1.17.

17 – Culture, Health and Illness

Assumptions:
Public Health problems are embedded in cultural contexts
The way people understand an environment is culturally specific (Here in America it is biomedical;
in other contexts sickness can be result of malevolent forces that send sickness your way)
People’s decision-making influenced by various social contexts/group memberships
People’s understandings of disease is very much based on the social groups around them
Decision-making compromised by contradictory and competing priorities (very often time there is
competing understandings of disease)
As a medical anthropologist it is really important to account for the various understandings of
disease causation for example

Data collection in Med Anth (qualitative)

Keep your sample size small
Quality over quantity
Not as interested in representative sample; rather the depth of info you get from interview
In-depth semi-structured interview
Get as much detail as possible
Goal is to prompt people to get more information; certain probes that will make people talk more
(“that’s very interesting, tell me more.” “Uh huh.”)
Utilize (if possible) multiple methods
In-depth interviewing
Focus groups (great way of generating a lot of info, people play off each other and can spur more
people to speak)
Key informant (individuals in the community who are experts in a particular topic; get some
baseline data from)
Participant observation (go into field, spend significant amount of time)

Qualitative Concepts
Qualitative research is systematic discovery
Generating knowledge of social events and processes and their meaning (discovery-oriented)
Exploring human interactions and how they interpret/interact with world around them
Analysis of patterns of shared understanding and variability
How much of what they (the subject) say coheres or diverges with shared understandings of
something?

Qualitative researchers value natural settings where lived experiences can be better understood
Where people live and work  natural setting

Expression of research in participants’ words, images, and sometimes in numbers

Language has symbolic meaning (language can determine how we see the world around us) 
Knowing a different language you can express the same general idea in a very different way;
reconfigures the way you see the world and the way you speak about the world
Important to listen carefully as informants talk about their experience (people often times will tell
you what you want to hear; important to read into what they are saying)
Raw data = narrative (the result of the interviewing process; bunch of text/transcription of the
interview is seen as the narrative data  the primary date that interviewers look at and draw
conclusions from)
Look into ethnographic film
Qualitative research process is flexible, emergent , and iterative
Study design not fixed
Finding emerge constantly
Analysis ongoing

Reflexivity is vital as question and observe yourself

You as a researcher have an effect on the community you are entering
Have to do a lot of self reflection and evaluate your impact
Partnership with participants
You are a key research instrument
How it is that your partners in field read you (and fit you into their cultural setting) have influence
on the kind of data you can collect and what people will feel comfortable talking to you about
Carry your own cultural baggage into the field, own framework and worldview  will influence the
types of questions you’ll ask and the information you will collect
But, must also be the objective observer (it’s a balance, but also a tension)

Sample Research Topics

Perceptions of sexually risk behavior
Health-seeking behavior
Barriers to health care access
Differential body perceptions among different ethnic/racial/national groups
Use/popularity of folk medicine locally
Healer/patient relations
Conflicts in explanatory models
What does “cultural competence” in medicine mean in practice?

Week 2 – 1.19.17

What does is it mean for the political economy to be a primary epidemiological factor?
 Political economy is the relationship between whatever base economy is and the
government and governance of the society you are looking at.
 Different types of modes of production influenced by the government it functions under.
(Post-industrial mode in the U.S.)
o Post-industrial is a shift in focus from factory work to financial transactions and
information technology.
 Historically here in the United States our governing body has really had an impact on the
economy we have.
 This is really an epidemiological factor for a few reasons:
o Influences the resources the country has
o Affects how diseases are viewed and handled
o Plays a part in the amount of healthcare and access the citizens have
o Relationship between health and wealth
 Relationship between poverty an ill health

Do you agree that biology and culture matter equally in terms of disease?
 Matter equally
  Socioeconomic status is a huge factor in determining health status

Why is ethnography an essential tool for understanding illness and disease?

 Ethnography  primary methodological tools anthropologists use to study culture; study,
analysis and description of a particular culture; when a researcher spends an extended
period time living in a culture to better understand it; process of moving from an outside
perspective to an inside perspective over time
o Participant observation
o Learning the language
o Extended time period
 Ethnography is important for studying illness and disease because individual cultures
experience, explain, and understand illness and disease in different ways.
o Cultural competence: the ability to understand, appreciate, and interact with
persons from cultures/belief systems other than one’s own.
 Ethnography can be valuable to observe illness and disease over time and how people
respond to it over an extended period
 Not all cultures view illness and disease under a biomedical approach; some submit to a
more holistic, traditional, or natural healing method

Mama Day by Gloria Nailer – book recommendation

Factors that Affect Re/Emerging Disease

 Hospital induced diseases
 Technology and industry paly an important role
Traveling is a major tool for the dissemination of diseases around the world
Break down of public health measures
 Lack of water safety and portability measures
o Allows for introduction bacteria and water-born illnesses
 Poor sanitation
o Can often be attributable to urbanization (people moving in great numbers to cities
which but stress on the sanitation systems)
 Poor hygiene practices
o Lack access to clean water (to wash their hands, clean their bodies, etc.)
Poverty and social inequality
 May lack availability of healthcare services
War and famine
 People end up displaced from their homes
 Health conditions and public health infrastructure are notoriously awful in refugee camps
 Increased risks of contracting diseases in refugee camps
Intent to Harm
 Potential for biological warfare
 Example: infecting Native American blankets with smallpox in order to gain access to Native
American controlled lands
 Many have been concerned that anthrax was being used for biological warfare here in the
U.S.
Lack of Political Will
 A country’s will to shore up public health systems and healthcare in countries
 Financial resources play a large role in this for some countries
Cholera

Case Study: Peru in the 1990s. In 1991 there would be the first appearance of cholera breakouts in
Latin America. Initially there were 12,000 cases that were reported, but it very quickly spread
across national borders (Brazil and Ecuador). People crossing the borders and spreading the
disease was a major factor here. Adds to the stigmatization of foreigners. Initial response to the
pandemics was from public health professionals and epidemiologists attempting to determine the
source. Focused on morbidly and mortality rates and also the number of people affected. Numbers
were larger inland, which was attributed to… The pathogen in this case was vibreo cholera. Focus
on the pathogen, modes of transmission and ways to combat further spread. The interest was in an
ecological perspective and to discovery the relationship between the pathogen, then environment
as well as the host. Also looked into cholera’s ability to upset reabsorption liquid in the small
intestine. People would experience profound cases of diarrhea and dehydration.
Spread of cholera was possible because of: breakdown in the sanitation systems, contaminated
waterways from fecal matter, poverty in the country really helps spread the illness, increasing
concentration in urban centers which can result in the breakdown of infrastructure, another
primary factor is human induced global warming (had temperatures been cooler the disease
pathogens may not have survived as well in the water sources.

Evolutionary/Ecological Perspective Privileges:

 Role of changing demographics
 Socioeconomic status issues
 Medical problems of the evolution of bacteria/its adaptation
 Maps out the relationship between the pathogen, host and the environment
 Aides when disease can be traced to a single agent

Interpretive Approach Hallmarks:

 Premised on this idea of meaning
o What does the disease mean to the individual
o What does it mean to the people around the individual
o How do they understand the disease?
o Networks of meaning for the sufferer
 What are the fears and expectation of the illness
 Meanings are grounded in the wider cultural belief system
 Interpretive approach would ask questions like: what are the metaphors that are associated
with disease? (Example: Vampire symbolism in Tuberculosis or “The Vapors,” consumption
was another term)
o Being aware of the
 Ethno-medical theories of illness and disease  how people understand the disease itself
(differing explanations how what people thing AIDS is for example, result of westernization
-> forgetting their cultures so they are punished by the ancestors, or a disease strictly for
sinners, etc.)
 Very interested in how people are responding to and reacting to illness
 Need to document the thoughts an feelings of the sufferer and their families (through
interviews and observations)
 Also accounting for how medical professionals account for the disease and derive the
underlying logic (interested in the etiology of these belief systems)
Book Recommendations: Dr. Larry Brilliant – Memoir: Sometimes Brilliant
Ken Kessey and the Marry Pranksters (Experimentation with Hallucinogenic Drugs)

What meanings does cholera bring with it?

 The idea that it is happening to poor populations
 Reveals breakdowns in infrastructure of society
 Reveals cleavages between indigenous populations and varying classes
 Usually vulnerable populations in society that get scapegoated as the spreaders of disease
 Marginalization of populations

What meanings are attached to the epidemic? By whom? And to what end?

Useful Framework: Work of Michelle Fouco

 Concept of discourse
o Public dissemination of information and who gets to talk about things in the public
sector
o A knowledge-power regime
o A system of belief and practice that makes certain things knowable and certain
things unknowable
o Usually the powerful individuals in society usually wield discourse and shape reality
– to define even the terms of how we talk about reality
 Fouco was interested in who it was in society that wields discourse
 He refers to discourse as the multiple ways of seeing, knowing and saying that link
conceptual practice of knowledge with the material practice of control.

 So in the case of cholera in Peru; the individuals who wielded discourse were those in the
city center, by the elite population
o Depended on public health intervention
o Stigmatized indigenous people
o Based on a biomedical/ecological perspective