Applying an anthropological perspective in health

We recently came across this interesting article about "Teaching medical students to challenge ‘unscientific’ racial categories." Anthropologists and other critical social scientists have long known that even though race is a social construction, it can have very real impacts in people's lives -- including in accessing health and healthcare.

This article explores how medical students continue to be taught to use racial stereotypes based in biology as shortcuts for diagnosing and treating illness. It also follows the work of Dr. Brooke Cunningham, a physician and sociologist, who challenges these harmful practices in teaching medicine. For Dr. Cunningham and others, the point of these reforms is to push medical students and future health professionals to think critically about race, and how these social categories impact individual health through lived experiences and structures of inequality.

“It’s not that race is irrelevant to health, but it’s not relevant to health because of innate differences. It’s relevant because racism affects people’s health.”

Although medical students are often repeatedly told throughout their education that race should be approached critically and understood as a social not biological construct, what's telling are the reactions of students to Cunningham's lecture based on the authority of medicine over social science:

Students who attended her recent lecture on race said Cunningham’s medical degree gave her added credibility.
“I think if she was just a social scientist, I would be more skeptical of whatever perspective she would bring to the conversation,” said Mac Garrett, a first-year medical student.

These insights raise some important questions to consider in how anthropologists and other social scientists might consider communicating their findings in applied contexts. How might we think about how social science evidence and arguments are interpreted by those we wish to influence, in order to be more persuasive? In order to create social change in applied contexts -- like medical students' training -- should we draw more on the the authority of critical social scientists who also have the clout of a medical degree?

Quick links and further reading:

• Teaching medical students to challenge ‘unscientific’ racial categories (10 March 2016, Stat)
• You might want to check out our links to anthropologists working in the health professions on our Applying an anthropological perspective outside of university page

Water Politics Syllabus & Resources

We have been seeing some very interesting discussions and resources emerging around water politics recently.

Image from "The Rights of the Whanganui River" (Peeps)

In addition to the many discussions happening in relation to #NODAPL and the importance of water to indigenous communities and ways of life in North America, the struggles for access to clean and safe drinking water in places like Flint, Michigan and across reserves in Canada, in March, you may have read the news that a Māori community has been successful in their battle to have New Zealand grant the Whanganui River the legal rights of a person. (The anthropological magazine Peeps published a beautiful photo essay on "The Rights of the Whanganui River" in their second issue earlier this year -- unfortunately, not available online.)

In response to these shifts and public spotlights, we offer readers a couple of interesting resources for thinking and teaching about water politics.

First, we'd like to draw attention to the thematic issue of the Canadian journal of anthropology, Anthropologica, published this past fall (Volume 58, Issue 2): An Amphibious Anthropology: The Production of Place at the Confluence of Land and Water, guest edited by Karine Gagné and Mattias Borg Rasmussen. Contributors to this issue draw on their ethnographic research to share insights into water politics and issues in the Himalayas, Bhutan, Bangladesh, Peru, and North America.

Each of these articles from Anthropologica would be a valuable addition and anthropological contribution to this already well-rounded (anthropology, geography, environmental studies) syllabus: "Water Rights and Social Protest: Politics, Governance, and the Meanings of Access" designed by Jake Blanc and Stepha Velednitsky (graduate students at the Center for Culture, History, and Environment (CHE), Nelson Institute for Environmental Studies at the University of Wisconsin-Madison). 

Quick links and further reading:

• A New Zealand River Now Has The Legal Rights Of A Human (16 March 2017, NPR)
• Peeps magazine
• Karine Gagné and Mattias Borg Rasmussen (eds.). 2016. Anthropologica. Thematic Section: An Amphibious Anthropology: The Production of Place at the Confluence of Land and Water. 58(2). 
• The "Water Rights and Social Protest: Politics, Governance, and the Meanings of Access" syllabus
• This Cultures of Energy podcast episode featuring anthropologist Jessica Barnes (winner of a Wenner-Gren engaged anthropology grant) on water politics in Egypt
• anthro everywhere!'s page on Reading Lists & Syllabi Resources

Fieldwork: preparing for the good, bad, and the ugly

From Anthropology Matters come this article by Amy Pollard: "Field of screams: difficulty and ethnographic fieldwork."

As explained in the abstract, many novice field researchers -- here, PhD students -- are often unprepared for the emotional toll of this staple of our discipline: the long-term, immersive field research trip.

Ethnographic fieldwork can be a time of intense vulnerability for PhD students. Often alone and in an unfamiliar context, they may face challenges that their pre-fieldwork training has done little to prepare them for. This study seeks to document some of the difficulties that PhD anthropologists at three UK universities have faced. It describes a range of feelings as experienced by 16 interviewees: alone, ashamed, bereaved, betrayed, depressed, desperate, disappointed, disturbed, embarrassed, fearful, frustrated, guilty, harassed, homeless, paranoid, regretful, silenced, stressed, trapped, uncomfortable, unprepared, unsupported, and unwell. The paper concludes with a set of questions for prospective fieldworkers, a reflection on the dilemmas faced by supervisors and university departments, and a proposal for action.

This piece should be essential reading for all students and advisors, including the concluding "Questions for PhD students" and notes on Supervisor and Departmental Dilemmas.

Quick links and further reading:

• Amy Pollard, "Field of screams: difficulty and ethnographic fieldwork" (Anthropology Matters, 2009)
• Past anthro everywhere! posts on doing ethnography:
• Book Report Entry #1: Field notes: A Guided Journal for Doing Anthropology (20 February 2017)
• Doing anthropology everywhere (14 November 2016)
• Blogging for research (9 January 2017)
• Podcasting (ethnography) in the classroom (11 July 2016)
• Other Advice for Grad Students including on Grad Student Wellness (anthro everywhere!)

Climate Change Resource for the Classroom

Leonardo Di Caprio has given open access to his environmental documentary on climate change. Entitled Before the Flood, Di Caprio wants to engender a sense of urgency regarding climate change and to show us the role we can play.

Important to note is that there may be a time limit in which this documentary is available for free (perhaps this is just its availability on cable); however, according to EcoWatch.com: from Oct. 30 through Nov. 6, you can also watch it on just about any website or device where you regularly stream online videos. The exhaustive list includes: Natgeotv.com, YouTube, Facebook, Twitter, Amazon, iTunes, Hulu, Sony PlayStation, GooglePlay, VOD/Video On Demand (through MVPD set-top boxes), MVPD Sites and Apps, Nat Geo TV Apps (iPhone, iPad and Apple TV, Roku, Android phones, Xbox One and 360, Samsung Connected TVs) and more.
You can watch it right here.

Check it out with your classes for those in need of something timely and important.

Resource: Transitioning from high school to post-secondary education

Many students struggle with culture shock as they make the transition between high school and post-secondary education. New freedoms for many students living away from home for the first time also mean new responsibilities and stresses. To this end, teenmentalhealth.org has created their Transitions resource to provide students with information and support strategies. From their website:

“Transitions”, the first publication of its kind,  provides first-year students with information on topics including time management, relationships, sexual activity, mental illness, suicide and addictions. The guide also includes mental health self-help information and contains recommendations where students can go to get help on their campus. 

Free for download as .pdf in book or pocket (mobile) versions, instructors may be interested in sharing this resource with their students, or checking out their Resources for Educators.

Quick links:

• Transitions (book and pocket versions) for download
• teenmentalhealth.org website with additional resources and links
• Resources for Educators
• Resources for Parents
• Resources for Friends

Anthropologist, CTO

Is it really that strange to think that an anthropologist would be the best choice for a Chief Technology Officer?

According to Susannah Fox, the CTO for HHS (U.S. Health and Human Services), no, it shouldn't be:

“We’re living through this time right now where technology is a Trojan Horse for change ... . We say technology, but we mean innovation. We say interoperability and open data, but we mean culture change. And this is why the HHS CTO is an anthropologist. I know about culture change. I know how difficult it is for everyone involved.” (mobihealthnews.com, 2016)

For Fox, part of this cultural change has to do with understanding patients' needs, and the technology hacks that people are already doing, as in the #WeAreNotWaiting movement among people living with diabetes.

 Quick links & further reading:

• "HHS CTO: Technology in healthcare is a Trojan Horse for culture change" (mobihealthnews.com, 2016)
• "Why An Anthropologist, Not A Technologist Was The Best Choice For HHS CTO Role" (2016, Forbes)
• #WeAreNotWaiting via twitter
• Fox' blog post, "Love made visible" (2013) in which she reflects on her archaeology/ anthropology background and what this brings to her work in the healthcare sector.
• anthro everywhere's page, "Applying an anthropological perspective outside of university"

Anthropology and Public Health Policy

Medical anthropologist (and medical student) Dave Campbell outlines "Anthropology's Contribution to Public Health Policy Development" (2011) in this accessible (and open access) piece published in the McGill Journal of Medicine.

The article is written for non-anthropologists, and therefore provides a useful brief overview of the history of medical anthropology, what it has contributed to public health policy to date, and importantly, areas where "anthropology can influence public health policy in ways that epidemiology or other methods cannot." In this relatively short paper, Campbell discusses the value of an anthropological perspective for public health and policy creation in terms of:

"(A) The ability to see culture in its proper context in the social world and how culture affects all research. (B) The ability to pick up on minute and seemingly irrelevant details. (C) Independence from biomedical goals and hegemony allows medical anthropologists to add a critical voice to the public health discourse. (D) Provision of objective, qualitative data in an otherwise quantitative field."

For more on the role of anthropology/ anthropologists in healthcare, check out the links on our Applying an anthropological perspective outside of university page.

Cultural constructions of illness

"The Diseases You Only Get if You Believe in Them" (2016, The Atlantic) looks at certain forms of illness that are culturally specific. In this piece, Julie Beck interviews Frank Bures, author of The Geography of Madness: Penis Thieves, Voodoo Death, and the Search for the Meaning of the World’s Strangest Syndromes (2016).

Although Bures' book begins and ends with the 'exotic' cultural syndrome of penis theft in places like Nigeria and China, the interview provides a really interesting discussion of cultural syndromes in general, and asks "why the United States is not immune from them, and why asking if they’re “real” is the wrong question."

Some interesting points for discussion here include  the cultural imperialism and ethnocentrism of Western medical knowledge above understandings of health and illness in other cultures, and a critical reflection on how Western experiences of health/ illness are also culturally constructed.

How Anthropology Can Transform Global Health Efforts

In the context of global health crises from tuberculosis to HIV/AIDS and Ebola, Jean Hunleth discusses How Anthropology Can Transform Global Health Efforts (American Association of University Women (AAUW) blog, 2015)

"Hunleth suggests that an anthropologist’s success in public health draws on being able to do three main things. First, viewing public health as a culture you are trying to learn by paying attention to the language, norms, assumptions, and behaviors of each distinct global health organization. Secondly, identifying hidden assumptions some public health programs make, and their potential to lead to unintended effects. And lastly, learning to draw on theories and methods from anthropology and showing your co-workers the value of using them."

Black Disabled Woman Syllabus

Vilissa Thompson, Disability Rights Consultant & Advocate, has created the Black Disabled Woman Syllabus in response to the lack of intersectionality she has seen in disability studies. In her work Thompson has found that many people "are ignorant of the experiences of Black Americans in general, Black women particularly, and when broken down further, Black disabled women specifically."

This syllabus, intended as a "living" document, currently provides a range of resources for educators and students on:

• Black Feminism / Womanism
• The Black Disabled Body & Identity
• Articles About Blackness, Feminism, &/or Disability
• Books about Blackness in America
• Fiction & Poetic Works
• Audio / Video
• Music

Additional links:

• Chronic Illness, Coping & Critiques: Writings of a Chronically Ill Anthropologist by Niki Thorne (York University) who has already shared and commented on Thompson's work and hashtag #DisabilityTooWhite (19 May 2016)
• Laurence Ralph's Renegade Dreams: Living Through Injury in Gangland Chicago (2015, University of Chicago Press) is an accessible ethnography that engages issues of race, (chronic) illness, and disability.

What is "sensemaking"? Anthropology in marketing

Quantitative research -- which has long been the market research standard -- can provide insights into broad patterns and customer metrics. While this 'big data' can tell a company a lot about their customers' habits and needs, there are some questions that this approach simply cannot answer. This is where "sensemaking" comes in.

In short, "sensemaking" is how anthropologists approach problem-solving. Applying the kinds of qualitative methods and critically culturally-relative perspective that anthropologists are trained to these questions provides insights into the everyday life experiences and meanings that people use to understand their worlds.

In "An Anthropologist Walks into a Bar…" (Harvard Business Review, 2014) Christian Madsbjerg and Mikkel B. Rasmussen explain how "sensemaking," or approaching a problem from an anthropological perspective, works and can provide companies with market-research solutions. "A growing number of organizations globally have begun to apply sense­making, having recognized that it can help solve some of the toughest business problems, such as finding new growth, winning in new markets, and capitalizing on cultural change." The authors recount how "sensemaking" solved key marketing problems for a major European brewing company, Lego Group, and Coloplast (a Danish medical technology firm). Coloplast found that despite their sophisicated R&D, their "biggest division, the ostomy division, was stagnating, even though the company was investing heavily in innovation and sales." This is when Coloplast decided to take a different approach.

Coloplast recast the question “How do we capture new sources of growth?” as “What is the experience of living with ostomy?” Its managers knew a lot about customer metrics—who bought how much of which products when, and so forth. But they realized they knew less about their customers’ worlds. What was it like to be an ostomy patient? How did it affect your self-image? Your social life? What was a good day, or a bad day?

In a classroom, this article might be useful for talking about the differences between qualitative and quantitative research, for illustrating cultural relativism in action, or for talking about the kinds of things that an anthropological perspective can bring to a workplace.

Racism in/and Medicine

In The Pain Gap: Why Doctors Offer Less Relief to Black Patients (2016, The Daily Beast), Keith Wailoo (Princeton professor in History and Public Affairs) discusses how the treatment of patients' pain by medical professionals is affected by systemic racism.

This article/ issue would be useful in discussions of how structural violence -- the kind of 'normalized' violence that is often difficult to see -- has concrete effects for those it is directed against. It also speaks to how our understandings of health and how we treat illness is also culturally constructed, and is directly affected by other cultural norms, beliefs, and practices such as North American understandings of racial difference.

You can also check out Wailoo's website where he provides further links to popular media on the how pain (and healthcare) is political.

Appropriating Indigenous Knowledge: Biopiracy or Scientific Colonialism

"Biopiracy: when indigenous knowledge is patented for profit" (7 March 2016) reflects on an ongoing form of colonial exploitation and cultural appropriation.

Historically, biopiracy has been linked to colonialism, with formerly colonised countries having many of their resources forcibly removed. Pepper, sugar, coffee, quinine, or rubber did, and still do, have significant impact on the world economies. All of them have a colonial past.
At the heart of the matter is the idea of ownership. Patents and trademarks are hotly defended by international trade organisations and multinational groups. But for many traditional farmers or indigenous groups, owning a constantly evolving and changing organism is illogical, as is assigning ownership to one person instead of a community of users.

Even though international organizations like the WTO have prompted the development of legal frameworks to protect plant and animal resources in the contexts of pharmaceutical and agricultural development, these legal interventions fall short of protecting or considering the cultural aspects of knowledge. 

From Mutilation to Alteration...

A research article in a medical journal is featuring largely in the news today. The authors, Arora and Jacobs, have argued that "we must adopt a more nuanced position that acknowledges a wide spectrum of procedures that alter female genitalia. (...) Acceptance of de minimis procedures [of female genital alteration] that generally do not carry long-term medical risks is culturally sensitive, does not discriminate on the basis of gender, and does not violate human rights" (here). The authors argue that accepting the 'minor' less invasive procedures is a compromise for those cultures (statically defined) who continue and want to continue these practices.

This discussion is often featured in Anthropology 101 courses as we talk about genital modification and its juxtaposition with cultural relativism (arguing that there is no universal standard and that one should not criticize from outside a culture) and universal human rights.

This is not a new debate however, the fact that the discussion of cultural relativism is occurring in the medical community is a new turn of this long-standing anthropological discussion. In class, I would also ask, what difference does a label make? Mutilation to alteration... 

Culture is medicine

"Culture is medicine: Doctor encourages Kwanlin Dün to use traditional healing model" (CBC, 21 February 2016)

In this short Q&A article, Dr. Mehl-Madrona discusses his "aims to incorporate the traditional knowledge of indigenous cultures into contemporary medicine and psychology." Although Dr. Mehl-Madrona's background is in psychiatry and psychology rather than anthropology, his views speak to anthropological approaches to understanding health and well-being.

What can you do with anthropology?

EDIT - This post has a permanent home on our page titled "Applying an anthropological perspective outside of university." This page is regularly updated with new links related to anthropologists who work outside of the university.

At university, a lot of students may find anthropology interesting as a course, but not really be sure what you can do with an anthropology degree or what your anthropological perspective can bring to a workplace after you graduate. 

The Anxious Anthropologist has already written a couple of great posts about the value of an anthropological perspective in general:

• How does an Anthropologist add value in the workplace? (Anxious Anthropologist)
• Why you need an Anthropologist in your organization  (Anxious Anthropologist)

Here are a few more links that help explain what an anthropological perspective can add in various fields:

JOURNALISM

• 'Why newsrooms need anthropologists' (journalism.co.uk, 2013)

MARKETING/ BRAND & PRODUCT DEVELOPMENT

• 'Big Data Needs Thick Data' (ethnographymatters.net, 2013) [I really like this article!]
• 'What is Thick Data and Why Should You Use it?' (brandwatch.com, 2014)
• 'Anthropology Inc' (theatlantic.com, 2013)
• 'How IKEA’s Unconventional Research Methods Inspire TheirNew Products' (designtaxi.com, 2015)

HEALTH PROFESSIONS

• 'A background in anthropology comes in handy on the wards' (www.kevinmd.com, 2015)
• 'An anthropologist on the wards' (scopeblog.stanford.edu, 2015)

TECHNOLOGY

• 'That 'Useless' Liberal Arts Degree Has Become Tech'sHottest Ticket' (forbes.com, 2015)