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Governing How We Care

Contesting Community and Defining Difference in U.S. Public Health Programs

Susan J. Shaw

Publication Year: 2012

As local governments and organizations assume more responsibility for ensuring the public health, identity politics play an increasing yet largely unexamined role in public and policy attitudes toward local problems. In Governing How We Care, medical anthropologist Susan Shaw examines the relationship between government and citizens using case studies of needle exchange and Welfare-to-Work programs to illustrate the meanings of cultural difference, ethnicity, and inequality in health care.

Drawing on ethnographic research conducted over six years in a small New England city, Shaw presents critical perspectives on public health intervention efforts. She looks at online developments in health care and makes important correlations between poverty and health care in the urban United States. Shaw also highlights the new concepts of community and forms of identity that emerge in our efforts to provide effective health care. Governing How We Care shows how government-sponsored community health and health care programs operate in an age of neoliberalism.

Published by: Temple University Press

Title Page, Copyright, Dedication

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pp. ix-x

I extend my sincere gratitude to the Wenner-Gren Foundation for Anthropological Research for its support of this work with the Hunt Postdoctoral Fellowship (2008–2009). Some of the research presented here was funded by the National Institute on Drug Abuse (R01 DA12569, Merrill Singer, Principal Investigator...

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pp. 1-17

When I was an ethnographer for a federally funded study on HIV risk and needle use, I met Dave Wood, a middle-aged, slightly built African American heroin user who spent many of his days circulating through a neighborhood shopping plaza where people would arrive to get their morning coffee at McDonald’s, pick up a loaf of bread at Sav-A-Lot...

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1. The Governmentality of Community Health

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pp. 18-40

Governmentality, as defined first by Michel Foucault (1991) and elaborated by subsequent social theorists and anthropologists (e.g., Inda 2005; Ong and Collier 2005), explores the knowledge formations and sets of practices that together work to construct and govern populations and subjects...

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Part I: Technologies of Citizenship and Difference

Long concerned with urban, low-income, and marginalized populations, community health workers and scholars use a range of strategies to highlight ethnic and racial health disparities and engage diverse groups in programs to improve health. These strategies and programs respond...

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2. Community Health Advocates: The Professionalization of “Like Helping Like”

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pp. 43-71

“Sometimes you just have to look the other way,” insisted Ron Washington to the room full of people attending a six-week training for new Community Health Advocates (CHAs). Numbering about twenty, the future outreach workers would go doorto- door in underserved neighborhoods...

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3. Neoliberalism at Work: Contemporary Scenarios of Governmental Reforms in Public Health and Social Work

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pp. 72-102

Seven months into my fieldwork in 1998, the CHA program began to receive federal welfare reform monies for operating support. As the health center began to take part in the nationwide reallocation of resources aimed at moving welfare recipients into the “world of work,” this new phase brought many changes...

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4. Technologies of Culturally Appropriate Health Care

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pp. 103-132

In the mid-1990s in Thornton, Massachusetts, activists and community health leaders worked to establish what would become Thornton Community Health Center (TCHC) as part of a struggle to bring quality, culturally appropriate health care to low-income and minority patients...

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Part II: Technologies of Prevention and Boundaries of Citizenship: Drug Use, Research, and Public Health

Terms such as community, culture, and difference become disaggregated into collections of practices and beliefs as we examine their multiple meanings in community health. Subject positions for health care workers are shaped by diverse forces, including the political...

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5. “I Always Use Bleach”: The Production and Circulation of Risk and Norms in Drug Research

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pp. 135-155

“I always use bleach—I never share my needles.” An injection drug user (IDU) speaking to a researcher knows this is the appropriate thing to say when she is asked, “Do you [how often do you, why do you] share your needles?” In ethnographic research I conducted on HIV risk among people who inject drugs in Thornton, participants repeated variations on these themes...

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6. Syringe Exchange as a Practice of Governing

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pp. 156-183

Despite widespread evidence of their effectiveness in reducing the spread of HIV among injection drug users (IDUs), syringe exchange programs (SEPs), which provide sterile syringes to IDUs in return for used ones, remain controversial. As perhaps the most widely practiced innovation of the harm reduction movement, SEPs act on users’ actions by providing...

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pp. 184-190

After college, I spent some time as an activist with the AIDS and women’s health movements in New York City. I remember attending endless strategy sessions in advance of protest actions, trying to come up with our demands...


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pp. 191-210


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pp. 211-214

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About the Author

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p. 215-215

Susan J. Shaw is Associate Professor in the School of Anthropology at the University of Arizona...

E-ISBN-13: 9781439906842
Print-ISBN-13: 9781439906835

Page Count: 214
Illustrations: 6
Publication Year: 2012