In class we watched two videos that advocated for
the eradication of polio worldwide. One
of these was a short interview with Bill Gates in which he discussed the
importance of polio eradication and the impact it will have. The other was by the WHO and it talked about
the polio vaccination campaigns in parts of the world and the significance of
them. Both of these videos help to
illustrate how we see this disease from our own perspective, and the influence
this has on health practices around the world.
It seems that in the West we tend to view diseases
from a biomedical perspective. In the
WHO video the cause of polio is a virus and the remedy is vaccination. This is not an inaccurate portrayal of polio,
but it does come from a certain background and it does not engage with some
important aspects of illness and disease.
This is inevitable, we cannot talk about everything at once so any time
we discuss a problem such as polio certain things are left out. The problem generally arises when we look at
which voices are being heard and why. In
many cases the prevailing international health view is driven by western
ideologies which lead to vertical control of health practices in developing
areas of the world. Some defenders of
this argue that this ideology is driven by objective science and is therefore
the ‘Truth’. To me, the idea of science as the truth is a complicated problem. I was raised, like most people I know, to believe in our idea of science as an objective form of knowledge- something that removes individual bias. I still believe in science as it is currently practiced and the importance of its objectivity, but I have trouble understanding whether this system is truly unbiased. This isn’t just to say that individual experimental results or data are influenced by who is performing them, but also that the framework of our idea of scientific knowledge is flawed. Part of this is due to the limitations on what kind of questions science can ask and how they can be answered. We have a wide range of scientific practices, from physics to social sciences and each discipline has their own kind of legitimacy. Not many people will question the theory of gravity, but the methods and usefulness of ethnography for example, are not as widely accepted.
I think that most people, including scientists, will
admit that our scientific process is flawed in that it cannot answer every
question. The problem arises in that
despite its flaws, this scientific knowledge is part of a dominant ideology in
the world today that values specific kinds of knowledge over others. If we think of science as a lens through
which we can view phenomena in order to make sense of them, then who is looking
through that lens matters as much as what we are using it to look at. The ways in which we understand things are also
socially constructed and are subject to the influences of power. So when we use scientific knowledge as the
gold standard to decide whether international health policy is legitimate, that
knowledge is coming from a certain place and has a certain ideology and power
structure attached to it. Of course all
knowledge is situated and that is something we cannot get away from, but in the
case of global health, this knowledge is generally coming from one place and
being asserted in another.
So why is this a problem? Generally speaking we imagine it is a good thing to cure people of polio and if we can use medical science and technology to accomplish this, then that is also good. What are the problems then with the WHO and the Gates Foundation pushing for a global eradication of polio? One issue that James Pfeiffer and Mark Nichter bring up is that the people who make these decisions “rarely have experience with health systems and services delivery in real-world settings in poor countries. Wide reaching policy decisions, such as the promotion of private health care, are often made on the basis of personal or institutional ideology, abstracted data, and conventional wisdom or bias.” (Pfeiffer and Nichter, 412) In the case of the eradication of polio, the decision is made by health professionals in developed nations, to be implemented in developing nations.
Why did the WHO and the Gates foundation choose
polio as the target for their resources?
Did they think that eradicating polio would make the most impact on the
communities involved, or maybe that it would be the most beneficial to everyone
throughout the world? What effect has
this had on how the groups that receive aid view polio? In Pakistan it has effected how government
institutions have decided to combat the disease. According to an NPR blog “Last year, the government declared a national emergency,
and with the help of international institutions, embarked on an aggressive
vaccination campaign. So far, the
results have been promising. The number of new polio cases is about a third of
last year's total of 198.” (Northam) As Anne Emanuelle Birn discussed in her
lecture, even though a lot of financing is coming in from outside sources, this
usually requires local funding and resources to accomplish the goals that are
implemented by international actors.
This means that a lot of Pakistani resources are also going to fight
polio, which is not a bad thing until we look at the varying reports of pneumonia
deaths in Pakistan, which claim between 35-80,000 deaths per year of children
under 5 years old. This seems like a
much more real and immediate problem for the community in question.
I downloaded this image from a website called ‘Raising
Malawi’, as part of a blog in which Thierry
Durand, an operations director for Doctors Without Borders, discusses the “systemic
failures in measles prevention programs.”
The blog continues on with the fact that “measles epidemics persist
despite long-running vaccinations programs.” (Raising Malawi) As we try to find scientific solutions to
epidemics of polio in Pakistan and Measles in Malawi, we tend to frame these
issues as biomedical problems that require biomedical solutions. Or if social problems are raised, then they
tend to be issues of conforming affected groups cultural ideas to objective
medical science.
If you look at the Gates foundation website the first sentence to explain their global health program claims “Our Global Health Program harnesses advances in science and technology to save lives in poor countries.” (Bill and Melinda Gates Foundation) The way that many western actors in international health discuss illness and disease in terms of politically neutral biomedical problems works to structure how we perceive the problems and also the possibilities how they can be solved. How is this scientific knowledge created and what power is associated with it? Who has access to this knowledge and in what context is it used? I think that when we interrogate these questions the result is that scientific knowledge is not politically neutral, and can only be viewed through differing social and cultural lenses. In the end, biomedicine is just one tool of many that can be used to help communities around the world to solve health issues, or sometimes a tool used to further certain ideological goals.
David Coomes
Pfeiffer, James,
and Mark Nichter. 2008. "What Can Critical Medical Anthropology Contribute
to Global Health?" Medical Anthropology Quarterly. 22 (4): 410-415.
Jackie Northam. http://www.npr.org/blogs/health/2012/10/17/162595455/how-the-taliban-is-thwarting-the-war-on-polioRaising Malawi. http://www.raisingmalawi.org/blog/entry/measles-outbreaks-persist-despite-best-efforts/
Bill and Melinda Gates Foundation. http://www.gatesfoundation.org/global-health/Pages/overview.aspx
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