- Global Health: Why Cultural Perceptions, Social Representations, and Biopolitics Matter
Comprehending and addressing the manifold causes and incarnations of [End Page 234] human suffering cannot be the domain of a single discipline or set of expertise. Human rights law and activism entwine and intersect with health and humanitarian concerns: the universal right to health and well-being has become a fundamental claim of international organizations, activists and engaged academics; and human rights and social justice-oriented public health agendas increasingly overlap in the NGO world. Mark Nichter's far-reaching yet concise book, Global Health: Why Cultural Perceptions, Social Representations, and Biopolitics Matter, is a contribution to the social science of public health that should also prove accessible, useful, and provocative to human rights workers.
Originally commissioned by UNICEFUNDP-World Bank-WHO to explain how social science has contributed to "cultural understandings" of "tropical diseases," Nichter instead treats biomedicine, public health, and international development themselves as cultural entities worthy of analysis. His explanations of global health issues challenge the "cultural barriers" models prevalent in public health, focusing on how health practitioners and policymakers shape the politics of global health through discourse and representation. In particular he explicitly disputes the notion of "tropical disease" itself, revealing it to be a colonial artifact that obscures the political and social contexts of diseases. Nichter argues for global health practices that foreground larger contextual, social, and political realities, and, with that objective in mind, outlines several potential modes of collaboration between medical anthropologists and practitioners. Global Health thus contributes to engage medical anthropology and interdisciplinary approaches to global health, as well as efforts by critical anthropologists to integrate research on local culture and global governance.
Global Health is divided into three sections. The first focuses on interactions between local (non-Western) perceptions of infectious disease and public health initiatives. Here Nichter highlights the importance of understanding ethno medicine, ethno physiology, indigenous, and hybrid models of illness transmission and categorization, and perceptions of pharmaceuticals. He takes to task public health's tendency to define nonbiomedical ideas as "cultural barriers" that medical anthropologists might help public health workers to "overcome." In the second section, Nichter elucidates the complex interplay of NGOs, states, and local politics, focusing on rhetoric, representation, and discourse in the fields of health and development policy. With admirable succinctness he demonstrates how prevailing public health and development rhetoric defines problems and populations in specific, strategic ways in order to frame and justify particular sorts of interventions. The third and final section of the book suggests areas of further research and collaboration between medical anthropology and other fields, in particular social epidemiology. Nichter outlines the effects of neoliberal reform and structural adjustment, unequal resource distribution, and NGO and government competition on health and health agendas. Using one interpretation of Foucault's concept of biopower as a framework, Nichter suggests strategies of governance and administration that address contemporary global health concerns such as biosecurity from emerging diseases, and health as a human right.
Each of the three sections of Global Health offers something germane to scholars and practitioners of human rights. Nichter's critiques of public health's cultural barrier models in the first section of the book are useful in reflecting on defenses of human rights [End Page 235] violations as cultural norms. Activists and lawyers might apply similar critiques to assess whether and how cultural defenses of human rights abuses tend toward victim-blaming, overlook larger structural forces, and fail to account for mutable ideas and values.
In the second section of the book, Nichter offers a compelling and concise description of how "development-speak," buzzwords, and strategically-manipulated statistics shape understandings of global health issues and influence attempts to solve global health problems. Nichter's observations should be of great interest to those who seek to understand how discourse, representations, and artful "packaging" frame, publicize, and potentially restrict understandings of human rights concerns and rights-oriented interventions.
Human rights practitioners should also find value in the book's final section, in which Nichter outlines how overlapping...