Health and Social Stratification

by

Carlos Martinez, Seth M. Holmes

• LAST MODIFIED: 24 April 2019
• DOI: 10.1093/obo/9780199766567-0213

Introduction

Since the beginnings of sociocultural anthropology, curiosities have been stoked by the question of why cultural difference exists. As anthropologists began to grapple with the political circumstances in which their discipline and their research subjects were enmeshed, the question of why disparities—rather than cultural difference—exist within and between societies took a more central place in the discipline. By the 1970s, many medical anthropologists turned their attention to the question of why disparities in health were being observed across populations. Since that time, medical anthropology has contributed significantly to the exploration of the connections between social stratification and health. Much of this scholarship has described the specific patterns of inequality, the lived experiences of those affected, and the impacts these disparities have on their lives, bodies, and psyches. Sociocultural anthropology as a whole has produced a wide range of scholarship on inequality, whether approached through the lenses of racialization, class, gender, sexuality, ecology, citizenship, im/migration, or a combination of these and other factors. Medical anthropologists have offered a number of key theoretical insights to articulate how these social inequalities lead to ill health (e.g., “structural violence”) and how medicalization has also produced its own forms of stratification (e.g., “therapeutic citizenship”). Studies of social stratification and health have pursued a wide range of scalar analyses, from examining the impacts of global neoliberal policies or humanitarian interventions to observations of the micropolitics of drug use and clinical interactions. In addition to producing an expanding literature on social stratification and health, many medical anthropologists have also sought to make their work useful for challenging inequalities by engaging in collaborative advocacy with their interlocutors as well as with public health researchers and policymakers. Medical anthropologists have engaged with other disciplines and frameworks, including importantly Marxist theory, feminist theory, science and technology studies, and postcolonial theory. In addition, biological anthropologists have produced key insights into the mechanisms by which inequalities become embodied. While this bibliography centers on contributions from sociocultural medical anthropology, certain key texts from biological anthropology and beyond the discipline have been included, particularly when their impact on studies of social stratification and health have been significant.

General Overviews and Edited Anthologies

Medical anthropologists have produced several anthologies over the last two decades focused on various forms of social stratification and their impacts on health. Kleinman, et al. 1997 contains a seminal edited collection of essays exploring the concept of social suffering, the political processes that undergird social suffering, and professional processes, such as medicalization, that shape responses. Part 1 of the classic textbook Brown and Closser 2016 features a section on structural violence, featuring articles by Paul Farmer and other medical anthropologists who have developed and utilized this concept. Nguyen and Peschard 2003 provides a helpful review of the ways that anthropologists contributed to a wide scholarship on the relationship between social inequalities and health. Baer, et al. 2004 is the first textbook to have collected a variety of important articles employing an explicit critical medical anthropology perspective to examine the social origins and inequalities of various diseases. Scheper-Hughes and Bourgois 2003 is a multidisciplinary collection of essays exploring the various conceptions and modes of violence, containing sections on everyday and structural forms of violence that engages with themes of social stratification and health. DelVecchio Good, et al. 2008 compiles a unique collection of ethnographic essays aimed at linking the social and psychological experiences of colonial subjugation. As the subfield of medical anthropology has grown, its engagements with other disciplines and subfields have also inevitably multiplied. Inhorn and Wentzell 2012 compiles a variety of authors to describe how they have pursued interdisciplinary approaches to health disparities and developed collaborations with activist movements and organizations. More recently, Mulligan and Castañeda 2017 gathers a collection of ethnographic essays grounded in the concept of stratified citizenship documenting the multiple ways people navigate medical exclusion following the passage of the Affordable Care Act.

• Baer, Hans A., Merrill Singer, and Ida Susser, eds. 2004. Medical anthropology and the world system. Westport, CT: Praeger.

  The first textbook to employ an explicit critical medical anthropological perspective to examine the social origins and inequalities of various diseases. The second section of the book specifically describes the social factors involved with a number of health behaviors and conditions, such as drug addiction and the AIDS epidemic.

• Brown, Peter J., and Svea Closser, eds. 2016. Understanding and applying medical anthropology. 3d ed. Walnut Creek, CA: Routledge.

  The updated version of this classic textbook introduces students to the wide range of theoretical, methodological, and practical perspectives and issues in the field of medical anthropology. Part 1 features a section on structural violence, with articles by Paul Farmer, Nancy Scheper-Hughes, and other medical anthropologists. The final section on global health issues also features key texts that engage questions of social stratification and health.

• DelVecchio Good, Mary-Jo, Sandra Teresa Hyde, Sarah Pinto, and Byron J. Good, eds. 2008. Postcolonial disorders. Berkeley: Univ. of California Press.

  A collection of ethnographic essays linking the social and the psychological, with an explicit emphasis on examining how histories of colonial subjugation have produced postcolonial subjectivities. Essays explore the psychological qualities of social life in postcolonial states, the ways that these have often been medicalized and posited as pathological disorders, and forms of enduring subjection.

• Inhorn, Marcia C., and Emily A. Wentzell, eds. 2012. Medical anthropology at the intersections: Histories, activisms, and futures. Durham, NC: Duke Univ. Press.

  A collection of essays by several prominent medical anthropologists exploring how the field has evolved through interdisciplinary engagements with other subfields, disciplines, and with a variety of social and medical concerns. The final section of the book discusses how medical anthropologists have used their work to engage in social activism in a variety of issues.

• Kleinman, Arthur, Veena Das, and Margaret M. Lock, eds. 1997. Social suffering. Berkeley: Univ. of California Press.

  A seminal multidisciplinary collection of essays exploring the concept of social suffering through various overlapping themes, including the cultural representations of suffering, the social experience of suffering, and the political and professional processes, such as medicalization, that shape the response to such suffering.

• Mulligan, Jessica, and Heidi Castañeda, eds. 2017. Unequal coverage: The experience of health care reform in the United States. New York: New York Univ. Press.

  A collection of ethnographic essays documenting the everyday experiences of individuals and families across the United States as they attempted to access coverage and care in the five years following the passage of the Affordable Care Act (ACA). Uses the concept of stratified citizenship to examine how the ACA, while succeeding in expanding access to care, did so unevenly, ultimately also generating inequality and stratification.

• Nguyen, Vinh-Kim, and Karine Peschard. 2003. Anthropology, inequality, and disease: A review. Annual Review of Anthropology 32:447–474.

  DOI: 10.1146/annurev.anthro.32.061002.093412

  Examines the multiple ways that anthropologists have contributed to a robust scholarship on the relationship between social inequality and health. Argues that ethnographic research provides a means for evading the pitfalls of methodological individualism, assumed universalism, and unidirectional causation in order to contribute to a greater understanding of the complex, multifactorial mechanisms by which inequality leads to ill health. Available online by subscription.

• Scheper-Hughes, Nancy, and Philippe I. Bourgois, eds. 2003. Violence in war and peace: An anthology. Malden, MA: Blackwell.

  A multidisciplinary collection of essays exploring the various conceptions and modes of violence (e.g., structural violence, symbolic violence, everyday violence), featuring contributions from a number of prominent anthropologists and philosophers.