Concepts of Healthy Eating Phase II (West Wales)

Key Terms: Food and health, 'healthy eating', Wales, alternative lifestyles, tourist food

Names of investigators:
Principal Investigator: Professor Pat Caplan
Research Associate: Dr. Janice Williams

Institutional affiliation:
Department of Anthropology, Goldsmiths College, University of London

Rationale:
These projects were set up to investigate people's own notions of the relationship between the food they ate, and their health. In order to do this it was considered important to situate food choices in their social and cultural context. Thefirst project (Phase I) was set in Lewisham, an urban area of London, whereas the second project (Phase II) was designed to provide comparative data with Phase I, which was located in an rural area of Wales.

Summary of aims and objectives

• To accumulate new information on food choices in Britain and the processes - social, cultural, political and economic - which lead to such choices in a diversity of settings, and in a rapidly changing situation.
• To encourage greater understanding of people's ideas about the relationship between food and health which may prove of practical use in seeking to improve diet and therefore morbidity and mortality rates.
• To refine anthropological theory and methodology in the area of food and diet by combining the approaches of political economy and cultural analysis, and by working at the micro-level, but situating the research in a much broader political, economic and geographical, as well as historical context.
• To demonstrate the value of anthropological analysis, especially the importance of symbolism, categorisation, and social relationships in the understanding of people's choice of diet.

Study Design

This study was located in a small town in west Wales and its rural hinterland. A variety of methods was used in this research, including open-ended, semi-structured interviews with both general informants and with retail, catering and health professionals. General informants included men and women of all ages, both Welsh and English-speaking, from middle and working class backgrounds. In addition, during the holiday season, a sample of tourists was interviewed. Selected local informants also kept 7-day food diaries, and filled in food frequency questionnaires, and a questionnaire was also filled out by local school children.

The researcher, Dr. Janice Williams, also engaged in participant observation by joining several local associations, including the Women's Institute, Wine Club, and Gardening Club, and attending meetings and other activities. She also participated in a wide range of events which included food: coffee mornings/evenings, local festivals and carnivals, agricultural shows, fairs and fetes, and fund-raising events.

All of the interviews with both general and professional informants were transcribed and entered on to a computer data-base (QSR NU.DIST) which allows for sophisticated analysis of textual material. Food diaries were also entered onto computer, and into the NUDIST data-base. The food frequency questionnaires were analysed by means of the Paradox data-base to obtain general statistical data about frequency of consumption of particular foods and to round out studies of particular households already interviewed.

Main findings

1. Patterns of diet are complex, and cannot always be correlated in any simple way with factors such as ethnicity, class, or age, although these are important. In this study, they have been considered in the context of household composition and organisation, time and money budgets, and cultural notions about what constitutes 'good food'.
2. There have been significant changes in diets during this century, and particularly over the last twenty-five years. Earlier this century, most farms were largely self-sufficient in food, and even townspeople kept pigs and grew vegetables. Today both rural-dwellers and townsfolk buy virtually all their own food, except for members of the 'alternative' communities, many of whom seek to practise as great a degree of self-sufficiency as possible.
3. There have also been great changes in what is available. The town has a variety of small food shops, and is half an hour's drive from two larger towns, each of which has small supermarkets. One has recently acquired a large branch of Tesco, which has had a significant effect on shopping patterns. Over the last twenty years, a number of wholefood shops have also sprung up in the area, primarily to serve the alternative community, but these are increasingly used by local residents too.
4. The 'proper meal', which has to be cooked from at least some raw ingredients, remains an important ideal norm, and is adhered to by the vast majority of informants at least once a day, although the 'Sunday dinner' is less significant for most informants under 40 than for older informants. For the majority of people, a proper meal should include meat in some form, although there were a number of vegetarians among our informants, and not all of these were 'alternatives'.
5. Some categories of the population have recently made innovations in diet to include pasta dishes, even curries and Chinese food. On the whole, however, older residents tend to be resistant to such changes, on the grounds that 'you don't know what's in them'.
6. This area is one with a high incidence of coronary heart disease and other diet-related diseases, and has been targeted for healthy eating advice through campaigns such as 'Heart-beat Wales'. Local people are not unaware of such advice, but the extent to which they are willing to adopt it varies. Many are highly sceptical, stating that experts are 'constantly changing their minds', so that 'if you listened to them, you'd never eat anything would you?' People also frequently cite the diet of their parents and grandparents, which was high in fat (particularly fatty bacon), arguing that 'it never did them any harm', and that most lived to ripe old age.
7. Many farming households thus still eat a diet which is high in fat and sugar. There are strong cultural reasons for this, including norms of hospitality and sociality, as well as continuity with past traditions. There is a relative lack of concern with body image, and a very low incidence of eating disorders.
8. Economic constraints also play a part in ability to adopt a 'healthy eating' diet: fruit and vegetables available locally are relatively expensive. Families on low incomes, especially those with children, or farming families with workers to feed, have often of necessity to choose inexpensive ways of eating, which includes large amounts of carbohydrate.
9. Nonetheless, dietary changes for health reasons are apparent:
   a) Those living an 'alternative' lifestyle have ideological, as well as health reasons for conforming quite closely to current nutritional wisdom. Many have moved from cities to this area to seek a new life-style, part of which includes a whole-food, organic, and perhaps vegetarian or vegan diet. There are also a large number of practitioners of complementary medicine in the area who tend to give dietary advice as well as remedies, and who have been consulted by significant numbers of non-alternatives.
   b) Other people, both townsfolk and rural-dwellers, have changed their diets in small ways: eating brown bread, switching to low-fat margarine. This is often attributed to information which is 'around'; the television is frequently cited in this regard.
   c) The most significant changes in diet are usually made because of a personal health problem such as a diagnosis of high blood pressure or diabetes. A significant number of older townsfolk with health problems such as arthritis has experimented with a variety of diets in an attempt to alleviate their symptoms. People are willing to make changes when health affects them directly, and when advice about how to do so is given by a friend, relative, or known and trusted health professional. They are much less likely to do so as a result of mass campaigns around issues like heart disease which are seen to be long-term risks which may never materialise.
10. There is a significant tourist industry in the area, and catering facilities to service it. Some of these include establishments offering a 'Welsh cuisine' which has, effectively, been 'invented' over the last twenty-five years, drawing on 'traditional' dishes and locally available items. Tourists themselves often seek out an 'authentic', regional cuisine, as well as foods which contain nostalgic associations. Such food is considered as a 'treat' and particularly suitable for the 'release' of holiday eating, as opposed to the 'control' which is more suitable for everyday life at home, and which frequently includes concerns about healthy eating. This a dichotomy lends further weight to the notion that there continues to be a perceived discrepancy between eating 'good food' and 'food which is good for you'.

Conclusions

Thus study has addressed, inter alia, reasons for the relative failure of healthy eating campaigns and why people eat what they do when they 'know' it is unhealthy. It has done so by analysing various forms of knowledge, incorporating both lay and expert notions of risk and scepticism, as well as cultural notions of the body and its relation to food. It has also studied some of the social relations involved in purchase, preparation and consumption of food, showing that what people eat is not only based upon individual choices and preferences, but is formed and constrained by circumstances which are essentially social and cultural.

Publications: books and working papers

• 1994. P. Caplan. 'Feasts, fasts, famines: food for thought' Berg Occasional Papers in Anthropology no. 2. Berg Publishers, Oxford and Providence USA, pp. 35.
• 1997. Book: P. Caplan (ed.) Food, Health and Identity, Routledge, London and New York, 280 pp. ISBN 0-415-15680-7
• 1998. Janice Williams: 'Globalisation in Rural Wales: Some Dietary Changes and Continuities on Welsh Farms' Goldsmiths College Working Paper, London. ISBN 0 902986 14 7.

Chapters in books and journal articles

• 1996. P. Caplan. 'Why do people eat what they do? Approaches to food and eating from a social science perspective' Clinical Child Psychology and Psychiatry, 1, no. 2. Sage London, Thousand Oaks (USA) and New Delhi, pp. 213-227.
• 1997. Janice Williams. '"We never eat like this at home": food on holiday' in P. Caplan (ed.) Food, Health and Identity. Routledge, London and New York July 1997. 280 pp. ISBN 0-415-15680-7
• 1998. Pat Caplan, Anne Keane, Anna Willetts, and Janice Williams. 'Studying Food in its Social and Cultural Contexts: approaches from an anthropological perspective' in A. Murcott (ed.) The Nation's Diet. London, Longman.
• 1999. Janice Williams: 'Shifting identities: vegetarians and meat-eaters in south-west Wales'. Special edition of the British Food Journal edited by Kathryn Backet-Milburn.
• 2003. Janice Williams: 'Vegetarian biographies in time and space' In C. Aull Davies and Stephanie Jones (eds.) Welsh Communities: new ethnographic perspectives. University of Wales Press.
• 2003. P. Caplan. 2003. Keynote lecture: 'Can risk management be universal: the significance of cultural and social differences' given at the Conference 'risk in Preventive Medicine' organised by the Union of Risk Management for Preventive Medicine World Society, Tokyo, March 27-8th 2003.