Future Directions

Growing interest in the link between globalization and health has stimulated anthropological research on how large-scale social forces and transnational movements produce local cultural forms. Local inadequacies in public health infrastructure, local disease ecologies that explain differences in exposure to pathogens, and local variations in biology have all been identified by medical anthropologists, and other researchers, as factors influencing the emergence of epidemics. Given the disproportionate impact of biomedical practices in influencing the disease ecology, this has been a good place to start.

However, anthropological attention must be paid to the impact on infectious diseases of global processes, whether they be ecological (as in the case of global warming) or socioeconomic (as in changes in agricultural production or forms of social inequality). For instance, deadly outbreaks of E. Coli O:157 epidemics have occurred, and have been linked to inadequate treatment of water and food. This underlines the potential of transformations in the industrial production of food to play a role in generating and/or spreading epidemics. The most dramatic example is the epidemic of new variant Creutzfeld-Jacob disease (vCJD), the modern form of kuru. "Mad cow disease" (Bovine Spongiform Encephalopathy, or BSE) led to an epidemic of vCJD in humans, because sporadic genetic events that produced disease-producing prions were amplified though industrial food production processes. Afflicted animals were "recycled," their carcasses used in the production of feed for other cows, in effect cannibalizing them. This introduced the pathogen into the bovine food chain as animal flour, spreading the disease to other cows and, eventually, to the humans that ate them. Debate over genetically modified foods (GM foods) has cited the BSE epidemic as a warning.

In the past, medical anthropologist have worked alongside public health practitioners to promote healthy dietary habits and encourage the adoption of hygienic measures to reduce the risk of water-borne infectious diseases (Nichter, 1989). As cultural diagnosticians, anthropologists adapted public health interventions to be congruent to local beliefs, and worked to ensure that public health interventions could be adopted to maximum effect—for example, by designing interventions to "sell" ORS as a treatment for childhood diarrhea. Morbidity and mortality from such water-borne infections remains a major health, challenge, increasingly because clean water is no longer affordable for the poor, who must purchase it from privatized urban water systems. However, the increasing burden of morbidity and mortality due to TB, HIV, and respiratory diseases (as smoking increases and air quality decreases in the sprawling cities of the Third World where more and more of the world's population is concentrated) indicates that anthropologists cannot be content to intervene post facto, but have a role to play in addressing these social ills upstream, before they crystallize as epidemics.

The lessons are clear. While understanding of microsocial processes, such as the beliefs and practices that inform everyday behavior, offers important insight, these must be complemented by social analysis that understands how local and micro-social processes are constrained by, or proliferate from, large-scale social forces. Medical anthropologists increasingly will be called upon as partners in public health and biomedical interventions targeting the "modern plagues" of HIV, MDRTB, and Hepatitis C. Ensuring the success of vaccine trials and anti-microbial treatment programs should not detract from the critical dimension of understanding inequities in access to these interventions, and understanding the processes that contribute to these inequities, as they furnish important insights into the biosocial processes that can crystallize as epidemics.

With the phenomenal advances in biotechnologies that allow us to track the molecular origins of epidemics with increasing accuracy, medical anthropologists have been furnished with powerful new tools for tracking the inscription of the social in the natural realm. Molecular epidemiology furnishes a biological archive that can be brought into dialogue with the historical record to answer important questions about the emergence of epidemics, as has been done with MDRTB and could be done with HIV and other emerging infections. This dialogue will be an important step to developing a global science of emerging epidemics.

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