Clinically applied anthropology is broadly the application of medical anthropology to clinical issues in health, mental health and social services. While still important, applied medical anthropologists do not necessarily need to work alongside clinicians to improve patient care and create safe communities. The application of our work can be found in such areas as genetic testing, informed consent, quality of care, and immigrant/refugee healthcare, with the goal of promoting holistic models of health and local voices.
Several months ago I took a position at Children’s Medical Center, Dallas as a research scientist in the Injury Prevention Department. Children’s is the seventh largest pediatric hospital in the nation and a Level 1 Trauma Center. My multidisciplinary team focuses on injury prevention because injuries are the leading cause of death and disability in children and adolescents. Each year, more children die as a result of injuries than from all other causes of death combined. Despite being an important issue, trauma and injury lags far behind other health priorities in research and funding, making it the most under-recognized public health problem facing us today.
Emerging medical disciplines, such as trauma and injury prevention, are ripe for the incorporation of anthropology. The notion that injuries are not “accidents”—events that happen at random—and instead are patterned, predictable and hence preventable, highlights the value of targeted research and community intervention. Clinically applied anthropology is ideally suited to studying this topic because the relationships between injury, behavior, and prevention are complex. There is a significant inequality of burden as research shows that people with lower income and education levels, ethnic minority individuals, and youth bear the brunt of traumatic injury. Repeatedly, and across the mechanisms of injury (eg, drowning, car crashes), ethnic minority children are injured at much higher rates than Caucasian children.
Many current theoretical models in medicine are unable to address these disparities. Anthropology acknowledges that injuries occur not only because of a lack of education about safety measures, but because larger issues are at work. By applying the concept of holism for example, prevention is successful when it addresses the micro-level of strengthening parent and child knowledge and increases parents’ confidence in the adoption of preventive measures to create a safe environment. Prevention is also successful when the macro-level of economic barriers is addressed. Providing free safety devices like car seats, as well as designing safer products at the legislative level can help overcome such barriers. Just as injuries represent a complex blend of factors, patients and families interface with a vast array of medical specialties, providers, and organizational systems that make up comprehensive trauma care treatment. Programs that consider trauma and injury prevention from multiple angles, such as an approach that seeks to strengthen individuals, strengthen communities, and improve access to services, coupled with broad economic and policy change are needed.
A relatively new field like trauma and injury prevention also benefits from anthropology’s methodological rigor. Most studies rely on retrospective data from hospital or national databases to quantify the frequency and outcome of injuries; prospective studies on the topic are largely quantitative, using survey data to understand and explain how and why children become injured. While these approaches are appropriate to answer certain kinds of questions, they may not be the most productive to explain why this public health crisis continues to exist and what we can do to stop it. My team’s ultimate goal is the creation of a “best practices” methodological toolkit for injury prevention research.
It is appealing for an applied anthropologist to work on a collaborative, multidisciplinary team that embraces a blend of theoretical and methodological models. Our projects follow an iterative process of research, education, advocacy, and evaluation so that all of our interventions stem from rich, local data. The benefits to the communities to whom we are accountable, namely children and families, are clear. It is equally exciting to have the opportunity to share and translate the tenets of anthropology into a successful injury prevention approach: using holistic, multidisciplinary, and culturally relevant research methodology to produce robust educational programs and policy.
Marisa K Abbe is a research scientist at Children’s Medical Center, Dallas and the Graduate Programs Coordinator for the University of North Texas Department of Anthropology.
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