A comparative ethnography of nutrition interventions: Structural violence and the industrialisation of agrifood systems in the Caribbean and the Pacific.

Public health interventions that involve strategies to re-localise food fail in part because they pay insufficient attention to the global history of industrial food and agriculture. In this paper we use the method of comparative ethnography and the concept of structural violence to illustrate how historical and geographical patterns related to colonialism and industrialisation (e.g. agrarian change, power relations and trade dependencies) hinder efforts to address diet-related non-communicable diseases on two small islands. We find comparative ethnography provides a useful framework for cross-country analysis of public health programmes that can complement quantitative analysis. At the same time, the concept of structural violence enables us to make sense of qualitative material and link the failure of such programmes to wider historical and geographical processes. We use ethnographic research carried out from April to August 2013 and from June to July 2014 in Trinidad (with follow-up online interviews in 2018) and in Nauru from February to May 2010 and August 2010 to February 2011. Our island case studies share commonalities that point to similar experiences of colonialism and industrialisation and comparable health-related challenges faced in everyday life.

Body size, body norms and some unintended consequences of obesity intervention in the Pacific islands.

BACKGROUND: Pacific Islanders have experienced over 50 years of obesity interventions-the longest of any region in the world. Yet, obesity-related non-communicable diseases (NCDs) continue to rise. 'Traditional' body norms have been cited as barriers to these interventions. AIM: In this study, we ask: 'What is the relationship between health interventions, body norms and people's experience of "fatness"? How - and why - have these changed over time?' We study two nations with high rates of obesity: Nauru and Samoa. SUBJECTS AND METHODS: Ethnographic fieldwork with people in everyday and clinical settings in Samoa (2011-2012; 2017) and Nauru (2010-2011). RESULTS: Body norms are not a single or universal set of values. Instead, multiple cultural influences-including global health, local community members and global media-interact to create a complex landscape of contradictory body norms. CONCLUSIONS: Body norms and body size interventions exist in an iterative relationship. Our findings suggest that Pacific island obesity interventions do not fail because they conflict with local body norms; rather, they fail because they powerfully re-shape body norms in ways that confuse and counteract their intended purpose. Left unacknowledged, this appears to have (unintended) consequences for the success of anti-obesity interventions.

The problem with relying on dietary surveys: sociocultural correctives to theories of dietary change in the Pacific islands.

BACKGROUND: Dietary surveys are frequently used as the basis for theorising nutritional change and diet-related non-communicable disease emergence (DR-NCD) in the Pacific islands. However, findings from historical survey data do not always align with ethnographic evidence. AIMS: This paper aims to examine the extent to which the two types of evidence can lead to similar conclusions, and draw out the implications for current theories of, and interventions addressing, nutritional change. SUBJECTS AND METHODS: Dietary surveys carried out on Nauru between 1927 and 1979 are reviewed and compared with ethnographic evidence documented by social researchers across the colonial and post-colonial periods. RESULTS: This comparison reveals several shortcomings of survey data. Nutritional issues considered to be relatively recent-such as high-fat, low-fibre diets and transition to imported foods-occurred a century ago in our analysis and point to a long history of nutrition policy and intervention failure. Further, there is limited evidence that caloric intake overall increased significantly over this period of time in Nauru. CONCLUSIONS: Theories of dietary change and DR-NCD emergence and resulting interventions could be improved through a more holistic approach to nutrition that integrates sociocultural and historical evidence about both the target population and the scientists doing the research.

The 'who' and 'what' of #diabetes on Twitter.

Social media are being increasingly used for health promotion, yet the landscape of users, messages and interactions in such fora is poorly understood. Studies of social media and diabetes have focused mostly on patients, or public agencies addressing it, but have not looked broadly at all of the participants or the diversity of content they contribute. We study Twitter conversations about diabetes through the systematic analysis of 2.5 million tweets collected over 8 months and the interactions between their authors. We address three questions. (1) What themes arise in these tweets? (2) Who are the most influential users? (3) Which type of users contribute to which themes? We answer these questions using a mixed-methods approach, integrating techniques from anthropology, network science and information retrieval such as thematic coding, temporal network analysis and community and topic detection. Diabetes-related tweets fall within broad thematic groups: health information, news, social interaction and commercial. At the same time, humorous messages and references to popular culture appear consistently, more than any other type of tweet. We classify authors according to their temporal 'hub' and 'authority' scores. Whereas the hub landscape is diffuse and fluid over time, top authorities are highly persistent across time and comprise bloggers, advocacy groups and NGOs related to diabetes, as well as for-profit entities without specific diabetes expertise. Top authorities fall into seven interest communities as derived from their Twitter follower network. Our findings have implications for public health professionals and policy makers who seek to use social media as an engagement tool and to inform policy design.

Framing obesity in UK policy from the Blair years, 1997-2015: the persistence of individualistic approaches despite overwhelming evidence of societal and economic factors, and the need for collective responsibility.

Since 1997, and despite several political changes, obesity policy in the UK has overwhelmingly framed obesity as a problem of individual responsibility. Reports, policies and interventions have emphasized that it is the responsibility of individual consumers to make personal changes to reduce obesity. The Foresight Report 'Tackling Obesities: Future Choices' (2007) attempted to reframe obesity as a complex problem that required multiple sites of intervention well beyond the range of personal responsibility. This framing formed the basis for policy and coincided with increasing acknowledgement of the complex nature of obesity in obesity research. Yet policy and interventions developed following Foresight, such as the Change4Life social marketing campaign, targeted individual consumer behaviour. With the Conservative-Liberal Democrat government of 2011, intervention shifted to corporate and individual responsibility, making corporations voluntarily responsible for motivating individual consumers to change. This article examines shifts in the framing of obesity from a problem of individual responsibility, towards collective responsibility, and back to the individual in UK government reports, policies and interventions between 1997 and 2015. We show that UK obesity policies reflect the landscape of policymakers, advisors, political pressures and values, as much as, if not more than, the landscape of evidence. The view that the individual should be the central site for obesity prevention and intervention has remained central to the political framing of population-level obesity, despite strong evidence contrary to this. Power dynamics in obesity governance processes have remained unchallenged by the UK government, and individualistic framing of obesity policy continues to offer the path of least resistance.

Was acupuncture developed by Han Dynasty Chinese anatomists?

Anatomical dissection has begun to reveal striking similarities between gross anatomical structures and the system of nomenclature used in traditional Chinese acupuncture. This paper argues that acupuncture point nomenclature is rooted in systematic anatomical investigation of cadaveric specimens, and that acupuncture points and meridians are purposefully named to reflect observable physical form. Two types of evidence are compared: observations of physical structures based on anatomical dissection, and translation and analysis of original Chinese texts. Evidence is contextualized through in-depth practical understanding of acupuncture. Points designated as [Chinese character] tian (heavenly/superior), [Chinese character] xia (below/inferior), [Chinese character] liao (bone-hole), [Chinese character] fei (flying), [Chinese character] wei (bend), and [Chinese character] xi (mountain stream/ravine) are investigated. These acupuncture point names: (a) specify position; (b) reflect function and/or form; (c) indicate homologous structures; (d) mark unusual structures; and/or (e) describe the physical appearance of a deep (dissected) structure by likening it to a homologous everyday object. Results raise intriguing possibilities for developing an understanding of acupuncture points and meridians firmly based in the material and functional anatomy of the human body. Such an understanding has the potential to open new fields of thought about functional anatomy. It also has implications for future investigations into the mechanisms of acupuncture, and gives some insights into the possible origins of this iconic area of Chinese medicine.

Obesity emergence in the Pacific islands: why understanding colonial history and social change is important.

OBJECTIVE: Between 1980 and 2008, two Pacific island nations - Nauru and the Cook Islands - experienced the fastest rates of increasing BMI in the world. Rates were over four times higher than the mean global BMI increase. The aim of the present paper is to examine why these populations have been so prone to obesity increases in recent times. DESIGN: Three explanatory frames that apply to both countries are presented: (i) geographic isolation and genetic predisposition; (ii) small population and low food production capacity; and (iii) social change under colonial influence. These are compared with social changes documented by anthropologists during the colonial and post-colonial periods. SETTING: Nauru and the Cook Islands. RESULTS: While islands are isolated, islanders are interconnected. Similarly, islands are small, but land use is socially determined. While obesity affects individuals, islanders are interdependent. New social values, which were rapidly propagated through institutions such as the colonial system of education and the cash economy, are today reflected in all aspects of islander life, including diet. Such historical social changes may predispose societies to obesity. CONCLUSIONS: Colonial processes may have put in place the conditions for subsequent rapidly escalating obesity. Of the three frameworks discussed, social change under colonial influence is not immutable to further change in the future and could take place rapidly. In theorising obesity emergence in the Pacific islands, there is a need to incorporate the idea of obesity being a product of interdependence and interconnectedness, rather than independence and individual choice.