As economic development and other forms of "modernization" occur in developing nations, those nations move from a period in which the picture of morbidity and mortality is shaped largely by infectious disease to one in which chronic, so-called "lifestyle" conditions predominate. This change has been attributed to shifts in the age structure of the population (the demographic transition), transformations in the structure and technologies of care, and sociocultural factors ranging from urbanization and income growth to the consumption of a high-fat diet and television watching. Existing models of this "health transition" lack the specificity required for most public health, health promotion, or social policy purposes, however. While cross-sectional studies have thoroughly described the factors associated with epidemiological regimes that characterize "pre-transition" and "post-transition" societies, the dynamics of the transition process have been relatively neglected. Previous studies have also failed to adequately account for institutional and organizational features of local ecologies. This research project focuses on a study of health transition in Chad. The research is stimulated by a $3.7 billion oil and pipeline project that is the largest construction project on the African continent. The three principal partners (the World Bank, a consortium of oil companies led by ExxonMobil, and the government of Chad) see the project as a "modernization" scheme that will improve development indices and reduce poverty. The ways that people adapt and change in response to the pipeline project and the type of 'modernization' that is expected to accompany it provide the conditions to study the health and nutrition transition processes as they are occurring. This project focuses specifically on one set of relationships implicated in health transition: those linking property regimes and systems of land tenure to agricultural production practices and soil ecology to patterns of household food consumption to nutritional and health status. One of the project's main objectives is to examine how households respond to changes in property regimes, particularly the transition from communal land trusts and collective ownership to individual and private holding, with special emphasis on the implications for agricultural production practices and soil systems. Other objectives are to investigate how changes in agricultural production practices impact household food security and to examine how food security is related to patterns of household food consumption and to the nutritional status of household members. The investigators will use a comparative perspective to examine the specificities of the transition process in three localities that differ in terms of their (1) proximity to the oilfields and pipeline; (2) productive base; (3) level of integration into the cash economy; and (4) access to health care facilities and institutions of governance. The project will incorporate household surveys, anthropometric measures, soil testing and land use surveys, archival research of judicial records, and interviews with local authorities and key stakeholders in the project.
This project will integrate disciplinary perspectives from the social sciences (political science, anthropology, economics), the health sciences (public health and medicine), and the natural sciences (ecology and soil science). It will provide interdisciplinary education and training for early-career researchers and students from the U.S. and Chad and will contribute to the development of research capacity in Chad. It will be conducted in collaboration with a Chadian NGO, the Centre de Support en Sante Internationale/Tchad (CSSI/T), and the Department of Natural Resource Sciences and Landscape Architecture at the University of Maryland. The project will contribute fundamental new insights and information regarding the dynamics of the health transition and to the role of institutional and organizational factors in local ecologies (including modes of governance) and how these factors shape the change process. The process of health transition is particularly important to study in the Chadian context because the pipeline project has been called a potential "model" for multi-stakeholder and public-private partnerships in low-income countries as well as a "test case" for globalization and public health. This project's research findings are expected to improve basic understanding of how globalization, "modernization," and public policy affect the poor. An award resulting from the FY 2005 NSF-wide competition on Human and Social Dynamics (HSD) supports this project. All NSF directorates and offices are involved in the coordinated management of the HSD competition and the portfolio of HSD awards.
