Dissertation Proposal - Aunchalee E. Loscalzo

November 2001

Healthy Ecosystems, Healthy People: Diet, Disease, and Natural Resource Management in Palau

I. Aim and Scope

A. Research Objectives

The proposed dissertation research is an anthropological investigation of food and health among Southwest Islanders of Palau. It addresses health and disease in an ecological framework that emphasizes interrelations among elements of the biophysical environment and human well-being. The primary research objective is to ascertain the biocultural significance of natural resources, particularly those consumed as food by Southwest Islanders. Data collection methods range from participant observation and interviews to anthropometry and a dietary survey. Research findings will contribute to the anthropological literature on the meanings and measures of food, including how diet and change influence the perceptions of and experience with illness. In an applied context, results also will inform community-based environmental conservation, monitoring, and management activities in Palau.

B. Theoretical Background

Biocultural perspectives in medical anthropology provide the theoretical framework for this project. A biocultural approach to the study of health entails the integration of its abstract/symbolic and tangible/biophysical dimensions (Armelagos et al 1986; Browner et al. 1986). In accord with biocultural approaches in anthropology, this investigation pertains to dietary health as well as the symbolic aspects of food resources. This type of synthesis encourages the concomitant evaluation of etic (outsider, western scientific) and emic (local, insider) concepts of health, healing, environment, and natural resource use. Diet is an ideal vantage point from which the community’s interest in and relationship with the land and sea can be elicited.

Food has occupied an important place in medical anthropological inquiry, due to the obvious correlation between nutritional status and disease. Studies of food have enlightened us about human biological variability and susceptibility to disease (e.g., Overfield 1985), the cultural context of food (e.g., Burghart 1990), and the health implications of using food as medicine (e.g., Etkin 1991, 1994; Johns 1997). Anthropological research makes a unique contribution to studies of food by uncovering culturally-grounded disease concepts and the food habits that influence people’s experiences with these diseases.

Diet-related health problems such as diabetes, hypertension, and obesity currently dominate medical anthropological research in the Pacific region. These diseases are emerging throughout Pacific island societies as traditional farming and fishing for subsistence is supplanted by consumption of pre-processed foods bought at the marketplace (Bloom 1987; Hankin 1970; Lewis and Rappaport 1995; Hanna 1998). Increased sedentary lifestyles and decreased physical activity is leading to higher rates of obesity among people throughout the developing world (Pollock 1995; Zimmet and King 1985). Understanding morbidity and mortality patterns in Pacific Island populations, thus, also requires knowledge of shifting people-environment relations that manifest themselves in disease (Finau 1996; Pollock 1999).

The intimate relationship between human health and the environment warrants research that explores the ecological implications of health, particularly how research can be used to ameliorate environmental degradation while also promoting human health and well-being (e.g., Rapport et al. 1998). While from an etic perspective, the strict management of natural resources is a top priority; emic perspectives on conservation problems may differ considerably (Adams et al. 1999). This observation is especially true in cases where biological resources that are at risk of overexploitation are important cultural, economic, or political resources. Many species that have been targeted for conservation in Palau are important culturally, as symbols of health, identity, and prosperity (Black and Johannes 1981; CCN 2000). The challenge for conservationists working on sustainable resource management in the Pacific is to gain a better understanding of local culture and its relationship to natural resource use (Black 2000a; Lobban and Schefter 1997).

II. Field Site and Preliminary Research

Echang is a small hamlet in Palau’s urban capital city, Koror. Approximately 150 individuals currently reside there. Most people are from one of the four southwest Palauan island states. Southwest Islanders from Tobi, Sonsorol, Pulo Ana, and Merir have been migrating to Echang for over 20 years. Southwest Islanders are culturally, linguistically, and politically distinct from the rest of the Palauan population found in the main Palauan islands. Southwest Islanders have a cultural and linguistic affinity to those found in the islands of Yap and Chuuk in the eastern region of the Federated States of Micronesia (Black 2000a).

Modern biomedical health care is readily available in Koror as well as supermarkets, restaurants, and other amenities of a developed city. Utilization of these resources, though, is largely determined by socioeconomic status. Most Southwest Islanders living in Echang are employed in Koror.

The health problems that I am aware of among Echang residents are respiratory infections, heart disease, diabetes, and obesity. Alcohol consumption is prevalent, and drug use has reportedly been rising in the community, particularly among the adolescents and young adults. Virtually no research has been done on indigenous medical systems of Southwest Palauan Islanders (one exception is Black 2000b). From my own observation during two previous visits there, biomedical health care and pharmaceuticals are popular among Echang residents, but again, accessibility to these resources may be an issue for many.

Subsistence fishing and farming augment what residents are able to buy in the marketplace, and preprocessed foods seem to be as popular as fresh fish and produce. Taro, cassava, and white rice are the staple carbohydrates in the diet and are usually eaten with fresh fish, fresh pork, or canned meat. A plot of land adjacent to Echang is used to cultivate taro and cassava, as well as banana and papaya. Fish is usually caught in the near shore fisheries of the main Palauan Islands. However, fish and other marine species are periodically brought to the main islands from the southwest (including Helen Reef). A small number of people still live in the Southwest Islands, and so these trips also serve as a means to transport canned foods, rice, and medical supplies to those living away from the city. The way in which traditional and contemporary modes of living coincide among Echang residents is an important dimension to the proposed research project.

I have been involved with Southwest Islanders living in Echang as a researcher since 1999. I worked with a small Hawaii-based non-profit organization, the Community Conservation Network (CCN), to initiate a community-based needs-assessment for marine resources at Helen Reef, a remote coral reef atoll ecosystem in the Southwestern Palauan Islands. CCN is a network of individuals devoted to supporting community-based sustainable resource management of biological diversity. The mission of CCN is to mobilize the skills and knowledge of regional experts, researchers, scholars, and local communities to better understand and implement localized biological and cultural conservation, resource management, and sustainable development. CCN is currently working with a broad network of people on various aspects of the Helen Reef project, from coral reef monitoring to developing a geographical information system (GIS) for Hatohobei State.

In 1999 I was a field assistant to Professor Peter Black, the primary research anthropologist, who was collecting data on indigenous concepts of environment, conservation, and conflict resolution. Together we compiled a word list of basic Tobin concepts of environment and their corresponding English translations. During June-July 2001 I worked with local scholars to analyze the strengths and weaknesses of the Helen Reef Management project, paying particular attention to community participation in planning, implementation, and assessment phases. An outcome of this collaboration was the development of a conceptual model for the Helen Reef Management plan.

I will continue my collaboration with CCN and affiliate organizations through this dissertation project. An understanding of local culture, community goals, community values, and local resource utilization provides a foundation upon which sustainable community participation in a management plan can be achieved.

III. METHODOLOGY

The methodology for this project is comprised of qualitative and quantitative strategies that reflect the biocultural implications of the research. I will conduct interviews with Southwestern Islanders residing in the village of Echang (approximately 150 individuals) as well as individuals (approximately 30) residing in the Southwest Islands. Core research methods include participant observation, interviews with individual informants, focus groups, anthropometrics, and dietary surveys.

A. Interviews and Participant Observation

A number of interviewing techniques will be employed to gather information about local perceptions of health, disease, and environment. Open-ended and semi-structured interviews will be carried out with individuals as well as with focus groups (Bernard 1994; Corel 1995; Weller and Romney 1988). Interview participants will primarily include community members, but will also involve local health care practitioners and members of the Palauan conservation community outside of Echang. Pile sort exercises will also be used to elicit cultural domains of importance to this research, such as disease categories, fish classification, and landscape features. Pile sorts will also aid in the development of cognitive maps, in other words, graphic depictions of how culturally meaningful categories are organized (Bernard 1994; Romney et al. 1986).

Interviews will address the following thematic areas: (1) concepts of food as they are related to health, well-being, and identity; (2) methods of collecting resources for food, preparing meals, and distributing food resources; (3) food cultivation practices; (4) concepts of conservation and management of food resources; (5) local definitions and explanations of environmental/ecological processes; (6) conflict management practices related to natural resources use at the community level; (7) concepts of health and illness including the relationship of food and health; (8) medical decision-making.

Participant observation is an essential aspect of ethnographic research because it adds perspective to interview responses and verbal discussion of research topics (Bernard 1994). Participant observation also provides an opportunity for the researcher to see people doing various activities first-hand, activities that may be too complex to describe in conversation, such as fishing techniques, farming, food rituals, and selection of food at the marketplace. In this project interviews and participant observation are considered equally important.

B. Review of Medical Records

In addition to interviewing Southwest Islanders about their health concerns and health history, local health care practitioners will also be asked questions about common health issues in the community. If possible, a survey of medical records will be conducted in order to have quantitative data with which to construct a statistical analysis of disease type and incidence within the study population during the past 10-20 years.

The information provided by health care practitioners will be compared to the interview responses of Southwest Islanders, to ascertain areas where professional and lay perspectives on health problems converge and/or diverge. Are the concerns of the biomedical community the same as those within the village community? Are the types of health care strategies that biomedical practitioners prescribe the same type of strategies that people in the village to address these health issues? If not, then why not? This type of research strategy provides an opportunity to learn where indigenous/local concepts of disease and healing conflict or mesh with more recently introduced biomedical concepts (e.g., Cassidy 1996; Etkin 1988).

C. Anthropometry

The following body measurements will be taken among a non-random sample of the study population and then used to ascertain estimated body composition (e.g., BMI, %body fat, fat distribution) and as indicators of susceptibility for diet-related disease (e.g., diabetes, hypertension, heart disease) (Hazel et al. 2000; Troiano et al. 1996; Zimmet and King 1985):

Height

Weight

Upper arm, triceps and bicep skinfold

Subscapular skinfold

Suprailiac skinfold

Abdominal skinfold

Abdominal circumference

Gluteal circumference

Upper arm circumference

Blood Pressure

Measurements will be taken among Southwestern Islanders living in Echang and, if possible, among Islanders still living in the home islands with the assistance of a professional health care worker. Measurements will be repeated periodically throughout the year with the Echang group to account for possible seasonal fluctuations in food availability and dietary patterns (Messer 1989).

These data address the questions: What are the physiological signs that imply a health disorder or healthfulness? Is obesity a sign of health or of sickness among Southwest Islanders? Are lay concepts of a healthy body and healthy physique similar or different from biomedical concepts? How do lay perceptions of body composition and health influence diet, physical activity, and health seeking behaviors?

D. Dietary Survey

A 12-month dietary survey will be carried out with a quota sample of households in Echang. During this period, daily scheduled and intermittent unscheduled (“spot check”) surveys will be used (Quandt 1987). Pre-cooked and cooked weight will be taken of foods prepared, and an estimate of how foods are portioned and distributed will be recorded. Careful notes on food preparation will be taken and, when appropriate, interviews will also be conducted during the survey. The objective of these surveys is not to measure exactly how much food a given individual eats, but rather to ascertain generally what people in the household, and community, are eating and how food resources are managed within each household (Pelto 1989). The surveys will also provide information about the relative composition of household diets, for example, the ratio of protein to carbohydrate, the quantity of fresh fruits and vegetables in a given meal, and the ratio of pre-processed foods to fresh foods.

Surveys will be augmented by interviews that will provide household demographic data and other information pertaining to the access to and distribution of food resources within the household. If possible, a similar survey will be carried out on Tobi, Sonsorol, and Pulo Anna Islands in the Southwestern Island chains for a rough comparison of food resources and dietary practices.

E. Market Surveys

A survey will be taken to ascertain if any portion of fish that is caught by local fishermen is taken to the Koror fish market for sale. If so, records will be kept of how much fish is caught (e.g., number of fish by species, weight of fish), how much is distributed to village members, and what is taken to market for sale. This information is germane to the question of management of local marine resources and the complex importance of natural resources in local economy, social networks, and community nutritional health. Food can be sold to provide income that may allow some households to participate in outside markets for other foods, alcohol and tobacco, or pharmaceuticals. Income generated from the sale of catch may prove to be an important factor in differential health status, and market surveys with interviews will provide the information necessary to make such an assessment.

IV. Significance

This project departs from the conventional model of dissertation research as a single-disciplinary and abstract theoretical endeavor. The data collected will enhance the development of a community-based natural resource management plan. By example it has the potential to encourage future multidisciplinary collaboration on conservation issues and will demonstrate the value of anthropology in what has typically been an arena void of anthropological input.

The theoretical contribution of this research lies within the study design and theoretical framework, which combines an interdisciplinary approach in researching and analyzing human health and environmental health. The biocultural implications of the research and the ecological context of health will come together through the analysis of data gathered through this project in concert with data gathered by other researchers from other disciplines.

The applied significance of this project extends to many levels. It has the potential to improve health care delivery for people in this community. It also will be used to enhance community-based conservation. The data gathered from this research will be useful in ameliorating conflict between local and conservationist ideas about the value of important marine species and how to manage them sustainably.

References Cited

Adams, T., P. Dalzell, and E. Ledua. 1999. Ocean Resources. In The Pacific Islands: Environment and Society. M. Rapaport, ed. Pp. 366 – 381. Honolulu: The Bess Press, Inc.

Armelagos, G. J., T. Leatherman, M. Ryan, and L. Sibley. 1992. Biocultural synthesis in medical anthropology. Medical Anthropology 14:35-52.

Bernard, R. A. 1994. Research Methods in Anthropology: Qualitative and Quantitative Approaches, Second Edition. Walnut Creek, London, and New Delhi: Alta Mira Press, Sage Publications, Inc.

Black, P. W.

2000a. Planning for the Future of Helen Reef: Socio-cultural Features of the Tobian Community and Their Implications. A Report and Recommendations. 15 January, 2000. Downloaded from - http://cas.gmu.edu/~tobi/thisisnow/planningforhelenreefsfuture2.htm 9/21/01.

2000b. Fourteen Medicinal Recipes from Tobi. Adapted in May 2000 from P. W. Blac, Medicinal Recipes of Tob, A Report Prepared for Entomology Laboratory, U.S. Trust Territory of the Pacific Islands, 1968. Downloaded from - http://cas.gmu.edu/~tobi/tobithings/medicine/fourteenmedicinalrecipes.htm 9/21/01.

Black, P. W. and R. Johannes. 1981. Fishing in the Southwest Islands. In Words of the Lagoon: Fishing and Marine Lore in the Palau District of Micronesia. R. Johannes, ed. Pp. 85-100. Berkeley: University of California Press.

Bloom, A. 1987. Health and nutrition in the Pacific: problems and policy issues. In Human Resources Development in the Pacific, ed. C. D. Throsby, pp. 53-88. Canberra: National Centre for Development Studies, Pacific Policy Papers No. 3.

Burghart, R. 1990. The cultural context of diet, disease, and the body. In Diet and Disease in Traditional and Developing Societies, G. A. Harrison and J. D. Waterlow, eds., Pp. 307-325. Cambridge: Cambridge University Press.

Cassidy, C. M. 1996. Cultural context of complementary and alternative medicine systems. In Fundamentals of Complementary and Alternative Medicine, M. Micozzi, ed, pp. 9-34. New York: Churchill Livingstone.

Community Conservation Network (CCN). 2000. Marine Resources of Helen Reef in the Year 2000: A summary report of the Helen Reef Baseline Monitoring Expeditions. Sponsored by the Hatohobei Natural Resource Management Program, Hatohobei State, Republic of Palau. Downloaded from – http://cas.gmu.edu/~tobi/thisisnow/Helen%20Reef%202000%20Monitoring%20Expedition.pdf. 9/21/01.

Coreil, J. 1995. Group methods in community health research: Medical Anthropology 61:193-210.

Etkin, N. L.

1996. Ethnopharmacology; the conjunction of medical ethnography and the biology of therapeutic action. In Medical Anthropology: A Handbook of Theory and Method, T. M. Johnson and C. F. Sargent, eds, pp. 151-164. New York: Praeger Publishers.

1994. The cull of the wild. In Eating on the Wild Side: The Pharmacologicl, Ecologicl, and Social Implications of Using Noncultigens, N. L. Etkin, ed. Pp. 1-21. Tucson: University of Arizona Press.

1991. Should we set a place for diet in ethnopharmacology. Journal of Ethnopharmacology 32:25-36.

1988. Cultural constructions of efficacy. In The Context of Medicines in Developing Countries: Studies in Pharmaceutical Anthropology, S. v.d. Geest and S. R. Whyte, eds., pp. 299-326. Dordrecht: Kluwer Academic Publishers.

Finau, S. A. 1996. Health, environment, and development: towards a Pacific paradigm. Pacific Health Dialog 3(2): 266-278.

Hanna, J. M. 1998. Migration and acculturation among Samoans: some sources of stress and support. Social Science and Medicine 46: 1325-1336.

Hankin, J. 1970. Dietary and disease patterns among Micronesians. American Journal of Clinical Nutrition 23(3): 344-352.

Hazel, A. Hiza, C. Pratt, A. L. Mardis, and R. Anand. 2000. Body Mass Index and Health. Nutrition Insights, Issue 16: 1-2.

Johns, T. and J. T. Romeo, eds. 1997. Functionality of Food Phytochemicals. New York: Plenum Press.

Lewis, N. and M. Rapaport. 1995. In a sea of change: health transitions in the Pacific. Health and Place 1(4): 211-226.

Lobban, CC. S. and M. Schefter. 1997. Tropical Pacific Island Environments. Mangilao, Guam: University of Guam Press.

McElroy, A. 1990. Biocultural models in studies of human health and adaptation. Medical Anthropology Quarterly 4(3): 243-265.

Messer, E. 1989. Methods for determinants of food intake. In Research Methods in Nutritional Anthropology, G. H. Pelto, P. J. Pelto, and E. Messer, eds. Hong Kong: United Nations University.

Overfield. 1985. Biochemical variation and differential disease susceptibility. In Biological Variation in Health and Illness: Race, Age, and Sex Differences, pp. 79-99. Menlo Park: Addison Wesley.

Pelto, P. J. and G. H. Pelto. 1996. Research designs in medical anthropology. In Medical Anthropology: Contemporary Theory and Method, C. F. Sargent and T. M. Johnston, eds., pp. 293-324. New York: Greenwood Press.

Pollock, N. J. 1995. Introduction. Social Aspects of Obesity, I. De Garine and N. Pollock, eds. New York: Gordon and Breach.

Pollock, N. J. and S. A. Finau. 1999. Chapter 23: Health. In The Pacific Islands: Environment and Society, M. Rapaport, ed, pp. 282 – 295. Honolulu, Hawaii: The Bess Press, Inc.

Quandt, S. A. 1987. Methods for determining dietary intake. In Nutritional Anthropology, F. D. Johnston, ed., pp. 67-84. New York: Alan R. Liss, Inc.

Rapport, D. , R. Costanza, P. R. Epstein, C. Gaudet, and R. Levins, eds. 1998. Ecosystem Health. Oxford: Blackwell Science, Inc.

Romney, A. K., S. C. Weller, and W. H. Batchelder. 1986. Culture as consensus: a theory of culture and informant accuracy. American Anthropologist 88:313-338.

Troiano, R. P., E. A. Frongillo, Jr., J. Sobal, and D. A. Levitsky. 1996. The relationship between body weight and mortality: a quantitative analysis of combined information from existing studies. International Journal of Obesity Related Metabolic Disorders 20:63-75.

Weller, S. C. and A. K. Romney. 1988. Structured Interviewing. Newbury Park, CA: Sage Publications, Inc.

Zimmet, P. and H. King. 1985. The epidemiology of diabetes mellitus: recent developments. Diabetes Annual 1:1-15.