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Rethinking food and nutrition education under changing socio-economic conditions
Rethinking food and nutrition education under changing socio-economic conditions
PREFATORY NOTE
The following is a report from a workshop held in Dar es Salaam 1726 June 1978. The workshop was organized by Committee 10 on "Education of the Public," of the International Union of Nutritional Sciences, Commission V on "Nutritional Education and Training," in collaboration with the Tanzania Food and Nutrition Centre. Dr. T.N. Maletnlema, Managing Director of TFNC and member of Committee 10/V, and Ms. Eva Sarakikya, nutrition educationist, TFNC, were responsible for all arrangements in Tanzania.
The workshop counted some 40 participants and observers from many parts of the world. The aim of the workshop was to take a fresh look at education about food and nutrition at all levels. Hitherto, nutrition educators have mainly been concerned with more straightforward practical aspects of nutrition education: what to tell about good food and a balanced diet, and how to get the messages across through the use of various audio-visual aids.
As will be seen from the report, this workshop had a more theoretical orientation than is usual in meetings on the same topic. While the need for continued discussions about concrete pedagogical problems is recognized, such problems should no longer be the only focus for nutrition educators Rather, the educators ought to become more aware of their potentially important role in the formation of policies that can lead to real improvements in the food and nutrition status of people in various societies.
It is the hope of Committee 10/V and the participants in the Tanzania Workshop that the report will stimulate discussion in other forums where the need may be felt to reconsider current approaches to education programmes on food and nutrition directed to various sectors of the public.
The report was worked out by the participants during the workshop. The format and content of a draft document were thoroughly discussed and approved on the last day of the workshop, while the necessary editing was carried out by a smaller group who stayed behind for this purpose. Individual participants should thus not be held responsible for the exact wording of the final version.
The organizers wish to thank SIDA and NORAD for their generous joint grant that made it possible to arrange the meeting, and the University of Dar es Salaam for offering its facilities, including accomodation, food, and meeting rooms. They further express their gratitude to all those individuals, in Tanzania and Norway, who in various ways helped to carry through the arrangement in a smooth way, despite many technical problems.
Wenche Barth Eide
Chairperson
IUNS Committee 10/V
I. OUTLINE OF THE PROBLEM
1. Introduction
In spite of increasing per capita food production, hunger and malnutrition are increasing in both developed and developing countries. According to the latest data from FAO, the number of hungry and malnourished increased from 401 million people in 1970 to 455 million in 1974* in the developing countries alone. This has happened in spite of an increase in average per capita food production of approximately 1 per cent per year in the developing countries in the first seven years of the 1970s.
The proposals for a New International Economic Order and the Basic Needs Approach that have been discussed by many nations and international development organizations will remain mere rhetoric unless the structural factors outlined below are addressed.
In this context there is a need for a re-thinking of the role of the nutrition educator** and others working with nutrition problems in research, planning, and education.
The traditional methods in nutrition education have mainly been based on the assumptions that the causes of malnutrition were to be found in ignorance or lack of motivation on the part of the individual and the failure of the individual to optimally use existing resources. This is evidently true in many cases and attacking this ignorance will continue to be a primary responsibility of the nutrition educator. However, the traditional assumptions prevent nutrition workers from having a clear perception of the basic causes of malnutrition. We must recognize that in the grave situation of most contemporary developed and developing countries there are limits to what traditional education alone can accomplish.
2. Food, Nutrition, and Society
Traditional nutrition education has concentrated on how food, through its nutrients, affects people and how people store and prepare their food. But nutrition also depends on access to food and thus must include people in their role as producers. In most contemporary societies, including those where many go hungry, the potentials for adequate food production actually exist. The equitable distribution of present production, the release of potentials, and the manner in which the productive resources are controlled are all constrained by the structure of the society.
Societies where people go hungry are often characterized by inequality of control over food-producing resources. The result is both the under-utilization and the mis-utilization of these resources. Thus, in highly stratified societies, built-in "inefficiencies and inequalities" thwart food production and distort its use. The real potential for food production can only be achieved in societies where the people exert democratic control over food-producing resources.
3. The Role of the Nutrition Educator
Acceptance of this approach to understanding the causes of malnutrition has strategic implications for nutrition education and for the role of the nutrition educator. If one accepts that malnutrition in the final analysis results from a maldistribution of food and the means for food production, then nutrition educators must come to grips with the need for redistribution of such resources and orient their activities accordingly. We have too long thought of ignorance as our chief enemy and failed to realize that one cannot educate people to use techniques and materials to which they have limited access. Nutrition educators must question why segments of the population are denied access to the means of adequate nutrition and how such means can be secured for them.
From this it follows that nutrition educators like everyone else play a political role in all societies. This role varies between societies and of course depends upon the ideology of the educator.
This in turn demands recognition that the distribution of resources, and even the food and nutrition practices in a society, are not accidental but reflect the conflicting interests and power relations in that society. Nutrition educators may be constrained to work within social frameworks not of their own choosing. But they should understand that the distribution of resources within and between societies is not fixed nor inevitable. This understanding should underlie the form and content of their activities
Obviously, the best strategy for nutrition educators must appear to conform to the social and economic structure in which the educator works. One cannot build on wishful thinking. For a society where the economic policy and programmes are consistently directed toward the redistribution of resources in order to enable every individual to provide him/herself with sufficient nutrients, the nutrition educator will be able to utilize any number of official as well as "grass-roots" organizations and institutions to provide nutrition information. The major goals of education are no longer those of teaching the skills or tactics for appropriating power in order to gain access to resources, but rather the goals are to teach people how to best utilize the resources that will increasingly be made available. In this case, more conventional ends of nutrition education, such as changing eating habits and health behaviour, may prove effective.
In a country with the serious intention of equalizing access to resources there are commonly a number of popular organizations, run by political parties or specific interest groups, which are used to develop the population through informal education. The nutrition educator should find such popular organizations, along with formal educational institutions and mass media, to be good resources for the promotion of nutrition information. On the societal level the nutrition educator should be encouraged to influence socioeconomic policy, if changes would further promote general well-being.
In a society, on the other hand, whose economic and social policies are either explicitly or implicitly directed towards the maintenance of the status quo-most commonly an economically stratified system-the strategy and role of the nutrition educator is much more complex. In this case there is a danger that the activities of the nutrition educator will be co-opted, so as to provide apparent rather than real attacks upon nutritional problems. This is particularly a problem if the nutrition educator sees his or her platform as one provided by government or by essentially official agencies. This is of course not to say that no good can be accomplished by working through such channels, but the nutrition educator should also be alert to opportunities that may exist to co-operate with organizations seeking social changes of broader context than those directly associated with nutrition-such as trade unions, community groups, and the like. For example, the nutrition educator is in a better position than most to provide these groups with irrefutable statistics indicating the human cost of policies promoting inequality.
In some societies an element of risk may be involved in this work, and in such cases international support and solidarity must be offered to nutrition educators by their professional colleagues.
II. SOME CONCRETE ISSUES RELEVANT TO THE PRACTICAL ACTIVITIES OF THE NUTRITION WORKER, RECONSIDERED IN THE LIGHT OF THE ABOVE CONSIDERATIONS
1. Analysis
As an initial step the nutrition worker should make a personal analysis of the factors or mechanisms in the society that determine the nutrition situation in the local context, including the possible effects of national and international development policies at this level. Reading and maintaining a dialogue with people who have identified some of these factors are necessary prerequisites to this process.
2. Interdisciplinary Approaches
The common claim for interdisciplinary approaches to nutrition analysis and practical activities must be made operational. This requires that the nutrition worker come to an understanding of the fact that the involvement of other scientists and professionals does not constitute a professional threat. Other people's ways of conceptualizing and examining the problems of, and solutions to, malnutrition must be accepted.
3. Re-orientation of Concepts and Practical Programmes
The perceptualization of many conventional and imported approaches to nutrition analysis and education is a form of "cultural imperialism," as it perpetuates dependency on knowledge generated in universities in the Western countries. While much of the basic nutritional knowledge related to biochemistry, physiology, and pathology is universal, nutrition problems related to the societal level are not and can only be studied in the given context in which nutrition activities, including education, will be carried out. Nutrition-oriented workers must therefore critically assess part of the knowledge they have acquired through various training programmes. Some examples of topics that must be totally re-oriented are as follows.
a. "Foreign" versus "traditional" dietary practices
Recommendations of dietary practices alien to local contexts have often been imposed on indigenous practices and have contributed to the low prestige and status of local foods and to beliefs in their inferior nutritive value. The most harmful among these consequences have been complementary feeding in very early infancy and the despising of prolonged breast-feeding.
b. The concept of food taboos
Careful attention should be given to the fact that food taboos too often have been used as an explanation for failure of nutrition programmes. There is an urgent need to re-think and re-conceptualize traditional ideas and biases held by professionals concerning the food taboos of population groups. This form of professional bias prevents the delivery of comprehensive health services. Studies and educational programmes appear to indicate that certain dietary avoidances are more directly rooted in real food scarcity than in mental constructions of individuals and groups. If so, these dietary practices can be overcome by an increased food supply and well-designed nutrition education programmes.
c. Food science and technology
Nutrition workers should give strong emphasis to the identification and improvement of socially appropriate technology in the field of food production, preservation, processing, preparation, and consumption. In particular, more attention must be given to the development of useful technologies for work carried out by women who are most commonly responsible for the food production, processing, and preparation at the local level. Activities of agrobusinesses and multi-nationals in food and related fields must be carefully analyzed for their impact on local technologies, so that these are not neglected and forgotten despite their appropriateness to a specific environment and socio-cultural conditions.
d. Population
Population strategies should be so designed as to increase the real options of people. The need for child spacing as a health measure to protect the nutrition of mothers and children should be central to any strategy. Population control activities, including sterilization without valid informed consent of the patient, must be arrested.
e. Food aid
Emergency relief food aid must be organized in such ways that it does not perpetuate dependency on external food supplies. Long-term food aid programmes should only be accepted if integrated with projects aimed at increasing food production and alleviating the need for food aid.
f. Nutritional priorities in food and agricultural research
The usefulness of programmes such as those aimed at producing non-traditional crops must be critically examined. Examples could include the green revolution package in Asia and the mini-green revolution now taking place in Africa. Genetic breeding programmes should first and foremost be advocated for crops natural to the given environment. They must take into account the need to preserve the possibilities for multiple rather than single cropping, as well as the necessity of using local manure or fertilizer rather than imported chemicals (e.g., insecticides). Programmes said to have specific nutritional objectives may have to be reexamined for the validity of the nutritional arguments. Breeding programmes for higher protein or amino-acid content of cereals are typical examples.
g. Affluence, nutrition, and health
The relationship between affluence and health must be further examined in the developed as well as in the developing countries. Exclusive emphasis on undernutrition will easily ignore that there are also dietary related diseases resulting from modernization and over consumption (e.g., heart diseases, obesity, colon cancer, etc.), which seem to affect people in the better-off groups of all societies. At the same time further analysis is needed of the consequences of new demands from these same groups on land use and primary food resources both at international and national levels. The possible price paid in terms of new forms of ill health among the well-off for the satisfaction of these demands should be discussed, documented, and acted upon. This could be a new selling argument in the efforts to educate and persuade politicians and planners that agricultural and other state policies must become more oriented towards equal distribution and the fulfillment of basic food and health needs for all.
h. Mass media
Mass media can be useful provided the limitations are recognized and the potential value does not become a dogma. Messages should be based on needs felt by those addressed. Whenever possible traditional methods of mass communication should be used provided these do not block the development process. In the use of modern mass communication, messages should be very specific and designed for clearly defined purposes. If a programme is to promote real change, it is important to establish effective structures to encourage follow-up actions, e.g., various promotion groups.
4. Research, Planning, and Evaluation
The external orientation of nutrition workers has often removed them from the context in which they work. There is a strong need for analyzing community set-ups, delineating the factors leading to malnutrition, and from this analysis to work out solutions to the problems. This is not a new suggestion, but the methods to be used have to change considerably if these approaches are to be effective. This implies active participation by the community in the definition of the problem, collection of data, planning, implementation, and evaluation of practical programmes. Data originating from such action programmes can in turn be utilized by central bodies for national overall planning, rather than the other way round.
The precise ways of generating local participation must be worked out within each specific context and no universal recipe can be given. However, with emphasis upon local participation there will no longer be a sharp demarkation line between research, action, and education.
It is not possible nor is it necessary to have a full overview of all the determinants involved in any food and nutrition programme and of their relative impact. there must therefore be a continuous evaluation of actions results, and views so as to provide a basis for reinterpretation of results and adjustment of the direction of the programmer.
5. Training of Nutrition Workers
In the light of the above reconsiderations, there is urgent need for re-orienting the training of all nutrition workers This new orientation must be undertaken to prevent further maintenance of myths regarding the causes of and solutions to malnutrition in the world.
III. CONCLUSIONS AND GENERAL RECOMMENDATIONS
1. Nutrition education must be alert to the nature of the constraints on various policies generated by international economic systems (e.g., the New International Economic Order) as well as on the proposed "Basic Needs Approach" to development strategy. In particular one needs to be aware of the following aspects relevant to food and nutrition.
2. Nutrition and nutrition education have too heavily concentrated on the side of individual consumption and its physiological effects. Nutrition education must clearly emphasize that malnutrition is the result of maldistribution of the means for food production, storage, and distribution, and of inequality in control over the access to food. The concept of nutrition must therefore be broadened to include these factors.
3. The socio-economic structure determines the role of the nutrition educator.
4. In most cases it is not possible to reach a full consensus on what nutrition education should be if there is not a shared view as to why malnutrition exists in a society. Nevertheless, a dialogue between holders of different views must be encouraged so that channels of communication remain open.
5. In some societies the work of exposing the root causes of malnutrition may place the job or personal safety of the nutrition educator at risk. In those cases support and solidarity must be offered to such workers by their professional colleagues.
IV. SPECIFIC RECOMMENDATIONS TO THE IUNS
In the light of the above considerations and general recommendations, the workshop recommended that the IUNS should:
APPENDIX
Participants
Antti Ahistrøm, Professor of Nutrition
Department of Nutrition, University of Helsinki
SF-00710 Helsinki 71, Finland
Han Bantje, Medical Sociologist
BRALUP, University of Dar es Salaam
Box 35097, Dar es Salaam, Tanzania
Dr. Josefina Bulatao-Jayme, Assistant Director
Food and Nutrition Research Institute
P.O.Box EA 467, Ermita, Manila, Philippines
(Member, Committee 10/V)
María Celeste Bustillo, Director, Nutrition Evaluation
Planner
National Food and Nutrition Plan
P.O.Box 1931, Bogota, Colombia
Freda Chale, Nutritionist
UNICEF, Box 4076, Dar es Salaam, Tanzania
Chapa Y. Chikamba, Assistant Executive Secretary
The National Food and Nutrition Commission
P.O.Box 2669, Lusaka, Zambia
Dr. Rajammal P. Devadas, Director and Professor
Sri Avinashilingam Home Science College
Coimbatore, 641011, India
Therese Drummond, Director for Nutrition and Rural Community
Education
Agricultural Missions, Inc., National Council of Churches
475 Riverside Drive, Room 624, New York, N.Y. 10027, USA
Wenche Barth Eide, Assistant Professor
Institute for Nutrition Research, University of Oslo
Box 1046, Blindern, Oslo 3, Norway
(Chairperson, IUNS Committee 10/V)
Sally Guttmacher, Assistant Professor
School of Public Health, Columbia University, Sociomedical
Sciences
600 West 1 68th Street, New York, N.Y. 10032, USA
Dr. Jørgen Høimark Jensen
Department of Food Preservation
Royal Veterinary and Agricultural University
Howitzvej 13,2000 Copenhagen D, Denmark
Dr. Norge W. Jerome, Professor
Department of Community Health
University of Kansas Medical Center
Rainbow Blvd. at 39th Street, Kansas City, Kansas 66103, USA
Dr. Urban Jonsson, Director
Nutrition Planning Department
Tanzania Food and Nutrition Centre
Box 977, Dar es Salaam, Tanzania
Felix K. Kaijage, Agricultural Nutritionist
Training Department, Ministry of Agriculture
Box 2066, Dar es Salaam, Tanzania
Felix Kalumuna, Director
Manpower and Training Department
Tanzania Food and Nutrition Centre
Box 977, Dar es Salaam, Tanzania
Yusuf Kassam, Senior Lecturer in Adult Education
Department of Education, University of Dar es Salaam
Box 35048, Dar es Salaam, Tanzania
Dr F. Katabaro
The Treasury Sectoral Planning
Box 9111, Dar es Salaam, Tanzania
Valerian P. Kimati, Professor, Head
Department of Paediatrics and Child Health
Faculty of Medicine, Muhimbili Medical Centre
Box 20693, Dar es Salaam, Tanzania
Frances Moore Lappé, Co-director
Institute for Food and Development Policy
2588 Mission Street. San Fransisco, Ca. 94110, USA
Elimosaria Maeda, Assistant Lecturer in Food Science and
Technology
Faculty of Agriculture, Forestry and Veterinary Science
University of Dar es Salaam
Box 643, Morogoro, Tanzania
Dr. Alex Maganga, Director
Medical Nutrition Department, Tanzania Food and Nutrition Centre
Box 977, Dar es Salaam, Tanzania
Dr. T.N. Maletolema, Managing Director
Tanzania Food and Nutrition Centre
Box 977, Dar es Salaam, Tanzania
(Member Committee 10/V)
Yohana Masisi, Senior Research Fellow/Planner
Institute of Adult Education
Box 20679, Dar es Salaam, Tanzania
Dr. Beatrice d e MeI
Department of Nutrition, Medical Research Institute
Colombo 8, Sri Lanka
Miriam Munoz de Chavez, Nutritionist,
Co-ordinator Food and Nutrition Plan
Cerrada de los Eucaliptos 17, San Jeronimo Lidice, Mexico 20, DF,
Mexico
Raphael Z. Mwajombe, MTUU Administrator
Ministry of National Education
Box 9121, Dar es Salaam, Tanzania
Dr. Richard Orraca-Tetteh, Senior Lecturer
Department of Nutrition and Food Science, University of Ghana
Box 1 34, Legon, Accra, Ghana
(Member Committee 10/V)
Eva Sarakikya, Nutrition Educationist
Tanzania Food and Nutrition Centre
Box 977, Dar es Salaam, Tanzania
Dr. Soekirman, Lecturer and Head, Division of Community
Extension Service
Academy of Nutrition
Box 8 KBYB, Kebayoran Barat, Jakarta Selatan, Indonesia
(Member Committee 10/V)
Dr. Filomina Steady, Social Anthropologist
Visiting Professor/Research Associate, African Studies Center
Boston University
10 Lenox Street, Brookline, Mass. 02146, USA
Dr. Maria-Liisa Swantz, Lecturer in Anthropology
University of Helsinki
Tunturikatu 4A7, 00100 Helsinki 10, Finland
Nancy Velarde, Nutritionist
Institute of Nutrition, Uppsala University
Box 551, 751 22 Uppsala, Sweden
Rodny Åsberg, Doctor of Education
Institute of Education, Fack
43120 Mølndal, Sweden
Observers
Gudrun Håan, Administrative Secretary
Institute for Nutrition Research, University of Oslo
Box 1046, Blindern, Oslo 3, Norway
Margaret Khonje, Medical Nutritionist
Tanzania Food and Nutrition Centre
Box 977, Dar es Salaam, Tanzania
Marja-Liisa Lahtinen, Head of Pedagogic Planning
The Union of Civic and Workers' Institutes
Cygnacnksenkatu 4B10, 00100 Helsinki 10, Finland
Dr Bjørn Ljunggvist, Biochemist, Food Scientist
Medical Nutrition Department, Tanzania Food and Nutrition Centre
Box 977, Dar es Salaam. Tanzania
Olyvia Mgaza, Nutrition Planner
Tanzania Food and Nutrition Centre
Box 977, Dar es Salaam, Tanzania
Betty Mlingi, Home Economist/Nutritionist
Tanzania Food and Nutrition Centre
Box 977, Dar es Salaam, Tanzania
Judith Ngowi, Assistant Nutrition Educationist
Tanzania Food and Nutrition Centre
Box 977, Dar es Salaam, Tanzania
Hannu Pulkkinen, Information Secretary
Peoples' Educational Association (KSL) in Finland
Jarrumiehenkatu 2, 00520 Helsinki 52, Finland
Mr. Wagara, Assistant Planner
Tanzania Food and Nutrition Centre
Box 977, Dar es Salaam, Tanzania