Chap 17 EE

Raymond Hames Author

11/18/2017 Added

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Narrated Power Point Chap 17 ANTH 212

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[00:00:01.480]Good afternoon to you all.
[00:00:03.064]Now we're on Chapter 17, and it will
[00:00:05.793]deal with health and illness, and this is really
[00:00:09.623]all about a field called medical anthropology,
[00:00:12.016]which is probably the fastest growing field of all
[00:00:17.362]in anthropology, and it has plenty of applied dimensions.
[00:00:21.242]Many anthropologists who go into this field
[00:00:23.714]also get a degree in Masters of Public Health.
[00:00:28.651]In this chapter we're going to talk about
[00:00:30.416]cultural understandings of health and illness,
[00:00:33.041]treatment of illnesses, political and economic
[00:00:36.120]influences on health--and this is very important,
[00:00:39.832]especially when we begin to talk about
[00:00:41.434]health disparities--and then important health conditions
[00:00:45.734]and diseases that we see around the world today.
[00:00:49.975]Medical anthropologists are increasingly realizing
[00:00:52.397]that biological and social factors need to be
[00:00:55.589]jointly considered if we are to reduce human suffering.
[00:00:59.398]That is, there are obvious biological causes for illnesses,
[00:01:03.560]but social factors play a large role.
[00:01:07.180]Whether it has to do with living in crowded conditions
[00:01:12.611]or, for example, having low status versus high status,
[00:01:16.250]these affect your probability of contracting
[00:01:20.384]a variety of different kinds of illnesses.
[00:01:23.557]Ethnomedicine is a traditional field in anthropology.
[00:01:27.442]It has to do with health-related beliefs, knowledge,
[00:01:29.443]and practices of a cultural group.
[00:01:31.706]So one could actually do an enthnography just focusing
[00:01:36.172]on the ethnomedicine of a particular group,
[00:01:39.441]and ethnomedical studies can be done in any kind of society.
[00:01:45.611]Typically there's a belief that ghosts
[00:01:47.989]and other supernatural agents cause illnesses,
[00:01:53.333]and people believe they've seen ghosts
[00:01:56.871]and they know what they can do.
[00:01:58.114]And when you tell them, for example,
[00:01:59.476]from your perspective from the West
[00:02:01.622]that there's germs that cause illnesses,
[00:02:04.948]they say, "Well we can't see germs,
[00:02:08.155]"but we can see and know a ghost."
[00:02:11.201]So you kinda get these conflicting views,
[00:02:14.324]and the job of the medical anthropologist is to kinda
[00:02:17.393]work with the people to integrate scientific knowledge
[00:02:21.158]into the causes of health and disease.
[00:02:25.885]Very frequently, if you look at ethnomedical systems,
[00:02:29.665]the concepts of balance or equilibrium are really important.
[00:02:32.637]You look at the Greek and European four humors
[00:02:37.500]causing various illnesses like blood, phlegm, etc.
[00:02:41.819]Or yin and yang in Asian, especially Chinese medicine.
[00:02:47.707]You find out that these forces,
[00:02:52.345]these entities that inhabit the body,
[00:02:55.152]characterize the body being out of whack,
[00:02:58.379]and a cure would essentially restore the equilibrium.
[00:03:02.376]It's a fairly common ethnomedical belief.
[00:03:05.914]Also supernatural forces are implicated,
[00:03:09.753]and these are obviously culturally specific,
[00:03:14.588]but what is taking over the world now in terms of
[00:03:17.922]effective treatment is a ethnomedical perspective
[00:03:21.802]called the biomedical paradigm, which essentially
[00:03:26.179]focuses on the actual causes of illnesses,
[00:03:33.605]in terms of things such as cancer or bacteria, viruses,
[00:03:41.006]things of that nature, and how they interact
[00:03:43.049]with social conditions to either stop their spread
[00:03:46.607]or enhance their flow through a particular society.
[00:03:53.436]Take a look at that highlight on page 392, trying to
[00:04:00.354]prevent and cure malaria in a Central American country,
[00:04:05.155]and certain cultural assumptions that
[00:04:09.103]medical anthropologists had to fully understand
[00:04:11.481]before they could begin to develop an effective means
[00:04:15.493]to safeguard the community against the ravages of malaria.
[00:04:19.795]They believed that shots were better than pills,
[00:04:21.863]so they weren't interested in taking pills,
[00:04:24.510]brightly packaged pills were superior to plain packaging,
[00:04:28.161]that is, something pretty and well-packaged
[00:04:31.827]was thought to be more effective, and then also
[00:04:34.635]costly treatments superior to cheap treatments.
[00:04:37.216]So as you read through that section, you notice
[00:04:40.230]they had to understand the cultural context
[00:04:43.660]before they began to develop an effective
[00:04:47.206]treatment program in the area of public health,
[00:04:49.916]in regards to malaria for these people.
[00:04:52.615]Medical practitioners--shamans are pretty well universal.
[00:04:59.602]They diagnose and treat disease, and they're typically
[00:05:05.800]members of the community in a closely-knit sense.
[00:05:09.792]Then we have the standard physicians, and again,
[00:05:12.921]they're essential, but they tend to occur,
[00:05:15.580]obviously, more recently in human history
[00:05:19.449]and in highly-developed nations.
[00:05:23.805]Here's an example of a shaman kissing her niece.
[00:05:30.822]You see that shamans are kinda more intimately related
[00:05:35.796]in the culture, in the social system,
[00:05:39.551]and sometimes they're not really paid anything
[00:05:45.045]other than they're just there to help.
[00:05:46.954]And so they engage in these pro-social activities,
[00:05:49.885]and they have quite a bit of status as a consequence
[00:05:52.723]of their ability to diagnose illnesses and to cure them.
[00:05:59.594]Here are the mechanisms used all over the world
[00:06:02.982]in terms of when an illness presents.
[00:06:06.411]The naming process, the shaman will diagnose
[00:06:11.202]what the problem is or what was causing the problem
[00:06:15.904]people are having, typically it's
[00:06:17.439]a supernatural sort of cause.
[00:06:20.079]Also the personality of the doctor or the shaman,
[00:06:24.233]empathy and interest in the welfare of the individual
[00:06:28.630]is something that they show as a personality trait
[00:06:31.161]that makes them more effective.
[00:06:32.903]Again, in the small-scale societies,
[00:06:36.031]you know them intimately--they may be a relative
[00:06:38.331]or an in-law or someone your parents grew up with,
[00:06:42.080]so they're not a stranger as they are in our system.
[00:06:45.739]The patient's expectations, that is,
[00:06:48.759]once the illness is named there's an understanding
[00:06:53.654]of the healing process and what may be done
[00:06:58.144]through a variety of different curing techniques.
[00:07:01.682]And a lot of this is what we call sympathetic magic,
[00:07:08.210]there's a great faith in the effectiveness of the shaman,
[00:07:16.450]so it puts the person who's ill in a better state of mind
[00:07:21.972]because they have this trust that everything's under control
[00:07:25.588]and that there's someone out there, the shaman,
[00:07:29.368]who's properly diagnosed the illness
[00:07:31.273]and is on their side and is going to cure them
[00:07:34.539]because of their effective techniques.
[00:07:38.072]This is an important section in the text,
[00:07:40.657]the political and economic influences on health.
[00:07:43.845]People with more social, economic, and political power
[00:07:46.709]in a society are generally healthier.
[00:07:48.671]No surprise there, they can live in cleaner environments,
[00:07:51.742]they can afford better medical care.
[00:07:54.646]One really great study, the Whitehall Study
[00:07:57.957]conducted by Marmot, looked at people in England
[00:08:02.304]who were all treated by the same entity,
[00:08:06.034]the National Health Service, because of
[00:08:07.515]universal health insurance in England.
[00:08:11.053]And what he discovered was that high-status people
[00:08:14.241]had fewer illnesses compared to lower-status people
[00:08:18.672]in the English bureaucratic system.
[00:08:23.863]And what he discovered was that the low-status people,
[00:08:27.656]because they were low-status,
[00:08:29.941]suffered higher levels of stress,
[00:08:32.033]which made them more susceptible
[00:08:34.391]to a variety of different kinds of chronic illnesses
[00:08:39.918]such as heart disease or even cancers,
[00:08:43.266]which really surprised a lot of people.
[00:08:45.913]A lot of it had to do with, for example--and we're beginning
[00:08:49.327]just to understand this more fully--hormone secretion,
[00:08:54.100]especially cortisol, which is a stress hormone.
[00:08:57.920]That dampens the immune system, that is,
[00:09:00.717]harms the body's ability to fight off disease.
[00:09:04.599]This is a really important study that's been replicated
[00:09:08.746]around the globe, showing that one's social status,
[00:09:12.240]in terms of having a lot of power versus a little power,
[00:09:16.093]can make a large difference.
[00:09:17.894]So in socially stratified societies, the poor
[00:09:19.774]usually have increased exposure to disease as well,
[00:09:22.049]because they live in crowded conditions,
[00:09:24.644]or their environmental concerns in terms of
[00:09:28.222]clean water supply are not taken as seriously
[00:09:31.345]as people who live in better areas.
[00:09:33.699]A good example would be Flint, Michigan,
[00:09:37.026]with the problem of lead in their water supply.
[00:09:41.470]And importantly, the underclass experience more stress,
[00:09:43.848]and it has an effect on their health,
[00:09:45.546]which is pointed out in this Whitehall study by Marmot.
[00:09:52.429]Some current health conditions and diseases.
[00:09:55.424]AIDS or HIV, the difference between
[00:09:57.299]is AIDS is really a set of symptoms,
[00:09:59.964]HIV is an identification of the virus
[00:10:02.890]that causes the problem.
[00:10:06.006]Also mental and emotional disorders,
[00:10:09.977]for example in this country, depression and anxiety,
[00:10:13.487]especially amongst students, is really increasing
[00:10:17.589]at really high rates, and we're really
[00:10:19.233]not sure what's going on here.
[00:10:21.789]But these emotional disorders are not
[00:10:24.700]evenly distributed throughout the globe.
[00:10:29.160]In some societies we find the concept of anxiety
[00:10:37.300]really not an important or prevalent issue.
[00:10:40.412]In other societies it is.
[00:10:42.274]Another one that's really important in the United States,
[00:10:44.514]is becoming more evident, is depression.
[00:10:48.999]But if we look in small-scale societies, tribal societies,
[00:10:52.660]depression really isn't an issue.
[00:10:55.636]Depressive disorders have a lot to do with
[00:10:58.547]poor social support or lack of social support.
[00:11:02.134]And then also undernutrition, which if your body
[00:11:06.073]is not supplied with what it needs,
[00:11:10.133]your immune system is not as effective,
[00:11:13.484]and so you have problems dealing with the illnesses.
[00:11:16.992]Especially young children, who also have to
[00:11:20.180]grow and develop and also fight off illnesses.
[00:11:26.811]So undernutrition, whether it's general core intake,
[00:11:30.995]calories per day, or intake of protein, fat,
[00:11:36.305]or micronutrients such as vitamins and minerals,
[00:11:41.403]are implicated in lots of health issues.
[00:11:48.487]AIDS is the leading cause of adult death
[00:11:50.634]in many countries today.
[00:11:52.114]Changes in attitudes, beliefs, and practices
[00:11:54.640]regarding sexual activity are really needed,
[00:11:58.746]from the use of condoms to not being so promiscuous.
[00:12:07.879]And it turns out that married women,
[00:12:09.956]even though they're not promiscuous,
[00:12:11.298]are at the greatest risk in many of these nations
[00:12:13.830]because it's their husbands, who may be away from home
[00:12:17.175]for a long period of time, will engage in unprotected sex
[00:12:22.978]and then bring it back to their wives.
[00:12:25.835]And there's higher probability that the women
[00:12:30.420]will contract AIDS just because of the nature
[00:12:33.779]of their genital organs compared to men.
[00:12:37.366]So, this is kind of interesting that married women
[00:12:41.392]in many places are at the greatest risk
[00:12:42.948]for getting HIV or illnesses, and other
[00:12:47.634]sexually transmitted diseases as well.
[00:12:53.019]What this has created, with the massive
[00:12:55.595]death of the parents, is all these orphans,
[00:12:58.967]these poor children who've lost their parents,
[00:13:02.386]and the social service situation for taking care of orphans
[00:13:08.006]is really overtaxed in these nations.
[00:13:10.680]In many instances, the clan or the extended family
[00:13:14.855]or the lineage will take care of children
[00:13:16.744]who've lost parents, but these groups are really stressed
[00:13:20.677]because so many of the adults have died,
[00:13:23.914]and so this is becoming a really serious kind of problem
[00:13:28.550]in terms of collateral damage,
[00:13:30.363]all these kids growing up without parents.
[00:13:35.699]Then we turn to health conditions and diseases.
[00:13:38.046]Many mental and emotional disorders are culturally specific.
[00:13:42.516]The text talks about susto, or fright,
[00:13:45.704]and how this is a specific kind of condition
[00:13:49.642]in parts of Latin America.
[00:13:52.306]And of course depression in the United States
[00:13:54.917]and parts of the West.
[00:13:57.038]It's rarely seen in the rest of the world,
[00:14:01.854]but in the West it's very common.
[00:14:05.496]So this has to do with how, for at least mental disorders,
[00:14:09.606]that one the cultural system can amplify
[00:14:13.632]or expose a certain kind of condition
[00:14:16.642]that's absent in other social systems.
[00:14:20.348]Undernutrition, again as I mentioned,
[00:14:22.484]many of the serious nutritional problems today
[00:14:24.428]are due to rapid culture change,
[00:14:25.741]particularly when there is an increasing social inequality.
[00:14:29.190]And then also part of it has to be to do with
[00:14:32.003]the introduction of essentially junk food,
[00:14:36.296]foods that may supply you with calories
[00:14:38.689]but are really deficient in the other kind
[00:14:41.803]of nutrients that you need or also provide
[00:14:46.441]a kind of oversupply of carbohydrate resources
[00:14:51.661]that can lead to things such as diabetes
[00:14:55.169]and other metabolic disorders talked about in the chapter.
[00:14:59.822]Here are some basic concepts and terms
[00:15:01.318]that you should be familiar with
[00:15:03.271]in order to do well on the exam.
[00:15:04.752]Ethnomedicine we talked about.
[00:15:06.740]The biomedical paradigm, that is, that
[00:15:09.740]taking in consideration biology and social
[00:15:14.512]and economic and political factors.
[00:15:16.653]What a shaman does, shamans are really important people
[00:15:19.372]because they identify an illness and they prescribe a cure
[00:15:24.677]and they have a very intimate relationship
[00:15:27.292]with people they treat, as opposed to a physician
[00:15:30.879]in our own society, who we may know a little bit
[00:15:34.338]but he doesn't take part in our social lives,
[00:15:38.406]he just treats us without really knowing us.
[00:15:43.975]The factors involved in AIDS transmission
[00:15:48.194]should be understood.
[00:15:49.802]Some mental disorders are culturally understood
[00:15:52.934]and elaborated, so culture can bring to fore certain kinds
[00:16:01.119]of illnesses that are absent in certain places.
[00:16:06.670]Such as, as I mentioned, depression or anxiety disorders
[00:16:10.366]in the West, and these things are rarely seen elsewhere,
[00:16:14.313]but they have other things, as the textbook indicates,
[00:16:18.147]that we don't have but they have.
[00:16:21.187]Undernutrition is a factor in many illnesses,
[00:16:26.145]and, I would add, one's social status is also
[00:16:31.332]a major factor, talked about the Whitehall study,
[00:16:34.071]and so understand that people who have higher status
[00:16:37.125]have less stress and better health outcomes,
[00:16:39.893]whereas people with lower status have greater stress,
[00:16:44.556]and that has to do with their hormonal profiles
[00:16:47.152]that lead to greater illnesses.
[00:16:50.132]And then more recently, although we're
[00:16:53.202]one of the most obese nations on earth,
[00:16:57.115]obesity is spreading to other parts of the developing world,
[00:17:02.040]and it's becoming a real problem in terms of
[00:17:05.035]creating a whole set of syndromes,
[00:17:07.763]especially metabolic disorders such as diabetes,
[00:17:11.045]high blood pressure, and things of that nature.
[00:17:14.360]So, that's it for this chapter.

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