The Patient Protection and Affordable Care Act (PPACA) of 2010 requires hospital systems in the United States to shift the culture of patient care from a focus on sick-care to a focus on prevention and wellness care. Little is known about how hospital systems will make this culture shift while retaining quality patient care. The purpose of this case study of a pioneering hospital-based PPACA-compliant initiative was to answer the research question of how Wallace's revitalization movement theory (RMT) "a rapid culture change model"could serve as a transferable evaluation framework for PPACA prevention and wellness care compliance in hospital-based programs. Kingdon's policy streams theory provided a conceptual framework. Data analysis included iterative, thematic coding of interviews with 3 primary stakeholders responsible for developing the policy, planning, and program implementation strategies of the Center for Total Health (CTH). Nineteen extensive primary source documents were included in the analysis as well. Findings supported the utility of the RMT structure and definitions in the identification of culture change dynamics in CTH. Additionally, this structure served as a scaffolding for grouping individual and institutional rapid culture change dynamics into stages that could be evaluated in terms of PPACA compliance. These stages effectively identified a Kingdon policy window in which PPACA mandates could be expected to result in culture change in multiple streams of public policy development, not only in wellness and sickness prevention, but also in local, state, and national health cost-saving initiatives in food-as-medicine, community identity, public health support networks. It could also reduce chronic disease and the rising institutional care delivery costs.

This dissertation engages with the driving motivations behind the actions of all those involved in The Gambia’s tourism-based sexual economy: the Gambian and other West African male and female sex workers, the Global North (habitually European) male and female tourists, the Gambian and expatriate Lebanese bar and restaurant owners, the Gambian state, and the semesters (members of the Gambian diaspora on vacation in The Gambia). It presents thick ethnographic accounts of interactions with Gambians and tourists, as they form temporary couples or friendships for the duration of tourists’ vacations, and sometimes for longer. This ethnography-rich dissertation pays careful attention to Gambian voices, which have been somewhat marginalized in the limited literature on sex tourism in The Gambia. It theorizes the existence of a Gambian sexscape, within which socio-sexual scripts are performed. The socio-sexual scripts that make the Gambian tourism-based sexual economy are re-located within Gambian society’s larger sexscape, which allows for a better consideration of the wider socio-economic, cultural, and political processes that have led to the formation of contemporary Gambian society. The dissertation briefly outlines The Gambia’s political and economic history, which explains the ongoing economic dependency and the importance of emigration for contemporary Gambian youth who want to escape the abject poverty in which too many live. It proposes a descriptive analysis of the Gambian sexscape and its socio-sexual scripts. Greater precision is given to the socio-sexual scripts that make the tourism-based sexual economy: chanters and white Global North female tourists; Gambian female sex workers and white Global North male tourists; Gambian men who have sex with Gambian men/semesters, and/or with white Global North male tourists. Finally, I adopt a socio-ecological approach to sexual health and examine the tourism-based sexual economy’ s impact on the country’s sexual health.

For over five centuries, the Muiscas have faced direct colonial aggression against their traditional belief systems and sacred practices that have been historically demonized and driven to the brink of extinction. Despite such circumstances, however, the Muisca community has thrived to the present day, and since the turn of the twentieth century has begun to undergo a process of re-identification as an indigenous community in an attempt to revitalize their ethnic identity and practices. These efforts of re-indigenization have challenged their historically coerced identities, actively engaging in returning to traditional practices and beliefs, demand cultural and spiritual liberties, and regain their proper rights to sacred lands, which have also been devastated for centuries. Based on an ethnographic study conducted in Colombia, this thesis examines how rituals in sacred places are of central importance to this community within the re-indigenization process that is currently underway in the Muisca community.

The dissertation research examines the socio-economic and political effects of community-based conservation initiatives within the Bagmara buffer zone community forests of Chitwan National Park, Nepal. In particular, the study investigates the role of buffer zones creation in structuring the way rural property rights have been defined, negotiated, and contested, in reinforcing or reducing patterns of ethnic dominance and exclusion, and in influencing how cultural identities are constituted and renegotiated. Using a political ecology framework with a specific focus on theoretical concepts of environmentality and territorialization, I conducted 12 months ethnographic and quantitative survey field research in the buffer zone communities of Chitwan National Park. I focused on documenting socioeconomic conditions and livelihood practices, and interpreting the meanings of residents’ lived experiences. In addition, I critically examined state and non-state conservation and development practices to understand how they work to produce identities, livelihoods, and landscapes in the park’s buffer zone. The ethnographic study documented diverse impacts of community-based conservation initiatives. One of the major effects is the distribution of costs and benefits, specifically elite capture of community forest and tourism benefits. Second is the existing conflict and potential conflict over the control of access, benefits, and territory based on social and cultural identities. Third is the reproduction of caste, ethnic, and class hierarchies. Fourth is the militarization of communities in and around the buffer zone and community forest. Fifth is the production of environmental and non-environmental subjects such as illegals and poachers. Finally, the sixth is the commodification of conservation spaces and subsequent ecological impacts. The research concludes that the discursive representation of humans and non-humans and the discourses and practices of economic development and biodiversity conservation produced and reproduced a number of negative social, political, and ecological consequences in the buffer zone of CNP. This dissertation concluded that the conservation and development practices are territorial projects to govern people and nature.

This exploratory research study examines changes in food and foodways (food habits) among Arab migrant families in a small community in Tampa, Florida. It also explores how those families’ children may play a role in the process of change. Within this community, I conducted my research study at a private school, where I recruited families with children between the ages of eight and seventeen. In applying the ecological model of food and nutrition and the developmental niche theoretical framework, this research draws on qualitative methods, including structured interviews with parents; focus group discussion with parents; a food survey; and children’s focus groups that included engaging activities such as vignettes (role playing), free-listing and sorting, and one-day food menus. I used MAXQDA 18 software for qualitative data analysis, and the results show that the main factors aiding in post-migration food and foodways changes are time constraints (lifestyle), ingredients, and availability and accessibility of permissible food (halal). Parent did not mention their children as a main factor; however, they perceive influence of their children. Feeding practices such as rewarding, restriction, forcing, and family meals were emerging themes, and children express their agency around those practices. Children developed their own agency regarding food because of their social and physical environments. Older children perceived their influence on their families’ food and foodways by introducing food items to their own families.

The anthropology of public policy critically examines policy and its processes and the myriad ways in which power is exercised. To explore these power dynamics, anthropologists studying policy often study up, or study through a particular policy field. This entails the risky work of studying powerful people, whose ability to retaliate against the researcher and others create methodological and ethical dilemmas and contradictions, as well as potentially harmful consequences. Politicians, bureaucrats, employees of powerful non-profits, and, in the public-private neoliberal reality, even the head decision makers within corporations are all prospective research participants--an intimidating prospect for most anthropologists. In contrast, engaged ethnography, with its presupposition that researchers will be aligned with politically marginalized groups, encourages the researcher to engage on a more transparent, reflexive, and expressly positioned level that attempts to make the researcher more exposed, thus equalizing the power differentials between the researcher and the researched. The inherent contradictions between engaged ethnography and studying up create a situation ripe for methodological and ethical dilemmas, but also for breaking new theoretical ground. This paper will critically examine my experiences with a dominant community development corporation involved in housing and urban development. As such, the purpose of this thesis is twofold. First, I aim to explore the theoretical contradictions, ethical dilemmas, and methodological quandaries that arise from pairing engaged anthropology with the studying up required by the anthropology of public policy. The aim of this query is to show how the difficulties that arose during my thesis research project expose gaps within each body of literature. Second, I hope to present engaging-up as a promising (not just problematic) method that can be employed to better understand a myriad of topical interests of anthropology. Because of its promise, it is important to document this failed attempt so that others may be better prepared. As such, my hope is that my consideration of the contradictions that were unable to be overcome will be described with enough ethnographic clarity and framed in broad enough methodological terms as to be helpful to other engaged ethnographers.

This thesis examines the social impact of wildlife conservation nonprofits (WCNs) in the United States and Ecuador. Cultural developments of environmentalism provide the social context for WCNs, informing trends in participation and conflict. WCNs rely on public support and engagement to advance their mission, which requires an image of legitimacy and healthy organizational culture. This thesis argues the relationship between WCNs and the public impacts their organizational sustainability and their success as a conservation institution.

This thesis is about primary care medicine in the United States today. Specifically, I look into primary care providers’ experiences working with patients in the context of the public’s current access to extensive health and medical information online. In this thesis, I discuss and analyze my conversations with physicians, nurse practitioners, and a physicians’ assistant about their objectives in primary care, the challenges they face, and their perceptions of patients’ ability to seek out information on their own. I explore providers’ educational emphasis in primary care consultations, and argue that this focus on education informs their views of patients’ independent research and involvement in care. I further argue that regardless of my informants’ enthusiasm about patient involvement and the merits of patient-education, these providers still hold and express a strong authority over medical knowledge and decisions. Thus in looking at the influence of what could be seen as a democratization of medical knowledge through public access and the Internet, it seems that the limitations of such access are still great in U.S. medical practice.

The United States is ranked 27th in the world for maternal mortality, yet spends twice as much on maternity care services as countries with better maternal health indicators. Stuck in a technocratic and physician-dominated maternity care system, the U.S. depends on expensive technologies to control birth out of fear of pain and litigation, costing Americans billions of dollars and depriving women of the opportunity to have a transformative birth experience. Through an analysis of the medicalization of birth and the current biomedical model in birth, in conjunction with open-ended interviews with 5 hospital midwives and 3 homebirth midwives, the benefits and challenges of incorporating a midwifery model of care into our maternity services are explored. The midwifery model emphasizes that birth is not pathology and that psychosocial factors play a large role in birth outcomes. Basing their practice on collaboration, education, and support, midwives empower women, avoid unnecessary interventions, and offer a lower cost and higher quality care alternative. The current monopoly of women’s health services by physicians is unsustainable. Incorporating midwives into the maternity care team could provide a sustainable alternative with the caliber of maternity care services that U.S. women and families deserve.

Commercial fisheries on the West Coast are traditionally managed under large-scale management and conservation plans implemented by state and federal agencies. This scale of management can present obstacles for fishing communities. This thesis examines emerging cases of attempts to define and implement sustainable management of commercial fisheries under a community-based co-management model. In Port Orford, Sitka, San Diego and Santa Barbara, preliminary community-based co-management models are enabling fishing communities to pursue social sustainability through preserving access, participating in local science, and direct marketing for fish products. These communities are actively reshaping traditional models of conceptualizing and managing common-pool resources like fisheries.