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Cross-Cultural Comparison and its Contribution to Perspectives in Medical Anthropology

Every discipline or sub-discipline is characterized by, among other things, a set of theoretical perspectives that support its subject matter. In this context, such a sib-field is medical anthropology. According to Foster and Anderson quoted in Gochman (1997), medical anthropology is a bio-cultural discipline that deals with socio-cultural and biological aspects of human behavior that affect people's health and consequent disease. On the other hand, cross-cultural studies are those studies that compare a certain phenomenon in the lens of many cultures. For instance, a medical anthropologist may be concerned with gender and disease in Latin American communities. As it shall be herein illustrated, this has a great deal of contribution in medical anthropology, a sub-field of Anthropology.

Before an examination of the contribution of cross-cultural comparison in every theoretical perspective, it is crucial to know what those theoretical perspectives are. Different scholars have put forward varying numbers of the perspectives to be applied in the sub-field. They also do not agree on what perspectives are best for addressing particular medical anthropological concerns. Baer, Singer and Susser (2003) quoted Robert Hahn as having suggested three perspectives. They also quoted Byron J. Good as having identified four perspectives in the study of medical anthropology. These include the critical paradigm, empiricist paradigm, 'meaning-centered' paradigm and the cognitive paradigm. Further, the above-mentioned three authors reported Ann McElroy and Patricia Townsend who also mentioned four other very different theoretical perspectives: Interpretive theories, critical theories, ecological theories and political ecological theories. McElroy and Townsend also refer to critical theories as political economy theories. It is crystal-clear that there is no consensus on a definite number and nature of theories to be used in medical anthropology. Nevertheless, they are excellent frameworks with which the anthropological inquiry could be advanced. Above all, the perspectives have converging points since they address the same subject matter. A short glimpse into two of these theories shall be done then their contribution elucidated. They are the Cultural Interpretive Theory and the Ecological Theory.

The key concept of the medical ecological theory is adaptation. According to Baer, Singer and Susser (2003), adaptation is the individual or group biological or behavioral changes which confer to the individual(s) the ability to survive in a certain environment. A group's level of health is considered the resultant effect of the relationships between the individuals and their surroundings. In other words, health is the degree, extent or level of people's environmental adaptation. The Mano community of Liberia and their adaptation to malaria illustrates this. It is reported that the community has had biological adaptations such that their hemoglobin-producing genes mutate to inhibit the production of plasmodium within the blood. This accords a considerable level of protection against severe malaria. On the other hand, behavioral adaptation is demonstrated by the dwellers of the arctic in their invention of the snow goggles that protect them from the adverse health effects from the sunlight glare reflected from the snow and ice (McElroy & Townsend, 1998).

Paradigmatic shift was seen in the proposition of the 'meaning-centered' and cultural interpretive theory that watered down the ecological emphases of heath and disease (Good, 1994). The central belief of the theory is that both victims and healers of diseases discern them through a variety of interpretive activities involving interaction of biological processes, cultural frames of meaning and social practices. In this approach, disease is a manifestation of a physical bodily reality caused by a certain phenomenon. These causative phenomena have to be culturally understood for a sustainable treatment and resultant healing. While biomedicine may exclusively attribute malaria to plasmodium, cultural beliefs of witchcraft have to be dealt with if at all the patient has to be healed.

The above concepts were only possible through cross-cultural comparison. As a result, the basis for different theoretical groupings has been possible. In other words, different theoretical perspectives were only possible through cross-cultural studies as their proponents made the observations in different cultures. For instance, in interpretive theories, cross-cultural comparison has helped in the knowledge of the different conceptions of the concepts of disease and health. While biomedical approaches may consider some conditions such as obesity as health problems, some cultures perceive it as being healthy. Additionally, other culture perceive malaria as a consequence of witchcraft whereas biomedicine attributes it to plasmodium.

In ecological theory, cross-cultural comparison has contributed a lot in the understanding of different health adaptations in relation to different environments. Through the theory, it was also understood why different diseases are more prevalent in some areas as opposed to others. Moreover, Baer, Singer and Susser noted that the ecological and interpretive approaches negated the core role of political economy in determination of disease and health. Different political economies were only possible through a cross-cultural lens. Cross-cultural comparisons have made manifest that there is a relationship between the economic life of persons and their status of health. In addition, these comparisons have made it possible for medical anthropologists to ascertain the connections between power differences in different social classes and the manifestation of disease. This formed the basis of critical theorists such as Marx and Engels. Finally, biomedicine and ethno-medicine may be considered as two different cultural comparisons: One from the West and the other from the ethnic societies of the developing and the underdeveloped world.

How Biomedicine is culture-bound

Biomedicine is a term that combines biology and medicine. It is concerned with conservation of life and the vital functions. Biomedicine is defined as clinical medicine that is built on the principles of biochemistry and physiology. According to Keating and Cambrosio (2003), it entails an investigation of the health situations through use of biological methods, theories and applications. On the other hand, culture connotes people's way of life. It encompasses people's practices, beliefs, values among other things. There exists a direct yet invisible relationship between biomedicine and people's way of life. The practice of biomedicine does not exist in isolation but in a social context: It involves people with their own practices and beliefs. In specific terms, people's beliefs on health influence the effectiveness of biomedical approaches to the diagnosis, treatment and cure of diseases.

Different societies have different conceptions of disease etiology or cause. For instance, some ethnic communities believe that people who have a 'bad eye' are likely to cause diarrhea in children whenever they look at them. Parents to such children are bound not to resort to biomedical interventions for the diarrhea but may seek what they belief is the 'cure' for children who have been 'looked at with a bad eye'. In addition, before the invention and spread of biomedicine, each society had its own ways of diagnosing and treating diseases that affected them. Such groups of people may be resistant to biomedicine that has for long been associated with the colonial rule with which it came. There are also cultural constructions that predispose different groups of the same society to different diseases. An example is the gender-based division of labor that for instance exposes women to massive amounts of water during washing. Since malaria-causing mosquitoes breed in water, more women than men are likely to register higher levels of malaria in such societies. The societal constructions of masculinity and femininity also lead men to risky behaviors such as avoiding hospitals since they 'are men' known not to fall sick easily. There are also cultural aspects that hold that 'real men do not finish their medication'. This and other cultural factors have been reported as immense obstacles to the effectiveness of biomedical cure and management of disease.  Biomedical practitioners have to take into considerations the role of culture in the perceptions of disease cause, treatment and cure.

In the Tenacious assumptions in the Western medicine, it is therein stipulated some of the reasons why biomedicine is not always successful in alleviating or managing human disease. According to Gordon (1988), although biomedicine has provided the technical knowhow, its practices extend beyond boundaries of medicine. It incorporates the social and the cultural perspectives in its dealings with disease and health. This is so because biological cosmology has to be well embedded with the social nature of humanity.

Although medical historians purport that biomedicine is not subject to cultural interpretations, medical anthropologists assert that the science is culture-bound (Baronov, 2008). In the view of medical anthropologists, Western biomedicine has to be contextualized in the way it transforms the recipient societies. In this view, biomedicine would be cynical if the political economies of the societies in which it is practiced. Otherwise, biomedicine would remain a foreign concept with no meaning to the target populations. This explains why some of the efforts by global health organizations such as the World Health Organization (WHO) have miserably failed to alleviate heath disparities in the underdeveloped and the developing world. These organizations have resulted to cultural approaches and community involvement in the fight against disease. The cultural approaches must have been informed by theories of development in which the 'bottom-up approach' has been found out to be the most effective way of sustainable and holistic development. According to David Baronov, for biomedicine to transform the Third World, the Third World must first transform the application of the science.  

In this regard, medical anthropological authorities perceive diseases as 'culture-bound syndromes' requiring cultural approaches especially in Black American societies. Due to this knowledge, biomedicine does not use a case in the generalization of others. This borrows from the principles of Boazian Anthropology including Cultural Relativism. In this view, one culture should not be used to judge others. Each culture is distinct in its own right. In this context, diagnostic procedures applied in the Western cultures, for instance, should not be 'transplanted' to other cultures since they may not work. Biomedicine's success depends on its ability to put into perspective the inherent ethno-medical beliefs. Even the research in medicine is cognizant of the fact that analyses of health variables are not a uniform procedure across cultures. Some cultural medical information requires content analysis as opposed to the statistical formulae applied in biomedicine.

The influence of culture on treatment trajectories cannot be underestimated. Some cultural categorizations render some diseases as minor conditions that should not be medically attended. Practitioners in the field of biomedicine are advised to investigate the basic societal issues relating to some patterns of disease incidence. It has also been noticed that patients are keen on who treats them. Varieties of Eastern cultures do not believe that a female doctor should attend to a male patient. Traditional healers are consulted to explain traditional beliefs to medical practitioners. Epidemiological studies are now incorporating environmental considerations giving rise to medical geography. This is justified by the fact that the binding culture exists in a place as anthropology studies human phenomena over time and across space.

Medicalization of Life by Scheper-Hughes: Accomplishments and Consequences in Brazil

Is there any connection between the human needs, sickness and medicine? Nancy Scheper-Hughes answered this question by exploring the disease Nervoso among the people of Alto do Cruzeiro. The relationship between this disease and human hunger and poverty was reported as having made the people nervous, lean and irritable. The condition is thus a 'social disease' of nervousness. This human condition was investigated by Nancy and suggested a medicalization of the people's needs through an understanding of the relationship between the body, the mind and the social life. The medicalization was possible through a healthcare system that applied biomedical approaches in the management of a problem that was socially manifested.

The phrase 'medicalization of life' as used by Nancy Scheper-Hughes is based on the people's social needs as the basis of health intervention. According to Scheper-Hughes (1993), much of the human social discomfort is caused by disease. In her opinion, a pharmaceutical restoration of those health defects would lead to a transformation of life. In the opinion of this write up, medicalization of life is a state of medical intervention and incorporation of bio-social problems in the healthcare system for an improvement of people's quality of life. This is illustrated by the Algerian woman's confession that before doctors came in their society; people never knew what illness was; they got sick, went to bed and died. With the advent of biomedicine, the members of society then knew what used to cause deaths. How medicalization of life was accomplished and the consequences have been discussed in the light of Pernambuco, a Brazilian State in the Northeast region of the country.

According to Scherper-Hughes, medicalization of life in Pernambuco has been very pronounced and exponential. She reported that in 1964, there were only very few privately owned hospitals. Due to the scarcity of the health services, Alto women delivered at home with the assistance of traditional midwives. She expressly wrote that there were no clinics for the poor apart from the state clinic that was located several kilometers from the town. Her first step in the 'medicalization of life' was taking immunization program not only to primary schools but also to homes of the people of Alto; yet another impoverished shantytown in the Northeastern Brazil. Contrastingly, the poor people of the region were opposed to medical care. This was illustrated by pregnant women's assertion that male doctors could take advantage of them during such intimate examinations. The most common diseases were malaria, tuberculosis and endemic schistosomiasis. They made use of traditional healers who used herbs to treat such conditions.

It could be argued that from the people's perspective, the immediate consequence of medicalization of life programs was the overturning of the belief that men were not supposed to meddle into the affairs of women's nudity without pro-creation ends. Moreover, by the time the author returned in 1982, there were notable advancements in the medicalization of life. Hospitals were expanded and maternity wards instituted such that even the poor women were able to deliver in hospitals. Reproductive health has also substantially improved following introduction of contraceptives and other birth control mechanisms. Municipal clinics and state-owned facilities introduced at least two-shift schedules for maximum attention to health concerns.

This move was also accompanied by policy nuances. For instance, in 1989, the municipio instituted a supervisor of the entire municipal free clinics under the title secretary of health. The social amenity expanded to the religious domains such as the Protestant and Catholic chapels thus initiating a monumental improvement in the whole society; including the Christians and traditionalists. The social disease nervosa and the people's needs were fairly 'medicalized'. This was a great social consequence since as indicated earlier, deprivation and misery manifest themselves through sickness. From a political perspective, Scherper-Hughes reported that public health became a core part of mayoral contestations in the town of Pernambuco. There was also a general political stability since the nervous effects of the disease nervosa became outdated. Succinctly put, the political participation of the people of the two towns was improved. There were swelling numbers of patients in Mayor's office with health concerns that needed to be addressed for the well-being of the town.

There were however lethal consequences of the drugs especially on the part of the illiterate population. This is probably a justification that development should be balanced for it to be fruitful: Education and health. According to Scherper-Hughes (1993), so as to make themselves relevant, the traditional healers made 'cocktails': Mixtures of traditional herbs and pharmaceutical medicine and antibiotics. This act and other cases of contamination led to deaths of people. The author also stated that the relationship between medicine and politics was evident in a central Brazil town of Born Jesus. She reported that the wealthy families were striving to make sure that their children studied medicine or became politicians. Political aristocrats began to control policy formulations, as they now owned clinics. Political leaders were expected to be patrons of major health facilities even if they had no prior experience. Health became a political symbol. Improvement in health was a slogan in almost every political manifesto. Further, political administration began to interfere with medical affairs. Although 'medicalization of life' had several consequences, the benefits were manifold as a change in political good will could lead to absolute better life.

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