midterm review

Question 1

, identify the three central features of anthropology. What is a central concept of anthropology?

Answer 1

o	Comparative (cross cult), evolutionary (change over time), holistic (multifaceted) 
culture as central concept

Question 2

• Briefly describe medical anthropology and how the central features of anthropological perspective may be applied to health and healing.

Answer 2

o Medical anthropology - the study of health, illness, healthcare, and related topics from a broad anthropological perspective.
o Central features applied – biocultural perspective – interaction of social, historical, ecological, and biological aspects applied to health issues – holistic, considers broadest range of factors to ascertain which are most significant contributors to variation in health

Question 3

how may medical anthropologists explore “emic” and “etic” perspectives (associated with participant-observation)?

Answer 3

 Emic – the insiders view from members of the society– an account of how a member of the group would describe or interpret the behavior of group members
 Etic – viewpoint of an outsider – viewing behavior from a distance with no prior knowledge of its emic meaning
 Explored through definitions of health

Question 4

 Briefly sum up the example using medical anthropologist Naomi Adelson and her work with the Cree.

Answer 4

 Worked with cree of norther Canada and described how they used the term being alive well to describe health

 term refers to protection from cold, physical activity, eating distinctively cree bush foods (from hunting-gathering)

 references the quality of the land that provides them with food, histoey, and social relations that supported their livelihoods as hunters

 difficult to achieve in context of colonization – etic description of cree health includes BMI, cholesterol, or hypertension

 emic perspective would be “being alive well”

Question 5

• Describe how a holistic perspective can be applied to health and disease (i.e., sum up some of the ideas from the class discussion).

Answer 5

o A holistic perspective on health and disease involves considering various aspects that impact health and disease. This could be age, history, the body, the environment, religion, sexuality, nutrition, economics, etc.
o

Question 6

• What three cultural studies are considered by Foster (1978) to form the roots of medical anthropology

Answer 6

• 1. The study of primitive medicine – witchcraft and magic
• 2. Studies of personality and mental health in diverse cultural settings
• 3. Applied studies in international public health and planned community change programs
•

Question 7

• Outline the development of medical anthropology

Answer 7

Post WWII – anthropologists are hired to generate data about health and nutrition – to ascertain fitness of americans + address wretched health conditions
o Creation of WHO in 1948 – anthrpologists hired to address cultural barriers to health promotion – dispel prevailing view that resistance to biomedical interventions was due to stubbornness, ignorance, or superstition

Question 8

• Briefly describe the biocultural perspective. What is the biocultural synthesis and what is it trying to address?

Answer 8

• considers the social, ecological, and biological aspects of health issues and how they interact within and across populations. It is a uniquely anthropological and holistic view of health
• individual as starting point then branch out holistically
• biocultural synthesis – wenner gren symposium – biology and culture are dialectically intertwined – addresses the “physical-cultural” DIVIDE - ie social and physical are connected

Question 9

• Briefly describe disease, illness, and sickness. Are these concepts understood the same way cross-culturally?

Answer 9

o disease – physiological alteration that impares function
o illness – the subjective experience of symptoms and suffering
o sickness- equated with disease, illness or both. Sociological meaning through the sick role.
o Sick role: socially recognized set of expectations for “sick” individuals.
o differ cross culturally

Question 10

• Briefly describe the three bodies: the individual body, the social body, and the body politic.

Answer 10

o The individual body: lived experience of the body-self (health as somatic; separation of mind v body) – the locus of disease
o Social body: presenting ideas through our body – the seam between physical body and social world of the individual - e.g. reflection of society – society with inequality can harm health vs harmonious society can improve health
o Body politic- the way social and political forces regulate and exert control over individual bodies

Question 11

what is meant by medicalization? How may it relate to the three bodies?

Answer 11

 Medicalization refers to the defining of a condition as a disease or in need of medical surveillance – occurs in situations where medicine and medical practitioners have social and cultural authority or when there is resistance to seeing health as closely tied to social conditions
 Ex. Medicalization of pregnancy and childbirth
 Can lead to inappropriate treatments as the focus is on biomedical treatment rather than social policies to prevent the condition – the three bodies are not all being considered when medicalization occurs

Question 12

o Distinguish between proximate and ultimate causes of disease. How do biomedical and biocultural perspectives differ in relation to these different causes of disease?

Answer 12

o Proximate cause of disease – the intermediate cause of some physiological disruption
o Ultimate – distant cause – the “why” – what factors contributed or put the individual at risk etc
 Can also be supernatural in some local definitions – the biocultural interpretations can differ from the biomedical

Question 13

• As discussed in the text and in class, what is meant (or not meant) by biological normalcy? How may it relate to health and disease? How may a body be deemed “abnormal”?

Answer 13

o The ways in which the statistical distributions of biological traits in a population, are related to normative views about what bodies should be like.
o Ideas about what is normal are often related to health
o

Question 14

 If there is a mismatch between a population’s genetic characteristics and the environment, what are we likely to see higher rates of?

Answer 14

• Morbidity and mortality

Question 15

 Is genetic adaptation the only way humans adapt to an environment? What is adaptability?

Answer 15

• No, there is also physiological plasticity / adaptability: shorter term, nonheritable changes that occur in individuals when they are confronted with immediate challenges to survival

Question 16

 What is meant by behavioural adaptability? How may behavioural adaptations create new challenges (i.e., consequences for health)?

Answer 16

• Cultural traditions may function as adaptability responses because groups have been exposed to different threats to their health over time as a result of their different historical and ecological circumstances
• barriers to transmission of behaviors: those strongly linked to a specific cultural or religious tradition are less likely to be transferred in the absence of migration, war, colonization, or proselytizing

Question 17

 Briefly describe how opportunities for adaptation may be severely constrained in the context of poverty.

Answer 17

• All adaptive responses require resources – if they are not available, the ability to adapt can be seriously compromised and lead to a downward spiral of health
• Impoverished living conditions generate multiple stressors that challenge health and well being
• Poverty is a root cause of health disparities – wealthier individuals have more resources = better for health
•

Question 18

o What is the focus of the political economy of health? What is it also referred to as?

Answer 18

 Power differentials and their impact on health

 Critical medical anth

Question 19

 What does Paul Farmer mean by “structural violence”? From this perspective, what is the only lasting solution to health differentials?

Answer 19

• How the social machinery of oppression is embodied in adverse health outcomes and needless suffering among the poor or victims of racism, sexism, or all of the above
• The only lasting solution is changes to the social, cultural, economic, and political structures that support or maintain differential access to resources within and between populations

Question 20

o Outline the common elements found in various ethnomedical systems.

Answer 20

 Theories of etiology (disease causation), diagnostic criteria, therapeutic measuresm formalized interactions between patients and healers, and mechanisms for training new healers

Question 21

 What is meant by the view that healing systems have become “pluralistic” (i.e., medical pluralism) in practice?

Answer 21

• The elements of one healing tradition may be incorporated into another or that individuals in a society may seek out healers from various traditions in their quest for health

Question 22

o Briefly describe interpretive approaches to illness and suffering.

Answer 22

 Anthropologists must fully understand (through long term ethnographic fieldwork) the role that various behaviors play be considered in the context of the worldview of individuals, which is itself related to historical, ecological, political, economic, and myriad of other factors - It becomes possible to see illness as the embodiment of an individual’s role within that culture.

Question 23

 Describe an example of a cultural syndrome (also referred to as “culture bound syndromes”; see also pp. 363-368 in the text for examples).

Answer 23

• Cultural syndromes: clusters of symptoms that are recognized as illness in one society but not necessarily in another
• Example: tensan in india: shares symptoms w clinical depression and anxiety but does not correspond with either and is often associated with difficult family relationships

Question 24

o Briefly describe applied medical anthropology.

Answer 24

 Applying the principles and ethnographic knowledge from anthropological scholarship to design or implement health policies

Question 25

o Define epidemiology. Is epidemiology only interested in infectious diseases?

Answer 25

 The study of the distribution of disease in a population

 Concerned with all diseases

Question 26

describe cosmopolitan medicine

Answer 26

Biomedicine or scientific, modern, western medicine

Stresses the value of technology, control over environment, and hierarchical healing roles

Supports control of disease through surgery, drugs, public health measures, and medical research

Question 27

describe humoral medicine

Answer 27

Derived from the philosophy of balance among fundamental qualities of nature

To deal with sickness, restore the body’s equilibrium: hot/cold, wet/dry

Roots in Hippocratic 4 humors: blood, phlegm, black bile, yellow bile

Question 28

o In terms of healer-patient relationships, how does one become a healer? Sum up a couple of examples (pp.49-53 in the text).

Answer 28

Most cultures recognize healers as belonging to a special vocational
or spiritual class (Figure 3.3). How someone becomes a healer varies
both within and across cultures. A common theme, given the
spiritualist nature of the healer role in many cultures, is that some
sort of divination is involved. Evidence of enhanced spiritual
qualities reinforces the healer as belonging to a class apart from the general population
 E.g., visitation during a dream among the Mayan Zinacanteco
 E.g., the 7th son or daughter in African American communities

Question 29

 Distinguish between social authority and cultural authority. What may be the result for a healing system if both are strong?

Answer 29

• Social authority: the ability to bring about the desired behavior in another person
• Cultural authority: the domain of knowledge & values
• If both are strong the healing system may eliminate other competing systems
•

Question 30

what are explanatory models? how can it be helpful?

Answer 30

• Different groups of people interpret causes of disease & treatment of illness differently
○ E.g., children’s illness narratives
Understanding explanatory models can reveal how people’s behaviour makes sense in a particular socio-cultural context
• May improve communication between patients & healers

Question 31

three theories to explain illness?

Answer 31

personalistic disease theory, naturalistic disease theory, emotionalistic disease theory

Question 32

describe personalistic disease theory

Answer 32

illness is due to the action of a supernatural agent

Question 33

describe emotionalistic disease theory

Answer 33

illness is due to a negative emotional experience

Question 34

describe naturalistic disease theory

Answer 34

illness is due to an impersonal factor (e.g. pathogen)

Question 35

describe the biomedicine view /biological causation

Answer 35

• Biologically based, positivistic scientific worldview
• Observable and verifiable
• Developed in a particular place (europe)
• In a particular time (18th century)
• Biological causes of ill health
• Empirically based view of natural phenomenon

Question 36

describe traditional medical systems / supernatural causation

Answer 36

• Wide range of practices/worldviews
• Developed in diverse cultural settings and ecological contexts
• e.g. ayurveda or navajo medicine
• Supernatural causes of ill health
• Supernatural agency - spirit or curse- as cause of disease
• Nocebo effect - “hmong sudden death”

Question 37

why is the “biological versus supernatural” dividing line seen as “obviously simplistic”?

Answer 37

• Obviously simplistic because - if we consider biomedicine a cultural system that has derived from a particular way
of knowing (a positivist scientific biology based on the observable
and verifiable) that developed in a particular place (Europe) at a
particular time (the end of the eighteenth century).

traditional medical systems encompass a wide range of practices that
have developed in multiple diverse cultural settings and ecological
contexts. Many do emphasize supernatural causality, but that does
not mean that they do not rely on the accumulation of scientific
knowledge and experience over generations.

Question 38

, what is the nocebo effect?

Answer 38

• A situation in which a patient develops side effects or symptoms that can occur with a drug or other therapy just because the patient believes they may occur.

Question 39

what are the three theoretical approaches to health systems?

Answer 39

interpretivist approach, critical medical anthropology, ecological/epidemiological approach

Question 40

describe the interpretivist approach to health systems

Answer 40

xplores how illness is defined and experienced

assumption: the healing system provides meaning for suffering

Question 41

describe the critical medical anthropology approach to health systems

Answer 41

examine how health systems are impacted by structural elements

Question 42

describe the ecological/epidemiological approach

Answer 42

focus on the interaction of the natural environment and culture in disease causation and spread (public health data

Question 43

describe the biomedicine approach to the body and healing

Answer 43

Emphasis on the individual and individual compliance
• Focus on the body and human pathophysiology
• Mechanistic view - treating sickness and disease, not always the patient
• Curing over prevention
• Pharmaceutical - pill as symbolic

Question 44

describe traditional chinese medicine approach

Answer 44

Traditional Chinese medicine

• Focus on balance
  
  • Holistic view
  • Human body as interrelated and interconnected with environment
• Involves herbal remedies, acupuncture, massage
  
  • Alternative medicine
  • Ethnopharmacology

Question 45

 What is ethnopharmacology?

Answer 45

• Ethnopharmacology is the study of indigenous medicines (almost always plant derived, hence the close relation of the field to ethnobotany), their use in their cultural contexts, and their possible applications in biomedicine

Question 46

• With respect to general dietary trends, what is the most relevant environment of evolutionary adaptation (EEA)? Briefly describe hunter-gatherer diets

Answer 46

o The most relevant EEA is the Upper Paleolithic, when humans were biologically “modern” and lived as hunter-gatherers
- were rich in meat and
light in seeds/grains or legumes and dairy beyond weaning.

Question 47

o Diets in wealthy countries deviate substantially from “hunter-gatherer” diets. What is this considered to lead to?

Answer 47

 Higher risk of chronic illnesses
 Chronic diseases such as cardiovascular disease (CVD), diabetes and cancer typically cause morbidity and mortality later in life

Question 48

o What do evolution-based diet books advocate? What assumptions are these diets predicated on? How do people try to recreate the paleolithic lifestyle?

Answer 48

 Large quantities of meat, fruits, veggies.
 Fasting for long periods of time, physical activity
 No bread or dairy
 predicated on certain assumptions about human ancestral diets, often that they were rich in meat and light in seeds/grains or legumes and dairy beyond weaning

Question 49

o How do we assess health and disease in the human past (using skeletal and dental remains)? What is the osteological paradox?

Answer 49

 • Harris lines – horizontal bands on long bones – indicate growth stoppage due to infection, undernutrition, or stress
• Enamel hypoplasia – bands of thin enamel in teeth. Placement indicates what age growth disruption occurred
• Porotic hyperostosis – indicator of anemia
• C3 vs c4 in bones
• Nitrogen isotopes
• Cavities

Osteology paradox – without knowledge of population size, increases in skeletal pathologies cannot necessarily be attributed to worsening health overall
•

Question 50

• What is lactase persistence? What attribute do all populations with high rates of lactase persistence share? What would this suggest?

Answer 50

o Lactase persistence – enzyme lactase is not shut off after weaning
o All share a deep history of keeping domestic animals (cows, goats, sheep, water buffalo) for milk

Question 51

o Although there would have been nutritional advantages with lactase persistence, is there evidence that populations that kept animals are better nourished? Outline the three other hypotheses for the spread of lactase persistent alleles in dairying populations.

Answer 51

 there is little evidence that populations that
kept dairy animals were better nourished
1. Provides lifelong access to an important carbohydrate and fluid source
 2. Lactose can aid in calcium absorption, avoiding vitamin D deficiency
 3. Drinking mammalian milk may accelerate reproductive maturation or physical growth

Question 52

o Briefly describe how the inclusion of milk in dietary guidelines (e.g., food guides) illustrates ideas around biological “normalcy”.

Answer 52

 In countries like the US where most of the population has European ancestry, the consumption of milk being normal is indicative of biological normalcy – lactase persistence (their physiology) is considered normal. In reality, lactase persistence is a mutation that our European ancestors developed.

Question 53

• What is celiac disease? When individuals with CD consume foods with gluten, how do their immune systems respond? Which populations is CD most prevalent in? Briefly describe the “evolutionary paradox of CD”.

Answer 53

o Celiac disease is an immunologically mediated sensitivity to gluten found in wheat, rye, and barley
o When gluten is consumed, the immune system damages the villi that line the small intestine in response. These villi are responsible for nutrient absorption
Highest in North Africa and north Europe
Paradox- CD is most prevalent in pops with long histories of wheat consumption

Question 54

, what is the “nutrition transition”? Outline the essential nutritional trends that Popkin described in his fourth pattern (i.e., “the nutrition transition”).

Answer 54

o The combination of overconsumption with less physical activity contributes to obesity and diabetes, which in turn are also risk factors for CVD and premature mortality

Question 55

• Obesity is an issue of global proportions. What is the “double burden” of malnutrition?

Answer 55

o Obesity prevalence is rising in many developing countries, where it often coexists with undernutrition, the so-called “double burden” of malnutrition

Question 56

o Are all obese bodies at risk? Explain. What may change mortality risk? What is the “thin-fat phenotype”? Are thinness and fatness solely biological categories?

Answer 56

o Not all obese bodies are at risk (ie fat patterning)
o Some people with obesity are metabolically healthy
o Both high and low bmi associated with risk
o Mortality risk changes by age and differs by gender
o in India, higher levels of fatness are seen at lower BMIs, resulting in what has been termed the “thin-fat” phenotype. Different countries and regional bodies set the cutoffs for normal, overweight, and obesity at different points.
o standards for body size change over time as a function of cultural trends and scientific understandings
o

Question 57

• What are the two major types of diabetes? Briefly describe Neel’s “thrifty genotype” hypothesis. Is everyone eating a calorie-rich diet equally likely to develop NIDDM?

Answer 57

o Type I: the problem derives from reduced insulin production and release by the pancreas
o Type II: results when the cells that are the targets of insulin (fat or muscle cells) become resistant to it, requiring more and more insulin to stimulate those cells to take up glucose
o Thrifty genotype: our hunter-gatherer ancestors experienced alternating periods of food abundance and food scarcity. Those with a quick insulin trigger (quickly released a large quantity of insulin in the presence of glucose in the blood stream), would have had a fitness advantage
o Not everyone eating a calory-rich diet is likely to develop NIDDM (type 2- non insulin dependent diabetes), some populations are more susceptible than others. Ex: Native Americans have high NIDDM and obesity.

Question 58

, the Akimel O’odham (formerly known as the Pima) have some of the highest rates of diabetes in the world. What does Smith-Morris argue effective prevention and treatment of diabetes among the Akimel O’odham must include?

Answer 58

 Effective prevention and treatment of diabetes must incorporate political-economic, cultural, genetic, and biological factors. The major proximate contributors to NIDDM risk derive from diet and activity patterns

Question 59

o Europeans appear to have lower rates of diabetes than other populations. Briefly sum up the argument linking an abundance of milk in northern European diets with lower diabetes rates.

Answer 59

 Individuals who had a thrifty genotype and who drank a lot of milk would have likely developed diabetes early in life and suffered higher rates of mortality at an earlier age because milk stimulates a rise in blood insulin, so thrifty genotypes could have been eliminated from the population.

Question 60

o Briefly describe the “thrifty phenotype” hypothesis. What is this hypothesis also referred to as?

Answer 60

 Also known as Developmental Origins of Health and Disease Hypothesis
 Exposure to nutrient scarcity during the fetal and infant stages of development result in metabolic programming for thriftiness
 If the environment is characterized by nutrient scarcity, the developing body makes a prediction that future conditions will be similar and alters its trajectory accordingly by developing more thrify mechanisms for nutrient uptake, retention, and metabolism

Question 61

• In terms of life history theory, what are the two fundamental constraints that organisms face? What are the two main “tasks”?

Answer 61

o Time and energy are the two main constraints

o The two main tasks are 1. Growth and maturation, and 2. reproduction

Question 62

o What influences the human life history process? What are the key predictors of the amount of resources an individual can access? Briefly describe the socio-cultural norms that may impact life history variation.

Answer 62

 Sociocultural phenomena
 Economic conditions are the key predictors of number of resources – wealthier people can grow larger and have more offspring
 Norms about childhood feeding, food taboos, restrictions placed on pregnant women, gender biases, appropriate time for marriage and reproduction, birth spacing, contraceptive use.


Question 63

• What is the commonly used measure of a newborn’s health status? Briefly sum up what can influence birth size. What do low birth weights among African Americans likely reflect?

Answer 63

o Birth weight is used to measure a newborn’s health status.
o Birth weight is influenced by maternal age, parity (how many previous births she has had), nutritional status (both current dietary behavior and weight, height, or fatness), infectious disease, smoking, altitude of residence, and sex and gestational age of the newborn.
-kely reflect ongoing structural
violence and racism that are embodied via maternal stress and other
pathways

Question 64

o Where are populations with the highest birthweights reported? Where are populations with the lowest birthweights reported? Briefly outline factors contributing to the high frequency of low-birth-weight babies in Indian and Pakistan.

Answer 64

 Populations with the highest average birth weights reported are in wealthy countries and the lowest are in South Asian countries.
 factors contributing to the high frequency of low-birth weight babies are young maternal ages (because girls are frequently married during adolescence), maternal stunting, undernutrition, including high rates of anemia, continued subsistence work during pregnancy, and constraints on prenatal care usage

Question 65

• The WHO recommends exclusive breastfeeding for 6 months. Outline the reasons for early weaning.

Answer 65

o maternal return to the workforce, lack of information on how to breastfeed successfully, lack of social support for breastfeeding, and easy availability and widespread promotion of infant formula

Question 66

why is breastfeeding recommended?

Answer 66

o Breast milk is tailored to the growth needs of infants. It has key nutrients: sugar, fat, protein. Hormones, antibodies that protect from infections.

Question 67

o There is a wealth of evidence supporting the benefits of breastfeeding. What has been seen as one reason for the global declines in breastfeeding rates? Briefly describe the concerns with baby formula in developing countries.

Answer 67

the 1960s and 1970s there were global declines in breastfeeding rates
that were attributed, in part, to aggressive marketing of formula to
pregnant women and new mothers
 Have to use water to mix baby formula, this can lead to infection if water is not clean.

Question 68

• What are the two main contributors to poor child growth? As discussed in the lecture, what are synergistic relationships? What is meant by the statement “height as the ‘biological standard of living’”?

Answer 68

o Under nutrition and infections are the two main contributors to poor growth.
o Synergistic relationships - A synergistic relationship occurs when two people create a greater contribution together than they would independently.

-The sensitivity of adult height to childhood living conditions has led to the use of height as a measure of the “biological standard of living”

Question 69

o Briefly sum up Bogin and colleagues’ work with Mayan children that revealed growth is extremely sensitive to social conditions.

Answer 69

 Guatemalan children (who were born in Guatemala) in the US had better health care, food, clean drinking water. The children living in Guatemala had irregular and unsafe drinking supply, no waste disposal, limited health care, and food scarcity. The children in the US were much taller and heavier than those in Guatemala.

Question 70

• Briefly describe the economist’s view of “small but healthy”. Sum up the three main criticisms of this view.

Answer 70

stunting as “adaptive” in resource scarce environments - ignores
underlying cause of growth deficits and the negative health consequences
1. Adaptations are not “good” but a trade-off between size and survival (developmental adaptation)
2. Assumes stunting is solely the effect of food shortage - ignores the synergistic relationship with infectious disease (especially diarrheal) and psychosocial stress
3. Why people live under such conditions not addressed

Question 71

• In terms of puberty and adolescence, what accelerates reproductive development? What can this lead to? What is the associated secular trend?

Answer 71

o Rapid growth accelerates reproductive development, leading to earlier puberty and age at menarche in girls. The secular trend is downward as there has been a decline in age at menarche from 16 years in the mid-nineteenth century to 12.5 years today in the US, Canada, and Europe.

Question 72

o What is considered to have shifted the age of menarche among the Bundi of highland New Guinea?

Answer 72

 The faster rate of decline was attributed to increased access to energy-rich foods and health care in both areas, but especially in the urban areas.

Question 73

o Do declines in the age of biological reproductive maturity match declines in the age of social maturity? What may this lead to?

Answer 73

 Declines in the age of biological reproductive maturity have not been matched by declines in the age of social maturity. Most jobs paying a wage require education beyond secondary school. This leads to high rates of sexually transmitted infections, teenage pregnancy, and psychological problems.

Question 74

3 ways to become Mayan healer

Answer 74

Visitation during dream from ancestral gods (3 dreams)

A potential healer is identified as such by an experienced healer

A person has seizures or epilepsy