ANTH/HSERV 475 Perspectives in Medical Anthropology University of WashingtonAlejandro Cerón Office: Denny Hall 417 Office hours: Wed 11 am -13 pm Week 6: Wed, 11/3/2010

Outline Today’s Goals: Today’s Goals: Explore the notion of health and its relation to illness/disease/sickness Explore the notion of health and its relation to illness/disease/sickness 1.Oral presentations  Alicia Fitzpatrick, Amran Ahmed, Alex Hernandez (link) link 2.Videos and discussion using last day’s concepts 3.Today’s readings

Self evaluation and feedback Self evaluation Self evaluation You are doing great as a group! You are doing great as a group! I understand differences (small/large group; more/less familiar with topics, etcetera) I understand differences (small/large group; more/less familiar with topics, etcetera) Main purpose: you reflect on your engagement and contribution. Main purpose: you reflect on your engagement and contribution. Feedback Feedback HelpfulSuggestions Many people Students presentations Readings Power point Videos Blog Small /Large group disc. More small group Some peopleLess small group More in-depth Cover less material Worried about exam

Using your feedback for improving More/Less small group: I will try to have discussions at least once every week. More/Less small group: I will try to have discussions at least once every week. More in-depth: More in-depth: We should talk. I can suggest readings or exercises. We should talk. I can suggest readings or exercises. Blog should allow you to go in depth. Blog should allow you to go in depth. Ask me Ask me Cover less material: I will, starting today! Cover less material: I will, starting today! Worried about exam Worried about exam Eliminate exam Eliminate exam Substitute with three 500-word COMMENTS to other student’s posts Substitute with three 500-word COMMENTS to other student’s posts One paragraph summarizing your classmate’s point One paragraph summarizing your classmate’s point One paragraph One paragraph Explaining what you disagree with and why Explaining what you disagree with and why Explaining what you found useful and why Explaining what you found useful and why

Film (60 min - link) link

Janzen, Ch 3. Fabric of Health Health: a philosophical, epistemological, ontological, normative puzzle with practical implications (explored in further detail in Almeida- Filho’s article). Health: a philosophical, epistemological, ontological, normative puzzle with practical implications (explored in further detail in Almeida- Filho’s article). Examples/generalizations of “classical medical traditions” Examples/generalizations of “classical medical traditions” Syncretism Syncretism Assess with concrete people, “local level” Assess with concrete people, “local level” Primary health care Primary health care

Janzen, Ch 3. Fabric of Health They all blend together in actual practice, in medical systems They all blend together in actual practice, in medical systems Personalistic : disease is explained as due to active, purposeful intervention of an agent, who may be human, nonhuman, or supernatural. The sick person is literally a victim, for reasons that concern him/her alone (Foster1976). Personalistic : disease is explained as due to active, purposeful intervention of an agent, who may be human, nonhuman, or supernatural. The sick person is literally a victim, for reasons that concern him/her alone (Foster1976). Naturalistic : explain illness in impersonal, systemic terms. It results from such natural forces or conditions as cold, heat, winds, dampness, and, above all, an upset in the balance of the basic body elements (Foster 1976). Based on observation. Naturalistic : explain illness in impersonal, systemic terms. It results from such natural forces or conditions as cold, heat, winds, dampness, and, above all, an upset in the balance of the basic body elements (Foster 1976). Based on observation. AnimisticMagicReligionScience Magic ReligionScience

Sociocultural group 1 (12%) Health care Wait Store Pharmacy Clinic - hospital Traditional Spiritual healing Father Job: institution outside community Highschool or more Teacher, book keeper, nurse Bilingual Mother Artisan – owner Job at institution outside Elementary school or more Bilingual Children Highschool Bilingual Family Owner of small store, corn mill Land: relatively small plot Church - leadership roles

Sociocultural group 2 (17%) Health care Wait Store Traditional Spiritual healing Father Agricultural work – owner Hires other people Few years elementary school Bilingual Mother Artisan – owner Unschooled Monolingual Children Elementary school Male Bilingual, Female Mono. Family Owner of small store, corn mill Money Lenders Land: large plot Church - most do not go

Sociocultural group 3 (32%) Health care Wait Home remedy Store Traditional Clinic Father Agricultural work – owner Work by family members Few years elementary school Bilingual Mother Artisan – hired Few years elementary school Bilingual Children High school Male Bilingual, Female Mono. Family Land: small plot Church - most do not go

Sociocultural group 4 (20%) Father Agricultural work – works for hire Few years elementary school Many monolingual Mother Artisan – works for hire Unschooled Monolingual Children Elementary school Male Bilingual, Female Mono. Family Land: small plot Church - most go, no leadership roles Health care Wait Home remedy Store

Almeida Filho: For a General Theory of Health Medical anthropological notions in context Medical anthropological notions in context Practical implications Practical implications Health Promoti on Preventi on Rehabilit ation Cure

Almeida Filho: For a General Theory of Health Kleinman’s use of I/D/S Kleinman’s use of I/D/S Young’s use of I/D/S Young’s use of I/D/S If you are interested in all this, keep an eye on: Semeiologic approaches to health-disease-care Semeiologic approaches to health-disease-care Byron Good Byron Good Gilles Bibeau and Ellen Corin Gilles Bibeau and Ellen Corin IllnessDiseaseSickness Illness SicknessDisease

Illness Disease Sickness 7 1myocardial infarction, tuberculosis and renal failure 2screening and predictive testing (prostate cancer, hypo- fibrinogenemia) 3common cold, tooth decay, aging, and seasickness 4Fibromyalgia, low back pain, whiplash, and chronic fatigue syndrome 5Asymptomatic instances of hyperglycemia, hypertension, and lactose intolerance 6general feeling of dissatisfaction, unpleasantness or incompetence, anxiety or melancholia 7Delinquency, dissidence, homosexuality, skin color, and masturbation (Historical examples) Examples from Hoffman 2002

Implications OntologicalEpistemologicalNormative Disease Illness Disease

Janzen Ch4. Population and Disease Evolution and adaptation Evolution and adaptation Matter Matter DO NOT determine DO NOT determine Primary health care Primary health care Social suffering vrs depression Social suffering vrs depression Social determinants of health Social determinants of health