Anthropological Perspectives in Public Health Ethics

The anthropological perspective in bioethics and public health ethics is evident in three areas: (1) the influence of anthropology’s culture concept on the practice or application of ethics in public health; (2) the adoption of anthropological methods and perspectives in research on public health and bioethics research; and (3) the study, by anthropologists, of the fields of public health and bioethics as distinct cultures themselves.

Anthropology’s involvement in bioethics flourished in the 1990s as complex health-related concerns, such as decision making regarding biotechnology and end-of-life care, were no longer satisfactorily addressed by professional or academic bioethicists. Growing out of medical sociology and its focus on the doctor-patient relationship, anthropologists expanded research on health communication to explore, for example, the impact of gender and medical authority on patient communication and outcomes.

Anthropologists also studied cultural interpretations of human biological processes. For example, in the Buddhist tradition, brain death is not accepted as the definitive marker of the end of human life; this and other culturally determined beliefs significantly restrict options for organ transplantation (Scheper-Hughes, forthcoming).

In another example of the influence of culture on the social meaning of disease, Japanese women do not report the same physical symptoms related to menopause as American women; and when they do experience similar physical symptoms, Japanese women underreport them in comparison to American women (Lock, 1993). Therefore, therapies for aging women in Japan are significantly different than those in the United States.
Through the ethnographic method, anthropology foregrounds the experiences of individuals and the moral frameworks that govern their ethical decision making, thus challenging bioethics’ focus on hegemonic ethical norms or biomedical authority (Kleinman, 1999, 2006). Anthropology also moves the study of bioethics into non-Western contexts, expanding its narrow geographical scope and promoting the importance of cross-cultural analysis; for example, introducing public health interventions to eliminate female feticide in South Asia.

The central lessons of anthropology for public health are that: (1) the human experience of health, illness, and disease is shaped not only by biological facts, but also by social and cultural issues; and (2) health-seeking behavior and decision making are significantly influenced by historical and economic contexts. Anthropological research demonstrates that local moral experiences and norms of reproduction, immunization, body modification, genetic testing, and research participation as well as definitions of health, personhood, or death are key variables shaping public health outcomes.