Food, Poverty and Lifestyle Patterns: How Diversity Matters

From Food and Poverty: Food Insecurity and Food Sovereignty among America’s Poor, Leslie Hossfeld, Julia F. Waity, and Brooke Kelly (eds.) Vanderbilt University Press (forthcoming 2017). Food, Poverty and Lifestyle Patterns: How Diversity Matters (pre-publication version) Michael Jindra and Nicolas Larchet In 2010, in the midst of the greatest economic crisis since the Great Depression, Newsweek magazine ran a cover story titled “The Dinner Divide: How Our Foodie Obsession is Driving Americans Apart.” The cover showed a plate broken in two halves. On its top half, a portion of quinoa and a carrot laid on a bed of kale, next to a piece of grilled salmon and a sprig of dill. The bottom half, on the other hand, offered a wedge of pepperoni pizza, as the reader learnt of an unprecedented surge of people living on food stamps, matched only by gourmet and organic food stores’ soaring profits (Miller 2010). This idea of food as a social marker is commonplace in sociology. Theories as diverse as Thorstein Veblen’s “leisure class” (1899), Norbert Elias’ “civilizing process” (1969), and Pierre Bourdieu’s “distinction” (1984) all revolve around the notion that individual tastes and manners reflect one’s position in the social structure, following a “trickle down” model (Trigg 2001) where upper class consumption is the ideal and lower classes simply try to copy them. These influential theories, however, tend to neglect the autonomy and agency of the lower classes, as if the culture of the poor could only be defined negatively, as “backwards” and lacking in diversity. Thus Bourdieu defines the “popular taste” as a “taste of necessity,” which favors the most “filling” and “economical” foods, in opposition to a bourgeois “taste of liberty” which emphasizes the manners of presenting, serving, and eating food (Bourdieu 1984, 6), which unfortunately reproduces stereotypes of upper class “culture” vs lower class “nature” (Grignon 1985). Social class is one aspect of a broader diversity that we argue is crucial to understanding issues of food and poverty. While much attention has been given to the structural forces of the American food system that links poverty to food insecurity (Cook and Frank 2008) and obesity (Drewnowski and Specter 2004), little attention has been paid to cultural issues mediating food and poverty, despite the recent growth of the field of “food and culture studies” (Counihan and Van Esterik 2013). Indeed, most social issues involve the interactions of social forces at three levels: structures, cultures, and persons (Abramson 2012, 2; Stephens, Markus, and Fryberg 2012) or as others put it, “macro,” “meso” and “micro” (Bosi and Della Porta 2012). Any initiatives designed to address eating and health issues and why they differ across categories such as race and class cannot be just individualistic, but must understand the entire socio-cultural context of food habits (Keith, Hemmerlein, and Clark 2015). Other chapters in this volume often highlight structural issues, while we focus on the diversity of how people live, including their lifestyles and the mediating role of culture. This also means understanding the major issue of the relation between individual motivations and structural constraints (Garcia-Ruíz 2015). There are indeed good reasons to consider culture in a study of food and poverty, since ignoring it can lead to ineffective policies. The history of diet reform movements in the United States is replete with cultural misunderstandings between middle class reformers and the working class and poor immigrants (Cummings 1940; Levenstein 1980). While recent nutrition interventions may be more sensitive to difference by promoting “culturally appropriate” dietary advice (Kreuter et al. 2003), some have criticized these approaches for leaving white, upper class assumptions about nutrition largely unquestioned, and for silencing health knowledge from other cultural traditions (Kimura et al. 2014, 39). Patterns in food consumption vary significantly across region, race/ethnicity and social class, along with connected lifestyle behaviors (Murray et al. 2006; Krueger, Bhaloo, and Rosenau 2009). How people eat is also influenced by demographic factors, such as gender, age and the family practices of one’s youth. Working back “up” the chain of influences, these family habits are influenced by regional/local patterns that vary by culture or ethnicity. Within these patterns there are also social class influences, whether one is from an upper, middle or lower class background, including factors such as income and education. These patterns may also change as groups become more wealthy and mobile and come into contact with other ways of life. There is also the strong influence of media advertising, news, popular culture, the massive growth of food industries such as fast food, and newer technologies such as the microwave, all of which have prompted major historical changes in world cuisine (Goody 2013), as for example in the transformation of pizza from a local Naples dish to an international phenomenon in the last half of the twentieth century (Helstosky 2008). The structures of the food system also limit what is available in a local area, from the presence of stores, to the choices available in those stores, which is determined by corporations gauging market demand to increase sales, and by their production system and goals of lowering costs (Nestle 2013). Figure 1: Life Influences on Food Habits: From the World to the Individual With all these influences, we end up with particular patterns that vary internationally and nationally, and all the way down to the family level. Even individual variations in food consumption and connected factors such as self-control have an impact on overall health and life success (Akst 2011; Mischel 2014), though these factors are in turn influenced by income, socialization and other contexts. In other words, causal factors go in multiple ways—behavior affects our well-being, and our well-being affects behavior. For instance, people eating together regularly makes for better families and more stability, with impacts on well-being including wealth (Fischler 2011; Patrick and Nicklas 2005). Declining health creates an increased risk of poverty, due to how it impacts work and stress and increases medical bills (Maroto 2015). What influences health? According to one study, behavioral factors contribute approximately 40% to health outcomes, with 30% due to genetics and the rest to environmental or structural factors (Schroeder 2007). These percentages can certainly be debated, and the division is too definitive, as these factors influence each other. If we want to understand why groups of people differ in their use of food, we need to understand all these influences, looking for regional, ethnic, class, gender, lifestyle and neighborhood variation in diet that can help us understand the complex mediations between food, poverty and health outcomes in the contemporary United States. Regional and Ethnic Variation in Diet Anthropologist Sidney Mintz once argued that there is no American cuisine, but only regional cuisines influenced by the cuisines of other nations (1996). Anthropologists see diet as a primary marker of “in-group” and “out-group” identities (Brown and Mussell 1984, 5). Even today, when one would assume that American eating habits have become homogenized by market forces, there are distinct regional trends: for instance, Northeasterners spend significantly more than the average Americans on hot dogs, fresh fish, bread and tea (Kittler, Sucher, and Nelms 2012, 459). Regional variation does not stop at the most “traditional” aspects of regional cuisines: in the 1980s geographers found that Californians had the largest number of “health” and “natural” food stores per capita in the U.S. and were more likely to adopt “exotic” produce in their diet, making California the “innovative center for foodways trends,” while the Midwest and South were the most traditional regions in this respect (Shortridge and Shortridge 1989). As a result of early migration and settlement patterns in the United States, regional and ethnic foodways are often intertwined (Brown and Mussell 1984). This is most apparent in the Southwestern and Southeastern regions of the United States, where regional cuisines have been largely shaped by Mexican and African American influences respectively. Deemed “central to the region’s image, its personality, and its character” (Egerton 1987, 2), the culinary tradition known as “southern food” is an especially complex cultural phenomenon where geography, religion, class, race and identity intersect. In the south, Protestants, those with lower levels of income and education, and blacks are more likely to eat southern foods such as okra, catfish, moon pie and boiled peanuts (Latshaw 2009). Because of its association with African roots and the labor of black cooks in plantation kitchens, southern food has become a “preserver of Black culture” (Hughes 1997), making African American dietary patterns especially resistant to nutrition interventions (Airhihenbuwa et al. 1996; Liburd 2003; James 2004). Case study 1: The invention of “soul food.” Calling the regional cuisine of the Southeastern United States “soul food” or “southern food” is a hotly debated question (Chavis 2008). A culinary equivalent to “soul music,” the term “soul food” first came into use in the 1960s to claim a distinctly African American cuisine at the peak of the civil rights movement. Brought to northern cities by rural black migrants, “soul food” developed as a response to the integrationist aspirations of an established black middle-class, which looked upon the “unsanitary” consumption habits of poor black southerners. The adoption of soul food as part of black urban identity is thus a potent example of “upward percolation” (Poe 1999), reversing the familiar “trickle down” model of consumption. A lot of the foods thought of as typically “southern” originated in West Africa, such as okra, watermelon, black-eyed-peas and rice (Carney 2001). Other southern staples like pork, sweet potatoes and maize were brought to Africa by European traders and were quickly adopted by West African cultures such as the Igbo and Mande before some of their people were forcibly sent to the Americas (Opie 2010). The hardships of slavery greatly influenced “soul food” as black cooks invented elaborated recipes and seasonings to make the best of leftovers from the master’s table, such as turkey necks, pigs’ feet and intestines (“chitterlings”). Since some of the highest levels of cardiovascular disease and obesity in the nation are to be found in the so-called “stroke belt” of the southeastern U.S. (Lanska and Kuller 1995; Mensah et al. 2005; Y. Wang and Beydoun 2007), some epidemiological studies have looked for differences in socioeconomic status to explain this disadvantage (Liao et al. 2009; Akil and Ahmad 2011), while others have blamed dietary patterns, calling for the adoption of a “plant-based diet” instead of a “Southern style diet” (Judd et al. 2013). Whatever the emphasis is on—class or culture—these regional disparities in health cannot be explained by income or race alone, since low-income whites living in the Northern Plains region have a substantially higher life expectancy than low-income whites in Appalachia and the Mississippi Valley (Murray et al. 2006). The longevity among Asian-Americans (highest in the U.S.) appears to be partly related to their diets and lifestyles—low fat intake and high in vegetables and fruits, with Latinos having lower intakes of vegetables than other groups (Patrick and Nicklas 2005; Murray et al. 2006). The role of other factors, such as emotions, also vary among groups. Black women reported eating for positive reasons whereas white women associated eating with negative emotions (Keith, Hemmerlein, and Clark 2015). Religion is also a factor that is often intertwined with race and ethnicity in the way it categorizes different foods as “pure” or “impure” and thus influences our notions of the body (Chen 2012; Norman 2012). All of these patterns reveal strong group differences in food consumption, preferences and associated lifestyles, varying by factors such as race/ethnicity, class, and subculture. Accounting for Social Class: Economic vs Cultural Capital Let’s turn our attention to social class as an influence on food consumption. The classic formulation of a relationship between income and food consumption was stated by the German statistician Ernst Engel (1895): as income increases, the proportion of income spent on food decreases. Thus in 2011, the poorest quintile of Americans spent 16% of their income on food, compared to 11% for the richest quintile, though the richest quintile still spent three times more on food than the poorest quintile, and five times more on dining out (Thompson 2013). For Pierre Bourdieu (1984), differences in food consumption depend on the different kinds of “capital” possessed by different classes and fractions of classes: industrial and commercial employers, who are relatively wealthier in “economic capital” (money, property) than in “cultural capital” (ability to use “high” culture, diplomas), tend to favor “rich” and “heavy” foods, which differ only in quality and cost from the foods eaten by industrial workers and commercial employees. Professions and teachers, on the other hand, who are relatively wealthier in “cultural capital,” mark their distance from those groups in their appetite for “light, low-calorie products.” Case study 2: Food and social class. The figure above is a simplified version of the “food space” and “social space” diagrams in Pierre Bourdieu’s Distinction (Bourdieu 1984, 128-129, 186). Occupational groups relatively wealthier in “cultural capital” are on the left of the “social space” while those wealthier in “economic capital” are on the right. The vertical axis, total capital volume, is “economic capital” and “cultural capital” combined (from “lower classes” at the bottom to “upper” or “dominant classes” at the top). The “food space” diagram, showing foods and cooking styles most common to each group, is based on various statistical analyses of food consumption surveys in 1960s-1970s France. Note that a contemporary North American food space would look slightly different (Watson 2012). Observed in 1970s France, the trend towards health-conscious eating habits among the upper classes is common across Europe and the United States: as a general rule, so-called “healthy” or “natural” foods such as lean meats, fish, whole grains and fresh produce are more common among groups of higher socioeconomic status, whereas fatty meats, refined grains and added fats are associated with a lower socioeconomic status (N. Darmon and Drewnowski 2008). Bourdieu’s contribution invites us to understand food in relation with other consumption patterns, as a coherent system of “dispositions” expressing distinctive “lifestyles” and “class cultures.” In his classic study of poor families in East Harlem, David Caplovitz observed that the poor were more likely to pay more for inferior products, falling prey to unscrupulous merchants and creditors. To make sense of this apparent paradox, he developed the notion of “compensatory consumption” (Caplovitz 1967): since the poor have little opportunity to base their identity on occupational or educational achievements, they may compensate for blocked mobility through their participation in mass consumption, which can hurt both pocketbook and health. When interviewing consumers, these sociological explanations often take a back seat to more immediate explanations. Unsurprisingly, people name taste as the most important influence on food choices, followed by cost (Glanz et al. 1998; Abhijit Banerjee and Duflo 2011). These reasons are important of course, but one must remember that they are strongly influenced by social forces and cultural contexts that operate on an unconscious level. Associated factors like attitudes toward body image, aesthetic norms and health vary substantially among people, based on class and ethnicity. The “thin” extreme of anorexia is found mainly among middle and upper class white women (M. Darmon 2009), while African Americans of all classes tend to accept larger body sizes (Bailey 2006; Keith, Hemmerlein, and Clark 2015). As we discuss below, opinions about nutrition interventions such as weight loss programs also differ significantly by class and ethnicity. Beyond Class to Lifestyles, Subcultures, Networks and Neighborhoods Bourdieu’s model of “distinction” is better at acknowledging diversity and agency among the upper classes than among the lower classes, but there is also quite a bit of diversity among the poor. For instance, poor people living in urban, suburban or rural areas have varied access to the same services for their basic needs (e.g. there is more food insecurity in rural areas), while the urban poor themselves differ in their orientations toward work, child-rearing, education or assistance (Hannerz 2004; Holloway et al. 1997; Salcedo and Rasse 2012). One still finds a vast array of occupational subcultures among the poor in today’s American cities, such as itinerants, street sellers, scavengers, intermittent workers and the homeless, as well as immigrant cultures that have resisted dominant consumerist orientations (Jindra 2014). Though the opportunities of the poor and minorities can be limited by structural constraints, they still have some agency to develop distinct lifestyles and traditions, as the history of “soul food” shows. Epidemiologists working with marketers have identified seven different “health lifestyle clusters” among the U.S. population, from those who have high levels of concern about nutrition and weight control (“Physical Fantastics”) to those who are more interested in taste or convenience (“Noninterested Nihilists”) (Glanz et al. 1998). The recent growth of “foodies” are a primary example of how these subcultures relate to other factors such as class: people at higher levels of income and education have the privilege to be choosy about the foods they eat while avoiding overt snobbery and exclusion (Johnston and Baumann 2009), echoing Bourdieu’s analysis of the “taste of liberty” of those groups who are wealthier in “cultural capital” (Bourdieu 1984). There is also diversity in “household cultures” (Dake and Thompson 1993), such as practices concerning eating, cleaning, sociality, and consumption habits. Some families have scheduled communal mealtimes, prompt cleanup, and savings patterns, in contrast to those who, for instance, rely more on takeout food at irregular times. These practices are set rather early in primary socialization, as children learn the habits of their families, contributing to generational patterns and ongoing inequality. Indeed, there is a growing body of evidence that shows how family and social environments (e.g. eating together, whether mothers work) play an important role in the development of children’s eating patterns, diet quality and/or obesity (Fischler 2011; Patrick and Nicklas 2005; Morrissey, Dunifon, and Kalil 2011). Television in particular plays an important role, as high levels of viewing are connected to high-fat convenience foods and a lack of exercise. Exposure to high levels of food advertising also plays a role. In general, greater TV means “higher intakes of energy, fat, sweet and salty snacks, and carbonated beverages and lower intakes of fruit and vegetables” with direct correlations between number of hours watched and high levels of obesity (Coon and Tucker 2002, 423). These connections are even more important given that television viewing is highest among low income groups and particularly among African Americans (The Nielsen Company 2014). The neighborhood in which one lives also has a strong effect on one’s life. The consumption of fast food, and its concentration in specific neighborhoods is said to contribute to obesity (Powell, Chaloupka, and Bao 2007). We will explore this below when discussing “food deserts,” but a key thing to remember about neighborhoods is that the social environment appears to play a more important role than the physical environment. That is, the strongest influences on people are other people and relationships, more so than the design or location of buildings and public spaces. In one study of weight-loss attitudes among urban poor black and white women, barriers to physical activity were more related to social influences such as the existence of “supporting networks of trusted peers,” rather than to the physical space such as the absence of sidewalks—though these also differ markedly by race (Keith, Hemmerlein, and Clark 2015). This takes us to the level of social networks. These, of course, are strongly influenced by our class, ethnicity and lifestyle affiliations, as we hang around those most similar to us in our tastes, outlooks and habits. Peers have a strong influence on eating habits, exercise and ultimately chronic diseases like obesity: public health researchers revisiting the Framingham Heart Study findings have thus been able to follow the spread of obesity in a social network over 32 years (1971-2002), especially among pairs of friends and siblings of the same sex—that is, people tended to gain weight when their friends and relatives gained weight around them Christakis and Fowler 2007; Keith, Hemmerlein, and Clark 2015(Christakis and Fowler 2007). Interestingly, the weight gain of immediate neighbors did not affect one’s chance of weight gain in the latter study, ruling out the influence of exposure to local environmental factors. Then there are also “psychosocial” factors that affect our eating behavior, such how we handle stress—higher for those in poverty—and resist temptation (Thirlaway and Upton 2009, 67). In sum, we must remember all of the factors that affect human action, from “macro” influences such as regional, ethnic and class determinants, to “micro” influences such as socialization into cultures, family structure and the effect of the social and physical environments (e.g. social networks and neighborhoods) in which one lives. Policy Implications and Initiatives The larger environment of a plethora of food choice, with many convenient but often unhealthy options, combined with increasingly sedentary lifestyles means that we face an ever-growing problem of inequality in health. This is exacerbated by growing income inequalities, combined with the increasing cost of fresh produce and the decreasing cost of snacks and soda that make “energy dense” foods (i.e. foods rich in fat and sugar) less expensive (Drewnowski and Specter 2004). Life expectancy in the U.S. is lower than in many other high-income countries, and our food habits are partly to blame for these “extremely large” geographic, racial and class disparities in health (Krueger, Bhaloo, and Rosenau 2009; Kulkarni et al. 2011). Various initiatives have been proposed to deal with the situation. Federal food assistance programs such as WIC (for mothers with young children) and SNAP (food stamps) are large sources of food for low income groups, and there is an ongoing debate over whether to tighten allowable categories of food to be purchased (Rosenberg 2013). In 2009 WIC changed its rules to require that milk must be reduced-fat, and bread and rice must be whole-grain, and participating stores must carry these. There is also a category of voucher specifically for produce. Early evidence shows that it has resulted in purchases of healthier foods (Rosenberg 2013). The FDA continually revises the food pyramid to encourage healthy eating, though it has been known to be subject to political pressure from the food industry (Nestle 2013). More recently, Michelle Obama’s nationwide “Let’s Move” campaign aimed at improving physical activity and healthy eating. There are also many local initiatives: at historically black Spelman College, for instance, after noticing that half of the female students had problems with obesity or diabetes, President Beverly Tatum eliminated intercollegiate sports in 2012 and diverted its funding toward health programs on campus that encouraged exercise and healthy eating. One cannot forget the multibillion dollar diet industry, and the increased numbers of weight loss programs that are implemented by institutions (with some controversy) such as health care systems or corporations looking to lower employee health care costs. As we’ve seen above, however, these popular programs are undertaken with individuals who are influenced by many different social forces. For one, these programs are received differently based on race and class, with exercise programs and healthy eating regimens generally regarded as middle and upper class phenomena (Wardle and Steptoe 2003; Garcia 2006). The poor also have different contexts for making decisions than higher income individuals, with higher overall stress leading to decisions that focus more on the short term (A. Banerjee and Mullainathan 2007). One recent study found significant differences in how black and white women perceived and reacted to these programs (Keith, Hemmerlein, and Clark 2015). As mentioned above, not only do black women have much less social support for healthy eating and losing weight, they also connect eating with pleasure much more than white women (who are thus at increased risk for anorexia). Other initiatives to improve healthy eating target the physical environment and how that limits or forces certain choices on individuals, or focus on the overall food system. The “food desert” thesis, for instance, argues that the lack of grocery stores carrying healthy options in poorer neighborhoods contributes to high obesity and poor health. This has prompted a movement designed to counter food deserts by placing healthy eating options in these areas. A USDA report, however, found that the “food desert” diagnosis was grossly exaggerated: only 2.2% of American households live more than one mile from a supermarket without access to a car, and 93% of the residents of low-income neighborhoods manage to drive to a supermarket to do their grocery shopping, either in their own car or with a parent or friend (Ver Ploeg 2009). More recently, other researchers have also found little evidence for the “food desert” thesis (Kolata 2012; Guthman 2011; Shier, An, and Sturm 2012; Elbel et al. 2015). Proponents of the importance of “food deserts” go against several factors, such as strong cultural and taste preferences for certain foods, and the simple fact that fruits and vegetables can cost more per calorie, making it harder for low income groups to afford them (Drewnowski and Specter 2004). Even giving away healthy food does not mean that people will eat it, as we commonly see with the tossing of fruits and vegetables in school lunchrooms around the country (Antoine, Donald, and Cox 2003; Upton, Upton, and Taylor 2012). Connected to this, the attempt to create “alternative food movements” to reach poor and minority consumers has been beset by the class and cultural distance between their organizers and the population (Alkon and McCullen 2011; Kato 2013; Larchet 2014). Because of the role played by informal peer pressure and social controls to conform to one’s group or culture, these are not easy things to change. Unspoken social norms within a group (e.g. what to consume and how to spend leisure time) are stronger than even verbal social support (Ball et al. 2010). We are strongly influenced by others, and any intervention strategies around healthy eating needs to take this into consideration by helping people see this influence, and by tackling the norms behind the practice. Simple educational initiatives don’t work as well (Thirlaway and Upton 2009, 79), though cities such as Oklahoma City have made progress with multi-pronged community-wide efforts that engage people personally (Tavernise 2012). Unsurprisingly, there are gaps between our good intentions and our ability to change other people’s behaviors, especially when it comes to potent cultural symbols like food habits which anthropologists have long recognized as especially resistant to change (Mead 1943). Human behavior towards food is certainly influenced by biological factors, but it needs to be understood in its sociocultural context, from the long-standing influences of regional, ethnic and class cultures down to family structures and our “psychosocial” selves. Some community programs, such as Bridges Out of Poverty, are designed to help participants understand all these factors, and then give them possible alternatives that can be adopted as “life plans.” Other programs focus on the tough demographic of school kids (Thirlaway and Upton 2009, 79–81) or utilize a “stages of change” model that examines a person’s readiness to change eating behaviors (Webb et al. 2014). Recognizing the entrenched inequalities of American life, the largest food bank network in the U.S., Feeding America, is also beginning to encourage local agencies to help their clients long-term through complex services, rather than just food handouts. This kind of “relational work” can include mentoring, coaching or case management, what one staff member called a “revolutionary” change away from straight charity (Jindra and Jindra 2015). Overall, relational work can help people who have difficulty navigating the increasing complexity of American consumer life, including the food system, though one must watch out for issues such as the differences in power relations between clients and staff. Conclusion To grasp the complexity of food and poverty, one needs to understand the unique lives of people, including the interplay of their individual biographies and cultural histories, the structural constraints that weigh upon them, and their potentialities or agency. Instead of taking only a “top-down” structural approach (e.g. the “food desert” thesis) or an individualistic approach (life as a series of choices), it is important to understand how diverse people live, paying attention to the multiple contextual factors of region, race/ethnicity, religion, class, social networks, neighborhoods and families. These all relate to the processes of our everyday lives, such as emotions (e.g. how we feel about food and our bodies) and beliefs that create and maintain patterned lifestyles (Smith 2015). Finally, one must not forget that these factors reflect as much as they contribute to ongoing socioeconomic inequalities, since poor health related to a poor diet—hunger and food insecurity, or diabetes and obesity—continue to disproportionately affect lower income populations, restricting their future life chances. Though a recent analysis of the National Health and Nutrition Examination Survey data from 1999 to 2010 indicates that dietary quality has overall improved among adults in the U.S., it is not happening among the poor: indeed, the “dietary gap” between those with the highest and lowest levels of socio-economic status increased over time (D. Wang et al. 2014). 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