Drone philanthropy?

This piece explores some of the dynamics of global health crowdfunding by examining the work of Watsi, a highly successful crowdfunding platform that raises funds to cover the costs of medical care for patients in countries throughout the global South. While Watsi relies on a somewhat traditional formula for fundraising that uses individual patient stories to attract donations, its origins, aims. and values reflect an imagined (and perhaps, probable) future of global health partnerships. What relationships and connections are enabled in this future space? What subjectivities, anxieties, and values are brought to the fore by Watsi’s modes of work? And what forms of intimacy and estrangement are enabled by such connections and relations? Watsi represents, I argue, a new kind of ‘drone philanthropy’ that both disrupts and evokes older forms of partnership, affiliation, and connection among donors, organizations, and individual recipients of aid

What only heaven hears: Citizens and the state in the wake of HIV scale-up in Lesotho

This dissertation poses a set of questions about the political impacts of the rapid and large-scale deployment of HIV programs (HIV "scale-up") in Lesotho. As HIV and global health initiatives have expanded over the past decade, they have had sociopolitical, as well as epidemiological, impacts. In particular, HIV scale-up elicited and demanded new political processes that continue to change how policy is crafted, how citizens are represented, and which values drive new health initiatives. More fundamentally, HIV initiatives have altered the ways that citizens, patients, and communities perceive themselves, the state, and their political worlds. Utilizing multi-sited ethnographic methods, this project observes how citizens in Lesotho are coping with these dramatic changes in their political worlds. The research reveals HIV scale-up's considerable and far-reaching impacts on citizen faith in democracy, perceptions of rights, access to key social protections, and feelings of belonging. In contrast to work on the impacts of social movements, activism, and political will on HIV policies, this dissertation inverts the causal direction of inquiry regarding health and politics. In doing so, it recognizes new global health movements as drivers of political change, mobilizing actors and resources in deploying programs in ways that are altering political worlds and subjectivities. A rich recent literature on biological and therapeutic citizenship in the time of AIDS has begun recognizing these trends and their impacts on patient subjectivity. This research expands the frame of inquiry to examine how public health interventions can also alter citizen subjectivity, expectations of democracy, and the structures of associational life. The dissertation also contributes data towards better understandings of recipient populations' perspectives on accountability, good governance, public-private partnerships, transparency, and participation—approaches currently touted as solutions to poor project outcomes. For citizens in Lesotho, these initiatives still look very much like anti-democratic enterprises. Field research was undertaken in two sites surrounding different clinical care models: the first was a government-run primary care clinic, and the second was a factory-based clinic in the country's garment industry, where a public-private partnership provided HIV services to workers. In both sites, research extended far beyond the clinic. In the former site, this meant working with: peri-urban communities served by the clinic; two support groups struggling to build partnerships with NGOs; local government institutions tasked with managing the HIV response; and traditional healers, community health workers, and patients giving and seeking care outside the clinic. In the second site, this meant exploring dynamics of discipline, productivity and "ethical" production in a transnationally-linked industry, as well as the social lives of workers outside their work. Though largely unforeseen by most global health actors, HIV policy has become an extremely effective delivery mechanism for specific political ideologies and ways of practicing politics in poor countries. Research conducted in these sites demonstrates that the expansive, far-reaching scale-up of HIV programs has fundamentally changed ideas about what citizens deserve, who is deserving, how decisions will be made about services, and who takes responsibility for services, and ultimately, the survival of citizens. The predominant experience of politics for most citizens in post-scale-up Lesotho is a feeling of abandonment, of not being heard. The research thus raises significant normative as well as pragmatic questions about the role and responsibility of global health projects in already fragile political systems, and the potential impacts of the political changes described here on patterns of health seeking and ill health in countries like Lesotho

A cross-sectional study of social inequities in medical crowdfunding campaigns in the United States

Americans are increasingly relying on crowdfunding to pay for the costs of healthcare. In medical crowdfunding, online platforms allow individuals to appeal to social networks to request donations for health and medical needs. Users are often told that success depends on how they organize and share their campaigns to increase social network engagement. However, experts have cautioned that MCF could exacerbate health and social disparities by amplifying the choices and biases of the crowd and leveraging these to determine who has access to financial support for healthcare. To date, research on potential axes of disparity in MCF, and their impacts on fundraising outcomes, has been limited. This paper presents an exploratory cross-sectional study of a randomized sample of 637 MCF campaigns on the popular platform Gofundme, for which the race, gender, age, and relationships of campaigners and campaign recipients were categorized alongside campaign characteristics and outcomes. Our analyses examine race, gender, and age disparities in MCF use, and tests how these are associated with differential campaign outcomes. The results show systemic disparities in MCF use and outcomes: non-white users are under-represented. There is significant evidence of an additional digital care labor burden on women organizers of campaigns, and marginalized race and gender groups are associated with poorer fundraising outcomes. Outcomes are only minimally associated with campaign characteristics under users' control, such as photos, videos, and updates. These results corroborate widespread concerns how technology fuels health inequities, and about how crowdfunding may be creating an unequal and biased marketplace for those seeking financial support to access healthcare. Further research and better data access are needed to explore these dynamics more deeply and inform policy for this largely unregulated industry.Comment: 26 pages, 2 figure

The contracting world of girls at puberty: Violence and gender-divergent access to the public sphere among adolescents in South Africa

This Population Council working paper describes a participatory mapping project undertaken with single-sex groups of grade 5 and grade 8–9 children in urban and rural KwaZulu-Natal, South Africa. At grade 5, female self-defined community areas were equal to or larger in size than those of males in both sites. However, wide gender divergence in access to the public sphere was found among grade 8–9 children. Although curtailed spatial access, especially in urban areas, is intended to protect post-pubescent girls, grade 8–9 girls reported most spaces in their small navigable areas unsafe. Reducing girls’ access to the public sphere does not increase their perceived safety, but may instead limit their access to opportunities for human development

Identifying sources of adolescent exclusion due to violence: Participatory mapping in South Africa

Adolescents in post-apartheid South Africa lead lives that are filled with new opportunities yet overshadowed by rampant violence and crime. The presence of multiple and simultaneous forms of violence and the systemic lack of safety are experienced most acutely by adolescents—in particular, adolescent girls. High levels of violence and crime within the community are coupled with violence within the home and schools. The Population Council’s Transitions to Adulthood Program examines the particular factors that shape adolescents’ life chances and choices. In South Africa, Council researchers have studied how economic literacy and life skills education affect young men and women who are economically and socially disenfranchised and at high risk for HIV infection. To take advantage of skills programs, young people must have access to safe spaces—in the home, school, and community. Promoting Healthy, Safe, and Productive Transitions to Adulthood Brief No. 30 explores Council initiatives to create safe spaces for adolescents and use community mapping, allow adolescents to influence community-based solutions, and translate adolescent knowledge into improved livelihoods

Donor data vacuuming

In this essay, we seek to understand how the stunning rise of data vacuuming, necessitated by the pretense of ‘partnership’ within global health, has fundamentally altered how routine health data in poor countries is collected, analyzed, prioritized, and used to inform management and policy. Writing as a team of authors with experiences on multiple sides of global health partnerships in the United States, Mozambique, Nepal, Lesotho, Kenya, and Cote d’Ivoire, we argue that solidarity-based partnership between donor and recipient countries is impossible when evidence production and management is effectively outsourced to external organizations to meet the criteria of donor partners. Specifically, to meet the 2030 Sustainable Development Goals, equity-oriented strategies are critically needed to create data collection, analysis, and use activities that are mutually beneficial and sustainable

Pre-emption strategies to block taxes on sugar-sweetened beverages: A framing analysis of Facebook advertising in support of Washington state initiative-1634

In 2018, the sugar-sweetened beverage (SSB) industry introduced a ballot measure (I-1634) in Washington State of the United States to prevent further local taxes on groceries. The measure, which passed, is emblematic of new pre-emptive legislative strategies by the SSB industry to block soda taxes and conceal those strategies under the guise of preventing burdensome ‘grocery taxes’. This paper uses qualitative framing analysis to examine a public archive of 1218 Facebook advertisements to understand how I-1634 proponents shaped public discourse and engaged in misinformation efforts online during the lead up to the passage of I-1634. Coding strategies identified 7 compelling and inter-related framing strategies used by the campaign. These included strategies that misinformed the public about the threat of grocery taxation and the economic impacts it would have on the region. Strategies to conceal the true intent of the ballot measure and the sponsors of the campaign were aided by Facebook’s advertising platform, which does not moderate misinformation in advertising and allows advertisers to conceal their sponsors. We urge public health researchers and advocates to pay more attention to how Facebook and other social media platforms can be used by industries to target voters, misinform publics, and misconstrue industry support

From a global crisis to the ‘end of AIDS’: New epidemics of signification

In the past decade, discourses about AIDS have taken a remarkable, and largely unquestioned, turn. Whereas mobilisations for treatment scale-up during the 2000s were premised on perceptions of an ‘epidemic out of control’, we have repeatedly been informed in more recent years that an end to AIDS is immanent. This new discourse and its resulting policies are motivated by post-recession financial pressures, a changing field of global institutions, and shifting health and development priorities. These shifts also reflect a biomedical triumphalism in HIV prevention and treatment, whereby shorter term, privatised, technological, and ‘cost-effective’ interventions are promoted over long-term support for antiretroviral treatment. To explore these changes, we utilise Treichler’s [(1987). How to have theory in an epidemic: Cultural chronicles of AIDS. Durham, NC: Duke University Press] view of AIDS as an ‘epidemic of signification’ to develop a review of ‘End of AIDS’ discourses in recent years. We use this review to investigate the political and philanthropic interests served by efforts to rebrand and re-signify the epidemic. We also hold up these discourses against the realities of treatment access in resource-poor countries, where ‘Ending AIDS’ has not heralded the end of an epidemic per se, but rather the end of external support for treatment programmes, highlighting new difficulties for sustaining treatment in this new era of the epidemic