RESUMO
Nutrition policymakers frequently treat their knowledge of nutrition as acultural and universal. We analyze food guidelines in Mexico and Guatemala to draw attention to embedded, but often unrecognized, cultural values of standardization and individual responsibility. We suggest that nutrition policy would be improved by attending to the cultural values within nutrition science, and that nutrition guidelines should attend not only to other people's cultures but to what we are calling "cultures of nutrition." We conclude by offering an example of an adaptive approach to policy-making that may be useful for handling situations where many different cultures of nutrition collide.
Assuntos
Dieta/etnologia , Política Nutricional , Saúde Pública , Antropologia Médica , Guatemala/etnologia , Guias como Assunto , Humanos , México/etnologiaRESUMO
Both public health experts and medical anthropologists are concerned with how health is shaped by environmental forces. This creates an important cross-disciplinary alliance, yet crucial differences in how the two disciplines tend to evaluate health remain. In this article, I compare public health's "social determinants of health" framework with anthropological interest in the sociality of health and illness. I draw on ethnographic fieldwork in Guatemala's highlands, to unpack (1) "the social," (2) "determinants," and (3) "of health." Ultimately, I show how the social determinants framework is deployed in ways that risk undermining its stated health justice goals, and highlight the benefits of an approach that does not know what health is ahead of doing research and which works closely with communities to respond to the effects of its own intervention. The article argues for the need to rework the emphasis on social determinants to make space for health's material-semiotic indeterminacy.
Assuntos
Saúde Pública , Determinantes Sociais da Saúde , Antropologia Médica , Guatemala , Disparidades em Assistência à Saúde , HumanosRESUMO
Thirty years ago, Nancy Scheper-Hughes and Margaret Lock outlined a strategy for 'future work in medical anthropology' that focused on three bodies. Their article - a zeitgeist for the field - sought to intervene into the Cartesian dualisms characterizing ethnomedical anthropology at the time. Taking a descriptive and diagnostic approach, they defined 'the mindful body' as a domain of future anthropological inquiry and mapped three analytic concepts that could be used to study it: the individual/phenomenological body, the social body, and the body politic. Three decades later, this paper returns to the 'three bodies'. It analyses ethnographic fieldwork on chronic illness, using a rescriptive, practice-oriented approach to bodies developed by science studies scholars that was not part of the initial three bodies framework. It illustrates how embodiment was a technical achievement in some practices, while in others bodies did not figure as relevant. This leads to the suggestion that an anthropology of health need not be organized around numerable bodies. The paper concludes by suggesting that future work in medical anthropology might embrace translational competency, which does not have the goal of better definitions (better health, better bodies, etc.) but the goal of better engaging with exchanges between medical and non-medical practices. That health professionals are themselves moving away from bodies to embrace 'planetary health' makes a practice-focused orientation especially crucial for medical anthropology today.
Assuntos
Pesquisa Biomédica , Medicina Tradicional , Obesidade/etnologia , Antropologia Médica , Feminino , Guatemala/etnologia , HumanosRESUMO
The Public Health Nutrition (PHN) community categorizes dietary-related chronic illnesses as "noncommunicable," fixing these afflictions within individual bodies where they are best managed by individual choices. Yet within clinical encounters in Guatemala, nutritionists and patients treat eating and dieting as relational, transmissible practices. Patients actively seek nutritionists' care, asserting their self-care attempts have failed and they need support from others; nutritionists meanwhile develop treatment plans that situate "personal choice" as lying outside the control of a solitary individual. This article moves between international policy-pedagogy and patient-nutritionist interactions to examine forms of personhood, responsibility, and rationalities of choice present in body weight-management practices in Guatemala. Although nutrition discourses might appear to exemplify how institutional (bio)power manifests through internalized self-monitoring and preoccupation for one's own self, I argue that within the lived experiences of "nutrition-in-action," the self-body of the patient becomes broadly conceived to include the nutritionist, the family, and the broader community.