Report

Teaser, summary, work performed and final results

Periodic Reporting for period 1 - FutureHealth (Global future health: a multi-sited ethnography of an adaptive intervention)

Teaser

This project studies a global health intervention to improve maternal/child nutrition. The intervention draws numerous disciplines and geographic regions together in a holistic pursuit of a sustainable and healthy collective future. It then unfolds in diverse and localized...

Summary

This project studies a global health intervention to improve maternal/child nutrition. The intervention draws numerous disciplines and geographic regions together in a holistic pursuit of a sustainable and healthy collective future. It then unfolds in diverse and localized ways. We study the intervention across several sites: the Netherlands, Guatemala-Los Angeles, Bhutan, and the Philippines. Where experts currently ask how to translate their knowledge into the field, we will ask how lessons from the field might be translated back into expert knowledge and, where relevant, made available elsewhere. The innovative force of our research is to ask how living with/in difference can become both a social ideal and a research style. The proposed research is a multi-sited ethnography of the first 1000 days of life intervention. It examines how the holistic and future-oriented concerns of sustainable development are taken up in the global health agenda and how this plays out in five national sites (the Netherlands, Guatemala, the Philippines, the United States and Bhutan). The research has three main objectives. First, it seeks to understand how the first 1000 days intervention is being shaped in an attempt to make global health future-oriented and how this intervention is then variously adapted as it gets implemented in different sites. Second, it seeks to revise and revitalize medical anthropology. Medical anthropologists have tended to take holism as a virtue of anthropology, a vantage point from which they could critique the field of global health for its reductionism. However, the first 1000 days intervention is itself holist by design. This project takes the important step of acknowledging and responding to this situation. It thereby contributes to reorienting medical anthropology to global health practices in the 21st century. This leads to the third objective, which is to develop social science techniques attuned to working with/in global health. We will refine the methods of “contrasting” and “co-laboring,” using them in both intra-disciplinary and interdisciplinary settings. These methods will allow us to offer health experts lessons from the ways that the first 1000 days intervention is adapted as it travels that they may use as inspiration when fine tuning their designs. In the process we enrich the anthropological repertoire, moving it beyond a choice between criticism or endorsement. In this way living with/in difference comes to figure as both a social ideal and a research style.

Work performed

The effective starting date of the project was 1 June 2018. The PI wrote and circulated the call for PhDs during the summer of 2018 and submitted and received ethical approval for the project from the Ethics Review Board of the Amsterdam Institute of Social Science Research. Interviews and recruitment happened in September, 2018 and PhD students began their contracts in October, 2018. Between October 2018 and May, 2019, PhDs 1) attended courses in methods and data analysis at the University of Amsterdam, 2) established their supervision committees, and 3) presented their proposal at the Society for Applied Anthropology’s annual conference and “Future Horizons in Medical Humanities” conference hosted by the Simpson Center at the University of Washington. Thompson and Yates-Doerr also made a week long trip to the Philippines to begin to establish contacts for the Philippines portion of the project. In May, the PhD students submitted their “8-month paper” (in which they outlined their specific thesis research project. The paper is similar to a qualifying exam). Between May and June, 2019, the 8 month papers were evaluated by the entire supervision committee. During this time all PhDs submitted ethical clearance reports for their projects to the University of Amsterdam’s Ethics Review Board. By the end of June, 2019, all PhDs received a passing grade on their 8-month paper. In addition, Sigmund and Kaul were approved by the University of Amsterdam’s ethics review board to begin their projects. (Thompson is waiting to establish contacts in the Philippines to apply). In July, 2019 the team met with outside experts in a three-day ethics retreat to further discuss ethical considerations of their project. Afterwards the PI travelled to the US and to Guatemala to establish contacts for the Guatemala and US portions of the project. Sigmund travelled to Guatemala in August and to the United States in September, doing pre-research set up. At the same time, Kaul travelled to Bhutan to begin to set up her project there. Throughout the fall 2019, and spring of 2020, the team has been refining research goals and establishing research contacts in the local sites in preparation for the research-phase of the project to begin.

Final results

So far, the anthropology of global health has mostly focused on biosecurity, disaster relief, HIV and other infectious and tropical diseases, sexual reproductive health, and clinical trials. Anthropological investigation of health experts’ growing concern for sustainability and noncommunicable disease requires a different theoretical approach than that focused on immediate infections and disasters. By attending to how linkages are made between biological and planetary health, crisis and chronicity, and fetal and global development, the project will help to develop this approach, while also generating valuable knowledge about transforming techniques of health governance. The observation that global policies are carried out in diverse, local ways on its own is not new; what is new about the research is that I attend to the fact that global health experts promoting the first 1000 days intervention are aware of this, and are thus actively working to coordinate across differences in geography, discipline, and timescale. Anthropologists have classically embraced holism as our value, critiquing health professionals as overly reductionist). Careful study of the global health community’s engagement with holism will generate insight into how holistic ambitions are implemented in practice, while also cultivating alternative pathways for anthropology to relate to global health other than through criticism. The project’s multi-sited approach is another important innovation. While valuable site-based work on the first 1000 days intervention has been carried out by anthropologists, comparative research across national sites has not yet been conducted. Though the project is multi- sited, it does not draw upon a range of sites to itself be global or holist. It conducts research across diverse sites to have empirically rich material for analysis—not to lay claim to a general, global truth. Moreover, the innovative technique of “contrasting” that this study adopts does not seek to compare static or distinct objects but to study the first 1000 days intervention as it circulates and transforms, taking up the challenge of comparing relational and transforming objects. This theorization will help to bridge two longstanding anthropological concerns: that of alterity, and that of travel and transition. The aim is to examine the meeting of differences in a way that does not pin these differences down. Anthropological analyses of the meeting of biology with governance have typically sought to describe broad, pervasive patterns; the ethnographer’s job was to accumulate local knowledge to shed light on phenomena occurring at global scale. Theories of bio-medicine, bio-politics, bio-security, bio-capital, and bio-power that were important for the field of anthropology in the late 20th and early 21st centuries were predicated upon the global stability of the relation between “the biological” and the medicine, politics, security, capital, and power to which biology was linked. Yet as ethnographers have begun to systematically carry out comparative work on global interventions, the heterogeneity of biology, medicine, politics, security, capital and power – as well as the heterogeneity of their relations – has become increasingly apparent. That “conceptual objects” do not easily hold stable across time and space raises important questions about how anthropological theories change as they travel, and how we might attend to these changes in our own practices of theorization. The project will reflect upon the “social lives” of theory in light of the intervention’s adaptability to better attune anthropological practices of theory-making to the contingencies of socio-material processes. Finally, the project’s focus on the adaptability of global concern for the first 1000 days will have highly promising implications for the design of health interventions. One of the health experts I interviewed while preparing this

Website & more info

More info: https://globalfuturehealth.org/.