Because its power remains naturalized: introducing the settler colonial determinants of health

By Bram Wispelwey, Osama Tanous, Yara Asi, Weeam Hammoudeh, and David Mills

Indigenous people suffer earlier death and more frequent and severe disease than their settler counterparts, a remarkably persistent reality over time, across settler colonized geographies, and despite their ongoing resistance to elimination. Although these health inequities are well-known, they have been impervious to comprehensive and convincing explication, let alone remediation. Settler colonial studies, a fast-growing multidisciplinary and interdisciplinary field, is a promising candidate to rectify this impasse. Settler colonialism’s relationship to health inequity is at once obvious and incompletely described, a paradox arising from epistemic coloniality and perceived analytic challenges that we address here in three parts. First, in considering settler colonialism an enduring structure rather than a past event, and by wedding this fundamental insight to the ascendant structural paradigm for understanding health inequities, a picture emerges in which this system of power serves as a foundational and ongoing configuration determining social and political mechanisms that impose on human health. Second, because modern racialization has served to solidify and maintain the hierarchies of colonial relations, settler colonialism adds explanatory power to racism’s health impacts and potential amelioration by historicizing this process for differentially racialized groups. Finally, advances in structural racism methodologies and the work of a few visionary scholars have already begun to elucidate the possibilities for a body of literature linking settler colonialism and health, illuminating future research opportunities and pathways toward the decolonization required for health equity.

Read the article here.

Pills That Swallow Policy: Clinical Ethnography of a Community Mental Health Program in Northern India

By Sumeet Jain and Sushrut Jadhav

India’s National Mental Health Program (NMHP) was initiated in 1982 with the objective of promoting community participation and accessible mental health services. A key component involves central government calculation and funding for psychotropic medication. Based on clinical ethnography of a community psychiatry program in north India, this article traces the biosocial journey of psychotropic pills from the centre to the periphery. As the pill journeys from the Ministry of Health to the clinic, its symbolic meaning transforms from an emphasis on accessibility and participation to the administration of a discrete ‘treatment’. Instead of embodying participation and access, the pill achieves the opposite: silencing community voices, re-enforcing existing barriers to care, and relying on pharmacological solutions for psychosocial problems. The symbolic inscription of NMHP policies on the pill fail because they are undercut by more powerful meanings generated from local cultural contexts. An understanding of this process is critical for the development of training and policy that can more effectively address local mental health concerns in rural India.

Read the article here.

The 4B movement: envisioning a feminist future with/in a non-reproductive future in Korea.

By Jieun Lee and Euisol Jeong

Recently, in Korea, young feminists launched the 4B (4非) movement: bihon, bichulsan, biyeonae, bisekseu, meaning the refusal of (heterosexual) marriage, childbirth, romance, and sexual relationships. The 4B movement encompasses not only criticisms of the pro-natalist turn in state policy and protests against it, but also various forms of self-help discussions and practices that are explicitly oriented towards women’s individual futures. In this article, Lee and Jeong explore how the 4B movement has given young feminists the opportunity to envision the future that they had been discouraged from imagining. Presenting a lived critique of contemporary Korea, these feminists ask how young women are led to imagine their current, single life as a temporary state, as consumer capitalism and the patriarchal state together place these young non-married women in an economically vulnerable position. They see this as achieved by endorsing ‘feminine’ desires and a presentist lifestyle, as well as excluding non-married women from opportunities in the job market and state-sponsored benefits in welfare services. They argue that the 4B movement and its discourses on the future and self-help could offer these women one possible way to envision a feminist future as individuals without being part of the state’s reproductive future.

Read the article here.

Palestinians’ mental and physical Health. An interview with Rita Giacaman.

By Sélima Kebaïli

While mental health is usually assessed using objective health indicators, these measurements fail to address the intricate impact of persistent violence on Palestinians’ lives.

Rita Giacaman is the founder of and a professor at the Institute of Community and Public Health at Birzeit University. She has chronicled the effects of Israeli military occupation on the life and health of Palestinians under occupation focusing on the impact of chronic war-like conditions and exposure to violence on the health and wellbeing of Palestinians. Her focus lies also on the psychological and social well-being of adolescents, aiming to create methods for implementing health and welfare programmes in prolonged violent conditions.

Read the text interview here.

Ringing the Existential Alarm: Exploring BirthStrike for Climate

By Heather McMullen and Katharine Dow

Photo: Matt Palmer

Climate change is altering the horizon of a liveable future and as a result giving rise to a host of anxieties: ecological, demographic, reproductive, and existential. The BirthStrike for Climate collective was a group of people who were reconsidering reproduction as a result of the climate crisis. In exploring the case of BirthStrike we consider how these decisions were used as a tool for “existential” activism and how the campaign was encountered and discredited in the public realm. We argue the campaign ignited numerous anxieties, resulting in an inability to “hear” the existential threat BirthStrikers aimed to call into focus.

Read the full article here.

The foreign gaze: authorship in academic global health

By Seye Abimbola

“There is a problem of gaze at the heart of academic global health. It is difficult to name. […] Recent bibliometric analyses confirm autorship imbalances patterns that are largely explained by entrenched power asymmetries in global health partnerships — between researchers in high-income countries (often the source of funds and agenda) and those in middle-income and especially low-income countries (where the research is often conducted). But we cannot talk about authorship without grappling with who we are as authors, who we imagine we write for (i.e., gaze), and the position or standpoint from which we write (i.e., pose).”

Drawing on the ideas of ‘foreign’ and ‘local’ gaze, Abimbola highlights how imbalances in autorship are generally a reflection of wider power inequalities in the production and dissemination of knowledge in global health.

Read the article here.

Rethinking Global Health: Frameworks of Power

By Rochelle A. Burgess

This book reflects and analyses the working of power in the field of global health– and what this goes on to produce. It asks the pivotal questions of, ‘who is global health for’ and ‘what is it that limits our ability to build responses that meet people where they are?’

Covering a wide range of topics from global mental health to Ebola, this book combines power analyses with interviews and personal reflections spanning the author’s decade-long career in global health. It interrogates how the search for global solutions can often end up far from where we anticipated. It also introduces readers to different frameworks for power analyses in the field, including an adaptation of the ‘matrix of domination’ for global health practice. Through this work, Dr Burgess develops a new model of Transformative Global Health, a framework that calls researchers and practitioners to adopt new orienting principles, placing community interests and voices at the heart of global health planning and solutions at all times.

Access the book here.

Why Do You Make It About Race? Epistemic Disobedience of a Public Health Doctoral Trainee

By Satrio Nindyo Istiko

In Australia, racism remains a challenge to dismantle within public health institutions. In this paper, Satrio Nindyo Istiko examines the pressures he experienced from some public health scholars and practitioners to conform to colonial and positivist approaches in knowledge production that still dominate the field. To challenge this hegemony, he aligned his research practices with what Mignolo calls “epistemic disobedience,” an approach to delink from Western ways of producing knowledge. Based on this experiential learning process, he argues epistemic disobedience should not be overlooked in the discussion of decolonizing research and antiracist pedagogy in the context of doctoral training. Through this reflection, he encourages public/global health PhD students from the Global South/Global majority to resist colonial perspectives as they navigate Western systems and cultures of producing knowledge.

Read the article here.

Will global health survive its decolonisation?

By Seye Abimbola and Madhukar Pai

There are growing calls to decolonise global health. This process is only just beginning. But what would success look like? Will global health survive its decolonisation? This is a question that fills us with imagination. It is a question that makes us reflect on what Martin Luther King Jr saw when he said in 1968, in the last speech he gave before he was killed, that “I’ve been to the mountaintop…and I’ve seen the Promised Land.” If what he saw was an equal, inclusive, and diverse world without a hint of supremacy, then, that world is still elusive. Similarly, an equal, inclusive, just, and diverse global health architecture without a hint of supremacy is not global health as we know it today.

Read the article here.

How Cancer Crossed the Color Line

By Keith Wailoo

Examining one hundred years in the public campaign against cancer, this path-breaking study of scientific, medical, and epidemiological writings and of cinematic and literary representations of disease, reveals how experts and the lay public saw cancer’s demographic shifts – from a stereotypical white female disease to equal opportunity killer — as a message about women, men, race and the changing color line.

Read the book here.

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