John Porter, an epidemiologist, has said of anthropology: "The discipline concentrates on what is actually happening and looks to 'the root' of where things come from" Porter. Whether this 'root' at the level of social interactions between individuals, a cultural nuance or the macrocosmic structures that impact a given population, anthropological methods of investigation have proven reliable in identifying it. The third feature unique to the new medical anthropology making it a valuable contributor to public health practice is its freedom from the theories and views of western biomedicine.
Biomedicine, epidemiology and the other contributing sciences are inherently reductionist and hence have a very narrow scope in which to view the phenomenon of illness or epidemic.
Everything is expected to have an explanation grounded in biology or 'science'. Scheper-Hughes states that: "our work should be at the margins, questioning premises, and subjecting epistemologies that represent powerful, political interests to oppositional thinking" "Three Propositions" This type of oppositional thinking is important in generating new theories and in promoting necessary discourse to effectuate much needed change in public health systems.
To this day, one often hears allegations against anthropology for its past as the 'handmaiden' of colonialism.
Culture and Health: Applying Medical Anthropology
As a result of having to defend itself from these claims, the discipline has become very critical of hegemonic power structures that are involved in neo-colonial oppression of the afflicted and underprivileged. Biomedicine is a classic example of such a potentially oppressive structure.
Several accounts exist that describe how "the doctor has replaced the priest as the custodian of social values" Turner For example, one author writes a detailed account of how the Public Health institution in the Philippines functions as an emissary of the state in subjecting people to foreign practices in order to effectuate control and domination over the public Anderson.
Anthropology's inward looking critical perspective of medicine and public health makes the data that it generates very important to the development of further policy. Scheper-Hughes states that it is "imperative to position ourselves squarely on the side of human suffering" "Three Propositions" Anthropologists have gone from being the handmaidens of colonial power to advocates for the afflicted and suffering.
Many of the other sciences that contribute to health policy share biomedicine's mechanistic paradigm. Criticism is necessary to stimulate improvements in structures or programs that are already firmly entrenched. Critical medical anthropology is able to provide this unique perspective to the field of public health. In order to remain in a good position to criticique biomedicine, it is important that anthropology maintain its distance from the biases and philosophies of western medicine.
Many medical anthropologists remain critical of anthropological research that is funded by interests vested in biomedicine. This type of funding arrangement prohibits a fully critical interpretation and thus "compromises what anthropology has to offer as a discipline" Parker and Harper 2. The fourth significant contribution that anthropology makes to the development of public health policy is its qualitative approach to data collection.
This is also unique to anthropology among all of the sciences that inform public health policy. The qualitative methodology of ethnography separates anthropology from all of the natural sciences and many of the social sciences. Ian Hacking explains why qualitative data is so important in his critique of statistical data: "The fetishistic collection of overt statistical data about a population has as its motto 'information and control' but it would more truly be 'disinformation and mismanagement'" His premise is that quantitative analysis requires extensive categorization.
Many of the categories that are used are in essence constructs of the investigators and do not even exist in the worldview of the informant.
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This creates a false perception of reality in the minds of policymakers that cannot be avoided through structured, quantitative analysis. A similar critique was voiced by Parker and Harper, about supposed qualitative research conducted by many traditionally quantitativelyoriented social scientists. Heavy reliance upon pre-designed questions, combined with spending limited periods of time in the field, inevitably structures the 'qualitative' in terms defined by the researcher rather than the researched; and this may well be at the expense of understanding the very people they seek to assist 3.
Culture and Health: Applying Medical Anthropology
True ethnographic data strives to sidestep these misunderstandings and misrepresentations by coming to an understanding of the worldviews of its participants. This is in contrast traditional public health research, which imposes a foreign view upon informants, or counts them and in doing so categorizes them into culturally constructed groups that support the researchers' own agenda.
Harper states: "one of the best ways to understand a situation is to spend extended periods of time interacting with those involved" Before appropriate policy can be developed it is crucial to gain a solid understanding of the situation and more importantly, how those affected think and feel about the situation. This understanding can only be gained through ethnographic inquiry.
Porter explains the importance of qualitative ethnographic research in policy development through the use of the statistical concept of the outlier. He states that as an epidemiologist, outliers skew data in ways that don't seem to make sense. Therefore oftentimes epidemiologists will seek for rational, explainable reasons to exclude outliers from datasets. He goes on to explain that it is important to look "for ways of supporting the outlier to speak" He has found that narratives derived through qualitative anthropological research methodologies allow him to discover this voice - the voice of "those who are normally unheard in the current international political climate" Thus far, this article has sought to underscore the importance of the development of the critical perspective in medical anthropology.
As has been described above, this is a crucial component of medical anthropology's contribution to public health. Despite anthropology's strengths outlined above, a common critique of CMA is that it is overly idealized and not in line with the realities of the world. However, Peacock states that "pragmatism and searching critique need not be mutually exclusive" Rylko-Bauer et al. They claim that "practice is part of the discipline's destiny and needs to be at the centre of discussions about anthropology's future" They not only stress how important it is for anthropology to take a practical stance, but further elaborate how such is possible:.
The discipline of public health is at the point of making a major decision, largely because of a publication known as the Black Report, which showed a very strong correlation between the income and health of a population Hamlin. Public health remains at a crossroads. The choice is between a narrow focus on health service issues and the health problems of individuals on the one hand, or a refocus on the major underlying causes of population health on the other.
Beaglehole and Bonita Anthropology is well-positioned to play a key role in the informing of health policy to address these issues. This article has focused on the changes that have occurred in medical anthropology and the anthropology of public health that allow it to be a modern and significant contributing discipline to public health policy development. Critical medical anthropology has the potential to be a great force towards informing public health policy that is focused on the macro-level underlying causes of poor health in a population.
Anthropology's distinct character as integrated, critical, holistic and qualitative makes it a very potent force in encouraging public health policy in a similarly critical direction. National Center for Biotechnology Information , U. Journal List Mcgill J Med v. Mcgill J Med. Author information Copyright and License information Disclaimer. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License, which permits for noncommercial use, distribution, and reproduction in any digital medium, provided the original work is properly cited and is not altered in any way.
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Farmer further elaborated on this issue: Scholars often weaken their contributions to an understanding of infectious diseases by making "immodest claims of causality. A - Integrated Perspective of Culture When striving to understand disease etiology among a given population, public health specialists and human ecologists often use a 'multifactorial model of disease' Curnow and Smith. Beaglehole and Bonita Anthropology is well-positioned to play a key role in the informing of health policy to address these issues. Anderson Warwick. Critical Inquiry.
Baer Hans. Social Science of Medicine. Beaglehole R, Bonita R. Public Health at the Crossroads: Achievements and Prospects. Instead, culture-bound syndromes are somatic , meaning they are physical manifestations of emotional pain. The existence of these conditions demonstrates the profound influence of culture and society on the experience of illness. Anorexia is considered a culture bound syndrome because of its strong association with cultures that place a high value on thinness as a measure of health and beauty.
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When we consider concepts of beauty from cultures all over the world, a common view of beauty is one of someone with additional fat. This may be because having additional fat in a place where food is expensive means that one is likely of a higher status. In societies like the United States where food is abundant, it is much more difficult to become thin than it is to become heavy.
Although anorexia is a complex condition, medical anthropologists and physicians have observed that it is much more common in Western cultural contexts among people with high socioeconomic status. In a contemporary context, anorexia may address a similar, but secular desire to assert self-control, particularly among teenagers.
During her research in Fiji, Anne Becker noted that young women who were exposed to advertisements and television programs from Western cultures like the United States and Australia became self-conscious about their bodies and began to alter their eating habits to emulate the thin ideal they saw on television. Anorexia, which had been unknown in Fiji, became an increasingly common problem.
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