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Anthropological Perspectives
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Annu. Rev. Anthropol. 2010. 39:149–65
First published online as a Review in Advance on
June 14, 2010
The Annual Review of Anthropology is online at
anthro.annualreviews.org
This article’s doi:
10.1146/annurev.anthro.012809.105101
Copyright ⃝ c 2010 by Annual Reviews.
All rights reserved
0084-6570/10/1021-0149$20.00
on Structural Adjustment
and Public Health
James Pfeiffer1 and Rachel Chapman2
1
Department of Global Health, Department of Health Services, School of Public Health,
University of Washington, Seattle, Washington 98195-7660;
email: jamespf@u.washington.edu
2
Department of Anthropology, University of Washington, Seattle, Washington
98195-3100; email: rrc4@uw.edu
Key Words
globalization, global health, neoliberalism, critical medical
anthropology, political economy, economic reform
Abstract
Thirty years since its first public use in 1980, the phrase structural ad-
justment remains obscure for many anthropologists and public health
workers. However, structural adjustment programs (SAPs) are the prac-
tical tools used by international financial institutions (IFIs) such as the
International Monetary Fund (IMF) and the World Bank to promote
the market fundamentalism that constitutes the core of neoliberalism. A
robust debate continues on the impact of SAPs on national economies
and public health. But the stories that anthropologists tell from the field
overwhelmingly speak to a new intensity of immiseration produced by
adjustment programs that have undermined public sector services for
the poor. This review provides a brief history of structural adjustment,
and then presents anthropological analyses of adjustment and public
health. The first section reviews studies of health services and the sec-
ond section examines literature that assesses broader social determinants
of health influenced by adjustment.
149
 AN39CH10-Pfeiffer ARI 20 August 2010 15:11

INTRODUCTION nations are IMF members, rich countries have

far greater voting power formally calibrated to
Thirty years since its first public use in 1980,
the size of their economies. The IMF’s role
SAP: structural the phrase structural adjustment remains ob-
adjustment program is to maintain stability in the global monetary
scure for many anthropologists and public
system, whereas the World Bank acts primar-
IFI: International health workers. Related terms such as globaliza-
Financial Institution ily as a lender for development projects. SAPs
tion, economic reform, and neoliberalism are
negotiated between the IFIs and national gov-
OPEC: Organization more widely circulated and often better under-
of Petroleum- ernments ostensibly seek to help governments
stood in both development and academic circles
Exporting Countries restructure their economies to control inflation,
(Harvey 2005). However, structural adjustment
repay international debt, and stimulate eco-
programs (or SAPs) are the practical tools used
nomic growth. The IFIs provide loans and debt
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by international financial institutions (IFIs)

relief to a target country if certain conditions
such as the International Monetary Fund (IMF)
are met; governments must reduce their public
and the World Bank at country level to pro-
Annu. Rev. Anthropol. 2010.39:149-165. Downloaded from www.annualreviews.org

sector workforce and lower remaining salaries,

mote the market fundamentalism that consti-
cut public sector budgets, remove subsidies and
tutes the core of neoliberalism. While other
price controls, devalue local currency, sell state-
instruments such as global and regional trade
owned enterprises and services, reduce taxes on
pacts, military interventions, and embargos are
foreign investment, weaken state environmen-
essential to enforce the neoliberal project more
tal and labor regulations, and deregulate move-
broadly, SAPs refer to the country-specific
ment of capital (Gershman & Irwin 2000).
agreements negotiated by the IFIs with local
A brief review of the history of adjust-
ministries of finance that have produced a cas-
ment and the cornerstone institutional liter-
cade of profound political, economic, and so-
ature helps map out anthropological engage-
cial changes in the Third World. The pri-
ments with SAPs. The emergence of the SAP
mary tenets of neoliberalism—promotion of
idea as both a policy and a process is intimately
free markets, privatization, small government,
bound up with the global economic downturn
and economic deregulation—have been opera-
of the 1970s, the ensuing international debt
tionalized at country level through concerted,
crisis, the shift among economic elites from
formulaic, and strategically harmonized action
Keynesianism to monetarism, and the politi-
by the IMF and World Bank through SAPs.
cal realization of this shift with the election
The advent of structural adjustment came on
of the Reagan and Thatcher administrations
the heels of colonialism and independence in
in the early 1980s (see Harvey 2005; also see
much of the developing world, especially Africa,
Gershman & Irwin 2000). OPEC’s hike in oil
and signaled a definitive shift in the relation-
prices in the early 1970s led to increased bor-
ship of the West to its former colonies; a shift
rowing by oil-importing countries and a sharp
characterized by novel tools of extraction and
increase in lending to poor countries by com-
new strategies of abandonment. A robust debate
mercial banks flush with petrodollars. With
continues on the impact of SAPs on national
global recession, prices for raw materials ex-
economies and public health. But the stories
ported by poor countries declined, rich coun-
that anthropologists tell from the field over-
try markets shrank, and interest rates on loans
whelmingly speak to a new intensity of immis-
increased. The debt crisis spiraled out of con-
eration produced by adjustment programs that
trol and eventually threatened the stability of
have ravaged public sector services for the poor.
Western lenders and the global financial
system.
A BRIEF HISTORY As a result, the IFIs moved away from
OF ADJUSTMENT Keynesian principles of government interven-
The IFIs were established as sister institutions tion to free-market approaches espoused by
at the end of World War II. Although most monetarists, led by University of Chicago

150 Pfeiffer · Chapman

 AN39CH10-Pfeiffer ARI 20 August 2010 15:11
economist Milton Friedman, who claimed that
economies free of regulation would grow more
quickly and that benefits would trickle down to
the poor (Harvey 2005). An influential World
Bank (1981) policy paper, entitled Accelerated
Development in Sub-Saharan. Africa: an Agenda
for Action by Elliot Berg (and widely known as
the Berg Report), laid blame for Africa’s eco-
nomic crisis squarely on African state interven-
tion, protectionism, and price subsidies that dis-
torted market forces and undercut economic
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growth (Arrighi 2002).
In 1980, the IFIs produced a new tool known
Annu. Rev. Anthropol. 2010.39:149-165. Downloaded from www.annualreviews.org
as the Enhanced Structural Adjustment Facility
(or ESAF); a credit package to be offered by IFIs
if macroeconomic conditionalities were met by
recipient governments. With the emergence of
the ESAF, IFIs began negotiating with local
Ministries of Finance to create SAPs, which
were remarkably uniform across countries. By
1991, 75 of the poorest countries in the world
had received adjustment loans, 30 in Africa and
at least 18 in Latin America (Gershman & Irwin
2000). The term Washington Consensus was
coined in 1989 to refer to the Washington,
D.C.–based IMF, World Bank, and U.S. Trea-
sury consortium, and came to signify the aus-
terity economies that SAPs produced.
Structural adjustment coincided with an-
other key moment in the public health world.
In 1978, the concept of Primary Health
Care (PHC) was embraced by 134 coun-
tries (including the United States) attend-
ing the landmark World Health Organiza-
tion (WHO)/UNICEF Alma Ata conference
in the former Soviet Union (now Kazakhstan)
(Paluzzi 2004). The PHC concept promoted
“Health for All” by 2000 through a package
of basic health care services made available to
all, especially the poor, through a public tiered
health system. The package included vacci-
nation, maternal-child health services, family
planning, endemic and epidemic disease con-
trol, first aid, and referral systems for complex
cases. It recognized the importance of mul-
tisectoral development to public health, and
celebrated community participation as a core
www.annualreviews.org • Structural Adjustment and Public Health
principle. But PHC immediately ran up against
the new constraints imposed by SAPs. Debates
erupted between those promoting a selective
PHC: primary health
PHC that called for realistic priority setting in care
light of severe resource constraints and aban-
WHO: World Health
donment of the grand vision of comprehensive Organization
PHC (Rifkin & Walt 1986, Justice 2000).
DALY: disability
In 1987, in a further blow to PHC, the adjusted life year
World Bank’s Financing Health Services in
Developing Countries (World Bank 1987) pro-
vided the blueprint for the privatization of
health services that included (a) user fees for
government facilities; (b) introduction of pri-
vate insurance; (c) encouragement of non-
governmental organizations (NGOs and other
private entities) to provide services; and (d ) de-
centralization of government services. These
prescriptions laid the groundwork for a gen-
eration of health and development policy in the
adjustment era. That same year, UNICEF pub-
lished its seminal but soft critique of SAPs en-
titled Adjustment with a Human Face (UNICEF
1987) that documented their negative effects
and argued for greater protections for the
poor. Also in 1987, the WHO and UNICEF
crafted the Bamako Initiative at a conference
in Mali, which provided guidelines to estab-
lish community-based health care financing in
Africa, based on imposition of local user fees,
to purchase drugs (UNICEF 1988).
In 1993, the World Bank’s annual report,
Investing in Health, introduced the disability
adjusted life year (DALY) as a measure of
health and promoted the principle of cost-
effectiveness to guide health investment (World
Bank 1993). The DALY provides a common
unit, or metric, of health loss that accounts for
the duration and severity of health conditions
in order to measure the overall burden of dis-
ease to prioritize investment of scarce resources
in poor countries (Murray & Lopez 1996). The
report signaled that the Bank now superseded
the WHO as the primary driver of global health
policy.
As part of the push toward privatization,
SAPs sought to redirect foreign aid to NGOs
and away from governments. The World
151
 AN39CH10-Pfeiffer ARI 20 August 2010 15:11
Bank, USAID and other major donors began
channeling large proportions of their health
funding to NGOs, producing an NGO explo-
PRSPs: Poverty
Reduction Strategy sion that is now the sine qua non of the neolib-
Papers eral period in Africa (Turshen 1999, Green &
Mathias 1997, Buse & Walt 1997).
Throughout the 1990s, as health indicators
were deteriorating across Africa, economies re-
mained anemic, and political opposition was
brewing in Latin America (Kim et al. 2000).
Under increasing criticism in 1996, the IFIs
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created the Heavily Indebted Poor Coun-
tries (HIPC) initiative that included 41 coun-
Annu. Rev. Anthropol. 2010.39:149-165. Downloaded from www.annualreviews.org
tries deemed to have unrepayable debt levels
(Gershman & Irwin 2000). They could receive
additional debt restructuring support if they
agreed to IFI conditionalities. By 1999, how-
ever, even the HIPC was seen by many as
too constraining and the ESAF was replaced
by the euphemistic Poverty Reduction and
Growth Facility (PRGF) implemented through
Poverty Reduction Strategy Papers (PRSPs)
(IMF/World Bank 2002, Craig & Porter 2003).
The new approach sought to redirect debt re-
lief toward poverty reduction programs. The
creation of PRSPs would be a consultative pro-
cess with local civil society to achieve a sense
of national ownership. However, critics main-
tain that the essential aspects of structural ad-
justment remain intact in the PRSP approach
(Wamala et al. 2007, Craig & Porter 2003,
Hammonds & Ooms 2004).
In Healthy Development: The World Bank
Strategy for Health, Nutrition, and Population
(World Bank 2007), the Bank sought to repo-
sition itself vis-à-vis the new architecture of
global health aid. The adoption of the Mille-
nium Development Goals (MDGs) as global
benchmarks by the United Nations in 2000 es-
tablished new health targets and challenged the
effectiveness of adjustment (Freedman 2005).
Major new funding for health and the AIDS cri-
sis from other sources has reduced the World
Bank’s relative contribution to global heath.
However, PRSPs continue to provide the basic
aid and development framework in most poor
countries.
152 Pfeiffer · Chapman
THE IMPACT OF SAPs
ON HEALTH
Critics of SAPs hypothesize a number of path-
ways through which adjustment policies can
harm public health including cuts to basic pub-
lic sector health care services; imposition of fees
for health care services; cuts to other public
sector services such as education, agriculture,
water and public works; unemployment caused
by lay-offs of public sector workers and income
declines resulting from wage cuts for those re-
maining; privatization of state industries that
often leads to layoffs; removal of state subsi-
dies for essentials and liberalized markets for
transport and food leading to price increases;
currency devaluation that often leads to im-
mediate and dramatic price increases for ba-
sic commodities, especially food; and increases
in social inequality and economic vulnerability
(Breman & Shelton 2007).
The World Bank and its supporters, on
the other hand, argue that adjustment policies
may cause hardship in the short run, but will
eventually stabilize economies, promote new
investment, and generate economic growth,
which will lead to greater tax income for ser-
vices (Sahn & Bernier 1995, Sahn et al. 1997,
Haddad et al. 1995). Privatization and user fees
for some services (such as health) will help
them become more efficient and lead to better
access. Greater economic growth will lead to
higher incomes, less distorted pricing for basic
needs, and more resources overall for health and
development.
The task of epidemiologically disentangling
and isolating the many influences on a nation’s
health is enormously challenging, so conclu-
sive findings on the impact of SAPs on specific
population-level health outcomes have been
elusive and controversial (Breman & Shelton
2007, Cornia et al. 2009, Harris & Seid 2004).
However, there is a more definitive literature
outside of anthropology that documents how
SAPs affect a wide range of proximate social de-
terminants of health. Important volumes that
address these determinants include Labonte
et al. (2009), Harris & Seid (2004), and Kawachi
 AN39CH10-Pfeiffer ARI 20 August 2010 15:11
& Wamala (2007). [See Sahn et al. (1997) for a
more favorable view.]
Social epidemiologists have provided use-
ful perspectives on the relationships among
structural adjustment programs, increases in so-
cial inequality, and population health outcomes
(Coburn 2000, Kawachi & Wamala 2007).
Public health and policy experts have provided
valuable insights into the NGO phenomenon
(Green & Mathias 1997, Buse & Walt 1997,
Mburu 1989, Cliff 1993). [See also Gwatkin
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et al. (1999), and Anand & Hanson (1998) for
discussions on the ethics of DALYs.]
Annu. Rev. Anthropol. 2010.39:149-165. Downloaded from www.annualreviews.org
Analysis of IFI policy can be found in De
Beyer et al. (2000) who have provided a more
sanguine assessment of SAPs and the role of
the Bank. But this contrasts with a chorus of
criticism in Fort et al. (2004), Chabot et al
(1996), Navarro (2004), Hanlon (1996), Laurell
(2000), Loewenson (1993), Hammonds &
Ooms (2004), and Ooms & Schrecker (2005).
There is a rich literature that documents
and examines the impact of structural ad-
justment on health services. Turshen’s (1999)
Privatizing Health Services in Africa is a criti-
cal touchstone treatise. Especially valuable con-
tributions also include McCoy et al. (2005),
McCoy et al. (2008), Jitta et al. (2003) for
Uganda, Birn et al. (2000) for Nicaragua, Gloyd
(1996) for Mozambique, Bassett et al. (1997)
for Zimbabwe, and Handa & King (2003) on
Jamaica. Literature assessing PRSPs has grown
in recent years and is best summarized in
Wamala et al. (2007) and Craig & Porter
(2003). Health economists of course have
weighed in on adjustment. Joseph Stiglitz
(2002) offers a scathing criticism of the World
Bank as its former chief economist (see also
Sachs 2005, WHO 2001). [For a more posi-
tive economist’s views of adjustment, see Sahn
et al. (1997).]
ANTHROPOLOGICAL
APPROACHES AND
CONTRIBUTIONS
Specific use of the term structural adjustment
is still sparse in the anthropology literature
www.annualreviews.org • Structural Adjustment and Public Health
on global health. Janes & Corbett (2009) have
offered a recent valuable review of anthropol-
ogy and global health more broadly. While
there is some important overlap with this work,
the review offered here focuses instead on an-
thropological research that identifies structural
adjustment policies in national settings and ei-
ther directly examines their effect on health ser-
vices, tracks their broader impact on social and
cultural life in ways that affect public health, or
describes processes of policy development and
resistance.
Several anthropological volumes outside the
medical anthropology literature speak to the
broader social processes of adjustment in ways
that can inform our approach to health. These
include Comaroff & Comaroff ’s (2001) Mil-
lennial Capitalism and the Culture of Neoliberal-
ism, Ferguson’s (2006) Global Shadows: Africa
in the Neoliberal World Order, and Escobar’s
(1995) Encountering Development. Most of the
anthropological work on SAPs and health has
been produced by scholars writing in the criti-
cal medical anthropology (CMA) tradition that
brings together, sometimes uncomfortably, po-
litical economic, poststructuralist, and critical
theory approaches to health and society. CMA
insists on locating sociocultural and health phe-
nomena in the context of historical, political
economic, and social forces that shape and con-
strain individual agency (Singer & Baer 1995),
often drawing on Marxian political economy or
Foucauldian notions of biopower and biopoli-
tics. The structural violence analytic, popular
among CMA adherents, offers an alternative
lens to reinterpret disease and mortality among
the poor as a form of violence that derives from
structured inequality (Farmer 2001). CMA pro-
vides a corrective to mainstream international
public health still rooted in narrow behaviorist
and cognitive models of health disparities.
Several important collections on SAPs and
health led by anthropologists have recently ap-
peared. Most prominent of these is Kim et al.’s
(2000b) Dying for Growth that unites the work
of anthropologists, economists, and histori-
ans in a sweeping indictment of adjustment
and neoliberalism. Castro & Singer’s (2004)
153
 AN39CH10-Pfeiffer ARI 20 August 2010 15:11
Unhealthy Health Policy includes several chap-
ters on SAPS; Baer et al.’s (2003) volume exam-
ines the intersection of world system’s theory
and medical anthropology. The Manderson &
Whiteford (2000) collection contains case stud-
ies of global health policy and neoliberalism.
Whiteford & Whiteford (2005) provides a
collection of ethnographies about water priva-
tization in poor countries. Nichter’s (2008) re-
cent volume offers a meditation on the power of
representation in the shaping of recent health
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policy, including structural adjustment. The
themes that have emerged in this and other an-
Annu. Rev. Anthropol. 2010.39:149-165. Downloaded from www.annualreviews.org
thropological literature on SAPs are elaborated
below.
The Impact of SAPs on Health
Care Services
Medical anthropologists have described
community-level experiences and responses
to the contraction of public sector health
services and the emergence of private care.
This work has focused primarily on imposition
of fees for service, the Bamako Initiative, the
discourse on cost-effectiveness, private sector
and informal market services, the proliferation
of NGOs to deliver services, and dynamics
of community participation so important to
the PHC concept. Woven within many of
these accounts are stories and exploration
of how patterns of health seeking have been
transformed in local communities.
The experience and performance of public
sector health workers themselves has emerged
as an important theme. Harriet Birungi (1998)
describes how biomedical injection technology
migrated to the private and informal sectors in
Uganda as the health system and quality of care
weakened under adjustment. Streefland (2005)
describes an emergent puvate zone in Uganda
in which public sector health workers scratch
out a living in the private and informal sectors to
subsidize their low salaries. Kira Foster (2005)
documents the effects of the neoliberal shift
since 1997 on provision of care in postapartheid
South Africa, highlighting strained relations
between health staff and local communities
154 Pfeiffer · Chapman
created by state budget cuts. Kyaddondo &
Whyte depict the demoralization among Ugan-
dan health workers as the health system was de-
centralized and privatized (2003). Lundy (1996)
dissects the effects of health system budget cuts
on health staff morale in Jamaica as salaries
were reduced and work conditions deteriorated.
Bassett et al. (1997) describe how Zimbabwe’s
SAP led to worsening conflict between nurses
and patients as workloads increased, salaries de-
clined, and work conditions eroded.
Maupin (2008) explains how adjustment
constraints on Guatemala’s maternal child
health services led to promotion of ineffective
traditional birth attendant (TBA) programs.
Towghi (2004) depicts the difficulties in
developing a TBA program in Pakistan
under a SAP as formal services have disap-
peared for referrals of high-risk pregnancies.
Chapman (2003) reveals how declines in ser-
vice quality, such as longer waiting times and
poor treatment, in Mozambique often delay
women’s use of antenatal care. Further notable
country-specific anthropological accounts of
adjustment and health service quality decline
include Nigeria (Adulana & Olomajeye 1999),
Malawi (Kalipeni 2004), Zaire (Schoepf et al.
1991), Peru (Kim et al. 2000), Haiti (Farmer
2001, Maternowska 2006), Brazil (Biehl 2007),
and Mongolia ( Janes 2004).
Ellen Foley (2009) provides one of the
few book-length ethnographies that explic-
itly traces the impact of structural adjustment
on health service delivery. She describes the
bankrupting of a local health center in Senegal
after adoption of the Bamako Initiative and ex-
poses the new official discourse of state-citizen
partnership and responsibilization as a gloss
for passing on health costs to poor communi-
ties. Keshavjee (2004) describes a similar failure
of a Bamako Initiative approach in post-Soviet
Tajikistan as fees were introduced to recover
costs. Ridde (2008) tracks the failings of the
Bamako Initiative in Burkina Faso. [See ad-
ditional reports on the negative consequences
of user fees on the poor in Zambia (Van der
Geest et al. 2000), Senegal (Desclaux 2004), and
Zimbabwe (Bassett et al. 1997).]
 AN39CH10-Pfeiffer ARI 20 August 2010 15:11
Smith-Nonini (1998) describes the embrace
of NGOs in El Salvador in the 1990s. The
right-wing ARENA government at the time
welcomed neoliberal reforms but was hesi-
tant to cede control of health provision to
NGOs. Janes (2004) questions the efficacy of
the NGO model of service delivery in market-
based health reform in Mongolia and chal-
lenges anthropologists to cast a critical eye
toward the emergence of civil society in de-
velopment discourse as a cover for privatiza-
by b-on: Inst. Superior de Ciencias do Trabalho e da Empresa (ISCTE) on 05/02/12. For personal use only.
tion. Drawing on fieldwork in Mozambique,
Pfeiffer (2003) claims that proliferation of
Annu. Rev. Anthropol. 2010.39:149-165. Downloaded from www.annualreviews.org
NGOs in the Mozambique has fragmented
the health sector and created an internal brain
drain from the public sector to NGOs, which
pay higher salaries. The contracting out of
services by national governments to NGOs,
most famously in Cambodia, is a newer dimen-
sion of the NGO phenomenon (Loevinsohn &
Harding 2005). Maupin’s (2009) study of con-
tracting in Guatemala offers one of the few
available case studies by an anthropologist.
Maupin describes how contracting of services
to NGOs in Guatemala may have undermined
civil participation in health reform. The NGOs
that were selected assumed primarily adminis-
trative roles and remained heavily dependent
on the Ministry of Health, thereby losing their
civil participation and service delivery roles.
Morgan (1993) argues for a political eco-
nomic assessment of community participation
in PHC in Costa Rica. Morgan’s thorough
(book-length) ethnography of participatory
processes in Costa Rica reveals the contested
nature of the concept itself among the World
Bank, local governments, and NGOs. The lan-
guage of decentralization, public/private part-
nership, civil society, community participation,
and sustainability entered the development dis-
cussion, in part to justify passing on the costs
of health care to communities. Similarly, Janes
(2004) argues for an activist/advocacy approach
to participation in health in the context of pri-
vatization in Mongolia to ensure that the poor
are heard.
Medical anthropologists have provided im-
portant critiques of the cost-effectiveness
www.annualreviews.org • Structural Adjustment and Public Health
argument by tying it to concerns for human
rights, equity, and ethics. Paul Farmer’s elo-
quent broadsides offer the strongest indictment
ART: antiretroviral
against the cost-effectiveness logic that has de- treatment
layed the provision of antiretroviral treatment
TB: tuberculosis
(ART) to the poor, undermined tuberculosis
(TB) programs, and otherwise prevented the
improvement of basic services in poor countries
(Farmer 2005, 2004, 2008; Castro & Farmer
2005). Janes & Chuluundorj (2004), Nichter
(2008), and Allotey et al. (2003) criticize the
use of DALYs for obscuring the social nature
of suffering—the social and economic losses far
exceed what is measured in the DALY.
The coincidence of the AIDS epidemic
with the imposition of structural adjustment
exposed global fault lines of inequality that
were deepened by SAPs. As Comaroff (2007,
p. 197) points out, “In retrospect, the timing
of its [AIDS] onset was uncanny: the disease
appeared like a memento mori in a world high
on the hype of Reaganomics, deregulation, and
the end of the Cold War.” Analysts pointed out
how SAPs and neoliberalism exacerbated the
social conditions that propelled the epidemic,
and undermined the public infrastructure
needed to scale-up AIDS treatment in poor
countries (Poku 2006, Piot 2001, Farmer
2001, Ooms et al. 2008, Lurie et al. 1995,
Singer 1997). Parker et al.’s (2000) review of
environmental influences on HIV prevention
offers a good early snapshot of work assessing
the impact of SAPs on the epidemic. Schoepf’s
(2001) review of anthropological research on
HIV/AIDS highlights how the inequality and
economic insecurity created by SAPs promotes
HIV transmission. Ida Susser’s (2009) recent
volume connects the politics of global health
governance to the growth of survival sex. See
similar studies for Lesotho (Romero-Daza
& Himmelgreen 1998), Haiti (Farmer et al.
1996), Zaire (Schoepf 2001), and South Africa
(Hunter 2007). This important body of work
belies the behaviorist and racist portrayals of a
promiscuous Africa, common in international
public health, that conjures a distinct African
sexuality to explain the severity of the African
AIDS crisis.
155
 AN39CH10-Pfeiffer ARI 20 August 2010 15:11
The surge in major funding over the past
six years for scale-up of life-saving ART in
poor countries from the President’s Emer-
PEPFAR: President’s
Emergency Program gency Program for AIDS Relief (PEPFAR), the
Global Fund to Fight AIDS, TB and Malaria
for AIDS Relief
(GFATM), and other major foundations has
GFATM: Global
Fund to Fight AIDS, collided directly with structural adjustment on
TB and Malaria the ground. The struggles to scale-up ART
through dilapidated and underresourced health
systems, and the difficulties in patient follow-
up and adherence have foregrounded the role
by b-on: Inst. Superior de Ciencias do Trabalho e da Empresa (ISCTE) on 05/02/12. For personal use only.
of SAPs in impeding an effective response
in spite of the new resources made available.
Annu. Rev. Anthropol. 2010.39:149-165. Downloaded from www.annualreviews.org
Castro (2006) assesses social factors that influ-
ence ART adherence such as user fees, poverty,
lack of income, and lack of food often exacer-
bated by SAPs. Castro & Farmer (2005) argue
that AIDS stigma must be understood in terms
of inequality and structural violence—often
worsened by SAPs (see also Abadı́a-Barrero &
Castro 2006). Desclaux (2004) describes chal-
lenges related to payment for ART in Senegal
and Whyte et al. (2004) discuss dilemmas
around charging for drugs in Uganda.
The scale-up of life-saving ART has stim-
ulated a growing poststructuralist and Fou-
cauldian literature on the pharmaceuticaliza-
tion of public health, therapeutic citizenship,
and biopolitics within the context of neolib-
eralism. Fassin (2007) provides a book-length
analysis of the biopolitics of the AIDS crisis in
South Africa with a special emphasis on AIDS
denialism and the legacy of apartheid—in re-
lation to the embrace of neoliberalism by the
ANC (2007). Biehl is concerned with the phar-
maceuticalization of AIDS and public health in
Brazil created through a narrowly defined verti-
cal scale-up of ART by an activist yet neoliberal
Brazilian state. He seeks to track the creation of
a new biomedical citizenship based on assess-
ment of risk for HIV care (2007). Nguyen et al.
(2007) have proposed a notion of therapeutic
citizenship that points to the growing transna-
tional influence of biomedical knowledge and
practice in the government of human and non-
human affairs. Petryna et al. (2006) have pro-
duced a volume of anthropological case studies
that examine the global pharmaceutical nexus
156 Pfeiffer · Chapman
in the context of neoliberalism, of which the
ARV drug industry plays a key role.
SAPs and Inequality
Beyond Healthcare
The broader effects of economic reform on lo-
cal societies that impact health—growing in-
equality and rapid class formation, land access
and food, water rights, gender disparities, the
commodification of social relations, unemploy-
ment, and the drops in income associated with
economic austerity measures—have attracted
the attention of anthropologists who explore
the political and social ecology of adjustment.
Janes (2004) examines the social ecology
of women’s reproductive health in Mongolia
as it reeled under free-market reform in the
post-Soviet period characterized by high un-
employment, famine, and the collapse of the
public health system. Biehl (2005) describes the
zones of social abandonment around Brazilian
cities where the sick, mentally ill, and home-
less are left to die. Maternowska (2006) offers
a book-length examination of fertility choices
and low levels of contraception use by poor
women in neoliberal Haiti in terms of inequal-
ity, uncertainty, and vulnerability. Chapman’s
(2003, 2004) ethnography of pregnancy in cen-
tral Mozambique uncovers how free-market
economics have commodified important so-
cial relationships and ritual processes through-
out the reproductive process, from virginity
fees to bridewealth, to pregnancy protection
rituals and traditional midwife support. Poor
women without access to money react by hid-
ing their pregnancies and avoiding biomedical
antenatal services. Pfeiffer (2002a, 2004, 2005;
Pfeiffer et al. 2007) argues that structural ad-
justment, inequality, and economic insecurity
in Mozambique have fueled the growth of faith-
healing Pentecostal and African Independent
churches with important implications for pub-
lic health and HIV/AIDS that are not yet well
understood. Sanders describes the commodifi-
cation of “occult” practices (2001) in Tanzania
as insecurity and inequality increased under
its SAP, and Whyte et al. (2004) similarly
 AN39CH10-Pfeiffer ARI 20 August 2010 15:11
examines the experience of misfortune and un-
certainty in Uganda exacerbated by neoliberal-
ism. See also Okuonzi (2004) for Uganda and
Schoepf et al. (2000) who describe the political
ecology of adjustment and its impact on health
in Congo, Rwanda, Ghana, and Senegal. Gill’s
(2000) ethnography of a peripheral migrant city
in Bolivia reveals the urban spoilation produced
by 15 years of neoliberal neglect in Bolivia’s
peri-urban neighborhoods.
Whiteford & Whiteford (2005) have pro-
by b-on: Inst. Superior de Ciencias do Trabalho e da Empresa (ISCTE) on 05/02/12. For personal use only.
duced a valuable collection of anthropologi-
cal work that focuses on adjustment, access to
Annu. Rev. Anthropol. 2010.39:149-165. Downloaded from www.annualreviews.org
water, and health in poor countries. Briggs &
Mantini-Briggs (2003) examine the cholera epi-
demic of 1991 in Venezuela under structural
adjustment and deconstruct the language, im-
agery, and rubric of representation elaborated
by the government to deflect blame onto neigh-
boring countries and the local poor, and to
obfuscate the links between the epidemic and
adjustment policies that had also provoked
wide-spread riots two years earlier. [See also
Loftus (2006) for discussion of the political
ecology of water access in South Africa.]
Gladwin’s (1991) edited volume, Struc-
tural Adjustment and African Women Farmers,
presents a series of early case studies from
around Africa that document the increased
workloads for women, loss of land access to pri-
vatization schemes, and consequent declines in
nutritional status associated with adjustment.
Schoepf’s chapter is a poignant case study of
Zaire where land privatization intersected with
local patriarchal ideologies to further under-
mine women farmers’ rights to land and to in-
tensify intrahousehold conflict. Johan Pottier
(1999) reviews how structural adjustment pro-
grams have reconfigured rural small holder
production by promoting failed cash-cropping,
removing price subsidies, and ending state-run
trading programs in ways that have under-
mined producers. Pfeiffer (2002b) similarly ar-
gues that in rural Mozambique, SAP policies
that removed subsidized purchase of rural pro-
duce by the state, eliminated women’s coopera-
tives, and privatized land, undermined women’s
ability to secure food. Commoditization of
www.annualreviews.org • Structural Adjustment and Public Health
social relationships made reliance on male cash
income even more important for nutrition in
the family. Janes (2004) describes how free-
market changes in Mongolia led to widespread
famine and food insecurity as the society
was decollectivized and households turned to-
ward self-provisioning. Vavrus (2005) discusses
how access to secondary education declined in
Tanzania as school fees were introduced and
subsidized prices for food were removed.
Nwajiuba et al. (2007) examine the SAP in
Nigeria and its influence on migration and
public health.
Wamala & Kawachi (2007) have provided
a concise summary of globalization, neolib-
eralism, and women’s health. Gender biases
in the health costs of adjustment cover a
broad range of sites, from the intensification
of women’s domestic and market work to
the interruption of children’s (especially
girls’) and women’s education to increases in
time inputs either to obtain basic services or
self-provision them (Gladwin 1991, Connelly
1996). Pamela Sparr’s (1994) seminal volume,
Mortgaging Women’s Live: Feminist Critiques of
Structural Adjustment, uses diverse case studies
to document the interrelated consequences
of restructuring and privatization. Included is
anthropologist Takyiwaa Manuh’s review of
the problematic employment consequences
and compensation measures of SAPs in Ghana,
and Mervat Hatem’s analysis of the impact of
SAPS on women’s health in Egypt. Feminist
theorists have argued that the politics of in-
ternational restructuring have had the greatest
effect on the sphere of social reproduction, and
thus, on women, while “amplifying” patriarchy
(Bakker & Gill 2003, Sassen 2003). Austerity
programs necessarily target poor, rural women,
whose lack of access to good land and small
chances of intensifying production would limit
their ability to benefit from the new market
conditions created by adjustment (Cliff 1991).
Without ways to boost their own incomes,
women suffer the hardships caused by inflation
and rising prices as subsidies and price controls
are dismantled (UNICEF 1991, p. 33). Because
more poor women than men live outside the
157
 AN39CH10-Pfeiffer ARI 20 August 2010 15:11
cash nexus, mainly those in rural areas, they are
more vulnerable to inflation, social conflict,
and uncertainty (Turshen 1999).
In Globalization, Women and Health in the
21st Century edited by Kickbusch et al. (2005),
the effects of global economic restructuring
and adjustment on health is a recurring theme
across the chapters. In her chapter, Doyal
explicitly lays out a dual framework for ex-
amining how gender relations shape the im-
pact of globalization on health and how the
by b-on: Inst. Superior de Ciencias do Trabalho e da Empresa (ISCTE) on 05/02/12. For personal use only.
globalization of health affects gender relations.
Anthropologist Lewando-Hunt considers the
Annu. Rev. Anthropol. 2010.39:149-165. Downloaded from www.annualreviews.org
health effects of women’s social movements and
Manish Desai reviews women’s international
health movements and organized resistances to
health restructuring and reform policies from a
critical social movement perspective. [See also
Elson (1995) and Zuckerman’s (2002) discus-
sion of gender and PRSPs, and Haddad et al.
(1995) for an economist’s review of gender di-
mensions of economic adjustment.]
Debt and structural adjustment burdens also
correlate with political conflict (Leatherman &
Thomas 2009). A recent volume reviews the re-
lationship between global health and political
conflict and violence (Rylko-Bauer et al. 2009).
In this compendium, Quesada carefully de-
scribes the relationship of structural adjustment
to direct violence in Nicaragua, Heggenhougen
describes similar dynamics in Guatemala, and
Farmer builds on the argument advanced by
Uvin (1998) that structural adjustment and
the inequalities it generated contributed to
the 1994 Rwandan genocide. Leatherman &
Thomas (2009) suggest that structural violence
in Peru, worsened by neoliberal reforms, cre-
ated the conditions for political violence.
HUMAN RIGHTS, RESISTANCE,
AND THE HEALTH “COMMONS”:
TOWARD AN ANTHROPOLOGY
OF STRUCTURAL ADJUSTMENT
The 30-year structural adjustment experiment
has constituted an assault on the public sec-
tor as an essential purveyor and guarantor of
158 Pfeiffer · Chapman
population health and welfare. The anthropol-
ogists reviewed here bear witness to the human
cost. If, as Farmer (2001, 2005, 2008) argues,
social and economic rights are human rights,
the role of a robust public sector and govern-
ment emerges as vital; not sufficient, but neces-
sary to guarantee the right to survive. Viewed
in this light, structural adjustment’s systematic
dismantling of public services for health, ed-
ucation, agriculture, water, and safety nets is
rightly seen as a war on the poor; its violence
measured in increased morbidity, malnutrition,
excess mortality, DALYs, and the harder-to-
quantify destruction of community that anthro-
pologists have tried to depict. In practical terms,
the struggle for public health in the structural
adjustment era, then, is the struggle to pre-
serve, renew, and revitalize the idea and role
of the public sphere. Anthropologist Smith-
Nonini (2006) argues in a recent essay that to
operationalize a right to health, a health system
should be seen as a commons, not as a mar-
ket, where priorities are set for the public good,
risk is shared, and health providers are account-
able to their communities. To argue for a health
commons directs anthropologists toward new
sites of engagement, application, and resistance.
For example, the large-scale international
response to the AIDS crisis underscores the
urgency to rebuild a public sector capable of
managing millions on treatment; the sheer lo-
gistics of the challenge now supersede ideology
as practitioners realize that AIDS treatment
on a mass scale simply cannot succeed in poor
countries through a SAP-created patchwork
of NGOs, charities, missions, and private
providers (Pfeiffer & Nichter 2008). It requires
functioning national health systems with an
adequate workforce, expanded training institu-
tions, and major infrastructure rebuilding (Mc-
Coy et al. 2005). Hence the new trends in global
health toward health system strengthening, op-
erations research, and implementation science
(Madon et al. 2007). However, such system
and public institution strengthening is blocked
by the IMF at virtually every turn, as carefully
documented by Rowden (2009) in his recent
 AN39CH10-Pfeiffer ARI 20 August 2010 15:11
scathing critique of the IFIs and the AIDS crisis.
Most egregiously, IMF-negotiated wage bill
caps codified into Medium Term Expenditure
Frameworks prevent the hiring of a sufficient
health workforce (as well as teachers and social
workers for that matter) and cap health sector
spending where per capita financing rates are
still a fraction of the minimum defined by
the WHO. To complicate matters, PEPFAR
funding reauthorized at over $50 billion over
five years now dwarfs every other source of
by b-on: Inst. Superior de Ciencias do Trabalho e da Empresa (ISCTE) on 05/02/12. For personal use only.
health sector support in most of its target
countries. In Mozambique in 2009, PEPFAR
Annu. Rev. Anthropol. 2010.39:149-165. Downloaded from www.annualreviews.org
dollars constituted nearly 60% of all funding
for health. While an anthropology of PEPFAR
is now being forged and the biopolitics of phar-
maceuticals, therapeutic citizenship, abstinence
policies, and condom distribution explored,
we are curiously silent about the single most
important dimension of PEPFAR funding; by
policy it is channeled to private NGOs rather
than to public sector health systems. Ironically,
however, PEPFAR is public funding and
therefore subject to political contestation and
public accountability. Medical anthropologists
can be effective advocates both in the countries
where they come from and where they do
fieldwork to help ensure that this historic
opportunity is not squandered on transient
NGOs and an imagined or avaricious private
sector. This scale of funding can build sustain-
able public sector health institutions to last for
a generation in most PEPFAR countries.
And the political ground is shifting. The
recent financial crisis in rich countries has
shaken market fundamentalism and rattled the
Chicago school (Cassidy 2010). The rise of
China as a financial and political player in the
developing world, especially in Africa, creates,
for better or worse, the first external chal-
lenge in centuries to Western hegemony for
which SAPs are the latest chapter. The ascen-
dance of the left in Latin America over the
past decade constitutes a direct confrontation
with the Washington Consensus (Petras 1997,
Wallerstein 2002). As Muntaner and colleagues
www.annualreviews.org • Structural Adjustment and Public Health
(2006) report, the new Venezuelan approach to
primary health care, Mision Barrio Adentro, rep-
resents massive public investment in multisec-
toral health for the poor and flatly rejects struc-
tural adjustment. The new approach embraces
the most comprehensive versions of primary
health care elaborated over 30 years earlier. As
Paluzzi & Garcia (2008) optimistically declare,
“Alma Ata is alive and well in Venezuela”.
New social movements have coalesced in
rich countries to challenge structural adjust-
ment, such as the People’s Health Move-
ment, myriad organizations that emerged from
the antiglobalization movement and so-called
Battle in Seattle in 1999, and consortia led by
Washington, D.C.–based ActionAid that trav-
els the United States giving macroeconomic
literacy trainings about structural adjustment
(Rowden 2009). A large consortium of in-
ternational NGOs is calling for an NGO
Code of Conduct for Health Systems Strength-
ening that seeks to reign in the abuses of
NGOs that drain resources from public sectors
(Pfeiffer et al. 2008).
So, should anthropologists study, or at least
grapple with IMF conditionalities, negotia-
tions around wage bill ceilings, Medium Term
Expenditure Frameworks, and NGO codes of
conduct? We argue here that the apparatus and
mechanics of structural adjustment matter—
they indicate sites and points of struggle,
engagement, and resistance (Rowden 2009).
An anthropology of structural adjustment and
public health should become unapologetically
applied, engaged in the pragmatics of service
delivery in the public sector, and committed
to uncovering the institutional and political
processes through which adjustment unfolds
and can be challenged. With these changing
political winds, a surprising surge in resources,
and a growing recognition that health is a
human right, it is perhaps more important
than it has ever been for anthropologists to
engage with our colleagues in other realms,
disciplines, and arenas to resurrect the public
sector and celebrate a new health commons.
159
 AN39CH10-Pfeiffer ARI 20 August 2010 15:11

DISCLOSURE STATEMENT
The authors are not aware of any affiliations, memberships, funding, or financial holdings that
might be perceived as affecting the objectivity of this review.

ACKNOWLEDGMENTS
We gratefully acknowledge the outstanding research assistance provided by Anna Zogas, doctoral
student in the Department of Anthropology at the University of Washington.
by b-on: Inst. Superior de Ciencias do Trabalho e da Empresa (ISCTE) on 05/02/12. For personal use only.

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Annual Review of
Anthropology

Contents Volume 39, 2010

by b-on: Inst. Superior de Ciencias do Trabalho e da Empresa (ISCTE) on 05/02/12. For personal use only.

Prefatory Chapter
A Life of Research in Biological Anthropology
Annu. Rev. Anthropol. 2010.39:149-165. Downloaded from www.annualreviews.org

Geoffrey A. Harrison ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 1

Archaeology
Preindustrial Markets and Marketing: Archaeological Perspectives
Gary M. Feinman and Christopher P. Garraty ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 167
Exhibiting Archaeology: Archaeology and Museums
Alex W. Barker ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 293
Defining Behavioral Modernity in the Context of Neandertal and
Anatomically Modern Human Populations
April Nowell ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 437
The Southwest School of Landscape Archaeology
Severin Fowles ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 453
Archaeology of the Eurasian Steppes and Mongolia
Bryan Hanks ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 469

Biological Anthropology
Miocene Hominids and the Origins of the African Apes and Humans
David R. Begun ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣67
Consanguineous Marriage and Human Evolution
A.H. Bittles and M.L. Black ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 193
Cooperative Breeding and its Significance to the Demographic Success
of Humans
Karen L. Kramer ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 417

Linguistics and Communicative Practices

Enactments of Expertise
E. Summerson Carr ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣17

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The Semiotics of Brand

Paul Manning ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣33
The Commodification of Language
Monica Heller ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 101
Sensory Impairment
Elizabeth Keating and R. Neill Hadder ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 115
The Audacity of Affect: Gender, Race, and History in Linguistic
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Accounts of Legitimacy and Belonging

Bonnie McElhinny ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 309
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Soundscapes: Toward a Sounded Anthropology

David W. Samuels, Louise Meintjes, Ana Maria Ochoa, and Thomas Porcello ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 329
Ethnographic Approaches to Digital Media
E. Gabriella Coleman ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 487

International Anthropology and Regional Studies

Peopling of the Pacific: A Holistic Anthropological Perspective
Patrick V. Kirch ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 131
Anthropologies of the United States
Jessica R. Cattelino ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 275

Sociocultural Anthropology
The Reorganization of the Sensory World
Thomas Porcello, Louise Meintjes, Ana Maria Ochoa, and David W. Samuels ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣51
The Anthropology of Secularism
Fenella Cannell ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣85
Anthropological Perspectives on Structural Adjustment and Public
Health
James Pfeiffer and Rachel Chapman ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 149
Food and the Senses
David E. Sutton ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 209
The Anthropology of Credit and Debt
Gustav Peebles ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 225
Sense and the Senses: Anthropology and the Study of Autism
Olga Solomon ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 241
Gender, Militarism, and Peace-Building: Projects of the Postconflict
Moment
Mary H. Moran ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 261

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Property and Persons: New Forms and Contests

in the Era of Neoliberalism
Eric Hirsch ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 347
Education, Religion, and Anthropology in Africa
Amy Stambach ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 361
The Anthropology of Genetically Modified Crops
Glenn Davis Stone ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 381
by b-on: Inst. Superior de Ciencias do Trabalho e da Empresa (ISCTE) on 05/02/12. For personal use only.

Water Sustainability: Anthropological Approaches and Prospects

Ben Orlove and Steven C. Caton ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 401
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Theme I: Modalities of Capitalism

The Semiotics of Brand
Paul Manning ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣33
The Commodification of Language
Monica Heller ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 101
Anthropological Perspectives on Structural Adjustment
and Public Health
James Pfeiffer and Rachel Chapman ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 149
Preindustrial Markets and Marketing: Archaeological Perspectives
Gary M. Feinman and Christopher P. Garraty ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 167
The Anthropology of Credit and Debt
Gustav Peebles ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 225
Property and Persons: New Forms and Contests in
the Era of Neoliberalism
Eric Hirsch ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 347
The Anthropology of Genetically Modified Crops
Glenn Davis Stone ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 381

Theme II: The Anthropology of the Senses

The Reorganization of the Sensory World
Thomas Porcello, Louise Meintjes, Ana Maria Ochoa and David W. Samuels ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣51
Sensory Impairment
Elizabeth Keating and R. Neill Hadder ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 115
Food and the Senses
David E. Sutton ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 209
Sense and the Senses: Anthropology and the Study of Autism
Olga Solomon ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 241

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Soundscapes: Toward a Sounded Anthropology

David W. Samuels, Louise Meintjes, Ana Maria Ochoa, and Thomas Porcello ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 329

Indexes

Cumulative Index of Contributing Authors, Volumes 30–39 ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 507

Cumulative Index of Chapter Titles, Volume 30–39 ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ ♣ 510
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Errata
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