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Paper short abstract:

Methodologies of science and medicine have come to inform public health policy making in novel context. Based on five cases studies in 2011-2012 in India. Sri Lanka and Nepal we analyse how health policy is formulated, and what kinds of evidence are deployed.

Paper long abstract:

Over the past decade or so, there has been an increased interest in generating evidence-based public health policies in South Asia. As a part of the research project 'Biomedical and Health Experimentation in South Asia [BHESA]' we investigated five studies in the public health sector that were concerned with generating 'rigorous' experimental evidence to persuade governments and policy makers to adopt new policies and programmes. Drawing on ethnographic fieldwork in three countries—India, Nepal and Sri Lanka—this paper interrogates the processes that intervene between public health and politics, through a discussion of selected case studies on evidence generation in public health policies and programmes. In addition to unpacking what is meant by 'rigour' in these studies, this paper explores the views of a range of actors, institutions and networks that put emphasis on evidence, and the underlying factors that influence the uptake of evidence in health policy-making in the three countries.

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Paper short abstract:

Domestic violence is an important problem now garnering more global health attention. In Albania, this is especially true given the country's recently enacted "Measures Against Family Violence." This timely study intends to relate a greater understanding of this new policy as it stands at the intersection of anthropology and global public health.

Paper long abstract:

Domestic violence is an important public health problem now garnering more global health attention, particularly with the newly established UN agency, UN Women. In Albania, this is especially true given the country's recently enacted and very progressive, "Measures Against Family Violence." In Albania, a country little studied in anthropological circles due to its decades long closed borders, the problem of domestic violence is both underreported and yet anecdotally widespread and deeply ingrained in some traditional views on family and honor. Given the country's developmental status as one of the poorest globally, it is currently seeking inclusion into the European Union. Since the fall of its longheld dictator, the country has undergone massive transition. It has developed an eager yet unstable market economy which is striving to escape corruption, constructed newly paved highways which are currently expanding and instituting telecommunications capabilities which are evolving at a dizzying pace. In these ways, the country inches toward EU ideals while still deeply agrarian. Importantly the country has made impressive progress recently by passing this new national policy and strengthening its legal foundation but this has been primarily through the impetus of international funding, namely USAID. The policy has great implications for the health and welfare of victims of violence, and gender relations more generally, but its abilities are deeply affected by the whims of international development. This timely study intends to relate a greater understanding of this new policy as it stands at the intersection of anthropology and global public health.

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This paper reports on ethnographic research on the rise of kidney failure among Mexico’s poor and the problems associated with accessing renal replacement therapies and the complex political and economic context within which these services are organised.

Paper long abstract:

Mexico has seen major changes to the nation's public health, with rates of infectious diseases falling while chronic conditions such as Kidney Failure are rising rapidly. Access to health care, however, is characterised by widening inequalities, attributed, in part, to the complex structuring of health care in the country. This is administered by way of a social security system, with health insurance available to people employed by the state or who work for private corporations. The majority of the population (i.e., those living in poverty) have severely restricted access to renal services and are forced to continually appeal to wider family and social networks, both in Mexico and the US, to support payment for this resource-intensive condition. Drawing on ethnographic research of Mexico's most active transplant programme and current thinking in critical medical anthropology, this paper examines the delivery of and access to renal services by Mexico's uninsured. It focuses attention on state failure, neo-liberalism and the increasing fragmentation and politically-driven delivery of renal replacement services.

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Paper short abstract:

This paper is a discussion on how religious agencies and agents approach and intervene when dealing with what has been called "re-privatization" of public health services in Brazil. It reflects on fieldwork ethnographic findings with participants of the Ayahuasca Religions.

Paper long abstract:

One of the "therapeutic" strategies of mental health public services in Brazil until recently was confinement. Gigantic and hyper populated psychiatric institutions were the only one destiny the official services provided for particularly low income population in need. Reacting to that conjuncture, it was launched in the 1980s the

movement for promoting a "Psyquiatric Reform". The PR in Brazil, following a worldwide expanded tendency, has addressed the issue of long permanency in psychiatric institutions, and has been followed by the so called "movimento anti-manicomial" (anti-manicomium movement). It follows also an investment on "ambulatory" focused mental health attention. However, an effect of the implementation of ambulatory attention has increased a searching for other resolutive agencies than the public ones, to face psychiatric related crisis. This paper therefore may reflect and discuss how religious agencies and agents

approach and intervene when dealing with what has been called "re-privatization" of public health services in Brazil. Particularly as a study case, I have carried out a fieldwork among participants of the so called Ayahuasca Religions, which use a psychoactive substance in their religious services. I look for to reflect on the possibilities, impossibilities, continuities and discontinuities and other issues related to the articulation between the praxis of the "public health agents" and "religious agents".

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Paper short abstract:

This paper describes the training programs for indigenous health agents. Leaders, women and shamans, have entered the primary health care arena as protagonists. The “problem-posing” methodology and collective construction have encouraged a new role for the AIS to provide differentiated attention.

Paper long abstract:

This paper describes and analyzes the history and process of training programs for indigenous health agents (AIS), developed by Escola Paulista de Medicina, Universidade Federal de São Paulo in the Xingu Indigenous Park, Mato Grosso, Brazil. During the past 30 years, the education of the AIS has undergone transformations in the effort to create new perspectives for intercultural dialogue that is essential for the provision of "differentiated attention", that is, health services that articulate with indigenous knowledge and practices. Evaluations of the training process have revealed limitations and differing expectations of the activities of these professionals. In addition, new Indigenous actors, including leaders, women and shamans, have entered the primary health care arena as protagonists. The adoption of the "problem-posing" methodology, based on critical pedagogy, which considers the student as the subject of the learning process, and the process of collective construction that incorporates traditional knowledge about health, diagnosis, treatment and cure, have encouraged a new role for the AIS, one that is no longer a mere agent of biomedicine, but one that is an interlocutor in the construction health services that seek to provide differentiated attention that is demanded by the National Health Policy for Indian Peoples.

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Paper short abstract:

This work is the result of an ethnographic research conducted in the National Health System of the city of Rio Tinto-PB, Northeast of Brazil, following a team from the Family Health Program, responsible for four locations in the rural area.

Paper long abstract:

This work is the result of an ethnographic research conducted in the National Health System of the city of Rio Tinto-PB, Northeast of Brazil, following a team from the Family Health Program, responsible for four locations in the rural area. We found that, despite the principles of the assistencial model proposed in the 1988 Constitution, the service is crossed by values related to the local symbolic system, intervening in interactions, offered care and potential of intervention on quality of life. We noted that the locations relate differently with the health team, ranging between two extremes: an informality that prevails and the other with intense formality in relations between professionals and users. Another aspect corresponds to the distinctions between professionals on staff and difficulties in reference to the local system, and another assigned to localities, considering: diseases, conceptions of health and access to the so-called "modernity" and its implications for health, food, entertainment.

Keywords: health system; business/user relations; health/disease, symbolic local systems

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Paper short abstract:

Drawing on ethnographic research in the south of Brazil this paper reflects on efforts to constitute cancer genetics, particularly related to breast cancer risk, as part of public health interventions. It examines the socio-cultural dynamics by which ‘prevention’ and ‘clinical need’ are being constituted in relation to genomics in this context.

Paper long abstract:

Drawing on ethnographic research in the south of Brazil this paper reflects on the social and cultural context of recent efforts to constitute cancer genetics as part of public health interventions, particularly as this relates to breast cancer risk. It will reflect on the process by which patients, families and clinicans engage and participate in these developments and also the way that novel technological interventions such as genetic testing traverse the fluid space of transnational research and the shifting ground of public health in Brazil. In this way the paper examines the soci-cultural dynamics and tensions by which 'prevention' and 'clinical need' are being constituted through recourse to a novel genomic interventions and in the context of an emerging and expanding economy such as Brasil.

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Paper short abstract:

Diabetes Care in American Samoa: contributions from anthropology and behavioral medicine. RK Rosen, J DePue, ST McGarvey. Describes the translation, implementation and study outcomes for a RCT of a culturally translated, community health worker delivered, diabetes self-management intervention in a Pacific culture with high diabetes prevalence.

Paper long abstract:

Diabetes Care in American Samoa is a randomized trial of a community health worker and primary care coordinated diabetes intervention. It provided self-management support to diabetes patients in a Pacific culture with high diabetes prevalence. Investigators include biological and medical anthropologists, psychologists, and MDs. This paper considers the cultural translation and delivery of this intervention, including how anthropology within the context of behavioral medicine and public health is different from, but dependent upon, ethnographic work. Practical realities of practicing medical anthropology in the context of global public health are considered, generally and specifically for this project.

We describe our research methodology for adapting this behavioral intervention to this specific cultural context, report the trial outcomes, and reflect on the success of this cultural translation. Reflections include: the effective use of qualitative data protocols in this context; adapting the concept of chronic disease self-management for a sociocentric society; helping patients balance personal health priorities with sometimes competing cultural obligations; conducting the study while managing the different priorities of research, medical care, and local culture.

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Paper short abstract:

This paper explores the complex interrelation between migration and diabetes among Indian and Pakistani migrants. In particular, explores Indians' and Pakistanis' experiences of diabetes control including perceptions of diabetes causation, as well as barriers and facilitators for diabetes diet adherence and on oral medication intake. The paper aims to add to the current limited body of knowledge which looks at South Asians’ perceptions and attitudes of type 2 diabetes, particularly towards diseases control and prevention. In particular, it aims to contribute to further understanding 'cultural' factors responsible for poor adherence to lifestyle advice and medication, and determinants of dietary behaviour as well as factors that might influence behaviour modification among such minority ethnic group.

Paper long abstract:

Indian and Pakistani migrants in the UK are up to six times more luckily to suffer from diabetes. Strategies for type 2 diabetes prevention however, often fail to encompass the social and cultural aspects within which the disease is lived, particularly among minority ethnic groups. Based on findings from a sixteen-month ethnographic fieldwork, this paper describes the role that distress around migration plays within Indians' and Pakistanis' diabetes onset. Beside issues around migration and settling, difficulties around diabetes were considered as increasing stress levels, particularly in relation to diabetes diet adherence. Diabetes diet was perceived as a threat to food habits which respondents employed to ensure culture continuity and identity. Migrants also employed alternative means for diabetes control, which they were reluctant to share with medical practitioners. Based on such findings, this paper highlights a growing need for anthropology and its methods to better inform public health strategies and diabetes prevention programs.

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Paper short abstract:

Using Mbya Guarani child ‘biographies’, this paper explores the biases, paradoxes and confusion that arise when they are diagnosed as ‘underweight’. It illustrates how anthropology can potentially contribute to the adaptation of the local nutritional health programme to Mbya child needs.

Paper long abstract:

This paper compares and contrasts a series of 'biographies' of Mbya Guarani children who are diagnosed as 'underweight' and registered in a Misiones nutritional programme (Hambre Cero), in Misiones, Argentina. The biographies are composed from multiple and often contradictory accounts - including Mbya Guarani parents, community health workers, doctors and where possible, children themselves - that centre on the children's lives as public health-narratives. In doing so, it explores the public nature of Mbya Guarani children's health in their community, as well as being objects of a provincial Public Health programme. Consequently, it takes the logic of the diagnoses, the anthropometric indicators and the accompanying interventions, as the central axes to undertake this analysis. It highlights the diffuse nature of Mbya children's health, showing how 'biographies', can jointly elucidate biases and paradoxes, where local contexts and histories are ignored, and potentially contribute to the adaption of the provincial Public Health programme to local needs.

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Paper short abstract:

This paper analyzes the meanings attached to the concept of “race” within public health institutions in Brazil, arguing for the need to go beyond clinical contexts incorporating how this category is lived and understood in everyday life.

Paper long abstract:

This paper analyzes the meanings attached to the concept of "race" within public health institutions in Brazil. This country has seen in the past decade an increase in public policies targeted towards the so-called "Black population". These policies have proven controversial due to the multiple meanings attached to the concept of "race" in Brazil. I explore this multiciplicity through a multi-sited ethnographic account of several clinical settings, such as doctor-patient interactions, application of neonatal screening and clinical readings of complete blood-count tests, showing how the biomedical usage of "race" is interwoven with other meanings attached to this category found in other realms of social life. I argue that in order to fully understand how race-based public health policies are enacted, it is necessary to go beyond the clinical context in our ethnographies, incorporating how this category is lived and understood in everyday life.

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Paper short abstract:

Focusing on maternal health-seeking behaviour in rural Ethiopia, this paper addresses reasons why women who utilise biomedical services at other times, do not deliver at health facilities.

Paper long abstract:

This paper argues that to maximise any healthcare intervention, the needs and perceptions of the intended beneficiaries must be rigorously incorporated into policy and programming. It focuses on maternal healthcare-seeking behaviour in rural Ethiopia, where maternal mortality rates remain amongst the highest in the world and only 18% of births are attended by a skilled attendant. We address why women who utilise biomedical services at other times, do not deliver at health facilities.

To increase the utilisation of facilities for childbirth, it is not sufficient to channel resources into expanding services and access alone. Tensions arise when maternal perspectives juxtapose the biomedical framework. Key socio-cultural determinants need to be harnessed as positive drivers for healthcare, whilst their impact as barriers are minimised. Based on operational research to improve Maternal Newborn and Child Health in Ethiopia and international safe motherhood initiatives, this paper presents evidence of the significance of anthropology, both in and of global public health.