W. H. R. Rivers Prize Essay (1986): Western Minds, Foreign Bodies

Abstract

In this essay I discuss the limited gain and potential harm of health development programs that are directed by the assumptions of Western ideologies surrounding the sickness domain. By contrast with the realities of medical practice in the West and the Third World, three aspects of the cultural model of biomedicine are examined: (1) the implicit assumption that biomedicine is a body of widely shared knowledge that directs sickness behavior, and that this knowledge and the institutions in which it is applied are objectively and intrinsically related to each other; (2) the belief in the effectiveness of biomedical techniques; and (3) the implicit model of the ideal rational patient. I argue that the effectiveness of health development projects is lessened if they are planned on the basis of this orthodox biomedical orientation. Furthermore, I suggest that the practice of viewing Third World health development in terms of biomedical ideology inhibits consideration of the influences of both the political and physical environments on the distribution of sickness. Health planners are advised not only to implement culturally appropriate projects but also to promote awareness of important influences on health that biomedical discourse helps obscure from consideration.