Collective eating and the management of chronic disease in Dakar: translating and enacting dietary advice

Abstract

In the past decade, Non-Communicable Diseases (NCDs) have become a highly visible public health issue in Senegal. In the absence of adequate and affordable care, people diagnosed with NCDs seek to manage their symptoms through the adoption of healthy diet. However, in households built on collective eating, dietary change is extremely challenging. Drawing on participant observation, biographical interviews, and focus groups with women in six households in the Dakar suburb of Pikine, this paper presents a relational analysis of the reception and translation of dietary advice within low-income households. Women diagnosed with chronic disease strategically 'bracketed' advice that was not possible to enact, prioritised collective transformation over individual change, and valued consumption that demonstrated 'respect' and solidarity over 'healthy eating'. I show that relational approaches open up new intervention and health promotion strategies for the prevention and management of Non-Communicable Diseases outside of the global North.

Living with ‘New Diseases’ in Dakar: Embodied Time and the Emergence of Chronicity

“…All food prepared in Dakar households is shared, and breaking off from communal meals to eat alone is considered a highly unusual, even provocative act (Crenn and Hassoun, 2014; Rubin and BeLue, 2017). The obligation of participating in shared meals makes it difficult in practice for people to take medical advice to shift dietary register or to practise ‘healthy eating’, although they can engage covert practices of withdrawal and restriction (Poleykett, 2021). The provision of food articulated and reinforced relationships, affirming and strengthening social bonds (Carsten, 1991).…”

“…These experiments with feedback between eating and bodily outcomes were conducted in the absence of continuous biomedical care and treatment and in a context where the adoption of an ideal ‘healthy’ diet was extremely difficult to achieve. Fresh vegetables, in particular, were too expensive for many families that I spoke to in Dakar, and the advice that people were often given to avoid meals based on starch was difficult to enact because of the vital cultural importance of shared dishes based on rice (Poleykett, 2021). In households built on collective eating, older people were under pressure to renew relations by presenting themselves at the communal bowl.…”

Interembodiment, Inheritance, and Intergenerational Health

“…Eating is a collective practice in Senegal, rooted in and managed by complex household relationships (Poleykett 2021). Nutrition is seen as both prevention and management of metabolic disorders, but nutritional advice is often directed to the individual, not the family or household.…”

“…Nutrition is seen as both prevention and management of metabolic disorders, but nutritional advice is often directed to the individual, not the family or household. “In a context where all food is shared and the act of collective eating carries a strong moral weight and cultural significance, there is a significant pressure for everyone to eat from the collective bowl and crafting an individual ‘diet’ is an extremely complex undertaking” (Poleykett 2021: 1). Family in sub‐Saharan Africa acts as buffer, prevention, and help for diabetes and hypertension, especially when the focus is on diet (BeLue 2017).…”

“…Family in sub‐Saharan Africa acts as buffer, prevention, and help for diabetes and hypertension, especially when the focus is on diet (BeLue 2017). In Senegal, changing eating patterns is viewed as both difficult and restrictive (BeLue 2017 ; Poleykett 2021; Vialard et al 2017).…”