Annelies J. D. van der Mijn Student number: 5768594 Master’s thesis in Sociology: Social Problems and Social Policy
First Supervisor: B. Paulle Second Supervisor: C. Huisman University of Amsterdam (UvA) annneliesvandermijn@hotmail.com 15nd of August, 2014
Just for the health of it:
An exploration of the eating and exercise behavior of children in Pendrecht,
and how it might be improved
Table of Contents Page
Chapter 1. Introduction 1
1.1 Problematic eating and exercise behavior 1
1.2 Overweight children and school 1
1.3 Pendrecht 2
1.4 Aim of this study and main research question 4
1.5 Sub question 1 4
1.6 Sub question 2 5
1.7 Sub question 3 6
Chapter 2. Theoretical background 7
2.1 Foucault’s theory on Bio-politics 7
2.2 Bourdieu’s theory on Habitus, Capital and Field 9
2.3 Elias’ theories on The Civilization Process and The Established and the Outsiders 11
2.4 Lipsky’s theory on Street Level Bureaucrats 13
Chapter 3. Methodological background 15
3.1 Methods used 15
3.2 Practicalities and difficulties 18
Chapter 4. Analysis sub question 1 20
4.1 Agenda setting 20
4.2 National Policy 21
4.3 How do these plans get put into practice? 22
4.4 Policy in Rotterdam 23
4.5 Projects in Rotterdam 24
4.6 Summary sub question 1 25
Chapter 5. Analysis sub question 2 26
5.1 Eating and exercise behavior 26
5.2 Perceptions of respondents on explanations for the observed behavior 29
5.3 Interventions and projects in Pendrecht 34
5.4 Effects of measures taken 39
5.5 Important criteria that make projects and interventions successful 40
Chapter 6. Analysis sub question 3 44
6.1 Diet and increase of exercise 44
6.2 The role of parents 45
6.3 Multi-level approach at school 47
6.4 Summary sub question 2 48
Chapter 7. Conclusion 50
References 53
1 Chapter 1. Introduction
1.1 Problematic eating and exercise behavior
There have been a lot of news articles on unhealthy eating and exercise behavior in the last couple of years. News articles for example report on society getting heavier and heavier, being overweight increases the chance on diabetes, heart disease, high blood pressure and cancer, and the amount that people exercise is not enough (NOS, 13th of March 2013, NU.nl, 2014, SCP, 2013). Not only do we not
exercise enough, sitting down too much increases the chance of passing away earlier in comparison to people that only sit down for a few hours a day (NU.nl, 2012). Aside from news articles focusing on society’s overall health, eating and exercise behavior of children in particular gets a lot of attention. Children don’t seem to get enough exercise, with only 46 percent of all children exercising for one hour or more each day (NOS, 6th of October, 2010). Their eating behavior is not much better, with nine out of
ten children not eating enough vegetables, and 75 percent not eating enough fruit to reach the
recommended daily intake (NOS, 26th of January 2013). But it is not only the media who show there are
problems in society with eating and exercise behavior; the outcome of scientific research supports the claims made in the media on the existence of a social health problem. We can thus see that health, and in particular eating and exercise behavior, is a hot topic these days. The increased attention in the media and scientific research on this topic makes this problem very alive in society, something that is necessary in order to generate the feeling of need for action.
1.2 Overweight children and school
A systematic analysis on obesity for the Global Burden of Disease Study 2013 (Ng, Fleming & Robinson et al., 2014) shows us that 23.8% of boys and 22.6% of girls in developed countries were overweight in 2013. ‘Because of the established health risks and substantial increases in prevalence, obesity has become a major global health challenge’ (Ng, Fleming & Robinson et al., 2014, p. 1).
Being overweight and not having healthy eating behavior and enough exercise will not only be bad for children’s physical health; it can also be an influence on their mental health and through this, their performance at school (Taras & Potts-Datema, 2005). The research by Yau, Castro and Tagani et al. (2012, p. 6) shows that children who are overweight scored lower in mathematics and language tests, had a lower IQ , and could not concentrate as well as children with a healthy weight. These negative consequences can possibly be of influence on their academic career and lifelong learning. Eventually this can cost the government a lot of money. ‘The costs of health care that are associated with being
2 working incapacity, as a result of being overweight and obesity, is approximately 2 billion a year’
(Ministry VWS, 2007, p. 10).
Overweight children are thus seen as a social problem. It is important for them to have the best possibilities for optimizing their health. According to the government, children are the future and we have to support them as best as possible in order to develop a healthy lifestyle.
‘Concern about the potential future implications of existing bodyweight/mass is heightened in UK policy discourse when it is focused on children and young people and resultant policy initiatives have in the main aimed to control and regulate children’s (potentially) obese bodies over and above adults’ (Evans & Colls in Rich et al., 2011, p. 115).
The government sees the setting of rules and stimulation of healthy behavior as justified in the youth’s best interest (Ministry VWS, 2011). We can see this in their decisions and interventions on problems related to children’s health in the Netherlands. On the 20th of February, 2014 for example, the Ministry
of Health, Welfare and Sport and the Ministry of Education, Culture and Science in the Netherlands announced that they would invest 2 million euros extra in supporting schools who want to invest in extra attention on sport, exercise and a healthy lifestyle for their students (Ministry VWS, 2014). In this way the government gives an extra incentive to schools already taking responsibility and being enthusiastic about trying to improve children’s health. This investment shows that interventions don’t just focus so much on parents anymore for teaching children about having a healthy lifestyle. The school and the neighborhood are playing a role in this as well. Health is thus not a private subject anymore. This can be explained by the idea that everyone has to take responsibility and participate in keeping our society healthy (Newman & Tonkens, 2011, 1). A healthy society starts with healthy individuals and everyone plays a part in this. Everyone gets the opportunity to have more responsibility, but on the other hand it is their duty to make the right choices. This is exactly what the government tries to influence; to get
everyone involved in improving our health. 1.3 Pendrecht
Pendrecht is one of Rotterdam’s socially weakest neighborhoods. Especially children have a hard time growing up in this neighborhood due to the bad living circumstances. This neighborhood has scored very low on the 2012 Social Index, a piece of research that investigates how every neighborhood scores on themes such as living environment, participation, capacities and social bonding (Gemeente Rotterdam, 2012, 1). The 2012 Social Index shows that this neighborhood scores very poor on health, which can result in people not having the capacity to participate in society. It can thus be that the government is of
3 the opinion that this neighborhood needs extra attention and support in order to improve the health of citizens, and especially the health of children.
But how can we understand that some people have a healthier lifestyle than others? Most importantly, an explanation for differences in being overweight between children can be found in the educational level of parents; ‘morbid obesity is more prevalent among children of low educated parents’ (van Dommelen et al., 2014, p. 94299). And these parents with low education levels may also have a lack of economic resources, a lack of knowledge and different ideas about what exactly entails a healthy
lifestyle. These possible explanations help us understand why neighborhoods that score low on the 2012 Social Index have a lot of people living there with a poor level of health (Gemeente Rotterdam, 2012, 1). Differences in overweight also sometimes get explained by differences in ethnic background, but we have to be very careful with these explanations. Van Dommelen et al. (2014) for example show us a difference in prevalence of morbid obesity between children of different ethnic background. According to them, children of Moroccan or Turkish origin have a higher prevalence on being overweight than children of native Dutch origin in The Netherlands. But it is not clear if these outcomes are controlled for other factors that can be of influence on being overweight, like for example class. It can be that class is an important factor in explaining why the Moroccan-Dutch and Turkish-Dutch children are seen as being more overweight than children from Dutch origin. The Moroccan-Dutch and Turkish-Dutch children in this research can be from a lower class, and are being compared to children of Dutch origin from a middle or higher class. Maybe class plays a more important factor in explaining why they are more overweight, instead of their ethnic background, if we can even define an ethnic background. After all, a lot of children with a Moroccan or Turkish background are the second or third generation of their family that live in The Netherlands. Can we then still say they are purely Moroccan or Turkish, and not at all influenced by the country they live in? We thus have to be really careful with assumptions on how ethnic, ethno-cultural and class-cultural background can be of influence.
However, despite the low scores in the 2012 Social Index on themes such as participation and social bonding, there is a voluntary organization of neighborhood residents ‘Vitaal Pendrecht’, that is very committed to improve the neighborhood and the living circumstances for residents (Startnotitie SDVB Onderzoek, 2014). They work very closely with schools and other organizations in their attempt to achieve this. Their latest project tries to improve children’s development and improve the social relations and quality of life in the neighborhood. This project is called ‘The Children’s Faculty’ (de
Kinderfaculteit) and is developed by ‘Vitaal Pendrecht’, together with foundation ‘De Verre Bergen’. This philanthropic organization wants to have ‘a long-lasting positive impact on the city of Rotterdam by
4 collaborating with, and also supporting, innovative initiatives that deal with social issues for, and also with, the citizens of Rotterdam’ (Stichting De Verre Bergen, 2013). Because of the fact that ‘De Verre Bergen’ is funding these projects with private money, they are not dependent on donations or the government.
The Children’s Faculty project has as the specific main goal to improve the social-emotional, cognitive, physical and talent development of children. This will hopefully lead to more self-assured children, improved school results, improved social skills and developed talent (Startnotitie SDVB Onderzoek, 2014). A wide range of after-school activities is offered to the children who attend one of the four primary schools in the neighborhood. These children will thus be from the age of four to twelve years old. The schools in the neighborhood are ‘Over de Slinge’ (Krabbedijksestraat and Sommelsdijkstraat), ‘De Beatrix school’, ‘De Koppeling’ (Special education) and ‘De Hoeksteen’. All these schools are very close together and located around Square 1953 (Plein 1953), a square in the middle of the
neighborhood. Most of the after-school activities from The Children’s Faculty are taught at locations around this square or the schools, with the exception of sports activities which take place at the sports clubs in the neighborhood. The Children’s Faculty and the schools work closely together to make these after-school activities happen. This project will hopefully, together with the primary schools, give a great boost to the neighborhood.
We can see that The Children’s Faculty has improving the physical development of children as one of their main goals. This is in line with the desire of the government that everyone plays a part in trying to improve the health of citizens, and with this the eating and exercise behavior of children. We can thus see policy get put into practice with this project.
1.3 Aim of this study and main research question
In this study I want to find out if The Children´s Faculty project and schools in Pendrecht are meeting the aim of the government to really make a difference in children’s lives when it comes to improving eating and exercise behavior. And can the measures and interventions in the project and at the schools be seen as promising and successful, based on previous research? Hence, the main research question of this study is:
What is the gap between what is expected by the government, what is actually happening in the field and what works according to literature with regard to eating and exercise behavior of children?
5 Answering this question will help get an idea of what the children in Pendrecht really need in order to improve their eating and exercise behavior. It can possibly help getting understanding on where improvement is needed in order to reach a healthy lifestyle for every child in the neighborhood. I will answer three sub questions that will help me get an answer to the main question.
1.5 Sub question 1 The first sub question is:
What can we see in the municipality of Rotterdam in terms of policy on improving eating and exercise behavior of children?
Answering this question will tell me what exactly the goal of the government is when we look at improving eating and exercise behavior, and how the municipality of Rotterdam gives shape to this in order to obtain the desired effects. First, we have to understand what they exactly see as problematic that needs attention. What do they think needs improvement and what do they see as successful outcomes and results? (McConnell, 2010). When we know what the main goals and expectations are, we can look at the policies and interventions actually developed and thus conclude what the municipality gives support to and sees as important interventions.
1.6 Sub question 2
The second sub question is:
What is actually happening in Pendrecht in order to improve children’s eating and exercising behavior?
This question goes from the more macro point of view on policy developed by the municipality to what actually happens on a micro level in a socially weak neighborhood, and thus the implementation of the policy. What do the people in Pendrecht know about healthy eating and exercise behavior? And how is the problem of unhealthy eating and exercise behavior perceived in Pendrecht by the different parties involved? What attention and support is needed according to them and what are the possible
explanations behind this way of looking at it? (Bacchi, 2009, Ch. 3). We thus have to get more insight on what is seen as the existing difficulties and problems in order to understand where people in the neighborhood direct their attention. What do the people that work with the children in the
neighborhood, like for example at the schools and The Children’s Faculty, see as problematic and where do they think attention and support is needed?
6 After understanding how the situation is actually being perceived, we can look at what the different programs actually entail and what the expected achievements are with these interventions. It will also be interesting to see if these programs cooperate; it will give insight into the possibility of interventions being compatible or even possibly counteracting each other. It is for example very important that interventions are being incorporated in the school well, so that the projects do not get in the way of regular teaching tasks. There should also be good cooperation between different projects. Good cooperation between projects with similar goals will help reach desired effects. It is important to know who takes the lead and makes the projects and interventions all cooperate together (Tuk & Verboom, 2013).
1.7 Sub question 3 The third sub question is:
What do previous interventions in other places and countries tell us about what works in terms of reaching policy goals related to improving eating and exercise behavior?
Answering this question could give us more insight on what sort of effects we can expect and should aim for. What is it exactly that interventions should aim for, and what sort of measures will be successful in order to make a change?
In the next chapters, I will describe the theoretical background that helped make sense of my findings, in what way I got access to the research, and the methods I used in order to answer the main question and sub questions. Answering the sub questions will give me the knowledge and information to answer the main question of this thesis. I will end with an overall conclusion that gives an answer to the main research question.
7 Chapter 2. Theoretical background
This theoretical framework can give further insight on the background of the social problems. This doesn’t mean that this research sticks with the theories discussed very strictly. They don’t give us a prediction of what we will find. They purely inform us on how we can understand possible observations. The theories not only help us understand our findings, but also guide us in what we should look for, in terms of possible questions to ask or observations related to the subject.
Five different theories have given me background knowledge that has helped me focus my research and what to expect in my analysis. These are Foucault’s theory on Bio-politics, Bourdieu’s theory on Habitus, Capital and Field, Elias theories on The Civilizing Process and The Established and the Outsiders, and Lipsky’s theory on Street Level Bureaucrats.
2.1 Foucault’s theory on Bio-politics
Foucault’s theory on Bio-politics can be used to get better understanding about findings in data for answering sub question 1.
Foucault has written about the idea that the government focuses more and more on ways to make the whole society healthy. It is all about the health of the social body. There are invisible power structures going on in society which, with the help of science, discipline every individual in society to the norm (Pike, 2008). These fields of power relations, as Foucault called them, are also associated with bio power, which is power performed in bio politics.
‘Biopower is a way of regulating social life ‘from within’ as individuals are trained to self- discipline and mitigate risk’ (Gibson & Dempsey, 2013).
Every individual thus internalizes norms without being conscious of this happening. These norms get set by the elite, but the elite themselves are also at the same time influenced by these power relations (Dagevos & Munnichs, 2007). In the eye of the elite, we should see the importance of having a good condition and healthy body. Being healthy will be a positive influence on productivity, self-discipline and social participation and is thus important for the whole society. It is thus not only a psychological process focused on the internalization of norms by the individual, it is also about socialization of the whole society.
8 The decision-making of individuals is influenced by the government; Foucault calls this governmentality. This can be understood as:
‘the ensemble formed by the institutions, procedures, analyses, and reflections, the calculations and tactics that allow the exercise of this very specific albeit complex form of power, which has as its target population, as its principal form of knowledge political economy, and as its essential technical means apparatuses of security’ (Foucault in De Giorgi, 2006, p. 69)
Through these politics, whole societies are being controlled in their actions, and entire communities are being managed to make citizens produce the desired policy outcomes of the government.
‘Technologies of government can be described as “those technologies imbued with aspirations for the shaping of conduct in the hope of producing certain desired effects and averting certain undesired events”’ (Pike, 2008, p. 415).
The theory of bio politics can be used to understand the increasing attention for having a healthy lifestyle. ‘There is a governmental concern for the physical condition of society in the broadest sense’ (Dagevos & Munnichs, 2007, p. 45). As we have seen in the introduction, being unhealthy and
overweight comes with a lot of diseases and higher death rates. Because of this, medical costs are rising. The government sees the negative effects of unhealthy eating and exercising behavior and wants to intervene in this negative development in order to keep the society under control and affordable. Greenhalgh (2012) describes this development by the government as ‘the war on fat’. Making people aware, and through this making them change their behavior, not only benefits the individuals that become healthier, it also benefits the whole society.
How can we understand the choice of the government for certain interventions and projects? We understand what the overall goal is of the government, but how do we see these intensions in specific policies and interventions? Foucault’s theory helps us understand why the government makes certain decisions. What social problems does the government for example see, and when do they see an
intervention as successful (McConnell, 2010)? More importantly, successful for who? After all, we should be aware of differences in what is considered successful when we look at reaching certain targets and improving health. Politics will always have an influence on policies, and policy success will always be a matter of interpretation and point of view. It depends on what your goal and focus is. We have to look at the reasons behind the development and implementation of policies in order to understand what results can be expected.
9 This brings us to the explanation of the recent increase in attention on unhealthy behavior. As we have seen before, the government wants to keep the society healthy. By focusing on what is normal and abnormal, it becomes clear what the prevailing norms are that are seen as healthy. We can see Foucault make this distinction in The Birth of the Clinic.
‘When one spoke of the life of groups and societies, of the life of the race, or even of the ‘psychological life’, one did not think first of the internal structure of the organized being, but of the medical bipolarity of the normal and the pathological.’ (Foucault, 2003, p. 35)
Unhealthy behavior can thus be seen as deviant behavior. Something needs to be done against this behavior in order to keep the body, and with this the society and its citizens, healthy.
2.2 Bourdieu’s theory on Habitus, Capital and Field
The theory of Bourdieu on Habitus, Capital and Field can be used in order to understand the behavior we will see when gathering data in order to answer sub question 2.
As we have read before in the introduction, Pendrecht is a neighborhood that scores very low on the 2012 Social Index (Gemeente Rotterdam, 2012, 1). It is likely that many children in this neighborhood have unhealthy eating and exercise behavior. Possible explanations, as we have seen in the introduction, can be found in a lack of education, lack of resources, lack of knowledge and cultural differences (van Dommelen et al., 2014).
The theory of Bourdieu can help us understand why we see differences in behavior between people. ‘His key concepts of habitus, capital and field offer insight in how and why individuals behave, choose and value the way they do’ (Pot, 2014, p. 15).
The habitus influences people in how they see the world, and what sort of ideas and opinions they have on things, and thus their behavior and actions.
´Because different conditions of existence produce different habitus - systems of generative schemes applicable, by simple transfer, to the most varied areas of practice – the practices engendered by the different habitus appear as systematic configurations of properties
expressing the differences objectively inscribed in conditions of existence in the form of systems of differential deviations which, (…) , function as lifestyles. (Bourdieu, 1984, p. 186).
People are always influenced by the relations they have with others; they are not individuals that make purely rational decisions. Bourdieu sees the individual as determined by society; ‘although individuals choose their lifestyles, they do not do so with complete free will, as the habitus predisposes them
10 toward certain choices’ (Cockerham et al., 1997, p. 328). We can thus understand the habitus as
dispositions and habits that feel like second nature to individuals. We reproduce these ideas, opinions, tastes and products that are part of where we come from (De Jong, 2003). This is how social and cultural differences come about. Bourdieu distinguishes three different forms of capital that are being imposed upon individuals by the groups they belong to. These different forms and levels of capital influence what disposition an individual has in the competitive social arena they find themselves in (Bourdieu, 1991).
‘For Bourdieu, a capital is any resource effective in a given social arena that enables one to appropriate the specific profits arising out of participation and contest in it. Capital comes in three principal species: economic (material and financial assets), cultural (scarce symbolic goods, skills and titles) and social (resources accrued by virtue of membership in a group)’ (Wacquant in Stones, 2007, p. 268).
Each of these different types of capital can thus give an explanation for the behavior, choices and actions of individuals.
Economic capital is thus material and financial assets. When we apply this capital to our subject, eating and exercise behavior of children in Pendrecht, we can see that a difference in eating and exercise behavior can be understood by differences in income of parents. Children from certain families might not have enough money to eat healthy food every day (Rawlins, 2009). Also sports can be seen as unaffordable (Dagevos & Munnichs, 2007). People might have other priorities in spending their money, and playing soccer at a club for example is not one of them. They might just not have the resources to make it possible.
Cultural capital is seen as symbolic goods, skills and titles. This type of capital gets acquired first through family and parental transmission. We can see this capital as embodied when the symbolic goods, skills or titles are really part of the individual’s being and part of the habitus. Cultural capital can give
understanding on the meaning that people give to certain behavior. Parents have certain customs and habits that are characteristic for the way they live their life. Symbolic goods, skills and titles influence them in what they do and think; it influences what they see as good behavior.
For example ‘levels of parental education, income and job occupation are seen as, ‘proxies’ for cultural behavior and lifestyle characteristics, ‘that children acquire from their parents’’ (Van der Slik et al., 2006, p. 265, in Sierra, 2010, p. 15). In the case of eating and exercise behavior, knowledge of parents about what healthy eating actually entails can be dependent on their education. It can be that they don’t know that their behavior is actually not good for them, or don’t see the problematic side of being overweight
11 (Regber, 2014). They are not able to pass knowledge on healthy eating and exercise on to their children, or even more problematic, pass on wrong knowledge and teach their children very unhealthy behavior. Individuals are also influenced by the symbolic meaning they give to certain behavior. It is for example not a custom to for certain people let girls participate in sports activities (Dagevos & Munnichs, 2007). This is seen as wrong and undesired. It thus might not have anything to do with them wanting to live an unhealthy life; there are certain symbolic explanations, often based on culture or religion, for the unhealthy behavior. Ethnicity is often named as an explaining factor for unhealthy eating and exercise behavior as well. However, as explained before, we should be careful using this explanation. Culture can be influenced by class and the place people live, which means ethnicity can’t be used as a good factor for unhealthy behavior. As we have thus seen here skills, education, symbolic meaning, and with this culture and religion, of parents can be of influence on the habitus formation of a child, and thus their unhealthy eating and exercise behavior.
Lastly, social capital is seen as resources that can be accessed through membership to a certain group or personal social network (Wacquant in Stones, 2007). These resources can help an individual to behave and act conforming to the norm. In this way they will fit in with the group and behave in a way that gives them the best possible position in the field. Bourdieu sees these social arenas everywhere; there is always a competition for the most power, best position and with this opportunities (De Jong, 2003). A lack of social capital could give us a possible understanding of why children in Pendrecht have unhealthy eating and exercise behavior. They do not have the support and resources from their personal social network to be able to live a healthy life. Maybe they do want to perform this behavior, and even know what healthy behavior entails, but they don’t have the support in actually doing it. It can be for example that their parents are not able to give the support and opportunity to their children to have healthier eating and exercise behavior, because they are not at home a lot, or don’t have the knowledge to make it possible. In the field of health, it can be hard for children in Pendrecht to perform the behavior that will give them optimal health and therefore good opportunities and chances in life.
2.3 Elias’ theories on The Civilization Process and The Established and the Outsiders
Elias’ theories on The Civilizing Process and The Established and the Outsiders help us understand the change in people’s behavior over the years. He describes in his theories how feelings of shame and embarrassment have increased and norms on what is right and wrong have changed. This has made people act more disciplined and structured now, in comparison to centuries ago. He sees this as an increasing social enforcement to self-restraint and describes this process of civilization in society as an
12 unplanned social revolution (De Jong, 2003). It must be taken into consideration that Elias never spoke of an improvement in behavior; he simply detects a change and wonders how this change comes about. Elias sees the increasing social interdependence as one of the main explanations for the increase in self-control (Elias, 1956, p. 232). Individuals are getting more and more dependent on each other and there is a lot of competition. They have to be more orientated on the future in close-knit figurations and have to take others into consideration in their behavior and actions.
‘The closer the web of interdependence becomes, in which the individual is enmeshed, the larger the social spaces over which this network extends, the greater is the social advantage of those able to moderate their effects, and the more strongly is each individual constraint from an early age to take account of his own or other people’s actions on a whole series of links in the social chain.’ (Elias, 1994, p. 448, as quoted in Newton, 2001, p. 471).
In order to take others into consideration, people are required to be more predictable and consistent in their behavior (Linklater & Mennell, 2010). This predictability will only exist once people act more structured and controlled. The increasing focus on the future goes hand in hand with the postponement of short-term goals focused on pleasure (De Jong, 2003).
Behavior of individuals, and thus the amount of structure and self-restraint, is dependent on what is seen as accepted by the figuration of people around them. The civilized behavior that people have developed and learned over the years is being passed on to new generations. Children learn what sort of behavior is accepted and expected by the people around them; ‘a figuration that has its own rules and laws, goals, ideals and codes’ (De Jong, 2003, p. 189). People internalize these rules and laws and reproduce them.
‘Elias rejected systems analysis and preferred the notion of figuration to stress that those forces stemmed from the ways in which people were bound together and by the pressures that they placed on one another.’ (Linklater & Mennell, 2010, p.388)
The internalization of these norms and rules on how to behave, create feelings of shame; the feeling that their uncivilized behavior is creating a risk for society and the group they are part of. The behavior becomes such an instinct that individuals forget the pressure that has been put upon them not to behave in a way that creates shame and embarrassment (Elias, 1978). Yet, not all individuals are equal in the amount of self-restraint and structure in their behavior. There will always be minority groups in society that are not on the same level in modern development as other groups. Individuals in some figurations
13 will be more capable of self-restraint and structured behavior than individuals in other groups. This can be explained on the one hand by different rules and laws describe what sort of behavior is accepted and desired. On the other hand, as Elias describes in his theory on the Established and the Outsiders,
differences in behavior can be explained by the difference in closeness and power (Paulle et al., 2012). Individuals from certain groups, with thus a different figuration than other groups, can feel the need to behave like individuals from other groups. The group with less power, the outsiders, train themselves to practice the expected civilized behavior, in the hope they will be accepted into the group with the most power: the established. Though, they will never become part of the established group by just acting according to the behavioral norms (De Jong, 2003). The established are seen as norm setting and want to reinforce this power by keeping a distance between them and outsiders. They develop distinguishing behavior that is more controlled and civilized than the behavior of others. Outsiders reinforce the power and status of the established by trying to accept the set civilized norms and conform to the higher civilized group.The possibility for the higher class to express this power and wealth is a possible explanation for the development of a more civilized society.
The theory of civilization by Elias can be used to understand the behavior of people in Pendrecht. On the one hand we can use the explanation Elias gives for uncivilized behavior because of a lack in self-restraint and structure. The people and children in Pendrecht don’t restrain themselves from short-term pleasure goals, in this case unhealthy eating and exercise behavior. The figurations they are part of don’t offer them the support, knowledge and opportunity to internalize civilized behavior. They don’t know what healthy eating and exercise entails or how to live healthy. On the other hand, the assumption that their behavior is not seen as civilized and desired gets strengthened by the fact that a lot of people in
Pendrecht have a low social economic status. They don’t have a lot of power and are seen as minorities, or in Elias calls them, outsiders. Their behavior can be used as a reference point for the higher classes in society to distinguish themselves. We must thus take into consideration that their behavior is not necessarily bad; it can be the difference in power, as we have seen before, that makes their behavior seen as unaccepted and a risk to society.
2.4 Lipsky’s theory on Street Level Bureaucrats
Lipsky’s theory on Street Level Bureaucrats focuses on the problematic part of politics getting put into practice (Lipsky, 1969). Street Level Bureaucrats are for example teachers, police officers or judges.
‘Street-level Bureaucrats are identified as people employed by government who: 1) are constantly called upon to interact with citizens in the regular course of their jobs; 2) have
14 significant independence in job decision-making; and 3) potentially have intensive impact on the lives of their clients. But they also stand in contact with government officials ‘ (Lipsky, 1969, p.1). Street Level Bureaucrats thus have to try to find the right balance between putting policies into practice, and performing their jobs according to how the government requires them to do so, and dealing with real life situations. Finding this balance can cause difficulties. Street Level Bureaucrats can for example experience a small availability of resources to perform their job. This can restrain them from reaching their goals. And with this lack of resources also comes the fact that employers sometimes set
unattainable job expectations. This makes it very hard for the Street Level Bureaucrats to perform their job well, and can cause a lot of pressure and stress. As we said before, Street Level Bureaucrats can have a lot of influence on someone’s life. And in order to get the job done, they have, as Lipsky calls it, a discretionary space. They make policies in their decisions, and ‘need autonomy in decision making processes and interventions’ (van der Haar, 2007, p. 72).This means they have to have the independence to perform the job according to their own insight, and through this to get the job done (Evans, 2010). When we apply this theory to our subject of improving eating and exercising behavior of children, we can understand that teachers and other professionals that work with children can be seen as Street Level Bureaucrats. Our data might tell us that they do know and experience the need of the government to improve health. We can find possible attempts back in their interventions and projects. But what are their experiences with achieving the set goals? Is it hard for them to make a difference? It can be that they don’t feel that they have the resources to actually change children’s behavior, or might even feel that it is not their responsibility to make a change. After all, where does the responsibility of the parent stop and that of the school begin? Ideas of respondents will tell us more on how they feel about the additional task they get at school. We might also see differences between professionals in putting policies and plans into practice.
As said at the beginning of this chapter, the theories discussed can help us understand the collected data and findings. How these theories can be connected to the collected data will be more deeply discussed in the chapters 4, 5 and 6 in which the sub questions will be answered. But first, the next chapter will describe what sort of methods we have actually used in order to collect this data and information, how we exactly got access to the field in order to conduct our research, and what sort practicalities and difficulties have been experienced in this process.
15 Chapter 3. Methodological background
3.1 Methods used
The approach used in this thesis is qualitative research. I will try to understand what exactly is happening regarding eating and exercise behavior of children as well on the level of policies by the government and municipality, as on the level of putting these policies into practice with interventions and measures. How can we understand certain choices and behavior of respondents? Knowing more on these aspects will not only give insight into why certain things happen, it will also give insight in what we could do to improve the current situation. In order to understand what works, we need to understand why the situation is the way it is.
The methods that I used in order to obtain this understanding are literature and discourse analysis, interviews and field observations. Within all different types of qualitative data gathering, I have used codes to focus my search for literature, interviews and observations. The codes that I have used mostly are: Sport behavior, Eating behavior, Exercise behavior, Explaining factors for eating and exercise behavior, Policy, The role of The Children’s Faculty in making a change, Success of interventions and measures, Problems and difficulties with interventions and measures, School and Children.
First of all, I made use of existing literature to get more familiar with the subject and the field. Existing theories will guide me in understanding certain observations and findings. Knowledge on the background or context of the subject for this thesis informs me about recent developments and what is seen as urgent and necessary to spend attention and support on (Flick, 2009). Why is this subject such a hot topic for instance for the government and in the media? It shows why this subject is socially relevant, what is still missing in research already done, and thus what my research can add to already existing information and theory on this subject.
Aside from getting more background information about the topic through existing literature, I also use qualitative literature analysis to answer my first sub question: What can we see in the municipality of Rotterdam in terms of policy on improving eating and exercise behavior of children?
Existing literature on policies and interventions developed by the municipality of Rotterdam will tell me more on what they see as the social problem that needs to be taken care of, and what they think will help in improving the situation (Yanow, 2014). I have found this information in resources like policy documents, internet websites on different intervention projects, and reports on different neighborhoods carried out by the municipality. Finding out how the municipality thinks about existing social problems will help me understand what their goal is with implementation of certain policies and interventions.
16 Interviews and field observations are used to answer the second sub question: What is actually
happening in Pendrecht in order to improve children’s eating and exercising behavior? As we have seen, I want to understand what is perceived as a social problem in Pendrecht and what is actually happening to deal with this social problem. The way the problem is seen by the people closely involved will be of influence on how possible problems are being dealt with. Understanding what the problem actually appears to be in their eyes is necessary in order to make an intervention successful (Bacchi, 2009, Ch. 3). Access to this field was given to me through my thesis coordinators. They are commissioned by ‘De Verre Bergen’ to do research and give reports on the effects and development of The Children’s Faculty. As a master’s student, I was given the opportunity to perform my own research and at the same time help generate data for the overall research on The Children’s Faculty in this starting period. This great opportunity of access to this field, The Children’s Faculty and the schools, has helped me to get to know the project better, and to get in contact with respondents who could tell me more on the subject of eating and exercise behavior of children.
A way of getting to know more about the project and reaching respondents was through volunteering for the project. Helping out with picking children up from school and walking them to the activities gave me the opportunity to engage with the people involved. It was possible for me to observe the classes given and possibly ask some questions or have an interview with the teacher afterwards. I have observed and helped out with bringing the children from the schools to the projects four times, observed different activities of The Children’s Faculty six times and also observed two PE classes at two different schools. An overview of the activities observed is given in table 1. Bringing the children from the schools to the projects took about half an hour every time, while observing the activities took around one to three hours every time. I have taken field notes during and after bringing children to the activities and observing activities.
An important respondent for reaching other respondents was the coordinator of the ‘School Sport Association’ (Schoolsportvereniging) from Over de Slinge and all sport activities at The Children’s Faculty. He put me in contact with some respondents at the schools, who in turn put me through to other
professionals who could potentially tell me more about the research subject; a perfect example of snowball sampling. The interviews gave me understanding on what respondents see as problematic, what they think are the reasonsfor these problems, what the schools and The Children’s Faculty project do at the moment to improve the current situation and behavior, and what the respondents think can be done to improve the situation even more. I have held a total of 16 interviews with professionals from the
17 schools, teachers from the after-school activities and a professional from foundation ‘De Verre Bergen’, the philanthropic organization making The Children’s Faculty project possible. Table 2 gives an overview of all interviews held with respondents. These interviews took around 45 minutes on average. The gathering of data at The Children’s Faculty and the schools in this study, by doing observations and interviews, has taken place within a five week period in the first three weeks of April, and the second week of May 2014. I used the program ‘ATLAS.ti’ to organize the collected data and get an overview of all codes and accompanying quotes. This program made the data accessible and useful, in order to get a good understanding of what is actually happening in Pendrecht when it comes to improving eating and exercise behavior, and what respondents thoughts and ideas are on the interventions and measures taken.
Table 1. Overview of activities observed.
Activities
1. Meeting with volunteers The Children’s Faculty
2. Journalism class The Children’s Faculty
3. Dance class The Children’s Faculty 4. Cooking class (observed two times)
The Children’s Faculty
5. Baseball class The Children’s Faculty 6. Zumba PE class at school 1
7. Dance class The Children’s Faculty 8. PE class at school 4
Table 2. Overview of interviews held with respondents.
Interviews
Respondent 1: Teacher school 1 Respondent 2: Special Aid school 1 Respondent 3: Teacher school 1 Respondent 4: Teacher school 4 Respondent 5: Headmaster school 4 Respondent 6: Teacher school 4 Respondent 7: Headmaster school 2 Respondent 8: Special Aid school 2 Respondent 9: Teacher school 2 Respondent 10: Teacher The Children’s Faculty
Respondent 11: Dietician school 1 Respondent 12: Teacher school 1 Respondent 13: Professional ‘De Verre Bergen’
Respondent 14: Special Aid school 1 Respondent 15: Physical Therapist school 4 Respondent 16: Teacher school 3
Qualitative analysis of literature is used to answer the third sub question: what do previous interventions in other places and countries tell us about what works in terms of reaching policy goals related to
18 online databases will tell me more about interventions previously implemented and evaluated. The outcome of the evaluations will teach us something about what sort of interventions have worked in similar cases. By knowing this, we can already make a comparison between what the municipality in Rotterdam does in order to deal with the social problems that have to do with eating and exercise behavior, and what apparently has worked before somewhere else. Other research and evaluation of projects can thus be inspiring for The Children’s Faculty.
3.2 Practicalities and difficulties
Qualitative research is largely inductive research (Babbie, 2007). This entails that theory will not be used to test hypotheses on what gives a valid explanation for what is happening. You have to be open to all information that is surprising and interesting to focus further research (Yanow, 2014). This research is thus more explorative and should in the end give us insight on how the situation in Pendrecht, when it comes to eating and exercising behavior, actually is, and what the children really need in order to improve their behavior. One should try to stay objective when trying to discover why certain
assumptions are the way they are. How do others understand the state of affairs, what are their ideas on what the problem actually entails and what should be done? However, we must realize that even when we try to be as objective as possible, our social constructs will always be second-degree social
constructs; according to Schütz ‘the constructs of the social sciences are, so to speak, constructs of second degree, that is, constructs of the constructs made by the actors on the social scene’ (Flick, 2009, p. 77). As with all different forms and types of research, we must still acknowledge that the outcomes of this research are always influenced by our own perceptions and ideas, even when we see the outcomes of this research as representative and valid.
It is clear that the data and knowledge that will be gathered on the social problem of this research is very case specific. Even though a different scenario can be very similar, this doesn’t mean that the results from this research are automatically applicable to other areas. The understanding of ideas and actions of people in this setting cannot simply be transposed for other places with similar social problems. Every context is different and we should keep in mind the differences between places and social communities. This research will give form purely to an understanding of what is happening in the neighborhood Pendrecht, but can also be relevant for research in the future on other neighborhoods that are more or less similar.
A factor that has made this research difficult to carry out was the lack of time for the gathering of data. The initial time to gather data was from the first of April until the 16th of May. However, because
19 professionals at the primary schools and at the after-school activities were our focus of research, we had to deal with a two week holiday period. This resulted in the time for data collection being only one month, and this has made it difficult to make appointments and to get in contact with respondents in time. For this reason I have only talked with one respondent at one of the schools. However, I do think that my data is satisfying enough to make my analysis valid, reliable and therefore representative of the ideas and meanings of people and actions at school and at The Children’s Faculty.
20 Chapter 4. Analysis Sub question 1.
As described before, sub question 1, ‘What can we see in the municipality of Rotterdam in terms of policy on improving eating and exercise behavior of children?’ is answered by analyzing literature, policy documents, internet websites on different intervention projects and reports on different neighborhoods carried out by the municipality. In this way we can get a clear understanding of how the municipality of Rotterdam is trying to improve eating and exercise behavior of children in terms of policies and
interventions. Understanding this will give insight in what the government and municipality has as goal and how they think they can reach this.
4.1 Agenda setting
To understand what the intention is of the government and municipality, we should know how this subject has been put on the agenda in the first place (McConnell, 2010). The social problem of being overweight ‘has changed from being an individual health problem into a public health problem’ (Dagevos & Munnichs, 2007, p. 155). Claim makers play a big role in this process (Guerrero, 2005). They can for example be doctors who worry about individual’s health but also economists who worry about the affordability of health care. It can be that they want to establish a moral panic, in order to get attention for their perceived problems. A useful tool for this is the media. The government gets influenced by this information, and at the same time uses this information, in their fight against fat. They can develop policies and implement interventions, aimed at improving people’s lifestyle, when the social norm towards being overweight has changed. Because of this need for support, ‘the increasing problem of being overweight has only been on the political agenda since 2003’ (Dagevos & Munnichs, 2007, p. 158). The extra attention in the media by organizations and companies will help change the norm towards being overweight, and through this government policies will achieve set goals easier. Evidence on accompanying health risks can help them get this support (Guerrero, 2005). It has a higher chance at succeeding when a lot of different groups support the intervention and desired change. Only dictating society top down what to do and change by the government will not have the desired effect (Ministry VWS, 2013). Multiple parties and organizations need to be involved to make a change. However, we should be aware of the fact that problems and negative effects can sometimes be over exaggerated by claim makers in order to produce change. This is necessary in order to make people aware of the need for action and not ignore the problem overall.
As described in the chapter on theoretical background, the theory of Foucault on bio politics can be used to gain understanding on why the government feels the need for action in order in order to keep society
21 healthy. The health of the social body is being threatened with the unhealthy behavior of individuals. No matter how this problem got on the agenda, the urge that something needs to be done is there. The government tries to control the health of society by trying to make people more aware of their behavior. Individuals have to feel the need to take care of themselves more, whether this is for their individual benefit, or for the benefit of the whole society. They need to take their responsibility, and this is exactly what the government attempts with policies and interventions on this social problem.
4.2 National policy
Policy on a national level is of influence on the policy and projects in Rotterdam. It is thus important to get a clear understanding of what the government wants to achieve, and what projects and measures are used in order to obtain these goals.
In 2006, the government of the Netherlands brought out the white paper ‘Kiezen voor een Gezond leven’, which means ‘choosing a healthy life’ (Ministry VWS, 2007, p. 7). This policy document focused on health improvement for the whole society on the component of obesity and overweight. The goal is to let levels of obesity in society not increase and bring a change in trend when it comes to adults and children being overweight. Another goal is to increase awareness and knowledge on health risks that come with being overweight. Making people more aware of the dangers of an unhealthy lifestyle will hopefully let them take responsibility for their behavior and will also generate more support in counteracting this public health problem. Lastly, making people more aware of this public health
problem will put it higher on the policy agenda and will hopefully result in more initiatives and projects. As we have already seen in the introduction, the government is especially concerned about the
unhealthy eating and exercise behavior of children. ‘The government has reserved funds for the intensification of policies against child obesity and overweight’ (Loket Gezond Leven, 2014, 3). Their ideas, concerns and goals related to the health of youth can be seen back in theJOGG approach (Youth On Healthy Weight or translated Jongeren Op Gezond Gewicht). This approach is already active in more than 60 municipalities in the Netherlands (JOGG, 2014). Public and private parties work together in neighborhoods that have a very high percentage of overweight youth. A good collaboration between these public and private parties is necessary to generate good effect (Ministry VWS, 2013). These parties are also from different fields and organizations, like for example education, health care, CJG (Centre for Youth and Family), JGZ (Youth Health Care), childcare, sport, media, recreation and welfare (CGG, 2014). Together with local companies, municipalities work together on this task of improving lifestyle with up to a hundred different parties. This special combination of public and private parties shows that a lot more
22 people are able to get involved in tackling this new public health problem of unhealthy eating and
exercise behavior. And this is exactly what the government wants; according to the theory of Foucault on bio-politics, everyone should be involved in trying to keep the society healthy. Abnormal, unhealthy behavior should be dealt with by everyone is society. The support of the government on these policies that get everyone involved can be understood as the logical result of their urge to maintain the health of society.
4.3 How do these plans get put into practice?
We can thus see that The Netherlands has a combined system of governmental and private organizations trying to improve the eating and exercise behavior of children. But how is it that they actually try to improve this behavior? How do these policies get put into practice and what do they entail? Within attempts to improve the health and behavior of youth (Jeugdgezondheidszorg), we can see a difference between primary prevention and secondary prevention. Primary prevention represents ‘giving information, advice, instruction and guidance on eating and exercise to the total population, specific groups, schools and municipalities’(NCJ, 2014, quote on website). This is for example done by
organizations and neighborhood initiatives. Point of focus in prevention are ‘children that have a high risk on becoming overweight like obese parents, low social-economic position, Turkish or Moroccan ethnicity and those that don’t exercise enough’ (Kist-van Holthe et al, 2012, p. 12). Neighborhoods that score low on the social index like Pendrecht are neighborhoods where a lot of children are at risk. Primary prevention is thus more focused on preventing the overall society, and specific target groups in particular, to develop or have unhealthy eating behavior. It is not specifically focused on curing health problems of individuals. However, secondary prevention does represent ‘signalizing overweight and obesity for individuals and monitoring trends in society on being overweight’ (NCJ, 2014, quote on website). This gets done by for example ‘GP’s, pediatrician, teachers, dietician, psychologist, pedagogue and physiotherapist’ (Kist-van Holthe et al., 2012, p. 12). Children get weighted and measured in order to detect overweight. This information gets saved into a digital file or put into a grow curve. When extra attention is needed, parents are given a plan to improve eating behavior and extra information. Secondary prevention is thus much more focused on individuals already having problems with their weight; it is more focused on curing the individuals’ health problem.
Often, the school is involved in interventions as well; there are many examples of interventions that show how the school and the neighborhood are involved, in improving children’s eating and exercise behavior. ‘The Healthy School’ (De Gezonde School) for example is one of these interventions by the
23 government that shows how the school is involved with the health of children (De Gezonde School, 2014). The government hopes to give a lot of schools in the future the vignette for a healthy school, proving their dedication and effort for a healthy lifestyle of children (Ministry VWS, 2013).
4.4 Policy in Rotterdam
Rotterdam as municipality has its own policy agenda. The social problems and goals here are comparable to the ones of the government on a national level.
GGD Rotterdam-Rijnmond (2010) describes overweight as a big problem in the city. In order to make a change in the unhealthy eating and exercise behavior of children, the problem needs to be approached with several measures. ‘First of all, information and advice is seen as very important, as well on
individual level as within a group. Second, there should be more availability of sport facilities in the neighborhood, so that the use of these facilities gets promoted. Third, the neighborhood should be a safe place to exercise and be outside. And lastly, healthy options should be available to choose from, like for example healthy food in cafeteria and supermarkets’ (GGD Rotterdam- Rijnmond, 2010, p. 21). Sport is seen as important (Gemeente Rotterdam, 2010). It does not only help prevent youth annoyance, create better social bonding in the neighborhood and improve school results; it also improves children’s health. In order to get more children play sports and exercise more, the Sport Paper (Sport Nota) will be put into practice. They want to do this by compensating the sport club contribution for children from low income families, keep the School Sport Associations (Schoolsportverenigingen) existent and increase their work, and the amount of Be Fit (Lekker Fit) schools has to go up. We can thus overall see that increasing exercise and sport activities are very high on the agenda of the municipality.
The budget for the municipality of Rotterdam in 2014 describes these policy goals again for this year. For the budget, ‘sport and education are very important pillars for talent development for youth (Gemeente Rotterdam, 2014.) As we have seen before, there is thus a close collaboration between different projects and interventions and schools.
Rotterdam is one of the 60 municipalities that works with JOGG. As we have seen, public and private parties work together to make good eating and exercise behavior for youth possible and attractive (JOGG, 2014). Apart from the School Sport Association and Be Fit, a lot of different organizations make an effort to improve children’s lifestyle.
24 4.5 Projects in Rotterdam
There are important projects in Rotterdam that try to improve eating and exercise behavior of children; Be Fit (Lekker Fit) and the School Sport Association. We can see the difference between preventative and curative projects.
Be Fit focusses on teaching children about healthy eating and exercise at school (Lekker Fit, 2014). They have for example special course books, study theme days and rules concerning eating and drinking like the encouragement of drinking water and only fruit as a snack during small breaks. Schools can indicate that they want to participate in the program, which will give them extra support in improving children’s health. These programs bring the government’s desired interventions into practice. This project is meant for all children at school and tries to teach them all how about having a healthy lifestyle. It is thus not specifically meant for children that are overweight or don’t eat and exercise healthy enough. The
municipality has set as goal for 2014 to add another six Be Fit schools (Gemeente Rotterdam, 2012, 2). In order to make this possible, extra gyms are needed to facilitate the increased amount of sport classes. There are already 21 School Sport Associations in Rotterdam for primary education (Gemeente
Rotterdam, 2014). These associations try to facilitate sport activities for children in neighborhoods where this is not always available. As we have seen for example, parents in neighborhoods with a low social index will not always have enough money to let their child become a member of a sports club, or they might not know what is actually available in the neighborhood. The School Sport Association can help them get in contact with different sport clubs and also help them with the fees associated with sports clubs when they are not able to. By offering participation in sport activities close to school and home, a lot more children will exercise more regularly.
The ‘Fat Friends Club’ (Dikke Vrienden Club, which means both good friends and fat friends because of the double meaning of ‘dikke’) tries to improve the eating and exercise behavior of children that are overweight or obese. These children have already been screened on weight and height and on the basis of these results invited to participate in this program. The Fat Friends Club tries to give extra attention and care to children that need it. The club makes the extra care that they need easier accessible. Apart from the different projects that are being facilitated to improve eating and exercise behavior, schools work also close together with health professionals. As we have seen before, we can think for example of GP’s, pediatrician, teachers, dietician, psychologist, pedagogue and physiotherapist’ (Kist-van Holthe et al., 2012, p. 12). A wide approach will tackle the social health problem from different angels (GGD Rotterdam-Rijnmond, 2010). Good collaboration between municipality and health professionals is
25 key to a ‘good process of monitoring, diagnose and reference, treatment, evaluation and after care (van Grieken, 2013, p. 13). Centre for Youth and Family can play an important role in this collaboration. 4.6 Summary sub question 1
In answering the first sub question, ‘What can we see in the municipality of Rotterdam in terms of policy on improving eating and exercise behavior of children?’, we have seen that the government feels the need to do something in order to improve unhealthy eating and exercise behavior. Foucault’s theory on bio-politics helps in understanding the recent developments in policy and interventions on improving eating and exercise behavior. It is seen as a social problem that something needs to be done against in order to keep the society healthy. This urge to improve behavior can be seen back in policy and
interventions on a national level and in the city of Rotterdam. Governmental and private organizations in cooperation with schools try to obtain this goal of improved eating and exercise behavior. We see a focus on more help, support and information in order to change unhealthy behavior. There is a difference between prevention and cure interventions, but we can overall say that the main focus in policies and interventions on this subject in the Netherlands and Rotterdam lies at improving habits and behavior in children’s eating and exercising.
The question now is if these approaches are going to be successful in order to make a change. We have seen what the goal is of the government and municipality of Rotterdam, and thus what they see as the social problem that something needs to be done against. The next step is to find out what is seen as the social problem according to the respondents in Pendrecht. Do they see the same problematic behavior as the municipality and the government, and do can thus be expected that the measures and projects by the municipality and government are going to be successful?
26 Chapter 5. Analysis Sub question 2.
Interviews and field notes of activities made it possible to answer sub question 2; What is actually happening in Pendrecht in order to improve children’s eating and exercising behavior?
In order to understand what is happening to improve children’s behavior in this neighborhood, there should, as described before, first be understanding of how respondents here perceive the problem. What is actually happening is partly based on what respondents see as important.
I will first describe what people see exactly as a social problem in Pendrecht when we talk about eating and exercise behavior.
5.1 Eating and exercise behavior
Eating behavior of children in the neighborhood is not perceived as very good, most respondents even see it as problematic. They see a lot of behavior that is unhealthy in their eyes. What is happening very often is that the children do not have breakfast in the morning, or want to eat their breakfast during the small break around ten o’clock. And when they do eat something, it is often an unhealthy choice. The respondents see that the children eat a lot of sweets, snacks, chips, fries. They do not often drink milk or water, but mostly sweetened fruit drinks.
Having breakfast for example. Those families that don’t have a lot of structure, and then ‘woop’ straight out of bed and off to school without breakfast. And then still not on time. Respondent 1, teacher.
Three juice boxes of Wicky (sweetened fruit drink), that is fine right? Or, it is fruit drink right, or something like that. But they just don’t have the understanding that that is just way too much sugar and that sort of things… And then you see them again in their lunch break with a bag of chips. That is tasty, a family bag. Respondent 2, special aid.
So you hear a lot about sweetened drinks, that they drink a lot of drinks which are very rich in sugar and barely any water…. And what you put on your sandwich, you see them make a lot of wrong choices, like things that contain a lot of fat… and sweets and snacks and such, chips, that sort of things. Respondent 11, dietician.
Overall we can thus see that the eating behavior of children in this neighborhood is not seen as healthy by the respondents. We must realize though that this is the behavior that stands out. It will not be that
27 every child eats unhealthy, but this is the behavior that is seen as problematic and therefore attracts attention.
But what are actually the consequences of this bad eating behavior? Three different consequences are mentioned by respondents. The first one is having a wrong eating rhythm as a consequence of not having breakfast in the morning. Because the children eat at the wrong time, they feel hungry again at the wrong time. They, for example, eat two sandwiches around ten o’clock, are then not hungry around lunchtime and do not eat anything, and do feel hungry again after school around three o’clock. They then choose unhealthy options to ease their hunger, like with chips and snacks.
Half of the children did not have breakfast which caused them to eat sandwiches during the morning break around ten o’clock, half past ten. This caused them not being hungry during lunchbreak, and they then hold it out till a quarter past three, and then they snack. So there was no rhythm of three meals a day. Respondent 1, teacher.
This behavior is seen as unhealthy and undesired. The theory of Elias can already give us a provisional understanding on why respondents see individuals with this behavior. Respondents detect a lack of structure, no rhythm and not being able to be on time as explanations for unhealthy eating and exercise behavior. Individuals are not able to restrain themselves from making unhealthy, short-term goal focused, decisions. They don’t see what sort of negative consequences unhealthy eating, and thus an unstructured life and wrong rhythm, can give, like for example children being overweight.
Yeah, when you look at the school playground, you do see a lot of children that are way too overweight. It is really bizarre how many children, I think that a quarter of them all is still on the low side, I think in some of the groups it must me over half. I expect. And really children that are way too heavy. That is a big problem. Respondent 7, headmaster.
Well one child, twelve years old, he was above a hundred kilo’s, really huge… That group had so many children with real weight issues. Huge belly’s, yeah you should look around you.
Respondent 9, teacher.
Another consequence that this unhealthy eating behavior has besides being overweight is the effect it has on children’s school results. Respondents see that having breakfast in the morning, and also what type of food children eat exactly, is of influence on their behavior and concentration.
(Without breakfast) It is hard to get started at school then, and if you don’t have lunch either, we are not able to teach our lessons. Respondent 5, headmaster.
