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Social science has long recognized the importance of understanding how interactions between culture and behavior shape disease patterns, especially in resource-poor areas where individuals draw on multiple medical treatments to maintain health. While global health programs aimed at controlling high infection rates of soil-transmitted helminthes among indigenous groups often acknowledge the value of local culture, little research has been able to examine this value. This study investigates the association between parental ethnomedical knowledge, parental biomedical knowledge, and household sanitation behavior and childhood soil-transmitted helminth infections among a group of foragers-farmers in the Bolivian Amazon (Tsimane'). During 2007, a parasitological survey was completed for 329 children (≤ 16 years of age) from 109 households in combination with a comprehensive survey of both of the child's parents to assess biomedical and ethnomedical knowledge and household sanitary environment. Soil-transmitted helminthes were found to be common with 67% of sample positive for hookworm species. Indices that capture a household's relative state of risky and preventive hygienic behavior were significantly associated with risk of hookworm infection. Mother's but not father's ethnomedical knowledge was also negatively associated with a child's probability of being positive for hookworm infection. The effect was stronger for young children and boys. Like many rural populations, Tsimane' actively draw upon multiple medical systems to respond to health challenges. Integration into markets and national societies is likely to affect local medical systems by increasing the use of biomedicine as formal education prioritizes biomedical over ethnomedical systems. This study underscores the value of considering both ethnomedical knowledge systems and household hygiene in public health campaigns to treat and control soil-transmitted helminths. There is no question that providing medication is critical, but this study demonstrates that poverty is not synonymous with either poor hygiene or the lack of valuable ethnomedicinal knowledge., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Research on the social determinants of health has highlighted (a) the adverse effects of social inequality on individual health and (b) the association between individual social rank and health. In this paper, we contribute to the growing literature on the health consequences of social inequalities by assessing the association between village level inequality in social rank, a form of non-material inequality, and indicators of nutritional status. We use quantitative survey information from 289 men (18+ years of age) from a society of forager-farmers in the Bolivian Amazon (Tsimane'). We construct village level measures of non-material inequality by using individual measures of men's positions in the village hierarchy according to prestige (or freely conferred deference) and dominance (or social rank obtained through power). We find that village inequality in dominance, but not village inequality in prestige, is associated with short-term indices of individual nutritional status. Doubling the coefficient of variation of dominance in a village would be associated to a 6.7% lower BMI, a 7.9% smaller mid-arm circumference, and a 27.1% smaller sum of four skin folds of men in the village. We also find that once we decouple individual social rank based on dominance from individual social rank based on prestige, only prestige-based social rank is associated with nutritional status. Potential explanations for our findings relate to the differential forms of resource access derived from the two forms of social hierarchies and to the social and psychological benefits associated with prestige versus the social costs and psychological stress generated by dominance.

Research with humans and non-human primate species has found an association between social rank and individual health. Among humans, a robust literature in industrial societies has shown that each step down the rank hierarchy is associated with increased morbidity and mortality. Here, we present supportive evidence for the social gradient in health drawing on data from 289 men (18+ years of age) from a society of foragers-farmers in the Bolivian Amazon (Tsimane'). We use a measure of social rank that captures the locally perceived position of a man in the hierarchy of important people in a village. In multivariate regression analysis we found a positive and statistically significant association between social rank and three standard indicators of nutritional status: body mass index (BMI), mid-arm circumference, and the sum of four skinfolds. Results persisted after controlling for material and psychosocial pathways that have been shown to mediate the association between individual socioeconomic status and health in industrial societies. Future research should explore locally-relevant psychosocial factors that may mediate the association between social status and health in non-industrial societies.

Researchers have found a positive association between income inequality and poor individual health. To explain the link, researchers have hypothesized that income inequality erodes community social capital, which unleashes negative emotions, stress, and stress behaviors that hurt health. Few studies have tested the hypothesized path. Here we estimate the association between (a) village income inequality and social capital, and (b) three distinct negative emotions (anger, fear, sadness) and one stress behavior (alcohol consumption). We use four quarters of panel data (2002-2003) from 655 adults in 13 villages of a foraging-farming society in the Bolivian Amazon (Tsimane'). We found that: (1) village income inequality was associated with more negative emotions but with less alcohol consumption, (2) social capital always bore a negative association with outcomes, and (3) results held up after introducing many changes to the main model. We conclude that village income inequality probably affects negative emotions and stress behaviors through other paths besides social capital because we conditioned for social capital. One such path is an innate dislike of inequality, which might have pre-human origins. Our prior research with the Tsimane' suggests that village income inequality bore an insignificant association with individual health. Therefore, village income inequality probably affects negative emotions and stress behaviors before undermining health.

Evidence has been accumulated about the adverse effects of income inequality on individual health in industrial nations, but we know less about its effect in small-scale, pre-industrial rural societies. Income inequality should have modest effects on individual health. First, norms of sharing and reciprocity should reduce the adverse effects of income inequality on individual health. Second, with sharing and reciprocity, personal income will spill over to the rest of the community, attenuating the protective role of individual income on individual health found in industrial nations. We test these ideas with data from Tsimane' Amerindians, a foraging and farming society in the Bolivian Amazon. Subjects included 479 household heads (13+ years of age) from 58 villages. Dependent variables included anthropometric indices of short-run nutritional status (body-mass index (BMI), and age- and sex-standardized z-scores of mid-arm muscle area and skinfolds). Proxies for income included area deforested per person the previous year and earnings per person in the last 2 weeks. Village income inequality was measured with the Gini coefficient. Income inequality did not correlate with anthropometric indices, most likely because of negative indirect effects from the omission of social-capital variables, which would lower the estimated impact of income inequality on health. The link between BMI and income and between skinfolds and income resembled a U and an inverted U; income did not correlate with mid-arm muscle area. The use of an experimental research design might allow for better estimates of how income inequality affects social capital and individual health.

Acute respiratory infections (ARI) are responsible for one quarter to one third of all deaths in infants and young children, with most deaths being attributed to pneumonia. At present, few measures exist to prevent pneumonia. However, most pneumonia deaths can be averted by treatment with an appropriate antibiotic. The effectiveness of this strategy depends on families' ability to recognize the signs of pneumonia, and to promptly seek care from a trained health practitioner. In order for health workers to communicate effectively with families about how to care for children with ARI, what signs to watch for, and when to come back for care, they need to know how families perceive and respond to respiratory infections. The WHO ARI Programme has recently developed a research protocol for conducting ethnographic studies of community perceptions and practices related to ARI. The purpose of this protocol is describe communities' explanatory models for ARI, identify cultural and other factors that facilitate or constrain appropriate home care and careseeking for children with ARI, and make recommendations to national ARI programmes about how to develop effective communication activities. This paper reports on two studies conducted in Bolivia using the WHO/ARI Focused Ethnographic Study (FES) protocol, and describes the way in which the data were utilized by the national ARI programme.