Duong Ly

Anth 215

Food Crisis

Food crisis has always been one of the major problems in many places around the world. It is one of the most debating topics of global health. There have been six major food crises in modern history, killing millions of people. The six of them are Soviet famine of 1932–1933, Great Chinese famine, Niger food crisis, world food price crisis, Sahel famine, East African drought. In the past, food crisis only affects Third world countries. However, recently it has taken a new path. According to the UN report, the world is now being endangered by a great famine because of its low food reserves.

In 2012, natural disasters, heat waves and drought severely damaged many corn and grain fields in the United States. Condition of harvested corns dropped significantly comparing to last year. The condition this year was rate at 31 percent good to excellent while last year it was rated at 77 percent. That data of corns alone showed a huge decrease in quality of the harvested corns. In fact, the UN published a report showing that failing harvests in the US, Ukraine, and other countries have caused the reserved food bank to drop to their lowest since 1974. It also published a statement saying that if there are any more natural disasters in the United States or other food-exporting countries, it will trigger a major food crisis all around the world. The food reserves have never been this low before; the world is truly being endangered by a hunger crisis. In the past six years, the food consumption has increased at a very fast rate while the amount of food grown hasn’t increased that much. The result was our food production couldn’t catch up with the amount of consumption. It depleted the food reserves, causing it to drop from an average of 107 days of consumption 10 years ago to under 74 days today, which was barely more than 2 months. In the past, the food reserves served as a backup source of food in case of natural disasters occur. However, since the food reserves have dropped so low, it can barely sustain the world population. Not only the reserved food source ran low, the price of food began to skyrocket. Scorching heat and severe drought drove the price of food and grocery to an extremely high price. According to a report of the United Nations Food and Agriculture Organization, the food price rose by 1.4% again in September after remain steady for two months. The price of dairy product claimed the highest price increase record with an increase of 7 percent in the last month. One of the major concerns of the agency was that an increase in food price could set off riots in the Middle East and Northern Africa. The current food price hasn’t reached the major food crisis in the past, but it is only 13 percent below the alarming level. Food crisis is a global health issue because it affects everyone around the world. If the food reserves are depleted, we will not have room to act when an unexpected natural disaster hit us. This is a serious problem considering severe weathers happened more and more in many countries in recent years, and the food consumption still continues to rise steadily. It is no longer a problem of the third world countries because the developed countries will be affected if the food reserves are depleted. It calls upon an effort to replenish the food reserves and find new strategies to allow food production meet the level of its consumption.

The article that used to investigate the food crisis problem is “The Impact of the Economic Crisis and the US Embargo on Health in Cuba” (Garfield, 1997). It is well known that there is always tension between the United States and Cuba. In the past, the tension was even greater that the United States imposed an embargo against Cuba which was estimated as the longest embargo in history. The embargo was made in 1961 after the 1959 revolution happened in Cuba. However, the embargo showed no negative effect to Cuba during the first three decades as Cuba was allowed to trade with the Soviet Union freely. In fact, it was shown in the article that 90 percent of Cuban international trade was with the Soviet Union. Its economy grew by a total of 2 percents from 1969 to 1975 and by 4 percents from 1975 to 1989. However, it didn’t last long till the breakup of the Soviet Union occurred in 1989. It had a great impact on the economy of Cuba because Cuba traded exclusively with the Soviet Union. From 1989 to 1993, the Soviet exports to Cuba decreased by 70 percents and the value of imported goods dropped from 8 billion to 1.7 billion. Around that time, the US also strengthened the embargo by passing Cuban Democracy Act which prohibited any All US subsidiary trade, including trade in food and medicines. It also discouraged ships from visiting Cuba by refusing to let it dock at United States ports if they had visited Cuba in the last 6 months. It effectively increased the cost of shipping to Cuba by 10 percents. The US embassy also threatened non US firms that traded with Cuba. Those actions ultimately created a blockage in Cuban’s international trade. The impact of the embargo became severe as Cuba was unable to find countries willing to trade with it. The former Soviet Union disbanded so there were no other countries helping Cuba. The result was a huge shortage of food and malnutrition in Cuba. Shortage of calorie, proteins and micronutrients threatened Cuban citizens, especially women, children, and elders. Poor nutrition and low sanitary condition led to tuberculosis from 1990 to 1994. To make the matter worse, the lack of imported fats from the Soviet Union led to another shortage in soap products. It directly caused the poor sanitation in the country which in turn caused widespread of pediculosis and scabies. Infant and maternal mortality began to rise because of infectious diseases and malnutrition. Social disruption became more common due to the declining in public transportation.  The Cuban government came up with some strategies to deal with the problem like rationing food and other scare resources, promoting riding bicycle instead of cars helped reducing the negative effect of embargo. However, food crisis in Cuba still threatened millions of people as the problem remained unsolved.

Medical anthropology would frame this problem as a problem caused by an external force. In this case, the food crisis in Cuba was caused by embargo imposed by the United States. The embargo effectively not only blocks all the trades between Cuba with the United States, but it also discourages trading between Cuba with other countries. Cuba is a small country and it is unable to produce enough food for its citizens. It has to rely on food imports from other countries.

In class, we learn about how to approach the global health problems in a medical anthropology perspective. In order to solve the Cuban food crisis, it requires a social change. The social change needed in this case is a change in conflict and military power. It is clear that the cause of the food crisis originates in the political conflict between the United States and Cuba during the cold war. To be more precise, the political conflict was between the United States and the Soviet Union, between the capitalist world and the communist world. At that time, the strategy employed by the United States to deal with the spread of communism was to do whatever it takes to stop other countries in the world from becoming communist. That was the reason why the United States decided to make an effort to stop the economic growth of Cuba by imposing an embargo on it. However, the embargo not only reduced Cuban economic growth but it also caused a major food crisis in that country for more than three decades. The food crisis devastated the countries by killing thousands of people and giving the opportunity for other global health problems to arise. From a medical anthropology perspective, I can tell that the negative impact was partly due to the lack of medical programs in Cuba. Poor people couldn’t afford to get adequate medical assistant, and the government didn’t come up with a universal healthcare for them. The unequal access to health services is the root of the problem. If the Cuban government changed their health services, gave everyone an equal access to health care, the food crisis would not have damaged the country that severely.

My understanding of the medical anthropology concepts changed after applying them to your selected problem. Before reading this article, I view global health problems as problems caused by political conflicts, military power, and other external factors. But after taking a closer look at the problem, it is clear that there is also “internal factors” which is how the victims deal with global health problems. In this case, the Cuban government could have come up with strategies that allow its citizens to have access to free public health. It could prevent epidemic and food crisis or at least slow down and reduce the negative impacts. Because global health problems usually involve with political conflicts and military power, it is very hard to prevent them. But it is possible to reduce their negative impacts by employing effective strategies. One of the effective strategies is to provide equal access to health services for everyone.

The definition of food crisis from a medical anthropological perspective re-shapes what needs to be done to address it. In order to stop the food crisis, we need to make preparation. Many countries waste their resources on cultivating crops that can produce biofuels just because it is more profitable. At the current low food reserves, it is better to use their lands and resources to produce food rather than biofuels. Some countries also neglect their agriculture, and it contributes to the decrease in food reserves. The prices of food continue to increase steadily over time because the food production hasn’t met the consumption. If this trend continues, a major food shortage will occur in the near future. It is urgent that the governments of countries around the world act now to prevent future food crisis.

In conclusion, what happen in Cuba should be a lesson that we could learn from. The food crisis happened because of political conflicts between the two countries. It is a common cause for many problems in the world. The Cuban government didn’t act in time to prevent negative impacts, letting the food crisis damaging the country for almost four decades. By looking at the problem in a medical anthropology perspective, we can understand more about the problem and come up with effective solutions for it.

Work Cite

"Farmers begin harvesting drought-damaged fields - Kearney Hub: Local News." Kearney Hub: At the Center of Nebraska life since 1888.. N.p., n.d. Web. 12 Dec. 2012. <http://www.kearneyhub.com/news/local/farmers-begin-harvesting-drought-damaged-fields/article_a832ad82-f13e-11e1-8759-0019bb2963f4.html>.

"Global Food Prices on the Rise, U.N. Says - NYTimes.com." The New York Times - Breaking News, World News & Multimedia. N.p., n.d. Web. 12 Dec. 2012. <http://www.nytimes.com/2012/10/05/world/global-food-prices-on-the-rise-united-nations-says.html>.

R Garfield and S Santana.  The impact of the economic crisis and the US embargo on health in Cuba. American Journal of Public Health January 1997: Vol. 87, No. 1, pp. 15-20.

doi: 10.2105/AJPH.87.1.15

Vidal, John. " UN warns of looming worldwide food crisis in 2013 | Global development | The Observer ." Latest US news, world news, sport and comment from the Guardian | guardiannews.com | The Guardian . N.p., n.d. Web. 12 Dec. 2012. <http://www.guardian.co.uk/global-development/2012/oct/14/un-global-food-crisis-warning>.

Global Political and Economic; Global unification

Introduction:

For this final paper, I chose to address the Global political and economic architecture problem from the Global Health Watch 3 to understand the cause and root that led to of our financial crisis, fuel crisis and food crisis; the three F’s. This section of the Global Health Watch 3 identified the cause and root to our financial crisis which then led to the other two F’s, food crisis and fuel crisis and connecting how one led to other. It also addressed how political leaders fail to recognize the effect of global warming, the practical result that due to extreme climate changes of the atmospheric concentrations of carbon dioxide and other greenhouse gas is largely driven by the emissions from production and energy consumption—the more energy used, the more fuel are used, the less resource which led to increase of gas and increase the cost of everything else. The article attempted to connect the dots of how the financial crisis result in the fuel crisis relate to the food crisis. While my other anthropology article The Problem with Politics: Some Problems in Forecasting Global Political Integration by Paul Roscoe addressed the important of global unification to resolving global issues. He empathize the significant of communication and interactions among political leaders to recognize and solve global problems. The development of technologies of communication and of the organizational structures both supports—and crucial to political and global unification. Through these two articles, it has allowed me to broaden my understanding the failure of economic, the result and reasons for our financial crisis and the importance of our leaders to recognize it together—communicate and attempt to “fix” the current problem. The Global Health Watch 3 addressed the problems providing detail information, the Problem with Politics provided details on fails of our leaders which both result in global financial crisis that both linked to the way humanity addresses the greenhouse gas emission and limit gaseous production problem. It appears that we understand the cause to the current global problem but the breakdown of the situation, humanity does know the what and why to the problem.

Body:

Problem-

From the Global Health Watch 3, I have focused on The global political and economic architecture section which allowed me to understand the connections between the crises. The world has been suffering from the three F’s: the food, fuel and financial crises.  Each one of the crisis is linked to each other and ties down to the fact that the lack of global warming knowledge. The fuel crisis we saw dated back in 1998 and 2000 when oil price doubled then it doubled again in 2003 and 2005 and again in 2005 and 2008.  “At its July 2008 peak of US$133 per barrel, the price was 94 per cent higher than it had been a year previously, and ten times the 1998 average.  Other fuel prices followed a similar trend. Even in the wake of the most serious global financial crisis since the 1930s, fuel prices are higher today than in any year except 2008, and more than four times their average level in the 1990s, (GHW 3, 26).” This supports the fact that the oil and gas price has not been stabilized for the past 14 years. Because of the rapid increase of the price of oil and gas, it has also rapid increase the price of food. Rice, an essential component of many people’s diet in the developing world was affected with the prices increasing more than fourfold from 2001 to 2008. This was also very similar to the price of maize. Rapid increase of fuel print contributes to the increase of food price—which both the US and the European Union are convinced to try shifting to biofuels for a change. The linkage between the fuel crisis and the climate crisis has a strong connection. The first contributes to the fuel crisis is the change of climate, “Atmospheric concentrations of carbon dioxide and other greenhouse gases, largely driven by emissions from production and domestic energy consumption, have already reached a level at which they raise the global average temperatures by around 1° centigrade from pre-industrial levels,” The absence of effective measures to reduce emission relative to the total production and consumption, a renewal of economic growth would drive yet, further increases, and the update trend that we tend to expect. For geographical reasons, the poorest countries are the among those worst affected— they have the least resources to protect themselves through “climate proofing. Their low incomes greatly exacerbated the impacts on the population.  The result is an increasing polarization between larger and more powerful ‘emerging market’ economies and a large number of smaller and poorer ‘submerging markets’, struggling to keep their heads above the water as the rising tide of global economic growth conspicuously fails to lift all boats. Climate change has definitely contributed to the food crisis in the agricultural commodity markets. For an example, recent study suggested that a significant negative net effect of climate-change-related temperature increases on rice in some locations in Asia. “The primary effect of the development crisis has been to increase the vulnerability of the poorest developing countries, particularly to the food and fuel crises, GHW 3, 15).”  The consequence of failing of the major economies to reduce the reliance on fossil fuels, an essential step to tackle climate, implies that demand for oil and gas on the international market is increasing rapidly than it would have had if it was reduced with the constraints on carbon emissions. Medical anthropology would have see the difference perceptions from cultural, social and individuals to conduct studies that will be benefiting.  We can clearly see that there has been studies on the usage of carbon emission and what we can do to reduce fuel usage, yet, nothing is put into practice.

Summarize-

The medical anthropology articles The problem with polities: some problems in Forecasting global political Integration by Paul Rocoe blames the political leadership structure and communication method for the lack of global unification . He also blames that humanity “presumed” that no global agreement would be instituted to limit gaseous production, which would be a solution to the current global issue. Medical anthropology approached the subject of global unification into two ways: empirical and theoretical. The theoretical approach is perhaps the most important reason why unification will continue to proceed and fragmentation recede during the long term is the “relentless” development of technologies of communication and of the organizational structures that both are supported. If leaders knows how to exercise their power they would be able to effectively interact with each other and create global unification. “ With the development of technologies of communication and locomotion, in particular those of industrial society, the time costs of bringing about political interactions have fallen dramatically, increasing the capacity of leaders to extend their power,” suggestion that there are resources now for leaders to reach out to each other. Although he did mention that it can be costly for political leaders to interaction and communicate with each other in hoping for global unification.  “Rather, their capacity to increase interaction will continue to expand and so too, we must conclude, will the capacity of leaders to extend their hegemony until, at some future date, the globe is unified.” The article also suggestion that while global unification may not be possible, yet, we should accept that social power is capable to secure the outcome of global unification. Power is capacity. “Resources are the “bases” or “vehicles” of power, the media that political actors deploy to achieve their particular ends, and depending on cultural context, they may take any number of forms. He suggest us to think and pay attention to the impact that global unification can change in policies, security, economic resources, addressing global warming, and any global problems we may face. He suggested that no matter where we are, the capacity we may carry, the move we take and actions to implement, it is all  important because it will piece itself together to some sort of unification itself. “ As human capacity to move across the face of the globe ever increases, as the ability to interact though electronic means that distant others develops yet, further, so too will the pace of all types of unification.  Assessing developments in these technologies will be important no matter in which kind of global unification we are interested in.”

Medical anthropology perspective would frame this problem to be a social, economic and political issue concerning how society functions and how we decide to exploit our resources. Whether is natural resources or environmental resources, we should be able to those resources to study and restore health and global issues. Medical anthropology would study the situation, find a study to apply, study the finding and implement a plan that is benefiting to the situation.  The author of the article stated the problems—lack of global unification and how it became a problem but he didn’t not address how we can significant change that issue besides proposing that political leaders or to-be leaders to communicate and work together. Now the GHW would do otherwise. The GHW had stated the problem, the issues relating to the problem, how it come to form, the component to the problems and how we significant change it.  The GHW suggest a plan to reduce energy usage, constraint on carbon emission, and safe energy.  Conserving energy would save money, and may resolve our financial crisis.

However, Medical anthropology would also collect data on the topic of reduction in oil and gas to carbon emission useage.  I think that the different techniques in observations such as indirect or direct observation would be beneficial to monitoring the effect of addressing the three F’s crisis of fuel, food and financial crisis that link to political power fail to communication and recognize the problem. Just as we mentioned in class that our perception is a process of gathering information through any or all of our sense, followed by the act of organizing this information and making sense of it. Our perception is share by our culture, politics, social position, etc, so we should, like the article stated, establish a strong form of communication structures among political leaders to address and resolve these global concerns we can currently facing together; form global unification.

Conclusion:

I definitely agreed that we because our political leaders fail to recognize that global warming may created or be linked to the current global issues we are currently facing and that if they are leaders as they are, they would take the initiative to interact and work together to resolve these global concerns. They should realize that droughts, hurricanes, natural disaster are all due to global warming is affecting the economy by effect our agriculture produce; food produce.  Our resource of energy or ways to produce energy should change because we are running low on natural resources. The higher the price for gas and oil, the higher transportation will cost to transport goods and that means the price for food also increases. Our leaders as they claimed themselves to be should take their roles as leaders to use any form of transportation and communication to acknowledge and understand the current crises and resolve it together. It is their job to use their power and implement changes effectively. We need them to take action and form global unification. I believe we can resolve many problems together if we are willing to sit down all together, listen, learn and come up with an action plan to really address global warming, the fuel, food and financial crises that we are currently facing and establish global unification. Through strong, powerful and effective leaderships from our leaders, we can not only recognize the problem but also address it through various perceptions we may have and form a strong, powerful and effective plan to protect and safe the global. The live in this planet and we have the right to protect and maintain it to the best it can be. 

Parents Decision on MMR Vaccine

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Rain Daley

12/12/12

Intro to M.A.G.H.

Final Paper

            In the case of childhood vaccination there is much controversy surrounding the evidence provided by the various sources available to parents that help shape their decision making process. One case in particular is the case of the measles, mumps and rubella or MMR vaccine. There have been many writings on the subject of vaccination and the factors that influence parental choice in the decision making process. An article written by Mike Poltorak et al. describes the opinions that parents have on the vaccine and what factors influence those opinions and ultimately the choice that parents make whether or not to vaccinate their children – in the case with the MMR vaccine specifically. The article provides the reader with an in-depth consideration of the social and political influences contributing to the parents decision making process and how those influences can be changed if they are not providing any positive, well-informed support for parents’ inquiry.

            In the past 7 years, the proportion of parents presenting their children for the combined measles, mumps and rubella vaccination has declined significantly.  The trend has presented such a significant decline that the issue has drawn in research interest and many people have aimed much of their research efforts towards investigating what influences has caused such a decline. The writers of this article aim their study toward the perceptions that parents have of the MMR vaccine and how those parents go about gaining information about the vaccine to base their opinions off of. With this vaccine as well as many others becoming more popular across multiple countries as an addition to suggested vaccine schedules the study of its popularity among those who would use it is important for understanding the way it should be presented and taught about. The social context in which information on the MMR vaccine is passed through public avenues is one of the main focuses of this article. In up taking a medical anthropology perspective in this particular case one can discover the external and internal determinants of parents personal research process and the social aspects which eventually lead to the decision they will make on whether or not to vaccinate their children.

            The specific study presented in the Poltorak article on MMR vaccine provides information extracted from the UK and deals mostly with analyzing the knowledge, attitudes and beliefs of parents that has focused particularly on perceptions of the benefits and risks of immunizations and sources of information about these. An alternate article by Ramsay et al. (2002) indicates that “67% of mothers perceive the MMR as safe or to carry only slight risk.” The overall perception of the MMR vaccine seems to be mostly positive despite the drop in coverage over the past decade. What is imagined to be responsible for the drop in coverage is a common fear of the adverse side effects that the vaccine can carry. These fears tend to be passed through means of public information and media sources like web forums and even information passed by word of mouth among various social circles. It is in these social contexts that misinformation can rapidly spread due to the lack of professional advice and opinion. In the case that parents do seek advice from a medical professional it is usually the case that these parents have already done a portion of research themselves through online information sources or other accessible sources of information so they approach a physician with an opinion and are only seeking support for that opinion rather than advice to base it off of. In an ideal case these parents should be seeking information from their clinician first before turning to alternative sources of information. However, these parents feel that their clinicians are usually too time compromised with more important tasks than to simply inform a parent with professional advice on their suggested vaccines. Many parents also struggle with distrust of their clinicians due to their assumption that their clinicians are suggesting vaccines only to meet their vaccine coverage goals. Despite this information, the common fact remains that doctors are still considered the most trusted source of information.

         The article also explores the ways in which information reaches parents during their decision making process and what socioeconomic aspects as well as past events in an individuals social life may influence what information they are willing to retain during inquiry. Pareek and Pattinson (2000) also “linked attitudes with social variables such as age, education, marital status, ethnicity, and class, associating (at least early) concern over MMR with those from higher socioeconomic grades. Other studies go beyond individual beliefs and social status to consider how culture, and social and political processes, shape parents’ immunization dilemmas and practices.” An associated notion of these studies is that of different members of alternate social classes having different levels of acceptance or refusal in regards to MMR vaccination. For example, perhaps lower socioeconomic families with high levels of stress being more accepting of clinician opinion and automatically taking advice for vaccination because of the need to simply get it done.  Opposed are the members of high socioeconomic class with less stressful schedules who may be more involved with natural forms of medicine seeking information through alternative information sources after a vaccine recommendation from their clinician. Apart from social aspects like socioeconomic standing that can play a roll in decisions on vaccination there are personal determinants such as an individuals background in medicine that puts them in a knowledgeable position to make an informed decision. Familial, professional, personal, philosophical and even travel experiences of mothers when they started to engage with vaccination as well as experiences of oneself or others catching childhood diseases with few serious effects, or less frequently, with complications, also feed into people’s perspectives on vaccination that can heavily influence their decision to vaccinate.

         Taking these in-depth, analytical approaches to understanding how parents make their decisions sets this study apart from say a quantitative article provided by the World Health Statistics report that simply converts these complex social arrangements of information and the avenues in which they flow to reach and influence the publics perceptions of vaccination into numbers and statistics about vaccine coverage. In cases such as this it is essential that a medical anthropological perspective is taken into use in order to understand just what really effects the decisions that parents make that can produce these quantitative charts. In understanding the determinants of decision making processes the institutions providing vaccine coverage can then be better advised on how to approach the issue of informing their patients and their parents on the various aspects of MMR vaccination.

         In observing the issues associated with MMR vaccine coverage one who chooses to investigate with a medical anthropological perspective could recognize that there are various opinions and personal experiences that ultimately influence the decisions that each individual makes on vaccination. Another important notion in regards to each parents decision making process is that the decisions made are ultimately based off of each individuals experiences making this a highly individualized process. With the idea of medical attention being so personal, which it should ultimately be perceives as by everyone including health providers, the presence of standardized vaccine schedules has posed many problems. Many parents are simply overwhelmed by the idea of sticking that many needles into their child during their first year of life. Many parents simply cant dedicate the time to going to the doctor so often while usually working and actually raising the child during it’s first year. Others have conflicting opinions that deter them from vaccination based on cultural difference or even an alternate opinion on what health care should look like. Medical pluralism is a very valid issue in regards to vaccination. The emerging belief in and support of natural or other alternative medicines that people tend to pursue when in doubt of standard medical care can play a significant roll in mothers decision to vaccinate. In such cases information such as “mothers who later rejected MMR had sought ‘natural’ or active birth” can be telling of the route in which a parent will take on the journey through vaccination and what their decisions can stem from. While in such cases, both birth and MMR decision might have been shaped by a prior worldview emphasizing a particular notion of ‘the natural’. These previously held views could be those that even develop from inside a medical institution itself. Birth experiences can guide thinking about vaccination, whether by reinforcing or undermining a previously held view.

         In this case, with how heavily weighted the social aspects associated with the decision making process of parents to vaccinate are, the concepts that flow through medical anthropology are easily applicable and very useful in understanding the process parents go through to reach their decision on vaccination.

“While many studies have treated MMR as a single decision, this research suggests this may misconceive parental engagement. Actual outcomes depend not on a singular deliberative calculus and the information and education that informs it, but on contingent and unfolding personal and social circumstances in an evolving engagement.”

         With this perspective in mind the process that parents go through to reach a final decision in the end is no simple, standard, linear process that will lead every parent down the same road to reach the point of a final decision. That is the very reason a medical anthropology perspective is so useful in analyzing the various aspects of the decision making process and what factors ultimately influence the decision a parent makes on whether or not to vaccinate their children with the MMR vaccine along with the many others. In an effort to increase MMR vaccine coverage the medical community must be informed of how to go about communicating with their patients and associated parents about vaccinations in a culturally sensitive way if need be. In the absence of cross cultural communication clinicians still have to be prepared to handle the variation of patients and each of their individual, socioeconomic circumstances and be well prepared to give balance, well-informed advice for their decision. Even in the case that a parent comes in to a doctors office with the intention to not vaccinate but to simply gain more information about vaccination the clinicians must act in an unbiased way in providing proper information for that parent to base their decision off of.

         In the case of the MMR vaccine there are still methods of gaining information through outlets such as web forums and medical articles that can guide a parent in one direction or another towards a final decision. However, understanding the significance and importance of having that information be unbiased, balanced and properly informative is where positive change can take place. The most significant of sources will be the clinicians that parents interact with face to face. It is the responsibility of these clinicians to come to their office prepared to answer the questions of their parents in a friendly informative way to promote trust and dependence on them for information. If these kinds of practices were to be carried out I believe that there could be a positive shift in the reliance of information towards health care providers as well as a similarly positive shift in vaccination coverage of MMR.

Sources:

Poltorak, Mike, Melissa Leach, James Fairhead, and Jackie Cassell. "‘MMR Talk’ and Vaccination Choices: An Ethnographic Study in Brighton." Social Science & Medicine 61.3 (2005): 709-19. Print.

The Right to Health and the Pharmaceutical Industry (Final Paper)

Monica Huelga

12/12/12

Anth 215: Final Paper

The Right to Health and the Pharmaceutical Industry

Government and corporations are regulating health of individuals by not permitting the right to the necessary health care. Pharmaceutical industries are playing with human health as a commodity and using people as test subjects for their profit, while discounting their rights as humans. I read an ethnographical article by Adriana Petryna from the University of Pennsylvania, Pharmaceuticals and the Right to Health: Reclaiming Patients and the Evidence Base of New Drugs. This work addresses two topics covered in the Global Health Watch 3; “the pharmaceutical industry and pharmaceutical endeavor” and “the right to health: the concept to action.” I am going to focus on “the right to health: the concept to action” in this report. Though the topic is straightforward, the solution and possible consequences are much larger. The pharmaceutical industry is a worldwide business that was created to enhance human health, but with political obstructions, social hierarchies, and consumerism and medicalization cultural pressures, the pharmaceutical industry is now harming the health of mankind.

From a medical anthropology approach, the main determinant of health must be examined: power. Power is the backbone of the issue. Companies are essentially selling their medications like retail merchandise. They have gained the power to persuade patients, or customers, to purchase their product in hopes to enhance quality of life. Medications are not being provided or available for all who need them, but ones who have reached a certain social status to afford the prescriptions. Individual citizens are losing power and their right to obtain medications when needed, which in turn impairs their health status.

An individual losing their right to health is a big concern because of the growingly neoliberal cultures. In such cultures, individual health solely involves that person. The government and industries, however, are imposing that duty by raising prices and limiting access of medications needed. Medications are also causing side effects, in turn requiring more medication to regulate symptoms, adding yet another cost. The mega corporations are initially controlling our health, and it is becoming a continuous cycle of needing their products. This idea of neoliberalism and neoliberal policies was addressed in Global Health Watch and discussed in class.

Medical anthropology reviews health, illness, and healing among cultures. These dictate on how people approach their resources regarding their health. The issue of the universal right to medication is that the pharmaceutical industry is morphing perceptions of sickness, illness, and disease to be treated with products, specifically that of their company’s. In this case, health is a luxury. In the pharmaceutical industries’ point of view, health is not very helpful to them. There is no improvement or treatment needed; therefore they are not a demographic for their products. However, clinical trials occasionally call for healthy individuals, so they may be a profitable rarity in some cases. I recall the class discussion on “local biology” and how the Western body is basically altered from the pharmaceutical craze we have become enraptured in and how it is relatively uncommon for a body to be pure and free of pharmaceuticals anymore. Health is now seen as not needing to be treated, primarily symptom wise, regardless of past treatments.

Petryna’s topic that she examined evolved around the trend of increased spending on research on new drugs and drug development over the past 30 years and the implications on patients’ rights to their health care. The high cost of conducting such trials and production increases the cost for the consumer in turn, and reduces accessibility of medications and challenges the ideology of the right for universal medical treatment. This article specifically examines the global pharmaceutical industries, physicians in specifically Poland and Brazil, and health policy makers’ relationship and the patient’s role in the medical business, regarding accessibility and rights to medications.

Pharmaceutical trials are in the background of the inequalities, which sequentially impact the universal right to health. Latin America and Eastern Europe are fairly new to the world of clinical trials. Petryna compared these sites with offshored trials in Poland and Brazil to find how proficiently an outsourced trial could favor a local health care system. Many recruits are found from contract research organizations (CROs). To capture the mindset of the CROs, one Polish doctor, a CRO member, says, “I don’t see patients, I see data” (305). This leads to questioning of the values of these trials and the motivation driving the production of medications, and essentially the politics of the health care industry. Humans can’t gain equal access to care if they aren’t even looked at as humans.

Trials have become globalized and transnational. Brazil’s clinical trial is a large, upcoming market of studies, and they have around 95% of their concentration in multicentered trials, which are those that involve second and third stages that Brazil estimates they use up to 70 countries. Despite the large array of possible beneficiaries from these trials, much of the clinical investment returns to the home country, regardless of what data are conveyed out. To secure quality data, “patent-related agreements, ethical guidelines, and other directives governing trial conduct” (308) are in play for international protocol to function locally. Brazil explained that greatly value ethical guidelines of the trials and patient confidentiality and protection is not only commercial value to them, but also their intellectual property.

Public health matters are questioned in this context. A Brazilian physician explains that, in trials, he cares for the patient by administering medication and then measuring the endpoints of the effects. That data is then sent off for companies to use. He explains that because these studies are essentially owned by an industry, all the physician has to do is follow the rules and recommendations put into play. He says, “they have bought everyone” (308).

This concept was explained as a “seeing data not patients” model. Both physicians and patients have been given the end purpose of providing “data integrity,” in which they are both morphed into a mold that will succeed that goal. Industries never meet patients, which has formed a desensitized, impersonal field of study.  In Poland specifically, who were even “considered to be too sympathetic” (308). Such physicians were not trusted to be able to contribute useful data to studies because they were not able to cut patients from clinical trials. Those who viewed health in a public health perspective, a more population leveled concern, tended to “over-enroll” patients so more could receive treatments. The patients not chosen to receive treatment would most likely not be able to afford the treatment for themselves. The critics of these “too sympathetic” physicians explain, “the industry’s propriety interests in data as well as maintaining market hold on its high-cost medicine was paramount” (309). The research has become a project that can be separated from patient-related factors and emotions, which creates guidelines overseeing minimal concern for patient’s well being.

Disconnect of industry and patients and the vague borders of research and medical care are an issue that is in the works of being tamed.  Aftermath of the research studies is being examined, in hopes to ensure further needed treatment for the patients involved. Clinical research and public health relations need to fundamentally be tapered for the sake of the patients and hopefully for their benefit as well, instead of just the industries’.

Brazil is conducing many studies to improve patient matters. One is regarded as bioequivalence studies, which is not only testing generic versus the brand-name drugs for lower costing quality care, but also creating regulations of the use of “exceptional” medicines, that are those of high-cost not typically covered by the universal heath care system. This, however, is reducing access to essential medicines, because of the astronomical price for the market as well. For instance, Brazil has the most advanced HIV/AIDS program of the developing world, but with the price tag of being so progressive and modern, citizens are suing the government in rage that they cannot obtain their essential medications when needed. Brazil is one of 115 countries with a constitutional right to health, despite the controversies and many stakeholders.

This ethnography stresses depth in sometimes seemingly surface matters. For instance, it is visible that physicians are not allowed to be “too sympathetic” and essential medications aren’t being available at a preferred and needed rate for patients. However, there are many social, political, and economical counterparts that come into play behind the scenes, creating such cases. To tackle such a wide array of problems, “creative partnerships between the public sector, academic science, and law can provide alternatives to these trends” (325).       

The Right to Health (RTH) approach, explained in Global Health Watch, is a useful medical anthropology framework for this case. This acknowledges many levels of the situation, local and global. There are many politics, governmental and corporal, that are vital to recognize. The RTH approach looks at the use of a common language for effective communication among all the different levels, the method of empowering individuals and local level stakeholders to account for their ideal outcome, the actual outcomes that are experienced, and what the overall quality of care is and the speculative ideal conditions. The approach also looks at views from vulnerable populations who are often subject to discrimination.

The approach seems logistical, yet there are many interpretations of what human rights are and the extent of care individuals are entitled to. Each situation must be analyzed with this proposal in mind, but approached contextually. Contextual aspects that must be approached are political and economical impacts, neoliberal ideologies, public health matters, and consequences of privatization on health services.

Social mobilization is also a result of a health equality movement, which ties back to the discussion of power as a main determinant of health.  With more power, accessibility to health care is far greater than of those in vulnerable, lower income populations. In the world today, there are vast disparities of income levels, therefore accessibility variability. A highly complex solution must be adapted for equal health rights, mostly because it is not dealing with just the rights to health care, but also the political and economical disparity background.  

Medical anthropological examinations of this problem would address many perspectives. Issues are typically richer than the surface analysis, consisting of many stakeholders and causative factors. All of those elements then have different perceptions that give the problem a new light. Different perceptions are important to acknowledge because it opens up angles that aren’t appreciated in other points of view. For instance, the industry’s perception is that the costs of drug trials are becoming higher and humans are needed for medical knowledge and evolution. On another level, the physicians are either just doing their job and letting the industries collect the data or they are being affected by the lack of heart and connection to patients required for such studies. Physician-patient relationships are not valued, but looked at as weak and unwanted. That leads to the perception for the patients and human subjects. The title of human “subjects” explains their value; they are basically a commodity, or a product of information, to the industries. They are being impacted by not receiving quality care, impaired accessibility to necessary medications, and they are ultimately having inflicted health problems from pharmaceutical drug trials and then not being treated for the lasting affects. The issue addressed in the ethnography has many players with different perception of the topic because of their environment and role they play in the matter.

Not only do different players have different perceptions, but also the quantity of perceptions and key players within one topic shapes one another. Patients’ perceive an issue to be that they cannot have constant access to medications they need. This is indeed a large issue, but it is not necessarily out of negligence like some may inquire. Groups are trying to give access to expensive drugs that are not typically covered by insurance or health care coverage, which is a courteous effort, despite the opposing impacts. Not all players are able to recognize these efforts, since it may not concern them and much of the work is behind the scenes. Also, those now being able to have access to the HIV/AIDS drugs, that are expensive and not typically available to all, perceive efforts as successful.

The examples just discussed are also an example of “situated knowledge” discussed in class and examined by Donna Haraway. This notion confronts the context of each situation and the idea that knowledge is contextual. This idea was demonstrated with mental health issues, but also the important role of the culture of biomedicine. Petryna’s ethnography greatly deals with the culture of biomedicine and the key players in the industry. The content of the knowledge is also contextual by each stakeholder, similar to the perceptions. For example, the physicians have the knowledge of who the test subjects, or patients, are, whereas the industry is only obtaining the statistical and objective data in result of the physician-patient interaction. The patient essentially has the least range of knowledge prospectively obtained because they are simply an object to the industry, with not much information, or true information rather, given. 

Keeping in mind the wide array of perceptions, contextual knowledge, and stakeholders in this situation, a conceptual perspective of the issue of patients’ right to health is slightly more complex. I strongly believe that everyone has the right to access of means to obtain optimal health, but it is not a simple task to grasp or manage. Industries are distant and collective. They are very removed from the studies and programs they are implementing, besides the profit and statistical information they receive. Granting permission for patients to acquire medications is not as straightforward as it seems, especially after reading this ethnographical work. There is an entire profit-centered dogma reigning over the entire biomedical culture that hinders the chance for change.

The medical anthropology view of analyzing the different dimensions and approaches to the issue create a more confusing approach to a solution. Addressing different perspectives reshapes possible solutions by marrying the different views into a more confined approach. There is never a solitary reason for a case, a single participant, nor a lone solution. An anthropological approach improves solutions by accounting for these different aspects and not assuming one interpretation. Assuming such straightforward reasons to a problem would result in failures of implementations, compared to a longer analysis of a problem, but more probable application.

This is an issue concerning the biomedicine culture. The biomedicine culture, however, is global, therefore within many other cultures. The human right to health is essential in preventing and treating illness and many global health concerns. Health care and accessibility is the surface issue, but there are many more causative factors that must be acknowledged in order to create an effective, lasting solution. There are political factors, economic limitations and barriers, and cultural values that must be accounted for in the plan. Brazil has a constitutional right to health, but it was evident there are still many more puzzles needing a resolution. Medical anthropology is imperative in finding formulas for a better system of health and people in general. The framework approaches many different aspects, decreasing the likelihood of negative consequences. Implementing a system to provide equal right to health for all is a long process with many dimensions that must be valued and accepted.

Bibliography

Global Health Watch 3: An Alternative World Health Report. London: Zed, 2011.

Petryna, Adriana. "Pharmaceuticals and the Right to Health: Reclaiming Patients

and the Evidence Base of New Drugs." Anthropological Quarterly 84.2 (2011): 305-29. Web.

The Anthropology View of Obesity

What’s obesity? What’s “overweight”?  At their most basic, these words are ways to describe having too much body fat. The commonly used tool for measurement is the body mass index, or BMI. People are considered obese when their body mass index exceeds 30 kg/m2. Obesity is often linked with images a heavy people shuffling slowly through life; obesity is usually tied to America or other western countries. Unfortunately, the problem of obesity today is larger than we think. According WHO2012-World Health Statistics, worldwide the prevalence of obesity almost doubled between 1980 and 2008. Once just a problem of wealthy nations, it now impacts countries at all economic levels. Despite the rates of obesity being higher in wealthier countries than low- and middle-income countries, it is indeed a worldwide problem today. There isn't a region in the world untouched by it and it has become a global epidemic.  

 Why is obesity defined as a problem? What’s the danger of obesity? WHO2012 - World Health Statistics reports that there are about 2.8 million people that die each year as a result of being overweight or obese. Obesity brings a wave of illnesses. It is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and increased health problems. It is linked to musculoskeletal, respiratory and psychological problem; people can suffer from Diabetes, Heart disease, stroke and several common cancers. It affects people not only physically, but also emotionally. It can lead to isolation, and a decrease in self-esteem. WHO warns that “Obesity is one of the most serious public health problems of the 21st century.” Overweight bodies will soon be the modal human form, and  to acknowledge what are the real causes of obesity will provide breakthroughs in the global struggle. For anthropologists, it’s clear that the reasons behind obesity are complex and there is no simple answer.

John. M. Janzen once defined medical anthropology as a study of the meaning of the signs of illness and suffering in the light of wider traditions.The remark of an anthropological research is the form behind the text --- the hidden structure of phenomena.  In the article “Obesity and Human Biology: Toward a Global Perspective”, author Alexandra Brewis combines various approaches from different research to examine the expansion of obesity. Through a biocultural  lens, she shows readers the embodiment of culture, social, economic and other environmental processes that an individual is exposed to through their lifetime, and how these processes are expressed in their physiology.  By screening these contributions, she highlights the complex pathways between biology and health related to excess weight--- they occur at multiple levels, dealing with the persons’ life experience as well as socio-ecological context.  It's a great piece which reflects the heterogeneity of medical anthropology.

Obesity and hunger are both related to food. They are two factors that the world does not rate together. But they are linked in a way that many individuals wouldn't connect themselves. Using Alexandra’s words, “obesity [has] emerged as exemplars in recent advances in understanding the role of early life history …” (Alexandra, 2012). To interpret this, we can use America as an example. Today America is the nation with the highest prevalence of overweight and obese individuals in the WHO region (62% overweight in both sexes, and 26% obese)(WHO P36), but historically it’s easy to draw a parallel with the poorer countries in the 1930s. During WWII, many draftees were rejected because of malnutrition. Until recently, privileged individuals and groups have been able to display embodied wealth by above-average body size, and it was a common condition only among the upper classes. Hunger, in many cases, resulted from disruptions to the food supply caused by war, plagues or, natural environment such as adverse weather changes. Hunger usually relates to poverty: The poor are hungry, and the hungry are usually poor. Hunger motivates people to change. Technological developments provided part of the solution to hunger, and the rise of industrialization created more efficient ways to produce less expensive food. With this historical background, we see the pathway people used to fight hunger and gain access to enough food.  With this historical background, we can gain a better understanding of the ironically opposite phenomenon today--- obesity. While technology benefits people, it also has altered patterns of life almost everywhere on Earth.

With the rising rate of obesity, there is an explicit linkage to diet, and obesity mediates an understanding of developmental processes in shaping disease. The rise of technology changed the way we farm and what we farm. They affect how we eat and what we eat. Processed food appears everywhere in today’s market: more refined grains, more added fats and oils, and more added sugar.  “…the very foods that are most traditional, fresh, and local—are in turn obesogenic” (Alexandra 2012).  Trends in calories consumed, snacking behavior, soft drink and modern fast food consumption have become part of the cause of obesity. In the essay, some anthropologists also present a different but equally ironic view of unforeseen trade-offs related to it--- The rise of technology makes people less active. Cars replace bikes; shopping online, socializing online, and playing online interactive games  has created a culture of sedentary lifestyles. Technology is also partially responsible for the increasing rate of obesity.

Alongside the impact of technology, obesity simply cannot be understood without placing it in its social context. “Convenience” has become major selling point in many different ways. Convenience stores are an example of this. They often offer less variety, higher prices, and lower quality products. In this article, the author uses term ‘Food Desert’ to describe areas that lack access to supermarkets with fresh and unprocessed foods but filled with “seven elevens and Q-marts”.  Food deserts often occur in lower income neighborhoods where grocers are unwilling to invest in a store for fear that they will be unable to turn a profit. More surprisingly, she finds households that grow in wealth eschew the market and shop more conveniently for what proves to be less nutrient dense and more expensive food sold in corner stores. She frames this as an example of a concrete type of microlevel mechanism that underpin the macrolevel processes like lifestyle changes. It’s notable that the appreciation for cooking is quickly disappearing. A few decades ago cooking was the center of a family home, women stayed home to cook and clean and the men brought home the bacon. But now a lot of the younger generation doesn't know how to cook, the ones that do know how to cook have difficulty finding the time to do so. Fast food is everywhere, and frozen, packaged and processed food is always available in the grocery store. Both partners in a marriage usually work full time, and have a hard time balancing work, relaxation and cooking.  The change of social structure together with "convenient fast food" make it more difficult to prepare a nutritionally balanced and healthy meal than defrost a frozen pizza.

Without culture context, a study may not be considered as anthropological study. Obesity is also a particularly fertile medium for exploring pathways between cultures, in part because it is universally imbued with symbolic meaning. Big body size and fatness often profoundly and shape and reflect identities. It’s hard to avoid the influence because we are surrounded by "our culture" and are constantly bombarded by people’s ideals toward body norms. In many countries today, where bodies are the dominant and preferred symbols of self, slimness is associated with health, beauty, wealth and attractiveness. In contrast, fatness and obesity are associated with ugliness, sexlessness, and undesirability but also with specific moral failings, such as a lack of self-control, social irresponsibility, ineptitude and laziness. Alexandra summaries the similar examples in Arab countries and describes how this affects people. Changing body norms creates fat fear, and a fear of food. People begin with pathological eating behavior, which leads to difficulty in the regulation of weight and results in weight gain. The resulting eating-disordered behavior and experiencing weight increase are example of cultural interference. 

While obesity is stigmatized in much of the modern world, particularly in the Western world, it was widely perceived as a symbol of wealth and fertility at other times in history, and still is in some parts of today's world.  Fatness is associated with wealth and abundance. Despite the number of ethnographic studies conducted which have detailed cultural contexts in which fat bodies express beauty and marriageability, many males worldwide still think the that fatness is related to fertility, familial responsibility and social belonging. The perceptions of ideal body size and corresponding behaviors are greatly influenced by culture and gender. Increasing body size of children also is a substantial secular trend in human biology . There is no denying that the shift to richer diets is a cause of this, but a few studies also show that children are more likely to be obese if they are boys, or from small households with few or no other children (Alexandra, 2003). China will be a good example.  In smaller middle-class families, kids normally have more permissive, less authoritarian parents. The values parents place on children, especially sons, can result in indulgent feeding because food treats are a cultural index of parental caring. Parents often value child fatness as a sign of health.  And their idea of feeding a child, including with food treats is an act of loving and caring. This could well translate into overfeeding at home and obesity..

Connecting the global changes over time in trade and periodic climatic disruptions, the increasing rates of obesity across the world are also broadly attributed to environments that are "obesogenic". In the essay, the author shows how trade and globalization of the food system affects people.  The dominant explanatory framework is that of nutrition transition which relates globalization, urbanization, and westernization to changing food environments across the populations of the world.  In this formulation, the rise of big industry and corporations make it difficult for small business and farmers to compete and stay in business. Communities previously reliant on subsistence farming now must enter the job market for monetary work and rely on the cheapest, nutritionally devoid, factory produced food items. In this formulation, changes in food prices have been linked to changes in how much we eat, as well as our risk of obesity. Global food supply becomes increasingly abundant, less expensive, and more-aggressively marketed, coupled with fast raise of fruit and vegetables. Andrew Seiden et al. suggest that “decreasing costs of highly processed foods leads over time to declining dietary quality and increased obesity (Alexandra,2012). In addition, economic inequalities within and between nations have ensured food security for significant sectors of society and for some nations as a whole, while denying food security for many others. WHO data indicates that in 2008, around 80% of all NCD deaths (29 million) occurred in low- and middle-income countries. Being limited to the healthy foods available, those that are of less wealth rely on cheap but unhealthy foods to bring an end to their hunger. They are less likely to receive adequate diets but more likely to access higher calorie foods that are affordable. They are victims of their economic status.

Obesity, as its heart, the result of many personal decisions---change diets or eat less. But the rise of obesity across many countries and disproportionately among the poor suggests that becoming fat cannot just be blamed on individual frailty. Medication like drug or surgery can  help in the most extreme cases; they don't, however, offer a solution to the wider problem. John. M. Janzen introduces the word "fabric" in relation to health in his book. He explains that fabric can become a useful image to show how anthropologist speaks about health and illness, and it includes cultural fabric, social fabric and economical fabric. They are the net that can envelop individual with life-enabling such as basic fresh water, shelter, and health; and how they are maintained or how they change also can torn and tatter people’s life. As we can see, one’s biology is manifested and affected by different aspects of society, culture and classes of economic; it is not just a single component. Face the fact that the world now filled with more people who are overweight than underweight, public health like WHO and medical perspectives paint obesity as a catastrophic epidemic that threatens to overwhelm health systems and undermine life expectancies globally. Yet, despite the loud messages about the health costs of being obese, weight gain is a seemingly universal aspect of the modern human condition. Obesity is a problem that cannot be fully understood independent of the culture or social group in which it appears; it will not be fully understood without the particular environment in which obesity is examined. Also, the growth of obesity has to do a lot with economic growth, which brings change in lifestyle. Even more, it may with an underlying genetic basis.

After all, there is no single solution to obesity, not the cause nor the cure; it cannot be tackled by individual action alone. We will only succeed if the problem is recognized, owned and addressed at every level and every part of society. For an anthropologist, the idea is that they can see through the surface to the pattern from which it springs, and look for the essentials to define it.  Disease is a language, is a way of communicating and storytelling. What we eat or what we choose to eat plays a large role in determining our risk of gaining weight. But our choices are shaped by the complex world in which we live — by the kinds of food available at home, by how far we live from the nearest supermarket or fast food restaurant, or even polices made by politicians. For an anthropologist food is a basic necessity, but it’s also much more. It can evoke memory and emotions; it is “toxic” because of the way it corrodes healthy lifestyles and promotes obesity. For an anthropologist, it’s about social relations, biological identity and self-hood. Drawing on many different studies with her own fieldwork, Alexandra A. Brewis addresses the critical questions as why obesity is defined as a problem and why some groups are so much more at risk than others. Grounded in a holistic anthropological approach and using a range of ethnographic and ecological case studies, Alexandra A. Brewis shows that the human tendency to become and stay fat makes perfect sense in terms of evolved human inclinations and the physical and social realities of modern life. Beyond the obesity epidemic, Alexandra Brewis presents us with topics like cultural perspectives, social determinants and the global economy which all prove indispensable when considering endemic obesity rates. They are interconnected with each other and influence people in interdependent ways. She suggests that a systems approach, which can place human biological and biocultural variation within the broader contexts, will be a useful step to informing effective prevention and intervention efforts. 

Bibliography

Brewis Alexandra, Biocultural Aspects of Obesity in Young Mexican, AMERICAN JOURNAL OF HUMAN BIOLOGY 15:446–460 (2003)

            Obesity related to over-nutrition is investigated in a sample of 219 Mexican children from affluent families, ages 6–12 years. Binary logistic regression shows that children are more likely to be obese if they are boys, from small households with few or no other children, and have more permissive, less authoritarian parents. The differences in obesity risk related to specific aspects of children’s developmental microniche emphasize the importance of including a focus on gender as a socio-ecological construct in human biological studies of child growth, development, and nutrition.

Brewis Alexandra, Obesity and Human Biology: Toward a Global Perspective, AMERICAN JOURNAL OF HUMAN BIOLOGY 24:258–260 (2012)                                                 In this special issue of American Journal of Human Biology, authors use varied approaches to examine the expansion of obesity globally, particularly what shape variability in people’s vulnerability to weight gain and its negative effects. The contributions together highlight how complex pathways between biology and health related to excess weight are strongly medicated, at multiple levels, by both socio-ecological context and life history. A systems approach, which can place human biological and biocultural variation iteratively within the broader contexts of developing and globalizing adiposity, will be a useful next step to informing effective prevention and intervention efforts.

WHO: WHO2012-World Health Statistics-W1