Anthropology, Inequality, and Disease: A Review

Abstract

▪ Abstract Anthropological approaches broaden and deepen our understanding of the finding that high levels of socioeconomic inequality correlate with worsened health outcomes across an entire society. Social scientists have debated whether such societies are unhealthy because of diminished social cohesion, psychobiological pathways, or the material environment. Anthropologists have questioned these mechanisms, emphasizing that fine-grained ethnographic studies reveal that social cohesion is locally and historically produced; psychobiological pathways involve complex, longitudinal biosocial dynamics suggesting causation cannot be viewed in purely biological terms; and material factors in health care need to be firmly situated within a broad geopolitical analysis. As a result, anthropological scholarship argues that this finding should be understood within a theoretical framework that avoids the pitfalls of methodological individualism, assumed universalism, and unidirectional causation. Rather, affliction must be understood as the embodiment of social hierarchy, a form of violence that for modern bodies is increasingly sublimated into differential disease rates and can be measured in terms of variances in morbidity and mortality between social groups. Ethnographies on the terrain of this neoliberal global health economy suggest that the violence of this inequality will continue to spiral as the exclusion of poorer societies from the global economy worsens their health—an illness poverty trap that, with few exceptions, has been greeted by a culture of indifference that is the hallmark of situations of extreme violence and terror. Studies of biocommodities and biomarkets index the processes by which those who are less well off trade in their long-term health for short-term gain, to the benefit of the long-term health of better-off individuals. Paradoxically, new biomedical technologies have served to heighten the commodification of the body, driving this trade in biological futures as well as organs and body parts.

Undocumented immigrants and their use of medical services in Orange County, California

“…Of particular concern has been the importance of the structural factors, especially inequality, influencing im/migrant healthseeking behavior (Dressler, 2010;Farmer, 2003;Nguyen & Peschard, 2003) and transnational public health problems (Collins-Dogrul, 2006). Ruiz-Casares et al (2010) suggest a research approach that engages the macrolevel (laws and practices established by states) when examining immigrant health-related practices, particularly during periods of hardening immigrant policies.…”

Identité, pratiques et territoire

“…À ce sujet, les analyses anthropologiques indiquent que les notions de santé et de maladie sont déterminées par la place symbolique que le corps occupe au sein de l'espace social (Fassin, 1996) défini par la culture dominante, à la fois celle des institutions d'État, de la collectivité et de la famille. Sur ce plan, les rapports entre les domaines social, économique, culturel et biologique (Bourdieu, 1980;Black, 1988;Wilkinson, 1996;Fassin, 1996;Nguyen et Peschard, 2003, Bibeau, 2004) semblent tisser ensemble le canevas de la santé humaine où la maladie est conçue comme l'expression d'un déséquilibre entre le microcosme de l'individu et le macrocosme de l'ordre social (Lock, 2002). À ce sujet, la ruralité est un terrain propice pour expliquer le concept des « biologies locales », lequel « éclaire en partie l'expérience incarnée, c'est-à-dire l'expérience des sensations physiques, notamment celle du bien-être, de la santé, de la maladie et qu'elles impliquent en réalité le corps matériel, mais que ce corps dépend lui-même de facteurs évolutifs, environnementaux, et autres » (Lock, 2005, p. 452).…”

<b>Necessidades, práticas e apoio social: dimensões subjetivas dos determinantes sociais de saúde</b>

“…Nesse sentido, a importância de incorporar as dimensões subjetivas para qualificar as desigualdades sociais está na compreensão de que o apoio social colabora no enfrentamento dessas disparidades (Nguyen et al 2003). As autoras consideram que o apoio social é produzido local e historicamente, revelando-se como um importante fator no enfrentamento de situações de adoecimento, as quais não se restringem apenas ao campo biológico e material.…”