When places come first: suffering, archetypal space and the problematic production of global health

Abstract

The rise of global health as a field of study and site of intervention has animated significant critical social science engagements. Of these, medical anthropology has arguably emerged as the ascendant in the field with its growing corpus of writing and advocacy largely animated by the discipline's 'suffering slot'. This paper thus applies a geographical critique to anthropology's moral, humanitarian impulse to give voice to suffering by exploring the spatial consequences of this mode of scholarship. It argues that the suffering slot inevitably leads global health researchers to certain archetypal spaces and that, in turn, these places: (i) are overwhelmingly biomedical; (ii) come to function as 'truth spots' in the production and circulation of global health knowledge and (iii) perpetuate a global health riddled with 'ignorance spots'. Given this, the paper asks what happens if we look beyond suffering to consider the hidden geographies of global health that might then be revealed. It argues that in order to develop a richer topography of global health knowledge and critique, we must also consider those spaces where pleasure and suffering intersect in ways that challenge the humanitarian impulse and crisis-led readings of health. These other archetypal spaces of global health -gyms, bars, supermarkets and more -are not flippant distractions from the grave reality of human suffering, but rather spaces that condition the genesis of suffering and where affliction is put aside in favour of pleasure. In arguing that we need to be far more attuned to the non-medical spaces where global health is produced, experienced and challenged, the paper also articulates how geography might productively meet anthropology in critical studies of global health.

Public Servants as Development Brokers: The Shaping of INGOs’ Reducing Teenage Pregnancy Projects in Malawi’s Primary Education Sector

“…My approach to data collection has provided me with very broad information on livelihoods, and the tensions between global norms and the aspects of lives that people value themselves (Marsland and Prince 2012). This approach resonates with arguments geographers have made recently in favour of foregrounding "place" in critical debates on global health, rather than the dominant medical anthropological focus on health centres and single interventions, as this is crucial for understanding the broader impact of global health initiatives (see also Herrick 2017;Neely and Nading 2017).…”

“…Politicaleconomy analyses gained popularity in the 1980s (Ortner 2016) analysis that hasaccording to Janes and Corbett (2009) the ultimate goal of reducing global health inequalities. Therefore, according to Pigg, this kind of analysis limits its focus to 'the local' and, as noted by Herrick (2017), to 'suffering'. Instead, following Brada (2011) and Fassin (2012), Pigg (2013) argues for an ethnography of global health itself; an "inquiry into the who, what, where, when, why, and how of all the activities that call themselves projects of global health" (p.128).…”

“…In fact, they often produce unintended consequences. Such unintended or unanticipated effects emerge because of the working or influence of local contexts which could not have been predicted from a rational evidencebased policy design process (Herrick 2016). Yet, an understanding of how unintended consequences occur, Herrick (2016) argues, is lacking in many anthropological contributions to global health.…”

Conditions of life in the city: medicine and gendered relations in Maputo, Mozambique

“…Bringing scholarship on medicine together with literature on ‘global cities’ (Robinson ), then, draws attention to how relational modes of personhood constitute both urban livelihoods and practices of healing. The conditions under which medical goods enable health and recovery, this work suggests, include not just economic possibilities or medical resources, whether transnational or public, but also practices of reciprocity that extend between households, through gendered family and friend relationships, and across the city (see also Herrick ; Yates‐Doerr & Carney ). In Maputo, these practices and relations are importantly shaped by the city and by the urban economies through which patients like Glória fashion the conditions of life for themselves and others.…”

Idioms of resilience among cancer patients in urban South Africa: An anthropological heuristic for the study of culture and resilience

“…These idioms or modes of expression are ''typically unquestioned normativity'' (Hinton & Lewis-Fernandez, 2010, p. 211) that reveal culturally located norms, values, and practices that inform not only experiences with distress but also methods and patterns of care-seeking and healing (Guarnaccia, 1992;Kaiser et al, 2015;Yarris, 2011Yarris, , 2014. Despite decades of inquiry into idioms of distress, few anthropologists have investigated the sociocultural dynamics that shape and promote positive health and well-being (Butt, 2002;Cassaniti, 2019, this issue;Herrick, 2017;Panter-Brick, 2015;Snodgrass, Dengah, Polzer, & Else, 2019, this issue) and the core concepts and expressions that reflect these experiences. We argue that the same adverse interpersonal, social, political, economic, and spiritual situations that elicit idioms of distress may also evoke a complementary range of resilient responses that anthropologists and transcultural psychiatrists have often neglected in their effort to understand social suffering.…”