 123–132, 2003. [PAG 17] PAGES D., “Figures du Chef Cuisinier. Première partie : de la créativité culturelle à l’engagement sociétal et public”, in GIRY J. (ed.), Les théories du complot à l’heure du numérique, Quaderni, Paris, 2017. [POU 13] POULAIN J.P., “Affirmation des particularismes individuels et évolution des modèles alimentaires”, in FISCHLER C. (ed.), Les alimentations particulières. Mangerons-nous encore ensemble demain ?, Odile Jacob, Paris, 2013. [PUJ 10] PUJOL F., Les 100 mots de la diététique et de la nutrition, PUF, Paris, 2010. [RAT 19] RATINAUD P., Iramuteq (Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires): Un logiciel libre construit avec des logiciels libres [Online], LERASS Laboratory, University of Toulouse 3, 2019, Available at: www.iramuteq.org (accessed March 4, 2019). [REB 06] REBILLARD F., “L’information journalistique sur l’internet, entre diffusion mass-médiatique et circulation réticulaire de l’actualité ”, in BROUDOUX E., CHARTRON G. (eds), Document numérique et société, ADBS Éditions, Paris, 2006. [REI 83] REINERT M., “Une méthode de classification descendante hiérarchique : application à l’analyse lexicale par contexte”, Les cahiers de l’analyse des données, vol. 8, no. 2, pp. 187–198, 1983. [REN 07] RENAUD L., Les médias et le façonnement des normes en matière de santé, Presses de l’Université du Québec, 2007. [ROM 08] ROMEYER H., “TIC et santé : entre information médicale et information de santé”, tic&société, vol. 2, no. 1, pp. 27–44, 2008. [ROM 15] ROMEYER H., “Le bien-être en normes : les programmes nationaux nutrition santé”, Questions de communication, vol. 27, pp. 41–61, 2015.

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[ROU 12] ROUSSEAU S., Food Media: Celebrity Chefs and the Politics of Everyday Interference, Berg, Oxford, 2012. [STO 13] STOLECKA-MAKOWSKA A., “Les sources d’information sur l’offre de produits sur internet pour le e-consommateur européen. Résultats de recherche”, Studia Ekonomiczne, vol. 151, pp. 192–205, 2013. [THO 15] THOMPSON P., From Field to Fork: Food Ethics for Everyone, Oxford University Press, 2015. [TOU 12] TOUBOUL A., DAMIAN-GAILLARD B., MARTY E., “La disparité des modes de traitement journalistiques et des énonciations éditoriales sur le web. Le cas d’un sondage sur Marine Le Pen et la présidentielle de 2012”, Réseaux, vol. 176, pp. 73–103, 2012.

PART 2

Education and Prevention: A Critical Approach to Discourses and Dispositives

Food and Health: Actor Strategies in Information and Communication, First Edition. Edited by Viviane Clavier and Jean-Philippe De Oliveira. © ISTE Ltd 2019. Published by ISTE Ltd and John Wiley & Sons, Inc.

5 Food at School: Between Science and Norm

5.1. Introduction In response to rising rates of overweight and obese children, the World Health Organization (WHO), the Food and Agriculture Organization (FAO) and UNICEF have encouraged national governments to promote – through information, education and communication1 – “healthy” eating habits starting from early childhood. In this context, the school setting is considered an essential site for the implementation of actions to guide food practices. The European Union’s Action Plan on Childhood Obesity 2014–2020 encourages member states to implement nutrition policies at school, thus confirming the key role conferred on schools in the development of knowledge and skills regarding nutrition and health. At the same time, the increasing prevalence of so-called educational approaches (to health, to citizenship) in schools attests to the importance given to

Chapter written by Simona DE IULIO, Susan KOVACS, Christian ORANGE, Denise ORANGERAVACHOL and Davide BORRELLI. 1 The “information, education, communication (IEC)” approach is the driving force behind WHO’s public health policies. This approach is defined as follows: “Information, education and communication initiatives are grounded in the concepts of prevention and primary health care. Largely concerned with individual behaviour change or reinforcement, and/or changes in social or community norms, public health education and communication seek to empower people vis à vis their health actions, and to garner social and political support for those actions” [WHO 01].

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fostering students’ autonomy, critical awareness and decision-making skills in the face of the health risks posed by consumer society2. The objective of this chapter is to explore the ways in which science is mobilized in the new primary school food education programs in three European countries – Belgium, France and Italy – and more particularly in the cities of Brussels, Lille and Naples. What scientific knowledge is referred to? How is this knowledge summoned, reformulated and recirculated? What do different actors make science “say” about food? For what reasons and in favor of what vision of health and the body? We will address these questions based on the results of exploratory surveys conducted as part of an interdisciplinary and international research program on school food education, communication and information, L’alimentation à l’école entre médiations, éducation et circulation des savoirs, co-financed by the ComUE Lille Nord de France3. Our work follows a tradition of studies on the publicization of science undertaken in recent decades in the information and communication sciences [BAB 05, JAC 90, JEA 94, PAI 05] and in education research [FAB 14, LAN 06]. We are particularly interested in the ways in which science communication and science pedagogy navigate between rational reasoning 2 We use the term “educational approach” to translate the French expression éducation à which designates an interdisciplinary model of teaching to develop students’ agency to address real-world problems; we use the adjective “educational” throughout this chapter in this specific sense. See [LAN 06]. 3 Our discussion is based on examples drawn from the results of methodologically heterogeneous qualitative surveys. In the case of Italy, the investigation was divided into two stages. The first aimed to identify how the theme of food is addressed in primary schools in Naples. We reviewed the three-year plans in the city’s 98 primary schools and the role given to food in the curriculum. The second stage focused on the analysis of extracurricular projects addressing food. During focus groups with teachers from five primary schools, we collected teaching kits produced by agri-food companies, which we then analyzed using a semio-pragmatic approach. In the case of Belgium, we studied the guidelines, curricula and recommendations of the City of Brussels in order to understand the underlying rationale behind food education in primary schools; we also conducted 10 interviews with kindergarten and primary school teachers, in order to analyze how these actors perceive the difficulty of conducting food education and the links they make with science education. As for France, we analyzed school curricula, official texts and national curricula developed on the basis of educational policies in the field of nutrition, health and food; we also studied a choice of pedagogical dispositives on the theme of food; and we conducted two series of ethnographic surveys to observe formal and informal teaching situations and awareness-raising activities relating to food and nutrition in the classroom or during extracurricular sessions, within two primary schools in the MEL (Lille European Metropolis), at CP (first grade), CE2 (third grade) and CM2 (fifth grade) levels.

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and popular belief. Public policies and school curricula rely on expert knowledge to lend authority to health recommendations and to acculturate students to experimental methods of scientific investigation. Yet we have found that one of the main challenges of food communication and food pedagogy lies less in understanding biological and nutritional phenomena than in finding ways to call into question dogmatic conclusions and unquestioned norms. Our research [DEI 14, ORA 18] has shown that food pedagogy and communication tend to focus primarily on nutritional norms and normalized behaviors. In order to explore the tensions between reasoned appropriation and unquestioned belief, we propose to study the ways in which public health and nutrition policies, embodied in info-communicational dispositives, reformulate expert knowledge for specific ends through processes of “trivialization” [JEA 08]. Our objective in this chapter is to further our understanding of the different facets and representations of science that are materialized in info-communicational artifacts and informational and pedagogical practices. The chapter is divided into three sections. The first section is devoted to the role of scientific expertise in public health and food policies and in food education programs in Belgium, France and Italy. Through a study of Belgian, Italian and French ministerial texts and school curricula and through analysis of the food education page in the online teaching portal Éduscol4, we explore the processes at play in the rewriting of scientific knowledge, as well as the representations of science which these processes imply and the values they carry. The second section discusses how scientific interdisciplinarity, encouraged by public authorities, is implemented within food pedagogies in school. We analyze the teachers’ point of view on this interdisciplinarity. Finally, the third section focuses on how science is mobilized in food info-communicational dispositives, including textbooks, classroom sessions, and pedagogical kits and projects created by companies in the agri-food sector. We show how various obstacles to interdisciplinarity, on the one hand, and the effort of public policies to guide behavior, on the other hand, contribute to overemphasis on the normative aspect of food education, to the 4 Éduscol is the French national portal of pedagogical resources operated by the Ministry of National Education for teaching professionals [EDU d].

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detriment of rational exploration of phenomena, whether they be physiological, social, economic or other. 5.2. Using scientific expertise to achieve public policy 5.2.1. Public policy on food education: strategic use of studies and statistics on obesity and overweight Governmental institutions in the three countries under study claim to base their knowledge, choices and policy actions concerning school food and food pedagogy directly on scientific expertise. Ministries, public agencies and regional and local authorities highlight their collaboration with scientists from the nutritional and epidemiological sciences, to whom they lend credence and authority. The credibility and prestige of these sciences derive from the scientific protocols used to elaborate knowledge. Partnerships are thus frequently established between government institutions and public universities or research institutes. It is through these partnerships that scientific studies are developed and carried out which aim to improve understanding of dietary practices among children; the results of these studies are then used to guide the choices of state authorities. In 2005, the Wallonia-Brussels Federation (FW-B, the French community of Belgium) implemented a “plan to promote healthy dietary and physical attitudes among children and adolescents in the Wallonia-Brussels Federation” [ENS 18a]. This plan, as explicitly noted in the project statement, is based on university studies – in particular surveys conducted since 1986 by the Université libre de Bruxelles (ULB, School of Public Health), under the patronage of the WHO. These studies show that the trend towards excess weight is more marked among students enrolled in vocational and technical programs than among those in general education. As part of the rationale given to justify this healthy living plan, the project cites the sharp decline in fruit and vegetable consumption: in 2002, 50% of young people consumed at least one fruit or vegetable per day, as compared to 77% 20 years previously. Similarly, in 2015, a series of “Guidelines for Food Education in Italian Schools” [IST 18] were put out by the Italian Ministry of Education, University and Research, in collaboration with the Ministry of Health, regional authorities, research institutes and Italian universities. The

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guidelines are explicitly based on data collected from surveys conducted between 2008 and 2014, as part of the “System for Monitoring Overweight and Obesity in Primary School Children (6–10 years), Okkio alla salute” [EPI 18]. This research program was in turn promoted and funded by the Italian Ministry of Health and coordinated by the National Center for epidemiology, surveillance and promotion of health (CNESPS) of the National Institute of Health (ISS), in collaboration with regional authorities and the Ministry of Education. As indicated on the Italian Ministry of Health website, the Okkio alla salute program aims to measure and describe the geographical variation and the evolution over time of children’s weight, eating habits, and physical activity levels. The program also seeks to identify school activities that promote healthy eating and physical exercise. The overall objective of the program is to “guide” the implementation of useful and effective initiatives to improve the health and living conditions of children in primary schools [EPI 18]5. The percentages of overweight (20.9%) and obese (9.8%) children are mentioned as “evidence” of a health emergency, in the face of which the Italian state is called upon to act (although the figures suggest that the obesity “pandemic” among young Italians seems to have abated). In this alarmist context, schools are entrusted with attending to students’ nutrition and food practices as part of their educational and cultural missions. Primary schools are considered to be particularly well placed to implement essential preventive action through food education initiatives for the younger generations [DEG 15, LAM 14]. At the same time, while public policies on food education are overtly based on the scientific results of nutritional research, economic factors are also at play. The “Guidelines for food education in Italian schools” encourage economic actors such as “the food industry, the agricultural sector, and production, distribution, sales and communication sectors” to collaborate with schools. To quote the instructions of the Italian Ministry of Education, University and Research again: economic actors “can and must structure relationships with schools, in order to work towards a common idea of promoting personal, social and environmental well-being, to be achieved in particular through food education developed by the school itself” [IST 18]. In France, school curricula and ministerial recommendations regarding food are closely linked to public health policies implemented by the State. For several years now, schools have been acting as a relay for the National 5 This research program is part of the initiative of the European section of the World Health Organization’s Childhood Obesity Surveillance Initiative (COSI). We underline this.

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Nutrition and Health Program (PNNS) and the National Food Program (PNA) launched in 2001 and 2010 respectively. These programs, and their national information campaigns, are based on the results of nutritional studies carried out by or for public agencies and their partners, such as the “Nutritional Surveillance and Epidemiology Research Team (ESEN)”6. These studies are cited, rewritten and simplified in documents prepared for school actors by specialized agencies such as the French National Institute for Prevention and Health Education (INPES)7; schools in turn integrate the principles of the PNNS and PNA programs into various dispositives, including curricula, textbooks, and lunchtime and cafeteria activities [BER 17]. The 2014 “Law of the Future for Agriculture, Food and Forestry (LAAAF)” establishes food education for young people as one of the priorities of public food policy: food information and food education are now mandatory in schools. 5.2.2. The “Food Education” page of the Éduscol web portal: rewriting technocratic science The “food education” page created in 2015 as a subsection of the Éduscol ministerial website provides an interesting example of the role of science and scientific research in food education policy. This page provides teachers with pedagogical resources, as well as links to official reports and to summaries of scientific research including statistical and epidemiological surveys. These resources provide key information on the scientific background of public policy on health and nutrition [EDU 15a]. This thematic sub-section of Éduscol gives unique insight into the phenomenon of rewriting and recontextualizing scientific results. The documents available on this page, as well as the links provided to access other documents, present the successive reworkings of the results of nutritional science for the benefit of educational actors. But rewriting means more than mere simplification. Indeed, if we take as a starting point one of the documents made available on the web page, the 2017 “opinion on the revision of nutritional guidelines” [HCS 17], and follow the active links of the bibliography, we can access the source of this opinion, an expert report elaborated by the French National Agency for Food, Environmental and Occupational Health Security (ANSES), published 6 Joint France Public Health/University Paris 13. 7 The INPES is responsible for the implementation of public health programs through health education and training programs; in 2016, the INPES was integrated into the National Public Health Agency.

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in 2016. This report details the research undertaken to update the nutritional guidelines of the 2010 PNNS program, through painstaking elaboration of a “food optimization tool” [ANS 16]. This “scientific edition” of the “official opinion” put out by the ANSES presents the results of five working groups (composed of nutritionists, pediatricians, epidemiologists, biologists and toxicologists) in their effort to “propose the scientific justification necessary for the development of food consumption benchmarks” [ANS 16, p. 5]. A diagram in this highly detailed report [ANS 16, p. 7], reproduced in Figure 5.1, summarizes the relationship between the data collected and the algorithmic tool:

Figure 5.1. A multifactorial model for food consumption, developed by the ANSES to create nutritional guidelines (source: [ANS 16]). For a color version of the figure, see www.iste.co.uk/clavier/health.zip

The diagram and text detail the protocol put into place in order to quantify a set of variables determining food risks and food safety. The desired result is an explanatory model of food consumption to be used for nutritional optimization. This study, cited and summarized for the benefit of the Éduscol community, promotes a distinctly technocratic and behavior management approach to nutritional science and food practices. The Éduscol site itself highlights prescriptive and normative nutritionist discourse even further by offering simplified versions of this detailed report. These summarized versions focus on data that support a behaviorist vision of food practices. The 2017 “Opinion on the revision of nutritional guidelines”

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of the High Council of Public Health provides a summary of the scientific edition of the 2016 ANSES report; in the opinion paper, health risks due to food contamination are minimized while individuals’ dietary behaviors are highlighted. In a similar way, the informational flyers and brochures elaborated for the French public during the 2011–20158 PNNS campaign offer little in-depth analysis of the social and psychological dimensions of nutrition. By contrast, the full scientific version of the 2011–2015 PNNS report offers a more nuanced approach, mentioning in particular the important contributions of scientific research on the social and cultural aspects of food and nutrition: “Diet and physical activity behaviors are socially determined, and are not only individual behaviors” [MIN 11]. In France as in Italy, public health and economic development concerns overlap. In France, the 2014 version of the PNA (available on Éduscol) [MIN 14] refers to statistical studies on economic activity that provide in-depth examination of the agri-food industry, with data on competitiveness, business concentration, employment and financing. The 2014 PNA report cites in particular the 2012 study “Panorama de l’industrie agroalimentaire”, which features statistics on French companies in the sector. The content of this report, a decision-making tool, forms a key component in the determination of educational priorities. In addition to promoting “eating habits adapted to one’s needs” [PNA, p. 6], food education aims as well to raise students’ awareness of the professional opportunities available in the food industries. The stated educational goals of “reinforcing the link between agriculture and society” [PNA, p. 7] and “raising young peoples’ and students’ awareness of the food professions that recruit” [PNA, p. 7] can be understood as directly related to the economic interests and objectives represented by the Ministry of Agriculture, summarized in the 2012 expert quantitative assessment of the health of French companies. This overlapping of the interests and challenges of public health and economic development helps to explain the paradoxical tendency in the food education policies of the three countries under study. Curricular policy makers rely on the one hand on scientific expertise in the domain of nutritional behaviors which emphasizes recommendations for self-governance to limit consumption, and on the other hand, they seek 8 A link to the PNNS nutritional campaign documents appears on the Éduscol page; this link directs the user to the PNNS “general public” website and instructional literature [MAN 18].

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out the expertise of economic actors who promote a gastronomical approach to food and an emphasis on pleasure, taste and learning about natural foods and local products. This dual perspective is also reflected in the push for interdisciplinary approaches to food and food practices in the current teaching policy. 5.3. Food pedagogy interdisciplinarity

and

the

challenge

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5.3.1. Promoting interdisciplinarity across school subjects For several years now, the importance of a holistic approach to school food and food pedagogy has been evident in all three countries through strong incentives for interdisciplinarity. In the case of France, a 2015 programmatic text posted on the Éduscol platform specifies that food education must strive to be multidimensional and must involve teachers from different disciplines, as well as other actors [EDU 15b]. This text echoes other guidelines that have been published for teachers over the past several years, focusing on nutrition as a multifaceted phenomenon. In French school curricula, in Cycle 1 (pre-school and early primary school), students learn about taste; in Cycle 2 (primary school), food is part of the science and history curriculum, as well as health education; in Cycle 3 (end of primary school – beginning of middle school), food is associated with geography and life sciences as well as the cross-disciplinary themes of “energy” and “sustainable development”; and in Cycle 4 (middle school), interdisciplinary dispositives such as the “Body, health, well-being, safety” project, launched in 2016, provide for exploration of the relationships between sports, nutrition and health through cross-disciplinary collaboration coordinated jointly by physical education, biology, technology, chemistry and mathematics teachers [MIN 18]. In addition, the school curricula implemented in 2015 in France highlight the need for students to adopt a systemic view of complex phenomena. The Cycle 2 primary school science curricula, for example, suggest “monitoring what goes in and out of the classroom (paper, recycling), the cafeteria (food, water, waste)”. This integrated and articulated vision of “production-consumption-recycling” processes promotes the development of aptitudes for systemic reasoning, complementing the content and modes of questioning covered in biology, which are focused on the role of nutrition and the identification of healthy eating behaviors.

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In Italy, national policy in the field of food education implemented in the 1980s emphasized the acquisition of technical and physiological knowledge (knowledge about calories, nutritional principles, metabolic functions, etc.). This approach equated food pedagogy with nutrition education. Subsequently, ministerial food programs in the 1990s began to include the areas of psychology and cultural anthropology and to encourage sensory education projects and cooking activities. As of 2001, food quality has been considered from wide-ranging perspectives including food security as well as sensory, nutritional, psychological and ecological approaches. Food in Italy is not considered to be a distinct subject matter, but a transversal theme with educational goals. The multi-year national “school and food” education program, implemented from 2009 to 2012, targeted students, teachers and families to promote the adoption of “healthy and good lifestyles”. In addition, the 2015 “Guidelines for Food Education in Italian Schools” encourage teachers and students to consider the act of eating as a complex act that concerns not only physiological questions, but also psychological, social and cultural domains. For Italian government authorities, food is not just “another” subject in addition to traditional school subjects, but an educational path, which must be organized by each teacher in an interdisciplinary and transdisciplinary approach, taking into account ethical, technical, didactic and methodological dimensions [IST 18]. From this holistic perspective, five knowledge areas are emphasized: the sensory relationship with food; nutrition (food composition, physiology of nutrition, nutrition and health); food preparation; food hygiene and food security; and the cultural dimension of food. The “guidelines” thus encourage the activation of skills in all teaching areas and consider food education as an “interdisciplinary, continuous and wide-ranging presence” in each subject. However, this interdisciplinary ambition remains difficult to implement. One of the difficulties lies in the dispersion of the theme across the curricula, whereas in fact traditional hierarchies persist between school subjects, contributing to curricular fragmentation and disciplinary isolation. In France, some subject matters (such as the science of taste) are only marginally recognized in the curricula (in kindergarten), without any real development at subsequent teaching levels. The “taste class” approach, initiated in the 1970s in France, carries little actual weight in the French school system. The areas of gastronomy and culinary culture, mentioned in the 2015

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programmatic text, also remain less well-developed in schools as compared to nutritional approaches to food. Similarly, in the competency framework elaborated by the Ministry of Education of the Wallonia-Brussels Federation (Belgium), which defines expectations for the first eight years of schooling, the question of food and health education only appears in the chapter “Éveil” (early learning activity) in the section dealing with the body: Descriptive anatomy is to be approached in a general way (human, animal and plant): its functional aspect […]; the connection of different systems […]; their complementarity; to raise awareness of health education and healthy lifestyles9. While a systemic approach to the study of the body is emphasized, nothing particular is said about food education. Consideration of current school curricula of the French-speaking schools of Brussels [ENS 18b]10 shows, for example, that official texts tend to “naturalize” interdisciplinary study in school, without explanation or guidance for the teacher. An example of this implicit and “naturalized” interdisciplinarity can be seen in the following passage from primary school curricular texts, in which we find a remarkable degree of polyphony: Develop awareness of the need for a balanced diet: examine and analyze food from a qualitative point of view. Create an advertisement for foods which are regularly consumed. Choose foods for a healthy and balanced diet (read and understand labels, look for the expiry date, etc.). Discover the specific vocabulary used in advertising and be aware of the seductive nature of the message. Be attentive to graphic design, color, legibility of packaging and labels. Be aware of nutritional deviations and their effects on health: malnourishment; overnutrition; malnutrition and doping (excess additives). Study the major food groups, their importance and effect(s) on the body.

9 Our emphasis. 10 In French-speaking Belgium, there are several networks of schools, each with their own programs, but all of which must refer to the same skills base.

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In this text, the discourse covers scientific analysis, media and advertising literacy education, critical choice-making and respect for norms. These norms play upon the opposition between “dietary balance” and “nutritional deviance”. The first expression is self-evident (who can be against a balanced diet?) and is not explained or justified: it resembles a food slogan rather than a scientific argument; the second normative expression (deviance) clearly makes a value judgment. In other words, this excerpt from the curriculum does not help teachers to distinguish between physiological phenomena, popularized epidemiological results and socio-cultural values. The Conseil de l’enseignement des communes et provinces (another network of schools in Wallonia-Brussels) school program seems much more homogeneous concerning food education. Four mandatory requirements are listed, written in the first person singular: The digestive system and its functions of absorption, breakdown, assimilation and storage: I must eat enough to grow. I need to vary my diet to provide my body with everything it needs. I avoid excess (sweets, fats, etc.). I chew well before I swallow. Digestion begins in the mouth (role of teeth, saliva, stomach, small intestine). The first two prescriptive statements are justified by reasons related to the functioning of the bodily organism, and yet they are closer to common sense judgments (eating enough to grow, eating a varied diet) rather than to scientific discourse; the other two rules – also common sense – are not justified at all. School curricula in French-speaking Belgium thus link food education to early science teaching, but provide little scientific evidence to promote understanding of recommendations, which resemble media slogans. In addition, school curricula tend to represent eating behaviors as individualized in a way similar to nutritional awareness campaigns such as the French PNNS program. Thus, in France, the Cycle 2 curriculum promotes the development of “responsible” behavior towards health; the Cycle 3 curriculum presents the idea of nutritional needs in terms of an individual’s energy efficiency as related to food intake, and in the official Core Skills and Knowledge framework (the Socle commun), a section devoted to “individual and social responsibility” specifies that each student must be “aware of the well-being and health issues of food and physical

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practices”11. In addition, within certain school disciplines such as biology, biomedical approaches to health remain preponderant, contributing to a decontextualized vision of food and nutrition [KOV 19] with emphasis on the cellular functioning of the body, to the detriment of a holistic vision of human life. 5.3.2. Interdisciplinarity in teachers’ discourse How do teachers appropriate these sometimes paradoxical and ambiguous guidelines on food and nutrition? In France, as in Italy and Belgium, the teachers whom we interviewed consider food as a wide-ranging subject. For teachers, food as a topic allows them to draw upon knowledge and skills from various fields: biology, history, geography, physical education and even mathematics (“when you follow a recipe, you have to know how to do calculations”, for example). Teachers consider the effort involved in practicing interdisciplinarity to be worthwhile for several reasons. According to teachers, cross-disciplinary approaches make it possible to grasp the complexity of a multi-faceted phenomenon such as food, and help make students aware of the links and the complementarities among various types of knowledge. The results of our survey12 show that teachers link the theme of nutrition to several different school subjects as well as to the priorities in their school’s multi-annual project. A primary school teacher in Lille told us that the theme of food “is coherent with our school project which encourages the creation of shared events… To meet this objective, we organize cooking workshops for them” (teacher, School 1, Lille, 2013). While these teachers do not actively call for or defend interdisciplinary approaches13, they recognize that the topic of food is widely distributed within school curricula: “The issue of food groups is covered in science class. And when we come to food hygiene, we switch to civic education. It’s in between” (interview with a teacher from CE2 [third grade], School 1, Lille, 2013). 11 The Core Skills (Socle commun de connaissance, de compétences et de culture) outlines the knowledge and skills that must be acquired at the end of compulsory schooling [EDU 16]. 12 We conducted individual and group ethnographic interviews with teachers from three primary schools in the metropolitan area of Lille, over two periods (2013–2014; 2016–2017). 13 See the work on teachers’ stance and degree of involvement in relation to educational approaches; these approaches provoke debate within the institution partly because of their place in the “margins” of school curricula [BAR 18, GIR 08].

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However, despite teachers’ willingness for transdisciplinary or interdisciplinary approaches to food, their implementation remains partial and difficult to achieve, and is often limited to extracurricular activities and workshops. In France, this difficulty can be explained at least in part by the particular attention given by teachers to the specific wording of school curricula in the main disciplinary areas, in the preparation of their courses. As a result, in their planning of teaching sequences, biological and nutritional aspects of food (diet, food classifications, digestion and energy expenditure) are emphasized, whereas the art of cooking and the art and science of gastronomy, which allow for consideration of food as a cultural and gustatory practice, are covered only sporadically, as school projects, workshops or in conjunction with isolated events such as France’s annual “Taste week”. In addition, some teachers or staff resist the idea of linking the biological and educational-personal health aspects of eating and food: “that’s not our thing here” (Principal, Primary school 2, 2013). Some teachers express doubts as to the effectiveness and relevance of introducing this theme into extracurricular projects or initiatives: such educational goals are sometimes seen as being within the exclusive purview of families rather than of schools. As this cautious attitude suggests, in their discourse teachers in the three cities of our survey tend to consider that food education should ultimately serve to instill good practices. This attitude is rarely called into question. According to one of the Neapolitan teachers interviewed, broad-based interdisciplinary food education can help students “acquire a method, follow rules, adopt good behaviors, in short to be disciplined”. For teachers in the Brussels school system, the fusion (confusion?) between science teaching and food education does not seem to present any particular problem14. One primary school teacher told us: In our country, we subdivide our early learning activities into scientific, historical and geographical areas. So, as a result, food is covered in scientific learning. We covered the topic food, we covered it last year through a healthy snack activity. So we covered it [food education] within early science teaching so that

14 We conducted interviews with 10 kindergarten and primary school teachers in Brussels.

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we could have healthy snacks, because the kids were only eating cookies and junk! In this teacher’s discourse, norms for healthy eating are expressed using the same criteria as those of the national nutritional programs and slogans: dietary balance and variety, to which the teacher adds the normative opposition between the good (fruit, water) and the bad (sugars, fat). This proximity between what is done in class and what is said elsewhere, particularly in the media, is reinforced by the resources imported from various information and advertising campaigns, with considerable prevalence given to the food pyramid. A primary school teacher explains: Well, it’s been a long time since I’ve done a class lesson on nutrition. We do activities such as classifying foods. They have crates of food and we try to classify the things we eat regularly; what we eat less often; and in the category of foods that we eat regularly, we categorize them into the healthy and less healthy; and in order to decide if foods are healthy or not healthy, we try to classify them using the nutritional pyramid, to see where each food goes. Thus, in Brussels schools, food education is presented in discourse which is close to the language of nutritional awareness campaigns. If the link with science seems obvious, it is based upon thematic associations (nutrition and the digestive system) rather than on attempts to connect scientific knowledge with the rules of a “good” diet. This is in itself perfectly understandable, since the rules which are promulgated (against fat, against sugar; eat just enough without excess, eat more fruit and vegetables) change regularly, and derive more from epidemiological results, common sense or lobbying than from scientific knowledge. The recent highly publicized change from discouraging fat to discouraging sugar is proof of this. However, this thematic proximity between scientific and educational approaches to food does not help teachers, and it certainly does not help students in Brussels to understand the meaning behind the rules of “good nutrition”. In France, the teachers we interviewed and observed in class all gave priority to the classification of food in teaching sequences. This is the case

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even in CP [first grade] despite the fact that school curricula for this level direct teachers to address the issue of personal and collective food hygiene (a question related more to civic education than to science)15. The topic of food classification appeals to teachers for both pedagogical and organizational reasons. On the one hand, course materials and ready-to-use sequences on the issue of food groups and food “families” are abundant and easy to find on the Web; teachers are able to locate what they consider to be fun, clear and adaptable resources in response to simple online queries using the keywords “food” and “CE2” on search engines. In addition, lessons on food classification often culminate with the study or the construction of tools such as the food daisy or the nutritional pyramid, or the production and drawing of balanced menus. These visual objects allow teachers to combine a scientific problem (studying criteria of food and nutrient classification) and behavioral prescriptions (vary your diet, manage your food intake, limit consumption of food that is dangerous to your health). However, as in the case for Brussels, while a scientific basis and scientific legitimacy are given to nutritional recommendations, such recommendations hardly leave the realm of mere “common sense” (avoiding sugars, varying your diet). In the end, the scientific question of “how to classify” is most often left unresolved in favor of a “ready-made” answer. When students themselves raise unexpected questions or propose possible solutions to the problem of classification, their input and suggestions, of potential heuristic value, are quickly set aside by teachers preoccupied with inculcating food norms [KOV 19, ORA 14]. Scientific knowledge on classification (of a cursory nature) is thus combined with, and confused with, assertoric knowledge and normative prescription. The source of scientific authority most often mentioned by teachers in interviews and during teaching sequences is the “nutritionist”. Teachers interviewed in Naples acknowledge in particular the undisputed role of local health authority (LHA) dietitians as medical and scientific experts in the field of food and nutrition. The same phenomenon was found among 15 As part of two series of surveys conducted in 2013–2014 and 2016–2017, we conducted 15 individual and group ethnographic interviews with the administrative and teaching staff of three primary schools, one kindergarten (école maternelle) and a junior high school (collège) in the Metropolitan area of Lille (in the cities of Lille, Ronchin, Tourcoing and Roubaix), and we observed activities and teaching sequences on food and nutrition in CP [first grade], CE2 [third grade] and CM1 [fourth grade] classes in two of these schools (in Ronchin and Roubaix).

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primary school teachers observed in classroom situations in Lille. In the process of information searches and in the selection of accessible and scientifically credible documents and materials, teachers tend to “delegate” the task of establishing scientific or pedagogical authority and trustworthiness. For example, a CP (first grade) teacher explained that the poster on nutritional balance which she used in her classroom was suggested to her by a nurse, whose recommendation gave sufficient weight and credibility to the poster. Yet the poster itself was created by a milk producers’ lobby and, not surprisingly, gives particular prominence to milk consumption. Another primary school teacher (third grade) showed us a “food daisy” diagram used to explain the “food groups” to her students. Without being able to cite the source of the diagram, this teacher considers it to be credible and useful based on its widespread use among her colleagues. The “daisy” diagram is, in fact, widely shared on personal and regional or national pedagogical websites. Our own exploration revealed that the “daisy” diagram was initially published by the well-respected Bordas publishing house, in a textbook series edited by the equally well-respected author and science teacher Raymond Tavernier. The reputation of the “daisy” has become so obvious as to require no further specific referencing by teachers. The trivialization of this Tavernier food “daisy” [JEA 08] and its use by teachers as “proof” rather than as a visual aid for problematized exploration of classification tends to recontextualize this diagram, moving it away from its initial function as an instrument to promote active learning [AST 08a]. In France, despite the recent shift in the focus of food pedagogy from nutritional science towards agriculture and the environment, the fact remains that the mobilization of science by teachers seems to bolster efforts to instill “good practices”. Science functions thus more according to a logic of expertise (“integration of scientific knowledge into a political decision-making process” [GRA 03, p. 175]) than as a means to promote exploration and production of reasoned and rational arguments or hypotheses. In the three countries studied, appeals to broaden scientific perspectives on food pedagogy thus derive from a heterogeneous mix of motives and finalities, from the didactic and pedagogical to the political and economic. As we have seen, current curricular instructions and institutional texts promote a holistic vision of food and nutrition. However, the construction of a truly integrated and comprehensive approach is hampered by several

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factors, including the presence of multiple and divergent underlying points of view, the fragmentation of curricular programs along disciplinary lines, and various organizational difficulties tending to curb the construction of an interdisciplinarity approach linking school subjects to educational projects and ambitions. 5.4. Food pedagogy and food communication dispositives: applied or normative science? 5.4.1. In praise of applied science: food in school textbooks Our analysis of the role and depiction of science in food curricula and teaching leads us to question, in a broader sense, the relationship between science and society: which scientific domains are mobilized to explain phenomena related to food? What role are scientists seen to play in dispositives such as textbooks, popular science magazines and pedagogical kits? How do these dispositives “stage” scientific inquiry as a social and professional activity? Is science seen as fundamental research or as expertise, close to political action [BAR 13, ROQ 97]? Do these dispositives reflect the call for interdisciplinary cooperation and interdisciplinary approaches to food in school? Can the creation and use of innovative pedagogical materials contribute to the shaping of an integrated and comprehensive vision of food as a “total social fact”, according to the expression proposed by Marcel Mauss [MAU 50]? Our analysis shows that in France, in documents targeting primary school students, little or no explicit information is provided about the scientific background of research projects, scientific disciplines or specific fields of study. In school textbooks and other science books, research and researchers are evoked in vague and general terms in chapters on food, nutrition and agriculture, for example: “biologists have studied” and “studies have shown”. In secondary school textbooks, the activity of scientific research is slightly more present than in primary school textbooks, but emphasis is placed on reporting the conclusions of studies funded by government authorities: the conduct of science is shown in its relationship to the conception and implementation of health policies, as is the case for the contents of the Éduscol portal.

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While the name and status of certain researchers are mentioned in textbooks, their discipline and precise nature of the research undertaken tend to be ignored: in one secondary school biology textbook, for example, a section on urban agriculture specifies the name of a professor, as well as his institutional affiliation, without indicating his research field. Here, the main objective of the passage is to provide evidence supporting the Food and Agricultural Organization’s (FAO) conclusions: As early as June 2005, the FAO reported that small urban farms were already feeding nearly 700 million people around the world. This idea was reaffirmed by Professor Despommier of Columbia University in New York. According to Professor Despommier, in the near future, it will be necessary to design vertical farms in city centers. [ROJ 08] This passage is representative of a tendency to de-emphasize the processes and activities of research and to accentuate results and applications. The effect is to cut off scientific results from the material and social conditions by which they are obtained. This relative impersonality of science is not specific to documents about food but characterizes pedagogical discourse and pedagogical documents more generally [KOV 11]; knowledge about the specific circumstances of production and circulation of scientific knowledge is subordinated to creating awareness about the universally-applicable scientific method. The result of such decontextualization is to present scientific activity as an ahistoric set of procedures for experimentation-validation. In a recent secondary school science textbook, a section on “food preservation” ends with a checklist inciting students to verify their compliance with the correct scientific method. This list suggests that the role of scientific inquiry is to lead individuals towards the development of behavioral guidelines: I trained myself to: formulate a scientific question; represent ideas in graphic form, in a table; write a detailed report on experiments and observations; relate acquired knowledge in science and technology to health, safety and environmental issues. [JUS 16] The last item in this list suggests that mastering “the” scientific method can lead to adapting one’s behavior. Science is thus primarily depicted as an invariable, applicative tool to support decision-making.

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5.4.2. Playful science as a means to promote eating behaviors The authors of popular science publications, unlike textbook writing and editorial teams, often transpose and rewrite scientific knowledge by creating fictional and playful enunciative frameworks. An article in a 2011 issue of Cosinus, a popular science magazine for young readers, can serve as an example. The article, which explains the nutritional recommendation of “5 fruits and vegetables per day”, is presented as a dialogue between the young boy Cosinus and his “learned” dog “Disciple”. The dog clarifies and justifies this highly publicized nutritional rule. When Cosinus asks why dietary recommendations are necessary, Disciple explains that nutritionists play an important role in reminding eaters about common sense rules and practices that today’s eating habits have made us forget: “Before, people grew their own garden… and ate their own produce all year round… There were enough crops for the whole year. Now, due to lack of time and by force of habit, people must make the effort to buy and prepare fruits and vegetables and as a result many people eat very little of these foods. So, nutritionists needed to remind us that fruits and vegetables are essential for maintaining good health” [DEM 11]. As this passage shows, nutritional science is seen as a return to the traditional know-how of peasant farmers. The voice of the dog Disciple conveys an image of nutritional science seeking to justify its effectiveness and pertinence through its own relation to simple “good sense” reasoning. The authority of nutritional science is thus derived from its simplicity and “hominess”. As Daniel Raichvarg has stated, popular science messages “go beyond and go astray from the knowledge from which they originate” [RAI 10, p. 108]16. In Italy, the case of initiatives promoted by the Parmalat company’s Educational Division is emblematic of the highly performative nature of the info-communicational and pedagogical dispositives created by economic actors in the agri-food sector. In these dispositives, the company speaks in the name of science and takes on a distinctly entertaining tone. In the Parmalat documents, this tone is created in part by a comic character who plays the role of an expert scientist: Professor Strampalat. With his funny face and messy hair, Professor Strampalat looks like stereotypical representations of Albert Einstein. As in the French dispositives studied, references to scientific knowledge, particularly biological and medical

16 Our translation.

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concepts, are scarce in the info-communicational and ludic artifacts created by Parmalat, a dairy company. In these materials, students are not expected to deal with or to learn about physiological phenomena such as digestion or metabolism. Moreover, little information is provided to promote understanding of animal breeding, livestock management, milk production or milk distribution processes. The dispositives created by Italian companies do not aim to reformulate and re-circulate scientific or technical knowledge about food. Their objective is not to fill students’ knowledge gap. When scientific evidence is provided (e.g. the calorie table or the nutritional composition of foods), it is done so that students can manage their behavior by comparing their daily food intake with the dietary needs indicated by nutritionists. The Parmalat kit provides youngsters with a self-assessment and measuring tool allowing them to visualize their own eating habits and to compare the results with the food pyramid. The info-communicational and pedagogical dispositives produced by economic actors aim to responsibilize young people and to create selfawareness in order to change behavior. These dispositives encourage each student to evaluate accurately and if need be, to correct his/her own eating practices when they do not seem to meet the standards of nutritional orthodoxy. Such a representation of science as an argument in support of “doing the right thing” raises the question of how to develop youngsters’ critical thinking and critical judgment. The educational aim of science, often normative, seems to contradict the professed goal, in curricula, of promoting problematized exploration of issues surrounding food, health and the environment. Some pedagogical situations, while devised with the intent of promoting critical thinking among students, deploy dispositives which steer students towards stances and behaviors based more on values (good and bad) than on scientific knowledge. We observed a series of workshops on organic farming, conceived and conducted by four university business school students in a primary school in the city of Roubaix (in the Lille Metropolitan area). The business students, as part of a year-long entrepreneurial project, founded and managed an association to promote awareness of the benefits of organic foods. They were invited by two fifth-grade teachers in a Roubaix primary school to

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work with their students on food production and distribution practices as related to contemporary consumption patterns. The teachers’ objectives, in keeping with the recently modified school curricula, were to implement an integrated economic, social and nutritional approach to food. The workshops devised by the four business students, who are neither professional teachers nor specialists on the issue organic farming, were well received by the teachers as well as by their classes. The fifth-graders appreciated the nontraditional aspect of the workshops: small groups of students rotated from one workshop activity to another, set up in different rooms around the school. Individual workshops were conducted using playful methods and materials. Our observations show, however, that the four business school students, who used tightly controlled question and answer formats for their activities, created forms of interaction resembling a “true/false” perspective on the phenomena under study. An emphasis on finding the “right answer” (to questions on the advantages and disadvantages of organic farming) predominated in the workshop interactions. Among the documents chosen by these four business school students for use in their workshops were two short videos created by the “e-graine” national environmental association. The main objective of this association is to “promote action for the construction of world solidarity and responsibility” by upholding certain values and principles, including “nondogmatic thinking: to develop analytical thinking without imposing ideas” [EGR 18]. The two films chosen for the workshops are part of a series of 25 short animated videos featuring a family who adopts the principles of sustainable development, the “Kiagi Family” (the “FamilyWhoActs”). The titles of the two videos are “Pourquoi faut-il manger bio” (Why should we eat organic foods?) (2009) and “Fruit et legumes de saison” (seasonal fruits and vegetables) (2010). Each video presents an episode in the life of the family, with humorous stigmatization of the father who represents the as yet “unconverted” individual, that is, the consumerist who, through ignorance or indifference, engages in practices that are not respectful of the environment and potentially dangerous to health. The videos highlight the benefits of organic farming (solidarity, ecology); the virtues of organic foods are presented by a producer or retailer. In these animated videos, expertise, made simple and familiar, is voiced by a “local” organic actor who campaigns for the cause of organic farming in everyday practices.

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5.4.3. When students take on the role of statisticians: relaying technocratic science This representation of science as producing assertoric discourse tends to legitimize inculcation of imposed choices. However, some recent teaching dispositives attempt to convey the rich variety of disciplinary approaches to food and their interrelationships and to promote critical and original thinking [AST 08b]. The example of a recent issue of the French pedagogical journal Textes et documents pour la classe (Texts and documents for the class) devoted to the theme of “Foods” offers perspectives on interdisciplinary approaches to food while highlighting current scientific research [TDC 16]. This issue features articles written by researchers from a wide range of scientific disciplines (literature, genetics, history, geography, geopolitics, anthropology, ethnobiology, taste sciences, nutritional sciences). Each article discusses current research and current debate on topics such as the history of gastronomy and agriculture, the relationship between gastronomy and literature, the genetic adaptation of the body to foods, the physiology of taste and the relationships between health and nutrition. The issue’s foreword is written by anthropologist José Muchnik, who argues for interdisciplinarity as the only solution for a complete understanding of food: “Food needs all of these insights to be understood: sensory, poetic, scientific, economic, sociological, and even religious insights” [TDC 16, p. 9]. Upon closer examination however, we find that this issue is written for two different uses. Longer synthetic articles written by researchers are intended for teachers as tools for reflection. The discourse of these pieces is nuanced, with authors calling into question certain results and pointing out when research is still in progress. Concerning the relationship between nutrition and health, for example, Serge Hercberg (President of the PNNS National Nutrition Program and professor of nutrition) explains that: “Recent research shows that there is new potential for preventing multiple chronic diseases by means of nutrition. However, a consensus on these issues remains to be reached” [TDC 16, p. 62]. However, a series of pedagogical modules is included in the issue, with suggested activities and exercises. These modules are characterized by disciplinary compartmentalization and strict adherence to school curricula. Rather than a science that “questions” we once again find evidence of a science of “truth”. The pedagogical module in the natural sciences primarily seeks to

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promote application of nutritional principles. Curricular programs and objectives for each discipline are clearly specified: the interdisciplinarity offered up in the issue is set aside in the construction of these pedagogical guides, conceived to respond to the specific daily needs of teachers in their lesson plans and thus confined to the logic of individual disciplines. In the pedagogical module on natural sciences and mathematics, an attempt is made to clarify the link between the development of nutritional recommendations and the conduct of scientific research, but this entry into the world of “science in the making” remains strategic. Concerning the nutritional pyramid for example, we are told that it “evolves according to the results scientific research” yet no specific detail is provided. The results of two American medical studies are cited, but the main objective is to give evidence supporting a link between whole grain consumption and “generally lower mortality”. Some critical analysis of the pertinence of different representations of dietary recommendations (pyramids, plates) is offered: we find information about the debate surrounding different versions of these visual tools. However, allusion to this controversy is primarily made to reinforce the validity of the “Healthy Eating Plate” diagram proposed by “nutrition experts” from Harvard University. The aim of the discussion remains above all applicative; the principle of respecting dietary recommendations is defended and the following statistical activity is proposed as an exercise for students: In secondary school, the Healthy Eating Plate can be used as part of a transdisciplinary project on food combining biology, mathematics and library services, in conjunction with health education (see curricular programs). The objective would be both to allow students to learn about health recommendations, on a personal level, and to critically evaluate their own diet, in order to correct it, if necessary. In concrete terms, the project is based on the implementation of a statistical health survey in school, in collaboration with the mathematics teacher. Through this activity, we see that the proposed approach encourages both individual dietary self-governance and statistical monitoring of a population (here, that of the school). This activity thus serves to transpose both the message and the methods of the national health agency’s nutritional

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campaign, which is bolstered and legitimized by the work of epidemiological research teams who carry out “health barometer” surveys supporting public policy through data collection. In this activity, students take on the role of epidemiological statisticians; school science seems to imitate technocratic science. 5.5. Conclusion In Belgium, France and Italy, educational approaches to food and eating are confined to the margins of traditional disciplinary curricula. This interstitial status is potentially a positive force for interdisciplinary cooperation, considered by school actors as essential for tackling complex socio-scientific subjects. Government authorities encourage food pedagogies which allow for a blending of so-called “hard” sciences with the human and social sciences, including history, sociology and anthropology. A holistic vision of food and nutrition is promoted and encouraged in school curricula, yet the multiplicity of competing points of view and the practical and theoretical difficulties of implementing interdisciplinarity remain major obstacles to an inclusive and convergent study of food. While recognizing the need for interdisciplinary inquiry and for an ambitious systemic and complex conception of food, school food pedagogical practice and teaching resources remain largely bound to medical, epidemiological discourse. In this context, science is seen as concerned with promoting norms and behaviors rather than as an exploratory process or ongoing investigative process. School food is thus characterized by competing visions: on the one hand, there is a biological and nutritional vision of food, legitimized by science curricula and health directives and given pride of place in the classroom, the “noble” school setting; on the other hand, there is a cultural and gastronomic vision of food, less visible in school programs because it is implemented through projects or workshops organized only sporadically, often outside of the classroom. For want of a better solution, the core features of food pedagogy and food communication in schools, and the principle concern of teachers in their course planning, are to be found in the hard sciences and more particularly in medical biology. In addition, the paradigm of nutritional science, as well as the emphasis in schools on experimentation for problem-solving and on

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applied knowledge through constructive action, leave little room for problematization and for development of critical thinking. The image of science in schools and public policy, although seen as a potential key to original, collaborative, interdisciplinary inquiry on complex topics such as food, in effect serves reductionist objectives, by relying on technocratic methods, supported by the State, directed towards the search for solutions which stress individual responsibility in the face of wide-ranging social issues and problems. 5.6. References [ANS 16] ANSES, Actualisation des repères du PNNS : révision des repères de consommations alimentaires, avis de l’ANSES. Collective expertise report, Paris, Édition scientifique, December 2016. Available at: www.anses.fr /en/system/files/NUT2012SA0103Ra-1.pdf (accessed May 15, 2018). [AST 08a] ASTOLFI J.-P., HOST V., “Victor Host, penseur de l’éveil et promoteur de la didactique des sciences”, Le Télémaque, vol. 34, no. 2, pp. 101–112, 2008. [AST 08b] ASTOLFI J.-P., La saveur des savoirs, ESF Éditeur, Paris, 2008. [BAB 05] BABOU I., LE MAREC J. (eds), Sciences, médias et société, Actes de colloque, École normale supérieure de lettres et sciences humaines, Lyon, 2005. Available at: sciences-medias.ens-lyon.fr. [BAR 13] BARBIER M., CAUCHARD L., JOLY P. et al., “Pour une approche pragmatique, écologique et politique de l’expertise”, Revue d’anthropologie des connaissances, vol. 7, no. 1, pp. 1–23, 2013. [BAR 18] BARTHES A., LANGE J.-M., “Développement durable, postures et responsabilité sociale des chercheurs en éducation”, Recherches en Éducation, no. 31, pp. 92–109, 2018. [BER 17] BERTHOUD M., Communication publique et alimentation : une étude des dispositifs info-communicationnels à destination des enfants dans les écoles primaires, PhD thesis, Université de Lille, 2017. [DEG 15] DE GARA L. (ed.), Le sfide del l’educazione alimentare. Prospettive nutrizionali, comunicative e didattiche, Armando, Rome, 2015. [DEI 14] DE IULIO S., KOVACS S., “Communiquer, prévenir, éduquer : circulation de normes et de savoirs sur les risques alimentaires à l’école”, Communication & Organisation, no. 45, pp. 99–114, 2014. [DEM 11] DEMIZIEUX L., “5 Fruits et légumes par jour”, Cosinus no. 131, p. 22, October 2011.

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[EDU 15a] EDUSCOL, “Education à l’alimentation”, 2015. Available at: eduscol.education.fr/cid48513/textes-reference.html (accessed May 14, 2018). [EDU 15b] EDUSCOL, “Pourquoi une éducation à l’alimentation à l’école ? Éducation à l’alimentation”, Eduscol, 2015. Available at: eduscol.education.fr/cid47664/une -education-alimentation-precoce-durable.html#lien1 (accessed May 16, 2018). [EDU 16] EDUSCOL, 2016. Available at: eduscol.education.fr/cid86943/le-soclecommun.html (accessed May 16, 2018). [EDU 18] EDUSCOL, 2018. Available at: http://eduscol.education8.fr/ (accessed May 14, 2018). [EGR 18] E-GRAINE, 2018. Available at: e-graine.org/history-and-values (accessed May 16, 2018). [ENS 18a] ENSEIGNEMENT.BE, Promotion des attitudes saines sur les plans alimentaire et physique [Online], Fédération Wallonie-Bruxelles, 2018. Available at: www.enseignement.be/index.php?page=5992&navi=2726 (accessed May 16, 2018). [ENS 18b] ENSEIGNEMENT.BE, Référentiels de base – programmes approuvés pour l'enseignement fondamental [Online], Fédération Wallonies-Bruxelles, 2018. Available at: www.enseignement.be/index.php?page=25201&navi=2438. [EPI 18] EPICENTRO, OKkio alla Salute: Promozione della salute e della crescita sana nei bambini della scuola primaria, Centro nazionale per la prevenzione delle malattie e la promozione della salute, 2018. Available at: www.epicentro.iss.it /okkioallasalute (accessed April 24, 2018). [FAB 14] FABRE M., WEIL-BARAIS A., XYPAS C., Les problèmes complexes flous en éducation, De Boeck, Brussels, 2014. [GIR 08] GIRAULT Y., SAUVE L., “L’éducation scientifique, l’éducation à l’environnement et l’éducation au développement durable, croisements, enjeux et mouvances”, ASTER, no. 46, pp. 1–21, 2008. [GRA 03] GRANJOU C., “L’expertise scientifique à destination politique”, Cahiers internationaux de sociologie, no. 114, pp. 175–183, 2003. [HCS 17] HCSP, “Avis relative à la révision des repères alimentaires pour les adultes du futur Programme national nutrition santé 2017–2021”, Haut conseil à la santé publique, 16 February 2017. Available at: cache.media.eduscol .education.fr/file/food/62/2/avis_HCSP_PNNS_2017_743622.pdf (accessed May 16, 2018). [IST 18] ISTRUZIONE, 2018. Available at: www.istruzione.it/allegati/2015 /MIUR_Linee_Guida_per_l%27Educazione_Alimentare_2015.pdf (accessed April 24, 2018).

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[JAC 90] JACOBI D., SCHIELE B., CYR M.F., “Note de synthèse [La vulgarisation scientifique et l’éducation non formelle]”, Revue française de pédagogie, no. 91, pp. 81–111, 1990. [JEA 08] JEANNERET Y., Penser la trivialité. La vie triviale des êtres culturels, Hermes-Lavoisier, Paris, 2008. [JEA 94] JEANNERET Y., Écrire la Science. Formes et enjeux de la vulgarisation, PUF, Paris, 1994. [JUS 16] JUSSERAND Y., SACHE M. (eds), Sciences & Technologie 6e, cycle 3, Programme 2016, Bordas, Paris, p. 90, 2016. [KOV 11] KOVACS S., “La transformation des documents : pratique pédagogique, savoir social”, in BEGUIN-VERBRUGGE A., KOVACS S. (eds), Le cahier et l’écran : culture informationnelle et premiers apprentissages documentaires, pp. 95–112, Hermes-Lavoisier, Paris, 2011. [KOV 19] KOVACS S., ORANGE-RAVACHOL D., “L’utilisation des documents sur l’alimentation dans la pratique ordinaire d’enseignants de l’école primaire”, in CARDON P., DE IULIO S. (eds), L’alimentation scolaire : acteurs, discours, normes et pratiques, PUR, Rennes, 2019 (forthcoming). [LAM 14] LAMBIASE M., BISAGNI M., CAPRÌ E. (eds), Mangiare a scuola. Riflessioni e proposte sui percorsi di educazione alimentare nella scuola, Mattioli, Piacenza, 2014. [LAN 06] LANGE J.-M., VICTOR P., “Didactique curriculaire et éducation à… la santé, l’environnement et au développement durable : quelles questions, quels repères ?”, Didaskalia, no. 28, pp. 85–100, 2006. [MAN 18] MANGERBOUGER, 2018. Available at: www.mangerbouger.fr/PNNS (accessed May 15, 2018). [MAU 50] MAUSS M., “Essai sur le don. Forme et raison de l’échange dans les sociétés archaïques”, in MAUSS M. (ed.), Sociologie et Anthropologie, pp. 143–279, PUF, Paris, 1950. [MIN 11] MINISTÈRE DU TRAVAIL, DE L’EMPLOI ET DE LA SANTÉ, PNNS: Programme national nutrition santé 2011–2015, p. 15, 2011. [MIN 14] MINISTÈRE DE L’AGRICULTURE, DE L’ALIMENTATION ET DE LA FÔRET, “Le nouveau programme national pour l’alimentation”, November 2014. Available at: cache.media.eduscol.education.fr/file/food/59/8/national_food _program_743598.pdf (accessed May 15, 2018).

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[MIN 18] MINISTÈRE DE L'ÉDUCATION NATIONALE ET DE LA JEUNESSE, Bulletin official special, 26 November 2015 : programmes d’enseignments de l’école élémentaire et du collège, 2018. Available at: www.education.gouv.fr /cid95812/au-bo-special-du-26-novembre-2015-programmes-d-enseignement-de -l-ecole-elementaire-et-du-college.html (accessed May 16, 2018). [ORA 14] ORANGE-RAVACHOL D., KOVACS S., “Conditions de possibilité d’une éducation nutritionnelle à l’école primaire : ce qu’apporte l’étude du couple “situation divergente/situation convergente”, Actes du colloque “Les “éducations à…”, levier(s) de transformation du système éducatif ?”, Rouen, November 17–19, 2014. [ORA 18] ORANGE-RAVACHOL D., KOVACS S., ORANGE C., “Éducation nutritionnelle et acculturation scientifique : quelles circulations de normes et de savoirs dans les discours adressés aux jeunes ?”, Éducation et socialisation – Les cahiers du CERFEE, no. 48, 2018. [PAI 05] PAILLIART I. (ed.), La publicisation de la science, PUG, Grenoble, 2005. [RAI 10] RAICHVARG D., “La vulgarisation des sciences : fausse “traduction” et vraie « interprétation »”, Hermès, La Revue, no. 56, pp. 105–112, 2010. [ROJ 08] ROJAT D., PEROL J.-M., SALVIAT B., SVT Programme 2008. Sciences de la Vie et de la Terre 3e, Nathan, Paris, p. 217, 2008. [ROQ 97] ROQUEPLO P., Entre savoir et décision, l’expertise scientifique, Éditions Quæ, Versailles, 1997. [TDC 16] TDC, Textes et documents pour la classe, numéro thématique “Nourritures”, no. 1102, 2016. [WHO 01] WHO, Information, Education, Communication. Lessons from the Past; Perspectives for the Future, Word Health Organization, p. 3, 2001.

6 Info-educational Dispositives to Educate Children about Nutrition

6.1. Introduction Since the 2000s, in a context where food is associated with multiple health risks (obesity, malnutrition and disease), the State and national public health authorities have developed extensive info-communication campaigns related to nutrition. Among the best known are those of the PNNS (French National Nutrition and Health Program), which has been widely covered by the media since 2001. Nutrition appears in these campaigns as a food model that guarantees health and that must be promoted and adopted by the population. Among the actors targeted by these campaigns, children are a particularly targeted category of the population, often referred to as the first “victims” of foodrelated risks, and also as “future consumers”1, who should be educated in good eating practices. At the same time, the school, an institution historically responsible for public education under the responsibility of the State, is designated by public institutions as a preferred place to relay health messages and educate students about the nutritional model. In this regard, public institutions have produced a large quantity of “pedagogical resources” such as educational kits, boxes and booklets, as well as multiple “teaching Chapter written by Marie BERTHOUD. 1 Programme national de nutrition santé 2011–2015 “The objective is to implement communication, information and education acts to facilitate students’ learning of good food practices.”

Food and Health: Actor Strategies in Information and Communication, First Edition. Edited by Viviane Clavier and Jean-Philippe De Oliveira. © ISTE Ltd 2019. Published by ISTE Ltd and John Wiley & Sons, Inc.

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materials” (posters, brochures, leaflets, flyers) for students on the themes of nutrition and health. The stated objective of these various info-educational dispositives is to “contribute to the evolution of French behavior in line with the recommendations of the PNNS” [SAN 17]. Our chapter aims to identify the means and strategies by which public institutions have sought to reach children in schools, the info-pedagogical tools they have produced for this purpose, the norms and knowledge that affect nutrition and that these tools update, as well as the actors mobilized to participate in their design and dissemination in the school context. We will try to answer the following questions: what dispositives are in place to guide school food practices? Who are the actors involved in this production? What strategies are being used to reach children in schools? Beyond these questions, this chapter contributes to the understanding of public communication issues related to school feeding. For this work, we carried out a semipragmatic analysis of the PNNS programs published since 2001, as well as information-pedagogical dispositives intended more specifically for French elementary schools and in which the theme of nutrition plays an important role: the “Léo and Léa” educational booklets, developed in 2012 by the former Institut national de prevention et d’éducation à la santé2 (INPES, now part of Santé publique France) and a committee composed of doctors, nutritionists and teachers. We considered our entire corpus from the concept of “dispositives”. In our view, those called “materials”, “instruments” and “tools” by public institutions can be understood as dispositives aimed at “capturing, orienting, determining, intercepting, modeling, controlling and ensuring the gestures, conduct, opinions and discourses” [AGA 07, p. 31] of children in school with regard to food. We have chosen to link the analysis of these “tools” to the Foucaultian concept of governmentality, thinking of them as operating modalities of biopower3. This interpretative posture is in line with Hélène Romeyer’s work, who states that “the PNNS can be perceived as a tool

2 French National Institute for Prevention and Health Education. 3 Michel Foucault envisages biopower as a “network” through which various bodies (school, family, state) and multiple dispositives are articulated [FOU 76, p. 720]. In this respect, the obvious intertwining between the “tools” of national public institutions in the field of school feeding can be precisely read as constituting a network of biopower dispositives.

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focused on the body and imbued with a regulation of the workings of life: mortality and longevity. It is indeed a power technique that specifically invests individual bodies” [ROM 15, p. 58]. In this definition given by Hélène Romeyer, we find the Foucaultian concept of dispositive, which can extend to all the materials we have collected. In addition, this Foucauldian concept makes it possible to study the pragmatic dimension of the “tools” and “instruments” produced by public authorities. Indeed, the work that has approached the concept of dispositives according to an info-communication approach has focused on underlining its pragmatic dimension [MON 13, PAQ 07, PER 99, SEU 10]. Based on this work, we note that the dispositives of our corpus are presented by public institutions as “pedagogical tools” and “educational instruments”, aimed at “changing behaviors” [PNN 11, p. 2]. We have thus hypothesized that these dispositives aimed at educating people about food not only mediatize knowledge and representations but are also intended to be “tools that guarantee learning, followed by a capacity for action” [SEU 10, p. 163], considering that one of the “communicative objectives” [SEU 10, p. 162] of these dispositives is to make children adopt specific behaviors. We have thus chosen to study the dispositives linked to our corpus from an analytical grid, allowing us to highlight both the knowledge, norms and values structured around food as well as the practices and behaviors that these dispositives engage and prescribe. This analysis grid aims to: – identify the knowledge and representations related to food updated by the dispositives (the themes and favored arguments in terms of health and nutrition) and the types of axiological strategies (mobilization of value systems and norms); – discern argumentation strategies, by which knowledge, norms and representations are updated – through the analysis of dramaturgical types (layout of the text, expressive function of the language, poetic function) and rhetoric (scientificity, reaction to the slogan, lexical field of “good” and the “bad”, “formulas”[SEU 10]); – detect the “dynamic uses” of the dispositives [PIG 06], that is, how these “tools” guide the practices of their use (the configuration of the dispositives, their formats: “guides”, “kits”, “instruments”);

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– identify the way in which the dispositives aim to “make-do” and guide practices: argumentative strategies (prescriptions) and pragmatic logic (game and exercise format, points and assessment system, quizzes), as well as the practical knowledge put forward in the dispositives (practices presented as best practices, modeled guidelines). In this chapter, we will show how public institutions have involved education and civil society professionals in the creation of these dispositives, demonstrating a willingness to build on their experiences in pedagogical communication techniques to adapt national nutritional messages to the world of school and childhood. It will also report on how the designers of these systems have sought to bring PNNS public health messages in line with the school environment, as well as with the children’s age groups, and have based their efforts on the modalities of pedagogical and recreational communication: popularization of knowledge, didactic methods, enrolment in teaching subjects, evaluation of knowledge and sequenced format as well as the use of official nutritional norms in pictures, games or activities. Finally, based on the case study of the “Léo and Léa” dispositives, we will examine the challenges of such nutritional education in schools today and how children are invited to govern their eating practices, as well as those of their peers. Before presenting the results of our analyses, we believe that terminological accuracy is important. In this chapter, we use the notion of “info-educational dispositives”, which highlights the interdependence between the issues and strategies of the dispositives studied. Within the information and communication sciences, terms such as information and communication have often been used in this way, such as information and communication, when it comes to studying info-communication dispositives. According to Viviane Couzinet, the dispositives can be thought of as “mediating effects and issues”, which makes it possible to grasp “the link that unites information and communication within knowledge dissemination systems” [COU 09, p. 6]. For our study, we believe that the dispositives produced in recent years by public institutions are not only intended to inform children but also to educate, train and ultimately accustom them to nutritional norms through experience. To this end, public institutions rely on the modalities of pedagogical communication, which, as we will see later, allows children to experiment with nutritional norms through exercises and games. The choice of this terminology is thus an interpretative key for our work.

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6.2. Educating about the nutritional model Since the 2000s, “nutritional education” in schools has become a priority, a “strategic lever” and a “dispositive” for public health institutions to focus on, with the aim of improving the “nutritional” status of children and “guiding young consumers towards nutritionally satisfying food choices” [PNN 2011–2015, p. 22]. For the PNNS, nutrition would be the health model to be promoted. In its definition, it would cover broader issues than food: The word “nutrition” should be understood to include issues related to nutrition (nutrients, foods, social, cultural, economic, sensory and cognitive determinants of eating behaviors) and physical activity. [PNN 11, p. 11] Thus, where nutrition would stop at eating and the factors that determine this practice, nutrition would include the issue of physical and sporting activities. In fact, this definition corresponds to the priority objective of the PNNS since 2001, formulated by the slogan “manger-bouger”4, an expression at the very origin of the PNNS website. “Nutrition” is a model, as it can guarantee the health of populations. Indeed, according to the PNNS, “satisfactory nutrition is a factor in protecting health”, as well as a “determinant of health” [PNN 11, p. 5]. Since 2001, its slogan has been: “Manger-bouger c’est la santé”5. The main objective would be to “improve the health status of the population as a whole, by addressing one of its major determinants, nutrition” [PNN 11, p. 7]. The nutritional model is also put forward as the solution to the main health and nutrition problems. Obesity, overweight, “sedentary” and nutritional pathologies are referred to as problems that originate, according to the PNNS, from “unsatisfactory  nutrition” [PNN 11, p. 15] and at the same time can be “reduced” [PNN 11, p. 16], “decreased” or “limited” by “nutritional actions” [PNN 11, p. 25].

4 Literally, “eat-move”. 5 An English translation of this would be “eating and moving is good for your health”.

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In order to promote nutrition and educate children about this model, national public health institutions have developed programs based on so-called “nutritional benchmarks”: a food classification and quantities (“grams”) adapted to daily life and meal patterns during the day. Fruits and vegetables should be consumed at least five times a day; bread, cereals, potatoes and dried vegetables at each meal; milk and dairy products three times a day; meat, poultry, fish products and eggs once or twice daily, while it would be a matter of limiting added fat, sugary products and salt. For Hélène Romeyer, who has studied the PNNS since 2001, the challenge of constructing such nutritional benchmarks is part of a desire to establish a normative and legitimate model of eating practices in order to impose behavioral changes on individuals. Nutrition is presented in the programs as a legitimate science, based on expert knowledge, including health norms and provided that citizen “well-being” is adhered to. According to the author, nutrition appears to be the subject of coercive communication in order to regulate individuals’ eating practices and, as such, can be understood from the Foucauldian notion of biopower. “Nutritional education in schools” would “educate and guide young consumers” [PNN 11, p. 22] according to these benchmarks. The challenge would be to transmit knowledge about nutrition, but also to encourage them to adopt it from an early age through the school system. Indeed, for the PNNS, nutritional education in schools would aim to “enable the transition from knowledge to the implementation of nutrition” [PNN 11, p. 22]. To this end, public health authorities propose to build on existing school-based “tools”, such as school curricula, while proposing new “tools”, such as “educational tools” [PNN 11, p. 21], kits defined as “recreational tools”, “analytical tools” or “documentary files” [PNN 11, p. 22]. 6.3. Designing info-pedagogical dispositives to educate about nutrition in schools The way in which these dispositives have been designed is quite interesting, as it reflects the implementation of a twofold logic: on the one hand, to apply the State’s strategy to disseminate PNNS recommendations in schools, and on the other hand, to involve health and education professionals in the development of multiple educational “materials”, while maintaining control over the messages that are updated in these said materials.

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6.3.1. The association of multiple professionals Since the early 2000s, schools have been entrusted by the French state with the task of participating in children’s nutritional education. For example, in 2001, a circular from the Ministry of Education mentioned the importance of “nutritional education” and “taste education” in schools. In 2002, a booklet entitled La restauration scolaire : équilibre, sécurité, plaisir proposed to teachers to set up workshops and activities around food education. In 2003, a new circular gave education professionals the role of preventing obesity and overweight students from becoming obese. Formalizing the importance of health and food education in schools, the State then sought to develop a set of educational dispositives to adapt national health and nutrition messages, particularly those of the PNNS, to schools and the young community, as well as to provide education professionals with appropriate tools. Today, there are a large number of info-educational dispositives (educational kits and bags, educational videos and booklets, posters, brochures, etc.) concerning nutrition for schools that are offered by public health institutions and available on the Internet from the INPES online catalogue or from the Ministry of Health’s Internet pages. The challenge for these institutions is to offer multiple “tools” that education and health professionals can reuse in educational institutions for children. For the design of these “teaching materials”, many partnerships have been established between the State, ministries and various professionals with experience in child nutrition in schools and in the publication of specialized books. In an interview conducted in 2014, Serge Hercberg, President of the PNNS, stressed the importance of relying on “the mobilization of different actors, particularly in the field, whether they are from the health or education sector, associations or local authorities” [SAN 18], with regard to the development of info-communication systems. The educational materials on nutrition that we have analyzed illustrate this desire to involve different professionals. For example, for the “Léo and Léa” tools, it was first of all health and nutrition professionals who were invited to join the editorial boards. Doctors (school doctors in particular), nurses, nutritionists and specialists in neuropharmacology, as well as psychologists, have participated in the production of these educational materials. In addition to this first

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health hub, there is also a hub of education professionals, including teachers, school principals, early childhood educators and academy inspectors. Thus, the objective of conducting nutritional education in schools via infopedagogical dispositives finds its two aspects by bringing together the fields of health and school education. The third actor who has been widely involved in the implementation of these schemes concerns the world of children’s publishing and creation. For example, illustrators and graphic designers who have collaborated with publishing houses such as Actes Sud Junior or Gallimard Jeunesse have taken part in the development of the “Léo and Léa” pedagogical booklets. 6.3.2. A homogeneous production The diversity and heterogeneity of the actors involved in the creation of this educational content could suggest the idea of a diversity of messages and a type of “cacophony” [MAU 10] of discourse between dispositives. Yet, despite this diversity of professionals, it is quite surprising to note that the content differs very little between them and even more so completely coincides with national public health messages such as those of the PNNS. This situation is explained first of all by the fact that it is the national public health authorities that coordinate and manage the design of content and the dissemination of most info-pedagogical dispositives. The official INPES website clearly indicates this association of professionals under the aegis of national authorities: The scientific content of each guide is developed by an ad hoc working group, coordinated by the French Food Safety Agency (AFSSA) […]. This group is made up of experts in human nutrition, with expertise in physiology, epidemiology, food consumption studies, food science and behavior: doctors, epidemiologists, dieticians, sociologists, health educators, and representatives of the main institutions concerned by the PNNS (InVs, INPES, etc.), as well as publishing specialists for the general public and professional representatives (INPES), who coordinate the publication of the documents. [SAN 17]

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The homogeneity of the messages is also explained by the fact that a large number of professionals involved in the implementation of these dispositives are themselves members of the national public health authorities that developed the national nutrition campaigns. Indeed, whether they are health or education professionals, most of these actors are members of committees and institutes created by the Ministry of Health or mandated by it. To illustrate this, we will take the particular example of the “Léo and Léa” educational booklets. Produced by the Groupe de recherche en éducation nutritionnelle (GREEN)6 and by INPES in 2005, the “Léo and Léa” booklets are info-educational dispositives, which take the form of popular documentary books on nutrition and food. One of the designers is Dr François Baudier, a member of the French High Council on Public Health (HCSP) and strategy director at the State’s public and administrative establishment under the Ministry of Health: the Franche-Comté Regional Health Agency (ARS). In 1991, he was also Deputy Director General of the French Committee for Health Education (formerly CFES, which became INPES in 2002). The production of the “Léo and Léa” educational booklets was also led by Brigitte Sandrin-Berthon, a public health physician who has worked in schools, a member of the Languedoc-Roussillon Regional Health Education Committee and the INPES, an institute mandated by the Ministry of Health and Social Affairs, as well as the president of the Chronic Diseases Specialist Commission at the High Council of Public Health (HCSP), also associated with the Ministry of Health. In addition to the design team, members of various public bodies such as the National Institute of Youth and Popular Education (INJEP) – mandated by the Ministry of Youth – are education professionals attached to the Departmental Directorate of National Education Services (DSDEN), as well as the actors of the National Agency for Health Security, Food, Environment and Work (ANSES), whose commission is under the responsibility of the Ministers of Agriculture, Consumer Affairs, Environment, Research, Health and Labor. Thus, the contributors to the “Léo and Léa” dispositives are directly linked to official public and state institutions and mandated by them to produce “material” in line with the PNNS “national guidelines”, which they themselves have sometimes helped to develop.

6 French research group concerned with nutritional education.

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In summary, public health institutions have sought to produce info-pedagogical dispositives to disseminate the official nutritional norms promoted by national programs in schools and childhood world. To do this, they relied on the skills of various professionals, whose role is to rewrite and adapt the official PNNS “guidelines”. This remains the “referent discourse” [BAR 15] around which the info-educational dispositives are constructed.

Figure 6.1. Example of production partnerships in “Léo and Léa” pedagogical booklets (source: [BER 17, p. 150]). For a color version of the figure, see www.iste.co.uk/clavier/health.zip

Thus, despite the diversity of actors and “tools”, info-pedagogical dispositives respond to the same “communicative objective”, the challenge of which would be to fight against the risks linked to food through education in knowledge and practical knowledge. This idea refers, in our opinion, to the work of Caroline Ollivier-Yaniv: It appears that public institutions have thus multiplied the modalities and procedures in order to make their action and policies known - in connection with the duty to inform; to debate and convince of their relevance and reactivate their legitimacy; also in order to encourage adherence to a definition of the general interest in a society characterized by the

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dissociation of legitimacy and trust; and finally, to promote the construction of social norms, the standardization of knowledge or the regulation of individuals’ behavior. [OLL 14, p. 11] According to Caroline Ollivier-Yaniv, if there is a multiplication of actors and procedures, it corresponds to the same intention on the part of the mobilized actors to inform, educate, guide and finally govern conduct. 6.4. Adapted national dispositives In this third part, we propose to examine how official nutritional messages are adapted to schools and the childhood world, using the analysis of the “Léo and Léa” educational booklets. Available from the INPES online catalogue, under the heading “nutrition”, these tools are intended for use in class or during extracurricular workshops and to approach nutritional benchmarks in a “fun” way7. Each of these cases consists of a booklet for children and a booklet for teachers and facilitators. 6.4.1. “Léo and Léa”: info-educational dispositives for schools These booklets are presented in a very didactic way: organized in different sequences identifiable by chapter, they explicitly define the stages of the teaching journey and the educational objectives of each session; they also draw up a list of the necessary materials and make posters, tables or graphs available to education professionals, on which to base lessons. They also reflect a pedagogical dimension adapted to children. Children’s booklets feature stories in which children’s characters tell a story about their daily lives, illustrated by a rich iconography. They offer exercises in the form of games, quizzes, riddles or tailored workshops to be done in groups and suggest ideas for school outings to teachers and facilitators. More specifically, the theme of nutrition is approached in a very diversified and transversal way. It is referred to as a need8, but it is also associated with gustatory pleasures and sensory discoveries (taste, cooking)9,

7 General introduction to the booklets for professionals, p. 2. 8 “Léo et la terre”, children’s booklet, pp. 22–28. 9 “Léa et le feu”, children’s booklet, pp. 7–10.

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with various contexts and events (lunch in the cafeteria10, a picnic11), with cultural practices (soups of the world)12, with the history and origin of food (the spice trade)13, with production, distribution and consumption patterns (the type of culture, distribution network)14, or with the functioning of the human body, plant life and their development. It is the subject of lessons related to multiple “disciplines” such as “life and earth sciences”, “geography”, “history”, “reading”, “vocabulary” or “mathematics”15. It is also an attempt to evoke more general subjects: community life, “good and bad habits” or sharing. In order to provide an overview of this transversality, we looked at the “Léo et la terre” box set (children’s booklet and professional booklet), in which the issue of nutrition is particularly addressed. It is first addressed through stories. The booklets have the specific feature of introducing the chapters with stories whose main characters are children. The narrative is in the first person singular, suggesting Léo’s or Léa’s point of view. In the case of “Léo et la terre”, one of them is entitled “L’arbre à pommes de terre” and features a “child of the city”16, who discovers how food grows (in the ground, on trees), the steps to cultivate it (ploughing, planting) and the different cultivation areas (fields, orchards, vegetable gardens). Another, “La clé d’Arthus”, tells the story of two children: one is sick from eating too many pears and the other swallows a key in class by mistake. Integrated into the chapter on digestion, the story covers the steps of absorption and expulsion of food (or objects accidentally swallowed) by the human body. “Le jour des frites” takes place in the school cafeteria: a group of students who love French fries decide to write a petition, demanding that they be served at every meal. In the booklet for professionals, this story introduces a debate with the students on the theme of “eating habits”17. In all the boxes, these stories almost always take place at school and place the characters in everyday life situations: recess, class, a school trip. 10 “Léa et l'air”, children’s booklet, pp. 22–25; “Léo et la terre”, children’s booklet, pp. 23–26. 11 “Léo et la terre”, children’s booklet, pp. 29–32. 12 “Léo et la terre”, children’s booklet, p. 33. 13 “Léa et le feu”, Teacher’s Booklet, p. 6. 14 “Léo et la terre”, children’s booklet, p. 1–7. 15 General introduction to the professional booklets, p. 1. 16 General introduction to the professional booklets. 17 “Léo et la terre”, professional booklet, p. 17.

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At the end of these stories, exercises, games and activities are offered. For example, using a drawing of a city with its port, factories and shops, children must trace the path of different foods (milk, tomatoes, wheat, meat) from the time they are grown/farmed to the time they are edible at the table. In another diagram illustrating a human body, they have to assign labels to parts of the digestive system (stomach, colon, pancreas, mouth, anus, liver, esophagus and small intestine). In the teacher and facilitator booklet, this game is defined as a way of “understanding what happens to food inside the body, after it has been ingested”18. Children are also asked to perform a “true or false” test19, based on a series of multiple-choice questions about food, its nutritional properties and the frequency with which it should be consumed. These questions include: “Fruits and vegetables contain vitamins that help you see well: True or false?” or “To grow up well and have strength all day long, 3 meals plus 1 snack are necessary: True or false?” Another question is: “Do you bite into food energetically?” allows “the role of food in physical effort”20 to be discovered. Exercises are also made available to teachers and facilitators, which make it possible to compose “balanced menus”21, based on images of food to be surmised. The theme of nutrition is also addressed through activities such as growing potatoes in the classroom, preparing a meal at school or building a solar cooker. To achieve this, the booklets outline the different steps to follow and the necessary materials. Ideas for visits are also offered to education professionals: organizing an outing to the farm or to a “food processing place” (bakery, cannery, etc.). It is a question of “discovering the different transformations undergone by food before it is consumed, or to increase its shelf life before being placed at the point of sale”22. It is also suggested that students are taken to the school cafeteria to meet the staff and understand how collective catering works. The booklets also advise classroom discussions and, from this perspective, set out in great detail the steps to be followed: the subject, the questions to ask students and the techniques to encourage children to speak out.

18 “Léo et la terre”, professional booklet, p. 10. 19 “Léo et la terre”, children’s booklet, p. 22. 20 “Léo et la terre”, professional booklet, p. 16. 21 “Léo et la terre”, professional booklet, p. 15. 22 “Léo et la terre”, professional booklet, p. 6.

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All these exercises, stories and workshops are linked to multiple educational objectives. According to the professional booklets, stories help children develop their imagination, their reading skills and their vocabulary. Exercises are a way of approaching knowledge about teaching subjects and tests are an opportunity to evaluate the knowledge and skills acquired by students and activities, to transmit a set of skills to them, in accordance with the stated objectives of the “Léo and Léa” kit. As real pedagogical tools for schools, “Léo and Léa” are presented as follows: […] the cases facilitate work on some of the skills linked to the common foundation of knowledge, skills and culture, namely, command of the French language, the main elements of mathematics and scientific culture, mastery of the usual information and communication techniques and social and civic skills.23 6.4.2. A tool belonging to national public institutions These dispositives are integrated by their format and enunciative modalities into the school framework and allow multiple themes of the school curriculum to be addressed in a playful way. But the latter are also part of a general strategy for health and nutrition promotion and education promoted by the PNNS. These kits have been co-funded, co-produced and published within the framework of the PNNS, and as such, they are dispositives designed to promote and educate people about “good” food, in accordance with the national program’s principles. This objective is not hidden, and the general introduction of professional booklets clearly states: This kit is part of a health promotion approach, the aim of which is to give individuals more control over their own health and more ways to improve it…. Health promotion is recognized and reaffirmed in Act No. 2013-595 of July 8, 2013, on orientation and programming for the rebuilding of the Republic

23 “Léo et la terre”, professional booklet, p. 2.

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school, which states in article 6 that "these actions promote their academic success and the reduction of health inequalities.24 While the link with national public health objectives is clear, the dissemination of national food benchmarks is more or less indirect: nutritional norms, as defined by the PNNS, play an important role in children’s booklets, although the direct reference to the program is not always explicit. For example, it is the adult characters in the stories that evoke them. In the story of “Léo et la terre” that takes place during lunch at school, the “cafeteria lady” is a central character. She advises children, tells them to finish their plates, taste food and favor vegetables. Described by Léo’s character as “nice” but “strict”25, she is also the spokeswoman for PNNS’s recommendations: eat fruit for good health, avoid salt and fat, and engage in physical activity. Based on this story, a debate to be conducted with the children is proposed on the question of “eating habits”26. The aim is to invite students to discuss more particularly “candy”, declared as “not very good for your health”27. “Léo et la terre” exercises and activities also address the nutritional norms that children must be taught. For example, the development of a “balanced menu” or a “test” entitled “from food to nutrients” teaches children the benefits of fruits and vegetables that “protect against certain diseases” and the notion of “nutritional balance in meals”28. In the professional guide, these two exercises are located under the theme of “nutrition”. Two tables indicating the “consumption benchmarks” are available to teachers and facilitators to help them “set out arguments”29. The first, entitled “The 7 Food Groups”, describes the “key nutrients”, as well as their “roles” and benefits on the body and health. The reference to the PNNS is explicit:

24 “Léo et la terre”, professional booklet, p. 2. 25 “Léo et la terre”, children’s booklet, p. 24. 26 “Léo et la terre”, Teacher’s Booklet, p. 19. 27 “Léo et la terre”, Teacher’s Booklet. 28 “Léo et la terre”, professional booklet, p. 15. 29 “Léo et la terre”, professional booklet, p. 12.

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The PNNS’ consumption benchmarks with its different food groups make it possible to approach food balance in a concrete way with children. The proposed color code makes it easy to visualize.30 The second table “PNNS consumption benchmarks” shows the organization in seven groups and explains the frequency with which the products are consumed: “fruits and/or vegetables: at least 5 times a day”; “added fats: to be limited”; “drinks: unlimited water”31. These two tables are obtained from the 2011–2015 PNNS, to which reference is clearly made. But they are not visible in the children’s booklet. In the latter, the consumption benchmarks are presented in the form of a pull-out poster, which shows, in the form of comic strips, “ten points to be in shape” throughout the day. The illustrations represent a children’s character in different situations: at the table, on a football field or on the street. Below the image, a text in the first person singular and in the present tense of the indicative indicates what to do during the day: “I avoid snacking”; “a meal that is too fatty is heavy and slow to digest: to avoid if I want to be in shape”; “I move, I get used to walking and I do physical activity”; or “I take care to eat fruits and vegetables: they are good for my health”32. This time, the reference to the PNNS is not specified, even if this document almost verbatim reproduces the national recommendations. Finally, the principles of national programs on nutrition and health are discussed throughout the sessions by being updated in the form of stories, exercises and workshops and thus adapted to the world of children and school. 6.4.3. A tool to mobilize children We also note that children are invited to mobilize the knowledge acquired about nutrition, to reuse the resources from the “Léo and Léa” dispositives with their family and friends and, beyond that, to actively participate in health promotion. Some of the educational content in the case examples is designed precisely for this purpose. 30 “Léo et la terre”, professional booklet, p. 13. 31 “Léo et la terre”, professional booklet, p. 14. 32 “Léo et la terre”, professional booklet.

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For example, the booklets provide children with tests to submit to their parents and friends. This is the case with the “Brevet du buveur d’eau” in the booklet “Léo et l’eau” (see illustration). This is a multiple-choice questionnaire, which addresses the health benefits of water. Children are invited to ask a series of questions to their relatives and, depending on the answers, to assign them a profile: the “good water drinker”, the “quite good water drinker”, the “too little to receive your certificate” or “you don’t drink enough”33. These profiles are each completed by prescriptions: “keep going”, “don’t stop”, “drink water REG-U-LAR-LY” or “don’t forget that you shouldn’t wait until you are thirsty to drink, it’s not good for your health”34. Children are thus assigned the role of an evaluator and prescriber of the “right” behavior to adopt. Similarly, each children’s booklet contains a pull-out poster for parents. It illustrates, in the form of comic strips, the health principles promoted in the programs, such as the right dietary guidelines to follow in a day35 or the recommendations for physical activity and sport36. The objective here is to address parents through children and thus to pursue the objective of health promotion into the family sphere. In addition, some activities are designed in such a way that children can take part in the food education of their peers. For example, the debate entitled “I love candy too much”37, part of the nutrition chapter of “Léo et la terre”, urges them to seek advice on how to make other children “lose” their eating “bad habits” such as “eating candy”38. In the same chapter, they are also asked to write a “catering charter”, which “will be proposed for signature by children who eat lunch at school”39 and by which members undertake, for example, to taste all foods at least once. At the end of each chapter, students are required to complete “evaluation forms”40. Presented in the form of a questionnaire, they propose exercises and simulations, based on which it is a question of mobilizing the knowledge acquired during the session. This is the case with the evaluation sheet in the “Léo et la terre” 33 “Léo et l’eau”, professional booklet, p. 5. 34 “Léo et l’eau”, professional booklet. 35 “Léo et l’eau”, children’s booklet, pp. 16–17. 36 “Léo et l’eau”, children’s booklet, pp. 16–17. 37 “Léo et la terre”, teacher’s booklet, p. 17. 38 “Léo et la terre”, teacher’s booklet. 39 “Léo et la terre”, teacher’s booklet, p. 19. 40 These evaluation sheets are additional documents to the booklets. They are available on the INPES website and can be downloaded or delivered with the entire box set.

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box, which invites children to answer questions such as: “to make him or her grow up well, here is the advice I would give to a younger person than me”, or “If a friend didn’t like a vegetable I love, here is the advice I would give”41. Jeu-Test 6

Fais passer le brevet du buveur d’eau. Fais passer ce brevet de buveur d’eau à tes amis, tes parents. Demande-leur de répondre sans tricher à ces questions, note leurs réponses dans les colonnes correspondantes. À la suite de cette enquête, tu pourras évaluer leurs capacités de buveur d’eau et leur donner des conseils pour s’améliorer. (Solution page 5 dans le livret de ton enseignant) 1. Quand as-tu envie de boire ? ■ jamais ● après un effort physique ▲ dès que tu vois de l’eau qui coule 2. Le fruit que tu préfères : ▲ le melon ■ la banane ● la pêche 3. Dans la journée, en plus des diverses boissons lait, thé, etc., tu bois : ▲ 4 à 5 verres d’eau par jour ● 1 à 2 verres d’eau par jour ■ zéro verre d’eau par jour 4. Comme dessert, tu préfères : ▲ un sorbet ■ une part de gâteau au chocolat ● une crème caramel

5. Tu pars faire une marche à pied : ■ tu ne prends jamais de gourde ▲ tu prends toujours une gourde ● tu prends un peu de monnaie pour te payer une boisson à l’arrivée. 6. Pendant le déjeuner, tu bois : ● une boisson sucrée ▲ de l’eau ■ du vin 7. En hors-d’œuvre, tu choisis : ■ un œuf dur mayonnaise ● une tomate ▲ de la salade 8. Sur la place du village que trouvestu le plus joli ? ■ l’école ▲ la fontaine ● la mairie

9. En fermant les yeux tu goûtes l’eau de deux verres (l’un d’eau minérale fraîche, et l’autre d’eau du robinet très froide) : ● tu sais distinguer l’eau froide et l’eau fraîche. ■ tu ne sens aucune différence entre les deux. ▲ tu sais distinguer la différence de goût entre les deux eaux. 10. Quand tu vas à la piscine, tu te dis : ● je bois avant pour ne pas avoir soif plus tard. ■ je n’aurai pas soif puisque je serai dans l’eau. ▲ je prends une gourde. Même si je suis dans l’eau, j’aurai soif puisqu’en nageant je fais un effort physique.

Figure 6.2. The water drinker’s certificate, “Léo et l’eau”42. For a color version of the figure, see www.iste.co.uk/clavier/health.zip

Thus, through various resources, the “Léo and Léa” dispositives assign to children a role of a mediator/prescriber, whose mission is to redistribute recommendations on health and “good” nutrition within and outside the school environment. 41 “Léo et la terre” evaluation sheet. 42 Children’s booklet, p. 6.

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6.5. Conclusion In conclusion, we consider that in order to defend, promote and educate about the nutritional model, public health institutions have sought ways to disseminate it in ways that are audible and understandable to children. Several strategies are emerging: the model is formulated according to benchmarks, establishing discourse in the form of discursive summaries; public health policies are looking for partners who are called upon to take part in the development of info-pedagogical dispositives to adapt these benchmarks to schools. Through the analysis we have carried out, we can see that, in order to promote and educate children about “good” nutrition, these info-educational dispositives are part of the same set of strategies: – public authorities have involved education and civil society professionals in their production, demonstrating a willingness to draw on their experience in pedagogical communication techniques; – these committees have co-produced dispositives, aimed at being in line with the school framework. To do this, they relied on the modalities of pedagogical school communication: the didactic method, the popularization of knowledge, the use of the “edutainment” format, enrolment in teaching subjects, the evaluation of knowledge, the short or sequenced format; – they have also sought to adapt to the age of the children by developing characters with whom they can identify, by constructing stories that take place in identified spaces (school, cafeteria, home and family) and in everyday situations (during meals, breaks and school outings), as well as by addressing themes that are supposed to fit into their daily lives (making new friends, sharing lunch, playing in the yard or reviewing a lesson); – the prescriptions and models relating to the “right” diet are rewritten to correspond to the pedagogical format: they are put into images and comic strips. They appear in the form of dialogues in the stories, are depicted in the conduct of the heroes, appear as the moral of the story or are translated into exercises, games and activities; – teachers and facilitators are mobilized to complement these dispositives and take part in the education of health principles, such as nutrition. To do this, they have at their disposal tools directly from the national PNNS program, which they can use in their arguments.

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Secondly, in our opinion, the dispositives meet the same objective: to update national nutritional benchmarks, so that they are known, adopted and even relayed by the students themselves. Beyond seeking to inculcate food norms in children, info-pedagogical dispositives give them a responsibility in the overall project of promoting health. Indeed, the dispositives seek to involve children in the dissemination of the nutritional model, by distributing pre-defined roles to them and assigning them missions within their families and peer groups. They thus find themselves involved in a public and political affair. Nutritional education would thus be aimed not only at providing a body of knowledge but also at having children adopt it, so that they themselves can act as intermediaries with their families and friends. In our opinion, this strategy refers to the work of Michel Foucault and the question of biopower. From this perspective, “learning [and] education” [FOU 15, p. 719] are “biopower” techniques, practicing on life and bodies, producing and relying on a set of norms and values. It would be made operational by dispositives that attempt to regulate and correct the behavior. This way of considering info-educational dispositives as an operating modality of biopower is relevant to our study, because it allows us to consider that public authorities’ interventions concerning nutrition do not only manifest themselves in the form of rigid and repressive regulatory frameworks but also in the form of playful, pedagogical and, a priori, harmless dispositives, seeking to prescribe, have children adopt and finally mobilize them so that they themselves are the representatives of food norms determined by health policies. 6.6. References [AGA 07] AGAMBEN G., Qu’est-ce qu’un dispositif  ?, Payot & Rivages, Paris, 2007. [BAR 15] BARDOU-BOISNIER S., CAILLAUD K., “Les dispositifs informationnels sur les compléments alimentaires : une affaire de santé publique”, in DE IULIO S., BARDOU-BOISNIER S., PAILLIART I. (eds), “L’alimentation, une affaire publique ? ”, Questions de communication, vol. 27, pp. 79–104, 2015.

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[BER 15] BERTHOUD M., DE IULIO S., “Apprendre à manger : l’éducation alimentaire à l’école entre politiques publiques, médiations marchandes et mobilisations citoyennes”, in S. DE IULIO, S. BARDOU-BOISNIER, I. PAILLIART (eds), “L’alimentation, une affaire publique ? ”, Questions de communication, vol. 27, pp. 105–128, 2015. [CAR 15] CARDON P., “Gouverner de l’intérieur”, in DE IULIO S., BARDOU-BOISNIER S., PAILLIART I. (eds), “L’alimentation, une affaire publique ?”, Questions de communication, vol. 27, pp. 63–77, 2015. [COU 09] COUZINET V., Dispositifs info-communicationnels : questions de médiations documentaires, Hermes-Lavoisier, Paris, 2009. [DEI 14] DE IULIO S., KOVACS S., “Communiquer, prévenir, Communication et Organisation, vol. 45, pp. 99–114, 2014.

éduquer”,

[FAS 04] FASSIN D., MEMMI D., Le gouvernement des corps, Éditions de l’École des hautes études en sciences sociales, Paris, 2004. [FIS 90] FISCHLER C., L’Homnivore : le goût, la cuisine et le corps, Odile Jacob, Paris, 1990. [FOU 15] FOUCAULT M., Œuvres. I, Gallimard, Bibliothèque de la Pléiade, Paris, 2015. [JEA 94] JEANNERET Y., Écrire la science : formes et enjeux de la vulgarisation, PUF, Paris, 1994. [JOU 02] JOURDAN D., BERGER D., “Éducation à la santé à l’école : pratiques et représentations des enseignants du primaire”, Santé Publique, vol. 4, pp. 403–423, 2002. [KOV 15] KOVACS S., ORANGE-RAVACHOL D., “La pyramide alimentaire : permanence et mutations d’un objet polymorphe controversé”,  in DE IULIO S., BARDOU-BOISNIER S., PAILLIART I. (eds), “L’alimentation, une affaire publique ?”, Questions de communication, vol. 27, pp. 129–149, 2015. [MAU 10] MAURICE A., “Une seule norme en vigueur pour de multiples pratiques : comment le vivent les adolescents ?”, Le mangeur Ocha, 2010, available at: www.lemangeur-ocha.com/texte/une-seule-norme-en-vigueur-pour-de-multiplespratiques-comment-le-vivent-les-adolescents, 2010. [MON 13] MONNOYER-SMITH L., “Le Web comme dispositif: comment appréhender le complexe ?”, in BARATS C. (ed.), Manuel d’analyse du web en Sciences Humaines et Sociales, Armand Colin, Paris, 2013. [NOU 04] NOURRISSON D., “Manger à l’école : une histoire morale”, Food and History, vol. 2, no. 1, pp. 227–240, 2004.

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[OLL 09] OLLIVIER-YANIV C., RINN M., Communication de l’État et gouvernement du social : pour une société parfaite ?, PUG, Grenoble, 2009. [OLL 14] OLLIVIER-YANIV C., UTARD J.-M., “Introduction. Pour un modèle intégratif de la communication dans l’action politique et publique”, in ALDRIN P., HUBE N., OLLIVIER-YANIV C. et al. (eds), Les mondes de la communication publique : légitimation et fabrique symbolique du politique, PUR, Rennes, 2014. [PAQ 07] PAQUIENSEGUY F., “Comment réfléchir à la formation des usages liés aux technologies de l’information et de la communication numériques ?”, Les Enjeux de l’information et de la communication, vol. 1, pp. 63–75, 2007. [PER 99] PERAYA D., “Médiation et médiatisation : le campus virtuel ”, Hermès, vol. 25, pp. 153–168, 1999. [PIG 06] PIGNIER N., “Pour une approche sémio-pragmatique de la communication. Le traitement sur le Web des publicités pour parfum”, Questions de communication, vol. 9, pp. 419–433, 2006. [POU 02] POULAIN J.-P., Sociologies de l’alimentation : les mangeurs et l’espace social alimentaire, PUF, Paris, 2002. [ROM 09] ROMEYER H., “La mise en scène des débats publics au cœur de la communication des organisations publiques”, Communication et organisation, vol. 35, pp. 48–59, 2009. [ROM 15] ROMEYER H., “Le bien-être en normes : les programmes nationaux nutrition santé”, in DE IULIO S., BARDOU-BOISNIER S., PAILLIART I. (eds), “L’alimentation, une affaire publique ?”, Questions de communication, vol. 27, pp. 41–61, 2015. [SAN 13] SANDRIN-BERTHON B., “Éducation thérapeutique et promotion de la santé : quelle démarche éducative ?”, Santé Publique, vol. HS2, pp. 125–135, 2013. [SAN 17] SANTÉ PUBLIQUE FRANCE, available at: inpes.santepubliquefrance.fr/ 10000/themes/nutrition/nutrition/nutrition_guides_food.asp (accessed September 30, 2017) [SAN 18] SANTÉ PUBLIQUE FRANCE, available at: inpes.santepubliquefrance.fr/30000/ pdf/hercberg_Pages%20of%20sante-action-430-1.pdf (accessed February 20, 2018). [SEU 10] SEURRAT A., “Les médias en kits pour promouvoir”, Les enjeux de l’information et de la communication, vol. 1, pp. 160–169, 2010.

7 Communication and Nutrition: The Clinician’s Point of View

7.1. Introduction The medical discipline of nutrition has long been a complementary medical specialization, accessible to general practitioners or specialists at the end of their course. This specialization therefore requires extending an already very long training path, and relatively few physicians have committed themselves to it. Since November 2017, this discipline has been part of the “endocrinology, diabetology, metabolic diseases” specialty, which is now known as “endocrinology, diabetology, nutrition”. However, it remains accessible to other specialties strongly concerned with nutrition, such as gastroenterologists or pediatricians, through cross-disciplinary medical training. This evolution aims to increase the number of doctors duly trained in the different aspects of nutritional diseases, in order to gradually move away from self-proclaimed nutrition specialists. Indeed, nutrition lends itself to role confusion. The word refers to our culinary cultural heritage, the agri-food economic field, health security as a tool that could bring us closer or further away from “good health”, even in the absence of “nutritional disease”. As such, many people – in both civil society and lay medical society – believe they have knowledge of nutrition and advice to give. These tips will travel some distance, sometimes through unexpected channels, and interfere with public health messages or advice from specialized professionals. They can even cause eating disorders. Chapter written by Anne-Laure BOREL.

Food and Health: Actor Strategies in Information and Communication, First Edition. Edited by Viviane Clavier and Jean-Philippe De Oliveira. © ISTE Ltd 2019. Published by ISTE Ltd and John Wiley & Sons, Inc.

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It is as an endocrinologist and diabetologist, with a complementary specialization in nutrition, that I was called upon to provide my testimony of the effects of communication on patients. Professor of medicine and specialized in the field of Nutrition at the University Hospital of Grenoble Alpes, France, my clinical activity mainly consists of managing patients with severe obesity. This testimony will report on how communication on nutrition can sometimes reinforce people’s difficulties with obesity in dealing with food. We will see how communication can lead to stigmatization. Finally, we will consider how communicating to the general population can create or reinforce eating disorders. 7.2. The physiology of eating behavior and its dysfunction in terms of obesity Eating is an instinctive action of the human body to ensure its homeostasis, that is, maintenance in a state of balance: what is consumed must be compensated by external contributions. It is regulated by many physiological pathways that can finely adapt energy intake to the needs of each individual, so as to stabilize weight in a balance called the body weight “set point”. Food intake is therefore extremely precise and based on the alternation of two states: hunger and satiety. Many internal signals from the digestive system, fat and muscle tissue are integrated into the central nervous system and modulate appetite and fullness. This mechanism allows self-regulation of energy input. Energy compensation can be made from one meal to another if one meal has been poorer or richer in energy intake. Thus, we can see that a patient who loses a few kilos in the context of an acute disease, from which they recovered quickly, will very quickly regain the kilos lost thanks to the temporary increase in appetite. Once the initial weight is restored, the appetite level returns to its previous level and weight stabilizes. Beyond these internal signals, the food offer is naturally influenced by the environment. It is part of a particular geography, climate and ecosystem. It is marked by a cultural culinary tradition (specific dishes, eating times) as well as family, professional and social dynamics. These different factors determine the “food supply” available to a subject. For example, the Inuit population, when living in isolation, without contact with the rest of the

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world, had no other food resource for most of the year than protein and fat of animal origin, derived from hunting or fishing. People who develop obesity have, for various reasons, cut off internal signals in their eating behavior that naturally guarantee their body weight set point. The easiest situation to understand corresponds to very rare genetic obesity, where the dysfunction of a gene renders ineffective the pathways that signal satiety. For the majority of individuals who develop obesity, the internal signals that should regulate their food intake are distanced. The reasons frequently encountered are distractions from the immediate environment: noise, television, requests from family members and family conflicts at mealtimes. There is also a major role for emotional eating, that is, the propensity to use food as a source of comfort in the face of a negative emotion. The foods chosen are often palatable and sweet, stimulating reward cycles. We can then observe the same addiction mechanisms as in other forms of addiction that make consumption necessary, to regain the feeling of relief, always at a higher level. After a variable initial mechanism (difficult life event, sudden cessation in major physical activity, pregnancy, obesogenic medication, etc.), which contributed to the gain of the first kilos, there is a very marked self-aggravation loop in people who try to control their weight through restrictive diets. All types of diets offer nutritional information which will induce cognitive control of eating behavior. The individual adjusts his or her food intake according to a “rule” that they have decided to adopt and set aside more than ever the instinctive eating sensations that should naturally guide consumption. A frequent and very illustrative example is the subject who refrains from eating between meals, to adhere to the recommendations aimed at avoiding snacking. When the question is asked: “Do you ever get hungry between meals?”, the answer is very often: “Yes, but in this case, I drink a glass of water”. To obey a nutritional rule set for themselves, the subject distances himself/herself from the energy need reported by the body and instead consumes water, which should have responded to a signal of thirst and not hunger. When he/she arrives at the next meal, the subject is in a situation of “very great hunger”, which will lead to favoring energy-dense foods. He/she will often eat faster, resulting in fullness being exceeded. In addition, the individual then has the impression that more food is needed, to “prevent” against hunger that may occur before the next meal and that will not be possible to satisfy. This cognitive feeding, which leads people to distance their intrinsic eating sensations, is not sustainable in the long term.

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The subject will sooner or later “let go” of the cognitive restriction they impose on himself/herself. He/she then feels an immense guilt that often finds its outlet in excessive food intake, compensating for previous frustrations. Thus, by imposing a cognitive restriction in conflict with our instinctive signals of internal regulation, a diet ultimately leads to a failure of weight loss and even to additional weight gain, reflecting the famous “weight cycling”, of which there are countless victims. This mechanism may be predominant in some obese individuals, who may have started their first diet in the absence of any excess weight, but to adhere to a societal norm of excessive thinness, and who have secondarily developed severe obesity through repeated exposure to diets and weight cycling.

Figure 7.1. Vicious circle of weight gain related to dieting or weight cycling

7.3. The “confusiogenic” effect of communication on nutrition among obese people Environmental factors determine our food supply: the economy (commercial food supply, availability of food shops in the surrounding area, type of food, cost of food), changes in urban planning, societal changes linked to working hours, family structures influence people’s eating habits. These changes in the environment have led to a shift in our lifestyle towards an excess of calories, a sedentary lifestyle and a decrease in physical activity. To counteract this evolution, public health actions can attempt to influence these environmental conditions. These approaches do not involve a cognitive integration of food information by a given individual aimed at consciously modifying their diet. They involve public authorities and the private sector, which can redirect their offers by taking into account public

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health issues: regulation for less salty and less fatty ready meals, less taxes for vegetables and fruits, development of cycle paths, etc. On the other hand, nutrition interventions, regardless of the communication channels, aim to consciously modify a subject’s diet because they have accepted the validity of the information and will accept this change as useful. This information is extensive, has different objectives and eventually becomes cacophonic. If we consider only institutional information, from public or private bodies as a reference, an individual receives both “hygienic” food injunctions, such as those developed by the PNNS (French National Nutrition and Health Program), and safety information (batch of contaminated infant milk, phytosanitary products), information aimed at protecting the environment (organic farming, short circuits) or social information (local products, fair trade). Beyond this official information, legitimized by the expertise of those who carry it, everyone is subjected to the perpetual bombardment from others regarding cognitive food choices in their environment. The neighbor, the sports coach, the actor or the trendy sportsman proselytize, highlighting their own food choices. Since nutrition is experienced by everyone, everyone can talk about it with conviction and charisma that are totally disconnected from real expertise. The medical profession is not exempt from such a behavior, giving nutritional advice rarely based on concrete theoretical knowledge, but on the conviction that their own functioning is virtuous and that they must naturally establish themselves as models. This projection towards patients – sometimes even of their own eating disorders – is all the more damaging as it is “dressed” in a white coat, which tends to stamp the advice given with a seal of knowledge. Everyone is subject to these different influences, which can potentially have an impact on their eating behavior, sometimes leading them in undesirable directions. People with obesity are particularly vulnerable to the information they receive about nutrition. We have seen that the mechanisms that lead to being overweight imply distancing oneself from the internal signals that regulate our food consumption. Overweight people also very often have a loss of self-confidence, at least in terms of their ability to make the right food choices. These factors contribute to their influential ability in relation to nutritional messages, which then take precedence over “inner messages”. When a patient consultant for obesity is asked: “How would you describe your eating habits?”, they answer most often: “Bad I suppose, since I am like that”, before describing everything that in their habits can deviate from a food that they imagine to be “dietetically correct”. Moreover,

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individuals have varied representations of what should be a “good diet”, for instance, the “sacrosanct” breakfast whose exemption certainly leads you to the flames of nutritional hell. This can be explained by a simple and fairly representative observation: if that person spent an hour watching television on a general channel from 7:30 p.m. to 8:30 p.m., for example, he/she is exposed to a prevention message on physical activity or dietary balance, an advertisement on the latest restrictive diet – whose effectiveness is demonstrated to you by photographs – or a report on the dangers of farmed salmon. The conclusion that is regularly heard at the end of the first medical interview is: “I don’t know what I should eat anymore!” 7.4. The danger of increasing the stigmatization of obese people through communication on nutrition It was in the 19th Century that slimness established itself as a new standard of build in France and became a sign of distinction among the wealthy classes. This standard has since been extended to all classes of society in France, while being overweight remains a sign of opulence appreciated in developing countries. The signs of this social norm are widely disseminated, including through the mass media. The Assemblé nationale recently passed a law in France to require magazines to mention when a photograph has been retouched to refine the model photographed, a sign of an awareness of the deviations of the cult of thinness. Overweight or obese people are the victims of this social norm, which by definition excludes them. Excess weight, considered unsightly, is the consequence of a “carelessness”, which disqualifies the person both physically and morally. Education tends to judge eating pleasure as reprehensible, especially for girls [DUP 13]. As a result, society’s view of overweight people is strongly negative, and it follows that obese people’s view of themselves becomes so too. France is one of the countries with the highest number of obesity surgeries related to the prevalence of this condition, with currently between 50,000 and 60,000 procedures carried out per year. This operation provides a very clear health benefit to people who have many diseases associated with weight. These are most often pathologies associated with abdominal fat

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distribution. These pathologies are more frequent in men, because they often have a higher abdominal fat content. However, it is observed that 80% of subjects who have obesity surgery are women, who have few diseases associated with their obesity. This observation highlights the difficulty that women, much more than men, have in experiencing being overweight from the point of view of its psycho-social impact. They are willing to have surgery, whose immediate risks cannot compete with the moral suffering caused by their excess weight. Overweight people are often advised by those around them with varying degrees of intent. Common meals often provide an opportunity for people to look at the plate and its contents, to make openly disapproving remarks or to control the portions. It is often very difficult for them to eat anything in public to avoid the gaze of those around them. Unpleasant comments from strangers are frequent. Sometimes, the sensitivity to others is such that even those who are devoid of bad intentions, but who stop at “difference”, are perceived as ostracizing. In this context, obese patients frequently report comments heard as they pass by, such as: “He does not eat his 5 fruits and vegetables a day!”. This is an example as to how public health messages aimed at preventing excess weight and obesity can be used against obese people. Public actions, which rightly warn about the health risks associated with excess weight, lead to this condition being recognized as “avoidable”. In short, the obese subject is seen as unable to follow simple nutritional advice, repeated through all “educational” communication channels. As such, a very successful “social marketing” experiment was first conducted in northern France and then extended to many municipalities. This was the “EPODE” experiment, with the slogan “Ensemble, protégeons de l’obesité nos enfants”1 [BOR 12], which has mobilized various actors in society: schools, town halls, shopping centers, etc., to act in synergy to promote messages promoting physical activity and a balanced diet. It appears that these efforts have limited the increase in the prevalence of excess weight and obesity among children in participating cities. By 2012, 500 municipalities in six countries had developed this program. However, to continue this innovative experience, the organizers changed the name of their program to “Vivons en Forme”2

1 “Together, let’s prevent childhood obesity”. 2 “Living together in good health”.

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(VIF), the first name having been considered stigmatizing by overweight people3. It should be recalled that one of the mechanisms involved in obesity is the use of food as a tool for emotional comfort. However, since food intake is then disconnected from an energy need, from a feeling of hunger, excess calories lead to weight gain. In this context, any hurtful or stigmatizing remark related to weight obviously generates profound discomfort. This will increase the use of emotional nutrition and thus increase the risk of excess weight. This is why nutritional or physical activity prevention messages, while beneficial to the prevention of excess weight in people of normal build, can be a contributing factor to more excess weight or obesity. Obese people today need communication messages to present obesity as a disease suffered by the individual and not brought on by inappropriate behavior. They need educational messages aimed at preventing the stigmatization and exclusion of obese people in social and economic life. 7.5. The danger of increased eating disorders through nutrition communication In different areas of public health, prevention messages delivered through different media do not reach their target audience. This was the case with the first campaigns to prevent the spread of HIV (Human Immunodeficiency Virus), which had difficulty reaching the most at-risk populations (drug addicts, for example), while the general population, at low risk of exposure, was besieged by preventive messages that provided unfounded anxiety about the real risk. Nutritional information messages aimed at preventing excess weight and obesity are no exception. While obesity is a disease whose frequency follows a very clear socioeconomic gradient, the most disadvantaged populations, who are considered to be most at-risk, are the least affected by prevention messages. On the other hand, the wealthier classes, concerned about their lifestyle, are strongly influenced by these messages. These same wealthier social strata are quick to seize any message with a “poisoning” theme. They will be the first to give priority to organic food for 3 See the website vivonsenforme.org.

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fear of pesticides, to believe the various warning messages, taken out of context, amplified and established as new food rules. For example, a man in his forties, athletic, can explain that he runs on an empty stomach in the morning to promote lipolysis, he only eats gluten-free starchy foods, he avoids snacking between meals or he compensates the caloric intake of a sweet treat by jogging. In addition, suffering from reflux, he says he has now removed coffee and alcohol from his diet. This diet is strongly constrained by multiple food hygiene rules, which cause a real “cognitive restriction”. This restriction exceeds the initial objective, which was to prevent excess weight, which could lead the individual to a lean figure that is not recommended for his health. Thus, nutritional information messages aimed at preventing excess weight and obesity generate continuous noise, whereas “hygienic” messages are internalized by those most receptive to prevention messages, at the expense of “gastronomic” or “taste” messages. These messages reinforce the desire to control one’s body, to protect oneself from aging, from developing diseases or even death, the inevitability of which is seen by some as unbearable. In the face of health accidents that occur in the individual’s surrounding environment, the individual protects themself from the anguish of being vulnerable to illness, old age and death, by choosing to impose upon themselves life rules that give them the illusion of avoiding any exposure to risks. Cognitive control of nutrition is, as such, a widespread contraphobic lever. 7.6. Conclusion Communication on nutrition is therefore tossed around in the headwinds. It can, contrary to its initial objective – to naturally maintain its influence in homeostasis – increase the difficulty for an overweight person in identifying their real nutritional needs. It can reinforce the stigmatization of overweight and obese people, by bringing together the discourse on healthy living in a much more prominent way than the communication on the dangers of smoking or excessive alcohol consumption, which are much more devastating from a health point of view. Finally, it may expose people without risk of being overweight to being at risk of restrictive eating disorders, to varying degrees of severity.

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There are therefore many challenges to be met for relevant nutrition communication. This communication must strike the right balance to inform the population about food consumption benchmarks while highlighting the pleasure of taste and gastronomy. It should not be oriented towards preventing weight gain in order not to reinforce negative projections on obesity but on the contrary to value a healthy diet, without a body weight objective. Finally, this communication must be heard as a reference in relation to erroneous food beliefs, which regenerate like the heads of Hydra. Many developments in this direction have already been made. For example, the PNNS slogan4 is now “Pour être en forme : mage moins sale, moins sucré”5 and not “Pour rester mince”6. To conclude, the ambition of joint action by civil society, the public and private sectors to promote a return to an urban environment more conducive to well-being and a healthier food supply appear to be prevention tools that are inseparable from communication efforts. 7.7. References [BOR 12] BORYS J.-M. et al., “EPODE. Approach for childhood obesity prevention: methods, progress and international development”, EEN Study Group Obesity Review, vol. 13, no. 4, pp. 299–315, 2012. [DUP 13] DUPUY A., Plaisirs alimentaires. Socialisation des enfants et des adolescents, PUR/François-Rabelais, Rennes, 2012.

4 mangerbouger.fr. 5 “To be in shape, eat less salty and sugary foods”. 6 “To stay slim”.

PART 3

Information, Food and Health: Consumers’ and Patients’ Points of View

Food and Health: Actor Strategies in Information and Communication, First Edition. Edited by Viviane Clavier and Jean-Philippe De Oliveira. © ISTE Ltd 2019. Published by ISTE Ltd and John Wiley & Sons, Inc.

8 Information Resources and Information Practices in the Context of the Medicalization of Food

8.1. Introduction In this chapter, we will focus on food information resources and information practices of patients and consumers concerned about their health. Our reflection is based on the results of exploratory research conducted as part of a program funded by the CNRS between 2015 and 20161 entitled MEDica, which is an acronym for the French “Médecine information communication alicaments”2. This study focused on the role of information in the field of food, the sources of information used by individuals, the role of certain sources such as food labeling and the role that health plays in these information practices. The study was part of a broader set of actions, aimed in particular to analyze the evolution of the agri-food industry’s supply of everyday consumer products, highlighting a “health promise”, such as functional food. Empirically, the program has made it possible to collect a corpus of press articles on food and health in the last three PNNS programs (French National Nutrition and Health Program); transcribe interviews with Chapter written by Viviane CLAVIER. 1 Alpes Grenoble innovation research project (AGIR); first support exploratory program “Médecine information-communication alicaments” (MEDica), Gresec and LFBA at the Université Grenoble Alpes. 2 Food for specified health use, or, more literally, medicine information, communication, functional food.

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various actors involved in the dissemination of messages or in the development of scientific studies (such as Santé publique France or ANSES); and collect data from questionnaires and interviews with consumers or patients. Our contribution focuses on this last part of the program, with the main results summarized in three points. First, obtaining information in the field of food is part of a responsible consumption approach marked by a general mistrust of food, industrial “healthy foods”, industrial brands and the discourses expressed by companies in the sector. Second, consumers are suspicious of food information that they consider contradictory. Third, despite the presence of many sources of information on food, respondents are faced with the difficulty of identifying reliable information. Beyond these results, which again raise questions of disorientation in terms of access to information, confidence and legitimacy with regard to information as well [PAG 18], this exploratory study is the starting point for a reflection on the practices and resources used by individuals when they learn about so-called “healthy” foods. Thus, are the informative practices of health-conscious consumers similar to those of sick patients, since nutrition is an essential component of health? In other words: do consumers who seek to stay healthy inform themselves in the same way as patients who seek to heal? Concerning the sources of information consulted by individuals, are there any sources specific to food? How is health addressed? What role do specialists play in helping individuals who are seeking information about food? On a theoretical level, our contribution gives an important place to context, which we approach as a theoretical construct and not as the convening of an already existing one, that is, a reality that would be imposed on the researcher – as are, for example, socio-economic variables (age, sex, socio-professional category). Recently, a review of research on the notion of context [PAG 16], which follows other literature reviews on this notion [JOH 03], showed that context is omnipresent in work on information activities and has various objectives: to locate the materials collected, propose explanatory variables to the observed results, model practices, etc. Our approach is in line with the same perspective and considers contextual elements, considered by researchers in sociology as a fundamental movement affecting society as a whole, and food in particular – specifically those related to the medicalization of social practices. The socio-historical dimension is recognized in the work on information practices as worthy of

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observing and understanding the recurrence of social uses and their stabilization over time [CHA 10, GAR 10, JOU 00]. We also consider social logics, which affect information-communication in several of its dimensions [MIE 04], and we assume that those prevailing in the field of health are also at work in food. This chapter is divided into three sections, which successively address the context of the study, the information practices and the resources consulted to learn more about food. 8.2. Taking context into account in the study of information practices and information resources Until now, the contextualized approach, which we have developed in collaboration [CLA 13, CLA 15], has compared a detailed analysis of the context of information use (generally in a professional situation) with a detailed study of resources, in order to characterize the diversity of access to information, consultation or exploitation of information. We focus here on three decisive elements to characterize the context of production and use of food information: the medicalization of society, the “nutritionalization of food” and the social logics that influence information and communication in the health field. 8.2.1. The medicalization of food Described by sociologists Pierre Aïach and Daniel Delanoë [AIA 98a] in particular as a large-scale phenomenon that dates back to the 19th Century, the medicalization of society has a multitude of manifestations. It is reflected in the increase in the number of doctors and health institutions, in the extension of the field of medical expertise in many areas of society’s activities, in the medicalization of life through health rhetoric, in the generalization of risk avoidance behaviors and in the pathologization of daily life. According to Pierre Aïach, risk detection and prevention appear to be the cornerstone of a fully medicalized society, which delegates to the individual the responsibility for their own health, whether it is to fight diseases, stay healthy or take care of themselves: health and well-being then become inseparable [AIA 98b]. Food is fully affected by this movement identified and called the “nutritionalization of food” by food sociologist Jean-Pierre Poulain [POU 09]. This researcher considers that there are two levels of

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medicalization, one related to the patient–physician relationship and the other to the mediatization of nutritional knowledge: The first is the management of food as part of the treatment of a specific disease. Nutritional advice is provided by the doctor, in the context of a therapeutic relationship. The second level, which could be called nutritionalization, corresponds to the dissemination of nutritional knowledge through the press, television, health education campaigns, etc., and to the reduction of food to its nutritional composition (macro- and micronutrients). The medicalization of food is carried out outside of medical face-to-face and is a matter of prevention […]. The demographic increase in the number of health professionals specializing in nutrition attests to this trend, as shown by the figures provided by the Direction de la recherche, des études, de l'évaluation et des statistiques (Drees) [DRE 17]. Over the past 10 years, the number of dietitians in France holding a BTS (advanced technician’s degree), DUT (technology degree) or other degree has increased steadily3. Overall, 94% of this paramedical profession in the health sector is female and has only been counted by Drees since 2010. Between 2010 and 2014, the total number of dietitians (male and female combined) increased by 37%, from 6,643 to 9,1174. Moreover, as Michel Krempf – Professor of University Hospital Practitioners specializing in endocrinology, metabolic diseases and nutrition at the Nantes University Hospital – announced in his report on the development of the dietetic profession [KRE 03], these professionals are the main target for the implementation of the PNNS in “the social body”, and an engagement letter was sent to them. There are high expectations for dietitians, who are considered to be one of the essential components of nutrition education, prevention of diet-related diseases (type 2 diabetes, obesity, cardiovascular diseases, etc.) and their treatment. According to this report, they have other tasks to perform, which concern several fields of social, health and professional action: to work with disadvantaged populations; to invest in both healthcare institutions and communities as well as the industry; to develop the liberal and public health sector; to set up 3 6,643 dieticians (male and female) in 2010; 7,168 in 2011, 7,871 in 2012, 8,525 in 2013 and 9,117 in 2014 (see the Drees website). 4 According to the 2003 Krempf report, the population of dieticians at that time represented 4,000 active graduates [KRE 03, p. 7]. In 2014, it reached 9,117 and has more than doubled in 10 years.

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nutrition care networks in liberal medicine; to organize nutrition education; to ensure functional nutrition links between different health professionals in the health system; etc. However, the demographics of nutrition professionals also differ. While dietitians are identified as the cornerstones of the successful implementation of public health policy, social expectations of scientists and nutritionists seem less explicit. Indeed, despite the presence of a consistent knowledge base, nutrition is, according to Ambroise Martin5, Professor of Nutrition and Biochemistry at the University of Lyon 1, “a recent, underdeveloped and still fragile university hospital discipline” [MAR 09, p. 7]. Nutrition does not appear as a specialty in the list of specialized medical degrees (Decree of September 22, 2004), but as complementary training to other specialties (endocrinology, diabetology, pediatrics, gastroenterology, etc.), which undoubtedly undermines its scientific recognition. The statistics on the demographics of doctors provided by Drees6 attest to the low number of doctors trained in nutrition7. Thus, the number of general practitioners specializing in diabetes and nutrition is not only quite low (about 1 per 2,000 general practitioners in total), but also decreased steadily between 2001 (date of the first PNNS) and 2011, from 122 to 85, representing a 30% decrease for this specialty. It is also surprising that nutrition – which is nevertheless a transversal specialty – appears only in addition to diabetology, whereas it concerns other specialties. Finally, since the term “nutritionist” is not regulated, it can be claimed by various professions, including those that are not related to health. This is a confusing situation when it comes to identifying a nutritional expert. These demographic considerations seem to favor a mediated approach to nutrition, even though the identified nutrition specialists come from different professional, medical or paramedical sectors or are self-proclaimed specialists (see Chapter 4). 5 Ambroise Martin, a nutrition expert, has been or is still a member of several bodies (Conseil national de l’alimentation, PNNS Steering Committee, European Food Safety Authority). 6 122 (general practitioners specializing in diabetes and nutrition) in 2001, 113 in 2002, 110 in 2003, 108 in 2004, 103 in 2005, 102 in 2006, 97 in 2007, 92 in 2008, 93 in 2009, 86 in 2010 and 85 in 2011. Available at: drees.socialsante.gouv.fr/etudes-et-statistiques (accessed January 25, 2018). 7 These statistics are compiled from the Adeli administrative register, which doctors are required to register with. According to Drees, a significant proportion of doctors do not do so, especially in hospitals. It is therefore likely that these statistics are not totally reliable.

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8.2.2. From nutritional information to the nutritionalization of knowledge A second element of context lies in a twofold movement: that of reducing food information to its nutritional characteristics and that of media coverage of nutritional knowledge in the public sphere. Several research studies, including those by sociologist Jean-Pierre Corbeau, show, for example, that the written press (senior, parent, women's, health, etc.) systematically refers to the PNNS to use the nutritional advice, slogans or nutritional messages issued in the recommendations [COR 07a]. Rather than sticking to the elements of discourse borrowed from the PNNS, let us return to nutritional information: where does it come from? How can we characterize it? Nutritional information is regulated information, on a legal level, that is most often presented as a complementary dispositive among other nutritional policy measures. According to Marine Friant-Perrot [FRI 17], a researcher in food and health law, information is a central dispositive in France: “As French law currently stands, the legal regulation of food behavior is essentially based on informational mechanisms” [FRI 17, p. 51]. These mechanisms are part of “flexible law”, and their purpose is to “modify or direct the behavior of their recipients, by encouraging – as much as possible – their support, and which “present, by their content and method of development, a degree of formalization and structuring, which is similar to legal rules” [CON 18]. Thus, the 2011–2015 PNNS planned to “promote accessibility to foods of good nutritional quality” by “continuing analyses aimed at improving consumer nutritional information in order to facilitate consumer choices”. The new PNNS 2017–2021, on the other hand, recognizing the limitations of public health strategies based on “nutritional communication and purely incentive approaches”, proposes new, more coercive measures, including strengthening regulatory measures to reduce commercial marketing pressure8. In the field of nutritional information, there are several texts and regulations at national, European and international levels. In France, article L21133-1, inserted into the Public Health Code by the Public Health Act of August 9, 2004, requires advertisers to affix a health message to all advertising messages for drinks with added sugar, salt or synthetic 8 Haut Conseil de la santé publique (HCSP). Available at: www.hcsp.fr/explore.cgi/domain reports notice? clefr=632 (accessed January 25, 2018).

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sweeteners or even manufactured food products. In Europe (EU), Regulation No. 1169/2011 of October 25, 2001 (known as the INCO Regulation) on consumer information on foodstuffs required that a nutritional declaration accompanies products at the end of 2016 to promote healthier consumption. Finally, the World Health Organization has also included the fight against nutritional diseases as an objective of its Action Plan against non-communicable diseases. The legislator’s expectations regarding nutritional information concern both the form and content. Concerning the form, the recommendations focus on colors, contrasts and font size on the labels. Nutritional messages must be legible or audible and clearly distinguishable from advertising or promotional messages [INS 17, p. 17]. Recommendations are also made regarding the layout, size or surface area devoted to health messages [INS 17, p. 10]. Concerning the content, information on the energy value of foods, on mandatory nutrients and, where applicable, on optional nutrients and on the unit of value should be expressed in 100 g/ml to “allow the consumer to compare similar products more easily”. [INS 17, p. 18]. Marine Friant-Perrot mentions that this “excessive abundance of information accompanying food is neither possible nor desirable”, and that this deluge of data, which constitutes an “informational paradigm” supposed to help consumers make an “appropriate choice”, is in reality neither a form of protection nor a decision support tool [FRI 13]. This author carried out a semantic analysis of legal texts and identified the formulations used to qualify the information and its nutritional relevance: “reliable information”, “complete information”, “necessary information”, “precise information”, “appropriate information”, “objective information”. The qualifiers identified here are at the origin of a reflection on various nutritional information systems (NISs), intended for the consumer and compared by the ANSES [ANS 18]. These visual forms – which appear in the form of logos, colors and graphics – fill here all the characteristics of a fixed, totally explicit code (finite vocabulary, set of finite combinations and meanings, a one-to-one relationship between the signified and the signifier, etc.): a guarantee of explicit and effective communication. These systems have led to studies on the impact of “simplified” nutritional information on consumer choices [GUY 16].

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In the end, nutritional information essentially appears as an instrument of the State’s nutritional policy, defined by several ministries. This approach leaves the technical and regulatory aspects for the general public in the background and confers on the three nutrition and health plans9 drawn up by Serge Hercberg [HER 14] a particular status of referent discourse, which plays a central role in the selection of nutritional knowledge, their structure and their media coverage. When nutritional knowledge is apprehended through the filter of this referent discourse, it operates a particular, normative and sometimes stigmatizing interpretation of food [DEI 15; ROM 15]. 8.2.3. Three social logics in the health sector Let us come to the last element of context, which highlights the role of social logic in the study of information practices and information. Bernard Miège emphasizes that information-communication is subject to social logics10 that are shaped by the strategies of social actors. In the field of health, we find three: the fragmentation of public space, information and individualization of practices [MIE 04, p. 127]. Thus, the Internet of health, and its various names (e-health, telemedicine, connected health, etc.), is part of a fragmented approach to the public space, supported by the development of digital dispositives, which are gradually blurring the boundaries between well-being, health and medicine, as noted by the Conseil national de l’ordre des médecins (French National Council of Physicians): Borders are increasingly blurred in the health and it is becoming difficult, if not absolute distinction between dispositives, objects used in the field of well-being, practice [CNO 15, p. 9].

world of connected random, to make an apps and connected health and medical

Other approaches evoke the socio-economic logics linked to the commodification of the Internet of health, such as Doctissimo [TOU 10], cost rationalization [GRO 07] or dispositives that provide a multitude of 9 PNNS 2001–2005; 2006–2010; 2011–2015. 10 These are processes that “[cross] through the fields of communication, and [correspond] to long-term movements, to the construction of which social actors actively contribute (and in a multiple and contradictory way), and affecting both production processes and production-consumption expressions, symbolic reorganizations, changes in the management of the society and mechanisms for the formation of social practices” [MIE 04, p. 194].

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information [ROM 08]. The second social logic refers to an “informationization” movement, which consists of “the increasing and accelerated circulation of published and unpublished information flows” [MIE 04]. Informationization is fully applicable to health information: some dispositives such as blogs or public discussion forums produce information, which is deployed outside traditional specialized information validation circuits. Some forms of hybridization are observed, mixing information based on medical authority and emotional forms of expression [PAG 11]. Despite the diversity of information validation bodies, such as “patient knowledge” [AKR 09], we observed that medical expertise nevertheless retained a legitimacy that was reflected in the discourses of Internet users [PAG 14]. Finally, we have identified a logic of “individualization” of information practices, which is linked to the responsibility of patients for their own health care [LEM 09] and which results in increased informational activity, with consequences at various levels (modification of patient–doctor relationships, need for moderation of forums, request for certification or labeling of sources, etc.). Considered as an essential determinant of health, food will fully find its place within the medical Internet by increasing the flow of unedited information, and will, according to our hypotheses, be part of the same logic of the individualization of practices. 8.3. More diversified information practices than in the health field As indicated above, we conducted a survey in collaboration with Céline Paganelli between April and May 2015, which resulted in 54 questionnaires being administered in a nutritionist’s office in Grenoble, France11. A total of 29 semi-directive interviews were conducted with 83 people (25 men and 58 women), aged between 20 and 80 years, with 45% of them more than 55 years old. Presented during two study days, in June 2016 and September 201712, this survey was put into perspective with larger national studies, such 11 Dr Amouyal-Sebaoun, general practitioner specialized in nutrition in Grenoble. 12 In collaboration with Céline Paganelli, results presented at two study days: - Santé, information-communication et alimentation. Les alcaments study day. Organized by Gresec and LFBA at the Institut de la communication et des médias, Échirolles, June 6, 2016; - La médiatisation culinaire et alimentaire study day, “Gastronomie et santé font-elles bon ménage? État des lieux des ressources informanelles et des pratiques”, Pôle Alimentation, Villa Rabelais, Tours, September 15, 2017.

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as the Études individuelles nationales des consommations alimentaires13 (now INCA), in particular the last two studies, INCA 2 (2006–2007) and INCA 3 (2015–2017), in which we were particularly interested in the opinions and attitudes of the French population towards food, the results on information sources and the reading of labels [ÉTU 09, EIN 17]. The results of the questionnaires, which we collected in the nutritionist’s office, are comparable to the interviews conducted with people without medical follow-up: the sources consulted are close and reveal that, even when individuals consult a specialized doctor, they also obtain information via labels (in close percentages), word of mouth and the media. However, this result does not allow us to precisely know what patients are looking for, since the level of detail in a questionnaire is not comparable with interviewees’ answers. Indeed, not all patients who completed the questionnaire had all the time they needed to answer the questions, as their presence in the waiting room was interrupted by the consultation. Interviews with the patients should therefore be considered. Apart from these reservations, we observed that there are two types of information practices, whose cross-checking modalities would merit a full study. On the one hand, there are targeted information-seeking practices, and on the other hand, there are more diffuse practices that are subject to current events, which are highly dependent on people’s lifestyles, the way they shop, their relationship with the environment and information itself. Both types of practices are underpinned by the objective of staying healthy or improving health status, if the person is ill. 8.3.1. Targeted and intentional practices With regard to medically supervised information practices, we observed during the analysis of the health discussion forums [PAG 11] that the participants’ requests for information were specific, linked to individual experience and were expressed in the form of testimonies. Information practices were finalized and oriented towards the search for improved health status or healing. These practices can be analyzed using health information seeking. Jeff Niederdeppe et al. discussed the specific features of this action. For example, it represents, “an active and intentional effort to obtain 13 National individual studies of food consumption.

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information” is related to “specific treatment or subject related to the health of the patient or a loved one”, and it allows decision-making [NIE 07, p. 155]. This trend has shown in particular the close links between medical education research and individuals’ social backgrounds, the complementary nature of online information research with other sources such as the attending physician [REN 08] or the fact that the quality of the information collected is closely linked to individuals’ cognitive skills [SHI 06]. This type of practice is being extended in food, and the literature on this subject is part of a trend called everyday life information seeking [MCK 03]. This trend includes all types of information research rooted in the daily lives of individuals [SAV 95] and mobilizes concepts from sociology [SAV 08]. The studies cover various populations (women, youth, disadvantaged populations) and focus on topics such as genetically modified foods [MCI 04] or food risks [KUT 14]. The resources studied can be the media, or social media such as blogs [SAV 10]. Some studies focus on the relationship between individuals’ medical knowledge and their preferences for sources of nutrition information [ERI 03]. Food covers a much broader spectrum of issues, which goes beyond nutrition and concerns social issues, such as food risks. In our interviews, targeted practices were apparent among people wishing to explore a subject in greater depth, and take a voluntary approach to obtaining information: “Otherwise, I am very sensitive to pesticides and fertilizers. Gosh, I really think about it a lot and watch TV shows about it. Fruit preservatives, I think that’s a real scandal!” Or: “I’m inquiring, yes. From articles, advertisements, I obtain information, I ask the pharmacist, the doctor…” Label reading was included in our survey as a primary source of information, with more than half of respondents indicating that they consulted them regularly (especially women), followed by word of mouth. The reading of labels was the subject of a targeted search for information specific to each individual: the carbohydrate rate for diabetes, the nutritional value for weight gain, etc. “I look at the nutritional value, for the rest I only read what is in the first 3 lines, I can’t decipher it, it’s written too small”. As for word of mouth, not only is the practice twice as common as going to a doctor, but the advice received from those around you is authoritative. When asked how people question food, some answered, “I can imagine everything. Maybe more word-of-mouth: if I have a girlfriend who tells me it’s good for you, I’ll buy it.” Doctors are therefore not among the best advisors – with one interviewee noting that their discourse agreed, predictably, that they brought nothing: “[I ask everywhere], except doctors, who always say that you should not eat fat, salt or sugar”. These observations show that the

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search for targeted information is carried out with both written and oral sources and that the advice of those around you is more legitimate than expert discourse. This conclusion differs from the one we have observed in the field of health, where a specialist in pathology demonstrated authority, and where – in case of doubt or questioning of medical authority – it was the discourse of peers with the same pathology that were listened to, experiential knowledge having legitimacy in the eyes of the person receiving the advice. In the case of food, as Professor Anne-Laure Borel notes, everyone seems to be allowed to give their opinion (see Chapter 7). 8.3.2. Floating and unintentional practices Concerning the second type of practices, we speak of “scanning” information to indicate that the means of obtaining information is less active than the previous ones, that it involves the routine use of the media and interpersonal exchanges and that this information is then memorized [KEL 09, KEL 10]. These practices have been observed in cancer information research, and show that they are influenced by individual knowledge, lifestyle choices and the context of screening [SHI 06]. To our knowledge, there is no work on the application of this concept to pathologies that concern food. These practices were also noted in the way the media are consumed: two forms of consumption would be [thus] identifiable, on the one hand, a voluntary consumption of selected information, and on the other, a “media bath”, from which individuals would be informed in a more opportunistic way [GRA 11, p. 26], and the authors add that with the Internet, “non-premeditated and often repeated exposure of the news would become [thus] an increasingly widespread consumption modality”. This research focuses on the possible link between media practices and public interest in citizenship, political engagement or confidence in institutions. Fabien Granjon and Aurélien Le Foulgoc’s state of the art [GRA 11] on the reception of media content and its effects shows results at the other end of the spectrum, with some studies indicating that an increase in news consumption would reinforce citizens’ distrust of institutions or, on the contrary, increase trust. Our interviews, although modest in number, led to the same observations. For example, when asked whether or not people find out about food, some people have had an obvious reaction of rejection and mistrust of discourses: “I don’t inform myself, but I sometimes hear programs on the radio: they make me smile. One day, what is good for your health, like

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milk, the next day: it’s bad for you. You should change your eating habits with each study. I don’t talk to the doctor or the pharmacist”. In our interviews, the media (TV, radio, press) and the Internet were not the most frequently cited sources, which was consistent with the results of the INCA studies. On the other hand, when these sources were mentioned, they were most often consulted without having been intentionally researched: “I don’t look for information other than what appears on labels”; “I read articles if I find them, if I come across them, but I don’t look for them.” In conclusion, our observations show the coexistence of two types of information practices: targeted practices that focus on labels and oral transmission and floating practices that promote the development of an information culture on food. This observation raises some gray areas. Thus, of all the people interviewed, only a few suffered from a pathology; therefore, we do not know whether widespread practices are more prevalent among people requiring a medical follow-up or healthy people. Nor do we know in which situation information is perceived as contradictory: is it when the practice is intentional or unintentional? Another question, partially addressed in our study, is the link between proven information practices and consumption behaviors that are confirmed only in cases where a pathology imposes a certain diet on the individual. For other cases, the interviews mainly suggest that it was previous education and eating habits that are decisive: “I don’t need precise information. I have received a food education (balanced eating, fresh produce, etc.) I am in good health. I don’t need to learn more than that about these issues”, or, about pesticides in vegetables: “Vegetables, yes, I buy very few, because they’re grown in the garden and I can (freeze) them.” 8.4. Sources of information and forms of medicalization of knowledge We are interested here in the resources mobilized by consumers and patients on food and health. We will focus on the role of health professionals as sources of information and on food issues in discussion forums. These results are put in perspective with older work on health [PAG 11, PAG 14], as well as with a survey conducted by Jean-Pierre Corbeau in 2006 on the impact of health messages in the press [COR 07a].

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8.4.1. Nutrition professionals as resources According to Ambroise Martin’s report, most food surveys show that the medical profession and dietitians would only represent the fourth or fifth source of nutritional information, after the written and audio-visual media, parents and friends, but “[that] they constitute a source of strong credibility in the face of an avalanche of information, often contradictory, to which patients /consumers are subjected” [MAR 09, p. 8]. INCA 2 (2006–2007)

INCA 3 (2015–2017)

64% Information programs on television or radio

59% Information programs on television or radio

63% Newspapers, magazines

58% Family

57% Family

57% Friends

56% Friends

53% Newspapers, magazines

46% Books

44% Internet

43% Advertising

40% Physicians or dietitians

40% Doctors or dietitians

39% Advertising

24% Internet

35% Books

12% Pharmacy staff or health food stores

18% Pharmacy staff or health food stores

9% Teachers or professors

7% Teachers or professors

Table 8.1. Sources of dietary information for adults aged 18–79 years [ÉTU 09, p. 160; EIN 17, p. 369]

Comparing the last two INCA 2 studies from 2006–2007 and INCA 3 from 2015–2017, out of 10 sources cited by adults, physicians and dietitians actually rank seventh (INCA 2) and sixth (INCA 3) (see Table 8.1). In 10 years, the rank of doctors and dietitians has risen by one place. Is this situation a consequence of the increase in the number of professionals trained in dietetics and nutrition in society and their recognition by the population? Is it the consequence of the increase in the prevalence of obesity, or of diet-related pathologies – which would lead to a situation of greater medical consultation? In these national surveys, the sources most frequently cited by adults are the traditional media (news programs), the family and the community.

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Thus, the surveys confirm that information practices can be carried out in a medicalized setting under the responsibility of a health professional, and those that are carried out on a daily basis, through media coverage, word of mouth, reading labels or consumer product packaging. Unlike health, where referring to a doctor is cited before the Internet in many national and European studies as the primary source of information for patients and in significant percentages14, doctors and nutrition professionals are not the favored interlocutors of the French with regard to their diet. The situation applies to other European countries and is therefore not an exception in France. According to a study conducted among 3,000 people in five European countries [NIE 14], 42% of respondents did not know how to find information related to nutrition (healthy eating) and only spoke to a doctor on these questions in the fourth position, which represented 30% of requests, against 60% who used Google as a first choice. Still according to this survey, the doctor plays a more important role in providing information related to diet when the respondent has health problems. The survey we conducted in the MEDica project confirms this situation, with health professionals coming in the fourth place (32.5%), behind food labels (54%), word of mouth (53%), the press and television (36%). Thus, we suggest three possible explanations for the fact that health professionals are not the favored interlocutors on nutritional practices. First of all, the questions that arise about food are not necessarily linked to a pathology, which would explain why the doctor (or dietitian) is not always involved. However, our interviews indicate that some people systematically consult a doctor, such as a pediatrician, about infant feeding. Second, there were no professionals identified as food specialists. In our interviews, only people who consulted a nutritionist or dietitian mentioned it. The others said they “don’t go to their doctor to talk about food” and “when they do, they don’t necessarily think about asking their questions about these topics at that time”. On the other hand, pharmacists and retailers (organic shops) seemed to be systematically questioned about food supplements. Finally, food was 14 In the 2007 IFOP barometer santé survey, the medical profession (family doctor, pharmacist and occupational physician) was cited as the most important source of information and accounted for 84% of sources, followed by the media (Internet, TV, print and radio) at 71%, public associations and bodies (general public health information campaigns, public medical organizations and patient associations) at 34%, friends and family at 31%, practical books on health and well-being at 20% and specialist shops at 12%. Available at: www.ifop.fr/media/poll/BaroSante2.pdf (accessed January 15, 2018).

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only considered in its nutritional dimension by certain specific populations who were very concerned about their health, such as wealthy socio-professional categories (see Chapter 10). 8.4.2. Food in health discussion forums There are several reasons for choosing health forums. Forums are the second most frequently cited source of health information by Internet users after doctors. Our objective was to observe how food was approached by individuals when they had health problems; therefore, the choice of forums seemed relevant to us to compensate for the absence of interviews with the patients in a medical practice setting. The second reason was the nature of the most popular topics on the Internet of health. Thus, the first position was “occasional health problems, diseases and treatments”, and the second position “nutrition and weight problems”, as revealed by the 2015 Baromètre santé survey [RIC 15]. Finally, INCA surveys 2 and 3 show that Internet use for food issues has almost doubled in less than 10 years, from 24% to 44% (see Table 8.1). It is likely that this progression will continue. We have selected a corpus of 14 discussion threads from the Doctissimo (12 threads), Le Journal des Femmes (one thread) and Carenity (one thread) forums, which took place between 2005 and 2018. The threads were devoted to serious diseases (Crohn’s disease), rare and orphan diseases (Cushing’s disease, Gilbert’s syndrome), chronic diseases (type 2 diabetes, cholesterol) as well as discussion threads on eating disorders (gastroparesis, morbid obesity, obesity surgery). With the exception of the latter theme, food was not necessarily at the heart of the exchanges, but food-related concerns always arose in the daily struggle against the disease. This corpus contains 764 messages exchanged, 193 of which refer to food, or a quarter of the exchanges. The threads that dealt most with diet (more than 30% of exchanges) discussed cholesterol, Gilbert syndrome and type 2 diabetes. One of the threads entitled “Your everyday meals” fell under the theme “Obesity surgery: gastric bands, bypass, gastroplasia”: 44% of the messages dealt with the composition of menus and mentioned the difficulties of eating after a surgical operation. Surprisingly, diet was not more present in the threads on morbid obesity and gastroparesis, with discussions focusing on weight control and side effects of the operation. We relied on content analysis methods described in [PAG 11, PAG 14], which include three levels of exchange description, the message being the

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unit of description. The first level describes the modes of interaction between participants and concerns requests or entry of information; the second level describes the types of information according to their intentionality. We distinguish three types of them: – practical information or advice on nutrition; – scientific information, which refers to specialized sources or reported speech from doctors; – testimonies. Finally, the third level refers to the food theme. Not surprisingly, a number of results are comparable. Thus, whether it was a question of discussing a pathology or a more specific question related to nutrition, there were more information entries (87% for nutrition and 59% for health issues) than requests for information (13% for nutrition and 36% for health issues). These percentages confirm the interest of forums as a source of information and not exclusively as a communication tool. However, these percentages also suggest that food – unlike health – is rarely questioned, as if knowledge is self-evident. Let us move on to the second level of analysis. For food, 50%15 of the exchanges were testimonies, followed by practical information or food advice (30%), then scientific information on nutrition (20%). These proportions can be compared to previous results on rare and orphan diseases: 64% of testimonies, 8% of practical information and advice, 5% of scientific information. Testimonies are always the most important, regardless of the theme. In the case of food, testimonies may focus on the health effects of dietary supplements: Twice I tried EZETROL® + red rice yeast! Results with red yeast rice: cholesterol level of 1.86 g; WITHOUT red rice yeast: 2.45 g, and increasing triglycerides! Concerning practical information and advice, the percentage was much higher for food, which confirms the tendency to rely on word of mouth: Beware of all these products! One day, I was the one who advised a friend to take Squalen 500. I read on this forum, 15 We have removed the largest thread “Your everyday meals” whose size is not comparable with other threads. If we add this, the proportion of testimonies reaches 70%.

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among other things, that this product could lower cholesterol. My friend bought it, she had 2.80 g total cholesterol, and after 2 months with Squalen, her rate was almost 4 g!!!!!! She had to take TAHOR 80 to reduce her rate to 2.5 g. Since then, I no longer advise anything.16 On the other hand, the percentage of scientific information was higher than in forums on rare diseases, where patients had a good knowledge of their pathology because of their chronic nature and the strong proximity they maintained with the medical profession. In the case of food, more frequent references were made to scientific studies published in the media, books or documentaries, but rarely to reported words from doctors, suggesting low use by nutrition professionals, with the exception of threads for diabetes, cholesterol or Crohn’s disease. When nutritionists were mentioned, it was often because the attending physician attached little importance to weight gain. As for dietitians, they were perceived as mediators, who “translated” nutritional information into meals: “so, in my opinion, the help of a dietitian will be essential; at least to calculate all this”. Concerning themes, four categories dominated in health threads: disease and symptoms, diagnostic and therapeutic treatments, anatomy and finally drugs. The first theme referred to the need to follow a diet, most often understood as a balanced one: “I eat a balanced diet and I no longer eat breakfast”; “I just pay much more attention to what I eat” or sometimes a special diet: “My son has a low protein diet (no meat, fish, eggs)”. The second theme mentioned banned foods or those to be banned: “Well, we must start by eliminating from our diet foods that are actually not easily digestible: no more chocolate, no more cow’s milk (and therefore no more cheese), no raw foods and, for the misfortune of all, very little alcohol”; “For me, I banned all fried foods (very fatty foods, such as fries, accras, donuts, fondue, etc.), fizzy drinks (Coke, Perrier, except for a sip from time to time…). Raw vegetables and fruit: moderately…. Everyone experiences their disease differently”; “I also avoided all foods that contained salt, that was very hard, but I made up for it after the cortisone stopped”; “I just eliminated red meats.” Finally, the third theme refers to recommended foods: “goat's milk is acceptable, because it is much more digestible for humans (goat’s cheese too)”; “I have favored fish, olive oil and vegetables in 16 Excerpts from the forums were transcribed.

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general”; “At a push, it’s rice, ham, pasta.” Food supplements were included in this category. No source was mentioned to know what a balanced diet consists of, as if individuals had internalized the “nutritionally correct” [HUB 07, p. 61]. However, this knowledge seems very weak, as attested by this testimony, which initiated the thread “Your everyday meals”: Sometimes it’s a problem, you’re not sure you’re eating a balanced diet, you don’t have any ideas, you don’t know. So, if we posted about our meals, it would help, wouldn’t it? We note that food information was presented in the form of knowledge, organized and structured into lists of prohibited or permitted foods. The knowledge was based on the evocation of a healthy diet based on a normative conception of dietetic or therapeutic diets: the Cretan diet, the anti-cholesterol diet, the low-protein diet, the salt-free diet, etc. Internet users’ comments focused more on “dietary adherence” [FOU 15] than on ways of enhancing meals, with the food gap always being sanctioned (by guilt or side effects). Thus, internalized normative knowledge about “healthy eating” dominated in this quest to improve health status. These results differ from those obtained by Jean-Pierre Corbeau in 2006 from press articles [COR 07a]. Indeed, in this study, three themes related to food were identified − gastronomy, health and slimness − and the researcher discussed the deleterious effects of nutritional knowledge17 on “eaters”. Press articles included many dramatic nutritional messages and developed a rhetoric of fear (additives, cardiovascular diseases, obesity, avian flu, etc.), which could lead to guilt [COR 07b]. Unlike the press, the threads studied did not include references to slimming or eating pleasure, there was no nutritional message from the PNNS, a result that may lead to relativizing the impact of the media on eating behaviors. We have certainly not conducted surveys on the reception of nutritional messages in the media. On the other hand, our results show above all a certain distance from these alarmist discourses, not to say a perplexity, which translates, as we have indicated, into informational disorientation and a lack of confidence in the sources. 17 Jean-Pierre Corbeau talks about nutritional information and not nutritional knowledge. We prefer to use this second term, since we consider nutritional information as a field of specialized information, whereas nutritional knowledge results from treatment (documentary, editorial, legal) or from an effort of appropriation by the subjects.

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8.5. Conclusion In this study on information and information practices in a context of medicalization of food, we used several methods: a questionnaire survey of patients in a doctor’s office; interviews with people of different ages and genders on food and health issues and content analysis of the food theme in health discussion forums. With regard to information practices, the quest for healthy eating can be reflected in a voluntary approach on the part of individuals to seek information or not. In the first case, the research was finalized, underpinned by an overall objective (staying healthy, taking care of yourself, losing weight, avoiding pesticides, eating organic, etc.). In the second case, despite the lack of research, individuals remained more or less informed via a media bath (floating radio use, monitoring news on television, daily conversations, etc.). These two types of practices coexist, which would explain why the same sources were cited by people who consult a nutrition professional and those who do not. In both search modes, oral sources were important. Unlike the search for information on health topics, the resources mobilized to learn about food seem less specialized. Thus, the use of nutrition professionals was less frequent, except when the pathologies had significant consequences on food. Several explanations seem possible to us. Nutrition specialists would be poorly identified because of the diversity of forms of expertise, status and tasks. Knowledge about nutrition would be internalized and solidified in the form of authorized or prohibited lists, diets, etc., which would rarely be questioned, so the use of an expert would seem superfluous. Finally, some attending physicians would not give sufficient attention to dietary issues (e.g., weight gain) and would provide agreed and prescriptive discourses that would be of no help, since patients already know them. Finally, the study shows that information appears to be one of the means available to individuals to take charge of their health, make decisions and make informed food choices, whether for health care or to stay healthy. The context is illuminating in several respects. With regard to the nutritionalization of knowledge, the PNNS, whose nutritional discourses are reported in the media, would mainly result in a strong internalization of food control rules among individuals, a situation that does not seem favorable to the convening of specialized resources. Finally, it appears that info-communication dispositives on food are deployed in the Internet of health such as forums, and that this unpublished information is based more

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on published information (books, information programs, press articles, etc.) than on the expertise of health professionals specialized in nutrition. 8.6. References [AIA 98a] AÏACH P., DELANOË D. (eds.), L’ère de la médicalisation. Ecce homo sanitas, Anthropos, Paris, 1998. [AIA 98b] AÏACH P., “Les voies de la médicalisation”, in AÏACH P., DELANOË D. (eds), L’ère de la médicalisation. Ecce homo sanitas, Anthropos, Paris, 1998. [AKR 09] AKRICH M., MEADEL C., “Les échanges entre patients sur Internet”, La Presse Médicale, pp. 1484–1493, 2009. Available at: halshs.archives-ouvertes.fr /halshs-00397215 (accessed August 3, 2018). [ANS 18] Five systems are compared: nutrient benchmarks, nutri-colors, nutri-scores (5C), Health Star Rating (HSR) and SENS. Available at: www.anses.fr/fr /content/syst%C3%A8mes-d%E2%80%99information-nutritionnelle-un-niveau -de-preuve-insuffisant-pour-d%C3%A9montrer-leur (accessed January 24, 2018). [CHA 10] CHAUDIRON S., IHADJADENE M., “De la recherche de l’information aux pratiques informationnelles”, Études de communication, vol. 35, pp. 1–14, 2010. [CLA 13] CLAVIER V., PAGANELLI C. (eds), L’information professionnelle, Hermes-Lavoisier, Paris, 2013. [CLA 15] CLAVIER V., PAGANELLI C., “Activités informationnelles et organisation des connaissances : résultats et perspectives pour l’information spécialisée”, Les cahiers de la Société française des sciences de la communication, vol. 11, pp. 170–175, 2015. [CNO 15] CONSEIL NATIONAL DE L’ORDRE DES MÉDECINS, “Santé connectée. De la E-santé à la santé connectée”, Conseil national de l’Ordre des médecins White book, 2015. Available at: www.conseil-national.medecin.fr /sites/default/files/medecins-sante-connectee.pdf (accessed January 22, 2018). [CON 18] Étude annuelle: Le droit souple. Available at: www.conseil -etat.fr/Decisions-Avis-Publications/Etudes-Publications/Rapports-Etudes/Etude -annuelle-2013-Le-droit-souple (accessed January 25, 2018). [COR 07a] CORBEAU J.-P.P. (ed.), Impact des discours nutritionnels sur les comportements alimentaires : une approche socio-anthropologique qualitative auprès de groupes ‘ciblés’, Report for the Institut national de la prévention et d’éducation pour la santé (INPES), Université de Tours, 2007. Available at: citeres.univ-tours.fr/p_vst/textes_en_ligne/rapport_inpes.pdf (accessed January 22, 2018).

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[GRO 07] GROSJEAN S., BONNEVILLE L., “Logiques d’implantation des TIC dans le secteur de la santé”, Revue française de gestion, vol. 172, no. 3, pp. 145–157, 2007. [GUY 16] GUY-GRAND B., “Impact des informations nutritionnelles simplifiées sur les choix des consommateurs”, Cahiers de nutrition et de diététique, vol. 51, no. 2, pp. 57–58, 2016. [HER 14] HERCBERG S., “Pour une politique nutritionnelle à la hauteur des enjeux de Santé Publique!”, Santé Publique, vol. 26, no. 3, pp. 281–282, 2014. [HUB 07] HUBERT A., La santé est dans votre assiette : même pas vrai ! Éditions Érès, Ramonville-Saint-Agne, 2007. [INS 17] INSERM, “Loi de santé publique du 9 août 2004 : messages sanitaires et marketing alimentaire”, Agir sur les comportements nutritionnels. Réglementations, marketing et influence des communications de santé, Éditions EDP Sciences, Montrouge, 2017. [JOH 03] JOHNSON D.-J., “On contexts of information seeking”, Information Processing and Management, vol. 39, no. 5, pp. 735–760, 2003. [JOU 00] JOUËT J., “Retour critique sur la sociologie des usages”, Réseaux, vol. 18, no. 100, pp. 487–521, 2000. [KEL 09] KELLY B., NIEDERDEPPE J., HORNIK R., “Validating measures of scanned information exposure in the context of cancer prevention and screening behaviors”, Journal of Health Communication, vol. 14, no. 8, pp. 721–740, 2009. [KEL 10] KELLY B., HORNIK R., ROMANTAN A., et al., “Cancer information scanning and seeking in the general population”, Journal of Health Communication, vol. 15, no. 7, pp. 734–753, 2010. [KRE 03] KREMPF M., Rapport sur l’évolution du métier de diététicien, Programme national nutrition santé (PNNS), 2003. Available at: www.afdn.org /fileadmin/pdf/rapport_krempf.pdf (accessed December 20, 2017). [KUT 14] KUTTSCHREUTER M., RUTSAERT P., HILVERDA F., et al., “Seeking information about food-related risks. The contribution of social media”, Food Quality and Preference, vol. 37, pp. 10–18, 2014. [LEM 09] LEMIRE M., “Internet et responsabilisation : perspective de l’usager au quotidien”, Santé Publique, vol. 21, Special Issue 2, pp. 13–25, 2009. [MAR 09] MARTIN A., La formation à la nutrition des professionnels, Public report to the French Health Minister, 2009. Available at: www.ladocumentationfrancaise .fr/rapports-publics/094000169-la-formation-a-la-nutrition-des-professionnels (accessed January 24, 2018).

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[MCI 04] MCINERNEY C., BIRD N., “Assessing website quality in context: retrieving information about genetically modified food on the Web”, Information Research, vol. 2, no. 10, 2004. Available at: InformationR.net/ir/10-2/paper213.html (accessed January 30, 2018). [MCK 03] MCKENZIE P.-J., “A model of information practices in accounts of everyday-life information seeking”, Journal of Documentation, vol. 59, no. 1, pp. 19–40, 2003. [MIE 04] MIEGE B., L’information-communication, objet de connaissance, De Boeck, Brussels, INA, Paris, 2004. [NIE 07] NIEDERDEPPE J., HORNIK R., KELLY B., et al., “Examining the dimensions of cancer-related information scanning and seeking behavior”, Health Communication, vol. 22, pp. 153–167, 2007. [NIE 14] NIEDZWIEDZKA B., MAZZOCCHI M., ASCHEMANN-WITZEL J. et al., “Determinants of information behaviour and information literacy related to healthy eating among Internet users in five European countries”, Information Research, vol. 19, no. 3, 2014. Available at: InformationR.net/ir/19-3/paper633.html (accessed November 23, 2017). [PAG 11] PAGANELLI C., CLAVIER V., “Le forum de discussion : une ressource informationnelle hybride entre information grand public et information spécialisée”, in YASRI-LABRIQUE E. (ed.), Les forums de discussion : agoras du e XXI siècle ? Théories, enjeux et pratiques discursives, L’Harmattan, Paris, 2011. [PAG 14] PAGANELLI C., CLAVIER V., “S’informer via des médias sociaux de santé : quelle place pour les experts ?”, Le Temps des médias, vol. 23, pp. 141–143, 2014. Article partly available at: www.histoiredesmedias.com/S-informer-via -des-medias-sociaux.html (accessed January 18, 2018). [PAG 16] PAGANELLI C., “Réflexions sur la pertinence de la notion de contexte dans les études relatives aux activités informationnelles”, Études de communication, vol. 46, no. 1, pp. 165–188, 2016. [PAG 18] PAGANELLI C. (ed.), Confidence and Legitimacy in Health Information and Communication, ISTE Press, London and John Wiley & Sons, New York, 2018. [POU 09] POULAIN J.-P., Sociologie de l’obésité, PUF, Paris, 2009. [REN 08] RENAHY E., PARIZOT I., CHAUVIN P., “Health information seeking on the Internet: a double divide? Results from a representative survey in the Paris metropolitan area, France 2005–2006”, BMC Public Health, vol. 8, no. 69, 2008.

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9 Labeling for Sustainable Food: The Consumer’s Point of View

9.1. The potential role for labeling from a sustainable food perspective The UN definition of sustainable food covers a wide area: Sustainable diets are protective and respectful of biodiversity and ecosystems, culturally acceptable, accessible, economically fair and affordable; nutritionally adequate, safe and healthy; while optimizing natural and human resources. [FAO 10] This definition should be compared with the extension of food concerns (price, hygiene and safety, hedonism, nutrition, environmental impacts, corporate social responsibility, etc.), motivating product differentiation by attributes and claims on packaging. Although these concerns are widely shared [LUS 09], the decision-making process related to sustainable food is far from obvious, as the dimensions it covers may conflict, and trade-offs may be necessary. Thus, how can we reconcile a short-term concern, which aims to reduce the cost of food, with a medium-term challenge of preserving health or that of safeguarding the environment in the long term? Assuming that priorities between these different challenges are established, public authorities have a number of levers at their disposal to guide decisions: norms, regulations, taxation, etc. Product information, including labeling, is one of these levers, as it could help consumers to better identify those who respect the principles of sustainable food. Chapter written by Anne LACROIX, Laurent MULLER and Bernard RUFFIEUX.

Food and Health: Actor Strategies in Information and Communication, First Edition. Edited by Viviane Clavier and Jean-Philippe De Oliveira. © ISTE Ltd 2019. Published by ISTE Ltd and John Wiley & Sons, Inc.

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As the European regulation on food labeling currently states (Regulation No. 1169/2011, known as “INCO”), the mandatory information to appear on pre-packaged products includes, among other things: the sales description that defines the product; the origin, which concerns only meat or if the omission of such information could mislead the consumer; the list of ingredients; the quantity of specific ingredients that are highlighted on the packaging or in the name and nutritional declaration1. As the latter is not widely read and understood by consumers [GRU 07], so-called “clarification” information would be welcome to better explain the product’s nutritional quality (see Table 9.2). Other characteristics relating to environmental impacts or corporate social responsibility are not declared to the consumer at the time of purchase. Without an “extension” of the scope of mandatory information (see Table 9.2), information on these so-called “trust” characteristics [DAR 73] is not accessible through consumption experience. Hence, informing consumers about these characteristics remains an important issue, especially since it can generate a strategic response from the companies that manufacture and distribute products. Indeed, the wager is twofold: – by having this information, consumers could make more sustainable choices; – by anticipating or reacting to these more virtuous behaviors, companies could offer products that are more in line with the general interest. This chapter reports on a study that aimed to explore the role that labeling plays today and what role it could play in the future to change consumer behavior. This chapter therefore deals with the role of information on choices of consumers who have already been widely solicited on this issue. Through numerous opinion polls [BEU 05, BEU 13, CLC 13, EUR 09, EUR 12, FSA 15, NCM 07], they have shown their interest in information within the scope of sustainable food: nutritional information, geographical origin of products, carbon footprint, etc. In addition, an abundance of scientific literature in economics and marketing has focused on nutritional

1 The nutritional declaration, mandatory since December 13, 2016, includes the contents of the following elements: energy value, amount of fat, saturated fatty acids, carbohydrates, sugars, proteins and salt.

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labeling [COW 05, GRU 07, HIE 12], environmental labeling [GAL 02, GRU 14] and ethical labeling [AUG 03]. These studies are very useful, but their limitations are known. Based on declaratory methods, they reveal data concerning opinions, knowledge or beliefs. These investigations, which are the result of surveys with no constraints and no consequences for the respondent, do not encourage respondents to reveal real purchasing behavior, let alone reveal future changes. The distance between declarative data and actual data is very large a priori in order to approach behavioral changes. On the one hand, there may be a large gap for a given consumer between what they consider their future desirable behavior to be and what they will be able to achieve. On the other hand, the consumer may want to “please” the interviewer – and themself at the same time – by answering what seems to them to be the “right answer”, by heading in a “politically correct” direction, for example. Finally, because they can simply ignore what their effective reaction to labeling will be, anticipating their own behavioral changes is indeed a difficult task. The work presented here aims to compare consumer statements with their actual behavior in using information on sustainable food. In this research, we considered the opinions, beliefs and perceptions of information by participants, to the extent that they impact actual behaviors. This work pays particular attention to disadvantaged populations, reputedly not very receptive to information [DRI 06]. 9.2. Data collection techniques This study was conducted as part of a unique collaboration between the Institut national de recherche agronomique (INRA) and the Association nationale de défense des consommateurs et usagers CLCV (Consommation, logement et cadre de vie). The actors of the CLCV association, through their militant approach to sustainable food, have in-depth field knowledge of consumer attitudes, particularly those of disadvantaged groups. INRA researchers have a scientific knowledge of sustainable food and consumer behavior. Functional complementarities between these two partners have thus been enhanced.

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Organization of the study The study was carried out by a team combining research skills and field expertise. On the research side, it was composed of Anne Lacroix (INRA), Laurent Muller (INRA) and Bernard Ruffieux (Grenoble INP); on the association side, it was composed of Celia Potdevin, Marine Desorge and Charles Pernin (CLCV). The study mobilized 45 volunteers from the CLCV to implement the surveys and experiments, as well as the experimental economics platform of the GAEL research unit and its team: Marie Cronfalt, Marianne Damois, Jean-Loup Dupuis and Cédric Lanu. The steering committee included ReineClaude Mader (CLCV), Christine Cherbut and Catherine Esnouf (INRA). Interests of the CLCV – to improve methods of investigation and exploitation of results; – to learn to take better account of bias; – to cross, for the interpretation of the results, the classical bases accessed by a consumer association with the results of scientific publications; – to stimulate greater interest among volunteer investigators by involving them in scientific research work. Interests of the INRA – to question consumers’ perception of sustainable food in order to enrich the theoretical and abstract vision of research; – to renew the survey methods, in particular by using tablets and the Internet; – to access a broader and more diverse sample of consumers.

Box 9.1. A “win-win” collaboration

To understand consumer attitudes and practices towards food information, the study developed and deployed four data collection techniques, each with a different perspective (see Table 9.1) and in response to the following questions: – At the time of their food purchases, which of the available information is used by consumers to make their choices?

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– What additional information would consumers want to have as a priority? – What credibility do consumers place on the various sources of information? – What representations do consumers have of the origin of a product? – How do consumers perceive food labeling and what do they expect from it? Methodology

Viewing angle

Data collected

Method

Experimental economics

Behaviors

Information used in a purchasing situation

Online experiment

Directive interview

Priorities

Selective classification of the additional information required

Face-to-face survey

Quantitative survey

Opinions and individual beliefs

Assessment of sources of information and the indication of product origin

Face-to-face survey

Collective expertise

Perceptions and expectations

Criticisms and proposals regarding food labeling

Focus groups

Table 9.1. Four collection techniques for analyzing consumer expectations and uses of information

These systems were deployed between January 2014 and October 2015 at more or less wide geographical levels (France as a whole, urban areas in some departments, Grenoble and Paris; for further details, see Boxes 9.2, 9.3 and 9.4). Approximately 2,000 people who regularly shop for food (exactly 2,008) took part in the study. The participants were mainly women (68.6%), almost exclusively urban (98%), and of an older age range (elderly) (14% below 30 years of age). A majority (59.8%) lived in a household with a standard of living2 below the French average: nearly half of them had a standard of living of less than €16,000 per year and therefore belonged to one of the first three French deciles (17% on the first decile, 30% on the second or third decile); more than a quarter had a standard of living between 2 A household’s standard of living is calculated according to the definition adopted by INSEE. This is the household’s disposable income in relation to the number of consumption units (consumption unit = 1 for the first adult, 0.5 for other persons above 14 years of age, 0.3 for children below 14 years of age). In France, the median annual standard of living was €20,150 in 2014.

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€16,000 and 23,000 per year and were in the median deciles (27% in the fourth, fifth or sixth decile) and only 26% had a standard of living above €23,000 per year and were in the upper deciles (i.e. seventh or more). 9.2.1. Observing information behaviors when purchasing To evaluate the information used by consumers when purchasing a product, several methodological approaches were possible: – interviewing the buyer in the store after purchase (post-purchase reporting method); – equipping the buyer with an oculometry device and observing the information which they are searching for (relevant method for a small number of individuals); – observing purchasing behavior in a context of experimental, controlled and stimulated economics: this approach was used here using the Internet as a tool (see Box 9.2). NOTE.– Experimental economics places actors in conditions as close as possible to the real world. In this type of experience, participants make effective and consequential choices: they choose real products that are actually assigned to them under certain conditions. Participants were put in a position to choose their preferred product from a given offer of substitutable products. To make this choice, they could access different categories of information, which allowed them to differentiate products. Access to this information was more or less time-consuming: to access each piece of information, a more or less long waiting time was randomly determined and known to the participants. Thus, the value that participants attributed to information was correlated with the time they were willing to “lose” by shopping online for access. Methodology: The experiment took place from June 17 to October 1, 2015. Participants were recruited via CLCV newsletters and social networks (see Table 9.2 for sample characteristics). A total of 1,493 individuals connected and 989 responded to the questionnaire and were selected for the study.

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The experiment lasted an average of 19 minutes. Protocol The participants’ task was to choose 14 products from three close substitutes. At the beginning of the task, only the generic name of the product was known and there was no way to differentiate between the three products labeled A, B and C. To choose between these three products, or reject a choice, synthetic information was made available to the participants. These covered the following areas: price, nutrition, environmental impact, corporate social responsibility, origin, brand and label (see screenshot in Appendix 1, section 9.8.1). This information was presented in a random order and was accessible at the subject’s request with a randomly drawn waiting time. The participants were encouraged to do this task seriously: 1 in 10 participants, drawn at random, received a €20 assortment of the products they had chosen.

Box 9.2. The online experience

Description of the sample

Average

Age

51.2 years

Gender Annual standard of living

(1)

€19,681

Residential area BMI

25.1

Consumers’ association In charge of food shopping Number of children (less than 14 years old) in the household

0.3

% Below 50 years of age

41.0

Women

72.5

Below the French average

50.9

Rural

5.2

Overweight, including obese

40.8

Members

44.0

Always

72.7

Households with children

19.7

Table 9.2. Description of the online experience sample. (1) Household disposable income divided by the number of consumption units (consumption unit = 1 for the first adult, 0.5 for other persons above 14 years of age, 0.3 for children below 14 years of age)

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9.2.2. Defining priorities for information To find out what information consumers would like to have, it was possible and inexpensive to use a simple questionnaire. By presenting them with several possible scenarios, the consumer was asked, each time, what would be their best choice. This approach was hypothetical and declarative in nature. Rather than following such an approach, it was chosen here to subject consumers to several concrete, increasingly constraining exercises as part of a face-to-face survey conducted by CLCV volunteers (see Box 9.3). Methodology The survey, conducted between February 7 and April 11, 2015, was conducted faceto-face using a tablet for an average duration of 13 minutes. A total of 10 departmental structures of the CLCV were mobilized and 1,000 people residing in urban areas were contacted (see Table 9.3 for sample characteristics). Quantitative questions The respondents’ task was to select additional packaging information for one of the following two products: eight packs of plain yoghurts and one pack of butter biscuits. The mandatory information appeared on the fictitious packaging: name, weight, use-by-date, ingredients and nutritional values. The respondents had to select the additional information they wanted to have, on the product packaging and on a dedicated website. After viewing the information selected for the package, the respondent was asked by different iterations (maximum 4) to reduce the amount of information to 3 in the end (see screenshots in Appendix 2, section 9.8.2). Qualitative questions In addition, the respondents were asked to give their opinions on the credibility of different sources of information and their beliefs based on the origin of two food products (rice and apples). Box 9.3. Face-to-face survey

Faced with food packaging on which the information required by the regulations was displayed, the participants had to mention the additional information they would like to receive (see Table 9.4): on the package itself (with a maximum of 15 pieces of information) and on a dedicated website

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(with a maximum of 20 possible pieces of information). In successive iterations, each participant was then forced to reduce the amount of information on the packaging to three pieces only. Description of the sample

Average

Age

49.5 years

Below 50 years of age

48.0

Women

64.9

€16,657

Below the French average

68.6

24.5

Overweight, including obese

38.3

Always

58.0

Households with children

22.6

Gender Annual standard of living

(1)

BMI In charge of food shopping Number of children (below 14 years old) in the household

%

0.3

Table 9.3. Description of the sample from the face-to-face survey. (1) Household disposable income divided by the number of consumption units (consumption unit = 1 for the first adult, 0.5 for other persons above 14 years of age, 0.3 for children below 14 years of age)

Environmental impacts

Corporate social responsibility

Nutrition

Processes

Origin of ingredients

5 color scale

Use of chemical products

Main ingredient: EU

Traffic lights system

Economic impacts

Traffic lights system

Presence of GMOs

Main ingredient: country

Overall score

Consumer protection

Prescriptive message

Animal welfare

All the ingredients

Quantified impacts

Place in the value chain

Daily contribution s reference

Health quality management

Main ingredient: region

Equivalent km

Working conditions

Table 9.4. Additional information available to respondents. On a gray background, so-called ‘clarification’ information aims to clarify the information that must be displayed or known by default; on a white background, so-called ‘enlargement’ information constitutes an extension of the scope of the information compared to that currently displayed

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This progressive selective classification procedure made it possible to assign a value to each piece of information offered. This value took into account both the frequency of information selection and its resilience in the information reduction process3. 9.2.3. Identifying opinions and beliefs The trust placed in the information provided and the image that consumers have of it undoubtedly affects their use. Therefore, it is important to reveal consumers’ opinions and beliefs in order to better understand how their behaviors are guided. We therefore wanted to collect the individual opinions of consumers about different information providers. Respondents were asked to answer the question: “who is best able to provide reliable information to consumers?”, by making a single choice among the five types of actors proposed. This question was given for nutritional characteristics, geographical origin, environmental impact and description of production processes. To the extent that significant literature shows that there is an influence of geographical origin on the value given to a product, this information caught our attention and oriented our investigation to explore beliefs related to the mention of a product’s origin. Thus, respondents were asked to rate products that differ according to their origin. This evaluation was conducted according to six categories of criteria: taste, price, nutrition, environment, processes and economic impacts (see Figure 9.1).

3 In the proposed exercise, participants selected, for the package, a maximum of 15 out of 20 available pieces of information (four for each of the five proposed areas: nutrition, origin, processes, environment and corporate social responsibility). Then, they were invited during different iterations (maximum four) to reduce the amount of information to a maximum of 12 at the first iteration, then nine at the second iteration, six at the third iteration and three at the end. We considered that the three pieces of information they kept at the end of these iterations were the ones to which they attached the most importance. To the information removed in the previous iteration, we assigned the value 4 and proceeded backwards to the information that may have been removed from the first iteration to which we assigned the value 1. The maximum sum of the values given to the information is therefore 45; it is 19 for each of the information domains.

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According to you, for each criterium, which is the best product among the following three mentioned? USA long-grain rice

Camargue long-grain rice

Italian long grain rice

I believe they are all good

From a taste perspective From a price perspective From a nutritional perspective From a production process perspective From an environmental impact perspective From an economic impact perspective

According to you, for each criterium, which is the best product among the following three mentioned? French Golden apple

Chinese Golden apple

Val de Loire Golden apple

I believe they are all good

From a taste perspective From a price perspective From a nutritional perspective From a production process perspective From an environmental impact perspective From an economic impact perspective

Figure 9.1. Questions to identify beliefs about the country from which a food product originates

9.2.4. Assessing expectations To understand consumers’ perceptions of food labeling better and their implicit and explicit, conscious and unconscious expectations of the action, focus groups were held (Box 9.4). The method used, that of focus groups, aimed to determine a group’s response and the attitude it adopts towards a product in particular. Methodology Two focus groups were conducted according to the same “driver” developed in collaboration with Mr Jacquinot (from Clos Cause Coaching): one in Grenoble on January 29, 2014, and the other in Paris on March 17, 2014. Objectives of the discussion sequences – make a critical assessment of the current food labeling system; – identify the scope of ideal labeling; – hierarchize the different dimensions;

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– assess the format; – identify the role and forms of latent information. Sample a total of 19 participants; 8 men and 11 women; 4 below 30 years of age, 9 between 30 and 50 years of age and 6 above 50 years of age; 10 from rather privileged social categories in one focus group, 9 participants from more modest social categories in the other. Box 9.4. Focus groups

Here, we sought to develop critical and collective expertise in food labeling. The aim was to develop a shared opinion, in order to identify what is or is not a consensus in terms of criticisms and proposals on product labeling. 9.3. Limited use of information when purchasing 9.3.1. Consultation of a small part of the available information In contrast to one of our hypotheses made during the development of our experimental protocol, the waiting time allocated to each piece of information had only a very limited effect on the frequency of its consultation. This result can be explained by the artificial context of the experience: the participants were at home, not feeling stress in a store context. They also had access to information that was much simpler than that usually available on packaging. Despite this context conducive to an informed decision, participants consulted on average only a quarter of the available information; 21% of purchases were even made “blind”, i.e. without any information being consulted. It is as if the consumer had limited cognitive capacity or low involvement: he/she only processed two or three pieces of information to

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choose a product, even though the information was easily accessible and presented in a summative format (the format for presenting the information preferred by consumers). 9.3.2. Price and origin: major benchmarks Price and origin were the most frequently consulted pieces of information: price was consulted in 35% of choices and origin in 33% (see Figure 9.2). Next came nutrition, brand and organic label (consulted in 23–25% of decisions), information on the environmental impact of products and finally the social responsibility of the manufacturing company (17 and 13% of decisions). When choosing a typical consumer product, price and origin were the key pieces of information sought. On the other hand, for products not included in the consumer’s current food directory, the organic label and brand served as referential information.

Figure 9.2. Distribution of information consulted in the purchasing situation (in %) during the online experience. For a color version of the figure, see www.iste.co.uk/clavier/health.zip

9.3.3. Influence of education and income levels on the use of information Differences in information practices were observed between participants. People with low standards of living or education consulted less information than those with higher standards of living (see Figure 9.3). On the one hand,

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standard of living did not discriminate very much against the areas of information consulted. At most, information on whether or not an organic label existed represented a larger proportion of the total number of consultations by participants with the highest incomes. On the other hand, education level and age were decisive variables in relation to the types of information consulted. Young people (especially those below 30 years of age) looked more at price than their elders; the latter looked for origin, CSR and environmental impact more often. Less educated participants consulted origin and quality labels more often, and nutrition and CSR less often than more educated participants.

Figure 9.3. Total amount of information consulted for the 14 products offered for purchase, according to standard of living during the online experience. ***; *: significant differences of 1% and 10%, respectively, according to the Wilcoxon test

9.3.4. Diversified benchmarks for sustainable food Nutrition information was of interest mainly to people with higher levels of education. Origin has been the preferred reference for older people with a lower level of education; the organic label was a reference for more privileged consumers and those who shopped occasionally for food; the brand was a reference for people who were overweight or obese. Information on the environmental impact of products and corporate responsibility received more attention from older participants, while younger participants focused on price.

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9.4. A widely shared desire for more information 9.4.1. A significant demand for information from less well-off consumers Of the consumers surveyed, 97% selected at least one additional piece of information (see Table 9.4) to display on the packaging and 64% wanted at least one additional piece of information to be available on the Internet. On average, during the first iteration, they selected 12 additional pieces of information: seven in regard to the packaging and five for the Internet. Four pieces of information were intended to clarify mandatory information and eight were additional pieces of information, extending the scope of mandatory labeling. The standard of living discriminated against the amount of additional information desired (see Figure 9.4): participants in the first three deciles selected more information for packaging. On the other hand, the amount of additional information to be put on the Internet and the nature of the information (clarification or broadening) were not different between the latter and the higher-income deciles.

Figure 9.4. Amount of additional information required depending on the standard of living and type of material during the face-to-face survey. **: significant differences at 5% according to the Wilcoxon test

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9.4.2. Packaging: a favored material Packaging was the preferred medium for receiving additional information. It should be noted that the amount of information selected for the Internet increased with the respondents’ level of education and decreased significantly with age. Packaging was clearly favored to accommodate the so-called “clarification” information: synthetic indicators on nutritional quality, the presence of GMOs or the use of chemicals, for example. The so-called “broadening” information can be linked back to the Internet, except for the information describing the origin of ingredients. There is a certain complementarity between these two materials. Packaging was preferred for information on production and manufacturing methods, nutrition and product origin. The Internet was the preferred medium for corporate social responsibility data. Finally, environmental information was equally distributed between the two media. 9.4.3. Priorities for clarification information on packaging More value was placed on information regarding the use of chemicals and the presence of GMOs. The origin of the ingredients that made up the product can be classified in the third position. Two pieces of information clarifying the nutritional quality of the product (traffic lights system and recommended daily intakes) were indistinguishably placed in the fourth position. With the exception of information on origin, these five pieces of information thus essentially included the so-called “clarification” information. Environmental and corporate social responsibility information was valued far behind the others (see Figure 9.5). This hierarchy is clearly widely shared by respondents; it strictly remained the same regardless of income level. When these results of the face-to-face survey are compared with the results of the online survey (see section 9.2), there is a double dissonance between “desires” and “behaviors”. First, consumers demanded a significant amount of information on packaging, when in fact little information was used when consumers were placed in a position of choice. Second, the information desired in the packaging survey does not coincide with the

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information most consulted in the online experiment (price and origin: see section 9.3.2).

Figure 9.5. Additional information values desired on the packaging, during the face-to-face survey. For a color version of the figure, see www.iste.co.uk/clavier/health.zip

9.5. Opinions expressing beliefs and mistrust 9.5.1. Origin, a vector of beliefs on sustainable food As we have seen, mentioning the origin of products is important information for consumers, both for the use they make of it when making purchases and for the value they place on it when selectively classifying the available information. Our survey results show that this interest in origin is largely marked by beliefs. Thus, products such as rice or apples, originating from France, were very often perceived as better than their foreign counterparts, regardless of the evaluation criterion: taste, price, nutritional quality, environmental impact, production process. The further away the products’ country of origin was, geographically from France, the less favorable the product was evaluated. On the other hand, consumers expressed a strong preference for products from their home region, when they were offered them. In short, consumers have a clear preference for proximity. Two non-rival hypotheses can explain these preferences. First, the local origin of the product can be considered as a practical overview of the dimensions of sustainable food. Second, local preference may be related to social behavior towards “insiders” (Homo parochius), which seek to favor members of their home group over others [GIN 00].

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9.5.2. Mistrust towards all actors in the food chain The focus groups revealed a strong level of mistrust towards most of the food information available. Participants expressed their fear that information was in fact disguised advertising and they were suspicious of many actors in the system: manufacturers, intermediaries, distributors and even public authorities. Consumers gave very little credibility to the information provided by the agri-food industries (see Figure 9.6) and, more surprisingly, information of ministerial origin appeared hardly more credible; only the French Ministry of the Environment came away with a better image. Consumers had more confidence in information from sources close to the scientific community about nutrition and the environment. Information from agricultural producers on origin and production methods was also more credible. In this “ranking” of more or less credible institutions, consumer and environmental associations occupied a modest place. This position could be more specific to France. Indeed, studies conducted in Italy and Europe more generally show that consumers generally have confidence in the associations that represent them [MAZ 08, NOC 14]. Similarly, the lack of credibility given to public authorities has already been noted as one of the characteristics of French consumers [MAZ 08]. 9.5.3. Simpler and more practical labeling During the focus groups, food labeling was considered useful for comparing products and making personal and even citizen choices. Thus, it allows choices to be made according to strict personal interest, or a collective interest, insofar as it includes certain elements of the company’s environmental impact and social responsibility. On the other hand, labeling ethics was considered too complex, illegible and suspicious. Consumers have therefore expressed expectations for simpler, hierarchical and harmonized information. In particular, they

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highlighted the need to segment information between legal or official and marketing information.

Figure 9.6. Credibility granted to different information providers, depending on the field concerned (source: face-to-face survey). For a color version of the figure, see www.iste.co.uk/clavier/health.zip

9.5.4. A plea for comprehensive information The results underlying the focus groups, the face-to-face survey and the online experience highlighted that for consumers, summative information should not replace detailed information, but should complement it. For the participants in this study, comprehensive information must be available, covering the entire scope of the sustainable food explored (nutrition, origin, production method and manufacturing process, environment, corporate social responsibility). However, focus group participants perceived the apparent contradiction between this increased need for accurate and comprehensive information and the desire for simplicity. The emerging solution is to include simple and harmonized information on packaging and to return detailed information to a virtual medium. However, it should be recalled that the participants in the face-to-face survey did not follow this rule, choosing to assign to the virtual medium only information relating to the environment and corporate social responsibility, the rest being available on packaging.

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9.6. Conclusions The objective of this study was to compare consumers’ expectations and practices regarding information on the sustainability of food products. Uses were observed at the time of purchase. 9.6.1. From desired information to the information used The consumers surveyed express the wish to have additional information alongside information provided for by the regulations. Not all of this desired information was actually used at the time of purchase. The contrast between the information desired and the actual use of it at the time of purchase was very marked for the most economically disadvantaged participants. Respondents with a low level of education wanted more information than those with a higher level of education. However, they used it less. From this point of view, our results converge with those presented by Drichoutis, Lazaridis and Nayga and Nayga, Lipinski and Savur [DRI 06, NAY 98], which show that information is mainly used by the best-educated people. This contrast between the desired and used information can be explained in several ways. The consumers may wish to use the information in the future, outside the act of purchase. They may also wish to make this information available for a use that they delegate to opinion leaders such as associations. Finally, they may wish to see the simple existence of this information as a source of pressure on the actors in the value chain by forcing them to be more transparent. In any case, consumers plead for information that is not limited to that which they actually use, as an aid to purchasing and consumption decisions. They want comprehensive, simple, clear and comprehensible information for all. 9.6.2. Sustainable food from a consumer point of view In a purchasing situation, price is the most important information on which the consumer needs to make a decision. Price is all the more important when the consumer is young.

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The second most frequently consulted information in purchasing situations is the origin of the product. It is as if the geographical proximity of food production was a relevant synthesis, an easy shortcut integrating the important dimensions of sustainable food in the eyes of the consumer. This raises two questions: to what extent does proximity effectively reflect the qualities of sustainable food? If it were to prove insufficient, what criteria, alternative or complementary – at least simple and synthetic – would it be appropriate to promote? In the focus groups, consumers proposed a very broad definition of sustainable food, covering vast and contrasting areas, projected towards distant futures for them (health) and for society a fortiori (environmental and societal impacts). This wide scope was confirmed when wishes were expressed. Even though consumers expressed a strong mistrust of the information provided to them, they demanded complete and clear information on product packaging or on the Internet. This information, which was requested but not ultimately used at the time of purchase, may not only have had an existence value, but it could also be a lever in the evolution of the food supply. Indeed, the consumer knows, if only through the media, the power of the information revealed. The active reading of the information made available to everyone required strategic responses from the various actors in the value chain, responses that were in the common and individual long-term interest. Should we leave it at that and rely only on the disclosure of information to regulate markets? In any case, important work remains to be done to clarify, give credibility, facilitate the use of information and align collective long-term issues with those of the consumer in a purchasing situation, both individual and short term. 9.7. Implications for stakeholders Our observations show that consumers consider information on food sustainability as it is currently available on packaging to be incomplete, unclear and unreliable. In addition, they use it little when making their choices. On this basis, three approaches could guide the actions to be taken by the various stakeholders in food labeling, whether they are public authorities, agri-food manufacturers, consumers or their representatives. The first approach is that, even though information on everything does not make sense – especially for packaging – and even though the

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information displayed is not fully used by consumers when shopping, efforts should be continued to make more complete information available to all. This analytical information must be reliable (from sources considered as such), simple and meaningful to the attentive consumer, as well as to delegates and supporters. Of course, the consumer is not the only one in charge, through his or her daily choices, of the way forward towards sustainable food. The market is a place of collective regulation that involves all stakeholders. The more precise nature of this analytical information has yet to be defined in order to meet the wishes expressed by consumers. Collaboration between researchers, consumer associations and consumers themselves is a way to advance this knowledge that will be necessary for public and private decision-makers. The second course of action is that in parallel and in addition to this analytical information, synthetic, prominent and easy-to-use information should be developed. This type of information would help guide consumers’ choices in terms of what they want and understand about sustainable food. Indeed, the orientation of choices must be made in a pragmatic way, on the basis of what is legitimate for consumers to favor, exclude, limit or substitute. In particular, their awareness of the scope and limits of geographical proximity as a relevant sign of sustainability is a priority. This perspective, again, requires work carried out by consumer interest delegates such as consumer associations and scientists (with a wide interdisciplinary scope), in conjunction with public authorities and value chain actors. The third approach is based on the observation that the use of information is largely determined by the social status of consumers: the best-educated consumers with the highest standards of living consulted a greater volume of information than those with lower levels of education and income. It would therefore be interesting to conduct a labeling education campaign targeting the most disadvantaged consumers. As such, the design of our experiment could be used to the extent that the participants’ comments highlighted the pedagogical nature of the exercise. On the one hand, it can be seen that people who appreciated the fun aspect of the experiment increased their information searching efforts; on the other hand, these people say they learned during the experience to avoid the “brand trap” and to discover the unsuspected quality of certain products, especially from a nutritional point of view. Consumer associations could play this role as trainers. However, it seems that to do so, they should improve their image, especially among young people who give them little credit as a source of information.

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9.8. Appendices 9.8.1. Appendix 1. Screenshot of the online experiment Three options (A, B and C) of the same food (here canned pineapple in syrup) were available to the participants of the online experience. As the images alone did not allow the three options to be distinguished, the participants could access different pieces of information (country of origin, price and weight, etc.) by clicking on the corresponding button in the box on the left-hand side. The desired information then appeared below each option in the center of the screen after the time delay indicated on the left. After successively selecting sufficient information to make a decision, participants clicked on their preferred option at the top of the screen (or on the tab “Ces produits ne m’intéressent pas” (These products do not interest me)).

Figure 9.7. Example of product choice during the online experience. The products are labeled A, B and C with information about them provided below. For a color version of the figure, see www.iste.co.uk/clavier/health.zip

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9.8.2. Appendix 2. Screenshot of the face-to-face survey

Figure 9.8. Areas of information requested by respondents. These areas include nutrition, production process, origin, corporate social responsibility and environment. For a color version of the figure, see www.iste.co.uk/clavier/health.zip

Respondents chose the additional information they wanted to receive either on the packaging or on the Internet. To make their choice, they selected an information group (nutrition, manufacturing process, etc.) and then an element of this group (e.g. for the “nutrition” group: scale, logo, etc.). Once respondents selected all the information they wanted to see on the products, they had to, iteratively, remove information from the packaging to limit themselves at the end of the exercise to only three pieces of information.

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Figure 9.9. Screenshot of the face-to-face survey. For a color version of the figure, see www.iste.co.uk/clavier/health.zip

9.9. References [AUG 03] AUGER P., BURKE P., DEVINNEY T. et al., “What will consumers pay for social product features?”, Journal of Business Ethics, vol. 42, no. 3, pp. 281–304, 2003. [BEU 05] BEUC, Report on European Consumers’ Perception of Foodstuffs Labelling. Results of Consumer Research conducted on behalf of BEUC from February to April 2005, available at: www.vzbv.de/sites/default/ files/mediapics/ beuc_foodstuffs_labelling_09_2005.pdf, 2005. [BEU 13] BEUC, “Where does my food come from? BEUC consumer survey on origin labelling on food”, available at: www.beuc.eu/ publications/2013-00043-01e.pdf, 2013.

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[CLC 13] CLCV, “Sondage sur l’information sur l’origine des produits alimentaires”, available at: www.lepointsurlatable.fr/images/documents/origineproduits/ CLCVCONSOOrigineproduitsalimCPDP05022012.pdf, 2013. [COW 05] COWBURN G., STOCKLEY L., “Consumer understanding and use of nutrition labelling: a systematic review”, Public Health Nutrition, vol. 8, no. 1, pp. 21–28, 2005. [DAR 73] DARBY M., KARNI E., “Free competition and the optimal amount of fraud”, Journal of Law and Economics, vol. 16, pp. 67–88, 1973. [DRI 06] DRICHOUTIS A., LAZARIDIS P., NAYGA R.M., “Consumers’use of nutritional labels: a review of research studies and issues”, Academy of Marketing Science Review, vol. 10, pp. 1–22, 2006. [EUR 09] EUROBAROMETER, Europeans’ attitudes towards the issue of sustainable consumption and production. Analytical report, available at: ec.europa.eu/ public_opinion/flash/fl_256_en.pdf , 2009. [EUR 12] EUROBAROMETER, “Europeans’attitudes towards food security, food quality and the countryside”, available at: ec.europa.eu/public_ opinion/archives/ebs/ ebs_389_en.pdf, 2012. [FAO 10] FOOD AND AGRICULTURAL ORGANIZATION OF THE UNITED NATIONS, “Definition of sustainable diets”, Proceedings of the International Scientific Symposium: Biodiversity And Sustainable Diets United Against Hunger, Rome, Italy, 3–5 November 2010. [FSA 15] FSANZ, “Consumer Label Survey 2015. Food Labelling Use and Understanding in Australia and New Zealand”, available at: www.foodstandards.gov.au/publications/Pages/consumerlabelsurvey2015.aspx, 2015. [GAL 02] GALLASTEGUI I.G., “The use of eco-labels: a review of the literature”, European Environment, vol. 12, pp. 316–331, 2002. [GIN 00] GINTIS H., Game Theory Evolving. A Problem-centered Introduction to Modelling Strategic Interaction, Princeton University Press, Princeton, 2000. [GRU 07] GRUNERT K.G., WILLS J., “A review of European research on consumer response to nutrition information on food labels”, Journal of Public Health, vol. 15, no. 5, pp. 385–399, 2007. [GRU 14] GRUNERT K.G., HIEKE S., WILLS J., “Sustainability labels on food products: consumer motivation, understanding and use”, Food Policy, vol. 44, pp. 177–189, 2014. [HIE 12] HIEKE S., TAYLOR C.R., “A critical review of the literature on nutritional labeling”, Journal of Consumer Affairs, vol. 46, no. 1, pp. 120–156, 2012.

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[LUS 09] LUSK J.L., BRIGGEMAN B.C., “Food values”, American Journal of Agricultural Economics, vol. 91, no. 1, pp. 184–196, 2009. [MAZ 08] MAZZOCCHI M., LOBB A., BRUCE TRAILL W. et al., “Food scares and trust: a European study”, Journal of Agricultural Economics, vol. 59, no. 1, pp. 2– 24, 2008. [NAY 98] NAYGA R.M., LIPINSKI D., SAVUR N., “Consumers’use of nutritional labels while food shopping and at home”, Journal of Consumer Affairs, vol. 32, no. 1, pp. 106–120, 1998. [NCM 07] NCM, Food Labelling: Nordic Consumers’Attitudes to Food Labelling, Nordic Council of Ministers, Copenhagen, 2007. [NOC 14] NOCELLA G., ROMANO D., STEFANI G., “Consumers’attitudes, trust and willingness to pay for food information”, International Journal of Consumer Studies, vol. 38, no. 2, pp. 153–165, 2014.

10 Social Appropriation of “Diet and Health” Information: From Public Health Campaigns to Digital Tools

10.1. Introduction1 The increase in social inequalities linked to health and the increase in chronic food-related diseases raise the question of the effectiveness of preventive and health promotion actions, particularly those undertaken since 2001 as part of the PNNS (French National Nutrition and Health Program) [IRZ 15, ROM 15]. Indeed, the public health campaigns on diet are struggling to reach the lower-income groups, which are not very sensitive to dietary recommendations that promote health [BAT 16, INS 14, REG 09]. Chapter written by Faustine RÉGNIER. 1 This reflection is based, in particular, on a French presentation entitled “Déterminants sociaux des comportements de prévention: des campagnes de santé publique aux outils connectés”, which was presented at the NutriPerso seminar, Paris-Saclay, on June 6, 2017. I would like to thank Louis-Georges Soler in particular for inviting me to present my work on this day and for giving me the opportunity to develop these analyses. In addition, three research projects conducted at INRA, Aliss, on power-connected tools are also mobilized: “Diet 3.0. Impacts des outils connectés pour une meilleure alimentation” (Métaprogramme Did'It, INRA); “FacilEat4All. Leviers et outils de promotion d’une meilleure alimentation pour tous via la numérique” (Ferrero and the Île-de-France Interdepartmental Regional Directorate for Food, Agriculture and Forestry) and “NutriPerso. Tailoring food and dietary recommendations to prevent chronic diseases: health, social and economic issues” (Strategic Research Initiative, Université Paris-Saclay, Louis-Georges Soler [ed.]). I would like to express my gratitude to those who have contributed to the funding of this research and who, with their trust, have made it possible to deploy it.

Food and Health: Actor Strategies in Information and Communication, First Edition. Edited by Viviane Clavier and Jean-Philippe De Oliveira. © ISTE Ltd 2019. Published by ISTE Ltd and John Wiley & Sons, Inc.

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However, we are in the midst of an economic crisis that has led to an increase in inequalities in food consumption and health [INS 14]. The ideal of a middle-class society, which dominated in the 1970s and 1980s, is slipping away from us [CHA 06], and with it, the hopes of social homogeneity. In a context of increasing inequalities in food consumption and health, as evidenced, for example, by the unequal prevalence of obesity [MAT 16] and diabetes [TAN 12], forms of polarization of food consumption, tastes and preferences are observed. In addition, the increase in chronic diseases of nutritional origin has led to prevention and awareness actions to improve nutrition, a major public health issue. At any rate, we find ourselves in a context that is sometimes referred to as the “digital revolution”. New health technologies – widely disseminated within French society [BIG 13] – are perceived as potentially more effective media for disseminating “diet and health”2 information, particularly among populations that are not very sensitive to traditional health recommendations, especially the working class. The spread of new diet technologies to the general public raises high hopes, but equally strong fears. The purpose of this contribution is to analyze the methods of disseminating “diet and health” information and its forms of social appropriation. The aim will be to identify the social determinants for perceiving “diet and health” information and the role of social structure in the way individuals receive and implement recommendations, first through public health campaigns and then through the recent use of digital tools. We will thus establish a comparison between the two forms of information dissemination, showing the parallels and possible particularities or shifts in the social appropriation of recommendations issued according to these two channels of dissemination. What are the social factors that shed light on the attention and implementation of general information, formulated for the entire population within the framework of the PNNS? To what extent could new technologies be more effective than public health campaigns, particularly because they are based on personalized information? Will the use and appropriation of

2 We refer to “diet and health” as all information relating to the dissemination of recommendations for a healthier diet, whether this injunction is explicit (“for your health, eat less fat”) or implicit (“five fruits and vegetables per day”).

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personalized information be simpler, for example, by avoiding the social divisions that mark how general campaigns are received? To answer these questions, our contribution is based first on a review of official documents (reports and expert opinions) evaluating the PNNS, then on documentation (medical, sociological or more broadly general public) and on digital “diet and health” tools. These documents are important for identifying PNNS policy directions and ambitions, on the one hand, and for identifying ICT issues in the food sector, on the other hand. This contribution also builds on our previous work on the dissemination and reception of nutrition-related health messages, disseminated within the framework of the PNNS [REG 09]3, as well as on ongoing research conducted at INRA on personalization tools in the field of diet, health and physical activity, which led to the creation of a corpus of 122 semi-directive interviews. Three populations are considered here. We first surveyed individuals using a customized “diet” or “physical activity” self-measurement tool (n = 81): these tools allowed for the measurement (of diet and physical activity), storage and sharing of data online and provided access to a social network with discussion forums. Three tools were taken into account: Weight Watchers and MyFitnessPal mobile applications, and physical activity monitoring tools (watches, bracelets or smartphone applications). We also surveyed individuals who participated in an experimental protocol for using a NutCracker “Cuisine” application in Magny4, in a particularly disadvantaged commune in the Paris suburbs5. This protocol aimed to raise awareness of better nutrition through a digital application that offers, in a fun way, recipes adapted to small budgets, and based on participation in an online social network6 [DAR 17]. This device is not presented here, but the interviews conducted with the women who used it allowed us to have access, on these digital “diet” issues, to the uses and representations of the least marginal group (middle classes) of the popular 3 Research funded by Ferrero and ANR AlimInfo. 4 The places and names of individuals have all been made anonymous. 5 In 2014, this French municipality had an unemployment rate of 14%. 6 This NutCracker project, co-financed by Ferrero and DRIAAF, involved the Foundation Agir contre l'exclusion (FACE), in charge of coordination in the field, and the ANCA Chair, which developed the scientific and pedagogical content of the application and created a teaching kit to help support beneficiaries. The development of the application was carried out by the start-up company NutCracker.

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categories (n = 9). This user group was supplemented by interviews with diabetic patients or those with pre-diabetic conditions, and users of personalization tools (n = 19). The specific problem of managing a pathology is not the subject of this work: these interviews were mobilized with a view to analyzing the social factors of use and appropriation of personalized “diet and health” tools. In order to be successful in the general population, this corpus was supplemented by interviews conducted with individuals who were no more or less users, a priori, of personalized tools. With these individuals, we reviewed the acceptability of digital technology and the uses of new technologies in all their dimensions, with a particular focus on “Food” digital technology (n = 13). 10.2. Dissemination and appropriation of “diet and health” information in public health campaigns 10.2.1. Dissemination of general information Following an alert issued by the WHO on a future obesity epidemic [WHO 97], diet has been the subject of public health plans in France since the early 2000s, which has led to the establishment and subsequent dissemination of a set of food recommendations. Launched in 2001, the PNNS’s general objective is to improve the health status of the entire French population by working on one of its major determinants, nutrition, as well as on physical activity [HON 11]. A series of nutritional recommendations – which will gradually become the official references in the field of nutrition – will be disseminated in this context, in order to promote better nutrition and increased physical activity. The PNNS puts nutrition on the political agenda as a factor in population health, leading to the promotion of a discipline – nutrition – that was previously undervalued. More specifically, obesity legitimizes, or at least constitutes, the outlook for this program [REC 17]. The PNNS has experienced four five-year waves: 2001–2005, 2006–2010, 2011–2015 and 2016–2019, which have led to several major information campaigns, such as “Manger bouger” (eat move) in 2004 and “5 fruits et légumes par jour” (5 fruits and vegetables per day) in 2008 [ROM 15]. These public health campaigns have targeted a wide audience, wishing to avoid, through specific targeting, the stigmatization of certain populations. The third campaign alone focused on reducing social health

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inequalities in the field of nutrition. As a result, the social dimensions of both food and adherence to the recommendations were less taken into account, and it appeared that these campaigns were not very effective in reaching the populations that would have needed them most: the low-income populations [BAT 16, INS 14, REG 09]. 10.2.2. General information: socially unequal reception Indeed, studies show a wide dissemination of these campaigns and good knowledge of them by the population, but a socially differentiated implementation. The Baromètre santé nutrition surveys in France reveal a significant improvement in knowledge of nutritional benchmarks highlighted by the PNNS between 2002 and 2008 [ESC 09]. However, this knowledge varies greatly depending on the food category. Some benchmarks are better known thanks to PNNS campaigns. In particular, the recommendation for fruits and vegetables has increased significantly (a 10-fold increase in individuals with knowledge of the benchmark between 2002 and 2008) [AFS 09]. However, increasing knowledge of nutrition does not lead to a change in eating habits. Although there has been a shift in food consumption towards greater compliance with PNNS benchmarks, consumption is still far from national recommendations: in particular, there are significant differences based on several socio-demographic factors (gender, age, economic level). It is then necessary to ask more precisely about how this general “diet and health” information is received and implemented. Our work shows that the nutritional recommendations issued as part of public health campaigns are widely known, but that their implementation reveals a strong social divide between the wealthier categories (managers) and the poorer categories (workers, employees, enforcement agents; see Figure 10.1). In the wealthy categories, dietary recommendations were well received, well understood and easily put into practice. In contrast, members of the lower-income classes were fully aware of the different recommendations, but perceived them as an external imposition that they should resist, in the name of their tastes and lifestyles. Between the two, members of the well-integrated categories were particularly attentive to health norms and

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very keen to implement them, but at the cost of considerable effort and high stress levels [REG 09].

Figure 10.1. Social appropriation of “Diet” public health campaigns: a strong social divide (source: [REG 09, p. 752])

This social divide can be explained by a series of social factors. The first are related to social status (profession, diploma level, income level). This leads to severe budgetary and time constraints, which shape both daily food practices and attention to PNNS recommendations. Budget was the main factor structuring food choices among the working class in our survey, and it is known that low-income households in France consume fewer products whose consumption is valued in terms of PNNS benchmarks, particularly fresh fruits and vegetables, and fish [PLE 12]. Coming from low-income backgrounds and on a path of social advancement, Khadidja explains: […] it is extremely expensive, like nothing else, to feed oneself properly, [now] I can afford to buy small quantities and of “good quality” (intermediate profession, 2 children). However, the difficulties in implementing the recommendations cannot be reduced to economic obstacles: food consumption has a social dimension, where collective tastes and representations are involved. Thus, the perception of what it means to eat well is a matter of differentiated social representations. In the wealthier categories in our survey, “eating well”

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meant being in immediate contact with health and weight loss, the two being often mixed, especially among women. Eating practices, and even preferences, were shaped by a concern for health and weight control. Individuals established an immediate link between their preferences and dietetics: in wealthier categories, individuals had a taste for what they considered to be healthy. On the other hand, for members of the lower-income categories, “eating well” was not related to health or a concern for achieving slimness: individuals had a taste for good things because they tasted good, and not because they were valued by dietetics. What was most important, in the diet of the working classes, was the abundance of food at the table and the possibility of a choice that is offered in particular to children. Thus, everything Christophe, a manager, opposed. He explained about one of his sons: “I really take care with him, so that he doesn’t eat just anything”; for Nicolas, also a manager, talking about his children, he revealed: “We monitor them”; for Valérie, a housewife, who spoke about the snacks she used to give to her children: I think that when a child comes home from school, well, we should make him happy because that’s the way it is […]. I didn’t think it was too dramatic to give a small bottle of Coke with a Mars bar, at 4 o’clock. This concern for food abundance (which can lead to forms of overindulgence, sometimes interpreted in terms of aberrant consumption in environments with limited budgetary resources) and choice (sometimes seen as a laxity, or even a resignation by parents, since it is a question of spoiling children through food) has very specific meanings: food, the first accessible luxury, represents a victory over a deficiency and previous frustration. Food consumption is the area where we prove that we are not rich, but that we have access to consumer society. In the context of identity erosion among the working class and the weakening of their major integration structures (labor, trade unions), food consumption is now considered as a form of integration and participation in social life. The third factor is socially differentiated conceptions of health. In the wealthier categories, we were dealing with a preventive approach, where health was conceived in the long term. The implementation of nutritional recommendations was part of a vision of time, a projection into the future and a form of betting on rules that we apply, but that we will have – perhaps – consequences in 40 years’ time. The attention paid to food was part of a

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healthy lifestyle and daily diet in the broadest sense. In the low-income categories, perspective was remedial. The model concerns that of disease that arises suddenly, when health is often an abstract concept. Food can heal, of course, but it can be done using a diet and on an ad hoc basis, and not in the sense of a healthy lifestyle: the temporal horizon is that of a meal. Consequently, the “health” argument used in the PNNS campaigns (“pour votre santé, mangez moins gras, moins sucré, moins salé” [for your health, eat less fat, less sugar, less salt]) was not very effective in low-income environments. Finally, the representations of the body differ according to social categories. Thus, if slimness is in particular the dominant norm of bodily excellence, then this concern for weight control was not socially shared: the interest in slimness increased with social hierarchy. Female managers and members of intermediate professions, who were less affected by obesity and had a smaller body size than the working class, also had a more constraining vision of the body size to be achieved in our survey: they weighed themselves and participated in sports activities more regularly. Françoise (manager, two children) justified her permanent attention to weight gain, which she has, over the years, incorporated: “And then I, like everyone else, when I eat, I get fat, so I keep an eye on myself”. On the other hand, in low-income environment, many overweight women were well aware of their overweight status, and they perceived their distance from the dominant norm of slimness, as conveyed by the media in particular. However, they also found themselves in a situation of de facto normality in their social membership group, where average body size was large and obesity was much more prevalent [REG 17a]. Karima (housewife, four children, husband a manual worker) explains: No, we like to eat, we like to eat. There are people who are thinner than us and who… me, it’s true, my weight has never bothered me […]. When people say to me, ‘Why don’t you lose weight?’ No, I’m fine as I am. In addition, there is a gender effect: gender differences double social differences [INS 14]. Women in our survey showed a higher sensitivity to the health dimension of diet than men, which led them to consume significantly more of the food categories considered “good for your health” and promoted in national campaigns (especially fruits and vegetables).

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Dynamic dimensions must also be taken into account: roles in the life courses that have a strong influence on feeding practices [DEV 05] and health behaviors. Some life course events are good occasions to implement recommendations. This is the case very specific for pregnancy [KAD 17] and parenthood [REC 17] – the arrival of a child make parents more attentive to preventive actions. The trajectory, migratory or social, also influences. Social ascent trajectories are thus dynamics that favor the implementation of information on “diet and health”. Conversely, among the lower-class groups we encountered in our investigations, there were high tensions among individuals, between the need to maintain past food practices that comply with the recommendations and the financial difficulties of continuing to apply them. Finally, social integration is a major challenge: attention to recommendations and nutrition as a health factor is all the more important as individuals are well integrated socially. There are strong differences between an individual whose integration was centered solely on the family and an individual who has a broader sociability, notably through employment. Thus, an individual in a modest environment, well integrated socially, in contact with members of categories who are better placed socially – for example, through employment – will be led to implement the recommendations more easily than an individual whose socialization is the exclusive responsibility of their social group. 10.3. “Diet and health” information and personalized digital tools: issues and shifts 10.3.1. Customization tools: are they effective media? Connected tools (smartphone applications, sensors) enable a new way for individuals to track their diet and physical activity [PHA 13]. Offering new possibilities for mediation on diet and health issues, they could prove to be more effective forms of preventive media for populations that are not very sensitive to conventional health recommendations: they would facilitate the dissemination of targeted and tailor-made recommendations at a lower cost [REG 16]. These tools are diverse, and the food-related fields they cover are vast: they are at the crossroads between health and well-being, and between culinary activity and sports activity. From there, tools centered on physical activity (connected watches, Fitbit bracelets, smartphone applications) are developing, among the most widespread, and tools centered on nutrition,

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most often from a nutritional perspective. Both types of tools are based on a self-measurement approach based on individuals quantifying their body functions related to diet and physical activity. Other tools are relevant to the management of a chronic disease, such as diabetes (connected glucometer, digital diary). Finally, some of them take the culinary field as their entry point, but also seek to promote a so-called “healthier” diet. For example, the Marmiton website and application are oriented towards cooking, but they also convey, through a “Better eating” section, “health” recommendations. Analysis of the literature on new technologies in the field of “diet and health” reveals high levels of stress between the hopes that these tools crystallize and the fears they raise. This stress is expressed at three levels: that of nutrition, that of individual behaviors and that of the social changes they can introduce (see Table 10.1).

Food

Individuals Company name

Hopes

Fears

Convenience

Medicalization and technicization

Dissemination of information

Standardization

Prevention

Commercial tools

Autonomy

Monitoring

Personalization

Accountability

Reduced inequalities

Increased inequalities

Table 10.1. Digital “Diet” tools: high stress levels

In terms of food practices, the practicality of the tools, their potential for large-scale spin-offs as well as the playful dimension of connected tools and gamification are an essential element in their appeal and effectiveness [ELL 11], particularly in the area of changing dietary practices. For example, the systematic review of randomized trials on the effectiveness of connected tools in physical activity and dietary behavior conducted by Broekhuizen et al. [BRO 12] highlights the positive effects of customized programs in terms of lack of information or generic information. Conversely, the risks of increased medicalization of the diet and health sectors [CNI 14] and therefore the risks of technological development are feared, as are those of standardization of private conduct [REG 17b]. At the individual level, some studies show how these tools can lead to empowerment [EUR 14, SWA 09]. The possibilities they offer in terms of

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personalization of information seem infinite and would make it possible to overcome one of the limits of general campaigns, that of not taking into account individuals’ specific natures or even those of certain target groups. However, the negative effects of tools that place the individual at the center of the devices are just as numerous. These dangers are highlighted, in a critical approach, particularly by sociology. Thus, D. Lupton’s work denounces the health imperative underlying many connected tools, which contribute to an increase in personal responsibility for health. The self-monitoring dimension of connected objects would be at the origin of new initiatives to standardize eating habits. Consequently, digital tools could well constitute new representatives of a form of domination [LUP 14]. Finally, at the level of social structure, it is not clear whether these tools will lead to a reduction in the social gradient of health or, on the contrary, to a worsening of inequalities. These stresses indicate that we have little knowledge today of the role and impacts that digital tools can have in providing “diet and health” information. What effects will the diffusion of these new tools have on the practices and representations of our diet? Does the chasm between wealthy and low-income categories, central to the appropriation of “diet and health” information, remain relevant in our relationship with digital technology? What are the uses that individuals make of digital technologies in their daily lives, and how do these uses modify their eating practices? Uses are all the more important because – as S. Fainzang points out in connection with connected tools in the health sector – it is not the existence of personalization tools that will modify behaviors, but the uses that individuals make of them, as well as their perceptions of them [FAI 17]. Moreover, what is the future of digital “diet and health” tools in a French context where the food sector is hardly part of a nutritional and quantified vision, unlike the United States, for example, and where autonomy is less valued than in the English-speaking world? Therefore, under what social conditions is personalized information effective, and what is the role of socio-economic factors? These questions are linked to four major social issues, which can be addressed in parallel with those of public health campaigns. The first challenge lies in social differences: these are strong in the adherence to general “diet and health” information. It is then a question of evaluating these hierarchical effects in the use of personalization tools. The second issue is the

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perception of information: the implementation of PNNS recommendations involves several socio-economic factors. What are the social, economic and cultural conditions for the use of digital tools? What social dimensions promote their effectiveness? Do we find the same factors as in the appropriation of general information, and are we dealing with an amplification, or a decrease in the role of these factors? The third issue concerns reactions to “diet and health” information. Information issued under the PNNS has shown flexible forms of membership (wealthy categories), resistance (low-income categories) and extreme membership (middle-class categories). What is the perception of the information disseminated by digital tools? What are the effects produced by the use of personalization tools, between autonomy and perverse effects (guilt, dependence)? Is there any shifting? Finally, the fourth issue concerns social inequalities. The “health” argument, as we have seen in the context of the PNNS, is not very effective within modest categories: is digital technology more effective? Finally, what leverage would be effective for these categories: that of self-measurement of food intake from a nutritional perspective or a culinary lever perhaps? 10.3.2. First lessons: plural shifts and appropriations of information via digital technology The results of research conducted at INRA on personalization tools in the field of food underline the persistence of a strong social divide in forms of appropriation, as well as transformations and shifts [REG 18b]. If we first consider the “diet and health” information relating to self-measurement tools, we observed a strong social divide in individuals who were rather resistant to digital technology and the self-quantification process, to the most connected individuals and the most adept at self-measurement. This opposition covers a second one, between those who had connected tools with a constrained and passive use and those who had a chosen and active use. This division reflects the opposition between individuals using digital tools to manage their weight gain, i.e. from a curative perspective, and those who used them for prevention. This corresponds to the opposition between low-income categories (workers, employees), on the one hand, and wealthy and middle-class categories, on the other hand (see Table 10.2). Membership of intermediate categories to “diet and health” information in digital tools shows a significant shift away from public health campaigns:

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these individuals seem to have found, with the use of digital tools, a mode of putting “diet and health” information into practice that is specific to them. Personalized self-tracking tools allow them to escape – especially in the event of being overweight – from those who overlook them socially, or from the medical authorities who supervise them. These tools constitute real tools of autonomy for those individuals who belong to this category of the population particularly attentive to food prescriptions and eager to implement them [REG 09], and at the same time critical towards traditional knowledge, resulting from medicine, for example [ADA 16]. This is particularly evident in the interview with Laure (intermediate profession, single without children): I have terrible memories of doctor’s check-ups, of dietician check-ups, where you get yelled at every time you step on the scale […], where there is mistrust of you, where they assume you’re lying […] An application, you are alone in front of this application, if it doesn’t work, there’s no one who will judge us, lecture us […] You can make adjustments yourself […], that’s what I like. Resistant

Convinced

Digital or self-measurement: “It was mandatory to note the pro-points, every time, at every meal”.

Adherence to self-measurement: “My concern is to count calories above all”; “I like to count and check”

Constrained and passive use: “I’m just looking to see, for the record”.

Select and active use “I keep myself in check using the app”

Curative perspective “I wanted to lose weight”; “it’s more a case of losing weight”

Preventive perspective: “It’s prevention”; “it’s more like prevention”

Modest categories: 32 individuals out of 79

Well-off categories and intermediates: 47 individuals out of 79

Table 10.2. Users of “Diet” self-measurement 7 tools: a strong social divide

7 We provide in quotation marks some excerpts from interviews that are particularly representative of the discourses collected.

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A series of social factors shed light on these differences [REG 18b] (see Table 10.3). Obstacles

Aids

Material obstacles

High-performance equipment and immediacy

Lack of knowledge of ICT and cultural illegitimacy

Familiarity with ICT

Food = freedom

Food = health

Without additional constraints

Sport and self-help

Measuring the budget

Measuring calories

Table 10.3. Aids and obstacles to the use of “diet and health” personalization tools

Some factors are specific to digital tools, in particular the technical dimension: the possession of high-performance tools limits the obstacles associated with slow connections or session interruptions, for example. In the case of Facebook, the technical instability of the prototype, with very frequent session interruptions – which forces users to enter their username and password each time – is the most common barrier mentioned in the interviews. Thus, Rokhia (working husband, father of four children) abandoned the use of the “Cuisine” application prototype, because of the reset constraints that required the reintroduction of a password: “[…] I logged in before, I forgot my code, but since then I’ve lost my password […]”. However, it is precisely the speed of use of applications that is a key factor in user satisfaction [JOS 15]. This is well expressed by Gabrielle (executive, married, two children), user of the MyFitnessPal application, who explains that keeping a food diary is a fast method. For example, entering your food intake for breakfast, “it takes two minutes, it’s very fast”. In addition, familiarity, by profession or level of education, with the Internet and new technologies led members of the well-off group to use connected tools much more easily. Danielle, talking about the Fitbit bracelet she has not been able to turn on since she bought it, explains: “I have one, but… but I don’t know how to use it. No one can explain to me how to connect it”. Other factors are related to diet and health issues. In particular, self-measurement tools correspond to the diet norms of wealthier categories,

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a social category that shows an interest in constant monitoring of diet and body size, from a preventive perspective: these individuals find in self-tracking tools a new, faster, more precise, often more playful mode of monitoring and controlling their diet and physical activity even more closely. The self-measurement approach is also favored by members of intermediate professions, who were shown to adhere more strongly than others to food injunctions: this middle class – which ranges from the most integrated of employees to the intermediate professions – finds in them, by imitation, a way to access, through their own channels, “diet and health” information and to put it more easily into practice [REG 18b]. For Aicha, an employee, MyFitnessPal represents the exercise of her freedom: “The freedom to choose what I want to eat. No one is forcing it on me. That’s what I didn’t like about dieting. It’s that on a given day, you have to eat this; on a given day, you have to eat that”. On the other hand, in the working class, the spread of self-measurement tools came up against a conception of food choices as a space for freedom, and a valuation of consumption “without counting” – i.e. not without limits, but without imposing on oneself an additional calculation, which is always present in households under strong economic constraints. In terms of “calculation”, Madeleine referred rather to her management under the constraints of the “shopping budget”, rather than that of calories. The diffusion of self-measurement tools also comes up against representations of health, which value a curative approach much more than preventive and specific representations where “taking care of your body” is hardly a matter of physical expenditure or quantification: on the contrary, it is a question of protecting, strengthening and reconstituting the body as a working tool and not as an object of work, now in terms of digital technology [TIL 14]. In addition, new technologies are more readily used for relaxation and leisure, in particular, online games, whether networked (role-playing, poker) or individual (e.g. solitaire), as well as good online deals, on eBay, for example [REG 18a]. The field conducted in the context of a pathology – diabetes – reveals, in the state of our analyses, the same lines of social division: the individuals who had most easily and quickly adopted self-measurement tools to manage the disease belonged to the well-off or intermediate environments [REG 17b]. However, some specific features are emerging. If, in the general

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population, we distinguished between active and passive uses, the context of a chronic disease reveals a third type of use, captive use [FAI 17]: the measurement and recording in writing of medical data, transmitted directly to medical teams, escapes the patient: “I enter my data and that’s it” (retired). Moreover, it is in this context of a pathology that a form of guilt is more explicitly expressed. The injunction to see a deviation from the dietary recommendations transmitted by the doctor, relayed by the digital tool, is a factor in making individuals feel guilty. Other factors emerge through the analysis of customization tools based on a culinary approach. These digital “Cuisine” tools are much more familiar to individuals than self-measurement tools, even in relatively modest environments, as evidenced by the success of the Marmiton application, for example. However, the culinary lever mobilized by NutCracker has generated limited support. The post-intervention field survey, conducted in Magny to evaluate the uses and impacts of this application on culinary practices, revealed very limited use of NutCracker by the women for whom it was intended. Of the 28 women to whom the application was presented, only seven downloaded it, and of these, four used it. Only Martine (see Box 10.1) reported frequent use, publishing recipes (nine shared recipes) and answering the quiz (she answered more than 200 questions). Thus, the least marginal group from low-income environments demonstrated a great distance maintained from these digital “Cuisine” tools: these were individuals whose living conditions were close to precarity with a strong dependence on social services. The integration of these individuals was based exclusively on the social group to which they belong and, for women, on family integration, due to unemployment and/or spatial distance from other social categories. Various factors combined here: the very limited command of digital tools, combined with social isolation, cumulated financial and time constraints, poorly written and even French language skills, as well as the refusal to expose oneself and to speak out in a social network, constitute particularly extreme obstacles in this case. Our analyses have thus underlined that the search by women from very low-income backgrounds for social ties in real life hindered their integration into digital communities [REG 18a].

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Good social integration In terms of NutCracker, Martine differed from the other women recruited in Magny by her very slightly superior social position. Particularly independent, she tried during the interview to indicate, with great finesse, her difference compared to the social background of women attending cooking workshops, and to distinguish herself from the bad reputation of a municipality often cited in the media for social problems, of which she is the subject. Even though she was looking for work at the time of the survey, Martine showed excellent social integration, linked to a strong local sociability, to associations in particular, which she combined with strong online sociability: Martine was particularly comfortable on the Internet, and specifically in the many social networks with which she was involved (Facebook, Twitter, Snapchat, Pinterest, YouTube). It was above all her position as a cultural intermediary, straddling two cultures, that led her to particularly invest in the field of “culinary” digital technology, whether it was NutCracker or, previously, other social sites or networks (Marmiton in particular, or her own Facebook page on which she publishes her recipes). Originally from Senegal, Martine arrived in France a few days after her birth: “So, I know the French culture, the culture of my country of origin; and here I am, I like mixing the two cultures a little bit and everything, yes that’s me”, which differentiated her from the other participants, who arrived much later in France, often as adults. This dual affiliation leads her to particularly invest in the culinary field as a means of exchange and discovery of cultures. As a way, also, to “value a little but this side of Magny, which we don’t know too well” and, she hopes, to reverse the negative image that is attached to her town. The ease of communicating online This good self-image also led her to be comfortable publishing her personal recipes online. Putting material online presupposes a real self-exposure: we know that cooking touches upon identity – individual or social [REG 06] – and it is very likely that for many women, publishing a recipe is experienced as the exposure of an intimate domain, that of domestic cooking or that of their cultural origins that they perceive as devalued in a migration context. Martine was particularly proud of her dual culture, which she liked to talk about in the survey. By a happy coincidence, moreover, the most popular recipe on NutCracker’s social network was the “spring chicken”, which she posted, and which is a recipe from her childhood. However, Martine needed a certain level of self-esteem to publish it, because the recipe differed both from French culinary traditions and from the dietary norms: first of all, the recipe was opposed to what Martine perceived as traditionally French: “In French culture, peas are not put with a tomato sauce and onions”. Second, she pointed out that the recipe, which includes two forms of starch (rice and peas), does not comply with the nutritional recommendations of which members of the working-class categories have been widely informed since the launch of the PNNS in 2001: “Peas are therefore starch… Rice also, therefore, it’s these two starchy foods in the recipe. It wasn’t very, very balanced”. Hence, her strong investment in the Facebook application. However, Martine faced a relative isolation in the particularly active use she had of it.

Box 10.1. Martine, the conditions for success

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These results finally lead us to question the respective place of the written word and the image: we were thus able to observe to what extent the image – videos on YouTube, as well as television – in these particularly disadvantaged environments competes with the written word, via new technologies as a means of disseminating information on diet. Talking about her sources of culinary inspiration, Éveline (employee, two children, divorced), a housekeeper, explains: “I often watch TV… But the Internet, I don’t use it”. People who were less comfortable with the French language used the Internet or applications to access culinary knowledge, but only through images: viewing culinary videos on YouTube was preferred over websites or applications where, despite the many photos, writing remains predominant. Keltoum (stay-at-home mother, working class, four children), uncomfortable with the French language, uses YouTube videos, links to which are sent to her by friends on WhatsApp: “I open the video, load it in full screen […]; it’s shorter, easier”. And to search the Internet, she uses Google’s microphone function so she does not have to write anything. 10.4. Conclusion Whether it is the dissemination of “diet and health” information as part of public health campaigns, or personalized dissemination through digital tools, the way individuals receive, interpret and put into practice this information reveals forms of social appropriation. The reception and implementation of the recommendations disseminated within the framework of the PNNS since 2001, targeting the whole French population, has shown the need to take into account the value systems, tastes and lifestyles of members of the low-income classes, so that these information dissemination actions are no longer considered as an injunction from the top down in society. New technologies, because they put the individual at the center, offer new opportunities for personalizing information. However, the forms of appropriating the “diet and health” information disseminated by personalization tools are also complex and linked to social dimensions. Some factors are similar to those found in the dissemination of public health campaigns (values and perceptions related to food, in particular), and others are specific to new technologies (ranging from technical issues to the role of

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the written word). Significant shifts must also be highlighted, particularly for members of intermediate professions. These individuals are particularly receptive to the recommendations made as part of public health campaigns, but have difficulty implementing them. Consequently, they have seized these new “diet and health” technologies. They have found, in the connected tools, a way of putting “diet and health” information into practice that is unique to them. However, digital tools are by no means a miracle solution to the social gradient of health. Access to these tools and the uses to which they are put to, involve a series of social factors that risk further marginalizing the most modest groups in society. From a public health perspective, it is essential to take into account the economic, cultural and social conditions of reception, in a context of growing health inequalities. 10.5. References [ADA 16] ADAMIEC C., Devenir sain. Des morales alimentaires aux écologies de soi, PUR/François Rabelais, Rennes, 2016. [AFS 09] AFSSA, Étude individuelle nationale des consommations alimentaires (INCA 2), Report, 2009. [BAT 16] DE BATZ C., FAUCON F., VOYNET D., Évaluation du programme national nutrition santé 2011-2015 et du Plan obésité 2010-2013, Inspection générale des affaires sociales, 2016. [BIG 13] BIGOT R., CROUTTE P., DAUDEY E., La diffusion des technologies de l’information et de la communication dans la société française, CREDOC, Report no. R297, pp. 1–273, 2013. [BRO 12] BROEKHUIZEN K., KROEZE W., VAN POPPEL M.N. et al., “A systematic review of randomized controlled trials on the effectiveness of computer-tailored physical activity and dietary behavior promotion programs: An update”, Annals of Behavioral Medicine, vol. 44, no. 2, pp. 259–286, 2012. [CHA 06] CHAUVEL L., Les classes moyennes à la dérive, Le Seuil, Paris, 2006. [CNI 14] COMMISSION NATIONALE DE L’INFORMATIQUE ET DES LIBERTÉS (CNIL), Le corps, nouvel objet connecté, Cahiers Innovation et Prospective, 2014.

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[DAR 17] DARCEL N., DUGRE M., REGNIER F., “Conception, mise en œuvre et mesure des effets d’un réseau micro-social pour la promotion d’une alimentation saine en milieu défavorisé”, Journées francophones de nutrition, Poster, Nantes, France, 13–15 December 2017. [ELL 11] ELLERBROK A., “Playful biometrics: controversial technology through the lens of play”, The Sociological Quarterly, vol. 52, no. 4, pp. 528–547, 2011. [ESC 09] ESCALON H., BOSSARD C., BECK F. (eds), Baromètre santé nutrition 2008, INPES, Saint-Denis, 2009. [EUR 14] EUROPEAN COMMISSION, Green Paper on mobile Health (“mHealth”), Green paper, April 2014. [FAI 17] FAINZANG S., “Patients, médecins et santé connectée”, Pratiques. Cahiers de la médecine utopique, vol. 79, no. 10, pp. 32–35, 2017. [HON 11] HONTA M., HASCHAR-NOE N., “Les politiques préventives de santé publique à l’épreuve de la territorialisation : l’introuvable gouvernance régionale du programme national nutrition santé en Aquitaine”, Sciences sociales et santé, no. 4, pp. 33–62, 2011. [INS 14] INSERM, EXPERTISE COLLECTIVE, Inégalités sociales de santé en lien avec l’alimentation et l’activité physique, Report, Inserm, Paris, 2014. [IRZ 15] IRZ X., LEROY P., RÉQUILLART V. et al., “Economic assessment of nutritional recommendations”, Journal of Health Economics, vol. 39, pp. 188–210, 2015. [JOS 15] JOSPE M.R., FAIRBAIRN K.A., GREEN P. et al., “Diet app use by sports dietitians: a survey in five countries”, JMIR mHealth and uHealth, vol. 1, no. 3, 2015. [KAD 17] KADAWATHAGEDAR M., KERSUZAN C., WAGNER S. et al., “Adéquation des consommations alimentaires des femmes enceintes de l’étude ELFE aux recommandations du Programme national nutrition santé”, Cahiers de nutrition et de diététique, vol. 52, pp. 78–88, 2017. [LUP 14] LUPTON D., “Beyond techno-utopia: critical approaches to digital health technologies”, Societies, vol. 4, pp. 706–711, 2014. [MAT 16] MATTA J., ZINS M., FERAL-PIERSSENS A.L. et al., “Prévalence du surpoids, de l’obésité et des facteurs de risque cardio-métaboliques dans la cohorte Constances”, Bulletin Epidémiologique Hebdomadaire, vols 35/36, pp. 640–646, 2016.

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[PHA 13] PHARABOD A.S., NIKOLSKI V., GRANJON F., “La mise en chiffres de soi. Une approche compréhensive des mesures personnelles”, Réseaux, vol. 177, pp. 97–129, 2013. [PLE 12] PLESSZ M., GOJARD S., “Do processed vegetables reduce the socio-economic differences in vegetable purchases? A study in France”, European Journal of Public Health, vol. 23, pp. 747–752, 2012. [REC 17] RECKINGER R., RÉGNIER F., “Diet and public health campaigns: implementation and appropriation of nutritional recommendations in France and Luxembourg”, Appetite, vol. 112, pp. 249–259, 2017. [REG 06] RÉGNIER F., LHUISSIER A., GOJARD S., Sociologie de l’alimentation, La Découverte, Paris, 2006. [REG 09] RÉGNIER F., MASULLO A., “Obésité, goûts et consommation. Intégration des normes d’alimentation et appartenance sociale”, Revue française de Sociologie, vol. 50, no. 4, pp. 747–773, 2009. [REG 16] RÉGNIER F. (ed.), E-Diet: Healthy eating through digital devices, Response to a call for tender by the National Research Agency, FranceLuxembourg, 2016. [REG 17a] RÉGNIER F., “Perception et mise en pratique des recommandations nutritionnelles : l’enjeu des inégalités sociales”, INSERM, Agir sur les comportements nutritionnels. Réglementation, marketing et influence des communications de santé, pp. 211–222, Éditions EDP Sciences, Montrouge, 2017. [REG 17b] RÉGNIER F., LURBE I., PUERTO K. et al., “Diabète et technologies numériques. Usages, tensions et transformations du care”, Journée TechnoCare Technologies du care en santé, Paris, France, 12 December 2017. [REG 18a] RÉGNIER F., “‘Goût de liberté’ et self-quantification : perceptions et appropriations des technologies de self-tracking dans les milieux modestes”, Réseaux, vols 208/209, pp. 95–120, 2018. [REG 18b] RÉGNIER F., CHAUVEL L., “Digital inequalities in the use of self-tracking diet and fitness apps: interview study on the influence of social, economic, and cultural factors”, JMIR mHealth and uHealth, vol. 6, no. 4, p. e101, 2018. [ROM 15] ROMEYER H., “Le bien-être en normes : Les plans nationaux nutrition-santé”, in DE IULIO S., BARDOU-BOISNIER S., PAILLIART I. (eds), “L’alimentation, une affaire publique ?”, Questions de communication, vol. 27, pp. 41–62, 2015.

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[SWA 09] SWAN M., “Emerging patient-driven health care models: an examination of health social networks, consumer personalized medicine and quantified self-tracking” International Journal of Environmental Research and Public Health, vol. 6, no. 2, pp. 492–525, 2009. [TAN 12] TANAKA T., GJONCA E., GULLIFORD M.C., “Income, wealth and risk of diabetes among older adults: cohort study using the English longitudinal study of ageing”, European Journal of Public Health, vol. 22, no. 3, pp. 310–317, 2012. [TIL 14] TILL C., “Exercise as labour: quantified self and the transformation of exercise into labour”, Societies, vol. 4, pp. 446–462, 2014. [WHO 97] WORLD HEALTH ORGANIZATION (WHO), Obesity: Preventing and managing the global epidemic. Report of a WHO Consultation on Obesity, Geneva, 3–5 June 1997, Report, WHO, 1997. Available at: http://www.who.int /iris/handle/10665/63854.

Postface

The questions addressed in the preceding chapters are important: how can we appreciate quality food information that can be perceived, understood and used by consumers, regardless of their social background, to take care of their health? How can health communication on nutrition – for example, in the context of the prevention of obesity and being overweight – be developed without stigmatizing the target audiences? How can young people and children be made aware of food information by taking into account their informational practices? What scientific knowledge is then mobilized for the development of information, education and prevention campaigns? These questions first of all recall the importance of information on food, which removes uncertainty about the composition of food products, by making visible what is not, and qualifying a product for its use by reducing it to its primary determinations and the conditions of its production. It is information for decision and action, in order to allow an informed purchase and consumption. This information presupposes appropriate literacy, that is, literacy that meets required levels of analysis and reception that allow critical appropriation. The visual form that this information takes is at the heart of marketing communication, which must comply with binding regulations and stimulate purchase, arouse “desire” or evoke taste, announce a (possible) pleasure to come. Information “factualizes” certain dimensions of the product, while marketing aims to enchant, even though it means misusing the product’s nutritional or even curative properties. Information reveals by its methods of

Food and Health: Actor Strategies in Information and Communication, First Edition. Edited by Viviane Clavier and Jean-Philippe De Oliveira. © ISTE Ltd 2019. Published by ISTE Ltd and John Wiley & Sons, Inc.

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qualification, the composition, nature and manufacturing of a product. It is therefore disenchanting, unless a new hygienist and health enchantment is carried out by the food itself. The information here seems quite austere, if it does not take on color and take on indicative forms. This is the case with information on nutrition, which is less suggestive than the communication of taste or the fictional communication of the healer-feeder. In a context of socially shared mistrust, and repeated food crises, food information could appear as a counterbalance to unrestrained communication-marketing, but we can guess that it is itself fabricated, composed and creating new myths. What tools do consumers have at their disposal to appropriate, evaluate and contextualize it? What then does health communication on nutrition do by prescribing standards? While it seems to provide guides, surveys note the very diverse exposure of users to information, depending on their social background, in particular: it becomes a source of confusion or a muddle of information, feelings of guilt arise, too. This information can be tailored to the individual and the person suffering from an eating disorder quickly becomes the one who “does not know how to do things”, or lacks the will or even the rigor to do so. In the prevention of obesity and being overweight, for example, information can indirectly mislead users and increase the distance they have taken from their own body signals. There is a link between information and practices, information and anxiety, information and social designation (of those who do not do the right thing). It is clear from this research that information on food in relation to public health is the result of a set of actors who sometimes have converging and sometimes contradictory interests: agri-food manufacturers, organic food actors, small producers, public authorities, associations and nutritionists who intend to act as regulators without constraint, health actors and experts. Between regulation, confidence-building and alarm, these actors play on information as a good and a tool that positions their own role. Which actors are audible, why and how? Media representation is essential here. However, these multiple forms of information are socially unequally consulted and required. Information on food nowadays is being digitized and automated in the form of applications: what modes of appropriation allow these provisions to take place and their own semiology?

Postface

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There is therefore a real interest in developing work and extending those collected in this book that focus on information on food; work that takes into account both the modes of classification of information, the nature of information, the designation (lexicon, terminology), the semiology of information, discursive invention, measurement and quantification, a person’s role and calculations they are involved in (thresholds, for example); the economic and industrial issues that shape food information, the social issues linked to this information (health, prevention, public policy, etc.), trust and mistrust generated, and their instigating markers, the audience of this information, the question of informational “literacy” and user skills, the fate of this information, its orientation for action, its archiving for possible investigation or recourse. In other words, we must develop a critical and longitudinal approach to food and health information related to eating practices. David DOUYÈRE

List of Authors

Estera BADAU CIM – IAME Universities of Paris 3 Sorbonne Nouvelle and Paris Diderot France

Anne-Laure BOREL INSERM Grenoble Alpes University Saint-Martin-d’Hères France

Sylvie BARDOU-BOISNIER GRESEC University of Clermont Auvergne Clermont-Ferrand France

Davide BORRELLI MedEat Research Suor Orsola Benincasa University of Naples Italy

Sarah BASTIEN CIMEOS University of Bourgogne Dijon France

Hélène BURZALA CIMEOS University of Bourgogne Dijon France

Marie BERTHOUD GÉRiiCO University of Lille Villeneuve d’Ascq France

Viviane CLAVIER GRESEC Grenoble Alpes University Saint-Martin-d’Hères France

Food and Health: Actor Strategies in Information and Communication, First Edition. Edited by Viviane Clavier and Jean-Philippe De Oliveira. © ISTE Ltd 2019. Published by ISTE Ltd and John Wiley & Sons, Inc.

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Simona DE IULIO GÉRiiCO University of Lille Villeneuve d’Ascq France

Audrey MOUTAT CeReS University of Limoges France

Christelle DE OLIVEIRA CeReS University of Limoges France

Laurent MULLER GAEL – INRA Grenoble Alpes University Saint-Martin-d’Hères France

Jean-Philippe DE OLIVEIRA GRESEC Grenoble Alpes University Saint-Martin-d’Hères France

Audrey NOACCO CIMEOS University of Bourgogne Dijon France

David DOUYÈRE PRIM François Rabelais University Tours France

Christian ORANGE CRSE Free University of Brussels Belgium

Clémentine HUGOL-GENTIAL CIMEOS University of Bourgogne Dijon France Susan KOVACS GÉRiiCO University of Lille Villeneuve d’Ascq France Anne LACROIX GAEL – INRA Grenoble Alpes University Saint-Martin-d’Hères France

Denise ORANGE-RAVACHOL CIREL – Théodile University of Lille Villeneuve d’Ascq France Faustine RÉGNIER ALISS – INRA University of Paris-Sacaly Ivry-sur-Seine France Bernard RUFFIEUX GAEL Institut National Polytechnique Grenoble France

Index

A, B, C actors’ logic, 20 AFSSA, 10, 136 allegation, 55 ANIA, 5, 6, 16, 17, 19, 20, 22–24 ANSES, 5, 9, 17, 24, 25, 104, 106, 124, 137, 164, 169 Antibiotic, 53 apples, xiv, xv, 29, 30, 38, 45–47, 49, 134, 141, 196, 205 associations, xiv, xv, 12, 16–19, 25, 29, 30, 32, 34, 36, 37, 40–42, 45, 48, 53–55, 67, 185, 206, 208, 210, 233, 240 balanced nutrition, 79, 86, 109, 110, 144 benchmarks, 78, 104, 105, 134, 139, 143–145, 147, 148, 160, 183, 201, 221, 222 cacophony, 8, 76, 92, 136 campaign education, 210 chef, 76, 87–91 cholesterol, 178–181 CNA, 5, 16, 20, 24, 25, 167

confidence, xv, 3, 5, 7–9, 13, 16, 18, 24, 25, 35, 36, 38, 48, 139, 155, 164, 174, 181, 190, 198, 206, 217, 240, 241 connected tools, 217, 225–228, 230, 235 controversy, 29–34, 36, 41, 42, 60, 62, 122 D, E, F diabetes, 6, 10, 14, 22, 166, 173, 178, 180, 218, 226, 231 diet, xiv, 14, 45, 46, 153, 156, 175, 180, 181, 224 dietetic, 8, 89, 122, 176, 181, 223 dispositive, xiii, 15, 22, 131, 168, 194, 219 doctors, xvi, 7, 12, 41, 75, 76, 80, 82, 83, 105, 130, 135, 136, 151, 165, 167, 170, 171, 173, 176–180, 182, 184 eating behavior, 151–153, 155, 158 education food, 102, 104, 108, 110, 135, 145 nutritional, xvi, 12, 108, 132, 133, 135–137, 148, 167

Food and Health: Actor Strategies in Information and Communication, First Edition. Edited by Viviane Clavier and Jean-Philippe De Oliveira. © ISTE Ltd 2019. Published by ISTE Ltd and John Wiley & Sons, Inc.

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EFSA, 11, 167 environment, xiv, 17, 18, 29, 31, 35, 37, 40, 41, 48, 56, 76, 78, 79, 84, 86, 88, 91, 115, 117, 119, 120, 152–155, 159, 160, 172, 189, 195, 198, 205–207 ethics, 12, 13, 38, 75, 76, 78, 79, 84, 86–88, 90–92, 108, 191 food, 78, 86 of responsibility, 86, 88, 90 experts, expertise, xiv, 5, 13, 16–20, 23, 24, 41, 47, 75–79, 81–83, 86, 88, 91, 101, 114, 122, 134, 136, 240 French health and nutrition program (PNNS), xvi, 3, 10, 15, 17, 18, 20, 22, 24, 25, 77, 78, 80, 90, 104–106, 110, 121, 125, 126, 130–138, 142–144, 147, 155, 163, 166–168, 170, 181, 182, 218–222, 224, 228 French national food program (PNA), 104 G, I, J Gastronomy, xv, 77–79, 89–91, 108, 112, 121, 181 industry agri-food, 34, 53–56, 59, 64, 66, 67, 163 pharmaceutical, 53, 54 information nutritional, 11, 88, 153, 158, 159, 168–170, 176, 180, 181 personalized, 218, 227 practices, xvi, 15, 18, 101, 163, 165, 170–172, 175, 177, 182, 239 journalistic mediation, 31

L, M, N labels, labeling, 109, 169 meat, xiv, xv, 9, 14, 15, 55–57, 59–63, 66, 141 media, xi, xiv, xv, 4, 6, 19, 21, 22, 25, 30, 32, 41, 42, 48, 60, 75–78, 82, 91, 110, 113, 156, 171–174, 176, 177, 180–182, 185, 209, 224, 233 coverage, xv, 8, 10, 19, 34, 42, 56, 57, 60–63, 76–78, 88, 166, 168, 170 medicalization of food, xvi, 163, 166, 182 mistrust, 36, 164, 174, 205, 206, 209, 229 norms, xiii, 3, 17, 19, 25, 78, 86, 88, 99, 110, 113, 114, 123, 130–132, 134, 138, 139, 143, 148, 189, 221, 230, 233, 240 health, 221 nutritional, 3, 132, 138, 143 nutritional knowledge, 76, 78, 166, 168, 170, 181 quality, 65, 168, 204, 205 nutritionist, xvi, 12, 76, 78–80, 82, 86, 91, 105, 118, 119, 130, 135, 180, 240 O, P, R obesity, xiv, 4, 6, 22, 129, 133, 152–154, 156–160, 166, 176, 181, 224 packaging, 11, 109, 190, 196, 203–205, 207, 212 pathology, xiv, 8, 166, 175, 177, 179, 180, 220, 231 pesticides, xiv, xv, 8, 29–32, 34–42, 45–48, 56, 159, 173, 175, 182

Index

public policy, 10, 104, 241 problem, xv, 25, 58, 66 sphere, 25, 30, 42, 43, 54, 67, 168, 170 regulation, 9, 73, 168, 190 responsibility, 75 risk, xiv, 6, 7, 29, 30, 32, 34, 35, 37, 41, 42, 45, 156, 158 S, T, V, W safety, 19, 151, 189 Santé publique France (SPF), xvi, 5, 17, 21, 104, 130, 164

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school, xvi, 99–103, 107, 108, 112, 114, 116, 119, 127, 129, 130, 132, 134–136, 138–145, 147, 223 status, 5, 8, 21, 22, 24, 31, 39, 48, 124, 133, 164, 168, 172, 181, 220, 231 sustainable food, 84, 189–192, 202, 205, 207–210 transparency, 18, 24, 36, 38, 208 vegetables, xiv, 22, 35, 77–81, 84–90, 102, 113, 118, 120, 134, 141, 143, 144, 157, 175, 180, 218, 220–222, 224 WHO, 10, 55, 63, 91, 99, 102, 220

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