The Precariousness of Public Health: On Tuberculosis Control in Contemporary France

Abstract

Through an ethnographic exploration of tuberculosis control in one of France's poorest regions, Seine-Saint-Denis, I interrogate the relationships between public health planning and interventions in conditions of multiple precarity. I show that the encounter between the feasible and the fantastic in the realm of public health generates feelings of absurdity and futility among medical professionals, characteristic of disease control in the precarious present. Precarity is neither a social and economic condition per se, nor is the link between disease and precarity static. It is a dynamic process of political inclusions, exclusions, and inequalities, which differ substantially within the unequal spheres of precarious lives. The contradictions in tuberculosis control that I describe are thus not only characteristic of French public health but of global public health today, where illusions in disease control encounter the exclusionary realities of social life.

Social determinants of pulmonary tuberculosis treatment non-adherence in Rio de Janeiro, Brazil

“…In addition to the ability to identify scenarios with a higher propensity for treatment non-adherence, these findings highlight that conditions of social and economic development also affect the conditions of tuberculosis treatment among the population of Rio de Janeiro. Kehr (2016) [ 31 ] observed that tuberculosis control, including ensuring full treatment of marginalized populations, depends not only on the availability of drugs and the functioning of health services, but also on social and political inclusion. Mason (2016) [ 32 ] reaffirmed the importance of social science and medical anthropology concepts in the understanding of tuberculosis, stressing the need to recognize the complexity of the social, economic, cultural, geographic, and political aspects involved in the control of tuberculosis[ 33 ], In an ethnographic study of the abandonment of tuberculosis treatment among Bolivians Aymara, Greene (2004) recognized that in addition to cultural differences, social determinants of access to treatment can reduce tuberculosis control.…”

Exploring Tuberculosis Riskscapes in a Papua New Guinean ‘Hotspot’

“…It runs speedily in because of hunger’. Ezra’s take on the dominant approaches to TB that favour medically orientated strategies such as testing, treatment and preventative treatment was that they are short-sighted and will not address the ‘social and political precarities that enable TB to prosper’ (Kehr, 2016, p. 383):We can keep on trying with our medicine… medicine will run out and the sickness will still remain. We can continuously fund many millions, and money will run out but this sick will still remain because this is an island [and] nobody is eating.…”

‘Exotic no more’: Tuberculosis, public debt and global health in Berlin

“…Cuts in medical services, rising user fees and the triage of those worthy or unworthy for ever more expensive treatments are domains in which the neoliberal feedback loop leads to the collapse of categorical distinctions between South and North, here and elsewhere, own and other, despite their stubborn solidity and their easy instrumentalisation for powerful politics of differentiation and exclusion, especially in the domain of migrant care (Kehr, 2016). In Berlin, renewed concerns with tuberculosis oscillate between an ongoing faith in techno-medical progress and public welfare and a parallel fear of social and economic decay that might threaten the slowing of disease incidence or even inverse the tendency.…”