ETHNO-EPIDEMIOLOGICAL EXPLANATORY MODEL
The term ethno-epidemiology has acquired two different but intertwined meanings in the social sciences. On the one hand, it refers to an emergent cross-disciplinary health research methodology that combines the strengths of direct participant observation and other qualitative methods for understanding social meanings and contexts as practiced in medical anthropology with the design, sampling, data collection, and analytical strategies focusing on risk factors and disease outcomes developed in epidemiology. This use is referred to here as ethno-epidemiological methodology. On the other hand, as Michael Agar notes in “Recasting the ‘Ethno’ in ‘Epidemiology’” (1996), the term is also used in the literature to refer to emic (i.e., insider) or folk systems of disease understanding and response. This usage is referred to as the ethno-epidemiological explanatory model. Together, these constitute important tools for conducting and targeting public health research.
When medical anthropology emerged as a field, it was concerned primarily with folk illness conceptions and related indigenous healing behaviors. On this foundation, it has evolved into a robust subdiscipline focused on studying the immediate cultural and broader social factors involved in the experience, understanding, and behavior of illness. Medical anthropologists use this information to contribute to empirically grounded public health development. Epidemiology developed as the scientific arm of public health centered on emergent disease causation, trends in disease occurrence, and assessment of the effectiveness of intervention. Since the mid-1970s, the boundary between medical anthropology and epidemiology has witnessed a growing number of conceptual and programmatic exchanges. Some contacts have been fraught with tensions, as occurred in the medical anthropological critique of epidemiological construction of “risk groups” in the HIV/AIDS epidemic, or when epidemiologists express wariness about small, nonrepresentative anthropological studies. Other points of contact have been highly collaborative and productive, such as various successful oral rehydration projects internationally. Although both disciplines bring a distinct approach to the study of the intersection of disease and behavior, epidemiology traditionally has taken the formal road of statistical and quantitative methods, whereas medical anthropology has favored qualitative strategies that allow access to on-the-ground behaviors and insider understandings. Ethno-epidemiological methodology is a direct product of efforts to build collaborative approaches between these two health-related research disciplines.
The development of ethno-epidemiological methodology reflects several trends in public health and medical anthropology, including: (1) a growing reliance on mixed-method research designs and multidisciplinary research teams in the investigation of health risks; (2) an increasing emphasis in medical anthropology on systematic data collection and analytic strategies and a corresponding decline among quantitative researchers in criticism of ethnography as being unscientific; and (3) a growing understanding of strategies for the triangulation or integration of different types of data. All of these changes are seen, for example, in the study of drug-related risks for the spread of HIV disease. Research in this arena now typically involves teams of experts from diverse disciplines; the integration of ethnographical, epidemiological, and other approaches to data collection; and achievement of enhanced outcomes based on the comparison of qualitative and quantitative findings.
More recently, there has been a push for an even greater integration of medical anthropology and epidemiology through the creation of cultural epidemiology. According to Jim Trostle (2005), cultural epidemiology promotes the study of diseases and their causes in terms of the contribution to health trends made by culture. Modeled after social epidemiology, which examines the health-related effects of social inequalities, cultural epidemiology would extend the variables under consideration to include folk systems of disease classification, meaning systems, culturally constituted risk patterns and conceptions, and other behaviors commonly analyzed as cultural in origin by medical anthropologists. These factors, Trostle maintains, should be critically important to epidemiology because people’s conceptions and behaviors impact their health. Raymond Massé (2001) introduced the term critical ethnoepidemiology to refer to the linking of an interpretativist analysis of local illness meaning and a critical analysis of asymmetric social and economic relationships.
ETHNO-EPIDEMIOLOGICAL EXPLANATORY MODEL
Arthur Kleinman (1980) introduced the term explanatory model to label the ideas activated during an episode of sickness and treatment by all those involved in the clinical process. Explanatory models provide culturally meaningful explanations of sickness (e.g., its nature and causes) and treatment (e.g., best practices) that are used in health decision-making. For example, in The Spirit Catches You and You Fall Down (1997), Anne Fadiman recounts the story of Lia Lee, a Hmong child who began having intense seizures, which were interpreted as signs of “soul loss” by her parents and a Hmong shaman, but diagnosed by physicians as epilepsy. Convinced that Lia’s parents were not administering the medicines they prescribed because of their faith in Hmong ethnomedicine, Lia’s doctors launched a successful effort to have her removed to foster care.
As Kleinman recognized, different parties active in a sickness incident—including professional healers, folk healers, and the wider social group of the patient—can embrace differing conceptions or models of illness, treatment, and recovery. Of interest to Kleinman, and many medical anthropologists ever since, are the relationship of explanatory models to the wider cultural systems of which they are a part and the nature of the interactions that unfold when alternative explanatory models meet (and perhaps clash) during sickness episodes in diverse sociogeographic settings.
Ethno-epidemiology in this sense, as an indigenous explanatory model of disease causation, spread, prevention, and treatment, reflects the growing medical and public-health understanding of the significant influence of patient attitude, experience, and behavior in sickness and recovery. D. Lee and coworkers (2004), for example, demonstrated that the Chinese cultural practice of peiyue —a postpartum custom of mandated family support—is associated with a lower risk of postnatal depression.
The two meanings of the term ethno-epidemiology described above are unified in their recognition of the fundamental importance of culture in health, with ethno-epidemiological methodology referring to approaches for its in-depth and systematic study, and ethno-epidemiological explanatory models labeling the local cultural conceptions of disease now recognized as a significant influence on disease expression and response.
SEE ALSO Anthropology, Medical; Disease; Public Health
Agar, Michael. 1996. Recasting the “Ethno” in “Epidemiology.” Medical Anthropology 16 (4): 391–403.
Fadiman, Anne. 1997. The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures. New York: Farrar, Straus, and Giroux.
Kleinman, Arthur. 1980. Patients and Healers in the Context of Culture. Berkeley: University of California Press.
Lee, D., Chan, S., Sahota, D., et al. 2004. A Prevalence Study of Antenatal Depression among Chinese Women. Journal of Affective Disorders 82 (1): 93–99.
Massé, Raymond. 2001. Towards a Critical Ethnoepidemiology of Social Suffering in Postcolonial Martinique. Sciences sociales et santé 19 (1): 45–54.
Reisinger, Heather. 2004. Counting Apples as Oranges: Epidemiology and Ethnography in Adolescent Substance Abuse Treatment. Qualitative Health Research 14 (2): 241–258.
Trostle, James. 2005. Epidemiology and Culture. Cambridge, U.K.: Cambridge University Press.