E. Christian Wells is Professor of Anthropology and Director of the Center for Brownfields Research & Redevelopment at the University of South Florida, where he served previously as the Founding Director of the Office of Sustainability and as Deputy Director of the Patel School of Global Sustainability. Dr. Wells is an applied environmental anthropologist committed to improving human and environmental health outcomes of re/development efforts in marginalized communities. With support from the National Science Foundation and the US Environmental Protection Agency, his research examines water and sanitation infrastructure transitions in underserved communities in the United States, Central America, and the Caribbean. Dr. Wells is a Fellow of the American Association for the Advancement of Science and is the recipient of the Sierra Club’s Black Bear Award in recognition of outstanding dedication to sustainability and the environment. He currently serves as President of the Florida Brownfields Association, the state’s largest nonprofit advocacy organization dedicated to improving public health through environmental justice.
Linda M. Whiteford, PhD, MPH, is Professor Emerita of Anthropology at the University of South Florida where she was Associate Vice President for Global Strategies, Associate Vice President for Academic Affairs and Strategic Initiatives, and Vice Provost. Dr. Whiteford was also the Founding Co-Director of the WHO Collaborating Center for Social Marketing and Social Justice at USF. She is past President of the Society for Applied Anthropology and the 2018 recipient of the Sol Tax Award for contributions to applied anthropology. Her research focuses on translating anthropological research into global health policies and practices, particularly concerning infectious and contagious water-related diseases. Dr. Whiteford’s research has been funded by the National Science Foundation, and she consults for the World Bank and The US Agency for International Development. Significant publications include Primary Health Care in Cuba: The Other Revolution; Anthropological Ethics for Research and Practice; Globalization, Water and Health: Resources in Times of Scarcity; and Global Health in Times of Violence.
Introduction
Merrill Singer, Pamela I. Erickson, and César Abadía-Barrero
Medical Anthropology is a “baby boomer” of sorts. It came into being alongside the unprecedented interest in the health and wellbeing of Third World peoples in the aftermath of WWII when the world was full of the hope and possibility that science, in this case biomedicine, could alleviate human suffering due to infectious disease and malnutrition, and then help eliminate or control many of the world’s major health problems. Many anthropologists of that era worked with the international health community (WHO, USAID, UNICEF, etc.) to bring biomedicine to the world. The presumption guiding this effort was that shown the effectiveness of biomedicine and modern public health methods (e.g., the health value of boiling water before drinking it), while addressing contextual and cultural barriers to change, people would readily adopt new ways and the threat of many diseases would begin to diminish. Seven decades later, a large proportion of the morbidity and mortality in our world is still due to the same tenacious problems of malnutrition, pregnancy-related complications, infectious diseases, and lack of access to high-quality health care. Although some of the diseases, like HIV/AIDS, are new, one old disease but only one, smallpox, has been eliminated. With economic development, the so-called Third World was re-branded in terms of the size of each country’s economy as low- or middle-income countries. With more “development,” these countries started to experience a mixed epidemiologic profile: “diseases of poverty,” on the one hand (Farmer 2003), and chronic conditions such as cancer, diabetes, and cardiovascular disease, on the other. The raising awareness of the world interconnectedness demonstrated how health profiles depended on key social determinants of global health such as living and working conditions; level of education; neighborhood characteristics; and access to water, sanitation, and health care services which are exacerbated by escalating levels of poverty, inequalities, war, genocide, and greed (Singer and Erickson 2013).
The political economic systems that have resulted from unconstrained capitalism and global free market policies married to a scientific positivism whose advocates thought they would save the world have become systems of structural violence (Galtung 1969) that are especially damaging to the poor and marginalized peoples of the planet. As Farmer (2003:1) indicates, structural violence refers to “a host of offenses against human dignity [including]: extreme and relative poverty, social inequalities ranging from racism to gender inequality, and the more spectacular forms of violence that are uncontested human rights abuses….” Medical anthropologists waver between people-centered approaches that include individual experiences and collective realities of lived marginalization and “social suffering” (Biehl and Petryna 2013; Kleinman et al. 1997), and infrastructures of violence, historical trauma, and systems of oppression. As Langer (1996:53) asserts, “We need a special kind of portraiture [and a special language] to sketch the anguish of people who have no agency in their fate because their enemy is not a discernible antagonist, but a ruthless racial ideology, an uncontrollable virus, or, more recently, a shell from a distant hillside exploding amid unsuspecting victims in a hospital or market square.”
If this were not enough, health problems have become more severe and widespread due to globalization (e.g. with the alteration of food supplies or migrants facing a range of aggressions in the host countries) (Castañeda 2019; Horton 2016; Perro and Adams 2017) global warming (with higher rates of heat stroke and other heat-related problems) (Baer and Singer 2018, Singer 2019 ), and environmental restructuring and degradation (with more pollutants and chemicals in the air, soil, water, and everyday use items), all of which interface with each other to effect syndemics (Singer 2009a), ecosyndemics (Singer 2009b), and ecocrises interactions (Baer and Singer 2018; Singer 2009c, 2010, 2019, 2021). Indeed, at least in the United States, life expectancy is declining and, at the same time, a myriad of mental health problems, metabolic and immune conditions, drug overdose, and gun violence are reaching “epidemic” proportions and affecting younger and younger generations (Perro and Adams 2017). We are in a situation in which health improvements and innovations coexist with longstanding inequalities and even worsening health indicators. The ever increasing costs of care given the for-profit characteristics of the pharmaceutical, biotechnology, and health delivery industries continue with minimal national or global regulations (Sunder Rajan 2017). The push for insurance-based privatization policies has been globally enforced in the Sustainable Development Goals as “Universal Health Coverage” (Abadía-Barrero and Bugbee 2019). As health care financing and metrics take over health decisions (Adams 2016; Metzl and Kirkland 2010; Mol 2008; Mulligan 2014), the most fundamental health care interventions, such as child and maternal health or immunizations, continue to receive funding and health technologies in the form of vertical programs, adding to the historical