Making and unmaking public health in Africa: Ethnographic and historical perspectives
Making and unmaking public health in Africa: Ethnographic and historical perspectives
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非洲公共卫生的成败：民族志和历史视角
DOI：
10.1080/17441692.2015.1062530
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发表时间：
2015
影响因子：
3.3
通讯作者：
Jorge Varanda
中科院分区：
文献类型：
--
作者：
Jorge Varanda
Ruth Prince的介绍在描绘非洲卫生行动的复杂历史以及地方和跨国环境之间的联系方面表现出色。它突出了政治背景和经济变化的作用，从帝国蓝图到独立后早期的中央集权社会主义计划，以及1980年代的结构调整方案的作用，为当今的新自由主义方法铺平了道路。报告介绍了基于危机、全球安全和人道主义行动的全球卫生意识形态框架（第28页），并指出了公私伙伴关系的作用（第33页）。自相矛盾的是，“审计文化”、制药业目标和专利立法的日益主导地位，并没有推动“人人享有健康”的方法，而是推动维持二十世纪世纪的垂直计划和“灵丹妙药”或技术修复。然而，正如本书的大多数作者--拉斯特、马歇尔、图西格南特、布朗、普林斯、盖斯勒--所指出的那样，非洲人，无论是病人和亲属、“志愿者”还是实地工作者，或者，我想补充一点，一些地方政府官员，并没有被动地接受跨国公司的印记。正如普林斯指出的那样，“非洲不仅是人道主义和发展干预措施的接受者;它还是一个蓬勃发展的私营治疗部门的所在地，该部门建立在更长的流动历史以及不同治疗传统和卫生专家之间的接触”（第15页）。最后指出了殖民前、殖民和独立后时期北方尼日利亚公共和公共利益的持续建设性质。马奎斯随后强调了公共、人口和人群之间的差异，以及公共卫生官员如何利用这些差异来阻止坦桑尼亚人参加葬礼的不卫生行为。两位作者都揭示了地方和西方的公共概念（源自哈贝马斯）之间的差距，这种概念往往将预先存在的公共卫生传统视为旨在社会控制、维护等级制度和权力问题的巫术。卫生官员认为当地人是一群不卫生、不正常的人，他们的行为遵循传统，而不是科学。这种概念上的差异和独特的特征是生物医学殖民主义强加的理由，如今，它们浮出水面，解释了全球计划的失败或艾滋病毒或埃博拉等流行病的出现。
The introduction by Ruth Prince excels in mapping the complex history of health actions in Africa and the links between local and transnational settings. It brings to the fore the role of political contexts and economic changes, from imperial blueprints to the centralised socialist plans of the early post-independence period, and the role of the 1980s Structural Adjustment Programmes that paved the way for present-day neoliberal approaches to views of health programmes. The ideological framework of global health, based on crisis, global security and humanitarian actions (p. 28) is unveiled, and the role of public–private partnerships (PPPs) is noted (p. 33). The increasing dominance of the ‘audit culture’, pharmaceutical industry goals, and patent legislation paradoxically push not for a ‘health for all’approach, but rather for the maintenance of twentieth century vertical programmes and ‘magic bullets’ or technical fixes. However, as most of the volume’s authors–Last, Marsland, Tousignant, Brown, Prince, Geissler–note, Africans, be they patients and relatives,‘voluntaries’, or fieldworkers, or, I would add, some local level government officials, did not passively accept the imprint of the transnational. As Prince notes,‘Africa is not merely a recipient of humanitarian and development interventions; it is also a site of a thriving private therapeutic sector that builds on longer histories of mobility and encounters between different therapeutic traditions and health experts’(p. 15).In Part I: Whose Public Health? Last notes the ongoing constructed nature of the public and of the public good in Northern Nigeria in the pre-colonial, colonial, and post-independence periods. Marsland follows suit by highlighting the differences between public, population, and crowds, and how these are used by public health officials to characterise unhygienic practices by Tanzanians attending funerals. Both authors reveal the gap between the local and western concept of the Public (derived from Habermas) which often presents pre-existing traditions of public health as witchcraft aimed at social control, maintenance of hierarchies, and questions of power. Health officials see locals as an ensemble of unhygienic and uncanny mass of bodies behaving under tradition, rather than science. This conceptual difference and particular traits are the sort of justifications employed for biomedical colonial imposition, and nowadays surface to explain failures of global programmes or the emergence of epidemics such as HIV or Ebola.