Oslo Summer School in Comparative Social Science Studies 2003

Culture, Health and Power:
Theory and Practice in Medical Anthropology

Lecturer: Professor Rayna Rapp,
Department of Anthropology,
New York University, USA

Main discipline: Anthropology
Dates: 28 July - 1 August 2003

"The human body is both the creative source of
experience and the site of domination."

- Byron Good, 1990

"(T)here is no society (Western or non-Western) where
explanations for pain, suffering, and death are systematically
dissociated from a larger social, political, cosmic order."

- Nancy Scheper-Hughes & Margaret Lock, 1991

"If we substitute defense against bio-terrorism for public health,
we risk coming to see the world's poor as a hostile reservoir of pestilence."

- David Keppel, 2001

Course description
Medical anthropology analyzes the relations among health, illness, social institutions and cultural representations. Medical anthropologists work comparatively, illuminating different systems for understanding and intervening into embodied problems. Although Western biomedicine has developed powerful theories and efficacious practices to treat all bodies in universal, pre-cultural terms, medical anthropology continually points to the differences in how bodies count: Who thrives; who falls ill and from what causes; who has access or lacks access to relevant expert healing resources are matters not only of biological vulnerability, but of culture and power.

This course provides an overview of the intersection where health, culture, and political-economic power meet. It traces the history of medical anthropology as it has moved from margin to center in Anglo-American anthropology, and engages discussions of the increasingly biotechnical and specialized medical services available to rich strata while health resources remain problematically inaccessible to the poor.

Scholarship in related fields, like science studies and the history of medicine, helps us to track the growing importance of "health" as an aspect of local, national, and international governance and contestation. The course requires a consideration of both the intellectually challenging materials on health and disease cross-culturally, and an interrogation of personal and social beliefs about bodies and the causes and responses to their vulnerabilities, as well.

Essential books for preparations
All participants are expected to have read the following 4 books in advance of the lecturing:


Lecture 1: Origins and Overview
Anglo-American medical anthropology emerged from two sets of research practices: (1) applied colonial medicine; and (2) philosophical and empirical evaluations of indigenous explanations of illness, embodied stigma, and misfortune. For much of the 20th Century, medical anthropology was a small and marginal field, caught between these two projects. But in the last twenty-five years, it has moved from margin to center, becoming a key site for debates concerning embodiment, governance, and international inequalities. What intellectual and social circumstances have conditioned these historical developments?


Lecture 2: The Culture of Western Biomedicine
Classic medical anthropological studies examined the rationality, healing practices, and efficacy of indigenous materia medica; identified "culture bound" syndromes; and analyzed barriers to the introduction of Western biomedical therapies. More recently, medical anthropologists have also turned their focus to the study of Western biomedicine, interrogating its cultural assumptions and performances. In examining cosmopolitan medicine as one ethno-medical system among many others, medical anthropologists also confront its physiological efficacy, institutional power, global claims and social consequences.


Lecture 3: Civilizational Traditions and Colonial Medicine: Resistance and Revitalization
Historians and philosophers of science, technology, and medicine have joined anthropologists in describing a rich variety of civilizational traditions in which the body and amelioration of its suffering hold a central place: Chinese, Indian, Islamic traditions all systematize knowledge and practice in health and healing. Thus colonial administrators did not encounter tabulae rasae when they incorporated medicine into their systems of governance. Amalgams, resistance, medical pluralism, and revivals of medical systems closely linked to nationalist movements were all potential outcomes of colonial rule and its various endings.


Lecture 4: Infections and Inequalities
The science of public health conventionally describes a health transition accompanying the demographic transition: industrialization, urbanization and proletarianization bring with them not only a decline in mortality rates leading to a decline in birth rates, but also a (relative) conquest of infectious diseases which increases the visibility and significance of chronic diseases. Recent critical debates in the field of public health point to the continued infections that accompany increased stratification of wealth. The spread of "classical" infectious diseases once regarded as controllable (eg. TB and malaria) has been joined by new epidemics like AIDS. Medical anthropologists have addressed the gap between public health explanations and the lived experiences of illness in the shadow of multiple and intersecting forms of inequality.


Lecture 5: Globalizing Health
As discussed on Days 1 & 2, health systems have long constituted powerful transnational forces. In the post-WW II period, international institutions like the WHO; the rise of NGOs explicitly concerned with health; and the multinational pharmaceutical industry have all contributed to rising consciousness of "global health" links between nations and populations across many divides of wealth and poverty; development and under- development; and across political systems.


Lecture 6: The Politics of Reproduction
Reproduction is simultaneously biological and social, it speaks to both continuity and change in the lives of individuals, kin groups, communities, and nations. Reproduction has also become a privileged site of analysis for social theory influenced by feminist concerns. In examining "stratified reproduction", we look at how the pregnancies and births of some strata of women are privileged and enabled, while those of others are despised, ignored, or actively discouraged. Under this label, the study of eugenics, the new reproductive technologies, and maternal/ child health campaigns can all be better understood.


Lecture 7: Remaking Life and Death
A host of radical interventions into the body from the New Reproductive Technologies and neonatal intensive care units to organ transplants and life-support systems have engaged foundational beliefs about the boundaries of life and death. These medical transformations intersect prior religious cosmological systems of understanding life and death. They also call into question accessibility and priorities in national and international health institutions.


Lecture 8: Remaking Life and Death, Continued
Biotechnology has been hailed as a "revolution" in "remaking life and death". But interventions at the level of gene, cell, organ and organism that claim to enhance or extend life can also be seen as promoting entrepreneurial investments in "the Somatic Individual". These technologies are helping to reframe individual active responsibilities for living (and dying) in relation to what Michel Foucault labeled " biopower".


Lecture 9: Bioethics and Health Policy
Emerging from the Nuremburg Trials and other nationally-specific revelations of medical abuse in the 1950s-80s, the field of bioethics has been shaped by movements aimed at reforming both medical research and clinical practice. In the USA and elsewhere, it quickly entered the regulatory apparatus of "bioinstitutions". Speaking the language of individual human rights, bioethics has also become part of the international discourse and practices of humanitarian medical aid; national and international health reform; and pharmaceutical testing and patenting. Anthropologists have recently begun to analyze bioethics as a potent discourse of health rights that speaks with a specifically Anglo-American philosophical intonation.


Lecture 10: Health Activism and the Future of Global Health
The women's health movement, AIDS activism, M�d�cins Sans Fronti�res, various forms of consumer activism, and an international disability rights movement have all made ethical and political claims on behalf of the stigmatized and the suffering for healthcare resources and representation. More radically and controversially, diverse social movements are increasingly claiming "insider status" in the making of scientific knowledge, and the setting of humane policy in research, clinical, and public health contexts. Are we witnessing the birth of "health democracies" or the triumph of the market-driven "somatic individual"? How might anthropologists contribute to current discussions about health activism and the future of health resources?


The lecturer:
Rayna Rapp received her undergraduate and advanced degrees in cultural anthropology from the University of Michigan, conducting extended field work in peasant villages in Southern France. She taught for almost thirty years at the Graduate Faculty of the New School for Social Research before moving to New York University in 2001. Her edited volume, Toward an Anthropology of Women (1975) contributed to the establishment of anthropological perspectives on gender, and to Women's Studies as an interdisciplinary field of study in the USA. Later co-edited volumes include Promissory Notes: Women in the Transition to Socialism (1988); Articulating Hidden Histories (1995); and Conceiving the New World Order: the Global Politics of Reproduction (1995). She is the author of sixty-five articles, many concerned with the intersection of gender and the politics of reproduction.

Her Testing Women, Testing the Fetus: the Social Impact of Amniocentesis (1999) was based on more than a decade of ethnographic field research on the new reproductive technologies. The book won three prizes in ethnographic writing; gender and health; and science/technology studies. Her current research is collaborative and extends in two directions: (1) ethnographic research on the manufacture, distribution, and uses of new genetic knowledge; (2) sociocultural analysis of the "epidemic" in learning disabilities now sweeping through US school-aged children.