CHAPTER 4
Chapter 4 Contents
IMPLICATIONS FOR HEALTH EDUCATION
4.1 HEALTH EDUCATION AND FOOD
4.1.1
Health Education Philosophy and Food Education: Catch 'em Young
4.1.1.1
Health education is "as yet unrefined and far too vague”
According to Cantle, health
education is "as yet unrefined and far too vague to
be the basis for educational activity in schools." He goes on to remark:
"To develop courses in health education
without attention
to important philosophical questions that should be asked of it is
both potentially wasteful of scarce resources and likely to
damage rather than improve a school's curriculum. One cannot
or rather should not proceed with any practical activity without a
full understanding of how the aims pursued are logically related
to alternative aims. In the case of health education this logical
analysis remains to be done and is a problem not resolved by
exact definition of terms, as some writers would claim.”
(Cantle,
1980: 28)
4.1.1.2 Do we aim to tell people what
to eat?
Williams and Farley (1980: 33) consider “...
the wider aims of health education
(when) we talk in terms of helping people to make their own decisions, of
increasing
autonomy, of fostering self-esteem, of developing good health practice. Achieving
these aims demands a process in the course of which behaviour, concepts,
attitudes and
values are explored and may be modified in the light of information.” The wider
aims
of food education are entirely commensurate with those identified by Williams
and
Farley. Hall (1984: 74) asks "Do we aim to tell
people what to eat or do we hope to
educate people in how to choose for themselves what to eat?"
An important underlying philosophy of food
education is that the foundation of
good parenthood in terms of correct dietary practices within the family are
laid down
in the school. But further to dietary practices the requirement is for parents
to
understand the wider social issues relating to food and eating.
4.1.1.3 When did you last eat together
as a family?
Izbicki (1982:10) asks the question
"What on earth has gone wrong with
children...?" at the start of an analysis of some reasons for the
February, 1982
'disturbances' at St. Saviours Primary School at Toxteth. The young pupils, it
will be
remembered, went beserk and wrecked the school. While his discussion concerns
discipline in the school he points out that there are important roles and
duties for
parents to fulfil and perform but they are increasingly avoiding them. In the
context of
the stabilising influence of the table his other important question to parents
is "When
did you last eat together as a family?" He asserts that the latest
form of deprivation is
no longer the lack of books in the home. "It now is that families no
longer eat
together. And that includes the better-off families in suburbia and green belt
houses."
On page 45 LINK we were talking about eating meals in front of the TV and, no
doubt,
conversation is limited anyway to natural breaks in the programme. There can be
no
'pass the butter, please' as everyone is self-contained. But that assumes
there's more
than one person at the 'meal' and no guarantees can be offered.
63
4.1.1.4 Today’s school food lacking nourishment might be the cause of behaviour problems
Not so long ago in the secondary school it was the practice to serve the lunch en
famille to tables of eight to ten pupils, where, in the more enlightened
schools, an
older prefect was almost a surrogate parent. Changing meal-patterns in the home
may
be the cause of change in the school but there are other influences which
include the
labour cost of presenting the meal in this way, decreasing amounts of time and
space
in which to pursue the eating activity and an increasing demand for more choice
of
different kinds of what is increasingly being called 'fast food'.
"Junk food" is Izbicki's term for
it, however, and raises a further interesting
point. If the food consumed today lacks certain levels of
nourishment it may be a
contributory cause of the present-day behaviour problems. "I should
not be surprised if
many of the children involved in that orgy of aggression existed on a diet of
junk
food, if that, and the odd packets of crisps and chewing gum. Proteins are no
doubt
kept to a bare minimum." Yellowlees (1981) expresses similar concern with
the
query: "Whether increasing urban violence and vandalism is due to a
cage-like
existence in tower blocks and in endless depressing streets, or to our
appalling food I
don't know."
4.1.1.5 Protection of a child against
… malnutrition is … just as
important as protection against ignorance.
The following quotation is relevant although
it is more concerned with the
provision of education than the provision of food.
"The case of food is interesting. Protection of a child
against starvation or malnutrition is presumably just as
important as protection against ignorance. It is difficult to
envisage, however, that any government, in its anxiety to see
that children have minimum standards of food and clothing,
would pass laws for compulsory and universal eating, or that it
should entertain measures which lead to increased taxes and
rates in order to provide children's food 'free' at local authority
kitchens or shops. It is still more difficult to imagine that most
people would unquestioningly accept this system, especially
where it had developed to the stage that for 'administrative
reasons' parents were allocated those shops which happened to
be nearest their homes; or that any complaint or special desire to
change their pre-selected shops should be dealt with by special
and quasi-judicial enquiry after a formal appointment with the
local 'Child Food Officer’ or, failing this, by pressure upon their
respective representatives on the local 'Child Food Committee'
or upon their local M.P. Yet strange as such hypothetical
measures may appear when applied to the provision of food and
clothing, they are nevertheless typical of English state education
as it has evolved by historical accident or administrative
expediency.
4.1.1.6 The abolition of compulsory
school meals provision
“Presumably it is recognised that the ability
in a free market
to change one's food shop when it threatens to become, or has
become, inefficient is an effective instrument whereby parents
can protect their children from inferior service in a prompt and
effective manner. If this is so, then one should expect that the
same arguments of protection would in this respect point in the
direction not of a state school system where it is normally
difficult to change one's 'supplier' but in the direction of a free
market where it is not.” (West, 1965: 14)
The protection mentioned came in the
compulsory provision of school meals.
Society is deemed to have progressed so far as to make such compulsion
unnecessary
– at least the Government thinks so witnessed by the
abolition of compulsory school
meals provision. Other forms of protection 'come to light' when a child
dies of
starvation or other food-related abuse.
64
4.1.1.7
Parents’ responsibility for the correct food education of their own
children
But food is not education and the analogy is
weak when one considers the wider
dimensions of education. This brings us to the point that today's generation
should be
educated into making wise food decisions and shouldering the responsibility for the
correct food education of their own children. (As I expounded in
"Delegated Food
Education": 1983c.)
https://scholar.google.com/scholar_lookup?title=Educational+catering%27s+failure+to+cater+for+health+education&author=Harrison%2C+A.F.&publication_year=1983
It is the right kind of material for a group of nutritionists to use in a
'brain-
storming' session where all ideas are identified and evaluated.
4.1.2 Social Nutrition
4.1.2.1 Gastro-geography
One attack on the problem concerned 'social
nutrition'. MacKenzie (1980) and
reported in 'Home Economics’ (Jan 1981: 14) defined it as "the study of
the social,
psychological and economic factors that determine food habits and of the means
by
which future choice may be influenced in the interests of better
nutrition." He pointed
out that people tend to ignore facts and advice, "just as people did not
stop smoking
when they were aware of the associations with lung cancer, so equally they did
not
modify their behaviour in food purchase and consumption in order to achieve an
optimum diet." An alternative interpretation of "social
nutrition" is provided by Neill
(1979: 23) who comments that "A whole host of factors operate in the area
of 'social
nutrition’ which is the aspect of food acceptability which decides that in
Great Britain
it is common to eat wheat, bread and butter... while in Ghana it is 'accepted'
to eat
cassava, yam..". While Denis-Jones (1972) would prefer to call this effect
"Gastro-
geography” Neill elaborates in terms of cultural restrictions, taboos,
prestige,
psychological factors, environmental considerations and the economics of food.
These
ideas are relevant to the geographical issues in Chapter 2.
[See current use of gastrogeography
https://www.google.com/search?client=firefox-b-d&q=gastrogeography ]
4.1.2.2 The vast problem of improving
the dietary habits of a nation
Lennon and Fieldhouse (1982) devote 114 pages
to "Social Nutrition". The back
cover relates that it "...aims to provide an insight into the many and
diverse factors –
from economic to psycho-social – involved in the formation of food habits, as
well as
showing that nutrition attitudes are influenced by numerous agencies including
the
media, health visitors, nurses, doctors, teachers, food manufacturers and our
own
families." While I am not here to review books it is very useful to those
whose interest
in such topics is more than superficial. The problem with reviews is that they
want to
say that book A is better or worse than book B and like to omit that as many
approaches as possible should be made on the vast problem of improving the
dietary
habits of a nation. The Lennon and Fieldhouse summary may have served to
describe
the present oeuvre in part and the reader can make up his own mind as to the
truth
in that claim.
4.1.3 "Everybody's Concern but
Nobody's Responsibility"
4.1.3.1 We cannot dismantle the school
meals service
It is obvious that no one person or agency
has responsibility for food education
any more than that a locus of responsibility for health education exists. There
is a
network of interest, activity and responsibility for specific dimensions of health
education according to the agency concerned. One problem arising from a
break-down
in the efficiency of the network is deciding which component is at fault. If
there is a
case of mass food poisoning its cause may be attributable to a specific event located
in
a specific organisation with reasonably clear rules concerning the control and
blame.
If, in the unlikely event today, there were several cases of rickets occurring
in a junior
school, those with some responsibility may include parents, the headmaster, the
school GP, other GPs in the area, the school
65
meals service, the local health office and
so on until we reach area and regional administration. Fisher warns: "we
could soon
see diseases like rickets reappearing among Britain's school children.",
(if we
dismantle the school meals service). (Times Educational Supplement,
28.11.1980).
4.1.3.2 It explains why nutrition
appears to be everybody's concern and nobody's responsibility
This part of the discussion attempts to
clarify the 'it is their responsibility'
dimension of food education by identifying the several interests and discussing
individual areas of responsibility. If we were able to give a global
perspective to the
lack of nutrition policy in Britain a similarly based view of responsibilities
can be
provided. "It has been said that the concept of nutrition is vague,
imprecise, and
difficult to bring into focus because it has bearing not just on any one sector
of
development, but on many of them... It explains why
nutrition appears to be
everybody's concern and nobody's responsibility" (World Health
Organisation, 1981:
20). Similar remarks have been made in the context of health education
(McCafferty
1979: 60. Scottish Education Department, 1974: 2).
4.1.3.3 Government expenditure on
health education is £1m. The NHS cost is
£400m annually
Having regard for what was said earlier
concerning the lack of a British nutrition
policy clearly the first responsibility that the Government has is to devise
one. If one
only looks at the large number of reports which have been produced it may
appear that
there is a policy but the way in which it appears biased in terms of producer
has
already been discussed. We can add here that there are other issues to be
considered
concerning, for example, tax on 'controversial' commodities such as alcohol. If
there
has been a policy it may have focused upon the amount to be spent on health
education. "It is a matter of more than usual interest that total
Government
expenditure on the health education of the people is one million pounds while
the cost
of the National Health Service is four thousand million pounds annually"
(Creditor,
1976, page 79). (See also discussion on Drink, Chapter 3, pp 55 - 57.)
https://www.google.com/search?client=firefox-b-d&q=Government+expenditure+on+health+education
4.1.3.4 Advertising, promotion, or
marketing techniques are the everyday equivalent of health education
Some areas of attention for those involved in
considering the Government's
responsibility for what occurs in food education include:
1) the place of food education in the overall
nutrition policy
2) the need for further research into what has
been termed 'social
nutrition'
3) the role of educational catering in relation
to the food curriculum and
the provision of meals at school
4) the effect of advertising on dietary
preferences and whether there is a
need for more control.
Concerning the "diversity and difficulty
in influencing factors affecting food
habits in the mature person" Robbins (personal communication) considers
that "...this
assumption bears serious and productive challenging". He draws (this
writer's)
attention to the success of food advertising "... which shows how those
purchasing
foods (which are the mature people) are radically changing their purchasing
habits."
He suggests that "... the intrusion of McDonalds type meals is a strong
example, but
within the supermarket, the explosion of low fat milk sales in a country where
milk
was seen as the apotheosis of good health also represents an interesting
example." He
goes on to say that these changes have been caused by "advertising, promotion, or
marketing techniques which are the everyday equivalent of health education."
4.1.3.5 Will industry use its responsibility
wisely?
If we are to pass the health education
responsibility on to industry then that for
food education will need to be passed to that industry. If it is influential in
changing
food choice and has a greater say in it will it use the responsibility wisely?
66
4.2 FUTURE RESEARCH
4.2.1 Catering for Hunger
4.2.1.1 Manufacturers respond to
consumer demand with "shocking pinks, luminous and fluorescent blues,
[etc]
The two important points arising from
Robbins's unpublished, but nevertheless
very valuable contribution to this discussion concern (a) the strength of
influence of
commercialism, and (b) its interpretation as a medium of health education by
someone
of expert status in the field. (He wrote in 1982 as Director of the Coronary
Prevention
Unit, Central-Middlesex Hospital, London.) If we take the commercial influence
issue
we can add that not only does it affect the mature food purchaser; children
also watch
television food advertisements aimed at a subsequent request for mother to
bring back
the latest pan-fried attraction. They also have pocket-money purchasing power
and
commercial interest is not lagging in that quarter. Murcott (1982a: 206)
identifies the
high cultural significance of sweets where manufacturers
respond to consumer
demand in terms of "shocking pinks, luminous and fluorescent blues,
vividly piebald"
and other colours.
4.2.1.2 Wicked chocolate
What is worthy of further research is the
extent to which manufacturers are
creating demand as opposed to satisfying it. It is obviously within their
interest to
stimulate new products and promote sales through television and radio
advertisements, comics and other children's magazines as well as placing the
commodities in front of eager eyes on the shop counter and by using machines in
the
street. Furthermore, advertisers know other weak points within the purchasing
consumer – young or old. "Advertising techniques are properly controlled
today, but
the marketing of some merchandise has always been on the basis 'go on, treat
yourself'. Innocent enough, of course, but much obesity and associated ailments
results from a desire to 'cheer oneself up with a bar of chocolate and some
biscuits',
maybe a learned trait from childhood." (Lazell 1980: 32). Certainly it can
survive into
adulthood's "wicked chocolate”! (Maitlis, 1986). (cf Fernyhough on page
26)
4.2.1.3 Food and drink manufacturers'
sales campaigns are influencing consumer choice
Turning attention to marketing techniques as
health education we might accept
the activities of the Milk Marketing Board within the suggestion made by
Robbin's
and have doubts about the Sugar Bureau promoting the use of its commodity. Most
would have strong reservations concerning the food and
drink manufacturers' sales
campaigns, but it cannot be ignored that they are influencing consumer choice.
The
ways in which they could put across wider messages might be explored in the
future
selecting those whose products are at the 'periphery of harm' such as chewing
gun.
Advertisements portraying the 'healthy life' of exercise, wide interests and
balanced
diet would have more effect if linked to this type of commodity as opposed to
the
more harmful confectionery and sweets. Research could well be done into the content
of advertisements and ask:
Who is influencing whom?
Who are shown to be leaders,
followers?
What significance is placed upon:
the product
the occasion
the people – their roles
their actual statuses
their perceived statuses
their age group
their
spending power?
What is the real significance
of the product?
a real food
a necessary food
an unnecessary 'food'
a 'peripheral' food item?
67
4.2.1.4 Advertising
does not affect the amount consumed, only the brand shares of the market. [?]
But we should not jump to the conclusion that
banning the advertising of alcohol, for
example, will reduce levels of alcohol abuse. At least, that is the opinion of
two
speakers at an international conference on "Health Education and the
Media" in
Edinburgh (Henry and Waterson, in the conference preprints, 1981, editors
Leathar et
al).
"Advertising
and promotion are the means by which consumers can be assured of
choice and competition." They go on to move that if attempts are made
"to reduce
consumption via price rises, advertising bans and distribution changes"
there will be
as in Norway, "no fall in total consumption or drink products but the
proportion of
drink products which are illegally manufactured has increased enormously."
(page
116) The speakers are obviously stating the case for not limiting the amount of
advertising and go on to 'show' that advertising does
not affect the amount consumed,
only the brand shares of the market. They also attempt to show that the
controls over
the content and style of advertisements are so rigid that no harmful
advertisements are
allowed to be used. Fynn (1981, 129-142) implicitly refutes many of these
arguments
relative to cigarette advertising and anyone involved with food education would
require to read the two studies cited here if they propose to conduct a serious
appraisal
of the issues. Maccoby and Farquar (1975: 117) discuss the situation of banning
cigarette advertising. As there is not so much need counter-advertising also
may be
reduced and the high rate of decrease in the rate of smoking which was apparent
before the ban, may level out.
4.2.1.5
Industry is out to create an appetite for their
products, desire for which is very often illogical."
If anything is lacking beyond a nutrition
policy it is a lack of faith in the experts
involved. (We look at this in greater depth later.) "Within the media, the
credibility of
nutritionists has been eroded because of the publishing of a mass of
conflicting and
confusing information. For this reason, ways must be found to involve the media
in
the educational exercise." (Turner, 1979a: 5) One should, however, reflect
upon an
alternative view. "Britons, lacking leadership for sensual enrichment
through food, are
mesmerized by food manufacturers and their advertising agents into buying
adulterated, fatty, sugary, salty foods, developed to the lowest common
denominator
of taste and smell and designed to enrich no-one but themselves." (Wright,
1981: 6).
Breckon (1976: 31) might add "It is important to remember that few, if any
food
advertisements rely on catering for hunger. They are out
to create an appetite for their
products, desire for which is in nutritional terms is very often
illogical."
4.2.1.6 Most of the research being done seems to be under the auspices of industry. It pays the piper.
"The food industry provides most of the foods that people eat and most
manufacturers ensure,...,the safety and quality and nutritive value of their product.
...
Manufacturers are continually studying trends in current consumer habits, food
consumption patterns, attitudes and preferences and, hence, are able to
identify
consumer needs." (Greenwood and Richardson, 1979: 31) That sounds quite
satisfactory until it is compared with the quotations in the previous
paragraph. It is a
question of 'needs', 'demand' and the 'creation' of both. Most of the research being
done seems to be under the auspices of the industry and the general public
may be
misled if they think that the British Nutrition Foundation is an independent or
government sponsored organization. But that is not to say that the BNF is not
doing
valuable work. Industry, however, pays the piper.
4.2.1.7
Life no longer must revolve around meals as it may have done in the
past.".
Having created the new demand they move in on
the 'habits' part of food habits.
Does the family take food for granted? It is not only food that is taken for
granted but
also the reason for eating it. Beyond the obvious consideration that we will
die if no
food is eaten. (Nicholson 1977: 35)
66
identifies that you eat "in order to
avoid
hunger...rather than because you are hungry." His analysis includes
discussion of
British eating behaviour which is centred upon four meals a day. "You eat
because it
is one o'clock, regardless of whether or not you actually feel hungry." We
can extend
his debate to consider that while there is a fair degree of freedom in the home
for a
person living alone to vary meal times per hunger, it will be more difficult to
accommodate individual eating behaviour within even the average nuclear family
of
two adults and two children. When the children are young the family plans its
daily
activities around a series of expectations that meals are to be/will be
available at
specified times. However, as King (1984: 11) has commented: "...it seems
that food
has to fit into individuals' life styles: life no longer must revolve around
meals as it
may have done in the past.".
4.2.1.8 People are quite used to 'eating to prevent hunger'
Accepting the limitations within the family
situation to providing food on the
basis of 'pangs rather than gongs' there is no point in contemplating the
provision of
come-when-you-please cafeterias in education or industry. While Nicholson's
contribution may bear validity in personal/physical terms there are numerous
operational obstacles to its implementation on the large scale. However, people are
quite used to 'eating to prevent hunger' and it could be problematic to
return to
demand feeding on the grand scale.
4.2.2
Mother
4.2.2.1 The modern mother's view is that 'wholesome food is good for you'
Going back to what we have noted concerning
apparently poor food choices and
reasonable health it is small wonder that there remain numerous obstacles to a
wide
understanding of the relationship between diet and good health. Perhaps too
little
attention has been paid to any implicit notion that the link between what is
eaten and
one's state of health is accepted as fact. This may stem from the modern mother's view
that 'wholesome food is good for you' as handed down from generation to
generation.
This advice was framed within a different life style and came from the lips of
mothers
whose influence on the household is different from what it is today. Perhaps
the
modern mother has lost the status enjoyed by her grandmother and any
nutritional
advice stated without the courage of her conviction is unlikely to be followed.
Murcott
(1982a: 207) identifies the cultural significance of the "cooked
dinner" and that the
"Preparation of the cooked dinner is women's work ...” which provides her
with
equivalent (but differentially derived) family status to the man as
bread-winner.
4.2.2.2 The 'cooked dinner' epitomizes the wife's obligation as homemaker
According to Murcott (op cit page 208) it is
the work put in to preparing the full meal
as opposed to, for example, "spaghetti, or egg or beans" which helps
her earn her
place as an important member of the family. "The
'cooked dinner' simultaneously
epitomizes the wife's obligation as homemaker..." If we reflect that
there is less
interest in the cooked dinner, the woman's stature as adviser, in this case,
nutritional
adviser is diminished and her children are less likely to follow her advice. If
the
reason for a high tea of fried convenience foods stems from her late arrival
from work
the mother may feel justified in providing it but there may not necessarily be
the
supposition that she has equivalent status as the bread-winning man even if her
wage
supplements or, as is increasingly the trend perhaps, replaces his wage.
4.2.2.3
Not good for girls to become involved in conflict which confuses their
trust in mother's judgement
Although we live in 'a woman's place is in
the home, society there has been a
shift away from the status of the mother's views on a matter as illustrated in
a Ministry
of Education Report and anxiety to maintain the 'apron strings'. "Certainly,
it is all to
the good if a girl brings home some
69
of the new ideas learned at school. Yet
within the
family there remains a certain risk of the new ideas clashing with mother’s
ideas.
Technique is not the only thing that matters and it is not
good at such a stage for girls
to become involved in any conflict which may confuse their trust in their
mother's
judgement." (Ministry of Education 1958: 58)
The last topic should promote some discussion
which could later progress to a
question of self-esteem. If there is a breaking down of roles within society as
may be
implicit within the above exposition it may be that there is also a lack of
goal-
definition on the part of young people in terms of their future roles.
4.2.2.4 Changing
consumer resistance to products which
are deemed to be nutritionally worthwhile
Looking this time at the previous material one aspect of the final model
(Figure
2.8 in Chapter 2) LINK is that it presents the potential for an action
plan of further
theoretical and practical research by area and discipline. Taking social
considerations
as the first example the "one o'clock factor" can be appraised by
measuring the extent
of salivation and other manifestations of physical hunger such as stomach and
alimentary tract content and comparing such results with questionnaire and
interview
findings related to appetite. Other data on appetite can be obtained using the
diary
approach to record time of day food was eaten and the weight etc details of the
food
(and drink). The National Food Survey "... has been a British institution
for forty years
now ...” and not infrequent papers and articles appear in journals a la Buss
(1982: 12).
Considering the importance of the provider in the form of the mother research
could
be conducted into the changing nature of her role in the home and, by that
fact, in the
kitchen. From "technical considerations" new food products can be
evaluated in terms
of who will process them in the home. Other dimensions here include the
opinions of
those who eat these innovations in the home set against different levels of
specific
food education approaches aimed at changing consumer
resistance to products which
are deemed to be nutritionally worthwhile.
4.2.2.5 Substitute domestic feeding
Turning attention to "substitute domestic feeding" (Hughes, 1976
coined this
term) there is much research to be carried out into the variety of such venues,
the
different kinds of offerings at different price levels and the different levels
of
satisfaction people are prepared to identify according to situation and price.
They will
vary according to the extent of commercialism – 'pure' when we walk into the
typical
restaurant but less so when we are at a wedding catered for by a firm (ie meals
bought
by someone but hospitably dispersed).
4.2.3 Hunger for Catering
4.2.3.1
More needs to be done to use
"School Meals as an Education Resource"
Noble, Thompson and Kipps (1982: 5,7) show
that more needs to be done to use
"School Meals as an Education Resource" and my own papers add to
this call (Harrison A F 1983a,
1983d). In the first of these I proposed that "... the term food education
... is taken to
mean:
1) The food dimensions of home economics teaching in schools and related
science teaching
2) The food dimensions of courses in domestic science and home economics
3) Courses in nutrition
4) Courses in hotel and catering
5) WEA adult education, evening institute and community education courses
and activities bearing such titles as Eating for Health."
70
4.2.3.2 A thumbnail sketch of hotel and
catering education
The essence of both my papers referred to
here was that food education and school
meals are on "separate tables" and are relevant to a) and b) above.
In a further paper
(1985b) I gave home economics teachers' self-perspectives some of which relate
to the
present discussion. (As papers take a time to come through the library system
for
those who would like any of my papers they need only use the Contact page on
this website.)
Courses in nutrition are taken to mean
degrees and are certain to investigate
some of the topics in this book. The last group is liable to be made up of
people
interested anyway in their health. That leaves hotel and catering education.
It might be useful to paint a thumbnail sketch of hotel and catering education.
Those who leave school with no formal qualifications and/or desire for full
time
college education find a job and attend on a day release basis. Some also
attend
colleges of FE one day a week or on blocks of a few weeks as part of the Youth
Training Scheme. Another scheme is for mature students on short full time
courses
under the Manpower Services Commission. Many young people with basic school
certificates attend two-year full time General Catering Courses and all that
has been
mentioned so far form the backbone of craft education in the industry.
There are two- and three-year catering and
hotel management courses at Ordinary
and Higher Diploma level, and some polytechnics offer degrees in this type of
management.
Three universities in the United Kingdom also offer degrees and they tend to be
four
year courses with a full year in industry.
4.2.3.3 Catering examination schemes
not in line with the latest approaches to healthy eating
At the time of writing (1986), one has had
ten years as a head of department of catering
in two FE colleges. Catering examination schemes are
only just beginning to
accommodate healthy eating as opposed to nutrition. Menus served in college
restaurants follow the schemes in the main although there are some who do much
more than pay lip service to such ideals as embodied in healthy eating. The
Autumn
issue of The London Food News 1985 drew attention to a survey of London college
catering departments and Brunner (1985) gave the details. These showed that
syllabuses for City and Guilds, and Business and Technician Education Council
catering examinations were not in line with the latest approaches to healthy
eating.
While only elementary research is necessary to establish the current position
more
systematic inquiry needs to be conducted into the reasons for a general
reluctance
throughout catering education to respond to health education initiatives.
4.2.3.4
The research requiring to be done includes an investigation into
reasons for failure of any policy
Another paper of mine (1982) is a report of a
"Health Education and Food"
conference attended by many people with food interests and they included
college staff. The results of a questionnaire sent to catering departments in
colleges
indicated a distinct lack of interest and progress relating to the wider
aspects of food
education. The scope for research into this type of problem is immense. Most catering
teachers are aware that their doyen, Escoffier, LINK would be in the thick of
such a
campaign as this to improve the diet of the nation through its providers.
On page 65 LINK were listed areas of
attention for those involved in considering the
Government's responsibility for what occurs in food education. Leaving aside
the
responsibility issue the research requiring to be done
includes an investigation into
reasons for failure of any policy whatever its purpose. Food education can
then be
appraised in the light of findings. The research into social nutrition could be
expanded
to cover resistance to intervention. The school meal jammed between nutrition
lessons
oozes malnutrition in some
71
quarters and research into that and better
ways of ensuring
that tuck shops sell healthier products would help pupils to become more
responsive
and responsible 'nutritional' parents. Finally, more independent research into
advertising and its effects on consumption patterns would enable manufacturers
to
come to terms with their role as food educators.
4.3 SOCIAL NEEDS
4.3.1 Tomorrow's sales campaign can be designed today in the light of the most recent financial data.
One important implication arising from the concept of individual or family food
preferences is that they are almost discrete and 'closed'. It has been strongly
suggested
that the commercial interest has greater effect in changing food preferences
than
health education. If the final model (fig 2.8 LINK) helps physicians and health
educationalists to have a better understanding of the influences upon food
preferences
they are warned that food manufacturers and their marketing men may find it of
greater use. Advertising is geared to today's purchase while health education
is more
concerned with tomorrow's well-being. Today's levels of health can be evaluated
in
terms of the death rate, visits to hospital, GP etc. Tomorrow's
sales campaign can be
designed today in the light of the most recent financial data. Tomorrow's
health
campaign is founded upon numerous sets of specialised data few of which are
quickly
and easily obtained and many of which are difficult to interpret with any
precision.
Which is not to say that the 'final' model is
precise. In some respects it is still a
provisional model, waiting for specific development or alteration by people
with
different jobs to do. Let the marketing men develop it to suit their own needs
but let us
ensure that health education has not been left behind in the race. The winning
post for
commercialism is profit and that for health education clearly must use the same
word.
The need to promote the notion of health-profit in terms of longer, healthier
life versus
the alternatives of chronic illness etc., is there and it competes on a
parallel track with
commercialism.
4.3.2 There will be a highly health-motivated family keen to increase its knowledge of food
We have considered the idea of food habits in terms of the satisfaction of social
needs and the desire to communicate. Wider attention needs to be paid to these
notions whereby the family is more aware of the social need to be healthy, the
mother’s family love and devotion is communicated by providing food which will
improve the health of the family, and the family reciprocates such sentiments
by
consuming that food and communicating back a genuine desire to try new foods
which purport to be health-giving. In time, there will
be a highly health-motivated
family which is keen to increase its knowledge of food, is prepared to
learn how to
take stock of what it eats (and drinks) and, in time, it learns how to evaluate
its food-
activities and their nutritional, social, psychological and economic
significance. There
is no desire that any one of these factors presumes a far greater proportion
and/or that
the family is turned into a set of obsessives.
If the stock-taking activity and resultant new policies change the diet from
mainly chips and mince with chops to a non-stop ingestion of proto-veg and soya
the
evaluation of what has been achieved has to be effected. Notwithstanding the
nutritional inadequacies of the new diet there are other outcomes. One of these
is
perhaps an increased lack of hospitability to uninvited guests. With the old diet
such an
approach could have been based on 'our food' and 'you are not going to see it
until we
have had time to present it in a socially acceptable light'. Until such time as
the 'new
diet' becomes normal we may have to revert to times when 'normal' people come
for a
meal.
72
4.3.3 Social imitation and consumer culture
4.3.3.1 Social imitation
Some social considerations were said not to
influence food preferences
overmuch; however, and prominent amongst these was 'social imitation'. This
seems
surprising in the face of lower class take up of foreign holidays, fast cars
etc.,
formerly confined to the upper classes. Perhaps limited to the nouveaux riches,
this
social phenomenon ought to be promoted once the upper class are presumed to be
following a proper diet.
4.3.3.2
A regimen of diet, jogging and
cosmetics
Another 'social-force' identified was bodily
health within 'Consumer Culture'
where, essentially, the glamour dimension was superior to everything else. The
interest here might be harnessed to the idea that outward appearance and inner
health
are closely related and while the former may ultimately deteriorate with age
and can
be propped up with creams and lotions, the inner health of the individual is
less easily
maintained and certainly not with cream and potions. As the average age of the
Briton
rises due to the post WW2 population-explosion perhaps he will be faced with
"a
new discourse of demography, centred upon a regimen of
diet, jogging and cosmetics
to control the alienated and disaffected citizens of retirement compounds.”
Turner,
1982: 29) As long as someone has access to "Three Score Years – and
Then?"
(Davies, 1981) all will be well.
4.4 SOCIAL REALITY
4.4.1 'Socio-economic food' with 'street psychology' overtones
The logical outcome of considering
'nutrient-starvation in the midst of plenty'
(see pp 11, 24) LINK is that we are faced today with nutrient food-induced
ill-health in the
midst of abundant nutrients. It is obviously a question of educating the public
to
choose the right food – a process which has been going on now for decades and
which
has largely failed. It is not suggested that tuning into the models devised
here is going
to solve any problems over night but they are intended to make a contribution.
4.4.2 Nutritional starvation in the midst of plenty
If there is nutritional starvation in the midst of
plenty there is a need to (a)
induce people to eat the right foods, and (b) induce people to stop eating the
wrong
foods and drinking too much of the wrong drink. If health education has failed
in any
one respect above all others it is because these dimensions have been attended
to
concurrently. The first consideration can be re-attacked armed with information
and
approaches from previous discussion. More consideration might be given now to
why
people eat wrong foods. We will start with the economic influence and progress
to the
socio-psychological even if we chose not to argue here that it is unwholesome;
it is
chosen as a 'socio-economic food' with 'street
psychology' overtones! The ensuing
discussion is more of a parable than an academic treatise.
4.4.3 Deep-freeze sociology
If any specific food-stuff could be singled
out as being an example of the
'creation of demand' it is the ice-cream. Granted that being beached on a hot
day will
tend to generate a craving for something cool it cannot be likewise accepted
that ding-
dong tones ringing through the still winter air (defeating the double glazing)
in
potentially two different ways confirm the desire for ice-cream unless the
situation is
viewed through Pavlovian spectacles.
If there is a sociology of December ice-cream it may involve identifying the
social classes which rush into the street at the sound of the approaching van.
Indeed,
and in the same way that the Cockney is able to qualify for the title in terms
of peals
emanating from Bow, the lower classes might be defined as being born within the
sounds of a more mobile tintinnabulation. Those who see themselves in the
higher
social order would deign to purchase such a commodity on the highway market and
can rest until the desire for ice-cream comes naturally (from the television
advertisement?) or a need to defrost
73
the 42 cubic foot deep-freeze. It has not
occurred
to the parents whose child sets off for ice-cream that the whole road may infer
they
have no deep-freeze. This is because it has not occurred to the whole road
either.
Those with a deep-freeze (a) are lacking in purchasing planning where this
commodity could be bought more cheaply (b) have not considered that bells =
ice-cream = expense and dietary excess (and environmental pollution of paper,
noise
etc).
4.4.4 The sociology of ice-cream moves in the Mafia direction
The sociology of ice-cream
moves off in a different direction again
when the
commercial geography is considered. To maintain a 'patch' may require a form of
Mafia where more than deep-freeze-glove fighting occurs. Thus, in considering
the
creation of demand there are issues which stretch well beyond merely economic
principles. There is the territorial and socio-economic issue relating to its
supply and
there is the social-psychology of the individually felt ‘need' based more on
appetite
than hunger, itself based on the creation of a habit the reminder of which is
the
(ap)peal of bells.
4.4.5 Bringing the supermarket to the
doorstep leaves menu planning to the last moment
Progressing from ice-cream we can consider
briefly the mobile-grocery van
which, in a limited way, brings the supermarket to the
doorstep. The main economic
issue is that the housewife is paying extra for her commodities. For the
housebound
the range of choice is very much reduced and the popular items take preference
over
the nutritious. It leaves the menu planning to the last
moment when what is available
(left, in most cases) is what is bought. For the more mobile housewife it is a
psychological support system for items which have been forgotten from the
supermarket excursion.
The immediacy effect of the ice-cream van carries over to the mobile grocery
van
where the horn announces to the young and not so young that sweets, fizzy
drinks
(‘missed the lemonade van – thank goodness you've arrived! ') and all sorts of
flour
confectionery are available. If we combine this activity with the normal
shopping visit
to the van the busy housewife can delegate a shopping list to the child with
zero
distance to travel and ‘spend the change on sweets for you and your friend'.
4.4.6 Isolationist attitudes will not
achieve a great deal
An emphasis here has been the commercialism
and, although the example has
been written in extreme terms, the boardrooms of other and larger food
companies
hear the boxing ring bells and their fight is no different in the final
analysis. All that
can be hoped is that such energy could be harnessed to improving diet.
We are reminded that the commercial world has much to offer the improvement
of the nation's health as conventional services including health education. It
is time for
health educationalists to place more emphasis on the commercial role, to
monitor
advertising more and to appeal to food manufacturers through the medium of
their
trade press. Any publications aimed at the mobile street supply network are the
obvious starting point but profit is a difficult demon to exorcise. The efforts
made to
influence demand for a more health-inducing product have to be strengthened.
Anyone might be taken in by the perhaps apparently water-tight approach which
has been adopted in this book. If that impression has been gained then the wide
ranging debate covering everything from social factors down to the provision
made
that in order to change any facet of society all one has to do is to alter the
circumstances directly involved. It cannot be stated strongly enough that isolationist
attitudes will not achieve a great deal and that these particular issues
addressed within
these pages have to be interpreted within the totality of the overall
situation.
74
4.4.7 Circular Reality
4.4.7.1 The Vicious Circle
The overall situation, however, differs
according to the 'have/have not'
circumstance identified in the Preface LINK. One dimension is poverty and
another is
affluence manifested in obesity. Let us
look at poverty first.
There is a vicious circle identified by Lowenberg et al which helps keep the
discussion to a minimum.
Figure 4.2(i) The Vicious Circle
As was earlier identified, doorstep buying in
small quantities occurs and none
more so in the context of the present situation. But the improvement of income
will do
very little if there is 'ignorance and lack of education' which means that far
more
changes have to occur before the food problems can be solved.
It is not too difficult to see a similar
vicious circle in a different situation where
there is probably no motivation whatsoever to break out of it. It might be
termed 'the
sedentary-affluence vicious circle'.
75
Figure 4.2 (ii) The ‘Sedentary-affluence’ Vicious Circle
NOTE --- OF
DEMAND
Both 'vicious circles' can be adapted,
altered or ignored but the different
problems represented remain to be solved. Finding the point at which the circle
must
be broken has to be tackled by all concerned not least those in health and food
education.
4.5 CHANGING THE NUTRITION MESSAGE
4.5.1 Man has little interest in food preparation or the healthy digestion of it by himself
The message may well be 'Send
Reinforcements...we are going to advance (but
we don't know where)' LINK whereby those who initiate the message do not
understand
what is involved in its content and also cannot formulate it in terms of the
recipient.
"At present neither parents, schoolmasters, nor industrial leaders possess
the attitudes
necessary to make the most of their opportunities as potential educators about
health".
(Burgess & Dean, 1962: 111)
Decades later there has been no real change
in the state of affairs described by
Burgess and Dean although there have been remarkable advances in most fields of
operation. If that comment related to potential health educators it is even
more sad that
we may well have made no real progress since the nineteenth century. "As a rule, man
has little knowledge of, or interest in, the processes by which food is
prepared for the
table or the conditions necessary to the healthy digestion of it by
himself".
(Thompson, 1891: 20). The present discussion concerns change in both educators
and
educated.
76
4.5.2 There are several dimensions of
the change in the nutrition message
In a rapidly changing society, we cannot even
fall back upon our basic beliefs
about food to provide the necessary moral support in the situation. Most of us
have
equated cheese, for example, with 'maximum health' – not any more. We may now
go
to our grave 'on an egg’ UPDATE. There are many other such changes to be made
in the ways
people view their food and the benefits they derive from it.
There are several dimensions of the change in the nutrition message:
message content those who send
the message
diffusion of the
message those who
receive the message
4.5.2.1 Message Content
"Education for health is not a set of
procedures that can be adopted once and for
all. It is a long process, always changing, whereby an individual is
continually
accepting or rejecting new information, new attitudes and new practices in
relation to
health". (Burgess and Dean: 1962, 109). The immediate task is to determine
the long-
term 'message' in order to finalise tomorrow's information and that for the day
after.
While we can consider the individual's reaction elsewhere it remains to clarify
what
the components of "the long process" are.
The long term message concerning health must continue to stress that there are
numerous factors which influence it and that the individual has to come to
terms with
his own set of factors. When he focuses upon his 'food factors' he has to
interpret his
dietary needs in the context of his life style which itself he has to appraise
in terms of
his own health objectives. If happy to become/remain overweight may be there
will be
no conflict: it is getting him to change the health objective which assumes
more
importance in the first round. The second round concerns a fight for greater
general
awareness of the relationship between diet and health. Assuming that this round
has
been won, the third and final round is fought on behalf of children who will be
influenced by their parents and educators to see the health point and to
prevent them
having to go in for the first round.
4.5.2.2
Attention must be paid to the
techniques used to persuade people to purchase the wrong foods
The boxing metaphor may not entirely fit the
situation but seems quite
appropriate when we reflect the strength of the various health improvement
endeavours and the strength of resistance. As we have seen, it is not a set of
procedures nor is it a straight set of thrusts, lunges and parries. like the
opponent, the
consumer is continually assessing the "new practices" and seems adept
at out-
manoeuvring health education.
Perhaps what has gone wrong within health
education is that everything has been
thrown at once – the opponent has 'been given all we have got' in the first
round by the
end of which health education is lowest on points. More efforts must be made in
relation to concentrating on themes – fibre, reduction of sugar – increase of
unprocessed starch, reduction of fats, exercise or whatever – in order to punch
home
the basic concepts. After all, we started this debate with the notion of the
fighting
force – here are the reinforcements!
But when the content of the food education
message is being derived or revised
due consideration must be made to the competition of commercialism in the food-
trade world and the success of advertising. Perhaps more attention
must be paid to the
techniques used to persuade people to purchase the wrong foods and use such
approaches to alter their preferences to their own ultimate benefit. You have
to
constantly tell them why these foods are wrong and back this up with the latest
findings.
77
4.5.2.3 Diffusion of the Message
The best (?) way to convey the message should be reappraised. Some in health
education have not been successful because they are looking for one method
above all
others as the best method. Even if one was found it would not last long as
people need
a variety of stimuli. Neither should we presume to reach everyone all the time.
'You
can 'health-educate' some of the people all the time (using a single
method?)...' it
would be nice if it were true. Klineberg comments that "Because of the
expanding
nature of communication it is not essential in a nutrition education programme
to
reach all the population at once, but it is essential to concentrate on
identifying,
reaching and convincing the opinion leaders, who can in turn affect others.
(Klineberg)". (Dr Otto Klineberg, Chairman of International Conference on
Malnutrition and Food Habits, Mexico, 1960: in Burgess and Dean: 1962, 74).
Thus, the methods of conveying the message change with the content.
Concentrate upon selected components and aim
for specific sectors of the population.
This is not being done; rather, that not enough of this approach is being
applied. There
seems to be ample scope for research into the sheer volume of messages being
relayed
to the consumer. This should take into account those stemming from health
education,
food education and sundry concerns as well as the complementary, competing and
opposing messages emanating from the commercial world. The analysis must extend
to the conflicting messages within health/food education which are due, in
part, to the
sheer volume of different interests and levels of expertise and where there is
little
coordination of the 'message-senders'.
4.5.2.4 Those who send the message
Anyone, who is in the 'change business' has
to be on firm ground. Teachers and
psychiatrists have such a basis but it is unclear as to the extent to which
health
educationalists have it. Nicholls (1983: 108) asks "What approach should
be used
when one group suggests that another group should change their eating habits?
Has
any group, for example, a government, the right to take decisions which affect
another
group?" Most would recognise that governments are there to do just that
but shy away
from taking the advice given out by health educationalists. They are not
imprisoned
for so doing.
There is an element of social control going on within health education of the
compulsory seat-belt-wearing variety but with no fines to impose upon
offenders.
"The guardians of society, when the genuine sanctions fall short, often
draw upon
their imagination. It is so easy to exagerate effects, to ignore exceptions, to
overlook
qualifying circumstances, to marshall financial consequences. Most moral
instruction
reeks with a goody-goody disingenuousness which everybody excuses because it is
salutary". (Ross, 1929: 305 of 1969 edition).
The punch-line in this statement is the last sentence and health educators have
got themselves on the wrong side of the image-game where good advice is
interpreted
as Sunday-school best intentions. The road to good health, however, is paved
with
best intentions and, to the consumer perhaps, the effects of poor diet have
been very
much exaggerated in terms of fanciful consequences. Thus, those who send the
message seem to be regarded as being tarred with the same brush.
78
4.5.2.5 Credibility
There is an idea promoted that 'brown bread is better than white therefore
white
bread is no good at all' which has been interpreted in terms of the
food-faddist:
"An example of a negative food fad arose at the beginning
of the discovery of the functions of vitamins. Because milled
wheat had been freed of its husk which contained vitamin
elements, Alfred McCann began to recommend whole-grain
bread, rather than white bread. The idea continued to grow until
a large number of people felt that white bread was little less than
poisonous and would eat nothing but whole-wheat bread. Since
the enrichment of the white flour with the raising vitamin B
complex, iron, and other constituents, white bread takes its place
as a valuable addition to the diet, and is nearly comparable to the
natural whole-grain bread. Yet certain individuals still will not
eat white bread. These people may be called faddists even
though the anti-white-bread idea has extended over a long
period of time and even though the reason for the belief is
obvious. It is the carrying of beliefs to the extreme rather than
living up to a fad that makes faddists". (Selling and Ferraro,
1947: 46/47).
It is perhaps such approaches as these within nutritional and health food
circles which
undermines the credibility of those who attempt to improve the nation's diet.
They are
seen as faddist and, who knows, they may be seen in terms of a similar sounding
word
– sadist! The alternative view point is that they are seen as perverts. An
interesting
point has been raised by Bates. "Maybe we are surrounded by food perverts,
undetected and unclassified, undermining the fibre of our civilization,
infiltrating our
diplomatic service, – influencing our mass media, corrupting our youth"
(Bates, 1958:
453). If this is the case then those conveyors of the health message as it
applies to diet
must have a zero credibility rating. Never mind diffusion of the message – let
us
reduce the amount of confusion relating to the societal perception of the
'do-gooders'
and their objectives.
Nutritional programmes, thirty years ago at least, were based on the concept of
adequacy. Since then there has been concern for excess – the disease of
affluence.
(Hall, 1982: 270.) Objectives to be included in modern programmes include
"optimum
as opposed to adequacy; proportions as opposed to absolute amounts; variety and
balance of sources as opposed to achieving the requirements by whatever means.”
(ibid) Although Hall's paper at the 1982 British Nutritional Foundation annual
conference was concerned with "...getting the message across" the
consumer
following the regimen advocated would be faced with challenges which included
deciphering the meaning of such terms as "nutrient density",
"calorie density",
"narrow horizontal spectrum", and "vertical sequence".
These terms were no doubt
understood by conference delegates.
4.5.2.6 Receivers of the Message
As Selling and Ferraro said (1947: 9) "Each person knows the food he
likes, and
the mere fact that research lookers in food have decided that other foods are
good for
him does not have very much effect in making him change his ways of
eating". This is
still true today and part of what has to be done is getting him to believe that
he has
found out the new information. Clearly, someone must break the vicious circle
of
their later discussion of the consumer as expert (due to the vast number of
meals
eaten) eating what he likes and liking what he
79
eats. New angles must be drawn on this
idea whereby the consumer is influenced over what he likes – the rest is easy –
he eats
what he likes. If he is "continually accepting or rejecting new
information" let this
information relate to what he should be putting on his plate (or, as we saw
earlier,
what his wife is putting on his plate.) If he is making correct decisions at
this level it
will be so much easier for him to assume responsibility for his own health and
later,
for that of his own children.
Not only must the message be changed but its
overall societal receptivity.
Featherstone considers health education an offshoot of preventative medicine
where
the individual "has to be persuaded to assume responsibility for his
health”. This can
be achieved when society is geared up to saving money which would otherwise be
spent on health services.
"...the health education movement is trying to bring about a change in the
moral
climate so that individuals assume increasing self responsibility for their
health, body
shape and appearance". (Featherstone, 1982: 25).
The 'classes for slimmers' within adult education is only a start in the non-
compulsory sector of education. Not too many adult education units are building
upon
the interest which is obviously there. Cultivate the interest in body shape and
extend it
forwards in terms of efficiency of the engine and outwards in terms of the rest
of the
family. Where are the classes with such titles as 'Sound diets for unsound
joggers'? In
this way specific messages can be related to specific groups within society.
Baroness
Phillips (1966: 31) warns against being specific and yet too general by
speaking "...of
groups of millions of people in terms of one." and says "It is
impossible to describe
housewives as a single group in the community." But is it sufficient to
aim at the
housewife in her mid-thirties attending an evening class or aerobics session?
It would
seem that one cannot be much more specific. The advertising man would not be
prepared to target on such a small gold and health education would have to sets
its
sights at the right group in order to be effective.
5.5.2.7 All
is not lost
5.5.2.7.1 A good example of any health education promotion maxim is 'don't attempt too much'
This phrase was used much earlier WHERE? and
it is apt here. There have been successful
nutrition programmes and, obviously, not too many can be described in any
detail.
What better word to convey a food message than 'FEAST'?
FEAST is an acronym for
"Food Education Applied to Social Trends" which was the title of the
Ashley Down,
Avon, Nutrition Education Research Project. It is worthwhile to make a meal of
it
now.
Burman (1981a: 2) points out its key concepts
as being "interdisciplinary
direction and participation, concentrated community involvement, on-going
communication and coordination." Its popular appeal in the local community
of its
operation may have derived from "Ashley"-the advice-giving wise food
owl who "is
becoming as familiar as the GPO's Busby now is nationally" (ibid 3).
Clearly, success
as described by Burman cannot rest solely upon a logo-type figure and the net
of
liaison between numerous specialists and the community is fully discussed. The
project started in April 1980 with plans to last for three years. Its framework
– "a well-
balanced eating pattern including a wide variety of foods" has the
objectives of
encouraging "reduction of sugar and sweet foods; reduction of fat; and
increase of
dietary fibre." These objectives derive from "Eating for Health"
(Health Departments
of Great Britain and Northern Ireland, 1978: 77).
It is a good example of any health
80
education
promotion maxim 'don't attempt too much' and is restricted to a few
essentials which, as Yellowlees (1978: 36) has indicated, "countless
papers on
nutrition again and again confirm." Burman's apt remark is that
"Perhaps in our
inevitable search for academic respectability we have lost sight of one basic
fact –
namely that nutrition concerns not only food but people and their health. In
terms of
health education it is of little use if people whilst knowing underlying
principles
regarding nutrition are not motivated to practise them as part of their own
life style."
(ibid: 2)
5.5.2.7.2 It is necessary to start with the very young child
In a later report, Burman (1981b: 33)
illustrates three main phases of the project:
"1. Introduction and initiation... 2. Consolidation and Development... 3.
Ongoing
projects within the community..." She highlights that there is an
"absence of national
food policies" and it is "only through dynamic educational thrusts at
grass root level,
followed by ongoing community involvement programmes will people become well
informed and better equipped to enable them to make wise food choices."
In an elaboration of what is involved at
primary school level Burman (1981c:
21) comments that it is easier to obtain the interest and involvement of
parents at this
stage. Probably of equal importance is the notion that if correct attitudes are
to be
established then it is necessary to start with the very
young child.
Although cooking has been included in the primary
school curriculum "...with
the very limited objective of offering a very enjoyable activity..." it
was hoped that it
will be harnessed to the aims of the project. It is vital to place these
activities on
"informed nutritional foundations" in order that "the children's
natural curiosity about
and interest in food is used to establish and consolidate the right attitudes
to wise food
choice."
5.5.2.7.3 The
general practitioner has little hope of re-education in a ten-
minute consultation
It is worth noting that in the County of Avon
there was good liaison between the
project team and there was "...another series of discussions with
colleagues in the
School Meals Service". They had queried the assumption made by the project
team
that all concerned with home economics teaching and educational catering
"had
accepted the necessity for the nation to be made aware of the value of reducing
the
intakes of sugar and fat...etc."
Pupils in secondary schools ware increasingly
involved in FEAST and carried
out surveys on household food consumption patterns. Overall "There has
been
unprecedented reaction from teachers, children and parents and their
recognition of its
importance and commitment to educational work has surpassed the project team's
initial hopes.”
Smith (1981: 8) continues the description of
the FEAST project from the general
practitioner perspective. He reviews the illnesses arising from poor diet
amongst 100
patients where "...33 were found to have complaints or problems either
directly due to
bad eating habits... or probably associated with diet...or probably adversely
affected
by overweight..." The information was presented at a seminar, itself a
rare opportunity
for such a person to get over various points to more than one person at a time.
"It is
not surprising...that the general practitioner has
little hope of re-education in a ten-
minute consultation." He points out, however, that "The formal
talk is of limited
value. Discussion groups, question sessions, 'Brains Trusts' all provide a
forum for
diet education."
5.5.2.7.4 An important part of any local activity is the involvement of District Dietitians
One way to attract the attention of people
within the community was to stage a
festival where the local residents were involved in organising it. But it is
not just a
question of holding events such as this in a sequence of unlinked,
uncoordinated
happenings. Burman, (1981d: 18) describes a series of
81
"pot-boilers" comprising:
1 a
children's poster competition
2 "mini-meetings" at
fortnightly intervals including Dr. Smith's contribution
3 a nutrition exhibition including
children’s posters
4 a PTA event for 200
5 newsletters
6 an "Ashley" competition
7 Ashley badges and car stickers
8 Ashley message posters aimed at "specific 'targets'."
Local celebrities were also involved as was local industry, radio but TV
"had
'bigger fish to fry'.”
It is interesting to note the use of the project's motif – Ashley Owl: "As
part of
various topics in (an infants) school, Ashley has been Sir Ashley, a bold
Knight at the
Court of King Arthur, one of Snow White's woodland friends, a snowy owl in
winter
and an intrepid astronaut." (Squire, 1982: 8). He was also involved in a
Scottish
Project, Christmas themes and in entertaining the elderly. Any success, and it
appears
to be substantial, is based on the involvement of as many in the community as
possible and the project provides numerous guidelines to others contemplating
such a
scheme, "...enthusiasm is infectious." In "Food for learning, a
Nutrition Project for the
Primary School" Squire provides a teaching pack of materials based on her
approach
to the integration of food studies in the curriculum.
An important part of any local activity is the
involvement of District Dietitians
and their interest had been harnessed to the ongoing activities. Williams
(1982: 19) is
the District Dietitian in the Avon Area Health Authority and describes her
early
involvement with FEAST. It was "a challenge and experience to work with
disciplines
outside the Health Service all working with a common aim and direction."
This brings
us back to the point made earlier in this study concerning the lack of policy
in the UK.
From Williams we can sense the frustration of numerous individual concerns each
working as an entity. FEAST was a
successful project and its potential in other areas of the country is
apparent providing it is adapted to the needs and interests of those in the
area. It
correlates well with a major theme of this book that you have to 'catch 'em
young'.
4.5.2.7 Conclusion
4.5.2.7.1 Procedure for Successful Health and Nutrition Education
Burgess and Dean (1962: 110) have provided a
list of "conditions for successful
education" in the field of nutrition. It would be more appropriate to
locate them within
a provisional model than repeat them here (Figure 4.3 below). Their list of
conditions is
helpful in devising a model of successful health and nutrition education but
comments
are necessary. There has been no assessment of the nutritional status of those
who
require to be educated and this must be done thoroughly. At the other end of
the
process it is only a part of what should be done to evaluate "the health
education work
and progress of the programme."
82
More specifically, the success of fulfilling the objectives must be evaluated –
if
none, then look at the health education work and progress of the programme.
Look at
the model provided here WHERE? and extend it, vary it according to the local
need. Assessment
of nutritional status may be a laudable concept in a bush village of forty
souls; health
education officers in the occidental world have a very different approach to
make
which does not accommodate rickets-ratios. They are faced with numerous
categories
of people and problems and an uncoordinated help-force of teachers, adult
educators,
administrators and other interested parties.
The fat man-in-the-street is an
un-self-fulfilling prophecy in relation to the
barrage of objectives within the conveyor belt of food education. How he
responds to
the uncoordinated help-force will be determined by his own health objectives.
If he
has none, food education has a long way to go. The educational diagnosis is too
late in
most cases and no amount of determining desired nutritional improvement will
achieve anything. This is not to nullify the procedure outlined in figure 4.1.
That can
be applied to a different population.
Figure 4.3 Procedure for Successful Health and Nutrition Education
(Developed from Burgess and Dean: 110)
4.5.2.8 There is a move within health education generally towards a greater decision-
freedom
Compare human feeding with that of household pets. The young child is weaned
and dietary integration follows a sometimes frenetic routine before he settles
down to
a compromise between what he receives at home, and school and joins in with
within
his circle of friends. But cats and dogs don't watch TV adverts but their mums
are
certain that this or that food is the one for them. The only pet-food decision
we can
observe is voting with their paws, Mum is following the same decision procedure
for
kids, dad and pets and the same type of advertising influences prevail across
the
situations. It is a question of who can shout loudest.
Once the food education programmes have been
devised the message has to be
put across. The competition, however, is severe. "The rule of expressive
range applies:
the energy of the communication varies directly to resistance and noise. ...
Any
individual trying to communicate amidst the clash and din of a noisy background,
finds himself engaging in extravagant gesture..." (Neiburg, 1973: 212).
Health and
food education has therefore to shout louder against the noise from industry
and
commercialism but with fewer extravagant gestures.
Fortunately, some of that is nice noise. For example, and it is one many, the
British Nutrition Foundation (BNF) (as industry) and the Health Education
Council
(HEC) produced in 1985 an easy to understand leaflet on "Eating for a
Healthier
Heart". The problem for food educators is getting people to follow the
good advice in
such leaflets.
There is a move within health education generally towards a greater decision-
freedom. In the introduction to his chapter on "Teaching Skills" Lee
(1981, 225)
comments that health education is about
"...translating the facts into a meaningful context which
allows people to make decisions as to the appropriate course of
actions with regard to their health behaviour. Health education
must be seen as a freeing exercise that gives the people the
means to choose as a result of greater awareness and
knowledge."
Cantle put it slightly wider when he remarked: "Health education has
become an
important part of the drive to prevent ill-health, by trying to influence the
way people
choose to live their lives."
The "appropriate course of action",
then, must be simplified. The NACNE
report is not written in simple terms but various leaflets and booklets which
include its
recommendations are. One of these is the "You are what you eat"
accompaniment to
the BBC programmes in 1986. Although "decision freedom" is not
splattered across
them the advice given is often sound. But once again the question should be
asked
concerning why there is still so much evidence of unsound diet. Is it
"media overload"
which leads to "media insensitivity"? "...excessive appeals for
emotional response lead
to impassivity and withdrawal.” (Neiburg, loc cit). When that happens decision
freedom seems irrelevant.
4.5.2.9 Send reinforcements; we're going to advance
An account of the BNF 'Attitudes to Eating'
conference in 1984 refers to "Eating
in the Early 1980s..." "The report concludes that changing eating
behaviour is simply
catching up with the modern British lifestyle. ... in order to improve people's
diet it is
important to find out why they enjoy the things they eat and improve upon
those."
(New Home Economics, 1986: 21). If they don't like the foods listed in the
sensible
leaflets why not include the ones they do and build upon that foundation?
Simplicity of the message is the keynote. NACNE (1983) did not reduce it down
to a few words but, as Cotterell (1986: 11) points out, there are "Dietary
Guidelines
for Americans" which are "admirably brief".
“1 Eat a variety of foods
2 Maintain reasonable weight
3 Avoid too much fat, saturated fat and
cholesterol
4 Eat foods with adequate starch and fibre
5 Avoid too much sugar
6 Avoid
too much sodium
7 If you drink alcoholic beverages do so in
moderation – and don't drive.
It would be a brave person who tried to improve upon these without new
evidence."
If similar lists produced here have failed there would be no harm in trying to
implement imported advice. It is not only deciding upon a message, it is
translating it,
delivering it and following it up afterwards.
The old Army message which went down the line started "Send reinforcements;
we're going to advance”. The last soldier was told "Send three and
fourpence; we’re
going to a dance." We were lucky enough to win that war – will we hold out
in the
nutrition battle? Will the latest nutrition message actually arrive in its
original form?
Will the fight be fought or merely refereed by health educationalists,
sociologists,
economists and numerous other 'ists'. let us not throw in the towel in the
endeavour to
provide new interpretations for a phrase discussed earlier LINK PAGE 28 – 'man is
what he eats’ !
85
pagetop Chapter 4 Contents
Third National Conference on Drugs & AIDS ... : 3 and 4 November 1992 here
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