Advances in Anthropology
2013. Vol.3, No.2, 65-70
Published Online May 2013 in SciRes (http://www.scirp.org/journal/aa) http://dx.doi.org/10.4236/aa.2013.32009
Cultural Competence in the Prevention and Treatment of Cancer:
The Case of Blueberries in North America
Niobra Samuel-Peterson
Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, USA
Received February 14th, 2013; revised March 14th, 2013; accepted March 24th, 2013
Copyright © 2013 Niobra Samuel-Peterson. This is an open access article distributed under the Creative Com-
mons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, pro-
vided the original work is properly cited.
Berry and berry-type fruits have gained the title of “super fruits” in recent years due to their anti-disease
promoting phytonutrients. While researchers have been hard at work isolating the mechanisms by which
these bioactive chemicals influence the human body, scientists have largely ignored the influence of cul-
ture on the co-evolutionary relationship between berry fruits and humans. This paper explores the phyto-
chemical makeup and cultural groundings of blueberries (Vaccinium corymbosum). Cultural and spiritual
connections of northeastern Native American groups such as the Ojibwe tribe with blueberries have in-
fluenced the survival of both species. Considering the poor consumption of fruits across the United States,
this paper presents the thesis that effectively changing the dietary habits of a population requires a multi-
faceted approach where scientific knowledge of the benefits of fruits in addition to the history and so-
ciocultural meaning of various fruits are taken into account. Moreover, this paper discusses the impor-
tance of sociocultural backgrounds (specifically of fruits) as a platform for strengthening cultural compe-
tence in order to more effectively communicate knowledge concerning the use of fruits in the prevention
and treatment of various cancers.
Keywords: Blueberries; Berry Fruits; Cultural Competence; Cancer
Introduction
In the movement towards gene specific dietary campaigns
and medical care, it is increasingly important to understand the
relationships that specific populations have with plants. Many
berry and berry-type fruits have been found to have a profound
impact on the culture and biochemistry of human populations.
These so called “super-fruits” have been singled out for their
anti-cancer, anti-inflammatory, anti-aging, and anti-neurodege-
nerative properties (Brown et al., 2012; Rendeiro et al., 2012;
Varoni et al., 2012; Mates et al., 2011; Meydani & Hasan, 2010;
Seeram, 2008a; Seeram, 2008b; Szajdek & Borowska, 2008).
Berry fruits popularly found in North American markets in-
clude blueberries (Vaccinium corymbosum), cranberries (Vac-
cinium macrocarpon), blackberries (Rubus spp.), black rasp-
berries (Rubus occidentalis), red raspberries (Rubus idaeus) and
strawberries (Fragaria ananassa). There is also a growing
trend in the sale of exotic “berry-type” fruits, including the
pomegranate (Punica granatum), goji berries (Lycium barba-
rum; also known as the wolfberry), fruits of Garcinia mangos-
tana, the Brazilian açaí berry (Euterpe oleraceae), and the
Chilean maqui berry (Aristote lia chilensis).
In recent years, the scientific community has taken steps to
increase and synthesize research on the health benefits of berry
fruits (Seeram, 2011; Seeram, 2008a). In 2005, the first Interna-
tional Berry Health Benefits Symposium was held in Corvallis,
Oregon. The purpose of this biennial conference series was “to
explore the latest scientific research related to berry consump-
tion and human health” (Seeram, 2008a). Current studies have
explained the anti-inflammatory, anti-neurodegenerative, and
antioxidant properties in berries as linked to their abundance of
phytochemicals (Brown et al., 2012; Rendeiro et al., 2012;
Varoni et al., 2012; Mates et al., 2011; Seeram, 2011; Meydani
& Hasan, 2010; Wood, 2010; Seeram, 2008a; Seeram, 2008b;
Szajdek & Borowska, 2008; Wu et al., 2004). Phytochemicals
(or phytonutrients) are non-nutritive elements of berries (and
other fruits and vegetables) that are bioactive and have positive
benefits on human health (Stoner & Seeram, 2011). Though
more scientific research is needed to further define the human
health benefits of specific berries, there is consensus that ber-
ries have extraordinary anti-disease potential (Brown et al.,
2012; de Kok, 2012; Renderio et al., 2012; Varoni et al., 2012;
Mates et al., 2011; Stoner & Seeram, 2011; Wood, 2010; See-
ram, 2008a; Stan et al., 2008; Parry et al., 2006; Wu et al.,
2004).
While a vast array of berry and berry-type fruits are con-
sumed in North America, this paper focuses on blueberries for
its rich cultural history and anti-cancer agents. The blueberry has
strong social, economic, and spiritual co-evolutionary lineages
that binds the fruit to specific human populations and ensures
the survival of both berries and humans. For example, the blue-
berry is also known as the “star berry” to some Native Ameri-
can tribes and is recognized as a gift from the Great Spirit
(Sliver & Allen, 2012; Norrgard, 2009). The traditional practice
of gathering berries (called “berrying”) echoed the gathering
practices of early humans and brought income to Native
American tribes throughout the European conquest of North
American territory (Norrgard, 2009). To modern citizens of the

N. SAMUEL-PETERSON
United States, the blueberry is a fruit that is tied to a sense of
nationalism due origins in North America. “Indeed, if anything
is more American than apple pie, it has to be blueberries,” ex-
claimed reporter Peter Tonge (1980). In this paper, I argue that
clinician and researcher knowledge of the blueberry in the con-
text of Native American and modern American society can con-
tribute to strengthening cultural competence within the Ameri-
can healthcare system, therefore expanding the foundation by
which providers can communicate with patients and improving
patient-provider relationships.
Moreover, a significant body of research explores the anti-
cancer properties of berry and berry-type fruits, drawing con-
clusions about the anti-cancer potential of singular berry con-
stituents (Seeram, 2008a; Seeram, 2008b; Seeram et al., 2006).
Cancer, in the United States is the second leading cause of
mortality (Siegel, 2012; CDC, 2011). Some believe cancer will
soon overtake heart disease as the leading cause of death for
Americans (Siegel et al., 2012). The literature, however, largely
ignores the culture surrounding blueberry cultivation and its
emergence as a super fruit. This background is important for
two primary reasons: first, it helps researchers to understand the
types of cultivars that are consumed and why. Second, back-
ground is needed to accurately identify strategies by which spe-
cific human populations are targeted for national consumption
campaigns. This paper focuses on co-evolutionary relationships
between humans and blueberries. First, I describe the berry‘s
cultivation, and its cultural history with the Ojibwe natives and
the broader American population. I then explore empirical
studies and reviews on the biochemistry of blueberries, paying
special attention to those bioactive compounds that are useful in
the prevention and treatment of cancer. Finally, I discuss the
importance of cultural background in the healthcare setting and
provide suggestions for healthcare professionals wishing to in-
crease their cultural competence in order to more effectively
encourage the consumption of super fruits for cancer treatment
and prevention purposes.
Background
Co-evolution refers to the reciprocal evolutionary change
driven by natural selection between two interacting species, for
example, fruits and humans (Thompson, 2005). Wild berries
were a notable source of nutrients for early hunter gathering so-
cieties (Kaplan, 2011). Early humans most likely took cues
from animals for introductions to various fruits with anti-di-
sease and nutritional properties. Berries were particularly attrac-
tive to humans because of their hues of blue-violet and red
during ripe seasons and their natural sweetness.
Blueberries
The blueberry (Vaccinium) is native to North America. Re-
cords of blueberries in American and native culture have dated
back well before the 20th century. “When Samuel de Champlain
discovered Lake Huron in 1616, he found Indians adding blue-
berries to sautauthig, a dish he described in his diary as deli-
cious. The Pilgrims were visited by friendly Indians in Ply-
mouth and presented with huge wicker baskets of dried blue-
berries. And one of the first meals Lewis and Clark ate around
the campfire with the Indians of the Northwest Territory was
smoke-dried venison with blueberries,” reports Marie Bianco of
the San Francisco Chronicle (1988).
Today, blueberries grow in three major varieties highbush
(corymbosum), rabbiteye (ashei), and lowbush (angustifolium).1
Highbush blueberries are most widely cultivated across the US.
The highbush blueberry originates in the Northern regions of
North America (USDA, 2012). Frederick Coville, US Depart-
ment of Agriculture botanist, and Elizabeth Coleman White are
given credit for the commercial cultivation of the highbush
berry. Together they found that blueberries flourish in moist,
acidic soil (pH 4.5 - 4.8) and require cross-pollination for
breeding (Kaplan, 2011). Coville and White uncovered these
facts between 1911 and 1913, which makes these highbush blue-
berries amongst the most recently domesticated crops in the
region (Kaplan, 2011). Results of Coville and White’s cross-
pollination breeding selected for the larger berries often found
in supermarkets today (Sliver & Allen, 2012; Kaplan, 2011).
The highbush blueberry can grow to be a maximum height of
12 feet (USDA, 2012). Rabbiteye blueberries, also known as
the southern black blueberry, are most commonly found in the
southeastern United States (USDA, 2012). Rabbiteye bushes
can grow to be 3 - 6 feet in height (USDA, 2012). Lowbush
blueberries are a “wild” variety initially found in eastern and
central Canada and the Northeastern US regions of North
America (USDA, 2012). Lowbush berries, characterized by a
smaller berry, are more difficult to cultivate. These berries grow
to a maximum height of only 2 feet (USDA, 2012). Though par-
ticular about the acidity of the soil, blueberries are a resilient
crop that thrives on recently burned land (Sliver & Allen, 2012;
Kaplan, 2011; Norrgard, 2009).
History
During the 19th and 20th centuries berrying was an important
form of labor that brought economic sustenance to the Ojibwe
tribe of Wisconsin and Michigan.2 In their 1837 and 1842 trea-
ties with the United States, the Ojibwe leaders reserved the
right to fish, hunt and gather on ceded land (Norrgard, 2009).
While non-Natives were interested in lumber, the Ojibwe peo-
ple sought to protect major food and clothing resources. During
the 1837 negotiations an Ojibwe leader stated:
My father. Your children are willing to let you have their
lands, but they wish to reserve the privilege of making su-
gar from the trees and getting their living from the Lakes
and Rivers, as they have done heretofore, and of remain-
ing in this Country. It is hard to give up the lands. They
will remain, and cannot be destroyed—but you may cut
down the Trees, and others will grow up. You know we
cannot live, deprived of Lakes and Rivers; There is some
give on the lands yet; & for that reason also, we wish to re-
main upon them, to get a living. Sometimes we scrape the
trees and eat of the bark. The Great Spirit above, made the
Earth, and causes it to produce, which enables us to live
(Norrgard, 2009).
Historians note that blueberries were not explicitly men-
tioned in treaty negotiations but agree that they were included
under plant resources due to the role of berrying in the
1According to the USDA, over 50 varieties of blueberries grown in North
America (USDA, 2012). Highbush and low
b
ush berries are among the most
commercially popular in the US.
2Many northern territory Native Americans have consumed blueberries,
however, the Ojibwe tribe provides some of the best records of their rela-
tionship with the berry.
66

N. SAMUEL-PETERSON
developing European American markets. (Sliver & Allen, 2012;
Norrgard, 2009)
By the time European settlers forced the removal of the Oi-
jibwe community from their native lands to reservations in
Wisconsin and Minnesota in the 1850s, berrying had become an
important resource in Ojibwe economic survival. The migration
of tribal families was dictated by crop production. One Ojibwe
man recounts: “In the summer of 1872, we moved from On-
tanogan with the whole family, paddling in birch bark canoes to
Eagle River, Michigan, where we joined other Indians living at
that place. Our occupation there was picking blueberries and
huckleberries and selling them to procure the necessities of
life” (Norrgard, 2009). Further, women who often had no male
relatives turned to berrying as their major source of income
because it was considered child-friendly labor (Norrgard, 2009).
In 1940, one Ojibwe grandson remembers:
…the mother was not deterred from participating in the
harvesting of natural, or wild, crops. These crops were the
edible roots, nuts, berries, maple sugar, and wild rice…
After cautioning the children to remain in the canoe, the
mother picked berries within sight and sound of the chil-
dren. The children played and slept in the raft the whole
day occasionally partaking of the food and drink left for
them by their mother… (Norrgard, 2009)
Ojibwe tribal tradition believes that all living things are gifts
from the Great Spirit. Blueberries were eaten in raw form as
well as in jellies, dried, and as juices (Sliver & Allen, 2012;
Moerman, 1998). Tribes called the berry the “star berry” due to
the five-point star that forms at its calyx (the blossom end of the
berry) (Sliver & Allen, 2012; NAED, 2012). Blueberry tea was
used medicinally to help cure chronic coughs and other com-
mon cold symptoms. Blueberry leaves were used to purify the
blood during lesion care (Sliver & Allen, 2012; NAED, 2012;
Howell, 2009). Other Native American tribes also used the
blueberry for medicinal purposes such as the Woods Cree tribe
that used blueberry stems to speed up recovery following child-
birth and to prevent miscarriages (Sliver & Allen, 2012; NAED,
2012).
Ojibwe berrying also influenced non-Native American socie-
ties. Berrying provided an entry into the European American
economy for Native Americans and a nutritious berry fruit for
early American settlers. Settlers bought berries picked off res-
ervation land from Natives to be eaten raw and in baked goods.
“A few blueberries have been brought into town this week, but
was all purchased promptly by our citizens for home consump-
tion, at a shilling [about $0.8 USD] a quart” reports the July
1883 edition of the North Wisconsin News (Norrgard, 2009).
Soon American settlers began to hire Native for berrying on
ceded land newly owned by the settlers (Norrgard, 2009). The
settlers observed that the Natives would purposely set fire to
portions of the blueberry fields every other year so production
would continue annually (Silver & Allen, 2012). With advances
in cultivation knowledge in the 1900s, Americans began to
operate their own blueberry farms (Sliver & Allen, 2012; Kap-
lan, 2011).
Blueberry regions have emerged across the United States in,
for example, New Jersey, Texas, and Michigan. Towns such as
Hammonton, New Jersey have held “Red White and Blueberry
Festivals” annually since the late 1980s (Donio, 2002). In 1984,
President Ronald Regan crowned Hammonton the “blueberry
capital of the world”. Due to the vital role of the crop in the
economy of this town, nearly every resident of Hammonton has
a blueberry story. The festival is a symbol of the relationship
between Hammonton’s blueberry farmers and the highbush
blueberry crop that has made the town famous and brought
about economic stability (DeAngelis, 2011; Donio, 2002). To-
day, the festival receives nearly 10,000 blueberry guests (De-
Angelis, 2011).
In the 1950s and 1960s, Texans began to research blueberry
cultivation in their state (Reese, 1985). Blueberries are native to
Eastern Texas. Researchers from Texas A&M University util-
ized these varieties to learn about Texas blueberries. They found
that there was a demand for increased acreage of blueberry pro-
duction in Texas due to consumption. They also saw that blue-
berry varieties grown in the state also have a profitable niche
because the Texas berry-growing season began a couple weeks
before the northern berry-growing season (Lee, 1986). Much ex-
citement surrounded blueberry farming. In the mid 1980s, Dal-
las newspapers reported that farmers had given up their soy-
bean crop in exchange for blueberries because blueberries (Lee,
1986). A Texas Department of Agriculture administrator was
quoted as saying, “It’s the most exciting new crop to be devel-
oped in many, many years,” (Lee, 1986).
Today, Michigan is the leading producer of highbush blue-
berries. The state gained this status in the mid-1980s, surpass-
ing New Jersey. The sandy Kalkaska soil makes this region
ideal for blueberries to thrive. The small city of South Haven,
Michigan is home to the National Blueberry Festival, which has
taken place annually since 1963 (Puhala, 1987). This festival is
one of four blueberry festivals that take place in Michigan
(Wood, 2008). The festival receives around 50,000 - 70,000
guests from all over the United States (Wood, 2008). Festivities
include cook-offs, pie eating contests, 5 k and 10 k runs, and
youth pageants, all in celebration of the blueberry.
Nationally, blueberries have become a symbol of American
culture. In addition to having been highlighted in songs such as
“Blueberry Hill”, produced in 1940, the blueberry has been an
integral part of American fruit medley imagery. Blueberries are
widely featured as the main ingredient to pies, cakes, muffins,
fruit salads and other delectable sweets. For Americans, red,
white, and blueberry cakes have become a Fourth of July tradi-
tion. While the white portion of the cakes may have been com-
prised of sour cream, whipped cream or cream cheese and the
red portion may have been raspberries, strawberries or water-
melon, the blue portion has remained blueberries. One Michi-
gan State University Department of Horticulture bulletin begins,
“The blueberry is even more American than turkey for thanks-
giving, for it was in this country in great abundance and was
highly prized by the Indians before the white settlers arrived”
(Johnston, 1959).
Methods
I searched the PubMed database for reviews on the phyto-
chemical components of blueberries. Search terms included:
blueberry or vaccinium, berry fruit or berries, phytochemi-
cals/phytonutrients/bioactive compounds and cancer. Reviews
were limited to those published in the last five years. Articles
published in peer-reviewed journals across the globe were in-
cluded. Articles about berry and berry-type fruits that did not
consider blueberries were excluded. This search methodology
was used in order to explore the biochemistry of blueberries
and the bioactive compounds within blueberries that may be

N. SAMUEL-PETERSON
useful in the prevention and treatment of various cancers.
Results
Review articles present clear evidence of the influence of
blueberries phytonutrients on brain functioning such as memory
and learning (Rendeiro et al., 2012); energy metabolism, adi-
posity and obesity (Meydani & Hasan, 2010); as well as cancer
prevention and treatment (Seeram, 2008a). In addition, blue-
berry seed flours have disease-preventing capabilities (Parry et
al., 2006). Table 1 shows the USDA (2012) nutritional facts
per 100 g of blueberries and their respective percentage of
daily-recommended amounts.
The anti-disease function of blueberries is mainly attributed
to the antioxidant properties of their bioactive compounds.
Though notes are made about variation given the type of blue
Table 1.
Blueberry (Vaccinium spp) nutrition factsa, per 100 g.
Principle Nutrient Value % of Daily
Recommendation
Energy 57 Kcal 3%
Carbohydrates 14.49 g 11%
Protein 0.74 g 1%
Total Fat 0.33 g 1%
Cholesterol 0 mg 0%
Dietary Fiber 2.4 g 6%
Vitamins
Folates 6 µg 1.5%
Niacin 0.418 mg 2.5%
Pantothenic acid 0.124 mg 2.5%
Pyridoxine 0.052 mg 4%
Riboflavin 0.041 mg 3%
Vitamin A 54 IU 2%
Vitamin C 9.7 mg 1.5%
Vitamin E 0.57 mg 4%
Vitamin K 19.3 µg 13%
Electrolytes
Sodium 1 mg 0%
Potassium 77 mg 2%
Minerals
Calcium 6 mg 0.5%
Iron 0.28 mg 3.5%
Magnesium 6 mg 1.5%
Manganese 0.336 mg 14%
Zinc 0.16 mg 1.5%
aUSDA2012.
berry studied, the literature finds that blueberries are rich in an-
thocyanins, flavanoids, phenolic acids, and stilbenes (Brown et
al., 2012; Rendeiro et al., 2012; Varoni et al., 2012; Mates et al.,
2011; Meydani & Hasan, 2010; Seeram, 2008a; Szajdek &
Borowska, 2008). Flavanoids, such as proanthocyanidins (con-
densed tannins) and anthocyanins are polyphenolic compounds
that are typically found in the skin of blueberries. Resveratrol is
a stilbene also found in the skin of blueberries; it acts as a de-
fense mechanism for berry fruits (Goswami, 2009; Udenigwe,
2008).
Articles that focus on the anti-cancer properties of blueber-
ries and berry fruits, mostly consider anthocyanins (Brown et
al., 2012; de Kok et al., 2012; Varoni et al., 2012; Mates et al.,
2011; Stan et al., 2008). This flavonoid has been shown to act
as an antioxidant. Antioxidants are “scavengers of various oxi-
dizing species, such as hydroxyl radical (•OH), peroxy radicals
(•OOR) or superoxide anion radical (O2•−), due to the presence
of a catechol group in conjunction with several hydroxyl
groups” (Mates et al., 2011). Moreover, flavonoids effect cell
proliferation and help regulate cancer signal transduction path-
ways (Collins et al., 2012; Mates et al., 2011). For example
black raspberry, red raspberry, blueberry, and cranberry seed
flours inhibit the proliferation of human HT29 colon cancer cell
line (Parry et al., 2006). In a very informative review published
in the Journal of Agriculture and Food Chemistry, Dr. Navin-
dra P. Seeram (2008a) summarizes:
Berry fruits have also been shown to inhibit the activities
of enzymes, which play a significant role in cancer me-
tastasis, such as matrix metalloproteinases (MMPs). A
recent study (2006) investigated the ability of flavonoid-
enriched fractions from low bush blueberry to down-
regulate MMP activity in DU145 human prostate cancer
cells. Differential down-regulation of MMPs was obse-
rved in cells exposed to both anthocyanin-and proantho-
cyanidin-enriched blueberry fractions. The possible in-
volvement of protein kinase-C and mitogen-activated pro-
tein kinase pathways in the flavonoid-mediated decreases
in MMP activity was observed. The authors concluded
that the down-regulation of MMP activities by the blue-
berry flavonoids might occur through multiple mecha-
nisms.
Recent literature also pays attention to the anti-cancer prop-
erties of resveratrol. Red wine is popularly known to contain
resveratrol from the red grapes. Resveratrol is also found in
blueberries in moderate quantities (Brown et al., 2012; Goswami,
2009). Resveratrol influences cancer at the initiation, promotion
and progression stages during the development of cancer (Ud-
enigwe, 2008). It can induce apoptosis in various cancer cells
without killing normal cells (Udenigwe, 2008). Resveratrol also
aids in the reduction of inflammatory diseases (Brown et al.,
2012; Udenigwe, 2008).
Finally, articles agree that the bioactive compounds within
blueberries aid in the prevention of a number of cancers in-
cluding breast, colon, esophageal, liver, ovarian, and prostate
(Brown et al., 2012; de Kok, 2012; Varoni et al., 2012; Mates et
al., 2011; Seeram, 2008a; Stan et al., 2008; Parry et al., 2006).
Discussion & Conclusion
Increased consumption of berry fruits can help in the preven-
tion of various cancers in a number of ways. Physiologically,
68

N. SAMUEL-PETERSON
prior research has found that the antioxidant properties of ber-
ries fight off free radicals in the body produced by oxidative
stress and the anti-cancer properties of berries protect against
DNA damage and induce apoptosis within cancer cells (Gos-
wami, 2009). Culturally, prior research has found that certain
populations have unique connections with the health promoting
fruits (Norgard, 2009). It is clear that the evolution of these
fruits is largely influenced by their cultivation by human popu-
lations. Wild blueberry bushes grow taller with large, plump
fruits. The Ojibwe people are an example of a population
whose geographic patterning and nutritional survival was in-
fluenced by the growth patterns of blueberries.
Cultural Competence
A nation-wide fruit and vegetable consumption program, en-
titled the “5 A Day Program” was instituted by the National
Cancer Institute (NCI) and the Produce for Better Health Foun-
dation in 1991 (Pivoka, 2011). The purpose of this campaign
was to improve awareness and consumption of fruits and vege-
tables within American society. At the program’s advent, only
8% of individuals reported being aware that they should con-
sume at least 5 servings of fruits and vegetables per day (Sta-
bles, 2002). By 2005, when the NCI gave lead authority of the
program over to the CDC, this awareness had increased to 40%
(National Cancer Institute, 2004). Unfortunately, researchers
have found that for the majority of Americans this heightened
awareness has not translated to heightened consumption of
fruits and vegetables (Pivoka et al., 2011). Cultural competence
on the part of health professionals may help to change this lack
of consumption through broader lines of communication and
familiar starting points for patients.
The movement towards personalized medical care has recog-
nized the importance of culturally competent providers (Beach
et al., 2005). There is a difference, however, between patient
centered care and culturally competent personalized care. Cul-
tural competence can be defined as:
...a set of congruent behaviors, attitudes, and policies that
come together in a system, agency, or among profession-
als that enables effective work in cross-cultural situations,
where “culture” refers to integrated patterns of human be-
havior that include the language, thoughts, communications,
actions, customs, beliefs, values, and institutions of racial,
ethnic, religious, or social groups, and “competence” im-
plies having the capacity to function effectively as an in-
dividual or an organization within the context of the cul-
tural beliefs, behaviors, and needs presented by patients
and their communities (American Association of Medical
Colleges, 2010).
Within this framework, culturally competent personalized
care focuses on the unique sociocultural background of a per-
son as opposed to solely a patient with a specific cancer or
illness (Beach et al., 2005). Cultural competence does improve
patient satisfaction and clinician attitudes and skills (Beach et
al., 2005). Through increased knowledge, healthcare profes-
sionals have a broader context in which they can encourage the
health and strength of their patients.
Cultural competence must be used in all aspects of public
health, including the marketing and promotion of health pro-
moting behaviors such as blueberry consumption. Two major
arguments can be made connecting berries, human disease and
cultural competence within healthcare. First, knowledge of both
the nutritional and cultural benefits of berries can aid in giving
healthcare providers the social capital needed to communicate
across ethnic boundaries. Clinicians and patients often build
trust on the basis of shared knowledge. For example, knowing
that Native Americans knew blueberries as the “star berries”
may be a common-ground conversation starter for clinicians wor-
king with Ojibwe people or those with similar Native American
ancestry. To Americans from past and present immigrant an-
cestry, blueberries are symbolic of the reds, whites and blues of
the United States, especially on the fourth of July. Food often
acts as a pathway to deeper relationship. For instance, when
conversations surround a relative’s amazing blueberry muffins
or the best recipe for blueberry pie. Why not utilize this know-
ledge of solidarity around food to encourage healthier and con-
sistent consumption patterns?
Second, exploring berries in the context in which they were
cultivated can help scientists further understand the dietary
patterns and disease susceptibility of specific populations. From
a plant-human coevolutionary standpoint, understanding the die-
tary patterns of early hunter-gathering societies and their evolu-
tion to agriculture has helped us draw conclusions about the
increased prevalence of various disease types. The same can be
true in the movement towards personalized drug therapies. Nu-
trients or phytonutrients found in the diets of ethnic ancestors
can help scientists understand how certain populations have
come to be more susceptible to certain cancers and not others.
Knowing the context in which these berries were consumed
helps scientists understand the environmental components and
social stressors that may have contributed to various gene ex-
pression or epigenetic mutations. Research is needed which
examines this intersection of plant-human culture, chemistry,
and human disease processes.
Acknowledgements
Special thanks to Dr. Fatimah Jackson as well as my col-
leagues in Anthropology 699: Human-Plant Coevolution from
where this paper was cultivated.
REFERENCES
American Association of Medical Colleges (2010). Cultural compe-
tence education for medical students. https://www.aamc.org/
Beach, M. C., Price, E. G., Gary, T. L., Robinson, K. A., Gozu, A., Pa-
lacio, A., Smarth, C., Jenckes, M. W., Feuerstein, K. A., Bass, E. B.,
Powe, N. R., & Cooper, L. A. (2005). Cultural competency: A sys-
tematic review of health care provider educational interventions.
Medical Care, 43, 356. doi:10.1097/01.mlr.0000156861.58905.96
Beach, M. C., Gary, T. L., Price, E. G., Robinson, K., Gozu, A., Palacio,
A., Smarth, C., Jenckes, M. W., Feuerstein, K. A., Bass, E. B., Powe,
N. R., & Cooper, L. A. (2006). Improving health care quality for ra-
cial/ethnic minorities: A systematic review of the best evidence re-
garding provider and organization interventions. BMC Public Health,
6, 104. doi:10.1186/1471-2458-6-104
Bianco, M. (1988). True blueberries are an all-American fruit. San
Francisco, CA: The San Francisco Chronicle.
Brown, E. M., Gill, C. I. R., McDougall, G. J., & Stewart, D. (2012).
Mechanisms underlying the anti-proliferative effects of berry com-
ponents in in vitro models of colon cancer. Current Pharmaceutical
Biotechnology, 13, 200-209. doi:10.2174/138920112798868773
Centers for Disease Control—Cancer Prevention and Control (CDC)
(2012). http://www.cdc.gov/cancer/
Collins, A. R., Azqueta, A., & Langie, S. A. S. (2012). Effects of mi-
cronutrients of DNA repair. European Journal of Nutrition, 51, 261-

N. SAMUEL-PETERSON
70
279. doi:10.1007/s00394-012-0318-4
DeAngelis, M. (2011). Sand in my shoes/singing (the praises of) the
blues/hammonton prepares to once again celebrate the blueberry
and its farmers (p. B1). Atlantic, NJ: The Press of Atlantic City.
Goswami, S. K., & Das, D. K. (2009). Resveratrol and chemopreven-
tion. Cancer Letters, 284, 1-6. doi:10.1016/j.canlet.2009.01.041
Howell, A. B. (2009). Update on the health benefits of cranberry and
blueberry. Acta Horticulturae, 810, 779-784.
Johston, S. (1959). Essentials of blueberry culture. East Lansing, MI:
Department of Horticulture, Michigan State University Agricultural
Experiment Station.
Kaplan, J. K. (2011). Blueberry growing comes to the national agricul-
tural library. Agricultural Research, 59 , 14-16.
de Kok, T. M. C. M., van Breda, S. G. J., & Briede, J. J. (2012). Ge-
nomics-based identification of molecular mechanisms behind the
cancer preventative action phytochemicals: Potential and challenges.
Current Pharmaceutical Biotechnology, 13, 255-264.
doi:10.2174/138920112798868601
Mates, J. M., Segura, J. A., Alonso, F. J., & Marquez, J. (2011). Anti-
cancer antioxidant regulatory functions of phytochemicals. Current
Medicinal Chemistry, 18, 2315-2338.
doi:10.2174/092986711795656036
Mahadevan, B., Mata, J. E., Albershardt, D. J., Stevens, J. F., Pereira, C.
B., Rodriguez-Proteau, R., Baird, W. M. (2005). The effects of red
raspberry extract on PAH transport across Calu-3 cell monolayer, an
in-vitro cell model. International Journal of Cancer Prevention, 2,
129-141.
Meydani, M., & Hasan, S. T. (2010). Dietary polyphenols and obesity.
Nutrients, 2, 737-751. doi:10.3390/nu2070737
Moerman, D. E. (1998). Native american ethnobotany. Portland, Ore-
gon: Timber Press.
Native American Ethnobotany Database (NAED) (2012).
http://herb.umd.umich.edu
Norrgard, C. (2009). From berries to orchards: Tracing the history of
berrying and economic transformation among Lake Superior Ojibwe.
The American Indian Quarte r ly , 33, 33-61.
doi:10.1353/aiq.0.0035
Pallas, L. A., Pegg, R. B., & Kerr, W. L. (2012). Quality factor, anti-
oxidant activity, and sensory properties of jet-tube dried rabbiteye
blueberries. Journal of the Science of Food and Agriculture, Pub-
lished Online Wiley Library. doi:10.1002/jsfa.5985
Parry, J., Su, L., Moore, J., Cheng, Z., Luther, M., Rao, J. N., Wang, J.,
& Yu, L. L. (2006). Chemical compositions, antioxidant capacities,
and antiproliferative activities of selected fruit seed flours. Journal of
Agricultural and Food C h e m is t r y , 54, 3773-3778.
doi:10.1021/jf060325k
Pivonka, E., Seymour, J., McKenna, J., Baxter, S. D., & Williams, S.
(2011). Development of the behaviorally focused fruits & veggies—
More matters public health initiative. Journal of the American Die-
tetic Association, 111, 1570-1577. doi:10.1016/j.jada.2011.07.001
Puhala, B. (1987). It’s blueberry time in Grand Haven. Chicago, IL:
Chicago-Sun Times.
Reagan, R. (1984). Remarks at a Reagan-Bush rally in Hammonton,
New Jersey. Public Papers of R ona ld Reagan: September 1984.
http://www.reagan.utexas.edu/archives/speeches/1984/91984c.htm.
Reese, S. (1985). It takes dedication to grow Texas blueberries. Dallas,
Tx: The Dallas Morning News.
Rendeiro, C., Guerreiro, J. D. T., Wiliams, C. M., & Spenser, J. P. E.,
(2012) 70th Anniversary Conference on “From plough through prac-
tice to policy”: Postgraduate symposium flavonoids as modulators of
memory and learning: Molecular interactions resulting in behavioural
effects. Proceedings of the Nutrition Society, 71, 246-262.
doi:10.1017/S0029665112000146
Seeram, N. P. (2008a). Berry fruits for cancer prevention: Current
status and future prospects. Journal of Agricultural and Food Chem-
istry, 56, 630-635. doi:10.1021/jf072504n
Seeram, N. P. (2008b). Symposium: Berry fruits: Compositional ele-
ments, biochemical activities, and the impact of their intake on hu-
man health performance, and disease. Journal of Agricultural and
Food Chemistry, 56, 627-629. doi:10.1021/jf071988k
Seeram, N. P. (2011). Emerging research supporting the positive effects
of berries on human health and disease prevention. Journal of Agri-
cultural and Food Chemistry, 60, 5685-5686.
doi:10.1021/jf203455z
Siegel, R., Naishadham, D., & Ahmedin, J. (2012). Cancer statistics,
2012. CA Cancer Journal fo r C l i ni c ians, 62, 10-29.
doi:10.3322/caac.20138
Silver B. & Allen, M. (2012). Commodity of the quarter: Blueberries.
Journal of Agricultural & Food Information, 13, 7-13.
doi:10.1080/10496505.2012.639664
Smith, H. (1932). Ethnobotany of the Ojibwe Indians. Bulletin of the
Public Museum of Milwaukee, 4, 327-525.
Stables, G. J., Subar, A. F., Patterson, B. H., Dodd, K., Heimendinger,
J., Van Duyn, M. A., & Nebeling, L. (2002). Changes in vegetable
and fruit consumption and awareness among US adults: Results of
the 1991 and 1997 5 a day for better health program surveys. Journal
of the American Dietetic Association, 102, 809-817.
doi:10.1016/S0002-8223(02)90181-1
Stan, S. D., Kar, S., Stoner, G. D., & Singh, S. V. (2008). Bioactive
food components and cancer risk reduction. Journal of Cellular Bio-
chemistry, 104, 339-356. doi:10.1002/jcb.21623
Stoner, G. D., & Seeram, N. P. (Eds). (2011). Berries and cancer pre-
vention. New York: Springer.
Szajdek, A., & Borowska, E. J. (2008). Bioactive compounds and heal-
th-promoting properties of berry fruits: A review. Plant Foods and
Human Nutrition, 63, 147-156. doi:10.1007/s11130-008-0097-5
Thompson, J. (2005). The geographic mosaic of coevolution. Chicago,
IL: University of Chicago Press.
Tonge, P. (1980). For overseas visitors, blueberries were a hit. Boston,
MA: The Christian Science Monitor.
Udenigwe, C. C., Ramprasath, V. R., Aluko, R. E., & Jones, P. J. H.
(2008). Potential of resveratrol in anticancer and anti-inflammatory
therapy. Nutrition Reviews, 66, 445-454.
doi:10.1111/j.1753-4887.2008.00076.x
Umezawa, T. (2003). Diversity in lignin biosynthesis. Phytochemistry
Reviews, 2, 371-390. doi:10.1146/annurev.arplant.54.031902.134938
United States Department of Agriculture (USDA) (2012).
http://www.ars.usda.gov
Varoni, E. M., Lodi, G., Sardella, A., Carrassi, A., & Iriti, M. (2012).
Plant polyphenols and oral health: Old phytochemicals for new fields.
Current Medicinal Chemistry, 19, 1706-1720.
doi:10.2174/092986712799945012
Wood, M. (2011). Blueberries and your health: Scientists study nutri-
tion secrets of popular fruit. Agricultural Re sea rch, 59, 9-13.
Wood, W. R. (2008). South Haven’s 45th national blueberry festival
celebrates more than just berries. Kalamazoo, MI: Kalamazoo Ga-
zette.
Wu, X., Beecher, G. R., Holden, J. M., Haytowitz, D. B., Gebhardt, S.
E., & Prior, R. L. (2004). Lipophilic and hydrophilic antioxidant ca-
pacities of common foods in the United States. Journal of Agricul-
tural and Food Chemistry, 52, 4026-4037. doi:10.1021/jf049696w