This narrative review paper explores how understanding of nutrition and public health have changed over time, influenced by developments in science, social changes and policy-making. The paper identifies some major paradigm shifts, such as the identification of vitamins in the early 20th century, and the recognition of the link between dietary patterns and some chronic diseases in the late 20th century.
Public health nutrition (PHN) seeks to protect and promote the nutrition-related health and wellbeing of populations. PHN science is dynamic and has evolved over time, helping to inform our understanding of the changing nature, scope, causes and solutions to PHN problems. This scientific basis has informed nutrition guidance and policy. Using a narrative synthesis method and guided by Kuhn’s theory on the structure of scientific revolutions, this paper reviews the historical development of PHN, aiming to understand the emergence of major scientific paradigms, paradigm shifts and evidence-informed guidance and policy. We propose that the development of PHN is characterized by the successive layering of paradigms resulting from interactions between science, social change and policy-making. Four eras of PHN are evident: the foundation, nutrient deficiency, dietary excess and imbalances, and environmental sustainability (ES). Dominant paradigms have been communicated through nutrient reference standards, dietary goals and dietary guidelines. Transitions from one era to the next indicated new ways of thinking about PHN, amounting to a paradigm shift. The bidirectional relationship between nutrition and ES is the latest challenge confronting PHN. Investigating PHN paradigm transitions reveals how we have arrived at current guidance and policies, and how PHN might progress into the future.
Ridgway, E., Baker, P., Woods, J. and Lawrence, M., 2019. Historical Developments and Paradigm Shifts in Public Health Nutrition Science, Guidance and Policy Actions: A Narrative Review. Nutrients, 11(3), p.531.
Read the full paper here. See also the Foodsource Building Block What is the nutrition transition?, the Foodsource chapter What can be done to shift eating patterns in healthier, more sustainable directions? and the FCRN report Plates, pyramids and planet – Developments in national healthy and sustainable dietary guidelines: a state of play assessment.