Mitsuho IKEDA
*This is the summary of the paper with same title written in Japanese and published in Kumamo Journal of Culture and Humanities vol. 52, pp.41-72, 1996.
1. Introduction
This paper is a survey and discussion of history of applied medical anthropology. Understanding this history, the author puts following hypotheses.
a) The "donators" of medical assistance, e.g., suzerain state, colonial officer, doctor, and medical stuff, determine the socio-historical frame of medical assistance. Then "recipients" , e.g., colony, colonial, patient, and people, are fashioned by "donators" as a result of social adaptation. And/or "recipients" fashion by oneself the subject of resistance. Then we should examine the formation of these social rolls taken in each historical event.
b) The applied medical anthropology did not have a single origin. It is still interdisciplinary area that has multiple histories and origins. Then we should consider the interrelation of historical events.
2. Tropical Medicine as a Colonial Science
The medical assistance abroad began in the end of nineteen centuries. "Civilized" western countries tried to introduce results of tropical medicine into their colonies and underdeveloped counties. The tropical medicine supported by colonial government is different from the missionary medicine because the former is motivated not by religion but by a kind of "humanistic motive". Moreover the introduction to tropical medicine in colony was motivated by militaristic, economic, and academic reasons.
Colonial government promoted eradication of tropical diseases, such as hookworm, yellow fever, and malaria, because these diseases were strong obstacle to productivity and profit not only for colony but for its suzerain state. Combating with tropical diseases, doctors and medical stuffs had a kind of feeling of "noblesse oblige" or "destiny of civilization". This attitude can be called "paternalism". And the field of the tropical medicine was the most integrated area of public health with microbiology, that is the most advanced area of medical science in that era. Colony was just like a experimental laboratory of suzerain.
In this paper the author examines these explanations adducing projects of the Rockefeller Foundation. Some British "functionalist" anthropologists offered to collaborate with such a philanthropic foundation through working out new strategy, e.g., nutritional program, among inhabitants in Africa.
3. Medical Assistance as a Diplomacy
During the world war II, American applied anthropologists succeeded in making new conceptual framework of methodology different from colonial paternalism. In their field of Latin American countries, they carry out "collaborative" method involved with certain community.
After the world war II, many projects of international public health related in the Point Four Program were programmed in the West. The competitive aid and assistance program between the East and the West escalated. The historical fact is certified this trend. The paper discusses on the birth of the Technical Cooperation Administration in 1950 and the pass of Public Low 480 in 1954 in United States policy.
In that time, anthropologists have the following two agreements on promoting medical assistance in underdeveloped countries. (1) Health and disease are not only medical but socio-cultural phenomena. (2) It is difficult to introduce directly medical system of industrial society to underdeveloped society. Health program should be a part of integrated system of developing plan.
According with these agreements, anthropologists contributed to inventing "action anthropology" and introducing theories of behavioral science.
4. Critical Moment
In 1960's, theories of international public health were elaborated. On the other hand the actual fields of health programs were in hard time. Anti-colonial movements inspired social scientists in developed countries to consider the social origin of disease and the commitment to policy beyond the technical appropriation for biomedicine.
In underdeveloped countries the people confronted with "disease of development", that is caused by environmental change of rapid development, e.g., Schistosomiasis epidemic around the dam basin. In moderate-developed countries the victims of development are also found. Rapid industrialization worsens infant nutritional conditions in families of labor class. Infant mortality is raising during at the beginning of the economic growth.
In 1968 the Society for Medical Anthropology was found for promoting anthropological studies relating with health and disease, publishing results of these studies, and educating the people who do and wants to do such activities. We suppose that there were many students motivated to research and practice in this field. We do not know, however, how social needs for medical anthropology exerted the influence for academic attitude of anthropologists in the United States.
5. Development of Health
After the Oil Shock of 1973 the economic difference between the North and the South was brought up an issue more than the difference between the East and the West. The demands for economic aid of the underdeveloped were continuously increasing, on the other hand the capability of economic assistance of developed countries were slightly damping down. The revisionism of idea of economic development, e.g. structural adjustments in the end of 1970's, have emerged.
The revisionism influenced sociocultural idea of health. To measure health by quantitative extent was one of the most representative issues. The author examines the controversy of mid-1980's between the "selective" and "comprehensive" approaches in Primary Health Care program based on the declaration of Alma-Ata in 1978, demonstrating diversities of degree of political commitment of anthropologists. Today there are many health programs carry out in philanthropic, governmental, non-governmental, and international organizations of the world.
In 1980's there was a conceptual turn of the definition of health in international public health setting. The definition shifted from a good condition given as human rights to a forcible faculty of acquirement in social life. Modern discussion of health has to be argued more politically than before.
6. Conclusion
The author criticizes the division of study of international public health into two positions; "applied" and "critical". This dichotomy is problematic and ineffective, if we confront with diversified aspects of international public health. We should construct and imagine newly applied medical anthropology as a practically constructed science in the social space.
The author proposes the necessity of teaching applied medical anthropology in Japanese university not only in medical schools but in related faculty and even in liberal arts.
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**The original paper has the following indexes.
1. Introduction
2. Tropical Medicine as a Colonial Science
2.1 Countermeasure against Tropical Diseases
2.2 Rockefeller Mission
2.3 Anthropology and Philanthropy
3. Medical Assistance as a Diplomacy
3.1 The World War II and American applied anthropology
3.2 Beginnings of Applied medical anthropology
3.3 Model for Medical Assistance
4. Critical Moment
4.1 Ideals and Realities
4.2 Problems of Development
4.3 Society for Medical Anthropology
5. Development of Health
5.1 Emerging Anthropology of Development
5.2 Primary Health Care
5.3 Diversifying Medical Assistance
6. Conclusion