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Global health: Why cultural perceptions, social representations, and biopolitics matter

Mark Nichter has given us a lot to think about in this book. It is a complicated book that captures the essence of anthropology’s contribution to bettering public health while urging us all to become more interdisciplinary in our work. Nichter suggests we return to a systems approach for thinking about and addressing global health issues by incorporating syndemics and ecosocial epidemiological approaches within the context of an in-depth cultural understanding of health beliefs, attitudes and behaviours. In Part I, Popular health culture, Nichter chronicles the contributions of studies on popular heath culture, a term that encompasses ethnophysiology and local medical systems as well as local interpretations of biomedicine and public health interventions. His examples, drawn largely from his own work in South Asia, address child survival and 10 diseases from the WHO’s Tropical Disease Research programme. The rich case studies show how local ethnomedicines extend well beyond the physicality of biomedical disease causation to incorporate other levels of causation (e.g., spiritual, social and environmental) that result in a locally informed hierarchy of risk calculation and local interpretations of biomedicine that can explain why people in local context do not always respond favourably to rational, evidencebased interventions. Nichter highlights the importance of understanding and incorporating local illness categories and the local language of illness and symptomatology for the prevention and treatment of infectious diseases and local (mis)understandings and (mis)applications of health messages about these diseases. He also suggests the need to expand health messaging beyond single diseases that are often interlinked on the ground (e.g., malaria, dengue, malnutrition and diarrhoea) and calls for a popular epidemiology approach that involves local participatory processes that include whole communities. The final chapter in this section addresses the growing importance of pharmaceuticals and outlines an agenda for studying the social lives of medicines and their local meaning, acceptance, and use and misuse as well as the meaning attached to the context of their delivery (e.g., private/public, cost, form, and colour). Part I reflects anthropology’s long-standing and important role in translating, linguistically and conceptually, between ethnoand biomedicines which capitalises on a grounded understanding of local culture, communication and society. In Part II, Rhetoric matters, Nichter turns to the social science of international health and the ways that health problems are framed. He points out that the international health hierarchy (i.e., health and development agencies) has enormous Global Public Health Vol. 6, No. 4, June 2011, 462 464