Closing the Gap. Anthropology – essential bridge between Health Plans and Reality

The “Closing the Gap” policy is an Australian Government policy aimed at reducing the health and social welfare indicators discrepencies between the Australian indigenous population and the rest of the Australian population. 

Many such policies are cooked up by individuals and groups that are very far away from the people whom they they intend to help.  Not matter how well intentioned these policies and plans may be, they often fail miserably in achieving what they were intended to do, perhaps because the policy maker fail to sit down and talk and listen to the people.

Recently, Prof. Jim Yong-kim, a medical graduate with a background in Medical Anthropology was appointed the head of The World Bank.  Not having an economic or financial background his appointment not surprisingly raised a few eyebrows and no doubt shook the status quo somewhat.  Here is an article from the Jarkata Post about the Prof. Jim Yong-Kim.  Interestingly Prof. Jim Yong-Kim was President Obama’s candidate for the post.  Obama’s mother, was an anthropologist engaged with issues related to development in Indonesia.

Anthropology: Essential element for successful development

C W Watson, Bandung | Sat, 05/26/2012 11:28 AM
When Prof. Jim Yong-kim was recently appointed head of the World Bank, several eyebrows were raised: Why was this man, Obama’s candidate for the job, chosen? He had no qualifications in economics or finance. His PhD is in social anthropology and he is a medical doctor.

How could he possibly be qualified for the job? One answer that was quickly forthcoming from Gillian Tett, a managing editor of the Financial Times, was that Kim “has tried to blend the seemingly opposed worlds of science and social science. His development work, for example, examined tuberculosis and Aids, both through the prism of germs and biology, but also the cultural and economic interactions of the poor. This type of research is called medical anthropology.” (Tett, FT 31 March p. 6)

The point that she — and US President Barack Obama — are making is that however much money is poured into development and however sophisticated your mathematical models are, unless that development is grounded in a real understanding of the circumstances of the everyday lives of the poor then development policy will have very little chance of success. To devise appropriate policies with a chance of success before you commence you must know a lot about “the cultural and economic interactions of the poor”.

It seem an obvious point, yet it has too often been ignored in the Indonesian context as Dr. Daoed Joesoef, a former Indonesian education and culture minister, has been repeating in several caustic opinion pieces in Kompas recently.

Policymakers, business consultants, and, dare I say it, academic institutions in Indonesia and world-wide are obsessed by the need for quantification, and believe with the passion of religious fanatics that statistics and graphs, surveys and questionnaires, in short what they call hard science, can solve every problem. And when the evidence shows them that they are wrong, they refuse to acknowledge it.

Countless development projects in Indonesia and elsewhere have failed because that hard statistical approach of economic modeling was flawed and inappropriate. In Indonesia the disastrous consequences of this blindness can be seen in the fields of education, health and conservation.

In education I have already demonstrated in these columns the futility for Indonesia of the concept of a world-class university measured in terms of performance indicators which are inappropriate for understanding the country’s higher education needs.

In health matters we have seen many recent attempts to make health treatment free for the poorest, but policymakers who have no experience of the processes through which poor people go when they are ill and seek treatment do not realize that the policies they develop in offices in Jakarta are ineffective.

Furthermore, basic programs such as KB (family planning) are failing because policymakers do not understand that the number of people who take up family-planning methods — the statistic they rely on to measure the success of the KB program — is not an indication that family planning is being practiced.

It was an awareness of this discrepancy between the apparent soundness of health policies on paper and their failure in the field, because people for whom they were intended did not want to take up the new initiatives, which Kim noted, and this observation turned him into medical anthropologist.

He wanted to know why people did not take up certain treatments: What were the cultural and economic constraints that inhibited them. The same point is made by Professor Sir Leszek Borysiewicz, the vice-chancellor of Cambridge University, who is a consultant surgeon in cervical cancer. In a talk last year he said “successful take-up depends on a program whose acceptability to patients must be informed by rigorous social science research that complements and completes the medical science” (Daily Telegraph, Oct. 20, 2011).

Again, he is hammering home the point that you need to find out how people live before you carry out a policy, and implicit in what he is saying is that surveys and questionnaires will not give you the answer: informed ethnographic observation of an anthropological kind will.

It is in the area of environmental conservation in Indonesia that the failure to make use of an anthropological insight has had perhaps the most disastrous consequences.

Conservation bodies are headed by teams of people with degrees in biology and genetics who are specialists in their field and very good at the job of, for example, monitoring populations of endangered species and their decline over time or mapping the loss of forest habitat.

Their reports contain figures, charts, and statistics and they use these very well to show that environmental damage is taking place and species are being lost as a result of human activity.

On paper the results look impressive, but go into the field and you will see that most conservation projects described in the reports in are failures which the statistics have disguised. The reason for the failure is that the hard scientists fail to see that that collection of data is only a very small corner of the picture.

We have known for some time that environmental degradation and ecological damage are taking place; what we need to do is to devise policies to prevent, or at least mitigate, the human activity that is leading to the loss. And here the hard science conservationist are at a loss.

They simply do not understand that the surveys they administer, using the usual Likert scale, the results of which tell them, for example, that 90 percent of the local population approve of environmental education, is meaningless.

What they need to do is understand in depth how local people interact with and think about their environment, and for this there is no substitute for the hard anthropological graft of talking and listening to people and observing on a daily basis what they do.

It is this belated recognition that has led at last to the publication of an excellent manual — to which I must confess to being a contributor — entitled Conducting Research in Conservation. A Social Science Perspective (Newing 2011).

The book or at least the approach that it advocates should be mandatory for everyone working in the field of conservation, since it sets out why an anthropological approach is so essential if conservation management is to succeed and gives practical instruction about how to go about conducting the appropriate research.

The presence of good anthropologists in teams planning and implementing development is not a guarantee of success but it makes the chance of it far more likely.

The writer is professor at School of Business and Management, Bandung Institute of Technology (ITB), and emeritus professor at School of Anthropology and Conservation, University of Kent, UK.

About Dr. Poyap J Rooney

Dr. Rooney is a medical doctor who has gained both his undergraduate medical degree and more recently his post graduate masters degree in clinical biochemistry at the University of Papua New Guinea.
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One Response to Closing the Gap. Anthropology – essential bridge between Health Plans and Reality

  1. Pingback: Kukipi Health Centre Refurbishment – PART 1 | Papua New Guinea – Health

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