The USA

Anthropology's contribution in public health is well researched and documented in the USA, as in the few examples discussed below. In Los Angeles, California, an anthropological cultural consensus analysis reported patients’ experiences of and perceptions about Chagas disease. The participatory explanatory models used in the research highlighted the barriers reported by the patients in accessing healthcare within and outside the health system; (Forsyth et al. 2021), thus explaining the reasons for non-access of treatments and recommending strategies to work on the barriers.

Similarly, application of a critical medical anthropology syndemic theory was used to understand factors associated with adult obesity in the Atlanta region among African-American adults. This revealed five characteristics to be directly linked to obesity, namely: age, gender, relationship status, frequency of eating three meals a day and frequency of alcohol consumption. Further, seven underlying measures as a root cause for endogenous alcohol consumption factors were identified, including age, gender, sexual orientation, self-esteem, impulsivity, criminality of friends and violence in the neighbourhood. The complex interactions among the many causes of obesity in this group lend credence to the employment of syndemic theory-based models in future studies. The structural model that emerged from this study reflected a plethora of evidence of synergistic effects among the key variables causing obesity (Elifson et al. 2016).

Continuing, with the significance of the syndemic approach, a review on interdisciplinary research on three pandemics—1918 influenza, 2009 influenza and COVID-19—on persistent racial, ethnic and indigenous disparities in morbidity and mortality, as well as those caused by previous illnesses and disabilities, led to discussions of strategies through which biological anthropologists could contribute to pandemics. The review concluded by stating that when studying pandemics, biological anthropologists can add rich historical and cross-cultural depth, shed light on the biosocial complexity of pandemics using syndemic theory, look into the effects of stress and stigma on society and health, and address significant methodological and ethical issues. Increased participation of biological anthropology in pandemic studies, public health research and policy is essential since COVID-19 is unlikely to be the last major pandemic (Dimka et al. 2022).

This section concludes with an interesting example of researchers drawing on anthropological theory and using a phenomenological approach to study the concept of ‘chosen family’ in the context of health, illness and the mutual provision of care among queer and transgender African-American adults in two states of the USA. The understanding of this population's experiences negotiating the idea of chosen family both inside and outside health care settings improved because of emergent themes of navigating healthcare systems, relying on each other and mutual aid. The implications of the findings could influence health care professionals in engagement of these populations and their support networks (Jackson Levin et al. 2020).

Europe

Europe has progressively adopted interdisciplinary health strategies for the benefit of the population. The COVID-19 pandemic reconfirmed the significance of understanding people's perceptions, social and physical situations and psychology for planning and executing health interventions. Considering the context, WHO's European region in collaboration with the University of Erfut (Germany) developed a tool to capture people's behavioural and cultural insights on COVID-19. The rapid, flexible and cost-effective tool monitored people's knowledge, risk perceptions, misperceptions, stigma, trust in the health authorities and recommendations made by them helped them to take appropriate health actions in response to the pandemic situation. This understanding helped to strategise consistent, competent, fair, objective, empathetic or sincere health measures targeting people's health behaviour in a positive way. So far, 30 countries in the region have used the tool and WHO has provided technical support in data collection, analysis and interpretation and reporting (World Health Organization 2020).

As another example in the context of the COVID-19 pandemic, in Serbia, cultural thought process was studied to understand vaccine refusal. It identified that a few had a negative attitude towards the preventive measures to control the pandemic. Some thought that the illness did not exist, whereas some opposed COVID-19 vaccination only. Some refused vaccination as they fervently adhered to their own principles based on a set of legal, moral or religious norms. Some were holding on to the myth that leading a healthy lifestyle would not expose them to any infections. Some people had reservations about all the information released by the media on thr pandemic. A few didn't have clear reasons for refusal and a few didn't trust the political systems and medical professionals treating the infection. Overall, there was cynicism in social, political and scientific discourses, with more people believing their feelings and convictions than facts. A discrete group created a pseudo theoretical situation which connected pandemic as a global crisis and perceived it to be causal and not relating to the local situations, especially Serbian socio-cultural situations. Such thoughts are examples of social solipsism (Žikić 2022). The population's perceptions could be clarified and barriers to vaccination could be eliminated through efforts to increase awareness.

Apart from the pandemic, in an example of elderly care in Spain, a theoretical approach of anthropology of morality was applied to understand challenges in care regimes based on family. The study drew on fieldwork conducted among working-class women born between 1920 and 1950. It interpreted the assessment of the ideal of family care by conventional women carers. Using a life history approach, participants were able to discuss several elements of their lives, including care, family, employment and the role of the state. The primary aim was to discuss the participants’ perception of their role as carers and their expectations about their own care in the context of a crisis of care provision. The research reflected women's descriptions of caregiving as a sense of moral obligation as well as sacrifice and resignation. However, they also acknowledged and publicly discussed the moral, physical and psychological costs that it frequently entails. A large proportion of older women showed reluctance to replicate this model towards the younger generations. They displayed new expectations, revisiting the scope of family obligation and connecting it to a revived idea of autonomy and independence. The research recommended that the experiences are connected to a growing need for public policies and the welfare state's complete growth in terms of citizenship rights (Bofill-Poch 2018).

India

In comparison to the USA and Europe, in India anthropology is considered to be a young discipline and has developed slowly. The four phases of development chronicled include a formative phase before 19th century marked by studies on tribal life and ethnographic accounts of India's sociocultural situations—most often conducted by anthropologists from outside India. In the constructive phase up to the 1950s, anthropology was introduced in the curriculum of postgraduate studies in Kolkata, followed by the creation of the Anthropological Survey of India. The analytical phase of the 1990s saw detailed contributions by Indian anthropologists in the analytical studies of complex societies and the evolution of context-specific research methods. The evaluation phase, up to the present, has witnessed the origin of different sub-fields, interests in medical anthropology, religion, development and psychological studies (Yamashit et al. 2004). There are not many examples of the use of anthropology in the public health field but a few are given below.

In the state of Uttar Pradesh, a study focused on the impact of accessing medicines through unlicensed village doctors, drug vendors and over-the-counter purchases on the public procurement services and political economies of drugs. It used methods of socio-anthropology of pharmaceuticals to get a clear understanding of the local issues related to access to medicines. Qualitative exploration revealed the present circumstances of public health care systems, functions of the informal sectors and demonstration of patients’ beliefs about access to health is equal to access to medicines (Dahdah et al. 2018).

Cultural ontologies of disease were studied from the perspectives of patients in order to get insight into the cultural nuances of cancer from a medical, historical and religious/spiritual view. Qualitative research sought patients’ understandings of cancer, its ‘origins’, its meanings and subsequent everyday experiences. In-depth interviews with 40 cancer patients in South India revealed some of the affective components of these interpretations of sickness as well as changing individual responsibility and societal moralities concerning cancer (Broom et al. 2018). Another research study conducted in western India utilised cultural epidemiology to gain insights into the stigma surrounding severe mental illness and deliberate self-harm (DSH) incidents. The study also examined the underlying issues that contributed to these DSH events (Weiss and Parker 2020). An exploration was conducted in a rural community in south India to investigate the socio-political and cultural dimensions of diabetes. The objective was to understand the extent of health literacy, explanatory models of diabetes and the effects of the illness on an individual's social and familial responsibilities. Recommendations were made to address systemic inequalities and foster individual empowerment (Little et al. 2016). The final example involves ethnographic research that demonstrated the use of social theory in understanding the multifaceted aspects of the Public Private Partnerships (PPP) model in the control of TB services in India. The essay explains how utilising social theory can help to comprehend the intricate interactions between the public, private and non-profit sectors (Salve et al. 2018).

The examples in India lead to a question. Is the use of anthropology in Indian public health scenario widely recognised, accepted, employed, documented and sufficient to address the public health problems of India?

Anthropology's potential for improving public health issues in India is underutilised and requires reinforcement. India's vast size, religious diversity, socio-cultural complexity, high disease burden and challenges in achieving the Sustainable Development Goals make it an ideal candidate for utilising anthropology in various health facets. Currently, however, there is a lack of evidence regarding the application of anthropology in developing culturally sensitive public health interventions and policies in India.

Public health professionals can leverage anthropology's research tools, such as participant observation and ethnography, to study community engagement, health-seeking behaviours and health communication. This approach allows for a deeper understanding of the community's perspective and facilitates the design of context-specific, accessible and culturally appropriate health programmes. Additionally, exploring the gendered dimensions of health is crucial, as gender roles and power dynamics significantly influence health outcomes in India. Anthropological research can examine the impact of gender on healthcare access utilisation and decision-making leading to the development of gender-sensitive policies and interventions that address disparities in health. Most importantly, studying indigenous populations’ public health issues, it would provide insights into their cultural, social and historical contexts. Understanding their particular health beliefs, habits and difficulties paves the way for the creation of suitable interventions and policies and would aim to enhance health outcomes.

Furthermore, the role of anthropologists in health policy and planning needs recognition. Conducting research on healthcare systems, policy implementation and the impact of health programmes can systematically identify the gaps and challenges in public health service delivery. It can also evaluate the effectiveness of interventions through a cultural lens, informing the development of evidence-based policies. The USA and Europe are more advanced in the use of anthropology in public health due to established academic programmes, robust research funding and infrastructure, effective integration into public health institutions, abundant research publications and resources, and a strong network for collaborations. In contrast, India has fewer dedicated academic programmes, faces challenges in research funding and infrastructures, has limited integration of anthropology into mainstream public health institutions and has comparatively fewer research publications and resources. Lastly, it is observed that Indian public health professionals, particularly medical doctors, often lack inclusivity and fail to effectively incorporate social scientists in addressing public health issues.

India is making progress in creating partnerships, but it may still be developing a strong network of scholars and practitioners in this area. With investments, collaborations and recognising the value of anthropology, India has the potential to expand anthropology's use in public health in the future.