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Modernization, Cultural Pluralism, and Health Care

Gretel H Pelto Norge W Jerome

Intracultural diversity and nutritional anthropology

Historically, cultural anthropologists have been remarkably uninterested in the nutritional systems of the communities they study. Ethnographers usually describe food procurement under the general heading of "economics," but food preparation, dietary patterns, and eating habits have received less systematic treatment. Assessment of nutritional quality and quantity is rarely, if ever, a subject of general ethnographic research. A few striking exceptions to this general lack of anthropological attention to diet do exist, most notably Audrey Richard's Hunger and Work in a Savage Tribe and the work of Margaret Mead and her collaborators in their research during World War II on food consumption habits of the American public. Of course, applied anthropologists have been working in public health and nutrition programs, but the lack of more widespread interest in their work is surprising given the long-term anthropological concern with integrating social and biological aspects of human behavior. The study of nutrition is a biocultural issue, par excellence. The consequences of food intake are biological; that is, individual biological functioning is directly and continuously affected by food intake over the course of a lifetime. But the nature of food intake-what people eat, how, when, where, and how much-is heavily influenced by social, political, and cultural processes. From assessment of nutrient distribution at the national level to analysis of nutrient distribution within communities and families, social variables are an integral part of nutritional outcomes. There are, however, both methodological and theoretical barriers to a successful integration of the social and biological aspects of nutritional research. A brief review of the major types of research by nutritionists and anthropologists should serve to demonstrate the nature of the problem. Research within nutritional science usually takes one of the following forms: 1. Studies by biochemists of the physiological functions of some nutrient. Frequently such research examines the relationships of different levels of a nutrient (vitamin, mineral, lipid, and so forth) to metabolic behavior, some aspects of growth, or disease process. Methodologically this type of research involves collecting data fr9m individual subjects (human or
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animal), with or without experimental manipulation of some of the relevant parameters. Relationships among the selected variables are then analyzed in order to generalize about human physiological processes. 2. Large-scale surveys of populations using biochemical and clinical assessments to determine nutritional status and/or interview techniques to elicit data on food intake, dietary patterning, and nutritional adequacy of diet, or some combination of each. In this type of research tile data are col1ected from individuals to create descriptive generalizations about a population, which may be as small as a community or as large as a nation. Results are frequently presented in terms of percentages of the population charac terized by particular nutritional states (for example, serum levels of vitamins and minerals), food consumption levels, or nutritionai adequacy of diet. 3. Food habit surveys. Foods consumed by individuals, families, households, or ethnic and economic subgroups of communities are recorded for a given period of time (using twen ty-four-hour recall, three-day records, seven day inventories) and are used to determine dietary habits and nutritional composition of food ingested. However, such surveys generally minimize the cultural and socioeconomic forces innuencing dietary practices. Anthropological Studies In sociocultural anthropology research design is quite different. An older research style, uncommon today, sought to describe tile cultural system of a people, often identified as a tribe or ethnic group. Descriptions of groups such as "the Navajo" or "the Nuer" were often generated from research in a particular community, with special focus on a few trusted key informants who provided verbal information about "the way we do things" or "the way we used to do things." More recently, a typical research style involves fieldwork in a community to describe its cultural patterns. The focus tends to be on normative description-of values, beliefs, and symbolic meanings of particular practices-as wel! as on descrip' tions of the usual way of carrying out subsistence activities, child training, and so on. Often the research concentrates on some particular aspect of community life, such as connict resolution, economic exchange, and kinship relations. The research methods associated witil much of cuI tural an thropology (whether problem-oriented or aimed at ethnographic description) utilize a mixture of ob servation and interviews of a carefully selected sample of. the community. A grca t deal of variability exists in the systematizing of data collection. Yet, with rare exceptions, the anthropologist produces a more or less generalized description of typical or normative cultural patterns. These problems with methodology have limited the integration of the biological and social aspects of nutrition in anthropological research. We can begin to see why tllere have been serious problems in trying to rela te the do ta of n utli tioll to those of cultural anthropology. Nutritional data are not easily artkuiatcd because anthropologists and nutritionists use different units of analysis and seck dif

fcren t kinds of generaliza tions. (We might add that similar problems exist within a1l0,uopology, where the disjunction between the methods and data of physical and cultural antJlfopologists have been a barrier to the development of a true bioculctural an tJuopology.) Of course, it is stating the obvious to suggest that disciplines differ in their units of analysis and theoretical constructs. The real issue in interdisciplinary reo search is whether units of analysis in one discipline can be identified with or ar ticulated into units of analysis in another. Thus, the data of macrobiology (for example, animal ecology) are not easily articula ted with research in chemistry, but when biologists focus on characteristics of individuals (on particular components of blood, hormones, and so forth) then collaboration with chemists becomes meaningful. The growth of research on human biochemistry demonstrates how effective interdisciplinary collaboration can be when the data can be articulated. What is required to bring cultural anthropology and nutrition into similar congruity? From the anthropological side, we must shift from an interest in normative description to a focus on intracultural diversity of behaviors and beliefs. We must describe societies in terms of the ranges of variation that are the realities of human life. For example, economic and political structures must be described not only in general terms but also in terms of the way they are reflected in individual behavior. Just as the value of biological parameters is measured for individuals, so the social and cuI tural variables must be measured for individuals. When anthropologists work in this way, their data can be readily linked with the data of nutritionists. From the nutrition side must come recognition that social processes are every bit as complex as biological processes and that their measurement is as difficult. Too often, for example, nutritional researchers have assumed that simply asking people about their income is a sufficient measure of socioeconomic status or that respondents' description of the composition of breakfast provides ample data for :letermining nutritional adequacy of that meal. Again, residence in particular :conomically marginal neighborhoods or villages is sometimes considered sufficient o identify low income status. Both verbal reports and place of residence can miss dtogether the subtle but significant differences in families' economic situations l1at may strongly affect nutrient intake. Just as biological measures are powerfully lffccted by the choice of the measurement technique, so too are social variables. rhe met1lOdological sophistica lion required to measure sociocultural factors is no maIler than that required to produce valid biological data. Therefore, in addition o congruence of units anthropologists and nutritionists also need an appreciation )f each otJlers' theoretical constructs and methodological problems. Recen tly, some researchers have tried to resolve some of the methodological lroblems in cultural anthropology and human nutrition by trying to account for iiversilies in food consumption, nutritional adequacy, and nutritional status of ndividuals in communities. In our work we have found that a research strategy that assumes intracultural [iversity is very useful for understanding the relationships of food consumption to

other social and cultural factors. For example, Jerome carried out intensive research with twentythree black households in Milwaukee, Wisconsin as part of a larger project on foodconsumption patterns of low income black families. The twentythree households did not present a homogeneous picture. Rather they exhibited a variety of eating and food preferences. What explains the differences? It was found that national and racial indices of socioeconomic status were not very useful in classifying the respondents (Jerome 1968). In terms of education, occupation, and income, most of the families could be placed at the bottom of the tripartite class structure. The characteristics that did make a difference in food consumption patterns included family background and length of residence in the South, time of migration and length of residence in the North, as well as home ownership, church membership, and several other sociocultural factors. By focusing on the difference within the community and systematically collecting data on individual and family characteristics, it was possible to delineate the major variables that affected food consumption and to examine the adaptation in progress. The research in Milwaukee reveals how people discard old modes of food consumption as they learn to use the resources of a new environment. In research in a Mexican community DeWalt and Pelto (in press) studied factors that contribute to dietary complexity. Within the community there were impressive differences in the varieties of food consumed, ranging from diets of mainly tortillas, beans, and chilis to those that were well-balanced and varied. Analysis of data on social status and beliefs suggests that in this community people's beliefs about the characteristics of particular foods have relatively little to do with the frequency of their consumption. Dietary complexity is, apparently, much more strongly affected by household composition, access to land, and occupation. As in the research in Milwaukee, an approach to the community that focused on normative patterns would have failed to discover such relationships. In an interesting study in a neighboring community in Mexico, Miriam Munoz de Ch~ vez and her colleagues (1974) studied differences in families of mal nourished and well-nourished children. Excluding families at both upper and lower ends of the economic spectrum, the researchers focused on families of farmersthirty-six families with well-nourished children and thirty-seven families with chilo dren who showed unequivocal signs of malnutrition. Among the variables that differentiated the two groups were: (1) differences in the ratio of children to adults within a household; (2) sex differences (68 percent of malnourished children were girls; 62 percent of well-nourished children were boys); (3) diet of mother; and (4) weaning history of the child. The researchers felt that the interpretation of these results and other findings should be approached cautiously because of the complexity of the data. They did not find any minor variations in feeding practices or in child care that might cause large differences in the physical state and health of the children. What was found was a spider's web of facts that needed to be proven (1974). We should add to the comments by Munoz and colleagues that in that part of Mexico, as elsewhere, even among seemingly homogeneous communal-land farmers

;~1l1be significant differences in economic status, based on access to paying Jiffe'rences in agricultural productivity, and number of wage earners in the }old. Time and again we have found that assumptions about the same social n are not warranted when households are examined more closely. In the sociocultural system of the United States there has been a good deal cussion recently about the health food movement, vegetarianism, and sofood faddism. These phenomena are often discussed in general terms, sug ; that vegetarians are all pretty much alike and people know a food faddist they see one. Bu t a closer look at the health food people shows a fascinating i ty in their complex networks. Even though articulation among the diverse s is maintained to some extent through magazines, books, and other publica as well as by traveling food evangelists, there are notable differences among lbiotic enthusiasts, followers of Guru Mallaraji, Diet-foraSmallPlanet vege s, and various meateating health food people (Kandel and Pelto, in press). rcsearch demonstrated the importance of social networks in affecting indio I food consumption patterns. A recent multivariate study of factors affecting malnutrition was carried out .e economist F. James Levinson and associates (1974) in a rural area of the b in northern India. The study sample comprised 496 children, including both ats (an economically and socially dominant group) and the Ramdasias (land igrlcultural laborers). Data included relatively short interviews with the chilo s mothers, examination of stool samples, and height, weight, and health ures. Nutritional status was determined from height, weight, and age accordo the wellknown Harvard standards. Nutrient intake was estimated for each

through the use of the twentyfour hour recall method. Roughly three times any of the Ramdasia children as Jat children were categorized as having third ~emalnutrition. It is perhaps not surprising that the sex of the child was a major variable in icting malnutrition in this Punjab population. Severe malnutrition appeared e about seven times as frequent among female children as among males. Levin concluded that sex, income of parents, age of child, disease status, and reo ed caloric intake were tlle major predictors of nutritional status and that the th and nutrition beliefs of tile childrens' mothers contributed to the prediction :alooc intake. Concerning programmatic recommendations, he suggested that IUse of large differences in economic position of the two groups "most inter ions which did not in some way augment real income would have a far greater live effect on the Jat child tllat on the Ramdasia" (1974:62). Thomas Marchione (in press) has recently studied factors related to dif nt nutritional status of infants in a Jamaican community using data on the rrelationships among economic, SGcial, arid cultural variables. Through factor lysis he was able to identify a series of significant variables, including a "nuclear Illy-solidarity" factor as well as "caretakermaturity" and "dependencyratio" tors. As in other recent studies, it was found that an infant is subjected to :Iter risk of malnutrition if there are oilier small children in the household. A

ural-subsistence-dependency" factor was a significant predictor as well, reflecting .e marginality and inadequacy of the small plots available to people for food Iltivation in the outlying areas. Although Marchione's data leave a considerable portion of total variance un<plained, his statistical analysis goes farther than most other community studies 1 identifying the inputs of different social and economic factors in predicting ariations in nutritional status within a community. Such a study does not, of ourse, tell us much about what to do about Jamaica's marginal position with reard to food sources, but it aids in the identification of nutritional risk factors in n-going community health programs. These studies delineating intracultural diversity move us further in the direcion of formulating theories and developing methodologies that capture the realiies of dietary adequacy in relation to sociocultural and biological variables. )eWalt and Pelto's research demonstrates that relationships between belief and lehavior are not as simple as was formerly assumed. Jerome takes us one step 'urther to demonstrate how these selection patterns parallel nutritional adequacy )f diet in various subgroups. Levinson's and Marchione's work show how belief Jatterns, food choice patterns, and dietary adequacy culmmate in differential nu;ritional status within the community.
Summary and Conclusion

We will briefly outline here some of the major ideas that emerge from analysis of these methodological trends in food and nutritional systems research. At the most general level, research that focuses on individuals, from both the biological and the sociocultural dimension, can greatly enhance our understanding of the complexities linking nutritional status, disease, ang other health measures with income, family cultural patterns, households structures, and other variables in adaptational systems. Some of the more recent and more sophisticated research is beginning to provide ways to sort out the relative strengths and predictive power of various social and cultural factors. In some cases income alone may be a powerful p(edictive factor in determining nutritional status. In other instances, the complex interactions of other intervening variables may disguise the effects of economic variables. Controlling a research design for economic factors, we have yet to demonstra te how and when beliefs and attitudes play significant roles in affecting people's health and nutritional behavior. When do adequate economic means lead to health, when to obesity and illness? People's support networks-their social systems-have strong effects on their adaptational styles and on their chances of success in coping with challenges to heal th and well-being. These support networks are very difficult to fit into research operations even with the most complicated interview schedules. The rich, qualitative data of participant observation sometimes fail to do justice to this socioculturpl dimension. Much more work is needed to get

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Modernization,

Cultural Pluralism, and Health

Care

a richer expression of this dimension into our predictive, theoretical frameworks. Sophisticated multifactor studies in nutrition and health can contribute sig. nificantly to general anthropological theory and to nutritional science; at the same time, they can aid in solving some of the practical heal th and nutritional problems of human communities. The point is that intracultural research strategies, focUSing on individuals and households as units of analysis, permit the specification of pre. dictive models by means of which "at-risk" subpopulations within communities can be identified. At the same time major barriers to the implementation of nutri. tional programs, counseling, and other efforts can be identified, as well as the places most responsive to intervention by well-informed community and regionai health efforts. Anthropologists working in the areas of nutrition and food consumption have significant contributions to make, especially in connection with conceptual. izing, making operational and measuring the effect of social, economic, and cultural variables. After all, that is what we are supposedly trained to do best. But sociocultural data will not advance multidisciplinary research unless we shape research strategies and conceptual units to be in conjunction with the data and theoretical constructs of our colleagues on the nutritional, biochemical side of the research enterprise. This paper is intended to further those research efforts.