Fermenting food in Scotland’s schools: A design-led dissertation project — Part 2: Background

Scotland’s unhealthy and unsustainable food behaviours are a consequence of a multitude of interconnected factors which have been accumulating for centuries. To dissect this wicked problem and understand its background in the light of previous literature and action, the causes and consequences of Scotland’s health, environmental and social status quo will first be portrayed. Previous interventions addressing the problem will then be evaluated, and future challenges and opportunities will finally be identified.

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1. Scotland’s food and health status quo

1.1. Health

First, Scotland’s diet is too high in calories, saturated fats, refined sugar, and salt, and too low in vegetables and fruits, fiber, and oil-rich fish (Food Standards Scotland, 2018)… The fact that it has not changed over the last 20 years can be explained by the convenience, the ubiquity, and the excessive advertising and promotion of over-processed food, but also by the heavy nature of the traditional Scottish diet, which was once necessary to live in the highlands, and more recently completed with very frequent consumption of fried food (Blades, 2004) and of sugary drinks. This poor diet is responsible for 65% of adults being overweight in Scotland, including 29% being obese, in 2016 (The Scottish Government, 2018). “Obesity is the second-biggest preventable cause of cancer, behind only smoking”, and “the most significant risk factor for developing type 2 diabetes” (ibid, p5). Malnutrition, therefore, causes deaths from various types of cancers, coronary heart disease, and strokes, but also leads to children’s dental decay and adults’ high blood pressure (The Scottish Government, 2018). This obesity epidemic is estimated to be responsible for approximately 33,000 deaths per year in the UK (Scarborough, 2010), with Scotland having the highest overweight and obesity levels of any UK nation (The Scottish Government, 2018).

But the effects are not only physical. Obesity also impacts psychological wellbeing, due to weight-related discrimination and stigma (Ciciurkaite & Perry, 2018) which can cause low self-esteem, long-term depression, and anxiety (Walter et al, 2015), which can even conduct to suicidal ideation (Goldney et al, 2009). In addition to this, more and more research on the gut-brain connection shows that the gut’s microbiome impacts the brain’s health (Lucas, 2018) and that obesity, thus “has a significant role in cognitive dysfunction and aging-associated cognitive disorders including dementia”, like Alzheimer’s and Parkinson’s diseases (Martin-Jiménez et al, 2017).

Because these health issues ask for regular and sometimes intensive care and medicine, “the total annual cost to the Scottish economy of overweight and obesity, including labour market-related costs such as lost productivity, is estimated to be between £0.9 billion and £4.6 billion” (The Scottish Government, 2018, p6). This important economic cost has its part to play in the fact that social protection and health represent the biggest shares of Scotland’s total public sector expenditure (Scottish Government, 2019).

1.2. Environment

Scotland’s unhealthy and unsustainable food behaviours also play a role in climate change. Consequently to the increase of population and of food demand, in addition to capitalism’s dependency on economical growth, Scotland’s food system deeply relies on industrialised intensive farming and production of over-processed food, mass transportation and cooling of international products, and excessive plastic packagings around fruits and vegetables… These are all factors that show and perpetuate the fact that the current food system’s vicious cycle causes humans to distance themselves from the environment. Indeed, human activity has gradually become seen as external to the environment, and people now exclude non-human actors from their decision-making processes (Dasgupta, 2021). While exploiting the Earth’s natural resources like what Heidegger calls a standing reserve (1977) at our service, we do not recognise these resources’ life-supporting value, and we allow “the ‘market’ to define what we value”, enriching “the sellers while impoverishing the soul and the earth”, without even being grateful or feeling indebted (Kimmerer, 2013, p307). This anthropocentric mindset results in high greenhouse gas emissions (Garnett, 2011), an important use of water and energy, the sterilisation of soils, water pollution, irreversible biodiversity loss, and quantities of non-biodegradable waste (Dasgupta, 2021)…

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Health systems have also an important impact on the environment. Climate change’s consequences on humans’ and the world’s health can now be viewed as another side effect of occidental modern medicine. Indeed, despite the small number of case studies on the subject, a 2019 study calculated that the health sector “accounts for 2–10% of national carbon footprints across all OECD countries, China and India” (De Decker, 2021), with Great Britain’s healthcare-related footprint representing 5.9% of its national carbon footprint in 2014 (Pichler, 2019). This can be explained by the high energy consumption of medical devices (like MRI scanners and hospital ventilation…), the industrialised production of pharmaceuticals, the greenhouse gas produced by inhalation anesthetics, and the manufacturing and waste management of medical single-use disposable material (De Decker, 2021). Considering the survival of the human species and of the environment instead of the survival of individual patients, De Decker therefore writes:

“Industrial society has given us effective medical treatments, but it’s also making us sick. […] As medical treatments become increasingly resource-intensive, the chances grow that the public health damage of a treatment outweighs the individual gain of a patient, especially at old age. […] A health care system that is more focused on preventive medicine, and which operates outside the logic of the market, could reduce emissions without negatively impacting health, maybe even improving it.” (De Decker, 2021)

This described alternative health system introduces the “one-health” concept, which recognises that the health and wellbeing of humans and of the environment are intrinsically linked (American Veterinary Medical Association, 2008). Therefore, it is suggested that more sustainable food and health systems can largely benefit humans.

1.3. Social

The state of the food and health status quo has both social causes and social consequences. The first reason for Scotland’s unhealthy and unsustainable food behaviours, is the subjectivity of “good food”’s definition. Indeed, healthiness is not necessarily part of a “good food”’s criteria, as this term is embedded in socio-cultural, economic, and even political environments. A major criteria is also the food’s ability to provide emotional and psychological comfort (Freeman and Gil, 2004). The manichean nature of this term also suggests that if someone’s diet does not include “bad food”, like the cliché “Scottish diet” (made of chips, pies, deep-fried Mars bars, and curries), this diet can then be considered as “good”, regardless to how diversified it is. By disengaging themselves from this stereotyped unhealthy diet, people might not feel concerned by expert food advice (Fuller, 2003), which can also often feel contradictory and confusing. This is a major cause of the failure of the “five a day” intervention (ibid).

Other social factors to these behaviours, are the perceived obstacles to improve them. The perceived time and monetary constraints to better food habits, especially prevalent in populations with a low socio-economic position (SEP), invite people to eat frozen pre-made meals (Van der Heijden et al, 2021). Although this unhealthy practice is less time-consuming than cooking from scratch, it can in fact be more expensive, according to a Scotland-based study (Whybrow et al, 2018). But while this study found that “healthier diets were not necessarily more sustainable” (with low greenhouse gas emissions), sustainable diets were generally more expensive than unsustainable ones. These concerns are thus partly founded, and populations with low SEP have therefore fewer chances to adopt healthier and more sustainable food behaviours.

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Another perceived obstacle is the lack of “ideas, knowledge and menu-planning skills necessary to organise a meal” (Bosley 1999 cited in Caraher et al. 1999, p.595). A 2002 UK-based survey found that, of the respondents, 60% of females and 27% of males considered themselves as confident cooks (Beardsworth et al. 2002, p.482). This lack of confidence largely results in gendered expectations about the cooking responsibility. More recent time-use data confirms that women in Scotland still do most of the unpaid care work: 68% of the housework and childcare is done by women (Scottish Government, 2019). The burden of this Gender Care Gap on women’s shoulders is even heavier when food-related unpaid work is expected to be healthy and sustainable. Therefore, if domestic work is not more equally distributed among genders, food behaviours will remain difficult to change.

By comparing empirical world data against The Limits to Growth’s societal collapse scenarios (Meadows et al, 1972), a very recent study confirmed the prediction of a major decline during the 2040 decade if the “Business as Usual” scenario persists, when industrial growth will finally stop and pollution will exponentially rise, affecting food production, health and standards of living (Herrington, 2021). In order to mitigate this collapse, future generations must urgently be prepared for food and health resiliency, and be able to challenge the health, environmental and social status quo.

2. Previous interventions

2.1. The Scottish Government’s intervention

Policies are key drivers for change in food and health systems, as they can have a significant impact through public regulations. On a world scale, the United Nation’s set of Sustainable Development Goals (SDGs) addresses the described problems in many ways. For example, the SDG2 which aims for food security, improved nutrition, and sustainable agriculture, through its target 2.2, plans to, “by 2030, end all forms of malnutrition” (United Nations, 2020). The SDG3, which aims for healthy lives and well-being for all, introduces target 3.4: “By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment” (United Nations, 2021). Even if these goals suggest indicators to measure the change, they remain only vague guidances, to initiate countries’ concrete action. On its side, the Scottish government has published in 2014 a national food and drink policy which envisions that by 2025, Scotland will be “a Good Food Nation” (The Scottish Government, 2014a), setting out in 2018 a range of measures across the areas of health, social justice, knowledge, environmental sustainability, and prosperity. In this framework, to allow nation-wide change across different socio-economic areas, the government initiated a series of food education interventions, like the “Better Eating, Better Learning” program (The Scottish Government, 2014b), and the introduction to Scotland of the international Eco-schools program (Keep Scotland Beautiful, 2021). The government is also funding the Education Scotland organisation “to support effective teaching about food as part of the school curriculum” and their Food for Thought Education Fund (ibid). Another intervention benefiting from the government’s funding is the Soil Association’s Food for Life catering mark program, which certifies school restaurants with health and sustainability conditions (ibid). Finally, more sustainable public procurement practices are initiated through a combination of eco-labels, standards, life-cycle assessment, and costing, with the “Catering for change” guidance (The Scottish Government, 2011). But again, knowledge can be a real obstacle for schools’ catering managers to make more sustainable and healthy choices (Sönnichsen, 2020).

2.2. Food and health education

There is indeed a real lack of food and health education across generations, resulting in all the problems mentioned above. Because it is particularly challenging to efficiently share knowledge once norms and behaviours have been integrated as habits, children are the major targets of food education programs. But neuroplasticity is not the only reason children can better learn new food habits (Masten, 2011). We can also talk about taste plasticity, since “dietary patterns establish early” (Lumeng and Fisher, 2018, p27). Through repeated exposure and taste experiences (Holley, 2015), a new food becomes familiar, therefore “appropriate, and what is appropriate is accepted and preferred” (Lumeng and Fisher, 2018, p27; Mennella, 2016). This exposure influences the taste but also the gut microbiome and thus the body’s biological acceptance of the food (Saavedra et al, 2013).

Schools are also largely targeted by food education because they provide a unique inclusive framework when people from a large range of socio-economic positions meet and learn the same content. To expand these equal chances to access to food education to access to healthy food, the Scottish Government has also committed to providing Universal Free School Meals (UFSM) for primary school children as of 2022 (The Scottish Government, 2021). Thanks to the benefits of peer-modeling (Topping, 2005) and of commensality in building a common identity (Masson, Bubendorff and Fraisse, 2018, p. 109), school meals are indeed a key food education tool. Encouraging further action to the “whole-school approach” to food, which values lunchtimes as learning times too, a working group made of the main Scottish food organsiations (Nourish Scotland, Scotland Excel, The Food Foundation, The Soil Association Scotland, Zero Waste Scotland…) suggests to also “raise the profile of the catering profession by developing career paths and opportunities for professional development” (Nourish Scotland et al, 2021).

When cooking something themselves, it is estimated that people feel more pleasure in eating it (Bech-Larsen and Tsalis, 2018). Because eating healthy thus depends on cooking healthy, food education programs also introduce cooking practices to schools, like the Chefs@School intervention (The Scottish Government, 2014a), or like special occasion cooking workshops and home economics classes. These are largely appreciated by all participants. Still, this might also be a stressful experience because of the lack of guidance actors have when developing programs (Asher et al, 2020).

The previous study on lack of food knowledge and attempts to address this gap has shown the potential of cooking and eating activities in schools but also underpins the remaining challenges to overcome.

3. Discussion about the background

3.1. Design for behavioural change

Because these previous interventions, as well as this work, try to reshape behaviours, they could benefit from the use of the methods of Behavioural Design, which aims to influence human behaviour (Lockton et al, 2010). The Fogg Behavior Model suggests that behavioural change can only occur depending on a person’s ability and motivation to take action (Fogg, 2009). Triggers for change should therefore act within this balance, which can evolve with time. But the fear of being imposed limited ways to behave can cause psychological reactance, and the holistic Embedded Design methods suggest shifting the real persuasive intent of a trigger (Gilliam et al, 2018) through Game and Narrative Design. An example of this is how the gamification of learning experiences can boost children’s motivation to learn (Prensky, 2006).

3.2. Challenging the gender care gap

Childhood is a major identity-building period, and if children mostly see women cooking, this activity will continue to be associated with “being a good mother” (Fuller, 2003) and will therefore remain “women’s duty”. On the other side, the identities of cooking men are still largely reduced to professional chefs, recreational cooks, or “gastrosexuals” (heterosexual men who use cooking skills only to impress friends and partners) (Lewis, 2020)… But, new paradigms slowly emerge, through for example the popularity of Jamie Oliver, who manages to incorporate “what have traditionally been seen as elements of feminine domestic practice into a domestic culinary masculinity” (Hollows, 2003, p. 237), which means cooking every day for friends and family and rejecting elite cuisines.

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This gender-task association has ruled for centuries in most of the world, largely based on the woman-nature and man-culture dualisms, which underline the links between women’s oppression and humanity’s domination of nature. In order to empower women and the environment, both working hand-in-hand, ecofeminist activists and thinkers seek to reclaim this imposed dualism. Cherishing women’s embodied link to Mother Earth by developing a spiritual but still grounded dimension to it (through rituals to food, menstruations and birth…), some of them call themselves witches (Hache, 2016). This comes with no surprise, as the estimated 35,000 to 100,000 women who were sentenced to death for practicing witchcraft (Wolfe, 1997) during the major witch-hunts (between the 15th and the 18th century), were in fact often healers, or women who earned their living thanks to indigenous knowledge of nature and the mastery of natural chemical transformations (Chollet, 2019). One of these mysterious processes was fermentation, and women were the ones practicing it daily, as, worldwide, “women are recognized as the original brewers of fermented drinks from fruits, roots, leaves, bark, and grains” (Grahn, 1993). In pre-Reformation Europe, the beer industry, which depends on the controlled decay of malted grains, was thus largely managed by women, the alewives. But when being a financially independent woman by using this “obscure” process became associated with making a pact with the devil, their pointy hat became the witches’ hat. Because unmarried alewives could not compete with couple-led or man-led businesses anymore, the beer industry became dominated by men (Bennett, 1991) and industrialised. Today, challenging the gender care gap can imply disrupting the narratives about food-related work, by empowering a daily cooking practice that allows both embodied and spiritual relationships to food.

3.4. Fermentation as a driver of change

Fermentation is, without coincidence, a powerful opportunity to address the challenges of Scotland’s food beahviours. This low-tech preparation and preservation method is estimated to be one of the factors that enabled settled agriculture, with archeological evidence, remains of oral, drawn, and written storytelling or ceremonies showing the importance of fermentation all over the world (Katz, 2017). In Scotland, fermentation is now mainly used for the preparation of many of Scotland’s daily diet’s food (cheese, yogurt, pickled food, alcohol…) but also for the industrialised manufacturing of probiotic medications. As one more link between witchcraft, food, and health, and as another evidence of the one-health concept (Bell, 2018), the regular consumption of fermented products helps balance the gut microbiota and preventing obesity and its related diseases (cancer, type 2 diabetes…) (Dahl, 2017). This is due to the presence of prebiotics and probiotics, which are created by the metabolic process in which an organism (bacteria or yeast) converts sugars into alcohol or lactic acid. Consuming enough probiotics can also benefit children’s mental health and behavioural disorder issues (like ADHD (attention deficit or hyperactivity disorder), or Aspergers syndrome), as they are often connected to the digestive system’s health (Fernandes, 2018).

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But instead of taking probiotic pills, the potential of fermentation as a resilient preventative medicine would only be fully explored if the fermentation process is made by the “patients” themselves. Indeed, the rituals that this process demands can introduce a sense of mutual care into the practice of cooking, creating a new human-food paradigm (Vansintjan, 2018). In addition to this, fermentation can facilitate distributed sustainable food systems, as, “because of its low investment costs, fermentation lends itself well to supporting small businesses, allowing them to take advantage of seasonality while practicing a time-tested low-tech method” and reducing food waste (Vansintjan, 2017). Fermentation’s benefits are therefore multiple and could help to prepare for a potential soon societal collapse.

But while the individual practice of fermentation is very popular in Asia or South America, it is nowadays quite underused in Scotland. This is partly due to the fear of bacteria and fungi that developed consequently to Pasteur’s work and the advent of microbiology, which, by scientifically explaining fermentation, destroyed the “prayers, rituals, and offerings” (Katz, 2017, p34). This also “gave rise to a sort of colonial outlook toward microorganisms, that they, like other elements of nature and other human cultures, must be dominated and exploited” (ibid), and thus, industrialised (which distanciates consumers from the food). Other reasons are that, although it can save money, it needs knowledge and time to start fermenting. People also usually do not know the infinite number of possible recipes: sauerkraut, kefir, kombucha, kimchi, miso, tempeh… Finally, the strong taste of fermented food can be another reason. Indeed, “‘sour’ is an important flavour that is not usually given to little ones in western cultures”, a cause to people’s preference for sweet food.

3.5. Conclusion of background

Two main objectives can be identified thanks to this review. First, a holistic re-proximity to food is needed, to allow people in Scotland to (re-)become native to their land (Kimmerer, 2013). This can be achieved thanks to food education and cooking practices. Secondly, children can be key actors of behavioural change, if they are provided with the tools to challenge the status quo, which can be massively distributed through schools. Because fermentation seems to represent a powerful tool to achieve this, a more specific research question can now be asked: how might we promote healthier and more sustainable food habits in Scotland through the introduction of the practice of fermentation to children? To determine how this work can address this question, its methodology and methods will first be described.

Read next part here: Part 3: Methodology

The entire bibliography is in the last story (Part 6: Conclusion)

Interaction Design Student www.emilie-schaefer.com