Decolonising and democratising Malawian public health

Abstract

Introduction. Transformative public health must move from its historically overly Eurocentric and professionally driven orientation towards local-contextualised, community-based health, empowerment and codesign of health research. Like many Pacific nations, Malawi is experiencing changes in its food systems which has health implications for Malawi people. This study sought to democratise and ‘open up’ the exploration of family eating through a photovoice collaboration with Malawian families with a view to understanding the links to a newly emerging and serious public health problem—that of diabetes.
 Methods. Four families located in a semi-rural district of Blantyre, Malawi were recruited and images were collected using phones by younger family members to create a photo food diary of breakfast, lunch, and dinner eaten in the home. Using the photos as a prompt, focus group discussions were undertaken with each family exploring past and current eating patterns, and eating concerns for health.
 Results. Thematic analysis of the photos and focus group transcripts revealed that staples, such as maize and sorghum, are still important in family eating. However, there is a worrying increase in consumption of obesogenic, processed foods such as sweetened beverages and snacks.
 Conclusion. Malawi is currently experiencing a ‘nutritional transition’ brought about by commercialisation of food and the growing threat to a sustainable and healthy food system from climate change. Drawing on indigenous wisdom, this study argues that co-designed research methodologies, such as photovoice, are necessary to empower communities’ collaboration in shaping issues of their own health.