Y Health
Y Health
Culture's Impact on International Nutrition with Dr. Ben Crookston
Dr. Ben Crookston addresses the impact of nutrition, especially in developing countries. He emphasizes why we should invest in nutrition and outlines the actions we can take. Crookston also discusses the overlap between culture and nutrition and how, in some cases, a change in culture may benefit nutrition.
Guest Bio
Dr. Ben Crookston serves as the research chair for BYU public health and teaches in the department. With an emphasis on international health and nutrition, Crookston has spent over 15 years conducting research in Asia, Africa, and Latin America. Additionally, he works alongside various nonprofits, evaluating programs and research relating to children's nutrition, growth, and health. From BYU, Crookston earned a BS in Zoology and later a Master’s in Public Health. He then went on to earn his PhD in Public Health from the University of Utah.
Additional Information
https://www.researchgate.net/profile/Benjamin-Crookston
Recorded, Edited & Produced by Christy Gonzalez, Harper Xinyu Zhang, and Tanya Gale
Welcome to Y Health, a podcast brought to you I'm Dr. Cougar Hall, a professor here at Brigham Young University. Whether you are a student, parent or BYU fan, this podcast will help you navigate the world of public health. Our podcast strives to help individuals receive accurate information regarding public health. So whether it's global or local, we will discuss how it pertains to you. Just kick back and relax as we talk about why health. Dr. Benjamin Crookston. Good morning. It's great to have you here on the Y Health podcast.
Ben :Good morning. Thanks for having me.
Cougar :If you don't mind, would you provide just a are, your educational background, and of course, what you do in the Department of Public Health at BYU?
Ben :Sure. I've been here at BYU for about 11 chair in our department over research. In addition to my teaching and my research responsibilities that I have, I came here from the University of Utah, where I finished my doctoral work in the School of Medicine. And then I stayed and I was a professor there for a couple of years. Did my undergraduate here actually in zoology? It's a degree we don't have anymore, but it's essentially human biology that was offered, then minored in psychology and then took a year off and worked. And then I came back here and did a master's in public health before going on to the University of Utah.
Cougar :Very cool. So I'm also a cougar and a ute. Enjoyed my time at the University of Utah. So if you don't mind, explain a little bit. I have family and friends who frequently say, but what do you do at BYU? Like, I don't it doesn't seem like you teach that much. Do you mind just taking a minute and kind of laying out what are your work responsibilities?
Ben :Most faculty at BYU, they're teaching versus is kind of a catchall for a lot of other things, is usually broken down in what we call 40, 40, 20. So about 40% of your time should be spent either teaching classes, preparing to teach, working with students on, on things that have come up in classes, meeting with students, etc.. Another 40% for us is spent in research, which can include a host of different activities from gathering data on the ground to writing papers, doing data analysis, preparing for all of that. And then the last thing service is really a host of other things we do to help out the university and local communities. So currently I serve as the Associate Chair in our department. I help with research in our department to push that forward. In the past have been the director of our graduate program and help to recruit students and help students as they go through that. I serve on other university and college and department committees as part of that, but we also do service outside of the university. So I help review journal articles I a number of non-profits I serve on their advisory board as they ask for help and guidance on the projects that they're doing. So it's funny because a lot of people I talk to think we just teach, but we spend a lot of time doing other things besides teaching too.
Cougar :You are someone who your research and your You teach a class called Health 480, which is international health. And you're also if I look at all of the folks in the department, I think you're the one who really has specialized in global or international health. Would you tell us a little bit about that, that overlap? And in particular, what are what are the things you've been researching and what you consider your expertise and research?
Ben :Yeah, so the class that I teach in an understanding what health is like and really resource poor areas. And as you mentioned, that's directly aligns with the research that I do that a lot of research I've done with you and others in the department specifically, I've spent a lot of time on addressing child nutrition, or we call it child undernutrition. So these are kids that experience stunting where they don't grow as much as they should in height or they experience wasting where they're too lean for their age or their gender. And I've worked a lot with non-profits who are doing programs to try to improve nutrition in children around the globe. And I've spent time with you and other faculty to evaluate how effective they've been at that. So a big part of my research is looks at child health and stunting child nutrition as well as I do do a lot of maternal health related projects to.
Cougar :We have a problem with nutrition in our own Have we exported that to other countries? Have we exported our overnutrition to the developing world?
Ben :Yeah, we have. I mean, we've exported a lot of our our culture and how we approach food and how we approach our lifestyle. And so now we're seeing this really interesting phenomenon, if you will, where in many what we call resource poor developing countries, households and areas within this country will have people who are both over nourished and undernourished. So in adults that will have a BMI that's too high and in kids that will have will be shorter than they should be or will experience leanness when they shouldn't be.
Cougar :Is that synonymous with a term called the Is that or is that something else?
Ben :Yeah. So double burden of disease or of meaning. In some cases. People are referring to countries that that have a large burden of both communicable and non-communicable diseases. So like the United States, for example, we don't have a lot of infectious diseases. Hard to say that in the midst of COVID or at the end of COVID, but typically what we suffer from are much more chronic or what we call non-communicable. Diseases. Right. However, developing countries have been historically known to deal with diseases that are really in our past. So malaria, tuberculosis, higher rates of pneumonia and a lot of what we call neglected tropical diseases like schistosomiasis. So these countries now are experiencing both those infectious or communicable diseases, but they're also starting to see more heart disease and cancer and other chronic diseases that are a result of lifestyle. And a lot of that has to do with this double burden of nutrition where they're experiencing both over and under nutrition in the same country.
Cougar :So are they are they eating enough calories right nutrients?
Ben :That's a really important question really where and there are some of these today, for example, such as Ukraine, parts of eastern DRC, others where you have war torn or you have conflict that's going on, except in the cases of refugees, internally displaced people and some famine, most kids actually get enough calories. The problem is they're getting it from one or two sources. So they might eat in the Andes. They might eat essentially mostly potatoes in West Africa. They might survive mostly on cassava. In most parts of Asia, they may mostly rice. So they're able to get enough calories through carbohydrates, but they don't have a very diverse diet. They're oftentimes lacking in protein, fats and other key micronutrients to help them to develop the way they should.
Cougar :That's very helpful to think about that, to change from one region to another, and some of the traditional foods that are absolutely a staple of a particular group of people of their diet. But how do we how do we increase that diversity? Right. Boy, I can see how that would be a real challenge. Tell me if I'm if I'm listening to this and I'm sitting somewhere in the developed world and the challenge that I have is I have too much food, there's plenty of diversity. And I, I may struggle with overconsumption. I might be eating too much and not moving quite enough. That's that's one of the impacts of modernity, I suppose. And yet I'm concerned about undernutrition or malnutrition in the developing world. What's the best way to go about that? How how do we do good and how we do how do we do good? Better, I suppose, maybe is a question I have for you.
Ben :Yeah. I want to first start off by addressing undernutrition. Like why does it matter if a child's a little bit shorter, for example, or a little bit lean as long as they're getting adequate calories and not dealing or suffering from hunger, why do we care so much? One of the things is what we know from lots and lots of good research is that kids that experience undernutrition actually at the same time that their body is not growing the way it should be. Their brain is not receiving the proper nourishment that it should be. So these kids actually score lower on IQ tests. They're behind cognitively. Parents tend to invest less in them when they have when they're constrained with the resources that they can invest. They'll start school later. They'll do more poorly in school, and they'll be more likely to drop out of school early. And particularly for girls who experience undernutrition or more likely to have low birth weight babies and repeat this whole cycle and it really keeps them in poverty. There's a really tight link between poverty and nutrition. And so people, you know, we've seen the numbers of childhood deaths around the world come down dramatically. It's amazing. When I first started in development in the early two, thousands more than 10 million kids were dying each year as a result of completely preventable diseases. And this has happened. 99% of these are in really poor countries. It's now down to around 5 million. So it's been cut by more than half. And so that's amazing. At the same time, undernutrition continues to be a pretty big problem because it's less it is about survival, but it's also less. It's more about thriving and doing well. So if I'm trying to figure out what can I do around the world to make the world a better place? Investing in programs and donating to groups that are addressing nutrition is one of the very best investments that you can make, just like stimulating your own child and making sure your own child has both opportunities to eat well and eat a diverse diet and the appropriate amounts of food and have lots of interaction with you when they're young has huge benefits for them over the course of their whole life. The same thing happens in a developing country.
Cougar :Very I'm really glad you went back and students ask in the past, like, why do we care that a child is stunted? In other words, they're they're short for their age. Why do we care? Like, are we trying to get more of these kids into the National Basketball Association? And that that's actually a comment I've heard from students. And for them to understand that link between cognitive development and then of course, the overriding link between poverty and the cycle of of poor health and poor health outcomes. So really investing in a child's nutrition. It sounds like that's that's one of the best things we can do in the in the developed world to help those around the globe.
Ben :Yeah, absolutely. I mean, outside of keeping pneumonia, malaria. Investing in nutrition is one of the very best investments that we can make. The challenge is and this kind of gets at the heart of your original question, too, is how do we do that? Well, like which groups actually go out and make a difference versus take great photos that they put on Instagram or whatever and and, you know, do hunger banquets and these really moving experiences for donors. But like who's actually making a difference on the ground and how do they do that? That's I think, the harder question.
Cougar :That's the messy part of your work.
Ben :Yeah, exactly.
Cougar :Yeah. And I suppose there's opportunities for also your citizenship or your service is to interact then with those nonprofits, with those really well intended groups and help them, whether it be with monitoring and evaluation, giving them helpful feedback, how they can improve what they're doing. And and certainly, of course, to monitor and to measure the children and make sure that our our most well-intended efforts are actually making a difference or moving the needle.
Ben :Yeah. I'm really committed to evaluation, not do, but I think ethically if we don't measure the impact of what we do, how would we ever know if we had negative or unintended consequences? And how would we ever make the right tweaks to make things better? So in my mind and in the way I see the world, if we're going to intervene in places and try to go about doing good, we also need to go about checking to see how what are the real impacts of the things that we do, which is why it's been really refreshing for us, you know, having worked with a number of non-profits who are very committed to that, who are humble enough to say, how well did this program go? We've invested a lot of time and money and energy and emotion into this program, but we still want to know we want you to be honest with us, to provide us with an objective report on what worked and what didn't work. And it is really messy because we're talking about human behavior. We're talking about all kinds of other factors that make a big difference from poverty to how women are treated in a particular culture, to the rights that different minority groups or indigenous groups may have in particular places. And yet none of that's an excuse for not doing anything. We should still be out doing it, but we should also be carefully observing how well what we do works at the same time.
Cougar :You're walking right into my next question, How do we address that? That elephant in the room, which is sometimes culture, it's just, well, this is the way we've always lived and this is the way we eat. This is the way we prepare food and this is the way we parent. And this is the way that husband and wife communicate or work together or don't communicate or don't work together. That has to be a challenge for global health. Any insights on that? In fact, if you don't mind, I should just back up and tell you that I've really been trying in my in my introduction to public health class to give my students a balanced approach. So right now in public health, in every class you take, you're going to learn about the social determinants of health, which is just the opposite of the individual determinants. Right? It's like, well, I'm going to get I'm going to get some good nutrition for myself. I'm going to make sure I get plenty of sleep and I'm going to engage in physical activity. These are things that I can do, and I'm going to make sure I get vaccinated like so those are within the individual. But we talk about the social determinants, which are things in our environment have to do with government in many instances, have to do with schooling, with with education, with access to care, with neighborhoods, with economics, right? With the finances of the whole situation. And so there's there's all of these things outside of the individual that very much determine health outcomes. So. Dr. Michael Marmot I think I would consider him to be the father of the social determinants of health. And he wrote a book called The Health Gap. I have my students read that and they and they very much enjoy it. It's a really nice introduction to what public health is. But I've had students complain that they're just getting like one side, one one perspective, and it's a left leaning and it's a progressive perspective, which is public health very much. So in recent semesters I've had them read a book from an economist named Thomas Sowell. Definitely more right leaning on the on on the conservative end of the continuum, if you will. And he has a quote in that book about culture. I hope this is okay to bring this up. He says, quote, Cultures exist to serve human beings. Human beings do not exist to preserve culture. So he's not one who's going to defend culture like, oh, well, this is the way we do it because this is culture. He's like, No, no, no, that's backwards. Culture should be helping human beings to thrive, to flourish. And if they're not, then we need to revise them. Culture should be evolving to support life and to support health outcomes in this case. So again, this goes back to this rub I think we have in global health, which is we can't just take what we're doing in one area and drop it in another and say, well, it might not be sensitive or responsive to culture, to the way you live here, but you should change and do what we do. This is something that I'm sure you've you've run up against and certainly informs your work. And I've already spoken to much. But any thoughts on that?
Ben :Any it's a really important point and And I don't know anybody in development who doesn't discuss this and think through this. And, you know, a lot of times in public health as a discipline, some people get frustrated with us because the answer oftentimes is it depends or it's complicated. You know, we like things a little bit more. Black and white culture is. Is really can be really productive for health, but it can be really counterproductive for health. And just because we as a country intervene in another country that may have different cultural values and and beliefs doesn't mean that everything we bring improves that country either. So let me give you two examples. So. The data is really clear that in countries that have higher gender equality, you have much better reproductive and maternal health outcomes. It's just across the board. In fact, the healthiest place in the world to be a woman is Sweden. And Sweden has one of the most equitable cultural environments in which to live. The countries in which women are most likely to die during childbirth are countries when there's a huge differential in the power dynamic between partners, between a husband and wife, or between committed partners or spouses. So when we go into a place where maybe gender equality is not very high, that's a challenge that we face. But you can't simply say, Well, you need to change because we have the answers for you. You have to come in with a certain element of humility and willingness to try to understand where they're coming from, and then an earnestness to try to reason and find common ground in which to improve things. At the same time, one could argue that part of what we've exported culturally to many developing countries has not helped them. Like the example you gave earlier, you know, our approach to food and our culture around food in an industrialised, food driven country is not necessarily in the best interests of people around the globe. And so if we start to if we continue to see obesity rates rising in these poor countries as a result of them adopting more of our cultural habits, then that's a downside to our culture that's being exported. So on one hand, we might say, well, as women are valued more it which happens typically more often in Western societies, then we're going to see better reproductive health outcomes. But as our food behaviors are adopted here, we may see worse as far as that goes. So I think for me it's much more nuanced and so it's hard for me to go in and say to anybody that their culture is wrong per say. But scientifically, you can show that certain behavioural patterns are either promote behavior or good health outcomes or they don't. And I think we can be honest about that. And sometimes things persist in culture that just nobody actually is attached like a great meaning to it. It just happens like a good example. This would be a project I worked on in Cambodia a number of years ago. We are promoting breastfeeding. It's one of the best behaviours that can improve the nutrition of children, save their lives by improving their immune system and help them to avoid dying from diarrhea, pneumonia, etc.. So we're working with the nonprofit there and we were measuring how well their program worked. And one of the. The World Health Organization recommends three key behaviors around breastfeeding. One is that the child is breastfed within the first hour of life, what we call early initiation, that they're exclusively breastfed for six months, which means they're given nothing else, no water or anything else, just breast milk, and that they complementary feed for up to two years after that. Well, in these rural communities in Cambodia, where we're working, women would oftentimes and this happens in a number of other locations, too, by the way, they would during the first few days when after the child's born, they actually wouldn't put the child to breast because colostrum, which is that first breast milk comes in, it's a little different color, it's a little different consistency. And over time people thought that it was bad and had adopted this kind of belief around it, that that wasn't good for the child. So they would essentially express the breast milk for the first three days, not give it to the child. And then when the normal milk came in, then that's when they'd put the child to breast. And during this time, like, you put that child at greatest risk because children most likely to die in the first 24 hours of life and then the first week of life. And so they had developed this this culture, this belief system that was really counterproductive for the health of a child. Well, when we went in there and we worked on this project and we worked with locals, local doctors and health care providers, and they taught these women about the value of colostrum. It turned out that there was no emotion about the culture, about this belief. It was just like, Oh, we were always told that that wasn't a good thing to do, but they hadn't tied anything else to that. So it was a very non-threatening, cultural thing to change. But when you get into like gender equality and the rights of men and women, that becomes much more threatening to certain people. So I think for us, part of it is recognizing where are some of our lower hanging fruit where we can see some cultural changes that will really benefit women and children. And then long term, we got to work on these other things. It doesn't mean we give up on them because to me, like gender equality is a right. It's something that everybody should have regardless of where they grow up. Yet at the same time, I think we have to be humble enough to to not just try to run roughshod over other cultures and people, but try to get to these better places over time and find some of these easier wins where we can build momentum together.
Cougar :I love that you mentioned approaching it with That's something I've been trying to emphasize in my classes. And also, quite frankly, I've been trying to remind myself, you and I have had many opportunities to travel the world together. A little sheepish about how many places we've been together, actually, but we travel in support of our research and working with large nonprofits. We also and this is a lot of fun for you and I, but each summer we do a study abroad program in the Department of Public Health. We go to Western Europe, and the origins of that program actually grew out of this cultural humility. I think what happened, if I remember back to, you know, when we had those first those first discussions six or seven years ago. It was that public health traditionally has gone to the resource poor settings and said, here, let's drop some knowledge on you. You can do some things better. But with our Europe Public Health Study Abroad program, we recognised that many nations through Scandinavia, down through Western Europe have much better health outcomes than we do. Can we go there? Can we humble ourselves and go and observe? What are they doing better than we are? And maybe we can start to adopt some of those things. So that's a long intro to my question, which is, as you've traveled the world, how has it changed you? How is it how has it pushed you towards being more humble and really valuing those opportunities to take the best from every country, every culture you've been to and change your life? I'm assuming it has. And my question I'm assuming that's happened because that has been the experience for me.
Ben :For me, one of the beauties of America is we haven't always retained the best of the cultures that have come here. And so as I travel, I love getting exposed to different ways of thinking about things and doing things, whether that's how to improve bike safety in the Netherlands and making being active on your way to work or being active on your way to the grocery store, safer and more convenient, or whether that's how we've observed many times in really resource poor areas where the simplicity of life in many of those cases has some great benefits to where people haven't overcrowded their lives with stress and routine that goes beyond what they were really programmed to do. I don't think we've ever been anywhere speaking for both of us where we, like you said, where we didn't come back and say, well, there's some real positive things that I can think about adopting to my own life that come from this. And hopefully that's part of the like I said, the beauty of America is that we should be inclusive about these ideals because we're a country of immigrants, you know, coupled with indigenous people who lived here who really have an opportunity to melt the very best of these things together and try to bring forth a culture as a country that is productive in life, satisfaction and health. Unfortunately, we also live in a country right now that's incredibly polarized and we have culture wars going on. So when I go to these other places and I and other countries have culture wars too, but when I go to these other places and I see how people interact with each other in real positive and productive ways and how the humanity comes out like I always come back a better person.
Cougar :Ben, thank you for that. You are so well spoken. It's so fun to just listen to you. I hope there's room in your class. I'd like to audit your class and just sit at your feet and learn. And I think I'm being totally serious, too. I just as I as we do these podcasts, I'm realizing that I have amazing colleagues and I could learn so much from them.
Ben :You're very kind.
Cougar :To wrap up today's podcast. I'd like to ask you, is there something that you've been reading lately where we are truly lifelong learners? At least that's the charge to be a lifelong learners. Anything you've been reading, anything you've been listening to lately that you could share with our audience?
Ben :Sure. Two books come to mind. One is Lift by Melinda Gates. And I would say that if if you're really interested in global health development, that book does a great job at connecting you with what that experience was like for Melinda. I know some people may say, well, how could I relate to this billionaire, you know, one of the wealthiest people in the world married to Bill Gates. But she does a remarkably good job at providing a very grounded perspective about what's going on in global health today. So it's really I highly recommend that book. I would say the other book that has really caused me to think deeply in the last year is a book called The Coddling of the American Mind. And one of the things that you and I are currently doing in our research, we're working with an organization in Washington, DC to study health resilience and to better understand what is it that helps some households and really poor circumstances to have better outcomes in the midst of like tons of headwind when they should have more infectious disease or they should have more poor health outcomes. How do some of them stand up to that adversity and do well and even thrive? So as we're studying that, we've been I've been reading this book on coddling in American mind, which really is talking about how they don't always use the term resilience, but really talking about how we may be doing a great disservice to the rising generations that we create safe spaces to the point where we're actually not creating any resilience. And people don't know how to deal with adversity and they don't know how to deal when things don't go their way psychologically, emotionally. And I think that's one of the hard things in trying to be and. All for being politically correct and sensitive and trying to be thoughtful about the thoughts and feelings of others. But I think that we have to be careful that that doesn't mean that we can't consider different approaches and viewpoints and that we can't take a minute to understand and seek to understand how somebody who thinks completely opposite from us, where they may be coming from, why they may take that, you know, even in today's world and just the recent news that we've had on Roe v Wade to to even though we may be really entrenched in what we think should happen at the Supreme Court, there's still great value in seeking to understand somebody who's on the opposite side of this issue. Why do they believe so strongly about it? Why are they so emotional about it? But what the calling in the American mind does a really good job at exposing. Especially one of the challenges in universities is we're not doing a good job and engaging in those important conversations because we're so worried that somebody is going to be offended or feel unsafe, that we won't even allow people to speak who may have different viewpoints than us and we label things as hate speech or that it's that it might incite riots or different things like that. And I'm not for hate speech again, like don't get me wrong, but I think this book does a good job and it's actually even though you may read it and think that it was written by conservatives, these are fairly liberal people, I think, on the whole. But I think they've done a great job at being objective, at presenting the science about what we're currently doing with the rising generation and maybe what we should be doing differently so that we create more resilience or grit is what another author, another term another author uses to better prepare this rising generation to deal with the challenges that they're facing.
Cougar :I really appreciate that. I've read one of those books. I need to read the other for sure. I think that is a nice reminder of what we're doing here in the academy, which is not not so much teaching students what to think, but teaching them how to think, how to make good arguments and how to how to really go to primary and secondary sources to think differently, to listen to other perspectives and leave a little bit of room between the years that there's there's a there's a chance that maybe I could learn something from someone else, and my own perspectives might be enlightened, I think. Yeah, wonderful.
Ben :I love that. I always say to my my students, You should know how I lean politically after this class. But I do want you to know what are the major viewpoints out there. So I intentionally give them and I know you do this in your class as well. I intentionally have them look at things from opposite views and then to process it. And what's awesome here at BYU is to process it in a gospel light and say, Well, how do either of these reconcile with the teachings of the church, the teachings of our Savior? And what can we glean from that?
Cougar :Very cool. I'm going to make sure that not children take your class. Dr. Ericson. Hey, really. Thank you. This has been a delight and really appreciate your time this morning. All the best.
Ben :Thank you.
Cougar :Thank you for joining us today. Catch us on our next episode and don't forget to subscribe to Future Y Health episodes.
