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Ill-health – even that associated to a degree with diet – and obesity have many other determinants than diet, and therefore need to be viewed in a framework that can account for a commensurate degree of complexity. Public health and agricultural experts agree that a broad perspective is important: “public health dietary guidelines and obesity prevention cannot be met without a focus on the food system, from field to fork” (Story, Hamm, et al. 2009, p.222). This

sobriquet suggests a linear hierarchy, which belies the complexity of a system with feedback mechanisms and reciprocal relationships and one that

incorporates key, inter-related spheres. The public’s food-related behaviour today takes place amidst this vast, complex food system; additionally, there are local and personal responses to the system as well as individual biology,

preferences and needs. Yet a gulf exists between national food-related policies and public health goals of reducing prevalence of obesity and chronic diet-related disease (Lang 2009; Jebb 2012). Policies affecting the food system influence what food is produced and how, accessibility, food prices (and disparities between those considered intrinsically healthy or not) and food promotional practices. This, in turn, has the potential to contribute to inequalities in obesity and health outcomes (Neff et al. 2009). As such, the nature of the food system influences the degree to which the public may or may not eat ‘responsibly’.

Approaching the issue using a ‘complex systems’ framework can help tease out the ways the relationships between elements of the system and actors within it influence dietary behaviours; this can add a more comprehensive dimension to

previous linear, contextual approaches to food environment research. A complex system is one which is composed of heterogeneous actors/variables that interact in non-linear relationships, and “the behavior of any one of the components depends in only an aggregate way on the behavior of the other components” (Simon 1962, p.474). Exploring relationships between actors in the food system can help to reveal how the pertinent actors construct responsibility for healthy diets.

Attempts to represent obesity within a system, have, however, been

problematic because of the extent of its complexity, amidst which diet is just one sphere. Despite this, obesity still provides the closest proxy for the diet-health pathway. The International Obesity Task Force (IOTF) drew up a “Causal web of societal influences on obesity prevalence”, which links determinants of obesity in terms of scale from individual physiology, through behaviour, local environment as well as national and international policy (Kumanyika 2001). In the IOTF web, the relational aspects are illustrated as uni-directional, while biology and experience of causative factors are not considered. In other words, although shown to be complicated, obesity in relation to the environment is not portrayed as complex (Finegood et al. 2010).

The most comprehensive description of obesity as a complex problem is shown as a ‘system map’ (see Figure 2.3, for the ‘bowl of spaghetti illustration of the complexity rather than to see any detail) in Tackling Obesities: Future Choices, a report by the United Kingdom (UK) Government’s Foresight Programme

(Butland 2007). Known as ‘The Foresight Report’, it categorises influences into:

media, social, psychological, economic, food, activity, infrastructure, developmental, biological and medical. In the face of such complexity, it is evident that any initiatives to encourage healthy eating by members of the public must be approached from a number of angles, and not necessarily in a linear fashion. It also demonstrates that a range of actors across the food system is responsible for factors that affect what the public eats. Indeed, complex systems’ characteristics are heterogeneous, non-linear, stochastic,

dynamic and related through feedback loops, where the components must have the capacity that matches the task required of them (Finegood 2011).

Complexity in this sense, is not just a descriptive property of the system, rather it helps provide a theoretical model useful for examining a given problem (Manson 2003).

Figure 2.3: The Foresight obesity system map

source: Tackling Obesities: Future Choices (Butland 2007; p91)

Finegood distills Meadows’ “places to intervene in a system” (Meadows 1999), suggesting that by taking a systems perspective, one can identify leverage points at which to take action and engender desired changes. Based on this

“[t]he systems approach to obesity leads quickly to the recognition that there is a need to understand system variables like capacity, complexity, connectivity, and social norms” (Finegood et al. 2010, p.S15). Meadows suggests that to change a system, altering lower order factors such as basic parameters are not as effective as changing more encompassing characteristics such as the rules of the system or its paradigm (Meadows 1999). Therefore, what a systems

perspective offers beyond, say the ANGELO or IOTF frameworks, is the ability to look not just at the ‘components’ but the relationships between

actors/variables in the system; and by exploring these links, find potential

‘levers’ for change and who may be responsible for each.

A complex systems approach provides a convenient framework for research by helping situate what and whom to investigate and how such constituents/actors are related. This in turn can help shed light on responsibility for dietary

behaviour. When examining the nutritional aspects of health, it can account for what has been described as “the mutual constitution of the local and the global” (Massey 2004, p.7). As such, it recognises that food is at once an

“intimate commodity” (Winson 1993) yet also a global commodity, one governed internationally yet consumed locally, one consumed in both public and private spheres; it can be seen at once as “a source of pleasure but also possible danger, and as a cultural but also industrial product” (Freidberg 2004, p.520). These are some of the issues with which public health grapples in attempting to improve population level dietary behaviour. Such complexity also reflects difficulties for the public in eating ‘responsibly’. Taking a complex systems perspective, additional insights could be reaped from examining the relationships between different actors and their prescribed roles and

responsibilities in the food system.