What can critical medical anthropology contribute to Global Health
James Pfeiffer and Mark Nichter
- The flow of international aid from wealthier to poorer countries has increased dramatically over the last
- This is attributable in part to the efforts of health activists, including medical anthropologists, who have
rendered bare the realities of health disparities and human suffering.
- Emergent health problems range from antibiotic resistance to tobacco use to SARS and avian flu to the flow
of health professionals from developing to developed countries.
- These problems demand global solutions, challenge the internal sovereignty of nation states, and involve
new sets of actors, networks, partnerships, and transnational health initiatives.
- Many medical anthropologists have fought to keep the health and health care problems of the world’s poor
on the radar screen of wealthier nations by calling attention to issues involving both social justice and
- Anthrapologists are concerned by reports of wasteful spending, poor planning, and uncoordinated project
development, which suggest a growing anarchy on the ground in global health efforts.
- This state of anarchy is fueled by an avalanche of resources landing on neglected health systems facing
workforce shortages and crumbling infrastructure unprepared to manage this largesse, having been
weakened by two decades of macroeconomic reforms
- SAPs (structural adjustment programs), promoted by WB and IMF, also known as Washington Consensus,
also now known as PRSPs (poverty reduction stratergy papers)
- This promotion of the private sector while, public services atrophied from underinvestment, left many
national health systems in a shambles, especially in Africa but also in other resource-poor countries.
- Training institutions have been starved, health workforces cut back, salaries reduced, management systems
undermined, and some specific services either scaled back or eliminated.
- As private health services and NGOs have multiplied, they have often contributed to the “brain drain” of
health workers from public systems.
- Beyond the health sector, the push for privatization and free market reforms has in some cases stimulated
economic growth but has also deepened social inequality and insecurity. The removal of price controls, food
subsidies, and other safety nets has had important effects on health that extend beyond the health sector
- There is growing recognition of the urgent need to build or rebuild health systems, yet the increasing flow of
aid from donors continues to promote narrow interventions and specific projects. This “stove-piping” of
projects creates additional stress on government health infrastructures while providing little in the way of
- A central concern is finding the best public–private sector balance in bringing quality services equitably and
universally to poor populations.
- Some contend that new resources can most effectively be spent by avoiding inef