Chapter 5 Lecture Notes

This chapter covers what I believe to be some of the most fundamental questions in cultural anthropology. That includes the experience of health, illness, disease and wellbeing cross-culturally.

Medical anthropology is one of the fastest growing fields within anthropology, and one of the most important. Medical anthropology primarily looks at cross-cultural studies of health and health problems and how the experience of illness is shaped by culture. In the beginning, medical anthropology was seen as a subfield of biological anthropology, but now it is very much recognized as one of the core subfields of cultural anthropology, and in fact as a discipline that creates a bridge between cultural and biological anthropology. Health is not experienced in a vacuum, and it is often equal parts biology and culture that effect health and the experience of health.

When we talk about cross-cultural studies of health but we’re really talking about is the field at ethnomedicine. What we have learned from medical anthropologists is that all cultures have what is called a health system. Health systems include the entire experience of health. Including perceptions and beliefs about the body; classifications of health problems; how people try to prevent illness and disease; and who does the healing within a cultural system.

There are some fascinating examples of how culture influences health and the perceptions of health cross culturally. For instance, through the concept in Japan about the wholeness of the body and it is called Gotai. Within that system it is believed that the most important thing for reincarnation is that one’s body remains hole in this lifetime. What that means is that Japanese people are very, very concerned with the wholeness of their body while they’re alive and this influences many of their health decisions. So much so that Japan has one of the lowest rate of surgery and organ donation and transplantation worldwide. We tend to think of things like surgery as simple medical necessities and someone tells us when we need them and when to have them done. We don't realize that the decisions of when to have surgery, whether to have surgery, or how to treat certain conditions are very much influenced by our cultural context.

Similarly in Brazil they have a cultural value on being beautiful. This high value placed on beauty is largely focused on females and consequently it affects female decisions about health. For instance, Brazil has one of the lowest rates of vaginal births in the world because it is believed that to have a natural vaginal birth would be to destroy essentially or alter the beauty of the female vagina. Consequently, most births among women who can afford to choose their method of birth, are C-sections.

I think one of the most interesting and compelling health systems that we experience in the United States, is the dichotomy between mental health and physical health. In the US, we have a very medicalized view of health and we separate out that which we experience in our bodies, from that which we experience in our heads. But we know from countless studies, anthropological and otherwise, that health does not happen in a vacuum. A person’s environment has everything to do with their health. The way you think and feel and the emotional experiences that a person has affect your physical self very much. Unfortunately in the US, the mind-body connection is often not recognized at all. In fact we have completely different doctors, and often different hospitals, to treat the mind and the body separately, and the two are very rarely connected.

In the Western medical model, we tend to think of disease and illness as being very cut and dry. However, we have found through medical anthropological studies, that there is absolutely no universal set of labels for health problems that apply in all cultures. Anthropologist have identified a number of categories that affect the way health problems are labeled in different cultures. These include: how disease and illness are looked at and connected; where an illness is believed to have come from; the vector or how a disease or illness is transmitted; the parts about the body that are affected by illness; and the symptoms experienced and associated with particular illnesses.

To illustrate the point of exactly how culturally influenced health and illness can be, medical anthropologists have discovered and described a number of health issues that appear to be culture specific. We call these culture specific syndromes. Culture specific syndromes are health problems with a set of symptoms that are associated with and experienced within a particular culture.

Medical anthropologist have found that often the factors that bring about many of these illnesses are social factors as opposed to biological ones. And to say that something is a cultural issue or a social issue does not mean that there aren’t real somatic symptoms experienced by people who suffer these culture specific syndromes. Interestingly, anthropologists and medical professionals have found that although these illnesses might be largely brought about by social and cultural factors- they can be fatal. It is not just in the mind. These are diseases and illnesses of the body as well, affected by the experiences of the mind.

Structural violence also affects health in very profound ways. The economic and political instability in Sub-Saharan Africa (as the result of colonialism and post-colonialist policies) has a direct impact on health. The lack of infrastructure and access to quality health care, along with extreme poverty and massive national debt, has all contributed to the HIV/AIDS crisis there. Of the 39 million people in the world who are infected with HIV, more than 25 million of them are on Sub-Saharan Africa.