Medical Anthropology: an evidence base for social and cultural inequalities in healthcare

This article introduces the field of Medical Anthropology. This field of research has long recognised differences in experiences of health on the basis of structural inequalities, social factors, and cultural processes.

In this course, the focus is on Muslim experiences of mental health problems and their experiences of mental health support. It is important, however, to emphasise that religion is just one factor that might impact on these experiences. Disparities, or inequalities, are evident across other characteristics that constitute identity and social life in a multicultural society.

The examination of health inequalities is an increasingly interdisciplinary field of study. It includes researchers from across arts and humanities disciplines including history, philosophy, psychology, political science, and religious studies (Inhorn and Wentzell 2012). Over the last fifty years, the field of Medical Anthropology has contributed a significant body of research evidence for health being shaped by a complex interaction of multiple factors, including:

-the accessibility and quality of health and care services

-individual behaviours

-social and cultural norms and understandings of health and illness

-wider determinants such as structural disadvantage.

This article explains what is meant by health inequalities and introduces learners, briefly, to the field of Medical Anthropology as a robust evidence base that inequalities on the basis of social, structural and cultural factors, exist on a range of domains – religion being one of these.

Health inequalities and protected characteristics

The term ‘health inequalities’ relates to differences in experiences of health, but also to the care received, and the opportunities that individuals and groups have to lead healthy lives (Williams et al. 2022).

‘Protected characteristics’ are features of the identities and everyday lives of individuals that can potentially lead to discrimination, or unfair treatment, in society. Protection against such discrimination is offered by the Equality Act 2010; religion is one of nine protected characteristics under the Act (Equality and Human Rights Commission 2021).

Healthcare research finds that inequalities in mental health exist across the range of protected characteristics. For example, sexual orientation is a protected characteristic and LGBT people experience higher rates of poor mental health than others (Williams et al. 2022).

For some people, their identities encompass combinations of protected characteristics that interact to influence health inequalities, this is referred to as intersectionality. Furthermore, people grouped according to one characteristic, such as a given religious group, will not be homogenous. The ways in which culture and social factors impact on health and illness are complex, and Medical Anthropology is a field of study that engages with this complexity for the benefit of wider society and healthcare professionals.

What is Medical Anthropology?

Anthropology focuses on interconnections and relationships between people in societies, and shows us that cultures, bodies, and experiences are created and understood within, and through, social relationships and interactions. Medical Anthropology has been a significant field of study and an established medical social science in North America and Western Europe since the 1960s: it is the study of health, illness, and healing, through time and across cultural settings (Inhorn and Wentzell 2012).

Medical anthropologists examine questions around the ways that people experience health and health problems. Who falls ill, and why? Who has access to health resources? Where is healing sought? They consider the impact of stigma and marginalisation in societies, and engage with questions around the roles of biopolitics, immigration, race, and citizenship in health disparities (Inhorn and Wentzell 2012). Researchers in this field recognise the important role of religion and faith in health and healing, and in the provision of care through humanitarianism around the world (Kleinman 2012).

Medical anthropologists find that meanings and relationships affect the course of ill-health, including: how symptoms are experienced; how help is sought; how treatment is evaluated; the trajectory of the illness and its social consequences (Kleinman 2012). People’s perspectives and experiences of health conditions are strongly influenced by cultural and historical changes that affect life in different eras and countries (Kleinman 2010).

Medical Anthropology and Mental Health

The field often combines medical perspectives with those that address social and cultural problems through health advocacy and activism. Arthur Kleinman is a prominent medical anthropologist and trained psychiatrist who specialises in the study of mental health. In his extensive body of work, Kleinman has examined the relationship between culture and experiences of mental health problems and care. He suggests that illness has biophysical causes, but it is also a social construct – understood in relation to social and cultural norms and values (Kleinman 2012).

Kleinman urges practitioners to be self-critical and sensitive in their practice, and to attempt to understand the worlds that the people they support inhabit, suggesting that not taking into account the perspectives of individuals and communities can have negative consequences for care (Kleinman 1985; 2010; Kleinman et al. 2006). He recommends that practitioners consider their own cultures, both as practitioners in their professional settings as well as their positions in wider society (Kleinman 2006).

Based on his professional expertise, and his own experiences as primary care-giver for his wife who suffered from age-related mental health problems, Kleinman emphasises the important role of families, close friends and wider social networks as care-givers and suggests that practitioners should be trained to respond to, and communicate with, these informal forms of support (Kleinman 2008; 2009; 2010).

Religion and Mental Health in Medical Anthropology

Other medical anthropologists, such as Simon Dein, have looked more closely at the relationship between religion and mental health (Dein 2006; 2010). Dein reviews research which finds that religious coping and religious healing for mental health problems are found within Western and non-Western cultures around the world. For example, in the use of faith healers by Muslim and Hindu communities in India and Pentecostal Christian communities around the world (Dein 2020). Whilst this course focuses on Muslim experiences of mental health, it is clear that the interplay between religion and mental health is a feature of societies and cultures around the world.

Dein and colleagues have suggested that there is a ‘religiosity gap’ between mental health practitioners and those they provide care to (Dein et al. 2010). Research shows that psychiatrists are less religious than their patients and may neglect religious issues in their clinical assessments (Dein et al. 2010). In an article for ‘The Psychiatrist’ journal, representing the Royal College of Psychiatrist’s Spirituality and Psychiatry Special Interest Group, Dein and colleagues advocate for psychiatrists to better understand the role that spirituality play in people’s lives – not just the beliefs they hold, but how they impact individuals’ experiences of mental health problems (Dein 2010). In this article, the authors suggest that psychiatrists should work in dialogue with religious pastoral care providers, like chaplains, to share knowledge as part of a two-way learning process. They conclude that understanding the relationship between spirituality, religion and mental health should be regarded as essential to good clinical practice, and not as an ‘optional extra’ (Dein et al. 2010).

Conclusion

Muslim experiences of mental health problems should be understood in relation to wider systems of inequality and disadvantage that may (or indeed may not) be related to their religion. Some of these inequalities arise from structural disadvantages such as migrant status or low socio-economic status, others may relate to the ways in which families, communities and societies understand mental health problems.

Knowledge from the field of Medical Anthropology helps to locate the disadvantage faced by Muslims within broader debates around health inequalities within healthcare settings and inequalities in wider society. Additionally, it can help us to understand how mental health problems are understood by individuals in relation to their families, communities, and their religious beliefs and practices.