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- Convenors:
-
Ursula Probst
(Freie Universität Berlin)
Marcos Freire de Andrade Neves (Freie Universität Berlin)
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- Format:
- Workshop
- Transfers:
- Closed for transfers
- Working groups:
- Medical Anthropology
Short Abstract:
This panel asks how health can be considered a common good, and the implications of this framing for accessibility, equality, and governance over life and death. It invites critical engagement with healthcare systems and encourages rethinking the boundaries of what constitutes the common in health.
Long Abstract:
Health is often framed as a universal right, yet global access to healthcare remains deeply stratified. While many national governments and international health organisations continue to profess a commitment to universal health care, structural inequities in health insurance systems and availabilities of health care are often concealed through individualized understandings of health and well-being, making health care ultimately appear to be a personal issue. The shortcomings of individualized human-centered approaches to health care have also become apparent in recent scholarship on planetary health, as well as through the critiques of communities affected by climate change and extractivism.
Building on these critiques of contemporary health (care) disparities, this panel interrogates whether health can, or should, be considered a common good, and the implications of this framing for accessibility, inequality, and governance over life and death. We invite contributions which explore examples and potentials of commoning health, as well as the social, economic, and political dimensions of making health and well-being a common endeavour.
Key topics include the political economy of healthcare, examining how different systems—from universal healthcare to privatized markets—impact health equity and access. We will also invite reflections on the structural inequalities that negatively affect certain populations well-being and access to healthcare as well as marginalized communal approaches to health care. Ultimately, this panel seeks to foster critical engagement with the future of health and healthcare systems, encouraging participants to rethink the boundaries of what constitutes the “common” in health.
Accepted contributions:
Session 1Contribution short abstract:
PrEP prevents HIV but is unequally accessible. This paper contrasts a pharmacist’s localized strategy with activists’ transnational solidarity efforts, examining who is granted or excluded from PrEP access and its promise of ‘careless sex,’ revealing tensions in sexual health as a ‘un/common good.’
Contribution long abstract:
Pre-Exposure Prophylaxis (PrEP) is an antiretroviral drug that effectively prevents HIV when taken as prescribed. Since 2019, PrEP and accompanying tests have been covered by statutory health insurance in Germany for so-called ‘risk groups,’ primarily but not exclusively gay men. While this coverage expanded access to sexual health, it also sparked debates about responsibility and ‘careless sex.’ Based on multi-sited fieldwork in Germany and Colombia, this paper examines two contrasting approaches to achieving access to PrEP: a pharmacist’s circumvention of German pharmaceutical law to offer PrEP at reduced prices before insurance coverage and the transnational activism of a Berlin-based group of migrants from Europe and Latin America advocating for solidarity with queer people in the Global South.
Both efforts are rooted in critiques of historical and systemic inequities affecting queer communities. The pharmacist’s approach focused on navigating the German system, achieving his goal with the inclusion of PrEP in public insurance. In contrast, the activists frame health as a global common good, viewing insurance coverage in Germany as only a partial victory. By juxtaposing these approaches, this paper interrogates the tensions between localized and transnational efforts to common sexual health and examines who remains excluded from access to PrEP and its promise of sexual liberation. Ultimately, it reflects on how these disparities challenge the notion of sexual health as a ‘un/common good’ in a deeply unequal world.
Contribution short abstract:
This paper investigates the international recruitment of health care workers as a response to Germany’s nursing crisis. It examines systemic challenges and precarities faced by Vietnamese nurses, highlighting the unsustainability of migration-focused solutions to structural issues in health care.
Contribution long abstract:
The nursing crisis in Germany reflects two interrelated issues: the country's struggle to compete with international recruitment efforts and the deteriorating state of its health system. The nursing shortage calls for collective solutions and government intervention, but current responses often rely on private-sector approaches. This paper examines the recruitment of Vietnamese nurses, highlighting the systemic challenges they face in care facilities, including overwork, staff shortages, and precarious working conditions. I aim to understand the affective and emotional dynamics shaping the everyday interactions of recruited workers, nursing school educators, and clinics. My research explores how policy responses to the crisis intersect with broader conceptualizations of health care and migration as un/common phenomena. Challenges are experienced as an individual responsibility or burden, although recruitment efforts are presented as serving the common good. Still, structural and bureaucratic barriers hinder to work and care. Instead, private service agencies promise quick and easy solutions, but not all are reputable which intensifies precarities and dependencies for Vietnamese nurses. My study uncovers structural inequalities that hinder the integration of international workers into the German health system and society. These barriers contribute to high dropout rates and perpetuate exploitative practices, raising critical questions about the sustainability and fairness of migration-driven solutions to the nursing crisis. By examining the recruitment of Vietnamese nurses in Germany's nursing crisis, this research highlights how health care as a "common good" is contested and fragmented, revealing the tensions between commodified labor practices and the collective aspirations of equitable and accessible health systems.
Contribution short abstract:
This research explores tensions between epidemiological surveillance and primary care in syphilis control in Brazil, based on a study with health professionals. It examine how integrality—a constitutional principle framing health as a common good—is applied in syphilis care work processes.
Contribution long abstract:
Syphilis has been classified as an epidemic in Brazil since 2015, representing a significant public health challenge. This persistence is particularly striking given the availability of diagnostic tests, and the accessibility of its effective treatment—penicillin, a low-cost and easy-to-administer drug. In Brazil, the response to syphilis is guided by the constitutional principle of integrality, which frames health as a Common Good. This principle emphasizes holistic care and fosters intersectoral articulation within the healthcare network.
This study explores the concept of integrality in syphilis control strategies in Brazil, focusing on the tensions between epidemiological surveillance and primary health care. This is post-doctoral research carried out in the field of public and collective health. Qualitative fieldwork was conducted using observations, semi-structured interviews, and focus groups with health professionals from a city in the metropolitan region of Porto Alegre, the capital of Rio Grande do Sul, Brazil’s southernmost state.
The research aims to understand the dynamics between these two sectors of the Brazilian health system, exploring their cooperation, conflicts and frictions. It investigates how integrality is understood and practiced in the work processes of syphilis care. The data produced reveals that while primary health care focuses on immediate individual cases under an emergency logic, epidemiological surveillance adopts a collective monitoring perspective. These differing temporalities make integrality a fragile and transient process in the health system's daily practices. Health as a Common Good depends not only on a public and universal system, but also on a coordinated one.
Contribution short abstract:
Taking Berlin emergency shelters for unhoused people as a vantage point, I examine (in)accessibilities of vital infrastructures in the city. I follow the various collective bodies that emerge when un/doing health and sheltered space amidst housing crisis and welfare bordering.
Contribution long abstract:
In Germany, access to emergency medical services as well as to emergency shelter is, in theory, for everyone. In consequence, death and suffering of unhoused persons on the street are easily framed as individual tragedies rather than severe systemic failures to provide access to vital infrastructures. In this contribution, I draw on ethnographic fieldwork with staff in emergency shelters for unhoused people in Berlin to examine (in)accessibilities of vital infrastructures in the city. Demedicalizing health (Yates-Doerr and Carney 2015), I understand the shelter as a site of doing and undoing health. It is a place in which essential resources such as warmth, water, and food are provided, yet also a space of crampedness, contagion and shortage, positioned precariously and chronically makeshift at the margins of welfare provision and of the city.
I mobilize three examples of un/doing health at the shelter, that each trouble the notion of the shelter as a common space and health as a common good. First, Covid-19 protective measures, which conflicted with the fluctuating rhythms and crowded density of the shelter. Second, Hausverbot (expulsion), which challenges the notion of the shelter as universally accessible space. And third, the practice of calling medical emergency services, which exposes care gaps and highlights the layering of a medical emergency under conditions of housing emergency.
Along these limits and cracks of doing common health and sheltered space amidst housing crisis and welfare bordering, different versions of collective bodies emerge.
Contribution short abstract:
A commitment to commonning healthcare requires a radical paradigm shift, distinctly around wage labor. Current (state) practices connecting wage labor, healthcare and the border regime create contradictions and push into precarity, (especially) migrantized individuals working in low-wage industries
Contribution long abstract:
In Germany, healthcare access represents a major obstacle for many migrants working in low-wage industries. Coverage is mandatory, potential patients paying through employment, a familial connection to an employed person or through out of pocket contribution. Wage labor is thus an essential element to access medical infrastructure, yet, paradoxically, labor in low-wage industries is the reason why many workers require long-term medical attention. Too often, because job security is essential for financial stability and right of residence, health is not prioritized.
Conflicts for health and social rights demonstrate patterns of treatment denial, medical negligence and structural racism that echo Fraser‘s (2017) observation on current practices which making (social) reproduction unsustainable under financial capitalism. Harsh physical labor creates a need for treatment and care/rest, which is often denied or skipped altogether in detriment of the workplace. Migrantized individuals are then forced into the position to fight for their social rights and access to the "common", "universal" healthcare.
This contribution draws from my ethnographic fieldwork working alongside the grassroot organization Arbeitslosenhilfe Oldenburg(ALSO) and maps struggles for (social) reproduction of intra-EU migrants in low-wage industries of the Oldenburg region. A Social (State) Regime analysis of a region dominated by the meat and delivery industry reveals failures in healthcare infrastructure for people whose health is bound, due to the physical nature of their work, to inevitably crack, and what role it plays for perpetuating multiple precarity. It also reveals paradoxes that intertwine the healthcare industry, racialization and wage labor.
Contribution short abstract:
On the basis of experiences with community health centres and community research labs in Hamburg and Bochum, this presentation discusses the potential of community research in the context of new approaches to health care that focus on healthy living conditions as a common good.
Contribution long abstract:
Individualised health approaches are criticised in particular in the context of structurally induced inequalities for not addressing disease-causing conditions (Holst 2021). The setting-based prevention projects funded nationwide in Germany therefore represent an important paradigm shift in the medically dominated downstream approaches of the German health system. However, these projects, which are often limited in time and not directed against living conditions that cause illness. This lecture presents community research as a participatory approach that deals with the consideration of healthy living conditions as commons. The knowledge of residents for improving health and social care in their neighbourhoods is incorporated in close cooperation with solidary community health centres. The Poliklinik Veddel was set up in Hamburg in 2017 and has been cooperating with HAW Hamburg since 2022 to establish a community research lab that supports to reduce health inequity (Falge & Betscher 2024). In a somewhat reverse order, community researchers in Bochum, with years of experience with community research-based prevention projects and inspired by the Policlinic have been advocating for the establishment of a community health centre for several years. On the basis of the experiences of the two community health clinics and community research labs, this lecture discusses the potential of community research in the context of new approaches to living condition-oriented health care.
Contribution short abstract:
Cutaneous leishmaniasis, has received limited attention from the global health initiatives though it is affecting disadvantaged populations. This research in Tigray empowered health professionals through training to promote seeking early biomedical treatment and influenced regional health policy.
Contribution long abstract:
Cutaneous leishmanias (CL) is recognized as one of the world’s neglected tropical diseases (NTDs), characterized by disfiguring, disabling and chronic diseases nature. CL is caused by protozoan parasites of the genus Leishmania and transmitted through the bites of infected female sandflies. Despite its significant impact on the well-being of those infected, leishmaniasis has received limited attention from global health initiatives.
This ethnographic study explored health professionals’ knowledge and practices on CL in three districts of Tigray with high prevalence: Degua Tembien, Sebuha Saesie, and Emba Alaje. It aimed at empowering people with CL and reducing stigma through a community engagement and involvement approach under the ECLIPSE program. Data were collected through observation, interviews with individuals affected by CL, interviews and focus group discussions with health professionals.
The findings reveal that the government had rarely paid attention to CL, resulting in health professionals lacking knowledge about the cause, transmission and biomedical treatment for CL. CL was not integrated into the health policy document along with the common diseases. Most health professionals had the same knowledge as their communities and had recommended local treatment for infected individuals who came to the health facility seeking help.
This intervention enabled health professionals to obtain adequate training on the theoretical knowledge, and practical skills of treating CL. It influenced health policy decision; maintaining a relationship from the smallest health unit up to the hospital, facilitating referral system for people with CL. Testimonies from individuals who got cured with biomedical treatment increased the seeking biomedical treatment.
Contribution short abstract:
This paper interrogates the training of workers at a public health school in the Lao People’s Democratic Republic where the idea of health as a common good and collective endeavour rests on values and practices of self-improvement and learning to improve others.
Contribution long abstract:
What can research on health care systems in socialist states contribute to discussions of health as a common good and collective endeavour? The public health care strategy (2021-2030) of the Lao People’s Democratic Republic builds on principles of universality, quality, fairness and equality. It aims for universal health coverage in the year 2025, to lift Laos out of the UN’s “least developed country” status in 2026, and achieve the SDGs by 2030.
In Lao PDR, global health goals, international aid and foreign capital are mobilized for a socialist project conceived in terms of “developing” and “civilizing” the (largely rural) population. In this political economy, public health and socio-economic development of Laos – mainly made possible through foreign investments – are entangled: corporations build hospitals and roads in exchange for land concessions or permissions for resource extraction. Yet some such developments have exacerbated health disparities: broken hydropower dams flood villages, pesticides spread on banana plantations pollute watercourses, deforestation reduces people’s access to nutritious foods.
In this context, the Lao state aims to train people as “good citizens” with revolutionary morals who take on the work of public health: to assess communities’ development status, plan interventions, and educate about matters of public health in homes and hospitals. Drawing on ethnographic fieldwork conducted at a Lao public health school between 2024-2025, this paper argues that health is conceived of as the citizens’ duty of self-improvement and improving others in order to achieve health as a universal, common good – but at what cost?