"Un pueblo tan dulce": Diabetes, depression, and obesity syndemics in Puerto Rico

Abstract

Diabetes, depression, and obesity are global health crises that disproportionately affect people with low socioeconomic status and other marginalized identities. These diseases have high incidence and prevalence rates in Puerto Rico due to high poverty and unemployment rates, changing dietary patterns, and Puerto Rico’s political status as a U.S. commonwealth. The myriad problems on the island contribute to the flight of Puerto Ricans to the mainland in search of better education and employment; there are currently more Puerto Ricans living on the mainland than there are in Puerto Rico. Puerto Rico’s political status is of particular importance, as it simultaneously contributes to and poses unique challenges to addressing the complex and myriad health crises on the island. As such, I take syndemic and critical medical anthropology approaches to maintain that depression, diabetes, and obesity are politicized in Puerto Rico. I draw on nearly a year of mixed-methods fieldwork to argue that depression, obesity and diabetes form a syndemic with the violence and political instability that are part and parcel of living in Puerto Rico. I named this syndemic the OVIDD (Obesity, Violence, political Instability, Diabetes, and Depression) Syndemic.\nOne of my key findings is that Puerto Rico’s political status exacerbates the incidence and prevalence rates of diabetes, depression, and obesity on the island. These diseases are politically charged, and their incidence and prevalence rates are unlikely to diminish without also improving the political and economic crises in Puerto Rico. The diseases in question interact deleteriously and syndemically, contributing to the OVIDD Syndemic in Puerto Rico. Moreover, the question of Puerto Rico’s political status has remained in flux since the United States acquired the island from Spain following the Spanish-American War of 1898. Puerto Ricans report preferring either full statehood or full independence and do no want to maintain the current status quo. However, despite Puerto Ricans’ pleas to the U.S. Government to change the island’s status, the government has thus far not made any effort to heed their wishes. This leaves the island in a state of political liminality in which Puerto Rico is neither an independent nation with the power to make its own decisions, nor a full state that receives full economic and political benefits from the United States.\nThese results highlight not only the necessity of syndemics as a theoretical framework for collecting and analyzing the data in this dissertation, but also the need for macro-level changes to the relationship between the United States and Puerto Rico.

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