Prof Mohan gave his views on how Singapore can enhance the engagement between the government and its citizens, especially in the context of key policy schemes such as CPF and Medishield Life in a Channel NewsAsia news coverage. Click on the image to access the article and the video.
As part of CARE, our team member Asha Rathina Pandi had the privilege to interview our visitor this summer, Professor Charles Leslie Briggs, the Alan Dundes Distinguished Professor of Folklore at University of California, Berkeley. Renowned globally as a leader in medical anthropology, Professor Briggs’ work on biocommunicability offers novel insights into the social construction processes through which the news media produce, circulate and reify knowledge and discourse about health, life, disease and death. Exploring the intersections of communication and biomedicine, he offers insights into communicative processes through which meanings are assigned to biological phenomena and ways in which these meanings are mobilised within the broader structures of power.
Background I am from the US, born and raised in Albuquerque, New Mexico, a small city with a population of about 500,000, located along the border of US and Mexico, which has indigenous population and also the descendants of people who were Mexican citizens before the US took over. I grew up in the North Valley, a section with a strong working class Latino/Latina population. I learnt Spanish, even though many of my Latinos/Chicanos friends did not know Spanish, a result of the forms of linguistic discrimination that is common in the United States. This situation prompted me to think about linguistic inequalities and associated forms of discrimination. When I was in high school and college, I was a radio disc jockey – radio announcer. Later, living in the northern part of the state, I became the first non-Hispanic, Spanish-speaking jockey in New Mexico. I became interested in issues of language and inequality – what happened to indigenous and Spanish-speaking people when their land was taken away. What happened when people were forced to speak English, such as in schools? Could we call this a loss of linguistic rights? I worked as community activist in Spanish-speaking communities; my training in anthropology helped me learn skills that aided in figuring out ways to bring oral testimonies to help in court cases that dealt with rights to land. Research Interests In New Mexico, how people used the different communicative forms to shape their own identities and their positions within the world, particularly as people who were denied their own history. In court cases, lawyers and state officials enjoyed privileged access to the documents, and in some cases crucial documents disappeared after the United States annexed the area in the mid-nineteenth century. People had powerful stories to tell – some recounted who had owned each piece of land and what they had done with the land – since the eighteenth century. There were powerful ways that people talked about collective views of working the land and fighting for community rights, as oppose to get-ahead individual motivations taught in the school. People also used stories, proverbs, jokes and other forms question the political practices that were used to marginalize the population. Linguistic and medical anthropology are two fields that seldom in dialogue. When people talked about language, health seldom comes up and vice-versa, except for with respect to a few topics, classically “doctor-patient interaction.” I am interested in that gap and trying to create productive dialogues. Health communication, in my view, lies at the centre here. Since 1986, I have worked primarily in Latin America, but also in various parts of the United States. Interest in Health News I began conducting research in 1986 with indigenous people, called Warao, in a rainforest in eastern Venezuela. Health conditions that are very bad due to the lack of potable water and sewage facilities; a fluvial area, it can take a long time to get to the clinic by padding a canoe. In 1992-1993, a cholera epidemic killed hundreds of people there. Arriving in the middle of the epidemic, I decided that if my research were ever going to be of real value, that was the moment. I began working with Dr. Clara Mantini, a Venezuelan public health physician, helping to set up small health projects, and we did research and health communication throughout the 40,000 km. area. One thing we noted, both nationally and in this region, was the public health officials had collaborated closely with journalists in “educating the public” about cholera. Nevertheless, they constructed a narrative that blamed low-income residents of urban barrios (informal communities), street vendors of food and drink and indigenous people for being cholera vectors. This story—which was constructed before any cases appeared in Venezuela—deepened stereotypes and social inequalities at the same time that it seemed to make actual epidemiological research seem unnecessary. I wanted to learn more about the power of media coverage and how it involves clinicians, public health practitioners, researchers, journalists, social movement organizations, and more. Thus, starting in 1993, I began thinking more broadly about why newspapers, television and radio stations are saturated with news on health. I began working with Dr Dan Hallin, a leading scholar in journalism, especially political news. We have been exploring these questions ever since: What is knowledge about health? Where does it come from? Who produces it? How does it move through the world? How can it legitimately circulate? Who are the audiences? Who should be listening? And what do they have to do? Most of us are considered passive receivers of health knowledge rather than producers. Health communication has been traditionally viewed as top-down and vertically-organized. My experience suggests that when health communication is organized in this fashion, it may reproduce power hierarchies, but it generally fails to address health problems or redress health inequities. Or, a market-oriented version suggests that it is all up to us! We are projected as consumers of both health information and health products, as processing the information we encounter in a broad range of sites, including the Internet, social media, and the “traditional media,” the basis of our own self-interest. Both approaches deny laypersons the status of being producers of health news, and having the right to critique the models of health that we’re given. Here’s the point: all of us produce valuable knowledge about health! So Hallin and I began with working with scholars in Latin America, especially Ecuador, Cuba, Argentina, Venezuela, the US, and elsewhere on health news. Our research led us to collaborate with journalists, public health officials, clinicians, and a range of populations, including immigrants, racialized groups, documenting and analysing the ideological work performed in each health news story of teaching basic conceptions of what health is and who possesses this knowledge. We also looked at what it means to be a health subject and how information and medical technologies are involved. Example of Project involving a Marginalized Community Let’s return to the example of the Warao people in Delta Amacuro State, where 26 percent of children die before they reach the age of 5. This figure should not allow us to sleep peacefully at night! It was emotional to see mothers mourning, struggling to save their children’s lives. Then came cholera. A well-known specialist at the International Centre for Diarrhoeal Disease Research, Bangladesh suggested that there are two places in the world that are most propitious for the emergence of a cholera epidemic: The Delta in Bangladesh and Delta Amacuro in Venezuela. Nevertheless, almost no preparations were made to prevent a cholera epidemic in Delta Amacuro prior its sudden beginning in July, 1992. Cholera can kill a healthy adult in 8 hours after the first symptom is felt. The high morbidity and mortality reflected structural conditions, but the end result was that people were stigmatized and blamed for the massive deaths. Our book, Stories in the time of cholera, talks about communicative inequalities and health inequalities that came together in the time of cholera. Expansion of Research With respect to the media and health project, Dr. Hallin and I are beginning to collaborate on comparative work in Europe, and we have spoken with researchers in Hong Kong. Our goal is to partner with scholars in health, communication, and media in these places. Work prior to 1986 I was an academic teacher, teaching in anthropology department focusing on language and cultural differences, forms of discriminations, and health issues, primarily working on land and language rights issues in New Mexico. I was trained as an undergraduate in a combination of philosophy, psychology and anthropology. At the University of Chicago, I explored linguistics and social/cultural anthropology. Languages I speak Spanish, English, also learned an indigenous language Warao; I can read French, German, and Portuguese. Interest in NUS I have been reading work of Prof. Mohan Dutta for years. His work on the culture-based critical approach to health communication, with its roots in subaltern and postcolonial study, has influenced my own work. I think that we are both interested in questions of how connections between biomedicine and health inequalities are produced. We both ask: what is the best means of delivering information, not in the sense of a hypodermic delivery of content but in advancing issues of justice and equity overall? I think we share a commitment to re-thinking how health communication is part of a larger social justice agenda and how that research should be connected with social change oriented always interventions. Research plan at NUS A concrete research agenda is emerging from my discussions with Prof. Dutta; we are rethinking basic ideas and texts, why and how we create boundaries between people in communication and anthropology and other disciplines, between academics and non-academics, especially people who are developing creative approaches through their active efforts to confront acute health inequities and pressing problems. This kind of collaboration involves working closely with people who are not professionals. How we might produce dialogues outside of academic world – journals, books but would be along with communities that have amazing ideas? We are thinking about creating videos that might reach a broader range of audiences than academic publications. One of my sources of inspiration is a program that arose in Caracas, the capital of Venezuela, after President Hugo Chávez Frías inspired a socialist revolution in 1999. At that time, approx. 60 percent of people were living in poverty, and they had limited access to healthcare. Privatization, the tremendous push to market health as a commodity, had debilitated the public system. For 3 years Chávez tried to strengthen public health services, but he was unsuccessful in getting the Health Ministry to work effectively with low-income families. In 2003, in a shanty town in Caracas, a global poverty theorist from the Central University of Venezuela worked with barrio residents, jointly generated creative dialogues, facilitated by the community workers who were from the poor families in these areas and had received a university education; these discussions took place in some of the poorest communities themselves. They researched conditions and brainstormed ideas, not through a top-down or a bottom-up approach, but one that was horizontally-organized. People focused centrally on how to reorganize healthcare by having doctors live in the communities and collaborate with community members to think about health, health delivery and prevention strategies. Few Venezuelan doctors were willing to live and work in barrios, so they collaborated with the Cuban Embassy to recruit Cuban physicians. Some 50 doctors came initially. People were immediately impressed with the respectful, horizontal way they interacted with their patients, not talking down to them. The doctors worked closely with laypersons who participated in local Health Committees, both in the clinic and throughout the neighbourhood, making decisions about how to organize the daily work of healthcare. This project is called Mission Barrio Adentro, and it helped spark ideas about how to transform global health through collaborations between a range of different actors, dialogues across disciplines, across boundaries between experts and non-experts, and also define health as a fundamental social right, not just as a commodity. I am very interested in thinking about how to weave progressive practices of health communication into such efforts. Advice to students of CNM Often in schools of public health, health communication is seen as an easy track. But that is a mistake! To do it well, you have to be able to learn a lot about how medicine and public health work, the heterogeneous and shifting ideologies and practices that guide work in these areas. At the same time, we need to know the fields of communication exceptionally well, including people’s shifting conceptions of what media are, what new media are, and how they work. And then, more challenging still, is the need to figure out how the two come together in particular contexts, and to document the effects of these intersections on different people, including how they reproduce and/or confront the social inequalities that seem to be deepening everywhere. I think that ethnography is extremely valuable here, particularly in exploring what people do in their daily lives, including with medical and technologies. [End of Interview]
With the recent Israel intervention in Palestine being reported by American news anchor Diane Sawyer, Dr Mohan analyses how this news coverage was framed in the context of how mainstream media becomes the instrument of propaganda for those in power.
In this week’s “CCA Concept Series” video, Dr Mohan talks about the interaction between culture and structures and why we need to understand how structures determine the way culture gets to be formed, reproduced and expressed in his paper “A Culture-Centred Approach to Listening: Voices of Social Change“. You can access the article here.