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Lecture 4

Lecture 4 - Global Health, Biomedicine and Medicalization - February 3.docx

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University of Toronto St. George
Tania Li

February 3, 2014. Lecture 4 – Global Health, Biomedicine and Medicalization MedicalAnthropology • Study of disease, health problems, health care systems, and theories about illness in different cultures and ethnic groups o Disease: a scientifically identified health threat o Illness: a condition of poor health perceived or felt by an individual or community o Health-care systems: beliefs, customs, specialists, techniques • Theories about causes of illness: o Personalistic disease theories: illness caused by agents such as sorcerers, witches, ghosts, or ancestral spirits o Emotionalistic disease theories: illness caused by extreme emotional experiences o Naturalistic disease theories: impersonal explanations of illness • 1. Biomedical Model o Scientific epistemology  Natural basis of illness; natural science o The human body and its functions  Claude Bernard (1813 – 1878)  An Introduction to the Study of Experimental Medicine (1865)  Homeostasis = health • Equilibrium, body in balance, constant • “Constancy of the internal environment is blah blah blah” • Concept applied to social theory; model for society as well; influenced Durkheim (father of sociology) o Epidemiology  Illness in populations/demography  Distribution of diseases • 2. Cultural – Interpretive Model o Transcending the limits of the biomedical model o Examining the “cultural” basis of illness and health o Phenomenology  Why do things happen to particular people at particular times  Form of philosophy that analyses subjectivity and personal experience o Gender aspect; important to healing in some cultures  What if women and men aren’t supposed to touch each other (publicly, if strangers) and all doctors are men, etc. • 3. Critical MedicalAnthropology Model o Does not reject biomedicine; recognizes its advances o Looks at how health can be related to larger factors o Health and social inequality  Different levels of access to different resources and treatments o Health and capitalism o Medicalization  Medicalizing various issues and illnesses (like mental issues such as sex addiction or hoarding) Shamanism • Universal mode of healing • Doctor, priest, social worker, mystic • Contact with spirit world o Heal “soul loss”; go into spirit world for cures • Same curing odds as MDs • Shared meaning between patient and healer is essential o Claude-Levi Strauss emphasised this • Anthropologists credited viability of shamanistic power as early as 19 century while scientific community was still rejecting their relevance as late as the 80s Paul Farmer: An Anthropology of Structural Violence • What is/was: o Structural violence o Liberation theology  60s and 70s radical political attention on LatinAmerica because of fascist dictatorships predominant in the area at the time; Catholic Church had been greatest defender of people in the area  Mixing of Marxist principles with Catholic Church doctrine; liberating the poor o Impact of “resistance” o Effects of specialization in social sciences o The role of France in Haitian history  Huge amount of French wealth came from exploiting Haiti andAfrican slaves o The history of US involvement  Diplomatic and economic embargo on Haiti; became an assembly line of manufactured US goods o Duvalier  Family that ran Haiti from 1957 to  Wealthy as fuck  Dictatorship; brutal regime; ruled by force; reputed to have killed 50 to 100 000 people during their regime  Also used voodoo as an instrument of state oppression; secret police thought to be powerful voodoo priests; Ton Ton? o Aristide  First democratically elected president 1991  Catholic priest: liberation theologian  Assassination attempts o AIDS theory  AIDS came from Haiti  In actuality it was introduced their through sex tourism industry FROM US o TB and Haitian folk belief  Thought it was caused by evil spirits; program implemented where population received medicine and they adopted a more naturalistic approach to explain sickness o Critique of structural violence?  Wacquant: structural violence fails to distinguish between different types of violence; how exactly are people living within the Western world complicit to structural violence Paul Farmer: Intelligent Design • Partners in Health (PiH) o Jim Yong Kim? • The first principle of the emerging global health movement o Don’t copy mainstream programs; what everybody else is doing; the United Nations; proceed from different principles • Accompagnateurs o Concept developed in Haiti o Community health workers; part of the poor o Concerned with how to GET medication to people; particularly people in hard to reach areas; simple logistical issues • The problem with NGOs o 60 000 AIDS NGOs at the time of writing this o Bureaucracy and high paying jobs; resources are directed to this as opposed to people who REALLY need them • Capping o Linked with neoliberal policy o Cap on health expenditure or it will be too costly o Farmer argues the best investment you can make is on healthcare expenditure; how you put people on the road to independence and autonomy • Stove-piping o Garret says that all the money that became available for fundingAIDS research and treatment was at a detriment to the rest of healthcare;AIDS became the celebrity disease that funneled funding away from other programs and diseases o Farmer says there ISN’T other programs;AIDS funding is important because you need to get the funding where you can get it and then morph what it is directed
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