In this episode I talk to Dr. Eva Neely, a lecturer at the School of Public Health at Massey University in Wellington, New Zealand. She has done some groundbreaking research on the social health meanings of food for youth in schools – which is a step away from the usual health-focused approach used when trying to influence outcomes for young people. Join us in our conversation as Eva explains why we should care about her research and who should pay attention to it.
Sarb Johal: Tell me a little bit about the backstory for this paper – what got you interested in this topic to start off with?
Eva Neely: When I was doing undergraduate and honest studies and health promotion, I was rather dissatisfied with the rather narrow framing and look on young people’s nutrition and how it was framed – how young people were always put in a bad light because they don’t adhere to the right fruit and vegetable levels, and all this and they’re a big risk for their future health. So, I always felt it was really undermining of young people and very narrow and it didn’t really take into account the whole picture. Also in the literature one thing I found when I was reading as that is how young people actually embody all these health promotion discourses and subsequently it makes them feel inadequate, so they often either resist them or they embody them and feel bad about themselves. And really I think what my overall interest in this is how a strong focus on this physical health lifestyle approach really impacts on health holistically and I think a much better focus for looking at health in any population really is as a more holistic picture – so looking at physical, mental and social health and how these affect each other and how we can actually approach health promotion from a more holistic empowerment-based approach. So, I think you know reading all those negative stories and seeing these themes emerge in the literature really got me interested in that area.
SJ: So, you mentioned this idea of health promotion discourses and the fact that you feel like it’s quite narrow and not holistic enough. Where did that take you in terms of how you designed your research project?
EN: Obviously, your personal stance on health really has an impact on on how you look at research – as you would know – and I think I’m personally someone who loves having people around for dinner, loves making food for others, loves sharing food, and I always just felt like food – obviously, it nourishes our bodies better nutrition helps nourish our body but the story doesn’t end quite there. And so my personal interest in and joy in nutrition from these different health perspectives clashed with what I read in the literature and I was always just quite interested in the concept of a health-promoting school. I’ve got quite a social determinants perspective of health; that it’s not up to individual choice always to make the right health choices, and that not everyone can and wants to make those choices that health promoters prescribe are the right choices. And so I guess I just started reading and reading and reading and, you know that first year of your PhD is pretty much what you do, and it just opens up all these areas and really showed me that there are some good approaches but the mainstream nutrition literature is really, really focused on just getting young people to eat the right nutrients rather than looking at it a bit more holistically.
SJ: You mentioned the social determinants of health approach and how when you look at food through that lens certain things are not really available perhaps because of your socio-economic position you know you can’t afford it, or you just don’t have the access because of your position rurally, that you can’t access good food. That’s really interesting. But you also talked a little bit about your ideas about the meaning of food, particularly in your home. And I guess that that’s something that you identified – is that we don’t know perhaps enough about the meaning of food and that ritual of food in a school environment. We know a little better about younger children but I guess it’s noticeable that the age group you choose to study here is not particularly young.
EN: No, and one thing I found when I was looking at the literature is that there was actually no real literature that looked at young people and their social health in terms of nutrition. I found things from anthropology and and so on from other fields that don’t really look at health in the same way health promotion does, and it was actually really interesting that there was not one single study I found that looked at looked at it in that way as I did. So, hence I took on a sort of a thematic synthesis approach to the literature to look at other people’s data with my lens on it because there was so little available on that kind of perspective. You’re right – when children are younger there’s a much bigger parental involvement in their nutrition than when they’re older and so it’s a lot more youth centered and less parental involvement when they get a bit older. And yes, there was not much available in the area.
SJ: So, it’s not just physical in terms of the outcomes – there are social outcomes as well. It’s not just about nutrition because the meaning of food is very different according to where you’re coming from with that. And sometimes nutrition is not a particularly helpful way of talking about food because it’s very limited – and you’ve also identified that for a younger age group the parent has quite a lot of influence around food but as people get older than that changes somewhat. So tell me about what you did and about the sorts of socially interesting findings in that sphere.
EN: When I was exploring how to approach this topic and I was reading about different ideasI came across – and as health promoters we we do praise ourselves on being quite interdisciplinary – so taking on approaches from different disciplines and reading through ethnographic anthropological research, I really found that approach of being with people and being able to observe their practices and being able to build relationships seemed like a really useful approach, so I started reading further on it. And it actually besides being a fantastic approach to explore what I wanted to explore, which was social food practices – which you can’t just ask someone about the everyday rituals because it’s quite reflective and a lot of these rituals and how we interact in every day are very tacit. So you don’t really think about them – they’re ingrained in our culture and how we how we practice. So, being on site somewhere where I could observe these repeatedly throughout a school year seemed like a really good approach to take. But the second aspect of that approach was also that I was able to be with the young people, understand their perspectives, build relationships, build trust, and they opened up in such a different way to me I think, because they got to know me and they felt valued. Because they felt like I was actually spending time with them to understand what their perspectives were and so on. So, I think the approach of actually then going into the school was fantastic and I ended up spending a whole school year in a secondary school with students. I had to approach a few schools so I did end up in an only girls school, which of course limits my findings to that particular cohort, but it was a fantastic opportunity to get in a girls school – there was lots going on with food so it was very interesting. And so I ended up a whole school year – I spent from February to November – I spent the whole year in the school. At the beginning I went five days a week and from Term 3 and in Term 4 I was more like three days a week and I spent most my day there. In terms of recruitment, I asked around all teachers and Year 13. The reason I recruited Year 13s was for one, that they’re 16 and older which means I only need to get consent from students – that was quite a practical thing – I didn’t need to approach their parents as well. And then also in Year 13 there’s no school uniform in New Zealand, so me being amongst those students I didn’t appear totally unsuited because I wasn’t markedly older than the students, so I kind of blended in a little bit more than if I were older and in a different uniform to them. So, that will sort of my my reason I chose to go with year 13 students, which is last year of school in New Zealand. And then I went to classes – I had four subjects I went to with different students; some of the students doubled up in some of my classes and I sat in with the students, I got to know them, I went to their lessons and the lessons were sometimes interesting. Later in the year – they were quite interesting because a lot of shared lunches happened and these kind of things in the lessons. At the beginning they were just for rapport building – just that – because if you’re sitting in the lesson you get up with other students, then they invite you to lunch or then invite you to come to their groups and that was the main reason for going to the lessons at the beginning …
SJ: Just to interject – sitting in through all those lessons for that long period of time – it sounds like a pretty immersive experience that you were involved in.
EN: Yeah, it was and I think partially I also chose this knowing that after this, if I do get into the academic job as I had hoped, I will probably never have that time again to dedicate to a research project. So I made the most of having three years to just delve in to one big research project and decided that such time intensive research would be really good, and I don’t think I’d ever have that time again – but I do think even with less time investment one could still get some of those benefits back through through actually spending time with the group you’re looking at
SJ: In that time that you were spending with these year 13, 16+ year olds, and then eventually getting invitations to go to lunch with them, what were the sorts of stories that you were hearing?
EN: Quite different. A lot of typical things you think 16 year olds are interested in, from boys to things going on at school, to other girls, to other groups. It was interesting seeing different group dynamics where someone was part of that group in this year, they weren’t part of that group previously, and all those sort of things. A lot of relationship based issues, and relationships would seem to me as one of the main things that matter to young people; where they stand, who are their friends. Because those do really seem their primary support people during that quite vulnerable period. And so I think those emerged as as key things in their talk and then as I happily then observed, food emerged in these practices as something quite noticeable sometimes when people having a fight and they didn’t offer to that person as part of the group when they were sharing food around. All these little little things that you’d only really pick up if you’d observe because no one would really tell you about those things happening.
SJ: Tell me more about how food and food rituals then mapped onto these relationships, both within the school and perhaps outside of the school as well.
EN: If you look at that paper, I had three key kind of rituals that I was able to put it into themes or groupings. Food was used to build, maintain, and regulate relationships. I personally felt that that initially it was a bit more reserved with me being around but then they kind of broke the ice by offering me some food and then you were kind of part of that group, when you’re sort in that circle you’re offered food. The girls were really big on sharing food when they had it – and the school was an urban school so in Year 13 you’re allowed to leave the school during your breaks – and they had a supermarket and various other food places right around the corner. So it was quite a common thing to go out for lunch. The first theme was the ‘lunch walk’. It was about asking others if they’d come out to go and get some lunch, and it wasn’t always that that person needed to buy lunch but it was that ritual of walking with a few friends. It wasn’t really a thing you wanted to do by yourself – you didn’t just go out it wasn’t that I wasn’t just the practicality of getting something to eat, it was more the social thing of linking up with others and going for walk to get some food. Sometimes that person said I don’t want anything and and they’ve convinced them by saying, ‘I’ll just get this and we’ll share it.’ Obviously, money played a bit of a role and some had a bit more than others, so those things were often kind of regulated by offering them something of what they had. So, the actual act of walking to get something to eat was much more central than just getting something to eat. Then also that ritualized sharing as I was talking about before is how it’s part of the group dynamic when somebody has something, to share that food with them or bring stuff explicitly to share with others. And gifting food was also quite a big thing there were often girls that make cupcakes to bring and share with others, or they made something for someone’s birthday and these were all sort of really ingrained practices that linked on to their relationships that were used as tools within these relationships and with other people, with other girls. And a majority of those things I didn’t get through my interviews that I also did with the students, but through just being there observing these practices – because it is so ingrained in how we just do everyday life.
SJ: So the interviews got you so far, but actually being there and observing and having an established long term relationship with this group of students just enabled you to see so much more?
EN: Yes, yes it did, and sometimes I started the interviews a bit later in the year – I didn’t do them immediately and because – some of the girls I didn’t know that well but some of them I knew quite well – and I could actually also ask them about things when things had happened, or how they felt about that because I’d observed and taken a note of it. And I could then draw on these events or practices later on in interview so I was able to get out a little bit more through that, but only again because I had been there previously to pick up on those things. I think my results would have been quite different and definitely less in-depth if I’d gone into a school just to do interviews.
SJ: So, Eva, here’s the tricky part then: you’ve got these three themes that you’ve identified – one around that lunch walk and that being something separate other than food but actually being getting from A to B with perhaps a group of other people that you’ve invited along, this idea of ritualised sharing, and this idea of being able to gift food as well. So, who should care about the findings and why is it relevant – what’s the point of this?
EN: I think there’s two messages, one more immediate surrounding the food but I think the overall message is for health promoters and for people working in schools, be it health promotion or teachers or people working with young people; to really be aware of our agenda and when we are trying to do good for young people, when we’re trying to promote things for young people, and not starting with epidemiology as a starting point but with young people’s perspectives and young people’s problems and their issues. And I think approaching it through that we can of course bring in some of some of our agenda but I think letting them speak, making sure we know what’s important to them and not undermining their opinions and when they tell us what it is – because that was one really strong link too. People often said, “yeah they asked us for our voice but then they don’t really do anything with that voice” – so that sort of tokenism of, ‘here’s young people’s voices!’ but really, we don’t do anything, we don’t act on this. So, really actually taking action on what they tell us is really key I think. On the overall big picture, this research will say when you’re working with young people be it in any setting really, not just schools but with young people around any health-related topics, is listen to what’s important to them in their lives. Young people know what’s healthy and what’s not healthy – and I don’t think we should stop making people aware of what’s healthy and what’s unhealthy, but I think this overarching health-ism agenda really delineates young people; it really makes them either … either it goes the way that they resist it and do the opposite because they know it’s not what they’re supposed to be doing, which, you know, is part of the job of a teenager. But then the other part is also that it infuses guilt with young people every time, you know … with their rising numbers of eating disorders, it’s really concerning to think about how little girls even already are starting to think about what they eat and what their weight is. And I think we really need to wonder if this obesity discourse is the right way we want to go. I’m all about a positive discourse on nutritious food and good food that nourishes their bodies and our minds and our social lives, and good physical activity, but really I think the bigger picture which is quite dear to me in my other research as well, is that this weight focus and this relating weight to health is really damaging, especially to young people – especially to young girls in these vulnerable years, which then sets them up for the rest of their adult lives, is that they’re worrying about a number on a scale or worrying about what the eating, and always feeling bad. And the thing is they end up eating these things and they feel bad about it so it just induces guilt rather than trying to focus on a positive balanced diet. I think starting with young people’s voices, their opinions on things and really getting a sense of what it is for them in they’re in their lives. Not every researcher will be able to dedicate a year to spend with their with their group of people they wanted to work with but I think you can achieve that even by just spinning some some time – a few days a week or a day a week for a few weeks, showing them that you are really interested in them and what’s important to them, and taking on those observations and being open to their opinions. I think that’s really important. And another thing is, I think, for a lot of people in health promotion, is to think about this health promotion, mental health promotion, but really I think it’s a big package – we’re people – we have physical, mental and social health needs and I think it’s really important to think about these in a whole picture, to weigh up if whenever we’re doing an intervention trying to improve something how does this impact on the whole holistic picture of health when we’re doing these things – because we want to make sure all those areas are being nourished and go forward from this.