Mapping Morality in Global Health

26 June 2018 - 27 June 2018

SG1 and SG2, Alison Richard Building

Registration for this conference is now closed. 

 

Convenors

Freya Jephcott (Cambridge Infectious Diseases, University of Cambridge)

Ferdinand Moyi Okwaro (Department of Social Anthropology, University of Oslo)

P. Wenzel Geissler (Department of Social Anthropology, University of Oslo)

Sophie Hermanns (The German Society for International Cooperation, GIZ)

Jenny Thornton (Department of Politics and International Studies, University of Cambridge)

 

Summary

Contemporary discussions about global health are rife with accusations, assumptions and assertions of morality, immorality and the irrelevance of both. New tensions and debates regarding morality in global health have arisen from a long history of colonial and mission medicine, post-colonial internationalism, and ever-changing formulations of equity and provision. Some of these discussions see classical moral reasoning re-examined, for example, the rise of ‘effective altruism’ and its challenges to the role of the emotive and political. Others resent the reliance on big data and pragmatism that shapes utilitarian approaches to global health. The quieter assertions of amorality around pursuits of medical science and the angry indictments levelled at the economic models of pharmaceutical complexes rely on moralising language, too.

This conference will provide a forum to vocalize, exorcise and ignite ideas of morality in global health. By bringing together scholars from disciplines such as anthropology, history, economics, epidemiology, political science, literature and theology, we hope to chart the forms and places of morality in global health.

 

Sponsors

 

                       

 

Supported by the Centre for Research in the Arts, Social Sciences and Humanities (CRASSH), the Galton Institute, the Institute of Medical Ethics, SciDev.Net, the University of Cambridge's Department of Social Anthropology, and the University of Oslo's Department of Social Anthropology.

 

Administrative assistance: conferences@crassh.cam.ac.uk.

 

Unfortunately, we are unable to arrange or book accommodation for registrants. The following websites may be of help:

Day 1 - Tuesday 26 June

8.30 - 9.00

Registration

9.00 - 9.20

Welcome and Introduction 

Freya Jephcott (University of Cambridge)

9.20 - 11.00

Session 1: Quantification

Chair: Freya Jephcott (University of Cambridge)

 

Peter Redfield (University of North Carolina)

'How Fungible is Human Life?'

 

Jean-Paul Gaudillier (Center of Medicine, Sciences, Health, Mental Health and Health Policy CERMES 3)

'Global health and its values: Triage and the making of the Global Burden of Diseases'

 

Emily Yates-Doerr (University of Amsterdam / Oregon State University)

'Strategic reductionism: Complexity, inequality, and the challenge of doing good science in global health'

11.00 - 11.20

Break

11.20 - 13.00

Session 2: Efficacy 

ChairP. Wenzel Geissler (University of Oslo)

 

Sophie Hermanns (The German Society for International Cooperation, GIZ)

'Running the numbers on doing good: politics of evidence and mass deworming for children'

 

Elizabeth F. Hall (University of Toronto)

'Opening a can of worms: replication, reduction and the production of evidence in global health'

 

Margaret Sleebom-Faulkner (University of Sussex)

'Non-Invasive Prenatal Testing (NIPT) - an exploration of morality in the context of biomedicalisation'

13.00 - 13.40

Lunch

13.40 - 15.20

Session 3: Collaboration 

Chair: Ferdinand Moyi Okwaro (University of Oslo)

 

Emmanuelle Roth (University of Cambridge)

'"The truth is sometimes better left unsaid"': (im)moralities of post-Ebola viral research in Guinea'

 

Noemi Tousignant (University College London)

'New Scales of the Moral: The Postcolonial Global and Health Research at the WHO in the 1970s'

 

Jenny Thornton (University of Cambridge)

'Ownership, authorship and challenging dependency in Rwandan health research partnerships'

15.20 - 15.40

Break

15.40 - 17.30

Session 4: Collaboration (contd.)

Chair: Watu Wamae (University of Cambridge)

 

Ferdinand Moyi Okwaro (University of Oslo)

'Scientific lives, ethos and morality in transnational medical research collaborations in Africa'

 

Angeliki Kerasidou (University of Oxford)

'The role of trust in global health research collaborations'

 

Tennie Videler (University of Cambridge)

'Pictures of Ageing in Uganda: An Exploration of Aspects of Morality in an International Interdisciplinary Project' 

Day Two - Wednesday 27 June

9.00 - 10.40

Session 5: Sovereignty

Chair: Christos Lynteris (University of St Andrews)

 

John Manton (London School of Hygiene and Tropical Medicine)

'“The smaller part of the country is in Government hands”: global health, national planning, and territorial turmoil in the postcolonial 1960s and 1970s'

 

John Harrington (Cardiff University)

'Sovereignty, Discipline and the Nation State in Global Health Governance'

 

Raphael Oidtmann (University of Mannheim)

'Between Morality and Security: Explaining the UN Security Council’s Response to the 2014 Ebola Outbreak'

10.40 - 11.00

Break

11.00 - 12.10

Session 6: Humanitarianism

Chair: Peter Redfield (University of North Carolina)

 

Sophie Roborgh (University of Cambridge)

'Local medical humanitarianism: the merits of a social movement theory approach'

 

Iain Wilkinson (University of Kent)

'The Sociology of Humanitarianism and Humanitarian Sociology'

12.10 - 13.00

Lunch

13.00 - 14.40

Session 7: Other Paradigms

Chair: Simon Reid-Henry (QMUL)

 

Dora Vargha (University of Exeter) 

'The Cold War morality of public health: a socialist viewpoint'

 

Ruth Jane Prince (University of Oslo) 

'Universal Health Coverage: Social justice, technical pragmatism, or neoliberal cooptation?'

 

James Wintrup (University of Cambridge)

'Suffering and faithfulness: Christian missionary morality in global health'

14.40 - 15.00

Break

15.00 - 16.40

Session 8: Proximity

Chair: Ruth Jane Prince (University of Oslo) 

 

Freya Jephcott (University of Cambridge)

'Abstractions of urgency in outbreak responses'

 

Sung-Joon Park (University of Halle 1)

'More than being touched: ethical conceptions of love and unmoralizing research on Ebola epidemics'

 

Guillaume Lachenal (Université Paris Diderot) and Pierre-Marie David (University of Montreal) 

'When global health does not care too much: The “Ebola” epidemic of Ngoyla (Cameroon, 1997-1998) and the moral issue of global health casualness'

16.40 - 16.55

Break

16.55 - 17.45

Closing Keynote

Claire Wendland (University of Wisconsin-Madison) 

'Moral concerns and patriarchal bargains in the fight for maternal health'

Jean-Paul Gaudillier (Center of Medicine, Sciences, Health, Mental Health and Health Policy CERMES 3)

'Global health and its values: Triage and the making of the Global Burden of Diseases'

This paper discusses the advent of global health as a new regime of values in the government of health at the international level, taking its most famous metrics – the Global Burden of Disease – as marker. The emergence of the GBD in the 1990s is a powerful example of the deep changes, which then affected the relationship between knowledge, disease and modes of intervention within a context of mounting neo-liberal reforms. This process has often been apprehended as a radical departure from the agenda of postwar international public health and its commitment to health as universal right. The paper qualifies this argument in two ways. First, it looks at the new relationship between health and economics, which was at the core of the WHO-World Bank first GBD published in 1993 with its logic of human capital, priority needs, cost-effectiveness, and valorization of health as investment for growth and development. Second, it briefly discusses the differences as well as the continuities between this form of economic triage and the political triage at stake in the Alma-Ata strategy of primary health care with its emphasis on nation-states and planning. Using triage and its moralities as lens, the paper finally discusses the reasons why – until now - the GBD has had limited impact on the selection of priority targets by global health big players.   


Elizabeth F. Hall (University of Toronto)

'Opening a can of worms: replication, reduction and the production of evidence in global health '

In 2015, a team of epidemiologists from the London School of Hygiene & Tropical Medicine published two re-analyses of an influential study on the impacts of mass deworming among school children in western Kenya. The original study – conducted by two US development economists – is perhaps the most well-known randomized controlled trial in development economics. It is an early example of the innovative use of cluster randomized field tests in the discipline and also forms part of the evidence base supporting mass deworming initiatives. According to the epidemiologists, their re-analyses cast doubt on the original study’s findings. Fierce controversy ensued: ‘worm wars’ has played out through heated technical debates conducted in academic journals, on blogs and in the mainstream media. 

For the epidemiologists and economists concerned, this was largely an epistemic debate about how reliable scientific knowledge is produced. In this paper I show some of the ways that these ostensibly epistemic debates were simultaneously moral and political debates. Through analyzing the statistical analyses, re-analyses and extensive public discussions about them, I trace different styles of statistical analysis and analytic judgements that made a difference. Some have been explicitly debated, others not. I show how some of these differences work through competing moral registers while also assuming different economies of healthcare and styles of reasoning. I explore how a particular statistical analysis entails a moral reduction, fixing (often implicitly) particular moral choices. Yet in this case the act of replication, and the broader set of evaluative practices of which it is a part, serve to (re)multiply the moralities at play. I ultimately argue that regimes of replication and evaluation both reduce and multiply the moralities at work in global health. 


John Harrington (Cardiff University)

'Sovereignty, Discipline and the Nation State in Global Health Governance'

While the complexity of transnational and international governance in global health is well mapped, less attention has been paid to the role of the nation state. In this paper I sketch an approach to this question through a critical reading of Lawrence Gostin’s Global Health Law (2014), drawing on work in governmentality studies and Third World Approaches to International Law. Gostin models the potential positive contribution of national institutions in fairly instrumental terms. Parliaments and ministries contribute, he suggests, by effectively implementing treaty obligations and pursuing health goals more or less mechanically. Viewed negatively, national authorities and individual leaders may present obstacles to the achievement of, what he labels as 'global health with justice'. Corruption, lack of transparency and the stymying of civil society are sources of this distrust. Though ostensibly universal, the examples given and idiom used suggest that the ‘states’ envisaged here are in fact those of the global south. The latter are problematized in terms of the Post-Washington consensus: weak rule of law, principal-agent problems and neo-patrimonial accumulation. Their independent action within and against the global health regime is marked as a selfish pursuit of national interests in realist fashion, for example Indonesia’s assertion of viral sovereignty in 2006 or the official Chinese response to SARS in 2003. Techniques of accountability, incentivization and legal responsibility, often combined, are proposed for disciplining unreliable states. ‘Country-ownership’ of global health governance mobilizes self-discipline (‘the conduct of conduct’) as opposed to any strong reassertion of national autonomy. It is worth exploring the extent to which these proposals reproduce tactics of global economic governance since the 1990s, and extend the emplacement of independent states in the post-colonial international order. 


Sophie Hermanns (The German Society for International Cooperation, GIZ)

'Running the numbers on doing good: politics of evidence and mass deworming for children'

This paper will look at why a particular type of evidence – quantitative data on (cost-) effectiveness, produced by randomized controlled trials (RCTs) – persuaded a particular set of philanthropic actors to support mass drug administration for children to fight tropical parasitic diseases. Understanding their distinctive moral framework and the way it changed parasitic disease control requires understanding other moral arguments that have been made about parasitic diseases and data from RCTs. The case of deworming offers insights into the history of the use of evidence in global health. Moreover, it illustrates how different schools of thought within the global health landscape assign moral worth to specific approaches and how “moralising” interventions shapes policy and politics. 

 

Freya Jephcott (University of Cambridge)

'Abstractions of urgency in outbreak responses'

The bioethicist Peter Singer introduces the notion of “effective altruism” with the story of a man and two drowning children; one in a shallow lake directly in front of the man and the other in a lake on the other side of the world. Singer proposes that the man ought to overcome his emotive impulses, and convenience, and recognise his equivalent moral obligations to assist both children. While I agree that we must overcome abstractions of urgency resulting from perceived proximity and commonalities - notably racial biases - so that those with an ability to act can live up to their responsibility anywhere in the world, I do not agree that the moral obligations to the two children are equivalent, nor that they should be made out as such in the name of moral efficacy. Indeed, this false equivalency, and the denial of the role of an intimate ethics of care in generating meaningful intervention, are responsible for a wealth of unchecked inefficiencies within contemporary outbreak responses. 

Drawing upon a four-year ethnographic study of an outbreak response in the Brong-Ahafo Region of Ghana and my experiences working as a field epidemiologist on a number of other outbreak responses, this paper traces public health professionals’ varying relationships with the suffering of their subjects and the consequences for the trajectories of outbreak responses. Rather than attempting to generate any general rules relating effective action and proximity, race, or any other form of intimacy, empathy and identification, this paper looks to assert the presence, complexity and significance of the intimate ethics of care in outbreak responses. 


Angeliki Kerasidou (University of Oxford)

'The role of trust in global health research collaborations'

It is often argued that trust is required to underpin and support good and ethical collaborations in global health research. However, very few have looked at what are the conditions and requirements of trust relationship. Global health research provides a particularly interesting context in which the role of trust in collaboration can be examined due to the particular dynamics between the collaborating partners.

In this paper I will defend two claims. My first claim is that given the particular characteristics of collaboration and demands of trust relationships, reliance is a better relational mode for a successful collaboration. My second claim is that in non-ideal collaborations, where there is power imbalance between the collaborating members, such as HIC-LMIC collaborations that are common in global health research, reliance comes short. In such situations trust becomes necessary. I will draw examples from the global health research context to illustrate and defend this claim. I will conclude that the promotion of good collaborations requires addressing both the power imbalance between partners and also the building of moral character of researchers involved in collaborative research.


Guillaume Lachenal (Université Paris Diderot) and Pierre-Marie David (University of Montreal) 

'When global health does not care too much. The “Ebola” epidemic of Ngoyla (Cameroon, 1997-1998) and the moral issue of global health casualness'

The ethical and moral problematization of global health has been dominated by the discussion of triage – understood as the necessary operation that hierarchize the lives that matter (to be cared for and ultimately saved) and the lives that may wait (e.g. Redfield, Nguyen, Fassin). In this paper we suggest that a moral gray zone also deserve attention, that is not reducible to the ethical calculations of the care/neglect or attend/disregard alternative. This zone is the domain of casualness, offhandedness or désinvolture, which can be defined provisionally as the moral and aesthetic positions by which one does not care to much (but still, cares), and actively limits its own (emotional and practical) commitment to a situation – by putting spatial and temporal frontiers to it, and by acting nonchalantly. To illustrate this further, we will present the results of a recent ethnographic research on the traces of a global health intervention in a very remote region of the Cameroon-Congo borderland. In 1997-1998 an epidemic of severe illness, associated with fever and bloody diarrhea, was signalled in the small town of Ngoyla, killing close to 100 people. Red alert: the epidemic was locally called “Ebola”, while the closest doctor (and derelict hospital) was more that a day of motorbike away.  A rescue mission was organized by the WHO and the Pasteur Institute in march 1998, which led to the elucidation of the cause of the epidemic (an association of highly pathogenic E. Coli and shigella), to the distribution of efficient antibiotics, to an hour-by-hour report of heroic medical action and to a series of publication in high-impact factor journals. Our ethnography was an assessment and a parody of this global health success story. Returning on the site of the epidemic 20 years later, and tracking through Cameroon and France all of the actors of the rescue mission, we came back with alternative narratives and chronologies of the epidemic and of the medico-scientific response to it. They suggest a critical moral anthropology of global health as just “passing”, as arriving always too late, and as not calling back.


John Manton (London School of Hygiene and Tropical Medicine)

'“The smaller part of the country is in Government hands”: global health, national planning, and territorial turmoil in the postcolonial 1960s and 1970s.'

Alongside macro-political processes which produced new global health optics, engendered novel developmental and planning logics at national level, and unleashed a series of postcolonial conflicts in Africa and Southeast Asia, there arose through the late 1960s and 1970s a specific set of humanitarian strategies and expertise in identifying and managing the onerous health needs of refugee, resource-poor, and nutrient-eficient populations. This paper considers health and humanitarian emergency planning responses to conflict and state failure in Nigeria, Laos and Cambodia, providing a historical reflection on the genealogy of humanitarian ethics, in the era of mass broadcast media and networked information.

At a period when health systems thinking became increasingly streamlined and refined, in Europe and North America, as well as in Africa, Asia and Latin America, the examples of health administration, epidemiology and disease control in 1960s and 1970s Laos and Cambodia, and humanitarian logics of triage in civil war torn Eastern Nigeria in the late 1960s highlight components of health planning and resource management that proved alternately and differentially vulnerable and resilient in the face of conflict and state failure. As part of a larger consideration of the relation between development and health planning, this paper maps out the moral stakes invoked as models of development in health fought to retain traction and legitimacy, while entangled in and undermined by gathering political turmoil and human tragedy.

 

Raphael Oidtmann (University of Mannheim)

'Between Morality and Security – Explaining the UN Security Council’s Response to the 2014 Ebola Outbreak '

The 2014 West African Ebola virus epidemic constituted a thitherto singular challenge to the regime of global public health. Besides the World Health Organization (WHO) designating the outbreak as a public health emergency of international concern in July 2014, the United Nations Security Council (UNSC) declared in September 2014 that the epidemic would also pose a threat to international peace and security pursuant to Art 39 UN Charter. Simultaneously, it called upon UN member states to facilitate additional resources so as to effectively fight the outbreak, including military and other emergency capabilities. Resolution 2177 was hence unprecedented in that the UNSC – for the first time in the history of post- 1945 international law – characterized a disease to be effectively capable of not only causing massive human suffering, but also to have a considerable potential of destabilizing a complete region to the extent of constituting a threat to international peace and security. 

The question, however, remains what triggered the UN Security Council to enter unchartered territory by effectively expanding the legal definition of a ‘threat to international peace and security’? On the one hand, one could argue that the Security Council’s determination was directed at fighting an indiscriminately killing pathogenic aggressor and that it therefore based its action on a moral (and possibly legal) obligation to assist and relief member states in need of large-scale multilateral support, including the deployment of specialized (military) capabilities. On the other hand, it could be held that the UN Security Council (and its constituent members) not acted out of a sense of moral obligation towards those countries in need, but instead based their action on considerations of self-preservation and selfishness, i.e. aimed at ‘intervening’ at a relatively early stage so as to minimize potential domestic ramifications caused by a contingent spread of the epidemic. 

The proposed contribution thus seeks to retrace the narratives employed within the UN Security Council by analysing correspondent statements of its member states as well as relevant meeting minutes in order to distil possible lines of argumentation while trying to highlight underlying motives for correlated action. 

 

Ferdinand Moyi Okwaro (University of Oslo)

'Scientific lives, ethos and morality in transnational medical research collaborations in Africa'

Global health initiatives emphasise the role of scientific capacity in addressing pressing health problems.  Consequently, global health funders make capacity building compulsory for research conducted in the lower and middle income countries. This paper examines the processes and practices of making scientific capacities in East Africa through the analysis of biographies of scientists in the era of collaborations. Global health collaborations between unequal partners are often, owed to scarce resources, the only means of forging scientific careers in the ‘Global South’. My analysis of African global health scientists’ scientific biographies shows that - contrary to familiar imaginaries of independent, truth-focused ‘scientific lives ‘ - African scientists are often not masters of their scientific lives. As a result, they often work on very diverse subjects – more or les distant from their training and personal interest – and rarely become heads of substantial, independent laboratories and research groups that push the boundaries of a well-defined scientific frontier. This paper examines the moralities or moral calculations that underpin these ‘scientist-making’ endeavours and practices, as well as the effect that these particular forms of scientific lives have on scientific ethos and scientists’ moral deliberations. In circumstances where career choices often are determined by the scientific concerns of dominant ‘Northern’ global health institutions and funders, rather than individual African scientists’ passions and desires for particular kinds of knowledge and truths – what effect does this have on scientists, ethos, and professional morality?  How are different moral commitments (e.g.  towards science, towards colleagues and students, towards larger collectives like the nation or the continent, and towards family and children) negotiated? How is the morality of practical and economic choices squared with the highly moralistic narratives of global health programmes and the universalist ethics of scientific truth-making and academic freedom?   These and other questions are examined through an in depth analysis of biographical interviews, CVs and scientific outputs of research scientists working in East African universities in the global health era, that were collected as part of an ethnographic study of research collaborations at major East African universities.          


Sung-Joon Park (University of Halle 1)

'More than being touched:  ethical conceptions of love and unmoralizing research on Ebola epidemics'

Touching—the feeling of surfaces, skin, bodies, fluids—and not being touched as a human by others produced the most moving stories about the disastrous effects of Ebola epidemics. As stories they become touching experiences of ‘the ethical’ of those who could not help ‘doing something’ and volunteered in the response, as Stacey Leigh Pigg aptly captures the morality of global health humanitarianism. Anthropological encounters are probably more inclined to keep a professional distance towards such arresting stories with the aim to strengthen a form of critique that does not simply denunciates the injustice at work in situations of facing death or struggling to survive but considers more broadly those structural conditions of poverty and inequalities through which, both, epidemics and global health interventions are made possible.

In this paper I use this foil to contrast different approaches to the ethical and reflect on the ethics of care in times of Ebola. This inquiry draws on a collaborative research project in which colleagues from Sierra Leone, Uganda, Germany and myself investigate the production of ‘Trust in Medicine after EVD epidemics’ in Sierra Leone, Uganda, and Ghana. Here, I focus on health workers’ caring experiences to propose an anthropology of ethics that explores the possibilities of freedom, instead of unmasking the conditions of unfreedom. To this end I draw on a form of social criticism, which following Nietzsche’s genealogical analysis shows how moral values become real through practices of moralizations. What interests me most in Nietzsche’s genealogical critique is the ethical concept of love proffered by his notion of the will. An ethical conception of love is useful to understand caring as an activity one cannot but help willing to do. This notion of love can be made productive for an unmoralizing anthropology, which charts how altruistic values become real, how altruistic judgments are made in the form of touching yet moralizing stories. And most importantly, as I wish to show, an ethical concept of love offers an alternative perspective on the relationship between care and individual autonomy that exhausts predominant theories of utilitarianism underlying contemporary development toward an ‘effective altruism’.


Ruth Jane Prince (University of Oslo)

'Universal Health Coverage: Social justice, technical pragmatism, or neoliberal cooptation?'

Inequity and the widening gap between public and privatized health-care are major challenges of our time. There is an urgent need for a rethinking of this model of health care and the kind of society it creates and upholds. The WHO’s pursuit of Universal Health Coverage appears to take up this challenge in its championing, at the level of rhetoric at least, values of social justice, the social collective and the public good. Defined as ensuring that everyone can access affordable, essential and quality health care (WHO 2010), UHC has been described by the WHO’s director as “the single most powerful concept public health has to offer” (Chan 2012) and is included under the Sustainable Development Goals. 

While UHC reforms are being experimented with across the globe, moves towards UHC are particularly important in Africa given the recent history of public health on the continent. Here, the past three decades have seen fundamental shifts in the relations between the public and the private in health-care financing and provision. Structural adjustment policies undermined the role of the state and its responsibility for public health and encouraged market-based solutions to health-care, while ‘cost-sharing’ policies pushed the burden of health-care costs onto the poor. While state protection and care for the public’s health has always been a fragile endeavor in many African countries, the neoliberal turn led to a hollowing out of state capacity, which was only partially filled by NGOs, transnational groups, humanitarian organizations, and privatization. Global health initiatives of the past decade vastly increased resources for particular diseases but have contributed to fragmentation, doing little to address the chronic neglect of national healthcare systems and citizens’ lack of trust in them. The recent Ebola crisis has thrown a spotlight onto these issues while exposing the limitations of a humanitarian, NGO-dominated response.

In this context, the move towards UHC appears to imagine a different kind of society, as it appears to represent the reinsertion of the state, the social collective and arguments of social justice into questions of health care access and provision. Indeed, the move towards UHC appears to push against ‘the death of the social’ that is so often decried in neoliberalism (Rose 1996). Here it shares similarities with recent interventions into social protection in the Global South, where countries like South Africa, Kenya, and Brazil are experimenting with “new kinds of welfare systems” (Ferguson 2015). Like Cash Transfer Schemes or Basic Income Grants, UHC is framed as a move towards new forms of redistribution in a world where inequality is increasing. However, like these experiments with welfare, UHC can be interpreted as a ‘sticking plaster’ solution that underwrites the social costs of late capitalism in its cautious pursuit of technical reform rather than societal transformation. Critics argue that UHC is the ‘trojan horse’ of neoliberal policies as it risks shifting the emphasis from public provision of services to merely universal access (Qadeer 2013, Birn 2016). 

In this presentation I will discuss these contradictions. Should we regard UHC as a return to mid-20th century ambitions regarding social justice and the social collective, or is it another technical intervention clothed in inspiring political rhetoric, pursuing technical solutions to social problems? Does UHC re-orientate politics and policy concerning public health towards values of solidarity, obligation and the public good? Or are moves towards UHC another example of the ‘cooptation’ (Birn 2016) of progressive moves by neoliberal agendas? Finally, what can ethnographic research offer in answer to these questions?

 

Peter Redfield (University of North Carolina)

'How Fungible is Human Life?'

The seamless magic of money, its essential power to measure and circulate, depends in large part on not worrying about internal equivalences. The capacity of one unit to substitute for another — without concern for specificity — permits interchange without friction or problems of translation. In this paper I will consider this attribute of fungibility relative to humanitarianism and global health, and ethically and politically charged efforts to “save lives”. To what extent, can human life serve as a fungible currency? The question is far from abstract, as measures of life play an increasingly central role in international moral discourse and justification for an impressive array of actions. Key metrics in global health, like the Disability Adjusted Life Year (DALY), rest squarely on assumed equivalences. NGO fundraising brochures, along with extensions of consequentialist ethics, suggest easy conversions between money and lives, and that more of the latter is always better (most strikingly in the movement for effective altruism). On the other hand, in both personal experience and most forms of cultural life, human existence is inherently biographical and associated with particular qualities, and thus not exchangeable at all. A sister is not the same as a second cousin, nor an ancestor nor a neighbor, let alone a stranger. Even if all might represent abstract unit of living, they remain distinct in relational position, emotional and psychological import. If anthropology’s early obsession with kinship tells us anything, it would be that many peoples have defined their essential being through highly specific relations. Non-consequentialist ethical systems, not to mention most religious traditions, remain attached to such specific qualities of being that resist easy liquidity or substitution. A logic of fungible humanity may thus not always translate smoothly in practice once beyond citadels of secular reason. Nor, I suggest, are they necessarily applied equally, given that life prospects, and ethical valuation, vary greatly across social stratification. A more revealing phrasing, then, might be to ask under what circumstances are lives treated as equivalent? And whose lives are designated as being interchangeable and whose are not? 

 

Sophie Roborgh (University of Cambridge)

'Local medical humanitarianism: the merits of a social movement theory approach'

This paper explores the complex position of local health workers at times of political unrest or conflict. It draws on social movement theory, a well-honed framework for conceptualising collective action in contention studies, but a novel approach in the study of local medical humanitarian initiatives. The paper consists of two parts. The first part focuses on the propriety of social movement theory as a framework of analysis for engagement with medical volunteers. It shows how the medical profession contains characteristics that make it highly suitable as a basis for the creation of a 'collective participation identity' driving medical voluntarism. In the second part of the paper, I illustrate the merits of this approach, by presenting the findings of a systematic analysis into the evolving interpretation of medical neutrality among Egyptian health workers, who provided medical assistance to injured protesters in the Egyptian uprising (2011-2013). In-depth interviews with 24 medical and non-medical volunteers on their perception of medical neutrality were matched with their mobilization and participation history. This allowed for an exploration of the extent towards which political considerations influenced their voluntary medical engagement. I firstly show that revolutionary political considerations played a central role in the health workers' mobilization into medical networks active in the protests, as well as in the interpretation of their medical and non-medical activities, and adherence to humanitarian principles. Secondly, I argue that the interpretation of medical neutrality among Egyptian physicians evolved significantly over time, culminating in the formation of a special category of medical volunteer, the mīdānī physician.


Emmanuelle Roth (University of Cambridge)

'"The truth is sometimes better left unsaid:: (im)moralities of post-Ebola viral research in Guinea'

Like the HIV/AIDS epidemic in the 2000s, the 2014–2016 Ebola outbreak has paved the way for a new 'scramble for Africa' in the field of global health science (Crane 2013). In the Forest region of Guinea, which reported the index case, international aid and research consortiums were quickly mounted in the aftermath to support infectious disease surveillance and research into the long-term immunology of the Ebola virus. Collecting data means gaining access to the biological fluids of survivors and Forest people, which is itself conditioned upon the permanence of global inequalities. Indeed, in an impoverished setting with resource-poor health infrastructures, Ebola survivors are seduced by the promise of free healthcare, financial compensation and access to foreign organisations. 

Taking advantage of inequalities to perform global health research has been criticized by anthropological scholarship as leading to 'ethical variability,' whereby ethical codes apply differently to vulnerable populations (Petryna 2005). This analysis underlies an accusation of transnational medical research as 'immoral.' However, this framework, focused on the moral limits of bioethics, does little to illuminate the complex moral negotiations locally at play in global health research.

Using data from my PhD research, I ask: how do local moralities bypass the denunciation of 'ethical variability' and facilitate the day-to-day workings of global health? In the aftermath of the Ebola outbreak, blood-sampling activities in Forest Guinea are entirely planned and carried out by Guinean scientists and health practitioners. This freedom of action enables them to enact their own moral rules as they juggle the competing requirements of care-giving, science-making and health surveillance. I discuss how a local ethos of secrecy smoothes the way for enlisting the cooperation of mistrustful populations in donating their bodily fluids. [It expresses itself through outright lies about the purpose of blood collection or the infectious risk represented by Ebola survivors.] I argue that local (im)moralities, if they may openly contradict research ethics, have the paradoxical potential of advancing global health objectives


Margaret Sleebom-Faulkner (University of Sussex)

'Non-Invasive Prenatal Testing (NIPT) - an exploration of morality in the context of biomedicalisation'

The introduction of NIPT has radically increased the accuracy and safety determining chromosomal conditions. Before NIPT was introduced there existed not only worries about safety, but also ethical concerns about the extended ability to prevent the birth of people with disabilities. These concerns differed not only among Asian and European societies, but also within Europe. I shall argue that the differences among national policies and moral attitudes regarding NIPT are increasingly disappearing, partly under the influence of ‘effective altruism’. Effective altruism is a movement that aims to identify the actions that achieve the most positive effects to enable rational choice in terms of the values of the individuals concerned, which has detrimental consequences for minority views and takes little account of cultural context. In the case of NIPT, however, I maintain that economic costs and transnational economic organisations drive this development, rather than rational considerations envisaged by effective altruism. I explain this trend politically, not by referring to a disappearance of ethical conflicts or differences, as they clearly do, but because politicians find it increasingly difficult to formulate ‘ethical guidelines’ in terms of religious and other cultural moralities. As a result, the different moralities do not receive the institutional support and attention necessary to discuss the life values involved in decisions around birth and its prevention.


Jenny Thornton (University of Cambridge)

'Ownership, authorship and challenging dependency in Rwandan health research partnerships'

In Rwanda, the dedication of researchers to disrupt implicit knowledge hierarchies in global health research partnerships does not stop when hierarchies have flattened but seeks to invert structures of inequality in their own favour. Through empirical findings from interviews with researchers in Rwanda and the UK, this paper will examine how global health partnerships with Rwandan partners intersect with the national drive towards ownership, away from dependency, and around equality.


Noemi Tousignant (University College London)

'New Scales of the Moral: The Postcolonial Global and Health Research at the WHO in the 1970s'

Terms and slogans such as NTDs and the “10/90 gap” both assume and promote awareness of an unequal distribution of the potential power of medical research to improve lives. This paper tracks how medical research came to be mapped as an unevenly distributed global resource, and discusses the forms of moral valuation and anticipation – or rather, perhaps, of speculation – this entailed. My focus is on early 1970s discussions at the WHO that led to the creation of its longstanding and well-regarded TDR (Tropical Disease Research) program. I describe the novel forms of “moral mapping” this program grew out of, as well as the alternative pathways – and their distinctive understandings of how research might generate value, power and futures – that were bypassed. I particularly emphasize how TDR and its alternatives proposed new ways of “collaborating” in transnational medical research. 


Dora Vargha (University of Exeter)

'The Cold War morality of public health: a socialist viewpoint'

In the early Cold War era, global health problems were situated in a complex web of collaboration, animosity, suspicion, scientific exchange and ideological debates. Public health officials and virologists in Eastern European countries often remarked on the superiority of socialist health, contrasting it with the immorality of market capitalism that continuously puts the health of citizens in peril for the sake of financial gain. Their American counterparts in turn greeted scientific results with scepticism and often considered socialist subjects to be oppressed into complying with state directives in science and medicine. The morals of public health in this Cold War ideological clash played an important role in how the respective sides approached their interventions into decolonising world. The concepts and practices underpinning global health problems, such as polio control in the 1950s demonstrate the ways in which both sides drew on moral obligations, rights and entitlement – with differing results. Through the case of polio vaccination campaigns in the late 1950s in Eastern Europe, this paper aims to situate socialist global health by untangling socialist morality and by investigating its intersections with the West. 


Tennie Videler (University of Cambridge)

'Pictures of Ageing in Uganda- An Exploration of Aspects of Morality in an International Interdisciplinary Project'

Our interdisciplinary pilot project is undertaken by an equitable partnership between demographers, medical researchers, public health researchers and practising artists, from Uganda and the UK. It investigates ageing in a semi-rural/ peri-urban district in Uganda, exploring how phenotype and cognitive function, living circumstances and responsibilities are related to age, including to (self) perceived age. The project is funded by the UK’s Global Challenges Research Fund, in this case through a MRC –AHRC call. This paper reports on the challenges of setting up an equitable partnership across different countries, races, professional backgrounds, disciplines and cultures. This required us to have a frank discussion about any misgivings and potential drawbacks of the collaboration we had embarked on, including actual or perceived inequality between British and Ugandan researchers and different disciplines. We report on we enabled these worries to be expressed, and how we worked together on mitigation approaches.


Claire Wendland (University of Wisconsin-Madison)

'Gendered projects in global health: maternity care as a laboratory for competing moralities'

Just beneath the surface of ostensibly technical global health surveillance and intervention projects lie competing moralities. These moralities—feminist or patriarchal, gerontocratic or egalitarian, calling for ufulu or for ubuntu—outline what it means to be a good man or a good woman. They are revealed in powerful narratives of blame and denunciation. They are also visible in the impositions (and failures) of new policies. Drawing on published scholarship and on ethnographic research on maternal health projects in Malawi, I show how “male involvement” policies call forth competing ideas about what it means to be a moral man. These and other initiatives risk striking a “patriarchal bargain”: male leadership and responsibility are reinforced, sometimes at substantial cost to the women who are ostensibly being protected.


Iain Wilkinson (University of Kent)

'The Sociology of Humanitarianism and Humanitarian Sociology'

A ‘humanitarian revolution’ took place at the foundations of modernity. This was recognised in early social science, but through most of twentieth century the character and conditions of modern humanitarianism were rarely addressed as serious matters for scholarly inquiry. By contrast, the social science of the twenty-first is characterised by a renewed and pronounced concern to set the character and practice of modern humanitarianism as matters for critical debate. The cultural values, moral purpose and social enactment of modern humanitarianism are being revisited as issues that operate at the frontiers of sociological and anthropological inquiries into the bounds of political aspiration and the possible futures that lies before us. In recent years I have sought to develop an explicitly humanitarian sociology committed to addressing problems of ‘social suffering’ and to advancing a ‘pedagogy of caregiving’. In this presentation provide a brief review of this project and outline agendas for further inquiry, critical debate and praxis.


James Wintrup (University of Cambridge)

'Suffering and faithfulness: Christian missionary morality in global health'

Christian medical missionaries have tended to feature, in recent anthropological work, as the colonial-era predecessors of present-day humanitarian organisations (Fassin 2013; Klassen 2011; Redfield 2013); at the same time, the most well-known ethnographies of medical missionaries are historical studies (e.g. Comaroff and Comaroff 1997; Hunt 1999). While this can give the impression that Christian medical missionaries have disappeared from the contemporary landscape, they continue to play a significant role in humanitarian and global health projects throughout the world. Drawing on long-term fieldwork at a hospital in rural Zambia, this paper considers how missionaries found moral meanings in their encounters with Zambian patients: from seeing suffering and the endurance of pain as evidence of “faithfulness”, to identifying the use of local healers (bang’anga) as a form of “sinfulness”. Such observations offer a way of highlighting what is distinctive about the moral visions of these Christian medical missionaries in comparison to other global health volunteers today.  


Emily Yates-Doerr (University of Amsterdam / Oregon State University)

'Strategic reductionism: Complexity, inequality, and the challenge of doing good science in global health'

During an ethnographic study of a maternal health intervention in Guatemala, global health scientists spoke frequently of the strategic reductionism needed to make health policy effective and alleviate social inequality. That 'science is political' was not, for these scientists, a point of critique but a point of departure. They acknowledged that living and dying were far too complex to be captured by metrics of mortality or stunting-- but held that this truth of complexity did not make for effective policies. For them, what reductionism may lose in accuracy, it makes up for in efficacy, such that reductionism becomes a more ethical mode of doing science -- and doing good -- than its alternatives. In this paper, I consider the moral argument for reductionism alongside an anthropological inclination to "stay with the trouble." I draw upon fieldwork with mothers, health workers, and various people in-between, to inquire as to who benefits and who suffers from these differing intellectual strategies. The paper aims to shift the premise of the debate away from reductionism/complexity, instead asking: which reductions bring about which kinds of social change? It further opens up the question: given competing moral logics, which, and whose, techniques of politics are allowed to matter?