Saturday, November 15, 2014

Traditional and Modern Scotland: Culture, Food, and Health

Scotland is a country that occupies the northern portion of the United Kingdom.  It contains hundreds of islands, and its mainland borders England to the south and the Atlantic Ocean to the north.  According to the 2011 census, its population is 5,295,000, the vast majority of which having white Scottish ethnicity.  The population density is about 68/km2, which compares to 34/km2 in the United States and 19/km2 in Idaho.  Scotland is a highly urbanized country with the majority of the population living in the Central Lowlands of Scotland around the chief cities of Glasgow and its capital Edinburgh.  

Scotland’s climate is temperate and variable.  It is warmed by the North Atlantic Current, which provides milder winter and summer conditions than similar latitudes around the world.  Rainfall varies across the country and usually totals 30 – 120 inches annually.  The total land area of Scotland is 78,387 km2, which is slightly smaller than Idaho’s land area of 83,570 km2.  The majority of the land is grassland with the remainder being divided among primarily woodland, urban development, and cropland.  The wildlife includes land animals such as wild cats, rodents, hares, highland cattle, ponies, deer, and sheep, as well as numerous birds and marine animals such as seals, dolphins, salmon, seabirds, eagles, grouse, and bats.  The mild climate, productive ecosystems, and diverse fauna have allowed habitants of Scotland to prosper for generations.

Scotland was historically home to several species of large mammals, which were hunted as food.  As these animals became extinct, other sources or food were developed.  Eventually, people came to rely on dairy, root vegetables, tubers, wild plants, and oats.  Strategies to preserve foods included fermenting milk, making broths, and using preservatives such as herbs, spices, and salt.  When people did consume meat, they used the entire animal and consumed the muscle meat in addition to organ meats, skin, bones, and other connective tissue.  

One of the most iconic foods of Scottish culture is known as haggis.  Haggis is a meaty concoction of offal and various other ingredients.  Organ meats typically included sheep heart, liver, and kidneys, which are mixed with onions, oats, suet, spices, and salt and encased in an animal’s stomach and slowly cooked for several hours.  Haggis became recognized as the national dish of Scotland as the main course of the Burns supper and is traditionally served with neeps, tatties, and dram (turnips, potatoes, and whiskey) (Kittler & Sucher, 2007).

When agriculture was developed, oats emerged as a staple crop due to the favorable growing conditions in the country.  Oats eventually became abundant in early Scottish diets because it was more reliable and less apt to spoil than other foods.  Oatmeal, porridge, gruel, pudding, bread, and powders were varieties that Scottish people used to transport, preserve, and consume oats.  One common method of preparing oatmeal has been to soak the groats overnight in a salted broth and cook it in the morning until it thickens.  Scotland's environment and natural abundance of dairy animals, fish, fruits, and vegetables has resulted in simple, hearty, and flavorful traditional diets.  

Modern cultural Scottish cuisine still strives to preserve the spirit of traditional dishes.  As globalization affects all modern societies today, cultural influence is emerging in modern culinary dishes.  This includes Irish and Asian influence.  Additionally, Scottish diets have shifted toward Western-style food habits, eating more fast-food, processed foods, and less vegetables and fruits.  Foods widely consumed in Scotland include skim milk, white fish, confectionery, cakes and pastries, and savory snacks (Forsyth, Macintyre, & Anderson, 1994). Other foods that are consumed but the levels of which depend on gender, age, and social class include fruit, vegetables, meat, bread, fats, sugar, and alcohol.

As Scotland has become more urbanized, access to healthy food is believed to be an important contributor to food choice.  Some studies have found that proximity to food stores is associated with difference among dietary patterns, body weight, and socioeconomic status.  A study in Scotland found that in urban settings, the distribution of retail food stores may not be a primary influence on diet (Macdonald, Ellaway, Ball, & Macintyre, 2011).  However, a recent analysis concluded that the associations between access to supermarkets and dietary behavior should take into account more than simply proximity but also conceptually appropriate measures of access (Thornton, Pearce, Macdonald, Lamb, & Ellaway, 2012).  Reduced consumption of milk, meat, and vegetables has been linked with poverty and other social inequalities in urban Scotland (Gray & Leyland, 2009).

Similar to other modern societies, Scotland is experiencing significant health concerns.  Scotland has one of the lowest life expectancies of the European Union (Hanlon et al., 2005).  Men are expected to live to age 76 and women are expected to live to age 80, which are about four years lower than EU averages.  More than 64% of men and 57% of women are overweight, and this is being accompanied by increased rates of chronic diseases (Steed, Walsh, & Reynolds, 2009).  Among adolescents, the rate of obesity is 15.9% in males and 14.9% in females, representing an increase of about 250% since 1987 (Craig, McNeill, Macdiarmid, Masson, & Holmes, 2010).  

The responsibility of dealing with these health concerns has primarily fallen on NHS Scotland, the national public health care service available to all permanent residents.  For those seeking alternative and complementary treatments, private health care systems are also available.  NHS Scotland has several boards and organizations that strive to improve the health of Scotland’s population.  There has been considerable research exploring the health of people in Scotland and the role that nutrition plays in the current health status.

The West of Scotland Twenty-07 Study was a study organized in 1986 to investigate the health circumstances among differences in socioeconomic status, gender, region, age, ethnic group, and family type (Benzeval et al., 2009).  A total of 4,510 people in three cohorts living near Glasgow were followed for 20 years starting in 1987 when participants were aged 15, 35, and 55.  The study has allowed researchers to follow changes in people's lives over 20 years and study the effects of these changes.  Many studies have used data from this study in various research areas.  They have found that there are significant differences among categories and that socioeconomic status, gender, region, age, ethnic group, and family type all are important factors when considering health status.

Among these analyses was a study on participant perception of healthful eating habits (Macintyre, McKay, & Ellaway, 2006).  Researchers survey participants about their thoughts on seven potential influences of health: habits, self-care, the environment, family relationships, one's constitution, money and luck.  The first three were regarded as very important, the second three as less important and luck as least important.  There were not much difference among gender, social class, and neighborhood.  This suggests that socioeconomic status may not be the primary factor determining impressions of healthful eating habits.

Another survey study determined that gender, household income, social class and current smoking status were associated with perceived healthful eating habits (Anderson & Hunt, 1992).  Women, people with higher income, people of non-manual households, and non-smokers were around twice as likely to be classified as healthy eaters compared to men, people with lower income, people of manual households and current smokers, respectively.

In a study of school-aged children, researchers identified associations between basic eating patterns and socioeconomic status, obesity and physical activity (Craig et al., 2010).  Eating patterns that included fruit and vegetables were significantly associated with higher socioeconomic status and higher education levels whereas patterns including snacks and puddings were associated with lower socioeconomic status and lower education levels.  There was no consistent association between eating patterns and BMI or physical activity.  However, screen time was inversely associated with “healthier” eating patterns.  

Another study found that around one third of Scotland’s population achieved at least 30 minutes of physical activity on most days (Mutrie & Hannah, 2004).  This was mostly achieved during leisure time, but it also included activity at work and around the home.  Lower levels of activity were reported by women and the elderly.  Walking was the most common activity.  This suggests that promotion of physical activity may be worthwhile targeting women and older adults while emphasizing walking as an activity.

There are many factors that affect the health of a population.  Nutritional status, physical activity, lifestyle habits, mental function, emotional and social factors, and others are all important factors to consider when addressing the health of a population.  Strategies to improve nation-wide health status should be weighed according to their potential costs and benefits.  In the case of Scotland, one strategy that may prove particularly beneficial may be addressing vitamin D status.

Scotland is a northern country, resulting in less opportunity for sunlight exposure and vitamin D production.  People living in Scotland have a lower average level of vitamin D than people in England and a higher incidence of several common chronic diseases (Gillie, 2008).  Vitamin D is important to a variety of health-related issues.  Insufficient vitamin D may contribute to increased rates of certain chronic diseases, including cancer, heart disease, stroke, multiple sclerosis, high blood pressure, diabetes, and arthritis.  It may also contribute to the lower life expectancy of the population of Scotland compared other European countries.  The vitamin D status of the Scottish population could easily be improved through nutritional supplementation or fortification with little investment.  Government action to improve vitamin D status may be a worthwhile step to improve the overall health of the Scottish population.

Scotland has a rich history with unique traditions and beautiful natural scenery.  Their lifestyles have historically been based on their connection with the land and each other.  Today, Scotland is experiencing health concerns that historically were not of major concern.  Strategies to return the health of Scotland to that of its past may include the return of certain cultural lifestyles, including traditional diets and activities.  Scotland has a rich culture based around the land and community.  Incorporating traditional diets and activities into modern urbanized lifestyles may encourage healthier habits and behaviors.  Small local farms, simple nutritious foods, and community social gatherings are all examples of their cultural traditions.  Social inequalities are certainly a concern, and social welfare systems in Scotland can reduce the impact of these discrepancies.  A multifaceted strategy to addressing the health of the people of Scotland would be the most appropriate and worthwhile approach.


References

Anderson, A. S., & Hunt, K. (1992). Who are the “healthy eaters”? Eating patterns and health promotion in the west of Scotland. Health Education Journal, 51(1), 3–10. 

Benzeval, M., Der, G., Ellaway, A., Hunt, K., Sweeting, H., West, P., & Macintyre, S. (2009). Cohort Profile: West of Scotland Twenty-07 Study: Health in the Community. International Journal of Epidemiology, 38(5), 1215–1223.

Craig, L. C. A., McNeill, G., Macdiarmid, J. I., Masson, L. F., & Holmes, B. A. (2010). Dietary patterns of school-age children in Scotland: association with socio-economic indicators, physical activity and obesity. The British journal of nutrition, 103(3), 319–334. 

Forsyth, A., Macintyre, S., & Anderson, A. (1994). Diets for disease? Intraurban variation in reported food consumption in Glasgow. Appetite, 22(3), 259–274. 

Gillie, O. (2008). Scotland’s Health Deficit: an Explanation and a Plan by Oliver Gillie. Health Research Forum Publishing.

Gray, L., & Leyland, A. H. (2009). A multilevel analysis of diet and socio-economic status in Scotland: investigating the “Glasgow effect”. Public health nutrition, 12(9), 1351–1358. 

Hanlon, P., Lawder, R. S., Buchanan, D., Redpath, A., Walsh, D., Wood, R., … Walsh, D. (2005). Why is mortality higher in Scotland than in England and Wales? Decreasing influence of socioeconomic deprivation between 1981 and 2001 supports the existence of a “Scottish Effect”. Journal of Public Health, 27(2), 199–204. 

Kittler, P. G., & Sucher, K. P. (2007). Food and Culture (5th ed.). Wadsworth Publishing.

Macdonald, L., Ellaway, A., Ball, K., & Macintyre, S. (2011). Is proximity to a food retail store associated with diet and BMI in Glasgow, Scotland? BMC public health, 11, 464. 

Macintyre, S., McKay, L., & Ellaway, A. (2006). Lay concepts of the relative importance of different influences on health; are there major socio-demographic variations? Health education research, 21(5), 731–739.

Mutrie, N., & Hannah, M. K. (2004). Some work hard while others play hard: the achievement of current recommendations for physical activity levels at work, at home, and in leisure time in the West of Scotland. International Journal of Health Promotion and Education, 42(4), 109–117.

Steed, H., Walsh, S., & Reynolds, N. (2009). A brief report of the epidemiology of obesity in the inflammatory bowel disease population of Tayside, Scotland. Obesity facts, 2(6), 370–372. 

Thornton, L. E., Pearce, J. R., Macdonald, L., Lamb, K. E., & Ellaway, A. (2012). Does the choice of neighbourhood supermarket access measure influence associations with individual-level fruit and vegetable consumption? A case study from Glasgow. International journal of health geographics, 11, 29.

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