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:

1. Contributing to the political economy of health.
2. Analyzing micro-macro relations.
3. Studying power relations at global and local levels.
4. Clarifying the meaning of “critical medical anthropology.”
5. Studying biomedicine and how it links the capitalist and working classes.
6. Examining the specific relationships between biomedicine and capitalism.
7. Conducting fieldwork on socialist health systems.
8. 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:

1. Field monitoring of the pandemic as a biosocial phenomenon.
2. Assessment of the biosocial origins and ongoing social influences of the pandemic.
3. 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.