Читать книгу A Companion to Medical Anthropology - Группа авторов - Страница 54

One of the most obvious and most practical midrange theories in medical anthropology is the theory of cultural relativity. It is also one of the most miss-applied and politically misused theories in anthropology. This theory is an expression of the empirical findings of anthropologists and other social scientists that groups tend to share consensual world views within the group, and differentiate those world views from others outside the group. Finding examples, from folk medicine to health care prevention programs, is easy, but the findings also frequently result in highly complex actions and recommendations (from calls for cultural competency, to representations that only members of the same culture, or social strata, or language group, or gender, or lifestyle orientation, etc. can understand X culture and therefore can be sufficiently culturally competent to deal with the health and medically related problems of that culture). These forms of cultural particularism tend to reinforce difference at the expense of the possibility for cross-cultural understanding and action. At the same time, the “one size fits all” universalism found in some health interventions is based on a view that constantly stumbles over social and cultural difference, to the detriment of understanding the actual confluence of culture, health, healing and medicine in peoples everyday lives.

One example of a successful applied medical anthropology project in this arena of work is the revision of an international classification of disabilities, the ICIDH CAR² study. The study had to satisfy 12 data needs in relation to both the ICIDH revision process: (1) identify linguistic equivalencies for conceptual transfer of elements of the classification into local languages and back to English; (2) explore the cultural contexts, practices, and values concerning disablements in the local culture; (3) investigate whether the proposed structure of the classification has good cross-cultural stability; (4) conduct an item-by-item evaluation of the cross-cultural applicability of each facet of the classification; (5) explore alternative models for the classification; (6) collect data on the parity or lack of parity in accommodation and level of stigma between mental health and physical disablements; (7) collect data on the boundaries between the three levels of the: classification system; (8) establish information on the thresholds that apply to disablements (when someone is considered disabled and when are they not shows significant cultural variability); (9) investigate information on stigma attached to various types of disablements; (10) produce a description of the current programs and need for programs that serves populations with disabilities; (11) compare the relative importance of different types of disabling conditions in different cultures; and (12) create a general description of the place and meaning of disabilities and disability programs in local cultures. The practical aspects of the design required conducting the research at a number of different centers around the world that have varying levels of experience with qualitative and quantitative research methods. The methods had to be easy to use, inexpensive, comprehensive, and capable of producing defensible results. The ICIDH CAR model was designed to address a consistent issue for multisite cross-cultural applied research. The research requires a standardized sampling framework that does not place an extreme burden on the various centers. We used qualitative sampling procedures for the bulk of the CAR study, except in those cases where statistical power needs dictated a quantitative sampling approach. The ethnographic sampling framework was comprised of selected individuals who were especially knowledgeable about their culture, rather than randomly selected individuals who might not be able to contribute substantively to the study (cf. Johnson 1990a,b; Schensul et al. 1999). The process appropriately differs from probabilistic (forms of random) sampling due to the goals of the study, especially the need to interview individuals who are cultural experts and who have substantive knowledge in the area of disablement. The final results of the study and application was a consensual, multi-national, revision of the old disabilities classification system into a new system for assessing functioning in cultural context, which is a significant paradigm shift for both WHO and the disabilities communities. (Ustun et al. 2001).