Abstract
Objects can do many things: attract and repel, kill and cure, help and hinder, benefit and disadvantage, problematize and solve. Sometimes they can do these things simultaneously, sometimes sequentially, often to differential degrees. Sometimes they do nothing at all. Such is the ambivalence of objects, their presence and potential, in human and non-human life, health and well-being. This special issue of the Journal of Material Culture has its origins in a panel convened at the EASA/RAI Anthropology of Global Health conference held at Brighton, Sussex, UK, in September 2015. Of the 11 papers presented, 6 have been included in this collection. Collectively, they consider the history and contemporary configurations of different aspects of the non-human, material world that have implications, real and imaginary, for global health, illness and disease.
The term ‘global health’ has risen in prominence in recent years and refers to ‘an area for study, research, and practice that places a priority on improving health and achieving health equity for all people worldwide’ (Koplan et al., 2009). Although when presented as such, global health is hardly objectionable, critics suggest that in practice global health – and especially when practised in the developing world – also involves new configurations of public and private health actors and top-down, often geographically remote, policy-making that can undermine health systems at national level, the delivery of free universal healthcare and the participation of local people in decision-making processes, among others (Biehl and Petryna, 2013b; Janes and Corbett, 2009; Pfeiffer and Chapman, 2010; Storeng and Mishra, 2014). For example, the Gates Foundation, perhaps the best-known organization in the global health field after the WHO, not only has a budget larger than that of the WHO but through its single-issue campaigns on problems like polio and malaria has been accused of diverting attention and resources away from other equally serious challenges that are not of personal interest to the small family board that runs the organization (Birn, 2014a, 2014b; Edwards, 2015; McCoy et al., 2009).
Commodities, technologies and substances play a crucial role in many global health interventions. From the search for wonder-drug vaccines and medicines to cheap and sustainable personal medical devices, global health research, practice and advocacy is centrally concerned with the discovery, production and distribution of objects that can improve health. The availability and increasing sophistication of technology are both seen as directly correlated with improved health outcomes (Howitt et al., 2012). Health systems in high-income countries increasingly depend on high-tech infrastructures, and health outcomes in low-income countries are considered unlikely to improve until ‘a concerted global effort to encourage the development and use of health technologies that can benefit the poorest people in the world’ has been made (p. 508). The other side of the coin, however, is that commodities, technologies and substances can kill. Modern societies (and their health systems) run on technological assemblages of materials and manufactures that have acute and chronic health effects (Singer and Baer, 2009). Objects like pesticides combine both potentialities at once, simultaneously promoting food security and controlling vector-borne diseases while seriously polluting people and planet (Widger, 2014).
Thus, the articles making up this special issue explore the ambivalences inherent in global health as a movement that both depends upon objects for its own advancement and seeks to tackle objects as the cause of ill health and disease. To that end, the collection is ordered by three common themes: (1) the place of objects ‘in’ and ‘of’ global health; (2) the ambivalence that attaches to, and can be produced by, objects that hold what is often a paradoxical pharmakon status (Derrida, 1981); and (3) the material inequalities that make objects more or less available, dangerous, or useful to people in different parts of the world. All of the articles are based on ethnographic and qualitative research conducted in single or multiple sites across the global north and south in countries such as India, Sri Lanka, Tanzania, Uruguay, the United States and Australia. One (Berk) involves an ‘auto-ethnography’ of the author’s own experience of living with an insulin pump, and another (Russell) consults English literary sources as part of his quest for a non-human ethnography of tobacco, a global health threat.
All the contributors have been inspired, one way or another, by recent developments in approaches to understanding the non-human, material world and its relevance to human health and wellbeing. The range of approaches drawn from are diverse and include material culture studies, Actor-Network-Theory (ANT), phenomenology and post-phenomenology, object-oriented ontology and speculative realism (Appadurai, 1986; Bennett, 2004; Brown, 2001; Harman, 2002; Holbraad, 2011; Latour, 2000, 2005; Miller, 1987). All the contributors take the position that in global health, as in most other spheres of human life, things matter, and have not been taken sufficiently seriously in many of the descriptions and analyses of contemporary global health concerns. Contributors draw direct inspiration from recent developments in the study of material things – either theoretical approaches to thinking about oxygen tanks, insulin pumps, cigarette packets and tobacco in the respective cases of Wainwright, Berk, Dennis and Alexiou, and Russell, while Widger and Genus use the object itself as a starting point for thinking about global health interventions and their ambivalent relationship with things.
Contributors have also been inspired by the intrinsic problem of ambivalence (Jovanović, 2016) defined here as a state or mode of being that is often attached to objects but bracketed with little further comment or criticism. Health is likewise an ephemeral, ambiguous concept and the relationship of objects to health, as well as the potentials contained within them, is similarly framed by ambivalence. This is true whether we explore the pharmakon-like way particular artefacts and substances contain the qualities of both remedy and poison, the ambivalence of ANT-style object agency vs the political-economy of corporate capital (frequently transected by humanist and posthumanist notions of morality and sociality), or the ambivalences and almost inevitable tensions between ethnographic particularism and global/public health expansionism. For several contributors – Widger, Wainwright and Berk – objects in/of global health offer a point of departure for thinking about ambivalence more deeply, be it the ambivalence of the pharmakon (tobacco as both panacea and public enemy Number 1, in Russell’s case) or the equivocality of global health’s promise to deliver health for all in a deeply unequal world. Widger, drawing from his long-term studies of suicide prevention via pesticide control, argues that ambivalence can also offer a positive and productive space for global health interventions to operate within.
A third theme, then, is an apparent juxtaposition – the relationship between objects themselves, and the contexts of health crisis and under- or over-development in which each of them appears. On surfaces often characterized by shiny new technologies, packages that symbolize the best (or worst) of medical, technological and scientific ‘progress’, objects simultaneously blind us to the relationships of global and local inequality that produce the illnesses they cure or cause, the barriers that limit access to them, and the remedial or harmful effects that they can have. This cyborgian perspective (Haraway, 1991) leads several contributors (Wainwright, Berk and Genus) to question the export of objects – and theories about objects – to the developing world, where global health technologies, experienced as goods, are either severely limited in their accessibility or, alternatively, seem to offer cheap fixes for grand challenges (Widger). For all the contributors, the role played by the objects of global health (oxygen tanks, insulin pumps, pesticide storage boxes, cigarette packets bedecked with health warnings) is also ambivalent in terms of the extent to which those objects really do correlate with improved health outcomes, as global health advocates would suggest.
As objects, particularly those high-tech ones in/of global health, become increasingly indistinguishable from global health itself, the contributions to this special issue make a timely contribution to the wider field of critical global health. This field of academic study and political activism questions the authority, methods and motivations of global health, highlighting for example the reductionist approach that it takes to health problems that foreground biological aetiology and marginalize crucial social, economic and political determinants (Biehl and Petryna, 2013a). Most contributors carry forward the central arguments of scholars in this field by showing how the objects either deployed or deplored by global health produce ambivalent relationships between people and things that can undermine the aims and aspirations of health-in-the-world.
This is the first special issue of the Journal of Material Culture that speaks directly to concerns of medical anthropology and human health. The articles it includes are inherently international and comparative in their scope, even as the objects they specify – from the molecular upwards – are grounded in the material reality of the everyday, and the tools and machines that produce them. As an issue joining theoretically sophisticated approaches to objects with empirical cases studies from around the world, the assembled articles offer nuanced accounts of urgent global health challenges that provide original perspectives on some of the most pressing questions of our times.
