Anthropology's Contribution to Public Health Policy Development

76 MJM 2010 13(1): 76-83 Copyright © 2010 by MJM CROSSROAdS Anthropology’s Contribution to Public Health Policy development Dave Campbell* Many people in the felds of medicine and the unequal power relationships that have been public health do not understand the potential role harmful to informants. She calls for anthropologists that anthropology could play in the development to take a critical stance against such structural and of public health policy. The intention of this article institutional violence (“Coming to Our Senses”). is to provide readers with an understanding of Holism has also become an important the unique perspective that medical anthropology hallmark of modern ethnography. Even the most could contribute to informing public health policy basic concept of classic anthropology – culture – decisions. has been rethought: “the modern view of culture is Socio-cultural anthropology has undergone to stress the importance of always seeing it within signifcant theoretical and pragmatic changes over its particular context... ‘culture’ cannot – and should the past half-century. As a discipline, anthropology never be – considered in a vacuum” (Helman 4,7). has been criticized for its role in imperial conquest. These fundamental changes in the broad discipline During colonial times, anthropologists often of socio-cultural anthropology have manifested accompanied colonial explorers and military in order themselves in each of its related sub-disciplines. to facilitate their work, this is often referred to as ‘the This paper will examine these changes in the sub- handmaiden era’ in the history of anthropology’s discipline of medical anthropology, and particularly history. It is said that in this role, anthropologists how these changes allow anthropology to make a gained the trust of natives using their linguistic contribution to public health policy development. profciency and cultural awareness in order to assist the colonial state in the implementation of RECENT EVOLUTION IN MEdICAL ANTROPOLOgy policies that ultimately led to further oppression and Anthropologists have been interested in disempowerment (Pels and Salemind). medical practices for many decades; however, Such critiques, among others, have led medical anthropology as a distinct subfeld is a to a signifcant redirection of anthropological relative newcomer in the world of academia. The thought and theory (Lewis). Social and cultural identifcation of the feld of medical anthropology anthropology have turned towards a more critical, is generally attributed to William Caudill in his refexive and holistic approach since that time. paper from 1953 entitled “Applied Anthropology This ‘reconstruction’ of anthropology has resulted in Medicine” (McElroy). Since that time Medical in an increase in criticism of those structures Anthropology has established a degree of that had previously been assumed as ‘right’ and independence from its parent discipline of social inherently ‘good’. Scheper-Hughes writes about and cultural anthropology. Despite this how social scientists have typically been blind to autonomy, medical anthropology’s disciplinary evolution has been greatly affected by the changes in social anthropology. *To whom correspondence should be addressed: Ethnomedicine was the frst of the subfelds Dave Campbell of medical anthropology to develop. The premises University of Calgary of this ideology was that gaining an understanding Email: [email protected] of local medical beliefs and practices could be Vol. 13 No. 1 Anthropology 77 benefcial in the provision of biomedical services a population as the sole result of its culture, instead to people in cultures where biomedicine was of looking also at their particular economic or social new and unknown. McElroy states that “Since situation” (Helman 5). Farmer further elaborated on the 1940s anthropologists have helped health this issue: care providers understand cultural differences in health behaviours” (3). Emphasis on this aspect of Scholars often weaken their medical anthropology led to the development of the contributions to an understanding ‘Explanatory Model’ framework (Kleinman) and the of infectious diseases by making benchmark volume ‘Clinically Applied Anthropology’ “immodest claims of causality.” These (Chrisman and Maretzki) among many others. claims are immodest because they are These works focused heavily on doctor-patient wrong or misleading. They are immodest interaction and how anthropology can be used as a because they distract attention from the tool in biomedicine. modest interventions that could treat This thinking was followed by a new wave and often enough cure people. And they of thinking that parallels the turn to refexivity in are immodest because they distract social anthropology. In 1983, the term ‘critical attention from the preventable social medical anthropology’ was introduced (Baer). This disorder that exacerbates biological new brand of medical anthropology was similar to disorder. (5) the new refexive social anthropology in that it was critical, holistic and inward looking: “it is the work Clearly, there was a need for the of anthropology turned in upon ourselves, our own anthropology of public health to adopt a similar society” (Scheper-Hughes “Three Propositions” perspective to that of critical medical anthropology. 196). Scheper-Hughes goes on to draw explicit Van Willigen defnes a dichotomy between parallels between colonial social anthropology and ‘anthropology in policy’ and ‘anthropology of policy’ clinical medical anthropology by saying that medical (164). This semantic technicality differentiates anthropologists played a vital role in establishing between anthropologists who assist policy makers the cultural hegemony of biomedicine. She calls for (reminiscent of clinically applied anthropology) and medical anthropologists to break with the feld of those who critically appraise the work of policy western medicine and distance themselves in order makers and their policies’ unintended negative to look back upon biomedicine objectively. effects upon the target population. Parker and Harper describe the anthropology of public health ANTHROPOLOgy Of PUBLIC HEALTH as that “which remains passionately concerned Hans Baer defnes critical medical about ill-health and deprivation and the need for anthropology as that which “aspires to merge theory public policy; but also remains committed to a and praxis in [a] desire to promote experiential health rigorous and critical analytical perspective” (2). as opposed to the functional health associated with With its new critical and refexive contemporary political economics around the world” perspective, anthropology has a lot to contribute to (1011). Since the emergence of critically applied the development of health policy. The feld of public medical anthropology, several anthropologists health – and more generally, policy development – have brought this brand of anthropological enquiry requires research contributions from a multitude of to the world of public health policy. disciplines. Williams states that “a multidisciplinary This is not to say that medical anthropology approach could best address the public health is new to public health. Anthropologists have been needs of a population” (Williams 1). involved in public health for many years. However, Public health’s primary concern is to prior to Critical Medical Anthropology (CMA), many improve the health of a population. This broad- medical anthropologists played the role of ‘cultural scope approach has brought epidemiology to brokers’ (Scheper-Hughes “Three Propositions”). be the most infuential discipline in health policy They were often involved in mediating between because by using methodical sampling methods populations and policy makers in much the same way one can theoretically extrapolate conclusions about in which medical anthropologists mediated between the state of health of entire populations. Turnock clinician and patient, or social anthropologists states that there are “fve basic sciences of public between colonizer and colonized. Inadvertent as it health: epidemiology, biostatistics, environmental may have been, utilizing anthropology in this role science, management sciences and behavioural in public health often inherently used techniques of sciences” (20). “victim blaming – that is, seeing the poor health of 78 Anthropology 2010 It would seem that despite great Many medical anthropologists see this anthropology’s potential for informing health policy, model of disease as outdated and inaccurate its actual contribution is quite small – seeing that it because “it reduces the investigation of social is grouped with a half-dozen behavioural sciences and cultural aspects of disease to discrete, static, as one of the fve informants of policymaking. quantifable ‘beliefs’ held by the study population” The reason for anthropology’s minimized role in (Parker and Harper 1-2). This factorial notion health policy development is likely founded in its of disease seems to involve the reasoning that primary methodological approach: ethnography. factors of disease causation such as biology and Thanks to an unabashed focus on individuals environment are beyond the reach of culture. A and small groups, many involved in the process modern conception of culture, as accepted by of policymaking have argued that the data that most anthropologists is signifcantly more complex generated by anthropological research is less and all-encompassing. In contemporary medical valuable because it

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