Eva Hilberg’s research while affiliated with The University of Sheffield and other places

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Publications (12)


The Terra Nullius of Intellectual Property
  • Article
  • Full-text available

May 2022

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68 Reads

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2 Citations

Ethics & International Affairs

Eva Hilberg

The current debate over the global distribution of COVID-19 vaccines once again highlights the many shortcomings of the modern intellectual property (IP) system, especially when it comes to equitable access to medicines. This essay argues that the (unspoken) conceptual center of struggles over access to new pharmaceuticals rests in the IP system's colonial legacy, which perceives the world as uncharted territory that is ripe for discovery and ownership. This vision of the world as a blank canvas, or terra nullius, sets aside any other models of ownership and devalues other traditional modes of relating to territory and nature. Several examples show the long-lasting exclusionary effects of this hidden legacy of colonial conquest in the field of public health, ranging from the spiraling price of insulin to the distribution of COVID-19 vaccines to the negotiation of sharing mechanisms for virus samples. In all of these cases, the continuing marginalization of other interests by the IP system can lead to exploitation, without either the “sources” of materials, such as those from whom the samples were taken, or the recipients of the eventual product having any say in matters of price and access. This legacy of fundamental exclusion needs to be recognized and addressed in order to arrive at more equitable solutions to public health emergencies such as the current pandemic.

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Encapsulation: Governing actual uncertainty in the coronavirus pandemic

February 2022

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42 Reads

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5 Citations

Sociology of Health & Illness

The coronavirus pandemic has revived scholarly engagement with the concept of biopolitics, with interpretations diagnosing either the widespread adoption of a classic biopolitical regime or the full‐blown emergence of totalitarian repression (or both of these simultaneously). Relying on a close analysis of different interventions taken by Israeli authorities in response to the pandemic, this article argues that, rather than classic biopolitical strategies, such governmental interventions are better understood in relation to a problem of actual uncertainty. The case of Israel demonstrates how state apparatuses responded to actual uncertainty with technologies that are linked to different rationalities and how these technologies enabled the creation and management of a new milieu. The article further argues that, in making and intervening upon this milieu, state apparatuses employed a particular normalisation strategy that is tied to a form of power that we term encapsulation.


Molecular sovereignties: patients, genomes, and the enduring biocoloniality of intellectual property

July 2021

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15 Reads

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3 Citations

BioSocieties

Monoclonal antibodies are revolutionizing cancer treatments, but come at an increasingly problematic price for health services worldwide. This leads to pressing demands for access, as in the case of Kadcyla. In 2015, patients in the United Kingdom invoked the sovereign rights of the Crown in order to demand access to this expensive yet potentially life-saving medicine that had prior been de-listed due to price. This article interprets this campaign as an act of sovereign reassertion against a fundamental exclusion, which, however, ultimately fails to challenge the concrete mechanism enabling this exclusion—intellectual property (IP). By connecting this example to other declarations of molecular sovereignty, the article argues that the use of sovereignty can perpetuate further exclusion. Drawing on the notion of biocoloniality (Schwartz-Marín and Restrepo 2013) it points out that the intellectual property regime contains a deeply embedded fiction of the world as terra nullius, a blank uninhabited canvas ripe for discovery and appropriation. This decontextualised vision of life as property works to exclude populations and patients from playing a significant role in determining the use of technologies and treatments. Instead of countering this fundamental exclusion, the concept of sovereignty further entrenches this assumption and merely contests the assignation of this property.


Human technologies, affect and the global psy-complex

May 2021

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51 Reads

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2 Citations

Economy and Society

Minds, behaviours and psyches are increasingly and explicitly problematized within social, economic, health, welfare, education and development policy, in both the global North and global South. While this shift is new, it also builds on a long colonial history of the constitution and governance of the ‘psy’. This special section considers these developments through critically engaging with them as human technologies whereby certain cognitions, affects and behaviours come to be made knowable, calculable and amenable to technological interventions and quantification. Starting with the concept of human technologies, this special section also seeks to extend it, troubling the prevailing account of technology’s role as governmentalization by placing this particular power/knowledge nexus in relation to other historical and current forms of power such as gender, race and coloniality. In this introduction to the special section, ‘Human technologies, affect and the global psy-complex’, we outline the conceptual and empirical contributions the collection of papers seeks to make.


The cultivation of digital health citizenship

February 2021

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97 Reads

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22 Citations

Social Science & Medicine

Contemporary health policy discourse renders individuals responsible for managing their health by means of digital technology. Seeing the digital as productive of citizenship, rather than facilitative of it, this paper unpacks the contested role of technology in acts of digital health citizenship. Drawing on longitudinal data collected in the English healthcare context, this article shows that digital health citizenship is produced through patients' involvement in the generation of health knowledge, including ‘big’ health data, digital artefacts, experiential knowledge and service feedback. The paper adds to existing literature by disaggregating the contested role of technology in displays of digital health citizenship, showing that digital health technology can give rise to expressions of altruism, belonging, and demands for recognition and change in healthcare, whilst responsibilising citizens for the care of themselves and others. The discussion shows how, rather than merely facilitating the actions of a free and autonomous subject, this citizenship often becomes algorithmically produced (e.g. through nudges) and remains isolated to separate instances of engagement without a long-term orientation. Our study enriches the growing sociological literature on health citizenship by exploring how digital technology produces health citizenship at the intersection of biosociality and technosociality.


‘The contested role of technology in acts of digital health citizenship’

January 2021

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167 Reads

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24 Citations

Social Science & Medicine

Contemporary health policy discourse renders individuals responsible for managing their health by means of digital technology. Seeing the digital as productive of citizenship, rather than facilitative of it, this paper unpacks the contested role of technology in acts of digital health citizenship. Drawing on longitudinal data collected in the English healthcare context, this article shows that digital health citizenship is produced through patients’ involvement in the generation of health knowledge, including ‘big’ health data, digital artefacts, experiential knowledge and service feedback. The paper adds to existing literature by disaggregating the contested role of technology in displays of digital health citizenship, showing that digital health technology can give rise to expressions of altruism, belonging, and demands for recognition and change in healthcare, whilst responsibilising citizens for the care of themselves and others. The discussion shows how, rather than merely facilitating the actions of a free and autonomous subject, this citizenship often becomes algorithmically produced (e.g. through nudges) and remains isolated to separate instances of engagement without a long-term orientation. Our study enriches the growing sociological literature on health citizenship by exploring how digital technology produces health citizenship at the intersection of biosociality and technosociality.


‘Built for expansion’: the ‘social life’ of the WHO's mental health GAP Intervention Guide

October 2019

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73 Reads

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23 Citations

Sociology of Health & Illness

The focus of this study is the WHO's mhGAP‐Intervention Guide (mhGAP‐IG) 2.0 (2016), an evidence‐based tool and guideline to help detect, diagnose and manage the most common mental disorders, designed for use by non‐specialists globally but particularly in low‐ and middle‐income countries. This research is a starting point in tracing the multiple ‘doings’ of mhGAP‐IG – connecting questions of how it is ‘done’ and what does it ‘do’ – to the living histories and wider global mental health assemblages that make the tool possible and shape its global circulation. We examine the conditions of possibility that produce and legitimate mhGAP‐IG, and the ways these are ‘black boxed’ through casting mhGAP‐IG in technical rather than epistemological terms. The study illuminates how its explicit design for global expansion positions mhGAP‐IG as open to questioning from those who are technical ‘insiders’ and setting the epistemological parameters of its own critique. It analyses mhGAP‐IG as an ‘inscription device’ that inscribes and materialises algorithmic imaginaries of mental health that impact on design and local implementation. This study is one attempt at initiating dialogue with the WHO from perspectives and methodological approaches not usually included in the conversation.



The construction of mental health as a technological problem in India

August 2018

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60 Reads

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29 Citations

This paper points to an underexplored relationship of reinforcement between processes of quantification and digitisation in the construction of mental health as amenable to technological intervention, in India. Increasingly, technology is used to collect mental health data, to diagnose mental health problems, and as a route of mental health intervention and clinical management. At the same time, mental health has become recognised as a new public health priority in India, and within national and global public health agendas. We explore two sites of the technological problematisation of mental health in India: a large-scale survey calculating prevalence, and a smartphone app to manage stress. We show how digital technology is deployed both to frame a ‘need’ for, and to implement, mental health interventions. We then trace the epistemologies and colonial histories of ‘psy’ technologies, which question assumptions of digital empowerment and of top-down ‘western’ imposition. Our findings show that in India such technologies work both to discipline and liberate users. The paper aims to encourage global debate inclusive of those positioned inside and outside of the ‘black box’ of mental health technology and data production, and to contribute to shaping a future research agenda that analyses quantification and digitisation as key drivers in global advocacy to make mental health count.


Between empowerment and self-discipline: Governing patients' conduct through technological self-care

July 2018

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241 Reads

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93 Citations

Social Science & Medicine

Recent health policy renders patients increasingly responsible for managing their health via digital technology such as health apps and online patient platforms. This paper discusses underlying tensions between empowerment and self-discipline embodied in discourses of technological self-care. It presents findings from documentary analysis and interviews with key players in the English digital health context including policy makers, health designers and patient organisations. We show how discourses ascribe to patients an enterprising identity, which is inculcated with economic interests and engenders self-discipline. However, this reading does not capture all implications of technological self-care. A governmentality lens also shows that technological self-care opens up the potential for a de-centring of medical knowledge and its subsequent communalization. The paper contributes to Foucauldian healthcare scholarship by showing how technology could engender agential actions that operate at the margins of an enterprising discourse.


Citations (10)


... 99 The third dynamic is the way in which acts of charity like those emblematized by COVAX become the only possible exception to the legacies of exclusion entrenched by global IP regimes. 100 COVAX continued a wider trend in global health governance of establishing public-private partnerships to finance and implement health interventions, with significant decision-making power being held by private interests (in this case the Gates Foundation). 101 As financialization leads to the interpenetration of ostensibly public interests with private interests in global health governance mechanisms like COVAX, philanthrocapitalist acts of charity can have the effect of depoliticizing the causes of inequitable access while sustaining the IP-protecting status quo. ...

Reference:

Reinscribing global hierarchies: COVID–19, racial capitalism and the liberal international order
The Terra Nullius of Intellectual Property

Ethics & International Affairs

... ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). the clinics and hospitals, such as in patients' homes and local communities. This migration of care from the hospitals' walls to the territory brings several advantages: the patient is taken in charge in his daily life context by a multidisciplinary team, accessing a healthcare networking platform [2], with an empowered role as "citizen patients" in the local communities [3,4] bypassing accessibility constraint issues that usually impact the in-clinic health services [5,6]. New digital health solutions also can answer the increasing need for health services in front of healthcare system overburdened issues. ...

The cultivation of digital health citizenship

Social Science & Medicine

... The Arab Spring's economic impact was profound, with significant withdrawal of foreign direct investment and a decline in tourism, affecting several sectors and exacerbating unemployment (Malik & Awadallah, 2013;Springborg, 2011;Echevarría & García-Enríquez, 2020;O'Sullivan et al., al., 2020;Rabi et al., 2022). The economic fallout from the pandemic deepened existing vulnerabilities, with a significant contraction in the MENA region's economy and a spike in unemployment rates, highlighting the need for comprehensive governance and economic policy reforms Al-Fawwaz, 2020;Fattouh & El-Katiri, 2019;Hanieh, 2020;Cammett et al., 2020;Hafner et al., 2020;Piketty, 2020;Sen, 2020). ...

Encapsulation: Governing actual uncertainty in the coronavirus pandemic
  • Citing Article
  • February 2022

Sociology of Health & Illness

... Агамбеном [6] ще на початку 1990-х рр. Протягом наступних 20-25 років до політичного дискурсу інтегрувалися такі концепти, як біогромадянство [7], геномний суверенітет [8], молекулярний суверенітет [9], біогеополітика [10]. Глобальна (транс)біополітика та пов'язані з нею конфлікти та протиріччя стають домінуючим трендом глобального політичного процесу, його філософськосвітоглядною та ментальною основою після пандемії COVID-19. ...

Molecular sovereignties: patients, genomes, and the enduring biocoloniality of intellectual property

BioSocieties

... For example, Abilify MyCite, a recent technology aimed at overcoming some of the problems of lack of insight, medication compliance, and decision-making capacity, has been explored. Klein et al. (2021) conducted a cross-sectional study to identify the effectiveness of human technologies that are used to affect the human psyche [35]. ABILIFY MYCITE is a prescribed aripiprazole tablet with an ingestible event marker (IEM) sensor designed to treat schizophrenia, bipolar disease alone or with lithium or valproate, acute or short-term treatment of anxiety or manic symptoms, palliative care, and treatment of depression. ...

Human technologies, affect and the global psy-complex
  • Citing Article
  • May 2021

Economy and Society

... Furthermore, the integration of digital solutions in healthcare systems has been explored extensively (Iyawa et al., 2017;Javaid & Khan, 2021;Kraus et al., 2021). Scholars have also looked into the challenges and opportunities within this ecosystem (Petrakaki et al., 2021;Walsh & Rumsfeld, 2017;Abasi et al., 2021). The impact of digital health innovations on patient care and healthcare delivery has been well-documented (Bygstad & Øvrelid, 2020;Kuo, 2011;Laurenza et al., 2018). ...

‘The contested role of technology in acts of digital health citizenship’

Social Science & Medicine

... The mental health gap guidelines are multiple-practiced and done (talked about and used) differently in different contexts 10,34 and these disparities are analytically important. The three main documents that are the focus for this analysis illustrate several dominant discourses that are ideological in character. ...

‘Built for expansion’: the ‘social life’ of the WHO's mental health GAP Intervention Guide
  • Citing Article
  • October 2019

Sociology of Health & Illness

... Governments have embraced digital technologies in mental healthcare as a costeffective, accessible alternative or supplement to face-to-face support. In November 2022, for example, the U.K. government announced '£40.2 million for research into mental health to develop and introduce digital technologies to support patients' (Department of Health and Social Care et al., 2022), and other governments, including in low and middle-income countries, have done similarly (Mills & Hilberg, 2020). Most notably, and seemingly more than any other care context, there is a massive private sector drive to digitise mental health care. ...

The construction of mental health as a technological problem in India
  • Citing Article
  • August 2018

... Good health literacy depends on good communication that is tailored to the individual and its skills and competencies. It is important to clarify whether and to what extent H&C technology supports and promotes the individual in its health literacy or, for example, overwhelms it with too much or poorly prepared information (Burr, Cristianini, and Ladyman 2018;Hansson 2018;Petrakaki, Hilberg, and Waring 2018). This category also includes the competence to interact with health, medical and care technology while maintaining one's own physical, mental and emotional integrity (example: interaction with service robots in hospitals) (Lin, Abney, and Bekey 2012;Sparrow 2016), as well as the aspect of transparency. ...

Between empowerment and self-discipline: Governing patients' conduct through technological self-care

Social Science & Medicine

... Instead, human rights-alongside the environment, public health, food security, labor, and culture-are regarded as 'non-trade concerns' in the trade regime. WTO rules, which are based on the core principles of non-discrimination and reciprocity, and whose scope has expanded beyond trade at the border to cover many areas of domestic regulation, have placed constraints on states' ability to legislate in favor of non-trade concerns (Lechner, 2016;Petersmann, 2006). 2 Indeed, trade often has been seen as trumping human rights at the WTO, based on controversial dispute panel rulings that have put commercial considerations above concerns like human rights, the environment and public health (Aaronson, 2007;He & Murphy, 2007;Hilberg, 2015). 3 There are also fears that the WTO can have a 'chilling effect' on human rights. ...

Promoting health or securing the market? The right to health and intellectual property between radical contestation and accommodation
  • Citing Article
  • June 2015