Anthropology, Medical
Anthropology, Medical
ORIGINS OF MEDICAL ANTHROPOLOGY
Medical anthropology is the subdiscipline of anthropology that focuses on the intersection of health, medicine, society, and culture. Generally thought to include the study of the impact of disease on society and the impact of society and culture on health and disease, medical anthropology encompasses several different paradigms for research, including biocultural anthropology; ethnomedi-cine; social and cultural factors in the incidence, prevalence, and treatment of disease, or social epidemiology; the political economy of health; and the inclusion of cultural and social concerns in the planning, implementation, and evaluation of projects, which is the core of applied medical anthropology.
ORIGINS OF MEDICAL ANTHROPOLOGY
In 1978 George Foster and Barbara Anderson, following Khwaja Hassan (1975), suggested that the field of contemporary medical anthropology has four distinct roots that came together in the mid-twentieth century to form a recognized subfield of inquiry: the interest in variation in human morphology and paleopathology that began in the mid-nineteenth century, carried out in part by anatomists and early physical anthropologists; the culture and personality movement, or psychological anthropology, that began in the early twentieth century as both an offshoot of and a critical alternative to Freudian psychology but gained strength during World War II because of increasing interest in understanding the psychological makeup of the different cultures involved in that conflict; the study of ethnomedicine, which began as part of ethnography in the nineteenth century but became a focus of study for culturally oriented medical anthropologists after the posthumous publication of W. H. R. Rivers’s Medicine, Magic, and Religion in 1924; and the applied anthropology of public health, which arose from the post–World War II interest in improving health practices and introducing biomedicine in developing countries. The continuation of these themes can be seen in contemporary medical anthropology in the form of bio-cultural anthropology, ethnomedicine, critical medical anthropology (CMA), applied medical anthropology, and psychological anthropology.
REVIEWS AND ORGANIZATIONS
The first review that addressed the subfield was William Caudill’s 1953 article “Applied Anthropology in Medicine.” As the title suggests, it was a review of the inclusion of anthropological concepts and ethnographic methods in medical settings, or in medical sociologist Robert Straus’s terms, social science in medicine (1957). The first review article with the title “Medical Anthropology” was published by Norman Scotch in 1963 and was more comprehensive in its approach. Subsequent reviews by Horacio Fabrega in 1971 and Anthony Colson and Karen Selby in 1974 continued to debate the nature of the field, with the latter article discussing whether medical anthropology constituted a subfield of anthropology or the intersection of anthropology and medicine.
By the mid-1970s, however, there was a well-organized association representing the field of medical anthropology that embraced the full range of work by people who called themselves medical anthropologists. The Society for Medical Anthropology (SMA) started as the Steering Committee for the Organization of Medical Anthropology, which began publication of the Medical Anthropology Newsletter (MAN) in 1968. MAN later became the Medical Anthropology Quarterly (MAQ). In 1987 MAQ achieved status as a peer-reviewed quarterly journal that publishes across the full range of research in medical anthropology.
PHILOSOPHIES AND THEORIES
Biocultural anthropology draws heavily on the work of the neoevolutionary theorists of the mid-twentieth century and the adaptation paradigm that entered medical anthropology in the 1970s after the publication in 1970 of Alexander Alland’s Adaptation in Cultural Anthropology: An Approach to Medical Anthropology. It includes anthropologists trained in cultural anthropology and those trained in biological anthropology and generally examines the way in which adaptation to particular physical and social environmental conditions shapes the experience of disease and illness in societies and the ways in which society adapts to challenges presented by disease. It also involves researchers working in human biology, and early interest among physical anthropologists and anatomists in paleopathology is represented currently by forensic anthropology. Biocultural anthropology has been criticized by writers with a CMA perspective for its failure to assess the assumptions in the adaptation/neoevolution-ary theoretical framework critically. However, current theorists such as Goodman and Leatherman (1998) and Andrea Wiley (2004) have attempted to include a political economy approach in biocultural anthropology.
Critical medical anthropology and the political economy of health approaches draw heavily on the work of Marxist and later poststructural social theorists such as Michel Foucault (1975). The central project of CMA is a critical examination of the assumptions and practice of biomedicine, their application in medicine and health policy, and the diffusion of biomedical understandings to non-Western settings, in Straus’s terms, social science of medicine (or ethnomedical systems). Drawing on the work of Rudolf Virchow, it also can include the application of theory from political economy to the understanding of the distribution of health and illness. Key books in this area include the works of Paul Farmer (1999, 2003), Merrill Singer (2006a, 2006b), and Nancy Scheper-Hughes (1992) and more comprehensive works such as Medical Anthropology in the World System (Baer, Singer, and Susser 2003).
Applied medical anthropology has its roots in the international public health movement that gained momentum after World War II. One of the first series of studies of the role of ethnomedical beliefs in the adoption of public health practices and biomedical treatment was carried out by anthropologists working for the Smithsonian Institution’s Bureau of American Ethnology under contract to the Office of Special Studies, which later became the U.S. Agency for International Development. Some of this work is summarized in Health, Culture, and Community, edited by Benjamin Paul (1955), which argued for the inclusion of the study of ethnomedical beliefs in the design and implementation of public health programs. A number of anthropologists have worked with bilateral and multilateral health organizations such as the U.S. Agency for International Development and the World Health Organization. Interest in the study of non-Western medical systems also has been incorporated, including Mark Nichter’s work on ethnomedical systems and medical change (1989, 1992). The line dividing primarily theoretically oriented and primarily applied research has become blurred. Several critical theorists, such as Merrill Singer and Paul Farmer, are deeply involved in the design and implementation of interventions and use a political economy approach to understand the epidemiology of disease and illness.
SEE ALSO Anthropology; Anthropology, Biological; Disease; Ethno-epidemiological Methodology; Foucault, Michel; Marxism; Medicine; Poststructuralism
BIBLIOGRAPHY
Alland, Alexander. 1970. Adaptation in Cultural Evolution: An Approach to Medical Anthropology. New York: Columbia University Press.
Baer, Hans A., Merrill Singer, and Ida Susser. 2003. Medical Anthropology and the World System. 2nd ed. Westport, CT: Praeger.
Caudill, William 1953. Applied Anthropology in Medicine. In Anthropology Today: An Encyclopedic Inventory, Prepared under the Chairmanship of A. L. Kroeber, ed. Alfred L. Kroeber, 771-791. Chicago: University of Chicago Press.
Colson, Anthony C., and Karen E. Selby. 1974. Medical Anthropology. Annual Review of Anthropology 3: 245-262.
Ember, Carol R., and Melvin Ember. 2003. Encyclopedia of Medical Anthropology: Health and Illness in the World’s Cultures, vols. 1 and 2. New York: Kluwer Academic/Plenum Publishers.
Fabrega, Horacio, Jr. 1971. Medical Anthropology. Annual Review of Anthropology. 167-229.
Farmer, Paul. 1999. Infections and Inequalities: The Modern Plagues. Berkeley: University of California Press.
Farmer, Paul. 2003. Pathologies of Power: Health, Human Rights, and the New War on the Poor. Berkeley: University of California Press.
Foster, George M., and Barbara Gallatin Anderson. 1978. Medical Anthropology. New York: Wiley.
Foucault, Michel. 1975. Birth of the Clinic: An Archaeology of Medical Perception. New York: Vintage.
Goodman, Alan, and Thomas Leatherman, eds. 1998. Building a New Biocultural Synthesis: Political-Economic Perspectives on Human Biology (Linking Levels of Analysis ). Ann Arbor: University of Michigan Press.
Hassan, Khwaja Arif. 1975. What Is Medical Anthropology? Medical Anthropology Newsletter 6 (3): 7-10.
Nichter, Mark. 1989. Anthropology and International Health: South Asian Case Studies. Dordrecht, Netherlands, and Boston: Kluwer Academic Publishers.
Nichter, Mark, ed. 1992. Anthropological Approaches to the Study of Ethnomedicine. Yverdon, Switzerland, and Langhorne, PA: Gordon and Breach Science Publishers.
Paul, Benjamin D., ed. 1955. Health, Culture, and Community: Case Studies of Public Reactions to Health Programs. New York: Russell Sage Foundation.
Rivers, W. H. R. 1924. Medicine, Magic, and Religion: The Fitz Patrick Lectures Delivered before the Royal College of Physicians of London. New York: Harcourt Brace.
Scheper-Hughes, Nancy. 1992. Death without Weeping: The Violence of Everyday Life in Brazil. Berkeley: University of California Press.
Scheper-Hughes, Nancy, and Margaret Lock. 1987. The Mindful Body: A Prolegomenon to Future Work in Medical Anthropology. Medical Anthropology Quarterly, New Series 1: 6-41.
Scotch, Norman A. 1963. Medical Anthropology. Biennial Review of Anthropology 3: 30-68.
Singer, Merrill. 2006a. The Face of Social Suffering: Life History of a Street Drug Addict. Long Grove, IL.: Waveland Press.
Singer, Merrill. 2006b. Something Dangerous: Emergent and Changing Illicit Drug Use and Community Health. Long Grove, IL: Waveland Press.
Straus, Robert. 1957. The Nature and Status of Medical Sociology. American Sociological Review 22: 200-204.
Trostle, James A. 2004. Epidemiology and Culture. Cambridge, U.K., and New York: Cambridge University Press.
Wiley, Andrea S. 2004. An Ecology of High-Altitude Infancy: A Biocultural Perspective. Cambridge, U.K., and New York: Cambridge University Press.
Kathleen Musante DeWalt