Anthropologists in Health and Economic Development

During the 1930s, many anthropologists worked in educational and medical welfare programs within colonial administrations (Montgomery & Bennett, 1979, p. 128; see also Asad, 1973) in Africa and Asia. Their express goal was, often enough, to protect the health of English and French colonial administrators. In the 1940s, these early projects were expanded into development assistance programs linked to the idea that technology would solve the economic underdevelopment of poor countries. Public health professionals expected that people in poor countries would accept the medical interventions of the colonial powers. When such efforts failed to yield results, many European health experts began seeking the assistance of anthropologists in order to comprehend native cosmologies and local understandings of health and healing. The stated goal was to understand why biomedical ideas and therapies were not readily accepted (Moore, Van Arsdale, Glittenberg, & Aldrich, 1987, p. 9; see also Paul, 1955).

In the 1950s, applied medical anthropologists were engaged in international public health to examine "cultural barriers" to health promotion and health campaigns and to design health programs that would be deemed culturally appropriate by local populations ("the natives"). Their role was to interpret community structures and help foreign or foreign-trained health technicians to implement top-down development programs (Farmer & Good, 1991, p. 137). There was, at the time, little critical reflection on the purpose of such programs or on the perceived needs of the populations the programs sought to serve. Studies of traditional healers, including birth attendants, proliferated at this time. Later, the anthropologists who produced such work were criticized as being "handmaidens" of biomedicine and cheerleaders of the Western "medical industrial complex."

By the 1960s, it was acknowledged that development work involved social processes so complex that technology alone was insufficient to solve the "underdevelopment" of poor countries (Foster, 1962). Soon, macro-economic growth became the professed solution, and the urban and industrial sectors became the focus of many development programs. Because anthropologists had been working largely on rural and community development programs, few of them remained involved in development work, although the field of medical anthropology was growing rapidly, especially in the United States (Pillsbury, 1986, p. 12).

During the 1970s, an exclusive emphasis on economic growth revealed itself to have its own limitations. Many actors—from policy-makers to researchers to peasant populations—argued that increasing social inequalities often followed increases of GDP. Some medical anthropologists were very critical of development programs, and directed their critiques at both the technical and the economic growth "solutions" to development.

A second strain of criticism of the "economic growth solution" came from dependency theory (Cardoso & Faletto, 1969/1978; Dos Santos, 1970; Prebisch, 1949) and world systems theory (Wallerstein, 1974). Both models allowed that the end of colonialism changed the political structures of relations between citizens of former colonies and administrators. However, the structure of economic relations, based on "free trade" and limited governmental involvement, was maintained and contributed to persisting inequalities between and within countries. Critics argued that the "economic growth solution" relied on several mistaken assumptions. One of the symptoms of growing economic inequalities was the persistence or "reemergence" of diseases that had been previously slated for eradication.

At the same time, the primary health care movement, based on community involvement and upon the concept of rights, opened the door for participation on the part of anthropologists in the design, implementation, and evaluation of PHC (Pillsbury, 1991, p. 66). George Foster encouraged the involvement of anthropologists in the health-policy arena by studying the bureaucratic structures and personnel of the development agencies themselves (see Foster, 1977; Tendler, 1975). The contributions of anthropologists to the development field were enhanced by improvements in the theory and methodology of anthropology, mainly the emergence of subfields devoted to problem solving in the areas of health, education, or agriculture. Studies of the impact on poor or otherwise marginalized groups of central decisions about health and social policies were also initiated.

In the 1980s, the participatory approach, enhanced by the primary health care movement, became a cornerstone of many development programs designed to be equitable. It was based on the idea that the lived experience of people ("putting people first"), and not GDP indicators, needed to be central to the conduct and evaluation of development programs (Cernea, 1985; Justice, 1989). People-centered development became one anthropological approach to economic development (Pillsbury, 1986, p. 22), a heterogeneous social process often informed by an interest in human rights (Bennett, 1996, p. S32) or in redressing gender inequalities (see Boserup, 1986).

By that time it had become increasingly clear that many of the health and social problems facing the world's poor populations were not in fact due to endogenous cultural factors but rather a complex series of push-pull forces that were undermining rural and small-scale economies, leading to urbanization and a decline in health status even as poor people took up wage labor. Furthermore, it also became clear that integration of poor communities into national and international economies does not necessarily improve their living conditions, and that economic prosperity and the ability to become consumers in a global market are not universal human goals. Finally, the growing social inequalities between and within countries have, in the absence of a social justice agenda, proven to be formidable barriers to the promotion of modern sanitation and health care. At the close of the last century, there was often more interest in studying inequalities of access to technologies than in remediating them.

In the 1990s, critical medical anthropologists started to explore current and past socioeconomic and political processes, to examine "how illness representations serve to represent and misrepresent power relations within a society" (Farmer & Good, 1991, p. 144), and to identify and expose structural forces that undermine the health of poor and marginalized groups. Anthropologists also began to study the role of international health institutions "managing inequality" rather than addressing the growing gap between rich and poor and the "outcome gap" necessarily associated with growing inequality (see Baer, Singer, & Susser, 1997; Donahue, 1989, 1990; Farmer, 1992, 1994, 1999; Farmer & Castro, 2002; Farmer, Connors, & Simmons, 1996; Farmer et al., 2001; Kim et al., 2000; Morgan, 1993, 1998; Singer, 1997; Stebbins, 1993; Whiteford, 1992, 1993, 1998; Whiteford & Manderson, 2000).

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