Last mile research: a conceptual map

Background: The term 'last mile' has been used across disciplines to refer to populations who are farthest away, most difficult to reach, or last to benefit from a program or service. However, last mile research lacks a shared understanding around its conceptualization.Objectives: This project used a concept mapping process to answer the questions: what is last mile research in global health and, how can it be used to make positive change for health equity in the last mile?Methods: Between July and December 2019, a five-stage concept mapping exercise was undertaken using online concept mapping software and an in-person consensus meeting. The stages were: establishment of an expert group and focus prompt; idea generation; sorting and rating; initial analysis and final consensus meeting.Results: A group of 15 health researchers with experience working with populations in last mile contexts and who were based at the Matariki Network institutions of Queen's University, CAN and Dartmouth College, USA took part. The resulting concept map had 64 unique idea statements and the process resulted in a map with five clusters. These included: (1) Last mile populations; (2) Research methods and approaches; (3) Structural and systemic factors; (4) Health system factors, and (5) Broader environmental factors. Central to the map were the ideas of equity, human rights, health systems, and contextual sensitivity.Conclusion: This is the first time 'last mile research' has been the focus of a formal concept mapping exercise. The resulting map showed consensus about who last mile populations are, how research should be undertaken in the last mile and why last mile health disparities exist. The map can be used to inform research training programs, however, repeating this process with researchers and members from different last mile populations would also add further insight.

Becoming a Force in the Zone: Hedonopolitics, Masculinity, and the Quest for Respect on Haiti’s Streets

This article explores neighborhood organizing among young men in urban Haiti as a vernacular enactment of sovereignty that involves both a hedonistic and a gendered logic. Under conditions of democratization and global governance, the urban block, or base, has become a key site for building political community and creating connections to those in power. Central to base politics are public outings that engender power and respect for the organizers by demonstrating their force not through violence but through masculine social pleasures. This article elaborates three key outings—a street party, a soccer tournament, and a beach day—organized by neighbors and supported by state, NGO, and criminal actors. By focusing on hedonopolitics, rather than on the common tropes of violence and death, this article extends recent work on the embodiment of sovereign power, while also showing that masculine pleasure represents an underanalyzed yet important dimension of sovereignty.