In the Journals

In the Journals July 2016 – Pt. I

Check out the first instalment of this month’s In the Journals!

 

Critical public health 

Global mental health and its critics: moving beyond the impasse (open access)

Sara Cooper

The field of Global Mental Health has very quickly engendered a new institutional and research landscape, having recently established a number of its own research centres and training programmes. Under the banner of this field, there has also been an explosion of international research programmes and interventions which have received significant financial backing from a range of international donors, development agencies, and governments.1 In sum, Global Mental Health has increasingly captured the imagination of a wide range of stakeholders and has made major strides in establishing mental health as a priority within the global health arena. Indeed, a recent Google search for ‘Global Mental Health’ on 1 November 2009 identified approximately 62,300 related sites, of which over 85% of them were registered since 2008 (Patel & Prince,2010). This increasingly powerful field has, however, also elicited a range of critical responses, with growing controversy over its conceptualisations, goals and imagined outcomes (Campbell & Burgess, 2012; Kirmayer & Pedersen, 2014; Mills & Fernando, 2014).

Stigmatizing surveillance: blood-borne pathogen protocol and the dangerous doctor

Valerie Webber, Janet Bartlett & Fern Brunger

HIV and hepatitis B and C are viruses that have been unduly set apart from other infectious diseases in terms of the symbolic pull they exert and the anxiety they produce. This is reflected in health care policy and protocol. Hospitals, health care regions and colleges of physicians and surgeons create guidelines and procedures that single out HIV or hepatitis B and C as requiring special attention. This paper examines such surveillance and stigma in blood-borne pathogen protocol, using the example of recently refined policies in Newfoundland, Canada. We argue that policies distinguishing HIV and hepatitis B and C as requiring special treatment are produced by a combination of four factors: (1) the ideological and political function of risk discourse, and how this overshadows actual measures of probability, (2) the historical association of HIV and hepatitis B and C as belonging to ‘deviant’ bodies, (3) the normalizing function of health surveillance mechanisms and (4) the contradictory image of the ‘sick’ doctor. It is crucial that health professionals be critical of bylaws that single out HIV and hepatitis B and C as these guidelines are unjust and may impede efforts to control the disease.

Colonial legacy and the experience of First Nations women in cervical cancer screening: a Canadian multi-community study

Pamela WakewichBrianne WoodCrystal DaveyAshlie LaframboiseIngeborg Zehbe & on behalf of the ACCSS group

Regular Papanicolaou (Pap) screening has dramatically reduced cervical cancer incidence in Canada since the 1950s. However, Indigenous women’s rates of cervical cancer remain disproportionately high, a factor which is not acknowledged in national media or in educational materials reporting Canada’s new cervical cancer screening guidelines. Here, we present findings from a cervical cancer screening initiative in Northwestern Ontario. Based on participatory action research, we worked with 10 First Nations communities in the Robinson Superior Treaty area to increase awareness of cervical cancer risk, develop culturally sensitive tools for screening and education and test the efficacy of human papillomavirus (HPV) self-sampling as an alternative to Pap cytology. We conducted 16 interviews with health care professionals and 9 focus groups with 69 women from the communities. A central theme for both health care providers (HCPs) and community members was the colonial legacy and its influence on women’s experiences of cervical cancer screening. This was evidenced by a strong sense of body shyness, including shame related to sexuality and sexually transmitted infections, concerns about confidentiality in clinical encounters and distrust or caution around HCPs. Reaffirming women’s traditional caregiving and educational roles, enhancing mother and daughter communication, improving cultural sensitivity in health care and education and adoption of HPV self-sampling to increase women’s privacy and control of the cervical cancer screening experience were endorsed. We argue that education and screening initiatives must reflect the cultural preferences of Indigenous women, empowering them to take control of their experiences of health and body in cervical cancer screening.

“Years ago”: reconciliation and First Nations narratives of tuberculosis in the Canadian Prairie Provinces

Sara Komarnisky, Paul Hackett, Sylvia Abonyi, Courtney Heffernan & Richard Long

For First Nations tuberculosis (TB) patients in the Prairie Provinces, the past matters. In this paper, we draw on the analysis of historical statements made by 20 First Nations interviewees with infectious TB to explore the function of talking about the past in relation to a current diagnosis of TB and the implications of historicity on contemporary TB prevention, programming and care. Despite interviewees not being asked directly about past contexts of TB treatment, they talked about historical topics such as the removal of First Nations TB patients from communities for treatment in distant sanatoria, painful and invasive surgical procedures once used to treat TB, and the attitudes that persist due to the ongoing failure to eliminate TB from First Nations communities. In these narratives, past experiences of TB treatment are intimately connected to present-day experiences and context. What happened ‘years ago’ profoundly affects the health and well-being of people diagnosed with TB today. Attempts to eliminate TB among First Nations peoples in Canada must also address its historical legacy. Understanding the contemporary effects of past TB treatment and mistreatment among First Nations peoples in the Prairie Provinces can also be seen as part of a larger project of truth and reconciliation in Canada, which involves both Indigenous and non-Indigenous Canadians.

The biopolitics of Māori biomass: towards a new epistemology for Māori health in Aotearoa/NewZealand (open access)

Isaac Warbrick, Andrew Dickson, Russell Prince & Ihirangi Heke

In this paper we consider what impact a biopolitics that creates a compliant self-governing weight-focused population has had on Māori health in Aotearoa/New Zealand. We frame this discussion with three vignettes that in different ways demonstrate the deleterious effects of the individualisation of health on Māori. We argue that the current biopolitics is best explained as ‘the health of Maoris’ not ‘Māori Health’. To counter this current biopolitics we put forward an alternative epistemology, the ‘Atua Matua’ framework. This epistemology pays respect to a Māori view of health that is holistic, encompassing physical, emotional, spiritual, cultural and familial well-being and does not give ground to the requirement for individualism so prevalent in neoliberalism. Finally, we consider what this new epistemology might offer to the public health agendas in Aotearoa and other countries where indigenous populations suffer ill health disproportionately. Thus, our implications have potential not only for Māori health but human health in general.

‘Quantify the Invisible’: notes toward a future of posture

Brad Millington

This paper contributes to the literature on the phenomenon termed mHealth through a critical examination of wearable posture-tracking technologies. The paper specifically reports on a qualitative document analysis of promotional materials for three devices, carried out with the aim of assessing their mode of operation, the logic underpinning their development and their purported benefits for users. Findings initially highlight how Lumo Lift and Lumo Back, made by the company Lumo Bodytech Inc., and Prana, made by Prana Tech LLC, are designed to enable haptic surveillance and discipline whereby the body is monitored and ‘reprimanded’ through the touch. These forms of interactive posture training are underpinned by scientific insight from fields such as biomechanics and by data science on consumer posture habits. In turn, the benefits for those engaging with commercial posture-tracking devices are said to include, unsurprisingly, better posture, but also a less tangible form of ‘optimised’ living. With these findings in mind, it is argued that the arrival of interactive posture technologies has two main implications. In one sense, whereas good posture has historically been imagined as a dividing line between ‘civilized’ humans and ‘uncivilized’ others, devices such as Lumo Lift make posture into a matter of posthuman optimisation: humans and non-humans are enfolded in the pursuit of self-betterment. In another sense, posture technologies are important in emboldening the wider mHealth phenomenon, privileging as they do the idea that commercial technologies are now allies and not foes when it comes to improving health.

Bianca in the neighborhood: moving beyond the ‘reach paradigm’ in public mental health

 Mare Knibbe, Marten de Vries & Klasien Horstman

This article offers a critical analysis of how to address social inequalities in mental health. In public mental health, inequalities are commonly construed as a problem of reach, implying that existing mental health expertise often fails to reach low-income groups. We discuss two critiques on the ‘reach-paradigm’ in mental health promotion: the impoverishment of idioms of distress and the tendency to transform complex political issues into clinical ones that are assumed to be backed by evidence. Furthermore, we present the findings of our ethnographic research of an alternative approach to mental health promotion that used media storytelling focused on local knowledge and social context. Our analysis is guided by anthropological research on idioms of distress and sociological literature on health promotion and social inequalities.

Polio, public health, and the new pathologies of militancy in Pakistan

Spenta Kakalia & Hasan H. Karrar

Since 2005, Pakistan has witnessed a net increase in polio, reaching a 15-year crest in 2014 when 306 cases were reported. Pakistan, along with Afghanistan, is one the remaining two polio-endemic countries. The numbers of cases reported in Pakistan in 2014 were far in excess of Afghanistan (28) and Nigeria (6). This paper focuses on the endemic militancy plaguing the country that has recently created grave obstacles for countrywide polio eradication. We argue that the relationship between polio and militancy in Pakistan has had two facets. First, polio vaccination efforts have become a casualty of militancy: over the last decade, polio vaccination was periodically banned in militant strongholds, large cohorts of children remained unvaccinated in remote frontier regions as vaccinators were unable to reach them, and anti-vaccination discourses in many parts of the country deterred others from vaccinating their children. The second relationship between the presence of polio in Pakistan and militancy is one where state-led polio vaccination efforts became a target of militancy. This was through the deliberate killing of polio workers; since July 2012, 71 contractual government employees tasked with administering polio vaccines have been killed, posing impediments to vaccine coverage. This paper concludes that in addition to implementing policies to improve vaccination coverage, endemic militancy must be addressed before polio can be eradicated.

Policing ‘Vancouver’s mental health crisis’: a critical discourse analysis

Jade Boyd & Thomas Kerr

In Canada and other western nations there has been an unprecedented expansion of criminal justice systems and a well documented increase in contact between people with mental illness with the police. Canadian police, especially in Vancouver, British Columbia (BC), have been increasingly at the forefront of discourse and regulation specific to mental health. Drawing on critical discourse analysis, this paper to explores this claim through a case study of four Vancouver Police Department (VPD) policy reports on ‘Vancouver’s mental health crisis’ from 2008 to 2013, which include recommendations for action. Analyzed is the VPD’s role in framing issues of mental health in one urban space. This study is the first analysis to critically examine the VPD reports on mental health in Vancouver, BC. The reports reproduce negative discourses about deinstitutionalization, mental illness and dangerousness that may contribute to further stigma and discrimination of persons with mental illness. Policing reports are widely drawn upon, thus critical analyses are particularly significant for policy-makers and public health professionals in and outside of Canada.

Embedded mistrust then and now: findings of a focus group study on African American perspectives on breast cancer and its treatment

Maria J. Ferrera, Rebecca T. Feinstein, William J. Walker & Sarah J. Gehlert

The risk of African American women dying from breast cancer is estimated to be 41% higher than that of White women throughout the USA. Using a community-based participatory research (CBPR) perspective, this qualitative study elicited attitudes, beliefs and concerns about breast cancer and its treatment amongst African Americans living in Chicago. Five hundred and three women and men were recruited from 15 of Chicago’s predominantly African American South Side neighborhoods. Participants were interviewed in 49 focus groups, 2–3 focus groups representing each neighborhood. Grounded theory was used to analyze data. A prevalent theme in the analysis was a general sense of mistrust amongst African Americans towards breast cancer treatment and the health care system at large. This theme involved notions of being treated like a guinea pig; living in the legacy of Tuskegee and other forms of historically rooted experimentation on African Americans; and being maltreated because of race. These findings suggest that historical and contemporary incidents remain a point of debate. Findings warrant the promotion of increased cultural sensitivity amongst health professionals regarding this historically rooted mistrust and its present-day implications.

International medicines governance 1940s to 1970s: lessons for public health

Belinda Townsend

Public health advocates aim to maximise affordable access to good quality essential medicines. This goal often conflicts with the profit-seeking ambitions of the pharmaceutical industry. Since the World Trade Organisation’s Trade-Related Aspects of Intellectual Property Rights agreement, the extension and enforcement of intellectual property (IP) rights has become the dominant discourse in global medicines governance. Public health advocates operating within this framework face significant obstacles and challenges. This paper presents an historical perspective to the contemporary debate over medicines and patents by examining the evolution of international medicines governance between the 1940s and 1970s. This research indicates that debates around IP and medicines were more advanced in terms of equity and access in the 1960s and 1970s than they are today. While acknowledging the existence of obstacles and challenges for advocates, the paper argues that alternative frameworks can and should be reasserted in global debates about medicines governance.

 

Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine 

Balancing exercises: Subjectivised narratives of balance in cancer self-health

John I MacArtney

Having a ‘balanced lifestyle’ is often promoted as one way to manage the competing demands of contemporary life. For people with cancer, those demands are often multiplied, particularly when they use self-health approaches that seek to bring together an array of biomedical and complementary and alternative medicine therapies and practices. Yet, how balance is used in this complex healthcare milieu and the affects it has on experiences of illness are less well understood. In order to follow the polyphonic narratives involved, two case studies of women with breast cancer who used cancer self-health approaches were analysed. By exploring different modes of subjectivation in the case studies, balance was found to affect experiences of health in contemporary society in multiple ways. In particular, it was one way through which participants saw themselves as being able to maintain a critical engagement not just with their healthcare, but with their self and life.

Beyond medicalization: Self-injuring acts revisited

Inger Ekman

For too long, medical/psychiatric and psychological studies, with focus on emotional sensitivity, personality traits, and correlation with psychopathology, have dominated research on self-injuring acts. The phenomenon thus has been defined as a predominantly medical issue. However, a large body of community prevalence studies show self-injuring acts to be a common phenomenon in society, and most of those who self-injure are unknown in psychiatric or other clinical settings. This article describes and analyzes the medicalization of self-injuring acts and argues a need to move research on self-injuring acts out of the medical paradigm. There is a need to explicitly explore the impact of social, cultural, structural, and gendered factors surrounding and influencing self-injuring acts. A non-medical approach, beyond the limits of the medical perspective, would feed research forward and create a more nuanced view on this widespread social phenomenon.

Emoting infertility online: A qualitative analysis of men’s forum posts

 Esmée Hanna and Brendan Gough

Relatively little research on infertility focuses exclusively or significantly on men’s experiences, particularly in relation to emotional aspects. Evidence that does exist around male infertility suggests that it is a distressing experience for men, due to stigma, threats to masculinity and the perceived need to suppress emotions, and that men and women experience infertility differently. Using thematic analysis, this article examines the online emoting of men in relation to infertility via forum posts from a men-only infertility discussion board. It was noted that men ‘talked’ to each other about the emotional burdens of infertility, personal coping strategies and relationships with others. Three major themes were identified following in-depth analysis: ‘the emotional rollercoaster’, ‘the tyranny of infertility’ and ‘infertility paranoia’. This article then offers insights into how men experience infertility emotionally, negotiate the emotional challenges involved (especially pertaining to diagnosis, treatment outcomes and their intimate relationships) and how they share (and find value in doing so) with other men the lived experience of infertility.

Establishing credibility, constructing understanding: The epistemic struggle over healthy eating in the Finnish dietetic blogosphere

Janne Huovila and Sampsa Saikkonen

What constitutes healthy eating is experiencing ongoing public debate, and this debate is increasingly taking place on the Internet. In this article, using a dialectical approach to analyse rhetorical discourse, we investigated how six highly popular Finnish nutrition counselling bloggers construct dietetic credibility and understanding. Their argumentation is compared to that of two academic experts contributing to the blog of the National Institute for Health and Welfare. Theoretically, we draw on Michael Billig’s notions on how thinking and understanding are pervasively argumentative and reflect wider socio-cultural contexts, and on the dilemmatic nature of common sense. We demonstrate how the popular Finnish nutrition counselling bloggers rhetorically constructed a more particularistic and individualistic understanding of healthy eating in their argumentation in critical opposition to the universalistic and population-based understanding. In the popular Finnish nutrition counselling bloggers argumentation, practical, subjective and moral knowledge was valued, alongside abstract, scientific knowledge. In contrast, the National Institute for Health and Welfare bloggers typically utilised population-based averages and causalities in their argumentation. We argue that arguing over healthy eating in the public domain is fundamentally an epistemic struggle, in which different forms of knowledge and ways of knowing are valued, and dilemmas related to healthy eating are deliberated.

Illness is Work: Revisiting the concept of illness careers and recognizing the identity work of patients with ME/CFS

Jan Grue

The concept of careers has an extensive history in the sociology of health and illness. Among other things, the notion of a career has been used to describe the changing identities of patients diagnosed with mental illness, to identify distinct stages in the progression of various illnesses, and to recognize the cooperative efforts of hospitalized patients. However, the career concept may be reanalyzed as part of an analytical metaphor that makes salient both the agency of people with illnesses and the social structures in which they are enmeshed. This metaphor, ILLNESS IS WORK, can valorize and aid understanding of the identity work and actions of patients with chronic illnesses, particularly illnesses with a low degree of social recognition and medical prestige such as myalgic encephalopathy and chronic fatigue syndrome.

Temporary sobriety initiatives as public pedagogy: Windows of opportunity for embodied learning

Julie Robert

Philanthropic temporary sobriety initiatives such as Dry July, FebFast and Ocsober have become increasingly popular in Australia and have begun to spread to other locations both for their fundraising potential and as a grassroots public health measure to promote more responsible attitudes to alcohol consumption. This article presents findings from a series of in-depth, post-campaign interviews with FebFast 2014 participants and staff about how these campaigns can be understood as a form of public pedagogy or non-traditional learning that purposefully cultivates and suggests health-promoting meanings for embodied experience. It explicates the mechanisms of public pedagogies that rely on embodiment and, importantly, considers the learner’s perspective on the pedagogical process. Temporary sobriety initiatives are found to operate thanks to (1) a structure that prescribes and facilitates short-term changes and enforces compliance with a social contract of philanthropy and (2) messaging that guides participants in their evaluation and assessment of their experience of temporary sobriety as physically and psychologically beneficial, as well as socially informative and impactful.

 

Health and Place 

Where are the schools? Children, families and food practices

Hannah Fairbrother, Penny Curtis, Elizabeth Goyder

Reducing childhood obesity is an international priority and children’s diets, food knowledge and practices have come under intense scrutiny in both policy and popular discourse. Notwithstanding evidence that health interventions which resonate with children’s own views are the most effective, there is still relatively little research which mobilises children’s everyday perspectives on food to inform public health policy. We report key findings from a qualitative study with 53 children aged 9–10, attending two socio-economically contrasting schools in the UK. The study explored children’s understandings of food in everyday life and their ideas about the relationship between food and health. Throughout the study, despite recent attempts to position schools as key sites for public health interventions, children consistently emphasised families as the locus for enduring food practices. The research highlights the value of listening to children and applying our understanding of their perspectives to ensure that public health initiatives work with the important influences on their diet and health that they themselves identify.

Painting place: Re-imagining landscapes for older people’s subjective wellbeing

Emma Rose, Stephen Lonsdale

This study provides insights into how a participatory painting activity impacts older people’s subjective wellbeing. The study uses qualitative methods to analyze the findings, and employs qualitative data collection methods to examine how creativity conducted in an environment of relational connectivity is beneficial to wellbeing. The findings demonstrate that processes of re-imagining landscape contribute to participants’ retaining significant places in the mind when physical engagement is limited. The study reveals how the activity of re-imagining landscape provokes emotions and memories that help participants connect the past with the present, and to connect their older and younger-age selves, positively to reaffirm their older age identity. The paper reflects on the intervention as a form of encounter with landscape whose benefits are potentially therapeutic for different groups, particularly those for whom engagement with memories may assist with processes of adaptation or transition.

Examining local processes when applying a cumulative impact policy to address harms of alcohol outlet density

Daniel Grace, Matt Egan, Karen Lock

One approach to addressing the negative health and social harms of excessive drinking has been to attempt to limit alcohol availability in areas of high outlet density. The Licensing Act (2003) enables English local authorities the power to implement a Cumulative Impact Policy (CIP) in order to tackle alcohol challenges. More than 100 English local authorities have implemented a CIP in one or more designated areas. We examined local licence decision-making in the context of implementing CIPs. Specifically, we explored the activities involved in alcohol licensing in one London local authority in order to explicate how local decision-making processes regarding alcohol outlet density occur. Institutional ethnographic research revealed that CIPs were contested on multiple grounds within the statutory licensing process of a local authority with this policy in place. CIPs are an example of multi-level governance in which national and local interests, legal powers and alcohol licensing priorities interface. Public health priorities can be advanced in the delivery of CIPs, but those priorities can at times be diluted by those of other stakeholders, both public sector and commercial.

Navigating identity, territorial stigma, and HIV care services in Vancouver, Canada: A qualitative study

Alexandra B. Collins, Surita Parashar, Kalysha Closson, Rosalind Baltzer Turje, Carol Strike, Ryan McNeil

This study examines the influence of territorial stigma on access to HIV care and other support services. Qualitative interviews were conducted with thirty people living with HIV (PLHIV) who use drugs recruited from the Dr. Peter Centre (DPC), an HIV care facility located in Vancouver, Canada’s West End neighbourhood that operates under a harm reduction approach. Findings demonstrated that territorial stigma can undermine access to critical support services and resources in spatially stigmatized neighbourhoods among PLHIV who use drugs who have relocated elsewhere. Furthermore, PLHIV moving from spatially stigmatized neighbourhoods – in this case, Vancouver’s Downtown Eastside – to access HIV care services experienced tension with different groups at the DPC (e.g., men who have sex with me, people who use drugs), as these groups sought to define who constituted a′normative’ client. Collectively, these findings demonstrate the urgent need to consider the siting of HIV care services as the epidemic evolves.

 

Health, Risk, and Society

Health professionals and the vaccine narrative: ‘the power of the personal story’ and the management of medical uncertainty

Terra Manca

Some vaccine supporters interpret vaccine uncertainties as a form of public ignorance caused by patients’ online research, failed physician–patient relationships, or inadequate knowledge translation. These interpretations often portray health professionals as homogeneously accepting of all scheduled vaccines for all patients. Nonetheless, health professionals may have limited knowledge about vaccines because the demands of their profession require them to have a broad understanding of a variety of health topics. In this article, I draw on data from interviews with twenty-six physicians and seven nurses in Alberta, Canada between 2013 and 2014, to examine how they used narratives to convey confidence, uncertainty, or doubts in vaccines. All interviewees supported the culturally dominant vaccine narrative that vaccines are essential to population health, yet they also spoke about uncertainties. Interviewees managed their uncertainties through tactics that confirmed accepting vaccination was the most desirable course of action. With each of these tactics, interviewees shared narratives about communicable diseases, vaccine benefits and risks to individual patients, and their reasons for trusting in medical science. When these narratives did not fully resolve medical uncertainties, health professionals often explained that either vaccination was beyond their professional responsibilities or that their uncertainties were irrelevant.

Personalised risk: new risk encounters facing migrant care workers

Karen Christensen & Jill Manthorpe

Many long-term care systems are seeking to address problems of growing demand, increasing expense, and higher user expectations. For many of them fostering care at home and private care arrangements are attractive options. The long-term care sector in England is typical of these systems. Over the last 2 decades, government policy in England has placed stronger emphasis on people’s choice and control when receiving care services. People with care and support needs may be eligible for public funds to employ care workers or to use them in other ways promote their well-being. These financial transactions are a major part of the policy of personalisation in adult social care, as confirmed by the Care Act 2014. Drawing on findings from life story interviews with 31 migrant care workers who had worked for disabled or older people in England, conducted 2011–2013, we note the potential for expanding the sociologically inspired concept ‘personalised risk’. This necessitates an appreciation of risks potentially faced by the multiple parties in the care relationship and a differentiated set of structural risks. Applying a multilevel analysis we highlight the potential risks of ‘informality’ of employment conditions experienced by directly employed care workers, the ‘emotional’ content of care worker-employer relationships, and ‘intimacy’ of employer/employee roles. In this article, we offer an empirical based contribution to the wider discussion of risks and risk theory derived from policy changes being adopted by many developed countries that increasingly emphasise individual responsibility for personal welfare within an uncertain and mobile social world.

Current conditions or future risks: certainty and uncertainty in decisions about statins

Louisa Polak

Preventive medications such as statins are recommended to an increasingly large number of people. To those who make these recommendations, prevention is synonymous with risk reduction; the clinical task of helping people decide about preventive medication is therefore widely framed as one of risk communication. In this article, I explore the role of risk and uncertainty in accounts of medication decisions, drawing on qualitative data from interviews carried out between 2011 and 2013 in the east of England with people who had been offered statins. I found that very few participants mentioned risk or likelihood, or described weighing benefits against harms, the process central to the risk communication project. Instead, those who had decided to take statins described their certainty that statins were needed to treat current problems. This certainty was informed by knowledge about the present or the past; information about possible future harms was presented solely as contributing to concern about current problems. In contrast, those who had decided not to take statins explained their decisions in terms of the inherent uncertainty of information about the future, presenting this uncertainty as a reason to decline medication. This asymmetry between explanations for accepting and for declining statins is rooted in differences between the ways past, present and future information are handled. These findings challenge the assumption that decisions about statins are construed as decisions about risk by those offered them, and raise questions about the usefulness of using risk and uncertainty as key concepts for theoretical accounts of what is going on when people consider taking preventive medication.

Governing homo economicus: risk management among young unemployed people in the Danish welfare state

Sabina Pultz

In this article, I examine how young unemployed people deal with the risk of unemployment in the Danish welfare state, focusing on two main issues. I examine the technologies currently being used in the unemployment system to manage youth unemployment and I explore how the young unemployed people who are the subject of these technologies understand and react to them. I also consider the affective work, which underpins these technologies and the ways this shapes the framing of risks. In this article, I draw on a Danish research study (2014–2015) that examined the ways in which the Danish unemployment fund operated and I used in-depth interviews to explore the ways in which 33 young unemployed Danes interacted with the unemployment fund. Using the conceptual tools provided by the governmentality risk perspective, I analysed the relationship between institutionalised risk management and individual risk management. I found that the management of risk at the institutional level invoked the use of a screening tool that categorised young unemployed people into risk groups and this categorisation determined the intervention the young unemployed persons received. I found that in the new unemployment system, young unemployed people were treated not only as homo economicus, that is, rational actors responding to economic incentives but they were also seen as sensitive beings whose feelings and affects could be shaped by technologies empowering and motivating them in order to enable them to manage their own risk of unemployment more effectively. This psychologised the issue of unemployment.

 

Humanity

Dossier on Africa, Human Rights, and Humanitarianism (in lieu of an abstract, overview of the issue)

Amal Hassan Fadlalla, Omolade Adunbi

Ongoing political conflicts in Africa, such as those in the Congo and the two Sudans, together with other transformations initiated by the Arab Spring in 2011, continue to generate debate about human rights and humanitarian interventions in the continent. Building on Mutua’s critique, the authors in this dossier move beyond the savior/savage narrative to re-interrogate the meaning of rights and national and transnational solidarities in the post–Cold War era. The five essays here examine the tensions between master narratives and counternarratives, the mobilization of new celebrities and humanitarian activists, the ‘‘intimate politics’’ of rights in low-income urban households, the re-Orientalization of Islam and Muslim cultures, and the continuous denial of pastoralists’ land rights.

Humanitarian Dispossession: Celebrity Activism and the Fragment-Nation of the Sudan

Amal Hassan Fadlalla

Celebritizing the Congo: How Ben Affleck Sells the Congo to Americans

Lisa Ann Richey, Alexandra Cosima Budabin

When Rights Come Home: The Intimate Politics of Women’s Rights in Urban Uganda

Robert Wyrod

The Cry for Human Rights: Violence, Transition, and the Egyptian Revolution

Nadine Naber, Atef Said

Conservation, Neoliberalism, and Human Rights in Kenya’s Arid Lands

Bilal Butt

 

International Journal of Social Psychiatry 

Exploring communication of traumatic experiences from Khmer Rouge genocide survivors to their offspring: In-depth interviews with both generations

Marianne Melander, Kjerstin Dahlblom, Bhoomikumar Jegannathan, and Gunnar Kullgren

Background: Traumatic events experienced by parents who have survived genocide influence mental health among their offspring. This study aims at exploring how the communication of traumatic events between Khmer Rouge survivors and their offspring was perceived by both generations.

Methods: Qualitative interviews were performed with six Khmer Rouge survivors and with six young people representing the second generation and were analysed using a content analysis approach.

Discussion: Parents felt that informing their children was important to instill gratitude for living a better life and to empower them. Among children, this was met with empathy but sometimes also disbelief and at times they blamed their parents for being too submissive.

Conclusion: The study discloses the complexity, pros and cons of intergenerational sharing of trauma.

 

Medical Anthropology 

Demedicalizing Health: The Kitchen as a Site of Care

Emily Yates-Doerr* & Megan A. Carney

Attention to culinary care can enrich the framing of health within medical anthropology. We focus on care practices in six Latin American kitchens to illuminate forms of health not located within a singular human subject. In these kitchens, women cared not for individuals but for meals, targeting the health of families and landscapes. Many medical anthropologists have critiqued health for its associations with biomedicine/biocapitalism, some even taking a stance ‘against health.’ Although sympathetic to this critique, our focus on women’s practices of caring for health through food highlights dissonances between clinical and nonclinical forms of health. We call for the development of an expanded vocabulary of health that recognizes health care treatment strategies that do not target solely the human body but also social, political, and environmental afflictions.

Going ‘Beyond the Numbers’: Maternal Death Reviews in India

Kim Gutschow

This essay discusses the Indian government’s implementation of maternal death reviews (MDR) across the country in response to a global WHO strategy called ‘Beyond the Numbers.’ India’s MDR process attempts to better count and assess maternal deaths across the country, yet considerable challenges remain. Existing studies of the MDR process in India still reveal systemic failures including poor quality of obstetric care, as well as omissions or delays of care that are covered up or denied. An ethnographic case study suggests ways that ethnographic sensibilities or techniques could be used to harness community stakeholders or lay perspectives by privileging ambiguity, multiplicity, and conflicting views in order to reveal these systemic omissions or failures of accountability. It concludes by suggesting how ethnographic ways of knowing might elicit lay concerns or critiques that threaten the very medical privileges that the MDR process inadvertently shores up.

Deadly Flies, Poor Profits, and Veterinary Pharmaceuticals: Sustaining the Control of Sleeping Sickness in Uganda

Kevin Louis Bardosh

Efforts to control neglected tropical diseases have increasingly focused on questions of implementation. But how should we conceptualize the implementation process? Drawing on ethnographic fieldwork between 2010 and 2012, in this article I explore efforts by a small-scale public–private partnership to use private veterinarians to sustainably control zoonotic sleeping sickness in Uganda. With a fundamental tension between business incentives and vector control, I show how divergences in knowledge, power, values, and social norms shaped project implementation and community responses. Reflecting more widely on the relationships between project plans and local realities, I argue that these encounters reveal the heuristic value in approaching global health interventions as evolving ‘social experiments.’ This metaphor reveals the uncertainty inherent to dominant narratives and models, the role of available expertise in defining the limits of action, and the need for continuous adaption to synchronize with emergent social and institutional topographies.

Relationships that Heal: Beyond the Patient-Healer Dyad in Mayan Therapy

Mónica Berger-González, Ana Vides-Porras, Sarah Strauss, Michael Heinrich, Simeón Taquirá & Pius Krütli

Biomedicine fosters particular styles of interaction and behaviors, with the therapeutic relationship seen as occurring between a doctor and patient. In contrast, where alternative modalities of healing are practiced, relationships go beyond a dyadic interaction and include wider social networks. In this article, we propose the existence of a ‘therapeutic unit’ in Maya healing practices in Guatemala that binds healer, wellness seeker, family, and community members, along with the spiritual and natural realms, into a coherent system requiring all of these elements to achieve success. Drawing on interviews with 67 Maya healers, we describe healers’ understanding of raxnaq’il nuk’aslemal (well-being), and show how these interactions activate wider networks that play crucial roles during treatments. We highlight how holism is expressed in relationships typical of indigenous healing systems, and how an appreciation of this is important for developing culturally appropriate health care provision systems.

 

Philosophy, Ethics, and Humanities in Medicine (open access)

Establishing the first institutional animal care and use committee in Egypt

Sohair R. Fahmy and Khadiga Gaafar

Background: Although animal research ethics committees (AREC) are well established in Western countries, this field is weakly developed and its concept is poorly understood in the Middle East and North Africa region.

Objective: Our main objective was to introduce the concept and requirements of ethical approaches in dealing with experimental animal in research and teaching in Egypt.

Methods: Due to its very recent inception, Cairo University, Faculty of Science IACUC decided to operate in accordance with Guide for the Care and Use of Laboratory Animals 8th Edition 2011 (the Guide) since Egypt has not yet compiled its own guide.

Results: Fifty protocols were reviewed in 2013–2014. Only ten protocols were reviewed in 2013, but in 2014, forty protocols were reviewed. In 2013 all protocols were approved and in 2014, number of approvals were 35, the number of deferrals were 4, and one refused protocol. Master’s theses (MSc) research protocols constituted the majority of the total reviewed protocols. This is attributed to the decision of the Board of the Faculty of Science, Cairo University in September, 2013 that the approval of the IACUC is mandatory before conducting any research involving animals or theses registration.

Conclusion: The first IACUC was established in the Cairo University, Faculty of Science, since 2012. The challenges encountered by the committee were diverse, such as the absence of laws that control the use of animal models in scientific research, lack of guidelines (protocols for experimental animals in research) and, mandatory ethical approval for any experimental animal research.

 


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