Consuming Inequality: Food Insecurity and Cardiometabolic Health in the American South Restricted; Files Only
Owens, Caroline (Summer 2023)
Published
Abstract
While the prevalence of global food insecurity has declined in recent decades, prominent scholarly and public concerns about “food problems” were enlivened by the emergent COVID-19 pandemic. In 2021, approximately 1.2 million individuals in Georgia experienced food insecurity. Concurrently, over one million Georgians were living with cardiovascular disease. Though numerous studies document associations between food insecurity and chronic conditions, including diabetes, hypertension, and cardiovascular diseases, few studies have probed the proposed proximate mechanisms underlying this relationship. Disparate epistemological, theoretical, and methodological approaches within the disciplines of nutrition and the social sciences have limited integrative examinations of plausible mechanisms for how food insecurity might be causally linked to chronic disease. Furthermore, while interventions have emerged to combat adverse health consequences associated with food insecurity, target mechanisms, program effectiveness, and the afterlives of these programs have been sparsely documented.
Drawing from over 14 months of ethnographically grounded and mixed-method research in the Southeast United States, this dissertation research attempts to address these gaps. Guided by frameworks of embodiment, this dissertation examines conditions of existence, stated accounts, and biomarkers to examine how the experience of food insecurity manifests in health outcomes, and, critically, what can be done to combat adverse consequences. Exploring provider perspectives on food security, social determinants, and patient well-being, it probes the potential role actors within healthcare systems play in confronting and alleviating health inequalities. Beyond these conditions of existence, it delves into the experiences and stated accounts of those involved in the chronic care complex by assessing how individuals living with chronic disease manage or cope with food, diet, and nutrition. By digging deeper into stories of the body, this dissertation explores the proposed biological and social consequences of these strategies and how these consequences contribute to cardiometabolic health among a sample of patients attending a safety-net community health clinic. Finally, in a more applied vein, it examines the effectiveness and potential promise of Produce Prescription Programs in breaking cycles of food insecurity and chronic disease, proffering insights into how to leverage anthropology toward the aim of building healthier, more equitable communities.
Table of Contents
Introduction 1
I. Chapter One Food Insecurity and Cardiometabolic Health at the Biocultural Interface: A scoping review 38
II. Chapter Three Testing Biosocial Mechanisms Postulated to Underlie Food Insecurity & Chronic Disease: Evidence from a clinic-based study 107
III. Chapter Four Can Produce Prescription Break the Cycle? Assessing the effectiveness of a “Food is Medicine” intervention 139
IV. Chapter Five Beyond What We Eat: Anthropology and the advancement of food security and well-being 191
Conclusion 233
Appendix Tables and Figures 245
Appendix of Data Collection Tools and Interview Guides 250
About this Dissertation
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File download under embargo until 16 August 2029 | 2023-06-06 12:55:00 -0400 | File download under embargo until 16 August 2029 |
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