Cultura y Nutrición (inglés)

8/7/2019 Cultura y Nutrición (inglés)

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CONSID ERING CULTURE IN NUTRITION AND FOOD SYSTEMS

An innovative approach to reducing chronic child malnutritionn

“Nutrition policies must refer to food, that is to meals, not to nutrients” World Health Organization (WHO)

THE CULTURAL APPROACH TO FOOD AND HUNGER IN ACTION AGAINST H

In general terms, food could be re-ferred to as a concept that combinestwo elements, namely nutrients andculture. And culture refers to thecustoms, institutions, and achieve-ments of a particular nation, peo-ple, or group. A cultural approach tohunger and malnutrition shall take

into account all factors relating to theculture of a society, including values,beliefs, standards, language, thinkingpatterns, behavioural norms and com-munications styles, as well as othersocial aspects related to food produc-tion, processing and consumption.

What are the factors that determinewhat people produce, buy and eat?Geography, poverty, market access,technical knowledge and access toresources all play a signi cant role.However, it is worth mentioning thatfood production, acquisition and con-sumption are also greatly in uenced bythe cultural habits and personal prefe-rences of the people in question.

ACF (Action Against Hunger, in French)has already situated “culture” as a keyelement in the Conceptual Frameworkto analyze the basic causes of mal-nutrition (ACF, 2008). Habits in sani-

An innovative approach to reducing chronic child malnutrition

tation and infant care, key variablesfor health and nutrition, vary greatlyacross cultures. The ACF White Paperin Nutrition explains that not onlytheir reproductive roles expose girlsand women to greater risk of malnutri-tion, but also lower social status andlevels of education, as well as cultural

factors which shape gender-relateddifferences in workloads and access toresources, traditional care practicesand food taboos.

ACF food security interventions aim totake into account the importance offood sovereignty: “the right of peopleto healthy and culturally appropriatefood produced through ecologicallysound and sustainable methods, andtheir right to de ne their own foodand agricultural systems” (ACF, 2008).Cultural context is included along withpolitical, social, historical and eco-nomic context amongst basic causesof malnutrition. ACF’s hands-on eldexperience in ghting child malnutri -tion is informed by the understandingthat local tradition not only shapesproduction choices and consumptionpreferences, but also child care prac-tices (ACF, 2009) and the managementof water and sanitation resources(House, 2007).

Bronwen Gillespie

Coordinadora Social, ACF-E PerúEmail: [email protected]

Carmen Porras GómezCoordinadora Regional Adjunta, ACF-ECentroaméricaEmail: [email protected]




Now we are taking a step further in theintegration of cultural considerationsin order to enrich our technical pro-posals in food and nutrition security.ACF would like to expand on an issuethat the World Health Organization hasalready recognized: “that nutritionpolicies must refer to alimentation,that is, to food, not to nutrients,” inan effort to recognize the centralityof socio-cultural identity inherent tosomething as personal as the food weeat (Contreras Hernandez and GraciaArnaiz, 2005).

WHY FOCUS ON CULTURE WHEN ADDRESS-ING CHRONIC MALNUTRITION?

As is generally agreed, an approachbuilt on understanding the local cul-tural helps guarantee the sustainabi-lity and relevance of the interventionby incorporating the beliefs, prefe-rences and vision of the local popu-lation not only in the baseline phase-understanding the culture in ques-tion-, but also in the community-basedapproach -for example, identifying thestakeholders through whom we cangain the con dence of the communi -ty-, methodological techniques suitedto the local lifestyle and, nally, inthose recommendations that may twithin their speci c production sys -tem. At ACF, we want to take furthersteps to systematically incorporate acultural approach into our programs.Let’s take a look at food security, oneof our main technical areas, through a“cultural” lens:

AvailabilityFood security is commonly brokendown into factors of food availability,access and consumption. Availabilityrefers to the offer of food, in quan-

tity and quality, whether it be grownlocally or imported to the area. Foodavailability goes through yearly cyclesaccording to the agricultural calendarand varies in accordance to changesin supply and demand and distributionpatterns in the larger socioeconomicsystem. Previously isolated communi-ties producing a diversi ed range of crops aimed at feeding the family,or to be traded with communities in

different ecological niches, have un-dergone signi cant cultural adapta -tion as a result of their exposure to

nancial incentives to grow for ex -port and to the uctuations of marketprices. The increased availability ofprocessed food in stores, coupled withchanging social mores, cause shifts ineating habits, which in turn contributeto the adoption of new agriculturalproduction practices with an empha-sis on production for sale, mostly ex-ports, rather than for family consump-tion or local markets. Income gainedfrom crops sold elsewhere is used tobuy less nutritious processed food,offering a partial explanation for ageneral reduction in the caloric intakeand diversity of diet (Pelto and Pelto,1990). Due to these changes in localproduction patterns, food of high nu-tritional quality may actually becomeless available. (Box 1)

AccessAlthough nutritious foods may be avai-lable, they may not be accessible toall. Access depends on income in orderto purchase food, as well as on accessto land and other productive resour-ces. Cultural factors have a prominentrole to play in every person’s accessto food. Not all family members have

equal access to the food availablewithin a family, depending on howfood is divided up for consumption.Often, extra food is provided to thefather or main income earner ratherthan to the children, as he is logicallyseen to play a more prominent role inthe family’s survival strategy. Inter-ventions aimed at improving nutritiondo not always lead to the expectedresults, as the cultural rules for fooduse are not well understood by thosein charge. (Box 2)

In some cases, family members maynot have access to certain foods asthey are deemed unsuitable on the ba-sis of age, gender or health. (Box 3)

Access, therefore, is not guaranteedequally to all family members at allmoments, although food may be avai-lable. Of course, this is not to say thatthere may not be a very good reason


“Understanding the local culturehelps guarantee the sustainbility of interventions”

“Not all family members have equalaccess to the food available withina family, depending on how food isdivided up for consumption”

BOX 1: Re-discovering QuinoaQuinoa, a traditional staple graioriginating in the Andes now prmoted world-wide as a health food,regaining ground as a crop in sommountain regions due to great interfrom importing countries such as United States, and falling rates of cal consumption are slowly recover(ACF-E, 2010).

BOX 2: Food aid for guests In Peru, the government provides tu

sh handouts to combat malnutritin the Highlands, and that food aimeant for children, is then servedcommunity dinners honouring out-town guests (ACF-E, 2010).

BOX 3: Cold and hot foods Andean cultures make an importdistinction between ‘cold’ foods a‘hot’ foods, referring not to temperatbut instead to their intrinsic qualit which underly complex consumpguidelines. As a result, certain vitamrich foods are not provided to childr(Kuhnlein and Pelto, 1997). Likewhot and cold considerations can patially explain the current eating habin severely malnourished communiof the Chorti´ ethnic group of easteGuatemala (López-García, 2002).





for these taboos, only that these localfood ways must be understood whenlooking at food and nutrition security.

ConsumptionFood may be available and accessible,but this does not imply that it will bechosen to be eaten. Food consumptionis intimately linked with one’s sense ofidentity. This is a factor which helpsto sustain incredibly varied eatinghabits worldwide, while making foodan area in which experiments withidentity are played out. As traditionallifestyles come into closer interactionwith a globalized consumer-orientedsystem, and as minorities continue tosuffer social prejudice, it should notbe surprising that consumption beha-viour mimics that of dominant classes.Western, carbohydrate-rich, urbandiets are highly regarded by poor ruralhouseholds and considered as a mo-dern aspiration; whereas rural, well-balanced diverse diets from the GlobalSouth are discarded as backward, oldfashioned habits. (Box 4)

Simply assuring that the family hasaccess to the required nutrients isnot enough. This is evident in the

ght against obesity in industria-lized nations, where families face a

multitude of affordable, healthyoptions but do not necessarily choosethem. Obesity is rampant in UnitedStates, coexisting with astonishinglevels of food insecurity, in a countrywith very high levels of income percapita and social budgets.

NutritionIt is useful to expand this discussionto look at nutrition security as well,a term that refers to the ability ofthe body to make use of the nutri-

ents consumed: for example, childrensuffering from illnesses such as diar-rhea are at increased risk of malnutri-tion. Nutrition security is compromisedby lack of potable water, inadequatesanitary and care practices and alack of health services or sanitationinfrastructure. Childcare norms varyextensively across cultures. Biologicaluse of nutrients can also change acrosscultural groups, as it can be related

to genetic differences based on theevolution of ethnic groups in speci cenvironments. (Box 5)

OUR CULTURAL APPROACH

Anthropological InquiryAnthropological studies help to iden-

tify not only the relevant practicesin terms of production and consump-tion but also the logic behind thesehabits and the structures within whichfamily life operates. This type ofresearch contributes to an in depthsite-speci c understanding of factorsthat can lead to malnutrition, such asfamily decision making behaviour,helping to avoid assumptions that in-creased incomes or food availabilitywill necessarily improve malnutritionrates. We have to be careful, how-ever, that the inclusion of “culture”as a factor to understand malnutritiondoes not allow external actors to uselocal beliefs as a scapegoat and blamecultural differences for high rates ofmalnutrition.

Carrying out basic anthropologicalinvestigations of local food cultureand traditional food systems will faci-litate the provision of local answers tonutritional problems. Well intentionedefforts to reduce chronic malnutri-tion may show marginal results for thepopulation in question if this step isoverlooked. (Box 6)

The documentation of cultural know-ledge, such as traditional medicine,cuisine, or resource management, isgaining ground in the eld of publichealth. The Food and Agriculture Or-ganization of the United Nations (FAO)is concerned that valuable knowledgefor community health, developed over

time in speci c ecological contexts,is at risk as previously isolated indi-genous communities come into furthercontact with the forces of globaliza-tion, often experiencing increased vul-nerability, poverty, reduced access toresources and marginalization which,in turn, imply further health threats(Kuhnlein et al. , 2009). FAO suggeststhat helping to protect cultural know-ledge as well as natural resources is

“Food may be available and ac-cesible, but it does not imply that itwill be chosen to be eaten”

BOX 4: The embarrassing secret of success An especially healthy family in L Atitlan, Guatemala was embarrassto admit publicly the secret of thnutrition success, that they eat the tdried sh caught in the lake, due to fact that those sh are stigmatized food for the poor (Kadetz, 2008).

BOX 5: Unhealthy diets lead todiseaseCertain populations can be gene-cally predisposed to nutrition-reladisease, and the shift in cultural habfrom a traditional diet to a more prcessed, high sugar and fat diet cabe particularly dangerous, resultiin high levels of diabetes and obesi WHO anticipates a doubling in tnumber of cases of Type 2 diabetfrom 150 million in 1997 to 300 mllion in 2025, with the greatest numbof new cases being in China and Ind(Lang and Heasman, 2004).

BOX 6: Papaya sex tabooRecent research carried out on vitam A in some communities in India shothat complex cultural food rules mthat although papaya is readily avalable, rich in vitamin A, and condered edible, it can only be consumby children 4 to 15 years old, in pabecause it is believed to cause imp-tence. Education campaigns must foon other local foods in order to avo wasting resources on a culturally acceptable food source (Kuhnlein aPelto, 1997).



key to minimizing public health pro-blems.

Understanding behaviour changeSocio-cultural inquiry is not just aboutidentifying local preferences andhabits but is also directed at ensuringthe suitability of our communicationtools and strategies for change. ACFrecognizes that nutrition educationis a complicated eld although ratheressential to revert rates of chronicmalnutrition, as the mother’s educa-tion may explain more than 50% oftheir children’s stunting (Smith andHaddad, 2000). (Box 7)

In developed countries, access to in-formation alone has not contributedto behaviour change. Taking this intoaccount, our approach aims to identifyfactors that motivate change at thecommunity and the individual leveland to recognize the sources of infor-mation and leadership that are mostmeaningful to community members.These may include health promot-ers, mid-wives, shamans or religiousleaders. Adults in similar socioeco-nomic situations but with signi cantlymore success in feeding their fami-lies a nutritious diet may prove to bemore important than nurses in helping

to improve nutrition in the village.Examples of these positive-deviationindividuals have been found to be stri-king and very useful for understandingcauses of chronic malnutrition as wellas for trying to tackle the problem(Kadetz, 2008).

Dialogue and exchangeA methodology that aims to meet par-ticipating groups as equal partners inthe process, that includes a perma-nent dialogue with the community and

with the local institutions is pursuedand incorporated into ACF projects.According to one of our local partnersin Peru: “Effort is made to engage ina horizontal dialogue, reinforcing therecognition that participants have asmuch to teach as any visiting expert,so that real participation and account-ability are both able to help determinethe direction of the work and ensureits validity for the community (SaludSin Límites, 2008).



A cultural approach must necessa-rily take into account the relations ofpower that exist between rural popu-lations, external organizations and thegovernment. This awareness helps toensure sensitivity in our inquiry phase.At the same time, an approach basedon dialogue, cultural understandingand awareness of power relations canitself form part of the content of theprogram. (Box 8)

Building theory and practiceACF continues to review the concep-tual framework for malnutrition, andis active in developing methodologyfor enhancing the use this frameworkand to strengthen nutrition causalanalysis. Given that we are gainingexperience in how to further inte-grate culture considerations into ourtechnical proposals in food and nutri-tion security, the lessons learned areexpected to contribute to these con-ceptual discussions and to a better un-derstanding of the complex causes ofchronic malnutrition.

The following frame of action for thesystematic incorporation of a culturalapproach to food and nutrition secu-rity describes a general work plan to

be initiated by ACF-E in Latin Americathrough its eld projects and workingpartnerships.

Review of relevant experiences.•

Initiate research on nutrition andculture within speci c areas witha high prevalence of malnutritionwhere ACF is carrying out eldprojects. Previous evaluations ofACF Food Security and Nutritionprojects will be reviewed in orderto draw on lessons learned and

pro t from a network of contactsactive in the space is domain: theinteraction between culture andfood and nutrition security.

Carry out ACF action-oriented•

research experiences. Underthe umbrella of current and fu-ture ACF interventions in the fourmissions active in the region (Cen-tral America, Colombia-Ecuador,

“We should not allow external ac-tors to use local beliefs as a scape-goat, blaming cultural differencesfor high rates of malnutrition”

BOX 7: Education for healthy habits what a hard task!Even in educated middle class contein Europe and North America, pubhealth policymakers face great chllenges in identifying how to help in viduals adopt healthy habits, to avotobacco, alcohol, and overeating. TNational Institute for Health in the has recommended that the governmeban TV advertising for children amake healthier snacks cheaper (Boley, 2010). In the USA, various stahave proposed additional taxes ounhealthy food (Lang and Heasma2004).

BOX 8: Making nutrition advice cleaIn situations where cultural marnalization plays a role in the accesquality and acceptability of health s- vices offered to minority populatiothe education of healthcare providein cultural sensitivity may be justrelevant as the education of moth within the community. For examnutrition projects can include suppto the health system in terms of recibased on local resources and prom-tion campaigns in the local languagand training for staff that promotes ctural respect and avoids highly “me

cal” explanations that are unclear fthe local population (Diez Cansecoet al. , 2003).



Peru and Paraguay-Bolivia) as wellas the AECID framework agree-ments 056 and 064 in Latin Amer-ica, action-oriented research ac-tivities will be developed with theaim of furthering the speci c un -derstanding of the socio-culturalcontext in food and nutrition issuesin the geographical areas in whichACF intervenes. These researchactivities will clearly contributeto the understanding of the CausalAnalysis of Malnutrition, a globalinitiative supported by the ACF In-ternational Network. The researchwill bene t from ongoing ACF pro-jects that will provide data, hu-man resources, logistical support,and valuable knowledge and con-tacts in the communities and withlocal authorities. Field researchwill include phases of data collec-tion, analysis and validation withcommunity members and otheractors involved.

Adapt methodology for ethnogra-•

phic research in nutrition andfood security. Existing tools forsocio-cultural research will beadapted for the speci c meth -odological requirements of eachstudy, and can be compiled to

serve as a guideline for other in-terested ACF interventions.

Publish research results and re-•

commendations. Research resultswill include conclusions regardingthe socio-cultural aspects of nutri-tion, information on positive tra-ditional nutrition practices, andrecommendations and guidelinesto incorporate culturally-adaptedbetter practices to address chronicand acute malnutrition in ACF in-

terventions, ranging from speci ctools to use in the eld to issuesfor advocacy at national level.

Impact evaluation.• After threeyears, the results of the culturalresearch will be evaluated in termsof the impact on the quality andsustainability of the interventionsin the eld, as well as in terms of the generation of valuable infor-



mation for the speci c ACF pro -grams in question. This phase willinclude an open discussion withinthe ACF International Network andbeyond and comparison with simi-lar experiences of other actors in-volved in nutrition and food secu-rity interventions.

Extract tools and conclusions to•

create ACF Guidelines for a Cul-tural Approach to Food and Nu-trition Security. A rst draft willbe developed, lead by ACF in LatinAmerica, taking into account inputand experiences from all interes-ted missions.

Advocacy with national govern-•

ments and international aidinstitutions to scale up evi-dence-based policies and activi-ties to address chronic and acutemalnutrition. Based on the ac-tion- oriented research conductedby ACF, speci c eld tools andpolicy recommendations will beelaborated and disseminated soas to provide National Authoritiesand International Agencies withre ned elements to better addresschronic and acute malnutrition,contributing to the understan-

ding of the non-economic factorsaffecting malnutrition and further-ing the causal analysis of hunger.

“Our approach aims to identifyfactors that motivate change at thecommunity and individual level”

“A cultural aproach must necessa-rily take into account the relationsof power that exist between rural

populations, external organizationsand the government”



Nicaragua:Managua, Nicaragua.Reparto San Juan, del Gimnasio Hércules,1C. al Sur, 1C. al Este, 1C. al Sur, 1/2C. al Oeste.Casa No. 206.Teléfono: +505 2255-5151TeleFax: +505 2278-8313Guatemala:Ciudad de Guatemala, Guatemala.4ta. Avenida 16-44, Zona 14.Teléfono: +502 2368-3030

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Cultura y Nutrición (inglés)