The Pacific Islands are undergoing rapid epidemiological changes, which include rising rates of obesity and related cardiometabolic disorders, such as type II diabetes, hypertension and heart disease. Since the 1970s in Samoa, in particular, the prevalence of obesity and related diseases has steadily increased, reflecting changing labor patterns, transnationalism, shifting food markets, and increased dependence on cash. Public health and clinical medicine have done little to haltthese trends. Using ethnographic methods, my research explores how Samoans respond to this rapid change through the concept of health agency. Looking to agency is an important counterweight to scholarly perspectives on individualization and risk, which are thought to accompany neoliberal shifts in global health. Pentecostal Christians are particularly critical in their interpretations of the social and epidemiological changes that have unfolded over the past seventy years. Across Samoa, Pentecostals link the rise in obesity and other cardiometabolic disorders with social decay. Drawing from the anthropology of Christianity and medical anthropology, my research examines the ways that Christianity shapes epidemic discourses in Samoa, as well as how people imagine health. 

Using agency as a conceptual tool provides insights into understanding how people make personal and social change despite enduring inequalities. By applying the analytic techniques involved with studying agency to the study of health, it is possible to see how religious practices generate socially embedded health management techniques. Samoa has been inundated with public health campaigns and interventions designed to reduce obesity, which often articulate an individualized notion of risk and responsibility. This individualization runs counter to Samoan notions of health and well-being that ground the individual within a larger dynamic network of family, church, and land. Working at the intersection of the anthropology of Christianity and medical anthropology calls into question analytic assumptions about the nature of the individualism associated with Christianity and biomedicine. By studying the active role of God in health management, it is possible to see the Christianity of biomedicine.

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.

Christianity, Cardiometabolic Disorders and Responsibility

Morning prayers at a diabetes clinic, 2011.

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.

“Believing for toes”: Faith, Care, and Diabetes-related Amputations in Samoa

The original buildings of the Tupua Tamasese Meaole Hospital. Moto'otua, 2017.

This project explores how Christians manage chronicity of physical disability resulting from advanced diabetes through vigilant symptom detection as informed by religiously-inspired care relations. This project aims to explore how Samoans care for diabetes and related complications in ways that escape epidemiological and global health research on health barriers—namely the relationship between symptom detection and religious healing. By assessing diabetes symptomologies, this project aims to understand examine how symptoms not locally associated with diabetes but predictive of amputation shape care choices. While health promotion knowledge is commonsense in Samoa, there are many symptoms that are not locally associated with diabetes, such as chronic wounds, numbness, or burning sensations. By understanding how Samoans seek care, including from biomedicine, indigenous medicine and Christian healing, for myriad symptoms, this project can offer an alternative to narratives of non-compliance or late presentation so common among health practitioners. By exploring how people care for their health outside clinical avenues, this project reframes diabetes management as care, which is located beyond individuals but instead situates diabetes as a social problem. In turn, the project questions the representation of diabetes as an asymptomatic disease.

Apia, 2017

Fat in Four Cultures

This is a comparative and collaborative project, drawing from longterm fieldwork engagements by Alex Brewis, Cindi Sturz-Sreethan, Amber Wutich and Sarah Trainer. Over the course of a year we developed an interview guide that each of us would bring to our fieldsites. Working to create a team ethnography, we interviewed urban women and their husbands about body preferences and food ideologies. My interviews primarily took place in the emerging cafe scene in Apia. The project draws from ethnography in Samoa, Paraguay, the United States and Japan.






The overarching analytic focus in my research is to explore the interconnections between agency and temporality in healing processes. Through such an analytic focus, I show that beyond the fact that health is culturally constructed, it is multiple. In other words, in coming to objectify the experience of the body as healthy, people develop complex and potentially conflicting ways to understand sickness, health and wellness. Situating the study of health through Christianity brings forward the very real ways that people, religious beliefs, and medicine work through the body, and thus dynamically shaping social environments.