Mark Nichter: Global Health: Why Cultural Perceptions, Social Representations, and Biopolitics Matter

Traditionally public health initiatives have focused on questionnaires and short interviews to identify the depth of local knowledge about a particular disease or to identify cultural barriers to health programs. Global Health by Mark Nichter (2008) demonstrates how qualitative in-depth ethnographic studies enhance our understanding of the relationship between local beliefs, rhetoric, and public health. This book challenges social scientists and medical practitioners to go beyond simplistic “cultural barrier” explanations for the failure of particular public health projects in the developing world. Health practitioners, patients, and social scientists all have their own culturally relevant strategies that determine if medicine is practiced in such a way as to effectively aid local health. The first section of the book is concerned with how local perceptions of the classification, causes and treatment of infectious disease shape responses to public health endeavors. This section is packed with cautionary tales of the complexity of public health programs in the developing world. Nichter organizes these examples for the reader into themes about local understanding of the body, health, diet, risk, illness and pharmaceuticals. For example, local understanding of what is considered healthy can shape who seeks medical care. In Cameroon, Ghana, and Nigeria blood in the urine of both male and female teens is considered part of normal development. This belief leads to delays in the treatment of schistosomiasis. This first section of the book strongly demonstrates that a detailed understanding folk epidemiology is crucial for constructing effective health plans. Nichter follows with a discussion of the interaction between public health rhetoric and local interpretations of those messages. Messages may hybridize when multiple public health messages are received. In northeastern Thailand public health messages about diarrhea, which encouraged people to keep water uncontaminated, were crossed with messages to control mosquito populations by covering water storage jars. Villagers thought that mosquito eggs in drinking water made people sick, and that covering jars would reduce diarrhea. Public health initiatives also interact with traditional medicine. For instance, side effects of drugs may be valued because they demonstrate that the medicine is effective and powerful. Thus, side effects are highly valued in areas where many counterfeits are found on the market, such as West Africa. However, patients are not the only players in the public health system. Nichter also investigates how rhetoric mobilizes popular support. Local perception of the government shapes the enthusiasm with which public health initiatives are followed. In the Dominican Republic, community members understood the importance of controlling the mosquito population to prevent dengue fever. However, the locals did not cooperate because the reputation of the government was so poor that all of its programs were suspect. In fact, politicians have large incentives to make highly visible and capital-intensive public health demonstrations to increase popularity, but this may make little improvement on local health. Rhetoric may also falsely represent the best way to implement medicine by presenting ideals rather than reality. For example, health programs aimed at young mothers may not be successful if these women do not have power within the household to make decisions about purchases or to leave the house unaccompanied. The last section of the book examines the possibilities for the next generation of global health research. He Hum Ecol (2009) 37:669–670 DOI 10.1007/s10745-009-9242-5