Applying Anthropology in the Global Village

Christina Wasson, Mary Odell Butler, Jacqueline Copeland-Carson

• Publisher: Routledge
• Year: 2016
• ISBN:
  9781315434636
• Edition: 1
• Topic: Scienze sociali
• Subtopic: Antropologia

The realities of the globalized world have revolutionized traditional concepts of culture, community, and identity—so how do applied social scientists use complicated, fluid new ideas such as translocality and ethnoscape to solve pressing human problems? In this book, leading scholar/practitioners survey the development of different subfields over at least two decades, then offer concrete case studies to show how they have incorporated and refined new concepts and methods. After an introduction synthesizing anthropological practice, key theoretical concepts, and ethnographic methods, chapters examine the arenas of public health, community development, finance, technology, transportation, gender, environment, immigration, aging, and child welfare. An innovative guide to joining dynamic theoretical concepts with on-the-ground problem solving, this book will be of interest to practitioners from a wide range of disciplines who work on social change, as well as an excellent addition to graduate and undergraduate courses.

1 Global Localities and the Management of Infectious Disease

Mary Odell Butler

DOI: 10.4324/9781315434650-2

Introduction

The more I have worked with the issue of global influences in the context of public health—or in any other context for that matter—the less certain I have become about what it means to talk about culture in a global sense. Much of what I know has been brought into question by all this change. Yet, anthropology has met this challenge with innovative concepts and approaches to traditional notions of culture, aided in no small part by applied anthropologists who work with this change every day, on the ground.

In the twenty-first century, we are all challenged to examine our understandings of how people organize themselves and how they act under these changing conditions. A vast literature on globalization describes the many aspects of global change, including in markets and capital, increases in migration and return migration, the detachment of work from locality, global tourism, daily communication among people over the Internet and social media (see Appadurai 1996; Edelman and Haugerud 2005; Hannerz 1996; Inda and Rosaldo 2002; Lewellen 2002; Trouillot 1995). In this chapter, I focus explicitly on the increase in connectivity of communities across the globe as it affects the transmission and control of infectious diseases.

As it turns out, the spread of disease is one example of a much broader phenomenon. As I write this, the nations of the Mediterranean and the Middle East are witnessing uprisings by citizens against governments they perceive as oppressive. The rapid spread of the idea that people can be successful in resisting authoritarian control is a new kind of contagion, one that is spread by the flow of information over the Internet and social media. The world is now linked densely by streams of “capital, people, commodities, images, and ideologies,” which results in borders becoming “increasingly porous, allowing more and more peoples and cultures to be cast into intense and immediate contact with each other” (Inda and Rosaldo 2002:2). The proliferation of linkages among communities facilitates the flow of ideas, commodities, and information as well. As the connectedness of the world increases, people are increasingly living in complex, multilayered communities with individuals who are themselves embedded in multiple contexts that overlap and interlock in many ways.

The visions of the world from the perspectives of anthropologists and public health professionals are distinct from one another but, as we will see, they are also complementary. Seen through the anthropological lens, people live embedded in culture, a shared understanding they acquire as part of their experience living and interacting with other humans in families, kin groups, communities, and nations. Culture is not a static entity, but a complex matrix made up of multiple exposures of people to other people directly or indirectly through education, literature, and media. The culture that shapes human life is not necessarily explicit and articulated. It is the task of the anthropologist to untangle and explain culture in such a way that those who live it will recognize the anthropologist’s description as correct. Anthropologists do this by asking people to tell us how they perceive the world and then assembling the perspectives of many into a description. The unit of anthropological analysis is the community, usually but not always defined geographically.

This perspective differs from that of public health in significant ways. Public health is grounded in the idea that it is the job of government to protect the public health—the health of communities. This requires monitoring, service delivery, and the development of policies for disease prevention or control for people living in some kind of government jurisdiction. Public health is usually described by measuring something, be it disease incidence and prevalence, risk factor distribution, or behavior change. The usual unit of public health intervention is the individual living in a designated territory. People will accept public health interventions if they understand the rationale behind them. There is a vast literature on health behavior designed to predict how individuals will act in response to such interventions (see Bandura 1986, 2004; Green and Kreuter 1991; Guo et al. 2011; Prochaska and DiClemente 1983).

There is also common ground on which we can communicate and build. Both fields are concerned with the responses of communities of people to challenges, in this case from health, disease, environmental degradation, and exposures to dangerous substances. We both tend to think in terms of geographic jurisdictions as the unit of study or action, a concept that is under increasing pressure from the shifting nature of community due to global flows of people and diseases. We share an understanding of the role of policy and political power in determining what happens to people “on the ground.” And we both take an ethical stance that recognizes the respect due to the people with whom we work, the critical nature of informed consent in interventions, and the commitment to do no harm.

The case of collaboration between public health and anthropology in addressing global health issues illustrates the essential nature of interdisciplinary approaches to global problems. The academic disciplines in which we are educated do not change rapidly in response to changes in the larger world, yet the issues that we address in our professional lives will mutate many times in our careers. Professional education continues far beyond the university, especially for anthropological practitioners, and much of what we learn, we learn from colleagues and clients in other fields. To maintain our edge in responding to emerging problems, we must cultivate flexibility and an open mind to what we can learn from others. Work across disciplinary boundaries in response to complex problems of social change is synergistic. Entirely new approaches can result from such collaboration.

To illustrate the way practicing anthropologists develop these new approaches in response to change, I will talk about tuberculosis (TB). TB is a companion of migration. Thus it is the global health problem par excellence, one that requires a global solution. TB is one of those diseases all too often attributed to the cultural practices of sufferers that result in unhygienic living conditions, failure to take advantage of preventive health services, and refusal to seek and maintain timely treatment. The basic causes of TB do in fact lie in the conditions of poverty and inequality (Farmer 1999). However, the first key anthropological insight into TB is that it is not culture that is to blame; it is poverty. Few middle-class Americans will ever know someone who is infected with TB, at least until measures to control the disease among the poor and the displaced fail. The disease is painfully familiar to the poor of all countries who are at continuing high risk because of crowded housing, poor nutrition, lack of resources to detect and treat the disease, or absence of the political will to intervene.

How then do we understand where TB happens, to whom it happens, and how to intervene? I will consider public health measures to control tuberculosis in terms of global localities. Global localities are home to communities that embed people simultaneously in many contexts—local, regional, national, and international. They are far less dependent on geographic space than are the communities that anthropologists have traditionally studied. Global localities are not geographically continuous, but consist of people linked into communities across the earth by kinship, shared cultural experience, communication, migration, and travel. The lived experience of community is different at different times as people’s relationships to geography, culture, employment, and worldwide interconnection via the Internet and social media evolve. Linkages to the outside and to each other may be different for the young and the old in the same households, and yet the global locality is experienced by people as community, the cultural world in which they function.

In the sections that follow, I describe the global movements of infectious diseases and the public health models that have evolved to contain them based on my own observations of public health policy and practice over 20 years as an anthropologist working on the evaluation of public health programs. I call on a growing body of fairly contentious literature on what public health should look like as contact among people and their microorganisms intensifies, and draw from anthropological thinking about globalization to explore its implications for public health approaches to infectious disease. I look at the application and applicability of the public health model as it has been refined over the last century in one situation, the control of tuberculosis in the U.S.-Mexico border.¹ Finally, I discuss the role of anthropology and anthropological practitioners in addressing problems of public health in the global locality.

Public Health in a Global Context

Many of the afflictions of the twenty-first century are diseases for which proven medical interventions are available to ameliorate or eliminate adverse consequences of disease even for those living with poverty, malnutrition, poor housing, and neglect. What is missing are the political will, the health infrastructure, and the health policies needed to make remedies available to those who need them. As a result, the world’s poor, wherever they live, are dying of diseases that are almost unknown to most people in wealthier countries.

The movement of people and their diseases across localities and boundaries is a significant characteristic of the new global environment. Business, travel, tourism, urbanization, and international migration have not only moved us from one place to another but have facilitated the movement of infectious diseases in ways unprecedented in more sedentary times (Gushulak and McPherson 2007). Diseases that have spread with people into new places include HIV/AIDS, cholera, dengue fever, malaria, and tuberculosis (Morse 1995; Wilson 1995, 2010). The consequences of migration for infectious diseases are especially grave because migratory populations are often the poor, the sick, and the powerless displaced by economic conditions, national disasters, or wars (Carballo and Nerukar 2001; Farmer 1996, 1999; Ioannidi-Kapolou 2010). Modernization itself leads to changes in production and to ecological degradation that bring people into close contact both with microbes and each other. No one is safe. Today, infectious disease is concentrated in the poor and the disenfranchised population. Microbes are not constrained by boundaries and economic differences, however. Globalization has facilitated the spread of infectious diseases in ways that have yet to make their full consequences felt among the advantaged populations who usually make policy decisions that affect the health and welfare of the poor.

The global spread of infectious diseases is nothing new. Diseases have always accompanied people as they have moved across territory with trade, armies, and resettlement of human populations. Syphilis emerged in Europe in 1495, three years after Columbus first landed in the Americas and during a time of intensification of long-distance warfare in Europe and the Middle East. Opinion is still divided over whether syphilis was a new disease that emerged from previous illnesses caused by a closely related organism, whether it came from the Far East along trade routes, or whether it was “Montezuma’s Revenge” brought to Europe from the Americas (Quetel 1990:34–37). Regardless of its origin, it had catastrophic effects on the population of Europe. Similar stories can be told about many other diseases. Each time the world has experienced a dramatic increase in connectivity, infectious diseases have entered history as an unintended companion of new opportunities (Apostolopoulos and Sonmez 2010; Porter 1999; Zinsser 1934).

The present movement of infectious disease is different from those of the past in its scale and the speed with which epidemic disease moves across space. Unprecedented numbers of people routinely travel across international boundaries with the speed made possible by modern travel. The spread of the H1N1 virus is a case in point. Influenza (“flu”) is a respiratory disease of greater or lesser severity spread by an unstable, rapidly mutating set of viral strains with a marked ability to move from animal populations to humans. The flu with which we are most familiar is a seasonal variety concentrated during the winter months. However, flu is very unpredictable, so public health authorities maintain a high level of vigilance for new flu strains or strains newly appearing in human populations.

The current “novel” H1N1 virus was first detected in Mexico in mid-April 2009. By the beginning of May, the disease had been reported in 21 countries (in addition to Mexico and the United States) with a total of 1,882 probable or confirmed cases (Morbidity and Mortality Weekly Report [MMWR] 2009). By June 11, when the World Health Organization (WHO) declared that a global pandemic of H1N1 was in place, the disease had been reported in 74 countries with almost 29,000 laboratory-confirmed cases (WHO 2009). For the period August 30, 2009, to January 9, 2010, the Centers for Disease Control (CDC) reported more than 61,000 cases in the U.S. and its territories with 1,779 confirmed fatalities (MMWR 2010).

The spread of H1N1 outside of Mexico has a clear link to international travel. In May 2009, of 178 cases worldwide for which a travel history was available, 84 percent reported recent travel to Mexico (MMWR 2009). Nor is H1N1 the only recent worldwide epidemic of a serious respiratory disease. The 2003 epidemic of Severe Acute Respiratory Syndrome (SARS) in 2002–2003 is another example. SARS is a serious respiratory disease of unknown etiology that apparently originated in Guandong Province, China, and moved with travelers to 11 countries in little more than a month after it was first reported by the Chinese Ministry of Health (MMWR 2003a, 2003c).

Like H1N1 and SARS, TB is a serious respiratory disease that moves with human populations. It is highly infectious, with an airborne route of transmission that disproportionately affects those of low socioeconomic status, crowded living conditions, and poor nutrition. It occurs at a very high rate in immigrant populations. In 2007, 58 percent of TB cases in the United States in persons of known origin were in foreign-born persons. In addition, 77 percent of Latinos and 96 percent of Asians with newly diagnosed cases of TB were foreign born (MMWR 2008). In one study in New Jersey, it was found that the incidence of TB in the foreign population increased from 20 percent in 1986 to 37 percent in 1995 (Liu et al. 1998).

Although the disease has been present for longer than anyone knows, it declined steadily in Europe and the United States over most of the twentieth century. Beginning ...

Table of contents

• Cover Page
• Half Title Page
• Title Page
• Copyright Page
• Table of Contents
• Introduction Global-Local Connections: The View from Applied Anthropology
• 1 Global Localities and the Management of Infectious Disease
• 2 Engendering Transport: Mapping Women and Men on the Move
• 3 Housing Interests: Developing Community in a Globalizing City
• 4 Policy, Applied Feminist Anthropological Practice, and the Traffic in Women
• 5 Global Climate Change from the Bottom Up
• 6 Aging and Transnational Immigration
• 7 Defining Family: Anthropological Contributions to Practice and Policy in Child Welfare
• 8 From Internationalism to Systemic Globalism in Health Leadership Training
• 9 Localizing the Global in Technology Design
• Conclusion Toward a Practice-based Ethnography in the Global Village
• Index
• About the Authors