We can best help you to prevent war not by repeating your words and following your methods but by finding new words and creating new methods.
Virginia Woolf, Three Guineas
Here’s a sample of words from the Well Now glossary. Some are new and some are borrowed as newcomers to conversations on food, health and lifestyle.
There are several definitions in the literature. When I talk about allostasis I use the meaning “a physiological adaptation to chronic stress”. Used in this sense, allostasis highlights shortcomings in the concept of homeostasis. Homeostasis explains how we respond to circumstances so our bodies get back into balance. For example, if we are too hot then hormonal, neuronal and behavioural changes occur so we sweat, remove clothes, open a window, drink water and so on until we cool down. In this example, there is an assumption that there are limits to whatever is causing us to get too hot, and these limits mean the heat will stop exerting an impact before we are irrevocably damaged or killed by it. The homeostatic model supports a view of a world without overwhelm. Here, the body ‘bounces back’ unchanged and infinitely resilient, and it is always within an individual’s capacity to alter their circumstances to ensure wellbeing.
If we are acutely stressed we respond with neuronal, hormonal and behavioural responses. When the stress has passed we gradually get back into balance. Allostasis recognises that if we live with chronic stress it is not always possible for our bodies to get back into balance. Instead, our system gets overloaded and we reach a changed state called allostasis. In this new state, we are more prone to disease processes linked to metabolism, such as diabetes, hypertension and heart disease. Allostasis sits within a heterostatic model. A heterostatic model supports us to think of the body-in-context, where power is literally incorporated, and as such it fosters a health justice imagination.
Interestingly, some researchers say social status is fundamental to the concept of allostasis. They note that homeostasis involves reflexive reactions but allostasis also involves the body’s response to our assessment of social relationships largely mediated through cortisol.
Ampowerment refers to a meaningful sense of one’s power-from-within. Lifestyle change falls under the rubric of ampowerment, which relates to self-care. Ampowerment fosters empowerment through links with a critical awareness of power-over, and increased capacity to engage in and influence power-with relationships. Empowerment is a process that involves systemic social change, with action preceded by collective consciousness raising. It does not stop at self-esteem. It is not about compliance or co-ercion.
(I previously used the term impowerment instead of ampowerment. Impowerment was coined by MacDonald and refers to the process of conferring power on a patient by someone in authority (Macdonald TH (1998) Rethinking Health Promotion: A global approach. Routledge, London). I think this fails to understand different types of power and redefined it to my own ends. However, then I thought more about this, and it seemed better that I come up with a different word instead of hijacking someone else’s.)
‘-genic’ means causing. Carcinogenic, for instance, means causing cancer.
Bigotogenic means causing bigotry. We are bigoted when we treat people with hatred and/or intolerance because of our own non-rational prejudices. Of course, we might rationalize these prejudices to ourselves.
I use the term bigotogenic because we are too often told by people with power that the environment is causing us to be fat, and that being fat is a bad thing. I want to draw attention to fact that terms that configure fatness as a problem arise from, and perpetuate, bigotry. This is true even if someone’s intent really is to improve population health and end weight stigma. I hope that using the term bigotogenic sheds light on the unintended consequences of a popular concept and encourages people to think again about how they speak about bodies, health and society.
Biochemistry of Discrimination
When we are discriminated against we have a body-mind response. This response was completely obscured in my dietetic training, and it felt important to make it visible so I named it the biochemistry of discrimination. There is lots you can find out about this. I put some details in a talk I gave in 2004 and you can see the slide here. The article I reference in it can be found here.
Calsplaining When someone explains health outcomes as being primarily a result of ‘lifestyle behaviours’ and/or BMI they are calsplaining. Calsplaining is useful if you want to promulgate a neoliberal ideology as it draws attention away from the profound manner in which that structural injustice impacts our bodies, minds, opportunities and health outcomes. Among other problems, calsplaining is inherently racist as its deep assumptions are that experiences of racialised injustice do not count as relevant in the health conversation. Despite this, the approach is widely supported, for example, by Public Health England, and popular psychological models that endorse it are still routinely taught to health practitioners.
Colliberation is the process of two or more people or groups working together to advance a project that has emancipatory aims.
Connected Eating Connected eating emerges from a philosophy (Well Now) concerned with challenging oppression and repairing harm done and being done. It is theorised to support self-care, collective healing and communal transformation.
It seeks to re-orient food narratives so they centre on respect i.e. dignity and justice. It offers a way of thinking about food and health, and of approaching eating, that values different ways of knowing and recognises the inter-relatedness of body-mind-society. This means it integrates body cues, values, our experiences (including trauma), and the context of our lives; it teaches that food and eating serve a range of roles and meet a range of needs concerning health, pleasure, values, relationship, self-care, emotions, identity etc. It is thus body aware, relational and intentionally political. These three principles are hallmarks of Well Now theory and practise.
Critical Appraisal This involves assessing research to see whether researchers have stuck to the rules of their discipline. It determines trustworthiness and usefulness within the accepted norms of a group. It discourages investigation of group rules, norms and values. As such, it inadvertently entrenches biases, and so mitigates against social justice and robust science.
Critical Dietetics originated as a movement in June 2009 and the enthusiasm that fuels its momentum confirms it as an idea whose time has come. Critical Dietetics create a space for critical inquiry and dialogue to build on and broaden the body of knowledge in dietetics through collective and inclusive efforts. It necessarily embraces multiple disciplines, perspectives and voices and members actively welcome contributions from allies who share our aims. Read more here https://criticaldieteticsblog.com/about/
Critical Thinking This involves us holding our truths up to the light of others’ understandings. It helps us find our blind spots. Critical thinking skills can be taught. They move us away from stereotype, hierarchy and judgement. They move us towards an open-minded discernment that values difference. This enables us to claim our many identities and be cool with others claiming theirs. Also known as criticality, and consciousness raising, critical thinking advances social justice. It is included as a Well Now way markers under the more everyday term ‘curiosity’
Dietitians for Social Justice
A UK-based group of dietitians and others who are passionate about ensuring work around food and health builds a fairer, safer world for all. We want to support and educate ourselves and others as we work together for change across the whole food web. We believe that bringing ‘social justice thinking’ to nutrition talk changes how we think about wellbeing, kindness and equality and that this will influence the conversations we have in other areas of life too.
Discovery or uncovery Model (of eating distress)
The discovery model of eating distress explores troubled eating in ways that question the culturally prescribed notions of a linear trajectory of healing that culminates in becoming free of eating disorder symptomology. It recognises the dangers of inadvertent ableism in narratives of ‘cure’. It situates eating distress within a broader movement of activists challenging mainstream perspectives on mental distress and draws on insights from the UK Recovery In the Bin movement, the concept of unrecovery, and Mad Studies.
“#DTMH is a community of academics, administrative staff and students at UCL, committed to righting racialised wrongs in our workplace and in the wider world.” From: http://www.dtmh.ucl.ac.uk
Evidence Based Practise
The judicious use of the best available evidence to inform treatment of individual patients, where the usefulness and quality of what counts as good evidence is assessed according to the values and parameters of biomedicine.
Healthism This refers to a belief system that sees health as the property and responsibility of the individual. It assumes health is derived from correct body/mind management practises. It sees the pursuit of health in this way as a moral obligation, ranked above everything else, like world peace or being kind.
It ignores the impact of poverty, oppression, war, violence, luck, historical atrocities, abuse and the environment from traffic, pollution to clean water and nuclear contamination and so on. It protects the status quo, leads to victim blaming and privilege, increases health inequities and fosters internalized oppression.
Healthism judges people’s human worth on the basis of their health, and often also on their degree of commitment to healthist beliefs and behaviours.
Critiques of healthism often contain the sentence ‘health is not a moral obligation’. This paradoxically embeds health within a reductionist framework, in other words, it locates health in individuals and ignores the role of power relations on health. It doesn’t make much sense when scrutinised as a stand-alone sentence, and I am imagining that the expanded version reads something like ‘the pursuit of personal health gain through an individual body-mind-lifestyle-improvement project is not a moral obligation’. The way I see it, ‘health is not a moral obligation’ succinctly naturalises the neoliberal assumption that lifestyle is strongly connected to health. It therefore naturalises a healthist mind-set. The statement ignores the way that our behaviours impact others’ health, and eclipses the socially embedded nature of health and disease.
I agree, lifestyle-change-for-personal-health-gain is not a moral obligation. (At the same time, the structure and preoccupation involved in body management offer a powerful means of emotional regulation, a role that also needs taking into account). Examining the underlying assumptions of ‘health is not a moral obligation’ , and considering why it is that we’ve been saying it, can help us unpick the deep roots of a healthist ideology. The conversation can catalyse relational thinking and envision alternatives: you may well believe that llifestyle-change-for-health-via-a-fairer-world, such as paying taxes and speaking up against bigotry, is a moral obligation.
Outside of healthism, health is understood as a function of our circumstances and histories: the dynamic sum of oppression, privilege, trauma, luck, in/access to clean water, green spaces, community and so on. If tackling racism and building a safe and sustainable world isn’t a moral obligation, I’m wondering what is?
A phenomenon in which fat people’s bodies are described using words that foster oppression and/or impede justice. The words may be used thoughtlessly, inadvertently or intentionally. Paradoxically, obgobbing is strongly prevalent in healthcare where it buttresses a neoliberal ideology. Obgobbing enacts power relations that strengthen existing hierarchies in knowledge creation and so it is helpful to those whose interests are best served by maintaining medical and academic norms. It serves to repress marginalised voices and cultivates systems of thought and practise that deny people their agency and dignity. It is therefore relevant to human rights, and is a health hazard.
It derives from the British slang term ‘gobbing off’ which means a somewhat righteous, somewhat aggressive rant. A close equivalent in American slang would be ‘mouthing off’.
At a population level the prevalence of conditions such as diabetes, hypertension and heart disease, is strongly correlated to toxic power. For example, authors of a large Canadian study* conclude “Traditional explanations focus on genetic and lifestyle causes, but increasing evidence is coming to support the view that type 2 diabetes is primarily a disease of material and social deprivation associated with poverty and marginalisation.” These metabolic conditions are conventionally called NCDs, non-communicable diseases, and lifestyle change is the recommended remedy for prevention and management. NCD terminology streamlines with and sanctions a neoliberal ideology that obscures power relations as a vector in illness.
So too, the likelihood of experiencing mental health problems is strongly related to someone’s experience of trauma, poverty and marginalisation. In which case, mental illness can also be viewed as a power-related illness. This framing stops us entrenching the body-mind split in how we talk about health and illness.
*Raphael D, et al : Type 2 Diabetes: Poverty, Priorities and Policy. The Social Determinants of the Incidence and Management of Type 2 DiabetesToronto:York University School of Health Policy and Management and School of Nursing; 2010.
Praxis Based Action
The judicious use of the best available evidence to address harms, repair injustice and advance liberation as a means to personal and population health improvement.
Ignorance shaped by someone’s relative privilege. The widespread denial of trauma in dietetic discourse is one example of how prignorance shapes what we see and what we don’t see. In this example, prignorance has an enormous detrimental impact on traumatised people’s lives as it leads to trauma-ignored practise. The narratives prignorance supports secure the status quo thereby further obscuring trauma, streamlining neoliberalism and entrenching ideas of meritocracy, all of which maintains professional norms and privilege.
Scriptocentrism is the notion that everything worth knowing can be written down or that written knowledge is superior to other forms of knowledge. Various authors point out how these beliefs resonate with and through forces of imperialism.
Social Determinants of Health
The WHO definition is “The social determinants of health are the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics.”
http://www.who.int/social_determinants/thecommission/finalreport/key_concepts/en/ Accessed 20.12.16
All too often the social determinants of health are misrepresented as ‘socially-stratified differences in people’s lifestyle habits’. In fact, lifestyle differences make only a small contribution to health inequalities. Non-lifestyle factors, like living with oppression or shame or insecurity play a much more significant role.
By way of example, imagine a food project that aims to reduce health inequalities by tacking the social determinants of health. If the project aim to focus on improved access to food then it might improve people’s nutritional wellbeing but any impact on the social determinants of health will be incidental. In fact, by implicitly giving the message “health is mainly determined by lifestyle” it can reinforce neoliberal beliefs and so do more harm than good. A food project that acknowledges social determinants will work to change narratives and practice about health, society and lifestyle, including being conscious of power dynamics and language.
This term was coined by Michael Marmot to describe the fact social standing directly affects our health and life expectancy. In other words, socio-economic position is an important determinant for health outcomes. This is true when effects of income, education, gender and lifestyle risk factors, such as smoking, are taken into account. Marmot identifies the feeling of “being in control” of one’s life as protective to health, and a lack of autonomy (low choice and poor control) as detrimental. Put another way, status syndrome states that “if you are treated as a second class citizen your health will suffer, even if you follow recommended public guidelines for diet, activity, smoking, skin care and so on”. Following this reasoning, public health will improve in when societies become more participatory and socially just.
Status Syndrome Denialist
Someone who denies the existence of status syndrome. This denial may be explicit or implicit and is seen across beliefs and behaviours. For example, I asked Alison Tedstone (Medact conference, Friday 8th Dec 2016), National Director with responsibility of diet, nutrition and healthy weight (my term) in the Health and Wellbeing Directorate of Public Health England (PHE), how her work integrated Marmot’s data from the Whitehall Studies. I said this data finds as little as 5-25% of health inequalities could be attributed to lifestyle. In her reply, she told me I /these figures were wrong. She then went on to talk about poverty and food ‘choice’. This makes Alison a status syndrome denialist. It also indicates her support for a neoliberal ideology.
Waymarkers (of Well Now)