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  • By Gaafar J. Uherbelau

When the sum undermines the parts

Koror — In the Pacific Island Times February issue, we observed a couple of articles that focused on important issues that ideally should make us ponder how we view our health, both individually and at the community level. We saw an article showcasing the arrival of assisted living to our shores, examining its (economic) viability and cultural acceptance – considering the cultural attitudes and practices we have traditionally maintained in caring for the elderly and we also saw an article from a scholar here at the University of Auckland looking at how Tongan cultural events provide people with hazardous access to sugar-sweetened beverages.

Now, it may seem to us that these issues are common, expected and inevitable in today’s globalized and commodified world, but what do they tell us about our culture and all of its forms of practices and how they affect our health? Are our cultural practices and beliefs as we hold them today supplementing the negative impacts imposed by the social determinants of our health?

Nowadays for us in Micronesia, it may be perceived that we have more differences in our cultures, political and economic status, etc. than what we have in common; but the truth is we are all being plagued by lifestyle diseases, regardless of which state, territory, or country we hail from within the region. And yes, we’ve probably heard it all before: Don’t Smoke; Drink Responsibly; Drink 8 Glasses of Water a Day; Be More Physically Active; Eat a Healthy Diet. This paternalistic list of Do’s and Don’ts goes on and on and on. But when we really think about it, how have these messages, these so-called health promoting “reminders” influenced our attitudes and conscience as individuals? Have they been effective enough to prompt us to change our lifestyles for the better? Probably not so much right?

OK. So yeah, some of us are lucky enough to have strong willpower that actually prompts us to make the necessary changes in our lives to become healthier, but for the rest of us, it’s a little bit hard to do or change things on our own. All those failed New Year’s resolutions that we thought were new but were actually just like you know, continuing resolutions from the past FY (fitness year), and not to mention our attempts to chew betel nut without cigarette hoping to gradually withdraw from chewing all together, drinking light beers instead of regular beer because it’s got fewer calories, and again, the list goes on and on. So what does this mean? Is it our fault as an individual that we can’t control the urge to overeat, or that we repeatedly try to convince ourselves that this “will be my last beer or last chew,” yet fail continuously? Maybe it’s not that simple.

Now, how often do we take time out of our daily lives to really look and think about how the world around us influences our health choices? And by world, I mean the neighborhood we live in, the atmosphere in our school or workplace; the access that we and our family have to affordable and nondiscriminatory primary health services; the amount of money left in our checking, let alone our savings account after rent that we can use to buy five servings of veggies daily; the nearest gym, fishing grounds, taro patch or garden that we can get our recommended weekly dose of physical activity, and the time needed to do it, etc. These may be regarded as some of the social determinants of our health – the environmental factors that affect our health. And what about our culture? How do the practices we are expected to attend, perform, or believe – how do they impact our health?

In Palau, while doctors and health promotion messages are delivered around the islands telling people to limit their consumption of fatty, salty and processed foods, it is still the norm and expectation that at least one pig is killed and prepared at all funerals and 90% of households have soy sauce on the table. While taxes are increased on tobacco products and awareness against drunk driving is repeatedly conducted, it is still socially acceptable to chew (and spit) in government offices and in school campuses as well as drinking alcohol in public places and while driving to and from nightclubs. While public health messages float around, reminding us that we need to eat vegetables and fruit every day, the price and unavailability of fresh produce are our first barriers to this healthy behavior.

So how do these incredibly contradicting practices and societal norms influence our health and our views of it? Perhaps we need to look beyond the choices we make ourselves (as individuals) in terms of health and look at the bigger picture to see how the structure of our society, culture, economy, education, and government impacts our health. For the next couple of months let’s examine the social and cultural determinants of our health. Maybe if we understand a little bit better – the larger forces that influence our wellbeing, then we might be able to adjust our attitudes and behaviors to achieve less unhealthiness.

Gaafar Uherbelau is a social marketer for the Palau Ministry of Health and is currently studying Social Sciences for Public Health at the University of Auckland, New Zealand. Send feedback to

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