We drafted questions for each chapter in the book. We hope they can help guide classroom and seminar discussions.
Introduction to the book
Critical Global Health
- What are the dominant actors, institutions and approaches at work in global health today?
- What distinguishes global health initiatives today from earlier approaches to international health?
- What are the limits and possibilities of “magic bullet” approaches in global health?
- Which evidence-making practices and modes of evaluation tend to be used to determine what works and what does not work in global health?
- How are beneficiaries of interventions typically defined and represented in global health? How is the agency of people and communities accounted for, or not?
- What do the authors mean by “people-centered evidence” and how is it different from the evidence produced by statistics and randomized trials?
- What makes social worlds “unpredictable” and how can we take consider this unpredictability in the design and evaluation of interventions?
- Going forward, what is the value of ethnographic research and case studies in the field of global health?
A Return to the Magic Bullet?
Malaria and Global Health in the Twenty-First Century
- What are some of the similarities and differences between policy approaches to malaria in the 1950s and those being promoted today?
- What limits and failures does Cueto identify in past magic bullet interventions? How does this history help us to critically examine current malaria control and eradication campaigns?
- How does Cueto explain the shift from “international” to “global” health, and why does it matter? What are the implications of framing malaria as a “global” problem?
- What kinds of assumptions are built into disease eradication policies?
- How do new medical technologies and shifts in international politics reshape strategies of disease eradication or control? In addition to malaria, also consider HIV/AIDS and tuberculosis.
- We hear a lot about successes, but how are failures in disease campaigns recognized and accounted for by the various actors involved?
- Why does a reliance on “magic bullet” technology persist in malaria control policy despite its previous failures, and how might we envision an alternative approach to malaria interventions?
- How have malaria campaigns been integrated with primary health care systems, or not? What difference does it make?
Evidence-Based Global Public Health
Subjects, Profits, Erasures
- What is “Evidence-Based Medicine” (EBM)? In what ways has it entered into and changed global public health?
- What are Randomized Controlled Trials (RCTs)? How are they deployed in the field of global health?
- With increasing dominance of quantitative analyses and forms of “generalizable” evidence in the design and evaluation of global health interventions, whose interests are being served?
- How did Evidence-Based Medicine influence the design and implementation of the interventions that Adams describes?
- How do we account for the social realities that were obscured by the dominant mode of evidence-making in Adams’ case studies? Who are the experts making up global health as a profitable data-making business? What are the implications of a political economy of profitable data-making for global healthcare delivery?
- How do our modes of evidence production shape the solutions we envision?
- Considering Adams’ critique of Evidence-Based Medicine in general and randomized controlled trials (RCTs) in particular, what adjustments and changes might improve the future use of these methods in global health?
- How does Adams make her case for the role of ethnography in the design and the effectiveness of global health interventions?
The “Right to Know” or “Know Your Rights”?
Human Rights and a People-Centered Approach to Health Policy
- What factors interfere with what the World Health Organization (WHO) calls “the right to know” one’s own HIV status?
- How is the “right to know” one’s own HIV status related to and different from a “right to know” the HIV status of others?
- What tensions between the right to individual privacy and public health concerns does Amon’s case study highlight? Are these tensions understood differently by ethicists, human rights activists and public health practioners?
- What structural forces do “knowing your rights” campaigns engage that “right to know” campaigns do not?
- How are social categories like gender, race, and class accounted for in HIV testing campaigns?
- How can treatment campaigns promote social justice in the face of discriminatory practices?
- For people who know their rights, what are the impediments to their ability to actually exercise them?
- What are some of the unique contributions of a human rights approach to global health?
Children as Victims
The Moral Economy of Childhood in the Times of AIDS
- What is a “moral economy”? How does a moral economy interface with a “political economy”? How does Fassin apply these concepts in the context of HIV/AIDS in South Africa?
- According to Fassin, “sensationalism” is often employed to garner support for South African citizens—particularly children—living with HIV/AIDS. How does he interpret the effects of this approach?
- What is the place of AIDS orphanhood in global health discourses and interventions?
- How is childhood constructed in the field of HIV/AIDS in South Africa? How does this construction obscure the lingering history of apartheid-era political and economic violence?
- What activist roles did Nkosi Johnson assume in the struggle for AIDS treatment access and care in South Africa? How did he in his role challenge the position of then-president Thabo Mbeki? How would you characterize Mbeki’s position?
- Innocent, abused, and orphaned children are often the focus of international concern about AIDS in Africa. How does this mobilization of moral sentiment speak to reigning priorities and strategies in global health and humanitarianism?
Belonging in Uganda’s Projectified Landscape of AIDS Care
- What is a “projectified landscape of AIDS care”?
- How is this landscape produced in Uganda, and by what national and international organizations?
- How do people navigate multiple treatment providers within this landscape?
- What are the implications of treating a patient as a client in a health system?
- What realities are the authors accounting for when they write of the emergence of “therapeutic clientship” in this landscape?
- According to the authors, what is the use and significance of ever-growing forms of clinical paperwork in the Ugandan AIDS landscape of care?
- How do HIV/AIDS programs differ from the medical care provided for other conditions in Uganda? What kinds of designs might allow these services to become more integrated?
- By attending to AIDS patients as actors embedded in social relations, what does this study reveal about state politics?
The Struggle for a Public Sector
PEPFAR in Mozambique
- How have structural adjustment policies impacted the primary healthcare systems of Mozambique and other African countries?
- Why has funding from the U.S. President’s Emergency Program for AIDS Relief (PEPFAR) mostly gone to international NGOs instead of Mozambique’s national healthcare system and related government services?
- In what ways is PEPFAR in Mozambique emblematic of global health interventions?
- What kinds of clinical structures and health professionals are necessary to implement this vertical AIDS treatment access program?
- What challenges do gender discrimination, transportation, and geography pose to the kinds of HIV/AIDS treatment interventions described by Pfeiffer?
- What do we learn from the experiences of women “lost to follow up” about the impact of structural and economic factors on treatment and disease at various scales?
- What are the tenets of an “NGO Code of Conduct,” and how can they be achieved?
- How does Pfeiffer’s role as a program director for Health Alliance International in Mozambique provide a basis for his anthropological analysis?
- How does Pfeiffer integrate quantitative data with qualitative evidence? How did ethnographic evidence in particular allow him to develop alternative plans of action?
- What are the benefits of integrating HIV/AIDS prevention and treatment programs into the public health system?
The Next Epidemic
Pain and the Politics of Relief in Botswana’s Cancer Ward
- Why is cancer the “next epidemic” in Africa?
- How does cancer relate to HIV/AIDS, both medically and politically, in Botswana?
- Why do people die of cancer in Botswana? What are the reasons behind cancer diagnosis and treatment being postponed or never received in Botswana and elsewhere in Africa?
- How would you answer Livingston’s question: “How and why does biomedicine proceed in Africa with so little palliation and so much compliance?”
- What are the obstacles to the medical palliation of pain in Africa?
- What non-medical care practices and human capacities are called forth in the cancer ward? What is the importance of joking and laughter in this account of pain management?
- How is global medicine a practice of trial and error? What comparisons can be drawn between medicine in resource-poor and resource-rich contexts?
A Salvage Ethnography of the Guinea Worm
Witchcraft, Oracles and Magic in a Disease Eradication Program
- Why was the guinea worm targeted for eradication, and by whom? Consider the different roles of international NGOs, governments, and local communities.
- What divergent meanings does the term “eradication” hold for various actors here (transnational funders, celebrity spokespeople, national health officials, local campaign workers, corporate donors, rural program recipients)?
- How does the focus on guinea worm eradication compare with other pressing community health concerns?
- How did rationales for eradication change over time?
- How did guinea worm programs cast target populations? How did people on the ground engage the representations and technologies associated with eradication?
- What models of disease causation and experience clash in Moran-Thomas’ ethnographic account?
- What different meanings of magic materialize in the encounter between the guinea worm and the “magic bullet” intervention?
- In this case study, who sets the health priorities of communities and countries as they are brought into global health initiatives?
- How might we imagine future community-based approaches to addressing water-borne diseases?
The Market for Anti-Tuberculosis Drugs in India
- Why is it important to understand the work and perspectives of Medical Representatives? What perspectives do they bring to health policy and the health system?
- According to Ecks and Harper it is as important to understand “the market” as it is “the patient”—why?
- What is DOTS? What have been some successes and key challenges in putting DOTS strategies into action in India?
- What role do international institutions such as the World Health Organization play in establishing treatment practices or programs for TB?
- How do Medical Representatives understand the limitations of DOTS? What implications does their perspective on DOTS have for patients, the public health sector, and the market for TB drugs?
- What actors, forces and interests shape the specific dynamics of prescription practices and treatment regimens on the ground?
- What treatment gaps are left open by the public sector and how are market actors filling these gaps?
- What do Ecks and Harper mean by “therapeutic anarchy”? How do they apply this concept in their analysis of TB treatment and drug access?
- How do the authors envision the potential role of Private-Public Mixes (PPMs) in the future of TB treatment in India?
Labor Instability and Community Mental Health
The Work of Pharmaceuticals in Santiago, Chile
- How would you characterize everyday life for people in La Pincoya?
- What is the interface between mental illness and economic insecurity?
- How do conditions of economic scarcity and instability complicate what it means to be clinically depressed?
- Who and what does the anthropologist engage in order to examine the ways in which mental health interventions unfold in this poor community in Santiago?
- What does Han mean by “the everyday”? Why does she consider it an important concept in her analysis?
- How do people use and circulate psycho-pharmaceuticals? What are the meanings attached to their consumption and exchange?
- What are the dominant agendas and approaches of the Global Mental Health movement? What are some of the challenges and limitations of applying these approaches in Santiago?
- What is a “package of care,” and how does Han critique its application in her field site?
- What would a “successful” mental health intervention in this particular community look like?
The Ascetic Subject of Compliance
The Turn to Chronic Diseases in Global Health
- How does the sharp rise in chronic diseases affect health systems and global health planning?
- How is science being mobilized in the current turn to chronic diseases in global health?
- What is the role of “race” in the new genetic approach to risk and health?
- According to Whitmarsh, what are the relationships between research and intervention in global health?
- What kind of information is emerging from biomedical research on chronic disease? And how is this information changing what it means to be at risk?
- What is the difference between a “syndrome” and a disease in the context of chronic conditions, and how does this distinction matter?
- How, according to Whitmarsh, does compliance become an individual’s “moral duty”? What forms of individual responsibility and accountability are entailed by the imperative “to know oneself biomedically”?
- What does the author mean by “biomedical asceticism” and does this concept say about emerging forms of patienthood in global health?
- What are the implications of a shift away from individual responsibility toward group risk or vulnerability?
Therapeutic Markets and the Judicialization of the Right to Health
- What is the “judicialization of the right to health” in Brazil?
- Which actors and interests drive this phenomenon? What are its historical antecedents?
- Is health a right or a commodity? How does Biehl and Petryna’s case study illuminate this conundrum?
- How do patient-litigants and their families reimagine socioeconomic and medical rights?
- What do the authors mean by the pharmaceuticalization of health care?
- What are some of the key medical and social characteristics of the patient-litigants in Biehl and Petryna’s case study?
- How does the judicialization phenomenon challenge “trickle-down” theories of medical technology access?
- What are the challenges of introducing new medical technologies into the public health care system?
- What are the responsibilities of pharmaceutical companies towards patients involved in clinical trials?
- What is “patient-citizen-consumer”? Through what processes does this new form of identity take shape?
- How does claiming the right to health in courts both empower and constrain individuals, families, physicians, and legal and political actors?