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Anthropology and epidemiology
J Ch E@daniol Vol. 41, No. 4, pp. 421-422, 1988 Pqamon Press plc.Printed in Great Britain
Occasional Book Review Editors’ Note: Although the Journal does not have a regular book review section, we occasionally Jind a review for an unusual, interesting book. The reviewer here is an epidemiologically oriented psychiatrist
Anthropology and Epidemiology. Edited by Janes C. R., Stall R. and Gifford S. M. Dordrecht, Holland: D. Reidel; 1986. US$69.00. The editors of this book have embarked on an ambitious project: to explore the potential nexus between the two apparently disparate disciplines of anthropology and epidemiology. Although the connections between the two are not readily obvious before reading the book, the editors provide persuasive evidence that both disciplines could benefit from intellectual crosspollination. The book is divided into four sections: I. Historical and Theoretical Perspectives; II. Infectious Diseases; III. Non-Infectious Diseases; and IV. Psycho-Social Conditions. The first section contains chapters that lay the historical groundwork for mutual collaboration between the two disciplines. The essays are informative and well-written, but the section as a whole is disappointing because it does not provide more details about possible models for integration of the two fields. Reading this book from the perspective of a clinical epidemiologist, it was fairly easy to appreciate in the remaining sections that anthropological studies could improve general&ability by employing more of the quantitative methods characteristic of epidemiology. The potential contributions that anthropology can make to epidemiology, however, are vital ones, and often not emphasized in traditional epidemiologic training. The following quote from the book clearly illustrates one aspect of the richness that anthropology can contribute to epidemiologic work: “ . . . although statistical calculations may be built on valid mathematical models, they run a serious risk of being inaccurate by excluding a vital human element: the way that people really (emphasis in original 421
text) approach illness and cope with death.” (p. 97). The above quotation was taken from one of two outstanding chapters in the book, both of which should be mandatory reading for any student of epidemiology. The first, by Marilyn Nations, is a discussion of the contributions made by ethnomedicine to infectious disease in general, and she uses much of her work on infant diarrhea in Brazil to provide examples. The chapter demonstrates the limitations of preventive programs in infectious disease that are based primarily on epidemiologic data, and the author argues that optimal efficacy may be obtained by a combination of ethnologic and epidemiologic approaches. The other chapter that is highly recommended contains a superb discussion of the concept of risk. The author is Sandra Gifford, and not only does she provide insight into the patient’s experience of medicalization of a benign disorder (benign breast lumps), but she creatively analyzes the multiple meanings of “risk”, and the relationships between these meanings. Beginning with the epidemiologic meaning of risk as a statistical calculation, often derived from population-based studies in which the epidemiologist never sees the subjects, she follows the concept as it filters down to the clinician and finally to the patient. She presents interesting data suggesting that the psychological meaning of risk to the clinican is often what mediates clinical decision-making, rather than the statistical or cognitive meanings of the concept. In spite of these strengths, however, there are some significant problems with this book. The book was born of the collective experiences of medical anthropologists working in the field of epidemiology, and the research presented is primarily anthropological. The major flaw in the book, however, lies not in its content, but in its structure. The book suffers, as do most compilations, from an uneven quality in the chapters, and a lack of continuity and theme. Some of the contributing authors creatively
422
Occasional Book Review
explore various aspects of the integrative possibilities between the two disciplines, while others do little more than present their anthropological research, which is rather dry reading and not particularly useful to the non-anthropologist. The editors could have easily improved the quality of the book by either expanding their first section to provide more essays that examined possible integrative models, or by unifying the text with summaries at the end of each chapter or section. As it stands, however, the book has less overall appeal to epidemiologists than anthropologists, and this is unfortunate. In spite of these problems, this book is recommended to professionals in both fields. Anthro-
pologists will find it useful because it provides examples of ways in which other anthropologists have attempted to bridge the gap between the two disciplines. Epidemiologists will be treated to an opportunity to view their subjects from a different perspective, but will find that a selective reading of the text will be most useful.
KATHLEENPAJER Yale University School of Medicine 333 Cedar Street P.O. Box 3333 New Haven, CT 06510
Occasional Book Review Editors’ Note: Although the Journal does not have a regular book review section, we occasionally Jind a review for an unusual, interesting book. The reviewer here is an epidemiologically oriented psychiatrist
Anthropology and Epidemiology. Edited by Janes C. R., Stall R. and Gifford S. M. Dordrecht, Holland: D. Reidel; 1986. US$69.00. The editors of this book have embarked on an ambitious project: to explore the potential nexus between the two apparently disparate disciplines of anthropology and epidemiology. Although the connections between the two are not readily obvious before reading the book, the editors provide persuasive evidence that both disciplines could benefit from intellectual crosspollination. The book is divided into four sections: I. Historical and Theoretical Perspectives; II. Infectious Diseases; III. Non-Infectious Diseases; and IV. Psycho-Social Conditions. The first section contains chapters that lay the historical groundwork for mutual collaboration between the two disciplines. The essays are informative and well-written, but the section as a whole is disappointing because it does not provide more details about possible models for integration of the two fields. Reading this book from the perspective of a clinical epidemiologist, it was fairly easy to appreciate in the remaining sections that anthropological studies could improve general&ability by employing more of the quantitative methods characteristic of epidemiology. The potential contributions that anthropology can make to epidemiology, however, are vital ones, and often not emphasized in traditional epidemiologic training. The following quote from the book clearly illustrates one aspect of the richness that anthropology can contribute to epidemiologic work: “ . . . although statistical calculations may be built on valid mathematical models, they run a serious risk of being inaccurate by excluding a vital human element: the way that people really (emphasis in original 421
text) approach illness and cope with death.” (p. 97). The above quotation was taken from one of two outstanding chapters in the book, both of which should be mandatory reading for any student of epidemiology. The first, by Marilyn Nations, is a discussion of the contributions made by ethnomedicine to infectious disease in general, and she uses much of her work on infant diarrhea in Brazil to provide examples. The chapter demonstrates the limitations of preventive programs in infectious disease that are based primarily on epidemiologic data, and the author argues that optimal efficacy may be obtained by a combination of ethnologic and epidemiologic approaches. The other chapter that is highly recommended contains a superb discussion of the concept of risk. The author is Sandra Gifford, and not only does she provide insight into the patient’s experience of medicalization of a benign disorder (benign breast lumps), but she creatively analyzes the multiple meanings of “risk”, and the relationships between these meanings. Beginning with the epidemiologic meaning of risk as a statistical calculation, often derived from population-based studies in which the epidemiologist never sees the subjects, she follows the concept as it filters down to the clinician and finally to the patient. She presents interesting data suggesting that the psychological meaning of risk to the clinican is often what mediates clinical decision-making, rather than the statistical or cognitive meanings of the concept. In spite of these strengths, however, there are some significant problems with this book. The book was born of the collective experiences of medical anthropologists working in the field of epidemiology, and the research presented is primarily anthropological. The major flaw in the book, however, lies not in its content, but in its structure. The book suffers, as do most compilations, from an uneven quality in the chapters, and a lack of continuity and theme. Some of the contributing authors creatively
422
Occasional Book Review
explore various aspects of the integrative possibilities between the two disciplines, while others do little more than present their anthropological research, which is rather dry reading and not particularly useful to the non-anthropologist. The editors could have easily improved the quality of the book by either expanding their first section to provide more essays that examined possible integrative models, or by unifying the text with summaries at the end of each chapter or section. As it stands, however, the book has less overall appeal to epidemiologists than anthropologists, and this is unfortunate. In spite of these problems, this book is recommended to professionals in both fields. Anthro-
pologists will find it useful because it provides examples of ways in which other anthropologists have attempted to bridge the gap between the two disciplines. Epidemiologists will be treated to an opportunity to view their subjects from a different perspective, but will find that a selective reading of the text will be most useful.
KATHLEENPAJER Yale University School of Medicine 333 Cedar Street P.O. Box 3333 New Haven, CT 06510