Anthropology of medicine 2024.ppt foe the first year studentsx

anthropology of medicine

1. [email protected] Office no. 106 Multidisciplinary Research Services (MRS) Tel no. 061 206 3005 05-10 August 2024

2. 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.

3. LEARNING OBJECTIVES Define biomedicine Explain the history of Medicalization Explain Anthropology of Medicine Explain Medical Knowledge and Integration of Traditional Medicine D efine Medical Pluralism Define Health Explain how culture affects health Illustrate how anthropological perspectives can facilitate effective health care Discuss the nature of cultural competence in health care Discuss medical anthropology’s major applications in addressing culture and its impacts on health Discuss the broad range of concerns people have with respect to their health

4. Introduction-Anthropologies of Medicine How anthropologist view biomedical practice in the context of cultural, social, and political variables in their analyses. Key Themes in Biomedicine: Medical Pluralism & Medicalization Medical Pluralism: Coexistence and interaction of multiple medical systems - Emphasizes cultural, social, and political contexts in understanding biomedical practice Medicalization: Framing health issues in medical terms - Neglects social and political origins of disease and illness - Imposes a universal standard of normality Assumption of a "Universal Body- Clinical biomedicine's focus on a standardized body - Disregards local understandings of health and well-being Emphasizes a narrow focus on the material body Challenging the Nature-Culture Dichotomy: Traditional acceptance of the biological view of the body Growing recognition of the need to integrate cultural and social dimensions

5. Biomedicine Western medicine , mainstream medicine or conventional medicine ) is a branch of medical science that applies biological and physiological principles to clinical practice . Biomedicine stresses standardized, evidence-based treatment validated through biological research, with treatment administered via formally trained doctors, nurses, and other such licensed practitioners Refer to the predominant medical theory & practice Medicine widely disseminated through-out the world & each of its many denominations, "Western," "Cosmopolitan," "Modern," "Scientific Biomedicine its principal origins in Western civilization, and have been a leading edge of modernism It has incorporated and now penetrates other traditions as well

6. History of Medicalization T he process of treating everyday life issues as medical problems. Historical focus on disease causation and social inequalities in health. Emphasis has shifted towards biomedicine and social control. Medicalization began long before the late 19th century. Early healers in Europe and Asia (250 BCE - 600 CE) dealt with physical and life course issues. Modern view : Medicalization linked with Western modernization and medical specialization. 17th century: "Engineering mentality" focused on controlling the natural world. 18th century: Medicine professionalized with state support and new medical knowledge. Expanded to lifecycle events: birth, adolescence, menopause, aging, and death. 19th century: State and professional standardization of health practices. Medical technologies and public health initiatives targeted everyday behaviors . Example: Surveillance of emotions, sexuality, and reproductive health.

7. History of Medicalization Anatomical pathological sciences, autopsy, physical examination, and statistical disease monitoring. Formation of public health as a state-supported discipline. Dividing practices": Sickness vs. health, illness vs. crime. Use of medical assemblages: hospitals, clinics, government offices. Introduction of technologies like the stethoscope for indirect body assessment. Mid-19th century: Hospitalization expanded, influencing all social classes. Seen as medical "imperialism" due to new power dynamics. Debate on whether this represents broader medicalization or specific institutional changes. Medicalization also seen in 19th-century Japan and China. In colonies (India, Africa, Southeast Asia, Latin America): Medicalization linked with colonization. Focus on protecting colonizers and civilizing the colonized rather than improving health. Medicalization has evolved from ancient practices to modern social control. Ongoing debate on its impacts and global variations. Influence of medical technologies and institutional changes on health practices.

8. Contextualizing Medical Knowledge Externalizing Discourse in Traditional Medical Systems Medical knowledge as deeply social, influenced by cultural and political contexts Shift towards analyzing biomedicine in socio-cultural context, following Michel Foucault's insights Across cultures, knowledge about health and illness has been systematically developed. W. H. R. Rivers: Argued that non-literate societies' medical practices are integral and logical, not mere superstition. Anthropologists have shown medical knowledge is culturally and regionally informed. E. E. Evans-Pritchard: Azande's belief in witchcraft as a rational response to misfortune.   Non-literate medical traditions often view disease causes as external, involving social relations, environment, and spiritual factors.

9. Contextualizing Medical Knowledge Externalizing Discourse in Traditional Medical Systems Illnesses are seen as distinct events without systematic anatomical links. Systems like Chinese medicine, Ayurveda, and Yunnani focus on signs of illness through surface and indirect internal observations. These systems do not assume a universal body, but consider body types and external conditions. Multi-Causal Explanations: Non-literate medical traditions often view disease causes as external, involving social relations, environment, and spiritual factors. Illnesses are seen as distinct events without systematic anatomical links. Systems like Chinese medicine, Ayurveda, and Yunnani focus on signs of illness through surface and indirect internal observations. These systems do not assume a universal body, but consider body types and external conditions.  

10. Contextualizing Medical Knowledge Biomedicine and Internalizing Discourse  Internalizing Approach: Biomedicine focuses on internal causes, often ignoring external factors except as contributing elements. Unexplained conditions are attributed to the current limits of scientific knowledge. Reductionistic Nature: Emphasis on detecting specific internal entities (e.g., viruses, genes) associated with disease. Unique development of anatomy and surgery, contributing to a focus on internal bodily representations. Global Impact: Globalization and biomedicine's spread have influenced traditional medical practices and ordinary people's understanding of health.  

11. Introduction to Traditional Medical Practices Knowledge and practices for preserving health have always existed globally. Early recordings by anthropologists began in the late 19th century Notable work by W. H. R. Rivers in the 1920s emphasized the systematic nature of medicine in non-literate societies.

12. Medical Pluralism Includes local healers, saints, priests, Ayurvedic doctors, midwives, astrologers, and biomedical doctors. Choices influenced by type of illness, beliefs, social status, and economic factors. Charles Leslie on Indigenous Medicine: Indigenous practices continue to thrive despite predictions of decline. People often consult multiple types of healers, showing biomedicine alone is not sufficient.

13. Global Perspectives on Medical Pluralism Japan's Integrated Approach: Despite advanced biomedical facilities, people also use East Asian medicine, acupuncture, herbalists, and more. Biomedical practitioners sometimes refer patients to traditional therapies. Medical Choices in Other Regions: Haiti and Bolivia: Choices often based on available resources, costs, and cultural perceptions. In some places, traditional beliefs mix with biomedical practices, sometimes leading to risky outcomes. Local Context and Biomedicine: Medical pluralism varies by location, influenced by local histories and cultural beliefs. People maintain indigenous theories of disease and local idioms of distress even when exposed to scientific knowledge.

14. Modernization and Integration of Traditional Medicine Traditional medical systems are dynamic and innovative. Integration and syncretism with biomedical practices have occurred. Indigenous healers often adopt biomedical technologies. Pressures and Influences: Governments encourage systematization and standardization. Media and internet influence healers to modernize and market their practices. Some healers receive basic biomedical training.

15. Regulation, Legitimacy, and Nationalism In urban areas, complementary practitioners are often regulated. Training includes anatomy, physiology, and traditional knowledge. Legitimacy and National Identity: Debate over legitimacy grounded in 'tradition' vs. 'modernity.' Some governments, like Indonesia, support traditional medicine for nationalistic reasons. In India, Ayurveda is promoted as a cultural defense against Western influences and biomedicine.

16. Concepts of health What is health?

17. 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).

18. World Health Organization’s Concept of Health 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?

19. Medical Anthropology Concepts of Health 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.

20. 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. 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.

21. For many people 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 for legislation to deny people’s access to foreign medicines

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

23. 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.

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

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

26. 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.

27. 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.

28. 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.