The Economics of Health and Wellness: Anthropological Perspectives: Volume 26

This 26th volume of REA focuses on the economics of health and wellness, and in doing so attempts to bring together two fields of research – economic anthropology and public health – that tend not to merge as often as they should. The volume includes 10 chapters that explore the general theme of the economics of health and wellness in an anthropological fashion and in a variety of settings and ways. All of them passed a selection process that included double-blind peer-review, and have been revised to various degrees based partly on the suggestions of the referees. On this note, I would like to extend my gratitude to the various scholars who took time out of their very busy schedules to review manuscripts for this volume. The chapters here all benefited greatly from their anonymous comments and recommendations.

Poor health conditions are a major factor in perpetuating poverty on the Pine Ridge Indian Reservation. This chapter explores the ways in which market-based health care delivery systems shirk health care costs of Lakota households on the periphery of the market economy. Furthermore, the economic value of health care services provided by these same marginal households is understated because market-based health care privileges commodified biomedicine. Examining economic activity beyond formal market integration reveals how households least able to bear the costs of health care subsidize the market economy at the expense of their own efforts to move out of poverty.

This study examines the decision process of household members in visiting local health care providers. It also explores the effect of various household level socioeconomic factors on motivating rural people to visit traditional versus modern health care providers in rural Bangladesh. I used the Population, Environment, and Poverty data collected from eight villages of rural Bangladesh in 1998 in addition to self-collected ethnographic survey information. The data suggest that a large majority of rural households attempt to visit locally available untrained health care providers first, and then trained doctors as the sickness worsens. The data also suggest that socio-cultural and economic factors are important in shaping their decision to visit traditional as opposed to modern health care providers. Training the traditional and untrained health care providers will be a wise option to ensure health care to the villagers.

Social and economic trends toward local governance form the context for health and mental health policy and the reorganization of care systems for cost-containment in the United States. Local management of public–private collaborations is promoted by state agencies as a means of rationalizing mental health care and community support services. This chapter analyses the local process of developing public–private partnerships for mental health care, based on an ethnographic case study of county Mental Health/Mental Retardation and behavioral health committees and coalitions in Texas, from 1995 to 2001. Following this period, local service agencies continued collaboration to increase community awareness and resources for care. Findings were that while the rapid transition to local control under conditions of reduced resources impeded implementation of a public–private mental health care system, commitment to a service safety net for persons with mental disabilities was sustained.

The impact of globalization on individual well-being through the interplay of self and standard forms of lifestyle aspirations, has generally received less attention than the merits of globalization at the macro-level. This chapter addresses this question by testing the hypothesis that poor rural-dwelling Botswana men suffer diminished well-being compared to their relatively well-off urban-dwelling counterparts as a result of unfulfilled lifestyle aspirations. The study combines ethnographic, psychological, and psychosomatic data to compare well-being among rural and urban adult Botswana men. Results indicate that failed urban migration associates with low cortisol and high depressive affect, and rural residence is also independently associated with high depressive affect. This psychosomatic syndrome may be similar to that observed in posttraumatic stress disorder, suggesting that the experience of failed urban migration is considerably more stressful than the demands of employed urban life in contemporary Botswana.

Logging industry fatalities recently became a focus for policy change in British Columbia. Through re-analysis of ethnographic data collected in 2001–2002 this chapter aims to investigate logging contractors’ attitudes toward workplace danger and to comment on the likelihood of success of the proposed policy changes. The contractors attributed workplace danger to the forest environment and to human error, which shaped their behavior and their attitudes toward taking risks. The contractors accepted the risk of physical harm rather than face almost certain economic loss. The proposed policy changes do not address the conditions that promoted this acceptance.

This chapter analyses efforts of the union and the management of a large urban transit company to address the high prevalence of hypertension among transit operators. Ethnographic evidence recounts the efforts to change the structure of work in order to decrease the problem. The chapter's key finding is that the features of the work environment that produce hypertension in transit operators in the first place also make it difficult for them to work together with their union leadership to push for lasting work changes necessary to improve their health over the long run.

Evidence from developed countries shows debt and bankruptcy to be correlated with medical expenditures. In Mexico, the formal financial sector does not lend for health needs. So, the solution is often found by borrowing from relatives, friends, and moneylenders, or pawning belongings after using savings, if any. Despite the recent and growing literature on income and health, and health financing, we have not come across a single study analyzing pawning and health. Our study fills this gap using a sample of 400 government owned pawnshop users from Puebla, Mexico. The findings from the study revealed that health expenditures are a significant reason for pawning and having medical insurance does not reduce the probability to pawn. Also, catastrophic health expenditures are correlated with a higher probability of not redeeming the pledge. We found that most pawnshop users have low income and losing a pledge is positively correlated with low or middle income and the number of people in the household.

This chapter explores the contribution of health care expenditure to basic needs satisfaction. It focuses on Nuevo Lugar, a shanty town of Lima with access to modern health care services and infrastructures. The research follows a three-step approach beginning with the investigation of what is understood as basic needs through people's concepts of the “good life”. It then identifies basic needs satisfiers in the slum – those goods and services people consume motivated by meeting their valued needs. Finally, it explores the case of expenditure on consultation fees, medicines and vitamin supplements. It finds that they might not make a significant contribution to people's physical health due to the lack of information on illnesses and treatments tailored to the local population, together with the high costs of medicines.

Wife battering has important impacts on the health of battered women, both in the short and long term. This form of gendered violence has been a significant problem in Vietnam. Recent economic, social, and cultural changes occurring in Vietnam, with a transformation toward a socialist-oriented market economy through the state's doi moi political program, have influenced multiple aspects of wife battering. These include perspectives of wife battering, battered women's access to health care, conceptualizations of the household, and the emergence of new international health programs for battered women. Women's health problems derived from wife battering must be understood as processes that are informed by cultural, political, and economic change, on both a societal level and in the lives of individual women experiencing this form of gendered violence.

Based on ethnographic data and a textual analysis, this chapter highlights the process of “therapization” of Buddhism in Western countries, with a specific emphasis on Tibetan Buddhism in France. Referring to the paradigm of “political economy of health”, as developed in recent medical anthropology, it attempts to explore the relationships between two concepts – economics and health – that had previously been considered separately, in the context of Western Buddhism. Further, this chapter's aim is to expose a potential application of theoretical economic models in an anthropological approach of Buddhist diffusion and appropriation in the West.