Diet and Nutrition in Institutions of Care: History and Policy
Dr Margaret Charleroy (Warwick) and Dr Jenny Crane (Warwick)
University of Warwick
21 April 2017
On 21 April 2017 the Centre for History of Medicine at the University of Warwick hosted a day event exploring the history of, and current policy around, diet and nutrition in institutions of care, Diet and Nutrition in Institutions of Care: History & Policy. The event was organised between two Wellcome Trust funded projects: Prisoners, Medical Care, and Entitlement to Health in England and Ireland and The Cultural History of the NHS.
Prue Leith couldn’t make it to the event because she was filming Bakeoff, but offered this endorsement of the conference:
It’s time we stopped ignoring institutional food. It can’t be right that 40% of hospital patients leave hospital worse nourished than they went in, that prisoners eat their meals in their cells, that nurses eat ‘on the go’ from vending machines. We need to identify the obstacles preventing caterers providing enjoyable nourishing food. I hope this conference will do exactly that and also inspire those with the power to do something about it to act.
We were extremely grateful for that endorsement, because it so nicely described our aims for the day. The conference began with a conversation between researchers on the two projects—myself, studying health in the UK prison system, and Dr Jenny Crane, studying the NHS—about differences and similarities in food provided in hospitals and prisons over time. Tabloids have been making this comparison at least since the post–World War II period, with disgusted headlines decrying that, ‘jailed criminals are fed better than sick hospital patients’, but it has never been subjected to rigorous historical study, and in contemporary discourse it often proves difficult to push past the hyperbole. The conference was motivated by the conviction that historical study of this topic can inform many of the real and pressing contemporary issues around institutional diet.
The simplicity of the tabloid outcry disguises deeper questions of dietary control and moral economy, and these are the questions we took as a foundation for the event’s discussion. Who decides what a ‘nutritious’ diet is for a patient or a prisoner? How has the power to make that assessment shifted over time, for example perhaps from prison and hospital governors towards physicians, or the emergent science of dietetics, or even towards patients and prisoners themselves? How much money has been spent on diet in institutions over time, and how have changes in this spending reflected broader shifts towards the private provision of prison and hospital services? Under what circumstances are specific diets provided for different groups of patients and prisoners—pregnant women, the elderly—and, again, what does this contrast tell us about social and cultural as well as medical change?
History and Policy
In examining this history, Jenny and I both became convinced that adequately answering the questions it raises requires bringing together historians with campaigners, dieticians, policymakers, and practitioners to discuss diet and nutrition in institutions of care over time. The papers presented at the event presented case studies of varied time periods and settings, framed from an equally diverse set of perspectives, which, drawn together, help us think about how histories of diet and nutrition can inform the ongoing organisation and practices of institutional care. Some of the issues discussed have changed radically over time—the types of food which populations are accustomed to, and see as ‘nutritious’, for example. Other questions are persistent over time—for instance about the extent to which the state, the voluntary sector, or the community should be responsible for providing food to vulnerable people. By looking at these issues historically, we can better understand the factors which have driven—and importantly those which have hindered—change in the past. In doing so, we build up a better understanding of the barriers which we face today in improving institutional diet. We can also use history to think carefully about the kinds of networks which have formed, historically and today, between practitioners, policy-makers, and publics, in order to inform and drive cultural and social shifts, as well as political ones.
All of our participants have expertise thinking about and working in what we call ‘institutions of care’—institutions established for the purposes of looking after specific groups, such as the ill and infirm, the old and the young. Using care as a lens sharpens the comparison between institutions, pushing us to ask different questions about how food has been used over time to apportion different types of ‘care’ to different groups. While tabloid newspapers have argued that hospital patients should receive more expensive food than prisoners, newspapers and politicians have questioned whether patients with diseases perceived as ‘self-inflicted’—obesity, type 2 diabetes or lung cancer—should have to pay more for their treatment, or have to buy food on the wards. Care, provided through food, is equally crucial to recovery, rehabilitation, and well-being in these institutions, and yet different moral politics surround spending on food in different ways in different institutions.
The day was focused around three themes, separated into three panels:
Control, management, choice, and agency: This turned our attention to how choice is determined, controlled, and mediated in institutions between policy-makers, campaign groups, medical professionals, and management, as well as by those who prepare and serve food within such contexts as the hospital and the prison.
Moral economy and entitlement: In this panel, we asked our panellists to analyse the vast discrepancies between state spending on food within prisons and hospitals. Notions of the ‘worthiness’ of patients, prisoners, and others, are shaped by media rhetoric and cultural convictions, and may be disrupted by the provision of extra food from visitors, the trading of food, or other factors.
Institutions and community: Here we discussed the extent to which a diet provided by an institution is distinctive. Examining diets provided within the community, by state and charities, such as through soup kitchens or meals-on-wheels services, can help us to interrogate the boundaries between state, community, and private provision, and assess how these have evolved in response to government policy, funding, and moral economies.
Read our article about history and policy of institutional food in The Conversation: What we can learn from the (often gruesome) history of food in hospitals and prisons.
Image credit: A British prison, 1944. Wikimedia Commons