The report takes a broad definition of food culture as ‘shared practices and meanings relating to food’, and then zooms in on the evidence within this field most directly relevant to health. We started by looking at studies of factors directly influencing food consumption practices, and then also considered the indirect effects of food production and policy cultures.

The research that we found showed how the practices and meanings people attach to food can cement their membership of socio-economic groups, as well as directly affecting their diet and health, implying that they can reduce social mobility and perpetuate inequalities. This makes the case for trying to ‘change culture’, but also underlines that doing so is a political act – it changes people’s sense of themselves – demanding that health intervention is accountable to the people affected and respects how much they have invested in the ways they eat, cook or shop.

We also reviewed Scottish and UK food and health policies of the past 20 years for their sensitivity to cultural issues. We found scant reference to these issues. They generally considered how the wider environment affected food choices, leaving culture as a black box in between or as shorthand for that which cannot be explained. When policies did call for ‘culture change’, it was in loose sense, which diluted accountability and risked blaming the victim.

A previous analysis – the review of the Scottish Diet Action Plan, published in 2006 – highlighted the culture of policy-making as a particular issue. It had suggested that shortfalls in policy performance could be explained by government’s consensual approach to “working with” the food industry, which had seen decision-makers “not deploy the full set of policy tools available”. Our review suggests that consensual approach is still the norm.

What does this mean in practice? Perhaps that ‘culture change’ begins at home, with policy makers reflecting on how their own institutional culture affects the nation’s health. More research into the meanings and values people attach to food could also be useful, particularly in validating and feeding into policy design the hard-learned know-how of community health practitioners. But we don’t suggest diverting more health research into new work on ‘food culture’ – that fact is that existing work on health inequalities does a pretty good job of explaining poor diet, and much of it touches on cultural issues, so the priority should be to make the most of that evidence.

The report was co-written by Ian Fitzpatrick, Tom MacMillan, Corinna Hawkes, Annie Anderson (University of Dundee) and Liz Dowler (University of Warwick).

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