Anthropology at the heart of medicine

Anthropology and medicine share many concerns, but have had trouble collaborating in the past. The anthropologist has had to plead both with his colleagues and physicians to move beyond a < culturalist > vision that would confine him to the study of traditional or alternative medicines and representations of populations and the sick. The anthropologist's approach perceived as intrusive has also raised fears in the medical world. These reciprocal misunderstandings and stereotypes need to be overcome by an anthropology that studies the practices and knowledge of modern medicine as they are elaborated daily. Anthropology will dialogue with medicine without judging it. In its turn, medicine will open its sites of healing and teaching to the anthropologist. Anthropology at the heart of medicine is organized around the idea that the paths and expectations of health professionals reflect the specicifities of the local system of health. The individual dimensions of practices cannot be divorced from the functioning of structures of health and decision. Finally, like any other kind of anthropology, medical anthropology must scrutinize its own methods and ethics in a critical way.     

Health care and health care seeking strategies among Puyallup Indians

This study replicated Kleinman's research on family-based popular health care in Taiwan among the Puyallup Indians of Washington. Standardized interviews were conducted among 80 Puyallup families to determine family health practices and beliefs, and the patterns of referral to professional practitioners. Comparisons are made between the Puyallup and Taiwanese family health care practices and health care seeking processes. The author concludes that the relative absence of folk medicine and the availability of free medical care among the Puyallup are the most important factors causing the variance between the rates of family treatment and the patterns of health care seeking behaviors between the Puyallup and the Taiwanese.     

‘Saving our people’: health workers,medical citizenship,and vernacular sovereignties in West Papua

Much anthropology has considered the social embeddedness of medical systems, personnel, and practices and the political subjectivities that may arise among health workers. I explore what medical citizenship looks like under conditions of settler colonialism in West Papua based on an ethnographic study of Dani (Balim) and Lani HIV nurses and NGO volunteers who see themselves and their activities as part of a broader effort to save Papuans from extinction. In particular, HIV work emerges as a biosocial obligation, meaning that workers give their expertise, attention, compassion, and treatment networks to people with HIV in the name of ensuring the vitality of the wider population, but giving care is not altruistic. As HIV workers respond to erasure, constraints, and racism, they put themselves at the centre of HIV care webs. ‘Traditional’ technologies transform healthcare encounters and challenge strategic ignorance about the epidemic. A close navigation of global health and settler power allows for flexible, independent, even surreptitious HIV practices that are deceptively radical and disruptive. Papuan HIV workers’ medical citizenship is encompassed by and expresses vernacular sovereignties.     

From “Shrinks” to “Urban Shamans”: Argentine Immigrants’ Therapeutic Eclecticism in New York City

This article examines Argentine immigrants' reliance on informal networks of care that enable their access to a variety of health providers in New York City (NYC). These providers range from health brokers (doctors known on a personal basis) to urban shamans, including folk healers and fortunetellers of various disciplines. A conceptual framework, based on analysis of social capital categories, is proposed for the examination of immigrants' access to valuable health resources, which are based on relationships of reciprocity and trust among parties. Results revealed immigrants' diverse patterns of health-seeking practices, most importantly their reliance on health brokers, epitomized by Argentine and Latino doctors who provide informal health assistance on the basis of sharing immigrants' social fields and ethnic interests. While mental health providers constitute a health resource shared by Argentines' social webs, urban shamans represent a trigger for the activation of women's emotional support webs. Contrary to the familiar assumption that dense and homogenous networks are more beneficial to their members, this article underscores the advantages of heterogeneous and fluid social webs that connect immigrants to a variety of resources, including referrals to diverse health practitioners.     

Going like Gangbusters: Transnational Tobacco Companies "Making a Killing" in South America

This article reports on the recent growth of transnational tobacco companies (TTCs) in South America. Although some scholarly attention has been directed toward such growth in Asia and eastern Europe, South America has also been targeted by the TTCs' aggressive expansionist practices in recent years. Fighting "Big Tobacco" is entirely different from combating most public health problems. Unlike cigarettes, most infectious diseases and maternal and child health problems never provide profits to transnational corporations and governments. Also, most public health problems (with alcohol being another notable exception) are not exacerbated by extensive advertising campaigns that promote the cause of the health problems. Supported by data gathered during three months of fieldwork in Ecuador, Peru, Chile, and Argentina in 1997, this article suggests that the TTCs' marketing strategies override cultural differences in the choices people make regarding smoking and health. Combining critical medical anthropology and public health, this article concludes that unless dramatic actions are taken, an avoidable outbreak of tobacco-related diseases will eventually reach epidemic proportions on the South American continent. It is also a "call to arms" for more medical anthropologists to investigate tobacco-related matters around the world.     

The health seeking process: An approach to the natural history of illness

Anthropological research on health-related behaviors in the United States has tended to emphasize folk illnesses among particular subcultural groups, obscuring the heterogeneity of popular culture health beliefs and practices in the lay health system. The development of theoretical models for this complex society will require research that stresses similarity as well as diversity within and between population groups. The health seeking process is proposed in this paper as a means to document natural histories of illness in any subculture. Concepts from medical anthropology and medical sociology are related to five components of health seeking — symptom definition, illness-related shifts in role behavior, lay consultation and referral, treatment actions, and adherence. Illustrative propositions to guide further research are proposed.1. This is a substantially revised and expanded version of the paper, Toward a Typology of Health Systems, given at the American Anthropological Association meetings in San Francisco, December 1975. Various stages in the conceptual development of the health seeking process have been presented in the following forums at the University of Washington: Colloquium in Nursing Research, November 1974; Behavioral Sciences Study Unit Seminar (Department of Psychiatry and Behavioral Sciences), February 1976; and the Seminar on Anthropological and Cross-Cultural Dimensions of Illness and Health Care, December 1976. Participants at these gatherings made many useful suggestions. The Office of Nursing Research in the School of Nursing (supported in part by grants NU 00369, DHEW, Division of Nursing, and RR 05758, DHEW, Division of Research Resources) provided bibliographic and typing assistance. Finally, I would like to thank Ursula Chrisman, Byron Good, Jennifer James, Arthur Kleinman, and Steve Shortell for their helpful comments on earlier drafts.     

In the shadow of "death with dignity": medicine and cultural quandaries of the vegetative state

In this paper I address one site of technological development and cultural production, the permanent or persistent comatose condition and the institutions and practices that enable this life form to exist. As with other medical sites of ambiguity and change under recent scrutiny by anthropologists, the locations in which comatose bodies thrive are those in which the routinization of technology use in the clinic and a legitimating social and economic context come together to permit and create a further remapping of the notions of "life" and "person." I explore the new forms of knowledge, practice, and the body that are created at this site and how they are negotiated, and I discuss how the shifting understanding of "'culture" and "nature" both have an impact on and are informed by American quandaries about approaching death. I argue that beings who are neither fully alive, biologically dead, nor "naturally" self-regulating, yet who are sustained by modern medical practices, destabilize the existing social order in ways that are different from other hybrid forms, [medical anthropology, anthropology of the body, bioethics, personhood, culture/nature dichotomy]     

Conditions of life in the city: medicine and gendered relations in Maputo,Mozambique

How do material conditions, urban life strategies, and postcolonial medical infrastructures shape the practices of care available to patients and families in Maputo? How do global health interventions articulate with urban economies, colonial legacies, and gendered relations? Under what conditions is health made available in Mozambique's capital? This article explores these questions through the experiences of one young woman as she moves through clinical and city spaces and through changing familial and residential situations. Showing how health is shaped by gendered relations and material circumstances (or condições) as they are refracted through urban space, her experiences make clear that care both requires and creates complex material‐relational conditions rooted in clinic practice, urban forms, and gendered social and familial life. In the midst of complex medical regimes and rapidly changing urban spaces, these conditions constitute the ground on which women access medicine but also give rise to exclusions from forms of care produced by both biomedicine and social relations. Arguing for greater attention to the role of gender, urban space, economy, and exchange in theorizing health in situated urban and transnational spaces, this article advocates for accounts that go beyond biomedical and clinical framings of life, health, and well‐being and that centre relational accounts of life in the city.     

Clinician experiences of managed mental health care: a rereading of the threat

The threat mental health professionals perceive in managed care, as indicated by their writings on the subject, is re-examined in light of evidence from an ethnographic study. Fieldwork focusing on clinician experiences of managed care was carried out at an urban community mental health center. Existing explanations of "the threat"—the possibility of deprofessionalization and the potential for deterioration in the quality of care—proved inadequate to account for the power it wielded at this site, perhaps because its full impact had yet to be felt at the time of data collection. A "rereading " suggests the meaning of managed care for this group of clinicians lies in the prospect of being gradually, unknowingly, and unwillingly reprofessionalized from critics into proponents simply by virtue of continuing to practice in a managed care context, and in losing a moral vision of good mental health treatment in the process, [clinician experience, mental health, managed care, medical anthropology]     

Patient morbidity and some patterns of family practice in southeastern Ontario.

Over a 7-month period the trial version of the International Classification of Health Problems in Primary Care (ICHPPC) was studied. Ten community physicians reported 28 399 encounters wtith 11 437 patients. The overall distribution of health problems was comparable to that found in other North American studies. Some differences between the morbidity distributions in urban and rural practices varies from those of previous Canadian studies. Other differences between practices appeared to be related to the interests and training of the individual physicians. The workload of the physicians varied considerably. Many of the encounters involved problems for which there may be minimal benefit from medical intervention, and there was a large discrepancy in the frequency of follow-up visits for specified stable chronic health problems. The implications of these interpractice variations in the altering field of health care are discussed.     

Beyond Critique: Rethinking Roles for the Anthropology of Mental Health

The current supremacy of the ‘bio-bio-bio’ model within the discipline of psychiatry has progressively marginalized social science approaches to mental health. This situation begs the question, what role is there for the anthropology of mental health? In this essay, I contend that there are three essential roles for the anthropology of mental health in an era of biological psychiatry. These roles are to (i) provide a meaningful critique of practices, beliefs, and movements within current psychiatry; (ii) illuminate the socio-cultural, clinical, and familial context of suffering and healing regarding emotional distress/mental illness; and (iii) act as a catalyst for positive change regarding healing, services and provisions for people with emotional distress/mental illness. My argument is unified by my contention that a credible anthropology of mental health intending to make a societal contribution should offer no opposition without proposition. In other words, any critique must be counter-balanced by the detailing of solutions and proposals for change. This will ensure that the anthropology of mental health continues to contribute critical knowledge to the understanding of mental suffering, distress, and healing. Such social and cultural approaches are becoming especially important given the widespread disenchantment with an increasingly dominant biological psychiatry.     

Nutritional psychiatry research: an emerging discipline and its intersection with global urbanization,environmental challenges and the evolutionary mismatch

In 21st-century public health, rapid urbanization and mental health disorders are a growing global concern. The relationship between diet, brain function and the risk of mental disorders has been the subject of intense research in recent years. In this review, we examine some of the potential socioeconomic and environmental challenges detracting from the traditional dietary patterns that might otherwise support positive mental health. In the context of urban expansion, climate change, cultural and technological changes and the global industrialization and ultraprocessing of food, findings related to nutrition and mental health are connected to some of the most pressing issues of our time. The research is also of relevance to matters of biophysiological anthropology. We explore some aspects of a potential evolutionary mismatch between our ancestral past (Paleolithic, Neolithic) and the contemporary nutritional environment. Changes related to dietary acid load, advanced glycation end products and microbiota (via dietary choices and cooking practices) may be of relevance to depression, anxiety and other mental disorders. In particular, the results of emerging studies demonstrate the importance of prenatal and early childhood dietary practices within the developmental origins of health and disease concept. There is still much work to be done before these population studies and their mirrored advances in bench research can provide translation to clinical medicine and public health policy. However, the clear message is that in the midst of a looming global epidemic, we ignore nutrition at our peril.     

Public Health Ethics and a Status for Pets as Person-Things

Within the field of medical ethics, discussions related to public health have mainly concentrated on issues that are closely tied to research and practice involving technologies and professional services, including vaccination, screening, and insurance coverage. Broader determinants of population health have received less attention, although this situation is rapidly changing. Against this backdrop, our specific contribution to the literature on ethics and law vis-à-vis promoting population health is to open up the ubiquitous presence of pets within cities and towns for further discussion. An expanding body of research suggests that pet animals are deeply relevant to people’s health (negatively and positively). Pet bylaws adopted by town and city councils have largely escaped notice, yet they are meaningful to consider in relation to everyday practices, social norms, and cultural values, and thus in relation to population health. Nevertheless, not least because they pivot on defining pets as private property belonging to individual people, pet bylaws raise emotionally charged ethical issues that have yet to be tackled in any of the health research on pet ownership. The literature in moral philosophy on animals is vast, and we do not claim to advance this field here. Rather, we pragmatically seek to reconcile philosophical objections to pet ownership with both animal welfare and public health. In doing so, we foreground theorizations of personhood and property from sociocultural anthropology.     

The emergence of biomedical anthropology and its implications for the future

Primarily during the past 15 years a distinct new area within physical anthropology has emerged, biomedical anthropology. Physical anthropologists have become heavily involved in studying problems of relevance to the health and illness patterns of living humans. There has been a proportionate increase in biomedically focused papers published in the American Journal of Physical Anthropology, in biomedically focused papers presented at annual meetings of the American Association of Physical Anthropologists, and in physical anthropology doctoral dissertations oriented toward modern biomedical phenomena. Proportionately more physical anthropologists are now employed in medical schools and there has been recent growth in the proportion of physical anthropologists in anthropology departments who claim some aspect of biomedical anthropology as a research interest. Increasingly, physical anthropologists are focusing their research on cardiovascular disease, the leading cause of death in America. These distinct trends are partially a result of the nature of physical anthropology and its unique biocultural perspective. However the growth of applied anthropology, the present academic marketplace, and the availability of research funds are probably also contributing factors. The emergency of biomedical anthropology holds promise for the future of physical anthropology and for its current employment crisis. Careers with academic and nonacademic organizations engaged in biomedical research appear to be a viable alternative to careers in departments of anthropology, for biomedical anthropologists. This will entail some reorientation of graduate training for physical anthropologists. More emphasis will have to be placed on substantive biomedical subjects, research methods, and data management and analysis.     

Race, Ethnicity, and Racism in Medical Anthropology, 1977–2002

Researchers across the health sciences are engaged in a vigorous debate over the role that the concepts of "race" and "ethnicity" play in health research and clinical practice. Here we contribute to that debate by examining how the concepts of race, ethnicity, and racism are used in medical–anthropological research. We present a content analysis of Medical Anthropology and Medical Anthropology Quarterly , based on a systematic random sample of empirical research articles ( n = 283) published in these journals from 1977 to 2002. We identify both differences and similarities in the use of race, ethnicity, and racism concepts in medical anthropology and neighboring disciplines, and we offer recommendations for ways that medical anthropologists can contribute to the broader debate over racial and ethnic inequalities in health.     

Race, ethnicity, and racism in medical anthropology, 1977-2002

Researchers across the health sciences are engaged in a vigorous debate over the role that the concepts of "race" and "ethnicity" play in health research and clinical practice. Here we contribute to that debate by examining how the concepts of race, ethnicity, and racism are used in medical-anthropological research. We present a content analysis of Medical Anthropology and Medical Anthropology Quarterly, based on a systematic random sample of empirical research articles (n = 283) published in these journals from 1977 to 2002. We identify both differences and similarities in the use of race, ethnicity, and racism concepts in medical anthropology and neighboring disciplines, and we offer recommendations for ways that medical anthropologists can contribute to the broader debate over racial and ethnic inequalities in health.     

2009 Society for Medical Anthropology Conference: Changing Anthropology,Changing Society

Fifty years after the founding of the field of medical anthropology, the Society for Medical Anthropology of the American Anthropological Association held its first independent meeting on September 24-27, 2009, at Yale University.Fifty years after the founding of the field of medical anthropology, the Society for Medical Anthropology of the American Anthropological Association held its first independent meeting on September 24-27, 2009, at Yale University in New Haven, Connecticut. The conference, Medical Anthropology at the Intersections, drew an international audience of more than 1,000 scholars.In her opening remarks, program Chair Marcia Inhorn noted that medical anthropology has been interdisciplinary since its inception. This assertion was supported at a roundtable discussion, Founding Medical Anthropology and the Society for Medical Anthropology, which featured four of the field’s founders.Asked to identify the factors that led to the development of medical anthropology, the panelists emphasized the role of changes in the practice and landscape of medicine in the late 1950s and early 1960s in the United States. According to Hazel Weidman, who helped spearhead the Society for Medical Anthropology, medical personnel sought social scientists’ guidance in the new clinical environments created by the increasing involvement of U.S. physicians in global development work and by the community-oriented approach to mental health encouraged by the Community Mental Health Act of 1963. The novel inclusion of lifestyle as a determinant of health at this time also played a role, according to Clifford Barnett. Norman Scotch, author of a 1963 review that had helped define medical anthropology as a field, noted that physicians at the time were very interested in the possible applications of the social sciences to medicine [1,2]. Joan Ablon recalled that this emphasis on application led some academic anthropologists to dismiss the medical anthropologist as a “handmaiden to the doctors.” Despite such resistance, interest in medical anthropology as a sub-field was clearly growing among anthropologists. When Weidman helped organize the first gathering of medical anthropologists at an anthropology conference in 1967, attendance was twice what was expected. Panel organizer Alan Harwood noted that the Society for Medical Anthropology transformed its newsletter into a professional journal, Medical Anthropology Quarterly, in 1983. According to Inhorn, the society has 1,300 members today.For the panelists, medical anthropology’s potential for application makes it a compelling scholarly pursuit. As Barnett stated in explaining his decision to work in anthropology: “If you know how a society works, you can change it.”     

Ethnomedicine in Tonga

Local medical practices in this Pacific archipelago are reviewed, the folk taxonomy and medicinal uses of 71 plants are discussed, and the medicinal applications of each species in some other regions of the Pacific are enumerated. Included are the plant parts used, Tongan names, the illnesses, and the preparations of the remedies.