Katherine Kenny

The biopolitics of global health: Life and death in neoliberal time

The opening years of the 21st century have witnessed the rise of ‘global health’ as the preferred label for attempts to govern the health of the global population. In this article, I locate the epistemological origins of global health in the introduction of the Disability Adjusted Life Year (DALY) metric in the World Bank’s Investing in Health report. I argue that the DALY metric accomplishes an economization of life by disaggregating lifetimes into component units of time and reassembling life as a revenue stream to be maximized through practices of self-investment in one’s own health – configured here as human capital. Life is reimagined as time and the individual as a neoliberal homo oeconomicus: as an entrepreneur of the self. I argue that the DALY metric is best conceived as a biopolitical technology of power that underpins the contemporary neoliberal global health regime.

Moral Ambivalence and Informal Care for the Dying

Caring for the dying presents perhaps the most challenging site of informal care. Participation in informal caring roles in such contexts has been prone to reification as a virtuous social practice, often without critical reflection as to the implications for caregivers. Here, drawing on interviews with carers who were providing care in the last few weeks or days of life, we develop an understanding of informal care in this setting as a morally ambiguous social practice, framed by social relations of duty, gift and virtue, but in turn encapsulating experiences of failure, shame and suffering. Such a contradictory understanding of caregiving is critical for understanding the tensions within end-of-life settings and also for countering the concealments produced by the valorization of informal care more broadly in modern societies. We present a critical analysis of informal cares contested character at the end of life, challenging normative understandings that are complicit in producing moral ambivalence, shame and suffering for individual carers.

Blaming Deadmen Causes, Culprits, and Chaos in Accounting for Technological Accidents

This article illustrates the shortcomings of an objectivist epistemology in publicly accounting for technological accidents. Public inquiries convened in the aftermath of accidents tend to operate with such an objectivist approach and, as a result, usually assign blame to either or both of two causal culprits: technical malfunction and socio-organizational failure. Following Downer, I argue that a constructivist understanding of technological failure opens the possibility of a third type of cause—one that is epistemological in nature. Public inquiries frequently fail to recognize these “epistemic accidents” and are thereby limited in their capacity to effect positive change. Using the case of a 2003 railway accident near Sydney, Australia, and the public inquiry that was convened in its wake, this article argues that recognizing the epistemological origins of failure holds promise for a more constructive way of accounting for and learning from technological accidents.

On waiting, hauntings and surviving: Chronicling life with cancer through solicited diaries:

The ‘typical’ trajectory of a person with cancer has been from diagnosis, through treatment, and towards cure (life) or the end of life (death). Yet, cancer survivorship as a social practice is no longer contained by such neat categorisations. Much of the lived experience of cancer now centres on: living with, rather than beyond, disease; the perpetuity of treatment rather than the spectre of disease; and, making sense of incurability. Using a solicited diary methodology, in this article the authors seek to chronicle life with cancer for those living in the in-between – the often-overlooked lives of incurable survivors. In the analysis of survivors’ diaries, the authors argue for an emphasis on the phenomenology of waiting and sociological exploration of how clinical prognostications affectively haunt the present. This, they posit, will further sociological understandings of the lived experience of affliction and care, especially within relations of chronicity and perpetuity, in this case focusing on advanced cancer and the steadily changing oncological milieu.

Cultural ontologies of cancer in India

Abstract India has undergone a considerable epidemiological transition in the past few decades. The rise of cancer and other chronic illnesses has, and will continue to have, a substantial impact on the overall burden of disease, as well as the lived experiences of illness in India. Little is known about the cultural inflection of cancer in the Indian medical, historical and religious/spiritual landscape, which is both highly varied and rapidly changing. Here, we explore some of the issues emergent from individuals’ experiences of illness including their understandings of cancer, its ‘origins’, its meanings and subsequent everyday experiences. Drawing on interviews with 40 people with cancer in Hyderabad, we focus on the cultural ontologies of cancer in India, the social moralities and evolving individual responsibilisation around cancer, and some of the affective dimensions of these interpretations of illness.

Improvisation, therapeutic brokerage and antibiotic (mis)use in India: a qualitative interview study of Hyderabadi physicians and pharmacists

ABSTRACT Antimicrobial resistance (AMR) is widely reported to be a rapidly escalating global health threat. Investigations into the social dimensions of AMR have tended to focus on economically wealthier nations, even though economically poorer countries are a site of considerable and often increasing antibiotic (mis)use. Understanding the global and local dynamics of antibiotic resistance, we propose, requires critical sociological investigation at the nexus of economic development, structural constraints, cultural norms, and infection-management practice. Here, to begin to unpack these intersections, we draw on qualitative interviews with physicians and pharmacists in Hyderabad to explore their accounts of the social dynamics of AMR in India. In particular, we focus on their accounts of practices of improvisation and self-medication with antibiotics; the nexus of informal and formal pharmaceutical economies and the vested interests therein; and the everyday brokering of antibiotics. We posit that responses to AMR need to be deeply embedded in the specificities of everyday practice, local market forces, and regulatory (im)possibilities with attention paid to the locally prevailing cultural norms.

“It doesn’t exist…”: negotiating palliative care from a culturally and linguistically diverse patient and caregiver perspective

BackgroundThe end of life represents a therapeutic context that acutely raises cultural and linguistic specificities, yet there is very little evidence illustrating the importance of such dynamics in shaping choices, trajectories and care practices. Culture and language interplay to offer considerable potential challenges to both patient and provider, with further work needed to explore patient and caregiver perspectives across cultures and linguistic groups, and provider perspectives. The objective of this study was to develop a critical, evidence-based understanding of the experiences of people from Culturally and Linguistically Diverse (CALD) backgrounds, and their caregivers, in a palliative care setting.MethodsA qualitative study, using semi-structured interviews to explore key experiences and perspectives of CALD patients and caregivers currently undergoing treatment under oncology or palliative care specialists in two Australian hospitals. Interviews were digitally audio recorded and transcribed in full. A thematic analysis was conducted utilising the framework approach.ResultsSixteen patients and fourteen caregivers from a range of CALD backgrounds participated in semi-structured interviews. The research identified four prevalent themes among participants: (1) Terminology in the transition to palliative care; (2) Communication, culture and pain management; (3) (Not) Talking about death and dying; and, (4) Religious faith as a coping strategy: challenging the terminal diagnosis.ConclusionsCALD patients and caregivers’ experiences are multifaceted, particularly in negotiating linguistic difficulties, beliefs about treatment, and issues related to death and dying. Greater attention is needed to develop effective communication skills, recognise CALD patients’ particular cultural, linguistic and spiritual values and needs, and acknowledge the unique nature of each doctor-patient interaction.

From “Health for All” to “Health as Investment:” The Role of Economic Rationalities in the Transition from International to Global Health 1978–2013

This chapter examines the role of economic rationalities in the transition from international health to global health since the late 1970s. It focuses, in particular, on the recent rise to prominence of non-communicable diseases on the global health agenda. Once considered to be diseases of affluence, non-communicable diseases (NCDs) such as cancer, diabetes, cardiovascular disease have recently come to be seen as a threat to both the global population and the global economy. Strategies to combat the proliferation of NCDs have simultaneous been shown to be particularly cost-effective, making NCD interventions a solid global health investment. This chapter contrasts the current era of global health, in which health is imagined in as a form of human capital and a site of investment with a post-war era of international health during which health was advocated as a human right and public good. Drawing on empirical material including historical documents, published reports and the scientific literature, it argues that the transition from international to global health can be best understood as resulting from the rise of economic rationalities in the field of world health over the last 25 years.

In one’s own time: Contesting the temporality and linearity of bereavement:

This article explores the experience and meaning of time from the perspective of caregivers who have recently been bereaved following the death of a family member. The study is situated within the broader cultural tendency to understand bereavement within the logic of stages, including the perception of bereavement as a somewhat predictable and certainly time-delimited ascent from a nadir in death to a ‘new normal’ once loss is accepted. Drawing on qualitative data from interviews with 15 bereaved family caregivers we challenge bereavement as a linear, temporally bound process, examining the multiple ways bereavement is experienced and how it variously resists ideas about the timeliness, desirability and even possibility of ‘recovery’. We posit, on the basis of these accounts, that the lived experience of bereavement offers considerable challenges to normative understandings of the social ties between the living and the dead and requires a broader reconceptualization of bereavement as an enduring affective state.