The Pacific Islands are undergoing rapid epidemiological transformation that includes rising rates of obesity and related cardiometabolic disorders, such as type II diabetes, hypertension and heart disease. My research centers on how Samoans understand rapid epidemiological change, and how epidemiological change transforms Samoan notions of well- being. I start from the premise that models of disease causality are social and potentially political, and demonstrate how local explanations for disease reflect culturally embedded notions of health while generating new forms of social critique.

Since the 1970s the prevalence of obesity and related diseases has steadily increased in the Samoan islands. Changing labor patterns, transnationalism, shifting food markets, and increased dependence on cash have all contributed to rising rates of disease. Public health and epidemiology scholars are increasingly focusing on the social factors that have led to epidemiological transformation in the region, such as changes in labor practices that are linked to dependence on imported foods. Social science research on obesity, however, tends to instead focus on the cultural meaning of body size. Both of these perspectives presume that changes in labor, food practices, and the meaning of fat unfold in similarly linear ways around the world. Without understanding local theories of epidemiological transformation, scholars and the public are left with an inadequate understanding of the relationship between social change and disease emergence.

Early Sunday morning on my drive to church, the air was thick with smoke from the umu (earth oven) used to cook to'ona'i (Sunday lunch)  2012.

I have followed the everyday lives of Samoan people managing their own metabolic disorders, and often caring for others, through clinics, healing sessions, and prayer meetings to explore the complex ways that “health” is discursively negotiated in relation to broader debates about the nature of wealth, inequality, and Christian social welfare. As a result, my research has developed around two distinct areas of enquiry:

Christianity, Cardiometabolic Disorders and Responsibility: This research explores how Pentecostal Christians associate the lived experience of cardiometabolic disorders with social suffering. By connecting fat and inequalities in new ways and explicitly linking psycho-social stress with cash poverty, I examine how Pentecostals create new forms of social support that are incorporated into healing practices. This work broadly challenges conventional academic accounts about the correlations between biomedical and public health efforts that individualize risk and the rise of cardiometabolic disorders. Samoan Pentecostals, instead, highlight the social dimensions of cardiometabolic suffering by coming to see their individual symptoms as manifestations of broader social and economic change. I explore how Pentecostals create health responsibility as responsibility to God and as a result, sometimes, enabled health practices to shift as well.

Morning prayers at a diabetes clinic, 2011. 

Environment, Heath Inequalities and Diabetes Amputations: Based on emerging materials from my dissertation research and recent pilot research, this new domain of research focuses on how chronic wounds and amputations related to diabetes shape experiences of the environment. Bridging disabilities studies, the anthropology of Christianity and food studies, this project focuses on how Samoans manage radical physical change and the physical environment with new bodies. I explore the ways that new bodies—including amputations, wounds, and prosthetics —challenge people’s ability to grow food, and therefore contribute to their families as socially recognizable persons. This work will contribute to anthropological rethinking of the relationship between the body, the physical environment, and health inequalities by tracking how chronic wounds and amputations are experienced differently based on wealth, region, and gender in Samoa.