Dissertation Proposal Defense, Margaux Fisher (May 2023)

This is a recording of Margaux Fisher' orals defense on Tuesday, May 30, 2023. 

Project Title: What Counts in Health? Networks of Health Equity Data and Activism in Louisiana and California

Orals Committee: Kim Fortun, Angela Jenks, Mike Fortun, George Marcus, and Alison Holman

Project Abstract: What does it mean to produce meaningful health equity data? The popularity of engaged research methods in the US reflects a growing recognition amongst public health officials and health professionals of the importance of opening up knowledge production and decision-making to communities in meaningful ways. Advocates trying to mobilize resources to improve children’s mental health are drawn to the promises of data work–the “technological, analytical, and emotional work” of making data meaningful (Fiske et al. 2019, 2). Engaged research collaborations between health professionals and community-based organizations are nevertheless frequently constrained by box-checking impulses driven by neoliberal management techniques that are widely referred to as “audit culture” (Storeng and Béhague 2014). This proposed project examines the data practices, managerial techniques, ideological frameworks, social and political histories, emotional entanglements, and imagined futures of a network of differently positioned researchers and community-based advocates working to understand and address the structural, political and environmental etiologies of children’s mental health inequities in Louisiana and California. Through 12 months of ethnographic research involving participant observation, interviews, and archival research, this project will examine how engaged research collaborations pluralize definitions of expertise and evidence in public health–changing what counts in health while paradoxically remaining constrained by principles of financial accounting that reinforce the logics of colonialism and racial capitalism. This project contributes to the anthropology of the United States, health systems research, and interdisciplinary studies of expertise and knowledge production by considering how the democratic dimensions of data work is reshaping fields of public health decision-making.  

Literature Review 1: Anthropology of the United States

Histories of subordinated knowledge (Harrison and Harrison 1999) point to a long tradition of anthropological research of the US that transcended conventional disciplinary boundaries by focusing on racializing structures of power, and anti-racist advocacy (Davis et al. 1941). This work foreshadowed projects of cultural critique and defamiliarization in the US focused on kinship (Schneider 1980; Bamford 2007), reproduction (Rapp 2001), and illness (Martin 1995). Studies of racialization and political economies of racism emerged more slowly as critical focal points (Harrison 1995), though they ultimately demonstrated how colonial and white supremacist processes have been integral to the formation of Western liberal modernity (Deloria 1988; Beliso-De Jesús and Pierre 2020). Intersectional approaches (Collins 2022; Crenshaw 1991) have helped identify macro-level constraints that produce health inequities, as well as the actions people undertake to reduce or eliminate health disparities (Schulz and Mullings 2006; Sangaramoorthy and Benton 2021). The concept of racial capitalism (Robinson 2000) has provided insight into the links between the state, racism, capitalism and environmental hazards (Pulido 2016), and health inequities (Garth 2020). Building on these frameworks, Carter (2021) offers the analytic concept of health omissionsto account for how anti-Black structural racism omits individuals from medical diagnosis, care, and research. By putting the accent on entrenched structures of racialized violence and exploitation, these approaches align with anti-colonial scholarship calling for a depathologizing approach attuned to both the present struggles of affected communities and their potential futures (Tuck 2009; Liboiron 2021).

This scholarship on the political economies of racism informs my focus on health equity advocacy alongside an analysis of historically and locally embedded forms of white supremacy. I draw on intersectionality and racial capitalism as critical frameworks for exploring: a) how public health frameworks and data practices have been shaped by the dialectic of race, class, and capital; b) how audit culture produces “health omissions” and racializing knowledge frameworks; and c) how critical scholarship and advocacy emerging in the wake Covid-19 have shaped collaborative health equity research practices and analytical frameworks. By examining these social processes, this project will advance conceptualizations of the state as a “terrain of struggle” composed of a “complex patchwork of practices” (Harrison 2022: 10) and illuminate how everyday practices of engaged research collaborations enable (or conversely inhibit) understandings of the structural, political and environmental processes that produce health. 

Literature Review 2: Global Health Systems and Anthropology

A subsection of critical medical anthropology focuses on health systems, building on a long tradition of anthropological focus on the social organization, power relations and politics of health systems (Justice 1986, Singer & Baer 1989, Farmer 2004, Pfeiffer & Nichter 2008). This subfield examines how people shape, enact and resist global health agendas, leveraging policymakers and health staff as points of entry. Ethnographies have focused on policy making and program implementation (Foley 2008), the impact of privatization and the commodification of care (Mulligan 2010, Biehl 2013), the application of health metrics (Janes 2004, Erickson 2012, Adams 2016, Biruk 2018, Oni-Orisan 2016), and community health practices and programs (Foster 1982, Morgan 1987, Mishra 2014). This body of work has expanded our understanding of how global health agendas are created by showing how development discourse is dominated by “master narratives”—discursive tools that frame problems in ways that delimit potential solutions (Nichter 2008). Logics of financialization increasingly inflect the development of health research, policy, and allocation of resources through narrow definitions of evidence intended to demonstrate cost-effectiveness (Storeng and Béhague 2014). Ideals of community participation have been co-opted for financial and political gains (Morgan 1993), and to justify passing the costs of care onto communities (Pfeiffer and Chapman 2010). However, relationships between global health stakeholders are fraught—power is often contested rather than monopolized (Gerret 2015). Drawing on previous work on contestations of power in public health and on health workers’ discomfort with the logics of financialization—even as they become increasingly caught up in re-inscribing their dominance (Abadía-Barrero 2022)—I explore the lived experience of such contradictions in public health projects and workplaces. How might health workers be critical of neoliberal management techniques, even as they re-inscribe them? How do these contradictions shape what makes data meaningful and affect the broader landscape of decision-making through which public health agendas emerge?

Literature Review 3: Studies of Expertise and Knowledge Production

Questions of power and truth are a central concern of expertise and knowledge production studies (Carsten 2000; Strathern 2000). Anthropologists and STS scholars have explored how scientific knowledge is shaped by historical legacies, regimes of truth, and unequal power relations (TallBear 2013; Parreñas 2018). Interrogations of science have also engaged with the idea of knowledge as dynamic, permeable, and unfixed (Latour 2013; Martin 1998)—and as a point of entry for critical intervention (Fleck 1979; Haraway 1988; Mol 2003; Benjamin 2018; Liboiron 2021). This subfield has been increasingly responsive to the democratization of scientific knowledge production and calls for engaged research in the face of problems that cannot be solved by research alone (Corburn 2005). This has shifted scholarly interest to issues such as expertise, credibility, the relationship between science and policy, and the role of public knowledge in science and technology, including studies of civic data practices and data activism (Lehtiniemi and Ruckenstein 2018; Fortun et al. 2021). At a time when science is increasingly threatened by post-truth politics, attending to the motivations, practices, and ideologies of participants engaged in practices of collective knowledge production (especially in advocacy, research and government settings) is urgently needed. I seek to contribute to this body of literature by exploring: a) how understanding of the requirements of justice—for children’s mental health, specifically—is meaningfully cultivated at a time of widespread backlash against public health; and b) how the democratization of data tools and expertise is enabling the contestation of public health agendas.