Table Of ContentANTHROPOLOGY AND EPIDEMIOLOGY
CULTURE, ILLNESS, AND HEALING
Editors:
MARGARET LOCK
Departments ofA nthropology and Humanities and Social Studies
in Medicine, McGill University, Montreal, Canada
ALLAN YOUNG
Department ofA nthropology, Case Western Reserve University,
Cleveland, Ohio, U.S.A.
Editorial Board:
ATWOOD D. GAINES
Departments ofA nthropology and Psychiatry, Case Western Reserve
University and Medical School, Cleveland. Ohio, U.S.A.
GILBERT LEWIS
Department of Anthropology, University of Cambridge,
England
GANANATH OBEYESEKERE
Department of Anthropology, Princeton University,
Princeton. New Jersey. U.S.A.
ANTHROPOLOGY
AND EPIDEMIOLOGY
Interdisciplinary Approaches to the Study ofH ealth
and Disease
Edited by
CRAIG R. JANES
Department ofA nthropology, University of Colorado, Denver, Colorado
RON STALL
Department of Urban Studies, Rutgers University, New Brunswick, New Jersey, and
The Alcohol Research Group, Berkeley, California
and
SANDRA M. GIFFORD
Division of Community Health, State Health Commission of Victoria,
Australia
D. REIDEL PUBLISHING COMPANY
A MEMBER OF THE KLUWER ACADEMIC PUBLISHERS GROUP
DORDRECHT/BOSTON/LANCASTER/TOKYO
Library or Congress Cataloging-in-Publication Data
Anthropology and epidemiology.
(Culture, illness, and healing)
Includes bibliographies and indexes.
1. Medical anthropology. 2. Anthropology,
Cultural. 3. Epidemiology. I. Janes, Craig R. (Craig
Robert), 1953- II. Stall, Ron, 1954- . III.
Gifford, Sandra M. IV. Series. [DNLM: 1. Anthro
pology, Cultural. 2. Epidemiology. W A 105 A628)
GN296.A55 1986 306'.46 86-20434
ISBN-13: 978-90-277-2249-2 e-ISBN-13: 978-94-009-3723-9
DOl: 10.1007/978-94-009-3723-9
Published by D. Reidel Publishing Company,
P.O. Box 17,3300 AA Dordrecht, Holland.
Sold and distributed in the U.S.A. and Canada
by K1uwer Academic Publishers,
101 Philip Drive, Assinippi Park, Norwell, MA 02061, U.S.A.
In all other countries, sold and distributed
by K1uwer Academic Publishers Group,
P.O. Box 322, 3300 AH Dordrecht, Holland.
2-0987 -300 ts
All Rights Reserved
© 1986 by D. Reidel Publishing Company
and copyrightholders as specified on appropriate pages within.
No part of the material protected by this copyright notice may be reproduced or
utilized in any form or by any means, electronic or mechanical,
including photocopying, recording or by any information storage and
retrieval system, without written permission from the copyright owner
TABLE OF CONTENTS
PREFACE Vll
SECTION I: HISTORICAL AND THEORETICAL
PERSPECTIVES
FREDERICK L. DUNN and CRAIG R. JANES / Introduction:
Medical Anthropology and Epidemiology 3
JAMES TROSTLE / Early Work in Anthropology and Epidemiology:
From Social Medicine to the Germ Theory, 1840 to 1920 35
JAMES TROSTLE / Anthropology and Epidemiology in the Twen-
tieth Century: A Selective History of Collaborative Projects and
Theoretical Affinities, 1920 to 1970 59
SECTION II: INFECTIOUS DISEASES
MARIL YN K. NATIONS / Epidemiological Research on Infectious
Disease: Quantitative Rigor or Rigormortis? Insights From Eth-
nomedicine 97
PETER KUNST ADTER / Ethnicity, Ecology, and Mortality Transi-
tions in Northwestern Thailand 125
E. MICHAEL GORMAN / The AIDS Epidemic in San Francisco:
Epidemiological and Anthropological Perspectives 157
SECTION III: NON -INFECTIOUS DISEASES
CRAIG R. JANES / Migration and Hypertension: An Ethnography of
Disease Risk in an Urban Samoan Community 175
SANDRA M. GIFFORD / The Meaning of Lumps: A Case Study of
the Ambiguities of Risk 213
SECTION IV: PSYCHO-SOCIAL CONDITIONS
JOHN D. O'NEIL / Colonial Stress in the Canadian Arctic: An
Ethnography of Young Adults Changing 249
RON STALL / Respondent-Identified Reasons for Change and
Stability in Alcohol Consumption as a Concomitant of the Aging
Process 275
v
vi TABLE OF CONTENTS
ROBERT A. RUBINSTEIN and JANET D. PERLOFF / Identifying
Psychosocial Disorders in Children: On Integrating Epidemiologi-
cal and Anthropological Understandings 303
LIST OF CONTRIBUTORS 333
INDEX OF NAMES 335
INDEX OF SUBJECTS 341
PREFACE
Over the past two decades increasing interest has emerged in the contribu
tions that the social sciences might make to the epidemiological study of
patterns of health and disease. Several reasons can be cited for this increasing
interest. Primary among these has been the rise of the chronic, non-infectious
diseases as important causes of morbidity and mortality within Western
populations during the 20th century. Generally speaking, the chronic, non
infectious diseases are strongly influenced by lifestyle variables, which are
themselves strongly influenced by social and cultural forces. The under
standing of the effects of the behavioral factors in, say, hypertension, thus
requires an understanding of the social and cultural factors which encourage
obesity, a sedentary lifestyle, non-compliance with anti-hypertensive medica
tions (or other prescribed regimens), and stress. Equally, there is a growing
awareness that considerations of human behavior and its social and cultural
determinants are important for understanding the distribution and control of
infectious diseases. Related to this expansion of epidemiologic interest into
the behavioral realm 'has been the development of etiological models which
focus on the psychological, biological and socio-cultural characteristics of
hosts, rather than exclusive concern with exposure to a particular agent or
even behavioral risk. Also during this period advances in statistical and
computing techniques have made accessible the ready testing of multivariate
causal models, and so have encouraged the measurement of the effects of
social and cultural factors on disease occurrence. Finally, (perhaps in partial
response to the previous reasons) the disciplines of epidemiology and
anthropology have undergone a parallel evolution. Epidemiologists have
been forced to define and measure complex social processes hypothesized to
impact on health and disease states. Anthropologists, on the other hand, have
become increasingly interested in the potential contributions of their disci
pline to resolve the day-to-day problems of specific populations, and
especially so within the realms of disease occurrence and medical care. These
convergent interests have created the opportunity for mutually beneficial
cross-disciplinary pollination.
The original idea behind this book can be said to have been formed, in
large part, in conversations between epidemiologists and medical anthro
pologists interested in the effects of social and cultural variables on health.
This volume has benefited most particularly from the experience of
researchers in the Department of Epidemiology and International Health
and Medical Anthropology Program of the University of California, San
Francisco, and in the School of Public Health of the University of California,
Vll
Craig R. Janes el al. (eds.). Anthropology and Epidemiology. vii-viii.
© 1986 by D. Reidel Publishing Company.
Vlll PREFACE
Berkeley. Acting on a growing interest on these two campuses, particularly,
among medical anthropologists either training or working in epidemiology,
Sandra Gifford and Ron Stall organized a session for the 1983 meetings of
the American Anthropological Association. Most of the contributors to the
book presented papers at this session or acted as discussants. The interest
attracted by the symposium and the lively discussion that followed the
presentation of papers convinced us of the need for this book. It became
clear that the idea of combining or integrating medical anthropology and
epidemiology represented an area of recognized potential.
Anthropology and epidemiology are multifaceted disciplines that claim a
diverse population of practitioners, teachers, and writers. There is thus no
single integrative model that embodies the many strengths of the two fields. It
is not simply a matter of applying anthropological techniques or theories to
understanding disease and disorder; a wide range of possible research
alternatives exists - from enlivening epidemiological data with ethnographic
detail to direct involvement by anthropologists in epidemiological research.
In this book we have endeavored to collect articles that represent several
analytic approaches to the concurrent use of anthropology and epidemiology
in the study of a variety of diseases and disorders. Other diseases, different
approaches, and varying integrative models exist; we hope they are explored
in subsequent publications. If the directions signaled by these diverse
contributions illuminate paths for future research, and invite further discus
sion and debate in the disciplines touched by anthropology and epidemiol
ogy, we will feel our purpose in undertaking this project ~as achieved.
Following our basic agenda to provide a sampling of research that draws
on various integrative models of anthropology and epidemiology, we have
structured the book according to major disease categories, and within these
broad categories case studies of particular places and peoples that range
from indigenous cultures of the Third or Fourth Worlds, to contemporary,
white, urban-American subcultures. We set the scene for these case studies in
Section I with a series of theoretical and historical essays that examine the
logic and historical underpinnings of interdisciplinary collaboration. Section
II offers three case studies of anthropological contributions to the study of
infectious disease. Section III presents two anthropological perspectives on
the major non-infectious conditions of cardiovascular disease and breast
cancer. Section IV considers the applicability of social science models and
methods in the case of three classes of mental health "disorders" - suicide,
alcohol problems, and hyperactivity in children.
Readers will note that the contributions of anthropology in this volume
are predominantly sociall cultural in nature. In addressing our many goals in
constructing this book, we were unable to give to physicallbiological
anthropology the justice it is due for its many contributions to human
paleoepidemiology, genetic epidemiology, and human ecology. In partial
defense of this omission, we feel that because the integration of epidemiology
PREFACE ix
and social/cultural anthropology has remained most problematic, one goal
has been to encourage cross-disciplinary dialogue in this area. We hope that
as interest in the potential for collaboration grows, future volumes will
appear that contain contributions from other sub-fields of anthropology as
well.
This volume was not conceived of as a primer in either epidemiology or
anthropology. Many excellent introductory texts and collections exist. In the
field of epidemiology we refer the reader to the introductory texts by
Abraham and David Lilienfeld, Foundations of Epidemiology, 2nd ed., New
York: Oxford University Press, 1980; and Judith Mausner and Anita
Kramer, Epidemiology - An Introductory Text, Philadelphia: W. B. Saunders
Company, 1985. For readers unfamiliar with epidemiologic concepts and
terminology, we suggest a concise dictionary by John Last, A Dictionary of
Epidemiology, New York: John Wiley and Sons, 1978. For readers
unfamiliar with anthropology, specifically medical anthropology, we suggest
perusal of the following texts: George Foster and Barbara Anderson, Medical
Anthropology, New York: Wiley, 1978; Lorna G. Moore, et aI., The
Biocultural Basis of Health: Expanding Views of Medical Anthropology, St.
Louis, Missouri: Mosby, 1980; and Ann McElroy and Patricia Townsend,
Medical Anthropology: An Ecological Perspective, North Scituate, Massachu
setts: Duxbury, 1979. For those interested in case sWdies of the relationship
between anthropology and public health, the following remains a classic
reference: Benjamin Paul (ed.), Health, Culture, and Community, New York:
Russell Sage Foundation, 1955. For more advanced reading in medical
anthropology, the series Culture, Illness, and Healing, edited by Arthur
Kleinman and published by the D. Reidel Company, is recommended.
This volume is the result of much hard work by many people. We would
first like to thank the contributors for faithfully sending us their drafts and
coping with our particular brand of "committee" editorship. Second, we
would like to thank the many organizations that provided us with the
necessary support .to attend to the duties of editing. These include the
Medical Anthropology Program of the University of California, San
Francisco; the Alcohol Research Group of the Medical Research Institute,
San Francisco, California; the Prevention Research Center of Berkeley,
California; and the World Health Organization Centre (Region 8) For
Diabetes Education and Control, Caulfield, Australia. We gratefully
acknowledge the diligent labors of Cathy Wasserman in indexing the volume,
and we thank Martin Scrivener of D. Reidel and the former series editor,
Arthur Kleinman, for their assistance in bringing this book to publication.
June 20,1986 SANDRA M. GIFFORD
CRAIG R. JANES
RON STALL
SECTION I
HISTORICAL AND THEORETICAL
PERSPECTIVES
Description:Over the past two decades increasing interest has emerged in the contribu tions that the social sciences might make to the epidemiological study of patterns of health and disease. Several reasons can be cited for this increasing interest. Primary among these has been the rise of the chronic, non-i
