{"id":540,"date":"2017-12-06T16:45:56","date_gmt":"2017-12-06T16:45:56","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/suny-culturalanthropology\/chapter\/health_and_medicine\/"},"modified":"2019-11-18T14:16:17","modified_gmt":"2019-11-18T14:16:17","slug":"health_and_medicine","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/suny-geneseo-culturalanthropology\/chapter\/health_and_medicine\/","title":{"raw":"Anthropological Approaches to Health and Medicine","rendered":"Anthropological Approaches to Health and Medicine"},"content":{"raw":"<div id=\"_idContainer793\" class=\"Basic-Text-Frame\">\r\n<div class=\"textbox learning-objectives\">\r\n<h3>Learning Objectives<\/h3>\r\n<ul>\r\n \t<li class=\"Learning-Objectives\">Define the terms ethnomedicine and\u00a0ethno-etiology.<\/li>\r\n \t<li>Explain how biomedicine is a product of Western ethno-etiology.<\/li>\r\n \t<li>Compare and contrast the healing techniques of biomedicine in Western Europe and North America, Traditional Chinese Medicine, and Communal Healing among the\u00a0!Kung.<\/li>\r\n \t<li>Describe some ways that social inequality impacts health.<\/li>\r\n \t<li>Explain how the social construction of illness can lead to sigma.<\/li>\r\n \t<li>Define\u00a0epidemiological transition.<\/li>\r\n \t<li class=\"Learning-Objectives\">Evaluate the positive and negative effects of biomedical technologies.<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n<h2>INTRODUCTION <em>by Sashur Henninger-Rener<\/em><\/h2>\r\n<div class=\"_idGenObjectLayout-1\">What does it mean to be \u201chealthy\u201d? It may seem odd to ask the question, but health is not a universal concept and each culture values different aspects of well-being. At the most basic level, health may be perceived as surviving each day with enough food and water, while other definitions of health may be based on being free of diseases or emotional troubles. Complicating things further is the fact that that each culture has a different causal explanation for disease. For instance, in ancient Greece health was considered to be the product of unbalanced humors or bodily fluids. The four humors included black bile, phlegm, yellow bile, and blood. The ancient Greeks believed that interactions among these humors explained differences not only in health, but in age, gender, and general disposition. Various things could influence the balance of the humors in a person\u2019s body including substances believed to be present in the air, changes in diet, or even temperature and weather. An imbalance in the humors was believed to cause diseases, mood problems, and mental illness.[footnote]Jermone Gilbert, <em>Humors, Hormones, and Neurosecretions<\/em> (New York: State University of New York Press, 1962).[\/footnote]<\/div>\r\n<div id=\"_idContainer810\" class=\"_idGenObjectStyleOverride-1\">\r\n<p class=\"Normal\">The World Health Organization (WHO) recognizes that the health of individuals and communities is affected by many factors: \u201cwhere we live, the state of our environment, genetics, our income and education level, and our relationships with friends and family.\u201d[footnote] World Health Organization, \u201cHealth Impact Assessment,\u201d http:\/\/www.who.int\/hia\/evidence\/doh\/en\/.[\/footnote]\u00a0Research conducted by the WHO suggests that these characteristics play a more significant role in affecting our health than any others, including having access to health care. For this reason, anthropologists who are interested in issues related to health and illness must use a broad holistic perspective that considers the influence of both biology and culture. <strong>Medical anthropology<\/strong>, a distinct sub-specialty within the discipline of anthropology, investigates human health and health care systems in comparative perspective, considering a wide range of bio-cultural dynamics that affect the well-being of human populations. Medical anthropologists study the perceived causes of illness as well as the techniques and treatments developed in a society to address health concerns. Using cultural relativism and a comparative approach, medical anthropologists seek to understand how ideas about health, illness, and the body are products of particular social and cultural contexts.<\/p>\r\n\r\n<h2 class=\"H1\"><span class=\"Annotation-reference CharOverride-3\">ETHNOMEDICINE <em>b<\/em><\/span><em>y Sashur Henninger-Rener<\/em><\/h2>\r\n[caption id=\"attachment_529\" align=\"aligncenter\" width=\"400\"]<img class=\"size-full wp-image-529\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/2795\/2017\/12\/06164533\/health_figure_1-e1512757742839.png\" alt=\"\" width=\"400\" height=\"444\" \/> Figure 1. Tibetan medicine poster.[\/caption]\r\n<p class=\"Normal\"><strong>Ethnomedicine<\/strong> is the comparative study of cultural ideas about wellness, illness, and healing. For the majority of our existence, human beings have depended on the resources of the natural environment and on health and healing techniques closely associated with spiritual beliefs. Many such practices, including some herbal remedies and techniques like acupuncture, have been studied scientifically and found to be effective.[footnote]George T. Lewith, <em>Acupuncture: Its Place in Western Medical Science<\/em> (United Kingdom: Merlin Press, 1998).[\/footnote] Others have not necessarily been proven medically effective by external scientific evidence, but continue to be embraced by communities that perceive them to be useful. When considering cultural ideas about health, an important place to start is with <strong>ethno-etiology<\/strong>: cultural explanations about the underlying causes of health problems.<\/p>\r\n<p class=\"Normal\">In the United States the dominant approach to thinking about health is <strong>biomedical.<\/strong> Illnesses are thought to be the result of specific, identifiable agents. This can include pathogens (viruses or bacteria), malfunction of the body\u2019s biochemical processes (conditions such as cancer), or physiological disorders (such as organ failure). In biomedicine as it is practiced in the United States (Western biomedicine), health is defined as the absence of disease or dysfunction, a perspective that notably excludes consideration of social or spiritual well-being.<\/p>\r\n<p class=\"Normal\">The biomedical approach to health strikes many people, particularly residents of the United States, as the best or at least the most \u201cfact-based\u201d approach to medicine. This is largely because Western biomedicine is based on the application of insights from science, particularly biology and chemistry, to the diagnosis and treatment of medical conditions. The effectiveness of biomedical treatments is assessed through rigorous testing using the scientific method and indeed Western biomedicine has produced successful treatments for many dangerous and complex conditions: everything from antibiotics and cures for cancer to organ transplantation.<\/p>\r\n<p class=\"Normal\">However, it is important to remember that the biomedical approach is itself embedded in a distinct cultural tradition, just like other ethno-etiologies. Biomedicine, and the scientific disciplines on which it is based, are products of Western history. The earliest Greek physicians Hippocrates (c. 406\u2013370 BC) and Galen (c. 129\u2013c. 200 AD) shaped the development of the biomedical perspective by providing early insights into anatomy, physiology, and the relationship between environment and health. From its origins in ancient Greece and Rome, the knowledge base that matured into contemporary Western biomedicine developed as part of the Scientific Revolution in Europe, slowly maturing into the medical profession recognized today. While the scientific method used in Western biomedicine represents a distinct and powerful \u201cway of knowing\u201d compared to other etiologies, the methods, procedures, and forms of reasoning used in biomedicine are products of Western culture.[footnote] Elliott Mishler, \u201cViewpoint: Critical Perspectives on the Biomedical Model,\u201d in E. Mishler, L.A. Rhodes, S. Hauser, R. Liem, S. Osherson, and N. Waxler, eds. <em>Social Contexts of Health, Illness, and Patient Care<\/em> (Cambridge, UK: Cambridge University Press)[\/footnote]<\/p>\r\n\r\n\r\n[caption id=\"attachment_532\" align=\"aligncenter\" width=\"299\"]<img class=\"size-full wp-image-532\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/2795\/2017\/12\/06164543\/health_figure_2-e1512757769730.png\" alt=\"\" width=\"299\" height=\"424\" \/> Figure 2: The Taiyang bladder meridian, one of several meridians recognized in traditional Chinese medicine. From Shou Hua\u2019s Jushikei Hakki, 1716, Tokyo.[\/caption]\r\n<p class=\"Normal\">In matters of health, as in other aspects of life, ethnocentrism predisposes people to believe that their own culture\u2019s traditions are the most effective. People from <span style=\"color: #993300\">non-North American and Western European<\/span> cultures do not necessarily agree that Western biomedicine is superior to their own ethno-etiologies. <span style=\"color: #993300\">\"<\/span>Western<span style=\"color: #993300\">\"<\/span> culture does not even have a monopoly on the concept of \u201cscience.\u201d Other cultures recognize their own forms of science separate from the Western tradition and these sciences have histories dating back hundreds or even thousands of years. One example is Traditional Chinese Medicine (TCM), a set of practices developed over more than 2,500 years to address physical complaints holistically through acupuncture, exercise, and herbal remedies. The tenets of Traditional Chinese Medicine are not based on science as it is defined in Western culture, but millions of people, including a growing number of people in the United States and Europe, regard TCM as credible and effective.<\/p>\r\n<p class=\"Normal\">Ultimately, all ethno-etiologies are rooted in shared cultural perceptions about the way the world works. Western biomedicine practitioners would correctly observe that the strength of Western biomedicine is derived from use of a scientific method that emphasizes objectively observable facts. However, this this would not be particularly persuasive to someone whose culture uses a different ethno-etiology or whose understanding of the world derives from a different tradition of \u201cscience.\u201d From a comparative perspective, Western biomedicine may be viewed as one ethno-etiology in a world of many alternatives.<\/p>\r\n\r\n<h2 class=\"Normal\">TECHNIQUES FOR HEALING<em> by Sashur Henninger-Rener<\/em><\/h2>\r\n<p class=\"Normal\">Western biomedicine tends to conceive of the human body as a kind of biological machine. When parts of the machine are damaged, defective, or out of balance, chemical or surgical interventions are the preferred therapeutic responses. Biomedical practitioners, who can be identified by their white coats and stethoscopes, are trained to detect observable or quantifiable symptoms of disease, often through the use of advanced imaging technologies or tests of bodily fluids like blood and urine. Problems detected through these means will be addressed. Other factors known to contribute to wellness, such as the patient\u2019s social relationships or emotional state of mind, are considered less relevant for both diagnosis and treatment. Other forms of healing, which derive from non-biomedical ethno-etiologies, reverse this formulation, giving priority to the social and spiritual.<\/p>\r\n<p class=\"Normal\">In Traditional Chinese Medicine, the body is thought to be governed by the same forces that animate the universe itself. One of these is <strong><em>chi<\/em> (qi)<\/strong>, a vital life force that flows through the body and energizes the body and its organs. Disruptions in the flow or balance of <em>chi<\/em> can lead to a lack of internal harmony and ultimately to health problems so TCM practitioners use treatments designed to unblock or redirect <em>chi<\/em>, including acupuncture, dietary changes, and herbal remedies. This is an example of <em>humoral healing, <\/em>an approach to healing that seeks to treat medical ailments by achieving a balance between the forces or elements of the body.<\/p>\r\n<p class=\"Normal\"><strong>Communal healing,<\/strong> a second category of medical treatment, directs the combined efforts of the community toward treating illness. In this approach, medical care is a collaboration between multiple people. Among the !Kung (<span class=\"st\">Ju\/\u2019hoansi) <\/span>of the Kalahari Desert in southern Africa, energy known as <em>n\/um<\/em> can be channeled by members of the community during a healing ritual and directed toward individuals suffering from illness. Richard Katz, Megan Bisele, and Verna St. Davis (1982) described an example of this kind of ceremony:<\/p>\r\n\r\n<blockquote>\r\n<p class=\"Quotation\"><span class=\"CharOverride-4\">The central event in this tradition is the all-night healing dance. Four times a month on the average, night signals the start of a healing dance. The women sit around the fire, singing and rhythmically clapping. The men, sometimes joined by the women, dance around the singers. As the dance intensifies, <\/span><span class=\"CharOverride-2\">n\/um,<\/span><span class=\"CharOverride-4\"> or spiritual energy, is activated by the healers, both men and women, but mostly among the dancing men. As <\/span><span class=\"CharOverride-2\">n\/um<\/span><span class=\"CharOverride-4\"> is activated in them, they begin to <\/span><span class=\"CharOverride-2\">kia<\/span><span class=\"CharOverride-4\">, or experience an enhancement of their consciousness. While experiencing <\/span><span class=\"CharOverride-2\">kia<\/span><span class=\"CharOverride-4\">, they heal all those at the dance.<\/span>[footnote]Richard Katz, Megan Biesele, and Verna St. Davis, <em>Healing Makes Our Hearts Happy: Spirituality and Cultural Transformation among the Kalahari Ju\/ \u2019hoansi<\/em> (Rochester VS, Inner Traditions, 1982), 34.[\/footnote]<\/p>\r\n<\/blockquote>\r\n<p class=\"Normal-no-indent\"><span class=\"CharOverride-4\">While communal healing techniques often involve harnessing supernatural forces such as the <\/span><span class=\"CharOverride-2\">num<\/span><span class=\"CharOverride-4\">, it is also true that these rituals help strengthen social bonds between people. Having a strong social and emotional support system is an important element of health in all human cultures.<\/span><\/p>\r\n\r\n<h2 class=\"H1\">THE EXPERIENCE OF ILLNESS IN PLACE\u00a0<span class=\"Annotation-reference CharOverride-3\"><em>b<\/em><\/span><em>y Sashur Henninger-Rener<\/em><\/h2>\r\n<h3 class=\"H2-below-H1\">Social Construction of Illness<\/h3>\r\n<p class=\"Normal\">As the above examples demonstrate, cultural attitudes affect how medical conditions will be perceived and how individuals with health problems will be regarded by the wider community. There is a difference, for instance, between a disease, which is a medical condition that can be objectively identified, and an illness, which is the subjective or personal experience of feeling unwell. Illnesses may be caused by disease, but the experience of being sick encompasses more than just the symptoms caused by the disease itself. Illnesses are, at least in part, social constructions: experiences that are given meaning by the relationships between the person who is sick and others.<\/p>\r\n<p class=\"Normal\">The course of an illness can worsen for instance, if the dominant society views the sickness as a moral failing. Obesity is an excellent example of the social construction of illness. The condition itself is a result of culturally induced habits and attitudes toward food, but despite this strong cultural component, many people regard obesity as a preventable circumstance, blaming individuals for becoming overweight. This attitude has a long cultural history. Consider for instance the religious connotations within Christianity of \u201cgluttony\u201d as a sin.[footnote]Collean Barry, Victoria Bresscall, Kelly D. Brownell, and Mark Schlesinger, \u201cObesity Metaphors: How Beliefs about Obesity Affect Support for Public Policy,\u201d The Milbank Quarterly 87 (2009): 7\u201347.[\/footnote] Such socially constructed <em>stigma<\/em> influences the subjective experience of the illness. Obese women have reported avoiding visits to physicians for fear of judgment and as a result may not receive treatments necessary to help their condition.[footnote]Peter Conrad and Kristen K. Barker, \u201cThe Social Construction of Illness: Key Insights and Policy Implications,\u201d <em>Journal of Health and Social Behavior<\/em>, 51(2010): s57-s79.[\/footnote] Peter Attia, a surgeon and medical researcher who delivered a <a href=\"https:\/\/www.ted.com\/talks\/peter_attia_what_if_we_re_wrong_about_diabetes\"><span class=\"Hyperlink\">TED Talk<\/span><\/a> on this subject, related the story of an obese woman who had to have her foot amputated, a common result of complications from obesity and diabetes. Even though he was a physician, he judged the woman to be lazy. \u201cIf you had just tried even a little bit,\u201d he had thought to himself before surgery.<\/p>\r\n\r\n<div class=\"textbox examples\">\r\n<h3>TED TALK<\/h3>\r\nhttps:\/\/www.ted.com\/talks\/peter_attia_what_if_we_re_wrong_about_diabetes?language=en\r\n\r\n<\/div>\r\n<p class=\"Normal\">Subsequently, new research revealed that insulin resistance, a precursor to diabetes, often develops as a result of the excess sugars used in many kinds of processed foods consumed commonly in the United States. As Attia observes, high rates of obesity in the United States are a reflection of the types of foods Americans have learned to consume as part of their cultural environment.[footnote]Peter Attia, \u201cIs the Obesity Crisis Hiding a Bigger Problem?,\u201d <em>TEDMED Talks<\/em> April 2013 Retrieved from https:\/\/www. ted.com\/talks\/peter_attia_what_if_we_re_wrong_about_diabetes.[\/footnote] In addition, the fact that foods that are high in sugars and fats are inexpensive and abundant, while healthier foods are expensive and unavailable in some communities, highlights the economic and social inequalities that contribute to the disease.<\/p>\r\n\r\n\r\n[caption id=\"attachment_538\" align=\"aligncenter\" width=\"800\"]<img class=\"size-full wp-image-538\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/2795\/2017\/12\/06164552\/380-e1512758083260.jpg\" alt=\"\" width=\"800\" height=\"398\" \/> Figure 3: AIDS prevention art, Mozambique. The text reads \"think of the consequences, change behavior, prevent HIV\/AIDS\".[\/caption]\r\n<p class=\"Normal\">The HIV\/AIDS virus provides another example of the way that the subjective experience of an illness can be influenced by social attitudes. Research in many countries has shown that people, including healthcare workers, make distinctions between patients who are \u201cinnocent\u201d victims of AIDS and those who are viewed as \u201cguilty.\u201d People who contracted HIV through sex or intravenous drug use are seen as guilty. The same judgment applies to people who contracted HIV through same-sex relationships in places where societal disapproval of same-sex relationships exists. People who contracted HIV from blood transfusions, or as babies, are viewed as innocent. The \u201cguilty\u201d HIV patients often find it more difficult to access medical care and are treated with disrespect or indifference in medical settings compared with superior treatment provided to those regarded as \u201cinnocent.\u201d In the wider community, \u201cguilty\u201d patients suffer from social marginalization and exclusion while \u201cinnocent\u201d patients receive greater social acceptance and practical assistance in responding to their needs for support and care.[footnote]Anish P. Mahajan, Jennifer N. Sayles, Vishal A. Patel, Robert H. Remien, Daniel Ortiz, Greg Szekeres, and Thomas J. Coates, \u201cStigma in the HIV\/AIDS Epidemic: A review of the Literature and Recommendations for the Way Forward,\u201d AIDS 22 supp. 2 (2008): S67-S79. [\/footnote]<\/p>\r\n<p class=\"Normal\">The stigma that applies to \u201cguilty\u201d patients also ignores the socioeconomic context in which HIV\/AIDS spreads. For instance, in Indonesia, poor women can make considerably more money as sex workers than in many other jobs: $10 an hour as a sex worker compared to 20 cents an hour in a factory.[footnote]Elizabeth Pisani, \u201cSex, Drugs, &amp; HIV: Let\u2019s Get Rational,\u201d <em>TED Talks<\/em> February 2010. http:\/\/www.ted.com\/talks\/elizabeth_pisani_sex_drugs_and_hiv_let_s_get_rational_1#t-1011824.[\/footnote] In a similar way, poverty and a lack of other choices contribute to a decision to engage in sex work in other societies, including in sub-Saharan Africa where rates of HIV infection are among the highest in the world. Poverty itself is one of the greatest \u201crisk factors\u201d for HIV infection.[footnote]United Nations, \u201cPoverty and AIDS: What\u2019s Really Driving the Epidemic?\u201d http:\/\/www.unfpa.org\/conversations\/facts. html.[\/footnote] The clear relationship between poverty, gender, and HIV infection has been the topic of a great deal of research in medical anthropology. One example is Paul Farmer\u2019s classic book, <em>AIDS and Accusation: Haiti and the Geography of Blame<\/em> (1992), which was one of the earliest books to critically evaluate the connection between poverty, racism, stigma, and neglect that allowed HIV to infect and kill thousands of Haitians. Projects like this are critical to developing holistic views of the entire cultural, economic, and political context that affects the spread of the virus and attempts to treat the disease. <a href=\"http:\/\/www.pih.org\/\"><span class=\"Hyperlink\">Partners in Health<\/span><\/a>, the non-profit medical organization Paul Farmer helped to found, continues to pursue innovative strategies to prevent and treat diseases like AIDS, strategies that recognize that poverty and social marginalization provide the environment in which the virus flourishes.<\/p>\r\n\r\n<div class=\"textbox examples\">\r\n<h3>TED talk<\/h3>\r\nhttps:\/\/www.ted.com\/talks\/mary_bassett_why_your_doctor_should_care_about_social_justice?referrer=playlist-the_link_between_health_and_racism\r\n\r\n<\/div>\r\n<h2 class=\"H1\">BIOMEDICAL TECHNOLOGIES\u00a0<span class=\"Annotation-reference CharOverride-3\"><em>b<\/em><\/span><em>y Sashur Henninger-Rener<\/em><\/h2>\r\n<p class=\"Normal\">In the history of human health, technology is an essential topic. Medical technologies have transformed human life. They have increased life expectancy rates, lowered child mortality rates, and are used to intervene in and often cure thousands of diseases. Of course, these accomplishments come with many cultural consequences. Successful efforts to intervene in the body biologically also have implications for cultural values and the social organization of communities, as demonstrated by the examples below.<\/p>\r\n\r\n<h3 class=\"H2\">Antibiotics and Immunizations<\/h3>\r\n<p class=\"Normal\">Infectious diseases caused by viruses and bacteria have taken an enormous toll on human populations for thousands of years. During recurring epidemics, tens of thousands of people have died from outbreaks of diseases like measles, the flu, or bubonic plague. The Black Death, a pandemic outbreak of plague that spread across Europe and Eurasia from 1346\u20131353 AD, killed as many as 200 million people, as much as a third of the European population. Penicillin, discovered in 1928 and mass produced for the first time in the early 1940s, was a turning point in the human fight against bacterial infections. Called a \u201cwonder drug\u201d by Time magazine, Penicillin became available at a time when bacterial infections were frequently fatal; the drug was glorified as a cure-all.[footnote]Robert Bud, \u201cAntibiotics: From Germophobia to the Carefree Life and Back Again.\u201d[\/footnote] An important factor to consider about the introduction of antibiotics is the change to an understanding of illness that was increasingly scientific and technical. Before science could provide cures, personalistic and naturalistic ethno-etiologies identified various root causes for sickness, but the invention of antibiotics contributed to a strengthening of the Western biomedical paradigm as well as a new era of profitability for the pharmaceutical industry.<\/p>\r\n<p class=\"Normal\">The effects of antibiotics have not been completely positive in all parts of the world. Along with other technological advances in areas such as sanitation and access to clean water, antibiotics contributed to an <strong>epidemiological transition<\/strong> characterized by a sharp drop in mortality rates, particularly among children. In many countries, the immediate effect was an increase in the human population as well as a shift in the kinds of diseases that were most prevalent. In wealthy countries, for instance, chronic conditions like heart disease or cancer have replaced bacterial infections as leading causes of death and the average lifespan has lengthened. In developing countries, the outcome has been mixed. Millions of lives have been saved by the availability of antibiotics, but high poverty and lack of access to regular medical care mean that many children who now survive the immediate dangers of infection during infancy succumb later in childhood to malnutrition, dehydration, or other ailments.[footnote]Nancy Scheper Hughes, Death Without Weeping: The Violence of Everyday Life in Brazil (Berkeley: University of California Press, 1989).[\/footnote]<\/p>\r\n\r\n\r\n[caption id=\"attachment_539\" align=\"aligncenter\" width=\"600\"]<img class=\"wp-image-539\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/2795\/2017\/12\/06164554\/381-e1512758178631.jpg\" alt=\"\" width=\"600\" height=\"406\" \/> Figure 4: Women and children waiting to enter a medical clinic in Somalia. The clinic is open 2 days each week and treats 400-500 people each day.[\/caption]\r\n<p class=\"Normal\">Another difficulty is the fact that many kinds of infections have become untreatable as a result of bacterial resistance. Medical anthropologists are concerned with the increase in rates of infectious diseases like tuberculosis and malaria that cannot be treated with many existing antibiotics. According to the World Health Organization, there are nearly 500,000 cases of drug resistant tuberculosis each year.[footnote]World Health Organization, \u201cAntimicrobial Resistance,\u201d http:\/\/www.who.int\/mediacentre\/factsheets\/fs194\/en\/.[\/footnote] New research is now focused on drug resistance, as well as the social and cultural components of this resistance such as the relationship between poverty and the spread of resistant strains of bacteria.<\/p>\r\n<p class=\"Normal\">Immunizations that can provide immunity against viral diseases have also transformed human health. The eradication of the smallpox virus in 1977 following a concerted global effort to vaccinate a large percentage of the world\u2019s population is one example of the success of this biotechnology. Before the development of the vaccine, the virus was killing 1\u20132 million people each year.[footnote]David Koplow, <em>Smallpox: The Fight to Eradicate a Global Scourge<\/em> (Berkeley: University of California Press, 2003).[\/footnote] Today, vaccines exist for many of the world\u2019s most dangerous viral diseases, but providing access to vaccines remains a challenge. The polio virus has been eliminated from most of the world following several decades of near universal vaccination, but the disease has made a comeback in a handful of countries, including Afghanistan, Nigeria, and Pakistan, where weak governments, inadequate healthcare systems, or war have made vaccinating children impossible. This example highlights the global inequalities that still exist in access to basic medical care.<\/p>\r\n<p class=\"Normal\">Because viruses have the ability to mutate and to jump between animals and people, human populations around the world also face the constant threat of new viral diseases. Influenza has been responsible for millions of deaths. In 1918, a pandemic of the H1N1 flu infected 500 million people, killing nearly 5 percent of the human population.[footnote]Jeffery K. Taubenberger, David Baltimore, Peter C. Doherty, Howard Markel, David M. Morens, Robert G. Webster, and Ian A. Wilson, \u201cReconstruction of the 1918 Influenza Virus: Unexpected Rewards from the Past,\u201d mBio 3 no. 5 (2012).[\/footnote] Not all influenza strains are that deadly, but it remains a dangerous illness and one that vaccines can only partially address.[footnote]Jeffrey Taubenberger and David Morens, \u201c1918 influenza: The Mother of All Pandemics,\u201d<em> Emerging Infectious Diseases<\/em>, 12 (2006).[\/footnote] Each year, the strains of the influenza virus placed in the annual \u201cflu shot\u201d are based on predictions about the strains that will be most common. Because the virus mutates frequently and is influenced by interactions between human and animal populations, there is always uncertainty about future forms of the virus.[footnote]Suzanne Clancy, \u201cGenetics of the Influenza Virus,\u201d <em>Nature Education<\/em>, 1(2008): 83.[\/footnote]<\/p>\r\n\r\n<h3 class=\"H2\">Reproductive Technologies<\/h3>\r\n<p class=\"Normal\">Today, the idea of \u201ccontraception\u201d is linked to the technology of hormone-based birth control. \u201cThe pill\u201d as we now know it, was not available in the United States until 1960, but attempts to both prevent or bring about pregnancy through technology date back to the earliest human communities. Techniques used to control the birthrate are an important subject for medical anthropologists because they have significant cultural implications.<\/p>\r\n<p class=\"Normal\">Many cultures use natural forms of birth control practices to influence the spacing of births. Among the !Kung, for instance, babies are breastfed for many months or even years, which hormonally suppress fertility and decrease the number of pregnancies a woman can have in her lifetime. In Enga, New Guinea, men and women do not live with one another following a birth, another practice that increases the time between pregnancies.[footnote]For more about these and other examples, see Carol P. MacCormack, <em>Ethnography of Fertility and Birth<\/em> (New York: Academic Press, 1982).[\/footnote] In contrast, cultures where there are social or religious reasons for avoiding birth control, including natural birth spacing methods, have higher birth rates. In the United States, the Comstock Act passed in 1873 banned contraception and even the distribution of information about contraception.<\/p>\r\n<p class=\"Normal\">Although the Comstock Act is a thing of the past, efforts in the United States to limit access to birth control and related medical services like abortion are ongoing. Many medical anthropologists study the ways in which access to reproductive technologies is affected by cultural values. Laury Oaks (2003) has investigated the way in which activists on both sides of the abortion debate attempt to culturally define the idea of \u201crisk\u201d as it relates to women\u2019s health. She notes that in the 1990s anti-abortion activists in the United States circulated misleading medical material suggesting that abortion increases rates of breast cancer. Although this claim was medically false, it was persuasive to many people and contributed to doubts about whether abortion posed a health risk to women, a concern that strengthened efforts to limit access to the procedure.[footnote]Laury Oaks, \u201cThe Social Politics of Health Risk Warning: Competing Claims about the Link between Abortion and Breast Cancer,\u201d in <em>Risk, Culture, and Health Inequality: Shifting Perceptions of Danger and Blame<\/em>, eds. Barbara Herr Harthorn and Laury Oaks (Westport, CT: Praeger, 2003). [\/footnote]<\/p>\r\n<p class=\"Normal\">Other forms of reproductive technology have emerged from the desire to increase fertility. The world of \u201cassisted reproduction,\u201d which includes technologies such as in vitro fertilization and surrogate pregnancy, has been the subject of many anthropological investigations. Marcia Inhorn, a medical anthropologist, has written several books about the growing popularity of in vitro fertilization in the Middle East. Her book, <em>The New Arab Man<\/em> (2012), explores the way in which infertility disrupts traditional notions of Arab masculinity that are based on fatherhood and she explores the ways that couples navigate conflicting cultural messages about the importance of parenthood and religious disapproval of assisted fertility.[footnote]Marcia C. Inhorn, <em>The New Arab Man: Emergent Masculinities, Technologies, and Islam in the Middle East<\/em> (Princeton, NJ: Princeton University Press, 2012).[\/footnote]<\/p>\r\n\r\n<h2 class=\"H1\">CONCLUSION\u00a0<span class=\"Annotation-reference CharOverride-3\"><em>b<\/em><\/span><em>y Sashur Henninger-Rener<\/em><\/h2>\r\n<p class=\"Normal\">As the global population becomes larger, it is increasingly challenging to address the health needs of the world\u2019s population. Today, 1 in 8 people in the world do not have access to adequate nutrition, the most basic element of good health.[footnote]Food and Agriculture Organization of the United Nations, \u201cThe Multiple Dimensions of Food Security,\u201d http:\/\/www.fao. org\/docrep\/018\/i3458e\/i3458e.pdf.[\/footnote] More than half the human population lives in an urban environment where infectious diseases can spread rapidly, sparking pandemics. Many of these cities include dense concentrations of poverty and healthcare systems that are not adequate to meet demand.[footnote]World Health Organization, \u201cUrbanization and Health,\u201d <em>Bulletin of the World Health Organization<\/em>, 88(2010): 241\u2013320.[\/footnote]\u00a0Globalization, a process that connects cultures through trade, tourism, and migration, contributes to the spread of pathogens that negatively affect human health and exacerbates political and economic inequalities that make the provision of healthcare more difficult.<\/p>\r\n<p class=\"Normal\">Human health is complex and these are daunting challenges, but medical anthropologists have a unique perspective to contribute to finding solutions. Medical anthropology offers a holistic perspective on the relationship between health and culture. As anthropologists study the ways people think about health and illness and the socioeconomic and cultural dynamics that affect the provision of health services, there is a potential to develop new methods for improving the health and quality of life for people all over the world.<\/p>\r\n\r\n<\/div>\r\n<div id=\"_idContainer810\" class=\"_idGenObjectStyleOverride-1\">\r\n<div class=\"textbox exercises\">\r\n<h3 class=\"H1\">DISCUSSION QUESTIONS<\/h3>\r\n<ol>\r\n \t<li class=\"Discussion-Questions-numbered\">Many cultures have ethno-etiologies that provide explanations for illness that are not based in science. From a biomedical perspective, the non-scientific medical treatments provided in these cultures have a low likelihood of success. Despite this, people tend to believe that the treatments are working. Why do you think people tend to be satisfied with the effectiveness of the treatments they receive?<\/li>\r\n \t<li class=\"Discussion-Questions-numbered\">How does poverty influence the health of populations around the world? Do you see this in your own community? Who should be responsible for addressing health care needs in impoverished communities.<\/li>\r\n<\/ol>\r\n<\/div>\r\n<div class=\"textbox examples\">\r\n<h3>TBD<\/h3>\r\nInsert Video Here\r\n\r\n<\/div>\r\n<\/div>","rendered":"<div id=\"_idContainer793\" class=\"Basic-Text-Frame\">\n<div class=\"textbox learning-objectives\">\n<h3>Learning Objectives<\/h3>\n<ul>\n<li class=\"Learning-Objectives\">Define the terms ethnomedicine and\u00a0ethno-etiology.<\/li>\n<li>Explain how biomedicine is a product of Western ethno-etiology.<\/li>\n<li>Compare and contrast the healing techniques of biomedicine in Western Europe and North America, Traditional Chinese Medicine, and Communal Healing among the\u00a0!Kung.<\/li>\n<li>Describe some ways that social inequality impacts health.<\/li>\n<li>Explain how the social construction of illness can lead to sigma.<\/li>\n<li>Define\u00a0epidemiological transition.<\/li>\n<li class=\"Learning-Objectives\">Evaluate the positive and negative effects of biomedical technologies.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<h2>INTRODUCTION <em>by Sashur Henninger-Rener<\/em><\/h2>\n<div class=\"_idGenObjectLayout-1\">What does it mean to be \u201chealthy\u201d? It may seem odd to ask the question, but health is not a universal concept and each culture values different aspects of well-being. At the most basic level, health may be perceived as surviving each day with enough food and water, while other definitions of health may be based on being free of diseases or emotional troubles. Complicating things further is the fact that that each culture has a different causal explanation for disease. For instance, in ancient Greece health was considered to be the product of unbalanced humors or bodily fluids. The four humors included black bile, phlegm, yellow bile, and blood. The ancient Greeks believed that interactions among these humors explained differences not only in health, but in age, gender, and general disposition. Various things could influence the balance of the humors in a person\u2019s body including substances believed to be present in the air, changes in diet, or even temperature and weather. An imbalance in the humors was believed to cause diseases, mood problems, and mental illness.<a class=\"footnote\" title=\"Jermone Gilbert, Humors, Hormones, and Neurosecretions (New York: State University of New York Press, 1962).\" id=\"return-footnote-540-1\" href=\"#footnote-540-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a><\/div>\n<div id=\"_idContainer810\" class=\"_idGenObjectStyleOverride-1\">\n<p class=\"Normal\">The World Health Organization (WHO) recognizes that the health of individuals and communities is affected by many factors: \u201cwhere we live, the state of our environment, genetics, our income and education level, and our relationships with friends and family.\u201d<a class=\"footnote\" title=\"World Health Organization, \u201cHealth Impact Assessment,\u201d http:\/\/www.who.int\/hia\/evidence\/doh\/en\/.\" id=\"return-footnote-540-2\" href=\"#footnote-540-2\" aria-label=\"Footnote 2\"><sup class=\"footnote\">[2]<\/sup><\/a>\u00a0Research conducted by the WHO suggests that these characteristics play a more significant role in affecting our health than any others, including having access to health care. For this reason, anthropologists who are interested in issues related to health and illness must use a broad holistic perspective that considers the influence of both biology and culture. <strong>Medical anthropology<\/strong>, a distinct sub-specialty within the discipline of anthropology, investigates human health and health care systems in comparative perspective, considering a wide range of bio-cultural dynamics that affect the well-being of human populations. Medical anthropologists study the perceived causes of illness as well as the techniques and treatments developed in a society to address health concerns. Using cultural relativism and a comparative approach, medical anthropologists seek to understand how ideas about health, illness, and the body are products of particular social and cultural contexts.<\/p>\n<h2 class=\"H1\"><span class=\"Annotation-reference CharOverride-3\">ETHNOMEDICINE <em>b<\/em><\/span><em>y Sashur Henninger-Rener<\/em><\/h2>\n<div id=\"attachment_529\" style=\"width: 410px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-529\" class=\"size-full wp-image-529\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/2795\/2017\/12\/06164533\/health_figure_1-e1512757742839.png\" alt=\"\" width=\"400\" height=\"444\" \/><\/p>\n<p id=\"caption-attachment-529\" class=\"wp-caption-text\">Figure 1. Tibetan medicine poster.<\/p>\n<\/div>\n<p class=\"Normal\"><strong>Ethnomedicine<\/strong> is the comparative study of cultural ideas about wellness, illness, and healing. For the majority of our existence, human beings have depended on the resources of the natural environment and on health and healing techniques closely associated with spiritual beliefs. Many such practices, including some herbal remedies and techniques like acupuncture, have been studied scientifically and found to be effective.<a class=\"footnote\" title=\"George T. Lewith, Acupuncture: Its Place in Western Medical Science (United Kingdom: Merlin Press, 1998).\" id=\"return-footnote-540-3\" href=\"#footnote-540-3\" aria-label=\"Footnote 3\"><sup class=\"footnote\">[3]<\/sup><\/a> Others have not necessarily been proven medically effective by external scientific evidence, but continue to be embraced by communities that perceive them to be useful. When considering cultural ideas about health, an important place to start is with <strong>ethno-etiology<\/strong>: cultural explanations about the underlying causes of health problems.<\/p>\n<p class=\"Normal\">In the United States the dominant approach to thinking about health is <strong>biomedical.<\/strong> Illnesses are thought to be the result of specific, identifiable agents. This can include pathogens (viruses or bacteria), malfunction of the body\u2019s biochemical processes (conditions such as cancer), or physiological disorders (such as organ failure). In biomedicine as it is practiced in the United States (Western biomedicine), health is defined as the absence of disease or dysfunction, a perspective that notably excludes consideration of social or spiritual well-being.<\/p>\n<p class=\"Normal\">The biomedical approach to health strikes many people, particularly residents of the United States, as the best or at least the most \u201cfact-based\u201d approach to medicine. This is largely because Western biomedicine is based on the application of insights from science, particularly biology and chemistry, to the diagnosis and treatment of medical conditions. The effectiveness of biomedical treatments is assessed through rigorous testing using the scientific method and indeed Western biomedicine has produced successful treatments for many dangerous and complex conditions: everything from antibiotics and cures for cancer to organ transplantation.<\/p>\n<p class=\"Normal\">However, it is important to remember that the biomedical approach is itself embedded in a distinct cultural tradition, just like other ethno-etiologies. Biomedicine, and the scientific disciplines on which it is based, are products of Western history. The earliest Greek physicians Hippocrates (c. 406\u2013370 BC) and Galen (c. 129\u2013c. 200 AD) shaped the development of the biomedical perspective by providing early insights into anatomy, physiology, and the relationship between environment and health. From its origins in ancient Greece and Rome, the knowledge base that matured into contemporary Western biomedicine developed as part of the Scientific Revolution in Europe, slowly maturing into the medical profession recognized today. While the scientific method used in Western biomedicine represents a distinct and powerful \u201cway of knowing\u201d compared to other etiologies, the methods, procedures, and forms of reasoning used in biomedicine are products of Western culture.<a class=\"footnote\" title=\"Elliott Mishler, \u201cViewpoint: Critical Perspectives on the Biomedical Model,\u201d in E. Mishler, L.A. Rhodes, S. Hauser, R. Liem, S. Osherson, and N. Waxler, eds. Social Contexts of Health, Illness, and Patient Care (Cambridge, UK: Cambridge University Press)\" id=\"return-footnote-540-4\" href=\"#footnote-540-4\" aria-label=\"Footnote 4\"><sup class=\"footnote\">[4]<\/sup><\/a><\/p>\n<div id=\"attachment_532\" style=\"width: 309px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-532\" class=\"size-full wp-image-532\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/2795\/2017\/12\/06164543\/health_figure_2-e1512757769730.png\" alt=\"\" width=\"299\" height=\"424\" \/><\/p>\n<p id=\"caption-attachment-532\" class=\"wp-caption-text\">Figure 2: The Taiyang bladder meridian, one of several meridians recognized in traditional Chinese medicine. From Shou Hua\u2019s Jushikei Hakki, 1716, Tokyo.<\/p>\n<\/div>\n<p class=\"Normal\">In matters of health, as in other aspects of life, ethnocentrism predisposes people to believe that their own culture\u2019s traditions are the most effective. People from <span style=\"color: #993300\">non-North American and Western European<\/span> cultures do not necessarily agree that Western biomedicine is superior to their own ethno-etiologies. <span style=\"color: #993300\">&#8220;<\/span>Western<span style=\"color: #993300\">&#8220;<\/span> culture does not even have a monopoly on the concept of \u201cscience.\u201d Other cultures recognize their own forms of science separate from the Western tradition and these sciences have histories dating back hundreds or even thousands of years. One example is Traditional Chinese Medicine (TCM), a set of practices developed over more than 2,500 years to address physical complaints holistically through acupuncture, exercise, and herbal remedies. The tenets of Traditional Chinese Medicine are not based on science as it is defined in Western culture, but millions of people, including a growing number of people in the United States and Europe, regard TCM as credible and effective.<\/p>\n<p class=\"Normal\">Ultimately, all ethno-etiologies are rooted in shared cultural perceptions about the way the world works. Western biomedicine practitioners would correctly observe that the strength of Western biomedicine is derived from use of a scientific method that emphasizes objectively observable facts. However, this this would not be particularly persuasive to someone whose culture uses a different ethno-etiology or whose understanding of the world derives from a different tradition of \u201cscience.\u201d From a comparative perspective, Western biomedicine may be viewed as one ethno-etiology in a world of many alternatives.<\/p>\n<h2 class=\"Normal\">TECHNIQUES FOR HEALING<em> by Sashur Henninger-Rener<\/em><\/h2>\n<p class=\"Normal\">Western biomedicine tends to conceive of the human body as a kind of biological machine. When parts of the machine are damaged, defective, or out of balance, chemical or surgical interventions are the preferred therapeutic responses. Biomedical practitioners, who can be identified by their white coats and stethoscopes, are trained to detect observable or quantifiable symptoms of disease, often through the use of advanced imaging technologies or tests of bodily fluids like blood and urine. Problems detected through these means will be addressed. Other factors known to contribute to wellness, such as the patient\u2019s social relationships or emotional state of mind, are considered less relevant for both diagnosis and treatment. Other forms of healing, which derive from non-biomedical ethno-etiologies, reverse this formulation, giving priority to the social and spiritual.<\/p>\n<p class=\"Normal\">In Traditional Chinese Medicine, the body is thought to be governed by the same forces that animate the universe itself. One of these is <strong><em>chi<\/em> (qi)<\/strong>, a vital life force that flows through the body and energizes the body and its organs. Disruptions in the flow or balance of <em>chi<\/em> can lead to a lack of internal harmony and ultimately to health problems so TCM practitioners use treatments designed to unblock or redirect <em>chi<\/em>, including acupuncture, dietary changes, and herbal remedies. This is an example of <em>humoral healing, <\/em>an approach to healing that seeks to treat medical ailments by achieving a balance between the forces or elements of the body.<\/p>\n<p class=\"Normal\"><strong>Communal healing,<\/strong> a second category of medical treatment, directs the combined efforts of the community toward treating illness. In this approach, medical care is a collaboration between multiple people. Among the !Kung (<span class=\"st\">Ju\/\u2019hoansi) <\/span>of the Kalahari Desert in southern Africa, energy known as <em>n\/um<\/em> can be channeled by members of the community during a healing ritual and directed toward individuals suffering from illness. Richard Katz, Megan Bisele, and Verna St. Davis (1982) described an example of this kind of ceremony:<\/p>\n<blockquote>\n<p class=\"Quotation\"><span class=\"CharOverride-4\">The central event in this tradition is the all-night healing dance. Four times a month on the average, night signals the start of a healing dance. The women sit around the fire, singing and rhythmically clapping. The men, sometimes joined by the women, dance around the singers. As the dance intensifies, <\/span><span class=\"CharOverride-2\">n\/um,<\/span><span class=\"CharOverride-4\"> or spiritual energy, is activated by the healers, both men and women, but mostly among the dancing men. As <\/span><span class=\"CharOverride-2\">n\/um<\/span><span class=\"CharOverride-4\"> is activated in them, they begin to <\/span><span class=\"CharOverride-2\">kia<\/span><span class=\"CharOverride-4\">, or experience an enhancement of their consciousness. While experiencing <\/span><span class=\"CharOverride-2\">kia<\/span><span class=\"CharOverride-4\">, they heal all those at the dance.<\/span><a class=\"footnote\" title=\"Richard Katz, Megan Biesele, and Verna St. Davis, Healing Makes Our Hearts Happy: Spirituality and Cultural Transformation among the Kalahari Ju\/ \u2019hoansi (Rochester VS, Inner Traditions, 1982), 34.\" id=\"return-footnote-540-5\" href=\"#footnote-540-5\" aria-label=\"Footnote 5\"><sup class=\"footnote\">[5]<\/sup><\/a><\/p>\n<\/blockquote>\n<p class=\"Normal-no-indent\"><span class=\"CharOverride-4\">While communal healing techniques often involve harnessing supernatural forces such as the <\/span><span class=\"CharOverride-2\">num<\/span><span class=\"CharOverride-4\">, it is also true that these rituals help strengthen social bonds between people. Having a strong social and emotional support system is an important element of health in all human cultures.<\/span><\/p>\n<h2 class=\"H1\">THE EXPERIENCE OF ILLNESS IN PLACE\u00a0<span class=\"Annotation-reference CharOverride-3\"><em>b<\/em><\/span><em>y Sashur Henninger-Rener<\/em><\/h2>\n<h3 class=\"H2-below-H1\">Social Construction of Illness<\/h3>\n<p class=\"Normal\">As the above examples demonstrate, cultural attitudes affect how medical conditions will be perceived and how individuals with health problems will be regarded by the wider community. There is a difference, for instance, between a disease, which is a medical condition that can be objectively identified, and an illness, which is the subjective or personal experience of feeling unwell. Illnesses may be caused by disease, but the experience of being sick encompasses more than just the symptoms caused by the disease itself. Illnesses are, at least in part, social constructions: experiences that are given meaning by the relationships between the person who is sick and others.<\/p>\n<p class=\"Normal\">The course of an illness can worsen for instance, if the dominant society views the sickness as a moral failing. Obesity is an excellent example of the social construction of illness. The condition itself is a result of culturally induced habits and attitudes toward food, but despite this strong cultural component, many people regard obesity as a preventable circumstance, blaming individuals for becoming overweight. This attitude has a long cultural history. Consider for instance the religious connotations within Christianity of \u201cgluttony\u201d as a sin.<a class=\"footnote\" title=\"Collean Barry, Victoria Bresscall, Kelly D. Brownell, and Mark Schlesinger, \u201cObesity Metaphors: How Beliefs about Obesity Affect Support for Public Policy,\u201d The Milbank Quarterly 87 (2009): 7\u201347.\" id=\"return-footnote-540-6\" href=\"#footnote-540-6\" aria-label=\"Footnote 6\"><sup class=\"footnote\">[6]<\/sup><\/a> Such socially constructed <em>stigma<\/em> influences the subjective experience of the illness. Obese women have reported avoiding visits to physicians for fear of judgment and as a result may not receive treatments necessary to help their condition.<a class=\"footnote\" title=\"Peter Conrad and Kristen K. Barker, \u201cThe Social Construction of Illness: Key Insights and Policy Implications,\u201d Journal of Health and Social Behavior, 51(2010): s57-s79.\" id=\"return-footnote-540-7\" href=\"#footnote-540-7\" aria-label=\"Footnote 7\"><sup class=\"footnote\">[7]<\/sup><\/a> Peter Attia, a surgeon and medical researcher who delivered a <a href=\"https:\/\/www.ted.com\/talks\/peter_attia_what_if_we_re_wrong_about_diabetes\"><span class=\"Hyperlink\">TED Talk<\/span><\/a> on this subject, related the story of an obese woman who had to have her foot amputated, a common result of complications from obesity and diabetes. Even though he was a physician, he judged the woman to be lazy. \u201cIf you had just tried even a little bit,\u201d he had thought to himself before surgery.<\/p>\n<div class=\"textbox examples\">\n<h3>TED TALK<\/h3>\n<p><iframe loading=\"lazy\" id=\"oembed-1\" title=\"Peter Attia: Is the obesity crisis hiding a bigger problem?\" src=\"https:\/\/embed.ted.com\/talks\/peter_attia_is_the_obesity_crisis_hiding_a_bigger_problem\" width=\"500\" height=\"282\" frameborder=\"0\" scrolling=\"no\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<\/div>\n<p class=\"Normal\">Subsequently, new research revealed that insulin resistance, a precursor to diabetes, often develops as a result of the excess sugars used in many kinds of processed foods consumed commonly in the United States. As Attia observes, high rates of obesity in the United States are a reflection of the types of foods Americans have learned to consume as part of their cultural environment.<a class=\"footnote\" title=\"Peter Attia, \u201cIs the Obesity Crisis Hiding a Bigger Problem?,\u201d TEDMED Talks April 2013 Retrieved from https:\/\/www. ted.com\/talks\/peter_attia_what_if_we_re_wrong_about_diabetes.\" id=\"return-footnote-540-8\" href=\"#footnote-540-8\" aria-label=\"Footnote 8\"><sup class=\"footnote\">[8]<\/sup><\/a> In addition, the fact that foods that are high in sugars and fats are inexpensive and abundant, while healthier foods are expensive and unavailable in some communities, highlights the economic and social inequalities that contribute to the disease.<\/p>\n<div id=\"attachment_538\" style=\"width: 810px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-538\" class=\"size-full wp-image-538\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/2795\/2017\/12\/06164552\/380-e1512758083260.jpg\" alt=\"\" width=\"800\" height=\"398\" \/><\/p>\n<p id=\"caption-attachment-538\" class=\"wp-caption-text\">Figure 3: AIDS prevention art, Mozambique. The text reads &#8220;think of the consequences, change behavior, prevent HIV\/AIDS&#8221;.<\/p>\n<\/div>\n<p class=\"Normal\">The HIV\/AIDS virus provides another example of the way that the subjective experience of an illness can be influenced by social attitudes. Research in many countries has shown that people, including healthcare workers, make distinctions between patients who are \u201cinnocent\u201d victims of AIDS and those who are viewed as \u201cguilty.\u201d People who contracted HIV through sex or intravenous drug use are seen as guilty. The same judgment applies to people who contracted HIV through same-sex relationships in places where societal disapproval of same-sex relationships exists. People who contracted HIV from blood transfusions, or as babies, are viewed as innocent. The \u201cguilty\u201d HIV patients often find it more difficult to access medical care and are treated with disrespect or indifference in medical settings compared with superior treatment provided to those regarded as \u201cinnocent.\u201d In the wider community, \u201cguilty\u201d patients suffer from social marginalization and exclusion while \u201cinnocent\u201d patients receive greater social acceptance and practical assistance in responding to their needs for support and care.<a class=\"footnote\" title=\"Anish P. Mahajan, Jennifer N. Sayles, Vishal A. Patel, Robert H. Remien, Daniel Ortiz, Greg Szekeres, and Thomas J. Coates, \u201cStigma in the HIV\/AIDS Epidemic: A review of the Literature and Recommendations for the Way Forward,\u201d AIDS 22 supp. 2 (2008): S67-S79.\" id=\"return-footnote-540-9\" href=\"#footnote-540-9\" aria-label=\"Footnote 9\"><sup class=\"footnote\">[9]<\/sup><\/a><\/p>\n<p class=\"Normal\">The stigma that applies to \u201cguilty\u201d patients also ignores the socioeconomic context in which HIV\/AIDS spreads. For instance, in Indonesia, poor women can make considerably more money as sex workers than in many other jobs: $10 an hour as a sex worker compared to 20 cents an hour in a factory.<a class=\"footnote\" title=\"Elizabeth Pisani, \u201cSex, Drugs, &amp; HIV: Let\u2019s Get Rational,\u201d TED Talks February 2010. http:\/\/www.ted.com\/talks\/elizabeth_pisani_sex_drugs_and_hiv_let_s_get_rational_1#t-1011824.\" id=\"return-footnote-540-10\" href=\"#footnote-540-10\" aria-label=\"Footnote 10\"><sup class=\"footnote\">[10]<\/sup><\/a> In a similar way, poverty and a lack of other choices contribute to a decision to engage in sex work in other societies, including in sub-Saharan Africa where rates of HIV infection are among the highest in the world. Poverty itself is one of the greatest \u201crisk factors\u201d for HIV infection.<a class=\"footnote\" title=\"United Nations, \u201cPoverty and AIDS: What\u2019s Really Driving the Epidemic?\u201d http:\/\/www.unfpa.org\/conversations\/facts. html.\" id=\"return-footnote-540-11\" href=\"#footnote-540-11\" aria-label=\"Footnote 11\"><sup class=\"footnote\">[11]<\/sup><\/a> The clear relationship between poverty, gender, and HIV infection has been the topic of a great deal of research in medical anthropology. One example is Paul Farmer\u2019s classic book, <em>AIDS and Accusation: Haiti and the Geography of Blame<\/em> (1992), which was one of the earliest books to critically evaluate the connection between poverty, racism, stigma, and neglect that allowed HIV to infect and kill thousands of Haitians. Projects like this are critical to developing holistic views of the entire cultural, economic, and political context that affects the spread of the virus and attempts to treat the disease. <a href=\"http:\/\/www.pih.org\/\"><span class=\"Hyperlink\">Partners in Health<\/span><\/a>, the non-profit medical organization Paul Farmer helped to found, continues to pursue innovative strategies to prevent and treat diseases like AIDS, strategies that recognize that poverty and social marginalization provide the environment in which the virus flourishes.<\/p>\n<div class=\"textbox examples\">\n<h3>TED talk<\/h3>\n<p><iframe loading=\"lazy\" id=\"oembed-2\" title=\"Mary Bassett: Why your doctor should care about social justice\" src=\"https:\/\/embed.ted.com\/talks\/mary_bassett_why_your_doctor_should_care_about_social_justice\" width=\"500\" height=\"282\" frameborder=\"0\" scrolling=\"no\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<\/div>\n<h2 class=\"H1\">BIOMEDICAL TECHNOLOGIES\u00a0<span class=\"Annotation-reference CharOverride-3\"><em>b<\/em><\/span><em>y Sashur Henninger-Rener<\/em><\/h2>\n<p class=\"Normal\">In the history of human health, technology is an essential topic. Medical technologies have transformed human life. They have increased life expectancy rates, lowered child mortality rates, and are used to intervene in and often cure thousands of diseases. Of course, these accomplishments come with many cultural consequences. Successful efforts to intervene in the body biologically also have implications for cultural values and the social organization of communities, as demonstrated by the examples below.<\/p>\n<h3 class=\"H2\">Antibiotics and Immunizations<\/h3>\n<p class=\"Normal\">Infectious diseases caused by viruses and bacteria have taken an enormous toll on human populations for thousands of years. During recurring epidemics, tens of thousands of people have died from outbreaks of diseases like measles, the flu, or bubonic plague. The Black Death, a pandemic outbreak of plague that spread across Europe and Eurasia from 1346\u20131353 AD, killed as many as 200 million people, as much as a third of the European population. Penicillin, discovered in 1928 and mass produced for the first time in the early 1940s, was a turning point in the human fight against bacterial infections. Called a \u201cwonder drug\u201d by Time magazine, Penicillin became available at a time when bacterial infections were frequently fatal; the drug was glorified as a cure-all.<a class=\"footnote\" title=\"Robert Bud, \u201cAntibiotics: From Germophobia to the Carefree Life and Back Again.\u201d\" id=\"return-footnote-540-12\" href=\"#footnote-540-12\" aria-label=\"Footnote 12\"><sup class=\"footnote\">[12]<\/sup><\/a> An important factor to consider about the introduction of antibiotics is the change to an understanding of illness that was increasingly scientific and technical. Before science could provide cures, personalistic and naturalistic ethno-etiologies identified various root causes for sickness, but the invention of antibiotics contributed to a strengthening of the Western biomedical paradigm as well as a new era of profitability for the pharmaceutical industry.<\/p>\n<p class=\"Normal\">The effects of antibiotics have not been completely positive in all parts of the world. Along with other technological advances in areas such as sanitation and access to clean water, antibiotics contributed to an <strong>epidemiological transition<\/strong> characterized by a sharp drop in mortality rates, particularly among children. In many countries, the immediate effect was an increase in the human population as well as a shift in the kinds of diseases that were most prevalent. In wealthy countries, for instance, chronic conditions like heart disease or cancer have replaced bacterial infections as leading causes of death and the average lifespan has lengthened. In developing countries, the outcome has been mixed. Millions of lives have been saved by the availability of antibiotics, but high poverty and lack of access to regular medical care mean that many children who now survive the immediate dangers of infection during infancy succumb later in childhood to malnutrition, dehydration, or other ailments.<a class=\"footnote\" title=\"Nancy Scheper Hughes, Death Without Weeping: The Violence of Everyday Life in Brazil (Berkeley: University of California Press, 1989).\" id=\"return-footnote-540-13\" href=\"#footnote-540-13\" aria-label=\"Footnote 13\"><sup class=\"footnote\">[13]<\/sup><\/a><\/p>\n<div id=\"attachment_539\" style=\"width: 610px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-539\" class=\"wp-image-539\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/2795\/2017\/12\/06164554\/381-e1512758178631.jpg\" alt=\"\" width=\"600\" height=\"406\" \/><\/p>\n<p id=\"caption-attachment-539\" class=\"wp-caption-text\">Figure 4: Women and children waiting to enter a medical clinic in Somalia. The clinic is open 2 days each week and treats 400-500 people each day.<\/p>\n<\/div>\n<p class=\"Normal\">Another difficulty is the fact that many kinds of infections have become untreatable as a result of bacterial resistance. Medical anthropologists are concerned with the increase in rates of infectious diseases like tuberculosis and malaria that cannot be treated with many existing antibiotics. According to the World Health Organization, there are nearly 500,000 cases of drug resistant tuberculosis each year.<a class=\"footnote\" title=\"World Health Organization, \u201cAntimicrobial Resistance,\u201d http:\/\/www.who.int\/mediacentre\/factsheets\/fs194\/en\/.\" id=\"return-footnote-540-14\" href=\"#footnote-540-14\" aria-label=\"Footnote 14\"><sup class=\"footnote\">[14]<\/sup><\/a> New research is now focused on drug resistance, as well as the social and cultural components of this resistance such as the relationship between poverty and the spread of resistant strains of bacteria.<\/p>\n<p class=\"Normal\">Immunizations that can provide immunity against viral diseases have also transformed human health. The eradication of the smallpox virus in 1977 following a concerted global effort to vaccinate a large percentage of the world\u2019s population is one example of the success of this biotechnology. Before the development of the vaccine, the virus was killing 1\u20132 million people each year.<a class=\"footnote\" title=\"David Koplow, Smallpox: The Fight to Eradicate a Global Scourge (Berkeley: University of California Press, 2003).\" id=\"return-footnote-540-15\" href=\"#footnote-540-15\" aria-label=\"Footnote 15\"><sup class=\"footnote\">[15]<\/sup><\/a> Today, vaccines exist for many of the world\u2019s most dangerous viral diseases, but providing access to vaccines remains a challenge. The polio virus has been eliminated from most of the world following several decades of near universal vaccination, but the disease has made a comeback in a handful of countries, including Afghanistan, Nigeria, and Pakistan, where weak governments, inadequate healthcare systems, or war have made vaccinating children impossible. This example highlights the global inequalities that still exist in access to basic medical care.<\/p>\n<p class=\"Normal\">Because viruses have the ability to mutate and to jump between animals and people, human populations around the world also face the constant threat of new viral diseases. Influenza has been responsible for millions of deaths. In 1918, a pandemic of the H1N1 flu infected 500 million people, killing nearly 5 percent of the human population.<a class=\"footnote\" title=\"Jeffery K. Taubenberger, David Baltimore, Peter C. Doherty, Howard Markel, David M. Morens, Robert G. Webster, and Ian A. Wilson, \u201cReconstruction of the 1918 Influenza Virus: Unexpected Rewards from the Past,\u201d mBio 3 no. 5 (2012).\" id=\"return-footnote-540-16\" href=\"#footnote-540-16\" aria-label=\"Footnote 16\"><sup class=\"footnote\">[16]<\/sup><\/a> Not all influenza strains are that deadly, but it remains a dangerous illness and one that vaccines can only partially address.<a class=\"footnote\" title=\"Jeffrey Taubenberger and David Morens, \u201c1918 influenza: The Mother of All Pandemics,\u201d Emerging Infectious Diseases, 12 (2006).\" id=\"return-footnote-540-17\" href=\"#footnote-540-17\" aria-label=\"Footnote 17\"><sup class=\"footnote\">[17]<\/sup><\/a> Each year, the strains of the influenza virus placed in the annual \u201cflu shot\u201d are based on predictions about the strains that will be most common. Because the virus mutates frequently and is influenced by interactions between human and animal populations, there is always uncertainty about future forms of the virus.<a class=\"footnote\" title=\"Suzanne Clancy, \u201cGenetics of the Influenza Virus,\u201d Nature Education, 1(2008): 83.\" id=\"return-footnote-540-18\" href=\"#footnote-540-18\" aria-label=\"Footnote 18\"><sup class=\"footnote\">[18]<\/sup><\/a><\/p>\n<h3 class=\"H2\">Reproductive Technologies<\/h3>\n<p class=\"Normal\">Today, the idea of \u201ccontraception\u201d is linked to the technology of hormone-based birth control. \u201cThe pill\u201d as we now know it, was not available in the United States until 1960, but attempts to both prevent or bring about pregnancy through technology date back to the earliest human communities. Techniques used to control the birthrate are an important subject for medical anthropologists because they have significant cultural implications.<\/p>\n<p class=\"Normal\">Many cultures use natural forms of birth control practices to influence the spacing of births. Among the !Kung, for instance, babies are breastfed for many months or even years, which hormonally suppress fertility and decrease the number of pregnancies a woman can have in her lifetime. In Enga, New Guinea, men and women do not live with one another following a birth, another practice that increases the time between pregnancies.<a class=\"footnote\" title=\"For more about these and other examples, see Carol P. MacCormack, Ethnography of Fertility and Birth (New York: Academic Press, 1982).\" id=\"return-footnote-540-19\" href=\"#footnote-540-19\" aria-label=\"Footnote 19\"><sup class=\"footnote\">[19]<\/sup><\/a> In contrast, cultures where there are social or religious reasons for avoiding birth control, including natural birth spacing methods, have higher birth rates. In the United States, the Comstock Act passed in 1873 banned contraception and even the distribution of information about contraception.<\/p>\n<p class=\"Normal\">Although the Comstock Act is a thing of the past, efforts in the United States to limit access to birth control and related medical services like abortion are ongoing. Many medical anthropologists study the ways in which access to reproductive technologies is affected by cultural values. Laury Oaks (2003) has investigated the way in which activists on both sides of the abortion debate attempt to culturally define the idea of \u201crisk\u201d as it relates to women\u2019s health. She notes that in the 1990s anti-abortion activists in the United States circulated misleading medical material suggesting that abortion increases rates of breast cancer. Although this claim was medically false, it was persuasive to many people and contributed to doubts about whether abortion posed a health risk to women, a concern that strengthened efforts to limit access to the procedure.<a class=\"footnote\" title=\"Laury Oaks, \u201cThe Social Politics of Health Risk Warning: Competing Claims about the Link between Abortion and Breast Cancer,\u201d in Risk, Culture, and Health Inequality: Shifting Perceptions of Danger and Blame, eds. Barbara Herr Harthorn and Laury Oaks (Westport, CT: Praeger, 2003).\" id=\"return-footnote-540-20\" href=\"#footnote-540-20\" aria-label=\"Footnote 20\"><sup class=\"footnote\">[20]<\/sup><\/a><\/p>\n<p class=\"Normal\">Other forms of reproductive technology have emerged from the desire to increase fertility. The world of \u201cassisted reproduction,\u201d which includes technologies such as in vitro fertilization and surrogate pregnancy, has been the subject of many anthropological investigations. Marcia Inhorn, a medical anthropologist, has written several books about the growing popularity of in vitro fertilization in the Middle East. Her book, <em>The New Arab Man<\/em> (2012), explores the way in which infertility disrupts traditional notions of Arab masculinity that are based on fatherhood and she explores the ways that couples navigate conflicting cultural messages about the importance of parenthood and religious disapproval of assisted fertility.<a class=\"footnote\" title=\"Marcia C. Inhorn, The New Arab Man: Emergent Masculinities, Technologies, and Islam in the Middle East (Princeton, NJ: Princeton University Press, 2012).\" id=\"return-footnote-540-21\" href=\"#footnote-540-21\" aria-label=\"Footnote 21\"><sup class=\"footnote\">[21]<\/sup><\/a><\/p>\n<h2 class=\"H1\">CONCLUSION\u00a0<span class=\"Annotation-reference CharOverride-3\"><em>b<\/em><\/span><em>y Sashur Henninger-Rener<\/em><\/h2>\n<p class=\"Normal\">As the global population becomes larger, it is increasingly challenging to address the health needs of the world\u2019s population. Today, 1 in 8 people in the world do not have access to adequate nutrition, the most basic element of good health.<a class=\"footnote\" title=\"Food and Agriculture Organization of the United Nations, \u201cThe Multiple Dimensions of Food Security,\u201d http:\/\/www.fao. org\/docrep\/018\/i3458e\/i3458e.pdf.\" id=\"return-footnote-540-22\" href=\"#footnote-540-22\" aria-label=\"Footnote 22\"><sup class=\"footnote\">[22]<\/sup><\/a> More than half the human population lives in an urban environment where infectious diseases can spread rapidly, sparking pandemics. Many of these cities include dense concentrations of poverty and healthcare systems that are not adequate to meet demand.<a class=\"footnote\" title=\"World Health Organization, \u201cUrbanization and Health,\u201d Bulletin of the World Health Organization, 88(2010): 241\u2013320.\" id=\"return-footnote-540-23\" href=\"#footnote-540-23\" aria-label=\"Footnote 23\"><sup class=\"footnote\">[23]<\/sup><\/a>\u00a0Globalization, a process that connects cultures through trade, tourism, and migration, contributes to the spread of pathogens that negatively affect human health and exacerbates political and economic inequalities that make the provision of healthcare more difficult.<\/p>\n<p class=\"Normal\">Human health is complex and these are daunting challenges, but medical anthropologists have a unique perspective to contribute to finding solutions. Medical anthropology offers a holistic perspective on the relationship between health and culture. As anthropologists study the ways people think about health and illness and the socioeconomic and cultural dynamics that affect the provision of health services, there is a potential to develop new methods for improving the health and quality of life for people all over the world.<\/p>\n<\/div>\n<div id=\"_idContainer810\" class=\"_idGenObjectStyleOverride-1\">\n<div class=\"textbox exercises\">\n<h3 class=\"H1\">DISCUSSION QUESTIONS<\/h3>\n<ol>\n<li class=\"Discussion-Questions-numbered\">Many cultures have ethno-etiologies that provide explanations for illness that are not based in science. From a biomedical perspective, the non-scientific medical treatments provided in these cultures have a low likelihood of success. Despite this, people tend to believe that the treatments are working. Why do you think people tend to be satisfied with the effectiveness of the treatments they receive?<\/li>\n<li class=\"Discussion-Questions-numbered\">How does poverty influence the health of populations around the world? Do you see this in your own community? Who should be responsible for addressing health care needs in impoverished communities.<\/li>\n<\/ol>\n<\/div>\n<div class=\"textbox examples\">\n<h3>TBD<\/h3>\n<p>Insert Video Here<\/p>\n<\/div>\n<\/div>\n\n\t\t\t <section class=\"citations-section\" role=\"contentinfo\">\n\t\t\t <h3>Candela Citations<\/h3>\n\t\t\t\t\t <div>\n\t\t\t\t\t\t <div id=\"citation-list-540\">\n\t\t\t\t\t\t\t <div class=\"licensing\"><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Shared previously<\/div><ul class=\"citation-list\"><li>Perspectives: An Open Invitation to Cultural Anthropology. <strong>Authored by<\/strong>: Edited by Nina Brown, Laura Tubelle de Gonzalez, and Thomas McIlwraith. <strong>Provided by<\/strong>: American Anthropological Association. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"http:\/\/perspectives.americananthro.org\/\">http:\/\/perspectives.americananthro.org\/<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/\">CC BY-NC: Attribution-NonCommercial<\/a><\/em><\/li><li>Health and Medicine . <strong>Authored by<\/strong>: Sashur Henninger-Rener. <strong>Provided by<\/strong>: University of LaVerne and the Los Angeles Community College District. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"http:\/\/perspectives.americananthro.org\/Chapters\/Health_and_Medicine.pdf\">http:\/\/perspectives.americananthro.org\/Chapters\/Health_and_Medicine.pdf<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/\">CC BY-NC: Attribution-NonCommercial<\/a><\/em><\/li><\/ul><\/div>\n\t\t\t\t\t\t <\/div>\n\t\t\t\t\t <\/div>\n\t\t\t <\/section><hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-540-1\">Jermone Gilbert, <em>Humors, Hormones, and Neurosecretions<\/em> (New York: State University of New York Press, 1962). <a href=\"#return-footnote-540-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><li id=\"footnote-540-2\"> World Health Organization, \u201cHealth Impact Assessment,\u201d http:\/\/www.who.int\/hia\/evidence\/doh\/en\/. <a href=\"#return-footnote-540-2\" class=\"return-footnote\" aria-label=\"Return to footnote 2\">&crarr;<\/a><\/li><li id=\"footnote-540-3\">George T. Lewith, <em>Acupuncture: Its Place in Western Medical Science<\/em> (United Kingdom: Merlin Press, 1998). <a href=\"#return-footnote-540-3\" class=\"return-footnote\" aria-label=\"Return to footnote 3\">&crarr;<\/a><\/li><li id=\"footnote-540-4\"> Elliott Mishler, \u201cViewpoint: Critical Perspectives on the Biomedical Model,\u201d in E. Mishler, L.A. Rhodes, S. Hauser, R. Liem, S. Osherson, and N. Waxler, eds. <em>Social Contexts of Health, Illness, and Patient Care<\/em> (Cambridge, UK: Cambridge University Press) <a href=\"#return-footnote-540-4\" class=\"return-footnote\" aria-label=\"Return to footnote 4\">&crarr;<\/a><\/li><li id=\"footnote-540-5\">Richard Katz, Megan Biesele, and Verna St. Davis, <em>Healing Makes Our Hearts Happy: Spirituality and Cultural Transformation among the Kalahari Ju\/ \u2019hoansi<\/em> (Rochester VS, Inner Traditions, 1982), 34. <a href=\"#return-footnote-540-5\" class=\"return-footnote\" aria-label=\"Return to footnote 5\">&crarr;<\/a><\/li><li id=\"footnote-540-6\">Collean Barry, Victoria Bresscall, Kelly D. Brownell, and Mark Schlesinger, \u201cObesity Metaphors: How Beliefs about Obesity Affect Support for Public Policy,\u201d The Milbank Quarterly 87 (2009): 7\u201347. <a href=\"#return-footnote-540-6\" class=\"return-footnote\" aria-label=\"Return to footnote 6\">&crarr;<\/a><\/li><li id=\"footnote-540-7\">Peter Conrad and Kristen K. Barker, \u201cThe Social Construction of Illness: Key Insights and Policy Implications,\u201d <em>Journal of Health and Social Behavior<\/em>, 51(2010): s57-s79. <a href=\"#return-footnote-540-7\" class=\"return-footnote\" aria-label=\"Return to footnote 7\">&crarr;<\/a><\/li><li id=\"footnote-540-8\">Peter Attia, \u201cIs the Obesity Crisis Hiding a Bigger Problem?,\u201d <em>TEDMED Talks<\/em> April 2013 Retrieved from https:\/\/www. ted.com\/talks\/peter_attia_what_if_we_re_wrong_about_diabetes. <a href=\"#return-footnote-540-8\" class=\"return-footnote\" aria-label=\"Return to footnote 8\">&crarr;<\/a><\/li><li id=\"footnote-540-9\">Anish P. Mahajan, Jennifer N. Sayles, Vishal A. Patel, Robert H. Remien, Daniel Ortiz, Greg Szekeres, and Thomas J. Coates, \u201cStigma in the HIV\/AIDS Epidemic: A review of the Literature and Recommendations for the Way Forward,\u201d AIDS 22 supp. 2 (2008): S67-S79.  <a href=\"#return-footnote-540-9\" class=\"return-footnote\" aria-label=\"Return to footnote 9\">&crarr;<\/a><\/li><li id=\"footnote-540-10\">Elizabeth Pisani, \u201cSex, Drugs, &amp; HIV: Let\u2019s Get Rational,\u201d <em>TED Talks<\/em> February 2010. http:\/\/www.ted.com\/talks\/elizabeth_pisani_sex_drugs_and_hiv_let_s_get_rational_1#t-1011824. <a href=\"#return-footnote-540-10\" class=\"return-footnote\" aria-label=\"Return to footnote 10\">&crarr;<\/a><\/li><li id=\"footnote-540-11\">United Nations, \u201cPoverty and AIDS: What\u2019s Really Driving the Epidemic?\u201d http:\/\/www.unfpa.org\/conversations\/facts. html. <a href=\"#return-footnote-540-11\" class=\"return-footnote\" aria-label=\"Return to footnote 11\">&crarr;<\/a><\/li><li id=\"footnote-540-12\">Robert Bud, \u201cAntibiotics: From Germophobia to the Carefree Life and Back Again.\u201d <a href=\"#return-footnote-540-12\" class=\"return-footnote\" aria-label=\"Return to footnote 12\">&crarr;<\/a><\/li><li id=\"footnote-540-13\">Nancy Scheper Hughes, Death Without Weeping: The Violence of Everyday Life in Brazil (Berkeley: University of California Press, 1989). <a href=\"#return-footnote-540-13\" class=\"return-footnote\" aria-label=\"Return to footnote 13\">&crarr;<\/a><\/li><li id=\"footnote-540-14\">World Health Organization, \u201cAntimicrobial Resistance,\u201d http:\/\/www.who.int\/mediacentre\/factsheets\/fs194\/en\/. <a href=\"#return-footnote-540-14\" class=\"return-footnote\" aria-label=\"Return to footnote 14\">&crarr;<\/a><\/li><li id=\"footnote-540-15\">David Koplow, <em>Smallpox: The Fight to Eradicate a Global Scourge<\/em> (Berkeley: University of California Press, 2003). <a href=\"#return-footnote-540-15\" class=\"return-footnote\" aria-label=\"Return to footnote 15\">&crarr;<\/a><\/li><li id=\"footnote-540-16\">Jeffery K. Taubenberger, David Baltimore, Peter C. Doherty, Howard Markel, David M. Morens, Robert G. Webster, and Ian A. Wilson, \u201cReconstruction of the 1918 Influenza Virus: Unexpected Rewards from the Past,\u201d mBio 3 no. 5 (2012). <a href=\"#return-footnote-540-16\" class=\"return-footnote\" aria-label=\"Return to footnote 16\">&crarr;<\/a><\/li><li id=\"footnote-540-17\">Jeffrey Taubenberger and David Morens, \u201c1918 influenza: The Mother of All Pandemics,\u201d<em> Emerging Infectious Diseases<\/em>, 12 (2006). <a href=\"#return-footnote-540-17\" class=\"return-footnote\" aria-label=\"Return to footnote 17\">&crarr;<\/a><\/li><li id=\"footnote-540-18\">Suzanne Clancy, \u201cGenetics of the Influenza Virus,\u201d <em>Nature Education<\/em>, 1(2008): 83. <a href=\"#return-footnote-540-18\" class=\"return-footnote\" aria-label=\"Return to footnote 18\">&crarr;<\/a><\/li><li id=\"footnote-540-19\">For more about these and other examples, see Carol P. MacCormack, <em>Ethnography of Fertility and Birth<\/em> (New York: Academic Press, 1982). <a href=\"#return-footnote-540-19\" class=\"return-footnote\" aria-label=\"Return to footnote 19\">&crarr;<\/a><\/li><li id=\"footnote-540-20\">Laury Oaks, \u201cThe Social Politics of Health Risk Warning: Competing Claims about the Link between Abortion and Breast Cancer,\u201d in <em>Risk, Culture, and Health Inequality: Shifting Perceptions of Danger and Blame<\/em>, eds. Barbara Herr Harthorn and Laury Oaks (Westport, CT: Praeger, 2003).  <a href=\"#return-footnote-540-20\" class=\"return-footnote\" aria-label=\"Return to footnote 20\">&crarr;<\/a><\/li><li id=\"footnote-540-21\">Marcia C. Inhorn, <em>The New Arab Man: Emergent Masculinities, Technologies, and Islam in the Middle East<\/em> (Princeton, NJ: Princeton University Press, 2012). <a href=\"#return-footnote-540-21\" class=\"return-footnote\" aria-label=\"Return to footnote 21\">&crarr;<\/a><\/li><li id=\"footnote-540-22\">Food and Agriculture Organization of the United Nations, \u201cThe Multiple Dimensions of Food Security,\u201d http:\/\/www.fao. org\/docrep\/018\/i3458e\/i3458e.pdf. <a href=\"#return-footnote-540-22\" class=\"return-footnote\" aria-label=\"Return to footnote 22\">&crarr;<\/a><\/li><li id=\"footnote-540-23\">World Health Organization, \u201cUrbanization and Health,\u201d <em>Bulletin of the World Health Organization<\/em>, 88(2010): 241\u2013320. <a href=\"#return-footnote-540-23\" class=\"return-footnote\" aria-label=\"Return to footnote 23\">&crarr;<\/a><\/li><\/ol><\/div>","protected":false},"author":311,"menu_order":16,"template":"","meta":{"_candela_citation":"[{\"type\":\"cc\",\"description\":\"Perspectives: An Open Invitation to Cultural Anthropology\",\"author\":\"Edited by Nina Brown, Laura Tubelle de Gonzalez, and Thomas McIlwraith\",\"organization\":\"American Anthropological Association\",\"url\":\"http:\/\/perspectives.americananthro.org\/\",\"project\":\"\",\"license\":\"cc-by-nc\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"Health and Medicine \",\"author\":\"Sashur Henninger-Rener\",\"organization\":\"University of LaVerne and the Los Angeles Community College District\",\"url\":\"http:\/\/perspectives.americananthro.org\/Chapters\/Health_and_Medicine.pdf\",\"project\":\"\",\"license\":\"cc-by-nc\",\"license_terms\":\"\"}]","CANDELA_OUTCOMES_GUID":"","pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-540","chapter","type-chapter","status-publish","hentry"],"part":3,"_links":{"self":[{"href":"https:\/\/courses.lumenlearning.com\/suny-geneseo-culturalanthropology\/wp-json\/pressbooks\/v2\/chapters\/540","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/courses.lumenlearning.com\/suny-geneseo-culturalanthropology\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/courses.lumenlearning.com\/suny-geneseo-culturalanthropology\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/suny-geneseo-culturalanthropology\/wp-json\/wp\/v2\/users\/311"}],"version-history":[{"count":12,"href":"https:\/\/courses.lumenlearning.com\/suny-geneseo-culturalanthropology\/wp-json\/pressbooks\/v2\/chapters\/540\/revisions"}],"predecessor-version":[{"id":1099,"href":"https:\/\/courses.lumenlearning.com\/suny-geneseo-culturalanthropology\/wp-json\/pressbooks\/v2\/chapters\/540\/revisions\/1099"}],"part":[{"href":"https:\/\/courses.lumenlearning.com\/suny-geneseo-culturalanthropology\/wp-json\/pressbooks\/v2\/parts\/3"}],"metadata":[{"href":"https:\/\/courses.lumenlearning.com\/suny-geneseo-culturalanthropology\/wp-json\/pressbooks\/v2\/chapters\/540\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/courses.lumenlearning.com\/suny-geneseo-culturalanthropology\/wp-json\/wp\/v2\/media?parent=540"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/suny-geneseo-culturalanthropology\/wp-json\/pressbooks\/v2\/chapter-type?post=540"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/suny-geneseo-culturalanthropology\/wp-json\/wp\/v2\/contributor?post=540"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/suny-geneseo-culturalanthropology\/wp-json\/wp\/v2\/license?post=540"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}