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Inequalities in Health: Pacific Perspectives


Holly Wardlow, Fabienne Labbé, Alice Servy

Session presentation

Health inequities are pervasive and a continuing challenge in the Pacific. Across the region, wide disparities in health delivery systems, great contrasts in the provision of health care in urban vs rural areas and inequalities of gender, age, class and identities intertwine to impact the vulnerability of individuals and groups to diseases and their ability to act in ways that favour their well-being and health. Our aim in this panel is to examine the manifold factors that shape inequality in health and illness in the Pacific. We especially seek to bring attention to dimensions of difference that, albeit crucial in the Pacific, are easily overlooked by approaches strictly concerned with commonly accepted axes of inequalities. These may include, for example, differences in social networks (e.g. having a relative who works at a health facility or not), in religious affiliation, in political ascendancy, in historical legacies (e.g. having grown up in a region affected by tribal fighting or not) and in access to information technologies. We welcome papers that explore these and other more specifically Pacific realities and how they intersect in complex and diverse ways with other forms of disparity to produce unique situations of health inequality.

Paper submissions are closed

Accepted papers

Global Inequality, Climate Change, and Impacts on Island Health: The Centrality of the Island Pacific

Marit Victoria Luker (Australian National University)

If contemporaneous climate change is largely attributed to the by-products of industrialised and populous nations, then the nations of the Island Pacific, in terms of their level of industrialization and population size, have contributed very little. Yet the nations of the island Pacific are experiencing, and are set to experience, acutely, effects of climate change that run contrary to their interests. These effects therefore embody extreme global inequality. They also include direct and indirect impacts on Island health. The effects of climate change on health are so marked that Pacific Islands health ministers and the United Nations see the Island Pacific as subject to three broad, simultaneous trends: the persistence of communicable diseases; the rise of non-communicable diseases; and changing climate. This presentation aims to present two analyses: first, the effects of climate change on PI health; second, PI responses to these health effects and to the broader challenge of climate change. It argues, in emphatic conclusion, and drawing on Island conceptualisation and agency, for the centrality of local conceptions of climate change and health.

Housing as a social determinant of health: Comparing Papua New Guinea and Aotearoa New Zealand

Barbara Anne Andersen (Massey University, Albany)

This paper lays out a framework for the anthropological investigation of housing as a social determinant of health in the Pacific. New Zealand-based researchers have pioneered the study of how Pacific and Māori health disparities are influenced by tenure insecurity, household crowding, urban sprawl, underheating, and poor building materials. Housing struggles have been incorporated into a syndemic model of illness that has potential to explain persistent ethnic inequities in health. This paper discusses whether these epidemiological insights from Aotearoa can be translated to aid understanding of health disparities in other Pacific countries. I focus on the case of Papua New Guinea, where housing options and social inequalities take significantly different forms, to suggest how an ethnographic and life history approach can illuminate the complex health impacts of poor housing. I argue that future research on housing and health in the Pacific needs to take into account the symbolic and moral values associated with dwelling types, residential patterns, and intergenerational and urban-rural kinship ties.

“Well-Being for Melanesia”: Quantified Lives, Inequalities and Care

Alexandra (Sandra) Widmer (York University)

How do inequalities figure in the assertion of knowledge of health and well-being? What kinds of inequalities are most prominent? This paper examines how ni-Vanuatu assert knowledge about well-being in two different registers and scales, one in the intensely local form of knowledge of women massage experts, another in the quantified knowledge of “Alternative indicators of Well-being for Melanesia”, a report researched and published by ni-Vanuatu politicians, chiefs and statisticians. Though at different scales and for different audiences, both forms of knowledge emphasize the importance of righting unequal relationships for well-being. Unequal work within households and unequal respect between husbands and wives are prominent in both registers of knowledge of well-being. However, putting both kinds of knowledge in dialogue in this paper, shows that the emphasis on economic exchange in the alternative indicators report, albeit non-monetary kinds of exchange, elides the importance of women’s care work for well-being.

Spatial disparities in the prevention of sexually transmitted infections in Vanuatu

Alice Servy (University of Strasbourg)

While only 12 HIV cases were recorded in Vanuatu between 2002 and 2017, other sexually transmitted infections (STIs) are widespread in the archipelago. To address this issue, the government and its partners have implemented HIV and other STI prevention activities, such as youth-friendly health services, peer education programs, workshops, plays, school activities, radio programs, hotlines, DVDs, pamphlets, comics and prevention posters. The overall ambition of the Reproductive Health Policy, which provides a framework for all STI prevention activities in Vanuatu, is to reach the entire population. However, most of the activities conducted in 2009-2013, during my fieldwork of eighteen months in the archipelago, were carried out in the cities of Port-Vila and Luganville.
In this paper, I explore spatial disparities in the prevention of HIV and other STIs in Vanuatu. It appears that these disparities can be partly explained by difficulties in intra- and inter-island transport of people and supplies, the significantly higher rates of school enrolment, radio equipment and DVD players in urban areas, along with a TV network available only in the Port-Vila area. Nevertheless, I argue that these spatial disparities are also related to the association between the town and the contraction of STIs commonly assumed by local and international prevention agencies − or more accurately, between certain urban groups and places and the transmission of these infections.

Health services in the Suowi Valley (1987-2018): From patrols by Lutheran services to the building of a clinic.

Pascale Bonnemère (Aix-Marseille University, CNRS, EHESS)

Inhabiting a valley located at the border of three provinces, the Ankave never benefited from health services that are common elsewhere in the country. In the eighties, they were regularly – although not frequently – visited by nurses from Lutheran services based in Menyamya (Morobe Province), who mainly administered vaccines to children.
More recently, following the building of an airstrip, which saw its first plane land in 2011, several NGOs and state agencies funded the building of a clinic and the training of local women in midwifery. Since 2012, the Ankave have received several visits from outreach teams of health workers composed of a doctor, nurses, and community health workers (CHW) in training.
Although there is no permanent health staff in the valley yet, these visits, which include lessons about basic hygiene and family planning, indubitably influenced the way people deal with their own health and reproductive life.
In April 2018, I was able to observe pregnancy and family planning consultations, which revealed some of the misunderstandings health workers may have about practices associated with pregnancy and birth in a remote rural setting and more generally about what living in a forest environment entails.
The paper explores the possible consequences of such misunderstandings in terms of the way health services are delivered and understood by the villagers.

Between a Fig and a Hard Place: Logging and Structural Violence in West Sepik Province, Papua New Guinea

Austin Hagwood (National Geographic Society/U.S. Department of State)

While anthropology has analysed the socioeconomic consequences of resource extraction in Papua New Guinea, there is an absence of work addressing the impact of clear-cut logging on medicinal plant resources and health inequalities. For people in Idam village, West Sepik Province, the rainforest is more than a commodity measured in log exports; it is a pharmacy and linkage between ecology and human health. But this landscape is about to transform. In a $3 billion agreement, Shenzen Vivafounders and the Metallurgical Corporation of China are breaking ground on the 800,000 hectare Idam-Siawi Agro-Forestry project, an industrial park slated to become the largest in the Southern Hemisphere. As advertised, the initiative promises to address needs in healthcare and transportation. In practice, development projects in West Sepik have disrupted customary lifeways and failed to fulfill agreements, precipitating higher rates of sorcery attacks while removing the very plant medicines on which people relied.
Focusing on the case of an 18-month-old girl with a tropical ulcer, my paper discusses health inequalities perpetuated by logging regimes in rural West Sepik. Through the lens of staple theory and structural violence, I discuss how developers pledge to remedy health inequalities while actually reviving them. I conclude with an ethnobotanical assessment of plant medicines in Idam village and analyse whether documenting customary plant resources can empower landowners in negotiations.

Navigating the Dimensions of Female Cancer Experience and the Embodiment of Social Inequality in Tonga

Patricia Fifita (University of Hawai'i-Manoa)

Drawing upon the intersections of gender, class, and health, this paper focuses on growing cancer health disparities in the Pacific through the lens of female cancer experience in the Kingdom of Tonga. Although multiple factors contribute to the increasing prevalence of cancer, breast cancer mortality rates in Tonga are disproportionately high primarily due to the late presentation of the disease. Using an intersectional and culturally grounded approach, this paper examines a collection of cancer illness narratives to explore how Tongan women, who have limited access to resources, navigate various obstacles and pathways to obtain proper health care and treatment for cancer. Reaching beyond a typical structural inequality analysis, I argue that cancer illness narratives give voice to a more nuanced and complex range of issues and experiences of inequality and suffering that are often silenced by stigma and shame and overlooked in public health studies. This paper will demonstrate how the collection of and re-telling of illness narratives can be a powerful tool for Tongan women in redefining personal subjectivity and confronting a wide range of structural asymmetries locally and globally. The different ways in which women of varying social class standing experience and navigate treatment for cancer reflects a profoundly complex embodiment of health and social inequality.

Problems of Faith: Vegetables, Healthy Diets and Pentecostal Healing

Jessica Hardin (Pacific University)

In the Samoan islands there has been a steady rise of cardiometabolic disorders since the 1950s and has been a site of over 30 years of epidemiological research, which have led to public interventions developed from this research base. Health promotion materials are ubiquitous, encouraging eating less and exercising more, stressing the importance of eating a vegetable-based diet and embracing planation labor as a form of fitness. All of these messages locate responsibility in a choice-model of health. Samoan public health, in an effort develop community-engagement, positions churches as partners or sites for “culturally appropriate” health promotion. However, Pentecostal churches are not considered ‘culturally appropriate” sites for this delivery, and yet, Pentecostals have a critical position on the so-called NCD epidemic. Drawing attention to the relationship between the social world and the spirit, Pentecostals brings into focus multiple and flexible etiologies derived from the basic logic that environments and relationships permeate the body in ways that create sickness and health. Instead of blaming individuals, Pentecostals talked about social barriers to health, in turn transforming the problem of food, fat, and fitness into a problem of faith. Through Pentecostal healing, Pentecostals came to identify their source of suffering in the social world where relationships—social, structural, economic—penetrated the body. Bringing together distinct anthropological ways of approaching illness—from the anthropology of Christianity and medical anthropology—shows the creative ways that structural limitations are negotiated by those living with cardiometabolic disorders.