Nutritional Social Work: What It Is and Why It Matters PDF

Article Journal of Social Work 2022, Vol. 22(2) 323–344 Nutritional social...

Article Journal of Social Work 2022, Vol. 22(2) 323–344 Nutritional social ! The Author(s) 2021 Article reuse guidelines: work: What it is sagepub.com/journals-permissions DOI: 10.1177/14680173211008367 and why it matters journals.sagepub.com/home/jsw Arielle Dylan and Jenni Cammaert School of Social Work, St. Thomas University, Fredericton, Canada Abstract ! Summary: This article introduces the area of nutritional social work, beyond the scope of food security and food injustice, from a critical, anti-oppressive and ecofem- inist lens. The goal was not to present concrete frameworks but to initiate a discussion surrounding the relevance of nutritional social work and point in a number of possible directions for incorporation of this subdiscipline into social work praxis. ! Findings: Nutritional security is an instrumental component of food security, as com- plete nutrition requires more than just enough energy for every human being. This purposeful combining of food security with nutrition security underscores the need to consider these two issues together, requiring integrated social and health outcomes, as well as cohesive community, policy and development goals aimed at eliminating food insecurity and malnutrition. These considerations need to involve the questions of availability, accessibility (both economically and geographically), cultural practices and sustainability that form the cornerstone of food justice efforts. ! Applications: The article highlights the potential contribution of nutritional social work to direct practice, community action, policy development, research and social work education, as it illuminates the pivotal role that nutritional security plays in relation to multilevel considerations of food insecurity, all the while ensuring all people, through participatory, democratizing, power-sharing and equity-creating processes, have access to nutritious foods. Keywords Social work, critical social work, human rights, social justice, social work practice, social work theory Corresponding author: Jenni Cammaert, St. Thomas University, 51 Dineen, Fredericton, New Brunswick e3b 5g3, Canada. Email: [email protected] 324 Journal of Social Work 22(2) Introduction In this article, the authors have coined the phrase nutritional social work to suggest a new area of consideration and practice within the field of social work. While matters of food security and food insecurity have for some time been considered part of the professional scope of social work, there needs to be a broader focus on nutritional concerns in all levels of social work practice. As a foundational con- tribution, this article aims to explain what exactly is meant by ‘nutritional social work’ and why this area is important to the profession. Broad and tentative directions for nutritional social work practice are suggested while leaving questions of how to implement this subfield of practice in specific multilevel contexts to future scholarship developed by those with expertize relevant to the variety of areas to which nutritional social work is germane (e.g., mental health, addictions, child development, health, community wellness, policy, etc.). Literature review According to a 2018 report issued by the World Health Organization, ‘the number of undernourished people is estimated to have reached 821 million – around one person out of every nine in the world.’ This multidimensional phenomenon of widespread undernourishment amongst the global human population is described as food inse- curity, which the World Food Summit (1996) defined as ‘a situation that exists when people lack secure access to sufficient amounts of safe and nutritious food for normal growth and development and an active and healthy life’ (p. 43). Typically, any assessment of food security necessitates consideration of food availability, food access and food utilization (World Food Programme, 2019). There are many sources of food insecurity. Certain global regions have struggled with food insecurity for decades due to persistent environmental and geopolitical factors (Brinkman & Hendrix, 2011; Cheeseman, 2016; Nagoda, 2015). Unequal distribution of wealth also plays a role as statistics indicate reduced access for various groups, including but not limited to single mothers, those living in poverty and marginalized and non- dominant culture groups (Raphael, 2016). Desertification caused by overgrazing, urbanization and climate change, amongst other factors, also contributes to the growing issue of food insecurity (Nellemann et al., 2009). The related factor of loss of arable soil, owing to erosion and pollution, leads to reduced acreage for food production consequently impacting food security (Henry et al., 2018). The troubling declining bee populations is another critical factor in any discussion of food insecu- rity ‘as close to 75 percent of the world’s crop producing fruits and seeds for human consumption depend, at least in part, on pollinators for sustained production, yield, and quality’ (Food and Agriculture Organization of the UN, 2013, p. 4). Climate change underpins many of the causal factors leading to food insecurity, such as food access and availability, namely through extreme weather events and rising sea levels (causing both land loss and unwanted salination; World Food Programme, 2014). Clearly, food insecurity impacts not only individuals, groups and communities, but Dylan and Cammaert 325 also national economies by reducing gross domestic product (Reeves et al., 2017) and straining the healthcare system (Tarasuk et al., 2015). Due to the considerable stress around food security and the numerous ways social workers have organized to engage with issues of food insecurity, the nutritional content of food needs to be considered by social workers at all levels of practice. Through a critical intersectional lens, this article will explore social work’s engagement with food security and suggest a shifted focus to nutritional social work. Considering the novelty of this area for social work this article aims to lay out a foundational argument for its needed pres- ence for anyone working with food insecurity in policy development, community engagement and direct practice. There exists a well-developed field of nutrition and nutritional practice (see for example, Buttriss et al., 2017; Elia et al., 2012; Smolin et al., 2015; Thompson et al., 2013). This article is not arguing for social workers to take up the professional practice of nutrition but rather to incorporate nutritional considerations into all levels of social practice. Social work’s engagement with food insecurity Since 1955, the social work literature has encountered a drastic increase in articles published on food insecurity (Burgess & Shier, 2018). Social work has been engaging with the issue of food insecurity in various ways, including strategies for policy change, community organizing and food-oriented projects, low-income food distribution and food insecurity deriving from various physical and mental health conditions. Because food insecurity negatively impacts child developmental and wellbeing, poor education- al outcomes can result for children experiencing poor nutrition, an issue that is com- pounded by the difficulty of detection because of shame or uncertainty surrounding options (Fram et al., 2014). According to UNICEF Office of Research (2017) Report Card 14, Canada ranked 37th out of 41 countries, with respect to child hunger, with higher ranks being associated with lower incidence of childhood hunger. Included in the ranking, were countries located in the Global North, which are predominantly located in the northern hemisphere and represent the wealthiest and most developed nations. Food Secure Canada, which seeks to achieve zero hunger for all, a sustainable food system and the availability of safe and healthy food, is advocating for the Canadian federal government to participate in a cost-shared universal nutritious food programme for schools that would ensure access to healthy meals for school-aged children daily (CBC, 2017). Canada Without Poverty (CWP) promotes the development of a national nutritious school food programme and argues the need for ‘strong, rights-based policies at all levels of government so that healthy eating can be accessible for all’ (CWP, 2019). Despite Canada having signed various food-rights agreements since 1948, the issue of food insecurity remains (Rideout et al., 2007). Policy Social work engagement with issues of food insecurity at the policy level has focused on a variety of areas, including inter alia food rights and food justice 326 Journal of Social Work 22(2) (Apaitia-Vague, 2011; Kaiser et al., 2015; Libal et al., 2014); advocacy and food security policies (Deepak, 2014; Kaiser, 2013; Kaiser et al., 2015; Kiehne & Mendoza, 2015), the ideal of a living wage (Kiehne & Mendoza, 2015; Wolfer & del Pilar, 2008) and social work education (Kaiser et al., 2015; Kenney & Young, 2019; Mallinger & Kerby, 2016). Deepak (2014) proposed policies to address food insecurity amongst farmers using local and pre-industrial practices, after examining, La Via Campesina, a transnational network of 150 local and national organization from Africa, Asia, Europe and the America. Specifically, through a critical lens, this article highlights the need to challenge existing discourse around patriarchal practi- ces and the necessity of global forces to assist gender equality and food sovereignty. Additionally, Wolfer and del Pilar (2008) argue the need to incorporate a living wage for fair trade organizations in order to reduce the effects of economic disadvantage, including food insecurity amongst developing countries. Community practice Social work also has been instrumental in developing community practices asso- ciated with food insecurity. Early social work engagement with issues of food security had a more limited charity-based role, focusing on food banks and pan- tries, and soup kitchens (Riches, 2002). Moreover, social work theory and practice has historically been more involved with food insecurity approaches that are indi- vidually focused, lacking a larger ecosystemic perspective and a political lens (Jacobson, 2007). For instance, Twill et al. (2016) outline the establishment of a food pantry at a post secondary institution in the United States for students who are food insecure. The authors highlight the additional barriers students can face in accessing community food banks, when struggling with limited financial resources, lack of a permanent residence and failure to meet community food bank protocols. While Twill and colleagues provide a wonderful example of community engage- ment and extensive partnership arrangements, their approach is still a stop-gap approach, however non-traditional, for its lack of explicit focus on structural change. Adopting a structural and critical perspective with respect to food banks and soup kitchens underscores that the need for such institutions and serv- ices invariably arises from societal inequities (Possick, 2019). More recent social work literature and practice demonstrates increasingly an awareness of multilevel considerations and draws considerably on progressive policy recommendations. To counteract the oft-described issue of food deserts and its cognate food swamps, community gardens have developed and grown in number in the past quarter century (Chen & Gregg, 2017; Himmelheber, 2014). Given that food deserts represent areas where there is a distinct inaccessibility to food, and food swamps are inundated with less nutritious foods contributing to food-related dis- eases (Imhoff, 2006), community gardens fill a gap by providing opportunities to determine and participate in nutritious food availability and production, while simultaneously creating openings for community building, agency and empower- ment (Kaiser & Hermsen, 2015; Peeters, 2012; Ragan & Dimitropoulos, 2017). Dylan and Cammaert 327 Community gardens also diminish the psychological distress associated with food insecurity by the comfort a local, community-led food source provides. Moreover, community gardens are... both a conscientizing and a mobilizing force, as evidenced by garden participants’ increased knowledge about food issues and the sustained involvement of a diversity of community members. Growth of social networks embodies the maximizing step in the empowerment process. (Himmelheber, 2014, p. 125) In urban centres where access to land is often limited, vertical farming serves as a pragmatic way to practice community gardening by growing vertically instead of horizontally. Unlike traditional North American agricultural practices, which are often based on monocrops, pesticide use and mechanized farming practices that are injurious to the land base, causing soil erosion and desertification (Boddy & Ramsay, 2016; Dylan, 2012), vertical farming is a sustainable alternative. Vertical farming not only enhances food security in urban centres but also stimulates green jobs, builds community capacity, increases agricultural potentiality, fosters engagement through stakeholder involvement, all while reducing the carbon foot- print by growing locally (Besthorn, 2013). Direct practice In many respects, the separation of policy and community (exemplified by these topics often being taught as separate courses in schools of social work) is artificial because the two areas inevitably intertwine in a complex synergistic relationship. The discussion above categorized the scholarship based on area of focus within multilevel social work practice but all social work scholarship addressing food insecurity necessarily includes policy and community considerations. Nowhere is this more evident than the topic of social work direct practice and food security. Historically, the social work profession had been at the forefront of working with individuals living with, and at-risk of, food insecurity as this was a central part of the purview of the early settlement house movement during the 1880s (Wagner, 1990). With the urge to legitimize as a profession, following the critique of Flexner (1915/2001), social work adopted more medical framings and moved toward intra- psychic understandings. Social work still considered food issues but primarily in the context of basic needs. This concern manifested in involvement with, or devel- opment of, soup kitchens, food drives, food banks and shelters and drop-in centres (Grenier et al., Possick, 2019; Pritt et al., 2018). Clinically, social workers engage with food issues in a medicalized fashion, assisting those living with a variety of health conditions including disordered eating, diabetes, cardiovascular conditions, and older adults and more (Bryson & Bosma, 2018; Glanz & Scharf, 1985; Hotte, 2018; McCaskill et al., 2016). Clearly social workers have for some time engaged with food issues in specialized subfields; however, nutritional social work has not been formally or widely integrated into the profession. For example, nutritional 328 Journal of Social Work 22(2) social work is not a term used within the profession and nutritional concerns do not usually surface in social work education and curricula. With the re-radicalizing of the profession achieved by pioneering scholars (Carniol, 1995; Finn & Jacobson, 2003; Galper, 1975) and contemporary scholars (Baines, 2017; Mullaly & Dupr!e, 2018) who have continued this work, social work’s involvement with food issues, ushered in by the wave of global concern regarding food insecurity in the past two decades, has a robust critical tone with a view to both personal and political realms. Because ‘effective social services and health care, sound policies, and just eco- nomic and legal systems are all underpinned at the most primitive level on a society that is well nourished,’ Freedman et al. (2011) argue persuasively ‘food constructs individuals and society. Its lack constrains’ (p. 1). With this understanding, any work with individuals experiencing food insecurity necessarily involves a multi- pronged approach to food injustices that addresses structural causes including racialized, gendered and economic disparities (Conway & Lassiter, 2011). Lombe et al. (2016) capture this multilevel commitment in their study exploring impacts of food insecurity by looking at outcomes of health nutrition education, food access issues for communities, advocacy roles, systemic barriers along cultural and gender lines and food policy through analysis of American based national surveys. Similarly, the American study conducted by Biggerstaff et al. (2002) explored food services usage, such as food banks and soup kitchens, and observed connec- tions with homelessness, family violence, and economic shortages and ends with the strenuous assertion that food insecurity interventions are incomplete without sound policy reform. Social work scholarly commentaries also discuss the need for household food insecurity to be addressed not only with direct service interven- tions and community involvement but also targeted policy change (Libal et al., 2014; Martinez & Kawam, 2014). Critical intersectionality perspective While much of the current food security literature indeed addresses multilevel concerns and focuses on increasing global food pressures and neoliberal policy climates, not all such scholarship is shot through with a critical intersectionality perspective. What are the different variables at play with respect to food insecurity for Indigenous peoples, women, those living with HIV, older adults, newcomers and migrant farm workers to name a few? How does the picture change when looking at rural versus urban realities? The impact of geographic location on food accessibility and availability is highlighted in an American study by Cafer and Kaiser (2016). While those living in urban centres typically live closer to grocery stores with greater food availability than their rural counterparts, they are also less likely to have vehicles, creating an issue of access when grocery stores are a prohibitively long walk away. In such cases, persons often rely on specialty stores where the food prices are higher. The obverse obtains with those living in rural areas where many have vehicles, Dylan and Cammaert 329 making grocery stores accessible but available food options are often circum- scribed (Cafer & Kaiser, 2016). Moreover, there is troubling correspondence between lower population densities characteristic of rural locales and government funding for food banks, despite some of the higher costs associated with food support services in these areas (Whitley, 2013). Obviously urban and rural expe- riences will vary internationally; however, findings of this kind are invaluable for reconceptualizing policy framings, community activities and programmes, and government subsidies and fiscal allocations in the efforts to achieve food security and food justice for all irrespective of geographic location. Food insecurity reflects a complex interaction between the various social, cul- tural and economic conditions faced by individuals. The literature clearly outlines that the burden of food insecurity is disproportionately higher amongst ethnic minority groups (Kiehne & Mendoza, 2015; Nam et al., 2015; Nord et al., 2010). Further, Nam et al. (2015) highlight in their American study that these differences are linked to economic and cultural resources and suggest that the best way to change these disparities is to eliminate socioeconomic disadvantages experienced by disadvantaged groups. While looking at newcomers’ experiences with food in their early settlement in Toronto, Lessa and Rocha (2012) emphasized the importance of examining the availability and cost of culturally diverse foods. They go on to suggest that the lack of availability of familiar fresh and quality ingredients reinforces power differentials between groups, underscoring the pervasive forms of racism and discrimination that persist through food choice. These studies highlight the need to understand the structural disparities that cause and maintain food insecurity, specifically amongst culturally and economi- cally diverse groups. Colonial and racist land practices in North America, including misappropriat- ing lands from Indigenous peoples, exacting free and punishing labour from African slaves and exploiting migrant farm workers with deplorable wages, have created the historical framework in which much agricultural operations and pro- duction are still rooted, however in different neocolonial forms, today (Turje, 2012). When food insecurity interventions are developed to help struggling, typi- cally low-income and frequently racialized, communities, the planning and pro- gramming is often developed by dominant-culture groups (Guthman, 2008; Slocum, 2007). This leads to paternalism with respect to who is setting and imple- menting the agenda and entirely undermines notions of equity, such as James Baldwin’s concept of the ‘welcome table’ (see, Farber, 2016) where people coalesce around food sharing irrespective of, yet simultaneously mindful of, social location in a spirit of community-building and ‘endless hospitality’. In the contemporary discourse surrounding food insecurity, there is the erroneous and strange calculus where farmers are only perceived through a food-security lens and thought to be separate from the low-income communities who are consumers of farmers’ prod- ucts (Turje, 2012). Such framings present a false picture by neglecting the ‘endless permutations of neoliberalism that threaten farmers and the urban poor alike’ (Turje, 2012, p. 135) yet invite questions about how to frame food security practice 330 Journal of Social Work 22(2) and policies in ways that are more inclusive and equitable. Nowhere is this more pressing than with respect to food insecurity and Indigenous Peoples. Amongst Indigenous Peoples both on- and off-reserve, the issue of food insecurity is con- siderable (see, e.g., Egeland et al., 2010; Ford, 2012; Power, 2008; Rosol et al., 2011; Rudolph & McLachlan, 2012; Skinner et al., 2013). This phenomenon is produced by a constellation of factors, including but not limited to land theft, broken treaties, racist governmental practices enacted by the nation state and more recently climate change. In this light, any work surrounding food insecurity must work in sincere partnership with food-insecure Indigenous communities at every step in the planning, development and implementation process to ensure food justice. Moreover, genuine food justice practices necessarily involve efforts to make postcolonialism a reality rather than simply a vapid term that is aspira- tional at best. Introducing nutritional social work Eating is often a communal activity with people sharing food around a table. The myriad factors influencing which foods are available and accessible affect individ- uals and communities. For this reason, Hamm and Bellows’ (2003) definition of food security, capturing as it does the community ethos, is particularly apt: ‘... a situation in which all community residents obtain a safe, culturally acceptable, nutritionally adequate diet through a sustainable food system that maximizes com- munity self-reliance and social justice’ (p. 37). This definition is being chosen as a foundation for our discussion of nutritional social work because its focus on safety, cultural acceptability, sustainability and promotion of self-reliance and social justice fit ethically and ideologically with the profession. Moreover, the phrase ‘nutritionally adequate diet’ suggests a concern not only with securing food (e.g., sufficient caloric intake), but also with having access to food that is nutritionally adequate. This emphasis on adequate nutrition is the focus of nutri- tional security scholarship and activism, an area largely overlooked in social work. Building on social work’s involvement in food security outlined above, this section of the article explores the novel concept of nutritional social work from a critical, anti-oppressive and ecofeminist framework. It is not enough to assert that all have a right to nutritious food: Achieving this goal requires consideration of the geopolitical environment in which food access and policies exist, where inequities produce favourable outcomes for some with respect to food security but not others. In this respect political paradigms, social structures and systemic barriers need to be explored and altered (Mullaly & Dupr!e, 2018) in the interest of food justice. Similarly, rather than looking at food insecurity as an individual challenge, the issue needs to be framed in the context of socio-political forces shaping the community and society, and how these simultaneously benefit some while further marginalizing others (Baines, 2017). Because ecofeminism addresses intersecting forms of oppression and includes historical and contemporary ecolog- ical degradation perpetrated by the dominant culture and its practices (Plumwood, Dylan and Cammaert 331 2002; Salleh, 2017; Shiva, 2016), an ecofeminist lens is particularly germane to any discussion of food insecurity, as food production necessarily depends on a healthy ecological base. Nutritional security is an instrumental component of food security, as complete nutrition requires more than just enough energy for every human being. We have known for a few decades that food insecure households tend to forfeit food quality and diversity in favour of quantity, in order to avoid physical hunger (Radimer et al., 1992). The United Nations Standing Committee on Nutrition, building on the previous food security definition developed by the Food and Agriculture Organization of the United Nations (FAO), define food and nutrition security conjointly as follows: Food and nutrition security exists when all people at all times have physical, social and economic access to food, which is consumed in sufficient quantity and quality to meet their dietary needs and food preferences, and is supported by an environment of adequate sanitation, health services and care, allowing for a healthy and active life. (Wüstefeld, 2013) This purposeful combining of food security with nutrition security underscores the need to consider these two issues together, requiring integrated social and health outcomes, as well as cohesive community, policy and development goals aimed at eliminating food insecurity and malnutrition. The need to guarantee available and accessible nutritious foods has been stressed by various international organiza- tions. One such organization, the FAO, has described ‘good nutrition’ as ‘the foundation for human health and well-being and physical and cognitive develop- ment’ (p. 4). Clearly, the implications of nutritional insecurity are vast, and inter- ventions must be implemented at every level of social work practice, including individual, community, policy, education and research. Nutritional security is an obvious social work issue because historically and in contemporary practice the profession works from a biopsychosocial modality and distinguishes itself from other helping professions using the person-in-environment context. The role of social work is vast as evidenced by the innumerable diverse contexts in which multilevel practice occurs. While some may argue that nutrition- al concerns are a health matter, not a social work matter, this line of thinking creates a false division between social work and health. Social workers have long been interested in various indices of health in the diverse contexts in which they work (e.g., child welfare, addictions, aging, mental health, etc.). With the growing body of literature connecting nutrition with mental health (see, e.g., Leyse- Wallace, 2013; Owen & Corfe, 2017), a key area of social work practice, social work may be remiss as a profession if not considering nutritional concerns as part of its purview. Social work has a long history of interprofessional practice, so this recommended foray into nutritional social work will likewise assume this collab- orative approach. Because of the enormous breadth of nutritional security con- cerns and the multilevel ramifications, each level of social work practice could 332 Journal of Social Work 22(2) constitute an article unto itself. However, because this is an introductory article, its purpose is to provide a foundational framework to begin the conversation around tabling nutritional security as within the social work purview. Nutritional social work framework Social work at all levels is eclectic and transdisciplinary engaging with scholarship from a variety of related fields, including psychology, psychiatry, sociology, polit- ical science, ecology, to name a few. For example, direct practice social work has borrowed considerably from the disciplines of psychiatry and psychology adopting practice theories and methodologies. In order to consider persons in environment, which is the sine qua non of social work practice, this borrowing is essential to understanding complex contexts and developing appropriate multilevel interven- tions plans. The following Venn diagram, depicting the intersecting and overlap- ping areas of multilevel practice, is not meant to be prescriptive but rather suggestive of potential areas for nutritional social work engagement in diverse contexts (Figure 1). Because nutritional social work is being proposed as a new sub-focus within the social work discipline and it is hoped this work will generate further related schol- arship, a model for practice would be premature. Instead, this diagram points to future directions for scholarship and practice that would include nutritional social work considerations. Direct practice Within the last decade scholars in the fields of psychology and psychiatry have begun to turn their lens to nutrition and its impact on psychological wellbeing, exploring and describing the role nutrition plays in mental health issues and recov- ery. Incipient connections are being established between mood disorders, primarily depression and anxiety and nutrition. In a rigorous systematic review and meta- analysis, Lai et al. (2013) found eating healthily (fruits, vegetables, fish and whole grains) reduces the associated odds of depression in adults primarily from the United States and European countries. Similar associations between depression and poor nutritional quality have been reported in recent literature. For example, M€ orkl et al. (2018) making the link between microbiota in the gut and mental health, find that poor nutritional intake is a factor in depression in their Austrian study. A study by Puloka et al. (2017) found, through multiple indicators, signif- icant relationships between mental health amongst New Zealand adolescents and both healthy and unhealthy eating, indicating poor dietary habits are associated with poorer mental health. A number of scholars are exploring the relationship between nutrition and mental health, finding links between poor nutritional quality and mental health issues and pointing to increased fruit and vegetable consumption being prophylactic for mental wellbeing (see, e.g., Aucoin & Bhardwaj, 2016; Jacka et al., 2017; Lang et al., 2015; Lim et al., 2016; Dylan and Cammaert 333 Direct Prac!ce with Individuals, Families and Groups - assessments inte in terv rven n!o !ons !ons - interven!onsns Policy Community Prac!ce and Engagement - ensuring access to nutri!ous foods - community gardens - living wage to increase - raising awareneess affordability - advoca!ng for food - local growing to security reduce food costs Figure 1. Nutritional social work framework: Possible directions for policy, community, and direct practice. McMartin et al., 2012; Rucklidge & Kaplan, 2016; Silva & Sobarzo-Sánchez, 2019; Sole et al., 2017). Because of these findings, scholarship in this area is moving in the direction of integrating this knowledge into prevention and intervention strategies. Social work has yet to pick up this line of practice, yet it behooves the profes- sion to do so given our purview of person-in-environment. The academic findings to date make incorporating nutritional considerations into the social work agenda part of sound evidence-based practice. With respect to social work practice involv- ing individuals, groups and families, nutritional considerations can be integrated throughout the assessment, planning, programme development and intervention processes. All such considerations need to involve the questions of availability, accessibility (both economically and geographically), cultural practices and sus- tainability that form the cornerstone of food justice efforts. In direct practice, this would encompass including a nutritional component in all social work assessments (being sure to include culturally specific food needs and preferences), critical 334 Journal of Social Work 22(2) knowledge-sharing regarding the nutrition and physical/mental health connection, involving nutritionists in interdisciplinary intervention planning, including nutri- tious food offerings in group contexts, and assisting with meal planning. At this direct-practice level, attention need be paid to the various structural and systemic forces that are shaping food accessibility and availability and how to aid service users in overcoming these barriers. Moreover, an important part of nutritional social work at the direct-practice level is helping people to reconnect with food production in their local region, the empowering practice of taking ownership of, and pride in, health and wellbeing through integrating fresh, local foods while reducing one’s carbon footprint. Community practice This way of integrating nutritional concerns into direct practice makes links with community, which is where much food and nutrition security scholarship has occurred thus far. Working within communities is foundational to social work both historically and today and is instrumental to improving the overall quality of life. Applying the lens of nutritional security to community practice incorporates a collaborative approach of revitalizing neighbourhoods, building resilience, address- ing food and ecological security and fostering a healthy local environment. The four key pillars of community practice outlined by Gamble and Weil (2010) are organiz- ing, planning, sustainable development and progressive change, with the entire framework being undergirded by social and ecological justice (p. 10). Moreover, progressive community change necessarily involves attending to ‘meaning, context, power, history, and possibility’ (Finn & Jacobson, 2003, p. 58). With respect to nutritional security and the role of social work, this critical model of community practice involves questioning who has access to nutritional security and why? What are the power relations determining access and availability? How has history shaped the existing food supply structures and systemic barriers to food? What political processes inform nutrition knowledge? How do big agri-businesses benefit from community members’ alienation from food production? What are the opportunities for more equitable, democratic, ecological and culturally and contextually relevant food production, distribution and consumption practices? With respect to organizing and planning, nutritional social workers can engage community members in multidirectional information sharing sessions to collective- ly enhance nutrition knowledge and related physical and mental health outcomes. Associated with this would be the grassroots development of community kitchens, community gardens, vertical gardens, networking with local farmers, integrating fresh food into pantries and food banks (with a view to eliminating their need), mapping out access points, transforming green spaces into viable growing spaces and coalition building pertaining to food security and food justice. Establishing and maintaining nutritional security necessitates the use of sustainable practices. Social workers incorporating nutritional considerations into their practice would do well to have an understanding of what has been termed the ‘triple bottom line’: Dylan and Cammaert 335 persons, economies and ecologies (Agui~ naga et al., 2018). This would help support the health and flourishing of community members and their collective wellbeing, assist in ensuring economic security and aid in protecting the landbase on which the community depends (Agui~ naga et al., 2018). Of course, for community practice to eventuate in progressive change, attention must be paid to issues of power, including both larger structural barriers and microphysics of power occurring in everyday life, with a commitment to empowerment, fair political processes and equal outcomes for all. Policy Dickens (2016) observes three mandates inhering in what he terms ‘the social policy triangle’ characterizing social policy in democratic countries of the global north as serving ‘to ensure the wellbeing (and welfare) of citizens, to promote the values of individual responsibility and family autonomy, and to uphold economic freedom and prosperity’ (p. 25). The focus of this model appears to be balancing capitalistic needs with individual needs in a strange calculus that omits overt inclu- sion of the environment and social justice. Of course, any well-functioning capi- talist nation-state in the western world needs to balance societal needs and economic considerations; however, in a social work context where social justice and societal transformation are imperative, policy models need to include matters of equity, ecology, rights and deliberate mechanisms for the democratization of policy processes and models. In this time of neoliberal globalism marked by fiscal retrenchment and govern- mental retreat, there is great need to safeguard existing policies designed to assist casualties of the capitalist and other oppressive systems, and to advocate for new ones. As Curry-Stevens cogently argues (2006), social workers advocating for var- ious social policy changes need to be profoundly committed to social movements. Her urging, which connects with social work’s historical foundation in the Settlement House Movement, is prudent given the evident success of numerous recent social movements – the Idle No More movement, Arab Springs, #MeToo, being some such examples. Successful advocacy is ‘counter-hegemonic,’ eliminat- ing participation in oppressive systems, and involves ‘campaign wins, constituency empowerment, organizational development, and grassroots leadership develop- ment’ (Curry-Stevens, 2006, p. 113), and the creation of truly equitable partner- ships and democratization of both participation and knowledge building processes to maximize inclusion of multiple voices. Considering the important individual, social, cultural, economic and ecological implication of nutritional insecurity, social workers need to push the political agenda for inclusive policies to address these dire needs at all levels of government. For instance, without a commitment to move the ecological agenda, nutrient qual- ity decline and barriers to access nutritious foods will increase due to the impact of extreme weather events, rising levels of carbon dioxide, increased application of pesticides and administration of veterinary drugs (Ziska et al., 2016). Social 336 Journal of Social Work 22(2) workers can accomplish this by supporting Green political initiatives that promote sustainable agriculture, decreased food waste and clean power. While promoting nutritious foods, it is essential to address rural and urban challenges to accessibil- ity, decrease financial burdens through reduced costs, targeted funding, income assistance and living wage policies. Promotion of nutritional foods can be encour- aged through subsidies for farmers producing food for the local area, start-up grants for community gardens, school policies regarding availability of foods and food education, and creation of marketing policies to encourage plant-based whole food consumption. While the Canadian Dietetics Association has made positive nutritional changes to the Canada food guide (Government of Canada, 2019), social workers need to be at the policy table critically examining and design- ing policies to make nutritional security a right of every citizen, while being cog- nizant of specific cultural, economic and ecological needs, and the unique needs of marginalized and low-income communities. Concluding remarks This article set out to assist with getting nutritional concerns, beyond the important scope of food security and food justice, on the social work agenda. While food security and food justice scholarship highlights the necessity of ensuring food acces- sibility and availability to all persons in all communities globally, the focus of this article, nutritional social work, highlights the role for social workers at direct, com- munity and policy levels in ensuring all people, through participatory, democratiz- ing, power-sharing and equity-creating processes, have access to nutritious foods. Gambrill and Gibbs (2009) present the following concepts essential to critical thinking originally proffered by Paul (1993), compellingly demonstrating their rele- vance to social work practice with all its ethical and social complexities: purpose, questions, point of view, concepts, assumptions, information, interpretation, con- clusions and implications. In the context of nutritional social work and security, these concepts can be critically applied. For example, What is the purpose of a specific food policy, programme, intervention, coalition, or teaching opportunity? What questions are being asked? By whom? For whom? Whose point of view is represented? What does this reveal about power relations? What concepts are used in the specific nutritional security initiative? Who put forward the concepts? What was the process in developing the concepts? What assumptions underlie the food security initiative? Do the assumptions represent a plurality of voices? If not, why? What is the information associated with the policy, programme, or intervention? From where does it come? Does it reflect a participatory process? How is information being interpreted? How is it gathered? Who is presenting it? Who does the informa- tion represent? How is information pertaining to the food initiative interpreted? By whom? For whom? Does the interpretation process involve multiple perspectives? What are the conclusions surrounding a nutritional security initiative? Who decides? What are the implications at all levels of practice? What is addressed and what is not? Who benefits and who does not? Is the initiative sustainable? Dylan and Cammaert 337 Using this framework is invaluable to assessing any strategy designed to increase nutritional security, as it ensures not only critical thinking but also creates avenues to incorporate the critical theoretical and practice perspectives of ecofem- inism, anti-oppressive practice and structural social work at every step in strategy development and at multilevel practice. As a foundational area of social work practice, nutritional social work has implications for social work education and research. Nutritional social work can be integrated into direct practice, communi- ty, theory and policy social work curricula at the undergraduate and graduate level. In direct practice courses, nutritional security can be introduced as a com- ponent of assessment, skill building and in interdisciplinary intervention planning. Community nutritional security assessment, community gardens and vertical gar- dening are all areas that can be added to community coursework. Critical theories and approaches to nutritional security can be readily integrated into existing social work theory classes, with urban planning, coalition building and policy develop- ment being integrated into macro level courses. Social work internships are also an area where nutritional security initiatives can contribute to student interaction with the field in areas such as community garden initiatives, drafting legislation, or social action organizing. In addition, continuing education opportunities can be created to build social work’s capacity in this field. Similarly, a multilevel research agenda needs to be created in order to examine the importance of nutritional social work for practice with individuals, families, groups, and communities, theory and policy. The objective for this article was to introduce the concept of nutritional security to the social work discipline, which is already strongly engaged with food security issues and a constellation of associated matters. The goal was not to present con- crete paths or frameworks but to initiate a discussion surrounding the relevance of nutritional social work and point in a number of possible directions for incorpo- ration of this subdiscipline into social work praxis. There is much work to be done in the area of nutritional social work at multilevel practice in myriad contexts and in education and research. It is our hope that this article will serve as a springboard to future practice and scholarship in nutritional social work. Funding The authors received no financial support for the research, authorship, and/or publication of this article. ORCID iD Jenni Cammaert https://orcid.org/0000-0002-5617-7986 References Agui~ naga, E., Henriques, I., Scheel, C., & Scheel, A. (2018). Building resilience: A self- sustainable community approach to the triple bottom line. Journal of Cleaner Production, 173, 186–196. https://doi.org/10.1016/j.jclepro.2017.01.094