MEDICAL ANTHROPOLOGY and the ANTHROPOLOGICAL

PERSPECTIVE

HistoryAdaptation

Symbol

Structure

Agency

Medical Anthropology and the Anthropological Perspective

• Methods• Evidence• Arguments

HistoryAdaptation

Symbol

Structure

Agency

Paul Farmer:Infections & Inequalities

• Emerging & re-emerging infectious diseases (adaptations)– Health transitions– Modern plagues

• Social inequalities & health (structure)• Epistemology & health practices

(meaning)• World systems & health (history)

EPIDEMIOLOGICAL -- HEALTH TRANSITIONS

• complex change in patterns of health and disease

• the interactions between these patterns and the demographic, economic, and sociological determinants and consequences.

Transitions & Disease Profiles

• pestilence and famine• receding pandemics• degenerative and man-made diseases

Life Expectancies as Measure of Health Transitions

From Infectious to Chronic Diseases

10 leading causes of death in US

19001. Influenza and pneumonia2. Tuberculosis3. Gastritis4. Diseases of the Heart5. Cerebrovascular Disease6. Chronic Nephritis7. Accidents8. Cancer9. Certain diseases of infancy10. Diptheria

19981. Heart Diseases (31.4% )

2. Cancer (23.3%)

3. Cerebrovascular diseases (6.9%)

4. COPD (4.7%)

5. Accidents (4.1%) 6. Pneumonia and Influenza

(3.7%)

7. Diabetes (2.7%)

8. Suicide (1.3%)

9. Diseases of Arteries (1.2%)

10. Nephritis (1.1%)

Ten leading causes of death (2000)Developed countries1. IHD 22.6%2. CVD 13.7%3. Lung Ca. 4.5%4. Respiratory infections 3.7%5. COPD 3.1%6. Colon Ca 2.6%7. Stomach Ca 1.9%8. Self-inflicted injuries 1.9%9. Diabetes 1.7%10. Breast Ca 1.6%

Developing countries1. IHD 9.1%2. CVD 8.0%3. Respiratory infections 7.7%4. HIV/AIDS 6.9%5. Perinatal conditions 5.6%6. COPD 5%7. Diarrhoeal diseases 4.9%8. Tuberculosis 3.7%9. Malaria 2.6%10. Road accidents 2.5%

Beaglehole and Yach. Lancet 2003

Demographic Transitions and Health

• Decreased fertility rates• Decreased infant mortality rates• Increased life expectancies at birth• Reflect shifts in social and economic

patterns• Changes in health conditions• Changes in health care

Population and demographic changes

Human Determinants of Transitions

• technological change• alterations in the environment• alterations in food type, availability,

production, preparation, and consumption• alterations in patterns of energy

expenditure• interplay of environmental factors and the

genetic pool of a community

Two Examples of Interplay of Human Determinants of Health

• Malaria & Sickle Cell Anemia• Type 2 Diabetes & Chronic Diseases

Epistemological Framework of Epidemiological Transitions

MULTIPLE EPIDEMIOLOGIC TRANSITIONS

• recent resurgence of infectious disease mortality marks a third epidemiologic transition

• characterized by newly emerging, re-emerging, and antibiotic resistant pathogens in the context of an accelerated globalization of human disease ecologies

Human Determinants of Transitions REDUX

• technological change• alterations in the environment• alterations in food type, availability,

production, preparation, and consumption• alterations in patterns of energy

expenditure• interplay of environmental factors and the

genetic pool of a community• Social inequality? Where is it?

“SOCIAL FORCES AND PROCESSES EMBODIED AS

BIOLOGICAL EVENTS”THE CRITICAL PERSPECTIVE

• Paul Farmer:• “Inequality itself constitutes our modern

plague – inequality is a pathogenic force”• “Social inequalities often determine both

the distribution of modern plagues and clinical outcomes among the afflicted”

Life Expectancy & Ethnicity in the US

First Nations people and Inuit face some serious health-related challenges, such as high rates of chronic and contagious diseases and shorter life expectancy.

Compared to the general Canadian population,

• Heart disease is 1.5 times higher; • Type 2 diabetes is 3 to 5 times higher among First Nations

people and rates are increasing among the Inuit; and • Tuberculosis infection rates are 8 to 10 times higher. • 15 per cent of new HIV and AIDS infections occur in

Aboriginal people.

First nations and TB

• The tuberculosis rate in the First Nations was 8 to 10 times that of the entire Canadian population in 1999. Overcrowded housing is associated with an increased risk of tuberculosis in a community

Table 3.2Notifiable Disease Incidence Rates for First Nations (Notifiable disease data were not available from 47 of the 144 communities in Ontario, and 29 of the 41 communities in Quebec. Data for the overall

Canadian population are from Health Canada, 2001) and Canada, 1999

Diseases preventable by routine vaccination

Notifiable disease First Nations(cases per 100,000)

Canada(cases per 100,000)

Haemophilus influenzae Type b 0 0.1

Measles 0 0.1

Mumps 0.8 0.3

Pertussis 57.6 20.0

Rubella 0.3 0.1

Sexually transmitted and bloodborne pathogens

Notifiable disease First Nations(cases per

100,000)

Canada(cases per

100,000)

Genital Chlamydia (Includes data from all Regions except Alberta.) 947.0 138.2

Hepatitis C 67.9 63.6

Enteric, food and waterborne diseases

Notifiable disease First Nations(cases per 100,000)

Canada(cases per 100,000)

Giardiasis 26.8 17.2

Hepatitis A 15.4 2.9

Shigellosis 69.6 3.6

Verotoxigenic E. coli 0 4.9

Bourdieu: 3 types of capital• Economic capital: command over economic

resources (cash, assets). • Social capital: resources based on group

membership, relationships, networks of influence and support.

• Cultural capital: forms of knowledge; skill; education; any advantages a person has which give them a higher status in society, including high expectations.– E.g. Parents provide children with cultural capital, the

attitudes and knowledge that makes the educational system a comfortable familiar place in which they can succeed easily.

Definitions of Social Capital• In contrast to classical and neoclassical economic theory

– assumes society is made up of the sum of persons acting individually to achieve non-collective goals

• Social capital inheres the structure of relationships between persons and among persons. – the institutions, relationships and norms that shape the quality and

quantity of a society's social interactions.

• Social capital has a material base as well as a moral base.

• People have different amounts of social capital– depending on the actual or potential resources– depending upon the size of the network to which they are linked– depending on the amount of economic and cultural capital the members

of that network have.

• Social capital is never independent of the other forms of capital

With regard to social capital, studies increasingly show that communities supported by a substantial stock of social capital have better economic and social performance (Putnam, 2000).

Better health, health conditions, and health care.

Social Capital & Health in Canada

Canada, Health, & Inequalities

Social & Cultural Capital:Non-Medical Determinants of Health • Compared with the Canadian population in 1996,

the First Nations population (on and off reserves) rated lower on all educational attainment.

• Among First Nations, the 1996 labour participation rate was 59% and the employment rate was 43%. – Rates for Canada as a whole were 68% and 62%,

respectively.

• First Nations unemployment rate was twice the Canadian rate in 1996.

Non-Medical Determinants of Health• In First Nations communities only 56.9% of homes

were considered adequate in 1999--00. • 33.6% of First Nations communities had at least

90% of their homes connected to a community sewage disposal system.

• In 1999, 65 First Nations and Inuit communities were under a boil water advisory for varying lengths of time--an average of 183 days of boil water advisories per affected community.

• Many communicable diseases such as giardiasis and shigellosis (both acute infectious diseases characterized by diarrhea, fever and nausea) can be traced to poor water quality

Cultural Capital & Health

World-Wide Health Inequalities

WORLD SYSTEMS

World Systems (I. Wallerstein) • A world-system is a social system

– one that has boundaries, structures, member groups, rules of legitimation, and coherence.

• made up of the conflicting forces which hold it together by tension and tear it apart as each group seeks eternally to remold it to its advantage.

• a life-span over which its characteristics change in some respects and remain stable in others.

• its structures -- at different times strong or weak in terms of the internal logic of its functioning.

Haiti, AIDS, & the Atlantic World System

Atlantic World System• the notion of the Americas, Africa, and Europe

as composing a "regional system" from the late fifteenth century to the present.

• questions of economic development, free and unfree labor, and working-class formation, as well as more recent interest in the making (and undoing?) of welfare states, frontiers, ethnicity, sexuality, and legal culture and institutions.

HIV/AIDS Worldwide

HIV/AIDS in Latin America & Caribbean

AIDS Incidence Rates

Mode of Transmission: Caribbean