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AIDS has been a devastating plague in much of sub-Saharan Africa, but the long-term implications for gender and sexuality are just emerging. This book tackles this issue head-on and examines how AIDS has altered the ways in which masculinity is lived in Uganda—a country known as Africa’s great AIDS success story. Based on over a decade of ethnographic research in an urban slum community called Bwaise, this book reveals the persistence of masculine privilege in the age of AIDS and the implications such privilege has for combating AIDS across the African continent.

Beautyscapes explores the rapidly developing global phenomenon of international medical travel, focusing specifically on patient-consumers seeking cosmetic surgery outside their home country and on those who enable them to access treatment abroad, including key figures such as surgeons and facilitators. Documenting the complex and sometimes fraught journeys of those who travel for treatment abroad, as well as the nature and power relations of the transnational IMT industry, this is the first book to focus specifically on cosmetic surgery tourism. A rich and theoretically sophisticated ethnography, Beautyscapes draws on key themes in studies of globalisation and mobility, such as gender and class, neoliberalism, social media, assemblage, conviviality and care, to explain the nature and growing popularity of cosmetic surgery tourism. The book challenges myths about vain and ill-informed travellers seeking surgery from ‘cowboy’ foreign doctors, yet also demonstrates the difficulties and dilemmas that medical tourists – especially cosmetic surgery tourists – face. Vividly illustrated with ethnographic material and with the voices of those directly involved in cosmetic surgery tourism, Beautyscapes is based on a large research project exploring cosmetic surgery journeys from Australia and China to East Asia and from the UK to Europe and North Africa.

This collection expands scholarly understandings of citizenship in an age in which the material body and its health, vitality, and natural and social environments not only create and discipline the citizen-subject, but also provide the conditions necessary for its recognition and political agency. Together, the chapters consider biocitizenship as a unique mode of biopolitical governance, but also as a response and sometimes a resistance to it. Looking closely at the ways in which the body and citizenship interanimate each other, the collection moves away from biocitizenship as a static form of biomedical subjectivity or category of belonging and redefines it as a dynamic and essential—sometimes generative, and sometimes limiting—element of biopolitics. The book has three primary goals: to serve as the first multidisciplinary forum on biocitizenship, bringing together a variety of voices from different fields (including voices from outside the academy); to redefine biocitizenship as a broad mode of political action linked to health, bodies, and life; and to critically interrogate both the “bio” and “citizenship” of biocitizenship.

The Politics of Metabolism analyses the racial ideas that underpin the metabolic syndrome as a new biomedical construction that aims to transform how contemporary medicine understands and treats metabolic health problems. It explains how metabolism serves as a site for the kind of society that simultaneously manufactures health problems and their remedies, deploys race as a way of concealing inequality, and constructs powerful ideas like metabolic syndrome to sever the relationship between body and society.

This book provides a history of the American natural and health foods industry and its leadership in the social movement oriented to spreading a natural foods way of life. The natural foods case is used to consider the broader question of what possibilities open up and what limits emerge when private enterprise is involved in movements advocating for broad-based social and cultural change. Beginning with the first American natural foods advocates in the early nineteenth century, and continuing to the early twenty-first century, this history shows how the leadership of the natural foods industry was central to transforming natural foods consumption from a culturally marginal activity associated with religious minorities, immigrants, the elderly, and the infirm, to a hip lifestyle associated with the young, the fit, and the affluent. In the process, industry helped lead the natural foods movement away from an emphasis on asceticism and simple living, and towards a valuation of indulgence and material comforts. The book argues that instead of acting as a singularly eradicalizing force, the natural and health foods industry reinforced the natural foods movement's often radical rejection of medical expertise. The natural foods case demonstrates that business interests promote a flexible approach to cultural meanings and symbols, which undermines cultural authority and catalyzes cultural change.

Care has been struggled for, resisted and celebrated. The failure to care in ‘care services’ has been seen as a human rights problem and evidence of malaise in contemporary society. But care has also been implicated in the oppression of disabled people and demoted in favour of choice in health and social care services. In this wide- ranging book Marian Barnes argues for care as an essential value in private lives and public policies. She considers the importance of care to well-being and social justice and applies insights from feminist care ethics to care work, and care within personal relationships. She also looks at ‘stranger relationships’, how we relate to the places in which we live, and the way in which public deliberation about social policy takes place. This book will be vital reading for all those wanting to apply relational understandings of humanity to social policy and practice.

Based on a multimethod study that centers on interviews with over 30 conservationists, field biologists, ecologists, paleontologists and over 3 years of my fieldwork on urban beaches in the New York City area, the Florida Keys, and international conferences, Catch and Release explores the interspecies relationships between humans and horseshoe crabs—our multiple sites of entanglement and enmeshment as we both come to matter. As I show, crabs and humans make each other in particular ways. Humans have literally harvested the life out of horseshoe crabs for multiple purposes; we interpret them for understanding geologic time, we bleed them for biomedical applications, we collect them for agricultural fertilizer, we eat them as delicacies, we rescue them for conservation, we capture them as bait, we categorize them as Endangered. In contrast, the crabs make humans matter by revealing our species vulnerability to endotoxins, offering opportunities for career opportunities and profiteering off of crab bodies, and fertilizing the soil of agricultural harvest for human food. In these acts of harvesting, I consider how horseshoe crabs and humans make meaning of events such as the Anthropocene (the epoch of geologic time that attributes climate change and species decline to human activities), global warming, and biomedical innovation.

There is constant pressure on hospitals to improve health care delivery and increase cost effectiveness. New initiatives are the order of the day in the dramatically different health care systems of the United States and Great Britain. Often these efforts are not successful. This book analyzes the successes and failures of efforts to improve hospitals and explains what factors make it likely that the implementation of reforms will be rewarded by positive transformation in a particular institution's day-to-day operation. The book's in-depth qualitative case studies of both top-down initiatives and changes first suggested by staff on the front lines of care point clearly to the importance of all hospital workers in effecting change and even influencing national policy. The book illuminates the critical role of workers, managers, and unions in enabling or constraining changes in policies and procedures and ensuring their implementation. It spotlights an Anglo-American model of hospital care and work organization, even while these countries retain their differences in access and payment. Entrenched professional roles, hierarchical workplace organization, and the sometimes-detached view of policymakers all shape the prospects for change in hospitals. The book provides important examples of how the dedication and imagination of the people who work in hospitals can make all the difference when it comes to providing quality health care even in a challenging economic environment.

For a generation, an intense debate has been waged over the expanding number of people who are diagnosed with a mental disorder and treated with prescription drugs such as Prozac and Adderall. One side, the psychiatric, sees progress. People suffering from mental illness are finally getting the treatment they need. The other side challenges the psychiatric perspective and the medicalization and treatment of common personality traits and forms of distress as mental disorders. Neither side has much to say about how people themselves explain their suffering and or envision a resolution. Chemically Imbalanced, based on interviews, explores this sense-making among people dealing with experiences of loss, disappointment, and underachievement. At the heart of distress is a gap between experience and valued standards and ideals of selfhood, and confusion over why things are not going as they should. People are in a predicament, and the book explores how many take up diagnostic categories, biological explanations, and pharmaceuticals as social objects and narratives to make sense of their situation and ameliorate it. These efforts reveal that a quiet but profound revolution in consciousness is underway. Ways of conceiving of suffering in terms of the mind, interpersonal experience, and social circumstances are being replaced with a thin and mechanistic language of the body/brain. The appeal of this “neurobiological imaginary,” the book argues, is not its explanatory power but in what it promises people they can be in our fluid and depthless culture. Despite the vaunted freedom, the imaginary has troubling and entrapping consequences.

This book focuses on the experiences and perspectives of children and young people who care for a parent with HIV in the global North and South. Drawing on in-depth qualitative research from the UK and Tanzania, it presents a unique insight into the similarities and differences in children' and parents' experiences across diverse socio-economic, cultural, and welfare contexts. The book makes a significant contribution to the growing research evidence on children and young people with caring responsibilities (‘young carers’) and the impacts of HIV and AIDS on families globally. It examines caring relationships within families affected by HIV and AIDS; the outcomes of caregiving; children‘s and families’ resilience; the factors influencing whether children become involved in care work; and local and global policy responses. The book also provides insight into the perspectives of parents living with HIV and service providers working with families.

To cut costs and maximize profits, hospitals in the United States and many other countries are outsourcing such tasks as cleaning and food preparation to private contractors. To examine this transformation in the healthcare industry, this book looks at the consequences of outsourcing from two perspectives: its impact on patient safety and its role in increasing socioeconomic inequality. The book argues that outsourcing has been disastrous for the cleanliness of hospitals—leading to an increased risk of hospital-acquired infections, a leading cause of severe illness and death—as well as for the effective delivery of other hospital services and the workers themselves. Interviews with the low-wage workers who keep hospitals running uncover claims of exposure to near-constant risk of injury and illness. Many report serious concerns about the quality of the work due to understaffing, high turnover, poor training and experience, inadequate cleaning supplies, and on-the-job injuries. The book also presents policy recommendations for improving patient safety by reducing the risk of hospital-acquired infection and ameliorating the work conditions and quality of life of hospital support workers. It makes the case that hospital outsourcing exemplifies the trend towards “low-road” service-sector jobs that threatens to undermine society's social health, as well as the physical health and well-being of patients in health care settings globally.

The natural world is marked by an ever-increasing loss of varied habitats, a growing number of species extinctions, and a full range of new kinds of dilemmas posed by global warming. At the same time, humans are also working to actively shape this natural world through contemporary bioscience and biotechnology. This book posits that cloned endangered animals in zoos sit at the apex of these two trends, as humans seek a scientific solution to environmental crisis. Often fraught with controversy, cloning technologies significantly affect our conceptualizations of and engagements with wildlife and nature. By studying animals at different locations, the book explores the human practices surrounding the cloning of endangered animals. Ultimately, the book concludes that the act of recalibrating nature through science is what most disturbs us about cloning animals in captivity, revealing that debates over cloning become, in the end, a site of political struggle between different human groups. Moreover, the book explores the implications of the social role that animals at the zoo play in the first place—how they are viewed, consumed, and used by humans for our own needs. A unique study uniting sociology and the study of science and technology, the book demonstrates just how much bioscience reproduces and changes our ideas about the meaning of life itself.

Americans come together to fight diseases. For over 100 years, they have asked their neighbors to contribute to disease campaigns and supported health policies that target one disease at a time. Common Enemies asks why disease campaigns are the battles Americans can agree to fight, why some diseases attract more attention than others, and how fighting one disease at a time changes how Americans distribute charitable dollars, prioritize policies, and promote health. Drawing on the first comprehensive data on thousands of organizations targeting hundreds of diseases over decades, the author shows that disease campaigns proliferate due to the perception of health as a universal goal, the appeal of narrowly targeted campaigns, and the strategic avoidance of controversy. They funnel vast sums of money and attention to a few favored diseases, and they prioritize awareness campaigns and medical research over preventing disease and ensuring access to healthcare. It’s easy to imagine more efficient ways to promote collective well-being. Yet the same forces that limit the potential of individual disease campaigns to improve health also stimulate the vast outpouring of money and attention. Rather than displacing attention to other problems, disease campaigns build up the capacity to address them.

The odyssey of Depo-Provera is a study of the politics of contraceptive drug risk management, which involves a lengthy struggle over the scientific assessment of the drug's health risk and acceptability of the injectable drug's use. In this struggle, the FDA, the federal government's drug licensing agency, has limited authority to manage the drug's risk and is one participant in a fragmented system of drug risk management that includes The Upjohn Company, physicians, and state judges and legislators. Depo-Provera's odyssey joins its national controversy over its contraceptive approval to its state civil and criminal legal experiences, which take the form of three overlapping stories told by Judith Weisz, Anne MacMurdo, and Roger Gauntlett. At the center of each of their stories is a trial.Judith Weisz chaired the FDA's Depo-Provera Public Board of Inquiry, a science court; Anne MacMurdo was the plaintiff in a state products liability suit against The Upjohn Company; and Roger Gauntlett, the defendant in a state statutory rape trial. Together their stories join the twenty-five-year national controversy over Upjohn's FDA application to have the drug licensed as a female contraceptive to the state medical malpractice and products liability issues raised by its contraceptive use and the criminal justice issues raised by its use as a probation and parole condition for sex offenders. Together they tell a collective story that provides an agenda for the principal participants to more effectively manage Depo-Provera's health risk and for the FDA to seriously consider banning the drug.

Trauma is a universal human experience. While each person responds differently to trauma, its presence in our lives nonetheless marks a continual thread through human history and prehistory. In Critical Trauma Studies, a diverse group of writers, activists, and scholars of sociology, anthropology, literature, and cultural studies reflects on the study of trauma and how multidisciplinary approaches lend richness and a sense of deeper understanding to this burgeoning field of inquiry. The original essays within this collection cover topics such as female suicide bombers from the Chechen Republic, singing prisoners in Iranian prison camps, sexual assault and survivor advocacy, and families facing the devastation of Hurricane Katrina. As it proceeds, Critical Trauma Studies never loses sight of the way those who study trauma as an academic field, and those who experience, narrate, and remediate trauma as a personal and embodied event, inform one another. Theoretically adventurous and deeply particular, this book aims to advance trauma studies as a discipline that transcends intellectual boundaries, to be mapped but also to be unmoored from conceptual and practical imperatives. Remaining embedded in lived experiences and material realities, Critical Trauma Studies frames the field as both richly unbounded and yet clearly defined, historical, and evidence-based.

Delivering babies was merely one aspect of the broad role of African American midwives in the twentieth-century South. Yet little has been written about the type of care they provided, or how midwifery and maternity care evolved under the increasing presence of local and federal health care structures. Using evidence from nursing, medical, and public health journals of the era; primary sources from state and county departments of health; and personal accounts from varied practitioners, Delivered by Midwives: African American Midwifery in the Twentieth-Century South provides a new perspective on the childbirth experience of African American women and their maternity care providers during the twentieth century. Moving beyond the usual racial dichotomy, the monograph exposes a more complex shift in childbirth culture to reveal the changing expectations and agency of African American women in their rejection of a two-tier maternity care system, and their demands to be part of an inclusive, desegregated society. This book identifies valuable aspects of a maternity care model that were discarded in the name of progress. Today concern about maternal mortality and persistent racial disparities have forced a reassessment of maternity care and elements of the long-abandoned care model are being reincorporated into modern practice, answering current health care dilemmas by heeding lessons from the past.

What distinguishes this book from the current literature is its analysis of malnutrition and its meticulous exploration of dietary transition, poverty nutrition traps and links between multiple anthropometric failures among children and their vulnerability to infectious diseases. It also explores the abysmal performance of the Public Distribution System and critiques its conversion into a universal food subsidy, investigates the links between affluence, obesity and non-communicable diseases (NCDs), and explores the health policy challenge of a ‘double burden of disease’: high communicable disease mortality and a growing burden of NCD mortality. It is puzzling that calorie intake has declined, despite rapid economic growth. An explanation is developed that encompasses the influences of food prices, growing affluence, urbanization, lifestyle changes and less strenuous activity levels. Dietary diversification had a role in lowering calorie intake. New light is shed on poverty nutrition traps that limit the ability of the undernourished to engage in productive and remunerative employment. Child malnutrition has remained stubbornly high. As simultaneous anthropometric failures among children (for example, wasting, stunting, and being underweight) are closely related to infectious diseases, a composite indicator of malnutrition, its variations and links to infectious diseases are analysed. Amelioration of child malnutrition through women’s empowerment is emphasised. As an epidemiological transition is underway—higher deaths from chronic degenerative non-communicable diseases (NCDs) than from communicable diseases—key contributory factors are aging, affluence, and being overweight/obese. Health policy choices are, however, confounded by the irreversibility of growing affluence, lifestyle changes and urbanization. Although controversial, a universal food subsidy was legislated recently as the National Food Security Act (NFSA). The critique rests on huge leakages that will magnify under NFSA and aggravate fiscal deficit without a drastic overhaul of the PDS. A distillation of lessons from policies pursued elsewhere and various initiatives in India is given. The vision that emerges is unavoidably incomplete in some respects, but illuminates successes and failures in designing and implementing policies.

Infectious disease is the most common cause of illness and death in Africa, yet health practitioners routinely fail to identify causative microorganisms in most patients. As a result, patients often do not receive the right medicine in time to cure them promptly even when such medicine is available, outbreaks are larger and more devastating than they should be, and the impact of control interventions is difficult to measure. Wrong prescriptions and prolonged infections amount to needless costs for patients and for health systems. This book argues that laboratory diagnostics are essential to the effective practice of medicine in Africa. The diversity of endemic life-threatening infections and limited public health resources in tropical Africa make the need for basic laboratory diagnostic support even more acute than in other parts of the world. This book gathers compelling case studies of inadequate diagnoses of diseases ranging from fevers to respiratory infections and sexually transmitted diseases. The inherited and widely prevalent health clinic model, which excludes or diminishes the hospital laboratory, is flawed, to often devastating effect. Fortunately, there are new technologies that make it possible to inexpensively implement testing at the primary care level. The book makes clear that routine use of appropriate diagnostic support should be part of every drug-delivery plan in Africa and that diagnostic development should be given high priority.

Equity and Access attempts to unravel the complex narrative of why inequities in the health sector are growing and access to basic health care is worsening, and the underlying forces that contribute to this situation. It draws attention to the way globalization has influenced India’s development trajectory as health care issues have assumed significant socio-economic and political significance in contemporary India. The volume explains how state and market forces have progressively heightened the iniquitous health care system and the process through which substantial burden of meeting health care needs has fallen on the individual households. Twenty-eight scholars comprising social scientists, medical experts, public health experts, policy makers, health activists, legal experts, and gender specialists have delved into the politics of access for different classes, castes, gender, and other categories to contribute to a new field of ‘health care studies’ in this volume. Adopting an interdisciplinary approach within a broader political-economy framework, the volume is useful for understanding power relations within social groups and complex organizational systems.

In the wake of the AIDS pandemic, legions of organizations and compassionate individuals descended on Africa from faraway places to offer their help and save lives. This book shows how the dreams of these altruists became entangled with complex institutional and human relationships. The book describes the often mismatched expectations and fantasies of those who seek to help, of the villagers who desperately seek help, and of the brokers on whom both Western altruists and impoverished villagers must rely. Based on years of fieldwork in the heavily AIDS-affected country of Malawi, this book digs into the sprawling AIDS enterprise and unravels the paradoxes of AIDS policy and practice. All who want to do good—from idealistic volunteers to world-weary development professionals—depend on brokers as guides, fixers, and cultural translators. These irreplaceable but frequently unseen local middlemen are the human connection between altruists' dreams and the realities of global philanthropy. Personal stories, public scandals, and intersecting, sometimes clashing fantasies bring the lofty intentions of AIDS altruism firmly down to earth. The book ultimately argues that altruists could accomplish more good, not by seeking to transform African lives but by helping Africans achieve their own goals. It unveils the tangled relations of those involved in the collective struggle to contain an epidemic.