ABSTRACT
Critical discussions about medicine and medical practices are cognoscente of the evolution of such practices and the historical and cross-cultural developments of healthcare systems, or arenas. in a seminal text, Charles Leslie outlined some of the key examples in terms of comparative (Asian) healthcare systems. This sets the scene for future generations of researchers to apply a more comparative understanding, not just to Asian medical systems but to any such cross-cultural analysis of medicine and health care. The text also brings into sharp relief the relative merits and potential drawbacks of applying a unified homogenized overarching approach to medical practice. This chapter therefore concerns itself with the idea of healthcare systems rather than any notion of a single universally agreed medical practice and the meaning this has for “modern medicine” in the contemporary world in the (post) industrial West and in the so-called developing societies.
Contemporary currents of Western medical thought and practice illustrate a particular cognitive trajectory and scholars have outlined linkages between medical knowledge and dominant (social) ideas in what have been described as “medical cosmologies.” 20 in this regard, medical endeavor may also be construed as a sociological and anthropological endeavor. 37 224Medical traditions are born in antiquity and are, by definition, ethnocentric. They are defined by the immediate circumstances and surroundings of individuals in context, that is, the socioeconomic, environmental, and cultural circumstances from which they emerge. We may regard these healthcare systems as profoundly personal and tied to such things as cosmological canopy, belief systems and ritual, organized religion, kinship structures, local topography, indigenous ethno pharmacological practices, food, and lifestyle behaviors. The point here is that when we come to look at such practices historically and cross-culturally, we see common themes, such as how individuals, groups, and societies respond to health chances 1 to relieve specific ailments or conditions. This is context based. We see this through, for example, organizational responses to care, within the family; or in the community; or through national, regional healthcare services; or via the use of indigenous pharmacological substances or ritualistic behavior or performance and symbolic meaning (such as prayer, penitence, or sacred offerings).
However, we also see important variations. Different cultures (and healthcare systems) rely on specific knowledge. These are often dependent on local resources and local notions of health beliefs and associated practices. These are derived from, and embedded in, tradition and culture. These beliefs and practices, while they may make sense locally, may not be easily translated to circumstances beyond the immediate environment. The classic anthropological example of this is Evans-Pritchard’s now-famous discussion surrounding the transmission of medical (magical) knowledge among the Azande. 11 , p 186) We also see trends. For example, dominant ideologies and power structures drive and legitimate practice, thereby giving license to practice and define authenticity. Nowhere is this truer than within the rise of “modern medicine,” particularly in the West. This “is embodied in and comes with the day-to-day rational-scientific practices associated with the work of doctors in the hospital or clinic” (Ref. [6], p. xii). Such everyday practices contribute to the (social) construction and reproduction of a particular world view or what some have termed a “biomedical discourse” or “clinical gaze.” 12 in the so-called advanced industrial world of the late 18th and early 19th centuries, health care made a profound move from within the community, to the more alienating hospital-clinic-based medicine that linked the “bench, the bedside, and 225the production plant,” and this came to characterize modern medicine (Ref. [25], p. 118). This development was tied to wider social, historical processes of the period, such as the growth of towns and cities amid rapid capitalist expansion in the West. 20 , 32 in addition, medical knowledge and health practice also progressed rapidly in the wake of various (more notably, colonial) conflicts. The world wars were also significant here. We see, for example, the “accelerated and intensified collaboration between biologists, clinicians and industrialists, a development exemplified by the wartime production of penicillin.... and the rapid growth of the pharmaceutical industry” (Ref. [25], p. 117). World War II, in particular, is seen as a key juncture in terms of the “biomedicalization” process.
