Medicine, Anthropology, Community

7/30/2019 Medicine, Anthropology, Community...

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Pelto & Pelto/Medicine, Anthropology, Community: An Overview ,'r{, 401'

Pertti J. PeltoGretel H. Pelto

Medicine, anthropology, community: an overviewI -i

Much discussion and debate in medical anthropology focuses on the relationships of anthropology to medicine and to the community. The definition of anappropriate relationship varies depending on whether a person is primarily identified with medicine, with a community, or with anthropology (1).

Medicine as Conceptual Field and as Social SystemThere are several different ways in which medical anthropologists relate to themedica1 eshblishment or modern medicine (2). For some researchers the important idea is scientific medicine as a cultural system. For example,. Fabrega andassociates have been concerned with "linking native conceptual traditions aboutillness with Western scientific medical knowledge" (Fabrega, 1974:7). In a similar'vein the focus of discussion in recent papers on the "hot-cold syndrome" has beenon the cultural assumptions involved in "contact between modern and traditionalforms of medicine" (Logan, 1973:392).

The concepts of modern medicine are generally embodied in the medicalpractitioners, often identified in anthropological research literature as physiciansor medical personnel. For example, George Foster, in discussing aspects of medicalanthropology in applied contexts, refers to situations in which "medical personnelasked the anthropologists: what can you tell us about cultural and social factorsthat will help explain the attitude of people toward health centers?" (Foster 1969:25). Although perhaps too many discussions have focused on the physician as thecentral figure representing medical personnel, quite a number of studies have alsoreferred to public health nurses', health aides, and others involved in health care.


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----, Modernization, Cultural Pluralism, and Health Care

Irefers were carried out in cooperation with public healt11 people who were working in community-based sanitation and disease,control programs (cf. Foster J969).Similarly, Margaret Clark's study, "Health in the Mexican-American Culture"(1959), makes a number of references to public healtl1 nurses, medical sc;cial workers, and other community-oriented personnel in California public health departments.

Ties and collaboration between anthropologists and public healtJ1 professionals came about to a considerable extent because of a common focus on communi-.ties (including those in developing countries). Public health people frequently encountered resistance to sanit:Jtion measures, vaccinations, prenatal clinics, and otherprograms, and anthropologists were in a position to eXfllain the "cultural barriers"to acceptance of modern health care.

However, anthropologists became aware of the limitations inherent in collaboration with public' heal tJ1 personnel. As Hocl1strasser and Tapp have po in ted out,"public health has evolved basically into a governmental arid largely preventiveform of social medicine .... Most of its major centers of research, teaching andpractice are now stationed outside or in a satellite relationship to the mainstreamof American medicine." In effect, Hochstrasser and Tapp argue, many anthropologists have been allied WitJ1 a segment of the medical system that is "a verysmall, usually marginal and often ineffectual activity in rnost medical schoolsthroughout th~ country" (1970:255).

We now come to a central problem in the relationship of anthropology tothe medical system. Anthropologists have been too slow in recognizing and inanalyzing the complexities, especially the different distributions of power, in themany sectors of the mcdical establishmcnt. Too often antJuopologists have refcrred to doctors or medical personnel as if they were a monolithic bloc in termsof power and privilege, WjtJl homogeneous vicws and common assumptions abouthealth care.

Ra ther significan t changes are ta'king place in the medica] system, especially


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iT'6(.T 403-----7.-,

. established that attempt to bridge the gaps between clinical medicine and heaJtilcare needs in communities.

With tile rapid expansion of community medicine, beginning in the 1960s, asignificant new dimension has been added to the medical system-one that willhopefully develop new links between medical schools, heaJtJl practitioners in communities, and social and/or behavioral scientists. A strong and growing movement within medical schools seeks to push the focus of ntlention into COI11-munities through research on healtil-care systems and placement of medical students in community-based training experiences.

We suggest that anthropologists pay much more attention than tlley haveto tile currents of change within medicine and try to establish lines of collaborationWitil people in community medicine in order to participate in new developments in.meuicaJ stuuent training as well as to help build research and action programs incommunity~oriented healtJl-care systems. This is not to say that anthropology'solder relationships with psychiatry and public health are unproductive. Far fro111 it.Without going into detail, we should note that the public healtll sector, itself, hasshifted- away from a long-time concentration on infectious disease to tackle thevery difficult areas of c1Honic i1lness, where sociocultural factors loom large as_major contribu tors. We are emphasizing community medicine here because it isolle of the significant new developments and because medical personnel, like anthropologists, are now focusing on the community as tile major arena of activity.

The CommunityThe community has been the favorite haunt of anthropologists ever since RobertRedfield developed the community study, beginning witil his memorable researchin Tepoztlan (1930). The focus in this type c:f research is on finite communities,different from other communities in the vicinity. They share similar cultural backgrounds but create distinct cultural styles in a particular microecological contex~.

Antinopological research in communities is ch,lfacterized by participant ob


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Modernization, Cultural Pluralism, and Health CareI

404 i~i"IIof the radical attack on anthropology during this period took the view that thefocus on the beliefs and aspirations of minority enclaves in the United Statesavoided inaccessibility of the benefits of modern health facilities to these groups.On the other hand, community mental health outposts, particularly those based onthe established medical models, were criticized for participating in the alienationof people from their folk medical practices and thus indirectly reducing medicalalternatives (Ayala 1975).

Although the locus of anthropological research and effort has most often.been the community, its primary conceptual focus has been on culture, usually de~fined as the concepts, beliefs, and norms characteristic of particular, identifiableethnic gl'oups. In tracommunity diversity of culture has been salient only when aparticular community contained more than one identifiable ethnic group-for"example, in "mixed" communities with black, Chicano, Puerto Rican, and European ethnic groups. The cultural patterns within each of these ethnic groups hasbeen assumed to be definable in relatively homogeneous or uniform terms.

However, the uniformist or homogeneic treatment of cultural norms andbeliefs, especially in relation to matters of health and disease, has come under increasing scrutiny and challenge (3). The sociologists Hessler and New have recentlypublished an analysis of intraethnic diversity among the Chinese in Boston (seeChapter VI-8). Logan and Morrill (1977) have examined intracommunity diversity with respect to the "hot-cold syndrome" among Guatemalans. Woods andGraves (1973) have demonstrated significant differences in health-seeking behaviorsin another Mayan group in Guatemala, and Schensul (1973) has commented onvariations in behavior and attitudes among Chicanos in a Chicago community. Furthermore, the work by Woods and Graves offers some statistical evidence that cultural beliefs are not necessarily the major factors influencing people's health behavior. A paper by DeWalt and Pelto (in press) makes the same point with regardto food consumption patterns in a Mexican community. In both the Woods-Gravesand DeWalt-Pelto studies, ec.bnomic factors appear to be more significant than


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o Pelto & PeltolJ1Iedicine, Anthropology, Community: An Overview - F6L.~1 ,4050 0.0I _. o. 0 _. .00 restablishment tllat can lead to problems of cOTllmunication. Anthropologists cannegotiate understandings and behavioral in teractions between medical people andcommunity people. TIlis model of Ule an Uuopologist's role often assumes that theproblems of getting effective health care to the people arise from misunderstandings. Often it is necessary for healih workers to learn to use the people;s health concepts in congruence willi their own concepts of modern medicine.

TIlere is logic in the culture broker model, and it has a great deal of appealbecause it makes an thropologists cOJDmunica tions experts in a complex process.Unfortunately, in practice there are often some serious problems with the model.Botll anthropologists and medical people have frequently been too simplistic inaccepting a uniformist view of health-care 'behavior 111at stresses cultural 'norms.Anthropologists have led medical people to expect clear-cut answers to questionsabout the comlllunity. Yet tJle broker model can be a useful one, especiaJly when itis based on more complex views of communities and medical systems.

However, there is ano111er dimension to consider. The culture-broker modelusually suggests some sort of equality of power between parties, but anlliropologists are p-ainfully aware of the differences in power, for people in the communityoften lack political and economic leverage compared to people in the heal111-caresystem and in government agencies. Consequently, some antJuopologists havetried In identify ways to inject political power into their applied activities. Research on behalf of organized consumer groups niay be one way in which somepoliticaJ and economic power can be mobilized (Marchione 1975).

ConclusionAs people in cOlllmunities and medical systems go through the process of redefining their relationships to each otJler, anthropologists must also develop new modelsfor tJleir relationships to .both groups. Certainly, the directions of change are not atall clear, and there are lllany competing views about what relationships between


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"""406:.,()1-Notes

-_.-----~.- .. --I1. We will be concerned mainly with cultural and/or social anthropology in this paper, at the sametime recognizing that there arc areas of physical anthropology th,t relate closely to medicalconcerns. However, the work of medically oriented physical anthrupologists has not focusedon community health systems as often as have the activities of cultural and/or sodalanlhropologists. Any full treatment of medical anthropology must discuss the relationship of bothphysical and cultural anthropology to medical establishments and to the communities servedby heal th-care systems.

2. The medical establishment or medical system refers to the social system(s) of modern or Westernmedicine, including hospitals and their personnel,. health-center organizations, physicians,nurses, dentists, and other members of health-care teams, as well as to the medical and dentalschools in which professionals arc trained. It also includes various medical societies and otherprofessional organizations. '

3. Uniformist cultural theory refers to the tendency among anthropologists and others to describe aculture in termsof norms and standards thought to be essentially homogeneous or uniformfor most well-socialized individuals of the given community or ethnic group.

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Medicine, Anthropology, Community