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- Convenors:
-
Tim Allen
(LSE)
Melissa Parker (London School of Hygiene and Tropical Medicine)
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- Format:
- Panel
- Sessions:
- Friday 21 January, -
Time zone: Europe/London
Short Abstract:
This panel explores how and why ignorance is maintained and institutionalised in the domains of global health and medical humanitarianism. Effective strategies for challenging this state of affairs, and the possibilities of developing ethnographically-informed policies will also be considered.
Long Abstract:
Engagement with evidence in the domain of global health and medical humanitarianism is contingent on agendas shaped by compelling and morally-imbued rhetoric. Saving strangers, ending poverty, eliminating diseases are all linked to pervasive assumptions and assertions about goals and achievements that are often at odds with ethnographic observations on the ground. Although the dissonance is striking, ethnographic findings are frequently set aside as if they are hidden or not known. Medical humanitarians who claim that they are assisting those most in need are, at one level, well aware that they only help some of those they can reach, and challenges, such as the need to preserve their own well-being, acutely constrain what they actually do. Similarly, global programmes, such as the mass distribution of tablets for controlling parasitic diseases fail, but are still promoted as if they are a magical solution to the suffering of the World's poor. Those involved in aid agencies, international organisations, and schools of public health commonly ignore what they know to be true, perhaps because intentions are considered more important than results. However, the way in which evidence is deployed and contained is also part of the story. Medical journals persistently publish articles that deploy data in ways that hide or obfuscate realities. That is partly because hierarchies of evidence set aside anthropological observations in favour of purportedly more scientifically robust numbers. Yet almost everyone is aware that those numbers are used to produce the needed outcomes to sustain existing strategies.
Accepted papers:
Session 1 Friday 21 January, 2022, -Paper short abstract:
Mass distribution of tablets is an ineffective way to treat parasitic infections. However, deworming has been promoted. An economist involved in promoting deworming was awarded a Nobel Prize. Evidence has been set aside. Ignorance has been optimised. This paper asks why and how that has occurred.
Paper long abstract:
Based on a social experiment about deworming of pupils in a group of schools in Western Kenya, a hugely influential article was published by two economists in 2004. The article is repeatedly cited to support mass drug administration for worm infections in Africa and elsewhere; and one of the authors subsequently established an organisation called Deworm the World. However, ethnographic work on deworming has demonstrated that, in practice, treatment coverage is much lower than supposed. Moreover, a reanalysis of the Kenyan data showed that the findings that had been presented were flawed. This prompted a fierce debate known as 'worm wars'. Although random control trials have confirmed that deworming in ineffective, it has continued on a massive scale, and one of the authors of the Kenyan article has been awarded a Nobel Prize for his achievements for indicating solutions to African poverty. Evidence has been promoted and maintained in ways that do not describe realities on the ground. Ignorance has been optimised. This paper asks why and how that has occurred.
Paper short abstract:
This paper proposes the concept of misdirection as a process by which attention is diverted from certain scientific approaches in global health to justify specific methodological, scientific, and political decisions in line with prevailing paradigmatic practices.
Paper long abstract:
This paper proposes the term misdirection as a process by which attention is diverted from certain scientific approaches in the malaria elimination paradigm to justify specific methodological, scientific, and political decisions. Misdirection, as it applies in magic, creates a sort of tunnel vision in which attention is diverted away from any action occurring outside the frame of the current paradigm. A crucial component of this misdirection process is the global standardization of intervention methodologies operating independently of local social contexts and the per- perceived impossibility to ‘localize’ such interventions. This conviction requires – and is simultaneously supported by the production of decontextualized evidence through the application of methodologies aiming at generalizability, in detriment of social context and variability. This process produces pseudo measurements and conclusions that are at the same time real in their adherence to paradigmatically valid methodologies and fake as they either remain empty of empirical significance or whose validity cannot be assessed as we have lost sight of the (local, social, cultural) variation it has decided to ignore. Using the example of research on the effectiveness of bed nets and topical repellents as malaria prevention tools and their expected use within the current paradigm of malaria elimination, we show how the inherent ambiguity of the pseudo allows consequent misdirection processes.
Paper short abstract:
We employ empirical qualitative data to demonstrate a process of misdirection in the implementation of minimally invasive autopsy in global South. Misdirection, as applied in magic, refers to the magician’s ability to create a tunnel vision diverting attention away from actions occurring elsewhere.
Paper long abstract:
Recently, global health practitioners and policymakers have been increasingly vocal about the complex challenges of identifying and quantifying the causes of death of the world’s poorest people. To address this cause-of-death uncertainty and to minimise longstanding sensitivities and reservations about full autopsies in the Global South, the Bill and Melinda Gates Foundation have been at the forefront of advocating minimally invasive autopsies (MIA) as a solution to firstly understanding why poor people die and then addressing the reasons why.
MIA involves using hollow needles to collect samples from key bodily organs and so is argued to potentially be more acceptable than a full autopsy, which requires opening the cadaver. In addition, MIA is considered a good means of collecting accurate bodily samples and can provide crucial information needed to address cause-of-death uncertainty.
In this paper, I employ empirical qualitative data to demonstrate a process of misdirection in the implementation of MIA in the Global South. Misdirection, as applied in magic, refers to the magician’s ability to create a tunnel vision thereby diverting attention away from noticing actions occurring elsewhere.
The trick of MIA as a ‘magic bullet’ is to conjure a clear vision of certainty in addressing cause-of-death data gap. However, the development and deployment of technologies such as MIA always constitute interventions in complex social and moral worlds, in this respect, are both solutions to and creators of new and enduring uncertainties. Therefore, MIA can be held up as an example of misdirection in at least three important ways.
Paper short abstract:
This paper problematizes new etiquette and manners produced by globalized Covid-19 responses. It argues that framing Covid-19 etiquette as a matter individual choice reproduces humanitarian ignorance, drawing attention away from stratification and inequalities ominously present in our societies.
Paper long abstract:
Since the beginning of the Covid-19 pandemic, rules for responsible and hygienic behavior have become essential for limiting viral transmission globally. Inevitably, in real-world contexts such rules activate new and puzzling forms of etiquette and manners, affecting nearly every person on the planet. This paper argues that short and persuasive Covid-19-related public health texts and images function as intertextual and multimodal ‘etiquette guides’ projected onto people, generating shame and embarrassment with regard to noncompliance, and leading to a spectrum of social and political tensions in ordinary contexts. The paper also discusses semiotic techniques employed in Covid-19 etiquette guides for projecting hidden norms and values onto people, including ideas about normal bodies and middle-class socio-material environments, asserting that Covid-19 etiquette compliance is a matter of individual choice. This strategic framing of Covid-19 etiquette effectively and subtly misdirects attention away from stratifying powers and inequalities present globally, contributing to the proliferation of humanitarian ignorance. Finally, the paper invites global health communities to pay more attention to the moral-emotional dimensions of seemingly simple health rules, and to consider the circulation of public health materials as a semiotic practice, creating novel kinds of oddities and stratifications.