Get to Zero

Today is World AIDS Day! On this date last year this blog had its first post commemorating the global day of solidarity in the fight against HIV/AIDS and in the last year – when the world marked 30 years of AIDS – I’d like to hope that I’ve contributed, in very small ways, to our communal effort of getting to zero.

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.

Summer Mash-up

Summer always seems to be busy and fly by in a flash, but the last few weeks (and the couple forthcoming) seem to be zooming..! In lieu of a full post or an “In the News” update, here are a few “mini” posts to keep things rolling…

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.

Know Your Neighbor

There has been a tremendous amount of talk as of late regarding priorities and funding in the global health arena with the recent G20 and G8 summits, and rightfully so, there are any number of seemingly impossible health challenges the global community faces. Luckily, there has been some discussion about the need for global health initiatives to be “culturally competent” (which many already strive to be!). I was originally planning to have a post on these calls to action, but several recent reports have spurred me to think more about “cultural competency” as a concept, since everyone seems to be using it. And besides, there are far smarter people to be talking about the details of global health funding and finance besides me..!

Tuesday, Trust for America’s Health released its annual report on obesity in the United States, F as in Fat. Not surprisingly, the report highlighted growing waistlines in both adults and children. With disparities in the South and among economically and ethnically marginalized populations. The report received a lot of press, as it should, but while reading many of the comments made on blogs and articles regarding these findings I found myself getting quite mad.  The seeming lack of empathy among my fellow Americans was astounding.

I’ve written about “non-judgement” when it comes to personal responsibility and health before, and don’t mean to beat this topic into the ground. Additionally, as an anthropologist, I will be the first to defend the fact that each of us come from our own perspective and experience. However, if we are going to strive to be non-judgmental of those around us and their choices, we have to learn to be culturally competent too, right?  But what does this mean?!

A recent piece from Diversity Inc. attempted to tackle this issue and whether culturally competent health care can close health disparity gaps – including obesity. A physician with the US Navy argues that yes, in fact, culturally competent care can work to close gaps – or should. She addresses stereotypes and language barriers directed towards minority and immigrant populations. Luckily, she also acknowledges that it is nearly impossible for any given individual to enter a situation completely unbiased by their own experience and cultural values.

This basic definition of “cultural competency” seems well and good, but far easier to apply to the “other” and not those right next to us. It is simple for most of us to point out the differences between ourselves and someone from a different religious, ethnic, or racial demographic both in our big cities and in communities half-way around the World. What about those right next to us, that on the surface seem to be the same?

For example, accusing the South of having poor eating habits and “cultural” connections to food is easy and naïve (I wrote on this a couple of years ago), and being culturally competent doesn’t just mean being able to speak the same language or know what you think someone else is eating. I applaud the global (and when I say global, I mean all of us!) health community’s continued efforts for both evidence-based AND culturally competent practices, but I hope that from time to time, we take a step-back and look at our neighbors…maybe we can’t become completely culturally competent, but hopefully culturally present..?