Periodic Reporting for period 4 - FutureHealth (Global future health: a multi-sited ethnography of an adaptive intervention)
Berichtszeitraum: 2022-12-01 bis 2023-11-30
This project studied a global health intervention to improve maternal/child nutrition. The intervention we analyzed drew 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. The team examined how the holistic and future-oriented concerns of sustainable development were taken up in the global health agenda and how this played out in different national sites. The research team carried out ethnographic field research across several sites: Guatemala, USA and Bhutan. Where experts asked how to translate their knowledge into the field, we explored how lessons from the field could be translated back into expert knowledge. First, we examined how the first 1000 days intervention was designed in an attempt to make global health future-oriented and investigated how this was variously adapted as it was implemented in different sites. Second, the analysis of our research sought to revise a core approach in 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 was holist by design. Our project took the important step of acknowledging and responding to this situation, thereby reorienting medical anthropology to global health practices in the 21st century. This led to the third objective, which was to develop social science techniques attuned to working with/in global health. We refined the methods of “contrasting” and “co-laboring,” using them in both intra-disciplinary and interdisciplinary settings. These methods have allowed 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.
The PI received ethical approval for the project from the UvA Ethics Review Board in 2018. The PhDs began their contracts in October 2018. In 2018 and 2019 the PhDs attended courses in methods and data analysis at the UvA, established supervision committees, and presented at the SAA’s annual conference and “Future Horizons in Medical Humanities” conference at the University of Washington. Thompson and Yates also made a trip to the Philippines to begin to establish contacts for the project. In May, the PhDs submitted their thesis research project. In 2019 the 8 month papers were evaluated and approved by the supervision committee. All PhDs submitted ethical clearance reports for their projects to the UvA’s Ethics Review Board and Sigmund and Kaul received approval to begin their projects. In July, 2019 the team met with experts in ethics retreat to discuss ethical considerations of their project. After the the team established research contacts at the local sites. In 2020 and 2021, because of Covid, the team halted plans for ethnographic fieldwork. Kaul delayed her fieldwork in Bhutan until it was safe and Thompson and Sigmund began to reimagine their work, changing fieldsites and methodologies. In 2021 the PhDs fieldwork resumed and the PI focused her time on writing a book based largely on archival and article analysis, as well as several chapters and article on the themes of maternal nutrition and global health. Kaul and Thompson co-authored articles with Yates for two different global health handbooks and also worked on drafting their theses. In 2022 Kaul returned to Bhutan to carry out intensive fieldwork. 2022 and 2023 also saw a return to attending conferences and holding workshops, including several workshops of interdisciplinary academics (anthropologists and nutrition scientists). We expect the PhDs to defend their dissertations in 2024, and the book that Yates wrote (Mal-Nutrition: Maternal Health Science and the Reproduction of Harm) will be published at the end of 2024.
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 has helped to develop this approach, while also generating valuable knowledge about transforming techniques of health governance. The research carefully attends to the fact that global health experts promoting the first 1000 days intervention are 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 has generated several publications that examine 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, the research adds comparative analysis across national sites. The innovative technique of “contrasting” that this study advanced did not seek to compare static or distinct objects but rather studied the first 1000 days intervention as it circulated and transforms, taking up the challenge of comparing relational and transforming objects. This theorization has helped to bridge two longstanding anthropological concerns: that of alterity, and that of travel and transition. The aim was to examine the meeting of differences in a way that did 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 raised 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 has produced numerous publications reflecting upon the “social lives” of theory in light of 'the first 1000 days of life' intervention’s adaptability to better attune anthropological practices of theory-making to the contingencies of socio-material processes. The project’s focus on the adaptability of global concern for maternal nutrition has highly promising implications for the design of health interventions.