Susan L. Erikson

Global Health Business: The Production and Performativity of Statistics in Sierra Leone and Germany

The global push for health statistics and electronic digital health information systems is about more than tracking health incidence and prevalence. It is also experienced on the ground as means to develop and maintain particular norms of health business, knowledge, and decision- and profit-making that are not innocent. Statistics make possible audit and accountability logics that undergird the management of health at a distance and that are increasingly necessary to the business of health. Health statistics are inextricable from their social milieus, yet as business artifacts they operate as if they are freely formed, objectively originated, and accurate. This article explicates health statistics as cultural forms and shows how they have been produced and performed in two very different countries: Sierra Leone and Germany. In both familiar and surprising ways, this article shows how statistics and their pursuit organize and discipline human behavior, constitute subject positions, and reify existing relations of power.

Beyond Desperation: Motivations for Dumpster™ Diving for Food in Vancouver

In the global food system, food is considered a disposable commodity and waste is produced at extraordinarily high levels. In a number of affluent nations, including Canada, “dumpster diving” for food has emerged as an approach to food provisioning. This article is based on a research project conducted for an honors thesis that examines dumpster diving for food in Vancouver, British Columbia. While an earlier report (Miewald 2009) identified dumpster diving in Vancouver as a survival strategy for people living in poverty who experience food insecurity, research for this article reveals that motivations also extend beyond economic desperation. The data contest some common assumptions and provide explanations of peoples motivations and their means of “dumpstering” in the Vancouver locale. As such, the article reveals divers’ broader political, social, and economic motivations in a specific locale, enabling an exploration of some systemic contradictions of food production, distribution, provisioning, and consumption.

Secrets from Whom

Clandestine financial dealings are at the core of new forms of philanthropic venture capitalism in global health. Worldwide, organizing principles of state-centric pastoral and clinical health care have given way to speculative, market-driven approaches to health. Because global finance is a normatively secretized social space, the increasing use of private financial instruments in health spaces previously publicly funded raises important questions about the remaking of global welfare processes, global public health incentives, and abandonments. Anthropological research shows that market value does not always link up with improved health outcomes. This article explores a related point: what are the relationships between financial secrecy and care? When the stakes are life and death, how much secret knowledge and private action is tolerable? Increasingly in global health finance, new forms of exclusion are emerging; disenfranchised people and nation-states participate in world systems but as compromised financial subjects. Asking “Who knows what?” and “What benefits whom?” opens up all manner of difference and differential stakes in well-being—financial and corporeal—and provides analytical traction on both new systems of advantage and recent intensifications of old systemic global inequalities.

Global health indicators and maternal health futures: The case of Intrauterine Growth Restriction

Public health indicators generally operate in the world as credible, apolitical and authoritative. But indicators are less stable than they appear. Clinical critiques of Intrauterine Growth Restriction (IUGR) criteria have been forthcoming for decades. This article, though, takes up the measuring and calculation gradients of IUGR in the ultrasound machine itself, including the software algorithms that identify IUGR. One hospital where research was conducted incorrectly predicted pathological birth outcomes 14 of 14 times. We are at a historical moment when the global use of prenatal diagnostic ultrasound for the express purpose of assessing IUGR is set to escalate. Medical imaging device corporations like Siemens, Toshiba, General Electric and Phillips are quite literally banking on it, and new forms of ultrasound technology and diagnostic software are increasingly available on smartphones, tablets and laptops. Clinical guidelines for IUGR – assumed to be authoritative and evidence-based – are evolving right along with the installation throughout the world of the technology capable of diagnosing it. Maternal malnutrition remains the single strongest predictive factor for IUGR, regardless of the technological investments currently amassing to identify the indicator, which is cause for a reassessment of priority spending and investment.

Cell Phones ≠ Self and Other Problems with Big Data Detection and Containment during Epidemics

Abstract Evidence from Sierra Leone reveals the significant limitations of big data in disease detection and containment efforts. Early in the 2014–2016 Ebola epidemic in West Africa, media heralded HealthMaps ability to detect the outbreak from newsfeeds. Later, big data—specifically, call detail record data collected from millions of cell phones—was hyped as useful for stopping the disease by tracking contagious people. It did not work. In this article, I trace the causes of big datas containment failures. During epidemics, big data experiments can have opportunity costs: namely, forestalling urgent response. Finally, what counts as data during epidemics must include that coming from anthropological technologies because they are so useful for detection and containment.

‘Worse than HIV’: The logics of cancer screening avoidance in Swaziland

ABSTRACT This article shows the consequences of competing global health agendas within differential clinical and social worlds. Specifically, it examines how HIV’s prominence in local clinical programming in Swaziland influences cervical cancer screening rates. Drawing on 2014 ethnographic research conducted in a semi-urban town in Swaziland, the interview and participant observation data show the relative scarcity of cervical cancer care and the consequences of HIV/AIDS funding and programming dominance. 20 women and 7 health workers were interviewed in homes, clinics and small businesses. Data were analysed using frameworks of medicoscapes and therapeutic citizenship. Results show that women’s patterns of screening avoidance were based on lengthy diagnostic procedures, treatment expense, therapeutic travel to neighbouring South Africa, and frequent therapeutic failure. In sum, avoidance of cervical screening in Swaziland has structural components, and is a product of organisational and political choices at local and global levels. This study challenges culturalist assumptions about African women’s avoidance of cervical cancer screening. In the future, delivering successful cervical cancer screening in Swaziland will depend on expanding cancer screening and treatment, which should be informed by perceptions of clinical care held by the very women public health practitioners aim to keep healthy.

Women's knowledge in Madagascar: A health needs assessment study

Abstract Nutritional and hygienic practices contribute to high morbidity and mortality rates related to malnutrition in Madagascar. This study, a research effort that brought together charitable organisations, non-governmental organisations (NGOs) and university collaborators, investigates womens health knowledge in the Anosy region of Madagascar. The needs assessment sought to characterise womens knowledge and understanding of nutrition and hygiene. Eight focus groups of 13–60 women each were conducted in the seven most impoverished communes of the Anosy region (n=373). Participants were recruited with the aid of a UK–Malagasy partnered NGO, Azafady. Study findings show that women fully understand the interplay between poor nutrition, hygiene and malnutrition but are unable to change everyday practices because the barriers to better nutrition and hygiene seem beyond their control. These findings may be used to prioritise projects and research seeking to improve nutrition and hygiene, thus reducing malnutrition in the Anosy region.