The Role of Medical Anthropology in Public Health (Sample Essay)

- Drawing from the Book, Fresh Fruit, Broken Bodies, & Other Sources

With the advancement of modern medicine and technology, public health has become a primary tool and standard to solve most medical issues in biological nature. However, as people live in such a complex world with a variety of social experiences and cultural backgrounds, standardized public health may not always solve the problem through the narrow focus on a biological basis. The role of medical anthropology is to examine different medical issues and phenomena as influenced by social and cultural factors (Coleman, 2020). Medical anthropology contributes to the understanding and practice of public health as being shaped by social and cultural factors in addition to the narrow biological focus, and such an approach helps to solve medical problems more comprehensively.?Medical anthropology serves as a supplementary approach to solve problems that are unseen by the public health, in order better to achieve the goal of “Health for All.”

In the book Fresh Fruit, Broken Bodies, Holmes (2013) observes migrant farmworkers suffering from the hierarchy; He argues that “this injurious hierarchy is neither willed nor planned by the farm executives and managers; rather, it is produced by larger social structures (Holmes, 2013, Ch. 2).” Medical anthropology pays attention to the racialized structures?that?remain unseen by society?and considers individuals to accept their positions in such hierarchy as natural. Thus, individuals are not making choices; instead, these migrant farmworkers are forced to migrate by social structures. While the public health focuses on the suffering issue that may cause physical discomforts, such a view from medical anthropology extends the understanding of public health to consider farmworker suffering as a result of the combination of structural and symbolic violence instead of and?in addition to the narrow biological issue (Holmes, 2013, Ch. 4).

According to Holmes (2013), structural violence refers to “the violence committed by configurations of social inequalities that, in the end, has injurious effects on bodies (Holmes, 2013, p. 43).” For example, people in a low position may lack the education to live healthy, lack access to fresh food, and lack access to high-quality healthcare. These issues regarding body experiences are not seen by public health. Drew Leder (1984) describes that people are living in the world with the lived-body, but public health examines the body as objects by fixed standards. Holmes challenges the idea of object-body; He argues that the body is shaped by different social and cultural experiences, and such social inequality will be embodied and manifested as in the body suffering. Besides, symbolic violence that naturalizes social inequity by keeping it “invisible” further enacts such social inequality without being exposed to the public society.

Unlike in public health, the embodied experience matters in medical anthropology. Holmes “wants to experience for himself how the poor suffer (Holmes, 2013, Ch. 1).” He argues that he cannot understand farmworkers without “being a farmworker” to pick strawberries and to cross the border with them. However, Holmes was treated differently, in the advantages, because of his skin color and speaking English. The supervisors would never call him deprecatory names as Oaxacan workers, and Holmes’ request can always be granted, unlike Oaxacan workers (Holmes, 2013, Ch. 2).?Such differences are not seen by public health.?In chapter 4 and 5, Holmes (2013) provides three cases of Triqui people interacting with physicians in San Miguel:

• Abelino is repetitively working outside due to being indigenous and,?therefore, has bad knee pain. The boss ignores it,?and Abelino has no choice to migrate because of his pain. This structural violence caused by position forces Abelino to get the pain knee. Then, the physician assumes that Abelino does not know how to pick and bend over properly. This symbolic violence further hurts Abelino as the physician focuses on his X-ray results instead of his narratives. The public health approach may fix his biological problem, but Abelino is still forced into the structural position,?and he is unable to work due to his knee.

• Crescencio has a 7-year-long headache. Because of that, Crescencio sometimes gets?angry at home and tries to drink a huge amount of beers to get rid of the headache. However, the clinic blames him for his drinking and makes assumptions that he is a violent alcoholic with abuse problems because he fits the stereotype of a typical male farmworker.

• Bernardo has chronic stomachache, which makes him unwilling to eat. However, a physician considers Bernardo’s stomachache as a result of poor eating habits without being aware of the history of chronic pain after torture by the police.

In these cases, physicians diagnose focusing on physical exams and racist assumptions. Physicians?are unable to see the patients’ social and cultural experiences; instead, they blame the patients based on their assumptions. Holmes (2013) argues that public health contains “the medical or clinical gaze;” doctors learn to objectify patients and their diseases but disregard social aspects of their experiences. The public health approach focuses narrowly on disease problems that describe how practitioners are trained to diagnose and treat the alternation in the biological body regarding the “normal state,” whereas medical anthropology considers illness problems that include how the patient feels or perceives the discomfort, and how the discomfort affects the patient’s life (Kleinman, 1988). In the public health approach, patients who feel the illness may bring illness problems to practitioners, who then translate and turn it into the disease problem. That said, the public health approach always has an objective standard that describes what happens on specific body parts, while the medical anthropology approach helps the public health approach to explain what happens to the person as shaped by social and cultural factors.

Besides, while public health creates standards, it treats particular symptoms regardless of individual differences. For example, mental disorders in the Diagnostic and Statistical Manual of Mental Disorders are diagnosed through categorical symptoms, even if some disorders are not just categorical. Obeyesekere (1985) argues that mental illness is always associated with particular social and cultural conditions, resulting from experiences in different backgrounds. The understanding of symptoms in the public health approach is based on certain standards, while different symptoms are considered differently in various social and cultural contexts. For example, Obeyesekere (1985) argues that depression in the understanding of public health is a set of sorrowful events in free-floating life, whereas Ashanti women would accept involutional psychotic reactions as a natural result of life's vicissitudes. That said, symptoms that are considered in public health may not be viewed as disorders?in different?social and cultural contexts. Therefore, while the public health presents a universal standard for symptoms, the role of medical anthropology is to help public health to explore individual differences regarding the particular social and cultural background that shapes the particular issue so that public health will not be "ruling" on all cases?universally?without different individual backgrounds. That said, given different backgrounds, issues that are considered abnormal in public health may be corrected as normal by the view of medical anthropology based on social and cultural experiences; In addition, medical anthropology may reveal those naturalized assumptions unseen by public health through denaturalization based on social and cultural structures.

Davis-Floyd (1987) argues that medical students learn the values of biomedicine through the rite of passage. This type of training shapes students as distinct as physicians who utilize the standardized tool of public health. It separates medical students from the patients who as real experienced humans. That said, the training and understanding of public health are restricted to the narrow, separate area, and medical anthropology can serve as a supplement to consider a conclusive view of medical issues through both the biological basis in public health practice?and?sociocultural aspects by adding?competency training for medical students.

To conclude, public health is a great tool to solve medical issues by utilizing standardized tools. However, such an approach ignores individual factors behind each case. The role of medical anthropology is to research social and cultural backgrounds that shape each people, uncover the “invisible” structural issues unseen by public health, promote the understand of public health to be more comprehensive, and integrate both biological basis and social, cultural basis in the public health practice.

Reference List?(Ordered by?Appearance, format not used due to technical issues.)

Coleman, J. S. 2000. Foundations of social theory. Cambridge, MA: Belknap Press of Harvard University?Press.

Holmes, Seth. 2013. Fresh Fruit, Broken Bodies: Migrant Farmworkers in the United States.?Berkeley: University of California Press.

Leder, Drew. 1984. “Medicine and paradigms of embodiment.” Journal of Medicine and Philosophy?9: 29–43.

Kleinman, Arthur. 1988. “Ch. 1: The Meaning of Symptoms and Disorders.” In The Illness?Narratives: Suffering, Healing & the Human Condition. New York: Basic Books.

Obeyesekere, Gananath. 1985. “Depression, Buddhism, and the work of culture in Sri?Lanka.” In Culture and Depression, A. M. Kleinman & B. Good (Eds.), Berkeley: University of California Press: 134–152.

Davis-Floyd, Robbie. 1987. “Obstetric Training as a Rite of Passage.” Medical Anthropology Quarterly?1(3): 288–318.