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Food, Health, and Global Justice

The U.S. Centers for Disease Control and Prevention (CDC 2015) estimates that 35 percent of American adults are obese, while 69 percent are overweight. The CDC also estimates that nearly one in every five children in the United States is obese. The National Bureau of Economic Research estimates that medical treatments of obesity cost US$168.4 billion a year, or 16.5 percent of national spending on medical care (Cawley and Meyerhoefer 2010). Public Health England (n.d.) estimates that 25 percent of the adult population in England is considered obese, while 62 percent of adults are overweight. The World Health Organization (WHO) estimates that in North America, large portions of Central and South America, most of Europe, Russia, and Australia, 60 percent of the population is overweight. The United States and the United Arab Emirates have the highest obesity rates, according to the WHO, at 32.6 and 33.8 percent, respectively. The rest of North America, those large portions of Central and South America, Europe, Russia, and Australia exhibit rates over 20 percent (WHO n.d.).

While obesity rates are highest in high-income countries, obesity is nonetheless associated with poverty (Drewnowski and Specter 2004). Poverty limits access to fresh, healthy food and encourages, if not requires, a reliance on processed or fast foods. At the same time, low-income countries are being targeted as new markets by global agribusiness and processed food corporations. In many low-income countries, infectious disease is declining, while obesity and obesity-related diseases as well as dental caries are on the rise. These epidemiological effects appear to be directly related to the incursion of global food into local markets (Prentice 2006).1 [End Page 1]

Undernourishment, particularly of mothers and children, remains responsible for about 10 percent of the global burden of disease. The WHO estimates that 104 million children around the world are undernourished. Maternal undernourishment frequently reflects gender inequity. Undernourishment also results from environmental catastrophes and civil or military violence as well as poverty or economic corruption and maldistribution of food (Burgess and Danga 2008).2 Conflict resolution, education for girls, and the elimination of corruption might allow the farming to flourish that would eliminate undernourishment.

The WHO estimates that there are 1.5 billion people globally who are overweight and 500 million who are obese, and these statistics are directly related to what and how humans eat. Globally, obesity accounts for 2.6 million deaths annually. It appears that humans around the globe are eating themselves to death.

Debates in food ethics frequently fail on two counts. First, they often hinge on a spurious dichotomy between individual responsibility and state coercion. Second, these discussions rarely pay attention to the sociality of food and to what food means to individual identity.

Medicine and public policy tend to focus on obesity as an individual problem that must be addressed with various disciplines and regimens of selfcontrol. The medicalization of obesity holds the individual responsible for her obesity, while undercutting her agency as insufficient to address her situation without relying on medical interventions and treatments. Efforts by the state to encourage healthy eating as public policy run afoul of claims to liberty, both on behalf of individual “choice” and on behalf of the “freedom” of the market. A proposal to ban the sale of supersize sodas meets with both moral indignation and commercial opposition, as if liberty were so thin a reality as to be embodied in the purchase of an enormous sugary drink.

Agency depends on a culture of possibilities, and the culture of food in the United States, for example, makes it very difficult for many people to eat healthy, satisfying food. A single mother of three who has unreliable transportation and lives in a food desert probably does not have access to fresh fruits and vegetables and organic products, the money to buy them if she did, or the time to invest in home-cooked meals.3

Moreover, while isolated bans on certain foods are unlikely to remake the culture of eating, they would not be a new intrusion of the state into the [End Page 2] domain of food, as the state has long been complicit with agribusiness in promoting industrial agriculture over smaller sustainable farming. Agribusiness is highly subsidized in the United States and other developed countries, and its intrusion into new markets is facilitated by the state.4

Global food companies pursue aggressive strategies to attach consumers to their brands exclusively and early on. Processed food companies make deals with underfunded schools around the globe to supply needed supplies or to support essential activities in exchange for the opportunity to position their products and brands prominently in the school experience, from the installation of vending machines and a spot on the school lunch line to the branding of notebooks and other merchandise. Companies offer children toys, caps, figures, pins, or other logo-bearing trinkets to reinforce attachment to the brand. The addictive nature of foods high in fat, sugar, and salt further undermines agency.

Any analysis of food ethics or food justice and any account of responsibility in relation to health would have to take into account the structure of the social and economic inequities that determine eating as well as the powerful commercial forces that undermine healthy eating in many cultures around the globe. Labor injustice, environmental risk, land and patent policies that favor global corporations, poverty, lack of education, gender inequity, the abuse of nonhuman animals, advertising, branding, and regulation of choice: all these issues are relevant to a discussion of food justice and responsible eating.

Food justice also requires attention to the way in which food comprises a network of social relations, from those who produce and prepare the food to those with whom it is eaten. It has only recently become possible for large populations to eat without knowing where their food came from or how it was produced. Frequently, agribusiness exerts fierce influence to prevent the conditions of food production from becoming known to hide both the suffering of human labor and the suffering of the animals eaten.5 Agribusiness produces what the French farmer and activist José Bové calls malbouffe, antifood, food that is unsatisfying and that has no locality (Gottlieb and Joshi 2013, 60). Malbouffe offers the same taste around the globe, so that food ceases to speak of place and to be a passage between humans and the rest of nature.

Historically, food has embodied the deepest family relations and a way of making and sustaining friends. Religious celebrations are “feasts” and consist in large part in the preparation of elaborate traditional meals. Mothers and daughters pass down recipes over generations, often marking them with a [End Page 3] special twist or flair of creativity. The smells and textures, the labor and techniques, the rituals and practices for producing, procuring, preparing, serving, and eating food provide a pervasive infrastructure of life and identity. Perhaps a healthy and pleasurable relation to food depends on participation in a culture of food that is both sensuously and socially satisfying.

The essays in this volume advance discussions in food ethics and food justice both by paying attention to the way in which food choices are structurally determined by a culture of possibilities and by attending to the affective dimensions of food and the constitutive role of food in identity. The first two essays address the structural inequities that constrain choice in relation to food. Erinn Cunniff Gilson reconceptualizes food, not as a commodity, but as a “site of vulnerability” and an “openness to affectivity.” Food provides a “medium of expression” and a point of “connection.” Paying attention to dependency, vulnerability, and relationality, Gilson exposes how familiar and accepted attitudes and practices undergird a range of structural injustices in agriculture and the culture of food. Gilson calls for a remaking of the relationships and practices around food to “foster eating and living well with others.” Food justice, she argues, is an essential element of justice.

Similarly, Helen L. Walls, Colin D. Butler, Jane Dixon, and Indira Samarawickrema also focus on the way in which structure determines agency. The authors demonstrate the social and cultural determinants of health and agency as well as the role that poverty and education play in shaping choice. They pay particular attention to the way in which environmental degradation and resource depletion disproportionately affect already vulnerable populations and increase existing social inequities. Like Gilson, they consider forms of solidarity that might be effective in securing a more just and healthier future.

The essays by Corine Pelluchon, Lisa H. Schwartzman, and Galya Hildesheimer and Hemda Gur-Arie all address the way in which powerful cultural forces, particularly norms of gender, shape individual identity in relation to food. The essay by Corine Pelluchon, the first that IJFAB has published in French, analyzes anorexia, not as a medicalized behavior disorder, but as a disturbance in “being with the world and with others.” Pelluchon argues that it is important to attend not only to the anorexic’s symptoms but also to her “manner of existing.” An unresolved opposition between body and mind afflicts the anorexic, so that she cannot exercise her autonomy except in abnegation of her body. Pelluchon’s feminist analysis reveals the undermining effect of gender roles and body ideals on the anorexic’s experience of herself as [End Page 4] an autonomous agent and explores the social tableau within which her agency emerges.

Lisa Schwartzman also criticizes contemporary discussions of food and obesity that focus on individual choice. The rhetoric of choice obscures the way in which eating habits are determined by race, class, and gender. Schwartzman argues that this rhetoric “has particularly negative effects on those suffering from eating disorders,” who tend overwhelmingly to be women. Current discussions often focus more on body size and shape than on health, exercise, and satisfying nutrition. Schwartzman links these cultural pressures around body type to cultural forces that treat women’s desires for both food and sex as threatening impulses that must be managed and controlled. Against this pathologizing of female desire, Schwartzman argues for a new, healthier approach to food that focuses on the cultivation of women’s desire and pleasure.

The essay by Galya Hildesheimer and Hemda Gur-Arie analyzes a recent Israeli law regulating body weight in the modeling industry. While criticizing the law, the authors note its importance as a “formal acknowledgment that extreme thinness is not an individual and private matter but a dangerous social phenomenon that needs to be attended to in the public sphere.” As the authors point out, modeling is only one of several industries that purvey ideals of health and beauty as a means to personal success. The sports, beauty, and fashion industries, and, to some extent, medicine all reflect a public ethos linking femininity, beauty, and body image to a healthy personality and personal autonomy. If the law oversimplifies the origins of eating disorders, it nonetheless provides an important recognition of the social determinants of health and the way in which identity and agency are shaped by a culture of possibilities.

The essays by Anne Barnhill and Stephanie R. Morain, Monique Jonas, and Sara M. Bergstresser and Erick Castellanos focus on specific public policy issues regarding feeding at the beginning and at the end of life. Anne Barnhill and Stephanie Morain critically evaluate policies promoting breast-feeding. While infant feeding practices reflect intimate choices, they are also a “legitimate target of public health intervention.” The authors argue that public policy should focus on reducing the social and cultural burden on breast-feeding mothers. In this way, the promotion of breast-feeding would enhance, rather than undermine, women’s agency and autonomy. Reconceptualizing breastfeeding as a public health issue encourages a shared social responsibility for [End Page 5] infant feeding and commitment to policies that facilitate and support nursing mothers.

Monique Jonas’s essay also addresses the intersection of maternal agency and public policy. Jonas shows how nutrition “advice” that purports to leave decision making to maternal “discretion” instead regularly installs standards that encourage the judgment of maternal performance. These standards, Jonas argues, may be neither “reasonable” nor “fair.” Failure to adhere to the nutrition guidelines may be based on social and economic inequities rather than personal failure. While supporting the necessity of such advice, Jonas argues that it must be accompanied by policies that support mothers in their efforts to adhere to the “highest standards of nutritional care.” Like Barnhill and Morain, Jonas calls for public health policies that enhance the agency of mothers.

The essay by Sara M. Bergstresser and Erick Castellanos addresses the issue of feeding in end-of-life care. The authors develop an account of the “moral valence” of food and feeding and show how they occur within an “elaborate set of social, economic, and cultural frameworks.” Food is “much more than sustenance,” and feeding is “a process through which social categories are constructed and reproduced,” especially categories of gender. The authors contrast this dense and rich appreciation of food as a network of relationships with the efforts in bioethics and medicine to treat end-of-life feeding as “artificial nutrition and hydration.” Physicians and bioethicists insist that this is an artificial medical technique, as distinct from the human activities of feeding and eating. Conflicts between physicians or bioethicists and families about the cessation of artificial nutrition and hydration often turn on radically different interpretations of the patient’s care. The authors recommend that physicians and bioethicists rethink this clinical situation in terms of the patient’s relational autonomy. Recognizing the relationality of the patient’s autonomy requires the physician or bioethicist to include the patient’s family or loved ones within the sphere of care.

The last word among the essays rightly goes to Alison Reiheld, who introduces a healthy note of skepticism about the “obesity epidemic.” Reiheld surveys the medical measures of obesity to call into question the conflation of health and body size. Framing obesity as a disease makes food and feeding a public health issue, and the responsibility for food and for health, Reiheld argues, falls disproportionately on women. By focusing on obesity as an individual responsibility, public health and bioethics ignore the structural determinants of what and how we eat and fail to intervene at the level of policy [End Page 6] in ways that would actually make healthy eating possible. Reiheld calls on bioethics and public health to focus on changing the infrastructures of how food is produced, procured, prepared, and consumed to create a culture of healthy and satisfying possibilities.

Most of these essays include some discussion of the problem of remaking the global food culture under global capitalism. Lynette Reid’s review essay of Thomas Piketty’s Capital in the Twenty-First Century addresses just this question of how a fair and just polity can be secured when capitalism produces the accumulation and concentration of wealth. Reid asks, “To what extent will we seek to divide and redistribute wealth, to what extent will we have to cope with the effects of growing inequality, and how should we do this?” Reid’s review turns the light of Piketty’s analysis on specific policy questions within feminist bioethics, including care labor, reproductive rights, access to and pressure on public health systems, and commodification.

Margaret Gray’s review of Food Chains, directed by Sanjay Rawal, also links food ethics to a critique of global capitalism. The film details the inequity and suffering that exist among Florida’s tomato pickers as an example of the fate of farm labor and small farmers under global agribusiness. Gray notes that the consumer is a “passive party to this exploitation” but also an “agent of change.” The review outlines several policy strategies and suggests concrete steps that consumers might take to address these injustices.

IJFAB has always been committed to expanding the discussion in bioethics to focus on the social, cultural, and economic determinants of health, and this issue locates eating at the heart of bioethics. Food is not merely a commodity but a network of relationships and an infrastructure of life. Food speaks to our deepest identities and our most intimate relationships. If humans around the globe are eating themselves to death, then it is time to remake the culture of possibilities that determines how we grow, share, prepare, and eat food. This will require a multidisciplinary, collaborative approach that links a phenomenology of food to labor and environmental justice, as well as strategies for achieving social and economic equity. How can we remake the infrastructures of food to ensure that everyone enjoys healthy, pleasurable eating shared with others?6 This issue of IJFAB initiates that conversation.

Mary C. Rawlinson

Mary C. Rawlinson, the editor of IJFAB and a professor of philosophy at Stony Brook University in New York, is the author of Just Life (forthcoming) as well as articles on literature and ethics, Hegel, and Proust. She is the editor or coeditor of Labor and Global Justice, the Routledge Handbook of Food Ethics (forthcoming), Engaging the World: Thinking after Irigaray (forthcoming), Thinking with Irigaray, The Voice of Breast Cancer in Medicine and Bioethics, and Derrida and Feminism. In 2013, she was a visiting fellow in ethics and philosophy at the London School of Hygiene and Tropical Medicine.

Notes

1. “The pandemic is transmitted through the vectors of subsidized agribusiness and multinational corporations providing cheap, highly refined, fats, oils, and carbohydrates” (Prentice 2006, 93). See also Popkin (1994). WHO (n.d.) cites the “double [End Page 7] burden of disease” in many developing countries, where infectious disease still proves a challenge at the same time that obesity-related diseases are rising rapidly.

2. The authors cite as the causes of undernourishment: “poverty, lack of information/economic security, war, lack of resources at all levels, unequal status of women, and/or natural disasters” (Burgess and Danga 2008).

3. The high rate of obesity in the United States correlates with a sharp decline in home cooking. See Cutler et al. (2003).

4. See, for example, President Obama’s New Alliance for Food Security. Despite rhetoric about including small farmers and women, they do not have a seat at the table with the president’s partners, Cargill or Monsanto. See German NGO Forum on Environment and Development (2013).

5. See, for example, Landfried (2013). See also Margaret Gray’s (2015) review of Food Chains in this issue for an example of the importance of labor justice in food ethics.

6. While I have emphasized here the sociality of food, I do not mean to deny the very real pleasures of eating alone. In at least one culture, the Balinese, eating is most often done on one’s own.

References

Burgess, Anne, and Louis Danga. 2008. “Undernourishment in Adults and Children: Causes, Consequences, and What We Can Do.” South Sudan Medical Journal 1 (2): 18–22.
Cawley, John, and Chad Meyerhoefer. 2010. “The Medical Care Costs of Obesity: An Instrumental Variables Approach.” Working Paper 16467. National Bureau of Economic Research, http://www.nber.org/papers/w16467.pdf. http://dx.doi.org/10.1016/j.jhealeco.2011.10.003
Centers for Disease Control and Prevention [CDC]. 2015. “Data & Statistics.” Atlanta: Division of Nutrition, Physical Activity, and Obesity, CDC. http://www.cdc.gov/obesity/data/index.html
Cutler, David M., Edward L. Glaeser, and Jesse M. Shapiro. 2003. “Why Have Americans Become More Obese?” Journal of Economic Perspectives 17 (3): 93–118. http://dx.doi.org/10.1257/089533003769204371
Drewnowski, A., and S. E. Specter. 2004. “Poverty and Obesity: The Role of Energy Density and Energy Costs.” American Journal of Clinical Nutrition 79 (1): 6–16. Medline: 14684391
German NGO Forum on Environment and Development. 2013. “The New Alliance for Food Security and Nutrition in Africa: Is the Initiative by the G8 Countries Suitable for Combating Poverty?” Berlin: Forum Umwelt und Entwicklung. https://www.globalpolicy.org/images/pdfs/GPFEurope/pospap_agle_g8_engl_fin4.pdf
Gottlieb, Robert, and Anupama Joshi. 2013. Food Justice. Cambridge, MA: MIT Press.
Landfried, Jessalee. 2013. “Bound and Gagged: Potential First Amendment Challenges to ‘Ag-Gag’ Laws.” Duke Environmental Law & Policy Forum 23 (2): 377–403. [End Page 8]
Popkin, Barry M. 1994. “The Nutrition Transition in Low-Income Countries: An Emerging Crisis.” Nutrition Reviews 52 (9): 285–98. http://dx.doi.org/10.1111/j.1753-4887.1994.tb01460.x. Medline: 7984344
Prentice, Andrew M. 2006. “The Emerging Epidemic of Obesity in Developing Countries.” International Journal of Epidemiology 35 (1): 93–99. http://dx.doi.org/10.1093/ije/dyi272. Medline: 16326822
Public Health England. n.d. “PHE Obesity.” https://www.noo.org.uk/
World Health Organization (WHO). n.d. “Health Topics: Obesity.” http://www.who.int/topics/obesity/en [End Page 9]