Making Better Numbers
How Anthropology and Epidemiology Are Revolutionizing Health Science Together
Introduction: When Numbers Lie
We've all seen the headlines: "Study Links Chemical X to Health Problem Y" or "Researchers Find Poverty Causes Worse Health Outcomes." These scientific conclusions shape everything from public policy to medical practice, but what if the numbers behind them are missing crucial parts of the story? What if our health statistics, despite their precise appearance, are actually poor measurements of reality because they fail to capture the complex ways people actually live?
Bioethnographic collaboration brings together anthropologists who study human cultures and societies with epidemiologists and exposure scientists who track health patterns in populations. Together, they're developing a more complete picture of how environment, inequality, and health intertwine 1 .
This revolutionary method is changing how scientists understand everything from sleep patterns to water quality to chemical exposure—and potentially transforming how we address health disparities around the world.
What Is Bioethnography? Beyond Numbers and Narratives
Bioethnography represents a methodological fusion that combines the rich, contextual understanding of ethnographic observation with the precise measurements of biological and environmental science. Unlike traditional interdisciplinary work where different approaches might run in parallel without truly integrating, bioethnography seeks to blend epistemologies—the very ways different disciplines know what they know 2 .
Core Principles
- Individuals aren't always the right unit of analysis—larger social, economic, and political processes shape bodily conditions
- Biological conditions are dynamic and historically shaped rather than static and predetermined
- Open-ended, inductive observation must precede hypothesis testing to avoid missing crucial context 7
Expert Insight
"Without knowing they are doing so, middle-class researchers tend to universalize their own experience and often do not know how to identify the important environmental drivers of the developmental origins of disease" 7 .
— Elizabeth F.S. Roberts, University of Michigan
Traditional Epidemiology vs. Bioethnographic Approach
| Aspect | Traditional Epidemiology | Bioethnographic Approach |
|---|---|---|
| Starting Point | Pre-defined hypotheses based on existing literature | Open-ended ethnographic observation |
| Data Collection | Standardized surveys and biological samples | Ethnographic fieldwork combined with biological sampling |
| Primary Focus | Individual behaviors and characteristics | Larger political-economic processes and environments |
| Context Treatment | Often treated as confounding variable | Central to understanding health outcomes |
| Assumptions | Tendency to universalize researcher experiences | Questions assumptions through immersive fieldwork |
The Mexico City Project: A Decade of Collaboration
The power of bioethnography comes to life in the ongoing Mexican Exposures (MEXPOS) project based in Mexico City. For over ten years, this collaboration has brought together anthropologists, epidemiologists, exposure scientists, biostatisticians, and health economists to study health and inequality in working-class neighborhoods 3 .
The project builds on ELEMENT (Early Life Exposures in Mexico to Environmental Toxicants), a longitudinal birth cohort study that began in 1994. ELEMENT has followed over 1,000 mother-child pairs, mostly from working-class neighborhoods, collecting biological samples (blood, urine, breast milk, hair, toenails, bone, and teeth) and administering questionnaires and psychometric testing 7 .
In 2014, Roberts began collaborating with ELEMENT researchers, living in participant neighborhoods and spending extensive time with six families—documenting their daily routines through field notes, photographs, and recordings. This immersive approach allowed her to observe aspects of life that never appear in standard surveys but might profoundly impact health 7 .
Working-class neighborhood in Mexico City where the MEXPOS study took place
A Closer Look: The Water Intermittency Study
One compelling example of bioethnography in action is the study of water intermittency—the irregular water supply that affects many Mexico City residents. This project demonstrates how ethnographic observation can lead to entirely new research questions and better quantitative measures.
Methodology: From Observation to National Survey
The research unfolded through a multi-stage process:
Research Process
- Ethnographic discovery: Researchers observed household adaptations to irregular water supplies 6
- Hypothesis development: Formed hypotheses about impacts on health and household economics
- Survey development: Created questions for the Mexican National Health and Nutrition Survey
- Iterative refinement: Balanced ethnographic complexity with quantitative comparability 2
- National data collection: Administered survey to 2,595 individuals across Mexico
Results and Analysis: The Hidden Costs of Water Scarcity
The findings revealed a striking paradox: most residents reported satisfaction with water quantity despite inadequate supply because they had developed extensive adaptation strategies. However, these strategies came with significant hidden costs 6 .
| Adaptation Strategy | Percentage of Households | Primary Costs |
|---|---|---|
| Water storage containers | 87% | Financial (cost of containers), space constraints |
| Purchased bottled water | 92% | Financial burden, plastic waste |
| Water reuse practices | 76% | Time investment, potential hygiene issues |
| Alternative water sources | 34% | Financial costs, uncertainty about quality |
| Rely on community networks | 28% | Social obligations, reciprocity demands |
The research demonstrated that the burden of adaptation fell disproportionately on marginalized households, exacerbating existing inequalities. Importantly, the team discovered that water storage practices often led to deterioration in drinking water quality—a previously unrecognized health risk 6 .
Perhaps most significantly, the bioethnographic approach revealed that conventional water metrics focused exclusively on quantity missed these crucial aspects of how water scarcity actually impacts health and household economics.
The Scientist's Toolkit: Essentials for Bioethnographic Research
Conducting successful bioethnographic research requires specific approaches and resources. Based on the MEXPOS projects, here are the essential components of this innovative methodology:
| Research Component | Function in Bioethnography | Examples from MEXPOS |
|---|---|---|
| Long-term ethnographic field work | Provides deep contextual understanding of participants' lives | Researcher living in Mexico City neighborhoods for a year, conducting regular household visits 7 |
| Biological sampling kits | Measures chemical exposures and biological processes | Collection of blood, urine, hair, and teeth samples for chemical analysis 7 |
| Multi-disciplinary team | Integrates diverse expertise and methodologies | Anthropologists, epidemiologists, engineers, biostatisticians working together 2 |
| Mediators | Facilitate communication across disciplinary boundaries | Junior researchers translating concepts between disciplines 2 |
| Iterative research design | Allows incorporation of ethnographic insights into quantitative methods | Adjusting survey questions based on initial fieldwork findings 2 |
| Flexible funding structures | Supports unconventional timelines and methodologies | Funding from NSF, Wenner-Gren Foundation, and University of Michigan 1 |
Team Composition
Successful bioethnography requires diverse expertise spanning anthropology, epidemiology, statistics, and environmental science.
Mediator Role
Mediators with cross-disciplinary training are essential for translating concepts and facilitating collaboration 2 .
Iterative Process
Research design must be flexible enough to incorporate insights from ongoing ethnographic fieldwork 2 .
The Challenges and Rewards of Working Across Disciplines
Bioethnographic collaboration doesn't come easily. Researchers report that the process can feel "awkward, clunky, and falter as members navigate the integration and destabilization it requires" 2 . Different disciplines often have conflicting:
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Timelines: Ethnography requires extended, open-ended time, while epidemiology often works with fixed funding cycles
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Epistemological frameworks: What counts as evidence varies between disciplines
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Analytical priorities: Anthropologists often seek complexity and context, while quantitative researchers may prioritize generalizability
These tensions create what collaborators call "generative friction"—moments of misunderstanding that reveal disciplinary assumptions and blind spots 2 . Rather than smoothing over these differences, successful bioethnographic teams harness them to produce new insights.
Benefits of Bioethnographic Collaboration
Conclusion: The Future of Making Better Numbers
Bioethnographic collaboration represents more than just a methodological innovation—it offers a fundamentally different way of understanding health and inequality. By taking seriously how social and biological processes intertwine in people's actual lives, this approach produces numbers that better reflect reality as experienced rather than reality as measured through disciplinary conventions.
"Numbers are necessary within policy making and life science worlds. For anthropology, one question is, can bioethnography make numbers that are truly tethered to the complex relationships that hold health conditions and inequality in place?" 3 .
The promise of bioethnography lies in its ability to create knowledge that can inform both scientific understanding and public policy while remaining attentive to the complexity of people's lives. As health challenges become increasingly complex in an interconnected and unequal world, making better numbers might be exactly what we need to build healthier futures for all.
This approach continues to evolve as researchers develop new ways to integrate ethnographic and biological data. Current projects are exploring everything from how household chemical exposures intersect with cultural practices to how sleep arrangements impact adolescent development 7 . Each project further refines the method while generating insights that would remain invisible through single disciplinary approaches.