Rational Sin

David Reubi explores how Chicago Economics remade Global Public Health

Epidemiological Imaginaries of the Social:Epidemiologists and Pathologies of Modernization in Postcolonial Africa

There is a growing anthropological literature analyzing the place that epidemiological surveillance occupies in contemporary global health. In this article, I build on this literature and take it into new directions by exploring what I call the epidemiological imaginaries of the social. Drawing on science and technology studies, I suggest that epidemiologists help make up the world, articulating complex and normatively loaded visions of social life that both enable and constrain action. More specifically, I argue that epidemiologists tell stories about the type of societies and people that compose the world and that these stories often shape global health policies and programs in powerful ways. To substantiate this argument, I examine epidemiologists’ efforts to map smoking in postcolonial Africa, documenting how they have imagined smokers and smoking through the lense of modernization theory and showing how these imaginaries have shaped tobacco control policies in the region up to this day.</p

Of Neoliberalism and Global Health:Human Capital, Market Failure and Sin/Social Taxes

This article tells a different but equally important story about neoliberalism and global health than the narrative on structural adjustment policies usually found in the literature. Rather than focus on macroeconomic structural adjustment policies, this story draws our attention to microeconomic taxation policies on tobacco, alcohol and sugar now widely recognised as the best strategy to control the global NCD epidemic. Structural adjustment policies are the product of the shift from statist to market-based development models, which was brought about by neoliberal thinkers like Peter Blau and Deepak Lal. In contrast, taxation policies are the result of a different epistemological rupture in international development: the move from economies and physical capital to people and human capital, advocated by Gary Becker and others. This move was part of a wider change, which saw Chicago School economists, under the influence of rational choice theory, redefine the object of their discipline, from the study of markets to individual choices. It was this concern with people and their choices that made it possible for Becker and others to identify the importance of price for the demand for tobacco, alcohol and sugar. The same concern also made it easier for them to recognise that there were inefficiencies in the tobacco, alcohol and sugar markets that required government intervention. This story, I suggest, shows that structural adjustment policies and pro-market ideology do not exhaust the relationship between neoliberalism and global health and should stop dictating how we, as political and social scientists, conceive it

Cartographic Infrastructures: Geographical pathology, tumour safaris, and colonial networks in British East Africa

In this article, we explore infrastructures—human, epistemic, and material—that enable the creation of maps and the stories they tell about the world. We develop the concept of ‘cartographic infrastructures’ to reveal the hidden and fragile political, scientific, and social worlds that undergird the production of maps and the truths they bring into being. To illustrate this, we examine a series of highly influential maps published in the early 1960s by Denis Burkitt—a colonial doctor working in British East Africa—showing the geographical distribution of a pediatric tumour in Africa. By correlating the tumour with altitude and rainfall, the maps suggested it had a viral origin, a finding that profoundly affected cancer research and helped accelerate the development of viral oncology. Using reports, diaries, and photos left behind by Burkitt and others, we excavate the cartographic infrastructures that underpinned his maps and viral hypothesis. First, we examine how the research tradition of geographical pathology—with its focus on environmental factors in carcinogenesis and its interest in Africa as a laboratory for cancer research—provided Burkitt with the theories, networks, and funding necessary to conduct his work. Second, we examine the surveillance practices, ranging from tumour safaris to geographical plotting, that enabled Burkitt to generate and interpret the data underlying his maps. Third, we analyze the communities of white colonial medical officers and missionary doctors spread across Africa with their shared imaginaries of race, empire, and adventure on which Burkitt relied to conduct his surveys.</p

The Model Multiple:Representing Cancer in Sub-Saharan Africa

Over the past half-century, modelling has come to play an increasingly important role in cancer research. These representational tools frame perceptions of malignant disease, guide public health responses and help determine which interventions are necessary. But what makes a cancer model a model? What authority do they have? What stories do they tell? And how do they shape our understanding of disease and bodies? To shed light on these questions, this paper explores the long history of cancer modelling in sub-Saharan Africa: a place where malignant disease has often been imagined as different, and where experimentation and improvisation in cancer research and treatment has been rife. Drawing on archival and ethnographic sources, we examine modelling strategies that health professionals have used to generate information about cancer in Africa from the mid-twentieth century to the present day. Focusing on three different case studies – anatomical models of Burkitt’s lymphoma patients, diagnostic models for Kaposi’s Sarcoma, and statistical models of the African smoking and lung cancer epidemic – we meditate on the multiplicity of models and modelling by identifying the epistemic strands that hold these representations together, as well as what sets them apart. In addition to contributing to discussions of how cancer research has taken shape beyond the Anglo-American realm, our paper helps expand and complicate our understandings of what a disease model is

Ethics governance, modernity and human beings' capacity to reflect and decide---a genealogy of medical research ethics in the UK and Singapore.

This PhD thesis explores how bioethics has reconfigured the way we think about, discuss and govern the scientific and medical use of the human body in the UK and Singapore. The thesis starts by analysing the language, knowledge, institutions and mechanisms that allowed people to render intelligible and organise the medical use of the human body before the emergence of bioethics. Then, drawing on the work of Michel Foucault, Ian Hacking and Nikolas Rose, the thesis examines and compares the conceptual, material and political conditions that made it possible, in both the UK and Singapore, to identify the medical use of human tissue as a 'problem of ethics' needing to be assessed and regulated. The thesis furthermore discusses a key component of bioethics - the procedure of informed consent - and analyzes how its use is reconfiguring subjectivities and contemporary notions of citizenship in both countries. On the basis of a systematic content analysis of key bioethics' journals from 1960 to the present and over twenty in-depth interviews with key experts in the field, the thesis makes two important findings. First, it explains how, in the UK, bioethical governance was developed to protect human beings from the dangers of modern science, while in Singapore it was introduced as part of the country's drive to be a modern and developed nation. Second, it argues that bioethical governance has brought into being, through its language, categories, procedures and experts, a new figure of the subject and citizen: the human being capable of reflecting and deciding on his or her own existence. These findings make an original contribution to (1) the sociological study of bioethics and the bioethical governance of the life sciences and (2) the literature on govern-mentality

The politics of non-communicable disease in the Global South

In this paper, we explore the emergence of non-communicable diseases (NCDs) as an object of political concern in and for countries of the global South. While epidemiologists and public health practitioners and scholars have long expressed concern with the changing global distribution of the burden of NCDs, it is only in more recent years that the aetiology, politics and consequences of these shifts have become an object of critical social scientific enquiry. These shifts mark the starting point for this special issue on ‘The Politics of NCDs in the Global South’ and act as the basis for new, critical interventions in how we understand NCDs. In this paper, we aim not only to introduce and contextualise the six contributions that form this special issue, but also to identify and explore three themes – problematisation, care and culture – that index the main areas of analytical and empirical concern that have motivated analyses of NCDs in the global South and are central to critical engagement with their political contours

The Internationalisation of Tobacco Control, 1950-2010.

This article explores the internationalisation of tobacco control as a case study in the history of international health regulation. Contrary to the existing literature on the topic, it argues that the history of international anti-smoking efforts is longer and richer than the making of the World Health Organisation's Framework Convention on Tobacco Control in the early twenty-first century. It thereby echoes the point made by other scholars about the importance of history when making sense of contemporary global health. Specifically, the article shows how the internationalisation of tobacco control started in the 1950s through informal contacts between scientists working on cancer research and how these initial interactions were followed by a growing number of more formal initiatives, from the World Conferences on Tobacco or Health to the Bloomberg Initiative to Reduce Tobacco Use. Rather than arranging these efforts in a linear narrative of progress culminating with the Framework Convention on Tobacco Control, we take anthropological claims about global health's uneven terrain seriously and portray a history of international tobacco control marked by ruptures and discontinuities. Specifically, we identify three successive periods, with each of them characterised by specific understandings of international action, tobacco control expertise, advocacy networks and funding strategies