Risk and Power: Dengue and Its Prevention and Control in Urban Cambodia

Sarah Smith (2010). Risk and Power: Dengue and Its Prevention and Control in Urban Cambodia PhD Thesis, School of Social Science, The University of Queensland.

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Author Sarah Smith
Thesis Title Risk and Power: Dengue and Its Prevention and Control in Urban Cambodia
School, Centre or Institute School of Social Science
Institution The University of Queensland
Publication date 2010-08
Thesis type PhD Thesis
Supervisor Fernanda Claudio
Andrew Page
Patricia Short
David Trigger
Total pages 213
Total colour pages 7
Total black and white pages 206
Abstract/Summary Abstract This is a study about the form and influence of power relations on health-related knowledge and practices. Specifically, the aim of this research is to understand the effects of the biopolitical global health paradigm on national and local practices around dengue and its prevention and control. The setting for this research was an urban area in Cambodia where dengue, the most widespread mosquito-borne virus in the world, was endemic, with periodic outbreaks. This aim was accomplished not only by exploring the global and national factors at play, but also by investigating and locating local knowledge and experiences within the context of intersubjective, and often disjointed, social relationships. Foucault’s concept of biopower offers a framework throughout which to understand the role that government and other actors have in promoting the health and wellbeing of a population. It is through structures of governmentality on both the national and transnational levels, that this biopower is asserted. This assertion of biopower, however, can be met with forms of counter-conduct, or resistance, in Foucauldian terms. Foucault’s work (Foucault 1980; 1984; 1991; 1994; 2004) provides neither a proscriptive approach nor a methodology for analysing relationships of power and workings of government. Rather, it offers a perspective, a lens through which to view interactions and processes on the global, national, and local levels. Finally, through Mary Douglas’ and Aaron Wildavsky’s work (Douglas 1966; 1992; Douglas and Wildavsky 1982) on the cultural approach to risk it becomes evident that conceptualizations of risk differ between the biomedical model and local understanding of illness, its causation, means of prevention, and appropriate therapeutic responses. These differing types of knowledge regarding what constitutes risk impact the biopolitical relations between advocates of the biomedical model, both at the global and national levels, and their target populations at the local level. Ethnographic data revealed that there were two distinct ways of expressing the concept of fever within the study area, which I call Village Boeng. Each form of fever was defined by a distinct aetiology, treatment, and prevention. As fever is accepted both within local and biomedical discourse of dengue, understanding of the typology of fever provided insight into local knowledge of dengue. Examination of local knowledge of dengue uncovered similarities between biomedical and local knowledge, yet also areas of difference. Local knowledge was, therefore, a syncretic mix of biomedical and traditional understandings as biomedical messages were interpreted and reinvented by the local population. This blending of knowledge types impacted upon both health seeking behaviours and practices around mosquito control. As there is no vaccine for dengue, prevention and control of the virus is predominantly done via mosquito control. As a result, this study explored the human relationship with both the built and natural environments as they play a role in local and biomedical interpretations of mosquito breeding. However, the local and biomedical interpretations of risk, as it pertained to dengue, conflicted. While burning rubbish was a practice endorsed by the government to eliminate potential mosquito breeding sites, local logic mandated that the rubbish be dried before burning to minimize the amount of smoke produced. This pollution was viewed as presenting a greater risk than the potential for dengue infection and therefore the residents of Village Boeng resisted the government messages. Local perception of water quality, which was stored and thus served as a mosquito breeding habitat, was based primarily upon visual appearance. Water that did not meet local criteria presented a risk and was therefore discarded. Public health supported the use of a larvacide as a means of mosquito control, however this practice altered the water’s appearance so that it was no longer viewed as clean by the local population. Ultimately, this study finds that there are conflicting understandings of risk between the biomedical and cultural perspectives. The political dimensions of this conflict are played out at the global, national, and local levels, resulting in power relations formed by and around biopolitical constructions and expressed through acts of governmentality. Such power relationships are multidimensional as acts of counter-conduct also emerge within the domain of biopower and governmentality.
Keyword Global health
Medical anthropology
Additional Notes 14, 40, 60, 110, 140, 153, 199

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Created: Fri, 13 May 2011, 21:43:51 EST by Ms Sarah Smith on behalf of Library - Information Access Service