Medicine Anthropology Theory
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Global health futures? Reckoning with a pandemic bond
Get PDFSince 2010, there has been a discernable expansion of global health financing forms using private equity, bonds, and ‘facilities’ to finance international development and humanitarian endeavors. I present the logics of the Pandemic Emergency Facility (PEF), a World Bank device that lashes together a bond, cash, and swaps to lie in reserve for an infectious disease outbreak. I explain how the PEF is emblematic of financial devices that have the potential to fund global health aid while offering investors a chance to make money. Reckoning with the pandemic bond means that we take account not only of the PEF (what does it organize and by what logics?) but also of the relationships it cultivates (what does it bind together?) and reproduces (what does it aim to multiply and what does it forsake?). I use ‘reckoning with’ as an analytic concept to help us think about measures and futures of global health in both economic and ethical registers, as well as to take account of how death data is used. Reckoning with something lets us pause to take account of where we are and where we are going, and helps us think about what we want. Is it necessary to translate the ethical obligation to help those who are suffering into financial devices that make people money, a trend we are clearly in the initial stages of? Are there conditions when the suffering of others as the source of financial speculation becomes desirable
Algorithmic futures: The life and death of Google Flu Trends
Get PDFIn the last few years, tracking systems that harvest web data to identify trends, calculate predictions, and warn about potential epidemic outbreaks have proliferated. These systems integrate crowdsourced data and digital traces, collecting information from a variety of online sources, and they promise to change the way governments, institutions, and individuals understand and respond to health concerns. This article examines some of the conceptual and practical challenges raised by the online algorithmic tracking of disease by focusing on the case of Google Flu Trends (GFT). Launched in 2008, GFT was Google’s flagship syndromic surveillance system, specializing in ‘real-time’ tracking of outbreaks of influenza. GFT mined massive amounts of data about online search behavior to extract patterns and anticipate the future of viral activity. But it did a poor job, and Google shut the system down in 2015. This paper focuses on GFT’s shortcomings, which were particularly severe during flu epidemics, when GFT struggled to make sense of the unexpected surges in the number of search queries. I suggest two reasons for GFT’s difficulties. First, it failed to keep track of the dynamics of contagion, at once biological and digital, as it affected what I call here the ‘googling crowds’. Search behavior during epidemics in part stems from a sort of viral anxiety not easily amenable to algorithmic anticipation, to the extent that the algorithm’s predictive capacity remains dependent on past data and patterns. Second, I suggest that GFT’s troubles were the result of how it collected data and performed what I call ‘epidemic reality’. GFT’s data became severed from the processes Google aimed to track, and the data took on a life of their own: a trackable life, in which there was little flu left. The story of GFT, I suggest, offers insight into contemporary tensions between the indomitable intensity of collective life and stubborn attempts at its algorithmic formalization
Disaggregating diabetes: New subtypes, causes, and care
Get PDFInterest in disaggregating diabetes into numerous subtypes is growing as patients and providers recognize the limitations of standard diabetes typologies. As anthropologists, we draw attention to how ‘subtyping’ may reduce stigma derived from the connection between obesity and ‘type 2 diabetes’. We highlight the complexities that drive diabetes and argue that an exclusive or dominant focus on diet and obesity obfuscates other underlying risks. Yet, we warn that subtyping may promote unnecessary pharmaceuticalization, especially for other subtypes of diabetes that may be associated with stress and inflammation. We call upon providers to continue to closely attend to patients’ lived experiences. While we recognize the shortcomings of the existing classificatory scheme, patients’ outcomes and prognoses are often more closely connected to the social and medical support they receive than to the underlying metabolic classification
NCDs: Names, sums, and parts
Get PDFThe global burden of mortality and morbidity attributable to noncommunicable diseases (NCDs) now exceeds that of infectious disease. Yet, concern is mounting that global political prioritisation and action have stalled. The failure of NCDs to capture public and political imaginations has been ascribed to a number of reasons, with some recently contending that the very name of the disease classification is to blame. In this piece, I reflect critically on why discourse about NCDs has not compelled global action proportionate to the magnitude of the suffering these diseases cause. Failure to act on NCDs, I argue, is not a failure of terminology alone
The problem of self-devouring growth: A forward-looking afterword
Get PDFHow should future health be measured, in light of the insights collected in this special issue? This afterword calls into question the imperative of economic growth, showing how insatiable growth, predicated on consumption, produces profound collateral health effects, a process termed here ‘self-devouring growth’. I argue for a new mode of value in public health predicated on refusing any calculus that separates desired effects from collateral effects
