Sustainable and Healthy Diets Supplement

Food and Nutrition Bulletin 2020, Vol. 41(2S) S59-S73 ª The Author(s) 2020 Sociocultural Influences on Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/0379572120975874 Food Choices and Implications journals.sagepub.com/home/fnb for Sustainable Healthy Diets

Eva C. Monterrosa, PhD1 , Edward A. Frongillo, PhD2 , Adam Drewnowski, PhD3, Saskia de Pee, PhD4,5, and Stefanie Vandevijvere, PhD6

Abstract Background: The global policy discourse on sustainability and health has called for dietary trans- formations that require diverse, concerted actions from governments and institutions. In this article, we highlight the need to examine sociocultural influences on food practices as precursors to food policy decisions. Discussion: Sociocultural food practices relate to ideas and materials that give rise to food choices and food patterns of a group. We begin with a discussion of how individuals experience, interpret, negotiate, and symbolize the food world around them. We examine primarily the ideational pathways, such as identity, gender, religion, and cultural prohibitions, and their influence on food practices. We then provide guiding questions, frameworks, and a brief overview of food choice values to support policy planning and design. Lastly, we explore how sociocultural change for sustainable or healthy diets is already happening through food movements, food lifestyles, and traditional diets.

Keywords food culture, sociocultural analysis, policy planning, policy design, food symbolism, food choice values, sustainable healthy diets

Introduction The current global food policy discourse on sus- tainability and health views healthy diets as key 1 The Global Alliance for Improved Nutrition, Geneva, for preventing malnutrition in all its forms.1 Indi- Switzerland vidual food choices that result in dietary patterns 2 University of South Carolina, Columbia, SC, USA 3 University of Washington, Seattle, WA, USA are considered important for achieving sustain- 4 2 UN World Food Programme, Rome, Italy ability targets. Scientists are calling for dietary 5 Tufts University, Boston, MA, USA transformations, urging diverse, coherent actions 6 Scientific Institute of (Sciensano), , from governments and institutions.3 From a policy perspective, orchestrating diet- ary change requires considerable effort. While Corresponding Author: Eva C. Monterrosa, The Global Alliance for Improved large dietary transformations have happened, Nutrition, Rue de Varembe 7, 1202 Geneva, Switzerland. they have occurred alongside dramatic shifts in Email: [email protected] S60 Food and Nutrition Bulletin 41(2S) livelihood, food production, and distribution. In information about values and attitudes for food Latin America, for example, rapid economic and eating.15 This transmission is partly respon- development that led to changes in urbanization, sible for the relative stability of food practices livelihoods, and food systems was accompanied over time.5 Cultural food practices change in the by the “nutrition transition” (ie, significant shift process of acculturation when immigrants are from plant-based diets to diets with a higher pro- exposed to new foods and to different culinary portion of energy from animal-source foods, and food acquisition practices.16 more vegetable oils and fats, and more added sugars4). More often, dietary change has been slower, more subtle, and dependent on sociocul- Personal System of Food Choice tural food practices.5 This article highlights the sociocultural influences on food choices and the The personal food system is important in under- importance of analysis of cultural food practices standing the many factors that influence food in the shaping of desirable and effective policy choice at the individual level and the role of cul- actions. ture in driving those choices. Food choice is about why people eat the foods they do, and decisions about food are the outcome of processes that are Cultural Food Practices complex, influenced by biological, psychologi- Cultural food practices refer to material and idea- cal, economic, social, cultural, physical, and tional (cognitive) elements that give rise to spe- political factors. Food choice behaviors are con- cific dietary patterns within a geographic region nected to social and economic expression of iden- or social group.6 Material elements include food tities, preferences, and cultural meanings and are production systems that grow, transport, and dis- an important determinant of nutritional status and tribute food; financial resources to acquire food; health. and meal preparation (acquisition, cooking, stor- Decisions about individual food choice age) and eating location. Ideational aspects involve multiple behaviors including acquiring, include cuisine, “rules” for meals, the ritualistic preparing, storing, giving away, serving, eating, uses of foods, prestige and status attributed to and cleaning up.17 These complex decisions foods, and social organization (roles, status) involve many considerations about what to eat around food production, preparation, and con- and when, where, and with whom to engage in sumption.6 In this article, we focus on ideational food behavior. Decisions are dynamic in both aspects of culture as an entry point to shifting historical time and within an individual’s life norms on how we grow, procure, and prepare our course in both short- and long-term time frames. foods. There are 3 dominant perspectives for analyz- Food practices are learned mainly through ing food choice.17 The rationalist perspective transmission from parents to children. The struc- assumes that individuals make decisions to max- ture and timing of meals, where food can be con- imize benefits and minimize costs. The structur- sumed (at table, with others, etc), and how to eat alist perspective assumes that social institutions (eg, food manners, eating pleasure) are learned and environmental factors determine (ie, from social groups (eg, families, schools, and enhance or constrain) decisions of individuals. peers). The learning process is both explicit, such The constructionist perspective assumes that in as verbal communication about what to eat and the process of decision-making, individuals exposure to information,7 and implicit, such as in experience, define, interpret, negotiate, manage, daily routines structured for children8 and in and symbolize the world around them. In this modeling of food behaviour.9,10 Cuisine (food section, we use a structuralist perspective to combinations, flavors, and seasonings) is a understand the determinants of individual food major influence in food acceptance11,12 and helps choice and a constructionist perspective to shape food preferences among children.13,14 understand the processes through which food Experiences that shape learning also transmit choice occurs.17 otroae al et Monterrosa

Figure 1. Social and environmental influences at multiple levels on food choice and diet-related behaviors.18 S61 S62 Food and Nutrition Bulletin 41(2S)

Determinants of Individual Food Choice In the third circle are the intrapersonal deter- minants (eg, attitudes, beliefs, motivations and The determinants of food choice can be repre- values, personal meanings, knowledge and sented through a multilevel socioecological skills),18 social and cultural norms, and interper- framework with concentric circles (Figure 1).18 sonal determinants (eg, family and social net- These multilevel determinants interact to influ- works). Attitudes, beliefs, motivations and ence food-related attitudes and beliefs. Interac- values, and knowledge and skills develop as indi- tions of the individual with the social and viduals move through their life course and physical environment influence food choices and become exposed to social and cultural norms. dietary behaviors. These determinants have influence on the foods At the inner-most circle, our food choices are that individuals acquire and prepare for consump- influenced by biology. The basic tastes (sweet, tion. Individuals assume identities related to food sour, salty, bitter, and umami) and olfaction con- which in turn influence food choice.28 Family and tribute to the overall perception of food flavor, social networks also determine food choice and these are influenced by genes, physiology, through observations of what others choose, and metabolism. Some foods elicit strong sensory negotiation with others with whom food is shared, pleasure responses. The oral sensation of fat is and support or lack of support from others in highly rewarding, especially in the presence of 19 making desired food choices. sugar, and the combination of sugar and fat is The fourth circle brings in broader environ- linked to the stimulation of pleasure receptors in mental and societal influences of food choices, 20 the brain. The food industry has been criticized many relating to the food supply, marketing, and for creating sweet, salty, and high-fat foods with societal food and nutrition policies and programs. the intent of capitalizing on innate biological pre- The social and environmental (economic, infor- 21 dispositions. The seeking of sweet and energy- mational, culture, physical) determinants noted dense foods may have had adaptive value when by Contento18 is described as “context” in the food was scarce or uncertain. The biological food choice process model.17 mechanisms that regulate food intake may not be a match for the current food supply that pro- vides low-cost palatable energy-dense foods with How Food Choice Occurs high reward potential and limited nutritional One way to understand how food choices occur is value. The biological factors that control food through the perspective of the life course.17 Life intake can be tempered by learning, experience, course refers to the prior events and experiences or be altered through disease states. The second of individuals and involves multiple trajectories, circle deals with interactions between the individ- transitions or turning points, and context. The life ual and their food choices and relates to familiar- course is the backdrop from which current influ- ity and learned safety, conditioned food ences on food choice occur.17 preferences,22 and conditioned satiety.23 The biology, intrapersonal factors, and the The specific foods that people like and their social and environmental factors (economic, patterns of food acceptance are largely learned informational, culture, physical) all influence through physiological conditioning acquired choice in complex ways. For example, ideals through experience of exposure to foods.22,24 formed through personal attitudes and beliefs and New foods gain preference through repeated cultural norms that provide individuals with exposure.25,26 Feelings of satiety are also modi- references to evaluate food behaviors. The role fied through physiological conditioning and emo- of biology and intrapersonal factors might give tional responses to the social context in which rise to personal identities that individuals develop eating occurs. Parents substantially shape the over time and through which they act. Personal context in which children encounter food by pro- resources, such as income, skills, relationships, viding, modeling, encouraging, restricting, and may be used to select certain foods and food pat- rewarding with food.24,27 terns over others. For example, a lack of time may Monterrosa et al S63 dictate a preference for more convenience foods expressed primarily through the social organiza- or not knowing how to cook might influence a tion (roles, status) around food production, pre- pattern of eating out. paration, and consumption,6 as well as the Resources are the many types of assets that are prestige attributed to foods and ritualistic uses weighedwhenmakingfoodchoice.Assets of foods. In this section, we examine the domi- include income and wealth, lack of cooking nant pathways in which ideational aspects influ- equipment and space to cook, appropriate skills ence food practices, in alignment with the and knowledge, relationships and networks, and intrapersonal, interpersonal, and social–cultural values and traditions. Some resources may determinants in Figure 1. enhance food choices, for example, income to provide access to foods. Others may constrain food choices, for example, lack of time dictating Pathway 1: Identity and Food convenience foods, and force trade-offs among Food practices communicate “who we are” in different resources. Social systems are the set of several ways. Food can be a symbol of personal relationships of individuals in which individuals identity, group affiliation,28 and cultural iden- encounter food with others; choices are made tity.31 Adolescents, for example, may use “junk considering values and interests among them. food” to signal belonging to a peer group, while Food choice, at the individual level, occurs healthy foods signal family.32,33 Food gifts and within the personal food systems as cognitive food sharing are important forms to express social processes guiding their food behaviors in set- belonging.5 Foods communicate a way of life. In tings.17 Central to personal food systems are food livelihoods centered on food production, food choice values (eg, taste, cost, health, conveni- holds deep significance compared to a utilitarian ence, relationships), along with the meanings and significance in urban societies, where food is pur- feelings that are associated with those values. chased rather than produced.34 Food also signals Food choice values vary among individuals and social status. Foods consumed by the wealthy are over the life course. Negotiations among food often associated with refinement,30,34 while low- choice values are essential to sort out which val- prestige foods are associated with food insecurity ues are most important to satisfy. Negotiations status35 or severe food shortage.36 may be subconscious, automatic, or less deliber- ate. In general, however, the negotiation process is largely conscious, often among values of an individual, but also can be among values of mul- Pathway 2: Gender and Food tiple individuals (eg, who are in a family). Gender expresses many of the ideational and nor- Linking cognitive evaluation of food choice mative aspects of food practices. Beliefs around and behavior are food choice strategies.17 Strate- femininity or masculinity contribute to gendered gies are simplified rules used by individuals to food selection,37 such as the strength and mascu- convert food choice values to behaviors. Strate- linity afforded to meats.38 In Western cultures, gies expedite food choice by acting as a guide. there are differences among the female and male Strategies that serve well become carefully con- food consumption patterns. For example, women structed over time into routines which make food eat less food, but also lighter meals and delicate choice predictable and comfortable while foods, such as vegetables and fruits.37 In patrili- accounting for other life demands.29 neal societies, men are given preferential treat- ment with regard to animal-source foods, which 39 Ideational Aspects of Food are prestigious. Women are subject to prohibi- tions on the basis of fertility, pregnancy, or qual- Practices ity of breast milk.39 Compared to men, women in Ideational aspects relate to symbols, meaning, rural Nepal consumed fewer prestige foods and and value given to food. Foods might even be had lower intake of calories, beta carotene, vita- 30 40 akin to language. Ideational aspects are min B2, and vitamin C. S64 Food and Nutrition Bulletin 41(2S)

Tasks associated with food production, acqui- Pathway 4: Food Prohibitions sition, preparation, cooking, and disposal are Food prohibitions exist in every culture48 for a also gender-specific, and task distribution dif- number of reasons, such as sympathetic magic, fers by cultures. In traditional patrilineal societ- transmigration of souls, religious sanctions, and ies, for example, the norm is that women are health.47 Food prohibitions may apply to individ- unpaid homemakers, with tasks organized uals based on their age, sex, or hierarchical posi- withinandaroundthehome.Foodcaringtasks tion. Some food prohibitions are associated with are often bound to identities of “being a good 47 41 menstruation, pregnancy, and lactation. During mother.” In some contexts, it may be culturally pregnancy, fears of miscarriage, difficult birth- acceptable for men to earn a wage as cooks in ing, and implications for who the child might restaurants, but men will not engage in any food- 5 become impose food restrictions that affect food related tasks at home. Thus, food caring tasks and nutrient intakes. Not all prohibitions are can contribute to gender stereotypes. Also nutritionally relevant, because the food being pro- women’s food tasks restrict their leisure time, 42 43 hibited can be substituted for another, the restric- rest, and participation in public life. For tion is temporary (lasting a few days or weeks), or example, in some rural communities in sub- the social consequences for breaking the prohibi- Saharan Africa, time spent collecting fuelwood tion are inconsequential. for cooking can range from 4 to 15 hours per week, depending on distance traveled, and this is often the responsibility of women, young, and old.44 Class and income modify the gendered Sociocultural Influences on Sustainable nature of intrahousehold food tasks, with higher Healthy Diets income households using paid (female) staff to The acceptability of and desirability for sustain- acquire food, cook, and cleanup. able healthy diets will be influenced by socio- The gendered division of household labor cultural factors. For example, cultural influences food access and control of financial prohibitions might exist for eggs and insects, 2 40 resources for food. When women have more protein sources with low greenhouse gas emis- access to economic resources, they generally will sions. Prohibitions for eggs may arise because 45 purchases more nutritious food and ensure a eggs have commonly represented fertility and more equitable sharing of food among women fecundity,47 which in some contexts, are associ- and children.46 ated with fear of barrenness, lasciviousness, or injury to the unborn child. Today, in North America and Europe, eating insects is largely 49 Pathway 3: Religion and Food unthinkable due to their “disgust” factor. The influence of gender on sustainable healthy diets Religions help define food practices through var- is also relevant. Policies that encourage using ious rules, symbols, and meanings. Fieldhouse less processed food (to reduce packaging) and 47 cites De Garine who notes that foods serve 6 more cooking at home may discriminate or fur- general functions in religious practice: (1) com- ther subjugate women. Where animal-source munication with God or other supernatural forces, foods are preferentially offered to men, the (2) demonstration of faith through symbolic acts promotion of plant-based foods may further con- and rituals, (3) rejection of worldliness, (4) done women’s inadequate access to animal- enhancement of feelings of identity or belonging- source food. In societies with many religions, ness, (5) expression of separateness, and (6) rein- exploring religious food practices would be rel- forcement of ecological pragmatism. These evant when considering system-wide actions, functions often define food proscriptions, food such as taxation on lamb or goat meat, symbols acceptability, and food practices among religious of religious affiliation, with high greenhouse gas groups. emissions.50 Table 1. Example Questions on Sociocultural Influences on Food Practices for Policy Planning and Design.

Sociocultural dimension Purpose in policy planning and design Examples of policy questions

Food as an expression of identity To understand which groups are What groups identify with specific foods in sustainable healthy diets? Within these - Social class and wealth more likely to consider groups, are there food symbolisms that might be used to construct a narrative - Status (hierarchy) sustainable healthy diets as and compelling story for the promotion of sustainable healthy diets? - Group affiliation (in)appropriate or as Are there foods synonymous with cultural identity (ie, tortilla in Mexico and Central (un)desirable America). How might this symbol, and what it represents, be used to position and promote sustainable healthy diets? What are linkages among foods in sustainable healthy diets, food choice values, and broader values? Gender as an expression of food To understand if a policy action Will policies to promote sustainable healthy diets increase female food care tasks access reinforces gender stereotypes, and subsequently reduce leisure time and participation in civic life? discriminates women, or changes How will policies affect food access and eating norms between men and women? food norms between men and - Will the policy discourage nutrient-rich foods eaten primarily by women? Eg, women Milk and yogurt in Western societies. - Will restrictions on animal-source foods disproportionately affect access to meat and milk for women in low- and middle-income countries? How might policies intensify identities of “good mothering” at the expense of “good caregiving” (gender neutral)? Food as an expression of religious To understand if dietary laws Will a policy directly affect foods that align with expressions of faith? For example, faith and belongingness (prescriptions and proscriptions) consider lamb (with a high green-house gas emission) among the Jewish and limit or encourage a sustainable Muslim religions. healthy diet Are there dietary laws that restrict consumption of animal-source foods for pregnancy, early childhood, adolescence? Will a policy for a plant-based diet further restrict access to animal-source foods during these critical growth periods, among vulnerable populations? Cultural food prohibitions as an To understand if a policy further What are food prohibitions among women and children? What are the beliefs expression between body and the condones prohibitions among underlying the food prohibition and what are social consequences for breaking it? supernatural women, children, and adolescent How long does food prohibition last and what impact will it have on food access and girls nutrient intakes? S65 S66 Food and Nutrition Bulletin 41(2S)

Table 2. Passim and Bennett’s Classification for Food Among Subgroups and for the Evolution of Food Practices.56

Category of foods Definition Ability to change

Core Universal use, regular and consistent in the form Changes in this category happen slowly, because of use. Staple foods are in this category core foods are foundational to eating practices, such that if the food is missing, a meal is incomplete Secondary Widely used but not universal, can be variable in Ability to modify foods in this category is higher core its use (frequency) and form. Foods prepared than in the core category. Usually foods in this for special events are in this category category are less emotionally important than core foods Periphery Foods in this category are consumed infrequently Category with greatest ease and fluidity for and are often characteristics of individuals and change not of subgroups

Sociocultural Influences of Food preparation, and consumption of food. These data are collected through in-depth research, such as in Practices and Policy Planning and 53-55 Design focused ethnographic studies. The Passim and Bennett’s classification is a Having summarized the individual and sociocul- descriptive framework useful for examining diet- tural influences on food practices, we now exam- ary practices at group level.56 This classification ine the frameworks and concepts that may assist draws on food use and frequency of consumption in policy planning and design. It is extremely (Table 2). In this framework, core foods are staple important to include experts in anthropology and foods, which are used by most of the population sociology so that pertinent questions are posed— (eg, rice in Philippines, tortilla in Mexico, bread see list of guiding questions in Table 1—and use- in the Netherlands). The secondary core includes ful inquiry and analytical frameworks are widely (but not universally) used foods such as selected. The sociocultural analysis should be fruits and vegetables, dairy products, and their conducted at the group level (not at the country various preparations, such as instant, ready-to- level), because there is significant variation eat, or frozen, and use forms (meals, snacks, etc). among and within social groups with regard to Secondary core foods also include foods prepared the ideational aspects of culture, which often for special events (ie, weekly family gatherings, results from situational factors.51 Sociocultural festivals). The periphery category foods are rarely analysis permits exploration of this diversity to used, or used by a small subgroup of the popula- avoid stereotypical inferences and unintended tion, such as very modern food innovations (eg, consequences. probiotic drink), expensive and prestigious foods, The biocultural framework52 is an inquiry or food “cravings” of pregnant women. The Pas- framework that examines the production, distri- sim and Bennett classification is useful for policy bution, acquisition, preparation, and consumption planning and design because it identifies food of food. It explores the physical and natural categories that are amenable to dietary change. resources for food production; social systems that Over time, the classification of foods evolves facilitate the import or export of food; social due to lower food prices, improvements in food organization of households, social institutions, storage and cooking technologies, and marketing and political and economic structures; and tech- of specific foods, so the Passim and Bennet nologies needed for food production, processing, framework is a useful tracking tool for the evolu- and preparation. It explores beliefs and values tion of food practices. Countries that already col- that affect and relate to the acquisition, lect food frequency, 24-hour recall, or dietary Monterrosa et al S67

Table 3. A List of Selected Food Choice Values From the Published Literature.

Values Descriptiona

Naturalness Minimal processing, fresh foods Taste (sensory appeal) Taste, smell, texture, flavor, and other sensorial aspects Appearance Attributes of food that make food appealing (eg, consistency of food, its color, presentation on plate) Cost or affordability Cost refers to price per reference amount. Affordability refers to cost per income or relative to other expenses Comfort Feelings (eg, happiness) experienced by eating the food Convenience Time saving in preparation, cooking, or cleaning Physical availability Distance that the consumer travelled to obtain food Tradition (food Traditional cuisines, foodways, food customs symbolism) Managing social Achieving harmony, accommodating preferences, managing conflicts relationships Nutrition (Health) Macro and micronutrients, trace elements, electrolytes, fiber, phytochemicals, antioxidants. Health-promoting or health-giving attributes of Not causing illness; free of chemical or microbial contamination and other hazards Variety Incorporation of multiple food groups into the diet (as defined by nutritionists). Another form of variety is the method of cooking the food (eg, boiling, frying, roasting) Environmental impact Land, water, energy used in producing or preparing food. Food loss and waste Origin Food provenance (eg, food miles, place of production) Fairness (ethics) All actors involved in food production benefit equally aDescriptions as stated in the literature; these are not standard definitions. record data through surveys can apply the Passim hierarchy of the relative importance of values, and Bennett classification for an examination of and the relative importance changes over core, secondary core, and periphery foods by dif- time.58,61 ferent population subgroups and regions. In the food choice literature,62-65 the “food choice value” label captures diverse ideas (see Table 3), from a food attribute (taste, appearance, Values and Food Choice Values and Their naturalness), to food procurement (availability, cost), and food preparation and eating (variety, Relevance to Food Practices convenience). Other food choice values refer to The ideational elements of culture, such as sym- an end state (safety and healthfulness), modes of bols, ideas, and meanings, are often expressed conduct (managing social relationships, fairness), in values. We draw on the anthropological (eva- or the material world (origin, environmental luations of our mode of conduct)57 and psycholo- impact). Because we use values to negotiate food gical (beliefs about an end state of existence)58 choices,17 it is important to determine how food definitions of values. choice values are linked to food symbols, mean- Values help negotiate food choices and/or sim- ings, and behaviors. plify choices. Lewin59 argues that a system of Concluding the extent to which food choice values is the foundation that influences decisions values determine food choice is difficult because on food and bring about conflicts of varying of 2 methodological challenges. The first relates intensities. Values are linked with feelings and to defining values and the purpose they serve in emotions.60 Cultural values are the shared ideals food choice. There are multiple definitions of the of what is good and desirable for a group, and term “value”; sometimes values are confounded these values are the basis for behavior norms.61 with attitudes, motives, or needs. Authors may For both individuals and societies, there is a not distinguish between instrumental and S68 Food and Nutrition Bulletin 41(2S) terminal food choice values, with the former as address how to grow, transport, source or buy, means to an end and the latter as a desirable end and cook foods. Some values encompass ethical, state (eg, ethical consumption).58 Because many moral reasons, which create a strong emotional personal food choice values are continuously connection with consumers.78 Movements thrive negotiated,17 they are probably used to achieve by fostering collective identities and building an end.63 shared emotional experiences.79 The second challenge relates to establishing In Western countries, progressive food move- attribution in the links between food choice val- ments aim to support sustainable healthy diets. ues and behavior. The prevailing notion in deci- The “slow food movement” seeks a consumer sion theory is that deliberative and automatic class that selects food based on health, sustain- process drive choice.66 Many (food) decisions are able livelihoods, and respect for the environ- automatic or subconscious,67 intuitively under- ment.80 This movement uses multiple values, stood,68,69 or embedded in food routines and such as sensory pleasure, naturalness, origin, fair- habits.29 Food choice values, on the other hand, ness, and environmental impact. Variations of are a cognitive concept which can be articulated, this movement are “locavores” or “naturalistic and food choice values are used in deliberative foodways” that support local, sustainable agricul- decision-making.29 In automatic decision con- ture and unprocessed foods.81 The organic food texts,68 a food choice value (often measured movement centers on nonchemical production of through survey and self-reports70) may reflect a crops and livestock.82 Organic food and “slow choice justification rather than choice predic- food” movements may or may not promote policy tion,66 so it is difficult to assign causal attribution change.82 Progressive movements are often criti- of a food choice value to a food-related intention cized as elitist. or behavior.68 Radical food movements, built on moral orien- Nevertheless, analysis of values is useful for tations (what we ought to do), are “food justice” policy planning and design. The utility of values or “food sovereignty.” In Western countries, lies in their ability to capture culturally relevant “food justice” addresses class and racial inequi- ideas, meanings, emotions, and beliefs and thus ties.83 In the global south, “food sovereignty” can be used to drive intentions58 and to change eschews dominant neoliberalism to food produc- norms and encourage new lifestyles (modes of tion, being based on principles of human rights, existence).71 When food choice values align with sustainable agrarian livelihoods, local agroecol- personal or cultural values, we find associations ogy, and knowledge.84 Food production is driven with food purchase intentions, for example, with by needs and aspirations of local people (rather organic foods in Europe,72 meat choices among than the market or corporations) for healthy and Dutch consumers,73 and environmentally friendly culturally appropriate foods.85 consumption behaviors among the Danish.74 Val- Food lifestyle is a system of cognitive cate- ues may help create stories, myths, and narratives gories (beliefs/attitudes) that link a set of goods because values capture deep, universal truths.75 (eg, food) to a set of values, and lifestyles are Emotions and forging emotional connections are enduring dispositions of behavior.86,87 For exam- indispensable for creating promotional cam- ple, veganism eschews exploitation of animals for paigns that motivate consumers toward health food, clothing, medicines, testing of drugs, or and sustainability.76,77 additives.88 Lifestyles, such as veganism and vegetarianism, are also bound to social89 and reli- Promoting Sociocultural Change in gious identity. The return to traditional cuisines values how Food Practices food is produced, creating emotional linkages Sociocultural change for sustainable or healthy with the cuisine of the past.90 The new food- diets is already happening through food move- based dietary guidelines of some Latin America ments, food lifestyles, and traditional cuisines. are redefining “traditional cuisine” not only as Food movements are built on multiple values that traditional recipes and meals but also consuming Monterrosa et al S69 minimally processed foods. The Brazilian food- consumers toward more ethical and citizen- based dietary guidelines, for example, recom- oriented food actions. mends consuming natural or minimally process An analysis of the sociocultural influences on foods and eating in accordance with Brazilian food practices is needed so that food policy fully food culture.91 A similar frame is evoked in the aligns with society and culture. This can be Uruguayan food-based dietary guidelines. In con- achieved by using the frameworks and concepts trast to traditional cuisines, Indigenous people’s we discussed, along with empirical data collected diets explicitly link food, health, environment through in-depth qualitative methods and sur- (biodiversity, land use), and cultural identity veys. For example, an ethnographic module could (rites, traditions).92 be applied to a subsample of dietary survey par- A critical question is whether traditional ways ticipants. This tool will be useful not only for of eating are associated with both better health identifying symbols, meanings, and values but and lower environmental footprints. In HIC, there also for examining food practices and its associa- is evidence on positive health and environmental tions with the ideational aspect of culture. Policy impacts for the Mediterranean93 and New Nordic makers should rely on local or international tech- diet.94 Among Canadian Artic Indigenous Peo- nical experts and agencies to facilitate the con- ples, meats and fish, native to the Artic, support vergence of feasible methods and carry them out. daily intakes of vitamins (B6,A,C,D,E,ribo- Global normative agencies should advocate for flavin) and minerals (iron, zinc, selenium, among sociocultural analysis to assess the acceptability others) for adults and children.95 In other con- and desirability for sustainable healthy diets. texts, however, the relationship between health and environmental footprint may be more com- Acknowledgments plex. For example, agropastoralist in Kenya, who depend on milk and meat from goats, camel, or E.A.F. drafted the section personal food system and food choice. E.M. drafted all other sections of the cattle, have better nutrient intakes of vitamin A 96 manuscript. All authors contributed to the conceptua- and B12, but families who shift to plant-based lization of the paper, revisions, and reviewed and diets show an increase in the risk of anemia approved the final draft of the manuscript. A version 97 among children. of this paper was presented at the International Con- sultation on Sustainable and Healthy Diets, FAO head- quarters, Rome, Italy, July 1-3, 2019. All authors Conclusions received a stipend from FAO for this paper. Policy planning and design to determine what actions could be taken to promote sustainable Declaration of Conflicting Interests healthy diets should include a sociocultural anal- The author(s) declared no potential conflicts of interest ysis to understand the acceptability and desirabil- with respect to the research, authorship, and/or publi- ity of any policy action. Individual choices are cation of this article. influenced by the broader sociocultural context, where in the process of decision-making individ- uals experience, define, interpret, negotiate, man- Funding age, and symbolize the world around them. The The author(s) disclosed receipt of the following ideas, symbols, and meanings associated with financial support for the research, authorship, and/or foods are part of our shared sociocultural context. publication of this article: This paper was made poss- Values are another way to link the individual and ible with funding from FAO. sociocultural level. Food movements, food life- styles, and traditional diets are examples of how ORCID iDs values, symbols, and ideas can be leveraged for Eva C. Monterrosa https://orcid.org/0000-0003- collective action, for alternative ways to grow, 1665-0756 procure, and consume foods. Businesses and civil Edward A. Frongillo https://orcid.org/0000-0002- society organizations can support and mobilize 8265-9815 S70 Food and Nutrition Bulletin 41(2S)

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