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Division of Nutritional Sciences, Cornell University, Ithaca, NY and * Joint Program in Urban Systems, University of Medicine & Dentistry of New Jersey, Newark, NJ
2To whom correspondence should be addressed. E-mail: gp32{at}cornell.edu.
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ABSTRACT |
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 TOP ABSTRACT Overview of studies of...Overview of studies of...Interrelationships of power and...Concluding remarksLITERATURE CITED |
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KEY WORDS: • social determinants of nutrition • scientific knowledge and nutrition inventions • maternal education • Mexico
A primary rationale for engaging in social research in nutrition is to inform and facilitate the application of nutritional science knowledge to public policy and public health practice. In this report we examine the implications of a central feature of most social research in nutrition: the tendency to focus predominantly on either power-related or belief-related determinants. We use the word power as a proxy for a large set of factors that reflect material, economic and political factors in human behavior, particularly economic conditions and social structures that affect people’s access to critical resources for nutrition, including time, money, education, health and social services. We use beliefs as a proxy for factors that reflect ideational, cultural and psychological features of human experience, including "knowledge," "attitudes" and "cultural expectations." As can be seen in the brief overviews below, both power-related and belief-related determinants can be identified and studied at every level of analysis from macrolevel (global, international) to microlevel (households, individuals).
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Overview of studies of power-related studies in nutrition3 |
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TOPABSTRACTOverview of studies of...Overview of studies of...Interrelationships of power and...Concluding remarksLITERATURE CITED |
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Other foci of research can also be classified under the general rubric of "power." Studies of gender differentials in food intake, which are concerned with social power, have attracted attention from investigators, particularly in South Asia where the consequences have been observed across a wide age spectrum. An interaction often exists between economic constraints and social power, such that the more flagrant patterns of male/female differences in access to high nutrient density food occur in conditions where total food availability is limited. However, even under conditions of general food adequacy there are populations in which access to food by one part of the population (women) is constrained simply by the fact of their female gender.
Another body of research has focused on intrahousehold power differentials and their effects on food intake and nutritional status. Although some manifestations of power derive from gender, this is not always the case. Among the types of power that have been studied in relation to nutrition are power differentials associated with generational position, birth order or, in polygynous societies, marriage order.
Research by sociologists, social psychologists and other health service investigators has produced a considerable body of work on the effects of power in health and social services. Studies in institutional environments (hospitals and nursing homes, schools, prisons) often include a detailed description of food- and nutrition-related features, even though nutritional consequences are typically not the central focus of such studies.
Evaluations of the design and management of nutrition intervention programs constitute yet another body of research concerned with power-related factors. Examination of the ways in which programs are affected by power differentials between recipients of programs and the agencies from which programs emanate is often included in the reflective discussions or "lessons learned" sections of evaluation reports. In nutrition less attention has been given to power differentials between frontline workers and higher level administrative personnel, but these also find their way into evaluation reports. Taken as a whole, "power-related" studies in nutrition have produced a wealth of evidence on the importance of material, economic and political factors as determinants of human nutrition.
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Overview of studies of beliefs and nutrition |
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TOPABSTRACTOverview of studies of...Overview of studies of...Interrelationships of power and...Concluding remarksLITERATURE CITED |
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Research on individual-level psychological characteristics constitutes another well-developed body of work on belief-related variables. These have been studied as "risk factors" for nutrition and health problems, and as predictors of response to interventions that are aimed at changing behavior, either through individual-level counseling or through community-level nutrition education interventions. In the latter set of studies, investigators have sought to determine how preexisting attitudes and psychological traits affect individuals’ responses to interventions. Among the types of psychological variables that have been examined in both "risk factor" and "response factor" studies are self-efficacy, locus of control and stage of behavior change with respect to a particular dietary or other health behavior. In general this body of work provides solid support for the importance of individual psychological characteristics in affecting food intake.
In evaluations of nutrition interventions, changes in "nutrition knowledge" and "attitudes" are often examined. Efforts to characterize the results of this diverse body of work have faced formidable methodological challenges, but the most systematic and careful efforts suggest that well-conceived and well-executed interventions can improve nutritional conditions through belief-mediated pathways.
Another large body of research has focused on the relationship of cultural beliefs and attitudes to nutrition and health outcomes. Studies in anthropology, sociology and communication, as well as nutrition program evaluations, have explored the multiple ways in which these factors shape food intake and responses to interventions. The subject matter ranges from infant feeding to elderly nutrition, from food restrictions and taboos to cultural values of hospitality and commensality. Considerable research, particularly in anthropology, has focused on how disjunctions between community belief systems and nutritional advice have affected intervention activities.
Taken as a whole, the corpus of research on belief-related factors in nutrition provides strong support for the importance of ideational, cultural and psychological features of human experience.
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Interrelationships of power and belief in nutrition |
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TOPABSTRACTOverview of studies of...Overview of studies of...Interrelationships of power and...Concluding remarksLITERATURE CITED |
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In a cross-sectional nutrition survey in Benin, data were collected on a number of social variables, including household economic status indicators and maternal education (1
). Regression analysis showed a modest but significant association of education and child size, and one might have concluded from these results that differences in schooling played only a minor role in accounting for differences in growth faltering. However, when an interactive analysis was conducted, a different picture emerged (2
). Maternal education appeared to make a considerable difference in a subgroup of families: those who were neither living in abject poverty nor were economically secure. Similar results have been reported for Bangladesh (3
) and Lesotho (4
). In these situations, material or economic variables appear to have been enabling or constraining factors that affected the potential for beliefs, knowledge or culture to play a significant role.
Through the use of data from the Nutrition CRSP study in the Solis Valley in Mexico, we conducted a series of analyses to examine how power-related and belief-related factors affected the diets of families and their preschool children. In this setting, where tortillas and beans form the basis of the household diet, dairy products are an important source of high value nutrients (5
,6
). As would be expected, intake of dairy foods tends to be low among the poorest families (Fig. 1
). Although the highest intakes occur in the families that are best off financially, better economic circumstances do not necessarily translate into higher dairy consumption. Instead, families in the highest economic group, measured by local standards, show the greatest variation in dairy consumption. The pattern of legume intake is the reverse of the pattern for dairy foods (Fig. 2
). Children in better-off families eat very little. Some of the poorest families have the highest intakes, but the group of poorest families also shows the widest range in legume consumption.
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). Similar to what was seen in Benin, Bangladesh and Lesotho, women with greater economic means and more education tended to feed their children more dairy foods (Fig. 3
). However, even in better-off households where mothers had more schooling, dietary quality was not uniformly high. There were also differences in the composition of diets of young children in poor families in which some received more dairy products in spite of household poverty. These results reflect, at least in part, the operation of other values and beliefs that influence how families allocate their resources.
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The results from the Mexico Nutrition CRSP study, and from other projects in which investigators not only collected data about power-related and belief-related variables, but also analyzed them in ways that reveal their interactions, support the proposition that nutritional outcomes are the result of complex interactions between material and ideational factors, between manifestations of economic and social power and psychological and social values. Because the dimensions of power and belief (or material conditions and cultural/psychological factors) are always in dynamic interaction in human experience and social life, they are mutually involved in determining dietary intake and nutritional status, and in influencing the success of interventions that are aimed at improving nutritional conditions.
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Concluding remarks |
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TOPABSTRACTOverview of studies of...Overview of studies of...Interrelationships of power and...Concluding remarksLITERATURE CITED |
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One of the primary conclusions that emerge from a multidimensional analysis is that, in nutrition and health interventions, one size does not fit all. There are parallels here with our emerging understandings of the implications of gene-nutrient interactions for population-based interventions. For example, in the extreme case of hemochromatosis, universal iron fortification increases the risk of disease for a small subgroup while benefiting a much larger group (7
). In the less dramatic case of interventions that work through social, economic and behavioral change, the issue may not be "risk" vs. "benefit" but "capacity to benefit" (8
,9
). Studies that reveal mechanisms also help to identify the types of supports that are required by different segments of the population for them to benefit.
Adopting an approach that encompasses both power-related and belief-related dimensions has several implications for future research on the social aspects of nutrition.
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FOOTNOTES |
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3 Because of space constraints references to representative examples are not included in this and the following section. They are available from the corresponding author.
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LITERATURE CITED |
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TOPABSTRACTOverview of studies of...Overview of studies of...Interrelationships of power and...Concluding remarksLITERATURE CITED |
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1. Niameogo, C. (1993) Maternal Education, Knowledge of Child Nutrition and Disease, and Child Nutritional Status in the District of Ouidah, Benin. Doctoral dissertation 1993 Cornell University Ithaca, NY.
2. Reed, B. A., Habicht, J.-P. & Niameogo, C. (1996) The effects of maternal education on child nutritional status depend on socio-environmental conditions. Int. J. Epidemiol. 25:585-592.
3. Menon, P., Habicht, J.-P. & Zeitlin, M. (1999) Maternal caring behaviors mediate the influence of maternal schooling on child nutrition in rural Bangladesh. FASEB J. 665.1 (abs.).
4. Ruel, M. T., Habicht, J.-P., Pinstrup-Andersen, P. & Grohn, Y. (1992) The mediating effect of maternal nutrition knowledge on the association between maternal schooling and child nutritional status in Lesotho. Am. J. Epidemiol. 135:904-914.
5. Allen, L. H., Backstrand, J. R., Chávez, A. & Pelto, G. H. (1992) Humans Cannot Live by Tortillas Alone: The Results of the Mexico Nutrition CRSP. Final report to USAID 1992 Department of Nutritional Sciences, University of Connecticut Storrs, CT.
6. Allen, L. H., Black, A. K., Backstrand, J. R., Pelto, G. H., Ely, R. D., Molina, E. & Chávez, A. (1993) An analytical approach for exploring the importance of dietary quality vs. quantity to the growth of Mexican children. Food Nutr. Bull. 13:95-104.
7. Backstrand, J. R. (2002) The history and future of food fortification in the United States: a public health perspective. Nutr. Rev. 60:15-26.[Medline]
8. Habicht, J.-P. & Pelletier, D. L. (1990) The importance of context in choosing nutritional indicators. J. Nutr. 120:1519-1524.
9. Ruel, M. T., Habicht, J.-P., Rasmussen, K. M. & Martorell, R. (1996) Screening for nutrition interventions: the risk or the differential-benefit approach?. Am. J. Clin. Nutr. 63:671-677.
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