Accepted Paper:

Creating health inequity: political construction of statistical reality and institutional barriers to access to health services in Bali Province, Indonesia  
I Nyoman Sutarsa (Australian National University)

Paper short abstract:

This paper explores the social and political construction of knowledge to illustrate the instrumentalist nature of the biomedical and public health approaches to knowledge production, and how the strategic use of this knowledge impedes access to health services among the marginalised group.

Paper long abstract:

The non-conforming groups who are subjected to moral judgments in contemporary Bali receive inequitable access to health services leading to lower health outcomes and premature death. They face structural and institutional barriers to access the available health services. Drawing on my 10 months of fieldwork in five districts in Bali Province, this paper explores the political and social construction of evidence to produce legitimate reality on HIV epidemic in Bali Province, Indonesia. I draw explanations on how the political construction of knowledge and the strategic use of this knowledge contributes to inequity in access to health services. My point of departure is the stark contrast of lived experiences of the transgender population in two districts. By linking the analysis of their lived experiences and the macro-social processes, I discover that the moral pathology narrative driven by socio-religious values and biomedical construction of 'at risk population' could explain the structural and institutional barriers to access to care. This moral rhetoric will dictate priority areas and allocation of health resources. The exclusion of the marginalised groups is constructed by aligning moralistic rhetoric and the powerful and normative power of statistical realities. This paper argues that the political construction of statistical realities and strategic use of it will determine which areas should be prioritised and to justify which population groups are allowed to be left behind.

Panel P30
Social death by neglect in health and health systems