Epidemiological Reflections of the Contribution of Anthropology to Public Health Policy and Practice

Abstract

The rise of science propelled man into tunnels of specialized knowledge. With every step forward in scientific knowledge, the less clearly he could see the world as a whole or his own self. (Milan Kundera, 1984, quoted in Lock & Scheper-Hughes, 1990 Summary. Academic disciplines like anthropology and epidemiology provide a niche for researchers to speak the same language, and to interrogate the assumptions that they use to investigate problems. How anthropological and epidemiological methods communicate and relate to each other affects the way public health policy is created but the philosophical underpinnings of each discipline makes this difficult. Anthropology is reflective, subjective and investigates complexity and the individual; epidemiology, in contrast, is objective and studies populations. Within epidemiological methods there is the utilitarian concept of potentially sacrificing the interests of the individual for the benefits of maximizing population welfare, whereas in anthropology the individual is always included. Other strengths of anthropology in the creation of public health policy include: its attention to complexity, questioning the familiar; helping with language and translation; reconfiguring boundaries to create novel frameworks; and being reflective. Public health requires research that is multi-, inter-and trans-disciplinary. To do this, there is a need for each discipline to respect the 'dignity of difference' between disciplines in order to help create appropriate and effective public health policy.

What 'outliers' tell us about missed opportunities for tuberculosis control: a cross-sectional study of patients in Mumbai, India

“…However, only a few community-based studies have explored the realities of patients who fail to access treatment through the national TB control programmes [22-24]. Identifying and highlighting the cases of 'outliers', i.e., individuals who 'just made it' into the programme - as opposed to discarding them from population based statistical profiles of a TB control programme - ensures that an analysis of missed opportunities is comprehensive and grounded in local level realities [25]. …”

Social, Historical and Cultural Dimensions of Tuberculosis

“…A dominant biomedical discourse regularly leaves public health policy swayed by statistics, but we can easily forget that statistics, just like medical labels, play into social and political frameworks. As epidemiologist John Porter (2006) writes, 'Certain disciplines currently hold more weight within public health discussions and in particular when discussing "evidence-based practice".' This article has attempted to bring key concepts from the social model to bear on the problem of TB in order to encourage more balanced discussions and a space for researchers to share a common vocabulary.…”

“…Barriers to diagnosis and treatment also include geographical challenges, economic difficulties, communication issues (Chemtob et al, 2000), fears of stigma (Nair et al, 1997;Coreil et al, 2010), unregulated private health care practices (Bhargava et al, 2011), non-adherence to treatment (Greene, 2004) and gender biases in health-seeking behaviour (Wang et al, 2008;Atre et al, 2009). Often left to operate at an intuitive level, perspectives from the humanities and social sciences contribute significantly to tackling the problem of TB by providing conceptual tools to pay attention to complexity, question the familiar, reconfigure boundaries to create novel frameworks and to critically examine assumptions, arguments and false reasoning (Porter, 2006).…”

Epidemiologists working together with anthropologists: lessons from a study to evaluate the epidemiological impact of a city-wide sanitation program

“…Despite its conceptual and methodological evolution over recent decades, however, modern epidemiology has been subject, mainly from social sciences, to a variety of criticisms, especially in relation to its capacity to make significant contributions towards understanding and solving the complex health problems of populations. As a possible solution to this theoretical and methodological inertia, some authors have proposed to advance on an interdisciplinary type of approach, through greater empirical proximity between epidemiologists and anthropologists 1,2 .…”

“…Some authors 1,2,3,4 have indicated studies with interdisciplinary or transdisciplinary approaches, or adopting multiple methods (triangulation), as a means of empirical approximation to comprehend complex questions.…”