Global Health, Geographical Contingency, and Contingent Geographies

Abstract

Health geography has emerged from under the “shadow of the medical” to become one of the most vibrant of all the subdisciplines. Yet, this success has also meant that health research has become increasingly siloed within this subdisciplinary domain. As this article explores, this represents a potential lost opportunity with regard to the study of global health, which has instead come to be dominated by anthropology and political science. Chief among the former's concerns are exploring the gap between the programmatic intentions of global health and the unintended or unanticipated consequences of their deployment. This article asserts that recent work on contingency within geography offers significant conceptual potential for examining this gap. It therefore uses the example of alcohol taxation in Botswana, an emergent global health target and tool, to explore how geographical contingency and the emergent, contingent geographies that result might help counter the prevailing tendency for geography to be side-stepped within critical studies of global health. At the very least, then, this intervention aims to encourage reflection by geographers on how to make explicit the all-too-often implicit links between their research and global health debates located outside the discipline.

健康地理学, 已脱离了 “医学阴影”, 浮现成为最活跃的次领域之一。但此般成功, 却也同时意味着健康研究逐渐在此一次领域范畴中受到孤立。如同本文所探讨的一般, 这代表着研究全球健康的潜在契机之丧失, 并成为人类学与政治科学所主宰的领域。前者的考量中, 最主要在于探讨全球健康的计画目的, 与其施展后的不经意或非预期结果之间的落差。本文主张, 晚近地理学中有关偶然性的研究, 提供了检视此一落差的重要概念潜能。本文因而使用博茨瓦纳所施行的酒税案例——一个全球健康的目标与工具——来探讨地理偶然性及其导致的浮现中且偶发的地理, 如何可能协助对抗全球健康的批判研究避开地理学的盛行趋势。此般介入的目的, 至少在于鼓励地理学者反思如何使其研究与领域之外的全球健康辩论之间过于隐晦的连结变得清晰可见。

La geografía de la salud ha emergido desde la “sombra de la geografía médica” para convertirse en una de las subdisciplinas más dinámicas. Sin embargo, este éxito ha significado también que la investigación sobre la salud crecientemente se haya enclaustrado dentro de este dominio subdisciplinario. Como lo explora este artículo, esto representa una potencial pérdida de oportunidad en lo que concierne al estudio de la salud global, que alternativamente ha llegado a caer dentro del dominio de la antropología y la ciencia política. Importante entre las preocupaciones de la primera son la exploración de la brecha entre las intenciones programáticas de la salud global y las consecuencias no intencionales o imprevistas de su despliegue. Este artículo sostiene que el trabajo reciente sobre contingencia dentro de la geografía presenta un significativo potencial conceptual para el examen de esa brecha. Este utiliza por lo eso el ejemplo de la tributación del alcohol en Botsuana, un propósito global emergente de la salud y herramienta para explorar de qué manera la contingencia geográfica y las geografías emergentes y contingentes que resultan podrían ayudar a contrarrestar la tendencia prevaleciente en geografía de ser soslayada dentro de los estudios críticos de la salud global. Como mínimo, entonces, esta intervención apunta a estimular la reflexión de los geógrafos sobre cómo hacer explícitos los más que frecuentes enlaces implícitos entre su investigación y los debates globales sobre salud ubicados fuera de la disciplina.

Key Words:

• alcohol
• Botswana
• complexity
• contingency
• geography
• global health

关键词：:

• 酒精
• 博茨瓦纳
• 复杂性
• 偶然性
• 地理
• 全球健康。

Palabras clave:

• alcohol
• Botsuana
• complejidad
• contingencia
• geografía
• salud global

Acknowledgments

Thanks to Dr. Gwen Lesetedi at the University of Botswana for her support and assistance with the research in Gaborone. Thanks also to the four anonymous referees for their most helpful comments and suggestions.

Funding

The research for this article was funded by a Wellcome Trust small grant (reference WT102456MA) entitled “The 2008 Botswanan Alcohol Policy: Risk, Politics and Consumption.”

Notes

1. It is interesting to note the following numbers of Academia.edu theme subscribers as a rough guide to subdisciplinary significance (figures as of 1 July 2015): human geography (26,297), cultural geography (10,898), medical geography (539), health geography (522), medical sociology (5,145), medical anthropology (20,650), global health (7,269), and public health (135,027).

2. In addition to excise duty, which cannot be changed by the individual member states of the Southern Africa Development Community.

3. Wagenaar, Tobler, and Komro's (2010) meta-analysis, for example, cites fifty studies, all of which come from either the United States, Canada, Finland, or Switzerland, all remarkably different contexts to the African countries for whom alcohol taxation is being pushed.

4. At the time of research £1 = Pula 10, $1 = Pula 6.25.

Additional information

Notes on contributors

Clare Herrick

CLARE HERRICK is a Senior Lecturer in the Department of Geography, King's College London, Strand, London WC2R 2LS, UK. E-mail: [email protected]. Her research interests include critical approaches to global health and the governance of the behavioral risk factors for noncommunicable disease in urban contexts.