With the Trust for America’s Health and amfAR I collaborated on research and policy development for structural and environmental prevention innovations for gay and bisexual and other men who have sex with men in the U.S. – changing the risk environment and the national structures that are inhibiting prevention for that population.

With the Organic Health Response(OHR) and the Ekialo Kiona Center(EK) I’ve continued my connection with the communities of Mfangano East, Lake Victoria, Kenya – primarily through assisting community grant writers to improve the well-being of those living with HIV – to turn the tide of HIV in this corner of the World. Through social solidarity, biomedical and agriculture innovations, and community driven vision, OHR and EK are changing the standards and definition of a “community-based organization”. And transforming the way people live with HIV.

So it wasn’t much, but something…

Now it is time to get to zero. Zero new infections; zero discrimination; and zero AIDS-related deaths. Getting to zero takes prevention and treatment and policy and community. It takes Health in All Policies and nutrition and the built environment and linkages to NCDs and sexual health and biomedical innovations and cultural competency. It takes many small contributions, from just about all of us.

*Want to make your own small contributions? Check-out the Whitman Walker Clinic and OHR for volunteer opportunities!

Image: Author’s own. Ekialo Kiona Center, Mfangano East, Lake Victoria, Kenya.

For those of you who pay any attention to this blog, you’ll remember (and see below) that I said I would be back at it in late September/early October… It is now late November, funny how life goes. I’m afraid I don’t have anything witty or insightful or even interesting to say today, but I needed a nudge to get back to writing and Thanksgiving was it.

There are certainly things to talk about, however! New country, new job (prevention, NCDs, the built environment, HiAPs…), continued work with OHR, World AIDS Day coming-up next week, and new thoughts on community prevention and well-being. Looks like maybe its time to get writing..!

I am thankful for many, many things this year, not in the least my brilliant, interesting and supportive family and friends. I am also thankful for the opportunities I have to travel, and try new things, and read interesting stories. I am thankful I have the means to enjoy a large Thanksgiving meal this weekend. And I am thankful for the chance, in my small ways, to help those in our communities who can not.

A new country, new city and new job (along with all the other changes that come with any one of these events) will inevitably lead to lots more to talk about, when time permits. In the meantime, please take a look at my colleagues on the blogroll and watch for coverage of the up-coming UN high level meeting on NCDs prevention and control.

Be well!

The Pacific Island nations are home to some of the highest rates of obesity in the world. While there is ongoing debate about the accuracy of the measurement of obesity and the creation of cutoff points for different categories of individual fatness (or thinness), data are useful insofar as they provide a crude indication that population obesity has risen across time and space. Approaching obesity as a social entity whose locus is the population, leads us to consider the broader context in which population health changes. I recently returned from carrying out ethnographic fieldwork in one Pacific island nation with a high rate of obesity. I did not go with the objective of identifying a ‘cause’ for obesity, but rather with the aim of better understanding the shifting political, social and economic landscapes that have been synonymous with a changing health landscape and population morphology.

I originally went into my fieldsite with some concern that my topic of study was obesity, a culturally-defined description of body shape. I was aware of the stigma attached to obesity and did not want to be perceived as just another health researcher who had not problematised the medical category (Alexandra Brewis has recently written an easy-to-read book problematising obesity from a bicultural perspective for an overview of some of the issues). Yet nor could I ignore the devastating comorbidities that are linked to obesity, such as diabetes mellitus and heart disease. Obesity data from the Pacific Islands are frequently cited, especially by the international media, in ways that sensationalize body size or as a means of offering critical commentary about peoples’ lifestyles. Such references are well known to Pacific Islanders, who highlight that foreigners ought to spend more time looking at their own country’s health rather than criticizing others; or if they really must focus on Pacific Island health, then they ought to focus on the real health concerns of the region and not simply aesthetics. I recall one story in particular that I read about my own fieldsite in the UK newspaper The Independent. The author informed readers that a popular local snack was a whole fried chicken and bucketful of Coke (this could not have been much further from reality), implying rather forcefully that people were entirely to blame for their country’s obesity rates. All of this aside, changing body morphology at a population level can inform us about the health impacts of social change, and this was, and continues to be, my central interest.

In my fieldsite, during the 1970s and 1980s, I learned that government officials discarded health reports flagging obesity and diabetes as serious issues; every five years another report would be presented to the government, and every five years this report would be disregarded in preference for more pressing matters of international relations, transport and investment. Their interests did not lie specifically in the long-term biological health of their people, but rather in the growth of their nation into a post-Independence ‘citizen of the world’ to ensure future prosperity. Likewise, people disregarded health warnings and pursued corporeal satisfaction and enjoyment. ‘But I feel fine!’ was, and still is, the common refrain. Perhaps population health change is not about the individual feeling fine or not, however, but rather about the society. It is not clear whether social illness is phenomenologically experienced in the same way as individual illness, nor is it clear how, or if, in the case of obesity it impacts health outcomes.

Obesity is intimately associated with the food we eat, and food is a substance which lies at the intersections between global political economy, sociality, sensory experience, human growth and physiological outcomes. So it is possible that obesity has the potential to be an indicator of simultaneously health and social change. It is becoming increasingly clear that obesity (and its co-morbidities) is not simply a product of individual behaviour; rather, obese populations are socially-produced following significant structural, economic, political and ecological changes.

Furthermore, food is not simply a source of energy, but also a means of building and maintaining social relationships, and reinforcing community cohesion. Today, industrial production, global markets and reduced collective consumption has changed the social value inherent in food. How has individualism, for instance, affected not only our consumption patterns, but their social value in our everyday lives? Could it be that increasing consumption is, in part, an attempt to compensate for the decreased social value of food?

In saying all of this, we should not single out Pacific Island countries. While their population obesity figures are high, current trends suggest that many other countries are not that far behind. Valuable lessons could be learned from their experiences.

*Excerpt from original publication – UBVO Opinion Paper Series, University of Oxford, July 2011. Download the complete paper at www.oxfordobesity.org.

**Amy McLennan is a PhD candidate in social anthropology at ISCA, University of Oxford.

10 Years of Medical Anthropology at Oxford: Last week I was in England to attend a reunion conference commemorating 1o years of medical anthropology at the University of Oxford. The conference brought together alumni, faculty past and present, current students, and others somehow linked or interested in the medical anthropology program at Oxford. I was fortunate enough to have been asked to speak on the opening panel designated to alumni in “the real world” – a very ambiguous phrase – where I discussed my work in public health policy, improving cultural competency in public health, and the impact medical anthropology has had on my career thus far.

The remainder of the conference was filled with fascinating presentations on current research both outside of and at Oxford – all linked to the program – along with several bottles of wine at dinner and multiple trips to the pub, of course. The holistic and broad spectrum nature of medical anthropology was clearly present with topics such as ethnobotany and ethno-heritage in Belize; “eating” dirt in Ethiopia; moving beyond the political ecology of obesity on Nauru; bridging the sociocultural and the biological with dance science; and “sick lit”.The conference concluded with an open discussion on the future and role of this medical anthropology program. While there was a clear tension regarding the place of medical anthropology in both the anthropology and health worlds; at the core of the discussion was how medical anthropology can and should be both academically “pure” and “real world” relevant. Myself and others spoke of being “translators” (albeit not always competent ones!) – infusing medical anthropology theory, methods and discourses into public health, global health, biomedicine and beyond. With so much to offer, my personal belief is that medical anthropology needs to do a better job of getting out there and being annoying. Something that can be done without losing the discipline of ethnography or theory. Here’s to many more years of medical anthropology at Oxford!

Stepping Up Part 2: In early May I posted on the pedometer steps challenge that my office was undertaking, well…the results are in! After three months, I walked (and swam and stretched and lifted) my way to 1,447,444 steps. I think this is a lot, but sadly it only got me 4th place overall.

When I discussed this challenge the first time, I talked about how acutely aware it had made me of how much I was and wasn’t moving in a given day and that still holds true today. I’ll happily admit I don’t think I’ll have any long-lasting behavior changes as a result of this competition, but I do appreciate how attuned it has made to the structures and activities in my life that both facilitate and limit physical activity – in many circumstances, it’s much easier said than done.

A Year Ago: About this time last year I was prepping for my first visit to the island of Mfangano, Lake Victoria, Kenya. Not only was this field visit crucial for my ongoing work with the Organic Health Response, but it set a foundation for my ongoing thinking on community prevention. As a concept, community prevention can take on many realities wherever it is and as a public health intervention mechanism, it has the potential to play a crucial role in the growing challenge of non-communicable and chronic diseases. These efforts will only be effective however, if realized on a community-by-community basis and appropriately integrated into larger health systems. Amazing how fast a year can go!

Happy 4th of July to all!

Image is author’s own – Exeter College, University of Oxford, morning of June 24, 2011.