Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Working with minority groups in developed countries
Box 32.3 Case study 3: food
values — “ I love you so much like I
do for barbeque ”
How do you know a person is healthy in Kenya? — if
they eat meat, butter and milk. For many Kenyans,
eating as much of these products as possible equates
to being physically fit and strong. Low fat milk has no
meaning, except perhaps to represent milk that is of
poorer quality. Milk comes from a cow and is healthy.
The importance of meat, milk and butter is highlighted
in the expression used to express deep love
for someone — “ Ninakupenda sana kama nyama
choma! ” This phrase translates literally to: “ I love you
so much like I do for barbeque. ”
unhealthy in developed countries (see Box 32.3 ).
Conversely, foods such as vegetables may be seen as
part of a poverty diet in the home country but are
seen as healthy and desirable in the host country.
• Physical activity is a product of poverty in the home
country, for example, walking or riding long distances
because of the cost of transport. Sport is only
for the young. Family duties then take over unless
sport represents a way of achieving wealth. In developed
countries it is seen as a healthy and desirable
activity for adults and families.
This contrast between life experiences in developing
versus developed countries shows the importance
of reframing obesity prevention health messages and
community program strategies to address conflicting
experiences. It also highlights the importance of
including strategies which promote healthy environments
and policies and thereby minimize reliance on
conscious behavioral change. 22
Responding to c ommunity n eeds
Shared recognition and prioritizing of health priorities
should ideally determine the direction of community
initiatives and the framing of health messages.
This can operate in many different ways, for example,
the community may identify the health issue and seek
research or program support to address it. Alternatively,
the health or academic sector may identify the health
issue and seek community support to identify ways to
address it. For example, obesity prevention programs
targeting reduction of soft drink consumption could
use the most relevant health message/s from the following
for the community group involved:
• promoting the health benefit of reducing soft drink
consumption;
• promoting water as safe to drink —migrants who
have come from countries with contaminated water
supplies may not be aware of this;
• promoting oral health —this is particularly relevant
in cultural groups such as some African communities
where the “ white ” smile is highly valued;
• promoting a switch from soft drinks to water as a
way of saving money.
Working closely with representatives of the community
is the best way to determine the messages and
strategies that are likely to be most relevant to the
community members.
Conclusion
There are additional complexities involved in developing
a community - based obesity prevention research
and program with minority groups in developed
countries. However, these additional considerations
can be negotiated successfully provided culturally
competent strategies are adopted, which rely on
respectful partnerships at all stages of the research and
intervention process and thus allow for mutual knowledge
exchange. Reflection on the researcher/practitioner
’ s cultural framework and allowance for diversity
both within and across minority groups will also demonstrate
the need for greater flexibility in strategies
and processes. This will result in more meaningful and
sustainable outcomes for the groups involved and
increased capacity for researchers and practitioners to
work effectively in culturally diverse settings. At a
broader level, culturally competent community outcomes
will potentially address the established health
inequities operating in relation to ethnicity and overweight/obesity.
References
1 Swinburn B , Egger GJ , Raza F : Dissecting obesogenic environments:
the development and application of a framework
for identifying and prioritising environmental interventions
for obesity . Prev Med 1999 ; 29 : 563 – 570 .
2 Summerbell C , Waters E , Edmunds L , Kelly S , Brown T ,
Campbell K : Interventions for preventing obesity in children
. CochraneDatabase Syst Rev 2005 ; 3 : CD 001871 .
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