Читать книгу A Companion to Medical Anthropology - Группа авторов - Страница 39

Critical biocultural anthropology approaches to health share many features with other areas of critical medical anthropology as well as social epidemiology (Krieger 2001), political ecology of health (Navarro 2004), critical perspectives in medical sociology (Annandale 2014), and critical health geography (Cutchin 2007). They all share an emphasis on inequalities, power relations, constrained agency, elucidating the pathways of embodiment that connect inequalities, biology, and health, and a critical examination of scientific inquiry. Yet, variations exist in these various critical approaches in terms of what processes are emphasized and what methods are foregrounded. For example, scholars more grounded in the social and cultural side of critical biocultural anthropology tend to produce deeper social analyses within a richer ethnographic grounding. They place much more emphasis on the individual and social experience of suffering, and privilege narratives as a way to bear witness to and make sense of affliction. In contrast, those with stronger roots in biological anthropology are more comfortable paying greater attention to evolutionary and ecological dynamics, to developmental plasticity, and to quantify the relationships between the social and the biological, as well as the specific pathways by which inequalities get under the skin (Goodman 2006; Hoke and Schell 2020). In this sense, they share much with social epidemiology’s efforts to quantify how social positions such as race, gender, and class are risk factors for disease, disability, and death, and pay greater attention to specific pathways of embodiment. What we see then are a set of approaches emerging from different disciplines and subdisciplines that share very similar goals of connecting history, political economy, and biology and health, yet that tend to emphasize different facets of complex biocultural interaction.

Given the roots of many critical biocultural anthropological studies of health in processes of evolution and development as well as political economy, a series of theoretical and methodological shifts in studies of human biology over the past several decades have tremendous implications for the way bodies are framed and for the ability to link social inequalities to biology and health through specific pathways of embodiment.

Within the areas of evolution and development, there has been a renewed attention to biological plasticity, niche construction, and multiple modes of inheritance as part of an extended evolutionary synthesis (Fuentes 2016; Hoke and McDade 2015) that make more legible links between social relations of power and biology (Hicks and Leonard 2014). Tracing pathways of embodiment to ground these conceptual links have been facilitated by advances in new field methods of biological measurement (e.g., the collection of dried blood spots and other biomarkers) that can provide data on multiple physiological pathways, including neuroendocrine, cardiopulmonary, and immune/inflammatory, through which social factors can contribute to health (McDade and Harris 2018; Worthman and Costello 2009).

The recognition of the impact of early stress on later health, framed in terms of fetal and/or metabolic programming and developmental origins of health and disease (DOHaD), and the role that epigenetics and the microbiome play in biology and health, are significant areas of advancement that have obvious implications for a critical biocultural medical anthropology. Perhaps the best-known example is the thrifty phenotype hypothesis that proposes a relationship between prenatal and early life nutrition and adult obesity, diabetes, and cardiovascular disease (Barker et al. 2002; Hales and Barker 2001), especially where there is a mismatch between the nutritional landscape during fetal development and the subsequent life-course. Such studies have advanced biocultural anthropology by working against genetic determinism and revealing instead the complex interplay between genetics, life course, and environments in the embodiment of human experiences. They have also helped shift perspectives on human variation toward situated bodies and biologies (Lock 2017) over universal bodies and biologies.

Because our environmental exposures are largely influenced by both cultural and social factors, epigenetic changes, changes in the microbiome, and developmental plasticity as pathways of embodiment provide links between broader social worlds and locally situated human biologies (Lock 2017). Epigenetic and microbial findings now make clear that the human genome is more reactive than directive (Fox-Keller 2014; Gilbert 2003; Lock 2017). So, we have new conceptualizations of “situated bodies” and “reactive genomes,” a genome far outnumbered by the number of genes in the microbial community that inhabits our external and internal environments and may shape many human biological processes. Rather than the human host as individual, many now speak of holobionts – host and its entire microbial community – and hologenomes as the genetic material of the holobiont (Gilbert et al. 2013 ; see also, Fuentes 2019). We increasingly recognize the embeddedness of humans in multispecies communities and its critical role in health (Brown and Nading 2019).

Multispecies interactions, holobionts and hologenomes, and metaphors of “unstable bodies” (Palsson 2016) and biosocial becomings (Ingold and Palsson 2014) speak to the relationality of all organisms and the irreducible interpenetration of the social and biological. As Fuentes (2019, p. 157) notes, “Bypassing the conceptualization of the biological, social, and ecological as distinct domains, and thinking of them as obligatorily intertwined processes of becoming (e.g., Ingold 2000 ), presents a powerful lens for understanding ourselves and our relationships with others in the Anthropocene – and a necessary tool to grapple with the complexities of health in the rapidly changing landscape of the 21st century.” All of these changes in the field speak directly to the critical role of environmental context writ large in shaping bodies, biology, and health, and that to “situate” bodies and biology ethnographic grounding is necessary.