ANTHROPOLOGY AND EPIDEMIOLOGY

ANTHROPOLOGY AND EPIDEMIOLOGY

CULTURE, ILLNESS, AND HEALING Editors: MARGARET LOCK Departments of Anthropology and Humanities and Social Studies in Medicine, McGill University, Montreal, Canada ALLAN YOUNG Department of Anthropology, Case Western Reserve University, Cleveland, Ohio, U.S.A. Editorial Board: ATWOOD D. GAINES Departments of Anthropology and Psychiatry, Case Western Reserve University and Medical School, Cleveland. Ohio, U.S.A. GILBERT LEWIS Department of Anthropology, University of Cambridge, England GANANATH OBEYESEKERE Department of Anthropology, Princeton University, Princeton. New Jersey. U.S.A.

ANTHROPOLOGY AND EPIDEMIOLOGY Interdisciplinary Approaches to the Study of Health and Disease Edited by CRAIG R. JANES Department of Anthropology, University of Colorado, Denver, Colorado RON STALL Department of Urban Studies, Rutgers University, New Brunswick, New Jersey, and The Alcohol Research Group, Berkeley, California and SANDRA M. GIFFORD Division of Community Health, State Health Commission of Victoria, Australia D. REIDEL PUBLISHING COMPANY A MEMBER OF THE KLUWER ACADEMIC PUBLISHERS GROUP DORDRECHT/BOSTON/LANCASTER/TOKYO

Library or Congress Cataloging-in-Publication Data Anthropology and epidemiology. (Culture, illness, and healing) Includes bibliographies and indexes. 1. Medical anthropology. 2. Anthropology, Cultural. 3. Epidemiology. I. Janes, Craig R. (Craig Robert), 1953- II. Stall, Ron, 1954-. III. Gifford, Sandra M. IV. Series. [DNLM: 1. Anthropology, Cultural. 2. Epidemiology. W A 105 A628) GN296.A55 1986 306'.46 86-20434 ISBN-13: 978-90-277-2249-2 DOl: 10.1007/978-94-009-3723-9 e-isbn-13: 978-94-009-3723-9 Published by D. Reidel Publishing Company, P.O. Box 17,3300 AA Dordrecht, Holland. Sold and distributed in the U.S.A. and Canada by K1uwer Academic Publishers, 101 Philip Drive, Assinippi Park, Norwell, MA 02061, U.S.A. In all other countries, sold and distributed by K1uwer Academic Publishers Group, P.O. Box 322, 3300 AH Dordrecht, Holland. 2-0987 -300 ts All Rights Reserved 1986 by D. Reidel Publishing Company and copyrightholders as specified on appropriate pages within. No part of the material protected by this copyright notice may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without written permission from the copyright owner

TABLE OF CONTENTS PREFACE Vll SECTION I: HISTORICAL AND THEORETICAL PERSPECTIVES FREDERICK L. DUNN and CRAIG R. JANES / Introduction: Medical Anthropology and Epidemiology 3 JAMES TROSTLE / Early Work in Anthropology and Epidemiology: From Social Medicine to the Germ Theory, 1840 to 1920 35 JAMES TROSTLE / Anthropology and Epidemiology in the Twentieth Century: A Selective History of Collaborative Projects and Theoretical Affinities, 1920 to 1970 59 SECTION II: INFECTIOUS DISEASES MARIL YN K. NATIONS / Epidemiological Research on Infectious Disease: Quantitative Rigor or Rigormortis? Insights From Ethnomedicine 97 PETER KUNST ADTER / Ethnicity, Ecology, and Mortality Transitions in Northwestern Thailand 125 E. MICHAEL GORMAN / The AIDS Epidemic in San Francisco: Epidemiological and Anthropological Perspectives 157 SECTION III: NON -INFECTIOUS DISEASES CRAIG R. JANES / Migration and Hypertension: An Ethnography of Disease Risk in an Urban Samoan Community 175 SANDRA M. GIFFORD / The Meaning of Lumps: A Case Study of the Ambiguities of Risk 213 SECTION IV: PSYCHO-SOCIAL CONDITIONS JOHN D. O'NEIL / Colonial Stress in the Canadian Arctic: An Ethnography of Young Adults Changing 249 RON STALL / Respondent-Identified Reasons for Change and Stability in Alcohol Consumption as a Concomitant of the Aging Process 275 v

vi TABLE OF CONTENTS ROBERT A. RUBINSTEIN and JANET D. PERLOFF / Identifying Psychosocial Disorders in Children: On Integrating Epidemiological and Anthropological Understandings 303 LIST OF CONTRIBUTORS 333 INDEX OF NAMES 335 INDEX OF SUBJECTS 341

PREFACE Over the past two decades increasing interest has emerged in the contributions that the social sciences might make to the epidemiological study of patterns of health and disease. Several reasons can be cited for this increasing interest. Primary among these has been the rise of the chronic, non-infectious diseases as important causes of morbidity and mortality within Western populations during the 20th century. Generally speaking, the chronic, noninfectious diseases are strongly influenced by lifestyle variables, which are themselves strongly influenced by social and cultural forces. The understanding of the effects of the behavioral factors in, say, hypertension, thus requires an understanding of the social and cultural factors which encourage obesity, a sedentary lifestyle, non-compliance with anti-hypertensive medications (or other prescribed regimens), and stress. Equally, there is a growing awareness that considerations of human behavior and its social and cultural determinants are important for understanding the distribution and control of infectious diseases. Related to this expansion of epidemiologic interest into the behavioral realm 'has been the development of etiological models which focus on the psychological, biological and socio-cultural characteristics of hosts, rather than exclusive concern with exposure to a particular agent or even behavioral risk. Also during this period advances in statistical and computing techniques have made accessible the ready testing of multivariate causal models, and so have encouraged the measurement of the effects of social and cultural factors on disease occurrence. Finally, (perhaps in partial response to the previous reasons) the disciplines of epidemiology and anthropology have undergone a parallel evolution. Epidemiologists have been forced to define and measure complex social processes hypothesized to impact on health and disease states. Anthropologists, on the other hand, have become increasingly interested in the potential contributions of their discipline to resolve the day-to-day problems of specific populations, and especially so within the realms of disease occurrence and medical care. These convergent interests have created the opportunity for mutually beneficial cross-disciplinary pollination. The original idea behind this book can be said to have been formed, in large part, in conversations between epidemiologists and medical anthropologists interested in the effects of social and cultural variables on health. This volume has benefited most particularly from the experience of researchers in the Department of Epidemiology and International Health and Medical Anthropology Program of the University of California, San Francisco, and in the School of Public Health of the University of California, Craig R. Janes el al. (eds.). Anthropology and Epidemiology. vii-viii. 1986 by D. Reidel Publishing Company. Vll

Vlll PREFACE Berkeley. Acting on a growing interest on these two campuses, particularly, among medical anthropologists either training or working in epidemiology, Sandra Gifford and Ron Stall organized a session for the 1983 meetings of the American Anthropological Association. Most of the contributors to the book presented papers at this session or acted as discussants. The interest attracted by the symposium and the lively discussion that followed the presentation of papers convinced us of the need for this book. It became clear that the idea of combining or integrating medical anthropology and epidemiology represented an area of recognized potential. Anthropology and epidemiology are multifaceted disciplines that claim a diverse population of practitioners, teachers, and writers. There is thus no single integrative model that embodies the many strengths of the two fields. It is not simply a matter of applying anthropological techniques or theories to understanding disease and disorder; a wide range of possible research alternatives exists - from enlivening epidemiological data with ethnographic detail to direct involvement by anthropologists in epidemiological research. In this book we have endeavored to collect articles that represent several analytic approaches to the concurrent use of anthropology and epidemiology in the study of a variety of diseases and disorders. Other diseases, different approaches, and varying integrative models exist; we hope they are explored in subsequent publications. If the directions signaled by these diverse contributions illuminate paths for future research, and invite further discussion and debate in the disciplines touched by anthropology and epidemiology, we will feel our purpose in undertaking this project ~as achieved. Following our basic agenda to provide a sampling of research that draws on various integrative models of anthropology and epidemiology, we have structured the book according to major disease categories, and within these broad categories case studies of particular places and peoples that range from indigenous cultures of the Third or Fourth Worlds, to contemporary, white, urban-american subcultures. We set the scene for these case studies in Section I with a series of theoretical and historical essays that examine the logic and historical underpinnings of interdisciplinary collaboration. Section II offers three case studies of anthropological contributions to the study of infectious disease. Section III presents two anthropological perspectives on the major non-infectious conditions of cardiovascular disease and breast cancer. Section IV considers the applicability of social science models and methods in the case of three classes of mental health "disorders" - suicide, alcohol problems, and hyperactivity in children. Readers will note that the contributions of anthropology in this volume are predominantly sociall cultural in nature. In addressing our many goals in constructing this book, we were unable to give to physicallbiological anthropology the justice it is due for its many contributions to human paleoepidemiology, genetic epidemiology, and human ecology. In partial defense of this omission, we feel that because the integration of epidemiology

PREFACE ix and social/cultural anthropology has remained most problematic, one goal has been to encourage cross-disciplinary dialogue in this area. We hope that as interest in the potential for collaboration grows, future volumes will appear that contain contributions from other sub-fields of anthropology as well. This volume was not conceived of as a primer in either epidemiology or anthropology. Many excellent introductory texts and collections exist. In the field of epidemiology we refer the reader to the introductory texts by Abraham and David Lilienfeld, Foundations of Epidemiology, 2nd ed., New York: Oxford University Press, 1980; and Judith Mausner and Anita Kramer, Epidemiology - An Introductory Text, Philadelphia: W. B. Saunders Company, 1985. For readers unfamiliar with epidemiologic concepts and terminology, we suggest a concise dictionary by John Last, A Dictionary of Epidemiology, New York: John Wiley and Sons, 1978. For readers unfamiliar with anthropology, specifically medical anthropology, we suggest perusal of the following texts: George Foster and Barbara Anderson, Medical Anthropology, New York: Wiley, 1978; Lorna G. Moore, et ai., The Biocultural Basis of Health: Expanding Views of Medical Anthropology, St. Louis, Missouri: Mosby, 1980; and Ann McElroy and Patricia Townsend, Medical Anthropology: An Ecological Perspective, North Scituate, Massachusetts: Duxbury, 1979. For those interested in case swdies of the relationship between anthropology and public health, the following remains a classic reference: Benjamin Paul (ed.), Health, Culture, and Community, New York: Russell Sage Foundation, 1955. For more advanced reading in medical anthropology, the series Culture, Illness, and Healing, edited by Arthur Kleinman and published by the D. Reidel Company, is recommended. This volume is the result of much hard work by many people. We would first like to thank the contributors for faithfully sending us their drafts and coping with our particular brand of "committee" editorship. Second, we would like to thank the many organizations that provided us with the necessary support.to attend to the duties of editing. These include the Medical Anthropology Program of the University of California, San Francisco; the Alcohol Research Group of the Medical Research Institute, San Francisco, California; the Prevention Research Center of Berkeley, California; and the World Health Organization Centre (Region 8) For Diabetes Education and Control, Caulfield, Australia. We gratefully acknowledge the diligent labors of Cathy Wasserman in indexing the volume, and we thank Martin Scrivener of D. Reidel and the former series editor, Arthur Kleinman, for their assistance in bringing this book to publication. June 20,1986 SANDRA M. GIFFORD CRAIG R. JANES RON STALL