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University of Toronto Scarborough
Health Studies
Rhan- Ju Song

HLTC05 –Social Determinants of Health Lecture 2: Bio-cultural Perspective on Health –Critical Medical Anthropology Tuesday, September 18, 2012 Quiz # 1: Socioeconomic status can include factors such as: a) Education and employment b) Income and housing type c) All of the above d) None of the above Anthropology’s Contributions to Epidemiology  Recognizes importance of culture, views about medicine and medical care (healing), which often do not reflect the Western biomedical paradigm  Recognition that individual humans are active participants in defining, treating and coping with disease o Focus on the individual rather than the group, what that individual does within the society o Active participants in the choices we make  Recognition that “causes” of human disease are culturally defined (not purely objective) o Different cultures have different ways to define disease o Defining illness is not objective  Recognizes how a culture’s response to disease changes when physical or social environment changes; greater stress (whether physiological, psychosocial) = greater susceptibility to pathogens and disease o How they cope and treat diseases in terms of as an individual or the group  Importance of historical contingency o Things that happened in your parents’ and grandparents’ in terms of health, can play a role in your current health whether it be a physiological or psychosocial Who is included? Who is excluded? Why?  Interest in who is in included and excluded in the analysis and why o For example: Why they’re are not part of the government statistics Critical Medical Anthropology  Critical framework o Group factors for ill health in society o Interested in biology and anthropology, but also looks at political economy and how it ties in with biology  Political economy of health and health care (effects of social inequality on human health)  (Anthropological perspective on political economy is focused on the production and exchange of goods, influences of government & capitalism on life history)  Political-Economic of Health: o i.e., ways in which health services are differentially allocated based on wealth; ways in which policy impacts health and delivery of health services  A critical approach seeks to uncover hidden causes of poor health - especially related to capitalism and neoliberal economics - while examining health structures on a macro and micro level o Not focused on or thinking about for instance; malaria being a disease and why the host (mosquito) had it in the first place o Interested in the bigger and smaller pictures of that society “System-Challenging Praxis” (Singer)  Goal of CMA: o Anthropologists should act and engage: challenge larger structures with the goal of meaningful social change  System-challenging praxis requires rooting out the origins of social inequity and exposing the relationship between social inequity and living and working conditions o Affect change in terms of government policy, for example o Many societies today are not equal in terms of social equality Diagram of Ancient Egypt  How society was divided  Pharaoh at top and farmers at the bottom  Another example was the caste system in Indian o People born into a specific level o Born as a farmer, future generations of your family will be considered to be a group of ‘farmers’ Structural Violence  A term broadly describing unjust, aberrant and corrupt social structures characterized by poverty and extensive social inequality, including racism and gender inequality  Structural violence is violence exerted systematically - that is, indirectly (and directly) - by everyone who belongs to a certain social order (Farmer 2004)  How society impose violence directly/indirectly: o Income inequality (and not be impoverished) o Political inequality o Social inequality o Gender inequality o Impoverishment o Social discrimination o Racism Critiques of Critical Medical Anthropology  Ecological MA: CMA ignores bio- & ecological factors o Still vital to know the responsible organisms, mode of transmission, progression of disease, etc. o Poverty plays a causal role, but the ‘selective agent’ remains natural  Interpretive MA (which questions culturally derived frameworks of meaning that are brought to bear on the experience of sickness) critique: o CMA depersonalizes the subject matter; too focused on analysis of social systems and things, while neglecting the particular, the existential, the subjective content of illness, suffering and healing as lived events and experiences (Scheper-Hughes) Social Inequality  Armelagos et al. 2005: 756:  “Concept of macroparasitism (McNeill 1976) to understand the changing pattern of inequality: when organisms appropriate others as continuing sources of food and energy, we can characterize that relationship as parasitism”  “Social stratification within societies and between them is an evolutionary strategy that we consider ‘‘macroparasitism’’ (Brown, 1987; McNeill, 1976) Epidemiological Transitions (Omran 1977) and Inequality  Transitions in the past 10-15 thousand years  Table 14.5 Emergence and growth of the major infectious diseases as a function of human population size (1970)  Mammalian – 10 thousand years ago o We were hunter and gatherers o Diseases:  Zoonotic, worms, bacteria, viral disease, viruses  10 000  Horticulturalist o Settled village o Didn’t move around o Less zoonotic disease o Intense farming o Domesticated plants/animals  5500. Intensive agriculture o A few cities > 100 00, mostly villages The First Epidemiological Transition  Fertile crescent (modern day Iraq) 10-12 thousand years ago o Agriculture began  Went from nomadic to settled village that can control food supply by harvesting grains grown in large numbers and become a surplus, the surplus causes increase in population such as more child births  Agriculture we see great shift in food supply and also in our demography because the population exploded Demographic Transition  Pathogens affect living condition Agriculture, Sedentism, and Population Increase  Increased population density results in (what agriculture brought to society): 1. Occupational stratification 2. Altered land use patterns 3. Contamination of water sources 4. Within-group exposure to pathogenic microorganisms 5. Increase between- and within-group heterogeneity in susceptibility or resistance to infectious agents 6. Increased group interactions (more frequently, longer periods) 7. Encroachment of human habitation (and agricultural fields) to wilderness perimeters, thus increasing contact with vectors of zoonotic viruses and bacteria (i.e., from domesticated animals) Social Classes with Differential Access to Resources  Image of farming  New jobs in charge or irrigation, where they put a canal or ditch, overseeing workers, new social status, more complex jobs with different social status in terms of who’s on top, who harvests, who stores it, who deals with animals  Large scale agriculture leads to social inequality  Change of different levels of people who have different access to resources such as water or food resources or even health care Agriculture  We see changes in: Demographic, Social, Ecological Change, and Increased Infectious Disease Risk Dental Health  Change in health status due to transition into agriculture from hunting and gathering lead people to have: o More starch and processed food o More cavities o Lose of teeth o Infections in the roots of their teeth that ate away their tooth and gums Anemia  Iron deficiency  Lots of starch and grains (weed and corn) causes inadequate iron intake o Happened a lot in farmers, iron deficient due to poor dental hygiene, o Become anemic if you have a lot of infectious disease which decrease iron deficiency, specifically in children dealing with all these factors that can promote anemia  Agriculture transition was not beneficial for our health  Porotic hyperostosis  Cribra orbitalia Growth and Development  Enamel hypoplasia: o HORIZONTAL lines on the teeth show disruptions in your development and at what age o Growth disruption leads to lines on your teeth o Can track when these disruptions and when they occurred based on studying their teeth  Stature o Difference in life history in two boy with the same age affected by disease, development, disruptions in their growth and their development o One boy might be taller than the other and both be the same age Infectious Diseases  TB Syphilis Leprosy and many others not evident in hard tissues (measles, influenza, smallpox, etc.)  Increase in infectious disease overall due to more people and due to inequality  Leprosy leads to deformation and loss of teeth  Infectious disease led to mass mortality Urbanization  Accompanied by disease: o Numerous epidemics in Europe from 16th century onward (influenza, plague, tuberculosis, smallpox, measles, cholera) o Intricately tied to undernutrition, SES, hygiene o Population aggregation o Trade (economic development) and travel Teotihuacan  Earliest city in Mesoamerica  150 B.C. – 750 A.D.  Was sixth largest city in the world at 722 after Constantine, Changan, Loyang, Ctesiphon, and Alexandria Figure 1.1 Cultural Evolution, Health and Inequality  Time vs. levels of health over time  Look at horizontal line, our ability to meet basic health need plummeted due to social inequality, dietary issues  Urbanization: o Best social status o Wealth and resources in smaller areas o Greater number of elites, greater divergent and how the small group is doing The Second Epidemiological Transition (Omran)  Greater inequality over time; occurred post WWII  Evolution of public health  able to treat infe
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