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Re-imagining global health through social medicine
... What has been missing from some of these debates is close attention being paid to how these processes take place 'on the ground' and whether they may be conceptualized in terms of a dynamic interplay (instead of a dichotomist split) between the global and the local and between the medical and the social (see Amin 2002;Adams et al. 2019). In the Portuguese setting, for instance, an unprecedented episode took place in which a methylphenidate-based psychostimulant was out of stock between April and June 2012 (Palha 2012). ...
... Such transformation calls for a renewed, critical perspective on the classic thesis of medicalization as it implies a culturally normative (and tendentially universalizing) view of medical knowledge and professionalism. This view tends to obscure cultural practices and everyday popular discourses about medicine and psychiatry as these are experienced outside English-speaking countries and in semiperipheral contexts (Filipe 2018(Filipe , 2020a(Filipe , 2020b) that do not fit neatly into the global North/South divide (see also Adams et al. 2019). ...
... Instead, it implies looking at what the interplay between medical globalization and social localization processes carries forward and leaves behind, how they shape the circulation and contextualization of pharmaceuticals, and how this process unfolds across multiple scales and spheres of action. More broadly, and in line with what Adams et al. (2019) argued recently, this conceptualization calls into question dichotomist framings in the context of global health that reinforce the divide between the medical versus the social and between the global versus the local. Those framings may indeed obfuscate the multiscalar social dynamics that underpin, in this case, the commercialization, prescription, and Content courtesy of Springer Nature, terms of use apply. ...
The last two decades have seen an exponential growth in the consumption and prescription of psychostimulants for the treatment of attention deficit hyperactivity disorder (ADHD) worldwide. While much has been said in the literature about the medicalization and globalization of ADHD, comparatively less is known about how these processes play out on the ground and outside English-speaking countries, where psychostimulants have become the first-line treatment for ADHD. By combining historical and clinical ethnographic research, this article charts the transnational histories and everyday lives of psychostimulants in Portugal at the nexus between what I term processes of medical globalization and social localization. It explores how international medical standards and pharmaceutical regulations converged with local prescribing trends and sociomaterial contingencies that placed this small Southern European country among the top 20 world consumers of methylphenidate. Following a methylphenidate shortage and the social explanations of clinicians, this exploration also shows how the dissemination of pharmaceutical sales and prescribing data by the media triggered a public––and increasingly politicized––debate on psychostimulant drug treatments. More broadly, this article illuminates how psychopharmaceuticals are circulated, contextualized, marketed, and modulated in their journey and it advances a relational and processual understanding of their shifting, multiscalar configurations.
... Therefore, systemic change is hindered not by a lack of means, but by the entrenched paradigm within sustainable development that views progress as linear material growth. If we are to reconcile the humanity-nature dualism and challenge the "economisation of life," (Adams et al., 2019(Adams et al., , p. 1388 we must dissolve the traditional conflation of progress with production and supersede it with alternative views. ...
... 39). Adams et al. (2019) further conceptualise this phenomenon in the "economisation of life" (p. 1388); whereby, the incentive to achieve social good hinges on its relevance to the horizon of the national economy. ...
This paper argues that the current growth-centric paradigm of sustainable development is fundamentally flawed and proposes a paradigm shift towards the biblical concept of the Sabbath. It critiques the internal contradictions of the SDGs and challenges the unsustainable pursuit of infinite growth in addressing social and ecological crises. By exploring Sabbath's principles of rest, recalibration, and redistribution, the paper offers an ethical foundation for self-limitation and a basis for human identity beyond productivity—addressing the shortcomings of the degrowth movement. It proposes practical applications of Sabbath principles at individual, community, and structural levels, drawing upon empirical examples to demonstrate their potential as pathways to environmental justice. These multi-level applications aim to bridge the gap between the intentions of international agreements and impactful local action. The paper concludes that Sabbath presents a transformative vision for sustainable development and environmental justice, fostering a harmonious relationship between humanity and the planet. Keywords: Sustainability, Development, Sabbath, Degrowth, Capitalism, Environmental Justice, Poverty, Well-being, Ethics, Religion.
... This theoretical approach and the argument I make in this article represents a departure from the notion that epidemiology, through its prioritization of measurements and numbers, leads to the erasure or neglect of the social, understood as people's experiences and narratives. This notion, which has a long history in Western thought, has been a recurring theme in many anthropological writings on global health metrics (Porter 2012; and see Adams et al. 2019;Erikson 2012;Lorway 2017). For example, Joao Biehl and Adriana Petryna (2013: 17-18), in their influential work on global health, argue that the "lives and stories" of "people on the ground"-what they call the "unpredictable social"-are "often smoothed over and averaged out by coarse-grained statistics." ...
... First, epidemiologists' choice of the social survey as their preferred research method impacts the sort of stories they can and cannot tell about smokers and smoking. Indeed, the structured questionnaires they tend to use do not generally allow them to say much about the web of meanings that people attach to smoking, in contrast to researchers committed to ethnography and thick description (Adams et al. 2019;Porter 2012). Second, to craft an ideal type like the African smoker, epidemiologists need to accentuate traits that hold across the continent while erasing unique individual qualities and regional variations (Adams 2016). ...
There is a growing anthropological literature analyzing the place that epidemiological surveillance occupies in contemporary global health. In this article, I build on this literature and take it into new directions by exploring what I call the epidemiological imaginaries of the social. Drawing on science and technology studies, I suggest that epidemiologists help make up the world, articulating complex and normatively loaded visions of social life that both enable and constrain action. More specifically, I argue that epidemiologists tell stories about the type of societies and people that compose the world and that these stories often shape global health policies and programs in powerful ways. To substantiate this argument, I examine epidemiologists’ efforts to map smoking in postcolonial Africa, documenting how they have imagined smokers and smoking through the lense of modernization theory and showing how these imaginaries have shaped tobacco control policies in the region up to this day.
... The framework presents one potential alternative to the present context and processes in global health research, policy and practice. The conceptualization of this imagined future does not aim to evaluate or predict the future of global health as a field, but rather explore one possible vision of change as it relates to ASRH policy, research, and practice [37,39,44,47,48,52,[54][55][56][57]. The framework describes two overarching shifts in this potential future, first, shifting the power in how we do global health and second, shifting the paradigm in which we think about global health. ...
Increasing global inequities have led to ongoing critiques of both the historical roots and current practices in global health. From this literature, questions have emerged about the future of global health and Canada’s role in this future. However, there is little research exploring the role of Canadian policy for global health funding and the experience of stakeholders that currently implement projects with Canadian funding. This study explores stakeholder perspectives of how Canada’s Feminist International Assistance Policy (FIAP) influences adolescent sexual and reproductive health (ASRH) projects and how these perspectives align with calls for change in global health as proposed by Chidwick et al. in the conceptual framework for an imagined future for global health. This study was conducted from February to May 2023 through eight interviews with key informants who were working on ASRH projects, funded through Global Affairs Canada. The study approach included stakeholder analysis and qualitative description. Results highlight the role of Canadian organizations in ASRH projects, importance of partnerships, influence of the FIAP, operational and contextual tensions that arise from implementing FIAP values in ASRH projects outside of Canada, along with stakeholder views on moving forward in global health policy and practice. Findings indicate that the language of the FIAP is aligned with calls for change in global health although there is opportunity for further action towards operationalizing this change. Specifically, findings highlight opportunity to create more flexible funding processes, expand monitoring and evaluation approaches to better include feminist approaches, promote rights-based and dignity-based practices in ASRH, and increase timelines to facilitate greater consultation and partnership building with communities. In conclusion, the FIAP creates an impactful foundation for change towards equity and justice in ASRH projects, although Canadian funding structures and processes need to continue to re-imagine how they support organizations to action these changes.
... Previous literature has highlighted the challenges of Social Prescribing implementation and evaluation (Adams, Behague, Caduff, Lowy, & Ortega, 2019;Bickerdike et al., 2017;Cunningham et al., 2023). The NHS (2014NHS ( , 2017 has also advocated the need for more robust evidence regarding the efficacy of Social Prescribing to produce evidence-based initiatives. ...
The UK's National Health Service has introduced Social Prescribing initiatives to tackle loneliness and ill‐health, yet it lacks a theoretical foundation and evidence base for Social Prescribing's effectiveness. Recent research applies the Social Identity Approach to Health (SIAH) to explain Social Prescribing's health benefits, emphasising how social connection unlocks health‐enhancing psychological mechanisms. This systematic review therefore aims to assess UK‐based Social Prescribing programmes designed to boost social connection and alleviate loneliness, examining programme efficacy and the role of SIAH processes in health outcomes. Following PRISMA guidelines, a narrative synthesis of articles published from May 5, 2006 (when social prescribing was first introduced in the NHS), to April 8, 2024, was conducted, and their quality assessed using CONSORT‐SPI (2018). Of these programmes, 10 employed a mixed‐methods design, 8 qualitative and 1 quantitative service evaluation, totalling 3,298 participants. Results indicate that Social Prescribing's psychological value lies in quality rather than quantity of social connections, with meaningful connections fostering shared identity, perceived support and self‐efficacy, the latter of which sustains social engagement post‐programme. The SIAH was a useful tool for mapping mixed‐methods findings onto a common theoretical framework to highlight these key proponents. Overall, this review underscores the importance of SIAH‐informed Social Prescribing interventions in enhancing social connectedness, reducing loneliness, and promoting overall health. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.
... As they contend, the narrowing of global health constitutes a coloniality of power and the end result is a more impoverished field in both intellectual and practical terms. Adams and colleagues argue that global health can be seen as a 'new regime of representation and intervention' (Adams et al., 2019(Adams et al., : 1384. ...
... (sanitaristas), when conceiving the term 'Collective Health' (Saúde Coletiva), sought distance from the traditional notion of Public Health and to incorporate the consideration of social determinants in health as one of the pillars to understand and act on the health of collectivities [12,13]. The Brazilian health reform project also had as a horizon the need for societal transformation as a whole, including the reorganization of power relations, based on the values of social justice and human rights [10,11,14,15]. ...
This essay aims to explore possibilities and challenges for the future of Social Medicine. [1] It is inspired by empirical ethnographic research, as part of a PhD in Collective Health, in a Brazilian public maternity hospital, which does not escape the contradictions of being part of a universal health system immersed in a context of deep racial, gender, social, and economic inequalities. To understand how the contradictions generated by social inequalities shape health services, relationships, subjectivities, and bodies, I analysed the hospital as an englobing technology in the care of abortion complications in Brazil. One of the key arguments is that stratification shapes practices and uses of biomedical technologies in health care [1]. Based on this experience analysing clinical encounters, in this essay, I briefly turn to the history of Brazilian Collective Health, along with theoretical and methodological inspirations from the field, to reflect on challenges for the future of social medicine [2,3,4]. To deepen the understanding of the dynamics of social relations established in the hospital, it was necessary to further the understanding of how the Brazilian health system is organized. My ethnographic research reveals that this specific organization is expressed in the ways of caring for women who seek the maternity ward to treat their health problems, for example.
... La mera noción de Norte-Sur Global es una metáfora del sufrimiento humano generado por la desigualdad que hace cuestionables las categorizaciones divisorias entre países ricos y pobres. Así, las etiquetas "Norte-Sur Global" son meros intentos correctivos para reemplazar conceptos anteriores de "Primer-Tercer Mundo" o "desarrollado-subdesarrollado", peor percibidos (Adams et al., 2019) y que van más allá de lo meramente geográfico. ...
El confinamiento contra la COVID-19 fue una de las medidas más globalizadas en el 2020. Sin embargo, su implementación e impacto en diferentes poblaciones fue muy dispar y su efecto en poblaciones del Sur Global sigue ampliamente invisibilizado aun tres años después. Este artículo, basado en un estudio cualitativo multisituado, es un acercamiento a esas otras realidades que quedaron ocultas. Explora diferentes experiencias del confinamiento y cómo se aplicaron en poblaciones de pocos recursos, desde la percepción de trabajadores humanitarios. Aunque los datos muestran que el confinamiento pudo contribuir a reducir la trasmisión y la mortalidad al inicio de la pandemia, los impactos adversos derivados de su universalización y duración hacen cuestionar el equilibrio riesgo/beneficio considerado para colectivos vulnerabilizados sin recursos, para quienes era inviable su implementación. Datos del estudio muestran la percepción de que, al poco tiempo de instaurarse, el confinamiento se instrumentalizó con fines más políticos que sanitarios. La sindemia devenida de la COVID-19 ha dado visibilidad a una relación entre el Norte y el Sur Global caracterizada por la hegemonía de los países más ricos en la toma de decisiones sobre políticas de salud. Estados, instituciones como la OMS y también organizaciones humanitarias han fracasado a la hora de adaptar las medidas a las diferentes poblaciones y apoyar a los más vulnerabilizados, poniendo de manifiesto resquicios colonialistas bajo nuestro concepto de salud global.
... We can include, in the case of P4, "prevention", "evidence", "risk", and "medicalization". According to Adams et al. 39 , such categories are not self-evident entities that exist in the world like "trees or rocks", but are mutable and synergistic concepts that play a complex role in helping us understand the human experience. ...
We conducted a genealogical analysis of quaternary prevention, an instrument of primary health care to address overmedicalization and iatrogenesis, based on related statements and interviews with the creators of this concept. This tool has been used in the reformulation of care and the doctor-patient relationship, but limited to the risk-benefit assessment by using current scientific evidence. In this study, we analyze the paradoxes of evidence-based medicine (EBM) and discuss the relationship of EBM and quaternary prevention and primary health care (PHC). Finally, we suggest questioning the truth of the evidence for the development of other health paradigms.
... Estas posturas críticas compartilham as dúvidas em torno de categorias estáveis como gênero, corpo, sujeito, sexo etc. Podemos incluir, no caso da P4, a "prevenção", a "evidência", o "risco" e a própria "medicalização". Como apontam Adams et al. 39 , tais categorias não são entidades autoevidentes que existem no mundo como "árvores ou pedras", mas conceitos mutáveis e sinérgicos que têm um papel complexo em nos ajudar a entender a experiência humana. ...
Resumo Realizamos uma análise genealógica da Prevenção Quaternária, instrumento da Atenção Primária à Saúde de enfrentamento à medicalização e a iatrogenia, a partir de seus enunciados e de entrevistas com seus formuladores. Identificamos que a ferramenta tem sido tanto apresentada como uma reformulação do cuidado e da relação médico-paciente, como também reduzida ao cálculo do risco-benefício por meio da aplicação atualizada de evidências científicas. Analisamos os paradoxos da Medicina Baseada em Evidências e problematizamos sua relação com a Prevenção Quaternária e a Atenção Primária à Saúde. Por fim, sugerimos questionar a verdade das evidências para o desenvolvimento de outros paradigmas de saúde.
... Iniciativas desse tipo contribuem para exportar modelos ocidentais de doença e tratamento, subestimam o papel dos praticantes da medicina tradicional, ignoram a variabilidade cultural na avaliação e resposta ao sofrimento mental, que é medicalizado, e negligenciam suas causas sociais e econômicas em países de baixa e média renda (ORTEGA; WENCESLAU, 2020). Neste e em outros exemplos, o "global" efetivamente se equipara ao domínio da formulação de políticas liderada pelos ideais e expertise em países do Norte Global, frequentemente endossados de maneira oficial pela OMS, e o "local" se identifica com as experiências de base no Sul Global, que geralmente não cumprem os objetivos e padrões da política global (ADAMS et al., 2019;BÉHAGUE;STORENG, 2013). ...
The essay explores Japan's policies of containing infection without heavy reliance on legally imposed lockdowns or digital surveillance. It examines the ‘social measures’ that local governments and the Ministry of Health relied on, including consistent public health messaging, contact tracing, education, with a focus on behavior modification. The pandemic worldwide has highlighted the importance of society in addition to the state in controlling infection. This article points out the benefits of this form of social control as well as its trade-offs, including stress concerning social expectations, informal forms of social control, and incidences of harassment and discrimination against the diseased.
Point-of-care tests (POCTs) have become technological solutions for many global health challenges. This meta-ethnography examines what in-depth qualitative research reveals about the “social lives” of POCTs from, highlighting key social considerations for policymakers, funders, developers and users in the design, development and deployment of POCTs. We screened qualitative research examining POCTs in low- and middle-income countries (LMICs) and selected 13 papers for synthesis. Findings illuminate five value-based logics—technological autonomy, care, scalability, rapidity and certainty—shaping global health innovation ecosystems and their entanglement with health systems. Our meta-ethnography suggests POCTs never achieve the technological autonomy often anticipated during design and development processes. Instead, they are both embedded in and constitutive of the dynamic relationships that make up health systems in practice. POCTs are often imagined as caring commodities; however, in use, notions of care inscribed in these devices are constantly negotiated and transformed in relation to multiple understandings of care. POCTs promise to standardize care across scale, yet our analysis indicates non-standard processes, diagnoses and treatment pathways as essential to “fluid technologies” rather than dangerous aberrations. The rapidity of POCTs is constructed and negotiated within multiple distinct temporal registers and POCTs operate as temporal objects that can either speed up or slow down experiences of diagnosis and innovation. Finally, while often valued as epistemic tools that can dispel diagnostic uncertainty, these papers demonstrate that POCTs contribute to new forms of uncertainty. Together, these papers point to knowledge practices as multiple, and POCTs as contributing to, rather than reducing, multiplicity. The values embedded in POCTs are fluid and contested, with important implications for the kind of care these tools can deliver. These findings can contribute to more reflexive approaches to global health innovation, which take into account limitations of established global health logics, and recognise the socio-technical complexity of health systems.
The arrival of Afro-descendant migrants, mainly from Haiti and the Dominican Republic, has led to the emergence of new discourses on migration, multiculturalism, and mental health in health services in Chile since 2010. In this article, I explore how mental health institutions, experts, and practitioners have taken a cultural turn in working with migrant communities in this new multicultural scenario. Based on a multisited ethnography conducted over 14 months in a neighbourhood of northern Santiago, I focus on the Migrant Program—a primary health care initiative implemented since 2013. I argue that health practitioners have tended to redefine cultural approaches in structural terms focusing mainly on class aspects such poverty, social stratification, and socioeconomic inequalities. I affirm that this structural-based approach finds its historical roots in a political and ideological context that provided the conditions for the development of community psychiatry experiences during the 1960s and 1970s, as well as in multicultural and gender policies promoted by the state since the 1990s. This case reveals how health institutions and practitioners have recently engaged in debates on migration and intersectionality from a structural approach in Chile.
The emergent threat of antimicrobial resistance (AMR) has resulted in debates around the use and preservation of effective antimicrobials. Concerns around AMR reflect a history of increasing dependence on antibiotics to address disease epidemics rooted in profound structural and systemic challenges. In the context of global health, this process, often referred to as pharmaceuticalisation, has commonly occurred within disease programmes, of which lessons are vital for adding nuance to conversations around antimicrobial stewardship. Tuberculosis (TB) is a notable example. A disease which accounts for one-third of AMR globally and remains the leading cause of death from a single infectious agent in many low – and middle-income countries, including South Africa. In this scoping review, we chart TB science in South Africa over 70 years of programming. We reviewed published manuscripts about the programme and critically reflected on the implications of our findings for stewardship. We identified cycles of programmatic responses to new drug availability and the emergence of drug resistance, which intersected with cycles of pharmaceuticalisation. These cycles reflect the political, economic, and social factors influencing programmatic decision-making. Our analysis offers a starting point for research exploring these cycles and drawing out implications for stewardship across the TB and AMR communities.
To explore the narrowing of the concept of ‘global’ in global health, this article traces how Latin America has held a place of both privilege and power as well as marginalisation in the field. We employ a modified extended case method to examine how Latin America has been ‘seen’ and ‘heard’ in understandings of global health, underscoring the region’s shifting role as a key site for research and practice in ‘tropical medicine’ from the mid-nineteenth century through World War II, to a major player and recipient of development assistance throughout the ‘international health’ era after World War II until the late twentieth century, to a region progressively marginalised within ‘global health’ since the mid-1980s/1990s. We argue that the progressive marginalisation of Latin America and Southern theory has not only hurt health equity and services, but also demonstrates the fundamental flaws in contemporary ‘global’ thinking. The narrowing of global health constitutes coloniality of power, with Northern institutions largely defining priority regions and epistemic approaches to health globally, thus impoverishing the field from the intellectual resources, political experience, and wisdom of Latin America’s long traditions of social medicine and collective health.
En este artículo exploramos las contradicciones y conflictos epistémicos, políticos y éticos que los profesionales de la salud mental encarnan en el trabajo tanto con migrantes haitianos como con agrupaciones de usuarios y exusuarios activistas en el contexto del sistema público de salud mental en Chile, marcado por procesos de neoliberalización durante los últimos treinta años. A partir de dos etnografías, argumentamos que el trabajo con ambos grupos interpela a los profesionales de salud mental respecto del alcance de sus disciplinas y en un plano profesional-individual. Lejos de reproducir pasivamente discursos y prácticas de dominación, los profesionales encarnan contradicciones y conflictos a partir de la incompatibilidad entre disciplinas “psi”; los conocimientos y prácticas ancladas a la medicina haitiano-creole y el vudú; y los cuestionamientos radicales a diagnósticos y tratamientos desarrollados por las agrupaciones de usuarios y exusuarios activistas. Los profesionales transforman y legitiman sus prácticas, interrogando y desafiando las concepciones universalistas de la identidad, la mente, el sufrimiento y el tratamiento. Enfatizamos que, más que un ejercicio intelectual, un llamado a la decolonización implica la politización de la práctica profesional en, o fuera de, los bordes de la psiquiatría y la salud mental en tanto sistema de gobierno.
Blockchain technology together with allied cryptocurrencies could have immense implications in both global health financing and global health equity and, eventually, contribute tremendously to universal health coverage. The Blockchain technology can ensure direct financial transactions for universal health coverage without third parties' interference, introduce novel multilateral financing options, enhance security, reduce fraud and corruption, and provide ample opportunities for free markets of health data, essential for discovery and innovation. Although blockchains present a secure, privacy-enabled, and accurate mechanism to store and exchange healthcare information and support for universal health coverage, there exist inherent dangers in the sectors that entail effective legal and regulatory measures. Additionally, there remains a significant knowledge gap encompassing the application of Blockchain technology in the universal healthcare systems, associated dilemmas, prospects, and policy options. This chapter aims to clarify the legal aspects of universal health coverage, application of Blockchain technology in diverse areas of healthcare systems, and regulatory and policy challenges along with their implications and finally, offers appropriate policy recommendations. To comprehend the relevant facts, findings, and issues, extensive literature was analyzed from both primary and secondary sources. The study employed the content analysis technique in reaching the concluding remarks by way of the authors' analysis. Finally, the findings have been demonstrated descriptively.
This study examines efforts to integrate social medicine into global health education and its potential to guide the new practice of structural competency. The methods employ participant observation and interviews with program coordinators and participants in a social medicine course. Areas of success included: pedagogical innovation, conscientizing course participants, decentralising global health practice, and promoting reflexivity. Accompanying these successes were points of friction, including: inequities in personal risk and mobility limitations among course participants, as well as complexities and nuances in unintentionally reproducing hierarchies of knowledge. Specifically, further recommendations from our research include: (1) incorporating innovative pedagogical approaches, which highlight social medicine practices outside the global north, prioritising opportunities for cross-collaboration among practitioners from the global south; (2) framing social theory as a bidirectional flow: global south traditions must be included in teaching social theory; (3) practising structural humility by highlighting the perspectives and expertise of communities experiencing social and structural marginalisation, while including strategies in organising and direct pathways to political engagement. These conclusions highlight how social medicine-based training can both build from and move beyond the competencies explicitly specified by the structural competency model to create a global health practice inclusive of diverse thought from around the world.
Health care systems throughout the United States are initiating collaborations with social services agencies. These cross-sector collaborations aim to address patients' social needs-such as housing, food, income, and transportation-in health care settings. However, such collaborations can be challenging as health care and social service sectors are composed of distinct missions, institutions, professional roles, and modes of distributing resources. This paper examines how the "high-risk" patient with both medical and social needs is constructed as a shared object of intervention across sectors. Using the concept of boundary object, we illustrate how the high-risk patient category aggregates and represents multiple types of information-medical, social, service utilization, and cost-in ways that facilitate its use across sectors. The high-risk patient category works as a boundary object, in part, by the differing interpretations of "risk" available to collaborators. During 2019-2021, we conducted 75 semi-structured interviews and 31 field observations to investigate a relatively large-scale, cross-sector collaboration effort in California known as CommunityConnect. This program uses a predictive algorithm and big data sets to assign risk scores to the population and directs integrated health care and social services to patients identified as high risk. While the high-risk patient category worked well to foster collaboration in administrative and policy contexts, we find that it was less useful for patient-level interactions, where frontline case managers were often hesitant or unable to communicate information about the risk-based eligibility process. We suggest that the predominance of health care utilization (and its impacts on costs) in constructing the high-risk patient category may be medicalizing social services, with the potential to deepen inequities.
High-income countries (HICs) which are said to have “reached” universal health coverage (UHC) typically still have coverage gaps, due to both formal policies and informal barriers which result in “hypothetical access”. In England, a user fee exemption has in principle made access to treatment for post-traumatic stress disorder (PTSD) and other mental health conditions thought to be caused by certain forms of violence universal, regardless of immigration status. This study explores the everyday governance of this mental health coverage for forced migrants in the English National Health Service (NHS) and NGO sector. Fieldwork was conducted in two waves, in 2015–2016 and 2019–2021, including six months of participant observation in an NGO and 21 semi-structured interviews with psy professionals across 16 NHS and NGO service providers. Further interviews were conducted with mental health commissioners and policymakers, as well as analysis of grey literature. Despite being formally covered for certain types of mental health care, in practice asylum seekers and undocumented migrants were often excluded by NHS providers. Undocumented migrants were also often excluded by NGO providers. Several rationalities linked discursive fields to practices developed by psy professionals and other street-level bureaucrats to govern coverage, in a process of “managing failure”. These rationalities are presented under three paired themes which draw attention to tensions and resistance in the governance of coverage: medicalisation and biolegitimacy; austerity and ethico-politics; and differential racialisation and decolonisation. Rationalities were associated with strategies and tactics such as social triage, clinical advocacy, obfuscation, evidence-based advocacy and silencing critique. The concept of “health coverage assemblage” is introduced to explain the complex, unstable, contingent and fragmented nature of UHC policies and programmes. Misrecognition and underestimation of the everyday work of health professionals in promoting, resisting and reproducing diverse rationalities within the assemblage may lead to missed opportunities for reform.
The notion of an ‘ignorant public’ is attributed in outbreak scenarios through dominant vaccination narratives that are institutionally reinforced by governments and the media across different contexts. The ignorant public narrative is a discursive shift that reduces public concerns about vaccines to a lack of knowledge, obscuring how these concerns are indicative of mistrust and anxiety or efforts to counter the dominance of acceptable and legitimate knowledge. This narrative risks a deflection of challenges in the structural determinants of vaccine uptake and depoliticise rumours and mistrust that arise during vaccination campaigns. Examples from Sierra Leone, Uganda, and India show how ‘ignorant public’ framings are used as explanation for vaccine hesitancy through assigned roles for institutions and publics, and the consequences this narrative has for vaccination encounters. These examples are based on ethnographic fieldwork and media analysis carried out before, during, and after outbreaks, of newly introduced vaccines for both human and animal health. Drawing on science communication and development studies, we show how this narrative then positions governmental concern about vaccine hesitancy as being a (largely) imagined issue of public ignorance. We argue that when institutions tasked with strengthening vaccine uptake see public ignorance as the key problem, this can obscure other problems, such as competing interests and experiences, and also minority group treatment. As a result, public governance is rationalised by assigning the ignorance label to certain public groups that stand in contrast to scientific and government expertise, and so accountability for low vaccine uptake is transferred onto the public.
The critique of global health is a longstanding tradition in the global health humanities (GHH). Typically, this critique takes an expected tack: critics take a slice of global health, identify its rhetoric, expose its power, and elucidate its unanticipated consequences. Here, I subject global health critique to its own approach—conducting a ‘rhetorical review’ of global health critique in order to ascertain whether it has rhetoric, power and unanticipated consequences of its own. Following this review, I find that global health critique has a rhetoric, and that this rhetoric can be organised into three types: (1) ‘global health as mere rhetoric’, (2) ‘splitting global health’, and (3) ‘figuring global health war.’ Ultimately, I argue that the rhetoric of GHH critique, like the rhetoric of global health, is a rhetoric of consequence—and a rhetoric worth revisiting.
Given the discipline's international focus, medical anthropologists have contributed to “global health” since well before it was consolidated as a field. This chapter argues that the intersection of medical anthropology with global health has fostered distinctive, productive domains of critical conceptual development. It organizes these in four overlapping domains: global health and the legacies of social medicine; anthropological perspectives on global health ethics; global studies of science and technology; and anthropological perspectives on global health governance. A medical anthropology of and in global health takes up the challenge of linking or grounding processes of globalization to health and health‐related practices (health movements, treatments, knowledges, programs, policy processes, humanitarian action, etc.) in local contexts. Social medicine's critical theoretical perspective focuses on health inequities in reference to assemblages of international and regional political economy, history, and development ideologies.
The digital health market is a growing component of a global health market that consumes around 15% of global GDP. Digital transformation needs to cost-effectively support global health and health system sustainability. This chapter identifies key high-level entities with the authority and potential ability to drive and enable successful digital health ecosystems to be realised. This requires strong leadership, collaboration, and well-targeted investments to clearly differentiate roles and responsibilities, avoid fragmentation, build on existing knowledge and technological advances, and adopt and mandate a set of key standards to form part of a new high-level foundational infrastructure needed to optimally support digital health transformations to take place. Health systems globally need to have the necessary infrastructure to enable real-time disease monitoring, optimise primary healthcare and prevention support, and to have sufficient capacity to support early intervention, continuing research and development activities. These activities and significant cost reductions are dependent upon optimum data collection and processing.
The purpose of this article is to understand the 'Rio Negro, We Care' campaign in its cosmopolitical implications for discussions of global health and human rights. This article is part of a collaborative process centred on the city of São Gabriel da Cachoeira and the Alto Rio Negro region of Brazil. This campaign was developed by the Department of Women of the Federation of Indigenous Organizations of Rio Negro (DMIRN/FOIRN) at the beginning of the COVID-19 pandemic. It had significant effects on the pandemic experience in the region during 2020. The Brazilian responses to the COVID-19 pandemic highlight complex, intersectional and neocolonial processes, associated with what has been understood as the necropolitics led by the Brazilian federal government. At the same time, such responses shed light on the limitations of the biopolitical orientation of public and global health for the management of the pandemic. We seek to narrate a cosmopolitical intervention located 'in culture' as a counterpoint to this process. Our analysis highlights questions in the field of global and planetary health milestones, such as the conditions of legitimacy for cosmological knowledge and care technologies, or the ontological implications of the persistent biopolitical bias of mainstream public health interventions.
“Categorical thinking” in social science research has been widely criticised by feminist scholars for conceptualising social categories as natural, de-contextualised, and internally homogeneous. This paper develops and applies a mixed-methods approach to the study of health inequalities, using social categories meaningfully in order to challenge categorical thinking. The approach is demonstrated through a case study of socio-economic (SES) inequalities in maternal healthcare access in Zambia.
This paper’s approach responds to the research agenda set by intersectional social epidemiologists by considering potential heterogeneity within categories, but also by exploring the context-specific meaning of categories, examining explanations at multiple levels, and interpreting results according to mutually constitutive social processes.
The study finds that meso-level institutions, “health service environments”, explain a large share of SES inequalities in maternal healthcare access. Women’s work, marital status, and levels of “autonomy” have heterogeneous implications for healthcare access across SES categories. Disadvantaged categories and their reproductive behaviours are stigmatised as 'backwards', in contrast to advantaged categories and their behaviours, which are associated with 'modernity' and 'development'. Challenging categorical thinking has important implications for social justice and health, by rejecting framings of a specific category as problematic or non-compliant, highlighting the possibility of change, and emphasising the political and structural nature of progress.
Mutual aid practice eschews paternalistic and charity-oriented development models and works to deactivate structures of inequity while building new infrastructures for living. Solidarity practices in the favelas have much to teach global and public health experts. Based on published reports and the insights of eight activists involved in mutual aid whom we interviewed, this paper explores how solidarity practices challenge three key assumptions in conventional global health and reveal the merits of social medicine in Latin America and global social medicine.
A perturbação de hiperatividade e déficit de atenção (PHDA) é considerada um dos problemas de comportamento e neurodesenvolvimento mais frequentes nas crianças e adolescentes em idade escolar, tanto em Portugal como a nível mundial. Além disso, a categorização diagnóstica da PHDA e a prescrição de psicoestimulantes como tratamento de primeira linha têm sido não só objeto de pesquisa científica e validação clínica, mas também alvo de polêmica e crítica social, sobretudo à luz do conceito de medicalização. Apesar do seu aspecto midiático e relevância em domínios tão diversos quanto os da educação, do medicamento, da saúde mental e dos apoios psicossociais, existe uma lacuna profunda na caracterização das dimensões históricas, socioéticas e institucionais da PHDA em Portugal. Aliando dados historiográficos e etnográficos à análise documental e da mídia, este artigo procura responder a esse desafio, traçando a trajetória social da PHDA neste país - desde a emergência da “hiperatividade” nos anos 1970/1980 ao debate público e político sobre a prescrição de psicoestimulantes. Dessa perspectiva interdisciplinar e por meio do estudo do caso português, procura contextualizar-se a definição, validação e ampliação da PHDA como parte de um processo dinâmico e socialmente situado na interseção de sistemas diagnósticos e farmacêuticos globais, contingências institucionais e socioeconômicas e, ainda, políticas públicas e especificidades locais. Discute-se, por fim, a forma como o caso da PHDA em Portugal contribui para o desenvolvimento de novas linhas de reflexão e de pesquisa interdisciplinar que permitem repensar o escopo social da saúde mental e da saúde global.
[article PDF in Portuguese]
Attention deficit and hyperactivity disorder (ADHD) is considered one of the most frequent behavioral and neurodevelopmental problems in school-age children and adolescents, both in Portugal and worldwide. The diagnostic categorization of ADHD and the prescription of psychostimulants as its first-line treatment have been the object not only of scientific research and clinical validation, but also of controversy and social critique, especially in light of the concept of medicalization. Despite its high profile and salience in such diverse fields as education, pharmaceuticals, mental health, and public policy, a significant gap remains in the characterization of socio-historical, ethical, and institutional dimensions of ADHD outside English-speaking countries. Combining historical and ethnographic research with document and media analysis, the article addresses that challenge by tracing the social trajectory of ADHD in Portugal, from the emergence of “hiperactivity” in the 1970s and 1980s to the current public and political debates on psychostimulant treatments and prescribing trends. From this interdisciplinary perspective and based on the Portuguese case study, the aim of this article is to contextualize the definition, validation, and expansion of ADHD as part of a dynamic and socially situated process in which global diagnostic and pharmaceutical systems intersect with institutional and socioeconomic contingencies, as well as local specificities and needs. More broadly, the article discusses how the case study of ADHD contributes to the development of interdisciplinary research that helps rethinking the social scope of mental health across local and global health contexts.
We describe a global health course and pedagogy that highlights the moral ambiguity and many ethical compromises that have emerged as the discipline has increasingly become institutionalised. We encourage students to reflect on how the oft-declared aspiration for global health equity still remains seriously contested as a normative and political matter, especially in settings like the USA. We further encourage students to reflect on how authentic concern for social justice, health equity and human rights are consistently undermined by unconscious and/or intentional fealty to standard operating procedures within hierarchical structures and systems. Lastly, we encourage students to openly question and critique the dominant socioeconomic and institutional paradigms that influence practitioner ways of thinking about global health. Our aim is to provide a learning space for students to at least imagine, if not demand, more daring modes of engagement. We also encourage our colleagues in the global health education community to be forthright that the process of institutionalising global health reliably favours our own interests more than those we claim to be most concerned about. If the ideal of global health is to build a bridge to human solidarity, we see substantial risk that current popularised approaches might never yield a structural tipping point.
Both public health experts and medical anthropologists are concerned with how health is shaped by environmental forces. This creates an important cross‐disciplinary alliance, yet crucial differences in how the two disciplines tend to evaluate health remain. In this article, I compare public health's “social determinants of health” framework with anthropological interest in the sociality of health and illness. I draw on ethnographic fieldwork in Guatemala's highlands, to unpack (1) “the social,” (2) “determinants,” and (3) “of health.” Ultimately, I show how the social determinants framework is deployed in ways that risk undermining its stated health justice goals, and highlight the benefits of an approach that does not know what health is ahead of doing research and which works closely with communities to respond to the effects of its own intervention. The article argues for the need to rework the emphasis on social determinants to make space for health's material‐semiotic indeterminacy
Due to factors related to increasing globalization, geopolitical conflicts, and climate change, tropical nursing is increasingly important. This article offers an overview of the Diploma in Tropical Nursing program and explores the challenges facing nurses who serve patients in tropical settings with limited resources.
The COVID-19 pandemic demonstrates the critical need to reimagine and repair the broken systems of global health. Specifically, the pandemic demonstrates the hollowness of the global health rhetoric of equity, the weaknesses of a health security-driven global health agenda, and the negative health impacts of power differentials not only globally, but also regionally and locally. This article analyses the effects of these inequities and calls on governments, multilateral agencies, universities, and NGOs to engage in true collaboration and partnership in this historic moment. Before this pandemic spreads further – including in the Global South – with potentially extreme impact, we must work together to rectify the field and practice of global health.
As part of a planned series from Global Public Health aimed at exploring both the epistemological and political differences in diverse public health approaches across different geographic and cultural regions, this special issue assembles papers that consider the legacy of the Latin American Social Medicine and Collective Health (LASM-CH) movements, as well as additional examples of contemporary social action for collective health from the region. In this introduction, we review the historical roots of LASM-CH and the movement’s primary contributions to research, activism and policy-making over the latter-half of the twentieth century. We also introduce the special issue’s contents. Spanning 19 papers, the articles in this special issue offer critical insight into efforts to create more equitable, participatory health regimes in the context of significant social and political change that many of the countries in the region have experienced in recent decades. We argue that as global health worldwide has been pushed to adopt increasingly conservative agendas, recognition of and attention to the legacies of Latin America’s epistemological innovations and social movement action in the domain of public health are especially warranted.
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A discussion of the recent transition to a new geological epoch, the Anthropocene, opens this article. The need to declare a new era has been declared necessary by geologists, together with other scientists and critical commentators due to the inordinate amount of human‐made destruction being imposed on the globe and its inhabitants. This destruction disproportionally effects those who are economically deprived and experience discrimination. An account of the recognition and routinization of epigenetics follows, in which an unexamined assumption of genetic determinism is debunked. A move to recognize human existence everywhere as contextualized in environments that impinge on body functioning throughout life opens up a discussion of the embodiment of trauma followed by six illustrative examples from the newly recognized field of environmental epigenetics.
Our new Case Studies in Social Medicine series highlights the importance of social concepts and context to clinical medicine. Articles in the series will discuss clinical cases and translate social medicine tools for use in education, clinical practice, and health system planning.
What are the epistemological and political contours of evidence today? This introduction to the special issue lays out key shifts in the contemporary politics of knowledge and describes the collective contribution of the six papers as an articulation of what we describe as a ‘new empiricism’, exploring how earlier historical appeals to evidence to defend political power and decision-making both chime with and differ from those of the contemporary era. We outline some emerging empirical frontiers in the study of instruments of calculation, from the evolution of the randomized controlled trial (RCT) to the growing importance of big data, and explore how these methodological transformations intersect with the alleged crisis of expertise in the ‘post-truth’ era. In so doing, we suggest that the ambiguity of evidence can be a powerful tool in itself, and we relate this ambiguity to the ideological commitment and moral fervour that is elicited through appeals to, and the performance of, evaluation.
In this paper, we posit the notion of ‘situated biologies’ as a conceptual contribution to the often-polarised debate over the material human body as being either local or universal. To argue our case, we briefly recapitulate the medical anthropological concept of ‘local biologies’ before highlighting current molecular biological research on epigenetics and its implications. We discuss how different forms of ‘local’ arise in environment/human entanglements and how material agency becomes situated and contingent through various knowledge practices. We conclude by developing the overarching concept of ‘situated biologies’ to further a collaborative ethnographic agenda that explores the multiple effects of particularising or universalising material agency in research on environment/human entanglements.
Between 2015 and 2016, Zika became an epidemic of global concern and the focus of intense media coverage. Using a hybrid model of frame and social representations theory, we examine how the Zika outbreak was reported in two major newspapers in Brazil: O Globo and Folha de São Paulo. The analysis of 186 articles published between December 2015 and May 2016 reveals a dominant 'war' frame supported by two sub-frames: one focused on eradicating the vector (mosquito) and another on controlling microcephaly, placing the burden of prevention on women. Scientific uncertainties about the virus and its relationship to microcephaly coupled with political uncertainties in Brazil increased the power of the war frame. This frame gave prominence and legitimacy to certain representations of disease management during the crisis, masking social and gender inequalities. We show how the cartography of the disease overlaps with that of poverty and regional inequality in Brazil to argue that addressing socio-economic aspects is essential, but normally neglected, in media communications during disease outbreaks like Zika.
The interdisciplinary, politically contested field of Global Health has often
been described as a consequence of, and response to, an intensification of
the mobilities of, and connectivities between, people, pathogens, ideas,
and infrastructure across national borders and large distances. However,
such global mobilities and connectivities are not as omnidirectional and
unpatterned as the rhetoric of many Global Health actors suggests.
Instead, we argue that they are suffused by a plethora of institutional,
national, and global political agendas, and substantially shaped by
transnational and postcolonial power relations. Furthermore, the
configurations that are typically subsumed under the category of Global
Health represent only a minor part of the range of im/mobilities and dis/
connectivities that are essential for understanding transformations of
epidemiological patterns, health care infrastructures, and the responses
to health-related challenges in a globalising world. In order to broaden
such a limiting analytical perspective, we propose to expand the
analytical focus in studying Global Health phenomena by paying close
attention to the myriad ways in which particular im/mobilities and dis/
connectivities constitute medicine and well-being in global and
transnational settings. Pursuing a conceptual shift from studies of
‘Global Health’ to studying ‘medical globalization’ may carve out new
analytical ground for such an endeavour.
Located high in Tanzania’s Usambara Mountains, Amani Hill Station has been a site of progressive scientific endeavours for over a century, pushing the boundaries of botanical, zoological and medical knowledge, and providing expertise for imperial expansion, colonial welfare, national progress and international development efforts. The station’s heyday was from the 1950s to the 1970s, a period of global disease eradication campaigns and the ‘Africanization’ of science. Today, Amani lies in a state of suspended motion. Officially part of a national network of medical research stations, its buildings and vegetation are only minimally maintained, and although some staff report for duty, scientific work has ceased. Neither ruin nor time capsule, Amani has become a quiet site of remains and material traces. This article examines the methodological potentials of re-enactment – on-site performances of past research practices – to engage ethnographically with the distinct temporalities and affective registers of life at the station. The heuristic power of re-enactment resides in its anachronicity, the tensions it introduces between immediacy and theatricality, authenticity and artifice, fidelity and futility. We suggest that re-enacting early post-colonial science as events unfolding in the present disrupts straightforward narratives about the promises and shortfalls of scientific progress, raising provocative questions about the sentiments and stakes of research in ‘the tropics’.
Medical research has been central to biomedicine in Africa for over a century, and Africa, along with other tropical areas, has been crucial to the development of medical science. At present, study populations in Africa participate in an increasing number of medical research projects and clinical trials, run by both public institutions and private companies. Global debates about the politics and ethics of this research are growing and local concerns are prompting calls for social studies of the "trial communities" produced by this scientific work. Drawing on rich, ethnographic and historiographic material, this volume represents the emergent field of anthropological inquiry that links Africanist ethnography to recent concerns with science, the state, and the culture of late capitalism in Africa. © 2011 P. Wenzel Geissler and Catherine Molyneux. All rights reserved.
As the world enjoys the promise of biomedical advances against HIV, numerous challenges remain. Some of these are connected to politics, others are connected to resource constraints. Other barriers are linked to the need to ensure that the concepts used to think about HIV remain current. Terms such as "MSM" (men who have sex with men) and "community" require critical interrogation at a moment when their political origins seem forgotten. Likewise, struggles between groups most affected by HIV and scientists and policymakers (an enduring feature of the epidemic) remain a key aspect of the response. The dangers of co-option and distraction remain real. In this context, it is vital to promote community ownership, political commitment, solidarity, and respect for differences, not as competing values, but as part of the ultimate solution to HIV. (Am J Public Health. Published online ahead of print June 11, 2015: e1-e7. doi:10.2105/AJPH.2015.302614).
Today all politics are reproductive politics, argues esteemed feminist critic Laura Briggs. From longer work hours to the election of Donald Trump, our current political crisis is above all about reproduction. Households are where we face our economic realities as social safety nets get cut and wages decline. Briggs brilliantly outlines how politicians' racist accounts of reproduction-stories of Black "welfare queens" and Latina "breeding machines"-were the leading wedge in the government and business disinvestment in families. With decreasing wages, rising McJobs, and no resources for family care, our households have grown ever more precarious over the past forty years in sharply race-and class-stratified ways. This crisis, argues Briggs, fuels all others-from immigration to gay marriage, anti-feminism to the rise of the Tea Party. © 2017 by The Regents of the University of California. All rights reserved.
In Designs for the Pluriverse Arturo Escobar presents a new vision of design theory and practice aimed at channeling design's world-making capacity toward ways of being and doing that are deeply attuned to justice and the Earth. Noting that most design—from consumer goods and digital technologies to built environments—currently serves capitalist ends, Escobar argues for the development of an “autonomous design” that eschews commercial and modernizing aims in favor of more collaborative and placed-based approaches. Such design attends to questions of environment, experience, and politics while focusing on the production of human experience based on the radical interdependence of all beings. Mapping autonomous design’s principles to the history of decolonial efforts of indigenous and Afro-descended people in Latin America, Escobar shows how refiguring current design practices could lead to the creation of more just and sustainable social orders.
This book examines the confusions and contradictions that manifest in prevalent attitudes towards the body, as well as in related bodily practices. The body is simultaneously our reference for the certainties of nature and the locus of a desire for transformation and reinvention. The body is at the same time worshipped and despised; an object of desire and of design. Francisco Ortega analyses how the body has become both a screen for the projection of our ideas and imaginings about ourselves and conversely an object of suspicion, anxiety, and discomfort. Addressing practices of corporeal ascesis (such as bodybuilding and dietetics), medical technologies, and radical anatomical modifications, Ortega documents the ambiguous legacy of a western theoretical tradition that has always despised the body. Utilising a theoretical framework that is mainly informed by the phenomenology of the body, feminist theory, disability studies and the thought of Michel Foucault, Corporeality, Medical Technologies and Contemporary Culture address several ethical and psychological issues associated with the experience and perception of the body in our cultural landscape. Drawing on these diverse areas of philosophical and analytical work, this book will interest those researching Law, Medicine, and Sociology.
Despite growing interest in understanding how social factors drive poor health outcomes, many academics, policy makers, scientists, elected officials, journalists, and others responsible for defining and responding to the public discourse remain reluctant to identify racism as a root cause of racial health inequities. In this conceptual report, the third in a Series on equity and equality in health in the USA, we use a contemporary and historical perspective to discuss research and interventions that grapple with the implications of what is known as structural racism on population health and health inequities. Structural racism refers to the totality of ways in which societies foster racial discrimination through mutually reinforcing systems of housing, education, employment, earnings, benefits, credit, media, health care, and criminal justice. These patterns and practices in turn reinforce discriminatory beliefs, values, and distribution of resources. We argue that a focus on structural racism offers a concrete, feasible, and promising approach towards advancing health equity and improving population health.
In 1958, the Pan American Health Organization declared that Brazil had successfully eradicated the mosquito Aedes aegypti, responsible for the transmission of yellow fever, dengue fever, chikungunya, and Zika virus. Yet in 2016 the Brazilian minister of health described the situation of dengue fever as "catastrophic." Discussing the recent epidemic of Zika virus, which amplified the crisis produced by the persistence of dengue fever, Brazil's president declared in January 2016 that "we are in the process of losing the war against the mosquito Aedes aegypti." I discuss the reasons for the failure to contain Aedes in Brazil and the consequences of this failure. A longue durée perspective favors a view of the Zika epidemic that does not present it as a health crisis to be contained with a technical solution alone but as a pathology that has the persistence of deeply entrenched structural problems and vulnerabilities. (Am J Public Health. Published online ahead of print February 16, 2017: e1-e8. doi:10.2105/AJPH.2017.303652).
The limits of technological quick fixes in contemporary malaria control and eradication programs
In light of current concern over pediatric immunization rates, 53 US parents with at least one child kindergarten age or younger were surveyed and interviewed regarding vaccine decision making. Data were collected in 2014 in San Diego, California. Herd immunity was not a salient issue: only six (11.3%) referenced the term or concept spontaneously; others had to be prompted. Parents familiar with herd immunity (70%) variously saw it as not just unnecessary but unproven, illogical, unrealistic, and unreliable. For instance, parents questioned its attainability because many adults do not immunize themselves. Some understood the concept negatively, as an instance of “herd mentality.” Further, having knowledge of herd immunity that public health experts would deem ‘correct’ did _not_ lead to full vaccination. Implications of findings for understanding how the public makes use of scientific information, the potential role of public health messaging regarding altruism and ‘free-riding,’ and assumptions that vaccine-cautious parents would willfully take advantage of herd immunity are explored in relation to parent role expectations and American individualism.
This book explores the unintended consequences of compassion in the world of immigration politics. Miriam Ticktin focuses on France and its humanitarian immigration practices to argue that a politics based on care and protection can lead the state to view issues of immigration and asylum through a medical lens. Examining two "regimes of care"-humanitarianism and the movement to stop violence against women-Ticktin asks what it means to permit the sick and sexually violated to cross borders while the impoverished cannot? She demonstrates how in an inhospitable immigration climate, unusual pathologies can become the means to residency papers, making conditions like HIV, cancer, and select experiences of sexual violence into distinct advantages for would-be migrants. Ticktin's analysis also indicts the inequalities forged by global capitalism that drive people to migrate, and the state practices that criminalize the majority of undocumented migrants at the expense of care for the exceptional few.
For centuries, medicine aimed to treat abnormalities. But today normality itself is open to medical modification. Equipped with a new molecular understanding of bodies and minds, and new techniques for manipulating basic life processes at the level of molecules, cells, and genes, medicine now seeks to manage human vital processes. The Politics of Life Itself offers a much-needed examination of recent developments in the life sciences and biomedicine that have led to the widespread politicization of medicine, human life, and biotechnology. Avoiding the hype of popular science and the pessimism of most social science, Nikolas Rose analyzes contemporary molecular biopolitics, examining developments in genomics, neuroscience, pharmacology, and psychopharmacology and the ways they have affected racial politics, crime control, and psychiatry. Rose analyzes the transformation of biomedicine from the practice of healing to the government of life; the new emphasis on treating disease susceptibilities rather than disease; the shift in our understanding of the patient; the emergence of new forms of medical activism; the rise of biocapital; and the mutations in biopower. He concludes that these developments have profound consequences for who we think we are, and who we want to be.
IntroductionMaking up the NationMaking Biological Citizens: From Public Value to BiovalueBiosociality: Active Biological CitizensPolitical Economies of Hope: Science, Citizenship, and the FutureProducing Biovalue: Materializing Ethics, Health, and WealthConclusion
Notes
In imagining the 'global' as the product of unprecedented flows and circulations, do we tend to ignore its uneven terrain, heterogeneity, and contestation? How might we resist taking the hydraulic turn and instead write critical histories of 'global' health? Postcolonial analysis can offer critical and realistic histories of scale making in biomedicine, of the configuring of the local and the global in global health. Thus we might hold within the same analytic frame biomedical colonial patriotism in the Philippines, biocolonial collecting in highland New Guinea, and the technoscientific nationalism of Biopolis in contemporary Singapore.
Examining the interactions between patients and doctors, this book aims to show how physicians' focus on physical complaints often fails to address patients' underlying concerns and also reinforces the societal problems that cause or aggravate these maladies.
Historians of medicine have struggled for centuries to make the case for history in medical education. They have developed
many arguments about the value of historical perspective, but their efforts have faced persistent obstacles, from limited
resources to curricular time constraints and skepticism about whether history actually is essential for physicians. Recent
proposals have suggested that history should ally itself with the other medical humanities and make the case that together
they can foster medical professionalism. We articulate a different approach and make the case for history as an essential
component of medical knowledge, reasoning, and practice. History offers essential insights about the causes of disease (e.g.,
the non-reductionistic mechanisms needed to account for changes in the burden of disease over time), the nature of efficacy
(e.g., why doctors think that their treatments work, and how have their assessments changed over time), and the contingency
of medical knowledge and practice amid the social, economic, and political contexts of medicine. These are all things that
physicians must know in order to be effective diagnosticians and caregivers, just as they must learn anatomy or pathophysiology.
The specific arguments we make can be fit, as needed, into the prevailing language of competencies in medical education.