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GEORGE ARMELAGOS
Emory University
E
LOIS ANN B
ERLIN University of Georgia
G
AY BECKER
University of California at San Francisco
P
ETER J. BROWN
Emory University
C. H. B
ROWNER University of California, Los Angeles
JAMES W. CAREY
Centers for Disease Control and Prevention
A
LEX COHEN Harvard University
WILLIAM W. D
RESSLER University of Alabama
R
OBERT EDGERTON University of California, Los Angeles
R
UTHBETH FINERMAN University of Memphis
LINDA C. GARRO University of California, Los Angeles
P
AUL HOCKINGS University of Illinois at Chicago
L
ESLIE SUE LIEBERMAN University of Central Florida
MARGARET LOCK McGill University
LENORE MANDERSON University of Melbourne
MAC MARSHALL University of Iowa
JAMES J. MCKENNA University of Notre Dame
CARMELLA C. MOORE University of California, Irvine
ARTHUR J. RUBEL (deceased) University of California, Irvine
SUSAN C. WELLER University of Texas Medical Branch, Galveston
Managing Editor Jo-Ann Teadtke
The Encyclopedia of Medical Anthropology was prepared under the auspices and with the support of the Human
Relations Area Files, Inc. (HRAF) at Yale University. The foremost international research organization in the field of
cultural anthropology, HRAF is a not-for-profit consortium of 19 Sponsoring Member institutions and more than
400 active and inactive Associate Member institutions in nearly 40 countries. The mission of HRAF is to provide
information that facilitates the worldwide comparative study of human behavior, society, and culture. The HRAF
Collection of Ethnography, which has been building since 1949, contains nearly one million pages of information,
organized by culture and indexed according to more than 700 subject categories, on the cultures of the world. An
increasing portion of the Collection of Ethnography, which now covers more than 380 cultures, is accessible via the
World Wide Web to member institutions. The HRAF Collection of Archaeology, the first installment of which
appeared in 1999, is also accessible on the Web to member institutions. HRAF also prepares multivolume reference
works with the help of nearly 2,000 scholars around the world, and sponsors Cross-Cultural Research: The Journal
of Comparative Social Science.
Advisory Board
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Thomas S. Abler, Department of Anthropology, University of Waterloo, Waterloo, Ontario
Rogaia Mustafa Abusharaf, Carr Center for Human Rights Policy, Kennedy School of Government, Harvard
University, Cambridge, Massachusetts
Steven Acheson, Archaeology Branch, Government of British Columbia, Victoria, British Columbia
Naomi Adelson, Department of Anthropology,York University, Toronto, Ontario
Pascale A. Allotey, Department of Public Health, University of Melbourne, Victoria, Australia
Hans A. Baer, Department of Anthropology, The George Washington University, Washington, D.C.
Eric J. Bailey, U.S. Department of Health & Human Services, National Institutes of Health, Bethesda, Maryland
Gay Becker, Department of Anthropology, History, and Social Medicine, University of California San Francisco, San
Francisco, California
Brent Berlin, Department of Anthropology, University of Georgia, Athens, Georgia
Elois Ann Berlin, Department of Anthropology, University of Georgia, Athens, Georgia
James R. Bindon, Department of Anthropology, University of Alabama, Tuscaloosa, Alabama
Astrid Blystad, Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
Barry Bogin, Department of Behavioral Sciences, University of Michigan-Dearborn, Dearborn, Michigan
Erika Bourguignon, Professor Emerita, the Ohio State University, Columbus, Ohio
David J. Boyd, Department of Anthropology, University of California, Davis, Davis, California
George Brandon, Department of Behavioral Medicine, City University of New York, New York, New York
Rae Bridgman, Department of City Planning, University of Manitoba, Winnipeg, Manitoba
Leslie Butt, Department of Pacific and Asian Studies, University of Victoria, Victoria, British Columbia
James W. Carey, Prevention Research Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and
Prevention, Atlanta, Georgia
Gloria Castillo, Universidad de San Carlos, San Carlos, Guatemala
Arachu Castro, Department of Social Medicine, Harvard Medical School, Boston, Massachusetts
Dia Cha, Anthropology and Ethnic Studies, St. Cloud State University, St. Cloud, Minnesota
Alex Cohen, Department of Social Medicine, Harvard Medical School, Boston, Massachusetts
Jeannine Coreil, Department of Community and Family Health, University of South Florida, Tampa, Florida
Jay Bouton Crain, Department of Anthropology, California State University, Sacramento, California
Kathleen A. Culhane-Pera, Department of Family Practice and Community Medicine, University of Minneapolis,
Minneapolis, Minnesota
Allan Clifford Darrah, Department of Anthropology, California State University, Sacramento, California
Nancy Romero-Daza, Department of Anthropology, University of South Florida, Tampa, Florida
Erin Picone-DeCaro, Prevention Research Branch, Division of HIV/AIDS Prevention, Centers for Disease Control
and Prevention, Atlanta, Georgia
Linus S. Digim’Rina, Department of Anthropology and Sociology, University of Papua New Guinea, Papua, New
Guinea
vii
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William W. Dressler, Department of Anthropology, The University of Alabama, Tuscaloosa, Alabama
Bettina Shell-Duncan, Department of Anthropology, University of Washington, Seattle, Washington
Mason Durie, Maori Research and Development, Massey University, Palmerston North, New Zealand
Delia Easton, Prevention Research Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and
Prevention, Atlanta, Georgia
Paul Farmer, Division of Social Medicine and Health Inequalities, Harvard Medical School, Boston
Steven Ferzacca, Department of Anthropology, University of Lethbridge, Lethbridge, Alberta
Ruthbeth Finerman, Department of Anthropology, The University of Memphis, Memphis, Tennessee
Robbie E. Davis-Floyd, Department of Anthropology, Case Western Reserve University, Cleveland, Ohio
Atwood D. Gaines, Anthropology, Bioethics, Nursing and Psychiatry, Case Western Reserve University and the
Schools of Medicine and Nursing, Cleveland, Ohio
Linda C. Garro, Department of Anthropology, University of California at Los Angeles, Los Angeles, California
Eugenia Georges, Department of Anthropology, Rice University, Houston, Texas
Tyson Gibbs, Department of Anthropology, University of North Texas, Denton, Texas
Irene Glasser, Community Renewal Team, Inc., Hartford, Connecticut
Jody Glittenberg, Department of Anthropology, University of Arizona, Tucson, Arizona
Nancie L. Gonzalez, Department of Anthropology, University of Maryland, College Park, Maryland
Elisa J. Gordon, Neiswanger Institute for Bioethics and Health Policy, Loyola University of Chicago, Maywood,
Illinois
Lawrence P. Greska, Department of Anthropology, Case Western Reserve University, Cleveland, Ohio
Raymond Hames, Department of Anthropology, University of Nebraska-Lincoln, Lincoln, Nebraska
Kate R. Hampshire, Department of Anthropology, University of Durham, Durham, England
Anita Hardon, Medical Anthropology Unit, Amsterdam School for Social Science Research, Amsterdam, The
Netherlands
Janice Harper, Department of Anthropology, University of Houston, Houston, Texas
Dwight B. Heath, Professor Emeritus, Anthropology Department, Brown University, Providence, Rhode Island
L. Carson Henderson, Department of Health Promotion Sciences, University of Oklahoma Health Sciences Center,
Oklahoma City, Oklahoma
J. Neil Henderson, Department of Health Promotion Sciences, University of Oklahoma Health Sciences Center,
Oklahoma City, Oklahoma
Catherine Hagan Hennessy, Health Care and Aging Studies Branch, Centers for Disease Control and Prevention,
Atlanta, Georgia
Warren M. Hern, Department of Anthropology, University of Colorado at Boulder, Boulder, Colorado
Ylva Hernlund, Department of Anthropology, University of Washington, Seattle, Washington
David Himmelgreen, Department of Anthropology, University of South Florida, Tampa, Florida
Paul Hockings, Adjunct Curator of Anthropology, Field Museum of Natural History, Chicago, Illinois
Darryl J. Holman, Department of Anthropology, University of Washington, Seattle, Washington
Daniel J. Hruschka, Department of Anthropology, Emory University, Atlanta, Georgia
Brad R. Huber, Department of Sociology and Anthropology, College of Charleston, Charleston, South Carolina
Carolina Izquierdo, Department of Anthropology, University of California, Los Angeles, Los Angeles, California
Heather A. Joseph, Division of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention, Centers
for Disease Control and Prevention, Atlanta, Georgia
Contributors
viii
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Sharon R. Kaufman, Department of Anthropology, History, and Social Medicine, University of California San
Francisco, San Francisco, California
Satish Kedia, Department of Anthropology, The University of Memphis, Memphis, Tennessee
Sunil K. Khanna, Department of Anthropology, Oregon State University, Corvallis, Oregon
Jill E. Korbin, Department of Anthropology, Case Western Reserve University, Cleveland, Ohio
Brandon A. Kohrt, Department of Anthropology, Emory University, Atlanta, Georgia
Waud H. Kracke, Department of Anthropology, University of Illinois at Chicago, Chicago, Illinois
Peter Kunstadter, Department of Medical Anthropology, History, and Social Medicine, University of California San
Francisco, San Francisco, California
Robin Shrestha-Kuwahara, Division of Tuberculosis Elimination, National Center for HIV, STD, and TB
Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
Jennifer Kuzara, Anthropology Department, Emory University,Atlanta, Georgia
Michelle Lampl, Department of Anthropology, Emory University, Atlanta, Georgia
Murray Last, Department of Anthropology, University College London, London, England
Robert Lawless, Department of Anthropology, Wichita State University, Wichita, Kansas
Barbara W. Lex, Former Professor of Anthropology, Harvard Medical School, Boston, Massachusetts
Leslie Sue Lieberman, Department of Sociology and Anthropology, University of Central Florida, Orlando, Florida
Xingwu Liu, Department of Anthropology, DePaul University, Chicago, Illinois
Margaret Lock, Department of Social Studies of Medicine and Department of Anthropology, McGill University,
Montreal, Quebec
Ron Loewe, Department of Sociology, Anthropology, and Social Work, Mississippi State University, Mississippi
State, Mississippi
Chris Lyttleton, Department of Anthropology, Macquarie University, Sydney,Australia
Larry Leon Mai, Departments of Anthropology and Biological Sciences, California State University at Long Beach,
Long Beach, California
Frank Marlowe, Department of Anthropology, Harvard University, Cambridge, Massachusetts
Gregory G. Maskarinec, Department of Family Practice and Community Health, University of Hawaii, Mililani,
Hawaii
Joanne McCloskey, Department of Family and Community Medicine, University of New Mexico Health Sciences
Center, Albuquerque, New Mexico
Ann McElroy, Department of Anthropology, State University of New York at Buffalo, Buffalo, New York
Barbara Burns McGrath, Departments of Anthropology and Epidemiology, University of Washington, Seattle,
Washington
James J. McKenna, Professor of Anthropology, University of Notre Dame, Notre Dame, Indiana
F. John Meaney, Department of Pediatrics, University of Arizona, Tucson, Arizona
Robert J. Meier, Chancellor’s Professor Emeritus, Department of Anthropology, Indiana University, Bloomington,
Indiana
William E. Mitchell, Department of Anthropology, University of Vermont, Burlington, Vermont
Mary Spink Neumann, Prevention Research Branch, Division of HIV/AIDS Prevention, Centers for Disease Control
and Prevention, Atlanta, Georgia
Vinh-Kim Nguyen, Department of Social Studies of Medicine, McGill University, Montreal, Quebec
Kathleen A. O’Connor, Department of Anthropology, University of Washington, Seattle, Washington
Contributors ix
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J. Bryan Page, Department of Anthropology, University of Miami, Coral Gables, Florida
Rebecca Plank, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
Ronald Provencher, Professor Emeritus, Department of Anthropology, Northern Illinois University, DeKalb, Illinois
Susan J. Rasmussen, Department of Anthropology, University of Houston, Houston, Texas
L.A. Rebhun, Department of Anthropology,Yale University, New Haven, Connecticut
Ole Bjørn Rekdal, Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway
Gun Roos, National Institute for Consumer Research, Oslo, Norway
Zdenek Salzmann, Professor Emeritus, University of Massachusetts at Amherst, Amherst, Massachusetts
Denise Saint Arnault, College of Nursing, Michigan State University, East Lansing, Michigan
Daphne Cobb St. John, Prevention Research Branch, Division of HIV/AIDS Prevention, Centers for Disease Control
and Prevention, Atlanta, Georgia
Carolyn Sargent, Department of Anthropology, Southern Methodist University, Dallas, Texas
Deborah Schwartz, Prevention Research Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and
Prevention, Atlanta, Georgia
Ian Shaw, Centre for Research in Medical Sociology and Health Policy, University of Nottingham, Nottingham,
England
Glenn H. Shepard, Jr., Instituto Nacional de Pesquisas de Amazˆonia, Manaus, Amazonas, Brazil
Russell P. Shuttleworth, Institute of Regional and Urban Development, University of California, Berkeley, Berkeley,
California
Merrill Singer, Hispanic Health Council, Hartford, Connecticut
Arushi Sinha, Department of Anthropology, Southern Methodist University, Dallas, Texas
Monique Skidmore, Centre for Cross-Cultural Research, Australian National University, Canberra, Australia
Elisa J. Sobo, Department of Family and Preventive Medicine, University of California San Diego, San Diego,
California
Jay Sokolovsky, University of South Florida St. Petersburg, St. Petersburg, Florida
John R. Stepp, Department of Anthropology, University of Georgia, Athens, Georgia
Peter H. Stephenson, Department of Anthropology, University of Victoria, Victoria, British Columbia
Esther Sumartojo, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention,
Atlanta, Georgia
Anne Hartley Sutherland, Department of Anthropology, Georgia State University, Atlanta, Georgia
Wenda R. Trevathan, Department of Sociology and Anthropology, New Mexico State University, Las Cruces, New
Mexico
Florencia Tola, Facultad de Filosofia y Letras, Universidad de Buenos Aires, Buenos Aires, Argentina
Douglas H. Ubelaker, Curator of Physical Anthropology, The Smithsonian Institution, Washington, D.C.
Claudia R. Veleggia, Department of Anthropology, Harvard University, Cambridge, Massachusetts
Sydney D. White, Department of Anthropology, Temple University, Philadelphia, Pennsylvania
Linda M. Whiteford, Department of Anthropology, University of South Florida at St. Petersburg, St. Petersburg,
Florida
Andrea Whittaker, The Melbourne Institute for Asian Languages and Societies, The University of Melbourne,
Melbourne, Australia
Contributors
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Maureen Wilce, Division of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention, Centers
for Disease Control and Prevention, Atlanta, Georgia
Michael Winkelman, Department of Anthropology, Arizona State University, Tempe, Arizona
Norma H. Wolff, Department of Anthropology, Iowa State University, Ames, Iowa
Louise Woodward, Nottinghamshire Healthcare NHS Trust, Nottingham, England
Michael R. Zimmerman, Department of Anthropology, University of Pennsylvania, Philadelphia, Pennsylvania
Contributors xi
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Illness and death are significant events for people everywhere. No one is spared. But medical beliefs and practices are
not the same everywhere. How people understand the causes of illness and death and how they cope with these events
vary from culture to culture. It is not surprising therefore that medical practitioners and others are becoming increas-
ingly aware of the need to understand the influence of society and culture on medical belief and practice. Culture—
the customary ways of thinking and acting in a society—often affects the outcome of illness, and even which illnesses
occur. So those who are actively engaged in studying health and illness are coming to realize that biological and
cultural factors need to be considered if we are to reduce human suffering.
The professional medicine of Western cultures has been called “biomedicine,” because it mostly deals with the
biology of the human body. But biomedicine, like the medicine of other cultures, is also influenced by conditions and
beliefs in the culture, and therefore reflects the value and norms of its creators. So, if biomedicine is socially
constructed and not just based on science, its beliefs and practices may partly derive from assumptions and biases in
the culture. For example, it used to be thought that some people refrained from drinking milk because they were igno-
rant. Now, biomedicine realizes that the avoidance of milk is a rational response to the likelihood that drinking milk
results in diarrhea and other discomforts in people who lack an enzyme (lactase) that allows easy digestion of the
sugar in milk (lactose). Anthropologists were the first to realize that drinking milk would cause serious problems for
many people. The anthropologists’ fieldwork in other cultures around the world revealed that people in many places
that have milking animals must sour the milk before they can drink it, to reduce or eliminate the sugar in it that would
otherwise make them sick.
Severe diarrhea may also be an effect of the culture’s system of social stratification. The direct causes of the
diarrhea may be biological, in the sense that the deaths are caused by bacterial or other infection. But why are so
many infants exposed to those infectious agents? Usually, the main reason is social or cultural. The affected infants
may mostly be poor. Because they are poor, they are likely to live with infected drinking water. Similarly, malnutri-
tion may be the biological result of a diet poor in protein. But such a diet is usually also a cultural phenomenon, reflect-
ing a society that has different classes of people, with very unequal access to the necessities of life, and unequal access
to decent medical care. For this and other reasons, medical anthropology is developing what has been called
a “biocultural synthesis” in its studies of health and illness.
Medical anthropology may even be in the forefront of the movement that is returning the entire field of anthro-
pology to its biocultural roots. In any case, the growth of jobs in medical anthropology is one of the more striking
developments in contemporary anthropology. Medical anthropology has developed into a very popular specialty, and
the Society for Medical Anthropology is now the second largest unit in the American Anthropological Association.
ORGANIZATION OF THIS ENCYCLOPEDIA
A total of 53 thematic and comparative essays begin these volumes. These essays are grouped into five sections: gen-
eral concepts and perspectives; medical systems; political, economic, and social issues; sexuality, reproduction, and the
life cycle; and health conditions and diseases. Then there are 52 cultural portraits of health and illness, articles that
describe the state of health and illness in 52 particular cultures around the world. Every cultural region of the world is
represented, as are cultures at all levels of social complexity. The Encyclopedia of Medical Anthropology is unique. In
addition to providing a large range of thematic essays, representing the various perspectives in medical anthropology,
these volumes are unique in focusing on so many particular cultures. No other single reference work comes close to
matching the depth and breadth of information on the varying cultural background of health and illness around the world.
We are able to provide the information contained here through the efforts of more than 100 contributors—generally
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