The family is often considered to be the primary way in which care is delivered – whether this is for children, the ill, those with particular needs and older people.  And while many families are effectively engaged in these different sorts of care, the fact is, as charity Age UK point out, there are 2.6 million people in England aged over 50 are unable to get care, including hundreds of thousands who are stuck on waiting lists for support or even just waiting to have their needs assessed. That means millions left struggling to meet their basic needs like go to the toilet, eat, get dressed or wash because they can’t do these things unaided.

We clearly have a challenge with the family unit being the leading mechanism for care to be delivered outside of public health services.  We make a case that different sorts of approaches can be used as ‘interventions’ for effective delivery of care: to do this we explore the nature of family in the delivery of care from a behavioural science perspective. The intention is to bring different thinking to this space in an attempt to address some of the longstanding challenges. A large part of this is to consider how friendship can be a key ingredient of the means we have available to draw on to deliver care.

The value of friendship

In her book, Radical Intimacy, writer Sophie K Rosa suggests the COVID era taught us that new approaches to care are possible. She made the point that many of us were able to find solace and pleasure in more communal approaches to care.  These included getting to know our neighbours better, grass-roots development of community led food co-ops, collaborative home schooling and the proliferation of WhatsApp groups to co-ordinate delivery of provisions to people isolating and to ask for, or offer, other kinds of support. 

There is a great deal of psychological research that suggests these sorts of approaches offer stable, healthy friendships which are crucial for our well-being and longevity. People who have friends are more satisfied with their lives, less likely to suffer from depression and are less likely to die from all causes, including heart problems and a range of chronic diseases.

So not only can friendships offer a means of delivering and receiving care, but the mechanism itself fosters wellbeing. This offers us an interesting lens for care alternatives that go beyond considering the family as the primary unit.

But what about the family?

The family is of course in many ways a highly successful and effective means of delivering care, offering people with various needs a stable caring set of relationships.  But at the same time, it often places the burden of care on one person, with women doing a disproportionate amount of the work. Of course there is movement for gender equality in this regard but as Alva Gotby points out, for women care work is typically performed on top of waged work.

Following on from last week’s article, Gotby suggests we could do well to think of families as work relations: arrangements of work, care and economic distribution entangled in property relations through practices of inheritance and privatisation of kinship. Whilst this might seem a very unfamiliar way of looking at families for many us, it is perhaps more easily understood by those that are structurally excluded – when family are no longer around or want nothing to so with them. 

In addition, the nuclear family is ever more unstable with high divorce rates; no new models are taking its place which is a problem as access to care and resources remains tied up to membership of family. Writer and psychotherapist Esther Perel talks about expectations that mean a single person (in a couple) is meant to provide what a village would provide:

“We keep wanting more. We are asking from one person what once an entire village used to provide.”

What alternatives are there?

As Rosa points out, we saw in COVID that care can come from ‘kinship’ that is not exclusive to families – friends in the community we live in can also provide this role.  Alternative models of care based on these sorts of relationships often come from groups that are frequently marginalised in society.  Perhaps because these groups have little to lose, they often lead the way in alternative ways of living that can act as inspiration for more radical care delivery structures.

Rosa highlights the African American tradition of ‘othermothering’ in which being an extra parent of someone else’s child means there is a guardianship of the community as a whole. Stephanie Coontz writes that black families have historically also been less likely to institutionalise the elderly as these people were instead cared for within extended kinship networks.

There is also a long history of working-class camaraderie outside the family, with sociality less anchored in familial terms. So whilst the family is a key part of care, there is a much more extended care network available through wider family ties, friendships and community engagement. As Rosa puts it:

“Most working-class people understand it perfectly well because, globally, most working-class people are…raising children that aren’t theirs with friends, siblings, cousins, partners, neighbours. Because this is all they’ve ever known culturally.”

Queer communities have also traditionally looked for care and support from places other than the nuclear family, Rosa writes about the QueerCare network, a trans-feminist autonomous care organisation providing training support and advocacy for queer and trans people aiming to build communities in which people know how to look after each other, with the necessary resources from nutritious food to medical equipment to legal support.

Rosa also writes about the way sex workers demonstrate the power of community care in the face of stigma and exclusion in mainstream services. Mutual aid includes organising meet-ups to share info and resources, building community safety networks online, and creating hardship funds and workers’ co-ops during times of crisis.

Projects of world making

It is clear from these examples that there are many different ways of organising ourselves and delivering care that loosen our reliance on the family.  This allows for more expansive forms of intimacy and emotional practices based on shared aims, rather than the privatised arrangements that come with family.  Other examples show the the possibilities of these more creative practices in different areas of care:

Housing: This recent article sets out how almshouses offer a form of collective care that has very real benefits: this is the oldest form of social housing in the world: they were exempt from the UK right to buy legislation and remain a permanent part of the community. A recent Almshouse Longevity Study found that those living in an almshouse receive a longevity boost of almost two and a half years – equating to an extra 15% of future life for someone aged in their early 70s.

Health: Peer support networks for those with chronic illnesses offer digital tools clearly offer opportunities for people to do just this, connecting us with others who might be a similar position and offering relevant experience and expertise.  These have been very successful in healthcare where people connect with others, in particular for instances of chronic conditions. People can be very creative, have plenty of ideas and sometimes even physical resources that they bring to an issue; so the opportunity, as peer support systems gain momentum is that it is possible to co-create with people as partners in the behaviour change challenge rather than treat them as passive recipients.

Food: Human geographer Megan Blake created Food Ladders, an evidence-based tool that helps local organisations increase everyday food security and connect communities by looking at the root issue of vulnerability. The framework identifies three crucial interventions to help small communities create cohesion when facing with high levels of food insecurity: Catching: provision of emergency food, food banks, access to social services to ‘catch’ the individual and help them cope with their immediate situation. Capacity building: to support those who are not in crisis but don’t have regular access to nutritious food. This is based on creating networks and social relationships through food such as voucher schemes, holiday clubs and shared cooking activities. Self-organised community change: supporting the local community, encouraging the creation of self-organised projects such as  cooperative food growing, regular social cooking to overcome loneliness.

Conclusions

Writer M.E. O’Brien suggests that “new heterogeneous family structures are a symptom of desperation as much as they are of the practice of care.” We can see how rethinking care to focus on friendship certainly offers interesting ways to support people that is less reliant on the ‘privatised’ care of families. These work for many people but far from all, either the care giver or the receiver.

It feels as if there are some key learnings for behavioural science practitioners here:  first, when considering when ‘interventions’ in the area of care, then it is important to be educated on the considerations that people such as Rosa highlight: that care delivered through families is not always available to everyone and that even when it is, there can be challenges for all involved. 

Second, more can be done to understand the psychology of different forms of friendship and the ways in which this can be a brought more to the fore as a means of supporting individuals and communities. 

Finally, there seems to be a relative lack of behavioural science on this topic – we call for a greater focus on the behavioural mechanisms that can facilitate the development of non-traditional caring communities and a better understanding of the effectiveness of the way in which both the public and private sector is able to both instigate but also support activities in this area.

Nearly half of working-age women are providing an average of 45 hours of unpaid care every week, while 25% of men provide 17 hours, according to a study from the thinktank Centre for Progressive Policy.  The disproportionate impact of these caring roles on women have serious consequences: one in three women say it blocks their career advancement, and linked to this, 22 per cent of women have persistent low income, compared to approximately 14 per cent of men. In other words, there are very serious structural consequences for women as a result of their caring activities.

Care giving of course involves physical and material assistance but also, at the heart of it, is emotional support.  This is often considered to be a characteristic of human behaviour that is highly authentic, reflecting an aspect of ourselves out of our direct control, as well as revealing of our ‘real’ preferences.  On that basis, it is easy to assume that women, who perform the bulk of the emotional care work in society, are doing this as a natural expression of their authentic spontaneous feelings, a natural part of their personalities.  

Behavioural science can be called upon help us look at this issue more closely, examining the assumptions about how emotion works.  And in doing so, we explore how emotion is treated in behavioural science, setting out how more can be done to develop a broader understanding of the wider based cultural mechanisms shaping the way we understand gender and emotion. We propose that this approach means we have alternative ways to consider the issue of care.

Emotion as authenticity

Much has been written about emotion and the way it is a signifier of something ‘authentic’, in contrast to our self-report that is somehow considered ‘contrived’ by comparison. Sitting underneath this is a view of emotion in terms of innate drives, reflecting instincts that mean we react in particular ways. So ‘anger’, for example, is a built-in defence mechanism of our animal ‘fight-flight-freeze’ pathways reflecting the notion of biological determinants, as shaped by evolutionary pressures.

Of course, as we have pointed out previously, this has long been challenged by people such as Lisa Feldman Barret who suggest that we do not construct our emotional concepts individually but are reliant upon social constructions through the culture we inhabit.  She illustrates this by pointing out that Russian has two distinct concepts for ‘anger’; German has three and Mandarin has five – making that case that if emotion were instinctual states, we would expect there only to be one.

It is easy to assume that our intuitive emotional responses are a marker of the wiring of our brains rather than reflective of the effects of culture.  And yet, it can seem behavioural science shies away from an exploration of what these cultural mechanisms actually look like.  Simply pointing out that emotional concepts are reliant upon our culture does not give us very much information to understand how this shapes behaviours (and therefore how to go about addressing them).

To help address and examine this further we call on the work of writer and organiser Alva Gotby.  In her book ‘They Call It Love: The Politics of Emotional Life’, she sets out a cogent case for the way that, as she puts it “Feelings are not non-political or private.”  She suggests that emotion is impossible to understand without exploring its deeply gendered connotations. 

Gender and emotion

Central to her argument is the way that the social rules for expressing emotion are very different for men and women: women are required to perform the management of good feelings – not only in the workplace but in their personal lives.  As such, women are seen as responsible for the emotional work that keeps everyone functioning at home while men tend to consider they only need to do the non-emotional labour, such as heavy lifting and technical expertise.  This emotional work is essential for communities, yet it is devalued and underpaid. Indeed, the CPP estimates that women in the UK are providing 23.2bn hours of unpaid childcare care worth an estimated £382bn, while men provide 9.7bn worth £160bn.

There is also something else significant going on: women’s emotional labour is seen as a natural expression of their authentic spontaneous feelings, a natural part of their personalities.  As writer Leopoldina Fortunati points out, this notion of women as generous implies that care is its own reward and to perform this work is a sufficient source of pleasure so that no other remuneration is needed. 

In this context masculinity appears as a lack of capacity for care, allowing men to often ignore the needs of others.  Gotby suggests this leads to men being less likely to perceive or be influenced by emotions as they have not had to train themselves in attending to the emotional needs of other people and can therefore put their own needs first. Indeed, this reflects the way in which women can end up acting as ‘conversational cheerleaders’ enhancing the social performance of others.  Pamela Fishman suggests that women are more likely to demonstrate they are actively listening, affirming their partner’s opinions and choices. 

All of this, Gotby suggests, creates a lived experience of our interior selves which feels masculine or feminine, with these gendered feelings appearing to reflect our authentic selves. On this basis, we are taught to see a particular type of labour coming from within the person rather than being externally imposed. 

This can be difficult to see because, as Gotby points out, women are often actively working to erase any signs of emotional labour, disguising it under banners of ‘niceness’ and ‘natural femininity’. This makes the emotional work an invisible backdrop against which more visible forms of labour and production to take place.

Perversely, while women perform more of the invisible work of attending to the feelings of others, Gotby suggests they are deemed to be excessively emotional themselves. This is a function of the circular association of femininity and emotion: femininity is devalued because of its connection with emotionality while emotion becomes devalued when coded as feminine.

Codified into labour

Because emotional labour is so deeply naturalised and seen as inherent in the personality of the worker, then it fails to acquire the status as saleable product separable from its seller. Revealing these mechanisms was the focus for 70’s activist group, Wages for Housework. They suggested, among other things, that women might choose to only smile when paid for it, and through this undermining the assumed authenticity of women’s emotional display.

Gotby suggests that the shift we need to make is to see emotional labour as work that society has imposed on them, which deserves to recognised as work, rather than a reflection of their supposedly natural interior lives. When women voice discontent with their position it is typically individualised rather than, as Gotby suggests, interpreted as acts of resistance. In other words, complaining women “are seen as nagging bitches, not workers in ‘struggle’.”

The Wages for Housework movement suggests an interesting reinterpretation of emotional practices: they suggest that ‘outlaw emotions’ such as anger can be used to broaden the way we see possible emotional practices: the process of pushing back through anger means that emotion moves from something individual to something communal.  As such, emotion is less concerned with the inner truth of an individual and instead we can see it as a collective habit that can become a political tool. 

Interestingly, comments about the collective nature of emotion is referenced in a 2019 paper by David Garcia and Bernard Rimé  that shows how this collective influence of emotion can transform the experiences of certain events (the paper looked at data collected from Twitter users after the Paris terrorist attacks of November 2015).

Implications for behavioural science

There is so much more that Gotby unpacks in her book than we can do justice to here. But, for our purpose, her work sets a challenge for the discipline of behavioural science. The points she raises run counter to a lot of the way in which emotion is referenced in behavioural science: these issues are either represented in non-mainstream parts of the discipline (such as Gender Studies) or generally ignored. 

Of course, mainstream behavioural science perspective does at times borrow from other disciplines to assist an understanding of broader societal issues. One example is Roy F. Baumeister and Kathleen D. Vohs who draw on economics and social exchange theory to offer a theory of sexual interactions.  But there has been little representation from the Feminist, Queer and Trans studies as well as Black Feminism sources that Gotby uses: surely these should be informing conversations in behavioural science? We argue that given behaviour can be understood using these disciplines, then they should be within the remit of behavioural science.

To ignore them and assume, in this instance, that emotions are a reflection on internalised states or simply to wave a hand loosely in the direction of ‘culture’ then we fail to properly understand the behaviours that we all have an interest in from marketers, policy makers to employers and all of us as individuals.

Implications for care

Failure to consider the way the social constructs that elide emotion and gender means we can over-emphasise certain aspect of the issue and not look closely enough at others.  Gotby suggests that there is too much of a focus on equality and the notion that men should help out at home.  Whilst this may be true and important, it does little to spell out the ‘labour relations’ and relations of power that created this set-up in the first place.

It also fails to address the way that women tend to retain the principal responsibility for ensuring domestic work gets done, even when they are shared more equally.  She suggests invisible forms of labour tend to remain unequally distributed even in supposedly egalitarian relationships and masculinity remains the standard against which women’s sameness or difference is measured.

Finding solutions therefore needs a greater focus on the systems that are in place and understanding how these create the outcomes we are seeing (perhaps another opportunity for Ruth Schmidt’s SPACE model).

In summary

Gotby’s book carefully sets out the arguments for the way that a rich and comprehensive literature is available to shed light on a significant range of issues – in this case how we need to understand what Gotby calls the ‘political economy of love’ to help unpack how we manage care.

Failure to bring this literature into a wider behavioural science analysis not only runs the danger of an outdated analysis of how to resolve some of our big societal challenges but also means we fail to properly understand some of the core pillars of the discipline.

Wellness is a term that is used to describe a huge range of areas as diverse as health, finance, dietary supplements, yoga, ‘chemical-free’ beauty products and clean eating, to name just a few.  How do all these disparate topics all come to be clustered in this way?  What is the underlying logic that puts them all under the heading of wellness?  Perhaps wellness does not have a fixed, shared meaning, in which case the things that we each see as legitimate to be considered as wellness may well vary depending on your point of view: one person’s notion of wellness may well be very different to another person’s. This means we can find ourselves in the position where some groups feel that others are defining wellness in a way that excludes them.

To help us unpack this, it is worth considering how we classify things – and then explore how this has significant implications for the way we go about wellness.

How we decide to group things

Psychologists Douglas Medin and Andrew Ortony coined the term ‘psychological essentialism’ to reflect our tendency to think of the world as divided into discrete kinds of things, each of which has as ‘essence’.  By this we mean an underlying quality that makes it part of a category of things.

Biological species are a prime example. It seems like a near universal human activity to organise the animal kingdom into species. But what gives an animal membership of a species? For example, what is it that makes a certain animal a porcupine? It’s not its quilly appearance as a porcupine without quills is still a porcupine. We tend to believe tacitly (and often explicitly) that what makes an animal a member of a certain species is less about its outward appearance but instead it is some deep fact about it – in this case, the porcupine essence – even though we might have no coherent idea of what that essence actually is.

This tells us something about wellness: we have a sense that a bunch of different things fit into this category we call wellness, but we do not really know what it is that determines this.  In a recent book, Colleen Derkatch interviewed 40 Canadians who regularly take natural health products and are actively interested in wellness. When they were asked to define wellness, she writes that their definitions were “thoughtful but nonspecific and often circular, with frequent pauses, false starts and frequent interruptions.” This surely illustrates how we have a bunch of activities that all have an ‘essence’ of wellness, but we do not quite know what that essence actually is!

Consistent with this, Medin and Ortony argue that we often do not have a fully worked out explanation of what the essence is that determines category membership. What we have is an ‘IOU for a theory’: a belief that there must be something that plays the role of essence, even though a description cannot be readily supplied.  And so surely this is the case with wellness.  We sense that we know what it is when we see it, but we cannot really pin down the ‘essence’ that binds these disparate activities together.

Wellness and cultural cognition

One way of understanding these intuitive decisions about the essence of categories such as ‘wellness’ is cultural cognition: the way cultural values shape our beliefs. To this end, we turn to the work of Dan Kahan who outlines the way cultural cognition explains why groups with different cultural outlooks (such as left or right of centre political orientation) disagree about important societal issues. 

Clearly there is a huge array of cultural values we could choose from: what we are seeking in the context of wellness is those values that help to explain how such a diverse range of items could be included in this category. We could, for example, choose a cultural value such as ‘naturalness’ but this does not help us to determine why things as diverse as financial wellbeing and Reiki are both considered to be wellness solutions.  

This huge variability in the topics in the category determines the cultural values we can draw on to look at this issue. We suggest two axes are useful here:

• Cultural reference points: This is the way some people value ‘mainstream’ cultural references versus those that value more ‘fringe’ reference points.

• Sources of authority: Some people value institutional sources of authority whilst others may look for authority from alternative, unorthodox sources.

For illustration purposes, we can see how this applies to a range of disparate wellness activities. For example, cold-water swimming is supported by evidence that is debateable, but largely considered to sit in mainstream cultural reference points.  By contrast, other activities such as those we saw relating to the use of crystals for wellness arguably lack an evidence base of effectiveness beyond a placebo effect and we might consider they tend to appeal to people that typically have more fringe cultural reference points.

Similarly, a focus on topics such as financial wellbeing are often the focus for those people that value both mainstream cultural references and the role of institutions to validate the claims made.  And finally, activities such as micro-dosing are in focus for those that value activities that are worthy of exploration by science- based authorities but that, nevertheless, draw on fairly fringe cultural references.

It is important to note that these categorisations are for the purposes of illustration and hypothesis generation –primary research is needed to validate and flesh them out.  But hopefully they show the way we can see the way in which these cultural values shape the way in which people can have quite different ways in which they understand wellness – whilst at the same time all these different activities continue to fall into the category.

This is not a static picture: for example, yoga has arguably moved from a position in which people that preferred fringe cultural references and relied on unorthodox sources for to assess veracity of the claims have now moved to a position which appeals to those that value mainstream cultural references and institutional sources of evidence. But in that process, we can expect the original proponents of yoga may feel that this transition (and the inevitable change in the way it is practiced) has resulted in an inauthentic variant of the discipline (in the way it is practices and positioned) which no longer appeals to them.

With this in mind, we can see how some groups consider they are effectively excluded from some versions of wellness. This is the perspective of Fariha Róisín who sets out the way that wellness culture has become a luxury good that excludes Black, brown, and Indigenous people.

We can also see the way that some wellness practices are driven in part by the ‘Underdog effect’, as those holding minority beliefs and challenging widely accepted scientific perspectives can feel as if their perspectives are being closed down by authorities. Given this, it is not difficult to see how conspiracy theory provides a common language, bringing these beliefs together as there is an embrace of stigmatized, or rejected knowledge. This is increasingly explored in the issue of Conspirituality, which seeks to explore a ‘rapidly growing web movement expressing an ideology fuelled by political disillusionment and the popularity of alternative worldviews’.   

In conclusion

Given the huge theoretical and practitioner base concerning wellness activities, it might seem strange to suggest there is a lack of fixed share meaning.  But what theorists understand versus the wider public can of course be very different.

Across the wider public there is a case to be made that the logic that links together the different items the category is elusive.  Many items are placed into the category of wellness, but the lack of a shared, fixed meaning can lead to intuitive definitions, shaped by very different (and likely unexamined) cultural values that we hold.

Should we be concerned?  There is, after all, a raft of things that we need for our wellness and different things will work for different people. But perhaps without some clearer shared meanings of what wellness involves, then we also run into dangers: some groups can be excluded from certain activities as it seems that certain wellness behaviours are tacitly only approved for specific groups of people. But also some may find it a surprise that although the way while they define wellness in a very mainstream way, it also sits in the same category as practices which are very fringe. Nothing wring with that necessarily but perhaps not always what is expected by people offering these services.

A more explicitly multi-dimensional understanding of wellness is perhaps called for which does not rely on intuitive cultural nuances: given the grouping is used then we might infer that there is an underlying essence that has a logic for people.  But perhaps more clearly identifying different orientations to this diverse discipline that reflects the key cultural values that shape the way people understand it, could well be a helpful approach.

Being well is something that concerns us all – indeed there are surely few more pressing issues for humans than our health and wellness. There is a huge investment to underpin this: the NHS costs the UK almost £200 billion, and McKinsey estimates the private wellness market to be worth $1.5 trillion globally, with an annual growth of 5 to 10 percent.  The scale of this spend reflects the way that health and wellness are issues that have long been the concern not only for all of us but health practitioners, policy makers, marketing strategists as well as science and technology companies.

The challenge for those with an interest in wellness is that is a slippery term and a hard topic to pin down – there are numerous definitions of what it is and many different considerations of how to achieve it. For example, the ONS have five different measures for being well covering the  individuals’ satisfaction with life, whether they feel the things they do in life are worthwhile, their positive and negative emotions, and their mental health.  They also identify 44 indicators, such as relationships, health, how we spend our time, where we live and so on. 

Whilst of course this is invaluable, perhaps this complexity suggests we could locate other ways of looking at this issue: might other ways of approaching the issue offer more simplicity and directness in how to tackle the challenge?

To do this, we highlight two key considerations. The first is definitional: what do we mean by wellness? Despite the ease with which we use it in everyday life, it is a surprisingly hard concept to pin down.  The second related issue is measurement: what are we actually measuring when we ask people about it? 

From this starting point we set out the case for challenging some of the thinking on these related issues and offer fresh perspectives on what it is and how we measure it: and with that, what we do to enhance wellness individually and societally. We  draw on the work of Iza Kavedzija to make the case that we can reframe the issue and rather than think in terms of outcomes and causes, perhaps it could be helpful to consider wellbeing as a process.

Definitions: wellness and wellbeing

There are two terms commonly used in this area – ‘wellness’ and ‘wellbeing’.  While they are used interchangeably, they have very different histories (note that we are using the term wellness in this article for simplicity).  This is useful to understand as they reflect quite different traditions in terms of what it is believed people need to ‘be well’.

The term ‘wellness’ has its roots in the biomedical—and frequently physical—as the “absence of any disease or impairment” and this continues to be the dominant way in which the term is used in public health.  However, the notion of ‘wellness’ has gradually gained in popular usage since the 1960s as the responsibility for being well has been increasingly been assigned to the individual, giving them tools, devices and drugs to manage their own happiness and efficiency. 

This has also led to people seeking to be the best possible version of themselves, to be as productive and ‘perfect’ as possible.  With the freedom from extrinsic control (as society become overtly relaxed) came instead a more powerful set of internalised intrinsic controls on ourselves, so that we demand of ourselves that we continuously improve.  This has been accompanied by a rise in technologies and solutions suggesting we can be a better version of ourselves.

Whilst ‘wellness’ has increasingly been associated with individual ways to optimise mental and physical outcomes, at the other end of the spectrum ‘wellbeing’ has often been associated with the notion that group-level factors are important for us to be well.  As such this will include themes such as mutuality, belonging, mission, justice, relational growth, effective leadership, and trust.  In fact, the World Health Organization defines health as “a state of complete physical, mental and social wellbeing”.

In summary then, we can then see that there are some very different traditions reflected in the terms ‘wellness’ and ‘wellbeing’.  Wellness is typically being associated with individual ways in which we are not only free from disease but also we are the best possible version of ourselves, physically, mentally and lifestyle wise.  Wellbeing on the other hand is often related to our embedded, social and communal lives, associated with the conditions in which we are able to feel secure and happy and able to flourish and thrive.

Measurement

Definitions are inevitably tied up with measurement approaches. A traditional approach to measurement would focus on disparity using a range of ‘objective’ indicators such as household debt, health, other welfare measures, reflecting a narrow view of being well (being physically and mentally healthy).  However, it is long been argued that we also need Subjective Wellbeing Measures that are better able to reflect a more nuanced view of wellbeing, reflecting how happy or satisfied we are. Socio-economic data may offer a range of insights into the circumstances of the population, but they do not necessarily tell you what people are thinking or feeling. Indeed, as leading policy expert Gus O’Donnell sets out:

“…an austerity programme or a recession will cause some people to have lower incomes, which economists regularly measure through the change in GDP, or to lose their jobs, which we measure through unemployment rates. But we rarely take into account the worry, stress, or anger that people feel in dealing with these things.”

If we simply measure what people are doing rather than how they feel, or how they think about things, there is a danger that we fail to represent what really matters to us. That led to an opening-up of the being well debate to a broader set of disciplines, reflecting a willingness to embrace a more nuanced (and with this inevitably more contested) approach to the topic. 

There has been a huge amount of activity in the measurement of wellness which is of course to be welcomed as much continues to be achieved by this focus.  And we see the ‘wellness’ versus ‘wellbeing’ debate reflected in the different forms of measurement with people such as Sarah C. White pointing to the way that Western societies have stress individual responsibility, including for their own happiness. This culturally shaped mindset seems to come through in many of the attitudes people report on their own being well.

We speculate that we are in the midst a shift from more individual considerations of wellness to a recognition of its more relational characteristics – from ‘wellness’ to ‘wellbeing’. But there is something a little nuanced and perhaps more even more important that we can also add to this. 

The move to self-report measures may well have led to a focus on measuring outcomes:  this is not unreasonable and is very much in the social scientists repertoire: we can then examine the way in which different inputs influence our wellbeing. But this assumes wellness as reflecting something we have – that there is a quantity within us individually that we can account for. And even if you take a more ‘wellbeing’ perspective (focusing on the social / relational determinants of being well), this still assumes the primacy of the individual level measurement of being well, albeit weight is given to the way this is influenced by social / relational factors.  But the notion that wellness is something that we can have certain amounts of is not quite as safe assumption as we might have assumed.

From outcomes to systems

To help unpack this a little, we turn to the work of Lisa Feldman Barrett who has developed a huge body of research on emotion. One of the core concepts that she uses to reference the way emotion works is ‘allostasis’, the process for the way the brain regulates the body according to costs and benefits, efficiently maintaining energy regulation. This has some fairly radical implications for our purposes: namely that brains did not evolve for subjective wellbeing outcomes but rather that our wellness is a useful by-product of effectively managing our allostatic load.

If this is the case, then there is an argument we are looking in the wrong place to measure wellness – what we need to understand it is less an outcome and more as a process.

While anthropologist Iza Kavedzija’s work does not explicitly reference allostasis, it does highlight the importance of processes for wellness.  The proposal is to shift the focus away from individuals and to think of people as continuously made up of interactions and their caring relationships with others.  This moves us away from a focus of wellness as an outcome or an achievement – it is not something we seek to attain or possess.  It is a quality of how multiple relationships that make up our lives unfold over time.

This means that to tackle wellness we need to think of the way we are all the result of our ‘relations of care’. To maintain this means we need to attend to ‘networks of care’ that might be in need of support or repair – and we therefore need ‘scaffolding’ that allows these caring relations to function effectively. As the landscape we inhabit changes, then so does the way in which these networks of relationships are managed.  The impact of the cost of living crisis is important here: we can see how this can devastate the way networks of care operate, resulting in much poorer wellness communities.

We need to recognise the importance of our entanglements with others as we seek to live well together: this reliance on others means that when we want change to happen, then we are not doing this individually but as a more collective endeavour. We can therefore see wellness as circulating in a network of relations of support rather than a simple cared / care-for pairing. 

In conclusion

Given this process-based approach, the focus of wellness measurement should surely move to considering the wider environment in which we live (based on what we know is important in terms of wellness).  The emphasis could be more inclusive so that we do not rely quite so much on individual outcomes (‘how much wellness do we have’) but to an identification of the structures (or systems) that are key to delivery of wellness (such as family, work, housing) and assessing how well these are ‘performing’, able to facilitate care and associated characteristics needed to create an environment that supports us.

Systems level thinking and measurement is again needed as we see how some environments facilitate a much better wellness community than others.  Adapting approaches is useful, such as Ruth Schmidt’s SPACE model which references the impact of ‘choice infrastructure’, but also tapping into wider narratives such as Doughnut Economics that emphasises the importance of holistic frameworks.

More on this important topic in future posts..

There has been an explosion in plant based foods with a recent report finding that 48% of the UK adult population claim to include at least one type of plant-based alternative to cow’s milk in their everyday diet (and 58% include at least one type of plant-based meat alternative). The finding is impressive for the industry, which is seeing record levels of investment.

The growth in the market is also a source of some controversy, with a recent report by Bloomberg suggesting that ‘plant-based meat is turning out to be a flop’. The article, was criticised by leading plant based food manufacturer, Impossible Foods, who called it “one-sided anecdotes and editorialized framing.” No doubt this debate will continue to run but it does raise the question of the degree to which demand for plant based foods will match the investment.

Navigating Naturalness podcast

To maintain the growth we have seen, it will be important to understand the different barriers to purchase of these types of food.  And a key consideration was recently flagged by Unilever in their quest for ‘cow-free’ ice cream.  Their R&D centre is exploring the use of ‘precision fermentation’, essentially using yeast to make dairy proteins (such as whey) that deliver the flavour of animal milk. The challenge posed by Unilever President of Ice Cream Matt Close was that customers may not perceive products made this way as being ‘natural.’ He suggested “What you don’t want consumers to think is that this is somehow fake and too scientific.”

This is certainly backed up by polling data (from the US at least) that indicates people have much greater trust in ‘foods that are naturally occurring,’ as shown below:

At one level, the evidence seems clear, that naturalness will win the day, and this could represent a challenge to the potential of plant-based foods.  But if we take a closer look then the findings are perhaps less clear. For example, while there is some resistance by meat eaters to become ‘flexitarians’ due to concerns about the ‘naturalness’ of plant-based milk and meat (see below), whilst there are also a similar number (10% for meats and 13% for milks) that feel that plant-based options are the more natural (data drawn from this report).

So just what foods we consider to be natural is clearly contested: perhaps to understand how to address this, we need to better understand the underlying psychology of the way we think about naturalness.

Defining natural

What does ‘natural’ mean to you? Is it a physical property of an item that has been freshly picked, for example, or home grown? Or is it something more abstract or conceptual? Either way, naturalness is desirable; it evokes images of untouched wilderness and of freedom, and can conjure a sense of spirituality, imagination or potential. 

Equally important is the feeling that naturalness carries a sense of appropriate order, or rightness - things are operating as intended. The word ‘natural’ in consumer marketing, especially in food, conveys ideas of purity, healthfulness and, above all, value.  Consumers, regardless of age, gender or other demographics, seem to consider ‘natural’ foods more desirable and worth more than ‘non-natural’, ‘artificial’ or ‘processed’ alternatives. 

There are typically two types of justification for wanting naturalness: instrumental and ideational. Instrumental reasons, which are the focus of much research, refer to the perceived advantages of naturalness, the feeling that it is inherently better - more attractive, healthier or kinder to the environment.  But it is not as simple as this.  When consumers’ instrumental reasons for preferring a natural item have been neutralised by offering, for example, an option that is chemically identical, the preference for the naturally derived item remains.  

This suggests that we also have ideational notions of naturalness – more abstract moral or aesthetic concepts, as opposed to the material health or environmental benefits of instrumental justification. 

An example of how this ideational conception of naturalness can matter as much, if not more, than instrumental reasons is the ‘toilet-to-tap’ phenomenon. All water is physically contaminated, and endlessly recycled. However, when people are asked if they would drink water that has been recycled from toilet water, the vast majority of consumers refuse to do so. The idea evokes feelings of disgust, a strong emotion often associated with bodily products. There are no practical (instrumental) reasons why we should not drink this water: our concern is to do with how we think and feel about it (our ideational response.)

Naturalness and processing

So what determines these ideational properties? One key finding from psychology suggests that our perceptions of naturalness of foods are influenced by the type and degree of processing it undergoes.  Natural items are fairly uncompromised if they are mixed with other natural products (such as fruits in a smoothie) or if there are changes in the physical states (such as freezing or crushing). However, if the natural product undergoes a change in the nature of the substance – such as by boiling, adding less natural items, or subtracting items from it, then perceptions of naturalness are significantly changed.  

To understand more about the effect of processing on perceptions of naturalness we can turn to psychologist Paul Rozin’s classic experiments with water and tomato paste in which they presented people with different levels of processing of the paste and asked to judge the naturalness:

• Original: Tomato paste

• Once-transformed: A combination of tomato paste and water

• Twice-transformed: The tomato paste that was combined with water, and then has the water removed. The paste is now identical to the original

They found that the ‘twice-transformed’ paste is not only considered less natural than the ‘once-transformed’ item but also less natural than the original – despite being identical in substance. 

One explanation for the results of this experiment draws on the role of essentialism in perceptions of naturalness. Essentialism can be defined as “some unique, hidden property of an object by virtue of which it is the object that it is.” If this product has a ‘natural essence’ in the eyes of the consumer, it should be unaltered by changes to its substance. But this ‘natural essence’ can be contaminated, in the case we have described by the processing involved.

Implications

These findings have not escaped the notice of some plant-based food manufacturers who have challenged the notion that their products are somehow less natural.  Take the example of Flora whose ‘Skip the cow’ campaign appears to directly reference notions of processing to position their product as the more natural alternative to butter:

What all this suggests is that how we define the boundary between natural or ‘unnatural’ is contested ground: there is no certainty that animal-based foods will necessarily always be considered the ‘natural’ option.  How we determine naturalness will be as much, if not more, about how we think about it rather than the food’s functional properties.

This means we need to take consider the wider cultural cues and signals related to naturalness. How we collectively agree on which characteristics we focus on to determine ‘naturalness’ is a behavioural science informed piece of cultural analysis - in a very similar way that we have considered the social underpinning of the way we evaluate risk.

This helps to explain why not all foods that we consider to be natural (such as sugar) are necessarily good for us. And why not all processed foods are bad for us: as Paul Rozin points out in our documentary, Tofu is highly processed yet is typically seen as natural. It is less about the ‘instrumental’ characteristics of the food and more about our ‘ideational’ response: it seems ‘naturalness’ is in the eye of the beholder, meaning that lab-based innovation has much to play for but will need to have a nuanced understanding of the way these things are weighed by the population.