Anthropology, Representation, and Performance Learning Outcomes By the end of this section, you will be able to: Identify how cultural identities, norms, values, and social structures are represented in art, music, and sports. Describe how art, music, and sports can function as means of resistance to dominant sociocultural forms and processes. Art, music, and sports all articulate the experiences of people. One of these experiences might be resistance or rebellion. Whether it is a piece of art depicting a revolution, a rap song challenging the establishment, or a protest at a sporting event on a global stage, expression of the need for change are common in contemporary culture. This section will explore cultural identities; the use of art, music, and sports as resistance; and the representations created by each specialization. Cultural Identities Think about sporting team uniforms or a clothing style worn by members of a musical group. Each outfit on its own may not be distinct or significant, but when worn by a group of athletes or musicians and their fans, they become a source of identity. Since prehistoric times, art, music, and sports have been a source of cultural identity. Arts and sports have been intertwined with several human rights movements and the push for diversity, equity, and inclusion. Music has been a means of coded language for escape. Sports have long been a platform for cultural identity and has presented opportunities for cultural evolution and resistance. The Olympics are just one example of a sporting event that is linked deeply with national identity and nation pride. The opening ceremonies of the Olympic games are celebrations of national identity and nation pride. (credit: “The team of Chile at the opening ceremony of the 1912 Summer Olympics” by photographer of IOC/Official Olympic Report/Wikimedia Commons, Public Domain) Art as Resistance Art is often used as an act of resistance. Graffiti and hip-hop are two forms of artistic expression that have been viewed as acts of resistance in modern times. The practice of graffiti as it is known today is reminiscent of ancient cave painting, as both are drawings, depictions, and writings on a wall. Ancient graffiti can help archaeologists understand general levels of literacy among a population of people or provide linguistic anthropologists with insight into the development of language through time. While writings on walls is an ancient practice, graffiti became a popular form of cultural expression in Western countries in the 1960s. Modern graffiti is often performed in public view, as it is intended to make a statement. Today, during most political uprisings, researchers are able to easily find graffiti expressing views that inform and shape the political movement. Although many appreciate the communicative and artistic qualities of graffiti, others view it as visual pollution, and graffiti continues to be met with opposition. One of the most iconic modern graffiti artists is Banksy, whose art is depicted in Figure 16.24. Banksy is the pseudonym of an English street artist who has been active for more than three decades (Ellsworth-Jones 2013). His identity remains unconfirmed. His work began to appear in the early 1990s in Bristol, England, and can now be found in cities around the world, including London, New York, and Paris. Based on reports from those who have secured interviews with him, Banksy views his art as an act of rebellion. He was often in trouble as a teenager, which is when he first began exploring art. His art typically responds to social or cultural issues. One example is his series in New Orleans, Louisiana, which critiqued the government response to Hurricane Katrina in 2005. This mural by graffiti artist Banksy references both the Grim Reaper and the yellow “smiley face.” (credit: “Banksy - Grin Reaper With Tag” by Szater/Wikimedia Commons, Public Domain) Music as Resistance Hip-hop is a form of music that has consistently served as a means of protesting injustice toward people of color. From its inception in the 1970s at neighborhood block parties, hip-hop has rapidly spread worldwide to influence various cultures, transitioning from the margins of American culture to a central element of global pop culture. The culture of hip-hop offers possibilities for rich anthropological exploration, including linguistics factors, performance, music, and lyricism. The messages expressed by hip-hop often include complex social commentaries. With increased representation has come increased acceptance of hip-hop as a respected art form. In 2018, rap artist Kendrick Lamar was awarded a Pulitzer Prize for his album DAMN. and lauded by former president Barack Obama (Hubbard 2019). His fourth album release, DAMN. demonstrated why some call him one of the most influential rappers of his time. Perhaps better known is Public Enemy, the mid-1980s rap group created by Chuck D and Flavor Flav . The group’s lyrics often cite their political beliefs and deep-seated opinions about American racism and the American media. The evolution of hip-hop can be observed in many countries and societies. In the 1980s, it first began appearing in Japan and the Middle East. In Japan, it is thought to have begun with Hiroshi Fujiwara , who had an appreciation for old-school hip-hop and began to play it publicly. In the Middle East, some call it Arab rap or Arabic hip-hop. Heavily influenced by Western culture, these artistic representations demonstrate the vast and culturally diverse adoption of hip-hop as art and expression. Klash , the Muslim rapper shown in Figure 16.25, is well known in Middle Eastern cultures for telling the story of Muslim people through his artistry. Rap is not a subculture but a media and method for telling a story and at times expressing the resistance of a group of people. Muslim rapper Klash with fellow rap artist Loon. From its origins in American inner cities, rap has spread around the globe. (credit: “klash with loon in jeddah city” by Ahmed550055/Wikimedia Commons, Public Domain) Even more recently, Native American hip-hop has been a medium for Native Americans to tell their story and preserve the history of their peoples. Founded in American rap and hip-hop culture, this new form of expression has been embraced by rappers throughout Native American communities. It has been used to tell stories, explain history, and even encourage political activism on social issues. Sports as Resistance Throughout time, sports have been a global focal point for resistance. The Olympics have repeatedly been a site of global resistance and a setting for challenging societal norms and expectations. In Figure 16.26, Black American athletes Tommie Smith and John Carlos , gold and bronze medalists respectively, are depicted raising black-gloved fists during their medal ceremony as the US national anthem plays (Smith 2011). This gesture became known as the 1968 Olympics Black Power salute. Smith later described his raised, black-gloved fist as a symbol of support for all those who are and have been oppressed. Smith and Carlos made their demonstration in response to human rights violations perpetuated in the United States. Another example of resistance was seen four years later, when Jackie Robinson , the first Black player in Major League Baseball, wrote in his autobiography, recalling the opening game of his first World Series championship: “As I write this twenty years later, I cannot stand and sing the anthem. I cannot salute the flag; I know that I am a black man in a white world” (Robinson [1972] 1995, xxiv). When Tommie Smith and John Carlos raised black-gloved fists at their Olympic medal ceremonies in 1968, they publicly expressed support for oppressed people and resistance to a culture viewed as perpetuating that oppression. (credit: “IMGP7613-olympics-mural” by Rae Allen/flickr, CC BY 2.0) For many, a more familiar act of protest is likely NFL player Colin Kaepernick ’s kneeling during the singing of the nation anthem in 2016 following the shooting deaths of Black men Michael Brown , Alton Sterling , and Philando Castille at the hands of police officers (Lief 2019). In 2016, approximately 68 percent of all NFL players were Black (Gertz 2017). Kaepernick continued to kneel during the anthem for the remainder of the season. His gesture was a symbol of support for the Black Lives Matter movement, which seeks to end police brutality against Black people and other forms of racially motivated violence in the United States. Initially, feedback regarding Kaepernick’s gesture within the sports world was negative. However, following the death of George Floyd in 2020, there has been an increased interest in understanding systemic oppression. This had led to initiatives by organizations such as the NFL, Black Lives Matter, and others to support inclusion and open dialogues about racism. Throughout the seasons following Kaepernick’s initial act of kneeling, it became common practice in the world of professional sports for athletes to kneel in solidarity. This included Black players and some White players. The 2016 Olympics in Rio de Janeiro were a demonstration of social stratification. Media coverage of the 2016 Rio Olympics reported on the less-than-acceptable environmental, safety, and health conditions. Athletes from more developed nations openly criticized the unsanitary and inhospitable conditions of the housing and training facilities, which included unpotable water sources, trash in commons areas, and dirty and unsanitary dormitories. While some protested silently, others used their global notoriety to publicly protest the conditions. The images and stories provided from Rio by journalists and mainstream media sources showed garbage-ridden streets, unsanitary rooms and facilities, and irreparably damaged buildings. For Rio, the Olympics were supposed to be a pinnacle of national pride and a positive contribution to the global stage. For many who attended, the event proved to be far less than the Olympic image depicted in popular imagination. Integral Features Art, music, and sports can themselves be forms of resistance and at the same time can display evidence of historical resistance. A protest, a cultural statement, the overthrow of a regime—all can be found in, and at times have even been started by, works of art, music, and sports. From the ancient Romans to professional American football players, people have used these mediums to fight for their causes and to ensure that the histories of their plights are recorded in the archives of time. Art, music, and sports have told the stories of people since prehistoric times. Ingrained in the human experience, these mediums have been used to establish cultural and national identity. The images in art, the words of song, and the traditions of sport have had significant impacts on established norms and senses of personal and group identity. These aspects of the human condition are so foundational that each has been used as a form of resistance. Art, music, and sports have each contributed to the development of people and societies in important ways, and can each reveal important aspects of both past and current cultures. A Study of Ethnomusicology Music is one of the most expressive and diverse forms of art. For this activity, do the following: Review ethnomusicological study techniques. Conduct your own ethnomusicological fieldwork. This can be done by interacting with musicians, attending a music event virtually or in person, or interviewing audience members at a musical performance. Interview both musicians and audience members about the meaning of the music. What did they hear? How did it make them feel? What did it make them want to do? Record the results of your interviews. Additionally, record your own response to the music. What did you hear? How did it make you feel? What does it make you want to do? Collect the information and write a 3–5-page comparative reflection paper on what you learned from your interviews and how they compare and contrast to your own experience and discoveries. All music-making activities are appropriate, whether a formal or informal concert, a street performance, or gospel singing in church. You should maintain a field journal to record data, observations, and analysis. Research and Literature Review Activity Pick two (2) different examples of visual art, from the same time period but different socioeconomic microcultures, to compare and contrast. Write a 3–5-page summary paper in which you do the following: Identify people and/or studies that have reported on anthropological finds relevant to the images you selected. Describe the evolution of the art form you are analyzing from an early time. Explain how the anthropological studies you cite compare with other anthropological study approaches. Address how the art studied is an evolutionary example of the human experience. Evaluate what you perceive to be the future of the art as it continues to develop and evolve in future generations. Summary Art, music, and sports are deeply intertwined with the human experience. Anthropology offers the space to examine art, music, and sports through a cultural lens in order to study the ways in which they exist within sociocultural frameworks. The anthropology of the arts is a subfield of cultural anthropology that explores the arts in a broader context within and between different cultural settings. Anthropologists study art differently than other social scientist, relying on data collection through direct, personal, in-depth observations of lived experiences and interactions. Art is expressed through a variety of formats, including music, visual art, literary art, and body art. Anthropology explores the various cultural manifestations of humanity. All cultures decorate and modify the human body in some way, whether temporarily or permanently. Body art can be spiritual, cultural, or aesthetic. This includes tattooing, body paint, and hairstyling. Ethnomusicology is a subfield of cultural anthropology that examines the music of different cultures and the people who make it, as well as the intended audience of the music. The interdisciplinary nature of ethnomusicology speaks to diverse approaches to studying the anthropology of music. Music as an art form expresses a wide array of perspectives and experiences. Sports are a form of performance, and each participant performs within a broader cultural context. Anthropologists of sport are interested in studying sports within the context of society. Sports culture has resulted in cultural phenomena based on the popularity of athletes. Sports also serve as an escape for many populations with limited choices in recreational activities. Critical Thinking Questions Resources Basketball or Nothing . 2019. Philadelphia: WorkShop Content Studios. Netflix, 6 episodes. Rice, Timothy. 2014. Ethnomusicology: A Very Short Introduction . New York: Oxford University Press. Stone, Ruth M. Theory for Ethnomusicology . 2008. Upper Saddle River, NJ: Pearson. Bibliography Boyd, Valerie. 2003. Wrapped in Rainbows: The Life of Zora Neale Hurston . New York: Scribner. Bradford, Sarah H. (1886) 1995. Harriet, the Moses of Her People . Chapel Hill: University of North Carolina at Chapel Hill. https://docsouth.unc.edu/neh/harriet/harriet.html. Brown, Emily J. 2005. “Instruments of Power: Musical Performance in Rituals of the Ancestral Puebloans of the American Southwest.” PhD diss., Columbia University. ProQuest (AAT 3159726). Calhoun, Craig, ed. 2002. Dictionary of the Social Sciences . S.v. “salvage ethnography.” New York: Oxford University Press. Campbell, Patricia Shehan. 2011. “Musical Enculturation: Sociocultural Influences and Meanings of Children’s Experiences in and through Music.” In A Cultural Psychology of Music Education , edited by Margaret S. Barrett, 61–81. New York: Oxford University Press. Carby, Hazel V. 2008. “The Politics of Fiction, Anthropology, and the Folk: Zora Neale Hurston.” In Zora Neale Hurston’s Their Eyes were Watching God, edited by Harold Bloom, new ed., 23–40. New York: Infobase Publishing. Cardona, Nina. 2015. “Bob Dylan Was a Catalyst, but the Nashville Cats Were the Ones Who Changed Music Row.” WPLN News. Nashville Public Radio, June 19, 2015. https://wpln.org/post/bob-dylan-was-a-catalyst-but-the-nashville-cats-were-the-ones-who-changed-music-row/. Chacko, Diya. 2020. “The Legacy of ‘Kobe!’ Jump Shots Lives On through Fans.” Los Angeles Times , January 27, 2020. https://www.latimes.com/sports/lakers/story/2020-01-27/kobe-bryant-jump-shots-legacy. Chairunnisa, Baiq Clara Dita, and Ade Solihat. 2019. “Henna Art in Global Era: From Traditional to Popular Culture.” In Joint Proceedings of the International Conference on Social Science and Character Educations (ICoSSCE 2018) and International Conference on Social Studies, Moral, and Character Education (ICSMC 2018) , edited by Amika Wardana, Aman, and Alifi Nur Prasetia Nugroho, 220–225. Amsterdam: Atlantis Press. https://www.atlantis-press.com/article/125910003. Damo, Arlei Sander, Ruben George Oliven, and Simoni Lahud Guedes. 2008. “Sports: An Anthropological Perspective.” Translated by Letícia Maria Costa da Nóbrega Cesarino. Horizontes Antropológicos 4 (Selected Edition). http://socialsciences.scielo.org/scielo.php?script=sci_arttext&pid=S0104-71832008000100002. Deter-Wolf, Aaron, Benoît Robitaille, Lars Krutak, and Sébastien Galliot. 2016. “The World’s Oldest Tattoos.” Journal of Archaeological Science: Reports 5:19–24. https://doi.org/10.1016/j.jasrep.2015.11.007. Dey, Archita, and Kaustav Das. 2017. “Why We Tattoo? Exploring the Motivation and Meaning.” Anthropology 5 (1). https://www.longdom.org/abstract/why-we-tattoo-exploring-the-motivation-and-meaning-36072.html. Ellsworth-Jones, Will. 2013. “The Story behind Banksy.” Smithsonian , February 2013. https://www.smithsonianmag.com/arts-culture/the-story-behind-banksy-4310304/. Flax, Peter. 2019. “How Rez Ball Is Transforming the Health and Fitness of a Whole Community.” Men’s Health , October 31, 2019. https://www.menshealth.com/fitness/a29614983/rezball-indian-reservation-basketball/. Gertz, Michael. 2017. “NFL Census 2016.” ProFootballLogic. April 19, 2017. http://www.profootballlogic.com/articles/nfl-census-2016/. Hoover, Joanne Sheehy. 2020. “Making Prehistoric Music: Musical Instruments from Ancestral Puebloan Sites.” NPS.gov. National Park Service, last updated April 9, 2020. https://www.nps.gov/articles/musical-instruments-from-ancestral-puebloan-sites.htm. Hubbard, Henry. 2019. “‘Pulitzer Kenny’ and the Culture of Classical Music: A Study of Cultural Prizes, Controversy, and a Capital-Based Alternative to Musical Value.” PhD diss., Johns Hopkins University. Jaiswal, Ajeet. 2019. “Anthropology and Sports.” International Journal of Research in Sociology and Anthropology 5 (3): 29–30. https://doi.org/10.20431/2454-8677.0503004. Jones, Sharon L. 2009. Critical Companion to Zora Neale Hurston: A Literary Reference to Her Life and Work . New York: Facts on File. Johnson, Guy B. 1931. “The Negro Spiritual: A Problem in Anthropology.” American Anthropologist 33 (2): 157–171. https://doi.org/10.1525/aa.1931.33.2.02a00020. Kristeller, Paul Oskar. 1990. Renaissance Thought and the Arts: Collected Essays . Expanded ed. Princeton, NJ: Princeton University Press. Large, David Clay. 2007. Nazi Games: The Olympics of 1936 . New York: W. W. Norton. Layton, Robert. 1989. “The Political Use of Australian Aboriginal Body Painting and Its Archaeological Implications.” In The Meanings of Things: Material Culture and Symbolic Expression , edited by Ian Hodder, 1–11. Boston: Unwin Hyman. Lief, Brian. 2019. “Athletes Engaging in Activism: Jackie Robinson, Muhammad Ali, Tommie Smith, and John Carlos and Their Influence on Colin Kaepernick.” Sr. independent study thesis, College of Wooster. https://openworks.wooster.edu/independentstudy/8522/. Moran, Ian P. 2010. “Punk: The Do-It-Yourself Subculture.” Social Sciences Journal 2010:58–65. https://westcollections.wcsu.edu/handle/20.500.12945/2257. Morphy, Howard, and Morgan Perkins. 2006. “The Anthropology of Art: A Reflection on Its History and Contemporary Practice.” In The Anthropology of Art: A Reader , edited by Howard Morphy and Morgan Perkins, 1–32. Malden, MA: Blackwell. Morris, Wesley. 2019. “Why Is Everyone Always Stealing Black Music?” New York Times Magazine , August 14, 2019. https://www.nytimes.com/interactive/2019/08/14/magazine/music-black-culture-appropriation.html. Nettl, Bruno. 2005. The Study of Ethnomusicology: Thirty-One Issues and Concepts . New ed. Urbana: University of Illinois Press. Plattner, Stuart. 2003. “Anthropology of Art.” In A Handbook of Cultural Economics , edited by Ruth Towse, 15–19. Northampton, MA: Edward Elgar. Ray, Sanjana. 2017. “How Bob Dylan Changed the Course of History through His Music.” YourStory. May 24, 2017. https://yourstory.com/2017/05/music-of-bob-dylan/. Rice, Prudence M. 2015. Pottery Analysis: A Sourcebook . 2nd ed. Chicago: University of Chicago Press. Rice, Timothy. 2017. “Reflections on Music and Identity in Ethnomusicology .” In Modeling Ethnomusicology , 139–160. New York: Oxford University Press. Robinson, Jackie. (1972) 1995. I Never Had It Made: An Autobiography of Jackie Robinson . As told to Alfred Duckett. Hopewell, NJ: Ecco Press. Shishlina, Natalia I., E. V. Belkevich, and A. N. Usachuk. 2013. “Bronze Age Tattoos: Sympathetic Magic or Decoration?” In Tattoos and Body Modifications in Antiquity: Proceedings of the Sessions at the EAA Annual Meetings in The Hague and Oslo, 2010/11 , edited by Philippe Della Casa and Constanze Witt, 67–74. Zurich: Chronos. Smith, Maureen Margaret. 2011. “The ‘Revolt of the Black Athlete’: Tommie Smith and John Carlos’s 1968 Black Power Salute Reconsidered.” In Myths and Milestones in the History of Sport , edited by Stephen Wagg, 159–184. New York: Palgrave Macmillan. Society for Ethnomusicology. n.d. “About Ethnomusicology.” Accessed September 1, 2021. https://www.ethnomusicology.org/page/AboutEthnomusicol. Tucci, Giuseppe. (1961) 2001. The Theory and Practice of the Mandala: With Special Reference to the Modern Psychology of the Subconscious . Translated by Alan Houghton Brodrick. Mineola, NY: Dover. United Nations Educational, Scientific and Cultural Organization. (2021). “What Is Intangible Cultural Heritage?” Intangible Heritage. Accessed September 6, 2021. https://ich.unesco.org/en/what-is-intangible-heritage-00003. Young, James O. 2008. Cultural Appropriation and the Arts . Malden, MA: Blackwell. Zablan, Audriana. 2010. “Primitive Art.” Expressions of Time: New York City Arts (blog). Macaulay Honors College, CUNY, November 1, 2010. https://eportfolios.macaulay.cuny.edu/weinroth10/2010/11/01/primitive-art/. Zaidel, Dahlia W., Marcos Nadal, Albert Flexas, and Enric Munar. 2013. “An Evolutionary Approach to Art and Aesthetic Experience.” Psychology of Aesthetics, Creativity, and the Arts 7 (1): 100–109. https://doi.org/10.1037/a0028797. graffiti drawings, depictions, and writings on a wall typically without permission and meant for the public to see

Social Sciences


Introduction The US Army Corp of Engineers opened this community health clinic in the country of Benin in West Africa in 2013. The clinic has waiting, consultation, observation and treatment rooms, and a drug store. (credit: “Pehunco Health Clinic opens” by US Army Corps of Engineers/Wale Adelakun/flickr, Public Domain) Health and a preoccupation with maintaining it permeates all aspects of human culture. Health is a concern to humans everywhere. There is no end to the variety of ways cultures across history have treated health, healing, and medicine. Human health and well-being sit at the intersection of biology and culture. Both physical and social environments shape well-being and health outcomes. Medical anthropology is a holistic specialty that draws on all four fields of anthropology but primarily builds on cultural anthropology and biological anthropology to understand the health implications of a culture’s impact on human physiology and well-being. How do you define health? How do you maintain your health? What factors do you think contribute to health and illness?

Social Sciences


What Is Medical Anthropology? Learning Outcomes By the end of this section, you will be able to do the following: Define health, illness, sickness, and the sick role. Describe early research and methods in medical anthropology. Explain Franz Boas’s influence in establishing the foundations of medical anthropology. Describe how medical anthropology has developed since World War II. Social Construction of Health The World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (World Health Organization 2020). Health is affected by multiple social, biological, and environmental factors. Disease is strictly biological—an abnormality that affects an individual’s physical structure, chemistry, or function. Going back to the time of the ancient Greek physician Hippocrates , doctors have regarded disease as the result of both a person’s lifestyle habits and the social environment in which they live. Illness , by comparison, is the individual’s sociocultural experience of a disruption to their physical or mental well-being. An individual’s perception of their own illness is shaped by how that illness is viewed, discussed, and explained by the society they live in. The social perception of another person’s sickness affects that person’s social well-being and how they are viewed and treated by others. Sick roles are the social expectations for a sick person’s behaviors based on their particular sickness—how they should act, how they should treat the sickness, and how others should treat them. Malady is the term anthropologists use to encompass disease, illness, and sickness. Health is your state of well-being. Disease is a biological abnormality. Illness is your sociocultural experience of health. Sickness is a social perception of ill health. Malady is a broad term for everything above. Term Definition Example Health State of well-being Wellness prior to infection Disease A biological abnormality Viral infection Illness A patient’s sociocultural experience of disrupted health Fever, sore throat, cough, worry about missing class, disappointment of missing an outing with friends Sickness A social perception of ill health Expectations such as: stay home and rest if you have a fever; do not attend class or go out with friends; see a doctor if it lasts longer than 48 hours Malady A broad term for everything above Disruption of health caused by a viral infection with fever, sore throat, cough; worry about missing work/class; and the social expectation you will stay home and rest Key Terms Used in Medical Anthropology Foundational to medical anthropology is an understanding of health and malady that includes social experiences and cultural definitions. Medical anthropology studies how societies construct understandings of health and illness, including medical treatments for all types of maladies. Culture affects how we perceive everything, including health. Culture shapes how people think and believe and the values they hold. It shapes everything people have and do. Many cultures approach health and illness in completely different ways from one another, often informed by a number of societal factors. Medical anthropology provides a framework for common study and comparison between cultures, highlighting systems and illustrating how culture determines how health is perceived. History of Medical Anthropology While medical anthropology is a relatively new subfield, it has deep roots within four-field American anthropology, with a strong connection to early European anthropologists’ study of religion. The holistic approach of Franz Boas was also key to the development of medical anthropology. One focus of Boas’s research was analysis of the “race theory” common in the 19th and early 20th centuries in the United States. According to this theory, one’s assigned racial category and ethnic background determined certain physical features as well as behavioral characteristics. Boas challenged this assumption through studies of the health and physiology of immigrant families in New York City in 1912. Boas found that there was a great deal of flexibility in human biological characteristics within an ethnic group, with social factors such as nutrition and child-rearing practices playing a key role in determining human development and health. He noted that cultural changes to nutrition and child-rearing practices, changes that are commonly a part of the immigrant experience, were linked to generational changes in biology. Boas provided empirical data from his own primary sources that refuted theories of biological inheritance as the source of social behaviors and revealed the impact of local environments (natural, modified, and social) in structuring cultural and physical outcomes. This foundation was starkly opposed to the inherent racism of social evolutionism, which was the dominant anthropological theory of his time. Boas’s students, such as Ruth Benedict , Margaret Mead , and Edward Sapir , all continued aspects of his work, taking their research in unique directions that affect medical anthropology to this day. Benedict’s cultural personality studies, Mead’s work on child-rearing practices and adolescence, and Sapir’s work on psychology and language laid the foundations of psychological anthropology. Their foray into psychological anthropology was preceded by the work of British psychiatrist and anthropologist W. H. R. Rivers (1901), who studied the inheritance of sensory capabilities and disabilities among Melanesian populations while participating in the Torres Strait island expedition in 1898. He developed a great respect for his Melanesian research participants and utilized his research findings to denounce the “noble savage” fallacy. By demonstrating that a shared biological mechanism of inheritance and environmental influences shaped the Melanesian senses in the same way as it did the British, he illustrated that their mental capacity was the same as Europeans. Franz Boas’s study on immigrants to the United States showed that health is influenced by a number of factors, including many determined by one’s social and physical environment. (credit: US National Archives and Records Administration/Wikimedia Commons, Public Domain) Medical anthropology also has roots in the anthropology of religion, a subfield of anthropology that shines a lens on many aspects of health. The anthropology of religion looks at how humans develop and enact spiritual beliefs in their daily lives and at how these beliefs are utilized as a form of social control. A number of commonly studied key frameworks of the anthropology of religion—rituals of healing, taboos of health, shamanic healing, health beliefs, cultural symbolism, and stigma, among them—focus on health and health outcomes. A number of notable early religious anthropologists, including E. E. Evans-Pritchard , Victor and Edith Turner , and Mary Douglas , did work on subjects such as healing rituals, misfortune and harm, pollution, and taboo. Evans-Pritchard’s work among the Azande people of North Central Africa continues to be foundational to medical anthropology. Especially important is the chapter “The Notion of Witchcraft Explains Unfortunate Events” from the book Witchcraft, Oracles and Magic among the Azande , which introduces the domain of causation and its many cross-cultural forms. This chapter directly impacted the concept of explanatory models, which we will cover in depth later in this chapter. The work of Victor and Edith Turner focused on ritual healing, pilgrimage, and socially enforced morality. Mary Douglas’s Purity and Danger ([1966] 2002) examined the concepts of pollution and taboo as well as rituals designed to restore purity. Her work continues to be influential, particularly for medical anthropologists focused on sickness-related stigma and its impact on patients’ illness experiences. World War II brought about a profound change in the way anthropologists did their work. A number of Boas’s students helped the British and United States governments during the war, a trend that continued after the war. Focusing on both public and private health initiatives, anthropologists increasingly worked to help people improve their health outcomes in the post-war era. These public health efforts were directly connected with the founding of the United Nations and the World Health Organization (WHO). In this period, well-being and health care were included in the declaration of human rights, and biomedical thinking became focused on “conquering” infectious disease. The formal founding of the discipline of medical anthropology can be traced to the late 1970s. One landmark is the publication of George Foster and Barbara Anderson’s (1978) medical anthropology textbook. However, many applied anthropologists and researchers in allied health fields, such as social epidemiology and public health, had been conducting cross-cultural health studies since the conclusion of World War II. These include Edward Wellin , Benjamin Paul , Erwin Ackerknecht , and John Cassell . Many of these early figures were themselves medical doctors who saw the limitations of a strictly biomechanical approach to health and disease. Paul Farmer, 1959–2022, Jim Yong Kim, 1959–present (left) Paul Farmer speaking at the University of Chicago in 2017. (credit: “Paul Farmer giving MacLeanPrize Lecture in 2017” by MacLean Center/Wikimedia Commons, CC-BY-3.0); (right) Jim Yong Kim speaking in New York City in 2018. (credit: “20th Anniversary Schwab Foundation GalaDinner” by Ben Hider/World Economic Forum/flickr, CC BY 2.0) Personal Histories: Paul Farmer was a medical anthropologist and physician who first visited Haiti in 1983 as a volunteer. Inspired by this experience, Farmer set out to find a way to bring necessary treatments to parts of the world seemingly forgotten by modern medicine. When Harvard Medical School began offering a dual PhD/MD program, Farmer was among the first enrolled, and he soon founded Partners in Health (PIH) with his colleagues. He championed affordable health care around the world. He is currently a professor of medicine and chief of the Division of Global Health Equity at Brigham and Women’s Hospital, while still being actively involved in Partners in Health. Farmer has written extensively on the AIDS epidemic, infectious diseases, and health equity. In 2003, Farmer was the subject of Tracy Kidder’s book Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who Would Cure the World, which is an accessible account of Farmer’s work with Partners in Health. He had three children with his wife, Didi Bertrand Farmer, a Hatian medical anthropologist. Like Farmer, Jim Yong Kim was one of the first to enroll in Harvard Medical’s dual medical anthropology PhD/MD program. He was a cofounder of Partners in Health while still in medical school, at a time when he was spending his summers in Haiti treating patients with limited access to health care. He championed the initial expansion of PIH into other countries, beginning with Peru. In 2003 Kim left Partners in Health to join the World Health Organization, becoming director of HIV/AIDs treatments and research in 2004. Under Kim, the WHO has fast-tracked a number of new treatments to help those affected by AIDS in Africa. Kim was the president of Dartmouth College from 2009 until 2012, when he became president of the World Bank. He held this position until 2019, when he left to join Global Infrastructure Partners. Area of Anthropology: medical anthropology, applied anthropology Accomplishments in the Field: Partners in Health was founded in 1987 by a group including Farmer and Kim, with the goal of setting up a clinic in Haiti to combat the devastation of the AIDS epidemic. Made up of volunteers, philanthropists, and medical students trained in anthropological methodology, the organization sought to combat the AIDS epidemic at a time when governments refused to adequately fund efforts to combat what was then perceived as a “gay disease.” By the mid-1990s, PIH was offering patients in Haiti treatments that cost hundreds of dollars, as opposed to the tens of thousands of dollars they would have cost in the United States. They have since duplicated this work in other settings, and their methods have been used by countless nonprofits around the world to offer life-saving treatments to impoverished communities. Importance of Their Work: Partners in Health works today in 11 countries, with a staff of over 18,000 spread across the globe. They build hospitals, health clinics, and research labs aimed at improving medical treatment and creating a more equitable global health care system. Their model has been replicated by countless organizations around the world to bring down the cost of health care and increase the quality of the care given. Since the 1980s, medical anthropologists have diversified the field through interdisciplinary applications of anthropology and the applied use of medical anthropology in health care and government policy. The role of the anthropologist in this work often varies but is typically focused on translating cultural nuance and biomedical knowledge into policy and human-centered care. Today, the field of medical anthropology includes applied anthropologists working in medical settings, nonprofits, and government entities such as the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), and the WHO. Academic medical anthropologists are problem-oriented researchers who study the complex relationship between human culture and health. As can be seen in the lives and careers of the medical anthropologists highlighted in this chapter’s profiles, medical anthropologists frequently occupy both academic and applied roles throughout their career as they seek to apply insights from their research to effect positive change in the lives of those they study. During the COVID-19 pandemic, medical recommendations informed emerging cultural taboos, highlighting the link between medicine and culture. (credit: “Covid-19” by Daniel Lobo/Daquellamanera.org/flickr, Public Domain) disease a biological agent that negatively affects health. health a state of complete well-being. illness a person’s experience of ill health, as defined by their culture. malady a term encompassing disease, illness, and sickness. sickness the cause of a person’s ill health that signifies to others how to treat that person socially. sick roles the social expectation of a person suffering from a sickness.

Social Sciences


Ethnomedicine Learning Outcomes By the end of this section, you will be able to do the following: Define ethnomedicine, traditional environmental knowledge, and biomedicine. Provide examples of cultural and societal systems that use religion and faith to heal. Define medical pluralism. Ethnomedicine is a society’s cultural knowledge about the management of health and treatments for illness, sickness, and disease. This includes the culturally appropriate process for seeking health care and the culturally defined signs and symptoms of illness that raise a health concern. Ethnomedical systems are frequently closely related to belief systems and religious practices. Healing can include rituals and natural treatments drawn from the local environment. Healing specialists in an ethnomedical system are knowledgeable individuals who undergo training or apprenticeship. Some examples of ethnomedical healers are midwives, doulas, herbalists, bonesetters, surgeons, and shamans, whose ethnomedicine existed in cultural traditions around the world prior to biomedicine. Anthropologists frequently note that ethnomedicinal healers possess knowledge of both how to heal and how to inflict harm by physical and sometimes metaphysical means. Ethnomedicine does not focus on “traditional” medicine, but instead allows for cross-cultural comparison of medical systems. A Peruvian shaman prepares herbal medicine for an upcoming ritual. (credit: “Shaman” by Alan Kotok/flickr, CC BY 2.0) Some forms of healing rely upon spiritual knowledge as a form of medicine. Within shamanism, people deliberately enter the spirit world to treat ailments, with the culture’s shaman acting as an emissary. The goal may be to eliminate the illness or to at least identify its source. Similarly, faith healing relies upon a shared understanding of faith and local beliefs, with spirituality pervading the healing process. Exorcising individuals of possession by negative spirits is a common form of faith healing that occurs within Christian, Islamic, Buddhist, and shamanic frameworks. In many cases, cultures that utilize biomedicine also utilize some forms of faith healing. Ethnopharmacology utilizes herbs, foods, and other natural substances to treat or heal illness. Traditional ethnopharmacological treatments are currently of great interest to pharmaceutical companies looking for new biomedical cures. Many common medicines have roots in ethnopharmacological traditions. Used in Chinese medicine, indigenous American healing, and traditional European medicine, willow bark is a widespread cure for headaches. In 1897, the chemist Dr. Felix Hoffmann , working for the Bayer corporation, isolated acetylsalicylic acid as the active pain-reducing ingredient in willow bark, giving the world Bayer aspirin. The concept of traditional ecological knowledge , or TEK, refers to medical knowledge of different herbs, animals, and resources in an environment that provides a basis for ethnomedicine. Many cultures have been able to translate detailed awareness of their environments, such as where water is and where and when certain herbs grow, into complex and effective ethnomedical systems (Houde 2007). In 2006, Victoria Reyes-Garcia , working with others, conducted a comprehensive study of Amazonian TEK. Victoria and her colleagues collected information regarding plants useful for food and medicine from 650 research participants from villages along the Maniqui River in the Amazon River basin. China’s traditional medicine system is another excellent example of an ethnomedical system that relies heavily on TEK and ethnopharmacology. While many in China do rely upon biomedicine to treat specific health problems, they also keep themselves in balance using traditional Chinese medicine. The decision of which health system to consult is often left to the patient, but at times doctors will suggest a patient visit a traditional apothecary and vice versa, creating a complementary medical system that makes use of both approaches. While bound by geography prior to the 19th century, in today’s globalized world a traditional Chinese doctor can use resources from anywhere around the world, whether it is dried body parts of a tiger or herbs found in another part of China. Chinese traditional medicine, as an ethnomedical system, is heavily influenced by culture and context. It focuses on balancing the body, utilizing a number of forces from the natural world. Traditional Chinese medicine makes use of substances as diverse as cicada shells, tiger livers, dinosaur bones, and ginseng to create medicine. Healers in this system are often in a role similar to Western pharmacists, concocting medicine in a variety of forms such as pills, tonics, and balms. The differences between a traditional Chinese medication healer and biomedical pharmacist include both the tools and ingredients used and the foundational assumptions about the cause of and treatments for various ailments. Around the world, traditional environmental knowledge is used both in place of biomedicine and alongside it. Biomedicine is an ethnomedical system deeply shaped by European and North American history and rooted in the cultural system of Western science. It draws heavily from biology and biochemistry. Biomedicine treats disease and injuries with scientifically tested cures. Biomedical health care professionals base their assessment of the validity of a treatment on the results of clinical trials, conducted following the principles of the scientific method. It should be noted that as each health care professional is not conducting their own research, but instead relying on the work of others, this assessment still requires faith. Biomedicine places its faith in the scientific method, where other ethnomedical systems place their faith in a deity, the healer’s power, or time-tested treatments passed down in traditional ecological knowledge. Biomedicine is not free from culture; it is an ethnomedical system shaped by Western cultural values and history. Biomedicine falls short of its ideal of scientific objectivity. Medical anthropologists have extensively documented the way systemic prejudices such as racism, classism, and sexism permeate biomedicine, impacting its effectiveness and perpetuating health inequalities. Still, in the Western world, biomedicine is often utilized as a point of comparison for other ethnomedical systems. Biomedicine has been critiqued by medical anthropologists for assuming predominance over other forms of healing and cultural knowledge. In many contexts, biomedicine is presumed to be superior because it is clinical and based on scientific knowledge. Yet this presumed superiority requires that a patient trusts and believes in science and the biomedical system. If a person mistrusts biomedicine, whether because of a bad experience with the biomedical model or a preference for another ethnomedical approach, their health outcomes will suffer if they are forced to rely on the biomedical system. Biomedicine can also disrupt and threaten culturally established treatments and cures. For example, in a culture that treats schizophrenia by granting a person spiritual power and treating them as part of the community, labeling that individual as mentally ill according to biomedical terms takes away their power and removes their agency. In most cases, a hybrid model, in which biomedicine does not assume supremacy but instead works alongside and supports ethnomedicine, is the most effective approach. A hybrid model accords the ill the ability to choose those treatments that they think will best help. An apothecary in a Nanjing hospital in China prepares a treatment grounded in traditional Chinese medicine. Contemporary medical facilities sometimes offer biomedical practice and ethnomedicine together in one setting. (credit: “Apothecary mixing traditional chinese medicine at Jiangsu Chinese Medical Hospital in Nanjing, China” by Kristoffer Trolle/flickr, CC BY 2.0) Medical pluralism occurs when competing ethnomedical traditions coexist and form distinct health subcultures with unique beliefs, practices, and organizations. In many contemporary societies, ethnomedical systems coexist with and frequently incorporate biomedicine. Biomedicine is privileged as the dominant health care system in the United States, but in many metropolitan areas, people can also consult practitioners of Chinese medicine, Ayurvedic medicine, homeopathic medicine, chiropractic medicine, and other ethnomedicinal systems from around the world. Examples of medical pluralism are fairly common in contemporary Western society: yoga as a treatment for stress and as a form of physical and mental therapy, essential oils derived from traditional medicine to enhance health, and countless others. Contemporary cultures often fuse biomedicine and ethnomedicine rather than just choosing one or the other. However, the privilege and medical authority of biomedicine does not always afford people the right to choose, or may give them only a limited capacity to do so. Anne Fadiman ’s (1998) The Spirit Catches You and You Fall Down , which explores the conflicts between a small hospital in California and the parents of a Hmong child with epilepsy over the child’s care, is a classic example of the cultural conflicts that can occur in medically pluralistic societies. In many parts of the world, biomedicine has accompanied colonialization, and indigenous health practices have been suppressed in favor of biomedicine. Juliet McMullin ’s (2010) Healthy Ancestor: Embodied Inequality and the Revitalization of Native Hawaiian Health discusses the suppression of Hawaii’s indigenous ethnomedical system as a long-lasting legacy of its colonial history. The book includes the efforts of contemporary Hawaiians to regain the healthy lifestyle of their precolonial ancestors. McMullin concludes that while contemporary biomedical health care professionals are more open to Hawaii’s ethnomedical practices than their predecessors were, there is still work to be done. biomedicine health care systems rooted in European and North American scientific knowledge. ethnomedicine a culture’s traditional knowledge and treatments for the management of health and illness. medical pluralism the use of both ethnomedicine and biomedicine. traditional ecological knowledge (TEK) traditional knowledge of one’s environment applied to the treatment of maladies.

Social Sciences


Theories and Methods Learning Outcomes By the end of this section, you will be able to do the following: Discuss the importance of cross-cultural comparison and cultural relativism in study of human health. Explain why both objectivity and subjectivity are needed in the study of health. Discuss ethnographic research methods and their specific applications to the study of human health. Summarize the theoretical frameworks that guide medical anthropologists. The Importance of Cultural Context Culture is at the center of all human perspectives and shapes all that humans do. Cultural relativism is crucial to medical anthropology. There is a great degree of variety in the symptoms and conditions that cultures note as significant indicators of diminished health. How the sick are treated varies between cultures as well, including the types of treatments prescribed for a particular sickness. Cultural context matters, and health outcomes determined by culture are informed by that culture’s many parts. The United States, for example, relies heavily on biomedicine, treating symptoms of mental and physical illness with medication. This prevalence is not merely an economic, social, or scientific consideration, but all three. A cultural group’s political-economic context and its cultural beliefs, traditions, and values all create the broader context in which a health system exists and all impact individuals on a psychosocial level. Behaviors such as dietary choices and preferences, substance use, and activity level—frequently labeled as lifestyle risk factors—are all heavily influenced by culture and political-economic forces. While Western cultures rely upon biomedicine, others favor ethnopharmacology and/or ritual healing. Medical anthropologists must attempt to observe and evaluate ethnomedical systems without a bias toward biomedicine. Medical anthropologists must be cautious of tendencies toward ethnocentrism. Ethnocentrism in medical anthropology takes the form of using the health system of one’s own culture as a point of comparison, giving it preference when analyzing and evaluating other systems. An American anthropologist who studies ethnomedicine in the Amazon River basin must be careful to limit their bias toward a biomedical approach as much as they can. That is not to say that subjective experience and opinion need be discarded entirely, merely that bias should be acknowledged and where necessary limited. Admitting bias is the first step in combating it. Being aware of one’s own ethnocentrism allows an anthropologist to analyze culture and medicine more truthfully. Methods of Medical Anthropology Medical anthropology is a highly intersectional subfield of anthropology. The field addresses both the biological and social dimensions of maladies and their treatments. Medical anthropologists must thus become comfortable with a wide-ranging tool kit, as diverse as health itself. Like all anthropologists, medical anthropologists rely on qualitative methods, such as ethnographic fieldwork, but they also must be able to appropriately use quantitative methods such as biometrics (including blood pressure, glucose levels, nutritional deficiencies, hormone levels, etc.) and medical statistics (such as rates of comorbidities, birth rates, mortality rates, and hospital readmission rates). Medical anthropologists can be found working in a myriad of endeavors: aiding public health initiatives, working in clinical settings, influencing health care policy, tracking the spread of a disease, or working for companies that develop medical technologies. The theories and methods of medical anthropology are invaluable to such endeavors. Qualitative Methods Within medical anthropology, a number of qualitative research methods are invaluable tools. Qualitative methods are hands-on, first-person approaches to research. An anthropologist in the room or on the ground writing down field notes based on what they see and recording events as they happen creates valuable data for themselves and for others. Participant observation is a methodology in which the anthropologist makes first-person observations while participating in a culture. In medical anthropology, participant observation can take many forms. Anthropologists observe and participate in clinical interactions, shamanic rituals, public health initiatives, and faith healing. A form of participant observation, clinical observations allow the anthropologist to see a culture’s healing practices at work. Whether a doctor is treating COVID-19 or a shaman is treating a case of soul loss, the anthropologist observes the dynamics of the treatment and in some cases actually participates as a patient or healer’s apprentice. This extremely hands-on method gives the anthropologist in-depth firsthand experience with a culture’s health system but also poses a risk of inviting personal bias. Anthropologists observe a myriad of topics, from clinical interactions to shamanic rituals, public health initiatives to faith healing. They carry these firsthand observations with them into their interviews, where they inform the questions they ask. In medical anthropology, interviews can take many forms, from informal chats to highly structured conversations. An example of a highly structured interview is an illness narrative interview. Illness narrative interviews are discussions of a person’s illness that are recorded by anthropologists. These interviews can be remarkably diverse: they can involve formal interviews or informal questioning and can be recorded, written down, or take place electronically via telephone or video conference call. The social construction of sickness and its impact on an individual’s illness experience is deeply personal. Illness narratives almost always focus on the person who is ill but can at times involve their caregivers, family, and immediate network as well. Another method commonly used in medical anthropology, health decision-making analysis , looks at the choices and considerations that go into deciding how to treat health issues. The anthropologist interviews the decision makers and creates a treatment decision tree, allowing for analysis of the decisions that determine what actions to take. These decisions can come from both the patient and the person providing the treatment. What religious or spiritual choices might make a person opt out of a procedure? What economic issues might they face at different parts of their illness or sickness? Health decision-making analysis is a useful tool for looking at how cultures treat sickness and health, and it highlights a culture’s economic hierarchies, spiritual beliefs, material realities, and social considerations such as caste and gender. Quantitative Methods Quantitative methods produce numeric data that can be counted, correlated, and evaluated for statistical significance. Anthropologists utilize census data, medical research data, and social statistics. They conduct quantitative surveys, social network analysis that quantifies social relationships, and analysis of biomarkers. Analysis of census data is an easy way for medical anthropologists to understand the demographics of the population they are studying, including birth and death rates. Census data can be broken down to analyze culturally specific demographics, such as ethnicity, religion, and other qualifiers as recorded by the census takers. At times, an anthropologist may have to record this data themselves if the available data is absent or insufficient. This type of analysis is often done as a kind of background research on the group being studying, creating a broader context for more specific analysis to follow. Also important to medical anthropologists are analyses of medical statistics . The study of medical records helps researchers understand who is getting treated for what sickness, determine the efficacy of specific treatments, and observe complications that arise with statistical significance, among other considerations. Analysis of census data combined with medical statistics allows doctors and other health providers, as well as medical anthropologists, to study a population and apply that data toward policy solutions. Famous examples include the World Health Organization’s work on health crises such as HIV/AIDS, Ebola, and COVID-19. Questionnaires are more personal to the anthropologist, allowing them to ask pointed questions pertinent to their particular research. Surveys make it possible for anthropologists to gather a large quantity of data that can then be used to inform the questions they ask using qualitative methods. Distribution methods for surveys vary and including means such as personally asking the questions, releasing the survey through a health care provider, or offering online surveys that participants choose to answer. These are the most common methods used by medical anthropologists. Different theories are influential in determining which of the methods a particular research might favor. These theories inform how an anthropologist might interpret their data, how they might compose a study from beginning to end, and how they interact with the people they study. Combined with more general anthropological theory, each anthropologist must craft a composite of theory and method to create their own personalized study of the world of human health. Theoretical Approaches to Medical Anthropology Social Health Biomedicine, the science-based ethnomedical system practiced in the United States, recognizes the impact physical health and mental health have on one another: when one falters, the other does as well. There is an increasing awareness in biomedicine of a third type of health, social health , which has long been recognized by many ethnomedical systems around the world. Each of the theoretical approaches to medical anthropology demonstrates that to develop a holistic understanding of human well-being, it is necessary to include mental, physical, and social health. Social health is driven by a complex set of sociocultural factors that impact an individual or community’s wellness. At a macro level, it includes the cultural and political-economic forces shaping the health of individuals and communities. An individual’s social health also includes the support a person receives from their extended social network, as well as the social pressures or stigma a person may face and the meaning that they ascribe to their experiences. Just as mental and physical health strongly influence one another, when a person’s social health falters, their physical and/or mental health declines as well. A person’s overall health is informed by their physical health, their mental health, and their social health. When one falters, the others are affected. (credit: Copyright Rice University, OpenStax, under CC BY NC-SA 4.0 license) Physical environments—whether they are natural, constructed, or modified environments—shape cultural adaptations and behaviors. People living on islands and people living in deserts inhabit very different environments that inform their cultures and affect their biology. On the other hand, culture often affects how humans interact with their environments. People who work in offices in Los Angeles and hunter-gatherers in the Amazon River basin interact with their environments differently, relying upon very different subsistence patterns and sets of material culture. Culture also informs human biology. Eating a lot of spicy foods changes a person’s biophysiology and health outcomes, as do dietary taboos such as refusing to eat pork. These dietary choices inform biology over generations as well as within a single lifetime. The Biocultural Approach The biocultural approach to anthropology acknowledges the links between culture and biology. Biology has informed human development and evolution, including the adaptations that have made culture, language, and social living possible. Culture, in turn, informs choices that can affect our biology. The biocultural approach analyzes the interaction between culture, biology, and health. It focuses on how the environment affects us, and the connections between biological adaptations and sociocultural ones. The biocultural approach draws on biometric and ethnographic data to understand how culture impacts health. The effects of environment on biology and culture are apparent in the treatment of survivors of the Fukushima Daiichi nuclear accident that occurred in 2011 in Japan. Studies regarding the genetic health of survivors focus on the combination of environmental damage and social stigma in Japan due to their potential exposure to radiation. Symbolic Approach Other theoretical approaches ask different types of questions. What does it mean to be a patient? What are the social expectations for the behaviors of a person diagnosed as suffering from a particular sickness? Why is it symbolically meaningful for a treatment to be prescribed by a medical doctor? These are questions typically asked by those utilizing a symbolic approach to medical anthropology. The symbolic approach focuses on the symbolic thinking and beliefs of a culture and how those beliefs affect social and especially health outcomes. A person’s beliefs affect how they perceive treatments and how they experience illness. The most obvious example of the symbolic approach at work is the placebo effect . If a person believes that a treatment will be effective, this belief will affect their health outcome. Often in medical trials, people who believe they are receiving a treatment but are in fact receiving a placebo, such as a sugar pill, will demonstrate physiological responses similar to those receiving an active substance. Accounting for the placebo effect is an important consideration for all medical studies. The opposite of the placebo effect, the nocebo effect, occurs when a person believes they are not receiving an effective medicine or that a treatment is harmful. Common to both phenomena is the importance of meaning-centered responses to health outcomes. One of the most potent examples of this is voodoo death , when psychosomatic effects—that is, physical effects created by social, cultural, and behavioral factors—such as fear brought on by culture and environment cause sudden death. Related to the symbolic approach of medical anthropology is the symbolic interaction approach to health utilized by medical sociologists. Both approaches recognize that health and illness are socially constructed concepts. The symbolic interaction approach to health focuses on the roles of the patient, caregiver, and health care provider and the interactions that take place between people occupying these roles. Medical Ecology Another major medical anthropology theory is medical ecology . Pioneered by Paul Baker and based on his work in the Andes and American Samoa in the 1960s and 1970s, medical ecology is a multidisciplinary approach that studies the effects of environment on health outcomes. Examples of these environmental influences include food sources, environmental disasters and damage, and how environmentally informed lifestyles affect health. Whereas the biocultural approach looks at the intersection of biology and culture, medical ecology focuses instead on how environment informs both health and the culture surrounding it. A popular example of these connections can be observed in what are termed Blue Zones , certain locations around the world where a significant number of people regularly live exceptionally long lives, many over a century. These communities can be found in the United States, Japan, Columbia, Italy, and Greece. Common links between people who live in these places include a high-vegetable, low-animal-product diet (eggs and fish are the exception), a lively social life and regular activity, and a strong sense of cultural identity. A negative example of the links between environment and health can be viewed in the Flint, Michigan, water crisis. In this case, pollution of the city water system negatively affected health outcomes due to high exposure to lead and Legionnaires’ disease. Studies, including a long-term study by the National Institutes of Health, confirm that the water, central to the larger environment of Flint, negatively affected citizens of all ages, with particular harm caused to children and the elderly. Okinawa is classified as a Blue Zone, indicating that there is a high concentration of people near or over 100 years old living there. The long lives of Okinawans demonstrate the contributions of diet and lifestyle to health. (Credit: “Sata angagi” by Hajime NAKANO/flickr, CC BY 2.0) Cultural Systems Model Culture is a chief consideration in another theory, the cultural systems model . Cross-cultural comparison is a core methodology for anthropology at large, and the cultural systems model is ideal for cross-cultural comparison of health systems and health outcomes. Cultures are made of various systems, which are informed by sociocultural, political-economic, and historical considerations. These systems can include health care systems, religious institutions and spiritual entities, economic organizations, and political and cultural groupings, among many others. Different cultures prioritize different systems and place greater or less value on different aspects of their culture and society. The cultural systems model analyzes the ways in which different cultures give preference to certain types of medical knowledge over others. And, using the cultural systems model, different cultures can be compared to one another. An example of the cultural systems model at work is Tsipy Ivry ’s Embodying Culture: Pregnancy in Japan and Israel (2009), which examines pregnancy and birth in Israel and Japan. A particular focus is how state-controlled regulation of pregnancy and cultural attitudes about pregnancy affect women differently in each society. Despite both societies having socialized medicine, each prioritizes the treatment of pregnant women and the infant differently. In the Israeli cultural model for pregnancy, life begins at a child’s first breath, which is when a woman becomes a mother. Ivry describes a cultural model that is deeply impacted by anxiety regarding fetal medical conditions that are deemed outside the mother’s and doctor’s control. As every pregnancy is treated as high risk, personhood and attachment are delayed until birth. The state of Israel is concerned with creating a safe and healthy gene pool and seeks to eliminate genes that may be harmful to offspring; thus, the national health care system pressures women to undergo extensive diagnostic testing and terminate pregnancies that pass on genes that are linked to disorders like Tay-Sachs disease. Japan, facing decreasing birthrates, pressures women to maximize health outcomes and forgo their own desires for the sake of the national birth rate. The cultural model for pregnancy in Japan emphasizes the importance of the mother’s body as a fetal environment. From conception, it is a mother’s responsibility to create a perfect environment for her child to grow. Mothers closely monitor their bodies, food intake, weight gain, and stressful interactions. In Japan, working during pregnancy is strongly discouraged. Ivry noted that many women even quit work in preparation for becoming pregnant, whereas in Israel mothers work right up to delivery. The cultural systems model also allows medical anthropologists to study how medical systems evolve when they come into contact with different cultures. An examination of the treatment of mental illness is a good way of highlighting this. While in the United States mental illness is treated with clinical therapy and pharmaceutical drugs, other countries treat mental illness differently. In Thailand, schizophrenia and gender dysmorphia are understood in the framework of culture. Instead of stigmatizing these conditions as illnesses, they are understood as gifts that serve much-needed roles in society. Conversely, in Japan, where psychological diagnoses have become mainstream in the last few decades and pharmaceutical treatment is more prominent than it once was, psychological treatment is stigmatized. Junko Kitanaka ’s work on depression in Japan highlights how people with depression are expected to suffer privately and in silence. She links this socially enforced silence to Japan’s high stress rates and high suicide rates (2015). The cultural systems model offers an effective way to evaluate these three approaches toward mental illness, giving a basis of comparison between the United States, Thailand, and Japan. Assigning ethnomedicine the same value as biomedicine rather than giving one primacy over the other, this important comparative model is central to the theoretical outlook of many medical anthropologists. A sign outside of Aokigahara Forest asks people to reconsider taking their own lives. This public health initiative targets the cultural tradition of people dying by suicide in the Aokigahara Forest. (Credit: “Aokigahara (suicide forest) + very tired Liz” by Liz Mc/flickr, CC BY 2.0) The cultural systems model encompasses a myriad of cross-disciplinary techniques and theories. In many cultures, certain phrases, actions, or displays, such as clothing or amulets, are recognized as communicating a level of distress to the larger community. Examples include the practices of hanging “the evil eye” in Greece and tying a yellow ribbon around an oak tree during World War II in the United States. These practices are termed idioms of distress , indirect ways of expressing distress within a certain cultural context. A more psychologically driven consideration is the cause of people’s behaviors, known as causal attributions . Causal attributions focus on both personal and situational causes of unexpected behaviors. A causal attribution for unusual behavior such as wandering the streets haplessly could be spirit possession within the context of Haitian Vodou, while in the United States behaviors such as sneezing and blowing one’s nose might be attributed to someone not taking care of themselves. Causal attributions can be important to one’s own illness. Anthropologist and psychiatrist Arthur Kleinman has concluded that if doctors and caregivers were to ask their patients what they think is wrong with them, these explanations might provide valuable information on treatment decisions. One patient might think that their epilepsy is caused by a spirit possession. Another might suggest that their developing diabetes in inevitable because of their culture and diet. These beliefs and explanations can guide a doctor to develop effective and appropriate treatments. The approach recommended by Kleinman is known as the explanatory model. The explanatory model encourages health care providers to ask probing questions of the patient to better understand their culture, their worldview, and their understanding of their own health. The Tuskegee syphilis experiment ran for 40 years, studying untreated syphilis in Black men who believed they were receiving treatment for other illnesses. (credit: National Archives Atlanta, GA (US government)/Wikimedia Commons, Public Domain) Political Economic Medical Anthropology Another medical anthropology approach is critical medical anthropology (CMA) , which is sometimes referred to as political economic medical anthropology (PEMA) . Critical medical anthropology has a specific interest in the inequalities of health outcomes caused by political and economic hierarchies. Critical medical anthropology advocates for community involvement and health care advocacy as ethical obligations. Defining biomedicine as capitalist medicine, this approach is critical of the social conditions that cause disease and health inequalities and of biomedicine’s role in perpetuating these systemic inequalities. CMA is also interested in the medicalization of social distress, a process that has led to a wide range of social problems and life circumstances being treated as medical problems under the purview of biomedicine. Systemic racism and structural violence create many negative health outcomes. Structural violence refers to the way in which social institutions, intentionally or otherwise, harm members of some groups within the larger society. Structural violence can affect things such as life expectancy, disability, or pregnancy outcomes and can lead to distrust of medical systems. The Tuskegee syphilis study, a decades-long “experiment” that studied the long-term effects of syphilis in Black men under the guise of medical treatment, is a prime example of structural violence at work within the United States medical system. Black men involved in the study were not told they had syphilis and were denied medical treatment for decades, with most dying of the disease. The government’s internal mechanisms for halting unethical studies failed to stop this experiment. It was only when public awareness of what was happening resulted in an outcry against the study that the experiments were stopped. Another area of interest to medical anthropologists working with a CMA approach is how medical systems might be inherently biased toward or against certain segments of society. The research of anthropologist Leith Mullings demonstrated a lifelong focus on structures of inequality and resistance. Her work in Ghana examined traditional medicine and religious practice through a postcolonial lens, which was critical of the colonial legacy of structural inequality she observed. Her work in the United States also focused on health inequalities, with a special interest in the intersection of race, class, and gender for Black women in urban areas. It has been documented that some doctors in the United States regularly ignore the pain of women, and this is especially true in cases where the doctor displays racial bias. This tendency has been cited in several studies, including a study in The New England Journal of Medicine that found that women are more likely to be misdiagnosed for coronary heart disease based on the symptoms they give and pain levels reported (Nubel 2000). Another study in the Journal of Pain found that women on average reported pain 20 percent more of the time than men and at a higher intensity (Ruau et al. 2012). Another example of research that takes a CMA approach is Khiara Bridges ’s 2011 Reproducing Race , which brings a critical lens to pregnancy as a site of racialization through her ethnography of a large New York City hospital. This medical racism contributes to the higher rates of African American infant and maternal mortality. Merrill Singer has done work on the role of social inequalities in drug addiction and in cycles of violence. This work has led to his development of the concept of syndemics , the social intersection of health comorbidities , or two health conditions that often occur together. For example, Japan’s hibakusha , or atomic bomb survivors of Hiroshima and Nagasaki, do not live as long as Japan’s normally long-lived population and are more likely to develop multiple types of cancer and other diseases tied to their exposure to nuclear radiation. In addition to these health risks, they face heavy discrimination from the larger Japanese population due to misinformation regarding nuclear radiation and radiation contamination. This discrimination carries over to the descendants of hibakusha , who have a higher rate of cancer than the average Japanese population despite having no detectable genetic damage from the atomic bombings. Studies are ongoing as to the cultural, economic, and genetic causes of this cancer. Syndemics is highlighted in the near-century-long struggle for numerous conditions caused by the atomic bombings to be recognized as related to the atomic bombings and thus treated by the Japanese government. Critical theories of health are an applied method, analyzing medical systems and applying critical theory, often with the goal of improving the system or improving policy. Recommendations for improvements often come out of research but may also be the starting point of a research project, as part of a data-finding mission to highlight disparity in health outcomes. Whether it is systemic racism in biomedical treatment or power discrepancies in ethnomedical rituals, critical theories of health are a key part of exploring medicine in action and understanding real medical consequences. From birth to the grave, social inequalities shape health outcomes, life expectancy, and unnecessary human suffering. Critical medical anthropology scholarship demonstrates the social forces shaping disease and health, from drug addiction to the impacts of climate change. This work becomes a self-evident call of action. It is medical anthropology in action. Angela Garcia 1971- Personal History: Angela Garcia comes from a small town along the Mexican border with New Mexico. She credits her background and upbringing with inspiring much of her later work in anthropology. Her early experiences have led her to focus on places where political and cultural spheres combine, resulting in inequality and violence. Within this framework, she has focused on medicine, postcolonial theory, and feminism. She first attended the University of California, Berkeley, and then earned a PhD from Harvard University in 2007, shortly thereafter publishing her first book, The Pastoral Clinic: Addiction and Dispossession along the Rio Grande . Area of Anthropology: medical anthropology, feminist anthropology Accomplishments in the Field: The Pastoral Clinic analyzes heroin addiction among Hispanic populations in New Mexico’s Rio Grande region. Garcia’s work focuses on the political and social realities that contribute to addiction and treatment, with dispossession as a central theme. The degradation of the surrounding environment and the economic decline of the Great Recession have been important factors in determining people’s life choices. Also influential has been a political reality that denies many participation or power. Garcia describes addiction as a recurring reality in the lives of many, leading them in and out of rehab in an endless cycle. Garcia also describes the damaging effects of addiction on relationships within families and communities. Garcia joined the Department of Anthropology at Stanford University in 2016. Her work has shifted to Mexico City, where she studies coercive rehabilitation centers run by the poor. She is particularly interested in political and criminal violence and in how informal centers like these exemplify the political and social climate within the larger Mexican nation. As much as these centers embody these realities, they also try to shift power away from pathways that lead to and encourage violence. In addition to this work, Garcia has also started examining addiction and mental illness in both Mexico and the United States Latinx (Latina/o) population. Importance of Their Work: Garcia publishes and presents frequently in preparation for books she is currently writing. Her work is crucial to understanding dispossession and power dynamics within the United States and Mexico, including how immigration and migration affect access to health care and shape identity. biocultural approach the assumption that culture is informed by physical and sociocultural elements. Blue Zones communities around the world with a high concentration of people near or over the age of 100. causal attributions a psychological concept used to study regular cultural behavior and how deviation from that behavior might be explained. clinical observations an ethnographic method resulting in a straightforward, clinical study of a medical situation. comorbidities two or more health conditions that often occur together. critical medical anthropology (CMA) a theory that highlights a culture’s inequalities, including inequalities in health care. critical theories of health an applied theory aimed at pointing out issues within health care systems and changing them for the better. cultural systems model a theory that analyzes how systems within a particular culture, including health care systems, affect one’s worldview and actions. health decision-making analysis a study of the decisions that go into a person’s health choices. idioms of distress indirect ways that members of a culture show distress. illness narrative interviews an ethnographic method used to collect information about an informant’s illness experience in their own words. medical ecology a multidisciplinary theory studying the effects of environment on lifestyle and health. medical statistics statistics regarding treatments for medical illnesses that inform an anthropologist’s study, as well as medical policy and health choices. participant observation a methodology in which the anthropologist makes first-person observations while participating in a culture. placebo effect the effect in which belief in a treatment’s efficacy creates a positive health outcome. political economic medical anthropology (PEMA) a theory that highlights a culture’s inequalities, including inequality in health care. social health an acknowledgement that one’s social interactions and standing are an important aspect of overall health. structural violence violence caused by political and social systems that prevent groups from taking care of themselves in multiple ways. symbolic approach a theory focusing on how a culture’s symbols affect social and health outcomes. symbolic interaction approach to health and approach that focuses on the interaction between patient and caregiver(s). syndemics the social intersection of comorbidities in health outcomes. voodoo death death brought on by psychosomatic belief in cultural and environmental effects.

Social Sciences