Enacting human rights in mental health care in Ghana
Ursula M. Read
The removal of vagrant lunatics from the streets of African cities has a long history in the context of colonial and postcolonial urbanization. However, the emergence of rights-based approaches to mental illness as part of the growing influence of global mental health in Ghana has led to a reframing of this historical legacy within the context of mental health reform. The continued practice of forcibly removing persons with mental illness for treatment within the psychiatric hospitals aims to appease public concerns over growing homelessness among mentally ill persons. At the same time it is also deployed as evidence of efforts to enact new mental health legislation to international agencies. This case illustrates the entanglements and tensions arising from attempts to enact mental health reform in a way which resonates both with international psychiatric practice and human rights and with local expectations of social order and development.
From colonial to cross-cultural psychiatry in Nigeria
Matthew M. Heaton
This chapter examines the development of mental health services during decolonization in Nigeria from the 1950s to 1970s, focusing particular attention on the life and work of Thomas Adeoye Lambo, Nigeria’s first European-trained psychiatrist of indigenous background. By connecting his psychiatric research and practice to local cultural expectations, nationalist developmentalist agendas and international programmes in cross-cultural psychiatric research, Lambo helped to cement professional psychiatry in Nigeria in ways that expanded upon the significantly underdeveloped colonial model. However, at the same time he adapted the European paradigm to better fit local circumstances, and those adaptations in turn recirculated into the global discourse, effecting a globalization of the way psychiatrists around the world thought about the nature and treatment of mental illness. The chapter argues that the development of mental health infrastructure in Nigeria was therefore local, national and international in ways that allow for more nuanced historical studies of the links between colonial psychiatry and contemporary global mental health agendas.
This chapter mobilizes the author’s double-sided experience as physician and anthropologist to reflect on what global health is about, what it is doing and what the social sciences – anthropology foremost, given its long engagement with the life of ‘others’ – have to say about it. Building on the idea that global health is both under-theorized and hyper-normative, the chapter identifies five lines of tensions whose dialectics are worth taking into account and analysing, since, at first sight, they look like irremediable polarities of the field, i.e. worldwide vs universal, moral vs economic, compassion vs predation, facts vs representations, scale vs time.
Constructing population in the search for disease genes
Numerous studies describe the genetic make-up of populations living outside Europe and North America. Many of these tackle human genetic variation with the explicit aim of identifying gene variants of medical significance for the populations studied. However, the chapter points to rather different motivations, showing how recent studies documenting the genetic constitution of non-Western populations have grown out of, and serve the purposes of, efforts to identify genetic factors which influence the health of populations in Europe and North America. Analysing the past thirty-five years of medical research literature, the chapter shows how, in this context, efforts to identify genetic variants of possible significance for disease aetiology have shifted to include large-scale association studies in populations rather than families. It discusses how research with local concerns must nonetheless take into account the global distribution of genes and genotypes, thus making studies of the genetic causes of disease, wherever conducted, increasingly global in their purview. The chapter also argues that this recent knowledge of human population genomics has developed in a way which reinscribes ideas of racial difference into biomedical understanding of human populations, and creates tools for excluding supposedly non-Western populations from research oriented towards the concerns of Western institutions.
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.
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’.
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.
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.
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.
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.