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.
一本不安的探索，揭示了全球健康的隱藏權力動態，透過兒童腹瀉及其在危地馬拉背景下的治療來觀察。
在高收入國家，兒童腹瀉導致的死亡似乎是荒謬的。然而，在世界其他地區，五歲以下的兒童中，腹瀉是第三大死亡原因。儘管有超過四十年的預防和治療計畫，這一最不光彩的全球健康問題仍然是一個關鍵挑戰。在《Underbelly》中，Rachel Hall-Clifford 深入探討了全球健康資金和發展政策的路徑，以及它們為受益個人和社區帶來的結果。Hall-Clifford 以在危地馬拉高地進行的十五年民族誌研究為基礎，專注於基層醫療服務的提供，作為全球健康和發展計畫失敗的關鍵範例。
作者解釋，危地馬拉擁有一個支離破碎的健康系統，雖然保障健康是一項人權，但也遭受系統性種族主義、健康服務不足及其可及性問題、因傷害和暴力遺留下的社區不信任，以及貶低性的父權主義。《Underbelly》結合了全球健康和醫學人類學的論述，探討了全球健康的行動者、結構和系統如何延續其所聲稱要解決的挑戰：這就是其隱秘的一面。Hall-Clifford 主張，全球健康計畫往往是在與其實施地點相距遙遠的辦公室中構思的，這些計畫常常會產生意想不到的後果，並促成多元化和排斥性的健康系統，這些系統反映了新自由主義經濟。她認為，如果我們要解決這一根深蒂固的健康不平等危機，就必須利用全球健康的巨大資源，將當地社區作為變革的推動者。
本書由原住民瑪雅醫療主任 Waleska López Canu 撰寫前言，並由全球健康知名專家 Arthur Kleinman 撰寫後記，強調了深入探討表面上看似無可爭辯的「好」事物的重要性，以理解現實生活中更複雜的真相。
Rachel Hall-Clifford is Assistant Professor of Human Health and Sociology at the Emory College of Arts and Sciences, Assistant Professor of Global Health at the Emory Rollins School of Public Health, and In-Country Director of the NAPA-OT Field School in Guatemala.
