DEPARTMENT OF ANTHROPOLOGY
UNIVERSITY OF TORONTO
2006-2007
ANT. 348Y THE ANTHROPOLOGY OF HEALTH
FALL TERM
Lectures
Room
Instructor
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Tutors
Tutorials
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Wednesdays 12:00-2:00 PM
Sidney Smith 2118
Richard B. Lee
Office 105B New College; Phone: 978-4008
Office hours : Wed. 3:00-5:00 PM
and by appointment.
email: richardb.lee@.utoronto.ca
Alyson Stone, Bright Drah, and Lauren Classen
TBA
NOTE: In the Winter Term, Prof. Wen-Ching Sung will be taking over the course.
Text: Fall: 1. Baer, Hans, Merrill Singer and Ida Susser 2003. Medical Anthropology
and the World System. SECOND EDITION; Westport, CN: Praeger. Available only from
the Toronto Women=s Bookstore, 73 Harbord St. (922-8744).
2. ANT 348 FALL Course Packet: available from Quality Control Copy Centre, 321 Bloor
St W. next to Bata Shoe Museum.
Note: Tutorials will begin later in September.
OUTLINE OF LECTURE TOPICS - FALL TERM
PART I: INTRODUCTIONS AND ORIENTATIONS
SEPTEMBER
1. 13th INTRODUCTION: MEDICAL ANTHROPOLOGY, PAST AND PRESENT
READINGS: none
Hour 1.
The central problematic; what the course is about; the outline, readings, tests, the essay,
tutorials, the strengths (and limitations) of the Fall readings and text; division of labour
between first and second terms; plans for films.
Hour 2.
-Some philosophical and methodological starting points:
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1. Are there biological universals in the field of health?
2. Are there cultural universals in the same field?
3. The status of Awestern@ biomedicine: God=s truth or yet another set of cultural
practices?
4. We assume that western medicine has much to offer to the world. Does the “West”
also have something to learn?
5. How can we approach the non-biological elements of disease? The question of social,
cultural, and historical aspects of health and illness.
The lecture will also introduce three core areas in medical anthropology which will be
recurrent themes throughout the course: 1) the epidemiology of health and illness; 2) the
critical political economy of health; and 3) the cultural context of disease.
2. 20st
BIOMEDICAL AND CULTURAL CONSTRUCTIONS OF ILLNESS
READ:- (1) Brown, Peter 1998. AUnderstanding Medical Anthropology.@ in P. Brown ed.
Understanding and Applying Medical Anthropology (UAMA) Mountain View CA: Mayfield
Publishing Co. Pp. 1-9. [READING PACKET 1-2]
(2) Brown, Peter, Ronald Barrett, and Mark Padilla 1998. AMedical Anthropology: An
Introduction to the Fields.@ in P. Brown ed. UAMA pp. 10-20. [READING PACKET 1-2]
REC: - McElroy, A. And P. Townsend. 1996. Medical Anthropology: An Ecological
Perspective. Boulder, CO: Westview Press.
- Sargent, C. and T. Johnson eds. 1996. Medical Anthropology: Contemporary Theory
and Method. Westport CT: Praeger.
Here we contrast two of the core approaches to medical anthropology the
biomedical and the cultural. The first has its roots in the scientific world view, the second
in the view of illness and health as culturally constituted. Anthropology has been the
unique forum for the encounter and dialogue between these two contrasting (but not
incompatible) approaches.
One of the ways they meet is in the question of the cultural context of health and
disease. This has been a traditional and still central focus of medical anthropology; it
considers first, the large question of how different cultural conditions and practices affect
health of members of a given culture; second, it examines the equally large question of
how members of different cultures conceptualize health, illness, and healing.
3. 27th HEALTH AND THE HUMAN CONDITION.
READ: - Baer, Hans, Merrill Singer and Ida Susser 2003. Medical Anthropology and the
World System SECOND EDITION (MAWS). Westport CN: Praeger; chapter 3, AHealth
and the environment: From foraging societies to the Capitalist world system@ pp. 57-82.
- Armelagos, George. 1998. AHealth and disease in prehistoric populations in
transition.@ In P. Brown ed. UAMA, pp. 59-69. [READINGS PACKET 3]
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REC: - Cohen, M. 1989. Health and the Rise of Civilization. New Haven: Yale University
Press.
- Cohen, M. And G. Armelagos 1984. Paleopathology and the Origins of Agriculture.
New Haven: Yale University Press.
- Eaton, S. Boyd, Marjorie Shostak and Melvin Konner. 1988. The Paleolithic
Prescription: A Program of Diet and Excercise and a Design for Living. New York: Harper
and Row.
- Frisancho, A. R. 1993. Human Adaptation and Accomodation. Ann Arbor: University of
Michigan Press.
- Logan, M. And E. E. Hunt 1978. Health and the Human Condition. North Scituate MA:
Duxbury.
A long view of the course of human health from hunters and gatherers, through
agrarian states and on to industrial and post-industrial societies. What are the
characteristic patterns of diseases and modes of treatment in each phase of human
history? What were the health effects of major world-historical transitions such as the
origins of agriculture, the origins of the state and early urbanization, and colonialism and
imperialism of the modern era.?
NOTE: FALL TERM SHORT ESSAY TOPICS WILL BE DISTRIBUTED THIS
WEEK. THE DEADLINE FOR SUBMISSION OF ESSAYS WILL BE NOVEMBER 22
OCTOBER
4. 4TH HEALTH AND DISEASE IN ONE CULTURE: THE JU/=HOANSI
READ: - Eaton, S. Boyd, Marjorie Shostak and Melvin Konner. 1998. AStone Agers in
the Fast Lane: Chronic degenerative diseases in evolutionary perspective.@ in P. Brown
ed. UAMA. Pp. 20-32. [READING PACKET 4]
REC: - Katz, Richard 1982. Boiling Energy: Community Healing among the !Kung.
Cambridge: Harvard University Press.
- Lee, R. B. 1979. The !Kung San: Men, Women, and Work in a Foraging Society.
Cambridge: Cambridge University Press.
-Truswell, Stuart and J.D.L. Hansen 1976. AMedical research among the !Kung.@ In R.
B. Lee and I DeVore eds. Kalahari Hunter-Gatherers: Studies of the !Kung San and their
Neighbors. Cambridge: Harvard University Press.
The Ju/=hoansi have been studied by medical anthropologists since the 1960s,
tracing their health history during a period of great transition. The lecture profiles their
health status in the colonial and post-colonial contexts and examines the cultural means
they have mobilized to maintain health.
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PART II CRITICAL MEDICAL ANTHROPOLOGY
5. 11th WHY CRITICAL MEDICAL ANTHROPOLOGY ?
READ:- Baer, Singer, and Susser 2003. Medical Anthropology and the World System
(MAWS). All of Part I AWhat is Medical Anthropology About?@ pp. 3-54.
- Farmer, Paul. Social inequalities and emerging infectious diseases. In P. Brown ed.
UAMA, pp. 98-107. [READING PACKET 5]
REC:- Navarro, Vicente 1976. Medicine under Capitalism. New York: Prodist.
- ____________ 1984. Crisis, Health, and Medicine: A Social Critique. New York:
Tavistock.
- Kleinman, Arthur 1995. Writing at the Margin: Discourse between Anthropology and
Medicine. Berkeley: Univ. Of California Press.
CMA addresses such issues as the relation and impact of Capitalist Industrialization
and the emergence of a global market on human health. Over the next few weeks the health
impacts of production and marketing of such products as tobacco and alcoholic beverages
will be considered, as well as the health impacts of the illicit drug trade and the AIDS
Pandemic. For the next four weeks the class will work through Baer, Singer, and Susser=s
AMedical Anthropology and the World System@ (Second Edition) using it as a framework for
examining case material drawn from other readings.
6. 18th CRITICAL MEDICAL ANTHROPOLOGY II. ALCOHOL, POVERTY AND
HOMELESSNESS.
READ:- Baer, Singer, and Susser MAWS 2003. Ch. 4: AHomelessness in the world
system, and ch. 5: ALegal addictions, Part I: Demon in a bottle.@ pp. 83-141.
As two examples of the critical approach in medical anthropology we take up first
the question of homelessness and explore the ways in which the broader political economy
of late capitalism contributes to the increasingly acute issue of people on the streets of the
affluent West, and in the cities of the Third World. Second alcohol is an example of a
powerful drug sold legally in most nations and yet at the same time is the cause of
enormous health and social problems consuming large portions of health care and social
service budgets.
7. 25TH CRITICAL MEDICAL ANTHROPOLOGY III: ADDICTIONS: LEGAL AND
OTHERWISE.
READ:- Baer, Singer, and Susser 2003. MAWS. Ch. 6, ALegal addictions, Part II:Up in
smoke.@ and ch. 7, AIllicit drugs: Self-medicating the hidden injuries of oppression.@ pp.
143-225.
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REC:- - Nichter, M. and E. Cartwright. Saving the children for the tobacco industry. In P.
Brown ed. UAMA, pp. 422-33.
-Glantz, Stan et.al; 1996. The Cigarette Papers. Berkeley: University of California Press.
-Pringle, Peter 1998. Cornered: Big Tobacco at the Bar of Justice. New York: Henry Holt.
- Hilts, P. 1996. Smokescreen: The Truth Behind the Tobacco Industry Coverup. New
York: Addison-Wesley.
Another toxic and lucrative (and legal!) drug source is tobacco. Perhaps the most
widely sold commercial product in the world, tobacco=s deadly health consequences are
well-documented and have produced reductions in consumption in the West; but sales
continue to mount in the Third World driven by sophisticated marketing strategies.
Illicit drugs (cocaine, heroin, marijuana etc.) constitute a multi-billion dollar industry
rivaling the legal drug trade in scope. Critical medical anthropology examines the drugs,
their centers of production, the human costs of their consumption, and the various
treatment strategies.
NOVEMBER
8. 1ST CMA IN ACTION: THE AIDS EPIDEMIC, 25 YEARS AND COUNTING AND
THE TORONTO WORLD AIDS CONGRESS, AUGUST 2006.
READ: - Baer, Singer, and Susser 2003. (MAWS). Chapter 8 @AIDS: A disease of the
global system.@ pp. 227-81.
REC:- Webb, Douglas 1997. HIV/AIDS in Africa. London: Pluto Press.
-Barnett, Tony and Alan Whiteside 2002. AIDS in the 21st Century: Disease and
Globalization.
- Go to the AIDS2006 Website and explore the recent AIDS Congress research and
activism.
HIV/AIDS is a pandemic of catastrophic dimensions especially in sub-Saharan Africa
where 70% of the world=s cases are found. Now coming under control in the First World,
the disease continues to spread in the Third World. The countries of southern Africa have
some of the highest sero-positive rates in the world. But other countries such as Russia,
India and China are also experiencing massive outbreaks. This past August, Toronto
hosted the world’s largest AIDS conference ever held, with 25,000 delegates. The lecture
looks at the conference, a unique mix of state-of-the-art AIDS research, politics, and grassroots social activism.
9. 8TH CMA V: A CASE STUDY OF HIV/AIDS IN NAMIBIA.
READ: Canada-Namibia AIDS Internship Program 2005. Forum on Social and
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Cultural Aspects on HIV/AIDS. Held at the University of Namibia July 25th, 2006, with
Namibian and Canadian students collaborating on research projects, pp. 1-26.
[READING PACKET 6].
REC: Kalipeni, Ezekiel et.al. editors 2004. HIV/AIDS in Africa: Beyond
Epidemiology. Oxford: Blackwell’s Publishing.
Since 1996 Prof. Lee has been working in Namibia on HIV/AIDS prevention research
and training. Starting in the summer of 1999, U. of T. students have traveled to Namibia to
work as research interns on the social and cultural aspects of HIV/AIDS. Working with local
researchers, the students addressed issues of how men, women, children and adolescents
are affected by the spread of AIDS and on why the epidemic has proven so difficult to
control. Special attention was focused on the work of governments, UN agencies and
NGOs in their efforts to fight the spread of the disease. The lecture will highlight some of
the key findings as Namibian communities and families attempt to deal with the stillrampant epidemic. Students from the 2006 Internship will present accounts of their recent
research.
PART III CULTURAL PERSPECTIVES ON HEALTH AND ILLNESS
10. 15th
ETHNOMEDICAL SYSTEMS.
READ:- Baer, Singer, and Susser MAWS 2003. Ch. 9 AMedical systems in indigenous
and precapitalist state societies.@ pp. 307-328.
- Foster, George 1998. ADisease etiologies in non-western medical systems.@ In UAMA,
110-117. [READING PACKET 7]
- Kleinman, Arthur 1998. ADo psychiatric disorders differ in different cultures?@ In UAMA,
pp. 185-95. [READING PACKET 8]
REC: - Hahn, Robert 1995. Sickness and Healing: An Anthropological Perspective. New
Haven: Yale University Press.
- Payer, Lynn 1988. Medicine and Culture. New York: Penguin.
- Sontag, Susan 1978. Illness as Metaphor. New York: Farrar, Strauss
and Giroux.
- Rubel, Arthur 1998. The epidemiology of a folk illness: Susto in Hispanic America. In
UAMA, pp. 196-206.
- Gaines, Atwood 1992. Ethnopsychiatry: The Cultural Construction of Professional and
Folk Psychiatries. Albany: State University of New York Press.
- Kleinman, A. And B. Good. 1985 Culture and Depression. Berkeley: University of
California Press.
It appears to be a human universal that all cultures have systematic beliefs and
practices around sickness and healing. All reflect on the symptoms of illness and their
underlying causes, and all have sets of practices for addressing those symptoms and
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causes and bringing the afflicted to wellness. These sets of practices include such
elements as pharmacopeia, dietary restrictions and recommendations, and prophylaxes
usually address both natural and supernatural theories of causation. Western biomedicine,
despite claims to the contrary, shares some of these theories and practices, combining
evidence-based medicine with treatments based on tradition, custom, and unsubstantiated
belief (driven in part by pharmceutical marketing practices). This lecture will introduce the
subject of ethnomedicine. In subsequent lectures the topic will be explored in greater
depth.
11. 22nd
SHAMANISM AND ITS COUNTERPARTS IN WESTERN MEDICINE.
NOTE: THE SHORT ESSAY ASSIGNMENT IS DUE TODAY. A SCHEDULE OF LATE
PENALTIES WILL BE POSTED.
READ:- Finkler, Kaja 1998. ASacred healing and biomedicine compared.@ In UAMA, pp.
118-128. [READING PACKET 9-10]
-Lévi-Strauss, Claude 1998. AThe sorcerer and his magic.@ In UAMA, 129-137.
[READING PACKET 9-10]
REC:-Vitebsky, Piers 1995. The Shaman: Voyages of the Soul, Trance, Ecstasy, and
Healing from Siberia to the Amazon. Boston: Little Brown.
- Harner, M. 1990. The Way of the Shaman. San Francisco: Harper and Row.
-Katz, R. 1982. Boiling Energy: Community Healing among the Kalahari !Kung.
Cambridge: Harvard U. P.
-Katz, R., M. Biesele, and V. St. Dennis, 1998. Healing Makes our Hearts Happy.
The term “shaman” is a Siberian word, but the phenomenon it describes is found in all
the world’s culture areas. Before the rise of the state and state religions, shamanistic
practices were the dominant form of religious expression especially in the area of healing.
Shamanism persists to the present in many forms. Frequent common elements include
trance states, sleight-of-hand, elaborate ritual paraphernalia, and long apprenticeships. The
lecture will explore some of the classic works on shamanism and attempt to understand its
biomedical basis. Attention will be given to the use of shamanistic forms, often
unacknowledged, in modern biomedicine. One such example is the use of guided imagery
in the treatment of cancer.
12. 29th BIOMEDICINE AND ITS DISCONTENTS: MEDICAL ANTHROPOLOGY
LOOKS AT HEALTH AND HEALTH CARE TODAY
READ:-Rosenberg, H. 1997. From Trash to Treasure. In J. Schneider and R. Rapp eds.
Articulating Hidden Histories. Berkeley: University of California Press. [READINGS
PACKAGE 11]
-Bezruchka, Stephen (2001) Is our society making you sick? Newsweek Feb. 26, 2001.
[READINGS PACKAGE 12]
-Bezruchka, Stephen (2004) U.S.A.: RICHEST nation, BIG GAP civilization, SICKEST
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population. Website: Population Health Forum. http://depts.washington.edu/eqhlth
[READINGS PACKAGE 13]
-Martin, Emily. Medical metaphors of women=s bodies: menstruation and menopause. In
UAMA, pp. 345-56. [READINGS PACKAGE 14]
- Angell, Marcia 2004. The truth about the drug companies. New York Review of Books
51(12): pp. 1-13. [READINGS PACKAGE 15].
REC. TBA
Contemporary biomedicine is a trillion dollar enterprise based on a two centuries of
accomplishments and medical discoveries. While biomedicine’s benefits are undeniable,
biomedicine also has its critics, who point to a number of issues where the biomedical
enterprise’s record is less than spotless. This concluding lecture of the term will point to
some of these critical issues and attempt to go beyond the triumphalism of modern
medicine to portray it in a more realistic, three dimensional light. Some of the issues to be
considered include:
1. Health and medicine and the environment (Rosenberg)
2. The unequal distribution of modern healthcare’s benefits: The Health Olympics
Bezruchka)
3. Health and gender: Is there male bias in medicine? (Martin)
4. The role of big business and profit in driving medicine’s priorities (Angell)
DECEMBER:
13. 6th T E R M T E S T I N C L A S S.
NOTE: TODAY IS ALSO THE DUE DATE FOR THE ALTERNATIVE
ASSIGNMENT FOR THOSE WHO WERE UNABLE TO ATTEND A TUTORIAL.
CHRISTMAS BREAK: CLASSES WILL RESUME WITH PROF. WEN-CHING
SUNG ON JANUARY 10TH WHEN THE SPRING TERM OUTLINE WILL BE
DISTRIBUTED.
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MARKS BREAKDOWN:
Fall Test 25%, Fall Essay 20%, Fall Class Participation 5% = 50%
Spring Test 25%, Spring Essay 20%, Spring Class Participation 5% = 50%