Paper short abstract:

Faced with public health concerns, one of which is the promotion of the therapeutic solution of self-medication with a minimum of risks, anthropology must maintain its critical posture in order to understand the individual practices at work in this field.

Paper long abstract:

One public health concern is that of promoting, ensuring or improving people's health with a minimum of risks. This is why, today in France, the promotion of self-medication as a therapeutic resource goes hand in hand with recommendations from both public authorities and health professionals, with a view to reducing associated risks and the uncertainty involved, and to laying down the conditions of such recourse. What is anthropology's role in this context? Is it to work with the public health system to ensure that these conditions are respected and to contribute towards the resolution of risks? Or is it to maintain its critical approach, by focusing the spotlight on patients, professionals, public authorities and the discourse of public health authorities? It is the latter option which must be chosen if we want to understand individual responses to public policies on this issue. I will here underline the methodological approach and epistemological posture that anthropology must adopt in order to ensure a specific contribution, i.e. in order to reveal the social behaviours which are really at work in the field of self-medication, the ways in which individuals manage the risk associated with this recourse, and the meaning that these practices take on.

Paper short abstract:

In a comparison of experiences from Denmark and Italy, relations between medicine and anthropology in public health are discussed. Can anthropology balance reconfiguring problems and offering solutions? Issues of medical formation, embodiment and the right to health are at the core of this paper.

Paper long abstract:

The paper will compare examples of ethnographic engagement in the public health field in Denmark and Italy. The authors claim that ethnographic practice should no more be considered as a method belonging exclusively to the medical anthropologist but it could be a sharable tool, a key practice for expressing a common agency both in the scientific and the public field in collaboration between medicine and anthropology. The stress is on the importance of dialogue and shared practices between anthropologists and physicians beginning during education. Recent European people's advocacies for health care as a "common good" are an attempt of counteract against the social-economic decline of the right to health in welfare societies. How do ethnographers and physician react to such a crisis in the two countries? Is the old quarrel on reductionism still an obstacle for dialogue or not? If the vocation of anthropologists consists in reconfiguring problems more that offering solutions how can this approach help the collaboration between physicians and ethnographers in the public health field? These are some of the questions to which the authors try to provide answers based on experiences with ethnography in the public health field in Denmark and Italy. Issues of medical formation, embodied knowledge health economy and the right to health are at the core of this comparative approach.

Paper short abstract:

‘Denormalization’ has become a concept widely used in public health discourse. It is not without its problems, as social scientists have pointed out. This paper argues for the need to interrogate the concept and its targets more carefully, using tobacco control as an example.

Paper long abstract:

Tobacco control has focussed on denormalization as a principle by which smoking prevalence rates can be reduced. Other branches of public health are taking up the concept too. Denormalization aims to change perceptions and meanings of a practice at a population level. Its focus on changing social norms rather than on individual behaviour change broadens the scope of tobacco control. However, as a concept it has been criticized recently for its tendency to stigmatize 'the smoker' (Bell et al 2010). The distinction between 'smoking' and 'smoker' is one frequently made in the more cutting edge domains of tobacco control as an attempt to circumvent this problem, but it is problematic and easily transgressed in everyday life. This paper will argue the need to rethink, or at least fine tune, public health approaches to denormalization, not only by interrogating the concept of 'the smoker' as a target for intervention but also by changing the focus of abnormality from 'smoker' to 'tobacco industry'. Tobacco distributors and suppliers, legal and illegal, fuel the 'tobacco epidemic' for shareholder or personal profit. Historical and contemporary analysis will be used to show how the denormalization agenda has tended to play out in practice and will suggest that, far from being a legitimate part of the corporate landscape, an alternative reading of the tobacco industry is as something of an aberration in late 20th century capitalism.

Paper short abstract:

Based on experiences with a large interdisciplinary research project on children’s health, this paper argues that an anthropological strength in public health research lies in the anthropological methodology. In other words, anthropology enables us to question the questions we ask.

Paper long abstract:

Based on fieldwork in Mali this paper discusses the role of anthropology (and the anthropologist) in a large public health research project on children's health. In the uncertainty and disquiet that comes with the battle to combat and avoid diseases in a setting where poverty and abysmal diseases are part of everyday life, children are often the most vulnerable. The project was carried out to shed light on mainly two types of diseases - malaria and diarrheal diseases - that strike children.

In practice the academic backgrounds of the researchers played a role in the methodological approach to the field. By emphasizing the logos in methodology this paper wishes to underscore that where anthropology sets itself apart from public health is, among other, in the way anthropologists think about method and how this affects fieldwork practices as well as analyses. By tracing two concepts, hygiene and children (both at once emic as well as etic) in a specific project, the paper shows how anthropology can contribute to an analysis that aims at avoiding reifications of conventional analytical assumptions. All in all the paper argues that the main role of anthropology in public health research, is the ability to move beyond even the best hidden assumptions and question our own questions, thereby enabling us to ask the right questions.

Paper short abstract:

I would analyze the anthropological implications of thinking about Primary Health Care as a patient-centered care domain, focusing on the role of the Community Health Worker. The foucaultian concepts of subjectification, governamentality and care of the self will be the main analytical instruments.

Paper long abstract:

The paper wants to propose an anthropological and critical analysis of the Primary Health Care (PHC) programs and practices, trying to bring into light the relations between the specific rationality and the tactics used for their implementation.

The central idea of the PHC programs is making the patient able to constantly check and monitor his own health conditions, and thus to reach the competence and instruments necessary to understand how to prevent illness. This is the so-called patient-centered care domain.

I will refer to my fieldwork research in Brazil on the role of the Community Health Worker (CHW), an important figure of the Family Health Program, the brazilian version of PHC.

Using the foucaultian concepts of subjectivation and governamentality, the paper will try to present the brazilian CHW as a subject who is supposed that act on the actions of governed citizens, in order to empower individuals regarding their health conditions. The CWH teaches his patients how to achieve a specific "care of the self", which is aimed at forming their capacity to invest on their own health, expecting a return in the future ("preventive approach").

What are the implications of this way of thinking about health? How can we analyse, in an anthropological perspective, the transition from a curative-based medicine to a preventive medicine, grounded over the family behaviours?

Paper short abstract:

Adolescents are perceived in public health literature simultaneously in terms of vulnerability and the future, dependence and autonomy, risk and expectations.This paper is an attempt, integrating epidemiological and anthropological perspectives, to understand Catalan adolescents’ emotions, feelings and mood states as phenomena with “social lives"

Paper long abstract:

Adolescents are perceived in public health literature simultaneously in terms of vulnerability and the future, dependence and autonomy, risk and expectations. A domain public health regard with a certain degree of concern is that of emotions and negative mood states because of its relationship to adolescents' mental health and risk behaviours. This paper is an attempt to understand Catalan adolescents' emotions, feelings and mood states as phenomena with "social lives". The first phase of our study consists of analysis of the social determinants of mood states of the adolescents interviewed by the PIF (a longitudinal study of families focusing especially on factors affecting the well-being of children and adolescents ). The results indicate the existence of two components of adolescent distress, interpreted here as (1) social isolation, disaffiliation, or structural difficulty in reproducing and maintaining the social self, expressed as feelings of sadness, solitude and boredom; and (2) a sense of inadequacy in relation to parental and adult expectations, expressed as feeling nervous, pressured, overwhelmed, and too busy to keep up with everyday life. The second phase focuses on chances and challenges of integrating qualitative and quantitative data and methods in the study of adolescent mental distress. The conclusions include recommendations concerning the importance of taking anthropological regard into account in adolescent health policies.

Paper short abstract:

The aim of this paper focuses in a research proposal in which scientific rigor and social responsibility must be the core of any project of Applied Anthropology. According to this proposal, we will present our experiences in research-action projects with ethnic and autochthon minorities in Catalan Public Health Services.

Paper long abstract:

After almost a century of debate about the unavoidable risks of Applied Anthropology, the social use of Anthropology is revealed as one of the most fruitful fields of discipline.

This paper starts from the argument of the priority of the social responsibility in any action of this field, the quality and scientific rigor as an inexcusable condition and as a part of social responsibility and their added value as contrasting of the research results.

From this starting point we exposed, as a model, the applied researches in Health Anthropology we have developed since 2005. We will analyse questions linked to the methodology used, final products and specially their practical uses to contribute to the improvement of health assistance to populations in situation or risk of social marginalization and ethnic minorities, either immigrants or autochthon. The explanation will focus in the research we carried out since the beginning of 2006 to the end of 2009, entitled Socioeconomic Inequalities and Cultural Difference in Health field in neighbourhoods with priority action in Catalonia (Agreement between Health Department of Generalitat de Catalunya - Catalan Government- and GRAFO -Research Group of Applied and Fundamental Anthropology- of Universitat Autònoma de Barcelona).

From the specific methodology of this project based in our proposal, we will highlight our experiences along the research process with particular emphasis to the uses of the results which have been specially oriented to the improvement of competences and knowledge about cultural differences and socioeconomic inequalities of people that medical professionals treat in their daily practice.

Paper short abstract:

Roma populations challenge not only citizenship categories, but also those of the ethnographer. Through an ethnography of the relationship between Roma and the Italian health system, this paper discusses the tension between the analysis of the misunderstanding on Roma and the risk of reproducing it.

Paper long abstract:

Several studies on Roma show how these groups constantly challenge the categories of citizenship and rights. But, in the same way, they also challenge anthropology's theoretical and methodological categories.

The relationship between Roma and the health system is the field where this tension is more clearly expressed, as healing is directly involved in biopolitical forms of action.

Security politics concerning the residents of Roma settlements (« campi nomadi ») in Italy show interesting crossings with specific health interventions taken in these urban areas. These same politics are alimented by false assumptions and misunderstandings about social and cultural characteristics of Roma groups ("nomadism", "cultural habits" and others). In this framework, anthropology often struggles with the paradox between the scientific duty of deconstructing these assumptions and the need to take into account their real effects.

This paper proposal relates to an ethnographic fieldwork conducted in Rome, observing the everyday work of a sanitary mobile unit dedicated to Roma settlements and held by the public health system. In a context where politics and security issues are considered "problematic", this case shows how a humanitarian health approach can be held by State not only to "provide help", but also for surveillance purposes and other political instances. Moreover, these actions are very often shaped by the same false assumptions affecting the institutional and public knowledge on Roma.

For such cases, how can medical-political anthropology of public health take into account all the instances and their sources without reproducing the same constant misunderstanding while describing its effects?

Paper short abstract:

The paper tries to present how matters of health and illness are de-localized from domestic rural sphere to a public one, externalized by appealing to state sanitary institutions and representatives.

Paper long abstract:

The paper tries to present how matters of health and illness are de-localized from domestic rural sphere to a public one, externalized by appealing to state sanitary institutions and representatives. Te main idea starts from the trouble caused by the fact that a crisis (an illness) once solved inside a cultural circle - family - community - village, is now more and more pushed towards a public system of health care. Starting from this idea we will try to bring arguments further on how this particular change at the medical level brings further changes at a symbolical and cultural levels, and how the rurals are trying to cope with the change. Even more the peasants are strongly resistent to this idea of new medicine and they need to find appropriate means to accept it. Some have given up to pills and other modern medical devices, others are still strugling to find alternate ways to deal with their health problems. Even so, the modern medical system is negociating day by day in small steps its status inside the rural communities.

Paper short abstract:

The presentation aims to discuss the global “pink wave” – campaigns by private and public institutions catching attention about breast cancer since the 1990s. The use of the pink ribbon as symbol and its application on luxury products is evaluated, as well as where and how “pink events” take place

Paper long abstract:

The presentation aims to discuss the global "pink wave" - campaigns by private and public institutions catching (women's) attention about breast cancer, its early detection and therapy since the 1990s. Breast cancer is sold as women's biggest health problem, although it is not, not only in industrialized countries but also in developing/emerging countries where still more women die during pregnancy, birth, and through violent conflicts etc.

Since 1992, when Evelyn Lauder invented the pink ribbon, it has been used as sign in campaigns around the globe, which are said to inform women about breast cancer. In Austria, every year more producers of "luxury products" such as expensive crèmes, perfumes, golf rackets, jewellery etc. are using the pink ribbon as image or fabricate their product in pink colour to join the campaign as advertising for their brand mark and for funding of research on breast cancer or financial help for patients.

Since 2005, the campaign is observed through observation of homepages, the media, public discourse, and also different campaigns (non-governmental initiatives) in Austria, Brazil and other European countries. The use of the pink ribbon is analysed from the following point of views: how the campaigns try to create awareness among the target group by making use of language and images; where and how events of these campaigns take place; if their information material is up-to-date actual and neutral and how it is presented. The transmitted information of the campaigns is consequently confronted with evidence-based-medicine knowledge about the early detection of breast cancer.

Paper short abstract:

The article is based on ethnography of the relationship between industrial pollution and cancer in Brindisi. I will propose a reflection on the practices and negotiation forms of cause-effect relationship between pollution and cancer within the local\global field of “public health”.

Paper long abstract:

Brindisi is a city in the South-east of Italy with high industrial density - two coal-fired power plants and a large petrochemical complex - and a high percentage of cancer deaths with an excess of a lung cancer. According to LILT - Italian League for Fighting Cancer - the number of deaths rose from 884 in 2006 to 960 in 2008 with data still on the rise. The pollution of coal power plants as well as that of petrochemical complex is considered as the main cause of diseases and deaths by the local doctors union and some social movements. However this report is constantly negotiated and redefined by the parties involved (energy companies, doctors, local social movements, politicians, researchers) in a very articulate public health field, that involves different local\global spheres of public, politic, professional and private life, in which power relations and high emotionally contrasts define the position of many social actors.

My paper is based on an ethnography started in 2009 and still in progress, focused on the relationship between pollution and disease in Brindisi. I will propose two lines of analysis strictly related. On one hand an ethnographic reflection on negotiation form and practices of categories and values as "right to health", "sick of coal", "public health", "medical authority" inside a cause-effect relationship between pollution and disease. On the other hand, I will try to reflect on the position of the ethnographer and the role of his own research within the conflictual field of public health policies.