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`Desculturizacion,' Urbanization, and Nutrition Transition Among Urban public health 176 (2019) 21e28 Available online at www.sciencedirect.com Public Health journal homepage: www.elsevier.com/puhe Themed Paper e Original Research ‘Desculturizacion,’ urbanization, and nutrition transition among urban Kichwas Indigenous communities residing in the Andes highlands of Ecuador * V.A. Chee a, , E. Teran b, I. Hernandez b,c, L. Wright a, R. Izurieta a, M. Reina-Ortiz a, M. Flores b, S. Bejarano a, L.U. Dao a, J. Baldwin d, D. Martinez-Tyson a a University of South Florida, College of Public Health, Tampa, FL, USA b Universidad San Francisco de Quito, Colegio de Ciencias de la Salud, Quito, Ecuador c Pontificia Universidad Catolica del Ecuador, Facultad de Enfermerı´a, Quito, Ecuador d Northern Arizona University, Center for Health Equity Research, Flagstaff, AZ, USA article info abstract Article history: Background: The nutrition transition continues to affect populations throughout the world. Received 11 February 2018 The added impact of market integration and urbanization exacerbates the impact of the Received in revised form nutrition transition upon Indigenous populations worldwide. 25 March 2019 Objectives: This study aims to explore the nutritional concerns of the urban Kichwas Accepted 17 July 2019 community residing in the Andes highlands of Ecuador. Available online 1 November 2019 Study design: This is a qualitative study. Methods: Eight focus groups were conducted with Kichwas men and women in November Keywords: 2015 in the Imbabura province of the Andes in Ecuador. Nutrition transition Data analysis: Applied thematic analysis was used to analyze findings regarding nutrition. Desculturizacion Results: The participants shared concerns regarding increased intake of fast food, poor meal Urbanization timing, and a shift in the child's food preferences that rejects traditional foods. They Market Integration among attributed these concerns to urbanization resulting from an increase in dual-income Indigenous households and a loss of cultural identity. Syndemic theory Conclusions: Synergistic cultural factors are related to nutritional concerns voiced by the Kichwas urban Kichwas community. Indigenous communities Public health implications: Syndemic theory is a useful interpretive lens regarding nutritional Andes highlands trends within the Kichwas communities as they relate to the increased risk of chronic disease. © 2019 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved. * Corresponding author. E-mail address: [email protected] (V.A. Chee). https://doi.org/10.1016/j.puhe.2019.07.015 0033-3506/© 2019 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved. 22 public health 176 (2019) 21e28 Indigenous peoples in Latin America.7 According to the In- Background ternational Working Group on Indigenous Affairs, more than half of the Ecuador's Kichwas people reside in the Central The nutrition transition refers to the epidemiologic shift from North Mountains of the Andes. This study took place in the infectious to chronic diseases that has accompanied global Imbabura province, one of the northern Andean provinces. dietary westernization. It unfolds in five stages: (1) food gath- The authors wish to acknowledge that the Kichwas people are ering; (2) famine; (3) receding famine; (4) degenerative diseases; also referred to as Quechua, who are generally Peruvian. The and (5) behavioral change to incorporate a healthy balanced use of the word Kichwas in this article reflects that the study diet, with the majority of populations being in the stage of either participants self-identify themselves as Kichwas, which is 1 receding famine or degenerative diseases. Several factors written in this manner because of the transition from the might contribute to this phenomenon, including the rise in Spanish to English alphabet, which includes the ‘Kich’ and sweet preferences; the availability of cheap caloric sweeteners; ‘was’ in place of the Spanish ‘Quech’ and ‘ua.’ This nominal imbalances between thirst, hunger, and their respective satiety difference is a linguistic distinction rather than a cultural one. mechanisms; the preferences for and inundative availability of This study was part of a larger cross-cultural study that nutrient-poor fatty foods; and a general aversion to physical examined the syndemics8,9 of HIV, nutrition, domestic 2 exertion. These changes are accompanied by several technol- violence, and substance abuse among the Mayan, Ngabe-€ ogy advances that herald the advent of our current era, in which Bugle and Kichwas peoples of Belize, Panama, and Ecuador the widespread availability of highly processed foods with respectively. In designing the focus group (FG) guide, re- chemical additives present an unprecedented threat to popu- searchers were careful to ask broad, open-ended questions lation longevity, health and well-being. Recent technological that probed for general community concerns in these topic advances of concern include the production of high-calorie, areas. As such, emergent findings regarding the nuances of sweetened beverages and the edible oil revolution - in the latter general nutritional concerns were not deeply probed. case, edible oils are made from high-yield oil seeds that facilitate easy and cost-effective extraction, which in turn in- Sampling and recruitment creases the industrial popularity of trans-fat oils in processed 2 foods. In this qualitative ethnographic study, eight focus groups In this global context of dietary westernization, the nutri- (FGs) were conducted among two Indigenous communities in tional consequences of urbanization upon Indigenous peoples is Ecuador. The researchers (E.T. and I.H.) who lead the team ' a growing area of research. For example, Gwich in tribe children practice of community medicine have a well-established his- of Alaska bypass traditional ancestral foods in favor of western tory and rapport with the community. Participants (n ¼ 59) 3 treats, primarily in the form of sweets and fatty foods. Similarly, were recruited through established community-based part- Aymara communities of the Bolivian Andes grapple with an nerships connected to various local Indigenous organizations. obesogenic urban environment in which unhealthy ‘junk foods’ The participants were told that they would be meeting with and ‘chemicals’ have supplanted healthy, ‘natural’, ‘Indigenous’ researchers who were interested in understanding commu- 4 foods from the countryside. As many of their Indigenous nity health concerns. This trust of the community was crucial counterparts around the world, urbanization has affected the to successful participant recruitment, in collaboration with traditional diet of the Kichwas people. Although little is docu- the Social Economic Kichwas organization that governs the mented regarding the Kichwas people and their health status, provinces and serves as a vital platform of community researchers have indicated that diabetes is a pressing concern in communication among elders, the wider community, and 5 Ecuador among rural and urban populations. parties such as the research team of this study. While the nutrition transition has been studied in several countries, little is known about how the nutrition transition Data collection and analysis phenomenon is affecting the Kichwas people of Ecuador. The purpose of this study was therefore to explore general nutri- Focus group facilitators were of the same sex as the focus tional concerns among the Indigenous Kichwas communities group participants. FGs were stratified by age and gender. This who reside in the Andes highlands of Ecuador. decision expressed respect for Indigenous cultural customs and gender roles in which women may defer to men’s voices and opinions even if they do not share the same perspective. Methods Similarly, younger generations are obligated to defer to the voice of their elders. For this reason, the participants were Research setting stratified by these characteristics of age and gender. The in- clusion criteria required that participants should be older than Ecuador is located in northwest South America and straddles 18 years, identify themselves as Kichwas, and reside within both the line of the Equator and the Andes Mountains. The one of the Indigenous communities in the Andes highlands of country is divided into three continental (the east, the coast, Ecuador. and the mountains) regions and one insular region (the Gal- Each group met once, for an average of four hours with apagos Islands). The Andes crosses the country from the north lunch provided at the two hour mark. The groups discussed to south and divides it into the three continental regions. the following topics: HIV, nutrition, domestic violence, and There are 14 Indigenous nationalities in Ecuador, totaling to substance abuse. Open-ended questions were used to 1.1 million,6 which represents 7% of the estimated number of encourage participation and to demonstrate that researchers public health 176 (2019) 21e28 23 were there to learn from the community as neutral outsiders chatarra’ (‘junk food’). The participants were specifically con- interested in the topic of nutrition. The participants were cerned about chronic diseases such as diabetes in conjunction given an incentive for their willingness to participate in the with the shift of household diets from traditional foods toward focus groups at the beginning of each focus group session. fried fatty foods that are easily available. In sharing their con- Prior to focus group data collection, a community
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