Medical Anthropology Exam 1

Medical Anthropology

study of factors that contribute to variability in health and disease in the past and present

Biocultural vs. Biomedical Perspective

Biomedical looks at your symptoms and gives you a present explanation and treatment

• PROXIMATE cause

Biocultural combines the biology with your environment and broader culture to explain the WHY

• ULTIMATE cause

Culture

patterns of behavior that are shared or common to a group, it is learned on individual, social, and symbolic levels

Franz Boas

Father of Anthropology, introducing cultural relativism theory

Studied child growth and development of immigrants and born-and-raised americans to explain how nutrition played a role

Cultural Relativism/Concept

people are uniquely adapted to their own sets of circumstances and we should judge them and their practices on their own terms not our own standards

Participant Observation (Emic vs. Etic)

observing a group for a long time to understand their practices

• ETIC perspective is your outsider understanding, you try to explain the culture using external ideas and frameworks

• EMIC is the perspective of who you observe, so you try to understand their culture using their internal ideas and definitions

Perspectives on Health: Spiritual, Work Capacity, and Biomedical

• Spiritual balance says you’re healthy when your body, mind, and spirit is in harmony

• Work capacity says you’re healthy if you are able to do daily work and contribute to your community

  • Biomedical says you’re healthy if the labs, vitals, and disease indicators show that

Biological Normalcy

statistically measured central tendencies for how our bodies should be like or what people in a given society consider a normal body to be

Examples of Health Relativism

• Depression in western societies is diagnosed with the DSM while others might use cosmology or shamans

• Hemoglobin at high altitudes is overproduced to compensate for lack of oxygen but this might be concerning if you were not living at high altitudes

  • BMI in girls is higher than in boys

Dimensions of Health: Disease, Illness, and Sickness

• Disease: physiological alteration that impairs function, an objective measure like injury, infection, malnutrition, genetic issue, etc.

• Illness: subjective experience of symptoms, usually explained via a person’s illness narrative, related to a change or impact in behavior

• Sickness: social legitimization AND STIGMATIZATION of disease, based on how sick you are perceived to be

Embodiment

ways in which the environment in which we lie in leaves traces in our biology or alters our development, ex. epigenetics

Evolution

Bio: changes in traits/characteristics in a population over time

Everyday: something changes for the better

Natural Selection

Bio: differential survival and reproduction due to differences in heritable, individual traits

Everyday: survival of the fittest (strongest)

• Fittest really means best able to reproduce

Adaptation

Bio: trait that confers some advantage for survival or reproduction within a particular environment

Everyday: changing to fit a situation

Evolutionary Theory

explains the process by which species change over time through mechanisms such as natural selection, genetic variation, and mutation

Evolutionary Thought: Aristotle

the earth is “full” aka everything that is possible already exists so species are fixed and there is a complexity hierarchy

Evolutionary Thought: Lamarck

living forms can change, the environment causes this during one’s lifetime, these changes can then get passed on to offspring

Evolutionary Thought: Darwin

evolution by natural selection, all individuals have variation upon which this acts, this selection is pushes by stressors like seasonality/climate, food availability, disease, and other species

Evolutionary Medicine

explains why humans are vulnerable to disease, looks at modern reactions and tries to understand their evolutionary function or benefit

Biomedicine

explains modern diseases with clinical data or understandings

Novel Environment (Mismatch)

humans lived for hundreds of years as hunter gatherers so adaptations for that environment are mismatched with modern conditions

• CVD’s in biomedicine are explained just by high intake of fats and sugars but evo med shows that our bodies are only adapted to environments of low availability of fats and sugars so we aren’t adapted to modern day intake levels

Evolved Defenses

things like pain, nausea/vomiting, sneezing, coughing, diarrhea, inflammation, fever, etc. are seen as signs of infection or disease but evo med looks at it as a protective response to the infection

Trade Offs

Ex. Sickle cell: sickling of blood cells, individuals with partial sickle cell genotype get immunity to malaria so the gene has been able to continue on in our population

Constraints

Vestigial or not quite ideally designed morphologies show that human bodies weren’t built perfectly but were rather a collection of evolved fixes for certain environments or situations

• respiratory/lung passage being right next to where we swallow food

• existence of appendix

Conflicts with Other Organisms

interactions with others drives change

• pathogens —> treated with drugs that it evolves resistance to as fast as we develop new drugs for it

• other humans —> competition for resources, decision whether to dedicate resources to self-growth or reproduction

Food Security

availability and access to adequate nutrition at all times to amounts that are needed to maintain a healthy and active life

4 Pillars of Food Security

Availability —> sufficient amount of food in a particular place

• stocked grocery stores

Access —> adequate resources for obtaining food

• busses, money, food stamps

Utilization —> nutritionally valuable and safe to eat food

• clean water, healthy options

Stability —> permanent and durable access to all of the above

Total Energy Expenditure (TEE)

Basal Metabolic Rate (BMR) —> energy our bodies need to function at rest

Dietary Induced Thermogenesis (DIT) —> energy our bodies use to process and digest food

Physical Activity (PA) —> energy our bodies use when working out

BMR Factors

Sex: men and women have different fat:muscle distribution

Age: older age = slower metabolism

Body Weight: heavier means burns/needs more calories

Body Comp: muscle burns more calorie than fat

Activity: active people have higher metabolisms even when at rest

Protein

Used for amino acids that make proteins for muscle and bone + immune support

Too much = kidney stones, colon cancer, heart disease

Too little = muscle catabolism, stunted growth, weak immune system

Fats

Used for energy storage, absorbing fat-soluble vitamins, and supporting brain, heart, and immune function

• Saturated: animal fats and plant oils

• Unsaturated: mono = omega 6 from veggie oils and nuts/seeds, poly = omega 3 from fish and flaxseed

• Trans: artificially made, fried food, margarine

Too Much = CVD’s

Too little = dry skin, fatigue, cognitive decline, poor wound healing

Carbohydrates

Main source of energy and fiber

• Simple: fruit, dairy, honey, refined sugar

• Complex: whole grains, legumes

Too much = increased blood sugar —> CVD and Diabetes

Too little = fatigue, brain fog, and muscle breakdown

Body Fat: Subcutaneous vs. Visceral

Subcutaneous = under the skin

Visceral = around the organs, associated w/ disease risk

Fat Soluble Vitamins (STORED)

A, D, E, K

Water Soluble Vitamins (PASSED THROUGH)

C, B

Vitamin D

Used to regulate calcium and phosphorus absorption and usage, comes from sun, fish, eggs

Too little = rickets, oseomalacia (soft bones), other skeletal deformities

Common Inorganic Minerals

Ca, Na, K, Fe, I, Zi

Calcium

Bone and tooth formation and muscle contraction, comes from dairy and leafy greens

Too little = osteoporosis

Iron

Part of hemoglobin and myoglobin for oxygen transport, comes from seafood, meat, legumes, leafy greens

Too much = diabetes, CVD, liver disease, vulnerable to infectious disease

Too little = fatigue, weakness, headaches, anemia

Dietary Reference Intakes (DRI’s)

Standards for nutrient intake developed by the institute of medicine

• Use daily value standards based on 2000kcal diet despite the fact that research on recs is constantly changing

Bipedalism

Drying during pliocene led to grassland environments that required more efficient locomotion (walking)

Brain Size evolution

Bipedalism led to dietary changes and increases in nutrition that allowed brains to grow

Human Ancestry

Came from common ancestry of chimps and bonobos

Australopithecines were ancestral H. sapiens, all part of hominids (taxonomic family of humans and fossil ancestors)

Hunter-Gatherer Models

Modern H-G’s are not equivalent to ancestral H-G’s due to modern conditions limiting their food access/hunting ranges

• Collected → leaves and fruits

• Hunted → vertebrates

• Processed → nuts, termites, honey

Agricultural Revolution

• Food surpluses, population increases, change in social hierarchies

• Monocropping (reliance on one crop, here carbs) lead to decreased diversity in nutrition

  • Zoonotic and infectious diseases due to living in all close proximity

Bioarchaeology

study of human remains from archaeological sites

Skeletal signs of Malnutrition

Spongy Bone —> anemia

• Prorotic hyperostosis: in cranial vault

• Cribra orbitalia: in orbital roof

Dental issues

• Enamel hypoplasia: bands along enamel from malnutrition

• Caries/cavities: breakdown due to high sugar/carb

Lactase Persistence

Ability to digest lactose (milk sugar) after infancy without issue, not something many can do in SE/E Asia, Pacific Islands, etc. b/c no history of domesticated milk animals

Obesity

Mismatch from increase in sugar and fat intake

Risk factors:

• genetic predisposition (epigenetic?)

• dietary changes

• physical activity changes

• government food policies

• socioeconomics

Diabetes

Chronic, metabolic disease characterized by elevated levels of blood glucose (sugar) due to insufficient insulin hormone use/production by pancreas leading to breakdown of heart, eyes, kidneys, nerves

• Leads to CVD which accounts for 50% of diabetes deaths

T1: Pancreas doesn’t produce enough insulin —> hyperglycemia

• frequent urination, thirst, constant hunger, weight loss, unexplained vision changes, fatigue

• needs daily insulin

• cause unknown

T2: ineffective use of insulin, risk comes from high body weight and inactivity

• similar symptoms to T1 but less extreme, goes undiagnosed for years

• accounts for 90% of diabetes cases worldwide

Gestational: hyperglycemia that arises in pregnancy and causes complications in preg and delivery

• can lead to increased risk of T2 in the future

Malnutrition Double Burden

coexistence of obesity and undernutrition as a result of changing disease patterns

• too much of the “wrong nutrition” and/or no nutrition at all

• high risk of metabolic disease due to dramatic nutritional change in lifetime

Thrifty Phenotype Hypothesis

poor nutrition at a very young age leads to impaired growth of cells that program the metabolism for nutritional adversity

ex. low birth weight —> obesity and CVD risk in adulthood

Agricultural Subsidies

government programs that support farmers, via grants, research and development, etc. that came out of the great depression, leading to lobbying that changes how governments policy-make about our diets and food spending

• Meat and dairy 63%

• Grains 20%

• Sugar, starch, oil, alcohol 15%

• Nuts and legumes 2%

• Fruits and vegetables <1%