17.4.4 The Inequalities of Health

Attempting to address the inequalities of health care is a primary application of the work of critical medical anthropologists. Inequalities are apparent in relation to COVID-19, the global pandemic that has left no corner of the world untouched. A number of agencies in the United States, including the National Institutes of Health and the American Civil Liberties Union, have determined that Black and Latinx populations have been most negatively affected by the virus, both in health outcomes and overall deaths per capita relative to their portion of the population. Several states have emphasized the need to ignore personal safety for the sake of economic “health,” essentially stating a willingness to sacrifice workers so their economic prospects do not falter. Meanwhile, people working on the front lines faced what is tantamount to class violence, as they could not afford to stay safely at home and social distance; indeed, it can be argued that later this class violence still applied, as the divide between remote working and those forced to work on-site created a stark contrast. The health of “essential workers” is put at risk. Aside from health care professionals, the category frequently falls along class lines, with the majority of “essential workers” employed in the service industry, in factories, or making deliveries. Economic inequalities and lack of access to health care providers both play a role in these trends. Similarly, the World Health Organization has highlighted how poorer countries have had their access to the many forms of COVID-19 treatment and prevention restricted by the demands of richer countries like the United States and Australia.

Another area in which medical anthropologists have documented health-related inequalities in the United States is access to nutritious foods. It has been well established that poor access to foods, particularly highly nutritious, diverse foods, can negatively affect health. People who live in food deserts, which are areas lacking access to good food, are more likely to develop debilitating illnesses and suffer from a basic lack of nutrition in several major fields. Amplifying the effect of food deserts is that these same areas often also lack access to health care services.

AIDS has provided a multigenerational study of the inequalities of health. At the beginning of the AIDS pandemic in the 1980s, the poorly understood disease was stated to be a “gay man’s virus” because it seemed to only affect gay and bisexual men. Medical anthropologists began studying the AIDS virus as early as 1983, with Norman Spencer notably studying cases in San Francisco. As the virus spread to other populations, research became more common and well-funded, receiving state support in some cases. Yet between poor and late funding and the spread of misinformation that took decades to reverse, AIDS devastated populations around the world. Medical anthropologist Brodie Ramin (2007) has applied anthropological knowledge and methods to AIDS treatment in Africa, utilizing cultural understanding to develop more effective methods of medical treatment and enhance public trust in these treatment methods.

Even today, AIDS is highly stigmatized and poorly treated in many places in the world. For over two decades now, Paul Farmer and Jim Yong Kim, both anthropologists and medical doctors, have worked with their organization, Partners in Health, to provide better health outcomes and access to poor, remote parts of the world. Their work has been instrumental in helping treat AIDS and other diseases in places such as Haiti. Jim Yong Kim used his role in the World Bank Group to help create better outcomes as well. Medical anthropology has the power to shape policy at the highest level of global health institutions, but it has much to overcome. Medical anthropologists are well aware of the severity of the problems of structural violence, systemic racism, and massive health inequalities around the world.

The COVID-19 pandemic changed many aspects of many cultures, affecting people’s professional, educational, and personal lives. Medical anthropologists Vincanne Adams and Alex Nading have already begun to analyze the social impact of COVID-19: “The pandemic continues to precipitate simultaneous dread over what is to come and loss over what appears to be gone forever, including loved ones, ways of life, and conceptual and literal safety nets” (2020). The COVID-19 pandemic has illustrated how deeply intertwined health and culture can be. Elisa J. Sobo’s work on the anti-vaccine movement in 2016 is now freshly relevant, as some people fear and mistrust both the COVID vaccine and the health measures to slow or prevent the spread of the virus proposed by nonprofits and governments. Adams and Nading build upon Sobo’s research, exploring the central role of belief and culture in the development of policy at the local, state, national, and international levels during the COVID-19 pandemic.

The COVID-19 pandemic has illustrated how deeply intertwined health and culture can be. Medical anthropology has a lot to offer public health and health care professionals. Incorporating medical anthropology and cultural competence into the training of health care professionals is a proactive step to begin addressing medical racism and the inequalities of health documented by medical anthropologists. It also gives health care professionals insight into the relationship between social health and physical and mental health priorities. The work of medical anthropologists on nutrition, reproduction, and infectious disease has significant implications for health care and public policy. Finally, understanding the wealth of cultural traditions and ethnomedical systems provides a greater appreciation for the diverse ways of understanding health and managing maladies. As the COVID-19 pandemic has demonstrated, health and health care are a complex social issue with global ramifications for billions of people.