THE monsoons are on their way, and most people are gearing up to prevent dengue fever, cholera and other such infectious/communicable diseases.
However, it might come as a shock that as per the latest WHO health statistics of Pakistan non-communicable diseases (NCDs) account for almost as many deaths in the country as infectious ones, and several times more than headline-grabbing infections such as bird flu.
When we ask questions about why Pakistan has such high rates of NCDs (heart disease, diabetes etc) we come up with simple answers such as ‘overeating’, or ‘not eating well enough’. But we often don’t have very good answers for ‘why’ people overeat, or what eating well enough means. Even doctors end up blaming patients for lack of willpower, rather than being able to un-package what compels people to eat a certain way.
Research has shown that if your parents have chronic diseases, the likelihood of you developing them is much higher. This is not only a genetic issue, but is as much about how we are raised.
The social scientist Anne Murcott identified in 1982 that the very nature of diet is linked to women, specifically mothers. She extensively showed how mothers are central to what is being cooked and why. Moreover, ideas of identity (and by extension, those of ethnicity, language, culture, religion and ancestry) were found to be central to the notions that inform mothers of what choices to make for their families’ diet.
So how does food go from simply being fuel for our bodies, to becoming a parameter — in some cases the only parameter — with which to judge the quality of life? When did food become so charged with the emotional significance of happiness and communal connotations of reward?
Research shows that food is viewed as a vehicle for notions of identity, as well as a means of communication. A study conducted by this writer on Pakistani immigrant mothers in Edinburgh confirmed this view. It was seen that the choices the mothers made on what to feed their families were intimately linked with the kinds of cultural values they wished to impart, as well as emotions that they wished to communicate.
The mothers felt that the food they prepared and served was what helped their children and husbands identify with both their family and their national/ethnic identity.
More importantly, mothers felt that by cooking food that their family liked, they were able to express their own feelings of affection. They believed that doing so would bring them all closer, leading the mother to feel appreciated and loved.
It is clear that some of these lessons can be (cautiously) inferred for the larger Pakistani society as well, although ‘why’ such decisions are taken may differ. In our society, food serves as a primary social and cultural source of identity, entertainment and communication.
Thus we see how when people attend weddings for example, the serving of particular food items and the partaking of a generous helping are synonymous with enjoying the occasion.
Similarly, spouses and parents (mostly women) cook special meals on birthdays, or as a reward to express their happiness.
But beyond celebrations and expressions, the consumption of food also represents health consequences.
In the study mentioned earlier, it was seen that the shocks and pressures of dealing with migration contributed to the desire to deal with emotions through food — often feelings of loneliness and homesickness were sought to be dissipated via a meal, which reminded one of home. When emotional stresses are largely being dealt through food, they have a higher chance of contributing to NCDs.
That being said, it is also important to speak of the dangers of generalising research without arming oneself with the knowledge to make informed decisions. When it comes to research, it is important to remember that an association does not imply causation.
The meaning of this can be illustrated by a brilliant example a professor gave me: if there is a town with many storks and a high birth-rate, it cannot be ruled out that the two are indeed associated.
However, it does not mean that storks are responsible for the numerous babies — the causation for storks could be as simple as multiple chimneys in houses with many families due to a town’s growing economy — leading to more storks in the town, as the birds enjoy sitting atop warm chimneys and nesting near them.
Therefore, although research conducted on a limited group of women in Edinburgh may have implications and similarities to situations women in Pakistan find themselves in, it doesn’t not mean that the ‘causes’ of their similar situations apply to both.
But, it does mean that there are findings in common. And given that they share ethnicity and results, it means that the research is a guide which can help identify certain health problems, and can be generalised to some extent in a larger population of people with the same health problems.
The most important point to note is that this research doesn’t claim that Pakistani eating habits or Pakistani cuisine are directly responsible for NCDs. Rather, it is important to understand that food serves specific purposes of communication and identity, and those purposes leave it vulnerable to abuse.
Issues like stress, lack of communication, and lack of non-food based recreation and celebrations generally make food the only parameter with which to express relaxation and reward achievements and occasions. But in doing so, we condemn ourselves to having the only thing helping us feel better leading to our ill-health.
The writer is a medical doctor with a Master’s degree in public health.