Paper No.

: 06 Human Growth Development and Nutrition

Module : 15 Meaning and Scope of Medical Anthropology

Development Team
Prof. Anup Kumar Kapoor
Principal Investigator
Department of Anthropology, University of Delhi

Prof. Anup Kumar kapoor

Paper Coordinator Dr.Department
Meenal Dhall
of Anthropology, University of Delhi
Department of Anthropology, University of Delhi

Dr. Ajeet
Dr. MeenalJaiswal
Dhall
Content Writer Department of
Department ofAnthropology, University of Delhi
Anthropology,Pondicherry University

Content Reviewer Prof. Satwanti Kapoor

Department of Anthropology, University of Delhi
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Human Growth Development and Nutrition

Anthropology
Meaning and Scope of Medical Anthropology
 Description Of Module

Subject Name Anthropology

Paper Name 06 Human Growth Development and Nutrition

Module Name/Title Meaning and Scope of Medical Anthropology

Module Id
15

Human Growth Development and Nutrition

Anthropology
Meaning and Scope of Medical Anthropology
 Contents

1. Introduction: What is Medical Anthropology?

2. History of Medical Anthropology

3. Theoretical orientation of Medical Anthropology

3.1 : Medical Ecology

3.2 : Ethnomedicine

3.3 : Applied Medical Anthropology

4. Scope of Medical Anthropology

5. Major Area of Study for Medical anthropologists are

6. Summary

Learning objectives:
 The course provides an introduction to the field of medical anthropology.
 It includes the application of different forms of social and cultural analysis to the study of
health, illness, and healing.
 The study of this module enables the students at postgraduate level to understand the
Theoretical orientation of Medical Anthropology.

Human Growth Development and Nutrition

Anthropology
Meaning and Scope of Medical Anthropology
 1. Introduction: What is Medical Anthropology?

Medical Anthropology is a subfield of anthropology that draws upon social, cultural, biological, and
linguistic anthropology to better understand those factors which influence health and well being (broadly
defined), the experience and distribution of illness, the prevention and treatment of sickness, healing
processes, the social relations of therapy management, and the cultural importance and utilization of
pluralistic medical systems. The discipline of medical anthropology draws upon many different theoretical
approaches.

It is as attentive to popular health culture as bioscientific epidemiology, and the social construction of
knowledge and politics of science as scientific discovery and hypothesis testing. Medical anthropologists
examine how the health of individuals, larger social formations, and the environment are affected by
interrelationships between humans and other species; cultural norms and social institutions; micro and
macro politics; and forces of globalization as each of these affects local worlds (Scotch, 1963; Steegmann,
1983; Thomas, 1973)

Medical Anthropology examines how health and well-being are socially and culturally constituted in
comparative and transnational contexts and the ways in which culture influences the experience of illness,
the practice of medicine and the process of healing for the individual and community. It explores how the
experiences and perceptions of the body, self or notion of the individual or person influence the illness
experience. It is also concerned with how cultural values and practices dynamically shape and are
themselves shaped by biomedical research and practice and non-Western medicines and healing traditions
(Romanucci et.al, 1983).

Medical anthropology is the study of human health and disease, health care systems, and bio-cultural
adaptation. The discipline draws upon the four fields of anthropology to analyse and compare the health of
regional populations and of ethnic and cultural enclaves, both prehistoric and contemporary. Collaboration
among paleopathologists, human biologists, ethnologists, and linguists has created a field that is autonomous
from any single sub-discipline, with strong potential for integration of physical and Cultural anthropology.
The field is also highly interdisciplinary, linking anthropology to sociology, economics, and geography, as
well as to medicine, nursing, public health, and other health professions.

Since the mid-1960s, medical anthropology has developed three major orientations. Medical ecology views
populations as biological as well as cultural units and studies interactions among ecological systems, health,
and human evolution. Ethno-medical analysis focuses on cultural systems of healing and the cognitive
parameters of illness (Paul, 1955; Polgar, 1962).

Applied medical anthropology deals with intervention, prevention, and policy issues and analyses the
socioeconomic forces and power differentials that influence access to care. In this triad, cultural
anthropology is most closely allied with ethno-medicine. In the formative years, some anthropologists
favoured identifying the field as "ethno-medicine," while others preferred "anthropology of health." The
term "medical anthropology prevailed, however, coming to represent a diversified range of orientations.

2. History of Medical Anthropology:

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Human Growth Development and Nutrition

Anthropology
Meaning and Scope of Medical Anthropology
 George M. Foster and Barbara Gallatin Anderson (1978) trace the development of medical anthropology to
four distinct sources: the interest of early physical anthropologists in human evolution and adaptation,
ethnographic interest in primitive medicine, studies of psychiatric phenomena in the culture and personality
school, and anthropological work in international health. William H. R. Rivers (1924), a physician, is
considered the first ethnologist of non-Western medical practices. Early theoretical work by Forrest E.
Clements (1932) and Erwin H. Ackerknecht (1942, 1946) also attempted to systematize primitive medical
beliefs and practices. Paralleling theory development were early applications of anthropological principles to
health problems. Since the 1940s anthropologists have helped health care providers understand cultural
differences in health behaviours, as shown in Benjamin D. Paufs edited volume Health, Culture and
Community: Case Studies of Public Reactions to Health Programs (1955), one of the first medical
anthropology texts.

William Caudill (1953) was the first to identify the field, followed by review articles by Steven Polgar
(1962) and by Norman Scotch (1963). Academics, applied scientists, and clinicians enthusiastically worked
in the 1960s to organize the emerging social science in medicine movement at national meetings of the
American Anthropological Association (AAA) and the Society for Applied Anthropology (SAA). Caudill,
Polgar, and Scotch were among the most active, as were Hazel Weidman, Arthur Rubel, Dorothea Leighton,
Clifford Barnett, Marvin Opler, Marion Pearsall, Donald Kennedy, Benjamin Paul, and Charles Leslie.

The Group for Medical Anthropology (GMA), established in 1967 with Weidman as chair, affiliated with
the SFAA in 1969. As the Society for Medical Anthropology (SMA), the organization became a formal
section of the AAA in 1972, with Dorothea Leighton, a psychiatrist-anthropologist, serving as its first
president. Membership grew from 657 in 1972 to 1,523 in 1993, including a few hundred Canadian and
other international members, primarily Europeans. Next to North America, Great Britain has the largest
number of medical anthropologists. Most of them are concerned more with political economy and clinical
issues than with bio-cultural perspectives. Increasing numbers of medical anthropologists work in Australia,
Latin America, the Philippines, and India.

3. Theoretical orientation of Medical Anthropology

3.1: Medical Ecology
Anthropologists using an ecological perspective to understand disease patterns view human populations as
biological as well as cultural entities. Taking a systems approach in research, culture is seen as one resource
for responding to environmental problems, but genetic and physiological processes carry equal weight. The
evolution, demography, and epidemiology of humans are subject to ecological forces, as are other species
(McElroy and Patricia, 1989; Moore, et al.,1980).

A key concept in medical ecology is "adaptation," the changes, modifications, and variations that increase
the chances of survival, reproductive success, and general wellbeing in an environment. Alexander Alland,
Jr. (1970), was one of the first to apply the concept of adaptation to medical anthropology. Humans adapt
through genetic change, physiological responses (short-term or developmental), cultural knowledge and
practices, and individual coping mechanisms. A basic premise is that health is an ineasure of environmental
adaptation, and disease indicates disequilibrium. A second premise is that the evolution of disease parallels
human biological and cultural evolution. The risks faced by foraging peoples differ from those of
agricultural groups and industrial societies, and the epidemiological profile of each subsistence type is a
function of human relations with the environment and with other species in the ecosystem, especially food
sources, domesticated animals, and pathogens.
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Human Growth Development and Nutrition

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Meaning and Scope of Medical Anthropology
 Medical ecology, unlike other orientations, assumes that biomedical disease categories are universal.
Disease rates can be measured, compared through time and across geographic space, and correlated with
changes in settlement patterns and subsistence. The frequencies of hemoglobin types can be measured and
mapped geographically in relation to the incidence of infectious diseases such as malaria. The impact of
diseases of contact, such as malaria, smallpox, and tuberculosis, on the native populations of the New World
can be studied historically.

In the field, medical ecologists study subsistence patterns and nutrition; children’s growth and development;
pregnancy and birth rates; population size, density, and mobility; chronic and infectious disease; hazards and
injury patterns; and demographic change over time. Research on prehistoric populations analyses skeletal
remains, house sites, settlement patterns, and ecology. Medical ecology has usually studied isolated
populations living in rigorous environments, such as high-altitude regions, the arctic, and tropical forests,
such as the classic work of Napoleon A. Chagnon (1992) and James V. Neel (1977) on the Yanomamo, the
work of A. T. Steegmann, Jr. (1983), on cold adaptation, and the long-term research in high-altitude regions
of South America by Paul T. Baker and Michael A. Little (1976) and by R. Brooke Thomas (1973) and their
respective colleagues and students (Clements, 1932; Foster and Barbara, 1978).

Increased attention has been given since the 1980s by human biologists and medical ecologists to
seasonality and health in agricultural populations, environmental and cultural regulation of fertility,
migration and change in health status, and to work productivity in chronically undernourished and infected
populations. The urban ecology of health is a new focus as well, and there is increasing dialogue with
political economy theorists with respect to developing a "political ecology of health."

3.2: Ethnomedicine
The ethnomedical perspective focuses on health beliefs and practices, cultural values, and social roles.
Originally limited to study of primitive or folk medicine, ethnomedicine has come to mean the health
maintenance system of any society. Health ethnographies encompass beliefs, knowledge, and values of
specialists and lay people; the roles of healers, patients or clients, and family members; the implements,
techniques, and pharmacopoeias of specialists; legal and economic aspects of health practices; and symbolic
and interpersonal components of the experience of illness (Logan and Edward, 1978).

Pluralistic societies often encompass several ethnomedical systems. Among these are cosmopolitan
medicine, a dominant system in North America and in urban centers elsewhere, which emphasizes empirical
research, naturalistic explanations, technology and surgery, use of extraordinary intervention to preserve
life, and hierarchical roles.

Humoral medicine, derived from ancient Greek medicine, emphasizes that health reflects balance among
bodily humors and their intrinsic qualities. Disequilibrium derives from ingestion of inappropriate food and
other substances, from change of climate, and from exposure to natural elements like air and water. Therapy
involves restoring equilibrium through applying or ingesting remedies opposite to the state of the body.
Humoral medicine coexists with other systems in Latin America, the Middle East, Malaysia, Indonesia, and
the Philippines. Ayurvedic medicine in India and Chinese traditional medicine meld humoral elements with
elements of other systems (Lock, 1980).

Human Growth Development and Nutrition

Anthropology
Meaning and Scope of Medical Anthropology
 A key concept in ethnomedicine is "explanatory model," introduced by Arthur Kleinman (1980).
Explanatory models (EMs) are notions about the causes of illness, diagnostic criteria, and treatment options.
In a clinical encounter, the EMs held by practitioners, patients, and family often differs. The ensuing
communication and negotiation of decisions for managing illness lead to the cultural "construction' of
illness. To the extent that disparity among EMs continues because of cultural, ethnic, or class differences,
communication remains problematic.

The disease-illness distinction is important conceptually in the study of ethnomedicine. Disease, defined
clinically as deviation from medical norms, is considered to be a Western biomedical category and not
universal. Biomedical terms such as "hypertension' or "diabetes" may not correspond to diagnostic
categories of a given ethnomedical system. Illness, in contrast, is the experience of impairment or distress,
as culturally defined and constructed. Cause of the illness may also be located in social and spiritual realms,
so that ethnomedical aetiology may include sorcery, soul loss, and spirit intrusion(Lock, 1980; Logan and
Edward, 1978).

In addition to negotiation of the meaning of illness, management of illness and disability also occur in a
social and cognitive matrix. Healing is often mediated by symbols and practices that induce conditioned
neurophysiological and immune system responses. The placebo effect of the healer's behaviour and symbols
to induce healing or to reduce stress is of central interest in ethnomedical studies.

Cultural psychiatry is closely allied with ethnomedicine. Many folk illnesses or "culture bound syndromes"
(such as susto, arctic hysteria, or amok) appear to be psychogenic, although environmental stressors play a
role in their onset. These folk illnesses do not fit easily into Western diagnostic categories (Kleinman, 1980;
Landy, 1977).

Ethnographic methods are primary in this orientation, and researchers usually do participant-observation,
sometimes becoming apprentices of healers and midwives. Some elicit ethnosemantic data on disease
categories, causes, and decision models in order to study underlying cognition. Interviews and life histories
allow in-depth analysis of the lives of healers and patients, and medical discourse analysis is a specialized
linguistic technique that studies the negotiation of meaning and power. Some specialists collect and analyze
pharmacologic items; others study the history of medical practices. Although traditionally researchers have
worked in folk societies, increasing numbers are studying pluralistic societies, such as Margaret Lock
(1980). Attention has been given since the mid-1980s to integrating ethnomedicine and ethnoecology, as in
studies of indigenous people's knowledge of medicinal plants. There is also strong interest in clinical
applications of ethnomedical treatments (Chagnon, 1992).

3.3 Applied Medical Anthropology

Theories of the cultural patterning of health behaviour can be applied in any arena. Following the pioneering
examples set by Margaret Clark, George Foster, and Perttl Pelto, anthropologists work, for example, in
clinics serving multicultural populations, in maternal and child health programs, on surveys of community
responses to environmental hazards, on program planning and evaluation in psychiatric hospitals, on AIDS
prevention projects, and on the reintegration of people with traumatic brain injury to community life. The
populations served are often people on the margins of mainstream society-refugees, native peoples, rural
elderly, drug addicts, people with disabilities, ethnic minorities. The difference between basic and applied
research is that applied medical anthropologists deliberately become advocates for the community and
attempt to do research that is useful and ethical.
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Meaning and Scope of Medical Anthropology
 While some applied research is a theoretical, others employ explicit theoretical frameworks. One notable
framework is the political economy of health, also called critical medical anthropology. Influenced by
Marxist theory and dependency theory, this approach analyses the impact of global economic systems,
particularly capitalism, on local and national health. Political economists such as Soheir Morsy, Hans Baer,
Lynn Morgan, and Merrill Singer argue that change programs should not be attempted unless one also
studies the social production of illness and poverty within the larger dynamics of class interactions,
colonialism, or world economic systems (Hill, 1991).

Critical clinical medical anthropology is an adjunct of political economy. This approach analyses biomedical
practice and the differentials in power and authoritative knowledge of practitioner and patient. Clinical
anthropology has been influenced by Michel Foucault's writings on the historical production of medical
knowledge and the notion that the body can become an arena in which social control issues are played out.
Usually focused on medical communication, the approach has been used particularly in relation to women's
reproductive health and has developed a controversial literature on the lexicalisation of women’s bodies
through the work of Brigitte Jordan, Emily Martin, Rayna Rapp, and others (Johnson and Carolyn, 1990).

Applied anthropology methods are eclectic, ranging from qualitative to highly quantitative. Ethnographers
have developed rapid assessment techniques to document community health needs during brief field trips.
Others trained in public health, epidemiology, nursing, or medicine may do clinical or laboratory procedures
or work with vital statistics. In quantitative approaches, rigorous attention is paid to sampling issues and
sophisticated statistical analysis, and informed consent procedures are followed. As Carole E. Hill (1991)
points out, many medical anthropologists are now working outside academia and combining standard
anthropological skills with technical planning and evaluation skills.

4. Scope of Medical Anthropology

Currently, research in medical anthropology is one of the main growth areas in the field of anthropology as a
whole and important processes of internal specialization are taking place. For this reason, any agenda is
always debatable. In general, we may consider the following six basic fields:

 the development of systems of medical knowledge and medical care

 the patient-physician relationship
 the integration of alternative medical systems in culturally diverse environments
 the interaction of social, environmental and biological factors which influence health and illness
both in the individual and the community as a whole
 the critical analysis of interaction between psychiatric services and migrant populations ("critical
ethnopsychiatry": Beneduce 2004, 2007)
 the impact of biomedicine and biomedical technologies in non-Western settings
Other subjects that have become central to the medical anthropology worldwide are violence and social
suffering (Farmer, 1999) as well as other issues that involve physical and psychological harm and suffering
that are not a result of illness. On the other hand, there are fields that intersect with medical anthropology in
terms of research methodology and theoretical production, such as cultural psychiatry and transcultural
psychiatry or ethnopsychiatry
Employment has been plentiful in medical anthropology. Especially from 1967 through the 1980s,
departments of preventive medicine, social psychiatry, pediatrics, nursing, schools of public health, and the
Public Health Service were employing social scientists, and training programs were also being established.
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Human Growth Development and Nutrition

Anthropology
Meaning and Scope of Medical Anthropology
 Several national and International university or educational institution establishes the course as well as
training programs in medical anthropology especially public health, to prepare for work in a wide array of
academic, clinical, government, and nongovernment positions..

Some careers in this field include: University Professor, Health Education Professional, Public Health
Researcher, Epidemiologist, Medical Scientist, Health Care Administrator, Health Outreach Coordinator, Health
and Social Policy Analyst, Health Care Consultant and Social Worker

5. Major Area of Study for Medical anthropologists are:

1. Health ramifications of ecological “adaptation and maladaptation”

2. Popular health culture and domestic health care practices
3. Local interpretations of bodily processes
4. Changing body projects and valued bodily attributes
5. Perceptions of risk, vulnerability and responsibility for illness and health care
6. Risk and protective dimensions of human behavior, cultural norms and social institutions
7. Preventative health and harm reduction practices
8. The experience of illness and the social relations of sickness
9. The range of factors driving health, nutrition and health care transitions
10. Ethnomedicine, pluralistic healing modalities, and healing processes
11. The social organization of clinical interactions
12. The cultural and historical conditions shaping medical practices and policies
13. Medical practices in the context of modernity, colonial, and post-colonial social formations
14. The use and interpretation of pharmaceuticals and forms of biotechnology
15. The commercialization and commodification of health and medicine
16. Disease distribution and health disparity
17. Differential use and availability of government and private health care resources
18. The political economy of health care provision.
19. The political ecology of infectious and vector borne diseases, chronic diseases and states of
malnutrition, and violence
20. The possibilities for a critically engaged yet clinically relevant application of anthropology

6. Summary
 Medical Anthropology is a subfield of anthropology
 The discipline of medical anthropology draws upon many different theoretical approaches.
 Medical Anthropology examines how health and well-being are socially and culturally constituted in
comparative and transnational contexts
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Human Growth Development and Nutrition

Anthropology
Meaning and Scope of Medical Anthropology
  Medical anthropology is the study of human health and disease, health care systems, and bio-cultural
adaptation.
 Applied medical anthropology deals with intervention, prevention, and policy issues and analyses the
socioeconomic forces and power differentials that influence access to care.
 George M. Foster and Barbara Gallatin Anderson (1978) trace the development of medical anthropology
to four distinct sources
 William Caudill (1953) was the first to identify the field, followed by review articles by Steven Polgar
(1962) and by Norman Scotch (1963).
 Anthropologists using an ecological perspective to understand disease patterns view human populations
as biological as well as cultural entities
 Medical ecology, unlike other orientations, assumes that biomedical disease categories are universal.
 The ethnomedical perspective focuses on health beliefs and practices, cultural values, and social roles.
 A key concept in ethnomedicine is "explanatory model," introduced by Arthur Kleinman (1980).
 The disease-illness distinction is important conceptually in the study of ethnomedicine.
 Cultural psychiatry is closely allied with ethnomedicine.
 Theories of the cultural patterning of health behaviour can be applied in any arena.
 Critical clinical medical anthropology is an adjunct of political economy.
 Currently, research in medical anthropology is one of the main growth areas in the field of anthropology
as a whole

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Human Growth Development and Nutrition

Anthropology
Meaning and Scope of Medical Anthropology