Paper short abstract:

Is the notion of cultural epidemiology productive or not and what are the research and policy implications.

Paper long abstract:

Anthropology and public health have engaged with each other for decades in attempts to understand, explain and combat illness and disease at population and community levels. At least since Janes, Stall, & Gifford (1986), efforts have been made to combine the epistemological and methodological underpinnings of the two disciplines with limited success and acceptance. The banner of cultural epidemiology is sometimes used to describe these labours but is more often than not rejected for insufficiently acknowledging the contributions of one or the other approaches. In this paper we discuss our experiences of bringing together a collection of works by social researchers and epidemiologists under the cultural epidemiology banner that explicitly include socio-cultural explanations for population level health and illness in wealthy and economically developing societies in Asia and Australasia. We ask whether the notion of cultural epidemiology is productive or not and what are the research and policy implications.

Paper short abstract:

This paper critiques the dominant public health discourse on the outbreak of bird flu in West Bengal (India) through a combination of ethnographic and archival work.

Paper long abstract:

The dominant discourse of the public health fraternity is that migratory birds, especially wild ducks, are the natural reservoir of avian influenza viruses. It has been reported that direct or indirect contact of domestic birds with wild migratory waterfowl has led to frequent outbreaks of the epidemic. The author of this paper examines the hypothesis that the outbreak of bird flu in West Bengal in mid-January 2008 was caused by the flight of migratory birds, which led to the quick spread of the virus in 14 districts of the 19 districts of West Bengal within a span of one and half months. Through an ethnographic study, the author explores whether there is an alternative 'narrative' to the outbreak of avian flu. He also looks at the role of local agencies and the logic of the market in understanding the epidemiology of local outbreaks. Further, the author also investigates the socio-political and ecological settings as well as the professional practices in order to understand the nature of the outbreak. In this study, he enquires whether medical anthropology helps us to shed new light on the outbreak of bird flu. And what are the complexities that arise from a parochial understanding of an epidemiology under the rubric of a scientific discipline?

Paper short abstract:

Public health and medical anthropologists read tuberculosis as two distinct narratives. This paper will explore how the opposing narratives on TB have fragmented our overall understanding of a once curable disease.

Paper long abstract:

Over the course of the past decade epidemiologists have measured the increasing incidence of Tuberculosis (TB), and more alarmingly, Drug Resistant forms of TB (DR-TB around the world. Local and international strategies for infection control and treatment protocol are essential in addressing the complicated conditions of TB and DR-TB. Public health and anthropology are working together to develop a more complete understanding of contagion, adherence and non-adherence to medication, migration, infection-control and treatment solutions. However, conducting collaborative research does not necessarily lead to effective solutions, the work often exposes the vulnerabilities and shortcomings of the other discipline, and as a result, research becomes increasingly a battle between the various schools of thought rather than the development for effective solutions. This paper examines DR-TB as two distinct narratives, one exposed by public health and the other by medical anthropologists, and these opposing narratives have fragmented the overall understanding of TB. To examine TB as text with various readings and interpretations will help to reveal the fissures and corroborations between the varying schools of thought to create a cohesive narrative that is reflective of the epidemiological and social concerns of what was once a curable disease.

Paper short abstract:

This paper presents a reflection on the process of exclusion and border crossing phenomena between the medical science and the informal sector through a case-study on the disqualification of a particular treatment against rheumatic immune-diseases in contemporary Brazil

Paper long abstract:

This paper reflects on exclusion and border crossing phenomena between the boundaries of science in the context of medical field and the informal sector in contemporary Brazil. To do this, I report and analyse a case-study of a particular treatment against rheumatic immune-diseases. The treatment was developed by medical doctors using standard scientific methods of testing in 1980s and was since then successfully applied in several cases. The treatment, however, has not been recognised and included within the established field of rheumatology and it is ignored within the context of public health. This exclusion caused that the treatment, faded in invisibility, is carried out by both medical professionals and patients illegally, carrying serious risks.

One of the central explanations for this exclusion is that the treatment is based on the opposite principle on which conventional treatments are based: instead to control symptoms through an artificial impairment of the immune-system using immunosuppressive agents, the treatment aims to strengthen the immune-system through stimulation using a specific vaccine. So in effect, the immune-system "relearns" to distinguish between own and strange cells and, therefore, stops attacking its own body (the so called "immune-reaction"). In order to understand this process of exclusion, firstly, I am going to reconstitute the trajectory of this treatment. Secondly, supported by a bibliographical research on related topics and ethnographic experience I will then discuss significant aspects of this trajectory in the light of the actor-network theory as well as of anthropological approaches on causality, taboo and fear.

Paper short abstract:

Films and anthropological writings indicate that Aboriginal infant rearing practices were robust over tens of millennia but many are no longer practiced. Infant rearing is discussed cross-culturally, with film clips, in the context of the environment of evolutionary adaptedness.

Paper long abstract:

Cro-magnum man is physically very similar to modern humans and a hunter gatherer lifestyle has prevailed for 99% of human evolutionary history. As Although biological evolution is still continuing,it has slowed down for humans examples of this I will show film clips of nomadic Australian Aborigines and the Fore from the highlands of New Guinea. Their way of dealing with infants and young toddlers meet their needs well unlike many Western (and other) parenting behaviours which are described in the context of recent research. Because cultural change is much faster than biological change, there is now a misfit in infant "expectations" and parental treatment influenced by culture. This is detrimental to infant development, particularly to the attachment between infant and mother and the consequent psychological sequelae.

As the ethnopaediatrician M.F. Small, points out, little research has been carried out comparing different infant rearing practices in accord with infants evolutionary nature but this does seem to be a way of making judgements of best practice which health professionals wish to be able to do in order to promulgate it.

Paper short abstract:

This paper will explore the individual’s and provider’s views on the responsibilisation of obesity in an effort to open dialogue on the presumed roles of each player. It will do this by taking as an example ethnographic fieldwork on dietary advice given in community dental practices.

Paper long abstract:

Public health is under tremendous pressure to stem the growing tide of obesity, yet primary care and public health efforts are not proving to be entirely successful. The ubiquitously applied health belief model expects the individual to take on an increasing level of responsibility (and arguably blame) for their own health, and the current rally of the neoliberalist agenda fuelled by the global economic crisis further impacts this deference of responsibility onto the individual.

But who is responsible for lifestyle modification, and if it is a shared one, what are the respective roles? Evidence indicates a wide disconnect between what the individual expects from primary care and public health providers and feels able to do on their own versus what providers believe their roles to be. Biocultural methodology of anthropology allows us to gain insight from individual and community perspectives to inform primary care and public health decision making.

This paper will explore the individual's and provider's views on the responsibilisation of obesity in an effort to open dialogue on the presumed roles of each player, and to begin the process of the development of a consensus of roles to provide an evidence base for effective primary care and public health commissioning. It will do this by taking as an example ethnographic fieldwork on dietary advice given in community dental practices in the north east of England.

Paper short abstract:

This paper discusses the experience of an anthropologist doing fieldwork about primary health care in Guinea-Bissau. It questions the role of an anthropologist in the process of health policy making and argues that a positive aspect is that it can help include the voice of beneficiaries.

Paper long abstract:

In recent years there has been increased interest in revitalizing the Alma Ata Declaration in order to achieve the Millennium Development Goals. The declaration, launched at a Who/Unicef conference on primary health care in 1978, was influential in rural communities in low-income countries all around the world. Its aim was Health for All by the Year 2000. Access to health care was considered a human right, and it should engage with maternal and child health, family planning, water and sanitation, essential drugs, food and nutrition, immunization, simple treatment, health education and control of endemic diseases. Community participation was considered crucial for successful implementation.

This paper is based on experience from 18 months of anthropological fieldwork in Guinea-Bissau between 2009 and 2011. The aim of the study was to explore the implementation of Alma Ata in rural Guinea-Bissau and the impact of various policies. Semi structured interviews were taken with representatives of international organizations and NGOs, responsible people at the Ministry of Health, health staff and villagers. Two meetings were attended at the Ministry of Health with international organizations and NGOs to discuss the future of community health care and draft a new policy.

This paper analyzes the role of an anthropologist in public health and how data gathered for a PhD thesis can influence the revitalization process and national health policies. It is argued that anthropological methodology and knowledge gained from fieldwork can be important in order to include the voice of villagers who would otherwise not have been heard.

Paper short abstract:

Confronted with an ageing population as well as the availability of ever better but more expensive treatments, chronic diseases have become a financial burden. Under these circumstances, the European Institutions have opened the debate to innovation from qualitative research in social science, participation unthinkable even five years ago.

Paper long abstract:

Methodological challenges can be encountered when (participantly) observing chronic diseases, but medical anthropology as well as the institutional ethnography (Abeles, 1995) both offer very strong toolboxes for tackling healthcare issues.

In the case of chronic diseases, the strength of ethnography is related to perceptions of everyday life and normality; trying to understand who patients trust and where they seek help when disease it not that thing that strikes and goes but stays for a lifetime; after the initial stages where technical knowledge is crucial, what makes a difference will seldom be the medical staff or technology; it may be similar people in similar situations; it may be alternative medicine of all kinds; it may be religion or other forms of spirituality; it may be none of the above. Nevertheless, anthropology is the only discipline that can legitimately deconstruct the predominant biomedical approach.

Anthropological methods are by default holistic, therefore they include the point of view of all the actors involved: supra-state, state and legislation, deriving institutions, civil society (patient organisations), industry, media, etc. In a debate which shifted from too much "doctor-" to too much "patient-"centered, such a holistic approach is crucial.

Cognitive anthropology is a major strength in the debate: how knowledge is produced, reproduced and transmitted. Cognitive anthropology can help with involving patients in the health literacy processes.

The issues raised in this abstract will be illustrated with ethnography on three categories of chronic diseases.

Paper short abstract:

Teaching “Anthropology of Health and Illness” is a challenge for both the teacher and the PhD students from a public health doctoral program. Basic theoretical concepts and fieldwork methodology are taught in order to enhance the students’ reflection, sensitivity and perception competences.

Paper long abstract:

Teaching " Anthropology of Health and Illness " to PhD students of the doctoral program public health at UMIT (an Austrian university) is giving a voice to anthropology within other courses. It is a challenge to the teacher, who works as an anthropologist in the Department of Public Health and Health Technology Assessment, and the students, who are part time students working in private or public health/disease/health care institutions. The students usually attend classes only for two-day seminars and in general, do not have anthropological knowledge. The challenge consists of how to relay theoretical concepts in such a way that will broaden their view of health and illness, improve their PhD projects, and enhance their general interest in health and life sciences. In this particular class, fieldwork is taught as part of a project. In addition, students' reflection, perception and sensitivity competences are enhanced through the analysis and discussion of studies. The students present their own PhD projects from an anthropological perspective, a perspective many students are surprised to discover and applicable to all topics where humans are involved. The transmission of anthropological knowledge about health and illness and the instructions of how to develop the competences are seen as fundamental for people with leadership positions in health-care institutions. People use these institutions for health treatment, care, information, prevention or promotion and bring in their thoughts, fears, feelings, health/illness behaviour.

Paper short abstract:

This presentation argues that public health practitioners should become more like anthropologists in their approaches to the populations and sub-groups with whom they work. It uses tobacco control as an example, but argues that anthropological methods could usefully be incorporated into all branches of public health.

Paper long abstract:

In this presentation, I shall propose a contribution of anthropology to public health that is less commonly recognised - the metaphorical suggestion that public health practitioners should become, or at least be more like, anthropologists in their approaches to the population groups and sub-groups with whom they work. For a branch of medicine and health with 'public' in its title, public health has a somewhat peculiar tendency to hold the subjects of its efforts at arm's length. A history of social anthropology will be presented that highlights the problems inherent in maintaining such a detached approach, and inviting public health practitioners to consider new methods of engaging with 'the public'. The specific example used will be tobacco control but, it will be argued, the principle of getting off the veranda is one that is relevant to all branches of public health.

Paper short abstract:

The complex relationship between complementary and alternative medicine (CAM) and biomedicine is explored using discourse analysis. Power relations and professional boundaries, science as a belief system, the nature of evidence and research, and the impact on patient care will be analysed.

Paper long abstract:

Complementary and alternative medicine (CAM) presents a view of health, illness and the body which challenges traditional biomedical and scientific assumptions. As CAM increases in popularity in the UK and other countries with primarily biomedical healthcare systems, biomedicine faces challenges to its position of authority and influence in the arena of health and health care. The way biomedicine faces these challenges will necessarily impact on patient care.

Discourse analysis, carried out on journal and newspaper articles and blog entries on the subject of CAM, explores the complex relationship between CAM and biomedicine, revealing how both think about themselves and each other, and how power relations and professional boundaries adapt and shift in response to new challenges and trends. This paper will analyse: the ways in which CAM's challenges to biomedicine actually maintain and reinforce the very culture they are attempting to counter by using biomedicine and science as a yardstick, appealing to biomedicine to bestow legitimacy, and by increasing scientisation; science as a belief system, whose adherents can be dedicated and dogmatic in its defence; the notion of evidence, evidence-based practice, and research and what these mean for CAM; and the seeming lack of focus on patients and their needs, the way patients are denied agency, and how this affects patient care.

Conclusions and recommendations include; increased and improved communication on all sides; greater educational opportunities; more appropriate research methods for investigating CAM; and greater focus on the needs and wishes of patients.

Paper short abstract:

Lithuanian verbal healing is unique living tradition of magical – herbal treatment directed by archaic concepts of health and illness. Nowadays it faces the threat of extinction and creates numerous challenges to anthropologists, authorities, clergy, biomedics and the general public as well.

Paper long abstract:

Due to late christianisation (15 c.) and long lasting remoteness of the region Lithuania preserved an archaic healing traditions which attracted scientific interest at turn of the 19 - 20 c. Unfortunately, research wasn't sufficient. Ethnomedicine was not popular among ethnologists of the 20 c. Most studies focused on verbal formulas of the charms only, neglecting wider contexts of healing practices. During Soviet period traditional healing was treated as "spiritual" practice and research was banned. Ironically, ritual and herbal segments of the healing tradition was separated by historical process of Lithuanian ethnology. Only after gaining independence (1990) ethnomedicine became field of scientific interest once again. Last few years of research gave very interesting and promising results. Complex approach and newest field work evidently show joint use of ritual, social and herbal means, along with vitality of tradition, despite its erosion and decline. Moreover, anthropologists revealed social conditions which are threatening for continuity of verbal healing tradition: transmision problem due to modernisation and immense emigration of young generation; negative attitude of local catholic Church; Soviet ideological inheritance in some medical and political circles and ever growing interests of pharmaceutical business. Being concerned about preservation and continuity of verbal healing tradition anthropologists raises question of declaring it as essential part of intangible heritage of Lithuania.

Paper short abstract:

Ethnobotany is widely used for the documentation of indigenous knowledge of plants by the indigenous communities of the world. Recently, ethnobotanical studies have been used for the discovery of new drugs development programme. This paper reports an ethnobotanical survey of medicinal plants used by the nomads of the Nara Desert, Pakistan. The presenting author thankfully acknowledge for travel grant by the Pakistan Science Foundation, Islamabad for presenting this paper in the conference.

Paper long abstract:

Ethnobotany is widely used for the documentation of indigenous knowledge of plants by the indigenous communities of the world. Recently, ethnobotanical studies have been used for the discovery of new drugs development programme. This paper reports an ethnobotanical survey of medicinal plants used by the nomads of the Nara Desert, Pakistan. Seventy six plant species belonging to 64 genera and 36 families were documented having medicinal use by the inhabitants of the study area. Of them, 25 species are proposed to have novel uses not recorded in the medicinal literature. About 50 types of ailments were treated with various parts of the 76 medicinal plant species. The maximum species were used for treating wounds (9 spp., 5.56%), followed by inflammation (8 spp., 4.94%), cooling agent (7 spp., 4.32%), skin diseases (7 spp., 4.32%), asthma (6 spp., 3.70%), constipation (6 spp., 3.70%), rheumatic/sciatic pain/sores/carbuncle (6 spp., 3.70% each) and ear infection/joint pain and inflammation (5 spp., 3.09% each). For making herbal recipes, leaves were the most utilized part (29.10%), followed by whole plant (26.12%), fruits (14.18%) and roots (8.96%), while rest of eight parts were scarcely used. For the preparation of recipes mostly powder (21.24%), followed by juice (19.47%), paste (18.58%) and decoctions (11.50%) as medicaments. This study will serve as benchmark for the development of certain drugs from the novel as well additional uses reported by this communication.