Critical Medical Anthropology


Definition


Critical medical anthropology is a theoretical approach within medical anthropology that uses a critical theoretical framework and focuses on the political economy of health and health care. Political economy, from an anthropological perspective, includes the study of producing and exchanging goods, and the influence of government policy and capitalism on all aspects of life. When applied to studying health and health care, the political economy of health may include ways in which health services are differentially allocated based on wealth, and ways in which policy impacts health and delivery of health services. Political economy of health is a central component of critical medical anthropology, and a critical approach to medical anthropology seeks to uncover hidden causes of poor health as they relate to capitalism and neoliberal economics while examining health structures on a macro and micro level.[1]

Key Figures


Critical medical anthropology (CMA) has been strongly shaped by medical anthropologist Merrill Singer. Singer promotes using CMA as an approach to researching health because of its applied focus, noting that medical anthropologists must critically question how situations for their research participants can be improve.[2] CMA is therefore a theoretical lens to inspire action and engagement in what Singer terms “system-challenging praxis”;[3] that is, actions undertaken in order to challenge larger structures with the goal of producing a meaningful social change. Engaging in system-challenging praxis involves “unmasking the origins of social inequity,[4] and exposing the relationship between social inequity and living and working conditions. Singer is also known for pioneering the term syndemic.

Nancy Scheper-Hughes is also an important figure in critical medical anthropology, arguing that CMA combines the intersections of personal, social, and political bodies.[5] Scheper-Hughes notes the shortcomings in the work of some social anthropologists and argues that social anthropology fails to explore the meaning of the body beyond a symbol upon which social meaning is inscribed.[6] Similarly, Scheper-Hughes claims that some theorists ignore individual perspectives about illness, highlighting theorist Michel Foucault’s work on biopower. Foucault defines biopower as the inseparability of the body from the will of the political apparatus (the State). Scheper-Hughes argues that Foucault describes the body in a way that is “devoid of subjectivity," [7] or lacking in a description that encompassesindividual perspectives. CMA, however, fills the voids left by earlier social anthropologists and cultural theorists by understanding that the body is the “terrain where social truths are forged and social contradictions played out, as well as the locus of personal resistance, activity, and struggle.[8] In other words, CMA understands that the body and the patient are impacted by larger, unseen social forces but that individuals also have a stake in their bodies, and are not simply agents to these larger social forces. Critical medical anthropology therefore blends an understanding of how structural forces are acted upon the body with an acknowledgement of individual agency.

Critique


Critiques of critical medical anthropology have come from scholars like Barbara and John Ehrenreich, who argue that the political economy of health perspective views medicine as “a desirable but poorly distributed commodity.[9] This type of critique recognizes that CMA is a materialist (concerned with material, in this case wealth and how it impacts access to care) approach to analyzing health structures, and other types of medical anthropology instead explore patient-clinic experiences and more phenomenological experiences of health, illness, and treatment.

Example


Critical medical anthropologists conduct research with many types of populations, including those who do not always have access to health care, such as undocumented immigrants in the United States. On a micro and macro level, examining immigrant health can include exploring how immigrants earn wages to purchase health care and sustain a healthy lifestyle (e.g. maintaining a nutritious diet). Unauthorized immigrants typically work in low-paying jobs in the service or agricultural economies, and these low-paying jobs do not generally pay enough for unauthorized immigrants to purchase private insurance. Moreover, the wages in these jobs are so low that unauthorized immigrants must often make difficult choices with their limited resources, and this often includes buying cheaper, less nutritious food over more expensive but more nutritious food. The inability to purchase nutritious food can lead to larger health problems, such hypertension or diabetes. This scenario demonstrates how health problems on a micro-level may occur as a result of working in a low-paying job, which is a macro-level problem, since market forces control low wages in the absence of policy to ensure better wages. Health care among unauthorized immigrants demonstrates ways in which CMA explores both macro and micro-level impacts of health and can be useful in gaining a holistic understanding of a particular problem.

Current Work


Paul Farmer is an influential figure practicing critical medical anthropology today. Farmer is trained as both an anthropologist and a medical doctor, based out of Harvard University. He co-founded partners in health, an organization that aims to “raise the standard of care for the poor everywhere,” and employs critical theory to understand the inequality in care experienced worldwide. [10] His books include Infections and Inequalities: The Modern Plagues[11]




Mark Nichter, a professor at the University of Arizona, “studies illness and healing as entry points for understanding ‘culture and socitey’ as well as ideology and disparity in the distribution of resources and different forms of capital.” He is well known for studying nicotine habits among youth and tuberculosis in the Philippines.[12]


Further Reading



  • Baer, Hans. 1982 On the Political Economy of Health. Medical Anthropology Newsletter 14(1): 1-17.
  • Benyshek DC, Martin JF, Johnston CS. 2001 A reconsideration of the origins of the type 2 diabetes epidemic among Native Americans and the implications for intervention policy. Medical Anthropology. 20(1):25-64
  • Himmelgreen DA, Romero Daza N, Vega M, Brenes Cambronero H, Amador E. (2006) ‘The Tourist Season Goes Down But Not the Prices.’ Tourism and Food Insecurity in Rural Costa Rica, Ecology of Food and Nutrition 45(4):295-321.
  • Morsy, Soheir. 1979 The Missing Link in Medical Anthropology: The Political Economy of Health. Reviews in Anthropology 6(3): 349-363.
  • Pfeiffer, James and Mark Nichter. 2008 What Can Critical Medical Anthropology Contribute to Global Health? Medical Anthropology Quarterly 22 (4): 410-415.
  • Wakefield, Melanie, Brian Flay, Mark Nichter, and Gary Giovino (2003). Role of the media in influencing trajectories of youth smoking. 98(s1): 79-103.


References


  1. ^ Singer, Merrill. (1995). Beyond the Ivory Tower: Critical Praxis in Medical Anthropology. Medical Anthropology Quarterly 9(1):80-106.
  2. ^ Singer, Merrill. (1995). Beyond the Ivory Tower: Critical Praxis in Medical Anthropology. Medical Anthropology Quarterly 9(1):80-106.
  3. ^ Singer, Merrill. (1995). Beyond the Ivory Tower: Critical Praxis in Medical Anthropology. Medical Anthropology Quarterly 9(1):80-106.
  4. ^ Singer, Merrill. (1995). Beyond the Ivory Tower: Critical Praxis in Medical Anthropology. Medical Anthropology Quarterly 9(1):80-106.
  5. ^ Scheper-Hughes, Nancy. (1994). Embodied Knowledge: Thinking with the Body in Critical Medical Anthropology. In Assessing Cultural Anthropology, Rob Borofsky, ed. New York: McGraw-Hill, pp 229-242.
  6. ^ Scheper-Hughes, Nancy. (1994). Embodied Knowledge: Thinking with the Body in Critical Medical Anthropology. In Assessing Cultural Anthropology, Rob Borofsky, ed. New York: McGraw-Hill, pp 229-242.
  7. ^ Scheper-Hughes, Nancy. (1994). Embodied Knowledge: Thinking with the Body in Critical Medical Anthropology. In Assessing Cultural Anthropology, Rob Borofsky, ed. New York: McGraw-Hill, pp 229-242.
  8. ^ Scheper-Hughes, Nancy. (1994). Embodied Knowledge: Thinking with the Body in Critical Medical Anthropology. In Assessing Cultural Anthropology, Rob Borofsky, ed. New York: McGraw-Hill, pp 229-242.
  9. ^ Morgan, Lynn. (1998). Dependency Theory in the Political Economy of Health: An Anthropological Critique In The Art of Anthropology: Readings, Sjaak van der Geest, Adri Rienks, eds. Pp 106-119. Amerstam: Het Spinhuis
  10. ^ http://www.pih.org/pages/what-we-do/
  11. ^ Farmer, Paul (1999). Infections and Inequalities: The Modern Plagues, updated edition. Berkeley: University of California Press.
  12. ^ http://datamonster.sbs.arizona.edu/anthropology/people/display_fac_details.php?id=36