studies. Mendenhall effectively connects the lived experience of structural violence and poverty to the syndemic interactions of diabetes and other health problems (e.g., HIV/AIDS and depression) across a number of global contexts (from Delhi, Nairobi, and Soweto to Chicago); and does so in large part by analytically connecting the hard edges of social worlds to the very personal experience of these worlds.
As well, Kasey Jernigan (2018) has developed an embodied heritage approach in work on obesity with the Choctaw of Oklahoma that brings “meaning making” into a critical biocultural approach. She situates the bodies, biology, social life, and cultural identity of Choctaw today within the historical traumas of the past, ranging from the Trail of Tears, broken treaties and loss of food and land sovereignty, forced assimilation through residential schools, and government-run food distribution programs. Jernigan links traumas of the past to meanings of Choctaw identity in the present, including the complex understanding of large bodies and related health outcomes. These are just three examples among others that illustrate the power and potential of bringing to the forefront analyses of the feelings, thoughts, emotions, concerns, and anxieties of lived experience into biocultural frameworks tying structural inequalities to biology and health.
Critical biocultural anthropologists have also begun to ask questions about the biosocial consequences of social issues such as the culture of capitalism as in the work of Elizabeth Sweet and colleagues (2018) on debt and “embodied neoliberalism,” and Hoke and Boen’s (2020) recent research into the health effects of eviction. Taking up subjects of debt, eviction, addiction, incarceration, and homelessness are obvious topics for which a critical biocultural approach might offer insights. These will become ever more critical in upcoming years as a product of profound inequalities and pandemic effects.
The community-based work (HEAT: Health Equity Alliance of Tallahassee) of Gravlee, community organizers, colleagues, and students in Tallahassee, that of Ravenscroft and Schell (2015) on environmental pollutants in partnership with the Mohawk, and Galloway and coworkers’ (Fafard-St. Germain et al. 2019; Galloway et al. 2020) research on food insecurity and on cancer experiences in partnership with Inuit communities, all point to the value and critical need for more community-engaged and participatory biocultural work. Studies such as these might hopefully be the rule rather than the exception in the future.
These examples illustrate trends in critical biocultural studies of health and illness toward expanding engagement with social theory, and expanding the breadth of questions and contexts of biocultural analysis with an eye toward addressing important issues of social justice. We imagine and expect further engagement with other theories and problems within the areas of biosociality, biological citizenship, and biocommunicability (Briggs 2003, 2016; Briggs and Nichter 2009; Franklin and McKinnon eds. 2001; Petryna 2005; Rabinow 1996; Rose and Novas 2005), that have emerged over the past several decades as important within medical anthropology. For example, advocacy around specific diseases based on biological citizenship is increasingly common and is part of the terrain of scientific research. Such acts of biological citizenship would seem to provide particularly rich avenues for critical biocultural research; research that demands a thorough knowledge and integration of biology and culture. Critical biocultural approaches might also draw on biocommunicability – the production, circulation, and reception of (biomedical) knowledge – that has been proposed as central to an anthropology of epidemics (Briggs and Nichter 2009), and to two moving ethnographies by Briggs and Mantini-Briggs (2003, 2016) that forcefully link the biopolitics of the production and flow of information to the emergence and spread of epidemics and unequal exposures, treatments, and human suffering. The stark inequities exposed by the current COVID-19 pandemic, the efforts to control, limit, and otherwise obscure or confuse the information the public receives, and the divided response to public health efforts, makes the biocommunicability around epidemics all the more relevant and urgent; and of obvious import to any future work on this and other pandemics by critical biocultural medical anthropologists.
Conclusions
During the tumultuous start of the second decade of the new millennium, continued police brutality directed against black men and the COVID-19 pandemic has exposed fault lines of power and inequality in the United States and across the globe. Inequities of life chances and access to basic resources such as housing, food, health care, transportation, and the Internet along axes that include race, class, and gender have been laid bare. Critically informed biocultural approaches in medical anthropology, ones that foreground the health consequences of power and inequalities, are one avenue toward a fuller understanding of how large-scale political-economic processes, including a global pandemic and racism in criminal justice, impact local-level lived realities and become embodied.
Biocultural approaches in medical anthropology have at times occupied center stage and at times have sat on the intellectual periphery. In the latter half of the twentieth century a “chasm” developed between biological and culture perspectives in anthropology, and this was nowhere more evident than in medical anthropology. Yet, there is no escaping that human health – the focus of medical anthropology – is quintessentially a biocultural phenomenon. The question ought not to be whether to engage with biology; rather, it ought to focus us on how biocultural approaches might best enhance our understanding of biology and health in political-economic and sociocultural contexts.
We argue here for approaches we have termed critical biocultural that lie at the intersection of critical medical and biocultural studies of health. The sources of inequalities, whether they link to political oppression, poor access to markets, structured barriers to land ownership, or failed education and health-care systems, are not trivial. The root causes of poverty or inequality shape the forms they take, discourses and practices, efforts to alleviate the problem, and these are all key to a more complete and “critical” biocultural approach in medical anthropology.
The global health problems we face now and in the future are endless, but as Richard Feachem (2000) stated in the first issues of the Bulletin of the World Health Organization for the twenty-first century, addressing the health consequences of social inequalities is the most important global health task for the twenty-first century. We need a full range of anthropological perspectives to meet this task, and biocultural perspectives are particularly important for specifying the biological as well as social dimensions linking inequalities and health. Addressing these issues will call on us to expand our perspectives in new directions and build new collaboration across disciplines. Indeed, “integrating biological and socio-cultural perspectives in concrete and project-oriented situations” (Hvalkof and Escobar 1998, p. 443) may be the best means of achieving a biocultural synthesis.
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8 Benezra,
