Culture and Epidemiology

Abstract

Trostle, James A.: 2005, Epidemiology and culture.New York: Cambridge University PressJames Trostle’s book ‘‘Epidemiology and Culture’’offers a number of valuable intended and unin-tended contributions. The main purpose of Tros-tle’s book is to argue for the benefits of greatercollaboration between epidemiology and anthro-pology in the pursuit of improving human health.He locates the most amenable point to bridge thetwo disciplines in the overlap of social epidemiol-ogy and cultural/medical anthropology. Accordingto Trostle, social epidemiology is the branch ofepidemiology most directly concerned with thehealth effects of social organization. And cultural/medical anthropology is concerned with culturallypatterned responses to diseases in the most expan-sive sense. Cultural/medical anthropology properlyconceived, Trostle writes, focuses attention ondisease classification, meaning, risk, and behaviourin addition to social variables such as income,marital status, occupation, and so forth. Moreover,when anthropologists examine culturally patternedresponses to disease, the practice of epidemiologyitself is analysed as a product of culture. One of thebenefits of interdisciplinary work, according toTrostle, would be the addition of ‘‘reflexivity’’ toepidemiology that is (sorely) lacking, and whichanthropologists have long made explicit in theirresearch. To show some of the limitations from thelack of anthropological skills and reflexivity inepidemiology, Trostle explains how the standardvariables of person, place, time, and race inepidemiological studies can have a great amountof variability due to cultural practices. Thoughgood epidemiologists are cognizant of the possi-bility of measurement errors or bias in theirresearch, Trostle advocates that greater use ofanthropological skills and explicit reflexivity willproduce better epidemiological research and con-sequently, better health interventions.The book is well organized with chapters on thehistory of epidemiology and social medicine, theanthropological critique of standard variables usedin epidemiological studies, the cultural influences inhealth research using surveys and clinical trials thatoften result in errors and bias, and a chapterdevoted to the anthropological analysis of infec-tious disease outbreaks using the example of thecholera epidemic in Latin America in the 1990s.The last two subject chapters are focused on thegrowing interest in public health interventions atthe community level, and the rise of non-profes-sional epidemiology taking the form of communityhealth activists undertaking research or the greaterreliance on local knowledge in developing studydesign and interventions. The strength of this booklies in its broad scope that covers history, methods,case studies, and current issues. Each chapter has afurther reading list and importantly, Trostle pro-vides comprehensive references which include someof the most seminal research studies in the fields ofsocial medicine, social epidemiology, and medicalanthropology. As Trostle acknowledges, each ofthe substantive chapters are drawn from previouspapers and presentations. As such, each chaptermerits attention and stands on its own. But Ibelieve the sum of the parts could be much morethan what Trostle articulates in the introductionand conclusion.Is epidemiology a natural or social science?While Trostle advocates the benefits of collabora-tive work between epidemiology and anthropol-ogy, he sidesteps what may be the biggest barrier tosuch collaboration; the boundary between the