Reading the Archive, Issue 2 | Airs, Waters, Places: Reading the Environment in Medical Anthropology

By Nadia Gaber, PhD

Table of Contents

Introduction
Selected Articles
Pedagogical Materials

Introduction

It was mid-November, and an eerie haze surrounded the anthropologists gathered in San Jose, California for our annual meeting. Smoke from the raging wildfires up north had traveled the two hundred miles south to where we sat. Not only that, it also traveled more than three thousand miles east, to at least Michigan, where friends and interlocutors told me they could smell it. A colleague was constantly checking the air quality index — “we’re at Beijing levels,” she said, like that meant something given. And yet, seeing people walk through the enveloping greyness, across now-vacant busy streets, with surgical masks and scarves and kerchiefs tied around their mouths, I do remember the distinct and jarring feeling of an altered world, perhaps my arrival into the Anthropocene.

This term, with its homology to anthropology, is meant to signal a new epoch, in which human activity reshapes the physical geography of the planet on a geologic scale. It heralds the coming of complex existential threats, and their attendant epistemological undoings – at least for those not already well aware. Certainly, it raises new issues for the field of anthropology in general, and medical anthropology in particular. Among these are questions about the materiality of our social worlds, the entanglements we have with companion species, the blurring of mechanical and organic technologies, the embodiment of distributed risks, and the limits of the very category of the human, anthropos — and its others.

Newer works in Medical Anthropology Quarterly explore these problems. Enabled by new techniques of visualization and imagination, the body/environment dichotomy has been put under duress by an extended politics of scale. At one extreme, the human body is the environment, for example in studies of the microbiome and symbiotic interspecies nature of our species being (see Lorimer 2019). At another, the environment is socially assembled space, the net effect of living and nonliving bodies, summing multispecies contact and contagion (see Brown and Kelly 2014) or a material reservoir of psychic and interpersonal histories (McIsaac 2020).

But through these new terrains, old debates travel. The title of this collection nods to the ancient origins of these problems, their trace of a humoral theory of disease. Hippocrates’ Airs, Waters, Places reads asa physicians’ guide to the geographic elements of health and illness, prescribing both a dietetic and aesthetic harmony with nature. These relationships — as between temperature and temperament — are not only etymological, but philosophical, epistemological, and always, political. 

A look back shows that study of the relationship between environment and health has long been central to medical anthropology, and yet the notion of environment remains unsettled. Because no retrospective on the concept could aim for completeness, leaving ever-open the question “What is the environment?,” this collection instead reads across the archive asking: “What do we make of the environment? And what does it make of us?”

***

The question is taken up most directly and quite carefully in Ian Whitmarsh’s 2013 article, “Troubling Environments,” in which the environment is figured through differing epistemological perspectives. Following a John Hopkins study on genomics and asthma in Barbados, Whitmarsh elaborates on the idea of “environment” as a mediator between the “natural” world of genomics and the “social” world of illness and health. Local Bajans attribute rising asthma rates to increasing “dust” (a miasma of modernity that arises from automobile pollution, industrial pesticides, roadwork, and more) in the air, but U.S. scientists transcribe these culturally situated notions of political pathogenicity into racially prefigured biological and genetic factors. This kind of molecularization places focus on individuals in ways that export U.S. notions of race and health, while supporting neoliberal pharmaceutical research and global health interventions.

This picture of environment is a critical departure from the early purview of medical anthropology, in which the environment largely appeared as a variable in global health promotion campaigns, constraining or enabling the ‘adherence’ of a community to particular interventions. The environment was essentially a backdrop to the descriptions of beliefs, taboos and rituals concerning illness, healing and faith that defined a culture — a culture that was more or less hospitable to the ingresses of biomedicine, and more or less adapted to the local terrain. Adaptation was a key concept indeed, derived from biological and cultural ecology; a term generally describing the processes by which social groups orient to external stressors, presumably to increase survival and health by minimizing danger and disease.

A “rift” appeared in medical anthropology in the early 1990s, much discussed in this journal, between the so-called ‘biocultural’ and ‘critical’ medical anthropologists. Bio-culturalists had argued a community’s ability to adapt to the environment–whether ecologically, economically, or politically–was an inherent trait of particular groups, an expression of their physiologic and cultural resources. Another school of thought emerged with critical political ecologists, who challenged the essentialism of these ideas, instead arguing that the conditions of global capital and political economy unequally distribute the very ability to adapt to the environment.

For example, whereas a biocultural approach might pose undernutrition or malnourishment as a problem of inadequate technologies of harvest or physical limits on responding to new patterns of rain or drought, political ecologists began to allege that such an explanation smuggles in a kind of ‘victim blaming’ by ignoring the political forces driving or sustaining poor diets. Instead, the political ecologists argue, researchers had to emphasize the capitalist and colonial relations through which the elite access healthy foods while the poor consume poor-quality diets. We might consider Jelliffe’s classic paper on “Commerciogenic Malnutrition,” published in 1972 in Nutrition Reviews, as archetypal of this approach.

“Too frequently one found the pediatrician in a tropical, sun-drenched country, exhorting mothers to use cod liver oil to prevent non-existent rickets. Or, one found the public health nurse from Europe advising mothers to feed their babies on orange juice when infantile scurvy did not exist, when oranges were unobtainable, when there was a real danger of unclean orange juice producing diarrhea and when the infant would be receiving adequate ascorbic acid through his mother’s milk. Likewise, the earnest unacculturated Western home economist could be demonstrating the preparation of infant foods with no consideration of their cost or of the limited kitchen possibilities in their mothers’ homes.”

Merill Singer’s 1989 piece, “The limitations of medical ecology,” set off the debate. Though framed only as a critique of the inability of medical ecology (with a biocultural approach) to describe the structure of social stratification within a group, the piece alleges that ecologists smuggle in a Darwinian notion of ‘environmental determinism’ (that an area’s natural resources determine what cultural forms and practices arise, as if culture is genetic potential [see Steward 1955]). Further, Singer suggests that this environmental determinism is often a veil for political domination. Andrea Wiley retorted, arguing that Singer’s was a mischaracterization, claiming that bioculturalists do not attend to ‘the social’ while relying on a definition of the environment as “an inert configuration of possibilities and limits to development” (Sahlins 1963, emphasis added) and therefore assuming the ‘natural’ and ‘social’ are separable spheres. 

Hans Baer followed with a panel at the AAAs in 1991 and his 1996 paper, “Towards a Political Ecology of Health in Medical Anthropology.” There he echoes the sentiment that the discipline should focus on historical imbalances of power and the capitalist drive that “despoils the ecologically fragile biosphere,” while acknowledging that critical medical anthropology (political ecology) “has given scant attention to ecological factors” (452). Presumably, to attend to politics was to return the environment to the backdrop of considerations. Replying in turn, Ann McElroy (1996) repeats Wiley’s analytic points while adding another: that political ecology risks ‘politicizing’ all anthropological research, making ‘social justice’ the end, rather than empirical or theoretical analysis. 

A generous reader may find that the difference is more a matter of emphasis than incongruity.

***

Echoes of Jelliffe’s ‘commerciogenic malnutrition’ can be heard in Richard Burghart’s “The Purity of Water at Hospital and at Home as a Problem of Intercultural Understanding” (1996). In this ethnographic study, Burghart examines the practices of water sterilization in Janakpur, Nepal. Most of the doctors in the area are locals with foreign training, thus they are fluent both culturally and linguistically with their patients. Doctors have advised women to boil water for fifteen minutes before it can be considered sterile; yet, women in the area have either ignored or changed the time/method of boiling to suit their own cultural understandings of water purity. Burghart argues that local understandings of what constitutes “pure” water have made a meta-linguistic conundrum of perception in which doctors prescribe techniques for sterilizing medical equipment — not water — and women interpret these instructions through their cultural understandings of “pure” water.

By contrast, we find more of the critical approach in Michael Ennis-McMillan’s “Suffering from Water” (2008) that attends to the collective phenomenological experience of social stratification, which flows through access to water. In the semi-arid community of La Purificacion, Mexico, “water suffering” is a daily occurrence for residents who have limited access to clean water in their homes. The range of bodily distress this “water suffering” puts community members under is itself a method by which people produce knowledge about their social condition. When the impetus for water suffering is a social inequity, like wealthier residents outsourcing water supplies rather than maintaining community water distribution systems, people come together to organize and narrate their suffering. By identifying with “water suffering” as a collectivity, community members are able to recognize and target inequity and dysfunction in their distribution of water resources.

The focus on social and political power relations in determining water access is echoed in other articles. In Amber Wutich’s “Intrahousehold Disparities between Women and Men’s Experiences of Water Insecurity and Emotional Distress in Urban Bolivia” (2009), bureaucratic restrictions on tapstands and evasive water vendors make securing water for poor households a continuously taxing task, whose responsibilities fall along gendered lines through the division of household labors, burdening women more intensely. In Nicola Bulled’s “The effects of Water Insecurity and Emotional Distress on Civic Action for Improved Water Infrastructure in South Africa” (2015), water access becomes a way of tying biological claims about the body’s need for water to social claims about access to the urban environment and its resources, and it is through built infrastructure that residents mediate their rights as citizens.

Elsewhere in the archive, in other settings, we find residents strategically represent the bodily effects of environmental harms to make claims on and against the state — complicating any easy division of body from environment. Singer’s ethnographic piece, “Down Cancer Alley” (2011) explores how the impacts of industrial pollution on health are internalized by poor, Black community residents in Donaldsonville, Louisiana. Nicknamed “Chemical Corridor,” the area is a site of exposure to a wide variety of environmental toxins: air pollution from nearby chemical factories, toxic water, and fumes from agribusiness all lead to highly elevated rates of cancer and other diseases that disproportionately affect Black communities. Singer analyzes how residents internalize and understand their health given the dissonance between industry pushed narratives and the realities of environmental pollution. Meanwhile, the state and chemical industries continuously downplay the severity of these environmental factors on health, instead pushing narratives of individual lifestyle choices to explain the heightened rates of disease in the area.

It echoes the Vietnamese state’s response to the 2007 cholera outbreak, where, as Martha Lincoln shows in “Tainted Commons, Public Health: The Politco-Moral Significance of Cholera in Vietnam” (2014), public health agencies repeatedly emphasize individualistic models of personal responsibility and middle class cleanliness, using those most vulnerable to exposure as scapegoats. In many ways, the observation reflects that the state, too, engages in ‘political ecological critique’ — noting carefully who has access to a safe environment, who is at risk, and how power operates – but to ends that are not necessarily equitable. In this case, though the outbreak of cholera occurred at a time of relative prosperity and growth of the middle class, the representation of street food vendors as sources of uncleanliness and disease (both physical and moral) was used to foster support for neoliberal restructuring of the economy. The vendors themselves, here figured as a kind of miasmatic threat to the public’s health, can be read as an environment against which middle-class Vietnamese bodies are defended.

In this century, as interconnected and rapid media circuits interpolate us into the emergencies of faraway environments, the distribution of their impacts remains highly fragmented, uneven, and unjust. Environmentalism appears the seedbed of a new, or renewed, humanitarianism, as the ambitions of the millennium development goals become subsumed by sustainable development goals for a new epoch, while hunger, water insecurity, lack of sanitation, inadequate shelter and tropical diseases persist. This increasingly begs the question: To what extent will anthropologists see our work as empirical description; theoretical problematization; activist intervention; or critical reflection? 

***

Two years later, writing amidst a renewed shelter in place order, under an extended state of coronavirus emergency, the emptied urban landscape and its masked publics are becoming increasingly familiar, if no less eerie. The slowing has accelerated the urgency of matters of political ecology often swept to the side by that churning ‘productivist ethic’ in all our busy lives. It also thrusts into relief the heterogeneity of modes of biocultural adaptation to ‘external stressors,’ including the titanic pressures of a jumped-species virus. The present is in part a process of unmaking and remaking our troubled environments.

Today, Baer’s plea for a critical medical anthropology and McElroy’s concern about the identity of the discipline with respect to scholarship and/as social change take on new force, given the climate of extreme political division, environmental emergency, pandemic susceptibility and deepening precarity. As the movement for Black lives forces a national reckoning with institutional (including academic) violence and the possibilities for repair, we are also being confronted with the systematization of climate denial, charges of ‘fake news’ and the manufacturing of doubt, requiring the bulwark of robust research.  

Following the contours set out in the adaptation debate, we might relegate police killings to the domain of the ‘social’ and coronavirus to the realm of the ‘natural’. Or, amidst the ‘twin pandemics’ of racism and coronavirus, we might ask, what might one – a virulent manifestation of social stratification and historical domination – have to do with the other – a zoonotic contagion whose worst effects are experienced by peoples of lower class and caste status?

Consider the realization, upon autopsy, that George Floyd, a Black man killed in public and on camera by police, had been infected with COVID-19. Consider the rationale, by a sitting Congressman, that Eric Garner — arrested in an asthmatic zip code for selling loose cigarettes, then choked to death by police using banned tactics — was liable for his own suffocation because he had a respiratory condition. Or the recognition, in Flint, that many residents were not able to adequately wash their hands to stall the pandemic because their water was unsafe, or not running at all. These environments are no doubt political, ethical and cultural, entangled in the nature of health and illness.

If a ‘cultural’ approach risks ignoring political and historical imbalances and a ‘critical’ approach risks relegating physical, biological and geographic considerations to the background, perhaps what the discipline needs is a ‘complex’ approach, with clear commitments.

We might start with the politics of breathing, and ask what concepts we need to clarify the racial and environmental distribution of pneuma — which for the Greeks was both physical air and personal vitality – and what research methods might be adequate to witness and respond to that clarion call: “I can’t breathe.”

Recommended citation: Gaber, Nadia. (2020) “Airs, Waters, Places: Reading the Environment in Medical Anthropology.” Medical Anthropology Quarterly Online.

Airs, Waters, Places: Articles from the MAQ Archive

Hookworms make us human: The microbiome, eco‐immunology, and a probiotic turn in western health care | Jamie Lorimer (2019)

Material proximities and hotspots: toward an anthropology of viral hemorrhagic fevers | Hannah Brown and Ann H Kelly (2014)

Identified Patient: Apartheid Syndrome, Political Therapeutics, and Generational Care in South Africa | Stephen McIsaac (2020)

Troubling “Environments” Postgenomics, Bajan Wheezing, and Lévi‐Strauss | Ian Whitmarsh (2013)

Adaptation and the biocultural paradigm in medical anthropology: a critical review | Andrea Wiley (1992)

Toward a political ecology of health in medical anthropology | Hans Baer (1996)

Should medical ecology be political? | Ann McElroy (1996)

The purity of water at hospital and at home as a problem of intercultural understanding | Richard Burghart (1996)

Suffering from water: social origins of bodily distress in a Mexican community | Michael C Ennis‐McMillan (2001)

Intrahousehold disparities in women and men’s experiences of water insecurity and emotional distress in urban Bolivia | Amber Wutich (2009)

The effects of water insecurity and emotional distress on civic action for improved water infrastructure in rural South Africa | Nicola Bulled (2017)

Down cancer alley: the lived experience of health and environmental suffering in Louisiana’s chemical corridor | Merrill Singer (2011)

Tainted Commons, Public Health: The Politico–Moral Significance of Cholera in Vietnam | Martha Lincoln (2014)

Pedagogical Materials

Prepared by Nadia Gaber

Reading Questions

Kim Fortun’s “Questioning a Text” has been adapted as a classroom teaching tool by Joe Dumit. These are general questions to guide a close and situated reading that can be made into a Google Form and posted on your course page as a weekly assignment. Instructors can access all of the responses in one editable spreadsheet to ease grading. Dumit’s example is here: https://dumit.net/ant2-debt2culture/. Angela Jenks reflects on this approach and suggests others at https://culanth.org/fieldsights/why-dont-students-read.

Discussion Questions

How do each of the readings frame the environment and people’s relationship to it?

  • What can we learn about the author from the way they approach the environment?
  • How does the author’s conception of the environment/s get reflected onto the subjects of their research?
  • What kind of conclusions about people are precluded by a particular environmental imaginary?

How would you describe the variations in approach to the concept of “health” within these readings?

  • Is health an individual or collective question?
  • What’s the role of culture in health?
  • How do people adapt to the introduction of new ideas of health?
  • How is health measured?

The concept of the Anthropocene asserts that human activity has become a geological/climate scale force.

  • What are some potential political repercussions that stem from this new concept?
  • What are the assumptions made about humans as we (re)imagine ourselves as a force of nature? What happens to classic ideas of individual agency, responsibility, or free will?
  • How might a writer’s standpoint (identity, geography, training, or otherwise) influence their approach to the environment?
  • Is the environment ‘local’? What boundaries of time and space does it encompass? Is it a privilege or a necessity to think ‘globally’?

More to Think With

As you watch these videos, think about how each imagines the environment and ‘its’ relationship to human cultures? What about non-human cultures?

Which take the biocultural approach, and which lean towards political ecology?

Is the environment a force of nature or culture? Or: how would you characterize it? Is a factory an environment?

What is the role of crisis, or disaster, in making the environment matter?

How are environments regulated, policed, and protected?

What techniques (visual, sonic, narrative, etc.) render the environment ‘local’ or ‘global’?  

How does the scale of representation affect the politics of responsibility?

Online Media, in no particular order:

Amalie Oil (2014). “Amalie Oil Company TV Commercial” Runtime: 0:30. No captioning available. https://www.youtube.com/watch?v=8oayIV-CjcQ

“Amalie Oil Company TV Spot during the Tampa Bay Lightning Hockey matches on SunSports.”

KCET Online (2010). “S1E4: Adaptation to Global Water Shortages.” Runtime 25:44. Autocaptions available. https://www.youtube.com/watch?v=O_EzIjfhwB4

“Anticipating future water needs, two regions on opposite sides of the world turn to technology for answers…”

Josh Fox, James Spione, Myron Dewey 2017. “AWAKE: A Dream from Standing Rock.” [Trailer] Bullfrog Films. Runtime: 3:00. Open captions. https://www.youtube.com/watch?v=Czd-VP6dlxA

“Moving from summer 2016, when demonstrations over the Dakota Access Pipeline’s demolishing of sacred Native burial grounds began, to the current and disheartening pipeline status, AWAKE, A Dream from Standing Rock is a powerful visual poem in three parts that uncovers complex hidden truths with simplicity.”

Journeyman Pictures. 2018. “Cape Town’s Water Crisis Approaches Day Zero.” Runtime 24:11. Autocaptions available. https://www.youtube.com/watch?v=jQQT9ZjmeTA

“A City Without Water: This year Cape Town has come dangerously close to running out of water – the first major city to do so. Efforts to reduce water usage have doubled – but will this be enough to stave off ‘Day Zero’?”

Tia Lessen and Carl Deal. 2008. “Trouble the Water” [Trailer]. Zeitgeist Films. Runtime 2:01. Autocaptions available. https://www.youtube.com/watch?v=Cq426VjZD1E

Trouble the Water is a redemptive tale of a couple surviving failed levees, bungling bureaucrats, and their own troubled past and a portrait of a community abandoned long before Hurricane Katrina hit.

Mark Achbar and Jennifer Abbott. 2003. The Corporation [18/23] Expansion Plan. Runtime 04:46. https://www.youtube.com/watch?v=xw5Fon_EjGw

Ch. 18. The beginning of the fight for the world’s most important resource: water. In Bolivia, privatization makes water unaffordable for many of its citizens and the resulting protest turns violent when the military opens fire. (Spanish captions and English autocaptioning available at this unofficial link —https://www.youtube.com/watch?v=6XldhBT-q8E.)

The Economist. 2015. How Bangladesh has adapted to climate change. Runtime 06:05. Closed captions available. https://www.youtube.com/watch?v=xWG_uzLmuug

Bangladesh is highly susceptible to climate change. Floods, cyclones and droughts are likely to increase as the Earth warms. Poor farmers are already trying to adapt.

Amanda Brown. 2013. “Underwater Documentary: Adaptation of Marine Animals (Koh Tao, Thailand). Runtime 05:03. Autocaptions available. https://www.youtube.com/watch?v=WrZEViYbkNc.

A short documentary outlining some adaptations of pelagic and benthic fauna including many bony fish, nudibranchs, gastropods and even a marine reptile! Made as part of the Oceans Below Videography Internship in the Spring of 2013 on the island of Koh Tao, Thailand.

BBC Reel. 2020. “Was this humanity’s biggest mistake?” Runtime 06:28. Open captions.

The Neolithic ushered in dramatic changes: civilizations with large populations, advancements in technology, arts and trade. But with the advent of agriculture, humans also began to experience malnutrition, starvation and epidemic diseases.

KCET. 1990. “The Thrifty Gene.” Science Take Five.Runtime 06:41. Autocaptions available. https://www.youtube.com/watch?v=6xiOba1NJZE

(No description available. Explores the then-emerging “thrifty gene” hypothesis about physiologic maladaptations to nutrition transition. Consider this research paper as accompaniment: https://onlinelibrary-wiley-com.ucsf.idm.oclc.org/doi/full/10.1111/obr.12807)

Foodtank. 2014. “Biocultural Diversity Combats Climate Change.” Runtime 02:29. Autocaptions available. https://www.youtube.com/watch?v=_qnEcVfYMDo.

Biocultural landscapes are holistic systems of culture and nature that have been shaped by human management over long periods of time. They maintain ecosystem health, utilize traditional knowledge, protect biodiversity, provide cultural value, build healthy soils, enhance resilience, nourish agriculture, fisheries, and forests, and mitigate climate change.

Asynchronous Class “Visit” Resources

Some incredible scholars put together a spreadsheet of pre-recorded teaching materials, especially useful when teaching virtually. Hat tip to RtA editor Zoë Wool for this share. https://tinyurl.com/asynchresource

References

Lorimer, Jamie. (2019). Hookworms make us human: The microbiome, eco‐immunology, and a probiotic turn in western health care. Medical Anthropology Quarterly33(1), 60-79.

Brown, Hannah & Kelly, Ann H. (2014). Material proximities and hotspots: toward an anthropology of viral hemorrhagic fevers. Medical Anthropology Quarterly28(2), 280-303.

McIsaac, Stephen. (2020). Identified Patient: Apartheid Syndrome, Political Therapeutics, and Generational Care in South Africa. Medical Anthropology Quarterly34(2), 192-209.

Whitmarsh, Ian. (2013). Troubling “Environments” Postgenomics, Bajan Wheezing, and Lévi‐Strauss. Medical Anthropology Quarterly27(4), 489-509.

Jelliffe, D. B. (1972). Commerciogenic malnutrition?. Nutrition Reviews30(9), 199-205.

Singer, Merrill. (1989). The limitations of medical ecology: the concept of adaptation in the context of social stratification and social transformation. Medical Anthropology10(4), 223-234.

Wiley, Andrea. (1992). Adaptation and the biocultural paradigm in medical anthropology: a critical review. Medical Anthropology Quarterly6(3), 216-236.

Steward, Julian. (1955). Variation in Ecological Adaptation: The Carrier Indians.”. The Theory of Culture Change: The Methodology of Multilinear Evolution, 173-7.

Baer, Hans. (1996). Toward a political ecology of health in medical anthropology. Medical Anthropology Quarterly10(4), 451-454.

McElroy, A. (1996). Should medical ecology be political?. Medical Anthropology Quarterly10(4), 519-522.

Burghart, R. (1996). The purity of water at hospital and at home as a problem of intercultural understanding. Medical Anthropology Quarterly10(1), 63-74.

Ennis‐McMillan, Michael C. (2001). Suffering from water: social origins of bodily distress in a Mexican community. Medical Anthropology Quarterly15(3), 368-390.

Wutich, Amber. (2009). Intrahousehold disparities in women and men’s experiences of water insecurity and emotional distress in urban Bolivia. Medical Anthropology Quarterly23(4), 436-454.

Bulled, Nicola. (2017). The effects of water insecurity and emotional distress on civic action for improved water infrastructure in rural South Africa. Medical Anthropology Quarterly31(1), 133-154.

Singer, Merrill (2011). Down cancer alley: the lived experience of health and environmental suffering in Louisiana’s chemical corridor. Medical Anthropology Quarterly25(2), 141-163.

Lincoln, Martha. (2014). Tainted Commons, Public Health: The Politico–Moral Significance of Cholera in Vietnam. Medical Anthropology Quarterly28(3), 342-361.

Sahlins, Marshall (1963). Culture and environment: The study of cultural ecology. Voice of America, US Information Agency.

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