Critical Consciousness of Food Systems as a Potential Lifestyle Intervention on Health Issues

Significance of Food Systems and Global Efforts

Creating innovative solutions to global health and nutrition disparities requires a systems thinking approach. Although there is no single definition for a systems approach to global access to nutritionally adequate food, the definition inherently involves the ways in which food is produced, distributed, and consumed. Each of these processes are managed and interact with one another and the cycle is generally referred to as the food systems. ³ This paradigm considers the connections and reciprocal effects among each component of the system. ⁴ Much like the traditional reductionist approach to nutrition research, ⁵ the global food systems constructs used here examine the role of the sum of all parts to incorporate all aspects of how our food is made, distributed, and consumed. Everything from how it is grown, processed, packaged, marketed, and utilized by consumers creates a cyclical network of interactions. Implementing change in such a complex and transdisciplinary system may seem daunting, but taking an epistemological approach allows for an understanding of human consumption and environmental health from a global perspective. ⁶

Modern food systems do not promote global access to the healthy diets needed for optimal health and well-being. What was once a cultural and nutritional necessity for populations, the industrialization of food has resulted in drastic changes to the health and well-being of people around the world. Changes in food production, consumption and disposal over the past 50 years have been driven by markets, urbanization, and income inequality to name a few.^7,8 For example, trading in pork bellies futures began in 1961 on the Chicago Mercantile Exchange in an effort to hedge the volatile pig market. This profit-driven approach reduced prices for pork, flooding the market with cheap, fatty products. The price of corn and other foodstuffs drive our economies, and therefore our consumption, on both local and global platforms. When food systems are driven by a wide range of structural, political, and socioeconomic factors, the nutritional value of food become insignificant compared with the economic gains they can yield. In recent years, global health organizations have emphasized the importance of addressing these concerns, and associated failures in food security we encounter on global and local levels with a systems thinking approach to better address human health challenges around the world.

Lack of stable availability, access, and utilization of healthy foods has led to a global epidemic of malnutrition that manifests differently in different regions of the world. Malnutrition results from deficiencies, excesses, or imbalances in essential nutrients and can lead to a wide range of health problems. ⁹ Rising incomes in developing countries generally result in higher consumption of nutrient-rich foods like fresh meat, fruits, and vegetables. However, there is a coinciding, more rapid rise in consumption of highly processed, high fat and sugar content, and nutrient-poor foods. ¹⁰ These low-quality diets, though increasingly providing adequate or higher than recommended calories, do not meet the recommended requirements of vitamins and minerals. With low-quality diets on the rise, rates of obesity and diet-related noncommunicable diseases such as diabetes and hypertension are increasing in nearly every region and most rapidly in low- and middle-income countries.^2,11

Combating this rise of diet related chronic diseases is one of the most important missions of world governments and medical organizations. Global health organizations like the FAO have developed a range of global health initiatives focused on innovation within food systems to support human nutrition and resilient food supplies. The United Nations initiated the “Decade of Action on Nutrition” in 2016 after the Second International Conference on Nutrition in 2014. This initiative aims to eliminate malnutrition in all its forms by 2030 by addressing nutritional issues with food policy measures, comprehensive education programs, and systematic change to global food systems. ¹² This goes well beyond the Sustainable Development Goal of eliminating hunger around the world.

The Decade of Action on Nutrition is an effort for countries and industries around the world to take action to support healthy food systems and distribution, with a focus on prioritizing a healthy population rather than a thriving economy. Additionally, the 2030 Agenda for Sustainable Development works to create coherent policies and strategies by thinking systematically about the various endogenous and exogenous factors that shape individuals’ food environments around the world. ¹³ There is overwhelming support for a food systems approach, rather than one directed at individuals. In order to meet these global goals and tackle human health and nutrition from a systems approach, we must address all aspects of food environments and individual decision making.

Food Systems From Social Cognitive Lens

Addressing, or arguing for, each aspect of the current food system (eg, nutritional effect) alone may not be helpful in tackling chronic health outcomes as it only plays a small part of the larger dynamic. Doing so may lead to the blaming of either the individual or the structure. Social cognitive framework therefore offers a lens in which chronic health outcomes can be tackled through the interdependent effects of environment, cognition, and behavior. For example, addressing nutrition and its impact on chronic health diseases should incorporate environmental factors associated with the multidimensional relationship, such as the way food is packaged, processed, marketed, transported, stored, and accessed, which may shape individual consumers’ knowledge of food, nutrition, and wellness. By assessing these relationships, which then shape the type of food people purchase, prepare, consume, and dispose, an understanding of the complexities that come with healthy choices and nutrition become more relatable. This allows for a deeper understanding of the interconnectedness among environment, cognition, and behavior within the food systems, which in turn offers scientists, educators, food producers, food processors, as well as consumers a framework to achieving desired health outcomes for all.

First developed in the 1960s by psychologist Albert Bandura, social cognitive theory links learning and individual behavior to the social environment in a dynamic system. ¹⁴ The theory is built on the idea that individuals’ behavior is influenced by the positive or negative feedback they receive from those in their social environment. That reinforcement is analyzed by the individuals’ own cognitive processes that result in a particular behavior. A cornerstone of this theory is the dynamic interactions between individual cognitive reasoning, individual behavior, and the heavy influence of environmental factors. ¹⁴

Food systems are an example of a social and physical environment affecting and responding to individual behavior. Based on individual cognition and environmental cues, certain behaviors manifest in a population that in turn support the environment which created them (Figure 1). Changing individual behavior may seem like the simplest solution to changing detrimental environments, but social and environmental norms exert extreme pressure on the individual. ¹⁵ Through the lens of social cognitive theory, cognition, behavior, and environment have reciprocal relationships and food systems innovation must address all 3 to support healthier lifestyles. Fostering individuals’ confidence in being able to decipher available information through their own cognitive processes and perform certain behaviors can be considered an example of self-efficacy and may have profound effects on global food systems. ¹⁶

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Figure 1.

Food systems effects on health based on social cognitive model.

Studies on food systems’ impact on health usually take into account a single or a small part of all the processes within the food systems, making it difficult to understand how the whole food systems play a key role in health and well-being of consumers. Within the food systems literature, social cognitive theory integration has been well-received, especially with its use in explaining nutrition behavior, ¹⁵ dietary behavior,^17-19 physical activity intervention, ¹⁹ food preparation/safety,^20,21 food consumption, ²² and food marketing/advertising media. ²³

While social cognitive theory emphasizes on “a multifaceted causal structure in which self-efficacy beliefs operate together with goals, outcome expectations, and perceived environmental impediments and facilitators in the regulation of human motivation, behavior, and well-being,”^24(p143) most studies based on this theory focus on the unidirectional impact of cognitive factor (ie, self-efficacy, outcome expectations, and self-regulation) on behavior (ie, food purchase, preparation, and consumption) and health outcomes. With this theory being argued for a multifaceted causal structure among the triadic interaction of cognition, behavior, and environment, health outcomes must be assessed and analyzed with the perspective of the whole system rather than from its individual dimensions.

Despite the absence of systemic examination of food systems on health outcomes based on social cognitive theory, it nevertheless provides a multifaceted causal structure that fits with each of the food systems processes. This conceptual structure is helpful not only for theoretical guidance for research but also for program development and intervention activities. However, some program interventions within the food systems aimed at promoting health and well-being of students such as Farm to School (FTS) does not explicitly state a theoretical framework on which it operates. ²⁵ Roche and colleagues^26(p357) based on their study of 632 elementary school children in Vermont using cluster analyses and their results suggested that “social cognitive theory is an appropriate framework within which FTS interventions may be considered.” Figure 1 shows the grouping of food systems processes based on the triadic, dynamic interaction of the environment (ie, food production to food disposal), cognition (ie, learned experience and knowledge of food, nutrition, and wellness), and behavior (ie, food purchasing to food disposing). Program interventions as well as research that follow a conceptual framework for their operational activities and study designs, therefore, help ensure that larger parts of the systems are being considered.

Critical Consciousness of Food Systems as a Potential Lifestyle Intervention

Studies based on social cognitive theory generally show the primary impact of cognitive factors (ie, self-efficacy, outcome expectations, and self-regulation) on behavior and health. Food systems are complex, and any examination of their impact on individuals’ health and well-being should take into account from a “blaming the victims” rationale. The food systems impact individual, economic, and environmental health across the globe while also acting as a powerful vehicle for social cohesion, community networks, and cultural traditions. Changes to the system must take into account inequities that may keep resulting benefits out of reach for marginalized populations, including people of color, women, and those living in rural, urban, or tribal areas. ²⁷ For example, individuals in low-income urban communities suffer from a disproportionately high rate of dietary and lifestyle influenced cardiovascular disease. The environmental factors associated with this inequity include lack of physical and monetary access to fresh food supermarkets (ie, food deserts), and social factors like decreased safety and lack of community cohesion. ²⁸

In recent years, “flexible labor” such as temporary, seasonal, and part-time work has become the standard for an increasing number of families around the world, particularly in low-income communities. This shift away from standard, full-time 9-to-5 jobs has moved workers out of careers previously supported by labor laws, union agreements, and training programs that ensure job protection and income security. ²⁹ An overwhelming majority of these flexible jobs are fundamentally linked to decreases in job security, reliable working hours, and access to benefits and paid family leave; as is commonly associated with lower socioeconomic classes. This pattern undermines the capital and psychosocial resources necessary for empowering individuals, families and communities to make healthy living choices. ³⁰

Restructuring the racial, social, and economic structural inequities in our food systems is crucial to ensure that all individuals—including the most vulnerable and disadvantaged—can participate and interact with the food environments around them. Social environmental factors such as race, cultural traditions and community dynamics have as much, if not more, profound effects on individuals’ food choices compared with socioeconomic status. ³¹ It is important to consider the interplay between socioeconomic status, race, and gender and social environments (ie, food production, food processing, marketing, packaging, and access) when developing comprehensive and innovative changes to our food systems that aim to promote the health and wellbeing of consumers.

There is no blueprint for a perfect food system, but encouraging individual agency (ie, cognitive factor) must take into account structural barriers (ie, environment) that may limit some individuals from reaching their highest potential (ie, health and well-being) and maximizing their agency within their environment. This critical consciousness of our current food systems allows general healthy populations as well as those who suffer from dietary-related diseases to feel empowered and liberated, which in turn may promote population wide health and well-being. Critical consciousness of structural barriers within our food systems is therefore a worthwhile lifestyle intervention approach that can be used along with nutrition lifestyle intervention, to ameliorate consumers’ dietary-related chronic diseases.

Conclusion

With an appropriate understanding of how our current food systems are operated, consumers suffering from chronic health issues especially the dietary-related ones, would gain critical consciousness of problems affecting their health and lifestyle choices beyond their control. Lifestyle intervention based on nutrition provides information on dietary intake and knowledge that can ameliorate certain illnesses and improve general wellness; however, incorporating critical consciousness of our broken food systems and the way in which they shape our food preparation and consumption would help maximize the overall health benefits of overall lifestyle interventions. Current food systems are highly ineffective because the “blame and shame” approach is often directed at the consumers rather than on other players on the supply side of the system. Therefore, in order to improve the accessibility and availability of healthy sustainable diets, every part of the food systems cycle—from research and production through to processing, storage, transportation, marketing, and retailing needs to be reformed, improved, and informed. There needs to be more education and awareness surrounding food and its connection to the overall food systems. Furthermore, a restructuring of the eating environment must take place, so that consumers have both the access and mindfulness to promote healthy food choices through informed consumption practices and healthy social and environmental relationships with the foods they eat.