The Pacific Islands are undergoing rapid epidemiological transformation that includes rising rates of obesity and related metabolic disorders, such as type II diabetes, hypertension and heart disease. I explore 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.  

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.

 Since the 1970s the prevalence of obesity and related diseases has steadily increased in the Samoan islands. For example, between 1978 and 1991 in rural Samoa, obesity increased for males by 297% and for females by 115%. 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. 

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. I 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 three distinct areas of enquiry: 

Christianity and Metabolic Disorders: My current book project, Food, Fat, and Fitness: The Christian Ends of Medicalization in Samoa, explores how Pentecostal Christians associate the lived experience of metabolic disorders with social suffering. By connecting fat and wealth 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. These Pentecostal churches provide an analytic framework that the social sciences lack: ways to practice healing that connect lived experience with social determinants of health. By focusing on social suffering, Pentecostals offer an inventive alternative to scholarly representations of medicalization that tend to eschew social dimensions of disease.

Food, Fat, and Nutrition: Another dimension of my research addresses the slippery meaning of food, fat and nutrition in everyday life in Samoa. In this work, I explore public health representations of food as well as the daily negotiations involved in securing “good food.” This work also engages critical thinking about fat––not to prove that fat is stigmatized or valued, but to address how fat is locally theorized in relation to shifts in global food, agriculture, and economy. While conversations about fat in non-Western contexts tend to center on the positive value of fat, this work shifts the conversation to a more relational analysis in which fat is political while being malleable in materiality and meaning.

As an extension of this work, I am developing a new project on the meaning of “safe” food in the Samoan islands. While food safety tends to be associated with concerns about contagion––in a time when sugar, fat, and salt are deeply problematized by health and trade officials––this new project seeks to understand the ways in which epidemic discourses around metabolic disorders is shaping notions of safety.

Religion in Global Public Health: My research also examines ways of incorporating the broader social context, which shapes lived experience of metabolic suffering, into applied interventions. This work considers what scholars and practitioners might learn from Pentecostal perspectives on disease, which challenge biomedical practices that isolate disease from social context. Particularly in the context of the Pacific Islands, I explore how integrating Christian approaches to health promotion may be an effective way to create public discussion about social determinants of health.

Morning prayers at a diabetes clinic, 2011.