Antropologia

Applying medical anthropology in the control of infectious disease
1. Lenore Manderson

Keywords:
* anthropology;
* public health;
* infectious disease;
* sustainable intervention

Abstract
This paper focuses on two roles of anthropology in the control of infectious disease. The first is in identifying and describing concerns and understandings of disease, including localknowledge of cause and treatment relevant to disease control. The second is in translating these local concerns into appropriate health interventions, for example, by providing information to be incorporated in education and communication strategies for disease control. Problems arise in control programmes with competing knowledge and value systems. Anthropology's role conventionally has been inthe translation of local concepts of illness and treatment, and the adaptation of biomedical knowledge to fit local aetiologies. Medical anthropology plays an important role in examining the local context of disease diagnosis, treatment and prevention, and the structural as well as conceptual barriers to improved health status. National (and international) public health goals which respect localpriorities are uncommon, and generic health goals rarely coincide with specific country and community needs. The success of interventions and control programmes is moderated by local priorities and conditions, and sustainable interventions need to acknowledge and address country-specific social, economic and political circumstances.

Introduction
Historically, anthropologists have always beeninterested in health and illness, diagnosis and healing and death and dying. This has been both as a consequence of the discipline's wider concerns with the management of crises and the search for causality in everyday life, and due to the role of science, religion, magic and ritual in protecting community welfare and ensuring continuity through generations. While medical anthropology as a discretesubdiscipline has a briefer history, its genesis is tied to anthropology's most fundamental questions of social and cultural life.
Anthropological interest in infectious disease control is, by contrast, relatively recent. The expanding range of specializations within medical anthropology has occurred partly due to continuing anthropological curiosity about the natural, biological and culturalworlds and their intersections. The focus on particular illnesses, including infectious diseases, has led to the exploration of various theoretical interests. The interest in infectious disease follows from anthropology's professionalization as an applied science, the interest of other public health scholars in anthropological methods and theories, and the involvement of anthropologists ininternational health programmes of multilateral organizations and bilateral aid programmes. The increasing presence of anthropology within WHO programmes is an example here (Gove & Pelto 1994; Vlassoff & Manderson 1994).
Practically, the failure to contain various infections biologically or environmentally, and the continued lack of comprehensive and enduring technical programmes leave us withhealth education and related behavioural interventions as the primary means to limit disease and reduce mortality. This emphasizes the need to understand better the roles of human behaviour and social structure in the transmission of infections, and to analyse the difficulties in introducing and sustaining interventions for prevention or treatment.

Belief, anthropology and public health
In hiscritique of developments in medical anthropology, Byron Good (1994) problematized the role of medical anthropology in public health. In most intervention-driven medical and public health programmes, he argued, scientific medical knowledge is positioned as superordinate to folk beliefs, constructing in the medical as in other domains a hierarchical relationship between cosmopolitan and indigenous...