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By Chris Cai, MS1
UCSF and its School of Medicine are justifiably recognized for stellar biomedical research and state-of-the art patient care. Far fewer people know that the school also contains a distinguished Department of Anthropology, History and Social Medicine (DAHSM) that has made a notable impact in the field.
Medical Anthropology is the study of the social, structural and ethical contexts that affect health. Understanding the political, economic and cultural sources of ill-health are important for medical education and clinical practice. The work of UCSF's Department of Anthropology, History and Social Medicine addresses the complexities of medical practice and health inequality in an increasingly diverse and global world.
Founded in 1975 as a joint program with anthropologists at UC Berkeley, the UCSF Medical Anthropology program was the very first in the nation to offer PhD training in this field. Along with the doctoral program in Medical Anthropology, DAHSM also offers a program in the History of Health Sciences (which will be the topic of a follow-up story.)
Faculty in the department have conducted research on racial disparities, alternative medicine, the political structures influencing health, and global health, and many other topics. “Our work speaks to health policy and health practitioners, and it influences communities both inside and outside medicine,” states DAHSM chair Sharon Kaufman, PhD.
In her book Ordinary Medicine: Extraordinary Treatments, Longer Lives and Where to Draw the Line, Kaufman shows how “the line between life-giving therapies and too much treatment is hard to see — it is obscured by a perfect storm created by private industry, insurance reimbursement, and the promises of evidence and new technologies.”
Another recent work authored by DASHM faculty is Metrics: What Counts in Global Health by Vincanne Adams, PhD, vice chair and former director of the DAHSM graduate program. In this book, she explores quantitative metrics—particularly the use of randomized, controlled trials in global health. Through a series of international case studies, it shows how ethnographic research can reveal the limits of quantitative methods. “Evidence-based metrics in global health settings can just as easily erase medical and health realities as elucidate them, making intervention all the more challenging," she said.
The doctoral program, directed by Ian Whitmarsh, PhD, trains PhD students in medical anthropology through its joint program with UC Berkeley’s Department of Anthropology. The PhD Program in medical anthropology also trains medical students from the MSTP program. Training both as social scientists and physicians, these students will be uniquely positioned to address the social dimensions of health.
First-year MSTP student Sheyda Aboii is the most recent MD/PhD candidate who will participate in an independent study with Dr. Knight. She is interested in the intersection between toxic exposure, race, and immigration. “Training in medical anthropology provides a pathway to critique and improve healthcare,” she said.
“Medical anthropology seeks to meet people where they’re at but also move beyond harm reduction at the individual level,” adds Fabian Fernandez, a-second year MD/PhD student. “We aim to leverage these narratives to radically change oppressive systems, structures, and ways of thinking.”
Fernandez is interested in community organizing and advocating for the health of queer and trans people of color in the US and abroad. “When we begin to understand the complexity of sex work—not as ‘inherently degrading’, ‘survival sex’, or ‘human trafficking’, but as a bodily practice entangled in local policies and power—we can better work with sex workers to address social support, healthcare needs, and community advocacy.”
“Anthropology offers a unique set of tools to study and think about the social contexts that produce health disparities and disease in ways that public health and traditional health sciences research may not capture,” said Raphael Frankfurter, another student in the doctoral program.
To introduce social science concepts into health professional training, DAHSM faculty and students have initiated the Structural Competency Working Group, a movement for “health professionals to recognize and respond to health and illness as the downstream effects of broad social, political, and economic structures.”
“People generally become healthcare providers because they want to help people,” says Josh Neff, a student in the JMP program and one of the leaders of the group. “Structural competency helps to recognize that truly helping our vulnerable patients requires structural-level changes. And if we’re successful, it will empower current and future providers to work in partnership with communities to realize this change."
To bring these concepts into the School of Medicine’s new Bridges curriculum, Neff, Knight, and Aimee Medeiros, PhD, another faculty in the department, partnered to incorporate structural competency training throughout the first two years of medical school. “This is a big step forward affirming social medicine as a foundational science,” said Dr. Knight.
This article features the Medical Anthropology Program. The second in this series will be published later this Spring, and will feature the History of Health Sciences Program.