Doing Applied Medical Anthropology in Australia and Malaysia

World Anthropologies 825 Rabinow, Paul. 1991. “Artificiality and Enlightenment: From So- Todd, Zoe. 2018. “The Decolonial Turn 2.0: The Reck- ciobiology to Biosociality.” In Incorporations, edited by Jonathan oning.” anthro{dendum}, June 15. https://anthrodendum. Crary and Sanford Kwinter, 234–52. New York: Zone Books. org/2018/06/15/the-decolonial-turn-2-0-the-reckoning/. Richardson, Sarah S., and Hallam Stevens, eds. 2015. Postgenomics: Tsing, Anna. L. 2005. Friction: An Ethnography of Global Connection. Perspectives on Biology after the Genome. Durham, NC: Duke Uni- Princeton, NJ: Princeton University Press. versity Press. Walters, Karina L., Selina A. Mohammed, Teresa Evans-Campbell, Rose, Nikolas. 2007. “Molecular Biopolitcs, Somatic Ethics and the Ramona E. Beltran,´ David H. Chae, and Bonnie Duran. 2011. Spirit of Biocapital.” Social Theory and Health 5:3–29. “Bodies Don’t Just Tell Stories, They Tell Histories.” Du Bois Scheper-Hughes, Nancy, and Margaret Lock. 1987. “The Mindful Review: Social Science Research on Race 8 (1): 179–89. Body: A Prolegomenon to Future Work in Medical Anthropol- Warin, Megan, Vivienne Moore, Michael Davies, and Stanley Uli- ogy.” Medical Anthropology Quarterly 1 (1): 6–41. jaszek. 2015. “Epigenetics and Obesity: The Reproduction of TallBear, Kim. 2013. Native American DNA: Tribal Belonging and the Habitus through Intracellular and Social Environments.” Body & False Promise of Genetic Science. Minneapolis: University of Min- Society 22 (4): 1–26. nesota Press. Wirihana, Rebecca, and Cherryl Smith. 2014. “Historical Trauma, Taussig,Karen-Sue,RaynaRapp,andDeborahHeath.2003.“Flexible Healing and Well-Being in Maori¯ Communities.” MAI Journal 3 Eugenics: Technologies of the Self in the Age of Genetics.” In (3): 197–210. Genetic Nature/Culture: Anthropology and Science Beyond the Two- Yehuda, Rachel, Nikolaos P. Daskalakis, A. Lehmer, Frank De- Culture Divide, edited by Alan H. Goodman, Deborah Heath, sarnaud, Heather N. Bader, Iouri Makotkine, Janine D. and M. Susan Lindee, 58–76. Berkeley: University of California Flory, Linda M. Bierer, Michael J. Meaney. 2014. “Influ- Press. ences of Maternal and Paternal PTSD on Epigenetic Reg- Thayer, Zaneta M., and Amy L. Non. 2015. “Anthropology Meets ulation of the Glucocorticoid Receptor Gene in Holocaust Epigenetics: Current and Future Directions.” American Anthro- Survivor Offspring.” American Journal of Psychiatry 171 (8): pologist 117 (4): 722–35. 872–80. Essay Having Impact: Doing Applied Medical Anthropology in Australia and Malaysia Narelle Warren These issues speak to a larger debate about the impact Monash University, Australia and the return on investment of research. Within an applied Pascale Allotey space, research questions often need to be policy driven and United Nations University–International Institute for Global Health, timely. Outcomes are the primary drivers. In higher edu- Malaysia cation institutions, research-funding models often require Daniel D. Reidpath significant contribution to the discipline and reflect shift- Monash University Malaysia ing priorities of the government, particularly in the case of public universities. ranslating medical anthropology into practice is in- In late 2015, the main nationally competitive funding creasingly important to ensure that it informs policy agency for anthropologists, the Australian Research Council, andT interventions that improve health outcomes. We work announced its funding priorities under the “National Inno- in settings where this “knowledge translation” is now an vation and Science Agenda” (www.arc.gov.au/nisa). Built explicit expectation, although how this is borne out dif- into this was—is—the expectation that research should have fers. For Allotey, who leads a global public health insti- “impact” and “engagement” in order to access institutional tute, and Reidpath, whose work informs national institutes and governmental support. What these terms mean in prac- of health, providing anthropological insights that can en- tice is open to interpretation and, importantly, may differ hance, transform, or otherwise influence how health and its from the definitions with which we are familiar. After all, interventions are understood and implemented at the pol- isn’t an integral part of what we do as medical anthropol- icy and community levels is an expected—and integral— ogists engagement? In undertaking ethnographic research, part of their roles. For Warren, funding and university we engage with literature, governance and policies, power environments have their own agendas around research and vested interests, communities, individual participants, translation and knowledge transfer, both notions that ul- and environments. Yet the “National Innovation and Science timately speak to the need for research to be usable in Agenda,” and those like it, are less concerned with these some way. types of engagement, focusing instead on the measurable 826 American Anthropologist • Vol. 120, No. 4 • December 2018 influence of our research outputs. Under this rubric, ideas As it is taught, practiced, and communicated in both settings of impact and engagement must be reinterpreted in light (Australia and Malaysia), medical anthropology is a discipline of recent shifts that increasingly shape universities based on that is notable because of how often it draws on or aligns corporate and bureaucratic models, in which a concern with with other disciplines (see Long and Baer 2018), most of- metrics is central (Cox 2013; Stelmach and von Wolff 2011). ten public health, general practice, psychology, Indigenous This poses problems for medical anthropologists to which studies, or a combination of these. the authors of this essay do not have the answers. Rather, Educated within the Australian context, like many of in this essay, we draw upon our own experiences to discuss our peers, we came to medical anthropology during doc- some challenges that these emerging agendas give rise to for toral training, following undergraduate training in the fields medical anthropology. of nursing and midwifery (Allotey) or sociology and psychology (Warren). Yet, since completing our formal training, MEDICAL ANTHROPOLOGY, WHAT’S THAT? our own medical anthropological practices have evolved in PROVIDING INSIGHTS FROM AN UNFAMILIAR response to the communities with whom we work and the DISCIPLINE focus of our work. We have sought to undertake research How—and how well—we can do translational and impact- that can inform public health practices and thus will have an ful medical anthropological research is significantly shaped impact (in some way) on the lives of those with whom we by the regard for and recognition afforded to the discipline work. Allotey and Reidpath (a social epidemiologist) have at the academic, popular/community, and state levels. In successfully worked together for over two decades in trans- Malaysia, as in Australia, as Long and Baer (2018) note, lating medical anthropology to inform public health theory medical anthropology is a small and somewhat marginal— and interventions. Their comparative work in Australia and albeit growing—subdiscipline. Few members of the broader Cameroon, for example, employed ethnography to ques- community seem to have an understanding of what medical tion the core assumptions of the disability-adjusted life year anthropology is or what insights it can offer (if the number of (DALY) and demonstrated that there is no universality in times we need to provide a definition of the discipline is an the burden of disease based purely on the health condition indication). This is not limited to the subdiscipline of medi- (Allotey et al. 2003; Allotey and Reidpath 2007). Below, cal anthropology but may also extend to anthropology more we reflect on our experiences in order to generate new dis- broadly. High school students are not taught anthropology, cussions about how medical anthropology can increase its although they do receive instruction in anthropological con- impact in settings where it is not seen as mainstream. cerns (e.g., indigeneity, diversity) as part of their education in social studies or the humanities. For most people, popu- QUESTIONS OF RELEVANCE: ENGAGING ACROSS lar media provide their only introduction to the discipline, DISCIPLINES which is thus understood as something to do with archaeol- Medical anthropology in both Malaysia and Australia often ogy (perhaps an artifact of the popularity of the Indiana Jones needs to have a strong public health focus to avoid the “inter- movies) or forensic anthropology (courtesy of the television esting, but so what?” questions from research and practicing show Bones). Yet, as Long and Baer (2018) highlight, these public health specialists. Rather than being seen as founda- reflect a four-fields approach to anthropology that doesn’t tional, medical anthropology is often seen by these more ap- align with the European-informed sociocultural anthropol- plied practitioners as providing direction and clarity around ogy taught in Malaysian and Australian universities (see also the implementation of behavior-change recommendations Manderson and Levine 2018). ratherthanasthedriverofnewareasforhealthpolicyandser- Medical anthropology is taught at less than one-quarter viceplanning.Whilethisseemsantitheticalatthedisciplinary of Australian undergraduate universities (and about one-half level—and we firmly believe that medical anthropological of those that offer undergraduate anthropology, according insights are deeply valuable in and of themselves—such

Load more