# Art, Music, and Sport

## Anthropology of Music

### Learning Outcomes

By the end of this section, you will be able to:
1. Define ethnomusicology.
2. Describe evidence of musical instruments in prehistory.
3. Articulate the importance of sociocultural context to the understanding of music.
4. Describe how music can form the basis of subculture and community.
5. Evaluate the potential of music to impact processes of social change.
6. Describe how cultural appropriation of music is related to social inequality and power.

### Music

Music is found in wide-ranging settings and format, including chants, musicals, live performances, recorded performances, and spiritual rituals. In prehistoric times, music was used to communicate, to tell the stories of people and express important elements of cultures. Music articulates the human experience, focusing on what people want to remember about their history and what they desire for the future. It has been used to heal, to demonstrate power, and to archive the experiences of people. Present-day music is an extension and an evolution of the music that has come before. It is a medium that represents the depths of time, culture, and history. Prehistoric musical instruments, called  in anthropology, include woodwinds and percussion instruments of ancient nomadic tribes. These instruments began as rudimentary music artifacts and evolved into more sophisticated technological equipment invented and formed for the exclusive purpose of creating music.

### Ethnomusicology

Someone who studies music from a global perspective, as a social practice, and through ethnographic field work is called an ethnomusicologist. The Society for Ethnomusicology defines ethnomusicology as “the study of music in its social and cultural contexts” (n.d.). Ethnomusicology is complex, requiring the work of many scientific disciplines. It requires study of many geographic areas, with a focus on the social practice of music and the human experience. Ethnomusicology is interdisciplinary, with a close relation to cultural anthropology. It is sometimes described as a historical research approach to understanding the cultures of people through their music. One well-known ethnomusicologist was Frances Densmore, who focused on the study of Native American music and culture.

### Musical Instruments in Prehistory

The field of ethnomusicology focuses on all aspects of music, including its genre, its message, the artist(s) who created it, and the instruments they used to do so. Have you ever considered why a particular musical instrument was created? Who made it? Why did they make it? What did they want it to do? How was it used? How did they dream up the design? Emily Brown (2005), formerly of the US National Park Service, studied the development of musical instruments in Ancestral Puebloan sites. Her study yielded insights into the types of instruments created. These included percussion and woodwind flutes that were used to create music culturally centric to the Puebloan people. Her study also yielded great insight into the structural hierarchy of those entrusted to manufacture music-making instruments. Not too dissimilar to today’s trade apprenticeships and master programs found in construction, Ancestral Puebloan people established a system of passing down the construction techniques central to creating musical instruments, ensuring that the knowledge would be carried on by future generations. Brown’s study connected music instruments to politics, music, social status, and social experiences.

### The Structure and Function of Music in Different Societies

Music is grounded in the human experience. It is a theatrical expression of its creator’s thoughts and perceptions. The structure of music has evolved along with the experiences of the humans who created it. Examples of this can be found in the early 1800s hymns of Choctaw tribes. These hymns provide an artistic expression of traumatic experiences, referring to a time when the Choctaw people were removed from their homelands and relocated to reservation lands by the US government. They speak of both individual and collective experiences as these peoples made the arduous journey to their new locations. The songs speak about broken promises, the journey, and the fate of their people.
For enslaved people, music was a mechanism of emotional escape from difficult situations as well as a means of communicating with those speaking different languages during the Middle Passage, the journey from Africa to locations of forced labor. One of the most iconic spirituals, or songs for survival, is “Go Down Moses.” Harriet Tubman, the legendary Underground Railroad conductor, said that she used this spiritual as a way to signal to those who were enslaved in the area who she wanted to help escape to freedom (Bradford [1886] 1995). The song ostensibly speaks about the experience of the Israelites enslaved by the Egyptians in ancient times. For enslaved Black people in America, the song spoke directly to their own longing for freedom. The chorus of “Go Down Moses” is as follows:
Listen to this song on the Library of Congress website.
Numerous populations have utilized music as a means of resistance. During the civil rights movement of the 20th century, Black artists such as Nina Simone, Aretha Franklin, and Sam Cooke used their music as a way to challenge structural inequity. Aretha Franklin, a Black singer, songwriter, and pianist, wrote and performed music anchored in the Black church that came to represent Black American culture. She achieved national and international fame for her rich voice and heartfelt performances, and she was able to use her artistic talents to bring a message of both hope and resistance to her audience. Her songs spoke to both where people were and where they wanted to be.
Sam Cooke was an American singer who was given the nickname “King of Soul” by his fans and those in the music industry. Like many, he started out singing in church, but eventually his music and passion evolved to secular music. He is credited with having significant influence on the civil rights movement, and his music often explored themes of oppression and fighting for a cause. The music of his first band, Soul Stirrers, focused on stirring the listener’s soul to engage in the movement for racial equality.
Perhaps no artist in recent times is better known for using music as a catalyst for social change than Bob Dylan. Dylan was a 1960s-era musical artist who spoke to many cultures and generations about injustice and the need for inclusion and change. His 1964 song “The Times They Are a-Changin’” urged politicians and voters to support the civil rights movement. He was also well known for his opposition to the Vietnam War. His music may have very well changed the course of history, given his influence on his fans’ thoughts, perspectives, and attitudes toward inclusion (Ray 2017).

### The Importance of Sociocultural Context in Understanding Music

Ethnomusicologist Patricia Campbell (2011) proposes that children’s perspectives on musical interests are derived from their family, community, and environment. How did you learn about music you liked? What did your parents listen to, and what do you listen to? While you may have learned about and grown to like other music as you aged, your appreciation for music is founded in the sociocultural environment that you were raised in. Imagine growing up in a family that only listened to Bansuri bamboo flute music. Would you even know, for example, what rap music is?

### Music as a Basis for Subculture and Community

The affiliation of music with identity became a common topic of inquiry in ethnomusicology in the 1980s, perhaps prompted by the music subcultures of the 1970s that arose among groups of people who did not identify with mainstream norms, values, or ideals. Among the music subcultures that emerged during that time was the punk subculture (Moran 2010). Though it was often seen as no more than youthful rebellion, the punk subculture formed its own community, values, and ideals founded in a do-it-yourself, or DIY, ethos. This can be found in the lyrics, music, and performances of punk groups such as the Ramones and the Clash, as well as more recent pop-influenced groups such as Green Day and Blink-182. The lyrics tell stories of needing to break from common ideals and values in order to think and do for oneself.

### Cultural Appropriation

Cultural practices important to communities are often integrated into the fabric of each person’s identity. Cultural appropriation is defined as the improper or disrespectful use of a meaningful element of a culture or identity outside of its intended cultural context by someone who is not a part of that culture or identity (Young 2008). The act of cultural appropriation by dominant cultures threatens to erase remaining parts of a culture that may already be jeopardized. Cultural appropriation is tied to social inequity in that it involves a socially dominant group using the culture of a marginalized group for exploitative or capitalist gain. The cultural significance of the appropriated elements is lost. While the act of cultural appropriation is centuries old, there has been a renewed call from marginalized communities in recent years to understand how and why this practice is harmful.
Wesley Morris (2019) wrote an article for the New York Times’ 1619 Project regarding the mass appropriation of Black music. Morris noted instances of appropriation by artists such as Steely Dan, Eminem, and Amy Winehouse, all White American or British music superstars. Musical appropriation is the use of one genre’s musical contributions in other music that is not of the same genre, style, or culture. The power of Black music to articulate the history, struggles, and marginalization of Black people has appealed to other social groups as well, many of them drawn to the ability of this music to communicate its message with clarity and boldness. Morris also discusses how, more recently, the appropriation of Black lyrics, songs, and musical presentation styles has become a method of addressing the need for integration and integrated culture. This can be seen in Black artist Lil Nas X’s 2019 remix of his hit song “Old Town Road,” for which he teamed up with White country musician Billy Ray Cyrus to perform a duet. The song itself is a blending of cultures, musical and racial, and offers a social contribution to evolving efforts at inclusion.


# Art, Music, and Sport

## An Anthropological View of Sport throughout Time

### Learning Outcomes

By the end of this section, you will be able to:
1. Describe the anthropology of sports.
2. Explain how sports are a form of performance.
3. Identify the role that sports can play for young people.
Sports are also deeply intertwined with the human experience. The anthropology of sports is a rapidly developing field that includes specialties such as physiological anthropology and human growth and development. Sports can be quite diverse; picture a Roman gladiator, a modern-day European football (soccer) player, and an ancient or recent Olympic competitor. Another example of a sport is Trobriand cricket, a bat-and-ball game played by Trobriand Islanders that had evolved considerably since its introduction by Christian missionaries at the turn of the 20th century. Sports are expressions of passions and reflections of the human experience. They have been practiced by many cultures throughout time and across the globe. This section will specifically focus on how sports have impacted human culture and how human culture has impacted sports in turn. It will consider the historical foundation of the culture of sports and briefly analyze the way people interact with sports today, examining how human culture and societal practices are influenced by not only individual athletes but also social structures.

### The Anthropology of Sports

Anthropologists understand sports as a cultural performance. The term performance can describe a plethora of actions, including any that are artful, active, or competitive—and sometimes some combination of all of these. Anthropologist Ajeet Jaiswal (2019) describes the anthropology of sports as the study of human growth and development. If one conceives of sports as a sort of performance, one also sees that each performance is unique to the performer. Each athlete, even the most impressive and seemingly unique, is a part of a larger performance. Consider your favorite sport or athletic competition. How long has it been in existence? Does it have roots in ancient times? Often, athletes and sports personalities—from Roman gladiators to more recent English footballers, American basketball players, and Olympic athletes—are considered singularly talented at their respective sports; however, without the broader cultural context that has cultivated gymnastics, tennis, soccer, and basketball, these talents would have no stage on which to perform.
Anthropologists who study sports do so within a larger context of sports and society. Interests of anthropologists researching sports might include archaeological research related to sports tools, cultural anthropological research pertaining to how humans interact with sports, or even biological/physical anthropological research on biological maturation or physical growth (Damo, Oliven, and Guedes 2008).
Sports artifacts such as the weapons of gladiators and tools used in old and recent Olympic sports have offered significant contributions to the anthropology of material art. Picture your favorite sport. It likely involves a specific tool that is a representation of that sport. Notable examples of such tools and artifacts include the lacrosse sticks of the Iroquois, hammers from the oldest Olympic hammer-throw competitions, and the modern-day American football uniform, which is designed for safety and decorated to represent affiliation, professionalism, and individual athletes.
Sports have also offered theatrical performances since ancient times. Picture the gladiators of ancient Rome entertaining the wealthy who could afford the best seats or wealthy English footballers entertaining those who are likely less wealthy. The status reversal of sports entertainers and audiences in modern-day sports represents the dichotomous nature of social status and is just one of many examples of cultural change throughout time.

### The Evolution of Sports

For most of documented human history, sports have been a significant part of the human experience for both audience and participants. Archaeological artifacts pertaining to sports, including colosseums, weapons, and artistic representations of competition, have been traced back to as early as 2000 BCE in China. These ancient sports featured competitions that tested the strength, stamina, and techniques of performers, such as footraces and physical fights. Today, many nations around the world participate in a version of the Olympic Games that were popular in the ancient Greek village of Olympia. Early events included a marathon run and wrestling. The Olympics were revived in the late 19th century, with the first modern games occurring in 1896 in Athens, Greece. Though rules and regulation may have been less stringent and defined in the sports of previous centuries, competition as entertainment has existed for millennia.
Sports can provide much more than mere entertainment to people and societies. Today, when thinking about modern sports, a person may think of professional athletes such as National Basketball Association (NBA) star Kobe Bryant or National Football League (NFL) great Walter Payton. In early competitions, the wealthy attended sporting events in which the athletes were typically not wealthy or privileged. In modern times, the commercialization of sports has largely reversed this trend, with “common” people attending sporting events to watch wealthy athletes compete. The business of sports has created opportunities for financial and cultural success for people with exceptional athletic abilities. The success of athletes such as Kobe Bryant created opportunities for other athletes, paving the way for the success of people who may not have otherwise thought it possible to experience the fame, notoriety, and financial success of a modern athlete (Chacko 2020).

### Youth Sports

Recreational sports for youth are common in various cultures. This can be especially important in marginalized communities, where youth sports are often viewed as deterrents from (or alternatives to) potentially dangerous activities or preventive structures that support youth development and community by focusing on positive actions that reduce adverse social behaviors. Youth sports programs are often community-building initiatives. One such initiative is the NFL’s Play 60 program, which challenges NFL football players to engage in activities with underrepresented communities, encouraging kids of all skill levels to come together to play sports.
Among Indigenous Americans, an aggressive style of basketball called reservation ball, or rezball for short, is prominent in reservation communities. Rezball is different from traditional basketball, as the techniques used encourage relentlessly aggressive play and quick shooting. For youth on reservations, this may be one of a limited number of recreation opportunities. Rezball is documented in the Netflix docuseries Basketball or Nothing and a 2009 ESPN story about the role of rezball in the culture of Native American children.


# Art, Music, and Sport

## Anthropology, Representation, and Performance

### Learning Outcomes

By the end of this section, you will be able to:
1. Identify how cultural identities, norms, values, and social structures are represented in art, music, and sports.
2. Describe how art, music, and sports can function as means of resistance to dominant sociocultural forms and processes.
Art, music, and sports all articulate the experiences of people. One of these experiences might be resistance or rebellion. Whether it is a piece of art depicting a revolution, a rap song challenging the establishment, or a protest at a sporting event on a global stage, expression of the need for change are common in contemporary culture. This section will explore cultural identities; the use of art, music, and sports as resistance; and the representations created by each specialization.

### Cultural Identities

Think about sporting team uniforms or a clothing style worn by members of a musical group. Each outfit on its own may not be distinct or significant, but when worn by a group of athletes or musicians and their fans, they become a source of identity. Since prehistoric times, art, music, and sports have been a source of cultural identity. Arts and sports have been intertwined with several human rights movements and the push for diversity, equity, and inclusion. Music has been a means of coded language for escape. Sports have long been a platform for cultural identity and has presented opportunities for cultural evolution and resistance. The Olympics are just one example of a sporting event that is linked deeply with national identity and nation pride.

### Art as Resistance

Art is often used as an act of resistance. Graffiti and hip-hop are two forms of artistic expression that have been viewed as acts of resistance in modern times. The practice of graffiti as it is known today is reminiscent of ancient cave painting, as both are drawings, depictions, and writings on a wall. Ancient graffiti can help archaeologists understand general levels of literacy among a population of people or provide linguistic anthropologists with insight into the development of language through time.
While writings on walls is an ancient practice, graffiti became a popular form of cultural expression in Western countries in the 1960s. Modern graffiti is often performed in public view, as it is intended to make a statement. Today, during most political uprisings, researchers are able to easily find graffiti expressing views that inform and shape the political movement. Although many appreciate the communicative and artistic qualities of graffiti, others view it as visual pollution, and graffiti continues to be met with opposition.
One of the most iconic modern graffiti artists is Banksy, whose art is depicted in Figure 16.24. Banksy is the pseudonym of an English street artist who has been active for more than three decades (Ellsworth-Jones 2013). His identity remains unconfirmed. His work began to appear in the early 1990s in Bristol, England, and can now be found in cities around the world, including London, New York, and Paris. Based on reports from those who have secured interviews with him, Banksy views his art as an act of rebellion. He was often in trouble as a teenager, which is when he first began exploring art. His art typically responds to social or cultural issues. One example is his series in New Orleans, Louisiana, which critiqued the government response to Hurricane Katrina in 2005.

### Music as Resistance

Hip-hop is a form of music that has consistently served as a means of protesting injustice toward people of color. From its inception in the 1970s at neighborhood block parties, hip-hop has rapidly spread worldwide to influence various cultures, transitioning from the margins of American culture to a central element of global pop culture. The culture of hip-hop offers possibilities for rich anthropological exploration, including linguistics factors, performance, music, and lyricism. The messages expressed by hip-hop often include complex social commentaries.
With increased representation has come increased acceptance of hip-hop as a respected art form. In 2018, rap artist Kendrick Lamar was awarded a Pulitzer Prize for his album DAMN. and lauded by former president Barack Obama (Hubbard 2019). His fourth album release, DAMN. demonstrated why some call him one of the most influential rappers of his time. Perhaps better known is Public Enemy, the mid-1980s rap group created by Chuck D and Flavor Flav. The group’s lyrics often cite their political beliefs and deep-seated opinions about American racism and the American media.
The evolution of hip-hop can be observed in many countries and societies. In the 1980s, it first began appearing in Japan and the Middle East. In Japan, it is thought to have begun with Hiroshi Fujiwara, who had an appreciation for old-school hip-hop and began to play it publicly. In the Middle East, some call it Arab rap or Arabic hip-hop. Heavily influenced by Western culture, these artistic representations demonstrate the vast and culturally diverse adoption of hip-hop as art and expression. Klash, the Muslim rapper shown in Figure 16.25, is well known in Middle Eastern cultures for telling the story of Muslim people through his artistry. Rap is not a subculture but a media and method for telling a story and at times expressing the resistance of a group of people.
Even more recently, Native American hip-hop has been a medium for Native Americans to tell their story and preserve the history of their peoples. Founded in American rap and hip-hop culture, this new form of expression has been embraced by rappers throughout Native American communities. It has been used to tell stories, explain history, and even encourage political activism on social issues.

### Sports as Resistance

Throughout time, sports have been a global focal point for resistance. The Olympics have repeatedly been a site of global resistance and a setting for challenging societal norms and expectations. In Figure 16.26, Black American athletes Tommie Smith and John Carlos, gold and bronze medalists respectively, are depicted raising black-gloved fists during their medal ceremony as the US national anthem plays (Smith 2011). This gesture became known as the 1968 Olympics Black Power salute. Smith later described his raised, black-gloved fist as a symbol of support for all those who are and have been oppressed. Smith and Carlos made their demonstration in response to human rights violations perpetuated in the United States. Another example of resistance was seen four years later, when Jackie Robinson, the first Black player in Major League Baseball, wrote in his autobiography, recalling the opening game of his first World Series championship: “As I write this twenty years later, I cannot stand and sing the anthem. I cannot salute the flag; I know that I am a black man in a white world” (Robinson [1972] 1995, xxiv).
For many, a more familiar act of protest is likely NFL player Colin Kaepernick’s kneeling during the singing of the nation anthem in 2016 following the shooting deaths of Black men Michael Brown, Alton Sterling, and Philando Castille at the hands of police officers (Lief 2019). In 2016, approximately 68 percent of all NFL players were Black (Gertz 2017). Kaepernick continued to kneel during the anthem for the remainder of the season. His gesture was a symbol of support for the Black Lives Matter movement, which seeks to end police brutality against Black people and other forms of racially motivated violence in the United States. Initially, feedback regarding Kaepernick’s gesture within the sports world was negative. However, following the death of George Floyd in 2020, there has been an increased interest in understanding systemic oppression. This had led to initiatives by organizations such as the NFL, Black Lives Matter, and others to support inclusion and open dialogues about racism. Throughout the seasons following Kaepernick’s initial act of kneeling, it became common practice in the world of professional sports for athletes to kneel in solidarity. This included Black players and some White players.
The 2016 Olympics in Rio de Janeiro were a demonstration of social stratification. Media coverage of the 2016 Rio Olympics reported on the less-than-acceptable environmental, safety, and health conditions. Athletes from more developed nations openly criticized the unsanitary and inhospitable conditions of the housing and training facilities, which included unpotable water sources, trash in commons areas, and dirty and unsanitary dormitories. While some protested silently, others used their global notoriety to publicly protest the conditions. The images and stories provided from Rio by journalists and mainstream media sources showed garbage-ridden streets, unsanitary rooms and facilities, and irreparably damaged buildings. For Rio, the Olympics were supposed to be a pinnacle of national pride and a positive contribution to the global stage. For many who attended, the event proved to be far less than the Olympic image depicted in popular imagination.

### Integral Features

Art, music, and sports can themselves be forms of resistance and at the same time can display evidence of historical resistance. A protest, a cultural statement, the overthrow of a regime—all can be found in, and at times have even been started by, works of art, music, and sports. From the ancient Romans to professional American football players, people have used these mediums to fight for their causes and to ensure that the histories of their plights are recorded in the archives of time.
Art, music, and sports have told the stories of people since prehistoric times. Ingrained in the human experience, these mediums have been used to establish cultural and national identity. The images in art, the words of song, and the traditions of sport have had significant impacts on established norms and senses of personal and group identity. These aspects of the human condition are so foundational that each has been used as a form of resistance. Art, music, and sports have each contributed to the development of people and societies in important ways, and can each reveal important aspects of both past and current cultures.

### Summary

Art, music, and sports are deeply intertwined with the human experience. Anthropology offers the space to examine art, music, and sports through a cultural lens in order to study the ways in which they exist within sociocultural frameworks.
The anthropology of the arts is a subfield of cultural anthropology that explores the arts in a broader context within and between different cultural settings. Anthropologists study art differently than other social scientist, relying on data collection through direct, personal, in-depth observations of lived experiences and interactions. Art is expressed through a variety of formats, including music, visual art, literary art, and body art.
Anthropology explores the various cultural manifestations of humanity. All cultures decorate and modify the human body in some way, whether temporarily or permanently. Body art can be spiritual, cultural, or aesthetic. This includes tattooing, body paint, and hairstyling.
Ethnomusicology is a subfield of cultural anthropology that examines the music of different cultures and the people who make it, as well as the intended audience of the music. The interdisciplinary nature of ethnomusicology speaks to diverse approaches to studying the anthropology of music. Music as an art form expresses a wide array of perspectives and experiences.
Sports are a form of performance, and each participant performs within a broader cultural context. Anthropologists of sport are interested in studying sports within the context of society. Sports culture has resulted in cultural phenomena based on the popularity of athletes. Sports also serve as an escape for many populations with limited choices in recreational activities.

### Critical Thinking Questions

### Resources

Basketball or Nothing. 2019. Philadelphia: WorkShop Content Studios. Netflix, 6 episodes.
Rice, Timothy. 2014. Ethnomusicology: A Very Short Introduction. New York: Oxford University Press.
Stone, Ruth M. Theory for Ethnomusicology. 2008. Upper Saddle River, NJ: Pearson.

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# Medical Anthropology

## Introduction

Health and a preoccupation with maintaining it permeates all aspects of human culture. Health is a concern to humans everywhere. There is no end to the variety of ways cultures across history have treated health, healing, and medicine. Human health and well-being sit at the intersection of biology and culture. Both physical and social environments shape well-being and health outcomes. Medical anthropology is a holistic specialty that draws on all four fields of anthropology but primarily builds on cultural anthropology and biological anthropology to understand the health implications of a culture’s impact on human physiology and well-being.
1. How do you define health?
2. How do you maintain your health?
3. What factors do you think contribute to health and illness?


# Medical Anthropology

## What Is Medical Anthropology?

### Learning Outcomes

By the end of this section, you will be able to do the following:
1. Define health, illness, sickness, and the sick role.
2. Describe early research and methods in medical anthropology.
3. Explain Franz Boas’s influence in establishing the foundations of medical anthropology.
4. Describe how medical anthropology has developed since World War II.

### Social Construction of Health

The World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (World Health Organization 2020). Health is affected by multiple social, biological, and environmental factors. Disease is strictly biological—an abnormality that affects an individual’s physical structure, chemistry, or function. Going back to the time of the ancient Greek physician Hippocrates, doctors have regarded disease as the result of both a person’s lifestyle habits and the social environment in which they live. Illness, by comparison, is the individual’s sociocultural experience of a disruption to their physical or mental well-being. An individual’s perception of their own illness is shaped by how that illness is viewed, discussed, and explained by the society they live in. The social perception of another person’s sickness affects that person’s social well-being and how they are viewed and treated by others. Sick roles are the social expectations for a sick person’s behaviors based on their particular sickness—how they should act, how they should treat the sickness, and how others should treat them. Malady is the term anthropologists use to encompass disease, illness, and sickness.
1. Health is your state of well-being.
2. Disease is a biological abnormality.
3. Illness is your sociocultural experience of health.
4. Sickness is a social perception of ill health.
5. Malady is a broad term for everything above.

Foundational to medical anthropology is an understanding of health and malady that includes social experiences and cultural definitions. Medical anthropology studies how societies construct understandings of health and illness, including medical treatments for all types of maladies. Culture affects how we perceive everything, including health. Culture shapes how people think and believe and the values they hold. It shapes everything people have and do. Many cultures approach health and illness in completely different ways from one another, often informed by a number of societal factors. Medical anthropology provides a framework for common study and comparison between cultures, highlighting systems and illustrating how culture determines how health is perceived.

### History of Medical Anthropology

While medical anthropology is a relatively new subfield, it has deep roots within four-field American anthropology, with a strong connection to early European anthropologists’ study of religion. The holistic approach of Franz Boas was also key to the development of medical anthropology. One focus of Boas’s research was analysis of the “race theory” common in the 19th and early 20th centuries in the United States. According to this theory, one’s assigned racial category and ethnic background determined certain physical features as well as behavioral characteristics. Boas challenged this assumption through studies of the health and physiology of immigrant families in New York City in 1912. Boas found that there was a great deal of flexibility in human biological characteristics within an ethnic group, with social factors such as nutrition and child-rearing practices playing a key role in determining human development and health. He noted that cultural changes to nutrition and child-rearing practices, changes that are commonly a part of the immigrant experience, were linked to generational changes in biology. Boas provided empirical data from his own primary sources that refuted theories of biological inheritance as the source of social behaviors and revealed the impact of local environments (natural, modified, and social) in structuring cultural and physical outcomes. This foundation was starkly opposed to the inherent racism of social evolutionism, which was the dominant anthropological theory of his time.
Boas’s students, such as Ruth Benedict, Margaret Mead, and Edward Sapir, all continued aspects of his work, taking their research in unique directions that affect medical anthropology to this day. Benedict’s cultural personality studies, Mead’s work on child-rearing practices and adolescence, and Sapir’s work on psychology and language laid the foundations of psychological anthropology. Their foray into psychological anthropology was preceded by the work of British psychiatrist and anthropologist W. H. R. Rivers (1901), who studied the inheritance of sensory capabilities and disabilities among Melanesian populations while participating in the Torres Strait island expedition in 1898. He developed a great respect for his Melanesian research participants and utilized his research findings to denounce the “noble savage” fallacy. By demonstrating that a shared biological mechanism of inheritance and environmental influences shaped the Melanesian senses in the same way as it did the British, he illustrated that their mental capacity was the same as Europeans.
Medical anthropology also has roots in the anthropology of religion, a subfield of anthropology that shines a lens on many aspects of health. The anthropology of religion looks at how humans develop and enact spiritual beliefs in their daily lives and at how these beliefs are utilized as a form of social control. A number of commonly studied key frameworks of the anthropology of religion—rituals of healing, taboos of health, shamanic healing, health beliefs, cultural symbolism, and stigma, among them—focus on health and health outcomes. A number of notable early religious anthropologists, including E. E. Evans-Pritchard, Victor and Edith Turner, and Mary Douglas, did work on subjects such as healing rituals, misfortune and harm, pollution, and taboo. Evans-Pritchard’s work among the Azande people of North Central Africa continues to be foundational to medical anthropology. Especially important is the chapter “The Notion of Witchcraft Explains Unfortunate Events” from the book Witchcraft, Oracles and Magic among the Azande, which introduces the domain of causation and its many cross-cultural forms. This chapter directly impacted the concept of explanatory models, which we will cover in depth later in this chapter. The work of Victor and Edith Turner focused on ritual healing, pilgrimage, and socially enforced morality. Mary Douglas’s Purity and Danger ([1966] 2002) examined the concepts of pollution and taboo as well as rituals designed to restore purity. Her work continues to be influential, particularly for medical anthropologists focused on sickness-related stigma and its impact on patients’ illness experiences.
World War II brought about a profound change in the way anthropologists did their work. A number of Boas’s students helped the British and United States governments during the war, a trend that continued after the war. Focusing on both public and private health initiatives, anthropologists increasingly worked to help people improve their health outcomes in the post-war era. These public health efforts were directly connected with the founding of the United Nations and the World Health Organization (WHO). In this period, well-being and health care were included in the declaration of human rights, and biomedical thinking became focused on “conquering” infectious disease.
The formal founding of the discipline of medical anthropology can be traced to the late 1970s. One landmark is the publication of George Foster and Barbara Anderson’s (1978) medical anthropology textbook. However, many applied anthropologists and researchers in allied health fields, such as social epidemiology and public health, had been conducting cross-cultural health studies since the conclusion of World War II. These include Edward Wellin, Benjamin Paul, Erwin Ackerknecht, and John Cassell. Many of these early figures were themselves medical doctors who saw the limitations of a strictly biomechanical approach to health and disease.
Since the 1980s, medical anthropologists have diversified the field through interdisciplinary applications of anthropology and the applied use of medical anthropology in health care and government policy. The role of the anthropologist in this work often varies but is typically focused on translating cultural nuance and biomedical knowledge into policy and human-centered care. Today, the field of medical anthropology includes applied anthropologists working in medical settings, nonprofits, and government entities such as the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), and the WHO. Academic medical anthropologists are problem-oriented researchers who study the complex relationship between human culture and health. As can be seen in the lives and careers of the medical anthropologists highlighted in this chapter’s profiles, medical anthropologists frequently occupy both academic and applied roles throughout their career as they seek to apply insights from their research to effect positive change in the lives of those they study.


# Medical Anthropology

## Ethnomedicine

### Learning Outcomes

By the end of this section, you will be able to do the following:
1. Define ethnomedicine, traditional environmental knowledge, and biomedicine.
2. Provide examples of cultural and societal systems that use religion and faith to heal.
3. Define medical pluralism.
Ethnomedicine is a society’s cultural knowledge about the management of health and treatments for illness, sickness, and disease. This includes the culturally appropriate process for seeking health care and the culturally defined signs and symptoms of illness that raise a health concern. Ethnomedical systems are frequently closely related to belief systems and religious practices. Healing can include rituals and natural treatments drawn from the local environment. Healing specialists in an ethnomedical system are knowledgeable individuals who undergo training or apprenticeship. Some examples of ethnomedical healers are midwives, doulas, herbalists, bonesetters, surgeons, and shamans, whose ethnomedicine existed in cultural traditions around the world prior to biomedicine. Anthropologists frequently note that ethnomedicinal healers possess knowledge of both how to heal and how to inflict harm by physical and sometimes metaphysical means. Ethnomedicine does not focus on “traditional” medicine, but instead allows for cross-cultural comparison of medical systems.
Some forms of healing rely upon spiritual knowledge as a form of medicine. Within shamanism, people deliberately enter the spirit world to treat ailments, with the culture’s shaman acting as an emissary. The goal may be to eliminate the illness or to at least identify its source. Similarly, faith healing relies upon a shared understanding of faith and local beliefs, with spirituality pervading the healing process. Exorcising individuals of possession by negative spirits is a common form of faith healing that occurs within Christian, Islamic, Buddhist, and shamanic frameworks. In many cases, cultures that utilize biomedicine also utilize some forms of faith healing.
Ethnopharmacology utilizes herbs, foods, and other natural substances to treat or heal illness. Traditional ethnopharmacological treatments are currently of great interest to pharmaceutical companies looking for new biomedical cures. Many common medicines have roots in ethnopharmacological traditions. Used in Chinese medicine, indigenous American healing, and traditional European medicine, willow bark is a widespread cure for headaches. In 1897, the chemist Dr. Felix Hoffmann, working for the Bayer corporation, isolated acetylsalicylic acid as the active pain-reducing ingredient in willow bark, giving the world Bayer aspirin.
The concept of traditional ecological knowledge, or TEK, refers to medical knowledge of different herbs, animals, and resources in an environment that provides a basis for ethnomedicine. Many cultures have been able to translate detailed awareness of their environments, such as where water is and where and when certain herbs grow, into complex and effective ethnomedical systems (Houde 2007). In 2006, Victoria Reyes-Garcia, working with others, conducted a comprehensive study of Amazonian TEK. Victoria and her colleagues collected information regarding plants useful for food and medicine from 650 research participants from villages along the Maniqui River in the Amazon River basin.
China’s traditional medicine system is another excellent example of an ethnomedical system that relies heavily on TEK and ethnopharmacology. While many in China do rely upon biomedicine to treat specific health problems, they also keep themselves in balance using traditional Chinese medicine. The decision of which health system to consult is often left to the patient, but at times doctors will suggest a patient visit a traditional apothecary and vice versa, creating a complementary medical system that makes use of both approaches. While bound by geography prior to the 19th century, in today’s globalized world a traditional Chinese doctor can use resources from anywhere around the world, whether it is dried body parts of a tiger or herbs found in another part of China. Chinese traditional medicine, as an ethnomedical system, is heavily influenced by culture and context. It focuses on balancing the body, utilizing a number of forces from the natural world. Traditional Chinese medicine makes use of substances as diverse as cicada shells, tiger livers, dinosaur bones, and ginseng to create medicine. Healers in this system are often in a role similar to Western pharmacists, concocting medicine in a variety of forms such as pills, tonics, and balms. The differences between a traditional Chinese medication healer and biomedical pharmacist include both the tools and ingredients used and the foundational assumptions about the cause of and treatments for various ailments. Around the world, traditional environmental knowledge is used both in place of biomedicine and alongside it.
Biomedicine is an ethnomedical system deeply shaped by European and North American history and rooted in the cultural system of Western science. It draws heavily from biology and biochemistry. Biomedicine treats disease and injuries with scientifically tested cures. Biomedical health care professionals base their assessment of the validity of a treatment on the results of clinical trials, conducted following the principles of the scientific method. It should be noted that as each health care professional is not conducting their own research, but instead relying on the work of others, this assessment still requires faith. Biomedicine places its faith in the scientific method, where other ethnomedical systems place their faith in a deity, the healer’s power, or time-tested treatments passed down in traditional ecological knowledge. Biomedicine is not free from culture; it is an ethnomedical system shaped by Western cultural values and history. Biomedicine falls short of its ideal of scientific objectivity. Medical anthropologists have extensively documented the way systemic prejudices such as racism, classism, and sexism permeate biomedicine, impacting its effectiveness and perpetuating health inequalities. Still, in the Western world, biomedicine is often utilized as a point of comparison for other ethnomedical systems.
Biomedicine has been critiqued by medical anthropologists for assuming predominance over other forms of healing and cultural knowledge. In many contexts, biomedicine is presumed to be superior because it is clinical and based on scientific knowledge. Yet this presumed superiority requires that a patient trusts and believes in science and the biomedical system. If a person mistrusts biomedicine, whether because of a bad experience with the biomedical model or a preference for another ethnomedical approach, their health outcomes will suffer if they are forced to rely on the biomedical system. Biomedicine can also disrupt and threaten culturally established treatments and cures. For example, in a culture that treats schizophrenia by granting a person spiritual power and treating them as part of the community, labeling that individual as mentally ill according to biomedical terms takes away their power and removes their agency. In most cases, a hybrid model, in which biomedicine does not assume supremacy but instead works alongside and supports ethnomedicine, is the most effective approach. A hybrid model accords the ill the ability to choose those treatments that they think will best help.
Medical pluralism occurs when competing ethnomedical traditions coexist and form distinct health subcultures with unique beliefs, practices, and organizations. In many contemporary societies, ethnomedical systems coexist with and frequently incorporate biomedicine. Biomedicine is privileged as the dominant health care system in the United States, but in many metropolitan areas, people can also consult practitioners of Chinese medicine, Ayurvedic medicine, homeopathic medicine, chiropractic medicine, and other ethnomedicinal systems from around the world. Examples of medical pluralism are fairly common in contemporary Western society: yoga as a treatment for stress and as a form of physical and mental therapy, essential oils derived from traditional medicine to enhance health, and countless others. Contemporary cultures often fuse biomedicine and ethnomedicine rather than just choosing one or the other. However, the privilege and medical authority of biomedicine does not always afford people the right to choose, or may give them only a limited capacity to do so. Anne Fadiman’s (1998) The Spirit Catches You and You Fall Down, which explores the conflicts between a small hospital in California and the parents of a Hmong child with epilepsy over the child’s care, is a classic example of the cultural conflicts that can occur in medically pluralistic societies.
In many parts of the world, biomedicine has accompanied colonialization, and indigenous health practices have been suppressed in favor of biomedicine. Juliet McMullin’s (2010) Healthy Ancestor: Embodied Inequality and the Revitalization of Native Hawaiian Health discusses the suppression of Hawaii’s indigenous ethnomedical system as a long-lasting legacy of its colonial history. The book includes the efforts of contemporary Hawaiians to regain the healthy lifestyle of their precolonial ancestors. McMullin concludes that while contemporary biomedical health care professionals are more open to Hawaii’s ethnomedical practices than their predecessors were, there is still work to be done.


# Medical Anthropology

## Theories and Methods

### Learning Outcomes

By the end of this section, you will be able to do the following:
1. Discuss the importance of cross-cultural comparison and cultural relativism in study of human health.
2. Explain why both objectivity and subjectivity are needed in the study of health.
3. Discuss ethnographic research methods and their specific applications to the study of human health.
4. Summarize the theoretical frameworks that guide medical anthropologists.

### The Importance of Cultural Context

Culture is at the center of all human perspectives and shapes all that humans do. Cultural relativism is crucial to medical anthropology. There is a great degree of variety in the symptoms and conditions that cultures note as significant indicators of diminished health. How the sick are treated varies between cultures as well, including the types of treatments prescribed for a particular sickness. Cultural context matters, and health outcomes determined by culture are informed by that culture’s many parts. The United States, for example, relies heavily on biomedicine, treating symptoms of mental and physical illness with medication. This prevalence is not merely an economic, social, or scientific consideration, but all three. A cultural group’s political-economic context and its cultural beliefs, traditions, and values all create the broader context in which a health system exists and all impact individuals on a psychosocial level. Behaviors such as dietary choices and preferences, substance use, and activity level—frequently labeled as lifestyle risk factors—are all heavily influenced by culture and political-economic forces.
While Western cultures rely upon biomedicine, others favor ethnopharmacology and/or ritual healing. Medical anthropologists must attempt to observe and evaluate ethnomedical systems without a bias toward biomedicine. Medical anthropologists must be cautious of tendencies toward ethnocentrism. Ethnocentrism in medical anthropology takes the form of using the health system of one’s own culture as a point of comparison, giving it preference when analyzing and evaluating other systems. An American anthropologist who studies ethnomedicine in the Amazon River basin must be careful to limit their bias toward a biomedical approach as much as they can. That is not to say that subjective experience and opinion need be discarded entirely, merely that bias should be acknowledged and where necessary limited. Admitting bias is the first step in combating it. Being aware of one’s own ethnocentrism allows an anthropologist to analyze culture and medicine more truthfully.

### Methods of Medical Anthropology

Medical anthropology is a highly intersectional subfield of anthropology. The field addresses both the biological and social dimensions of maladies and their treatments. Medical anthropologists must thus become comfortable with a wide-ranging tool kit, as diverse as health itself. Like all anthropologists, medical anthropologists rely on qualitative methods, such as ethnographic fieldwork, but they also must be able to appropriately use quantitative methods such as biometrics (including blood pressure, glucose levels, nutritional deficiencies, hormone levels, etc.) and medical statistics (such as rates of comorbidities, birth rates, mortality rates, and hospital readmission rates). Medical anthropologists can be found working in a myriad of endeavors: aiding public health initiatives, working in clinical settings, influencing health care policy, tracking the spread of a disease, or working for companies that develop medical technologies. The theories and methods of medical anthropology are invaluable to such endeavors.

### Qualitative Methods

Within medical anthropology, a number of qualitative research methods are invaluable tools. Qualitative methods are hands-on, first-person approaches to research. An anthropologist in the room or on the ground writing down field notes based on what they see and recording events as they happen creates valuable data for themselves and for others.
Participant observation is a methodology in which the anthropologist makes first-person observations while participating in a culture. In medical anthropology, participant observation can take many forms. Anthropologists observe and participate in clinical interactions, shamanic rituals, public health initiatives, and faith healing. A form of participant observation, clinical observations allow the anthropologist to see a culture’s healing practices at work. Whether a doctor is treating COVID-19 or a shaman is treating a case of soul loss, the anthropologist observes the dynamics of the treatment and in some cases actually participates as a patient or healer’s apprentice. This extremely hands-on method gives the anthropologist in-depth firsthand experience with a culture’s health system but also poses a risk of inviting personal bias.
Anthropologists observe a myriad of topics, from clinical interactions to shamanic rituals, public health initiatives to faith healing. They carry these firsthand observations with them into their interviews, where they inform the questions they ask. In medical anthropology, interviews can take many forms, from informal chats to highly structured conversations. An example of a highly structured interview is an illness narrative interview. Illness narrative interviews are discussions of a person’s illness that are recorded by anthropologists. These interviews can be remarkably diverse: they can involve formal interviews or informal questioning and can be recorded, written down, or take place electronically via telephone or video conference call. The social construction of sickness and its impact on an individual’s illness experience is deeply personal. Illness narratives almost always focus on the person who is ill but can at times involve their caregivers, family, and immediate network as well.
Another method commonly used in medical anthropology, health decision-making analysis, looks at the choices and considerations that go into deciding how to treat health issues. The anthropologist interviews the decision makers and creates a treatment decision tree, allowing for analysis of the decisions that determine what actions to take. These decisions can come from both the patient and the person providing the treatment. What religious or spiritual choices might make a person opt out of a procedure? What economic issues might they face at different parts of their illness or sickness? Health decision-making analysis is a useful tool for looking at how cultures treat sickness and health, and it highlights a culture’s economic hierarchies, spiritual beliefs, material realities, and social considerations such as caste and gender.

### Quantitative Methods

Quantitative methods produce numeric data that can be counted, correlated, and evaluated for statistical significance. Anthropologists utilize census data, medical research data, and social statistics. They conduct quantitative surveys, social network analysis that quantifies social relationships, and analysis of biomarkers. Analysis of census data is an easy way for medical anthropologists to understand the demographics of the population they are studying, including birth and death rates. Census data can be broken down to analyze culturally specific demographics, such as ethnicity, religion, and other qualifiers as recorded by the census takers. At times, an anthropologist may have to record this data themselves if the available data is absent or insufficient. This type of analysis is often done as a kind of background research on the group being studying, creating a broader context for more specific analysis to follow.
Also important to medical anthropologists are analyses of medical statistics. The study of medical records helps researchers understand who is getting treated for what sickness, determine the efficacy of specific treatments, and observe complications that arise with statistical significance, among other considerations. Analysis of census data combined with medical statistics allows doctors and other health providers, as well as medical anthropologists, to study a population and apply that data toward policy solutions. Famous examples include the World Health Organization’s work on health crises such as HIV/AIDS, Ebola, and COVID-19.
Questionnaires are more personal to the anthropologist, allowing them to ask pointed questions pertinent to their particular research. Surveys make it possible for anthropologists to gather a large quantity of data that can then be used to inform the questions they ask using qualitative methods. Distribution methods for surveys vary and including means such as personally asking the questions, releasing the survey through a health care provider, or offering online surveys that participants choose to answer.
These are the most common methods used by medical anthropologists. Different theories are influential in determining which of the methods a particular research might favor. These theories inform how an anthropologist might interpret their data, how they might compose a study from beginning to end, and how they interact with the people they study. Combined with more general anthropological theory, each anthropologist must craft a composite of theory and method to create their own personalized study of the world of human health.

### Theoretical Approaches to Medical Anthropology

### Social Health

Biomedicine, the science-based ethnomedical system practiced in the United States, recognizes the impact physical health and mental health have on one another: when one falters, the other does as well. There is an increasing awareness in biomedicine of a third type of health, social health, which has long been recognized by many ethnomedical systems around the world. Each of the theoretical approaches to medical anthropology demonstrates that to develop a holistic understanding of human well-being, it is necessary to include mental, physical, and social health. Social health is driven by a complex set of sociocultural factors that impact an individual or community’s wellness. At a macro level, it includes the cultural and political-economic forces shaping the health of individuals and communities. An individual’s social health also includes the support a person receives from their extended social network, as well as the social pressures or stigma a person may face and the meaning that they ascribe to their experiences. Just as mental and physical health strongly influence one another, when a person’s social health falters, their physical and/or mental health declines as well.
Physical environments—whether they are natural, constructed, or modified environments—shape cultural adaptations and behaviors. People living on islands and people living in deserts inhabit very different environments that inform their cultures and affect their biology. On the other hand, culture often affects how humans interact with their environments. People who work in offices in Los Angeles and hunter-gatherers in the Amazon River basin interact with their environments differently, relying upon very different subsistence patterns and sets of material culture. Culture also informs human biology. Eating a lot of spicy foods changes a person’s biophysiology and health outcomes, as do dietary taboos such as refusing to eat pork. These dietary choices inform biology over generations as well as within a single lifetime.

### The Biocultural Approach

The biocultural approach to anthropology acknowledges the links between culture and biology. Biology has informed human development and evolution, including the adaptations that have made culture, language, and social living possible. Culture, in turn, informs choices that can affect our biology. The biocultural approach analyzes the interaction between culture, biology, and health. It focuses on how the environment affects us, and the connections between biological adaptations and sociocultural ones. The biocultural approach draws on biometric and ethnographic data to understand how culture impacts health. The effects of environment on biology and culture are apparent in the treatment of survivors of the Fukushima Daiichi nuclear accident that occurred in 2011 in Japan. Studies regarding the genetic health of survivors focus on the combination of environmental damage and social stigma in Japan due to their potential exposure to radiation.

### Symbolic Approach

Other theoretical approaches ask different types of questions. What does it mean to be a patient? What are the social expectations for the behaviors of a person diagnosed as suffering from a particular sickness? Why is it symbolically meaningful for a treatment to be prescribed by a medical doctor? These are questions typically asked by those utilizing a symbolic approach to medical anthropology. The symbolic approach focuses on the symbolic thinking and beliefs of a culture and how those beliefs affect social and especially health outcomes.
A person’s beliefs affect how they perceive treatments and how they experience illness. The most obvious example of the symbolic approach at work is the placebo effect. If a person believes that a treatment will be effective, this belief will affect their health outcome. Often in medical trials, people who believe they are receiving a treatment but are in fact receiving a placebo, such as a sugar pill, will demonstrate physiological responses similar to those receiving an active substance. Accounting for the placebo effect is an important consideration for all medical studies. The opposite of the placebo effect, the nocebo effect, occurs when a person believes they are not receiving an effective medicine or that a treatment is harmful. Common to both phenomena is the importance of meaning-centered responses to health outcomes. One of the most potent examples of this is voodoo death, when psychosomatic effects—that is, physical effects created by social, cultural, and behavioral factors—such as fear brought on by culture and environment cause sudden death. Related to the symbolic approach of medical anthropology is the symbolic interaction approach to health utilized by medical sociologists. Both approaches recognize that health and illness are socially constructed concepts. The symbolic interaction approach to health focuses on the roles of the patient, caregiver, and health care provider and the interactions that take place between people occupying these roles.

### Medical Ecology

Another major medical anthropology theory is medical ecology. Pioneered by Paul Baker and based on his work in the Andes and American Samoa in the 1960s and 1970s, medical ecology is a multidisciplinary approach that studies the effects of environment on health outcomes. Examples of these environmental influences include food sources, environmental disasters and damage, and how environmentally informed lifestyles affect health. Whereas the biocultural approach looks at the intersection of biology and culture, medical ecology focuses instead on how environment informs both health and the culture surrounding it.
A popular example of these connections can be observed in what are termed Blue Zones, certain locations around the world where a significant number of people regularly live exceptionally long lives, many over a century. These communities can be found in the United States, Japan, Columbia, Italy, and Greece. Common links between people who live in these places include a high-vegetable, low-animal-product diet (eggs and fish are the exception), a lively social life and regular activity, and a strong sense of cultural identity.
A negative example of the links between environment and health can be viewed in the Flint, Michigan, water crisis. In this case, pollution of the city water system negatively affected health outcomes due to high exposure to lead and Legionnaires’ disease. Studies, including a long-term study by the National Institutes of Health, confirm that the water, central to the larger environment of Flint, negatively affected citizens of all ages, with particular harm caused to children and the elderly.

### Cultural Systems Model

Culture is a chief consideration in another theory, the cultural systems model. Cross-cultural comparison is a core methodology for anthropology at large, and the cultural systems model is ideal for cross-cultural comparison of health systems and health outcomes. Cultures are made of various systems, which are informed by sociocultural, political-economic, and historical considerations. These systems can include health care systems, religious institutions and spiritual entities, economic organizations, and political and cultural groupings, among many others. Different cultures prioritize different systems and place greater or less value on different aspects of their culture and society. The cultural systems model analyzes the ways in which different cultures give preference to certain types of medical knowledge over others. And, using the cultural systems model, different cultures can be compared to one another.
An example of the cultural systems model at work is Tsipy Ivry’s Embodying Culture: Pregnancy in Japan and Israel (2009), which examines pregnancy and birth in Israel and Japan. A particular focus is how state-controlled regulation of pregnancy and cultural attitudes about pregnancy affect women differently in each society. Despite both societies having socialized medicine, each prioritizes the treatment of pregnant women and the infant differently.
In the Israeli cultural model for pregnancy, life begins at a child’s first breath, which is when a woman becomes a mother. Ivry describes a cultural model that is deeply impacted by anxiety regarding fetal medical conditions that are deemed outside the mother’s and doctor’s control. As every pregnancy is treated as high risk, personhood and attachment are delayed until birth. The state of Israel is concerned with creating a safe and healthy gene pool and seeks to eliminate genes that may be harmful to offspring; thus, the national health care system pressures women to undergo extensive diagnostic testing and terminate pregnancies that pass on genes that are linked to disorders like Tay-Sachs disease.
Japan, facing decreasing birthrates, pressures women to maximize health outcomes and forgo their own desires for the sake of the national birth rate. The cultural model for pregnancy in Japan emphasizes the importance of the mother’s body as a fetal environment. From conception, it is a mother’s responsibility to create a perfect environment for her child to grow. Mothers closely monitor their bodies, food intake, weight gain, and stressful interactions. In Japan, working during pregnancy is strongly discouraged. Ivry noted that many women even quit work in preparation for becoming pregnant, whereas in Israel mothers work right up to delivery.
The cultural systems model also allows medical anthropologists to study how medical systems evolve when they come into contact with different cultures. An examination of the treatment of mental illness is a good way of highlighting this. While in the United States mental illness is treated with clinical therapy and pharmaceutical drugs, other countries treat mental illness differently. In Thailand, schizophrenia and gender dysmorphia are understood in the framework of culture. Instead of stigmatizing these conditions as illnesses, they are understood as gifts that serve much-needed roles in society. Conversely, in Japan, where psychological diagnoses have become mainstream in the last few decades and pharmaceutical treatment is more prominent than it once was, psychological treatment is stigmatized. Junko Kitanaka’s work on depression in Japan highlights how people with depression are expected to suffer privately and in silence. She links this socially enforced silence to Japan’s high stress rates and high suicide rates (2015). The cultural systems model offers an effective way to evaluate these three approaches toward mental illness, giving a basis of comparison between the United States, Thailand, and Japan. Assigning ethnomedicine the same value as biomedicine rather than giving one primacy over the other, this important comparative model is central to the theoretical outlook of many medical anthropologists.
The cultural systems model encompasses a myriad of cross-disciplinary techniques and theories. In many cultures, certain phrases, actions, or displays, such as clothing or amulets, are recognized as communicating a level of distress to the larger community. Examples include the practices of hanging “the evil eye” in Greece and tying a yellow ribbon around an oak tree during World War II in the United States. These practices are termed idioms of distress, indirect ways of expressing distress within a certain cultural context. A more psychologically driven consideration is the cause of people’s behaviors, known as causal attributions. Causal attributions focus on both personal and situational causes of unexpected behaviors. A causal attribution for unusual behavior such as wandering the streets haplessly could be spirit possession within the context of Haitian Vodou, while in the United States behaviors such as sneezing and blowing one’s nose might be attributed to someone not taking care of themselves.
Causal attributions can be important to one’s own illness. Anthropologist and psychiatrist Arthur Kleinman has concluded that if doctors and caregivers were to ask their patients what they think is wrong with them, these explanations might provide valuable information on treatment decisions. One patient might think that their epilepsy is caused by a spirit possession. Another might suggest that their developing diabetes in inevitable because of their culture and diet. These beliefs and explanations can guide a doctor to develop effective and appropriate treatments. The approach recommended by Kleinman is known as the explanatory model. The explanatory model encourages health care providers to ask probing questions of the patient to better understand their culture, their worldview, and their understanding of their own health.

### Political Economic Medical Anthropology

Another medical anthropology approach is critical medical anthropology (CMA), which is sometimes referred to as political economic medical anthropology (PEMA). Critical medical anthropology has a specific interest in the inequalities of health outcomes caused by political and economic hierarchies. Critical medical anthropology advocates for community involvement and health care advocacy as ethical obligations. Defining biomedicine as capitalist medicine, this approach is critical of the social conditions that cause disease and health inequalities and of biomedicine’s role in perpetuating these systemic inequalities. CMA is also interested in the medicalization of social distress, a process that has led to a wide range of social problems and life circumstances being treated as medical problems under the purview of biomedicine.
Systemic racism and structural violence create many negative health outcomes. Structural violence refers to the way in which social institutions, intentionally or otherwise, harm members of some groups within the larger society. Structural violence can affect things such as life expectancy, disability, or pregnancy outcomes and can lead to distrust of medical systems. The Tuskegee syphilis study, a decades-long “experiment” that studied the long-term effects of syphilis in Black men under the guise of medical treatment, is a prime example of structural violence at work within the United States medical system. Black men involved in the study were not told they had syphilis and were denied medical treatment for decades, with most dying of the disease. The government’s internal mechanisms for halting unethical studies failed to stop this experiment. It was only when public awareness of what was happening resulted in an outcry against the study that the experiments were stopped.
Another area of interest to medical anthropologists working with a CMA approach is how medical systems might be inherently biased toward or against certain segments of society. The research of anthropologist Leith Mullings demonstrated a lifelong focus on structures of inequality and resistance. Her work in Ghana examined traditional medicine and religious practice through a postcolonial lens, which was critical of the colonial legacy of structural inequality she observed. Her work in the United States also focused on health inequalities, with a special interest in the intersection of race, class, and gender for Black women in urban areas. It has been documented that some doctors in the United States regularly ignore the pain of women, and this is especially true in cases where the doctor displays racial bias. This tendency has been cited in several studies, including a study in The New England Journal of Medicine that found that women are more likely to be misdiagnosed for coronary heart disease based on the symptoms they give and pain levels reported (Nubel 2000). Another study in the Journal of Pain found that women on average reported pain 20 percent more of the time than men and at a higher intensity (Ruau et al. 2012). Another example of research that takes a CMA approach is Khiara Bridges’s 2011 Reproducing Race, which brings a critical lens to pregnancy as a site of racialization through her ethnography of a large New York City hospital. This medical racism contributes to the higher rates of African American infant and maternal mortality.
Merrill Singer has done work on the role of social inequalities in drug addiction and in cycles of violence. This work has led to his development of the concept of syndemics, the social intersection of health comorbidities, or two health conditions that often occur together. For example, Japan’s hibakusha, or atomic bomb survivors of Hiroshima and Nagasaki, do not live as long as Japan’s normally long-lived population and are more likely to develop multiple types of cancer and other diseases tied to their exposure to nuclear radiation. In addition to these health risks, they face heavy discrimination from the larger Japanese population due to misinformation regarding nuclear radiation and radiation contamination. This discrimination carries over to the descendants of hibakusha, who have a higher rate of cancer than the average Japanese population despite having no detectable genetic damage from the atomic bombings. Studies are ongoing as to the cultural, economic, and genetic causes of this cancer. Syndemics is highlighted in the near-century-long struggle for numerous conditions caused by the atomic bombings to be recognized as related to the atomic bombings and thus treated by the Japanese government.
Critical theories of health are an applied method, analyzing medical systems and applying critical theory, often with the goal of improving the system or improving policy. Recommendations for improvements often come out of research but may also be the starting point of a research project, as part of a data-finding mission to highlight disparity in health outcomes. Whether it is systemic racism in biomedical treatment or power discrepancies in ethnomedical rituals, critical theories of health are a key part of exploring medicine in action and understanding real medical consequences. From birth to the grave, social inequalities shape health outcomes, life expectancy, and unnecessary human suffering. Critical medical anthropology scholarship demonstrates the social forces shaping disease and health, from drug addiction to the impacts of climate change. This work becomes a self-evident call of action. It is medical anthropology in action.