Does cultural capital contribute to educational inequalities in food consumption in the Netherlands? A cross-sectional analysis of the GLOBE-2011 survey

Studies consistently find a socioeconomic gradient in healthy dietary intakes [1‐6]. However, interventions to encourage healthy food consumption have only had small effects, and if so, particularly among high socioeconomic groups [7, 8]. Therefore, there is a high need to identify relevant determinants of healthy food consumption in order to find entry points for developing interventions that may increase healthier food consumption, especially among low socioeconomic groups.

Previous studies have identified explanatory factors that partly explain socioeconomic inequalities in diet. Economic resources, such as an adequate food budget, are typically connected to an individual’s socioeconomic position, and to healthy food intakes, as lower-quality diets generally cost less per calorie [1, 9, 10]. Also, social resources, measured through membership in support-providing networks, perceived social support, or perceived social norms, have shown to be associated with healthy food intakes [11, 12], although their contribution to socioeconomic differences in healthy food consumption is less clear [1, 13]. As measures of economic and social resources cannot fully explain the socioeconomic gradient in healthy food consumption, recently, studies have appeared taking a different angle. These studies have linked cultural resources to health inequalities [14, 15], and have argued that culture-based activities, knowledge and perceptions present a unique form of health-relevant ‘capital’.

Culture can be defined as the culture-based resources that shape and influence people’s habits, values, norms, knowledge and preferences, acquired mostly through social learning [14]. Learning conditions vary across socioeconomic groups and milieus, and so culture does as well [14]. Culture, further, is well-known for its important nfluence on food consumption, as it determines what people consider to be acceptable and preferable foods, and what the amount and combinations of food they choose [16, 17]. Although some research has emerged over the last few years [18‐20], empirical evidence for the role of cultural factors for the explanation of socioeconomic inequalities in food consumption is still limited.

Among the most influential studies regarding the role of culture for daily practices is the work of the French sociologist Pierre Bourdieu (1930–2003) [21]. High socioeconomic groups, over their life courses, acquire more capital and ‘use’ this to develop a taste for specific forms of music, lecture, leisure activities, and foods. Bourdieu defines three types of capital that play a role in this process, namely cultural, economic, and social capital. Cultural capital is a non-material resource that accumulates throughout the life course, acquired through education and life-long socialisation, and includes “the distinctive forms of knowledge and ability that people acquire [...] from their training in the cultural disciplines” [21]. Through available cultural capital in the family, one is more inclined to ‘inherit’ cultural resources that can be mobilised to accumulate incorporated cultural capital [22]. Cultural capital emerges in three different states: incorporated cultural capital (e.g. values, skills, cultural participation), objectivised cultural capital (e.g. books, tools) and institutionalised cultural capital (e.g. educational degrees, professional titles) [21]. Lareau and Weininger ([23], p. 156) refer to incorporated cultural capital as “the legitimate cultural attitudes, preferences and behaviours […] that are internalized during the socialization process”. Incorporated cultural capital, “the form of long-lasting dispositions of the mind and the body”, entails socialisation, personal effort, and time investment ([22], p. 47). In line with reflections by Abel [14], we expect incorporated cultural capital to be more important for educational inequalities in food choices than institutionalised and objectivised cultural capital. Also, incorporated cultural capital has the largest potential to be on the causal chain between socioeconomic position and healthy food choices. It is not possible to convey incorporated cultural capital to someone else, as would be possible with economic capital or objectivised cultural capital.

Besides cultural capital, Bourdieu also acknowledges the importance of economic and social capital. Economic capital comprises all sources of income (including wealth), as well as the security of having a reliable income. Social capital is defined by Bourdieu as “the aggregate of the actual or potential resources which are linked to possession of a durable network of more or less institutionalized relationships of mutual acquaintance or recognition”. Economic, social and cultural capital are correlated and feed on each other. The different forms of capital can be converted as, for example, personal savings (economic capital) can be used to pay for advanced education (cultural capital) [14]. The roles of economic and social capital for inequalities in health and health-behaviours have been studied rather extensively, whereas the role of cultural capital is largely unknown. The aim of this study is to investigate whether cultural capital contributes to the explanation of socioeconomic inequalities in food consumption among adults, over and above social and economic capital.

Self-reported data were collected by means of a large-scale postal survey in 2011, administered as a new wave of data collection for the longitudinal GLOBE study [24]. The research was conducted according to the Declaration of Helsinki, and informed consent was obtained from all subjects. No formal approval of the medical ethics committee of the Erasmus University Medical Centre was required for the study. The use of personal data in the GLOBE study is in compliance with the Dutch Personal Data Protection Act and the Municipal Database Act, and has been registered with the Dutch Data Protection Authority (number 1248943).

Of the respondents to the previous GLOBE survey in 2004, which formed a stratified sample of the 25–75 years old population in the city of Eindhoven and surrounding cities in 2004 (N = 4784), n = 249 had died, n = 76 had emigrated, and n = 14 were lost to follow-up (i.e. no correct address information available), which resulted in a sample of N = 4437 that was sent the 2011-survey. For the total of 2983 respondents that returned the survey (response 67.2%), missing values for sex (n = 21), age (n = 24), and educational level (n = 172) could largely be replaced by information from the 2004-questionnaire, resulting in only one case with a missing value for age and 29 cases with missing values for educational level. These 30 respondents were excluded from the analysis, resulting in an analytic sample of N = 2953.

The mean age of the sample was 56.4 years (SD 13.0) and 56.7% was female (Table 2). In general, educational inequalities in healthy food consumption were larger than those in unhealthy food consumption (Table 3). Low educated were more likely to report a low overall healthy food consumption (PR 1.48, 95% CI 1.28–1.73), low whole wheat bread consumption (PR 1.38, 95% CI 1.08–1.76), low vegetable consumption (PR 1.46, 95% CI 1.23–1.73) and a low consumption of meat-substitutes and fish (PR 1.66, 95% CI 1.37–2.02) than high educated. Regarding unhealthy food outcomes, low educational groups were about twice as likely to have a high fried food consumption (PR 2.03, 95% CI 1.44–2.86), but no significant inequalities in overall unhealthy food, red meat, or soft drink consumption were observed. Outcomes for which no educational inequalities were found, were not further analysed in multivariate models.

In univariate models (as presented in Table 3), lower levels of cultural, social and economic capital were in general related to lower healthy food consumption and higher unhealthy food consumption (except for red meat). Incorporated cultural capital was most consistently and strongest associated with the outcomes, compared to institutionalised and objectivised cultural capital. Those with low social capital were more likely to report a low overall healthy food consumption (PR 1.17, 95% CI 1.06–1.28), and a low consumption of whole wheat bread (PR 1.27, 95% CI 1.12–1.44), fruit (PR 1.16, 95% CI 1.07–1.26), and meat-substitutes and fish (PR 1.30, 95% CI 1.16–1.46). A low level of economic capital was associated with low overall healthy food consumption, low whole-wheat bread consumption, low fruit consumption, and low red meat consumption.

In multivariate models including educational level, and cultural, social and economic capital, cultural capital remained significantly associated with all outcomes (Table 4). Having less cultural capital was related to a lower overall healthy food consumption (PR 1.35, 95% CI 1.22–1.49), lower consumption of whole wheat bread (PR 1.21, 95% CI 1.05–1.38), vegetables (PR 1.55, 95% CI 1.40–1.71), and meat-substitutes & fish (PR 1.74, 95% CI 1.53–1.97), and a higher consumption of fried food (PR 1.59, 95% CI 1.31–1.93). Social capital remained associated with overall healthy food consumption, whole wheat bread consumption, and meat-substitutes & fish consumption, but economic capital with none of the outcomes. In these multivariate models, PR’s for the low educational group attenuated considerably after inclusion of the capital variables (Table 4), compared to the model with only confounders (Table 3). For instance, the PR of the lowest compared to the highest educational group for having a low overall healthy food consumption decreased from 1.48 (95% CI 1.28–1.73) (when only adjusted for confounders; Table 3) to 1.22 (95% CI 1.04–1.43), when cultural, social and economic capital were taken into account (Table 4). However, educational inequalities in food consumption remained significant for all outcomes.

This is the first study to investigate the contributions of cultural, social and economic capital to educational inequalities in food consumption among adults. Educational inequalities in healthy food consumption were larger than those in unhealthy food consumption. Cultural capital contributed to the explanation of educational inequalities in food consumption more so than social and economic capital. Associations between cultural capital and food consumption remained significant when adjusted for social and economic capital.

Our finding that low educational groups consumed less healthy foods is in line with previous empirical studies [1‐5]. These results also largely confirm Bourdieu’s own observations regarding food consumption, as reported in his book Distinction: A Social Critique of the Judgement of Taste [21]. He wrote that individuals from lower classes with a low level of capital tended to prefer ‘heavy, fatty, fattening foods, which are also cheap’ ([21], p. 177) and preferred ‘the plentiful’ as opposed to ‘the light, refined, and delicate foods’ valued by high classes with higher levels of capital [19, 21]. Further, he observed that those with high cultural capital seemed to be more inclined towards asceticism and pursue original foods with an abundance of vegetables, whereas those with high economic capital preferred more traditional, rich dishes - a taste that resembles those of lower classes [19, 21]. In line with this, we saw that those with higher economic capital were more likely to consume more of the “traditional, rich” red meat products (e.g. beef, pork, mince, and burgers).

While we found clear positive relations between educational level and healthy food consumption, and between cultural capital and healthy food consumption, fewer associations with unhealthy food consumption were found. Apparently, possessing higher levels of cultural capital facilitates the choice of healthy foods, but having more cultural capital does not seem to prevent against unhealthy food consumption. This finding may suggest that high educated, with more cultural capital, make healthy food choices for other reasons than for reasons of health (because, if the latter was the case, one would expect them to also refrain from unhealthy foods). Following Bourdieu’s line of reasoning, one interpretation could be that healthy foods are consumed for reasons of distinction, and that consuming healthy foods is considered a more effective means of ‘distinction’ than refraining from unhealthy foods. A reason for this could be that a behaviour you practise (e.g. eating healthy foods) is more visible and obvious, and therefore more useful for distinction, than a behaviour you refrain from (e.g. not eating unhealthy foods). The findings from a study into educational differences in ‘super foods’ consumption also point to this mechanism of distinction [39].

Economic capital showed only weak associations with food consumption, and did hardly contribute to the explanation of educational inequalities in healthy and unhealthy food consumption. This could be due to the selection of the specific food products that were analysed, as the unhealthy food options (white bread, fried foods, red meat products) may not necessarily be cheaper than their healthy counterparts. However, also previous research from the Netherlands did not found indications that price considerations are an important barrier for healthy food consumption among low educational groups in the Netherlands [2, 40, 41].

Our finding that cultural capital adds to explanation of educational inequalities in food choices, over and above economic and social capital, is in line with two previous studies among adolescents [18, 20]. Taking all capital variables into account in multivariate models considerably reduced the educational inequalities in healthy and unhealthy food consumption, but not completely. This indicates that other factors than those covered by cultural, social, and economic capital contribute to the observed gradients. A factor that we did not take into account, and that has found to play a role in the international context (e.g. U.K. and U.S.), is the neighbourhood food environment, i.e. the accessibility and availability of healthy foods [42, 43]. In a compact country like the Netherlands, where the average distance from home to a supermarket (in which, in general, a wide variety of healthy, good-quality food products is available against reasonable prices) is 900 m [44], we have no signs of the existence of so-called ‘food deserts’ [45], nor the existence of large inequalities in food environmental attributes between low and high socioeconomic neighbourhoods [46].

Cultural capital is related to healthy food consumption and contributes to the explanation of educational inequalities in healthy food consumption, over and above economic and social capital. The socialisation processes through which cultural capital is acquired could offer new entry-points for the promotion of healthy food consumption among low educational groups.