Teaching nutritional sciences in times of cholera

This year that is now beginning is increasingly resembling March 2nd, 2020, the day the first cases of SARS-CoV-2 were reported in Portugal. Initially, an undefined fear took hold, until uncertainty about the future descended upon us, and fear of the other contaminated our daily lives. Now, almost five years later, we are witnessing the resurgence of fear. Fear of the other who is a stranger to us, fear of war, of an increasingly uncertain climate, and a lack of faith in science and the institutions that produce science.

For those who produce science, for those who teach and pedagogize, these are times of enormous challenges. Times in which academia is increasingly forced to fight for its integrity and independence in the face of powers that attempt to manipulate the facts it produces. But the questioning of science and scientific institutions, or the manipulation of facts produced by academia, is not a new situation in our history or entirely surprising. Even in the food sector, which has always been an area of ​​economic, social, political, and even religious dispute, this has happened many times throughout the centuries. What is surprising now is the scale of this attempt and the new means available to those who try to manipulate. But on the other hand, a more prepared academia is now expected, one that understands the impossibility of neutrality and its role in society. Because it realizes that, devoid of humanist values, it will increasingly become a tool at the service of despots. This is an urgent discussion to have in our university in these times.

Challenging science in times of uncertainty

The role of science in assessing and managing "hazards" has gradually gone through several phases throughout history, where scientific knowledge and the society that lives with it have interrelated and mutually influenced each other. As the idea that the origin and overcoming of "hazards" is theological in nature fades, industrial societies have attempted to contain hazards through their understanding and subsequent management using various methods. These methods, despite incorporating an increasingly consistent and specific scientific basis over the years, have always been strongly influenced by the social, economic, and political matrix of the time and place in which they are situated.

In the early 19th century, the increasing prevalence of infectious diseases such as tuberculosis, cholera, and typhus in England produced not only increased anxiety but also distrust in the expansion of the British Empire and the process of industrialization. Cholera seemed to be related to the increasingly frequent arrival of people from India, and typhus to poor sanitation and overcrowding in urban areas. At that time, the Sanitary Reform Movement and the anti-contagious doctrine that underpinned it emerged. This theory argued that these diseases were caused not by any microorganisms or other then-unknown mechanisms, but by garbage and its fumes produced by large urban concentrations and poor sanitation, which would create a "miasma" or a "fog of disease" that covered large urban centers. Edwin Chadwick in 1842 and Florence Nightingale in 1859 publicized these ideas and the need for broad public intervention through experts to control the problem. In 1842, Chadwick published an extensive report, the "Report on the Condition of the Labouring Classes of Great Britain," in which he mapped the most problematic areas and the different levels of exposure to garbage and its fumes. He also presented solutions that involved altering sanitary infrastructure and creating a "Ministry of Health" and "Health Officers" capable of "accurately detecting and effectively preventing" outbreaks of disease. Despite several inconsistencies and difficulty for the layperson to understand, the publications of these two authors had a huge impact throughout the country. For the anxious population, the scope of the problem was clearly defined, making it predictable and controllable. By removing these conditions, that is, by encouraging people and authorities to take more care with the "hygiene" of public and private spaces, the problem would be solved. For the authorities, industrial growth, urban expansion, or the free movement of people and goods within the vast British Empire were not at risk, although these could be affected if the "Quarantine Laws," which had been used since the 17th century to prevent seemingly similar cases, were reinstated.

This process of "containing the danger," where the proposed solutions did not impede economic growth or free movement, already foreshadowed, albeit in an incipient way, the process of risk analysis and some of the tensions that currently exist around its assessment and management by scientists and policymakers globally.

This tension has since been repeated in various parts of the world before the COVID-19 outbreak.

In the city of Porto, between July 4th and 6th, 1899, the physician Ricardo Jorge , who was then Director of the Municipal Health Post, identified, through laboratory analysis, several people infected with bubonic plague. On July 12th, he suggested to the city's civil governor the "internment and isolation of all those infected" and later suggested the "imposition of a sanitary cordon around the city." As measures to contain this contagious disease, Ricardo Jorge recommended preventing entry and exit from Porto and promoted inspection and disinfection actions in port areas and railway stations, also closing commercial establishments and some factories. Faced with the economic and financial losses that the sanitary cordon imposed on the city, Ricardo Jorge saw his carriage stoned during his medical visits, requiring a police escort. Newspapers such as O Comércio do Porto and the Porto Commercial Association contested these measures and denounced a strategy to weaken Porto's economic activity from the central power in Lisbon. The newspaper added: "Public health above all, yes; "But it is not permissible, under the guise of public health, to bring ruin to a country, annihilate its commerce, and reduce to misery those who earn their daily bread from industry." Later, Ricardo Jorge would be forced to leave the city. In total, 320 people would be infected, resulting in 132 deaths. Leaving Porto, Ricardo Jorge would implement a national health reform and found the Directorate-General of Health. Meanwhile, the sanitary cordon would end on the eve of Christmas, and the bubonic plague would be contained, practically within the city, but the role of the sanitary cordon in this outcome would never be quantifiable.

Recently, on February 5, 2025, Argentina announced its withdrawal from the World Health Organization (WHO), justifying its decision in an official statement as follows: “The WHO was created in 1948 to coordinate the response to global health emergencies, but it failed its greatest test: it promoted internal quarantines without a scientific basis when leading the fight against COVID-19. The quarantines caused one of the greatest economic catastrophes in world history and, according to the 1988 Rome Statute, the quarantine strategy can be classified as a crime against humanity. In our country, the WHO supported a government that kept children out of school, left hundreds of thousands of workers without income, bankrupted businesses and small and medium-sized enterprises, and cost us 130,000 lives. Currently, the evidence indicates that the WHO's prescriptions do not work because they are the result of political influence and not science. Furthermore, the WHO has confirmed its inflexibility in changing its approach and, far from admitting its errors, chooses to…” "To continue assuming responsibilities that do not belong to them and to limit the sovereignty of countries. It is urgent that the international community rethink the reason for the existence of supranational organizations, funded by all of us, that do not fulfill the objectives for which they were created, become involved in international politics, and seek to impose themselves on member countries."

The challenge to science is once again intensifying these days. And the challenge to a university that has a teaching model based on pluralistic democratic values ​​and that promotes social equality is following the same path. There is a desire for a neutral school, detached from social reflection. As if the school were apolitical and did not stimulate reflection on these issues. And as if our actions, even the most basic ones like the act of eating, were not eminently political and did not globally affect other human beings.

The act of eating as a political act

In the area of ​​food, consumption reflects a specific social practice. The act of consuming defines an area of ​​social interactions traditionally characterized by acts of protection (in the case of mothers), by anxiety, for example, and by a culture associated with symbolic values ​​and the formation of tastes and knowledge in relation to the environment. Therefore, it is likely that perceptions of risk are strongly influenced by the social and cultural matrix of the societies in which consumers are involved.

Our societies have recently been characterized as increasingly complex and uncertain, with significant impacts on consumer confidence in food and related institutions. In the late 1980s, the concept of Risk Society emerged. According to its main theorist, Ulrich Beck, current Western societies have progressively ceased to focus on combating scarcity (food, among other basic needs), thus removing from the modernization process its previous basis of legitimacy: the fight against evident scarcity, for which some of its secondary effects were acceptable. According to the author, current society is characterized by new risks. These risks are mostly invisible, being established by knowledge, which can dramatize or minimize them, and are sensitive to social processes of definition, where whoever defines the risk becomes a crucial socio-political actor. This type of risk also affects those who produce and those who benefit from it, often being global risks, producing new types of inequalities, where knowledge acquires a new political meaning. The fact that these risks have increasingly fewer boundaries, and that public opinion may be unwilling to accept them, leads to increased public and political interference in the sphere of corporate and even national autonomy. For Beck, defining new risks (who defines them and how they are defined) requires the "perceptive organs" of science (theories, experimentation, measurement instruments) to make them visible and interpret them as dangers. Science and its institutions are not only responsible for detecting dangers, but also for their valuation and prioritization. Having lost part of the "cognitive sovereignty" to detect dangers, the everyday awareness of risk is thus a theoretical and therefore "scientific" awareness. In addition to Beck, other authors such as Giddens and Sulkunen have explored this uncertainty present in modern societies and the need for individuals to trust institutions they poorly understand. This trust differs from the familiarity or faith present in earlier times, and can be interpreted as a motive for freedom or, conversely, a cause of anxiety. Another school of thought, including authors like Luhmann and Shapiro, suggests that one characteristic of current societies is that most people have lost the capacity to gather, process, and interpret all relevant information, having to resort to the evaluation and interpretation of various experts scattered across space and time.

In other words, food consumers seem increasingly dependent on an extremely complex and dynamic food system made up of long chains of stakeholders and products, many of which are unknown. Understanding this system requires a vast amount of knowledge that cannot be fully grasped by the public. It is in this context of increasing dependence on anonymous institutional actors that the need to trust something or someone must be understood. Both Luhmann and Shapiro indicated trust as an important mechanism for reducing complexity and overcoming feelings of uncertainty.

This need for universities and other public institutions to establish themselves as spaces of trust is a huge and current challenge. These institutions can be the World Health Organization (WHO), the Directorate-General of Health (DGS), or academia. For this reason, their credibility, or attacks on their credibility, are at the center of various political agendas.

Teaching is never an apolitical act

The university is a space where knowledge is produced, influenced by society, but which should be sufficiently independent of economic and political power, allowing freedom of expression and forming citizens who respect others and their differences. The roots of the academy, founded by Plato, aimed to guarantee an institutionalized space of freedom as opposed to the freedom of the marketplace (agora) and away from the city (polis). But it was a space that could not be indifferent to the street. According to Hannah Arendt in "The Promise of Politics" (2007): The decisive point in this context is not so much the conflict between the polis and the philosophers (who were in the academy), but the simple fact that this indifference of one domain towards the other, seemingly offering a temporary solution to the conflict, could not last precisely because the space of the few and their freedom would not have the possibility of fulfilling the functions attributed to a political space, including all those who had the possibility of enjoying freedom. The few, wherever they may have isolated themselves from the many – whether in the form of academic indifference or oligarchic government – ​​have manifestly ended up depending on the many, particularly in all aspects of common life that require concrete action.” And this attention to the street has necessarily increased over the last few years, as “technoscientific euphoria has increased, but so has illiteracy of civic values,” in the words of Daniel Innerarity.

A university that does not educate citizens who respect others and their differences, and does not fight against inequality and discrimination, will not be fulfilling its mission. Science associated with these values ​​cannot be apolitical, or detached from the problems of the polis, which is ultimately all of us. According to the Council of the European Union (15738/23), our open democratic societies depend on public debate that allows well-informed citizens to express their will and opinion through free and fair political processes. “Media literacy, the safe, critical and responsible use of digital technologies from a human-centered perspective, and a correct understanding of the current challenges related to disinformation and misinformation are therefore essential for informed democratic participation and, ultimately, for the learning processes that take place in our universities.”

For these reasons, we advocate for the teaching and understanding of public policies in nutrition science education. Nutritionists need training that allows them to reflect on how the food system influences us and how we can try to influence it through tools and mechanisms of public participation and in democratic regimes with a mandate for action. This knowledge is crucial for understanding and acting upon the set of people, institutions, places, and activities that play a relevant role in the production, processing, transportation, sale, marketing, and ultimately, the consumption of food. Food systems influence dietary patterns, determining the types of food that are produced, the foods that are accessible, both physically and economically, and people's food preferences. They are also fundamental to ensuring food and nutritional security, people's livelihoods, and environmental sustainability.

As we wrote earlier in defining the concept of "compromised nutrition," we need a model for action on food and nutrition issues that integrates the determinants of inadequate food intake within a systemic framework, going beyond individual issues, and that has the capacity to make pragmatic proposals for action and collective mobilization on these determinants, both locally and globally, involving civil society, stakeholders, political forces, and academia. This model of action also prioritizes transparent participation free from conflicts of interest. It presupposes "the need for adequate training of health professionals in this field, particularly nutritionists, knowledge of monitoring processes and participation in public policies, especially in areas that shape food consumption, and greater intervention throughout the food system, particularly in the most sensitive and influential areas of inadequate intake by the most vulnerable population groups, such as the production, marketing, and promotion of food products."

A new way of teaching Nutrition Policy – ​​The role of innovation and the arts in times of cholera

But teaching public policy doesn't necessarily have to be a barren area, devoid of innovation and even humor. I quote Professor Daniel Innerarart again from his book "Politics for the Perplexed" (2019): "What has run out is not politics itself, but rather a particular form of politics, specifically that which corresponds to the era of the territorially delimited and politically integrated society (...) Politics must be able to generate the necessary knowledge – of ideas, instruments or procedures – to moderate a knowledge society that operates in a networked and transnational way." We know this in the food sector, where food systems are embedded in transnational contexts and operate globally, creating difficulties for isolated measures defined in national food policies or strategies, requiring innovation and cooperation. The case of regulating food marketing aimed at children or nutritional labeling are good examples of these difficulties, where cooperation is essential and where the WHO has led several processes bringing together dispersed states incapable of a global strategy. Perhaps this explains the recent intention to establish these organizations as the main targets of the new political offensive and to promote a return to food policies that promote national food identities, market protectionism, and food product taxation.

Returning to the beginning of our text and to more recent times, when we were confined during the most acute phase of the Covid-19 pandemic, the proximity to the arts and artists, to culture and artistic works, demonstrated the power of the emotions provoked by art in promoting our well-being and stimulated resilience to fear, loneliness, and uncertain times. I subscribe to the words of Inês Pedrosa, who said that "schools are places where one learns to uninstall fear." Perhaps understanding decision-making processes and participating in these processes are ways to uninstall fear. The same happens when we participate in processes of cultural inclusion, that is, participation in narratives, in the collective narrative, in the meanings that unite people and in the possibility of sharing them. Therefore, I believe it is important to combine the teaching of public policies, in these times when there seems to be less space for humanist thought, with the voice of artists who quickly overcome the barriers that separate us and allow for hope. Whether through cinema, literature, music, dance, painting, or photography. We offer an example of satire that compels reflection and thought about the political process. Here is an example from the book "Instalação do Medo" (2012) by Rui Zink, which can be a pedagogical tool for understanding fear as a driving force in politics, but also as a space for a challenging and sarcastic view of the bureaucrats of fear and their weaknesses.

“On the threshold, two men. One in a suit and tie, elegant, slender, with a thin nose and lips, a technocratic briefcase in his hand. The other, stockier, with a closed expression, overalls, a toolbox in a large hand.
 – S-sorry, I was with the washing machine, I didn’t hear…
 But as he says this, the woman realizes it’s the wrong lie. There’s no noise from the washing machine coming from the kitchen.
 The men look at the woman as if they weren’t looking at her.
 It’s strange. The men don’t have a threatening air. Quite the opposite. The one in the suit even seems talkative; the other, yes, is more brutish, heavy, absent.
 – Good morning, madam – says the one in the suit, with his talkative air – We’ve come to instill fear.
 – F-fear?...
 The talkative man in the suit makes a rhetorical expression of astonishment:
 – You weren’t warned, madam? – The man makes a face of astonishment with his eyes.
 The woman bites her lip:
 – Does it have to be today?” "It's just that I had already planned it…"
 The man in the suit, talkative though polite, is firm:
 "Madam, progress doesn't stop. It's for the good of the country.
 " "Yes. But I wasn't prepared…
  The man in the suit looks disappointed:
 "Don't tell me you're against the good of the country.
 " "I…
 " "Or against progress.
 " "…
 " "Or against fear."
 The woman bites her lip:
 "No. Of course not…"
 The woman should have realized from the beginning that the elegant man in the suit, talkative, wouldn't back down. And no, he doesn't:
 "Madam, you know that instilling fear is a patriotic objective. Directive No. 359/13. Ordinance 8: 'All homes must have fear installed within 120 days.'" "You're familiar with the ordinance, aren't you?
 - Well…
 - And the Directive?
 - Yes…
 - It's important. A significant event. Crucial for proper functioning. It's crucial for everyone's well-being that the implementation of fear be done promptly and orderly, and that the integration deadlines be met."