Global public health policy transfer and dengue fever in Putrajaya, Malaysia: a critical discourse analysis

Abstract

This study critically analyzed the operationalization and materialization of globally hegemonic dengue fever discourse at the local level in the city of Putrajaya, Malaysia. Textual analysis of the World Health Organization's First report on neglected tropical diseases (NTDs) (2010) identified three discursive strategies in the WHO's effort to set the agenda for research and action on neglected diseases: the nomination of dengue fever as a disease of the impoverished and voiceless other; the predication of neglected disease status on environmental and behavioural uncleanliness; and the framing of so-called ‘pro-poor’ neglected tropical disease discourse as a new paradigm under which targeting these othered people, behaviours and environments is a key strategy for NTD management and control. Further analysis of the transcripts of 14 key informant interviews conducted with experts in public health, governance and urban development in Putrajaya found that discursive links between dengue and poverty contributed to the inappropriate transfer of globally dominant dengue control strategies to Putrajaya's non-poor local environment. These findings indicate that endemic dengue emerged in Putrajaya in part because planners, health officials and residents reproduced in their plans, policies and behaviours the construction of the disease as one of the other. The findings call into question the characterization of dengue fever as a disease of poor people, unclean spaces and unsanitary behaviours, and raise new questions about the appropriateness of targeting NTD initiatives to the poor. The findings also highlight the need for locally appropriate public health policies for infectious disease control in non-poor environments.

Keywords:

• healthy public policy
• illness
• critique

Acknowledgements

This study was funded in part by the SSHRC Vanier Canada Graduate Scholarship & Michael Smith Foreign Study Supplement, the IDRC Doctoral Research Award, and the United Nations University Institute on Water, Environment and Health (UNU-INWEH).