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Janes, Craig
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 Professor
of Anthropology, Health, and Behavioral Sciences
Colorado University, Denver
Globalization, Medical Pluralism and Community Health:
The Case of Post-Transition Mongolia
United States
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Craig Janes (USA) is Professor and former Chair
of the Department of Anthropology at the University of Colorado-Denver
and Associate Professor of Family Medicine at the University
of Colorado Health Sciences Center, also in Denver. He is
a core faculty member in the interdisciplinary Health and
Behavioral Sciences doctoral program, a program he initiated
in 1994, and which he directed from its inception until
1997. At present, Dr. Janes is a visiting scholar at the
University of California-Berkeley School of Public Health,
Prevention Research Center, where he is completing advanced
training in GIS applications to public health.
Dr. Janes received his Ph.D. in Medical Anthropology from
the University of California Berkeley/San Francisco in1984,
and has a broad background in applied medical anthropology
and epidemiology. His present research interests include
international public health, maternal and child health,
social epidemiology, and the political economy of global
health reform. He has applied these interests in Mongolia,
Taiwan, the Tibet Autonomous Region, China, Samoa, and the
United States
Dr. Janes has served on the Executive Board of the Society
for Medical Anthropology from 1997-1999. From 1997-1998,
he was a Fulbright scholar in Taiwan, where he taught international
health and social science applications in public health
in the Graduate School of Public Health, National Taiwan
University.
Professor Janes has published 18 journal articles, authored
one book, edited another, and written five book chapters.
He has received several grants in support of this research
from the National Institutes of Health, the National Science
Foundation, National Oceanic and Atmospheric Administration
and the Environmental Protection Agency.
Selected Publications:
· Janes, Craig R. (2001) Tibetan medicine at the
Crossroads: Radical Modernity and the Social Organization
of Traditional Medicine in the Tibet Autonomous Region,
China. In Samuel, Geoffrey and Linda Connor, eds., Healing
Power and Modernity in Asian Societies. Bergen and Garvey.
· Janes, Craig R. (1999) The Health Transition and
the Crisis of Traditional Medicine: The Case of Tibet. Social
Science and Medicine 48: 1803-1820.
· Janes, Craig R. (1999) Imagined Lives, Suffering
and the Work of Culture: The Embodied Discourses of Conflict
in Modern Tibet. Medical Anthropology Quarterly 13:
391-412.
· Janes, Craig R. (1995) The Transformations of Tibetan
Medicine. Medical Anthropology Quarterly, 9: 6-39
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Globalization, Medical Pluralism and Community Health:
The Case of Post-Transition Mongolia
The goal of this research project is to examine carefully
changes to the Mongolian health care sector occurring since
transition to a market economy in the early 1990s, looking
in particular at the rapid development of plural healing
traditions and funding mechanisms, and the consequences
of this new pluralism for public health. One consequence
of rapid globalization has been the radical reform of health
care systems in formally socialist (e.g., former Soviet
republics), or socialist-governed market economies (e.g.,
China). In these locales (and in most others), health care
has been transformed from an essential social service of
government to a commodity. The resulting reorganization
of health care, experimental insurance schemes, managed
care, and private sector development has had several important,
yet poorly studied, consequences for public health.
Previous research by the author in Southwestern China and
Mongolia has shown the most important consequences to be:
1) a pluralization of the health sector with the development
of multiple modes of healing ("traditional" medicines
and other heterodox systems) in the context of a collapsing
public sector and rapid growth of an ineffectively regulated
private market; 2) as a consequence of the emergence of
this "new pluralism", a decline in health care
access and quality, particularly in rural areas and among
the urban poor, perpetuating, if not accentuating, health
inequalities; and 3) potential impacts on those health outcomes
most sensitive to health care access and quality: maternal
and child health, reproductive health, and palliative care
for the chronically-ill.
A thorough evaluation of these changes is critical to the
design and implementation of appropriate community health
programs, particularly among rural and urban poor populations.
Mongolia, given the recency of its transition to a free-market
system, its previously well-developed medical system, and
the existence of multiple modes of healing, offers an ideal
setting for the investigation of the relationship between
health reform, the rise of pluralism in the context of private
markets, and public health.
The proposed study focuses on the development and consequences
of medical pluralism in two communities: 1) a peri-urban
neighborhood of Ulaanbaatar, Mongolia; and 2) a county in
a rural province (Arhangai) of western Mongolia. Specific
research questions can be summarized as follows: What are
the patterns of recent change in, and nature and geographic
distribution of, the dominant modes of healing in post-transition
Mongolia? What roles - politically, economically, culturally
and epidemiologically - are played by the different healing
institutions in the study communities? What are the decision
"rules," barriers, constraints, and facilitators
that determine community members' choice health care resources
in different illness situations?
What are the potential consequences to public health of
the new medical pluralism in post-transition Mongolia?
The proposed research addresses the social and economic
contexts of global health system reform and is intended
to assess the public health implications of that reform,
particularly for the poor. The main focus of the research
is on the interaction of the sociocultural, economic, and
policy dimensions of globalization and how each affect in
local contexts the development of a new, market-based medical
pluralism. Of particular concern is the degree to which
this new pluralism affects access to essential health care
and drugs.
The research focuses on the a particular local setting
- post-transition Mongolia - that is argued to be, because
of history and recency of economic transition, an ideal
setting for answering the research objectives described
above. The phenomena under consideration are of broader
significance to a number of societies in the developing
world. The transformations in medical pluralism are, in
fact, a product of global economic change, and are therefore
of comparative importance internationally. Many of the conversations
among the participants in the NCS program will likely revolve
around these critical topics. I hope to be able to contribute
substantially to these discussions given my ongoing research.
Most importantly, however, I anticipate learning a great
deal from my NCS colleagues who come from countries who
are now facing difficult decisions with regard to providing
access to health care through a combination of biomedical
and "traditional" or "indigenous" medical
systems. Not only do I believe we will learn much from each
other, I certainly hope that we will, in our own ways, seek
to affect global health policy by insuring that emerging
pluralisms redress, rather than accentuate, health inequalities.
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| NCS Scholars, Midterm Meeting, Mexico. |
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NCS Scholars Lori Leonard and Seggane Musisi during first Global Health Summer Course Meeting.
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| Conferences & Workshops Calendar |
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