Anthropology

Historical and anthropological approaches to a changing regime of governance

What does global health stem from, when is it born, how does it relate to the contemporary world order? This book explores the origins of global health, a new regime of health intervention in countries of the global South, born around 1990. It proposes an encompassing view of the transition from international public health to global health, bringing together historians and anthropologists to explore the relationship between knowledge, practices and policies. It aims at interrogating two gaps left by historical and anthropological studies of the governance of health outside Europe and North America. The first is a temporal gap between the historiography of international public health through the 1970s and the numerous anthropological studies of global health in the present. The second originates in problems of scale. Macro-inquiries of institutions and politics, and micro-investigations of local configurations, abound. The book relies on a stronger engagement between history and anthropology, i.e. the harnessing of concepts (circulation, scale, transnationalism) crossing both of them, and on four domains of intervention: tuberculosis, mental health, medical genetics and traditional (Asian) medicines. The volume analyses how the new modes of ‘interventions on the life of others’ recently appeared, why they blur the classical divides between North and South and how they relate to the more general neoliberal turn in politics and economy. The book is meant for academics, students and health professionals interested in new discussions about the transnational circulation of drugs, bugs, therapies, biomedical technologies and people in the context of the ‘neoliberal turn’ in development practices.

Introduction
Claire Beaudevin, Jean-Paul Gaudillière, Christoph Gradmann, Anne M. Lovell, and Laurent Pordié

The introduction explores the ways in which history and anthropology have approached global health and its origins. It suggests that this new regime of health intervention in countries of the global South, born around 1990, differs from the previous regime of international public health at three levels: the actors involved, the targets prioritized and the tools mobilized. The introduction further identifies two gaps left by historical and anthropological studies of the governance of health outside Europe and North America: (1) a temporal gap between the historiography of international public health through the 1970s and the numerous anthropological studies of global health in the present; (2) a gap originating in problems of scale. Macro-inquiries of institutions and politics abound, as do micro-investigations of local configurations. Pleading for a strong engagement between the two disciplines and the harnessing of common concepts, the introduction explores why and how the four domains of interventions selected in the book (tuberculosis, mental health, medical genetics and traditional (Asian) medicines) can contribute to a better understanding of the new modes of ‘interventions on the life of others’ and how they relate to the more general ‘neoliberal turn’.

in Global health and the new world order
Jean-Paul Gaudillière, Christoph Gradmann, and Andrew McDowell

This chapter discusses two local histories of tuberculosis (TB) to bridge gaps between history and anthropology in global health. Outlining TB’s resurgent interest within the two disciplines from about 1990, the chapter shows that historiographic concern for TB, although limited, arose from increased multi-drug resistant tuberculosis (MDR-TB) rates in high-income countries. As for the historical discipline, this resulted in a focus on policies. Medical anthropology, by contrast, took a sustained interest in drug-based disease control and produced myriad studies of DOTS (Directly Observed Therapy, Short-Course) as practice. The local histories we consider – first Tanzania-based treatment trials from 1982 as a successful challenge to the World Health Organization WHO’s primary health care policy and second India’s transition to a DOTS-inspired control programme from 1993 – reveal that TB’s resurgent moment was an important part of local discussions about care, control and development in the age of globalization.

in Global health and the new world order
The case of R337h in Brazil
Sahra Gibbon

This chapter examines the increasingly visible meeting points between genomics and global health through the lens of rare genetic disease. Focusing on the association between R337h, a particular biomarker that has been identified at high population frequency in Brazil, and a cancer syndrome, it examines how rareness and the politics it enfolds is defined and put to work across terrains of local and global social action. It draws from ethnographic research undertaken in cancer genetic clinics in the south of Brazil with health professionals, scientists and patient communities. It examines the strategic movement between a politics of ‘singularisation’ and ‘numbers’ in how a focus on rare genetic disease is unfolding in this context and the complex vectors through which new yet partial realignments between genomics and global health are being made.

in Global health and the new world order
Nora Engel

This chapter discusses the tension between standardization and localization in efforts to control tuberculosis (TB); between programmatic considerations and responding to individual care needs, including particular TB strains, co-morbidities, personal pharmaceutical histories or socio-economic circumstances. Drawing on science and technology studies methodology, including a focus on how standards are made to work, the chapter uses anthropological and sociological literature on the DOTS (Directly Observed Therapy, Short-Course) strategy and examples from fieldwork at multi-drug resistant tuberculosis (MDR-TB) treatment sites in India in the 2000s to examine this tension. Standardized disease control programmes employing drugs, such as DOTS, are often portrayed as struggling with inherent dilemmas between standardization and localization. However, as this chapter shows, such emphasis obscures the productive roles that standards can play. They can act as facilitators in local negation and adaption of global disease control strategies, serving as communicative tools between different actors on different levels.

in Global health and the new world order
Nitsan Chorev

Taking the 2014–16 Ebola crisis in West Africa as entry point, this chapter examines the ways in which the World Health Organization (WHO) operates in a world of global health. In the wake of the crisis, much criticism of the situation was directed at the WHO. Why did it not respond faster? And why did it insist on a limited role of guidance and coordination, even once it realized the severity of the situation? The chapter argues that the WHO’s response to the Ebola crisis was a particularly dramatic manifestation of a transformation – in priorities, practices and rhetoric – that occurred in the 1990s as a strategic adaptation to the external pressures of neoliberalism. As a result, the WHO bureaucracy was able to avoid a complete neoliberal turnaround and preserve some of its interests. Most importantly, the WHO was able to maintain its central concern with health at the global level and to redefine its own position in the new ‘global health architecture’ in a way that did not completely marginalize it. But this came with a cost. And the inability to effectively respond to the Ebola epidemic offers one manifestation of what these costs entail.

in Global health and the new world order
Acupuncture and the techno-politics of bodyscape
Wen-Hua Kuo

Acupuncture is a peculiar way of reading and treating people via meridians inside their bodies punctuated by regulatory points. However similar they may look, acupuncture points are located and function differently according to the tradition to which they belong. An attempt to harmonize these points was therefore launched by the World Health Organization as a foundation to advance research and learning of acupuncture worldwide. But not much progress has been made since its two attempts at standardization, one from 1983 to 1989 on nomenclature and the other from 2003 to 2008 on location. Departing from a simple interpretation that claims such negotiations as purely diplomatic in the political context of East Asia, this chapter aims to explore the changing meaning of acupuncture points as they are disputed and transformed among the experts assigned to establish standards.

in Global health and the new world order
Open Access (free)
Aurore Schmitt and Welmoet Wels
Human Remains and Violence: An Interdisciplinary Journal
Open Access (free)
Élisabeth Anstett, Jean-Marc Dreyfus, and Caroline Fournet
Human Remains and Violence: An Interdisciplinary Journal
The Tomašica mass grave and the trial of Ratko Mladić
Caroline Fournet

This article focuses on the judicial consideration of the scientific analysis of the Tomašica mass grave, in the Prijedor municipality of Republika Srpska in Bosnia-Herzegovina. Often referred to as the largest mass grave in Europe since the Second World War, this grave was fully discovered in September 2013 and the scientific evidence gathered was included in the prosecution of Ratko Mladić before the International Criminal Tribunal for the Former Yugoslavia. Based on the exhaustive analysis of all the publicly available trial transcripts, this article presents how the Tomašica evidence proved symptomatic of the way in which forensic sciences and international criminal justice intertwine and of the impact of the former over the latter on the admissibility of evidence, the conduct of proceedings and the qualification of the crimes perpetrated.

Human Remains and Violence: An Interdisciplinary Journal