Health dispossessions and the moralization of disease: the case of diarrhea in the Mekong Delta, Vietnam

Abstract

Despite the swift development of Vietnam's water supply and sanitation (wat/san) sector, over the last ten years there have been 1.5 million annual documented cases of diarrhea. Western perspectives blame insufficient medical or economic advancement for failing to prevent diarrhea and its treatment, failing to grasp how disease is shaped in the cultural, moral and political domain. This article examines the nature and function of public health policy and discourse against the spread of the disease in Can Tho City, Mekong Delta. Some 94 qualitative interviews were conducted with government representatives, medical staff and water experts, and a survey of 131 households in urban and rural areas. Focusing only on improving the construction of wat/san 'hardware' does not improve 'cultural software', and ignores the needs of vulnerable minorities, compromising the control of diarrhea. I also show how state discourse follows neoliberal approaches in individualizing health responsibilities, and moralizing disease. Local (mis)perceptions and risky behaviors emerge as the result of structural constraints that include poverty, a lack of access to useful health information, and the cultivation of stigma around diarrhea. These types of health dispossessions serve a political purpose, where the state escapes responsibility for public health failures, and thus enhancing its efforts to maintain legitimacy as a good implementer and a 'caring head.' Keywords: Vietnam, public health, health individualization, moralization of disease, blame discourse, diarrhea. RésuméMalgré le développement rapide du secteur de l'approvisionnement en eau et de l'assainissement (wat / san) au Vietnam, il y a eu au cours des dix dernières années 1,5 million de cas annuels de diarrhée. Les perspectives occidentales accusent l'insuffisance de progrès médicaux ou économiques pour ne pas prévenir la diarrhée et son traitement, ne comprenant pas comment la maladie est façonnée dans le domaine culturel, moral et politique. Cet article examine la nature et la fonction de la politique de santé publique et le discours contre la propagation de la maladie dans la ville de Can Tho, dans le delta du Mékong. Quelque 94 entrevues qualitatives ont été menées auprès de représentants du gouvernement, du personnel médical et des experts en eau, et une enquête auprès de 131 ménages vivant en milieu urbain et rural. Se concentrer uniquement sur l'amélioration de la construction du «matériel» wat / san n'améliore pas les «logiciels culturels» et ignore les besoins des minorités vulnérables, compromettant ainsi le contrôle de la diarrhée. Je montre aussi comment le discours d'Etat suit les approches néolibérales en individualisant les responsabilités en matière de santé et en moralisant les maladies. Les perceptions locales et les comportements à risque sont le résultat de contraintes structurelles qui incluent la pauvreté, le manque d'accès à des informations utiles sur la santé et la propagation de la stigmatisation autour de la diarrhée. Ces types de dépossessi...

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