15/01/06

"Ethnographic perspectives needed in discussion on public health care system"

In the current discussion on reforming the American public health care system, ethnographic perspectives are especially needed — and sadly lacking, Sarah Horton and Louise Lamphere write in Anthropology News January 2006. They call for an "Anthropology of Health Policy":

Anthropologists’ relative neglect of health policy issues may lie, in part, in our tendency to view the realm of policy as outside our disciplinary scope. Yet in doing so, we have ceded the field of health policy to health economists, who have long held hegemonic sway over the terms in which we discuss and understand the current American health care system. Terms such as the “law of demand” and “cost-efficiencies” are commonly used to explain the logic of imposing cost-sharing through premiums and deductibles. Patients are instead portrayed as “consumers of health care,” naturalizing the idea of health care as a commodity whose use must be restricted.

As medical anthropologists were once instrumental in challenging the terms of the rationality debate three decades ago, it is time we dust off our boxing gloves. There are multiple levels of analysis at which anthropologists can make a contribution to debates over health policy—at the levels of individual behavior, institutional policy and public discourse.

(...)

Finally, as ethnographers, we should continue to document how such reforms play out in our tattered health care safety net. Perhaps nowhere else are the effects of such reforms more visible to the ethnographic eye.

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