Infant mortality in China

High infant mortality rates in China have been a consistent problem for the large country. The leading causes of infant deaths in 2008 were pneumonia, birth asphyxia, and preterm birth conditions. According to one study, social factors also play a large role in infant mortality rates. More educated women were more likely to take advantage of prenatal care and delivery assistance facilities. This differential usage of medical care before and after birth continues to contribute to the social origins of infant mortality. Additionally, infant mortality rates are higher in rural areas than in urban areas, likely due to the increased access to hospitals and health care in urban regions. One study discusses that infants born in rural settings are four times more likely to die than infants born in urban delivery centers.

Through the increasing use of medical pregnancy care and hospital deliveries after 1970, China has been able to reduce its high infant mortality rate. Newborn deaths in China also dropped 62% from 1996 to 2008. One study says that the driving force behind this new trend is the government rather than the personal disposable income for the average Chinese citizen. China launched an initiative in 2000 to promote hospital deliveries, especially in rural regions. This initiative allowed more resources to be available for pregnant women before birth and during delivery, and it has also increased awareness of the issue nationwide. Now, China has an infant mortality rate of about 16/1000 birth (ranked 112th worldwide) compared to the United States, which has an infant mortality rate of 6/1000 (ranked 176th).

Anthropologists G. R. Delong and P. W. Leslie have recently studied infant mortality in China. They are looking into more specific factors that affect infant mortality, such as the effect of iodination of water in iodine-deficient areas of China. Studying these specific factors of infant mortality will help us gain a greater understanding of its origins and how best to fix the problem.  (Article from: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(96)12365-5/fulltext)

Sources:
http://blogs.wsj.com/chinarealtime/2011/09/19/report-china-sees-dramatic-drop-in-infant-deaths/

http://www.ncbi.nlm.nih.gov/pubmed/20346815

http://escholarship.org/uc/item/0r6938nn#page-5

Clinical Medical Anthropology

I chose to further investigate clinical medical anthropology. I feel this intersection of applied medical anthropology definitely relates to my career interests as I am hoping to be a primary care physician. As a physician who likely sees a wide variety of patients on a day-to-day basis, it will be important for me to understand the implications of culture on illness. A basic understanding of clinical medical anthropology will be a huge advantage in this career field.

If I were working for a health care provider such as another doctor who was not an anthropologist, I think it would be useful for me to have a background in anthropological perspectives.  Working in hospital or private practice, I would treat patients with a wide variety of cultural backgrounds and viewpoints about health and illness. Additionally, you can never know what a person’s view about health and illness are just by looking at them. As the Kleinman and Benson paper discussed, culture cannot always be simply reduced to a set of technical definitions and terms. Patients of a certain ethnicity- such as “Chinese” or “Hispanic”- cannot just be assumed to have a certain core set of beliefs because of their ethnic traits. It would be very useful to have a certain degree of cultural competency in such a clinical setting because it would allow the physician to best diagnose and treat each patient as an individual. No patient or physician is a blank slate; we each have our own set of beliefs and practices. As a physician, it would be my job to understand and empathize with different perspectives of different cultures, and a background in clinical medical anthropology would be very useful. The biomedicine model does not always prepare clinicians to handle the cultural and social aspects of an illness, but the clinicians does need to be aware that these factors have a great deal of effect on health care.

Outside source: http://ptjournal.apta.org/content/64/6/929.full.pdf

Lecture material: http://anthropology.msu.edu/anp204-us12/files/2012/06/6.-Kleinman-and-Benson-Anthropology-in-the-clinic.pdf

Acne

I chose to analyze acne as a highly medicalized condition in U.S. culture. Many people are affected by acne, but I think the sheer number of acne commercials and “treatment systems” have allowed it to become medicalized in our culture. Rather than a normal part of growing up, it’s seen as a malady that needs to be medicated. I think there are heavy cultural influences that re-framed acne as an illness. Teens and young adults with acne are subject to the constant influence of popular culture and media, which tells them they don’t fit the “ideal” if they have acne. Our culture emphasizes the importance of clear skin with every flawless celebrity that graces the cover of magazines and movies. There are hundreds of acne treatments on the market today, ranging from antibiotics to medicated face washes to chemical peels.

Additionally, everywhere we turn we find a new acne commercial for the next greatest acne treatment system. I included a commercial for Proactive that features Justin Bieber, a teen sensation and a very recognizable individual. The commercial shows the Biebs performing at a packed concert and playing basketball with a group of friends. This advertising strategy insinuates that it’s hard to have a good social life when you have acne. Pop media outlets such as television, movies, reflect this cultural ideology and magazines, and each shows us that the most important thing is to look good. Additionally, it shows how easy the product is to use and emphasizes its low cost, making the consumer feel that the choice to use proactive is logical and obvious. It also pushes the popularity of the product with a bandwagon approach; it is advertised as the best acne system in the country and uses a celebrity to get its point across. Lastly, the commercial shows a product that is backed by certified dermatologists, which makes the consumer feel the product is legitimate and makes the condition of acne a medically validated concern.

Male/Female

This week’s materials were interesting for me, because I’ve never really taken time to consider the culture of biomedicine before. As was discussed in the lectures, we don’t really see biomedicine as having a culture, because we view at is the scientific truth. We sometimes see it as both universal and objective, but it really is a reflection of our culture as a society. Part of the culture of biomedicine is its history. As stated in the lecture materials, it is a healthcare system that is culturally constructed and amended over time, as with the implementation of germ theory. Additionally, it holds beliefs about dichotomies, uses rituals and symbols, and involves rites of passage on a regular basis. A recent trend in the culture of biomedicine is biomedicalization, where medical intervention is used to enhance the body and behavior. I think it’s important to have an understanding of the culture of biomedicine because it helps put our medical system into perspective when compared to other medical systems.

I think dichotomies are an important concept in biomedicine. They could have arisen over time out of a need to compare and contrast in the medical field. For example, it’s hard to classify something as “healthy” if there is no opposite term like “ill”. Dichotomies help us describe and explain these concepts. However, although they appear black and white at first glance, I feel that dichotomies always have a gray area that is not always taken into account. It’s hard and usually inaccurate to classify something as mutually exclusive of the other.

The dichotomy of male/female is interesting to me because it seems so socially and culturally constructed. As discussed in the lecture materials, some cultures do not draw such distinct lines between male and female, and some don’t recognize any line at all. In my opinion, the male/female dichotomy can be described in terms of sex and gender. Sex is the chromosomes we are born with (although there is some gray area here too, as some individuals are not just XY or XX). Our gender is male or female depending on how we feel and act within a certain culture and society; however, our gender is often assigned to us based on the nature of genitalia. I think there is a lot of room for gray area here too, as gender roles and the male/female dichotomy don’t really allow for hermaphrodites, inter-sexed individuals, etc. This dichotomy is accepted as logical and easy to interpret by some because it’s easy to only looks at a person’s biological appearance and genetic make-up and label them as either male or female.

True Life: I have schizophrenia

The True Life episode that I chose focuses on three young individuals (Amber, Josh, and Ben) who have been diagnosed with schizophrenia. As different people, they each deal with their illness differently and I would classify each of their stories with a different illness narrative.

Amber’s illness narrative is a quest. She looks at her schizophrenia as a journey and a process, but she has hope that one day she will have no symptoms. Her emphasis is on being able to function better and better, especially in a college setting. Josh’s illness narrative is chaos. He views his schizophrenia as chronic. Not only does he think the illness will never get better, but he actually doesn’t want to get rid of his symptoms because he feels less lonely when he hears voices. Josh refuses professional medical treatment and he seems to have little hope that his life will improve. Ben’s narrative is somewhere between a quest and chaos. For the majority of the episode, he honestly doesn’t seem to be doing anything to improve his condition or seek help. However, he does hope to be able to improve his ability to function over time and eventually seeks more consistent treatment.

In our culture, I think that most mental illnesses are somewhat stigmatized. In schizophrenia, the individuals may be looked down upon as being “crazy” and somewhat ostracized. The sick role of these individuals shows their rights and responsibilities with the illness. They acknowledge that they are ill, and most submit to the care of a professional to validate their illness. They are often excused from normal responsibilities (holding a job, attending class) due to their illness.

There are a few experiences with medical professionals throughout the episode. Josh refused professional help and clearly didn’t trust it. Amber went to group meetings for mental illness and private counseling, both of which seemed to help her cope with her condition. Ben is never shown seeking professional help, but he is taking prescription medicines and therefore has sought help from a biomedical doctor.

These individuals use their illness narrative to share their experiences with family and friends, and it helps them feel less isolated. Sharing their experiences through narratives helps health professionals understand what is happening, and allows them to respond with the best possible treatment.  As in the post-partum blog we read this week, using illness narratives helps the individual relate to others experiencing the same illness and helps them improve their health.

Post-Partum Depression

I found the material about post-partum depression to be an interesting topic in this week’s lecture materials. Post-partum depression is triggered by the birth of a child, and can occur in both men and women. Its symptoms can include irritability, loss of energy, crying spells, feelings of worthlessness, and negative feelings toward the baby. In the blog “A Dad’s Story of Male Post-Partum Depression” the man felt symptoms of confusion, exhaustion, and cynicism.

Culture can make the experience of post-partum depression more difficult for the person, because it is sometimes seen as a subjective medical condition and even looked down upon. I think this illness is sometimes frowned upon because in our culture people are always expected to react with joy to the birth of their child, and are expected to hide their difficulties in dealing with the new arrival. Therefore, post-partum depression is seen as a character flaw or weakness in a person. The person may be more inclined to hide his or her illness in this kind of cultural environment, rather than showing “weakness” and acknowledging the problem to a doctor or family/friends. Biomedicine could be used to treat post-partum depression if the person is willing to seek treatment. If the person doesn’t want to admit they are experiencing an illness, it can delay treatment and allow the illness to progress. In the blog from this week’s materials, the dad cites individual counseling and antidepressants as possible sources of treatment.

I think belief and healing are directly related. The video “Placebo: cracking the code” helped detail just how powerful the mind is. Some of the examples were incredible. The most striking for me was the study concerning the knee surgery vs. placebo surgery, and how comparable the results were. As they discussed in the video, before there was modern medicine, humans survived and were able to treat and heal themselves. In my own experience, I tend to deny to myself when I’m starting to feel sick. In these cases I often take a Vitamin C supplement, which probably acts as a placebo to keep me feeling healthier. I think the body can do amazing things if the mind will let it; obviously, biomedicine can make a significant impact as well, but positive thinking and belief are big contributing factors.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004481/

Nervios in Latin America

Nervios is a culture-bound syndrome that is indigenous to Latin American populations. The term is sometimes used interchangeably with ‘nervousness’ or ‘anxiety’, although the article says it is not synonymous with formal diagnostic criteria of anxiety disorders found in the DSM, nor is it acknowledged by biomedical practitioners. As with many other culture-bound syndromes, nervios can be an explanation of an illness, a symptom, or a cause of another illness. The symptoms of nervios encompass a wide range of symptoms of Western illnesses, from depression to schizophrenia. Biological symptoms include crying fits, shaking, or trembling. Additionally, nervios is said to occur mainly in women. However, many symptoms appear to be more psychological in nature and include feelings of depression or sadness, and feelings of hopelessness. Despite the numerous emotional and interpersonal symptoms in addition to physical symptoms, Latin American communities do not consider nervios to be a mental illness. Puerto Ricans in particular differentiate between types of nervios; ‘ser nervioso’ is to be a nervous person in general, as a personality type; ‘padecer de los nervios’ is literally ‘to suffer’ from nerves, and is more of an illness associated with depression; ‘ataques de nervios’ are nervous attacks that can occur as a result of a particularly stressful event. From a social and cultural perspective, nervios can be a way of expressing distress from everyday problems and conflicts, such as family fights. The causes of this illness vary, and can be attributed to the experience of financial difficulties, food and work problems, accidents, not eating well, or drinking too much. Nervios carries a broad variety of interpretations across different Latin American regions, demographic groups, and communities; so much so, in fact, it has been argued that nervios defies the definition of a culture-bound syndrome. However, analysis of responses to questions concerning the causes, symptoms, and treatments revealed that: “A single, shared system of knowledge about nervios exists for each sample of respondents.” (Baer 315-333)

A doctor or psychologist (professional sector) appears to be recommended to give treatment for nervios; according to the article, there seems to be a preference for psychotherapy over medication. Folk healers (folk sector) and home treatments (popular sector) do not seem to be as well documented for treatment. The DSM-IV-TR is said to include a listing for nervios, making me assume that it may be recognized to some extent in Western medicine.

Baer, Roberta D. et al. “A cross-cultural approach to the study of the folk illness
Nervios.” Culture, Medicine, and Psychiatry 27 (2003): 315-37. Print.

http://www.springerlink.com.proxy1.cl.msu.edu/content/xp653t40p3420425/fulltext.pdf
 

Shamans in Mongolia

The documentary “The Horse Boy” was a very interesting film for me. As I do not have any family members or friends with autism, I honestly did not know much about it. The documentary follows a couple and their four-year-old son through their struggles with autism. Frustrated with the limitations of Western biomedicine on their son’s autism, the parents decide to embark on a journey to seek out the fabled shamans of Mongolia. As Rowan (the son) seems to have a special connection with horses, they hope the nomadic horse and reindeer tribes of Mongolia will have a positive effect on him. They encounter many struggles even while in Mongolia, including Rowan’s inconsolable tantrums and his father’s guilt that he isn’t doing the right thing. The family of three seeks out numerous shamans and undergoes several shamanic rituals designed to treat Rowan’s autism. After the last shamanic ritual, Rowan seems to be more interactive with other children, happier, and has fewer episodes of tantrums. Although the mom seems hesitant to admit that shamanism is what helped her son, he did indeed seem improved by the end of the film.

The healers in this documentary were the nomadic shamans of Mongolia. They seemed to be revered and well respected by the people, and therefore may enjoy a higher social status than the average Mongolian. However, they certainly did not seem wealthy in a Western sense of the word. Their clothing was worn, but they frequently were attended by assistants and seemed in control of any social situation. Most of the shamans dressed in colorful costumes that often included some animal feature, such as eagle feathers. The techniques they used involved chanting, prayer, consumption of ritualistic drinks, and communication with the spirit world. Additionally, these rituals involved the whole family and often many other shamans as well.

I believe the shamans operate in the folk sector. Their treatment methods were non-invasive and holistic, generally involving the whole family. Additionally, the shamans appeared to be somewhat sacred individuals who shared the cultural values of the society. There techniques were highly spiritual and ritualized, and there was no use of biomedicine or Western medicine. The body and symptoms are understood with respect to the spirit, a person’s ancestors, and other surrounding spirits.

In Sickness and In Wealth

I only got a few of the questions right on the Health Equity Quiz! I thought it presented some very interesting statistics. The most surprising to me was that life expectancy in the U.S. is ranked only 29th in the world, and yet the U.S. spends more than twice the average per person of other industrialized countries. Most of the statistics in the quiz did not reflect well on the state of health and healthcare in the U.S.

I chose the “In Sickness and in Wealth” case study. The video shows the lives of four families with very different socioeconomic statuses in parts of Louisville, Kentucky. As we see throughout the video, the family with the highest socioeconomic status also is able to maintain the highest level of health; they have time to exercise, take vacations, and are able to eat well. They also have the highest life expectancy. As the video starts to show families with lower and lower socioeconomic status, we see life expectancy decrease. These families tend to not have the time or resources to make choices to eat well or exercise frequently. Additionally, the video describes a study about chronic stress and corresponding high cortisol levels, which could contribute to poorer health and lower life expectancy. In summary, the video shows us that our socioeconomic class can shape our opportunities and resources for good health.

Politics, economics, environment, culture, biology, and individual choices are all factors that interact to impact health and illness. Economics plays a role because if you have the financial resources to seek out medical assistance when you’re ill, you’re more likely to be able to afford prescription medicine and regain your health. Additionally, you’ll be able to take preventative measures for your health, such as eating well and exercising.  Politics and policy-making can help create a better environment to live in, but it can also create a poorer living environment as well. Living in an unhealthy environment reduces a person’s opportunities for good health, because they are constantly surrounded by factors such as poor air quality or little access to healthy foods. Our biology and our genes are a basic starting point for our health, and a family history of certain diseases may mean we are more likely to have them ourselves, especially if the environmental conditions do not allow for preventative medicine. Lastly, culture and individual choices have a huge impact on health and illness. For instance, different cultures have vastly different definitions of what constitutes a disease and how it is treated. If a person’s own cultural context does not correspond with that of the doctor treating him or her, they may not receive the treatment they need or desire to prevent the spread of disease. Despite our individual environments and biology, we all have the opportunity to make decisions that have a positive impact on our health, such as exercising.

Cystic Fibrosis in White Americans

 

Citation for image: http://www.lung.org/assets/documents/publications/solddc-chapters/cf.pdf. This illustration shows the prevalence rates of cystic fibrosis according to a person’s race and ethnicity.

I chose cystic fibrosis as the health issue that is disproportionately prevalent among Caucasians. Cystic fibrosis is a disease that causes breathing difficulties and recurrent lung infections. Cystic Fibrosis is among the most common inherited diseases in Caucasian Americans; the disease occurs in 1/2500-3500 Caucasian newborns. It also occurs in other ethnic groups, but is much less common, affecting about 1/13,000 Hispanic Americans, 1/17,000 African Americans and 1/31,000 Asian Americans. (http://ghr.nlm.nih.gov/condition/cystic-fibrosis)

I believe that cystic fibrosis could be most common in white Americans for primarily genetic reasons. Cystic fibrosis is an inherited disease caused by a defective gene for a particular protein that controls the balance of chloride in the body. It could be that it is more likely for Caucasians to have the cystic fibrosis mutation in that particular gene that they then pass on to their children. In order to develop cystic fibrosis, a person must inherit a copy of the defective gene from each parent. Additionally, because cystic fibrosis is a recessive autosomal disease, it is more likely for the child of two Caucasian parents to have the disease than the child of two parents of mixed ethnicities, as these non-Caucasian parents are less likely to carry the gene mutation that leads to cystic fibrosis. There could also be social determinants of this disease, if in a particular socio-economic group, groups of Caucasians only produce children with other Caucasian, and groups of non-Caucasian only produce children with non-Caucasians. This would keep the cystic fibrosis gene mutation primarily in Caucasian gene pools. (http://www.lung.org/assets/documents/publications/solddc-chapters/cf.pdf)

Citation for image: http://www.medicinenet.com/cystic_fibrosis/page2.htm

Based on the material from the lectures this week, I believe that race, genetics, and health have a dynamic and interdependent relationship. Studies tell us that certain disease have higher rates of prevalence among certain ethnic group or races; however, lecture material tells us that there is no such thing as biologically discrete races. For instance, in the lecture material, there was a discussion about Bidal being a “racialized medicine” that is more effective in African Americans. However, we also learned that race is politically, culturally, and economically charged; it is not a proxy for genetics. Therefore, neither race nor genetics is the sole determinant in health. Health as a whole is affected by a person’s culture, environment, socioeconomic group, ethnicity, and genetics.