Paper short abstract:

A discussion of the nutrition awareness work carried out by the state in the rural Peruvian Andes will help shed light on how social relations are intrinsic to the way that public health work is implemented and understood by those targeted by the health service.

Paper long abstract:

In the Peruvian Highlands, the public health system is working to reach all children and pregnant women, as part of its move towards universal coverage. This paper is concerned with a specific priority as defined by the state for the rural Andes - that of chronic childhood malnutrition. With a focus on nutrition programs and services operating in a rural district of the Peruvian Highlands, I will describe how the encounters between mothers and healthcare workers are subject to particular prejudices and agendas on both sides, shaped by the historical nature of state presence in the zone. I argue that a perspective that explores the state not only as structure and policy, but as actual social relations between real people, can shed light on how public health challenges are conceptualized. The paper will look at the way that both state workers and mothers targeted by nutrition programs negotiate their way through the expectations raised by public health programs, and will raise questions regarding the negative associations surrounding public (versus private) healthcare, on both sides. Local actors can be seen to transform and interpret the state public health agenda in ways which inadvertently undermine the initial policy intention. I will ask whether decision makers or policy actors can find spaces in which to address this process.