First published 1990 by Westview Press
Published 2018 by Routledge
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Copyright 1990 by Taylor & Francis
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Library of Congress Cataloging-in-Publication Data
Anthropology and primary health care / edited by Jeannine Coreil and
J. Dennis Mull
p. cm.
Includes index.
ISBN 0-8133-8138-X
1. Medical careDeveloping countries. 2. Social medicine
Developing countries. 3. Medical anthropologyDeveloping
countries. I. Coreil, Jeannine. II. Mull, J. Dennis.
[DNLM: 1. Developing Countries. 2. Health Planning. 3. Primary
Health Care. 4. Social Medicine. WA 31 A628]
RA441.5.A57 1990
362.1 '09172' 4dc20
DNLM/DLC
for Library of Congress
90-12857
CIP
ISBN 13: 978-0-367-01607-4 (hbk)
A book on anthropology and primary health care is particularly appropriate at this time. With their increasing involvement in addressing the health problems of developing countries, anthropologists and other social scientists need to learn from the experiences of others. They need to consider specific experiences or case studies in light of relevant ethnomedical models and to seek general principles of human behavior and societal organization which will aid the effort to improve health. But in addition, the improvement of health must be seen as an inter-disciplinary task. Therefore, this book should be of great value to physicians, epidemiologists, program managers, and other international health professionals. These individuals have a great need to understand the contributions that social science methodologies and perspectives and their social sciences colleagues can offer to the common struggle to improve health.
Health is an undeniable human right, yet one achieved by few in the developing world. Defined in the Constitution of the World Health Organization as a state of physical, mental, and social wellbeing and not merely the absence of disease or infirmity, health stands as an important social goal, albeit one hard to measure at either an individual or a societal level. It is often taken for granted and appreciated only in its absence with the occurrence of illness; hence the tendency in most populations to ignore or undervalue actions that promote health or prevent disease and to demand medical services for even mild and self-limited illnesses. Thus, optimal preservation of health requires an active approach on the part of individuals and communities. This approach should recognize the right to health of all members of the population and must include specific actions to support health at an individual and community level. It must also include the more broad aspects of development that lead to improvements in quality of life with an emphasis on health.
The desire to achieve health for all is not new, but it has taken time for sufficient momentum to build to make it an important part of national and international policy. Even now, it is too often national or international rhetoric rather than policy. Too often other forces determine allocation of resources. The objective of health for all was included in the WHO Constitution in 1948 and the work of three decades led to the Declaration of Alma-Ata in which Health for All by the Year 2000 was further established as a rallying cry. Clearly, the current stress on greater equity in health care and health status is an essential ingredient in achieving health for all.
As part of the growing commitment to equity in health, there has been increasing attention directed to concerns and health problems at the population or community level. There has been an important recognition that curative care delivered from hospitals, clinics, or physicians offices is inadequate to meet the health needs of the population. This has led to disease control programs delivered at the community level and a new emphasis on prevention, e.g., immunizations for children, rather than cure. As experience has accumulated, both the successes and failures of these initiatives have become obvious. Interventions that are efficacious and cost-effective in controlled settings are more problematic when implemented in diverse field situations. The provision of these seemingly simple intervention technologies is in reality complex, and their potential impact is diminished by cultural, sociopolitical, and economic factors. For example, the use of oral rehydration therapy for management of diarrheal dehydration in clinical settings has led to dramatic improvements in illness outcome with reductions in cost. However, the promotion of techniques for management of diarrhea to reduce or treat dehydration at the community level has been more problematic. Furthermore, while ORT may avert a death from dehydration in a clinical setting, its potential to reduce childhood mortality in a community setting will be reduced by the continuing risk for the child of other illnesses and malnutrition. This is not to conclude that ORT is without value at the community level, but rather that the type and magnitude of effort needed to establish effective use were underestimated and the potential impact overstated. Similar examples could be raised in regard to other community-level interventions.
It is important to consider possible solutions to overcome these constraints in implementation of health interventions. In some cases, the technology must be modified to adapt to cultural, economic, or environmental conditions. In other situations, improved training or communications methods may overcome an implementation problem. Another approach is to broaden the scope of the intervention, such as promoting dietary management of diarrhea and improved infant feeding instead of focusing only on fluid therapy. Often it would seem better to take a more integrated approach to deal with specific health problems and to deliver services for multiple problems in a more comprehensive fashion. In this way, curative efforts can be linked with preventive services and community improvement.
As we learn from our experiences, health programs continue to evolve. Further progress will require thoughtful evaluation and reformulation by interdisciplinary teams. Such teams must include epidemiologic perspectives on the distribution and determinants of disease in the population and social science perspectives on the determinants of human behavior and on communications, along with clinical and management expertise. The further enhancement of intersectoral approaches will make this need for continuous examination and improvement more profound, but potentially will make such interventions even more successful.
