IV Conclusion Is Cholera a Signpost
More than 150 years ago, in 1848, an epidemic of typhus was raging in Upper Silesia, part of what is now Poland. In Chapter 2, I mentioned Rudolf Virchow, the cellular pathologist and political progressive, who wrote at that time that e pidemics are like sign-posts from which the statesman can read that there is a national disturbance that not even careless politics can overlook Virchow 1848 1985 . Medical anthropology focuses our attention on the interplay between disease as an outcome of...
I Patterns of Disease and Patterns of Culture
Human reactions to disease also create patterns. Imagine a Peruvian fisherman who ate contaminated shellfish in January 1991, contracted cholera, and died. Individuals in his town gathered to wash the body and to mourn the deceased. They drank and ate together, finding companionship. But some of the participants were exposed to cholera in the shared water. Their travels after the funeral changed the likelihood of exposure for many others, and the number of people they saw and the activities...
III Applying an Integrated CulturalEpidemiological Approach
Culture influences the patterning of disease through many pathways, ranging from who is counted to what is noticed to where people obtain help for suffering. Its influence can be seen in the varying ways parents try to protect their children from the common cold, as well as in the differential power of epidemiology across nations. More complete understanding of the range of cultural influences on disease patterning will come as more frequent and profound interactions take place between the...
I Scientific Attention to the Social Environment in the Nineteenth Century
The origins of exchanges between anthropologists and epidemiologists go back at least to the mid-nineteenth century Trostle 1986a . Both disciplines were founded at about that time and developed in an environment characterized by rapid social change with dramatic consequences for human health. Factory production fostered urban migration and hazardous working conditions, while scientists and social activists, attuned to the upheaval, examined the impact of these changes on human health. In...
Sociocultural History of Disease
Exposure Epidemic onset Crisis recognition Intervention - - Ecological susceptibility Individual amp social risk Care-seeking Recovery or recrimination Figure 5.3. A sociocultural history of disease. The cholera outbreak also provides us an opportunity to examine the distribution and use of a society's resources. When it returned to Latin America as a visitor from a prior century, it spread rapidly within poor urban neighborhoods and stigmatized populations. It was a grim reminder and...
IV Data Collection and the Challenges of Human Attention
Not all measurement error can be attributed to respondent or interviewer manipulation, or to what sociologist Erving Goffman aptly called the presentation of self in everyday life. Humans simply do not measure some things very well, and their memory of incidents, dates, and faces often is exaggerated. The most public example of this problem can be seen in the controversies over the accuracy of eyewitness identifications of criminals when these were later compared with DNA analyses. A high...
III Aspects of the Category Person
Many different population attributes are categorized under the category person. The most obvious of these are age and sex, both associated with a wide range of illnesses. Other components of human existence classified under the category person include aspects of social position occupation, wealth, education , human behaviors that increase or reduce health, and physical attributes relevant to health status nutritional status, height and weight, blood pressure . More recently, social...
II Epidemiology and Medical Anthropology in Collaboration
A. Returning to Social Medicine A South African Experiment One such experiment in constructing a national health service began in South Africa in the late 1930s, culminating in the founding of the Pholela also spelled Polela Health Center in 1940 and the Institute of Family and Community Health IFCH in 1945. Pholela was a small rural clinic where an interdisciplinary team of clinicians, epidemiologists, and health workers first worked out the ideas of community health care used over the next...
II Epidemiology and Medical Anthropology
Both epidemiology and medical anthropology are scientific disciplines that search for patterns of disease and behavior. They both have humanity at their core. The disciplines are separated by history and tradition -epidemiology tends to be statistical and quantitative, anthropology textual and qualitative, but this book brings them together. My vision of an integrated and interdisciplinary dialogue has been created, and is shared, by many like-minded anthropologists and epidemiologists who...
III Cholera in Latin America A Sociocultural History of Disease
Cholera has spread to large portions of the world seven times since the first decade of the nineteenth century, in pervasive epidemics called pandemics. During the present seventh pandemic two major types of cholera are circulating in the world, Classic and El Tor, each with different levels of virulence probability of infection given exposure . Cholera returned to Latin America in the form of the El Tor type in January 1991 the last previous epidemic on the South American continent had...
Perceiving and Representing Risk
Epidemiologists came under increasingly critical public scrutiny in the 1990s. In 1993 the Lancet published an editorial with the provocative heading Do epidemiologists cause epidemics It inquired whether epidemiologists were making too many errors in their calculations of disease burden and causation, and whether the public was placing excessive confidence in - and deriving excessive anxiety from - epidemiological results. A 1995 news report in the journal Science, titled Epidemiology faces...
IV The Tools of Intervention Research An Anthropological Analysis of Randomized
A. How Patient and Physician Expectations Influence the Conduct of Randomized Controlled Trials Epidemiology today is a primary source of the research designs relied on to produce authoritative proof of the efficacy of some new intervention. Randomized controlled trials RCTs are considered the most convincing form of epidemiologic data about treatment efficacy. But RCTs are a technology rather than a source of truth. This section argues that better understanding of the sociocultural components...
Anthropological Contributions to the Study of Cholera
Those with power were expected to take action against cholera. Those without power were the likely victims. Each had a choice of action, quarantine, cleansing, medical provision, prayer or just doing nothing on the one hand, and flight, anger, alarm, obedience to regulations, or just doing nothing on the other. Values emerged in choices between life and property, between work and safety, between charitable action and government agencies. Morris 1976 18-19, on the 1832 cholera epidemic in...
I Introduction
Anthropology and epidemiology are dedicated directly or indirectly to the study of human cultural practices and how those practices affect human health and disease. They must be fundamentally concerned with the theories that help guide and explain their discoveries as well as with the methods used to make those discoveries. Chapter 2 explained that these disciplines began with a fundamental concern for fieldwork, with the researchers always refining and adjusting how and why they collect...
Figures
1.1 Comparison of percentages of subjects in three samples clinic, mixed community and clinic, and pure community with scores in four regions of elevation on a Psychosocial Functioning Scale of the Washington Psychosocial Seizure Inventory page 16 3.1 Distribution shaded of Aedes aegypti mosquitoes in the Americas in 1970, at the end of the mosquito eradication program, and in 1997 64 4.1 Public opinion poll in Shoe comic strip 4.2 Monthly prevalence estimates of illness in the community and...
III Data Collection as Social Exchange
The process of collecting data is often a process of social exchange. This means that conveying information from one person to another is done in exchange for desired goods or services like money, future patient referrals, or authorship on articles or some sentiment like pride, loyalty, duty, or altruism . The social exchanges between a doctor and a patient in a hospital, or an interviewer and a person in her home, can be quite different from those involved in acquiring access to particular...
I Popular and Professional Ideas about Risk
Anthropological research on classification and knowledge production can help shed light on this problem. In addition to their descriptions of disease burden, epidemiologists and other public health scientists produce public messages about one key topic risk. Risk is the rhetorical vehicle Figure 7.1. Medical news cartoon. Borgman, J. The Cincinnati Inquirer, 1997. Reprinted with special permission of King Features Syndicate. Figure 7.1. Medical news cartoon. Borgman, J. The Cincinnati Inquirer,...
II Bias in Epidemiology and Its Anthropological Counterparts
Bias, or systematic error, is a critical concept in epidemiologic research. Bias is a threat to validity that cannot be resolved through additional analysis. Bias may inflate or minimize estimates, but if results are biased, then no amount of analysis will uncover the true values. Epidemiologists have classified as many as 35 different types of bias Sackett 1979 , but anthropologists reviewing the list will recognize many familiar research topics. For example, epidemiologists define selection...
Acknowledgments
In 1978 an anthropology professor at Columbia University, Ida Susser, told me that she was enrolled in a postdoctoral training program in psychiatric epidemiology at Columbia's medical school. As a naive undergraduate I thought it alarming - and wonderful - that one could study a field that contained so many syllables. My anthropological training at Columbia under Lambros Comitas, Alexander Alland, Charles Harrington, Marvin Harris, Leith Mullings, Joan Vincent, Ida Susser, and George Bond...