University of South Florida Scholar Commons Graduate Theses and Dissertations Graduate School 8-19-2009 Hunger of the Body, Hunger of the Mind: The Experience of Food Insecurity in Rural, Non-Peninsular Malaysia Elizabeth Elliott Cooper University of South Florida Follow this and additional works at: https://scholarcommons.usf.edu/etd Part of the American Studies Commons Scholar Commons Citation Cooper, Elizabeth Elliott, "Hunger of the Body, Hunger of the Mind: The Experience of Food Insecurity in Rural, Non-Peninsular Malaysia" (2009). Graduate Theses and Dissertations. https://scholarcommons.usf.edu/etd/1908 This Dissertation is brought to you for free and open access by the Graduate School at Scholar Commons. It has been accepted for inclusion in Graduate Theses and Dissertations by an authorized administrator of Scholar Commons. For more information, please contact [email protected]. Hunger of the Body, Hunger of the Mind: The Experience of Food Insecurity in Rural, Non-Peninsular Malaysia by Elizabeth Elliott Cooper A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy Department of Anthropology College of Arts and Sciences University of South Florida Co-Major Professor: Linda M. Whiteford, Ph.D. Co-Major Professor: David A. Himmelgreen, Ph.D. E. Christian Wells, Ph.D. Donna J. Petersen, Sc.D. Azliyati Azizan, Ph.D. Date of Approval: August 19, 2009 Keywords: child health, nutritional programming, cultural consensus, biocultural theory, Sarawak, Malaysian Borneo © Copyright 2009 , Elizabeth Elliott Cooper If the misery of the poor be caused not by the laws of nature, but by our institutions, great is our sin. -Charles Darwin, Voyage of the Beagle (1839) Now one thing’s for certain And two things for sure Being poor is a disease Gotta hustle up a cure -M.I.A., “Paper Planes” Kala (2007) I truly believe that fieldwork made me an anthropologist. All metamorphoses are painful, and Malaysia has been my crucible. The people of Kpg. Trusan Jaya and Kpg. Tanah Hitam helped sustain me throughout this often difficult process, offering me humor, kindness, protection and even friendship – small, fleeting spaces to be just myself. Their lives and examples reminded me of the beauty and endurance within these communities and inspired me to persevere in my own way. Even from across the ocean, my family has accepted my absences, given me freedom and support, and somehow managed to love me through both mistakes and successes. In the end, academics have only words and thoughts. Although you deserve more, this dissertation is dedicated to each of you: Normah bt. Abdullah Nenden Sabtuyah bt. Ass Sulastri bt. Rajak Jaibah bt. Hj. Lajit Mohtadi b. Masli James Elliott Williams, Jr. Linda Byrd Williams Sarah Caroline Williams Doris Byrd ACKNOWLEDGEMENTS Preliminary research and data collection was supported by a student Fulbright Full Grant to Malaysia; the National Science Foundation (NSF) Doctoral Dissertation Improvement Grant under Award Number 0751828; and the Sigma Xi Scientific Research Society Grant-in-Aid of Research. In-kind support was provided by the Malaysian-American Commission on Educational Exchange (MACEE), the Universiti Malaysia Sarawak (UNIMAS), and the non-governmental organization, Angkatan Zaman Mansang (AZAM). My connection to Malaysia began serendipitously in April 2005 when my work for the USF Global Health Department brought me into contact with the UNIMAS delegation. It is a testament to the inclusiveness and foresight of the UNIMAS-USF Partnership that they so readily accepted me with my still unformed research agenda. Similarly, I appreciate the enthusiasm and patience of those who supported me that first summer in Sarawak as I tried to find a place and relevance for myself and my research. In particular, I want to thank Dora, Denver, Mawar, and Kojek for letting me be both a friend and a co-worker and Yahya b. Ahmad, who honestly and with incredible humor taught me about the internal workings of the Sarawak State Health Department. I have little doubt that my affiliation with UNIMAS will be among the most rewarding of my professional career, and I want to express my sincere thanks to Mutalip Abdullah, Noor’ain Aini, Hew Cheng Sim, and the office staff of the Fakulti Sains Sosial. Fieldwork would have been impossible without the training I received at the NSF Summer Institute for Research Design and the Universiti Kebangsaan Malaysia (UKM) Institute of the Malay World and Civilization. Writing would have been equally impossible without the flexibility and insightful comments of my committee members. Finally, I want to say thank you to my friends – to Casey and Ben for putting me up in Kuala Lumpur; to Cisco for being generally amazing and helping me survive the field experience; to Marc for his editing and cooking; to Jeremy for his statistical help and inappropriate humor; to Janelle, Jennifer, and Erica for re-socializing me; to Kate and Ernesto for the great coffee and conversation, and to Jonny for just being around. TABLE OF CONTENTS LIST OF TABLES v LIST OF FIGURES vii LIST OF IMAGES ix ABSTRACT xii CHAPTER ONE: INTRODUCTION 1 Statement of the Problem 2 Theoretical Orientation: A Biocultural Synthesis 4 Specific Research Objectives (SROs) and Related Hypotheses (H) 6 Brief Results Overview 8 Organization and Chapter Contents 9 Significance of the Research 10 CHAPTER TWO: THE MALAYSIAN CONTEXT 11 General Overview of the Nation and its History 11 Physical Environment and Climate 11 Population 14 Health and Relative Development 16 Politics and Government 19 Historical Overview 22 Thematic Assessment: Broad Trends and Implications 29 Malaysian (Ethnic) Political Identities and Socioeconomic Policy 29 The Developmental Divide with Malaysian Borneo 33 Public Health Programming 35 Program Pemulihan Kanak-Kanak Kekurangan Zat Makanan (PPKZM) 37 CHAPTER THREE: METHODOLOGY 41 Background to the Research Design 41 Research Assistants 47 Research Site Selection Rationale 49 Timetable for Data Collection 49 Specific Methodologies Employed 52 Community-Based Data Collection 52 Assessment of the Total Survey Population 52 i Household Census and Mapping 52 Child Anthropometry 53 Household Food Insecurity Access Scale (HFIAS) 56 Household Survey 59 Data Collection Based on Sampling 60 Participant Observation 62 Ethnographic Interviews 64 Free Lists 64 Pile Sorts 67 Rating Scales 69 Additional Methodologies 72 Recipe Collection 72 Community Price Survey 73 Additional Community Mapping 74 Data Collection at the Ministry of Health, State Health Department, and Local Clinics 74 CHAPTER FOUR: THE COMMUNITY FIELDSITE 76 A Brief Local History 78 Development Efforts over Time 83 The Villages Today 87 Composition and Income Measures for Study Households 87 Social Roles and Age Distributions 88 Monthly Houesehold Income Estimates 91 Contextualizing Household Income 94 Perceived Need 94 Occupation and Alternative Measures 96 Food Insecurity Rates for Study Households 104 Nutritional Status, Illness, and Health-Related Interactions 108 Child Nutritional Status and Anthropometric Indices 108 Child Illness Incidence and Perceptions of the Clinic 114 Clinic-Based Nutritional Information and Services (PPKZM) 116 Overview of Child Feeding Strategies and Perceptions 117 CHAPTER FIVE: TECHNIQUES FOR DATA ANALYSIS 120 Free Lists 120 Meaningfulness of the Domains and Boundary Selection 121 Justification of Aggregation: Cultural Consensus Analysis 122 Formal and Informal Consensus Analysis 124 Justification of Informal Consensus Analysis 126 Informal Consensus Analysis Procedure for Free-Listing Data 129 Patterns of Difference among Participants 130 Comparing the General and Child-Specific Food Domains 133 Pile Sorts 135 Creating the Similarity Matrices 135 ii Creating Multidimensional Scaling (MDS) Plots 137 Interpreting the Multidimensional Scaling (MDS) Plots 139 Assessing Visual Interpretations with Property Fitting (PROFIT) and Cluster Analysis 141 Analyzing Rating Data 141 Cultural Consensus Analysis 143 Property Fitting (PROFIT) Analysis 144 Hierarchical Clustering Analysis 145 Additional Uses of Cultural Consensus Analysis 146 Recipe Collections 147 CHAPTER SIX: RESULTS FOR CONCEPTIONS OF FOOD AND NUTRITION 149 Free Lists 149 List Length and Content 149 Meaningfulness of the Domain and Boundary Selection 151 Agreement and the Justification of Aggregation 153 Patterns of Difference among Participants 155 Comparing the General and Child-Specific Food Domains 155 Pile Sorts 159 MDS Results and Visual Interpretations of Community-Based Pile Sorts 159 MDS Results and Visual Interpretations of Clinic-Based Pile Sorts 177 Property Fitting (PROFIT) and Cluster Analysis Results for the Community-Based Pile Sorts 184 Rating Data Results 184 Cultural Consensus Analysis 184 Property Fitting (PROFIT) Analysis 196 Hierarchical Cluster Analysis Results for the Community Pile Sorts 198 Hierarchical Cluster Analysis Results for the Clinic Health Worker Pile Sorts 201 Additional Cultural Consensus Analysis Results 201 Common Village Food Items as Appetite Enhancers or Suppressants 201 Belief Statement Analysis 207 Recipe Collections 209 Comparison of Community-Derived Child-Specific and General Family Recipes 209 Comparison of Community-Derived and Clinic Recipes 213 CHAPTER SEVEN: SUMMATION, DISCUSSION, AND CONCLUDING RECOMMENDATIONS 217 Main Findings 217 Demographic and Socioeconomic Measures for Study Households 217 Food Insecurity Rates for Study Households 220 Child Nutritional Status and