Introduction To The Course:
 What is medical Anthropology?
    Foster & Anderson:

A biocultural discipline concerned with both the biological and sociocultural aspects of human
behavior and particularly with the ways in which the two interact and have interacted throughout
human history to influence health and disease.

What were your immediate reactions to the experiences and situation discussed by Dettwyler?

From this discussion can you suggest Empirical Generalizations in medical anth:??

1. Universality of disease: beliefs about ill-health are a central feature of culture.  Often these are

linked to beliefs about the origin of a much wider range of misfortune(including accidents,
interpersonal conflicts, natural disasters, crop failures, etc)
2. Methods and roles have been developed for coping with disease
3. Perceptions, knowledge, and beliefs about disease are culturally consistent.

 

1. How do the medical resources of Magnambougou compare to those available in the U.S.?  In your

experience.  What medical resources are you familiar with/do you use?
 traditional herbalists, govt run MCH center (PMI), hospital ( 20 min. away), amulets,
village maternity clinic
 
2. What are the main diseases / children people in Mali must contend with?  What about in the U.S.?

Did you contend with or have knowledge of?
malaria, hepatitis, ear infection, measles, upper resp. infect,, diarrhea, polio, PCM
(kwashiorkor/funu bana, parasites, schistosomiasis, never grow up children/ turn into
snakes, dental problems -caries, abscess, exposed roots, dental wear,, bicycle injuries,
down's syndrome, diphtheria, goiter, FLK/sere/severe malnut - ment retard., vit. A,
cholera, diphtheria tetanus,
    What are the differences and similarities?  Why do you think they exist?
 
3.  What does it mean when the author says" normal is what you are used to?"

This then leads us into the idea of how health and illness are perceived and dealt with by people.  As indicated before there are the Empirical Generalizations.  These then are the focus of the field of Med. Anth.
 

The roots of contemporary medical anthropology can be traced to three rather different sources:
 1. traditional ethnographic interest in primitive "medicine"
 2. culture and personality movement of the late 1930's and 40's
 3. international public health work after WW II

Early work:

Rivers'(1924): "Primitive" medicine is different from "modern" medicine.  World view - beliefs about
The 1950's were a time when research in medical anth grew in importance especially in the area of applied anth  - assoc. with public health.

In the 1960's Society for medical Anth formed and the label Medical Anthropology was adopted.

In 1970's Colson and Selby reviewed the literature (1971-1973) and identified 4 areas of research:

1. Medical ecology - biomed. aspects of human adaptation (Medical Ecology)

Phys. anth. approach, concerned with disease (abnormalities in the structure and or
function of organs and/or organ systems, pathological states whether or not they are culturally
recognized), epidemiological, human adaptation studies, evolutionary approach
 
2. Ethnomedicine:  focus on illness (Pathology defined in context of culture refers to a person's

perceptions and experiences of certain socially devalued states including, but not limited to disease).  Illness as a cultural category, classification systems, explanatory models, treatment strategies, compliance behavior, practitioner-patient interaction etc. ( disease vs illness in Dettwyler).
 
3.  Health Problems research: health needs of a partic. pop ( aged, teens etc), contemporary health problems

(drug addiction etc).  Often attempt to bring anthropological approach to treatment program.
 
4.   Health Care Delivery Systems: institutions, personnel, programs avail to meet health needs.  Clinical anth

- stress, urbanization, migration etc.

The biocultural approach  is a recent development and is still being discussed in the literature - many med anth -
talk about a lack of a central theory or paradigm.

Week 2:
Review:
   Medical Anthropology
      Medical ecology
      Ethnomedicine
key concepts:
       biocultural: physical & cultural:
         as a subject it lies in the overlap between the two and draws insights from both
       interact
       human history

From the Dettwyler discussion we can generate Empirical Generalizations in medical anthropology:
1. Universality of disease
2. Methods and roles have been developed for coping with disease
3. Perceptions, knowledge, and beliefs about disease are culturally consistent.
 
The roots of contemporary medical anthropology can be traced to three rather different sources:
 1. traditional ethnographic interest in primitive "medicine"
 2. culture and personality movement of the late 1930's and 40's
 3. international public health work after WW II
 
 

Definitions:
  disease
  illness
  sickness

Theoretical Models in Medical Anthropology:

1. environmental/evolutionary theory

   Adaptation Model:
   The model which we have just looked at: Evolutionary/environmental modelargues physical
environment and human adaptations to it are principal determinants of sickness and healing
2. cultural theory

 Explanatory Model: Provides explanation for 5 aspects of illness:
1.  etiology of the condition:
2.  timing and mode of onset of symptoms:
3.  The pathophysiological process involved
4.  the natural history and severity of the illness
5.  the appropriate treatments of the condition
3. political/economic theory - critical medical anthropology.

WEEK 3
The adaptation model:
Components: abiotic, biotic, cultural  (derivative of Odum)
 
Basis of Adaptation Model:
   Anthropology. interp of adaptation:
       adjustment
       fitness
       confers relative benefit -
           biological concept of fitness - reproductive advantage

 Adaptation - individual - population - community (Odum)
     evolutionary theory explains adapt as two stage process:
        1. production of variation
        2. sorting of variants by natural selection

 Mechanisms:
    Individual: graded response system:
       non genetic
       alteration of phenotype (not genotype)
               developmental acclimatization (irreversible)
       acclimatization
       acclimation
       habituation
       behavior
 
  Population: forces of evolution - changes in genetic material - or freq.

     mutation *
     natural selection *
     drift
     flow
     recombination

 Socio-cultural adaptation:

     Learning
     Plasticity
     Domains of cultural behavior and response arenas
          Economic
          Social
          Political
          Ideological

Definition of Disease
 (M & T):  Organic pathology or abnormality; impairment in ability to rally from an environmental. insult.

 (Brown & Inhorn):

set of objective, clinically identifiable symptoms environmental. perspective: disease does not exist as a thing in and of itself.  Disease is a process triggered by an interaction between a host and an environmental insult.  It is one possible outcome of the relationship between host and potential pathogen.

 Disease involves:
      interaction between

   agent (animate or inanimate proximal cause)
    host (human)
   environment
plus: biocultural response and impact of the disease

Cause of Disease:
 causation is rarely single or simple
  factors involved:
   agent characteristics
   host characteristics: age, sex, nutrition. status, stress, human-human
     interaction, contact etc. adequacy of ventilation, medical care etc.
 

Classification of agents: (Brown & Inhorn)
Genetic
Nutritional
Environmental
Psychogenic
Iatrogenic
Infectious
 virus
  bacteria
  intermediate between virus and bacteria
  fungi
  parasite
(Some researchers add a 7th: physiological - events and changes in normal life span can give rise to disease: morning sickness)
 

The biological Effects of disease (Not Covered inClass)

Using the adaptation model one of the reasons to study the effect/impact of disease is to: evaluate a population's
adaptation to its environment another is to predict the outcome of a particular stress (disease)

How do we evaluate?
 Demography: Contribute to size, structure and distribution of population
  Mortality
  life expectancy
  fertility there are a number of ways that in which disease status affects fertility: reducing fecundability;
causing sterility; extending birth interval
  growth and development

Introduce Three other perspectives/Models:
 Cultural Construction of Reality / Illness
 Political/Economic Theories/ Critical Medical Anthropology
 Interactionist/ New Synthesis
 

TOPIC FOCUS:
What are the determinants of health?
 What are the causal factors?
 What are the biological pathways through which these causal factors operate?

Why do we see differences in health status among individuals and among populations or distinct groups of
individuals?

 Why do we see changes in mortality in a society over time?
 

Resources:
 Evans et al.  Why are Some People Healthy and Others Not?
  Chapters:
   Introduction
   Producing Health, Consuming Health Care
 

The explanatory model that we are trying to develop in this class then is centered on the interactionist approach.
Focus on a broad conceptual framework which looks at the health of populations (and thus the differences among
populations) HETEROGENEITIES in POPULATION HEALTH, as being related to:

  evolutionary & social history
  stages of life cycle
  population characteristics
  sources of heterogeneities
 
 

The explanatory model that we are trying to develop in this class then is centered on the interactionist
approach.  Focus on a broad conceptual framework which looks at the health of populations (and thus
the differences among populations) HETEROGENEITIES in POPULATION HEALTH:  evolutionary &
social history
    stages of life cycle
    population characteristics
    sources of heterogeneities

Explanatory Model Includes:  Ideas about the Evolution of Human-Disease Interaction  (HUMAN
ADAPTATION)
Types of evidence/information used:
 1. Paleopathology/ Fossil Record: focus - information concerning disease
 2. Paleodemography: data: osteology, demography, coprolites, cultural evidence
 3. Ethnographic extrapolation

The fossil record: interp - some diseases were species specific , some more wide spread
 General types:
  periostitis:
  osteomyelitis:
 
Human populations and disease: Disease Profile and Transitions over time:
 Early human populations:

  env. trauma
  accidents
  biotic pathogens - most likely viral : able to survive in small groups
  reproductive

 Modern Hunting Gathering/foraging populations:
 wounds, accidents
 relatively low infant mortality
 
 Horticultural/Agricultural populations:
Researchers hypothesize a big change in the lifestyle - env and therefore disease
  infectious                        High infant mortality
  parasitic                          High birth rate
  epidemic & endemic

Contemporary Industrialized pops:
   degenerative disease
   Infectious
   environmental trauma
   lifestyle
 

Review: Huss-Ashmore: Introduction
Demographic Transition Model
Epidemiological Transition Model
Lifestyle Transition Model
Fourth World Model