From an anthropological perspective, health is largely viewed as a state of physical, mental and social well-being shaped by a complex interplay of biological, environmental and social cultural factors. The scholarly contributions of anthropology in understanding health and illness narratives, social inclusion, equity and diversity are monumental and profoundly innovative. More importantly, the social, cultural, economic, political and environmental determinants of health are deeply entwined, influencing and shaping each other in complex and challenging ways.
My recent ethnographic field research in Raksirang of Makwanpur was an interesting and humbling experience in terms of exploring health and illness narratives of indigenous and socially-excluded communities such as Chepangs. Moreover, my intellectual curiosity was to understand how local governments have been responsive to these communities in terms of inclusive policies to enhance their easy access to basic health care and other social protection services.
Within and across societies, illness is largely viewed as a culturally interpreted subjective experience of becoming unwell. Such an experience is influenced by a range of factors such as age, gender, social status and access to health care. Additionally, indigenous knowledge and practices are deeply embedded in social and gender relations, cultural norms, values and religions.
The ethnographic insights from the fieldwork have offered new frameworks for examining and exploring how indigenous communities are organized, and their knowledge, understanding and experiences of health care are shaped by cultural norms and social hierarchies.
Seeking health care is largely a social process. The way people and health care providers interact is influenced by culture. Interactions such as eye contact and language are also important to make people more comfortable in accessing health care. The systemic barriers such as discrimination or bias often yield worse health outcomes.
The intersection of health and illness is an interesting area of exploration. It helps explain how relationships and power dynamics within and across social structures in local health systems have enabled or constrained the agency of the local communities in accessing health care.
My understanding on reflective approach to ethnography was meaningful in terms of enriching ethnographic data and ensuring a more nuanced understanding of local perspectives on inclusive health governance.
Listening to interesting stories of Chepangs about their health and illness narratives, my questions about why they do the way they do are variously answered. The stories about illness are not just accounts of personal experience but also reflect cultural values and beliefs about health and healing. Their age-old practices to seek health care from natural resources, traditional healers, religious and spiritual leaders do exist. But they have started to visit health facilities and consult with health workers or volunteers for health care.
Michael Taussig, a doctor and anthropologist, argues that understanding illness requires attention not only to biomedical models but also to the subjective experiences of individuals who are ill. The emphasis is more on the importance of illness narratives in understanding local health care practices. By examining how people experience illness at a personal level, Taussig provides insight into how medical practices shape individual experiences and social structures.
Interestingly, the shamanic practices of the indigenous communities are culturally constructed and historically nurtured. In recent years, with public health awareness, local government’s inclusive priorities for health, education and improved infrastructure such as housing, rural road, water and sanitation and telecommunications, the livelihoods of indigenous communities have greatly improved.
Instead of a health post, now there is a rural hospital in Raksirang which has good health infrastructure and trained human resources. Local government provides additional allowance to mothers who are pregnant and deliver in hospital to encourage the communities for institutional delivery and immunizations. Nutrition allowance to families is another local initiative to address malnutrition and other social protection services in need.
Despite noted progress, the reality is still different. Poor and socially marginalized communities in remote areas of Raksirang have limited access to essential health care. There are little efforts exploring how individuals and communities perceive, experience and cope with what they understand about illness. Moreover, the importance of understanding local healing traditions and practices is overlooked as it can impact how the communities respond to illness or disease.
Going beyond biology, a more holistic understanding of health and illness is required in the changed socio-political context. More specifically, there needs to be a more inclusive and reflexive understanding of political leaders, officials of local government, health workers and civil society activists to promote intersectionality approach in planning and delivering health care services.
In addressing most pressing health challenges, anthropological perspectives can contribute to shape the future of health and social well-being by developing culturally appropriate interventions and advocating for health equity. Evidence suggests that social, economic and political structures have profound implications on health outcomes. Moreover, social inequalities significantly contribute to health disparities and social injustice within and across social groups.
As we move forward, a broader socio-cultural approach helps local governments to be more creative, accountable and responsive to the unmet health care needs of communities which are culturally appropriate. Moreover, it is high time to critically challenge the traditional ways of thinking about illness, medicine and health care, and build a resilient and sustainable system for health.
The author is a health policy analyst
