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- Convenors:
-
Kaveri Qureshi
(University of Edinburgh)
Marlee Tichenor (Durham University)
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- Format:
- Panel
- Sessions:
- Tuesday 18 January, -
Time zone: Europe/London
Short Abstract:
What distinctive contributions do ethnographic methods make to understanding health policy, and what are the methodological questions that ethnographers of health policy face? This panel seeks to bring together ethnographers of health policy in order to reflect on these questions.
Long Abstract:
Medical anthropologists increasingly find themselves studying global apparatuses of health policy, working with policy-makers, scientific experts, civil society organisations and other stakeholders. Ethnographic perspectives may be used to probe health policy from the standpoint of policy subjects, reading the state from the margins; or to study street-level bureaucrats at the interface between policies and their publics; or even to work within the corridors of power. What distinctive contributions do ethnographic methods make to understanding health policy, and what are the methodological questions that ethnographers of health policy face? These might include problems associated with ‘studying up’, or so-called ‘elite interviewing’, or ethnographies of institutions, or combining historical ethnographic techniques like participant observation with archival analysis. May an engagement with policy documents and their evolution provide greater historical depth to the insights gleaned from participant observation? By the nature of their work, do policy ethnographers have a specific concern with non-human actors, such as the files and desks that anthropologies of bureaucracy have often emphasised? Finally, are there particular ethical quandaries associated with health policy ethnography, concerning for example the negotiation of our responsibilities, as fieldworkers and as writers, towards our informants when they inhabit positions of institutional power? Can ethical frameworks designed to protect the vulnerable become tools of censorship? This panel seeks to bring together anthropologists of health policy in order to reflect on these questions.
Accepted papers:
Session 1 Tuesday 18 January, 2022, -Paper short abstract:
How can ethnographic methods track implicit & explicit forms of structural casteism in Indian public health policy & praxis? This paper theorizes insights from 14 months of ethnographic fieldwork in North India with public health doctors, activists & afflicted patient-groups amid COVID-19.
Paper long abstract:
In 2018, India expanded its public health frontiers through a national health protection policy (Ayushman Bharat Yojana) targeting 100 million of the country's most economically marginalized families. Albeit officially described as the "world's largest government funded healthcare (insurance) programme" that lays the foundations for achieving Universal Health Coverage (UHC) in India, my paper argues for a more nuanced ethnographic examination of India's public health scheme and it's underlying epistemic schemas. Based primarily on fieldwork in New Delhi's low and middle-income neighbourhoods and hospitals with public health doctors, activists, afflicted patient-groups and their families amid COVID-19, I ask, how are Indian public health policy and praxis animated by theories of wellness which systematically ignore caste as a primary determinant of structural harm, risk and debility for 400 million Dalit ('lower-caste') bodies? How can ethnography uncover and unlayer the structural and symbolic field(s) of asymmetric power relations in which practitioners, beneficiaries and institutions of (neo)liberal public health policy remain embedded? How do ostensibly "pro-poor" and "pro-women" health policies enact a proscriptive ethics rooted in and through biased and casted social facts? How can ethnography assemble and attend to everyday moments in which the violence of care and the violence of casteism are (co)produced through public health policy? And importantly, how are ethnographic methods privileged (and at-risk) in their ability to track implicit and explicit forms of structural casteism in Indian public health, including the implications of health policy’s refusal to name casteism as a threat to community health outcomes and life-chances?
Paper short abstract:
Based on WHO documents, this ethnography deals with the institutionalization of the concept of “tradition” as a characteristic of contemporary health systems. The paper aims to show how this concept starts to produce new identities, limits and possibilities for modern medicine and pharmacy.
Paper long abstract:
In this paper, we undertake an ethnography based on documents of the World Health Organization (WHO) that deal with the institutionalization of the concept of “tradition” as a characteristic of contemporary medicine and pharmacy. Our interest is focused precisely on the way in which this term has been mobilized within the scope of global health recommendations and, not least, on its effects while being instituted as a therapeutic category. We follow the flow of this concept through physical and digital documents, produced from the organization's headquarters, to regional branches in Africa and Asia, paying attention to how the idea of tradition/traditionality--as an identity and cultural aspect; also geographical and temporal, affective and invented, sometimes very localized but generally more universal--starts to produce new identities, limits and possibilities for modern medicine and pharmacy. We show that new modes of therapeutic legitimation are now validated in the context of global health, where "traditional use" presents itself as a turning point for a new stage in the life and history of medications. Contrary to the path that led to the purification of a drug that was separate from both nature and culture, we identify the hybridization policies inscribed in the documents of the World Health Organization as a new regime of truth instituted in the therapeutic field.
Paper short abstract:
This paper explores the ethical pitfalls of interacting with political elites in ethnographic research on global health diplomacy. It focusses on issues of consent and the unequal relationship between researcher and informant.
Paper long abstract:
Policy-making within global health is often a diplomatic endeavour: countries send delegations to places like Geneva and New York to agree policies and goals, ranging from World Health Organization (WHO) recommendations to the Sustainable Development Goals (SDGs). Ethnographic research on ‘global health diplomacy’ relies on interaction with policy elites, at both national and international levels. These include representatives of the private sector and non-governmental organisations, scientific experts, civil servants and diplomats, including ambassadors.
In this paper, I discuss the opportunities and challenges of interacting with policy elites, examining negotiating access to institutions and meetings for participant observation, conducting interviews and communicating research findings. I draw upon several projects over the past twelve years on policy-making at the WHO and on Sweden’s role in global health policy, based on participant observation, interviews and archival research. While the vast majority of my interactions with policy elites have been positive, in the paper I discuss a situation in which an ambassador withdrew consent after reading my preliminary research findings, using degrading and bullying language to do so.
This vignette raises questions of consent, academic freedom, the protection of researchers and the relationship between public and private personas. While in many cases it is reasonable for individuals to censor material about personal opinions, I argue against government representatives censoring material about their official duties, and call into question the usefulness of traditional research ethical frameworks to handle these situations.
Paper short abstract:
This talk explores how patients and medical practitioners in Tanzania employ embodied epistemologies to identify substandard pharmaceuticals. I argue that ethnographic attunement to such non-institutionalized forms of empiricism can offer crucial correctives to global health policies.
Paper long abstract:
Powerful pharmaceuticals are readily available for purchase throughout Tanzania and global health policy makers decry this situation as dangerous and disordered, as if no rules govern the use of drugs in Africa. In the prevailing global health understanding, ‘truth’ lies in the laboratory science that goes into the making and proper prescription of drugs, and such deviations as ‘overuse’ and ‘misuse’ result from the fact that locals misunderstand what these drugs are and how they should be used. To investigate this global health concern, I employed a grounded ethnographic approach, carried out in the regional capital of Iringa, Tanzania. Over three years of fieldwork, I observed how embodied epistemologies frequently enabled my interlocutors to evaluate the quality of various drugs and identify substandard pharmaceuticals through their material qualities like color, texture, smell, and taste. In this talk, I focus on one prominent example in which patients recognized the poor quality of antiretroviral drugs (ARVs) that were produced by the Tanzanian Pharmaceutical Industry and distributed throughout public facilities. Patients and doctors shook capsules to determine which were still good, or in Dr. K’s words, “which ones were shaking well like sand,” and then exchanged sticky-texture pills for the sand-texture ones in order to continue treatment in the context of drug shortages. I conclude that ethnographic methods offer crucial correctives to global health policies—such as those seeking to “rationalize” drug use—in part by challenging the containment of empirical experimentation within spaces of global capital, laboratories, and the neoliberal state.