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IN MY OPINION

The end of medical anthropology in Canada?

A manifesto.

By JANICE GRAHAM, NAOMI ADELSON, SYLVIE FORTIN, GILLES BIBEAU, MARGARET LOCK, SANDRA HYDE, MARY ELLEN MACDONALD, IGNACE OLAZABAL, PETER STEPHENSON + JAMES WALDRAM | FEB 07 2011

Social science and humanities health researchers have long considered the Social Sciences and Humanities Research Council their primary funding agency. In 2009, however, a strategic financial review of SSHRC highlighted a perceived overlap in funding from SSHRC and the Canadian Institutes of Health Research. To meet its own budget constraints, SSHRC imposed an absolute reduction in its funding for health-related research, independent of any discussions with CIHR. Social science and humanities health researchers were told that SSHRC would no longer fund their research and “to explore eligibility” with CIHR.

While CIHR has supported some medical anthropology, our researchers have had less success with CIHR for critically engaged, qualitative research, particularly in internation-al settings. CIHR had envisioned “population research” to include the social, cultural and environmental aspects of health and disease as one of the “four pillars” of research (biomedical, clinical, health systems and services, and population research) that it funds. Yet, despite this, CIHR has acknowledged “barriers to Pillar Four researchers fully participating in CIHR research.”

Many anthropologists are concerned. Even though some have had success with CIHR, this has often been accomplished only by downplaying the anthropological aspects of their work. There remain considerable impediments to supporting social sciences and humanities health research at CIHR. We note, in particular, fundamental epistemological and practical challenges with CIHR’s targeted funding priorities favouring commercial research with industry partnerships and research that addresses the needs of decision makers. Despite talk of a global health initiative, CIHR acknowledges that opportunities for the types of international research in local communities commonly conducted by anthropologists remain largely beyond CIHR’s priorities.

We are deeply concerned that what is currently understood as “qualitative health research” at CIHR does not include the critical social sciences; rather, it is evaluative and positivist in orientation. It does not derive from ethnographically based, theoretically engaged empirical studies conducted by anthropologists trained to work intensively to elicit and contextualize values and perceived health care needs at the local level. Even as CIHR is mandated to fund social sciences health research, we face a decade-long history of inattention by CIHR to the fundamental epistemological research modalities, objectives and outcomes common in the social sciences. To date, no CIHR peer-review committee is composed substantially of social scientists.

It is still unclear whether anthropological research designed to be carried out by single investigators in international settings is eligible for CIHR funding. Researchers must second-guess whether they’re expected to design their research as short-term, hypothesis-driven evaluative studies, eligible for funding only if relevant to policymakers and, ultimately, to the health of Canadians, as the CIHR mandate suggests. Also unclear is whether research designed to analyze historical, social, cultural and political dimensions of the production of biomedical knowledge and related technologies and practices is acceptable. Importantly, can medical anthropology research survive in Canada if graduate students in these fields cannot get funding?

Here are a few examples of the kinds of research done by medical anthro-pologists that likely won’t be funded by SSHRC or CIHR: health impacts of Canadian aid funding to Haiti; the role of indigenous healers in primary healthcare around the world; impacts of medical tourism on Cuba; international trade in body organs. Medical an–thro-pologists and some medical sociologists are falling through the cracks in this new funding arrangement.

Health is inherently social and cultural. SSHRC has always understood this; CIHR, we fear, does not. We face the possible extermination of one of the most vibrant, high-demand and policy-relevant health disciplines, the only scholarly field that places culture at the centre of the analysis of health and that characteristically does so in both national and international contexts. In a multicultural, settler society with a substantial aboriginal population, and in a world where health is at the core of developmental, political and social issues in so many countries, where Canada otherwise wishes to have an impact, does this make any sense?

We call for a constructive consultation process with SSHRC and CIHR and invite all social science and humanities health researchers to engage in these critical discussions.

Janice Graham, who holds the Canada Research Chair in Bioethics at Dalhousie University, is president of the Canadian Anthropology Society. The nine other authors are internationally recognized scholars from universities across Canada. Their full report appears at www.cas-sca.ca.

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  1. Morgan Holmes / February 15, 2011 at 18:38

    We owe a great debt to Janice Graham, Naomi Adelson, Sylvie Fortin, Gilles Bibeau, Margaret Lock, Sandra Hyde, Mary Ellen Macdonald, Ignace Olazabal, Peter Stephenson, and James Waldram for this ‘state of affairs’ assessment.

    Writing as one whose work straddles medical anthropology and sociology of the sort that is grounded in queer, feminist and post-structuralist analyses the social, cultural and political imbrications of biomedical knowledge and clinical practice, I know all to well that CIHR funding is out of the question for my research projects, and that it is also out of the question for the post-doc candidate who had hoped to work under my supervision.

    We need funding bodies that will appreciate that the goal of social science and humanities based research on ‘health’ is not to deliver new profits in the form of patentable goods, but to ameliorate the socio-cultural aspects of ‘health’ (as a social good, political obstacle, exploited resource for political opportunists, and manifestation of socio-cultural stratification).

  2. Geneviève Rail / February 15, 2011 at 13:52

    Congratulations to Janice Graham and her colleagues for that “manifesto”!

    I and so many more colleagues across Canada also have profound concerns about the SSHRC “overhaul” and the dwindling support “critical” health researchers now receive from CIHR. CIHR is bound to find our research eccentric, depressing or unacceptable. With projects like ours (dealing with discursive constructions of health, focusing on health and poststructuralist subjectivity, providing a critique of evidence-based medicine or of biomedicalization), we have very little confidence that CIHR review committees (perhaps with the exception of HLE) have the necessary expertise or interest to fairly assess the breadth of our critical proposals. We fear that until CIHR is equipped to deal with feminist, poststructuralist, anti-colonialist, and/or queer research or any research informed by anything other than a mainstream positivist perspective, traditional SSHRC-funded health researchers will hesitate to send their proposals to CIHR.

    It is also worth remarking that CIHR’s budget has not been increased enough to accommodate the wide range of humanities and social science projects that deal with health. So one can assume a two-tier system that will prioritize empirical and quantitative research. In his letter of October 2009, Pierre Chartrand stated that CIHR welcomes humanities and social science research that “includes research on social determinants of health.” This means not much else than opening the door to researchers doing epidemiological research or researchers doing a Canadian brand of “Population Health” research. Surely these are not additions that change anything to the current distribution of research funds. The statement also indicates that many at CIHR do not understand the nature of much (traditionally SSHRC-funded) research in the domain of health or that such research is intended to be disqualified, buried in silence. A significant amount of health research in the social sciences and humanities does not deal with “social determinants of health”: on the contrary, it looks at the social, cultural, political, and rhetorical EFFECTS of burgeoning medical technologies, healthcare management and delivery. Many are theoretically informed projects that are critical of Canada’s medical cultures and at times critical of the way that traditional CIHR-funded researchers inform health care, from patient subjectivity to policy.

    While CIHR has written to welcome previously SSHRC-funded health scholars, it has not changed its mandate, which is: “To excel, according to internationally accepted standards of scientific excellence, in the creation of new knowledge and its translation into improved health for Canadians, more effective health services and products and a strengthened Canadian health care system.” But the onus rests on the applicant to clearly state the link between the application and CIHR’s mandate. Such mandate may seem wonderful to traditional CIHR researchers but to so many social sciences of health researchers, it is problematic on many grounds. To name just two, we believe that: (a) given the methodological fundamentalism that seems to pervade the health and medical field, many of our methodological and theoretical approaches will be either immediately disqualified or ultimately found not to reach the “internationally accepted standards of scientific excellence” that we so like to critique; and (b) so many social science and humanities health research projects are NOT designed to be readily “translated” – CIHR’s standards of practicality and “deliverability” have the potential to eliminate many health scholars seeking research funding.

    Canadians continue to pay dearly for “health” that will less and less be the object of reflective studies and external critique. Willingly or unwillingly, research councils have participated in a political decision that has deeply anti-intellectual and anti-demo

  3. Geneviève Rail / February 15, 2011 at 17:00

    PREVIOUS COMMENT HAS BEEN CUT. PLEASE READ BELOW FOR THE LAST PARAGRAPH OF GENEVIEVE RAIL’S ABOVE COMMENT

    Canadians continue to pay dearly for “health” that will less and less be the object of reflective studies and external critique. Willingly or unwillingly, research councils have participated in a political decision that has deeply anti-intellectual and anti-democratic effects in terms of policing the production of knowledge, further marginalizing certain health research communities, and effectively silencing the voice of critique in the field of health. I join Janice Graham in asking that CIHR and SSHRC start a consultation and address this issue as soon as possible.

    Geneviève Rail, Ph.D.

    Principal, Simone de Beauvoir Institute

    Concordia University

  4. Joan Eakin / March 1, 2011 at 11:31

    I completely endorse the manifesto put out by the anthropologists, and applaud their initiative. I am a medical sociologist and have been doing qualitative health research since the early 1970’s, all in medical schools. My research has been heavily funded by SSHRC over the years; I have been director of a doctoral program in Social Science and Health at the Universty of Toronto (Public Health)and am currently director of the Centre for Critical Qualitative Health Research at the University of Toronto. I know first hand the signficance of the shift of health research to CIHR. I agree that the era of theoretical informed and directed intepretive social science in the health is very threatened in the current arrangement. It is a big loss for Canadian (and international)health scholarship.

  5. Albert Banerjee / March 1, 2011 at 16:56

    As a sociologist I completely endorse the manifesto and applaud the initiative of anthropologists in raising some serious problems with the transition of health research ‘funding’ from SSHRC to CIHR. This shift is not a satisfactory means of addressing the inadequate funding of SSHRC. Further, as others have noted, it is overly optimistic to assume that CIHR has the capacity to evaluate the diversity of non-mainstream – e.g. feminist, Marxist, post structuralist, queer, postcolonial – perspectives. I am especially troubled by what this will mean for critical social science scholarship, which has played an important role in transforming how Canadians think about and practice health. This move will prove immensely detrimental not only for Canadian researchers but for the health of Canadians. And while I welcome the proposed dialogue between SSHRC and CIHR, I would ask SSHRC to reconsider their decision and opt for other strategies to address inadequate funding.

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