Anthropology & Medicine最新文献

How can ethnographic methods track implicit & explicit forms of structural casteism in Indian public health policy and praxis? How can a critical attention to ordinary stories and subjectivities of casted lives reveal the underlying Brahmanical moralities, assumptions and imaginations of public health but equally also unravel anti-caste counter-framings/counter-theorizations of symptoms, afflictions, injuries and chronic wounds wrought by caste? How, in other words, can the horizons of anti-colonial theory-making be expanded to capaciously conceptualize casteism as a core determinant of community health outcomes and life-chances in India? By mobilizing 'counter-storytelling' as a concept and method for critical medical anthropology from the Global South, and case studies from longitudinal ethnography in northern India, this paper provides a dual critique of: 1. Public health praxis in relation to questions of caste, addiction, respiratory debilitation, air pollution and TB. And, 2. Epistemologies of health policy making pertaining to wellness for 'the poor' and the gendered and casted labour of community care workers like ASHAs and non-institutionalized health actors.

In this introduction to our special issue, we take a wide view of the history and epistemic stakes of anthropological and ethnographic approaches to health policy. Drawing on the history of critical medical anthropology, the anthropology of policy, and critical policy studies, we show how anthropologies of health policy are particularly essential in this current moment, as policy production becomes increasingly abstracted and even more entwined with specific forms of evidence making. Taken together, the contributors of this special issue argue that anthropology's interventions into health policy are essential in three ways. First, they shed light on the practices of policy 'communities', the pragmatic parameters under which they work, and the central logics under which health policy actors are operating. Second, they examine the effects of policy implementation upon those intended to be the subjects of health policy, highlighting the effects of policy for those marginalised by gender, race, and caste. Here, anthropology provides a view into the 'lived experience' of those targeted by health policy, but it also demands that anthropologists provide 'counter-stories' and 'counter-evidences' that dismantle narrow systems of policy knowledge production. Finally, anthropological attention provides an essential lens into the things that carry over in the act of policy reform-the past reverberations and imperial inheritances. Together with our contributors, we call for anthropologies of health policy that work to highlight and dismantle such inheritances.

As people, particularly those ageing and living with disabilities, struggle with how care is enacted, integrated care has gained policy purchase in the United Kingdom. Despite integration's apparent popularity, its contribution to improved care for people has been questioned, exposing uncertainties about its associated benefits. Nonetheless, over decades a remarkably consistent approach to integrated care has advanced partnerships between the NHS and local government. Accordingly, in 2014 the Scottish Government mandated Health and Social Care Integration (HSCI) via the Scottish Public Bodies (Joint Working) (Scotland) Act. Emerging from an interorganisational ethnography of the implementation of a Health and Social Care Partnership in 2016, in a place I call 'Kintra', I interrogated what happened when NHS Kintra and Kintra Council endeavoured to implement HSCI according to the precepts of 'the Act'. Immersed in the everyday arrangements in the spaces of governance, I attended to how these policy actors worked to both (re)configure and held things together behind care frontiers, and away from the bodywork of direct care. I charted their efforts to comply with regulations, plan, and build governance apparatuses through documents. In following documents, I show the ways in which HSCI was materialised through documentation. I reveal how, in the mundane mattering of document manufacturing, possibilities for (re)forming the carescape emerged. I deploy a posthuman practice stance to show not only the way in which 'papery' partnerships between the NHS and local government 'enact' care, but also how they make worlds through a sociomaterial politics of anticipation.

Health scientists have claimed that urban transit workers suffer from higher rates of stress-related disease than workers in most other occupations. This paper examines how a network of scientists and labor organizers constructed the problem of transit worker stress as a global phenomenon. According to study participants, transit workers worldwide are subject to a similar set of stress-related risks, which can serve as a basis for worker solidarity. This paper analyzes how the concept of stress has been used to identify pathogenic environments and considers anthropological claims that the concept often abstracts and depoliticizes harmful arrangements. The findings show that scientists and labor organizers use the stress concept to construct a figure of a universally at-risk transit worker that serves the ends of transnational labor organizing. At the same time, by focusing on the case of San Francisco's transit workers, this analysis shows that a persistent association between stress and 'hard work'-in both lay and scientific discourses-may block recognition of stress-related harms for transit workers who are accused of being lazy and overpaid.

Previous research on the stigma associated with cutaneous leishmaniasis, a vector-transmitted parasitic disease, focuses on aesthetic appearance affectation as the leading cause of stigmatisation. However, Indigenous populations in the hinterland of Amazonian Ecuador trigger stigma expressions by recognising (muco)cutaneous leishmaniasis, primarily through atypical smell, followed by the odd voice sound, appearance and taste. This empirical way of recognising symptoms relies on embodied forms of identifying a disease, contrasting the Western supremacy of visuality and demanding to be understood via multi-sensorial anthropology. Through ethnographic research and data retrieved from eighty-three semistructured interviews and fifteen focus groups in seven Ecuadorian ethnic groups - including six Indigenous groups in the Amazon region - this paper analyses how the sensorium is a health thermometer. Findings reveal that differentiated cultural responses to a sense of peril, contagion and social (self)rejection, understood as stigma expressions, are linked to the holistic approach to health (or well-being) shared by Indigenous populations. In forest societies, well-being is explained through successful (non-)human relationships, and disease permeates through bodies that lack balanced relations.

Since the introduction of the Improving Access to Psychological Therapies (IAPT) programme in NHS England, psychological therapy has gained traction as 'evidence-based' and 'effective' in both clinical and economic terms. In the process, psychotherapeutic care has been reconstituted as highly manualised, standardised, and quantifiable. Drawing on anthropological fieldwork with mental health practitioners, this paper examines some common tensions that practitioners experience in their daily work where psychotherapy is sought within the framework of evidence-based medicine (EBM). For therapists working within IAPT, extensive monitoring and practices of accountability have come to undermine psychotherapeutic efforts to care for patients as 'people'. As a result, many practitioners now feel that they are working in a 'factory of therapy' whereby psychological treatment is recast in the service of outcome measures, and by which critique of the IAPT service, as well as caring relations within it, have been precluded.

Since the 2000s, hundreds of government-funded health insurance (GFHI) schemes were introduced in India. These schemes are meant to prevent poorer households from incurring catastrophic health expenditures. Through GFHIs, policy-makers want to mobilize the decision-making powers of private consumers in a liberalized healthcare market. Patients are called upon to act as 'co-creators' of healthcare value by optimizing supply through demand. Based on long-term ethnographic fieldwork with insurance users in South India, we argue that GFHIs fail because people experience the value of insurance in drastically different ways that only partly overlap with how the policy assumes they value insurance. In addition, the hollow promises of health coverage can be experienced as so frustrating that signing up for health insurance actually makes people feel devalued.

In early 2020, when the first COVID-19 cases were confirmed in Switzerland, the federal government started implementing measures such as national stay-at-home recommendations and a strict limitation of health care services use. General practitioners (GPs) and their at-risk patients faced similar uncertainties and grappled with subsequent sensemaking of the unprecedented situation. Qualitative interviews with 24 GPs and 37 at-risk patients were conducted which were analyzed using thematic analysis. Weick's (1993) four sources of -resilience - improvisation, virtual role systems, attitudes of wisdom and respectful interaction - heuristically guide the exploration of on-the-ground experiences and informal ways GPs and their at-risk patients sought to ensure continuity of primary care. GPs used their metaphorical Swiss army knives of learned tools as well as existing knowledge and relationships to adapt to the extenuating circumstances. Through improvisation, GPs and patients found pragmatic solutions, such as using local farmer apple brandy as disinfectant or at-home treatments of clavicle fractures. Through virtual role systems, GPs and patients came to terms with new and shifting roles, such as "good soldier" and "at-risk patient" categorizations. Both parties adopted attitudes of wisdom by accepting that they could not know everything. They also diversified their sources of information through personal relationships, formal networks, and the internet. The GP-patient relationship grew in importance through respectful interaction, and intersubjective reflection helped make sense of shifting roles and ambiguous guidelines. The empirical analysis of this paper contributes to theoretical considerations of sensemaking, resilience, crisis settings and health systems.