Constructing Hierarchy

Structural forces are implicated in the production of illness as well as with the provision of health care and treatment. There is a variety of socioeconomic and structural parameters on which health care is not only defined but also delivered. These parameters may be ethnicity (including "racial" classification), sexual orientation, class, and gender.

Ethnicity

Though issues of discrimination based on skin color were the foundations of political activism in the 1960s and

1970s, "race" did not constitute a central focus of anthropological study until much more recently (Harrison, 1999). It is only within the last two decades or so that anthropologists have taken the position that "race" is a social category, not a meaningful biological category as applied to humans. By focusing attention on the perceived ethnic differences, the physician defers attention from clinical shortcomings (Stein, 1985). For example, the African American experience has been well studied (e.g., Powdermaker, 1939; Stack, 1974). Among the medical community, the importance of ethnicity and race as a basis for the provision of health care are only now becoming apparent. In the case of cardiovascular disease, recent studies document that African Americans are less likely to receive the same types of preventive screening measures as European Americans, resulting in a higher morbidity and mortality rates, with African American women being the most disadvantaged group. As Brown (2002) states, "Overall, the general pattern of care suggests that African-American women may receive high-technology cardiac treatment significantly less often than all other race and sex categories." Racial disparities in the provision of health care are corroborated by other researchers (e.g., Funk et al., 2002) and represent the tip of the iceberg into the inquiry of ethnicity and race and as a determinant of health care status.

By demonstrating the different socialization patterns of European American and African American youth, anthropology has provided a context for understanding variances in health behavior and practice based on racial categories (Boone, 1989; Heurtin-Roberts & Reisin, 1993; Wilson, 1985). For instance, young African American women have a less stereotypical body image, and they are more comfortable with their own bodies (Parker et al., 1995). In addition, among African American women condom use is motivated not by economic considerations but by affective ties and notions of self-esteem (Sobo, 1995). Self-supporting women with strong kinship ties demonstrate a higher incidence of condom use, while those women who depended upon their male partners for both affection and/or income are less likely to insist upon condom use. Variation in such behavior has definite implications for health status.

Another more recent example is an analysis of the push-pull factors influencing alcoholism among Native Americans (Spicer, 1997). Among members of this group, alcohol is considered a communal commodity and is thus shared freely; drinkers must be willing to provide alcohol in a reciprocal manner. Those who partake of this communal resource without contributing to it are publicly shamed and ridiculed, though they may still be allowed to drink. Individuals may go to great lengths to contribute to this communal resource, selling household items in order to obtain money for liquor, which is then shared among friends. Anthropological research has demonstrated that health is inextricably linked to the social indices of "racial" categories and class in the American experience.

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