The Socio-Political and Cultural Determinants of Diarrheal Disease in the Mekong Delta : From Discourse to Incidence

The annual diarrhoea deaths of children under 5 years old in the world are at the striking level of 1 - 3 million. Together with pneumonia, diarrhoea is one of the primary killers of children and especially the poor, with countries in Africa and South East Asia (SEA) bearing most of its global burden. Vietnam is a country which, despite its official exit from poverty during the 1990s, has been facing an average of over 1.5 million annual documented cases of diarrhoea for the period between 2005 and 2011. This high incidence of the disease persists despite the existence of known preventions, and thus remains an ongoing development concern. By examining the case of diarrheal disease in the region of Vietnam's Mekong Delta, the study strives to understand the factors that govern this essentially preventable health risk. The goal of this study is particularly to answer how cultural, social and political environments define and shape the spread of diarrheal disease in Can Tho City in Vietnam's Mekong Delta. In order to achieve this goal, the study draws greatly from the theoretical current of Political Ecology. Tracing the roots of inequalities that come together with the use of natural resources, political ecologists usually seek to answer how knowledge around these risks is being constructed. Through this questioning of socio-environmental problems, power emerges as an element which determines if and how policy will be turned into practice and whom this process will benefit. Similarly, as this study aims at locating ‘the political’ in disease, it asks questions such as: what guides the spread of disease physically, what hinders its control institutionally and why people are disempowered from being able to be adequately protected from it. Engaging with questions of how the risk of disease is constructed, communicated and understood, this study, therefore, also calls for a better understanding of the agents who produce, receive and circulate that knowledge. The field of Critical Medical Anthropology proves extremely useful in exploring human health in this regard, laying bare issues of access to wealth and power, relating health patterns to socio-political aspects and to the cultural meanings that are ascribed to disease. In the case of Vietnam, it was shown how the projected image of a modernized and developed state which procures for its citizens highly contradicts the reality of a degrading and increasingly unhealthy environment, with significant parts of the population being vulnerable and suffering from a disease that can be controlled. This now obvious contradiction, however, remains blurred within the country. The constructed discourse marginalises the poor and normalises suffering, while at the same time legitimising the state's abdication of its responsibility to provide basic healthcare and clean water; instead the state transfers these responsibilities to the people. The Vietnamese state has subtly, but methodically, designed its institutions in a way that they obey bureaucratic order and present proof of their prescribed activities; even if in reality, much of the policy is hardly ever turned into meaningful practice. As this study shows, even though indicators of disease (incidence and mortality) provide a measurable and logical way to assess health risks, this type of assessment defines the risk of disease in a very narrow manner. It is for this reason that biomedical experts, public health practitioners and international think-tanks on health need to engage in a sincere dialogue with the humanities, including ethnographers, sociologists and political scientists. Although the methodologies and the epistemologies followed in these widely-defined fields might diverge immensely, they share a common interest of acting for the improvement of human health. If such a claim holds truth, then there is a lot to be gained from interdisciplinary thinking and sharing

Health dispossessions and the moralization of disease: the case of diarrhea in the Mekong Delta, Vietnam

Abstract Despite the swift development of Vietnam's water supply and sanitation (wat/san) sector, over the last ten years there have been 1.5 million annual documented cases of diarrhea. Western perspectives blame insufficient medical or economic advancement for failing to prevent diarrhea and its treatment, failing to grasp how disease is shaped in the cultural, moral and political domain. This article examines the nature and function of public health policy and discourse against the spread of the disease in Can Tho City, Mekong Delta. Some 94 qualitative interviews were conducted with government representatives, medical staff and water experts, and a survey of 131 households in urban and rural areas. Focusing only on improving the construction of wat/san 'hardware' does not improve 'cultural software', and ignores the needs of vulnerable minorities, compromising the control of diarrhea. I also show how state discourse follows neoliberal approaches in individualizing health responsibilities, and moralizing disease. Local (mis)perceptions and risky behaviors emerge as the result of structural constraints that include poverty, a lack of access to useful health information, and the cultivation of stigma around diarrhea. These types of health dispossessions serve a political purpose, where the state escapes responsibility for public health failures, and thus enhancing its efforts to maintain legitimacy as a good implementer and a 'caring head.' Keywords: Vietnam, public health, health individualization, moralization of disease, blame discourse, diarrhea

Reflecting on emotional political ecoloiges.

Three researchers share their thoughts about a roundtable discussion on Emotional Political Ecologies during the ENTITLE Undisciplined Environments Conference, held in Stockholm from 20 to 24 March 2016

The notion of justice in funded research on urban sustainability : performing on a postpolitical stage or staging the political?

Unidad de excelencia María de Maeztu CEX2019-000940-MAltres ajuts: Maria de Maeztu MDM-2021Urban sustainability has often been accused of tending mostly to its environmental and economic dimensions, neglecting or marginalising issues of justice. Simultaneously, the European Union has been increasingly funding research explicitly focused on the intersection of justice, sustainability and the city. The role of such research in furthering or jeopardising just urban sustainability objectives and outcomes so far remains underexplored. We conducted a discourse analysis on 27 selected research projects funded by the EU FP7 and Horizon 2020 schemes and which focus on the themes of urban sustainability and justice, supplemented by qualitative interviews with core researchers in those projects, to examine their potential in (re-)politicising or depoliticising urban sustainability. Our findings indicate that justice is often loosely defined through terms such as "stakeholder participation," "inclusion," or "diversity" in urban sustainability interventions, and research projects fail to pay attention to structural and historical drivers of injustice within a broader context of political economy, society and culture. We find this trend mostly in international collaborative projects that are implementation-oriented and promise to fast track inter- or trans-disciplinarity within a context of precarious research contracts and limited timescales for researchers. We build on earlier critiques of the ecological modernist character of EU research and policy priorities and contribute further by demonstrating how the academic entrepreneurial system perpetrated by EU-funded projects can undermine the politicising possibilities of research. To overcome funding constraints, we urge funders to allow for broader methods and timescales to examine and reflect on what are, or could be, just urban sustainabilities

Tracing narratives and perceptions in the political ecologies of health and disease

Political ecology has, in the past decade, emerged as an increasingly accepted framework for studying issues of health and disease and has thus given rise to a distinct sub-field: the political ecologies of health and disease (PEHD). More recently, scholars have suggested more specific avenues through which the sub-field can be further developed and focused. Building on recent work, we suggest that the role of health perceptions and health discourses is one area that could benefit from examination through the lens of political ecology. The papers in this special section thus intend to further contribute to the empirical richness of this area of study, through an emphasis on anthropological and cultural aspects of health injustices. We emphasize the role of health perceptions, in particular, as a way of exploring how people's experiences of the local environment often differ from dominant discourses related to un/healthy environments, and the effects stemming from this disjuncture

Injustice in Urban Sustainability

This book uses a unique typology of ten core drivers of injustice to explore and question common assumptions around what urban sustainability means, how it can be implemented, and how it is manifested in or driven by urban interventions that hinge on claims of sustainability. Aligned with critical environmental justice studies, the book highlights the contradictions of urban sustainability in relation to justice. It argues that urban neighbourhoods cannot be greener, more sustainable and liveable unless their communities are strengthened by the protection of the right to housing, public space, infrastructure and healthy amenities. Linked to the individual drivers, ten short empirical case studies from across Europe and North America provide a systematic analysis of research, policy and practice conducted under urban sustainability agendas in cities such as Barcelona, Glasgow, Athens, Boston and Montréal, and show how social and environmental justice is, or is not, being taken into account. By doing so, the book uncovers the risks of continuing urban sustainability agendas while ignoring, and therefore perpetuating, systemic drivers of inequity and injustice operating within and outside of the city. Accessibly written for students in urban studies, critical geography and planning, this is a useful and analytical synthesis of issues relating to urban sustainability, environmental and social justice

Injustice in Urban Sustainability

This book uses a unique typology of ten core drivers of injustice to explore and question common assumptions around what urban sustainability means, how it can be implemented, and how it is manifested in or driven by urban interventions that hinge on claims of sustainability. Aligned with critical environmental justice studies, the book highlights the contradictions of urban sustainability in relation to justice. It argues that urban neighbourhoods cannot be greener, more sustainable and liveable unless their communities are strengthened by the protection of the right to housing, public space, infrastructure and healthy amenities. Linked to the individual drivers, ten short empirical case studies from across Europe and North America provide a systematic analysis of research, policy and practice conducted under urban sustainability agendas in cities such as Barcelona, Glasgow, Athens, Boston and Montréal, and show how social and environmental justice is, or is not, being taken into account. By doing so, the book uncovers the risks of continuing urban sustainability agendas while ignoring, and therefore perpetuating, systemic drivers of inequity and injustice operating within and outside of the city. Accessibly written for students in urban studies, critical geography and planning, this is a useful and analytical synthesis of issues relating to urban sustainability, environmental and social justice

Influence of socio-economic, demographic and climate factors on the regional distribution of dengue in the United States and Mexico

Unidad de excelencia María de Maeztu CEX2019-000940-MBackground: This study examines the impact of climate, socio-economic and demographic factors on the incidence of dengue in regions of the United States and Mexico. We select factors shown to predict dengue at a local level and test whether the association can be generalized to the regional or state level. In addition, we assess how different indicators perform compared to per capita gross domestic product (GDP), an indicator that is commonly used to predict the future distribution of dengue. Methods: A unique spatial-temporal dataset was created by collating information from a variety of data sources to perform empirical analyses at the regional level. Relevant regions for the analysis were selected based on their receptivity and vulnerability to dengue. A conceptual framework was elaborated to guide variable selection. The relationship between the incidence of dengue and the climate, socio-economic and demographic factors was modelled via a Generalized Additive Model (GAM), which also accounted for the spatial and temporal auto-correlation. Results: The socio-economic indicator (representing household income, education of the labour force, life expectancy at birth, and housing overcrowding), as well as more extensive access to broadband are associated with a drop in the incidence of dengue; by contrast, population growth and inter-regional migration are associated with higher incidence, after taking climate into account. An ageing population is also a predictor of higher incidence, but the relationship is concave and flattens at high rates. The rate of active physicians is associated with higher incidence, most likely because of more accurate reporting. If focusing on Mexico only, results remain broadly similar, however, workforce education was a better predictor of a drop in the incidence of dengue than household income. Conclusions: Two lessons can be drawn from this study: first, while higher GDP is generally associated with a drop in the incidence of dengue, a more granular analysis reveals that the crucial factors are a rise in education (with fewer jobs in the primary sector) and better access to information or technological infrastructure. Secondly, factors that were shown to have an impact of dengue at the local level are also good predictors at the regional level. These indices may help us better understand factors responsible for the global distribution of dengue and also, given a warming climate, may help us to better predict vulnerable populations on a larger scale

Gentrification and health in two global cities : a call to identify impacts for socially-vulnerable residents

Unidad de excelencia María de Maeztu MdM-2015-0552In global cities, the impacts of gentrification on the lives and well-being of socially vulnerable residents have occupied political agendas. Yet to date, research on how gentrification affects a multiplicity of health outcomes has remained scarce. While much of the nascent quantitative research helps to identify associations between gentrification and determined health outcomes, it tends to draw from static datasets collected for other studies to draw a posteriori and non-longitudinal conclusions. There is little attention in traditional public health research to purposely understand the health impacts of the complex, multi-layered, and rapid change produced by gentrification. Moreover, few studies examine the pathways and socio-spatial dynamics of the association between gentrification and health. In response, we use qualitative data collected in Boston and Barcelona to comprehensively identify how the health and well-being of long-term residents may be affected by gentrification and to call for new multi-methods research. In this initial assessment, we find a range of potential detrimental factors and potential pathways associated with gentrification, including individual-level physical and mental health outcomes such as obesity, asthma, chronic stress, and depression; neighborhood-level health determinants such as safety and new drug-dealing/use; and institutional-level health determinants such as healthcare precarity and worsened school conditions