As the global population becomes larger, it is increasingly challenging to address the health needs of the world’s population. Today, 1 in 8 people in the world do not have access to adequate nutrition, the most basic element of good health.61 More than half the human population lives in an urban environment where infectious diseases can spread rapidly, sparking pandemics. Many of these cities include dense concentrations of poverty and healthcare systems that are not adequate to meet demand. 62Globalization, a process that connects cultures through trade, tourism, and migration, contributes to the spread of pathogens that negatively affect human health and exacerbates political and economic inequalities that make the provision of healthcare more difficult.
Human health is complex and these are daunting challenges, but medical anthropologists have a unique perspective to contribute to finding solutions. Medical anthropology offers a holistic perspective on human evolutionary and biocultural adaptations as well as insights into the relationship between health and culture. As anthropologists study the ways people think about health and illness and the socioeconomic and cultural dynamics that affect the provision of health services, there is a potential to develop new methods for improving the health and quality of life for people all over the world.
This chapter describes several examples of diseases that result from interactions between biology and culture such as obesity. Why is it important to consider cultural factors that contribute to illness rather than placing blame on individuals? What are some other examples of illnesses that have cultural as well as biological causes?
Many cultures have ethno-etiologies that provide explanations for illness that are not based in science. From a biomedical perspective, the non-scientific medical treatments provided in these cultures have a low likelihood of success. Despite this, people tend to believe that the treatments are working. Why do you think people tend to be satisfied with the effectiveness of the treatments they receive?
How does poverty influence the health of populations around the world? Do you see this in your own community? Who should be responsible for addressing health care needs in impoverished communities?
Adaptive: traits that increase the capacity of individuals to survive and reproduce.
Biocultural evolution: describes the interactions between biology and culture that have influenced human evolution.
Biomedical: an approach to medicine that is based on the application of insights from science, particularly biology and chemistry.
Communal healing: an approach to healing that directs the combined efforts of the community toward treating illness.
Culture-bound syndrome: an illness recognized only within a specific culture.
Emotionalistic explanation: suggests that illnesses are caused by strong emotions such as fright, anger, or grief; this is an example of a naturalistic ethno-etiology.
Epidemiological transition: the sharp drop in mortality rates, particularly among children, that occurs in a society as a result of improved sanitation and access to healthcare.
Ethno-etiology: cultural explanations about the underlying causes of health problems.
Ethnomedicine: the comparative study of cultural ideas about wellness, illness, and healing.
Humoral healing: an approach to healing that seeks to treat medical ailments by achieving a balance between the forces, or elements, of the body
Maladaptive: traits that decrease the capacity of individuals to survive and reproduce.
Medical anthropology: a distinct sub-specialty within the discipline of anthropology that investigates human health and health care systems in comparative perspective.
Naturalistic ethno-etiology: views disease as the result of natural forces such as cold, heat, winds, or an upset in the balance of the basic body elements.
Personalistic ethno-etiology: views disease as the result of the actions of human or supernatural beings.
Placebo effect: a response to treatment that occurs because the person receiving the treatment believes it will work, not because the treatment itself is effective.
Shaman: a person who specializes in contacting the world of the spirits.
Somatic: symptoms that are physical manifestations of emotional pain.
Zoonotic: diseases that have origins in animals and are transmitted to humans.
ABOUT THE AUTHOR
Sashur Henninger-Rener is an anthropologist with research in the fields of comparative religion and psychological anthropology. She received a Master of Arts from Columbia University in the City of New York in Anthropology and has since been researching and teaching. Currently, Sashur is teaching with The University of LaVerne and the Los Angeles Community College District in the fields of Cultural and Biological Anthropology. In her free time, Sashur enjoys traveling the world, visiting archaeological and cultural sites along the way. She and her husband are actively involved in animal rescuing, hoping to eventually found their own animal rescue for animals that are waiting to find homes.
1. Jermone Gilbert, Humors, Hormones, and Neurosecretions (New York: State University of New York Press, 1962).
2. World Health Organization, “Health Impact Assessment,” http://www.who.int/hia/evidence/doh/en/.
3. Sally McBrearty and Allison Brooks, “The Revolution That Wasn’t: A New Interpretation of the Origin of Modern Humans,” Journal of Human Evolution 39 (1999), 453–563.
4. U.S. Center for Disease Control and Prevention, “Adult Obesity Facts,” http://www.cdc.gov/obesity/data/adult.html.
5. Marjorie G. Whiting, A Cross Cultural Nutrition Survey (Cambridge, MA: Harvard School of Public Health, 1968).
6. Ian A.M. Prior, “The Price of Civilization,” Nutrition Today 6 no. 4 (1971): 2–11.
7. Steven Connor, “Deadly malaria may have risen with the spread of agriculture,” National Geographic, http://news.nationalgeographic.com/news/2001/06/0625_wiresmalaria.html.
8. Jared Diamond, “The Arrow of Disease,” Discover Magazine, October 1992. http://discovermagazine.com/1992/oct/thearrowofdiseas137.
9. World Health Organization, “Cholera,” http://www.who.int/mediacentre/factsheets/fs107/en/.
10. George J. Armelagos and John R. Dewey, “Evolutionary Response to Human Infectious Disease,” BioScience, 25(1970): 271–275.
11. William McNeill, Plagues and People (New York: Doubleday, 1976).
12. Ian Barnes, Anna Duda, Oliver Pybus, Mark G. Thomas. Ancient Urbanisation Predicts Genetic Resistance To Tuberculosis,” Evolution 65 no. 3 (2011): 842–848.
13. George T. Lewith, Acupuncture: Its Place in Western Medical Science (United Kingdom: Merlin Press, 1998).
14. George M. Foster, “Disease Etiologies in Non-Western Medical Systems,”
American Anthropologist 78 no 4 (1976): 773–782.
15. Ibid., 775
16. S.F. Nadel, The Nuba: An Anthropological Study of the Hill Tribes in Kordofan (Oxford: Oxford University Press, 1947), 173.
17. Foster, “Disease Etiologies in Non-Western Medical Systems,” 775.
18. A.J. Rubel, “The Epidemiology of a Folk Illness: Susto in Hispanic America,” Ethnology
3 (1964): 268–283.
19. Robert T. Trotter II, “Susto: The Context of Community Morbidity Patterns,” Ethnology 21 no. 3 (1982): 215–226.
20. Frank J. Lipp, “The Study of Disease in Relation to Culture: The Susto Complexe Among the Mixe of Oaxaco,” Dialectical Anthropology 12 no. 4 (1987): 435–442.
21. E.E. Evans-Pritchard, Witchcraft, Oracles and Magic Among the Azande (Oxford: Oxford University Press, 1937), 70.
22. Leonard B. Glick, “Medicine as an Ethnographic Category: The Gimi of the New Guinea Highlands,” Ethnology 6 (1967): 31–56.
23. Elliott Mishler, “Viewpoint: Critical Perspectives on the Biomedical Model,” in
E. Mishler, L.A. Rhodes, S. Hauser, R. Liem, S. Osherson, and N. Waxler, eds.
Social Contexts of Health, Illness, and Patient Care (Cambridge, UK: Cambridge University Press).
24. Richard Katz, Megan Biesele, and Verna St. Davis, Healing Makes Our Hearts Happy: Spirituality and Cultural Transformation among the Kalahari Ju/ ’hoansi (Rochester VS, Inner Traditions, 1982), 34.
25. Michael Bliss, William Osler: A Life in Medicine (Oxford: Oxford University Press, 1999), 276.
26. William Osler, “The Faith That Heals,” British Medical Journal 1 (1910): 1470–1472.
27. Cara Feinberg, “The Placebo Phenomenon,” Harvard Magazine http://harvardmagazine.com/2013/01/the-placebo-phenomenon.
28. Ted J. Kaptchuk, and Franklin G. Miller, “Placebo Effects in Medicine,” New England Journal of Medicine 373 (2015):8–9.
29. Robert Bud, “Antibiotics: From Germophobia to the Carefree Life and Back Again,” in Medicating Modern America: Prescription Drugs in History, ed. Andrea Tone and Elizabeth Siegel Watkins (New York: New York University Press, 2007).
30. H. Benson, J.A. Dusek, J.B. Sherwood, P. Lam, C.F. Bethea, and W. Carpenter, “Study of the Therapeutic Effects of Intercessory Prayer (STEP) in Cardiac Bypass Patients: A Multicenter Randomized Trial of Uncertainty and Certainty of Receiving Intercessory Prayer,” American Heart Journal 151 (2006):934–942.
31. National Cancer Institute, “Acupuncture,” http://www.cancer.gov/cancertopics/pdq/cam/acupuncture/healthprofessional/page5.
32. Mira Taow, “The Religious and Medicinal Uses of Cannabis in China, India, and Tibet,” Journal of Psychoactive Drugs 13(1981): 23–24.
33. Marsella, A. and White, G., eds. Cultural Conceptions of Mental Health and Therapy (Dordrecht, Netherlands: D. Reidel, 1982).
34. Dominic T.S. Lee, Joan Kleinman, and Arthur Kleinman, “Rethinking Depression: An Ethnographic Study of the Experiences of Depression Among Chinese,” Harvard Review of Psychiatry 15 no 1 (2007):1–8.
35. Arthur Kleinman, Rethinking Psychiatry: From Cultural Category to Personal Experience (New York: The Free Press, 1988).
36. Robert Lemelson and L.K. Suryani, “Cultural Formulation of Psychiatric Diagnoses: The Spirits, Penyakit Ngeb and the Social Suppression of Memory: A Complex Clinical Case from Bali,” Culture, Medicine and Psychiatry 30 no. 3 (2006): 389–413.
37. For more information about these studies, see J. Leff et al., “The International Pilot Study of Schizophrenia: Five-Year Follow-Up Findings,” Psychological Medicine 22 (1992):131–45; A. Jablensky et al., “Schizophrenia: Manifestations, Incidence and Course in Different Cultures: A World Health Organization Ten-Country Study,” Psychological Medicine Monograph Supplement 20(1992); N. Sartorius et al., “Early Manifestations and First-Contact Incidence of Schizophrenia in Different Cultures,” Psychological Medicine 16 (1986):909–28.
38. Bernice A. Pescosolido, Jack K. Martin, Sigrun Olafsdottir, J. Scott Long, Karen Kafadar, and Tait R. Medina, “The Theory of Industrial Society and Cultural Schemata: Does the ‘Cultural Myth of Stigma’ Underlie the WHO Schizophrenia Paradox?,” American Journal of Sociology 121 no. 3 (2015): 783–825.
39. Collean Barry, Victoria Bresscall, Kelly D. Brownell, and Mark Schlesinger, “Obesity Metaphors: How Beliefs about Obesity Affect Support for Public Policy,” The Milbank Quarterly 87 (2009): 7–47.
40. Peter Conrad and Kristen K. Barker, “The Social Construction of Illness: Key Insights and Policy Implications,” Journal of Health and Social Behavior, 51(2010): s57-s79.
41. Peter Attia, “Is the Obesity Crisis Hiding a Bigger Problem?,” TEDMED Talks April 2013 Retrieved from https://www.ted.com/talks/peter_attia_what_if_we_re_wrong_about_diabetes.
42. Anish P. Mahajan, Jennifer N. Sayles, Vishal A. Patel, Robert H. Remien, Daniel Ortiz, Greg Szekeres, and Thomas J. Coates, “Stigma in the HIV/AIDS Epidemic: A review of the Literature and Recommendations for the Way Forward,” AIDS 22 supp. 2 (2008): S67-S79.
43. Elizabeth Pisani, “Sex, Drugs, & HIV: Let’s Get Rational,” TED Talks February 2010. http://www.ted.com/talks/elizabeth_p...al_1#t-1011824.
44. United Nations, “Poverty and AIDS: What’s Really Driving the Epidemic?” http://www.unfpa.org/conversations/facts.html.
45. Maria Makino, Koji Tsuboi, and Lorraine Dennerstein, “Prevalence of Eating Disorders: A Comparison of Western and Non-Western Countries,” Medscape General Medicine 6 no. 3 (2004):49.
46. Joan Jacobs Brumberg, Fasting girls: The Emergence of Anorexia Nervosa as a Modern Disease (Cambridge, MA: Harvard University Press, 1988).
47. Anne E. Becker, “Television, Disordered Eating, and Young Women in Fiji: Negotiating Body Image and Identity during Rapid Social Change” Culture, Medicine and Psychiatry, 28 no. 4 (2004):533–559.
48. Sing Lee, “Reconsidering the Status of Anorexia Nervosa as a Western Culture-Bound Syndrome,” Social Science & Medicine 42 no. 1 (1996): 21–34.
49. L.A. Rebhun, “Swallowing Frogs: Anger and Illness in Northeast Brazil,” Medical Anthropology Quarterly 8 no. 4 (1994):360–382.
50. Ibid., 369–371
51. Robert Bud, “Antibiotics: From Germophobia to the Carefree Life and Back Again.”
52. Nancy Scheper Hughes, Death Without Weeping: The Violence of Everyday Life in Brazil (Berkeley: University of California Press, 1989).
53. World Health Organization, “Antimicrobial Resistance,” http://www.who.int/mediacentre/factsheets/fs194/en/.
54. David Koplow, Smallpox: The Fight to Eradicate a Global Scourge (Berkeley: University of California Press, 2003).
55. Jeffery K. Taubenberger, David Baltimore, Peter C. Doherty, Howard Markel, David M. Morens, Robert G. Webster, and Ian A. Wilson, “Reconstruction of the 1918 Influenza Virus: Unexpected Rewards from the Past,” mBio 3 no. 5 (2012).
56. Jeffrey Taubenberger and David Morens, “1918 influenza: The Mother of All Pandemics,” Emerging Infectious Diseases, 12 (2006).
57. Suzanne Clancy, “Genetics of the Influenza Virus,” Nature Education, 1(2008): 83.
58. For more about these and other examples, see Carol P. MacCormack, Ethnography of Fertility and Birth (New York: Academic Press, 1982).
59. Laury Oaks, “The Social Politics of Health Risk Warning: Competing Claims about the Link between Abortion and Breast Cancer,” in Risk, Culture, and Health Inequality: Shifting Perceptions of Danger and Blame, eds. Barbara Herr Harthorn and Laury Oaks (Westport, CT: Praeger, 2003).
60. Marcia C. Inhorn, The New Arab Man: Emergent Masculinities, Technologies, and Islam in the Middle East (Princeton, NJ: Princeton University Press, 2012).
61. Food and Agriculture Organization of the United Nations, “The Multiple Dimensions of Food Security,” http://www.fao.org/docrep/018/i3458e/i3458e.pdf.
62. World Health Organization, “Urbanization and Health,” Bulletin of the World Health Organization, 88(2010): 241–320.