Medical Anthropology Research Paper

Medical Anthropology Research Paper

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Medical anthropology refers to anthropology’s discipline that deals with diseases and health care systems. Cross-cultural, historical and evolutionary perspectives are used to study the contribution of cultural and biological factors to human health and disease. They study a variety health and health-care issues, including cultural barriers and prevention of disease, health crises, and pandemics. Medical anthropology can be applied to geography, economics and linguistics. It also includes biochemistry, genetics.

Three ways medical anthropology differs from other social sciences is:
1) It covers a greater geographical and temporal range of human experience from archaeological and paleontological research, to the ethnographic studies and modern-day health care system systems.
2) It seeks out the sociocultural factors and bioecological variables that are responsible for defining and characterizing health, illness, or disease.
It employs both quantitative and qualitative methods. Quantitative methods are used to identify patterns in disease, social patterns and other factors that influence health and disease. Qualitative methods are used to determine the cultural values and fundamental ways of living that make up the basis of a society’s health care system. They also help identify the relationship between society’s ideal, or normative culture (what people think things should be) and real culture (what people do).

THE HISTORY MEDICAL ANOPOLOGY

Four sources contributed to the foundation for medical anthropology were (1) biological Anthropology, (2) ethnographic Studies of Health Care Systems, (3) the Culture and Personality Movement of the 1930s/40s, and (4) The post-World War II International Public Health Movement, which has led a global consciousness about the impact of diseases on societies.

EARLY STUDS

THE EXOTIC
Early ethnographic studies that focused on non-Western societies’ medical traditions and health-care practices focused on magicoreligious beliefs. This included witchcraft, sorcery and religion. It also examined the relationship between health and sickness. The underlying causes of illness (natural or spiritual) and the types and methods of healing. E. E. Evans Pritchard’s Witchcraft, Oracles, and Magic Among the Azande (1937), a classic example is from this era. His research and other related studies provided insight into the cultural premise of medical knowledge, customs, rituals and roles of different practitioners (natural, supernatural, and occult).

William H. R. Rivers (1924), British psychologist and experimental psychoanalyst; Erwin H. Forrest Clements (22) was an anthropologist. Ackerknecht (1942 & 1971) is a physician and an anthropologist who were all important contributors to the early studies on health. These three scholars were heavily influenced by functional theory and historical diffusion, which were the predominant approaches of anthropologists in early 20th-century anthropology.

The classification system was established by Diffusionists for certain cultural domains (e.g.
etiology and cause of illness) as well as the subtypes (e.g. spiritual, natural, and occult). Once a domain has been defined, its subtypes can be used to identify cultural domains and trace their migration from geographic centers. Functional theory considered cultures to be a complex collection of individual parts that contribute to the overall society.

William H. R. Rivers (1924), is the first to attempt to connect the practice and culture of medicine. He presented a classification of cultural domains of the etiology of disease in a series of lectures to the Royal College of Physicians (1915-1916). The model was inspired by early 20th-century attempts in the 20th century to classify possible explanations for disease causality in primitive or traditional medicine. They were classified as religious or magical. Three types of disease can be caused by humans: (1) by the use of magic or sorcery by human agents; (2) by supernatural or spiritual agents such as deities or spirits breaking taboos; (3) by natural agencies or natural processes. He also linked perceived disease etiology and the type of treatment sought by the practitioner or curer.

Rivers’ (1924) findings were based upon two fundamental propositions. First, primitive medical practices do not follow random, unmeaningful, disconnected patterns. They are based on “definite theories concerning the cause of disease. . . [And are] both logically and systematized, and in some ways more rational than ours” (pp. 51-52). The second is that primitive medical practices and beliefs are social institutions, which can be subject to the exact same laws as other social processes and must be studied with the same methods. (p. 55). These revelations were in direct contradiction to the scientific view at that time. However, primitive medicine was not considered scientific due to the magicoreligious nature etiologies. Good, 1994. Rivers saw primitive medicine and modern medicine as two separate, incompatible entities of study in which magico-religious beliefs and practices of primitive medicine could not be considered in the same realm as naturalistic-scientific modern medicine (Wellin, 1977).

Forest Clements (1932), an Anthropologist, used a diffusionist approach to analyse non-Western medical beliefs. He identified five types of etiology, including sorcery. These traits were then distributed worldwide and the chronological sequences, paths of diffusion and geographic centers of each one were proposed. Clements’s contribution added credence and support to the idea of all cultures having systems that define diseases (see Wellin in 1977).

Erwin Ackerknecht (1942), has been credited with being one of the pioneers in medical anthropology. Functional theory was used to study ethnographic evidence of non-Western culture’s medical beliefs. British functionalists, Marcel Mauss (French sociologus), Boasian tradition, and Ruth Benedict, Columbia University, were all influences on him. Ackerknecht’s writings from the 1940s and the 1950s are part of Medicine and Ethnology. He looked at the cultural relativist perspective of how a disease’s perceived cause reflected social tension in a society. This included how the threat that one might be accused of sorcery or witchcraft causing the illness could serve as a powerful sanction to keep the status-quo from being altered.

Ackerknecht (1942), among the first to suggest that disease concepts can be culturally constructed. Clements was wrong in his focus on individual cultural traits, but he emphasized the whole cultural structure of a society. He didn’t see primitive medicine in a singular entity. Each culture had its own systems. The medical system was understood as an integral part or a group of parts that are interconnected with each other. Non-Western cultures saw disease as a product and result of customs. It was also divorced from the environment and its distribution. Wellin, 1977) also believed that primitive medicine was a separate entity to Western “scientific-based medicine”.

The study of human physical characteristics from a biological perspective.
Anthropologists who specialize in physical (biological), anthropology have helped to understand how culture and evolution affect human health. The biological approach examines the genetic, morphological and physiological variation of people who have lived in various environments. Their interests in human biology and genetics are similar to those of biomedicine. The study of “the spread of disease, physiological adaptations and health status” is a common interest for biological anthropologists and medical anthropologists (Brown 1997, p. Evolutionary theory focuses on understanding the history of disease and what it may have to do with current health issues. The second biological approach focuses on morphological and physiological variation as well as genetic variation among individuals living under different conditions.

CULTURE & PERSONALITY

In the 1930s and 1940s, anthropologists and psychiatrists joined forces to examine the interdependence of personality and sociocultural environments. A wide range of topics were investigated during this time: (a) the nature/nurture debate, (b) sibling rivalry, (c) instinct, (d) aggression, (e) culture-bound syndromes, (f) the cross-cultural applicability of Freud’s theory to mental illness, and (g) the universality of biomedicalpsychiatric categories (see Pool & Geissler, 2005).

This period saw a variety of studies. Some were more theoretically focused, while others were focused on improving the quality of health care. Ruth Benedict (1934) Patterns of Culture was a seminal theory work of the time. Benedict claims that each culture has its own personality traits, which are derived from the diversity of human potentialities. This creates the unique personality and character of that culture. Representative studies that focused upon improving health care included the Leighton (1941), which studied the introduction of modern health care to Navahos, and the Devereaux (1940), which examined therapeutic fitness on a schizophrenic ward. Joseph (1942), however, described how cultural differences between Indian patients and biomedical doctors in Southwest America impeded therapeutic interaction.

INTERNATIONAL PUBLIC-HEALTH MOVEMENT POST-WORLDWAR II

In the 1930s, and 1940s, international public-health anthropologists were first employed. To address public health problems, the United States formed partnerships with Latin American countries in 1942. The international public health movement that followed World War II was what helped to define the role of anthropology as a discipline in the study and management of diseases and health care systems. These projects focused on solving specific health problems within particular cultures. Rockefeller Foundation was among the first backers of public-health projects. They sponsored applied projects like Philips (1955), Ceylon hookworm campaign. After World War II, medical anthropology’s applied roots were strengthened by cooperation in foreign aid programs. The International Cooperation Administration ran the early programs. Later, it was administered by the United States Agency for International Development. Programs were designed to combat epidemics, improve water supply, and identify any obstacles or facilitators to aid programs’ success. It was also in the 1950s that anthropologists first held official positions at international health organizations.

Benjamin Paul’s edited collection Health, Culture and Community, case studies of public reactions to health programs (1955) is one of the most influential posts-World War II works. This work made a significant contribution towards the field and practice of applied anthropology. This study was designed to examine “the immediate environment where medicine meets community” (p. He used social science methods to study medical health care systems. His work showed that Western-based programs of medical intervention must consider the local beliefs surrounding how illness is defined and treated. He focused on how traditional health-related practices were influenced by the new medical system.
Caudill, in 1953, conducted a survey of anthropological study in the field in “Applied Anthropology in Medicine”. Scotch (1963) also contributed to the development and expansion of medical anthropology.

Several universals were discovered by medical anthropologists working in international public health. 38-47).

SOCIETY MEDICAL-ANTHROPOLOGY

The Society for Medical Anthropology has a short history. It can be found at the Society for Applied Anthropology Web website (www.sfaa.com), but also on the Medical Anthropology Website (www.medanthro.net). Although medical Anthropology began in the 20th-century, formal organizations such as the Society for Medical Anthropology were not formed until the 1960s. The Roster of Anthropologists. This was the name of the organization in the early days of the Society for Medical Anthropology. In 1967, the Organization of Medical Anthropology was established. The OMA hosted its first workshop at the American Anthropological Association’s 1968 Annual Meetings. It then changed its name to Group of Medical Anthropology. At the 1970 American Anthropological Association’s Annual Meetings (henceforth AAA), the OMA changed its name to the Society for Medical Anthropology. The Society for Medical Anthropology adopted its constitution and became an official AAA section. The AAA’s largest section today is the SMA.

Medical Anthropology Quarterly, Medical Anthropology, Culture, Medicine and Psychiatry, Social Science and Medicine, and Ethnomedizin, are the main journals associated with SMA. The SMA is closely associated with the Society for Applied Anthropology, the Association for Anthropology and Gerontology, the Society for the Anthropology of Food and Nutrition, and the Medical Anthropology Students’ Association.

Today’s topic of discussion is global health.
Medical anthropologists’ theories and practices have made a significant contribution to the theory and empirical understanding of culture, medical knowledge, practice, and medicine. Several basic themes and questions addressed by medical anthropologists today are (a) the development of systems of medical knowledge and health care; (b) the roles of healers in the well-being of societies through the study of patient-practitioner relationships and the relationships between different types of health practitioners; (c) the integration of alternative and complementary medical systems in culturally diverse environments; (d) the interactions among and impact of biological, environmental, and social factors on health and illness at both individual and community levels; (e) the impact of general political and economic forces on the health of individuals and communities and the interplay between social structures (e.g., political and economic arrangements), ecological settings, and disease-causing agents; and (f) the effects of biomedicine and biomedical technologies (www.en.wikipedia.org/wiki/ medical_anthropology).

BASIC TERMS AND CONCEPTS

Like any discipline, the definitions of jargon can differ from the lay definitions. Baer et al. (1997, pp.
4-12) discussed some of the basic concepts and terminology used in medical anthrology. This includes health, disease, illness and health care systems. The following is the definition of each term.

WHO defined health as “not only the absence or infirmity of disease or illness but total physical and mental well-being” in 1978 (Baer, 1997, p.4). Critical medical anthropologists argue that this definition is too narrow and should be expanded to include access and control over the basic materials and nonmaterials that sustain and support life at a high quality of satisfaction.

Medical anthropologists can distinguish between two types of disease: one is a medical condition that is caused by an infection or pathological condition, and the other is illness (sufferer’s experience). This is a culturally constructed definition of how people see a particular state of being abnormal from the norm (Baer et. al., 1997). 6-7). Brown (1998) noted that … 8-9). Brown (1998, pp.

Foster and Anderson (1978), pages. Foster and Anderson (1978, pp.

Each culture devises its own medical system to address the threats of disease. Specialists with specific knowledge that can diagnose and treat illnesses are called practitioners or curers. Medical pluralism refers to the coexistence of multiple medical systems within a single society (Baer and al. 1997, pp. 7-11).

Biomedicine, also called Western, Western, or scientific allopathic medicine, focuses on disease pathology and causes (e.g. germs, viruses and bacteria) and treatment. (Baer, 1997, pp. 11-13). Ethnomedicine can be defined as any culturally constructed system of health care for any society. Folk medicine and popular medicines are other terms that can be used to describe ethnomedicine. Until the turn of the 21st century, biomedicine and ethnomedicine were treated as separate systems with the scientific-biomedical approach seen as uniform, objective, and not culturally constructed. Lynn Payer (1988) studied biomedicine in England. She found that it is not a single system. However, biomedicine can be culturally constructed and may differ from one culture to the next.

What strategies are available?
Brown (1998), p. 2) provided an overview of two main approaches medical anthropologists use to address health care questions-the biocultural or cultural. Each approach has its own unique set of theoretical orientations and methods of research and analysis.

BIOCULTURAL AAPPROACH

The biocultural approach explores how people adapt and change their environment to improve or worsen health. The biocultural approach focuses on topics such as human evolution and disease, health and medicine and human biological variation.

CULTURAL AAPPROACH

Cultural approaches examine the beliefs, values, and underlying ideas that underlie the diagnosis and treatment of illness. The study covers belief systems and ethnomedical theories, as well the social production of sickness and healing in cross-cultural perspectives.

APPLIED AAPPROACHES

An applied medical anthropologist applies anthropological theory to solve specific medical problems. Medical anthropology has two main areas: clinical studies and health. Clinical studies have examined the differences between doctor and patient explanation models to improve communication.
Public health is the application area. It focuses on program development and policy making. 16-17).

Pool and Geissler (2005) noted that “applied medical anthrology” is designed to solve health problems in specific settings. . . . Theoretical medical ananthropology is intended to “understand the functioning and cultural phenomena of medical systems and formulate more general theories concerning their underlying processes” (p. 31).

THEORETICAL AAPPROACHES

There are many theories that can be used to study medical anthropologists. Byron Good (1994), Medicine, Rationality, and Experience. A Anthropological Perspective, discussed four theories: (1) The empiricist paradigm, (2) The Cognitive paradigm, (3) Meaning-centered paradigm, and (4) Critical paradigm. Ann McElroy (2009 in Medical Anthropology in Ecological Perspective), and Patricia Townsend (2009 in Medical Anthropology in Ecological Perspective), discussed four theoretical approaches. Joralemon (1999) identified the cultural constructivist or interpretive approach, the ecological or ecological/evolutionary approach, the critical medical approach, and the applied medical approach. Here are the main principles of medical anthropologists’ primary theoretical approaches.

ECOLOGICAL/EVOLUTIONARY THEORETICAL MEDICAL APPROACH

Before the 1960s, medical anthropology’s theoretical orientation was primarily based upon a sociocultural approach. The 1960s saw a shift in theoretical orientation to a more biological one. The ecological/evolutionary approach is a biocultural approach to the study of disease that applies the concept of human adaptation to the dimensions of disease. Studying how a population’s ecological and health systems interact with each other and their forms of adaptation gives us a way to look at how humans adapt in different environments.

Alexander Alland (1970), one the pioneers of this approach, believed that humans adapt or resist environmental challenges through genetic, physiological or cultural changes. The medical ecology approach is founded upon three principles. (1) Environmental adaptation is a measure to health; disease indicates disequilibrium. (2) Disease mirrors human biological, cultural, and social evolution. (3) Biomedical disease types are universal. McElroy & Townsend’s Medical Anthropology: An Ecological Perspective (1979) builds on Alland’s model and adds a politicalecological perspective. This approach is closely linked to the work of medical epidemiologists and ecologists (p. 3).

Critics of the ecological model have pointed out that it fails to recognize the influence of social relations on which cultural structures rise in power. Critical medical anthropologists ask two fundamental questions: (1) Whose interests and social realities are expressed in particular cultural constructs? (2) What historical realities led to their creation? They also criticize ecological approaches that focus on external realities and ignore the evolutionary history of hierarchical structures which have shaped the political economy of human societies (Baer et. al. 1997, p. 23).

COGNITIVE THORITICAL MEDICAL AAPPROACH

Farmer & Good (Pool & Geissler), pp. 34-35). Farmer and Good (Pool & Geissler, 2005, pp. This method examines the differences in cognitive processing between cultures. Early studies were focused on how symptoms, diseases, causes, and healing methods were classified and how these are organized relative to one another, including patterns of healthcare seeking. Cognitive anthropologists study the cultural models and cross-cultural variations of certain disorders as well as the level of consensus among people about them. Others focus on illness narratives and the cultural structures that underlie them. They examine the relationship between formal properties and natural discourse, context, or performance characteristics of illness representations.

The cognitive approach to illness representations is being criticized for not including historical and socio-cultural factors in the equation.
Cognitive anthropologists are criticized for not paying enough attention to the practical and performative aspects of illness models presented in formal, semantic terms. They also point out that cognitive anthropologists may not be aware of the actual methods used to elicit these models.

CULTURAL CUSTIVIST, CULTURAL INTERRPRETIVE, MEANING-CENTEREDMEDICAL APPROACH

The cultural-interpretive theoretical approach to medical anthropology began in the 1970s when Arthur Kleinman (1978, 1980) argued that medical systems were cultural systems and that “explanatory models” could best explain how illnesses are understood by all those who participate in an illness experience-the individual, the family, the practitioners. Cultural-interpretive anthropologists explore the cultural construction of illnesses and the responses to disease. Explanatory maps provide insight into how people perceive etiology. A person’s explanation model of an illness may be different from the one of a practitioner due to cultural, social, and ethnic differences. This can lead to miscommunication between patients and practitioners. Kleinman called for medical anthropologists working in clinical settings to help patients and doctors understand their illnesses.

Good (1994) said that the culturalinterpretive approach was developed in response to the ecological/evolutionary approach. The underlying difference between the two approaches is that the ecological approach treats disease as part of nature and is therefore external to culture, while the cultural-interpretive approach sees disease as an explanatory model or cultural construction of human reality. Cultural-interpretive researchers work with patients and practitioners in clinical environments in their investigation of explanatory models. This is different from cognitive researchers, who use formal elicitation methods for determining the underlying codes or structure of people’s perceptions of illness.

Mary-Jo Delvecchio Good & Byron Good invented the “meaning-centered method” for studying illness. It is based on the basic assumptions and methods of the interpretive approach. Good (1977) and Good and Good (1980, 1982) reported positive findings. “The meaning of illness is determined by-but not limited to-the network meanings that illness has in a specific culture.” (Good & Good 1980, p. 176).

Critical medical anthropologists cite interpretive and meaning-centered methods for failing to pay attention and the impact of power imbalances in clinical settings and on the maintenance and perpetuation of social dominance.

CRITICAL THEORETICAL AAPPROACH

Critical medical-anthropology combines Marxist theory with dependency theory in order to examine the effects of global political-economic systems and local and national health. Press (1990, page 1001) identified three main concerns of critical medical ananthropology. They were (1) How do capitalism, Western technology, and/or imperialism impact health care systems in third world countries. (2) What role does logistics play in the availability, allocation, access, and management of biomedical materials, both in industrialized and nonWestern nations? (3) What role does biomedicine play in spreading global capitalism?

Questions such as “What is critical medical anthropology?” are addressed by critical medical anthropology.
1) Who is in control of the biomedicine agencies?
2) In what form and how is this power delegated
3) How is this power expressed through the social relations between the various actors and groups that make up the health-care system?
4) What is the most significant contradiction in biomedicine and related arenas, of struggle and resistence that have an impact on the functioning of the medical and human systems? (Baer et al., 1997, p. 27).

Critical medical focuses more on the practice than on symbols and meaning. It promotes experiential health over functional health. Critical medical and socioeconomic anthropology examines the impact of wealth, power, status, and social class on the distribution and pattern of disease. They also challenge the assumptions behind the biomedical model of disease. It examines how illness representations and misrepresentations can strengthen the control over the powerful and wealthy as well the forms of resistance that are used by the suffering and distressed.
Critical medical anthropologists suggest that there should be four levels to power relations in order to analyze the delivery of health care services.
1) The macrosocial layer
2) The intermediate social layer
3) The microsocial layer, and
4) An individual who has a goal to synthesize the macrolevel as well as the middle and microlevels (Baer, 1990). 1011-1012).

Press (1990) is criticised for its lack of insight into “on and ground medical organization, patient interaction, and culture of patientshood in specific diseases or illnesses” (p.1001).

CRITICAL INTERRPRETIVE APPROACH

The critical-interpretive approach synthesizes the critical medical-anthropology approach and the explanatory model approach by incorporating a microlevel and macrolevel approach to understanding health care. While the explanatory models provide insight at the microlevel in patient beliefs, critical medical anthropology provides information on the political, economic, and social factors that affect health care. In the critical-interpretive approach, medical knowledge is not conceived of as an autonomous body but as rooted in and continually modified by practice and social and political change.

Nancy Scheper-Hughes and Margaret Lock (1987) challenged the nature of the biomedical separation of “mind from body, spirit from matter, and real from unreal” (p. 6) in their proposed critical-interpretive approach. Lock and Scheper-Hughes (1990) defined the task of critical-interpretive medical anthropology as first to “describe the culturally constructed variety of metaphorical conceptions (conscious and unconscious) about the body and associated narratives and then to show the social, political and individual uses to which these conceptions are applied in practice” (p. 44). Three ways are they able to identify the body:
1) The body’s individuality, or “body self,” and the vulnerability it experiences in sickness and health.
2) The social organism is the state in which nature, society, or culture are healthy. A healthy body means that it is an example of “organic wholeness”. If the body is sick, it can be considered a model if conflict, disintegration or disharmony.
3) The body politic refers to the regulation and surveillance of both the individual or collective body in “reproduction. Sexuality, work. leisure. sickness” Lock & Scheper Hughes, 1990, pp. 45-70).

What methods are available?
Medical anthropologists have a majority of their training in cultural anthropology. They use the theory, cultural approach, and research methods from anthropology to study health care. However, they also draw upon other social-behavioral science such as biology, psychology and nutrition. Qualitative research is based on multimethod data collection. This approach is sometimes called triangulation. Triangulation is a method that allows researchers to develop a comprehensive understanding of a phenomena by using multiple methods. This strategy enhances any research by adding rigor and breadth to it.

The traditional methods of qualitative work by anthropologists include participant observation, direct observation, key consultants interviews, in-depth interviews and focus groups. There were new methods available before the 21st-century, which allowed anthropologists quickly to assess the health of patients and their concerns.

Trotter (1991), described the rapid assessment methods. Rapid methods can be used “to identify key problems, cultural domains or health beliefs, as well as to provide support mechanisms to allow the project success” (p. There are three types of rapid-assessment methods:
1) those that help in determining what cultural domains are relevant to the health care industry (e.g.: free listings)
2) the ones used for determining the basic structural frameworks in cultural domains (e.g. scales, pile varieties, and triads).
3.) those that investigate the consensual qualities of a cultural realm (e.g., consensus-theory approach) (Trotter, 1991, pp. 187-188. See also Bernard, 1992; Gladwin 1989; Pelto and Pelto 1996; Young 1980.

CONCLUSION & FUTURE INSTRUCTIONS

Singer (1989) suggested that medical anthropologists integrate the four theories they use to address health care issues. Baer et al. Three of the main theoretical models were integrated in a breakthrough report by Baer et. al. Medical ecologists adopted a more politically-ecological approach. Interpretive medical analysts acknowledged and attempted to produce work that included economic and political considerations. Critical medical anthropologists became more conscious of the role of politics in the construction and maintenance of meaning.

Integration of the different medical-anthropological theoretical approaches provides three major benefits to the study of health care and to the understanding of the factors that affect diseases, the effectiveness of treatments and health care delivery from local communities to the global community. In particular, integration is an opportunity for medical-anthropologists.
1) To investigate the ecological, cultural, and biological factors that impact diseases and their treatment.
2) To consider the economic and political forces that impact disease patterns and access health care resources.
3) To allow for health-based interventions if necessary (Joralemon 1999, p. 12).

Multidisciplinary approaches to health research are possible in the 21st Century. Physician-anthropologist Cecil Helman (1994) called for future research to involve “adopting a much more global perspective-a holistic view of the complex interactions between cultures, economic systems, political organizations and ecology of the planet itself ” (p. 338). An interdisciplinarity approach is also important. Because medical anthropology recognizes that disease patterns and societies’ beliefs and values are interrelated, it can be used to complement epidemiology’s study into the distribution and determinants. Medical anthropology is a way to provide information about local culture and values for public health care programs. These insights can reduce barriers to intervention and encourage cooperation between biomedical and traditional practitioners. Anthropologists who work on international projects can provide insights into how international policies and programs affect health care delivery. A global, integrated, and multidisciplinary approach will be most effective in meeting global health care’s challenges.