Part 3 - return to Part 1.
Neoliberalism – shaping thought, word and consumption.
Neoliberalism has played a significant part in privileging markets and economic incentives to the detriment of cultural, social and environmental factors important for health and wellbeing (d’Ávila Viana & da Silva, 2018). Neoliberal reforms in the 1980’s shaped education and shrank independent science in New Zealand; and accelerated private public partnerships to the benefit of industry. (Peters, 2003)
Neoliberal cultures coalesced with computational and communications advances that favoured industry influence while never seeming to account for biological health risk in modern market-driven economies. Digital comms accelerated influence between the government and the public sector, streamlining meetings and partnerships that could be tactically applied to advance institutional relations and lock in contracts.
Over the same period, technologies to promote democratic inclusion and public participation were not prioritised.
Neoliberal policies promoted freemarket thinking, and embedded fiscally responsible pro-market managerial cultures, across science and research, locking in universities and research institutions to linear and ‘fiscally responsible’ innovation and excellence norms. These shifts inevitably financially restricted open scientific and ethical inquiry that could draw attention to market failure - accelerating and overlapping chronic and mental health disease burdens - that might challenge current medical single silo disease research practices and regulatory norms.
While innovation centric health research opened up research to identify markers for cancer, or markers to identify molecular and genetic pathways for drugs - the same technologies were not applied at scale to identify toxicity and nutrient deficiency and the environmental drivers of disease.
Neoliberal thought inevitably valorised the convenience of industry providing it’s own data to support the introduction of technologies; and shifted the bulk of scientific research to supporting market development and innovation.
New Zealand knowledge around mental illness is frequently framed by industry (RANZCP, 2016). The ‘voice of nutrition in New Zealand is alarmingly quiet’, and the state doesn’t appear to have broadly queried children’s nutritional status since 2002 (Parnell, Scragg, Wilson, Schaaf, & Fitzgerald, 2002).
Political parties, charities and non-government organisations sequester their funding (Flahive, 2018; XRB, 2019) and are sufficiently powerful to impact and influence policy. Knowledge pathways are hampered by dominant offshore owned media who may not protect the public interest (Myllylahti , 2018).
Limited capabilities - but it’s your personal responsibility
The ideological neoliberal project (Ward & England, 2007) of individualisation diminished the ability of government to regulate in the public interest (Palmer & Butler, 2018). The decline of the welfare state and promotion of neoliberal citizenship shaped around individualised responsibility has altered how home cooking is performed, directly reshaping the daily diet.
Healthy diets are positioned in our culture as a behavioural choice, yet the seductive power of obesogenic environments, promoting highly accessible cheap, hyper-addictive, low-nutrient food remain undiscussed in media and policy.
Neoliberal policy has driven inequality (Pereda-Perez & Howard, 2015; Stiglitz, 2013). Inequality has left lower-socioeconomic families struggling to pay basic expenses and with job pressures that may result in little time for cooking (Stiglitz, 2013).
The media environment does not restrict junk food advertising; and secondary school cooking education does not include sufficient budgets to ensure nourishing, vegetable-based meals are the baseline cooking skill. Instead, wheat and sugar access has resulted in cooking education focussing on baking. In this environment, home cooking has become devalued, and traditional food customs and skills have eroded, undermining efforts to educate young people in food, nutrition and cooking (Slater, 2017).
Retail prices for ultra-processed food have remained suppressed and affordable despite creating a range of externalities that includes pollution, toxicity, soil degradation, wage exploitation and non-communicable disease – creating a ‘myth of cheap food’ (Carolan, 2018; Horrigan, Lawrence, & Walker, 2002).
Markets have been shaped to prioritise access to cheap processed food; an average of five pesticide formulations sprayed on arable crops (Garthwaite, et al., 2014); and the chemicals in foodstuffs are weakly regulated (Evans, Martin, Faust, & Kortenkamp, 2016; Trasande, 2019).
The corporate strategy of the processed food industry has enabled it to permeate contemporary culture and resist public policy measures through social, scientific and political communication (Miller & Harkins, 2010).
There are temporal, economic, and social barriers to nutrient dense diets for lower socio-economic groups, which result in higher consumption of calorie-dense but low nutrient processed food. Groups who consume more processed food, consume less protein (Steele, Raubenheimer, Simpson, Baraldi, & Monteiro, 2018).
Low income groups are most vulnerable to comorbidity – as anxiety and depression are frequently accompanied by a multiplicity of metabolic and inflammatory, diet related conditions that further impact wellbeing (Liu & Zhu, 2018).
The individualised responsibility promulgated by neoliberalism as a social, political and economic paradigm places a double burden on those who have ‘least control over their conditions of life and work’ (Glasgow & Schrecker, 2015, p. 282).
Ultraprocessed diets permeate cultural and social life
As nations have become richer, the proportion of diet containing ‘empty calories’ which include refined sugars, fats, oils and alcohol has increased substantially to form almost half the diet. U.S. government subsidies of high fructose corn syrup have expanded the market increasing per capita consumption more than ten-fold while keeping prices of FMCGs low (Timmermans & Haas, 2008).
‘Transnational corporations are major drivers of the acceleration of the nutrition transition—ie, from traditional diets of whole or minimally processed foods to highly processed foods and drinks’ (Moodie, et al., 2011, p. 671).
While the burden of poverty and insufficiency falls more starkly on low income groups, money may not change mental distress (Thoits, 1999, p. 134) due to familial cultures which divert to convenience foods. This supports a dietary stress theory that wealthier groups are also at risk of nutrient mediated mental illness.
The top sources of energy for American teenagers include grain desserts, pizza and soda (Reedy & Krebs-Smith, 2010) There are familial patterns of cooking, preparing and celebrating food, and addiction plays a major part in food purchase patterns (Lustig, 2017; Moss, 2014).
In neoliberal cultures, teenage life is shaped by a cognitive dissonance that keeps mental health separate from other gut related problems - creeping skin problems, sleep issues, digestive troubles, hormonal challenges. Sadness and anxiety could remain on the margins as some mysterious bit of bad luck.
Neurochemical responses to addictive foods mirror animal models of drug addiction, and the food industry employ
‘sophisticated industrial techniques to enhance the rewarding properties of their products’ (Carter, et al., 2016) (Lustig, 2017)
Wheat appears also to be addictive (Trivedi, et al., 2015).
Further, neoliberal culture has shaped the medical response. It is less possible to secure patents for natural products than synthetic psychiatric medication. This leaves prospects for nutritional supplement and food-based therapy without the blockbuster pathway that is secured by unique drug patents, historically reducing the power of natural industries (Hess, 2007).
Herbal medicine sits outside modern pharmacology in Western medicine. Yet there is a significant body of work citing the effectiveness of herbs (Tang, Tang, & Leonard, 2017, p. 2).
Conclusion
I have proposed that there is sufficient evidence to illustrate that depression and anxiety are directly connected to the health of the gastrointestinal tract and nutritional status and this hits lower socio-economic communities, children, and women disproportionately. Depression and anxiety are the leading cause of mental health loss for New Zealanders (MHF, 2014).
Many symptoms are directly connected to malnutrition and a dysregulated gastrointestinal tract and that these problems have been exacerbated by a neoliberal culture that has privileged economic factors over social and cultural factors. The Ministry of Health claim
‘There is currently no good evidence that dietary interventions are effective in treating depression’ (Ministry of Health, 2008).
is false. The data exists, but it is inconvenient.
The science demonstrates that the modern diet is damaging, and this sits as an indictment of current policy and the privileging of intranational food systems that priviledge cheap, nutrient poor ultraprocessed food.
Symptoms of depression and anxiety can be alleviated with diet and improve physiological resilience. As Rucklidge and Kaplan suggest, the combination of dietary pattern, physical activity, and social activities reduce the risk of depression by 50%. If a drug with no side effects promoted the same benefits, it would be a best seller. Micronutrient treatment as an approach may help alleviate depression, anxiety, sleep and attentional problems (Rucklidge & Kaplan, 2016).
Epigenetics and microbiome science overlap with nutrition science and bring to the attention evidence for exciting environmental ‘plasticity’ - where evidence based policy can mediate health and disease; shape the life course (Mansfield & Guthman, 2014) and change the genetic expression of grandchildren and great grandchildren.
This may also explain why it has been so hard to nail down genetic drivers for mental illness, and why familial habits shape health and disease. It may help explain why nutrition or absence of it, have deep intergenerational consequences. Disease is individual and inherently social. It is mediated by genetic expression; shaped by social and biological factors including capital, gender, ethnicity, and habitude, but significantly, and perhaps most importantly, driven by cultures that either promote or fail to embed healthy, wholefood diets; and prevent, or fail to prevent dietary toxicity.
Yet there are few studies examining dietary interventions (Murphy, et al., 2019) particularly where studies identify interconnected improvements to health parameters across biology. I.e. what is the cost of a whole food diet that reduces psychiatric conditions while commensurately reducing type 2 diabetes, inflammatory conditions, cancer risk and reducing days taken for sick leave? Data indicates that transfer to a healthy diet may not be overly onerous, once the cost of convenience food is taken out (Tong, et al., 2018).
For sociologists that only focus on mental illness without focussing on food and nutrition, capital has looked on, relatively unthreatened, as sociologists condemned psychiatric practices and medicalisation, but did not challenge the capture of the food chain, nor provide a solution to mental illness outside stress and trauma. For sociologists had no answer to ‘the problem’ of depression and anxiety and psychiatric medication was approved (legitimised) by government agencies. Critical scrutiny posed no defining challenge to greater vested interests.
The failure of policy to protect both human health and the environment via diet mediation is a global challenge (Tilman & Clark, 2014). Environmental nutrition could be situated as a new frontier for public health, necessarily incorporating rather than excluding mental health (Sabaté, Harwatt, & Soret, 2016). Policy and health action can educate and incentivise dietary change. Knowledge drivers and social networks that frame knowledge and risk around food health – the media and public relations industry, education can be cultivated (Glasgow & Schrecker, 2015; The Lancet NCD Action Group, 2013).
If change is to occur, the political economy of addiction must be addressed (Lustig, 2017). The role of addictive ‘hyperpalatable’ food groups as a barrier to dietary change should be explored in policy and education (Carter, et al., 2016; Gearhardt, Grilo, DiLeone, Brownell, & Potenza, 2010).
Demands for evidence-based science can shift qualitative symptoms into a complementary category and place empirical evidence in the forefront of diagnostic medicine for human health that includes mental health. This could include stool testing, insulin testing, hormonal, - including cortisol and thyroid function tests, tests to analyse inflammation (C-reactive protein) and liver function tests. Levels of iron, vitamin D, B12, and magnesium are important, particularly in pregnancy, and connected to mental health, immune function and sleep.
This is front end testing, rather than back end medicalisation.
Finally, simply medicalising micronutrients, or probiotics, avoids consideration of the reason these interventions work, they are substitutes, in place of an adequate diet, with microbiome expanding prebiotic fibre that improves nutrient absorption, and aids resilience. All too frequently, without adjustment in policy, micronutrients, probiotics and whole foods can only be afforded by wealthier groups.
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