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Meek LA. Countering the logics of war in global health policy: fake drugs, antimicrobial resistance, and fugitive science. Anthropol Med 2024:1-17. [PMID: 38958044 DOI: 10.1080/13648470.2023.2274685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 09/19/2023] [Indexed: 07/04/2024]
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 supposedly misunderstand what these drugs are and how they should be used. However, my ethnographic research in Tanzania reveals that embodied epistemologies frequently enable medical practitioners and patients to evaluate the quality of various drugs and to identify chakachua (substandard or adulterated) pharmaceuticals through their material and sensory qualities-a practice I conceptualize as a form of 'fugitive science' (Rusert 2017). In light of this, I analyze the WHO's National Action Plan for Antimicrobial Resistance in Tanzania, demonstrating how such global health policies disregard this knowledge, employing neocolonial rhetoric that presents 'ignorance' and 'lack of hygiene' as the sources of growing antimicrobial resistance while simultaneously obscuring structural inequalities. I argue that such forms of global health surveillance operate through the logics and epistemologies of war (Chow 2006; Terry 2017) in ways that render populations in the Global South into threats and targets. I conclude by suggesting that fugitive science can work as counter-evidence to health security frameworks and, as such, represents a furtive form of resistance to these militarized logics.
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Affiliation(s)
- Laura A Meek
- Department of Community, Culture, and Global Studies, The University of British Columbia, Okanagan, Kelowna, British Columbia, Canada
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2
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Perez-Brumer A, Hill D, Parker R. Latin America at the margins? Implications of the geographic and epistemic narrowing of 'global' health. Glob Public Health 2024; 19:2295443. [PMID: 38147567 DOI: 10.1080/17441692.2023.2295443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 12/11/2023] [Indexed: 12/28/2023]
Abstract
To explore the narrowing of the concept of 'global' in global health, this article traces how Latin America has held a place of both privilege and power as well as marginalisation in the field. We employ a modified extended case method to examine how Latin America has been 'seen' and 'heard' in understandings of global health, underscoring the region's shifting role as a key site for research and practice in 'tropical medicine' from the mid-nineteenth century through World War II, to a major player and recipient of development assistance throughout the 'international health' era after World War II until the late twentieth century, to a region progressively marginalised within 'global health' since the mid-1980s/1990s. We argue that the progressive marginalisation of Latin America and Southern theory has not only hurt health equity and services, but also demonstrates the fundamental flaws in contemporary 'global' thinking. The narrowing of global health constitutes coloniality of power, with Northern institutions largely defining priority regions and epistemic approaches to health globally, thus impoverishing the field from the intellectual resources, political experience, and wisdom of Latin America's long traditions of social medicine and collective health.
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Affiliation(s)
- Amaya Perez-Brumer
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Center for Interdisciplinary Research in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - David Hill
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Richard Parker
- Associação Brasileira Interdisciplinar de AIDS (ABIA), Rio de Janeiro, Brazil
- Sexuality Policy Watch (SPW), Rio de Janeiro, Brazil
- Department of Sociomedical Sciences, Columbia University, New York, NY, USA
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3
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Percival V, Thoms OT, Oppenheim B, Rowlands D, Chisadza C, Fewer S, Yamey G, Alexander AC, Allaham CL, Causevic S, Daudelin F, Gloppen S, Guha-Sapir D, Hadaf M, Henderson S, Hoffman SJ, Langer A, Lebbos TJ, Leomil L, Lyytikäinen M, Malhotra A, Mkandawire P, Norris HA, Ottersen OP, Phillips J, Rawet S, Salikova A, Shekh Mohamed I, Zazai G, Halonen T, Kyobutungi C, Bhutta ZA, Friberg P. The Lancet Commission on peaceful societies through health equity and gender equality. Lancet 2023; 402:1661-1722. [PMID: 37689077 DOI: 10.1016/s0140-6736(23)01348-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/01/2023] [Accepted: 06/26/2023] [Indexed: 09/11/2023]
Affiliation(s)
- Valerie Percival
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON, Canada; The Wilson Center, Washington DC, USA.
| | - Oskar T Thoms
- Department of Political Science, University of Toronto, Mississauga, ON, Canada
| | - Ben Oppenheim
- Ginkgo Bioworks, Boston, MA, USA; New York University Center on International Cooperation, New York, NY, USA
| | - Dane Rowlands
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON, Canada
| | - Carolyn Chisadza
- Department of Economics, University of Pretoria, Pretoria, South Africa
| | - Sara Fewer
- Department of Global Public Health, Stockholm, Sweden; Swedish Institute for Global Health Transformation (SIGHT), Stockholm, Sweden
| | - Gavin Yamey
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Amy C Alexander
- Quality of Government Institute, Department of Political Science, University of Gothenburg, Gothenburg, Sweden
| | - Chloe L Allaham
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON, Canada
| | - Sara Causevic
- Department of Global Public Health, Stockholm, Sweden; Swedish Institute for Global Health Transformation (SIGHT), Stockholm, Sweden; Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - François Daudelin
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Siri Gloppen
- University of Bergen, Bergen, Norway; LawTransform, CMI-UiB Centre on Law and Social Transformation, Bergen, Norway
| | - Debarati Guha-Sapir
- Institute of Health and Society, UC Louvain, Brussels, Belgium; Johns Hopkins Center for Humanitarian Health, Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | - Maseh Hadaf
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON, Canada
| | - Samuel Henderson
- Department of Political Science, University of Toronto, Toronto, ON, Canada
| | | | - Ana Langer
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Toni Joe Lebbos
- School of Public Policy and Administration, Carleton University, Ottawa, ON, Canada
| | - Luiz Leomil
- Department of Political Science, Carleton University, Ottawa, ON, Canada
| | | | - Anju Malhotra
- Center for Women's Health and Gender Equality, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Paul Mkandawire
- Human Rights and Social Justice Program, Carleton University, Ottawa, ON, Canada
| | - Holly A Norris
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON, Canada
| | - Ole Petter Ottersen
- Office of the President, Karolinska Institutet, Stockholm, Sweden; University of Oslo, Oslo, Norway
| | - Jason Phillips
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON, Canada
| | - Sigrún Rawet
- Department for Multilateral Development Banks, Sustainability and Climate, Ministry for Foreign Affairs, Stockholm, Sweden
| | | | - Idil Shekh Mohamed
- Swedish Institute for Global Health Transformation (SIGHT), Stockholm, Sweden
| | - Ghazal Zazai
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON, Canada
| | | | | | - Zulfiqar A Bhutta
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan; The Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan; SickKids Centre for Global Child Health, Toronto, ON, Canada
| | - Peter Friberg
- Swedish Institute for Global Health Transformation (SIGHT), Stockholm, Sweden; School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Roberts S, Kelman I. Governing digital health for infectious disease outbreaks. Glob Public Health 2023; 18:2241894. [PMID: 37620749 DOI: 10.1080/17441692.2023.2241894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023]
Abstract
ABSTRACTHow can governing digital health for infectious disease outbreaks be enhanced? In many ways, the COVID-19 pandemic has simultaneously represented both the potential and marked limitations of digital health practices for infectious disease outbreaks. During the pandemic's initial stages, states along with Big Data and Big Tech actors unleashed a scope of both established and experimental digital technologies for tracking infections, hospitalisations, and deaths from COVID-19 - and sometimes exposure to the virus SARS-CoV-2. Despite the proliferation of these technologies at the global level, transnational and cross-border integration, and cooperation within digital health responses to COVID-19 often faltered, while digital health regulations were fragmented, contested, and uncoordinated. This article presents a critiquing reflection of approaches to conceptualising, understanding, and implementing digital health for infectious disease outbreaks, observed from COVID-19 and previous examples. In assessing the strengths and limitations of existing practices of governing digital health for infectious disease outbreaks, this article particularly examines 'informal' digital health to build upon and consider how digitised responses to addressing and governing infectious disease outbreaks may be reconceptualised, revisited, or revised.
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Affiliation(s)
- Stephen Roberts
- Institute for Global Health, University College London, London, UK
| | - Ilan Kelman
- Institute for Global Health, Institute for Risk and Disaster Reduction (IRDR), University College London, London, UK
- University of Agder, Kristiansand, Norway
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Lange IL, Nalwadda CK, Kiguli J, Penn-Kekana L. The Ambiguity Imperative: "Success" in a Maternal Health Program in Uganda. Med Anthropol 2021; 40:458-472. [PMID: 34106797 DOI: 10.1080/01459740.2021.1922901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Global health programs are compelled to demonstrate impact on their target populations. We study an example of social franchising - a popular healthcare delivery model in low/middle-income countries - in the Ugandan private maternal health sector. The discrepancies between the program's official profile and its actual operation reveal the franchise responded to its beneficiaries, but in a way incoherent with typical evidence production on social franchises, which privileges simple narratives blurring the details of program enactment. Building on concepts of not-knowing and the production of success, we consider the implications of an imperative to maintain ambiguity in global health programming and academia.
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Affiliation(s)
- Isabelle L Lange
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Christine Kayemba Nalwadda
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Juliet Kiguli
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Loveday Penn-Kekana
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Eboreime EA, Olawepo JO, Banke-Thomas A, Abejirinde IOO, Abimbola S. Appraising and addressing design and implementation failure in global health: A pragmatic framework. Glob Public Health 2020; 16:1122-1130. [PMID: 32896213 DOI: 10.1080/17441692.2020.1814379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
There have been recent concerns about the failure of several global health interventions. Interventions are considered to have failed when they are unable to achieve the intended results. Failure may be linked to how the intervention was designed (design failure) or how it was implemented (implementation failure). Recently, substantial efforts have been employed to improve the outcomes of health interventions. These efforts have led to the development of several theories, models, and frameworks in implementation science to improve the quality of implementation, bridging the divide between evidence and practice. But significant gaps still exist. Whereas much work has been done to develop frameworks and approaches to improve implementation fidelity, not as much effort has been done to guide the adherence of interventions to program theory during the design of the programs. Further, there have been concerns about the applicability of these frameworks in the real-world. This article uses examples to illustrate these gaps and further proposes a pragmatic framework to address identified gaps, thus aiding evidence-informed program design and implementation. The proposed Theory-Design-Implementation (TyDI) framework will support policymakers, program planners and implementers to address potential design and implementation failure, thus improving the fidelity of interventions.
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Affiliation(s)
- Ejemai Amaize Eboreime
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Department of Planning, Research and Statistics, National Primary Healthcare Development Agency, Abuja, Nigeria
| | - John Olajide Olawepo
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, USA.,Department of Health Sciences, Bouve College of Health Sciences, Northeastern University, Boston, MA, USA
| | | | - Ibukun-Oluwa Omolade Abejirinde
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Seye Abimbola
- The School of Public Health, The University of Sydney, Sydney, Australia.,The George Institute for Global Health, The University of New South Wales, Sydney, Australia
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