Wednesday 9th September
12:00-13:30, Jubilee Lecture Theatre
The Ebola moment: Mobilising engaged anthropology for global health
Melissa Leach (Sussex University, Institute of Development Studies)
If the Ebola epidemic of 2014-15 has marked a defining moment for global health, highlighting inescapably the threats unleashed by dynamic bio-socialities in interconnected and unequal worlds, it has also been a defining moment for anthropology’s position and contribution. Drawing on deeper wells of personal connection, knowledge and moral sensibility, anthropologists from the affected region and across the world came together and engaged with local, national and international responses in unprecedented ways. While anthropology on the global health frontlines is nothing new, this has been distinct for its rapidity, scale, networks, and legitimacy and voice - including at the highest levels. Speaking for many, with due humility, I will illustrate how these anthropological engagements have unfolded in understanding, learning and action around disease transmission and mobility; care for the sick and the dead; contextualising resistance; health systems and governance, and pharmaceutical and vaccine trials. I will suggest that together, these interactions constitute and signal the emergence of a mode of engaged anthropology that transgresses tired distinctions and productively integrates academic/theoretical and policy/practice producers and audiences; instrumental/solution-focused and critical/reflexive purposes, and immediate/rapid and long/deep timeframes. Does what we have collectively lived and done this year offer a model for the future in a world of growing global health threats?
What it means to involve and mobilize communities in fighting against ebola in Guinea
Slyvain Faye (Faculty of Arts and Social Sciences (FLSH) UCAD Senegal)
Community participation in the struggle against Ebola is much discussed but not yet fully accepted in practice, either by those who establish polices or by those who are their targets. Contrasting experiences of Guinea Conakry and Mali show the importance to partners of recognizing local expertise.
When people are considered to have the ability to find answers to the problem of Ebola and contribute to the fight, as happened in Mali, their collective mobilizations are more positive and facilitate interactions with medical teams. In contrast, in Guinea Conakry, communal violence took place. These events were more an expression of criticism of government denial and lack of recognition of local perspectives than they were reluctance on the part of an ignorant community to accept “good health”.
If the Village Vigilance Committees (VVCs) that are proclaimed as community leadership do not put an end to that community’s distrust, it is because they refer primarily to “biomedical” sovereignty as the source of their authority. Yet these same communities give proof of their expertise by initiating responses for their own protection, responses that are not adequately recognized (eg. local Vigilance committees and autarkic practices). Violence is also a demonstration of popular criticism of local political authorities, a criticism extending beyond health; including tax breaks granted to large foreign companies extracting natural resources or exploiting the local peasantry. Events also illustrate the questioning of established outsourcing of public tasks by governments and express the demand for better recognition of people’s own participation in public action.
Thursday 10th September
Jubilee Lecture Theatre
Engaged Medical Anthropology: The Lure and Perils of Global Health
Brigit Obrist (Institute of Social Anthropology, University of Basel)
The broad field of global health offers medical anthropologists many opportunities for an engagement with crucial issues in our rapidly changing world. Health problems in Africa, Asia and Latin America are no longer peripheral concerns but primary targets of multilateral aid programs, large philanthropic organizations and key commercial players. This shift of attention has resulted in dramatic increases of funding and has transformed the ways in which health problems are identified and tackled. Global health initiatives have increasingly called for cross-disciplinary expertise and often specifically invited anthropologists to participate. Beyond finding individual employment and funding, many anthropologists have seen the new interest in their expertise as an opening for making a difference in the solution of increasingly complex health problems. The lures of joining global health as a field of practice are great, but they can often only be indulged in at the peril of ignoring critical questions about global health as an object of academic study in social and cultural science. Critically engaged medical anthropologists question the donor-driven and positivist understanding of global health as a technical process, seemingly disconnected to the economic, environmental, political and social context in which it operates. They challenge preconceived norms, expectations and assumptions of biomedicine, public health and development agendas and call for an ideologically neutral, reflexive approach. By explicitly addressing the tension generated between the more instrumental and the more reflexive forms of engagement, medical anthropology can stimulate creative debates on concepts, approaches and underlying epistemologies shaping the field of global health.
Friday 11th September
Jubilee Lecture Theatre
Numbers and Stories in Global Health: Metrics and the Evidence Economy
Vincanne Adams (University of California, San Francisco)
The recent shift from International Health Development to Global Health Sciences has ushered in complex transformations in the practices of audit, funding, and intervention in the effort to improve health outcomes on a global scale. One of the most important features of this shift has been the growing reliance on specific kinds of quantitative metrics that make use of evidence-based measures, experimental research platforms, and cost-effectiveness rubrics for even the most intractable problems and most promising interventions. Collectively these trends pose a problem of knowledge in relation to how we understand efficacy and how we pay for these efforts. By tracing the shift from DALYs to Randomized Controlled Trials in global health, this paper investigates how counting practices matter not only in relation to health but also in relation to market-driven commercial funding infrastructures. When do efforts to “scale up” become the best indices for successful innovation and, alternatively, when do they become an impediment to health? Do public-private for-profit partnerships in global health work to improve health outcomes and what metrics should be used to determine this? Finally, what alternative kinds of evidence are useful for global health work and how might they impact our sense of accountability?
Widening the range of evidence used to inform decisions and policies: can this improve the accountability
and appropriateness of decisions in global health?
Simon Lewin (Norwegian Knowledge Centre for the Health Services and South African Medical Research Council) and Christopher J Colvin (University of Cape Town)
The last fifteen years have seen growing interest in both how research evidence can be better used to inform decisions and policies in global health, and in approaches to facilitate this process. These approaches include systematic reviews of studies, evidence-based guidelines and policy briefs. These approaches aim to bring together the ‘best available’ evidence to inform a decision and are seen as a way of increasing the transparency of decision making. The concept of evidence-informed decision making has been critiqued on a number of fronts, including for constituting an overly positivist approach to decision making; for failing to capture adequately the complexity of decision making; and for privileging knowledge legitimated as ‘evidence’ over other forms of knowledge and experience. In this paper we reflect on our recent efforts to facilitate the systematic use of evidence from qualitative studies in WHO guidelines as well as our work to develop an approach to assess how much confidence to place in evidence from syntheses of qualitative studies. This experience has raised questions of what constitutes legitimate knowledge within these global processes; how different types of knowledge / evidence are used by different stakeholder groups; and interactions between the local and the global in relation to knowledge production and use. We discuss the extent to which these efforts could improve the accountability and appropriateness of decisions in global health, through opening spaces for knowledge that better reflects people’s views and experiences of health and health services and through creating opportunities for more critical perspectives.