Rosa Van Kesteren Phd Pure

Coventry University DOCTOR OF PHILOSOPHY A Practice Theory Approach to Inequalities in Healthy Eating Van Kesteren, Rosa Award date: 2019 Awarding institution: Coventry University Link to publication General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of this thesis for personal non-commercial research or study • This thesis cannot be reproduced or quoted extensively from without first obtaining permission from the copyright holder(s) • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Download date: 05. Oct. 2021 A Practice Theory Approach to Inequalities in Healthy Eating By Rosa van Kesteren PhD September, 2018 i Some materials have been removed from this thesis due to Third Party Copyright. Pages where material has been removed are clearly marked in the electronic version. The unabridged version of the thesis can be viewed at the Lanchester Library, Coventry University. ii A Practice Theory Approach to Inequalities in Healthy Eating By Rosa van Kesteren September, 2018 A thesis submitted in partial fulfilment of the University’s requirements for the Degree of Doctor of Philosophy /Master of Philosophy/Master of Research iii Applicant: Certificate of Ethical Approval Rosa Van Kesteren Project Title:A Practice Theoretic Approach to Healthy Eating Behaviours This is to certify that the above named applicant has completed the Coventry University Ethical Approval process and their project has been confirmed and approved as Medium Risk Date of approval: 14 September 2016 Project Reference Number: P45049 iv Applicant: CertiFicate oF Ethical Approval Rosa Van Kesteren Project Title:A Practice Theoretic Approach to Healthy Eating Behaviours This is to certify that the above named applicant has completed the Coventry University Ethical Approval process and their project has been confirmed and approved as Medium Risk Date of approval: 06 September 2017 Project Reference Number: P53304 v Applicant: CertiFicate oF Ethical Approval Rosa Van Kesteren Project Title:A Practice Theoretic Approach to Inequalities in Healthy Eating Behaviours This is to certify that the above named applicant has completed the Coventry University Ethical Approval process and their project has been confirmed and approved as Medium Risk Date of approval: 10 May 2018 Project Reference Number: P69824 vi Some materials have been removed from this thesis due to Third Party Copyright. Pages where material has been removed are clearly marked in the electronic version. The unabridged version of the thesis can be viewed at the Lanchester Library, Coventry University. vii Abstract This thesis builds up an empirically grounded argument that healthy eating is better understood as a social practice than an individual choice, and that this shift has important implications for how we understand and address socially striated differences in eating different types of food. While knowledge that vegetables are healthy is widespread, this hasn’t stopped their consumption decreasing - especially among poorer demographics. Rather than being a product of a knowledge deficit, the persistence of unhealthy eating demonstrates a knowledge-action gap, where ideas of what healthy eating is fail to become part of what we regularly do. From a practice perspective, the expectation that abstract knowledge will translate into action fundamentally misconstrues the ‘power of our minds’ to dictate our actions. Using a practice-based approach I argue that our capacities for voluntary control are much more limited, with the real power over what we eat lying with a vast network of underlying non-cognitive elements, interconnected daily practices and political economic forces which together determine the field of possibility. The space for agency is created through practices, which determine what is easy or hard, possible or not. If the constituents of eating practices are not allied with healthy eating even the best intentions will flounder. Based on data from a case study of 25 mothers in two different areas of Bristol, this thesis sets out how the non-cognitive elements, other practices of our lives and political economic influences tend increasingly to align with ultra-processed foods across four component practices of eating: food preparation, eating occasions, food provisioning and taste judgements. Additionally, although the histories and contexts in which practices evolve are unique for every person, it argues that lives lived in greater deprivation skew these involuntary aspects of practice especially strongly in favour of greater incorporation of ultra- processed foods, augmenting an existing inequity. This research develops methodological innovations to face the epistemological challenge of accessing practices and draws out five aims for practice-based interventions capable of closing the healthy eating gap: create conditions in which healthy eating innovations can be repeated into automaticity; build on existing eating habits; change the relative availability of minimally and ultra-processed foods; take on some of the risk of developing healthier practices; and intervene where habits are or can be disrupted. Understanding inequalities in healthy eating as practices undermines rational individualist ideologies and their potential for closing the healthy eating gap. This particularly true for education-based interventions which serve to justify blaming those who are most disadvantaged for the inequalities in preventable ill-health which tax their wellbeing and take years off their lives. viii Dedicated to Richard Temple. Who believed that every dream I chased was worth it and constantly reminded me that it would be OK in the end. He was the strongest springboard into life anyone could wish for and our Sunday aubergine dish ritual will always be central to my understanding of food and love. I wish he could have seen this. I would like to thank my mother Connie van Kesteren for giving me constant support, standing by me in the pain of recruitment and reminding me of the soothing power of chips after a hard day. Thanks are also due to my brother Mischa van Kesteren for always challenging me and my partner Chris Maughan for providing constant counsel, understanding my first world problems and viscerally grounding me in a routine outside this PhD! This thesis would not have been possible without Adrian Evans. Thank you for being a supportive supervisor par excellence: for always having time for me, for helping me through every crisis of how to proceed while pursuing social change, and for exploring every new idea of mine with enthusiasm, support and patience. I am also very grateful to my second supervisor Moya Kneafsey for her firm, fair and compassionate input over the three years of this project. ix Table of Contents Abstract ........................................................................................................................... vii 1. The need for a practice-based approach to healthy eating ............................................. 1 1.1. A changing eating environment ..................................................................................... 2 1.2. Current public health responses .................................................................................... 4 1.3. The need for a practice-based approach ........................................................................ 6 1.4. The contributions of this thesis ...................................................................................... 7 2. Literature review and theoretical justification ............................................................. 11 2.1. Public health context: the need to address unconscious aspects of health behaviours ...... 11 2.2. A practice approach as well placed to contribute in this context ....................................... 14 2.2.1. What is a practice? ............................................................................................................ 16 2.3. What makes an eating practice healthy? ........................................................................... 22 2.3.1. Simplifying healthy eating according to degree of industrial processing .......................... 24 2.3.2. Healthy eating practices are not reducible to bodily nutrition ......................................... 29 2.3.3. Healthy eating practices are not reducible to weight ....................................................... 33 2.4. Promising practice-based pathways to changing eating habits .......................................... 35 2.4.1. Changing elements of eating practices ............................................................................. 36 2.4.2. Changing related practices of living .................................................................................. 37 2.4.3. Changing with the times ................................................................................................... 38 2.4.4. Changing ‘upstream’ at the source of social

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