Ethnography of health for social change: impact on public perception and policy.

Social Science & Medicine 99 (2013) 116e118 Contents lists available at ScienceDirect Social Science & Medicine journal homepage: www.elsevier.com/locate/socscimed Introduction Ethnography of Health for Social Change: Impact on public perception and policy Introduction This special issue addresses a core problem of social science: the relationship of research to public perception and policy. It focuses on the potential impact of ethnographic research on the way its au- diences see health problems, conduct their professional and per- sonal lives, and become politically active. How can ethnography foster public engagement in health issues? Ethnography has an established role in health research. It eluci- dates the cultural logics driving health related behavior, and the un- examined assumptions that frame problems of relevance to health. It places these ﬁndings in historical, economic and political context in ways that quantitative research alone does not. And given the widespread use of narrative in mass media’s shaping of public opinion in the U.S., ethnographic narratives promise to make a distinct contribution to public perceptions and policy. Medical an- thropology and sociology have long been employing ethnographic methods to answer speciﬁc health and medicine-related questions. They have had a demonstrable impact on professional and organi- zational practices as well as on our theoretical understandings of health and medicine. But what broader effects might ethnographic work, ranging from theoretical to applied, have on public discourse and policy agendas? This is a question for cultural anthropology and qualitative soci- ologydﬁelds that have called for self-examination regarding the public relevance of their work (Burawoy, 2009; Gans, 2010). It is also a question for qualitative public health and policy researchers, whose methodologies may be less established within their larger disciplines. In the U.S., national meetings of the American Anthro- pological Association, and academic publishers such as the editors of the journal Ethnography and of the University of California Press book series on Public Anthropology, strive to bring ethnography to bear on issues of public importance. Leaders in a movement within academia to promote public ethnography have deﬁned it as “The type of research and writing that directly engages with the critical social issues of our time.Authors of such works passionately inscribe, translate, and perform their research in order to.emo- tionally engage, educate, and move the public to action.” (Tedlock, 2007) Yet there is little consensus on how to achieve this goal. Articles in this special issue describe ethnographic research of relevance to health and consider the actual or potential impact of their ﬁndings on public debate and policy. In order to demonstrate cross cutting core issues, as well as the speciﬁcity and diversity of the ways that ethnographic research reaches larger publics in particular contexts, we deliberately include ethnographers working in geographically and thematically diverse settings. 0277-9536/$ e see front matter O 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.socscimed.2013.11.001 Contributors to this issue cluster around three cross cutting topics in which ethnography has historically played a prominent role: 1) critical perspectives on global health; 2) marginalizing pro- cesses of poverty, stigma and violence; and 3) community based participation and advocacy. First, global health initiatives have required the ﬁne grained and interpretive perspective offered by ethnographers, which has led to indispensable insights among global health practitioners and agencies about the ways that concepts and interventions do, or do not, translate across borders, languages and cultural groups (Janes, 2010; Kleinman, 2010; Nichter, 2008). In fact, ethnographers are often able to explain counterintuitive outcomes when health in- terventions are transported from one locale to another. Second, ethnographers have historically had unique access to marginalized groups, and attended to their on-the-ground lived ex- periences, illuminating both the local mechanisms by which larger policies or institutions negatively impact health, and the ways that marginalized groups attempt to adapt to and resist unfavorable pol- icies and institutions (Hammersley & Atkinson, 2007; Kleinman, Das, & Lock, 1997). Third, when these groups or health organiza- tions attempt to advocate for themselves against the larger struc- tural forces that entrench health and social inequalities, ethnographers are often those who document this advocacy and its symbolic and material sources. The ethnographic stance of rep- resenting alternative world views lends itself to envisioning alter- native politics and institutions. It also lends itself to participatory research in which research subjects shape the questions and prod- ucts of health research itself (Israel, 2005; Minkler & Wallerstein, The ethnographic record is rich with research that illuminates health inequalities and calls for social change as health intervention. Ethnographers are often called upon to assess the effects of profes- sional and institutional practices on health outcomes. And a growing number of ethnographers are “studying up; ” analyzing the cultural frames and social practices of large institutions, professionals, scien- tists, marketers, journalists and policy-makers themselves. Yet the ways that their diverse ethnographies inform publics and policy makers have seldom been examined in a systematic way. This special issue takes up the question of how ethnographic research can uniquely contribute to public perception and policy surrounding health issues. It poses this question to academic, theo- retical ethnographers who pursue topics of public interest. To that end, this issue assembles the work of ethnographers who strive to illuminate the social mechanisms of health disparities, as well as an anthropologist-cum-magazine publisher, an online editor, a policy- maker-cum-visual ethnographer, and a local and national health ofﬁcial who comment on these ethnographic perspectives from