Anthropology of Global Health
Content taken from the Prospect Journal of International Affairs at UCSD. View original article.
By Nekia Lane
In the wake of an exciting event at UC San Diego, “New Frontiers in Global Justice: A Conference with Amartya Sen,” PROSPECT had the opportunity to sit down with one of the minds who contributed significantly to the weekend’s discussion of global justice: Professor Janis H. Jenkins, Ph.D. A professor of anthropology and adjunct professor of psychiatry at UCSD, Professor Jenkins is an internationally renowned medical and psychiatric anthropologist, known for her expertise on the convergence of psychiatry and anthropology. She spoke earlier this month about local knowledge and a comparison view of justice — presenting a distinct and memorable analysis of prominent theories discussed by Dr. Sen. Beginning with the development of an anthropological framework for conceptualizing justice theories, Professor Jenkins highlighted four points of reference for an anthropological approach. First, she stated that more than any other social science, anthropology is dedicated to exploring both the universal aspects of the human experience, and what is unique to specific circumstances. A second and crucial method in approaching such debates is the need for anthropologists to engage in both implicit and explicit comparative methods. Thirdly, an understanding of the indivisibility of culture and knowledge is an established norm within anthropology today. Lastly, Professor Jenkins presented an interlocking set of assumptions held by scholars in her field, including “the primacy of lived experience; the centrality of local moral worlds; social determinants of health and illness such as worldwide inequalities of gender and income; and the reciprocal shaping of subjective experience and institutional forces of the nation-state and globalization.”
From there she followed with a thorough analysis of justice theories placed in a context of global health, and more specifically, global mental health. Professor Jenkins shed light on an otherwise overshadowed realm of thought, calling to attention the resonating influence of global mental health in relation to established understandings of well-being (as perceived both internally and externally), justice, and injustice. She evoked Sen’s theory that security does not guarantee justice, but insecurity may imply injustice to the extent that both offend human dignity. With regard to internal and external views of individual well-being, Professor Jenkins argued, “the manner in which insecurity is palpable in the internal view is directly related to the manner in which insecurity is produced by injustice in the external view.” With these crucial points in mind, she moved to a discussion of the role of depression in low-income nations, and the crippling effect it has on the establishment of justice around the world. Professor Jenkins enthralled the conference’s audience by presenting intriguing cases in which depression has manifested as self-accusations of witchcraft in the women of certain regions in Ghana (due to powerful social and economic forces), creating circumstances that severely compromise their well-being and security.
Professor Jenkins concluded with firm insistence that the detrimental effects of culturally established gendered and economic inequalities are staggering, and cannot be seen as anything other than injustices.
PROSPECT: You have discussed ideas of justice and injustice in relation to well-being and mental health. How can the exploration of this subject through a unique anthropological lens contribute to understandings of global justice? In other words, what do you think anthropologists can bring to the table that philosophers and political theorists do not?
JENKINS: I can think of two ways: first, by focusing on the lived experience of particular persons we can get at a sense of the immediacy of what’s at stake for whomever we’re working with in their local moral world. That’s what we would call an experience near a level of analysis. Anthropologists also work with a framework of broader social forces to include economics, and in my case psychology, and social and cultural forces, and how these social and cultural forces shape individual persons and vice versa in this reciprocal relationship so that you’re getting the bigger picture. Anthropology shines a light both on personal lived experience in a real-world context on one hand, but also on larger-scale forces that shape and influence those experiences on the other. Those are two ways, but I can also think of a third way with a very explicit focus on cultural meaning because the concept of justice has to articulate within the framework of local moral worlds: sometimes it may be contested, and sometimes it can be a moment for consciousness or social change, or sometimes it may be a relatively easy alignment for understandings of justice across a variety of cultural settings. And then of course as I said in my talk, anthropologists — and political scientists as well — work explicitly with a comparative method.
PROSPECT: You quoted Dr. Sen’s statement: “To address problems we must first recognize them.” Do you feel as though considerations of mental health and psychology in discussions of justice are not properly recognized? If so, why do you think that is?
JENKINS: Yes, I do. I think that is especially true in global health, which is an area that others and I work in now. Within global health it is a relatively recent point of emphasis to focus on mental health — in other words, to say, as I said in my talk, citing a recent publication from The Lancet, that there is no health without mental health. I think for discussions of justice that is something that has not been attended to very much or well worked out theoretically or empirically. Sen has this notion of well being which is a very commonly used kind of construct and he has a particular way in which he uses it in his writing that we talked about in the conference. But he doesn’t have that much, and it’s not his job to really flesh out every aspect of it, but he points to it and its importance through the work of Arthur Kleinman — but that, I believe, needs to be elaborated considerably.
PROSPECT: It is a field of more recent consideration.
JENKINS: Yes, well, problems with mental health are not unique in having a social stigma attached to them; there are other types of illnesses, many that we could think of, that are also socially stigmatized. However, there is broadly, across cultures, transnationally, a good deal of social stigma attached to mental illnesses and for that reason a kind of silencing or erasure that needs to change. Some people are dedicated to working towards that goal and making it an area that really gets attention.
PROSPECT: Wonderful. Shedding light on the fact that mental illness, too, is a disease.
JENKINS: Exactly. For example, there’s so much attention to HIV/AIDS, and there must be: that’s a matter of life and death. But as I mentioned in the talk, mental health and the many different types of problems, but particularly depression, is huge in terms of the effect that it has on a person’s ability to live productively, happily, and it affects all the people in their network. So it’s a huge problem and it’s really under-recognized due to a variety of cultural impediments. We have these ideas: “Oh, just get over it; it’s a personality flaw of some kind; it’s not real, it’s a personal weakness,” as opposed to a very urgent source of distress.
PROSPECT: It’s a strong force. Another interesting matter you raised was Sen’s idea that internal views of health are clearly significant to one’s well-being. If perceptions of disease and health can be subjective, is this evidence of the power of the human mind?
JENKINS: Well, there’s no doubt that minds are very powerful forces in the shaping of individual health status, but that’s not the only source. So I would not say that I think that it’s a matter of a person’s attitude whether they would or wouldn’t be healthy if they, say, will themselves to be healthy or have a positive attitude. Research has shown that people who have more optimistic attitudes sometimes have better health in some areas but in many ways that turns out not to be associated. Social determinants of disease and illness are very powerful: features of structural violence in the forms of racism, sexism, or gender inequality and many other economic barriers, as well as cultural notions of the way things are, are very powerful forces in affecting health status. So I like to be careful about not endorsing in my view this kind of American version of ethno-psychology that would hold that “it’s all in your mind and if you simply have a positive mental attitude all will be well or more likely to be well.” I don’t think that’s always the case by any means.
PROSPECT: Great, thank you very much. Is there anything else you would like to add, perhaps a word of advice for Prospect readers or students who are interested in global justice?
JENKINS: Yes. I would draw on my recent experience of teaching an undergraduate course on global health and cultural diversity that I taught last quarter for the first time. It was quite a wonderful experience. The experiences of entering into the life worlds of other persons around the globe and probing issues that matter in terms of health status — those can be real life-altering experiences.
Photo courtesy of Dr. Jenkins’ faculty profile.