Melissa Parker | London School of Hygiene & Tropical Medicine (original) (raw)
Papers by Melissa Parker
Policymakers and practitioners should beware of inadequacies in the World Health Organisation’s r... more Policymakers and practitioners should beware of inadequacies in the World Health Organisation’s recent assessment of mental health in conflict settings. While raising the profile of these issues, by universalising mental disorder classifications across cultures a simplified understanding might harm the roll-out of effective therapies, leading to the question: what would increased and scaled-up interventions actually achieve? Based on a paper in Anthropology Today, this is the first in a two-part series on the anthropology behind ‘trauma’ in war-affected and post-conflict settings.
The term ‘neglected tropical diseases’ (NTDs) points to the need for a biosocial perspective. Alt... more The term ‘neglected tropical diseases’ (NTDs) points to the need for a biosocial perspective. Although ‘diseases’ are widely understood as biological phenomena, ‘neglect’ is inherently social. Social priorities, social relations and social behaviour profoundly influence the design, implementation and evaluation of control programmes. Yet, these dimensions of neglect are, themselves, neglected. Instead, emphasis is being placed on preventive chemotherapy – a technical, context-free approach which relies almost entirely on the mass distribution of drugs, at regular intervals, to populations living in endemic areas. This article reflects on the processes which have enabled an NTD ‘brand’ identity to emerge, and it comments on a disquieting disengagement with some of the more critical insights about the consequences of mass drug administration. Building on the work of biosocial scholars studying other aspects of health and disease, a more adequate, evidence-based approach is delineated....
Disasters
Discussions of African responses to Covid-19 have focussed on the state and its international bac... more Discussions of African responses to Covid-19 have focussed on the state and its international backers. Far less is known about the role of a wider range of public authorities, including chiefs, professional associations, faith-based and civil society organisations, humanitarians, criminal gangs, local security services and armed groups. We begin to fill this gap by investigating how the pandemic provided opportunities for claims to and contests over power in areas of the Democratic Republic of the Congo, Uganda and South Sudan. Ethnographic research is used to argue that local forms of public authority can be akin to miniature sovereigns, able to interpret dictates, policies, and advice as they see fit. It reveals how alongside coping with existing complex protracted crises, many try to advance their own agendas and secure political, social, and material benefits. However, it also shows how those they seek to govern do not passively accept the new normal, instead often finding room to challenge those in positions of power and influence. We assess which, if any, of these actions and reactions will have lasting effects on local notions of statehood and argue for the utility of a public authorities lens in times of crisis. This article is protected by copyright. All rights reserved.
Medical Anthropology
It is unclear how public authorities shaped responses to Ebola in Sierra Leone. Focusing on one v... more It is unclear how public authorities shaped responses to Ebola in Sierra Leone. Focusing on one village, we analyze what happened when "staff, stuff, space, and systems" were absent. Mutuality between neighbors, linked to secret societies, necessitated collective care for infected loved ones, irrespective of the risks. Practical learning was quick. Numbers recovering were reported to be higher among people treated in hidden locations, compared to those taken to Ebola Treatment Centres. Our findings challenge positive post-Ebola narratives about international aid and military deployment. A morally appropriate people's science emerged under the radar of external scrutiny, including that of a paramount chief.
Journal of Biosocial Science, 2016
Many of the articles published in this special issue were presented at a workshop organised under... more Many of the articles published in this special issue were presented at a workshop organised under the auspices of the Biosocial Society in July 2013 at the Royal Anthropological
Journal of Biosocial Science, 2016
SummaryRecent debates about deworming school-aged children in East Africa have been described as ... more SummaryRecent debates about deworming school-aged children in East Africa have been described as the ‘Worm Wars’. The stakes are high. Deworming has become one of the top priorities in the fight against infectious diseases. Staff at the World Health Organization, the Gates Foundation and the World Bank (among other institutions) have endorsed the approach, and school-based treatments are a key component of large-scale mass drug administration programmes. Drawing on field research in Uganda and Tanzania, and engaging with both biological and social evidence, this article shows that assertions about the effects of school-based deworming are over-optimistic. The results of a much-cited study on deworming Kenyan school children, which has been used to promote the intervention, are flawed, and a systematic review of randomized controlled trials demonstrates that deworming is unlikely to improve overall public health. Also, confusions arise by applying the term deworming to a variety of v...
Social Science & Medicine, 1992
Schistosoma mansoni is often perceived by governments and international aid agencies to present a... more Schistosoma mansoni is often perceived by governments and international aid agencies to present a major public health problem in the tropical and subtropical world. This perception persists in spite of the fact that biomedical practitioners and research workers disagree about the nature and extent of disease and disability caused by schistosomes. This paper raises the question of whether S. mans& should continue to be given priority as a public health problem in Gezira Province, Sudan. Biomedical and continuous observational data are blended with ethnographic information in order to develop a more integrated picture of the impact of S. mansoni on daily activity patterns among women. Research took place in one village in the Gezira/Managil irrigation scheme. The study is characterized by a small sample and a paired design. That is, 11 infected women were paired with 11 uninfected women. These women were engaged in agricultural activities in the cotton picking season and they were matched for a wide range of social and economic factors that might otherwise have affected their working activities. Observations were conducted on a minute by minute basis in the cotton fields. These data, in combination with ethnographic information and data indicating female productive output, showed that infection with S. mansoni significantly altered activity patterns in the cotton fields. That is, infected women (with an arithmetic mean egg output of 1958 eggs/g) attempted to pick as much cotton as possible in the shortest time period feasible in the morning. This pattern was partially repeated by infected women who returned to the fields in the afternoon. However, a significant number of infected women felt too weak to sustain this work regime and the economic implications of this finding are discussed. Finally, Fisher's exact probability test showed that infected women were significantly less likely to undertake persona1 care activities between cotton picking sessions and this result suggests they may have been too tired and/or had a diminished perception of their own well-being. The implications of these results for public health policy in Gezira Province are discussed.
Learning from HIV and AIDS, 2003
Anthropological reflections on HIV prevention strategies: the case for targeting London's ba... more Anthropological reflections on HIV prevention strategies: the case for targeting London's backrooms MELISSA PARKER Introduction Eight years ago the anthropologist Ralph Bolton (1995: 289) wrote: 'Prevention efforts have enjoyed limited success-behaviours have changed to ...
Learning from HIV and AIDS, 2003
This disease is not like any other. .. in the 20 years since the disease was recognised, more tha... more This disease is not like any other. .. in the 20 years since the disease was recognised, more than 20 million people have died from it. Another 40 million are infected. New infections are occurring at the rate of 15,000 a day, and the rate is still increasing. Unless there is a significant change for the better almost all these people will die. The Economist, July 11th 2002 1 [A]t current infection rates, AIDS, the deadliest epidemic in human history, will kill 68 million people in the 45 most affected countries over the next 20 years. . .
Journal of General Internal Medicine, 2010
Journal of Biosocial Science, 2006
The Journal of Biosocial Science regularly publishes papers addressing the social and cultural as... more The Journal of Biosocial Science regularly publishes papers addressing the social and cultural aspects of disease, sickness and well-being. Most of these papers attempt to understand the prevalence and distribution of disease and sickness within and between populations as well as local responses to biomedical interventions and public health policy more generally. They fall broadly within the remit of human ecology; and they embrace a ‘factorial’ model of disease in which social and cultural factors are deemed to be just one of a number of factors to be considered alongside a range of other factors. These include biological features of the infecting organism; nutritional factors; environmental factors; psychological factors; and genetic factors influencing susceptibility to disease at an individual and population level.
Health Research Policy and …, 2011
Ethnographic research was undertaken over a period of four years between 2005-2009 in north-west ... more Ethnographic research was undertaken over a period of four years between 2005-2009 in north-west and south-east Uganda. In addition to participant observation, survey data recording self-reported take-up of drugs for schistosomiasis, soil-transmitted helminths and, where ...
Africa, 1995
Female circumcision is practised in more than twenty African countries as well as in a number of ... more Female circumcision is practised in more than twenty African countries as well as in a number of countries in the Middle East, and it has been estimated that at least 100 million females have been circumcised worldwide. It is striking, however, that much more concern has been expressed about female circumcision than about other operations or infections which adversely affect the reproductive health of women. In the academic arena, it is also interesting that gynaecologists, epidemiologists and anthropologists have tended to focus on a relatively small number of questions, and even these have rarely been investigated in any depth. This article focuses on the work of researchers from Europe and North America in order to show that intense emotions underlie this interest and concern. Amidst growing interest in the anthropology of emotions it is suggested that greater attention should be paid to understanding the source of these emotions and the way in which they influence fieldwork and ...
Journal of Biosocial Science, 2016
SummaryThe term ‘neglected tropical diseases’ (NTDs) points to the need for a biosocial perspecti... more SummaryThe term ‘neglected tropical diseases’ (NTDs) points to the need for a biosocial perspective. Although ‘diseases’ are widely understood as biological phenomena, ‘neglect’ is inherently social. Social priorities, social relations and social behaviour profoundly influence the design, implementation and evaluation of control programmes. Yet, these dimensions of neglect are, themselves, neglected. Instead, emphasis is being placed on preventive chemotherapy – a technical, context-free approach which relies almost entirely on the mass distribution of drugs, at regular intervals, to populations living in endemic areas. This article reflects on the processes which have enabled an NTD ‘brand’ identity to emerge, and it comments on a disquieting disengagement with some of the more critical insights about the consequences of mass drug administration. Building on the work of biosocial scholars studying other aspects of health and disease, a more adequate, evidence-based approach is deli...
Social Science & Medicine, 2022
Global debates about vaccines as a key element of pandemic response and future preparedness in th... more Global debates about vaccines as a key element of pandemic response and future preparedness in the era of Covid-19 currently focus on questions of supply, with attention to global injustice in vaccine distribution and African countries as rightful beneficiaries of international de-regulation and financing initiatives such as COVAX. At the same time, vaccine demand and uptake are seen to be threatened by hesitancy, often attributed to an increasingly globalised anti-vaxx movement and its propagation of misinformation and conspiracy, now reaching African populations through a social media ‘infodemic’. Underplayed in these debates are the socio-political contexts through which vaccine technologies enter and are interpreted within African settings, and the crucial intersections between supply and demand. We explore these through a ‘vaccine anxieties’ framework attending to both desires for and worries about vaccines, as shaped by bodily, societal and wider political understandings and experiences. This provides an analytical lens to organise and interpret ethnographic and narrative accounts in local and national settings in Uganda and Sierra Leone, and their (dis)connections with global debates and geopolitics. In considering the socially-embedded reasons why people want or do not want Covid-19 vaccines, and how this intersects with the dynamics of vaccine supply, access and distribution in rapidly-unfolding epidemic situations, we bring new, expanded insights into debates about vaccine confidence and vaccine preparedness.
Journal of biosocial science, 2008
Summary. A strong case has recently been made by academics and policymakers to develop national p... more Summary. A strong case has recently been made by academics and policymakers to develop national programmes for the integrated control of Africa's 'neglected tropical diseases'. Uganda was the first country to develop a programme for the integrated control of two of these ...
Policymakers and practitioners should beware of inadequacies in the World Health Organisation’s r... more Policymakers and practitioners should beware of inadequacies in the World Health Organisation’s recent assessment of mental health in conflict settings. While raising the profile of these issues, by universalising mental disorder classifications across cultures a simplified understanding might harm the roll-out of effective therapies, leading to the question: what would increased and scaled-up interventions actually achieve? Based on a paper in Anthropology Today, this is the first in a two-part series on the anthropology behind ‘trauma’ in war-affected and post-conflict settings.
The term ‘neglected tropical diseases’ (NTDs) points to the need for a biosocial perspective. Alt... more The term ‘neglected tropical diseases’ (NTDs) points to the need for a biosocial perspective. Although ‘diseases’ are widely understood as biological phenomena, ‘neglect’ is inherently social. Social priorities, social relations and social behaviour profoundly influence the design, implementation and evaluation of control programmes. Yet, these dimensions of neglect are, themselves, neglected. Instead, emphasis is being placed on preventive chemotherapy – a technical, context-free approach which relies almost entirely on the mass distribution of drugs, at regular intervals, to populations living in endemic areas. This article reflects on the processes which have enabled an NTD ‘brand’ identity to emerge, and it comments on a disquieting disengagement with some of the more critical insights about the consequences of mass drug administration. Building on the work of biosocial scholars studying other aspects of health and disease, a more adequate, evidence-based approach is delineated....
Disasters
Discussions of African responses to Covid-19 have focussed on the state and its international bac... more Discussions of African responses to Covid-19 have focussed on the state and its international backers. Far less is known about the role of a wider range of public authorities, including chiefs, professional associations, faith-based and civil society organisations, humanitarians, criminal gangs, local security services and armed groups. We begin to fill this gap by investigating how the pandemic provided opportunities for claims to and contests over power in areas of the Democratic Republic of the Congo, Uganda and South Sudan. Ethnographic research is used to argue that local forms of public authority can be akin to miniature sovereigns, able to interpret dictates, policies, and advice as they see fit. It reveals how alongside coping with existing complex protracted crises, many try to advance their own agendas and secure political, social, and material benefits. However, it also shows how those they seek to govern do not passively accept the new normal, instead often finding room to challenge those in positions of power and influence. We assess which, if any, of these actions and reactions will have lasting effects on local notions of statehood and argue for the utility of a public authorities lens in times of crisis. This article is protected by copyright. All rights reserved.
Medical Anthropology
It is unclear how public authorities shaped responses to Ebola in Sierra Leone. Focusing on one v... more It is unclear how public authorities shaped responses to Ebola in Sierra Leone. Focusing on one village, we analyze what happened when "staff, stuff, space, and systems" were absent. Mutuality between neighbors, linked to secret societies, necessitated collective care for infected loved ones, irrespective of the risks. Practical learning was quick. Numbers recovering were reported to be higher among people treated in hidden locations, compared to those taken to Ebola Treatment Centres. Our findings challenge positive post-Ebola narratives about international aid and military deployment. A morally appropriate people's science emerged under the radar of external scrutiny, including that of a paramount chief.
Journal of Biosocial Science, 2016
Many of the articles published in this special issue were presented at a workshop organised under... more Many of the articles published in this special issue were presented at a workshop organised under the auspices of the Biosocial Society in July 2013 at the Royal Anthropological
Journal of Biosocial Science, 2016
SummaryRecent debates about deworming school-aged children in East Africa have been described as ... more SummaryRecent debates about deworming school-aged children in East Africa have been described as the ‘Worm Wars’. The stakes are high. Deworming has become one of the top priorities in the fight against infectious diseases. Staff at the World Health Organization, the Gates Foundation and the World Bank (among other institutions) have endorsed the approach, and school-based treatments are a key component of large-scale mass drug administration programmes. Drawing on field research in Uganda and Tanzania, and engaging with both biological and social evidence, this article shows that assertions about the effects of school-based deworming are over-optimistic. The results of a much-cited study on deworming Kenyan school children, which has been used to promote the intervention, are flawed, and a systematic review of randomized controlled trials demonstrates that deworming is unlikely to improve overall public health. Also, confusions arise by applying the term deworming to a variety of v...
Social Science & Medicine, 1992
Schistosoma mansoni is often perceived by governments and international aid agencies to present a... more Schistosoma mansoni is often perceived by governments and international aid agencies to present a major public health problem in the tropical and subtropical world. This perception persists in spite of the fact that biomedical practitioners and research workers disagree about the nature and extent of disease and disability caused by schistosomes. This paper raises the question of whether S. mans& should continue to be given priority as a public health problem in Gezira Province, Sudan. Biomedical and continuous observational data are blended with ethnographic information in order to develop a more integrated picture of the impact of S. mansoni on daily activity patterns among women. Research took place in one village in the Gezira/Managil irrigation scheme. The study is characterized by a small sample and a paired design. That is, 11 infected women were paired with 11 uninfected women. These women were engaged in agricultural activities in the cotton picking season and they were matched for a wide range of social and economic factors that might otherwise have affected their working activities. Observations were conducted on a minute by minute basis in the cotton fields. These data, in combination with ethnographic information and data indicating female productive output, showed that infection with S. mansoni significantly altered activity patterns in the cotton fields. That is, infected women (with an arithmetic mean egg output of 1958 eggs/g) attempted to pick as much cotton as possible in the shortest time period feasible in the morning. This pattern was partially repeated by infected women who returned to the fields in the afternoon. However, a significant number of infected women felt too weak to sustain this work regime and the economic implications of this finding are discussed. Finally, Fisher's exact probability test showed that infected women were significantly less likely to undertake persona1 care activities between cotton picking sessions and this result suggests they may have been too tired and/or had a diminished perception of their own well-being. The implications of these results for public health policy in Gezira Province are discussed.
Learning from HIV and AIDS, 2003
Anthropological reflections on HIV prevention strategies: the case for targeting London's ba... more Anthropological reflections on HIV prevention strategies: the case for targeting London's backrooms MELISSA PARKER Introduction Eight years ago the anthropologist Ralph Bolton (1995: 289) wrote: 'Prevention efforts have enjoyed limited success-behaviours have changed to ...
Learning from HIV and AIDS, 2003
This disease is not like any other. .. in the 20 years since the disease was recognised, more tha... more This disease is not like any other. .. in the 20 years since the disease was recognised, more than 20 million people have died from it. Another 40 million are infected. New infections are occurring at the rate of 15,000 a day, and the rate is still increasing. Unless there is a significant change for the better almost all these people will die. The Economist, July 11th 2002 1 [A]t current infection rates, AIDS, the deadliest epidemic in human history, will kill 68 million people in the 45 most affected countries over the next 20 years. . .
Journal of General Internal Medicine, 2010
Journal of Biosocial Science, 2006
The Journal of Biosocial Science regularly publishes papers addressing the social and cultural as... more The Journal of Biosocial Science regularly publishes papers addressing the social and cultural aspects of disease, sickness and well-being. Most of these papers attempt to understand the prevalence and distribution of disease and sickness within and between populations as well as local responses to biomedical interventions and public health policy more generally. They fall broadly within the remit of human ecology; and they embrace a ‘factorial’ model of disease in which social and cultural factors are deemed to be just one of a number of factors to be considered alongside a range of other factors. These include biological features of the infecting organism; nutritional factors; environmental factors; psychological factors; and genetic factors influencing susceptibility to disease at an individual and population level.
Health Research Policy and …, 2011
Ethnographic research was undertaken over a period of four years between 2005-2009 in north-west ... more Ethnographic research was undertaken over a period of four years between 2005-2009 in north-west and south-east Uganda. In addition to participant observation, survey data recording self-reported take-up of drugs for schistosomiasis, soil-transmitted helminths and, where ...
Africa, 1995
Female circumcision is practised in more than twenty African countries as well as in a number of ... more Female circumcision is practised in more than twenty African countries as well as in a number of countries in the Middle East, and it has been estimated that at least 100 million females have been circumcised worldwide. It is striking, however, that much more concern has been expressed about female circumcision than about other operations or infections which adversely affect the reproductive health of women. In the academic arena, it is also interesting that gynaecologists, epidemiologists and anthropologists have tended to focus on a relatively small number of questions, and even these have rarely been investigated in any depth. This article focuses on the work of researchers from Europe and North America in order to show that intense emotions underlie this interest and concern. Amidst growing interest in the anthropology of emotions it is suggested that greater attention should be paid to understanding the source of these emotions and the way in which they influence fieldwork and ...
Journal of Biosocial Science, 2016
SummaryThe term ‘neglected tropical diseases’ (NTDs) points to the need for a biosocial perspecti... more SummaryThe term ‘neglected tropical diseases’ (NTDs) points to the need for a biosocial perspective. Although ‘diseases’ are widely understood as biological phenomena, ‘neglect’ is inherently social. Social priorities, social relations and social behaviour profoundly influence the design, implementation and evaluation of control programmes. Yet, these dimensions of neglect are, themselves, neglected. Instead, emphasis is being placed on preventive chemotherapy – a technical, context-free approach which relies almost entirely on the mass distribution of drugs, at regular intervals, to populations living in endemic areas. This article reflects on the processes which have enabled an NTD ‘brand’ identity to emerge, and it comments on a disquieting disengagement with some of the more critical insights about the consequences of mass drug administration. Building on the work of biosocial scholars studying other aspects of health and disease, a more adequate, evidence-based approach is deli...
Social Science & Medicine, 2022
Global debates about vaccines as a key element of pandemic response and future preparedness in th... more Global debates about vaccines as a key element of pandemic response and future preparedness in the era of Covid-19 currently focus on questions of supply, with attention to global injustice in vaccine distribution and African countries as rightful beneficiaries of international de-regulation and financing initiatives such as COVAX. At the same time, vaccine demand and uptake are seen to be threatened by hesitancy, often attributed to an increasingly globalised anti-vaxx movement and its propagation of misinformation and conspiracy, now reaching African populations through a social media ‘infodemic’. Underplayed in these debates are the socio-political contexts through which vaccine technologies enter and are interpreted within African settings, and the crucial intersections between supply and demand. We explore these through a ‘vaccine anxieties’ framework attending to both desires for and worries about vaccines, as shaped by bodily, societal and wider political understandings and experiences. This provides an analytical lens to organise and interpret ethnographic and narrative accounts in local and national settings in Uganda and Sierra Leone, and their (dis)connections with global debates and geopolitics. In considering the socially-embedded reasons why people want or do not want Covid-19 vaccines, and how this intersects with the dynamics of vaccine supply, access and distribution in rapidly-unfolding epidemic situations, we bring new, expanded insights into debates about vaccine confidence and vaccine preparedness.
Journal of biosocial science, 2008
Summary. A strong case has recently been made by academics and policymakers to develop national p... more Summary. A strong case has recently been made by academics and policymakers to develop national programmes for the integrated control of Africa's 'neglected tropical diseases'. Uganda was the first country to develop a programme for the integrated control of two of these ...