ANT208 Midterm Notes illustrate the underlying causes of variation
Anthropological Perspectives on Health or similarities.
and Illness • Holism is the idea that natural systems
(physical, biological, chemical, social,
What is anthropology? economic, mental, linguistic, etc.) and their
• discipline that investigates the nature that properties should be viewed as wholes, not
causes of human variation and those as collections of parts.
aspects of life that are common to all of • Not one factor contribute the most
humanity. It is the study of people . difference in response to disease, it depends
• Franz Boas a geographic worker in the Arctic on the environment and different
advocated systematic and long-term characteristics.
ﬁeldwork as a way of understanding people • Comparative analysis highlights the way
of different culture. He includes bio, different combo of factors affect health.
language, cultural history and archeological
excavations NOT just behavior. The Cultural Concept
• Boas came up with the concept of cultural • Culture is the beliefs, values, practices and
relativism which means not to judge one traditions of a group. These traditions of
culture to another superior one but rather behavior include subsistence and economic
made sense of the culture on their terms. practices, social organization, rituals, diets,
• Four ﬁelds in anthropology- Linguistic and healing practices.
anthropology; archaeology; biological • Culture is not static, its dynamic and
anthropology; cultural anthropology. changing in a historical and geological
The Development of Medical Anthropology • Ethnographic ﬁeldwork - (Ethnography) is
• During WW2 growing employment of the systematics description if human culture
anthropologists to gather info on health and by doing ﬁeldwork in a society for long-term.
nutrition of populations in the US. • Participation-observation- the participation
• Creation of World Health Organization in in, yet detached observation of a group’s
1948, anthropologists were hired to break behaviors, giving an inside and outside view.
down cultural barriers. • Insider view is called Emic perspective and
• George Foster, a founding ﬁgure, would use accounts from a member of that
demonstrated the utility of anthological group.
knowledge to enhance health intervention. • Etic viewpoint is an outside view observing
• Medical Anthropology is centered around 2 behavior as from a distance and with no
things: ethnomedicine and international previous knowledge.
What is Medical Anthropology? • It considers the social, ecological, and
• Is the study of health, illness, healthcare, biological aspects of health issues and they
and related topics from broad interact with populations.
anthropological perspectives. • Bioculture analysis is inherited historical and
• It investigates differences in health and seeking the roots of cultural behavior.
disease experienced by using cross- • It considers the body as a starting point but
cultural approach, comparing and not the ending point like biomedicine
contrasting sociocultrual situations to • Biomedicine developed 18th C in europe
and views disease as having unique biological causes within the body like individual to his or her experience,
microorganisms or cells growth. The body is cultural orientation and social
the only “environment” for understanding the environment.
• Anthropology started as colonialism began Sickness
and studying other people turned from being I. Sick role- Talcott Parson said that it
really racist to cultural relativism. means there is a socially recognized set
of expectations for sick individuals.
What is Health? II. Requires recognition- to take on a sick
• According the the WHO, health is a state of role one must have a disease thats
complete social, psychological, and physical recognized as legitimate , like a doctors
• There is variation in what constitutes III. Can be associated with stigma - Susan
healthiness within populations and well- said people with cancer sometimes get
being like body fat or blood count, thus this shunned by relatives as if it was an
deﬁnition can’t be universal. infectious disease.
• Health and appropriate measures of well- • Social Integration, a term Lisa Berkam
being are culturally speciﬁc coined that said relative risk of dying
increased as level of social support declined
Distinctions between these 3 factors that are for both genders.
often interchangeable within populations:
Disease refers to the physiological alterations The Locus of Health: The Body and Society
that impair functions in some way. • Hughes and Lock said there are 3 bodies to
1. Derived from biomedical science consider in analysis of health and
2. Injury ; infection(derived from disease: the individual body, social body,
microorganisms); malnutrition(Lack and the body politics.
of food - protein-energy malnutrition • Individual body (self) is focused in Western
PEM ). ; genetic (sexual biomedicine as the sole locus of disease
reproduction, mutations); • Social body is the physical body and the
chronic(from genetic factors but social world of that person.
result of long-term behaviors like • Body politics is the way which social and
heart disease, cancer); political forces control bodies in a society.
psychological or behavioral • Medicalization is deﬁne a condition as a
Illness is the subjective experience of disease or in need of medical surveillance,
symptoms and suffering like pregnancy and childbirth.
1. motivates health-seeking behavior
2. Arthur came up with explanatory Biological/ Medical Normalcy
model- individuals construct or • Distinction b/w biocultural and biomedical
“make sense” of their experience of perspectives on disease.
maladies, describing them as • Both take the focus on the body as the
illness narratives. starting point but the endpoint is not the body
3. Needs to be a close articulation for biocultural.
between illness and diagnosis of • Needed to understand disease **
disease in therapeutic encounters. • Need also to establish a relationship
4. Illness is a more holistic concept between traits and increased/decreased
than disease , as it links the risks of disease • State versus range **
• Biomedical perspective versus range ** Descriptive Epidemiology
• Proximate cause means nearby and in this • Prevalence: The number or proportion of
case it refers to the immediate cause of cases or events or conditions in a given
some psychological disruption, like a population
bacteria is the proximate cause of a fever. • Incidence: number of new cases in a given
• Ultimate causes of disease is what time period/ given population
biocultural analysis uses which is to look at • Epidemic: the occurrence of more cases of
the individual in its environment, regional, a disease in a particular area or among a
and national condition to how it shaped their particular population in a given period of time
risk of disease. • Pandemic :an epidemic which occurs over a
• In general the WHO standards are lower very wide area
than the CDC standards, especially from • Endemic: the constant presence of a disease
ages 6 months to 32 months in growth size or condition, within a particular geographic
charts. area or population group
• CDC standards are for “optimal” growth • Morbidity: any departure, subjective or
but in fact US babies are over-nourished. objective, from a state of well-‐being
• Biological normalcy- the assumption that • Mortality: death
all human biologies resemble those of one • Mortality Rate: A measure of the frequency
group. Historically European biology is of occurrence of death in a deﬁned
considered “normal” for the species, hence population during a speciﬁed interval of time
the “normal” type of biology. Others are
hence “abnormal” Healers and Healing (chapter 3)
• Biological normalcy can come to be • Healing: to restore to health
applied to what appear to be “abnormal • healing takes time like a bone fracture but
states” or no known sure within that given humans intervene by putting splints or cast
society. to fasten healing time.
• Conversely abnormality can come to be • Culture strongly inﬂuences healing
applied to what are in fact normal states • Different cultures have different healing
• Medicalization or pathologization ( The roles, but all cultures specify healing roles
treatment of a health or behavior condition that are recognized and legitimized by
as if it were a medical condition)** members.
• Race is historically used to describe • Recognize different criteria for becoming a
biological distinct types of humans, now healer
often used to refer to a group that is socially Medical Pluralism
marked as biologically different. These • the existence of multiple healing systems
differences are due to genetic variation. within a culture
• Common in state-level societies
Epidemiology • Persistence of alternative medicines
• Study of the distribution and determinants of depends upon multiple factors- Cultural
disease (infectious or not) in a population beliefs; relationship to other traditions;
and the application of this to health effectiveness, ability to complement
problems. biomedical treatments.
• Descriptive epidemiology: who, what, • Views of the body and disease causation
where, when relate directly to the diagnosis of health
• Analytic epidemiology: how and why conditions. Alternative and Complementary Medicines • Placebo effect-a beneﬁcial effect, produced
• Alternative medicine refers to medical by a placebo drug or treatment, that cannot
practices that are undertaken to replace be attributed to the properties of the placebo
standard biomedical practice itself, and must therefore be due to the
• Complementary medicines are those used patient's belief in that treatment.
in conjunction with standard biomedical • nocebo effect-harmless substance that
practice creates harmful effects in a patient who
• ethnocentrism and ethnomedicocentric bias takes it. The nocebo effect is the negative
because it views biomedicine as superior if reaction experienced by a patient who
other medicine is seen as “alternative receives it = sickness or death.
• Ethnopharmacology- the study of • Evidence-based medicine- intellectual
indigenous medicines. movement within biomedicine initiated in
Alternative Medicines Today 1990s that advocated that patient care be
• Acupuncture- A traditional Chinese based explicitly on the best clinical research
medicine based on the insertion id needles evidence, and the patient has the right to
massages or the application of heat at make their own clinical decisions.
speciﬁc point of the body. • Differential diagnosis/decision-making
• Chiropractic- A clinical system developed at trees (EBM) illustrates the foundation of
the 19th C in US, which is based off of experience and systematic research, and
manual manipulation of the muscuoloskeletal peer review, on which biomedical practices
system and the nerve system and the effects should be based on. Bottom is Expert
of these disorders in general health. opinion and top is systematic reviews=
• Navajo Medicine- include 4 primary quality of evidence + as u go up the
avenues - biomedicine, traditional healing, pyramid.
Native American Church healing, and • Existence of such efforts suggest a response
Christian healing. to non-systematic nature of such practices
Biomedicine as Cultural System • Becoming a h’iloletik involves: visitation
• Predominant ethnomedical system of West during a dream(3 dreams summoned before
• Has a lengthy history the gods), a potential h’iloletik is identiﬁed by
• Local/global inﬂuence has grown over time - another h’iloletik, and when a person is
Why?*** having a seizure means they are
• Person’s organs can be harvested if the predisposed to becoming h’iloletik.
other person is declared brain dead and • White coat ceremony- for US medical
approval from the dead person or their students, promoted by Arnold Gold
family. Foundation, self-contuse passage rite
• Brain dead- diagnosed when a person is in
a coma, unable to breathe on their own, no Evolution On Health
response to stimuli in the head or pupils, or • Evolutionary theory is a set if well-
swallowing and no electrical activity to the supported hypothesis that explains how
brain. biological systems came about and how they
• Placebo-a harmless pill, medicine, or changed over time, and how they
procedure prescribed more for the maintained.
psychological beneﬁt to the patient than for • Charles Darwin provided natural selection-
any physiological effect explain how organisms acquired traits and how closely related they are to the reproduction by working on the species
environment. inheritable genetics, DNA.
• Evolution- changes in the characteristics of • sort term adaptability is called physiological
a population over time. Natural selection is a plasticity.
mechanism of evolution.
• Evolutionary Medicine, Design, Strategy **** Recognizing adaptations:
• Much of concern is oriented to the question 1) trait is a variation on an earlier form;
of what we are NOT adapted for 2) trait is heritable;
• mismatch conditions*** 3) trait enhances reproductive success
• Adaptation is a trait the confers some Implications of adaptations
survival or reproductive advantage. • context-speciﬁc or environment of
• Adaptations are measured in ﬁtness, evolutionary adaptation ****
deﬁned as reproductive success. • Context speciﬁc***
• Humans use health indexes to evaluate • Involve trade-offs- cost and beneﬁts from
their ﬁtness. adaptation to genes, or short term
• Selective forces are environmental factors alterations, or behavioral change.
that pose threats to the survival and • Maximize ﬁtness, not health***
reproductive and immediate danger of their
health and wellbeing. Adaptationism
• View that most traits are “optimal
Natural Selection adaptations”
1. Constitutes to the Variation within a • Constraints on variation?
population and b/w populations • Species may be successful in but poorly
2. Many variations are genetically heritable, adapted to their environment
and must be inherited to be acted upon
3. Organisms compete for limited resources, Behavioral Adaptability
thus ﬁtness of species depend on their • Particularly important for humans , since we
traits and how well its suited for the are large brained species, cognitively astute.
environment. • Variation in behavioral adaptations may be
4) Natural selection isn’t random, differential evident in:cultural traditions and healing
reproductive traditions. Genes aren’t transferred quickly
success = ﬁtness and natural selection vs behaviors that can be across
works on reproductive success. individuals and populations.
5) Only mutations are random, evolution and • 2 dimensions of biocultural analysis: local
natural selection are nonrandom. adaptive responses to health challenges and
• Survival and successful reproduction are the nature of those speciﬁc challenges and
more likely for some than others how they became threats to health in a
OR Natural Selection is population.
More favorable traits are more successful in • Humans are niche constructors***
1) surviving; • Present additional challenges**
2) reproducing; and are thus Cultural Approaches in Medical Anthro
3) naturally selected over time • Critical Medical Anthropology- an analysis
• Fitness relative ability of an organism to if how power differentially impacts health
survive and transmit its genes • Paul Farmer coined “ Structural Violence” -
• Adaptation, useful feature, shaped by natural how the social machinery of oppression is
selection, that promotes survival and embodies in adverse health outcomes and are quite common
needless suffering amongst the poor. 1. Epidemiological problems:
• There are clear positive correlation's with confounding factors- when suspected dietary
life expectancy and per capita wealth. factors is associated w/ others that isn’t
• Ethnomedical Systems- healing traditions considered i.e.. red wine consumption
of a given culture. -Duplicate ﬁndings of some studies- make
• All healing traditions have elements of same errors
common: theories of etiology (disease -A lot of dietary studies based off
causation), diagnostic criteria, therapeutic questionnaire data i.e.. how much they
measures, formalized interactions b/w eat/ amt of alcohol – ppl underestimate
patient and healers. Healing traditions seen amount of calorie intake
in small scale societies. -Ecological studies- doing diff studies in
• Healing traditions have come to be Pluralistic different places, different dietary
meaning using elements of various traditions factors, medical practices
for their health.
Interpretive Approaches to Illness and Mechanistic models are highly
Suffering oversimpliﬁed- portray food consumption
• Interpretive approach- to understand and digestion as mechanistic processes
medical system, health and disease strictly -It is more complicate- enzymes , co enzymes
within their cultural context, Clifford Geertz. etc
• 6 stages with a patient and a doctor include: -Studies based off lab rats- complicate
opening, presenting complaint, examination, validity in comparison to humans
diagnosis, treatment, and closing application of study
• Applied Medical Anthropology- a branch 3.Intervention studies:
of medical anthro that involves applying the -Ie. lifestyle counseling, dietary counseling –
principles and enthographic knowledge random control
derived from anthropological scholarship to -Cant do lifestyle study through double-blind
the design or implementation of health studies lifestyle change ( they’re aware of It)
policies and intervention.
Chapter 4 -Bias which are derived from non academic
Diet and Nutrition in Health factors
Diet & lifestyle issues- lifestyle ie. exercise -Discover publication bias through meta-
people are more active now than they analysis – studies in the studies
were before however obesity has increased and try to ﬁnd inconsistent trend
Biomedicine and nutrition
Biomedicine- concern w/ interventions, 5.Preconceived Ideas
mechanistic view of health – surgery / - Ideas ppl have in head but don’t know why-
pharmaceutical intervention impacts way studies are done
Bicultural: viewing all these things from
bunch of disciplinary distance than just 6.Citation bias:
mechanistic account from biomedicine -Readers don’t have time to follow all
Paradigms: organized philosophies guides publications studies , inﬂuential
Field like social science, no uniﬁed paradigms studies become more inﬂuential etc – end up
Fractured discipline where these changes being more cited -Beneﬁt of omega 3 fatty acids -Lyon diet heart study: lower risk of morbidity
-Drug studies tend to get more played out in -Type 2 diabetes, hypertension , stroke etc,
media than nutritional common
studies- prob from pharm marketing -Better diet than av. western diet but not that
Part 2: Popular Dietary Ideas
High ﬁbre diets: Omega-3 enriched diets:
-Often paired with low fat diets Compare Greenland inuit- better health
Western med history- ﬁbre in concern w/ outcome
“autointoxication” physician paradigm- -High quantities of O3FA may not be good,
give to speed up bowels, emerged in 1970s. problem with clotting
-Towell and Burkitt- found in clinics that
ppl there have no western diseases – CVD, Sodium Restriction:
cancer, obesity etc. -Importance of salt in western society
-Lancet (1989) – intervention study- mortality 75% of salt in our diet comes from processed
over time, group who rec’d ﬁbre advice- more sources ie. bread, crackers etc .
likely to die, showing ﬁbre may not be as -Most epidemiology studies weak
beneﬁcial relationship w/ blood pressure
-Ppl who prefer whole wheat= Less CVD -Ppl who eat a lot of salt, processed foods , or
High levels of Phytic acid – binds to minerals lots potassium but less sodium
in digestive tract , excrete vitamins. Vitamins and Minerals:
-Wheat bran interferes with absorption of
vitamins and minerals negative Ca Carbohydrate restriction:
balance, decreased iron absorption Glycemic index: how fast carbs break down
Irish nutritional survey- increased whole into blood sugar
wheat, rickets increased. Rickets (softening of Carb restriction better for ppl who are obese
bones) , bone density decreased Cross culturally
-Diets high in wheat bran, lead to development
of rickets Red wine:
Beneﬁt of consuming red wine- “French
Low fat diet: paradox” highest amt of sat.fat in western
Fruits and vegetables: world, but lowest levels of coronary heart
We believe that consumption of fruits/veg disease
provide nutrients – high water content Ethanol vs. red wine= bestows same beneﬁt
provide satiety- less likely to eat more as red wine up to 62% lower risk but
How do we get ppl to eat more fruits/veg impact on total mortality not less b/c increase
risk of accidents
Calorie Restriction: Resveratol- compound in red wine- beneﬁcial
-Increased life expectancy in other animals in some way, lots of studies in lab rats
Improved cardiovascular risk factors in non- w/ high fat glucose diets have high lifespan but
human primates the amt you’d have to have to get
-Don’t eat deserts, sodas etc, but eat nutr. that amt is 700 bottles per day
Dense foods like yams and beans etc
Part III: Hominin Diets
Mediterranean diets: 1.Bipedalism
-Lower rates of heart disease Developed bipedalism- frugivory diet- eat nothing but fruit. Everyone in lineage was increased CO2 in atmosphere, affect ability
consuming fruit, believe bc forest land to grow stuff
depleting developed Able to venture out into -Requires lots of land
savanna lands to acquire new sources of -Agriculturalists wean child. At ages 1-2, allow
food to have more children faster adapt to
2. Transition away from frugivory lifestyle make hard to go back to h&g after
Stopped relying exclusively on fruit adapt to agriculture. great for
Australopiths – small canines (for tearing into increase pop, but Decrease in health
fruit) robust teeth – grinding USOs -Main dietary changes from H&G to
underground storage organs – advantage- agriculture:
high storage of food foraging for -Decline in nutritional quality b/c narrower
food is reliable range of foods H&G had diverse diet
Au. Africanus: robust jaw- larger muscles -Decrease in animal food
Crops vulnerable to drought and disease
3. Larger Brains: Dental health :
Homo Habilis- ﬁrst hominid evidence in meat -Increase in carbs in diet
consumption –see in dentition, smaller
cheek teeth Changes in cavities, lesions and tooth loss
Impotysny points- hunting and gathering – smaller bits = lots more in farmer than H&G
evolutionary adaptation for modern Smaller posterior teeth b/c increase in
humans anatomy cavities
Increased brain size correlates w/ more Hyperplasia: enamel defects
nutrient dense food. Death of enamel producing cells- weakened
Dental chipping- Decrease in agriculturalist b/c
-We have small colon b/c we absorb more eating more soft foods
nutrients via SI Smaller jaws, decrease in robusticity and
size = musculature so vanished over time
Teeth crowding- smaller jaw malocclusion
Hunting and gathering
Meat is important- high fat food Want edge-to- edge bites
Dietary quality correlates inversely w/ body Growth rate- less nutritional diets, become
Gathering=gender division of labour Children grow less- lower lvl of stature
Hunting= gain of calories Stature declines w/ agricultural adaptation
Osteoarthritis- disorder of mech deign of
Adaptation- working tgt w/ division of labour
Ancestral H&G collect fruit , leaves, roots, skeletal articulations=Loss of bone joint
seeds etc surfaces
¼ or less of western diet •Humans require the same amount of
High concentration of vit and min, nutrients nutrients and various diets meet these
No grains, beans, dairy, reﬁned fats and needs= omnivores= no “ideal diet”
A certain number of calories are needed to
stay alive, 20% goes to your brain.
4. Agricultural recolution •Energy is derived from 2 main sources:
Dietary change- intensive cultivation of crop carbs in plant foods and fat in animals
-Thought that agriculture was greatest human •Protein is needed because of amino acids,
adaptation and 9 are essential amino acids.
-Agricultural revolution- enviro changes, • Fatty acids are needed too, linoleic acid, • Thus having a lot of Vitamin C to prevent
used to make steroid hormones. common cold isn't effective since its
• Macronutrients are carbs, protein and fat excreted out.
and micronutrients are vitamins and • In response to low nutrients there are