Designing a course on global public health from a social scientific perspective is challenging to say the least. One needs not only to introduce students to the topics, concepts, and relevant literature, but also provide them with all the historical, political, and social context they will invariably need to fully understand the biggest problems facing public health. To complicate things, many of the students interested in global health, medicine, and infectious disease are science or pre-med majors—or future practitioners—and thus often have little experience with social science or humanities courses. Luckily, for those of us teaching these increasingly popular courses and interacting with such students, Merrill Singer’s latest book provides an excellent overview of the complexities involved in doing work in the field of public health today.
This book is an attempt to lay the groundwork for an anthropology of infectious disease, defined as “the arena of applied and basic anthropological research that focuses on the interaction among sociocultural, biological, political, economic, and ecological variables involved in the etiology, prevalence, experience, impact, cultural understanding, prevent, and treatment of infectious disease” (p. 21). Of course, work in this field has been going on for decades, so in many ways the anthropology of infectious disease is nothing new. However, Singer’s attention to the “biocultural or biosocial conceptualization” (p. 31) of infectious disease throughout the text makes it perfect for introducing anthropology to non-anthropologists interested in public health or medicine.
The book goes beyond laying the groundwork for an anthropology of infectious disease, introducing the reader to some of the basic terms and practices of epidemiology, multispecies ethnography, and ecology. Indeed, perhaps what is most useful and interesting is the book’s attention to the ecology of disease, already a hot topic within epidemiology, medicine, environmental studies, and public health. Singer explores the sociality and interconnectivity of both the micro and macroscopic worlds, arguing that any neat separation between the human and nonhuman realms is not only inaccurate from a scientific perspective but gets in the way of our capacity to fully understand the dynamic interactions at play in outbreaks of infectious disease.
The first half of the book is a comprehensive introduction to all the various “denizens of the microbial world,” or actors that play a significant role in human health (a list that includes mosquitos, retroviruses, and gut bacteria). The second half of the book examines the complex interactions between microbes, animals, humans, and our built and natural environments that produce disease. Of most interest here are: the explanation of “pluralea interactions” (p. 145)—or the effects of environmental change on the ecological aspects of infectious diseases; the examination of the human and nonhuman factors affecting the very real problems of emergent, reemergent, and drug-resistant diseases; and the various meanings and usages of the concept of “syndemic.”
Singer defines a syndemic as encompassing “damaging biological, biobehavioral, and/or psychobiological interactions between two or more copresent diseases, including infectious diseases, within individuals and within populations that the adverse social, cultural, and environmental contexts in which they occur make possible or worsen” (p, 197). This term, Singer suggests, allows us to examine the ways in which one disease impacts another, or the ways in which socioeconomic factors affect disease rates or treatment outcomes. Syndemic is a fuzzy concept, but this works in its favor. Because it incorporates so many biocultural and political factors into its purview, the term acts as a check on terms that are more biomedical in scope, such as pandemic, epidemic, or outbreak. Syndemics are reminders that outbreaks of infectious disease don’t happen in a vacuum and are rarely about the transmission or treatment of a single microbial agent. The lived world is far messier than the general, and increasingly outdated, models of disease etiology and transmission that early epidemiology utilized. The fact that the term “syndemic” has enjoyed success within the field of public health is evidence that Singer has tapped into the current microbial zeitgeist in global health.
While Singer’s book is a solid textbook for introducing students to social scientific aspects of infectious disease, it may not work as well for graduate-level classes or for scholars already working within the field. There’s not much that is new here, despite Singer’s use of examples from current work to illustrate most of his arguments. What may be valuable for other anthropologists already familiar with the literature is the book’s bevy of pertinent examples culled from other works and scholarly studies. Each chapter is filled with synopses of anthropological investigations into a myriad of diseases and outbreak events. In fact, the writing style—while choppy and occasionally reminiscent of a laundry-list of disease outbreak events and anecdotes—conjures up the feel of sitting down in Singer’s office and enjoying an opportunity to pick this venerable scholar’s brain about his decades-long experience working in public health. For this alone, anyone interested in delving into the field of infectious diseases or learning more about anthropology in and of public health should read this book.