The Legitimacy of Healthcare and Public Health : Anthropological Perspectives

The complex, highly problematic, often thorny dynamics of trust and authority are central to the anthropological study of legitimacy. In this book, this sine qua non runs across the in-depth examination of the ways in which healthcare and public health are managed by the authorities and experienced by the people on the ground in urban Europe, the USA, India, Africa, Latin America and the Far and Middle East. This book brings comparatively together anthropological studies on healthcare and public health rigorously based on in-depth empirical knowledge. Inspired by the current debate on legitimacy, legitimation and de-legitimation, the contributions do not refrain from taking into account the impact of the Covid-19 pandemic on the health systems under study, but carefully avoid letting this issue monopolise the discussion. This book raises key challenges to our understanding of healthcare practices and the governance of public health. With a keen eye on urban life, its inequalities and the ever-expanding gap between rulers and the ruled, the findings address important questions on the complex ways in which authorities gain, keep, or lose the public’s trust. Contents 6 Notes on Contributors 8 Chapter 1: Introduction: On Legitimacy, Healthcare and Public Safety 14 References 29 Chapter 2: Health Inequalities and Ethics of Responsibility: A Comparative Ethnography 31 Italy: A National or Regional Health Service? 33 Regional Disparities and “Health Migration”: A Vicious Circle 35 Variations of Professional Responsibility 39 The UK: A National Health System Across National Regions 41 NHS Trust, Charities and Patient Groups: A Symbiotic Relationship 44 A “Labour of Love”: The Role of Nurses 48 Pandemic Ruptures and “Broken” Public Health Systems 49 Conclusion: Resilience as a (Misleadingly) Legitimating Argument 51 References 53 Chapter 3: Misgovernance Kills: Italian Evidence 56 A Triple Whammy to the Ordinary Italian 57 Misgovernance Kills 1: Public Health Care from Right to Commodity to Privilege 59 Misgovernance Kills 2: Public Health Hazards 67 Misgovernance Kills 3: Ideologically Misguided Policies 69 A Blunt Note 76 References 77 Video Evidence — Examples 82 Chapter 4: The Fragility of Legitimacy: Access to Health Care in Manantali, Mali 83 Legitimacy in Health Care 84 Mali’s Health Care System 85 Legitimacy in the Early Years of Independence 85 Structural Adjustment and Innovation in Health Care 87 Health Care in Manantali 91 The Situation and Context 91 New Health Care Institutions 93 The Legitimacy of Manantali’s Health Institutions 97 Normative Legitimacy 97 Performance Legitimacy 98 Process Legitimacy 101 Conclusion 102 References 104 Chapter 5: “I Chose This ‘Other Way’”: An Ethnographic Approach to Medical Pluralism Within the Context of Greek Cancer Care 106 Introduction 106 Cancer and Medical Pluralism in Greece 108 The Construction of the Biomedical Subject 109 The Right to (the Right) Choice 111 The “Otherness” Within and During Medical Pluralism 114 The Dangerous “Other” and the Right of Choice 115 Medical Realities Revisited 118 References 118 Chapter 6: Covid-19 Pandemic, Hydroxychloroquine, and Healthcare System in Turkey 121 Introduction 121 A Miraculous Drug 124 A Bag of Pills 126 Drugs as Legal Rights 128 Legitimacy and Pills 132 Conclusion 134 References 135 Chapter 7: Negotiating Power over Human Bodies: Populism, People and the Politics of Health in Delhi 138 Introduction 138 Legitimacy of the Ruler 139 Populism and the BJP Regime 143 The Pandemic and Its Aftermath 146 To Conclude: How Legitimate Is the Present Regime? And for Whom? 153 References 155 Chapter 8: The Poverty of Opportunity: Where Are We Going; Where Have We Been 157 History Repeats Itself 158 The American Health Care System 159 Covid-19 and Poverty 161 The Long Hauler Search for Diagnosis and Treatment 162 Being Sick and Poor 171 Economics and the Search for Legitimate Treatment 173 Conclusion 175 References 175 Chapter 9: The Views of Selected Tennesseans on Universal Health Care as a Right 177 I Had a Dream 178 Story 1. House and Home 179 Story 2. So Sue Me 179 Story 3. Bad Teeth 179 Story 4. Brain Tumor 180 Story 5. Dying Little Girl 180 A Legitimate Right? 182 It Ain’t Necessarily So 185 Déjà Vu All Over Again: The Status Quo 186 Conclusions 186 References 188 Chapter 10: The Biopolitics of Complementary Spiritual Healing in South Korea and Israel 191 Healing Through Lived Religion: The Cosmological Perspective 195 The Healing Potential of Deceased Tsaddikim in Israel 196 The Healing Potential of Spirits and Gods in Korea 198 Healing Through Interaction with Healers: The Performative Aspect 201 The Healing Potential of Tsaddik Veneration in Israel 201 The Healing Potential of Spirit Possession Practices in Korea 204 Healing with and Without Doctors: The Interaction with Modern Medicine 206 Complementing Modern Medicine with Tsaddik Veneration in Israel 207 Complementing Modern Medicine with Shamanic Interventions in Korea 208 Conclusion 209 References 210 Chapter 11: Health Sovereignty in West-Central Mexico: Legitimacy from the Grassroots 212 Introduction 212 Food/Health Sovereignty 215 Top-Down Legitimacy in Mexico 216 Legitimacy and Grassroots Organizing 218 The Research Site 218 Field Methods 219 Talleres Verdes, Green Workshops 219 People 219 Community 221 Purpose 222 The Writing on the Wall 223 Discussion 223 Conclusion 225 References 225 Chapter 12: Disabled People and Access to the Labour Market: The Case of Greece 228 Introduction 228 Limited Citizenship 231 Methodology 235 People with Disabilities and the Labour Market 235 Unemployed People with Disabilities 236 People with Disabilities Employed in the Public Sector 239 People with Disabilities Employed in the Private Sector 240 Self-Employed People with Disabilities 243 Conclusions 244 References 248 Electronic Sources 249 Chapter 13: Managing Public Health in a Fragile Consociation: Lebanon Between Wars, Explosions and the Covid-19 Pandemic 250 Prologue 250 Introduction 252 Theorizing Consociational Legitimacy 254 Traversing the Risks of the Consociational (un)Order 256 Epilogue 264 References 265 Chapter 14: Interrogating the Public Health Approach: Lessons from the Field of Urban Violence 267 Introduction 267 Legitimacy and the Public Health Approach 268 Settings and Methods 273 Diagnosing Urban Violence 274 Treating Urban Violence 278 Recovery from Urban Violence 281 Conclusion 283 References 285 Chapter 15: Maintaining the Health of the Public: Containing the Threat of Terrorist Resurgence in Contemporary Peru 288 Sustaining the Recovery, Surveilling the Public 295 Antecedents 300 Coda 306 References 308 Newspapers 309 Index 310