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

Understanding the links between human health, ecosystem health, and food systems in Small Island Developing States using stakeholder-informed causal loop diagrams

Globalized food systems are a major driver of climate change, biodiversity loss, environmental degradation, and the increasing prevalence of overweight and obesity in society. Small Island Developing States (SIDS) are particularly sensitive to the negative effects of rapid environmental change, with many also exhibiting a heavy reliance on food imports and high burdens of nutrition-related disease, resulting in calls to (re)localize their food systems. Such a transition represents a complex challenge, with adaptation interventions in one part of the food system contingent on the success of interventions in other parts. To help address this challenge, we used group model-building techniques from the science of system dynamics to engage food system stakeholders in Caribbean and Pacific SIDS. Our aim was to understand the drivers of unhealthy and unsustainable food systems in SIDS, and the potential role that increased local food production could play in transformative adaptation. We present two causal loop diagrams (CLDs) considered helpful in designing resilience-enhancing interventions in local food systems. These CLDs represent 'dynamic hypotheses' and provide starting points that can be adapted to local contexts for identifying food system factors, understanding the interactions between them, and co-creating and implementing adaptation interventions, particularly in SIDS. The results can help guide understanding of complexity, assist in the co-creation of interventions, and reduce the risk of maladaptive consequences.

Recipes for Resilience: Engaging Caribbean Youth in Climate Action and Food Heritage through Stories and Song

This paper presents findings from the Recipes for Resilience project, an international, interdisciplinary collaboration between Caribbean and UK scholars of history, geography, anthropology, cultural studies, development studies, ethnobotany, and climate-risk studies, and the research partners, the Caribbean Youth Environment Network. The purpose of the project was to investigate how agrifood heritage may be mobilized in creative ways to engage Caribbean youth in climate action and justice. The project utilized arts and humanities methods, such as storytelling, songwriting, online games, and brief research-led talks, culminating in the co-created song: “Food and Resistance for Climate Resilience”. The results of the project provide evidence that climate action requires arts and humanities methods to appeal to youth, as opposed to purely fact-based or scientific forms of climate communication. We conclude that co-creative methods such as music and storytelling can inspire youth to engage in climate action, in this case through a (re)valuation culinary and agricultural heritage.

Policy Implications of Structural Violence and Syndemic Dynamics: A Lens for Addressing Latinx Immigrant Diabetes Health Disparities

PURPOSE OF REVIEW

The purpose of this review is to explore using theoretical frameworks of structural violence and syndemics to understand Latinx health disparities with a focus on type 2 diabetes (T2D). We propose that combining these frameworks is a valuable approach for revealing complex root-cause dynamics and explaining the nuances of how and why health disparities exist. We discuss the importance of the relationship between T2D, fear, and stigma.

RECENT FINDINGS

Immigration policy creates structural conditions that invite unauthorized immigration while simultaneously excluding undocumented immigrants from access to healthcare resources. Structural exclusion then breeds fear of immigration status disclosure and deportation and, in the highly politicized immigration context that has emerged over the past two decades, also assigns social sigma to immigration status. Undocumented immigrants lack access to healthcare and health insurance; they cannot afford state-of-the-art drugs, they tend to be socially isolated and lack social capital to navigate systems; they are financially limited by poverty and lack of resources, emotionally taxed by the experience of discrimination, humiliation, and language-related challenges; and they have a toxic immigration stress load in the form of multidimensional fear. Potential areas for policy change are identified. Type 2 diabetes (T2D) follows racial, ethnic, and class fault lines that reflect unequal social and structural dynamics. Latinx immigrants are at disproportionate risk and explaining immigrant T2D social geography requires a holistic lens.

Reclaiming traditional, plant-based, climate-resilient food systems in small islands

Small island developing states face challenges in cultivating healthy food systems and are currently bearing substantial burdens of obesity and type 2 diabetes. Local food production-rooted in collective local and Indigenous traditions, self-sufficiency, and climate-adaptive agricultural practices-has long emphasised a fibre-rich, plant-based diet; however, common histories of dietary colonialism have replaced local, small-scale farming and fisheries with non-nutritive cash crops, intensive livestock operations, and high-quality food exportation. Along with declines in traditional food availability, the resulting food import dependence has fostered a diabetogenic ecosystem composed of energy-dense cereal products, animal-based fats, and processed foods. The destabilisation of local food sectors undermines small island social and cultural systems, contributes to impoverishment and food insecurity during natural disasters, and, ultimately, can reduce diet quality and increase type 2 diabetes risk. Despite ongoing marginalisation of traditional local food systems, locally produced foods such as starchy roots, legumes, fruits, and seafood persist as nutritious and ecologically relevant cornerstones of self-determined local economic productivity and dietary health. Findings from community and epidemiological work suggest that local food production-bolstered by local and Indigenous agroecological knowledge, cultural preservation, and collective agency-can aid in reclaiming healthy and climate-resilient small island food systems.

"We used to get food from the garden." Understanding changing practices of local food production and consumption in small island states

Many Small Island Developing States (SIDS) lead global rates in obesity and non-communicable chronic diseases (NCDs). Drivers for this are complex and include lack of food sovereignty, evidenced by an increasing reliance on cheap nutrient-poor food imports and a focus on export orientated cash crop production for much local agriculture. To better inform SIDS' policy goals of improving nutrition through increased local food production, we explored in two SIDS current practices of food production and consumption. Teams of researchers from the two main regional universities conducted 28 focus groups in Fiji in the Pacific and Saint Vincent and the Grenadines in the Caribbean with rural and urban communities of different socio-economic or land-owning status. In both countries home gardens were still common, valued as providing staple foods to households and contributing to health and livelihoods. Yet social changes had been experienced over the life course and across generations, such as increased purchase of foods, consumption of processed and often imported foods, and fast foods. While participants associated local foods with better nutrition and health outcomes than imported foods, some local foods were also acknowledged as unhealthy (e.g. locally produced tinned products, pesticide contaminated fresh produce). Finally, as food and related health advice moves globally, crossing national boundaries, and through formal and informal channels, local experiences can be confusing and contested. We suggest the need to understand temporal and spatial aspects of social practices, as social practices and their meaning change over time, travel globally and are experienced locally. To enhance and support re-localising food to counteract unhealthy consumption of ultra-processed, shop-bought, often imported foods, it is vital to understand these lived experiences of changes and resulting uncertainties, and to explicitly build on the longstanding positive relationships that people continue to express about home gardens and local food.

Tackling child malnutrition in Jamaica, 1962-2020

On the eve of independence in 1962, malnutrition was the largest single cause of death in Jamaica for children under one. Although child malnutrition rates have rapidly declined since 1962, today Jamaica experiences a double burden of malnutrition: the coexistence of pockets of high child malnutrition with rising levels of childhood obesity. Based on a wide range of sources, including public documents, newspaper reports, scientific studies and reports by international agencies, this article examines a gradual decline in child malnutrition and the rise of the double burden of malnutrition in Jamaica from independence to the present. It will first of all show that changes in the global economy and overseas loans and aid both aided and limited the ability of the Jamaican government to lower child malnutrition levels and also contributed to a rise in childhood obesity. Second, it will illustrate that a traditional deficit-led approach to child malnutrition was followed in post-independent Jamaica, focussing on the public and individuals as targets for intervention and using quantitative measures to trace progress. And third, it will question whether the double burden of child malnutrition will give rise to 'healthy publics'-'dynamic collectives of people, ideas and environments that can enable health and well-being'.

Nutrition Justice: Uncovering Invisible Pathways to Malnutrition

We propose the use of the analytic frame of "nutrition justice" to reconcile the separate imperatives of Global Health for nutritional sufficiency for all, the requirement to eradicate childhood malnutrition, and the need for strategies to check the emerging pandemic of the double burden of malnutrition in the Global South. Malnutrition and its consequences of growth stunting are the result of disruption to the nutritional ecology of childhood from structural violence. This is mediated through loss of food security and perturbation to the cultural status of food, and on the prerequisites for nurture during infancy and early childhood. These socio-political factors obscure the role of biological adaptation to nutritional constraint on growth and hence the causal pathway to the double burden of malnutrition. In this paper we describe how the effects of historical and contemporary structural violence on the nutritional ecology of childhood are mediated using the examples of remote Aboriginal Australia and the Lao PDR. Both populations live by force of circumstance in a "metabolic ghetto" that has disrupted the prerequisites for parental nurturing through loss of food security and of traditional sources of transitional staple foods for weaning. Growth faltering and stunting of stature are markers of adaptation to nutritional constraint yet are also the first steps on the track to the double burden. We discuss the implications of these observations for strategies for global food sufficiency by mean of a thought-experiment of the effect of food and nutrient sufficiency for growth on future health and metabolic adaptation.