Realist Approach to Social Policies (RASP) study to reduce socioeconomic health inequalities through systems change: protocol for a research project combining mixed-methods realist research with institutional action research.

INTRODUCTION: Health inequalities are rooted in inequality in vital resources for health, including financial resources, a supportive informal network, a stable living situation, work or daytime activities or education and literacy. About 25% of Dutch citizens experience deprivation of such resources. Social policy consists of crucial instruments for improving resources in those groups but can also have adverse effects and lead to additional burdens. This project aims to contribute to the reduction of health inequalities through (1) a better understanding of how social policy interventions can contribute to reducing health inequality through the redistribution of burdens and resources and (2) developing anticipatory governance strategies to implement those insights, contributing to a change in social policy systems. METHODS AND ANALYSIS: Two systems approaches are combined for establishing a systems change in the Netherlands. First, a realist approach enables insights into what in social policy interventions may impact health outcomes, for whom and under what circumstances. Second, an institutional approach enables scaling up these insights, by acknowledging the crucial role of institutional actors for accomplishing a systems change. Together with stakeholders, we perform a realist review of the literature and identify existing promising social policy interventions. Next, we execute mixed-methods realist evaluations of selected social policy interventions in seven municipalities, ranging from small, mid-size to large, and in both urban and rural settings. Simultaneously, through action research with (national) institutional actors, we facilitate development of anticipatory governance strategies. ETHICS AND DISSEMINATION: This study is not liable to the Medical Research Involving Subjects Act (WMO). Informed consent to participate in the study is obtained from participants for the use of all forms of personally identifiable data. Dissemination will be codeveloped with target populations and includes communication materials for citizens, education materials for students, workshops, infographics and decision tools for policy-makers and publications for professionals.

Game changers for meat and masculinity? Male athletes' perspectives on mixed and plant-based diets.

The dietary choices of male athletes are increasingly a topic of moral and nutritional debate. Though it has long been a consensus that athletes require animal products to advance their athletic goals, this understanding is now challenged in academic and popular sources based on nutritional evidence and concern about the environmental impacts of animal products. In order to better understand how (semi-)professional male athletes perceive plant-based diets and diets containing animal products, thirteen semi-structured interviews were conducted with male athletes competing nationally and internationally, including mixed and plant-based eaters. Interviews were analysed through reflexive thematic analysis, in line with a critical, qualitative research methodology. Justifications for meat, situated knowledge and masculinity were used as theoretical lenses. Our analysis shows how athletes reproduce nutritional claims about the necessity of protein for athletes, but disagree on the suitability of plant-based sources. This nutritional discourse derives from a broad range of sources, including professional nutritionists, friends, online influencers, and media. Second, when explaining their own food practices, food being 'nice' and 'normal' - common justifications for meat as evidenced in the 4N theory - often supersede necessity. Embedding these views in their everyday lives as athletes shows that food environments and shared eating practices fortify a mixed diet as normal, and plant-based diets as anomalous. It further shows how the view of meat being normal is subject to shifting masculinity norms. Interviewees reject meat eating as normal and masculine for men, while male athletes who show dedication, constraint, and knowledge in a plant-based diet are viewed positively. As role models for diet and masculinity, this has implications for a potential role of athletes in a societal transition towards lower consumption of animal products.

"Too big to fail": the resilience and entrenchment of food aid through food banks in the Netherlands during the COVID-19 pandemic.

This paper aims to better understand the resilience and further entrenchment of food aid through food banks in the context of the COVID-19 pandemic. During the first months of the pandemic in the Netherlands, concerns quickly rose about the number of people falling into conditions of food insecurity. Adding insult to injury, food banks reported problems in their operations. The analysis shows that after some adaptations to initial problems, food banks were largely able to continue their service. This ability was partly based on organizational flexibility. However, in order to understand the resilience of food aid through food banks, it is imperative to understand food banks as part of a system of food aid that extends beyond the organizational boundaries. This system includes a range of other actors and resources, including donors, public support and governmental backing that contributed to the resilience of the food aid system. While this embeddedness in a system as well as broad public support were essential for the resilience of food aid through food banks, both factors also indicate the further entrenchment of food banks in the understanding and practices of ensuring food security for people in poverty. Ultimately, when the root causes of a need for food aid are not addressed, a resilient system of food aid through food banks can eventually prove detrimental to societal resilience, specifically the ability to ensure dignified access to adequate food.

Backlash against Meat Curtailment Policies in online discourse: Populism as a missing link.

Given overwhelming evidence that current levels of meat consumption jeopardize human and planetary health, there is a need for governmental action to reduce meat consumption (i.e., Meat Curtailment Policies, or MCPs). However, few such policies are actually being implemented, in part due to fear of backlash. Better understanding the ideological underpinning of backlash is thus crucial for designing strategies that can further the much needed transition towards more plant-based diets. To address this issue, this study unravels the diverse ideological notions informing backlash in discourse against MCPs. Data consists of three news articles in right-wing publications and over 2700 corresponding comments, posted on Facebook in response to policy proposals to reduce animal protein consumption in the Netherlands. Analysis of the data is based on a framework for ideological discourse analysis, which enables the identification of ideological notions through recognizing semantic and formal structures in text. The research reveals that next to the well documented notions related to neoliberalism (e.g., freedom of choice) and carnism (e.g., meat is normal), populist notions are a significant ideological basis of backlash. In addition, ideological notions related to populism, such as anti-elitism, are interlocked with carnism and neoliberalism. The analysis contributes to a better understanding of the socio-political nature of backlash against MCPs. It suggests that while notions related to carnism can explain how people justify their meat consumption, such notions are only partly relevant for explaining resistance to MCPs. Such resistance is not just an individual response, but a theme around which groups of people converge, through shared ideologies.