Anthropology & Medicine最新文献

In recent decades, policy makers around the world have been working on implementing various technologies into healthcare, and the Covid19 pandemic fueled this process. The specialized technological solutions for telecare - the use of technologies for care at a distance - are often adopted by users in different ways than intended, or are abandoned if the users cannot find applications that are meaningful to them. However, beyond specialized healthcare technologies, people are incorporating mundane digital technologies into their (health)care practices. In this paper, we draw on ethnographic research on the use of everyday digital technologies in Indian families where migrating children who are professional nurses care for their aging parents at a distance. Our findings show that 1) remote elder care is enacted through frequent calling which further fosters trust, necessary to provide healthcare remotely; 2) the motivation for older adults to engage with digital technologies is grounded in the value of family and affect which is consequential also for health; 3) technologies, too, require care-work in the form of everyday maintenance; and 4) in-person visits from children remain important, indicating that hybrid interaction is optimal for good care at a distance. We conclude that taking these findings into account may contribute to a more successful implementation of formal telecare systems.

Using examples from the National Health Service in England, this paper illustrates key features of contemporary healthcare governance: the way decisions are hidden in places that are 'in between' and 'out of reach'; the enrolment of doctors in governing; and the important role played by 'boring things', such as power point slides, flow charts, and forms. The essay shows how anthropological proximity and perspectives can extend and deepen understanding of contemporary political power. It does this firstly by showing the importance of agency in the operation of governmentality, and secondly by illuminating the limits of governmentality. The different elements of governing assemblages, such as global management experts, medical leaders, forms of knowledge and analytical technologies, are brought together through the strategic act of framing. Frames are contested and resisted, requiring more visible forms of control.

Governments across the world differently invoked citizen responsibility for responding to the risk of COVID-19 infection. Approaches which focused on changing social practices served to reinforce distinctions between 'sanitary' and 'unsanitary' citizenship. This paper examines citizens' responses to public health policy messaging, exploring as a case study the reception of UK Government messaging about responsible behaviour during the first two years of the COVID-19 pandemic. We examine the public responses to such messaging from narrative interviews with 43 people who became ill with COVID-19. These interviews were with people who identified as members of the minoritised religious and racialised groups, who were most heavily burdened by the impact of COVID-19. Interviewees challenged assumptions that they were 'irresponsible' for having caught COVID-19, and instead directed attention towards the ways in which pandemic guidance was unworkable. Some actively critiqued government messaging, questioning the problematic racialisation of pandemic messaging and challenging individual responsibilisation for the management of the pandemic. Through this analysis we demonstrate the active role of citizens in enacting, and at times resisting, health policy.

Religious leaders, development experts and state officials in Pakistan were brought together on shared platforms to negotiate a morally-appropriate but scientifically informed response to HIV. Instead of dialogue and negotiation in line with the secular ideal of development, the moral authority of the religious figure compelled others to forefront the conservative in them, thereby undermining the goal of HIV prevention in the country. The everyday practices of state officials and health experts were already infused with Islamic public morality but the inclusion of religious leaders resulted in acceptance of their conservative position on HIV, gender and sexuality. Through the case study of an Inter-Religious Council on HIV, I argue that intervention strategies which specifically involve religious leaders end up enabling systematic marginalization of those who are already at a greater risk of HIV.

In 2016 Swedish law was amended to allow single women to access fertility treatment with donor sperm. In this paper, based on interviews, document analysis and autoethnographic insights, I examine the implementation of this law using human rights approaches, specifically the availability, accessibility, acceptability, and quality framework (AAAQ Framework). While the law extended the scope of reproductive rights, the health system was unprepared. Five years on, women seek care in the private sector or continue to travel abroad due in large part to waiting times which can be up to four years in some regions. The paper also provides a meeting point between anthropology and policy analysis. The law change provides a pathway for analyzing the Swedish health system and political context, particularly the relationships between the private and public sectors and between different regions, and the balance of responsibility between national and regional levels. While many of the challenges are unique to the Swedish context, they also offer lessons for countries which have or are considering expanding access to fertility treatment for single women and other patient groups, thus demonstrating the importance of ethnographic approaches in health policy analysis.

The 'task to come' in anthropological fieldwork is rarely discussed explicitly as a set of underpinning methodological, analytical, conceptual, and theoretical precepts and practices. Drawing on learnings from a study of policymakers in the Australian Public Service - a non-conventional fieldwork location - this paper presents an account of how the anthropologist instituted direction and purpose or 'fruitful ways of looking' as an orientation to policy ethnography and the sense-making journey that follows. This paper progresses three interrelated aims: (1) to argue that, through ethnographic fieldwork, anthropology adds value to understanding the policy setting and its actors as engaged in purposeful and meaningful work underpinned by policy knowledge and expertise; (2) provocate that anthropology should contribute to research agendas outside of critical normative disciplinary interests in power and control; (3) illustrate that preparation is useful to tailor the production of anthropological knowledge to its context. An 'interpretive framework' is described as the culmination of this approach to collecting and interpreting ethnographic field data, demonstrating how this attends to the policy setting as socio-cultural domain with actors engaged in shared practices, routines and rituals, steeped in policy-practitioner skills, knowledge and expertise - or policy 'craft'. Together, this conditioned the anthropological gaze to take in everyday activities involved in policy work and enabled the study of meetings and documents to discern what happens during these structured conversations to better understand how policy staff engage with academic research in meeting their policy responsibilities under the expectations of the evidence-based policy agenda.

Powerful pharmaceuticals are readily available for purchase throughout Tanzania and global health policy makers decry this situation as dangerous and disordered, as if no rules govern the use of drugs in Africa. In the prevailing global health understanding, 'truth' lies in the laboratory science that goes into the making and proper prescription of drugs, and such deviations as 'overuse' and 'misuse' result from the fact that locals supposedly misunderstand what these drugs are and how they should be used. However, my ethnographic research in Tanzania reveals that embodied epistemologies frequently enable medical practitioners and patients to evaluate the quality of various drugs and to identify chakachua (substandard or adulterated) pharmaceuticals through their material and sensory qualities-a practice I conceptualize as a form of 'fugitive science' (Rusert 2017). In light of this, I analyze the WHO's National Action Plan for Antimicrobial Resistance in Tanzania, demonstrating how such global health policies disregard this knowledge, employing neocolonial rhetoric that presents 'ignorance' and 'lack of hygiene' as the sources of growing antimicrobial resistance while simultaneously obscuring structural inequalities. I argue that such forms of global health surveillance operate through the logics and epistemologies of war (Chow 2006; Terry 2017) in ways that render populations in the Global South into threats and targets. I conclude by suggesting that fugitive science can work as counter-evidence to health security frameworks and, as such, represents a furtive form of resistance to these militarized logics.