Global Health in Times of Violence

Edited by Barbara Rylko-Bauer, Linda Whiteford and Paul Farmer

SAR Press, 2009, 304 pages

 

Global Heath in Times of Violence is a fantastic book that belongs on the syllabus of every medical anthropology and global health course, particularly those focusing on the social determinants of health. This volume, edited by Barbara Rylko-Bauer, Linda Whiteford and Paul Farmer, contains a smorgåsbord of research from the editors, along with chapters by Philippe Bourgois, Didier Fassin, H.K. Heggenhougen, Carolyn Nordstrom, James Quesada and Merrill Singer.  These individuals have shaped critical medical anthropology and through this volume they present a ‘greatest hits’ of the sub-field.

The authors aim to unravel the linkages between macro-level global forces and local experiences, and to tease out the relationships amongst different kinds of violence: visible/invisible, physical, symbolic, structural and normalized.  They do this by using ethnographic narratives, introducing us to individuals they encountered during their research in sub-Saharan Africa, Central America, several cities in the United States and through historical (and personal) research in Nazi-occupied Poland.  For instance, we meet Catorzina in Angola, whose name means fourteen and indicates that she is ‘old enough’ to be used for sex and exploitative labor; Barbara Rylko-Bauer introduces us to her mother, a Polish prisoner-doctor in Nazi camps and H.K. Heggenhougen tells the story of Francisco Curruchiche, a Guatemalan community-health worker who is murdered.

Aside from the content, the book also stands out because of its accessible language. In other pieces, some of these same authors can be convoluted and overly complicated in their diction.  However, the editors have ensured a book that is accessible to anthropologists, as well as those in other disciplines that intersect with global heath. Highlights include Philippe Bourgois’ delightfully simple explanation of Foucault’s biopower and governmentality, along with Merrill Singer’s discussion of  ‘syndemic theory.’

Similarly, much of the literature on the political economy of health within medical anthropology can be rather Marxist in tone, without being reflexive about the authors’ own ideological standpoint. The heartbreaking stories in this book have the potential to make even the most politically conservative readers angry about disastrous effects of neoliberal policies in these field sites. However, the use of relatively neutral language makes the book more palatable to a general audience, including academics and pundits outside of anthropology. There are some exceptions, particularly James Quesada’s chapter (“the relentless neoliberal assault imperils individuals”), but generally this volume remains accessible.

Recently, in Anthropology Today, Hugh Gusterson lamented the way in which anthropologists are left out of debates in current and international affairs (. Specifically, he discusses how economists and political scientists are seen to have jurisdiction over economics, war and peace.  This volume shows how anthropologists – and medical anthropologists, specially – have valuable contributions to make in macro and microeconomics and in peace and conflict studies  – and the accessible style helps in this venture.

There is little to find flawed with this volume, but there were threads of the research that I would have liked to see followed further.  For example, most of the fieldwork sites are difficult ones.  I could imagine that some of the earlier research  (particularly in 1980s Central America) would have trouble passing university or funding review boards today, mainly due to institutional liability and insurance issues.  For the benefit of students and early career researchers, it would have been helpful for the authors to reflect on the difficulties of gaining access to and staying safe in the field.

I would have also liked to see the authors continue their fieldwork further up the linkages, although perhaps this volume will inspire others to carry on this research. For example, Singer begins his analysis of street violence in Hartford by noting that Hartford houses the headquarters of the Colt Manufacturing Company, which led me to wonder what happens on the manufacturing line or in the boardrooms of this firearms producer and how these individuals relate to street violence and the ‘hyperghetto’ of Hartford.

Citing James Pfeiffer and Mark Nichter (2008), the editors also discuss the ‘growing recognition of the complete ways in which global health is affected by power structures and international relations.’ To this end, I would have liked to see more interrogation of the geopolitical: what happens in ‘on the ground’ in diplomatic sites and international organizations?  If we are to discuss the ways in the World Trade Organization, World Bank or International Monetary Fund affect the day-to-day lives of the individuals who we met through these ethnographic narratives, then the reader also needs ethnographic narratives of civil servants in Geneva or Washington – something only briefly touched upon here, particularly in Caroline Nordstrom and Linda Whiteford’s chapters. This vein of research could also interrogate the statistics on health and violence that guide policy; James Quesada discusses the ‘political arithmetic’ that creates social, political and economic indicators – but I am left wanting more.

However, feeling left wanting more is perhaps another strength of the book.  This book will serve to introduce the next generation of medical anthropologists and those entering careers in global health to the authors who have defined critical medical anthropology and to the themes and debates throughout the past thirty-five years, ideally inspiring them to continue the work of fighting injustice and inequality.

Rachel Irwin, Ph.D, is a senior researcher at the Stockholm International Peace Research Institute (SIPRI).  Her current work focuses on women’s participation in political processes.  In her previous research, she examined political ritual at the World Health Organization.

 

References

Gusterson, Hugh (2013) Anthropology in the News? Anthropology Today 29(6):11-13

Pfeiffer, J. and M. Nichter (2008). “What Can Critical Medical Anthropology Contribute to Health? A Health Systems Perspective.” Medical Anthropology Quarterly 22(4): 410-415.