Applied Medical Anthropology UCL Module Overview

Ethnographic design is a qualitative research approach that studies groups, organizations, and communities by immersing researchers in the cultural context to observe, analyze, and interpret participants' behaviors, beliefs, meanings, and practices, thereby revealing the regularities and shared knowledge within social systems and cultural processes.

Ethnographic research follows principles including: availability of informants, understanding cultural knowledge, identifying concepts informants use to classify experiences, and translating informal cultural knowledge into scientific descriptions. Research questions might include why pregnant women prefer traditional birth attendants or how cultural aspects influence healthcare-seeking behaviors. This approach reveals that high rates of herbal medicine use in certain countries are influenced by cultural beliefs. Understanding these cultural contexts helps public health professionals design culturally appropriate interventions that respect local traditions while improving health outcomes.

Qualitative research in public health focuses on understanding meaning and lived experiences through methods like interviews, focus groups, observations, and document analysis, rather than measuring change or examining cause and effect; it captures community experiences, identifies social and cultural health determinants, and informs intervention design, though it requires smaller sample sizes, careful ethical consideration, and researcher reflexivity to ensure rigor.

PUBH 726 covers qualitative research methods for public health practice, which can be applied throughout all phases of the public health practice cycle: assessment, implementation of policies and programs, and evaluation. The course teaches methods including observation (using all senses to understand how people move and operate within spaces), in-depth interviews (learning to ask questions that let people tell their own stories), and community participatory approaches like photovoice and journey mapping. Qualitative methods help practitioners understand lived experiences and inform decision-making in areas such as reproductive rights, food equity, and healthcare access.

Three qualitative research designs capture participant experiences: phenomenological studies gather narratives through interviews and focus groups about individual experiences; case studies follow one or two individuals through time to showcase intervention experiences; ethnographic research examines cultural groups' interpretations. Data collection methods include interviews, case studies, focus groups, artifacts, surveys, logs, and simulation models. Sampling strategies vary by method: random sampling is rarely feasible in qualitative research, so researchers use convenience sampling (accessible participants) or purposeful sampling targeting specific criteria. Snowball sampling uses participant referrals, while theoretical sampling targets individuals meeting specific demographic or experiential criteria.

Teachers working with diverse student populations can employ three complementary approaches: (1) Cultural competency involves learning generalized knowledge about students' countries of origin, such as languages, customs, and social practices; (2) Cultural humility shifts focus to learning directly from students and their families about their specific experiences, placing them as experts rather than relying on generalizations; (3) Structural competency examines how U.S. institutions, agencies, and policies shape refugee and immigrant experiences, such as the 12-month assistance period and integration processes. Each approach has strengths and limitations, and combining them provides a more comprehensive framework for understanding and supporting students from diverse backgrounds.

Cultural humility requires lifelong commitment to self-evaluation, desire to fix power imbalances, and community partnerships for advocacy. Structural competence enables recognition of how social determinants influence clinical presentations. Together, these frameworks require providers to think about both individual factors and structural forces affecting patients. Effective anti-racism work demands creating safe spaces for learning, particularly for non-minoritized individuals who must engage in this work without harming those directly impacted by their learning processes.

Structural competency training follows a systematic four-step approach: First, teach clinicians to analyze patient presentations by examining how neighborhood conditions, institutions, and policies contribute to illness rather than focusing solely on individual risks or cultural factors. Second, help clinicians articulate cases in terms of structural drivers to make these factors visible in clinical documentation and discussions. Third, provide hands-on experience working on structural interventions outside traditional clinical settings, such as community organizing or policy advocacy. Fourth, practice cultural humility, recognizing clinicians lack expertise about structures and must collaborate with community organizers while building trust over time. This approach replaces cultural competency's focus on individual differences with structural analysis.

This video explores the limitations of traditional cultural competency training in healthcare education and introduces structural competency as an alternative framework. It highlights how cultural competency often focuses on individual beliefs and behaviors, potentially overlooking systemic forces that shape health outcomes. The video advocates for structural competency, which directs attention to the social, economic, and political structures—such as racism, poverty, and housing inequality—that produce health disparities. Viewers are guided to recognize how clinical practice can be disconnected from broader social justice issues and are encouraged to integrate awareness of these structures into patient care. The video also emphasizes the importance of identifying and collaborating with community partners and resources to bridge clinical work with advocacy efforts. Narrative humility is presented as a complementary approach, promoting listening, self-reflection, and openness to patients’ stories without assuming expert knowledge. Together, structural competency and narrative humility aim to transform healthcare delivery by addressing root causes of inequity rather than surface-level cultural differences. The content is grounded in the context of a 2016 healthcare summit, indicating its relevance to professional development in clinical and public health settings.

Cultural competency involves developing congruent behaviors, attitudes, and policies to work effectively across cultural differences, while cultural humility requires maintaining an other-oriented stance that acknowledges one's own cultural limitations and actively seeks to understand the cultural identities most important to others; both approaches require recognizing that diversity encompasses multiple intersecting identity factors (race/ethnicity, religion, nationality, disability, class, and socioeconomic status) and that dominant versus subordinate group dynamics significantly impact how individuals experience and navigate service systems.

Global health as currently organized is deeply colonial. Tropical medicine, the precursor to global health, was euphemism for protecting colonizers from the diseases of the tropics. The sanitary conferences of Europe, precursors to WHO, were developed to stem cross-border transmission of diseases to enable global trade. From the outset, global health governance architectures were not designed for particular publics but for specific colonial interests, making them blind to the needs and priorities of other populations. To decolonize global health, we must be prepared to shift the structures of decision-making and power to the periphery where previously colonized people have been ignored or unable to participate in important decisions about health governance.

The development of Western biomedicine during the 19th century was fundamentally intertwined with colonial processes, where medical knowledge and practices were developed and justified through colonial experiences, including the exploitation of enslaved populations for medical experimentation, the creation of scientific racism to legitimize racial hierarchies, and the establishment of healthcare systems that perpetuated colonial power structures; this historical analysis reveals that contemporary healthcare practices continue to carry the legacies of these colonial foundations, necessitating ongoing efforts to decolonize medical education and practice through critical awareness and alternative epistemologies.

This conference, part of the WHO Global Health Histories project, examines how global health perpetuates colonial power structures. Key themes include: (1) Global health is neocolonialist, with mental health workers functioning as new missionaries imposing Western diagnoses; (2) Anthropology itself was a colonial project used to measure and define local subjects for colonial benefit; (3) The task is not complete and can never be complete, but we must embrace it nonetheless; (4) All global health features emanate from and remain enmeshed in historical relationships to colonialism and scientific imperialism; (5) We must recognize and acknowledge these relationships before critically understanding implications for future practices.

Global health systems and practices have deep colonial origins, with early international health organizations developing within colonial contexts and adopting paternalistic attitudes toward colonized populations; this historical legacy continues to influence contemporary global health approaches through top-down decision-making, faith in biotechnological solutions, and limited downward accountability to local communities, necessitating active decolonization efforts in research, education, and practice.

Decolonizing global health requires transforming academic curricula to include decolonization topics across all healthcare disciplines, examining who teaches and frames the curriculum. Colonial systems disrupted family structures through migrant labor, reinforced patriarchal systems limiting women's participation, and disregarded indigenous health traditions. Colonial powers concentrated resources in urban centers, creating persistent rural-urban healthcare divides. True decolonization addresses both historical injustices and contemporary recolonization in academic and healthcare environments, requiring changes in metrics, authorship practices, and funding distribution to ensure equitable access to research and healthcare benefits.