Medical Anthro

Exam 1

What is anthropology?

From the Greek: Anthropos= the study of humans

4 subfields

4 subfields

• Biological

• Socio-Cultural

• Linguistic

• Archeaology

What is medical anthropology?

Study of factors hat contribute to variability in health and disease in past and present populations

Example of medical anthropology

causes of death is different in human remains

Definition from textbook of medical anthropology

• a subfield of anthropology that draws upon social, cultural, biological and linguistic anthropology to better understand those factors which influence health and well being (broadly defined), the experience and distribution of illness, the prevention and treatment of sickness, health processes, the social relations of therapy management, and the cultural importance of and utilization of pluralistic  medical systems.” (Wiley and Allen, p. 6)

When you think about different kinds of illnesses and disease that affect humans…

• Do these all have the same sorts of causes?

  • No, they are very different explanations for why diseases occur 

• Do these affect all human groups equally?

• What determines the distribution and the severity of human disease?

Type 2 Diabetes Causes

• Causes/Factors: obesity, high blood pressure, diet (low fiber, high sugar/fat foods)

  • Low vitamins

Who in our society are more likely to eat. low quality foods?

• Poor people in bad neighborhoods

• Big families that are in poverty

  • Maybe they don’t have access to healthcare and that is tied to good quality jobs

Bicultural perspective

• Wee need to know something about the gene/biology, physical environment and culture

Takeaways from the course

• Understand the scope of medical anthology and how it utilizes perspectives from he subfields of anthropology

• Explain the significance of a bicultural approach to human health and illness

• Provide examples of how biology and culture interact to shape human health

• Apply course concepts to understand contemporary social issues associated with health and illness

The culture concept

• Patterns of behavior that are shared or common to a group

  • Beliefs, practices, values, traditions

• Culture is learned individual, social, symbolic

  • This can be family, friends, society

Origin of medical anthropology

Franz Boas (1858-1942)

Franz Boas (1858-1942)

• “Father of American Anthropology”

  • Curator of the American Museum of Natural History

  • Professor of Anthology, Columbia University

  • Established American Anthropological Association

• He was trained in physics, macroscience, and geography

What did Boas do in the Arctic?

• he ended up doing work in the arctic

  • He lived with communities and learned and observed their cultural practices

    • Material, culture, transitions, languages, food, etc

  • He began to collect data of the anthropology of these indigenous people

What concept did Boas make up?

Cultural relativism

Cultural Relativism

People are uniquely developed to their own circumstances

• His conclusion wasn't;t that these people were less intelligent than western europeans

• However, he thought that they were different and did things their own way

Boas’s research

He recruited 18,000 children that were children of immigrants and published this two volume study

• He measured their growth

• He was interested in knowing how how children that were having immigrants grew up

  • Physically

  • Human growth as a trait is an interaction with biology and their environment

• Nutrition that children were given in NYC was much better than nutrition than their parents gots in their own home countries

  • Early nutrition is critical attain their maximum height and growth

Bodies of children in study in Context

• Environments and Change

• Methods

  • Studied immigrants and their children across generation

  • Measured head shape, body proportions, and stature

• Findings

  • Children’s bodies differ from their parents

  • Environment influenced growth, not just hereditary

Cultural relativism

The ability to understand a culture or cultural practice on its own terms and not make judgements using the standards of ones own culture

Understanding Cultural Relativism in Health

Spiritual Balance

Functional/Work Capacity

Biomedical

Spiritual Balance

Health is harmony of body, mind, and spirit ; rituals an community practices are key to well being

Functional/Work Capacity

Health is the ability to preform daily work and contribute to the community; strength and stamina matter most

Biomedical

Health is measured in lab tests, vital signs, and abets of disease; treatment focuses on medical interventions

Ethnography

systemic description of human culture

Participant Observation

studying by observing and participating in cultural practices

Emic

Taking part of cultural traditions, language etc but also observing. The insiders perspective the communities perspective

Etic

• Outsider’s perspective

Biomedical (causes)

Cause of disease is quite proximate; go to the doctor because of a cold and runny nose, and you take a flu test and have the flu (physiological explanations)

• Something is present in a blood test, why someone isn’t feeling well, and what their disease is. Also has to don with behavior (someone who smokes gets lung cancer) (physical activity: diabetes, less active, which makes it more complex)

• Also looking at who is more likely to get disease, like poorer people are more likely to get diabetes because of how expensive healthy food is and health care. 

Bicultural (causes)

Different causes and may not be getting better from. the flu, lung infection, and coping for weeks

• What explains this?

  • (you have influenza A, but there are other causes; you're stressed, taking a toll on your body.)

• A larger ultimate explanation for why the disease exists and persists (the more ultimate cause) 

  →We need both; technology isn't fixing issues. We need to look at social, cultural, and environmental 

  Instead of what or how, we ask WHY?
  
  

Population patterning

• minorities individuals, poorer people, bad communities, etc 

Why is this group of people more likely to develop type 2 diabetes?

• Diet, lifestyle, inactivity, etc

World Health Organization (WHO) definition of Health

Heath is a “state of complete social, psychological, and partial well being”

Biological normalcy

• “the ways in which the statistical measures of chemical tendency and variance such as means, medians, and modes views about what bodies “should” be like or what people in a given society consider to be a “normal” human body” (Wiley & Allen p 23-24)

• What is really normal?

  •  Most of the data sets are from white European men which is not inclusive 

  • Using measure like BMI to prove healthy that is not inclusive 

    • I'm obese when really I am healthy

    • Normal= healthy and “abnormal”= unhealthy 

• This should be documented in different populations 

  • Association between a trait and risk of disease

• Where do ideas about what is normal come from?

  • Social learning and what you have been exposed to

  • Understand that not everyone is exposed to the same thing 

Relativism of Health

Differences between populations

Depression

Diagnosed using DSM in Western medicine (DSM acknowledges that ist is difficult to apply this to every culture because it is not that simple).

Symptoms could look different in different cultures

• In some cultures, when someone is diagnosed with depression, there is a chemical imbalance and need for medication, but in other cultures we could treat symptoms with prayers and community action

• Hemoglobin levels at high and low altitudes (healthy hemoglobin is different in different environments)

Relativism of health:within population differences

BMI in girls and boys

Infant mortality by maternal age

Dimensions of health

Disease

Illness

Sickness

Disease (definition)

• Definition: Physiological alteration that impairs function

• This is an objective measure that be used cross culturally

Disease types and examples

• Injury 

• Infection

• Malnutrition

• Genetic 

• Chronic 

• psychological/behavioral 

What might causes these disease to vary between different human groups?

• A bicultural definition gives better reason for why it looks different

What is illness?

Subjective experience of symptoms and suffering

• Complaints that bring you to a doctor

Examples of Illness

Change in behavior- pain, stuffy nose

Illness and disease

What you describe is going to be a very nice fit of the providers diagnose of disease

• That will make you symptoms (illness) go away

• When this doesn't happen it's hard for people

Good fit

symptoms → diagnosis

Poor fit

Symptoms → no diagnose or wrong diagnosis

• Same symptoms can have many different diagnosis 

• No symptoms → but you have a diagnosis

Illness narratives (Quote)

Arthur Klienman

Quote: →“Illness complaints are what patients and their families bring to the practitioner. Indeed, locally shared illness idioms create a common ground for patient and practitioners to understand each other in their initial encounter. The practitioner, too, has been socialized into a particular collective experience of illness. Disease, however, is what the practitioner creates in the recasting of illness in terms of theories of disorder.”

Illness Narrative

→Explanatory model to better understand how individuals describe and make sense of their experiences with disease and disorder

Illness narratives: Questions are asked to diagnose illness

• What do you think has caused your problem?

• Why do you think it started when it did?

• What do you think your sickness does to you?

• How does it work?

• How severe is your sickness?

• Will it have a short or long course?

• What kind of treatment do you think you should receive 

• What are the chief problems that your sickness has caused you?

• Comparing disease to illness: reductionism

These are more biocultural perspective

What is sickness?

• Sociology of sickness (who decides if you are really sick)

  • Exceptions of sickness versus well individuals

  • Legitimacy

  • Stigma

Where does health reside?

Three bodies of health (Scheper-Hughes and Lock 1987)

• Individual body

• Social body

• Body politic

Embodiment

The ways in which the environment in which humans live leaves… profound traces in human biology, or alters biological development in children

Everyday vs. scientific definition- Evolution

Everyday- something gets better over time, how an individual develops as a person. Implies direction, purpose and a change that happens within an individual

Scientific- the change in inherited traits over successive generations in populations of organisms

Theory

Everyday: something that is possibly true (a hunch or guess) but not know to be true

Scientific: a well substantiated explanation of some aspect of the natural world that can incorporate facts, laws, inferences and tested hypothesis.

• Explanation of phenomena that comes about through repeated observation and experimentation

Adaption

• Everyday: the process of changing to fit a situation

• Scientific: an alternation in a trait of an organism that results from natural selection and by which the organism becomes better bel tis survive and reproduce in its environment

Aristotle

The earth is full and everything that is possible already exists

All living forms can be arranged on a scale from less to more complex

Species are feed, permeant in form and do not change over time

Lamark

• Individual living forms can change

• Changes happen in response to differing environment conditions (ex. long neck giraffes necks from stretching)

• Acquired characteristics can be passed iff to offspring

Darwin

• Charles Darwin (1809-1882)

  • After graduating from Cambridge, Darwin's professor recommended him for the position of naturalist on H.M.S. Beagle.

  •  The voyage of the Beagle lasted five years (1831 to 1836) and provided the observations and evidence (in the form of specimens) that became the foundation for Darwin's theories.

Galapagos Islands

• Darwin on the Galápagos Islands

• On the voyage of the Beagle, Darwin visited the Galapagos Islands located off the coast of Ecuador.

There was a lot of pressure form the scientific community to get these finding out from the island

• Darwin spent more than twenty years studying the specimens, experimenting, and reviewing the notes of his voyage.

•  In 1859, Darwin published On the Origin of Species by Means of Natural Selection.

• This publication caused great debate and what is now viewed as a scientific revolution.

• Darwin formed a theory that could account for the biological world.

Quote on Charles Darwin

 On the the Origin Species

• I am fully convinced that species are not immutable; but that those belonging to what are called the same genera are lineal descendants of some other and generally extinct species, in the same manner as the acknowledged varieties of any one species are the descendants of that species. Furthermore, I am convinced that natural selection has been the most important, but not the exclusive, means of modification.”

Example of Natural Selection

• The finches are not all the same

• Color, beak size, bird size all had variability 

  • Some of these traits were advantageous, beak size allowed them to access food better, reproduced better

Darwins Observations

• All species have the capacity to produce more offspring than the environment can support

• Population size remains stable over time

• Environmental resources are limited

• All living things show variation; no two individuals of a species are exactly the same

• Much of this variation is heritable

Inferences

• More individuals born that can supported by available resources → competition and variability in survival

• Non-random survival → Individuals whose inherited characteristics allow them to compete successfully for resources will be disproportionately represented in ethnic next generation

  • Differential survival and reproduction = natural selection

  • Over generations, the unequal amity of indiums to survive and reproduce will lead to a change in the proportion of individuals traits that allow them to more successfully compete for resources

    • Change in trait frequency over time = evolution

Natural selection, adaption, and evolution

• IF there are organisms that reproduce, and

• IF offspring inherit traits from their parents, and

• IF there is variability of traits, and IF the environment cannot support all

• members of a growing population,

• THEN those members of the population with less-adaptive traits (determined by the environment) will die out, and those members with more-adaptive traits (determined by the environment) will thrive (differential survival and reproduction)

4 conditions for natural selection

• Inheritance

• Variation

• Environmental limits/competition

• Differential survival and reproduction

Difference between Lamark and Darwin evolution

• Lamarck:

  • Giraffe’s stretched their necks to reach leaves and eventually their necks became longer after many generations

• Darwin:

  • Variation in neck length, natural selection favors longer necks, over time this trait is passed on and there are more giraffes with lower necks

Drivers of evolutionary change: Selective forces/stressors

• Environmental stressors that impact survival and reproduction

  • Seasonality/climate

  • Food availability

  • Disease

  • Other species

  • Other individuals

• Example- Darwin’s finches as a exemplar for evolution in action

  • 1977 drought made larger harder seeds more available

  • 85% drop in finches, fiches with smaller beaks died, finches with larger beaks survived

Evolutionary medicine

Scientific Theory and Natural Selection

Scientific theory

• a well supported explanation of the natural world phenomena that can include law, hypothesis and facts (ex. cell theory, theory of evolution)

Natural Selection

• differences in survival and reproduction

Evolutionary medicine- what is the purview of this field?

• The purview is the 5 categories of disease vulnerability and examples

  • Nesse and Williams (1998)

    • 1. Novel environments

    • 2. Evolved defenses

    • 3. Trade-offs

    • 4. Constraints

    • 5. Conflicts with other organisms

• Why do people still get sick?

Novel environments (mismatch)

The environment we live in now doesn’t match the environment we are involved in

• Example: of coping with novelty

  • Disease related to high fat diet (type 2 diabetes)

  • addiction

  • Breast cancer

  • Heart Attack- human bodies evolved in an enviornment with low availability to fat

Evolved Defenses

• Pain

• Nausea and vomiting

• Sneezing and coughing

• Diarrhea

• Inflammation and fever

• Iron deficiency

• Pregnancy sickness

• Anxiety

Smoke detector response

Your body with think something its much bigger than it is

• it is sensitive so it thinks a small infection/invader so its sets off multiple alarms

Evolved defense: fiver

Biomedicine- sign of infection

Evolutionary medicine- proactive response to infection

Trade-offs

• Sickle cell disease 

• Cystic fibrosis 

• Aging 

• (benefits and costs equal out) 

Trade-offs: sickle cell disease

• Disorder that affects red blood cells 

• Mutation that causes hemoglobin molecules to form improperly 

• Sickle-shaped cells get stuck in blood vessels, causing pain and damage to organs 

Selective advantage to sickle cell trait in malaria-endemic environments: 

• HbSS—children with sickle cell disease

• HbAA- children without any sickle cell genes 

• HbAS- children with the sickle cell trait 

Constraints

• Design of vertebrae eye

• Design of respiratory/lung passage

• Appendix

Conflicts with other organisms

• Pathogens

• Venomous snakes ad spiders

• Other humans

  • Competition for access to resources

  • Maternal/fetal competition

Components of total energy requirements

• Total Energy Expenditure

• Basal Metabolic Rate (BMR)

• Diet Induced Thermogenesis

• Physical Activity (PA)

Total Energy Expenditure (TEE)

BMR + DIT + PA

Basal Metabolic Rate (BMR)

• Amount of energy expressed in calories that is required to keep the body functioning at rest

Diet Induced Thermogenesis (DIT)

• energy expended to digest, absorb, and convert food to energy

Physical Activity (PA)

• amount of energy expressed in calories that is required for physical activity

Factors that affect basal metabolic rate (BMR)

○ Biological sex - males tend to have higher BMR than females because they have

more muscle mass

○ Body weight - The more you weigh, the higher your BMR

○ Body Composition - People with a higher proportion of muscle mass tend to have

a higher BMR because muscle tissue burns more calories at rest than fat

○ Age - as you get older your BMR decreases due to loss of muscle mass

○ Activity Patterns - more activity increases your BMR

Macronutrients

• Protein

• Fat/Fatty Acids

• Carbohydrate

Protein

Function: source of amino acid used to make proteins in the body.

Component of muscle, bone, proteins that transport oxygen to tissues

■ Best Source: Meat, animal products, beans, quinoa and buckwheat

■ Too Much (animal protein): Kidney stones, colon cancer, heart disease

(from high fat diet)

■ Deficiency: Body doesn’t build muscle, muscle catabolism, compromises

immune function, growth retardation in children, Kwashiorkor (protein

energy malnutrition)

Fat/fatty acids

Function: Stored energy, insulation and organ protection, absorption of fat

soluble vitamins, brain function, heart health, reducing inflammation,

source of essential fatty acids (omega 3 and omega 6)

■ Deficiency: Lack of omega 3’s or omega 6’s can lead to dry skin, poor

wound healing and cognitive decline

Types of Fatty Acid

• Saturated:

  • animal fats and some plant oils (coconut oil), solid at

room temp.

• Unsaturated

  • Monounsaturated: olive oil, avocado

  • Poly unsaturated: omega 3 and 6 in flaxseed and fish

• Trans Fat:

  • artificially created, found in processed foods and fried

foods, margarine and non-dairy reamer

Essential Fatty Acids (EFA)

The polyunsaturated fats that the body cannot synthesize and must be obtained from the diet like

• Omega 3 (flax and chiaseeds, fatty fish, walnuts) for brain health, reducing inflammation and heart health

• Omega 6 (vegetable oils, nuts and seeds) for immune response, inflammation regulation and skin health) Balance between them is important

Carbohydrate

Types: Simple (sugar) and Complex (starch, fiber)

■ Function: main source of energy for body, passage of food through

intestine (fiber), only small amounts of energy from carbs is stored (liver,

muscles store glycogen, about 1 days worth of calories)

■ Sources

- Simple: fruits, dairy products, honey, maple syrup, refined sugar

products

- Complex: whole grains, legumes, potatoes, corn, peas

■ Too much: inc. blood sugar, inc. insulin which is then stored as fat in cells,

obesity, type II diabetes, heart disease

Micronutrients

• Vitamin D

• Calcium

• Iron

Vitamin D (fat soluble and minerals)

Function: regulates calcium and phosphorus absorption and utilization in

bone growth

■ Sources: Sun (synthesized by body), egg yolk, salmon, sardines, tuna,

fortified dairy products

■ Deficiency: Rickets, osteomalacia (soft bones), skeletal deformities

Calcium (mineral, inorganic)

• Function: bone and tooth formation, regulates muscle contraction including heartbeat, activates enzymes

• Sources: dairy, collared greens, sardines with bones, shrimp

• Deficiency: osteoporosis (long term)

Iron (mineral, inorganic)

Function: component of hemoglobin, myoglobin, oxygen transport

■ Sources: seafood, meat , legumes, whole and enriched grains, potatoes,

egg yolk, green vegetables and dried fruit

■ Deficiency: extreme fatigue, weakness, headaches

■ Too much: diabetes, heart disease, liver disease, vulnerability to infectious

disease

Goals and problems of dietary inferences intakes (DRIs)

standard for nutrient intake developed by the Food and Nutrition Board of the Institute of Medicine. Used for planning and assessing standards for food programs

Different guidelines such as

Estimated average requirements (EAR)

Recommended Daily Allowance (RDA)

Adequate Intake Levels (AI)

Problems of Dietary reference intakes

■ Food labels use yet another standard: daily value (DVs) which is regulated

by the USDA and based on a 2000 calorie diet

■ Change according to the latest science and health concerns

■ Developed using data from the US and European countries

Nutrition Transitions

Anatomical changes during human evolution linked to nutrition transitions and supporting evidence

Bipedalism in Atutralopithecines

• Pliocene climate change 4-5 mya, African environments became drier, frosted areas gave away to open grasslands, patchy food distribution

• Upright walking for entry efficient locomotion

Big brain in early homo genus

■ Rapid increase in brain size

■ Increase in body size, dental changes

■ Change in dietary patterns allowed for increase in brain size

■ Brain tissue uses 20% of metabolic energy

Dentition (teeth)

■ Change in teeth suggest changes in dietary patterns

■ Chimps have larger canines than humans