By Christie W.Kiefer . Published by Springer Publishing Company , November 2006 . Hardback , 304 pages with index . ISBN 0826115578 .
Reviewed by Celia McMichael
Refugee Health Research Centre, School of Social Sciences, La Trobe University, Victoria
Health anthropology investigates and describes the complexity of public health issues, focusing on the social and cultural dimensions of illness and well-being. This book aims to provide an overview of the concepts, approaches and skills used in anthropological research of health and illness. It is written primarily with novice researchers in mind, and specifically health workers and health scientists who have an interest in using anthropological methods to understand and address the social causes of ill health.
Divided into 13 chapters, Kiefer's book considers the contribution of cultural anthropology to health sciences, the theoretical underpinnings of naturalistic inquiry, design of research projects, methods for data collection and analysis including a chapter dedicated to the role and techniques of action anthropology, and theoretical frameworks for understanding health and illness. The final two chapters identify methods for teaching health anthropology and discuss criteria for evaluating quality in social science research. Case studies are provided from both developed and developing countries that describe research and community-based health projects and illustrate the value and methods of health anthropology research.
The book provides some practical advice on anthropological research methods and analysis: negotiating roles in the field, participant observation, taking field-notes, unobtrusive methods, interview techniques, action research, and summarising and analysing data. For example, the chapter on collecting data contains discussion of the practicalities of unobtrusive and background research: informal conversation with community members; attention to history and social change in the area; mapping the physical features of a community; and reviewing publicly available routine records. The section on interview methods includes advice on where to conduct interviews, how to ask questions, maintaining rapport, and keeping interview records. Examples from research are used to illustrate the inductive and adaptive nature of qualitative inquiry. The relevant chapters do not provide in-depth guidance on methods, but rather offer an introduction to procedures and techniques for collecting and analysing anthropological research.
Kiefer largely eschews the notion of verification as a measure of quality in social science research, arguing that the validity of health anthropology research lies in its usefulness. He suggests that good research draws upon sound methods in order to develop useful understanding and solutions to problems. The health anthropologist is presented as having an applied role in using action anthropology processes to help empower communities. Kiefer states that action anthropology can help people understand their lives and needs “in new ways that will encourage them to change some things about the way they live”.
Given this emphasis on the health researcher as an “outside helper in promoting the process of empowerment”, the book would benefit from further critical discussion of the relationship between the researcher and the community he or she is working with. Kiefer states that social researchers should acknowledge their own values and aims and how they affect their work, and provides suggestions on securing trust and co-operation, participation in everyday life, learning to fit in, wearing appropriate clothes, and managing culture shock. However, reflexive anthropological theory and research is also concerned with: the ‘crisis of representation’, questioning the position of anthropologists as ethnographers representing other people's cultures; ethical dilemmas around the perpetuation of power differentials between anthropologists and communities; and efforts to allow communities to speak for themselves.1,2,4 While Kiefer does refer to some of these issues, more thorough discussion would be informative for readers who are new to qualitative inquiry.
Kiefer highlights the role of theoretical frameworks in shaping research questions and methodological design and linking knowledge to action. His discussion of the “theory of needs” makes the important point that health is only one of many competing human needs, and behaviours can be understood as strategies for balancing these needs (p.158). Kiefer suggests that anthropology can understand these competing needs by placing health and illness within a broader cultural framework. He presents cultural frameworks as locally situated systems of belief and behaviours that interlock to form a coherent view of the world. In recent decades, however, more nuanced accounts of culture have emerged that: highlight ambiguity and difference within social and cultural contexts; seek to engage with ‘hidden populations’ and marginalised groups such as children, homeless people, women, and refugee populations; and examine the impact of political histories, structural violence, social inequities, and globalisation. These analytical perspectives are central to much health and medical anthropology and could be further emphasised.
Kiefer aims to provide an accessible and practical guide to health anthropology research for those who are relatively inexperienced in qualitative and anthropological methods. It provides a good account of the capacity of health anthropology for pragmatic engagement with communities and their health concerns. The book would be strengthened by further critical reflection on ethical issues, debates and dilemmas within anthropology and the social sciences, as these are important aspects of applied health anthropology and could be discussed without reliance on “social science jargon”. As Peacock notes, “pragmatism and searching critique need not be mutually exclusive”.3 However, on the whole students in health sciences will find this book to be a useful introduction to the role and methods of anthropology in health research.