This article is available open access under a CC BY-NC-ND 4.
0 license thanks to the generous support
from a global network of libraries as part of the Knowledge Unlatched Select initiative.
The Role of Anthropology in India’s Public Health
A Comparative Perspective with the USA and Europe
Manisha Nitin Gore
Abstract: Conducting research on healthcare systems, policy implementation and the impact
of health programmes can systematically identify the gaps and challenges in public health
service delivery in India. Anthropology is particularly useful for so doing, but the role of an-
thropologists in health policy and planning needs recognition in India, as they can evaluate
the effectiveness of interventions through a cultural lens, informing the development of evi-
dence-based policies. The USA and Europe are more advanced in the use of anthropology in
public health, due to their established academic programmes, robust research funding and in-
frastructure, and effective integration into public health institutions. Anthropological analy-
sis and intervention has the capacity to improve Indian public health practice, particularly in
terms of inclusivity and diversity issues.
Keywords: anthropological influence, India, public health
Public health is as much an art or a craft as it is a sci- field in its own right around and after the 18th cen-
ence, and that is what makes the practice of public tury (Barnard and Spencer 2002).
health difficult, exciting and rewarding. Apart from From early on, scholars knew the interdisciplin-
more precise medical sciences, it depends on and ary nature of anthropology. In the 20th century, so-
takes inputs from fields such as sociology, culture, cial anthropology in the UK and cultural anthropol-
politics and history, making it an immensely com- ogy in the USA started to draw significant attention
plex field (Gethmann 2015). For example, during the among other social sciences because of the many
COVID-19 pandemic, people in India would not test unique methods of investigating a problem. These
for COVID-19 even if they had symptoms because include evaluation of diversity in cultures, in-depth
they feared that if they tested and the test came out understanding of the context, participant observa-
to be positive, they would be forced into quarantine, tion and ethnography as research designs and the
an unaffordable luxury to many for different rea- content development through fieldwork, and de-
sons. Similarly, even in 2023, many people with dia- tailed involvement in the process of research (Erik-
betes in India believe diabetes is a disease caused by sen 2004). Anthropology has many subfields, such as
indulgence in sugary sweet food and that drinking socio-cultural anthropology, physical and biological
bitter juices such as bitter gourd or margosa (neem) anthropology and evolutionary anthropology. Medi-
can control diabetes (Rai and Kishore 2009). Public cal anthropology studies: Human health and disease,
health, as these examples elucidate, requires clear health care systems, and bio-cultural adaptations
understanding of these subtle nuanced aspects of (Kottak 2010).
human lives rather than just knowledge about their Public health and anthropology, both being com-
medical details. Therein lies the interesting intersec- munity oriented, have demonstrated success stories
tion of public health with the fascinating field of an- in combating many public health issues (Hahn and
thropology. Anthropology is the discipline that in- Inhorn 2008). Though anthropology has a huge po-
quires not only into the basics of human biology but tential to contribute to human health and well-be-
also about socio-cultural, political, behavioural and ing, it is applied sub-optimally in addressing public
relational aspects of human life (Guest 2013). health issues.
Historically, from Aristotle until the 18th century, There is a wide scope for anthropology and pub-
we find widespread references to anthropology as a lic health to work in tandem for bettering human
discipline. However, anthropology became a distinct well-being (Wiley and Allen 2009). This article en-
Anthropology in Action, 30, no. 2 (Summer 2023): 14–18 © The Author(s)
ISSN 0967-201X (Print) ISSN 1752-2285 (Online)
doi:10.3167/aia.2023.300202
The Role of Anthropology in India’s Public Health | AiA
deavours to discuss, with the help of a few lucid public health research and policy is essential since
practical examples of success stories, the actual and COVID-19 is unlikely to be the last major pandemic
potential contributions that anthropology has made (Dimka et al. 2022).
or can make if harnessed well. In doing so, it intends This section concludes with an interesting exam-
to draw from the literature in US, European and In- ple of researchers drawing on anthropological theory
dian contexts, comparing and contrasting the studies and using a phenomenological approach to study the
conducted in these three regions of the world. concept of ‘chosen family’ in the context of health, ill-
ness and the mutual provision of care among queer
and transgender African-American adults in two
The USA states of the USA. The understanding of this popu-
lation’s experiences negotiating the idea of chosen
Anthropology’s contribution in public health is well family both inside and outside health care settings
researched and documented in the USA, as in the improved because of emergent themes of navigating
few examples discussed below. In Los Angeles, Cali- healthcare systems, relying on each other and mutual
fornia, an anthropological cultural consensus analy- aid. The implications of the findings could influence
sis reported patients’ experiences of and perceptions health care professionals in engagement of these pop-
about Chagas disease. The participatory explanatory ulations and their support networks (Jackson Levin
models used in the research highlighted the barri- et al. 2020).
ers reported by the patients in accessing healthcare
within and outside the health system; (Forsyth et al.
2021), thus explaining the reasons for non-access of Europe
treatments and recommending strategies to work on
the barriers. Europe has progressively adopted interdisciplinary
Similarly, application of a critical medical anthro- health strategies for the benefit of the population. The
pology syndemic theory was used to understand fac- COVID-19 pandemic reconfirmed the significance of
tors associated with adult obesity in the Atlanta re- understanding people’s perceptions, social and phys-
gion among African-American adults. This revealed ical situations and psychology for planning and ex-
five characteristics to be directly linked to obesity, ecuting health interventions. Considering the con-
namely: age, gender, relationship status, frequency text, WHO’s European region in collaboration with
of eating three meals a day and frequency of alcohol the University of Erfut (Germany) developed a tool
consumption. Further, seven underlying measures to capture people’s behavioural and cultural insights
as a root cause for endogenous alcohol consumption on COVID-19. The rapid, flexible and cost-effective
factors were identified, including age, gender, sex- tool monitored people’s knowledge, risk perceptions,
ual orientation, self-esteem, impulsivity, criminality misperceptions, stigma, trust in the health authorities
of friends and violence in the neighbourhood. The and recommendations made by them helped them
complex interactions among the many causes of obe- to take appropriate health actions in response to the
sity in this group lend credence to the employment pandemic situation. This understanding helped to
of syndemic theory-based models in future studies. strategise consistent, competent, fair, objective, em-
The structural model that emerged from this study pathetic or sincere health measures targeting people’s
reflected a plethora of evidence of synergistic effects health behaviour in a positive way. So far, 30 coun-
among the key variables causing obesity (Elifson et tries in the region have used the tool and WHO has
al. 2016). provided technical support in data collection, analy-
Continuing, with the significance of the syndemic sis and interpretation and reporting (World Health
approach, a review on interdisciplinary research on Organization 2020).
three pandemics—1918 influenza, 2009 influenza and As another example in the context of the COVID-19
COVID-19—on persistent racial, ethnic and indige- pandemic, in Serbia, cultural thought process was
nous disparities in morbidity and mortality, as well studied to understand vaccine refusal. It identified
as those caused by previous illnesses and disabilities, that a few had a negative attitude towards the pre-
led to discussions of strategies through which biolog- ventive measures to control the pandemic. Some
ical anthropologists could contribute to pandemics. thought that the illness did not exist, whereas some
The review concluded by stating that when studying opposed COVID-19 vaccination only. Some refused
pandemics, biological anthropologists can add rich vaccination as they fervently adhered to their own
historical and cross-cultural depth, shed light on the principles based on a set of legal, moral or religious
biosocial complexity of pandemics using syndemic norms. Some were holding on to the myth that lead-
theory, look into the effects of stress and stigma on ing a healthy lifestyle would not expose them to any
society and health, and address significant meth- infections. Some people had reservations about all the
odological and ethical issues. Increased participa- information released by the media on thr pandemic.
tion of biological anthropology in pandemic studies, A few didn’t have clear reasons for refusal and a few
| 15
AiA | Manisha Nitin Gore
didn’t trust the political systems and medical profes- phase, up to the present, has witnessed the origin of
sionals treating the infection. Overall, there was cyni- different sub-fields, interests in medical anthropol-
cism in social, political and scientific discourses, with ogy, religion, development and psychological studies
more people believing their feelings and convictions (Yamashit et al. 2004). There are not many examples
than facts. A discrete group created a pseudo theoret- of the use of anthropology in the public health field
ical situation which connected pandemic as a global but a few are given below.
crisis and perceived it to be causal and not relating In the state of Uttar Pradesh, a study focused
to the local situations, especially Serbian socio-cul- on the impact of accessing medicines through un-
tural situations. Such thoughts are examples of social licensed village doctors, drug vendors and over-
solipsism (Žikić 2022). The population’s perceptions the-counter purchases on the public procurement
could be clarified and barriers to vaccination could services and political economies of drugs. It used
be eliminated through efforts to increase awareness. methods of socio-anthropology of pharmaceuticals to
Apart from the pandemic, in an example of el- get a clear understanding of the local issues related to
derly care in Spain, a theoretical approach of anthro- access to medicines. Qualitative exploration revealed
pology of morality was applied to understand chal- the present circumstances of public health care sys-
lenges in care regimes based on family. The study tems, functions of the informal sectors and demon-
drew on fieldwork conducted among working-class stration of patients’ beliefs about access to health is
women born between 1920 and 1950. It interpreted equal to access to medicines (Dahdah et al. 2018).
the assessment of the ideal of family care by conven- Cultural ontologies of disease were studied from
tional women carers. Using a life history approach, the perspectives of patients in order to get insight
participants were able to discuss several elements of into the cultural nuances of cancer from a medical,
their lives, including care, family, employment and historical and religious/spiritual view. Qualitative
the role of the state. The primary aim was to dis- research sought patients’ understandings of cancer,
cuss the participants’ perception of their role as car- its ‘origins’, its meanings and subsequent everyday
ers and their expectations about their own care in the experiences. In-depth interviews with 40 cancer pa-
context of a crisis of care provision. The research re- tients in South India revealed some of the affective
flected women’s descriptions of caregiving as a sense components of these interpretations of sickness as
of moral obligation as well as sacrifice and resigna- well as changing individual responsibility and soci-
tion. However, they also acknowledged and publicly etal moralities concerning cancer (Broom et al. 2018).
discussed the moral, physical and psychological costs Another research study conducted in western India
that it frequently entails. A large proportion of older utilised cultural epidemiology to gain insights into
women showed reluctance to replicate this model to- the stigma surrounding severe mental illness and de-
wards the younger generations. They displayed new liberate self-harm (DSH) incidents. The study also
expectations, revisiting the scope of family obligation examined the underlying issues that contributed to
and connecting it to a revived idea of autonomy and these DSH events (Weiss and Parker 2020). An explo-
independence. The research recommended that the ration was conducted in a rural community in south
experiences are connected to a growing need for pub- India to investigate the socio-political and cultural
lic policies and the welfare state’s complete growth in dimensions of diabetes. The objective was to under-
terms of citizenship rights (Bofill-Poch 2018). stand the extent of health literacy, explanatory mod-
els of diabetes and the effects of the illness on an
individual’s social and familial responsibilities. Rec-
India ommendations were made to address systemic in-
equalities and foster individual empowerment (Little
In comparison to the USA and Europe, in India et al. 2016). The final example involves ethnographic
anthropology is considered to be a young discipline research that demonstrated the use of social theory in
and has developed slowly. The four phases of devel- understanding the multifaceted aspects of the Pub-
opment chronicled include a formative phase before lic Private Partnerships (PPP) model in the control of
19th century marked by studies on tribal life and TB services in India. The essay explains how utilising
ethnographic accounts of India’s sociocultural sit- social theory can help to comprehend the intricate in-
uations—most often conducted by anthropologists teractions between the public, private and non-profit
from outside India. In the constructive phase up to sectors (Salve et al. 2018).
the 1950s, anthropology was introduced in the cur- The examples in India lead to a question. Is the
riculum of postgraduate studies in Kolkata, followed use of anthropology in Indian public health scenario
by the creation of the Anthropological Survey of In- widely recognised, accepted, employed, documented
dia. The analytical phase of the 1990s saw detailed and sufficient to address the public health problems
contributions by Indian anthropologists in the ana- of India?
lytical studies of complex societies and the evolution Anthropology’s potential for improving public
of context-specific research methods. The evaluation health issues in India is underutilised and requires
16 |
The Role of Anthropology in India’s Public Health | AiA
reinforcement. India’s vast size, religious diversity, anthropology, India has the potential to expand an-
socio-cultural complexity, high disease burden and thropology’s use in public health in the future.
challenges in achieving the Sustainable Development
Goals make it an ideal candidate for utilising anthro-
pology in various health facets. Currently, however, Acknowledgements
there is a lack of evidence regarding the application
of anthropology in developing culturally sensitive The author would like to express heartfelt gratitude
public health interventions and policies in India. to Dr Avinash Patwardhan, Adjunct Assistant Profes-
Public health professionals can leverage anthro- sor, Department of Global and Community Health,
pology’s research tools, such as participant obser- George Mason University for his invaluable contribu-
vation and ethnography, to study community en- tion to the conception, writing and reviewing of this
gagement, health-seeking behaviours and health research article. His expertise, guidance and dedica-
communication. This approach allows for a deeper tion have been instrumental in shaping the overall di-
understanding of the community’s perspective and rection and quality of this work.
facilitates the design of context-specific, accessible
and culturally appropriate health programmes. Ad-
ditionally, exploring the gendered dimensions of Manisha Gore is an outcome-oriented public health
health is crucial, as gender roles and power dynam- professional and anthropologist whose expertise
ics significantly influence health outcomes in India. spans HIV/AIDS, maternal and child health, non-com-
Anthropological research can examine the impact municable diseases, community nutrition and mental
of gender on healthcare access utilisation and de- health. Gore focuses on key thematic areas, includ-
cision-making leading to the development of gen- ing the social determinants of HIV/AIDS among fe-
der-sensitive policies and interventions that address male sex workers, men having sex with men and
disparities in health. Most importantly, studying in- transgender individuals. Additionally, her research
digenous populations’ public health issues, it would explores common mental disorders in adolescents,
provide insights into their cultural, social and histor- addressing reproductive health challenges in young
ical contexts. Understanding their particular health adults and promoting food security in rural areas.
beliefs, habits and difficulties paves the way for the Assistant Professor, Faculty of Medical and Health
creation of suitable interventions and policies and Sciences, Symbiosis International (Deemed Univer-
would aim to enhance health outcomes. sity), Pune, India. [email protected]
Furthermore, the role of anthropologists in health 0000-0002-4558-1983
policy and planning needs recognition. Conducting
research on healthcare systems, policy implementa-
tion and the impact of health programmes can sys- References
tematically identify the gaps and challenges in public
health service delivery. It can also evaluate the effec- Barnard, A. and J. Spencer (eds) (2002), Encyclopedia
tiveness of interventions through a cultural lens, in- of Social and Cultural Anthropology (London:
forming the development of evidence-based policies. Routledge), https://chairoflogicphiloscult.files.
The USA and Europe are more advanced in the use wordpress.com/2013/02/encyclopedia-of-social-and-
of anthropology in public health due to established cultural-anthropology.pdf.
academic programmes, robust research funding and Bofill-Poch, S. (2018), ‘Changing Moralities: Rethinking
infrastructure, effective integration into public health Elderly Care in Spain’, The Australian Journal
institutions, abundant research publications and re- of Anthropology 29, no. 2: 237–249, https://doi.
sources, and a strong network for collaborations. In org/10.1111/taja.12282.
contrast, India has fewer dedicated academic pro- Broom, A., K. Kenny, V. Bowden, N. Muppavaram and
grammes, faces challenges in research funding and M. Chittem (2018), ‘Cultural Ontologies of Cancer in
infrastructures, has limited integration of anthropol- India’, Critical Public Health 28, no. 1: 48–58, https://
ogy into mainstream public health institutions and doi.org/10.1080/09581596.2017.1288288.
has comparatively fewer research publications and Dahdah, M. A., A. Kumar and M. Quet (2018), ‘Empty
resources. Lastly, it is observed that Indian public Stocks and Loose Paper: Governing Access to
health professionals, particularly medical doctors, of- Medicines through Informality in Northern India’,
ten lack inclusivity and fail to effectively incorporate International Sociology 33, no. 6: 778–795, DOI:
social scientists in addressing public health issues. 10.1177/0268580918792779.
India is making progress in creating partnerships, Dimka, J., T. P. van Doren and H. T. Battles (2022),
but it may still be developing a strong network of ‘Pandemics, Past and Present: The Role of Biological
scholars and practitioners in this area. With invest- Anthropology in Interdisciplinary Pandemic
ments, collaborations and recognising the value of Studies’, American Journal of Biological Anthropology
178: 256–291, DOI: 10.1002/ajpa.24517.
| 17
AiA | Manisha Nitin Gore
Elifson, K. W., H. Klein and C. E. Sterk (2016), ‘The Little, M., Humphries, S., Patel, K., & Dewey, C. (2017).
Value of Using a Syndemics Theory Conceptual Decoding the Type 2 Diabetes Epidemic in Rural
Model to Understand the Factors Associated with India. Medical Anthropology, 36(2), 96–110. https://
Obesity in a Southern, Urban Community Sample doi.org/10.1080/01459740.2016.1231676
of Disadvantaged African-American Adults’, Journal Rai, M., & Kishore, J. (2009). Myths about
of National Black Nurses’ Association: JNBNA 27, diabetes and its treatment in North Indian
no. 1, https://www.ncbi.nlm.nih.gov/pmc/articles/ population. International Journal of Diabetes in
PMC6110300/. Developing Countries, 29(3), 129.
Eriksen, T. H. (2004), What is Anthropology? (London: Salve, S., K. Harris, K. Sheikh and J. D. Porter (2018),
Pluto Press). ‘Understanding the Complex Relationships among
Forsyth, C. J., S. Hernandez, C. A. Flores, M. F. Roman, Actors Involved in the Implementation of Public–
J. M. Nieto, G. Marquez, … and S. K. Meymandi Private Mix (PPM) for TB Control in India, Using
(2021), ‘“You Don’t Have a Normal Life”: Coping Social Theory’, International Journal for Equity
with Chagas Disease in Los Angeles, California’, in Health 17, no. 1–15, https://doi.org/10.1186/
Medical Anthropology 40, no. 6: 525–540, https://doi.or s12939-018-0785-1.
g/10.1080/01459740.2021.1894559 Weiss, M. G., & Parkar, S. R. (2020). Facets of clinical
Gethmann, C. F., M. Carrier, G. Hanekamp, M. Kaiser, stigma after attempted suicide in Mumbai, India.
G. Kamp, S. Lingner, … and F. Thiele (2015), Anthropology & Medicine, 27(2), 212-233. doi:10.108
Interdisciplinary Research and Trans-Disciplinary 0/13648470.2019.1640025
Validity Claims (New York: Springer). Wiley, A. S. and J. S. Allen (2009), Medical Anthropology:
Guest, K. J. (2013), Cultural Anthropology: A Toolkit for a A Biocultural Approach (Oxford: Oxford University
Global Age (New York: WW Norton & Company). Press).
Hahn, R. A. and M. C. Inhorn (2008), Anthropology World Health Organization (2020), ‘Survey
and Public Health: Bridging Differences in Culture and Tool and Guidance: Rapid, Simple, Flexible
Society (Oxford: Oxford University Press). Behavioural Insights on COVID-19’, 29 July
Jackson Levin, N., S. K. Kattari, E. K. Piellusch and E. 2020 (No. WHO/EURO: 2020-696-40431-54222),
Watson (2020), ‘“We Just Take Care of Each Other”: https://www.who.int/europe/tools-and-toolkits/
Navigating “Chosen Family” in the Context of who-tool-for-behavioural-insights-on-covid-19.
Health, Illness, and the Mutual Provision of Care Yamashita, S., J. Bosco and J. S. Eades (eds) (2004), The
Amongst Queer and Transgender Young Adults’, Making of Anthropology in East and Southeast Asia
International Journal of Environmental Research (Vol. 3). New York: Berghahn Books.
and Public Health 17, no. 19: 7346, doi: 10.3390/ Žikić, B. (2022), ‘COVID-19 Vaccine Refusal in
ijerph17197346. Serbia as an Example of Social Solipsism’,
Kottak, C. P. (2010), Cultural Anthropology: Appreciating Етноантрополошки проблеми 17, no. 1: 233–257,
Cultural Diversity (New York: McGraw-Hill). DOI: https://doi.org/10.21301/eap.v17i1.8.
18 |
