As a trained nutritionist, I was taught about food and nutrition mainly as a science, chemical interactions divorced from their larger cultural contexts. Western scientists have “fine-tuned” nutritional components into large categories (protein, carbohydrates, fat) and small categories (vitamins, minerals). I was taught that this form of categorization is science, it is biological, and these are the components that are compatible with life on this planet.
Nutrition has been medicalized in the West, but humans enjoy the taste of food as well, ensuring that food and nutrition have become part of consumer culture. Each time we sit down to a table, or put something in our mouth we do so in the context of this culture. There are good foods (vegetables, fruits, organics, whole) and bad foods (fast food, convenience food, GMO’s, pesticides). Western society also has a somewhat collective understanding of snack food and comfort food, healthy food and unhealthy food, food for babies and food the elderly. There are foods that men eat, and foods that women eat. This is food, but this is NOT food.
Biological necessities such as food and nutrition do not develop outside of the context of culture and human interaction. In fact, we can probably say that one of the roles of “culture” has been to modify these biological dispositions, and the most rudimentary ways we do this is through categorization. George Lakoff explained in Women, Fire and Dangerous Things “…the chain of inference–from conjunction to categorization to commonality–is the norm. The inference is based on the common idea of what it means to be in the same category: things are categorized together on the basis of what they have in common”. Creating and understanding categories helps us reaffirm our shared identity that is culture.
There are multiple and contradictory categories of food and nutrition globally. Because nutrition and food are inextricably linked both politically and economically to health, however, what foods are categorized and why, matters. Food and nutrition are packaged and marketed for things like taste and enjoyment. But food is also packaged and sold to promote health, oftentimes by corporations with the blessing of global health organizations. This is primarily done through our understanding of the biomedical model of nutrition. Worldwide, however, traditional categories of what foods are healthy and why do not always integrate well into this model.
Food Categorization in China
In the dominant Chinese medical paradigm, food and nutrition is used as an integral part of health and healing that is much different from this biomedical paradigm of the West. The categories of protein, carbohydrates and fat make sense to Chinese people, who understand the biological and chemical premise behind these concepts, but are much less important to their everyday understanding of the interaction between food and health.
When many Chinese people sit down to a meal, everything on the table is there for a reason not, in fact, having to do with taste. Thousands of years of collective history dictates what is on that table and why. This one is good for your skin; this one will help calm you down. This food is excellent for your digestion, but this one you can’t eat with that one or it will cause harm. You can NEVER eat that food in the summer. There are foods that increase your “qi” (energy), and ones that cause it to slow down. A menstruating woman should eat this, this and this, and not that, that or EVER that.
Because China is currently transitioning to a consumer-driven economy, this idea of nutrition as health in both a Western and Chinese sense is being sold to the masses. This article last year by the Wall Street Journal wrongly states that Chinese people are becoming “more health conscious”. What the article meant, I’m assuming, is they are becoming more aware of Western concepts of health and nutrition. In the “Western” concept, we add more to our diet and foods (vitamins, health foods, organics) in order to make ourselves more healthy. There is a belief that adding medicines, adding supplements, adding culturally and biologically defined nutrients to our everyday routine, we can make ourselves healthy, wipe out disease and increase wellness. This concept does not work in the dominant Chinese paradigm, however, as there is more a focus on balance and harmony. But because our idea of “adding more” has shaped the way we treat micronutrient deficiencies through food fortification globally, trying to integrate this in China is turning out to be problematic.
Food Fortification and Health
Food fortification is the process of adding nutrients to foods where they don’t naturally occur. The premise is by adding micronutrients that lack in the diet (for whatever reason) to foods that are widely eaten, we can decrease the incidence of these deficiencies. It has been very successful in many parts of the world, China included (see this blog post for more information). China implemented an iodine salt program a few years ago, and has essentially eliminated iodine deficiency from its populace. Outside of the iodized salt program, however, China has been unable to implement other nationwide food fortification programs for folic acid, iron, or vitamin A (among others).
To illustrate this point and its significance, I will use my current research area of complementary feeding in infants. Complementary feeding includes all foods other than breastmilk or its alternatives, and is strongly influenced by culture. Western concepts of complementary feeding, including those recommended by the American Pediatric Association, are based on our ideas of nutrition and medicine more than traditional beliefs. Here is a complementary feeding guide that I use on my own website and blog that shows what is appropriate and why. If you notice the very first food we recommend to give a child, it is iron-fortified infant cereal.
There are a variety of foods that babies need at around 6 months that breastmilk no longer provides, including iron, zinc, protein and extra calories. American companies saw this, and baby’s propensities towards allergies as a business opportunity and created iron-fortified cereal. While I won’t go into the small details of why they recommended iron-fortified cereal (or some of the problems associated with this), it has turned into a cultural norm in the U.S. to feed your baby iron-fortified cereal as the first food.
This has not worked in China for a number of reasons, but first and foremost is the way the dominant Chinese paradigm has categorized foods. There is no straight concept of “baby” food; this has been created by corporations in the Western world and has only been introduced to China recently. There is no difference between “baby foods” and “adult foods” intrinsically; in the U.S. and in other parts of the world, “baby foods” are in a jar and pureed and labeled by “baby food” brands. In China, “baby foods” are categorized by other things, including texture and traditional food ways.
For now, “baby food” has not gained popularity in China for a variety of reasons. But because of this, coupled with the dominant global model for preventing vitamin deficiencies being through fortification of baby foods, iron-deficiency anemia remains a problem in all areas of China. In other words, the way we have categorized foods has shaped how we prevent “disease”, but these categories do not exist in other parts of the world. The question nutritionists and physicians are grappling with in China, then, is how do we prevent iron deficiency if the dominant paradigms for prevention it (i.e. fortification and supplementation) aren’t widely accepted?
There is much value by scientific categories assigned by the dominant Western biomedical model of nutrition and food. More than a few researchers, Chinese and Western, however, are mystified at how to integrate these cultural systems created from categorization. It is not news that food is culturally relevant, and it is not news that public health campaigns need to be more localized to be successful. But the last 30 years has seen the integration of China, India, and other parts of the “non-western” world into the global market. This is not only affecting consumerism of food products globally, but also how food and nutrition interacts in global public health programs.