Health agency and social justice: A qualitative inquiry into fast food workers and eating behavior

Ruger (2010) points out a truism that people not only want to be healthy; they also want the ability to pursue health. This latter goal – health agency - requires more than health knowledge; it requires the ability to process, interpret and act in ways directed toward health goals. A lack of health agency may play an important role in perpetuating health inequities.

We conducted a qualitative study with college students from lower income families (n=15) employed in fast food restaurants who experience individual and environmental-level constraints in healthy eating. Our goal was to reveal the content of constraints faced by vulnerable populations that limit health agency. Students were interviewed in-depth about eating at school and home, restaurant food policies, relationships in the work setting, and how they understood "normal eating" and being "in control" of their food intake. Students whose eating behaviors were constrained in their work environments (e.g., 10 minute eating breaks, restrictions on cost/types of food) expressed low levels of health agency. Conventional nutritional messages (through school and popular media) were sometimes experienced as controlling and thus rejected. Descriptions of healthy eating were vague, and students were reluctant to label certain eating patterns as "unhealthy."

Our study shows how social justice and public health may converge through facilitating health agency in vulnerable populations. It provides directions for education, policy and interventions: 1) by revealing embedded contexts that give rise to particular concepts of agency and control; and 2) by unpacking these concepts to better understand health disparities.