《Underbelly：儿童腹泻和全球健康中的隐藏地方现实》

Rachel Hall-Clifford | 2024 | ISBN: 0262547767 | English | 282 pages | True PDF | 16 MB

An unsettling exploration of the hidden power dynamics of global health, seen through the lens of childhood diarrhea and its treatment within the Guatemalan context.

Deaths from childhood diarrhea seem preposterous in high-income countries. Yet, for children under five years old in the rest of the world, diarrhea is the third highest cause of mortality. Despite a glut of prevention and treatment programming spanning more than forty years, this least glamorous of global health ills remains a critical problem. In Underbelly, Rachel Hall-Clifford takes a hard look at the pathways of global health funding and development policies and the outcomes they deliver for recipient individuals and communities. Drawing on fifteen years of ethnographic research in highland Guatemala, Hall-Clifford focuses on the provision of primary health care services as a critical exemplar of how global health and development programs fall short.

Guatemala has a fragmented health system, the author explains, that guarantees health as a human right but also suffers from systemic racism, inadequate health services and access to those services, community distrust from a legacy of harm and violence, and a demeaning paternalism. Bringing together the discourses of global health and medical anthropology, Underbelly explores the ways in which global health—its actors, structures, and systems—perpetuates the challenges it purports to fix: this is the underbelly. Hall-Clifford argues that global health programs, conceived in offices distant from the places in which they are delivered, often have unintended consequences and contribute to pluralistic and exclusionary health systems that mirror neoliberal economies. She argues that if we are to fix this entrenched crisis of health inequity, we must use the immense resources of global health to center local communities as drivers of change.

With a foreword written by Waleska López Canu, an Indigenous Maya medical director, and an afterword by Arthur Kleinman, renowned expert in global health, this book underscores the importance of looking deeper into what seems on its surface incontrovertibly “good” to understand the more complex realities on the ground and in people's lives.

全球健康中隐藏的权力动态通过儿童腹泻及其治疗在危地马拉的视角进行了一次不安稳的探索。高收入国家里，由于儿童腹泻导致的死亡似乎不合逻辑。然而，在世界其他地方，对于5岁以下的孩子来说，腹泻是导致死亡的第三大原因。尽管过去四十余年中有大量的预防和治疗方法，但这个全球健康领域中最不显眼的问题仍然是一项关键性问题。 在《腹地》中，Rachel Hall-Clifford 严肃审视了全球健康资金与发展政策的路径及其对受助个体与社群产生的影响。她基于过去十五年关于中美洲高地危地马拉的民族志研究，在《腹地》中聚焦于初级医疗服务的提供，作为检验全球健康和发展项目未能达到预期效果的关键范例。 危地马拉拥有碎片化的医疗体系，该系统保证了人人都享有健康权，但同时也遭受系统性种族主义、不足的医疗服务及服务获取、从过去的伤害和暴力遗留下来的信任缺失，以及一种轻蔑的家长式管理。《腹地》结合了全球健康与医学人类学的话语，在探究全球健康——其参与者、结构和体系——是如何延续其所声称要解决的问题：这就是“腹地”。Hall-Clifford 认为，由远距离办公室构想出来的全球健康项目往往会产生意料之外的后果，并且会促进多元而排他的医疗系统，这与新自由主义经济模式相似。她认为，如果我们希望解决这种根深蒂固的卫生不公危机，我们有必要利用全球健康的巨大资源，将当地社区置于变革的核心位置。 由原住民玛雅医学总监Waleska López Canu撰写引言，并有诺贝尔健康专家Arthur Kleinman 编写尾声，本书强调了深入探索看似明显“正确”的事物的重要性，以理解地面上和人们生活中的更复杂现实。

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