Contents
Medical Anthropology studies
human health problems and healing systems in their broad social and cultural
contexts. Medical anthropologists engage in both basic research into health and
healing systems and applied research aimed at the improvement of therapeutic
care in clinical settings or community public health programs in prevention and
disease control. Drawing from biological and social sciences, as well as
clinical sciences, medical anthropologists have contributed significantly to
the understanding and improvement of human health and health services
worldwide. As a result, the growth of the subdiscipline in recent years as
reflected in publications and meetings, training programs, and influence
outside of anthropology has been remarkable.
Medical anthropology is not characterized
by a single theoretical paradigm. For example, ethnographic description and
analysis of religion and healing systems are as old as anthropology itself,
while new approaches like critical medical anthropology are the product of more
recent intellectual trends. This has sometimes led to intense debates within
the field such as those between clinically applied medical anthropologists
(interested in making cultural knowledge useful to the aims of medical
practitioners) and critical medical anthropologists (interested in the
phenomenology and political economy of biomedicine). But, even though the scope
of intellectual inquiry is very diverse, it is possible to identify five basic
approaches: biomedical, ethnomedical, ecological, critical, and applied. These
approaches share three fundamental premises:
1. illness
and healing are fundamental to the human experience and are best understood
holistically in the contexts of human biology and cultural diversity
2. disease
represents an aspect of the environment that is both influenced by human
behavior and requires biocultural adaptations
3. the
cultural aspects of health systems have important pragmatic consequences for
the acceptability, effectiveness, and improvement of health care, particularly
in multicultural societies
Approaches:
Ethnomedical approach:
The initial development of medical anthropology derived
from anthropological interest in different illness beliefs and healing
practices (Rubel & Hass 1996).
Cultures have developed more or less organized approaches
to understand and treat afflictions, and identify the agents, forces, or
conditions believed responsible for them. Ethnomedicine is that branch of
medical anthropology concerned with the cross-cultural study of these systems.
While medical systems or elements thereof were foci of research early in the
20th century in the work of W. H. Rivers, the study of popular systems of health
and illness did not coalesce into a field of study
in anthropology until the 1980s. Foundational
formulations of the field of medical anthropology appeared in the 1950s and
1960s, in the works of such writers as William Caudill and Steven Polgar.
The earliest ethnomedical research was confined to the
study of non-Western societies and exotic cultures and was generally subsumed
under the comparative study of religion. Ideas about sickness and therapeutic
rituals were analyzed as a window on underlying cosmological beliefs and
cultural values. As the intimate relationship between the concepts of illness
and the social organization were recognized, ethnomedicine became a common
focus of ethnographic research. Fabrega (1975: 969) defined this approach as
"the study of how members of different cultures think about disease and
organize themselves toward medical treatment and the social organization of
treatment itself." Typical ethnomedical studies focus on the classification
and cultural meaning of illness (both somatic and mental), the health-seeking
behaviors of people suffering from illness, and the theories, training, and
practices of healers. Nichter (1992: x) described twelve areas of current
ethnomedical work, including the "study of the afflicted body as a space
where competing ideologies are contested and emergent ideologies are developed
through medico-religious practices and institutions which guide the production
of knowledge."
Biomedical approach:
Although not always recognized as such, much of the research
in BIOLOGICAL ANTHROPOLOGY using the standard epistemology of science and
focusing on human biology and the health consequences of different stresses is
part of medical anthropology (F. Johnston & Low 1984). For example, it has
long been recognized that DISEASE has acted as an important agent of natural
selection in genetic and cultural EVOLUTION. Biomedical anthropologists have
used immunological studies to trace EPIDEMICS. Biological anthropologists have
examined human physiological adaptations to a wide variety of stresses,
including high elevation, cold temperatures, nutritional deprivation, and
infectious disease. Laboratory-based scientific methods (such as the
biochemical analyses of ethnopharmacological compounds) are used to analyze the
biochemical and physiological functioning of ethnomedical practices. This type
of analysis played a role in the discovery of a Hepatitis vaccine (Blumberg
1982).
Ecological Approaches:
The ecological approach in medical anthropology focuses on
how human cultural and behavioral patterns shape the complex interactions of
the pathogen, the environment, and the human host, and produce both infectious
and noninfectious disease states (Inhorn & Brown 1997). In recent years,
ecological studies of health and illness have looked beyond local socioeconomic
factors that influence disease rates to emphasize the larger political economic
forces that constrain the behavior choices of populations. Both Ecological
Anthropology and political ecology examine how cultural, physical, and
political-economic environments shape the distribution of disease morbidity and
mortality. Disease patterns described with epidemiological methods (in regard
to time, place, and person) often reflect cultural practices associated with
diet, activity patterns, sexuality, and so forth. In addition, culturally
defined group practices such as the introduction of IRRIGATION agriculture can
transform the disease ecological balance in favor of a pathogen like malaria or
shistosomiasis, and in turn damage health. Ecological analyses in medical
anthropology also reveal many cases where cultural changes improve health for
some groups.
Critica Approaches:
Critical medical anthropology (CMA) is a label applied to
two distinct intellectual movements that influenced the field during the 1980s
and 1990s. One emphasized the marxist approaches to understanding how
macrosociological political-economic forces influence health and structure
health-care systems. The second movement is more epistemological, it questions
the intellectual underpinnings of contemporary biomedical theory and practice.
This approach has been influenced by postmodern thinkers like Foucault who
emphasize the social-constructionist nature of reality and the social power
inherent in hegemonic institutions like "Biomedicine." What these
movements have in common is the demand for a fundamental rethinking of the
premises and purposes of medical anthropology.
The political-economic orientation of CMA views health
issues in the light of the larger political and economic forces that pattern
human relationships, shape social behavior, and condition collective experience
(Merrill Singer 1989). Macrolevel processes such as world CAPITALISM are seen
as the dominant forces that shape clinical practice and influence the
distribution of disease. Medicine is perceived not only as a set of procedures
and treatments, but also as a particular set of social relationships and an
ideology that legitimates them. Recognition of the centrality of the
political-economic dimensions of both sickness and healing, as well as the
unequal social relationships between healers and patients is the hallmark of
this approach.
The second branch of CMA challenges the epistemology and
universality of assumptions underlying the theory and practice of Western
medicine, which were conventionally exempt from cultural analysis in medical
anthropology. This approach has been responsible for the label
"biomedicine." Medical anthropologists like Lock and Scheper-Hughes
(1996) advocate the deconstruction of how mind and body are conceptualized as a
way to gain insight into how health care is planned and delivered in Western
societies. The separation of mind and body in biomedical science is so
pervasive that there is a need for more precise vocabulary for the interactions
of mind, body, and society.
Applied Approaches
Interest in the applied aspects of medical anthropology has
been present since the initiation of the discipline. There are two branches of
applied work, clinical and public health. Clinically applied medical
anthropology is best known for its use of explanatory models to explore
conceptual differences between physicians' and patients' perceptions of disease
and illness. Clinically applied anthropologists work in biomedical settings
with health practitioners and the delivery of health care services; they are
also involved in the training of future professionals. Without a single
theoretical proposition, it can be interpreted as anthropological theory and
methods devoted to the topics of health, illness, and health care. Clinical
medical anthropological research has a very wide range, including microlevel
studies of health-care choices, illness beliefs, and life-course events like
CHILDBIRTH or menopause; the examination of cultural influences on
health-seeking behavior, disease distributions, the experience of illness
(e.g., pain), and interactions of healers and patient (i.e., compliance); and
macrolevel research on health-care systems and their political and economic
contexts (Chrisman & Johnson 1996). Some clinically applied medical
anthropologists are employed within hospitals and clinics as cultural mediators
and interpreters.
Applied medical anthropology research in public health has
gained importance in recent decades (Coreil & Mull 1990). More medical
anthropologists are working in international health projects, particularly
because of the programmatic emphasis on primary health care and interventions
in nutrition and oral rehydration therapy that require community participation.
Anthropologists have worked on all aspects of such projects, including problem
identification and analysis, intervention, and evaluation of specific health
problems.
This is a brief outline on medical anthropology (bilingual, meant for my college students)