Thinking about an anthropology of health care
Dr Lorelei Jones
12 July 2019
This week Bangor University’s School of Health Sciences is holding its annual International Health Services Research Summer School. Delegates from around the word will be presenting their research, attending a myriad of masterclasses, and there will be a dinner at Teras, in the Main Arts building of the ‘University on the Hill’, for the speakers and delegates to network and discuss the week. The weather at this time of year is glorious. If you step outside you can see down to the water, Anglesey, Puffin Island. This year I will attending as faculty, to talk about an anthropology of healthcare.
It is a very creative time to be at the School of Health Sciences. Ellie Overs, our new artist in residence, is developing her work on visual ethnography, and each new PhD and Professional Doctorate student brings fresh ideas, enthusiasm, and energy to study the entanglements of culture and care. On Friday I will be talking about some of the things I am interested in - culture, power, and change in organisations; professional communities and identity; and new forms of knowledge and what they imply for how we care. But I have also been thinking more generally about the contribution of anthropology to healthcare.
Designers of new technology love anthropologists. It’s what Ellen Pader called the ‘ethnographic sensibility’ - understanding people, why we do the things we do, what we value, our priorities, and the dilemmas we face, what we are trying to accomplish, and the strategies we develop to do this. Anthropologists can show the sense in what might seem, from the outside, irrational or inexplicable behaviour. In healthcare, anthropology can help those involved in developing new interventions by illuminating the everyday practices of those who plan, give and receive care. This understanding can ground the design of interventions, making them more effective, acceptable, and feasible in real-world contexts.
But we do something more important than that. We show that innovation isn’t everything.
Anthropologists also study the more mundane labour of maintenance and repair. The tinkering and bricolage of healthcare staff, patients and carers that accomplishes quality and safety in fragmented and resource-constrained contexts. The work that is invisible, because it is done by women, or those lower down organizational hierarchies. It’s not sexy, but it keeps things going.
'Photograph courtesy of Eleanor Overs'
Making healthcare ‘better’
It is a privilege to teach and supervise doctors, nurses and midwives. The students at the School of Health Sciences all want to make the care they provide to people better, and as they progress in their careers they will be responsible for developing new services, or improving existing ones. I think one of the most important ways that anthropology can contribute to practice is by fostering creativity, by suggesting a different way to understand a problem.
‘Better’ doesn’t just mean more effective, it can mean more ethical, more inclusive, and more participatory. Outcomes are important, but patients also value the relational dimensions of health care, and the everyday experience of being cared for. Patients care about the way that staff communicate and interact with them, their families and carers, and the way staff communicate and interact with each other. Patients care about the care environment, not just because they want to feel comfortable and safe, but because they see the material environment as symbolic of the values, attitudes and behaviour of the organisation. Anthropologists share a commitment to ‘being there’, where the action is, as it happens and can therefore contribute rich insights on the full range of dimensions of healthcare that matter to patients.
Anthropology can also support a more inclusive and participatory mode of healthcare. Anthropological research is orientated to revealing the multiple meanings and perspectives on shared activities and to including the experiences of people who might otherwise be excluded or marginalised in decisions about health services. We ask ‘whose values are in the design of the service?’ ‘Whose ‘version’ of healthcare underlies the way care is provided?’ ‘What other ways are there to understand healthcare?’ We are also interested in finding ways to incorporate into our research an opportunity for patients and staff to ‘speak for themselves’. This isn’t to say we always get it right. Like healthcare staff, we are also concerned with how we can make our practice better.
The more I think about it the more I realise that anthropology and healthcare are, in many ways, similar. Like healthcare, anthropology comes from the heart and the mind. Anthropology is always, at the same time, about doing (fieldwork), thinking (what is going on here?) and writing (‘thick descriptions’ that integrate description with theory). But it always starts from the heart. Like healthcare professionals, we know when something doesn’t feel right, and that’s when we start to ask questions. Anthropology is always felt, as much as it is done, thought, and written.