Lucy Aphramor (they/them) is a radical dietitian who puts a critical spin on food beliefs many of us take for granted. Lucy explains how structural inequalities and white supremacy are core risk factors for disease and shows us how narrow and oppressive – and racist – the dominant Euro-American notion of health really is. We interviewed Lucy for this issue of Rooted because we feel this perspective is valuable in the exploration of the theme of health and agroecology.
Lucy, can you tell me how you define health?
“'What does health mean to you?' is one of my go-to opening questions when I'm working with someone therapeutically as a dietitian. The question opens up a conversation about values, anxieties and deep beliefs. It disturbs the idea that there’s one right definition of health and even that it can have a fixed meaning.
I think it’s useful to expose this because I don’t think health is a strategically useful concept if the goal is to improve human and nonhuman flourishing through social change, even if it is through food sovereignty.
In conversations around non-communicable or diet-related disease, for instance, health is commonly understood as a personal state that is overwhelmingly determined by diet, exercise, smoking and alcohol intake. These are behaviours that are in turn held to be largely explained by willpower and knowledge and skills. Intertwined with this, weight is believed to be an indicative reflection of lifestyle habits so that being thin becomes synonymous with being healthy. This model obscures the enduring and intergenerational impact of living with inequity by locating human wellbeing in vitamins, meritocracy and calories. The word ‘health’ creates and sustains the construct of a standalone atomistic human body completely extracted from all relationships, as if life is untouched by the experience of power."
You often say: “You can't talk usefully about sugar without talking about the plantations.” Can you tell us more about that?
"So, the public health discourse says: don't eat sugar. Sugar has an incredible power to dysregulate your metabolism and can cause diabetes. But in this case, sugar is set aside from other things that will also impact your metabolism in a way that could cause diabetes. What about the metabolic, intergenerational impact of the legacy of the sugar plantations? That too impacts metabolism. Black scholars have been saying for decades that we need to look at racism to understand health, but again, because the way that knowledge is generated around food privileges biomedicine and coloniality, Black knowledge is ignored. The fact is that socio-structural factors cause health problems, but the over-focus on diet in particular, and lifestyle more generally, diverts attention away from the research that shows this.
Class and heart disease is another perfect example. Diet-related diseases, like heart disease, are presented as if they are overwhelmingly determined by health behaviours (diet, exercise, smoking, alcohol intake). But they are strongly power-related diseases. More than 50 years of longitudinal data, however, demonstrates that class position impacts heart disease beyond any impact from diet. But if you look at British Heart Foundation leaflets, for example, classism and other social factors are just tagged on to the advice about how to live a ‘healthy’ lifestyle. This framing, where health is explained by lifestyle, hides the detrimental metabolic and material impact of living with the daily grind of insecurity, violence, oppression and poverty. These experiences all influence physiological pathways that predispose people to heart disease, whatever the person eats. That’s not saying food doesn’t matter – it’s saying public health nutrition norms reproduce classism and neoliberalism."
Can you say more about health discourses and racism?
"As I just said, nutrition discourse strips away the enduring and intergenerational embodied impact of living with racism. For example, public health nutrition messages teach that hypertension is something that develops due to salt intake and ‘excess’ calories - and remain quiet about the rigorous data that links racism and hypertension. Obscuring the daily impacts of racism on a body as a factor in diet-related disease is one form of racism in nutrition recommendations.
A second form of racism is enacted when pictorial food guides that claim to be for the general population are really only appropriate for a certain group of people and have an Anglo bias. For example, many Asian people are lactose intolerant but still are encouraged to consume dairy. The recommendation for vegetable and fruit intake is inappropriate for those with gut problems or small appetites and impossible for many people to follow due to low income or reliance on food aid. Centering whiteness has material consequences, as the narratives enhance privileged people’s sense of worthiness and harm everyone else through blame, shame, guilt, gaslighting, alienation, stigma and embedding the status quo.
Third, wherever Western nutrition science is used as the only valid way of understanding food, or at least the ‘best’ way, we perpetuate scientific imperialism. This has anti-Black consequences, devaluing other ways of understanding food and flourishing. Every time we put foods into groups by nutrient content we rely on a colonial logic: this taxonomy isn’t inevitable, or ‘normal’, or inherently equitable or benign – it’s just so common it escapes critical scrutiny. Thus attempts to correct lack of representation, as mentioned above, have led to African-Caribbean and ‘South Asian’ versions of the UK food guide. Of course representation is vital, but swapping foods in and out of a colonial template leaves the deep racist logic unseen and untouched.
A fourth form of racism in health discourses is the anti-fatness agenda that is happening wherever terms like ‘obesity’ and ‘overweight’ are being used. The idea that public health needs to focus on getting people to reduce their Body Mass Index (BMI) is so often rehearsed by experts that it gets treated as an incontestable, neutral, ‘scientifically proven’ fact. But the BMI is not only an unreliable metric for measuring health, it originated, and continues to serve, as a means of ranking bodies to validate race, class, and gender prejudice. Where fat bodies had previously been praised, fatness began to be portrayed by white scientists as evidence of ‘savagery’ and racial inferiority. To cite the brilliant Black fat trans scholar Da’Shaun Harrison, anti-fatness only exists as a coherent ideology with anti-Blackness. This doesn’t mean to imply that everyone recommending ‘weight management’ intends racism, but once we become aware of the connection, we need to address it … presuming we don’t in fact intend to perpetuate racism. Anti-racist public health interventions are not organised around BMI."
How do you see the relationship between health and agroecology?
"Ah! We’re back at the impasse and opportunity contingent in the term ‘health’. To answer this usefully I need to go back to the question of what do you mean by health? How do you measure it? I do think that the conversation about agroecology, health and food has a lot to offer as long as we keep approaching it through relationality and not through this idea of standalone nutrients.
For instance, agroecology showcases how to approach food relationally, so we look beyond nutrients, refuse to commodify food, and build food-related narratives that cultivate anti-racism, gender equity, that embrace care, spirituality, body respect, the sacred, that seek to metabolise trauma held in land and Beings, and that know food and eating as intimately entangled with tradition and ceremony and language.
Instead of the time-bound individualistic ethics of biomedicine, this agenda needs an ethics of reckoning, care and repair. Food narratives nested in an agroecological cosmovision lend themselves to this. The ecosystems-thinking of agroecology readily accommodates earth, power, humans and nonhumans, and many ways of knowing. Agroecology helps us hold in mind that that which is life-affirming exceeds vitamins and minerals and exposes the political misdirection of reducing ‘health’ to lifestyle. It’s designed to help us figure out right relationships in polycrisis. And if health is the thing that emerges at the confluence of words like love, vitality, liberation and abolition, then agroecology is a powerful potentiator."
I gift you my anger and trauma and terror my intellect poetry rigour and error
as filters for a vision of caring better where we’re in it together with practitioner privilege
in it together plaiting the minute, the meaning, the mattering
in it together because living is quantum
and in it differently, because a sexist mind-set anywhere is the protein backbone of rape culture, eating disorders, war, another tree species felled forever
spells the very soul’s extinction
and we shouldn’t qualify as dietitian until we can join these dots so that every health policy reads as a peace treaty
because the body is not a commodity …
Interview by Jessica Milgroom, Research Fellow at the Institute for Sociology and Peasant Studies, Cordoba, Spain. Contact: jessica.milgroom@gmail.com
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This article is part of Issue 2-2025: Cultivating health and healing
