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Race, Ethnicity, and Racism in Medical Anthropology, 1977–2002
Abstract
Researchers across the health sciences are engaged in a vigorous debate over the role that the concepts of "race" and "ethnicity" play in health research and clinical practice. Here we contribute to that debate by examining how the concepts of race, ethnicity, and racism are used in medical-anthropological research. We present a content analysis of Medical Anthropology and Medical Anthropology Quarterly, based on a systematic random sample of empirical research articles (n = 283) published in these journals from 1977 to 2002. We identify both differences and similarities in the use of race, ethnicity, and racism concepts in medical anthropology and neighboring disciplines, and we offer recommendations for ways that medical anthropologists can contribute to the broader debate over racial and ethnic inequalities in health.
... Rather, their priority should be the analysis of racism and racialisation. The work of geneticists and biological anthropologists undermines the ontological status of 'races' as discrete, immutable, and intergenerationally stable biological entities (Matt Cartmill and Brown 2003;Marr Cartmill 1998;Gravlee and Sweet 2008;Littlefield et al. 1982). Yet, not everyone has bought into this knowledge, and forms of racism that draw on the alterity of being are, for those of us in the know, alive and well. ...
... Surveys of how anthropology as a discipline understands racism have revealed a lack of consensus around key concepts. Although this problem has been noted more widely among physical and biological anthropologists (Matt Cartmill and Brown 2003;Marr Cartmill 1998;Gravlee and Sweet 2008;Littlefield et al. 1982), there is a growing literature on this topic among medical anthropologists. Ann Morning (2011) highlights how there is still very little consensus on the constructed nature of race and that neither race nor racism have been presented 'as a lens through which everyday people can make sense of racial stratification' (Morning 2011, 235)-an issue that I argue deserves fuller investigation. ...
... Ethnicity is, therefore, an active concept whereas race is reduced to a passive, indelible, and consequently objectified state of being. Moreover, race and ethnicity are often used interchangeably in health research and, if they are defined at all, these definitions are relegated to the endnotes of articles (Gravlee and Sweet 2008). ...
In the United Kingdom, the government's failure to consistently record the race and ethnicity of those who have died from COVID-19 and the disproportionate mortality impact of the virus on Black, Asian and Minority Ethnic (BAME) communities speaks to a systemic failure to account for the interplay between the social construction of race and the lived experience of racism, itself presented biologically as 'poor health'. This failure has run for far longer and far deeper than many would care to admit. In this article, I use my own positionality as a 'Mixed-Race Black' woman to argue that the unique place of medical anthropology to sit at the intersection of the social, political, biological, and ecological means it can provide alternative approaches to understanding the disproportionate impacts of the pandemic and lay some foundations for repair strategies that encompass the patterns, processes, and constructs of health inequality.
... Rather, their priority should be the analysis of racism and racialisation. The work of geneticists and biological anthropologists undermines the ontological status of 'races' as discrete, immutable, and intergenerationally stable biological entities (Matt Cartmill and Brown 2003;Marr Cartmill 1998;Gravlee and Sweet 2008;Littlefield et al. 1982). Yet, not everyone has bought into this knowledge, and forms of racism that draw on the alterity of being are, for those of us in the know, alive and well. ...
... Surveys of how anthropology as a discipline understands racism have revealed a lack of consensus around key concepts. Although this problem has been noted more widely among physical and biological anthropologists (Matt Cartmill and Brown 2003;Marr Cartmill 1998;Gravlee and Sweet 2008;Littlefield et al. 1982), there is a growing literature on this topic among medical anthropologists. Ann Morning (2011) highlights how there is still very little consensus on the constructed nature of race and that neither race nor racism have been presented 'as a lens through which everyday people can make sense of racial stratification' (Morning 2011, 235)-an issue that I argue deserves fuller investigation. ...
... Ethnicity is, therefore, an active concept whereas race is reduced to a passive, indelible, and consequently objectified state of being. Moreover, race and ethnicity are often used interchangeably in health research and, if they are defined at all, these definitions are relegated to the endnotes of articles (Gravlee and Sweet 2008). ...
In the UK, the failure to record the race and ethnicity of Covid-19 deaths, and the disproportionate mortality impact of the virus on Black Asian and Minority Ethnic (BAME) communities, speaks to a systemic failure to account for the interplay between the social construction of race, the lived experience of racism, and its biological presentation as 'poor health' amongst the discriminated-against. This failure has run for far longer and runs far deeper than many would care to admit, including within medical anthropology itself. In this article, I argue that by theorising race and the practice of racism as relational phenomena tied to deeper and broader structures of ideology and inequality, we may generate clearer insights for how medical anthropology can unpack the nuances of health disparities and Covid-19 repair strategies.
... They link their vulnerability to kidney failure to larger social, political, and economic structures, while refuting corrupt medical facilities' claims on their bodies by locating them firmly within God's ownership (Hamdy 2008). In appealing to local biologies, these patients and family members point to how social, political, and economic history becomes embedded in people's very physiology (Lock 1993a(Lock , 1993b(Lock , 2001(Lock , 2010Fausto-Sterling 2005, 2008Gravlee 2009;Gravlee and Sweet 2008;Fassin 2003Fassin , 2007. If we are to rely on Euro-American popular and medical discourse about there being 'no harm' posed to a healthy kidney donor, then there is good reason to question its relevance and applicability elsewhere. ...
... I began this article suspicious of the claim that 'Egyptian culture' alone could explain patients' reluctance to accept the medical risk posed to living kidney donors. Lock has argued that anthropologists as a whole (particularly those not focusing on health or medicine) have been reluctant to take up questions of biological diversity for fear that human biological difference might be used as evidence of racist agendas (Lock and Nguyen 2010; see also Gravlee and Sweet 2008). We might consider the mid-1980s to mid-1990s as the climax of the anthropological inner turmoil over the 'culture' concept-a time when 'culture' was taken up as a racializing and essentializing gesture-in contrast to its original formulation. ...
... Eventually, cultural anthropologists abandoned measuring human biological difference altogether, understanding culture as 'superorganic' and wholly unrelated from biological development, as defined by Boas' student, Alfred Kroeber (1952Kroeber ( [1919; Barkan 1992). Since Kroeber, cultural anthropologists have been reticent to address biological difference among people (Lock and Nguyen 2010;Fullwiley 2011;Gravlee and Sweet 2008;Barkan 1992). But medical anthropologists trouble this reticence by asking whether human biologies need to be compatible so that social claims can be recognized. ...
Why do patients in need of kidney transplants in Egypt decline offers of kidney donation from their family members out of reluctance to cause them harm? Is it not universally the case that a living donor could live in complete health with a single remaining kidney? To address this conundrum, I discuss a case study from Egypt, in which patients reveal social, political, and environmental stresses on organ function that challenge the presumed universal efficacy and safety of kidney transplantation. I demonstrate that the biomedical position on the tolerable risks posed to the living donor is conditional and premised on particular social and historical contingencies that can be misaligned when applied in other contexts. Drawing on the work of Margaret Lock, I illustrate how analytical contributions of medical anthropologists can shed light on a political and public health impasse about how to legally regulate organ transplantation in Egypt.
... In such contexts, policy language serves to protect organizations and the powerful individuals within them. This finding is unsurprising given academic medicine's longstanding history of oppressing minoritized social groups while elevating dominant ones (Smedley, et al., 2003;Gravlee & Sweet, 2008;Seabrook & Wyatt-Nichol, 2016;Boatright et al., 2017;Edmond et al., 2001). In the context of increased attention to addressing equity and anti-racism, it remains to be seen if academic organizations will align with legislative and regulatory bodies in perpetuating stigma and bias towards minority and fragile groups, or work to dismantle inequities experienced by the individuals in the academic community. ...
The importance of advancing equity, diversity, and inclusion for all members of the academic medical community has gained recent attention. Academic medical organizations have attempted to increase broader representation while seeking structural reforms consistent with the goal of enhancing equity and reducing disproportionality. However, efforts remain constrained while minority groups continue to experience discrimination. In this study, the authors sought to identify and understand the discursive effects of discrimination policies within medical education. The authors assembled an archive of 22 texts consisting of publicly available discrimination and harassment policy documents in 13 Canadian medical schools that were active as of November 2019. Each text was analysed to identify themes, rhetorical strategies, problematization, and power relations. Policies described truth statements that appear to idealize equity, yet there were discourses related to professionalism and neutrality that were in tension with these ideals. There was also tension between organizations’ framing of a shared responsibility for addressing discrimination and individual responsibility on complainants. Lastly, there were also competing discourses on promoting freedom from discrimination and the concept of academic freedom. Overall, findings reveal several areas of tension that shape how discrimination is addressed in policy versus practice. Existing discourses regarding self-protection and academic freedom suggest equity cannot be advanced through policy discourse alone and more substantive structural transformation may be necessary. Existing approaches may be inadequate to address discrimination unless academic medical organizations interrogate the source of these discursive tensions and consider asymmetries of power.
... It is common knowledge that migrants and ethnic minorities face numerous inequities in health and healthcare in many countries, including in Europe. In the last few decades, a great deal of attention has been paid to this subject by both the humanities and social sciences as well as the health and medical sciences (Gravlee and Sweet 2008;Paradies et al. 2015;Priest and Williams 2018). Despite the intense research focus on ethnic inequities in healthcare, very few researchers have examined how racism establishes and intensifies these inequities (Nelson 2002;Bhopal 2007;Ahlberg et al. 2019). ...
The article analyzes the impact of language barriers on the medical treatment of foreign-speaking patients and illustrates that the absence of systemic, institutional responses to language barriers in healthcare facilities exacerbates racist attitudes toward migrants and ethnic groups. The article is based on 201 interviews with healthcare workers, employees of public or non-governmental institutions as well as users of healthcare services that were conducted between 2018 and 2019 in twelve local communities in Slovenia. Following the methodological and conceptual framework, the first part of the article highlights the various negative consequences of language barriers experienced by healthcare workers and foreign-speaking patients. The second part shows that in the absence of an accessible network of professional intercultural mediators or interpreters, healthcare workers are left to their own devices with respect to overcoming language barriers. Finally, the last part of the article shows that many interlocutors are increasingly searching for the culprit for this situation. Some healthcare workers attribute the responsibility to the abstract concept of the “system”, while others attribute the responsibility exclusively to migrants, thus perpetuating key elements of the culture of racism present in Slovenia. In this culture of racism, knowledge of Slovene language becomes one of the most important criteria that distinguishes deserving from undeserving migrants. The latter are a privileged object of racist responses at the level of cultural, institutional and personal racism, which is proving to be mutually toxic.
... Perhaps the most important way that race is relevant to biological anthropology today is in the biomedical implications of social race (Gravlee & Sweet, 2008). While races do not exist as genealogical entities, there are significant biological differences between social groups caused by a variety of factors and their interrelationships. ...
... As a result, the image arises of social groups as differing from each other purely on the basis of ethnicity. This tendency to ascribe causal power to ethnicity or culture has been observed more widely in relation to (sexual) health (Epstein 2007;Gravlee and Sweet 2008;Proctor, Krumeich, and Meershoek 2011). Such framings decrease attention for similarities between groups and differences within groups, privileging a specific notion of social groups. ...
Ethnicity is a frequently used measure in research into youth and sexuality in the Netherlands, a country known and admired for its favourable sexual health outcomes. This paper critically examines the production of knowledge about sexuality and ethnicity in the Netherlands. It traces the concept of ethnicity through four research practices (rationales of taking up ethnicity and compiling research populations; determining ethnicity; statistical calculations and making recommendations). It shows how the notion of ethnicity is flexible, slippery and changeable, yet at the same time becomes solidified and naturalized in relation to sexuality. The paper is based on a literature review of youth and sexuality in the Netherlands.
... We have seen that it could be either the "ancestral" genetic variation or some kind of genetic variation co-varying with it; we should ask what is the causal weight of either ancestral genetic variation or unknown genetic traits co-varying with genetic ancestry, in determining different predispositions to CD in the individuals of different SIRs. The first kind of genetic variation is considered unlikely to be causally relevant for the development of CD (Keita et al. 2004, Gravlee and Sweet 2008, Aldrich et al. 2012, therefore no causal weight should reasonably be attributed to it. What about the second kind of genetic variants? ...
... Despite these potential limitations, our study points to new directions at the crossroads of cultural psychiatry and medical communication. In line with current social science research (Gravlee & Sweet 2008), we have reported data on race and ethnicity because these categories exist as markers of social difference and discrimination in the United States. Ironically, cultural competence initiatives in the United States have sometimes reinforced racial and ethnic stereotypes by presenting lists of traits for clinicians to remember rather than clarify the complex socio-cultural environments in which patients live (Gregg & Saha 2006;Jenks 2011). ...
Objectives:
Cross-cultural mental health researchers often analyze patient explanatory models of illness to optimize service provision. The Cultural Formulation Interview (CFI) is a cross-cultural assessment tool released in May 2013 with DSM-5 to revise shortcomings from the DSM-IV Outline for Cultural Formulation (OCF). The CFI field trial took place in 6 countries, 14 sites, and with 321 patients to explore its feasibility, acceptability, and clinical utility with patients and clinicians. We sought to analyze if and how CFI feasibility, acceptability, and clinical utility were related to patient-clinician communication.
Design:
We report data from the New York site which enrolled 7 clinicians and 32 patients in 32 patient-clinician dyads. We undertook a data analysis independent of the parent field trial by conducting content analyses of debriefing interviews with all participants (n = 64) based on codebooks derived from frameworks for medical communication and implementation outcomes. Three coders created codebooks, coded independently, established inter-rater coding reliability, and analyzed if the CFI affects medical communication with respect to feasibility, acceptability, and clinical utility.
Results:
Despite racial, ethnical, cultural, and professional differences within our group of patients and clinicians, we found that promoting satisfaction through the interview, eliciting data, eliciting the patient's perspective, and perceiving data at multiple levels were common codes that explained how the CFI affected medical communication. We also found that all but two codes fell under the implementation outcome of clinical utility, two fell under acceptability, and none fell under feasibility.
Conclusion:
Our study offers new directions for research on how a cultural interview affects patient-clinician communication. Future research can analyze how the CFI and other cultural interviews impact medical communication in clinical settings with subsequent effects on outcomes such as medication adherence, appointment retention, and health condition.
... Social epidemiologists like Krieger (2005Krieger ( , 2011 and those in allied fields like Dressler et al. (2005) and Gravlee and Sweet (2008) in medical anthropology, have argued compellingly that research linking bodily outcomes to social experience can productively destabilize popular American cultural assumptions that racial differences are innate and immutable. Yet tracing the shifting course of epidemiological research about preterm delivery (PTD) the 1990s and 2000s poses new questions about how the persuasive power of this important strategy may vary across different research topics. ...
... In this paper, we address some of the research needs remaining in this area. Gravlee and Sweet (2008) call for additional ethnographic research on the hidden assumptions health researchers have about race. In addition, they cite the need for studies that clarify the relation between race and ethnicity. ...
Objectives:
This study adds to the discussion of appropriate categories of analysis in health research. We contribute data based on actual interviews about the concepts of race and ethnicity, conducted among a broad range of US health researchers.
Design:
In-person qualitative interviews were conducted with 73 scientists at two health research institutions, one that focused on public health research, and one that focused on research about a specific disease. This represents a larger and more interdisciplinary sample of health researchers than has been previously interviewed about these topics.
Results:
We identify a core model of how race and ethnicity are understood. The respondents were confused about the concepts of race and ethnicity and their link to genetic differences between populations; many treated these concepts as interchangeable and genetically based. Although ethnicity was considered somewhat more socially constructed, it was often felt to cause unhealthy behavior. In addition, the situation is not improving; the younger health researchers tended to put a stronger emphasis on the genetic aspects of race than did the older health researchers.
Conclusion:
Unlike reviews of how these concepts are used in scientific publications in which race and ethnicity are often undefined, our face-to-face interviews with these researchers allowed an understanding of their concepts of race and ethnicity. Building on their actual perspectives, these data suggest alternative approaches to formal and continuing educational training for health researchers. We recommend beginning with discussions of human diversity, and then moving on to what race and ethnicity are - and are not.
... Among the ways in which race is relevant to biological anthropology, the biomedical implications of race may have the largest social importance (Gravlee and Sweet 2008). While races do not exist as genealogical entities, there are significant biological differences between social groups caused by a variety of factors and their interrelationships. ...
... Two common problems contribute to this limitation. First, race is often used uncritically as a proxy for unspecified genetic, sociocultural, or behavioral risk factors111213. Such usage makes it impossible to untangle the independent influence of genetic and sociocultural factors or to detect interactions between them. ...
The role of race in human genetics and biomedical research is among the most contested issues in science. Much debate centers on the relative importance of genetic versus sociocultural factors in explaining racial inequalities in health. However, few studies integrate genetic and sociocultural data to test competing explanations directly.
We draw on ethnographic, epidemiologic, and genetic data collected in Southeastern Puerto Rico to isolate two distinct variables for which race is often used as a proxy: genetic ancestry versus social classification. We show that color, an aspect of social classification based on the culturally defined meaning of race in Puerto Rico, better predicts blood pressure than does a genetic-based estimate of continental ancestry. We also find that incorporating sociocultural variables reveals a new and significant association between a candidate gene polymorphism for hypertension (alpha(2C) adrenergic receptor deletion) and blood pressure.
This study addresses the recognized need to measure both genetic and sociocultural factors in research on racial inequalities in health. Our preliminary results provide the most direct evidence to date that previously reported associations between genetic ancestry and health may be attributable to sociocultural factors related to race and racism, rather than to functional genetic differences between racially defined groups. Our results also imply that including sociocultural variables in future research may improve our ability to detect significant allele-phenotype associations. Thus, measuring sociocultural factors related to race may both empower future genetic association studies and help to clarify the biological consequences of social inequalities.
... Ethnography is the traditional method for uncovering such locally-specific beliefs, norms, values, and behaviors. Ethnography is also well-suited to address three common critiques of epidemiology and population health studies that employ culturally constructed categories such as race and ethnicity (Comstock et al. 2004;Gravlee and Sweet 2008). First, it can clarify the local meaning of racial and ethnic categories, which are often used without explicit definition. ...
... Some of us, for example, study the nature and evolutionary causes of global patterns of neutral genetic variation (e.g., in this issue, Hunley et al.; Long et al.; Relethford), while others are more interested in the social and health-related implications of local phenotypic patterns, especially in the United States (e.g., see articles by Edgar; Gravlee). The former tend to emphasize ancient demographic events that may have produced meaningful genetic differences between groups, while the latter tend to focus on the relative impact of recent sociocultural processes on group structure and the apportionment of phenotypic variation (Hanson and Butler, 1997;Goodman and Leatherman, 1998;Stojanowski, 2005;Edgar, 2007;Gravlee and Sweet, 2008). These different foci come into play, for example, in the debate over whether racial categories should be used in medical genetic research (e.g., Gravlee, this issue; Wilson et al., 2001;Risch et al., 2002;Burchard et al., 2003;Cooper et al., 2003;Keita et al., 2004;Sankar et al., 2004). ...
... Racial–genetic determinism persists in part because of the uncritical use of race in biomedical sciences and public health. Systematic reviews in health-related disciplines show that race is widely used—appearing in 80% of recent articles—but that it is seldom defined (Anderson and Moscou, 1998; Drevdahl et al., 2001; Comstock et al., 2004; Gravlee and Sweet, 2008 ). For example, in three independent reviews of literature in genetics (Sankar et al. 2007), infant mortality research (Anderson and Moscou, 1998), and health services research (Williams, 1994), not a single article defined race. ...
The current debate over racial inequalities in health is arguably the most important venue for advancing both scientific and public understanding of race, racism, and human biological variation. In the United States and elsewhere, there are well-defined inequalities between racially defined groups for a range of biological outcomes-cardiovascular disease, diabetes, stroke, certain cancers, low birth weight, preterm delivery, and others. Among biomedical researchers, these patterns are often taken as evidence of fundamental genetic differences between alleged races. However, a growing body of evidence establishes the primacy of social inequalities in the origin and persistence of racial health disparities. Here, I summarize this evidence and argue that the debate over racial inequalities in health presents an opportunity to refine the critique of race in three ways: 1) to reiterate why the race concept is inconsistent with patterns of global human genetic diversity; 2) to refocus attention on the complex, environmental influences on human biology at multiple levels of analysis and across the lifecourse; and 3) to revise the claim that race is a cultural construct and expand research on the sociocultural reality of race and racism. Drawing on recent developments in neighboring disciplines, I present a model for explaining how racial inequality becomes embodied-literally-in the biological well-being of racialized groups and individuals. This model requires a shift in the way we articulate the critique of race as bad biology.
Many Black and brown women are classified as ‘high risk’ and follow obstetric-led pathways. This may be the result of social determinants of health, or over pathologisation as a result of racial bias by healthcare providers and systems. There may be times when social determinants are mistaken for innate physiological differences, leading to iatrogenic harm. There is both over and underdiagnosis resulting from racial bias in midwifery care. Women with intermediate risk factors may benefit from midwifery-led care, especially Black and brown women. Community-based, relational, women-centred midwifery models of care can reduce the problems of pathologisation and redress some social inequalities.
Over the last century, anthropological discourse about race changed dramatically. Once a core concept in anthropology, it is now widely accepted as the “myth” coined by Ashley Montagu to denote that race is a social construction with no basis in biology. The social constructivist view of race was long in the making in American anthropology. Typological thinking about human variation persists in science and society and race continues to be important to biological anthropologists in many ways. This chapter explores three of them. First, the race concept is not dead. Second, racial thinking may still influence researchers' understanding of human variation, population relationships, and human evolution. Finally, while social races are not genealogical entities, they have biological dimensions. The race concept is currently alive and well in the general public, providing fodder for neo‐fascists globally, but it has also persisted in biological anthropology until very recently.
High-profile instances of police and citizen brutality against Black people in the United States in 2020 spurred increased attention to longstanding racial injustice, leading to widespread adoption of anti-racism concepts, discussions, and efforts. Due to the relative infancy of anti-racism agendas on an organizational level, effective anti-racism strategies and best practices are still being developed. The author-a Black psychiatry resident-aims to contribute to the anti-racism efforts and discourse happening nationally within medicine and psychiatry. A personal account is given reviewing challenges and successes from recent anti-racism efforts on the organizational level of a psychiatry residency program.
Izhajajoč iz temeljnega vprašanja, kaj je slovenska antropologija na pragu 21. stoletja, članek odkriva njene temeljne vsebinske značilnosti. Na podlagi analize vsebine 1162 znanstvenih člankov, poglavij, raziskovalnih poročil, poglavij v knjigah in knjig, objavljenih med letoma 2000 in 2021 in katerih avtorji so izbrani slovenski antropologi, članek detektira temeljne teme in tematske sklope ter na tej osnovi mapira vsebino, strukturo in povezanost polja slovenske antropologije. Rezultati kažejo, da: 1. je v slovenski antropologiji 25 tematskih sklopov, ki so po frekventnosti in kontinuiranosti razdeljeni v primarno, sekundarno in terciarno skupino; 2. da je polje slovenske antropologije sicer tematsko bogato in razgibano, vendar pa so teme razmeroma izolirane, ozko fokusirane in kažejo nizko stopnjo tematskega prepletanja; 3. da je polje močno feminizirano; 4. da ima nizko stopnjo mednarodnega dosega in pretežno osredinjeno na nacionalni kontekst ter 5. da ima tudi z vidika citiranosti razmeroma omejen znanstveni domet.
Siyaset, iktisat ve teolojinin kesişim hatlarında ortaya çıkan Eski Yunan mitolojisi, Prometheus-Epimetheus mitosu vasıtasıyla insanın ilişkisel ontolojisine ve ancak işbirliği sayesinde-erdemli biçimde-hayatta kalabilen "doğasına" göndermede bulunarak, insanı siyasal bir varlık şeklinde tasavvur eder. Buna göre siyaset, düzen mantığının sürdürülebilmesi için insanların zor yordamıyla yönlendirilmesinden fazlasıdır. Bu durum, insan türünde diğer canlılar ve hayvanlara kıyasla var olan bir fazlalıktan kaynaklan-maktadır. İnsan "doğası gereği" canlılar dünyasının yalın yaşamı yani zoe olmaklığının ötesinde kendisini kamusal hâle getirmek zorunda kalmış bir yaratıktır. Tüm "insani" davranış ve eylemleri ile bios'a aittir; bu durumu, onu "doğal" olarak bir zoon politikon yapmaktadır (Aristotales 2020; Agamben 2013). İnsan hayatta kalmak için kamusallaşmak zorunda olan ve kamusallaşma süre-cinde de siyasallaşmak durumunda kalan bir canlı olduğuna göre, salt zor yoluyla yönlendirilmesi düşünülemez. Yeryüzüne, varolu-şa, insan bedenine ve bereketin üzerinden sağlandığı kutsallığa ilişkin şartlar ve işleyiş kurallarının hakikiliği (doğallığı) üzerinden artık yönetenler safına geçmiş azınlığın, yönetilenlerden daha çok nemalandığı sisteme rıza gösterir.
Despite repeated calls by scholars to critically engage with the concepts of race and ethnicity in US epidemiologic research, the incorporation of these social constructs in scholarship may be suboptimal. This study characterizes the conceptualization, operationalization, and utilization of race and ethnicity in US research published in leading journals whose publications shape discourse and norms around race, ethnicity, and health within the field of epidemiology. We systematically reviewed randomly selected articles from prominent epidemiology journals across five periods: 1995-99, 2000-04, 2005-09, 2010-14, 2015-18. All original human-subjects research conducted in the US was eligible for review. Information on definitions, measurement, coding, and use in analysis was extracted. We reviewed 1050 articles, including 414 (39%) in analyses. Four studies explicitly defined race and/or ethnicity. Authors rarely made clear delineations between race and ethnicity, often adopting an ethno-racial construct. In the majority of studies across time periods, authors did not state how race and/or ethnicity was measured. Top coding schemes included “Black, White” (race), “Hispanic, Non-Hispanic” (ethnicity), and “Black, White, Hispanic” (ethno-racial). Most often, race and ethnicity were deemed “not of interest” in analyses (e.g., control variable). Broadly, disciplinary practices have remained largely the same between 1995-2018 and are in need of improvement.
The editorial independence of biomedical journals allows flexibility to meet a wide range of research interests. However, it also is a barrier for coordination between journals to solve challenging issues such as racial bias in the scientific literature. A standardized tool to screen for racial bias could prevent the publication of racially biased papers. Biomedical journals would maintain editorial autonomy while still allowing comparable data to be collected and analyzed across journals. A racially diverse research team carried out a three-phase study to generate and test a racial bias assessment tool for biomedical research. Phase 1, an in-depth, structured literature search to identify recommendations, found near complete agreement in the literature on addressing race in biomedical research. Phase 2, construction of a framework from those recommendations, provides the major innovation of this paper. The framework includes three dimensions of race: 1) context, 2) tone and terminology, and 3) analysis, which are the basis for the Race Equity Vetting Instrument for Editorial Workflow (REVIEW) tool. Phase 3, pilot testing the assessment tool, showed that the REVIEW tool was effective at flagging multiple concerns in widely criticized articles. This study demonstrates the feasibility of the proposed REVIEW tool to reduce racial bias in research. Next steps include testing this tool on a broader sample of biomedical research to determine how the tool performs on more subtle examples of racial bias.
To understand the implications of the forensic anthropological practice of “ancestry” estimation, we explore terminology that has been employed in forensic anthropological research. The goal is to evaluate how such terms can often circulate within social contexts as a result, which may center forensic anthropologists as constituting “race” itself through analysis and categorization. This research evaluates terminology used in anthropological articles of the Journal of Forensic Sciences between 1972 and 2020 (n = 314). Terminology was placed into two categories: classifiers and descriptors. Classifiers were standardized into one of five options: “race,” “ancestry,” “population,” “ethnic,” or “other.” Descriptors included terms used to describe individuals within these classificatory systems. We also compared these terms to those in the NamUs database and the U.S. census. Our results found that the terms “ancestry” and “race” are often conflated and “ancestry” largely supplanted “race” in the 1990s without a similar change in research approach. The NamUs and census terminology are not the same as that used in forensic anthropological research; illustrating a disconnect in the terms used to identify the missing, unidentified, and in social contexts with those used in anthropological research. We provide histories of all of these terms and conclude with suggestions for how to use terminology in the future. It is important for forensic anthropologists to be cognizant of the terms they use in medicolegal contexts, publications, and in public and/or professional spaces. The continued use of misrepresentative and improper language further marginalizes groups and perpetuates oppression rooted in systemic racism.
Importance
The reporting of race provides transparency to the representativeness of data and helps inform health care disparities. The International Committee of Medical Journal Editors (ICMJE) developed recommendations to promote quality reporting of race; however, the frequency of reporting continues to be low among most medical journals.
Objective
To assess the frequency as well as quality of race reporting among publications from high-ranking broad-focused surgical research journals.
Design, Setting, and Participants
A literature review and bibliometric analysis was performed examining all human-based primary research articles published in 2019 from 7 surgical journals: JAMA Surgery, Journal of the American College of Surgeons, Annals of Surgery, Surgery, American Journal of Surgery, Journal of Surgical Research, and Journal of Surgical Education. The 5 journals that stated they follow the ICMJE recommendations were analyzed against the 2 journals that did not explicitly claim adherence.
Main Outcomes and Measures
Measured study outcomes included race reporting frequency and use of the ICMJE recommendations for quality reporting of race.
Results
A total of 2485 publications were included in the study. The mean (SD) frequency of reporting of race and ethnicity in publications of ICMJE vs non-ICMJE journals was 32.8% (8.4) and 32.0% (20.9), respectively (P = .72). Adherence to ICMJE recommendations for reporting race was more frequent in ICMJE journals than non-ICMJE journals (mean [SD] of 73.1% [17.8] vs 37.0% [10.2]; P < .001).
Conclusions and Relevance
The frequency of race and ethnicity reporting among surgical journals is low. A journal’s statement of adherence to ICMJE recommendations did not affect the frequency of race and ethnicity reporting; however, there was an increase in the use of ICMJE quality metrics. These findings suggest the need for increased and more standardized reporting of racial and ethnic demographic data among surgical journals.
Kidney disease continues to manifest stark U.S. racial inequities, revealing the entrenchment of racism and bias within multiple facets of society including in our institutions, practices, norms, and beliefs. In this perspective, we synthesize theory and evidence to describe why an understanding of race and racism is integral to kidney care, providing examples of how kidney health disparities manifest interpersonal and structural racism. We then describe racialized medicine and color-blind approaches as well as their pitfalls, offering in their place suggestions to embed anti-racism and equity lens into our practice. We propose examples of how we can enhance kidney health equity by enhancing our structural competency, equity-focused race consciousness, and by centering investigation and solutions around the needs of the most marginalized. To achieve equitable outcomes for all, our medical institutions must embed anti-racism and equity into all aspects of advocacy, policy, patient/community engagement, educational efforts, and clinical care processes. Organizations engaged in kidney care should commit to promoting structural equity and eliminating potential sources of bias across referral practices, guidelines, research agendas, and in clinical care. Kidney care providers should reaffirm our commitment to structurally competent patient care and educational endeavors in which empathy and continuous self-education about social drivers of health and inequity, racism, and bias are integral. We envision a future in which kidney health equity is a reality for all. Through bold collective and sustained investment, we can achieve this critical goal.
This paper examines the COVID-19 pandemic in light of two key concepts in medical anthropology: syndemics and structural violence. Following a discussion of the nature of these two concepts, the paper addresses the direct and associated literatures on the syndemic and structural violence features of the COVID pandemic, with a specific focus on: 1) the importance of local socioenvironmental conditions/demographics and disease configurations in creating varying local syndemic expressions; 2) the ways that the pandemic has exposed the grave weaknesses in global health care investment; and 3) how the syndemic nature of the pandemic reveals the rising rate of noncommunicable diseases and their potential for interaction with current and future infectious disease. The paper concludes with a discussion on the role of anthropology in responding to COVID-19 from a syndemics perspective.
For decades, sociologists and anthropologists have been at the forefront of theorizing and empirically documenting how racism negatively affects the health and well-being of socially marginalized racial groups in the United States (e.g., Bridges 2011; Gravlee and Sweet 2008; Williams and Sternthal 2010). By contrast, most public health researchers’ explanations for racial health disparities have largely on treated race as a risk factor, rather than attending to how racism operates as a powerful and enduring social determinant of worse health and health outcomes among African-Americans. Important exceptions exist, however, particularly in the area of maternal and child health. Arline Geronimus (1992) developed the ‘weathering hypothesis’ to describe how chronic stress resulting from a lifetime of discrimination contributes to higher rates of adverse birth outcomes among Black women. Around the same time, a collaborative of women of color founded the reproductive justice movement to draw attention to how socially, politically, and economically marginalized women—and in particular, Black women—have been subject to myriad forms of reproductive oppression, including forced and coercive sterilization practices, curtailed access to abortion care, and obstetric violence (Ross & Solinger, 2017). This group advanced a vision of reproductive freedom that included not only the right to end a pregnancy but also the right to have and parent children in safe and healthy environments, free from discrimination and violence. Since then, the reproductive justice movement’s powerful paradigm for thinking about reproduction—both biological and social—encourages us to imagine how, to paraphrase Monica McLemore, this could all be different.
Racism and bias are American medicine's fatal flaw. They permeate clinical practice and biomedical research, and their influence on medical education is even more profound because it is through medical education that racism and bias are perpetuated across generations and throughout history. This insidious influence has persisted despite the stated values of the medical profession and well-intentioned efforts to lessen their impact. The authors assert that racism and bias in the learning and work environment of medical school can be mitigated only through a formal change management process that leads to change that is institutionally transformational, and individually transformative. The authors describe the sequence of events at one U.S. medical school, beginning in 2016, that led from student activism to an initiative that encompasses every functional sphere within medical education. They also reflect on personal and structural lessons learned during the course of designing and implementing this initiative. Eliminating racism and bias demands that medical educators embrace a change process that is lifelong, people-centered, incremental, and non-linear. It requires the courage to constantly course correct while never losing sight of the ultimate goal: health care and medical education that are free of racism and bias.
Background
A professional association journal should reflect the needs of its organization, its readers, and the field it represents. Evaluating the needs that the Journal of Human Lactation has met, and those it has not, is essential if it is to remain relevant to its readers.
Aims
(1) Describe the characteristics of articles published from 1985 through 2018. (2) Describe content intended to educate lactation support providers and clinicians. (3) Explore the ways the content has illustrated the growth and development of lactation knowledge, and (4) identify the reoccurring content threads consistent throughout the 34 years.
Methods
A prospective mixed methods approach incorporating a quantitative content analysis and a qualitative thematic analysis was used. Frequency distributions were done on all the variables extracted from published articles ( N = 1586). The second level of analysis identified themes using an iterative and consensus approach.
Results
Mirroring the growth in the lactation field, the volume of research articles published each year has increased along with the percent of research articles per issue. Research methods have become more diverse. The international scope and relevance, while always present, has been steadily increasing. Threads identified were; striving for international scope, advancing lactation education, developing a body of knowledge that informs clinical practice in lactation, and creating a centralized place for multidisciplinary research about lactation.
Conclusion
The body of work published in the Journal of Human Lactation parallels the development of the lactation specialty. We have highlighted areas for improvement and possible further study.
Purpose:
The objective of this study was to illustrate the global research productivity and tendency of forensic anthropology in recent ten years (2008-2017) by bibliometric analysis.
Methods:
"Forensic anthropology" was used as the Medical Subject Headings term and topic in PubMed and Web of Science Core Collection.
Results:
As 5130 articles retrieved, two independent investigators evaluated all of them respectively. After restricting the published year, excluding duplicated and irrelevant articles, 1663 articles were available. The total of 219 countries and regions contributed to this research and the United States was the most productive country. There were 201 peer-reviewed journals including all of articles and two of them were identified as core journals according to Bradford's law. Eight of the top 10 productive authors were from developed countries. The top 10 cited articles were published by authors from developed countries with half in the United States. Sex estimation and age estimation were the most popular topics.
Conclusions:
With the basic and recognized methodology administered in this study, it provided a relative broad view to evaluate the scientific research capacity of forensic anthropology and reveal the worldwide tendency in this field.
A growing set of epidemiological data links personal financial debt to negative mental and physical health outcomes. These findings point to debt as a potentially significant socioeconomic determinant of population health, especially given rising rates of household and consumer debt in industrialized nations. However, the political and economic contexts in which rising consumer debt is embedded and the ways in which it is experienced in everyday life are underexplored in this epidemiological literature. This gap leaves open questions about how best to situate and understand debt as a health determinant with both psychosocial and neo-material attributes. In this article, we discuss findings from a qualitative study of personal debt experience in Boston, Massachusetts. Participants’ debt narratives highlight the powerful feelings of shame, guilt, and personal responsibility that debt engenders. The findings point to the influence of neoliberal ideology in shaping emotional responses to debt and suggest that these responses may be important pathways through which debt affects health. We discuss our findings within the broader landscape of American neoliberal economic policy and its role in shaping trends of consumer debt burden.
The prevalence of metabolic syndrome is increasing worldwide and has become a risk factor for the development of chronic kidney disease. The complex linkage between metabolic syndrome and chronic kidney disease is under research and the factors involved beyond the biological pathogenesis include demographic, sociological and psychological factors that are related to the metabolic syndrome prevalence. The social context of disease causation is as relevant to today's clinical scientist and practitioner as biomarker-directed risk stratification and therapy. The aim of this review is to compare the criteria for diagnosis among different international health organizations, identifying all factors that contribute to the development of this association between metabolic syndrome and chronic kidney disease, and categorizing them by those that could be useful for preventive strategies. In addition, patients with metabolic syndrome have microvascular disease characterized by microalbuminuria, decreased glomerular filtration rate, tubular atrophy, interstitial fibrosis, and glomerulosclerosis. These effects may be due to insulin resistance, hypertension, dyslipidemias, activation of inflammatory processes, fibrotic, dysbiosis and generation of oxidative stress; which cause an imbalance in the main vasoactive factors and thus endothelial dysfunction, deteriorating the renal function. Furthermore, since unhealthy eating habits and a sedentary lifestyle are among the strongest risk factors related to these diseases, lifestyle interventions programs have been recommended for facilitating positive changes in behavior at the individual level. However, further research is needed to promote multiple social, economic and political transformations, shifting the intervention emphasis from individual education, counseling, regimens and medications to community, national and global institutions.
Though mainstream sociological theory has been founded within dualisms such as structure/agency, nature/culture, and mind/matter, a thread within sociology dating back to Spencer and Tarde (Karakayali, 2015) favoured a monist ontology that cut across such dualistic categories. This thread has been reinvigorated by recent developments in social theory, including the new materialisms, posthumanism and affect theories. Here we assess what a monist or ‘flat’ ontology means for sociological understanding of key concepts such as structures and systems, power and resistance. We examine two monistic sociologies: Bruno Latour’s ‘sociology of associations’ and DeLanda’s ontology of assemblages. Understandings of social processes in terms of structures, systems or mechanisms are replaced with a focus upon the micropolitics of events and interactions. Power is a flux of forces or ‘affects’ fully immanent within events, while resistance is similarly an affective flow in events producing micropolitical effects contrary to power or control.
In this chapter, the challenges of applying cultural, biological, and structural models to child maltreatment are discussed. As a prolegomenon toward more biocultural approaches of conceptualizing maltreatment in the field of global mental health, the relationship between culture and biology is explored from multiple vantages. First, culture moderates the relationship risk of maltreatment and biological factors such as sex, disabilities, and medical illness. Second, the evidence for biological sequelae of maltreatment is scarce from a cross-cultural perspective. Some forms of maltreatment are overrepresented in low and middle income countries such as female genital cutting, and forced conscription of child soldiers, leading to increased and diverse health consequences. Third, the cross-cultural evidence for gene-by-environment interactions is limited by variation in prevalence of alleles and exposures. Fourth, structural factors and macro-cultural processes underlie most biocultural interactions. Macro-cultural process should be targets of intervention.
This paper explores the collection of Aboriginal identification within a longitudinal health study that has continued though decades of socio-political change. The Mater University of Queensland Study of Pregnancy is a birth cohort study that commenced in Brisbane in the early 1980s. Until 2014 it relied on mother-reported race-based categories at baseline to determine Indigenous status. Thirty study-children (now adults) who were originally identified as having a parent who was an 'Australian Aborigine' uiere followed up 30 years later. Only 15 of this group self-identified as Aboriginal and/or Torres Strait Islander. Considering recent studies have shown Aboriginal and Torres Strait Islander people are increasingly more likely to self-identify as such, an archival investigation of the original questionnaires was undertaken to check for systematic miscodes. Handwritten markings on the original questionnaires showed that group affiliation cannot always be easily classified into imprecise race-based categories. To do so ignores the reality and complexities of a lived cultural identity, including multiple ethnicities or ancestries. This paper takes a sociological approach to explore some of the difficulties in attempting to capture ethnic identification in administrative datasets.
http://search.informit.com.au/fullText;dn=747186277403890;res=IELIND
Background: The role of race in human genetics and biomedical research is among the most contested issues in science. Much debate centers on the relative importance of genetic versus sociocultural factors in explaining racial inequalities in health. However, few studies integrate genetic and sociocultural data to test competing explanations directly.
This paper examines a federally funded research and training collaboration between an Ivy League psychiatric research center and a historically Black university and medical center. This collaboration focuses on issues of psychiatric recovery and rehabilitation among African Americans. In addition, this multidisciplinary collaboration aims to build the research capacity at both institutions and to contribute to the tradition of research in culture and mental health within the medical social sciences and cultural psychiatry. This article provides a window into the complex, often messy, dynamics of a collaboration that cross cuts institutional, disciplinary, and demographic boundaries. Taking an auto-ethnographic approach, we intend to illustrate how collaborative relationships unfold and are constructed through ongoing reciprocal flows of knowledge and experience. Central to this aim is a consideration of how issues of power, privilege, and the hidden transcript of race shape the nature of our research and training efforts.
Osteology is a subdiscipline of anthropology and archeology which studies the macroscopic and microscopic structure of bones. Experts in the field of osteology apply their knowledge in recovering and interpreting changes in skeletal tissue, determining the action of different biological and cultural factors on bone morphology. Osteology is often applied to investigations in various disciplines such as history and archeology, demography, epidemiology, forensics and criminology. The development of osteology in the 21st century is supported mainly by its application in the context of forensic practice. Osteology approaches are being used by forensic anthropologists in order to facilitate the reconstruction of the biological profile of the remains and the identification of the deceased. They can also provide useful information for understanding the cause, manner and mechanism of death. The article aims to describe, relying on rich literature, the basic osteological techniques used in forensic anthropology. In addition to determining the biological profile (race, gender, age), the authors emphasize the importance of osteology in determining the circumstances of injuries and time of death. The practical contribution of osteology in forensics is manifested also within juridical processes as it has proved useful in investigations of crime scenes, human rights violations, mass incidents and wars. Forensic anthropology deals also with population, secular and geographically determined variations in bone morphology, confirming its important position within physical anthropology. The development of forensic anthropology in 21st century is not questionable. The conceptual and practical advancements in complementary fields, the development of new osteological techniques and the utilization of molecular and biochemical technologies are continuously supporting its scientific and practical progress.
ABSTRACT Significant differences in views on race (once a core anthropological concept) occur between scientists from different countries. In light of the ongoing race debate, we present the concept's current status in Europe. On three occasions in 2002–03, we surveyed European anthropologists' opinions toward the biological race concept. The participants were asked whether they agreed that there are biological races within the species Homo sapiens. A dependence was sought between the type of response and several factors. Three of these factors—country of academic education, discipline, and age—were found to be significant in differentiating the replies. Respondents educated in Western Europe, physical anthropologists, and middle-aged persons reject race more frequently than respondents educated in Eastern Europe, people in other branches of science, and those from both younger and older generations. The survey shows that the views of anthropologists on race are sociopolitically (ideologically) influenced and highly dependent on education. [Keywords: human races, race concept, physical anthropology, Europe]
The relative contribution of genetic and environmental influences to the US black-white disparity in cardiovascular disease (CVD) is hotly debated within the public health, anthropology, and medical communities. In this article, we review evidence for developmental and epigenetic pathways linking early life environments with CVD, and critically evaluate their possible role in the origins of these racial health disparities. African Americans not only suffer from a disproportionate burden of CVD relative to whites, but also have higher rates of the perinatal health disparities now known to be the antecedents of these conditions. There is extensive evidence for a social origin to prematurity and low birth weight in African Americans, reflecting pathways such as the effects of discrimination on maternal stress physiology. In light of the inverse relationship between birth weight and adult CVD, there is now a strong rationale to consider developmental and epigenetic mechanisms as links between early life environmental factors like maternal stress during pregnancy and adult race-based health disparities in diseases like hypertension, diabetes, stroke, and coronary heart disease. The model outlined here builds upon social constructivist perspectives to highlight an important set of mechanisms by which social influences can become embodied, having durable and even transgenerational influences on the most pressing US health disparities. We conclude that environmentally responsive phenotypic plasticity, in combination with the better-studied acute and chronic effects of social-environmental exposures, provides a more parsimonious explanation than genetics for the persistence of CVD disparities between members of socially imposed racial categories.
How far has anthropology come in becoming racially inclusive? In this article, we analyze an online survey of anthropology graduate students and faculty of color undertaken by the AAA Commission on Race and Racism in Anthropology. Despite some progress, institutional and attitudinal barriers remain. We use the concept of “white public space” to analyze these barriers: departmental labor is divided in ways that assign to faculty and graduate students of color responsibilities that have lower status and rewards than those of their white counterparts. Colorblind racial explanatory practices—discourses that explain away racially unequal institutional practices as being “not about race”—are common. We argue that such practices make many anthropology departments feel like white-owned social and intellectual spaces. We conclude by suggesting steps with which anthropology departments can create more inclusive social spaces that are owned equally by scholars of color and their white peers.
Osteology is a subdiscipline of anthropology and archeology which studies the macroscopic and microscopic structure of bones. Experts in the field of osteology apply their knowledge in recovering and interpreting changes in skeletal tissue, determining the action of different biological and cultural factors on bone morphology. Osteology is often applied to investigations in various disciplines such as history and archeology, demography, epidemiology, forensics and criminology. The development of osteology in the 21st century is supported mainly by its application in the context of forensic practice. Osteology approaches are being used by forensic anthropologists in order to facilitate the reconstruction of the biological profile of the remains and the identification of the deceased. They can also provide useful information for understanding the cause, manner and mechanism of death. The article aims to describe, relying on rich literature, the basic osteological techniques used in forensic anthropology. In addition to determining the biological profile (race, gender, age), the authors emphasize the importance of osteology in determining the circumstances of injuries and time of death. The practical contribution of osteology in forensics is manifested also within juridical processes as it has proved useful in investigations of crime scenes, human rights violations, mass incidents and wars. Forensic anthropology deals also with population, secular and geographically determined variations in bone morphology, confirming its important position within physical anthropology. The development of forensic anthropology in 21st century is not questionable. The conceptual and practical advancements in complementary fields, the development of new osteological techniques and the utilization of molecular and biochemical technologies are continuously supporting its scientific and practical progress.
El propósito central de este ensayo es mostrar la necesidad de ampliar nuestros referentes teóricos y metodológicos en el estudio de la relación entre etnicidad y salud, a partir de la premisa de particularizar el análisis epidemiológico mediante la integración de datos cuantitativos y cualitativos, en concordancia con el enfoque de la epidemiología sociocultural. Para ello, el trabajo aborda inicialmente el estado del arte para proponer la conveniencia de distinguir entre tres ámbitos relacionados: el genotipo, el fenotipo y la etnicidad. Enseguida
se presentan algunos resultados selectos de investigación que pretenden señalar ciertas diferencias relevantes entre los pueblos indígenas del país y los de la región noroeste de México. Finalmente, se amplían algunas reflexiones emanadas de este ejercicio a modo de conclusiones y se examina la pertinencia de la epidemiología sociocultural como marco analítico para aplicarse en particular al estudio de la salud en poblaciones étnicamente diferenciadas.
Anthropological approaches broaden and deepen our understanding of the finding that high levels of socioeconomic inequality correlate with worsened health outcomes across an entire society. Social scientists have debated whether such societies are unhealthy because of diminished social cohesion, psychobiological pathways, or the material environment. Anthropologists have questioned these mechanisms, emphasizing that fine-grained ethnographic studies reveal that social cohesion is locally and historically produced; psychobiological pathways involve complex, longitudinal biosocial dynamics suggesting causation cannot be viewed in purely biological terms; and material factors in health care need to be firmly situated within a broad geopolitical analysis. As a result, anthropological scholarship argues that this finding should be understood within a theoretical framework that avoids the pitfalls of methodological individualism, assumed universalism, and unidirectional causation. Rather, affliction must be understood as the embodiment of social hierarchy, a form of violence that for modern bodies is increasingly sublimated into differential disease rates and can be measured in terms of variances in morbidity and mortality between social groups. Ethnographies on the terrain of this neoliberal global health economy suggest that the violence of this inequality will continue to spiral as the exclusion of poorer societies from the global economy worsens their health-an illness poverty trap that, with few exceptions, has been greeted by a culture of indifference that is the hallmark of situations of extreme violence and terror. Studies of biocommodities and biomarkets index the processes by which those who are less well off trade in their long-term health for short-term gain, to the benefit of the long-term health of better-off individuals. Paradoxically, new biomedical technologies have served to heighten the commodification of the body, driving this trade in biological futures as well as organs and body parts.
Bulletin of the History of Medicine 78.1 (2004) 253-255
This book is an important contribution to medical anthropology, and provides tools that are sorely needed in the recuperation of public health—for on a global scale, we are all in a state of emergency not so dissimilar to the cholera epidemic that overwhelmed residents of Venezuela's Orinoco delta in 1992. The accounts of the epidemic by anthropologist Charles Briggs and his physician coauthor Clara Mantini-Briggs are strengthened by their personal experience in the country's poor delta provinces during the outbreak. The authors provide a comprehensive account of the intersection between indigenous and clinical narratives about disease, race, and power, and conclude with an astute analysis of reemerging infectious disease and poverty in the context of transnational neoliberal economics and the politics of globalization.
Briggs, the principal author, centers the book around what he calls "medical profiling": racialized public and professional narratives about the mostly indigenous "victims" of the Venezuelan epidemic. Ironically, cholera need not be fatal if patients are orally rehydrated, yet in Delta Amacuro, a state long neglected in public health outreach and national budgets, hundreds of Warao villagers died in a matter of months. The book documents the role of official public health authorities and of the media in dividing the public into "sanitary citizens," with complex identities and nationality intact, and "unsanitary subjects," whose identity became reduced to stereotypes of race or class and associated with a predictable package of cultural beliefs and behaviors (p. 33).
Venezuelans initially encountered cholera in the form of nationalist claims and rumors from remote borderlands—cholera literally threatened the body politic, violating borders and puncturing the image of modernity and scientific notions of progress so carefully cultivated by the government. In the delta region, where the outbreak was most deadly, the indigenous population became cast in public statements and media accounts as an orientalist "other" set in contrast to, and outside of, the national project. Official narratives privileged cultural and behavioral explanations of the deadly epidemic (e.g., inadequate cooking, poor hygiene) that individualized its impact and laid the blame on its victims. Such accounts, the authors note, decentered other interpretations, such as those based on underfunded sanitary and health infrastructure or the land and labor exploitation that have made poverty and malnutrition endemic to the delta.
The text is replete with examples showing how the gaze of the media and health authorities tended to fixate on exotic features such as indigena spiritual and magical beliefs about the origins and treatment of disease—but in fact, as Briggs and Mantini-Briggs show, there were counternarratives for those who sought them out. For example, the failure of male indigenous healers to cure the deadly diarrhea actually enhanced the power of women in the villages. As a result, women became the primary repositories of cultural memory about the epidemic.
In a cautionary note to anthropologists, Briggs lays out the pitfalls of what he calls "cultural reasoning," in which the notion of culture becomes decontextualized and invoked in explaining complex issues. Such explanations risk becoming objectified as common knowledge and appropriated in institutional ideologies. Used in this way, he warns, cultural reasoning acquires a "liberal patina [which] helps disguise timeworn stereotypes and institutional agendas," and provides a framework for racial profiling (p. 318).
The authors illustrate how the epidemic became appropriated by dissident political parties (including supporters of Hugo Chavez), who denounced the rising poverty that belied elite promises of the development that would arise from the country's petroleum reserves. The unheard narratives of indigenous people themselves tended to focus on the lack of resources and power, and often betrayed a distrust of governmental authority.
Ironically, Venezuelan health administrators found themselves in a defensive posture—initially minimizing the impact of the disease as affecting remote and isolated pockets of indigenous victims, for fear of being blamed for the outbreak and losing their meager funding. Initial propaganda on...
The description and explanation of racial and ethnic health disparities are major initiatives of the public health research establishment. Black Americans suffer on nearly every measure of health in relation to white Americans. Five theoretical models have been proposed to explain these disparities: a racial-genetic model, a health-behavior model, a socioeconomic status model, a psychosocial stress model, and a structural-constructivist model. We selectively review literature on health disparities, emphasizing research on low birth weight and high blood pressure. The psychosocial stress model and the structural-constructivist model offer greatest promise to explain disparities. In future research, theoretical elaboration and operational specificity are needed to distinguish among three distinct factors: (a) genetic variants contributing to disease risk; (b) ethnoracial or folk racial categories masquerading as biology; and (c) ethnic group membership. Such elaboration is necessary to move beyond t...
Historically, anthropology has occupied a central place in the construction and reconstruction of race as both an intellectual device and a social reality. Critiques of the biological concept of race have led many anthropologists to adopt a “no-race” posture and an approach to intergroup difference highlighting ethnicity-based principles of classification and organization. Often, however, the singular focus on ethnicity has left unaddressed the persistence of racism and its invidious impact on local communities, nation-states, and the global system. Within the past decade, anthropologists have revitalized their interest in the complex and often covert structures and dynamics of racial inequality. Recent studies shed light on race’s heightened volatility on contemporary sociocultural landscapes, the racialization of ethno-nationalist conflicts, anthropology’s multiple traditions of antiracism, and intranational as well as international variations in racial constructions, including the conventionally neglec...
Indigenous populations in New World nations share the common experience of culture contact with outsiders and a prolonged history of prejudice and discrimination. This historical reality continues to have profound effects on their well-being, as demonstrated by their relative disadvantages in socioeconomic status on the one hand, and in their delayed demographic and epidemiological transitions on the other. In this study one aspect of aboriginals' epidemiological situation is examined: their mortality experience between the early 1980s and early 1990s. The groups studied are the Canadian Indians, the American Indians and the New Zealand Maori (data for Australian Aboriginals could not be obtained). Cause-specific death rates of these three minority groups are compared with those of their respective non-indigenous populations using multivariate log-linear competing risks models. The empirical results are consistent with the proposition that the contemporary mortality conditions of these three minorities reflect, in varying degrees, problems associated with poverty, marginalization and social disorganization. Of the three minority groups, the Canadian Indians appear to suffer more from these types of conditions, and the Maori the least.
L'A. compare les effets de la critique postmoderne dans deux champs disciplinaires differents, la psychologie et l'anthropologie culturelle. Il suggere qu'en raison de la methodologie specifique de la psychologie, celle-ci a pu faire face de facon plus constructive et positive a la critique postmoderne et qu'elle peut ainsi inspirer l'anthropologie pour mieux resister cette critique. Il tente de montrer que dans la critique postmoderne, les bebes de l'empirisme et de la generalisation scientifique ont ete jete avec les eaux du bain : l'objectivite, l'homogeneite et l'unite culturelle, les faits et la verite scientifiques, l'Alterite, et la science comme activite apolitique. Selon l'A., reconnaitre la pertinence de la critique postmoderne envers ces six hypotheses, d'une part, ne remet pas forcement en cause la methodologie empirique et, d'autre part, n'entraine pas necessairement la redefinition de l'anthropologie comme litterature.
Accounts of the nature, cause, and course of mental illness and self-labeling are explored as interdependent domains with a cohort of individuals diagnosed as having major psychiatric disorders. Explanations and descriptions of mental illness and propensities to self-label are shown to be interrelated in a multidirectional, multidimensional manner. Normalizing talk and illness accounts that are both patterned and diverse, and both stable and variable over time, pervade the discourse of individuals in the cohort. Sociocultural factors, particularly social race, gender, and type of illness explanation, have a stronger association with self-labeling than clinical factors, such as formal diagnosis. The concepts of “illness-identity work” and “illness-identity talk” are developed as a means for exploring self and sickness among persons with chronic illnesses.
Race and ethnicity are variables frequently used in medical research. However, researchers employ race and ethnicity in different ways and with differing intent. This leads to confusion over the interpretation of racial or ethnic differences. This study sought to determine how race and ethnicity are used in research on infant mortality.
We did a structured literature review of original research related to infant mortality published between January 1995 and June 1996 and indexed in the Core Contents section of MEDLINE.
The majority of articles (54%) mentioned race and ethnicity. US studies mentioned race or ethnicity more than non-US studies (80% versus 22%). Only one study defined the method used to determine the ethnicity of patients; no study defined race or the methodology used in determining patients' race. Researchers primarily used race and ethnicity to describe study populations. Some racial and ethnic identifiers may have been stigmatizing to the subjects studied. The second most common use of race or ethnicity was as a potential confounder. Only one article discussed racism as a contributing factor in infant mortality.
There are several problems and ambiguities in the use of race and ethnicity in clinical research. Researchers who use racial or ethnic categories should do so for specified reasons and adopt clear definitions of the categories used.
To examine assumptions underlying federal health statistics on racial and ethnic groups in the United States.
Studies conducted by federal agencies and other investigators, and technical appendices of published vital statistics and census reports.
Several assumptions underlying federal health statistics on racial and ethnic groups are not well supported. Conceptual (as opposed to operational) definitions of race and ethnicity are not available, and scientific grounds for definition are not considered. Procedures for the ascertainment of race and ethnicity vary within and among data-collection agencies. Miscounting and misclassification may vary by an order of magnitude between whites and other races. The responses of individuals to questions of racial and ethnic identity differ for different indicators, in different surveys, and at different times. As a result, counts, rates, and rate ratios may not be meaningful or accurate. Particularly for Hispanics and for races other than whites or blacks, there are inconsistencies in statistical information that may hinder health research and program development.
Improvement of federal health statistics for racial and ethnic groups requires (1) clarification of goals for classification, (2) adoption of scientific principles for the validation and definition of the categories "race" and "ethnicity," (3) assessment of perceived social identity in the population, and (4) periodic evaluation.
This article reports on a study of perceptions of breast and cervical cancer risk factors among 27 U.S.-born Chicanas, 39 Mexican and 28 Salvadoran immigrants, 27 Anglo women, and 30 physicians in northern Orange County, California. In open-ended responses explaining why women might be at risk for both cancers, Latinas expressed two general themes: physical stress and trauma to the body, and behavior and lifestyle choices. Interviewees ranked the specific risk factors that they themselves mentioned. Cultural consensus of ranked data revealed that Mexican and Salvadoran immigrants had a model of cancer risks that was different from those of Anglo women and physicians. U.S.-born Chicanas were bicultural in their views, which overlapped with both Mexican women's and Anglo women's views, but less so with physicians' views. Comparing views about the two cancers revealed that general themes apply across both cancers, that Latina immigrants agreed less on the risk factors for cervical cancer than for breast cancer, and that there is a consistent pattern in the different ways Latinas, Anglos, and physicians perceive risk factors for both cancers.
Epidemiologic studies of racial differences sorely lack sound and explicit hypotheses. Race is a social convention, not a biological concept. Its careless use in epidemiology demonstrates a failure to generate appropriate hypotheses to study its role in health. Studies of hypertension in blacks illustrate the point. Two underlying pitfalls plague hypothesis generation: directionality involving the null and alternative hypotheses and circularity, where efforts to understand social factors have the effect of emphasizing racial differences. The proper prescription is to identify explicitly the hypotheses of interest, including their origins and implication.
This book shows how practitioners in the emerging field of 'cultural epidemiology' describe human health, communicate with diverse audiences, and intervene to improve health and prevent disease. It uses textual and statistical portraits of disease to describe past and present collaborations between anthropology and epidemiology. Interpreting epidemiology as a cultural practice helps to reveal the ways in which measurement, causal thinking, and intervention design are all influenced by belief, habit, and theories of power. By unpacking many common disease risks and epidemiologic categories, this book reveals unexamined assumptions and shows how sociocultural context influences measurement of disease. Examples include studies of epilepsy, cholera, mortality on the Titanic, breastfeeding, and adolescent smoking. The book describes methods as varied as observing individuals, measuring social networks, and compiling data from death certificates. It argues that effective public health interventions must work more often and better at the level of entire communities.
In this essay, I suggest that American sociocultural anthropology has been a "color blind" profession for nearly a half century and that, as a discipline, we need to restore and refine our color perceptions in order to fight the supposedly fixed opposition in American society between "black" and "white" and deal with the racist consequences of this folk opposition. In the first section, "How Anthropology Became 'Color Blind,'" I delineate the circumstances under which anthropology became the "color blind" profession. In the second section, "Teaching Color Blindness," I discuss the tendency, in teaching sociocultural anthropology, to ignore racism and its effects. In the final section, "Restoring Color Vision," I take up the questions of what the profession needs to do next to cope with racism and its consequences, emphasizing especially the issue of group identities, how they are formulated, inculcated, and overcome, and proposing a Foucauldian model - following Foucault's lead in analyzing relations of biopower and race - for formulating new ways of responding to and resisting the inevitable recastings of racist ideas.
This article poses the question of the social and intellectual conditions for genuine social scientific internationalism, through an analysis of the worldwide spread of a new global vulgate resulting from the false and uncontrolled universalization of the folk concepts and preoccupations of American society and academe. The terms, themes and tropes of this new planetary doxa - 'multiculturalism', 'globalization', 'liberals versus communitarians', 'underclass', racial 'minority' and identity, etc. - tend to project and impose on all societies American concerns and viewpoints, thereby transfigured into tools of analysis and yardsticks of policy fit to naturalize the peculiar historical experience of one peculiar society, tacitly instituted as a model for humanity. The article suggests how the logic of the international circulation of ideas, the transformations of the academic field, the strategies of foundations and publishers, and of local collaborators in global conceptual 'import-export' converge to foster a particularly powerful and pernicious form of cultural imperialism of which academics are at once perpetrators and victims.
Pathologies of Power uses harrowing stories of life--and death--in extreme situations to interrogate our understanding of human rights. Paul Farmer, a physician and anthropologist with twenty years of experience working in Haiti, Peru, and Russia, argues that promoting the social and economic rights of the world's poor is the most important human rights struggle of our times. With passionate eyewitness accounts from the prisons of Russia and the beleaguered villages of Haiti and Chiapas, this book links the lived experiences of individual victims to a broader analysis of structural violence. Farmer challenges conventional thinking within human rights circles and exposes the relationships between political and economic injustice, on one hand, and the suffering and illness of the powerless, on the other. Farmer shows that the same social forces that give rise to epidemic diseases such as HIV and tuberculosis also sculpt risk for human rights violations. He illustrates the ways that racism and gender inequality in the United States are embodied as disease and death. Yet this book is far from a hopeless inventory of abuse. Farmer's disturbing examples are linked to a guarded optimism that new medical and social technologies will develop in tandem with a more informed sense of social justice. Otherwise, he concludes, we will be guilty of managing social inequality rather than addressing structural violence. Farmer's urgent plea to think about human rights in the context of global public health and to consider critical issues of quality and access for the world's poor should be of fundamental concern to a world characterized by the bizarre proximity of surfeit and suffering.
This article poses the question of the social and intellectual conditions for genuine social scientific internationalism, through an analysis of the worldwide spread of a new global vulgate resulting from the false and uncontrolled universalization of the folk concepts and preoccupations of American society and academe. The terms, themes and tropes of this new planetary doxa - `multiculturalism', `globalization', `liberals versus communitarians', `underclass', racial `minority' and identity, etc. - tend to project and impose on all societies American concerns and viewpoints, thereby transfigured into tools of analysis and yardsticks of policy fit to naturalize the peculiar historical experience of one peculiar society, tacitly instituted as a model for humanity. The article suggests how the logic of the international circulation of ideas, the transformations of the academic field, the strategies of foundations and publishers, and of local collaborators in global conceptual `import-export' converge to foster a particularly powerful and pernicious form of cultural imperialism of which academics are at once perpetrators and victims.
Amniocentesis is one of the new reproductive technologies, and a new health profession, the genetic counselor, has been developed to communicate medical information to patients about its risks and benefits. In this article I examine the language of genetic counseling as it communicates and miscommunicates not only medical information but also structural power arrangements, social knowledge, and popular meanings about medically defined disability. The analysis—based on two years of field-work in New York City hospitals observing amniocentesis intake interviews, interviewing 30 genetic counselors, and visiting scores of pregnant patients at home—focuses on the multiple understandings that arise at the intersection of professional and popular knowledge in contemporary American life.
Anthropology, despite its historic role in both creating and dismantling the American racial worldview, seems barely visible in contemporary scholarly and public discussions of "race." The authors argue that race should once again be central to anthropological inquiry, that cultural and physical anthropologists must jointly develop and publicly disseminate a unified, uniquely anthropological perspective. They suggest ways to proceed and identify internal barriers that must be overcome before the anthropological voice can be heard.
Analysis of physical anthropology textbooks published in the United States in the years 1932-79 reveals a significant decline in support for the race concept, expecially in the 1970s. Before 1970 the great majority of texts expressed the view that races exist and that the race concept is a valid tool for the description and study of human variation. In the 1970s an increasing proportion of texts rejected the race concept, with the no-race view becoming the most frequent one by 1975-79. Although the accumulation of new knowledge about human variation has contributed to the dramatic shift in textbook treatments of race, we argue that changes in the social context of anthropology have also been important. The political milieu of the 1960s coupled with the rapid institutional expansion of anthropology and the changing sociocultural characteristics of anthropologists and their students have contributed to the decline of the race concept in physical anthropology textbooks.
Objective:
To evaluate the impact of the National Healthy Lifestyle Programme, a noncommunicable disease intervention programme for major cardiovascular disease risk factors in Singapore, implemented in 1992.
Methods:
The evaluation was carried out in 1998 by the Singapore National Health Survey (NHS). The reference population was 2.2 million multiracial Singapore residents, 18-69 years of age. A population-based survey sample (n = 4723) was selected by disproportionate stratified and systematic sampling. Anthropometric and blood pressure measurements were carried out on all subjects and blood samples were taken for biochemical analysis.
Findings:
The 1998 results suggest that the National Healthy Lifestyle Programme significantly decreased regular smoking and increased regular exercise over 1992 levels and stabilized the prevalence of obesity and diabetes mellitus. However, the prevalence of high total blood cholesterol and hypertension increased. Ethnic differences in the prevalence of diabetes mellitus, hypertension, and smoking; and in lipid profile and exercise levels were also observed.
Conclusion:
The intervention had mixed results after six years. Successful strategies have been continued and strengthened.
Racial and ethnic minorities tend to receive a lower quality of healthcare than non-minorities, even when access-related factors, such as patients' insurance status and income, are controlled. The sources of these disparities are complex, are rooted in historic and contemporary inequities, and involve many participants at several levels, including health systems, their administrative and bureaucratic processes, utilization managers, healthcare professionals, and patients. Consistent with the charge, the study committee focused part of its analysis on the clinical encounter itself, and found evidence that stereotyping, biases, and uncertainty on the part of healthcare providers can all contribute to unequal treatment. The conditions in which many clinical encounters take place- characterized by high time pressure, cognitive complexity, and pressures for cost-containment—may enhance the likelihood that these processes will result in care poorly matched to minority patients' needs. Minorities may experience a range of other barriers to accessing care, even when insured at the same level as whites, including barriers of language, geography, and cultural familiarity. Further, financial and institutional arrangements of health systems, as well as the legal, regulatory, and policy environment in which they operate, may have disparate and negative effects on minorities' ability to attain quality care. A comprehensive, multi-level strategy is needed to eliminate these disparities. Broad sectors—including healthcare providers, their patients, payors, health plan purchasers, and society at large—should be made aware of the healthcare gap between racial and ethnic groups in the United
In August 1992, cholera broke out in Mariusa, a community in the Venezuelan Orinoco delta primarily inhabited by Warao indigenas. This epidemic and its aftermath are brilliantly analyzed in this provocative book.
Causing violent diarrhea and vomiting, cholera can lead to death within hours. It is relatively easy to treat and prevent, but the Mariusans did not know that. Their healers could not cure them and outstanding narrators were unable to speak as terror made "a mockery of sense-making" (p. 77). When a highly respected healer died, Mariusans fled in panic. Some managed to reach a small clinic; in a central chapter of this book, physician Clara Mantini-Briggs describes the days she fought the dirt and smell of death here.
Too terrified to return to their homes, the survivors attempted to flee to a nearby city, but they were rounded up by the military and placed in quarantine. This not only violated their rights as Venezuelan citizens but also went against the recommendations of the World Health Organization (WHO): isolation cannot prevent cholera from spreading. The epidemic continued, but since doctors lacked essential laboratory equipment, they could not perform the tests necessary to confirm the cases, enabling officials to evade WHO requirements that cholera must always be reported. The actual number of victims is unknown; perhaps five hundred delta residents died from cholera during 1992 and 1993.
Other political and medical failures also made this catastrophe possible. The belated information campaigns that were launched were largely directed at middle-class Venezuelans. The indigenas, on the other hand, were blamed for spreading the disease: they were superstitious, ate raw shellfish, and refused modern hygiene. An "at risk" population was identified, as cultural and racial stereotypes were turned into scientific knowledge. Anthropological works—including Charles Briggs's own studies of Warao medical practices and songs—were used as evidence. Once identified, the ingredients of this discourse of blame kept circulating in the form of "stories, images, policies, manuals, and statistics" (p. xvi). But no blame was placed on governmental failures to provide people with clean water, schools, and health services.
Indigenas did not accept that they were at fault. They staged protest marches and explained the epidemic in alternate ways: it was caused by angry spirits (hebu), by illegal oil spills, by transnational commerce in the wake of the Gulf War, or by poisonous American "superbacteria." But the media ignored their marches and explanations—explanations that can be said to contain deep metaphoric truths at a time when global companies gained increasing hold on the world economy, a time when conditions worsened for many of the poor. For the people of the Orinoco delta, the cholera epidemic inaugurated a decade of mounting hardships, and many became homeless due to the expansion of the petroleum industry. Yet, little was done to improve their situation, and cholera struck again: in 1996, 1997, and 1998. Now even fewer medical resources than before were available; the media were silent as people were dying.
This is a voluminous book, rich in data, perspectives, and analytical linkages. Two topics are central. One is stories, storytelling, and the circulation of stories. Narrators are quoted at length and they step forward as complex individuals, be they cholera victims, vernacular healers, medical doctors, politicians, journalists, scholars, international health workers, priests, or others. It is by quoting and analyzing the words of storytellers that the authors show how the discourse of blame was constructed. Through the stories, they also present a nuanced picture of the multitude of voices and wills involved in the tragedy. In this way, they challenge all simplified dichotomies.
At the same time, however, the authors demonstrate how the discourse of blame can be understood in the light of a conceptual pair that constitutes another topic that is central to this book: sanitary citizens versus unsanitary subjects. Sanitary citizens are the moderns who understand the value of scientific health care, hygiene, and schooling. Unsanitary subjects are the defective premoderns who do not understand this and who belong in a "natural habitat." Casting indigenas in this role made it possible to incarcerate them and to exclude them from full participation in social and political life. But the distinction...
This article presents a systematic ethnographic study of emic ethnic classification in Puerto Rico, including a replication and extension of Marvin Harris's (1970) seminal study in Brazil. I address three questions: (1) what are the core emic categories of color? (2) what dimensions of semantic structure organize this cultural domain? and (3) is the assumption of a shared cultural model justified? Data are from two sets of ethnographic interviews in southeastern Puerto Rico, including 23 free listing interviews and 42 structured interviews using Harris's standardized facial portraits. Results indicate a small core of salient emic categories with well-defined semantic structure and high interinformant agreement, reflecting shared cultural understandings of color. I discuss how systematic ethnographic methods can contribute to comparative research on ethnic classification.
Ethnographies, particularly from Southern Africa, often suggest that there is a single notion of pollution as a state of ‘ritual’ impurity, which in medical anthropology can be found as an etiological category. While ‘the’ notion of pollution is often used as a tool in social and cultural analysis, it is rarely considered as an object of analysis, i.e. there is a failure to problematize it. In this paper we argue that in Southern African ethnomedicine, competing notions of pollution can be found. Drawing on preliminary research into the emic illness category ‘dirty wombs’ we suggest that, in addition to pollution being a state or etiological category, there are categories of diseases related to pollution which themselves have etiologies, and that, in parts of the Southern African region, there is a notion of non‐ritual pollution which is an ethno‐pathological process, a general idiom through which disease is expressed.
Any thorough understanding of the modern epidemics of AIDS and tuberculosis in Haiti or elsewhere in the postcolonial world requires a thorough knowledge of history and political economy. This essay, based on over a decade of research in rural Haiti, draws on the work of Sidney Mintz and others who have linked the interpretive project of modern anthropology to a historical understanding of the large-scale social and economic structures in which affliction is embedded. The emergence and persistence of these epidemics in Haiti, where they are the leading causes of young-adult death, is rooted in the enduring effects of European expansion in the New World and in the slavery and racism with which it was associated. A syncretic and properly biosocial anthropology of these and other plagues moves us beyond noting, for example, their strong association with poverty and social inequalities to an understanding of how such inequalities are embodied as differential risk for infection and, among those already infected, for adverse outcomes including death. Since these two diseases have different modes of transmission, different pathophysiologies, and different treatments, part of the interpretive task is to link such an anthropology to epidemiology and to an understanding of differential access to new diagnostic and therapeutic tools now available to the fortunate few. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Advances in biocultural research have been hampered by the lack of an explicit theory of culture. Culture can be viewed as a collection of cultural models of specific domains with empirically verifiable distributions within a social group. Individuals are variably able to approximate these models in their own beliefs and behavior, a concept referred to as “cultural consonance.” Cultural consonance is hypothesized to be associated with psychophysiologic outcomes, including blood pressure and depressive symptoms. In this article, the cultural domain of family life in Brazil is used to illustrate both the concept and measurement of cultural consonance. It is associated with arterial blood pressure and depressive symptoms, controlling for covariates and other explanatory variables. This theoretical orientation can define more precisely the cultural in the biocultural.
In this essay, I suggest that American sociocultural anthropology has been a "color blind" profession for nearly a half century and that, as a discipline, we need to restore and refine our color perceptions in order to fight the supposedly fixed opposition in American society between "black" and "white" and deal with the racist consequences of this folk opposition. In the first section, 'How Anthropology Became 'Color Blind,'" I delineate the circumstances under which anthropology became the "color blind" profession. In the second section, "Teaching Color Blindness," I discuss the tendency, in teaching sociocultural anthropology, to ignore racism and its effects. In the final section, "Restoring Color Vision," I take up the questions of what the profession needs to do next to cope with racism and its consequences, emphasizing especially the issue of group identities, how they are formulated, inculcated, and overcome, and proposing a Foucauldian model—following Foucault's lead in analyzing relations of biopower and race—for formulating new ways of responding to and resisting the inevitable recastings of racist ideas,
This article presents findings of ethnographic research in the San Francisco Bay Area, exploring the recent phenomenon of Asian American women undergoing cosmetic surgery to have their eyelids restructured, their nose bridges heightened, and the tips of their noses altered. This research suggests that Asian American women who undergo these types of surgery have internalized not only a gender ideology that validates their monetary and time investment in the alteration of their bodies, but also a racial ideology that associates their natural features with dullness, passivity, and lack of emotion. With the authority of scientific rationality, medicine effectively promotes these racial and gender stereotypes and thereby bolsters the consumer-oriented society, of which it is apart and from which it benefits. Data are drawn from structured interviews with plastic surgeons and patients, medical literature and newspaper articles, and basic medical statistics.
Anthropology, with its dual emphasis on biology and culture, is--or should be--the discipline most suited to the study of the complex interactions between these aspects of our lives. Unfortunately, since the early decades of this century, biological and cultural anthropology have grown distinct, and a holistic vision of anthropology has suffered. This book brings culture and biology back together in new and refreshing ways. Directly addressing earlier criticisms of biological anthropology, Building a New Biocultural Synthesis concerns how culture and political economy affect human biology--e.g., people's nutritional status, the spread of disease, exposure to pollution--and how biological consequences might then have further effects on cultural, social, and economic systems. Contributors to the volume offer case studies on health, nutrition, and violence among prehistoric and historical peoples in the Americas; theoretical chapters on nonracial approaches to human variation and the development of critical, humanistic and political ecological approaches in biocultural anthropology; and explorations of biological conditions in contemporary societies in relationship to global changes. Building a New Biocultural Synthesis will sharpen and enrich the relevance of anthropology for understanding a wide variety of struggles to cope with and combat persistent human suffering. It should appeal to all anthropologists and be of interest to sister disciplines such as nutrition and sociology. Alan H. Goodman is Professor of Anthropology, Hampshire College. Thomas L. Leatherman is Associate Professor of Anthropology, University of South Carolina.
1st Issued as a Paperback Bibliogr. s. 191-197
Journal of Health Politics, Policy and Law 27.3 (2002) 513-516
What should priority research areas be for the National Institutes of Health (NIH)? Is NIH currently overlooking critical, promising research? Does the structure of NIH impede the charting of future directions that might pay large dividends?
The confluence of three factors make such questions as these particularly salient. First, choices about how research dollars are apportioned now may help determine the existence of future treatments as well as overall health care costs. These are significant matters at any time, but especially so in the present political climate with the growing concern over the soaring national health care bill. Second, the magnitude of the federal government research enterprise elevates its decision making regarding research priorities to the level of a critical issue. The federal government is the single largest sponsor of medical research, and the vast majority of its research money is appropriated to NIH. A bipartisan congressional drive, currently proceeding successfully, may double NIH's annual budget over five years, from $13 billion in 1998 to $26 billion by 2003, and as NIH receives larger shares of the budgetary pie, the stakes regarding the spending of its money increase. Third, discontent with NIH's priority-setting criteria has exploded recently, with various constituencies pressuring NIH for explanations, justifications, and modifications (Johnson 1998; Marshall 1997). Disease-advocacy groups, for instance, increasingly have complained that their disease fails to get a fair share of funds. Congress, hearing these protests and with allocation concerns of its own, in 1997 requested the Institute of Medicine (IOM) to study NIH priority setting (U.S. Congress 1997).
In New Horizons in Health: An Integrative Approach, the Committee on Future Directions for Behavioral and Social Sciences Research at NIH presents recommendations and a research plan for NIH regarding behavioral and social sciences. The committee, created by the National Research Council (NRC) at the request of NIH's Office of Behavioral and Social Sciences Research (OBSSR), comprises fifteen scientists with records in multidisciplinary research from diverse backgrounds and fields of expertise. The committee's report is a commissioned study, intended to guide NIH in supporting priority areas in the behavioral and social sciences.
Not surprisingly, considering the committee's origin, a major argument of New Horizons in Health is that behavioral and social sciences, which currently capture limited attention or are viewed as peripheral at some NIH institutes, merit a greater research investment. The Committee on Future Directions contends that this research is fundamental to developing a comprehensive understanding of disease etiology and holds broad significance for multiple disease outcomes and health promotion. To realize the potential, greater integration of biomedical sciences on the one hand and behavioral and social sciences on the other hand is critical; in other words, the suggestion is that NIH institutionalize a new approach, integrating biomedical and social behavioral fields of inquiry. More specifically, the study recommends ten priority areas for research investment to integrate these fields at NIH and furnishes a thorough discussion of each of these areas. The ten thematic priorities, satisfying "the complementary demands of high scientific payoff and response to pressing health concerns" (2), are predisease pathways, positive health, gene expression, personal ties, healthy communities, inequality, population health, interventions, methodology, and infrastructure.
The report by the Committee on Future Directions has obvious strengths. It offers an in-depth and serious exploration of the potential contributions of behavioral and social sciences research to the NIH mission and, as intended, should help to dispel the notion that this research is in any way peripheral to NIH. The comprehensive examination of the ten recommended priorities also succeeds in reinforcing the reader's appreciation of the broad significance of behavioral and social sciences research for multiple diseases and health promotion more generally. In addition, clarity and detail characterize the arguments throughout the report. The editors purposefully and carefully discuss complex issues and their interrelationships...
The routine presentation of epidemiologic data by "race" has been challenged as impeding identification of modifiable risk factors and fostering an unsubstantiated belief in the biologic distinctness of the "races." This study examines the past and current uses of "race" in US epidemiologic research. The authors reviewed every paper published in the 1921, 1930, 1940, 1950, and 1960 volumes of the American Journal of Hygiene and in the 1965, 1970, 1975, 1980, 1985, and 1990 volumes of the American Journal of Epidemiology. Of the total of 1,200 papers published during the sample years, 558 reports of original epidemiologic research conducted in the United States were identified. The proportion of these papers containing a reference to "race" rose steadily from 1975. However, the proportion of papers reporting inclusion of "nonwhite" populations did not show a parallel increase. Exclusion of "nonwhite" subjects and description of predominantly "white" study populations increased instead. Recommendations for future epidemiologic practice include the following: 1) greater inclusion of "nonwhite" populations in epidemiologic research and 2) vigorous investigation of the root causes of observed "race"-associated differences.
The resonance between scientific theory and ideology is starkly revealed by the medical debate on slavery, alleged black inferiority, and racial differences in disease: opposing doctors invoked the same science, but relied on contrary assumptions, to reach antagonistic conclusions. Reductionist, biological determinist, and ahistorical premises underlay the dominant belief that innate racial differences led to black bondage and racial disparities in health; an anti-reductionist and historical approach supported the minority view that social factors rooted in the planters' need for cheap labor explained both. From 1830 to 1850, doctors debated the accuracy, validity, and interpretation of their findings. In the 1850s, "apolitical" doctors sought to purge medicine of politics to regain scientific objectivity, yet the first generation of black physicians argued that politics inevitably affected medical inquiry. The Civil War and Emancipation spurred studies relating the health of blacks and poor whites to social conditions, while the destruction of Reconstruction led to the resurgence of racist medicine. Comprehending how politics set the terms and tempo of this polemic can provide insight into current controversies on racial differences in disease.
Use of the category of race in epidemiologic research presupposes scientific validity for a system that divides man into subspecies. Although the significance of race may be clear-cut in many practical situations, an adequate theoretical construct based on biologic principles does not exist. Anthropologists have in large measure abandoned the biologic concept of race, and its persistent widespread use in epidemiology is a scientific anachronism. The assumption that race designates important genetic factors in a population is in most cases false. Racial definitions should be seen as primarily social in origin and should be clues to environmental-rather than genetic-causes of disease. An understanding of the social forces leading to racial differentials in health will give further direction to preventive campaigns.
This study examined ways in which race/ethnicity has been conceptualized and used in the health services research literature as published in Health Services Research (HSR).
All articles published in HSR from its inception in 1966 to 1990.
The analyses were restricted to U.S.-based empirical research on humans or in which human population characteristics are described. This study identifies the terms used for race and/or ethnicity, the frequency with which they occur, and the purposes for which they are utilized.
The study documents that race/ethnicity is widely used in the health services literature to stratify or adjust results and to describe the sample or population of the study. Terms used for race are seldom defined and race is frequently employed in a routine and uncritical manner to represent ill-defined social and cultural factors.
Researchers and practitioners must give more careful attention to the conceptualization and measurement of race. An understanding of racial/ethnic differences in patterns of health service utilization will require efforts to catalog and quantify the specific social and cultural factors that are differentially distributed by racial and ethnic status.
Contemporary urban societies display in high relief the action of social stratification on human biology. Recent studies of biological responses to urban environments and of socioeconomically disadvantaged people indicate that culture allocates risks disproportionately to some individuals and groups within society through its constituent values and related patterns of behavior. Although risk allocation is present in all societies, it is very clear in urban environments within stratified societies where high exposure to harmful materials is many times more likely for some segments of society. In urban environments, culture may be seen as adding stressors to the environment by concentrating naturally occurring materials to levels that are toxic to humans and through the creation of new toxic materials. In stratified societies the risk of exposure to these new stressors is focused on the socioeconomically disadvantaged. This exposure has consequences that increase the likelihood of more exposure and more socioeconomic disadvantage, thereby increasing social stratification. This suggests that models of biocultural interaction include a feedback relationship in which biological factors influence the sociocultural system in addition to the usual action of the sociocultural system on biological features and responses. This model strongly reinforces the view that stressors can originate from cultural arrangements.