Their recent volume Lazy, Crazy, and Disgusting effectively employs a critical biocultural lens that considers evolutionary, political economic, cognitive, and biological dimensions of stigma as seen in obesity, mental illness, and in a range of public health initiatives. In their carefully balancing the potential health consequences of obesity and the stigma of overweight, Brewis and Wutich (2020) provide an example of the complexities and importance of ethnographically grounded biocultural research.
Embodiment of Race and the Health Consequences Racism It is now widely accepted that race is not in our genes but rather, race becomes biological through discourses and practices. Biocultural anthropologists, such as Michael Blakey (1998) have been at the forefront of questioning the naturalization of the idea of race. A key aspect of this work is a critical evaluation of how race is used in medical practice, specifically a systemic critique of the myth that health differences by race are due to racial differences in genetics (Goodman 2000). Rather, racism is seen as both a powerful psychosocial stress and a structural inequality, and the source for profound racial health disparities. Studies of the biology or embodiment of racism that call on both inequalities and stress as a source of racial health inequalities present another fertile area of research within a critical biocultural approach (Armelagos and Goodman 1998; Blakey 1994, 1998, 2001; Dressler et al. 2005; Goodman 1997; Gravlee 2009; Gravlee et al. 2005; Kuzawa and Sweet 2009).
Medical sociologists and social epidemiologists have led the way in the beginning to understand the magnitude and various manifestations of how racism is a public health issue leading to shorter lives and more illness and disease (e.g., Geronimus 1992; Krieger 2020; Williams and Mohammed 2013). For example, David and Collins (1997) have demonstrated how growing up in a racist society, rather than genetics, is related to low birth weight, and by extension, infant mortality. They show that the birth weights of babies born in African-born women are more like the birth weights of babies born to white women than black women who grew up in the United States.
Social epidemiologists have recently developed a number of interview guides and questionnaires that assess recent acts and perceptions of racism, racial discrimination and harassment, and implicit biases (for an excellent summary of this literature, see Karlsen and Nazoo 2008). In general, epidemiologists attempt to develop methods that are valid across context, in a universal way, but these instruments can miss the important sociocultural context of words, gestures, and actions. As well, most measures of racism focus on interpersonal issues and miss connections to the historic and structural features of the political economy of racism.
Recently, medical anthropologists working with critical biocultural perspectives have begun to address some of the inadequacies in these approaches by exploring how the lived experience of race and racism might lead to health differences. For example, Dressler and Bindon (2000) have linked the realities of being African American in the southern United States to cultural consonance, or the ability of individuals to approximate in their own behavior the shared cultural models of their society. Lack of consonance was associated with elevated blood pressure. In the end, they note that the inability to achieve the perceived goals associated with local cultural models might be anticipated for African Americans in racist societies where frequent unemployment, low wages, poor living conditions are part of the lived experience for many. Gravlee and coworkers (2005) begin with an ethnographic understanding of the meaning of skin color in Puerto Rico and demonstrate how those local meanings mediated experiences of racism and stress in specific local contexts; connecting social categories of race/color with socioeconomic status and blood pressure. These analyses offer a social, cultural, and environmentally based explanation for the racial variation in blood pressure found in much medical and public health research.
More recently, Gravlee and colleagues (2015, Rej et al. 2020) have developed a multiyear study using community-based participatory methods on the experience of discrimination and biological outcomes among African Americans living in Tallahassee, Florida (Gravlee et al. 2015). Their work follows from epidemiological studies on the experience of discrimination, with the addition that they considered both direct and indirect (friends and family network members) experience of bias (Rej et al. 2020). One aspect of this work has focused on how reported experiences of direct and indirect unfair treatment may be associated with telomere lengths (TL). Telomeres are found at the ends of chromosomes, and their shortening is an indicator of cellular health and aging. Prior research shows that TL is a risk factor for earlier onset of disease, and shortening of telomeres is associated with chronic psychosocial stress. Telomere length is but one of many mechanisms of how racism becomes biological, and collectively the known mechanisms and effects are probably just the tip of the iceberg. On a more theoretical and general level, this seems to be related to the weathering hypothesis originally proposed by Geronimus (1992) to explain the way that lifelong exposure to stress leads to low birth weight in African Americans. It may be that a good deal of the many unconscionable health inequalities by race is due to the weathering consequences of lifelong exposures to stress.
As we write, COVID-19 is exposing the depths of racial inequities in health among people of color in the United States. As of June 2020, the Centers for Disease Control and Prevention (CDC) reported that 21.8% of COVID-19 cases in the United States were African Americans and 33.8% were Latinx, despite the fact that these groups comprise only 13% and 18% of the US population, respectively. In a report of hospitalized patients, 33% were African Americans, despite representing only 18% of a catchment area population. The numbers have changed throughout time, but the disproportion has been consistent across the United States (Tai et al. 2020). Unsurprisingly, initially speculations as to race differentials in excess morbidity, hospitalization, and mortality focused on genetics, lifestyle, and preexisting conditions. However, it is now clear that genetics is not an explanation, and if anything, the genetic disadvantage is mostly pointed toward European-derived groups. “Life-style” is a risk but is related to the position of the poor and communities of color within larger political and social systems. They are more likely to be on the front lines, so-called essential workers, providing services during the pandemic and are thereby at increased exposure. Similarly, preexisting conditions such as obesity and heart disease are important risk factors, but these too are the result of racial inequalities in access to health care, nutrition, and also to the prior noted stresses of racism (Graves 2020).
Engaging Ethnographic Methods in Critical Biocultural Health Research
Over the past several decades, one important growing trend in critical biocultural studies of health has been a stronger engagement with ethnographic methods. The degree to which recent biocultural health studies work to integrate ethnography with biological indicators such as blood spots and other biomarkers makes connections between the biological and social worlds ever more legible (Hoke 2020; Sweet et al. 2018; Tallman 2018). A number of sociocultural medical anthropologists have employed the uses of similar biomarkers and situated their work in biocultural frameworks (Jernigan 2018; Mendenhall 2019; Oths 1998; Seligman 2014; Weaver 2018). Among others, Singer et al. (2017), Singer (2020), and Mendenhall (2019) have led the way in developing syndemics as a biosocial concept important to public health and medical sciences as well as medical anthropology.
Some of the more richly ethnographically grounded studies draw heavily on the use of narrative and meaning to breathe life into otherwise disembodied data of lived experience. For example, Lesley Jo Weaver’s Sugar and Tension (2018) is an ethnographic study of women in North India around the stresses of managing diabetes. Along with Emily Mendenhall’s recent book Rethinking Diabetes: Entanglements with Trauma, Poverty and HIV, they provide a road map for richly ethnographic critical biocultural studies. Mendenhall effectively connects the lived experience of structural violence and poverty to the syndemic interactions of diabetes and other health problems (e.g., HIV/AIDS and depression) across a number of global contexts (from Delhi, Nairobi, and Soweto to Chicago); and does so in large part by analytically connecting the hard edges of social worlds to the very personal experience of these worlds.
As well, Kasey Jernigan (2018) has developed an embodied heritage approach in work on obesity with the Choctaw of Oklahoma that brings “meaning making” into a critical biocultural approach. She situates the bodies, biology, social life, and cultural identity of Choctaw today within the historical traumas of the past, ranging from the Trail