Contested Knowledges of the Commons in Southeast Asia

Environmental questions are at the heart of many development dilemmas in Southeast Asia. New actors and technologies, changing domestic politics, policies, and economies - as well as shifting geopolitical contexts, are remaking nature-society relations in the region. A failure to address transnational environmental challenges could not only undermine ASEAN’s legitimacy but also have drastic consequences for the region’s security and its political and economic stability. In addressing these questions in Work Package 1 (WP1), we are particularly concerned with contested knowledges of “the commons” and competition over resources. We consider the environment as a driver of processes of regional integration, but also of conflicts between various actors in the region. Our research focuses on three environmental contexts namely: sea; rivers; and air. In addressing all three our emphasis is on the transition to a low-carbon economy. The aim of this paper is to present the theoretical framework of our work as well as the three main strands of our research. In the first section, we explain our understanding of the concept of ecological knowledge. This is followed by a presentation of our methodological approaches, while the last section presents the individual research projects in the WP, arranged in three modules.This project has received funding from the European Union’s Horizon 2020 Research and Innovation Programme under grant agreement N°770562

Sovereign anxiety in Myanmar: An emotional geopolitics of China's Belt and Road Initiative

Geographers have increasingly attended to the role of emotion in geopolitical en-counters and the geopolitics of cross- border infrastructure projects. While schol-ars have theorised fear as an emotion produced by elite geopolitical discourses and encounters between bodies, we know much less about how infrastructure's materialities provoke fear and anxiety. Furthermore, key distinctions between anxiety – or a psychological state of insecurity and unease – and fear, which is attached to a specific target object, are still not fully understood. Focused on the uncertainties over China's Belt and Road Initiative (BRI), we develop the concept of sovereign anxiety – a generalised condition of unease over the security of one's political community – to account for how the BRI generates not only the hard materials of infrastructure (e.g., roads, dams and pipelines), but also the social practices of affect and emotion. Sovereign anxiety, we argue, is heightened by the absence of transparency over China's infrastructure investments in Myanmar. In this paper, we trace how sovereign anxiety is variously experienced and grounded in residents' observations, personal biographies, social histories, and sense of community belonging. We also identify three themes by which fears of the BRI are articulated: relations, roads, and resources. This article contributes an emotional geopolitics perspective to grounded studies of the BRI, while also demonstrating the geopolitical significance of attending to the emotional lives of infrastructure in relation to the BRI and beyond

Knowledge infrastructures, conflictual coproduction, and the politics of planning : A post-foundational approach to political capability in Nepal and Thailand

In an era of rapid urbanisation, understanding how marginalised groups shape and are shaped by planning has never been more urgent. Here, we focus on the political capability of marginalised groups, centring analysis on the control (or lack of control) that they have over their livelihoods and environment. Focused on the politics of participatory planning that surround the Kirtipur and Baan Mankong Housing Projects in Nepal and Thailand, we develop a post-foundational approach to explore how the political capabilities of informal settlers and their representatives are bound up in the realisation of conflict. Crucially, our analysis reveals the discourses, alliances, and expertise – referred to as knowledge infrastructures – that are mobilised by constituted and constituent forms of power to construct and contest urban development. Building upon this framework, we demonstrate how technocratic knowledge infrastructures support hegemonic encroachment discourses that, in turn, condition the emergence of insurgent knowledge infrastructures. In doing so, we show that the political capabilities of informal settlers are fundamentally tied to how these insurgent knowledge infrastructures support participatory planning processes conducive to political subjectivisation. Ultimately, we reveal how participatory planning generates struggles for equality and rights that shape the urban as an arena of conflictual coproduction

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research