W.B.C.S. Main 2018 Question Answer – Anthropology – Biomedical Anthropology.

WBCS  ২০১৮ মেইনস  প্রশ্নের উত্তর – নৃবিদ্যা- বায়োমেডিকাল নৃবিজ্ঞান।

1)Ennumerate the perspective of Biomedical anthropology in the understanding of non communicable diseases.

The epidemic spread of NCDs such as diabetes, depression, and eating disorders demonstrates that they are communicable, even if they are not infectious. We need to more critically explore how they might be communicable in specific environments. All diseases with epidemic potential, we argue, should be assumed to be communicable in a broader sense, and that the underlying medical distinction between infectious and noninfectious diseases confuses our understanding of NCD epidemics when these categories are treated as synonymous with ‘communicable’ and ‘noncommunicable’ diseases, respectively. The dominant role accorded to the concept of ‘lifestyle’, with its focus on individual responsibility, is part of the problem, rather than the solution, and the labelling of some NCDs as ‘lifestyle diseases’ is misleading. Founded on a critical understanding of global health and globalized medicine, we propose to explore the dynamics of the phenomena of contamination and biosocial contagion in networks. An analytics of biosocial epidemics needs to be developed by a medical anthropology that is engaged in a critical dialogue with both medicine and biology.Continue Reading W.B.C.S. Main 2018 Question Answer – Anthropology – Biomedical Anthropology.

Classifying CDs and NCDs

The CD-NCD distinction is intrinsically linked to different forms of biosociality and ideas about causation and lifestyle. Within the realm of communicable disease, chronic bacterial and viral infections such as tuberculosis (TB) and human immunodeficiency virus (HIV) have formed the biological basis for global treatment regimes that temporarily or permanently reorganize the lives of potential and actual patients and their relatives. These regimes also introduce the concept of risk to individual lives and households, and they create new kinds of people (Hacking 1986), such as HIV risk groups (Fordham 2001) and TB treatment ‘defaulters’ (Seeberg 2014), as well as therapy management groups and other types of patient networks (Meinert 2013; Meinert, Mogensen, and Twebaze 2009; Nguyen 2010).

NCDs, for which, by definition, a single infectant cannot be identified, are understood as having a multifactorial cause that usually cannot be effectively addressed with a single intervention. The major form of biosociality linked to NCDs is the ‘healthy lifestyle’ regime, which is presented as a moral imperative, requiring personal efforts to help keep society’s health costs down. It is a combined expression of the individual and greater common good. Hence, control of NCDs is primarily linked to health campaigns that seek to regulate the major risk factors associated with cardiovascular disease, cancer, diabetes, and chronic lung disease. The focus on lifestyle in health promotion has played an important part in establishing forms of biosociality that emphasize individual choice, for example, through healthy living campaigns and patient schools (Grøn 2004; Lupton 1995).

Although lifestyle may be an unusual focus in the management of treatable CDs, control of the most common NCDs tends to have the individual and his or her lifestyle as a primary target. Inherently moral constructions of undesired lifestyles, and the benign rewards of intrinsically healthy lifestyles are widely circulated by public health campaigns (Kelly and Charlton 1995). Sometimes, lifestyle interventions are accompanied by other, more complex interventions that resemble vector control. For example, in the case of malaria, rather than targeting the disease itself, some interventions target the vector – mosquitoes that transmit the disease – through insect repellent or insecticide treated bed nets. Aspects of public health measures against tobacco-induced lung-disease may resemble vector control. Some interventions, such as smoking-cessation campaigns, follow the standard lifestyle approach, trying to enable individuals to stop habits and dependencies that are perceived as undesirable. At the same time, the creation of the concept of ‘passive smoking’ (Jackson 1994) transcends the focus on individual lifestyle, and establishes smoking as health hazard in contexts of work, public transportation, family life, and pregnancy. But another strand of public health control has attempted to limit the spread of tobacco use by regulating the tobacco market through advertising restrictions and taxation, as proposed in the 1985 WHO report discussed above. This is more similar to the classic CD approach, implicitly positioning tobacco as an inorganic ‘vector’ of lung cancer and cardiovascular disease and attacking the spread of this vector in a poorly regulated market.

The case of epidemic (and endemic) tobacco-induced lung disease directs us to more useful ways of understanding the spread of disease than the current distinction between NCD and CD seems to allow. This approach is linked to the distinction between macro- and micro-parasitism, proposed by Baer, Singer, and Susser (2003). Although micro-parasites such as bacteria define the class of CDs, macro-parasites such as harmful industries may significantly influence the spread of NCDs. Following this line of thought, the global market has become an effective channel for communicating a number of diseases that are classified as NCDs, such as certain forms of cancer, certain mental illnesses, diabetes, and chronic obstructive lung disease. Although we recognize that such diseases are clinically defined by their microbiological characteristics, we suggest that their epidemic potential – that is, their ability to spread epidemically in populations – may be better understood in terms of their biosocial dynamics, as these are embedded in political economy and human biologies.

Contamination, configuration, predisposition

The elimination of the concept of ‘contagion’ from biomedical discourse may be seen as a result of the discovery of microbiological infectants, such as bacteria, which led to the creation of the category of ‘infectious diseases’ (Pernick 2002). This reclassification involved the reduction of a broad social and moral domain of contagion to one of biology. In the early twentieth century, this evolution of overarching medical concepts of noninfectious versus infectious diseases resulted in the authoritative distinction between noncommunicable and communicable disease, guided by the definition of communicable disease published in Control of Communicable Diseases, by the American Public Health Association in 1920 (Pernick 2002). As a category, NCD was an unsatisfactory definition from the outset; it was a residual category that was defined negatively, in terms of not being infectious. Could contagion have been kept as a meaningful category for understanding how some of these diseases may have epidemic potential.

Historically, contagion has been a problematic concept because of its heavy moral connotations, which have facilitated a process of ‘othering’ directed against those believed to be contagious. The concept often conflated the disease and the identity of the afflicted person, and served to justify stigmatization and social exclusion. In the absence of effective health care, such mechanisms may have protected some from disease. Yet, the distribution of both disease and health care is impacted by social forces, including deeply moralizing ones (Brandt and Rozin 1997). We suggest that contagion and the related notion of contamination may be used as analytical categories to capture these social dimensions of the spread of disease.

Rosenberg (1992, 295) sees ‘contagion’ as part of the more general concept of ‘contamination’, that is, ‘an event or agent that might subvert a health-maintaining configuration’. Thus, contamination subsumes the categories of contagion, infection, and pollution (for example, poisoning). He contrasts ‘contamination’ with the concept of ‘configuration’, which implies a focus on environment and social life. In Rosenberg’s view, as orientations that inform explanations of disease (and their epidemic occurrences), the former tends to be reductionist and monocausal, whereas the latter emphasizes system and interconnection – but they are not necessarily mutually exclusive.

Rosenberg (1992, 296) notes that a third term, ‘predisposition’, is used to explain why not all become ill when they are similarly exposed to contamination within a given configuration: ‘healers and laypeople have always needed to explain the immunity of some individuals from the epidemic “influence” surrounding them’. Where explanations of predisposition have historically been open to moral and religious interpretations, genetic explanations and the identification of biomarkers have more recently radically changed the understanding of predisposition.

The foregoing three concepts are, in Rosenberg’s historical account, types of explanations. However, they may also be used as analytical concepts. As such, their relevance has not decreased with the technological advances of medicine; an exploration of the relationships among contamination, predisposition, and configuration in epidemics of NCDs may be more useful, in terms of explanatory power, than is the idea of individualized and optional lifestyles.

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