Thursday, January 08, 2009

Diversity: of eating and teaching

From a didactic point of view, a professor is always concerned about getting her students interested and involved in the topic/course of study. One way to do it is to call for discussion around current events in the field. In an Environmental and occupational health course I'm taking at the Graduate School of Public Health, we're blogging about and discussing recently published news articles. Here's my first post.

Crop diversity: Eat it or lose it is an article that appeared on the BBC website on Jan 6th 2009

There are many reasons for incorporating diversity into our diet: our own health, a healthier local farming community, and a healthier environment. Agricultural anthropologist, Jeff Bentley, argues that we’re also more likely to make it past a climate change crisis if we have a large crop gene pool--it’s likely that one of many possible cultivars will survive an environmental shock. All over the world, farmers are moving toward cultivating high-yielding varieties, effectively reducing our gene pool of cultivated crops. However, if demand for some of the older, traditionally consumed varieties existed, farmers may be more likely to grow them. It is up to us, then, to increase the variety of foods we consume, and to consciously make choices to buy traditional varieties of produce.

This is a ‘wicked’ environmental problem because there are multiple stakeholders with possibly different viewpoints. Farmers may be reluctant to grow traditional varieties until demand can be built up for those types of food, so farming of these cultivars may need to be subsidized even as people are educated about the virtues of consuming ‘older varieties’ of food. Seeds for traditional varieties may need to be made available in areas where these cultivars have been lost. People may have become accustomed to the ‘refined’ taste of rice or wheat, and may be unwilling to go back to eating quinoa, millets and other traditional foods. Furthermore, it may be important, in a world worried about climate change, to increase demand for traditional cultivars locally. Skyrocketing demand for purple Peruvian potatoes in Pittsburgh is less sustainable from the point of view of the climate, than increasing demand for these potatoes within Peru.

It will probably take deliberation between local governments, farmers, traders and consumers in order to build a market for traditional foods from the ground up. In Southern India, there is a group that is considering generating a recipe for millet cookies, and trying to replace the wheat-based, ubiquitously available 'Glucose biscuits' in village stores. This will take time, effort, and resources. Participatory approaches will have to be used to design policies that suit all the stakeholders.

I’m not sure if there are local, ‘traditional’ varieties of crops in the Pittsburgh area. May be older varieties of apple or squash? But we could all eat a more diverse diet sourced from local farmers, and in so doing, improve our own health as well as that of our community and our environment.

Friday, January 02, 2009

Rajashree Papal: Community Health Worker and Epi researcher

I have written previously about Community Health workers in Dahanu Taluka (Maharashtra) and in Harur Taluka (Tamil Nadu).

I also met community health workers in Purandhar Taluka, Pune district (Maharashtra) who were trained by the Foundation for Research in Community Health (FRCH): Pushpa, Kalpana, and Rajashree are all remarkable women, but Rajashree stood out for the epidemiological research she'd done.

Rajashree Tai (center, reading) at a meeting in Mandhar Hamlet

Rajashree is an Arogya Tai in Mandhar hamlet (served by the Parinche Primary Health Center [PHC]). Many women in her hamlet used to report feeling tired and not having a healthy appetite. Suspecting anemia, Rajashree got the PHC to check the Hemoglobin level in about 50 women from her hamlet. Mandhar is a small hamlet in a mountainous region south of Pune, where people are dependent on rains for agriculture. She compared the Hemoglobin of women here to that of women from Khengrewadi, a village with access to year-round irrigation for agriculture.

Rajashree Tai found that the prevalence of anemia in Khengrewadi was far less than that in Mandhar, where 84% of the women tested were anemic. She referred people who were severely anemic to the PHC and got them Iron Folic Acid tablets-the PHC initially denied these tablets to anemic women saying they were only meant for pregnant women. However, Rajashree managed to lobby the PHC officials to provide IFA tablets to anemic women. She also counseled others in the village to eat leafy vegetables and use iron vessels to cook food in. She was able to reduce the prevalence of anemia by 50% in her village.

Rajashree had categorized her data, allowing her to make a fairly detailed comparison of Mandhar and Khengrewadi. For instance, there were a fair number of women with Hemoglobin levels between 6.1 and 7, 7.1 and 8, 8.1 and 9 in Mandhar, but none in these categories in Khengrewadi (everyone tested in Khengrewadi had a Hemoglobin level >9.0). I'm not going to reproduce all her data here, but they showed that the odds of a woman having anemia (with Hemoglobin <9.0) in Mandhar are about 50 times that in Khengrewadi.

It is interesting that in neither village did anyone tested have a hemoglobin level >12.0, which would be normal for adult women. There could be at least two reasons for this: 1. it could have something to do with the accuracy of the test in Parinche, or 2. it could be that people in this area have a depressed level of hemoglobin in general. If the second case is true, people with a healthy diet still have a Hemoglobin level <12.0. I wonder if this might warrant a rethink about the normal range of Hemoglobin for adult women in this area based on their diet?