are mediated by multiple interacting causes that require anthropological inquiry and policy intervention.
The burden of chronic diseases – heart disease, cancer, stroke, diabetes, asthma – continue to be distributed unevenly across minority groups. Yet statistics also disclose impressive variations. In the United States, for example, there is the so-called Latino Epidemiological Paradox: Latinos, who generally experience a low socio-economic status, nonetheless, have health outcomes that are either equal or better than non-Hispanic whites. African Americans, by comparison, experience significantly higher rates of infant mortality, death, diabetes, HIV/AIDS, heart attacks, strokes, and homicides. Differences in levels of institutionalized racism, dietary patterns, and the influence of the Spanish language as a protective cultural barrier have been pointed to as possible explanations for this paradox. Notably, health indices of Latino immigrants worsen from generation to generation in the United States, owing perhaps to a loss of balanced diet or tobacco or substance abuse as well as limited accessibility of health care services (Hernandez and Charney 1998).
The latest cluster of disorders to receive attention in the health transition is the rising rates of substance abuse, violence, psychological trauma, depression, suicide, and related mental health problems (Desjarlais et al. 1995). This group of health problems has increased to epidemic proportions both in developed and developing societies. Anthropological studies indicate that these problems often cluster together in settings of deep poverty, and societal breakdown. They are compounded by the fact that services tend to be limited, and health care financing and resources are inadequate. Many psychiatric hospitals in China, Russia, and Latin America continue to rely on a model of care involving prolonged stays in locked wards with anti-psychotic medication and physical treatment (Phillips 1998). Anthropological interventions have gone beyond explication of the ‘soft’ variables underpinning mental health problems, and focus on the ways social, economic, and political contexts shape the formation, distribution, and manifestation of disorders. Thus in the anthropological perspective, health problems and social problems are inseparable; health policies and social policies are viewed as necessary complements in defining criteria and techniques of successful rehabilitation.
2. Local variations in illness and health
In response to emerging sets of health issues, anthropologists have identified the need for cross-cultural studies of health, healing, and patterns of morbidity in local contexts. One thread linking these studies is the importance of understanding patterns of everyday life experience, local knowledge, and social networks that influence personal agency and access to health care, as well as modes of transmission of diseases. From this perspective, health is seen as not simply originating in individuals themselves or deriving strictly from social