Candace Johnson

Framing and the politics of public health: An examination of competing health narratives in Honduras

Abstract According to the World Bank, Honduras is a health and development success story. Over the past few decades, it has experienced economic growth, expanded public health infrastructure, and improved key health indicators. However, these achievements do not serve as evidence of success for global public health agencies, such as the World Health Organisation (WHO) and the Pan American Health Organisation (PAHO). The WHO has identified Honduras as a ‘priority country’ due to extreme levels of poverty, inequality, indebtedness, and poor health. What accounts for these divergent evaluations, and what are their consequences for vulnerable and marginalised populations? I argue that the framing of health is important and demands examination because it reveals political dynamics and shapes policy options. Furthermore, individual frames are incomplete, differentially inclusive, and ultimately inadequate as explanatory and analytic frameworks.

Health as Culture and Nationalism in Cuba

Abstract This article examines the ways in which the development of health systems and health “rights” contribute to a countrys identity. The centrality of health care to Cuban nationalism expresses political and social values, while achievements in health and medicine establish domestic and international dimensions of regime legitimacy. Cuban health indicators and medical advancements have created both symbolic and real capital, and can be properly understood as cultural products of the revolution. It is argued in this article that Cubas excellent health indicators, which secure a significant measure of social equality, productivity, and well-being, as well as its national identity, are threatened by emerging inequality and increased public health risks that are associated with economic decline and the expansion of the tourist industry and foreign interests on the island.

The virtues of repression: politics and health in revolutionary Cuba

Cuba is a country of contradictions. It has high levels of absolute poverty and low levels of relative poverty. It is a poor country with very strong health indicators. Even with the adjustments to life expectancy and infant mortality ratios as suggested by Geloso and colleagues, Cuban health indicators are excellent by global standards. In addition, the regime has promised and fulfilled human rights in the areas of social entitlements to health care, education, food, and housing, while it has consistently violated human rights as political and civil rights. Cubans tend to be intensely critical of their government’s failure to respect human rights, allow economic freedom, and permit political dissent, yet simultaneously proud of the Revolution’s anti-imperial stance, vis-à-vis the USA in particular, as well as its rejection of a version of life that valorizes capitalist bourgeois consumption. In the field of health, as Geloso and colleagues point out, Cuba has achieved high levels of population health through possible manipulation of data (although this is not unique to either Cuba or authoritarian regimes) and coercive public policies. If Cuba is manipulating the data to produce more favorable health indicators in order to achieve nationalistic goals, what does this mean? At best, the manipulation creates inaccuracies and masks health system weaknesses, and fails to acknowledge the means through which gains are achieved. The analysis of Geloso and colleagues suggests that this is a problem primarily attributable to poor, authoritarian regimes that have significant power to manoeuver meagre resources. Some of the evidence that they provide includes the ratio of late foetal deaths to neonatal deaths, which is much higher in Cuba than in other countries in the region and elsewhere. But other indicators are not mutually determinant. For example, there seems to be no relationship between infant mortality and maternal mortality, although both indicators can be considered to serve as proxy measures, which is to say that they reveal complex socio-political dynamics and multiple underlying factors. The contextual factors mentioned by the authors suggest that Cuba’s health indicators are artificially improved or enhanced by the circumstances of deprivation. Thus, it appears that there are virtues of both repression and scarcity. At worst, manipulation of health data reveals that impressive health indicators are achieved through coercive measures, such as state-imposed quarantine for infectious diseases (as in the early years of the AIDS epidemic), internment in hogares maternos, or forced abortions. On one research trip to Cuba a woman told me that she had been pregnant and going to regular health check-ups (which are mandatory). During one such visit, the health practitioner who examined her told her that she was not pregnant after all, but that she had developed a uterine cyst, which had to be removed. The cyst was removed, but the woman was convinced that this was a mistake, that she had been pregnant, and that the foetus was removed. In her opinion, this confusion and tragic error was the result of medical incompetence. Her regular doctor was out of the country on a medical diplomatic mission and the replacement was poorly trained. She blamed the government for sending its doctors abroad and leaving Cubans to suffer at home. Many other women who participated in my research complained about the consequences of Cuba’s medical internationalism for similar reasons (Johnson 2016, p. 174). The Cuban government’s possible manipulation of data and propensity to take advantage of the circumstances of deprivation to bolster health outcomes (such as few cars that result in few traffic fatalities or the years of the Special Period that limited caloric intake and required people to walk long distances to find food, supplies or work) also reveal that there is a high cost paid by citizens for the achievement of impressive health indicators. In the areas of maternal and infant health, it appears that this cost is borne most heavily by women. This is a brutal reality, one that reveals yet another contradiction. Pregnant women are well cared for. They receive extra rations and are provided with services and medical care that are not available to the rest of the population, but they are under continuous surveillance and have absolutely no options. They cannot deviate from the medical protocols established by the regime and they have no choices to make concerning where to give birth or who will attend—they will all give birth in the regional maternity hospital with an obstetrician in attendance. A woman with “good connections” and enough money can secure her preferred doctor throughout pregnancy and at the birth, and can arrange for a c-section without having to endure labour for the period of time prescribed by the state. Cuban women are proud of their country’s achievements in health care, but insist that this is fulfilment of their inalienable human right to health and not the product of political benevolence. They deplore the poor conditions in hospitals, lack of choice, and disruptions to

Pregnant woman versus mosquito: A feminist epidemiology of Zika virus

This article investigates the contradictions between public health protocols and infection containment efforts concerning Zika virus and reproductive rights. In El Salvador, for example, women are being advised to avoid pregnancy until 2018, at which time local authorities hope that the virus will be under control. This is not so easy, however, as there is limited access to contraception, abortion is illegal in all instances, and women tend to have little household authority. In this article, I examine the policy, legal, and political contradictions related to the global proliferation of Zika virus in the context of ongoing debates about stratified reproduction. This term conceptualizes the phenomenon that accords different values to reproductive tasks undertaken by women in different socioeconomic, cultural, and national contexts. Whereas reproduction and reproductive autonomy tend to be highly respected and protected for relatively privileged women in the Global North, they tend to be much less so for women of the Global South. Furthermore, the adherence to public and private divisions in both national and transnational contexts segregates reproductive rights from the mainstream of political negotiation and public health intervention, and in doing so frustrates progress toward the realization of global reproductive rights.

The Human Rights Framing of Maternal Health: A Strategy for Politicization or a Path to Genuine Empowerment?

In light of New Delhi High Courts recent declaration (during 2000) of maternal mortality a human rights issue (in a public interest litigation case), this paper seeks to deconstruct this verdict in the broader context of global discourse surrounding the framing of maternal health as a human right. The paper questions whether the two rights formulation i.e. the right to maternal health and the right to maternal survival are synonymous and if not, then how do these conceptualizations weigh in on the implicit and explicit entitlements that follow. Second, the paper explores the practical and policy dimensions that must complement such human rights framing to adequately tackle the complex problem of preventable maternal deaths. The available evidence on the state of maternal health in India (as elsewhere) indicates that the issue rests at the intersection of complex political, social, economic, and cultural factors. Inequitable access to health care, social inequality and gender inequality are at the core of the problem and tackling the latter requires innovative policy making. The paper concludes that human rights framing may help politicize the issue and offer it a more important place on the public (and political) agenda, but it may not automatically yield groundbreaking policy solutions necessary to sufficiently address the main problem.

Gendered States: Women, Unemployment Insurance, and the Political Economy of the Welfare State in Canada, 1945–1997

Gendered States: Women, Unemployment Insurance, and the Political Economy of the Welfare State in Canada, 1945–1997, Ann Porter, Toronto: University of Toronto Press, 2003, pp. 355 It is amazing that Canadian society has been consistently bewildered as to the social, political and economic placement of women. In her new book, Ann Porter explains that the labour requirement that enabled womens participation in the workforce during the Second World War created a post-war environment that was inequitable, illogical, gendered, and “regulating.” Thus, progressive measures were to produce regressive results, as they were taken for the sake of nationalism and not gender equality. Porter documents the change in Unemployment Insurance (UI) policy from limited coverage for certain groups of male workers that could not engage in productive labour to “site of contestation over womens entitlement to state benefits” (66).