Cultural epidemiology: An introduction and overview

Although the value of interdisciplinary collaboration between epidemiology and anthropology is both widely acknowledged and hotly contested, effective international health policy and multicultural health programmes require it. The EMIC framework for cultural studies of illness was developed in response to such needs, and a cultural epidemiology emerged from that framework as an interdisciplinary field of research on locally valid representations of illness and their distributions in cultural context. These representations are specified by variables, descriptions, and narrative accounts of illness experience, its meaning, and associated illness behaviour. Specialized interactive qualitative and quantitative research methods provide a descriptive account, facilitate comparisons, and clarify the cultural basis of risk, course, and outcomes of practical significance for clinical practice and public health. This paper discusses the theoretical underpinnings of cultural epidemiology and an operational formulation for examining patterns of distress, perceived causes, and help-seeking. Five additional papers in this special issue of Anthropology and Medicine indicate how the EMIC has been used and has engendered an ethnographically grounded cultural epidemiology. Although this overview and these papers are concerned exclusively with mental health, a complementary stream of active research on leprosy, tuberculosis, epilepsy, and other tropical infectious, neurological, and medical disorders is ongoing. Next steps for cultural epidemiology in mental health research are discussed, including (1) further clinic-based studies of psychiatric disorders, (2) studies of deliberate self-harm in clinic and community settings, (3) complementary cultural components of psychiatric epidemiological surveys, (4) baseline assessments to guide community programmes, and (5) contributions to intervention studies.