Anthropology, knowledge-flows and global health

Abstract

Global health programmes are damaged by blockages in the upward flow of information from localities and regional centres about realities of professional practice and about patients' lives and conditions of treatment. Power differentials between local actors and national or international decision-makers present further obstacles to effective action. Anthropological research and action, in its most effective current forms, make important contributions to these issues. This research often continues over the long term, intensively. It can be multi-sited, studying actors at local, national and international levels simultaneously. It studies the relative knowledge and power of impoverished patients and global decision-makers, all within a single frame. By doing so, anthropological research is capable of providing new and important insights on the diverse meanings of patient decision-making, informed consent, non-compliance, public health reporting, the building of political coalitions for health and many other issues.

Keywords:

• global health
• anthropology
• ethnography
• public health
• bioethics

Notes

1. Stewart (2007) made a detailed study of words used for risk and other central bioethical concepts, as they are currently used in the Luganda language, in Uganda. She undertook this focused and carefully specified study as a follow-up to her own ethical concerns that emerged during her extended research in Uganda for a Ph.D. dissertation. On Confucian ethics in China, see Kleinman and Nie (forthcoming). Research on consent in the Gambia is reported in Geissler et al. (2008). The research was based on extended interviews by the authors with fieldworkers about their lives and careers and their role in the malaria vaccine trials. The research is based, in addition, on questionnaires administered to 181 men from the vaccine trial villages, and 80 open-ended interviews with survey participants. Geissler has been engaged in extended field research in Africa since 1994.

2. For a rich account of the dilemmas faced by nurses and other health care workers in Botswana, based on ethnographic research from 2002 to 2004, see Carpenter (2008).

3. The ethnographic study of immunisation in India is reported on by Das (1999). The study is the product of a group Social Science and Immunization Project. Das has been doing ethnography in India for several decades.

4. The study of tuberculosis in Delhi is part of a larger longitudinal research project on poverty and urban health in India. A general description of this research, as it applies to pharmaceuticals, is given in Das and Das (2006). A more detailed analysis of responses to tuberculosis is in Das (2007).

5. This paragraph and the following one are based on a longitudinal ethnographic research project of Steven Feierman in Tanzania, since 1966. For a general account, see Feierman (2000).

6. The account of Gaucher's disease is given in an extended, multi-sited study of contract research organisations and their social context, based on ethnographic research over several years (Petryna 2009).

7. The account of AIDS policy and social mobilisation in Brazil is given by Richard Parker, based on ethnographic work since the 1980s. In addition, Parker spent a period from 1989 to 1990 as a staff member of the WHO's Global Programme on AIDS, a brief period in 1992 as Chief of the Prevention Unit for the Brazilian National AIDS Programme, and a number of years as Executive Director, then Secretary General, and then President of the Brazilian Interdisciplinary AIDS Association (ABIA). For an extended account, see Parker (2007). A brief account is given in Parker (2008).