Intracultural variation in blood pressure in Beira, Mozambique

234 Pages·2002·6.3 MB·English

by  Barkey, Nanette Louise

INTRACULTURALVARIATIONINBLOODPRESSUREINBEIRA,
MOZAMBIQUE
By
NANETTELOUISEBARKEY
v'.ii
v>s
ADISSERTATIONPRESENTEDTOTHEGRADUATESCHOOL
OFTHEUNIVERSITYOFFLORIDAINPARTIALFULFILLMENT
OFTHEREQUIREMENTSFORTHEDEGREEOF
DOCTOROFPHILOSOPHY
UNIVERSITYOFFLORIDA
2002 ,^'
ACKNOWLEDGMENTS
ManypeopleinMozambiqueandtheU.S.helpedtomakethisdissertation
possible.AtEduardoMondlaneUniversity1oweadebtofgratitudetoDrs.Paula,Ana,
Teresa,Rafael,Mate,MariaJose,Zonjo,andTino.Myanthropologystudentsin2000
and2001taughtmeaboutlifeinMozambiqueandmedicalanthropology,especially
Emidio,ManaIvonne,Fransisca,Katia,Aurelio,andSalvador.AlsoinMaputo,Iwantto
thankHarrietMcGuirewhomadesomanygoodthingshappenforme,asdidEsmerelda
andJoao,SteveandMichelle,JillandRichard,Karen,Chad,andAnnie.OlandaBataand
MarcosFreirehavebeenfriendssinceGainesville,andtheircontinuedfriendshipin
Mozambiqueisajoy.
InBeirathere1hadmorefriendsandcolleagues.AttheCatholicUniversity:
FatherMike,FatherElias,Dawndra,Rose,Greg,andSilvestrewereallhelpful.Atthe
UP:Dr.Uacane,andatARPAC:Dr.Chuva.andJoaoJoaquimweresupportive.Atthe
ProvincialMinistryofHealth:Drs.Amos,Cristina,Selma,andMussaparticipated.
Bizeque,Aguida,andFransicsowereoutstandingresearchassistants,andIthankthem.
WehadgoodfriendstokeepuscompanyinBeira,includingJanet,Nicky,Maureen,
Christy,BillandTara.AmillionthanksgotoDonaFatimaandDonaEmeliafor
everythingtheydid. , ^
AttheUniversityofFlorida,Ioweadebtofgratitudetomycolleaguesinthe
CenterforAfricanStudiesandtheAnthropologyDepartment,especiallyPeter,Parakh,
Andy,Elli,Paige,George,Isaac,Dave,Hank,Ken,Rachel,andLance.Bethwasthekind
offriendandacademiccolleaguewealldreamofliaving.Shehelpedinwaystoo
numeroustolist.IoweRussandCarolemyunendinggratitudeforalloftheirhelpand
supportoverthesefiveyears.FromDr.Chege1learnedaboutAfrica,teaching,research,
andwriting.IthankhimandAnnieforalltheirsupport,andforhavingencouragedmeto
visitMozambique.JimStansburyandLeslieLiebermanservedasoutstandingcommittee
membersandsupporters.HuntandJeanneDavisalwaysprovidedaplacetolivewhenI
wasinneed,andmadesure1wasworkinghard.MarvinHarrissharedwithmehis
passionforMozambiquebeforehepassedaway.
KathyandBillarealwaysthereforadviceandencouragement.Jeanninehasbeen
agreatsourceofsupportandafriendsincewemet.Torayparentsandmyhusband,I
owethelargestdebt.Theirsupporthelpedmemakeitthroughallthetoughspotsand
theirlovehasbeenwrappedaroundmeatalltimes.
Ul
1
TABLEOFCONTENTS
page
ACKNOWLEDGMENTS ii
ABSTRACT vi
CHAPTER
1 INTRODUCTION 1
CultureChangeandIntraculturalVariation 2
CulturalConsensusModelingtoStudyVariation 6
TheEffectsofCultureChangeonHealth 9
HighBloodPressureinAfrica:AnOverview 1
TheResearchProject 12
2SETTING 16
Mozambique 16
TheCityofBeira 28
PontaOea 38
3REVIEWOFTHELITERATURE 44
Introduction 44
AnOverviewofHypertensioninAfrica 45
DefiningandMeasuringPsychosocialStress 63
CulturalConsensusModelingtoStudyPsychosocialStressandSocialSupport 74
Summary 84
4HYPOTHESES 86
Introduction 86
PhaseOneHypotheses 88
PhaseTwoHypotheses 89
5PHASEONE:ETHNOGRAPHY 90
ConsensusModeling:Reprise 90
MethodsUsedinPhaseOne 91
FreelistandRankingsFindings 102
DiscussionoftheFindings 110
PreparingtheQuestionnaireforPhaseTwo 122
6PHASETWO:MODELTESTING 126
PhaseTwo:SurveyMethods 126
PresentationofPreliminaryResults 142
SurveyResults 144
7CONCLUSION 177
APPENDIX
ALEGENDANDMAPOFPONTAGEA 187
BLIFESTYLEITEMSFROMTWENTYTWOFREELISTS 189
CQUESTIONNAIREINENGLISH 192
DQUESTIONNAIREINPORTUGUESE 197
EORALCONSENT-INSTITUTIONALREVIEWBOARD 202
FTABLEOFEDUCATIONALCATEGORIESFROMTHEMOZAMBICAN
CENSUS 209
REFERENCES 210
BIOGRAPHICALSKETCH 225
AbstractofDissertationPresentedtotheGraduateSchool
oftheUniversityofFloridainPartialFulfillmentofthe
RequirementsfortheDegreeofDoctorofPhilosophy
INTRACULTURALVARIATIONINBLOODPRESSUREINBEIRA,
MOZAMBIQUE
By
NanetteLouiseBarkey
December2002
Chair:H.RussellBernard
MajorDepartment:Anthropology
Theresearchdescribedinthisdissertationevaluatestheroleofpsychosocial
stressandsocialsupportinthedevelopmentofhighbloodpressureinaneighborhoodin
Beira,Mozambique.Itusesconsensusmodelingtodevelopculture-specificmodelsof
lifestyleandsocialsupport,andtestswhetherconsonancewiththesemodelsispredictive
ofhighbloodpressureorbuffersagainstit.Bloodpressurewasmeasuredasan
expressionofpsychosocialstress,aswellasanindicatorofachronicdisease.
Mozambiquehasbeenexperiencingrapidsocial,politicalandeconomicchange
inrecentyears.TheresearchwasconductedinthemiddleclassneighborhoodofBeira,
Mozambique,thecountry'ssecondlargestcity.TheneighborhoodofPontaGeaishome
topeoplefromavarietyofethnicbackgrounds,ages,somatictypes,andsocioeconomic
andeducationallevels.Allparticipantswereadultsovertheageofthirtywhoare
MozambicancitizenscurrentlylivinginPontaGea.
Theresearchwasconductedintwophases:thefirstethnographicandtheseconda
house-to-housesurvey.Theculturalmodelsoflifestyleandsocialsupportwere
developedintheethnographicphase.TherewasstrongconsensusamongthePonta
Geansabouttheelementsofthesetwomodels.Theresearchteaminterviewed261people
inthesurveyduringthesecondphase.Attheendoftheinterview,participantshadtheir
height,weightandbloodpressuremeasured.
Thesurveydatasuggestthatconsonancewiththemodelofasuccessfullifestyle
waspredictiveofhigherbloodpressure,aswasageandobesity.WealthierMozambicans
hadhigherbloodpressurethantheirpoorercounterparts.Socialsupporthadamild
bufferingeffectonbloodpressure,controllingforlifestyle,ageandobesity.Theresults
suggestthatmoreresearchisneededtounderstandthemechanismsthroughwhich
psychosocialstressleadstonegativehealthoutcomesandworkisneededtodevelopnew
methodsformeasuringthisconnection.
c
>
INCTHRAOPDTUECRTI1ON
Thestudypresentedhereemergesattheintersectionoftwolargeendeavors
withinanthropology:thestudyofsocietiesintransitionandthestudyofhealthwithinits
culturalcontext.Tworelateduniversalsinthehumanexperienceformthefoundationof
thisresearch:culturesareconstantlychangingandallhumansexperienceillness.The
researchquestionisbasedontheseuniversalsandcontributestothesetwoendeavors.
Theresearchprojectdescribedinthisdissertationexamineshowpsychosocialstress
arisingfromculturechangeleadstoillhealth,specificallyhighbloodpressure.
Mozambiqueisanidealsettingforthisresearchbecauseithasundergone
tremendoussocial,economic,andpoliticalchangesinthelastdecadeandahalfIchose
highbloodpressureasthehealthoutcomeforfourreasons.1)Bloodpressurereadings
areanon-invasivemeasureofstressthatcanbecollectedeasilyinfieldsettingswithout
theneedforlaboratoriesandrefrigeration.2)Theincidenceofchronicdiseases,
includinghypertension,isincreasingacrossAfricaandtoslowthisincreasewehaveto
haveabetterunderstandingofthecausesofhypertension.3)Onapredissertationvisit,
Mozambicanstoldmethathighbloodpressureisbecomingmoreofaprobleminrecent
years,whichtheyattributetothechangestakingplacethere,andtheyaskedmetostudy
it.4)Finally,thereisasubstantialamountofresearchonbloodpressureinboth
anthropologyandpublichealth,providingasolidcomparativebasisformyresearch.
CultureChangeandIntraculturalVariation
DefiningCulture
Inordertopresenttopicslikeculturechangeandintraculturalvariation,Istart
withabriefdiscussionofculture.Inthisdissertation1useadefinitionofculturethat
drawsontheworkofShore(1996),D'Andrade(1984),Handwerker(2002),andothers,
whoemphasizethecognitivenatureofculture,withlessemphasisonbehavior.
Handwerker(2002)summarizesEdwardTylor's1871definitionofcultureas"the
knowledgepeopleusetolivetheirlivesandthewaythattheydoso"(p.107).
Handwerkeralsooffershisowndefinitionofcultureas"thesystemsofmental
constructionsthatpeopleusetointerpretandrespondtotheworldofexperience,andthe
behaviorisomorphicwiththosesystemsofmeaning"(p.109).
Dressier(1999a)explainshowD'Andrade's(1984)modelofculturalmeaning
systemsisusefiilwhenstudyingintraculturalvariation.
Tkhnioswlinedegsesetnhcaetiisndaicvoigdnuailtsivleeamrondienlsoocficaullitzuartei,oninawnhdischharceulwtiutrheoisthveiremweemdbaesrtsheof
thesocietythatenablesindividualstoresolveroutineproblemsandtomakesense
ofoneanother'sbehavior.Atthesametime,thistheoryplacesconsiderable
emphasisonthemeaningofeventsandcircumstancesandideas,(p.595)(italics
added)
D'Andrade's"notionofcultureasasharedandlearnedculturepool"iscentralto
bothculturalconsensusmodelingandthestudyofintraculturalvariation(Romneyetal.
1986),whichareexplainedbelow.Cultureissharedandlearnedbymembersofagroup,
butitisnotequallylearnedorsharedbyallmembers.Aswestudyvariationincultural
knowledge,welearnaboutpeople'srolesinasociety,theflowofpowerandknowledge,
andtheeconomic,health,andsocialoutcomesofthisdiversitywithinonegroup.
LikeD'Andrade,Shore(1996)buildshistheoryofcultureonculturalmodels.For
Shore,therearethreementalmodels,twopersonalandoneconventional.Thefirsttwo
modelsareattheindividuallevel:psychologicalandcultural.Shore'sthirdmentalmodel,
"institutedmodels,"isbasedonGeertz'snotionoftemplates,whichareheldatthesocial
level."Institutedmodelsaretheexternalorpublicaspectofculture,andrepresent
commonsourcedomainsbywhichindividualsschematicizeconventionalmental
models"(Shore1996p.312).ForShore,thelinkbetweenexternalculturalmodelsand
thetwotypesofindividualmentalmodelsismeaning.Accordingtohim,humanscan
retainindividualknowledgebits,buttheyalsoassignmeaningtothesebits,andthis
meaningisinfiisedwithculture.
CultureChange
Manyforcesaffectculturechange.Foryears,anthropologists,sociologists,and
othersocialscientistshavestudiedmodernization,theprocessbywhich"traditional"
peoplebecame"modem"(cf,InkelesandSmith1974,Barth1967).Usuallythisprocess
isassumedtoincludetheadoptionofWesternmodesofproduction,reproductionand
consumption.Thisphenomenonwasalsoreferredtoasacculturationorwesternization.
Criticsofthesestudiesquestionedthevalueorpowerassociatedwithbeing
modem,challengedtheassumptionthatwestemculturewasthemodelofwhatwas
modem,andaskedwhetherallsocietiestravelalongthesametrajectoryonaninevitable
pathtowardmodernity(F.Cooper2001).Modernizationstudieshavefallenoutofvogue,
andhavebeenreplacedinthelastdecadebyagrowinginterestinglobalization.
Globalizationcommonlyreferstotheadoptionofwestemeconomicsystemsandcultural
traitsbynon-westempeople,or"one-wayflowofculturefromtheWesttotherest"(Inda
andRosaldo2002p.35).AnotedAfricanhistoriannotesthelimitationsofthesestudies