Why is Haiti so poor?

UPDATE 1/14: This post was linked in a story by Discovery News’ James Williams.

Haiti and the Dominican Republic share the island of Hispaniola. Following the island’s discovery by Columbus in 1492, Spanish colonialists exterminated the island’s indigenous Arawak Indians. In 1697, the French took control of what is now Haiti and instituted an exceptionally cruel system of African plantation slavery. In the late 1700s, the half million slaves revolted. In what is the only successful slave revolution in history, they ousted the French and established the first Black republic in the Western Hemisphere.

Haiti’s population of over eight million people occupies a territory somewhat smaller than the state of Maryland in the United States. The land is rugged, hilly or mountainous. More than 90 percent of the forests have been cleared. Haiti is the poorest country in the Western Hemisphere. Extreme inequality exists between the urban elite, who live in the capital city of Port-au-Prince, and everyone else.

The people in the countryside are referred to as peyizan yo (the plural form of peyizan), a Creole term for small farmers who produce for their own use and for the market (Smith 2001). Many also participate in small-scale marketing. Most peyizan yo in Haiti own their land. They grow vegetables, fruits (especially mangoes), sugarcane, rice and corn.

Accurate health statistics are not available, but even rough estimates show that Haiti has the highest prevalence of HIV/AIDS of any country in the region. Medical anthropologist Paul Farmer emphasizes the role of colonialism in the past and global structural inequalities now in causing these high rates (1992).

Colonial plantation owners grew fabulously rich from this island. It produced more wealth for France than all of France’s other colonies combined and more than the 13 colonies in North America produced for Britain. Why is Haiti so poor now?

Colonialism launched environmental degradation by clearing forests. After the revolution, the new citizens carried with them the traumatic history of slavery. Now, neocolonialism and globalization are leaving new scars. For decades, the United States has played, and still plays, a powerful role in supporting conservative political regimes.

In contrast to these structural explanations, some people point to problems with the Haitian people: They cannot work together, and they lack a vision of the future.

Opposed to these views are the findings of Jennie Smith’s ethnographic research in southwestern Haiti, which shed light on the life of peyizan yo and offer perspectives on their development (2001). She found many active social organizations with functions such as labor sharing, to help each member get his or her field planted on time, and cost sharing, to help pay for health care or funerals. Also, peyizan yo have clear opinions about their vision for the future, including hopes for relative economic equality, political leaders with a sense of social service, respe (respect), and access of citizens to basic social services.

The early colonizers did not decide to occupy Haiti because it was poor. It was colonialism and its extractive ways that have made Haiti poor today.

Sources:

“Culturama: The Peyizan Yo of Haiti,” in Barbara D Miller, Cultural Anthropology, 5th edition, Pearson. 2009, p. 404.

Smith, Jennie M. 2001. When the Hands Are Many: Community Organization and Change in Rural Haiti. Ithaca, NY: Cornell University Press.

Farmer, Paul, 1992. AIDS and Accusation: Haiti and the Geography of Blame.

Image: “Haitian Girl” by Flickr user Billtacular, licensed by creative commons.

Thanks to Samuel Martínez of the University of Connecticut for pointing out that the Haitian Creole plural “yo” means that one should not include an article in front of the noun.

Anthro in the news 1/11/10

• Tell it to the Marines
NPR aired an interview with cultural anthropologist Paula Holmes-Eber who teaches “operational culture” at Marine Corps University in Quantico, Virginia. Classes include discussion of cultural sensitivity and the cultural/social consequences of military presence and military actions, such as blowing up a bridge.

• Nacirema craziness goes global
In an article called “The Americanization of Mental Illness” in The New York Times Magazine, Ethan Watters (blog) describes how Western, especially American, globalization includes the spread of Western/American understandings of mental health and illness. He points to some of the negative consequences of this trend.

In discussing why people diagnosed with schizophrenia in developing countries fare better than those in industrialized countries, he draws on the work of medical anthropologist Juli McGruder of the University of Puget Sound. McGruder’s research in Zanzibar shows how Swahili spiritual beliefs and healing practices help the ill person by avoiding stigma and keeping social and family ties intact. Note: Nacirema is “American” spelled backwards.

• Guardians of the nameless dead
The bodies of hundreds of victims of political violence in Colombia are often disposed of by being thrown into rivers. Sometimes the bodies wash up on the river bank. WIS News describes the work of one local civil servant, Maria Ines Mejia, who spends time recovering bodies from the Cauca River and thereby helping authorities record the deaths and chronicle the killings.

Maria Victoria Uribe, an anthropologist with Colombia’s National Commission of Reconciliation and Reparation, names people like Mejia as “unknown heroes.” Michelle Hamilton, an expert in body composition who directs the Forensic Anthropology Center at Texas State University, notes that “…you can imagine trying to grab onto a water-logged body with the skin slipping off. It can come off in your hands.”

• Celebration and warning
Survival International’s “weighty coffee-table book,” We Are One: A Celebration of Tribal Peoples, is reviewed in the Ecologist. The unity and diversity of indigenous peoples around the world is celebrated in beautiful photographs and through the words of tribal and non-tribal people. Given that Survival International commissioned the book, it also expectedly contains a message of deep concern about the dangers to survival that so many indigenous/tribal cultures face.

• Who rules?
Janine Wedel is a cultural anthropologist and professor of public policy at George Mason University. Her book, The Shadow Elite: How the World’s New Power Brokers Undermine Democracy, Government, and the Free Market, was reviewed in the Financial Times and by Arianna Huffington of the Huffington Post. Wedel has appeared at several book launches in D.C.
Continue reading “Anthro in the news 1/11/10” →

Toward a new decade in psychiatry

An editorial in Nature argues that funding is meager for research on psychiatric diseases compared to that for other major diseases. Focusing just on schizophrenia, new directions for the upcoming decade include: considering why the efficacy of medications has not improved other than reducing side effects; changing the focus on diagnosis and drugs in late stages of the disease to identifying biomarkers and environmental factors that put people at risk; devoting more research to deeper understanding of the underlying biology; devoting more research to “environmental” (socio-cultural) factors; bringing together knowledge in various disciplines; deepening the exposure of psychiatrists to biology.

This blogger adds that a deepened exposure of psychiatrists to medical anthropology and its attention to environmental factors including illness labeling, stigma, and non-medical treatment options is even more important than more biology. If it is in fact true that, as the editorial claims, about 80% of the pattern of schizophrenia in populations “seems to be determined by genetics” with an unknown share of that percentage “susceptible” to environmental influences, and if the other 20% is directly determined by “environmental factors,” then the proportion that is purely or directly biological alone may be more like 60%…and the other 40% either directly or indirectly shaped by environmental factors. Who knows – these percentages all “seem” to be guesswork, but even the crudest guesswork leaves a lot of room for social/cultural factors. And it just may be easier to deal with/change/prevent such social/cultural factors than it is to mess around with someone’s genes.

The next decade for psychiatry should be the decade of cultural psychiatry.

Image: “Brains” by Flickr user Curious Expeditions, licensed by Creative Commons.

#1 cultural anthropologist of the decade

As any cultural anthropologist will tell you, a decade is an arbitrary cultural construction with no inherent meaning. I agree. But it does offer a potentially interesting way to bracket a period of time within which a lot happens but not too much — at least not too much for my memory to handle.

On Morning Joe today, some commentators were going through a list of top 10 events of the decade, with the 9/11 attacks ranked as number one, the most significant. As I watched, I wondered if it would make sense to compile a ranked list of the most important cultural anthropologists of the decade. It seemed impossibly difficult, especially the ranking part. But then it hit me that I could reasonably make a case for a number one cultural anthropologist of the decade.

I hereby, with all the authority of a lone blogger, name Paul Farmer (Wiki, bio) as #1 Cultural Anthropologist of the Decade.

Here’s why, in case you do not already agree with me. He has published many important scholarly works, beginning with his groundbreaking exposure of the politics and racism that led to blaming Haiti for the origin and spread of HIV/AIDS.

In addition to his many scholarly publications, Farmer is an influential global health practitioner and activist and co-founder of Partners in Health. Tracy Kidder’s book about him and his health work in Haiti, Mountains beyond Mountains, is widely read. CBS did a documentary on him in 2008. The Skoll Foundation named him “Entrepreneur of the Year” in 2008. In 2009, he was a top contender for the position of head of the U.S. Agency for International Development, and in the same year he was named U.S. deputy special envoy to Haiti.

Within the discipline of anthropology, Farmer has placed consideration of poverty, social inequality and social justice in the mainstream of research and writing. His use of the term “structural violence” has ensured its significance well beyond medical anthropology. His insistence on taking poverty and social inequality seriously as primary causes of health problems worldwide has helped shake the foundations of western biomedicine. He has helped forge importance links between health and human rights.

Rich anecdotal evidence from my experience teaching at GW also supports my naming of Farmer as #1 Cultural Anthropologist of the Decade. In my undergraduate cultural anthropology class, when I ask who has heard of him, many hands shoot up. Of these students, most have read Mountains Beyond Mountains. A few have heard him speak. In my upper level class on medical anthropology, an even larger proportion of students is aware of his work, and many have read one of his books in another class (they will in my class as well). In my graduate seminars, most students have read at least one of his books and perhaps also an article or two.

Beyond the impressive level of awareness among my students of Farmer’s contributions to health and anthropology, however, is what I refer to as The Paul Farmer Effect (PFE). I created this term to refer to the Pied Piper role he plays: I keep hearing from students that want to be a Paul Farmer. And they are choosing courses, majors and minors, to help achieve that goal.

Thus enrollments at GW in classes in medical anthropology, culture and human rights and cultural anthropology generally are booming. Increasing numbers of B.A. students are combining majors in anthropology, global health and/or international affairs, and adding a minor or two if they cannot fit in a double major. At the graduate level, our dual M.A. degree in international development studies and public health is very popular, and there is strong demand for a similar dual master’s degree in anthropology and public health. Every year, I receive inquiries from medical students about how they can include anthropology in their training.

The Paul Farmer Effect.

At GW, I began to notice it five years ago or so. Since then, the PFE has not abated. It is growing. Because of the PFE, more students each year combine their academic interests in anthropology, global health and international affairs. These students are beginning to graduate and go on to pursue humanitarian careers. Thanks to Paul Farmer and the PFE, they are more powerfully informed and more motivated to make the world a better place than would otherwise be the case.

Anthropologyworks 10 best of 2009

The following list was determined by a panel of one, though, as you can see, many of the choices are externally validated. Congratulations to one and all!

Best Student Essays in Public Anthropology: The public anthropology award winners of 2009 are 19 students in Diana French’s Anthropology 100 class, Introduction to Cultural Anthropology, at the University of British Columbia-Okanagan.
Best Anthropology Song … or was it the only one? Certainly the only one performed at the AAA meetings.
http://vimeo.com/moogaloop.swf?clip_id=8035515&server=vimeo.com&show_title=1&show_byline=1&show_portrait=0&color=&fullscreen=1
Best Long-term Field Research: Olga Linares, of the Smithsonian’s Tropical Research Institute in Panama, has been doing fieldwork in three regions of Senegal for 40 years. She has witnessed many changes including a doubling of the number of poor people, declining rainfall, abandonment of rice fields and effects of the drop in currency value. She describes how Senegalese women farmers creatively cope with these changes.
Best Contribution to Anthropological Ethics: the AAA-commissioned report (PDF) on the Human Terrain System was submitted in November; the product of many months of work by several contributors, it condemns the role of anthropologists in U.S. military operations.

Best Special Issue of a Journal: Social Science and Medicine, Volume 70, issue 1 (requires login), edited by Catherine Panter-Brick of Durham University, contains 20 articles on conflict, violence and health. I will be assigning several of them in my spring medical anthropology seminar.
Best News About One of My GW Colleagues: Patty Kelly, research professor of anthropology, is co-winner of the Sharon Stephens Prize and runner-up for the Victor Turner Prize for her book, Lydia’s Open Door: Inside Mexico’s Most Modern Brothel.
Best New Journal: Collaborative Anthropologies, edited by Luke Eric Lassiter.
Best Anthropology Conference: The September meeting of the Society for Medical Anthropology at Yale University. Although I wasn’t able to attend, my colleagues who did have praised the plenary speakers, rich array of papers, impressive attendance and organization, including meals for the attendees.
Best Kinship Story: The President of the United States’ mother was a cultural anthropologist, and Duke University Press published a revised version of her dissertation, Surviving against Odds.
Best Public Impact: A shared shout-out to Antonio N. Zavaleta, professor of anthropology at the University of Texas at Brownsville and Texas Southmost College, who received the Premio Otli Award from the Mexican government for his work improving the quality of life for Mexican citizens living abroad, and to Patricia Easteal, associate professor in the University of Canberra’s faculty of law, who won the Australian of the Year Award for her efforts in advancing human rights and justice in Australia. More info here.

Must read: The Maintenance of Life by Frances Norwood

by Barbara Miller

Rumors about end-of-life policies in the US health care reform debate of 2009 loomed large, enflaming talk about “death panels” that would “pull the plug on grandma.”Anyone who seeks to be informed about alternatives to the current US system (or non-system) for end-of-life care should read Frances Norwood’s book, The Maintenance of Life: Preventing Social Death through Euthanasia Talk and End-of-Life Care–Lessons from the Netherlands.

Dr. Norwood has a PhD from the joint medical anthropology program at the University of California at Berkeley and San Francisco. For her dissertation, she chose an unusual and challenging topic: the day to day experience of dying and death. She decided to carry out fieldwork in The Netherlands because it has the longest legal practice of euthanasia and assisted suicide and is known for its end-of-life policy. She studied Dutch and then spent 15 months in and around Amsterdam accompanying huisartsen (physicians of the home) on their visits to terminally ill people. She interviewed patients, family members, physicians, home care employees, advocates, and researchers. The core of her research is intensive observation and discussions with 10 huisartsen and 25 of their end-of-life patients and their families.

In The Maintenance of Life, Norwood provides poignant narratives of home visits, including those that resulted in the voluntary death of the patient. She laces the narratives together with a convincing analysis of how “euthanasia talk” is a critical component of end-of-life care in The Netherlands.

What is euthanasia talk? According to Norwood, it is a “discourse,” or culturally shaped way of discussing one’s preferred death. Euthanasia itself, while an option in The Netherlands, is rarely resorted to. But euthanasia talk is widespread and has five steps. It begins with an initial request by a patient with the huisarts. Of Dr. Norwood’s 25 participants who were facing the end of life, 14 had made the initial verbal request. No doctor, however, would grant the request immediately. It must be repeated over time, and family members must be involved in the discussion and agree to the choice. All of this makes for an orchestrated pause in the discussions. The second step requires a written statement. A third step involves setting a date for a second opinion. In the fourth step, the patient repeats the request for a euthanasia date and their reason. The fifth step is a euthanasia death. All along the way, euthanasia discourse is happening.

In The Netherlands, the percentage of euthanasia deaths has been around 2 percent of all deaths since 1990; the percentage of assisted suicides is even lower, around .1 percent. In 2005, fewer than 1 in 10 people who initiated requests died by euthanasia or assisted suicide. Of those who made concrete requests, one in three did so.

Euthanasia policy in The Netherlands, far from pulling the plug on grandma, gives grandma some sense of agency as she faces death, according to Norwood. It helps reduce, to some degree, the pain of “social death” in which a dying person is no longer considered by family members and others to be the whole person they were before becoming terminally ill. Euthanasia discourse thus serves as a kind of therapeutic narrative which helps to retain a person’s social self, identity, and sense of orderliness. Orderliness and control are, according to Norwood, key features of Dutch culture.

At the end of her book, Norwood offers insights for US health end-of-life policies. She advises that policies and practices that work in The Netherlands are not easily transferrable to the United States for many reasons, both structural and cultural. The US does not have universal health care and a tradition of home-visiting physicians. The emphasis in the US on individualism means that patients, families, and physicians do not typically work together as a collective. The medicalization of death in the US does not allow sufficient attention to non-medical and cost-effective options that can improve the end of life: home care, nursing and personal care, respite for family members, and coordinated case management.

While humane end-of-life options in the US as a whole seem far from those available in The Netherlands, Oregon’s Death with Dignity Act of 1997, which allows Physician Assisted Suicide, is a positive step forward. Clearly, there is a need for a much more comprehensive look at end-of-life options than is provided for through the initiative called National Healthcare Decisions Day (NHDD) — one day a year! And what about provisions in the health care reform package for Medicare to cover the cost of conversations with a physician about end of life choices. A recent request for Medicare coverage for a conversation with a physician about end-of-life options once every five years (!) has met with outraged opposition from Republicans.

Read Fannie Norwood’s book. It’s important, well-written, and will give you much to think about. I hope more cultural anthropologists take up the challenge to study the end of life, social death, and non-medical therapies.

Dr. Frances Norwood spoke about her research on euthanasia in The Netherlands as part of the Culture in Global Affairs series at the Elliott School of International Affairs, October 30, 2009.

Death (sticks) & taxes

Local governments in the Republic of Korea that earn the most local revenue from the tobacco consumption tax (TCT) are less likely to participate in the central government’s anti-smoking campaign. Statistical analysis of data on 163 municipalities revealed a clear policy conflict and points to the need to reduce local governments’ dependence on TCT revenue by supporting alternative sources of revenue.

The authors mention the need for further research to investigate local policy environments and changing social and regional patterns of smoking, and comparative studies of tobacco tax policy.

Let’s not leave out attention to advertising campaigns sponsored by tobacco companies and who they are targeting as well as public health education programs that need to target the same groups as the tobacco companies in order to counteract the lure of the ads.

The world needs more anthro-doctors

by Barbara Miller

Dr. Lewis Wall is dedicating his life to repairing obstetric fistulas of women in Africa. Nicholas Kristof, who has been writing about fistulas since 2002, lauds him for his work, as we all should.

Dr. Wall is an ob-gyn at Washington University. When not in St. Louis, he has done many fistula repairs for women in Africa: “You take a human being who has been in the abyss of despair and –boom! — you have a transformed woman. She has her life back.”

A fistula is a hole. An obstetric fistula is a hole due to the birthing process either between the vagina and the rectum or between the between the vagina and the bladder. Because of the fistula, the woman becomes incontinent, with either urine or faeces coming out of her vagina. She is typically abandoned by her husband and becomes a social outcast.

Obstetric fistulas are common throughout much of the developing world for a variety of reasons: childbirth of very young and/or malnourished women, poverty, female genital cutting and infibulation, lack of access to prenatal and delivery care and to emergency obstetric services. Related to many of these factors is a culture of patriarchy which devalues and disempowers women and girls, offering them little say in when and how to bear a child and whether or not they can access medical care when a problem arises.

Kristof has been writing about fistulas and the heroic efforts of many to repair them, including Dr. Catherine Simpson. He is delighted that Dr. Wall will also be opening a fistula hospital soon in Niger.

Kristof tells us that Dr. Wall started out as an anthropologist working in West Africa where he learned to speak Hausa. “But he concluded that the world needed doctors more than it needed anthropologists.” So he went to medical school at age 27.

Sorry, but the world doesn’t need just “more doctors.” Starting with the great tradition launched by anthropologist/psychiatrist Arthur Kleinman, medical anthropologists have for long pointed out the limitations of western biomedicine including what its scope allows it to treat and the related narrow training of doctors. In treatment and training, technology rules. Medical students are systematically sleep deprived and distanced from their patients. Melvin Konner’s book Becoming a Doctor convincingly recounts these processes. Konner is a biocultural anthropologist with field experience among foragers of the Kalahari desert. He decided to attend medical school, and then wrote about it as a dehumanizing rite of passage. He does not practice medicine but continues to teach anthropology and comment in the public media from time to time about how to reform medical school in the U.S.

If Dr. Wall had gone straight to medical school, chances are slim to nonexistent that he would have repaired a single obstetric fistula in Africa. Instead, being first an anthropologist first afforded Dr. Wall the contextual awareness and humanitarian spirit that medical school training totally bypasses.

The anthro-doc combo has become an increasingly valued option by many young people in the U.S. (if my students are a good sample, and I believe they are), popularized especially by Paul Farmer. Farmer is the only anthropologist I know who has inspired a documentary book while still living: Tracy Kidder’s Mountain beyond Mountain. Many of my students have read this book and want to become some version of Paul Farmer, combining anthropology with a profession that helps people who are resource-poor and ill. Our classes in medical anthropology and global health are always oversubscribed. I call it the “Farmer effect.”

So Dr. Wall was only partially correct. The world doesn’t need more doctors. The world needs more anthro-doctors. As well as people who combine anthropology with other healing/health-related professions such as public health, nursing, midwifery, and more. As Dr. Wall might admit: you do need to know something about “the people.”

Pills against poverty: Easterly speaks power to Farmer

by Barbara Miller

Paul Farmer walks on water for a lot of people around the world, from Haitian villagers he has treated in his clinic to my GW students who he has inspired with his writings. So what to think when one of my favorite economists, Bill Easterly, zaps him in an opinion piece in The Financial Times for promoting programs that have helped the middle and upper classes and bypassed the poor?

Answer: Easterly has a point. International “health rights” cannot only be about providing ARDs (anti-retroviral drugs). Especially if, as Easterly claims, international aid-supported programs are giving access to these life-saving and costly drugs differentially to better-off people in Africa.

This is an ugly thought but one worth pondering. It would not be the first time in international aid that benefits bypassed the poor and landed with the better-off.

If you read Farmer’s books, and I do every year since I assign his writings in my undergraduate and graduate medical anthropology classes, you will see the interplay between Farmer the anthropologist and Farmer the doctor. The doctor wins. Farmer the doctor is interested in treating, not preventing, illness. Treatment, through drugs, wins out over more anthropological concerns about social inequality, causes of poverty, and “solutions” such as empowerment, employment and other ways to reduce inequality.

Farmer has walked the walk in the hard scrabble hills of Haiti (to get a sense of Farmer the humanitarian healer, read Tracy Kidder’s docu-ography of him, Mountain Beyond Mountain). He has seen countless AIDS victims living in extreme poverty. He has been in Russian prisons and seen the ravages of XMDRTB. He has seen the work of structural violence. His medical political activism: He prescribes ARDs and lobbies in Washington for more funding for ARDs.

Pills alleviate pain and suffering and can extend life. A health rights position says that access to such pills should be equal for all. But in the end, pills don’t cure the diseases called poverty and inequality. Easterly offers a corrective view.

Photo, “Pills & Container (Landscape)”, from Flickr via Creative Commons.

Critical medical anthropology gone mild?

by Barbara Miller

Merrill Singer’s 1989 article “The Coming of Age of Critical Medical Anthropology” is a landmark contribution in shaping the direction of critical medical anthropology. In its conclusion, he lists seven tasks that I paraphrase as:

Contributing to the political economy of health.
Analyzing micro-macro relations.
Studying power relations at global and local levels.
Clarifying the meaning of “critical medical anthropology.”
Studying biomedicine and how it links the capitalist and working classes.
Examining the specific relationships between biomedicine and capitalism.
Conducting fieldwork on socialist health systems.
Contributing to the creation of a new medical system that is counter-hegemonic.

Every year, I assign this article, along with other early writings in critical medical anthropology, for the first week of my graduate medical anthropology seminar. It never fails to generate good class discussion.

In recent years, Singer has become a veritable publishing machine, turning out articles, chapters, and co-authored or co-edited books at an amazing rate. He is now an Associate Editor of the journal Medical Anthropology. As testimony to his many professional and academic achievements, Singer has received major awards including the Rudolph Virchow Prize, the George Foster Memorial Award for Practicing Anthropology, the AIDS and Anthropology Paper Prize, and the Prize for Distinguished Achievement in the Critical Study of North America. After working for many years with the Hispanic Health Council in Hartford, he is now professor of anthropology at the University of Connecticut and affiliated with Yale University’s Center for Interdisciplinary Research on AIDS.

Without doubt, Merrill Singer is a pillar of medical anthropology.

So I was delighted to see an essay by him in Medical Anthropology entitled “Pathogens Gone Wild? Medical Anthropology and the ‘Swine Flu’ Pandemic.” (By the way, Singer invented and mainstreamed the term “pandemic”). In the early part of the article, true to form, Singer talks about the “macropolitics” and “micropolitics” of epidemics and anxiety-producing “emerging diseases.” He points to the causal role of anthropogenic global environmental changes in emerging diseases and how such changes differentially affect the poor. He makes a pitch for medical anthropology as being of particular value in understanding modern epidemics because of its attention to biosocial and biopolitical processes and its grounded study of the social factors of disease. All vintage Singer.

Turning to H1N1 specifically, he provides a list of tasks for medical anthropology:

Field monitoring of the pandemic as a biosocial phenomenon.
Assessment of the biosocial origins and ongoing social influences of the pandemic.
Involvement that is research-based and culturally-informed in public health efforts.

Under point #1, he includes important topics such as mapping the “geography of blame” and critical analysis of social stigma and of media overreaction. Under point #2, he urges anthropologists to probe possible connections between the H1N1 outbreak and industrial farm animal production (IFAP) including improper disposal of animal waste. Here he makes a pitch for syndemics in examining human-animal linkages as routes of transmission. His discussion of point #3 receives only one paragraph in which he says that anthropologists can contribute to health care programs in several ways including: formative research for program design and involvement in program implementation, management, and evaluation, and in public education programs. This paragraph reads as if it came from an applied anthropology cookbook–nothing Singerish here.

The three points, however, stand as valid even if the last is weakly developed. But the article is not up to the standard set in his 1989 article. First, at the global level, the role of the pharmaceutical industry and the likely huge profits being reaped from the sale of the vaccine must be brought in to the picture of H1N1 to make it more complete. Second, the vaccine links to another missing topic: medical anthropologists should do local-level research to about people’s refusal to get the vaccine, including health care providers. This topic will provide insights into people’s fear of the unknown side-effects of the vaccine and their resistance to the bioestablishment which promotes the vaccine as a moral imperative.

Compared to the Merrill Singer who wrote the 1989 article, the Merrill Singer of 2009 has gone mild. In his recent essay, he is right to finger capitalist agriculture but errant in ignoring pharmaceutical capitalism. Furthermore, the new Merrill Singer seems to have abandoned his 1989 vision of anthropology contributing to a “counter-hegemonic” health system.

My heartfelt congratulations to Merrill Singer for all his accomplishments. At the same time, I miss the Merrill of twenty years ago.

Photo, “Influenza Virus H1N1 HA Protein”, on Flickr via Creative Commons.