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In the post-war era the conceptualisation of diseases in relation to food funda- mentally changed. Unlike the earlier discoveries of nutrition where certain disease states, for example rickets in children, could be said to be eradicated by the provision of vitamins or minerals, later discourses in nutritional science were never able to make such outright claims. This was because food was now part of ‘lifestyle’, and nutrition was not a sole factor in ‘lifestyle’ diseases. To facilitate an understanding of the multifactorial nature of diseases of ‘lifestyle’, notions of susceptibility or ‘risk’ were widely circulated. In the last chapter we saw how this concept operated for child health in the early part of the century. But in the post- war era the new possibilities opened up by a discourse on ‘lifestyle’ cast a much wider mortality and morbidity net over the community. Now that an individual’s behaviours could be categorised through ‘lifestyle’ risk factors, one was never truly healthy. There would inevitably be a behaviour in one’s ‘lifestyle’ which, however trivial, carried a certain degree of ‘risk’. Indeed, the lifestyles of individ- uals could now be represented as a collection of ‘risk factors’. The range of eating behaviours deemed to be ‘unhealthy’, and their commonplace nature in everyday life, meant that almost the whole population was ‘at risk’. Expanding on Armstrong (1995), we can say that, for Australia from the second half of the twen- tieth century, illness and health could no longer be considered as discrete entities. Health, as we have seen, is only ‘potential’ health. Predisposition, pre-illness and ‘at risk’ states complicate a person’s health profile. The situation is made more difficult because hereditary factors are believed to play an important role in the development of diseases of ‘lifestyle’ (Simopoulos et al., 1993). Thus genetic pre- disposition to illness means that one’s parents become a ‘risk’ that has to be factored into one’s ‘lifestyle’ equations. The estimate of an individual’s health sta- tus thus depends on a tally of the past, by way of their genetic inheritance, and the present, by way of their current ‘lifestyle’, in order to make predictions about the future. As Armstrong (1995: 401) points out, each risk factor does not necessarily

produce an illness, it simply opens up a space of future possibilities. Whereas hos- pital medicine examines the three-dimensional body for pathologies in the form of concrete lesions, surveillance medicine ‘analyses a four-dimensional space in which a temporal axis is joined to the living density of corporal volume [and in which] illness becomes a point of perpetual becoming’ (Armstrong, 1995: 402). We may even add a fifth dimension to this model. Barker’s ‘fetal origins’ hypoth- esis (1995) proposes that the nutritional environment in utero is crucial to the development of chronic disease in later life. An individual’s ‘pre-birth’ experience therefore becomes an important risk factor too.

Health, in terms of an outward display of a fit and healthy body, now becomes meaningless since subtle signs of illness may be hidden. No longer can individu- als rely on how they feel as a prediction of their health. Just as in the early part of the twentieth century clinical ‘tools’ were required to test for pre-existing nutri- tion diseases in childhood, so, too, in the latter half of the century more ‘tools’ and tests were needed to detect ‘risk factors’ which potentially affected the whole pop- ulation. A whole ‘nutrition landscape’ now opens up; a new expanse that requires new vantage points from which the precarious nature of eating can be surveyed according to, first, a set of dietary criteria (normalised as dietary targets, goals or guidelines against which eating practices can be judged) and, second, a normal range of biochemical indices and anthropometrics, or body measurements.

Because the whole population is now potentially sick and therefore under sur- veillance, it makes little sense to confine the assessment and diagnosis of disease to clinics, hospitals or surgeries. In Australia, health promotion and disease sur- veillance campaigns have moved into the community to provide spot checks on ‘lifestyle’ in a variety of social spaces such as shopping malls, sporting clubs, worksites and community entertainment events (James et al., 1991; Fardon et al., 1992). Here lifestyles and risk factors can be rapidly checked: a serum cholesterol estimate takes three minutes; a blood pressure reading takes two minutes; a scan of an individual’s diet for ‘risky’ foods only sixty seconds. In this way the popula- tion is rapidly divided into ‘high’ and ‘low’ risk categories. This categorisation of individuals does not stop at ‘bio-data’: other factors also have to be considered. Since socio-economic and psychological factors are now considered to influence food choice, an individual’s social status also becomes a ‘risk’ factor (Turrell and Najman, 1995) as do their psychological traits (Falconer et al., 1993). Categories of ‘high-risk’ lifestyles, therefore, have to account for the psycho-social back- ground of the individual in as much as this is believed to affect food choice and compliance with dietary regimes (Smith et al., 1995; Glanz et al., 1990). These psycho-social discourses are also included in the promotion of nutrition. For example, social marketing techniques, defined as problem-solving processes which are based on ‘understanding the consumer’s reality and [fashioning] pro- grammes that are relevant to this reality’ (Lefebvre et al., 1995), are widespread in the promotion of nutrition discourse. In-depth interviews and focus groups uncover consumer values and beliefs, pleasures and desires about food, which then become incorporated into nutrition intervention programmes (Droulez and

Mortensen, 1996). In this way nutrition discourse on food choice conflates with the concerns of other human sciences.

The ‘nutrition landscape’, like any other, shifts and changes form in response to certain influences. For nutrition, these influences have usually come in the form of ‘new’ findings about, on the one hand, food and its effects on the body resulting from biomedical science and epidemiology and, on the other, social and moral con- cerns about certain lifestyles amplified by discourses on affluence. As we have said, because the whole population is ‘at risk’, everyone becomes the target of nutrition surveillance. So as well as large surveys on the population’s eating habits (see, for example, Commonwealth Department of Health, 1986), the population is broken down for closer examination and specific terrains are identified within the landscape of nutrition. Thus the eating habits of infants (Hitchcock et al., 1986), teenagers (Magarey and Boulton, 1995), women (Harvey et al., 1993), men (Australian Dairy Council, 1993) and the elderly (Magarey et al., 1993) have had individual attention. Groups defined as having ‘special needs’ – breastfeeding women (Hartmann et al., 1995), vegetarians (Rouse et al., 1982) and athletes (Harrison et al., 1991) – have also been singled out for examination. As the popu- lation is traversed, categorised and classified in relation to eating habits and diet-related diseases, new ‘regimes of truth’ emerge. It has been accepted, for example, that ‘diseases of affluence’ are, in fact, much more common in less afflu- ent groups. Economically underprivileged groups have a greater incidence of almost all diet-related disease categories. For underprivileged populations, such as Australian Aborigines, death rates due to cardiovascular disease are up to twenty times greater than ‘standard’ population death rates (Report of Nutrition Taskforce of the Better Health Commission, 1987: 44). Thus a little more than one hundred years after it was mobilised as a community concern, nutrition again focuses on the underprivileged for dietary reform. This situation has been complicated by the recognition that many foods once promoted as ‘healthy’ are actually more expen- sive than those which are considered to be nutritionally undesirable (Santich, 1992). Discourses on affluence have had to be reformulated to accommodate dif- ferent socio-economic circumstances and nutrition has now become incorporated into a humanist discourse on equality and social justice (Duff, 1994).

Because of the multiple opportunities that now exist for intervention and sur- veillance of nutrition, these are no longer the sole domain of the custodians of nutritional knowledge such as nutritionists and dietitians. Nutrition advice is now propagated through a multitude of professions and groups. The Royal Australasian College of Physicians (1989: 10), for example, recommends that ‘nutrition knowledge be widely disseminated by family and community leaders ... the formal education system ... the primary health care system’. Furthermore, the College believes that nutritional surveillance should be undertaken by a panoply of health and other professionals (for example, pharmacists, dentists, psycholo- gists and physical educators) who are ‘uniquely placed to undertake nutritional assessments related to their area of research’ (Royal Australasian College of Physicians, 1989: 10).

In this way the dietary habits of the population are judged in relation to indices of nutrient needs or ‘recommended dietary intakes’, which themselves are subject to change on the basis of ‘new’ findings (see National Health and Medical Research Council, 1990). For example, a review of the Australian recommended daily intakes in the early 1980s saw a readjustment of the recommendations for a variety of nutrients based on new findings of ‘adequacy’ (Truswell, 1990). Of course, understandings of ‘adequacy’ are themselves highly problematic, since they are not defined solely according to an absence of deficiency symptoms. They are, instead, informed by a variety of other discourses concerning what might be ‘good’, ‘optimal’ or ‘healthy’ for individuals or populations. But as Dye Gussow and Thomas put it:

[this] is something like the difference between defining health on the one hand as the avoidance of disease, and on the other – as the World Health Organisation has proposed – as ‘a state of physical, mental and social well- being, not merely an absence of disease’.

(Dye Gussow and Thomas, 1986: 57)

In the end, what is considered to be nutritionally adequate is a judgement based on what is considered to be ‘optimal’ or ‘proper functioning’. And, as we have noted elsewhere, since there are no a priori conditions on which to judge what is ‘proper’, this has to be socially defined; it is based on a society’s expectations of its individuals (Armstrong, 1987). It is because of this fact that recommended nutrient intakes differ over time and often from country to country (Dye Gussow and Thomas, 1986: 59).

The moral urgency of nutrition is such that ‘new’ findings sweep across the nutrition landscape, often with surprising speed, sometimes displacing and trans- forming, but often adding another layer to what was already present by way of knowledges and practices. A good example concerns recent knowledge of the decreased incidence of neural tube defect in infants whose mother’s diets were supplemented with folic acid (Bower and Stanley, 1992). Shortly after these find- ings were mooted, dietary advice about folate in food was being distributed to women, and foods fortified with folate appeared in the Australian marketplace. Nutrition thus rapidly instills itself into professional and public discourse. And the incorporation of nutrition into the food supply itself ensures that nutritional science takes up residence in a variety of locations, but none so important as the home, which we will be looking at shortly. Food products now carry an abun- dance of information relating to their nutritional content, some of which symbolises expert nutrition approval (Shrapnel, 1994).

Modern nutrition, then, is a technology of power which objectifies bodies in relation to specific outcomes. Nutrition constructs subjects as objects through knowledges about the size and shape of their bodies (in relation to recommended values); their internal body systems, for example, blood lipids such as high/low density lipoproteins (in relation to recommended values); the quality and quantity

of foods they consume (again in relation to recommended values); and their thoughts and feelings about food and health. As a technology of power, nutrition brings Foucault’s five disciplinary operations into play:

it refers individual actions to a whole that is at once a field of comparison, a space of differentiation and the principle of rule to be followed. [Second] it differentiates individuals from one another, in terms of the following overall rule: that the rule be made to function as a minimal threshold, as an average to be respected or as an optimum towards which one must move. [Third] it measures in quantitative terms and hierarchizes in terms of value the abili- ties, the level, the nature of individuals. [Fourth] it introduces through this ‘value-giving’ measure, the constraint of a conformity that must be achieved. Lastly, it traces the limit that will define difference in relation to all other dif- ferences, the external frontier of the abnormal.

(Foucault, 1979: 182–183)

As always, we would need to remember that, as a technology of power, nutrition should not be considered oppressive and restrictive but, rather, productive. Indeed, as a ‘regime of truth’, nutrition produces new and ever more specific sub- jectivities for individuals and populations. As Foucault says about power: ‘It invests [individuals], is transmitted by them and through them’ (Foucault, 1979: 27). In terms of its role in the reduction of disease, some would argue that nutri- tion has also been productive in promoting health. Truswell (1995), for example, highlights the decreasing incidence towards the end of the twentieth century of a number of diet-related diseases which he identifies with the promotion of nutri- tion. This is not to say that conventional nutritional strategies have gone uncriticised and in the next section we will examine some of these criticisms.