Medical Anthropology and Epidemiology: Diverges or Converges? (Inhorn, 1995) PDF

Medical Anthropology and Epidemiology: ○ Until it became an elective in medical Diverges or Converges? schools in US (Inhorn, 1995)...

Medical Anthropology and Epidemiology: ○ Until it became an elective in medical Diverges or Converges? schools in US (Inhorn, 1995) ○ Physicians interested in public health take further studies/specializations in this field as Main Idea: With the lack of interdisciplinary it is not offered in undergrad and med anthropological-epidemiological research due to the schools perceptions among medical anthropologists that MA and Problem encountered by both MA and EPI: hard to epidemiology diverge, there is a greater call for collaboration translate epistemological assumptions to clinical through identifying five of these perceived areas of divergence medicine as epidemiology is population and and attempting to reconceptualize them as areas of public-health-based without clinical intervention convergence. ○ This similar structural positions vis a vis biomedicine should unite the two fields Introduction CONCLUSION: epidemiology and medical anthropology tackle Trostle: noted that despite historical efforts of collaborating the different perceptions of disease but converge in the problem two fields, it has been one of “benign neglect,” many “missed of translating these into clinical interventions opportunities” and active “schism.” 2. Epidemiology is reductionistic and positivistic; FIVE MAJOR AREAS OF DIVERGENCE anthropology is holistic and humanistic as perceived by medical anthropologists Epidemiology is seen as a highly scientific, - These areas may have prevented interdisciplinary computer-laboratory-based from of connections from flourishing number-crunching, devoid of human interactions - Hence, reconceptualized as areas of convergence to ○ Not a monolithic enterprise, not all produce studies that are greater than the sum of epidemiologists are reductionists (narrowly their individual anthropological or epidemiological focused on limited conceptions of diseases) contributions. ○ Neither lacking in breadth, interdisciplinary Disclaimer: Article is not about RRL but on sparking vigor and critical reflexivity conversation and discussions, with existing schisms to be ○ Some epidemiologists are broad and bridged. holistic, even anthropological ○ 19th Century epidemiological studies 1. Epidemiologists study biomedically defined attended to both behavioral and social diseases; anthropologists study illness experiences factors Epidemiology: the study of the distribution and ○ Positivistic discipline: inherently apolotical, determinants of diseases and injuries in human ahistorical and acultural, decontextualized populations perspective ○ Disease-oriented and disease as a Western ○ BUT epidemiology has considered the biomedical construct political-economic nature of numerous ○ Disease: abnormalities in the sturcture health problems and/or function of organs and organ MA is seen as highly interactive and interpretive, systems; pathological states whether or not intensive encounter with real people they are culturally recognized CONCLUSION: Epidemiology is not solely scientific, but it also Misconceptions: disease is objective takes into account culture relative to people’s lived and culture-free experiences, similar to MA. BUT disease itself is a cultural construction as evidenced by: 3. Epidemiology and Anthropology employ different 1. Rapidly changing state of affairs in biomedical methods definitions of disease states Epidemiology 2. Degree to which ‘folk models’ permeate ○ Said to use narrow “scientism” through biomedical physician’s notions of disease scientific methodology (aka methodolatry) definition and causation (technical terms vs ○ HOWEVER, vast epi studies are not folk language) experimental but are observational 3. Degree to which biomedical definitions of ○ MA studies are participant observational; disease and disease causation differ from one with a similar method of EPI through talking cultural context to another with people (interview, FGDs) Paradigm Shift: when both fields combine their Difference in methods: scope rather than kind definitions of multiple causes of illness (research designs and data analysis methods) Epidemiology & MA is not necessarily uncritical in ○ MA has greater variety of methods and less accepting biomedical notions of disease normative methodological standards ○ ex. Social epidemiology (study of the social ○ EPI deals with larger sample sizes and work relations of poor health rather than narrowly with people who do not view themselves defined disease outcomes) connected in any way Epidemiology is a mere ‘handmaiden’ of biomedicine Some (ex. Genetic epidemiology) ○ Rather, it is a statistical discipline of work with small sample sizes of biomedicine where epidemiology is a public individuals who are often related health specialty  ○ Similar in data collection: interviewing, archival research, and record view Many MA are attracted to epidemiology due to ‘methodological fit’ Given the increasing number of dually (both working on the convergence of the two fields) trained individuals, synthetic studies are expected to increase CONCLUSION: there are no fixed rules dividing the two on a methodological basis; they have greater similarities than differences. 4. Epidemiology ‘blames victims’ for their ‘risky’ behaviors; anthropology examines the macro-level conditions giving rise to those behaviors Cause of this perception: EPI is concerned with the relationship between human behavior and disease leading to victim blaming BUT epidemiology is population-based ○ Identifying population-based behavior is not the same as ‘blaming individuals’ or their cultures ○ It’s only failure is that it never went beyond mere identification of the behavior and attempting to explain these in the cultural context of a population ○ It asks who, what, when, where, how, but NOT why MA resolves this gap by attempting to explain but not blame CONCLUSION: epidemiology identifies (not blames) the risk factors from the population-based behavior and culture, and MA tries to comprehensively and contextually explain these to the people 5. Epidemiology generates ‘risk’ and medicalizes life; anthropology critiques ‘risk’ and attempts to alleviate human suffering EPI may overmedicalize life by identifying and providing definitions of risky behavior, at-risk groups and risk-reduction strategies ○ Can be taken advantage of by the biomedical community (pharmacies, laboratories, etc.) HOWEVER, both EPI and MA share the major goal of producing knowledge to alleviate human suffering ○ Useful in prevention Need for an alternative discourse on risk, one that is concerned with disease, debility, and death (not just one aspect but all and its overlaps) of the many less privileged areas in the world CONCLUSION: Both EPI and MA share the goal of producing knowledge to alleviate human suffering ARTICLE CONCLUSION Synthetic, interdisciplinary anthropological-epidemiological research is relatively rare because of the predominant areas of divergence. However, the convergence of the two must be understood to obtain a valuable opportunity to move the discipline in exciting new directions.