Medical Anthropology - Applied Medical Anthropology

Applied Medical Anthropology

In the United States, Canada, Mexico and Brazil, collaboration between anthropology and medicine was initially concerned with implementing community health programs among ethnic and cultural minorities and with the qualitative and ethnographic evaluation of health institutions (hospitals and mental hospitals) and primary care services. Regarding the community health programs, the intention was to resolve the problems of establishing these services for a complex mosaic of ethnic groups. The ethnographic evaluation involved analyzing the interclass conflicts within the institutions which had an undesirable effect on their administrative reorganization and their institutional objectives, particularly those conflicts among doctors, nurses, auxiliary staff and administrative staff. The ethnographic reports show that interclass crises directly affected therapeutic criteria and care of the ill. They also contributed new methodological criteria for evaluating the new institutions resulting from the reforms as well as experimental care techniques such as therapeutic communities.

The ethnographic evidence supported criticisms of institutional custodialism and contributed decisively to policies of deinstitutionalizing psychiatric and social care in general and led to, in some countries such as Italy, a rethink of the guidelines on education and promoting health.

The empirical answers to these questions led to anthropologists being involved in many areas. These included: developing international and community health programs in developing countries; evaluating the influence of social and cultural variables in the epidemiology of certain forms of psychiatric pathology (transcultural psychiatry); studying cultural resistance to innovation in therapeutic and care practices; analysing healing practices toward immigrants; and studying traditional healers, folk healers and empirical midwives who may be reinvented as health workers (the so-called barefoot doctors).

Also, since the 1960s, biomedicine in developed countries has been faced by a series of problems which demand that we inspect the (unfortunately-named) predisposing social or cultural factors, which have been reduced to mere variables in quantitative protocols and subordinated to causal biological or genetic interpretations. Among these the following are of particular note:

a) The transition between a dominant system designed for acute infectious pathology to a system designed for chromic degenerative pathology without any specific etiological therapy. b) The emergence of the need to develop long term treatment mechanisms and strategies, as opposed to incisive therapeutic treatments. c) The influence of concepts such as quality of life in relation to classic biomedical therapeutic criteria.

Added to these are the problems associated with implementing community health mechanisms. These problems are perceived initially as tools for fighting against unequal access to health services. However, once a comprehensive service is available to the public, new problems emerge out of ethnic, cultural or religious differences, or from differences between age groups, genders or social classes.

If implementing community care mechanisms gives rise to one set of problems, then a whole new set of problems also arises when these same mechanisms are dismantled and the responsibilities which they once assumed are placed back on the shoulders of individual members of society.

In all these fields, local and qualitative ethnographic research is indispensable for understanding the way patients and their social networks incorporate knowledge on health and illness when their experience is nuanced by complex cultural influences. These influences result from the nature of social relations in advanced societies and from the influence of social communication media, especially audiovisual media and advertising.