In the history of human health, technology is an essential topic. Medical technologies have transformed human life. They have increased life expectancy rates, lowered child mortality rates, and are used to intervene in and often cure thousands of diseases. Of course, these accomplishments come with many cultural consequences. Successful efforts to intervene in the body biologically also have implications for cultural values and the social organization of communities, as demonstrated by the examples below.
Antibiotics and Immunizations
Infectious diseases caused by viruses and bacteria have taken an enormous toll on human populations for thousands of years. During recurring epidemics, tens of thousands of people have died from outbreaks of diseases like measles, the flu, or bubonic plague. The Black Death, a pandemic outbreak of plague that spread across Europe and Eurasia from 1346–1353 AD, killed as many as 200 million people, as much as a third of the European population. Penicillin, discovered in 1928 and mass produced for the first time in the early 1940s, was a turning point in the human fight against bacterial infections. Called a “wonder drug” by Time magazine, Penicillin became available at a time when bacterial infections were frequently fatal; the drug was glorified as a cure-all.51 An important factor to consider about the introduction of antibiotics is the change to an understanding of illness that was increasingly scientific and technical. Before science could provide cures, personalistic and naturalistic ethno-etiologies identified various root causes for sickness, but the invention of antibiotics contributed to a strengthening of the Western biomedical paradigm as well as a new era of profitability for the pharmaceutical industry.
The effects of antibiotics have not been completely positive in all parts of the world. Along with other technological advances in areas such as sanitation and access to clean water, antibiotics contributed to an epidemiological transition characterized by a sharp drop in mortality rates, particularly among children. In many countries, the immediate effect was an increase in the human population as well as a shift in the kinds of diseases that were most prevalent. In wealthy countries, for instance, chronic conditions like heart disease or cancer have replaced bacterial infections as leading causes of death and the average lifespan has lengthened. In developing countries, the outcome has been mixed. Millions of lives have been saved by the availability of antibiotics, but high poverty and lack of access to regular medical care mean that many children who now survive the immediate dangers of infection during infancy succumb later in childhood to malnutrition, dehydration, or other ailments.52
Another difficulty is the fact that many kinds of infections have become untreatable as a result of bacterial resistance. Medical anthropologists are concerned with the increase in rates of infectious diseases like tuberculosis and malaria that cannot be treated with many existing antibiotics. According to the World Health Organization, there are nearly 500,000 cases of drug resistant tuberculosis each year.53 New research is now focused on drug resistance, as well as the social and cultural components of this resistance such as the relationship between poverty and the spread of resistant strains of bacteria.
Immunizations that can provide immunity against viral diseases have also transformed human health. The eradication of the smallpox virus in 1977 following a concerted global effort to vaccinate a large percentage of the world’s population is one example of the success of this biotechnology. Before the development of the vaccine, the virus was killing 1–2 million people each year.54 Today, vaccines exist for many of the world’s most dangerous viral diseases, but providing access to vaccines remains a challenge. The polio virus has been eliminated from most of the world following several decades of near universal vaccination, but the disease has made a comeback in a handful of countries, including Afghanistan, Nigeria, and Pakistan, where weak governments, inadequate healthcare systems, or war have made vaccinating children impossible. This example highlights the global inequalities that still exist in access to basic medical care.
Because viruses have the ability to mutate and to jump between animals and people, human populations around the world also face the constant threat of new viral diseases. Influenza has been responsible for millions of deaths. In 1918, a pandemic of the H1N1 flu infected 500 million people, killing nearly 5 percent of the human population.55 Not all influenza strains are that deadly, but it remains a dangerous illness and one that vaccines can only partially address.56 Each year, the strains of the influenza virus placed in the annual “flu shot” are based on predictions about the strains that will be most common. Because the virus mutates frequently and is influenced by interactions between human and animal populations, there is always uncertainty about future forms of the virus.57
Today, the idea of “contraception” is linked to the technology of hormone-based birth control. “The pill” as we now know it, was not available in the United States until 1960, but attempts to both prevent or bring about pregnancy through technology date back to the earliest human communities. Techniques used to control the birthrate are an important subject for medical anthropologists because they have significant cultural implications.
Many cultures use natural forms of birth control practices to influence the spacing of births. Among the !Kung, for instance, babies are breastfed for many months or even years, which hormonally suppress fertility and decrease the number of pregnancies a woman can have in her lifetime. In Enga, New Guinea, men and women do not live with one another following a birth, another practice that increases the time between pregnancies.58 In contrast, cultures where there are social or religious reasons for avoiding birth control, including natural birth spacing methods, have higher birth rates. In the United States, the Comstock Act passed in 1873 banned contraception and even the distribution of information about contraception.
Although the Comstock Act is a thing of the past, efforts in the United States to limit access to birth control and related medical services like abortion are ongoing. Many medical anthropologists study the ways in which access to reproductive technologies is affected by cultural values. Laury Oaks (2003) has investigated the way in which activists on both sides of the abortion debate attempt to culturally define the idea of “risk” as it relates to women’s health. She notes that in the 1990s anti-abortion activists in the United States circulated misleading medical material suggesting that abortion increases rates of breast cancer. Although this claim was medically false, it was persuasive to many people and contributed to doubts about whether abortion posed a health risk to women, a concern that strengthened efforts to limit access to the procedure.59
Other forms of reproductive technology have emerged from the desire to increase fertility. The world of “assisted reproduction,” which includes technologies such as in vitro fertilization and surrogate pregnancy, has been the subject of many anthropological investigations. Marcia Inhorn, a medical anthropologist, has written several books about the growing popularity of in vitro fertilization in the Middle East. Her book, The New Arab Man (2012), explores the way in which infertility disrupts traditional notions of Arab masculinity that are based on fatherhood and she explores the ways that couples navigate conflicting cultural messages about the importance of parenthood and religious disapproval of assisted fertility.60