strategies” (p. 4) should be applied. This includes being free to redefine research questions and methods as research moves along, as well as to question initial research assumptions with the express goals of “reconfiguring the boundaries of the problem” (Lambert and McKevitt 2002, p. 212) and making sure that various stakeholders’ standpoints are represented. Happily, health-care experts, too, increasingly recognize the shortcomings of a factorial gaze; medical anthropology has contributed greatly to the nascent growth of a new methodological openness in these circles.
Biocultural Developments
Despite the scorn for science promulgated by some in the later twentieth century, biological medical anthropologists continued to attract students and quietly made substantial progress. They could afford to be quiet: Many journals outside of anthropology gladly accept their work. Importantly, in terms of tenure and promotion, many of the extra-anthropological journals that welcome biological anthropology have higher impact factors than those of the home discipline. Publications in such journals also can “count” more on grant applications, thereby helping assure a steadier stream of funding.
In the 1970s, the term “biomedical” had been applied to biologically oriented work with fairly immediate clinical applications or relevance for investigations of universal (albeit perhaps locally expressed) biological or disease processes. As time wore on, political ecology, which acknowledges that power relations affect the ways that human groups handle their natural environments (e.g., water, soil), and documents the health ramifications thereof, grew increasingly popular. While its treatment of culture was rudimentary, political ecology did offer an alternative to the narrower adaptationist perspective promoted by some environmentally oriented anthropologists.
By the 1990s, some biological anthropologists who had followed developments in critical theory acknowledged political ecology’s reductionist tendencies and called for deeper appreciation of the dialectical relationship between culture and biology (see Baer 1996; Singer 1996). A more sophisticated biocultural synthesis emerged – one highlighting the complexly interactive roles that social structures and the local and global political economies that support them play in biological outcomes (see Goodman and Leatherman 1998). Some areas of inquiry benefitting from this approach are global malnutrition, tourism’s impact on host population health, the situational emergence of syndemic clusters of disease or affliction, the consequences of declared and undeclared wars, or of structural racism, and even how pollution, deforestation, soil degradation, and climate change have affected human health. Such anthropogenic hazards can converge, each having a multiplier effect on the other, and thereby on human (and other species’) well-being; and effects can be transgenerational.
For example, a disenfranchised cultural group’s socioeconomic status can both set that group up for toxicant exposures and be the outcome of such exposures, experienced earlier. To wit: for years various factories discharged contaminants into the St. Lawrence River, upstream of Akwesasne Mohawk territory (which spans the US-Canada border). Fishing, hunting, and gathering became problematically dangerous: Developmental and reproductive abnormalities co-occurred with high pollutant levels, as did depressed thyroid activity, and obesity. Worse, one generation’s exposure-linked problems reduce life opportunities (e.g., educational achievement) for subsequent generations, compounding the toll as social distinctions become self-reinforcing (Schell 2012; Schell, Ravenscroft, Cole, Jacobs, Newman, and Akwesasne Task Force on the Environment 2005).
The demographic impact of COVID-19 follows a similar pattern: diseases more common in minoritized groups due largely to the legacy of their disenfranchisement (e.g., diabetes) increase the risk for infection and death from COVID-19. Concurrently, living and occupational conditions for such groups entail a higher risk for exposure. These inequitable arrangements simultaneously support an economy that benefits its investors and owners.
Biocultural explorations have advanced more than political ecology. For instance, investigations into culture’s role in creating and sustaining the placebo effect led to advances in theory regarding how healing works. Questions regarding the mechanisms whereby culture is embodied have enhanced our understanding of “stress.” Biologically oriented work has illuminated human–plant interaction, including regarding the microbiome and the antimicrobial value of certain herbs. Interest in trans-species or “human animal health” also has grown in recent years, as has our appreciation for multi-system interconnectivity.
THEORY TO THE CENTER
As the twentieth century drew to a close, and medical anthropology matured, the subfield’s theoretical and methodological advances began informing and inspiring the larger discipline. General debates concerning culture, power, representation, social justice, and other issues increasingly reflected advances stemming from medical anthropology. This was seen in work on narrative or storytelling; identity creation and maintenance, and subjectivity and temporality (especially in relation to stigmatized physical and mental conditions); the role and impact of audit and surveillance systems and authoritative knowledge; health-care consumerism, pluralism, and syncretism; local and global health inequities; postcolonial trauma, and so on. Much of this work, it must be said (and see later), was influenced by extra-anthropological ideas, such as: Johan Galtung’s “structural violence” (1969, but see also Virchow 1985 [1848]), Michel Foucault’s “governmentality” and “biopower” (e.g., 1976) and, more recently, Gilles Deleuze and Felix Guattari’s “rhizomatic” perspective (1987), with the latter leading to an amplification of agency, desire, and potentiality, and indeterminacy in explorations of biopower. Another arena from which medical anthropology has strongly drawn of late (and added to) is Science and Technology Studies.
The hope for generating generally relevant anthropological theories and concepts always has been there: As noted, some opposed medical anthropology’s instantiation as a subfield for fear that it might contribute unduly to the fragmentation of the field as well as to mute the subdiscipline’s ability to speak to pan-anthropological concerns. Yet, despite the persistent argument for medical anthropology’s relevance to “issues of interest to the discipline [as a whole, such as] culture contact, the acceptance of innovations, the organization of professional subcultures, and aspects of role theory among many others” (Colson and Selby 1974, p. 254) and despite exceptions to the rule, it was not really until the late 1980s and 1990s that such relevance was strongly seen. This marked medical anthropology’s emergence from the margin into the mainstream of the field (Johnson and Sargent 1990; see also Singer 1992a). More recent evidence of this has been the prevalence of health-related anthropology occurring outside of the subfield altogether, and of individuals not belonging to the SMA self-identifying as “medical” anthropologists.
Reinventing Wheels?
The named subdiscipline of medical anthropology has existed now for over 60 years. Its degree programs and textbooks have proliferated. However, and perhaps partly as a result, much present scholarship is in some ways redundant. For one thing, concepts and new bits of jargon delineated in popular publications are applied or repeated ad nauseam as others seeking to advance follow fashion. Take, for instance, “biological citizenship,” key to Adriana Petryna’s theorization of Chernobyl-injured Ukranians’ struggles with the state over access to health care and related resources (2002). Petryna’s work was part of a wave of innovative writing on biosociality (Rabinow’s term) that also spawned various other forms of corporeally anchored “citizenships.” By the end of the decade, however, the biocitizenship construct had, some said, lost its analytic power (Cooter 2008; and see Whyte 2009).
A second source of redundant scholarship in medical anthropology today is its magnitude. The literature is vastly more extensive now than a generation ago, making total command a real challenge. Concurrently, journal submission length limits have shrunk as publishers have had to economize (and to accommodate readers’ new habits), limiting the thoroughness of literature reviews. Sometimes areas of study, despite certain scholars’ insistence that they
