MEDICAL ANTHROPOLOGY

Ben Villareal III

Anthropology:The Four Subfields

ANTHROPOLOGY

PHYSICAL ANTHROPOLOGY

ARCHCAEOLOGY

CULTURAL ANTHROPOLOGY

ETHNOLOGY

LINGUISTIC ANTHROPOLOGY

The word anthropology stems from the Greek words anthropo, meaning “human being” or “humankind”

and logia, translated as “knowledge of” or ‘study of.

Thus, we can define anthropology as the systematic study of humankind.

Culture

Culture is a fundamental concept within the discipline of anthropology.

Culture...is that complex whole which includes knowledge, belief, arts, morals, law, custom, and any other capabilities and habits acquired by man as a member of society.(1871, E.B.Tylor)

In the past, anthropologist attempted to make a simple distinction between culture and society.

Society was said to consist of the patterns of relationships among people within a specified territory, and culture was viewed as the byproducts of those relationships.

Now, many anthropologist have adopted the hybrid term sociocultural sytem-a combination of the terms society (or social) and culture—refer to what used to be called “society” or “culture”.

“To future generations of health care professionals and

medical social scientists—that they may better understand

the roles of culture in health and well-being, and in

the care of patients and prevention of disease.”

APPLIED MEDICALANTHROPOLOGY

AND HEALTH CAREPart 1

LEARNING OBJECTIVES■ Introduce how culture affects health■ Illustrate how anthropological perspectives can facilitate effective health care■ Introduce the nature of cultural competence in health care■ Illustrate medical anthropology’s major applications in addressing cultures’impacts on health■ Illustrate the broad range of concerns people have with respect to their health

Medical anthropology is the primary discipline

addressing the interfaces of medicine,culture, and health

behavior and incorporating

cultural perspectives into clinical

settings and public health programs.

Health professionals need knowledge of culture andcross-cultural relationship skills because health services are more effective when responsiveto cultural needs.

Cross-cultural skills also are important in relationships among providersof different cultures when, for example, African American and Filipino nursesinteract with each other or with Anglo, Hispanic, or Hindu physicians.

Culture, involves the learned patterns of shared group behavior. These learned shared behaviors are the framework for understanding and explaining all human behavior.

According to Durch, Bailey, and Stoto (1997),

“Improving health is a sharedresponsibility of health care providers, public health officials, and a variety of other actors in the community.” This requires people with an ability to engage communitiesin a culturally appropriate manner and understanding of their cultural systems, health beliefs, and practices.

AREAS OF MEDICAL ANTHROPOLOGYPUBLIC HEALTH

1. Design primary health care programs and coordinate community development2. Develop immunization, family planning, and infant and maternal health programs3. Introduce oral rehydration and immunization programs4. Develop culturally based drug abuse rehabilitation and prevention programs

5. Perform health education and preventive medicine6. Perform epidemiological studies and community assessments7. Provide health policy analysis and advocacy8. Supply international health and international medical relief (aid)9. Perform health systems integration (traditional and modern)

What do health professionals—

providers, researchers, social service personnel,

educators,and other “helping

professionals”—need to know about the

effects of culture onhealth?

They all need systematic ways of studying cultural effects on health and developingcultural competence.

Cultural responsiveness is necessary for providers, researchers, and educators if they are to be effective in relating to others across the barriers of culturaldifferences.

The cultural perspectives of medical anthropology are essential for providingcompetent care, effective community health programs, and patient education.

For biomedicine to be effective, providers need to know whether a patient views the physician as believable and trustworthy, the diagnosis as acceptable, the symptoms as problematic, and the treatment as accessible and effective.

for example, through producing environmental contamination,work activities, contact with animals, sexual practices, diet, clothing, hygienicpractices, and others.

Ethnomedical studies (see Bannerman, Burton, and Wen-Chieh, 1983) reveal thathealth problems and treatments are conceptualized within cultural frameworks. Culturedirectly affects the manifestations of conditions, their assessment and social implications,and processes of treatment.

Ethnomedical analyses show the importance of understandinghealing from the cultural perspective of the group, their social dynamics, the socialroles of healers, and the conceptual and cosmological systems (Rubel and Hass, 1990).

Many contemporary U.S. health issues illustrate underlying cultural dynamics:■ Death due to lifestyle (e.g., poor diet and alcohol and cigarette use)■ Political decisions that leave major segments of the population without healthservices■ The spread of infectious diseases through immigration and lifestyles■ Pharmaceutical companies and physicians’ groups lobbying Congress for legislationto deny U.S. citizens access to foreign medicines

CONCEPTS OF HEALTH

What is health?

Conceptions of what constitutes health vary widely.

This book takes Durch and colleagues’ (1997) perspective that health involves not only physical, mental, and social well-being but also the ability to participate in everyday activities in family, community, and work, commanding the personal and social resources necessary to adapt to changing circumstances.

Ancient meanings of health implicating the sacred (holy, hallowed) illustrate a broad range of concerns still attested to in contemporary ethnomedical systems: wholeness,morality, wickedness, spiritual crises, soul loss, possession, bewitchment, and other maladiesthat afflict humans.

To some people, health is a general sense of well-being, “feeling good.” For others, health includes the expectations that they will not become ill or will beable to recover quickly. For most, health involves the ability to do what they want to do, with one’s body not presenting difficulty in normal activities. For some, health has moral connotations, with disease the consequence of immorality. People’s prominent concerns with health generally encompass physical, psychological, emotional, and spiritual dimensions of well-being.

Etymological Views of HealthThese wider concerns of health are reflected in ancient root meanings of “heal,” “disease,” “sickness,” and “illness.” Heal means “To restore to health . . . to set right, amend. . . . To rid of sin, anxiety or the like. . . . To become whole and sound”. Heal is derived from the Indo-European root kailo -, which means“whole,” “holy,” and “good men”; Old English derivative forms include “holy,” “hallowed,” and “whole.” Disease has its root meaning in “ease” and means a reversal of ease.Sick, meaning “ailing, ill, unwell,” “mentally ill or disturbed,” also refers to suffering or deeply affected by emotions, mental affliction, or corruption. Sick is derived from the Indo-European root seug -, meaning “troubled” or “sad.”

The linguistic roots of ill in the Middle English ill(e) mean “bad” or “sickness of body or mind”; older meanings emphasized evil andwickedness, still reflected in its use to refer to evil, hostile intentions, wrongdoing, wickedness, sin, and disaster.

The responses to health maladies represented in the concepts of medicine and care also reflect broader concerns.

Medicine derives from the Latin medicina and the Indo-European root med -, which means “to take appropriate measures.”

Cure means “restoration of health” from the Indo-European root cûra, “care” cure also has ecclesiastical or religious significance, meaning “spiritual charge or care of souls, as of a priest for his congregation,” from the Medieval Latin curatus,“one having spiritual cure or charge”.

World Health Organization’s Concept of Health The World Health Organization (WHO) characterized health as complete physical, mental, and social well-being and the capability to function in the face of changing circumstances. The WHO also emphasized the “highest possible level of health” that allows people to participate in social life and work productively (World Health Organization, 1992).

Health involves social and personalresources in addition to physical conditions; a sense of overall well-being derived from work, family, and community; and other relations, including psychosocial and spiritual(Durch et al., 1997).

Some consider the WHO definition to also have problems. Can people be healthy when others suffer from inequality and a lack of resources?

What about emotional, spiritual, moral, and metaphysical effects on one’s sense of well-being?What about one’s sense of ill health from environmental circumstances, war, injustice, and violence?

Would it make you feel sick to know that children were being massacred and tortured in a nearby country by extremists? Others’ pain can be our own.

Critical Medical Anthropology Concepts of Health

Critical medical anthropology adopts perspectives on health that emphasize the importance of access to resources necessary for sustaining life at a high level of satisfaction.

Health is analyzed from the perspectives of the societal factors that affect the distribution of health resources and threats to health (e.g., environmental contamination). Health conditions are affected by political decisions regarding resources for immunizations provided for care, access to care and nutrition, and exposure to environmental conditions and socially produced risks such as poverty and crime.

The recognition of health effects in social, economic, and environmental factors force attention to be paid to the interactions of biological and social conditions.

Multiple environmental interactions, including a range of economic, social, political, and ideological influences, mold the interactions at the microlevel of interpersonal dynamics of community and family that consequentlyshape an individual person’s physiological conditions.

PUBLIC HEALTH CONCEPTS OF HEALTH

Public health models (see Healthy Communities2000: Model Standards [American Public Health Association, 1991] and the AssessmentProtocol for Excellence in Public Health [see Durch et al., 1997]) emphasize communityinvolvement as key to a conceptualization of health. Healthy communities havehealth institutions that are accountable, incorporating community involvement fromplanning stages through implementation and evaluation activities.

Community health includes services provided (treatment, immunizations) and standard performance measures. Because availability of care is a major aspect of community health, health includes the capacity of the community’s health institutions to respond to potential health problems. Responsiveness requires thathealth institutions understand cultural and social effects on health, incorporate communityperspectives on needs and desired services, and assess perceptions of the quality of services.

EXPERIENCE OF MALADIES

Threats to health are discussed as a malady , an umbrella term for unwanted health conditions that encompasses many concerns about compromisedwell-being. Many things cause health maladies: “germs” such as bacteria, virus, and fungi;our behaviors, such as smoking, drinking, and overeating; our psychological concerns, suchas worries, depression, and anxiety; and even others’ behaviors, such as assaults or vehicularmanslaughter.

Different kinds of maladies such as disease, illness, and sickness are consideredsynonyms in English, but there are important distinctions among them in medicalanthropology.

CULTURAL MODELS FOR HEALTH ASSESSMENT

Part II

LEARNING OBJECTIVES ● Present cultural systems models as bases for understanding cultural influenceson health.

● Differentiate aspects of cultural systems to emphasize material, social, and mental influences on health.

● Present different ideological aspects of culture that can be used to enhancehealth, particularly religious healing approaches that provide healing and care.

● Introduce evaluation procedures for ascertaining health needs and programeffectiveness.

Culturally responsive care requires attention to many cultural effects on health. Medicalanthropology, medicine, transcultural nursing, public health, and social work address culturethrough similar approaches that involve cultural systems models.

While sharing core elements,these models also have variation reflecting context- and task-specific differences in the particular aspects of health on which they focus.

Culture, the patterns of shared group behavior transmitted between generations throughlearning, provides the core conceptual framework for understanding all of human behavior, including health behavior.

The effects of culture are found throughout human life, beginning with basic survival functions and structuring of interactions with the physical environment.

Culture affects health through what we eat, how we protect and expose ourselves, patterns of sex and procreation, our hygienic practices, how we bond together, and lifestyle behaviors.

Culture produces risk factors, conditions associated with an increased likelihood of diseases, such as smoking cigarettes or eating poorly cooked meats or the blood of animals.

Culture also provides systems that humans use as protective factors that reduce disease risks, such as hygienic rituals of bathing and purification and prohibitions of sex outside of marriage and good food.

Cultural conditions are basic to producing the health problems and what we do about them.

Culture guides the experience and management of health conditions through the classification of the condition and treatments available. For example, biomedicine might diagnose a cold and provide you with a decongestant, whereas an ethnomedical healer might consider you to have excess dampness and prescribe a tea to heat up your lungs.

1. To examine the ways that culture affects health, medical anthropologists, physicians, nurses, and public and community health practitioners (e.g., Brody, 1973; Engel, 1977, 1980; Blum, 1983; Leininger, 1991, 1995; Baer et al., 1986; Sallis and Owen, 1998) have proposed similar conceptual frameworks.

These systems models address health and disease in relationship to the ecology, the total physical and social environments.

These models incorporate demographic, technological, economic, political, and other social conditions that affect the physical environment. They also describe specific areas of cultural systems affecting health.

2. Cultural systems perspectives prominent in community health include the “environment of health” or “force-field paradigm” (Blum, 1983; Evans and Stoddart, 1994) that views health as a product of the relationships among many subsystems or fields, emphasizing

■ The physical environment, including sanitation, housing, environmental toxicity, and the physical infrastructure (roads, water, transportation)

■The social environment, including family, work, class, education, and social networks

■ Individual behavior, especially aspects of lifestyle that link people to the environment

■ Medical care services, part of the social environment with a special role in health

■ The genetic and biological levels

These interdependent subsystems affect one another, operating through naturalresources, the population and its ecological balance, and cultural systems mediatinghuman interaction with all of the force fields: resources, social networks, and medicalservices.

CULTURAL INFRASTRUCTURE, STRUCTURE, AND SUPERSTRUCTURESystems models help reveal the regularly occurring features of cultural and social life by providing a metatheoretical perspective for examining group influences on individualbehavior.

Harris (1988) characterized the cultural system as entailing three major aspects:

Infrastructure: institutions that mediate relations to the physical environment such asroads, sanitary water, and housing

Structure: social relations with others such as families and community networks

Superstructure: behaviors and ideas or mental representations, such as beliefs aboutthe causes of diseases and the best means of treating them

Major Aspects of Cultural SystemsCultural System

Level Function Activity

Superstructure

Mental Ideology, beliefs,

meaning

Communication

Structure Social Social organization

Interpersonal relations

Infrastructure

Material Technology, economy

Behavior

COMMUNITY HEALTH ASSESSMENT

The development of effective health programs requires resources—physical and intellectual—to engage community involvement, beginning with planning stages and continuing through healthprogram implementation and evaluation activities.

Community involvement is necessary because effectiveness must be measured in goals specific to the particular community and its circumstances. Because improving the community’s perception of its health is part of public health goals, determining community views of desirable improvements in its health is part of an evaluation.

The health of a community is a function not only of biological disease rates but also of quality-of-life concerns based on cultural values and expectations.Community approaches are central to health because they reflect social expectationsregarding quality of life.

A variety of models exist for community involvement in the implementation ofhealth improvement programs (e.g., Healthy People, 2010 [National Center for HealthStatistics, 2000]; Healthy Communities, 2000: Model Standards [American PublicHealth Association, 1991]; Assessment Protocol for Excellence [in Public Health; APEX]; Planned Approach to Community Health); Community Oriented Primary Care;and Healthy People and Cities programs [see Lasker et al., 1997; Durch et al., 1997]).

The APEX model focuses on the following steps:Community Process Steps■Assess organizational capacities for community relations and organization■Collect and analyze health data■Form community health committee to identify, prioritize, and analyze community health needs■ Inventory community health resources■ Develop and implement community health

plan■ Monitor achievement of health goals

Implementing Model StandardsThe following steps are critical for implementing model standards:■ Assess agency capacity for community engagement■ Develop agency capacity-building plan■ Assess community organization and structures■ Organize community members in health coalitions

■ Assess community health needs■ Determine community priorities and health resources■ Select outcome objectives■ Develop intervention strategies■ Implement intervention strategies■ Conduct continuous monitoring and evaluation

A variety of methods are used to assess and adapt to community and cultural factors in assessing health care issues (Brownlee, 1978):■ Practicing direct personal involvement in doing the research■ Building personal relations and involving community members■ Finding a confidant who can help bridge the culture gap■ Understanding the other culture, particularly its differences, as normal■ Utilizing community resources and networks

■ Observing and listening before asking and acting■ Finding out if any special rules of protocol need to be followed■ Getting to know local leaders: residents who are widely respected■ Talking to ordinary workers and community people■ Getting to know the patients, the recipients of care

■ Learning through participating, observing, and informal conversations■ Determining cultural attitudes toward questioning and adapting questions to the culture■ Learning how to interview within the local area■ Learning when to ask questions and what questions not to ask

CREATIVE ASSESSMENT

1. By group, or individual2. The scope of health programs (a.k.a.,

Cultural Systems Models should solely improve the SPUQC community; the works must be give orientation to the importance of health.

3. Deadline will be on October 15, 2010.4. Submit it through electronic copy like, DVD

Prepared by: Prof. Ben Villareal III, M.A.