Medical Anthropology

MEDICAL ANTHROPOLOGY

Ben Villareal III

Anthropology:
The Four Subfields
PHYSICAL
ANTHROPOLOGY

LINGUISTIC ANTHROPOLOGY
ARCHCAEOLOGY
ANTHROPOLOGY

CULTURAL
ANTHROPOLOGY
ETHNOLOGY

Culture is a
fundamental concept
within the discipline
of anthropology.

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

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

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

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

“To future generations of health care
professionals and
medical social scientists—that they may better
understand
the roles of culture in health and well-being, and
in
the care of patients and prevention of disease.”

APPLIED MEDICAL
ANTHROPOLOGY
AND HEALTH CARE
Part 1

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

Medical anthropology is the
primary discipline
addressing the interfaces
of medicine,
culture, and health behavior
and incorporating
cultural perspectives into
clinical
settings and public health
programs.

Health
professionals need
knowledge of
culture and
cross-cultural
relationship skills
because health
services are more
effective when
responsive
to cultural needs.

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

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

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

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

AREAS OF MEDICAL ANTHROPOLOGY
PUBLIC HEALTH

5. Perform health education and
preventive medicine
6. Perform epidemiological studies
and community assessments
7. Provide health policy analysis
and advocacy
8. Supply international health and
international medical relief (aid)
9. Perform health systems
integration (traditional and
modern)

What do health
professionals—
providers,
researchers, social
service personnel,
educators,
and other “helping
professionals”—need
to know about the
effects of culture on
health?

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

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

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

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

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

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

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

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

CONCEPTS OF HEALTH

What is health?

Conceptions of what constitutes health
vary widely.

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

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

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

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

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

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

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

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

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

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

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

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

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

Critical Medical Anthropology Concepts of Health

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

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

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

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

PUBLIC HEALTH CONCEPTS OF HEALTH

Public health models (see Healthy Communities
2000: Model Standards [American Public Health
Association, 1991] and the Assessment
Protocol for Excellence in Public Health [see
Durch et al., 1997]) emphasize community
involvement as key to a conceptualization of
health. Healthy communities have
health institutions that are
accountable, incorporating community
involvement from
planning stages through implementation and
evaluation activities.

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

EXPERIENCE OF MALADIES

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

Different kinds of maladies such as disease,
illness, and sickness are considered
synonyms in English, but there are important
distinctions among them in medical
anthropology.

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

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

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

● Introduce evaluation procedures for ascertaining health needs and program
effectiveness.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

■ The genetic and biological levels

These interdependent subsystems affect one
another, operating through natural
resources, the population and its ecological
balance, and cultural systems mediating
human interaction with all of the force fields:
resources, social networks, and medical
services.

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

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

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

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

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

Major Aspects of Cultural Systems
Cultural Level Function Activity
System

Superstruct Mental Ideology, Communication
ure beliefs,
meaning

Structure Social Social Interpersonal relations
organization

Infrastructur Material Technology, Behavior
e economy

COMMUNITY HEALTH ASSESSMENT

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

Community involvement is necessary because
effectiveness must be measured in goals specific
to the particular community and its circumstances.
Because improving the community’s perception of
its health is part of public health goals,
determining community views of desirable
improvements in its health is part of an evaluation.
The health of a community is a function not only
of biological disease rates but also of quality-of-
life concerns based on cultural values and
expectations.
Community approaches are central to health
because they reflect social expectations
regarding quality of life.

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

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

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

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

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

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

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

CREATIVE ASSESSMENT

1. By group, or individual
2. The scope of health programs
(a.k.a., Cultural Systems Models should
solely improve the SPUQC community; the
works must be give orientation to the
importance of health.
3. Deadline will be on October 15, 2010.
4. Submit it through electronic copy like, DVD

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

Medical Anthropology

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