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Chap 17 EE
Narrated Power Point Chap 17 ANTH 212
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Good afternoon to you all.
Now we're on Chapter 17, and it will
deal with health and illness, and this is really
all about a field called medical anthropology,
which is probably the fastest growing field of all
in anthropology, and it has plenty of applied dimensions.
Many anthropologists who go into this field
also get a degree in Masters of Public Health.
In this chapter we're going to talk about
cultural understandings of health and illness,
treatment of illnesses, political and economic
influences on health--and this is very important,
especially when we begin to talk about
health disparities--and then important health conditions
and diseases that we see around the world today.
Medical anthropologists are increasingly realizing
that biological and social factors need to be
jointly considered if we are to reduce human suffering.
That is, there are obvious biological causes for illnesses,
but social factors play a large role.
Whether it has to do with living in crowded conditions
or, for example, having low status versus high status,
these affect your probability of contracting
a variety of different kinds of illnesses.
Ethnomedicine is a traditional field in anthropology.
It has to do with health-related beliefs, knowledge,
and practices of a cultural group.
So one could actually do an enthnography just focusing
on the ethnomedicine of a particular group,
and ethnomedical studies can be done in any kind of society.
Typically there's a belief that ghosts
and other supernatural agents cause illnesses,
and people believe they've seen ghosts
and they know what they can do.
And when you tell them, for example,
from your perspective from the West
that there's germs that cause illnesses,
they say, "Well we can't see germs,
"but we can see and know a ghost."
So you kinda get these conflicting views,
and the job of the medical anthropologist is to kinda
work with the people to integrate scientific knowledge
into the causes of health and disease.
Very frequently, if you look at ethnomedical systems,
the concepts of balance or equilibrium are really important.
You look at the Greek and European four humors
causing various illnesses like blood, phlegm, etc.
Or yin and yang in Asian, especially Chinese medicine.
You find out that these forces,
these entities that inhabit the body,
characterize the body being out of whack,
and a cure would essentially restore the equilibrium.
It's a fairly common ethnomedical belief.
Also supernatural forces are implicated,
and these are obviously culturally specific,
but what is taking over the world now in terms of
effective treatment is a ethnomedical perspective
called the biomedical paradigm, which essentially
focuses on the actual causes of illnesses,
in terms of things such as cancer or bacteria, viruses,
things of that nature, and how they interact
with social conditions to either stop their spread
or enhance their flow through a particular society.
Take a look at that highlight on page 392, trying to
prevent and cure malaria in a Central American country,
and certain cultural assumptions that
medical anthropologists had to fully understand
before they could begin to develop an effective means
to safeguard the community against the ravages of malaria.
They believed that shots were better than pills,
so they weren't interested in taking pills,
brightly packaged pills were superior to plain packaging,
that is, something pretty and well-packaged
was thought to be more effective, and then also
costly treatments superior to cheap treatments.
So as you read through that section, you notice
they had to understand the cultural context
before they began to develop an effective
treatment program in the area of public health,
in regards to malaria for these people.
Medical practitioners--shamans are pretty well universal.
They diagnose and treat disease, and they're typically
members of the community in a closely-knit sense.
Then we have the standard physicians, and again,
they're essential, but they tend to occur,
obviously, more recently in human history
and in highly-developed nations.
Here's an example of a shaman kissing her niece.
You see that shamans are kinda more intimately related
in the culture, in the social system,
and sometimes they're not really paid anything
other than they're just there to help.
And so they engage in these pro-social activities,
and they have quite a bit of status as a consequence
of their ability to diagnose illnesses and to cure them.
Here are the mechanisms used all over the world
in terms of when an illness presents.
The naming process, the shaman will diagnose
what the problem is or what was causing the problem
people are having, typically it's
a supernatural sort of cause.
Also the personality of the doctor or the shaman,
empathy and interest in the welfare of the individual
is something that they show as a personality trait
that makes them more effective.
Again, in the small-scale societies,
you know them intimately--they may be a relative
or an in-law or someone your parents grew up with,
so they're not a stranger as they are in our system.
The patient's expectations, that is,
once the illness is named there's an understanding
of the healing process and what may be done
through a variety of different curing techniques.
And a lot of this is what we call sympathetic magic,
there's a great faith in the effectiveness of the shaman,
so it puts the person who's ill in a better state of mind
because they have this trust that everything's under control
and that there's someone out there, the shaman,
who's properly diagnosed the illness
and is on their side and is going to cure them
because of their effective techniques.
This is an important section in the text,
the political and economic influences on health.
People with more social, economic, and political power
in a society are generally healthier.
No surprise there, they can live in cleaner environments,
they can afford better medical care.
One really great study, the Whitehall Study
conducted by Marmot, looked at people in England
who were all treated by the same entity,
the National Health Service, because of
universal health insurance in England.
And what he discovered was that high-status people
had fewer illnesses compared to lower-status people
in the English bureaucratic system.
And what he discovered was that the low-status people,
because they were low-status,
suffered higher levels of stress,
which made them more susceptible
to a variety of different kinds of chronic illnesses
such as heart disease or even cancers,
which really surprised a lot of people.
A lot of it had to do with, for example--and we're beginning
just to understand this more fully--hormone secretion,
especially cortisol, which is a stress hormone.
That dampens the immune system, that is,
harms the body's ability to fight off disease.
This is a really important study that's been replicated
around the globe, showing that one's social status,
in terms of having a lot of power versus a little power,
can make a large difference.
So in socially stratified societies, the poor
usually have increased exposure to disease as well,
because they live in crowded conditions,
or their environmental concerns in terms of
clean water supply are not taken as seriously
as people who live in better areas.
A good example would be Flint, Michigan,
with the problem of lead in their water supply.
And importantly, the underclass experience more stress,
and it has an effect on their health,
which is pointed out in this Whitehall study by Marmot.
Some current health conditions and diseases.
AIDS or HIV, the difference between
is AIDS is really a set of symptoms,
HIV is an identification of the virus
that causes the problem.
Also mental and emotional disorders,
for example in this country, depression and anxiety,
especially amongst students, is really increasing
at really high rates, and we're really
not sure what's going on here.
But these emotional disorders are not
evenly distributed throughout the globe.
In some societies we find the concept of anxiety
really not an important or prevalent issue.
In other societies it is.
Another one that's really important in the United States,
is becoming more evident, is depression.
But if we look in small-scale societies, tribal societies,
depression really isn't an issue.
Depressive disorders have a lot to do with
poor social support or lack of social support.
And then also undernutrition, which if your body
is not supplied with what it needs,
your immune system is not as effective,
and so you have problems dealing with the illnesses.
Especially young children, who also have to
grow and develop and also fight off illnesses.
So undernutrition, whether it's general core intake,
calories per day, or intake of protein, fat,
or micronutrients such as vitamins and minerals,
are implicated in lots of health issues.
AIDS is the leading cause of adult death
in many countries today.
Changes in attitudes, beliefs, and practices
regarding sexual activity are really needed,
from the use of condoms to not being so promiscuous.
And it turns out that married women,
even though they're not promiscuous,
are at the greatest risk in many of these nations
because it's their husbands, who may be away from home
for a long period of time, will engage in unprotected sex
and then bring it back to their wives.
And there's higher probability that the women
will contract AIDS just because of the nature
of their genital organs compared to men.
So, this is kind of interesting that married women
in many places are at the greatest risk
for getting HIV or illnesses, and other
sexually transmitted diseases as well.
What this has created, with the massive
death of the parents, is all these orphans,
these poor children who've lost their parents,
and the social service situation for taking care of orphans
is really overtaxed in these nations.
In many instances, the clan or the extended family
or the lineage will take care of children
who've lost parents, but these groups are really stressed
because so many of the adults have died,
and so this is becoming a really serious kind of problem
in terms of collateral damage,
all these kids growing up without parents.
Then we turn to health conditions and diseases.
Many mental and emotional disorders are culturally specific.
The text talks about susto, or fright,
and how this is a specific kind of condition
in parts of Latin America.
And of course depression in the United States
and parts of the West.
It's rarely seen in the rest of the world,
but in the West it's very common.
So this has to do with how, for at least mental disorders,
that one the cultural system can amplify
or expose a certain kind of condition
that's absent in other social systems.
Undernutrition, again as I mentioned,
many of the serious nutritional problems today
are due to rapid culture change,
particularly when there is an increasing social inequality.
And then also part of it has to be to do with
the introduction of essentially junk food,
foods that may supply you with calories
but are really deficient in the other kind
of nutrients that you need or also provide
a kind of oversupply of carbohydrate resources
that can lead to things such as diabetes
and other metabolic disorders talked about in the chapter.
Here are some basic concepts and terms
that you should be familiar with
in order to do well on the exam.
Ethnomedicine we talked about.
The biomedical paradigm, that is, that
taking in consideration biology and social
and economic and political factors.
What a shaman does, shamans are really important people
because they identify an illness and they prescribe a cure
and they have a very intimate relationship
with people they treat, as opposed to a physician
in our own society, who we may know a little bit
but he doesn't take part in our social lives,
he just treats us without really knowing us.
The factors involved in AIDS transmission
should be understood.
Some mental disorders are culturally understood
and elaborated, so culture can bring to fore certain kinds
of illnesses that are absent in certain places.
Such as, as I mentioned, depression or anxiety disorders
in the West, and these things are rarely seen elsewhere,
but they have other things, as the textbook indicates,
that we don't have but they have.
Undernutrition is a factor in many illnesses,
and, I would add, one's social status is also
a major factor, talked about the Whitehall study,
and so understand that people who have higher status
have less stress and better health outcomes,
whereas people with lower status have greater stress,
and that has to do with their hormonal profiles
that lead to greater illnesses.
And then more recently, although we're
one of the most obese nations on earth,
obesity is spreading to other parts of the developing world,
and it's becoming a real problem in terms of
creating a whole set of syndromes,
especially metabolic disorders such as diabetes,
high blood pressure, and things of that nature.
So, that's it for this chapter.
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