Global epidemics, malnutrition, inequality, infant mortality, inaccessible healthcare. It is not surprising that “Global Health” has becoming a prevailing brand associated with international aid organizations, NGOs, charitable foundations and big-name donors. The health of people even in relatively remote areas has increasingly become an object of global concern, as drug-resistant diseases, population displacement, and medical infrastructure create wider instability and risk in an era of greater connectivity and mobility. Medical anthropologists, of course, have been doing work on medicine, health, and well-being in remote areas across the world for decades and can offer a refreshingly critical view of “global health” discourses, the power relationships they create and enforce, and their underlying logics, which are often far removed from local concerns and ways of life.
This was one of the points of noted anthropologist and active AAGE member, Dr. Brigit Obrist at her keynote lecture at the University of Sussex, where she addressed around three-hundred medical anthropologists from Europe, America, and across the world, gathered for “MAGic 2015: Anthropology and global health: interrogating theory, policy and practice.” Dr. Obrist, who has been conducting research most recently in Tanzania on various projects including aging and adulthood, is the Professor of Anthropology at the Institute of Social Anthropology, University of Basel, Switzerland. Using her extensive experience, she spoke of both the “lures and perils” of engaged medical anthropology, encouraging us to remain committed to rigorous collaborative and community-based work that questions remotely conceived “best practice”. Not an easy task given the force and funding of today’s humanitarian health organizations, but one nonetheless, that anthropologists hold dear.
It was fantastic to see Dr. Obrist, together with her partner and fellow medical anthropologist Piet Van Eeuwijk (AAGE member and Vice-Chair of the European Association of Social Anthropology Medical Anthropologists Network) in such prominent positions within the European medical anthropology world. Dr. Van Eeuwijk convened a session on “Global Ageing: toward a shift from cure to care,” including four presentations representing scholars in the UK, Netherlands, and Switzerland.
I was honored to start the session, speaking on my work on vulnerability and the work of care in contemporary Japan. I argued that under conditions of severe labor shortage and increasing privatization of eldercare, carer vulnerability becomes both an affective asset and a dangerous liability. Carework constantly exceeds boundaries circumscribed by policies, at times motivating compassion and at other times, violence.
Renske Visser (University of Bath) highlighted case studies drawn from her work on end of life, aging-in-place, and the oldest old in Southwest England. She found that in contrast to prevailing images of the medicalized death (in a hospital or nursing home) and the “good” death in one’s home, individuals thinking about end-of-life often shift their decisions about where to die based on constantly changing circumstances. Such dynamism is often overlooked, argued Visser, and has impact for how we think about care and dwelling.
Following a break, we heard two papers on aging in Tanzania, first by Josien de Klerk (Leiden University) and second, Piet van Eeuwijk (University of Basel). Dr. de Klerk’s presentation, “Precarious intimacies: (Grand) parenting over time in rural northwest Tanzania” looked at intergenerational relationships that she has followed since her initial fieldwork in 2003. While others have looked at the health risks of grandparents caring for grandchildren (who often come under care from traumatic separation from parents), Dr. de Klerk’s paper used video and testimonies that demonstrated ways older adults became close confidants in matters of grief and loss.
Dr. van Eeuwijk wrapped up the panel with a paper on diabetes in urban Tanzania, where it is a frighteningly common and deadly condition among the elderly population there, for whom the standard lifestyle adaptations (diet, exercise) is a challenge to integrate into their daily lives. Dr. van Eeuwijk’s paper combined both ethnographic, individual accounts of living with diabetes as well as reflections on how this might expand on concepts like successful aging, selfcare, and chronicity.
Other MAGic 2015 papers on topics related to aging and end of life included
- Objectifying care- Using morphine as a care tool. Andrea Buhl (University of Basel)
- Results of the Mexican Non-Contributory Social Pension Program on older adults mental well-being. Maria del Pilar Torres Pereda (National Institute of Public Health)
- Screening for dementia: fluidity and the Mini Mental State Examination in India. Brianca Brijnath (Monash University)
Despite this strong representation at the conference, most work on aging and the life course remains marginal within mainstream medical anthropology, with its focus either on critiquing medically circumscribed categories of particular illnesses (HIV/AIDS, cholera, asthma, e.g.), or critiques of medical or humanitarian institutions, technologies, or policies. Old age, when it is addressed, tends to be similarly linked to these kinds of disease-specific critiques (Lock’s work on Alzheimer‘s, or Solimeo’s on Parkinson’s, e.g.), both as a way to focus the research subject and create a gateway to broader discussions of the intersection of medicine and age. I had not thought of it this way until I heard one of Josien de Klerk’s elderly Tanzanian interlocutors, who remarked, “aging is an illness!” Was this an indication of the increasing medicalization of normal age-related declines? Or was she inviting us to expand our ideas of illness to a broader field of everyday suffering in ways that can offer alternate frameworks for medical anthropology? I like to think it is, at least in part, the latter, and that anthropologists looking at aging are helping to deconstruct some of the taken for granted models of global health, and offer alternative perspectives that will become increasingly relevant as the world’s populations continue to grow older. So thank you to all of those who presented for the inspiration, and I look forward to many more MAGic’al meetings with many more AAGE members in the mix.