Medical Anthropology studies human health problems and healing systems in their broad social and cultural contexts. Medical anthropologists engage in both basic research into health and healing systems and applied research aimed at the improvement of therapeutic care in clinical settings or community public health programs in prevention and disease control. Drawing from biological and social sciences, as well as clinical sciences, medical anthropologists have contributed significantly to the understanding and improvement of human health and health services worldwide. As a result, the growth of the subdiscipline in recent years as reflected in publications and meetings, training programs, and influence outside of anthropology has been remarkable.
Medical anthropology is not characterized by a single theoretical paradigm. For example, ethnographic description and analysis of religion and healing systems are as old as anthropology itself, while new approaches like critical medical anthropology are the product of more recent intellectual trends. This has sometimes led to intense debates within the field such as those between clinically applied medical anthropologists (interested in making cultural knowledge useful to the aims of medical practitioners) and critical medical anthropologists (interested in the phenomenology and political economy of biomedicine). But, even though the scope of intellectual inquiry is very diverse, it is possible to identify five basic approaches: biomedical, ethnomedical, ecological, critical, and applied. These approaches share three fundamental premises:
1. illness and healing are fundamental to the human experience and are best understood holistically in the contexts of human biology and cultural diversity
2. disease represents an aspect of the environment that is both influenced by human behavior and requires biocultural adaptations
3. the cultural aspects of health systems have important pragmatic consequences for the acceptability, effectiveness, and improvement of health care, particularly in multicultural societies
The initial development of medical anthropology derived from anthropological interest in different illness beliefs and healing practices (Rubel & Hass 1996).
Cultures have developed more or less organized approaches to understand and treat afflictions, and identify the agents, forces, or conditions believed responsible for them. Ethnomedicine is that branch of medical anthropology concerned with the cross-cultural study of these systems. While medical systems or elements thereof were foci of research early in the 20th century in the work of W. H. Rivers, the study of popular systems of health and illness did not coalesce into a field of study
in anthropology until the 1980s. Foundational formulations of the field of medical anthropology appeared in the 1950s and 1960s, in the works of such writers as William Caudill and Steven Polgar.
The earliest ethnomedical research was confined to the study of non-Western societies and exotic cultures and was generally subsumed under the comparative study of religion. Ideas about sickness and therapeutic rituals were analyzed as a window on underlying cosmological beliefs and cultural values. As the intimate relationship between the concepts of illness and the social organization were recognized, ethnomedicine became a common focus of ethnographic research. Fabrega (1975: 969) defined this approach as "the study of how members of different cultures think about disease and organize themselves toward medical treatment and the social organization of treatment itself." Typical ethnomedical studies focus on the classification and cultural meaning of illness (both somatic and mental), the health-seeking behaviors of people suffering from illness, and the theories, training, and practices of healers. Nichter (1992: x) described twelve areas of current ethnomedical work, including the "study of the afflicted body as a space where competing ideologies are contested and emergent ideologies are developed through medico-religious practices and institutions which guide the production of knowledge."
Although not always recognized as such, much of the research in BIOLOGICAL ANTHROPOLOGY using the standard epistemology of science and focusing on human biology and the health consequences of different stresses is part of medical anthropology (F. Johnston & Low 1984). For example, it has long been recognized that DISEASE has acted as an important agent of natural selection in genetic and cultural EVOLUTION. Biomedical anthropologists have used immunological studies to trace EPIDEMICS. Biological anthropologists have examined human physiological adaptations to a wide variety of stresses, including high elevation, cold temperatures, nutritional deprivation, and infectious disease. Laboratory-based scientific methods (such as the biochemical analyses of ethnopharmacological compounds) are used to analyze the biochemical and physiological functioning of ethnomedical practices. This type of analysis played a role in the discovery of a Hepatitis vaccine (Blumberg 1982).
The ecological approach in medical anthropology focuses on how human cultural and behavioral patterns shape the complex interactions of the pathogen, the environment, and the human host, and produce both infectious and noninfectious disease states (Inhorn & Brown 1997). In recent years, ecological studies of health and illness have looked beyond local socioeconomic factors that influence disease rates to emphasize the larger political economic forces that constrain the behavior choices of populations. Both Ecological Anthropology and political ecology examine how cultural, physical, and political-economic environments shape the distribution of disease morbidity and mortality. Disease patterns described with epidemiological methods (in regard to time, place, and person) often reflect cultural practices associated with diet, activity patterns, sexuality, and so forth. In addition, culturally defined group practices such as the introduction of IRRIGATION agriculture can transform the disease ecological balance in favor of a pathogen like malaria or shistosomiasis, and in turn damage health. Ecological analyses in medical anthropology also reveal many cases where cultural changes improve health for some groups.
Critical medical anthropology (CMA) is a label applied to two distinct intellectual movements that influenced the field during the 1980s and 1990s. One emphasized the marxist approaches to understanding how macrosociological political-economic forces influence health and structure health-care systems. The second movement is more epistemological, it questions the intellectual underpinnings of contemporary biomedical theory and practice. This approach has been influenced by postmodern thinkers like Foucault who emphasize the social-constructionist nature of reality and the social power inherent in hegemonic institutions like "Biomedicine." What these movements have in common is the demand for a fundamental rethinking of the premises and purposes of medical anthropology.
The political-economic orientation of CMA views health issues in the light of the larger political and economic forces that pattern human relationships, shape social behavior, and condition collective experience (Merrill Singer 1989). Macrolevel processes such as world CAPITALISM are seen as the dominant forces that shape clinical practice and influence the distribution of disease. Medicine is perceived not only as a set of procedures and treatments, but also as a particular set of social relationships and an ideology that legitimates them. Recognition of the centrality of the political-economic dimensions of both sickness and healing, as well as the unequal social relationships between healers and patients is the hallmark of this approach.
The second branch of CMA challenges the epistemology and universality of assumptions underlying the theory and practice of Western medicine, which were conventionally exempt from cultural analysis in medical anthropology. This approach has been responsible for the label "biomedicine." Medical anthropologists like Lock and Scheper-Hughes (1996) advocate the deconstruction of how mind and body are conceptualized as a way to gain insight into how health care is planned and delivered in Western societies. The separation of mind and body in biomedical science is so pervasive that there is a need for more precise vocabulary for the interactions of mind, body, and society.
Interest in the applied aspects of medical anthropology has been present since the initiation of the discipline. There are two branches of applied work, clinical and public health. Clinically applied medical anthropology is best known for its use of explanatory models to explore conceptual differences between physicians' and patients' perceptions of disease and illness. Clinically applied anthropologists work in biomedical settings with health practitioners and the delivery of health care services; they are also involved in the training of future professionals. Without a single theoretical proposition, it can be interpreted as anthropological theory and methods devoted to the topics of health, illness, and health care. Clinical medical anthropological research has a very wide range, including microlevel studies of health-care choices, illness beliefs, and life-course events like CHILDBIRTH or menopause; the examination of cultural influences on health-seeking behavior, disease distributions, the experience of illness (e.g., pain), and interactions of healers and patient (i.e., compliance); and macrolevel research on health-care systems and their political and economic contexts (Chrisman & Johnson 1996). Some clinically applied medical anthropologists are employed within hospitals and clinics as cultural mediators and interpreters.
Applied medical anthropology research in public health has gained importance in recent decades (Coreil & Mull 1990). More medical anthropologists are working in international health projects, particularly because of the programmatic emphasis on primary health care and interventions in nutrition and oral rehydration therapy that require community participation. Anthropologists have worked on all aspects of such projects, including problem identification and analysis, intervention, and evaluation of specific health problems.