Dietary choices, cooking styles and eating habits are all influenced by a number of factors. In part, they are the product of personal preferences, but they are also determined by the availability and cost of food, by the ways in which food and nutritional advice are promoted and distributed, and by cultural values – those attitudes, beliefs and customs that shape our behaviour and help to dictate our choices. After some 65 years of living and eating and watching others eating, and having enjoyed ever more and variable types of food and changes in my dietary pattern, the concept of culture provides a great perspective to both look back and into the future.

Coming from the Netherlands and from a family with a decreasing agricultural background, I remember my grandparents keeping a few pigs, chickens and rabbits for multiple purposes, including eating them, and largely growing their own vegetables. Pea soup with boiled pig nose, feet and ears was a delicacy for my grandfather. I enjoyed my grandmother’s chicken soup which was filled with the remains of the rooster that had dared to peck at my grandfather. Home-grown boiled potatoes with a lot of gravy were part of a diet that fitted a culture of hard physical work. Being able to do the required physical amount of work was as close to health as this diet could get.

My mother and my father, who was a civil servant in the national tax department, slowly introduced us to more ‘exotic’ food, such as Italian ‘macaroni’. I remember the first paprika and tomato on our table, which my father never came to like. When I was a teenager the first restaurant I entered with my family was Indonesian-Chinese. These were more affordable than the average Dutch restaurant and became popular after many Dutchmen had migrated back from Indonesia to the Netherlands, taking oriental food cultures with them. I had school friends whose parents would hardly eat potatoes but mainly boiled or baked rice.

Dutch people from Turkish and Morroccan backgrounds have recently introduced us to their sweet pastry, lambs meat, kebabs and new herbs, which are now easily available in all cities. One month a year they have their cultural feast of Ramadan, fast during the day, and always refrain from pork meat or alcohol as their culture prescribes.

My wife and I slowly introduced more French and Italian cooking into our cooking pattern, increasing the amount and number of vegetables, and occasionally preparing a vegetarian meal. We learned from friends, who had become `biological’ cooks, that a vegetarian meal could be more than just beans, lentils, salads and cheese. In the meantime I began to cook ‘Indonesian food’ myself and discovered the number of great herbs and flavours that we import from around the world. Nowadays Japanese, Chinese, Indian and Thai cooking ingredients and fresh herbs and vegetables are accessible from neighbourhood stores and fusion cooking is expanding immensely.

There are now other culturally determined dietary preferences, influenced by concerns about health, but also by larger concerns about global ecological sustainability. Some people choose food from specific value perspectives, i.e. the value of environmental sustainability. They buy mainly vegetarian food items that have not been transported too far, to save energy, reduce pollution, stabilize the climate and allow sufficient food production for a future world hosting several billion people more. From this perspective, a cow can be an air-polluting, energy-consuming monster.

Linking ‘health’ to our food culture is another increasing trend. In my younger days drinking a litre of whole milk was officially healthy; now we have a fashion of labelling food items ‘unhealthy’ or ‘healthy’, even though the term `healthy’ is rarely defined.

We also increasingly see public choice and enjoyment of food for its wonderful taste and I must confess that I often join them for the joy and amusement of dining together with friends and family. I am too often drinking what my public health conscience would consider a little too much alcohol, as wines from Europe, South America or Africa are often so enjoyable. These interests have been carried over into the next generation of my family. Like many others, my daughter-in-law keeps a food website that displays and discusses international and multi-cultural recipes and news (De Avonden @ 2 Hoog) and my son, who is a general practitioner, has a degree in wine science.

For some people, ‘easy’ or `fast’ food has become the preferred culture of choice, facilitating the spread of McDonald’s hamburger restaurants and a culture where people in cities regularly eat on the streets. For others food has to be affordable, often cheap, both by their limited financial ability and by the fact that their value system forces them to set different priorities.

As a public health generalist and working on public health status and forecast reports for the Netherlands, I was confronted with the dietary risk factors contributing to chronic diseases, including cardiovascular disease, cancer, diabetes, obesity and food-borne infectious diseases. I remember writing a small chapter on obesity for our 1993 report, when the obesity epidemic still had to emerge and we referred to ‘Quetelet Index’, rather than BMI. We noted that the relation between overweight and cancer was inconclusive still. In the meantime peanuts appeared to occasionally contain aflatoxins, food allergies were quickly on the rise and our homes for the elderly had problems with salmonella and norovirus infections. Food safety became a serious issue and required a culture change in larger and smaller kitchens and in food production facilities.

Recently, the Netherlands National Institute for Public Health and the Environment (RIVM) has undertaken a scientific foresight exercise, a so-called ‘knowledge synthesis’, on diet and nutrition that focuses on food safety, health and sustainability. The developing pattern of the different food cultures, food choices and dietary patterns that I have touched upon above will influence global agriculture, international trade, national economic activity and our future health and food safety. Can we in the future ensure that diets are safe, healthy, sustainable and culturally acceptable at the same time? What choices do we have to make in the future as citizens, farmers, shop-keepers, industrial entrepreneurs or policy makers? What policies will help us to keep all cultures happy and optimize our safety, health and sustainability? How can we nudge certain cultures towards slightly different choices? Can we make the healthy choice the easy and affordable choice? What will be the price we have to pay? Culture will remain a dominant factor in all of this.

This post was written by Professor Peter Achterberg, Senior Advisor at RIVM, his work can also be seen in this World Health Organisation interview.