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In this study we examine the relationship between education, racial discrimination and health among white (n = 227), African Caribbean (n = 213) and Indian and Pakistani (n = 233) adults aged between 18 and 59 years living in Leeds, England, as measured in a stratified population survey. Measures of discrimination included any physical attack, verbal abuse and a combined variable, any discrimination due to race, colour, ethnicity or sex. Analyses were conducted examining the relationship between education and discrimination, discrimination and health, and discrimination and health controlling for education. People educated above secondary level were more likely than people educated to secondary level or below to report being physically attacked, verbally abused and exposed to discrimination. People from minority ethnic groups (African Caribbean and Indian Pakistani) were more likely to be verbally abused and exposed to discrimination than the white group. Ethnicity and education interacted for African Caribbeans, such that respondents with post-school qualifications were more likely to report verbal abuse or any discrimination. There was no association between having been exposed to any kind of discrimination and having fair or poor health. Physical attack and any discrimination were associated with anxiety, worry and depression. The results remained unchanged when ethnicity and education were included in the models. Education and ethnicity were associated with differences in exposure to discrimination. In turn, exposure to discrimination was associated with higher levels of anxiety, worry or depression although there was no association between discrimination and health. The results support the contention that racial discrimination may play an important role in modifying the relationship between ethnicity, socioeconomic position and health. The counter-intuitive relationship between education and levels of reported discrimination in non-minority ethnic groups highlights the value of explicitly modeling discrimination to gain a better understanding of the social determinants of health. Keywords: UK; Ethnicity; Socioeconomic status (SES), Health; Discrimination; Racism; Education

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1467-9566.2007.01034.x Byline: Christabel Owens (1), Helen Lambert (2), Keith Lloyd (3), Jenny Donovan (2) Keywords: narrative reconstruction; suicide; lay explanations; moral tales; parental bereavement Abstract: Abstract Suicide research relies heavily on accounts provided by bereaved relatives, using a method known as the psychological autopsy. Psychological autopsy studies are invariably quantitative in design and their findings reinforce the medical model of suicide, emphasising the role of mental illness. They largely ignore the meanings that narrators attach to events, the nature of the sense-making task and the influences bearing upon it. This study drew on psychological autopsy data but used qualitative analytic methods. Fourteen semi-structured interviews with the parents of young men aged 18-30 who had taken their own lives form the basis for this paper. Some parents represent their sons as victims who were cruelly destroyed by external forces, while others portray them as agents of their own destruction. Either way, their narratives are dominated by moral rather than medical categories and by questions of personal accountability. We show how the parents use the interview to perform a complex reconstructive task, striving to piece together both their son's and their own shattered biographies and repair damage to their moral identities. We argue that their stories represent survival tools, enabling them not only to make sense of the past but also to face their own future. Author Affiliation: (1)Peninsula Medical School, Universities of Exeter and Plymouth (2)Department of Social Medicine, University of Bristol (3)School of Medicine, University of Wales Swansea Article note: Address for correspondence: Christabel Owens, Mental Health Research Group, Peninsula Medical School, Wonford House, Dryden Road, Exeter EX2 5AF, e-mail: christabel.owens@pms.ac.uk

Global policy on HIV prevention among marginalised populations recommends a community-based approach with participation and mobilisation as central features. The overall aim is to empower individuals and groups to reduce their vulnerability to HIV. Community empowerment initiatives have had mixed results, however, in spite of utilising very similar peer-education based intervention strategies. This is particularly true of community-based interventions in sex work settings. Drawing upon an ethnographic study conducted in the early years of a well-known sex worker initiative--the Sonagachi STD/HIV Intervention Project (SHIP) in Kolkata, India--this paper argues that ethnographic research can illuminate the complex and inter-dependent dynamics of context, practice, agency and power that are specific to a project and shape the course of intervention implementation in ways that may be 'hidden' in conventional techniques of project reporting. Two detailed excerpts of what we refer to as 'private contexts of practice' are presented--focusing upon the complex processes underlying community mobilisation and peer education. We show that the gathering of ethnographic forms of evidence in conjunction with more conventional evaluation measures has two distinct benefits. First, an ethnographic approach is able to capture the play of power through observation of real-time events that involve multiple actors with widely different perspectives, as compared with retrospective accounts from carefully selected project representatives (the usual practice in project evaluations). Second, observation of actual intervention practices can reveal insights that may be hard for project staff to articulate or difficult to pinpoint, and can highlight important points of divergence and convergence from intervention theory or planning documents. Keywords: HIV: Sex work: Community interventions; Ethnography; Implementation research; India

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2005.11.023 Byline: Helen Lambert Keywords: Evidence; Evidence-based medicine; Anthropology; Narrative-based medicine; Methodology; Qualitative research Abstract: This paper takes as a focus of anthropological enquiry the set of techniques and practices for the appraisal and clinical application of research evidence that has become known as evidence-based medicine (EBM) (or, more recently, evidence-based health care). It first delineates and classifies the criticisms of EBM emerging from within the health professions. It then charts the evolution of EBM in responding to these criticisms and uncovers its character as a pedagogical innovation aimed at transforming clinical practice. It identifies EBM as an indeterminate and malleable range of techniques and practices characterised not by particular kinds of methodological rigour, but by the pursuit of a new approach to medical knowledge and authority. It situates this characterisation within a contemporaneous political and economic climate of declining trust and growing accountability. This analysis provides a basis from which to consider the notions of evidence implicit in EBM itself and also in the qualitative social sciences, including anthropology, which not only critique but also contribute to these notions themselves. Finally, the paper considers possible future trajectories for EBM with regard to the incorporation of cultural and structural dimensions of health and the inclusion of qualitative material in the evidence base. Author Affiliation: Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PY, UK

This paper takes as a focus of anthropological enquiry the set of techniques and practices for the appraisal and clinical application of research evidence that has become known as evidence-based medicine (EBM) (or, more recently, evidence-based health care). It first delineates and classifies the criticisms of EBM emerging from within the health professions. It then charts the evolution of EBM in responding to these criticisms and uncovers its character as a pedagogical innovation aimed at transforming clinical practice. It identifies EBM as an indeterminate and malleable range of techniques and practices characterised not by particular kinds of methodological rigour, but by the pursuit of a new approach to medical knowledge and authority. It situates this characterisation within a contemporaneous political and economic climate of declining trust and growing accountability. This analysis provides a basis from which to consider the notions of evidence implicit in EBM itself and also in the qualitative social sciences, including anthropology, which not only critique but also contribute to these notions themselves. Finally, the paper considers possible future trajectories for EBM with regard to the incorporation of cultural and structural dimensions of health and the inclusion of qualitative material in the evidence base. Keywords: Evidence; Evidence-based medicine; Anthropology; Narrative-based medicine; Methodology; Qualitative research

Objectives. We investigated the contributions of gender, caste, and standard of living to inequalities in mortality across the life course in India. Methods. We conducted a multilevel cross-sectional analysis of individual mortality, using the 1998-1999 Indian National Family Health Survey data for 529321 individuals from 26 states. Results. Substantial mortality differentials were observed between the lowest and highest standard-of-living quintiles across all age groups, ranging from an odds ratio (OR) of 4.61 (95% confidence interval [CI]=2.98, 7.13) in the age group 2 to 5 years to an OR of 1.97 (95% Cl=1.68, 2.32) in the age group 45 to 64 years. Excess mortality for girls was evident only for the age group 2 to 5 years (OR = 1.33, 95% CI=1.13, 1.58). Substantial caste differentials were observed at the beginning and end stages of life. Area variation in mortality is partially a result of the compositional effects of household standard of living and caste. Conclusions. The mortality burden, across the life course in India, falls disproportionately on economically disadvantaged and lower-caste groups. Residual state-level variation in mortality suggests an underlying ecology to the mortality divide in India. (doi:10.2105/AJPH.2004.060103)

This paper considers certain ways of describing and treating sickness in rural Rajasthan, and the representations of sickness and of the body on which they are based. Two indigenous medical or |ethnomedical' perspectives on illness and its treatment emerge from the analysis of ethnographic material collected during field research in northern India. In the first part of the paper various characterizations of South Asian medicine are discussed, and I suggest that Western preconceptions about the nature and purpose of medicine' itself has led one of these perspectives to be highlighted in anthropological considerations at the expense of the other. A further dimension of ethnomedicine emerges through discussions of local therapeutic rituals and discourses about sickness and the body. This consideration of one domain of local therapeutics reveals its underlying cultural logic and highlights ethnomedical formulations that have heretofore been analytically neglected. It does not address the formal or textually based Indian medical traditions to any extent. It is concerned with the cultural construction of sickness and medicine among Hindu lay people and folk healers and employs folkloric material that, though rarely considered in anthropological writings on South Asia, may be a fruitful guide to the meanings which sickness has for those experiencing and treating it.

VAN DER GEEST, SJAAK & RIA REIS (eds). Ethnocentrism: reflections on medical anthropology, vi, 152 pp., bibliogrs. Amsterdam: Aksant, 2002. €13.00 This intriguing little volume was produced by the Medical [...]

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The woman you once knew Her body has changed 273 billion times Since you last touched it. Each change was imperceptible, but absolute. Perhaps you recall the small things: the [...]

This paper presents and discusses selected findings from a study of health-seeking strategies in relation to sexual health among a group of female sex workers in Calcutta. India. Background information on sex work and sexually transmitted disease in Calcutta is followed by the presentation of findings pertaining to women's understandings of (sexual) health, treatment-seeking and service utilisation. In the urban context where health services are readily available, patterns of initial treatment-seeking are shown to be generally (biomedically) appropriate, but subsequent 'non-compliant' therapeutic practices give cause for concern. Conventional approaches to the study of 'health-seeking behaviour' are reviewed in the light of these findings and questions raised about the appropriateness of approaches that focus on initial choice of treatment type and/or assume processes of health-seeking to be determined primarily by cultural 'beliefs' about illness. Inherent biomedical and culturalist biases in the orientation of such research are shown to produce an analytic neglect of the dual influences of material life conditions and people's perceptions of health, rather than illness, upon health-related strategies. Recommendations are made for operational research and policy formulation on the provision of effective sexual health services, and implications are drawn for the scope of interventions and applied research directed at improving sexual health. Key words - health-seeking behaviour, India, HIV, sex work, sexual health, sexually transmitted diseases, compliance