Paper short abstract:

Can heat be disentangled from other determinants of health problems? I explore this question by reflecting on ongonig research on chronic kidney disease among Nicaraguan sugarcane workers.

Paper long abstract:

In my current research on chronic kidney disease of nontraditional causes (CKDnt) among sugarcane cutters in Nicaragua, I am increasingly running up against the suggestion that CKDnt, which seems to be strongly linked to lengthy exposure to extreme heat, is on the rise worldwide due to global climate change. This suggestion is provocative, but it also has the whiff of the "magic bullet." After all, when I began looking into CKDnt just a year ago, activists and experts were talking with some assurance about the key role played by pesticides. Direct evidence of that role, however, is less available than evidence for heat stress. But how much heat is too much heat? Can a rise in mean temperatures by just one degree cause an epidemic? If so, what does that mean? Given the historical place of kidney-related diseases in discussions of "social determinants" of health, CKDnt raises questions about the limits of the social. While I was initially attracted to the problem of CKDnt due to an interest in chemicals, I'm now struggling to devise a meaningful way of talking about heat. In this paper, I argue that in all of the discussions of the Anthropocene in STS and allied fields, heat has been under-theorized. Medical anthropology, with its deep roots in studies of health models based on notions of heat, cold, wetness, and dryness, might offer some new and potentially fruitful ground for engaging climate change debates.