Critique of the Fruit and Veggies-More Matters Campaign – Chantal Dewey
The majority of U.S. adults continue to consume fewer than five servings of fruits and vegetables daily.[i] It is important to acknowledge this trend given that fruits and vegetables are known to play an important role in preventing cardiovascular disease, diabetes, and some cancers.1 Beginning in 1991, the Department of Health and Human Services developed the 5-A-Day for Better Health Program, which has since been re-named the Fruit and Veggies-More Matters initiative.
The Fruit and Veggies-More Matters initiative seeks to increase fruit and vegetable consumption by raising public awareness and providing consumers with specific information on how to meet the daily recommendations. The website, which is the focus of the campaign, explains the benefits of fruits and vegetables, tips on how to comply with recommendations, sample recipes, and easy to understand serving sizes. Unfortunately, this national project has failed to meet its goals.1 In order to better understand why this campaign was so ineffective, this paper presents an in-depth critique of the Fruit and Veggies-More Matters initiative.
Critique #1: Individual-level approach
National efforts to increase fruit and vegetable consumption have been primarily focused at the individual level. The Fruit and Veggies-More Matters initiative is premised on the assumption that increased public awareness will lead to behavior change. In particular, the campaign has developed a website that the public can visit to get information on the personal health benefits of fruit and vegetables as well as expert cooking advice, nutrition information, and shopping tips. This type of individualized approach is not unexpected given that the vast majority of public health programs are based off of traditional behavior change theories. These theories focus on targeting the individual by addressing knowledge, attitudes, decision-making processes, and skills.[ii] This approach is also a product of a deep seated westernized notion that people should take personal responsibility for their health.2
The individual-focused approach taken by the Fruit and Veggies-More Matters campaign has limited usefulness. This is because it fails to consider the interpersonal, organizational, community, and public policy factors which have been shown to be very influential on health behavior.2 On a daily basis, many people have little control over their dietary decisions. For instance, several studies have documented the absence of grocery stores and farmers markets in low-income communities.3 In addition, healthy food choices are often unaffordable and not as practical for people with limited resources given that fresh produce doesn’t last as long as processed foods.4 By and large, even if people are aware that they must eat more fresh produce, they may be unable to do so.
This public health campaign also fails to consider the influence exerted by large food corporations that extensively market unhealthy food products to consumers.5 There is an increasing amount of literature suggesting that lifestyle choices are the direct result of corporate decisions and that food companies limit consumer options to maximize profits.5 Thus the Fruit and Veggies-More Matters initiative is misguided in placing more blame on the individual rather than institutions.
Another reason this individual-based approach is flawed is because it fails to consider the attitudes, beliefs, and socio-cultural norms related to diet.6 For instance, the literature suggests that food plays a large part in cultural identity. In particular, food sharing is often associated with strong individual, family, and group ties.6 Depending on the culture, food can symbolize values of hospitality, mutual caring, group solidarity, common goals, and social obligations.6 As a result, it is very hard for individuals to change their dietary behavior given that they will be straying from their cultural norms.
The Fruit and Veggies-More Matters campaign is particularly insensitive to people from diverse cultures. The majority of information offered on the website does not recognize that the types of foods consumed and how they are prepared varies by ethnicity, gender, age, and social class.7 In particular, the majority of sample menus offered are based on American-style cuisine. Overall, this campaign fails to recognize the social, cultural, and environmental factors that have been shown to play an important role in preventing people from changing their dietary behavior.
Lastly, by focusing on the individual, the Fruit and Veggies-More Matters initiative neglects to realize that individuals behave differently when they are in a group. As mentioned above, people are constantly surrounded by and influenced by others. Studies have shown that group dynamics are very powerful predictors of behavior.8 For instance, a recent study on smoking trends in the Framingham Heart study demonstrated that smoking cessation was influenced by people’s social ties.9 A person’s chance of quitting smoking significantly increased if they had a relationship with a non-smoker. This phenomenon was also demonstrated for obesity trends. The Fruit and Veggies-More Matters initiative may have been more successful had they targeted whole households, groups of friends, or an entire work place. Such non-individualized approaches incorporate social norms and act on the idea that people are more likely to change if their close acquaintances have adopted the new behavior.
Critique #2: Human behavior is rational
A second drawback of the Fruit and Veggies-More Matters initiative is that it assumes human behavior is rational. There is an increasing amount of literature documenting that this view point is misguided.10 First of all, studies have shown that people do not rationally assess the true costs of an action. People tend to take ownership in their behavior and come to value it more than it is actually worth. The Fruit and Veggies-More Matters initiative fails to account for this irrational behavior by underestimating the attachment people have to their diet. Food is a significant part of someone’s identity and there are emotional costs of changing dietary behavior. People fear giving up something that has become an integral part of their lives. Studies have shown that in order to get people to break this self-control, they need a jolt.10 Simply providing the public with information is insufficient to stir irrational people into action.
Another irrational characteristic is that people do not always value what we expect them to value. For instance, what the public health community sees as important, such as improved health, is not always perceived that way by the public. People tend to value friendship, belonging, autonomy, freedom, and attractiveness more than health.11 Targeting these values has been shown to be effective at changing health-related behavior. For instance the Truth campaign was a successful initiative that played off of youth rebellion in order to prevent adolescents from smoking.11 This campaign recognized that a youth’s reason for smoking had everything to do with emotion and nothing to do with rational decision making.11 Furthermore, people tend to live in the moment and value things that give them immediate satisfaction. Thus, the potential for adverse health outcomes in the distant future is not an imminent enough threat to influence personal decisions.
Overall, the Fruit and Veggies-More Matters initiative was incorrect in assuming people behave rationally when they weigh the cost and benefits of behavior change. Giving people information about the health benefits of eating vegetables is insufficient to get people to change their current dietary habits. In addition, health behavior is rarely motivated by concerns about health. Several other values are far more important to people. Lastly, it is hard for people to comprehend risk especially when it relates to an adverse outcome far in the future.
Critique #3: Behavior is planned
A third limitation of the Fruit and Veggies-More Matters initiative is that it is based on the premise that behavior is planned. In particular, it assumes that once people are aware of the importance of consuming five or more servings of fruits and vegetables, they will make up a grocery list, go to the store, and comply with the recommendations. However behavior is often unplanned, especially when it comes to diet. People are busy and may not be able to access fruits and vegetables quickly and easily. Moreover, few people have the time and energy to go through all the steps outlined above.
This intervention helps people plan vegetable-rich meals, without taking into account life’s unexpected nature. In particular, plans can be altered due to unexpected environmental factors that are out of an individual’s control. For instance, the grocery store may be inaccessible by public transportation or an individual may not have access to a computer to print out cooking tips and sample grocery lists. Alternatively, people may buy the fruits and vegetables but cannot find the time in their busy schedules to learn how to prepare them. In this situation, people may have to throw out all the wasted produce and opt not to make another attempt at the behavior change. Also, even if people don’t have a busy schedule, they may procrastinate and give-up on their long-term goals for immediate gratification.10
Moreover, this initiative follows a similar line of thinking as the trans-theoretical model and is consequently susceptible to similar criticisms. This model postulates that people progress through stages of pre-contemplation, contemplation, preparation, action, and maintenance.12 The Fruit and Veggies-More Matters initiative attempts to target people in the pre-contemplation, contemplation, and preparation stages. A major flaw in this line of thinking is that it is unclear how people get from one stage to the next. In particular, once people use the website and get prepared, there are no measures in place to push the person into action. Overall, this campaign’s emphasis on planned behavior is flawed and unrealistic given the unpredictable nature of life.
The Fruit and Veggies-More Matters initiative was developed to address poor national compliance with daily fruit and vegetable recommendations. The campaign’s main tool to achieve its goals is a website that offers information regarding the importance of fruits and vegetables and tips on how to increase consumption. This paper identified three main reasons why the Fruit and Veggies-More Matters initiative is ineffective. First of all, this campaign is focused at the individual level. This individualized approach fails to consider the social, cultural, environmental, and corporate factors that can play a large role in an individual’s dietary decisions. In addition, this initiative does not recognize the power of group dynamics and the potential to spread health behavior across dense social networks.
The second criticism is that the Fruit and Veggies-More Matters initiative assumes behavior is rational. This assumption fails to acknowledge that people take ownership in their daily habits and consequently face difficulties changing routines. In addition, people rarely value future health benefits as a motivator for behavior change. Instead people assign importance to more proximal values such as friendship, belonging, autonomy, freedom, and attractiveness.
The third drawback of this campaign is that it assumes that behavior is planned. All the tools on the website encourage people to take a planned approach to increasing fruit and vegetable consumption. This tactic is not conducive to the unpredictable nature of life.
Overall, given that only 25% of Americans are meeting the national fruit and vegetable recommendations, there is a need for a new public health approach.12 This new approach should be centered at the group level and account for irrational and unplanned behavior.
Counter-Proposal to Fruit and Veggies-More Matters Campaign- Chantal Dewey
The Fruit and Veggies-More Matters Campaign is struggling to meet its objectives given its enduring attachment to principles rooted in traditional health behavior change theories. In particular, it is centered on the individual, assumes that people are rational, and believes behavior is planned. This paper proposes a novel campaign called the Fruit and Vegetable Alliance (FAVA) which aims to improve upon the flaws in the current initiative.
FAVA Component #1: Community-Level Approach
The Fruit and Vegetable Alliance (FAVA) campaign recognizes that environmental, social, and cultural factors play a significant role in an individual’s dietary decisions.13,14 Thus the intent of FAVA is to create change by building community capacity, working in collaboration with communities, and providing a framework for residents to acquire the skills and resources necessary to increase fruit and vegetable consumption. This type of approach is supported by many studies documenting the power of community-based interventions, and is much more comprehensive than the individual-based Fruit and Veggies More Matter Campaign.13,14
The FAVA campaign will address two main environmental barriers to increasing fruit and vegetable consumption. The first is limited availability of fresh produce in low-income communities. The campaign will tackle this issue by setting up weakly farmers markets. Studies have shown that farmers markets can play an important role in bringing fruits and vegetables to areas that are currently underserved by supermarkets.15
The farmers market will be located in a central location that is accessible to the majority of the population. The time and place of the farmers market will be advertised using local media outlets. In the beginning, the farmers market will feature samples of prepared vegetables and live music courtesy of local musicians. Over time, people will come to associate the purchasing of fresh produce with values of community and socializing.16 The farmers market will also provide an arena for educational displays, cooking demonstrations with vegetables, and festivals that help consumers get involved in the farmers' market experience. This initiative is much better than Fruit and Veggies-More Matters because it recognizes access issues and social norms as important factors that impact an individual’s fruits and vegetable consumption.
The second environmental barrier is limited access to grocery stores. New research is beginning to provide support for the role of grocery stores as important contributors to nutrition among residents of neighborhoods.15 A recent study found that individuals’ fruit and vegetable intake increased with each additional supermarket in a census tract.17 To address this access issue, FAVA will set up a shuttle to the nearest grocery store once a week.
Overall, these environmental initiatives are a huge improvement from the Fruit and Veggies-More Matters Campaign which fails to challenge the social structures that shape people’s choices and decisions.
Several studies have demonstrated that group dynamics are very powerful predictors of behavior.8 In particular, people are more likely to change if their close acquaintances have adopted a new behavior.8 In light of this, the FAVA campaign will organize free drop-in evening group cooking classes at local schools and/or community centers that target entire households, group of friends, and families. Community members will be invited to spend an hour cooking meals that satisfy current recommendations for daily fruit and vegetable consumption.
Once these cooking nights are well established in the community, special nights will be organized featuring different themes. For instance, there will be a family night, friends’ night, and student night. These sessions will provide a great environment to foster positive social norms around cooking fruits and vegetables. In addition, the teachers of the class will include a diverse group of community members, ranging from single parents, working couples, retired adults, and even high school students. This will ensure that the teachers connect well with the majority of community members. Also, to promote community involvement, participants can volunteer to help teach future classes.
An increasing number of published studies have shown that an intervention that targets social norms is an effective method of promoting health behavior.18 In addition, community settings where groups of people interact offer important potential for improving eating patterns.15 These findings make it clear that the FAVA initiative will be much more successful than Fruits and Veggies-More Matters.
The evening group classes will also be used to address cultural factors. In particular, culture-specific nights will be organized. The teachers will be of a similar cultural background as the participants and will teach simple ways to incorporate fruits and vegetables into specific dishes. This initiative is important given that food plays a large part in cultural identity.6 Moreover, unlike the Fruit and Veggies-More Matters Initiative, this approach allows individuals to change their behavior without feeling culturally isolated.
II. People are irrational
The Fruit and Vegetable Alliance (FAVA) campaign acknowledges that people do not behave rationally, especially when it comes to dietary decisions. One irrational characteristic is that people rarely value health. In light of this, FAVA will target more influential values such as community, friendship, attractiveness, autonomy, and ownership. FAVA will create a set of commercials that utilize the principles of Marketing Theory and Advertising Theory.
Marketing Theory will be used by “branding” fruits and vegetables so people associate them with values that are important to them.19 For example, the FAVA commercial will show a group of attractive-looking friends cooking vegetable dishes together and then sitting down to dinner. People who watch the commercial will connect vegetable consumption with attractiveness, friendship and having fun.
In addition, this commercial will use several of the principles found in Advertising Theory. 19 In particular, it will promise people that eating fruits and vegetables will improve their appearance, and will offer the benefit of meeting new people and learning new cooking-skills. These promises will be backed up by the images in the commercial and captivating background music. As an aside, a version of culturally-appropriate commercials will be developed in order to accommodate all racial and ethnic groups. This will ensure that the campaign message reaches a diverse group of people.
Another set of commercials will show a group of people going to the free evening cooking classes or visiting the farmers market. These commercials will also be based off of Marketing and Advertising Theories. Instead of attractiveness and friendship, these commercials will promote values of community. In addition, these commercials will serve as useful advertisements for the farmers market and cooking classes. Furthermore, this media campaign will help to integrate all the different aspects of the FAVA initiative.
These commercials are a significant improvement over the Fruit and Veggies-More Matters campaign. This is because rather than targeting health, they focus on more pertinent values. Also, campaigns based on Marketing and Advertising Theory have proven to be successful at targeting masses of consumers and changing their behavior simultaneously.10,11 One such campaign was the Truth campaign which used both of these theories to effectively prevent adolescent smoking. 11 Lastly, studies have shown that the use of advertising is a useful strategy in encouraging the purchase of fruits and vegetables.15
III. Behavior is Unplanned
Unlike the Fruit and Veggies-More Matters campaign, FAVA has tailored its intervention to accommodate unplanned behavior. First of all, the free cooking classes are in the evening, offered several days a week, and are on a drop-in basis. This increases the likelihood that busy people are able to attend. Also, the sessions are taught by busy people who understand where people are coming from and are able to offer useful advice on how to work around the unplanned nature of life. In particular, this initiative will allow for the exchange of recipes that incorporate fruits and vegetables into meals without having to plan.
Secondly, the farmers markets provide opportunities for unplanned shopping. For instance, having farmers markets situated near train stations, child centers, schools, places of employment, or other locations on the way home, will increase the likelihood that people will stop-by.15
A third initiative that FAVA will implement is to encourage local grocery stores and farmers markets to distribute recipes featuring easy to make vegetable-rich meals. The recipes will involve very simple ingredients and even direct people to the appropriate aisle. This will be valuable given that most people’s shopping experience is unplanned. 15
Overall, the Fruit and Veggies-More Matters campaign is flawed because it assumes that life is very predictable. Fortunately, the FAVA campaign is much more realistic and accounts for unplanned behavior.
The Fruit and Vegetable Alliance (FAVA) is a multi-faceted campaign that consists of community-based initiatives ranging from farmers markets, group cooking classes, commercials, and improved grocery store accessibility. This type of approach is well-supported by the literature and offers a promising strategy for dietary behavior change.20 All in all, the FAVA campaign addresses the main flaws in the Fruit and Vegetable More-Matters campaign; it is community-based and it accounts for irrational and unplanned behavior.
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