Culture and bodies: an interdisciplinary approach to non-communicable disease prevention in Malawi and Tanzania

The incidence of non-communicable diseases such as hypertension and diabetes is rapidly increasing in countries in Sub-Saharan Africa, like Malawi and Tanzania. In 2010, there were more than 2 million deaths from non-communicable diseases in the region, which was a 46% increase from 1990. Many people in Malawi and Tanzania, as elsewhere in Sub-Saharan Africa, are moving from rural areas into cities. Here, calorie-dense foods and drinks are easily accessible, and opportunities to be physically active reduced. These factors, together with traditional cultural norms, such as a larger body size being associated with respect and attractiveness, contribute to increasing risk of non-communicable diseases in both countries. People's understandings and responses to non-communicable diseases draw on biomedical, as well as traditional, knowledges; traditional healers, as well as medical doctors and nurses, are consulted in attempts to understand (and treat) the symptoms of non-communicable diseases.

If interventions to prevent non-communicable diseases in Sub-Saharan Africa are to be effective, it is essential they reflect not only Western experiences and biomedical accounts, but also local knowledges, perceptions and values. However, as these local knowledges and values are often deeply-rooted and unspoken, traditional research methods, such as surveys and interviews, are often inadequate to describe them. Community arts offer an alternative approach. They have great potential to allow researchers to access people's cultural, emotional and historical beliefs and practices, and then to work creatively together with local communities to develop non-communicable disease interventions that reflect these beliefs and practices.

In this project, we aim to develop an interdisciplinary partnership of medical and social science, and arts and humanities researchers, and local arts organisations in Malawi and Tanzania to learn together as we work closely with local communities to create culturally-relevant approaches to non-communicable disease prevention in Malawi and Tanzania. We will do this using a variety of methods drawn from the different disciplines we represent. We will first analyse existing survey data from both countries, and conduct a review of previous arts-based health promotion initiatives in the region. This information will inform pilot projects in Malawi and Tanzania working with people living in or near cities to use community arts to access local knowledges, perceptions and values, and to develop a culturally-relevant intervention activity. By the end of the project, we will produce a framework describing ways of using community arts in non-communicable disease prevention. This will allow us to apply for more finding to test, refine and evaluate the framework in other settings in Malawi, Tanzania, throughout Sub-Saharan Africa, and beyond.

The project will allow partners to develop new interdisciplinary understandings and skills around gaining access to complex local knowledges, perceptions and values, and working closely with local people to develop innovative approaches to non-communicable disease prevention. Participation in the project will build research skills capacity in the UK, Malawi and Tanzania. Local communities will benefit from involvement in the project through becoming more aware of how to prevent non-communicable diseases in ways that are culturally-relevant for them. We will publicise our findings widely to local residents, and to local, national and international policymakers, practitioners and other researchers, through face-to-face and online events, and conferences, and through local, national and social media. We will also have a dedicated project website which will host project news and outputs (translated into local languages, where appropriate), as well as an online resource bank to support other researchers to use similar approaches to non-communicable disease prevention.

The ultimate aim of the interdisciplinary partnership that will form during the course of this project is to develop and implement robust arts-mediated methodologies that will support the creation of interventions that are culturally-situated and culturally-relevant, but which are also coherent with biomedical evidence on the aetiology of NCDs. The project therefore has potential to transform the landscape of NCD prevention in Malawi, Tanzania, and throughout SSA. The ultimate beneficiaries are the individuals, communities and nations who are currently facing a rapidly-increasing NCD epidemic that is threatening to have a devastating effect both on individual lives, in terms of morbidity and mortality, but also on national economies, in terms of the burden they present to already-limited health and social care resources.

The immediate beneficiaries are the communities in urban/peri-urban settings in Malawi and Tanzania that form the focus of the pilot projects. Through the activities proposed in the pilot projects, local residents in these areas will develop a heightened awareness of NCDs and the problems they pose both at an individual, and at a wider societal, level. In addition, these communities will understand how they might make changes (e.g. to their diet or activity levels) that are coherent with their local knowledges, perceptions and values, to help them reduce their own personal NCD risk.

Other potential beneficiaries are local artists in both countries who will develop an understanding of the role and value of their work in creating culturally-relevant NCD prevention interventions. The project will highlight potential avenues of employment for them in relation to developing innovative arts-based solutions to global health problems. Our collaborative partners, the Art and Global Health Centre Africa, and Art House Africa, will be ideally placed to disseminate project outputs to artists more widely through their existing and emerging networks in Malawi and Tanzania.

Local and national policymakers, and local, national and international NGOs also stand to benefit from the project, which will go at least some way to offering innovative and potentially effective solutions to the health and societal problems they face at a local, regional and national level, as the prevalence of NCDs increases in their districts, regions and countries. We will use existing links to these organizations within our partner research institutes, the Malawi Epidemiology and Intervention Research Unit and the Ifakara Health Institute (in Tanzania), to ensure they are fully informed of the work of the project. We will also use webinars, and work closely with the health journalist on our advisory panel, to reach wider policymaker and NGO audiences in Malawi, Tanzania and beyond.

Finally, the project will benefit academics and researchers in a number of ways. Members of the partnership will develop new interdisciplinary understandings of the context of NCDs in Malawi and Tanzania, and of potential solutions. The wider academic community will be able to use the innovative arts-mediated methodologies developed during the project. These will be made readily available on the project website for application in NCD prevention studies, and also in research to find solutions to other major global health problems internationally.