CONSIDERING CULTURE IN NUTRITION AND FOOD SYSTEMS
An innovative approach to reducing chronic child malnutritionn
“Nutrition policies must refer to food, that is to meals, not to nutrients” World Health Organization (WHO)
THE CULTURAL APPROACH TO FOOD AND HUNGER IN ACTION AGAINST HUNGER
In general terms, food could be re-
ferred to as a concept that combines
two elements, namely nutrients and
culture. And culture refers to the
customs, institutions, and achieve-
ments of a particular nation, peo-
ple, or group. A cultural approach to
Bronwen Gillespie hunger and malnutrition shall take
Coordinadora Social, ACF-E Perú into account all factors relating to the
Email: coordsoc-pe@acf-e.org culture of a society, including values,
beliefs, standards, language, thinking
patterns, behavioural norms and com-
munications styles, as well as other
social aspects related to food produc-
tion, processing and consumption.
Carmen Porras Gómez What are the factors that determine
Coordinadora Regional Adjunta, ACF-E what people produce, buy and eat?
Centroamérica Geography, poverty, market access,
Email: dehom-ca@acf-e.org technical knowledge and access to
resources all play a significant role.
However, it is worth mentioning that
food production, acquisition and con-
sumption are also greatly influenced by
the cultural habits and personal prefe-
rences of the people in question.
ACF (Action Against Hunger, in French)
has already situated “culture” as a key
element in the Conceptual Framework
to analyze the basic causes of mal-
nutrition (ACF, 2008). Habits in sani-
An innovative approach to reducing chronic child malnutrition
tation and infant care, key variables
for health and nutrition, vary greatly
across cultures. The ACF White Paper
in Nutrition explains that not only
their reproductive roles expose girls
and women to greater risk of malnutri-
tion, but also lower social status and
levels of education, as well as cultural
factors which shape gender-related
differences in workloads and access to
resources, traditional care practices
and food taboos.
ACF food security interventions aim to
take into account the importance of
food sovereignty: “the right of people
to healthy and culturally appropriate
food produced through ecologically
sound and sustainable methods, and
their right to define their own food
and agricultural systems” (ACF, 2008).
Cultural context is included along with
political, social, historical and eco-
nomic context amongst basic causes
of malnutrition. ACF’s hands-on field
experience in fighting child malnutri-
tion is informed by the understanding
that local tradition not only shapes
production choices and consumption
preferences, but also child care prac-
tices (ACF, 2009) and the management
of water and sanitation resources
(House, 2007).
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CONSIDERING CULTURE IN NUTRITION AND FOOD SYSTEMS
Now we are taking a step further in the
integration of cultural considerations
in order to enrich our technical pro-
posals in food and nutrition security.
ACF would like to expand on an issue
that the World Health Organization has
already recognized: “that nutrition
policies must refer to alimentation,
that is, to food, not to nutrients,” in
an effort to recognize the centrality
of socio-cultural identity inherent to
something as personal as the food we
eat (Contreras Hernandez and Gracia
Arnaiz, 2005).
WHY FOCUS ON CULTURE WHEN ADDRESS-
ING CHRONIC MALNUTRITION?
As is generally agreed, an approach
built on understanding the local cul-
tural helps guarantee the sustainabi-
lity and relevance of the intervention
by incorporating the beliefs, prefe-
rences and vision of the local popu-
lation not only in the baseline phase
-understanding the culture in ques-
tion-, but also in the community-based
approach -for example, identifying the
stakeholders through whom we can
gain the confidence of the communi-
ty-, methodological techniques suited
to the local lifestyle and, finally, in
those recommendations that may fit
within their specific production sys-
tem. At ACF, we want to take further
steps to systematically incorporate a
cultural approach into our programs.
Let’s take a look at food security, one
of our main technical areas, through a
“cultural” lens:
Availability
Food security is commonly broken
down into factors of food availability,
access and consumption. Availability
refers to the offer of food, in quan-
tity and quality, whether it be grown
locally or imported to the area. Food
availability goes through yearly cycles
according to the agricultural calendar
and varies in accordance to changes
in supply and demand and distribution
patterns in the larger socioeconomic
system. Previously isolated communi-
ties producing a diversified range of
crops aimed at feeding the family,
or to be traded with communities in
An innovative approach to reducing chronic child malnutrition
different ecological niches, have un-
dergone significant cultural adapta-
tion as a result of their exposure to
financial incentives to grow for ex-
port and to the fluctuations of market
prices. The increased availability of
processed food in stores, coupled with
changing social mores, cause shifts in
eating habits, which in turn contribute
to the adoption of new agricultural
production practices with an empha-
sis on production for sale, mostly ex-
ports, rather than for family consump-
tion or local markets. Income gained
from crops sold elsewhere is used to
buy less nutritious processed food,
offering a partial explanation for a
general reduction in the caloric intake
and diversity of diet (Pelto and Pelto,
1990). Due to these changes in local
production patterns, food of high nu-
tritional quality may actually become
less available. (Box 1)
Access
Although nutritious foods may be avai-
lable, they may not be accessible to
all. Access depends on income in order
to purchase food, as well as on access
to land and other productive resour-
ces. Cultural factors have a prominent
role to play in every person’s access
to food. Not all family members have
equal access to the food available
within a family, depending on how
food is divided up for consumption.
Often, extra food is provided to the
father or main income earner rather
than to the children, as he is logically
seen to play a more prominent role in
the family’s survival strategy. Inter-
ventions aimed at improving nutrition
do not always lead to the expected
results, as the cultural rules for food
use are not well understood by those
in charge. (Box 2)
In some cases, family members may
not have access to certain foods as
they are deemed unsuitable on the ba-
sis of age, gender or health. (Box 3)
Access, therefore, is not guaranteed
equally to all family members at all
moments, although food may be avai-
lable. Of course, this is not to say that
there may not be a very good reason
“Understanding the local culture
helps guarantee the sustainbility of
interventions”
“Not all family members have equal
access to the food available within
a family, depending on how food is
divided up for consumption”
BOX 1: Re-discovering Quinoa
Quinoa, a traditional staple grain
originating in the Andes now pro-
moted world-wide as a health food, is
regaining ground as a crop in some
mountain regions due to great interest
from importing countries such as the
United States, and falling rates of lo-
cal consumption are slowly recovering
(ACF-E, 2010).
BOX 2: Food aid for guests
In Peru, the government provides tuna
fish handouts to combat malnutrition
in the Highlands, and that food aid,
meant for children, is then served at
community dinners honouring out-of-
town guests (ACF-E, 2010).
BOX 3: Cold and hot foods
Andean cultures make an important
distinction between ‘cold’ foods and
‘hot’ foods, referring not to temperature
but instead to their intrinsic qualities,
which underly complex consumption
guidelines. As a result, certain vitamin-
rich foods are not provided to children
(Kuhnlein and Pelto, 1997). Likewise,
hot and cold considerations can par-
tially explain the current eating habits
in severely malnourished communities
of the Chorti´ ethnic group of eastern
Guatemala (López-García, 2002).
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CONSIDERING CULTURE IN NUTRITION AND FOOD SYSTEMS

for these taboos, only that these local to genetic differences based on the
food ways must be understood when evolution of ethnic groups in specific
looking at food and nutrition security. environments. (Box 5)

Consumption OUR CULTURAL APPROACH

Food may be available and accessible,
but this does not imply that it will be
chosen to be eaten. Food consumption
is intimately linked with one’s sense of
identity. This is a factor which helps
to sustain incredibly varied eating
habits worldwide, while making food
an area in which experiments with
identity are played out. As traditional
lifestyles come into closer interaction
with a globalized consumer-oriented
system, and as minorities continue to
suffer social prejudice, it should not
be surprising that consumption beha-
viour mimics that of dominant classes.
Western, carbohydrate-rich, urban
diets are highly regarded by poor rural
households and considered as a mo-
dern aspiration; whereas rural, well-
balanced diverse diets from the Global
South are discarded as backward, old
fashioned habits. (Box 4)
Simply assuring that the family has
access to the required nutrients is
not enough. This is evident in the
fight against obesity in industria-
lized nations, where families face a
multitude of affordable, healthy
options but do not necessarily choose
them. Obesity is rampant in United
States, coexisting with astonishing
levels of food insecurity, in a country
with very high levels of income per
capita and social budgets.
Nutrition
It is useful to expand this discussion
to look at nutrition security as well,
a term that refers to the ability of
the body to make use of the nutri-
ents consumed: for example, children
suffering from illnesses such as diar-
rhea are at increased risk of malnutri-
tion. Nutrition security is compromised
by lack of potable water, inadequate
sanitary and care practices and a
lack of health services or sanitation
infrastructure. Childcare norms vary
extensively across cultures. Biological
use of nutrients can also change across
cultural groups, as it can be related
Anthropological Inquiry
Anthropological studies help to iden-
tify not only the relevant practices
in terms of production and consump-
tion but also the logic behind these
habits and the structures within which
family life operates. This type of
research contributes to an in depth
site-specific understanding of factors
that can lead to malnutrition, such as
family decision making behaviour,
helping to avoid assumptions that in-
creased incomes or food availability
will necessarily improve malnutrition
rates. We have to be careful, how-
ever, that the inclusion of “culture”
as a factor to understand malnutrition
does not allow external actors to use
local beliefs as a scapegoat and blame
cultural differences for high rates of
malnutrition.
Carrying out basic anthropological
investigations of local food culture
and traditional food systems will faci-
litate the provision of local answers to
nutritional problems. Well intentioned
efforts to reduce chronic malnutri-
tion may show marginal results for the
population in question if this step is
overlooked. (Box 6)
The documentation of cultural know-
ledge, such as traditional medicine,
cuisine, or resource management, is
gaining ground in the field of public
health. The Food and Agriculture Or-
ganization of the United Nations (FAO)
is concerned that valuable knowledge
for community health, developed over
time in specific ecological contexts,
is at risk as previously isolated indi-
genous communities come into further
contact with the forces of globaliza-
tion, often experiencing increased vul-
nerability, poverty, reduced access to
resources and marginalization which,
in turn, imply further health threats
(Kuhnlein et al., 2009). FAO suggests
that helping to protect cultural know-
ledge as well as natural resources is
“Food may be available and ac-
cesible, but it does not imply that it
will be chosen to be eaten”
BOX 4: The embarrassing secret
of success
An especially healthy family in Lago
Atitlan, Guatemala was embarrassed
to admit publicly the secret of their
nutrition success, that they eat the tiny
dried fish caught in the lake, due to the
fact that those fish are stigmatized as
food for the poor (Kadetz, 2008).
BOX 5: Unhealthy diets lead to
disease
Certain populations can be geneti-
cally predisposed to nutrition-related
disease, and the shift in cultural habits
from a traditional diet to a more pro-
cessed, high sugar and fat diet can
be particularly dangerous, resulting
in high levels of diabetes and obesity.
WHO anticipates a doubling in the
number of cases of Type 2 diabetes
from 150 million in 1997 to 300 mi-
llion in 2025, with the greatest number
of new cases being in China and India
(Lang and Heasman, 2004).
BOX 6: Papaya sex taboo
Recent research carried out on vitamin
A in some communities in India shows
that complex cultural food rules mean
that although papaya is readily avai-
lable, rich in vitamin A, and consi-
dered edible, it can only be consumed
by children 4 to 15 years old, in part
because it is believed to cause impo-
tence. Education campaigns must focus
on other local foods in order to avoid
wasting resources on a culturally un-
acceptable food source (Kuhnlein and
Pelto, 1997).

An innovative approach to reducing chronic child malnutrition 3

CONSIDERING CULTURE IN NUTRITION AND FOOD SYSTEMS
key to minimizing public health pro-
blems.
Understanding behaviour change
Socio-cultural inquiry is not just about
identifying local preferences and
habits but is also directed at ensuring
the suitability of our communication
tools and strategies for change. ACF
recognizes that nutrition education
is a complicated field although rather
essential to revert rates of chronic
malnutrition, as the mother’s educa-
tion may explain more than 50% of
their children’s stunting (Smith and
Haddad, 2000). (Box 7)
In developed countries, access to in-
formation alone has not contributed
to behaviour change. Taking this into
account, our approach aims to identify
factors that motivate change at the
community and the individual level
and to recognize the sources of infor-
mation and leadership that are most
meaningful to community members.
These may include health promot-
ers, mid-wives, shamans or religious
leaders. Adults in similar socioeco-
nomic situations but with significantly
more success in feeding their fami-
lies a nutritious diet may prove to be
more important than nurses in helping
to improve nutrition in the village.
Examples of these positive-deviation
individuals have been found to be stri-
king and very useful for understanding
causes of chronic malnutrition as well
as for trying to tackle the problem
(Kadetz, 2008).
Dialogue and exchange
A methodology that aims to meet par-
ticipating groups as equal partners in
the process, that includes a perma-
nent dialogue with the community and
with the local institutions is pursued
and incorporated into ACF projects.
According to one of our local partners
in Peru: “Effort is made to engage in
a horizontal dialogue, reinforcing the
recognition that participants have as
much to teach as any visiting expert,
so that real participation and account-
ability are both able to help determine
the direction of the work and ensure
its validity for the community (Salud
Sin Límites, 2008).
An innovative approach to reducing chronic child malnutrition
A cultural approach must necessa-
rily take into account the relations of
power that exist between rural popu-
lations, external organizations and the
government. This awareness helps to
ensure sensitivity in our inquiry phase.
At the same time, an approach based
on dialogue, cultural understanding
and awareness of power relations can
itself form part of the content of the
program. (Box 8)
Building theory and practice
ACF continues to review the concep-
tual framework for malnutrition, and
is active in developing methodology
for enhancing the use this framework
and to strengthen nutrition causal
analysis. Given that we are gaining
experience in how to further inte-
grate culture considerations into our
technical proposals in food and nutri-
tion security, the lessons learned are
expected to contribute to these con-
ceptual discussions and to a better un-
derstanding of the complex causes of
chronic malnutrition.
The following frame of action for the
systematic incorporation of a cultural
approach to food and nutrition secu-
rity describes a general work plan to
be initiated by ACF-E in Latin America
through its field projects and working
partnerships.
• Review of relevant experiences.
Initiate research on nutrition and
culture within specific areas with
a high prevalence of malnutrition
where ACF is carrying out field
projects. Previous evaluations of
ACF Food Security and Nutrition
projects will be reviewed in order
to draw on lessons learned and
profit from a network of contacts
active in the space is domain: the
interaction between culture and
food and nutrition security.
• Carry out ACF action-oriented
research experiences. Under
the umbrella of current and fu-
ture ACF interventions in the four
missions active in the region (Cen-
tral America, Colombia-Ecuador,
“We should not allow external ac-
tors to use local beliefs as a scape-
goat, blaming cultural differences
for high rates of malnutrition”
BOX 7: Education for healthy habits:
what a hard task!
Even in educated middle class contexts
in Europe and North America, public
health policymakers face great cha-
llenges in identifying how to help indi-
viduals adopt healthy habits, to avoid
tobacco, alcohol, and overeating. The
National Institute for Health in the UK
has recommended that the government
ban TV advertising for children and
make healthier snacks cheaper (Bose-
ley, 2010). In the USA, various states
have proposed additional taxes on
unhealthy food (Lang and Heasman,
2004).
BOX 8: Making nutrition advice clear
In situations where cultural margi-
nalization plays a role in the access,
quality and acceptability of health ser-
vices offered to minority populations,
the education of healthcare providers
in cultural sensitivity may be just as
relevant as the education of mothers
within the community. For example,
nutrition projects can include support
to the health system in terms of recipes
based on local resources and promo-
tion campaigns in the local language,
and training for staff that promotes cul-
tural respect and avoids highly “medi-
cal” explanations that are unclear for
the local population (Diez Canseco et
al., 2003).
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CONSIDERING CULTURE IN NUTRITION AND FOOD SYSTEMS
Peru and Paraguay-Bolivia) as well
as the AECID framework agree-
ments 056 and 064 in Latin Amer-
ica, action-oriented research ac-
tivities will be developed with the
aim of furthering the specific un-
derstanding of the socio-cultural
context in food and nutrition issues
in the geographical areas in which
ACF intervenes. These research
activities will clearly contribute
to the understanding of the Causal
Analysis of Malnutrition, a global
initiative supported by the ACF In-
ternational Network. The research
will benefit from ongoing ACF pro-
jects that will provide data, hu-
man resources, logistical support,
and valuable knowledge and con-
tacts in the communities and with
local authorities. Field research
will include phases of data collec-
tion, analysis and validation with
community members and other
actors involved.
• Adapt methodology for ethnogra-
phic research in nutrition and
food security. Existing tools for
socio-cultural research will be
adapted for the specific meth-
odological requirements of each
study, and can be compiled to
serve as a guideline for other in-
terested ACF interventions.
• Publish research results and re-
commendations. Research results
will include conclusions regarding
the socio-cultural aspects of nutri-
tion, information on positive tra-
ditional nutrition practices, and
recommendations and guidelines
to incorporate culturally-adapted
better practices to address chronic
and acute malnutrition in ACF in-
terventions, ranging from specific
tools to use in the field to issues
for advocacy at national level.
• Impact evaluation. After three
years, the results of the cultural
research will be evaluated in terms
of the impact on the quality and
sustainability of the interventions
in the field, as well as in terms of
the generation of valuable infor-
An innovative approach to reducing chronic child malnutrition
mation for the specific ACF pro-
grams in question. This phase will
include an open discussion within
the ACF International Network and
beyond and comparison with simi-
lar experiences of other actors in-
“Our approach aims to identify
volved in nutrition and food secu- factors that motivate change at the
rity interventions. community and individual level”
• Extract tools and conclusions to “A cultural aproach must necessa-
create ACF Guidelines for a Cul-
tural Approach to Food and Nu-
rily take into account the relations
trition Security. A first draft will of power that exist between rural
be developed, lead by ACF in Latin populations, external organizations
America, taking into account input and the government”
and experiences from all interes-
ted missions.
• Advocacy with national govern-
ments and international aid
institutions to scale up evi-
dence-based policies and activi-
ties to address chronic and acute
malnutrition. Based on the ac-
tion- oriented research conducted
by ACF, specific field tools and
policy recommendations will be
elaborated and disseminated so
as to provide National Authorities
and International Agencies with
refined elements to better address
chronic and acute malnutrition,
contributing to the understan-
ding of the non-economic factors
affecting malnutrition and further-
ing the causal analysis of hunger.
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CONSIDERING CULTURE IN NUTRITION AND FOOD SYSTEMS

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Misión Perú: Nicaragua:

Francisco del Castillo nº 235, San Antonio, Managua, Nicaragua.
Miraflores Reparto San Juan, del Gimnasio Hércules,
Lima (Perú) 1C. al Sur, 1C. al Este, 1C. al Sur, 1/2C. al Oeste.
Tlf/Fax: +51 1 6282835/36 Casa No. 206.
E-mail: acfe-pe@acf-e.org Teléfono: +505 2255-5151
TeleFax: +505 2278-8313
Guatemala:
Ciudad de Guatemala, Guatemala.
4ta. Avenida 16-44, Zona 14.
Teléfono: +502 2368-3030

An innovative approach to reducing chronic child malnutrition 6